S.D. Admin. R. 20:06:55:09

Current through Register Vol. 51, page 39, September 16, 2024

Section 20:06:55:09 - Individuals whose coverage ended by reason of reaching a dependent eligibility threshold - Group health plan special enrollee

Any child enrolling in a group health plan pursuant to § 20:06:55:05 must be treated as if the child were a special enrollee, as provided under the rules of 45 C.F.R. § 146.117(d). Accordingly, the child and, if the child would not be a participant once enrolled in the plan, the participant through whom the child is otherwise eligible for coverage under the plan, must be offered all the benefit packages available to similarly situated individuals who did not lose coverage by reason of cessation of dependent status. For this purpose, any difference in benefits or cost-sharing requirements constitutes a different benefit package. The child also cannot be required to pay more for coverage than similarly situated individuals who did not lose coverage by reason of cessation of dependent status.

S.D. Admin. R. 20:06:55:09

37 SDR 63, effective 9/23/2010; 37 SDR 111, effective 12/7/2010.

General Authority: SDCL 58-17-87, 58-18-79.

Law Implemented: SDCL 58-17-87, 58-18-79.