S.D. Admin. R. 20:06:55:25.01

Current through Register Vol. 50, page 159, June 17, 2024
Section 20:06:55:25.01 - Individual plans - No preexisting condition

No health policy, certificate, or plan may limit or exclude coverage based upon a preexisting condition for a person. For policies issued after March 23, 2010, but before September 23, 2010, any remaining preexisting condition waiting period must be removed beginning on the first day of the policy year following September 22, 2010. For individual policies issued after September 22, 2010, no preexisting waiting period for persons under the age of 19 may be applied. For persons who are age 19 or over no preexisting condition may apply after December 31, 2013. This section does not apply to grandfathered plans.

If a health insurance issuer offers health insurance coverage in any level of coverage other than excepted benefits, the issuer shall also offer such coverage in that level as a plan in which the only enrollees are individuals who, as of the beginning of a plan year, have not attained the age of 21.

This section does not apply to a plan that is stand-alone dental.

Except for those coverages that are excepted benefits pursuant to § 20:06:55:27, this section applies to any plan of individual health insurance coverage and to any health benefit plan subject to the provisions of SDCL 58-17-66 to 58-17-87, inclusive.

S.D. Admin. R. 20:06:55:25.01

39 SDR 203, effective 6/10/2013.

General Authority: SDCL 58-17-87.

Law Implemented: SDCL 58-17-84, 58-17-87, 58-17-97.