S.D. Admin. R. 20:06:55:50.02

Current through Register Vol. 50, page 159, June 17, 2024

Section 20:06:55:50.02 - Special enrollment period effective dates

After December 31, 2013, a health insurance issuer must provide special enrollment periods consistent with this section inside the Exchange, during which qualified individuals and enrollees may enroll in nongrandfathered health plans or change enrollment from one plan to another. Once a qualified individual is determined eligible for a special enrollment period, the health insurance issuer must ensure that the qualified individual's date of coverage is:

(1) Between the first and the fifteenth day of any month, the plan must ensure a coverage effective date of the first day of the following month;

(2) Between the sixteenth and the last day of any month, the plan must ensure a coverage effective date of the first day of the second following month;

(3) In the case of birth, adoption or placement for adoption, or placement in foster care, the plan must ensure that coverage is effective on the date of birth, adoption, placement for adoption, or placement in foster care. If the Exchange permits the qualified individual or enrollee to elect a coverage effective date of the first day of the month following the date of birth, adoption, placement for adoption, or placement in foster care, the Exchange must ensure coverage is effective on such date elected by the qualified individual or enrollee;

(4) In the case of marriage, or in the case where a qualified individual loses minimum essential coverage, the plan must ensure coverage is effective on the first day of the month following plan selection;

(5) In the case of a qualified individual or enrollee eligible for a special enrollment period as described in §§ 20:06:55:50(4), 20:06:55:50(5), or 20:06:55:50(7) the plan must ensure coverage is effective on an appropriate date based on the circumstances of the special enrollment period; and

(6) In a case where an individual loses coverage as described in subdivision 20:06:55:50(1) if the plan selection is made before or on the day of the loss of coverage, the Exchange must ensure that the coverage effective date is on the first day of the month following the loss of coverage. If the plan selection is made after the loss of coverage, the Exchange must ensure that coverage is effective in accordance with subsection (1) and (2) of this section or on the first day of the month following plan selection in accordance with subsection (3) and (4) of this section.

(7) In the case of a court order the plan must ensure that coverage is effective for a qualified individual or enrollee on the date the court order is effective, or it may permit the qualified individual or enrollee to elect a coverage effective date in accordance with subparagraph 1. If the Exchange permits the qualified individual or enrollee to elect a coverage effective date in accordance with subparagraph 1 of this section, the Exchange must ensure coverage is effective on the date duly selected by the qualified individual or enrollee.

(8) If an enrollee or his or her dependent dies, the plan must ensure that coverage is effective on the first day of the month following the plan selection, or it may permit the enrollee or his or her dependent to elect a coverage effective date in accordance with subparagraph 1. If the Exchange permits the enrollee or his or her dependent to elect a coverage effective date in accordance with paragraph sub 1 of this section, the Exchange must ensure coverage is effective on the date duly selected by the enrollee or his or her dependent.

S.D. Admin. R. 20:06:55:50.02

39 SDR 203, adopted June 10, 2013, effective 1/1/2014; 45 SDR 045, effective 10/10/2018

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

Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.