S.D. Admin. R. 20:06:56:01

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

Section 20:06:56:01 - Definitions

(1) "Actuarial value," a measure of the percentage of expected health care costs a health plan will cover for a standard population and can be considered a general summary measure of health plan generosity;

(2) "Actuarial value calculator," used to determine the actuarial value of applicable plans. It is developed using a set of claims data weighted to reflect the standard population projected to enroll in the individual and small group markets for the identified year of enrollment;

(3) "Base-benchmark plan," the plan that is selected by the state from the options described in 45 CFR § 156.100(a), or a default benchmark plan, as described in 45 CFR § 156.100(c), prior to any adjustments made pursuant to the benchmark standards described in 45 CFR § 156.110;

(4) "De minimis variation," is the allowable variation in the actuarial value of a health plan that does not result in a material difference in the true dollar value of the health plan is +/-2 percentage points;

(5) "Essential health benefits benchmark plan," is the standardized set of essential health benefits that must be met by a qualified health plan;

(6) "HHS," United States Department of Health and Human Services;

(7) "Premium adjustment percentage," the percentage by which the average per capita premium for health insurance coverage for the preceding calendar year exceeds such average per capita premium for health insurance.

S.D. Admin. R. 20:06:56:01

39 SDR 203, effective 6/10/2013.

General Authority: SDCL 58-17-87.

Law Implemented: SDCL 58-17-87.