S.D. Admin. R. 20:06:56:10

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

Section 20:06:56:10 - Actuarial value calculator

A health insurance issuer may use the actuarial value calculator to determine the actuarial value of a health plan made available by Health and Human Services. Actuarial Value within a de minimis variation determines whether a health plan offers a bronze, silver, gold, or platinum level of coverage.

If a health plan's design is not compatible with the actuarial value calculator, the issuer must meet the following:

(1) Submit the actuarial certification from an actuary, who is a member of the American Academy of Actuaries, on the chosen methodology identified in subdivisions (2) and (3) of this section;

(2) Calculate the plan's actuarial value by estimating a fit of its plan design into the parameters of the actuarial value calculator and having an actuary, who is a member of the American Academy of Actuaries, certify that the plan design was fit appropriately in accordance with generally accepted actuarial principles and methodologies; or

(3) Use the actuarial value calculator to determine the actuarial value for the plan provisions that fit within the calculator parameters and have an actuary, who is a member of the American Academy of Actuaries, calculate and certify, in accordance with generally accepted actuarial principles and methodologies, appropriate adjustments to the actuarial value identified by the calculator, for plan design features that deviate substantially from the parameters of the actuarial value calculator.

The calculation methods described in subdivisions (2) and (3) of this section may include only in-network cost-sharing, including multi-tier networks.

S.D. Admin. R. 20:06:56:10

39 SDR 203, effective 6/10/2013.

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

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