S.D. Admin. R. 20:06:58:11
A group health plan, or health insurance coverage offered by an issuer in connection with a group health plan, that provides both medical or surgical benefits and mental health or substance use disorder benefits may not apply any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification this is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all, medical or surgical benefits, in the same classification. Whether a financial requirement or treatment limitation is a predominant financial requirement or treatment limitation that applies to substantially all medical surgical benefits in a classification is determined separately for each type of financial requirement or treatment limitation. The application of the rules found in §§ 20:06:58:11 to 20:06:58:13, inclusive, to financial requirements and quantitative treatment limitation is addressed in §§ 20:06:58:14 to 20:06:58:22, inclusive; the application of the rules of §§ 20:06:58:11 to 20:06:58:13, inclusive, to nonquantitative treatment limitations is addressed in §§ 20:06:58:24 and 20:06:58:25.
S.D. Admin. R. 20:06:58:11
General Authority: SDCL 58-17-87, 58-18-79, 58-18-79(15).
Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.