S.D. Admin. R. 20:06:58:20
If a plan, or health insurance coverage, provides benefits through multiple tiers of in-network providers, such as an in-network tier of preferred providers with more generous cost-sharing to participants than a separate in-network tier of participating providers, the plan may divide its benefits furnished on an in-network basis into sub-classifications that reflect network tiers, if the tiering is based on reasonable factors determined in accordance with § 20:06:58:23 and without regard to whether a provider provides services with respect to medical or surgical benefits or mental health or substance use disorder benefits. After the sub-classifications are established, the plan or issuer may not impose any financial requirement or treatment limitation on mental health or substance use disorder benefits in any sub-classification that is more restrictive than the predominant financial requirement or treatment limitation that applies to substantially all medical or surgical benefits in the sub-classification using the methodology set forth in §§ 20:06:58:14 to 20:06:58:17, inclusive.
S.D. Admin. R. 20:06:58:20
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.