Rule 20:06:21:36 Basis for continuation of coverage from group defined.
20:06:21:36. Basis for continuation of coverage from group
defined. For the purposes of §§ 20:06:21:09 to 20:06:21:17, inclusive,
§ 20:06:21:35, and this section, a basis for continuation of coverage
means a policy provision that maintains coverage under the existing group
policy when the coverage would otherwise terminate and that is subject only to
the continued timely payment of premiums when due.
Group policies which restrict
provision of benefits and services to, or contain incentives to use, certain
providers or facilities may provide continuation benefits which are
substantially equivalent to the benefits of the existing group policy. The
director shall determine the substantial equivalence of benefits. In
determining substantial equivalence, the director shall take into consideration
the differences between managed care and nonmanaged care plans, including
provider system arrangements; service availability; benefit levels; and
23 SDR 55, effective October 20, 1996.
Authority: SDCL 58-17B-4.
Implemented: SDCL 58-17B-4.
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