20:06:40:81. Special enrollment triggers. A health insurance issuer offering health insurance coverage in the group market and SHOP Exchange as defined in § 20:06:55:32 must allow for an individual to enroll or change from one nongrandfathered health plan to another as a result of the following triggers:
(1) The death of the covered individual;
(2) The termination of individual's employer coverage other than by reason of gross misconduct, or reduction of hours of the covered employee's spouse;
(3) The divorce or legal separation;
(4) Individual becoming entitled to benefits under XVII of the Social Security Act;
(5) Dependent child ceasing to be dependent child;
(6) A proceeding in a case under Title 11, United States Code, commencing on or after July 1, 1986, with respect to the employer from whose employment the covered individual retired at any time;
(7) An individual gains a dependent or becomes a dependent through marriage, birth adoption or placement for adoption;
(8) An individual, who was not previously a citizen, national, or lawfully present individual gains such status; and
(9) A qualified individual or enrollee gains access to nongrandfathered health plan as a result of a permanent move.
This section does not apply to grandfathered plans.
Source: 39 SDR 203, effective June 10, 2013.
General Authority: SDCL 58-18-79.
Law Implemented: SDCL 58-18-79, 58-18-80.
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