Rule 20:06:40:81 Special enrollment triggers.
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
(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
(4) Individual becoming entitled
to benefits under XVII of the Social Security Act;
(5) Dependent child ceasing to be
(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
(7) An individual gains a
dependent or becomes a dependent through marriage, birth adoption or placement
(8) An individual, who was not
previously a citizen, national, or lawfully present individual gains such
(9) A qualified individual or
enrollee gains access to nongrandfathered health plan as a result of a
This section does not apply to grandfathered
39 SDR 203, effective June 10, 2013.
Authority: SDCL 58-18-79.
Implemented: SDCL 58-18-79, 58-18-80.
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