20:06:55:15.  Group plans -- Lifetime limits. A group health plan may not establish any lifetime limit or any annual limit on the dollar amount of essential benefits for any individual except as permitted in § 20:06:55:16. However, a flexible spending arrangement may have an annual limit on the dollar amount of benefits. Nothing in this section prohibits a group health plan from placing annual or lifetime limits on specific covered benefits that are not essential benefits. Essential benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care. Nothing in this section prohibits a group health plan from excluding all benefits for a given condition.

          Source: 37 SDR 63, effective September 23, 2010; 37 SDR 111, effective December 7, 2010.

          General Authority: SDCL 58-18-79.

          Law Implemented: SDCL 58-18-79.