20:06:55:21.  Individual plans -- Lifetime limits. No individual policy of insurance may establish a lifetime limit on the dollar value of essential benefits for any covered person or an unreasonable annual limit on the dollar value of essential benefits for any covered person. Nothing in this section prohibits a 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 health plan from excluding all benefits for a given condition. The written notice requirements described in § 20:06:55:18 apply to individual plans of insurance.

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

          General Authority: SDCL 58-17-87.

          Law Implemented: SDCL 58-17-87.