20:06:55:24.  Individual plans -- Applicability. Except for those coverages that are excepted benefits pursuant to SDCL subdivision 58-17-69(13), §§ 20:06:55:21 to 20:06:55:23, inclusive, apply to any plan of individual health insurance coverage and to any health benefit plan subject to the provisions of SDCL 58-17-66 to 58-17-87, inclusive.

          Sections 20:06:55:21 to 20:06:55:23, inclusive, do not apply to individual plans with respect to annual limits if the plans are grandfathered plans pursuant to 75 Fed. Reg. 116 (2010) to be codified at 26 C.F.R. § 54 and 602, 29 C.F.R. § 2590, and 45 C.F.R. § 147.

          For plan or policy years beginning prior to January 1, 2014, an individual health insurance policy is exempt from the annual limit requirements if the policy is approved for a waiver from such requirements by the U.S. Department of Health and Human Services but such exemption only applies for the specified period of time that the waiver from the U.S. Department of Health and Human Services is applicable.

          At the time a policy receives a waiver from the U.S. Department of Health and Human Services, the health carrier shall notify prospective applicants and affected policyholders and the commissioner in each state where prospective applicants and any affected insured are known to reside.

          At the time the waiver expires or is otherwise no longer in effect, the health carrier shall notify affected policyholders and the commissioner in each state where any affected insured is known to reside.

          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.