20:06:56:05.  Substituted benefits. A plan may substitute benefits from the essential health benefits benchmark benefit plan if it meets the following conditions:

          (1)  The substitute benefit is actuarial equivalent to the essential health benefit;

          (2)  The substitute benefit is made only within the same essential benefit category; and

          (3)  The benefit is not a prescription drug benefit.

          The plan must submit evidence of the actuarial equivalence of the substituted benefit to the director. The certification must be conducted by a member of the American Academy of Actuaries, be based on an analysis performed in accordance with generally accepted actuarial principles and methodologies, and use a standardized plan population. Actuarial equivalence of benefits is determined regardless of cost sharing.

          Source: 39 SDR 203, effective June 10, 2013.

          General Authority: SDCL 58-17-87, 58-18-79.

          Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.