20:06:58:14.  Financial requirements and quantitative treatment limitations -- Determining substantially all. For purposes of §§ 20:06:58:07 to 20:06:58:25, inclusive, a type of financial requirement or quantitative treatment limitation is considered to apply to substantially all medical or surgical benefits in a classification of benefits if it applies to at least two-thirds of all medical or surgical benefits in that classification. Benefits expressed as subject to a zero level of a type of financial requirement are treated as benefits not subject to that type of financial requirement, and benefits expressed as subject to a quantitative treatment limitation that is unlimited are treated as benefits not subject to that type of quantitative treatment limitation. If a type of financial requirement or quantitative treatment limitation does not apply to at least two-thirds of all medical or surgical benefits in a classification, then that type cannot be applied to mental health or substance use disorder benefits in that classification.

          Source: 41 SDR 93, effective December 3, 2014.

          General Authority: SDCL 58-17-87, 58-18-79, 58-18-79(15).

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