<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 20:06:55:20 Group plans -- Applicability.</title> <META NAME="Keywords" Content="Administrative Rules 20:06:55:20"> <META NAME="Description" Content="Administrative Rules 20:06:55:20 Group plans -- Applicability."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="2006550002000d_files/filelist.xml"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14533</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>1</o:TotalTime> <o:Created>2011-02-28T15:06:00Z</o:Created> <o:LastSaved>2011-02-28T15:06:00Z</o:LastSaved> <o:Pages>1</o:Pages> <o:Words>211</o:Words> <o:Characters>1208</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>10</o:Lines> <o:Paragraphs>2</o:Paragraphs> <o:CharactersWithSpaces>1417</o:CharactersWithSpaces> <o:Version>10.6867</o:Version> </o:DocumentProperties> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:PunctuationKerning/> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; 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</span><b style='mso-bidi-font-weight:normal'>20:06:55:20.&nbsp;&nbsp;Group plans -- Applicability.</b> Sections 20:06:55:15 to 20:06:55:19, inclusive, apply for plan years beginning after September 22, 2010, and apply to any employer based health plan, including health benefit plans subject to the provisions of SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-42">58-18-42</A> but do not apply to excepted benefits.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>For plan or policy years beginning prior to January 1, 2014, a group 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.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>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.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>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.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Source:</b> 37 SDR 63, effective September 23, 2010; 37 SDR 111, effective December 7, 2010.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-79">58-18-79.</A><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-43">58-18-43</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-44">58-18-44</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-45">58-18-45</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-48">58-18-48</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-51.1">58-18-51.1</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-79">58-18-79.</A><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in 40.5pt .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span></p> </div> </body> </html>