<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s531dab05-9ba5-499e-b75b-3a04f0bf7d25Normal { text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000000 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000001 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s531dab05-9ba5-499e-b75b-3a04f0bf7d25000002 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25Normal"><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">    </span><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000000">20:06:21:36.  Basis for continuation of coverage from group defined.</span><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont"> For the purposes of §§ </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:09"><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000001">20:06:21:09</span></a><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont"> to </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:17"><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000001">20:06:21:17</span></a><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">, inclusive, § </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:35"><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000001">20:06:21:35</span></a><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">, and this section, a basis for continuation of coverage means a policy provision that maintains coverage under the existing group policy when the coverage would otherwise terminate and that is subject only to the continued timely payment of premiums when due.</span></p><p dir="ltr" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25Normal"><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25000002"> </span></p><p dir="ltr" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25Normal"><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">    Group policies which restrict provision of benefits and services to, or contain incentives to use, certain providers or facilities may provide continuation benefits which are substantially equivalent to the benefits of the existing group policy. The director shall determine the substantial equivalence of benefits. In determining substantial equivalence, the director shall take into consideration the differences between managed care and nonmanaged care plans, including provider system arrangements; service availability; benefit levels; and administrative complexity.</span></p><p dir="ltr" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25Normal"><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25000002"> </span></p><p dir="ltr" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25Normal"><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">    </span><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000000">Source:</span><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont"> 23 SDR 55, effective </span><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">October 20, 1996.</span></p><p dir="ltr" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25Normal"><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">    </span><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000000">General Authority:</span><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000001">58-17B-4</span></a><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">.</span></p><p dir="ltr" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25Normal"><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">    </span><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000000">Law Implemented:</span><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont-000001">58-17B-4</span></a><span class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25DefaultParagraphFont">.</span></p><p dir="ltr" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25Normal"><span xml:space="preserve" class="s531dab05-9ba5-499e-b75b-3a04f0bf7d25000002"> </span></p></div></body></html>