With respect to the premium rate a health insurance issuer charges for health insurance coverage offered in the individual or small group market, the rate may only vary with respect to the particular plan or coverage involved by the following factors:

1. (1) Whether the plan or coverage covers an individual or a family;
2. (2) Rating area;
3. (3) Age, except the rate may not vary by more than 3:1 for like individuals of different age who are age 21 and older. The variation in rate must be actuarially justified for individuals under age 21, consistent with the uniform age rating curve under § 20:06:22:30. For purposes of identifying the appropriate age adjustment under this subdivision and the age band in § 20:06:22:31, applicable to a specific enrollee, the enrollee's age as of the date of policy issuance or renewal shall be used; and

4. (4) Tobacco use, except such rate may not vary by more than 1.5:1 for like individuals who vary in tobacco usage and may only be applied with respect to individuals who may legally use tobacco under state law.

   The premium rate may not vary with respect to the particular plan or coverage involved by any other factor not described in this section.

Source: 39 SDR 203, effective June 10, 2013; 46 SDR 26, effective September 4, 2019.

General Authority: SDCL 58-17-4.2 , 58-17-87 , 58-18B-18 , 58-18B-36.

Law Implemented: SDCL 58-17-74.1 , 58-17-87 , 58-18B-18 , 58-18B-36.

Prior versions effective: 2013-06-10.