A health plan is a catastrophic plan if it meets the following conditions:

1. (1) Meets all applicable requirements for health insurance coverage in the individual market and is offered only in the individual market;
2. (2) Does not provide a bronze, silver, gold, or platinum level of coverage described in § 20:06:56:11;
3. (3) Provides coverage of the essential health benefits under § 20:06:56:03 once the annual limitation on cost sharing is reached;
4. (4) Provides coverage for at least three primary care visits per year before reaching the deductible; and

5. (5) Covers only individuals who meet either of the following conditions:

   1. (a) Have not attained the age of 30 prior to the first day of the plan year;

   2. (b) Have received a certificate of exemption for the reasons identified in section 1302(e)(2)(B)(i) or (ii) of PPACA as defined in § 20:06:55:32.

      A catastrophic plan may not impose any cost-sharing requirements, such as a copayment, coinsurance, or deductible, for preventive services, in accordance with § 20:06:56:03. For other than self-only coverage, each individual enrolled must meet the requirements.

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

General Authority: SDCL 58-17-87.

Law Implemented: SDCL 58-17-87.