In order to participate in an Exchange, a health insurance issuer must have in effect a certification issued or recognized by the director to demonstrate that each health plan it offers in an Exchange is a qualified health plan. The director may certify a health plan as a qualified health plan if the requirements of § 20:06:55:35 are met or the director determines that making the health plan available is in the interest of the qualified individuals and qualified employers. The director may not exclude a health plan on the following basis:

1. (1) Such plan is a fee-for-service plan;
2. (2) Through the imposition of premium price controls; or
3. (3) That the health plan provides treatments necessary to prevent patients' deaths in circumstances determined to be inappropriate or too costly.

Source: 39 SDR 203, adopted June 10, 2013, effective January 1, 2014.

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

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