A plan may substitute benefits from the essential health benefits benchmark benefit plan if it meets the following conditions:

1. (1) The substitute benefit is actuarial equivalent to the essential health benefit;
2. (2) The substitute benefit is made only within the same essential benefit category; and

3. (3) The benefit is not a prescription drug benefit.

   The plan must submit evidence of the actuarial equivalence of the substituted benefit to the director. The certification must be conducted by a member of the American Academy of Actuaries, be based on an analysis performed in accordance with generally accepted actuarial principles and methodologies, and use a standardized plan population. Actuarial equivalence of benefits is determined regardless of cost sharing.

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

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

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