58-18B-15. Provisions for premium rates.
Premium rates for health benefit plans subject to this chapter are subject to the following provisions:
(1)Adjustments in rates for claim experience, health status, and duration of coverage may not be charged to individual employees or dependents. Any such adjustments shall be applied uniformly to the rates charged for all employees and dependents of the small employer;
(2)A small employer carrier may utilize industry as a case characteristic in establishing premium rates, if the highest rate factor associated with any industry classification does not exceed the lowest rate factor associated with any industry classification by more than fifteen percent;
(3)Small employer carriers shall apply rating factors, including case characteristics, consistently with respect to all small employers in a class of business;
(4)For the purposes of this section, a health benefit plan that utilizes a restricted provider network is not considered similar coverage to a health benefit plan that does not utilize such a network, if utilization of the restricted provider network results in substantial differences in claims costs; and
(5)No small employer carrier may use case characteristics, other than age, gender, industry, family composition, and group size without prior approval of the director.
Source: SL 1995, ch 281, ยง8.
Structure South Dakota Codified Laws
Chapter 18B - Regulation Of Small Businesses' Group And Blanket Health Insurance
Section 58-18B-1 - Definition of terms.
Section 58-18B-2 - Chapter applicable to small employer benefit plans.
Section 58-18B-3 - Regulations on premium rates.
Section 58-18B-3.1 - Base rate increase to be filed with director--Approval or disapproval.
Section 58-18B-6 - Disclosure in solicitation and sales materials.
Section 58-18B-7 - Information and documentation required--Disclosure.
Section 58-18B-8 - Suspension of rate requirements.
Section 58-18B-9 - Application of chapter.
Section 58-18B-11 - Health maintenance organization considered separate carrier.
Section 58-18B-13 - Transition period when acquiring additional class of business.
Section 58-18B-14 - Rate changes only for small employer business.
Section 58-18B-15 - Provisions for premium rates.
Section 58-18B-17 - Limit on premium rates.
Section 58-18B-18 - Promulgation of rules for rating practices.
Section 58-18B-23 - Uniform application of requirements used to determine eligibility of employers.
Section 58-18B-27 - Modification to exclude certain diseases prohibited.
Section 58-18B-36 - Rules governing implementation and administration of this chapter.
Section 58-18B-37 - Marketing health benefit plans--Denial of coverage to employer.
Section 58-18B-38 - Prohibited activities of small employer carriers or insurance producers.
Section 58-18B-39 - Information regarding restricted network provision of carrier.
Section 58-18B-41 - Compensation of insurance producer based on percentage of premium.
Section 58-18B-45 - Reasons for denial of coverage to be in writing.
Section 58-18B-47 - Third-party administrator treated as small employer carrier.
Section 58-18B-48 - Chapter not applicable to certain group health insurance plans.
Section 58-18B-49 - Establishing risk adjusters.
Section 58-18B-50 - Minimum inpatient care coverage following delivery.
Section 58-18B-52 - Notice to employees--Disclosures.
Section 58-18B-54 - Application--Exemptions.
Section 58-18B-57 - Diabetes coverage not required of certain plans.
Section 58-18B-58 - Health benefit plans to provide coverage for prostate cancer screening.
Section 58-18B-60 - Coverage for treatment of hearing impairment for persons under age nineteen.