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Rule 20:06:13:77 Creditable coverage.

          20:06:13:77.  Creditable coverage. For purposes of this chapter, creditable coverage is defined as follows:

          (1)  "Creditable coverage," with respect to an individual, coverage of the individual provided under any of the following:

               (a)   A group health plan;

               (b)   Health insurance coverage;

               (c)   Part A or Part B of Title XVIII of the Social Security Act (Medicare);

               (d)   Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under § 1928;

               (e)   Chapter 55 of Title, 10 United States Code (CHAMPUS);

               (f)    A medical care program of the Indian Health Service or of a tribal organization;

               (g)   A state health benefits risk pool;

               (h)   A health plan offered under chapter 89 of Title 5, United States Code (Federal Employees Health Benefits Program);

               (i)    A public health plan as defined in federal regulation; and

               (j)    A health benefit plan under § 5(e) of the Peace Corps Act (22 U.S.C. § 2504(e));

          (2)  "Creditable coverage” may not include one or more, or any combination, of the following

               (a)   Coverage only for accident or disability income insurance, or any combination;

               (b)   Coverage issued as a supplement to liability insurance;

               (c)   Liability insurance, including general liability insurance and automobile liability insurance;

               (d)   Workers' compensation or similar insurance;

               (e)   Automobile medical payment insurance;

               (f)    Credit-only insurance;

               (g)   Coverage for on-site medical clinics; and

               (h)   Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits;

          (3)  "Creditable coverage," may not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan;

               (a)   Limited scope dental or vision benefits;

               (b)   Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; and

               (c)   Any other similar, limited benefits as are specified in federal regulations;

          (4)  "Creditable coverage," may not include the following benefits if offered as independent, noncoordinated benefits:

               (a)   Coverage only for a specified disease or illness; and

               (b)   Hospital indemnity or other fixed indemnity insurance;

          (5)  "Creditable coverage" may not include the following if it is offered as a separate policy, certificate, or contract of insurance:

               (a)   Medicare supplemental health insurance as defined under § 1882(g)(1) of the Social Security Act;

               (b)   Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; and

               (c)   Similar supplemental coverage provided to coverage under a group health plan.

          Source: 25 SDR 44, effective September 30, 1998.

          General Authority: SDCL 58-17A-2(9).

          Law Implemented: SDCL 58-17A-2(9).


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