Rule 20:06:39:04.01 Certificates required upon loss of coverage.
required upon loss of coverage (effective January 1, 2014). A health
insurance issuer must automatically provide a certificate of creditable
coverage to any individual losing coverage. At any time within 24 months after
coverage ceases, a health insurance issuer must also provide additional
certificates pursuant to requests by or on behalf of an individual. Each
certificate must be provided in a reasonable and prompt fashion. A separate fee
may not be charged for the provision of a certificate, but the cost of this
service may be factored into the policy premium.
After July 1, 1998, a health insurance
issuer must provide certificates as required in this section for dependents as
well as the individual to whom the coverage was issued. Before July 1, 1998, a
health insurance issuer may satisfy the requirement for certificates
identifying coverage for dependents by providing the name of the policyholder
and specifying that family coverage is in force. Before July 1, 1998, if the health
insurance issuer is requested to provide a certificate for a dependent, the
health insurance issuer must make reasonable efforts to obtain and provide the
name of the dependent.
If a health insurance issuer provides
coverage in connection with another type of creditable coverage, the health
insurance issuer must provide a certificate as required by this section. A
health insurance issuer may, for an individual with at least 12 months of
creditable coverage without a break in coverage exceeding 63 days, simply
certify that the individual has 12 months of creditable coverage.
39 SDR 203, adopted June 10, 2013, effective January 1, 2014.
Authority: SDCL 58-17-87(2).
Implemented: SDCL 58-11-1, 58-17-85, 58-17-87, 58-33-36.
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