Rule 20:06:39:71 Special enrollment triggers.
enrollment triggers. After December 31, 2013, a health insurance
issuer offering health insurance coverage in the individual market outside the
Exchange must allow for an individual or dependent to enroll or change from one
plan to another as a result of the following qualifying events:
(1) The death of the covered
(2) The termination of
individual's employer coverage other than by reason of gross misconduct, or
reduction of hours of the covered employee's spouse;
(3) The divorce or legal
(4) Individual becoming entitled
to benefits under XVII of the Social Security Act;
(5) Dependent child ceasing to be
(6) A proceeding in a case under
Title 11, United States Code, commencing on or after July 1, 1986, with respect
to the employer from whose employment the covered individual retired at any
(7) An individual gains a
dependent or becomes a dependent through marriage, birth, adoption, or
placement for adoption;
(8) An individual, who was not
previously a citizen, national, or lawfully present individual gains such
(9) A qualified individual or
enrollee gains access to nongrandfathered health plan as a result of a
A health insurance issuer in the individual
market must provide, with respect to individuals enrolled in non-calendar year,
a limited open enrollment period beginning on the date that is 30 calendar days
prior to the date the policy year ends in 2014.
This section does not apply to grandfathered
39 SDR 203, effective June 10, 2013.
Authority: SDCL 58-17-87.
Implemented: SDCL 58-17-87.
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