20:06:39:27.  Requirements for basic plan -- Schedule of benefits. The schedule of benefits for the basic plan are as follows:

          (1)  A deductible per person of at least $1,000 but nor more than $5,000. Carriers must offer at least the $1,000 and the $5,000 deductible options;

          (2)  An emergency room deductible of $50 for each emergency room visit unless the person is subsequently admitted as an inpatient. The emergency room deductible applies toward meeting the out-of-pocket maximum;

          (3)  A coinsurance maximum of $4,000 per person. The percentage of coinsurance is 40 percent of the eligible charges for covered services received from participating or nonparticipating providers; and

          (4)  A lifetime benefits maximum of:

               (a)  $1,000,000 per person;

               (b)  $250,000 for the treatment of AID/HIV;

               (c)  90 days of inpatient treatment for alcoholism;

               (d)  50 percent of covered charges up to a $10,000 maximum for the outpatient treatment of alcoholism and chemical dependency. There is a $50 maximum fee for each outpatient visit; and

               (e)  $10,000 for the inpatient treatment of chemical dependency, excluding the treatment of alcoholism.

          All of the limits in (4)(b) to (4)(e), inclusive, in this section may apply toward meeting the $1,000,000 lifetime maximum per person.

          Source: 27 SDR 69, effective January 15, 2001.

          General Authority: SDCL 58-17-87.

          Law Implemented: SDCL 58-17-85.