Rule 20:06:40:01 Waiting periods, affiliation periods, and applications relating to breaks in coverage.
20:06:40:01. Waiting
periods, affiliation periods, and applications relating to breaks in coverage
(repealed January 1, 2014). Waiting periods and delays in the
provision of coverage by the employer do not count toward the maximum break in
coverage of 63 days. An affiliation period may not be used in counting toward
the maximum break in coverage. Any waiting period for a new employee to be
eligible to enroll in the employer’s health benefit plan counts toward the
satisfaction of any waiting period for preexisting conditions contained in that
health benefit plan. For employees who have a waiting period after employment
to qualify for coverage under the employer’s health benefit plan, the
enrollment date is the date of employment. For late enrollees, the enrollment
date is the date coverage begins. The time period after substantial completion
of an application for coverage does not count toward the maximum 63-day break
in coverage whether or not coverage is ultimately obtained. If an individual
withdraws a pending application or fails to fully complete a pending
application after a reasonable period of time, the carrier may count the period
of time since substantial completion of the application toward the maximum
break in coverage of 63 days.
Source:
24 SDR 35, effective September 19, 1997; 39 SDR 203, effective June 10, 2013,
repealed January 1, 2014.
General
Authority: SDCL 58-18-79.
Law
Implemented: SDCL 58-18-43, 58-18-44, 58-18-45, 58-18-48, 58-18-79.
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