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. 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.
24 SDR 35, effective September 19, 1997.
Authority: SDCL 58-18-79.
Implemented: SDCL 58-18-43, 58-18-44, 58-18-45, 58-18-48, 58-18-79.
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