Section · Administrative Rules of South Dakota · View on sdlegislature.gov ↗
coverage. For purposes of this chapter, creditable coverage is defined as follows: (1) "Creditable coverage," with respect to an individual, coverage of the individual provided under any of the following: (a) A group health plan; (b) Health insurance coverage; (c) Part A or Part B of Title XVIII of the Social Security Act (Medicare); (d) Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under § 1928; (e) Chapter 55 of Title, 10 United States Code (CHAMPUS); (f) A medical care program of the Indian Health Service or of a tribal organization; (g) A state health benefits risk pool; (h) A health plan offered under chapter 89 of Title 5, United States Code (Federal Employees Health Benefits Program); (i) A public health plan as defined in federal regulation; and (j) A health benefit plan under § 5(e) of the Peace Corps Act (22 U.S.C. § 2504(e)); (2) "Creditable coverage” may not include one or more, or any combination, of the following: (a) Coverage only for accident or disability income insurance, or any combination; (b) Coverage issued as a supplement to liability insurance; (c) Liability insurance, including general liability insurance and automobile liability insurance; (d) Workers' compensation or similar insurance; (e) Automobile medical payment insurance; (f) Credit-only insurance; (g) Coverage for on-site medical clinics; and (h) Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits; (3) "Creditable coverage," may not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan: (a) Limited scope dental or vision benefits; (b) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; and (c) Any other similar, limited benefits as are specified in federal regulations; (4) "Creditable coverage," may not include the following benefits if offered as independent, noncoordinated benefits: (a) Coverage only for a specified disease or illness; and (b) Hospital indemnity or other fixed indemnity insurance; (5) "Creditable coverage" may not include the following if it is offered as a separate policy, certificate, or contract of insurance: (a) Medicare supplemental health insurance as defined under § 1882(g)(1) of the Social Security Act; (b) Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; and (c) Similar supplemental coverage provided to coverage under a group health plan.
Source: 25 SDR 44, effective September 30, 1998.