58-18A-54. Allowable expenses defined.
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/sd/title-58/chapter-58-18/58-18a-54·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
For the purposes of this chapter, the term, allowable expense, means any health care expense, including coinsurance or copayments and without reduction for any applicable deductible, that is covered in full or in part by any of the plans covering the person.
If a plan is advised by a covered person that all plans covering the person are high-deductible health plans and the person intends to contribute to a health savings account established in accordance with section 223 of the Internal Revenue Code of 1986, the primary high-deductible health plan's deductible is not an allowable expense, except for any health care expense incurred that may not be subject to the deductible as described in section 223(c)(2)(C) of the Internal Revenue Code of 1986.
An expense or a portion of an expense that is not covered by any of the plans is not an allowable expense.
Any expense that a provider by law or in accordance with a contractual agreement is prohibited from charging a covered person is not an allowable expense.