58-18B-15. Provisions for premium rates.
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/sd/title-58/chapter-58-18/58-18b-15·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Premium rates for health benefit plans subject to this chapter are subject to the following provisions:
(1)Adjustments in rates for claim experience, health status, and duration of coverage may not be charged to individual employees or dependents. Any such adjustments shall be applied uniformly to the rates charged for all employees and dependents of the small employer;
(2)A small employer carrier may utilize industry as a case characteristic in establishing premium rates, if the highest rate factor associated with any industry classification does not exceed the lowest rate factor associated with any industry classification by more than fifteen percent;
(3)Small employer carriers shall apply rating factors, including case characteristics, consistently with respect to all small employers in a class of business;
(4)For the purposes of this section, a health benefit plan that utilizes a restricted provider network is not considered similar coverage to a health benefit plan that does not utilize such a network, if utilization of the restricted provider network results in substantial differences in claims costs; and
(5)No small employer carrier may use case characteristics, other than age, gender, industry, family composition, and group size without prior approval of the director.