ARSD 20:06:55:35. Qualified health plan defined

A qualified health plan is a health plan that has been certified by the division that such plan meets the following criteria: (1) Provides the essential health benefits package described in § 20:06:56:03; (2) Meets actuarial value standards as described in § 20:06:56:11; (3) Is licensed by and in good standing with the director; (4) Includes a network that is compliant with SDCL chapter 58-17F, § 20:06:55:36 and § 20:06:55:37; (5) Complies with marketing laws; (6) Is accredited based on local performance by an accrediting entity recognized by HHS as described in § 20:06:56:12; (7) The rates comply with chapter 20:06:22 and § 20:06:55:45; (8) Is non-discrimination compliant with chapter 20:06:45; (9) Includes plan variations for individuals eligible for cost-sharing reductions and for American Indian and Alaska Native populations; (10) Complies with the benefit design standards, as defined in § 20:06:56:08; (11) Implements and reports on a quality improvement strategy or strategies to disclose and report information on health care quality and outcomes; (12) Complies with the standards related to the risk adjustment program under 45 CFR part 153 (March 12, 2012). Stand-alone dental plans are not required to comply with subdivisions (1),(2),(6),(7),(9),(10),(11), and (12). Stand-alone dental plans must meet the plan criteria identified in § 20:06:56:06.