ARSD 20:06:56:05. Substituted benefits

A plan may substitute benefits from the essential health benefits benchmark benefit plan if it meets the following conditions: (1) The substitute benefit is actuarial equivalent to the essential health benefit; (2) The substitute benefit is made only within the same essential benefit category; and (3) The benefit is not a prescription drug benefit. The plan must submit evidence of the actuarial equivalence of the substituted benefit to the director. The certification must be conducted by a member of the American Academy of Actuaries, be based on an analysis performed in accordance with generally accepted actuarial principles and methodologies, and use a standardized plan population. Actuarial equivalence of benefits is determined regardless of cost sharing.