SD State Updates - 2015 Jan 05 No.01

On April 23, 2015, the South Dakota DOI issued Bulletin 15-03, which outlines the composite premium billing methodology the state proposed to CMS for non-grandfathered (non-transitional) small employer health insurance issued off the exchange. The DOI specifically proposed a four-tiered premium structure with rates for employee, employee plus spouse, employee plus child(ren) and employee plus spouse and child(ren). This alternate tiered composite premium methodology is the only composite methodology allowed for these plans. Issuers who don’t use this methodology must use the per-member rating system. Additionally, if an issuer chooses to offer this alternative composite methodology, it must offer it to all small employer groups.

The bulletin also explained that if an insurer chooses to surcharge for tobacco usage, tobacco premiums cannot be integrated with these composite premiums. Instead, the tobacco rating factor will be added to the composite premium for each individual who uses tobacco. The methodology received federal approval on April 1, 2015.

Bulletin 15-03 »