Continuation of Benefits (COBRA) in South Dakota (SD)

Federal COBRA

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) generally requires group health plans sponsored by employers with 20 or more employees in the prior year to offer employees and their families the option to continue benefits for limited periods of time when coverage under the plan would otherwise end due to certain qualifying events. These events include voluntary or involuntary job loss, reduction in hours worked, death, divorce, and other life events.  

COBRA sets rules for how and when continuation coverage must be offered, how employees and their families may elect COBRA, and what circumstances justify terminating coverage. The length of time for which continuation coverage must be made available depends on the type of qualifying event. For termination of employment or a reduction in hours, the maximum period of COBRA is generally 18 months. Up to 36 months of coverage may be available due to other qualifying events, or if a second qualifying event occurs during the initial period of COBRA coverage.

Please review our COBRA Steps to Success to understand the key areas involved in implementing COBRA for your company. Most states also have laws (commonly referred to as "mini-COBRA" laws) which require that group health plans provide COBRA-like continuation of benefits for certain employees and their families.

South Dakota Continuation of Coverage

South Dakota's continuation law provides employees of small businesses (those with fewer than 20 employees) and eligible dependents the right to continue health insurance benefits under the current employer's group policy in certain instances when coverage would otherwise terminate. 

Qualifying Events

Continuation coverage must be provided for employees and eligible dependents for a period of up to 18 months upon:

• Termination of employment (except for termination due to gross misconduct); or
• Termination of group health coverage by the insurer, other than termination of the policy or contract itself and the replacement by similar coverage.

In the event an employee or eligible dependent is determined to be disabled under the Social Security Act at any time during the first 60 days of continuation coverage, coverage can be continued for 29 months.

Eligible dependents may continue coverage for up to 36 months due to the following qualifying events:

• Death of the employee;
• Loss of eligibility as a qualified family member under the group policy;
• Ineligibility for Medicare;
• Employee's eligibility for Medicare benefits; or
• Divorce or legal separation of the employee.

Continuation Not Required in Certain Instances

A person is not entitled to continuation of coverage under state law if:

• The person is covered for similar benefits by another individual or group policy;
• Similar benefits are provided for or available to such person under state or federal law (except for a person who becomes entitled to Medicare or who is covered under another group plan on or before continuation is elected);
• Continuation of benefits together with other coverage would result in overinsurance according to the insurer's standards;
• There has been fraud or material misrepresentation in applying for any benefits under the continued policy;
• The person failed to pay any required contribution;
• There has been cancellation of all similar insurance policies in the entire state;
• The plan could terminate the coverage of a similarly situated active employee on the same basis for cause; or
• The group health insurance policy is terminated by the insurer for failure to meet the insurer's participation or eligibility requirements.

Notice Requirements and Premium Payments

The premium for a continuation policy may not exceed 102% of the group rate, except that the premium amount may not exceed 150% of the applicable premium for any month after the 18th month.
 
Notice of the right to continuation must be included in each certificate of coverage.

For More Information

• South Dakota Division of Insurance: COBRA and State Continuation for Employers  
• South Dakota Codified Laws (§58-18-7.5 et seq.) 

Dependent Status and Health Insurance

Under the federal Patient Protection and Affordable Care Act (Health Care Reform), beginning with plan years starting on or after September 23, 2010, group health plans that offer dependent coverage must make the coverage available until a child reaches the age of 26. There is a temporary exception for grandfathered group health plans, which may exclude adult children who are eligible to enroll in an employer-sponsored health plan other than the group health plan of the parent. This exception will no longer be available for plan years beginning on or after January 1, 2014.

Individual states may have requirements that are more favorable to plan participants. For information about your state, please click here and contact your state insurance department for guidance.