reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-161 - Services under individualized service plan, family service plan, or education program.

58-17-161. Services under individualized service plan, family service plan, or education program.
Nothing in §§58-17-154 to 58-17-162, inclusive, may be construed to affect any obligation to provide services to a person under an individualized family service plan, an individualized education program, or an individualized service plan.
Source:
SL 2015, ch 250, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-162 - Effective date of §§ 58-17-154 to 58-17-161.

58-17-162. Effective date of §§58-17-154 to 58-17-161.
The effective date of §§58-17-154 to 58-17-161, inclusive, is the first plan year, policy year, or renewal date on or after January 1, 2016.
Source:
SL 2015, ch 250, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-163 - Dental care insurers to honor assignment of benefits.

58-17-163. Dental care insurers to honor assignment of benefits.
Any insurer that provides dental care insurance to a person shall honor an assignment, made in writing by the person insured under the policy, of payments due under the policy to a dentist or a dental corporation for dental care services provided to the person that is insured under the policy. Upon notice of the assignment, the insurer shall make payments directly to the dentist or dental corporation providing the dental care services. A dentist or dental corporation with a valid assignment may bill the insurer and notify the insurer of the assignment. Upon request of the insurer, the dentist or dental corporation shall provide a copy of the assignment to the insurer.
Source:
SL 2017, ch 213, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-164 - Revocation of assignment of dental insurance benefits.

58-17-164. Revocation of assignment of dental insurance benefits.
A person may revoke an assignment made pursuant to §58-17-163 with or without the consent of the dentist or dental corporation. The revocation shall be in writing. The person shall provide notice of the revocation to the insurer. The insurer shall send a copy of the revocation notice to the dentist or dental corporation subject to the assignment. The revocation is effective when both the insurer and the dentist or dental corporation have received a copy of the revocation notice. The revocation is only effective for any charges incurred after both parties have received the revocation notice.
Source:
SL 2017, ch 213, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-165 - Reimbursement of payment from insured following receipt of payment from insurer.

58-17-165. Reimbursement of payment from insured following receipt of payment from insurer.
If, under an assignment authorized in §58-17-163, a dentist or dental corporation collects payment from a person and subsequently receives payment from the insurer, the dentist or dental corporation shall reimburse the person, less any applicable copayments, deductibles, or coinsurance amounts, within forty-five days.
Source:
SL 2017, ch 213, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-166 - Scope of benefits not affected--Medical benefits not included .

58-17-166. Scope of benefits not affected--Medical benefits not included .
Nothing in §§58-17-163 to 58-17-165, inclusive, limits an insurer's ability to determine the scope of the insurer's benefits, services, or any other terms of the insurer's policies or to negotiate any contract with a licensed health care provider regarding reimbursement rates or any other lawful provisions.
The provisions of §§58-17-163 to 58-17-166, inclusive, apply only to any policy of insurance insuring dental care services. The provisions of §§58-17-163 to 58-17-166, inclusive, do not apply to any service payable as a medical benefit pursuant to a health benefit plan as defined in subdivision 58-17-66(9).
Source:
SL 2017, ch 213, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-167 - Definitions pertaining to telehealth coverage.

58-17-167. Definitions pertaining to telehealth coverage.
Terms used in §§58-17-167 to 58-17-170, inclusive, mean:
(1)"Health care professional," as defined in §58-17F-1;
(2)"Health care services," as defined in §58-17F-1;
(3)"Health insurer," as defined in §58-17-100;
(4)"Telehealth," the delivery of health care services through the use of HIPAA-compliant interactive audio-video. The term does not include the delivery of health care services through audio-only telephone, electronic mail message, text message, mail service, facsimile transmission, or any combination thereof.
Source:
SL 2019, ch 211, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-168 - Coverage for health care services provided through telehealth.

58-17-168. Coverage for health care services provided through telehealth.
No health insurer may exclude a service for coverage solely because the service is provided through telehealth and not provided through in-person consultation or contact between a health care professional and a patient. Health care services delivered by telehealth must be appropriate and delivered in accordance with applicable law and generally accepted health care practices and standards prevailing at the time the health care services are provided, including rules adopted by the appropriate professional licensing board having oversight of the health care professional providing the health care services. Health insurers are not required to provide coverage for health care services that are not medically necessary.
This section does not:
(1)Prohibit a health insurer from establishing criteria that a health care professional must meet to demonstrate the safety and efficacy of delivering a particular health care service via telehealth that the health insurer does not already reimburse other health care professionals for delivering via telehealth so long as the criteria are not unduly burdensome or unreasonable for the particular services;
(2)Prevent a health insurer from requiring a health care professional to agree to certain documentation or billing practices designed to protect the health insurer or patients from fraudulent claims so long as the practices are not unduly burdensome or unreasonable for the particular services; or
(3)Prevent a health insurer from including a deductible, copayment, or coinsurance requirement for a health care service provided via telehealth, if the deductible, copayment, or coinsurance is not in addition to and does not exceed the deductible, copayment, or coinsurance applicable if the same services were provided through in-person contact.
Source:
SL 2019, ch 211, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-169 - Discrimination between coverage for services provided in person and through telehealth prohibited.

58-17-169. Discrimination between coverage for services provided in person and through telehealth prohibited.
A health insurance policy, contract, or plan providing for third-party payment may not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth as long as the services are appropriate to be provided through telehealth. Nothing in §§58-17-167 to 58-17-170, inclusive, prohibits a health insurer and a health care professional from entering into a contract for telehealth with terms subject to negotiation.
Source:
SL 2019, ch 211, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-170 - Application of telehealth coverage requirements.

58-17-170. Application of telehealth coverage requirements.
The requirements of §§58-17-168 and 58-17-169 apply to any health insurer offering any individual or group health insurance policy, contract, certificate, or plan delivered, issued for delivery, or renewed in South Dakota on or after January 1, 2020. The requirements of §§58-17-168 and 58-17-169 do not apply to any plan, policy, or contract providing coverage only for:
(1)Specified disease;
(2)Hospital indemnity;
(3)Fixed indemnity;
(4)Accident-only;
(5)Credit accident and health insurance;
(6)Vision;
(7)Prescription drug;
(8)Medicare supplement;
(9)Long-term care;
(10)Disability income insurance;
(11)Coverage issued as a supplement to liability insurance;
(12)Workers' compensation or similar insurance;
(13)Automobile medical payment insurance; or
(14)Individual health benefit plans of six-months or less duration that are not renewable.
The requirements of §§58-17-168 and 58-17-169 do not apply to services offered that are not part of the policy, contract, certificate, or plan offered and for which there is no premium charged.
Source:
SL 2019, ch 211, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-171 - Payment for dental services--Credit card requirement prohibited.

58-17-171. Payment for dental services--Credit card requirement prohibited.
No plan of insurance insuring dental care services may contain restrictions on methods of payment to the dentist in which the only acceptable payment method is a credit card payment.
Source: SL 2022, ch 182, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-1 - Definition of terms.

58-17A-1.Definition of terms.
Terms used in this chapter mean:
(1)"Applicant," in the case of an individual medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; and in the case of a group medicare supplement policy or subscriber contract, the proposed certificate holder;
(2)"Certificate," any certificate issued under a group medicare supplement policy, which policy has been delivered or issued for delivery in this state;
(3)"Certificate form," the form on which the certificate is delivered or issued for delivery by the issuer;
(4)"Issuer," includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state medicare supplement policies or certificates;
(5)"Medicare," the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 and as amended through December31, 1991;
(6)"Medicare supplement policy," a group or individual policy of health insurance or a subscriber contract of nonprofit hospital, medical and surgical service plans, or health maintenance organizations, which is advertised, marketed, or designed primarily as a supplement to reimbursements under medicare for the hospital, medical or surgical expenses of persons eligible for medicare. The term does not include insurance policies or health care benefit plans, including group conversion policies, provided to medicare eligible persons which policies are not marketed or held to be medicare supplement policies or benefit plans, nor does it apply to a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations. The term does not include a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act, 42 U.S.C. §1395 et seq., or a policy issued under a demonstration project specified in 42 U.S. C. §1395ss(g)(i). The term does not include any medicare advantage plan established under Medicare Part C, any outpatient prescription drug plan established under Medicare Part D, or any health care prepayment plan that provides benefits pursuant to an agreement under §1833(a)(1)(A) of the Social Security Act;
(7)"Policy form," the form on which the policy is delivered or issued for delivery by the issuer.
Source:
SL 1982, ch 360, §1; SL 1989, ch 431, §1; SL 1990, ch 396, §1; SL 1992, ch 347, §1; SL 1996, ch 293, §1; SL 2005, ch 267, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-2 - Regulations to establish specific standards for policy provisions.

58-17A-2. Regulations to establish specific standards for policy provisions.
The director shall promulgate rules pursuant to chapter 1-26 to establish specific standards and requirements for medicare supplement policies and certificates. The standards and requirements shall be in addition to and in accordance with applicable laws of this state and may cover, but are not limited to:
(1)Terms of renewability;
(2)Initial and subsequent conditions of eligibility;
(3)Nonduplication of coverage;
(4)Probationary periods;
(5)Benefit limitations, exceptions, and reductions;
(6)Elimination periods;
(7)Requirements for replacement;
(8)Recurrent conditions;
(9)Definitions of terms;
(10)Filing requirements for forms and rates and rate schedules;
(11)Marketing practices;
(12)Reporting practices;
(13)Compensation arrangements between insurers or other entities and their agents, representatives, or producers;
(14)Suitability and appropriateness of policy sold;
(15)Data on application forms;
(16)Continuation and conversion rights;
(17)Loss ratio requirements and refund and credit calculations;
(18)Suspension and reinstitution of coverage; and
(19)Refund of premium for duplication and suspension and reinstitution of coverage.
The director may promulgate rules pursuant to chapter 1-26 that specify prohibited policy or certificate provisions not otherwise specifically authorized by statute which, in the opinion of the director, are unjust, unfair, or unfairly discriminatory to any person insured or proposed for coverage under a medicare supplement policy or certificate. The director may also promulgate rules assuring public access to rate and form information, establishing procedures for rate and form approvals or disapprovals, and establishing a uniform methodology for calculating and reporting loss ratios.
The director shall promulgate rules pursuant to chapter 1-26 to establish minimum standards for benefits and claims payment under medicare supplement policies and certificates and to establish procedures for rate hearings.
Source:
SL 1982, ch 360, §2; SL 1989, ch 431, §2; SL 1990, ch 396, §2; SL 1992, ch 347, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-3 - Preexisting conditions--Policy provisions.

58-17A-3. Preexisting conditions--Policy provisions.
Notwithstanding any other provision of law, a medicare supplement policy or certificate may not exclude or limit benefits for losses incurred more than six months from the effective date of coverage for a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.
Source:
SL 1982, ch 360, §3; SL 1992, ch 347, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-3.1 - Preexisting conditions provision prohibited in replacement policy--Exception.

58-17A-3.1. Preexisting conditions provision prohibited in replacement policy--Exception.
A policy or certificate of insurance providing medicare supplement benefits which is sold to a consumer to replace an existing, in-force medicare supplement policy may not contain any provision limiting payment of benefits due to preexisting conditions of the insured except, if there is any time period remaining relating to the exclusion of coverage for preexisting conditions as specified in the underlying policy, that remaining waiting period for coverage of preexisting conditions shall apply to the new policy unless the policy otherwise provides a lesser waiting period. The waiver applies to all time periods applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods in the new medicare supplement.
Source:
SL 1989, ch 432, §1; SL 1997, ch 291, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-4 - Reasonable benefits required--Regulations to establish minimum standard from loss ratios--Policies issued through mail or mass media advertising.

58-17A-4. Reasonable benefits required--Regulations to establish minimum standard from loss ratios--Policies issued through mail or mass media advertising.
Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director shall issue regulations to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experience or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis and earned premiums and in accordance with accepted actuarial principles and practices. For purposes of regulations issued pursuant to this section, medicare supplement policies issued as a result of solicitations of individuals through the mail or mass media advertising, including both print and broadcast advertising, shall be treated as individual policies.
Source:
SL 1982, ch 360, §4; SL 1989, ch 431, §3; SL 1992, ch 347, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-5 - Outline of coverage delivered at time of application for insurance.

58-17A-5. Outline of coverage delivered at time of application for insurance.
To provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate may be delivered or issued for delivery in this state and no certificate may be delivered pursuant to a group medicare supplement policy delivered or issued for delivery in this state unless an outline of coverage is delivered to the applicant at the time application is made. The director shall prescribe the format and content of the outline of coverage required by this section. For purposes of this section, "format" means style, arrangements, and overall appearance, including such items as size, color, and prominence of type and the arrangement of text and captions. The outline of coverage shall include:
(1)A description of the principal benefits and coverage provided in the policy;
(2)A statement of the exceptions, reductions and limitations contained in the policy;
(3)A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age; and
(4)A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
Source:
SL 1982, ch 360, §5; SL 1992, ch 347, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-6 - Informational brochures.

58-17A-6. Informational brochures.
The director may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for medicare which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of medicare. Except in the case of direct response insurance policies or certificates, the director may require by regulation that the information brochure be provided to any prospective insureds eligible for medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies or certificates, the director may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for medicare but in no event later than the time of policy delivery.
Source:
SL 1982, ch 360, §6; SL 1992, ch 347, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-7 - Health insurance policies--Requirements for information regarding medicare coverage.

58-17A-7. Health insurance policies--Requirements for information regarding medicare coverage.
The director may promulgate rules pursuant to chapter 1-26 for captions or notice requirements determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not medicare supplement coverages, for all health insurance policies sold to persons eligible for medicare other than medicare supplement policies and disability income policies.
The director may promulgate rules pursuant to chapter 1-26 to govern the full and fair disclosure of information, marketing, and conduct of insurance producers in connection with the replacement of health insurance policies, subscriber contracts, and certificates by persons eligible for medicare.
Source:
SL 1982, ch 360, §7; SL 1989, ch 431, §7; SL 1992, ch 347, §8; SL 1996, ch 293, §2; SL 1997, ch 291, §1; SL 2001, ch 286, §119.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-8 - Notice of right to return and right to premium refund printed in medicare supplement policies and certificates--Payment of refund.

58-17A-8. Notice of right to return and right to premium refund printed in medicare supplement policies and certificates--Payment of refund.
Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within thirty days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason.
Any refund made pursuant to this section shall be paid directly to the applicant by the issuer within thirty days of receipt of the returned policy.
Source:
SL 1982, ch 360, §8; SL 1989, ch 431, §8; SL 1992, ch 347, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-8.1 - Issuance of policies by insurance company, nonprofit hospital service plan, medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--Term of retention.

58-17A-8.1. Issuance of policies by insurance company, nonprofit hospital service plan, medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--Term of retention.
An issuer shall issue policies in this state for which an examination period is required in accordance with one of the following methods:
(1)If the policy is delivered by an insurance producer, a receipt shall be signed by the policyowner acknowledging delivery of the policy. The receipt shall include the policy number and the date of the delivery;
(2)If the policy is delivered by mail, it shall be sent by registered or certified mail, return receipt requested, or a certificate of mailing shall be obtained showing the date the policy was mailed to the policyowner. For policy issuances verified by a certificate of mailing, it is presumed that the policy is received by the policyowner ten days from the date of mailing.
The receipts and the certificates of mailing described in this section shall be retained by the issuer for five years. If a producer obtains the delivery receipt, the producer shall forward the signed delivery receipt to the insurer.
Source:
SL 1982, ch 28, §18; SL 1987, ch 374, §4; SL 1992, ch 347, §10; SL 2001, ch 286, §120; SL 2003, ch 249, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-9 - Regulations subject to Administrative Procedures Act.

58-17A-9. Regulations subject to Administrative Procedures Act.
Regulations promulgated pursuant to this chapter shall be subject to the provisions of chapter 1-26.
Source:
SL 1982, ch 360, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-10 - Filing requirements--Master policy--Rates, rating schedules, and supporting documentation--Riders or amendments to delete outpatient prescription drug benefits.

58-17A-10. Filing requirements--Master policy--Rates, rating schedules, and supporting documentation--Riders or amendments to delete outpatient prescription drug benefits.
Every issuer providing group medicare supplement insurance benefits to a resident of this state shall file a copy of the master policy and any certificate used in this state in accordance with the filing requirements and procedures applicable to group medicare supplement policies issued in this state.
Every issuer providing medicare supplement policies or certificates in this state shall annually file its rates, rating schedule, and supporting documentation demonstrating that it is in compliance with the applicable loss ratio standards of this state. All filings of rates and rating schedules shall demonstrate that the actual and expected losses in relation to premiums comply with the requirements of this chapter.
An issuer shall file any riders or amendments to policy or certificate forms to delete outpatient prescription drug benefits as required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 for any policy or certificate issued in this state.
Source:
SL 1989, ch 431, §4; SL 1992, ch 347, §11; SL 2005, ch 267, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-11 - Premiums to be adjusted to produce a loss ratio conforming with minimum standards--Form of adjustments.

58-17A-11. Premiums to be adjusted to produce a loss ratio conforming with minimum standards--Form of adjustments.
Every issuer providing medicare supplement insurance or benefits to a resident of this state shall make premium adjustments as are necessary to produce an expected loss ratio under a policy or certificate as will conform with minimum loss ratio standards for medicare supplement policies and certificates which is expected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums by the issuer. No premium adjustment which would modify the loss ratio experience under the policy other than the adjustments described herein may be made with respect to a policy at any time other than upon its renewal date. Premium adjustments shall be in the form of refunds or premium credits and shall be made no later than upon renewal if a credit is given, or within sixty days of the renewal date if a refund is provided to the premium payer.
Source:
SL 1989, ch 431, §5; SL 1992, ch 347, §12.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-13 - Review of advertisements of issuers providing medicare supplement insurance.

58-17A-13. Review of advertisements of issuers providing medicare supplement insurance.
Every issuer providing medicare supplement insurance policies or certificates in this state shall provide, prior to its use, a copy of any advertisement used in this state whether through written, radio, or television medium to the director for review.
Source:
SL 1989, ch 431, §9; SL 1992, ch 347, §13.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-14 - Requirements for replacement of policy.

58-17A-14. Requirements for replacement of policy.
An issuer replaces a medicare supplement policy if:
(1)The issuer discontinues or does not renew a medicare supplement policy and offers an alternative medicare supplement policy to its insured; or
(2)The newer policy has an effective date which coincides with or which is within thirty days after the date the older policy covering that same insured discontinued. An issuer does not violate medicare supplement replacement requirements unless that issuer or its representative knew or reasonably should have known of the older policy.
Source:
SL 1989, ch 432, §2; SL 1992, ch 347, §14; SL 1993, ch 361; SL 1995, ch 279.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-15 - Sale of second policy prohibited except as replacement--Liability of issuer.

58-17A-15. Sale of second policy prohibited except as replacement--Liability of issuer.
No issuer or insurance producer may sell a medicare supplement policy to a person who has an existing, in force medicare supplement policy unless the issuer or insurance producer is replacing the existing coverage. However, no issuer is liable beyond a refund of premium for the duplication of such medicare supplement coverage when a statement, signed by the insured, is obtained from the insured verifying that no other medicare supplement coverage is then in effect.
Source:
SL 1989, ch 432, §3; SL 1992, ch 347, §15; SL 2001, ch 286, §121.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-16 - Additional penalties for violation of title.

58-17A-16. Additional penalties for violation of title.
In addition to any other applicable penalties or other administrative remedies for violations of this title, the director may require issuers violating any provision of this chapter or rules promulgated pursuant to this chapter to cease marketing any medicare supplement policy or certificate in this state which is related directly or indirectly to a violation, or may require such issuer to take such actions as are necessary to comply with the provisions of this chapter, or both.
Source:
SL 1992, ch 347, §16.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17A - Medicare Supplement Policies › Section 58-17A-17 - Conditional or discriminatory policy or certificate prohibited.

58-17A-17. Conditional or discriminatory policy or certificate prohibited.
No issuer may deny or condition the issuance or effectiveness of any medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant if an application for a policy or certificate is submitted prior to or during the six-month period beginning with the first day of the month in which an individual is sixty-five years of age or older and is enrolled for benefits under medicare part B. Each medicare supplement policy and certificate currently available from an issuer shall be made available to all applicants who qualify under this section without regard to age.
This does not prevent the exclusion of benefits under a policy or certificate during the first six months based on a preexisting condition for which the policyholder or certificate holder received treatment or was otherwise diagnosed during the six months before the policy or certificate became effective.
Source:
SL 1992, ch 347, §17; SL 1996, ch 293, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-1 - Scope.

58-17B-1. Scope.
This chapter applies to policies delivered or issued for delivery in this state on or after July 1, 1989. This law does not supersede the obligations of entities subject to this chapter to comply with other applicable insurance laws insofar as they do not conflict with this chapter. Laws and rules designed and intended to apply to medicare supplement insurance policies may not be applied to long-term care insurance. A policy which is not advertised, marketed, or offered as long-term care insurance or nursing facility insurance need not meet the requirements of this chapter.
Source:
SL 1989, ch 440, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-3 - Minimum requirements for individual policy.

58-17B-3. Minimum requirements for individual policy.
An individual policy delivered or issued for delivery may not contain provisions less favorable to the insured than "guaranteed renewable" for life.
Source:
SL 1989, ch 440, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-4 - Adoption of rules--Standards for disclosure.

58-17B-4. Adoption of rules--Standards for disclosure.
The director may adopt rules, pursuant to chapter 1-26, that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, marketing, and definitions of terms.
The director shall develop minimum standards for benefits contained in the marketing and sale of long-term care coverage or other coverages containing long-term care benefits which do not provide institutional care benefits. The standards shall be established by rules promulgated pursuant to chapter 1-26. The standards shall take into consideration the special status of persons in the long-term care insurance market and be designed to afford protection of the public through disclosure and other informational requirements, minimum requirements for coverages and exclusions contained in such policies or certificates, prohibition or prescription of marketing or sales practices, financial and solvency requirements, disclosure and requirements relating to incontestability, and requirements for the continuity of coverage through continuation, conversion, or reinstatement. The director shall design standards to prohibit unjust, unfair, or discriminatory treatment of any person insured or proposed for coverage under this chapter. The director may adopt nationally developed standards to the extent that those standards are appropriate for the state considering the impact on the availability and cost of the insurance and the health care delivery system existing in South Dakota. The standards may include minimum amounts of coverage not otherwise specified in this chapter; the definitions; type, number, and use of benefit triggers such as activities of daily living, the types of facilities, and criteria for reimbursement for assisted living centers; requirements for home health care and home health agencies; the content and use of application forms; when and how coverage must be extended; and reports from insurers and others engaged in the business of long-term care insurance relating to how insureds have been treated and how compliance with this chapter has been achieved.
Source:
SL 1989, ch 440, §4; SL 1996, ch 294.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-5 - Grounds for termination and certain provisions prohibited.

58-17B-5. Grounds for termination and certain provisions prohibited.
No long-term care insurance policy may:
(1)Be cancelled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; or
(2)Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; or
(3)Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care.
Source:
SL 1989, ch 440, §5; SL 1990, ch 398, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-5.1 - Replacement of policy--Waiver of time periods.

58-17B-5.1. Replacement of policy--Waiver of time periods.
If a long-term care policy replaces another long-term care policy issued by the company or by an affiliated company, the insurer shall waive any time period applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods in the new long-term care policy for similar benefits to the extent such time was spent under the original policy.
Source:
SL 1990, ch 398, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-6 - Defining "preexisting conditions"--Requirements--Exclusions for loss or confinement--Extending limitation periods.

58-17B-6. Defining "preexisting conditions"--Requirements--Exclusions for loss or confinement--Extending limitation periods.
No long-term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in subdivision 58-17B-2(4)(a):
(1)Shall use a definition of "preexisting condition" which is more restrictive than the following: Preexisting condition means a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person;
(2)May exclude coverage for a loss or confinement which is the result of a preexisting condition unless such loss or confinement begins within six months following the effective date of coverage of an insured person.
The director may extend the limitation periods set forth herein as to specific age group categories in specific policy forms upon findings that the extension is in the best interest of the public. The definition of "preexisting condition" does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurer's established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subdivision (2) of this section expires. No long-term care insurance policy or certificates may exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subdivision (2) of this section.
Source:
SL 1989, ch 440, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-7 - Requirements for long-term care insurance policies--Post-confinement, post-acute care, or recuperative benefits.

58-17B-7. Requirements for long-term care insurance policies--Post-confinement, post-acute care, or recuperative benefits.
No long-term care insurance policy may be delivered or issued for delivery in this state if the policy:
(1)Conditions eligibility for any benefits on a prior hospitalization requirement;
(2)Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or
(3)Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care or recuperative benefits on a prior institutionalization requirement.
Post-confinement, post-acute care, or recuperative benefits do not include home health care, adult day care, or any other benefit based on treatment or services received.
A long-term care insurance policy, continuing post-confinement, post-acute care, or recuperative benefits, shall clearly label, in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits," such limitations or conditions, including any required number of days of confinement.
A long-term care insurance policy or rider which conditions eligibility of non-institutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than thirty days, except waiver of premium which may not require a prior institutional stay of more than ninety days.
Source:
SL 1989, ch 440, §7; SL 1991, ch 401.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-8 - Adoption of rules to establish loss ratio standards.

58-17B-8. Adoption of rules to establish loss ratio standards.
The director may adopt rules, pursuant to chapter 1-26, establishing loss ratio standards for long-term care insurance policies provided that a specific reference to long-term insurance policies is contained in the regulation.
Source:
SL 1989, ch 440, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-9 - Policyholder's right to return--Notice.

58-17B-9. Policyholder's right to return--Notice.
Long-term care insurance policyholders shall have the right to return the policy within thirty days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Long-term care insurance policies shall have a notice prominently printed on the first page of the policy or attached thereto stating in substance that the policyholder shall have the right to return the policy within thirty days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason.
Source:
SL 1989, ch 440, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-10 - Delivery of outline of coverage--Contents.

58-17B-10. Delivery of outline of coverage--Contents.
An outline of coverage shall be delivered to an applicant for an individual long-term care insurance policy at the time of application for an individual policy. In the case of direct response solicitations, the insurer shall deliver the outline of coverage upon the applicant's request, but regardless of request shall make delivery no later than at the time of policy delivery. Such outline of coverage shall include:
(1)A description of the principal benefits and coverage provided in the policy;
(2)A statement of the principal exclusions, reductions and limitations contained in the policy;
(3)A statement of the renewal provisions, including any reservation in the policy of a right to change premiums; and
(4)A statement that the outline of coverage is a summary of the policy issued or applied for, and that the policy should be consulted to determine governing contractual provisions.
Source:
SL 1989, ch 440, §11.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-11 - Contents of certificate.

58-17B-11. Contents of certificate.
A certificate issued pursuant to a group long-term care insurance policy which policy is delivered or issued for delivery in this state shall include:
(1)A description of the principal benefits and coverage provided in the policy;
(2)A statement of the principal exclusions, reductions and limitations contained in the policy; and
(3)A statement that the group master policy determines governing contractual provision.
Source:
SL 1989, ch 440, §12.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-12 - Compliance with chapter prerequisite to advertisement, marketing, offer.

58-17B-12. Compliance with chapter prerequisite to advertisement, marketing, offer.
No policy may be advertised, marketed, or offered as long-term care or nursing facility insurance unless it complies with the provisions of this chapter.
Source:
SL 1989, ch 440, §13.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-13 - Endorsement required--Cost-of-living adjustment not required.

58-17B-13. Endorsement required--Cost-of-living adjustment not required.
Any long-term care policy offered for sale in this state shall offer as an endorsement an annual cost-of-living adjustment in daily benefits paid.
Nothing in this section requires an insurer that offers a long-term care policy which pays benefits on an expense-incurred basis or which is a life insurance policy with long-term care benefits as a part of the life policy or a rider to the life policy to offer a cost-of-living adjustment.
Source:
SL 1989, ch 440, §14; SL 1990, ch 398, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-13.1 - Establishment of standards and requirements for cost-of-living adjustment.

58-17B-13.1. Establishment of standards and requirements for cost-of-living adjustment.
The director may promulgate rules pursuant to chapter 1-26 to establish specific standards and requirements for a cost-of-living adjustment to long-term care policies. The standards or requirements may cover:
(1)Types and duration of adjustments;
(2)Underwriting; and
(3)Amount of adjustment.
Source:
SL 1990, ch 398, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-14 - Coverage offered to resident under group policy issued in other state--Requirements.

58-17B-14. Coverage offered to resident under group policy issued in other state--Requirements.
No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in subdivisions 58-17B-2(4)(a) and (4)(d) unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met.
Source:
SL 1989, ch 440, §16.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-15 - Rules in accordance with chapter 1-26.

58-17B-15. Rules in accordance with chapter 1-26.
Rules adopted pursuant to this chapter shall be in accordance with the provisions of chapter 1-26.
Source:
SL 1989, ch 440, §17.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17B - Standards For Long-Term Care Insurance › Section 58-17B-16 - Temporary absence from nursing home or assisted living facility--Effect on benefits for long-term care charges and other requirements--Application.

58-17B-16. Temporary absence from nursing home or assisted living facility--Effect on benefits for long-term care charges and other requirements--Application.
If an insured is receiving benefits for long-term care services in a nursing home or assisted living facility under a long-term care policy or certificate subject to this chapter, and temporarily leaves the nursing home or assisted living facility for a period not to exceed fourteen days annually, the insurer may not reduce or limit benefits for long-term care charges incurred by the insured during that temporary absence unless otherwise provided in the policy or certificate. The insurer may not consider that absence in determining whether the insured qualifies or continues to qualify for a waiver of premium or other policy or certificate benefits or eligibility requirements. This section applies to all policies or certificates that are issued after June30, 2005.
Source:
SL 2005, ch 268, §1.