2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 29C - Life And Health Insurance Guaranty Association › Section 58-29C-48 - Definitions.

58-29C-48. Definitions.
Terms used in this chapter mean:
(1)"Account," either of the two accounts created under §58-29C-49;
(2)"Association," the South Dakota Life and Health Insurance Guaranty Association described in §58-29C-49;
(3)"Authorized assessment" or the term "authorized" when used in the context of assessments, means a resolution by the board of directors has been passed whereby an assessment will be called immediately or in the future from member insurers for a specified amount. An assessment is authorized when the resolution is passed;
(4)"Benefit plan," a specific employee, union, or association of natural persons benefit plan;
(5)"Called assessment" or the term "called" when used in the context of assessments, means that a notice has been issued by the association to member insurers requiring that an authorized assessment be paid within the time frame set forth within the notice. An authorized assessment becomes a called assessment when notice is mailed by the association to member insurers;
(6)"Contractual obligation," an obligation under a policy or contract or certificate under a group policy or contract, or portion thereof for which coverage is provided under §58-29C-46;
(7)"Covered contract" or "covered policy," a policy or contract or portion of a policy or contract for which coverage is provided under §58-29C-46;
(8)"Extra-contractual claims," include, for example, claims relating to bad faith in the payment of claims, punitive or exemplary damages, or attorneys' fees and costs;
(9)"Health benefit plan," any hospital or medical expense policy or certificate. This term does not include:
(a)Accident only insurance;
(b)Credit insurance;
(c)Dental only insurance;
(d)Vision only insurance;
(e)Medicare supplement insurance;
(f)Benefits for long-term care, home health care, community-based care, or any combination thereof;
(g)Disability income insurance;
(h)Coverage for on-site medical clinics; or
(i)Specified disease, hospital confinement indemnity, or limited benefit health insurance if the types of coverage do not provide coordination of benefits and are provided under separate policies or certificates;
(10)"Impaired insurer," a member insurer which, after July 1, 2003, is not an insolvent insurer, and is placed under an order of rehabilitation or conservation by a court of competent jurisdiction;
(11)"Insolvent insurer," a member insurer which after July 1, 2003, is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency;
(12)"Member insurer," an insurer licensed or that holds a certificate of authority to transact in this state any kind of insurance for which coverage is provided under §58-29C-46, and includes an insurer whose license or certificate of authority in this state may have been suspended, revoked, not renewed, or voluntarily withdrawn, but does not include:
(a)A hospital or medical service organization, whether for profit or nonprofit;
(b)A health maintenance organization;
(c)A fraternal benefit society;
(d)A mandatory state pooling plan;
(e)A mutual assessment company or other person that operates on an assessment basis;
(f)An insurance exchange;
(g)An organization engaged in the issuance of charitable gift annuities, which is described in §58-1-16; or
(h)An entity similar to any of the above;
(13)"Moody's Corporate Bond Yield Average," the Monthly Average Corporates as published by Moody's Investors Service, Inc., or any successor thereto;
(14)"Owner" of a policy or contract, "policyholder," "policy owner," and "contract owner," the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and properly recorded as the owner on the books of the member insurer. The terms owner, contract owner, policyholder, and policy owner do not include persons with a mere beneficial interest in a policy or contract;
(15)"Person," an individual, corporation, limited liability company, partnership, association, governmental body or entity, or voluntary organization;
(16)"Premiums," amounts or considerations (by whatever name called) received on covered policies or contracts less returned premiums, considerations, and deposits and less dividends and experience credits. The term, premiums, does not include amounts or considerations received for policies or contracts or for the portions of policies or contracts for which coverage is not provided under subpart B of §58-29C-46 except that assessable premium may not be reduced on account of subsection 58-29C-46B(2)(c) relating to interest limitations and subdivision 58-29C-46C(2) relating to limitations with respect to one individual, one participant, and one policy or contract owner. Premiums do not include:
(a)Premiums on an unallocated annuity contract; or
(b)With respect to multiple nongroup policies of life insurance owned by one owner, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, premiums in excess of five million dollars with respect to these policies or contracts, regardless of the number of policies or contracts held by the owner;
(17)"Principal place of business" of a plan sponsor or a person other than a natural person, the single state in which the natural persons who establish policy for the direction, control, and coordination of the operations of the entity as a whole primarily exercise that function, determined by the association in its reasonable judgment by considering the following factors:
(a)The state in which the primary executive and administrative headquarters of the entity is located;
(b)The state in which the principal office of the chief executive officer of the entity is located;
(c)The state in which the board of directors (or similar governing person or persons) of the entity conducts the majority of its meetings;
(d)The state in which the executive or management committee of the board of directors (or similar governing person or persons) of the entity conducts the majority of its meetings;
(e)The state from which the management of the overall operations of the entity is directed; and
(f)In the case of a benefit plan sponsored by affiliated companies comprising a consolidated corporation, the state in which the holding company or controlling affiliate has its principal place of business as determined using the above factors. However, in the case of a plan sponsor, if more than fifty percent of the participants in the benefit plan are employed in a single state, that state is determined to be the principal place of business of the plan sponsor.
The principal place of business of a plan sponsor of a benefit plan is determined to be the principal place of business of the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan that, in lieu of a specific or clear designation of a principal place of business, is determined to be the principal place of business of the employer or employee organization that has the largest investment in the benefit plan in question;
(18)"Receivership court," the court in the insolvent or impaired insurer's state having jurisdiction over the conservation, rehabilitation, or liquidation of the member insurer;
(19)"Resident," a person to whom a contractual obligation is owed and who resides in this state on the date of entry of a court order that determines a member insurer to be an impaired insurer or a court order that determines a member insurer to be an insolvent insurer. A person may be a resident of only one state, which in the case of a person other than a natural person is its principal place of business. Citizens of the United States that are either (i) residents of foreign countries, or (ii) residents of United States possessions, territories, or protectorates that do not have an association similar to the association created by this chapter, are determined to be residents of the state of domicile of the member insurer that issued the policies or contracts;
(20)"Structured settlement annuity," an annuity purchased in order to fund periodic payments for a plaintiff or other claimant in payment for or with respect to personal injury suffered by the plaintiff or other claimant;
(21)"State," a state, the District of Columbia, Puerto Rico, and a United States possession, territory, or protectorate;
(22)"Supplemental contact," a written agreement entered into for the distribution of proceeds under a life, health, or annuity policy or contract;
(23)"Unallocated annuity contract," an annuity contract or group annuity certificate that is not issued to and owned by an individual, except to the extent of any annuity benefits guaranteed to an individual by an insurer under the contract or certificate.
Source:
SL 2003, ch 252, §5; SL 2013, ch 252, §2; SL 2020, ch 210, § 3.