reglab/statecodes huggingface dataset:
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:12 - Reinsurance agreements - Transfer of assets

Current through Register Vol. 51, page 10, July 15, 2024
The reinsurance agreement may also contain the following provisions:
(1) That give the assuming insurer the right to seek approval from the ceding insurer, which may not be unreasonably or arbitrarily withheld, to withdraw from the trust account all or any part of the trust assets and transfer those assets to the assuming insurer, if:
(a) The assuming insurer, at the time of withdrawal, replaces the withdrawn assets with other qualified assets having a current fair market value equal to the market value of the assets withdrawn so as to maintain at all times the deposit in the required amount; or
(b) After withdrawal and transfer, the current fair market value of the trust account is no less than 102 percent of the required amount;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:13 - Use of trust agreement to reduce liability for reinsurance

Current through Register Vol. 51, page 10, July 15, 2024
A trust agreement may be used to reduce any liability for reinsurance ceded to an unauthorized assuming insurer in financial statements required to be filed with this division in compliance with the provisions of this chapter if it is established by the date of filing of the financial statement of the ceding insurer. The reduction for the existence of an acceptable trust account may be up to the current fair market value of acceptable assets available to be withdrawn from the trust account at that time, but the reduction may be no greater than the specific obligations under the reinsurance agreement that the trust account was established to secure.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:14 - Acceptability of existing trust agreements

Current through Register Vol. 51, page 10, July 15, 2024
A trust agreement or underlying reinsurance agreement in existence before January 1, 2018 will continue to be acceptable to the director until renewal of the underlying reinsurance agreement, at which time the agreements must be in full compliance with this chapter.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:15 - Actions of director unaffected by failure to identify beneficiary

Current through Register Vol. 51, page 10, July 15, 2024
The failure of a trust agreement to specifically identify the beneficiary as defined in §
									20:06:31:07  does not affect any actions or rights which the director may take or possess pursuant to SDCL title 58.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:16 - Other security

Current through Register Vol. 51, page 10, July 15, 2024
A ceding insurer may take credit for unencumbered funds withheld by the ceding insurer in the United States that are subject to withdrawal solely by the ceding insurer and under its exclusive control.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:17 - Contracts affected

Current through Register Vol. 51, page 10, July 15, 2024
All new and renewal transactions entered into after December 31, 2017, must conform to the requirements of this chapter if credit for reinsurance is to be given to the ceding insurer.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:18 - Letters of credit qualified under SDCL 58-14-16

Current through Register Vol. 51, page 10, July 15, 2024
The letter of credit must be clean, irrevocable, unconditional and issued or confirmed by a qualified United States financial institution as defined in SDCL  58-14-16.18. The letter of credit shall contain an issue date and expiration date and shall stipulate that the beneficiary need only draw a sight draft under the letter of credit and present it to obtain funds and that no other document need be presented. The letter of credit also shall indicate that it is not subject to any condition or qualifications outside of the letter of credit. The letter of credit may not contain reference to any other agreements, documents or entities, except as provided in §
									20:06:31:21.
The letter of credit shall contain a statement to the effect that the obligation of the qualified United States financial institution under the letter of credit is in no way contingent upon reimbursement with respect thereto.
As used in this section, beneficiary, means the domestic insurer for whose benefit the letter of credit has been established and any successor of the beneficiary by operation of law. If a court of law appoints a successor in interest to the named beneficiary, then the named beneficiary includes and is limited to the court appointed domiciliary receiver, including conservator, rehabilitator or liquidator.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:19 - Heading and term for letters of credit

Current through Register Vol. 51, page 10, July 15, 2024
The heading of the letter of credit may include a boxed section containing the name of the applicant and other appropriate notations to provide a reference for the letter of credit. The boxed section shall be clearly marked to indicate that such information is for internal identification purposes only.
The term of the letter of credit shall be for at least one year and shall contain an evergreen clause that prevents the expiration of the letter of credit without due notice from the issuer. The evergreen clause shall provide for a period of no less than 30 days notice prior to expiration date or nonrenewal.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:20 - Letter of credit issued by a financial institution

Current through Register Vol. 51, page 10, July 15, 2024
If the letter of credit is issued by a financial institution authorized to issue letters of credit, other than a qualified United States financial institution as described SDCL  58-14-16.18, then the following additional requirements shall be met:
(1) The issuing financial institution shall formally designate the confirming qualified United States financial institution as its agent for the receipt and payment of the drafts; and
(2) The evergreen clause shall provide for 30 days notice prior to expiration date for nonrenewal.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:21 - Reinsurance agreements in conjunction with letters of credit

Current through Register Vol. 51, page 10, July 15, 2024
The reinsurance agreement in conjunction with which the letter of credit is obtained may contain provisions that:
(1) Require the assuming insurer to provide letters of credit to the ceding insurer and specify what they are to cover;
(2) Stipulate that the assuming insurer and ceding insurer agree that the letter of credit provided by the assuming insurer pursuant to the provisions of the reinsurance agreement may be drawn upon at any time, notwithstanding any other provisions in the agreement, and shall be utilized by the ceding insurer or its successors in interest only for one or more of the following reasons:
(a) To pay or reimburse the ceding insurer for:
(i) The assuming insurers share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurers, to the owners of policies reinsured under the reinsurance agreement on account of cancellations of such policies;
(ii) The assuming insurers share, under the specific reinsurance agreement, of surrenders and benefits or losses paid by the ceding insurer, but not yet recovered from the assuming insurers, under the terms and provisions of the policies reinsured under the reinsurance agreement; and
(iii) Any other amounts necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:22 - Interest payments and amounts drawn in excess

Current through Register Vol. 51, page 10, July 15, 2024
Nothing contained in §
									20:06:31:21  shall preclude the ceding insurer and assuming insurer from providing for:
(1) An interest payment, at a rate not in excess of the prime rate of interest, on the amounts held pursuant to subdivision 20:06:31:21(2); or
(2) The return of any amounts drawn down on the letters of credit in excess of the actual amounts required that are subsequently determined not to be due.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:23 - Letters of credit and Uniform Customs and Practice for Documentary Credits

Current through Register Vol. 51, page 10, July 15, 2024
The letter of credit shall state whether it is subject to and governed by the laws of this state or the Uniform Customs and Practice for Documentary Credits of the International Chamber of Commerce Publication 600 (UCP 600) or International Standby Practices of the International Chamber of Commerce Publication 590 (ISP98), or any successor publication, and all drafts drawn thereunder shall be presentable at an office in the United States of a qualified United States financial institution.
If the letter of credit is made subject to the Uniform Customs and Practice for Documentary Credits of the International Chamber of Commerce Publication 600 (UCP 600) or International Standby Practices of the International Chamber of Commerce Publication 590 (ISP98), or any successor publication, then the letter of credit shall specifically address and provide for an extension of time to draw against the letter of credit in the event that one or more of the occurrences specified in Article 36 of Publication 600 or any other successor publication, occur.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:24 - Insolvency and intermediary clauses

Current through Register Vol. 51, page 10, July 15, 2024
Credit will not be granted, nor an asset or reduction from liability allowed, to a ceding insurer for reinsurance effected with assuming insurers meeting the requirements of §§
									20:06:31:01  to 20:06:31:12, inclusive, 20:06:31:25 to 20:06:31:33, inclusive, or otherwise in compliance with SDCL  58-14-7 to  58-14-16.1, inclusive, and 58-14-16.16 to 58-14-16.20, inclusive, after the effective date of this section unless the reinsurance agreement:
(1) Includes a proper insolvency clause, which stipulates that reinsurance is payable directly to the liquidator or successor without diminution regardless of the status of the ceding company, in compliance with SDCL chapter 58-29 B;
(2) Includes a provision pursuant to SDCL  58-14-7 to  58-14-16.1,inclusive, and 58-14-16.16 to 58-14-16.20, inclusive, whereby the assuming insurer, if an unauthorized assuming insurer, has submitted to the jurisdiction of an alternative dispute resolution panel or court of competent jurisdiction within the United States, has agreed to comply with all requirements necessary to give the court or panel jurisdiction, has designated an agent upon whom service of process may be effected, and has agreed to abide by the final decision of the court or panel; and
(3) Includes a proper reinsurance intermediary clause, if applicable, which stipulates that the credit risk for the intermediary is carried by the assuming insurer.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:26 - Certified reinsurers certification procedure

Current through Register Vol. 51, page 10, July 15, 2024
The director shall post notice on the divisions website promptly upon receipt of any application for certification, including instructions on how members of the public may respond to the application. The director may not take final action on the application until at least 30 days after posting the notice required by this section.
The director shall issue written notice to an assuming insurer that has made application and been approved as a certified reinsurer. Included in such notice shall be the rating assigned the certified reinsurer in accordance with §
									20:06:31:25. The director shall publish a list of all certified reinsurers and their ratings.
In order to be eligible for certification, the assuming insurer shall meet the following requirements:
(1) The assuming insurer must be domiciled and licensed to transact insurance or reinsurance in a Qualified Jurisdiction, as determined by the director pursuant to §
									20:06:31:32.
(2) The assuming insurer must maintain capital and surplus, or its equivalent, of no less than $250,000,000 calculated in accordance with subdivision 20:06:31:27(8). This requirement may also be satisfied by an association including incorporated and individual unincorporated underwriters having minimum capital and surplus equivalents, net of liabilities, of at least $250,000,000 and a central fund containing a balance of at least $250,000,000.
(3) The assuming insurer must maintain financial strength ratings from two or more rating agencies deemed acceptable by the director. These ratings shall be based on interactive communication between the rating agency and the assuming insurer and may not be based solely on publicly available information. These financial strength ratings will be one factor used by the director in determining the rating that is assigned to the assuming insurer. Acceptable rating agencies including, Standard & Poors, Moodys Investors Service, Fitch Ratings, A.M. Best Company; or any other Nationally Recognized Statistical Rating Organization; and
(4) The certified reinsurer must comply with any other requirements reasonably imposed by the director.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16.1,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:28 - Certified reinsurers - prompt payment of claims

Current through Register Vol. 51, page 10, July 15, 2024
Based on the analysis conducted under subdivision 20:06:31:27(5) of a certified reinsurers reputation for prompt payment of claims, the director may make appropriate adjustments in the security the certified reinsurer is required to post to protect its liabilities to U.S. ceding insurers, provided that the director shall, at a minimum, increase the security the certified reinsurer is required to post by one rating level under subdivision 20:06:31:27(1), if the director finds:
(1) More than 15 percent of the certified reinsurers ceding insurance clients have overdue reinsurance recoverables on paid losses of 90 days or more which are not in dispute and which exceed $100,000 for each cedent; or
(2) The aggregate amount of reinsurance recoverables on paid losses which are not in dispute that are overdue by 90 days or more exceeds $50,000,000.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16.1,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:29 - Certified reinsurers - form filing

Current through Register Vol. 51, page 10, July 15, 2024
A certified reinsurer must submit a properly executed Form CR-1, provided by the director, as evidence of its submission to the jurisdiction of this state, appointment of the director as an agent for service of process in this state, and agreement to provide security for one hundred percent of the assuming insurers liabilities attributable to reinsurance ceded by U.S. ceding insurers if it resists enforcement of a final U.S. judgment. The director may not certify any assuming insurer that is domiciled in a jurisdiction that the director has determined does not adequately and promptly enforce final U.S. judgments or arbitration awards. The form of the initial and renewal application will be provided by the director.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16.1,  58-14-17
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:30 - Certified reinsurers - filing requirements

Current through Register Vol. 51, page 10, July 15, 2024
The certified reinsurer must agree to meet applicable information filing requirements as determined by the director, both with respect to an initial application for certification and on an ongoing basis. All information submitted by certified reinsurers shall be investigated by the division. The filing requirements are, as follows:
(1) Notify the director within ten days of any regulatory actions taken against the certified reinsurer, any change in the provisions of its domiciliary license or any change in rating by an approved rating agency, including a statement describing such changes and the reasons therefore;
(2) Annually file the applicable Form CR-F or CR-S, provided by the director;
(3) Annually file the report of the independent auditor on the financial statements of the insurance enterprise, on the basis described in subdivision (4) of this section;
(4) Annually file the most recent audited financial statements, regulatory filings, and actuarial opinion as filed with the certified reinsurer's domiciliary jurisdiction, with a translation into English. Upon the initial certification, audited financial statements for the last two years filed with the certified reinsurer' s supervisor;
(5) At least annually file an updated list of all disputed and overdue reinsurance claims regarding reinsurance assumed from U.S. domestic ceding insurers;
(6) File a certification from the certified reinsurer's domestic regulator that the certified reinsurer is in good standing and maintains capital in excess of the jurisdiction's highest regulatory action level; and
(7) Any other information that the director may reasonably require.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16.1,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:31 - Certified reinsurers - change in rating or revocation of certification

Current through Register Vol. 51, page 10, July 15, 2024
In the case of a downgrade by a rating agency or other disqualifying circumstance, the director shall upon written notice assign a new rating to the certified reinsurer in accordance with the requirements of subdivision 20:06:31:27(1).
The director shall have the authority to suspend, revoke, or otherwise modify a certified reinsurers certification at any time if the certified reinsurer fails to meet its obligations or security requirements under this section, or if other financial or operating results of the certified reinsurer, or documented significant delays in payment by the certified reinsurer, lead the director to reconsider the certified reinsurers ability or willingness to meet its contractual obligations.
If the rating of a certified reinsurer is upgraded by the director, the certified reinsurer may meet the security requirements applicable to its new rating on a prospective basis, but the director shall require the certified reinsurer to post security under the previously applicable security requirements as to all contracts in force on or before the effective date of the upgraded rating. If the rating of a certified reinsurer is downgraded by the director, the director shall require the certified reinsurer to meet the security requirements applicable to its new rating for all business it has assumed as a certified reinsurer.
Upon revocation of the certification of a certified reinsurer by the director, the assuming insurer shall be required to post security in accordance with §
									20:06:31:06  in order for the ceding insurer to continue to take credit for reinsurance ceded to the assuming insurer. If funds continue to be held in trust, the director may allow additional credit equal to the ceding insurers pro rata share of such funds, discounted to reflect the risk of uncollectibility and anticipated expenses of trust administration. Notwithstanding the change of a certified reinsurers rating or revocation of its certification, a domestic insurer that has ceded reinsurance to that certified reinsurer may not be denied credit for reinsurance for a period of three months for all reinsurance ceded to that certified reinsurer, unless the reinsurance is found by the director to be at high risk of uncollectibility.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16.1,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Section 20:06:31:33 - Certified reinsurers recognition of certification

Current through Register Vol. 51, page 10, July 15, 2024
If an applicant for certification has been certified as a reinsurer in an National Association of Insurance Commissioners accredited jurisdiction, the director has the discretion to defer to that jurisdictions certification, and to defer to the rating assigned by that jurisdiction, if the assuming insurer submits a properly executed Form CR-1, provided by the director, and such additional information as the director requires. The assuming insurer shall be considered to be a certified reinsurer in this state.
Any change in the certified reinsurers status or rating in the other jurisdiction shall apply automatically in this state as of the date it takes effect in the other jurisdiction. The certified reinsurer shall notify the director of any change in its status or rating within ten days after receiving notice of the change.
The director may withdraw recognition of the other jurisdictions rating at any time and assign a new rating in accordance with §
									20:06:31:31.
The director may withdraw recognition of the other jurisdictions certification at any time, with written notice to the certified reinsurer. Unless the director suspends or revokes the certified reinsurers certification in accordance with §
									20:06:31:31, the certified reinsurers certification shall remain in good standing in this state for a period of three months, which shall be extended if additional time is necessary to consider the assuming insurers application for certification in this state.
In addition to the clauses required in §
									20:06:31:24, reinsurance contracts entered into or renewed under this section shall include a proper funding clause, which requires the certified reinsurer to provide and maintain security in an amount sufficient to avoid the imposition of any financial statement penalty on the ceding insurer under this section for reinsurance ceded to the certified reinsurer.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-16.1,  58-14-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:31 - Credit for reinsurance › Appendix A - Certificate of Assuming Insurer

Current through Register Vol. 51, page 10, July 15, 2024
APPENDIX A
FORM AR-1
CERTIFICATE OF ASSUMING INSURER
I, _______________________________________ _______________________________________
(name of officer) (title of officer)
of ___________________________________________________________________ the assuming insurer
(name of assuming insurer)
under a reinsurance agreement(s) with one or more insurers domiciled in ___________________________
(name of state)
hereby certify that ____________________________________________________ ("Assuming insurer"):
(name of assuming insurer)
1. Submits to the jurisdiction of any court of competent jurisdiction in _____________________________
(ceding insurer's state of domicile)
by the adjudication of any issues arising out of the reinsurance agreement(s), agrees to comply with all requirements necessary to give such court jurisdiction, and will abide by the final decision of such court or any appellate court in the event of an appeal. Nothing in this paragraph constitutes or should be understood to constitute a waiver of Assuming Insurer's rights to commence an action in any court of competent jurisdiction in the United States, to remove an action to a United States District court, or to seek a transfer of a case to another court as permitted by the laws of the United States or of any state in the United States. This paragraph is not intended to conflict with or override the obligation of the parties to the reinsurance agreement(s) to arbitrate their disputes if such an obligation is created in the agreement(s).
2. Designates the Insurance Commissioner of ________________________________________________
(ceding insurer's state of domicile)
as its lawful attorney upon whom may be served any lawful process in any action, suit or proceeding arising out of the reinsurance agreement(s) instituted by or on behalf of the ceding insurer.
3. Submits to the authority of the Insurance Commissioner of ____________________________________
(ceding insurer's state of domicile)
to examine its books and records and agrees to bear the expense of any such examination.
4. Submits with this form a current list of insurers domiciled in __________________________________
(ceding insurer's state of domicile)
reinsured by Assuming Insurer and undertakes to submit additions to or deletions from the list to the Insurance Commissioner at least once per calendar quarter.
Dated: ____________________________________ _______________________________________
(name of assuming insurer)
By: ___________________________________
(name of officer)
___________________________________
(title of officer)
Note
: This form was taken from the National Association of Insurance Commissioners Credit for Reinsurance Model Act, Model Regulation Service for January of 1991, page 786-13.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:32 - Declaratory rulings › Section 20:06:32:01 - Petition for declaratory ruling

Current through Register Vol. 51, page 10, July 15, 2024
Any interested party wishing the Division of Insurance to rule on the applicability to that party of any statutory provision or rule or order may file a petition for a declaratory ruling in accordance with SDCL  1-26-15 with the director of the division. The petition must reference the applicable statutory provision or rule or order and state generally the factual situation existing under which the question arises. The petition must be verified by the petitioner, except that matters not within the personal knowledge of the petitioner may be on information or belief. The petition shall identify the class of persons or entities known by the petitioner to have a present interest which would be affected by the declaratory ruling. The petition shall identify any specific persons or entities who have prior to the filing of the petition communicated with the petitioner through written documentation concerning a dispute on the matter to be ruled upon, and the director shall name them as parties. A declaration may not prejudice the rights of persons or entities not parties to the proceeding. This chapter does not create a cause of action against any petitioner.
General Authority:
SDCL  1-26-15.
Law Implemented:
SDCL  1-26-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:32 - Declaratory rulings › Section 20:06:32:03 - Hearings on petition for declaratory ruling

Current through Register Vol. 51, page 10, July 15, 2024
A hearing on a petition for declaratory ruling must be public. Testimony must be tape recorded or preserved by other equivalent means. Any person may request that testimony given at such a hearing be transcribed. Each person requesting a transcript must pay a pro rata share of the transcription expense. Parties may make their own provisions to have court reporters present at the hearing. Briefs may be filed by interested parties at the director's discretion.
General Authority:
SDCL  1-26-15.
Law Implemented:
SDCL  1-26-15,  1-26-22.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:32 - Declaratory rulings › Section 20:06:32:04 - Prehearing conference

Current through Register Vol. 51, page 10, July 15, 2024
The director may require a prehearing conference with all parties involved in a contested case.
General Authority:
SDCL  1-26-15.
Law Implemented:
SDCL  1-26-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:32 - Declaratory rulings › Section 20:06:32:05 - Conduct of hearings

Current through Register Vol. 51, page 10, July 15, 2024
Hearings, unless otherwise required by statute, must be conducted in accordance with this chapter and in accordance with the provisions of SDCL chapter 1-26.
General Authority:
SDCL  1-26-15.
Law Implemented:
SDCL  1-26-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:32 - Declaratory rulings › Section 20:06:32:06 - Notice of time and place of hearings - Hearing examiner

Current through Register Vol. 51, page 10, July 15, 2024
Hearings shall be held at the time and place directed by the director. The director shall send written notice of the hearing to all parties at least ten days before the hearing date. For the purpose of the hearing, the director may designate a hearing examiner from the Office of Hearing Examiners.
General Authority:
SDCL  1-26-15.
Law Implemented:
SDCL  1-26-15,  1-26-16.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:32 - Declaratory rulings › Section 20:06:32:07 - All parties to be heard

Current through Register Vol. 51, page 10, July 15, 2024
The hearing examiner may order proposed findings of fact and conclusions of law from any party to the hearing on the examiner's own motion or at the request of any party.
General Authority:
SDCL  1-26-15.
Law Implemented:
SDCL  1-26-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:32 - Declaratory rulings › Section 20:06:32:08 - Decisions

Current through Register Vol. 51, page 10, July 15, 2024
The director shall make a declaratory ruling within 30 days after the hearing examiner submits proposed findings of fact and conclusions of law to the director. The director may take an additional 60 days to make a ruling if written notice of the extension is sent to all of the parties within the original 30-day period.
General Authority:
SDCL  1-26-15.
Law Implemented:
SDCL  1-26-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:32 - Declaratory rulings › Section 20:06:32:09 - Refusal to rule

Current through Register Vol. 51, page 10, July 15, 2024
The director may refuse to make a declaratory ruling if the ruling would not end the uncertainty or controversy giving rise to the proceeding. The refusal must be sent to all parties in accordance with the time constraints of §
									20:06:32:08.
General Authority:
SDCL  1-26-15.
Law Implemented:
SDCL  1-26-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:33 - Utilization review organizations and managed care entities › Section 20:06:33:01 - Registration fee

Current through Register Vol. 51, page 10, July 15, 2024
The fee for initial or annual registration of a utilization review organization or a managed care contractor is $250.
General Authority:
SDCL  58-17F-16,  58-17F-20,  58-17H-35,  58-17H-39.
Law Implemented:
SDCL  58-17F-16,  58-17H-35, 58-18-75.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:33 - Utilization review organizations and managed care entities › Section 20:06:33:02 - Form and content of access plans

Current through Register Vol. 51, page 10, July 15, 2024
Each initial filing of an access plan pursuant to SDCL  58-17F-10 must contain the following:
(1) A complete copy of the entire access plan;
(2) A complete copy of the current provider network in place listed by specialty and location;
(3) Any formalized steps that a covered person must utilize to obtain a referral;
(4) An annual survey, or other method approved by the director, to assess the satisfaction of covered persons that includes, at a minimum, questions designed to elicit how the covered person is generally satisfied and how the covered person feels the managed care plan meets the covered person's health care needs;
(5) In addition to the description of the method for informing covered persons required pursuant to SDCL subdivision 58-17F-10(5), a copy of the disclosure required by SDCL  58-17F-4, a copy of the health carrier's grievance procedures, a summary of utilization review procedures provided to prospective covered persons, and a copy of the membership card pursuant to SDCL  58-17H-33;
(6) A copy of any written materials provided to covered persons that would generally inform such persons of the systems or processes that may be used to change primary care professionals as required by SDCL subdivision  58-17F-10 (7);
(7) In conjunction with the plan for providing continuity of care as required by SDCL subdivision 58-17F-10(8), a copy of the language used in any provider contract that pertains to continuity of care; and
(8) A specimen copy of all provider contracts.
Discounted fee for service plans are not required to comply with subdivisions (3), (4), and (7). Discounted fee for service plans are not required to comply with subdivision (6) if the plan does not use or require the use of primary care professionals. Stand-alone dental plans are not required to comply with subdivisions (3), (4), (6), and (7).
General Authority:
SDCL 58-17F-10,  58-17F-21.
Law Implemented:
SDCL  58-17F-4,  58-17F-10,  58-17F-21.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:33 - Utilization review organizations and managed care entities › Section 20:06:33:03 - Annual filing of access plans

Current through Register Vol. 51, page 10, July 15, 2024
A health insurance issuer is required to either file any changes or an attestation stating no changes have been made, annually on or before September 30th of each year of their access plan filing.
General Authority:
SDCL  58-17F-10,  58-17F-21.
Law Implemented:
SDCL  58-17F-4,  58-17F-10,  58-17F-21.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:33 - Utilization review organizations and managed care entities › Section 20:06:33:04 - Centers of Excellence - Access plans

Current through Register Vol. 51, page 10, July 15, 2024
Each contracted Center of Excellence and each contracted network of a Center of Excellence must be included in a health carrier's access plan. For purposes of network adequacy pursuant to §§58-17F-5 to 58-17F-9, inclusive, the health carrier's entire Center of Excellence network including both direct contracted Centers of Excellence and contracted networks shall be considered. A health carrier may not contract with a Center of Excellence network or any other network that is not registered pursuant to §58-17F-16. Nothing in this section affects the ability of carriers to select network providers as permitted by SDCL subdivision 58-17F-11(3). For purposes of this section a Center of Excellence means a provider of transplant services that is medically recognized as having special expertise to perform a particular transplant or transplants. Transplant providers that separately contract with a health carrier do not constitute a network pursuant to this section.
General Authority:
SDCL  58-17F-10,  58-17F-21(4)(5).
Law Implemented:
SDCL  58-17F-5,  58-17F-6,  58-17F-7,  58-17F-8,  58-17F-9.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:34 - Grievance procedures › Section 20:06:34:10 - Requests for urgent care determinations

Current through Register Vol. 51, page 10, July 15, 2024
The provisions of SDCL  58-17H-41 apply only to requests for urgent care determinations.
General Authority:
SDCL  58-17H-49.
Law Implemented:
SDCL  58-17H-41.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:34 - Grievance procedures › Section 20:06:34:11 - Scope of retrospective review

Current through Register Vol. 51, page 10, July 15, 2024
Retrospective review does not include an audit performed by a carrier subsequent to the adjudication of a claim provided that the audit does not result in any financial liability against the insured.
General Authority:
SDCL  58-17H-49.
Law Implemented:
SDCL  58-17H-30.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:35 - Maternity coverage › Section 20:06:35:01 - Notice requirements

Current through Register Vol. 51, page 10, July 15, 2024
The notice to policyholders of a change in maternity coverage, whether it is a separate notice or is incorporated within a mailing to policyholders, must contain the following language, with the caption in 14-point bold type or greater:
IMPORTANT NOTICE OF CHANGES IN MATERNITY COVERAGE
"Your health insurance contract now contains additional coverage for maternity. Coverage for at least 48 hours of in-patient care following a vaginal delivery and 96 hours following a delivery by cesarean for the mother and her newborn child is required. However, if the treating physician determines, using appropriate medical criteria, that a shorter length of hospitalization is appropriate, you have coverage for that shorter stay and also for one follow-up visit in the first 48 hours after discharge to verify the condition of the mother and newborn. Deductibles and copayments may still apply to this extension of coverage."
The language, but not the caption, of the actual notice used by insurers may vary from the language of this notice if it is substantially similar to this notice; unless the coverage in question specifically provides for the statutorially required maternity coverage, the notice prominently discloses there is additional coverage; and the notice contains the amount and type of maternity coverage available.
General Authority:
SDCL  58-17-90,  58-18-78,  58-18B-52,  58-38-39,  58-40-36,  58-41-114.
Law Implemented:
SDCL  58-17-90,  58-18-78,  58-18B-52,  58-38-39,  58-40-36,  58-41-114.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:36 - Risk-based capital (RBC) reports › Section 20:06:36:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
As used in this chapter:
(1) "Adjusted RBC report" means an RBC report that has been adjusted by the director in accordance with §
									20:06:36:06;
(2) "Corrective order" means an order that has been issued by the director and which specifies the corrective actions;
(3) "Domestic insurer" means any insurance company domiciled in this state or any entity required to comply with RBC pursuant to SDCL  58-4-48;
(4) "Domestic health organization" means any health organization domiciled in this state;
(5) "Foreign insurer" means any insurance company that is licensed to do business in this state but not domiciled in this state;
(6) "Foreign health organization" means any health organization that is licensed to do business in this state, but not domiciled in this state;
(7) "Health Organization" means any health maintenance organization, limited health service organization, dental or vision plan, hospital, medical and dental indemnity or service corporation and other managed care organization licensed under SDCL title 58 but does not include an organization that is:
(a) Licensed as a life or health insurer or property and casualty insurer; and
(b) Subject to either life or property and casualty RBC requirements;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:36 - Risk-based capital (RBC) reports › Section 20:06:36:02 - RBC levels defined

Current through Register Vol. 51, page 10, July 15, 2024
RBC levels are defined as follows:
(1) Company action level RBC is the product of 2.0 and its authorized control level RBC;
(2) Regulatory action level RBC is the product of 1.5 and its authorized control level RBC;
(3) Authorized control level RBC is the number determined under the risk-based capital formula in accordance with the RBC instructions;
(4) Mandatory control level RBC is the product of .70 and the authorized control level RBC.
General Authority:
SDCL  58-4-48.
Law Implemented:
SDCL  58-4-48.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:36 - Risk-based capital (RBC) reports › Section 20:06:36:03 - RBC reports

Current through Register Vol. 51, page 10, July 15, 2024
As required by SDCL  58-4-48, each domestic insurer or domestic health organization shall file by March 1 a report of its RBC levels as of the end of the calendar year just ended, in a form and containing the information required by the RBC instructions.
Each domestic insurer or domestic health organization shall file its RBC report with the NAIC in accordance with the RBC instructions and with the insurance director in any state in which the insurer or health organization is authorized to do business if that insurance director has requested in writing that the report be filed. If a request is made, the insurer or health organization shall file its RBC report by the later of 15 days from the receipt of notice to file its RBC report with that state or the filing date.
General Authority:
SDCL  58-4-48.
Law Implemented:
SDCL  58-4-48.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:36 - Risk-based capital (RBC) reports › Section 20:06:36:04 - Life and health insurer's RBC reports

Current through Register Vol. 51, page 10, July 15, 2024
A life and health insurer's RBC report shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take into account, and may adjust for the covariance between, the following factors determined in each case by applying the factors in the manner set forth in the RBC instructions:
(1) The risk to the insurer's assets;
(2) The risk of adverse insurance experience to the insurer's liabilities and obligations;
(3) The interest rate risk to the insurer's business; and
(4) All other business risks and any other relevant risks as set forth in the RBC instructions.
General Authority:
SDCL  58-4-48.
Law Implemented:
SDCL  58-4-48.
1.
2013 NAIC Life Risk-Based Capital Report.
Cost: $45.
2.
2013 NAIC Health Risk-Based Capital Report.
Cost: $45.
Copies of references 1 and 2 may be obtained from the National Association of Insurance Commissioners, 1100 Walnut Street, Ste. 1500, Kansas City, MO 64106-2197, (816) 783-8300;
http://www.naic.org
.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:36 - Risk-based capital (RBC) reports › Section 20:06:36:05 - Property and casualty insurer's and health organization's RBC reports

Current through Register Vol. 51, page 10, July 15, 2024
A property and casualty insurer's or health organization's RBC report shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take into account, and may adjust for the covariance between, the following factors determined in each case by applying the factors in the manner set forth in the RBC instructions:
(1) Asset risk;
(2) Credit risk;
(3) Underwriting risk; and
(4) All other business risks and any other relevant risks as set forth in the RBC instructions.
General Authority:
SDCL  58-4-48.
Law Implemented:
SDCL  58-4-48.
2013 NAIC Property and Casualty Risk-Based Capital Report
; National Association of Insurance Commissioners. Copies may be obtained from the NAIC, 1100 Walnut Street, Ste. 1500, Kansas City, MO 64106-2197, (816) 783-8300;
http://www.naic.org
. Cost: $45.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:36 - Risk-based capital (RBC) reports › Section 20:06:36:06 - Adjusted RBC report

Current through Register Vol. 51, page 10, July 15, 2024
If a domestic insurer or domestic health organization files an RBC report which in the judgment of the director is inaccurate, the director shall adjust the RBC report to correct the inaccuracy and shall notify the insurer or health organization of the adjustment. The notice shall contain a statement of the reason for the adjustment. An RBC report so adjusted is referred to as an adjusted RBC report.
General Authority:
SDCL  58-4-48.
Law Implemented:
SDCL  58-4-48.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:36 - Risk-based capital (RBC) reports › Section 20:06:36:07 - Company action level event

Current through Register Vol. 51, page 10, July 15, 2024
A company action level event is any of the following events:
(1) The filing of an RBC report by an insurer or health organization which indicates one of the following:
(a) The insurer's or health organization's total adjusted capital is greater than or equal to its regulatory action level RBC but less than its company action level RBC;
(b) If the insurer is a life or health insurer, the insurer has total adjusted capital which is greater than or equal to its company action level RBC but less than the product of its authorized control level RBC and 3.0 and has a negative trend. A negative trend is determined in accordance with the trend test calculation in the Life RBC instructions;
(c) If the insurer is a property and casualty insurer, the insurer has total adjusted capital which is greater than or equal to its company action level RBC but less than the product of its authorized control level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the property and casualty RBC instructions; or
(d) If a health organization, the health organization has a total adjusted capital which is greater than or equal to its company action level RBC but less than the product of its authorized control level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the health RBC instructions;