reglab/statecodes huggingface dataset:
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:38 - Life insurance illustrations › Section 20:06:38:35 - Generally recognized expense table - Approval

Current through Register Vol. 51, page 10, July 15, 2024
The director may approve any generally recognized expense table based on fully allocated expenses representing a significant portion of insurance companies if the expense table has been approved by the National Association of Insurance Commissioners and the director determines that the expense table provides adequate protection for the insurance buying public of this state.
General Authority:
SDCL  58-33-5.1.
Law Implemented:
SDCL  58-33-5.1.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:38 - Life insurance illustrations › Appendix A - Generally Recognized Expense Table Approved by the Director

Current through Register Vol. 51, page 10, July 15, 2024
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South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:38 - Life insurance illustrations › Appendix B - Sample Acknowledgment

Current through Register Vol. 51, page 10, July 15, 2024
SAMPLE ACKNOWLEDGMENT
I certify that I displayed a computer screen illustration for ______________________ that complies with state requirements and for which no hard copy was furnished. The illustration was based on the following personal and policy information:
1. Gender Male _____ Female _____
2. Age _______________________________
3. Underwriting or rating class _______________________________
4. Type of policy _______________________________
5. Type of rider _______________________________
6. Initial death benefit _______________________________
7. Dividend option election _______________________________
(or application of non-
guaranteed elements, if
applicable)
8. Guaranteed interest rate(s) _______________________________
9. Nonguaranteed interest rate(s) _______________________________
_______________________________
AGENT
DATE:_________________________
I acknowledge that I viewed a computer screen illustration based on the information as stated above. No hard copy of the illustration was furnished. I understand that an illustration conforming to the policy as issued will be provided to me no later than at the time the policy is delivered.
_______________________________
APPLICANT
DATE:_________________________
An illustration conforming to the requirements of the model must be prepared and personally delivered by the agent on or before delivery of the policy.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:01 - Dual eligibility

Current through Register Vol. 51, page 10, July 15, 2024
An individual who is otherwise eligible may not be denied coverage under SDCL 58-17-85 for the reason that the individual is also eligible for a conversion policy or other individual coverage. Individuals eligible for coverage under this section may not be required to provide proof that coverage was denied by another carrier in order to obtain coverage under SDCL 58-17-85.
General Authority:
SDCL  58-17-87(2).
Law Implemented:
SDCL 58-17-85,  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:02 - Creditable coverage and preexisting waiting periods for newborn and adopted children

Current through Register Vol. 51, page 10, July 15, 2024
The requirements of this section apply to any health benefit plan as defined in SDCL subdivision 58-17-66(9).
General Authority:
SDCL  58-17-30.2,  58-17-87(2).
Law Implemented:
SDCL  58-17-30.2,  58-17-84, 58-17-85,  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:03 - Permissible rating factors

Current through Register Vol. 51, page 10, July 15, 2024
A health benefit plan may use health status and weight in determining the rate charged for an individual when issuing a new policy or certificate. The application of rating factors based on health status or weight is limited to a 30 percent deviation from the index rate. Adjustments in the rating factors based on health status or weight may not be made after coverage is issued.
General Authority:
SDCL  58-17-75.
Law Implemented:
SDCL  58-17-74.
Definition of index rate, SDCL  58-17-66.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:04.01 - Certificates required upon loss of coverage (effective January 1, 2014)

Current through Register Vol. 51, page 10, July 15, 2024
A health insurance issuer must provide a certificate of creditable coverage or simply certify that the individual has creditable coverage to any individual losing coverage upon requests by or on behalf of an individual. At any time within 24 months after coverage ceases, a health insurance issuer must also provide additional certificates or certifications upon requests by or on behalf of an individual. Each certificate or certification must be provided in a reasonable and prompt fashion. A separate fee may not be charged for the provision of a certificate or certification, but the cost of this service may be factored into the policy premium.
If a health insurance issuer provides coverage in connection with another type of creditable coverage, the health insurance issuer must provide a certificate or certification as required by this section.
General Authority:
SDCL  58-17-87(2).
Law Implemented:
SDCL  58-11-1, 58-17-85,  58-17-87,  58-33-36.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:05 - Standards for determinations on length of preexisting waiting periods

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL  58-17-87(2).
Law Implemented:
SDCL  58-17-84, 58-17-85,  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:06.01 - Student health plans - Bona fide association plans

Current through Register Vol. 51, page 10, July 15, 2024
A student health plan is an association plan that provides coverage to students of a college or university. A student health plan that is a bona fide association plan under SDCL  58-18B-48 is not required to renew coverage once the covered individual is no longer a student.
General Authority:
SDCL  58-17-87(1),(2),(3),(4).
Law Implemented:
SDCL  58-17-69,  58-17-70,  58-17-82, 58-17-85,  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:07 - Requirements for breaks in coverage when applying for a new policy

Current through Register Vol. 51, page 10, July 15, 2024
The maximum break in coverage of 63 days does not apply to the period of time after an individual applies for an individual policy if coverage is actually issued pursuant to that application.
General Authority:
SDCL  58-17-87(2),(3).
Law Implemented:
SDCL  58-17-84, 58-17-85,  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:08.01 - Active marketing required

Current through Register Vol. 51, page 10, July 15, 2024
No health insurance issuer may employ marketing practices or benefit designs that will have the effect of discouraging applicants from exercising their open enrollment rights under §
									20:06:39:59. No health insurance issuer may, in any manner penalize agents for submitting applications for those qualifying for open enrollment under §
									20:06:39:59. If a health insurance issuer in the individual market offers health insurance coverage in any level of coverage specified under section 1302(d)(1) of PPACA as defined in §
									20:06:55:32, the issuer must offer coverage in that level to individuals who, as of the beginning of a plan year, have not attained the age of 21.
General Authority:
SDCL  58-17-87(6).
Law Implemented:
SDCL  58-17-87(6).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:09 - Prohibited practices

Current through Register Vol. 51, page 10, July 15, 2024
No carrier or agent may, directly or indirectly, engage in the following activities:
(1) Encouraging or directing eligible individuals to refrain from filing an application for coverage with the carrier because of the health status, claims experience, industry, occupation, or geographic location of the individual; or
(2) Encouraging or directing eligible individuals to seek coverage from another carrier because of the health status, claims experience, industry, occupation, or geographic location of the individual.
General Authority:
SDCL  58-17-87(6).
Law Implemented:
SDCL  58-17-87(6).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:10 - Prohibited compensation arrangements

Current through Register Vol. 51, page 10, July 15, 2024
Each carrier must provide reasonable compensation to an insurance producer for the sale of a basic or standard health benefit plan or those plans the carrier has chosen to offer on a guaranteed issue basis in lieu of the basic and standard plans. No carrier may, directly or indirectly, enter into any contract, agreement, or arrangement with an insurance producer which provides for or results in the compensation paid to an insurance producer for the sale of a health benefit plan to be reduced because the insured qualified for coverage pursuant to SDCL 58-17-85. A carrier may pay a commission percentage that does not vary based upon health status. A carrier may reimburse producers for insureds qualified pursuant to SDCL 58-17-85 on a basis that varies the commission percentage or that is based only upon the premium of a lesser rated risk provided that the aggregate compensation received by the producer is not less than would have been paid by the carrier for a similarly situated individual who qualified for a lower rate. No compensation is required if the insurance producer is compensated by the carrier on a noncommission basis for selling its products other than basic or standard plans.
General Authority:
SDCL  58-17-87(8).
Law Implemented:
SDCL  58-17-87(8).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:19 - Guaranteed issue - Effective date of coverage

Current through Register Vol. 51, page 10, July 15, 2024
Upon receipt of an application for any major medical coverage subject to SDCL  58-17-66 to  58-17-87, inclusive, from an individual eligible under SDCL 58-17-85, whether or not the product applied for is on a guaranteed issue basis, the carrier must issue the policy with an effective date corresponding to the date of the application. If an eligible person makes the application prior to the actual date of termination of existing creditable coverage, the carrier may issue the coverage with an effective date coinciding with the termination date of the creditable coverage.
General Authority:
SDCL 58-17-85,  58-17-87(14).
Law Implemented:
SDCL 58-17-85,  58-17-87(14).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:20 - Guaranteed issue - Tolling of 63-day time frame

Current through Register Vol. 51, page 10, July 15, 2024
Any substantially completed application, whether an underwritten application or one specifically designed for guaranteed issue products, will toll the 63-day time frame for persons eligible pursuant to SDCL 58-17-85 not only for the carrier to which the application was submitted but also for any subsequent carriers from which the individual is seeking coverage.
General Authority:
SDCL  58-17-87(2)(14).
Law Implemented:
SDCL 58-17-85,  58-17-87(2)(14).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:20.05 - Effective date of guaranteed issue plan

Current through Register Vol. 51, page 10, July 15, 2024
Any eligible applicant that makes timely application pursuant to SDCL 58-17-85 and §§
									20:06:39:19  to 20:06:39:20.04, inclusive, must be issued coverage with an effective date consistent with the original application regardless of which carrier the application was made with or which type of benefit plan was applied for. If the original application was made prior to the date of loss of prior creditable coverage, the effective date of the guaranteed issue plan shall coincide with the date of loss of creditable coverage. For those making an initial timely application during the 63-day timeframe following loss of creditable coverage a guaranteed issue plan must be issued with an effective date that coincides with the date of the initial application. For those making application during the 63-day timeframe following loss of creditable coverage where an initial application is rejected and where a subsequent application is made within the 63-day timeframe, but more than 30 days following the rejection of the initial application, the date of the subsequent application is the effective date of the guaranteed issue plan. If the carrier and the applicant wish to make the plan's effective date other than what is required by this section, then any mutually agreeable effective date may be used.
General Authority:
SDCL 58-17-85,  58-17-87(2).
Law Implemented:
SDCL 58-17-85.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:21 - Definition of ordinarily prudent person in preexisting condition clauses

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL  58-17-87(3)(4)(11)(15).
Law Implemented:
SDCL  58-17-84,  58-17-97.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:22 - Fair market standards for carriers

Current through Register Vol. 51, page 10, July 15, 2024
A carrier may not terminate, fail to renew, or limit its contract or agreement of representation with an agent for any reason related to the health status, claims experience, occupation, or geographic location of the individuals placed or sought to be placed by the agent with the carrier.
General Authority:
SDCL  58-17-87(6)(8).
Law Implemented:
SDCL  58-17-87(6)(8).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:23 - Group applicability to individual market

Current through Register Vol. 51, page 10, July 15, 2024
The provisions of §§
									20:06:40:17  to 20:06:40:17.02, inclusive, apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to a health insurance issuer in connection with a group health plan in small or large groups.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:30 - Usual, customary, and reasonable charges for standard and basic plans

Current through Register Vol. 51, page 10, July 15, 2024
For any claim for which the usual, customary, and reasonable policy or contract provision is used, the eligible benefits must be paid at no less than the eightieth percentile of the usual, customary, and reasonable amount for the standard and basic plans. Benefits obtained from network providers may not use the usual, customary and reasonable provisions.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL 58-17-85.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:32 - Contract of more than six months - Defined

Current through Register Vol. 51, page 10, July 15, 2024
The phrase, contract of more than six months duration, means any contract that provides for renewal by the insured for a period beyond six months after the inception date. The phrase does not include short-term major medical plan that is nonrenewable.
General Authority:
SDCL  58-17-87(4).
Law Implemented:
SDCL  58-17-66(9).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:34.01 - Disclosure requirements

Current through Register Vol. 51, page 10, July 15, 2024
Any policy or certificate of specified disease, short-term hospital-surgical care of six months or less duration but not including short-term major medical, hospital confinement indemnity, limited benefit health insurance, or other policy or certificate that provides less benefits than essential health benefits must clearly and prominently disclose that the policy is a limited benefit health insurance plan. The following is an example of a disclosure for limited benefit coverages that is in compliance provided it is prominent and otherwise meets the requirements of this section:
This limited health benefits plan does not provide comprehensive medical coverage. It is a basic or limited benefits policy and is not intended to cover all medical expenses. This plan is not designed to cover the costs of serious or chronic illness.
For short-term major medical policies clear and prominent disclosure of the preexisting condition limitation and the short-term duration of the product must be made. The following notice is an example of a short-term major medical disclosure that is in compliance provided it is prominent and otherwise meets the requirements of this section:
This policy is a short-term medical insurance policy/certificate which provides coverage for less than 12 months and excludes coverage for preexisting conditions. Short-term major medical plans do not satisfy the requirement for individuals to have insurance under the Patient Protection and Affordable Care Act and individuals who have purchased short-term major medical coverage may be subject to federal penalties for not having minimum essential coverage.
The disclosures required by this section must be contained on the first page of the policy. The requirements of this section also apply to outlines of coverage. Nothing in this section applies to Medicare supplement, long-term care, disability or credit health insurance coverages.
General Authority:
SDCL  58-17-87(6),  58-33A-7(13).
Law Implemented:
SDCL  58-17-70,  58-33A-2(1),(3),(4),(6), and (10).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:34.02 - Renewability of short term major medical plans

Current through Register Vol. 51, page 10, July 15, 2024
For short term major medical plans defined under §58-17-66(14), the policy has an expiration date specified in the contract that is less than 12 months after the original effective date of the contract and, taking into account renewals or extensions, has a duration of no longer than 36 months in total.
General Authority:
SDCL  58-17-87(4).
Law Implemented:
SDCL  58-17-66(9).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:35 - Policy not subject to group requirements

Current through Register Vol. 51, page 10, July 15, 2024
If a carrier upon application for an individual health benefit plan takes reasonable steps to ensure that premiums are not paid by an employer, then a carrier, upon becoming aware of a premium payment by an employer for an individual health benefit plan, must request substitute payment from the individual insured which is not paid by an employer
A carrier which fails to either take reasonable steps to ensure premiums are not paid by an employer during the application process or fails to request substitute payment from the individual insured which is not paid by an employer must treat the policy or policies as group contracts if a payment is received from an employer unless the employer has only one employee.
General Authority:
SDCL  58-17-70,  58-18B-2.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:36 - Medically necessary leave of absence defined

Current through Register Vol. 51, page 10, July 15, 2024
For purposes of §§
									20:06:39:37  to 20:06:39:39, inclusive, the phrase medically necessary leave of absence means a leave of absence from an accredited institution of higher learning or any other change in enrollment at such an institution that
(1) Commences while a qualifying child is suffering from a serious illness or injury;
(2) Is medically necessary; and
(3) Causes the qualifying child to lose student status for purposes of coverage under the terms of the plan.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:37 - Dependent coverage

Current through Register Vol. 51, page 10, July 15, 2024
Any health insurance issuer issuing a health benefit plan that provides dependent coverage for any qualifying child may not terminate coverage due to a medically necessary leave of absence for a period of twelve months after the first day of leave or the date on which such coverage would otherwise terminate under the terms of the plan, whichever is earlier. A qualifying child whose benefits are continued under this section is entitled to the same benefits as if the qualifying child continued to be a covered student and was not on a medically necessary leave of absence.
The health benefit plan must receive written certification of the medically necessary leave of absence by a treating physician of the qualifying child that states that the child is suffering from a serious illness or injury and that the leave of absence or other change of enrollment is medically necessary.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:38 - Notification

Current through Register Vol. 51, page 10, July 15, 2024
Any health insurance carrier providing health insurance coverage, shall include, with any notice regarding a requirement for certification of student status for coverage under the plan, a description of the terms of §
									20:06:39:37  for continued coverage during any medically necessary leave of absence. Such description shall be in language that is understandable to the typical plan participant.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:39 - Continued application in case of changed coverage

Current through Register Vol. 51, page 10, July 15, 2024
The provisions of §§
									20:06:39:37  and 20:06:39:38  apply if there is a change in coverage for the dependent child and if the following occur:
(1) Dependent child of a participant or beneficiary is in a period of coverage under a health benefit plan offered in connection with such a plan, pursuant to a medically necessary leave of absence of the child;
(2) The manner in which the participant or beneficiary is covered under the plan changes, whether through a change in health insurance coverage or health insurance issuer, a change between health insurance coverage and self-insured coverage, or otherwise; and
(3) The coverage as so changed continues to provide coverage of beneficiaries as dependent children.
This section applies to coverage of the child under the changed coverage for the remainder of the period of the medically necessary leave of absence of the dependent child under the plan in the same manner as it would have applied if the changed coverage had been the previous coverage.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:40 - Effective date

Current through Register Vol. 51, page 10, July 15, 2024
Sections 20:06:39:36 to 20:06:39:39, inclusive, apply to plan years beginning after December 31, 2009.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:41 - Creditable coverage - Children's Health Insurance Program

Current through Register Vol. 51, page 10, July 15, 2024
Coverage provided pursuant to a state's Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act is creditable coverage.
General Authority:
SDCL  58-17-87(13).
Law Implemented:
SDCL  58-17-69, 58-17-85,  58-18-44.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:42 - Association health insurance plans subject to individual market rating requirements

Current through Register Vol. 51, page 10, July 15, 2024
A health insurance issuer issuing health policies or certificates to an association must file its premium rates in accordance with the requirements of SDCL  58-17-4.1 to  58-17-4.3, inclusive, and chapter 20:06:22. The requirements of this section apply to rates for any newly approved policies or certificates to be offered in this state and to any increase in premium rates for previously issued certificates that take effect after June 30, 2010. This section does not apply to any association plan exclusively issued to employers as members of an association, to any association plan that is an excepted benefit as defined by SDCL  58-17-69(13), or to any association plan which provides blanket health insurance.
Student health plans must comply with the applicable requirements of this chapter for policy years beginning after December 31, 2013. For purposes of student plans, policy year is not dependent upon the effective date of coverage of individual students or dependents.
General Authority:
SDCL  58-17-87(5).
Law Implemented:
SDCL  58-17-4.1,  58-17-4.2,  58-17-4.3.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:43 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Unless otherwise provided, the following terms are defined for purposes of §§ 20:06:39:43  to 20:06:39:56, inclusive:
(1) "Collect," with respect to information, to request, require, or purchase such information;
(2) "Family member," with respect to an individual, a dependent of the individual or any other person who is a first-degree, second-degree, third-degree, or fourth-degree relative of the individual or of a dependent of the individual. Relatives by affinity such as by marriage or adoption are treated the same as relatives by consanguinity that is, relatives who share a common biological ancestor. In determining the degree of the relationship, relatives by less than full consanguinity such as half-siblings, who share only one parent are treated the same as relatives by full consanguinity such as siblings who share both parents;
(3) "First-degree relatives," parents, spouses, siblings, and children;
(4) "Fourth-degree relatives," great-great grandparents, great-great grandchildren, and children of first cousins;
(5) "Genetic information:"
(a) The individual's genetic tests;
(b) The genetic tests of family members of the individual;
(c) The manifestation of a disease or disorder in family members of the individual; or
(d) Any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by the individual or any family member of the individual.
With respect to a pregnant woman or a family member of the pregnant woman, the term includes genetic information of any fetus carried by the pregnant woman. With respect to an individual or a family member of the individual who is utilizing an assisted reproductive technology, the term includes genetic information of any embryo legally held by the individual or family member. However, the term does not include information about sex or age of any individual;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:44 - Prohibition on genetic information in setting premium rates

Current through Register Vol. 51, page 10, July 15, 2024
An issuer offering health insurance coverage in the individual market may not adjust premium amounts for an individual on the basis of genetic information regarding the individual or a family member of the individual.
Nothing in this section precludes an issuer from adjusting premium amounts for an individual on the basis of a manifestation of a disease or disorder in that individual, or on the basis of a manifestation of a disease or disorder in a family member of that individual if the family member is covered under the policy that covers the individual.
However, the manifestation of a disease or disorder in one individual may not also be used as genetic information about other individuals covered under the policy issued to that individual or used to further increase premium amounts.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-11-1,  58-17-4.2, 48-17-74.1,  58-17-87,  58-33-13.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:45 - Limitation on requesting or requiring genetic testing

Current through Register Vol. 51, page 10, July 15, 2024
Except as otherwise provided, an issuer offering health insurance coverage in the individual market may not request or require an individual or a family member of the individual to undergo a genetic test.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:46 - Exceptions to requiring genetic testing

Current through Register Vol. 51, page 10, July 15, 2024
Nothing in §
									20:06:39:45  limits the authority of a health care professional who is providing health care services to an individual to request that the individual undergo a genetic test.
Nothing in §
									20:06:39:45  precludes an issuer offering health insurance in the individual market from obtaining and using the results of a genetic test in making a determination regarding payment. Therefore, if an issuer conditions payment for an item or service based on its medical appropriateness and the medical appropriateness of the item or service depends on a covered individual's genetic makeup, the issuer is permitted to condition payment on the outcome of a genetic test and may refuse payment if the covered individual does not undergo the genetic test. An issuer in the individual market may only request the minimum amount of information necessary to make a determination regarding payment. The minimum amount of information necessary is determined in accordance with the minimum necessary standard in 45 CFR 164.502(b) of the privacy regulations issued under the Health Insurance Portability and Accountability Act.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:47 - Research exception

Current through Register Vol. 51, page 10, July 15, 2024
An issuer may request, but not require, that an individual or family member covered under the same policy undergo a genetic test if all of the following conditions are met:
(1) The issuer makes the request pursuant to research, as defined in 45 CFR 46.102(d), that complies with 45 CFR Part 46 or equivalent federal regulations, and any applicable state or local law or regulations for the protection of human subjects in research; and
(2) The issuer makes the request in writing, and the request clearly indicates to each individual or, in the case of a minor child, to the legal guardian of the child that:
(a) Compliance with the request is voluntary; and
(b) Noncompliance will have no effect on eligibility for benefits or premium amounts. The issuer must complete a copy of the Notice of Research Exception form found in Appendix B and submit the form to the federal Secretary of Health and Human Services. No genetic information collected or acquired under this section may be used for underwriting purposes.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:48 - Prohibitions on collection of genetic information for underwriting purposes

Current through Register Vol. 51, page 10, July 15, 2024
An issuer offering health insurance coverage in the individual market may not collect genetic information for underwriting purposes.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:49 - Medical appropriateness

Current through Register Vol. 51, page 10, July 15, 2024
An issuer in the individual market may limit or exclude a benefit based on whether the benefit is medically appropriate. The determination of whether the benefit is medically appropriate is not within the meaning of underwriting purposes. Therefore, if an issuer conditions a benefit based on its medical appropriateness and the medical appropriateness of the benefit depends on a covered individual's genetic information, the issuer may condition the benefit on the genetic information. An issuer may only request the minimum amount of genetic information necessary to determine medical appropriateness and may deny the benefit if the covered individual does not provide the genetic information required to determine medical appropriateness.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:50 - Collection of genetic information prior to or in connection with enrollment

Current through Register Vol. 51, page 10, July 15, 2024
An issuer offering health insurance coverage in the individual market may not collect genetic information with respect to any individual prior to the individual's enrollment under the coverage or in connection with that individual's enrollment. Whether or not an individual's information is collected prior to that individual's effective date of coverage is determined based upon the time of collection.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:51 - Incidental collection exception

Current through Register Vol. 51, page 10, July 15, 2024
If an issuer offering health insurance coverage in the individual market obtains genetic information incidental to the collection of other information concerning any individual, the collection is not a violation of §
									20:06:39:50, as long as the collection is not for underwriting purposes in violation of §§
									20:06:39:48  and 20:06:39:49. The incidental collection exception in this section does not apply to any collection where it is reasonable to anticipate that health information will be received, unless the issuer explicitly provides that genetic information should not be provided to the issuer.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:52 - Prohibition on genetic information as a condition of eligibility

Current through Register Vol. 51, page 10, July 15, 2024
An issuer offering health insurance coverage in the individual market may not establish rules for the eligibility, including continued eligibility, of any individual to enroll in individual health insurance coverage based on genetic information.
Nothing in this section precludes an issuer from establishing rules for eligibility for an individual to enroll in individual health insurance coverage based on the manifestation of a disease or disorder in that individual, or in a family member of that individual when the family member is covered under the policy that covers the individual.
General Authority:
SDCL  58-17-87,  58-17-87(2).
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:53 - Prohibition on genetic information as preexisting condition

Current through Register Vol. 51, page 10, July 15, 2024
An issuer offering health insurance coverage in the individual market may not, on the basis of genetic information, impose any preexisting condition exclusion with respect to that coverage.
Nothing in this section precludes an issuer from imposing any preexisting condition exclusion for an individual with respect to health insurance coverage on the basis of a manifestation of a disease or disorder in that individual.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-84(4),  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:54 - Medicare supplemental health insurance

Current through Register Vol. 51, page 10, July 15, 2024
The requirements of §§
									20:06:39:43  to 20:06:39:56, inclusive, do not apply to Medicare supplemental health insurance policies. However, Medicare supplemental health insurance policies are subject to §§
									20:06:13:87  to 20:06:13:92, inclusive.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:55 - Applicability to excepted benefits

Current through Register Vol. 51, page 10, July 15, 2024
Sections 20:06:39:43 to 20:06:39:54, inclusive, do not apply to excepted benefits as defined by 42 USC 300gg- 91(c), as of August 1, 2010.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:56 - Effective date

Current through Register Vol. 51, page 10, July 15, 2024
Sections 20:06:39:43 to 20:06:39:54 apply for plan years beginning on or after the effective date of those sections.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:57 - Guaranteed availability of coverage in the individual market

Current through Register Vol. 51, page 10, July 15, 2024
After December 31, 2013, a health insurance issuer that offers health insurance coverage in the individual market in this state must offer to any individual in the state all products that are approved for sale in the applicable market, and must accept any individual that applies for any of those products. Nothing in this section requires an issuer to offer or provide coverage outside its approved service area.
A health insurance issuer offering health insurance coverage in the individual market, other than excepted benefits, must ensure that such coverage includes the essential health benefits package as defined in §
									20:06:56:03  effective for plan or policy years beginning after December 31, 2013. Except for catastrophic plans, any plans not providing at least a bronze level of coverage or not providing essential health benefits as defined in §
									20:06:56:03  must be issued as a supplement to other health insurance coverage and may not be used to replace essential health benefits coverage, a grandfathered health benefit plan or a catastrophic plan.
An issuer may but is not required to confirm residence of any applicant or insured to confirm eligibility. Nothing requires an issuer to exclude nonresidents or international students or their dependents from coverage on a student health plan.
Nothing in this section applies to long-term care, medicare supplement, short-term major medical, accident only, stand-alone dental, TRICARE, disability income, or other policies providing coverage based upon a disability trigger.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:58 - Denial of coverage

Current through Register Vol. 51, page 10, July 15, 2024
After December 31, 2013, a health insurance issuer may deny health insurance coverage in the individual market outside the Exchange if the issuer has demonstrated to the director the following:
(1) The health insurance issuer does not have the financial reserves necessary to underwrite additional coverage;
(2) The health insurance issuer is applying the denial uniformly to all individuals in the individual market without regard to the claims experience of those individuals, and their dependents or any health status-related factor relating to such individuals, and dependents.
An issuer that denies coverage to any individual may not offer coverage in the individual market before the later of the following dates: the 181st day after the date the issuer denies coverage or the date the issuer demonstrates to the director that the issuer has sufficient financial reserves to underwrite additional coverage.
Nothing in this section limits an issuer's ability to renew coverage already in force or relieve the issuer of the responsibility to renew that coverage. Coverage offered after the 180-day period specified in this section is subject to the requirements of this section and §
										20:06:55:42. The ability to offer or renew coverage as specified by this section and §
										20:06:55:42  is subject to all applicable service area requirements and restrictions.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:59 - Open enrollment

Current through Register Vol. 51, page 10, July 15, 2024
After December 31, 2013, a health insurance issuer must provide an initial open enrollment period and annual open enrollment periods outside the individual Exchange, during which qualified individuals may enroll in a non-grandfathered plan or enrollees may change plans. Except as provided by §
									20:06:39:63, a health insurance issuer may restrict enrollment to a qualified individual or an enrollee to change plans during the initial open enrollment period, the annual open enrollment period, or a special enrollment period for which the qualified individual or enrollee has been determined eligible.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:60 - Initial open enrollment period

Current through Register Vol. 51, page 10, July 15, 2024
The initial open enrollment period in the individual market outside the individual market Exchange begins October 1, 2013, and extends through March 31, 2014. The effective coverage dates for the initial open enrollment period are as follows:
(1) For a person enrolling on or before December 15, 2013, the issuer must make the coverage effective on January 1, 2014;
(2) For a person enrolling between the first and fifteenth day of January 1, 2014, to March 15, 2014, the issuer must make coverage effective on the first day of the following month; and
(3) For a person enrolling between the sixteenth and last day of the month for any month between December 2013 and March 31, 2014, the issuer must make coverage effective on the first day of the second following month.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:61 - Annual open enrollment period

Current through Register Vol. 51, page 10, July 15, 2024
Health insurance issuers must provide an annual open enrollment period for the individual market.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:39 - Individual plans › Section 20:06:39:62 - Special enrollment period effective dates

Current through Register Vol. 51, page 10, July 15, 2024
After December 31, 2013, a health insurance issuer must provide special enrollment periods consistent with this section outside the Exchange, during which qualified individuals and enrollees may enroll in nongrandfathered health plans or change enrollment from one plan to another. Once a qualified individual is determined eligible for a special enrollment period, the health insurance issuer must ensure that the qualified individual's effective date of coverage is:
(1) Between the first and the fifteenth day of any month, the plan must ensure a coverage effective date of the first day of the following month;
(2) Between the sixteenth and the last day of any month, the plan must ensure a coverage effective date of the first day of the second following month;
(3) In the case of birth, adoption or placement for adoption, the plan must ensure that coverage is effective on the date of birth, adoption, or placement for adoption; and
(4) In the case of marriage, or in the case where a qualified individual loses minimum essential coverage, the plan must ensure coverage is effective on the first day of the following month.
Unless specifically stated otherwise herein, a qualified individual or enrollee has 60 days from the date of a triggering event to select a nongrandfathered health plan.
General Authority:
SDCL  58-17-87.
Law Implemented:
SDCL  58-17-87.