reglab/statecodes huggingface dataset:
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:22 - Loss ratios for health insurance policies › Section 20:06:22:34 - Permitted plan-level adjustments to the index rate

Current through Register Vol. 51, page 10, July 15, 2024
For each plan year or policy years beginning after December 31, 2013, a health insurance issuer may vary premium rates for a particular plan from its index rate for a relevant market in this state based only on the following actuarially justified plan specific factors:
(1) The actuarial value and costsharing design of the plan;
(2) The plan's provider network, delivery system characteristics, and utilization management practices;
(3) The benefits provided under the plan that are in addition to the essential health benefits. These additional benefits must be pooled with similar benefits within the single risk pool and the claims experience from those benefits must be utilized to determine rate variations for plans that offer those benefits in addition to essential health benefits;
(4) Administrative costs, excluding Exchange user fees; and
(5) With respect to catastrophic plans, the expected impact of the specific eligibility categories for those plans.
General Authority:
SDCL  58-17-4.2,  58-17-87,  58-18B-18,  58-18B-36.
Law Implemented:
58-17-74.1. 58-17-87, 58-18B-18, 58-18B-36.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:22 - Loss ratios for health insurance policies › Section 20:06:22:35 - Frequency of index rate and plan-level adjustments

Current through Register Vol. 51, page 10, July 15, 2024
A health insurance issuer may not establish an index rate and make the market-wide adjustments pursuant to 20:06:22:33, or make the plan-level adjustments pursuant to 20:06:22:33, more or less frequently than annually, except as provided in f this section.
A health insurance issuer in the small group market may establish index rates and make the marketwide adjustments pursuant to 20:06:22:33, and make the plan-level adjustments pursuant to 20:06:22:33, no more frequently than quarterly. Any changes to rates must have effective dates of January 1, April 1, July 1, or October 1. Such rates may only apply to coverage issued or renewed on or after the rate effective date and will apply for the entire plan year of the group health plan.
General Authority:
SDCL  58-17-4.2,  58-17-87,  58-18B-18,  58-18B-36.
Law Implemented:
SDCL  58-17-74.1,  58-17-87,  58-18B-18,  58-18B-36.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:22 - Loss ratios for health insurance policies › Section 20:06:22:36 - Applicability

Current through Register Vol. 51, page 10, July 15, 2024
The provisions of §§
									20:06:22:27  to 20:06:22:35, inclusive, apply for plan years beginning after December 31, 2013, in the small group market and for policy years beginning after December 31, 2013, for the individual market. The provisions of §§
									20:06:22:27  to 20:06:22:35, inclusive, do not apply to grandfathered health plans.
Effective January 1, 2014, the provisions of §§
									20:06:22:27  to 20:06:22:34, inclusive, apply to any individual plan, group, or small employer plan other than excepted benefits as defined in §
									20:06:55:27  and grandfathered plans.
General Authority:
SDCL  58-17-4.2,  58-17-87,  58-18B-18,  58-18B-36.
Law Implemented:
SDCL  58-17-74.1,  58-17-87,  58-18B-18,  58-18B-36.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:23 - Financial condition of insurers › Section 20:06:23:01 - Increase in capital and surplus

Current through Register Vol. 51, page 10, July 15, 2024
The division may require an insurer to increase its capital and surplus based on the type of risk it is writing, the amount of risk it is writing, a change in its investment portfolio, change in the lines the company is writing, unusual ratios produced by the National Association of Insurance Commissioners Insurance Regulatory Information System, or any other factor which indicates it is necessary for the protection of policyholders. The increase may be based on industry-accepted practices and standards.
General Authority:
SDCL  58-4-1,  58-4-39.
Law Implemented:
SDCL  58-4-39.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:23 - Financial condition of insurers › Section 20:06:23:03 - Criteria for dividends

Current through Register Vol. 51, page 10, July 15, 2024
In determining whether any dividend should be paid, disallowed, or limited by an insurer, the director may consider the following:
(1) If the insurer is in a hazardous financial condition under §
									20:06:23:02;
(2) If the insurer would become impaired, financially distressed or troubled, or insolvent after the payment;
(3) If the insurer could not meet its obligations;
(4) If the insurer cannot meet the requirements of SDCL  58-5A-34;
(5) If the insurer's surplus as regards policyholders is not reasonable in relation to the company's outstanding liabilities and adequate to its financial needs; or
(6) If the dividends paid are reasonable based on the adequacy of the level of surplus remaining after the dividend payment or the quality of the company's earnings and the extent to which the reported earnings include extraordinary items, such as surplus relief reinsurance transactions and reserve destrengthening.
General Authority:
SDCL  58-5A-70.
Law Implemented:
SDCL  58-5A-70.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:23 - Financial condition of insurers › Section 20:06:23:04 - Criteria for targeted exams

Current through Register Vol. 51, page 10, July 15, 2024
In targeting a company for an examination not within the five-year examination schedule, the division may use any one of the following criteria in making that determination:
(1) The company meets any of the hazardous financial condition criteria in §
									20:06:23:02;
(2) The company fails to complete the annual or quarterly statement correctly;
(3) The company is in violation of any section of Title 58;
(4) The nature and number of consumer complaints; or
(5) Another state requests or invites participation in a targeted examination.
General Authority:
SDCL  58-3-26.
Law Implemented:
SDCL  58-3-1,  58-3-26.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:23 - Financial condition of insurers › Section 20:06:23:05 - Farm mutual annual statement information

Current through Register Vol. 51, page 10, July 15, 2024
A farm mutual shall file the annual statement adopted by the division on December 31, 1989, and shall report all information required by the annual statement unless waived by the division. The farm mutual shall report the unearned premium reserve calculation, but the division may not consider the calculation for deciding the provisions of SDCL chapter 58-29 B until the filing of the 1993 annual statement.
General Authority:
SDCL  58-35-59.
Law Implemented:
SDCL  58-35-59.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:25 - Annual financial filing requirements › Section 20:06:25:01 - Annual statements

Current through Register Vol. 51, page 10, July 15, 2024
The insurer's annual statement must be filed in accordance with the standards adopted by the National Association of Insurance Commissioners in the 2023 edition of the
Accounting Practices and Procedures Manual
, and the 2022 editions of the following
Annual Statement Instructions
manuals:
Life, Accident, and Health
;
Property and Casualty
;
Health
; and
Title
.
General Authority:
SDCL  58-6-75.
Law Implemented:
SDCL  58-6-75.
The amended version of this section by 50 SDR 157, effective 7/1/2024 is not yet available.
1.
Annual Statement Instructions - Life, Accident, and Health
, 2022 edition. Cost: $174.
2.
Annual Statement Instructions - Property and Casualty
, 2022 edition. Cost: $174.
3.
Annual Statement Instructions - Health
, 2022 edition. Cost: $174.
4.
Annual Statement Instructions - Title
, 2022 edition. Cost: $174.
5.
Accounting Practices and Procedures Manual
, 2023. Cost: $550.
Copies of references 1 through 5 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 20:06:25 - Annual financial filing requirements › Section 20:06:25:01.01 - Accounting methods for certain surety bonds

Current through Register Vol. 51, page 10, July 15, 2024
Insurers writing surety bonds guaranteeing to lending institutions the repayment of student loans made by lending institutions may, in lieu of compliance with SSAP60 of the
Accounting Practices and Procedures Manual
, develop premium earning patterns that are representative of their claims and expense patterns by loan and program, and compute unearned premium reserves according to those premium earning patterns. In lieu of compliance with SSAP3 of the
Accounting Practices and Procedures Manual
, changes in accounting estimates, for this method of accounting only, may be amortized over the remaining life of the student loans utilizing pro-rated current premium earning patterns. In lieu of compliance with SSAP53 of the
Accounting Practices and Procedures Manual,
such insurers may recognize written premiums when due.
General Authority:
SDCL  58-6-75.
Law Implemented:
SDCL  58-6-75.
The amended version of this section by 50 SDR 157, effective 7/1/2024 is not yet available.
Accounting Practices and Procedures Manual
, 2023 edition. Copies 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
. Cost: $550.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:25 - Annual financial filing requirements › Section 20:06:25:01.02 - Accounting methods for bail bonds

Current through Register Vol. 51, page 10, July 15, 2024
Insurers writing bail bonds may, in lieu of compliance with SSAP 53 of the
Accounting Practices and Procedures Manual
, report bail bond written premiums less agent commissions and may recognize total premiums as earned on the effective date of the bonds. Insurers reporting premiums on this method must file a supplemental Schedule T with their annual statement setting forth the gross premiums by state for premium tax purposes.
General Authority:
SDCL  58-6-75.
Law Implemented:
SDCL  58-6-75.
The amended version of this section by 50 SDR 157, effective 7/1/2024 is not yet available.
Accounting Practices and Procedures Manual
, 2023 edition. Copies 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
. Cost: $550.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:25 - Annual financial filing requirements › Section 20:06:25:02 - Actuarial opinions

Current through Register Vol. 51, page 10, July 15, 2024
Actuarial opinions must be filed in accordance with standards adopted by the National Association of Insurance Commissioners in the manuals on
Annual Statement Instructions - Life, Accident, and Health
, 2022 edition and
Annual Statement Instructions - Property and Casualty
, 2022 edition.
General Authority:
SDCL  58-26-13.1,  58-26-46.
Law Implemented:
SDCL  58-26-13.1,  58-26-46.
The amended version of this section by 50 SDR 157, effective 7/1/2024 is not yet available.
1.
Annual Statement Instructions - Life, Accident, and Health
, 2022 edition. Cost: $174.
2.
Annual Statement Instructions - Property and Casualty
, 2022 edition. Cost: $174.
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 20:06:26 - Rating and valuation of investments › Section 20:06:26:01 - Standards for rating and valuation of investments

Current through Register Vol. 51, page 10, July 15, 2024
The standards of the division for purposes of rating and valuing investments are the standards set forth in the
Purposes and Procedures Manual of the NAIC Investment Analysis Office
, 2022 edition.
General Authority:
SDCL  58-27-108.
Law Implemented:
SDCL  58-27-108.
The amended version of this section by 50 SDR 157, effective 7/1/2024 is not yet available.
Purposes and Procedures Manual of the NAIC Investment Analysis Office
, 2022 edition, 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: $0.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:27 - Standardized health care forms › Section 20:06:27:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this section mean:
(1) "ASC Z12N standard format," the standards for electronic data interchange within the health care industry developed by the Accredited Standards Committee Z12N Insurance Subcommittee of the American National Standards Institute;
(2) "CDT-2 codes," the current dental terminology prescribed by the American Dental Association;
(3) "CPT-4 codes," codes for medical services and procedures performed by medical providers as listed in Physicians Current Procedural Terminology, (CPT '95) Fourth Edition, published by the American Medical Association;
(4) "HCFA," the Health Care Financing Administration of the U.S. Department of Health and Human Services;
(5) "HCFA Form 1450," the health insurance claim form maintained by HCFA for use by institutional care practitioners;
(6) "HCFA Form 1500," the health insurance claim form maintained by HCFA for use by health care practitioners;
(7) "HCPCS," HCFA's common procedure coding system which describes products, supplies, procedures, and health professional services;
(8) "HCPCS Level 1 Codes," the AMA's CPT-4 codes and modifiers for professional services and procedures;
(9) "HCPCS Level 2 Codes," alphanumeric codes and modifiers for health care products and supplies, as well as some codes for professional services not included in the AMA's CPT-4;
(10) "HCPCS Level 3 Codes," local alphanumeric codes and modifiers for items and services not included in the HCPCS Level 1 or HCPCS Level 2;
(11) "Health care practitioner," a provider of health care as follows:
(a) A chiropractor licensed under SDCL chapter 36-5;
(b) A corporation or partnership of health care practitioners listed in this subdivision;
(c) A dentist licensed under SDCL chapter 36-6 A;
(d) A nurse licensed under SDCL chapter 36-9 or 36-9 A;
(e) An optometrist licensed under SDCL chapter 36-7;
(f) A physician licensed under SDCL chapter 36-4;
(g) A podiatrist licensed under SDCL chapter 36-8;
(h) A psychologist licensed under SDCL chapter 36-27 A;
(i) A speech, physical, respiratory, or occupational therapist licensed under SDCL chapter 36-10 or 36-31;
(j) A medical assistant licensed under SDCL chapter 36-9 B;
(k) A physician assistant licensed under SDCL chapter 36-4 A; or
(l) An emergency medical technician licensed under SDCL chapter 36-4 B;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:27 - Standardized health care forms › Section 20:06:27:02 - Scope

Current through Register Vol. 51, page 10, July 15, 2024
Except as otherwise specifically provided, the requirements of this chapter apply to issuers, health care providers, and institutional care practitioners. Nothing in this chapter prevents an issuer from requesting additional information that is not contained on the required forms to determine eligibility of the claim for payment if required under the terms of the policy, certificate, program, or plan the claimant is covered under. Nothing in this chapter prohibits an issuer, health care practitioner, or institutional care practitioner from using alternative forms or procedures for filing claims as specified in a written contract between the health care practitioner or institutional care practitioner and issuer. Nothing in this chapter applies to disability insurance.
General Authority:
SDCL  58-12-14.
Law Implemented:
SDCL  58-12-12.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:27 - Standardized health care forms › Section 20:06:27:03 - Requirements for use of HCFA Form 1500

Current through Register Vol. 51, page 10, July 15, 2024
The HCFA Form 1500 shall be used as follows:
(1) Health care practitioners, other than dentists, shall use the HCFA Form 1500, adopted by HCFA, approved by AMA Council on Medical Service in August, 1988, and in effect in May of 1995, when filing claims for professional services with issuers. Health care practitioners that bill patients directly shall provide a completed HCFA Form 1500 in addition to any other explanatory information used to bill the patient if requested by the patient. Issuers may only require health care practitioners to use the following coding systems for the initial filing of claims for health care services:
(a) HCPCS Level 1, Level 2, and Level 3 codes in effect as of June 30, 1995; and
(b) ICD-9-CM codes in effect as of June 30, 1995;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:27 - Standardized health care forms › Section 20:06:27:04 - Requirements for use of HCFA Form 1450

Current through Register Vol. 51, page 10, July 15, 2024
The HCFA Form 1450 shall be used as follows:
(1) Institutional care practitioners shall use the HCFA Form UB-92 HCFA-1450, adopted by HCFA and in effect as of June 30, 1995, when filing claims for health care services with issuers. When requested by the patient, institutional care providers that bill patients directly shall provide a completed HCFA Form 1450 in addition to any other explanation or information used to bill the patient;
(2) Issuers may require institutional care practitioners to use only the following coding system for the initial filing of claims for health care services:
(a) ICD-9-CM codes, in effect as of June 30, 1995;
(b) Revenue codes, in effect as of June 30, 1995;
(c) HCPCS Level 1, Level 2, and Level 3 codes, in effect as of June 30, 1995; and
(d) The information outlined in subdivision 20:06:27:03(3), if the charges include direct service furnished by a health care practitioner and the direct service is not covered by the instructions for the HCFA Form 1450;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:27 - Standardized health care forms › Section 20:06:27:05 - Requirements for use of J512 Form

Current through Register Vol. 51, page 10, July 15, 2024
The J512 Form shall be used as follows:
(1) Dentists shall use the Dental Claim Form, J512, adopted by the American Dental Association as of 1994, according to instructions contained in the American Dental Association's Current Dental Terminology CDT-2, 1995-2000, for filing claims with issuers for professional dental services. When requested by the patient, dentists that bill patients directly shall provide the patient with a completed J512 Form in addition to any other form used to bill the patient;
(2) Issuers may not require a dentist to use any code other than the CDT-2 codes for the initial filing of claims for dental care services, unless the use of supplemental codes is defined and permitted in a written contract between the issuer and dentist;
(3) Dentists performing procedures within their scope of practice which do not have assigned CDT-2 codes may use the HCFA 1500 Form with the applicable CPT-4 codes. Issuers must accept the J512 Form or, as applicable, the HCFA 1500 Form.
General Authority:
SDCL  58-12-14.
Law Implemented:
SDCL  58-12-12.
Form J512
, adopted in 1994, American Dental Association. Copies may be obtained from the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Cost: $25.20, plus $3.95 for shipping and handling.
Current Dental Terminology CDT-2
, Second Edition, 1995-2000, American Dental Association. Copies may be obtained from the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Cost: $29.95.
Physicians' Current Procedural Terminology CPT'95
, Fourth Edition, 1994, Health Care Financing Administration, U.S. Department of Health and Human Services. Copies may be obtained from the American Medical Association, P.O. Box 7046, Dover, DE 19903-7046. Cost: $41.95, plus shipping and handling.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:27 - Standardized health care forms › Section 20:06:27:06 - General provisions for the filing and processing of claims

Current through Register Vol. 51, page 10, July 15, 2024
Health care practitioners, institutional care practitioners, and issuers shall file and process claims in the following manner:
(1) Health care practitioners and institutional care practitioners shall file claims in a manner consistent with the requirements of this chapter. Claims filed in paper form must be printed on 8.5 x 11-inch paper;
(2) Issuers shall accept forms submitted in compliance with this chapter for the processing of claims;
(3) Health care practitioners, institutional care practitioners, and issuers shall:
(a) Use and accept HCFA Form 1500, HCFA Form 1450, and J512 Form and the instructions for these forms in the billing of patients or their representatives and filing claims with issuers; and
(b) Modify their billing and claim reimbursement practices to encompass the coding changes for all billing and claim filing by the effective date of the changes set forth by the developers of the forms, codes, and procedures required under this chapter.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:27 - Standardized health care forms › Section 20:06:27:07 - Mandatory electronic format

Current through Register Vol. 51, page 10, July 15, 2024
Issuers that receive claims or send payments by electronic means shall, by the date on which the Health Care Financing Administration requires it of Medicare intermediaries and carriers, accept the ASC X12N standard format for the health care claims submission transaction set (837) and send the ASC X12N health care claim payment transaction set (835), both of which have been adopted by the Data Interchange Standards Association, Inc. (DISA) as of December, 1994.
General Authority:
SDCL  58-12-14.
Law Implemented:
SDCL  58-12-12.
ASC X12N Draft Version 3, Release 5 Standards
, published December, 1994, by the Data Interchange Standards Association, Inc. (DISA) and distributed by Washington Publishing Company (WPC). Copies of the entire standards manual may be obtained from EDI Support Services, P.O. Box 203, Chadron, OH 44024-0203. Cost: $425 each.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:28 - Form filing requirements › Section 20:06:28:01 - Filing fees - Identification and documentation

Current through Register Vol. 51, page 10, July 15, 2024
A form filing is not considered filed for purposes of SDCL chapter 58-11 unless the following requirements are met:
(1) Any requisite retaliatory fee owed, pursuant to SDCL  58-6-70, is noted on the cover letter accompanying the forms and is paid upon receipt of the quarterly billing sent by the Division of Insurance;
(2) All required forms must be completed and filed including identification and date approved as to which other forms the form is intended to be used with, and, if applicable, a copy of the form and a cover letter which lists the forms contained in the filing, contains a general description of their intended market use, and provides the insurer's NAIC number;
(3) For purposes of an insurer making an informational filing, sufficient documentation is provided to show that the group in question is eligible for the coverage under the provisions of Title 58.
General Authority:
SDCL  58-11-63.
Law Implemented:
SDCL  58-11-12,  58-11-63.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:28 - Form filing requirements › Section 20:06:28:03 - Filings by third parties

Current through Register Vol. 51, page 10, July 15, 2024
If an entity other than the insurer whose forms are being filed makes the filing, an authorization from the insurer must accompany the filing.
General Authority:
SDCL  58-11-63.
Law Implemented:
SDCL  58-11-12,  58-11-63.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:28 - Form filing requirements › Section 20:06:28:06 - Life and annuity filings - Actuarial certification of rating and nonforfeiture requirements

Current through Register Vol. 51, page 10, July 15, 2024
Each life and annuity filing must contain an actuarial certification certifying that rating and nonforfeiture requirements have been met. The certification must include the certifying actuary's designation.
General Authority:
SDCL  58-11-63.
Law Implemented:
SDCL  58-11-12,  58-11-63.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:28 - Form filing requirements › Section 20:06:28:07 - Property and casualty filings - Identification - Reference filings prohibited - Exception

Current through Register Vol. 51, page 10, July 15, 2024
Each property or casualty filing which uses an Insurance Services Organization (ISO) form or other licensed rating organization shall include in the form number an edition date identifying the applicable month and year. A letter referring to the ISO form with its edition date may be filed without actual copies of the ISO forms to be used. Filings, commonly referred to as "me too" filings, in which an insurer makes a filing referring to another insurer's approved filing and requests approval of its use are not permitted. Reference filings are only permitted if a subscriber is using a licensed advisory organization's forms.
General Authority:
SDCL  58-11-63.
Law Implemented:
SDCL  58-11-12,  58-11-63.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:28 - Form filing requirements › Section 20:06:28:08 - Electronic filings

Current through Register Vol. 51, page 10, July 15, 2024
All form filings must be submitted through the System for Electronic Rate and Form filing, SERFF. An electronic form filing must meet the requirements of this chapter only to the extent that the requirements are consistent with the electronic filing of forms. Each filing submitted to the division through SERFF may only contain forms from one Type of Insurance, (TOI). Nothing in this section exempts an insurer from the payment of retaliatory fees nor does it prohibit the division from requiring the use of a designated electronic transmission form.
General Authority:
SDCL  58-11-63.
Law Implemented:
SDCL  58-11-12,  58-11-63.
System for Electronic Rate and Form Filing
, SERFF. Copies of industry manuals may be obtained from National Association of Insurance Commissioners, 2301 McGee Street, Suite 800, Kansas City, Missouri, 64108-2604,
http://www.serff.org/index.htm
.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:28 - Form filing requirements › Section 20:06:28:09 - Workers' compensation claim expenditure report required

Current through Register Vol. 51, page 10, July 15, 2024
Each insurer providing workers' compensation insurance in this state must file a workers' compensation claim expenditure report each month before the sixteenth day of the month. The claim expenditure report must contain all claim information relative to the prior month's expenditures.
General Authority:
SDCL  58-2-39(3),  58-3-26.
Law Implemented:
SDCL  58-1-26,  58-2-22,  58-3-7.4,  58-4-44.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:29 - Cancellations and replacements › Section 20:06:29:00 - Lending institution coverage

Current through Register Vol. 51, page 10, July 15, 2024
For purposes of this chapter the terms policyholder and insured include borrowers whose property is covered through coverage purchased by the lending institution covering that lending institution's interest in the property.
General Authority:
SDCL  58-11-63(1).
Law Implemented:
SDCL  58-11-63(1).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:29 - Cancellations and replacements › Section 20:06:29:01 - Cancellation by insurer or policyholder

Current through Register Vol. 51, page 10, July 15, 2024
An insurer canceling a policy must return to the policyholder unearned premiums on at least a pro rata basis. An insurer may use a short rate calculation of unearned premiums if the cancellation is at the request of the policyholder. A cancellation is not considered to be at the request of the policyholder if the premium increases at policy renewal or at inception in excess of the quoted rate and the insurer fails to provide notice of the premium increase before the renewal or inception date. If it is specified in the policy, an insurer may either calculate all cancellations short rate or consider the premium fully earned at policy inception for short term or seasonal policies. The requirements of this section do not apply to surety insurance which requires the payment of a minimum premium or a premium that is fully earned pursuant to rules or rates filed and approved by the division. Nothing in this section prohibits an insurer from having a minimum premium of not more than $25 on property and casualty coverage provided that the minimum premium is filed as part of a rating plan pursuant to SDCL chapter 58-24. This section does not apply to life insurance.
General Authority:
SDCL  58-11-63(7)(9).
Law Implemented:
SDCL  58-11-63(7)(9),  58-33-83,  58-33-84.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:29 - Cancellations and replacements › Section 20:06:29:02 - Replacement of policy

Current through Register Vol. 51, page 10, July 15, 2024
This section applies to the cancellation date of any replaced policy, other than a life or health policy. If the replacing policy is already effective on the date an insured or an insured's representative makes a request for cancellation of the replaced policy, the cancellation date of the replaced policy shall coincide with the effective date of the replacing policy if the insured or an insured's representative provides to the replaced insurer one of the following:
(1) A copy of the declaration of the replacing policy or a binder issued under the authority of the replacing insurer; or
(2) The replaced policy or a properly completed lost policy release form.
However, if a document in subdivision (1) or (2) is not provided to the replaced insurer, the cancellation date of the replaced policy shall coincide with the date of request for cancellation of the replaced policy.
A personal policy is considered to be a replacing policy for coverage purchased by a lending institution for its interest in the property of the borrower.
The insurer who is honoring a request for cancellation made pursuant to this section is not liable for coverage under the policy after the effective date of the cancellation regardless of the date the cancellation was requested.
A replaced insurer who, pursuant to the policy, made one or more Public Utilities Commission form filings, a similar filing in another state, or an Interstate Commerce Commission filing is not required to comply with this section unless the replacing insurer provides a hold harmless agreement for the period of time during which the filing requires the replaced carrier to continue with the risk.
General Authority:
SDCL  58-11-63(1)(4)(7).
Law Implemented:
SDCL  58-11-63(1)(4)(7),  58-33-35,  58-33-83.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:29 - Cancellations and replacements › Section 20:06:29:03 - Cancellation refunds

Current through Register Vol. 51, page 10, July 15, 2024
An insurer shall issue and mail any refund due the insured within 20 days after the insurer receives a request for cancellation or, if the insurer cancels the policy, within 20 days after the effective date of the cancellation.
General Authority:
SDCL  58-11-63
Law Implemented:
SDCL  58-11-63.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:29 - Cancellations and replacements › Section 20:06:29:04 - Format for notice of transfer of insurance

Current through Register Vol. 51, page 10, July 15, 2024
An insurer that transfers a policyholder to another insurer within the same group of insurers may issue, in lieu of a nonrenewal notice, a notice that contains the following information:
(1) The name of the new insurer;
(2) The date that the new insurer assumes liability under the policy; and
(3) A general statement as to the reason for the change in insurers.
This section applies to all personal automobile insurance, homeowner insurance, property and casualty insurance as defined in SDCL  58-9-5 to  58-9-33, inclusive.
General Authority:
SDCL  58-1-14,  58-1-15,  58-11-51,  58-11-63(7).
Law Implemented:
SDCL  58-1-14,  58-1-15,  58-11-51.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:29 - Cancellations and replacements › Section 20:06:29:05 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter mean:
(1) "Pro rata method," the pro rata unearned gross premium method produces the minimum refund amount to be used for insurance under which premiums are collected from the insured on a basis other than a minimum premium or fully earned basis as allowed pursuant to §
									20:06:29:01, where the refund amount is to be determined by multiplying the original gross single premium times the quotient arrived at by dividing the number of remaining days by the number of days in the term;
(2) "Short rate method," the pro rata method of unearned premium reduced by an administrative expense factor not to exceed 10%;
(3) "Earned premium," the premium that has been used during the policy term. It is the premium that is payable to the insurer for the time period for which insurance was provided;
(4) "Unearned premium," that portion of the written premium applicable to the unexpired or unused part of the period for which the premium has been calculated.
General Authority:
SDCL  58-11-63(1).
Law Implemented:
SDCL  58-11-63(1).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:30 - Life and health reinsurance › Section 20:06:30:01 - Scope

Current through Register Vol. 51, page 10, July 15, 2024
This chapter applies to all domestic life and accident and health insurers and to all other licensed life and accident and health insurers which are not subject to a substantially similar regulation in their domiciliary state. This chapter also applies to the accident and health business of licensed property and casualty insurers. This chapter does not apply to assumption reinsurance, yearly renewable term reinsurance, or certain nonproportional reinsurance, such as stop loss or catastrophe reinsurance, except as referenced in §
									20:06:30:14.
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 20:06:30 - Life and health reinsurance › Section 20:06:30:03 - Certain assets allowed to be held without segregation

Current through Register Vol. 51, page 10, July 15, 2024
Notwithstanding the requirements of subdivision 20:06:30:02(7), the assets supporting the reserves for the following classes of business and any classes of business which do not have a significant credit quality, reinvestment, or disintermediation risk may be held by the ceding company without segregation:
(1) Health insurance - Long term care/Long term disability;
(2) Traditional nonpar permanent;
(3) Traditional par permanent;
(4) Adjustable premium permanent;
(5) Indeterminate premium permanent; and
(6) Universal life fixed premium, no dump-in premiums allowed.
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 20:06:30 - Life and health reinsurance › Section 20:06:30:04 - Formula for determining reserve interest rate adjustment

Current through Register Vol. 51, page 10, July 15, 2024
The associated formula for determining the reserve interest rate adjustment must reflect the ceding company's investment earnings and incorporate all realized and unrealized gains and losses reflected in the statutory statement. The following is an acceptable formula:
Rate = 2 (I + CG) / X + Y - I - CG
Where: I is the net investment income in Exhibit 2, line 16, column 7, page 10 of the Annual Statement for the year ended December 31, 1994;
CG is capital gains less capital losses in Exhibit 4, line 10, column 4, page 11 of the Annual Statement for the year ended December 31, 1994;
X is the current year cash and invested assets, page 2, line 10A, column 1, plus investment income due and accrued, page 2, line 16, column 1, less borrowed money, page 3, line 22, column 1, all in the Annual Statement for the year ended December 31, 1994; and
Y is the same as X but for the prior year.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
Life, Accident & Health Annual Statement for the Year Ended December 31, 1994
, pages 2, 3, 10 and 11. National Association of Insurance Commissioners. Copies may be obtained from the South Dakota Division of Insurance, 124 South Euclid Avenue, 2nd Floor, Pierre, SD 57501-2000, (605) 773-3563. Cost: $.75 a page.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:30 - Life and health reinsurance › Section 20:06:30:05 - Table of risk categories

Current through Register Vol. 51, page 10, July 15, 2024
The following is a table of risk categories that are considered to be significant for purposes of considering the transfer of risk. The categories of risk are as follows:
(1) Morbidity;
(2) Mortality;
(3) Lapse - The risk that a policy will voluntarily terminate before the recoupment of a statutory surplus strain experienced at issue of the policy;
(4) Credit quality (C1) - The risk that invested assets supporting the reinsured business will decrease in value. The main hazards are that assets will default or that there will be a decrease in earning power. It excludes market value declines due to changes in interest rate;
(5) Reinvestment (C3) - The risk that interest rates will fall and funds reinvested, coupon payments or monies received upon asset maturity or call, will therefore earn less than expected. If asset durations are less than liability durations, the mismatch will increase;
(6) Disintermediation (C3) - The risk that interest rates rise and policy loans and surrenders increase or maturing contracts do not renew at anticipated rates of renewal. If asset durations are greater than the liability durations, the mismatch will increase. Policyholders will move their funds into new products offering higher rates. The company may have to sell assets at a loss to provide for these withdrawals.
TABLE OF RISK CATEGORIES
+ = Significant 0 = Insignificant
1
2
3
4
5
6
Health insurance - other than LTC/LTD*
+
0
+
0
0
0
Health insurance - LTC/LTD*
+
0
+
+
+
0
Immediate annuities
0
+
0
+
+
0
Single premium deferred annuities
0
0
+
+
+
+
Flexible premium deferred annuities
0
0
+
+
+
+
Guaranteed interest contracts
0
0
0
+
+
+
Other annuity deposit business
0
0
+
+
+
+
Single premium whole life
0
+
+
+
+
+
Traditional nonpar permanent
0
+
+
+
+
+
Traditional nonpar term
0
+
+
0
0
0
Traditional par permanent
0
+
+
+
+
+
Traditional par term
0
+
+
0
0
0
Adjustable premium permanent
0
+
+
+
+
+
Indeterminate premium permanent
0
+
+
+
+
+
Universal life flexible premium
0
+
+
+
+
+
Universal life fixed premium
0
+
+
+
+
+
Universal life fixed premium - dump
0
+
+
+
+
+
in premiums allowed
*LTC = long term care insurance
*LTD = long term disability insurance
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 20:06:30 - Life and health reinsurance › Section 20:06:30:06 - Prior approval of director required for reserve credits or establishing assets

Current through Register Vol. 51, page 10, July 15, 2024
Notwithstanding the first paragraph of §
									20:06:30:02, an insurer subject to this chapter may, with the prior approval of the director, take a reserve credit or establish an asset that the director considers to be consistent with SDCL title 58 or this article, including actuarial interpretations or standards adopted by the division.
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 20:06:30 - Life and health reinsurance › Section 20:06:30:07 - Agreements - Actuarial information required about financial impact

Current through Register Vol. 51, page 10, July 15, 2024
An agreement entered into after the effective date of this chapter which involves the reinsurance of business issued before the effective date of the agreement, along with any subsequent amendments to the agreement, must be filed by the ceding company with the director within 30 days from its date of execution. Each filing must include data detailing the financial impact of the transaction. The ceding insurer's actuary who signs the financial statement actuarial opinion regarding valuation of reserves shall consider this chapter and any applicable actuarial standards of practice when determining the proper credit in financial statements filed with this division. The actuary shall maintain documentation and be prepared upon request to describe the actuarial work performed for inclusion in the financial statements and to demonstrate that such work conforms to this chapter.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
Actuarial Standards of Practice
, American Academy of Actuaries. Copies may be obtained free of charge on the website: http://www.actuarialstandardsboard.org/asops.htm.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:30 - Life and health reinsurance › Section 20:06:30:08 - Agreements - Reporting of surplus increases

Current through Register Vol. 51, page 10, July 15, 2024
Any increase in surplus net of federal income tax resulting from arrangements described in §
									20:06:30:07  must be identified separately on the insurer's financial statement required by SDCL  58-6-75 as a surplus item in aggregate write-ins for gains and losses in surplus in the Capital and Surplus Account, line 46, page 4 of the Annual Statement for the year ended December 31, 1994. Recognition of the surplus increase as income must be reflected on a net of tax basis in "Commissions and expense allowances on reinsurance ceded," line 5, page 4 of the Annual Statement for the year ended December 31, 1994, as earnings emerge from the business reinsured. See the examples at the end of this section.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
Examples:
(1) On the last day of calendar year N, company XYZ pays a $20 million initial commission and expense allowance to company ABC for reinsuring an existing block of business. Assuming a 34 percent tax rate, the net increase in surplus at inception is $13.2 million ($20 million - $6.8 million) which is reported on page 4, line 46, "Aggregate write-ins for gains and losses in surplus" in the Capital and Surplus Account of the Annual Statement for the year ended December 31, 1994. $6.8 million (34% of $20 million) is reported as income on page 4, line 5, of the "Commissions and expense allowances on reinsurance ceded," line 5, of the Summary Operations of the Annual Statement for the year ended December 31, 1995.
(2) At the end of year N+1, the business has earned $4 million. Company ABC has paid $.5 million in profit and risk charges in arrears for the year and has received a $1 million experience refund. Company ABC's Annual Statement would report $1.65 million [66% of ($4 million - $1 million - $.5 million), up to a maximum of $13.2 million] on page 4, line 5, of "Commissions and expense allowances on reinsurance ceded," of the Summary of Operations of the Annual Statement for the year ended December 31, 1994, and - $1.65 million on page 4, line 46, on "Aggregate write-ins for gains and losses in surplus," of the Capital and Surplus Account of the Annual Statement for the Year Ended December 31, 1994. The experience refund would be reported separately as a miscellaneous income item in the Summary of Operations of the Annual Statement for the year ended December 31, 1994.
Life, Accident & Health Annual Statement for the Year Ended December 31, 1994
, page 4. National Association of Insurance Commissioners. Copies may be obtained from the South Dakota Division of Insurance, 124 South Euclid Avenue, 2nd Floor, Pierre, SD 57501-2000, (605) 773-3563. Cost: $.75 a page.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:30 - Life and health reinsurance › Section 20:06:30:09 - Execution of agreement, amendment, or letter of intent required

Current through Register Vol. 51, page 10, July 15, 2024
A reinsurance agreement or an amendment to an agreement may not be used to reduce a liability or to establish an asset in any financial statement filed with the division unless the agreement, amendment, or a binding letter of intent has been executed by both parties no later than the "as of date" of the financial statement.
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 20:06:30 - Life and health reinsurance › Section 20:06:30:10 - Letter of intent - Time allowed for execution of agreement or amendment

Current through Register Vol. 51, page 10, July 15, 2024
A reinsurance agreement or an amendment to a reinsurance agreement must be executed within 90 days after the execution date of a letter of intent for credit to be granted for the reinsurance ceded.
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 20:06:30 - Life and health reinsurance › Section 20:06:30:11 - Reinsurance agreement - Required provisions

Current through Register Vol. 51, page 10, July 15, 2024
The reinsurance agreement must contain the following provisions:
(1) That the agreement constitutes the entire agreement between the parties regarding the business being reinsured and there are no understandings between the parties other than those expressed in the agreement; and
(2) That any change or modification to the agreement is void unless it is made by amendment to the agreement and signed by both parties.
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 20:06:30 - Life and health reinsurance › Section 20:06:30:12 - Existing agreements

Current through Register Vol. 51, page 10, July 15, 2024
Insurers subject to this chapter shall reduce to zero by January 1, 1996, any reserve credits or assets established regarding reinsurance agreements entered into before the effective date of this chapter which, under the provisions of this chapter, are not entitled to recognition.
General Authority:
SDCL  58-14-17.
Law Implemented:
SDCL  58-14-17.
Reinsurance, SDCL chapter 58-14.