reglab/statecodes huggingface dataset:
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:57 - Standards for marketing

Current through Register Vol. 51, page 10, July 15, 2024
Every issuer, health care service plan, or other entity marketing Medicare supplement insurance coverage in this state, directly or through its agents or representatives, shall:
(1) Establish marketing procedures to assure that any comparison of policies or certificates by its agents or other representatives will be fair and accurate;
(2) Establish marketing procedures to assure that excessive insurance is not sold or issued;
(3) Display prominently by type, stamp, or other means on the first page of the outline of coverage and policy or certificate the following:
"Notice to buyer: This policy may not cover all of your medical expenses"
;
(4) Inquire and otherwise make every effort to identify whether a prospective applicant, certificate holder, or enrollee for Medicare supplement insurance already has accident and sickness insurance and the types and amounts; and
(5) Establish auditable procedures for verifying compliance with this section.
General Authority:
SDCL  58-4-1,  58-17A-2.
Law Implemented:
SDCL  58-17A-2,  58-17A-7.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:58 - Marketing practices prohibited

Current through Register Vol. 51, page 10, July 15, 2024
No person may employ any method of marketing to induce the purchase of insurance through force, fright, or threat whether explicit or implied or apply undue pressure to purchase insurance. No person may directly or indirectly use any method of marketing that fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance agent or insurance company.
The following acts and practices are specifically prohibited in marketing:
(1) "Twisting," knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purposes of inducing or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert an insurance policy or to take out a policy of insurance with another insurer;
(2) ''High pressure tactics," employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance;
(3) "Cold lead advertising," making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance agent or insurance company.
General Authority:
SDCL  58-4-1,  58-17A-2.
Law Implemented:
SDCL  58-17A-2,  58-17A-7.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:58.01 - Health insurance advertisement rate disclosures

Current through Register Vol. 51, page 10, July 15, 2024
Unless the disclosure made as required by §
									20:06:13:58.02 is provided, no individual or group health insurance policy or certificate may in its advertisements include statements that directly or indirectly indicate that:
(1) Premiums or rates do not increase with age;
(2) Premiums or rates do not increase because of health conditions; or
(3) An insured will not be singled out for a rate or premium increase.
Policies for which no rate increase may be applied for any reason are exempt from the provisions of this section.
General Authority:
SDCL  58-17A-2(11).
Law Implemented:
SDCL  58-33-5,  58-33-6.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:58.02 - Health insurance advertisement disclosure statements

Current through Register Vol. 51, page 10, July 15, 2024
Any health insurance advertisement that includes a statement for which disclosure is required pursuant to §
									20:06:13:58.01 must contain in close proximity to any such statement and in an at least as conspicuous a form as the statement itself, the following disclosure or an alternative as may be approved by the director:
Premiums or rates may increase for other reasons such as an increase applicable to all persons covered under this type of policy or certificate in this state.
General Authority:
SDCL  58-17A-2(11).
Law Implemented:
SDCL  58-33-5,  58-33-6.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:59 - Reporting of multiple policies

Current through Register Vol. 51, page 10, July 15, 2024
For each individual resident of this state for whom the insurer or entity has in force more than one Medicare supplement insurance policy or certificate, each insurer or other entity providing Medicare supplement insurance coverage in this state shall report to the director by March 1 the policy and certificate numbers and the dates of issuance, grouped by individual policyholder.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:60 - Cancellation or nonrenewal of policies

Current through Register Vol. 51, page 10, July 15, 2024
Except as authorized by the director, an issuer may not cancel or refuse to renew a Medicare supplement policy or certificate for any reason other than nonpayment of premium or material misrepresentation. Each Medicare supplement policy must be guaranteed renewable.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:60.01 - Guaranteed renewable with benefit changes

Current through Register Vol. 51, page 10, July 15, 2024
An issuer that eliminates an outpatient prescription drug benefit as a result of requirements imposed by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 shall be deemed to satisfy the guaranteed renewable provision of §
									20:06:13:60.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:61 - Agent compensation limited

Current through Register Vol. 51, page 10, July 15, 2024
An issuer or other entity may provide a commission or other compensation to an agent or other representative for the sale of a Medicare supplement policy or certificate only if the commission or compensation for the first year is no more than 200 percent of the commission or compensation paid for selling or servicing the policy or certificate in the second year or period.
The commission or other compensation provided in subsequent or renewal years must be the same as that provided in the second year or period and must be provided for at least five renewal years.
An issuer or other entity may not provide compensation to its agents or other producers and an agent or producer may not receive compensation greater than the renewal compensation payable by the replacing issuer on renewal policies or certificates if an existing policy or certificate is replaced.
For purposes of this section, the term, compensation, includes pecuniary and nonpecuniary remuneration of any kind relating to the sale or renewal of the policy or certificate, including bonuses, gifts, prizes, awards, and finder's fees.
Any commission advance or commission loan or other compensation by whatever named called, whether measured alone or in conjunction with other commissions, provided by an issuer or other entity, may not exceed the monetary threshold for a first year commission as required by this section. The fact that a commission loan or commission advance may be required to be repaid later or reduced if the insurance is terminated does not allow for compensation at any time to be in excess of the first year limitations required by this section.
General Authority:
SDCL  58-4-1,  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:63 - Medicare select policies and certificates

Current through Register Vol. 51, page 10, July 15, 2024
Sections 20:06:13:63 to 20:06:13:76, inclusive, apply to Medicare select policies and certificates, as defined in §
									20:06:13:02.
A policy or certificate may not be advertised as a Medicare select policy or certificate unless it meets the requirements of § 20:06:13:63  to 20:06:13:76, inclusive.
General Authority:
SDCL  58-17A-2(11).
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:64 - Medicare select authorization

Current through Register Vol. 51, page 10, July 15, 2024
The director may authorize an issuer to offer a Medicare select policy or certificate pursuant to §
									20:06:13:63  to 20:06:13:76, inclusive, and § 4358 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 if the director finds that the issuer has satisfied all of the requirements of these sections.
General Authority:
SDCL  58-17A-2(10),  58-17A-2(12).
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:65 - Approval required for issuance

Current through Register Vol. 51, page 10, July 15, 2024
A Medicare select issuer may not issue a Medicare select policy or certificate in this state until its plan of operation has been approved by the director, pursuant to SDCL  58-17A-2.
General Authority:
SDCL  58-17A-2(10),  58-17A-2(12).
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:66 - Filing plan of operation

Current through Register Vol. 51, page 10, July 15, 2024
A Medicare select issuer shall file a proposed plan of operation with the director in a format prescribed by the director. The plan of operation must contain at least the following information:
(1) Evidence that all covered services that are subject to restricted network provisions are available and accessible through network providers, including a demonstration that:
(a) Such services can be provided by network providers with reasonable promptness regarding geographic location, hours of operation, and after-hour care. The hours of operation and availability of after-hour care must reflect the usual practice in the local area. Geographic availability must reflect the usual travel times within the community;
(b) The number of network providers in the service area is sufficient for current and expected policyholders either to deliver adequately all services that are subject to a restricted network provision or to make appropriate referrals.
(c) There are written agreements with network providers describing specific responsibilities;
(d) Emergency care is available 24 hours a day and 7 days a week;
(e) In the case of covered services that are subject to a restricted network provision and are provided on a prepaid basis, there are written agreements with network providers prohibiting such providers from billing or otherwise seeking reimbursement from or recourse against any individual insured under a Medicare select policy or certificate. This subsection does not apply to supplemental charges or coinsurance amounts as stated in the Medicare select policy or certificate;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:67 - Filing of changes

Current through Register Vol. 51, page 10, July 15, 2024
A Medicare select issuer shall file any proposed changes to the plan of operation, except for changes to the list of network providers, with the director before implementing the changes. The changes are considered to be approved by the director after 30 days unless they are specifically disapproved.
An updated list of network providers must be filed with the director at least quarterly.
General Authority:
SDCL  58-17A-2(12),  58-17A-2,  58-17A-7.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:68 - Network restrictions

Current through Register Vol. 51, page 10, July 15, 2024
A Medicare select policy or certificate may not restrict payment for covered services provided by providers outside the network if:
(1) The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury, or a condition; and
(2) It is not appropriate given specific circumstances, such as time or distance, to obtain such services through a network provider.
General Authority:
SDCL  58-17A-2(5),  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:69 - Coverage for unavailable services

Current through Register Vol. 51, page 10, July 15, 2024
A Medicare select policy or certificate shall provide payment for full coverage under the policy for covered services that are not available through network providers.
General Authority:
SDCL  58-17A-2(5),  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:70 - Disclosure and outline of coverage requirements

Current through Register Vol. 51, page 10, July 15, 2024
A Medicare select issuer shall make full disclosure in writing of the provisions, restrictions, and limitations of the Medicare select policy or certificate to each applicant. This disclosure must include at least the following:
(1) An outline of coverage sufficient to permit the applicant to compare the coverage and premiums of the Medicare select policy or certificate with other Medicare supplement policies or certificates offered by the issuer and other Medicare select policies or certificates;
(2) A description of the network providers, including primary care physicians, specialty physicians, hospitals, and other providers. At a minimum, the description must include each provider's address, telephone number, and hours of operation;
(3) A description of the restricted network provisions, including payments for coinsurance and deductibles when providers other than network providers are utilized. Except to the extent specified in the policy or certificate, expenses incurred when using out-of-network providers do not count toward the out-of-pocket annual limit contained in plans K and L;
(4) A description of coverage for emergency and urgently needed care and other out-of-service area coverage;
(5) A description of limitations on referrals to restricted network providers and to other providers;
(6) A description of the policyholders' rights to purchase any other Medicare supplement policy or certificate otherwise offered by the issuer; and
(7) A description of the Medicare select issuer's quality assurance program and grievance procedure.
General Authority:
SDCL  58-17A-2(11),  58-17A-2(14),  58-17A-6,  58-17A-7.
Law Implemented:
SDCL  58-17A-2,  58-17A-5.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:71 - Applicant signature required

Current through Register Vol. 51, page 10, July 15, 2024
Prior to the sale of a Medicare select policy or certificate, a Medicare select issuer must obtain from the applicant a signed and dated form stating that the applicant has received the information provided, pursuant to §
									20:06:13:70, and that the applicant understands the restrictions of the Medicare select policy or certificate.
General Authority:
SDCL  58-17A-2(11),  58-17A-2(14),  58-17A-7.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:72 - Complaints and grievances

Current through Register Vol. 51, page 10, July 15, 2024
A Medicare select issuer must have and use procedures for hearing complaints and resolving written grievances from subscribers. Such procedures must be aimed at mutual agreement for settlement and may include arbitration procedures. Grievance procedures must meet the following requirements:
(1) The grievance procedure must be described in the policy and certificate and in the outline of coverage;
(2) At the time the policy or certificate is issued, the issuer must provide detailed information to the policyholder describing how a grievance may be registered with the issuer;
(3) The issuer must consider grievances in a timely manner and transmit them to decision-makers who have authority to investigate the issue fully and take corrective action;
(4) If a grievance is found to be valid, the issuer must take corrective action promptly;
(5) The issuer must notify all concerned parties about the results of a grievance;
(6) The issuer must report no later than March 31 each year to the director regarding its grievance procedure in a format provided by the director. The report must contain the number of grievances filed in the past year and a summary of the subject, nature, and resolution of the grievances.
General Authority:
SDCL  58-17A-2(5),  58-17A-2(12),  58-17A-2,  58-17A-7.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:73 - Required offer of other Medicare supplement coverage

Current through Register Vol. 51, page 10, July 15, 2024
At the time of initial purchase, a Medicare select issuer must make available to each applicant for a Medicare select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate otherwise offered by the issuer.
General Authority:
SDCL  58-17A-2(2),  58-17A-2(11),  58-17A-2(14).
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:74 - Required offer of replacement coverage without a restricted network provision

Current through Register Vol. 51, page 10, July 15, 2024
At the request of an individual insured under a Medicare select policy or certificate, a Medicare select issuer must make available to the individual insured the opportunity to purchase a Medicare supplement policy or certificate offered by the issuer which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer must make such policies or certificates available without requiring evidence of insurability after the Medicare select policy or certificate has been in force for six months.
For the purpose of this section, a Medicare supplement policy or certificate is considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare select policy or certificate being replaced. For the purpose of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for prescription drugs, coverage for at-home recovery services, or coverage for Part B excess charges.
General Authority:
SDCL  58-17A-2(2),  58-17A-2(11),  58-17A-2(14).
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:75 - Continuation

Current through Register Vol. 51, page 10, July 15, 2024
Medicare select policies and certificates must provide for continuation coverage if the secretary of health and human services determines that Medicare select policies and certificates issued pursuant to §§
									20:06:13:63  to 20:06:13:76, inclusive, should be discontinued because the Medicare select program was not reauthorized under law or it was substantially amended.
Each Medicare select issuer must make available to each individual insured under a Medicare select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate offered by the issuer which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer must make such policies and certificates available without requiring evidence of insurability.
For the purpose of this section, a Medicare supplement policy or certificate is considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for prescription drugs, coverage for at-home recovery services, or coverage for Part B excess charges.
General Authority:
SDCL  58-17A-2(2),  58-17A-2(7),  58-17A-2(16).
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:76 - Compliance with data requests

Current through Register Vol. 51, page 10, July 15, 2024
A Medicare select issuer must comply with requests for data made by state or federal agencies, including the United States Department of Health and Human Services, for the purpose of evaluating the Medicare select program.
General Authority:
SDCL  58-17A-2(12).
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:77 - Creditable coverage

Current through Register Vol. 51, page 10, July 15, 2024
For purposes of this chapter, creditable coverage is defined as follows:
(1) "Creditable coverage," with respect to an individual, coverage of the individual provided under any of the following:
(a) A group health plan;
(b) Health insurance coverage;
(c) Part A or Part B of Title XVIII of the Social Security Act (Medicare);
(d) Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under § 1928;
(e) Chapter 55 of Title, 10 United States Code (CHAMPUS);
(f) A medical care program of the Indian Health Service or of a tribal organization;
(g) A state health benefits risk pool;
(h) A health plan offered under chapter 89 of Title 5, United States Code (Federal Employees Health Benefits Program);
(i) A public health plan as defined in federal regulation; and
(j) A health benefit plan under § 5(e) of the Peace Corps Act (22 U.S.C. §
											2504(e));
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:78 - Medicare Advantage plan

Current through Register Vol. 51, page 10, July 15, 2024
For purposes of this chapter, Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w- 28(b)(1), as in effect on January 1, 2004, and includes:
(1) Coordinated care plans which provide health care services, including health maintenance organization plans, with or without a point-of-service option, plans offered by provider-sponsored organizations, and preferred provider organization plans;
(2) Medicare medical savings account plans coupled with a contribution into a Medicare Advantage medical savings account; and
(3) Medicare Advantage private fee-for-service plans.
General Authority:
SDCL  58-17A-2(9).
Law Implemented:
SDCL  58-17A-2(9).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:79 - Guaranteed issue

Current through Register Vol. 51, page 10, July 15, 2024
With respect to an eligible person, an issuer may not deny or condition the issuance or effectiveness of a Medicare supplement policy described in §
									20:06:13:81  that is offered and is available for issuance to a new enrollee by the issuer, may not discriminate in the pricing of a Medicare supplement policy because of the eligible person's health status, claims experience, receipt of health care, or medical condition, and may not impose an exclusion of benefits based on a preexisting condition under a Medicare supplement policy.
General Authority:
SDCL  58-17A-2(2)(5)(11).
Law Implemented:
SDCL  58-17A-2(2)(5)(11),  58-17A-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:80 - Guaranteed issue - Eligible persons

Current through Register Vol. 51, page 10, July 15, 2024
An eligible person is one who seeks to enroll under the policy during the period specified in § 20:06:13:80.01 and who submits evidence of the date of termination, disenrollment, or Medicare part D enrollment with the application for a Medicare supplement policy, and who is described in any of the following paragraphs:
(1) The person is enrolled under an employee welfare benefit plan or an employer-based health insurance plan that provides health benefits, and coverage under the plan terminates for that person;
(2) The person is 65 years of age or older and is enrolled with a Program of All-Inclusive Care for the Elderly (PACE) provider under § 1894 of the Social Security Act, and there are circumstances similar to those described below that would permit discontinuance of the person's enrollment with such provider if the person were enrolled in a Medicare Advantage plan, or the person is enrolled with a Medicare Advantage organization under a Medicare Advantage plan under part C of Medicare, and any of the following circumstances apply:
(a) The certification of the organization or plan under this part has been terminated;
(b) The organization has terminated or otherwise discontinued providing the plan in the area in which the person resides;
(c) The person is no longer eligible to elect the plan because of a change in the person's place of residence or other change in circumstances specified by the secretary, but not including termination of the person's enrollment on the basis described in § 1851(g)(3)(B) of the federal Social Security Act, if the person has not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under § 1856, or the plan is terminated for all individuals within a residence area;
(d) The person demonstrates, in accordance with guidelines established by the secretary, that:
(i) The organization offering the plan substantially violated a material provision of the organization's contract under part C of Medicare in relation to the person, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide the covered care in accordance with applicable quality standards; or
(ii) The organization, or agent or other entity acting on the organization's behalf, materially misrepresented the plan's provisions in marketing the plan to the person; or
(e) The person meets any other exceptional conditions as the secretary may provide;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:80.01 - Guaranteed issue time periods

Current through Register Vol. 51, page 10, July 15, 2024
(1) In the case of an individual described in subdivision 20:06:13:80(1), the guaranteed issue period begins on the later of:
(a) the date the individual receives a notice of termination or cessation of all supplemental health benefits (or, if a notice is not received, notice that a claim has been denied because of such a termination or cessation);
(b) or the date that the applicable coverage terminates or ceases and ends 63 days thereafter;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:80.02 - Extended medigap access for interrupted trial periods

Current through Register Vol. 51, page 10, July 15, 2024
(1) In the case of an individual described in subdivision 20:06:13:80(5) (or deemed to be so described, pursuant to this subsection) whose enrollment with an organization or provider described in subdivision 20:06:13:80(5)(a) is involuntarily terminated within the first twelve (12) months of enrollment, and who, without an intervening enrollment, enrolls with another such organization or provider, the subsequent enrollment shall be deemed to be an initial enrollment described in subdivision 20:06:13:80(5);
(2) In the case of an individual described in subdivision 20:06:13:80(6) (or deemed to be so described, pursuant to this subsection) whose enrollment with a plan or in a program described in subdivision 20:06:13:80(6) is involuntarily terminated within the first twelve (12) months of enrollment, and who, without an intervening enrollment, enrolls in another such plan or program, the subsequent enrollment shall be deemed to be an initial enrollment described in subdivision 20:06:13:80(6); and
(3) For purposes of subdivisions 20:06:13:80(5) and (6), no enrollment of an individual with an organization or provider described in subdivision 20:06:13:80(5)(a), or with a plan or in a program described in subdivision 20:06:13:80(6), may be deemed to be an initial enrollment under this subsection after the two-year period beginning on the date on which the individual first enrolled with such an organization, provider, plan, or program.
General Authority:
SDCL  58-17A-2(2)(9)(16).
Law Implemented:
SDCL  58-17A-2(2)(9)(16).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:81 - Guaranteed issue - Products to which eligible persons are entitled

Current through Register Vol. 51, page 10, July 15, 2024
The Medicare supplement policies to which an eligible person is entitled are as follows:
(1) A person eligible under subdivisions 20:06:13:80(1),(2), (3), or (4) is entitled to a Plan A, B, C, F, F with high deductible, K, or L Medicare supplement policy offered by an issuer;
(2) A person eligible under subdivision 20:06:13:80(5) is entitled to the same Medicare supplement policy in which the individual was most recently enrolled, if available from the same issuer, or, if not available, a policy described in subdivision (1) of this section. After December 31, 2005, if the individual was most recently enrolled in a Medicare supplement policy with an outpatient prescription drug benefit, a Medicare supplement policy described in this subdivision is:
(a) The policy available from the same issuer but modified to remove outpatient prescription drug coverage; or
(b) At the election of the policyholder, an A, B, C, F, F with high deductible, K, or L policy that is offered by any issuer;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:82 - Guaranteed issue - Notification provisions

Current through Register Vol. 51, page 10, July 15, 2024
(1) At the time of an event described in §
									20:06:13:80  because of which a person loses coverage or benefits due to the termination of a contract or agreement, policy, or plan, the organization that terminates the contract or agreement, the issuer terminating the policy, or the administrator of the plan being terminated, respectively, shall notify the person of that person's rights under this section, and of the obligations of issuers of Medicare supplement policies under §
									20:06:13:79. The notice shall be communicated along with the notice of termination.
(2) At the time of an event described in §
									20:06:13:80  because of which a person ceases enrollment under a contract or agreement, policy, or plan, the organization that offers the contract or agreement, regardless of the basis for the cessation of enrollment, the issuer offering the policy, or the administrator of the plan, respectively, shall notify the person of that person's rights under this section, and of the obligations of issuers of Medicare supplement policies under §
									20:06:13:79. The notice shall be communicated within 10 working days of the issuer receiving notification of disenrollment.
General Authority:
SDCL  58-17A-2(1)(2)(12)(16)(18).
Law Implemented:
SDCL  58-17A-2(1)(2)(12)(16)(18).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:83 - Open enrollment

Current through Register Vol. 51, page 10, July 15, 2024
If an applicant qualifies under SDCL  58-17A-17 and submits an application during the time period referenced in SDCL  58-17A-17 and, as of the date of application, has had a continuous period of creditable coverage of at least six months, the issuer may not exclude benefits based on a preexisting condition. If the applicant qualifies under SDCL  58-17A-17 and submits an application during the time period referenced in SDCL  58-17A-17 and, as of the date of application, has had a continuous period of creditable coverage that is less than six months, the issuer shall reduce the period of any preexisting condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The secretary shall specify the manner of the reduction under this section.
General Authority:
SDCL  58-17A-2(2)(5).
Law Implemented:
SDCL  58-17A-2(2)(5),  58-17A-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:84 - Open enrollment required for Medicare eligible individuals regardless of age

Current through Register Vol. 51, page 10, July 15, 2024
Any individual, regardless of age, who becomes eligible for Medicare by reason of age or disability, is entitled to open enrollment into any Medicare supplement policy if application is made within six months of enrollment in Part B of Medicare. This rule applies only to individuals who become eligible for Medicare on or after July 1, 1999. Nothing in this rule prohibits a carrier from using rating methodologies on a class basis for those that qualify for Medicare by reason of disability if:
(1) The rate is an actuarially justified rate; and
(2) The rate does not exceed the rate that the carrier has for an individual who qualifies for Medicare by reason of age and is 75 years of age.
General Authority:
SDCL  58-17A-2(2),  58-17A-2(5).
Law Implemented:
SDCL  58-17A-2(2),  58-17A-2(5),  58-17A-17.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:85 - Notice requirements

Current through Register Vol. 51, page 10, July 15, 2024
Any issuer shall comply with any notice requirement of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
General Authority:
SDCL  58-4-1,  58-17A-2,  58-17A-7.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:86 - Exchanging of standardized plan

Current through Register Vol. 51, page 10, July 15, 2024
An issuer may make a written offer to a policyholder or certificateholder to exchange during a specified period from a 1990 standardized plan to a 2010 standardized plan.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:86.01 - Exchanging of standardized plan - Age rate schedule

Current through Register Vol. 51, page 10, July 15, 2024
An issuer need not provide justification to the director if the insured replaces a 1990 Standardized policy or certificate with an issue age rated 2010 Standardized policy or certificate at the insured's original issue age. If an insured's policy or certificate to be replaced is priced on an issue age rate schedule at the time of such offer, the rate charged to the insured for the new exchanged policy shall recognize the policy reserve buildup, due to the pre-funding inherent in the use of an issue age rate basis, for the benefit of the insured. The method proposed to be used by an issuer must be submitted with the director through the System for Electronic Rate and Form filing, SERFF.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
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 20:06:13 - Medicare supplement insurance › Section 20:06:13:86.02 - Exchanging of standardized plan - Rating class

Current through Register Vol. 51, page 10, July 15, 2024
The rating class of the new policy or certificate is the class closest to the insured's class of the replaced coverage.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:86.03 - Exchanging of standardized plan - Preexisting conditions and incontestability period

Current through Register Vol. 51, page 10, July 15, 2024
An issuer may not apply new pre-existing condition limitations or a new incontestability period to the new policy for those benefits contained in the exchanged 1990 standardized policy or certificate of the insured. Pre-existing condition limitations may be applied of no more than six months to any added benefits contained in the new 2010 standardized policy or certificate not contained in the exchanged policy.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:86.04 - Exchanging of standardized plan - Offering

Current through Register Vol. 51, page 10, July 15, 2024
The new policy or certificate shall be offered to all policyholders or certificateholders within a given plan, except where the offer or issue would be in violation of state or federal law.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:87 - Applicability of genetic information

Current through Register Vol. 51, page 10, July 15, 2024
Sections 20:06:13:88 to 20:06:13:92, inclusive, apply to all policies with policy years beginning after May 20, 2009.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:88 - Definitions applicable to genetic information

Current through Register Vol. 51, page 10, July 15, 2024
The following terms are defined for purposes of §§ 20:06:13:88  to 20:06:13:92, inclusive:
(1) "Family member," with respect to an individual, any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual;
(2) "Genetic information," with respect to any individual, information about such individual's genetic tests, the genetic tests of family members of such individual, and the manifestation of a disease or disorder in family members of such individual. Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual. Any reference to genetic information concerning an individual or family member of an individual who is a pregnant woman includes genetic information of any fetus carried by such pregnant woman, or with respect to an individual or family member utilizing reproductive technology, includes genetic information of any embryo legally held by an individual or family member. The term genetic information does not include information about the sex or age of any individual;
(3) "Genetic services," a genetic test, genetic education, or genetic counseling. Genetic counseling includes obtaining, interpreting, or assessing genetic information;
(4) "Genetic test," an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detect genotypes, mutations, or chromosomal changes. The term, genetic test, does not mean an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes; or an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved;
(5) "Issuer of a Medicare supplement policy or certificate," includes any insurance company, fraternal benefit society, health care service plan, health maintenance organization, third party administrator, or other person acting for or on behalf of such issuer, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates;
(6) "Underwriting purposes:"
(a) Rules for, or determination of, eligibility, including enrollment and continued eligibility, for benefits under the policy;
(b) The computation of premium or contribution amounts under the policy;
(c) The application of any pre-existing condition exclusion under the policy; and
(d) Other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:89 - Use of genetic information

Current through Register Vol. 51, page 10, July 15, 2024
An issuer of a Medicare supplement policy or certificate may not deny or condition the issuance or effectiveness of the policy or certificate, including the imposition of any exclusion of benefits under the policy based on a pre-existing condition on the basis of the genetic information with respect to such individual. The issuer may not discriminate in the pricing of the policy or certificate including the adjustment of premium rates of an individual on the basis of the genetic information with respect to such individual. Nothing in this section may be construed to limit the ability of an issuer, to the extent otherwise permitted by law, from denying or conditioning the issuance or effectiveness of the policy or certificate or increasing the premium for a group based on the manifestation of a disease or disorder of an insured or applicant or increasing the premium for any policy issued to an individual based on the manifestation of a disease or disorder of an individual who is covered under the policy. In such case, the manifestation of a disease or disorder in one individual may not also be used as genetic information about other group members and to further increase the premium for the group.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:90 - Request of genetic testing

Current through Register Vol. 51, page 10, July 15, 2024
Except as provided under §
									20:06:13:91  an issuer of a Medicare supplement policy or certificate may not request or require an individual or a family member of such individual to undergo a genetic test. This section may not be construed to preclude an issuer of a Medicare supplement policy or certificate from obtaining and using the results of a genetic test in making a determination regarding payment as defined for the purposes of applying the regulations promulgated under Part C of Title XI and section 264 of the Health Insurance Portability and Accountability Act of 1996, and consistent with §
									20:06:13:88. An issuer of a Medicare supplement policy or certificate may request only the minimum amount of information necessary to accomplish the intended purpose.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:91 - Requirement of genetic testing

Current through Register Vol. 51, page 10, July 15, 2024
An issuer of a Medicare supplement policy may request, but not require, that an individual or a family member of such individual undergo a genetic test if each of the following conditions is met:
(1) The request is made pursuant to research that complies with Part 46 of Title 45, Code of Federal Regulations, or equivalent federal regulations, and any applicable state or local law or regulations for the protection of human subjects in research;
(2) The issuer clearly indicates to each individual, or in the case of a minor child, to the legal guardian of such child, to whom the request is made that:
(a) Compliance with the request is voluntary; and
(b) Non-compliance will have no effect on enrollment status or premium or contribution amounts;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:92 - Genetic information - Underwriting purposes and enrollment

Current through Register Vol. 51, page 10, July 15, 2024
An issuer of a Medicare supplement policy or certificate may not request, require, or purchase genetic information for underwriting purposes. An issuer of a Medicare supplement policy or certificate may not request, require, or purchase genetic information for underwriting purposes with respect to any individual prior to such individual's enrollment under the policy in connection with such enrollment.
If genetic information is obtained incidental to the requesting, requiring, or purchasing of other information concerning any individual, such request, requirement, or purchase may not be considered a violation of this section.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.