reglab/statecodes huggingface dataset:
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:10 - Advertisements and solicitations of health and life insurance › Section 20:06:10:26 - Life insurance policy summary

Current through Register Vol. 51, page 10, July 15, 2024
The life insurance policy summary must contain, but is not limited to, the following:
(1) A prominently placed title as follows:
STATEMENT OF POLICY COST AND BENEFIT INFORMATION
;
(2) The name and address of the insurance agent, or, if no agent is involved, a statement of the inquiry procedure to be followed;
(3) The full name and home office or administrative office address of the company which writes the life insurance policy;
(4) The generic name of the basic policy and each rider;
(5) A clear illustration of the premium and benefit patterns which contains the following applicable amounts in total, not on a per thousand or per unit basis, for the first five policy years and representative policy years thereafter including, but not limited to, the years for which life insurance cost indexes are displayed and at least one age from 60 through 65 or policy maturity whichever is earlier:
(a) The annual premium for the basic policy;
(b) The annual premium for each optional rider;
(c) The guaranteed amount payable, at the beginning of the policy year, upon death for any cause other than suicide or any other specifically enumerated exclusion, which is provided by the basic policy and each optional rider. The benefits provided under the basic policy and each rider must be shown separately;
(d) The total guaranteed cash surrender values at the end of the year with values shown separately for the basic policy and each rider;
(e) The cash dividends payable at the end of the year with values shown separately for the basic policy and each rider. Dividends need not be displayed beyond the twentieth policy year;
(f) The guaranteed endowment amounts payable under the policy which are not included under guaranteed cash surrender values in subsection 20:06:10:25(5)(d);
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:10 - Advertisements and solicitations of health and life insurance › Section 20:06:10:27 - Life insurance policy summary requirements

Current through Register Vol. 51, page 10, July 15, 2024
The life insurance policy summary must be a separate document and all information required to be disclosed must be set out in such a manner that no portion is minimized or made obscure. Any amounts which remain level for two or more years of the policy may be represented by a single number if it is clearly indicated which amounts are applicable for each policy year. If more than one insured is covered under one policy or rider, guaranteed death benefits must be displayed separately for each insured or for each class of insureds if death benefits do not differ within the class. Zero amounts must be displayed as zero and may not be displayed as a blank space.
General Authority:
SDCL  58-33A-7.
Law Implemented:
SDCL  58-33-5,  58-33-6.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:10 - Advertisements and solicitations of health and life insurance › Section 20:06:10:28 - Failure to comply

Current through Register Vol. 51, page 10, July 15, 2024
Failure of an insurer to provide or deliver a buyer's guide or a policy summary shall constitute an omission which misrepresents the benefits, advantages, conditions, or terms of an insurance policy and may be a violation of SDCL  58-33-5.
General Authority:
SDCL  58-33A-7.
Law Implemented:
SDCL  58-33-5,  58-33-6.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:10 - Advertisements and solicitations of health and life insurance › Section 20:06:10:29 - Effective date

Current through Register Vol. 51, page 10, July 15, 2024
This chapter applies to all solicitations of life insurance commencing on or after April 15, 1980.
General Authority:
SDCL  58-33A-7.
Law Implemented:
SDCL  58-33-5,  58-33-6.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:10 - Advertisements and solicitations of health and life insurance › Section 20:06:10:30 - Life insurance buyer's guide

Current through Register Vol. 51, page 10, July 15, 2024
All insurers must use the National Association of Insurance Commissioners Life Insurance Buyer's Guide, as found in Appendix A of the Life Insurance Disclosure Model Regulation, adopted by the National Association of Insurance Commissioners in 2001.
General Authority:
SDCL  58-33A-7,  58-33A-9.
Law Implemented:
SDCL  58-33-9.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:11 - Restrictions on insiders' interests › Section 20:06:11:01 - Exemptions from restrictions on insiders' interests, board of directors

Current through Register Vol. 51, page 10, July 15, 2024
Subject to the provisions of §
									20:06:11:04, SDCL  58-5-61 shall not prevent the receipt of any fee, brokerage, commission or other consideration by a director, or by a corporation or partnership in which such director has a beneficial interest, on account of services rendered to an insurer as a securities broker, lawyer, licensed practitioner of a healing art or licensed insurance agent of the insurer provided such director is not otherwise an officer or employee of the insurer. The fee, brokerage, commission or other consideration shall not exceed the usual or customary compensation for similar services by members, not directors, of the same profession or business.
General Authority:
SDCL  58-4-1,  58-5-65.
Law Implemented:
SDCL  58-5-61.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:11 - Restrictions on insiders' interests › Section 20:06:11:02 - Exemptions from restrictions on insiders' interests, officers

Current through Register Vol. 51, page 10, July 15, 2024
SDCL  58-5-61 shall not prevent the receipt of any fee, commission or other consideration by an officer, or by a corporation or partnership in which such officer has a beneficial interest, on account of services rendered to an insurer as a lawyer or licensed practitioner of a healing art provided the conditions specified in §
									20:06:11:01  are met.
General Authority:
SDCL  58-4-1,  58-5-65.
Law Implemented:
SDCL  58-5-61.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:11 - Restrictions on insiders' interests › Section 20:06:11:03 - Definition of "pecuniarily interested"

Current through Register Vol. 51, page 10, July 15, 2024
Any officer or director, any member of any committee, or any employee charged with the duty of investing an insurer's funds shall be deemed not to be pecuniarily interested in any particular transaction of the insurer because of the receipt of:
(1) Compensation for regular services rendered in employment by the insurer; or
(2) Payments, under a contract, for which services were rendered to the insurer prior to such person becoming an officer, director, member of a committee, or employee charged with the duty of investing the insurer's funds.
General Authority:
SDCL  58-4-1,  58-5-65.
Law Implemented:
SDCL  58-5-61.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:11 - Restrictions on insiders' interests › Section 20:06:11:04 - Exceptions

Current through Register Vol. 51, page 10, July 15, 2024
Section 20:06:11:01 shall not apply if the number of directors who would be in violation of SDCL  58-5-61, were it not for the exemptions provided by §
									20:06:11:01, exceeds two-fifths of the total elected membership of the board of directors.
General Authority:
SDCL  58-4-1,  58-5-65.
Law Implemented:
SDCL  58-5-61.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:11 - Restrictions on insiders' interests › Section 20:06:11:05 - Application for exemptions

Current through Register Vol. 51, page 10, July 15, 2024
Any transaction or series of transactions not otherwise provided for under §
									20:06:11:01  may be declared exempt from the application of SDCL  58-5-61, solely to enable the payment of reasonable compensation to a director, officer or employee, upon application by the insurer and approval of the director. The fee, brokerage, commission or other consideration shall not exceed the usual or customary compensation for similar services by members, not directors, officers or employees of the same profession or business. Said application shall include:
(1) A specific description of the particular transaction or transactions for which approval is sought;
(2) Copies of all contracts and other legal documents involved or to be involved in the transaction;
(3) A description of all assets involved in the transaction;
(4) The names, titles, capacities and business relationships of all persons in any way involved in the transaction who are connected with the insurer or any of its affiliates, officers, directors, managers, or controlling persons or entities in any of the capacities described in SDCL  58-5-61;
(5) A description of any and all consideration on either or any side of the transaction;
(6) Evidence that its governing board has specifically authorized the filing of the application; and
(7) Such other information, opinions or matters as the director may require.
General Authority:
SDCL  58-4-1,  58-5-65.
Law Implemented:
SDCL  58-5-61.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:12 - Examinations › Section 20:06:12:03 - Examiner I qualifications

Current through Register Vol. 51, page 10, July 15, 2024
An examiner I shall have the following education or experience:
(1) A bachelor's degree from an accredited college or university with at least 15 college credits in accounting and a major in either accounting, finance, insurance, statistics, general business administration or economics; or
(2) Public or private accounting experience for a minimum of two years and at least 15 college credits in accounting; or
(3) Accounting experience for a minimum of three years in the capacity of treasurer, assistant treasurer, controller, assistant controller or auditor for an insurance company's home office or autonomous branch office; or
(4) A combination of education and experience considered by the director of insurance to be a satisfactory equivalent.
General Authority:
SDCL  58-3-26.
Law Implemented:
SDCL  58-3-1,  58-3-3.3,  58-3-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:12 - Examinations › Section 20:06:12:04 - Examiner II qualifications

Current through Register Vol. 51, page 10, July 15, 2024
An examiner II shall have the following education or experience:
(1) A bachelor's degree from an accredited college or university with a major in either accounting, finance, insurance, statistics, general business administration or economics and a minimum of 15 college credits in accounting, plus at least 4 years of reasonable insurance department examination experience; or
(2) Public or private insurance experience in accounting for a minimum of 5 years and at least 15 college credits in accounting; or
(3) Accounting experience for at least 8 years in the capacity of treasurer, assistant treasurer, controller, assistant controller or auditor for an insurance company's home office or autonomous branch office; or
(4) An advanced college degree in business administration, accounting, finance, insurance, statistics, economics or another related field or a law degree, which may be substituted for 3 years of the required experience; or
(5) A combination of education and experience considered by the director of insurance to be a satisfactory equivalent.
General Authority:
SDCL  58-3-26.
Law Implemented:
SDCL  58-3-1,  58-3-3.3,  58-3-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:12 - Examinations › Section 20:06:12:05 - Examiner III qualifications

Current through Register Vol. 51, page 10, July 15, 2024
An examiner III shall have the following education and experience:
(1) A bachelor's degree from an accredited college or university with a major in accounting, finance, insurance, statistics, general business administration or economics and a minimum of 15 college credits in accounting, plus at least 6 years of responsible insurance department examination experience; or
(2) Public or private insurance accounting experience for a minimum of six years and at least 15 college credits in accounting; or
(3) Accounting experience for at least 10 years in the capacity of treasurer, assistant treasurer, controller, assistant controller or auditor in an insurance company's home office or autonomous branch office; or
(4) An advanced college degree in business administration, accounting, finance, insurance, statistics, economics or another related field or a law degree, which may be substituted for 3 years of the required experience; or
(5) A combination of education and experience considered by the director of insurance to be a satisfactory equivalent.
General Authority:
SDCL  58-3-26.
Law Implemented:
SDCL  58-3-1,  58-3-3.3,  58-3-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:12 - Examinations › Section 20:06:12:06 - Classification of examiners appointed prior to effective date of this chapter

Current through Register Vol. 51, page 10, July 15, 2024
Examiners appointed prior to the effective date of this chapter may retain the classifications to which they were appointed without meeting the requirements of this chapter.
General Authority:
SDCL  58-3-26.
Law Implemented:
SDCL  58-3-1,  58-3-3.3,  58-3-15.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:12 - Examinations › Section 20:06:12:07 - Guidelines for examination reports

Current through Register Vol. 51, page 10, July 15, 2024
The insurer's examination report must be prepared in accordance with standards adopted by the National Association of Insurance Commissioners in the Financial Condition Examiners Handbook, 2023 edition.
General Authority:
SDCL  58-3-11,  58-3-26.
Law Implemented:
SDCL  58-3-11.
The amended version of this section by 50 SDR 157, effective 7/1/2024 is not yet available.
Financial Condition Examiners Handbook, 2023 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: $342.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:12 - Examinations › Section 20:06:12:08 - Applicability

Current through Register Vol. 51, page 10, July 15, 2024
Sections 20:06:12:01 to 20:06:12:07, inclusive, apply to financial examinations and do not apply to market conduct examinations.
General Authority:
SDCL  58-3-11,  58-3-26.
Law Implemented:
SDCL  58-3-11.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:12 - Examinations › Section 20:06:12:09 - Examination facilitation

Current through Register Vol. 51, page 10, July 15, 2024
Facilitation for purposes of SDCL  58-3-7 for any examination, including financial, market conduct, and agency examinations, includes prompt and accurate production of accounts, records, documents, files and other relevant information as well as cooperation during the examination process. Failure by the persons being examined to supply accounts, records, documents, files or other relevant information in a timely manner constitutes a violation of SDCL  58-3-7.
General Authority:
SDCL  58-33A-7.
Law Implemented:
SDCL  58-33A-5,  58-33-6.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:02.01 - Requirements for definition of "accident" and similar words in policies

Current through Register Vol. 51, page 10, July 15, 2024
"Accidental injury" or "accidental means" shall be defined in a Medicare supplement policy by employing results language and may not include words which establish an accidental means test or use words such as "external," "violent," or "visible wounds" or similar words of description or characterization.
The definition may not be more restrictive than the following "Injury or injuries for which benefits are provided" means accidental bodily injury sustained by the insured person which is the direct result of an accident, which is independent of disease or bodily infirmity or any other cause, and which occurs while insurance coverage is in force.
The definition may provide that injuries do not include injuries for which benefits are provided or available under any workers' compensation, employer's liability, or similar law or any motor vehicle no-fault plan, unless prohibited by 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 20:06:13:02.02 - Requirements for definitions in policies

Current through Register Vol. 51, page 10, July 15, 2024
No policy or certificate may be advertised, solicited, or issued for delivery in this state as a Medicare supplement policy or certificate unless the policy or certificate contains definitions or terms which conform to SDCL chapter 58-17 A and this chapter.
A hospital may be defined in relation to its status, facilities, and available services or to reflect its accreditation by the Joint Commission on Accreditation of Hospitals, but not more restrictively than as in the Medicare program, 42 U.S.C. §
										1395 et seq, as in effect on July 1, 1992.
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 20:06:13:03 - Applicability

Current through Register Vol. 51, page 10, July 15, 2024
This chapter applies to all Medicare supplement policies advertised, solicited, delivered, or issued in this state, to all Medicare supplement certificates issued under group Medicare supplement policies, contracts issued for delivery in this state, nonprofit Medicare supplement plans, health maintenance organization contracts, and Medicare supplement coverage sold by fraternals. This chapter also applies to policies and certificates which are not Medicare supplements but are sold to people eligible for Medicare. This chapter does not apply to any policy exempted by SDCL  58-17A-1.
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 20:06:13:14 - Eligible expenses under Medicare

Current through Register Vol. 51, page 10, July 15, 2024
Eligible expenses under Medicare means medical expenses that are covered by Medicare to the extent recognized as reasonable and customary by Medicare. Payments, benefits, benefit periods, medical necessity, policy limitations, or exclusions may not be more restrictive than as used by Medicare.
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 20:06:13:16 - Waiver of coverage not allowed

Current through Register Vol. 51, page 10, July 15, 2024
No Medicare supplement policy may use a waiver to exclude, limit, or reduce benefits for a specifically named or described preexisting sickness or physical condition.
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 20:06:13:17 - Applicability of benefit standards

Current through Register Vol. 51, page 10, July 15, 2024
The following benefit standards described in §§ 20:06:13:17.02 and 20:06:13:17.03 are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state after July 16, 1992, and prior to June 1, 2010, and no policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards.
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 20:06:13:17.02 - General standards for 1990 standardized Medicare supplement benefit plans

Current through Register Vol. 51, page 10, July 15, 2024
The following standards apply to Medicare supplement policies issued for delivery after July 16, 1992, and prior to June 1, 2010, and certificates and are in addition to all other requirements of this chapter:
(1) Indemnity for losses resulting from sickness must be on the same basis as losses resulting from an accident;
(2) Benefits designed to cover cost-sharing amounts under Medicare must be changed to coincide with changes in applicable Medicare deductible, copayment, or coinsurance amounts. Premiums may be modified to correspond with such changes.
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 20:06:13:17.03 - Standards for basic core benefits for 1990 standardized Medicare supplement benefit plans

Current through Register Vol. 51, page 10, July 15, 2024
Each insurer shall make available a policy or certificate including only the following basic core package of benefits to each prospective insured. In addition to the basic core package, an issuer may make available to prospective insureds any of the other Medicare supplement insurance plans as provided in §§
									20:06:13:17.05 and 20:06:13:17.06. The additional plans may not be offered in lieu of the basic core plan. The basic core benefits required for all benefit plans issued for delivery after July 16, 1992, and prior to June 1, 2010, are as follows:
(1) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day to the 90th day, inclusive, in any Medicare benefit period;
(2) Coverage of Part A Medicare eligible expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;
(3) Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100 percent of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;
(4) Coverage under Medicare Parts A and B for the reasonable cost of the first 3 pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, 42 C.F.R. §
										409.87(a)(1) (October 1, 1991), unless replaced in accordance with federal regulations, 42 C.F.R. §
										409.87(d);
(5) Coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the copayment amount, of Medicare-eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible, 42 U.S.C. §
										1395 et seq, as in effect on July 1, 1999.
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 20:06:13:17.05 - Requirements for standard Medicare supplement benefit plans

Current through Register Vol. 51, page 10, July 15, 2024
An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form containing only the basic core benefits, as defined in §
									20:06:13:17.03.
No groups, packages, or combinations of Medicare supplement benefits other than those listed in §
									20:06:13:17.06 may be offered for sale in this state, except as permitted in §§
									20:06:13:17.02 to 20:06:13:17.04, inclusive, and §§
									20:06:13:63  to 20:06:13:76, inclusive.
Benefit plans must be uniform in structure, language, designation, and format to the standard benefit Plans A to L, inclusive, listed in §
									20:06:13:17.06 and must conform to the definitions in SDCL chapter 58-17 A and §§
									20:06:13:17.02 to 20:06:13:17.04, inclusive. Each benefit must be structured in accordance with the format provided in §§
									20:06:13:17.02 to 20:06:13:17.04, inclusive, and must list the benefits in the order shown in § 20:06:13:17.06. For purposes of this section, the phrase, structure, language, and format, means style, arrangement, and overall content of a benefit.
An issuer may use, in addition to the benefit plan designations required in this section, other designations to the extent permitted by this chapter.
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 20:06:13:17.07 - Suspension of coverage during period of eligibility for Medicaid

Current through Register Vol. 51, page 10, July 15, 2024
A Medicare supplement policy or certificate must provide that benefits and premiums under the policy be suspended at the request of the policyholder or certificateholder for not more than 24 months if the policyholder or certificateholder applies for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act (Medicaid) and if the policyholder or certificateholder notifies the issuer of the policy or certificate within 90 days after the date the individual becomes entitled to Medicaid assistance. Upon receipt of timely notice, the issuer shall return to the policyholder or certificateholder that portion of the premium attributable to the period of Medicaid eligibility, subject to adjustment for paid claims. This section applies to 1990 standardized Medicare supplement benefit plans as well as 2010 standardized Medicare supplement benefit plans.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.
Medicaid eligibility, art 67:16.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:17.08 - Reinstitution of coverage following loss of eligibility for Medicaid

Current through Register Vol. 51, page 10, July 15, 2024
If suspension of Medicare supplement coverage occurs for a period of eligibility for Medicaid and if the policyholder or certificateholder loses entitlement to Medicaid, the policy or certificate shall be automatically reinstituted effective as of the date of termination of entitlement if the policyholder or certificateholder provides notice of loss of entitlement to Medicaid within 90 days after the date of the loss and pays the premium attributable to the period, effective as of the date of termination of entitlement.
Reinstitution of Medicare supplement coverage must comply with the following requirements:
(1) The coverage may not provide for any waiting period for treatment of preexisting conditions;
(2) The coverage must be substantially equivalent to coverage in effect before the date of suspension. If the suspended policy or certificate provided coverage for outpatient prescription drugs, reinstitution of the policy or certificate for Medicare part D enrollees shall be without coverage for outpatient prescription drugs and shall otherwise provide substantially equivalent coverage to the coverage in effect before the date of suspension; and
(3) The coverage must provide for classification of premiums on terms at least as favorable to the policyholder or certificateholder as the premium classification terms that would have applied to the policyholder or certificateholder had the coverage not been suspended. This section applies to 1990 standardized Medicare supplement benefit plans as well as 2010 standardized Medicare supplement benefit plans.
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 20:06:13:17.09 - Suspension requested by policyholder

Current through Register Vol. 51, page 10, July 15, 2024
Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended for a period at the request of the policyholder if the policyholder is entitled to benefits under § 226(b) of the Social Security Act and is covered under a group health plan as defined in § 1862(b)(1)(a)(v) of the Social Security Act. The period of suspension shall be for a period as prescribed by the director. The director shall consider any pertinent federal regulations in determining the time period. If suspension occurs and then the policyholder or certificateholder loses coverage under the group health plan, the policy shall be automatically reinstituted, effective as of the date of loss of coverage. However, the policyholder must, in order to have the policy automatically reinstituted, provide to the issuer of the suspended coverage notice of loss of coverage within 90 days after the date of such loss of coverage and pay the premium attributable to the period, effective as of the date of termination of enrollment in the group health plan. If the suspended policy provided coverage for outpatient prescription drugs, reinstitution of the policy or certificate for Medicare Part D enrollees shall be without coverage for outpatient prescription drugs and shall otherwise provide substantially equivalent coverage to the coverage in effect before the date of suspension.
Reinstitution of Medicare supplement coverage must comply with the following requirements:
(1) The coverage may not provide for any waiting period for treatment of preexisting conditions;
(2) The coverage must be substantially equivalent to coverage in effect before the date of suspension. If the suspended policy or certificate provided coverage for outpatient prescription drugs, reinstitution of the policy or certificate for Medicare Part D enrollees shall be without coverage for outpatient prescription drugs and shall otherwise provide substantially equivalent coverage to the coverage in effect before the date of suspension; and
(3) The coverage must provide for classification of premiums on terms at least as favorable to the policyholder or certificateholder as the premium classification terms that would have applied to the policyholder or certificateholder had the coverage not been suspended.
This section applies to 1990 standardized Medicare supplement benefit plans as well as 2010 standardized Medicare supplement benefit plans.
General Authority:
SDCL  58-17A-2(18).
Law Implemented:
SDCL  58-17A-2(18).
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:17.10 - Prescription drug benefits under Medicare supplement plans

Current through Register Vol. 51, page 10, July 15, 2024
The following provisions apply to Medicare supplement plans:
(1) A Medicare supplement plan with benefits for outpatient prescription drugs in existence prior to January 1, 2006, shall be renewed for current policyholders who do not enroll in Medicare Part D at the option of the insured subject to §§
									20:06:13:19, 20:06:13:56, 20:06:13:60  and 20:06:13:60.01;
(2) A Medicare supplement plan with benefits for outpatient prescription drugs may not be issued after December 31, 2005;
(3) After December 31, 2005, a Medicare supplement policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in Medicare Part D unless:
(a) The policy is modified to eliminate outpatient prescription drug coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a Medicare Part D plan; and
(b) Premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of Medicare Part D enrollment, accounting for any claims paid, if applicable.
This section applies to 1990 standardized Medicare supplement benefit plans.
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:17.11 - General standards for standardized Medicare supplement benefit plan - Issued for delivery after May 31, 2010

Current through Register Vol. 51, page 10, July 15, 2024
The following standards apply to Medicare supplement policies and certificates issued for delivery after May 31, 2010, and are in addition to all other requirements of this chapter:
(1) A Medicare supplement policy or certificate may not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents;
(2) A Medicare supplement policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, copayment, or coinsurance amounts. Premiums may be modified to correspond with such changes;
(3) No Medicare supplement policy or certificate may provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium;
(4) Each Medicare supplement policy shall be guaranteed renewable:
(a) The issuer may not cancel or nonrenew the policy solely on the ground of health status of the individual;
(b) The issuer may not cancel or nonrenew the policy for any reason other than nonpayment of premium or material misrepresentation;
(c) If the Medicare supplement policy is terminated by the group policyholder and is not replaced as provided in subsection e, the issuer shall offer certificateholders an individual Medicare supplement policy which at the option of the certificateholder:
(i) Provides for continuation of the benefits contained in the group policy; or
(ii) Provides for benefits that otherwise meet the requirements of this subsection;
(d) If an individual is a certificateholder in a group Medicare supplement policy and the individual terminates membership in the group, the issuer shall:
(i) Offer the certificateholder the conversion opportunity described in §
											20:06:13:56; or
(ii) At the option of the group policyholder, offer the certificateholder continuation of coverage under the group policy;
(e) If a group Medicare supplement policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new policy does not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:17.12 - Standards for basic core benefits common to Medicare supplement insurance benefit Plans A, B, C, D, F, F with High Deductible, G, M, and N

Current through Register Vol. 51, page 10, July 15, 2024
Every issuer of Medicare supplement insurance benefit plans shall make available a policy or certificate including only the following basic core package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare Supplement Insurance Benefit Plans in addition to the basic core package, but not in lieu of it. The following benefits must be included in policies or certificates issued for delivery after May 31, 2010:
(1) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;
(2) Coverage of Part A Medicare eligible expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;
(3) Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100 percent of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;
(4) Coverage under Medicare Parts A and B for the reasonable cost of the first three pints of blood or equivalent quantities of packed red blood cells, federal regulations 42 C.F.R 409.87(a)(1) unless replaced in accordance with federal regulations 42 C.F.R. §
										409.87(d);
(5) Coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the copayment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible;
(6) Coverage of cost sharing for all Part A Medicare eligible hospice care and respite care expenses.
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 20:06:13:17.13 - Standards for additional benefits

Current through Register Vol. 51, page 10, July 15, 2024
The following additional benefits shall be included in Medicare supplement benefit Plans B, C, D, F, F with High Deductible, G, M, and N as described in §
									20:06:13:17.11:
(1) Medicare Part A Deductible: Coverage for 100 percent of the Medicare Part A inpatient hospital deductible amount per benefit period;
(2) Medicare Part A Deductible: Coverage for 50 percent of the Medicare Part A inpatient hospital deductible amount per benefit period;
(3) Skilled Nursing Facility Care: Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A;
(4) Medicare Part B Deductible: Coverage for 100 percent of the Medicare Part B deductible amount per calendar year regardless of hospital confinement;
(5) One Hundred Percent of the Medicare Part B excess charges: Coverage for all of the difference between the actual Medicare Part B charges as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge;
(6) Medically Necessary Emergency Care in a Foreign Country: Coverage to the extent not covered by Medicare for 80 percent of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician, and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first 60 consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000. For purposes of this benefit, the term, emergency care, means care needed immediately because of an injury or an illness of sudden and unexpected onset.
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 20:06:13:17.14 - Requirements for standard Medicare supplement benefit plans - Plans issued after May 31, 2010

Current through Register Vol. 51, page 10, July 15, 2024
An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form containing only the basic core benefits, as defined in §
									20:06:13:17.12.
If an issuer makes available any of the additional benefits described in §
									20:06:13:17.13, or offers standardized benefit Plans K or L, then the issuer shall make available to each prospective policyholder and certificateholder, in addition to a policy form or certificate form with only the core benefits, a policy form or certificate containing either standardized benefit Plan C or standardized benefit Plan F.
No groups, packages, or combinations of Medicare supplement benefits other than those listed in this chapter shall be offered for sale in this state.
Benefit plans shall be uniform in structure, language, designation, and format to the standard benefit plans listed in this section and conform to the definitions in §
									20:06:13:02. Each benefit shall be structured in accordance with the format provided in §§
									20:06:13:17.12 and 20:06:13:17.13. For purposes of this section, structure, language, and format means style, arrangement, and overall content of a benefit.
In addition to the benefit plan designations required in this section, an issuer may use other designations to the extent permitted by 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 20:06:13:17.15 - Make-up of standardized benefit plans - Issued after May 31, 2010

Current through Register Vol. 51, page 10, July 15, 2024
The requirements for the make-up of standardized Medicare supplement benefit Plans A to L, inclusive, are as follows:
(1) Standardized Medicare supplement benefit Plan A shall include only the following: The core benefits as defined in §
									20:06:13:17.12;
(2) Standardized Medicare supplement benefit Plan B shall include the following: The basic core benefit as defined in §
									20:06:13:17.12, plus 100 percent of the Medicare Part A deductible as defined in §
									20:06:13:17.13;
(3) Standardized Medicare supplement benefit Plan C shall include only the following: The basic core benefit as defined in §
									20:06:13:17.12, plus 100 percent of the Medicare Part A deductible, skilled nursing facility care, one hundred percent of the Medicare Part B deductible, and medically necessary emergency care in a foreign country as defined in §
									20:06:13:17.13;
(4) Standardized Medicare supplement benefit Part D shall include only the following: The core benefit as defined in §
									20:06:13:17.12, plus 100 percent of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in §
									20:06:13:17.13;
(5) Standardized Medicare supplement regular Plan F shall include only the following: The core benefit as defined in §
									20:06:13:17.12, plus 100 percent of the Medicare Part A deductible, the skilled nursing facility care, one hundred percent of the Medicare Part B deductible, 100 percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in §
									20:06:13:17.13;
(6) Standardized Medicare supplement Plan F with High Deductible shall include only the following: 100 percent of covered expenses following the payment of the annual deductible set forth in subsection (b):
(a) The basic core benefit as defined in §
										20:06:13:17.12, plus 100 percent of the Medicare Part A deductible, skilled nursing facility care, 100 percent of the Medicare Part B deductible, 100 percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in §
										20:06:13:17.12(1),(3),(4),(5), and (6);
(b) The annual deductible in Plan F with High Deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by regular Plan F, and shall be in addition to any other specific benefit deductibles. The basis for the deductible shall be $1,500 and shall be adjusted annually from 1999 by the Secretary of the U.S. Department of Health and Human Services to reflect the change in the Consumer Price Index for all urban consumers for the twelve-month period ending with August of the preceding year, and rounded to the nearest multiple of ten dollars;
South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:06 - INSURANCE › Chapter 20:06:13 - Medicare supplement insurance › Section 20:06:13:18 - Premium adjustments to match Medicare benefit adjustments

Current through Register Vol. 51, page 10, July 15, 2024
Premiums may be adjusted to correspond to changes in Medicare deductible and copayment percentage factors. Before a rate adjustment can be implemented, the rate adjustment must have prior approval from the division. Approval will be based on the percentage of increase requested, prior experience, and an explanation of how the percentage of increase was derived.
General Authority:
SDCL  58-17A-2,  58-17A-5.
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 20:06:13:19 - Renewability

Current through Register Vol. 51, page 10, July 15, 2024
An insurer may not reserve the right not to renew a policy. A noncancellable, guaranteed renewable, or noncancellable and guaranteed renewable policy may not:
(1) Terminate coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium; or
(2) Be cancelled or nonrenewed by the insurer solely on the grounds of deterioration of health.
If a Medicare supplement policy eliminates an outpatient prescription drug benefit as a result of requirements imposed by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the modified policy shall be deemed to satisfy the guaranteed renewal requirements of this section. This section applies to 1990 standardized Medicare supplement benefit plans as well as 2010 standardized Medicare supplement benefit plans.
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 20:06:13:20 - Extended benefits on termination of insurance

Current through Register Vol. 51, page 10, July 15, 2024
The payment of benefits shall be continued beyond the termination of insurance if a loss began while the policy was in force and continues past termination. The extension of benefits beyond termination may be predicated on continuous total disability of the insured. Limits on the duration of the policy benefit period or maximum benefit amounts, if any, may be applied to coverage past termination. Receipt of Medicare part D benefits may not be considered in determining a continuous loss.
General Authority:
SDCL  58-17A-2.
Law Implemented:
SDCL  58-17A-2.