Department of Labor and Regulation

Title - Division of Insurance email the Division of Insurance

Group Disability
Health Rate & Form Filing Requirements

South Dakota Codified Laws
21-25A-3 Arbitration not permitted.
58-9-3 "Health insurance" defined.
58-11-1 "Premium" defined.
58-11-2 Contents of policy.
58-11-3 Statement of basis and rates for determination of premium included in policy.
58-11-5 Standard or uniform provisions of insurance contracts.
58-11-7 Substitute provisions required by law of domicile of foreign or alien insurer, approval by director.
58-11-8 Assessable policies.
58-11-10 Additional policy provisions.
58-11-11 Charter and bylaws, inclusion as part of contract of insurance.
58-11-12 Policy forms must be submitted for approval.
58-11-21 Discretionary clause not permitted.
58-11-22 Identification of contracts issued and forms filed with director.
58-11-23 Execution of policy by authorized representative of insurer.
58-11-26 Jointly issued policies.
58-11-27 Combination policy.
58-11-36 Assignment of policies.
58-11-39 Modification by rider, endorsement, or application made part of policy.
58-11-62 Notice of intent to cease marketing block of business.
58-11A-1 Definitions.
58-11A-2 Policies subject to chapter.
58-11A-3 Reading ease.
58-11A-4 Alternate reading ease tests.
58-11A-5 Certificate concerning reading ease.
58-11A-6 Variation of reading ease requirement.
58-11A-9 Law permitting issuance of policies after form on file for specified period.
58-17-97 Provisions covering preexisting conditions.
58-17-108 "Disability income insurance" defined.
58-17-109 Exclusion or reduction of benefits.
58-17-110 Commencement of loss.
58-17-111 Minimum standards.  
58-18-1 Group health insurance defined.
58-18-2 Employee group insurance authorized.
58-18-3 Association member and employee group insurance authorized.
58-18-4 Industry fund group insurance authorized.
58-18-5 Issuance to person or organization to which group life insurance policy may be issued.
58-18-7.17 Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited.
58-18-8 Representations by applicant not warranties.
58-18-9 Summary statement of coverage for delivery to member of insured group.
58-18-10 Additions to group originally insured.
58-18-11 Direct payment for hospital, medical, or surgical services--Option of insurer.
58-18-11.1 Reduction of benefits because of increase in statutory disability benefits prohibited.
58-18-35 Notice required for rate increase by group health insurance company.
58-18-49 Carrier's offer of coverage to employer--Coverage of all eligible employees.
58-33-13 Unfair discrimination as misdemeanor.
58-33-13.1 Sex or marital status discrimination prohibited.
58-33-13.2 Definition of sex or marital status discrimination terms.
Administrative Rules of South Dakota
20:06:28:01 Filing fees.
20:06:28:03 Filings by third parties.
20:06:28:08 Electronic filings.
20:06:42:01 Eligible associations defined.
20:06:42:02 Credit unions.
20:06:47:01 Scope.
20:06:47:02 Establishment of claims procedures.
20:06:47:03 Unacceptable claims procedures.
20:06:47:04 Initial benefit determination.
20:06:47:05 Adverse benefit notification.
20:06:47:06 Appeal of adverse benefit determination.
20:06:47:07 Full and fair review.
20:06:47:08 Relevant claim information.
20:06:52 Discretionary Clause not permitted
Bulletins
Bulletin 98-6 Use of Trusts in Marketing Life and Health Insurance (replaces 98-4)
Bulletin 07-01 SERFF required for all form and rate filings
Bulletin 08-04
  • An application or a policy form may not include a statement that indicates that the agent cannot bind the company. An application or a policy form may contain language that indicates that agents or others have no authority to modify or waive any provisions of the policy or certificate.
  • For disability policies or certificates, the provisions of SDCL 58-17-109 allowing for reduction of benefits if the insured is receiving benefits under a governmental program or eligible to receive benefits under another insurance policy do not extend to benefits received or eligible to be received by the spouse or child of the insured.
  • No policy or certificate may contain a provision that allows for the decision of a insurer selected medical provider to be binding for purposes of determining medical appropriateness or medical necessity of any claimed benefit.
  • No health policy or certificate amendment or endorsement filing may contain blank provisions that may be completed upon issuance by the insurer.
  • No policy or certificate may exclude covered sicknesses or injuries caused by alcohol or drug use unless it is in the commission of a felony.




 

 


Division of Insurance
445 E. Capitol Avenue
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369