Group Long-Term Care
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. |
| 58-17B-1 | Scope. |
| 58-17B-2 | Definition of terms. |
| 58-17B-3 | Minimum requirements for individual policy. |
| 58-17B-5 | Grounds for termination and certain provisions prohibited. |
| 58-17B-5.1 | Replacement of policy. |
| 58-17B-6 | Defining "preexisting conditions". |
| 58-17B-7 | Requirements for long-term care insurance policies. |
| 58-17B-9 | Free look period. |
| 58-17B-11 | Contents of certificate. |
| 58-17B-12 | Compliance with chapter prerequisite to advertisement, marketing, offer. |
| 58-17B-13 | Endorsement required. |
| 58-17B-16 | Temporary absence from nursing home or assisted living facility. |
| 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. |
| 58-18-10 | Additions to group originally insured. |
| 58-18-11 | Direct payment for hospital, medical, or surgical services--Option of insurer. |
| Chapter 58-18A | Coordination of benefits. |
| 58-33-13 | Unfair discrimination as misdemeanor. |
| 58-33A-2 | Purpose of chapter. |
| 58-33A-3 | "Advertisement" defined. |
| 58-33A-6 | Format and content of outline of coverage. |
| 58-33A-8 | Required disclosures to be clear and conspicuous. |
| 58-33A-8.1 | Disclosure of usual, customary, and reasonable limitation provision required. |
| 58-33A-10 | Advertisements not to be deceptive or misleading. |
| Administrative Rules of South Dakota | |
| 20:06:10:01 | Definitions. |
| 20:06:10:02 | Advertisements subject to regulations. |
| 20:06:10:03 | Method of disclosure of required information. |
| 20:06:10:04 | Form and content of health and life insurance advertisements. |
| 20:06:10:05 | Advertisements of benefits payable, losses covered, or premiums payable. |
| 20:06:10:05.01 | Health insurance advertisements of benefits payable, losses covered, or premiums payable. |
| 20:06:10:06 | Exceptions, reductions, and limitations. |
| 20:06:10:07 | Preexisting conditions in health insurance policies. |
| 20:06:10:08 | Necessity for disclosing policy provisions relating to renewability, cancelability, and termination. |
| 20:06:10:08.01 | Health insurance advertisement rate disclosures. |
| 20:06:10:08.02 | Health insurance advertisement disclosure statements. |
| 20:06:10:09 | Testimonials or endorsements by third parties. |
| 20:06:10:10 | Use of statistics. |
| 20:06:10:11 | Identification of plan or number of policies. |
| 20:06:10:12 | Disparaging comparisons and statements. |
| 20:06:10:13 | Jurisdictional licensing and status of insurer. |
| 20:06:10:14 | Identity of insurer and agent. |
| 20:06:10:15 | Group or quasi-group implications. |
| 20:06:10:16 | Introductory, initial, or special offers. |
| 20:06:10:17 | Statements about an insurer. |
| 20:06:14:01 | Definitions. |
| 20:06:14:02 | Scope. |
| 20:06:14:03 | General requirements. |
| 20:06:14:03.02 | General requirements for health insurance solicitation. |
| 20:06:14:03.03 | Identity of insurer -- Status of insurer. |
| 20:06:14:03.04 | Introductory, initial, or special offers. |
| 20:06:14:03.05 | Testimonials or endorsements by third parties. |
| 20:06:14:03.06 | Use of statistics. |
| 20:06:14:03.07 | Exceptions, reductions, and limitations. |
| 20:06:14:03.08 | Preexisting conditions in health insurance policies. |
| 20:06:50 | Model coordination of benefits contract provisions. |
| 20:06:21:01 | Definitions. |
| 20:06:21:01.01 | Nature of care -- How defined. |
| 20:06:21:01.02 | Service providers -- How defined. |
| 20:06:21:01.03 | Long-term care insurance defined. |
| 20:06:21:01.04 | Similar policy forms. |
| 20:06:21:02 | Minimum standards for long-term care insurance policies. |
| 20:06:21:02.01 | Annuity policies with long-term care benefits subject to waiting period. |
| 20:06:21:03 | Renewability of group policies -- Required disclosures. |
| 20:06:21:04 | Permissible exclusions from coverage. |
| 20:06:21:05 | Loss ratios. |
| 20:06:21:05.01 | Relation of benefits to premium for accelerated death benefit on life insurance. |
| 20:06:21:06 | Cost-of-living adjustments -- Basis. |
| 20:06:21:06.01 | Cost-of-living adjustments -- Minimum standards. |
| 20:06:21:06.02 | Group cost-of-living adjustments -- Exceptions. |
| 20:06:21:06.03 | Cost-of-living adjustments -- Continuation of benefit increases. |
| 20:06:21:06.04 | Cost-of-living adjustments -- Automatic increases -- Conspicuous offer of constant premium. |
| 20:06:21:06.05 | Cost-of-living adjustments -- Rejection by policyholder. |
| 20:06:21:07 | Applicability of rules to long-term care insurance riders. |
| 20:06:21:08 | "Medically necessary" defined. |
| 20:06:21:09 | Basis for conversion of coverage from group defined. |
| 20:06:21:10 | Converted policy from group defined. |
| 20:06:21:11 | Converted policy from group -- Time allowed for written application. |
| 20:06:21:12 | Converted policy from group -- Calculation of policy premium. |
| 20:06:21:13 | Continuation or conversion is mandatory -- Exceptions. |
| 20:06:21:14 | Converted policy from group to individual -- Reduction of benefits -- Exception. |
| 20:06:21:15 | Converted policy from group -- Benefits payable. |
| 20:06:21:16 | Converted policy from group -- Eligibility for coverage of relatives. |
| 20:06:21:17 | Converted policy from group -- Managed care plan defined. |
| 20:06:21:18 | Discontinuance and replacement of a group policy. |
| 20:06:21:19 | Premium increase prohibitions. |
| 20:06:21:20 | Lapse or termination notice required. |
| 20:06:21:21 | Lapse or termination for payment through payroll or pension deduction plan. |
| 20:06:21:22 | Lapse or termination for nonpayment of premium. |
| 20:06:21:23 | Disclosure of renewability. |
| 20:06:21:24 | Disclosure of payment of benefits based on certain standards. |
| 20:06:21:25 | Disclosure of limitations on preexisting conditions. |
| 20:06:21:26 | Disclosure of other limitations or conditions on eligibility for benefits. |
| 20:06:21:26.01 | Notice to claimants. |
| 20:06:21:27 | Outline of coverage. |
| 20:06:21:28 | Outline of coverage -- Standard format. |
| 20:06:21:28.01 | Applications -- Questions about replacement. |
| 20:06:21:29 | Replacement notices. |
| 20:06:21:30 | Filing requirements for advertising -- Exemption. |
| 20:06:21:31 | Standards for marketing -- Requirements. |
| 20:06:21:32 | Standards for marketing -- Prohibited practices. |
| 20:06:21:33 | Standards for marketing -- Associations. |
| 20:06:21:34 | Extension of benefits. |
| 20:06:21:35 | Basis for continuation or conversion from group coverage required. |
| 20:06:21:36 | Basis for continuation of coverage from group defined. |
| 20:06:21:37 | Reinstatement. |
| 20:06:21:38 | Disclosure of riders and endorsements. |
| 20:06:21:39 | Disclosure of tax consequences. |
| 20:06:21:40 | Applications -- Health and medication questions. |
| 20:06:21:41 | Applications -- Notice about incorrect answers. |
| 20:06:21:42 | Policies -- Notice about incorrect answers on applications. |
| 20:06:21:43 | Elderly applicants -- Required information. |
| 20:06:21:45 | Records of rescissions -- Maintaining and filing records. |
| 20:06:21:46 | Minimum standards for home health and community care benefits. |
| 20:06:21:47 | Policy summary for individual life insurance policy containing long-term care benefits. |
| 20:06:21:48 | Monthly report to policyholder. |
| 20:06:21:49 | Incontestability period. |
| 20:06:21:50 | Assisted living center or facility defined. |
| 20:06:21:51 | Assisted living centers -- Minimum benefit standards. |
| 20:06:21:52 | Reporting requirements for insurers. |
| 20:06:21:53 | Appropriateness of recommended purchase or replacement. |
| 20:06:21:53.01 | Suitability standards. |
| 20:06:21:53.02 | Suitability -- Long-term care insurance personal worksheet. |
| 20:06:21:53.03 | Suitability -- Response letter. |
| 20:06:21:53.04 | Suitability -- Policies not included. |
| 20:06:21:53.05 | Suitability -- Overinsurance. |
| 20:06:21:55 | Standards for benefit triggers. |
| 20:06:21:56 | Additional standards for benefit triggers for qualified long-term care insurance contracts. |
| 20:06:21:57 | Nonforfeiture benefits. |
| 20:06:21:58 | Nonforfeiture benefit requirement. |
| 20:06:21:60 | Required disclosure of rating practices to consumers -- Rate stabilization. |
| 20:06:21:61 | Initial filing requirements. |
| 20:06:21:63 | Premium rate schedule increases -- Notice of pending increase. |
| 20:06:21:64 | Premium rate schedule increase requirements. |
| 20:06:21:65 | Premium rate schedule increases -- Review by the director |
| 20:06:21:66 | Premium rate schedule increases -- Adverse lapsation. |
| 20:06:21:67 | Premium rate schedule increases -- Policies to which does not apply. |
| 20:06:21:68 | Premium rate schedule increases -- Group insurance policies. |
| 20:06:21:69 | Premium rate schedule increases -- Adoption of rules. |
| 20:06:21:70 | Premium rate schedule increases -- Exceptional increases. |
| 20:06:21:71 | Permitted compensation arrangements. |
| 20:06:21:72 | Disclosure to applicant for a claim denial. |
| 20:06:21:73 | Providers in a different state. |
| 20:06:21:76 | Long-term care partnership policies -- Inflation protection requirements. |
| 20:06:21:77 | Long-term care partnership policies -- Required policy disclosures. |
| 20:06:21:78 | Long-term care partnership policies -- Filing requirements. |
| 20:06:21:79 | Long-term care -- Minimum benefit requirements. |
| 20:06:21:80 | Long-term care partnership policies -- Policy amendments. |
| 20:06:21:81 | Long-term care policies -- Policy amendments. |
| 20:06:21:86 | Right to reduce coverage and lower premiums. |
| Appendix A | Outline of Coverage. |
| Appendix B | Replacement of Individual Accident and Sickness or Long-Term Care Coverage. |
| Appendix C | Replacement of Accident and Sickness or Long-Term Care Coverage. |
| Appendix D | Rescission Reporting Form. |
| Appendix E | Personal Worksheet. |
| Appendix F | Disclosure Form. |
| Appendix G | Response Letter. |
| Appendix H | Sample Claims Denial Format. |
| Appendix I | Potential Rate Increase Disclosure Form. |
| Appendix J | Replacement and Lapse Reporting Form. |
| Appendix K | Partnership Disclosure Form. |
| Appendix L | Partnership Certification Form. |
| 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. |
| 20:06:52 | Discretionary Clause not permitted |
| Bulletin | |
| 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 long term care insurance advertisements, including those that contain invitations to attend a meeting at which no solicitations will take place, the term “seminar” may not be used.
- For any policy or certificate exclusions for doctors that are family members must permit coverage for treatment by family members if it is the only doctor in the area provided that the doctor is acting within the scope of practice.
- 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
445 E. Capitol Avenue
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369
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