Department of Labor and Regulation

Title - Division of Insurance email the Division of Insurance

Individual Medicare Supplement
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.
58-17-1 Requirements for all health insurance policies delivered in state.
58-17-2 Persons covered by policy.
58-17-2.1 Health insurance on a franchise plan.
58-17-3 Time of commencement and termination to be set out in policy.
58-17-4 Consideration for policy to be stated.
58-17-4.1 Filing and prior approval of individual premium rates by director.
58-17-4.2 Premium rates required to be reasonable.
58-17-5 Identification of forms, riders and endorsements--Form number, location.
58-17-6 Style and arrangement of policy provisions--Printing, size of type.
58-17-7 Documents forming part of policy--Setting forth in full, rates and classifications excepted.
58-17-8 Exceptions and reductions of coverage to be clearly set out.
58-17-9 Renewal of policy at option of insurer--Statement in policy so informing the policyholder.
58-17-10.2 Individual policy for insured's spouse required in policies covering spouse.
58-17-12 Required provisions.
58-17-13 Omission from policy of inapplicable provision.
58-17-14 Insured signature required for contract changes.
58-17-15 Incontestability clause.
58-17-16 Incontestability clause--Optional provisions.
58-17-17 Grace period on premiums required in policy.
58-17-18 Renewal of policy.
58-17-19 Reinstatement when premium not paid within grace period.
58-17-20 Omission of provision as to application of premiums accepted in connection with reinstatement.
58-17-21 Notice of claim.
58-17-22 Notice of claim--Optional provision.
58-17-23 Claim forms--Furnishing by insurer.
58-17-24 Proofs of loss--Provision required in policy.
58-17-25 Time of payment of claims.
58-17-26 Payment of claims.
58-17-27 Payment of claims--Optional provisions.
58-17-28 Physical examination and autopsy in case of death.
58-17-29 Time limits for legal action.
58-17-30 Beneficiary.
58-17-30.8 Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited.
58-17-31 Optional policy provisions.
58-17-32 Occupational change.
58-17-33 Misstatement of age.
58-17-37 Unpaid premiums--Deduction from benefits.
58-17-38 Conformity with state statutes of insured.
58-17-39 Illegal occupation of insured.
58-17-40 Renewal of policy at option of insurer.
58-17-41 Order of policy provisions.
58-17-44 Foreign or alien insurer--Policy provision required by home state.
58-17-45 Policy of domestic insurer delivered in other state.
58-17-46 Policy provisions not subject to chapter.
58-17-47 Nonconforming and conflicting provisions construed in conformity with statute.
58-17A-1 Definition of terms.
58-17A-3 Preexisting conditions.
58-17A-3.1 Preexisting conditions provision prohibited in replacement policy.
58-17A-4 Reasonable benefits required.
58-17A-8 Free look period.
58-17A-10 Filing requirements.
58-17A-11 Premiums to be adjusted to produce a loss ratio conforming with minimum standards.
58-17A-13 Review of advertisements of issuers providing medicare supplement insurance.
58-17A-17 Conditional or discriminatory policy or certificate prohibited.
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.
20:06:13:02 Definitions.
20:06:13:02.01 Requirements for definition of "accident" and similar words in policies.
20:06:13:02.02 Requirements for definitions in policies.
20:06:13:14 Eligible expenses under Medicare.
20:06:13:16 Waiver of coverage not allowed.
20:06:13:17 Applicability of benefit standards.
20:06:13:17.02 General standards.
20:06:13:17.03 Standards for basic "core" benefits required for all benefit plans.
20:06:13:17.04 Standards for additional benefits.
20:06:13:17.05 Requirements for standard Medicare supplement benefit plans.
20:06:13:17.06 Make-up of standardized benefit plans.
20:06:13:17.07 Suspension of coverage during period of eligibility for Medicaid.
20:06:13:17.08 Reinstitution of coverage following loss of eligibility for Medicaid.
20:06:13:17.09 Suspension requested by policyholder.
20:06:13:17.10 Prescription drug benefits under Medicare supplement plans.
20:06:13:17.11 General standards for standardized Medicare supplement benefit plan -- Issued for delivery after May 31, 2010.
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.
20:06:13:17.13 Standards for additional benefits.
20:06:13:17.14 Requirements for standard Medicare supplement benefit plans -- Plans issued after May 31, 2010.
20:06:13:17.15 Make-up of standardized benefit plans -- Issued after May 31, 2010.
20:06:13:18 Premium adjustments to match Medicare benefit adjustments.
20:06:13:19 Renewability.
20:06:13:20 Extended benefits on termination of insurance.
20:06:13:21 Loss ratio standards.
20:06:13:21.01 Refund or credit calculation.
20:06:13:22 Annual filing of premium rates.
20:06:13:22.01 Filing of premium adjustments after Medicare benefit change.
20:06:13:22.03 Filing and approval of policies and certificates and of premium rates required.
20:06:13:22.04 One policy or certificate form allowed.
20:06:13:22.05 Discontinuance of availability.
20:06:13:22.06 Combination of experience for calculation of refund or credit.
20:06:13:22.07 New or innovative benefits -- Policy or certificate form allowed -- Exceptions -- Issued after May 31, 2010.
20:06:13:24 Disclosure of preexisting conditions.
20:06:13:25 Increased benefits after issue.
20:06:13:26 Separate additional premium disclosure.
20:06:13:29 Use of term "Medicare supplement."
20:06:13:30 Disclosure requirements for policies or subscriber contracts that are not Medicare supplement policies.
20:06:13:31 Notice requirements for policies or certificates that are not Medicare supplement policies.
20:06:13:31.01 Disclosure requirements for Medicare supplement policies.
20:06:13:31.02 Usual, "customary," and "reasonable" requirements prohibited.
20:06:13:31.03 Free look period.
20:06:13:32 Requirements concerning application forms and replacement coverage.
20:06:13:36 Outline of coverage requirements.
20:06:13:38 Revisions of outline of coverage.
20:06:13:39 Outline of coverage requirements for "usual and customary" benefits.
20:06:13:40 Style and arrangement for outline of coverage.
20:06:13:48 Payment and recognition of physicians.
20:06:13:50 Policy classification -- Requirements and limitations.
20:06:13:52 Filing of policies to comply with Medicare changes.
20:06:13:56 Continuation and conversion rights.
20:06:13:58.01 Health insurance advertisement rate disclosures.
20:06:13:58.02 Health insurance advertisement disclosure statements.
20:06:13:60 Cancellation or nonrenewal of policies.
20:06:13:60.01 Guaranteed renewable with benefit changes.
20:06:13:63 Medicare select policies and certificates.
20:06:13:64 Medicare select authorization.
20:06:13:65 Approval required for issuance.
20:06:13:66 Filing plan of operation.
20:06:13:67 Filing of changes.
20:06:13:68 Network restrictions.
20:06:13:69 Coverage for unavailable services.
20:06:13:70 Disclosure and outline of coverage requirements.
20:06:13:71 Applicant signature required.
20:06:13:72 Complaints and grievances.
20:06:13:73  Required offer of other Medicare supplement coverage.
20:06:13:74 Required offer of replacement coverage without a restricted network provision.
20:06:13:75 Continuation.
20:06:13:77 Creditable coverage.
20:06:13:78 Medicare Advantage plan.
20:06:13:79 Guaranteed issue.
20:06:13:80 Guaranteed issue -- Eligible persons.
20:06:13:80.01 Guaranteed issue time periods.
20:06:13:80.02 Extended medigap access for interrupted trial periods.
20:06:13:81 Guaranteed issue -- Products to which eligible persons are entitled.
20:06:13:82 Guaranteed issue -- Notification provisions.
20:06:13:83 Open enrollment.
20:06:13:84 Open enrollment required for Medicare eligible individuals regardless of age.
20:06:13:85 Notice requirements.
20:06:13:86 Exchanging of standardized plan
20:06:13:86.01 Exchanging of standardized plan -- Age rate schedule
20:06:13:86.02 Exchanging of standardized plan -- Rating class
20:06:13:86.03 Exchanging of standardized plan -- Preexisting conditions and incontestability period.
20:06:13:86.04 Exchanging of standardized plan -- Offering.
Appendix A Medicare Supplement Refund Calculation Forms.
Appendix B Form for Reporting Medicare Supplement Policies.
Appendix C Notice to Applicant Regarding Replacement of Medicare Supplement Insurance.
Appendix D Outline of Medicare Supplement Coverage Policies Plans A through J.
Appendix E Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare.
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.
20:06:22:03 Rate filing required,
 20:06:22:04 Filings of rate revisions.
20:06:22:05 Requirements for history of experience.
20:06:28:01 Filing fees.
20:06:28:03 Filings by third parties.
20:06:28:08 Electronic filings.
20:06:52 Discretionary Clause not permitted
Bulletins
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 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