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Division of Insurance - Health Rate & Form Filing Requirements
Group Disability
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. |
| 58-11-22 | 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. |
| 20:06:52:02 | 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 | Health Policy Rate & Form Filing |
- 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.