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Division of Insurance - Health Rate & Form Filing Requirements
Individual 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. |
| 58-17-1 | 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. |
| 58-17-10.1 | Reduction of policy at option of insurer - statement included in policy so informing policyholder. |
| 58-17-11 | Free look period. |
| 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. |
| 58-17-17 | 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. |
| 58-17-34 | Earnings of insured - policy provision for adjustment of benefits. |
| 58-17-35 | Earnings adjustment clause to be coupled with insured's right to continue policy in force. |
| 58-17-36 | Option of insurer to define valid loss of time coverage. |
| 58-17-37 | Unpaid premiums--Deduction from benefits. |
| 58-17-38 | Conformity with state statutes of insured. |
| 58-17-39 | Illegal occupation of insured. |
| 58-17-41 | Order of policy provisions. |
| 58-17-42 | Age limit in policy. |
| 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. |
| 58-17-97 | 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. |
| 58-33-13 | 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 |
|
| 20:06:22:01 | Types of renewal clauses. |
| 20:06:22:02 | Anticipated loss ratio requirements. |
| 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. |
| 20:06:39:21 | Definition of ordinarily prudent person in preexisting condition clauses. |
| 20:06:52:02 | Discretionary clause not permitted. |
Bulletins |
|
| Bulletin 07-01 | SERFF required for all form and rate filings. |
| Bulletin 08-04 | Health Policy Rate and 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 an 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.