Chapter 20:06:13 — MEDICARE SUPPLEMENT INSURANCE

Rule 20:06:13:02.02 Requirements for definitions in policies. 20:06:13:02.02. Requirements for definitions in policies. No policy or certificate may be advertised, solicited, or issued for delivery in this state as a Medicare supplement policy or certificate unless the policy or …

Rule 20:06:13:03 Applicability. 20:06:13:03. Applicability. This chapter applies to all Medicare supplement policies advertised, solicited, delivered, or issued in this state, to all Medicare supplement certificates issued under group Medicare supplement policies, contracts issue…

Rule 20:06:13:04 Repealed. 20:06:13:04. Allowed restrictions on coverage of accidents.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; 15 SDR 143, effective March 29, 1989; repealed, 18 SDR 225, effective July 17, 1992.

Rule 20:06:13:05 Repealed. 20:06:13:05. Effects of other insurance and coverage of accidents.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; repealed, 18 SDR 225, effective July 17, 1992.

Rule 20:06:13:06 Repealed. 20:06:13:06. Restrictions for accidents while employed.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; repealed, 16 SDR 174, effective May 2, 1990.

Rule 20:06:13:07 Repealed. 20:06:13:07. Denial of benefits to persons in skilled nursing facilities prohibited.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; 15 SDR 143, effective March 29, 1989; repealed, 18 SDR 225, effectiv…

Rule 20:06:13:08 Repealed. 20:06:13:08. Skilled nursing facility -- Exclusions.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; repealed, 18 SDR 225, effective July 17, 1992.

Rule 20:06:13:09 Repealed. 20:06:13:09. Hospital reimbursement by nonprofit plans.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; repealed, 18 SDR 225, effective July 17, 1992.

Rule 20:06:13:10 Repealed. 20:06:13:10. Mental or emotional disorders -- Limitations and exclusions.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; 15 SDR 143, effective March 29, 1989; repealed, 18 SDR 225, effective July 17, …

Rule 20:06:13:11 Repealed. 20:06:13:11. Nurse -- Description of classes.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; repealed, 18 SDR 225, effective July 17, 1992.

Rule 20:06:13:12 Repealed. 20:06:13:12. Coverage of sickness -- Allowed restrictions.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; repealed, 15 SDR 143, effective March 29, 1989.

Rule 20:06:13:13 Repealed. 20:06:13:13. Coverage of sickness -- Other insurance. Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; repealed, 36 SDR 209, effective July 1, 2010.

Rule 20:06:13:14 Eligible expenses under Medicare. 20:06:13:14. Eligible expenses under Medicare. Eligible expenses under Medicare means medical expenses that are covered by Medicare to the extent recognized as reasonable and customary by Medicare. Payments, benefits, benefit per…

Rule 20:06:13:14.01 Repealed. 20:06:13:14.01. Health care expenses defined -- Exclusions.Repealed. Source: 15 SDR 143, effective March 29, 1989; repealed, 31 SDR 214, effective July 6, 2005.

Rule 20:06:13:15 Repealed. 20:06:13:15. Permitted policy limitations and exclusions. Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; repealed, 18 SDR 225, effective July 17, 1992.

Rule 20:06:13:16 Waiver of coverage not allowed. 20:06:13:16. Waiver of coverage not allowed. No Medicare supplement policy may use a waiver to exclude, limit, or reduce benefits for a specifically named or described preexisting sickness or physical condition. Source: 8 SDR 174, …

Rule 20:06:13:17 Applicability of benefit standards. 20:06:13:17. Applicability of benefit standards. The following benefit standards described in §§ 20:06:13:17.02 and 20:06:13:17.03 are applicable to all Medicare supplement policies or certificates delivered or issued for deliv…

Rule 20:06:13:17.01 Repealed. 20:06:13:17.01. Benefits restored. Repealed. Source: 16 SDR 174, effective May 2, 1990; repealed, 35 SDR 183, effective February 2, 2009.

Rule 20:06:13:17.02 General standards for 1990 standardized Medicare supplement benefit plans. 20:06:13:17.02. General standards for 1990 standardized Medicare supplement benefit plans. The following standards apply to Medicare supplement policies issued for delivery after July 1…

Rule 20:06:13:17.03 Standards for basic core benefits for 1990 standardized Medicare supplemen plans. 20:06:13:17.03. Standards for basic core benefits for 1990 standardized Medicare supplement benefit plans. Each insurer shall make available a policy or certificate including onl…

Rule 20:06:13:17.04 Standards for additional benefits for 1990 standardized Medicare supplement plans. 20:06:13:17.04. Standards for additional benefits for 1990 standardized Medicare supplement benefit plans. The following additional benefits must be included in Medicare supplem…

Rule 20:06:13:17.05 Requirements for standard Medicare supplement benefit plans. 20:06:13:17.05. Requirements for standard Medicare supplement benefit plans. An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form co…

Rule 20:06:13:17.06 Make-up of standardized benefit plans. 20:06:13:17.06. Make-up of standardized benefit plans. The requirements for the make-up of standardized Medicare supplement benefit plans issued for delivery after July 16, 1992, and prior to June 1, 2010, A to L, inclusi…

Rule 20:06:13:17.07 Suspension of coverage during period of eligibility for Medicaid. 20:06:13:17.07. Suspension of coverage during period of eligibility for Medicaid. A Medicare supplement policy or certificate must provide that benefits and premiums under the policy be suspende…

Rule 20:06:13:17.08 Reinstitution of coverage following loss of eligibility for Medicaid. 20:06:13:17.08. Reinstitution of coverage following loss of eligibility for Medicaid. If suspension of Medicare supplement coverage occurs for a period of eligibility for Medicaid and if the…

Rule 20:06:13:17.09 Suspension requested by policyholder. 20:06:13:17.09. Suspension requested by policyholder. Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended for a period at the request of the policyholder if the poli…

Rule 20:06:13:17.10 Prescription drug benefits under Medicare supplement plans. 20:06:13:17.10. Prescription drug benefits under Medicare supplement plans. The following provisions apply to Medicare supplement plans: (1) A Medicare supplement plan with benefits for outpatient pre…

Rule 20:06:13:17.11 General standards for standardized Medicare supplement benefit plan -- Issued for delivery after May 31, 2010. 20:06:13:17.11. General standards for standardized Medicare supplement benefit plan -- Issued for delivery after May 31, 2010. The following standard…

Rule 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. 20:06:13:17.12. Standards for basic core benefits common to Medicare supplement insurance benefit Plans A, B, C, D, F, F…

Rule 20:06:13:17.13 Standards for additional benefits. 20:06:13:17.13. Standards for additional benefits. The following additional benefits shall be included in Medicare supplement benefit Plans B, C, D, F, F with High Deductible, G, M, and N as described in § 20:06:13:17.11: (1)…

Rule 20:06:13:17.14 Requirements for standard Medicare supplement benefit plans -- Plans issued after May 31, 2010. 20:06:13:17.14. Requirements for standard Medicare supplement benefit plans -- Plans issued after May 31, 2010. An issuer shall make available to each prospective p…

Rule 20:06:13:17.15 Make-up of standardized benefit plans -- Issued after May 31, 2010. 20:06:13:17.15. Make-up of standardized benefit plans -- Issued after May 31, 2010. The requirements for the make-up of standardized Medicare supplement benefit Plans A to L, inclusive, are as…

Rule 20:06:13:17.16 Standard Medicare supplement benefit plans for 2020 standardized Medicare supplement benefit plan policies or certificates issued for delivery to individuals newly eligible for Medicare after December 31, 2019. 20:06:13:17.16. Standard Medicare supplement bene…

Rule 20:06:13:18 Premium adjustments to match Medicare benefit adjustments. 20:06:13:18. Premium adjustments to match Medicare benefit adjustments. Premiums may be adjusted to correspond to changes in Medicare deductible and copayment percentage factors. Before a rate adjustment …

Rule 20:06:13:19 Renewability. 20:06:13:19. Renewability. An insurer may not reserve the right not to renew a policy. A noncancellable, guaranteed renewable, or noncancellable and guaranteed renewable policy may not: (1) Terminate coverage of a spouse solely because of the occurr…

Rule 20:06:13:20 Extended benefits on termination of insurance. 20:06:13:20. Extended benefits on termination of insurance. The payment of benefits shall be continued beyond the termination of insurance if a loss began while the policy was in force and continues past termination.…

Rule 20:06:13:21 Loss ratio standards. 20:06:13:21. Loss ratio standards. A Medicare supplement policy form or certificate form may not be delivered or issued for delivery in this state unless the policy form or certificate form can be expected, as estimated for the entire period…

Rule 20:06:13:21.01 Refund or credit calculation. 20:06:13:21.01. Refund or credit calculation. An issuer shall collect and file with the director by May 31 of each year the data required on the forms in Appendix A at the end of this chapter for each type in a standard Medicare s…

Rule 20:06:13:22 Annual filing of premium rates. 20:06:13:22. Annual filing of premium rates. An issuer of Medicare supplement policies and certificates issued either before or after the effective date of this rule must file its rates, rating schedule, and supporting documentatio…

Rule 20:06:13:22.01 Filing of premium adjustments after Medicare benefit change. 20:06:13:22.01. Filing of premium adjustments after Medicare benefit change. As soon as practicable, but prior to the effective date of enhancements in Medicare benefits, each issuer of Medicare supp…

Rule 20:06:13:22.02 Public hearings. 20:06:13:22.02. Public hearings. The director may conduct a public hearing to gather information concerning a request by an issuer for an increase in a rate for a policy form or certificate form issued either before or after the effective date…

Rule 20:06:13:22.03 Filing and approval of policies and certificates and of premium rates required. 20:06:13:22.03. Filing and approval of policies and certificates and of premium rates required. An issuer may not deliver or issue for delivery a policy or certificate to a residen…

Rule 20:06:13:22.04 One policy or certificate form allowed -- Exceptions. 20:06:13:22.04. One policy or certificate form allowed -- Exceptions. An issuer may not file for approval more than one form of a policy or certificate of each type for each standard Medicare supplement ben…

Rule 20:06:13:22.05 Discontinuance of availability. 20:06:13:22.05. Discontinuance of availability. An issuer shall continue to make available for purchase any policy form or certificate form issued after the effective date of this rule that has been approved by the director, unl…

Rule 20:06:13:22.06 Combination of experience for calculation of refund or credit. 20:06:13:22.06. Combination of experience for calculation of refund or credit. The experience of all policy forms or certificate forms of the same type in a standard Medicare supplement benefit pla…

Rule 20:06:13:22.07 New or innovative benefits -- Policy or certificate form allowed -- Exceptions -- Issued after May 31, 2010. 20:06:13:22.07. New or innovative benefits -- Policy or certificate form allowed -- Exceptions -- Issued after May 31, 2010. An issuer may, with the pr…

Rule 20:06:13:23 Repealed. 20:06:13:23. Rate increases.Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; repealed, 18 SDR 225, effective July 17, 1992.