Chapter 20:06:13 — MEDICARE SUPPLEMENT INSURANCE

Rule 20:06:13:63 Medicare select policies and certificates. 20:06:13:63. Medicare select policies and certificates. Sections 20:06:13:63 to 20:06:13:76, inclusive, apply to Medicare select policies and certificates, as defined in § 20:06:13:02. A policy or certificate may not be …

Rule 20:06:13:64 Medicare select authorization. 20:06:13:64. Medicare select authorization. The director may authorize an issuer to offer a Medicare select policy or certificate pursuant to § 20:06:13:63 to 20:06:13:76, inclusive, and § 4358 of the Omnibus Budget Reconciliation A…

Rule 20:06:13:65 Approval required for issuance. 20:06:13:65. Approval required for issuance. A Medicare select issuer may not issue a Medicare select policy or certificate in this state until its plan of operation has been approved by the director, pursuant to SDCL 58-17A-2. Sou…

Rule 20:06:13:66 Filing plan of operation. 20:06:13:66. Filing plan of operation. A Medicare select issuer shall file a proposed plan of operation with the director in a format prescribed by the director. The plan of operation must contain at least the following information: (1) …

Rule 20:06:13:67 Filing of changes. 20:06:13:67. Filing of changes. A Medicare select issuer shall file any proposed changes to the plan of operation, except for changes to the list of network providers, with the director before implementing the changes. The changes are considere…

Rule 20:06:13:68 Network restrictions. 20:06:13:68. Network restrictions. A Medicare select policy or certificate may not restrict payment for covered services provided by providers outside the network if: (1) The services are for symptoms requiring emergency care or are immediat…

Rule 20:06:13:69 Coverage for unavailable services. 20:06:13:69. Coverage for unavailable services. A Medicare select policy or certificate shall provide payment for full coverage under the policy for covered services that are not available through network providers. Source: 22 S…

Rule 20:06:13:70 Disclosure and outline of coverage requirements. 20:06:13:70. Disclosure and outline of coverage requirements. A Medicare select issuer shall make full disclosure in writing of the provisions, restrictions, and limitations of the Medicare select policy or certifi…

Rule 20:06:13:71 Applicant signature required. 20:06:13:71. Applicant signature required. Prior to the sale of a Medicare select policy or certificate, a Medicare select issuer must obtain from the applicant a signed and dated form stating that the applicant has received the info…

Rule 20:06:13:72 Complaints and grievances. 20:06:13:72. Complaints and grievances. A Medicare select issuer must have and use procedures for hearing complaints and resolving written grievances from subscribers. Such procedures must be aimed at mutual agreement for settlement and…

Rule 20:06:13:73 Required offer of other Medicare supplement coverage. 20:06:13:73. Required offer of other Medicare supplement coverage. At the time of initial purchase, a Medicare select issuer must make available to each applicant for a Medicare select policy or certificate th…

Rule 20:06:13:74 Required offer of replacement coverage without a restricted network provision. 20:06:13:74. Required offer of replacement coverage without a restricted network provision. At the request of an individual insured under a Medicare select policy or certificate, a Med…

Rule 20:06:13:75 Continuation. 20:06:13:75. Continuation. Medicare select policies and certificates must provide for continuation coverage if the secretary of health and human services determines that Medicare select policies and certificates issued pursuant to §§ 20:06:13:63 to …

Rule 20:06:13:76 Compliance with data requests. 20:06:13:76. Compliance with data requests. A Medicare select issuer must comply with requests for data made by state or federal agencies, including the United States Department of Health and Human Services, for the purpose of evalu…

Rule 20:06:13:77 Creditable coverage. 20:06:13:77. Creditable coverage. For purposes of this chapter, creditable coverage is defined as follows: (1) "Creditable coverage," with respect to an individual, coverage of the individual provided under any of the following: (a) A group h…

Rule 20:06:13:78 Medicare Advantage plan. 20:06:13:78. Medicare Advantage plan. For purposes of this chapter, Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), as in effect on January 1, 2004, and in…

Rule 20:06:13:79 Guaranteed issue. 20:06:13:79. Guaranteed issue. With respect to an eligible person, an issuer may not deny or condition the issuance or effectiveness of a Medicare supplement policy described in § 20:06:13:81 that is offered and is available for issuance to a ne…

Rule 20:06:13:80 Guaranteed issue -- Eligible persons. 20:06:13:80. Guaranteed issue -- Eligible persons. An eligible person is one who seeks to enroll under the policy during the period specified in § 20:06:13:80.01 and who submits evidence of the date of termination, disenrollm…

Rule 20:06:13:80.01 Guaranteed issue time periods. 20:06:13:80.01. Guaranteed issue time periods. (1) In the case of an individual described in subdivision 20:06:13:80(1), the guaranteed issue period begins on the later of: (a) the date the individual receives a notice of termina…

Rule 20:06:13:80.02 Extended medigap access for interrupted trial periods. 20:06:13:80.02. Extended medigap access for interrupted trial periods. (1) In the case of an individual described in subdivision 20:06:13:80(5) (or deemed to be so described, pursuant to this subsection) w…

Rule 20:06:13:81 Guaranteed issue -- Products to which eligible persons are entitled. 20:06:13:81. Guaranteed issue -- Products to which eligible persons are entitled. The Medicare supplement policies to which an eligible person is entitled are as follows: (1) A person eligible u…

Rule 20:06:13:82 Guaranteed issue -- Notification provisions. 20:06:13:82. Guaranteed issue -- Notification provisions. (1) At the time of an event described in § 20:06:13:80 because of which a person loses coverage or benefits due to the termination of a contract or agreement, p…

Rule 20:06:13:83 Open enrollment.` 20:06:13:83. Open enrollment. If an applicant qualifies under SDCL 58-17A-17 and submits an application during the time period referenced in SDCL 58-17A-17 and, as of the date of application, has had a continuous period of creditable coverage of…

Rule 20:06:13:84 Open enrollment required for Medicare eligible individuals regardless of age. 20:06:13:84. Open enrollment required for Medicare eligible individuals regardless of age. Any individual, regardless of age, who becomes eligible for Medicare by reason of age or disab…

Rule 20:06:13:85 Notice requirement. 20:06:13:85. Notice requirement. Any issuer shall comply with any notice requirement of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Source: 31 SDR 214, effective July 6, 2005. General Authority: SDCL 58-4-1, 58-…

Rule 20:06:13:86 Exchanging of standardized plan. 20:06:13:86. Exchanging of standardized plan. An issuer may make a written offer to a policyholder or certificateholder to exchange during a specified period from a 1990 standardized plan to a 2010 standardized plan. Source: 35 SD…

Rule 20:06:13:86.01 Exchanging of standardized plan -- Age rate schedule. 20:06:13:86.01. Exchanging of standardized plan -- Age rate schedule. An issuer need not provide justification to the director if the insured replaces a 1990 Standardized policy or certificate with an issue…

Rule 20:06:13:86.02 Excahnging of standardized plan -- Rating class. 20:06:13:86.02. Exchanging of standardized plan -- Rating class. The rating class of the new policy or certificate is the class closest to the insured's class of the replaced coverage. Source: 35 SDR 183, effect…

Rule 20:06:13:86.03 Exchanging of standardized plan -- Preexisting conditions and incontestability period. 20:06:13:86.03. Exchanging of standardized plan -- Preexisting conditions and incontestability period. An issuer may not apply new pre-existing condition limitations or a ne…

Rule 20:06:13:86.04 Exchanging of standardized plan -- Offering. 20:06:13:86.04. Exchanging of standardized plan -- Offering. The new policy or certificate shall be offered to all policyholders or certificateholders within a given plan, except where the offer or issue would be in…

Rule 20:06:13:87 Applicability of genetic information. 20:06:13:87. Applicability of genetic information. Sections 20:06:13:88 to 20:06:13:92, inclusive, apply to all policies with policy years beginning after May 20, 2009. Source: 35 SDR 183, effective February 2, 2009. General …

Rule 20:06:13:88 Definitions applicable to genetic information. 20:06:13:88. Definitions applicable to genetic information. The following terms are defined for purposes of §§ 20:06:13:88 to 20:06:13:92, inclusive: (1) "Family member," with respect to an individual, any other indi…

Rule 20:06:13:89 Use of genetic information. 20:06:13:89. Use of genetic information. An issuer of a Medicare supplement policy or certificate may not deny or condition the issuance or effectiveness of the policy or certificate, including the imposition of any exclusion of benefi…

Rule 20:06:13:90 Request of genetic testing. 20:06:13:90. Request of genetic testing. Except as provided under § 20:06:13:91 an issuer of a Medicare supplement policy or certificate may not request or require an individual or a family member of such individual to undergo a geneti…

Rule 20:06:13:91 Requirement of genetic testing. 20:06:13:91. Requirement of genetic testing. An issuer of a Medicare supplement policy may request, but not require, that an individual or a family member of such individual undergo a genetic test if each of the following condition…

Rule 20:06:13:92 Genetic information -- Underwriting purposes and enrollment. 20:06:13:92. Genetic information -- Underwriting purposes and enrollment. An issuer of a Medicare supplement policy or certificate may not request, require, or purchase genetic information for underwrit…