Chapter 20:06:13 — MEDICARE SUPPLEMENT INSURANCE

Rule 20:06:13:27 Buyer's guide. 20:06:13:27. Buyer's guide. Issuers of accident and sickness policies or certificates which provide hospital or medical expense coverage on an expense-incurred or indemnity basis to persons eligible for Medicare shall provide to applicants a copy o…

Rule 20:06:13:28 Delivery of buyer's guide. 20:06:13:28. Delivery of buyer's guide. A policy sold through an agent shall include a buyer's guide at the time of application. The agent shall obtain a signed acknowledgment of receipt from the applicant. The insurer shall maintain th…

Rule 20:06:13:29 Use of term "Medicare supplement." 20:06:13:29. Use of term "Medicare supplement." A policy or insurance contract not in compliance with this chapter may not use the terms "Medicare supplement," "medigap," "Medicare wrap-around," or words of similar meaning and m…

Rule 20:06:13:30 Disclosure requirements for policies or subscriber contracts that are not Medicare supplement policies. 20:06:13:30. Disclosure requirements for policies or subscriber contracts that are not Medicare supplement policies. Any issuer selling an accident and sicknes…

Rule 20:06:13:31 Notice requirements for policies or certificates that are not Medicare supplement policies. 20:06:13:31. Notice requirements for policies or certificates that are not Medicare supplement policies. The disclosure notice required by § 20:06:13:30 must be in at leas…

Rule 20:06:13:31.01 Disclosure requirements for Medicare supplement policies -- Riders and endorsements. 20:06:13:31.01. Disclosure requirements for Medicare supplement policies -- Riders and endorsements. Medicare supplement policies shall include a renewal, continuation, or non…

Rule 20:06:13:31.02 "Usual," "customary," and "reasonable" requirements prohibited. 20:06:13:31.02. "Usual," "customary," and "reasonable" requirements prohibited. Medicare supplement policies or certificates may not provide for the payment of benefits based on standards describe…

Rule 20:06:13:31.03 Right of return. 20:06:13:31.03. Right of return. Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate, or attached thereto, stating in substance that the policyholder or certifica…

Rule 20:06:13:32 Requirements concerning application forms and replacement coverage. 20:06:13:32. Requirements concerning application forms and replacement coverage. Application forms must include the following statements and questions which are designed to elicit information as …

Rule 20:06:13:32.01 Transferred. 20:06:13:32.01. Transferred to § 20:06:13:32.

Rule 20:06:13:32.02 Disclosure by agent. 20:06:13:32.02. Disclosure by agent. On the application or the supplementary application or form, agents shall list any health insurance policies they have sold to the applicant. The list shall contain policies still in force and policies …

Rule 20:06:13:33 Repealed. 20:06:13:33. Replacement requirements for agents. Repealed. Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; 16 SDR 174, effective May 2, 1990; repealed, 35 SDR 306, effective July 1, 2009.

Rule 20:06:13:34 Replacement requirements for direct response insurers. 20:06:13:34. Replacement requirements for direct response insurers. Direct response insurers shall deliver a notice regarding replacement of coverage to the applicant at the time the policy is issued. Source:…

Rule 20:06:13:35 Notice of replacement. 20:06:13:35. Notice of replacement. Upon determining that a sale will involve replacement of Medicare supplement coverage, any issuer, other than a direct response issuer, or its agent, shall furnish the applicant, prior to issuance or deli…

Rule 20:06:13:36 Outline of coverage requirements. 20:06:13:36. Outline of coverage requirements. An outline of coverage for Medicare supplement policies, as found in Appendix D at the end of this chapter, must be provided. The outline of coverage provided to applicants pursuant …

Rule 20:06:13:37 Delivery of outline of coverage. 20:06:13:37. Delivery of outline of coverage. Issuers issuing Medicare supplement policies for delivery in this state shall provide the outline of coverage at the time the application is taken. Except for direct response policies,…

Rule 20:06:13:38 Revisions of outline of coverage. 20:06:13:38. Revisions of outline of coverage. If the coverage actually provided is different from the coverage outlined at the time of application, a substitute outline of coverage showing the coverage actually issued shall acco…

Rule 20:06:13:39 Repealed. 20:06:13:39. Outline of coverage requirements for "usual and customary" benefits. Repealed Source: 8 SDR 174, effective July 1, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; 22 SDR 107, effective February 18, 1996; repealed, 36 SDR 209, effectiv…

Rule 20:06:13:40 Style and arrangement for outline of coverage. 20:06:13:40. Style and arrangement for outline of coverage. The style, arrangement, and overall appearance of a policy may not give undue prominence to any portion of the text. Every portion of the text must be clear…

Rule 20:06:13:41 Repealed. 20:06:13:41. Supplemental disclosure form.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; 22 SDR 107, effective February 18, 1996; repealed, 25 SDR 13, effective …

Rule 20:06:13:42 Repealed. 20:06:13:42. Variable information for supplemental disclosure form. 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, 36 SDR 209, effective July 1, 2010.

Rule 20:06:13:43 Overinsurance. 20:06:13:43. Overinsurance. A health insurance policy issued to a Medicaid recipient or to a person who already possesses insurance substantially covering the same risk and paying for the same coverage is overinsurance. If the director determines a…

Rule 20:06:13:43.01 Misrepresentation -- Unfair or deceptive trade practices. 20:06:13:43.01. Misrepresentation -- Unfair or deceptive trade practices. An agent is presumed to have violated SDCL 58-33-5 when the agent knowingly solicits, procures, or sells to any prospective insu…

Rule 20:06:13:43.02 Determination of suitability. 20:06:13:43.02. Determination of suitability. To determine whether the sale or solicitation of policies described in § 20:06:13:43.01 is reasonable, prudent, or in the prospective insured's best interest, the agent, if any, shall …

Rule 20:06:13:43.03 Medicare supplement and Medicare Part C (Medicare Advantage) or Medicare Cost duplication. 20:06:13:43.03. Medicare supplement and Medicare Part C (Medicare Advantage) or Medicare Cost duplication. Duplication of coverage between Medicare supplement insurance …

Rule 20:06:13:44 Failure to provide required forms. 20:06:13:44. Failure to provide required forms. Failure of an insurance agent to provide any forms required by this chapter is a violation of this state's Unfair Trade Practices Act. Failure of a direct response insurer to provi…

Rule 20:06:13:45 Refund in replacement situations. 20:06:13:45. Refund in replacement situations. An insurer issuing a Medicare supplement policy replacing a Medicare supplement policy shall allow for a full refund of premium if the refund is requested within 30 days after the in…

Rule 20:06:13:46 Coverage replaced within the same company. 20:06:13:46. Coverage replaced within the same company. An insurer issuing new insurance replacing insurance with the same insurer shall allow the insured 30 days to reinstate the replaced coverage without evidence of in…

Rule 20:06:13:47 Insurance replaced by the same agent. 20:06:13:47. Insurance replaced by the same agent. If an agent replaces insurance originally placed by that agent, the insured shall be allowed to reinstate the replaced coverage if application is made within 30 days after th…

Rule 20:06:13:48 Repealed. 20:06:13:48. Payment and recognition of physicians. Repealed. Source: 15 SDR 143, effective March 29, 1989; 18 SDR 225, effective July 17, 1992; repealed, 36 SDR 209, effective July 1, 2010.

Rule 20:06:13:49 Requirements for claims payment. 20:06:13:49. Requirements for claims payment. An issuer shall comply with § 1882(c)(3) of the Social Security Act {as enacted by § 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203}, 4…

Rule 20:06:13:50 Policy classification -- Requirements and limitations. 20:06:13:50. Policy classification -- Requirements and limitations. No agent or insurer may classify a Medicare supplement policy as a 100 percent policy or describe any benefit as paying 100 percent unless t…

Rule 20:06:13:51 Notice of benefit change. 20:06:13:51. Notice of benefit change. At least 30 days before the annual effective date of Medicare benefit changes each issuer, health care service plan, or other entity providing Medicare supplement insurance or benefits to a resident…

Rule 20:06:13:52 Repealed. 20:06:13:52. Filing of policies to comply with Medicare changes. Repealed. Source: 15 SDR 143, effective March 29, 1989; repealed, 36 SDR 209, effective July 1, 2010.

Rule 20:06:13:53 Duplication of coverage prohibited. 20:06:13:53. Duplication of coverage prohibited. No Medicare supplement insurance policy, contract, or certificate may be issued or issued for delivery in this state which provides benefits which duplicate benefits provided by …

Rule 20:06:13:54 Repealed. 20:06:13:54. Reinstitution of coverage. Repealed. Source: 16 SDR 174, effective May 2, 1990; repealed, 36 SDR 209, effective July 1, 2010.

Rule 20:06:13:55 Exception to reinstitution of coverage. 20:06:13:55. Exception to reinstitution of coverage. An insurer is not required to make the offer under § 20:06:13:54 to an individual who is a policyholder or certificateholder in another Medicare supplement policy as of J…

Rule 20:06:13:56 Continuation and conversion rights. 20:06:13:56. Continuation and conversion rights. Group members of a group Medicare supplement insurance policy may continue or convert their rights under the following conditions: (1) If a group Medicare supplement insurance po…

Rule 20:06:13:57 Standards for marketing. 20:06:13:57. Standards for marketing. Every issuer, health care service plan, or other entity marketing Medicare supplement insurance coverage in this state, directly or through its agents or representatives, shall: (1) Establish marketin…

Rule 20:06:13:58 Marketing practices prohibited. 20:06:13:58. Marketing practices prohibited. No person may employ any method of marketing to induce the purchase of insurance through force, fright, or threat whether explicit or implied or apply undue pressure to purchase insuranc…

Rule 20:06:13:58.01 Health insurance advertisement rate disclosures. 20:06:13:58.01. Health insurance advertisement rate disclosures. Unless the disclosure made as required by § 20:06:13:58.02 is provided, no individual or group health insurance policy or certificate may in its a…

Rule 20:06:13:58.02 Health insurance advertisement disclosure statements. 20:06:13:58.02. Health insurance advertisement disclosure statements. Any health insurance advertisement that includes a statement for which disclosure is required pursuant to § 20:06:13:58.01 must contain …

Rule 20:06:13:59 Reporting of multiple policies. 20:06:13:59. Reporting of multiple policies. For each individual resident of this state for whom the insurer or entity has in force more than one Medicare supplement insurance policy or certificate, each insurer or other entity pro…

Rule 20:06:13:60 Cancellation or nonrenewal of policies. 20:06:13:60. Cancellation or nonrenewal of policies. Except as authorized by the director, an issuer may not cancel or refuse to renew a Medicare supplement policy or certificate for any reason other than nonpayment of prem…

Rule 20:06:13:60.01 Guaranteed renewable with benefit changes. 20:06:13:60.01. Guaranteed renewable with benefit changes. An issuer that eliminates an outpatient prescription drug benefit as a result of requirements imposed by the Medicare Prescription Drug, Improvement and Moder…

Rule 20:06:13:61 Agent compensation limited. 20:06:13:61. Agent compensation limited. An issuer or other entity may provide a commission or other compensation to an agent or other representative for the sale of a Medicare supplement policy or certificate only if the commission or…

Rule 20:06:13:62 Repealed. 20:06:13:62. Requirements of insurers. Repealed. Source: 17 SDR 58, effective October 29, 1990; repealed, 36 SDR 209, effective July 1, 2010.