South Dakota Administrative Code

Rule 20:06:23:04 Criteria for targeted exams. 20:06:23:04. Criteria for targeted exams. In targeting a company for an examination not within the five-year examination schedule, the division may use any one of the following criteria in making that determination: (1) The company me…

Rule 20:06:23:05 Farm mutual annual statement information. 20:06:23:05. Farm mutual annual statement information. A farm mutual shall file the annual statement adopted by the division on December 31, 1989, and shall report all information required by the annual statement unless w…

20:06:25:01. Annual statements. An insurer shall file an annual statement in accordance with the standards adopted by the National Association of Insurance Commissioners in the 2025 edition of the Accounting Practices and Procedures Manual, and the 2024 editions of the following …

20:06:25:01.01. Accounting methods for certain surety bonds. An insurer writing surety bonds guaranteeing to lending institutions the repayment of student loans made by lending institutions may, in lieu of compliance with SSAP No. 60 of the Accounting Practices and Procedures Man…

20:06:25:01.02. Accounting methods for bail bonds. An insurer writing bail bonds may, in lieu of compliance with SSAP No. 53 of the Accounting Practices and Procedures Manual, 2025 edition, report bail bond written premiums less agent commissions and may recognize total premiums …

20:06:25:02. Actuarial opinions. Actuarial opinions must be filed in accordance with standards adopted by the National Association of Insurance Commissioners in the manuals on Annual Statement Instructions - Life, Accident, and Health/Fraternal, 2024 edition, and Annual Statement…

20:06:26:01. Standards for rating and valuation of investments. The division's standards for rating and valuing investments are set forth in the Purposes and Procedures Manual of the NAIC Investment Analysis Office, 2024 edition. Source: 21 SDR 144, effective February 19, 1995; 2…

Rule 20:06:27:01 Definitions. 20:06:27:01. Definitions. Terms used in this section mean: (1) "ASC Z12N standard format," the standards for electronic data interchange within the health care industry developed by the Accredited Standards Committee Z12N Insurance Subcommittee of th…

Rule 20:06:27:02 Scope. 20:06:27:02. Scope. Except as otherwise specifically provided, the requirements of this chapter apply to issuers, health care providers, and institutional care practitioners. Nothing in this chapter prevents an issuer from requesting additional information…

Rule 20:06:27:03 Requirements for use of HCFA Form 1500. 20:06:27:03. Requirements for use of HCFA Form 1500. The HCFA Form 1500 shall be used as follows: (1) Health care practitioners, other than dentists, shall use the HCFA Form 1500, adopted by HCFA, approved by AMA Council on…

Rule 20:06:27:04 Requirements for use of HCFA Form 1450. 20:06:27:04. Requirements for use of HCFA Form 1450. The HCFA Form 1450 shall be used as follows: (1) Institutional care practitioners shall use the HCFA Form UB-92 HCFA-1450, adopted by HCFA and in effect as of June 30, 19…

Rule 20:06:27:05 Requirements for use of J512 Form. 20:06:27:05. Requirements for use of J512 Form. The J512 Form shall be used as follows: (1) Dentists shall use the Dental Claim Form, J512, adopted by the American Dental Association as of 1994, according to instructions contain…

Rule 20:06:27:06 General provisions for the filing and processing of claims. 20:06:27:06. General provisions for the filing and processing of claims. Health care practitioners, institutional care practitioners, and issuers shall file and process claims in the following manner: (1…

Rule 20:06:27:07 Mandatory electronic format. 20:06:27:07. Mandatory electronic format. Issuers that receive claims or send payments by electronic means shall, by the date on which the Health Care Financing Administration requires it of Medicare intermediaries and carriers, accep…

Rule 20:06:28:01 Filing fees -- Identification and documentation 20:06:28:01. Filing fees -- Identification and documentation. A form filing is not considered filed for purposes of SDCL chapter 58-11 unless the following requirements are met: (1) Any requisite retaliatory fee owe…

Rule 20:06:28:02 Repealed. 20:06:28:02. Duplicates. Repealed. Source: 22 SDR 52, effective October 25, 1995; repealed, 33 SDR 230, effective July 2, 2007.

Rule 20:06:28:03 Filings by third parties. 20:06:28:03. Filings by third parties. If an entity other than the insurer whose forms are being filed makes the filing, an authorization from the insurer must accompany the filing. Source: 22 SDR 52, effective October 25, 1995. General …

Rule 20:06:28:04 Repealed. 20:06:28:04. Follow-up correspondence -- Identification. Repealed. Source: 22 SDR 52, effective October 25, 1995; repealed, 33 SDR 230, effective July 2, 2007.

Rule 20:06:28:05 Repealed. 20:06:28:05. Self-addressed, stamped envelope. Repealed. Source: 22 SDR 52, effective October 25, 1995; repealed, 33 SDR 230, effective July 2, 2007.

Rule 20:06:28:06 Life and annuity filings -- Actuarial certification of rating and nonforfeiture requirements. 20:06:28:06. Life and annuity filings -- Actuarial certification of rating and nonforfeiture requirements. Each life and annuity filing must contain an actuarial certifi…

Rule 20:06:28:07 Property and casualty filings -- Identification -- Reference filings prohibited -- Exception. 20:06:28:07. Property and casualty filings -- Identification -- Reference filings prohibited -- Exception. Each property or casualty filing which uses an Insurance Servi…

Rule 20:06:28:08 Electronic filings. 20:06:28:08. Electronic filings. All form filings must be submitted through the System for Electronic Rate and Form filing, SERFF. An electronic form filing must meet the requirements of this chapter only to the extent that the requirements ar…

Rule 20:06:28:09 Workers' compensation claim expenditure report required. 20:06:28:09. Workers' compensation claim expenditure report required. Each insurer providing workers' compensation insurance in this state must file a workers' compensation claim expenditure report each mon…

Rule 20:06:29:00 Lending institution coverage. 20:06:29:00. Lending institution coverage. For purposes of this chapter the terms policyholder and insured include borrowers whose property is covered through coverage purchased by the lending institution covering that lending instit…

Rule 20:06:29:01 Cancellation by insurer or policyholder. 20:06:29:01. Cancellation by insurer or policyholder. An insurer canceling a policy must return to the policyholder unearned premiums on at least a pro rata basis. An insurer may use a short rate calculation of unearned pr…

Rule 20:06:29:02 Replacement of policy. 20:06:29:02. Replacement of policy. This section applies to the cancellation date of any replaced policy, other than a life or health policy. If the replacing policy is already effective on the date an insured or an insured's representative…

Rule 20:06:29:03 Cancellation refunds. 20:06:29:03. Cancellation refunds. An insurer shall issue and mail any refund due the insured within 20 days after the insurer receives a request for cancellation or, if the insurer cancels the policy, within 20 days after the effective date…

Rule 20:06:29:04 Format for notice of transfer of insurance. 20:06:29:04. Format for notice of transfer of insurance. An insurer that transfers a policyholder to another insurer within the same group of insurers may issue, in lieu of a nonrenewal notice, a notice that contains th…

Rule 20:06:29:05 Definitions. 20:06:29:05. Definitions. Terms used in this chapter mean: (1) "Pro rata method," the pro rata unearned gross premium method produces the minimum refund amount to be used for insurance under which premiums are collected from the insured on a basis ot…

20:06:30:01. Scope. This chapter applies to all domestic life and accident and health insurers and to all other licensed life and accident and health insurers which are not subject to a substantially similar regulation in their domiciliary state. This chapter also applies to the …

Rule 20:06:30:02 Conditions prohibiting reductions in liability or establishment of assets. 20:06:30:02. Conditions prohibiting reductions in liability or establishment of assets. An insurer subject to this chapter may not, for reinsurance ceded, reduce a liability or establish a…

Rule 20:06:30:03 Certain assets allowed to be held without segregation. 20:06:30:03. Certain assets allowed to be held without segregation. Notwithstanding the requirements of subdivision 20:06:30:02(7), the assets supporting the reserves for the following classes of business and…

Rule 20:06:30:04 Formula for determining reserve interest rate adjustment. 20:06:30:04. Formula for determining reserve interest rate adjustment. The associated formula for determining the reserve interest rate adjustment must reflect the ceding company's investment earnings and …

Rule 20:06:30:05 Table of risk categories. 20:06:30:05. Table of risk categories. The following is a table of risk categories that are considered to be significant for purposes of considering the transfer of risk. The categories of risk are as follows: (1) Morbidity; (2) Mortalit…

Rule 20:06:30:06 Prior approval of director required for reserve credits or establishing assets. 20:06:30:06. Prior approval of director required for reserve credits or establishing assets. Notwithstanding the first paragraph of §20:06:30:02, an insurer subject to this chapter ma…

Rule 20:06:30:07 Agreements -- Actuarial information required about financial impact. 20:06:30:07. Agreements -- Actuarial information required about financial impact. An agreement entered into after the effective date of this chapter which involves the reinsurance of business is…

Rule 20:06:30:08 Agreements -- Reporting of surplus increases. 20:06:30:08. Agreements -- Reporting of surplus increases. Any increase in surplus net of federal income tax resulting from arrangements described in § 20:06:30:07 must be identified separately on the insurer's financ…

Rule 20:06:30:09 Execution of agreement, amendment, or letter of intent required. 20:06:30:09. Execution of agreement, amendment, or letter of intent required. A reinsurance agreement or an amendment to an agreement may not be used to reduce a liability or to establish an asset i…

Rule 20:06:30:10 Letter of intent -- Time allowed for execution of agreement or amendment. 20:06:30:10. Letter of intent -- Time allowed for execution of agreement or amendment. A reinsurance agreement or an amendment to a reinsurance agreement must be executed within 90 days aft…

Rule 20:06:30:11 Reinsurance agreement -- Required provisions. 20:06:30:11. Reinsurance agreement -- Required provisions. The reinsurance agreement must contain the following provisions: (1) That the agreement constitutes the entire agreement between the parties regarding the bus…

Rule 20:06:30:12 Existing agreements. 20:06:30:12. Existing agreements. Insurers subject to this chapter shall reduce to zero by January 1, 1996, any reserve credits or assets established regarding reinsurance agreements entered into before the effective date of this chapter whic…

20:06:30:13. Definitions. The following definitions apply to §§ 20:06:30:13 to 20:06:30:20, inclusive: (1) “Actuarial method,” the methodology used to determine the required level of primary security, as described in § 20:06:30:14; (2) “Covered policy,” subject to the exemptions …

20:06:30:14. The actuarial method. A ceding insurer shall use the VM-20 actuarial method to establish the required level of primary security for each reinsurance treaty subject to §§ 20:06:30:13 to 20:06:30:20, inclusive, applied on a treaty-by-treaty basis from the Valuation Man…

20:06:30:14.01. Adjustments for other reinsurance treaties. The adjustments for other reinsurance treaties may only be made with respect to reinsurance treaties entered into directly by the ceding insurer. The ceding insurer may not make an adjustment as a result of a retrocessio…

20:06:30:15. Valuation used for purposes of calculations. For purposes of calculating the required level of primary security pursuant to the actuarial method and determining the amount of primary security and other security, as applicable, held by or on behalf of the ceding insur…

20:06:30:16. Requirements applicable to a covered policy to obtain credit for reinsurance. Subject to the exemptions described in § 20:06:30:18 and the provisions of § 20:06:30:17, credit for reinsurance must be allowed with respect to ceded liabilities pertaining to a covered po…

20:06:30:17. Requirements at inception date and on an on-going basis -- Remediation. The requirements of § 20:06:30:16 must be satisfied as of the date that risks under a covered policy are ceded, if that date is on or after the effective date of §§ 20:06:30:13 to 20:06:30:20, in…

20:06:30:18. Exemptions. Sections 20:06:30:13 to 20:06:30:20, inclusive, do not apply to the following: (1) Reinsurance of: (a) A policy that satisfies the criteria for an exemption under the attained-age-based yearly renewable term life insurance policies exemption or the unitar…

20:06:30:19. Prohibition against avoidance. No insurer that has a covered policy as to which §§ 20:06:30:13 to 20:06:30:20, inclusive, apply may take any action, or enter into any transaction or arrangement, if the purpose of that action, transaction or arrangement is to avoid th…

20:06:30:20. Applicability. In the event of a direct conflict between the provisions of §§ 20:06:30:13 to 20:06:30:20, inclusive, and the provisions in chapter 20:06:31, the provisions of §§ 20:06:30:13 to 20:06:30:20, inclusive, apply, but only to the extent of the conflict. Sou…