South Dakota Administrative Code

Rule 20:06:32:05 Conduct of hearings. 20:06:32:05. Conduct of hearings. Hearings, unless otherwise required by statute, must be conducted in accordance with this chapter and in accordance with the provisions of SDCL chapter 1-26. Source: 23 SDR 179, effective April 27, 1997. Gene…

Rule 20:06:32:06 Notice of time and place of hearings -- Hearing examiner. 20:06:32:06. Notice of time and place of hearings -- Hearing examiner. Hearings shall be held at the time and place directed by the director. The director shall send written notice of the hearing to all pa…

Rule 20:06:32:07 All parties to be heard. 20:06:32:07. All parties to be heard. The hearing examiner may order proposed findings of fact and conclusions of law from any party to the hearing on the examiner's own motion or at the request of any party. Source: 23 SDR 179, effective…

Rule 20:06:32:08 Decisions. 20:06:32:08. Decisions. The director shall make a declaratory ruling within 30 days after the hearing examiner submits proposed findings of fact and conclusions of law to the director. The director may take an additional 60 days to make a ruling if wri…

Rule 20:06:32:09 Refusal to rule. 20:06:32:09. Refusal to rule. The director may refuse to make a declaratory ruling if the ruling would not end the uncertainty or controversy giving rise to the proceeding. The refusal must be sent to all parties in accordance with the time const…

Rule 20:06:33:01 Registration fee. 20:06:33:01. Registration fee. The fee for initial or annual registration of a utilization review organization or a managed care contractor is $250. Source: 23 SDR 2, effective July 1, 1996; 25 SDR 167, effective July 1, 1999; 37 SDR 241, effect…

Rule 20:06:33:02 Form and content of access plans. 20:06:33:02. Form and content of access plans. Each initial filing of an access plan pursuant to SDCL 58-17F-10 must contain the following: (1) A complete copy of the entire access plan; (2) A complete copy of the current provide…

Rule 20:06:33:03 Annual filing of access plans. 20:06:33:03. Annual filing of access plans. A health insurance issuer is required to either file any changes or an attestation stating no changes have been made, annually on or before September 30th of each year of their access plan…

Rule 20:06:33:04 Centers of Excellence -- Access plans. 20:06:33:04. Centers of Excellence -- Access plans. Each contracted Center of Excellence and each contracted network of a Center of Excellence must be included in a health carrier's access plan. For purposes of network adequ…

Rule 20:06:34:01 Repealed. 20:06:34:01. Definitions.Repealed. Source: 24 SDR 85, effective December 31, 1997; 28 SDR 4, effective July 26, 2001; repealed, 30 SDR 39, effective September 28, 2003.

Rule 20:06:34:02 Repealed. 20:06:34:02. Grievance procedure.Repealed. Source: 24 SDR 85, effective December 31, 1997; 28 SDR 4, effective July 26, 2001; repealed, 30 SDR 39, effective September 28, 2003.

Rule 20:06:34:03 Repealed. 20:06:34:03. Submission of a grievance.Repealed. Source: 24 SDR 85, effective December 31, 1997; 28 SDR 4, effective July 26, 2001; repealed, 30 SDR 39, effective September 28, 2003.

Rule 20:06:34:04 Repealed. 20:06:34:04. Review of a grievance.Repealed. Source: 24 SDR 85, effective December 31, 1997; 28 SDR 4, effective July 26, 2001; repealed, 30 SDR 39, effective September 28, 2003.

Rule 20:06:34:05 Repealed. 20:06:34:05. Standard review timetable.Repealed. Source: 24 SDR 85, effective December 31, 1997; 28 SDR 4, effective July 26, 2001; repealed, 30 SDR 39, effective September 28, 2003.

Rule 20:06:34:06 Repealed. 20:06:34:06. Availability of expedited review.Repealed. Source: 24 SDR 85, effective December 31, 1997; 28 SDR 4, effective July 26, 2001; repealed, 30 SDR 39, effective September 28, 2003.

Rule 20:06:34:07 Repealed. 20:06:34:07. Expedited review.Repealed. Source: 24 SDR 85, effective December 31, 1977; 28 SDR 4, effective July 26, 2001; repealed, 30 SDR 39, effective September 28, 2003.

Rule 20:06:34:08 Repealed. 20:06:34:08. Appeal from expedited review decision.Repealed. Source: 24 SDR 85, effective December 31, 1997; 28 SDR 4, effective July 26, 2001; repealed, 30 SDR 39, effective September 28, 2003.

Rule 20:06:34:09 Repealed. 20:06:34:09. Written decision contents.Repealed. Source: 24 SDR 85, effective December 31, 1997; 28 SDR 4, effective July 26, 2001; repealed, 30 SDR 39, effective September 28, 2003.

Rule 20:06:34:10 Requests for urgent care determinations. 20:06:34:10. Requests for urgent care determinations. The provisions of SDCL 58-17H-41 apply only to requests for urgent care determinations. Source: 30 SDR 39, effective September 28, 2003; 37 SDR 241, effective July 1, 2…

Rule 20:06:34:11 Scope of retrospective review. 20:06:34:11. Scope of retrospective review. Retrospective review does not include an audit performed by a carrier subsequent to the adjudication of a claim provided that the audit does not result in any financial liability against t…

20:06:34:12. Grievance report required. Repealed. Source: 31 SDR 67, effective November 14, 2004; 37 SDR 241, effective July 1, 2011; 50 SDR 13, effective August 10, 2023.

Rule 20:06:35:01 Notice requirements. 20:06:35:01. Notice requirements. The notice to policyholders of a change in maternity coverage, whether it is a separate notice or is incorporated within a mailing to policyholders, must contain the following language, with the caption in 14…

20:06:36:01. Definitions. Terms used in this chapter mean: (1) "Adjusted RBC report," a RBC report that has been adjusted by the director in accordance with § 20:06:36:06; (2) "Corrective order," an order that has been issued by the director and which specifies the corrective act…

Rule 20:06:36:02 RBC levels defined. 20:06:36:02. RBC levels defined. RBC levels are defined as follows: (1) Company action level RBC is the product of 2.0 and its authorized control level RBC; (2) Regulatory action level RBC is the product of 1.5 and its authorized control level…

Rule 20:06:36:03 RBC reports. 20:06:36:03. RBC reports. As required by SDCL 58-4-48, each domestic insurer or domestic health organization shall file by March 1 a report of its RBC levels as of the end of the calendar year just ended, in a form and containing the information requ…

Rule 20:06:36:04 Life and health insurer's RBC reports. 20:06:36:04. Life and health insurer's RBC reports. A life and health insurer's RBC report shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take into account, and may ad…

Rule 20:06:36:05 Property and casualty insurer's and health organization's RBC reports. 20:06:36:05. Property and casualty insurer's and health organization's RBC reports. A property and casualty insurer's or health organization's RBC report shall be determined in accordance with…

Rule 20:06:36:06 Adjusted RBC report. 20:06:36:06. Adjusted RBC report. If a domestic insurer or domestic health organization files an RBC report which in the judgment of the director is inaccurate, the director shall adjust the RBC report to correct the inaccuracy and shall noti…

Rule 20:06:36:07 Company action level event. 20:06:36:07. Company action level event. A company action level event is any of the following events: (1) The filing of an RBC report by an insurer or health organization which indicates one of the following: (a) The insurer's or healt…

Rule 20:06:36:08 Company action level event -- Filing of RBC plan. 20:06:36:08. Company action level event -- Filing of RBC plan. If a company action level event occurs, the insurer or health organization shall prepare and submit to the director an RBC plan which does the followi…

Rule 20:06:36:09 Time for filing RBC plan. 20:06:36:09. Time for filing RBC plan. The RBC plan must be submitted within 45 days of the company action level event or, if the insurer or health organization challenges an adjusted RBC report pursuant to § 20:06:36:21, within 45 days …

Rule 20:06:36:10 Review of RBC plan by director. 20:06:36:10. Review of RBC plan by director. Within 60 days after the submission by an insurer or health organization of an RBC plan to the director, the director may notify the insurer whether the RBC plan shall be implemented or …

Rule 20:06:36:11 Unsatisfactory RBC plan -- Notice of regulatory action event. 20:06:36:11. Unsatisfactory RBC plan -- Notice of regulatory action event. If the director notifies an insurer or health organization that the insurer's or health organization's RBC plan or revised RBC…

Rule 20:06:36:12 Additional filing requirements for RBC plan. 20:06:36:12. Additional filing requirements for RBC plan. Each domestic insurer or domestic health organization that files an RBC plan or revised RBC plan with the director shall file a copy of the RBC plan or revised …

Rule 20:06:36:13 Regulatory action level event. 20:06:36:13. Regulatory action level event. A regulatory action level event, for any insurer or health organization, is any of the following: (1) The filing of an RBC report by the insurer or health organization which indicates that…

Rule 20:06:36:14 Regulatory action level event -- Required actions by director. 20:06:36:14. Regulatory action level event -- Required actions by director. If a regulatory action level event occurs, the director shall do the following: (1) Require the insurer or health organizati…

Rule 20:06:36:15 Regulatory action level event -- Time for filing RBC plan or revised RBC plan. 20:06:36:15. Regulatory action level event -- Time for filing RBC plan or revised RBC plan. The RBC plan or revised RBC plan must be submitted as follows: (1) Within 45 days after the …

Rule 20:06:36:16 Regulatory action level event -- Hiring of consultants by director. 20:06:36:16. Regulatory action level event -- Hiring of consultants by director. The director may retain actuaries and investment experts and other consultants necessary in the judgment of the di…

Rule 20:06:36:17 Authorized control level event. 20:06:36:17. Authorized control level event. An authorized control level event is any of the following events: (1) The filing of an RBC report by the insurer or health organization which indicates that the insurer's or health organ…

Rule 20:06:36:18 Authorized control level event -- Actions of director. 20:06:36:18. Authorized control level event -- Actions of director. If an authorized control level event occurs, the director shall do the following: (1) Take actions required under §§ 20:06:36:13 to 20:06:36…

Rule 20:06:36:19 Mandatory control level event. 20:06:36:19. Mandatory control level event. A mandatory control level event is any of the following: (1) The filing of an RBC report which indicates that the insurer's or health organization's total adjusted capital is less than its…

Rule 20:06:36:20 Mandatory control level event -- Actions of director. 20:06:36:20. Mandatory control level event -- Actions of director. If a mandatory control level event occurs for a life or health insurer or health organization, the director shall take the actions necessary t…

Rule 20:06:36:21 Hearings. 20:06:36:21. Hearings. An insurer or health organization may challenge any determination or action by the director by requesting the director for a confidential division hearing within five days after notice to an insurer or health organization by the d…

Rule 20:06:36:22 Confidentiality of RBC reports. 20:06:36:22. Confidentiality of RBC reports. All RBC reports, to the extent that information in them is not required to be set forth in a publicly available annual statement schedule, and RBC plans, including the results or report …

Rule 20:06:36:22.01 Confidentiality of RBC reports -- Sharing and receiving of information by director. 20:06:36:22.01. Confidentiality of RBC reports -- Sharing and receiving of information by director. In order to assist in the performance of the director's duties, the director…

Rule 20:06:36:22.02 Confidentiality of RBC reports -- Waiver. 20:06:36:22.02. Confidentiality of RBC reports -- Waiver. No waiver of any applicable privilege or claim of confidentiality in the documents, materials, or information occurs as a result of disclosure to the director o…

Rule 20:06:36:23 Assertions regarding RBC reports prohibited. 20:06:36:23. Assertions regarding RBC reports prohibited. Except as otherwise required by this chapter, any person engaged in any manner in the insurance business may not make, either directly or indirectly, an asserti…