South Dakota Administrative Code

Rule 20:06:39:13 Repealed. 20:06:39:13. Guaranteed issue -- Formula for calculating percentage of premiums attributable to high-risk individuals. Repealed. Source: 25 SDR 13, effective August 13, 1998; 28 SDR 105, effective February 3, 2002; repealed, 32 SDR 232, effective July 1…

Rule 20:06:39:14 Repealed. 20:06:39:14. Guaranteed issue -- High-risk individuals. Repealed. Source: 25 SDR 13, effective August 13, 1998; 28 SDR 105, effective February 3, 2002; repealed, 32 SDR 232, effective July 10, 2006.

Rule 20:06:39:15 Repealed. 20:06:39:15. Guaranteed issue -- Report of meeting statutory threshold. Repealed. Source: 25 SDR 13, effective August 13, 1998; 28 SDR 105, effective February 3, 2002; repealed, 32 SDR 232, effective July 10, 2006.

Rule 20:06:39:16 Repealed. 20:06:39:16. Guaranteed issue -- Application for determination of disproportionate share. Repealed. Source: 25 SDR 13, effective August 13, 1998; repealed, 32 SDR 232, effective July 10, 2006.

Rule 20:06:39:17 Repealed. 20:06:39:17. Guaranteed issue -- Filing of application. Repealed. Source: 25 SDR 13, effective August 13, 1998; repealed, 32 SDR 232, effective July 10, 2006.

Rule 20:06:39:18 Repealed. 20:06:39:18. Guaranteed issue -- Director’s determination. Repealed. Source: 25 SDR 13, effective August 13, 1998; repealed, 32 SDR 232, effective July 10, 2006.

Rule 20:06:39:19 Guaranteed issue -- Effective date of coverage. 20:06:39:19. Guaranteed issue -- Effective date of coverage. Upon receipt of an application for any major medical coverage subject to SDCL 58-17-66 to 58-17-87, inclusive, from an individual eligible under SDCL 58-1…

Rule 20:06:39:20 Guaranteed issue -- Tolling of 63-day time frame. 20:06:39:20. Guaranteed issue -- Tolling of 63-day time frame. Any substantially completed application, whether an underwritten application or one specifically designed for guaranteed issue products, will toll the…

Rule 20:06:39:20.01 Required timeframe in which to submit subsequent applications for guaranteed issue plans if rejection was received after February 24, 2002. 20:06:39:20.01. Required timeframe in which to submit subsequent applications for guaranteed issue plans if rejection wa…

Rule 20:06:39:20.02 Required timeframe in which to submit subsequent applications for guaranteed issue plans if rejection was received prior to February 25, 2002. 20:06:39:20.02. Required timeframe in which to submit subsequent applications for guaranteed issue plans if rejection…

Rule 20:06:39:20.03 Subsequent rejections and timeframes. 20:06:39:20.03. Subsequent rejections and timeframes. Repealed. Source: 28 SDR 158, effective May 19, 2002; repealed, 32 SDR 232, effective July 10, 2006.

Rule 20:06:39:20.04 Exceptions for those applying during 63-day timeframe following loss of creditable coverage. 20:06:39:20.04. Exceptions for those applying during 63-day timeframe following loss of creditable coverage. Repealed. Source: 28 SDR 158, effective May 19, 2002; repe…

Rule 20:06:39:20.05 Effective date of guaranteed issue plan. 20:06:39:20.05. Effective date of guaranteed issue plan. Any eligible applicant that makes timely application pursuant to SDCL 58-17-85 and §§ 20:06:39:19 to 20:06:39:20.04, inclusive, must be issued coverage with an ef…

Rule 20:06:39:20.06 Repealed. 20:06:39:20.06. Notice requirements regarding guaranteed issue when rejecting applications. Repealed. Source: 28 SDR 158, effective May 19, 2002; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:39:21 Definition of ordinarily prudent person in preexisting condition clauses. 20:06:39:21. Definition of ordinarily prudent person in preexisting condition clauses. For diseases that include symptoms of denial or failure to recognize the disease or illness, a carrier…

Rule 20:06:39:22 Fair market standards for carriers. 20:06:39:22. Fair market standards for carriers. A carrier may not terminate, fail to renew, or limit its contract or agreement of representation with an agent for any reason related to the health status, claims experience, occ…

Rule 20:06:39:23 Group applicability to individual market. 20:06:39:23. Group applicability to individual market. The provisions of §§ 20:06:40:17 to 20:06:40:17.02, inclusive, apply to health insurance coverage offered by a health insurance issuer in the individual market in the…

Rule 20:06:39:24 Repealed. 20:06:39:24. Requirements for standard plan -- Schedule of benefits. Repealed. Source: 27 SDR 69, effective January 15, 2001; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:39:25 Repealed. 20:06:39:25. Requirements for standard plan -- Eligible expenses. Repealed. Source: 27 SDR 69, effective January 15, 2001; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:39:26 Repealed. 20:06:39:26. Requirements for standard plan -- Allowable exceptions and limitations. Repealed. Source: 27 SDR 69, effective January 15, 2001; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:39:27 Repealed. 20:06:39:27. Requirements for basic plan -- Schedule of benefits. Repealed. Source: 27 SDR 69, effective January 15, 2001; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:39:28 Repealed. 20:06:39:28. Requirements for basic plan -- Eligible expenses. Repealed. Source: 27 SDR 69, effective January 15, 2001; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:39:29 Repealed. 20:06:39:29. Requirements for basic plan -- Allowable exceptions and limitations. Repealed. Source: 27 SDR 69, effective January 15, 2001; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:39:30 Usual, customary, and reasonable charges for standard and basic plans. 20:06:39:30. Usual, customary, and reasonable charges for standard and basic plans. For any claim for which the usual, customary, and reasonable policy or contract provision is used, the eligi…

Rule 20:06:39:31 Repealed. 20:06:39:31. Network available for standard and basic plans. Repealed. Source: 27 SDR 69, effective January 15, 2001; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:39:32 Contract of more than six months -- Defined. 20:06:39:32. Contract of more than six months -- Defined. The phrase, contract of more than six months duration, means any contract that provides for renewal by the insured for a period beyond six months after the ince…

Rule 20:06:39:33 Repealed. 20:06:39:33. Coverages prior to August 1, 2003. Repealed. Source: 32 SDR 232, effective July 10, 2006; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:39:34 Repealed. 20:06:39:34. Disclosure requirements. Repealed. Source: 34 SDR 200, effective January 28, 2008; 37 SDR 215, effective May 31, 2011; 39 SDR 203, effective June 10, 2013, repealed, January 1, 2014. Rule 20:06:39:34.01 Disclosure requirements. 20:06:39:34.…

Rule 20:06:39:34.01 Disclosure requirements. 20:06:39:34.01. Disclosure requirements. Any policy or certificate of specified disease, short-term hospital-surgical care having a duration of six months or less but not including short-term major medical, hospital confinement indemni…

Rule 20:06:39:34.02 Renewability of short term major medical plans. 20:06:39:34.02. Renewability of short term major medical plans. For short term major medical plans, as defined in SDCL subdivision 58-17-66(14), the policy must specify an expiration date that is less than 12 mon…

Rule 20:06:39:35 Policy not subject to group requirements. 20:06:39:35. Policy not subject to group requirements. If a carrier upon application for an individual health benefit plan takes reasonable steps to ensure that premiums are not paid by an employer, then a carrier, upon b…

Rule 20:06:39:36 Medically necessary leave of absence defined. 20:06:39:36. Medically necessary leave of absence defined. For purposes of §§ 20:06:39:37 to 20:06:39:39, inclusive, the phrase medically necessary leave of absence means a leave of absence from an accredited institut…

Rule 20:06:39:37 Dependent coverage. 20:06:39:37. Dependent coverage. Any health insurance issuer issuing a health benefit plan that provides dependent coverage for any qualifying child may not terminate coverage due to a medically necessary leave of absence for a period of twelv…

Rule 20:06:39:38 Notification. 20:06:39:38. Notification. Any health insurance carrier providing health insurance coverage, shall include, with any notice regarding a requirement for certification of student status for coverage under the plan, a description of the terms of § 20:0…

Rule 20:06:39:39 Continued application in case of changed coverage. 20:06:39:39. Continued application in case of changed coverage. The provisions of §§ 20:06:39:37 and 20:06:39:38 apply if there is a change in coverage for the dependent child and if the following occur: (1) Depe…

Rule 20:06:39:40 Effective date. 20:06:39:40. Effective date. Sections 20:06:39:36 to 20:06:39:39, inclusive, apply to plan years beginning after December 31, 2009. Source: 36 SDR 96, effective December 9, 2009. General Authority: SDCL 58-17-87. Law Implemented: SDCL 58-17-87.

Rule 20:06:39:41 Creditable coverage -- Children's Health Insurance Program. 20:06:39:41. Creditable coverage -- Children's Health Insurance Program. Coverage provided pursuant to a state's Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act is c…

Rule 20:06:39:42 Association health insurance plans subject to individual market rating requirements. 20:06:39:42. Association health insurance plans subject to individual market rating requirements. A health insurance issuer issuing health policies or certificates to an associat…

Rule 20:06:39:43 Definitions. 20:06:39:43. Definitions. Unless otherwise provided, the following terms are defined for purposes of §§ 20:06:39:43 to 20:06:39:56, inclusive: (1) "Collect," with respect to information, to request, require, or purchase such information; (2) "Family …

Rule 20:06:39:44 Prohibition on genetic information in setting premium rates. 20:06:39:44. Prohibition on genetic information in setting premium rates. An issuer offering health insurance coverage in the individual market may not adjust premium amounts for an individual on the ba…

Rule 20:06:39:45 Limitation on requesting or requiring genetic testing. 20:06:39:45. Limitation on requesting or requiring genetic testing. Except as otherwise provided, an issuer offering health insurance coverage in the individual market may not request or require an individual…

Rule 20:06:39:46 Exceptions to requiring genetic testing. 20:06:39:46. Exceptions to requiring genetic testing. Nothing in § 20:06:39:45 limits the authority of a health care professional who is providing health care services to an individual to request that the individual underg…

Rule 20:06:39:47 Research exception. 20:06:39:47. Research exception. An issuer may request, but not require, that an individual or family member covered under the same policy undergo a genetic test if all of the following conditions are met: (1) The issuer makes the request purs…

Rule 20:06:39:48 Prohibitions on collection of genetic information for underwriting purposes. 20:06:39:48. Prohibitions on collection of genetic information for underwriting purposes. An issuer offering health insurance coverage in the individual market may not collect genetic in…

Rule 20:06:39:49 Medical appropriateness. 20:06:39:49. Medical appropriateness. An issuer in the individual market may limit or exclude a benefit based on whether the benefit is medically appropriate. The determination of whether the benefit is medically appropriate is not within…

Rule 20:06:39:50 Collection of genetic information prior to or in connection with enrollment. 20:06:39:50. Collection of genetic information prior to or in connection with enrollment. An issuer offering health insurance coverage in the individual market may not collect genetic in…

Rule 20:06:39:51 Incidental collection exception. 20:06:39:51. Incidental collection exception. If an issuer offering health insurance coverage in the individual market obtains genetic information incidental to the collection of other information concerning any individual, the co…