South Dakota Administrative Code

Rule 20:06:40:74 Repealed. 20:06:40:74. Establishment of sub-classifications for determining parity for outpatient benefits. Repealed. Source: 37 SDR 215, effective May 31, 2011; 39 SDR 219, effective June 26, 2013; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:75 Definitions. 20:06:40:75. Definitions. (1) "Employer contribution rule," a requirement relating to the minimum level or amount of employer contribution toward the premium for enrollment of participants and beneficiaries; (2) "Group participation rule," a requirem…

Rule 20:06:40:76 Guaranteed issue. 20:06:40:76. Guaranteed issue. A small employer health insurance issuer must offer each of its small employer plans to any eligible small employer on a guaranteed issue basis without medical underwriting. A small employer health insurance issuer…

Rule 20:06:40:77 Disclosure requirements. 20:06:40:77. Disclosure requirements. In its sales and solicitation materials, a health insurance issuer must disclose that the following specific materials are available upon request: (1) A statement detailing the health insurance issuer…

Rule 20:06:40:78 Guaranteed availability of coverage in the group market. 20:06:40:78. Guaranteed availability of coverage in the group market. A health insurance issuer that offers health insurance in the group market in this state must offer to any individual or employer in the…

Rule 20:06:40:79 Denial of coverage. 20:06:40:79. Denial of coverage. A health insurance issuer may deny health insurance coverage in the group market if the issuer demonstrates to the director the following: (1) The health insurance issuer does not have the financial reserves ne…

Rule 20:06:40:80 Special enrollment period effective dates. 20:06:40:80. Special enrollment period effective dates. A health insurance issuer must provide special enrollment periods consistent with this section, during which qualified individuals and enrollees may enroll in plans…

Rule 20:06:40:81 Special enrollment triggers. 20:06:40:81. Special enrollment triggers. A health insurance issuer offering health insurance coverage in the group market and SHOP Exchange as defined in § 20:06:55:32 must allow for an individual to enroll or change from one nongran…

Rule 20:06:40:82 Nonrenew or discontinuance of coverage. 20:06:40:82. Nonrenew or discontinuance of coverage. A health insurance issuer offering health insurance coverage in the group market is required to renew or continue in force the coverage at the option of the plan sponsor …

Rule 20:06:40:83 Discontinuing a particular product. 20:06:40:83. Discontinuing a particular product. If an issuer discontinues offering a particular product in the group market, that product may be discontinued by the issuer in the applicable market only if the following occurs:…

Rule 20:06:40:84 Discontinuing all coverage. 20:06:40:84. Discontinuing all coverage. An issuer may elect to discontinue offering all health insurance coverage in the group market, or all markets, in a state in accordance with applicable state law only if the issuer meets all of …

Rule 20:06:40:85 Exception for uniform modification of coverage. 20:06:40:85. Exception for uniform modification of coverage. Only at the time of coverage renewal may issuers modify the health insurance coverage for a product offered to a group health plan in the following: (1) L…

Rule 20:06:40:86 Preexisting condition exclusion and waiting period prohibited. 20:06:40:86. Preexisting condition exclusion and waiting period prohibited. A health insurance issuer offering a group health benefit plan may not impose any preexisting condition exclusion or preexis…

Rule 20:06:40:87 Clinical trial. 20:06:40:87. Clinical trial. A health insurance issuer that offers a health benefit plan providing group market health insurance coverage in this state may not: (1) Deny participation by a qualified individual in an approved clinical trial; (2) De…

Rule 20:06:40:88 Full-time equivalents treated as full-time employees. 20:06:40:88. Full-time equivalents treated as full-time employees. Solely for purposes of determining whether an employer is an applicable large employer under this paragraph, an employer shall, in addition to…

Rule 20:06:40:89 Applicability. 20:06:40:89. Applicability. The provisions of §§ 20:06:40:75 to 20:06:40:88 apply for plan years beginning after December 31, 2013. Except as otherwise specified in this chapter, the chapter applies to small and large employers. Sections 20:06:40:7…

Rule 20:06:41:01 Repealed. 20:06:41:01. Guaranteed issue. Repealed. Source: 24 SDR 35, effective September 29, 1997; 39 SDR 203, adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:02 Repealed. 20:06:41:02. Disclosure requirements. Repealed. Source: 24 SDR 35, effective September 29, 1997; 39 SDR 203, adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:03 Repealed. 20:06:41:03. Guaranteed issue -- Criteria for meeting the exception for issuing coverage to high-risk small employers. Repealed. Source: 25 SDR 13, effective August 13, 1998; 39 SDR 203 adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:04 Repealed. 20:06:41:04. Guaranteed issue -- Premiums counted toward 2 percent threshold. Repealed. Source: 25 SDR 13, effective August 13, 1998; 39 SDR 203, adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:05 Repealed. 20:06:41:05. Guaranteed issue -- Formula for calculating percentage of premiums attributable to high-risk small employers. Repealed. Source: 25 SDR 13, effective August 13, 1998; 39 SDR 203, adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:06 Repealed, 20:06:41:06. Guaranteed issue -- High-risk small employers. Repealed. Source: 25 SDR 13, effective August 13, 1998; 39 SDR 203, adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:07 Repealed. 20:06:41:07. Guaranteed issue -- Report of meeting 2 percent threshold. Repealed. Source: 25 SDR 13, effective August 13, 1998; 39 SDR 203, adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:08 Repealed. 20:06:41:08. Guaranteed issue -- Application for determination of disproportionate share. Repealed. Source: 25 SDR 13, effective August 13, 1998; 39 SDR 203, adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:09 Repealed. 20:06:41:09. Guaranteed issue -- Filing of application. Repealed. Source: 25 SDR 13, effective August 13, 1998; 39 SDR 203, adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:10 Repealed. 20:06:41:10. Guaranteed issue -- Director’s determination. Repealed. Source: 25 SDR 13, effective August 13, 1998; 39 SDR 203, adopted June 10, 2013, repealed January 1, 2014.

Rule 20:06:41:11 Effective dates. 20:06:41:11. Effective dates. Sections 20:06:41:01 to 20:06:41:11, inclusive, are repealed effective January 1, 2014. Source: 39 SDR 203, effective June 10, 2013. General Authority: SDCL 58-18B-20. Law Implemented: SDCL 58-18B-20.

Rule 20:06:42:01 Eligible associations defined. 20:06:42:01. Eligible associations defined. A bona fide association is a group of persons who have joined for some common purpose or goal. A bona fide association is eligible for the issuance of group health insurance if all of the …

Rule 20:06:42:01.01 Notification to association members. 20:06:42:01.01. Notification to association members. Each application for insurance and each policy and certificate issued by an insurer through an association plan with employer members shall contain in ten-point type on t…

Rule 20:06:42:02 Credit unions. 20:06:42:02. Credit unions. Credit unions formed pursuant to state or federal law are associations eligible for the issuance of group health insurance. Source: 26 SDR 44, effective October 6, 1999. General Authority: SDCL 58-18-62. Law Implemented:…

Rule 20:06:43:01 Definitions. 20:06:43:01. Definitions. Terms used in this chapter mean: (1) "1983 Table 'a'," a mortality table developed by the Society of Actuaries Committee to Recommend a New Mortality Basis for Individual Annuity Valuation and adopted as a recognized mortali…

Rule 20:06:43:02 Individual annuity or pure endowment contracts. 20:06:43:02. Individual annuity or pure endowment contracts. (1) Except as provided in subdivision 2 of this section, the 1983 Table "a" and the Annuity 2000 Mortality Table are recognized and approved as individual…

Rule 20:06:43:02.01 Application of the 2012 IAR Mortality Table. 20:06:43:02.01. Application of the 2012 IAR Mortality Table. In using the 2012 IAR Mortality Table, the mortality rate for a person age x in year (2012 + n) is calculated as follows: qx2012+n=qx2012(1-G2x)n The resu…

Rule 20:06:43:03 Group annuity or pure endowment contracts. 20:06:43:03. Group annuity or pure endowment contracts. (1) Except as provided in subdivision 2 of this section, the 1983 GAM Table, the 1983 Table "a", and the 1994 GAR Table are recognized and approved as group annuity…

Rule 20:06:43:04 Application of the 1994 GAR Table. 20:06:43:04. Application of the 1994 GAR Table. In using the 1994 GAR Table, the mortality rate for a person age x in year (1994 + n) is calculated as follow: qx1994+n=qx1994(1-AAx)n where the qx1994s and AAxs are as specified i…

Rule 20:06:44:01 Definitions. 20:06:44:01. Definitions. Terms used in this chapter mean: (1) "Director," the director of the Division of Insurance, Department of Labor and Regulation; (2) "Division," the Division of Insurance, Department of Labor and Regulation; (3) "Department,"…

Rule 20:06:44:02 Standards and criteria for qualification as a nonprofit organization. 20:06:44:02. Standards and criteria for qualification as a nonprofit organization. To qualify as a nonprofit organization as described under SDCL subdivision 58-4A-13(7) the organization must: …

Rule 20:06:44:03 Procedures for recognition as a nonprofit organization. 20:06:44:03. Procedures for recognition as a nonprofit organization. Any organization that seeks recognition as a nonprofit organization under SDCL subdivision 58-4A-13(7) shall comply with the following pro…

Rule 20:06:45:01 Purpose and scope. 20:06:45:01. Purpose and scope. (1) Purpose. This chapter governs the treatment of nonpublic personal health information and nonpublic personal financial information about individuals by all licensees of the state insurance division. This chapt…

Rule 20:06:45:02 Rule of construction. 20:06:45:02. Rule of construction. The examples in this chapter and the sample clauses in Appendix A of this chapter are not exclusive. Compliance with an example or use of a sample clause, to the extent applicable, constitutes compliance wi…

Rule 20:06:45:03 Definitions. 20:06:45:03. Definitions. Terms used in this chapter mean, unless the context requires otherwise: (1) "Affiliate," any company that controls, is controlled by, or is under common control with another company. (2) (A) "Clear and conspicuous," that a n…

Rule 20:06:45:04 Initial privacy notice to consumers required. 20:06:45:04. Initial privacy notice to consumers required. (1) Initial notice requirement. A licensee shall provide a clear and conspicuous notice that accurately reflects its privacy policies and practices to: (A) Cu…

Rule 20:06:45:05 Annual privacy notice to customers required. 20:06:45:05. Annual privacy notice to customers required. (1) (A) General rule. A licensee shall provide a clear and conspicuous notice to customers that accurately reflects its privacy policies and practices not less …

Rule 20:06:45:06 Information to be included in privacy notices. 20:06:45:06. Information to be included in privacy notices. (1) General rule. The initial, annual, and revised privacy notices that a licensee provides under §§ 20:06:45:04, 20:06:45:05, and 20:06:45:08 shall include…

Rule 20:06:45:07 Form of opt out notice to consumers and opt out methods. 20:06:45:07. Form of opt out notice to consumers and opt out methods. (1) (A) Form of opt out notice. If a licensee is required to provide an opt out notice under subdivision 20:06:45:10(1), it shall provid…

Rule 20:06:45:08 Revised privacy notices. 20:06:45:08. Revised privacy notices. (1) General rule. Except as otherwise authorized in this chapter, a licensee may not, directly or through an affiliate, disclose any nonpublic personal financial information about a consumer to a nona…

Rule 20:06:45:09 Delivery. 20:06:45:09. Delivery. (1) How to provide notices. A licensee shall provide any notices that this chapter requires so that each customer can reasonably be expected to receive actual notice in writing or, if the consumer agrees, electronically. (2) (A) E…