South Dakota Administrative Code

Rule 20:06:45:13 Exception to opt out requirements for disclosure of nonpublic personal financial information for service providers and joint marketing. 20:06:45:13. Exception to opt out requirements for disclosure of nonpublic personal financial information for service providers…

Rule 20:06:45:14 Exceptions to notice and opt out requirements for disclosure of nonpublic personal financial information for processing and servicing transactions. 20:06:45:14. Exceptions to notice and opt out requirements for disclosure of nonpublic personal financial informati…

Rule 20:06:45:15 Other exceptions to notice and opt out requirements for disclosure of nonpublic personal financial information. 20:06:45:15. Other exceptions to notice and opt out requirements for disclosure of nonpublic personal financial information. (1) Exceptions to opt out …

Rule 20:06:45:16 Protection of Fair Credit Reporting Act. 20:06:45:16. Protection of Fair Credit Reporting Act. Nothing in this chapter may be construed to modify, limit, or supersede the operation of the federal Fair Credit Reporting Act (15 U.S.C. 1681 et seq.), and no inferenc…

Rule 20:06:45:17 Nondiscrimination. 20:06:45:17. Nondiscrimination. A licensee may not discriminate against any consumer or customer because that consumer or customer has opted out from the disclosure of his or her nonpublic personal financial information pursuant to the provisio…

Rule 20:06:45:18 Effective date. 20:06:45:18. Effective date. (1) Effective date. This chapter is effective July 1, 2001. (2) (A) Notice requirement for consumers who are the licensee's customers on the compliance date. By July 1, 2001, a licensee shall provide an initial notice,…

Rule 20:06:45:19 Obligation to provide information to director. 20:06:45:19. Obligation to provide information to director. Nothing in this chapter shall in any way affect the obligations of any licensee to provide information to the director under the laws and rules of this stat…

Rule 20:06:45:20 Information security program. 20:06:45:20. Information security program. Each licensee shall implement a comprehensive written information security program that includes administrative, technical, and physical safeguards for the protection of customer information…

Rule 20:06:45:21 Objectives of information security program. 20:06:45:21. Objectives of information security program. A licensee's information security program shall be designed to: (A) Ensure the security and confidentiality of customer information; (B) Protect against any antic…

Rule 20:06:45:22 Examples of methods of development and implementation. 20:06:45:22. Examples of methods of development and implementation. The actions and procedures described in §§ 20:06:45:23 to 20:06:45:26, inclusive, are examples of methods of implementing the requirements o…

Rule 20:06:45:23 Assess risk. 20:06:45:23. Assess risk. The licensee: (A) Identifies reasonably foreseeable internal or external threats that could result in unauthorized disclosure, misuse, alteration, or destruction of customer information or customer information systems; (B) A…

Rule 20:06:45:24 Manage and control risk. 20:06:45:24. Manage and control risk. The licensee: (A) Designs its information security program to control the identified risks, commensurate with the sensitivity of the information, as well as the complexity and scope of the licensee's …

Rule 20:06:45:25 Oversee service provider arrangements. 20:06:45:25. Oversee service provider arrangements. The licensee: (A) Exercises appropriate due diligence in selecting its service providers; and (B) Requires its service providers to implement appropriate measures designed …

Rule 20:06:45:26 Adjust the program. 20:06:45:26. Adjust the program. The licensee monitors, evaluates, and adjusts, as appropriate, the information security program in light of any relevant changes in technology, the sensitivity of its customer information, internal or external …

Rule 20:06:45:27 Disclosure of nonpublic personal health information. 20:06:45:27. Disclosure of nonpublic personal health information. A licensee may not disclose nonpublic personal health information about a consumer or customer unless an authorization is obtained from the cons…

Rule 20:06:45:28 Authorization to disclose nonpublic personal health information. 20:06:45:28. Authorization to disclose nonpublic personal health information. An authorization to disclose nonpublic personal health information pursuant to § 20:06:45:27 shall be in written or elec…

Rule 20:06:45:29 Authorization delivery. 20:06:45:29. Authorization delivery. A request for authorization and an authorization form may be delivered to a customer as part of an opt-out notice pursuant to § 20:06:45:09 if the request and the authorization form are clear and conspi…

Rule 20:06:45:30 Relationship to federal rules. 20:06:45:30. Relationship to federal rules. Irrespective of whether a licensee is subject to the federal Health Insurance Portability and Accountability Act privacy rule as promulgated by the U.S. Department of Health and Human Serv…

Rule 20:06:45:31 Relationship to state laws. 20:06:45:31. Relationship to state laws. Nothing in this chapter preempts or supercedes existing state law related to medical records, or health or insurance information privacy. Source: 31 SDR 67, effective November 14, 2004. General …

Rule 20:06:46:01 Definitions. 20:06:46:01. Definitions. Terms used in this chapter mean: (1) "Affiliation period," a period of time that must expire before health insurance coverage provided by a carrier becomes effective, and during which the carrier is not required to provide b…

Rule 20:06:46:02 Criteria that cannot be used to determine benefit eligibility. 20:06:46:02. Criteria that cannot be used to determine benefit eligibility. A carrier may not use health status; medical condition, including both physical and mental illnesses; claims experience; rec…

Rule 20:06:46:03 Rules for eligibility may not discriminate based on any health factor. 20:06:46:03. Rules for eligibility may not discriminate based on any health factor. A carrier subject to this chapter may not establish a rule for eligibility, including continued eligibility,…

Rule 20:06:46:04 Condition of enrollment or continued enrollment may not require additional premium for similarly situated individuals. 20:06:46:04. Condition of enrollment or continued enrollment may not require additional premium for similarly situated individuals. A carrier su…

Rule 20:06:46:05 Premium or contribution differential based on completion of a bona fide wellness program. 20:06:46:05. Premium or contribution differential based on completion of a bona fide wellness program. Notwithstanding § 20:06:46:04, a carrier subject to this chapter may e…

Rule 20:06:46:06 Benefit restrictions must be uniformly applied to all similarly situated individuals. 20:06:46:06. Benefit restrictions must be uniformly applied to all similarly situated individuals. Except as required by this section, § 20:06:46:03 does not require a carrier s…

Rule 20:06:46:07 Treatment resulting from domestic violence or a medical condition. 20:06:46:07. Treatment resulting from domestic violence or a medical condition. If a carrier subject to this chapter generally provides benefits for a type of injury, the plan or carrier may not d…

Rule 20:06:46:08 Preexisting condition exclusion requirements. 20:06:46:08. Preexisting condition exclusion requirements. Section 20:06:46:03 does not prohibit a carrier subject to this chapter from imposing a preexisting condition exclusion period if the preexisting exclusion pe…

Rule 20:06:46:09 Treatment of similarly situated individuals. 20:06:46:09. Treatment of similarly situated individuals. Sections 20:06:46:06 to 20:06:46:12, inclusive, apply only within a group of individuals who are treated as similarly situated individuals. Source: 29 SDR 48, e…

Rule 20:06:46:10 Employment based factors in determining two or more distinct groups of participants. 20:06:46:10. Employment based factors in determining two or more distinct groups of participants. Subject to § 20:06:46:12, § 20:06:46:03 does not prohibit a carrier subject to t…

Rule 20:06:46:11 Beneficiaries treated as two or more distinct groups. 20:06:46:11. Beneficiaries treated as two or more distinct groups. Subject to § 20:06:46:12, § 20:06:46:03 does not prohibit a carrier subject to this chapter from treating beneficiaries as two or more distinc…

Rule 20:06:46:12 Creation or modification of an employment or coverage classification not permitted. 20:06:46:12. Creation or modification of an employment or coverage classification not permitted. Notwithstanding §§ 20:06:46:10 and 20:06:46:11, unless permitted under § 20:06:46:…

Rule 20:06:46:13 Rule of eligibility or individual's premium or contribution rate. 20:06:46:13. Rule of eligibility or individual's premium or contribution rate. Except to the extent permitted under § 20:06:46:14 or 20:06:46:15, in accordance with §§ 20:06:46:03 to 20:06:46:05, i…

Rule 20:06:46:14 Actively-at-work not a condition of eligibility or premium or contribution rate. 20:06:46:14. Actively-at-work not a condition of eligibility or premium or contribution rate. In accordance with §§ 20:06:46:03 to 20:06:46:05, inclusive, a carrier subject to this c…

Rule 20:06:46:15 Rule of eligibility or individual premium or contribution permitted. 20:06:46:15. Rule of eligibility or individual premium or contribution permitted. Notwithstanding §§ 20:06:46:13 and 20:06:46:14, a carrier subject to this chapter may establish a rule of eligib…

Rule 20:06:47:01 Scope. 20:06:47:01. Scope. This chapter applies to group disability income insurance policies as defined in SDCL 58-17-108. Source: 30 SDR 39, effective September 28, 2003; 37 SDR 241, effective July 1, 2011. General Authority: SDCL 58-17H-49. Law Implemented: SD…

Rule 20:06:47:02 Establishment of claims procedures. 20:06:47:02. Establishment of claims procedures. Any plan providing disability benefits shall establish and maintain reasonable claim procedures. The procedures shall include the following: (1) A description of all claim proced…

Rule 20:06:47:03 Unacceptable claims procedures. 20:06:47:03. Unacceptable claims procedures. The claims procedures may not contain any provisions or be administered in a method that unduly inhibits or hampers the initiation or processing of claims for benefits such as: (1) Denyi…

Rule 20:06:47:04 Initial benefit determination. 20:06:47:04. Initial benefit determination. Any plan providing disability benefits shall notify a covered person, or if applicable, the covered person's authorized representative, of a benefit determination within a reasonable time …

Rule 20:06:47:05 Adverse benefit notification. 20:06:47:05. Adverse benefit notification. The plan shall provide a covered person or, if applicable, the person's authorized representative, with written or electronic notification of any adverse benefit determination in a manner ca…

Rule 20:06:47:06 Appeal of adverse benefit determination. 20:06:47:06. Appeal of adverse benefit determination. Any plan providing disability benefits, upon receipt of an appeal of an adverse benefit determination, shall notify a covered person or, if applicable, the covered pers…

Rule 20:06:47:07 Full and fair review. 20:06:47:07. Full and fair review. The plan shall provide full and fair review of an adverse benefit determination. Evidence of a full and fair review consists of the following: (1) A reasonable opportunity to submit written comments, docume…

Rule 20:06:47:08 Relevant claim information. 20:06:47:08. Relevant claim information. A document, record, or other information shall be considered relevant to a claim if such document, record, or other information: (1) Was relied upon in making the benefit determination; (2) Was …

Rule 20:06:48:01 Repealed. 20:06:48:01. Eligible person -- Defined. Repealed. Source: 30 SDR 51, effective October 28, 2003; repealed, SL 2015, ch 249, § 32, effective July 1, 2015.

Rule 20:06:48:02 Repealed. 20:06:48:02. Enrollment forms. Repealed. Source: 30 SDR 51, effective October 28, 2003; repealed, SL 2015, ch 249, § 33, effective July 1, 2015.

Rule 20:06:48:03 Repealed. 20:06:48:03. Tolling of 63-day timeframe. Repealed. Source: 30 SDR 51, effective October 28, 2003; 31 SDR 214, effective July 6, 2005; repealed, SL 2015, ch 249, § 33, effective July 1, 2015.

Rule 20:06:48:04 Repealed. 20:06:48:04. Risk pool application timeframe. Repealed. Source: 30 SDR 51, effective October 28, 2003; repealed, SL 2015, ch 249, § 33, effective July 1, 2015.

Rule 20:06:48:05 Repealed. 20:06:48:05. Effective date of risk pool coverage. Repealed. Source: 30 SDR 51, effective October 28, 2003; repealed, SL 2015, ch 249, § 33, effective July 1, 2015.