Title 58, INSURANCE

No issuer may deny or condition the issuance or effectiveness of any medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of health care, or …

The director shall promulgate rules pursuant to chapter 1-26 to establish specific standards and requirements for medicare supplement policies and certificates. The standards and requirements shall be in addition to and in accordance with applicable laws of this state and may cov…

Notwithstanding any other provision of law, a medicare supplement policy or certificate may not exclude or limit benefits for losses incurred more than six months from the effective date of coverage for a preexisting condition. The policy or certificate may not define a preexisti…

A policy or certificate of insurance providing medicare supplement benefits which is sold to a consumer to replace an existing, in - force medicare supplement policy may not contain any provision limiting payment of benefits due to preexisting conditions of the insured except, if…

Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director shall issue regulations to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experie…

To provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate may be delivered or issued for delivery in this state and no certificate may be delivered pursuant to a group medicare supplement policy delivered or …

The director may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for medicare which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of medicare. Exc…

The director may promulgate rules pursuant to chapter 1-26 for captions or notice requirements determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not medicare supplement coverages, for all health insurance p…

Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within thirty days of its delivery and to hav…

An issuer shall issue policies in this state for which an examination period is required in accordance with one of the following methods: (1) If the policy is delivered by an insurance producer, a receipt shall be signed by the policyowner acknowledging delivery of the policy. Th…

Regulations promulgated pursuant to this chapter shall be subject to the provisions of chapter 1-26 . Source: SL 1982, ch 360 , § 9.

This chapter applies to policies delivered or issued for delivery in this state on or after July 1, 1989. This law does not supersede the obligations of entities subject to this chapter to comply with other applicable insurance laws insofar as they do not conflict with this chapt…

An outline of coverage shall be delivered to an applicant for an individual long - term care insurance policy at the time of application for an individual policy. In the case of direct response solicitations, the insurer shall deliver the outline of coverage upon the applicant's …

A certificate issued pursuant to a group long - term care insurance policy which policy is delivered or issued for delivery in this state shall include: (1) A description of the principal benefits and coverage provided in the policy; (2) A statement of the principal exclusions, r…

No policy may be advertised, marketed, or offered as long - term care or nursing facility insurance unless it complies with the provisions of this chapter. Source: SL 1989, ch 440 , § 13.

Any long - term care policy offered for sale in this state shall offer as an endorsement an annual cost - of - living adjustment in daily benefits paid. Nothing in this section requires an insurer that offers a long - term care policy which pays benefits on an expense - incurred …

The director may promulgate rules pursuant to chapter 1-26 to establish specific standards and requirements for a cost - of - living adjustment to long - term care policies. The standards or requirements may cover: (1) Types and duration of adjustments; (2) Underwriting; and (3) …

No group long - term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in subdivisions 58-17B-2(4)(a) and (4)(d) unless this state or another state having statutory and regulatory long - term care …

Rules adopted pursuant to this chapter shall be in accordance with the provisions of chapter 1-26 . Source: SL 1989, ch 440 , § 17.

If an insured is receiving benefits for long-term care services in a nursing home or assisted living facility under a long-term care policy or certificate subject to this chapter, and temporarily leaves the nursing home or assisted living facility for a period not to exceed fourt…

Terms used in this chapter mean: (1) "Applicant," (a) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (b) In the case of a group long-term care insurance policy, the proposed certificate holder; (2) "Certificate," a…

An individual policy delivered or issued for delivery may not contain provisions less favorable to the insured than "guaranteed renewable" for life. Source: SL 1989, ch 440 , § 3.

The director may adopt rules, pursuant to chapter 1-26 , that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long - term care insurance policies, terms of renewability, initial and subsequent conditions o…

No long - term care insurance policy may: (1) Be cancelled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; or (2) Contain a provision establishing a new waiting p…

If a long - term care policy replaces another long - term care policy issued by the company or by an affiliated company, the insurer shall waive any time period applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods in the new long - …

No long - term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in subdivision 58-17B-2(4)(a): (1) Shall use a definition of "preexisting condition" which is more restrictive than the following: Preexisting condition …

No long - term care insurance policy may be delivered or issued for delivery in this state if the policy: (1) Conditions eligibility for any benefits on a prior hospitalization requirement; (2) Conditions eligibility for benefits provided in an institutional care setting on the r…

The director may adopt rules, pursuant to chapter 1-26 , establishing loss ratio standards for long - term care insurance policies provided that a specific reference to long - term insurance policies is contained in the regulation. Source: SL 1989, ch 440 , § 9.

Long - term care insurance policyholders shall have the right to return the policy within thirty days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Long - term care insurance policies shall …

Terms used in this chapter mean: (1) "Utilization review," a review of health care services provided or to be provided to an individual to assist in the determination of the nature of the injury or condition, or the appropriateness of the treatment provided or to be provided; (2)…

A utilization review organization that conducts utilization reviews solely for property and casualty insurers in this state pursuant to policies issued in this state is not subject to chapters 58-17F , 58-17G , 58-17H , and 58-17I except that any such utilization review organizat…

Any property and casualty insurer seeking utilization review with respect to an insurance contract issued in this state may only use a utilization review organization registered pursuant to this chapter. Source: SL 2002, ch 231 , § 3.

Any utilization review pursuant to this chapter shall be administered by a qualified licensed health care professional. Any adverse determination shall be evaluated by an appropriately licensed and clinically qualified health care professional. Any utilization review evaluation s…

No utilization review organization may base its fees or charges on any recommendation for reduction in payment under an insurance contract or on a percentage of claim savings. Source: SL 2002, ch 231 , § 5.

An insurer that denies, in whole or in part, a policyholder's claim after consideration of a utilization review shall provide the policyholder with an opportunity to request reconsideration and to submit additional information relating to the claim. Source: SL 2002, ch 231 , § 6.

Nothing in this chapter is intended to create or abrogate any cause of action as a result of a violation of the standards in this chapter. Source: SL 2002, ch 231 , § 7.

For the purposes of this chapter, the term, affiliate, means a person that directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the person specified. For the purposes of this section, the term, control, or con…

After the receipt of an application filed pursuant to § 58-17E-9 , the director shall review the application and notify the applicant of any deficiencies in the application. Source: SL 2006, ch 257 , § 9.

Prior to registration by the director, each discount medical plan organization shall establish an internet website in order to conform to the requirements of § 58-17E-31 . Source: SL 2006, ch 257 , § 10.

Any registration is effective for one year, unless prior to its expiration the registration is renewed in accordance with this section or suspended or revoked in accordance with § 58-17E-14 . At least forty-five days before a registration expires, the discount medical plan organi…

The director shall renew the registration of each holder that meets the requirements of this chapter. Source: SL 2006, ch 257 , § 12.

The director may suspend the authority of a discount medical plan organization to enroll new members or refuse to renew or revoke a discount medical plan organization's registration if the director finds that any of the following conditions exist: (1) The discount medical plan or…

If the director has cause to believe that grounds for the nonrenewal, suspension, or revocation of a registration exists, the director shall notify the discount medical plan organization in writing specifically stating the grounds for the refusal to renew or suspension or revocat…

If the registration of a discount medical plan organization is surrendered, revoked, or not renewed, the discount medical plan organization shall proceed, immediately following the effective date of the order of revocation or, in the case of a nonrenewal, the date of expiration o…

The director shall, in its order suspending the authority of the discount medical plan organization to enroll new members, specify the period during which the suspension is to be in effect and the conditions, if any, that shall be met by the discount medical plan organization pri…

In lieu of suspending or revoking a discount medical plan organization's registration pursuant to § 58-17E-14 , if the discount medical plan organization has been found to have violated any provision of this chapter, the director may enter into a consent order pursuant to § 58-4-…