CHAPTER 20:06:13 MEDICARE SUPPLEMENT INSURANCE. 20:06:13:02.01 Requirements for definition of "accident" and similar words in policies.
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1 CHAPTER 20:06:13 MEDICARE SUPPLEMENT INSURANCE Section 20:06:13:01 Repealed. 20:06:13:02 Definitions. 20:06:13:02.01 Requirements for definition of "accident" and similar words in policies. 20:06:13:02.02 Requirements for definitions in policies. 20:06:13:03 Applicability. 20:06:13:04 to 20:06:13:13 Repealed. 20:06:13:14 Eligible expenses under Medicare. 20:06:13:14.01 and 20:06:13:15 Repealed. 20:06:13:16 Waiver of coverage not allowed. 20:06:13:17 Applicability of benefit standards. 20:06:13:17.01 Repealed. 20:06:13:17.02 General standards for 1990 standardized Medicare supplement benefit plans. 20:06:13:17.03 Standards for basic core benefits for 1990 standardized Medicare supplement benefit plans. 20:06:13:17.04 Standards for additional benefits for 1990 standardized Medicare supplement benefit plans. 20:06:13:17.05 Requirements for standard Medicare supplement benefit plans. 20:06:13:17.06 Make-up of standardized benefit plans. 20:06:13:17.07 Suspension of coverage during period of eligibility for Medicaid. 1
2 20:06:13:17.08 Reinstitution of coverage following loss of eligibility for Medicaid. 20:06:13:17.09 Suspension requested by policyholder. 20:06:13:17.10 Prescription drug benefits under Medicare supplement plans. 20:06:13:17.11 General standards for standardized Medicare supplement benefit plan -- Issued for delivery after May 31, :06:13:17.12 Standards for basic core benefits common to Medicare supplement insurance benefit Plans A, B, C, D, F, F with High Deductible, G, M, and N. 20:06:13:17.13 Standards for additional benefits. 20:06:13:17.14 Requirements for standard Medicare supplement benefit plans -- Plans issued after May 31, :06:13:17.15 Make-up of standardized benefit plans -- Issued after May 31, :06:13:18 Premium adjustments to match Medicare benefit adjustments. 20:06:13:19 Renewability. 20:06:13:20 Extended benefits on termination of insurance. 20:06:13:21 Loss ratio standards. 20:06:13:21.01 Refund or credit calculation. 20:06:13:22 Annual filing of premium rates. 20:06:13:22.01 Filing of premium adjustments after Medicare benefit change. 20:06:13:22.02 Public hearings. 20:06:13:22.03 Filing and approval of policies and certificates and of premium rates required. 20:06:13:22.04 One policy or certificate form allowed -- Exceptions. 20:06:13:22.05 Discontinuance of availability. 2
3 20:06:13:22.06 Combination of experience for calculation of refund or credit. 20:06:13:22.07 New or innovative benefits -- Policy or certificate form allowed -- Exceptions -- Issued after May 31, :06:13:23 Repealed. 20:06:13:24 Disclosure of preexisting conditions. 20:06:13:25 Increased benefits after issue. 20:06:13:26 Separate additional premium disclosure. 20:06:13:27 Buyer's guide. 20:06:13:28 Delivery of buyer's guide. 20:06:13:29 Use of term "Medicare supplement." 20:06:13:30 Disclosure requirements for policies or subscriber contracts that are not Medicare supplement policies. 20:06:13:31 Notice requirements for policies or certificates that are not Medicare supplement policies. 20:06:13:31.01 Disclosure requirements for Medicare supplement policies -- Riders and endorsements. 20:06:13:31.02 "Usual," "customary," and "reasonable" requirements prohibited. 20:06:13:31.03 Right of return. 20:06:13:32 Requirements concerning application forms and replacement coverage. 20:06:13:32.01 Transferred. 20:06:13:32.02 Disclosure by agent. 20:06:13:33 Repealed. 20:06:13:34 Replacement requirements for direct response insurers. 20:06:13:35 Notice of replacement. 3
4 20:06:13:36 Outline of coverage requirements. 20:06:13:37 Delivery of outline of coverage. 20:06:13:38 Revisions of outline of coverage. 20:06:13:39 Repealed. 20:06:13:40 Style and arrangement for outline of coverage. 20:06:13:41 and 20:06:13:42 Repealed. 20:06:13:43 Overinsurance. 20:06:13:43.01 Misrepresentation -- Unfair or deceptive trade practices. 20:06:13:43.02 Determination of suitability. 20:06:13:43.03 Medicare supplement and Medicare Part C (Medicare Advantage) or Medicare Cost duplication. 20:06:13:44 Failure to provide required forms. 20:06:13:45 Refund in replacement situations. 20:06:13:46 Coverage replaced within the same company. 20:06:13:47 Insurance replaced by the same agent. 20:06:13:48 Repealed. 20:06:13:49 Requirements for claims payment. 20:06:13:50 Policy classification -- Requirements and limitations. 20:06:13:51 Notice of benefit change. 20:06:13:52 Repealed. 20:06:13:53 Duplication of coverage prohibited. 20:06:13:54 Repealed. 20:06:13:55 Exception to reinstitution of coverage. 20:06:13:56 Continuation and conversion rights. 4
5 20:06:13:57 Standards for marketing. 20:06:13:58 Marketing practices prohibited. 20:06:13:58.01 Health insurance advertisement rate disclosures 20:06:13:58.02 Health insurance advertisement disclosure statements. 20:06:13:59 Reporting of multiple policies. 20:06:13:60 Cancellation or nonrenewal of policies. 20:06:13:60.01 Guaranteed renewable with benefit changes. 20:06:13:61 Agent compensation limited. 20:06:13:62 Repealed. 20:06:13:63 Medicare select policies and certificates. 20:06:13:64 Medicare select authorization. 20:06:13:65 Approval required for issuance. 20:06:13:66 Filing plan of operation. 20:06:13:67 Filing of changes. 20:06:13:68 Network restrictions. 20:06:13:69 Coverage for unavailable services. 20:06:13:70 Disclosure and outline of coverage requirements. 20:06:13:71 Applicant signature required. 20:06:13:72 Complaints and grievances. 20:06:13:73 Required offer of other Medicare supplement coverage. 20:06:13:74 Required offer of replacement coverage without a restricted network provision. 20:06:13:75 Continuation. 20:06:13:76 Compliance with data requests. 5
6 20:06:13:77 Creditable coverage. 20:06:13:78 Medicare Advantage plan. 20:06:13:79 Guaranteed issue. 20:06:13:80 Guaranteed issue -- Eligible persons. 20:06:13:80.01 Guaranteed issue time periods. 20:06:13:80.02 Extended medigap access for interrupted trial periods. 20:06:13:81 Guaranteed issue -- Products to which eligible persons are entitled. 20:06:13:82 Guaranteed issue -- Notification provisions. 20:06:13:83 Open enrollment. 20:06:13:84 Open enrollment required for Medicare eligible individuals regardless of age. 20:06:13:85 Notice requirements. 20:06:13:86 Exchanging of standardized plan. 20:06:13:86.01 Exchanging of standardized plan -- Age rate schedule. 20:06:13:86.02 Exchanging of standardized plan -- Rating class. 20:06:13:86.03 Exchanging of standardized plan -- Preexisting conditions and incontestability period. 20:06:13:86.04 Exchanging of standardized plan -- Offering. 20:06:13:87 Applicability of genetic information. 20:06:13:88 Definitions applicable to genetic information. 20:06:13:89 Use of genetic information. 20:06:13:90 Request of genetic testing. 20:06:13:91 Requirement of genetic testing. 6
7 20:06:13:92 Genetic information -- Underwriting purposes and enrollment. Appendix A Medicare Supplement Refund Calculation Forms. Appendix B Form for Reporting Medicare Supplement Policies. Appendix C Notice to Applicant Regarding Replacement of Medicare Supplement Insurance. Appendix D Outline of Medicare Supplement Coverage Policies Plans A through N. Appendix E Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare. 20:06:13: Medicare supplement and Medicare Part C (Medicare Advantage) or Medicare Cost duplication. Duplication of coverage between Medicare supplement insurance and coverage issued pursuant to Medicare Part C or Medicare Cost requires adjustment of the coverage dates by the Medicare supplement issuer regardless of whether the Medicare supplement coverage is replacing Medicare Part C coverage or Medicare Cost or is being replaced by Medicare Part C or Medicare Cost coverage. If the issuer's Medicare supplement coverage is being replaced by Medicare Part C or Medicare Cost, the issuer must, upon receipt of written notice from the policyholder that he or she desires to terminate the policy and of documentation substantiating the Medicare Part C coverage or Medicare Cost, adjust the coverage dates so as to terminate coverage on the date that coincides with the effective date of the Medicare Part C or Medicare Cost coverage and must refund any unearned premium based upon that revised termination date to the insured. The issuer may deduct claims paid from the refund amount for any claims incurred during the adjusted coverage time frame. Nothing in this section requires a refund of premium for any time frame in excess of five years prior to the date of written notice. If the 7
8 Medicare supplement plan is replacing a Medicare Part C or Medicare Cost plan then the procedures for replacing issuer pursuant to 20:06:13:43 apply. Source: 35 SDR 48, effective September 8, General Authority: SDCL 58-17A-2(3). Law Implemented: SDCL 58-17A-2(3). 8
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