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ARSD 20:06:13 – Medicare Supplement Insurance | Midpage
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Administrative Rules of South Dakota
Title 20
20:06
Chapter 20:06:13
ARSD 20:06:13
Medicare Supplement Insurance
20:06:13:02
Definitions.
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Requirements for definition of "accident" and similar words in policies.
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Requirements for definitions in policies.
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Applicability.
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Eligible expenses under Medicare.
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Waiver of coverage not allowed.
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Applicability of benefit standards.
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General standards for 1990 standardized Medicare supplement benefit plans.
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Standards for basic core benefits for 1990 standardized Medicare supplemen plans.
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Standards for additional benefits for 1990 standardized Medicare supplement plans.
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Requirements for standard Medicare supplement benefit plans.
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Make-up of standardized benefit plans.
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Suspension of coverage during period of eligibility for Medicaid.
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Reinstitution of coverage following loss of eligibility for Medicaid.
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Suspension requested by policyholder.
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Prescription drug benefits under Medicare supplement plans.
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General standards for standardized Medicare supplement benefit plan -- Issued for delivery after May 31, 2010.
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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.
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Standards for additional benefits.
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Requirements for standard Medicare supplement benefit plans -- Plans issued after May 31, 2010.
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Make-up of standardized benefit plans -- Issued after May 31, 2010.
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Standard Medicare supplement benefit plans for 2020 standardized Medicare supplement benefit plan policies or certificates issued for delivery to individuals newly eligible for Medicare after December 31, 2019.
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Premium adjustments to match Medicare benefit adjustments.
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Renewability.
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Extended benefits on termination of insurance.
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Loss ratio standards.
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Refund or credit calculation.
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Annual filing of premium rates.
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Filing of premium adjustments after Medicare benefit change.
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Public hearings.
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Filing and approval of policies and certificates and of premium rates required.
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One policy or certificate form allowed -- Exceptions.
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Discontinuance of availability.
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Combination of experience for calculation of refund or credit.
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New or innovative benefits -- Policy or certificate form allowed -- Exceptions -- Issued after May 31, 2010.
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Disclosure of preexisting conditions.
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Increased benefits after issue.
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Separate additional premium disclosure.
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Buyer's guide.
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Delivery of buyer's guide.
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Use of term "Medicare supplement."
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Disclosure requirements for policies or subscriber contracts that are not Medicare supplement policies.
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Notice requirements for policies or certificates that are not Medicare supplement policies.
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Disclosure requirements for Medicare supplement policies -- Riders and endorsements.
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"Usual," "customary," and "reasonable" requirements prohibited.
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Right of return.
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Requirements concerning application forms and replacement coverage.
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Disclosure by agent.
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Replacement requirements for direct response insurers.
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Notice of replacement.
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Outline of coverage requirements.
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Delivery of outline of coverage.
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Revisions of outline of coverage.
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Style and arrangement for outline of coverage.
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Overinsurance.
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Misrepresentation -- Unfair or deceptive trade practices.
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Determination of suitability.
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Medicare supplement and Medicare Part C (Medicare Advantage) or Medicare Cost duplication.
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Failure to provide required forms.
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Refund in replacement situations.
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Coverage replaced within the same company.
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Insurance replaced by the same agent.
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Requirements for claims payment.
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Policy classification -- Requirements and limitations.
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Notice of benefit change.
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Duplication of coverage prohibited.
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Exception to reinstitution of coverage.
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Continuation and conversion rights.
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Standards for marketing.
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Marketing practices prohibited.
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Health insurance advertisement rate disclosures.
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Health insurance advertisement disclosure statements.
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Reporting of multiple policies.
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Cancellation or nonrenewal of policies.
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Guaranteed renewable with benefit changes.
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Agent compensation limited.
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Medicare select policies and certificates.
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Medicare select authorization.
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Approval required for issuance.
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Filing plan of operation.
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Filing of changes.
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Network restrictions.
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Coverage for unavailable services.
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Disclosure and outline of coverage requirements.
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Applicant signature required.
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Complaints and grievances.
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Required offer of other Medicare supplement coverage.
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Required offer of replacement coverage without a restricted network provision.
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Continuation.
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Compliance with data requests.
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Creditable coverage.
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Medicare Advantage plan.
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Guaranteed issue.
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Guaranteed issue -- Eligible persons.
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Guaranteed issue time periods.
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Extended medigap access for interrupted trial periods.
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Guaranteed issue -- Products to which eligible persons are entitled.
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Guaranteed issue -- Notification provisions.
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Open enrollment.`
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Open enrollment required for Medicare eligible individuals regardless of age.
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Notice requirement.
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Exchanging of standardized plan.
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Exchanging of standardized plan -- Age rate schedule.
20:06:13:86.02
Excahnging of standardized plan -- Rating class.
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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.
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Definitions applicable to genetic information.
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Use of genetic information.
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Request of genetic testing.
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Requirement of genetic testing.
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Genetic information -- Underwriting purposes and enrollment.
20:06:13:0A
Medicare Supplement Refund Calculation Forms.
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Form for Reporting Medicare Supplement Policies.
20:06:13:0C
Notice to Applicant Regarding Replacement of Medicare Supplement Insurance.
20:06:13:0D
Outline of Medicare Supplement Coverage Policies Plans A through N.
20:06:13:0E
Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare.