ARSD 20:06:21 – Long-term Care Insurance | Midpage

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Administrative Rules of South Dakota

Chapter 20:06:21

ARSD 20:06:21

Long-term Care Insurance

20:06:21:01Definitions.20:06:21:01.01Nature of care -- How defined.20:06:21:01.02Service providers -- How defined.20:06:21:01.03Long-term care insurance.20:06:21:01.04Similar policy forms.20:06:21:01.05Treatment of accelerated benefits in life insurance.20:06:21:01.06Claim and clean claim -- Defined.20:06:21:02Minimum standards for long-term care insurance policies.20:06:21:02.01Annuity policies with long-term care benefits subject to waiting period.20:06:21:03Renewability of group policies -- Required disclosures.20:06:21:04Permissible exclusions from coverage.20:06:21:05Loss ratios.20:06:21:05.01Relation of benefits to premium for accelerated death benefit on life insurance.20:06:21:06Cost-of-living adjustments -- Basis.20:06:21:06.01Cost-of-living adjustments -- Minimum standards.20:06:21:06.02Group cost-of-living adjustments -- Exceptions.20:06:21:06.03Cost-of-living adjustments -- Continuation of benefit increases.20:06:21:06.04Cost-of-living adjustments -- Automatic increases -- Conspicuous offer of constant premium.20:06:21:06.05Cost-of-living adjustments -- Rejection by policyholder.20:06:21:07Applicability of rules to long-term care insurance riders.20:06:21:08"Medically necessary" defined.20:06:21:09Basis for conversion of coverage from group defined.20:06:21:10Converted policy from group defined.20:06:21:11Converted policy from group -- Time allowed for written application.20:06:21:12Converted policy from group -- Calculation of policy premium.20:06:21:13Continuation or conversion is mandatory -- Exceptions.20:06:21:14Converted policy from group to individual -- Reduction of benefits -- Exception.20:06:21:15Converted policy from group -- Benefits payable.20:06:21:16Converted policy from group -- Eligibility for coverage of relatives.20:06:21:17Converted policy from group -- Managed care plan defined.20:06:21:18Discontinuance and replacement of a group policy.20:06:21:19Premium increase prohibitions.20:06:21:20Lapse or termination notice required.20:06:21:21Lapse or termination for payment through payroll or pension deduction plan.20:06:21:22Lapse or termination for nonpayment of premium.20:06:21:23Disclosure of renewability.20:06:21:24Disclosure of payment of benefits based on certain standards.20:06:21:25Disclosure of limitations on preexisting conditions.20:06:21:26Disclosure of other limitations or conditions on eligibility for benefits.20:06:21:26.01Notice to claimants -- Temporary leave.20:06:21:27Outline of coverage.20:06:21:28Outline of coverage -- Standard format.20:06:21:28.01Applications -- Questions about replacement.20:06:21:29Replacement notices.20:06:21:30Filing requirements for advertising -- Exemption.20:06:21:31Standards for marketing -- Requirements.20:06:21:32Standards for marketing -- Prohibited practices.20:06:21:33Standards for marketing -- Associations.20:06:21:34Extension of benefits.20:06:21:35Basis for continuation or conversion from group coverage required.20:06:21:36Basis for continuation of coverage from group defined.20:06:21:37Reinstatement.20:06:21:38Disclosure of riders and endorsements.20:06:21:39Disclosure of tax consequences.20:06:21:40Applications -- Health and medication questions.20:06:21:41Applications -- Notice about incorrect answers.20:06:21:42Policies -- Notice about incorrect answers on applications.20:06:21:43Elderly applicants -- Required information.20:06:21:44Applications -- Delivery.20:06:21:45Records of rescissions -- Maintaining and filing records.20:06:21:46Minimum standards for home health and community care benefits.20:06:21:47Policy summary for individual life insurance policy containing long-term care benefits.20:06:21:48Monthly report to policyholder.20:06:21:49Incontestability period.20:06:21:50Assisted living center or facility defined.20:06:21:51Assisted living centers -- Minimum benefit standards.20:06:21:52Reporting requirements for insurers.20:06:21:53Appropriateness of recommended purchase or replacement.20:06:21:53.01Suitability standards.20:06:21:53.02Suitability -- Long-term care insurance personal worksheet.20:06:21:53.03Suitability -- Response letter.20:06:21:53.04Suitability -- Policies not included.20:06:21:53.05Suitabililty -- Overinsurance.20:06:21:54Requirement to deliver shopper's guide.20:06:21:55Standards for benefit triggers.20:06:21:56Additional standards for benefit triggers for qualified long-term care insurance contracts.20:06:21:57Nonforfeiture benefits.20:06:21:58Nonforfeiture benefit requirement.20:06:21:59Electronic enrollment for group policies.20:06:21:60Required disclosure of rating practices to consumers -- Rate stabilization.20:06:21:61Initial filing requirements.20:06:21:62Reserve standards.20:06:21:63Premium rate schedule increases -- Notice of pending increase.20:06:21:64Premium rate schedule increase requirements.20:06:21:65Premium rate schedule increases -- Review by the director 20:06:21:66Premium rate schedule increases -- Adverse lapsation.20:06:21:67Premium rate schedule increases -- Policies to which does not apply.20:06:21:68Premium rate schedule increases -- Group insurance policies.20:06:21:69Premium rate schedule increases -- Adoption of rules.20:06:21:70Premium rate schedule increases -- Exceptional increases.20:06:21:71Permitted compensation arrangements.20:06:21:72Disclosure to applicant for a claim denial.20:06:21:73Providers in a different state.20:06:21:74Producer training required to market long-term care partnership plans.20:06:21:74.01Long-term care plan training topics for producers.20:06:21:75Insurers required to verify agent training and maintain records.20:06:21:76Long-term care partnership policies -- Inflation protection requirements.20:06:21:77Long-term care partnership policies -- Required policy disclosures.20:06:21:78Long-term care partnership policies -- Filing requirements.20:06:21:79Long-term care -- Minimum benefit requirements.20:06:21:80Long-term care partnership policies -- Policy amendments.20:06:21:81Long-term care policies -- Policy amendments.20:06:21:82Availability of new services or providers.20:06:21:83Policies issued considered exchanges.20:06:21:84Policies offered through employers, labor unions, and associations.20:06:21:85Applicability of new provider or service requirements.20:06:21:86Right to reduce coverage and lower premiums.20:06:21:87Authorized representative.20:06:21:88Notice to insured.20:06:21:89Internal appeal.20:06:21:90Internal appeal notice requirements.20:06:21:91Independent review of benefit trigger determination.20:06:21:92Independent review process.20:06:21:93Additional appeal information.20:06:21:94Independent review notification.20:06:21:95Independent review organization selection.20:06:21:96Review of information.20:06:21:97Additional information to independent review.20:06:21:98Process if determination overturned.20:06:21:99Review decision requirements.20:06:21:100Acceptance of state certification.20:06:21:101Certification of long-term care insurance independent review organizations.20:06:21:102Maintenance of records and reporting obligations by independent review organizations.20:06:21:103Additional rights.20:06:21:104Applicability.20:06:21:105Payment of clean claim.20:06:21:106Claim timeframes.20:06:21:107Unpaid claims.20:06:21:108Violations.20:06:21:0AOutline of Coverage.20:06:21:0BReplacement of Individual Accident and Sickness or Long-Term Care Coverage.20:06:21:0CReplacement of Accident and Sickness or Long-Term Care Coverage.20:06:21:0DRescission Reporting Form.20:06:21:0EPersonal Worksheet.20:06:21:0FDisclosure Form.20:06:21:0GResponse Letter.20:06:21:0HClaims Denial Reporting Form.20:06:21:0IPotential Rate Increase Disclosure Form.20:06:21:0JReplacement and Lapse Reporting Form.20:06:21:0KPartnership Disclosure Form.20:06:21:0LPartnership Certification Form.20:06:21:0MGuidelines for Long-Term Care Independent Review Entities.