58-17B-4.   Adoption of rules--Standards for disclosure. 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 of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, marketing, and definitions of terms.

     The director shall develop minimum standards for benefits contained in the marketing and sale of long-term care coverage or other coverages containing long-term care benefits which do not provide institutional care benefits. The standards shall be established by rules promulgated pursuant to chapter 1-26. The standards shall take into consideration the special status of persons in the long-term care insurance market and be designed to afford protection of the public through disclosure and other informational requirements, minimum requirements for coverages and exclusions contained in such policies or certificates, prohibition or prescription of marketing or sales practices, financial and solvency requirements, disclosure and requirements relating to incontestability, and requirements for the continuity of coverage through continuation, conversion, or reinstatement. The director shall design standards to prohibit unjust, unfair, or discriminatory treatment of any person insured or proposed for coverage under this chapter. The director may adopt nationally developed standards to the extent that those standards are appropriate for the state considering the impact on the availability and cost of the insurance and the health care delivery system existing in South Dakota. The standards may include minimum amounts of coverage not otherwise specified in this chapter; the definitions; type, number, and use of benefit triggers such as activities of daily living, the types of facilities, and criteria for reimbursement for assisted living centers; requirements for home health care and home health agencies; the content and use of application forms; when and how coverage must be extended; and reports from insurers and others engaged in the business of long-term care insurance relating to how insureds have been treated and how compliance with this chapter has been achieved.

Source: SL 1989, ch 440, § 4; SL 1996, ch 294.

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