58-17-87. Director to promulgate rules for individual health insurance--Scope of rules. The director shall promulgate rules pursuant to chapter 1-26 to cover:
(1) Terms or renewability;
(2) Conditions of eligibility;
(3) Benefit limitations, exceptions, and reductions;
(4) Definition of terms;
(5) Filing requirements for forms, rates, and rate schedules;
(6) Marketing practices;
(7) Reporting practices;
(8) Compensation arrangements between insurers or other entities and their agents, representatives, or producers;
(9) Suitability and appropriateness of the policy sold;
(10) Certificates of coverage;
(11) Determinations with regard to waiting periods;
(12) College plans;
(13) Creditable coverages;
(14) Breaks in coverage;
(15) The application of waiting periods; and
(16) Risk spreading mechanisms.
The director shall promulgate rules pursuant to chapter 1-26 that specify prohibited policy or certificate provisions not otherwise specifically authorized by statute which, in the opinion of the director, are unjust, unfair, or unfairly discriminatory to any person insured or proposed for coverage under an individual policy or certificate. The director shall also promulgate rules pursuant to chapter 1-26 assuring public access to rate and form information and establishing procedures for rate and form approvals and disapprovals. If any federal standards are in place which would require additional steps to meet those standards beyond what is required by this chapter, the director shall promulgate rules to require the offering of health insurance plans, in addition to those specifically required by § 58-17-85, the underwriting and coverage criteria that may be utilized for such health insurance plans, and other requirements related to the coverage criteria and availability of health insurance to individuals in this state in order to minimally meet the federal standards.
Source: SL 1996, ch 286, § 22; SL 1997, ch 289, § 6; SL 1998, ch 289, § 4.
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