Rule 20:06:21:52 Reporting requirements for insurers.
20:06:21:52. Reporting requirements for insurers. Each
insurer must comply with the following reporting requirements for long-term
(1) The insurer must
maintain records for each agent of that agent's amount of replacement sales as
a percent of the agent's total annual sales and the amount of lapses of
long-term care insurance policies sold by the agent as a percent of the agent's
total annual sales;
(2) The insurer must report
to the director annually by June 30 the ten percent of its agents with the
greatest percentages of lapses and replacements as measured by subdivision (1)
of this section (Appendix J);
(3) The insurer must report
to the director annually by June 30 the number of lapsed policies as a percent
of its total annual sales and as a percent of its total number of policies in
force as of the end of the preceding calendar year (Appendix J);
(4) The insurer must report
to the director annually by June 30 the number of replacement policies sold as
a percent of its total annual sales and as a percent of its total number of
policies in force as of the preceding calendar year (Appendix J); and
(5) Every insurer shall
report to the director annually by June 30, for qualified long-term care
insurance contracts, the number of claims denied for each class of business,
expressed as a percentage of claims denied (Appendix H).
No finding by the director of a
violation of insurance laws may be based solely upon reported replacement and
For the purposes of this section,
"policy" means only long-term care insurance, "claim" means
a request for payment of benefits under an in force policy regardless of
whether the benefit claimed is covered under the policy or any terms or
conditions of the policy have been met, "denied" means the insurer
refuses to pay a claim for any reason other than for claims not paid for
failure to meet the waiting period or because of an applicable preexisting
condition, and "report" means on a statewide basis.
23 SDR 55, effective October 20, 1996; 28 SDR 157, effective May 19, 2002.
Authority: SDCL 58-17B-4.
Implemented: SDCL 58-17B-4.
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