<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.sba3498b9-92be-45e5-8712-8c3e67f98150Normal { text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000000 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sba3498b9-92be-45e5-8712-8c3e67f98150000001 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000002 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    </span><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000000">20:06:21:04.  Permissible exclusions from coverage.</span><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont"> A long-term care insurance policy may exclude or limit coverage for the following:</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (1)  Declared or undeclared war;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (2)  Suicide or self-inflicted injuries;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (3)  Alcoholism or drug abuse. This subdivision does not permit an exclusion or limitation for long-term care services due to the insured's alcoholism or drug abuse, other than for the treatment of alcoholism or drug abuse;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (4)  Mental or emotional disorder;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (5)  Pre-existing conditions;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (6)  Participation in a felony, riot, or insurrection;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (7)  Treatment in a government facility at no charge to the insured or that portion of any treatment which is paid by a government plan;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (8)  Limitations based on territory;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (9)  Mental or nervous disorders. This subdivision does not permit exclusion or limitation of benefits because of Alzheimer's disease;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (10)  Aviation. This exclusion applies only to passengers who have not paid fares;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (11)  Workers' compensation. Work-related injuries or illnesses if benefits are paid under workers' compensation or other similar laws;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (12)  Service or care provided by a family member unless:</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">        (a)  The family member is a regular employee of the service or care provider furnishing the service or care;</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">        (b)  The service or care provider receives the payment for the service or care; and</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">        (c)  The family member receives no compensation other than the normal compensation for an employee in his or her job category; or</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    (13)  For group coverage issued on a guaranteed issue basis an inability to perform activities of daily living or a severe cognitive impairment that predated the coverage and was continuous in determining whether the benefit triggers have been met. An inability to perform an activity of daily living that pre-dated coverage is considered continuous unless the insured demonstrates that the insured has regained the ability to perform that activity of daily living based on the same standards that are applied as benefit triggers under the policy.</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    </span><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000000">Source:</span><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont"> 16 SDR 208, effective June 3, 1990; 22 SDR 97, effective December 18, 1995; 28 SDR 157, effective May 19, 2002; 29 SDR 107, effective February 5, 2003; 31 SDR 21, effective August 23, 2004.</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    </span><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000000">General Authority:</span><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-4-1"><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000002">58-4-1</span></a><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">, </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000002">58-17B-4</span></a><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">, </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-15"><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000002">58-17B-15</span></a><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">.</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    </span><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000000">Law Implemented:</span><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-11"><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000002">58-17B-11</span></a><span class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">.</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p></div></body></html>