<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>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 style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    </span><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000000">20:06:21:04.  Permissible exclusions from coverage.</span><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    </span><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000000">Source:</span><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    </span><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000000">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-4-1"><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000002">58-4-1</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">, </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000002">58-17B-4</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">, </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-15"><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000002">58-17B-15</span></a><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">.</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">    </span><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000000">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-11"><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont-000002">58-17B-11</span></a><span style="white-space: pre-wrap;" class="sba3498b9-92be-45e5-8712-8c3e67f98150DefaultParagraphFont">.</span></p><p dir="ltr" class="sba3498b9-92be-45e5-8712-8c3e67f98150Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sba3498b9-92be-45e5-8712-8c3e67f98150000001"> </span></p></div></body></html>