20:06:10:08. Necessity
for disclosing policy provisions relating to renewability, cancelability, and
termination. When an advertisement or solicitation refers to either a
dollar amount or a period of time for which any benefit is payable, or the cost
of the policy, or specific policy benefit, or the loss for which such benefit
is payable, it shall disclose general policy exceptions, reductions, and
limitations, in a manner which does not minimize or render obscure the
qualifying conditions.
Source:
4 SDR 6, effective August 9, 1977; 12 SDR 151, 12 SDR 155, effective July 1,
1986; 27 SDR 54, effective December 4, 2000; 38 SDR 116, effective January 10,
2012.
General
Authority: SDCL 58-33A-7.
Law
Implemented: SDCL 58-33-5, 58-33-6, 58-33-7, 58-33A-8, 58-33A-10.
20:06:10:08.01. Health
insurance advertisement rate disclosures.
Unless the disclosure as required by § 20:06:10:08.02 is provided,
no individual or group health insurance policy or certificate may in its
advertisements or solicitations include statements that directly or indirectly
indicate that:
(1) Premiums or rates do
not increase with age;
(2) Premiums or rates do
not increase because of health conditions; or
(3) An insured will not be
singled out for a rate or premium increase.
Policies for which no rate increase
may be applied for any reason are exempt from the provisions of this section.
Source:
32 SDR 128, effective January 29, 2006; 38 SDR 116, effective January 10, 2012.
General
Authority: SDCL 58-33A-7.
Law
Implemented: SDCL 58-33-5, 58-33-6, 58-33A-2, 58-33A-8.
20:06:10:08.02. Health
insurance advertisement or solicitation disclosure statements. Any health
insurance advertisement or solicitation that includes a statement for which
disclosure is required pursuant to § 20:06:10:08.01 must contain in close
proximity to any such statement and in an at least as conspicuous a form as the
statement itself, the following disclosure or an alternative as may be approved
by the director:
Premiums or rates may increase for
other reasons such as an increase applicable to all persons covered under this
type of policy or certificate in this state.
Failure to comply with any provision
of this section creates a presumption that an advertisement or solicitation is
deceptive, misrepresentative, or misleading.
Source:
32 SDR 128, effective January 29, 2006; 38 SDR 116, effective January 10, 2012.
General
Authority: SDCL 58-33A-7(13)(14)(15).
Law
Implemented: SDCL 58-33-5, 58-33-6, 58-33A-2, 58-33A-8.
20:06:10:08.03. Short term major medical advertising disclosure. No advertisement or solicitation of short term major medical insurance may be used in this state unless the following disclosure statement is prominently displayed in that advertisement or solicitation: "This short term major medical policy is [nonrenewable/renewable]."
No short term major medical policy may be sold in this state unless the following separate disclosure in bold 14 point type is signed and acknowledged by the applicant:
"This short term major medical policy is [nonrenewable/renewable]. This policy provides coverage for [number of days or months that is less than 12 months]. A renewal or extension of this policy or additional policies must have a combined duration of no more than 36 months in total. This policy has exclusions such as preexisting conditions and does not provide all coverage required by the Patient Protection and Affordable Care Act."
If the application is taken by an agent, the agent is responsible for forwarding this signed disclosure to the insurer. For direct marketed solicitations, the insurer must provide this disclosure with the application. No insurer may issue a short term major medical policy unless a signed disclosure, as required by this section, is received. If the transaction involves a replacement, the agent or, if forwarded by the agent to the insurer, the insurer shall, in accordance with SDCL 58-1-26 keep documentation indicating compliance with § 20:06:10:08.02.
Source: 33 SDR 107, effective December 26, 2006; 38 SDR 116, effective January 10, 2012; 40 SDR 102, effective December 3, 2013; 47 SDR 68, effective December 7, 2020.
General Authority: SDCL 58-33A-7(14).
Law Implemented: SDCL 58-33A-8, 58-33A-10.
