Rule 20:06:10:07 Preexisting conditions in health insurance policies.
conditions in health insurance policies. Preexisting conditions in health
insurance policies are treated as follows:
(1) An advertisement or
solicitation of health insurance which is subject to the requirements of this
chapter shall, in negative terms, disclose the extent to which any loss is not
covered if the cause of the loss is traceable to a condition existing prior to
the effective date of the policy. The term "preexisting condition"
without a definition or description may not be used;
(2) If a policy does not
cover losses resulting from preexisting conditions, no advertisement or
solicitation of the policy may state or imply that the applicant's physical
condition or medical history will not affect the issuance of the policy or
payment of a claim under it. This subdivision prohibits the use of the phrase
"no medical examination required" and similar phrases, but does not
prohibit explaining "automatic issue." If an insurer requires a medical examination for a specified policy,
the advertisement or solicitation must disclose that a medical examination is
(3) If an advertisement or
solicitation contains an application form to be completed by the applicant and
returned by mail for a direct response insurance product, the application form
must contain a question or statement which reflects the preexisting condition
provisions of the policy immediately preceding the blank space for the
applicant's signature. The question or statement must be substantially as follows:
(a) "Do you
understand that this policy will not pay benefits during the first _____
year(s) after the issue date for a preexisting medical condition which you now
have or have had in the past?"
(b) "I understand
that the policy applied for will not pay benefits for any loss incurred during
the first _____ year(s) after the issue date because of a preexisting medical
condition which I now have or have had in the past."
4 SDR 6, effective August 9, 1977; 12 SDR 151, 12 SDR 155, effective July 1,
1986; 15 SDR 143, effective March 29, 1989; 27 SDR 54, effective December 4,
2000; 38 SDR 116, effective January 10, 2012.
Authority: SDCL 58-33A-7.
Implemented: SDCL 58-33-5, 58-33-6, 58-33-7; 58-33A-8, 58-33A-10.
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