Rule 20:06:21:10 Converted policy from group defined.
20:06:21:10. Converted policy from group defined. For the
purposes of §§ 20:06:21:09 to 21:06:21:17, inclusive, a converted policy
from group is an individual policy of long-term care insurance providing
benefits identical to or benefits determined by the director to be
substantially equivalent to or in excess of those provided under the group
policy from which conversion is made.
If the group policy from which
conversion is made restricts provision of benefits and services to, or contains
incentives to use, certain providers or facilities, the director, in
determining the substantial equivalence of benefits, shall take into
consideration the differences between managed care and nonmanaged
care plans, including provider system arrangements; service availability;
benefit levels; and administrative complexity.
22 SDR 97, effective December 18, 1995.
Authority: SDCL 58-17B-4.
Implemented: SDCL 58-17B-5.1.
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