Rule 20:06:21:28.01 Applications -- Questions about replacement.
-- Questions about replacement. Application forms shall include questions
designed to elicit information as to whether, as of the date of the
application, the applicant has another long-term care insurance policy or
certificate in force or whether a long-term care policy or certificate is
intended to replace any other accident and sickness or long-term care policy or
certificate presently in force. A supplementary application or other form to be
signed by the applicant and the agent, if any, containing the questions may be
used. Unless coverage is direct marketed, the agent must ask and record the
answers to all questions on the forms.
An insurer may complete or make
contractual arrangements for persons other than agents to complete the
appropriate application questions. The requirements of chapter 20:06:45 apply
to such arrangements. If an insurer uses a contractor or performs the service
of completing the application, the contractor or person performing the service
must ask the applicant the appropriate application questions and such persons
must record the applicant's responses to the questions in the application.
While assisting the applicant in completing the application, a contractor is
prohibited from attempting to sell or to interest the applicant in purchasing
any product. The insurer is responsible for any failure to ask and accurately
record the applicant's responses. Nothing in this section in any way modifies
the requirement for a person to hold an insurance agent license if that person
sells, solicits, or negotiates insurance.
Nothing in this section in any way
modifies the requirement for a person to hold an insurance agent license if
that person sells, solicits, or negotiates insurance.
If the policy is a replacement policy
issued to a group defined by SDCL 58-17A-1(6), the required questions may be modified only to the extent necessary to elicit information about health or long-term care insurance policies other than the group policy being replaced, provided that the certificateholders have been notified of the replacement.
The questions required by this section
are as follows:
(1) Do you have another
long-term care insurance policy or certificate in force (including a health
care service contract or a health maintenance organization contract)?
(2) Did you have another
long-term care insurance policy or certificate in force during the last 12
(a) If so, with which
(b) What is the
expiration or "paid-to" date of that policy?
(c) If that policy
lapsed, when did it lapse?
(3) Are you covered by
(4) Do you intend to
replace any of your medical or health insurance coverage with this policy
Agents must list any other health
insurance policies they have sold to the applicant which are still in force and
policies sold in the past five years which are no longer in force.
An insurer may delete the question in
subdivision (2)(b) of this section from the application if the insurer either
obtains the same information by means of a suitability form to be completed by
the agent or obtains this information during the underwriting process.
23 SDR 55, effective October 20, 1996; 37 SDR 215, effective May 31, 2011; 39
SDR 10, effective August 1, 2012.
Authority: SDCL 58-17B-4.
Implemented: SDCL 58-17B-4, 58-17B-5.1.
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