Rule 20:06:39:04 Certificates required upon loss of coverage.
required upon loss of coverage (repealed January 1, 2014). A
carrier must automatically provide a certificate containing language that is
substantially similar to the language contained in Appendix A at the end of
this chapter to any individual losing coverage. At any time within 24 months
after coverage ceases, a carrier must also provide additional certificates
pursuant to requests by or on behalf of an individual. Each certificate must be
provided in a reasonable and prompt fashion. A separate fee may not be charged
for the provision of a certificate, but the cost of this service may be
factored into the policy premium.
After July 1, 1998, a
carrier must provide certificates as required in this section for dependents as
well as the individual to whom the coverage was issued. Before July 1, 1998, a
carrier may satisfy the requirement for certificates identifying coverage for
dependents by providing the name of the policyholder and specifying that family
coverage is in force. Before July 1, 1998, if the carrier is requested to
provide a certificate for a dependent, the carrier must make reasonable efforts
to obtain and provide the name of the dependent.
If a carrier provides coverage in connection
with another type of creditable coverage, the carrier must provide a
certificate as required by this section. A carrier may, for an individual with
at least 12 months of creditable coverage without a break in coverage exceeding
63 days, simply certify that the individual has 12 months of creditable
24 SDR 35, effective September 29, 1997; 39 SDR 203, effective June 10, 2013,
repealed January 1, 2014.
Authority: SDCL 58-17-87(2).
Implemented: SDCL 58-11-1, 58-17-85, 58-17-87, 58-33-36.
Back to 20:06:39