Rule 20:06:40:04 Standards for determinations on length of preexisting waiting periods.
20:06:40:04. Standards for determinations on length of
preexisting waiting periods. A carrier must
determine whether an individual is eligible for coverage pursuant to SDCL 58-18-48. In making that determination a carrier must exercise reasonable diligence. Reasonable diligence may include questions on an application for insurance designed to elicit information on the individual�s eligibility for coverage under SDCL 58-18-48. A carrier may not use the absence of a certificate described in � 20:06:39:04 or 20:06:40:03 as the only method of determining eligibility for coverage pursuant to SDCL 58-18-48. The carrier must take into account all information presented by the individual. The carrier must consider the individual to have furnished a certificate if the individual attests to the period of creditable coverage, presents relevant corroborating evidence of some creditable coverage during the period, and cooperates with the carrier�s efforts to verify the individual�s coverage. The provisions of this section also apply to complete or partial waivers of preexisting condition waiting periods.
24 SDR 35, effective September 29, 1997.
Authority: SDCL 58-18-79.
Implemented: SDCL 58-18-44, 58-18-45, 58-18-48, 58-18-79.
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