Rule 20:06:21:79 Long-term care -- Minimum benefit requirements.
20:06:21:79. Long-term care -- Minimum benefit requirements.
Any long-term care policy, certificate, or contract issued in this state must
contain at least one year of nursing facility coverage. A daily benefit of not
less than $100 per day must be included in the policy, certificate, or contract
unless one of the following are met:
(1) A suitability form is
completed showing that a lesser amount per day is suitable for the applicant
and both of the following:
(a) The commissions
paid to the agent are renewal commissions only; and
(b) The applicant
acknowledges in writing that the applicant understands the daily benefits are
less than the minimum otherwise required and are not sufficient to fund the per
day costs in nursing homes based upon current data available;
(2) The agent has submitted
the suitability form and accompanying documentation to the division and the
division determines that the benefits as applied for are suitable;
(3) If the policy,
certificate, or contract is issued with at least $100 per day in daily benefits
and the insured requests to decrease the daily benefit below $100 per day, the
suitability forms and disclosure required by subdivision (1) are provided to
(4) A new policy,
certificate, or contract with a daily benefit of less than $100 per day when
combined with any existing long-term care coverage, the combined total of the
daily benefits equals or exceeds $100. All long-term care policies in force
covering the insured must be considered in determining whether the benefit
meets the $100 per day minimum standard; or
(5) Except for policies
subject to § 58-17B-2(4)(d), the long-term care
policy is a group plan for which an employer or labor union contributes part or
all of the premium for the long-term care policy.
A policy, certificate, or contract
issued with a minimum of $100 per day or issued in compliance with subdivisions
one through five may be issued as a long-term care partnership policy.
33 SDR 230, effective July 2, 2007; 34 SDR 88, effective September 10, 2007.
Authority: SDCL 58-17B-4.
Implemented: SDCL 28-6-38, 58-17B-4.
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