58-17-87 Director to promulgate rules for individual health insurance--Scope of rules.
Director to promulgate rules for individual health insurance--Scope of rules.
director shall promulgate rules pursuant to chapter 1-26 to cover:
Terms or renewability;
Conditions of eligibility;
Benefit limitations, exceptions, and reductions;
Definition of terms;
Filing requirements for forms, rates, and rate schedules;
Compensation arrangements between insurers or other entities and their agents,
representatives, or producers;
Suitability and appropriateness of the policy sold;
Certificates of coverage;
Determinations with regard to waiting periods;
Breaks in coverage;
The application of waiting periods; and
Risk spreading mechanisms.
The director shall promulgate rules pursuant to chapter 1-26 that specify prohibited policy or
certificate provisions not otherwise specifically authorized by statute which, in the opinion of the
director, are unjust, unfair, or unfairly discriminatory to any person insured or proposed for coverage
under an individual policy or certificate. The director shall also promulgate rules pursuant to chapter
1-26 assuring public access to rate and form information and establishing procedures for rate and
form approvals and disapprovals. If any federal standards are in place which would require additional
steps to meet those standards beyond what is required by this chapter, the director shall promulgate
rules to require the offering of health insurance plans, in addition to those specifically required by
§ 58-17-85, the underwriting and coverage criteria that may be utilized for such health insurance
plans, and other requirements related to the coverage criteria and availability of health insurance to
individuals in this state in order to minimally meet the federal standards.
Source: SL 1996, ch 286, § 22; SL 1997, ch 289, § 6; SL 1998, ch 289, § 4.