S.D. Admin. R. 20:06:13:32 - Requirements concerning application forms and replacement coverage
Application forms must include the following statements and questions which are designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medicaid coverage, or another health insurance policy or certificate in force, or whether a Medicare supplement policy or certificate is intended to replace any other accident and sickness policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and agent containing such questions and statements may be used. Unless coverage is direct marketed, the agent must ask and record the answers to all questions on the forms. In the case of a direct response issuer, a copy of the application or supplemental form, signed by the applicant and acknowledged by the issuer, must be returned to the applicant by the issuer upon delivery of the policy.
In lieu of the agent's recording all of the applicant's responses, an insurer may record or make contractual arrangements for persons other than agents to record the applicant's responses. Prior to issuance of coverage, the insurer, agent, or contractor involved in the application process must ask all remaining application questions and such persons must accurately record the applicant's responses to each of the applicable questions in the application. The insurer is responsible for any failure to ask and accurately record the applicant's responses to each applicable question. The privacy requirements outlined in chapter 20:06:45 and the Medicare Supplement marketing restrictions outlined in § 20:06:13:58 apply to such arrangements.
Nothing in this section may be construed to prohibit the insurer from denying an incomplete application or to require that further questions be asked of the applicant once the response to a question clearly indicates the applicant is ineligible for coverage.
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 Medicare Supplement insurance or any other kind of insurance.
While assisting the applicant, a non-licensed person is prohibited from attempting to sell or to interest the applicant in purchasing any product, insurance related or otherwise.
The required statements and questions are as follows:
STATEMENTS
QUESTIONS
If you lost or are losing other health insurance coverage and received a notice from your previous insurer stating that you were eligible for guaranteed issue of a Medicare supplement insurance policy, or that you had certain rights to buy such a policy, you may be guaranteed acceptance in one or more of our Medicare supplement plans. Please include a copy of the notice from your previous insurer with your application. PLEASE ANSWER ALL QUESTIONS.
[Please mark YES or NO below with an "X"]
To the best of your knowledge,
Yes ______ No ______
Yes ______ No ______
Yes ______ No ______
If yes,
Yes ______ No ______
Yes ______ No ______
START ___/___/___ END ___/___/___
Yes ______ No ______
Yes ______ No ______
Yes ______ No ______
Yes ______ No ______
____________________________________________________________________
Yes ______ No ______
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
START ___/___/___ END ___/___/___
(If you are still covered under the other policy, leave "END" blank.)
Notes
General Authority: SDCL 58-17A-2(3)(7).
Law Implemented: SDCL 58-17A-2(3)(7).
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