Employers have no obligation under South Dakota law to offer long-term care insurance to their employees. However, if long-term care insurance is among the benefits offered, certain state law requirements limit how the plan may be designed.
Preexisting condition limitations in long-term care insurance policies may not exclude coverage for more than six months after the effective date of coverage under the policy. Additionally, a “preexisting condition” cannot be defined more restrictively than as a condition for which medical advice or treatment was recommended by or received from a healthcare services provider within six months before the effective date of coverage (SDCL Sec. 58-17B-6).
Generally, group long-term care insurance plans issued in South Dakota must provide for continuation or conversion of coverage (ARSD 20:06:21:13).
The elimination period provided in a long-term insurance policy for any one confinement generally may not exceed 100 days. An insurer may make application to the Division of Insurance for an elimination period in excess of 100 days, provided that specific suitability criteria or underwriting procedures are filed with the application. The application may be approved if the procedures or criteria provide adequate protection for consumers (ARSD 20:06:21:02).