<html> <head> <title>Rule 20:06:40:04 Standards for determinations on length of preexisting waiting periods.</title> <META NAME="Keywords" Content="Administrative Rules 20:06:40:04"> <META NAME="Description" Content="Administrative Rules 20:06:40:04 Standards for determinations on length of preexisting waiting periods."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p><b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 20:06:40:04.&nbsp;&nbsp;Standards for determinations on length of preexisting waiting periods.</b> A carrier must determine whether an individual is eligible for coverage pursuant to SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-48">58-18-48.</A> 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 §&nbsp;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.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 24 SDR 35, effective September 29, 1997.</p> <p><b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-79">58-18-79.</A></p> <p><b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-44">58-18-44</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-45">58-18-45</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-48">58-18-48</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-18-79">58-18-79.</A></p> </div> </body> </html>