South Carolina's senior-market rules come from Regulation 69-46 (Medicare supplement), the Long-Term Care Insurance Act (chapter 38-72), and Regulation 69-44 (LTC). Expect questions on free looks, outlines, preexisting-condition limits, sales practices, Medicaid suspension, and LTC protections and training. How Medicare works (Parts A-D, enrollment, plan letters, Medicaid, LTC triggers) is in the national Senior and Special Needs guide.

Medicare supplement (Regulation 69-46)

Plans and benefits

• Policies follow standardized lettered plans (Sec. 9).
• A plan covering the Part B deductible can't be sold to people first eligible for Medicare on or after January 1, 2020 (Sec. 9.2).
• Benefits can't be based on "usual and customary" charge standards (Sec. 17A(3)).

Free look and required documents

• Free look: 30 days (Sec. 17A(5)).
• The Guide to Health Insurance for People with Medicare is delivered at the time of application, with a signed acknowledgment (Sec. 17A(6)).
• The first page states: "This policy may not cover all of your medical expenses." (Sec. 20A(3))
• Policy changes made because of Medicare changes must be announced at least 30 days before they take effect (Sec. 17B).

Open enrollment and preexisting conditions (Sec. 11)

• Open enrollment lasts 6 months, starting the first day of the month the person is 65 or older and enrolled in Part B. During it, the insurer can't deny coverage or rate it up for health.
• An applicant with 6 months of prior creditable coverage can't have benefits excluded for a preexisting condition.
• Otherwise, a policy may exclude preexisting conditions for the first 6 months, for conditions treated in the prior 6 months.

Replacement and existing coverage

• The application asks about existing coverage to protect the applicant when coverage is replaced (Sec. 18).
• A replacing policy may not impose new preexisting or waiting periods if the old policy was in force at least 6 months (Sec. 23B).

Medicaid suspension (Sec. 18A)

• A policyholder who becomes eligible for Medicaid may have benefits and premiums suspended for up to 24 months, if suspension is requested within 90 days.

Prohibited practices (Sec. 20-22)

• Cold lead advertising, such as a mailer that hides that an agent will call.
• High pressure tactics, such as saying the person will lose Medicare benefits.
• Duplicate policies. Insurers report residents with more than one Medigap policy by March 1 each year.
• Selling to a Part C enrollee unless the coverage takes effect after Part C ends.

Long-term care insurance (chapter 38-72; Regulation 69-44)

Renewability and policy standards

• Individual LTC policies must be guaranteed renewable or noncancellable (69-44, Sec. 6A).
• A policy may be canceled or nonrenewed only for nonpayment (38-72-60(B)).
• It may not cover skilled nursing only.
• Preexisting conditions: the definition can reach back no more than 6 months (38-72-60(C)).
• Prior stays:
  • Benefits can't depend on a prior hospital stay (38-72-60(D)).
  • A rider requiring a prior institutional stay for post-confinement benefits can require no more than 30 days.
• Mental conditions: a policy may exclude mental or nervous disorders but not Alzheimer's disease (69-44, Sec. 6B).
• Home health care: if covered, it must total at least half of one year's nursing home benefit, and personal care by a home health aide can't be excluded (Sec. 12).
• Applicants 80 and older: the insurer gets a physical exam report or other medical evidence before issuing, unless the policy is guaranteed issue (Sec. 11C).

Contestability (38-72-65)

• In force 6 months to 2 years: rescission only for a material misrepresentation that pertains to the condition for which benefits are sought.
• After 2 years: only for knowing and intentional misrepresentation.

Free look, outline and delivery (38-72-60)

• Free look: 30 days from delivery.
• Outline of coverage: in an agent solicitation, delivered before the application is presented.
• Delivery: within 30 days after approval.
• Denied claims: a written explanation within 60 days of a request.

Lapse protection (38-72-66)

• Before issuing an individual policy, the insurer gets a lapse-notice designee or a signed waiver.
• No lapse for nonpayment without 30 days' notice to the insured and the designee.
• A lapse caused by cognitive impairment can be reinstated within 5 months.

Inflation and nonforfeiture

• Insurers must offer inflation protection of at least 5% compounded annually. Declining it requires a signed rejection (69-44, Sec. 13).
• If the applicant declines nonforfeiture, a contingent benefit upon lapse still applies after a large rate increase (38-72-67).

Group LTC

• A person covered at least 6 months may convert to individual coverage within 31 days after termination (69-44, Sec. 6D).

Benefit triggers

• Qualified LTC benefits are triggered by inability to perform ADLs or by cognitive impairment.

Producer training (38-72-69)

• A one-time 8-hour course, then 4 hours every 24 months.

Annuities for seniors

• Annuity recommendations follow the best interest standard of Regulation 69-29. See the South Carolina Annuities guide.

Common exam traps

• Free looks: Medigap 30 days, LTC 30 days. The ordinary life and A&H free look is 10 days.
• Medicaid suspension: up to 24 months, requested within 90 days.
• LTC can't require a prior hospital stay. A post-confinement rider may require up to 30 days.
• LTC can't exclude Alzheimer's.
• Inflation offer: 5% compound. Training: 8 hours, then 4 hours every two years.