There is a newer version of the South Dakota Codified Laws
2006 South Dakota Code - 17 — Health Insurance Policies
- 58-17-1 — Requirements for all health insurance policies delivered in state.
- 58-17-1.1 — Policies to cover low-dose mammography--Extent of coverage.
- 58-17-1.2 — Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.
- 58-17-1.3 — Diabetes coverage not required of certain plans and policies.
- 58-17-2 — Persons covered by policy.
- 58-17-2.1 — Health insurance on a franchise plan.
- 58-17-2.2 — Conversion privileges of insured's spouse upon divorce.
- 58-17-2.3 — Health benefit plan-Dependent coverage termination-Age-Application.
- 58-17-3 — Time of commencement and termination to be set out in policy.
- 58-17-4 — Consideration for policy to be stated.
- 58-17-4.1 — Filing and prior approval of individual premium rates by director--Notice ofdisapproval or approval.
- 58-17-4.2 — Premium rates required to be reasonable--Rules to establish minimumstandards promulgated by director.
- 58-17-4.3 — Transferred.
- 58-17-5 — Identification of forms, riders and endorsements--Form number, location.
- 58-17-6 — Style and arrangement of policy provisions--Printing, size of type.
- 58-17-7 — Documents forming part of policy--Setting forth in full, rates andclassifications excepted.
- 58-17-8 — Exceptions and reductions of coverage to be clearly set out.
- 58-17-9 — Renewal of policy at option of insurer--Statement in policy so informing thepolicyholder.
- 58-17-10 — Repealed.
- 58-17-10.1 — Reduction of benefits because of increase in statutory disability benefitsprohibited.
- 58-17-10.2 — Individual policy for insured's spouse required in policies covering spouse--Eligibility--Coverage--Waiting periods.
- 58-17-11 — Return of policy by purchaser--Refund of premium paid--Dissatisfactionwith terms after examination.
- 58-17-11.1 — Issuance of policies by insurance company, nonprofit hospital service plan,medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--Term of retention.
- 58-17-12 — Required provisions--Captions--Substitutes, approval by director.
- 58-17-13 — Omission from policy of inapplicable provision--Approval of director--Modification of inconsistent provision.
- 58-17-14 — Entire contract clause required in policy--Changes in policy, formalrequirements--Exceptions.
- 58-17-15 — Incontestability clause--Time limit on certain defenses--Misstatements byapplicant.
- 58-17-16 — Incontestability clause--Optional provisions.
- 58-17-17 — Grace period on premiums required in policy.
- 58-17-18 — Renewal of policy--Restriction on company's right to refuse.
- 58-17-19 — Reinstatement when premium not paid within grace period.
- 58-17-20 — Omission of provision as to application of premiums accepted in connectionwith reinstatement--Right of insured to continue policy in force by paymentof premiums.
- 58-17-21 — Notice of claim--Provision required in policy.
- 58-17-22 — Notice of claim--Loss of time benefit--Optional provision, insertion byinsurer.
- 58-17-23 — Claim forms--Furnishing by insurer.
- 58-17-24 — Proofs of loss--Provision required in policy.
- 58-17-25 — Time of payment of claims--Provision required in policy.
- 58-17-26 — Payment of claims--Persons to whom benefits payable--Provision requiredin policy.
- 58-17-27 — Payment of claims--Optional provisions, insertion by insurer.
- 58-17-28 — Physical examination of insured--Autopsy in death claims--Provisionrequired in policy.
- 58-17-29 — Action to recover under policy--Time for beginning.
- 58-17-30 — Beneficiary--Changes reserved to insured.
- 58-17-30.1 — Continuation of coverage for physically handicapped or mentally retardedchild--Proof of dependency.
- 58-17-30.2 — Family coverage to include newborn or newly adopted children--Paymentof claim not to be withheld during bonding period of adopted child.
- 58-17-30.3 — Premature birth and congenital defects covered--Applicability.
- 58-17-30.4 — Notice of birth or adoption required for continued coverage.
- 58-17-30.5 — Coverage for inpatient alcoholism treatment required.
- 58-17-30.6 — Alcoholism benefits provided--Days of care.
- 58-17-30.7 — Policies excluded from alcoholism coverage requirements.
- 58-17-30.8 — Exclusion of benefits for injury while under the influence of alcohol or drugsprohibited--Exception for sickness or injury caused in commission of felony.
- 58-17-31 — Optional policy provisions.
- 58-17-32 — Occupational change--Policy provision for adjustment of premium orbenefits.
- 58-17-33 — Misstatement of age--Policy provision for adjustment of benefits.
- 58-17-34 — Earnings of insured--Policy provision for adjustment of benefits.
- 58-17-35 — Earnings adjustment clause to be coupled with insured's right to continuepolicy in force.
- 58-17-36 — Option of insurer to define "valid loss of time coverage".
- 58-17-37 — Unpaid premiums--Deduction from benefits.
- 58-17-38 — Conformity with state statutes of insured.
- 58-17-39 — Illegal occupation of insured.
- 58-17-40 — Renewal of policy at option of insurer.
- 58-17-41 — Order of policy provisions.
- 58-17-42 — Age limit in policy--Effect of acceptance of premiums or misstatement ofage.
- 58-17-43 — Third parties taking policy covering insured.
- 58-17-44 — Foreign or alien insurer--Policy provision required by home state.
- 58-17-45 — Policy of domestic insurer delivered in other state--Compliance with lawsof other state.
- 58-17-46 — Policy provisions not subject to chapter--Conforming to statute required.
- 58-17-47 — Nonconforming and conflicting provisions construed in conformity withstatute.
- 58-17-48 — Liability and workers' compensation insurance--Inapplicability of healthinsurance provisions.
- 58-17-49 — Health insurance provisions inapplicable to group or blanket policy.
- 58-17-50 — Life insurance, endowment or annuity contracts not subject to healthinsurance provisions.
- 58-17-51 — Health insurance provisions inapplicable to reinsurance.
- 58-17-52 — Prior contracts or policies excepted.
- 58-17-53 — Optometric services--Reimbursement, exceptions.
- 58-17-54 — Reimbursement provisions applicable to all healing arts licensees--Self-insurance plans for public employees--Restrictions on policylimitations.
- 58-17-55 — Reimbursement provisions applicable to licensed hospitals.
- 58-17-56 — Reimbursement for service rendered or supervised by qualified mentalhealth professional.
- 58-17-57 — "Abuse of health insurance" defined--Violation as misdemeanor.
- 58-17-58 — Waiver of required deductible or co-payment for charitable purposespermitted.
- 58-17-59 — When waiver presumed.
- 58-17-60 — Certain payments exempt.
- 58-17-61 — Assignment of health insurance proceeds to certain hospitals authorized.
- 58-17-62 — Coverage for phenylketonuria.
- 58-17-63 — "Health benefit plan" defined.
- 58-17-64 — Minimum loss ratio for individual health benefit plans.
- 58-17-65 — Individual health insurance plan used in conjunction with managed care planor utilization review organization.
- 58-17-66 — Definitions for 58-17-66 to 58-17-87.
- 58-17-67 — "Professional association" defined.
- 58-17-68 — "Professional association plan" defined.
- 58-17-69 — "Creditable coverage" defined.
- 58-17-70 — Application of 58-17-66 to 58-17-87, inclusive.
- 58-17-71 — Separate classes of individual business--Reasons--Number.
- 58-17-72 — Transitional period when additional class of business acquired.
- 58-17-73 — Director approval required to establish additional classes of business--Ratesor rating methodologies.
- 58-17-74 — Provisions for premium rates for individual health benefit plans.
- 58-17-74.1 — Premium rate limitations.
- 58-17-75 — Promulgation of rules for rates charged for individual health benefit plans.
- 58-17-76 — Transfer into or out of class of business.
- 58-17-77 — Temporary suspension of premium rates for individual health insurance--Reasons.
- 58-17-78 — Required disclosure when offering individual health benefit plan.
- 58-17-79 — Documentation of rating methods and practices.
- 58-17-80 — Filing of actuarial certification by carrier of individual health benefit plans.
- 58-17-81 — Availability of information on rating methods and practices of carriersoffering individual health benefit plans.
- 58-17-82 — Renewal of individual health benefit plans--Exceptions.
- 58-17-83 — Election not to renew individual health benefit plan--Future businessrestricted.
- 58-17-84 — Provisions of compliance for any individual health benefit plan.
- 58-17-84.1 — Anesthesia and hospitalization for dental care to be provided certain coveredpersons.
- 58-17-85 — Acceptance of applicant with prior health benefit plan--Residencyrequirement--Application deadline.
- 58-17-85.1 — Health carrier to offer additional deductible options.
- 58-17-86 — Repealed.
- 58-17-87 — Director to promulgate rules for individual health insurance--Scope of rules.
- 58-17-88 — Minimum inpatient care coverage following delivery.
- 58-17-89 — Shorter hospital stay permitted--Follow-up visit within forty-eight hoursrequired.
- 58-17-90 — Notice to policyholders--Disclosures.
- 58-17-91 — Repealed.
- 58-17-97 — Provisions covering preexisting conditions.
- 58-17-98 — Health insurance policies to provide coverage for biologically-based mentalillnesses.
- 58-17-99 — Application of § 58-17-98--Exemptions.
- 58-17-100 — Definitions.
- 58-17-101 — Insurer may not exclude certain off-label uses of prescription drugs.
- 58-17-102 — Exceptions.
- 58-17-103 — Provisions limited to cancer or life threatening diseases.
- 58-17-104 — Deductibles, copayments, and managed care review not affected.
- 58-17-105 — Drugs used in research trials not covered.
- 58-17-106 — No reduction or limitation of coverage otherwise required by law.
- 58-17-107 — Health insurance policies to provide coverage for prostate cancer screening.
- 58-17-108 — "Disability income insurance" defined.
- 58-17-109 — Exclusion or reduction of benefits.
- 58-17-110 — Commencement of loss.
- 58-17-111 — Minimum standards--Exceptions.
- 58-17-112 — Promulgation of rules regarding disability income policies--Content.
- 58-17-113 — Legislative findings.
- 58-17-114 — Definitions.
- 58-17-115 — Health insurance coverage risk pool established.
- 58-17-116 — Administration of risk pool--Appointment of board--Members--Board maycontract for performance of functions.
- 58-17-117 — Board to request bids for administrator of risk pool--Effective date of bid--Board may continue administration in lieu of satisfactory bid--Oversight byboard.
- 58-17-118 — Advisory panel established--Members--Terms--Functions.
- 58-17-119 — Administrative functions of board--Annual report to Legislature--Contents.
- 58-17-120 — South Dakota risk pool fund established--Purpose.
- 58-17-121 — Powers and authority of board--Immunity not waived.
- 58-17-122 — Third-party liability--Subrogation of third-party payment by risk pool--Waiver of subrogation rights.
- 58-17-123 — Notification of coverage status to health care or pharmacy provider--Requestfor payment constitutes agreement--Reimbursement rates--Provider barredfrom billing enrollee for covered services.
- 58-17-124 — Promulgation of rules--Scope of rules.
- 58-17-125 — Premium rates to be reasonable--Establishment of rates--Determination ofaverage carrier rates--Actuarial adjustment of rates.
- 58-17-126 — Annual fiscal determination of payments, costs and losses--Abatement ordeferral of loss assessments--Initial or interim assessments--Maximumassessments--Gains--Assessment of carriers.
- 58-17-127 — Audits, periodic and annual.
- 58-17-128 — Plans--Filing and approval.
- 58-17-129 — No fee or tax applicable to pool.
- 58-17-130 — Pool to offer three plan designs--Board to establish coverage and benefits--Alteration by law--Deductibles and expenses--Out-of-pocket maximum--Mental illness coverage--Additional designs.
- 58-17-131 — Disease management programs--Cost containment mechanisms--Enrolleenon-participation and expense responsibility.
- 58-17-132 — Pharmacy benefits--Deductibles and coinsurance amounts--Refusal ofintervention or cost containment mechanism.
- 58-17-133 — Plan-year benefit maximums.
- 58-17-134 — Lifetime benefit maximums.
- 58-17-135 — Newborn coverage and eligibility.
- 58-17-136 — Noneligibility of certain persons--Coverage under risk pool provisions inexcess of other governmentally-provided insurances--Exception--Ineligibility of enrollee at lifetime maximum--Termination of coverage--Employer-paid premium deemed equivalent coverage.
- 58-17-137 — Rates not to change except on class basis--Disclosure.
- 58-17-138 — Limitations on civil actions or criminal liability--Request for hearing.
- 58-17-139 — Carrier to provide notice of availability and application form--Format.
- 58-17-140 — Recision of policies issued prior to August 1, 2003.
- 58-17-141 — Commissions paid to insurance producer not to exceed three percent.
- 58-17-142 — Maximum premium rates for plans issued prior to August 1, 2003--Rateprovisions of § 58-17-75 to apply upon carrier's discontinuance of activemarketing.
- 58-17-143 — Preferred provider contracts with out-of-state providers--Limitations onpayments by risk pool.
Disclaimer: These codes may not be the most recent version. South Dakota may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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