There is a newer version of the South Dakota Codified Laws
2012 South Dakota Codified Laws
Title 58 INSURANCE
Chapter 17. Health Insurance Policies
- §58-17-1 Requirements for all health insurance policies delivered in state.
- §58-17-1.1 Grandfathered plans required 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.
- §58-17-1.4 Policies required to cover occult breast cancer screening.
- §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 Dependent coverage termination--Age--Full-time students.
- §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 approval of individual policy premium rates.
- §58-17-4.2 Premium rates required to be reasonable--Rules to establish minimum standards 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 and classifications 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 the policyholder.
- §58-17-10 Repealed.
- §58-17-10.1 Reduction of benefits because of increase in statutory disability benefits prohibited.
- §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--Dissatisfaction with 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 and change clauses required--Signed acceptance required for endorsements.
- §58-17-15 Time limit on certain defenses--Application of section.
- §58-17-16 Repealed.
- §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 connection with reinstatement--Right of insured to continue policy in force by payment of premiums.
- §58-17-21 Notice of claim--Provision required in policy.
- §58-17-22 Notice of claim--Loss of time benefit--Optional provision, insertion by insurer.
- §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 required in policy.
- §58-17-27 Payment of claims--Optional provisions, insertion by insurer.
- §58-17-28 Physical examination of insured--Autopsy in death claims--Provision required 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 retarded child--Proof of dependency.
- §58-17-30.2 Family coverage to include newborn or newly adopted children--Payment of 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 drugs prohibited--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 or benefits.
- §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 continue policy 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 of age.
- §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 laws of 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 with statute.
- §58-17-48 Liability and workers' compensation insurance--Inapplicability of health insurance 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 health insurance 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 policy limitations.
- §58-17-54.1 Copayment or coinsurance amounts for chiropractic, physical therapy, or occupational therapy services.
- §58-17-55 Reimbursement provisions applicable to licensed hospitals.
- §58-17-56 Reimbursement for service rendered or supervised by qualified mental health professional.
- §58-17-57 "Abuse of health insurance" defined--Violation as misdemeanor.
- §58-17-58 Waiver of required deductible or co-payment for charitable purposes permitted.
- §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 plan or 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--Rates or 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 Repealed.
- §58-17-81 Availability of information on rating methods and practices of carriers offering 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 business restricted.
- §58-17-84 Provisions for carriers providing individual coverage other than excepted benefits.
- §58-17-84.1 Anesthesia and hospitalization for dental care to be provided certain covered persons.
- §58-17-85 Eligibility requirements for state risk pool--Residency requirement--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 hours required.
- §58-17-90 Notice to policyholders--Disclosures.
- §58-17-91 to 58-17-96. Repealed.
- §58-17-97 Provisions covering preexisting conditions.
- §58-17-98 Health insurance policies to provide coverage for biologically-based mental illnesses.
- §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 Board to administer risk pool--Members--Contracts.
- §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 by board.
- §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.
- §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--Request for payment constitutes agreement--Reimbursement rates--Provider barred from 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 of average rates--Actuarial adjustment.
- §58-17-126 Annual fiscal determination of payments, costs and losses--Abatement or deferral of loss assessments--Initial or interim assessments--Maximum assessments--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 at least three plan designs--Board to establish coverage and benefits--Alteration--Mental illness coverage--Additional designs.
- §58-17-131 Disease management programs--Cost containment mechanisms--Enrollee non-participation and expense responsibility.
- §58-17-132 Pharmacy benefits.
- §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 in excess 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--Rate provisions of § 58-17-75 to apply upon carrier's discontinuance of active marketing.
- §58-17-143 Preferred provider contracts with out-of-state providers--Limitations on payments by risk pool.
- §58-17-144 Eligibility of otherwise uninsurable persons under age nineteen for enrollment in risk pool--Open enrollment.
- §58-17-145 Six-month waiting period for preexisting conditions.
- §58-17-146 Dental insurers prohibited from setting fees for noncovered service.
- §58-17-147 Elective abortion coverage prohibited in qualified health plan offered through health insurance exchange.
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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