South Dakota 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- 58-17-10 — Repealed.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.