2019 South Dakota Codified Laws
Title 58 - Insurance
Chapter 18A - Coordination Of Benefits Of Health Plans
§ 58-18A-77 Coordination of benefits of complying and noncomplying plans.
58-18A-77. Coordination of benefits of complying and noncomplying plans. A plan with order of benefit determination provisions that comply with §§ 58-18A-53 to 58-18A-83, inclusive, may coordinate its benefits with a plan that is excess or always secondary or that uses order of benefit determination provisions that are inconsistent with those contained in §§ 58-18A-53 to 58-18A-83, inclusive, on the following basis:
(1) If the complying plan is the primary plan, it shall pay or provide its benefits first;
(2) If the complying plan is the secondary plan, it shall pay or provide its benefits first, but the amount of the benefits payable shall be determined as if the complying plan were the secondary plan. In such a situation, the payment shall be the limit of the complying plan's liability; and
(3) If the noncomplying plan does not provide the information needed by the complying plan to determine its benefits within a reasonable time after it is requested to do so, the complying plan shall assume that the benefits of the noncomplying plan are identical to its own, and shall pay its benefits accordingly. If, within two years of payment, the complying plan receives information as to the actual benefits of the noncomplying plan, it shall adjust payments accordingly.
Source: SL 2006, ch 259, § 25.
