Title 58 — INSURANCE
79 chapters · 3,532 sections in this title.
SDCL § 58-17-4 Consideration for policy to be stated
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The entire money and other considerations therefor shall be expressed in a policy of health insurance. Source: SL 1966, ch 111 , ch 25, § 2 (1).
SDCL § 58-17-4.1 Filing and approval of individual policy premium rates
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Premium rates charged for any individual accident and health insurance policy issued pursuant to this chapter shall be filed with and are subject to the approval of the director. The rates shall be filed for approval, administered, and reviewed subject to all of the applicable pr…
SDCL § 58-17-4.2 Premium rates required to be reasonable--Rules to establish minimum standards promulgated by director
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Premium rates charged for any individual accident and health insurance policy pursuant to this chapter shall be reasonable in relation to the benefits available under the policy. The director shall promulgate rules pursuant to chapter 1-26 to establish minimum standards in accord…
SDCL § 58-17-4.3 Transferred to § 58-17-74.1 by SL 2005, ch 10 , § 41
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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…
SDCL § 58-17-40 Renewal of policy at option of insurer
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Health insurance policies, other than accident insurance only policies, in which the insurer reserves the right to refuse renewal on an individual basis, shall provide in substance in a provision thereof or in an endorsement thereon or rider attached thereto that subject to the r…
SDCL § 58-17-41 Order of policy provisions
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The provisions which are the subject of §§ 58-17-14 to 58-17-39 , inclusive, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections or, at the option of the insu…
SDCL § 58-17-42 Age limit in policy--Effect of acceptance of premiums or misstatement of age
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If any policy of health insurance contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer a…
SDCL § 58-17-43 Third parties taking policy covering insured
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The word "insured," as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, b…
SDCL § 58-17-44 Foreign or alien insurer--Policy provision required by home state
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Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this chapter and which is prescribed or required by the law …
SDCL § 58-17-45 Policy of domestic insurer delivered in other state--Compliance with laws of other state
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Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of such other state or country. Source: SL 1966, ch 111 , ch 25, § 26 (2).
SDCL § 58-17-46 Policy provisions not subject to chapter--Conforming to statute required
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No policy provision which is not subject to this chapter shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this chapter. Source: SL 1966, ch 111 , ch 25, § 27 (1).
SDCL § 58-17-47 Nonconforming and conflicting provisions construed in conformity with statute
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A policy delivered or issued for delivery to any person in this state in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the…
SDCL § 58-17-48 Liability and workers' compensation insurance--Inapplicability of health insurance provisions
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Nothing in §§ 58-17-1 to 58-17-47 , inclusive, shall apply to or affect any policy of liability or workers' compensation and employers liability insurance. Source: SL 1966, ch 111 , ch 25, § 1 (1).
SDCL § 58-17-49 Health insurance provisions inapplicable to group or blanket policy
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Nothing in §§ 58-17-1 to 58-17-47 , inclusive, shall apply to or affect any group or blanket policy. Source: SL 1966, ch 111 , ch 25, § 1 (2).
SDCL § 58-17-5 Identification of forms, riders and endorsements--Form number, location
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Each form for a policy of health insurance, including riders and endorsements, shall be identified by a form number in the lower left - hand corner of the first page thereof. Source: SL 1966, ch 111 , ch 25, § 2 (6).
SDCL § 58-17-50 Life insurance, endowment or annuity contracts not subject to health insurance provisions
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Nothing in §§ 58-17-1 to 58-17-47 , inclusive, shall apply to or affect life insurance, endowment, or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to health insurance as: (1) Provide additional benefits in case of dismemberment …
SDCL § 58-17-51 Health insurance provisions inapplicable to reinsurance
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Nothing in §§ 58-17-1 to 58-17-47 , inclusive, shall apply to or affect reinsurance. Source: SL 1966, ch 111 , ch 25, § 1 (4).
SDCL § 58-17-52 Prior contracts or policies excepted
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The provisions of §§ 58-17-1 to 58-17-51 , inclusive, shall not apply to any contracts or policies entered into or issued prior to February 8, 1966, nor to any extensions, renewals, or modifications thereof or amendments thereto whenever made. Source: SL 1966, ch 111 , ch 25, § 2…
SDCL § 58-17-53 Optometric services--Reimbursement, exceptions
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If an insurer provides by contract, policy, certificate, or any other means whatever, for a service, or for the partial or total reimbursement, payment, or cost of a service to or on behalf of any of its policyholders, group policyholders, subscribers, or group subscribers, or an…
SDCL § 58-17-54.1 Copayment or coinsurance amounts for chiropractic, physical therapy, or occupational therapy services
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No health insurer may impose any copayment or coinsurance amount on an insured for services rendered by a doctor of chiropractic licensed pursuant to chapter 36-5 , an occupational therapist licensed pursuant to chapter 36-31 , or a physical therapist licensed pursuant to chapter…
SDCL § 58-17-55 Reimbursement provisions applicable to licensed hospitals
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Notwithstanding any provision of any policy of insurance subject to the general provisions of this title, whenever such policy or contract provides for reimbursement for any service which may be legally performed by a hospital licensed in this state which has an organized medical…
SDCL § 58-17-56 Reimbursement for service rendered or supervised by qualified mental health professional
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Notwithstanding any provision of any policy of insurance subject to the general provisions of this title, whenever such policy or contract provides for reimbursement for any service rendered by or directly supervised by a qualified mental health professional as defined in § 27A-1…
SDCL § 58-17-57 Abuse of health insurance as misdemeanor
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A person who provides health care commits abuse of health insurance, if, as a regular business practice, he knowingly accepts from any third - party payor, as payment in full for services rendered, the amount the third - party payor covers, or submits a fee to a third - party pay…
SDCL § 58-17-58 Waiver of required deductible or co - payment for charitable purposes permitted
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However, a person may waive any required deductible or co - payment for charitable purposes if: (1) The person who provides the health care determines that the services are necessary for the immediate health and welfare of the insured; (2) The waiver is made on a case - by - case…
SDCL § 58-17-59 When waiver presumed
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Any person who provides health care and who waives the deductible or co - payment for more than one - fourth of his patients during any calendar year, excluding waivers under § 58-17-58 , or who advertises that he will accept from any third - party payor, as payment in full for s…
SDCL § 58-17-6 Style and arrangement of policy provisions--Printing, size of type
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The style, arrangement, and overall appearance of a policy of health insurance shall give no undue prominence to any portion of the text, and every printed portion of the text of the policy and of any endorsements or attached papers shall be plainly printed in light - faced type …
SDCL § 58-17-60 Certain payments exempt
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Payments made pursuant to federal medicare laws or payments made to the health - care provider according to a contract or agreement between an employer and employee which requires a third - party payor to pay the full amount for health - care services are exempt from §§ 58-17-57 …
SDCL § 58-17-61 Assignment of health insurance proceeds to certain hospitals authorized
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Any person insured by a health insurance company, health maintenance organization, preferred provider organization, individual practice association, or nonprofit hospital service corporation may assign in writing benefits from such policy, contract, or certificate to a hospital l…
SDCL § 58-17-62 Coverage for phenylketonuria
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Every policy of health insurance that is delivered, issued for delivery or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall offer coverage for testing, diagnosis, and treatment of phenylketonuria inclu…
SDCL § 58-17-63 Health benefit plan defined
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For the purposes of §§ 58-17-64 , 58-18-63 , 58-38-36 , and 58-40-33 , a health benefit plan is any hospital or medical policy or certificate, hospital or medical service plan, or health maintenance organization subscriber contract. The term does not include specified disease, ho…
SDCL § 58-17-65 Individual health insurance plan used in conjunction with managed care plan or utilization review organization
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If a managed care plan or utilization review organization is used in conjunction with an individual health insurance plan, the managed care plan or utilization review organization shall establish a written utilization review program, registering a utilization review organization,…
SDCL § 58-17-66 SDCL 58-17-66
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Definitions for 58-17-66 through
SDCL § 58-17-67 Professional association defined
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For purposes of §§ 58-17-66 to 58-17-87 , inclusive, the term, professional association, means any association that meets all of the following criteria: (1) Serves a single profession that requires a significant amount of education, training, or experience or a license or certifi…
SDCL § 58-17-68 Professional association plan defined
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For purposes of §§ 58-17-66 to 58-17-87 , inclusive, the term, professional association plan, means a health benefit plan offered through a professional association that covers members of a professional association and their dependents, and not others, in this state regardless of…
SDCL § 58-17-69 Creditable coverage defined
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For purposes of §§ 58-17-66 to 58-17-87 , inclusive, the term, creditable coverage, means benefits or coverage provided under: (1) An employer - based health insurance or health benefit arrangement that provides benefits similar to or exceeding benefits provided under the basic h…
SDCL § 58-17-7 Documents forming part of policy--Setting forth in full, rates and classifications excepted
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A policy of health insurance shall contain no provision purporting to make any portion of the charter, rules, Constitution, or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or referen…
SDCL § 58-17-70 Application of 58-17-66 to 58-17-87 , inclusive
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Sections 58-17-66 to 58-17-87 , inclusive, apply to any individual health benefit plan or certificate delivered or issued for delivery in the state. Sections 58-17-66 to 58-17-87 , inclusive, apply to any certificate issued to an eligible person that evidences coverage under a po…
SDCL § 58-17-71 Separate classes of individual business--Reasons--Number
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A carrier may establish a separate class of individual business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons: (1) The carrier used more than one type of system for the marketing and sale of health b…
SDCL § 58-17-72 Transitional period when additional class of business acquired
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The director may provide for a period of transition in order for a carrier to come into compliance with § 58-17-71 in the instance of acquisition of an additional class of business from another carrier. Source: SL 1996, ch 286 , § 7.
SDCL § 58-17-73 Director approval required to establish additional classes of business--Rates or rating methodologies
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The director may approve the establishment of additional classes of business upon application to the director and a finding by the director that such action would enhance the efficiency and fairness of the individual marketplace. Nothing in §§ 58-17-66 to 58-17-87 , inclusive, re…
SDCL § 58-17-74 Provisions for premium rates for individual health benefit plans
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Premium rates for individual health benefit plans subject to §§ 58-17-66 to 58-17-87 , inclusive, are subject to the following provisions: (1) Any new policy issued after the effective date of §§ 58-17-66 to 58-17-87 , inclusive, is subject to the provisions of §§ 58-17-66 to 58-…
SDCL § 58-17-74.1 Premium rate limitations
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Any health benefit plan issued before July 1, 1996, is subject to the rating limitations provided in this section. For a class of business, the premium rates charged during a rating period to individuals with similar case characteristics for the same or similar coverage, or the r…
SDCL § 58-17-75 Promulgation of rules for rates charged for individual health benefit plans
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The director shall promulgate rules pursuant to chapter 1-26 to ensure that rating practices used by carriers are consistent with the purposes of §§ 58-17-66 to 58-17-87 , inclusive, including rules that ensure that differences in rates charged for individual health benefit plans…
SDCL § 58-17-76 Transfer into or out of class of business
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No carrier may transfer a person involuntarily into or out of a class of business. No carrier may offer to transfer a person into or out of a class of business unless such an offer is made to transfer all persons in the class of business without regard to claim experience or dura…
SDCL § 58-17-77 Temporary suspension of premium rates for individual health insurance--Reasons
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The director may suspend for a specified period the application of subdivision 58-17-74(2) as to the premium rates for one or more rating periods upon a filing by the carrier and a finding by the director either that the suspension is reasonable in light of the financial conditio…
SDCL § 58-17-78 Required disclosure when offering individual health benefit plan
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In connection with the offering for sale of any individual health benefit plan to a person, a carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of: (1) The extent to which premium rates for a specified person are established or adjusted …
SDCL § 58-17-79 Documentation of rating methods and practices
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Each carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly ac…
SDCL § 58-17-8 Exceptions and reductions of coverage to be clearly set out
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The exceptions and reductions of indemnity shall be set forth in a policy of health insurance and, other than those contained in §§ 58-17-14 to 58-17-39 , inclusive, shall be printed, at the insurer's option, either included with the benefit provision to which they apply, or unde…
SDCL § 58-17-80 Repealed by SL 2009, ch 262 , § 1
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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. 5…
SDCL § 58-17-81 Availability of information on rating methods and practices of carriers offering individual health benefit plans
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A carrier shall make the information and documentation described in § 58-17-79 available to the director upon request. Except in cases of violations of §§ 58-17-66 to 58-17-87 , inclusive, the information is proprietary and trade secret information and may not be disclosed by the…