Title 58 — INSURANCE

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 r…

A health carrier or plan provider subject to §§ 58-17-154 to 58-17-162 , inclusive, shall have the right to request a review of the treatment that a person is receiving not more than once every three months unless the insurer and the person's licensed physician or licensed psycho…

58-17-164 Revocation of assignment of dental insurance benefits. 58-17-165 Reimbursement of payment from insured following receipt of payment from insurer. 58-17-166 Scope of benefits not affected--Medical benefits not included . 58-17-167 Definitions pertaining to telehealth cov…

58-17-158 Authorization, prior approval, and other care management requirements--Annual maximum benefit. 58-17-159 Qualifications of person performing or supervising applied behavior analysis. 58-17-160 Review of treatment. 58-17-161 Services under individualized service plan, fa…

Any insurer that provides dental care insurance to a person shall honor an assignment, made in writing by the person insured under the policy, of payments due under the policy to a dentist or a dental corporation for dental care services provided to the person that is insured und…

A person may revoke an assignment made pursuant to § 58-17-163 with or without the consent of the dentist or dental corporation. The revocation shall be in writing. The person shall provide notice of the revocation to the insurer. The insurer shall send a copy of the revocation n…

If, under an assignment authorized in § 58-17-163 , a dentist or dental corporation collects payment from a person and subsequently receives payment from the insurer, the dentist or dental corporation shall reimburse the person, less any applicable copayments, deductibles, or coi…

Nothing in §§ 58-17-163 to 58-17-165 , inclusive, limits an insurer's ability to determine the scope of the insurer's benefits, services, or any other terms of the insurer's policies or to negotiate any contract with a licensed health care provider regarding reimbursement rates o…

Terms used in §§ 58-17-167 to 58-17-170 , inclusive, mean: (1) "Health care professional," as defined in § 58-17F-1 ; (2) "Health care services," as defined in § 58-17F-1 ; (3) "Health insurer," as defined in § 58-17-100 ; (4) "Telehealth," the delivery of health care services th…

No health insurer may exclude a service for coverage solely because the service is provided through telehealth and not provided through in-person consultation or contact between a health care professional and a patient. Health care services delivered by telehealth must be appropr…

A health insurance policy, contract, or plan providing for third-party payment may not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth as long as the services are a…

There shall be a provision as follows: "Grace period: A grace period of __________ (insert a number not less than seven days for weekly premium policies, ten days for monthly premium policies and thirty - one days for all other policies) days will be granted for the payment of ea…

The requirements of §§ 58-17-168 and 58-17-169 apply to any health insurer offering any individual or group health insurance policy, contract, certificate, or plan delivered, issued for delivery, or renewed in South Dakota on or after January 1, 2020. The requirements of §§ 58-17…

No plan of insurance insuring dental care services may contain restrictions on methods of payment to the dentist in which the only acceptable payment method is a credit card payment. Source: SL 2022, ch 182 , § 1.

A policy in which the insurer reserves the right to refuse renewal shall have the following clause at the beginning of the provision in § 58-17-17 , "Unless not less than thirty days prior to the premium due date the insurer has delivered to the insured or has mailed to his last …

There shall be a provision as follows: "Reinstatement: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any insurance producer duly authorized by the insurer to accept such premium, without…

A policy of health insurance shall purport to insure only one person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family, who shall be deemed the policyholder, any two or more eligible members of that family…

Health insurance on a franchise plan is hereby declared to be that form of health insurance issued to: (1) Three or more employees of any corporation, copartnership, or individual employer or any governmental corporation, agency, or department thereof; or (2) Ten or more members …

No accident or health insurance policy providing coverage of hospital or medical expense which in addition to covering the insured also provides coverage to the spouse of the insured shall be issued without a provision that provides that upon divorce of the insured and the insure…

No insurer or health carrier issuing health insurance coverage, other than excepted benefits, that provides dependent coverage for any qualifying child, as defined by rules promulgated pursuant to § 58-17-87 , may terminate coverage due to attainment of a limiting age below age t…

The last sentence of the provision in § 58-17-19 may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums until at least age fifty, or, in the case of a policy issued after age forty - four, for at …

There shall be a provision as follows: "Notice of claim: Written notice of claim must be given to the insurer within twenty days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf o…

In a policy providing a loss - of - time benefit which may be payable for at least two years, an insurer may at its option insert the following between the first and second sentences of the provision in § 58-17-21 : "Subject to the qualifications set forth below, if the insured s…

There shall be a provision as follows: "Claim forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such noti…

There shall be a provision as follows: "Proofs of loss: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety days after the termination…

There shall be a provision as follows: "Time of payment of claims: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment, will be paid immediately upon receipt of due written proof of such loss. Subject to due writt…

There shall be a provision as follows: "Payment of claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designat…

The following provisions, or either of them, may be included with the provision in § 58-17-26 at the option of the insurer: "If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or otherwise not competent to…

There shall be a provision as follows: "Physical examinations and autopsy: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make …

There shall be a provision as follows: "Legal actions: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action …

The time when the insurance takes effect and terminates shall be expressed in a policy of health insurance. Source: SL 1966, ch 111 , ch 25, § 2 (2).

There shall be a provision as follows: "Change of beneficiary: Unless the insured makes an irrevocable designation of beneficiary, the right to change a beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender …

An individual health insurance policy, which is delivered or issued for delivery in this state and which provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the policy, shall also provide that attainm…

Any individual health insurance policy and individual or indemnity type contract issued by a nonprofit corporation which offers coverage for a family member of an insured or subscriber shall provide that the health insurance benefits applicable for children are payable with respe…

The coverage for a newly born child from the moment of birth or for a newly adopted child, from the beginning of the six-month adoption bonding period, shall consist of coverage of injury or sickness including the necessary care and treatment of premature birth and medically diag…

An insurer may require notice that a newly born or newly adopted child is to be added to the policy or that coverage is to be changed from single or spousal coverage to family coverage. However, the insurer may not require notification sooner than the birth of the child or the st…

Any insurer which delivers or issues for delivery in this state any insurance policy under this chapter which provides coverage on an expense incurred basis shall offer, in writing, to include in such policy or contract issued or renewed on or after July 1, 1979, coverage for the…

The alcoholism coverage to be offered shall provide benefits on the same basis as benefits provided for the treatment of other sicknesses covered under the policy; however, the coverage by the insurance carrier need not exceed thirty days' care in any six - month period, and the …

Sections 58-17-30.5 and 58-17-30.6 do not apply to accident only, or limited or specified disease policies. Source: SL 1977, ch 410 , § 4; SL 1979, ch 344 , § 2; SL 1982, ch 362 ; SL 1999, ch 249 , § 1.

A policy or certificate of health insurance for an individual that is delivered, issued for delivery, or renewed in this state may not exclude the payment of benefits for injuries sustained by an insured person because the insured was under the influence of alcohol or drugs, as d…

For any insurer that chooses to automatically cover any newborn or newly adopted child as a dependent without requiring the notice in § 58-17-30.4 and does not collect or track the demographic information on the dependent child, the insurer shall take reasonable steps to provide …

Except as provided in § 58-17-13 , no policy of health insurance delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in §§ 58-17-32 to 58-17-40 , inclusive, unless such provisions are in the words in which the sam…

There may be a provision as follows: "Change of occupation: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to…

There may be a provision as follows: "Misstatement of age: If the age of the insured has been misstated all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age." Source: SL 1966, ch 111 , ch 25, § 18.

There may be a provision as follows: "Relation of earnings to insurance: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly …

The policy provision in § 58-17-34 may be inserted only in a policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums until at least age fifty, or, in the case of a policy issued after age forty - four, for at least five y…

The insurer may, at its option, include in the provision in § 58-17-34 a definition of "valid loss of time coverage," approved as to form by the director, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject…

There may be a provision as follows: "Unpaid premiums: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom." Source: SL 1966, ch 111 , ch 25, § 20.

There may be a provision as follows: "Conformity with state statutes: Any provision of this policy which, on its effective date is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such…

There may be a provision as follows: "Illegal occupation: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupa…