Title 58, INSURANCE

Each policy of health insurance that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a policy that provides coverage for specified disease or other limited benefit coverage, shall provide coverage for screening for the presence of …

No individual insurance policy for loss of time or disability benefits issued, amended, renewed, or delivered in this state shall contain any provision offsetting, or in any other manner reducing, any benefit under the policy by the amount of, or in proportion to, any increase in…

No 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 eligibility for medicare or social security disab…

Terms used in §§ 58-17-100 to 58-17-106 , inclusive, mean: (1) "FDA," the federal Food and Drug Administration; (2) "Health insurer," any person who provides health insurance in this state. The term includes a licensed insurance company, a prepaid hospital or medical service plan…

No health insurer issuing a policy which provides coverage for prescription drugs may exclude coverage of any drug used for the treatment of cancer or life threatening conditions on the grounds that the drug has not been approved by the FDA for that indication if that drug is rec…

No coverage is required under §§ 58-17-100 to 58-17-106 , inclusive, for the following: (1) Any drug that has not been fully licensed or approved by the FDA; (2) The use of any drug if the FDA has determined that use to be contraindicated; or (3) Any experimental drug not otherwi…

The provisions of §§ 58-17-100 to 58-17-106 , inclusive, apply to drugs used in the treatment for cancer or life threatening diseases only, and nothing in §§ 58-17-100 to 58-17-106 , inclusive, may be construed to create, impair, alter, limit, modify, enlarge, abrogate, or prohib…

Nothing in §§ 58-17-100 to 58-17-106 , inclusive, may be construed to prevent the application of contractual deductibles or copayment provisions or managed care review. Source: SL 2000, ch 242 , § 5.

The following drugs or services are not subject to coverage under § 58-17-101 : (1) Any drug that is used in research trials sponsored by the manufacturer of that drug or a governmental entity; or (2) Any drug or service furnished in a research trial, if the sponsor of the resear…

Sections 58-17-100 to 58-17-106 , inclusive, may not be used to reduce or limit coverage for off - label use of drugs otherwise required by law or contract. Source: SL 2000, ch 242 , § 7.

Every policy of health insurance that covers a male and 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 provide the following coverage for diagnostic screeni…

For the purposes of §§ 58-17-108 to 58-17-112 , inclusive, the term, disability income insurance, means a policy or certificate of insurance that primarily provides payment to or for the benefit of the policyholder or certificate holder based, in whole or in part, upon lost wages…

Any disability income insurance policy may include provisions that exclude or reduce benefits if the insured is collecting other benefits under a government program or is eligible to receive benefits under other insurance coverage. If the insured subsequently receives other benef…

Every individual health insurance policy or contract, except single premium nonrenewable policies or contracts, issued for delivery in South Dakota on or after December 31, 1966, by an insurance company, nonprofit hospital service plan, or medical service corporation, shall have …

An insurance company, nonprofit hospital service plan, medical service corporation, health maintenance organization, or fraternal benefit society shall issue policies in this state for which an examination period is required in accordance with one of the following methods: (1) If…

No disability income insurance policy may require the loss to commence less than thirty days after the date of the accident. Source: SL 2001, ch 276 , § 3.

Except for overhead expense, buy - sell coverage, or other similar business disability income insurance coverage, a disability income insurance policy shall meet the following minimum standards: (1) Provide that periodic payments that are payable at ages after sixty - two and red…

The director may promulgate rules pursuant to chapter 1-26 to protect the insurance - buying public with regard to disability income policies. However, the director shall take into account the effect any such rule may have on the availability of coverage. The rules may include: (…

Except as provided in § 58-17-13 , each policy of health insurance delivered or issued for delivery to any person in this state shall contain the provisions specified in §§ 58-17-14 to 58-17-29 , inclusive, in the words in which the same appear; except, that the insurer may, at i…

If any such provision is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the director shall omit from such policy any inapplicable provision or part of a provision and shall modify an…

There shall be a provision as follows: "Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy is valid until approved by an executive officer of the insurance compa…

Any carrier of any in force individual health benefit plan issued guarantee issued policies prior to August 1, 2003, for which rates are established pursuant to § 58-17-75 , may set and charge a maximum premium rate of not more than two and two-tenths times the base premium rate …

No contract between an insurer and a dentist may require a dentist to provide services for an insured at a fee set by the contract unless the services are covered services under the terms of the insured's plan or policy. For the purposes of this section, the term, covered service…

Any assignment or other contractual term in an agreement between an insurer and a dentist that purports to share, transfer, or assign contractual discounts to a third party insurer or entity, without relinquishing the insurer's rights, is severable and voidable at the dentist's o…

Pursuant to the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, no qualified health plan offered through a health insurance exchange established in the state may include elective abortion coverage. For the purposes of this section, an elective abortion is an abor…

Any qualified health plan as defined by the Patient Protection and Affordable Care Act of 2010 sold in South Dakota through a public health care exchange, as mandated by the Patient Protection and Affordable Care Act of 2010, shall provide for placement through a licensed insuran…

Terms used in §§ 58-17-149 to 58-17-152 , inclusive, mean: (1) "Application date," the date on which a health insurer or other entity responsible for the credentialing of health care professionals on behalf of the health insurer receives the health care professional's completed a…

There shall be a provision as follows: "Time limit on certain defenses: (1) After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to den…

A health insurer shall make retrospective payment for all clean claims submitted by a health care professional after the credentialing period for covered services provided by the health care professional during the credentialing period subject to all of the following: (1) The cre…

Within ten business days of receiving a request for an application to be credentialed by a health care professional, a health insurer or other entity responsible for the credentialing of health care professionals on behalf of the health insurer shall send an application form to t…

Nothing in §§ 58-17-149 to 58-17-151 , inclusive, applies to services provided by a health care professional that are covered by Medicaid, Medicare, TRICARE, or other health care benefit program subject to federal regulations regarding eligibility and provider payments. Nothing i…

Any qualified health plan issued on or after January 1, 2015, that offers coverage for professional audiology services shall include coverage for medically necessary physician services appropriate for the treatment of hearing impairment to a person under the age of nineteen. This…

Terms used in §§ 58-17-155 to 58-17-162 , inclusive, mean: (1) "Applied behavior analysis," the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, includi…

Nothing in §§ 58-17-154 to 58-17-162 , inclusive, applies to nongrandfathered plans in the individual and small group markets that are required to include essential health benefits under the federal Patient Protection and Affordable Care Act of 2010, as in effect on January 1, 20…

Except as provided in § 58-17-155 , §§ 58-17-154 through 58-17-162 apply to all individual and group health insurance policies, contracts, and certificates issued by health carriers as defined in § 58-17H-1 and self-funded nonfederal governmental plans with the exception of the s…

Every policy, contract, certificate, or plan subject to the provisions of §§ 58-17-154 to 58-17-162 , inclusive, shall provide coverage for applied behavior analysis for the treatment of autism spectrum disorders consistent with §§ 58-17-154 to 58-17-162 , inclusive. Source: SL 2…

Coverage for an applied behavior analysis may be subject to pre-authorization, prior approval, and other care management requirements including limits on the number of individual visits a person may make for applied behavior analysis subject to the general care management provisi…

Any person who performs or supervises applied behavior analysis shall: (1) Be licensed by the South Dakota Board of Medical and Osteopathic Examiners or the Board of Examiners of Psychologists and have documented training and competence in applied behavior analysis; or (2) Be lic…

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…

Nothing in §§ 58-17-154 to 58-17-162 , inclusive, may be construed to affect any obligation to provide services to a person under an individualized family service plan, an individualized education program, or an individualized service plan. Source: SL 2015, ch 250 , § 8.

The effective date of §§ 58-17-154 to 58-17-161 , inclusive, is the first plan year, policy year, or renewal date on or after January 1, 2016. Source: SL 2015, ch 250 , § 9.

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…