Title 58 — INSURANCE

No policy of health insurance may be delivered or issued for delivery to any person in this state unless it otherwise complies with this title, with §§ 58-17-1.1 to 58-17-11 , inclusive, and with §§ 58-17-84.1 and

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 by low-dose mammogra…

Every policy of health insurance 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, in writing, coverage for equipment, supplies, and self - management trainin…

The provisions of § 58-17-1.2 do not apply to any plan, policy, or contract that provides coverage only for: (1) Specified disease; (2) Hospital indemnity; (3) Fixed indemnity; (4) Accident - only; (5) Credit; (6) Dental; (7) Vision; (8) Prescription drug; (9) Medicare supplement…

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 …

58-17-10.1 Reduction of benefits because of increase in statutory disability benefits prohibited. 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 prem…

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: (…

58-17-116

Jan. 1, 2017. 58-17-117 58-17-117 , 58-17-118. Repealed by SL 2015, ch 249 , §§ 6, 7. 58-17-119 58-17-119 to 58-17-124. Repealed by SL 2015, ch 249 , § 36, eff. Jan. 1, 2017. 58-17-125

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…

58-17-126

Jan. 1, 2017. 58-17-127 58-17-127 to 58-17-137. Repealed by SL 2015, ch 249 , §§ 12 to 22. 58-17-138

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…

Jan. 1, 2017. 58-17-139 58-17-139 to 58-17-141. Repealed by SL 2015, ch 249 , §§ 24 to 26. 58-17-142 Maximum premium rates for plans issued prior to August 1, 2003--Rate provisions of § 58-17-75 to apply upon carrier's discontinuance of active marketing. 58-17-143

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 …

Jan. 1, 2017. 58-17-144 58-17-144 , 58-17-145. Repealed by SL 2015, ch 249 , §§ 28, 29. 58-17-145.1 Repealed. 58-17-146 Dental insurers prohibited from setting fees for noncovered service. 58-17-146.1 Certain contract terms voidable by dentist. 58-17-147 Elective abortion coverag…

Source: SL 2015, ch 249 , § 30; SL 2024, ch 1 (Ex. Ord. 24-1), § 35, eff. Apr. 8, 2024; SL 2025, ch 197 , § 8.

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…

Nothing in §§ 58-17-149 to 58-17-151 , inclusive, requires a health insurer or other entity responsible for credentialing health care professionals on behalf of the health insurer to take any action in violation of the requirements of the National Committee for Quality Assurance …

Application of §§ 58-17-149 to

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…

Definitions for §§ 58-17-155 to

Exceptions to application of §§ 58-17-154 to

Policies, contracts, certificates, and plans subject to §§ 58-17-154 to

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…