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79 chapters · 3,426 sections in this title.
SDCL § 58-17G-1 Definitions
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Terms used in this chapter mean: (1) "Closed plan," a managed care plan or health carrier that requires covered persons to use participating providers under the terms of the managed care plan or health carrier and does not provide any benefits for out-of-network services except f…
SDCL § 58-17G-2 Health benefit plan defined
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For the purposes of this chapter, the term, health benefit plan, means a policy, contract, certificate, or agreement entered into, offered, or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. The term inc…
SDCL § 58-17G-3 Health carrier to develop and maintain systems to measure quality of services--System requirements--Description of quality assessment program to be filed with director
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Any health carrier that provides managed care plans shall develop and maintain the infrastructure and disclosure systems necessary to measure the quality of health care services provided to covered persons on a regular basis and appropriate to the types of plans offered by the he…
SDCL § 58-17G-4 Health carrier issuing closed plan to develop quality improvement activities--Minimum requirements of quality improvement activities
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Any health carrier that issues a closed plan, or a combination plan having a closed component, shall, in addition to complying with the requirements of § 58-17G-3 , develop and maintain the internal structures and activities necessary to improve the quality of care being provided…
