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79 chapters · 3,426 sections in this title.
SDCL § 58-17H-1 Definitions
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Terms used in this chapter mean: (1) "Adverse determination," any of the following: (a) A determination by a health carrier or the carrier's designee utilization review organization that, based upon the information provided, a request by a covered person for a benefit under the h…
SDCL § 58-17H-10 Negotiated amounts for in-network providers for a particular emergency service
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If a health benefit plan has more than one negotiated amount for in-network providers for a particular emergency service, the amount in subdivision 58-17H-8 (1) is the median of these negotiated amounts. Source: SL 2011, ch 219 , § 35. Commission Note: SL 2012, ch 239, § 1 provid…
SDCL § 58-17H-11 General cost-sharing requirements allowed
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Any cost-sharing requirement other than a copayment or coinsurance requirement, such as a deductible or out-of-pocket maximum, may be imposed with respect to emergency services provided out-of-network if the cost-sharing requirement generally applies to out-of-network benefits. A…
SDCL § 58-17H-12 Access to representative for post-evaluation or post-stabilization services
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For immediately required post-evaluation or post-stabilization services, a health carrier shall provide access to a designated representative twenty-four hours a day, seven days a week, to facilitate review, or otherwise provide coverage with no financial penalty to the covered p…
