Title 58 — INSURANCE
79 chapters · 3,532 sections in this title.
SDCL § 58-17K-1 Definitions
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Terms used in this chapter mean: (1) "Accumulated amount," the amount of financial responsibility an enrollee has incurred at the time a request for cost-sharing information is made, with respect to a deductible or out-of-pocket limit as calculated under rules promulgated by the …
SDCL § 58-17K-10 Rules and regulations
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The director shall promulgate rules, pursuant to chapter 1-26 , for the following: (1) The definition of terms; (2) Required cost-sharing liability disclosures; (3) The method and format requirements for disclosures; (4) Calculations pertaining to information, disclosure, and his…
SDCL § 58-17K-11 Plan years effective
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The provisions of § 58-17K-5 are effective for plan years beginning on or after January 1, 2022. The provisions of §§ 58-17K-2 to 58-17K-4 , inclusive, are effective for plan years beginning on or after January 1, 2024. Source: SL 2021, ch 213 , § 11.
SDCL § 58-17K-2 Cost-sharing information described--Required disclosure to enrollees
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At the request of an enrollee, the health insurer shall provide: (1) An estimate, which is accurate at the time of the request, of the enrollee's cost-sharing liability for a requested covered item or service furnished by a provider reflecting any cost-sharing reductions the enro…
SDCL § 58-17K-3 Cost-sharing information disclosed--Required internet method and format
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The cost-sharing information to be provided under this chapter shall be made available without a subscription or other fee through a self-service tool on a website that provides real-time responses based on cost-sharing information that is accurate at the time of request. A healt…
SDCL § 58-17K-4 Cost-sharing information disclosed--Paper or other method on request--Limit on providers per request
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An enrollee may request, in accordance with § 58-17K-3 , the required cost-sharing information be provided in a paper form. In responding to such a request, a health insurer may limit the number of providers to no fewer than twenty providers per request. A health insurer shall di…
SDCL § 58-17K-5 Prescription drug file--Required public disclosure--Method, format, and updates
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A health insurer shall make available to the public on a website a machine-readable prescription drug file that includes: (1) A health insurance oversight identifier or employer identification number; (2) The NDC and the proprietary and nonproprietary name assigned to the NDC by …
SDCL § 58-17K-6 Cost-sharing information or prescription drug file--Third party contract to provide information--Health insurer responsible
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A health insurer may enter into a written agreement with a third-party administrator, health care claims clearinghouse, pharmacy benefit manager, or other third party to provide the required cost-sharing information or prescription drug file in compliance with this chapter. If a …
SDCL § 58-17K-7 Acting in good faith--Error or omission--Reliance on other entity
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A health insurer acting in good faith and with reasonable diligence is not in violation of this chapter solely because the health insurer: (1) Makes an error or omission in a disclosure required in this chapter, provided the health insurer corrects the information as soon as prac…
SDCL § 58-17K-8 Compliance with applicable laws required
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Nothing in this chapter alters or affects a health insurer's duty to comply with requirements under applicable state and federal laws, including those governing accessibility, privacy, or security of information required to be disclosed under this chapter, or those governing the …
SDCL § 58-17K-9 Applicability to certain plans
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Nothing in this chapter applies to: (1) A grandfathered health plan; (2) A health reimbursement arrangement or other account-based group health plan as defined in 29 CFR 2590.715-2711(d)(6) as of January 1, 2020; (3) A short term limited duration plan; (4) Accident insurance; (5)…