Title 58 — INSURANCE

Any health benefit plan as defined by § 58-18-42 shall cover anesthesia and hospital charges for dental care provided to a covered person who: (1) Is a child under age five; or (2) Is severely disabled or otherwise suffers from a developmental disability as determined by a licens…

Except as provided in §§ 58-18-42 to 58-18-49 , inclusive, a health benefit plan subject to this chapter is renewable to all eligible employees and dependents at the option of the employer, except for the following reasons: (1) The employer has failed to pay premiums or contribut…

If an employer carrier elects not to renew all of its health benefit plans delivered or issued for delivery to employers in this state, the carrier shall: (1) Be prohibited from writing new business in the employer market in this state for a period of five years from the date of …

If an employer has an existing health benefit plan, the carrier shall accept for coverage under the health benefit plan new employees and the dependents of new employees, if the new employee had creditable coverage within the prior sixty - three days from the date the new employe…

If an employer carrier offers coverage to an employer, the employer carrier shall offer coverage to all of the eligible employees of an employer and their dependents. An employer carrier may not offer coverage to only certain individuals in an employer group or to only part of th…

Group health insurance may be under a policy issued to any person or organization to which a policy of group life insurance may be issued or delivered in this state to insure any class or classes of individuals that could be insured under such group life policy. Source: SL 1966, …

The provisions of §§ 58-18-42 to 58-18-49 , inclusive, apply to health benefit plans which provide health coverage on a self - funded basis through nonfederal government employers, college plans issued on a blanket basis, and church plans. Any self - funded nonfederal government …

Notwithstanding the provisions of chapter 47-34A and §§ 47-15-2 and 47-22-4 , any organization may form for the purposes of purchasing group health insurance on a voluntary basis. For purposes of §§ 58-18-52 to 58-18-62 , inclusive, an organization means any nonprofit organizatio…

Any political subdivision of the state may join with other organizations which are not political subdivisions of the state to operate as an organization formed under § 58-18-52 for the purpose of purchasing health insurance pursuant to the provisions in §§ 58-18-52 to 58-18-62 , …

Any organization may have a group health insurance policy issued to that organization on behalf of its members who would be insured under such policy. Members may join the organization, for the purpose of obtaining group health insurance, as individuals, employers, labor unions, …

The organization shall be responsible for negotiating the terms and conditions of insurance contracts, collection of premiums, and providing notice to members. Source: SL 1994, ch 382 , § 3.

The organization may provide not less than forty - five days advance notice of any benefit or premium change to its members. Source: SL 1994, ch 382 , § 4.

Any organization is subject to all applicable provisions of chapter 58-3 and chapter 58-33 . Source: SL 1994, ch 382 , § 5.

Any organization shall, prior to its engaging in the business of insurance, obtain approval from the Division of Insurance. The division may deny approval or withdraw approval of an organization to engage in the business of insurance for any of the following reasons: (1) Any of t…

The organization shall hold all premiums received in trust and promptly remit premiums to the person entitled thereto. Source: SL 1994, ch 382 , § 7.

Any insurer issuing group health insurance pursuant to §§ 58-18-52 to 58-18-62 , inclusive, is subject to all of the provisions of chapter 58-18B relating to rates. Source: SL 1994, ch 382 , § 8.

Group health insurance may be under a policy issued to cover any other substantially similar group which, in the discretion of the director, may be subject to the issuance of a group health policy or contract. Source: SL 1966, ch 111 , ch 26, § 1 (5).

Group health insurance, as defined in § 58-18-1 , is required to offer to extend health insurance coverage to proprietors, partners, and executive corporate officer employees who are participating in such group insurance in their place of employment if such proprietor, partner, o…

An insurer may as a condition of offering coverage or continuing coverage require reasonable participation requirements of groups who become members of an organization. Source: SL 1994, ch 382 , § 9.

Any organization formed pursuant to §§ 58-18-52 to 58-18-62 , inclusive, is exempt from the antitrust provisions under chapter 37-1 . Source: SL 1994, ch 382 , § 10.

The director may promulgate rules pursuant to chapter 1-26 to further the provisions of §§ 58-18-52 to 58-18-62 , inclusive, and for purposes of carrying out the provisions of §§ 58-18-1 to 58-18-6 , inclusive, and to ensure that group health insurance coverage is issued to eligi…

Premium rates for employer health benefit plans shall produce a minimum lifetime loss ratio of not less than seventy - five percent. The director may promulgate rules pursuant to chapter 1-26 which modify the minimum loss ratio required based upon the specific plan design or othe…

Any group health policy which contains provisions for the payment by the insurer of benefits for expenses incurred on account of hospital, nursing, medical, or surgical services shall provide for the continuation of benefit provisions, or any part or parts thereof, without eviden…

No insurer may be required to offer or renew a continuation or conversion policy covering any person if: (1) The person is covered for similar benefits by another individual or group policy; (2) Similar benefits are provided for or available to such person, by reason of any state…

Subject to the conditions set forth for continuation in §§ 58-18-7 to 58-18-7.11 , inclusive, a qualified beneficiary may continue coverage for a total of thirty - six months under the following conditions: (1) If at the death of the employee or member, the qualified beneficiary'…

The premium for the conversion policy shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk for each person to be covered under that policy and to the type and amount of insurance provided. The premium for a continuati…

A notification of the continuation and conversion rights shall be included in each certificate of coverage. Source: SL 1984, ch 326 , § 10.

The insurer may elect to provide group insurance coverage in lieu of the issuance of a converted individual policy. Source: SL 1984, ch 326 , § 11; SL 1987, ch 378 , § 2; SL 1988, ch 400 , § 4. 58-18-7.16. Repealed by SL 2001, ch 280 , § 15

58-18-7.18 Continuation coverage to be same as that available to similarly situated beneficiaries--Option to decrease benefits. 58-18-7.19 Probationary period for continuation or conversion coverage prohibited. 58-18-7.20 Construction with chapter 58-18C . 58-18-7.21 Continued co…

A group health insurance policy or certificate that is delivered, issued for delivery, or renewed in this state may not exclude the payment of benefits for injuries sustained by an insured person because the insured was under the influence of alcohol or drugs, as defined by §

Continuation coverage shall be the same coverage as is available to any similarly situated beneficiary under the plan with respect to whom a qualifying event has not occurred. If coverage is modified under the plan for any group of similarly situated beneficiaries who are not und…

No new probationary or waiting period may be applied to the continuation or conversion coverage. Source: SL 2001, ch 280 , § 4.

The alcoholism coverage shall provide benefits on the same basis as benefits provided for the treatment of other sicknesses covered under the group policy; provided, however, that the coverage by the insurance carrier need not exceed thirty days' care in any six - month period, a…

Nothing in §§ 58-18-7.4 , 58-18-7.5 , 58-18-7.11 , 58-18-7.12 , 58-18-7.13 , 58-18-7.18 , 58-18-7.19 , 58-18-7.20 , or 58-18-79 applies to or qualifies any person for any continuation or conversion right available in chapter 58-18C . Source: SL 2001, ch 280 , § 5.

Nothing in § 58-18-7.18 or 58-18C-5 may be construed to limit an insurer's ability to use the experience from those persons who have continued coverage pursuant to § 58-18-7.18 or 58-18C-5 for rating purposes for the employer group from which coverage was continued. An insurer is…

Sections 58-18-7.1 and 58-18-7.2 do not apply to accident only, or limited or specified disease policies. Source: SL 1975, ch 314 , § 3; SL 1999, ch 249 , § 2.

An employee or qualified beneficiary who has the right under the group policy to convert the group accident or health insurance plan shall be issued, without evidence of insurability, upon application to the company during the one hundred eighty days prior to expiration of covera…

Every health benefit program that is self - insured, and every policy of group health insurance providing benefits for hospital or medical expenses delivered or issued for delivery in this state, by a commercial health insurance company, by a nonprofit medical and surgical servic…

If a group health insurance policy that is issued or renewed on or after July 1, 1996, provides maternity coverage, the policy shall provide coverage for a minimum of forty - eight hours of inpatient care following a vaginal delivery and a minimum of ninety - six hours of inpatie…

If the treating physician determines that the mother and the newborn meet medical criteria contained in Guidelines for Perinatal Care, Third Edition, of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists as in effect on January 1, 1996,…

The group health insurer shall provide notice to employees or members regarding the coverage required by §§ 58-18-76 and 58-18-77 in accordance with rules adopted by the director of the Division of Insurance pursuant to chapter 1-26 . The notice shall be in writing and prominentl…

If any federal standards are in place which require additional steps to meet those standards beyond what is required by this chapter, the director may promulgate rules, pursuant to chapter 1-26 , to require the offering of health insurance plans, the underwriting criteria that ma…

Each such group health insurance policy shall contain in substance a provision that, in the absence of fraud, all statements made by applicants or the policyholder or by an insured person shall be deemed representations and not warranties, and that no statement made for the purpo…

Every group health insurance policy, including a certificate that is subject to approval pursuant to § 58-11-12 , 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, s…

The provisions of § 58-18-80 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;…

Any carrier who is or has provided coverage to an employer shall provide, at the written request of the employer, annual reports of the claims experience of that employer for the immediate past policy period and for any time frames which are not in excess of three years prior to …

Every group health insurance policy, including a certificate that is subject to approval pursuant to § 58-11-12 , delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for special disease or other limited benefit coverage, shall provi…

The provisions of § 58-18-83 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;…

Every group health insurance policy 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 scre…

Any accident and sickness plan or certificate other than credit health insurance as defined in subdivision 58-19-2(1) and a health benefit plan is subject to subdivision 58-18-45(1). Source: SL 2001, ch 275 , § 6; SL 2013, ch 248 , § 2.