Title 58 — INSURANCE

Five or more natural persons of full age and of either sex, all of whom are residents of this state and citizens of the United States, may form, under the provisions of the laws of this state relating to corporations, so far as those provisions are applicable and are not inconsis…

The rates charged by any medical and surgical plan corporation to the subscriber for medical and surgical service shall at all times be subject to the approval of the director. The contracts by any such corporation with the subscribers for medical and surgical service shall at al…

The contracts by any medical and surgical plan corporation with the subscribers for medical and surgical service shall be entered into only with physicians and surgeons regularly licensed to practice their profession by the State of South Dakota. All contracts issued by such corp…

Any nonprofit service corporation which delivers or issues for delivery in this state service or indemnity type contracts to any individual subscriber or group shall offer, in writing, to include in such contracts issued or renewed on or after July 1, 1979, coverage for the inpat…

A service or indemnity - type contract issued by a nonprofit medical or surgical service plan corporation 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 u…

The alcoholism coverage to be offered in writing shall provide benefits on the same basis as benefits provided for the treatment of other sicknesses covered under the contract; provided, however, that the coverage by the service corporation need not exceed thirty days' care in an…

Sections 58-38-11.1 and 58-38-11.2 shall not apply to group major - medical service plans or accident only, or limited or specified disease plans. Source: SL 1975, ch 314 , § 3.

No accident or 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 se…

No accident or 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 divorce of the insured and the insure…

No group health insurance policy or group subscriber contract issued by a nonprofit corporation delivered or issued for delivery in this state may contain a provision requiring coordination of benefits, integration of benefits, or lessening of policy benefits because of the exist…

If at any time that the subscriber or certificate holder is entitled to medical and surgical service no contracting physician and surgeon is available, the medical and surgical plan corporation shall provide such care by physicians and surgeons who have not contracted with such c…

Nothing in this chapter shall authorize any person, association, or corporation to engage, in any manner, in the practice of medicine or surgery. Source: SL 1966, ch 111 , ch 21, § 5.

All acquisition and administrative expenses in connection with such medical and surgical service corporation shall at all times be subject to control by the director. Source: SL 1966, ch 111 , ch 21, § 9.

The funds of any corporation subject to the provisions of this chapter shall be invested only in securities permitted by the laws of this state for the investment of assets of life insurance companies. Source: SL 1966, ch 111 , ch 21, § 10.

A nonprofit medical and surgical service plan corporation organized under the laws of another state or any territory may, with the approval of the director, and under the rules as may be promulgated, consistent with the provisions of this chapter, transact and carry on its busine…

Every medical and surgical plan corporation shall annually on or before the first day of March file in the office of the director a statement verified by at least two of the principal officers of said corporation showing its condition on the preceding thirty - first day of Decemb…

The director may investigate and examine the books and records of any medical and surgical plan corporation, and may summon and examine under oath its officers, representatives, insurance producers, employees, or other persons in relation to the affairs, transactions, and conditi…

Any medical and surgical plan corporation is exempt from all provisions of the insurance laws of this state other than in this chapter. However, the corporation is subject to the provisions of this title on matters of hearings, appeals, mergers, dissolutions, licensure of insuran…

The words "physicians and surgeons" as used in this chapter shall include all those persons who are licensed pursuant to chapters 36-4, 36-4A, and 36-9A. Source: SL 1966, ch 111 , ch 21, § 12; SL 1980, ch 355 , § 1.

This chapter may be cited as the Medical and Surgical Plan Law. Source: SL 1966, ch 111 , ch 21, § 1.

Forty - five days before a contract rate increase is effective, the medical and surgical plan corporation shall notify the group employer or association in writing that the contract rate for the medical and surgical plan operated by the corporation will be increased. Source: SL 1…

Each service or indemnity-type contract issued by a nonprofit medical and surgical service plan corporation that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a contract that provides coverage for specified disease or other limit…

Each service or indemnity-type contract issued by a nonprofit medical and surgical service plan corporation that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a contract that provides coverage for specified disease or other limit…

Every service or indemnity - type contract issued by a nonprofit medical and surgical service plan corporation 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…

A medical and surgical plan corporation licensed under this chapter may establish and operate a nonprofit hospital service plan under the provisions of chapter 58-40 . Such plan shall be governed by chapter 58-40 , but is exempt from the provisions of §

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 §§ 58-38-25 to 58-38-35 , inclusive, an organization means any nonprofit organizatio…

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.

The articles of incorporation of every such corporation, and amendments thereto, shall be submitted to the director, whose approval thereof shall be endorsed thereon before the same are filed with the secretary of state; provided, however, that if the articles of incorporation of…

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 §§ 58-38-25 to 58-38-35 , inclusive, is subject to all of the provisions of chapter 58-18B relating to rates. Source: SL 1994, ch 382 , § 8.

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 §§ 58-38-25 to 58-38-35 , 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 §§ 58-38-25 to 58-38-35 , 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 small 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 o…

If a service or indemnity - type contract issued or renewed on or after July 1, 1996, by a nonprofit medical and surgical service plan corporation provides maternity coverage, the contract shall provide coverage for a minimum of forty - eight hours of inpatient care following a v…

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 nonprofit medical and surgical service plan corporation shall provide notice to subscribers regarding the coverage required by § 58-38-37 in accordance with rules adopted by the director of the Division of Insurance pursuant to chapter 1-26 . The notice shall be in writing an…

A medical and surgical plan corporation shall consist of a board of directors and of such members, grouped in such classes, as the bylaws of the corporation shall provide. Source: SL 1966, ch 111 , ch 21, § 4.

Every service or indemnity - type contract issued by a nonprofit medical and surgical service plan corporation 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, shal…

The provisions of § 58-38-40 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 service or indemnity - type contract issued by a nonprofit medical and surgical service plan corporation delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall provid…

The provisions of § 58-38-42 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 service or indemnity - type contract issued by a nonprofit medical or surgical service plan corporation 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 …

The business of a medical and surgical plan corporation shall be managed by a board of directors of at least five persons possessing the same general qualifications as the incorporators and they shall be selected, and their number fixed, in the manner set out in the bylaws for th…

A corporation subject to the provisions of this chapter may issue contracts only when the director has by formal license authorized it to do so. Violation of this section is a Class 2 misdemeanor. Source: SL 1966, ch 111 , ch 21, § 6; SL 1978, ch 359 , § 2.

Application for the license required by § 58-38-6 shall be made on forms to be approved by the director, containing such information as he shall deem necessary. Each application for such license shall be accompanied by copies of the following documents: (1) Certified copy of its …