Title 58 — INSURANCE
79 chapters · 3,532 sections in this title.
SDCL § 58-41-25 Fiduciary responsibilities to enrollees
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Any director, officer, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of such organization shall be responsible for such funds in a fiduciary relationship to the enrollees. Source: SL 1974, ch …
SDCL § 58-41-25.1 Investments
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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 1985, ch 393 , § 14.
SDCL § 58-41-26 Exemption from insurance laws--Exceptions--Taxation
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Any health maintenance organization is exempt from all provisions of the insurance laws of this state other than this chapter. However, the corporation is subject to the provisions of this title on matters and procedures of mergers and licensure of insurance producers. The corpor…
SDCL § 58-41-27 Repealed by SL 1985, ch 393 , § 9 58-41-28 Solicitation of enrollment not deemed professional advertising
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58-41-29 Contracts and necessary activities. 58-41-29.1 Notice required for rate increase in health maintenance contract by a health maintenance organization. 58-41-30 Sources of payment for enrollee services--Application by medical assistance recipient. 58-41-31 Direct payments …
SDCL § 58-41-28 Solicitation of enrollment not deemed professional advertising
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Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals. Source: SL 1974, ch 321 , § 52.
SDCL § 58-41-29 Contracts and necessary activities
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A health maintenance organization may enter into health maintenance contracts in this state and engage in any other activities consistent with this chapter which are necessary to the performance of its obligations under such contracts or authorize its representatives to do so. So…
SDCL § 58-41-29.1 Notice required for rate increase in health maintenance contract by a health maintenance organization
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Forty - five days before a health maintenance contract rate increase is effective, the health maintenance organization shall notify the enrolling unit in writing that the contract rate for the health maintenance contract offered by the organization will be increased. Source: SL 1…
SDCL § 58-41-3 Certificate of authority required for health maintenance organization or contracts--Violation as misdemeanor
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No person shall establish or operate a health maintenance organization in this state, nor sell or offer to sell, or solicit offers to purchase or receive advance or periodic consideration in conjunction with a health maintenance organization or health maintenance contract unless …
SDCL § 58-41-30 Sources of payment for enrollee services--Application by medical assistance recipient
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Each health maintenance organization authorized to operate under this chapter or its representative, may accept from governmental agencies, private agencies, corporations, associations, groups, individuals, or other persons, payments covering all or part of the cost of health car…
SDCL § 58-41-31 Direct payments to enrollees prohibited
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No health maintenance organization or representative thereof may by a health maintenance contract or evidence of coverage provide for the reimbursement of an enrollee other than through a policy of insurance, except to refund payments made by or on behalf of an enrollee. Source: …
SDCL § 58-41-32 Use of words descriptive of insurance, casualty, or surety business as misdemeanor--Exception
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No health maintenance organization or representative thereof may use in its name, contracts, or literature any of the words "insurance," "casualty," "surety," "mutual," or any other words which are descriptive of the insurance, casualty, or surety business or deceptively similar …
SDCL § 58-41-33 Trade practice laws applicable
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Each health maintenance organization, health maintenance contract, and evidence of coverage shall be subject to chapter 58-33 , relating to the regulation of trade practices, except to the extent that the director determines that the nature of health maintenance organizations, he…
SDCL § 58-41-34 Evidence of coverage issued to enrollees
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Every enrollee residing in this state is entitled to evidence of coverage under a health maintenance contract. The health maintenance organization or its designated representative shall issue the evidence of coverage. Source: SL 1974, ch 321 , § 18.
SDCL § 58-41-35 Contents required in evidence of coverage
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An evidence of coverage shall contain a clear, concise, and complete statement of: (1) The health care services and the insurance or other benefits, if any, to which the enrollee is entitled under the health care plan; (2) Any exclusions or limitations on the services, kind of se…
SDCL § 58-41-35.1 Alcoholism coverage to be offered at time contract is negotiated
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At the time of negotiation of any health maintenance contract, the health maintenance organization shall offer, in writing, to provide the coverage prescribed by §§ 58-17-30.5 and
SDCL § 58-41-35.5 Grandfathered contracts required to cover low-dose mammography--Extent of coverage
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Each health maintenance contract 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 limited benefit coverage, shall provide coverage for screening by low-dose mammo…
SDCL § 58-41-35.6 Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony
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A health maintenance contract 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 §
SDCL § 58-41-35.7 Contracts required to cover occult breast cancer screening
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Each health maintenance contract 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 limited benefit coverage, shall provide coverage for screening for the presence …
SDCL § 58-41-36 Unfair and misleading information in evidence of coverage as misdemeanor
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No evidence of coverage shall contain provisions or statements which are unjust, unfair, inequitable, misleading, or deceptive, as defined in §§ 58-41-37 to 58-41-40 , inclusive. Violation of this section is a Class 2 misdemeanor. Source: SL 1974, ch 321 , §§ 19 (1), 50; SDCL Sup…
SDCL § 58-41-37 Deceptive advertising or evidence of coverage as misdemeanor
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No health maintenance organization or representative thereof may cause or knowingly permit the use of advertising or solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. Violation of this section is a Class 2 misdemeanor. Source: SL …
SDCL § 58-41-38 Statements deemed untrue
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For the purposes of this chapter, a statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect which is or may be significant to an enrollee of, or person considering enrollment in, a health maintenance organization. Source: SL 197…
SDCL § 58-41-39 Statements deemed misleading
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For the purposes of this chapter, a statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue, if, in the total context in which such statement is made or such item of information is communicated, such statement or item of inform…
SDCL § 58-41-4 Application for certificate of authority required
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Notwithstanding any law of this state to the contrary, any corporation organized to do so shall apply to the director of the Division of Insurance for a certificate of authority to establish and operate a health maintenance organization in compliance with the provisions of this c…
SDCL § 58-41-40 Evidence of coverage deemed deceptive
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For the purposes of this chapter, an evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format, as well as language, shall be such as to cause a reasonable person, not possessing specia…
SDCL § 58-41-41 Issuance to enrollees of change in evidence of coverage
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Any approved change in evidence of coverage shall be issued to each enrollee. Source: SL 1974, ch 321 , § 21.
SDCL § 58-41-42 Evidence of coverage to be approved before use--Violation as misdemeanor
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No evidence of coverage or amendment thereto shall be issued or delivered to any person in this state until a copy of the form of the evidence of coverage or amendment thereto has been filed with and approved by the director. Violation of this section is a Class 2 misdemeanor. So…
SDCL § 58-41-43 Filing and approval requirements applicable
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A copy of the form of evidence of coverage to be used in this state, and any amendment thereto, shall be subject to the filing and approval requirements of § 58-41-42 unless it is subject to the jurisdiction of the director under the laws governing health insurance or hospital or…
SDCL § 58-41-44 Charges to enrollees--Fairness--Actuary's certificate
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Charges for comprehensive health maintenance services may be established in accordance with actuarial principles for various categories of enrollees, provided that such charges applicable to an enrollee shall not be individually determined based on the status of his health. Howev…
SDCL § 58-41-45 Discrimination as misdemeanor
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No health maintenance organization or representative thereof may discriminate in the rates charged enrollees except in accordance with accepted actuarial principles. Violation of this section is a Class 2 misdemeanor. Source: SL 1974, ch 321 , §§ 32 (6), (7), 50; SDCL Supp, § 58-…
SDCL § 58-41-5 Repealed by SL 1985, ch 393 , § 7 58-41-6 Verification and form of application--Contents
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58-41-7 Financial statements required with application. 58-41-8 Copies of forms required with application. 58-41-9 Marketing, charges, and financial plans required with application. 58-41-10 Appointment to receive process required of foreign applicant. 58-41-11 Surety bond or dep…
SDCL § 58-41-50 Authorized expenses
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Authorized expenses of health maintenance organizations include: (1) Cash rebates to enrollees, or to persons who have made payments on behalf of enrollees; (2) Free or reduced cost health service to enrollees; or (3) Payments to providers or other persons based upon the efficien…
SDCL § 58-41-51 Repealed by SL 2013, ch 256 , § 16
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58-41-51.1 Individual policy required for covered spouse of insured--Eligibility--Coverage--Waiting periods. 58-41-51.2 Conversion privileges of insured's spouse upon divorce. 58-41-51.3 Continuation and conversion coverage to be offered. 58-41-52 Contracts with providers of heal…
SDCL § 58-41-51.1 Individual policy required for covered spouse of insured--Eligibility--Coverage--Waiting periods
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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…
SDCL § 58-41-51.2 Conversion privileges of insured's spouse upon divorce
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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…
SDCL § 58-41-51.3 Continuation and conversion coverage to be offered
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At the time of negotiation of any health maintenance contract, the health maintenance organization shall offer, in writing, to provide the coverage prescribed by §§ 58-18-7.5 to 58-18-7.15 , inclusive. Source: SL 1985, ch 393 , § 13.
SDCL § 58-41-52 Contracts with providers of health care services
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A health maintenance organization may contract with providers of health care services to render the services the health maintenance organization has promised to provide under the terms of its health maintenance contracts. Source: SL 1974, ch 321 , § 13.
SDCL § 58-41-52.1 Collection for covered services prohibited
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Except for coinsurance, deductibles, or copayments as specifically provided in the evidence of coverage, in no event, including nonpayment by the health maintenance organization, insolvency of the health maintenance organization, or breach of contract among the health maintenance…
SDCL § 58-41-52.2 Contracts--Hold harmless provision
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All contracts among health maintenance organizations, risk bearing entities, and participating providers shall include a hold harmless provision specifying protection for enrollees consistent with §§ 58-41-52.1 to 58-41-52.3, inclusive. Any attempted waiver or amendment in a mann…
SDCL § 58-41-52.3 Hold harmless provision--Language of provision
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The requirements of § 58-41-52.2 shall be met by including a provision substantially similar to the following: Provider agrees that in no event, including but not limited to nonpayment by the health maintenance organization or intermediary organization, insolvency of the health m…
SDCL § 58-41-53 Repealed by SL 1999, ch 245 , § 21 58-41-54 Contracts with insurance companies and nonprofit health service plan corporations authorized--Limitations
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58-41-55 Insurance contracts authorized--Group coverage--Benefit payments. 58-41-56 Contracts for management and administrative services authorized. 58-41-57 Payment of unreasonably high expenses as misdemeanor. 58-41-58 58-41-58 to 58-41-62. Repealed by SL 1996, ch 296 , §§ 9 to…
SDCL § 58-41-54 Contracts with insurance companies and nonprofit health service plan corporations authorized--Limitations
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A health maintenance organization may, subject to the limitations of subdivision 58-41-17(5) and of § 58-41-19 , contract with insurance companies and nonprofit health service plan corporations for insurance, indemnity, or reimbursement of its cost of providing health care servic…
SDCL § 58-41-55 Insurance contracts authorized--Group coverage--Benefit payments
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Notwithstanding any law to the contrary, an insurer or a hospital or medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provid…
SDCL § 58-41-56 Contracts for management and administrative services authorized
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A health maintenance organization may contract with other persons for the provision of services, including, but not limited to, managerial and administration, marketing and enrolling, data processing, actuarial analysis, and billing services. Source: SL 1974, ch 321 , § 14.
SDCL § 58-41-57 Payment of unreasonably high expenses as misdemeanor
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No health maintenance organization shall incur or pay for any expense of any nature which is unreasonably high in relation to the value of the service or goods provided. Violation of this section is a Class 2 misdemeanor. Source: SL 1974, ch 321 , §§ 41, 50; SDCL Supp, § 58-41-77…
SDCL § 58-41-6 Verification and form of application--Contents
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Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant, shall include an application fee, and shall be in a form prescribed by the director. Each application shall include the following: (1) A copy of the basi…
SDCL § 58-41-63 General annual report required--Form and contents
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Every health maintenance organization shall annually, on or before March first, file a report verified by at least two principal officers with the director, covering the preceding calendar year. Such report shall be on forms prescribed by the director and shall include: (1) A fin…
SDCL § 58-41-64 Repealed by SL 1985, ch 393 , § 10 58-41-65 Applications, filings and reports as public documents
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58-41-66 Annual summary for enrollees required--Contents. 58-41-67 Promulgation of rules. 58-41-68 58-41-68 to 58-41-72. Repealed by SL 2013, ch 256 , §§ 20 to 24. 58-41-73 Physician-patient privileges. 58-41-74 Confidential data--Exceptions. 58-41-75 58-41-75 , 58-41-76. Repeale…
SDCL § 58-41-65 Applications, filings and reports as public documents
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All applications, filings, and reports required under this chapter are public documents except as provided for by §
SDCL § 58-41-66 Annual summary for enrollees required--Contents
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Every health maintenance organization or its representative shall annually, before April first, provide to its enrollees a summary of: (1) Its most recent annual financial statement, including a balance sheet and statement of receipts and disbursements; (2) A description of the h…
SDCL § 58-41-67 Promulgation of rules
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The director may, pursuant to chapter 1-26 , promulgate such reasonable rules as are necessary to carry out the provisions of this chapter. Included among such rules shall be those which provide minimum requirements for the provision of comprehensive health maintenance services, …