Title 58 — INSURANCE
79 chapters · 3,532 sections in this title.
SDCL § 58-17-77 Temporary suspension of premium rates for individual health insurance--Reasons
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The director may suspend for a specified period the application of subdivision 58-17-74(2) as to the premium rates for one or more rating periods upon a filing by the carrier and a finding by the director either that the suspension is reasonable in light of the financial conditio…
SDCL § 58-17-78 Required disclosure when offering individual health benefit plan
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In connection with the offering for sale of any individual health benefit plan to a person, a carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of: (1) The extent to which premium rates for a specified person are established or adjusted …
SDCL § 58-17-79 Documentation of rating methods and practices
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Each carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly ac…
SDCL § 58-17-8 Exceptions and reductions of coverage to be clearly set out
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The exceptions and reductions of indemnity shall be set forth in a policy of health insurance and, other than those contained in §§ 58-17-14 to 58-17-39 , inclusive, shall be printed, at the insurer's option, either included with the benefit provision to which they apply, or unde…
SDCL § 58-17-80 Repealed by SL 2009, ch 262 , § 1
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58-17-81 Availability of information on rating methods and practices of carriers offering individual health benefit plans. 58-17-82 Renewal of individual health benefit plans--Exceptions. 58-17-83 Election not to renew individual health benefit plan--Future business restricted. 5…
SDCL § 58-17-81 Availability of information on rating methods and practices of carriers offering individual health benefit plans
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A carrier shall make the information and documentation described in § 58-17-79 available to the director upon request. Except in cases of violations of §§ 58-17-66 to 58-17-87 , inclusive, the information is proprietary and trade secret information and may not be disclosed by the…
SDCL § 58-17-82 Renewal of individual health benefit plans--Exceptions
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An individual health benefit plan subject to §§ 58-17-66 to 58-17-87 , inclusive, is renewable with respect to any person or dependent at the option of the person and may not be terminated by the insurer at any time, except as provided in § 58-17-15 or in any of the following cas…
SDCL § 58-17-83 Election not to renew individual health benefit plan--Future business restricted
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No carrier that elects not to renew an individual health benefit plan under subdivision 58-17-82(4) may write new business in the individual health benefit plan market in the state for a period of five years from the date of notice to the director. Source: SL 1996, ch 286 , § 18.
SDCL § 58-17-84 Provisions for carriers providing individual coverage other than excepted benefits
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Any health carrier providing individual coverage, other than excepted benefits, shall comply with the following provisions: (1) No individual coverage may deny, exclude, or limit benefits for a covered individual for claims incurred more than twelve months following the effective…
SDCL § 58-17-84.1 (Text of section effective until the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospitalization for dental care to be provided certain covered persons
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Any health benefit plan as defined by § 58-17-63 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…
SDCL § 58-17-86 Repealed by SL 2003 (SS) ch 1, § 33
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58-17-87 Director to promulgate rules for individual health insurance--Scope of rules. 58-17-88 Minimum inpatient care coverage following delivery. 58-17-89 Shorter hospital stay permitted--Follow-up visit within forty-eight hours required. 58-17-90 Notice to policyholders--Discl…
SDCL § 58-17-87 Director to promulgate rules for individual health insurance--Scope of rules
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The director shall promulgate rules pursuant to chapter 1-26 to cover: (1) Terms or renewability; (2) Conditions of eligibility; (3) Benefit limitations, exceptions, and reductions; (4) Definition of terms; (5) Filing requirements for forms, rates, and rate schedules; (6) Marketi…
SDCL § 58-17-88 Minimum inpatient care coverage following delivery
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If a 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 inpatient car…
SDCL § 58-17-89 Shorter hospital stay permitted--Follow - up visit within forty - eight hours required
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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,…
SDCL § 58-17-9 Renewal of policy at option of insurer--Statement in policy so informing the policyholder
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In any case where a policy of health insurance is subject to renewal at the option of the insurer there shall be prominently printed both on the cover page and on the first page of such policy a statement so informing the policyholder. Source: SL 1966, ch 111 , ch 25, § 2 (9). 58…
SDCL § 58-17-90 Notice to policyholders--Disclosures
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The health insurer shall provide notice to policyholders regarding the coverage required by §§ 58-17-88 and 58-17-89 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 prominently positioned …
SDCL § 58-17-97 Provisions covering preexisting conditions
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Any accident and sickness policy or certificate subject to the provisions of this chapter, other than credit health insurance as defined in subdivision 58-19-2(1) and a health benefit plan as defined in § 58-17-66 , shall comply with the following provisions: (1) No policy or cer…
SDCL § 58-17-98 Health insurance policies to provide coverage for biologically - based mental illnesses
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Every policy of health insurance 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, in writing, coverage for the treatment and diagnosis of biologicall…
SDCL § 58-17-99 Application of § 58-17-98 --Exemptions
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The provisions of § 58-17-98 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;…
SDCL § 58-17A-1 Definition of terms
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Terms used in this chapter mean: (1) "Applicant," in the case of an individual medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; and in the case of a group medicare supplement policy or subscriber contract, the proposed ce…
SDCL § 58-17A-10 Filing requirements--Master policy--Rates, rating schedules, and supporting documentation--Riders or amendments to delete outpatient prescription drug benefits
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Every issuer providing group medicare supplement insurance benefits to a resident of this state shall file a copy of the master policy and any certificate used in this state in accordance with the filing requirements and procedures applicable to group medicare supplement policies…
SDCL § 58-17A-11 Premiums to be adjusted to produce a loss ratio conforming with minimum standards--Form of adjustments
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Every issuer providing medicare supplement insurance or benefits to a resident of this state shall make premium adjustments as are necessary to produce an expected loss ratio under a policy or certificate as will conform with minimum loss ratio standards for medicare supplement p…
SDCL § 58-17A-13 Review of advertisements of issuers providing medicare supplement insurance
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Every issuer providing medicare supplement insurance policies or certificates in this state shall provide, prior to its use, a copy of any advertisement used in this state whether through written, radio, or television medium to the director for review. Source: SL 1989, ch 431 , §…
SDCL § 58-17A-14 Requirements for replacement of policy
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An issuer replaces a medicare supplement policy if: (1) The issuer discontinues or does not renew a medicare supplement policy and offers an alternative medicare supplement policy to its insured; or (2) The newer policy has an effective date which coincides with or which is withi…
SDCL § 58-17A-15 Sale of second policy prohibited except as replacement--Liability of issuer
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No issuer or insurance producer may sell a medicare supplement policy to a person who has an existing, in force medicare supplement policy unless the issuer or insurance producer is replacing the existing coverage. However, no issuer is liable beyond a refund of premium for the d…
SDCL § 58-17A-16 Additional penalties for violation of title
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In addition to any other applicable penalties or other administrative remedies for violations of this title, the director may require issuers violating any provision of this chapter or rules promulgated pursuant to this chapter to cease marketing any medicare supplement policy or…
SDCL § 58-17A-17 Conditional or discriminatory policy or certificate prohibited
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No issuer may deny or condition the issuance or effectiveness of any medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of health care, or …
SDCL § 58-17A-2 Regulations to establish specific standards for policy provisions
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The director shall promulgate rules pursuant to chapter 1-26 to establish specific standards and requirements for medicare supplement policies and certificates. The standards and requirements shall be in addition to and in accordance with applicable laws of this state and may cov…
SDCL § 58-17A-3 Preexisting conditions--Policy provisions
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Notwithstanding any other provision of law, a medicare supplement policy or certificate may not exclude or limit benefits for losses incurred more than six months from the effective date of coverage for a preexisting condition. The policy or certificate may not define a preexisti…
SDCL § 58-17A-3.1 Preexisting conditions provision prohibited in replacement policy--Exception
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A policy or certificate of insurance providing medicare supplement benefits which is sold to a consumer to replace an existing, in - force medicare supplement policy may not contain any provision limiting payment of benefits due to preexisting conditions of the insured except, if…
SDCL § 58-17A-4 Reasonable benefits required--Regulations to establish minimum standard from loss ratios--Policies issued through mail or mass media advertising
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Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director shall issue regulations to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experie…
SDCL § 58-17A-5 Outline of coverage delivered at time of application for insurance
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To provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate may be delivered or issued for delivery in this state and no certificate may be delivered pursuant to a group medicare supplement policy delivered or …
SDCL § 58-17A-6 Informational brochures
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The director may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for medicare which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of medicare. Exc…
SDCL § 58-17A-7 Health insurance policies--Requirements for information regarding medicare coverage
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The director may promulgate rules pursuant to chapter 1-26 for captions or notice requirements determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not medicare supplement coverages, for all health insurance p…
SDCL § 58-17A-8 Notice of right to return and right to premium refund printed in medicare supplement policies and certificates--Payment of refund
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Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within thirty days of its delivery and to hav…
SDCL § 58-17A-8.1 Issuance of policies by insurance company, nonprofit hospital service plan, medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--Term of retention
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An issuer shall issue policies in this state for which an examination period is required in accordance with one of the following methods: (1) If the policy is delivered by an insurance producer, a receipt shall be signed by the policyowner acknowledging delivery of the policy. Th…
SDCL § 58-17A-9 Regulations subject to Administrative Procedures Act
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Regulations promulgated pursuant to this chapter shall be subject to the provisions of chapter 1-26 . Source: SL 1982, ch 360 , § 9.
SDCL § 58-17B-1 Scope
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This chapter applies to policies delivered or issued for delivery in this state on or after July 1, 1989. This law does not supersede the obligations of entities subject to this chapter to comply with other applicable insurance laws insofar as they do not conflict with this chapt…
SDCL § 58-17B-10 Delivery of outline of coverage--Contents
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An outline of coverage shall be delivered to an applicant for an individual long - term care insurance policy at the time of application for an individual policy. In the case of direct response solicitations, the insurer shall deliver the outline of coverage upon the applicant's …
SDCL § 58-17B-11 Contents of certificate
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A certificate issued pursuant to a group long - term care insurance policy which policy is delivered or issued for delivery in this state shall include: (1) A description of the principal benefits and coverage provided in the policy; (2) A statement of the principal exclusions, r…
SDCL § 58-17B-12 Compliance with chapter prerequisite to advertisement, marketing, offer
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No policy may be advertised, marketed, or offered as long - term care or nursing facility insurance unless it complies with the provisions of this chapter. Source: SL 1989, ch 440 , § 13.
SDCL § 58-17B-13 Endorsement required--Cost - of - living adjustment not required
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Any long - term care policy offered for sale in this state shall offer as an endorsement an annual cost - of - living adjustment in daily benefits paid. Nothing in this section requires an insurer that offers a long - term care policy which pays benefits on an expense - incurred …
SDCL § 58-17B-13.1 Establishment of standards and requirements for cost - of - living adjustment
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The director may promulgate rules pursuant to chapter 1-26 to establish specific standards and requirements for a cost - of - living adjustment to long - term care policies. The standards or requirements may cover: (1) Types and duration of adjustments; (2) Underwriting; and (3) …
SDCL § 58-17B-14 Coverage offered to resident under group policy issued in other state--Requirements
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No group long - term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in subdivisions 58-17B-2(4)(a) and (4)(d) unless this state or another state having statutory and regulatory long - term care …
SDCL § 58-17B-15 Rules in accordance with chapter 1-26
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Rules adopted pursuant to this chapter shall be in accordance with the provisions of chapter 1-26 . Source: SL 1989, ch 440 , § 17.
SDCL § 58-17B-16 Temporary absence from nursing home or assisted living facility--Effect on benefits for long-term care charges and other requirements--Application
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If an insured is receiving benefits for long-term care services in a nursing home or assisted living facility under a long-term care policy or certificate subject to this chapter, and temporarily leaves the nursing home or assisted living facility for a period not to exceed fourt…
SDCL § 58-17B-3 Minimum requirements for individual policy
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An individual policy delivered or issued for delivery may not contain provisions less favorable to the insured than "guaranteed renewable" for life. Source: SL 1989, ch 440 , § 3.
SDCL § 58-17B-4 Adoption of rules--Standards for disclosure
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The director may adopt rules, pursuant to chapter 1-26 , that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long - term care insurance policies, terms of renewability, initial and subsequent conditions o…
SDCL § 58-17B-5 Grounds for termination and certain provisions prohibited
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No long - term care insurance policy may: (1) Be cancelled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; or (2) Contain a provision establishing a new waiting p…
SDCL § 58-17B-5.1 Replacement of policy--Waiver of time periods
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If a long - term care policy replaces another long - term care policy issued by the company or by an affiliated company, the insurer shall waive any time period applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods in the new long - …