Title 58, INSURANCE

Except for the director, the assets or securities held in this state as a deposit pursuant to §§ 58-17E-20 and 58-17E-21 are not subject to levy by a judgment creditor or other claimant of the discount medical plan organization. Source: SL 2006, ch 257 , § 22.

The director may examine or investigate the business and affairs of any discount medical plan organization to protect the interests of the residents of this state based on the following reasons, including complaint indices, recent complaints, information from other states, or as …

If the discount medical plan organization cancels a membership for any reason other than nonpayment of fees by the member, the discount medical plan organization shall make a pro rata reimbursement of all periodic charges to the member. Source: SL 2006, ch 257 , § 24.

A discount medical plan organization shall prepare written materials for its members that specifies the benefits a member is to receive under the discount medical plan and that complies with §§ 58-17E-38 , 58-17E-40 , and 58-17E-42 to 58-17E-44 , inclusive. Source: SL 2006, ch 25…

Any provider offering medical or ancillary services to members shall provide the services in accordance with a written agreement entered into directly by the provider or indirectly by a provider network to which the provider belongs. Source: SL 2006, ch 257 , § 26.

A provider agreement between a discount medical plan organization and a provider shall provide the following: (1) A list of the medical or ancillary services and products to be provided at a discount; (2) The amount or amounts of the discounts or, alternatively, a fee schedule th…

A provider agreement between a discount medical plan organization and a provider network shall require that the provider network have written agreements with its providers that: (1) Contain the provisions described in § 58-17E-27 ; (2) Authorize the provider network to contract w…

A provider agreement between a discount medical plan organization and an entity that contracts with a provider network shall require that the entity, in its contracts with the provider network, require the provider network to have written agreements with its providers that comply…

For the purposes of this chapter, the term, discount prescription drug plan, means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration provides access for its plan members to providers of pharmacy services and the righ…

The discount medical plan organization shall maintain a copy of each active provider agreement into which it has entered. Source: SL 2006, ch 257 , § 30.

Each discount medical plan organization shall maintain on an internet website page an up-to-date list of the names and addresses of the providers with which it has contracted directly or through a provider network. The internet website address shall be prominently displayed on al…

The provisions of §§ 58-17E-26 to 58-17E-31 , inclusive, apply to those providers with which the discount medical plan organization has contracted with directly or indirectly as well as those providers that are members of a provider network with which the discount medical plan or…

A discount medical plan organization may market directly or contract with other marketers for the distribution of its product. The discount medical plan organization shall have an executed written agreement with a marketer prior to the marketer's marketing, promoting, selling, or…

The agreement between the discount medical plan organization and the marketer shall prohibit the marketer from using advertising, marketing materials, brochures, and discount medical plan cards without the discount medical plan organization's approval in writing. Source: SL 2006,…

The discount medical plan organization shall be bound by and is responsible for the activities of a marketer that are within the scope of the marketer's contract with the organization, or are otherwise approved by or under the direction and control of the organization. Source: SL…

A discount medical plan organization shall approve in writing any advertisement, marketing material, brochure, or discount card used by marketers to market, promote, sell, or distribute the discount medical plan prior to their use. Source: SL 2006, ch 257 , § 36.

Upon request, a discount medical plan organization shall submit to the director any advertising, marketing material, or brochure regarding a discount medical plan. Source: SL 2006, ch 257 , § 37.

Any advertisement of a discount medical plan organization shall be truthful and not misleading in fact or in implication. An advertisement is misleading if it has a capacity or tendency to mislead or deceive based on the overall impression that the advertisement is reasonably exp…

Any person subject to registration pursuant to § 58-17E-9 shall prominently and boldly disclose that the product is not insurance. Any advertisements or solicitations made by such a person are subject to the provisions of §§ 58-33A-2 to 58-33A-4 , inclusive, and §§ 58-33A-7 to 58…

For the purposes of this chapter, discount medical plan organization, means an entity that, in exchange for fees, dues, charges, or other consideration, provides access for discount medical plan members to providers of medical or ancillary services and the right to receive medica…

No discount medical plan organization may: (1) Except as otherwise provided in this chapter or as a disclaimer of any relationship between discount medical plan benefits and insurance, or as a description of an insurance product connected with a discount medical plan, use the ter…

No person subject to registration pursuant to § 58-17E-9 may receive personal information, money, or other consideration for enrollment in a plan or program until the consumer has signed a contract or agreement with the person and no later than at the time the contract is signed,…

If the initial contact with a prospective member is by telephone, the disclosures required by § 58-17E-41 shall be made orally and included in the initial written materials that describe the benefits under the discount medical plan provided to the prospective or new member. Sourc…

In addition to the general disclosures required by § 58-17E-41 , each discount medical plan organization shall provide to each new member a copy of the terms of the discount medical plan in written materials. Source: SL 2006, ch 257 , § 41.

The written materials required under this chapter shall be clear and include information on: (1) The name of the member; (2) The benefits to be provided under the discount medical plan; (3) Any processing fees and periodic charges associated with the discount medical plan; (4) Th…

Any plan or program offered by a person subject to registration pursuant to § 58-17E-9 shall provide thirty days from the date of the signed consumer contract or agreement, or thirty days from the receipt of the disclosures required by § 58-17E-41 if the consumer purchased the pl…

Each discount medical plan organization shall provide the director at least thirty days advance notice of any change in the discount medical plan organization's name, principal business address, mailing address, or internet website address. Source: SL 2006, ch 257 , § 43.

Nothing in this chapter may be construed to discharge any requirements imposed by subdivision 37-24-6(12). Source: SL 2006, ch 257 , § 46.

Terms used in this chapter mean: (1) "Ancillary services," includes audiology, dental, vision, mental health, substance abuse, chiropractic, and podiatry services; (2) "Facility," an institution providing medical or ancillary services or a health care setting. The term includes: …

This chapter applies to all discount medical plan organizations doing business in South Dakota. Source: SL 2006, ch 257 , § 6.

A discount medical plan organization that is a health carrier registered pursuant to Title 58: (1) Is not required to register as a discount medical plan organization. However, any of its affiliates that operate as a discount medical plan organization in this state shall comply w…

If a discount medical plan organization loses its registration, or other form of authority to operate as a discount medical plan organization in another state, or is the subject of any disciplinary administrative proceeding related to the organization's operating as a discount me…

Any discount medical plan organization that is not offered directly by a health carrier as provided by this chapter, shall register in a format as prescribed by the director and shall file reports and conduct business under the same standards as required of utilization review org…

Terms used in this chapter mean: (1) "Closed plan," a managed care plan or health carrier that requires covered persons to use participating providers under the terms of the managed care plan or health carrier and does not provide any benefits for out-of-network services except f…

The health carrier shall file with the director, in a manner and form defined by rules promulgated pursuant to chapter 1-26 by the director, an access plan meeting the requirements of this chapter, for each of the managed care plans that the carrier offers in this state. The carr…

Any health carrier offering a managed care plan shall satisfy all the following requirements: (1) The health carrier shall establish a mechanism by which the participating provider will be notified on an ongoing basis of the specific covered health services for which the provider…

In any contractual arrangement between a health carrier and an intermediary, the following shall apply: (1) The health carrier's ultimate statutory responsibility to monitor the offering of covered benefits to covered persons shall be maintained whether or not any functions or du…

Any health carrier shall file with the director sample contract forms proposed for use with its participating providers and intermediaries. Any health carrier shall submit material changes to a sample contract that would affect a provision required by this chapter, or any rules p…

The execution of a contract by a health carrier does not relieve the health carrier of its liability to any person with whom it has contracted for the provision of services, nor of its responsibility for compliance with the law or applicable regulations. Any contract shall be in …

In addition to any other remedies permitted by law, if the director determines that a health carrier has not contracted with enough participating providers to assure that covered persons have accessible health care services in a geographic area, that a health carrier's access pla…

Each managed care contractor, as defined in § 58-17F-1 , shall register with the director prior to engaging in any managed care business in this state. The registration shall be in a format prescribed by the director. In prescribing the form or in carrying out other functions req…

Any managed care contractor which has previously registered in this state shall, on or before July first of each year, file with the Division of Insurance any changes to the initial or subsequent annual registration for the managed care contractor. Source: SL 2011, ch 219 , § 17.…

The director or the secretary may request information from any managed care contractor at any time pertaining to its activities in this state. The managed care contractor shall respond to all requests for information within twenty days. Source: SL 2011, ch 219 , § 18. Commission …

No managed care contractor may engage in managed care activities in this state unless the managed care contractor is properly registered. The director may issue a cease and desist order against any managed care contractor which fails to comply with the requirements of §§ 58-17F-1…

For the purposes of this chapter, the term, health benefit plan, means a policy, contract, certificate, or agreement entered into, offered, or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. The term inc…

The director may require the payment of a fee in conjunction with the initial or annual registration of a managed care contractor not to exceed two hundred fifty dollars per registration. The fee shall be established by rules promulgated pursuant to chapter 1-26 . Source: SL 2011…