Title 58, INSURANCE

Nothing in this chapter applies to: (1) A grandfathered health plan; (2) A health reimbursement arrangement or other account-based group health plan as defined in 29 CFR 2590.715-2711(d)(6) as of January 1, 2020; (3) A short term limited duration plan; (4) Accident insurance; (5)…

Group health insurance is that form of health insurance covering groups of persons as defined in §§ 58-18-2 to 58-18-6 , inclusive, with or without one or more members of their families or one or more of their dependents, or covering one or more members of the families or one or …

Each such group health insurance policy shall contain in substance a provision that to the group originally insured may be added from time to time eligible new employees or members or dependents, as the case may be, in accordance with the terms of the policy. Source: SL 1966, ch …

Any group health policy may on request by the group policyholder provide that all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option, be paid directly to the hospital or person …

No group insurance policy for loss of time or disability benefits issued, amended, renewed or delivered in this state shall contain any provision offsetting, or in any other manner reducing, any benefit under the policy by the amount of, or in proportion to, any increase in disab…

Blanket health insurance is hereby declared to be that form of health insurance covering groups of persons as enumerated in one of §§ 58-18-13 to 58-18-19 , inclusive. Source: SL 1966, ch 111 , ch 26, § 4.

Blanket health insurance may be under a policy or contract issued to any common carrier or to any operator, owner, or lessee of a means of transportation, who or which shall be deemed the policyholder, covering a group defined as all persons or all persons of a class who may beco…

Blanket health insurance may be under a policy or contract issued to an employer, who shall be deemed the policyholder, covering all employees, dependents, or guests, defined by reference to specified hazards incident to the activities or operations of the employer or any class o…

Blanket health insurance may be under a policy or contract issued to a school, or other institution of learning, camp or sponsor thereof; or to the head or principal thereof, who or which shall be deemed the policyholder, covering students or campers. Supervisors and employees ma…

Blanket health insurance may be under a policy or contract issued in the name of any religious, charitable, recreational, educational, or civic organization, which shall be deemed the policyholder, covering participants in activities sponsored by the organization. Source: SL 1966…

Blanket health insurance may be under a policy or contract issued to a sports team or sponsors thereof which shall be deemed the policyholder, covering members, officials, and supervisors. Source: SL 1966, ch 111 , ch 26, § 4 (5).

Blanket health insurance may be under a policy or contract issued in the name of any volunteer fire department, first aid, or other such volunteer group, or agency having jurisdiction thereof, which shall be deemed the policyholder, covering all of the members of such fire depart…

Blanket health insurance may be under a policy or contract issued to cover any other risk or class of risks which, in the discretion of the director may be properly eligible for blanket health insurance. The discretion of the director may be exercised on an individual risk basis …

Group health insurance may be under a policy issued to an employer or trustees of a fund established by an employer, who shall be deemed the policyholder, insuring employees of such employer for the benefit of persons other than the employer. The term "employees" as used herein s…

Any insurer authorized to write health insurance in this state may issue blanket health insurance. No such blanket policy or certificate may be issued or delivered, or coverage solicited, in this state unless a copy of the form thereof has been filed in accordance with § 58-11-12…

Subject to § 58-18-20 , every blanket health insurance policy shall contain a provision that the policy and the application shall constitute the entire contract between the parties, and that all statements made by the policyholder shall, in absence of fraud, be deemed representat…

Subject to § 58-18-20 , every blanket health insurance policy shall contain a provision that written notice of sickness or of injury must be given to the insurer within thirty days after the date when such sickness or injury occurred. Failure to give notice within such time shall…

Subject to § 58-18-20 , every blanket health insurance policy shall contain a provision that the insurer will furnish to the policyholder such forms as are usually furnished by it for filing proof of loss. If such forms are not furnished before the expiration of fifteen days afte…

Subject to § 58-18-20 , every blanket health insurance policy shall contain a provision that in the case of claim for loss of time for disability, written proof of such loss must be furnished to the insurer within thirty days after the commencement of the period for which the ins…

Subject to § 58-18-20 , every blanket health insurance policy shall contain a provision that all benefits payable under the policy other than benefits for loss of time will be payable immediately upon receipt of due written proof of such loss, and that, subject to due proof of lo…

Subject to § 58-18-20 , every blanket health insurance policy shall contain a provision that the insurer at its own expense, shall have the right and opportunity to examine the person of the insured when and so often as it may reasonably require during the pendency of claim under…

Subject to § 58-18-20 , every blanket health insurance policy shall contain a provision that no action at law or in equity shall be brought to recover under the policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requ…

An individual application shall not be required from a person covered under a blanket health policy or contract, nor shall it be necessary for the insurer to furnish each person a certificate. Source: SL 1966, ch 111 , ch 26, § 6.

All benefits under any blanket health policy shall be payable to the person insured, or to his designated beneficiary or beneficiaries, or to his estate; except, that if the person insured be a minor or mentally incompetent, such benefits may be made payable to his parents, guard…

Group health insurance may be under a policy issued to a bona fide association of employers, including a labor union, that has a constitution and bylaws and that has been organized and is maintained in good faith with at least one substantial business purpose unrelated to obtaini…

The provisions of this chapter shall not apply to any contracts or policies entered into or issued prior to February 8, 1966, nor to any extensions, renewals, or modifications thereof or amendments thereto whenever made. Source: SL 1966, ch 111 , ch 26, § 8.

A group or blanket health insurance policy, which is delivered or issued for delivery in this state and which provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the policy, shall also provide that at…

No insurer or health carrier issuing health insurance coverage, other than excepted benefits, that provides dependent coverage for any qualifying child, as defined by rules promulgated pursuant to § 58-18-79 , may terminate coverage due to attainment of a limiting age below age t…

Any group health insurance policy and group service or indemnity type contract issued by a nonprofit corporation which offers coverage for a family member of an insured or subscriber shall provide that the health insurance benefits applicable for children are payable with respect…

The coverage for a newly born child from the moment of birth or for a newly adopted child, from the beginning of the six-month adoption bonding period, shall consist of coverage of injury or sickness including the necessary care and treatment of premature birth and medically diag…

An insurer may require notice that a newly born or newly adopted child is to be added to the policy or that coverage is to be changed from single or spousal coverage to family coverage. However, the insurer may not require notification sooner than the birth of the child or the st…

Forty - five days before a premium rate increase is effective, the group health insurance company shall notify the policy holder in writing that the premium rate for the group health insurance will be increased. Source: SL 1989, ch 434 , § 1.

Each group health insurance policy that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a policy that provides coverage for specified disease or other limited benefit coverage, shall provide coverage for screening by low-dose mammo…

Each group health insurance policy that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a policy that provides coverage for specified disease or other limited benefit coverage, shall provide coverage for screening for the presence …

No policy of group health insurance providing benefits for hospital and medical expenses delivered in this state that is offered by a commercial health insurance company, by a nonprofit medical and surgical plan corporation, by a nonprofit hospital service plan corporation, by a …

All health benefit programs, as defined in § 58-18-37 , shall provide an annual period of enrollment of at least thirty days during which period any pharmacy licensed under chapter 36-11 may elect to participate in the plan under the terms and conditions then offered unless the p…

Any provision in a health insurance policy offered in this state which violates the provisions in § 58-18-37 is void. Source: SL 1990, ch 395 , § 3.

Group health insurance may be under a policy issued to the trustees of a fund established by two or more employers in the same or related industry or by one or more labor unions or by one or more employers and one or more labor unions or by an association as defined in § 58-18-3 …

A group health insurance policy may not be issued to an association under §§ 58-18-3 and 58-18-4 that is formed, owned, or controlled by any of the following, other than to the extent the entities participate in the group or association in their capacity as employer members of th…

An employer member that participates in an association under §§ 58-18-3 and 58-18-4 shall participate in the association plan for a period of not less than three consecutive calendar years. Any contract issued to an association shall contain reasonable enforcement provisions incl…

An association plan based in this state or any other state shall follow all applicable South Dakota laws and administrative rules if the association plan covers South Dakota residents. Source: SL 2019, ch 212 , § 4.

A health insurer offering a fully insured health benefit plan through an association shall: (1) Guarantee acceptance of all eligible individuals under the employer members' association or fully insured multiple employer arrangement and, if coverage is offered to spouses and depen…

The Division of Insurance shall enforce the provisions of §§ 58-18-37 to 58-18-39 , inclusive. Source: SL 1990, ch 395 , § 4.

Every group health insurance policy 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 offer coverage for testing, diagnosis and treatment of phenylketonuria in…

For the purposes of this chapter, a health benefit plan is any hospital or medical expense incurred policy or certificate, hospital or medical service plan, contract, or health maintenance organization subscriber contract. The term does not include specified disease, hospital ind…

For the purposes of this chapter, a late enrollee is an eligible employee or dependent who requests enrollment in a health benefit plan of an employer following the initial enrollment period during which the individual is entitled to enroll under the terms of the health benefit p…