Title 58 — INSURANCE
79 chapters · 3,532 sections in this title.
SDCL § 58-17I-16 Promulgation of rules
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The director, in consultation with the secretary, shall promulgate rules, pursuant to chapter 1-26 , to establish time frames relative to the filing of grievances, the disposition of grievances, and the response to the aggrieved person. Rules may also be promulgated covering defi…
SDCL § 58-17I-2 Health benefit plan defined
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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…
SDCL § 58-17I-3 Urgent care request defined
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For the purposes of this chapter, the term, urgent care request, means a request for a health care service or course of treatment with respect to which the time periods for making a nonurgent care request determination: (1) Could seriously jeopardize the life or health of the cov…
SDCL § 58-17I-4 Register of grievances required--Information to be compiled--Maintenance
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Each health carrier shall maintain in a register written records to document all grievances received including the notices and claims associated with the grievances during a calendar year. A request for a first level review of a grievance involving an adverse determination shall …
SDCL § 58-17I-5 Repealed
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Source: SL 2011, ch 219 , § 77; SL 2023, ch 165 , § 1.
SDCL § 58-17I-6 Grievance procedures--Filing--Certificate of compliance--Contact information
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Except as specified in this chapter, each health carrier shall use written procedures for receiving and resolving grievances from covered persons, as provided in §§ 58-17I-7 to 58-17I-11 , inclusive. If a health carrier fails to strictly adhere to the requirements of §§ 58-17I-7 …
SDCL § 58-17I-7 Review of adverse determination--Time for filing--Designation and notice of reviewers--Scope of review
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Within one hundred eighty days after the date of receipt of a notice of an adverse determination sent pursuant to chapter 58-17H , any covered person or the covered person's authorized representative may file a grievance with the health carrier requesting a first level review of …
SDCL § 58-17I-8 Rights of covered person or authorized representative on review--Access to documentation
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No covered person has the right to attend, or to have a representative in attendance, at the first level review. However, the covered person or, if applicable, the covered person's authorized representative may: (1) Submit written comments, documents, records, and other material …
SDCL § 58-17I-9 Time for decision and notice--Calculation of time periods
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A health carrier shall notify and issue a decision in writing or electronically to the covered person or, if applicable, the covered person's authorized representative, within the following time frames: (1) With respect to a grievance requesting a first level review of an adverse…
SDCL § 58-17J-1 Definitions
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Terms used in this chapter mean: (1) "Health benefit plan," any hospital or medical expense policy or certificate, hospital or medical service plan, nonprofit hospital, medical-surgical health service corporation contract or certificate, provider sponsored integrated health deliv…
SDCL § 58-17J-2 Patient choice--Health care provider participation
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No health insurer, including the South Dakota Medicaid program, may obstruct patient choice by excluding a health care provider licensed under the laws of this state from participating on the health insurer's panel of providers if the provider is located within the geographic cov…
SDCL § 58-17K-1 Definitions
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Terms used in this chapter mean: (1) "Accumulated amount," the amount of financial responsibility an enrollee has incurred at the time a request for cost-sharing information is made, with respect to a deductible or out-of-pocket limit as calculated under rules promulgated by the …
SDCL § 58-17K-10 Rules and regulations
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The director shall promulgate rules, pursuant to chapter 1-26 , for the following: (1) The definition of terms; (2) Required cost-sharing liability disclosures; (3) The method and format requirements for disclosures; (4) Calculations pertaining to information, disclosure, and his…
SDCL § 58-17K-11 Plan years effective
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The provisions of § 58-17K-5 are effective for plan years beginning on or after January 1, 2022. The provisions of §§ 58-17K-2 to 58-17K-4 , inclusive, are effective for plan years beginning on or after January 1, 2024. Source: SL 2021, ch 213 , § 11.
SDCL § 58-17K-2 Cost-sharing information described--Required disclosure to enrollees
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At the request of an enrollee, the health insurer shall provide: (1) An estimate, which is accurate at the time of the request, of the enrollee's cost-sharing liability for a requested covered item or service furnished by a provider reflecting any cost-sharing reductions the enro…
SDCL § 58-17K-3 Cost-sharing information disclosed--Required internet method and format
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The cost-sharing information to be provided under this chapter shall be made available without a subscription or other fee through a self-service tool on a website that provides real-time responses based on cost-sharing information that is accurate at the time of request. A healt…
SDCL § 58-17K-4 Cost-sharing information disclosed--Paper or other method on request--Limit on providers per request
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An enrollee may request, in accordance with § 58-17K-3 , the required cost-sharing information be provided in a paper form. In responding to such a request, a health insurer may limit the number of providers to no fewer than twenty providers per request. A health insurer shall di…
SDCL § 58-17K-5 Prescription drug file--Required public disclosure--Method, format, and updates
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A health insurer shall make available to the public on a website a machine-readable prescription drug file that includes: (1) A health insurance oversight identifier or employer identification number; (2) The NDC and the proprietary and nonproprietary name assigned to the NDC by …
SDCL § 58-17K-6 Cost-sharing information or prescription drug file--Third party contract to provide information--Health insurer responsible
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A health insurer may enter into a written agreement with a third-party administrator, health care claims clearinghouse, pharmacy benefit manager, or other third party to provide the required cost-sharing information or prescription drug file in compliance with this chapter. If a …
SDCL § 58-17K-7 Acting in good faith--Error or omission--Reliance on other entity
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A health insurer acting in good faith and with reasonable diligence is not in violation of this chapter solely because the health insurer: (1) Makes an error or omission in a disclosure required in this chapter, provided the health insurer corrects the information as soon as prac…
SDCL § 58-17K-8 Compliance with applicable laws required
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Nothing in this chapter alters or affects a health insurer's duty to comply with requirements under applicable state and federal laws, including those governing accessibility, privacy, or security of information required to be disclosed under this chapter, or those governing the …
SDCL § 58-17K-9 Applicability to certain plans
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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)…
SDCL 58-5A-29
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Source: SL 2006, ch 257 , § 1.
An authorized self-funded multiple employer trust may include as participating employers both small employers and large employers
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Source: SL 2005, ch 272 , § 8; SL 2019, ch 212 , § 11.
Source: SL 1994, ch 381 , § 1; SL 1995, ch 280
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58-18-64 to 58-18-75. Repealed by SL 2000, ch 243 , §§ 4 to 15
SDCL § 58-18-1 Group health insurance defined
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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 …
SDCL § 58-18-10 Additions to group originally insured
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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 …
SDCL § 58-18-11 Direct payment for hospital, medical, or surgical services--Option of insurer
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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 …
SDCL § 58-18-11.1 Reduction of benefits because of increase in statutory disability benefits prohibited
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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…
SDCL § 58-18-11.2 Repealed by SL 2009, ch 266 , § 1
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58-18-12 Blanket health insurance defined. 58-18-13 Blanket health insurance for passengers on common carrier. 58-18-14 Blanket health insurance for employees, dependents, or guests with reference to hazardous activities. 58-18-15 Blanket health insurance for institutions of lear…
SDCL § 58-18-12 Blanket health insurance defined
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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.
SDCL § 58-18-13 Blanket health insurance for passengers on common carrier
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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…
SDCL § 58-18-14 Blanket health insurance for employees, dependents, or guests with reference to hazardous activities
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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…
SDCL § 58-18-15 Blanket health insurance for institutions of learning, camps, or sponsors
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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…
SDCL § 58-18-16 Blanket health insurance for religious, charitable, recreational, educational, or civic organizations
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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…
SDCL § 58-18-17 Blanket health insurance for sports team or sponsors
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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).
SDCL § 58-18-18 Blanket health insurance for volunteer group or agency
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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…
SDCL § 58-18-19 Blanket health insurance for other risks approved by director
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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 …
SDCL § 58-18-2 Employee group insurance authorized--Employees defined
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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…
SDCL § 58-18-20 Authority to issue blanket health insurance--Filing of copy of form--Required provisions
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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 §
SDCL § 58-18-21 Policy and application constitute entire contract--Statements by policyholder not warranties--Written statement required for use in defense of claim
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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…
SDCL § 58-18-22 Sickness or injury--Provision for notice to insurer
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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…
SDCL § 58-18-23 Forms for filing proof of loss--Failure of insurer to furnish, submission of written proof
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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…
SDCL § 58-18-24 Claim for loss of time--Time for furnishing proof of loss--Notice of continuance of disability
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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…
SDCL § 58-18-25 Time for payment of benefits
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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…
SDCL § 58-18-26 Physical examination of insured--Autopsy in death claims
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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…
SDCL § 58-18-27 Time for commencement of action to recover under policy
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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…
SDCL § 58-18-28 Individual application and certificate not required under blanket policy
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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.
SDCL § 58-18-29 Persons to whom benefits payable under blanket health policy
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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…
SDCL § 58-18-3 Employer association group health insurance authorized--Employees defined
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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…