Title 58 — INSURANCE

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…

For the purposes of this chapter, creditable coverage are benefits or coverage provided under: (1) Medicare or medicaid; (2) An employer - based health insurance plan or health benefit arrangement that provides benefits similar to or exceeding benefits provided under a health ben…

Any health carrier providing group coverage, other than excepted benefits, shall comply with the following provisions: (1) No policy may deny, exclude, or limit benefits for a covered individual for claims incurred more than twelve months following the effective date of the indiv…

Any health benefit plan as defined by § 58-18-42 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…

Except as provided in §§ 58-18-42 to 58-18-49 , inclusive, a health benefit plan subject to this chapter is renewable to all eligible employees and dependents at the option of the employer, except for the following reasons: (1) The employer has failed to pay premiums or contribut…

If an employer carrier elects not to renew all of its health benefit plans delivered or issued for delivery to employers in this state, the carrier shall: (1) Be prohibited from writing new business in the employer market in this state for a period of five years from the date of …

If an employer has an existing health benefit plan, the carrier shall accept for coverage under the health benefit plan new employees and the dependents of new employees, if the new employee had creditable coverage within the prior sixty - three days from the date the new employe…

If an employer carrier offers coverage to an employer, the employer carrier shall offer coverage to all of the eligible employees of an employer and their dependents. An employer carrier may not offer coverage to only certain individuals in an employer group or to only part of th…

Group health insurance may be under a policy issued to any person or organization to which a policy of group life insurance may be issued or delivered in this state to insure any class or classes of individuals that could be insured under such group life policy. Source: SL 1966, …

The provisions of §§ 58-18-42 to 58-18-49 , inclusive, apply to health benefit plans which provide health coverage on a self - funded basis through nonfederal government employers, college plans issued on a blanket basis, and church plans. Any self - funded nonfederal government …

Notwithstanding the provisions of chapter 47-34A and §§ 47-15-2 and 47-22-4 , any organization may form for the purposes of purchasing group health insurance on a voluntary basis. For purposes of §§ 58-18-52 to 58-18-62 , inclusive, an organization means any nonprofit organizatio…

Any political subdivision of the state may join with other organizations which are not political subdivisions of the state to operate as an organization formed under § 58-18-52 for the purpose of purchasing health insurance pursuant to the provisions in §§ 58-18-52 to 58-18-62 , …

Any organization may have a group health insurance policy issued to that organization on behalf of its members who would be insured under such policy. Members may join the organization, for the purpose of obtaining group health insurance, as individuals, employers, labor unions, …

The organization shall be responsible for negotiating the terms and conditions of insurance contracts, collection of premiums, and providing notice to members. Source: SL 1994, ch 382 , § 3.

The organization may provide not less than forty - five days advance notice of any benefit or premium change to its members. Source: SL 1994, ch 382 , § 4.

Any organization is subject to all applicable provisions of chapter 58-3 and chapter 58-33 . Source: SL 1994, ch 382 , § 5.

Any organization shall, prior to its engaging in the business of insurance, obtain approval from the Division of Insurance. The division may deny approval or withdraw approval of an organization to engage in the business of insurance for any of the following reasons: (1) Any of t…

The organization shall hold all premiums received in trust and promptly remit premiums to the person entitled thereto. Source: SL 1994, ch 382 , § 7.

Any insurer issuing group health insurance pursuant to §§ 58-18-52 to 58-18-62 , inclusive, is subject to all of the provisions of chapter 58-18B relating to rates. Source: SL 1994, ch 382 , § 8.

Group health insurance may be under a policy issued to cover any other substantially similar group which, in the discretion of the director, may be subject to the issuance of a group health policy or contract. Source: SL 1966, ch 111 , ch 26, § 1 (5).

Group health insurance, as defined in § 58-18-1 , is required to offer to extend health insurance coverage to proprietors, partners, and executive corporate officer employees who are participating in such group insurance in their place of employment if such proprietor, partner, o…

An insurer may as a condition of offering coverage or continuing coverage require reasonable participation requirements of groups who become members of an organization. Source: SL 1994, ch 382 , § 9.

Any organization formed pursuant to §§ 58-18-52 to 58-18-62 , inclusive, is exempt from the antitrust provisions under chapter 37-1 . Source: SL 1994, ch 382 , § 10.

The director may promulgate rules pursuant to chapter 1-26 to further the provisions of §§ 58-18-52 to 58-18-62 , inclusive, and for purposes of carrying out the provisions of §§ 58-18-1 to 58-18-6 , inclusive, and to ensure that group health insurance coverage is issued to eligi…

Premium rates for employer health benefit plans shall produce a minimum lifetime loss ratio of not less than seventy - five percent. The director may promulgate rules pursuant to chapter 1-26 which modify the minimum loss ratio required based upon the specific plan design or othe…

Any group health policy which contains provisions for the payment by the insurer of benefits for expenses incurred on account of hospital, nursing, medical, or surgical services shall provide for the continuation of benefit provisions, or any part or parts thereof, without eviden…

No insurer may be required to offer or renew a continuation or conversion policy covering any person if: (1) The person is covered for similar benefits by another individual or group policy; (2) Similar benefits are provided for or available to such person, by reason of any state…

Subject to the conditions set forth for continuation in §§ 58-18-7 to 58-18-7.11 , inclusive, a qualified beneficiary may continue coverage for a total of thirty - six months under the following conditions: (1) If at the death of the employee or member, the qualified beneficiary'…

The premium for the conversion policy shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk for each person to be covered under that policy and to the type and amount of insurance provided. The premium for a continuati…

A notification of the continuation and conversion rights shall be included in each certificate of coverage. Source: SL 1984, ch 326 , § 10.