Title 58 — INSURANCE

The insurer may elect to provide group insurance coverage in lieu of the issuance of a converted individual policy. Source: SL 1984, ch 326 , § 11; SL 1987, ch 378 , § 2; SL 1988, ch 400 , § 4. 58-18-7.16. Repealed by SL 2001, ch 280 , § 15

58-18-7.18 Continuation coverage to be same as that available to similarly situated beneficiaries--Option to decrease benefits. 58-18-7.19 Probationary period for continuation or conversion coverage prohibited. 58-18-7.20 Construction with chapter 58-18C . 58-18-7.21 Continued co…

A group health insurance policy or certificate that is delivered, issued for delivery, or renewed in this state may not exclude the payment of benefits for injuries sustained by an insured person because the insured was under the influence of alcohol or drugs, as defined by §

Continuation coverage shall be the same coverage as is available to any similarly situated beneficiary under the plan with respect to whom a qualifying event has not occurred. If coverage is modified under the plan for any group of similarly situated beneficiaries who are not und…

No new probationary or waiting period may be applied to the continuation or conversion coverage. Source: SL 2001, ch 280 , § 4.

The alcoholism coverage shall provide benefits on the same basis as benefits provided for the treatment of other sicknesses covered under the group policy; provided, however, that the coverage by the insurance carrier need not exceed thirty days' care in any six - month period, a…

Nothing in §§ 58-18-7.4 , 58-18-7.5 , 58-18-7.11 , 58-18-7.12 , 58-18-7.13 , 58-18-7.18 , 58-18-7.19 , 58-18-7.20 , or 58-18-79 applies to or qualifies any person for any continuation or conversion right available in chapter 58-18C . Source: SL 2001, ch 280 , § 5.

Nothing in § 58-18-7.18 or 58-18C-5 may be construed to limit an insurer's ability to use the experience from those persons who have continued coverage pursuant to § 58-18-7.18 or 58-18C-5 for rating purposes for the employer group from which coverage was continued. An insurer is…

Sections 58-18-7.1 and 58-18-7.2 do not apply to accident only, or limited or specified disease policies. Source: SL 1975, ch 314 , § 3; SL 1999, ch 249 , § 2.

An employee or qualified beneficiary who has the right under the group policy to convert the group accident or health insurance plan shall be issued, without evidence of insurability, upon application to the company during the one hundred eighty days prior to expiration of covera…

Every health benefit program that is self - insured, and every policy of group health insurance providing benefits for hospital or medical expenses delivered or issued for delivery in this state, by a commercial health insurance company, by a nonprofit medical and surgical servic…

If a group 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 inpatie…

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,…

The group health insurer shall provide notice to employees or members regarding the coverage required by §§ 58-18-76 and 58-18-77 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 prominentl…

If any federal standards are in place which require additional steps to meet those standards beyond what is required by this chapter, the director may promulgate rules, pursuant to chapter 1-26 , to require the offering of health insurance plans, the underwriting criteria that ma…

Each such group health insurance policy shall contain in substance a provision that, in the absence of fraud, all statements made by applicants or the policyholder or by an insured person shall be deemed representations and not warranties, and that no statement made for the purpo…

Every group health insurance policy, including a certificate that is subject to approval pursuant to § 58-11-12 , 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, s…

The provisions of § 58-18-80 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;…

Any carrier who is or has provided coverage to an employer shall provide, at the written request of the employer, annual reports of the claims experience of that employer for the immediate past policy period and for any time frames which are not in excess of three years prior to …

Every group health insurance policy, including a certificate that is subject to approval pursuant to § 58-11-12 , delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for special disease or other limited benefit coverage, shall provi…

The provisions of § 58-18-83 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;…

Every group health insurance policy that covers a male and 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 the following coverage for diagnostic scre…

Any accident and sickness plan or certificate other than credit health insurance as defined in subdivision 58-19-2(1) and a health benefit plan is subject to subdivision 58-18-45(1). Source: SL 2001, ch 275 , § 6; SL 2013, ch 248 , § 2.

The director may promulgate rules pursuant to chapter 1-26 pertaining to the use of genetic information, whether the genetic information was derived from a genetic test or from another source, as it relates to group health benefit plans. Source: SL 2001, ch 267 , § 3.

A self-funded multiple employer trust, as defined in section 3 of the federal Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002, paragraph 40, that is sponsored by an association, may be authorized by the director if the multiple employer trust meets all of the fo…

An association not formed in this state may request a waiver of subdivisions 58-18-88(3) and (5) regarding organization in South Dakota to sponsor a multiple employer trust in this state if the association provides sufficient evidence a waiver is in the best interests of the insu…

The director shall promulgate rules, pursuant to chapter 1-26 , pertaining to multiple employer trusts in the following areas: (1) Consumer protection issues including minimum coverage standards for health policies; claims processing and payment practices; resolution of consumer …

Each such group health insurance policy shall contain in substance a provision that the insurer will furnish to the policyholder for delivery to each employee or member of the insured group, a statement in summary form of the essential features of the insurance coverage of such e…

Except as otherwise provided in this chapter, an authorized multiple employer trust may not be determined to be or considered to be an insurance company or association of any kind or character under this title, or subject to the provisions of §§ 58-8-6 to 58-8-19 , inclusive. Sou…

A multiple employer trust authorized under this chapter may have its authorization suspended or revoked by the director for violating any applicable provision of this title. The director may take action in lieu of suspension or revocation as though the trust were an insurer as pr…

If not otherwise provided, a multiple employer trust doing business in this state on a self-funded basis shall pay premium taxes as required in chapter 10-44 based upon the amount each participating employer contributes, including any amounts contributed by employees and dependen…

No agent may sell, solicit, or negotiate a self-funded multiple employer trust authorized under this chapter unless the agent is licensed to sell life and health insurance pursuant to chapter 58-30 . Source: SL 2005, ch 272 , § 7; SL 2019, ch 212 , § 10.

The provisions of this chapter regarding multiple employer trusts do not apply to any single employer self-funded plan as preempted by Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1144 or any arrangement exempted pursuant to §

Any qualified health plan issued on or after January 1, 2015, that offers coverage for professional audiology services shall include coverage for medically necessary physician services appropriate for the treatment of hearing impairment to a person under the age of nineteen. This…

Terms used in this chapter mean: (1) "Birthday," refers only to a month and day in a calendar year and does not include the year in which the person was born; (2) "Claim," a request that benefits of a plan be provided or paid. The benefits claimed may be in the form of: (a) Servi…

For the purposes of this chapter, the term, allowable expense, means any health care expense, including coinsurance or copayments and without reduction for any applicable deductible, that is covered in full or in part by any of the plans covering the person. If a plan is advised …

The following are examples of expenses that are not allowable expenses: (1) If a person is confined in a private hospital room, the difference between the cost of a semi-private room in the hospital and the private room is not an allowable expense, unless one of the plans provide…

For the purposes of this chapter, the term, allowable expense, may exclude certain types of coverage or benefits such as dental care, vision care, prescription drugs, or hearing aids. A plan that limits the application of COB to certain coverages or benefits may limit the definit…

For the purposes of this chapter, the term, plan, means a form of coverage with which coordination is allowed. Separate parts of a plan for members of a group that are provided through alternative contracts that are intended to be part of a coordinated package of benefits are con…

For the purposes of this chapter, the term, plan, includes: (1) Group and nongroup insurance contracts and subscriber contracts; (2) Uninsured arrangements of group or group-type coverage; (3) Group and nongroup coverage through closed panel plans; (4) Group-type contracts; (5) T…

For the purposes of this chapter, the term, plan, does not include: (1) Hospital indemnity coverage benefits or other fixed indemnity coverage; (2) Accident only coverage; (3) Specified disease or specified accident coverage; (4) Limited benefit health coverage; (5) School accide…

Sections 58-18A-53 to 58-18A-83 , inclusive, apply to all plans that are issued on or after January 1, 2007. Source: SL 2006, ch 259 , § 8.

The director shall promulgate rules pursuant to chapter 1-26 to carry out the provisions of §§ 58-18A-53 to 58-18A-83 , inclusive. In promulgating any rules, the director shall give great weight to any national standards that may exist for the coordination of benefits for plans. …

No COB provision may be used that permits a plan to reduce its benefits on the basis that: (1) Another plan exists and the covered person did not enroll in that plan; (2) A person is or could have been covered under another plan, except with respect to Part B of Medicare; or (3) …

No plan may contain a provision that its benefits are always excess or always secondary except in accordance with the rules permitted by §§ 58-18A-53 to 58-18A-83 , inclusive. No plan is required to coordinate benefits provided that it pays benefits as a primary plan; but if the …

Under the terms of a closed panel plan, no benefits are payable if the covered person does not use the services of a closed panel provider. No COB occurs if a covered person is enrolled in two or more closed panel plans and obtains services from a provider in one of the closed pa…

No plan may use a COB provision, or any other provision, that allows it to reduce its benefits with respect to any other coverage its insured may have that does not meet the definition of a plan as provided by §§ 58-18A-53 to 58-18A-83 , inclusive. Source: SL 2006, ch 259 , § 13.

If a person is covered by two or more plans, the provisions for determining the order of benefit payments are as follows: (1) The primary plan shall pay or provide its benefits as if any secondary plan did not exist; (2) If the primary plan is a closed panel plan and the secondar…

A plan may take into consideration the benefits paid or provided by another plan only if, under the provisions of §§ 58-18A-53 to 58-18A-83 , inclusive, it is secondary to that other plan. Source: SL 2006, ch 259 , § 15.

Order of benefits determined under §§ 58-18A-69 to