Title 58, INSURANCE

The provisions of § 58-40-37 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 service or indemnity - type contract issued by a nonprofit hospital service plan corporation 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, in writin…

The business of a hospital service plan corporation shall be managed by a board of directors of at least five persons possessing the same general qualifications as the incorporators and they shall be selected, and their number fixed, in the manner set out in the bylaws for three …

The provisions of § 58-40-39 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 service or indemnity - type contract issued by a nonprofit hospital service plan or organization 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…

A corporation subject to the provisions of this chapter may issue contracts only when the director has by formal certificate or license authorized it to do so. Violation of this section is a Class 2 misdemeanor. Source: SL 1966, ch 111 , ch 21, § 18; SL 1978, ch 359 , § 2.

Application for the certificate of authority or license required by § 58-40-5 shall be made on forms to be approved by the director, containing such information as he shall deem necessary. Each application for such certificate or license shall be accompanied by copies of the foll…

The director shall issue a certificate of authority or license upon being satisfied on the following points: (1) That the applicant is established as a bona fide nonprofit hospital service corporation; (2) That the contracts between the applicant and the participating hospitals o…

Any hospital service plan corporation organized under the provisions of this chapter may enter into contracts for the rendering of hospital service to any of its subscribers with licensed hospitals maintained and operated by any corporation, association, individual or any politic…

Hospital service is meant to include the usual and customary service furnished by hospitals but nothing in this chapter shall authorize any person, association or corporation to engage, in any manner, in the practice of healing, or the practice of medicine, as defined by law. Sou…

Terms used in this chapter mean: (1) "Comprehensive health maintenance services," a set of comprehensive health services which the enrollees might reasonably require to be maintained in good health, including as a minimum, but not limited to, emergency care, inpatient hospital an…

Each application for a certificate of authority by an applicant not domiciled in this state shall include a power of attorney duly executed by such applicant, appointing the director and his successors in office, and duly authorized deputies, as the true and lawful attorney of su…

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 §§ 58-41-99 to 58-41-109 , inclusive, is subject to all of the provisions of chapter 58-18B relating to rates. Source: SL 1994, ch 382 , § 8.

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 §§ 58-41-99 to 58-41-109 , 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 §§ 58-41-99 to 58-41-109 , 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 elig…

Each health maintenance organization shall furnish a surety bond in an amount satisfactory to the director or deposit with the director cash or securities acceptable to him in at least the same amount as a guarantee that the obligations to the enrollees will be performed. The dir…

Nothing in this chapter applies to a medical provider who enters into a contract with the State of South Dakota for services pursuant to chapter 3-12A . Source: SL 1995, ch 294 , § 1.

Any medical provider who enters into a contract for medical services with a licensed health maintenance organization or a health insurer licensed pursuant to this title is not required to be licensed pursuant to this chapter. Source: SL 1995, ch 294 , § 2.

If a health maintenance contract issued or renewed on or after July 1, 1996, by a health maintenance organization provides maternity coverage, the contract shall provide coverage for a minimum of forty - eight hours of inpatient care following a vaginal delivery and a minimum of …

Source: SL 1996, ch 292 , § 16; SL 1998, ch 290 , § 6. 58-41-113 . Shorter hospital stay permitted--Follow - up visit within forty - eight hours required. If the treating physician determines that the mother and the newborn meet medical criteria contained in Guidelines for Perina…

The health maintenance organization shall provide notice to enrollees regarding the coverage required by § 58-41-112 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 prominently positioned …

Every health maintenance contract 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, in writing, coverage for the treatment and diagnosis of biological…

The provisions of § 58-41-115 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 health maintenance contract 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, in writing, coverage for equipment, supplies, and self - management traini…

The provisions of § 58-41-117 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 health maintenance contract 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 screen…

The director shall determine whether the applicant for a certificate of authority has: (1) Demonstrated the willingness and potential ability to assure that health care services will be provided in a manner to assure both the availability and accessibility of adequate personnel a…

A health maintenance organization shall file annually, as part of its access plan, a list of all risk bearing entities with which it has an agreement or contract and the number of covered persons assigned or selected by each risk bearing entity. Source: SL 2013, ch 256 , § 35.

In entering into, amending, or renewing a contract with a risk bearing entity, a health maintenance organization shall, unless already specified in the contract, provide the following, upon request, to a risk bearing entity: (1) At the time the contract is entered into, a written…

A health maintenance organization shall include in any contract with a risk bearing entity a requirement that the risk bearing entity provide to the health maintenance organization at the time a contract is entered into and annually thereafter the following: (1) Annual audited GA…

A health maintenance organization shall require in any contract with a risk bearing entity that the risk bearing entity provide notice to the health maintenance organization within thirty days of: (1) Any changes involving the ownership structure of the risk bearing entity; or (2…

A health maintenance organization shall have procedures in place to notify the director within a reasonable time that a risk bearing entity has materially failed to perform under its contract with the health maintenance organization. A health maintenance organization is not in vi…

Any information provided to the director by a health maintenance organization relative to risk bearing entities with which it is contracted is confidential and may not be disclosed to any person except to the extent that it is necessary to carry out the purposes of §§ 58-41-120 t…

Notwithstanding any agreement to the contrary, the health maintenance organization shall: (1) Retain full responsibility on a prospective basis for the provision of health care services pursuant to any applicable health benefit plan; and (2) At all times, be able to demonstrate t…

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…

To the extent that it furthers the purposes of this chapter, the director shall attempt to coordinate the operations of this chapter relating to the quality of health care services with the operations of 42 U.S.C. sections 1320c to 1320c-19. Source: SL 1974, ch 321 , § 54; SL 201…

Any health maintenance organization authorized under this chapter shall not be deemed to be practicing a healing art. Source: SL 1974, ch 321 , § 53.

Any optometrist licensed pursuant to chapter 36-7 , podiatrist licensed pursuant to chapter 36-8 , chiropractor licensed pursuant to chapter 36-5 , psychologist licensed pursuant to chapter 36-27A , dentist licensed pursuant to chapter 36-6A , or social worker licensed under § 36…

The director of the Division of Insurance shall issue or deny a certificate of authority to any person filing an application pursuant to this chapter. Issuance of a certificate of authority shall be granted upon payment of the application fee prescribed in § 58-41-26 if the direc…