Title 58 — INSURANCE
79 chapters · 3,532 sections in this title.
SDCL § 58-39-9 Care provided by noncontracting dentist--Contracting dentist unavailable
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If at any time that the subscriber or certificate holder is entitled to dental service no dentist is available or in case of emergency or expediency, the dental service corporation shall provide such care by dentists who have not contracted with such corporation to such extent as…
SDCL § 58-40-1 Incorporators, number required--Purpose of incorporation
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Five or more natural persons of full age and of either sex, all of whom are residents of this state and citizens of the United States, may form, under the provisions of the laws of this state relating to benevolent corporations, so far as those provisions are applicable and are n…
SDCL § 58-40-10 Contracts with subscribers--Required provisions
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A hospital service plan corporation may enter into contracts for the rendering of hospital service to the subscribers only with hospitals duly conforming with the laws of the State of South Dakota, and approved for participation by the director; provided that the hospital service…
SDCL § 58-40-10.1 Coverage for inpatient treatment of alcoholism to be offered in individual or group plans
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Any nonprofit hospital service plan that delivers or issues for delivery in this state service or indemnity type contracts to any individual subscriber or group shall offer, in writing, to include in such contracts issued or renewed on or after July 1, 1979, coverage for the inpa…
SDCL § 58-40-10.10 Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony
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A service or indemnity - type contract issued by a nonprofit hospital service plan or organization 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 th…
SDCL § 58-40-10.2 Benefits provided under alcoholism coverage--Maximum treatment periods permitted
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The alcoholism coverage to be offered in writing shall provide benefits on the same basis as benefits provided for the treatment of other sicknesses covered under the contract; provided, however, that the coverage by the service corporation need not exceed thirty days' care in an…
SDCL § 58-40-10.3 Plans not within alcoholism coverage requirement
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Sections 58-40-10.1 and 58-40-10.2 shall not apply to group major - medical service plans or accident only, or limited or specified disease plans. Source: SL 1979, ch 344 , § 11.
SDCL § 58-40-10.4 Individual policy required for covered spouse of insured--Eligibility--Coverage--Waiting periods
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No accident or health insurance policy providing coverage of hospital or medical expense which in addition to covering the insured also provides coverage to the spouse of the insured shall be issued without a provision that provides that upon eligibility for medicare or social se…
SDCL § 58-40-10.5 Conversion privileges of insured's spouse upon divorce
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No accident or health insurance policy providing coverage of hospital or medical expense which in addition to covering the insured also provides coverage to the spouse of the insured shall be issued without a provision that provides that upon divorce of the insured and the insure…
SDCL § 58-40-10.6 Coordination, integration, or lessening of benefits restricted
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No group health insurance policy or group subscriber contract issued by a nonprofit corporation delivered or issued for delivery in this state may contain a provision requiring coordination of benefits, integration of benefits, or lessening of policy benefits because of the exist…
SDCL § 58-40-11 Care provided by noncontracting hospitals--Contracting hospital unavailable
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All contracts issued by a hospital service plan corporation to the subscribers shall constitute direct obligations of the corporation and of the hospitals with which such corporation has contracted for hospital service. If at any time that the certificate holder is entitled to ho…
SDCL § 58-40-12 Rates charged for services--Approval by director
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The rates charged to the subscribers for hospital service and the rates of payment by a hospital service plan corporation to the contracting hospitals at all times shall be subject to the approval of the director. Source: SL 1966, ch 111 , ch 21, § 17.
SDCL § 58-40-12.1 Notice required for rate increase by hospital service plan corporation
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Forty - five days before a contract rate increase is effective, the hospital service plan corporation shall notify the group employer or association in writing that the contract rate for the hospital service plan operated by the corporation will be increased. Source: SL 1989, ch …
SDCL § 58-40-13 Expenses of acquisition and administration--Control by director
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All acquisition and administrative expenses in connection with such hospital service corporation shall at all times be subject to control by the director. Source: SL 1966, ch 111 , ch 21, § 21.
SDCL § 58-40-14 Permitted investments
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The funds of any corporation subject to the provisions of this chapter shall be invested only in securities permitted by the laws of this state for the investment of assets of life insurers. Source: SL 1966, ch 111 , ch 21, § 22.
SDCL § 58-40-15 Foreign corporation--Transaction of business in state
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A nonprofit hospital service plan corporation organized under the laws of another state or any territory may with the approval of the director and under the rules as may be promulgated, consistent with the provisions of this chapter, transact and carry on its business in this sta…
SDCL § 58-40-16 Annual statement of financial condition--Filing--Verification--Form and contents
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Every hospital service plan corporation shall annually on or before the first day of March file with the director a statement verified by at least two of the principal officers of said corporation showing its condition on the thirty - first day of the preceding December; the stat…
SDCL § 58-40-17 Investigation and examination by director--Cost borne by corporation
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The director may investigate and examine the books and records of any hospital service plan corporation, and may summon and examine under oath its officers, representatives, insurance producers, employees, or other persons in relation to the affairs, transactions, and conditions …
SDCL § 58-40-18 Exemption from other insurance laws--Exceptions
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A hospital service plan corporation is exempt from all provisions of the insurance laws of this state other than in this chapter. However, the corporation is subject to the provisions of this title on matters of hearings, appeals, mergers, dissolutions, licensure of insurance pro…
SDCL § 58-40-19 Citation of chapter
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This chapter may be cited as the Hospital Service Plan Law. Source: SL 1966, ch 111 , ch 21, § 13.
SDCL § 58-40-2 Articles of incorporation and amendments--Approval by director--Filing with secretary of state
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The articles of incorporation of every hospital service plan corporation, and amendments thereto, shall be submitted to the director, whose approval thereof shall be endorsed thereon before the same are filed with the secretary of state; provided, however, that if the articles of…
SDCL § 58-40-20 Grandfathered service and indemnity-type contracts required to cover low-dose mammography--Extent of coverage
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Each service or indemnity-type contract issued by a nonprofit hospital service plan corporation that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a contract that provides coverage for specified disease or other limited benefit c…
SDCL § 58-40-20.1 Service and indemnity-type contracts required to cover occult breast cancer screening
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Each service or indemnity-type contract issued by a nonprofit hospital service plan corporation that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a contract that provides coverage for specified disease or other limited benefit c…
SDCL § 58-40-21 Coverage for phenylketonuria
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Every service or indemnity - type contract issued by a nonprofit hospital service plan corporation 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 cove…
SDCL § 58-40-22 Formation of voluntary health insurance purchasing organizations
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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 §§ 58-40-22 to 58-40-32 , inclusive, an organization means any nonprofit organizatio…
SDCL § 58-40-23 Membership of voluntary health insurance purchasing organizations
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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, …
SDCL § 58-40-24 Purchasing organization's responsibility for negotiating terms and conditions
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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.
SDCL § 58-40-25 Purchasing organization's notice of premium charge
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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.
SDCL § 58-40-26 Additional chapters applicable to purchasing organization
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Any organization is subject to all applicable provisions of chapter 58-3 and chapter 58-33 . Source: SL 1994, ch 382 , § 5.
SDCL § 58-40-27 Approval of purchasing organization by Division of Insurance
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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…
SDCL § 58-40-28 Premiums held in trust by purchasing organization
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The organization shall hold all premiums received in trust and promptly remit premiums to the person entitled thereto. Source: SL 1994, ch 382 , § 7.
SDCL § 58-40-29 Rates for group health insurance issued to purchasing organizations
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Any insurer issuing group health insurance pursuant to §§ 58-40-22 to 58-40-32 , inclusive, is subject to all of the provisions of chapter 58-18B relating to rates. Source: SL 1994, ch 382 , § 8.
SDCL § 58-40-3 Members and directors
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A hospital plan corporation shall consist of a board of directors and of such members, grouped in such classes, as the bylaws of the corporation shall provide. Source: SL 1966, ch 111 , ch 21, § 16.
SDCL § 58-40-30 Reasonable participation requirements for group members of purchasing organizations
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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.
SDCL § 58-40-31 Purchasing organizations exempt from antitrust provisions
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Any organization formed pursuant to §§ 58-40-22 to 58-40-32 , inclusive, is exempt from the antitrust provisions under chapter 37-1 . Source: SL 1994, ch 382 , § 10.
SDCL § 58-40-32 Promulgation of rules for purchasing organizations
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The director may promulgate rules pursuant to chapter 1-26 to further the provisions of §§ 58-40-22 to 58-40-32 , 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…
SDCL § 58-40-33 Minimum loss ratio for small employer health benefit plans
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Premium rates for individual 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 on the specific design of the produ…
SDCL § 58-40-34 Minimum inpatient care coverage following delivery
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If a service or indemnity - type contract issued or renewed on or after July 1, 1996, by a nonprofit hospital service plan corporation provides maternity coverage, the contract shall provide coverage for a minimum of forty - eight hours of inpatient care following a vaginal deliv…
SDCL § 58-40-35 Shorter hospital stay permitted--Follow - up visit within forty - eight hours required
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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,…
SDCL § 58-40-36 Notice to subscribers--Disclosure
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The nonprofit hospital service plan corporation shall provide notice to subscribers regarding the coverage required by § 58-40-34 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…
SDCL § 58-40-37 Health insurance policies to provide coverage for biologically - based mental illnesses
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Every service or indemnity - type contract issued by a nonprofit hospital service plan corporation 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, i…
SDCL § 58-40-38 Application--Exemptions
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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;…
SDCL § 58-40-39 Policies to provide coverage for diabetes supplies, equipment, and education--Exceptions--Conditions and limitations
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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…
Board of directors--Minimum number--Qualifications--Selection--Term of office
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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 …
SDCL § 58-40-40 Diabetes coverage not required of certain plans and policies
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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;…
SDCL § 58-40-41 Contracts to provide coverage for prostate cancer screening
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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…
SDCL § 58-40-5 License to issue contracts required--Violation as misdemeanor
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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.
SDCL § 58-40-6 Application for license--Form and contents--Documents accompanying
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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…
SDCL § 58-40-7 Issuance of license--Matters considered by director
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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…
SDCL § 58-40-8 Contracts with subscribers
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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…