reglab/housing_qa huggingface dataset:
SD Codified L § 58-17E-40 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-40 - Prohibited conduct.

58-17E-40. Prohibited conduct.No discount medical plan organization may:(1)Except as otherwise provided in this chapter or as a disclaimer of any relationship between discount medical plan benefits and insurance, or as a description of an insurance product connected with a discount medical plan, use the term, insurance, in any advertisement, marketing material, brochure, or discount medical plan cards;(2)Use in any advertisement, marketing material, brochure, or discount medical plan card, the terms, health plan, coverage, co-pay, co-payments, deductible, preexisting conditions, guaranteed issue, premium, PPO, preferred provider organization, or other term in a manner that could reasonably mislead an individual into believing that the discount medical plan is health insurance;(3)Use language in any advertisement, marketing material, brochure, or discount medical plan card with respect to being licensed or registered by the Division of Insurance in a manner that could reasonably mislead an individual into believing that the discount medical plan is insurance or has been endorsed by the state;(4)Make misleading, deceptive, or fraudulent representations regarding the discount or range of discounts offered by the discount medical plan or the access to any range of discounts offered by the discount medical plan;(5)Have restrictions on access to discount medical plan providers, including, except for hospital services, waiting periods and notification periods; or(6)Pay providers any fees for medical or ancillary services or collect or accept money from a member to pay a provider for medical or ancillary services provided under the discount medical plan, unless the discount medical plan organization has an active certificate of authority to act as a third party administrator in accordance with chapter 58-29D. Source: SL 2006, ch 257, §39.
SD Codified L § 58-17E-42 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-42 - Disclosures required for telephone contacts.

58-17E-42. Disclosures required for telephone contacts.If the initial contact with a prospective member is by telephone, the disclosures required by §58-17E-41 shall be made orally and included in the initial written materials that describe the benefits under the discount medical plan provided to the prospective or new member. Source: SL 2006, ch 257, §40.
SD Codified L § 58-17E-43 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-43 - Member to be provided written copy of terms of plan.

58-17E-43. Member to be provided written copy of terms of plan.In addition to the general disclosures required by §58-17E-41, each discount medical plan organization shall provide to each new member a copy of the terms of the discount medical plan in written materials. Source: SL 2006, ch 257, §41.
SD Codified L § 58-17E-44 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-44 - Contents of written materials.

58-17E-44. Contents of written materials.The written materials required under this chapter shall be clear and include information on:(1)The name of the member;(2)The benefits to be provided under the discount medical plan;(3)Any processing fees and periodic charges associated with the discount medical plan;(4)The mode of payment of any processing fees and periodic charges, such as monthly, quarterly, or otherwise, and procedures for changing the mode of payment;(5)Any limitations, exclusions, or exceptions regarding the receipt of discount medical plan benefits;(6)Any waiting periods for certain medical or ancillary services under the discount medical plan;(7)Procedures for obtaining discounts under the discount medical plan, such as requiring members to contact the discount medical plan organization to make an appointment with a provider on the member's behalf;(8)Cancellation procedures, including information on the member's thirty-day cancellation rights and refund requirements and procedures for obtaining refunds;(9)Renewal, termination, and cancellation terms and conditions;(10)Procedures for adding new members to a family discount medical plan, if applicable;(11)Procedures for filing complaints under the discount medical plan organization's complaint system and information that, if the member remains dissatisfied after completing the organization's complaint system, the plan member may contact the local insurance department in the member's state; and(12)The name and mailing address of the registered discount medical plan organization or other entity where the member can make inquiries about the plan, send cancellation notices, and file complaints. Source: SL 2006, ch 257, §42.
SD Codified L § 58-17E-45 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-45 - Consumer's right to return plan or program--Refund.

58-17E-45. Consumer's right to return plan or program--Refund.Any plan or program offered by a person subject to registration pursuant to §58-17E-9 shall provide thirty days from the date of the signed consumer contract or agreement, or thirty days from the receipt of the disclosures required by §58-17E-41 if the consumer purchased the plan or program over the telephone, in which the consumer may return the plan or program to the person or agent through whom it was purchased and have all costs of the plan or program, excluding a nominal processing fee as prescribed by the director by rules promulgated pursuant to chapter 1-26, refunded in full. Source: SL 2005, ch 269, §4; SDCL, §58-17C-107.
SD Codified L § 58-17E-46 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-46 - Notice to director of change in plan.

58-17E-46. Notice to director of change in plan.Each discount medical plan organization shall provide the director at least thirty days advance notice of any change in the discount medical plan organization's name, principal business address, mailing address, or internet website address. Source: SL 2006, ch 257, §43.
SD Codified L § 58-17E-47 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-47 - Construction with trade practices statute.

 58-17E-47. Construction with trade practices statute.Nothing in this chapter may be construed to discharge any requirements imposed by subdivision 37-24-6(12). Source: SL 2006, ch 257, §46.
SD Codified L § 58-17F-3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-3 - Medical director required for managed care plans.

58-17F-3. Medical director required for managed care plans.Any managed care plan shall provide for the appointment of a medical director who has an unrestricted license to practice medicine. However, a managed care plan that specializes in a specific healing art shall provide for the appointment of a director who has an unrestricted license to practice in that healing art. The director is responsible for oversight of treatment policies, protocols, quality assurance activities, and utilization management decisions of the managed care plan. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §3.
SD Codified L § 58-17F-5 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-5 - Health carrier to maintain provider network sufficient to assure services without unreasonable delay--Emergency services--Determination of sufficiency.

58-17F-5. Health carrier to maintain provider network sufficient to assure services without unreasonable delay--Emergency services--Determination of sufficiency.A health carrier providing a managed care plan shall maintain a network that is sufficient in numbers and types of providers to assure that all services to covered persons will be accessible without unreasonable delay. In the case of emergency services, covered persons shall have access twenty-four hours a day, seven days a week. Sufficiency shall be determined in accordance with the requirements of this section, and may be established by reference to any reasonable criteria used by the carrier, including: provider-covered person ratios by specialty; primary care provider-covered person ratios; geographic accessibility; waiting times for appointments with participating providers; hours of operation; and the volume of technological and specialty services available to serve the needs of covered persons requiring technologically advanced or specialty care. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §5.
SD Codified L § 58-17F-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-6 - Where provider network is insufficient, covered benefit to be made available at no greater cost.

58-17F-6. Where provider network is insufficient, covered benefit to be made available at no greater cost.In any case where the health carrier has an insufficient number or type of participating provider to provide a covered benefit, the health carrier shall ensure that the covered person obtains the covered benefit at no greater cost to the covered person than if the benefit were obtained from participating providers, or shall make other arrangements acceptable to the director. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §6.
SD Codified L § 58-17F-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-7 - Health carrier to ensure provider proximity to covered persons.

58-17F-7. Health carrier to ensure provider proximity to covered persons.The health carrier shall establish and maintain adequate arrangements to ensure reasonable proximity of participating providers to the business or personal residence of covered persons. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §7.
SD Codified L § 58-17F-8 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-8 - Health carrier to monitor provider ability, capacity, and authority--Financial capability to be monitored in capitated plans.

58-17F-8. Health carrier to monitor provider ability, capacity, and authority--Financial capability to be monitored in capitated plans.The health carrier shall monitor, on an ongoing basis, the ability, clinical capacity, and legal authority of its providers to furnish all contracted benefits to covered persons. In the case of capitated plans, the health carrier shall also monitor the financial capability of the provider. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §8.
SD Codified L § 58-17F-9 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-9 - Factors to consider in determining network adequacy.

58-17F-9. Factors to consider in determining network adequacy.In determining whether a health carrier has complied with any network adequacy provision of this chapter, the director shall give due consideration to the relative availability of healthcare providers in the service area and to the willingness of providers to join a network. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §9.
SD Codified L § 58-17F-12 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-12 - Provisions governing contractual arrangements between health carriers and intermediaries.

58-17F-12. Provisions governing contractual arrangements between health carriers and intermediaries.In any contractual arrangement between a health carrier and an intermediary, the following shall apply:(1)The health carrier's ultimate statutory responsibility to monitor the offering of covered benefits to covered persons shall be maintained whether or not any functions or duties are contractually delegated or assigned to the intermediary;(2)The health carrier may approve or disapprove participation status of a subcontracted provider in its own or a contracted network for the purpose of delivering covered benefits to the carrier's covered persons;(3)The health carrier shall maintain copies of all intermediary health care subcontracts at its principal place of business in the state, or ensure that it has access to all intermediary subcontracts, including the right to make copies to facilitate regulatory review, upon twenty days prior written notice from the health carrier;(4)If applicable, an intermediary shall transmit utilization documentation and claims paid documentation to the health carrier. The carrier shall monitor the timeliness and appropriateness of payments made to providers and health care services received by covered persons;(5)An intermediary shall maintain the books, records, financial information, and documentation of services provided to covered persons and preserve them for examination pursuant to chapter 58-3;(6)An intermediary shall allow the director access to the intermediary's books, records, financial information, and any documentation of services provided to covered persons, as necessary to determine compliance with this chapter; and(7)The health carrier may, in the event of the intermediary's insolvency, require the assignment to the health carrier of the provisions of a provider's contract addressing the provider's obligation to furnish covered services. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §12.
SD Codified L § 58-17F-13 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-13 - Sample contract forms to be filed with director--Material changes to be submitted--Certain changes not material--Director's inaction within certain time deemed approval--Contract copies to be provided upon request.

58-17F-13. Sample contract forms to be filed with director--Material changes to be submitted--Certain changes not material--Director's inaction within certain time deemed approval--Contract copies to be provided upon request.Any health carrier shall file with the director sample contract forms proposed for use with its participating providers and intermediaries. Any health carrier shall submit material changes to a sample contract that would affect a provision required by this chapter, or any rules promulgated pursuant to this chapter, to the director for approval thirty days prior to use. Changes in provider payment rates, coinsurance, copayments, or deductibles, or other plan benefit modifications are not considered material changes for the purpose of this section. If the director takes no action within sixty days after submission of a material change to a contract by a health carrier, the change is deemed approved. The health carrier shall maintain provider and intermediary contracts and provide copies to the division or department upon request. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §13.
SD Codified L § 58-17F-14 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-14 - Contract does not relieve health carrier of liability.

58-17F-14. Contract does not relieve health carrier of liability.The execution of a contract by a health carrier does not relieve the health carrier of its liability to any person with whom it has contracted for the provision of services, nor of its responsibility for compliance with the law or applicable regulations. Any contract shall be in writing and subject to review by the director, if requested. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §14.
SD Codified L § 58-17F-15 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-15 - Remedies available to director against health carrier found not in compliance.

58-17F-15. Remedies available to director against health carrier found not in compliance.In addition to any other remedies permitted by law, if the director determines that a health carrier has not contracted with enough participating providers to assure that covered persons have accessible health care services in a geographic area, that a health carrier's access plan does not assure reasonable access to covered benefits, that a health carrier has entered into a contract that does not comply with this chapter, or that a health carrier has not complied with a provision of this chapter, the director may institute a corrective action that shall be followed by the health carrier or may use any of the director's other enforcement powers to obtain the health carrier's compliance with this chapter.A covered person shall have access to emergency services twenty-four hours a day, seven days a week to treat emergency medical conditions that require immediate medical attention. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §15.
SD Codified L § 58-17F-16 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-16 - Managed care contractor to register with director.

58-17F-16. Managed care contractor to register with director.Each managed care contractor, as defined in §58-17F-1, shall register with the director prior to engaging in any managed care business in this state. The registration shall be in a format prescribed by the director. In prescribing the form or in carrying out other functions required by §§58-17F-16 to 58-17F-20, inclusive, the director shall consult with the secretary if applicable. The director or the secretary may require that the following information be submitted:(1)Information relating to its actual or anticipated activities in this state;(2)The status of any accreditation designation it holds or has sought;(3)Information pertaining to its place of business, officers, and directors;(4)Qualifications of review staff; and(5)Any other information reasonable and necessary to monitor its activities in this state. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §16.
SD Codified L § 58-17F-17 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-17 - Filing changes in registration information.

58-17F-17. Filing changes in registration information.Any managed care contractor which has previously registered in this state shall, on or before July first of each year, file with the Division of Insurance any changes to the initial or subsequent annual registration for the managed care contractor. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §17.