reglab/housing_qa huggingface dataset:
SD Codified L § 58-18A-67 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-67 - Coordination of benefits only available to secondary plans.

58-18A-67. Coordination of benefits only available to secondary plans.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.
SD Codified L § 58-18A-68 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-68 - Order of benefits determined under §§ 58-18A-69 to 58-18A-74.

58-18A-68. Order of benefits determined under §§58-18A-69 to 58-18A-74.Each plan shall determine its order of benefits using the first section of §§58-18A-69 to 58-18A-74, inclusive, that applies. Source: SL 2006, ch 259, §16.
SD Codified L § 58-18A-69 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-69 - Plan covering person other than as dependent.

58-18A-69.Plan covering person other than as dependent.The plan that covers the person other than as a dependent, for example as an employee, member, subscriber, policyholder, or retiree, is the primary plan and the plan that covers the person as a dependent is the secondary plan.However, if the person is a medicare beneficiary, and, as a result of the provisions of Title XVIII of the Social Security Act and implementing regulations, medicare is:(1)Secondary to the plan covering the person as a dependent; and(2)Primary to the plan covering the person as other than a dependent (e. g. a retired employee);then the order of benefits is reversed so that the plan covering the person as an employee, member, subscriber, policyholder, or retiree is the secondary plan and the other plan covering the person as a dependent is the primary plan. Source: SL 2006, ch 259, §17.
SD Codified L § 58-18A-70 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-70 - Plan covering dependent child.

58-18A-70. Plan covering dependent child.Unless there is a court decree stating otherwise, plans covering a dependent child shall determine the order of benefits as follows:(1)For a dependent child whose parents are married or are living together, whether or not they have ever been married:(a)The plan of the parent whose birthday falls earlier in the calendar year is the primary plan; or(b)If both parents have the same birthday, the plan that has covered the parent longest is the primary plan;(2)For a dependent child whose parents are divorced or separated or are not living together, whether or not they have ever been married:(a)If a court decree states that one of the parents is responsible for the dependent child's health care expenses or health care coverage and the plan of that parent has actual knowledge of those terms, that plan is primary. If the parent with responsibility has no health care coverage for the dependent child's health care expenses, but that parent's spouse does, that parent's spouse's plan is the primary plan. This item does not apply with respect to any plan year during which benefits are paid or provided before the entity has actual knowledge of the court decree provision;(b)If a court decree states that both parents are responsible for the dependent child's health care expenses or health care coverage, the provisions of subdivision (1) of this section shall determine the order of benefits;(c)If a court decree states that the parents have joint custody without specifying that one parent has responsibility for the health care expenses or health care coverage of the dependent child, the provisions of subdivision (1) of this section shall determine the order of benefits; or(d)If there is no court decree allocating responsibility for the child's health care expenses or health care coverage, the order of benefits for the child are as follows:(i)The plan covering the custodial parent;(ii)The plan covering the custodial parent's spouse;(iii)The plan covering the noncustodial parent; and then(iv)The plan covering the noncustodial parent's spouse;(3)For a dependent child covered under more than one plan of individuals who are not the parents of the child, the order of benefits shall be determined, as applicable, pursuant to subdivision (1) or (2) of this section as if those individuals were parents of the child; and(4)For a dependent child who has coverage under either or both parents' plans and also has his or her own coverage as a dependent under a spouse's plan, the provisions of §58-18A-73 apply. If the dependent child's coverage under the spouse's plan began on the same date as the dependent child's coverage under either or both parents' plans, the order of benefits shall be determined, as applicable, pursuant to the provisions of subdivision (1) of this section to the dependent child's parent or parents and the dependent's spouse. Source: SL 2006, ch 259, §18; SL 2015, ch 253, §2.
SD Codified L § 58-18A-71 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-71 - Plan covering person as active employee.

58-18A-71. Plan covering person as active employee.The plan that covers a person as an active employee that is, an employee who is neither laid off nor retired or as a dependent of an active employee is the primary plan. The plan covering that same person as a retired or laid-off employee or as a dependent of a retired or laid-off employee is the secondary plan.If the other plan does not have the provisions of this section, and as a result, the plans do not agree on the order of benefits, the provisions of this section do not apply.This section does not apply if the provisions in §58-18A-69 can determine the order of benefits. Source: SL 2006, ch 259, §19.
SD Codified L § 58-18A-72 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-72 - Coverage under COBRA or right of continuation.

58-18A-72. Coverage under COBRA or right of continuation.If a person whose coverage is provided pursuant to COBRA or under a right of continuation pursuant to state or other federal law is covered under another plan, the plan covering the person as an employee, member, subscriber, or retiree or covering the person as a dependent of an employee, member, subscriber, or retiree is the primary plan and the plan covering that same person pursuant to COBRA or under a right of continuation pursuant to state or other federal law is the secondary plan.If the other plan does not have these provisions, and if, as a result, the plans do not agree on the order of benefits, these provisions do not apply.This section does not apply if the provisions in §58-18A-69 determine the order of benefits. Source: SL 2006, ch 259, §20.
SD Codified L § 58-18A-73 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-73 - Plan covering person for longer period of time.

58-18A-73. Plan covering person for longer period of time.If the preceding provisions in §§58-18A-69 to 58-18A-72, inclusive, do not determine the order of benefits, the plan that covered the person for the longer period of time is the primary plan and the plan that covered the person for the shorter period of time is the secondary plan.To determine the length of time a person has been covered under a plan, two successive plans shall be treated as one if the covered person was eligible under the second plan within twenty-four hours after coverage under the first plan ended.The start of a new plan does not include:(1)A change in the amount or scope of a plan's benefits;(2)A change in the entity that pays, provides, or administers the plan's benefits; or(3)A change from one type of plan to another, such as, from a single employer plan to a multiple employer plan.The person's length of time covered under a plan is measured from the person's first date of coverage under that plan. If that date is not readily available for a group plan, the date the person first became a member of the group shall be used as the date from which to determine the length of time the person's coverage under the present plan has been in force. Source: SL 2006, ch 259, §21.
SD Codified L § 58-18A-74 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-74 - Sharing of allowable expenses equally.

58-18A-74. Sharing of allowable expenses equally.If the preceding provisions of §§58-18A-69 to 58-18A-73, inclusive, do not determine the order of benefits, the allowable expenses shall be shared equally between the plans. Source: SL 2006, ch 259, §22.
SD Codified L § 58-18A-75 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-75 - Calculation of amount to be paid by secondary plan.

58-18A-75. Calculation of amount to be paid by secondary plan.In determining the amount to be paid by the secondary plan on a claim, if the plan wishes to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in the absence of other health care coverage and apply that calculated amount to any allowable expense under its plan that is unpaid by the primary plan. The secondary plan may reduce its payment by the amount so that, when combined with the amount paid by the primary plan, the total benefits paid or provided by all plans for the claim do not exceed one hundred percent of the total allowable expense for that claim. In addition, the secondary plan shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage. Source: SL 2006, ch 259, §23.
SD Codified L § 58-18A-76 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-76 - Plan providing benefits as services.

58-18A-76. Plan providing benefits as services.A secondary plan that provides benefits in the form of services may recover the reasonable cash value of the services from the primary plan, to the extent that benefits for the services are covered by the primary plan and have not already been paid or provided by the primary plan. Nothing in this section requires a plan to reimburse a covered person in cash for the value of services provided by a plan that provides benefits in the form of services. Source: SL 2006, ch 259, §24.
SD Codified L § 58-18A-77 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-77 - Coordination of benefits of complying and noncomplying plans.

58-18A-77. Coordination of benefits of complying and noncomplying plans.A plan with order of benefit determination provisions that comply with §§58-18A-53 to 58-18A-83, inclusive, may coordinate its benefits with a plan that is excess or always secondary or that uses order of benefit determination provisions that are inconsistent with those contained in §§58-18A-53 to 58-18A-83, inclusive, on the following basis:(1)If the complying plan is the primary plan, it shall pay or provide its benefits first;(2)If the complying plan is the secondary plan, it shall pay or provide its benefits first, but the amount of the benefits payable shall be determined as if the complying plan were the secondary plan. In such a situation, the payment shall be the limit of the complying plan's liability; and(3)If the noncomplying plan does not provide the information needed by the complying plan to determine its benefits within a reasonable time after it is requested to do so, the complying plan shall assume that the benefits of the noncomplying plan are identical to its own, and shall pay its benefits accordingly. If, within two years of payment, the complying plan receives information as to the actual benefits of the noncomplying plan, it shall adjust payments accordingly. Source: SL 2006, ch 259, §25.
SD Codified L § 58-18A-78 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-78 - Noncomplying secondary plan to advance difference covered person would have received if complying plan had been secondary plan.

58-18A-78. Noncomplying secondary plan to advance difference covered person would have received if complying plan had been secondary plan.If the noncomplying plan reduces its benefits so that the covered person receives less in benefits than the covered person would have received had the complying plan paid or provided its benefits as the secondary plan and the noncomplying plan paid or provided its benefits as the primary plan, then the complying plan shall advance to the covered person or on behalf of the covered person an amount equal to the difference.In no event may the complying plan advance more than the complying plan would have paid had it been the primary plan less any amount it previously paid for the same expense or service. In consideration of the advance, the complying plan shall be subrogated to all rights of the covered person against the noncomplying plan. The advance by the complying plan shall also be without prejudice to any claim it may have against a noncomplying plan in the absence of subrogation. Source: SL 2006, ch 259, §26.
SD Codified L § 58-18A-79 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-79 - Subrogation distinguished.

58-18A-79. Subrogation distinguished.COB differs from subrogation. Provisions for one may be included in health care benefits contracts without compelling the inclusion or exclusion of the other. Source: SL 2006, ch 259, §27.
SD Codified L § 58-18A-80 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-80 - Paying of claim where plans disagree on order of benefits.

58-18A-80. Paying of claim where plans disagree on order of benefits.If the plans cannot agree on the order of benefits within thirty calendar days after the plans have received all of the information needed to pay the claim, the plans shall immediately pay the claim in equal shares and determine their relative liabilities following payment. However, no plan is required to pay more than it would have paid had it been the primary plan. Source: SL 2006, ch 259, §28.
SD Codified L § 58-18A-81 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-81 - Time for bringing existing contract into compliance with statutory requirements.

58-18A-81. Time for bringing existing contract into compliance with statutory requirements.A contract that provides health care benefits and that was issued before July 1, 2006, shall be brought into compliance with §§58-18A-53 to 58-18A-83, inclusive, by the later of:(1)The next anniversary date or renewal date of the contract;(2)Twelve months following July 1, 2006; or(3)The expiration of any applicable collectively bargained contract pursuant to which it was written.For the transition period between the adoption of §§58-18A-53 to 58-18A-83, inclusive, and the timeframe for which plans are to be in compliance pursuant to this section, no plan that is subject to the prior COB requirements may be considered a noncomplying plan by a plan subject to the new COB requirements. If there is a conflict between the prior COB requirements under the prior act and the new COB requirements under §§58-18A-53 to 58-18A-83, inclusive, the prior COB requirements shall apply. Source: SL 2006, ch 259, §29.
SD Codified L § 58-18A-82 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-82 - Proceedings not subject to statutory requirements.

58-18A-82. Proceedings not subject to statutory requirements.Sections 58-18A-53 to 58-18A-83, inclusive, do not affect an action or proceeding commenced before July 1, 2006. Source: SL 2006, ch 259, §30.
SD Codified L § 58-18A-83 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-83 - Duties, rights accrued, and offenses committed prior to July 1, 2007.

58-18A-83. Duties, rights accrued, and offenses committed prior to July 1, 2007.Sections 58-18A-53 to 58-18A-83, inclusive, do not impair or affect any duty or act done, offense committed or right accruing, accrued or acquired or liability, penalty, forfeiture or punishment incurred prior to the date on or after July 1, 2007, but the same may be employed, asserted, enforced, prosecuted or inflicted, as fully and to the same extent as if this enactment had not been passed. Source: SL 2006, ch 259, §33.
SD Codified L § 58-18B-2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18B - Regulation Of Small Businesses' Group And Blanket Health Insurance|Section 58-18B-2 - Chapter applicable to small employer benefit plans.

58-18B-2. Chapter applicable to small employer benefit plans.This chapter is applicable to any health benefit plan which provides coverage to two or more employees of a small employer and policies which meet the following criteria:(1)Any portion of the premium or benefits is paid by or on behalf of the small employer; or(2)The health benefit plan is treated by the employer or any of the eligible employees or dependents as part of a plan or program for the purposes of section 125 or section 106 of the United States Internal Revenue Code as of January 1, 1995.This chapter does not apply to any employer plan with only one employee. Any employer plan with only one employee, even if the employer pays a portion or all of the premium, may be sold as individual policies subject to the provisions of chapter 58-17. If a plan covering one employee is sold as an individual plan and new employees are added which brings the number of employees to at least two but not more than fifty, then the individual carrier may nonrenew the coverage or accept those new employees and bring the plan into compliance with the applicable provisions of chapters 58-18 and 58-18B. Source: SL 1991, ch 402, §2; SL 1995, ch 281, §2; SL 1996, ch 298; SL 1998, ch 292, §1.
SD Codified L § 58-18B-3.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18B - Regulation Of Small Businesses' Group And Blanket Health Insurance|Section 58-18B-3.1 - Base rate increase to be filed with director--Approval or disapproval.

58-18B-3.1. Base rate increase to be filed with director--Approval or disapproval.No small employer carrier may increase its small employer base rates unless the small employer carrier has filed the base rate increase with the director for review at least thirty days prior to the implementation of the rate increase. The base rates are deemed approved at the expiration of thirty days after the filing thereof unless disapproved by the director within thirty days after the date of filing. The filing of the base rate increase shall include documentation sufficient to actuarially justify the increase and a history of the earned premiums and incurred claims on the policy forms applicable to the rate increase. The base rates shall be reasonable in relation to the benefits. (SL 2011, ch 216, §19 provides: "The provisions of this Act are 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 216, §18.
SD Codified L § 58-18B-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18B - Regulation Of Small Businesses' Group And Blanket Health Insurance|Section 58-18B-6 - Disclosure in solicitation and sales materials.

58-18B-6. Disclosure in solicitation and sales materials.Each small employer carrier shall make reasonable disclosure in solicitation and sales materials provided to small employers of the following:(1)The extent to which premium rates for a specific small employer are established or adjusted due to the claim experience, health status or duration of coverage of the employees or dependents of the small employer;(2)The provisions concerning the carrier's right to change premium rates and the factors, including case characteristics, which affect changes in premium rates;(3)A description of the class of business in which the small employer is or will be included, including the applicable grouping of plans; and(4)The provisions relating to renewability of coverage. Source: SL 1991, ch 402, §6.
SD Codified L § 58-18B-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18B - Regulation Of Small Businesses' Group And Blanket Health Insurance|Section 58-18B-7 - Information and documentation required--Disclosure.

58-18B-7. Information and documentation required--Disclosure.Each small employer carrier shall maintain at the carrier's principal place of business a complete and detailed description of the carrier's rating practices and renewal underwriting practices, including information and documentation which demonstrate that the carrier's rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.A small employer carrier shall make the information and documentation required by this section available to the director upon request. Except in cases of violations of this chapter, the information shall be considered proprietary and trade secret information and is not subject to disclosure by the director to persons outside of the division except as agreed to by the carrier or by order of a court, or if requested by a law enforcement officer or another state insurance agency. Source: SL 1991, ch 402, §7; SL 1995, ch 281, §12; SL 2009, ch 262, §2.
SD Codified L § 58-18B-8 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18B - Regulation Of Small Businesses' Group And Blanket Health Insurance|Section 58-18B-8 - Suspension of rate requirements.

58-18B-8. Suspension of rate requirements.The director may suspend all or any part of the premium rate requirements of §58-18B-3 applicable to one or more small employers for one or more rating periods upon a filing by the small employer carrier and a finding by the director that either the suspension is reasonable in light of the financial condition of the carrier or that the suspension would enhance the efficiency and fairness of the marketplace for small employer health insurance. Source: SL 1991, ch 402, §8.
SD Codified L § 58-18B-9 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18B - Regulation Of Small Businesses' Group And Blanket Health Insurance|Section 58-18B-9 - Application of chapter.

58-18B-9. Application of chapter.The provisions of this chapter apply to each health benefit plan for a small employer that is delivered, issued for delivery, renewed or continued in this state after July 1, 1992. The date a plan is continued is the first rating period which commences after July 1, 1992. Source: SL 1991, ch 402, §9.
SD Codified L § 58-18B-11 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18B - Regulation Of Small Businesses' Group And Blanket Health Insurance|Section 58-18B-11 - Health maintenance organization considered separate carrier.

58-18B-11. Health maintenance organization considered separate carrier.An affiliated carrier that is a health maintenance organization having a certificate of authority under chapter 58-41 may be considered to be a separate carrier for the purposes of this chapter. Source: SL 1995, ch 281, §4.