reglab/housing_qa huggingface dataset:
SD Codified L § 58-17B-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-6 - Defining "preexisting conditions"--Requirements--Exclusions for loss or confinement--Extending limitation periods.

58-17B-6. Defining "preexisting conditions"--Requirements--Exclusions for loss or confinement--Extending limitation periods.No long-term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in subdivision 58-17B-2(4)(a):(1)Shall use a definition of "preexisting condition" which is more restrictive than the following: Preexisting condition means a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person;(2)May exclude coverage for a loss or confinement which is the result of a preexisting condition unless such loss or confinement begins within six months following the effective date of coverage of an insured person.The director may extend the limitation periods set forth herein as to specific age group categories in specific policy forms upon findings that the extension is in the best interest of the public. The definition of "preexisting condition" does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurer's established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subdivision (2) of this section expires. No long-term care insurance policy or certificates may exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subdivision (2) of this section. Source: SL 1989, ch 440, §6.
SD Codified L § 58-17B-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-7 - Requirements for long-term care insurance policies--Post-confinement, post-acute care, or recuperative benefits.

58-17B-7. Requirements for long-term care insurance policies--Post-confinement, post-acute care, or recuperative benefits.No long-term care insurance policy may be delivered or issued for delivery in this state if the policy:(1)Conditions eligibility for any benefits on a prior hospitalization requirement;(2)Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or(3)Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care or recuperative benefits on a prior institutionalization requirement.Post-confinement, post-acute care, or recuperative benefits do not include home health care, adult day care, or any other benefit based on treatment or services received.A long-term care insurance policy, continuing post-confinement, post-acute care, or recuperative benefits, shall clearly label, in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits," such limitations or conditions, including any required number of days of confinement.A long-term care insurance policy or rider which conditions eligibility of non-institutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than thirty days, except waiver of premium which may not require a prior institutional stay of more than ninety days. Source: SL 1989, ch 440, §7; SL 1991, ch 401.
SD Codified L § 58-17B-8 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-8 - Adoption of rules to establish loss ratio standards.

58-17B-8. Adoption of rules to establish loss ratio standards.The director may adopt rules, pursuant to chapter 1-26, establishing loss ratio standards for long-term care insurance policies provided that a specific reference to long-term insurance policies is contained in the regulation. Source: SL 1989, ch 440, §9.
SD Codified L § 58-17B-9 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-9 - Policyholder's right to return--Notice.

58-17B-9. Policyholder's right to return--Notice.Long-term care insurance policyholders shall have the right to return the policy within thirty days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Long-term care insurance policies shall have a notice prominently printed on the first page of the policy or attached thereto stating in substance that the policyholder shall have the right to return the policy within thirty days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Source: SL 1989, ch 440, §10.
SD Codified L § 58-17B-10 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-10 - Delivery of outline of coverage--Contents.

58-17B-10. Delivery of outline of coverage--Contents.An outline of coverage shall be delivered to an applicant for an individual long-term care insurance policy at the time of application for an individual policy. In the case of direct response solicitations, the insurer shall deliver the outline of coverage upon the applicant's request, but regardless of request shall make delivery no later than at the time of policy delivery. Such outline of coverage shall include:(1)A description of the principal benefits and coverage provided in the policy;(2)A statement of the principal exclusions, reductions and limitations contained in the policy;(3)A statement of the renewal provisions, including any reservation in the policy of a right to change premiums; and(4)A statement that the outline of coverage is a summary of the policy issued or applied for, and that the policy should be consulted to determine governing contractual provisions. Source: SL 1989, ch 440, §11.
SD Codified L § 58-17B-11 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-11 - Contents of certificate.

58-17B-11. Contents of certificate.A certificate issued pursuant to a group long-term care insurance policy which policy is delivered or issued for delivery in this state shall include:(1)A description of the principal benefits and coverage provided in the policy;(2)A statement of the principal exclusions, reductions and limitations contained in the policy; and(3)A statement that the group master policy determines governing contractual provision. Source: SL 1989, ch 440, §12.
SD Codified L § 58-17B-12 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-12 - Compliance with chapter prerequisite to advertisement, marketing, offer.

58-17B-12. Compliance with chapter prerequisite to advertisement, marketing, offer.No policy may be advertised, marketed, or offered as long-term care or nursing facility insurance unless it complies with the provisions of this chapter. Source: SL 1989, ch 440, §13.
SD Codified L § 58-17B-13 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-13 - Endorsement required--Cost-of-living adjustment not required.

58-17B-13. Endorsement required--Cost-of-living adjustment not required.Any long-term care policy offered for sale in this state shall offer as an endorsement an annual cost-of-living adjustment in daily benefits paid.Nothing in this section requires an insurer that offers a long-term care policy which pays benefits on an expense-incurred basis or which is a life insurance policy with long-term care benefits as a part of the life policy or a rider to the life policy to offer a cost-of-living adjustment. Source: SL 1989, ch 440, §14; SL 1990, ch 398, §3.
SD Codified L § 58-17B-13.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-13.1 - Establishment of standards and requirements for cost-of-living adjustment.

58-17B-13.1. Establishment of standards and requirements for cost-of-living adjustment.The director may promulgate rules pursuant to chapter 1-26 to establish specific standards and requirements for a cost-of-living adjustment to long-term care policies. The standards or requirements may cover:(1)Types and duration of adjustments;(2)Underwriting; and(3)Amount of adjustment. Source: SL 1990, ch 398, §4.
SD Codified L § 58-17B-14 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-14 - Coverage offered to resident under group policy issued in other state--Requirements.

58-17B-14. Coverage offered to resident under group policy issued in other state--Requirements.No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in subdivisions 58-17B-2(4)(a) and (4)(d) unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met. Source: SL 1989, ch 440, §16.
SD Codified L § 58-17B-15 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-15 - Rules in accordance with chapter 1-26.

58-17B-15. Rules in accordance with chapter 1-26.Rules adopted pursuant to this chapter shall be in accordance with the provisions of chapter 1-26. Source: SL 1989, ch 440, §17.
SD Codified L § 58-17B-16 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17B - Standards For Long-Term Care Insurance|Section 58-17B-16 - Temporary absence from nursing home or assisted living facility--Effect on benefits for long-term care charges and other requirements--Application.

58-17B-16. Temporary absence from nursing home or assisted living facility--Effect on benefits for long-term care charges and other requirements--Application.If an insured is receiving benefits for long-term care services in a nursing home or assisted living facility under a long-term care policy or certificate subject to this chapter, and temporarily leaves the nursing home or assisted living facility for a period not to exceed fourteen days annually, the insurer may not reduce or limit benefits for long-term care charges incurred by the insured during that temporary absence unless otherwise provided in the policy or certificate. The insurer may not consider that absence in determining whether the insured qualifies or continues to qualify for a waiver of premium or other policy or certificate benefits or eligibility requirements. This section applies to all policies or certificates that are issued after June30, 2005. Source: SL 2005, ch 268, §1.
SD Codified L § 58-17D-1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers|Section 58-17D-1 - Definitions.

58-17D-1. Definitions.Terms used in this chapter mean:(1)"Utilization review," a review of health care services provided or to be provided to an individual to assist in the determination of the nature of the injury or condition, or the appropriateness of the treatment provided or to be provided;(2)"Utilization review organization," any entity that provides utilization review services as defined in this chapter. Source: SL 2002, ch 231, §1.
SD Codified L § 58-17D-2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers|Section 58-17D-2 - Certain utilization review organizations exempt from managed health care provisions.

58-17D-2. Certain utilization review organizations exempt from managed health care provisions.A utilization review organization that conducts utilization reviews solely for property and casualty insurers in this state pursuant to policies issued in this state is not subject to chapters 58-17F, 58-17G, 58-17H, and 58-17I except that any such utilization review organization shall register in the same manner as prescribed for utilization review organizations pursuant to §§58-17H-35 to 58-17H-39, inclusive. (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 2002, ch 231, §2; SL 2011, ch 219, §97.
SD Codified L § 58-17D-3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers|Section 58-17D-3 - Property and casualty insurers to use registered utilization review organizations.

58-17D-3. Property and casualty insurers to use registered utilization review organizations.Any property and casualty insurer seeking utilization review with respect to an insurance contract issued in this state may only use a utilization review organization registered pursuant to this chapter. Source: SL 2002, ch 231, §3.
SD Codified L § 58-17D-4 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers|Section 58-17D-4 - Utilization review to be administered by qualified professional.

58-17D-4. Utilization review to be administered by qualified professional.Any utilization review pursuant to this chapter shall be administered by a qualified licensed health care professional. Any adverse determination shall be evaluated by an appropriately licensed and clinically qualified health care professional. Any utilization review evaluation shall use generally accepted standards for treatment of the illness, injury, or condition reviewed. Any utilization review opinion shall be signed by the professional who performed the review. Source: SL 2002, ch 231, §4.
SD Codified L § 58-17D-5 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers|Section 58-17D-5 - Certain basis for fees prohibited.

58-17D-5. Certain basis for fees prohibited.No utilization review organization may base its fees or charges on any recommendation for reduction in payment under an insurance contract or on a percentage of claim savings. Source: SL 2002, ch 231, §5.
SD Codified L § 58-17D-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers|Section 58-17D-6 - Insurer denying policyholder's claim to provide for reconsideration.

58-17D-6. Insurer denying policyholder's claim to provide for reconsideration.An insurer that denies, in whole or in part, a policyholder's claim after consideration of a utilization review shall provide the policyholder with an opportunity to request reconsideration and to submit additional information relating to the claim. Source: SL 2002, ch 231, §6.
SD Codified L § 58-17D-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers|Section 58-17D-7 - No cause of action created or abrogated.

58-17D-7. No cause of action created or abrogated.Nothing in this chapter is intended to create or abrogate any cause of action as a result of a violation of the standards in this chapter. Source: SL 2002, ch 231, §7.
SD Codified L § 58-17E-1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-1 - Affiliate defined.

58-17E-1. Affiliate defined.For the purposes of this chapter, the term, affiliate, means a person that directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the person specified. For the purposes of this section, the term, control, or controlled by, or under common control with, means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control is presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing ten percent or more of the voting securities of any other person. This presumption may be rebutted by a showing made in the manner provided by §58-5A-29. Source: SL 2006, ch 257, §1.
SD Codified L § 58-17E-2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-2 - Discount medical plan defined.

58-17E-2. Discount medical plan defined.For the purposes of this chapter, the term, discount medical plan, means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, offers access for its members to providers of medical or ancillary services and the right to receive discounts on medical or ancillary services provided under the discount medical plan from those providers. The term includes a prescription drug discount plan.The term does not include:(1)A plan that does not charge a membership or other fee to use the discount medical plan;(2)Any product otherwise regulated under Title 58;(3)A patient access program; or(4)A medicare prescription drug plan. Source: SL 2006, ch 257, §2.
SD Codified L § 58-17E-3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-3 - Discount prescription drug plan defined.

58-17E-3. Discount prescription drug plan defined.For the purposes of this chapter, the term, discount prescription drug plan, means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration provides access for its plan members to providers of pharmacy services and the right to receive discounts on pharmacy services provided under the discount prescription drug plan from those providers. Source: SL 2006, ch 257, §3.
SD Codified L § 58-17E-4 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-4 - Discount medical plan organization defined.

58-17E-4. Discount medical plan organization defined.For the purposes of this chapter, discount medical plan organization, means an entity that, in exchange for fees, dues, charges, or other consideration, provides access for discount medical plan members to providers of medical or ancillary services and the right to receive medical or speciality services from those providers at a discount. It is the organization that contracts with providers, provider networks, or other discount medical plan organizations to offer access to medical or speciality services at a discount and determines the charge to discount medical plan members. Source: SL 2006, ch 257, §4.
SD Codified L § 58-17E-5 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-5 - Definitions.

58-17E-5. Definitions.Terms used in this chapter mean:(1)"Ancillary services," includes audiology, dental, vision, mental health, substance abuse, chiropractic, and podiatry services;(2)"Facility," an institution providing medical or ancillary services or a health care setting. The term includes:(a)A hospital or other licensed inpatient center;(b)An ambulatory surgical or treatment center;(c)A skilled nursing center;(d)A residential treatment center;(e)A rehabilitation center; and(f)A diagnostic, laboratory or imaging center;(3)"Health care professional," a physician, pharmacist, or other health care practitioner who is licensed, accredited, or certified to perform specified medical or ancillary services within the scope of his or her license, accreditation, certification, or other appropriate authority consistent with state law;(4)"Marketer," a person or entity that markets, promotes, sells, or distributes a discount medical plan, including a private label entity that places its name on and markets or distributes a discount medical plan pursuant to a marketing agreement with a discount medical plan organization;(5)"Medical services," any maintenance care of, or preventive care for, the human body, or care, service, or treatment of an illness or dysfunction of, or injury to, the human body. The term includes physician care, inpatient care, hospital surgical services, emergency services, ambulance services, dental care services, vision care services, mental health services, substance abuse services, chiropractic services, podiatric services, laboratory services, medical equipment and supplies, pharmacy services or ancillary services;(6)"Medicare prescription drug plan," a plan that provides Medicare Part D prescription drug benefit in accordance with the requirements of the federal Medicare Prescription Drug, Improvement and Modernization Act of 2003;(7)"Member," any individual who pays fees, dues, charges, or other consideration for the right to receive the benefits of a discount medical plan. Member does not include any individual who enrolls in a patient access program;(8)"Patient access program," a voluntary program sponsored by a pharmaceutical manufacturer or a consortium of pharmaceutical manufacturers, that provide free or discounted health care products directly to low-income or uninsured individuals either through a discount card or direct shipment;(9)"Provider," any health care professional or facility that has contracted, directly or indirectly, with a discount medical plan organization to provide medical or ancillary services to members;(10)"Provider network," an entity that negotiates directly or indirectly with a discount medical plan organization on behalf of more than one provider to provide medical or ancillary services to members. Source: SL 2006, ch 257, §5.
SD Codified L § 58-17E-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-6 - Application of chapter.

58-17E-6. Application of chapter.This chapter applies to all discount medical plan organizations doing business in South Dakota. Source: SL 2006, ch 257, §6.
SD Codified L § 58-17E-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17E - Discount Medical Plans|Section 58-17E-7 - Registration exception and compliance requirements for otherwise registered health carriers.

58-17E-7. Registration exception and compliance requirements for otherwise registered health carriers.A discount medical plan organization that is a health carrier registered pursuant to Title 58:(1)Is not required to register as a discount medical plan organization. However, any of its affiliates that operate as a discount medical plan organization in this state shall comply with all provisions of this chapter and shall register as a discount medical plan organization;(2)Is required to comply with §§58-17E-24 to 58-17E-38, inclusive, 58-17E-40, and 58-17E-42 to 58-17E-44, inclusive. Source: SL 2006, ch 257, §7.