reglab/housing_qa huggingface dataset:
SD Codified L § 58-17-97 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-97 - Provisions covering preexisting conditions.

58-17-97. Provisions covering preexisting conditions.Any accident and sickness policy or certificate subject to the provisions of this chapter, other than credit health insurance as defined in subdivision 58-19-2(1) and a health benefit plan as defined in §58-17-66, shall comply with the following provisions:(1)No policy or certificate may deny, exclude, or limit benefits for a covered individual for claims incurred more than twelve months following the effective date of the person's coverage due to a preexisting condition;(2)No policy or certificate may define a preexisting condition more restrictively than:(a)A condition that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment during the twelve months immediately preceding the effective date of coverage;(b)A condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve months immediately preceding the effective date of coverage; or(c)A pregnancy existing on the effective date of coverage. Source: SL 1997, ch 288, §2; SL 2001, ch 275, §4; SL 2013, ch 248, §1.
SD Codified L § 58-17-98 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-98 - Health insurance policies to provide coverage for biologically-based mental illnesses.

58-17-98. Health insurance policies to provide coverage for biologically-based mental illnesses.Every policy of health insurance that is delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall provide, in writing, coverage for the treatment and diagnosis of biologically-based mental illnesses with the same dollar limits, deductibles, coinsurance factors, and restrictions as for other covered illnesses.The term, biologically-based mental illness, means schizophrenia and other psychotic disorders, bipolar disorder, major depression, and obsessive-compulsive disorder. Source: SL 1998, ch 291, §1; SL 1999, ch 251, §1.
SD Codified L § 58-17-99 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-99 - Application of § 58-17-98--Exemptions.

58-17-99. Application of §58-17-98--Exemptions.The provisions of §58-17-98 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;(10)Long-term care;(11)Disability income insurance;(12)Coverage issued as a supplement to liability insurance;(13)Workers' compensation or similar insurance;(14)Automobile medical payment insurance; or(15)Individual health benefit plans of six-months duration or less that are not renewable. Source: SL 1998, ch 291, §7.
SD Codified L § 58-17-100 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-100 - Definitions.

58-17-100. Definitions.Terms used in §§58-17-100 to 58-17-106, inclusive, mean:(1)"FDA," the federal Food and Drug Administration;(2)"Health insurer," any person who provides health insurance in this state. The term includes a licensed insurance company, a prepaid hospital or medical service plan, a health maintenance organization, a multiple employer welfare arrangement, or any person providing a plan of health insurance subject to state insurance regulation;(3)"Life threatening," either or both of the following:(a)A disease or condition where the likelihood of death is high, unless the course of the disease is interrupted; or(b)A disease or condition with potentially fatal outcomes where the end point of clinical intervention is survival;(4)"Medical literature," a published scientific study in a journal or other publication in which original manuscripts have been published only after critical review for scientific accuracy, validity, and reliability by unbiased independent experts and a determination by the International Committee of Medical Journal Editors that it meets the Uniform Requirements for Manuscripts submitted to biomedical journals. The term, medical literature, does not include a publication or a supplement to a publication that is sponsored to a significant extent by a pharmaceutical manufacturing company or health carrier;(5)"Standard reference compendia," one of the following:(a)The United States Pharmacopeia Drug Information;(b)DRUGDEX; or(c)The American Hospital Formulary Service Drug Information;(6)"Off-label," the use of an FDA approved drug for an indication that is not included in the approved labeling;(7)"Drug," any substance prescribed by a licensed health care provider acting within the scope of the provider's license and that is intended for use in the diagnosis, mitigation, treatment, or prevention of disease and is taken by mouth; injected into a muscle, the skin, a blood vessel, or cavity of the body; applied to the skin; or otherwise assimilated by the body. The term, drug, includes only those substances that are approved by the FDA for at least one indication. Source: SL 2000, ch 242, §1.
SD Codified L § 58-17-101 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-101 - Insurer may not exclude certain off-label uses of prescription drugs.

58-17-101. Insurer may not exclude certain off-label uses of prescription drugs.No health insurer issuing a policy which provides coverage for prescription drugs may exclude coverage of any drug used for the treatment of cancer or life threatening conditions on the grounds that the drug has not been approved by the FDA for that indication if that drug is recognized for treatment of such indication in one of the standard reference compendia or in the medical literature. The prescribing physician shall submit documentation supporting the proposed off-label use or uses to the insurer, if requested. Any coverage of a drug that serves as the primary treatment required by §§58-17-100 to 58-17-106, inclusive, shall also include medically necessary services associated with the administration of the drug. Source: SL 2000, ch 242, §2.
SD Codified L § 58-17-102 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-102 - Exceptions.

58-17-102. Exceptions.No coverage is required under §§58-17-100 to 58-17-106, inclusive, for the following:(1)Any drug that has not been fully licensed or approved by the FDA;(2)The use of any drug if the FDA has determined that use to be contraindicated; or(3)Any experimental drug not otherwise approved for any indication by the FDA. Source: SL 2000, ch 242, §3.
SD Codified L § 58-17-103 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-103 - Provisions limited to cancer or life threatening diseases.

58-17-103. Provisions limited to cancer or life threatening diseases.The provisions of §§58-17-100 to 58-17-106, inclusive, apply to drugs used in the treatment for cancer or life threatening diseases only, and nothing in §§58-17-100 to 58-17-106, inclusive, may be construed to create, impair, alter, limit, modify, enlarge, abrogate, or prohibit reimbursement for medications used in the treatment of any other disease or condition. Source: SL 2000, ch 242, §4.
SD Codified L § 58-17-104 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-104 - Deductibles, copayments, and managed care review not affected.

58-17-104. Deductibles, copayments, and managed care review not affected.Nothing in §§58-17-100 to 58-17-106, inclusive, may be construed to prevent the application of contractual deductibles or copayment provisions or managed care review. Source: SL 2000, ch 242, §5.
SD Codified L § 58-17-105 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-105 - Drugs used in research trials not covered.

58-17-105. Drugs used in research trials not covered.The following drugs or services are not subject to coverage under §58-17-101:(1)Any drug that is used in research trials sponsored by the manufacturer of that drug or a governmental entity; or(2)Any drug or service furnished in a research trial, if the sponsor of the research trial furnishes the drug or service without charge to any participant in the research trial. Source: SL 2000, ch 242, §6.
SD Codified L § 58-17-106 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-106 - No reduction or limitation of coverage otherwise required by law.

58-17-106. No reduction or limitation of coverage otherwise required by law.Sections 58-17-100 to 58-17-106, inclusive, may not be used to reduce or limit coverage for off-label use of drugs otherwise required by law or contract. Source: SL 2000, ch 242, §7.
SD Codified L § 58-17-107 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-107 - Health insurance policies to provide coverage for prostate cancer screening.

58-17-107. Health insurance policies to provide coverage for prostate cancer screening.Every policy of health insurance that covers a male and that is delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall provide the following coverage for diagnostic screening for prostate cancer:(1)An annual medically recognized diagnostic examination, including a digital rectal examination and a prostate-specific antigen test, as follows:(a)For asymptomatic men aged fifty and over; and(b)For men aged forty-five and over at high risk for prostate cancer; and(2)For males of any age who have a prior history of prostate cancer, medically indicated diagnostic testing at intervals recommended by a physician, including the digital rectal examination, prostate-specific antigen test, and bone scan. Source: SL 2001, ch 277, §1.
SD Codified L § 58-17-108 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-108 - "Disability income insurance" defined.

58-17-108. Disability income insurance defined.For the purposes of §§58-17-108 to 58-17-112, inclusive, the term, disability income insurance, means a policy or certificate of insurance that primarily provides payment to or for the benefit of the policyholder or certificate holder based, in whole or in part, upon lost wages or other earned income or business or financial losses as a result of an inability to work due to sickness, injury, or a combination of sickness and injury. Source: SL 2001, ch 276, §1.
SD Codified L § 58-17-109 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-109 - Exclusion or reduction of benefits.

58-17-109. Exclusion or reduction of benefits.Any disability income insurance policy may include provisions that exclude or reduce benefits if the insured is collecting other benefits under a government program or is eligible to receive benefits under other insurance coverage. If the insured subsequently receives other benefits for a period for which the insurer paid benefits, the insurer may require reimbursement from the insured for any benefits already paid that otherwise would not have been paid. If the insured fails to make timely application for any other insurance coverage or governmental program for which that insured may be eligible, fails to actively and in good faith pursue all appeals procedures if benefits under other insurance or governmental program have been denied, or fails to produce satisfactory evidence that the applications have been made and the appeals pursued, benefits may be reduced or withheld. Source: SL 2001, ch 276, §2.
SD Codified L § 58-17-110 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-110 - Commencement of loss.

58-17-110. Commencement of loss.No disability income insurance policy may require the loss to commence less than thirty days after the date of the accident. Source: SL 2001, ch 276, §3.
SD Codified L § 58-17-111 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-111 - Minimum standards--Exceptions.

58-17-111. Minimum standards--Exceptions.Except for overhead expense, buy-sell coverage, or other similar business disability income insurance coverage, a disability income insurance policy shall meet the following minimum standards:(1)Provide that periodic payments that are payable at ages after sixty-two and reduced solely on the basis of age are at least fifty percent of the amounts payable immediately prior to age sixty-two or in the case of an employer group plan that has twenty or more employees, that periodic payments are actuarially equivalent regardless of age;(2)Contain an elimination period no greater than:(a)Ninety days in the case of coverage providing a benefit of one year or less;(b)One hundred eighty days in the case of coverage providing a benefit of more than one year but not greater than two years;(c)Three hundred sixty-five days in the case of coverage providing a benefit of more than two years but not greater than five years; or(d)Seven hundred thirty days in the case of coverage providing a benefit greater than five years resulting from sickness or injury;(3)Provide a maximum benefit period of at least six months for long-term disability income insurance and at least twelve weeks for short-term disability income insurance. However, in the case of a policy covering disability arising out of pregnancy, childbirth, or miscarriage, the maximum benefit period may be one month, except if the plan is an employer plan with fifteen or more employees, then the maximum benefit period for pregnancy, childbirth, or miscarriage may not be less than the maximum benefit period for other covered disabilities;(4)Include no reduction in benefits because of any cost of living increase in social security or similar benefits during a benefit period;(5)Require only one elimination period if a policy provides total disability income benefits and partial disability income benefits.A long-term disability income insurance policy may have longer elimination periods if the policy is issued in conjunction with or supplemental to a limited duration self-insured or other short-term disability income policy. The provisions of this section do not apply to an employer plan if at least fifty percent of the covered employee's disability income benefits are subject to federal income taxes. Source: SL 2001, ch 276, §4.
SD Codified L § 58-17-112 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-112 - Promulgation of rules regarding disability income policies--Content.

58-17-112. Promulgation of rules regarding disability income policies--Content.The director may promulgate rules pursuant to chapter 1-26 to protect the insurance-buying public with regard to disability income policies. However, the director shall take into account the effect any such rule may have on the availability of coverage. The rules may include:(1)Definition of terms;(2)Permissible exclusions;(3)Return of premium provisions;(4)Terms of renewability;(5)Disclosure requirements;(6)Benefit triggers, if such rules permit the use of activities of daily living as an acceptable benefit trigger; and(7)Limitations, exceptions, and reductions. Source: SL 2001, ch 276, §5.
SD Codified L § 58-17-142 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-142 - Maximum premium rates for plans issued prior to August 1, 2003--Rate provisions of § 58-17-75 to apply upon carrier's discontinuance of active marketing.

58-17-142. Maximum premium rates for plans issued prior to August 1, 2003--Rate provisions of §58-17-75 to apply upon carrier's discontinuance of active marketing.Any carrier of any in force individual health benefit plan issued guarantee issued policies prior to August 1, 2003, for which rates are established pursuant to §58-17-75, may set and charge a maximum premium rate of not more than two and two-tenths times the base premium rate until January 1, 2005, and may set and charge a maximum premium rate of not more than two and one-half times the base premium rate for each year thereafter, if the carrier actively markets individual major medical policies in this state during the entire year of 2003 and each year thereafter. If, in any year after 2003, the carrier discontinues actively marketing individual health benefit plans in this state, the premium rate provisions of §58-17-75 apply to those policies in force issued guarantee issued policies from the date of the carrier's discontinuance of active marketing.The provisions of this section apply only to grandfathered plans pursuant to 75 Fed. Reg. 116 (2010) to be codified at 26 C.F.R. §§54 and 602, as of January 1, 2015, and 29 C.F.R. §2590, as of January 1, 2015, and 45 C.F.R. §147, as of January 1, 2015. Source: SL 2003 (SS), ch 2, §1, eff. Sept. 26, 2003; SL 2015, ch 249, §27.
SD Codified L § 58-17-145.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-145.1 - Deadline for submission of health claim under risk pool.

58-17-145.1. Deadline for submission of health claim under risk pool.Any person covered under a risk pool established pursuant to the provisions of §58-17-113 in the State of South Dakota may submit a health claim within six months from June 30, 2015. Each claim shall be submitted in writing to the Bureau of Human Resources. A claim shall be paid in accordance with the South Dakota risk pool plan document in effect July 1, 2014, through June 30, 2015, inclusive. Source: SL 2015, ch 249, §30.
SD Codified L § 58-17-146 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-146 - Dental insurers prohibited from setting fees for noncovered service.

58-17-146. Dental insurers prohibited from setting fees for noncovered service.No contract between an insurer and a dentist may require a dentist to provide services for an insured at a fee set by the contract unless the services are covered services under the terms of the insured's plan or policy. For the purposes of this section, the term, covered services, means services reimbursable under the plan, policy, or contract, subject to such contractual limitations on benefits as may apply, including deductibles, waiting periods, frequency limitations, or charges over the benefit maximum. Source: SL 2010, ch 239, §1.
SD Codified L § 58-17-146.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-146.1 - Certain contract terms voidable by dentist.

58-17-146.1. Certain contract terms voidable by dentist. Any assignment or other contractual term in an agreement between an insurer and a dentist that purports to share, transfer, or assign contractual discounts to a third party insurer or entity, without relinquishing the insurer's rights, is severable and voidable at the dentist's option at the time the agreement is executed by the dentist. The third party access provision of the agreement shall be clearly identified.For purposes of this section, a third party insurer or entity does not include an insurer or entity operating under the same brand licensee program as the contracting insurer. Source: SL 2021, ch 212, § 1.
SD Codified L § 58-17-147 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-147 - Elective abortion coverage prohibited in qualified health plan offered through health insurance exchange.

58-17-147. Elective abortion coverage prohibited in qualified health plan offered through health insurance exchange.Pursuant to the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, no qualified health plan offered through a health insurance exchange established in the state may include elective abortion coverage.For the purposes of this section, an elective abortion is an abortion performed for any reason other than a medical emergency as set forth in subdivision 34-23A-1(5). Source: SL 2012, ch 245, §§1, 2.
SD Codified L § 58-17-148 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-148 - Qualified health plan sold through exchange to provide for placement through licensed insurance producer--Commissions.

58-17-148. Qualified health plan sold through exchange to provide for placement through licensed insurance producer--Commissions.Any qualified health plan as defined by the Patient Protection and Affordable Care Act of 2010 sold in South Dakota through a public health care exchange, as mandated by the Patient Protection and Affordable Care Act of 2010, shall provide for placement through a licensed insurance producer upon enrollment. Any commission paid by a health insurance carrier for the sale of a qualified health plan through a public health exchange shall be the same as a commission paid by the same health insurance carrier outside the public exchange for a similar plan. Source: SL 2013, ch 249, §1.
SD Codified L § 58-17-149 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-149 - Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period.

58-17-149. Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period.Terms used in §§58-17-149 to 58-17-152, inclusive, mean:(1)"Application date," the date on which a health insurer or other entity responsible for the credentialing of health care professionals on behalf of the health insurer receives the health care professional's completed application for credentialing or change request;(2)"Clean claim," as defined in §58-12-19;(3)"Health care professional," as defined in subdivision 58-17F-1(8);(4)"Health insurer," as defined in subdivision 58-17-100(2);(5)"Special Review," a supplemental review of a health care professional's completed application for credentialing or change request by a health insurer or other entity responsible for credentialing of health care professionals necessitated by credible evidence received by a health insurer or other entity responsible for credentialing of health care professionals as it relates to investigation of the following: action taken against the applicant's licensure status, action taken against the applicant's professional society status, verified complaints to facilities, or licensing agency regarding the applicant; the applicant's non-completion of training programs; a criminal proceeding brought against the applicant a malpractice claim brought against the applicant; loss of a Drug Enforcement Administration certificate or state-controlled substance certificate; loss of a Medicare or Medicaid certification status; or involuntary termination of credentialing by a different health insurer. Source: SL 2014, ch 236, §1.