reglab/housing_qa huggingface dataset:
SD Codified L § 58-18-88 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-88 - Authorization of self-funded multiple employer trust sponsored by association--Conditions.

58-18-88. Authorization of self-funded multiple employer trust sponsored by association--Conditions.A self-funded multiple employer trust, as defined in section 3 of the federal Employee Retirement Income Security Act of 1974, 29 U.S.C. §1002, paragraph 40, that is sponsored by an association, may be authorized by the director if the multiple employer trust meets all of the following conditions:(1)The multiple employer trust is administered by an authorized insurer or a licensed or registered third-party administrator;(2)The multiple employer trust is sponsored and maintained by a bona fide association of employers eligible to procure coverage under §§58-18-3 and 58-18-4;(3)The association sponsoring the multiple employer trust is established by employers in a homogenous trade, industry, line of business, or profession with commonality of interest. The association has a constitution or bylaws, and is organized under the laws of South Dakota;(4)The association sponsoring the multiple employer trust has a substantial business purpose other than sponsorship of an employer welfare benefit plan;(5)The association sponsoring the multiple employer trust is a nonprofit entity organized under applicable South Dakota law;(6)The multiple employer trust's board of trustees shall assess participating employers in an amount necessary to remedy deficiencies at any time the assets and stop loss insurance policies of the multiple employer trust are insufficient to:(a)Pay claims made against the multiple employer trust;(b)Discharge liabilities and obligations relating to health benefit plan claims; or(c)Maintain adequate reserves and surpluses;(7)The multiple employer trust:(a)Meets the capital and surplus requirements of §58-6-23;(b)Meets the risk based capital requirements of §58-4-48;(c)Is subject to the hazardous financial condition requirements of §§58-4-39 to 58-4-42, inclusive;(d)Invests its assets pursuant to the requirements of chapters 58-26 and 58-27;(e)Is subject to chapter 58-3 on the same basis as insurers;(f)Is subject to the insurers supervision, rehabilitation, and liquidation provisions of chapter 58-29B;(g)Maintains a minimum loss ratio of eighty-five percent or be community rated; and(h)Complies with all coverage mandates that are applicable to group health insurance under this title;(8)Each sponsoring association is comprised of and controlled by employer members, consists of five hundred or more covered employees, and has been in existence for a period of three continuous years; (9)Any solicitation or sales materials to prospective members discloses the provisions regarding fees and assessments for participation in the multiple employer trust; and(10)The director, after consideration of the impact on the insurance-buying public, determines that the arrangement is in the best interests of the public.  Source: SL 2005, ch 272, §2; SL 2014, ch 238, §1; SL 2019, ch 212, §6.
SD Codified L § 58-18-88.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-88.1 - Request for waiver by association formed in another state.

58-18-88.1. Request for waiver by association formed in another state.An association not formed in this state may request a waiver of subdivisions 58-18-88(3) and (5) regarding organization in South Dakota to sponsor a multiple employer trust in this state if the association provides sufficient evidence a waiver is in the best interests of the insurance-buying public. An association not formed in this state shall be in full compliance with the laws of all states where the association does business. Source: SL 2019, ch 212, §7.
SD Codified L § 58-18-89 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-89 - Promulgation of rules pertaining to multiple employer trusts.

58-18-89. Promulgation of rules pertaining to multiple employer trusts.The director shall promulgate rules, pursuant to chapter 1-26, pertaining to multiple employer trusts in the following areas:(1)Consumer protection issues including minimum coverage standards for health policies; claims processing and payment practices; resolution of consumer complaints; compliance with federal HIPAA standards; plan termination processes and managed care protections; financial and market conduct record keeping and reporting; and unfair trade practices; and(2)Financial and plan solvency issues including investment capital requirements; surplus and deposit requirements; claims reserves, stop loss coverage, and standards for entry and exit of plan members including a nonrefundable minimum deposit of not less than two thousand five hundred dollars plus two percent of first year contributions on an annual basis; and production of financial statements, audited financial statements, and actuarial opinions. Source: SL 2005, ch 272, §3.
SD Codified L § 58-18-90 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-90 - Multiple employer trust not insurance company or association or subject to specified provisions--Exception.

58-18-90. Multiple employer trust not insurance company or association or subject to specified provisions--Exception.Except as otherwise provided in this chapter, an authorized multiple employer trust may not be determined to be or considered to be an insurance company or association of any kind or character under this title, or subject to the provisions of §§58-8-6 to 58-8-19, inclusive. Source: SL 2005, ch 272, §4; SL 2019, ch 212, §8.
SD Codified L § 58-18-91 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-91 - Suspension or revocation of authorization of multiple employer trust--Action in lieu of suspension or revocation.

58-18-91. Suspension or revocation of authorization of multiple employer trust--Action in lieu of suspension or revocation.A multiple employer trust authorized under this chapter may have its authorization suspended or revoked by the director for violating any applicable provision of this title. The director may take action in lieu of suspension or revocation as though the trust were an insurer as provided by §58-4-28.1. Source: SL 2005, ch 272, §5; SL 2019, ch 212, §9.
SD Codified L § 58-18-92 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-92 - Payment of premium taxes.

58-18-92. Payment of premium taxes.If not otherwise provided, a multiple employer trust doing business in this state on a self-funded basis shall pay premium taxes as required in chapter 10-44 based upon the amount each participating employer contributes, including any amounts contributed by employees and dependents, to the plan on an annual basis. If a multiple employer trust purchases excess or stop loss coverage, the multiple employer trust may not be taxed additionally for that coverage. Source: SL 2005, ch 272, §6.
SD Codified L § 58-18-93 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-93 - Agent licensing requirements.

58-18-93. Agent licensing requirements.No agent may sell, solicit, or negotiate a self-funded multiple employer trust authorized under this chapter unless the agent is licensed to sell life and health insurance pursuant to chapter 58-30. Source: SL 2005, ch 272, §7; SL 2019, ch 212, §10.
SD Codified L § 58-18-94 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-94 - Application of provisions regarding multiple employer trusts--Inclusion of large and small employers.

58-18-94. Application of provisions regarding multiple employer trusts--Inclusion of large and small employers.The provisions of this chapter regarding multiple employer trusts do not apply to any single employer self-funded plan as preempted by Employee Retirement Income Security Act of 1974, 29 U.S.C. §1144 or any arrangement exempted pursuant to §1-24-17. An authorized self-funded multiple employer trust may include as participating employers both small employers and large employers. Source: SL 2005, ch 272, §8; SL 2019, ch 212, §11.
SD Codified L § 58-18-95 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-95 - Coverage for treatment of hearing impairment for persons under age nineteen.

58-18-95. Coverage for treatment of hearing impairment for persons under age nineteen.Any qualified health plan issued on or after January 1, 2015, that offers coverage for professional audiology services shall include coverage for medically necessary physician services appropriate for the treatment of hearing impairment to a person under the age of nineteen. This shall include professional services rendered by an audiologist licensed pursuant to chapter 36-24.The benefits provided shall be subject to the same dollar limits, deductibles, coinsurance and other limitations provided for other covered benefits in the policy.Nothing in this section requires the payment by the health plan of hearing aids, devices, or equipment to correct hearing impairment or loss. Source: SL 2014, ch 237, §2.
SD Codified L § 58-18A-54 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-54 - Allowable expenses defined.

58-18A-54. Allowable expenses defined.For the purposes of this chapter, the term, allowable expense, means any health care expense, including coinsurance or copayments and without reduction for any applicable deductible, that is covered in full or in part by any of the plans covering the person.If a plan is advised by a covered person that all plans covering the person are high-deductible health plans and the person intends to contribute to a health savings account established in accordance with section 223 of the Internal Revenue Code of 1986, the primary high-deductible health plan's deductible is not an allowable expense, except for any health care expense incurred that may not be subject to the deductible as described in section 223(c)(2)(C) of the Internal Revenue Code of 1986.An expense or a portion of an expense that is not covered by any of the plans is not an allowable expense.Any expense that a provider by law or in accordance with a contractual agreement is prohibited from charging a covered person is not an allowable expense. Source: SL 2006, ch 259, §2.
SD Codified L § 58-18A-55 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-55 - Expenses that are not allowable.

58-18A-55. Expenses that are not allowable.The following are examples of expenses that are not allowable expenses:(1)If a person is confined in a private hospital room, the difference between the cost of a semi-private room in the hospital and the private room is not an allowable expense, unless one of the plans provides coverage for private hospital room expenses;(2)If a person is covered by two or more plans that compute their benefit payments on the basis of usual and customary fees or relative value schedule reimbursement or other similar reimbursement methodology, any amount charged by the provider in excess of the highest reimbursement amount for a specified benefit is not an allowable expense;(3)If a person is covered by two or more plans that provide benefits or services on the basis of negotiated fees, any amount in excess of the highest of the negotiated fees is not an allowable expense; and(4)If a person is covered by one plan that calculates its benefits or services on the basis of usual and customary fees or relative value schedule reimbursement or other similar reimbursement methodology and another plan that provides its benefits or services on the basis of negotiated fees, the primary plan's payment arrangement shall be the allowable expense for all plans. However, if the provider has contracted with the secondary plan to provide the benefit or service for a specific negotiated fee or payment amount that is different than the primary plan's payment arrangement and if the provider's contract permits, that negotiated fee or payment shall be the allowable expense used by the secondary plan to determine its benefits. Source: SL 2006, ch 259, §3.
SD Codified L § 58-18A-56 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-56 - Exclusion of certain expenses.

58-18A-56. Exclusion of certain expenses.For the purposes of this chapter, the term, allowable expense, may exclude certain types of coverage or benefits such as dental care, vision care, prescription drugs, or hearing aids. A plan that limits the application of COB to certain coverages or benefits may limit the definition of allowable expense in its contract to expenses that are similar to the expenses that it provides. If COB is restricted to specific coverages or benefits in a contract, the definition of allowable expense shall include similar expenses to which COB applies.If a plan provides benefits in the form of services, the reasonable cash value of each service shall be considered an allowable expense and a benefit paid.The amount of the reduction may be excluded from allowable expense if a covered person's benefits are reduced under a primary plan because the covered person does not comply with the plan provisions concerning second surgical opinions or pre-certification of admissions or services, or because the covered person has a lower benefit because the covered person did not use a preferred provider. Source: SL 2006, ch 259, §4.
SD Codified L § 58-18A-57 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-57 - Plan defined--Types of coverage considered in coordination of benefits to be stated.

58-18A-57. Plan defined--Types of coverage considered in coordination of benefits to be stated.For the purposes of this chapter, the term, plan, means a form of coverage with which coordination is allowed. Separate parts of a plan for members of a group that are provided through alternative contracts that are intended to be part of a coordinated package of benefits are considered one plan and there is no COB among the separate parts of the plan.If a plan coordinates benefits, its contract shall state the types of coverage that will be considered in applying the COB provision of that contract. Whether the contract uses the term, plan, or some other term such as program, the contractual definition may be no broader than the definition of plan in this section. Source: SL 2006, ch 259, §5.
SD Codified L § 58-18A-58 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-58 - Contracts and coverages included within definition of plan.

58-18A-58. Contracts and coverages included within definition of plan.For the purposes of this chapter, the term, plan, includes:(1)Group and nongroup insurance contracts and subscriber contracts;(2)Uninsured arrangements of group or group-type coverage;(3)Group and nongroup coverage through closed panel plans;(4)Group-type contracts;(5)The medical care components of long-term care contracts, such as skilled nursing care;(6)The medical benefits coverage in automobile no fault and traditional automobile fault type contracts;(7)Medicare or other governmental benefits, as permitted by law, except for the medical assistance program. That part of the definition of plan may be limited to the hospital, medical, and surgical benefits of the governmental program; and(8)Group and nongroup insurance contracts and subscriber contracts that pay or reimburse for the cost of dental care. Source: SL 2006, ch 259, §6; SL 2007, ch 290, §1; SL 2015, ch 253, §1.
SD Codified L § 58-18A-59 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-59 - Contracts and coverages not included within definition of plan.

58-18A-59. Contracts and coverages not included within definition of plan.For the purposes of this chapter, the term, plan, does not include:(1)Hospital indemnity coverage benefits or other fixed indemnity coverage;(2)Accident only coverage;(3)Specified disease or specified accident coverage;(4)Limited benefit health coverage;(5)School accident-type coverages that cover students for accidents only, including athletic injuries, either on a twenty-four-hour basis or on a to-and-from-school basis;(6)Medicare supplement policies;(7)A state plan under the medical assistance program;(8)A governmental plan, which, by law, provides benefits that are in excess of those of any private insurance plan or other nongovernmental plan ; or(9)Benefits provided in long-term care insurance policies for nonmedical services including personal care, adult day care, homemaker services, assistance with activities of daily living, respite care and custodial care, or for contracts that pay a fixed daily benefit without regard to expenses incurred or the receipt of services. Source: SL 2006, ch 259, §7; SL 2007, ch 290, §2.
SD Codified L § 58-18A-60 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-60 - Application date.

58-18A-60. Application date.Sections 58-18A-53 to 58-18A-83, inclusive, apply to all plans that are issued on or after January 1, 2007. Source: SL 2006, ch 259, §8.
SD Codified L § 58-18A-61 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-61 - Promulgation of rules concerning coordination of health plan benefits.

58-18A-61. Promulgation of rules concerning coordination of health plan benefits.The director shall promulgate rules pursuant to chapter 1-26 to carry out the provisions of §§58-18A-53 to 58-18A-83, inclusive. In promulgating any rules, the director shall give great weight to any national standards that may exist for the coordination of benefits for plans. The rules are limited to:(1)Definition of terms;(2)Sample policy provisions; and(3)Disclosure requirements. Source: SL 2006, ch 259, §9.
SD Codified L § 58-18A-62 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-62 - Prohibited grounds for reduction of benefits.

58-18A-62. Prohibited grounds for reduction of benefits.No COB provision may be used that permits a plan to reduce its benefits on the basis that:(1)Another plan exists and the covered person did not enroll in that plan;(2)A person is or could have been covered under another plan, except with respect to Part B of Medicare; or(3)A person has elected an option under another plan providing a lower level of benefits than another option that could have been elected. Source: SL 2006, ch 259, §10.
SD Codified L § 58-18A-63 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-63 - Restriction on excess or secondary benefits provisions.

58-18A-63. Restriction on excess or secondary benefits provisions.No plan may contain a provision that its benefits are always excess or always secondary except in accordance with the rules permitted by §§58-18A-53 to 58-18A-83, inclusive. No plan is required to coordinate benefits provided that it pays benefits as a primary plan; but if the plan coordinates benefits, it shall do so in compliance with the provisions of this chapter. Source: SL 2006, ch 259, §11.
SD Codified L § 58-18A-64 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-64 - Closed panel plans.

58-18A-64. Closed panel plans.Under the terms of a closed panel plan, no benefits are payable if the covered person does not use the services of a closed panel provider. No COB occurs if a covered person is enrolled in two or more closed panel plans and obtains services from a provider in one of the closed panel plans because the other closed panel plan (the one whose providers were not used) has no liability. However, COB may occur during the plan year if the covered person receives emergency services that would have been covered by both plans. In such a case, the secondary plan shall use the provisions of §58-18A-75 to determine the amount it should pay for the benefit. Source: SL 2006, ch 259, §12.
SD Codified L § 58-18A-65 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-65 - Prohibition on reduction of benefits for coverage not qualifying as plan.

58-18A-65. Prohibition on reduction of benefits for coverage not qualifying as plan.No plan may use a COB provision, or any other provision, that allows it to reduce its benefits with respect to any other coverage its insured may have that does not meet the definition of a plan as provided by §§58-18A-53 to 58-18A-83, inclusive. Source: SL 2006, ch 259, §13.
SD Codified L § 58-18A-66 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18A - Coordination Of Benefits Of Health Plans|Section 58-18A-66 - Order of benefit payments.

58-18A-66. Order of benefit payments.If a person is covered by two or more plans, the provisions for determining the order of benefit payments are as follows:(1)The primary plan shall pay or provide its benefits as if any secondary plan did not exist;(2)If the primary plan is a closed panel plan and the secondary plan is not a closed panel plan, the secondary plan shall pay or provide benefits as if it were the primary plan when a covered person uses a nonpanel provider, except for emergency services or authorized referrals that are paid or provided by the primary plan;(3)If multiple contracts providing coordinated coverage are treated as a single plan under §§58-18A-53 to 58-18A-83, inclusive, this section applies only to the plan as a whole, and coordination among the component contracts is governed by the terms of the contracts. If more than one carrier pays or provides benefits under the plan, the carrier designated as primary within the plan shall be responsible for the plan's compliance with §§58-18A-53 to 58-18A-83, inclusive;(4)If a person is covered by more than one secondary plan, the order of benefit determination provisions of §§58-18A-53 to 58-18A-83, inclusive, decide the order in which secondary plans benefits are determined in relation to each other. Each secondary plan shall take into consideration the benefits of any primary plan and the benefits of any other plan, which, under the provisions of §§58-18A-53 to 58-18A-83, inclusive, has its benefits determined before those of that secondary plan;(5)Except as provided in subdivision (2) of this section, a plan that does not contain order of benefit determination provisions that are consistent with §§58-18A-53 to 58-18A-83, inclusive, is always the primary plan unless the provisions of both plans, regardless of the provisions of this section, state that the complying plan is primary;(6)Coverage that is obtained by virtue of membership in a group and designed to supplement a part of a basic package of benefits may provide that the supplementary coverage shall be excess to any other parts of the plan provided by the contract holder. Examples of these types of situations are major medical coverages that are superimposed over base plan hospital and surgical benefits, and insurance type coverages that are written in connection with a closed panel plan to provide out-of-network benefits. Source: SL 2006, ch 259, §14.