reglab/housing_qa huggingface dataset:
SD Codified L § 58-18-33 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-33 - Premature birth, congenital defects, and birth abnormalities covered--Applicability.

58-18-33. Premature birth, congenital defects, and birth abnormalities covered--Applicability.The coverage for a newly born child from the moment of birth or for a newly adopted child, from the beginning of the six-month adoption bonding period, shall consist of coverage of injury or sickness including the necessary care and treatment of premature birth and medically diagnosed congenital defects and birth abnormalities. The coverage required by this section applies to any subsequent health benefit plan that is purchased providing coverage for that newly born or newly adopted child. If there is a break in coverage that exceeds sixty-three days, the health benefit plan may apply preexisting exclusion limitations as permitted by §58-18-45. The provisions of §§ 58-18-32 to 58-18-34, inclusive, apply to any group health benefit plan issued or renewed by any health insurer, health carrier, health maintenance organization, fraternal benefit society, nonprofit medical and surgical plan, nonprofit hospital service plan, or other entity providing coverage through a health benefit plan subject to the provisions of this title. Source: SL 1974, ch 322; SDCL Supp, §58-17-30.3; SL 1976, ch 313, §2; SL 1984, ch 327, §2; SL 2001, ch 274, §2; SL 2006, ch 258, §1.
SD Codified L § 58-18-34 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-34 - Notice of birth or adoption required for continued coverage.

58-18-34. Notice of birth or adoption required for continued coverage.An insurer may require notice that a newly born or newly adopted child is to be added to the policy or that coverage is to be changed from single or spousal coverage to family coverage. However, the insurer may not require notification sooner than the birth of the child or the start of the adoption bonding period. If the child is added or coverage changed to family coverage before the birth of the child or the start of the adoption bonding period, no additional premium may be charged by the insurer until the birth of the child or the start of the adoption bonding period. The insurer shall take reasonable steps to provide adequate notice to insureds of the need to alter coverage to ensure newborn or adopted children are covered and of the lack of premium adjustment until the birth of the child or the start of the adoption bonding period. An insurer is considered to have taken reasonable steps if prominent disclosure of the requirements of this section are included in a certificate, subscriber contract, evidence of coverage, or employee handbook if such are provided to all insureds.If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child or notification of the start of the six-month adoption bonding period for an adopted child or start of the bonding period and payment of the required premium or fees be furnished to the insurer or nonprofit service or indemnity corporation within thirty-one days after the date of birth or notification of the start of the six-month adoption bonding period for an adopted child or start of the bonding period in order to have the coverage continued beyond the thirty-one day period. Source: SL 1974, ch 322; SDCL Supp, §58-17-30.4; SL 1984, ch 327, §3; SL 1994, ch 387, §8.
SD Codified L § 58-18-35 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-35 - Notice required for rate increase by group health insurance company.

58-18-35. Notice required for rate increase by group health insurance company.Forty-five days before a premium rate increase is effective, the group health insurance company shall notify the policy holder in writing that the premium rate for the group health insurance will be increased. Source: SL 1989, ch 434, §1.
SD Codified L § 58-18-36 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-36 - Grandfathered plans required to cover low-dose mammography--Extent of coverage.

58-18-36. Grandfathered plans required to cover low-dose mammography--Extent of coverage.Each group health insurance policy that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a policy that provides coverage for specified disease or other limited benefit coverage, shall provide coverage for screening by low-dose mammography for the presence of occult breast cancer that is subject to the same dollar limits, deductibles and coinsurance factors as for other radiological examinations. Coverage for the screening shall be provided as follows: ages thirty-five to thirty-nine, one baseline mammography; ages forty to forty-nine, a mammography every other year; and age fifty and older, a mammography every year.As used in this section, "low-dose mammography" means the X ray examination of the breast using equipment dedicated specifically for mammography, including the X ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad midbreast, with two views for each breast and with interpretation by a qualified radiologist.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, 29 C.F.R. §2590, and 45 C.F.R. §147. (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 1990, ch 397, §§1, 4; SL 1991, ch 400, §4; SL 2011, ch 216, §9.
SD Codified L § 58-18-36.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-36.1 - Policies required to cover occult breast cancer screening.

58-18-36.1.Policies required to cover occult breast cancer screening.Each group health insurance policy that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a policy that provides coverage for specified disease or other limited benefit coverage, shall provide coverage for screening for the presence of occult breast cancer.The provisions of this section apply only to plans that are not grandfathered pursuant to 75 Fed. Reg. 116 (2010) to be codified at 26 C.F.R. §§54 and 602, 29 C.F.R. §2590, and 45 C.F. R. §147. (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, §15.
SD Codified L § 58-18-37 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-37 - Freedom of choice for pharmacy services.

58-18-37. Freedom of choice for pharmacy services.No policy of group health insurance providing benefits for hospital and medical expenses delivered in this state that is offered by a commercial health insurance company, by a nonprofit medical and surgical plan corporation, by a nonprofit hospital service plan corporation, by a health maintenance organization, by a preferred provider organization, by an individual practice association or by a similar mechanism may:(1)Deny any licensed pharmacy or licensed pharmacist as defined in §36-11-2 the right to participate as a participating provider for any policy or plan on the same terms and conditions as are offered to any other provider of pharmacy services under the policy or plan;(2)Prevent any person who is a party to or beneficiary of any health insurance policy from selecting a licensed pharmacy of his choice to furnish the pharmaceutical services offered under any policy or plan, provided that the pharmacy is a participating provider under the same terms and conditions of the policy or plan as those offered to any other provider of pharmacy services; or(3)Permit or mandate any difference in coverage for or impose any different conditions, including copayment fees, whether the prescription benefits are provided through direct contact with a pharmacy or by use of an out-of-state mail order service so long as the provider selected is a participant in the plan involved. Source: SL 1990, ch 395, §1.
SD Codified L § 58-18-38 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-38 - Annual period of enrollment for licensed pharmacies--Actual notice of enrollment period not required.

58-18-38. Annual period of enrollment for licensed pharmacies--Actual notice of enrollment period not required.All health benefit programs, as defined in §58-18-37, shall provide an annual period of enrollment of at least thirty days during which period any pharmacy licensed under chapter 36-11 may elect to participate in the plan under the terms and conditions then offered unless the pharmacy has lost its status as a participating provider due to its failure to comply with the terms and conditions of its participating provider agreement. Health benefit programs are not required to provide actual notice of the period of open enrollment to the pharmacy. Source: SL 1990, ch 395, §2.
SD Codified L § 58-18-39 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-39 - Provisions denying choice for pharmacy services as void.

58-18-39. Provisions denying choice for pharmacy services as void.Any provision in a health insurance policy offered in this state which violates the provisions in §58-18-37 is void. Source: SL 1990, ch 395, §3.
SD Codified L § 58-18-40 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-40 - Enforcement of provisions permitting choice for pharmacy services.

58-18-40. Enforcement of provisions permitting choice for pharmacy services.The Division of Insurance shall enforce the provisions of §§58-18-37 to 58-18-39, inclusive. Source: SL 1990, ch 395, §4.
SD Codified L § 58-18-41 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-41 - Coverage for phenylketonuria.

58-18-41. Coverage for phenylketonuria.Every group health insurance policy 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 offer coverage for testing, diagnosis and treatment of phenylketonuria including dietary management, formulas, case management, intake and screening, assessment, comprehensive care planning and service referral. Source: SL 1992, ch 348, §3.
SD Codified L § 58-18-42 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-42 - "Health benefit plan" defined.

58-18-42. Health benefit plan defined.For the purposes of this chapter, a health benefit plan is any hospital or medical expense incurred policy or certificate, hospital or medical service plan, contract, or health maintenance organization subscriber contract. The term does not include specified disease, hospital indemnity, fixed indemnity, accident-only, credit, dental, vision, medicare supplement, long-term care, or disability income insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, or automobile medical payment insurance. Source: SL 1994, ch 383, §1.
SD Codified L § 58-18-43 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-43 - "Late enrollee" defined.

58-18-43. Late enrollee determined.For the purposes of this chapter, a late enrollee is an eligible employee or dependent who requests enrollment in a health benefit plan of an employer following the initial enrollment period during which the individual is entitled to enroll under the terms of the health benefit plan, if the initial enrollment period is a period of at least thirty days. However, no eligible employee or dependent may be considered a late enrollee if:(1)The individual:(a)Was covered under creditable coverage at the time of the initial enrollment;(b)Lost coverage under creditable coverage as a result of termination of employment or eligibility, reduction of hours, the involuntary termination of the creditable coverage, death of a spouse, legal separation, or divorce; and(c)Requests enrollment within sixty-three days after termination of the creditable coverage;(2)The individual is employed by an employer that offers multiple health benefit plans and the individual elects a different plan during an open enrollment period;(3)A court has ordered coverage be provided for a spouse or minor or dependent child under a covered employee's health benefit plan and request for enrollment is made within thirty days after issuance of the court order; or(4)Child custody has changed by agreement of the parties to a child custody agreement or to a child custody order which agreement has not yet been included in a court order. Source: SL 1994, ch 383, §2; SL 1997, ch 289, §7.
SD Codified L § 58-18-44 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-44 - "Creditable coverage" defined.

58-18-44. Creditable coverage determined.For the purposes of this chapter, creditable coverage are benefits or coverage provided under:(1)Medicare or medicaid;(2)An employer-based health insurance plan or health benefit arrangement that provides benefits similar to or exceeding benefits provided under a health benefit plan;(3)An individual health insurance policy including coverage issued by a health maintenance organization, a fraternal benefit society, a nonprofit medical and surgical plan, a nonprofit hospital service plan that provides benefits similar to or exceeding the benefits provided under the basic plan pursuant to chapter 58-18B, or an employee welfare benefit plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974 as adopted by the director pursuant to chapter 1-26, to the extent that the plan provides directly or through insurance, reimbursement or otherwise to employees or their dependents medical care for the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body and amounts paid for the transportation primarily for and essential to medical care;(4)Chapter 55 of Title 10, United States Code;(5)A medical care program of the Indian Health Service or of a tribal organization;(6)A state health benefits risk pool;(7)A health plan offered under Chapter 89 of Title 5, United States Code;(8)A public health plan;(9)A health benefit plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e));(10)A short-term limited-duration policy; or(11)A college plan. Source: SL 1994, ch 383, §3; SL 1997, ch 289, §8; SL 1998, ch 289, §5.
SD Codified L § 58-18-45.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-45.1 - (Text of section effective until the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospitalization for dental care to be provided certain covered persons.

58-18-45.1.(Text of section effective until the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospitalization for dental care to be provided certain covered persons.Any health benefit plan as defined by §58-18-42 shall cover anesthesia and hospital charges for dental care provided to a covered person who:(1)Is a child under age five; or(2)Is severely disabled or otherwise suffers from a developmental disability as determined by a licensed physician which places such person at serious risk.Such coverage applies regardless of whether the services are provided in a hospital or a dental office. A health carrier may require prior authorization of hospitalization for dental care procedures in the same manner that prior authorization is required for hospitalization for other covered diseases or conditions.(Text of section effective the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospital or ambulatory surgery center charges for dental care to be covered for certain persons. Any health benefit plan as defined by §58-18-42 shall cover anesthesia and hospital or ambulatory surgery center charges for dental care provided to a covered person who:(1)Is a child under age five; or(2)If determined by a licensed physician, is severely disabled, has a developmental disability, or otherwise has a medical condition that places the person at serious medical risk.The coverage applies regardless of whether the services are provided in a hospital, ambulatory surgery center, or a dental office. A health carrier may require prior authorization in the same manner that prior authorization is required for other covered diseases or conditions. Source: SL 1999, ch 248, §3; SL 2018, ch 279, §2, eff. Jan. 1, 2019.
SD Codified L § 58-18-46 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-46 - Renewability of health benefit plans--Employer's election--Exceptions.

58-18-46. Renewability of health benefit plans--Employer's election--Exceptions.Except as provided in §§58-18-42 to 58-18-49, inclusive, a health benefit plan subject to this chapter is renewable to all eligible employees and dependents at the option of the employer, except for the following reasons:(1)The employer has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the insurer has not received timely premium payments;(2)Fraud or intentional misrepresentation of material fact by the employer;(3)Noncompliance with the carrier's employer contribution or participation requirements;(4)The number of individuals covered under the plan is less than the number or percentage of eligible individuals required under the plan;(5)In the case of a health insurance issuer that offers health insurance coverage in the market through a network plan, there is no longer any enrollees in connection with the plan who live, reside, or work in the service area of the issuer or in the area for which the issuer is authorized to do business and the issuer would deny enrollment with respect to the plan as provided for in §58-18B-37;(6)The employer carrier elects to nonrenew all of its health benefit plans delivered or issued for delivery to employers in this state;(7)In the case of health insurance coverage that is made available only through one or more bona fide associations, the membership of an employer in the association (on the basis of which the coverage is provided) ceases but only if the coverage is terminated uniformly without regard to any health status-related factor relating to any covered individual; or(8)If the issuer decides to discontinue offering a particular type of group health insurance offered in the group market, coverage of such type may be discontinued if:(a)The issuer provides notice to each employer provided coverage of this type in such market (and any participant and beneficiary covered under such coverage) of the discontinuation at least ninety days prior to the date of the discontinuation of the coverage;(b)The issuer offers to each employer provided coverage of this type in such market, the option to purchase all other health insurance coverage currently being offered by the issuer to a group health plan in such market;(c)In exercising the option to discontinue coverage of this type and in offering the option of coverage under subsection (b), the issuer acts uniformly without regard to the claims experience of those employers or any health status-related factor relating to any participant or beneficiary covered or any new participant or beneficiary who may become eligible for such coverage.If a carrier nonrenews a health benefit plan pursuant to this section, the director shall assist affected employers in finding replacement coverage.  Source: SL 1994, ch 383, §5; SL 1997, ch 289, §10; SL 2001, ch 275, §5.
SD Codified L § 58-18-47 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-47 - Nonrenewal of health benefit plans by an employer carrier.

58-18-47. Nonrenewal of health benefit plans by an employer carrier.If an employer carrier elects not to renew all of its health benefit plans delivered or issued for delivery to employers in this state, the carrier shall:(1)Be prohibited from writing new business in the employer market in this state for a period of five years from the date of notice to the director;(2)Provide advance notice of the decision not to renew to the director in each state in which it is licensed; and(3)Provide notice of the decision not to renew coverage to all affected employers and to the director in each state in which an affected insured individual is known to reside at least one hundred eighty days prior to the nonrenewal of any health benefit plans by the carrier.Notice to the director under this section shall be provided at least three working days prior to the notice to the affected employers. In the case of an employer carrier doing business in one established geographic service area of the state, this section applies only to the carrier's operations in that service area. Source: SL 1994, ch 383, §6.
SD Codified L § 58-18-48 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-48 - Acceptance of new employees for coverage under employer's existing health benefit plan.

58-18-48. Acceptance of new employees for coverage under employer's existing health benefit plan.If an employer has an existing health benefit plan, the carrier shall accept for coverage under the health benefit plan new employees and the dependents of new employees, if the new employee had creditable coverage within the prior sixty-three days from the date the new employee is eligible for coverage. The coverage shall be issued without exclusionary riders. The carrier is not required to provide coverage for new employees or dependents who are late enrollees or who have not had creditable coverage within sixty-three days before applying for coverage. The exception allowing late enrollees to be excluded is limited to the time frames required by subdivisions 58-18-45(3) and (5). Policies may not exclude children, as set forth in subdivision 58-18-43(4), from the definition of eligible dependents. No person may be excluded from coverage based upon discriminatory criteria as defined by the director in rules promulgated pursuant to chapter 1-26. Source: SL 1994, ch 383, §8; SL 1996, ch 295; SL 1997, ch 289, §11; SL 1998, ch 289, §7.