reglab/housing_qa huggingface dataset:
SD Codified L § 58-41-105 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-105 - Premiums held in trust by purchasing organization.

58-41-105. Premiums held in trust by purchasing organization.The organization shall hold all premiums received in trust and promptly remit premiums to the person entitled thereto. Source: SL 1994, ch 382, §7.
SD Codified L § 58-41-106 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-106 - Rates for group health insurance issued to purchasing organizations.

58-41-106. Rates for group health insurance issued to purchasing organizations.Any insurer issuing group health insurance pursuant to §§58-41-99 to 58-41-109, inclusive, is subject to all of the provisions of chapter 58-18B relating to rates. Source: SL 1994, ch 382, §8.
SD Codified L § 58-41-107 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-107 - Reasonable participation requirements for group members of purchasing organizations.

58-41-107. Reasonable participation requirements for group members of purchasing organizations.An insurer may as a condition of offering coverage or continuing coverage require reasonable participation requirements of groups who become members of an organization. Source: SL 1994, ch 382, §9.
SD Codified L § 58-41-108 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-108 - Purchasing organizations exempt from antitrust provisions.

58-41-108. Purchasing organizations exempt from antitrust provisions.Any organization formed pursuant to §§58-41-99 to 58-41-109, inclusive, is exempt from the antitrust provisions under chapter 37-1. Source: SL 1994, ch 382, §10.
SD Codified L § 58-41-109 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-109 - Promulgation of rules for purchasing organizations.

58-41-109. Promulgation of rules for purchasing organizations.The director may promulgate rules pursuant to chapter 1-26 to further the provisions of §§58-41-99 to 58-41-109, inclusive, and for purposes of carrying out the provisions of §§58-18-1 to 58-18-6, inclusive, and to ensure that group health insurance coverage is issued to eligible groups and that organizations are formed and operated to further the purpose of providing economical group health insurance for its members. The rules may include:(1)Definition of terms;(2)Criteria for determining groups, associations, organizations, and trusts and their eligibility for coverage;(3)Criteria for determining substantially similar groups or for determining related industries;(4)Application requirements and procedures;(5)Reasonable compensation; and(6)Organizational structure. Source: SL 1994, ch 382, §11.
SD Codified L § 58-41-110 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-110 - Application of chapter to provider contracting with state.

58-41-110. Application of chapter to provider contracting with state.Nothing in this chapter applies to a medical provider who enters into a contract with the State of South Dakota for services pursuant to chapter 3-12A. Source: SL 1995, ch 294, §1.
SD Codified L § 58-41-111 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-111 - Application of chapter to provider contracting with licensed health maintenance organization.

58-41-111. Application of chapter to provider contracting with licensed health maintenance organization.Any medical provider who enters into a contract for medical services with a licensed health maintenance organization or a health insurer licensed pursuant to this title is not required to be licensed pursuant to this chapter. Source: SL 1995, ch 294, §2.
SD Codified L § 58-41-112 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-112 - Minimum inpatient care coverage following delivery.

58-41-112. Minimum inpatient care coverage following delivery.If a health maintenance contract issued or renewed on or after July 1, 1996, by a health maintenance organization provides maternity coverage, the contract shall provide coverage for a minimum of forty-eight hours of inpatient care following a vaginal delivery and a minimum of ninety-six hours of inpatient care following delivery by cesarean section for a mother and her newborn child in a health care facility licensed pursuant to chapter 34-12, except as otherwise provided in §58-41-113. Any individual policy and any policy issued to employers with less than fifteen employees that provides coverage for complications of pregnancy, and does not provide other maternity benefits, is not required to comply with this section. Source: SL 1996, ch 292, §16; SL 1998, ch 290, §6.
SD Codified L § 58-41-113 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-113 - Shorter hospital stay permitted--Follow-up visit within forty-eight hours required.

58-41-113. Shorter hospital stay permitted--Follow-up visit within forty-eight hours required.If the treating physician determines that the mother and the newborn meet medical criteria contained in Guidelines for Perinatal Care, Third Edition, of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists as in effect on January 1, 1996, a health maintenance contract may provide coverage for a shorter length of hospital inpatient stay for services related to maternity and newborn care than is required in §58-41-112 if the coverage includes one follow-up visit in the first forty-eight hours after discharge to verify the condition of the mother and newborn. Source: SL 1996, ch 292, §17.
SD Codified L § 58-41-114 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-114 - Notice to enrollees--Disclosures.

58-41-114. Notice to enrollees--Disclosures.The health maintenance organization shall provide notice to enrollees regarding the coverage required by §58-41-112 in accordance with rules adopted by the director of the Division of Insurance pursuant to chapter 1-26. The notice shall be in writing and prominently positioned in any literature or correspondence. The notice shall be transmitted to enrollees in the next mailing to enrollees, in the yearly informational packet sent to enrollees, or by January 1, 1997, whichever is earliest. Source: SL 1996, ch 292, §18.
SD Codified L § 58-41-115 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-115 - Health insurance policies to provide coverage for biologically-based mental illnesses.

58-41-115. Health insurance policies to provide coverage for biologically-based mental illnesses.Every health maintenance contract 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, §6; SL 1999, ch 251, §6.
SD Codified L § 58-41-116 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-116 - Application--Exemptions.

58-41-116. Application--Exemptions.The provisions of §58-41-115 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 § 58-41-117 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-117 - Policies to provide coverage for diabetes supplies, equipment, and education--Exceptions--Conditions and limitations.

58-41-117. Policies to provide coverage for diabetes supplies, equipment, and education--Exceptions--Conditions and limitations.Every health maintenance contract 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 equipment, supplies, and self-management training and education, including medical nutrition therapy, for treatment of persons diagnosed with diabetes if prescribed by a physician or other licensed health care provider legally authorized to prescribe such treatment. Medical nutrition therapy does not include any food items or nonprescription drugs.Coverage for medically necessary equipment and supplies shall include blood glucose monitors, blood glucose monitors for the legally blind, test strips for glucose monitors, urine testing strips, insulin, injection aids, lancets, lancet devices, syringes, insulin pumps and all supplies for the pump, insulin infusion devices, prescribed oral agents for controlling blood sugars, glucose agents, glucagon kits, insulin measurement and administration aids for the visually impaired, and other medical devices for treatment of diabetes.Diabetes self-management training and education shall be covered if: (a) the service is provided by a physician, nurse, dietitian, pharmacist, or other licensed health care provider who satisfies the current academic eligibility requirements of the National Certification Board for Diabetic Educators and has completed a course in diabetes education and training or has been certified as a diabetes educator; and (b) the training and education is based upon a diabetes program recognized by the American Diabetes Association or a diabetes program with a curriculum approved by the American Diabetes Association or the South Dakota Department of Health.Coverage of diabetes self-management training is limited to (a) persons who are newly diagnosed with diabetes or have received no prior diabetes education; (b) persons who require a change in current therapy; (c) persons who have a co-morbid condition such as heart disease or renal failure; or (d) persons whose diabetes condition is unstable. Under these circumstances, no more than two comprehensive education programs per lifetime and up to eight follow-up visits per year need be covered. Coverage is limited to the closest available qualified education program that provides the necessary management training to accomplish the prescribed treatment.The benefits provided in this section are subject to the same dollar limits, deductibles, coinsurance, and other restrictions established for all other benefits covered in the contract. Source: SL 1999, ch 252, §11.
SD Codified L § 58-41-118 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-118 - Diabetes coverage not required of certain plans and policies.

58-41-118. Diabetes coverage not required of certain plans and policies.The provisions of §58-41-117 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;(15)Individual health benefit plans of six-months' duration or less that are not renewable; or(16)Individual nonmajor medical insurance. Source: SL 1999, ch 252, §12.
SD Codified L § 58-41-119 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-119 - Contracts to provide coverage for prostate cancer screening.

58-41-119. Contracts to provide coverage for prostate cancer screening.Every health maintenance contract 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, §6.
SD Codified L § 58-41-120 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-120 - Annual report on risk bearing entities.

58-41-120. Annual report on risk bearing entities.A health maintenance organization shall file annually, as part of its access plan, a list of all risk bearing entities with which it has an agreement or contract and the number of covered persons assigned or selected by each risk bearing entity. Source: SL 2013, ch 256, §35.
SD Codified L § 58-41-121 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-121 - Documents provided to risk bearing entity by health maintenance organization.

58-41-121. Documents provided to risk bearing entity by health maintenance organization.In entering into, amending, or renewing a contract with a risk bearing entity, a health maintenance organization shall, unless already specified in the contract, provide the following, upon request, to a risk bearing entity:(1)At the time the contract is entered into, a written statement describing the amount or method of remuneration to be paid to the risk bearing entity. If any part of the remuneration is a calculated amount based on variable factors, the payment methodology upon which the calculated amount will be determined. The statement shall specify the services and expenses for which the risk bearing entity is financially liable in whole or part;(2)At the time payment is made, the basis of the calculation of that payment;(3)For health benefit plans in which the covered persons are assigned to the risk bearing entity under a capitated payment arrangement, a list of enrollees and payments due to the risk bearing entity, to be provided monthly if not already available to the risk bearing entity;(4)At the time the contract is entered into, a copy of the health maintenance organization's most recent annual statement filed with the NAIC; and(5)Once the contract is in effect, the quarterly or annual statement. Source: SL 2013, ch 256, §36.
SD Codified L § 58-41-122 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-122 - Documents provided to health maintenance organization by risk bearing entity.

58-41-122.Documents provided to health maintenance organization by risk bearing entity.A health maintenance organization shall include in any contract with a risk bearing entity a requirement that the risk bearing entity provide to the health maintenance organization at the time a contract is entered into and annually thereafter the following:(1)Annual audited GAAP report in accordance with generally accepted accounting principles in the United States (U.S. GAAP);(2)Documentation that satisfies the health maintenance organization that the risk bearing entity has sufficient ability to accept risk; and(3)Documentation that satisfies the health maintenance organization that the risk bearing entity has appropriate management expertise and infrastructure.The contract shall also require that the risk bearing entity on a quarterly basis provide status reports that include the following:(1)Financial statements prepared in accordance with U. S. GAAP;(2)An aging report of the percentage of claims that have been paid, pended, or denied, across all contracts with risk bearing entities; and(3)On a monthly basis, a report of the estimated reported claims and incurred but not reported claims liability of the risk bearing entity. Source: SL 2013, ch 256, §37.
SD Codified L § 58-41-123 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-123 - Notice by risk bearing entity of change in conditions--Assignment of contract.

58-41-123. Notice by risk bearing entity of change in conditions--Assignment of contract.A health maintenance organization shall require in any contract with a risk bearing entity that the risk bearing entity provide notice to the health maintenance organization within thirty days of:(1)Any changes involving the ownership structure of the risk bearing entity; or(2)Financial or operational concerns regarding the financial viability of the risk bearing entity.A health maintenance organization shall also require in any contract with a risk bearing entity a provision that allows the director, in the event that a risk bearing entity fails to comply with any provision of §§58-41-120 to 58-41-126, inclusive, to assign for six months, the risk bearing entity's contract with providers to furnish covered services. Source: SL 2013, ch 256, §38.
SD Codified L § 58-41-124 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-124 - Notice to director that risk bearing entity has materially failed to perform contract.

58-41-124. Notice to director that risk bearing entity has materially failed to perform contract.A health maintenance organization shall have procedures in place to notify the director within a reasonable time that a risk bearing entity has materially failed to perform under its contract with the health maintenance organization. A health maintenance organization is not in violation of this section if it acts in good faith in its attempt to comply with this section. A health maintenance organization shall maintain systems and controls for reviewing the information provided to the health maintenance organization by the risk bearing entity pursuant to §§58-41-120 to 58-41-126, inclusive. Source: SL 2013, ch 256, §39.
SD Codified L § 58-41-125 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-125 - Confidentiality of information.

58-41-125. Confidentiality of information.Any information provided to the director by a health maintenance organization relative to risk bearing entities with which it is contracted is confidential and may not be disclosed to any person except to the extent that it is necessary to carry out the purposes of §§58-41-120 to 58-41-126, inclusive, and as allowed by state law, regardless of whether the information is in the form of paper, is preserved on microfilm, or is stored in computer readable form. If the information is disclosed pursuant to this section, the health maintenance organization providing the notice is not liable for the disclosure or any subsequent use or misuse of the information. The health maintenance organization is entitled to claim any statutory privileges against disclosure that the entity that provided the information to the health maintenance organization is entitled to claim. This section is not intended to create a private right of action. Source: SL 2013, ch 256, §40.
SD Codified L § 58-41-126 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-126 - Nontransferable responsibilities of health maintenance organization.

58-41-126. Nontransferable responsibilities of health maintenance organization.Notwithstanding any agreement to the contrary, the health maintenance organization shall:(1)Retain full responsibility on a prospective basis for the provision of health care services pursuant to any applicable health benefit plan; and(2)At all times, be able to demonstrate to the satisfaction of the director that the health maintenance organization can fulfill its nontransferable obligation to provide health care services to covered persons in any event, including the failure, for any reason, of a risk bearing entity. Source: SL 2013, ch 256, §41.
SD Codified L § 58-41-127 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-127 - Coverage for treatment of hearing impairment for persons under age nineteen.

58-41-127. 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, §4.