reglab/housing_qa huggingface dataset:
SD Codified L § 58-41-35.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-35.1 - Alcoholism coverage to be offered at time contract is negotiated.

58-41-35.1. Alcoholism coverage to be offered at time contract is negotiated.At the time of negotiation of any health maintenance contract, the health maintenance organization shall offer, in writing, to provide the coverage prescribed by §§58-17-30.5 and 58-18-7.1. Source: SL 1979, ch 344, §12.
SD Codified L § 58-41-35.5 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-35.5 - Grandfathered contracts required to cover low-dose mammography--Extent of coverage.

58-41-35.5. Grandfathered contracts required to cover low-dose mammography--Extent of coverage.Each health maintenance contract that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a contract 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 (SL 2011, ch 216, §19 provides: "The provisions of this Act are repealed if the Patient Protection and Affordable Care Act, Pub.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, 7; SL 1991, ch 400, §7; SL 2011, ch 216, §12.
SD Codified L § 58-41-35.6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-35.6 - Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony.

58-41-35.6. Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony.A health maintenance contract that is delivered, issued for delivery, or renewed in this state may not exclude the payment of benefits for injuries sustained by an insured person because the insured was under the influence of alcohol or drugs, as defined by §32-23-1.Nothing in this section precludes a health maintenance contract from excluding coverage for an insured for any sickness or injury caused in the commission of a felony. Source: SL 1997, ch 290, §§6, 7.
SD Codified L § 58-41-35.7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-35.7 - Contracts required to cover occult breast cancer screening.

58-41-35.7.Contracts required to cover occult breast cancer screening.Each health maintenance contract that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a contract 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, §17.
SD Codified L § 58-41-36 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-36 - Unfair and misleading information in evidence of coverage as misdemeanor.

58-41-36. Unfair and misleading information in evidence of coverage as misdemeanor.No evidence of coverage shall contain provisions or statements which are unjust, unfair, inequitable, misleading, or deceptive, as defined in §§58-41-37 to 58-41-40, inclusive. Violation of this section is a Class 2 misdemeanor. Source: SL 1974, ch 321, §§19 (1), 50; SDCL Supp, §58-41-77; SL 1978, ch 359, §2.
SD Codified L § 58-41-37 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-37 - Deceptive advertising or evidence of coverage as misdemeanor.

58-41-37. Deceptive advertising or evidence of coverage as misdemeanor.No health maintenance organization or representative thereof may cause or knowingly permit the use of advertising or solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. Violation of this section is a Class 2 misdemeanor. Source: SL 1974, ch 321, §§32 (1), 50; SDCL, §58-41-77; SL 1978, ch 359, §2.
SD Codified L § 58-41-38 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-38 - Statements deemed untrue.

58-41-38. Statements deemed untrue.For the purposes of this chapter, a statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect which is or may be significant to an enrollee of, or person considering enrollment in, a health maintenance organization. Source: SL 1974, ch 321, §32 (1) (a).
SD Codified L § 58-41-39 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-39 - Statements deemed misleading.

58-41-39. Statements deemed misleading.For the purposes of this chapter, a statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue, if, in the total context in which such statement is made or such item of information is communicated, such statement or item of information may be reasonably understood by a reasonable person, not possessing special knowledge regarding health care coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation, or disadvantage of possible significance to an enrollee of, or person considering enrollment in, a health care plan, if such benefit or advantage or absence of limitation, exclusion, or disadvantage does not in fact exist. Source: SL 1974, ch 321, §32 (1) (b).
SD Codified L § 58-41-40 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-40 - Evidence of coverage deemed deceptive.

58-41-40. Evidence of coverage deemed deceptive.For the purposes of this chapter, an evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format, as well as language, shall be such as to cause a reasonable person, not possessing special knowledge regarding health care plans and evidences of coverage therefor, to expect benefits, services, charges, or other advantages which the evidence of coverage does not regularly make available for enrollees covered under such evidence of coverage. Source: SL 1974, ch 321, §32 (1) (c).
SD Codified L § 58-41-41 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-41 - Issuance to enrollees of change in evidence of coverage.

58-41-41. Issuance to enrollees of change in evidence of coverage.Any approved change in evidence of coverage shall be issued to each enrollee. Source: SL 1974, ch 321, §21.
SD Codified L § 58-41-42 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-42 - Evidence of coverage to be approved before use--Violation as misdemeanor.

58-41-42. Evidence of coverage to be approved before use--Violation as misdemeanor.No evidence of coverage or amendment thereto shall be issued or delivered to any person in this state until a copy of the form of the evidence of coverage or amendment thereto has been filed with and approved by the director. Violation of this section is a Class 2 misdemeanor. Source: SL 1974, ch 321, §§20, 50; SDCL Supp, §58-41-77; SL 1978, ch 359, §2.
SD Codified L § 58-41-43 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-43 - Filing and approval requirements applicable.

58-41-43. Filing and approval requirements applicable.A copy of the form of evidence of coverage to be used in this state, and any amendment thereto, shall be subject to the filing and approval requirements of §58-41-42 unless it is subject to the jurisdiction of the director under the laws governing health insurance or hospital or medical service corporations in which event the filing and approval provisions of such laws shall apply. To the extent, however, that such provisions do not fulfill the requirements of §§58-41-35 and 58-41-36, the requirements of said sections shall be applicable. Source: SL 1974, ch 321, §22.
SD Codified L § 58-41-44 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-44 - Charges to enrollees--Fairness--Actuary's certificate.

58-41-44. Charges to enrollees--Fairness--Actuary's certificate.Charges for comprehensive health maintenance services may be established in accordance with actuarial principles for various categories of enrollees, provided that such charges applicable to an enrollee shall not be individually determined based on the status of his health. However, the charges shall not be excessive, inadequate, or unfairly discriminatory. A certification, by a qualified actuary, to the appropriateness of the charges, based on reasonable assumptions, shall accompany the filing along with adequate supporting information. Source: SL 1974, ch 321, §23 (1).
SD Codified L § 58-41-45 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-45 - Discrimination as misdemeanor.

58-41-45. Discrimination as misdemeanor.No health maintenance organization or representative thereof may discriminate in the rates charged enrollees except in accordance with accepted actuarial principles.Violation of this section is a Class 2 misdemeanor. Source: SL 1974, ch 321, §§32 (6), (7), 50; SDCL Supp, §58-41-77; SL 1978, ch 359, §2; SL 2013, ch 256, §11.
SD Codified L § 58-41-50 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-50 - Authorized expenses.

58-41-50. Authorized expenses.Authorized expenses of health maintenance organizations include:(1)Cash rebates to enrollees, or to persons who have made payments on behalf of enrollees;(2)Free or reduced cost health service to enrollees; or(3)Payments to providers or other persons based upon the efficient provision of services or as incentives to provide quality care. Source: SL 1974, ch 321, §§32 (8), 50; SDCL Supp, §58-41-77; SL 1978, ch 359, §2; SL 1985, ch 393, §6.
SD Codified L § 58-41-51.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-51.1 - Individual policy required for covered spouse of insured--Eligibility--Coverage--Waiting periods.

58-41-51.1. Individual policy required for covered spouse of insured--Eligibility--Coverage--Waiting periods.No accident or health insurance policy providing coverage of hospital or medical expense which in addition to covering the insured also provides coverage to the spouse of the insured shall be issued without a provision that provides that upon eligibility for medicare or social security disability benefits by one spouse the other spouse shall be entitled to have issued to him or her, without evidence of insurability, upon application to the company within sixty days following the eligibility, and upon payment of the appropriate premium, an individual policy of accident or health insurance. Such policy shall provide the coverage then being issued by the insurer which is most nearly similar to the existing coverages. This obligation can be met by continuation of coverage for spouse under existing policy at the appropriate premium. Any and all probationary or waiting periods set forth in such policy shall be considered as being met to the extent coverage was in force under the prior policy. Source: SL 1979, ch 343.
SD Codified L § 58-41-51.2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-51.2 - Conversion privileges of insured's spouse upon divorce.

58-41-51.2. Conversion privileges of insured's spouse upon divorce.No accident or health insurance policy providing coverage of hospital or medical expense which in addition to covering the insured also provides coverage to the spouse of the insured shall be issued without a provision that provides that upon divorce of the insured and the insured's spouse, the spouse is entitled to have issued to him or her, without evidence of insurability, upon application to the company within thirty days following the eligibility, and upon payment of the appropriate premium, an individual policy of accident or health insurance. Such policy shall provide the coverage then being issued by the insurer which is most nearly similar to the existing coverages. This obligation can be met by continuation of coverage for spouse under existing policy at the appropriate premium. Any and all probationary or waiting periods set forth in such policy shall be considered as being met to the extent coverage was in force under the prior policy. Source: SL 1980, ch 354.
SD Codified L § 58-41-51.3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-51.3 - Continuation and conversion coverage to be offered.

58-41-51.3. Continuation and conversion coverage to be offered.At the time of negotiation of any health maintenance contract, the health maintenance organization shall offer, in writing, to provide the coverage prescribed by §§58-18-7.5 to 58-18-7.15, inclusive. Source: SL 1985, ch 393, §13.
SD Codified L § 58-41-52 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-52 - Contracts with providers of health care services.

58-41-52. Contracts with providers of health care services.A health maintenance organization may contract with providers of health care services to render the services the health maintenance organization has promised to provide under the terms of its health maintenance contracts. Source: SL 1974, ch 321, §13.
SD Codified L § 58-41-52.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-52.1 - Collection for covered services prohibited.

  58-41-52.1  .  Collection for covered services prohibited.   Except for coinsurance, deductibles, or copayments as specifically provided in the evidence of coverage, in no event, including nonpayment by the health maintenance organization, insolvency of the health maintenance organization, or breach of contract among the health maintenance organization, risk bearing entity, or participating provider, may a risk bearing entity or participating provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against an enrollee or a person other than the health maintenance organization acting on behalf of   the enrollee for covered services provided. No risk bearing entity or participating provider, nor any agent, trustee or assignee of the risk bearing entity or participating provider may maintain an action at law against an enrollee to collect sums owed by the health maintenance organization.     Source:  SL 2020, ch 210, § 10.
SD Codified L § 58-41-52.2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-52.2 - Contracts--Hold harmless provision.

  58-41-52.2  .  Contracts--Hold harmless provision.   All contracts among health maintenance organizations, risk bearing entities, and participating providers shall include a hold harmless provision specifying protection for enrollees consistent with §§  58-41-52.1   to 58-41-52.3, inclusive. Any attempted waiver or amendment in a manner materially adverse to the interests of enrollees of a hold harmless provision are null and void and unenforceable. Any violation of the provisions of this section constitutes an unfair trade practice under chapter   58-33  .     Source:  SL 2020, ch 210, § 11.
SD Codified L § 58-41-52.3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-52.3 - Hold harmless provision--Language of provision.

  58-41-52.3  .  Hold harmless provision--Language of provision.   The requirements of §  58-41-52.2   shall be met by including a provision substantially similar to the following:   Provider agrees that in no event, including but not limited to nonpayment by the health maintenance organization or intermediary organization, insolvency of the health maintenance organization or intermediary organization, or breach of this agreement, may the provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against an enrollee or a person (other than the health maintenance organization or intermediary organization) acting on behalf of the enrollee for covered services provided pursuant to this agreement. This agreement does not prohibit the provider from collecting coinsurance, deductibles, copayments or services in excess of limits, as specifically provided in the evidence of coverage, or fees for uncovered services delivered on a fee-for-service basis to enrollees.     Source:  SL 2020, ch 210, § 12.
SD Codified L § 58-41-54 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-54 - Contracts with insurance companies and nonprofit health service plan corporations authorized--Limitations.

58-41-54. Contracts with insurance companies and nonprofit health service plan corporations authorized--Limitations.A health maintenance organization may, subject to the limitations of subdivision 58-41-17(5) and of §58-41-19, contract with insurance companies and nonprofit health service plan corporations for insurance, indemnity, or reimbursement of its cost of providing health care services for enrollees or against the risks incurred by the health maintenance organization and may contract with insurance companies and nonprofit health service plan corporations to insure or cover the enrollees' costs and expenses in the health maintenance organization, including the customary prepayment amount and any copayment obligations. If contracts are made with insurance companies or nonprofit health service plan corporations, such companies or corporations must be authorized to transact business in this state. Source: SL 1974, ch 321, §§13, 14.
SD Codified L § 58-41-55 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-55 - Insurance contracts authorized--Group coverage--Benefit payments.

58-41-55. Insurance contracts authorized--Group coverage--Benefit payments.Notwithstanding any law to the contrary, an insurer or a hospital or medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group for group coverage under the insurance laws and the health service plan corporation laws of this state. Under such contracts, the insurer or health service plan corporation may make benefit payments to health maintenance organizations for health care services rendered, or to be rendered, by providers pursuant to the health care plan. Any insurer, or health service plan corporation, licensed to do business in this state, is authorized to provide the types of coverages described in §58-41-54. Source: SL 1974, ch 321, §35.
SD Codified L § 58-41-56 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-56 - Contracts for management and administrative services authorized.

58-41-56. Contracts for management and administrative services authorized.A health maintenance organization may contract with other persons for the provision of services, including, but not limited to, managerial and administration, marketing and enrolling, data processing, actuarial analysis, and billing services. Source: SL 1974, ch 321, §14.
SD Codified L § 58-41-57 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-57 - Payment of unreasonably high expenses as misdemeanor.

58-41-57. Payment of unreasonably high expenses as misdemeanor.No health maintenance organization shall incur or pay for any expense of any nature which is unreasonably high in relation to the value of the service or goods provided. Violation of this section is a Class 2 misdemeanor. Source: SL 1974, ch 321, §§41, 50; SDCL Supp, §58-41-77; SL 1978, ch 359, §2.