reglab/housing_qa huggingface dataset:
SD Codified L § 58-41-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-7 - Financial statements required with application.

58-41-7. Financial statements required with application.Each application for a certificate of authority shall include financial statements showing the applicant's assets, liabilities, and sources of financial support. If the applicant's financial affairs are audited by independent certified public accountants, a copy of the applicant's most recent regular certified financial statement shall be deemed to satisfy this requirement unless the director directs that additional or more recent financial information is required for the proper administration of this chapter. Source: SL 1974, ch 321, §6 (7).
SD Codified L § 58-41-8 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-8 - Copies of forms required with application.

58-41-8. Copies of forms required with application.Each application for a certificate of authority shall include:(1)A copy of the form of each evidence of coverage to be issued to the enrollees;(2)A copy of the form of each individual or group health maintenance contract which is to be issued to enrollees or their representatives. Source: SL 1974, ch 321, §6 (5), (6).
SD Codified L § 58-41-9 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-9 - Marketing, charges, and financial plans required with application.

58-41-9. Marketing, charges, and financial plans required with application.Each application for a certificate of authority shall include a description of the proposed method of marketing the plan, a schedule of proposed charges, and a financial plan which includes a three-year projection of the expenses and income and other sources of future capital. Source: SL 1974, ch 321, §6 (8).
SD Codified L § 58-41-10 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-10 - Appointment to receive process required of foreign applicant.

58-41-10. Appointment to receive process required of foreign applicant.Each application for a certificate of authority by an applicant not domiciled in this state shall include a power of attorney duly executed by such applicant, appointing the director and his successors in office, and duly authorized deputies, as the true and lawful attorney of such applicant in and for this state upon whom all lawful process in any legal action or proceeding against the health maintenance organization on a cause of action arising in this state may be served. Source: SL 1974, ch 321, §6 (9).
SD Codified L § 58-41-11 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-11 - Surety bond or deposit required--Waiver.

58-41-11. Surety bond or deposit required--Waiver.Each health maintenance organization shall furnish a surety bond in an amount satisfactory to the director or deposit with the director cash or securities acceptable to him in at least the same amount as a guarantee that the obligations to the enrollees will be performed. The director may waive this requirement whenever he is satisfied that the assets of the organization or its contracts with insurers, hospital or medical service corporations, governments, or other organizations are sufficient to reasonably assure the performance of its obligations. Source: SL 1974, ch 321, §31.
SD Codified L § 58-41-12 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-12 - Determination of health care qualifications.

58-41-12. Determination of health care qualifications.The director shall determine whether the applicant for a certificate of authority has:(1)Demonstrated the willingness and potential ability to assure that health care services will be provided in a manner to assure both the availability and accessibility of adequate personnel and facilities consistent with the requirements of chapter 58-17F;(2)Arrangements, established in accordance with regulations promulgated by the director for an ongoing quality of health care assurance program consistent with the requirements of chapter 58-17F, concerning health care processes and outcomes;(3)A procedure, established in accordance with rules promulgated pursuant to chapter 1-26 by the director, to develop, compile, evaluate, and report statistics relating to the cost of its operations, the pattern of utilization of its services, the availability and accessibility of its services, and such other matters as may be reasonably required by the director; and(4)Reasonable provisions for emergency and out-of-area health care services. Source: SL 1974, ch 321, §8; SL 1999, ch 245, §20; SL 2011, ch 219, §101; SL 2013, ch 256, §4.
SD Codified L § 58-41-13 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-13 - Coordination with federal professional standards review.

58-41-13.Coordination with federal professional standards review.To the extent that it furthers the purposes of this chapter, the director shall attempt to coordinate the operations of this chapter relating to the quality of health care services with the operations of 42 U.S. C. sections 1320c to 1320c-19. Source: SL 1974, ch 321, §54; SL 2013, ch 256, §5.
SD Codified L § 58-41-15 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-15 - Health maintenance not considered practice of healing arts.

58-41-15. Health maintenance not considered practice of healing arts.Any health maintenance organization authorized under this chapter shall not be deemed to be practicing a healing art. Source: SL 1974, ch 321, §53.
SD Codified L § 58-41-15.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-15.1 - Certain healing arts practitioners to participate in alternate health care delivery systems.

58-41-15.1. Certain healing arts practitioners to participate in alternate health care delivery systems.Any optometrist licensed pursuant to chapter 36-7, podiatrist licensed pursuant to chapter 36-8, chiropractor licensed pursuant to chapter 36-5, psychologist licensed pursuant to chapter 36-27A, dentist licensed pursuant to chapter 36-6A, or social worker licensed under §36-26-17, may organize or contract for services with a corporation organized under the laws of this state by licensed practitioners of the healing arts, for the purpose of negotiating group health care contracts and providing services within the scope of their respective licenses with alternate health care delivery systems, including health maintenance organizations, preferred provider organizations, individual practices organizations, or other similar entities. Source: SL 1987, ch 269, §2; SL 2013, ch 256, §6.
SD Codified L § 58-41-17 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-17 - Issuance or denial of certificate--Fee--Conditions for issuance.

58-41-17. Issuance or denial of certificate--Fee--Conditions for issuance.The director of the Division of Insurance shall issue or deny a certificate of authority to any person filing an application pursuant to this chapter. Issuance of a certificate of authority shall be granted upon payment of the application fee prescribed in §58-41-26 if the director is satisfied that the following conditions are met:(1)The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy, and possess good reputations;(2)The health maintenance organization's proposed plan of operation meets the requirements of §58-41-12;(3)The health maintenance contract constitutes an appropriate mechanism whereby the health maintenance organization will effectively provide or arrange for the provision of comprehensive health maintenance services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments;(4)The health maintenance organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees;(5)The health maintenance organization will assume full financial risk on a prospective basis for the provision of comprehensive health maintenance services, including hospital care;(6)The enrollees will be afforded an opportunity to participate in matters of policy and operation pursuant to §§58-41-23 and 58-41-24; and(7)Nothing in the proposed method of operation, as shown by the information submitted pursuant to §§58-41-4 to 58-41-10, inclusive, or by independent investigation, is contrary to the public interest.A certificate of authority may be denied only after compliance with the requirements of §§58-41-87 to 58-41-90, inclusive. Source: SL 1974, ch 321, §10; SL 1985, ch 393, §15; SL 2013, ch 256, §8.
SD Codified L § 58-41-18 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-18 - Factors considered in determining financial responsibility.

58-41-18. Factors considered in determining financial responsibility.In making a determination under subdivision 58-41-17(4), the director may consider:(1)The financial soundness of the applicant's arrangements for health care services and the proposed schedule of charges used in connection therewith;(2)The adequacy of its working capital;(3)Arrangements which will guarantee for a reasonable period of time the continued availability or payment of the cost of health care services in the event of discontinuance of the health maintenance organization;(4)Agreements with providers for the provision of health care services; and(5)Any surety bond or deposit of cash or securities submitted in accordance with §58-41-11 as a guarantee that the obligations will be duly performed. Source: SL 1974, ch 321, §10 (4).
SD Codified L § 58-41-19 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-19 - Insurance arrangements permitted.

58-41-19. Insurance arrangements permitted.The requirement of subdivision 58-41-17(5) shall not prohibit a health maintenance organization from obtaining insurance or making other arrangements:(1)For the cost of providing to any enrollee comprehensive health maintenance services, the aggregate value of which exceeds five thousand dollars in any year;(2)For the cost of providing comprehensive health care services to its members on a nonelective emergency basis, or while they are outside the area served by the organization; or(3)For not more than ninety-five percent of the amount by which the health maintenance organization's costs for any of its fiscal years exceeds one hundred five percent of its income for such fiscal years. Source: SL 1974, ch 321, §10 (5).
SD Codified L § 58-41-20 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-20 - Corporation operating after certification.

58-41-20. Corporation operating after certification.Any corporation may, upon obtaining a certificate of authority as required in this chapter, operate as a health maintenance organization. Source: SL 1974, ch 321, §11; SL 1985, ch 393, §3.
SD Codified L § 58-41-21 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-21 - Foreign corporations qualifying--Exemption from other requirements.

58-41-21. Foreign corporations qualifying--Exemption from other requirements.A foreign corporation may qualify under this chapter, and if such corporation fully complies with the provisions of Title 58, then such corporation shall be exempt from complying with other provisions of the South Dakota Code concerning foreign corporations. Source: SL 1974, ch 321, §3; SL 1985, ch 393, §4.
SD Codified L § 58-41-22 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-22 - Filing of notice of modification of operation--Approval if not disapproved--Exemptions.

58-41-22. Filing of notice of modification of operation--Approval if not disapproved--Exemptions.A health maintenance organization shall, unless otherwise provided for in this chapter, file a notice describing any modification of the operation set out in the information required by §§58-41-6 to 58-41-10, inclusive. Such a notice shall be filed with the director prior to the modification. If the director does not disapprove within thirty days of filing, such modification shall be deemed approved. The director may promulgate rules and regulations exempting from the filing requirements of this section those items he deems unnecessary. Source: SL 1974, ch 321, §7.
SD Codified L § 58-41-23 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-23 - Composition of governing body--Consumer representation.

58-41-23. Composition of governing body--Consumer representation.The governing body of any health maintenance organization may include enrollees, providers, or other individuals. However, after a health maintenance organization has been authorized under this chapter for one year, at least twenty percent of the governing body of a health maintenance organization shall be composed of consumers. A consumer, is any person other than a person whose occupation involves the administration of health activities or the providing of health services. Source: SL 1974, ch 321, §§2 (9), 16; SL 1985, ch 393, §5; SL 2014, ch 244, §1.
SD Codified L § 58-41-24 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-24 - Mechanisms for enrollee participation in policy and operation of governing body.

58-41-24. Mechanisms for enrollee participation in policy and operation of governing body.The governing body shall establish a mechanism to afford the enrollees an opportunity to express their opinions in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms as may be prescribed or permitted by the director. Source: SL 1974, ch 321, §16; SL 2013, ch 256, §9.
SD Codified L § 58-41-25 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-25 - Fiduciary responsibilities to enrollees.

58-41-25. Fiduciary responsibilities to enrollees.Any director, officer, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of such organization shall be responsible for such funds in a fiduciary relationship to the enrollees. Source: SL 1974, ch 321, §17.
SD Codified L § 58-41-25.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-25.1 - Investments.

58-41-25.1. Investments.The funds of any corporation subject to the provisions of this chapter shall be invested only in securities permitted by the laws of this state for the investment of assets of life insurance companies. Source: SL 1985, ch 393, §14.
SD Codified L § 58-41-26 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-26 - Exemption from insurance laws--Exceptions--Taxation.

58-41-26. Exemption from insurance laws--Exceptions--Taxation.Any health maintenance organization is exempt from all provisions of the insurance laws of this state other than this chapter. However, the corporation is subject to the provisions of this title on matters and procedures of mergers and licensure of insurance producers. The corporation is also subject to fees and taxation as insurers under §58-2-29 and chapter 10-44. The corporation is also subject to §§58-17-53 and 58-17-54 if entering into a contract after July 1, 1990, with the State of South Dakota, counties, school districts, municipalities, and any other unit of state government using public funds. The state, however, may not collect premium taxes for insurance written on individuals residing outside this state or property located outside this state if no comparable tax is paid by the direct writing health maintenance organization to any appropriate taxing authority. Health maintenance organizations are also subject to the following chapters: 58-1, 58-2, 58-3, 58-4, 58-5, 58-5A, 58-6, 58-7, 58-11, 58-12, 58-14, 58-17, 58-17A, 58-17F, 58-17G, 58-17H, 58-17I, 58-18, 58-18A, 58-18B, 58-18C, 58-26, 58-27, 58-29B on the same basis as insurers, 58-30, 58-33A; and 58-43. Nothing in chapters 58-5 or 58-6 may be construed to prohibit a nonprofit health maintenance organization from transacting business under this title based upon its nonprofit status.To the extent that a health maintenance organization is compliant with the provisions of chapters 58-17F to 58-17I, inclusive, for purposes of network adequacy, quality assessment and improvements, utilization review and benefit determinations, and grievance procedure, the health maintenance organization is compliant with the provisions of this chapter. Source: SL 1974, ch 321, §51; SL 1985, ch 393, §8; SL 1990, ch 411; SL 2001, ch 286, §226; SL 2007, ch 293, §1; SL 2013, ch 256, §10; SL 2020, ch 210, § 13.
SD Codified L § 58-41-28 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-28 - Solicitation of enrollment not deemed professional advertising.

58-41-28. Solicitation of enrollment not deemed professional advertising.Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals. Source: SL 1974, ch 321, §52.
SD Codified L § 58-41-29 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-29 - Contracts and necessary activities.

58-41-29. Contracts and necessary activities.A health maintenance organization may enter into health maintenance contracts in this state and engage in any other activities consistent with this chapter which are necessary to the performance of its obligations under such contracts or authorize its representatives to do so. Source: SL 1974, ch 321, §12.
SD Codified L § 58-41-29.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-29.1 - Notice required for rate increase in health maintenance contract by a health maintenance organization.

58-41-29.1. Notice required for rate increase in health maintenance contract by a health maintenance organization.Forty-five days before a health maintenance contract rate increase is effective, the health maintenance organization shall notify the enrolling unit in writing that the contract rate for the health maintenance contract offered by the organization will be increased. Source: SL 1989, ch 434, §4.
SD Codified L § 58-41-30 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-30 - Sources of payment for enrollee services--Application by medical assistance recipient.

58-41-30. Sources of payment for enrollee services--Application by medical assistance recipient.Each health maintenance organization authorized to operate under this chapter or its representative, may accept from governmental agencies, private agencies, corporations, associations, groups, individuals, or other persons, payments covering all or part of the cost of health care service provided to enrollees. Any recipient of medical assistance, pursuant to Title 28, may make application to join a health maintenance organization which has been approved for medical assistance by the secretary of the Department of Social Services. Source: SL 1974, ch 321, §15.
SD Codified L § 58-41-31 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-31 - Direct payments to enrollees prohibited.

58-41-31. Direct payments to enrollees prohibited.No health maintenance organization or representative thereof may by a health maintenance contract or evidence of coverage provide for the reimbursement of an enrollee other than through a policy of insurance, except to refund payments made by or on behalf of an enrollee. Source: SL 1974, ch 321, §32 (4).
SD Codified L § 58-41-32 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-32 - Use of words descriptive of insurance, casualty, or surety business as misdemeanor--Exception.

58-41-32. Use of words descriptive of insurance, casualty, or surety business as misdemeanor--Exception.No health maintenance organization or representative thereof may use in its name, contracts, or literature any of the words "insurance," "casualty," "surety," "mutual," or any other words which are descriptive of the insurance, casualty, or surety business or deceptively similar to the name or description of any insurance or surety corporation doing business in this state; provided, however, that when a health maintenance organization has contracted with an insurance company for any coverage permitted by this chapter, it may so state. Violation of this section is a Class 2 misdemeanor. Source: SL 1974, ch 321, §§32 (3), 50; SDCL Supp, §58-41-77; SL 1978, ch 359, §2.
SD Codified L § 58-41-33 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-33 - Trade practice laws applicable.

58-41-33. Trade practice laws applicable.Each health maintenance organization, health maintenance contract, and evidence of coverage shall be subject to chapter 58-33, relating to the regulation of trade practices, except to the extent that the director determines that the nature of health maintenance organizations, health maintenance contracts, and evidences of coverage render such chapter clearly inappropriate. Source: SL 1974, ch 321, §33.
SD Codified L § 58-41-34 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-34 - Evidence of coverage issued to enrollees.

58-41-34. Evidence of coverage issued to enrollees.Every enrollee residing in this state is entitled to evidence of coverage under a health maintenance contract. The health maintenance organization or its designated representative shall issue the evidence of coverage. Source: SL 1974, ch 321, §18.
SD Codified L § 58-41-35 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 41 - Health Maintenance Organizations|Section 58-41-35 - Contents required in evidence of coverage.

58-41-35. Contents required in evidence of coverage.An evidence of coverage shall contain a clear, concise, and complete statement of:(1)The health care services and the insurance or other benefits, if any, to which the enrollee is entitled under the health care plan;(2)Any exclusions or limitations on the services, kind of services, benefits, or kind of benefits, to be provided, including any deductible or copayment feature;(3)Where and in what manner information is available as to how service, including emergency and out-of-area services, may be obtained;(4)The total amount of payment and copayment if any, for health care services and the indemnity or service benefits, if any, which the enrollee is obligated to pay with respect to individual contracts, or an indication whether the plan is contributory or noncontributory with respect to group certificates; and(5)A description of the health maintenance organization's method for resolving enrollee complaints. Source: SL 1974, ch 321, §19 (2).