reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers › Section 58-17D-1 - Definitions.

58-17D-1. Definitions.
Terms used in this chapter mean:
(1)"Utilization review," a review of health care services provided or to be provided to an individual to assist in the determination of the nature of the injury or condition, or the appropriateness of the treatment provided or to be provided;
(2)"Utilization review organization," any entity that provides utilization review services as defined in this chapter.
Source:
SL 2002, ch 231, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers › Section 58-17D-2 - Certain utilization review organizations exempt from managed health care provisions.

58-17D-2. Certain utilization review organizations exempt from managed health care provisions.
A utilization review organization that conducts utilization reviews solely for property and casualty insurers in this state pursuant to policies issued in this state is not subject to chapters 58-17F, 58-17G, 58-17H, and 58-17I except that any such utilization review organization shall register in the same manner as prescribed for utilization review organizations pursuant to §§58-17H-35 to 58-17H-39, inclusive. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub.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 2002, ch 231, §2; SL 2011, ch 219, §97.
Commission Note: SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub.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."
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers › Section 58-17D-3 - Property and casualty insurers to use registered utilization review organizations.

58-17D-3. Property and casualty insurers to use registered utilization review organizations.
Any property and casualty insurer seeking utilization review with respect to an insurance contract issued in this state may only use a utilization review organization registered pursuant to this chapter.
Source:
SL 2002, ch 231, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers › Section 58-17D-4 - Utilization review to be administered by qualified professional.

58-17D-4. Utilization review to be administered by qualified professional.
Any utilization review pursuant to this chapter shall be administered by a qualified licensed health care professional. Any adverse determination shall be evaluated by an appropriately licensed and clinically qualified health care professional. Any utilization review evaluation shall use generally accepted standards for treatment of the illness, injury, or condition reviewed. Any utilization review opinion shall be signed by the professional who performed the review.
Source:
SL 2002, ch 231, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers › Section 58-17D-5 - Certain basis for fees prohibited.

58-17D-5. Certain basis for fees prohibited.
No utilization review organization may base its fees or charges on any recommendation for reduction in payment under an insurance contract or on a percentage of claim savings.
Source:
SL 2002, ch 231, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers › Section 58-17D-6 - Insurer denying policyholder's claim to provide for reconsideration.

58-17D-6. Insurer denying policyholder's claim to provide for reconsideration.
An insurer that denies, in whole or in part, a policyholder's claim after consideration of a utilization review shall provide the policyholder with an opportunity to request reconsideration and to submit additional information relating to the claim.
Source:
SL 2002, ch 231, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17D - Standards For Utilization Review For Property And Casualty Insurers › Section 58-17D-7 - No cause of action created or abrogated.

58-17D-7. No cause of action created or abrogated.
Nothing in this chapter is intended to create or abrogate any cause of action as a result of a violation of the standards in this chapter.
Source:
SL 2002, ch 231, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-1 - Affiliate defined.

58-17E-1. Affiliate defined.
For the purposes of this chapter, the term, affiliate, means a person that directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the person specified. For the purposes of this section, the term, control, or controlled by, or under common control with, means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control is presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing ten percent or more of the voting securities of any other person. This presumption may be rebutted by a showing made in the manner provided by §58-5A-29.
Source:
SL 2006, ch 257, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-2 - Discount medical plan defined.

58-17E-2. Discount medical plan defined.
For the purposes of this chapter, the term, discount medical plan, means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, offers access for its members to providers of medical or ancillary services and the right to receive discounts on medical or ancillary services provided under the discount medical plan from those providers. The term includes a prescription drug discount plan.
The term does not include:
(1)A plan that does not charge a membership or other fee to use the discount medical plan;
(2)Any product otherwise regulated under Title 58;
(3)A patient access program; or
(4)A medicare prescription drug plan.
Source:
SL 2006, ch 257, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-3 - Discount prescription drug plan defined.

58-17E-3. Discount prescription drug plan defined.
For the purposes of this chapter, the term, discount prescription drug plan, means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration provides access for its plan members to providers of pharmacy services and the right to receive discounts on pharmacy services provided under the discount prescription drug plan from those providers.
Source:
SL 2006, ch 257, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-4 - Discount medical plan organization defined.

58-17E-4. Discount medical plan organization defined.
For the purposes of this chapter, discount medical plan organization, means an entity that, in exchange for fees, dues, charges, or other consideration, provides access for discount medical plan members to providers of medical or ancillary services and the right to receive medical or speciality services from those providers at a discount. It is the organization that contracts with providers, provider networks, or other discount medical plan organizations to offer access to medical or speciality services at a discount and determines the charge to discount medical plan members.
Source:
SL 2006, ch 257, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-5 - Definitions.

58-17E-5. Definitions.
Terms used in this chapter mean:
(1)"Ancillary services," includes audiology, dental, vision, mental health, substance abuse, chiropractic, and podiatry services;
(2)"Facility," an institution providing medical or ancillary services or a health care setting. The term includes:
(a)A hospital or other licensed inpatient center;
(b)An ambulatory surgical or treatment center;
(c)A skilled nursing center;
(d)A residential treatment center;
(e)A rehabilitation center; and
(f)A diagnostic, laboratory or imaging center;
(3)"Health care professional," a physician, pharmacist, or other health care practitioner who is licensed, accredited, or certified to perform specified medical or ancillary services within the scope of his or her license, accreditation, certification, or other appropriate authority consistent with state law;
(4)"Marketer," a person or entity that markets, promotes, sells, or distributes a discount medical plan, including a private label entity that places its name on and markets or distributes a discount medical plan pursuant to a marketing agreement with a discount medical plan organization;
(5)"Medical services," any maintenance care of, or preventive care for, the human body, or care, service, or treatment of an illness or dysfunction of, or injury to, the human body. The term includes physician care, inpatient care, hospital surgical services, emergency services, ambulance services, dental care services, vision care services, mental health services, substance abuse services, chiropractic services, podiatric services, laboratory services, medical equipment and supplies, pharmacy services or ancillary services;
(6)"Medicare prescription drug plan," a plan that provides Medicare Part D prescription drug benefit in accordance with the requirements of the federal Medicare Prescription Drug, Improvement and Modernization Act of 2003;
(7)"Member," any individual who pays fees, dues, charges, or other consideration for the right to receive the benefits of a discount medical plan. Member does not include any individual who enrolls in a patient access program;
(8)"Patient access program," a voluntary program sponsored by a pharmaceutical manufacturer or a consortium of pharmaceutical manufacturers, that provide free or discounted health care products directly to low-income or uninsured individuals either through a discount card or direct shipment;
(9)"Provider," any health care professional or facility that has contracted, directly or indirectly, with a discount medical plan organization to provide medical or ancillary services to members;
(10)"Provider network," an entity that negotiates directly or indirectly with a discount medical plan organization on behalf of more than one provider to provide medical or ancillary services to members.
Source:
SL 2006, ch 257, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-7 - Registration exception and compliance requirements for otherwise registered health carriers.

58-17E-7. Registration exception and compliance requirements for otherwise registered health carriers.
A discount medical plan organization that is a health carrier registered pursuant to Title 58:
(1)Is not required to register as a discount medical plan organization. However, any of its affiliates that operate as a discount medical plan organization in this state shall comply with all provisions of this chapter and shall register as a discount medical plan organization;
(2)Is required to comply with §§58-17E-24 to 58-17E-38, inclusive, 58-17E-40, and 58-17E-42 to 58-17E-44, inclusive.
Source:
SL 2006, ch 257, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-8 - Notification of director required where discount medical plan organization loses registration or is subject to disciplinary proceeding in another state.

58-17E-8. Notification of director required where discount medical plan organization loses registration or is subject to disciplinary proceeding in another state.
If a discount medical plan organization loses its registration, or other form of authority to operate as a discount medical plan organization in another state, or is the subject of any disciplinary administrative proceeding related to the organization's operating as a discount medical plan organization in another state, the discount medical plan organization shall immediately notify the director.
Source:
SL 2006, ch 257, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-9 - Registration of discount medical plan organization.

58-17E-9. Registration of discount medical plan organization.
Any discount medical plan organization that is not offered directly by a health carrier as provided by this chapter, shall register in a format as prescribed by the director and shall file reports and conduct business under the same standards as required of utilization review organizations in accordance with provisions of §§58-17H-36 and 58-17H-37. No health carrier may offer or provide coverage through a person not registered but required to be registered pursuant to §§58-17E-9, 58-17E-39, 58-17E-41, and 58-17E-45, inclusive. Any plan or program that is registered pursuant to §58-17F-16 is not required to maintain a separate registration pursuant to §§58-17E-9, 58-17E-39, 58-17E-41, and 58-17E-45, inclusive. Any plan or program of discounted goods or services that is offered by a health carrier in conjunction with a health benefit plan, as defined in §§58-18-42 and 58-17-66(9), a Medicare supplement policy as defined in §58-17A-1, or other insurance product that is offered by an authorized insurer and that is subject to the jurisdiction of the director is not required to be registered pursuant to §§58-17E-9, 58-17E-39, 58-17E-41, and 58-17E-45, inclusive.
Source: SL 2005, ch 269, §1; SDCL §58-17C-104; SL 2006, ch 257, §44; SL 2011, ch 219, §98.
Commission Note: SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed 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."
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-10 - Review of application.

58-17E-10. Review of application.
After the receipt of an application filed pursuant to §58-17E-9, the director shall review the application and notify the applicant of any deficiencies in the application.
Source:
SL 2006, ch 257, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-11 - Internet website to be established.

58-17E-11. Internet website to be established.
Prior to registration by the director, each discount medical plan organization shall establish an internet website in order to conform to the requirements of §58-17E-31.
Source:
SL 2006, ch 257, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-12 - Duration of registration--Renewal applications.

58-17E-12. Duration of registration--Renewal applications.
Any registration is effective for one year, unless prior to its expiration the registration is renewed in accordance with this section or suspended or revoked in accordance with §58-17E-14. At least forty-five days before a registration expires, the discount medical plan organization shall submit a renewal application form.
Source:
SL 2006, ch 257, §11; SL 2008, ch 265, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-14 - Nonrenewal, suspension, or revocation of registration.

58-17E-14. Nonrenewal, suspension, or revocation of registration.
The director may suspend the authority of a discount medical plan organization to enroll new members or refuse to renew or revoke a discount medical plan organization's registration if the director finds that any of the following conditions exist:
(1)The discount medical plan organization is not operating in compliance with this chapter;
(2)The discount medical plan organization has advertised, merchandised, or attempted to merchandise its services in such a manner as to misrepresent its services or capacity for service or has engaged in deceptive, misleading, or unfair practices with respect to advertising or merchandising;
(3)The discount medical plan organization is not fulfilling its obligations as a discount medical plan organization; or
(4)The continued operation of the discount medical plan organization would be hazardous to its members.
Source:
SL 2006, ch 257, §13.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-15 - Notice of grounds for nonrenewal, suspension, or revocation--Hearing.

58-17E-15. Notice of grounds for nonrenewal, suspension, or revocation--Hearing.
If the director has cause to believe that grounds for the nonrenewal, suspension, or revocation of a registration exists, the director shall notify the discount medical plan organization in writing specifically stating the grounds for the refusal to renew or suspension or revocation and may pursue a hearing on the matter in accordance with the provisions of the chapter 1-26.
Source:
SL 2006, ch 257, §14.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-16 - Winding up of affairs.

58-17E-16. Winding up of affairs.
If the registration of a discount medical plan organization is surrendered, revoked, or not renewed, the discount medical plan organization shall proceed, immediately following the effective date of the order of revocation or, in the case of a nonrenewal, the date of expiration of the registration, to wind up its affairs transacted under the registration. The discount medical plan organization may not engage in any further advertising, solicitation, collecting of fees or renewal of contracts.
Source:
SL 2006, ch 257, §15.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-17 - Duration of suspension--Conditions for reinstatement.

58-17E-17. Duration of suspension--Conditions for reinstatement.
The director shall, in its order suspending the authority of the discount medical plan organization to enroll new members, specify the period during which the suspension is to be in effect and the conditions, if any, that shall be met by the discount medical plan organization prior to reinstatement of its registration to enroll members. The director may rescind or modify the order of suspension prior to the expiration of the suspension period. No registration of a discount medical plan organization may be reinstated unless requested by the discount medical plan organization. The director may not grant the request for reinstatement if the director finds that the circumstances for which the suspension occurred still exist or are likely to recur.
Source:
SL 2006, ch 257, §16.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-18 - Consent orders.

58-17E-18. Consent orders.
In lieu of suspending or revoking a discount medical plan organization's registration pursuant to §58-17E-14, if the discount medical plan organization has been found to have violated any provision of this chapter, the director may enter into a consent order pursuant to §58-4-28.1.
Source:
SL 2006, ch 257, §17.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-19 - Registration exception for providers giving discounts to own patients.

58-17E-19. Registration exception for providers giving discounts to own patients.
A provider who provides discounts to the provider's own patients without any cost or fee of any kind to the patient is not required to obtain and maintain a registration under this chapter as a discount medical plan organization.
Source:
SL 2006, ch 257, §18.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-20 - Surety bond.

58-17E-20. Surety bond.
Each registered discount medical plan organization shall maintain in force a surety bond in its own name in an amount not less than twenty thousand dollars and shall be in favor of any person and the director of the Division of Insurance for the benefit of any person who is damaged by any violation of §§58-17E-9, 58-17E-39, 58-17E-41, and 58-17E-45, inclusive, including any violation by the supplier or by any other person that markets, promotes, advertises, or otherwise distributes a discount card on behalf of the supplier. The bond shall cover any violation occurring during the time period during which the bond is in effect. The bond shall be issued by an insurance company licensed to do business in this state. A copy of the bond or a statement identifying the depository, trustee, and account number of the surety account, and thereafter proof of annual renewal of the bond or maintenance of the surety account, shall be filed with the director.
Source:
SL 2006, ch 257, §20.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-21 - Deposit in lieu of surety bond.

58-17E-21. Deposit in lieu of surety bond.
In lieu of the bond required by §58-17E-20, a registered discount medical plan organization may deposit and maintain deposited with the director, or at the discretion of the director, with any organization or trustee acceptable to the director through which a custodial or controlled account is utilized, cash, securities, or any combination of these or other measures that are acceptable to the director which at all times have a market value of not less than thirty-five thousand dollars. All income from the deposit is an asset of the discount medical plan organization.
Source:
SL 2006, ch 257, §21.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-22 - Surety bonds and deposits not subject to levy by claimants.

58-17E-22. Surety bonds and deposits not subject to levy by claimants.
Except for the director, the assets or securities held in this state as a deposit pursuant to §§58-17E-20 and 58-17E-21 are not subject to levy by a judgment creditor or other claimant of the discount medical plan organization.
Source:
SL 2006, ch 257, §22.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-23 - Examination or investigation of discount medical organization--Expenses.

58-17E-23. Examination or investigation of discount medical organization--Expenses.
The director may examine or investigate the business and affairs of any discount medical plan organization to protect the interests of the residents of this state based on the following reasons, including complaint indices, recent complaints, information from other states, or as the director deems necessary. An examination or investigation shall be performed in accordance with the provisions of chapter 58-3. The discount medical plan organization that is the subject of the examination or investigation shall pay the expenses incurred in conducting the examination or investigation. Failure by the discount medical plan organization to pay the expenses is grounds for denial of a registration to operate as a discount medical plan organization or revocation of a registration to operate as a discount medical plan organization.
The discount medical plan organization is subject to the provisions of §58-33-66.
Source:
SL 2006, ch 257, §23.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-24 - Pro rata reimbursement of charges upon cancellation of membership.

58-17E-24. Pro rata reimbursement of charges upon cancellation of membership.
If the discount medical plan organization cancels a membership for any reason other than nonpayment of fees by the member, the discount medical plan organization shall make a pro rata reimbursement of all periodic charges to the member.
Source:
SL 2006, ch 257, §24.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-25 - Written materials on member benefits.

58-17E-25. Written materials on member benefits.
A discount medical plan organization shall prepare written materials for its members that specifies the benefits a member is to receive under the discount medical plan and that complies with §§58-17E-38, 58-17E-40, and 58-17E-42 to 58-17E-44, inclusive.
Source:
SL 2006, ch 257, §25.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-26 - Services to be provided in accordance with written agreement.

58-17E-26. Services to be provided in accordance with written agreement.
Any provider offering medical or ancillary services to members shall provide the services in accordance with a written agreement entered into directly by the provider or indirectly by a provider network to which the provider belongs.
Source:
SL 2006, ch 257, §26.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-27 - Contents of provider agreement.

58-17E-27. Contents of provider agreement.
A provider agreement between a discount medical plan organization and a provider shall provide the following:
(1)A list of the medical or ancillary services and products to be provided at a discount;
(2)The amount or amounts of the discounts or, alternatively, a fee schedule that reflects the provider's discounted rates; and
(3)That the provider will not charge members more than the discounted rates.
Source:
SL 2006, ch 257, §27.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-28 - Contents of provider network agreement.

58-17E-28. Contents of provider network agreement.
A provider agreement between a discount medical plan organization and a provider network shall require that the provider network have written agreements with its providers that:
(1)Contain the provisions described in §58-17E-27;
(2)Authorize the provider network to contract with the discount medical plan organization on behalf of the provider; and
(3)Require the provider network to maintain an up-to-date list of its contracted providers and to provide the list on a monthly basis to the discount medical plan organization.
Source:
SL 2006, ch 257, §28.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-29 - Agreements with entity contracting with provider network.

58-17E-29. Agreements with entity contracting with provider network.
A provider agreement between a discount medical plan organization and an entity that contracts with a provider network shall require that the entity, in its contracts with the provider network, require the provider network to have written agreements with its providers that comply with the provisions of §58-17E-28.
Source:
SL 2006, ch 257, §29.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-31 - Internet website requirements.

58-17E-31. Internet website requirements.
Each discount medical plan organization shall maintain on an internet website page an up-to-date list of the names and addresses of the providers with which it has contracted directly or through a provider network. The internet website address shall be prominently displayed on all of its advertisements, marketing materials, brochures, and discount medical plan cards.
Source:
SL 2006, ch 257, §31.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-32 - Application of provider agreement requirements.

58-17E-32. Application of provider agreement requirements.
The provisions of §§58-17E-26 to 58-17E-31, inclusive, apply to those providers with which the discount medical plan organization has contracted with directly or indirectly as well as those providers that are members of a provider network with which the discount medical plan organization has contracted directly or indirectly.
Source:
SL 2006, ch 257, §32.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-33 - Marketing of product--Agreement.

58-17E-33. Marketing of product--Agreement.
A discount medical plan organization may market directly or contract with other marketers for the distribution of its product. The discount medical plan organization shall have an executed written agreement with a marketer prior to the marketer's marketing, promoting, selling, or distributing the discount medical plan.
Source:
SL 2006, ch 257, §33.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-34 - Contents of marketing agreement.

58-17E-34. Contents of marketing agreement.
The agreement between the discount medical plan organization and the marketer shall prohibit the marketer from using advertising, marketing materials, brochures, and discount medical plan cards without the discount medical plan organization's approval in writing.
Source:
SL 2006, ch 257, §34.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-35 - Liability for conduct of marketer.

58-17E-35. Liability for conduct of marketer.
The discount medical plan organization shall be bound by and is responsible for the activities of a marketer that are within the scope of the marketer's contract with the organization, or are otherwise approved by or under the direction and control of the organization.
Source:
SL 2006, ch 257, §35.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-36 - Approval of advertisements and marketing materials.

58-17E-36. Approval of advertisements and marketing materials.
A discount medical plan organization shall approve in writing any advertisement, marketing material, brochure, or discount card used by marketers to market, promote, sell, or distribute the discount medical plan prior to their use.
Source:
SL 2006, ch 257, §36.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-37 - Submission of advertising and marketing materials to director.

58-17E-37. Submission of advertising and marketing materials to director.
Upon request, a discount medical plan organization shall submit to the director any advertising, marketing material, or brochure regarding a discount medical plan.
Source:
SL 2006, ch 257, §37.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-38 - Advertisements to be truthful and not misleading.

58-17E-38. Advertisements to be truthful and not misleading.
Any advertisement of a discount medical plan organization shall be truthful and not misleading in fact or in implication. An advertisement is misleading if it has a capacity or tendency to mislead or deceive based on the overall impression that the advertisement is reasonably expected to create within the segment of the public to which it is directed.
Source:
SL 2006, ch 257, §38.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-39 - Disclosure that product is not insurance--Advertisements--Rules--Revocation of registration--Agents.

58-17E-39. Disclosure that product is not insurance--Advertisements--Rules--Revocation of registration--Agents.
Any person subject to registration pursuant to §58-17E-9 shall prominently and boldly disclose that the product is not insurance. Any advertisements or solicitations made by such a person are subject to the provisions of §§58-33A-2 to 58-33A-4, inclusive, and §§58-33A-7 to 58-33A-8, inclusive, and §§58-33A-10 to 58-33A-12, inclusive. Any administrative rule promulgated pursuant to §58-33A-7 does not apply to those registered pursuant to the provisions of §§58-17E-9, 58-17E-39, 58-17E-41, and 58-17E-45, inclusive, unless specifically referenced in the rule. If any person fails to comply with these provisions or the provisions of §§58-17E-9, 58-17E-39, 58-17E-41, and 58-17E-45, inclusive, the director may issue an order to cease and desist pursuant to the provisions of chapter 58-4 and may revoke the registration. Any such action by the director is subject to notice and hearing as provided pursuant to chapter 1-26 and §58-4-7. A person acting as an agent as defined in chapter 58-30 who sells, solicits, or negotiates a plan or program containing insurance benefits shall meet the licensing and appointment requirements of that chapter if the person is otherwise required to be licensed pursuant to the provisions of chapter 58-30.
Source:
SL 2005, ch 269, §2; SDCL §58-17C-105; SL 2015, ch 260, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-40 - Prohibited conduct.

58-17E-40. Prohibited conduct.
No discount medical plan organization may:
(1)Except as otherwise provided in this chapter or as a disclaimer of any relationship between discount medical plan benefits and insurance, or as a description of an insurance product connected with a discount medical plan, use the term, insurance, in any advertisement, marketing material, brochure, or discount medical plan cards;
(2)Use in any advertisement, marketing material, brochure, or discount medical plan card, the terms, health plan, coverage, co-pay, co-payments, deductible, preexisting conditions, guaranteed issue, premium, PPO, preferred provider organization, or other term in a manner that could reasonably mislead an individual into believing that the discount medical plan is health insurance;
(3)Use language in any advertisement, marketing material, brochure, or discount medical plan card with respect to being licensed or registered by the Division of Insurance in a manner that could reasonably mislead an individual into believing that the discount medical plan is insurance or has been endorsed by the state;
(4)Make misleading, deceptive, or fraudulent representations regarding the discount or range of discounts offered by the discount medical plan or the access to any range of discounts offered by the discount medical plan;
(5)Have restrictions on access to discount medical plan providers, including, except for hospital services, waiting periods and notification periods; or
(6)Pay providers any fees for medical or ancillary services or collect or accept money from a member to pay a provider for medical or ancillary services provided under the discount medical plan, unless the discount medical plan organization has an active certificate of authority to act as a third party administrator in accordance with chapter 58-29D.
Source:
SL 2006, ch 257, §39.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-42 - Disclosures required for telephone contacts.

58-17E-42. Disclosures required for telephone contacts.
If the initial contact with a prospective member is by telephone, the disclosures required by §58-17E-41 shall be made orally and included in the initial written materials that describe the benefits under the discount medical plan provided to the prospective or new member.
Source:
SL 2006, ch 257, §40.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-43 - Member to be provided written copy of terms of plan.

58-17E-43. Member to be provided written copy of terms of plan.
In addition to the general disclosures required by §58-17E-41, each discount medical plan organization shall provide to each new member a copy of the terms of the discount medical plan in written materials.
Source:
SL 2006, ch 257, §41.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-44 - Contents of written materials.

58-17E-44. Contents of written materials.
The written materials required under this chapter shall be clear and include information on:
(1)The name of the member;
(2)The benefits to be provided under the discount medical plan;
(3)Any processing fees and periodic charges associated with the discount medical plan;
(4)The mode of payment of any processing fees and periodic charges, such as monthly, quarterly, or otherwise, and procedures for changing the mode of payment;
(5)Any limitations, exclusions, or exceptions regarding the receipt of discount medical plan benefits;
(6)Any waiting periods for certain medical or ancillary services under the discount medical plan;
(7)Procedures for obtaining discounts under the discount medical plan, such as requiring members to contact the discount medical plan organization to make an appointment with a provider on the member's behalf;
(8)Cancellation procedures, including information on the member's thirty-day cancellation rights and refund requirements and procedures for obtaining refunds;
(9)Renewal, termination, and cancellation terms and conditions;
(10)Procedures for adding new members to a family discount medical plan, if applicable;
(11)Procedures for filing complaints under the discount medical plan organization's complaint system and information that, if the member remains dissatisfied after completing the organization's complaint system, the plan member may contact the local insurance department in the member's state; and
(12)The name and mailing address of the registered discount medical plan organization or other entity where the member can make inquiries about the plan, send cancellation notices, and file complaints.
Source:
SL 2006, ch 257, §42.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-45 - Consumer's right to return plan or program--Refund.

58-17E-45. Consumer's right to return plan or program--Refund.
Any plan or program offered by a person subject to registration pursuant to §58-17E-9 shall provide thirty days from the date of the signed consumer contract or agreement, or thirty days from the receipt of the disclosures required by §58-17E-41 if the consumer purchased the plan or program over the telephone, in which the consumer may return the plan or program to the person or agent through whom it was purchased and have all costs of the plan or program, excluding a nominal processing fee as prescribed by the director by rules promulgated pursuant to chapter 1-26, refunded in full.
Source:
SL 2005, ch 269, §4; SDCL, §58-17C-107.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17E - Discount Medical Plans › Section 58-17E-46 - Notice to director of change in plan.

58-17E-46. Notice to director of change in plan.
Each discount medical plan organization shall provide the director at least thirty days advance notice of any change in the discount medical plan organization's name, principal business address, mailing address, or internet website address.
Source:
SL 2006, ch 257, §43.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17F - Network Adequacy Standards › Section 58-17F-3 - Medical director required for managed care plans.

58-17F-3. Medical director required for managed care plans.
Any managed care plan shall provide for the appointment of a medical director who has an unrestricted license to practice medicine. However, a managed care plan that specializes in a specific healing art shall provide for the appointment of a director who has an unrestricted license to practice in that healing art. The director is responsible for oversight of treatment policies, protocols, quality assurance activities, and utilization management decisions of the managed care plan.
Source: SL 2011, ch 219, §3.
Commission Note: SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed 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."
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17F - Network Adequacy Standards › Section 58-17F-5 - Health carrier to maintain provider network sufficient to assure services without unreasonable delay--Emergency services--Determination of sufficiency.

58-17F-5. Health carrier to maintain provider network sufficient to assure services without unreasonable delay--Emergency services--Determination of sufficiency.
A health carrier providing a managed care plan shall maintain a network that is sufficient in numbers and types of providers to assure that all services to covered persons will be accessible without unreasonable delay. In the case of emergency services, covered persons shall have access twenty-four hours a day, seven days a week. Sufficiency shall be determined in accordance with the requirements of this section, and may be established by reference to any reasonable criteria used by the carrier, including: provider-covered person ratios by specialty; primary care provider-covered person ratios; geographic accessibility; waiting times for appointments with participating providers; hours of operation; and the volume of technological and specialty services available to serve the needs of covered persons requiring technologically advanced or specialty care.
Source: SL 2011, ch 219, §5.
Commission Note: SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed 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."
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17F - Network Adequacy Standards › Section 58-17F-6 - Where provider network is insufficient, covered benefit to be made available at no greater cost.

58-17F-6. Where provider network is insufficient, covered benefit to be made available at no greater cost.
In any case where the health carrier has an insufficient number or type of participating provider to provide a covered benefit, the health carrier shall ensure that the covered person obtains the covered benefit at no greater cost to the covered person than if the benefit were obtained from participating providers, or shall make other arrangements acceptable to the director.
Source: SL 2011, ch 219, §6.
Commission Note: SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed 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."
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17F - Network Adequacy Standards › Section 58-17F-7 - Health carrier to ensure provider proximity to covered persons.

58-17F-7. Health carrier to ensure provider proximity to covered persons.
The health carrier shall establish and maintain adequate arrangements to ensure reasonable proximity of participating providers to the business or personal residence of covered persons.
Source: SL 2011, ch 219, §7.
Commission Note: SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed 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."
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17F - Network Adequacy Standards › Section 58-17F-8 - Health carrier to monitor provider ability, capacity, and authority--Financial capability to be monitored in capitated plans.

58-17F-8. Health carrier to monitor provider ability, capacity, and authority--Financial capability to be monitored in capitated plans.
The health carrier shall monitor, on an ongoing basis, the ability, clinical capacity, and legal authority of its providers to furnish all contracted benefits to covered persons. In the case of capitated plans, the health carrier shall also monitor the financial capability of the provider.
Source: SL 2011, ch 219, §8.
Commission Note: SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed 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."
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17F - Network Adequacy Standards › Section 58-17F-9 - Factors to consider in determining network adequacy.

58-17F-9. Factors to consider in determining network adequacy.
In determining whether a health carrier has complied with any network adequacy provision of this chapter, the director shall give due consideration to the relative availability of healthcare providers in the service area and to the willingness of providers to join a network.
Source: SL 2011, ch 219, §9.
Commission Note: SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed 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."