reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-28 - Examination of domestic, foreign, and alien societies--Requirements--Responsibility for expenses--Report of examination.

58-37A-28. Examination of domestic, foreign, and alien societies--Requirements--Responsibility for expenses--Report of examination.
The director, or any person appointed by the director, may examine any domestic, foreign, or alien society transacting or applying for admission to transact business in this state in the same manner as authorized for examination of domestic, foreign, or alien insurers. Requirements of notice and an opportunity to respond before findings are made public as provided in the laws regulating insurers are also applicable to the examination of societies.
The expense of each examination and of each valuation, including compensation and actual expense of examiners, shall be paid by the society examined or whose certificates are valued, upon statements furnished by the director.
A summary of the report of the director and the recommendations or statements of the director that accompany the report, shall be read at the first meeting of the board of directors or corresponding body of the society following their receipt, and if directed by the director, shall also be read at the first meeting of the supreme legislative or governing body of the society following their receipt. A copy of the report, recommendations, and statements of the director shall be furnished by the society to each member of the board of directors or other governing body.
Source:
SL 1990, ch 410, §28.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-29 - Foreign or alien society--Qualifications and procedure for admission to transact business in state.

58-37A-29. Foreign or alien society--Qualifications and procedure for admission to transact business in state.
It is a Class 2 misdemeanor for any foreign or alien society to transact business in this state without a license issued by the director. Any foreign or alien society desiring admission to this state shall have the qualifications required of domestic societies organized under this chapter. Any foreign or alien society may be licensed to transact business in this state upon filing with the director:
(1)A duly certified copy of its articles of incorporation;
(2)A copy of its bylaws, certified by its secretary or corresponding officer;
(3)A power of attorney to the director as prescribed in §58-37A-35;
(4)A statement of its business under oath of its president and secretary or corresponding officers in a form prescribed by the director, verified by an examination made by the supervising insurance official of its home state or other state, territory, province, or country, satisfactory to the director;
(5)Certification from the proper official of its home state, territory, province, or country that the society is legally incorporated and licensed to transact business;
(6)Copies of its certificate forms; and
(7)Any other information as the director considers necessary;
and upon a showing that its assets are invested in accordance with the provisions of this chapter.
Source:
SL 1990, ch 410, §29.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-33 - Insurance producers--When license is required.

58-37A-33. Insurance producers--When license is required.
Any insurance producer of a society shall be licensed in accordance with the provisions of chapter 58-30 regulating the licensing, revocation, suspension, or termination of license of resident and nonresident insurance producers.
Source:
SL 1990, ch 410, §33; SL 2001, ch 286, §218.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-34 - Applicability of unfair trade prohibitions--Determination of membership requirements and to whom benefits offered.

58-37A-34. Applicability of unfair trade prohibitions--Determination of membership requirements and to whom benefits offered.
Any society and insurance producer authorized to do business in this state is subject to the provisions of chapter 58-33 relating to unfair trade practices. However, nothing in these provisions may be construed as applying to or affecting the right of any society to determine its eligibility requirements for membership or be construed as applying to or affecting the offering of benefits exclusively to members or persons eligible for membership in the society by a subsidiary corporation or affiliated organization of the society.
Source:
SL 1990, ch 410, §34; SL 2001, ch 286, §219.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-35 - Appointment of director as attorney for service of process--Copy forwarded to secretary of society--Time for filing answer--Fee paid by plaintiff.

58-37A-35. Appointment of director as attorney for service of process--Copy forwarded to secretary of society--Time for filing answer--Fee paid by plaintiff.
Any society authorized to do business in this state shall appoint in writing the director to be its attorney upon whom all lawful process in any action or proceeding against it may be served and shall agree in writing that any lawful process against it which is served on the attorney shall be of the same legal force and validity as if served upon the society and that the authority shall continue in force so long as any liability remains outstanding in this state. Copies of this appointment, certified by the director, are sufficient evidence of it and shall be admitted in evidence with the same force and effect as the original was admitted.
Service shall only be made upon the director, or if absent, upon the person in charge of the director's office. It shall be made in duplicate and shall constitute sufficient service upon the society. If legal process against a society is served upon the director, the director shall immediately forward one of the duplicate copies by registered mail, prepaid, directed to the secretary or corresponding officer. No service may require a society to file its answer, pleading, or defense in less than thirty days from the date of mailing the copy of the service to a society. No legal process may be served upon a society except in the manner provided in this section. At the time of serving any process upon the director, the plaintiff, or complainant in the action shall pay to the director a fee as set forth in subsection 58-2-29(12)(c).
Source:
SL 1990, ch 410, §35.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-36 - Fraudulent statements, and soliciting membership in unlicensed societies as crimes.

58-37A-36. Fraudulent statements, and soliciting membership in unlicensed societies as crimes.
No person may knowingly make any false or fraudulent statement or representation in or with reference to any application for membership or for the purpose of obtaining money from or a benefit in any society. A violation of this provision is a Class 2 misdemeanor.
Any person who willfully makes a false or fraudulent statement in any verified report or declaration under oath required or authorized by this chapter or of any material fact or thing contained in a sworn statement concerning the death or disability of an insured for the purpose of procuring payment of a benefit named in the certificate is guilty of perjury.
No person may solicit membership for, or in any manner assist in procuring membership in, any society not licensed to do business in this state. A violation of this provision is a Class 2 misdemeanor.
Source:
SL 1990, ch 410, §36.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-37 - Judicial review of actions of director.

58-37A-37. Judicial review of actions of director.
All decisions and findings of the director made under the provisions of this chapter are subject to review by proper proceedings in any court of competent jurisdiction in this state.
Source:
SL 1990, ch 410, §37.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-38 - Exempt societies--Allowance of compensation for procuring new members prohibited--Director to determine exemption--Exempt societies not subject to insurance laws.

58-37A-38. Exempt societies--Allowance of compensation for procuring new members prohibited--Director to determine exemption--Exempt societies not subject to insurance laws.
Nothing contained in this chapter may be construed as to apply to:
(1)Grand or subordinate lodges of societies, orders, or associations now doing business in this state which provide benefits exclusively through local or subordinate lodges;
(2)Orders, societies, or associations which admit to membership only persons engaged in crafts or hazardous occupations, in the same or similar lines of business, insuring only their own members and their families, and the ladies' societies or ladies' auxiliaries to these orders, societies, or associations;
(3)Domestic societies which limit their membership to employees of a particular municipality, designated firm, business house, or corporation which provide for a death benefit of not more than four hundred dollars or disability benefits of not more than three hundred fifty dollars to any person in any one year, or both; or
(4)Domestic societies or associations of a purely religious, charitable, or benevolent description, which provide for a death benefit of not more than four hundred dollars or for disability benefits of not more than three hundred fifty dollars to any one person in any one year, or both.
Any such society or association described in subdivision (3) or (4) of this section which provides for death or disability benefits for which benefit certificates are issued, and any such society or association included in subdivision (4) of this section which has more than one thousand members, is not exempt from the provisions of this chapter.
No society which, by the provisions of this section, is exempt from the requirements of this chapter, except any society described in subdivision (2) of this section may give or allow, or promise to give or allow, to any person any compensation for procuring new members.
Every society which provides for benefits in case of death or disability resulting solely from accident and which does not obligate itself to pay natural death or sick benefits has all of the privileges and is subject to the provisions of this chapter. However, the provisions of this chapter relating to medical examination, valuations of benefit certificates and incontestability, do not apply to that society.
The director may require from any society or association, by examination or otherwise, the information that will enable the director to determine whether the society or association is exempt from the provisions of this chapter.
Any society, exempt under the provisions of this section, is also exempt from all other provisions of the insurance laws of this state.
Source:
SL 1990, ch 410, §38; SL 1992, ch 60, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-38.1 - Inapplicability of subdivision 58-37A-38(2) to certain societies, orders, and associations.

58-37A-38.1. Inapplicability of subdivision 58-37A-38(2) to certain societies, orders, and associations.
The provisions of subdivision 58-37A-38(2) do not apply to any society, order, or association which had a certificate of authority in this state as of July 1, 2006, nor to any society, order, or association which is formed on or after July 1, 2007. Any society, order or association not exempt pursuant to the provisions of this section shall hold a certificate of authority in this state.
Source:
SL 2007, ch 55, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 37A - Fraternal Benefit Societies › Section 58-37A-39 - Application of other provisions.

58-37A-39. Application of other provisions.
In addition to the provisions contained in this chapter, the following chapters and provisions of the South Dakota Code also apply to fraternal benefit societies, to the extent applicable and not in conflict with the express provisions of this chapter and the reasonable implications of this chapter:
(1)Chapter 47-6;
(2)Chapter 58-1;
(3)Chapter 58-2, with the exception of §58-2-29;
(4)Chapter 58-3;
(5)Chapter 58-4;
(6)Chapter 58-5;
(7)Sections 58-6-8, 58-6-46, and 58-6-47;
(8)Chapters 58-15, 58-17, 58-17A, 58-17B, and 58-18;
(9)Chapter 58-29B;
(10)Chapter 58-30;
(11)Chapter 58-33;
(12)Chapters 58-17F, 58-17G, 58-17H, 58-17I, and 58-33A. (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 1990, ch 410, §39; SL 2001, ch 289, §1; SL 2003, ch 256, §1; SL 2011, ch 219, §100.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-1 - Incorporators, number required--Purpose of incorporation.

58-38-1. Incorporators, number required--Purpose of incorporation.
Five or more natural persons of full age and of either sex, all of whom are residents of this state and citizens of the United States, may form, under the provisions of the laws of this state relating to corporations, so far as those provisions are applicable and are not inconsistent with the provisions of this chapter, a nonprofit medical and surgical service plan corporation for the purpose of establishing, maintaining, and operating a nonprofit medical and surgical plan, whereby medical and surgical service may be provided at the expense of said corporation by duly licensed physicians and surgeons, to such of the public as become subscribers to said corporation under a contract which entitles each subscriber to medical and professional care. Such corporation shall be governed by this chapter and shall be subject to regulation and supervision by the director as hereinafter provided.
Source:
SL 1966, ch 111, ch 21, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-2 - "Physicians and surgeons" defined.

58-38-2. Physicians and surgeons defined.
The words "physicians and surgeons" as used in this chapter shall include all those persons who are licensed pursuant to chapters 36-4, 36-4A, and 36-9A.
Source:
SL 1966, ch 111, ch 21, §12; SL 1980, ch 355, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-3 - Articles of incorporation and amendments--Approval by director--Filing with secretary of state.

58-38-3. Articles of incorporation and amendments--Approval by director--Filing with secretary of state.
The articles of incorporation of every such corporation, and amendments thereto, shall be submitted to the director, whose approval thereof shall be endorsed thereon before the same are filed with the secretary of state; provided, however, that if the articles of incorporation of any such corporation shall have been filed with the secretary of state prior to July 1, 1966, the approval thereof by the director shall be evidenced by a separate instrument in writing filed with the secretary of state.
Source:
SL 1966, ch 111, ch 21, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-4 - Members and directors.

58-38-4. Members and directors.
A medical and surgical plan corporation shall consist of a board of directors and of such members, grouped in such classes, as the bylaws of the corporation shall provide.
Source:
SL 1966, ch 111, ch 21, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-5 - Board of directors--Minimum number--Qualifications--Selection--Term of office.

58-38-5. Board of directors--Minimum number--Qualifications--Selection--Term of office.
The business of a medical and surgical plan corporation shall be managed by a board of directors of at least five persons possessing the same general qualifications as the incorporators and they shall be selected, and their number fixed, in the manner set out in the bylaws for three-year terms. At least a majority of the directors of said corporation must be at all times physicians or surgeons who have contracted, or may contract with such corporation to render to its subscribers medical or surgical service.
Source:
SL 1966, ch 111, ch 21, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-6 - License to issue contracts required--Violation as misdemeanor.

58-38-6. License to issue contracts required--Violation as misdemeanor.
A corporation subject to the provisions of this chapter may issue contracts only when the director has by formal license authorized it to do so. Violation of this section is a Class 2 misdemeanor.
Source:
SL 1966, ch 111, ch 21, §6; SL 1978, ch 359, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-7 - Application for license--Form and contents--Documents accompanying.

58-38-7. Application for license--Form and contents--Documents accompanying.
Application for the license required by §58-38-6 shall be made on forms to be approved by the director, containing such information as he shall deem necessary. Each application for such license shall be accompanied by copies of the following documents:
(1)Certified copy of its charter or certificate of incorporation;
(2)Bylaws;
(3)Proposed contracts between the corporation and participating physicians and surgeons showing the terms under which medical and surgical service is to be furnished to subscribers;
(4)Contracts to be issued to subscribers showing the benefits to which they are entitled;
(5)A table of the rates to be charged to the subscribers; and
(6)Financial statement of the corporation, including the amounts of contribution paid or agreed to be paid to the corporation for working capital and the name of each contributor and the terms of each contribution.
Source:
SL 1966, ch 111, ch 21, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-8 - Issuance of license--Matters considered by director.

58-38-8. Issuance of license--Matters considered by director.
The director shall issue a license upon being satisfied on the following points:
(1)That the applicant is established as a bona fide nonprofit medical and surgical service corporation;
(2)That the contracts between the applicant and the participating physicians and surgeons obligate each physician and surgeon to render service to which each subscriber may be entitled under the contract issued to the subscribers;
(3)That the rates to be charged and benefits to be provided are fair and reasonable;
(4)That amounts provided as working capital of the corporation are repayable only out of earned income over and above operating expenses, physicians and surgeons expenses, and such reserve as the director may deem adequate; and
(5)That the amount of money actually available for working capital be sufficient to carry all acquisition costs and operating expenses for a reasonable period of time from the date of the issuance of the certificate.
Source:
SL 1966, ch 111, ch 21, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-9 - Contracts with subscribers.

58-38-9. Contracts with subscribers.
Any medical and surgical plan corporation, organized under the provisions of this chapter, may enter into contracts with subscribers to furnish medical and surgical service through physicians and surgeons. The medical and surgical plan operated by such corporation shall also provide for such service to subscribers by the physician and surgeon chosen by the subscriber without regard to whether such physician and surgeon has a contract for service with such corporation.
Source:
SL 1966, ch 111, ch 21, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-10 - Rates charged for services--Approval by director.

58-38-10. Rates charged for services--Approval by director.
The rates charged by any medical and surgical plan corporation to the subscriber for medical and surgical service shall at all times be subject to the approval of the director. The contracts by any such corporation with the subscribers for medical and surgical service shall at all times be subject to the approval of the director.
Source:
SL 1966, ch 111, ch 21, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-11 - Contracts with subscribers--Required provisions.

58-38-11. Contracts with subscribers--Required provisions.
The contracts by any medical and surgical plan corporation with the subscribers for medical and surgical service shall be entered into only with physicians and surgeons regularly licensed to practice their profession by the State of South Dakota. All contracts issued by such corporation to the subscribers shall constitute direct obligations of the corporation and of the physician or surgeon with whom such corporation has contracted for medical and surgical service and shall provide for medical and surgical service to subscribers by the physician and surgeon chosen by the patient without regard to whether said physician and surgeon has a contract with said corporation, and at the same rate as provided in the contract of the corporation for service by other than contracting physicians and surgeons in case of emergency or expediency.
Source:
SL 1966, ch 111, ch 21, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-11.1 - Coverage for inpatient treatment of alcoholism to be offered in contracts.

58-38-11.1. Coverage for inpatient treatment of alcoholism to be offered in contracts.
Any nonprofit service corporation which delivers or issues for delivery in this state service or indemnity type contracts to any individual subscriber or group shall offer, in writing, to include in such contracts issued or renewed on or after July 1, 1979, coverage for the inpatient treatment of alcoholism in licensed hospitals and residential primary treatment facilities approved by the State of South Dakota which are carrying out an approved program pursuant to diagnosis and recommendation of a doctor of medicine. When coverage for inpatient treatment of alcoholism is included in any policy or contract, such coverage shall include treatment at any South Dakota approved inpatient alcoholism treatment facility.
Source:
SL 1975, ch 314, §1; SL 1976, ch 314, §2; SL 1977, ch 411, §3; SL 1979, ch 344, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-11.2 - Benefits provided under alcoholism coverage--Maximum treatment periods permitted.

58-38-11.2. Benefits provided under alcoholism coverage--Maximum treatment periods permitted.
The alcoholism coverage to be offered in writing shall provide benefits on the same basis as benefits provided for the treatment of other sicknesses covered under the contract; provided, however, that the coverage by the service corporation need not exceed thirty days' care in any six-month period, and further provided that the total days' care per recipient need not exceed ninety days during the life of the contract.
Source:
SL 1975, ch 314, §2; SL 1977, ch 411, §4; SL 1979, ch 344, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-11.3 - Plans not within alcoholism coverage requirement.

58-38-11.3. Plans not within alcoholism coverage requirement.
Sections 58-38-11.1 and 58-38-11.2 shall not apply to group major-medical service plans or accident only, or limited or specified disease plans.
Source:
SL 1975, ch 314, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-11.4 - Individual accident or health policy required for covered spouse of insured--Eligibility--Coverage--Waiting periods.

58-38-11.4. Individual accident or health 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.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-11.5 - Conversion privileges of insured's spouse upon divorce.

58-38-11.5. 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.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-11.6 - Coordination, integration, or lessening of benefits restricted.

58-38-11.6. Coordination, integration, or lessening of benefits restricted.
No group health insurance policy or group subscriber contract issued by a nonprofit corporation delivered or issued for delivery in this state may contain a provision requiring coordination of benefits, integration of benefits, or lessening of policy benefits because of the existence or availability of coverage under an individual health insurance policy or individual subscriber contract issued by a nonprofit corporation.
An individual health insurance policy or individual subscriber contract issued by a nonprofit corporation may be rescinded within its contestable period for material misrepresentation if the full premium is refunded.
This section applies to policies issued or renewed after July 1, 1981.
Source:
SL 1981, ch 362, §§1, 2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-11.10 - Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony.

58-38-11.10. 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 service or indemnity-type contract issued by a nonprofit medical or surgical service plan corporation 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 hospital or medical service plan from excluding coverage for an insured for any sickness or injury caused in the commission of a felony.
Source:
SL 1997, ch 290, §§4, 7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-12 - Care provided by noncontracting physicians--Contracting physician unavailable.

58-38-12. Care provided by noncontracting physicians--Contracting physician unavailable.
If at any time that the subscriber or certificate holder is entitled to medical and surgical service no contracting physician and surgeon is available, the medical and surgical plan corporation shall provide such care by physicians and surgeons who have not contracted with such corporation, to such extent as the subscriber or certificate holder is entitled to under his certificate, and at the same rate and for the same fees as is provided for care by noncontracting physicians and surgeons, but not to exceed the limitation provided for in the certificate.
Source:
SL 1966, ch 111, ch 21, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-13 - Practice of medicine not authorized by chapter.

58-38-13. Practice of medicine not authorized by chapter.
Nothing in this chapter shall authorize any person, association, or corporation to engage, in any manner, in the practice of medicine or surgery.
Source:
SL 1966, ch 111, ch 21, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-14 - Expenses of acquisition and administration--Control by director.

58-38-14. Expenses of acquisition and administration--Control by director.
All acquisition and administrative expenses in connection with such medical and surgical service corporation shall at all times be subject to control by the director.
Source:
SL 1966, ch 111, ch 21, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-15 - Permitted investments.

58-38-15. Permitted 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 1966, ch 111, ch 21, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-16 - Foreign corporation--Transaction of business in state.

58-38-16. Foreign corporation--Transaction of business in state.
A nonprofit medical and surgical service plan corporation organized under the laws of another state or any territory may, with the approval of the director, and under the rules as may be promulgated, consistent with the provisions of this chapter, transact and carry on its business in this state, provided it shall first file with the director:
(1)A duly certified copy of its charter or articles of incorporation;
(2)A verified statement of the condition of its affairs for the next preceding calendar year;
(3)A duly certified and authenticated appointment of the director as its true and lawful agent in and for this state, upon whom all lawful process in any action or proceeding against the insurer may be served with the same effect as if a domestic insurer served in this state, such appointment to stipulate that any lawful process against such insurer served on such agent shall be of the same legal force and validity as if served on the insurer, and that the authority shall continue in force as long as any liability remains outstanding against such insurer in this state. Such service may be made on the director in the manner provided by statute for service of process, or may be made by filing a copy of such process in the office of the director. Whenever any such process is served upon the director, he shall forthwith forward a copy thereof by mail, postpaid, directed to the secretary of the insurer; or in case of insurers in foreign countries, to the resident manager thereof, in this country, and to its general agent in this state; and
(4)Evidence satisfactory to the director that such corporation has existing contracts for the rendering of medical and surgical service to the subscribers with at least twenty physicians and surgeons licensed to practice their profession in the State of South Dakota, approved for participation by the director.
Any such foreign corporation shall be subject to the laws of this state pertaining to reciprocal relations imposed upon foreign insurers transacting or doing business in this state.
Source:
SL 1966, ch 111, ch 21, §11; SL 1986, ch 22, §40.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-17 - Annual statement of financial condition--Filing--Verification--Form and contents.

58-38-17. Annual statement of financial condition--Filing--Verification--Form and contents.
Every medical and surgical plan corporation shall annually on or before the first day of March file in the office of the director a statement verified by at least two of the principal officers of said corporation showing its condition on the preceding thirty-first day of December; the statement shall be in such form and shall contain such matters as the director shall prescribe.
Source:
SL 1966, ch 111, ch 21, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-18 - Investigation and examination by director--Cost borne by corporation.

58-38-18. Investigation and examination by director--Cost borne by corporation.
The director may investigate and examine the books and records of any medical and surgical plan corporation, and may summon and examine under oath its officers, representatives, insurance producers, employees, or other persons in relation to the affairs, transactions, and conditions of the corporation.
The director shall conduct an examination of each corporation at least every five years pursuant to chapter 58-3, and the cost of the regular or other special examinations shall be borne by the corporation.
Source:
SL 1966, ch 111, ch 21, §8; SL 1994, ch 389, §1; SL 2001, ch 286, §220.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-19 - Exemption from other insurance laws--Exceptions.

58-38-19. Exemption from other insurance laws--Exceptions.
Any medical and surgical plan corporation is exempt from all provisions of the insurance laws of this state other than in this chapter. However, the corporation is subject to the provisions of this title on matters of hearings, appeals, mergers, dissolutions, licensure of insurance producers, and procedures on such matters. The corporation is also subject to §§58-4-39 to 58-4-42, inclusive; 58-6-75; 58-17-17, and 58-17-19 for nongroup policies only; §§58-17-54; 58-17-56; 58-30-124 to 58-30-139, inclusive; and to the fees and taxation as insurers covered by this title; and to chapters 58-3, 58-5A, 58-14, 58-18B, 58-26, 58-27, 58-29B, 58-29D, 58-33, 58-43, and 58-44.
Source:
SL 1966, ch 111, ch 21, §2; SL 1980, ch 361; SL 1982, ch 367, §1; SL 1991, ch 408, §1; SL 1991, ch 409; SL 1994, ch 386, §2; SL 2001, ch 286, §221.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-21 - Notice required by medical and surgical plan corporation for rate increase.

58-38-21. Notice required by medical and surgical plan corporation for rate increase.
Forty-five days before a contract rate increase is effective, the medical and surgical plan corporation shall notify the group employer or association in writing that the contract rate for the medical and surgical plan operated by the corporation will be increased.
Source:
SL 1989, ch 434, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-22 - Grandfathered service and indemnity-type contracts required to cover low-dose mammography--Extent of coverage.

58-38-22. Grandfathered service and indemnity-type contracts required to cover low-dose mammography--Extent of coverage.
Each service or indemnity-type contract issued by a nonprofit medical and surgical service plan corporation 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.
Source: SL 1990, ch 397, §§1, 5; SL 1991, ch 400, §5; SL 2011, ch 216, §7.
Commission Note: 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."
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-22.1 - Service and indemnity-type contracts required to cover occult breast cancer screening.

58-38-22.1. Service and indemnity-type contracts required to cover occult breast cancer screening.
Each service or indemnity-type contract issued by a nonprofit medical and surgical service plan corporation 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.
Source: SL 2011, ch 216, §14.
Commission Note: 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."
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-23 - Coverage for phenylketonuria.

58-38-23. Coverage for phenylketonuria.
Every service or indemnity-type contract issued by a nonprofit medical and surgical service plan corporation that is delivered, issued for delivery or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall offer coverage for testing, diagnosis, and treatment of phenylketonuria including dietary management, formulas, case management, intake and screening, assessment, comprehensive care planning, and service referral.
Source:
SL 1992, ch 348, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-24 - Hospital service plan authorized.

58-38-24. Hospital service plan authorized.
A medical and surgical plan corporation licensed under this chapter may establish and operate a nonprofit hospital service plan under the provisions of chapter 58-40. Such plan shall be governed by chapter 58-40, but is exempt from the provisions of §58-40-4.
Source:
SL 1993, ch 374.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-25 - Formation of voluntary health insurance purchasing organizations.

58-38-25. Formation of voluntary health insurance purchasing organizations.
Notwithstanding the provisions of chapter 47-34A and §§ 47-15-2 and 47-22-4, any organization may form for the purposes of purchasing group health insurance on a voluntary basis. For purposes of §§58-38-25 to 58-38-35, inclusive, an organization means any nonprofit organization or nonprofit corporation formed under South Dakota law.
Source:
SL 1994, ch 382, §1; SL 2021, ch 210, § 22.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-26 - Membership of voluntary health insurance purchasing organizations.

58-38-26. Membership of voluntary health insurance purchasing organizations.
Any organization may have a group health insurance policy issued to that organization on behalf of its members who would be insured under such policy. Members may join the organization, for the purpose of obtaining group health insurance, as individuals, employers, labor unions, associations, or substantially similar groups.
Source:
SL 1994, ch 382, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-27 - Purchasing organization's responsibility for negotiating terms and conditions.

58-38-27. Purchasing organization's responsibility for negotiating terms and conditions.
The organization shall be responsible for negotiating the terms and conditions of insurance contracts, collection of premiums, and providing notice to members.
Source:
SL 1994, ch 382, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-28 - Purchasing organization's notice of premium charge.

58-38-28. Purchasing organization's notice of premium charge.
The organization may provide not less than forty-five days advance notice of any benefit or premium change to its members.
Source:
SL 1994, ch 382, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-30 - Approval of purchasing organization by Division of Insurance.

58-38-30. Approval of purchasing organization by Division of Insurance.
Any organization shall, prior to its engaging in the business of insurance, obtain approval from the Division of Insurance. The division may deny approval or withdraw approval of an organization to engage in the business of insurance for any of the following reasons:
(1)Any of the grounds specified in §58-6-8;
(2)Insufficient membership control of the organization;
(3)Unreasonable compensation to officers, directors, or employees of the organization;
(4)Misuse of premiums; or
(5)Refusal to be examined or to cooperate in an examination.
Source:
SL 1994, ch 382, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-31 - Premiums held in trust by purchasing organization.

58-38-31. Premiums held in trust by purchasing organization.
The organization shall hold all premiums received in trust and promptly remit premiums to the person entitled thereto.
Source:
SL 1994, ch 382, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-32 - Rates for group health insurance issued to purchasing organizations.

58-38-32. Rates for group health insurance issued to purchasing organizations.
Any insurer issuing group health insurance pursuant to §§58-38-25 to 58-38-35, inclusive, is subject to all of the provisions of chapter 58-18B relating to rates.
Source:
SL 1994, ch 382, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-33 - Reasonable participation requirements for group members of purchasing organizations.

58-38-33. Reasonable participation requirements for group members of purchasing organizations.
An insurer may as a condition of offering coverage or continuing coverage require reasonable participation requirements of groups who become members of an organization.
Source:
SL 1994, ch 382, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-34 - Purchasing organizations exempt from antitrust provisions.

58-38-34. Purchasing organizations exempt from antitrust provisions.
Any organization formed pursuant to §§58-38-25 to 58-38-35, inclusive, is exempt from the antitrust provisions under chapter 37-1.
Source:
SL 1994, ch 382, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-35 - Promulgation of rules for purchasing organizations.

58-38-35. Promulgation of rules for purchasing organizations.
The director may promulgate rules pursuant to chapter 1-26 to further the provisions of §§58-38-25 to 58-38-35, inclusive, and for purposes of carrying out the provisions of §§58-18-1 to 58-18-6, inclusive, and to ensure that group health insurance coverage is issued to eligible groups and that organizations are formed and operated to further the purpose of providing economical group health insurance for its members. The rules may include:
(1)Definition of terms;
(2)Criteria for determining groups, associations, organizations, and trusts and their eligibility for coverage;
(3)Criteria for determining substantially similar groups or for determining related industries;
(4)Application requirements and procedures;
(5)Reasonable compensation; and
(6)Organizational structure.
Source:
SL 1994, ch 382, §11.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 38 - Nonprofit Medical And Surgical Plans › Section 58-38-36 - Minimum loss ratio for small employer health benefit plans.

58-38-36. Minimum loss ratio for small employer health benefit plans.
Premium rates for small employer health benefit plans shall produce a minimum lifetime loss ratio of not less than seventy-five percent. The director may promulgate rules pursuant to chapter 1-26 which modify the minimum loss ratio required based upon the specific plan design or other objective and pertinent criteria.
Source:
SL 1994, ch 381, §1.