reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 16 - Group Life Insurance Policies › Section 58-16-52 - Notice of discontinuance.

58-16-52. Notice of discontinuance.
A notice of discontinuance given by the carrier shall include a request to the group policyholder or other entity involved to notify employees covered under the policy of the date as of which the group policy, contract, or certificate will discontinue and to advise that, unless otherwise provided in the policy, contract, or certificate, the carrier is not liable for claims for losses incurred after the date of discontinuance. The notice of discontinuance also shall advise, in any instance in which the plan involves employee contributions, that if the policyholder or other entity continues to collect contributions for the coverage beyond the date of discontinuance, the policyholder or other entity may be held solely liable for the benefits with respect to which the contributions have been collected.
The carrier shall prepare and furnish to the policyholder or other entity at the same time the carrier gives a notice of discontinuance, a supply of, or access to, notice forms to be distributed to the employees or members concerned, indicating the discontinuance and the effective date of the discontinuance, and urging the employees or members to refer to their certificates or contracts in order to determine what rights, if any, are available to them upon the discontinuance.
Source:
SL 2009, ch 261, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 16 - Group Life Insurance Policies › Section 58-16-53 - Extension of benefits at discontinuance in the event of total disability.

58-16-53. Extension of benefits at discontinuance in the event of total disability.
Each group policy, contract, or certificate subject to the provisions of §§58-16-49 to 58-16-54, inclusive, issued on or after July 1, 2009, or under which the level of benefits is altered, modified, or amended on or after July 1, 2009, shall provide a reasonable provision for extension of benefits in the event of total disability at the date of discontinuance of the group policy, contract, or certificate as required by this section.
In the case of a group life plan that contains a disability benefit extension of any type, including premium waiver extension, extended death benefit in event of total disability, or payment of income for a specified period during total disability, the discontinuance of the group policy, contract, or certificate may not operate to terminate the extension.
Any applicable extension of benefits or accrued liability shall be described in any policy or contract involved as well as in group insurance certificates. The benefits payable during any period of extension of benefits or accrued liability may be subject to the policy's, contract's, or certificate's regular benefit limits, such as benefits ceasing at exhaustion of a benefit period or of maximum benefits.
Source:
SL 2009, ch 261, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-1 - Requirements for all health insurance policies delivered in state.

58-17-1. Requirements for all health insurance policies delivered in state.
No policy of health insurance may be delivered or issued for delivery to any person in this state unless it otherwise complies with this title, with §§58-17-1.1 to 58-17-11, inclusive, and with §§58-17-84.1 and 58-18-45.1.
Source:
SL 1966, ch 111, ch 25, §2; SL 1991, ch 400, §1; SL 1999, ch 248, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-1.1 - Grandfathered plans required to cover low-dose mammography--Extent of coverage.

58-17-1.1. Grandfathered plans required to cover low-dose mammography--Extent of coverage.
Each policy of health insurance that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a policy 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, 2; SL 1991, ch 400, §2; SL 2011, ch 216, §1.
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 17 - Health Insurance Policies › Section 58-17-1.2 - Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.

58-17-1.2. Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.
Every policy of health insurance delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall provide, in writing, coverage for equipment, supplies, and self-management training and education, including medical nutrition therapy, for treatment of persons diagnosed with diabetes if prescribed by a physician or other licensed health care provider legally authorized to prescribe such treatment. Medical nutrition therapy does not include any food items or nonprescription drugs.
Coverage for medically necessary equipment and supplies shall include blood glucose monitors, blood glucose monitors for the legally blind, test strips for glucose monitors, urine testing strips, insulin, injection aids, lancets, lancet devices, syringes, insulin pumps and all supplies for the pump, insulin infusion devices, prescribed oral agents for controlling blood sugars, glucose agents, glucagon kits, insulin measurement and administration aids for the visually impaired, and other medical devices for treatment of diabetes.
Diabetes self-management training and education shall be covered if: (a) the service is provided by a physician, nurse, dietitian, pharmacist, or other licensed health care provider who satisfies the current academic eligibility requirements of the National Certification Board for Diabetic Educators and has completed a course in diabetes education and training or has been certified as a diabetes educator; and (b) the training and education is based upon a diabetes program recognized by the American Diabetes Association or a diabetes program with a curriculum approved by the American Diabetes Association or the South Dakota Department of Health.
Coverage of diabetes self-management training is limited to (a) persons who are newly diagnosed with diabetes or have received no prior diabetes education; (b) persons who require a change in current therapy; (c) persons who have a co-morbid condition such as heart disease or renal failure; or (d) persons whose diabetes condition is unstable. Under these circumstances, no more than two comprehensive education programs per lifetime and up to eight follow-up visits per year need be covered. Coverage is limited to the closest available qualified education program that provides the necessary management training to accomplish the prescribed treatment.
The benefits provided in this section are subject to the same dollar limits, deductibles, coinsurance, and other restrictions established for all other benefits covered in the policy.
Source:
SL 1999, ch 252, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-1.3 - Diabetes coverage not required of certain plans and policies.

58-17-1.3. Diabetes coverage not required of certain plans and policies.
The provisions of §58-17-1.2 do not apply to any plan, policy, or contract that provides coverage only for:
(1)Specified disease;
(2)Hospital indemnity;
(3)Fixed indemnity;
(4)Accident-only;
(5)Credit;
(6)Dental;
(7)Vision;
(8)Prescription drug;
(9)Medicare supplement;
(10)Long-term care;
(11)Disability income insurance;
(12)Coverage issued as a supplement to liability insurance;
(13)Workers' compensation or similar insurance;
(14)Automobile medical payment insurance;
(15)Individual health benefit plans of six-months duration or less that are not renewable; or
(16)Individual nonmajor medical insurance.
Source:
SL 1999, ch 252, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-1.4 - Policies required to cover occult breast cancer screening.

58-17-1.4.Policies required to cover occult breast cancer screening.
Each policy of health insurance that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a policy 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, §13.
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 17 - Health Insurance Policies › Section 58-17-2 - Persons covered by policy.

58-17-2. Persons covered by policy.
A policy of health insurance shall purport to insure only one person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family, who shall be deemed the policyholder, any two or more eligible members of that family, including husband, wife, dependent children, or any children under a specified age which shall not exceed nineteen years and any other person dependent upon the policyholder or any other person related to and resident in the household of the insured.
Source:
SL 1966, ch 111, ch 25, §2 (3).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-2.1 - Health insurance on a franchise plan.

58-17-2.1. Health insurance on a franchise plan.
Health insurance on a franchise plan is hereby declared to be that form of health insurance issued to:
(1)Three or more employees of any corporation, copartnership, or individual employer or any governmental corporation, agency, or department thereof; or
(2)Ten or more members of any trade, occupational, or professional association, or of a labor union, or of any other association having had an active existence for at least two years where such association or union has a constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance; where such persons, with or without their dependents, are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for by such persons, under an arrangement whereby the premiums on such policies may be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association for its members, or by some designated person acting on behalf of such employer or association or by the insured directly to the insurer, if permitted by the insurer. The term, employees, as used in this section may be deemed to include the officers, managers, and employees and retired employees of the employer and the individual proprietor or partnership.
Health insurance may be marketed on a franchise basis to members or employees of an employer, labor union, or association. Except as provided for by §58-18B-2, health insurance marketed on a franchise basis may have the individual's premiums paid by the employer, labor union, or association. Marketing a policy on a franchise basis does not exempt any policy from any applicable requirement under this title except as provided in §58-33-13.
Source:
SL 1966, ch 111, ch 25, §30 as added by SL 1968, ch 137; SL 2000, ch 241, §§1, 2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-2.2 - Conversion privileges of insured's spouse upon divorce.

58-17-2.2. Conversion privileges of insured's spouse upon divorce.
No accident or health insurance policy providing coverage of hospital or medical expense which in addition to covering the insured also provides coverage to the spouse of the insured shall be issued without a provision that provides that upon divorce of the insured and the insured's spouse, the spouse is entitled to have issued to him or her, without evidence of insurability, upon application to the company within thirty days following the eligibility, and upon payment of the appropriate premium, an individual policy of accident or health insurance. Such policy shall provide the coverage then being issued by the insurer which is most nearly similar to the existing coverages. This obligation can be met by continuation of coverage for spouse under existing policy at the appropriate premium. Any and all probationary or waiting periods set forth in such policy shall be considered as being met to the extent coverage was in force under the prior policy.
Source:
SL 1980, ch 354.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-2.3 - Dependent coverage termination--Age--Full-time students.

58-17-2.3. Dependent coverage termination--Age--Full-time students.
No insurer or health carrier issuing health insurance coverage, other than excepted benefits, that provides dependent coverage for any qualifying child, as defined by rules promulgated pursuant to §58-17-87, may terminate coverage due to attainment of a limiting age below age twenty-six. If the dependent remains a full-time student upon attaining the age of twenty-six, but not exceeding the age of twenty-nine, the insurer shall provide for the continuation of coverage for that dependent at the insured's option. However, the provisions of this section do not apply to any qualifying relative, as defined by rules promulgated pursuant to §58-17-87, whose gross income is less than the exemption amount as prescribed by the director by rules promulgated pursuant to chapter 1-26. Continuation of coverage for full-time students attaining the age of twenty-four is not required if the dependent has other creditable coverage in force nor required for any full-time students who attained the age of twenty-four prior to July 1, 2007.
Source: SL 2005, ch 265, §1; SL 2007, ch 288, §1; SL 2011, ch 216, §2.
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 17 - Health Insurance Policies › Section 58-17-3 - Time of commencement and termination to be set out in policy.

58-17-3. Time of commencement and termination to be set out in policy.
The time when the insurance takes effect and terminates shall be expressed in a policy of health insurance.
Source:
SL 1966, ch 111, ch 25, §2 (2).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-4 - Consideration for policy to be stated.

58-17-4. Consideration for policy to be stated.
The entire money and other considerations therefor shall be expressed in a policy of health insurance.
Source:
SL 1966, ch 111, ch 25, §2 (1).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-4.1 - Filing and approval of individual policy premium rates.

58-17-4.1. Filing and approval of individual policy premium rates.
Premium rates charged for any individual accident and health insurance policy issued pursuant to this chapter shall be filed with and are subject to the approval of the director. The rates shall be filed for approval, administered, and reviewed subject to all of the applicable procedures in accordance with §§58-11-64 to 58-11-76, inclusive.
Source: SL 1988, ch 399, §1; SL 2006, ch 254, §1; SL 2011, ch 216, §3.
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 17 - Health Insurance Policies › Section 58-17-4.2 - Premium rates required to be reasonable--Rules to establish minimum standards promulgated by director.

58-17-4.2. Premium rates required to be reasonable--Rules to establish minimum standards promulgated by director.
Premium rates charged for any individual accident and health insurance policy pursuant to this chapter shall be reasonable in relation to the benefits available under the policy. The director shall promulgate rules pursuant to chapter 1-26 to establish minimum standards in accordance with accepted actuarial principles and practices, for loss ratios of individual accident and health insurance policies on the basis of incurred claims experience and earned premiums.
Source:
SL 1988, ch 399, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-5 - Identification of forms, riders and endorsements--Form number, location.

58-17-5. Identification of forms, riders and endorsements--Form number, location.
Each form for a policy of health insurance, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof.
Source:
SL 1966, ch 111, ch 25, §2 (6).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-6 - Style and arrangement of policy provisions--Printing, size of type.

58-17-6. Style and arrangement of policy provisions--Printing, size of type.
The style, arrangement, and overall appearance of a policy of health insurance shall give no undue prominence to any portion of the text, and every printed portion of the text of the policy and of any endorsements or attached papers shall be plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten point with a lower case unspaced alphabet length not less than one hundred twenty point; the "text" shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description, if any, and captions and subcaptions.
Source:
SL 1966, ch 111, ch 25, §2 (4).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-7 - Documents forming part of policy--Setting forth in full, rates and classifications excepted.

58-17-7. Documents forming part of policy--Setting forth in full, rates and classifications excepted.
A policy of health insurance shall contain no provision purporting to make any portion of the charter, rules, Constitution, or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the director.
Source:
SL 1966, ch 111, ch 25, §2 (7).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-8 - Exceptions and reductions of coverage to be clearly set out.

58-17-8. Exceptions and reductions of coverage to be clearly set out.
The exceptions and reductions of indemnity shall be set forth in a policy of health insurance and, other than those contained in §§58-17-14 to 58-17-39, inclusive, shall be printed, at the insurer's option, either included with the benefit provision to which they apply, or under an appropriate caption such as "Exceptions," or "Exceptions and Reductions," except that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies.
Source:
SL 1966, ch 111, ch 25, §2 (5).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-9 - Renewal of policy at option of insurer--Statement in policy so informing the policyholder.

58-17-9. Renewal of policy at option of insurer--Statement in policy so informing the policyholder.
In any case where a policy of health insurance is subject to renewal at the option of the insurer there shall be prominently printed both on the cover page and on the first page of such policy a statement so informing the policyholder.
Source:
SL 1966, ch 111, ch 25, §2 (9).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-10.1 - Reduction of benefits because of increase in statutory disability benefits prohibited.

58-17-10.1. Reduction of benefits because of increase in statutory disability benefits prohibited.
No individual insurance policy for loss of time or disability benefits issued, amended, renewed, or delivered in this state shall contain any provision offsetting, or in any other manner reducing, any benefit under the policy by the amount of, or in proportion to, any increase in disability benefits received or receivable under the federal Social Security Act, the Railroad Retirement Act, any veteran's disability compensation and survivor benefits act, workers' compensation, or any similar federal or state law, as amended subsequent to the date of commencement of such benefit.
Source:
SL 1976, ch 312.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-10.2 - Individual policy for insured's spouse required in policies covering spouse--Eligibility--Coverage--Waiting periods.

58-17-10.2. Individual policy for insured's spouse required in policies covering spouse--Eligibility--Coverage--Waiting periods.
No 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 17 - Health Insurance Policies › Section 58-17-11 - Return of policy by purchaser--Refund of premium paid--Dissatisfaction with terms after examination.

58-17-11. Return of policy by purchaser--Refund of premium paid--Dissatisfaction with terms after examination.
Every individual health insurance policy or contract, except single premium nonrenewable policies or contracts, issued for delivery in South Dakota on or after December 31, 1966, by an insurance company, nonprofit hospital service plan, or medical service corporation, shall have printed thereon or attached thereto a notice stating in substance that the person to whom the policy or contract is issued shall be permitted to return the policy or contract within ten days of its delivery to said purchaser and to have the premium paid refunded if, after examination of the policy or contract, the purchaser is not satisfied with it for any reason. If a policyholder or purchaser pursuant to such notice, returns the policy or contract to the company or association at its home or branch office or to the insurance producer through whom it was purchased, it is void from the beginning and the parties shall be in the same position as if no policy or contract had been issued.
Source:
SL 1966, ch 111, ch 25, §2 (8); SL 2001, ch 286, §114.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-11.1 - Issuance of policies by insurance company, nonprofit hospital service plan, medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--Term of retention.

58-17-11.1. Issuance of policies by insurance company, nonprofit hospital service plan, medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--Term of retention.
An insurance company, nonprofit hospital service plan, medical service corporation, health maintenance organization, or fraternal benefit society shall issue policies in this state for which an examination period is required in accordance with one of the following methods:
(1)If the policy is delivered by an insurance producer, a receipt shall be signed by the policyowner acknowledging delivery of the policy. The receipt shall include the policy number and the date of the delivery;
(2)If the policy is delivered by mail, it shall be sent by registered or certified mail, return receipt requested, or a certificate of mailing shall be obtained showing the date the policy was mailed to the policyowner. For policy issuances verified by a certificate of mailing, it is presumed that the policy is received by the policyowner ten days from the date of mailing.
The receipts and the certificates of mailing described in this section shall be retained by the insurer for five years. If a producer obtains the delivery receipt, the producer shall forward the signed delivery receipt to the insurer.
Source:
SL 1982, ch 28, §18; SL 1987, ch 374, §3; SL 2001, ch 286, §115; SL 2002, ch 232, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-12 - Required provisions--Captions--Substitutes, approval by director.

58-17-12. Required provisions--Captions--Substitutes, approval by director.
Except as provided in §58-17-13, each policy of health insurance delivered or issued for delivery to any person in this state shall contain the provisions specified in §§58-17-14 to 58-17-29, inclusive, in the words in which the same appear; except, that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the director which are in each instance not less favorable in any respect to the insured or the beneficiary. Each such provision shall be preceded individually by the applicable caption shown, or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the director may approve.
Source:
SL 1966, ch 111, ch 25, §3 (1).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-13 - Omission from policy of inapplicable provision--Approval of director--Modification of inconsistent provision.

58-17-13. Omission from policy of inapplicable provision--Approval of director--Modification of inconsistent provision.
If any such provision is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the director shall omit from such policy any inapplicable provision or part of a provision and shall modify any inconsistent provision or part of a provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.
Source:
SL 1966, ch 111, ch 25, §3 (2).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-14 - Entire contract and change clauses required--Signed acceptance required for endorsements.

58-17-14. Entire contract and change clauses required--Signed acceptance required for endorsements.
There shall be a provision as follows: "Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy is valid until approved by an executive officer of the insurance company and unless such approval is endorsed or attached to this policy. No insurance producer has authority to change this policy or to waive any of its provisions."Any rider, endorsement, or application added to a policy, upon policy issuance, after the date of issue, or at reinstatement or renewal which reduces or eliminates benefits or coverage in the policy requires signed acceptance by the policyholder. After the date of policy issue, any rider or endorsement which increases benefits or coverage with an accompanying increase in premium during the policy term must be agreed to in writing signed by the insured, unless the increased benefits or coverage is required by law. Coverage as required by §58-17-98 may be reduced or eliminated by a rider to, or an endorsement on, a new policy if the insurer would reject the application for the policy without the rider or endorsement based upon the applicant's preexisting condition of the type covered by §58-17-98 and if there is signed acceptance by the policyholder.
Source:
SL 1966, ch 111, ch 25, §4; SL 1974, ch 315; SL 1982, ch 361; SL 2001, ch 286, §116; SL 2002, ch 234, §2; SL 2003, ch 247, §1; SL 2010, ch 237, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-15 - Time limit on certain defenses--Application of section.

58-17-15. Time limit on certain defenses--Application of section.
There shall be a provision as follows: "Time limit on certain defenses: (1) After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability, as defined in the policy, commencing after the expiration of such two-year period."
The foregoing policy provision may not be construed to affect any legal requirement for avoidance of a policy or denial of a claim during such initial two-year period, nor to limit the application of §§58-17-32 to 58-17-39, inclusive, in the event of misstatement with respect to age or occupation or other insurance. This section only applies to excepted benefits. This section does not apply to any long-term care insurance policy or certificate.
Source: SL 1966, ch 111, ch 25, §5; SL 2011, ch 216, §4.
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 17 - Health Insurance Policies › Section 58-17-17 - Grace period on premiums required in policy.

58-17-17. Grace period on premiums required in policy.
There shall be a provision as follows: "Grace period: A grace period of __________ (insert a number not less than seven days for weekly premium policies, ten days for monthly premium policies and thirty-one days for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force." If a claim arises under the policy during such period of grace the amount of any proportionate premium due or overdue for the grace period may be deducted from the policy proceeds but such deduction shall not renew the policy or further extend the grace period. Claims arising during a grace period shall be compensable whether or not a renewal premium has been tendered or accepted subject to any other policy defenses.
A policy which gives the policyholder the right to select any one of two or more modes of premium payment by remitting an amount stated in the policy for that particular mode of payment, without requiring any formal request on the part of the policyholder for changing the mode of premium payment, shall provide a grace period of thirty-one days.
Source:
SL 1966, ch 111, ch 25, §6; SL 1977, ch 407, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-18 - Renewal of policy--Restriction on company's right to refuse.

58-17-18. Renewal of policy--Restriction on company's right to refuse.
A policy in which the insurer reserves the right to refuse renewal shall have the following clause at the beginning of the provision in §58-17-17,
"Unless not less than thirty days prior to the premium due date the insurer has delivered to the insured or has mailed to his last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted."
Source:
SL 1966, ch 111, ch 25, §6; SL 1977, ch 407, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-19 - Reinstatement when premium not paid within grace period.

58-17-19. Reinstatement when premium not paid within grace period.
There shall be a provision as follows: "Reinstatement: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any insurance producer duly authorized by the insurer to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy; provided, however, that if the insurer or such insurance producer requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the forty-fifth day following the date of such conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of such application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than ten days after such date. In all other respects the insured and insurer shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed hereon or attached hereto in connection with a reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than sixty days prior to the date of reinstatement."
Source:
SL 1966, ch 111, ch 25, §7; SL 2001, ch 286, §117.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-20 - Omission of provision as to application of premiums accepted in connection with reinstatement--Right of insured to continue policy in force by payment of premiums.

58-17-20. Omission of provision as to application of premiums accepted in connection with reinstatement--Right of insured to continue policy in force by payment of premiums.
The last sentence of the provision in §58-17-19 may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums until at least age fifty, or, in the case of a policy issued after age forty-four, for at least five years from its date of issue.
Source:
SL 1966, ch 111, ch 25, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-21 - Notice of claim--Provision required in policy.

58-17-21. Notice of claim--Provision required in policy.
There shall be a provision as follows: "Notice of claim: Written notice of claim must be given to the insurer within twenty days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at __________ (insert the location of such office as the insurer may designate for the purpose), or to any authorized insurance producer of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer."
Source:
SL 1966, ch 111, ch 25, §8; SL 2001, ch 286, §118.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-22 - Notice of claim--Loss of time benefit--Optional provision, insertion by insurer.

58-17-22. Notice of claim--Loss of time benefit--Optional provision, insertion by insurer.
In a policy providing a loss-of-time benefit which may be payable for at least two years, an insurer may at its option insert the following between the first and second sentences of the provision in §58-17-21: "Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two years, he shall, at least once in every six months after having given notice of the claim, give to the insurer notice of continuance of the disability, except in the event of legal incapacity. The period of six months following any filing of proof by the insured or any payment by the insurer on account of such claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured's right to any indemnity which would otherwise have accrued during the period of six months preceding the date on which such notice is actually given."
Source:
SL 1966, ch 111, ch 25, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-23 - Claim forms--Furnishing by insurer.

58-17-23. Claim forms--Furnishing by insurer.
There shall be a provision as follows: "Claim forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made."
Source:
SL 1966, ch 111, ch 25, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-24 - Proofs of loss--Provision required in policy.

58-17-24. Proofs of loss--Provision required in policy.
There shall be a provision as follows: "Proofs of loss: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety days after the termination of the period for which the insurer is liable and in case of claim for any other loss within ninety days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required."
Source:
SL 1966, ch 111, ch 25, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-25 - Time of payment of claims--Provision required in policy.

58-17-25. Time of payment of claims--Provision required in policy.
There shall be a provision as follows: "Time of payment of claims: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment, will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid __________ (insert period for payment which must not be less frequently than monthly) and any balance remaining unpaid upon termination of liability will be paid immediately upon receipt of due written proof."
Source:
SL 1966, ch 111, ch 25, §11.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-26 - Payment of claims--Persons to whom benefits payable--Provision required in policy.

58-17-26. Payment of claims--Persons to whom benefits payable--Provision required in policy.
There shall be a provision as follows: "Payment of claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured's death may, at the option of the insurer, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the insured."
Source:
SL 1966, ch 111, ch 25, §12.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-27 - Payment of claims--Optional provisions, insertion by insurer.

58-17-27. Payment of claims--Optional provisions, insertion by insurer.
The following provisions, or either of them, may be included with the provision in §58-17-26 at the option of the insurer: "If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or otherwise not competent to give a valid release, the insurer may pay such indemnity, up to an amount not exceeding $__________ (insert an amount which shall not exceed one thousand dollars), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any payment made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the extent of such payment."
"Subject to any written direction of the insured in the application or otherwise all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option and unless the insured requests otherwise in writing not later than the time of filing proof of such loss, be paid directly to the hospital or person rendering such services; but it is not required that the service be rendered by a particular hospital or person."
Source:
SL 1966, ch 111, ch 25, §12.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-28 - Physical examination of insured--Autopsy in death claims--Provision required in policy.

58-17-28. Physical examination of insured--Autopsy in death claims--Provision required in policy.
There shall be a provision as follows: "Physical examinations and autopsy: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law."
Source:
SL 1966, ch 111, ch 25, §13.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-29 - Action to recover under policy--Time for beginning.

58-17-29. Action to recover under policy--Time for beginning.
There shall be a provision as follows: "Legal actions: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three years after the written proof of loss is required to be furnished."
Source:
SL 1966, ch 111, ch 25, §14.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-30.1 - Continuation of coverage for child with intellectual or physical disability--Proof of dependency.

58-17-30.1. Continuation of coverage for child with intellectual or physical disability--Proof of dependency.
An individual health insurance policy, which is delivered or issued for delivery in this state and which provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the policy, shall also provide that attainment of such limiting age shall not operate to terminate the coverage of such child while the child is and continues to be both (a) incapable of self-sustaining employment by reason of intellectual disability or physical disability and (b) chiefly dependent upon the policyholder for support and maintenance, provided proof of such incapacity and dependency is furnished to the insurer by the policyholder within thirty-one days of the child's attainment of the limiting age and subsequently as may be required by the insurer but not more frequently than annually after the two-year period following the child's attainment of the limiting age.
Source:
SL 1969, ch 140; SL 2013, ch 125, §18.