reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-46 - Renewability of health benefit plans--Employer's election--Exceptions.

58-18-46. Renewability of health benefit plans--Employer's election--Exceptions.
Except as provided in §§58-18-42 to 58-18-49, inclusive, a health benefit plan subject to this chapter is renewable to all eligible employees and dependents at the option of the employer, except for the following reasons:
(1)The employer has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the insurer has not received timely premium payments;
(2)Fraud or intentional misrepresentation of material fact by the employer;
(3)Noncompliance with the carrier's employer contribution or participation requirements;
(4)The number of individuals covered under the plan is less than the number or percentage of eligible individuals required under the plan;
(5)In the case of a health insurance issuer that offers health insurance coverage in the market through a network plan, there is no longer any enrollees in connection with the plan who live, reside, or work in the service area of the issuer or in the area for which the issuer is authorized to do business and the issuer would deny enrollment with respect to the plan as provided for in §58-18B-37;
(6)The employer carrier elects to nonrenew all of its health benefit plans delivered or issued for delivery to employers in this state;
(7)In the case of health insurance coverage that is made available only through one or more bona fide associations, the membership of an employer in the association (on the basis of which the coverage is provided) ceases but only if the coverage is terminated uniformly without regard to any health status-related factor relating to any covered individual; or
(8)If the issuer decides to discontinue offering a particular type of group health insurance offered in the group market, coverage of such type may be discontinued if:
(a)The issuer provides notice to each employer provided coverage of this type in such market (and any participant and beneficiary covered under such coverage) of the discontinuation at least ninety days prior to the date of the discontinuation of the coverage;
(b)The issuer offers to each employer provided coverage of this type in such market, the option to purchase all other health insurance coverage currently being offered by the issuer to a group health plan in such market;
(c)In exercising the option to discontinue coverage of this type and in offering the option of coverage under subsection (b), the issuer acts uniformly without regard to the claims experience of those employers or any health status-related factor relating to any participant or beneficiary covered or any new participant or beneficiary who may become eligible for such coverage.
If a carrier nonrenews a health benefit plan pursuant to this section, the director shall assist affected employers in finding replacement coverage.
Source:
SL 1994, ch 383, §5; SL 1997, ch 289, §10; SL 2001, ch 275, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-47 - Nonrenewal of health benefit plans by an employer carrier.

58-18-47. Nonrenewal of health benefit plans by an employer carrier.
If an employer carrier elects not to renew all of its health benefit plans delivered or issued for delivery to employers in this state, the carrier shall:
(1)Be prohibited from writing new business in the employer market in this state for a period of five years from the date of notice to the director;
(2)Provide advance notice of the decision not to renew to the director in each state in which it is licensed; and
(3)Provide notice of the decision not to renew coverage to all affected employers and to the director in each state in which an affected insured individual is known to reside at least one hundred eighty days prior to the nonrenewal of any health benefit plans by the carrier.
Notice to the director under this section shall be provided at least three working days prior to the notice to the affected employers. In the case of an employer carrier doing business in one established geographic service area of the state, this section applies only to the carrier's operations in that service area.
Source:
SL 1994, ch 383, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-48 - Acceptance of new employees for coverage under employer's existing health benefit plan.

58-18-48. Acceptance of new employees for coverage under employer's existing health benefit plan.
If an employer has an existing health benefit plan, the carrier shall accept for coverage under the health benefit plan new employees and the dependents of new employees, if the new employee had creditable coverage within the prior sixty-three days from the date the new employee is eligible for coverage. The coverage shall be issued without exclusionary riders. The carrier is not required to provide coverage for new employees or dependents who are late enrollees or who have not had creditable coverage within sixty-three days before applying for coverage. The exception allowing late enrollees to be excluded is limited to the time frames required by subdivisions 58-18-45(3) and (5). Policies may not exclude children, as set forth in subdivision 58-18-43(4), from the definition of eligible dependents. No person may be excluded from coverage based upon discriminatory criteria as defined by the director in rules promulgated pursuant to chapter 1-26.
Source:
SL 1994, ch 383, §8; SL 1996, ch 295; SL 1997, ch 289, §11; SL 1998, ch 289, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-49 - Carrier's offer of coverage to employer--Coverage of all eligible employees.

58-18-49. Carrier's offer of coverage to employer--Coverage of all eligible employees.
If an employer carrier offers coverage to an employer, the employer carrier shall offer coverage to all of the eligible employees of an employer and their dependents. An employer carrier may not offer coverage to only certain individuals in an employer group or to only part of the group, except in the case of late enrollees.
Source:
SL 1994, ch 383, §9; SL 1995, ch 281, §21.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-51.1 - Application of §§ 58-18-42 to 58-18-49, inclusive.

58-18-51.1. Application of §§58-18-42 to 58-18-49, inclusive.
The provisions of §§58-18-42 to 58-18-49, inclusive, apply to health benefit plans which provide health coverage on a self-funded basis through nonfederal government employers, college plans issued on a blanket basis, and church plans. Any self-funded nonfederal government employer plan is subject to the provisions of §§58-18-42 to 58-18-49, inclusive, whether or not it is a single employer plan, a pooled arrangement, a cooperative, through a joint powers agreement, or other similar mechanism for providing health coverage.
Source:
SL 1997, ch 289, §24; SL 2000, ch 250, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-52 - Formation of voluntary health insurance purchasing organizations.

58-18-52. 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 §§58-18-52 to 58-18-62, inclusive, an organization means any nonprofit organization or nonprofit corporation formed under South Dakota law. Stop loss or excess insurance may be purchased in the same manner as group health insurance is purchased pursuant to §§58-18-52 to 58-18-62, inclusive.
Source:
SL 1994, ch 382, §1; SL 1998, ch 293, §2; SL 2021, ch 210, § 16.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-52.1 - Political subdivisions permitted to join with health insurance purchasing organizations.

58-18-52.1. Political subdivisions permitted to join with health insurance purchasing organizations.
Any political subdivision of the state may join with other organizations which are not political subdivisions of the state to operate as an organization formed under §58-18-52 for the purpose of purchasing health insurance pursuant to the provisions in §§58-18-52 to 58-18-62, inclusive, and reducing costs to local government.
Source:
SL 2012, ch 246, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-53 - Membership of voluntary health insurance purchasing organizations.

58-18-53. 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 18 - Group And Blanket Health Insurance Policies › Section 58-18-54 - Purchasing organization's responsibility for negotiating terms and conditions.

58-18-54. 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 18 - Group And Blanket Health Insurance Policies › Section 58-18-55 - Purchasing organization's notice of premium charge.

58-18-55. 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 18 - Group And Blanket Health Insurance Policies › Section 58-18-56 - Additional chapters applicable to purchasing organization.

58-18-56. Additional chapters applicable to purchasing organization.
Any organization is subject to all applicable provisions of chapter 58-3 and chapter 58-33.
Source:
SL 1994, ch 382, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-57 - Approval of purchasing organization by Division of Insurance.

58-18-57. 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 18 - Group And Blanket Health Insurance Policies › Section 58-18-58 - Premiums held in trust by purchasing organization.

58-18-58. 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 18 - Group And Blanket Health Insurance Policies › Section 58-18-59 - Rates for group health insurance issued to purchasing organizations.

58-18-59. Rates for group health insurance issued to purchasing organizations.
Any insurer issuing group health insurance pursuant to §§58-18-52 to 58-18-62, 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 18 - Group And Blanket Health Insurance Policies › Section 58-18-60 - Reasonable participation requirements for group members of purchasing organizations.

58-18-60. 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 18 - Group And Blanket Health Insurance Policies › Section 58-18-61 - Purchasing organizations exempt from antitrust provisions.

58-18-61. Purchasing organizations exempt from antitrust provisions.
Any organization formed pursuant to §§58-18-52 to 58-18-62, 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 18 - Group And Blanket Health Insurance Policies › Section 58-18-62 - Promulgation of rules for purchasing organizations.

58-18-62. Promulgation of rules for purchasing organizations.
The director may promulgate rules pursuant to chapter 1-26 to further the provisions of §§58-18-52 to 58-18-62, 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 18 - Group And Blanket Health Insurance Policies › Section 58-18-63 - Minimum loss ratio for employer health benefit plans--Application of section.

58-18-63. Minimum loss ratio for employer health benefit plans--Application of section.
Premium rates for 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. An insurer is not required to meet the minimum loss ratio on each policy issued. An insurer which does not make a filing specifying the blocks of business for which it will meet the minimum loss ratio requirements of this section will be required to meet the minimum loss ratio requirement in the aggregate on its entire employer block of business in this state. This section does not apply to any insurer which is required to comply with §58-17-64.
Source:
SL 1994, ch 381, §1; SL 1995, ch 280.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-76 - Minimum inpatient care coverage following delivery.

58-18-76. Minimum inpatient care coverage following delivery.
If a group health insurance policy that is issued or renewed on or after July 1, 1996, provides maternity coverage, the policy shall provide coverage for a minimum of forty-eight hours of inpatient care following a vaginal delivery and a minimum of ninety-six hours of inpatient care following delivery by cesarean section for a mother and her newborn child in a health care facility licensed pursuant to chapter 34-12, except as otherwise provided in §58-18-77. Any policy issued to employers with less than fifteen employees that provides coverage for complications of pregnancy, and does not provide other maternity benefits, is not required to comply with this section.
Source:
SL 1996, ch 292, §4; SL 1998, ch 290, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-77 - Shorter hospital stay permitted--Follow-up within forty-eight hours required.

58-18-77. Shorter hospital stay permitted--Follow-up within forty-eight hours required.
If the treating physician determines that the mother and the newborn meet medical criteria contained in Guidelines for Perinatal Care, Third Edition, of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists as in effect on January 1, 1996, a group health insurance policy may provide coverage for a shorter length of hospital inpatient stay for services related to maternity and newborn care than is required in §58-18-76 if the coverage includes one follow-up visit in the first forty-eight hours after discharge to verify the condition of the mother and newborn.
Source:
SL 1996, ch 292, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-78 - Notice to employees or members--Disclosures.

58-18-78. Notice to employees or members--Disclosures.
The group health insurer shall provide notice to employees or members regarding the coverage required by §§58-18-76 and 58-18-77 in accordance with rules adopted by the director of the Division of Insurance pursuant to chapter 1-26. The notice shall be in writing and prominently positioned in any literature or correspondence. The notice shall be transmitted to employees or members in the next mailing to employees or members, in the yearly informational packet sent to employees or members, or by January 1, 1997, whichever is earliest.
Source:
SL 1996, ch 292, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-79 - Promulgation of rules to minimally meet federal standards--Additional rules--Scope.

58-18-79. Promulgation of rules to minimally meet federal standards--Additional rules--Scope.
If any federal standards are in place which require additional steps to meet those standards beyond what is required by this chapter, the director may promulgate rules, pursuant to chapter 1-26, to require the offering of health insurance plans, the underwriting criteria that may be utilized for such health insurance plans, the type and scope of preexisting waiting periods and creditable coverage, the standards for nonrenewability of coverage, and other requirements related to the availability of health insurance to employers and their employees and dependents in this state in order to minimally meet the federal standards.
The director may also promulgate rules, pursuant to chapter 1-26, pertaining to employer health benefit plans in the areas of:
(1)Definition of terms;
(2)The issuance of certificates of coverage upon loss of health insurance coverage;
(3)Determinations relative to the application of waiting periods;
(4)Special enrollment periods;
(5)Treatment of late enrollees;
(6)Preexisting condition and other waiting periods;
(7)Breaks in coverage;
(8)Affiliation periods;
(9)Nondiscrimination standards;
(10)Notices;
(11)Renewal rights;
(12)Dates of enrollment;
(13)Creditable coverages including methods of crediting coverage;
(14)Risk spreading mechanisms;
(15)Requirements pertaining to mental health benefit levels in employer group plans other than small employer group plans;
(16)Continuation and conversion requirements; and
(17)Claims, provided the rules are consistent with applicable federal requirements for claims procedures, administration, and enforcement, including 29 CFR Part 2560.
Source:
SL 1997, ch 289, §25; SL 1998, ch 289, §22; SL 2001, ch 280, §16; SL 2002, ch 236, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-80 - Health insurance policies to provide coverage for biologically-based mental illnesses.

58-18-80. Health insurance policies to provide coverage for biologically-based mental illnesses.
Every group health insurance policy, including a certificate that is subject to approval pursuant to §58-11-12, 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 provide, in writing, coverage for the treatment and diagnosis of biologically-based mental illnesses with the same dollar limits, deductibles, coinsurance factors, and restrictions as for other covered illnesses.
The term, biologically-based mental illness, means schizophrenia and other psychotic disorders, bipolar disorder, major depression, and obsessive-compulsive disorder.
Source:
SL 1998, ch 291, §2; SL 1999, ch 251, §2; SL 2000, ch 244, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-81 - Application--Exemptions.

58-18-81. Application--Exemptions.
The provisions of §58-18-80 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; or
(15)Individual health benefit plans of six-months duration or less that are not renewable.
Source:
SL 1998, ch 291, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-82 - Carrier to provide annual report--Time frame--Information.

58-18-82. Carrier to provide annual report--Time frame--Information.
Any carrier who is or has provided coverage to an employer shall provide, at the written request of the employer, annual reports of the claims experience of that employer for the immediate past policy period and for any time frames which are not in excess of three years prior to the policy period for which the request was made. A carrier is not required to provide any claims information that pertains to a prior carrier's experience with that employer. The claims report shall be in sufficient detail so as to provide the employer with data necessary to realistically assess the employer's future health insurance needs.
Source:
SL 1998, ch 289, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-83 - Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.

58-18-83. Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.
Every group health insurance policy, including a certificate that is subject to approval pursuant to §58-11-12, delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for special 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, §3; SL 2000, ch 244, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-84 - Diabetes coverage not required of certain plans and policies.

58-18-84. Diabetes coverage not required of certain plans and policies.
The provisions of §58-18-83 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, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-85 - Policies to provide coverage for prostate cancer screening.

58-18-85. Policies to provide coverage for prostate cancer screening.
Every group health insurance policy that covers a male and 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 provide the following coverage for diagnostic screening for prostate cancer:
(1)An annual medically recognized diagnostic examination, including a digital rectal examination and a prostate-specific antigen test, as follows:
(a)For asymptomatic men aged fifty and over; and
(b)For men aged forty-five and over at high risk for prostate cancer; and
(2)For males of any age who have a prior history of prostate cancer, medically indicated diagnostic testing at intervals recommended by a physician, including the digital rectal examination, prostate-specific antigen test, and bone scan.
Source:
SL 2001, ch 277, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-86 - Plans subject to § 58-18-45--Exceptions.

58-18-86. Plans subject to §58-18-45--Exceptions.
Any accident and sickness plan or certificate other than credit health insurance as defined in subdivision 58-19-2(1) and a health benefit plan is subject to subdivision 58-18-45(1).
Source:
SL 2001, ch 275, §6; SL 2013, ch 248, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-87 - Director to promulgate rules governing use of genetic information.

58-18-87. Director to promulgate rules governing use of genetic information.
The director may promulgate rules pursuant to chapter 1-26 pertaining to the use of genetic information, whether the genetic information was derived from a genetic test or from another source, as it relates to group health benefit plans.
Source:
SL 2001, ch 267, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-88 - Authorization of self-funded multiple employer trust sponsored by association--Conditions.

58-18-88. Authorization of self-funded multiple employer trust sponsored by association--Conditions.
A self-funded multiple employer trust, as defined in section 3 of the federal Employee Retirement Income Security Act of 1974, 29 U.S.C. §1002, paragraph 40, that is sponsored by an association, may be authorized by the director if the multiple employer trust meets all of the following conditions:
(1)The multiple employer trust is administered by an authorized insurer or a licensed or registered third-party administrator;
(2)The multiple employer trust is sponsored and maintained by a bona fide association of employers eligible to procure coverage under §§58-18-3 and 58-18-4;
(3)The association sponsoring the multiple employer trust is established by employers in a homogenous trade, industry, line of business, or profession with commonality of interest. The association has a constitution or bylaws, and is organized under the laws of South Dakota;
(4)The association sponsoring the multiple employer trust has a substantial business purpose other than sponsorship of an employer welfare benefit plan;
(5)The association sponsoring the multiple employer trust is a nonprofit entity organized under applicable South Dakota law;
(6)The multiple employer trust's board of trustees shall assess participating employers in an amount necessary to remedy deficiencies at any time the assets and stop loss insurance policies of the multiple employer trust are insufficient to:
(a)Pay claims made against the multiple employer trust;
(b)Discharge liabilities and obligations relating to health benefit plan claims; or
(c)Maintain adequate reserves and surpluses;
(7)The multiple employer trust:
(a)Meets the capital and surplus requirements of §58-6-23;
(b)Meets the risk based capital requirements of §58-4-48;
(c)Is subject to the hazardous financial condition requirements of §§58-4-39 to 58-4-42, inclusive;
(d)Invests its assets pursuant to the requirements of chapters 58-26 and 58-27;
(e)Is subject to chapter 58-3 on the same basis as insurers;
(f)Is subject to the insurers supervision, rehabilitation, and liquidation provisions of chapter 58-29B;
(g)Maintains a minimum loss ratio of eighty-five percent or be community rated; and
(h)Complies with all coverage mandates that are applicable to group health insurance under this title;
(8)Each sponsoring association is comprised of and controlled by employer members, consists of five hundred or more covered employees, and has been in existence for a period of three continuous years;
(9)Any solicitation or sales materials to prospective members discloses the provisions regarding fees and assessments for participation in the multiple employer trust; and
(10)The director, after consideration of the impact on the insurance-buying public, determines that the arrangement is in the best interests of the public.
Source:
SL 2005, ch 272, §2; SL 2014, ch 238, §1; SL 2019, ch 212, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-88.1 - Request for waiver by association formed in another state.

58-18-88.1. Request for waiver by association formed in another state.
An association not formed in this state may request a waiver of subdivisions 58-18-88(3) and (5) regarding organization in South Dakota to sponsor a multiple employer trust in this state if the association provides sufficient evidence a waiver is in the best interests of the insurance-buying public. An association not formed in this state shall be in full compliance with the laws of all states where the association does business.
Source:
SL 2019, ch 212, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-89 - Promulgation of rules pertaining to multiple employer trusts.

58-18-89. Promulgation of rules pertaining to multiple employer trusts.
The director shall promulgate rules, pursuant to chapter 1-26, pertaining to multiple employer trusts in the following areas:
(1)Consumer protection issues including minimum coverage standards for health policies; claims processing and payment practices; resolution of consumer complaints; compliance with federal HIPAA standards; plan termination processes and managed care protections; financial and market conduct record keeping and reporting; and unfair trade practices; and
(2)Financial and plan solvency issues including investment capital requirements; surplus and deposit requirements; claims reserves, stop loss coverage, and standards for entry and exit of plan members including a nonrefundable minimum deposit of not less than two thousand five hundred dollars plus two percent of first year contributions on an annual basis; and production of financial statements, audited financial statements, and actuarial opinions.
Source:
SL 2005, ch 272, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-90 - Multiple employer trust not insurance company or association or subject to specified provisions--Exception.

58-18-90. Multiple employer trust not insurance company or association or subject to specified provisions--Exception.
Except as otherwise provided in this chapter, an authorized multiple employer trust may not be determined to be or considered to be an insurance company or association of any kind or character under this title, or subject to the provisions of §§58-8-6 to 58-8-19, inclusive.
Source:
SL 2005, ch 272, §4; SL 2019, ch 212, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-91 - Suspension or revocation of authorization of multiple employer trust--Action in lieu of suspension or revocation.

58-18-91. Suspension or revocation of authorization of multiple employer trust--Action in lieu of suspension or revocation.
A multiple employer trust authorized under this chapter may have its authorization suspended or revoked by the director for violating any applicable provision of this title. The director may take action in lieu of suspension or revocation as though the trust were an insurer as provided by §58-4-28.1.
Source:
SL 2005, ch 272, §5; SL 2019, ch 212, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-92 - Payment of premium taxes.

58-18-92. Payment of premium taxes.
If not otherwise provided, a multiple employer trust doing business in this state on a self-funded basis shall pay premium taxes as required in chapter 10-44 based upon the amount each participating employer contributes, including any amounts contributed by employees and dependents, to the plan on an annual basis. If a multiple employer trust purchases excess or stop loss coverage, the multiple employer trust may not be taxed additionally for that coverage.
Source:
SL 2005, ch 272, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-93 - Agent licensing requirements.

58-18-93. Agent licensing requirements.
No agent may sell, solicit, or negotiate a self-funded multiple employer trust authorized under this chapter unless the agent is licensed to sell life and health insurance pursuant to chapter 58-30.
Source:
SL 2005, ch 272, §7; SL 2019, ch 212, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-94 - Application of provisions regarding multiple employer trusts--Inclusion of large and small employers.

58-18-94. Application of provisions regarding multiple employer trusts--Inclusion of large and small employers.
The provisions of this chapter regarding multiple employer trusts do not apply to any single employer self-funded plan as preempted by Employee Retirement Income Security Act of 1974, 29 U.S.C. §1144 or any arrangement exempted pursuant to §1-24-17. An authorized self-funded multiple employer trust may include as participating employers both small employers and large employers.
Source:
SL 2005, ch 272, §8; SL 2019, ch 212, §11.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18 - Group And Blanket Health Insurance Policies › Section 58-18-95 - Coverage for treatment of hearing impairment for persons under age nineteen.

58-18-95. Coverage for treatment of hearing impairment for persons under age nineteen.
Any qualified health plan issued on or after January 1, 2015, that offers coverage for professional audiology services shall include coverage for medically necessary physician services appropriate for the treatment of hearing impairment to a person under the age of nineteen. This shall include professional services rendered by an audiologist licensed pursuant to chapter 36-24.
The benefits provided shall be subject to the same dollar limits, deductibles, coinsurance and other limitations provided for other covered benefits in the policy.
Nothing in this section requires the payment by the health plan of hearing aids, devices, or equipment to correct hearing impairment or loss.
Source:
SL 2014, ch 237, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-54 - Allowable expenses defined.

58-18A-54. Allowable expenses defined.
For the purposes of this chapter, the term, allowable expense, means any health care expense, including coinsurance or copayments and without reduction for any applicable deductible, that is covered in full or in part by any of the plans covering the person.
If a plan is advised by a covered person that all plans covering the person are high-deductible health plans and the person intends to contribute to a health savings account established in accordance with section 223 of the Internal Revenue Code of 1986, the primary high-deductible health plan's deductible is not an allowable expense, except for any health care expense incurred that may not be subject to the deductible as described in section 223(c)(2)(C) of the Internal Revenue Code of 1986.
An expense or a portion of an expense that is not covered by any of the plans is not an allowable expense.
Any expense that a provider by law or in accordance with a contractual agreement is prohibited from charging a covered person is not an allowable expense.
Source:
SL 2006, ch 259, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-55 - Expenses that are not allowable.

58-18A-55. Expenses that are not allowable.
The following are examples of expenses that are not allowable expenses:
(1)If a person is confined in a private hospital room, the difference between the cost of a semi-private room in the hospital and the private room is not an allowable expense, unless one of the plans provides coverage for private hospital room expenses;
(2)If a person is covered by two or more plans that compute their benefit payments on the basis of usual and customary fees or relative value schedule reimbursement or other similar reimbursement methodology, any amount charged by the provider in excess of the highest reimbursement amount for a specified benefit is not an allowable expense;
(3)If a person is covered by two or more plans that provide benefits or services on the basis of negotiated fees, any amount in excess of the highest of the negotiated fees is not an allowable expense; and
(4)If a person is covered by one plan that calculates its benefits or services on the basis of usual and customary fees or relative value schedule reimbursement or other similar reimbursement methodology and another plan that provides its benefits or services on the basis of negotiated fees, the primary plan's payment arrangement shall be the allowable expense for all plans. However, if the provider has contracted with the secondary plan to provide the benefit or service for a specific negotiated fee or payment amount that is different than the primary plan's payment arrangement and if the provider's contract permits, that negotiated fee or payment shall be the allowable expense used by the secondary plan to determine its benefits.
Source:
SL 2006, ch 259, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-56 - Exclusion of certain expenses.

58-18A-56. Exclusion of certain expenses.
For the purposes of this chapter, the term, allowable expense, may exclude certain types of coverage or benefits such as dental care, vision care, prescription drugs, or hearing aids. A plan that limits the application of COB to certain coverages or benefits may limit the definition of allowable expense in its contract to expenses that are similar to the expenses that it provides. If COB is restricted to specific coverages or benefits in a contract, the definition of allowable expense shall include similar expenses to which COB applies.
If a plan provides benefits in the form of services, the reasonable cash value of each service shall be considered an allowable expense and a benefit paid.
The amount of the reduction may be excluded from allowable expense if a covered person's benefits are reduced under a primary plan because the covered person does not comply with the plan provisions concerning second surgical opinions or pre-certification of admissions or services, or because the covered person has a lower benefit because the covered person did not use a preferred provider.
Source:
SL 2006, ch 259, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-57 - Plan defined--Types of coverage considered in coordination of benefits to be stated.

58-18A-57. Plan defined--Types of coverage considered in coordination of benefits to be stated.
For the purposes of this chapter, the term, plan, means a form of coverage with which coordination is allowed. Separate parts of a plan for members of a group that are provided through alternative contracts that are intended to be part of a coordinated package of benefits are considered one plan and there is no COB among the separate parts of the plan.
If a plan coordinates benefits, its contract shall state the types of coverage that will be considered in applying the COB provision of that contract. Whether the contract uses the term, plan, or some other term such as program, the contractual definition may be no broader than the definition of plan in this section.
Source:
SL 2006, ch 259, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-58 - Contracts and coverages included within definition of plan.

58-18A-58. Contracts and coverages included within definition of plan.
For the purposes of this chapter, the term, plan, includes:
(1)Group and nongroup insurance contracts and subscriber contracts;
(2)Uninsured arrangements of group or group-type coverage;
(3)Group and nongroup coverage through closed panel plans;
(4)Group-type contracts;
(5)The medical care components of long-term care contracts, such as skilled nursing care;
(6)The medical benefits coverage in automobile no fault and traditional automobile fault type contracts;
(7)Medicare or other governmental benefits, as permitted by law, except for the medical assistance program. That part of the definition of plan may be limited to the hospital, medical, and surgical benefits of the governmental program; and
(8)Group and nongroup insurance contracts and subscriber contracts that pay or reimburse for the cost of dental care.
Source:
SL 2006, ch 259, §6; SL 2007, ch 290, §1; SL 2015, ch 253, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-59 - Contracts and coverages not included within definition of plan.

58-18A-59. Contracts and coverages not included within definition of plan.
For the purposes of this chapter, the term, plan, does not include:
(1)Hospital indemnity coverage benefits or other fixed indemnity coverage;
(2)Accident only coverage;
(3)Specified disease or specified accident coverage;
(4)Limited benefit health coverage;
(5)School accident-type coverages that cover students for accidents only, including athletic injuries, either on a twenty-four-hour basis or on a to-and-from-school basis;
(6)Medicare supplement policies;
(7)A state plan under the medical assistance program;
(8)A governmental plan, which, by law, provides benefits that are in excess of those of any private insurance plan or other nongovernmental plan ; or
(9)Benefits provided in long-term care insurance policies for nonmedical services including personal care, adult day care, homemaker services, assistance with activities of daily living, respite care and custodial care, or for contracts that pay a fixed daily benefit without regard to expenses incurred or the receipt of services.
Source:
SL 2006, ch 259, §7; SL 2007, ch 290, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-60 - Application date.

58-18A-60. Application date.
Sections 58-18A-53 to 58-18A-83, inclusive, apply to all plans that are issued on or after January 1, 2007.
Source:
SL 2006, ch 259, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-61 - Promulgation of rules concerning coordination of health plan benefits.

58-18A-61. Promulgation of rules concerning coordination of health plan benefits.
The director shall promulgate rules pursuant to chapter 1-26 to carry out the provisions of §§58-18A-53 to 58-18A-83, inclusive. In promulgating any rules, the director shall give great weight to any national standards that may exist for the coordination of benefits for plans. The rules are limited to:
(1)Definition of terms;
(2)Sample policy provisions; and
(3)Disclosure requirements.
Source:
SL 2006, ch 259, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-62 - Prohibited grounds for reduction of benefits.

58-18A-62. Prohibited grounds for reduction of benefits.
No COB provision may be used that permits a plan to reduce its benefits on the basis that:
(1)Another plan exists and the covered person did not enroll in that plan;
(2)A person is or could have been covered under another plan, except with respect to Part B of Medicare; or
(3)A person has elected an option under another plan providing a lower level of benefits than another option that could have been elected.
Source:
SL 2006, ch 259, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 18A - Coordination Of Benefits Of Health Plans › Section 58-18A-63 - Restriction on excess or secondary benefits provisions.

58-18A-63. Restriction on excess or secondary benefits provisions.
No plan may contain a provision that its benefits are always excess or always secondary except in accordance with the rules permitted by §§58-18A-53 to 58-18A-83, inclusive. No plan is required to coordinate benefits provided that it pays benefits as a primary plan; but if the plan coordinates benefits, it shall do so in compliance with the provisions of this chapter.
Source:
SL 2006, ch 259, §11.