reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-72 - Transitional period when additional class of business acquired.

58-17-72. Transitional period when additional class of business acquired.
The director may provide for a period of transition in order for a carrier to come into compliance with §58-17-71 in the instance of acquisition of an additional class of business from another carrier.
Source:
SL 1996, ch 286, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-73 - Director approval required to establish additional classes of business--Rates or rating methodologies.

58-17-73. Director approval required to establish additional classes of business--Rates or rating methodologies.
The director may approve the establishment of additional classes of business upon application to the director and a finding by the director that such action would enhance the efficiency and fairness of the individual marketplace. Nothing in §§58-17-66 to 58-17-87, inclusive, requires a carrier to change any of its rates or rating methodologies for any business other than the individual business subject to the provisions of §§58-17-66 to 58-17-87, inclusive.
Source:
SL 1996, ch 286, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-74 - Provisions for premium rates for individual health benefit plans.

58-17-74. Provisions for premium rates for individual health benefit plans.
Premium rates for individual health benefit plans subject to §§58-17-66 to 58-17-87, inclusive, are subject to the following provisions:
(1)Any new policy issued after the effective date of §§58-17-66 to 58-17-87, inclusive, is subject to the provisions of §§58-17-66 to 58-17-87, inclusive;
(2)The index rate for a rating period for any class of individual business may not exceed the index rate for any other class of individual business by more than twenty percent;
(3)For a class of business, the premium rates charged during a rating period to individuals with similar case characteristics for the same or similar coverage, or the rates that could be charged to such individuals under the rating system for that class of business, may not vary from the index rate by more than thirty percent of the index rate;
(4)An adjustment applied to a single block of business may not exceed the adjustment applied to all blocks of business by more than fifteen percent due to the claim experience or health status of that block of business;
(5)Any adjustment in rates for claim experience and duration of coverage may not be charged to specific individual policyholders. Any such adjustment shall be applied uniformly to the rates charged for any person and dependents of the person within each class of business;
(6)Premium rates for individual health benefit plans shall comply with the requirements of §§58-17-66 to 58-17-87, inclusive;
(7)Each carrier shall apply rating factors consistently with respect to all persons in a class of business. Rating factors shall produce premiums for identical persons which differ only by the amounts attributable to plan design;
(8)No carrier may use characteristics other than age, gender, lifestyle, family composition, and geographic area without prior approval of the director. The maximum rating differential based solely on age may not exceed a factor of 5:1; and
(9)All rate adjustments based on geographic area shall reflect actual differences in the health care costs of the respective areas.
The rating provisions of subdivisions (1), (2), (3), (4), and (6) of this section do not apply to individual health benefit plans issued by a carrier to qualifying individuals on a guaranteed issue basis. However, the rate for any individual covered on a guaranteed issue basis may not exceed two and one half times the base rate of the class of business with the lowest index rate.
Source:
SL 1996, ch 286, §9; SL 2008, ch 263, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-74.1 - Premium rate limitations.

58-17-74.1. Premium rate limitations.
Any health benefit plan issued before July1, 1996, is subject to the rating limitations provided in this section. For a class of business, the premium rates charged during a rating period to individuals with similar case characteristics for the same or similar coverage, or the rates that could be charged to such individuals under the rating system for that class of business, may not exceed three times the base premium rate after July1, 2001, two and one-half times the base premium rate after July 1, 2003, and two times the base premium rate after July1, 2005.
Source:
SL 2000, ch 240, §1; SDCL §58-17-4.3; SL 2005, ch 10, §41.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-75 - Promulgation of rules for rates charged for individual health benefit plans.

58-17-75. Promulgation of rules for rates charged for individual health benefit plans.
The director shall promulgate rules pursuant to chapter 1-26 to ensure that rating practices used by carriers are consistent with the purposes of §§58-17-66 to 58-17-87, inclusive, including rules that ensure that differences in rates charged for individual health benefit plans by carriers are reasonable, and reflect objective differences in plan design, age, and gender of the insured.
Source:
SL 1996, ch 286, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-76 - Transfer into or out of class of business.

58-17-76. Transfer into or out of class of business.
No carrier may transfer a person involuntarily into or out of a class of business. No carrier may offer to transfer a person into or out of a class of business unless such an offer is made to transfer all persons in the class of business without regard to claim experience or duration of coverage since issue.
Source:
SL 1996, ch 286, §11.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-77 - Temporary suspension of premium rates for individual health insurance--Reasons.

58-17-77. Temporary suspension of premium rates for individual health insurance--Reasons.
The director may suspend for a specified period the application of subdivision 58-17-74(2) as to the premium rates for one or more rating periods upon a filing by the carrier and a finding by the director either that the suspension is reasonable in light of the financial condition of the carrier or that the suspension would enhance the efficiency and fairness of the marketplace for individual health insurance.
Source:
SL 1996, ch 286, §12.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-78 - Required disclosure when offering individual health benefit plan.

58-17-78. Required disclosure when offering individual health benefit plan.
In connection with the offering for sale of any individual health benefit plan to a person, a carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of:
(1)The extent to which premium rates for a specified person are established or adjusted based upon age and gender;
(2)The provisions of the individual health benefit plan concerning the carrier's right to change premium rates and the factors that affect changes in premium rates;
(3)The provisions relating to renewability of policies and contracts; and
(4)The provisions relating to any preexisting condition provision.
Source:
SL 1996, ch 286, §13.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-79 - Documentation of rating methods and practices.

58-17-79. Documentation of rating methods and practices.
Each carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.
Source:
SL 1996, ch 286, §14.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-81 - Availability of information on rating methods and practices of carriers offering individual health benefit plans.

58-17-81. Availability of information on rating methods and practices of carriers offering individual health benefit plans.
A carrier shall make the information and documentation described in §58-17-79 available to the director upon request. Except in cases of violations of §§58-17-66 to 58-17-87, inclusive, the information is proprietary and trade secret information and may not be disclosed by the director to persons outside of the division, except in the case of an administrative proceeding, to the Office of Hearing Examiners or the court in question or except as agreed to by the carrier or as ordered by a court of competent jurisdiction.
Source:
SL 1996, ch 286, §16.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-83 - Election not to renew individual health benefit plan--Future business restricted.

58-17-83. Election not to renew individual health benefit plan--Future business restricted.
No carrier that elects not to renew an individual health benefit plan under subdivision 58-17-82(4) may write new business in the individual health benefit plan market in the state for a period of five years from the date of notice to the director.
Source:
SL 1996, ch 286, §18.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-84.1 - (Text of section effective until the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospitalization for dental care to be provided certain covered persons.

58-17-84.1.(Text of section effective until the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospitalization for dental care to be provided certain covered persons.
Any health benefit plan as defined by §58-17-63 shall cover anesthesia and hospital charges for dental care provided to a covered person who:
(1)Is a child under age five; or
(2)Is severely disabled or otherwise suffers from a developmental disability as determined by a licensed physician which places such person at serious risk.
Such coverage applies regardless of whether the services are provided in a hospital or a dental office. A health carrier may require prior authorization of hospitalization for dental care procedures in the same manner that prior authorization is required for hospitalization for other covered diseases or conditions.
(Text of section effective the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospital or ambulatory surgery center charges for dental care to be covered for certain persons. Any health benefit plan as defined by §58-17-63 shall cover anesthesia and hospital or ambulatory surgery center charges for dental care provided to a covered person who:
(1)Is a child under age five; or
(2)If determined by a licensed physician, is severely disabled, has a developmental disability, or otherwise has a medical condition that places the person at serious medical risk.
The coverage applies regardless of whether the services are provided in a hospital, ambulatory surgery center, or a dental office. A health carrier may require prior authorization in the same manner that prior authorization is required for other covered diseases or conditions.
Source:
SL 1999, ch 248, §2; SL 2018, ch 279, §1, eff. Jan. 1, 2019.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-87 - Director to promulgate rules for individual health insurance--Scope of rules.

58-17-87. Director to promulgate rules for individual health insurance--Scope of rules.
The director shall promulgate rules pursuant to chapter 1-26 to cover:
(1)Terms or renewability;
(2)Conditions of eligibility;
(3)Benefit limitations, exceptions, and reductions;
(4)Definition of terms;
(5)Filing requirements for forms, rates, and rate schedules;
(6)Marketing practices;
(7)Reporting practices;
(8)Compensation arrangements between insurers or other entities and their agents, representatives, or producers;
(9)Suitability and appropriateness of the policy sold;
(10)Certificates of coverage;
(11)Determinations with regard to waiting periods;
(12)College plans;
(13)Creditable coverages;
(14)Breaks in coverage;
(15)The application of waiting periods; and
(16)Risk spreading mechanisms.
The director shall promulgate rules pursuant to chapter 1-26 that specify prohibited policy or certificate provisions not otherwise specifically authorized by statute which, in the opinion of the director, are unjust, unfair, or unfairly discriminatory to any person insured or proposed for coverage under an individual policy or certificate. The director shall also promulgate rules pursuant to chapter 1-26 assuring public access to rate and form information and establishing procedures for rate and form approvals and disapprovals. If any federal standards are in place which would require additional steps to meet those standards beyond what is required by this chapter, the director shall promulgate rules to require the offering of health insurance plans, the underwriting and coverage criteria that may be utilized for such health insurance plans, and other requirements related to the coverage criteria and availability of health insurance to individuals in this state in order to minimally meet the federal standards.
Source:
SL 1996, ch 286, §22; SL 1997, ch 289, §6; SL 1998, ch 289, §4; SL 2021, ch 210, § 11.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-88 - Minimum inpatient care coverage following delivery.

58-17-88. Minimum inpatient care coverage following delivery.
If a 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 §58-17-89. Any policy 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, §1; SL 1998, ch 290, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-89 - Shorter hospital stay permitted--Follow-up visit within forty-eight hours required.

58-17-89. Shorter hospital stay permitted--Follow-up visit 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 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 §58-17-88 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, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-90 - Notice to policyholders--Disclosures.

58-17-90. Notice to policyholders--Disclosures.
The health insurer shall provide notice to policyholders regarding the coverage required by §§58-17-88 and 58-17-89 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 policyholders in the next mailing to policyholders, in the yearly informational packet sent to policyholders, or by January 1, 1997, whichever is earliest.
Source:
SL 1996, ch 292, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-97 - Provisions covering preexisting conditions.

58-17-97. Provisions covering preexisting conditions.
Any accident and sickness policy or certificate subject to the provisions of this chapter, other than credit health insurance as defined in subdivision 58-19-2(1) and a health benefit plan as defined in §58-17-66, shall comply with the following provisions:
(1)No policy or certificate may deny, exclude, or limit benefits for a covered individual for claims incurred more than twelve months following the effective date of the person's coverage due to a preexisting condition;
(2)No policy or certificate may define a preexisting condition more restrictively than:
(a)A condition that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment during the twelve months immediately preceding the effective date of coverage;
(b)A condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve months immediately preceding the effective date of coverage; or
(c)A pregnancy existing on the effective date of coverage.
Source:
SL 1997, ch 288, §2; SL 2001, ch 275, §4; SL 2013, ch 248, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-98 - Health insurance policies to provide coverage for biologically-based mental illnesses.

58-17-98. Health insurance policies to provide coverage for biologically-based mental illnesses.
Every policy of health insurance 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, §1; SL 1999, ch 251, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-99 - Application of § 58-17-98--Exemptions.

58-17-99. Application of §58-17-98--Exemptions.
The provisions of §58-17-98 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 17 - Health Insurance Policies › Section 58-17-100 - Definitions.

58-17-100. Definitions.
Terms used in §§58-17-100 to 58-17-106, inclusive, mean:
(1)"FDA," the federal Food and Drug Administration;
(2)"Health insurer," any person who provides health insurance in this state. The term includes a licensed insurance company, a prepaid hospital or medical service plan, a health maintenance organization, a multiple employer welfare arrangement, or any person providing a plan of health insurance subject to state insurance regulation;
(3)"Life threatening," either or both of the following:
(a)A disease or condition where the likelihood of death is high, unless the course of the disease is interrupted; or
(b)A disease or condition with potentially fatal outcomes where the end point of clinical intervention is survival;
(4)"Medical literature," a published scientific study in a journal or other publication in which original manuscripts have been published only after critical review for scientific accuracy, validity, and reliability by unbiased independent experts and a determination by the International Committee of Medical Journal Editors that it meets the Uniform Requirements for Manuscripts submitted to biomedical journals. The term, medical literature, does not include a publication or a supplement to a publication that is sponsored to a significant extent by a pharmaceutical manufacturing company or health carrier;
(5)"Standard reference compendia," one of the following:
(a)The United States Pharmacopeia Drug Information;
(b)DRUGDEX; or
(c)The American Hospital Formulary Service Drug Information;
(6)"Off-label," the use of an FDA approved drug for an indication that is not included in the approved labeling;
(7)"Drug," any substance prescribed by a licensed health care provider acting within the scope of the provider's license and that is intended for use in the diagnosis, mitigation, treatment, or prevention of disease and is taken by mouth; injected into a muscle, the skin, a blood vessel, or cavity of the body; applied to the skin; or otherwise assimilated by the body. The term, drug, includes only those substances that are approved by the FDA for at least one indication.
Source:
SL 2000, ch 242, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-101 - Insurer may not exclude certain off-label uses of prescription drugs.

58-17-101. Insurer may not exclude certain off-label uses of prescription drugs.
No health insurer issuing a policy which provides coverage for prescription drugs may exclude coverage of any drug used for the treatment of cancer or life threatening conditions on the grounds that the drug has not been approved by the FDA for that indication if that drug is recognized for treatment of such indication in one of the standard reference compendia or in the medical literature. The prescribing physician shall submit documentation supporting the proposed off-label use or uses to the insurer, if requested. Any coverage of a drug that serves as the primary treatment required by §§58-17-100 to 58-17-106, inclusive, shall also include medically necessary services associated with the administration of the drug.
Source:
SL 2000, ch 242, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-102 - Exceptions.

58-17-102. Exceptions.
No coverage is required under §§58-17-100 to 58-17-106, inclusive, for the following:
(1)Any drug that has not been fully licensed or approved by the FDA;
(2)The use of any drug if the FDA has determined that use to be contraindicated; or
(3)Any experimental drug not otherwise approved for any indication by the FDA.
Source:
SL 2000, ch 242, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-103 - Provisions limited to cancer or life threatening diseases.

58-17-103. Provisions limited to cancer or life threatening diseases.
The provisions of §§58-17-100 to 58-17-106, inclusive, apply to drugs used in the treatment for cancer or life threatening diseases only, and nothing in §§58-17-100 to 58-17-106, inclusive, may be construed to create, impair, alter, limit, modify, enlarge, abrogate, or prohibit reimbursement for medications used in the treatment of any other disease or condition.
Source:
SL 2000, ch 242, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-104 - Deductibles, copayments, and managed care review not affected.

58-17-104. Deductibles, copayments, and managed care review not affected.
Nothing in §§58-17-100 to 58-17-106, inclusive, may be construed to prevent the application of contractual deductibles or copayment provisions or managed care review.
Source:
SL 2000, ch 242, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-105 - Drugs used in research trials not covered.

58-17-105. Drugs used in research trials not covered.
The following drugs or services are not subject to coverage under §58-17-101:
(1)Any drug that is used in research trials sponsored by the manufacturer of that drug or a governmental entity; or
(2)Any drug or service furnished in a research trial, if the sponsor of the research trial furnishes the drug or service without charge to any participant in the research trial.
Source:
SL 2000, ch 242, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-106 - No reduction or limitation of coverage otherwise required by law.

58-17-106. No reduction or limitation of coverage otherwise required by law.
Sections 58-17-100 to 58-17-106, inclusive, may not be used to reduce or limit coverage for off-label use of drugs otherwise required by law or contract.
Source:
SL 2000, ch 242, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-107 - Health insurance policies to provide coverage for prostate cancer screening.

58-17-107. Health insurance policies to provide coverage for prostate cancer screening.
Every policy of health insurance 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, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-108 - "Disability income insurance" defined.

58-17-108. Disability income insurance defined.
For the purposes of §§58-17-108 to 58-17-112, inclusive, the term, disability income insurance, means a policy or certificate of insurance that primarily provides payment to or for the benefit of the policyholder or certificate holder based, in whole or in part, upon lost wages or other earned income or business or financial losses as a result of an inability to work due to sickness, injury, or a combination of sickness and injury.
Source:
SL 2001, ch 276, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-109 - Exclusion or reduction of benefits.

58-17-109. Exclusion or reduction of benefits.
Any disability income insurance policy may include provisions that exclude or reduce benefits if the insured is collecting other benefits under a government program or is eligible to receive benefits under other insurance coverage. If the insured subsequently receives other benefits for a period for which the insurer paid benefits, the insurer may require reimbursement from the insured for any benefits already paid that otherwise would not have been paid. If the insured fails to make timely application for any other insurance coverage or governmental program for which that insured may be eligible, fails to actively and in good faith pursue all appeals procedures if benefits under other insurance or governmental program have been denied, or fails to produce satisfactory evidence that the applications have been made and the appeals pursued, benefits may be reduced or withheld.
Source:
SL 2001, ch 276, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-111 - Minimum standards--Exceptions.

58-17-111. Minimum standards--Exceptions.
Except for overhead expense, buy-sell coverage, or other similar business disability income insurance coverage, a disability income insurance policy shall meet the following minimum standards:
(1)Provide that periodic payments that are payable at ages after sixty-two and reduced solely on the basis of age are at least fifty percent of the amounts payable immediately prior to age sixty-two or in the case of an employer group plan that has twenty or more employees, that periodic payments are actuarially equivalent regardless of age;
(2)Contain an elimination period no greater than:
(a)Ninety days in the case of coverage providing a benefit of one year or less;
(b)One hundred eighty days in the case of coverage providing a benefit of more than one year but not greater than two years;
(c)Three hundred sixty-five days in the case of coverage providing a benefit of more than two years but not greater than five years; or
(d)Seven hundred thirty days in the case of coverage providing a benefit greater than five years resulting from sickness or injury;
(3)Provide a maximum benefit period of at least six months for long-term disability income insurance and at least twelve weeks for short-term disability income insurance. However, in the case of a policy covering disability arising out of pregnancy, childbirth, or miscarriage, the maximum benefit period may be one month, except if the plan is an employer plan with fifteen or more employees, then the maximum benefit period for pregnancy, childbirth, or miscarriage may not be less than the maximum benefit period for other covered disabilities;
(4)Include no reduction in benefits because of any cost of living increase in social security or similar benefits during a benefit period;
(5)Require only one elimination period if a policy provides total disability income benefits and partial disability income benefits.
A long-term disability income insurance policy may have longer elimination periods if the policy is issued in conjunction with or supplemental to a limited duration self-insured or other short-term disability income policy. The provisions of this section do not apply to an employer plan if at least fifty percent of the covered employee's disability income benefits are subject to federal income taxes.
Source:
SL 2001, ch 276, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-112 - Promulgation of rules regarding disability income policies--Content.

58-17-112. Promulgation of rules regarding disability income policies--Content.
The director may promulgate rules pursuant to chapter 1-26 to protect the insurance-buying public with regard to disability income policies. However, the director shall take into account the effect any such rule may have on the availability of coverage. The rules may include:
(1)Definition of terms;
(2)Permissible exclusions;
(3)Return of premium provisions;
(4)Terms of renewability;
(5)Disclosure requirements;
(6)Benefit triggers, if such rules permit the use of activities of daily living as an acceptable benefit trigger; and
(7)Limitations, exceptions, and reductions.
Source:
SL 2001, ch 276, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-142 - Maximum premium rates for plans issued prior to August 1, 2003--Rate provisions of § 58-17-75 to apply upon carrier's discontinuance of active marketing.

58-17-142. Maximum premium rates for plans issued prior to August 1, 2003--Rate provisions of §58-17-75 to apply upon carrier's discontinuance of active marketing.
Any carrier of any in force individual health benefit plan issued guarantee issued policies prior to August 1, 2003, for which rates are established pursuant to §58-17-75, may set and charge a maximum premium rate of not more than two and two-tenths times the base premium rate until January 1, 2005, and may set and charge a maximum premium rate of not more than two and one-half times the base premium rate for each year thereafter, if the carrier actively markets individual major medical policies in this state during the entire year of 2003 and each year thereafter. If, in any year after 2003, the carrier discontinues actively marketing individual health benefit plans in this state, the premium rate provisions of §58-17-75 apply to those policies in force issued guarantee issued policies from the date of the carrier's discontinuance of active marketing.
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, as of January 1, 2015, and 29 C.F.R. §2590, as of January 1, 2015, and 45 C.F.R. §147, as of January 1, 2015.
Source:
SL 2003 (SS), ch 2, §1, eff. Sept. 26, 2003; SL 2015, ch 249, §27.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-145.1 - Deadline for submission of health claim under risk pool.

58-17-145.1. Deadline for submission of health claim under risk pool.
Any person covered under a risk pool established pursuant to the provisions of §58-17-113 in the State of South Dakota may submit a health claim within six months from June 30, 2015. Each claim shall be submitted in writing to the Bureau of Human Resources. A claim shall be paid in accordance with the South Dakota risk pool plan document in effect July 1, 2014, through June 30, 2015, inclusive.
Source:
SL 2015, ch 249, §30.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-146 - Dental insurers prohibited from setting fees for noncovered service.

58-17-146. Dental insurers prohibited from setting fees for noncovered service.
No contract between an insurer and a dentist may require a dentist to provide services for an insured at a fee set by the contract unless the services are covered services under the terms of the insured's plan or policy. For the purposes of this section, the term, covered services, means services reimbursable under the plan, policy, or contract, subject to such contractual limitations on benefits as may apply, including deductibles, waiting periods, frequency limitations, or charges over the benefit maximum.
Source:
SL 2010, ch 239, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-146.1 - Certain contract terms voidable by dentist.

58-17-146.1. Certain contract terms voidable by dentist.
Any assignment or other contractual term in an agreement between an insurer and a dentist that purports to share, transfer, or assign contractual discounts to a third party insurer or entity, without relinquishing the insurer's rights, is severable and voidable at the dentist's option at the time the agreement is executed by the dentist. The third party access provision of the agreement shall be clearly identified.
For purposes of this section, a third party insurer or entity does not include an insurer or entity operating under the same brand licensee program as the contracting insurer.
Source:
SL 2021, ch 212, § 1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-147 - Elective abortion coverage prohibited in qualified health plan offered through health insurance exchange.

58-17-147. Elective abortion coverage prohibited in qualified health plan offered through health insurance exchange.
Pursuant to the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, no qualified health plan offered through a health insurance exchange established in the state may include elective abortion coverage.
For the purposes of this section, an elective abortion is an abortion performed for any reason other than a medical emergency as set forth in subdivision 34-23A-1(5).
Source:
SL 2012, ch 245, §§1, 2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-148 - Qualified health plan sold through exchange to provide for placement through licensed insurance producer--Commissions.

58-17-148. Qualified health plan sold through exchange to provide for placement through licensed insurance producer--Commissions.
Any qualified health plan as defined by the Patient Protection and Affordable Care Act of 2010 sold in South Dakota through a public health care exchange, as mandated by the Patient Protection and Affordable Care Act of 2010, shall provide for placement through a licensed insurance producer upon enrollment. Any commission paid by a health insurance carrier for the sale of a qualified health plan through a public health exchange shall be the same as a commission paid by the same health insurance carrier outside the public exchange for a similar plan.
Source:
SL 2013, ch 249, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-149 - Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period.

58-17-149. Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period.
Terms used in §§58-17-149 to 58-17-152, inclusive, mean:
(1)"Application date," the date on which a health insurer or other entity responsible for the credentialing of health care professionals on behalf of the health insurer receives the health care professional's completed application for credentialing or change request;
(2)"Clean claim," as defined in §58-12-19;
(3)"Health care professional," as defined in subdivision 58-17F-1(8);
(4)"Health insurer," as defined in subdivision 58-17-100(2);
(5)"Special Review," a supplemental review of a health care professional's completed application for credentialing or change request by a health insurer or other entity responsible for credentialing of health care professionals necessitated by credible evidence received by a health insurer or other entity responsible for credentialing of health care professionals as it relates to investigation of the following: action taken against the applicant's licensure status, action taken against the applicant's professional society status, verified complaints to facilities, or licensing agency regarding the applicant; the applicant's non-completion of training programs; a criminal proceeding brought against the applicant a malpractice claim brought against the applicant; loss of a Drug Enforcement Administration certificate or state-controlled substance certificate; loss of a Medicare or Medicaid certification status; or involuntary termination of credentialing by a different health insurer.
Source:
SL 2014, ch 236, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-151 - Applications to be credentialed.

58-17-151. Applications to be credentialed.
Within ten business days of receiving a request for an application to be credentialed by a health care professional, a health insurer or other entity responsible for the credentialing of health care professionals on behalf of the health insurer shall send an application form to the professional, unless the application to be credentialed is available electronically on a public website. The application form shall identify and itemize all documentation and other information that the insurer or entity must receive in order for an application to be complete.
Source:
SL 2014, ch 236, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-152 - Application of §§ 58-17-149 to 58-17-151.

58-17-152. Application of §§58-17-149 to 58-17-151.
Nothing in §§58-17-149 to 58-17-151, inclusive, applies to services provided by a health care professional that are covered by Medicaid, Medicare, TRICARE, or other health care benefit program subject to federal regulations regarding eligibility and provider payments. Nothing in §§58-17-149 to 58-17-151, inclusive, requires a health insurer or other entity responsible for credentialing health care professionals on behalf of the health insurer to take any action in violation of the requirements of the National Committee for Quality Assurance (NCQA) or Utilization Review Accreditation Commission (URAC).
Nothing in §§58-17-149 to 58-17-151, inclusive, requires a health insurer or other entity responsible for credentialing health care professionals on behalf of the health insurer to credential a health care professional or to permit a non-credentialed health care professional to participate in the health insurer's provider network.
Source:
SL 2014, ch 236, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-153 - Coverage for treatment of hearing impairment for persons under age nineteen.

58-17-153. 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, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-154 - Definitions for §§ 58-17-155 to 58-17-162.

58-17-154. Definitions for §§58-17-155 to 58-17-162.
Terms used in §§58-17-155 to 58-17-162, inclusive, mean:
(1)"Applied behavior analysis," the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior;
(2)"Autism spectrum disorder," a complex neurodevelopmental medical disorder characterized by social impairment, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior;
(3)"Behavioral health treatment," evidence-based interventions that:
(a)Achieve specific improvements in functional capacity of a person; and
(b)Are provided or supervised by a licensed practitioner as provided in §58-17-159;
(4)"Treatment," evidence-based care which is prescribed or ordered for a person diagnosed with an autism spectrum disorder by a licensed physician or psychologist, including:
(a)Behavioral health treatment;
(b)Pharmacy care; and
(c)Therapeutic care.
Source:
SL 2015, ch 250, §1; SL 2017, ch 212, §1, eff. Jan. 1, 2018.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-155 - Exceptions to application of §§ 58-17-154 to 58-17-162.

58-17-155. Exceptions to application of §§58-17-154 to 58-17-162.
Nothing in §§58-17-154 to 58-17-162, inclusive, applies to nongrandfathered plans in the individual and small group markets that are required to include essential health benefits under the federal Patient Protection and Affordable Care Act of 2010, as in effect on January 1, 2015, or to Medicare supplement, accident-only, specified disease, hospital indemnity, disability income, long-term care, major medical policies with a limited duration of less than twelve months, or other limited benefit hospital insurance policies, or any plan or coverage exempted from state regulation by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 18, as in effect on January 1, 2015.
Source:
SL 2015, ch 250, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-156 - Policies, contracts, certificates, and plans subject to §§ 58-17-154 to 58-17-162.

58-17-156. Policies, contracts, certificates, and plans subject to §§58-17-154 to 58-17-162.
Except as provided in §58-17-155, §§58-17-154 through 58-17-162 apply to all individual and group health insurance policies, contracts, and certificates issued by health carriers as defined in §58-17H-1 and self-funded nonfederal governmental plans with the exception of the state employee health plan sponsored by the State of South Dakota.
Source:
SL 2015, ch 250, §3; SL 2020, ch 209, § 6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-157 - Coverage for applied behavior analysis for treatment of autism spectrum disorders.

58-17-157. Coverage for applied behavior analysis for treatment of autism spectrum disorders.
Every policy, contract, certificate, or plan subject to the provisions of §§58-17-154 to 58-17-162, inclusive, shall provide coverage for applied behavior analysis for the treatment of autism spectrum disorders consistent with §§58-17-154 to 58-17-162, inclusive.
Source:
SL 2015, ch 250, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-158 - Authorization, prior approval, and other care management requirements--Annual maximum benefit.

58-17-158. Authorization, prior approval, and other care management requirements--Annual maximum benefit.
Coverage for an applied behavior analysis may be subject to pre-authorization, prior approval, and other care management requirements including limits on the number of individual visits a person may make for applied behavior analysis subject to the general care management provisions of the plan, and may be subject to dollar limits, deductibles, copayments, or coinsurance provisions that apply to other medical or surgical services covered under the policy. The coverage for applied behavior analysis shall provide an annual maximum benefit that may not be less than the following:
(1)Through age 6 $36,000
(2)Age 7 through age 13 $25,000
(3)Age 14 through age 18 $12,500
Source:
SL 2015, ch 250, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-159 - Qualifications of person performing or supervising applied behavior analysis.

58-17-159. Qualifications of person performing or supervising applied behavior analysis.
Any person who performs or supervises applied behavior analysis shall:
(1)Be licensed by the South Dakota Board of Medical and Osteopathic Examiners or the Board of Examiners of Psychologists and have documented training and competence in applied behavior analysis; or
(2)Be licensed by the South Dakota Board of Social Workers as a licensed behavior analyst.
Source:
SL 2015, ch 250, §6; SL 2017, ch 212, §2, eff. Jan. 1, 2018.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-160 - Review of treatment.

58-17-160. Review of treatment.
A health carrier or plan provider subject to §§58-17-154 to 58-17-162, inclusive, shall have the right to request a review of the treatment that a person is receiving not more than once every three months unless the insurer and the person's licensed physician or licensed psychologist execute an agreement that a more frequent review is necessary. Any agreement regarding the right to review a treatment plan more frequently applies only to a particular person receiving applied behavior analysis and may not apply to all persons receiving applied behavior analysis by a licensed physician, licensed psychologist, or licensed behavior analyst. The cost of obtaining a review under this section shall be paid by the health carrier or plan.
Source:
SL 2015, ch 250, §7; SL 2017, ch 212, §3, eff. Jan. 1, 2018.