reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-76 - Notification of suspected fraud.

58-33-76. Notification of suspected fraud.
An insurer, or any person authorized to act on its behalf, which reasonably believes that a false or fraudulent claim, statement, or representation has occurred, may notify an authorized agency and provide it with all relevant information in its possession.
Source:
SL 1993, ch 368, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-77 - Accessibility of information relevant to suspected fraud--Types of information.

58-33-77. Accessibility of information relevant to suspected fraud--Types of information.
Upon request by an insurer to an authorized agency or by an authorized agency to an insurer, each may provide to the other, directly or through any person authorized to act on its behalf, all information relevant to any suspected false or fraudulent claim, statement, or representation, including the following information:
(1)Insurance policy information relevant to an investigation, including any application for such a policy;
(2)Available policy premium payment records;
(3)History of previous claims made by an insured; and
(4)Information relating to the investigation of any suspected insurance fraud, including statements of any person, proofs of loss and notice of loss.
Source:
SL 1993, ch 368, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-78 - Time limit on information to and from authorized agency.

58-33-78. Time limit on information to and from authorized agency.
An authorized agency accepting information from an insurer pursuant to §§58-33-76 and 58-33-77 shall provide within thirty days of a written request therefor any information in its possession or control relevant to the suspected false or fraudulent claim, statement, or representation of which the insurer notified the agency. An authorized agency receiving information pursuant to §§58-33-76 and 58-33-77 may release or provide any relevant information in its possession to any other authorized agency.
Source:
SL 1993, ch 368, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-79 - Liability of supplier of information.

58-33-79. Liability of supplier of information.
Any insurer, authorized agency, or person authorized to act on their behalf, acting without bad faith or malice, who provides or receives information pursuant to §§58-33-76 and 58-33-77 is not subject to criminal prosecution, civil penalty, or civil liability therefor, except in cases of perjury or insurance fraud.
Source:
SL 1993, ch 368, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-80 - Liability of those who supply information or testify as to fraud.

58-33-80. Liability of those who supply information or testify as to fraud.
Any person acting without malice who provides information to, cooperates with or testifies pursuant to a subpoena for an authorized agency, an insurer, the National Association of Insurance Commissioners or any not-for-profit organization established to detect and prevent fraudulent insurance claims is not subject to criminal prosecution, civil penalty, or civil liability, except in cases of perjury or insurance fraud.
Source:
SL 1993, ch 368, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-81 - Notification to policyholder of request for information.

58-33-81. Notification to policyholder of request for information.
Notwithstanding the provisions of §§58-33-76 to 58-33-77, inclusive, the authorized agency shall notify in writing, the policyholder of any request for information.
Source:
SL 1993, ch 368, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-82 - Confidentiality of information regarding suspected fraud--Testimony by authorized agency personnel.

58-33-82. Confidentiality of information regarding suspected fraud--Testimony by authorized agency personnel.
Any authorized agency or insurer which receives any information furnished pursuant to §§58-33-75 to 58-33-81, inclusive, shall hold the information in confidence until such time as its release is required pursuant to a criminal or civil proceeding. Any authorized agency, or its personnel, may be required to testify in any litigation in which the insurer at interest is named as a party.
Source:
SL 1993, ch 368, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-83 - Refund of unearned life and health insurance premiums on canceled policy--Exceptions.

58-33-83. Refund of unearned life and health insurance premiums on canceled policy--Exceptions.
If any life insurance policy or health insurance policy is canceled before its renewal date or expiration date, other than by the death of the insured, and the insured has paid premiums in advance on the policy, the insurer shall refund to the owner of the policy the unearned portion of the premiums paid beyond the end of the month in which the cancellation occurred.
A cancellation of an automatic bank draft authorization does not constitute a request for cancellation of the policy. In the event of a cancellation of an automatic bank draft authorization without a request for cancellation of the policy, all applicable grace periods shall be provided.
This section applies to all life insurance policies, except group life insurance policies, and to all health insurance policies, except medicare supplement policies as defined in §58-17A-1 and long term care policies as defined in §58-17B-2.
Source:
SL 1994, ch 372, §3; SL 1995, ch 291; SL 2010, ch 244, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-84 - Refund of unearned life and health insurance premiums on canceled policy due to death of insured--Exceptions.

58-33-84. Refund of unearned life and health insurance premiums on canceled policy due to death of insured--Exceptions.
If any life insurance policy or health insurance policy is canceled before its renewal date or expiration date because of the death of the insured and the premiums have been paid in advance on the policy, the insurer shall refund the unearned portion of the premiums paid beyond the end of the month in which the cancellation occurred to the named beneficiary or, if there is no named beneficiary, to the estate of the insured.
This section applies to all life insurance policies, except group life insurance policies, and to all health insurance policies in effect on July 1, 1994, or issued thereafter.
Source:
SL 1994, ch 372, §4; SL 2010, ch 244, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-85 - Health insurers prohibited from denying enrollment of dependent child on certain grounds.

58-33-85. Health insurers prohibited from denying enrollment of dependent child on certain grounds.
Any insurer subject to this chapter, including any group health plan, as defined in section 607(1) of the Employee Retirement Income Security Act of 1974, as amended to January 1, 1994, who are engaged in the business of health insurance is prohibited from denying enrollment of a dependent child under the health insurance coverage of either the child's natural, adoptive, or stepparents for any of the following reasons:
(1)The child was born out of wedlock; or
(2)The child is not claimed as a dependent on the parent's federal income tax return; or
(3)The child does not reside with the parent or in the insurer's service area.
Source:
SL 1994, ch 387, §1; SL 2001, ch 274, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-86 - Prohibitions against a health insurer from using information pertaining to medical assistance eligibility.

58-33-86. Prohibitions against a health insurer from using information pertaining to medical assistance eligibility.
Any insurer subject to this chapter who is engaged in the business of health insurance is prohibited from using information pertaining to medical assistance eligibility under Title XIX of the Social Security Act as amended to January 1, 1994, or any other state's equivalent medicaid program, as a factor in enrolling or underwriting any individual or in making payments for benefits to any individual or in making payments for benefits on behalf of a covered individual.
Source:
SL 1994, ch 387, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-87 - Payments of health insurance benefits for medical assistance recipients.

58-33-87. Payments of health insurance benefits for medical assistance recipients.
Any insurer subject to this chapter who is engaged in the business of health insurance shall provide that payment for benefits with respect to any participant who receives benefits from the Department of Social Services medical assistance program under Title XIX of the Social Security Act as amended to January 1, 1994, shall be made in accordance with the assignment of rights for medical support as required by §28-6-7.1 without additional restrictions or requirements as compared with any other agent or assignee of any other individual so covered by the insurer.
Source:
SL 1994, ch 387, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-88 - Health insurance for dependent child through noncustodial parent's insurer.

58-33-88. Health insurance for dependent child through noncustodial parent's insurer.
Any insurer subject to this chapter who is engaged in the business of health insurance is required in any case in which a dependent child has health insurance coverage through the insurer of the noncustodial parent to provide all information to the custodial parent as may be necessary for the child to obtain benefits provided by such coverage. The insurer shall accept and make direct payment on claims submitted by either the custodial parent, a provider who has received authorization from the custodial parent, or by the Department of Social Services if there is a valid order in effect for medical support for covered services rendered to a dependent child without approval or authorization of the noncustodial parent.
Source:
SL 1994, ch 387, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-89 - Reporting regulatory activities and complaint handling.

58-33-89. Reporting regulatory activities and complaint handling.
The Division of Insurance shall regularly report to the National Association of Insurance Commissioners regarding its regulatory activities and its complaint handling. The reports shall include information on all disciplinary actions taken and all consumer complaints received. In the reports the division shall, to the extent reasonably possible, use accepted National Association of Insurance Commissioners databases. The report may not be considered a public record open to inspection pursuant to §1-27-1.
Source:
SL 1995, ch 292, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-90 - Sale of securities by unregistered insurance producer prohibited.

58-33-90. Sale of securities by unregistered insurance producer prohibited.
No insurance producer may offer or sell any security in this state unless the insurance producer is properly registered or exempt from registration pursuant to chapter 47-31B.
Source:
SL 2001, ch 287, §1; SL 2004, ch 278, §67.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-91 - Sale of unregistered securities by insurance producer prohibited.

58-33-91. Sale of unregistered securities by insurance producer prohibited.
No insurance producer may offer or sell any security in this state unless the security is registered or exempt from registration pursuant to chapter 47-31B.
Source:
SL 2001, ch 287, §2; SL 2004, ch 278, §68.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-92 - Sale of unregistered business opportunity by insurance producer prohibited.

58-33-92. Sale of unregistered business opportunity by insurance producer prohibited.
No insurance producer may offer or sell any business opportunity in this state unless the business opportunity is registered or exempt from registration under chapter 37-25A.
Source:
SL 2001, ch 287, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-94 - Acts constituting transaction of insurance business in or from state.

58-33-94. Acts constituting transaction of insurance business in or from state.
For purposes of §§58-33-93 to 58-33-116, inclusive, any of the following acts in this state effected by mail or otherwise by a nonadmitted insurer or by any person acting with the actual or apparent authority of the insurer, on behalf of the insurer, constitutes the transaction of an insurance business in or from this state:
(1)The making of or proposing to make, as an insurer, an insurance contract;
(2)The making of or proposing to make, as guarantor or surety, any contract of guaranty or suretyship as a vocation and not merely incidental to any other legitimate business or activity of the guarantor or surety;
(3)The taking or receiving of an application for insurance;
(4)The receiving or collection of any premium, commission, membership fees, assessments, dues, or other consideration for insurance or any part thereof;
(5)The issuance or delivery in this state of contracts of insurance to residents of this state or to persons authorized to do business in this state;
(6)The solicitation, negotiation, procurement, or effectuation of insurance or renewals thereof;
(7)The dissemination of information as to coverage or rates, or forwarding of applications, or delivery of policies or contracts, or inspection of risks, the fixing of rates or investigation or adjustment of claims or losses or the transaction of matters subsequent to effectuation of the contract and arising out of it, or any other manner of representing or assisting a person or insurer in the transaction of risks with respect to properties, risks, or exposures located or to be performed in this state;
(8)The transaction of any kind of insurance business specifically recognized as transacting an insurance business within the meaning of the statutes relating to insurance;
(9)The offering of insurance; or
(10)Offering an agreement or contract which purports to alter, amend or void coverage of an insurance contract.
No provision of this section prohibits employees, officers, directors, or partners of a commercial insured from acting in the capacity of an insurance manager or buyer in placing insurance on behalf of the employer, if the person's compensation is not based on buying insurance. The venue of an act committed by mail is at the point where the matter transmitted by mail is delivered or issued for delivery or takes effect.
Source:
SL 2007, ch 292, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-95 - Transacting of insurance defined.

58-33-95. Transacting of insurance defined.
For the purposes of §§58-33-93 to 58-33-116, inclusive, the term, transacting of insurance, includes:
(1)Issuing a stop loss policy covering an employer located in this state. Stop loss policy coverage of an employer for claims incurred under the employer's self-funded health benefit plan is insurance, not reinsurance, regardless of whether the contract is described by the insurer as reinsurance;
(2)Issuing a stop loss policy to a trust or trustee, whether the trust or trustee is located in this state or otherwise, with an employer located in this state directly or indirectly the beneficiary of the trust;
(3)Agreeing to loan or advance funds to pay claims incurred under an employer's self-funded health benefit plan if the availability of funds to advance is significantly dependent on payment of contributions and the claims experience of two or more employers who have entered into similar loan or advance agreements; or
(4)Engaging in a risk distribution arrangement providing for compensation of loss through the provision of services, including an arrangement established through marketing or representations to consumers, without specification in a contract.
Source:
SL 2007, ch 292, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-96 - Unauthorized health insurance defined.

58-33-96. Unauthorized health insurance defined.
For the purposes of §§58-33-93 to 58-33-116, inclusive, the term, unauthorized health insurance, means health insurance offered by a nonadmitted insurer except to the extent the laws of this state allow the coverage to be offered by a nonadmitted insurer licensed in another state through an employer or group located out of state; and includes health care benefits or coverage offered by a professional employer organization or an employee leasing arrangement that is not:
(1)Fully insured by an admitted insurer; or
(2)Licensed or otherwise authorized under the laws of this state to offer a self-funded health benefit plan.
Source:
SL 2007, ch 292, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-97 - Exclusions from unauthorized health insurance.

58-33-97. Exclusions from unauthorized health insurance.
Unauthorized health insurance does not include:
(1)Health care benefits or coverage under an employee welfare benefit plan of the employees of two or more employers (including one or more self-employed individuals), that is established or maintained under or pursuant to a collective bargaining agreement under the criteria provided under 29 CFR 2510.3-40 as of January 1, 2007;
(2)Health care benefits or coverage under an employee welfare benefit plan established or maintained by a rural electric cooperative or a rural telephone cooperative as defined under 29 U.S.C. §1002(40)(B) as of January 1, 2007;
(3)Health care benefits or coverage under an employee welfare benefit plan of the employees of two or more employers but only if the employers are within the same control group so the plan is deemed to be a single employer plan under 29 U.S.C. §1002(40)(B) as of January 1, 2007; or
(4)Health care benefits or coverage under a church plan as defined under 29 U.S.C §1002(33) as of January 1, 2007.
Source:
SL 2007, ch 292, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-98 - Notification of division required concerning unauthorized health insurance product--Review of division website--Stop loss insurers.

58-33-98. Notification of division required concerning unauthorized health insurance product--Review of division website--Stop loss insurers.
A licensee shall notify the division MEWA contact if the licensee knows a product is, or is about to be, offered to the public in this state, and the licensee, based on the information known to the licensee, reasonably should know the product is unauthorized health insurance. A licensee meets the requirements of this section if that licensee reviews the division's website of admitted health insurers and either does not notify the division's MEWA contact if that insurer is listed as an admitted insurer or notifies the division's MEWA contact if that insurer is not listed as an admitted insurer. For the purposes of this section an insurer does not include a stop loss insurer but a stop loss insurer is a licensee under this section. Knowledge of a producer regarding an unrelated unauthorized health insurance arrangement is not imputed to licensed insurers represented by that producer. Circumstances where a licensee knows that a product is, or is about to be, offered to the public in this state, include if the licensee knows that any person is:
(1)Recruiting producers to solicit or offer, or is soliciting or offering, a health benefit plan generally to the public in this state; or
(2)Seeking an administrator for, or is administering a health benefit plan that is intended to be offered generally to the public in this state.
A licensee complies with this section if the licensee notifies the division within thirty days or a period reasonable under the circumstances, whichever is later.
Source:
SL 2007, ch 292, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-99 - Circumstances in which licensee should know product is unauthorized health insurance.

58-33-99. Circumstances in which licensee should know product is unauthorized health insurance.
Circumstances where a licensee reasonably should know that a product is unauthorized health insurance include the following:
(1)The licensee knows that the product is represented to be a self-funded plan and that it is offered widely to the multiple employers or generally to individuals;
(2)The licensee knows that the product is a professional employer organization self-funded plan and that it is offered widely to multiple client employers; or
(3)The licensee knows that the plan is represented to be a self-funded plan established or maintained pursuant to a collective bargaining agreement and that the plan is offered widely to multiple employers, or generally to individuals, or both, through agents who are compensated on a commission or similar basis.
A licensee may provide other evidence to the division to indicate that the licensee did not reasonably know that a product is unauthorized. In making its determination regarding whether a licensee should have known the product is unauthorized and the appropriateness of any penalty for failing to notify the division of such a product, the division shall consider the prior experience and the existence or lack of training of that licensee.
Source:
SL 2007, ch 292, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-100 - Confidentiality of notifications--Use of information in legal and regulatory actions.

58-33-100. Confidentiality of notifications--Use of information in legal and regulatory actions.
Any notification made pursuant to §58-33-98 is confidential and privileged from disclosure in response to a subpoena or otherwise, and is not subject to discovery or admissible in evidence in any private action. Nothing in §§58-33-93 to 58-33-116, inclusive, limits the director's authority to use a report filed or information provided pursuant to §§58-33-93 to 58-33-116, inclusive, in the furtherance of any legal or regulatory action that the director, in the director's sole discretion, determines to be necessary to further the purposes of §§58-33-93 to 58-33-116, inclusive.
Source:
SL 2007, ch 292, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-101 - Disclosure of information to agencies of other states or federal government--Conditions--Immunity from civil liability.

58-33-101. Disclosure of information to agencies of other states or federal government--Conditions--Immunity from civil liability.
Nothing in §§58-33-93 to 58-33-116, inclusive, prevents the director from disclosing the contents of a report or notification filed under this section to the insurance division of any other state or agency of the federal government at any time, or any other regulatory or law enforcement agency if the agency or office receiving the report or matters relating thereto agrees to hold it confidential and in a manner consistent with §§58-33-93 to 58-33-116, inclusive. A report filed or notification provided under §§58-33-93 to 58-33-116, inclusive, is confidential and privileged from disclosure in response to a subpoena or otherwise except to the extent the director determines disclosure is appropriate to accomplish a regulatory purpose. There is no civil liability imposed on and no cause of action arises from a person's furnishing information pursuant to §§58-33-93 to 58-33-116, inclusive, concerning suspected, anticipated, or completed acts, if the information is provided to or received from:
(1)The director or the director's employees, agents, or representatives;
(2)Federal, state, or local law enforcement or regulatory officials or their employees, agents, or representatives;
(3)A person involved in the prevention and detection of fraudulent insurance acts or that person's agents, employees, or representatives; or
(4)The NAIC or its employees, agents, or representatives.
Source:
SL 2007, ch 292, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-102 - Due diligence investigation required of insurance producer before offering health benefit plan.

58-33-102. Due diligence investigation required of insurance producer before offering health benefit plan.
An insurance producer, prior to engaging in or assisting any person to engage in offering a health benefit plan to an employer or person located in this state, shall carry out appropriate due diligence to establish that the health benefit plan is not unauthorized health insurance, including those measures reasonably appropriate to establish:
(1)For any insurance coverage that is represented as issued relating to the health benefit plan:
(a)The insurer issued the policy;
(b)The coverage is as represented;
(c)The insurer is an admitted insurer in this state; and
(d)The policy has been filed with, and approved by, the division or is exempt from filing requirements;
(2)For any health benefit plan that is represented as established or maintained pursuant to a collective bargaining agreement, the health benefit plan is established or maintained under or pursuant to a collective bargaining agreement under the criteria provided under 29 CFR 2510.3-40 as of January 1, 2007;
(3)For any health benefit plan that is represented as established or maintained by an employee leasing arrangement or professional employer organization, the health benefit plan is fully insured; or
(4)For any health benefit plan that is represented as established by a single employer, the health benefit plan is covering solely employees and their dependents, and the employer controls and directs the work of the employee.
Source:
SL 2007, ch 292, §10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-103 - Due diligence investigation required of insurance producer before submitting stop loss policy application for health benefit plan.

58-33-103. Due diligence investigation required of insurance producer before submitting stop loss policy application for health benefit plan.
An insurance producer, prior to submitting an application for a stop loss policy to an insurer for a health benefit plan offered to employees, employee dependents, or a person located in this state, shall carry out appropriate due diligence to establish that the health benefit plan is not unauthorized health insurance, including measures reasonably appropriate to establish:
(1)For any health benefit plan that is represented as established or maintained pursuant to a collective bargaining agreement, the health benefit plan is established or maintained under or pursuant to a collective bargaining agreement under the criteria provided under 29 CFR 2510.3-40 as of January 1, 2007;
(2)The health benefit plan that is not offered by an employee leasing arrangement or professional employer organization to client employers; or
(3)For any health benefit plan that is represented as established by a single employer, that the health benefit plan is covering solely employees, and dependents of employees, of the employer and the employer controls and directs the work of the employee.
Source:
SL 2007, ch 292, §11.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-104 - Due diligence investigation required of third party administrator before entering into any administrative contract for health benefit plan.

58-33-104. Due diligence investigation required of third party administrator before entering into any administrative contract for health benefit plan.
A third party administrator, prior to entering into any administrative contract for a health benefit plan, and prior to assisting any person with administration of a health benefit plan, covering employees of an employer or a person located in this state, shall carry out appropriate due diligence to establish that the health benefit plan is not unauthorized health insurance, including those measures reasonably appropriate to establish:
(1)Through initial inquiry, contract provisions and measures to monitor and enforce compliance with the contract provisions, that for any insurance coverage that is represented as issued relating to the health benefit plan:
(a)The insurer issued the policy;
(b)The coverage is as represented;
(c)The insurer is an admitted insurer in this state; and
(d)The policy has been filed with, and approved by, the division or is exempt from filing requirements;
(2)For any health benefit plan that is represented as established or maintained pursuant to a collective bargaining agreement, the health benefit plan is established or maintained under or pursuant to a collective bargaining agreement under the criteria provided under 29 CFR 2510.3-40 as of January 1, 2007;
(3)For any health benefit plan that is represented as established or maintained by an employee leasing arrangement or professional employer organization, the health benefit plan is fully insured; or
(4)For any health benefit plan that is represented as established by a single employer, that the health benefit plan is covering solely employees and their dependents, and the employer controls and directs the work of the employee.
Source:
SL 2007, ch 292, §12.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-105 - Due diligence investigation required of insurer before issuing stop loss policy for health benefit plan.

58-33-105. Due diligence investigation required of insurer before issuing stop loss policy for health benefit plan.
An insurer, prior to issuing a stop loss policy for a health benefit plan covering employees, employee dependents, or individuals located in this state, shall carry out appropriate due diligence to establish that the health benefit plan is not unauthorized health insurance, including those measures reasonably appropriate to establish:
(1)For any health benefit plan that is represented as established or maintained pursuant to a collective bargaining agreement, the health benefit plan is established or maintained under or pursuant to a collective bargaining agreement under the criteria provided under 29 CFR 2510.3-40 as of January 1, 2007;
(2)The health benefit plan is not offered by an employee leasing arrangement or professional employer organization to client employers; or
(3)For any health benefit plan that is represented as established by a single employer, the health benefit plan is covering solely employees, and dependents of employees, of the employer and the employer controls and directs the work of the employee.
Source:
SL 2007, ch 292, §13.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-106 - Requirements for engaging in transacting of insurance by issuing stop loss policy.

58-33-106. Requirements for engaging in transacting of insurance by issuing stop loss policy.
No insurer may engage in the transacting of insurance by issuing a stop loss policy unless the insurer is an admitted insurer in this state and the stop loss policy form has been filed and approved by the division, unless the form is exempt by law from filing. The transacting of insurance includes:
(1)Issuing a stop loss policy covering an employer located in this state. Coverage of an employer for claims incurred under the employer's self-funded health benefit plan with a stop loss policy is insurance, not reinsurance, regardless of whether the contract is described by the insurer as reinsurance; or
(2)Issuing a stop loss policy to a trust or trustee, whether the trust or trustee is located in this state or otherwise, if an employer located in this state is directly or indirectly the beneficiary of the trust.
Source:
SL 2007, ch 292, §14.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-107 - Written disclosures required before issuing contract for stop loss policy.

58-33-107. Written disclosures required before issuing contract for stop loss policy.
No insurer may engage in the transacting of insurance in this state by issuing a stop loss policy unless, prior to issuing a contract for the stop loss policy, the insurer discloses clearly and conspicuously to the employer, in writing the following:
(1)The employer is not covered for claims below the stop loss attachment point;
(2)A description of the attachment point, including the specific and aggregate attachment points; and
(3)The insurer provides no other coverage of the employer's retention.
Source:
SL 2007, ch 292, §15.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-108 - Due diligence investigation required of preferred provider organization before contracting with offeror or provider of health benefit plan.

58-33-108. Due diligence investigation required of preferred provider organization before contracting with offeror or provider of health benefit plan.
A preferred provider organization, prior to entering into any contract with a person offering or providing a health benefit plan in this state, shall carry out appropriate due diligence to establish that the health benefit plan is not unauthorized health insurance, including those measures reasonably appropriate to establish:
(1)Through initial inquiry, contract provisions, and measures to monitor and enforce compliance with the contract provisions, that for any insurance coverage that is represented as issued relating to the health benefit plan:
(a)The insurer issued the policy;
(b)The coverage is as represented;
(c)The insurer is an admitted insurer in this state; and
(d)The policy has been filed with and approved by the division or is exempt from filing requirements;
(2)For any health benefit plan that is represented as established or maintained pursuant to a collective bargaining agreement, the health benefit plan is established or maintained under or pursuant to a collective bargaining agreement under the criteria provided under 29 CFR 2510.3-40 as of January 1, 2007;
(3)For any health benefit plan that is represented as established or maintained by an employee leasing arrangement or professional employer organization, the health benefit plan is fully insured; or
(4)For any health benefit plan that is represented as established by a single employer, the health benefit plan is covering solely employees, and dependents of employees, of the employer and the employer controls and directs the work of the employee.
Source:
SL 2007, ch 292, §16.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-109 - Defenses available to person who acts according to written advice of MEWA contact.

58-33-109. Defenses available to person who acts according to written advice of MEWA contact.
A licensee or other person who acts according to the written advice of the MEWA contact has a defense to any violation of §§58-33-103 to 58-33-108, inclusive, if the information provided by the licensee or other person to the MEWA contact, to the extent material to the MEWA contact's advice, is accurate and complete.
For the purpose of §§58-33-93 to 58-33-116, inclusive, the division's published list of admitted insurers on its web site is deemed to be accurate. A licensee or other person has a defense to any allegation that a listed insurer is not an admitted insurer. Nothing in §§58-33-93 to 58-33-116, inclusive, requires a licensee or other person to notify the division of an unauthorized product or insurer if that licensee or person has reviewed the division's website and the unauthorized insurer is listed as an admitted insurer.
Source:
SL 2007, ch 292, §17.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-110 - Circumstances mitigating violation of §§58-33-102 to 58-33-108.

58-33-110. Circumstances mitigating violation of §§58-33-102 to 58-33-108.
Any violation of §§58-33-102 to 58-33-108, inclusive, is mitigated, and the division shall reduce or eliminate any sanction otherwise applicable, if a licensee or other person demonstrates all of the following:
(1)The licensee or other person maintained supervisory procedures and controls that complied with §58-33-112;
(2)The violation occurred despite the maintenance of those procedures and controls;
(3)The licensee or other person promptly reported the health benefit plan to the MEWA contact once the licensee or other person had actual knowledge that it was unauthorized health insurance; and
(4)The licensee or other person took prompt corrective action.
Source:
SL 2007, ch 292, §18.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-111 - Due diligence not required with respect to unassisted health benefit plan where not engaged in transacting of insurance.

58-33-111. Due diligence not required with respect to unassisted health benefit plan where not engaged in transacting of insurance.
Nothing in §58-33-109 or 58-33-110 requires a producer, third party administrator, insurer, or preferred provider organization to conduct due diligence with respect to a health benefit plan that it is not assisting and with respect to which it does not engage in the transacting of insurance.
Source:
SL 2007, ch 292, §19.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-112 - Documented supervision procedures and controls.

58-33-112. Documented supervision procedures and controls.
An insurance producer, third party administrator, insurer, preferred provider organization, or an agent of the same shall establish and maintain documented supervision procedures and controls that are reasonably designed to achieve compliance with §§58-33-93 to 58-33-116, inclusive. The supervisory procedures shall include:
(1)Training;
(2)Internal controls;
(3)Periodic audits;
(4)Supervisory review; and
(5)Monitoring and enforcement of contractual provisions established under §§58-33-104 and 58-33-108.
The extent of the supervisory procedures and controls a producer is required to maintain under this section may appropriately reflect the size and complexity of the producer's operations and the scope and nature of the producer's insurance activities.
Source:
SL 2007, ch 292, §20.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-113 - Continuing education--Summary of supervision procedures and controls.

58-33-113. Continuing education--Summary of supervision procedures and controls.
An insurer providing health insurance in this state shall require its listed producers to obtain not less than one hour of continuing education every four years covering:
(1)Identification of unauthorized health insurance; and
(2)The producer's responsibilities under §§58-33-93 to 58-33-116, inclusive.
A third party administrator, preferred provider organization, or insurer shall include in its application for a license a brief summary of its procedures and controls required under §58-33-112. A license or registration application may be denied if the applicant fails to demonstrate that the applicant maintains the required procedures and controls.
Source:
SL 2007, ch 292, §21.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-114 - Suspension or revocation of registration of preferred provider organization for violation--Other action to assure future compliance.

58-33-114. Suspension or revocation of registration of preferred provider organization for violation--Other action to assure future compliance.
If a preferred provider organization violates a provision of §§58-33-93 to 58-33-116, inclusive, the organization's registration may be suspended or revoked or other action may be taken by the director as is otherwise authorized by this title to ensure that compliance with §§58-33-93 to 58-33-116, inclusive, will be achieved in the future.
Source:
SL 2007, ch 292, §22.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-115 - Inapplicability to joint powers agreements.

58-33-115. Inapplicability to joint powers agreements.
Nothing in §§58-33-93 to 58-33-116, inclusive, applies to a joint powers agreement authorized pursuant to chapter 1-24.
Source:
SL 2007, ch 292, §23.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-116 - Inapplicability to arrangements not issued to person in state or solicited in state.

58-33-116. Inapplicability to arrangements not issued to person in state or solicited in state.
Nothing in §§58-33-93 to 58-33-116, inclusive, applies to an admitted insurer, nonadmitted insurer, or a MEWA if the arrangement is neither issued to a person in this state nor solicited in this state. For purposes of this section, the phrase, issued to a person, does not include providing a certificate of coverage, evidence of coverage, or other similar documents to an employee, participant, or dependent showing coverage under an employer's health benefit plan or arrangement.
Source:
SL 2007, ch 292, §24.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-118 - Solicitation or sale of life insurance or annuity to active duty service member.

58-33-118. Solicitation or sale of life insurance or annuity to active duty service member.
Sections 58-33-117 to 58-33-130, inclusive, apply only to the solicitation or sale of any life insurance or annuity product by an insurer or insurance producer to an active duty service member of the armed forces of the United States.
Nothing in §§58-33-117 to 58-33-130, inclusive, creates a private cause of action for a violation of §§58-33-117 to 58-33-130, inclusive.
Source:
SL 2008, ch 272, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-119 - Certain solicitations and sales excluded.

58-33-119. Certain solicitations and sales excluded.
Sections 58-33-117 to 58-33-130, inclusive, do not apply to solicitations or sales involving:
(1)Credit insurance;
(2)Group life insurance or group annuities where there is no in-person, face-to-face solicitation of individuals by an insurance producer or where the contract or certificate does not include a side fund;
(3)An application to the existing insurer that issued the existing policy or contract if a contractual change or a conversion privilege is being exercised; or, if the existing policy or contract is being replaced by the same insurer pursuant to a program filed with and approved by the director; or, if a term conversion privilege is exercised among corporate affiliates;
(4)Individual stand-alone health policies, including disability income policies;
(5)Contracts offered by Servicemembers' Group Life Insurance or Veterans' Group Life Insurance;
(6)Life insurance contracts offered through or by a nonprofit military association, qualifying under Section 501 (c) (23) of the Internal Revenue Code (IRC) as of January 1, 2008, and which are not underwritten by an insurer; or
(7)Contracts used to fund:
(a)An employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act as of January 1, 2008;
(b)A plan described by Sections 401(a), 401(k), 403(b), 408(k) or 408(p) of the IRC, as of January 1, 2008, if established or maintained by an employer;
(c)A government or church plan defined in Section 414 of the IRC as of January 1, 2008, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under Section 457 of the IRC as of January 1, 2008;
(d)A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;
(e)Settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or
(f)Prearranged funeral contracts.
Source:
SL 2008, ch 272, §3; SL 2018, ch 278, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-120 - Education of members of armed forces in accordance with Department of Defense instruction permitted.

58-33-120. Education of members of armed forces in accordance with Department of Defense instruction permitted.
Nothing in §§58-33-117 to 58-33-130, inclusive, abrogates the ability of nonprofit organizations or other organizations to educate members of the armed forces of the United States in accordance with Department of Defense DoD Instruction 1344.07--PERSONAL COMMERCIAL SOLICITATION ON DOD INSTALLATIONS as of January 1, 2008.
Source:
SL 2008, ch 272, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 33 - Unfair Trade Practices › Section 58-33-121 - Certain advertisements and marketing exempt--Face-to-face meetings not exempt.

58-33-121. Certain advertisements and marketing exempt--Face-to-face meetings not exempt.
For purposes of §§58-33-117 to 58-33-130, inclusive, general advertisements, direct mail and internet marketing does not constitute solicitation. Telephone marketing does not constitute solicitation if the caller explicitly and conspicuously discloses that the product concerned is life insurance and makes no statements that avoid a clear and unequivocal statement that life insurance is the subject matter of the solicitation. However, nothing in this section exempts an insurer or insurance producer from §§58-33-117 to 58-33-130, inclusive, in any in-person, face-to-face meeting established as a result of the solicitation exemptions identified in this section.
Source:
SL 2008, ch 272, §5.