reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-30.2 - Family coverage to include newborn or newly adopted children--Payment of claim not to be withheld during bonding period of adopted child.

58-17-30.2. Family coverage to include newborn or newly adopted children--Payment of claim not to be withheld during bonding period of adopted child.
Any individual health insurance policy and individual or indemnity type contract issued by a nonprofit corporation which offers coverage for a family member of an insured or subscriber shall provide that the health insurance benefits applicable for children are payable with respect to a newly born child of the insured or subscriber from the moment of birth or to a newly adopted child of the insured or subscriber from the beginning of the six-month adoption bonding period. The newly born or newly adopted child shall be added to the policy without underwriting and without the imposition of any preexisting waiting period. Any policy or contract issued before July 1, 1974, shall, upon its next anniversary date, also provide that the health insurance benefits applicable for children are payable with respect to a newly born child of the insured or subscriber from the moment of birth or to a newly adopted child of the insured or subscriber from the beginning of the six-month adoption bonding period. Payment of any valid insurance claim may not be withheld during the bonding period of an adopted child.
Source:
SL 1974, ch 322; SL 1976, ch 313, §1; SL 1977, ch 408; SL 1983, ch 375, §1; SL 1988, ch 401; SL 1994, ch 387, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-30.3 - Premature birth and congenital defects covered--Applicability.

58-17-30.3. Premature birth and congenital defects covered--Applicability.
The coverage for a newly born child from the moment of birth or for a newly adopted child, from the beginning of the six-month adoption bonding period, shall consist of coverage of injury or sickness including the necessary care and treatment of premature birth and medically diagnosed congenital defects and birth abnormalities. The provisions of §§58-17-30.2 to 58-17-30.4, inclusive, apply to any individually written health benefit plan issued or renewed by any health insurer, health carrier, health maintenance organization, fraternal benefit society, nonprofit medical and surgical plan, nonprofit hospital service plan, or other entity providing coverage through a health benefit plan subject to the provisions of this title.
Source:
SL 1974, ch 322; SL 1976, ch 313, §2; SL 1983, ch 375, §2; SL 1984, ch 327, §13; SL 2001, ch 274, §1; SL 2015, ch 249, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-30.4 - Notice of birth or adoption required for continued coverage.

58-17-30.4. Notice of birth or adoption required for continued coverage.
An insurer may require notice that a newly born or newly adopted child is to be added to the policy or that coverage is to be changed from single or spousal coverage to family coverage. However, the insurer may not require notification sooner than the birth of the child or the start of the adoption bonding period. If the child is added or coverage changed to family coverage before the birth of the child or the start of the adoption bonding period, no additional premium may be charged by the insurer until the birth of the child or the start of the adoption bonding period. The insurer shall take reasonable steps to provide adequate notice to insureds of the need to alter coverage to ensure newborn or adopted children are covered and of the lack of premium adjustment until the birth of the child or the start of the adoption bonding period. An insurer is considered to have taken reasonable steps if prominent disclosure of the requirements of this section are included in a certificate, subscriber contract, evidence of coverage, or employee handbook if such are provided to all insureds.
If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child or notification of the start of the six-month adoption bonding period for an adopted child and payment of the required premium or fees be furnished to the insurer or nonprofit service or indemnity corporation within thirty-one days after the date of birth or start of the bonding period in order to have the coverage continued beyond the thirty-one day period.
Source:
SL 1974, ch 322; SL 1983, ch 375, §3; SL 1994, ch 387, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-30.5 - Coverage for inpatient alcoholism treatment required.

58-17-30.5. Coverage for inpatient alcoholism treatment required.
Any insurer which delivers or issues for delivery in this state any insurance policy under this chapter which provides coverage on an expense incurred basis shall offer, in writing, to include in such policy or contract issued or renewed on or after July 1, 1979, coverage for the inpatient treatment of alcoholism in licensed hospitals and residential primary treatment facilities approved by the State of South Dakota which are carrying out an approved program pursuant to the diagnosis and recommendation of a doctor of medicine. When coverage for inpatient treatment is included in any policy, such coverage shall include inpatient treatment at any South Dakota approved inpatient alcoholism treatment facility.
Source:
SL 1977, ch 410, §2; SL 1979, ch 344, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-30.6 - Alcoholism benefits provided--Days of care.

58-17-30.6. Alcoholism benefits provided--Days of care.
The alcoholism coverage to be offered shall provide benefits on the same basis as benefits provided for the treatment of other sicknesses covered under the policy; however, the coverage by the insurance carrier need not exceed thirty days' care in any six-month period, and the total days care per recipient need not exceed ninety days during the life of the contract.
Source:
SL 1977, ch 410, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-30.7 - Policies excluded from alcoholism coverage requirements.

58-17-30.7. Policies excluded from alcoholism coverage requirements.
Sections 58-17-30.5 and 58-17-30.6 do not apply to accident only, or limited or specified disease policies.
Source:
SL 1977, ch 410, §4; SL 1979, ch 344, §2; SL 1982, ch 362; SL 1999, ch 249, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-30.8 - Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony.

58-17-30.8. Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony.
A policy or certificate of health insurance for an individual that is delivered, issued for delivery, or renewed in this state may not exclude the payment of benefits for injuries sustained by an insured person because the insured was under the influence of alcohol or drugs, as defined by §32-23-1.
Nothing in this section precludes a health insurer from excluding coverage for an insured for any sickness or injury caused in the commission of a felony.
Source:
SL 1997, ch 290, §§1, 7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-30.9 - Notice that dependent is no longer eligible for coverage--Premium adjustment.

58-17-30.9. Notice that dependent is no longer eligible for coverage--Premium adjustment.
For any insurer that chooses to automatically cover any newborn or newly adopted child as a dependent without requiring the notice in §58-17-30.4 and does not collect or track the demographic information on the dependent child, the insurer shall take reasonable steps to provide adequate notice of the insured's responsibility to advise the insurer when there is no longer any child eligible for dependent coverage. An insurer is considered to have taken reasonable steps if prominent disclosure of this responsibility is included in the policy or certificate, subscriber contract, evidence of coverage, or employee handbook if such are provided to all insureds and also provided to prospective insureds at the time of application for coverage. Upon receipt of a notice that a dependent is no longer eligible, the insurer shall adjust the coverage accordingly and, if applicable, return to the insured any unearned premium. This section applies to any policy or certificate subject to the provisions of chapters 58-17 and 58-18.
Source:
SL 2013, ch 247, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-31 - Optional policy provisions.

58-17-31. Optional policy provisions.
Except as provided in §58-17-13, no policy of health insurance delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in §§58-17-32 to 58-17-40, inclusive, unless such provisions are in the words in which the same appear in the applicable section, except that the insurer may, at its option, use in lieu of any such provision a corresponding provision of different wording approved by the director which is not less favorable in any respect to the insured or the beneficiary. Any such provision contained in the policy shall be preceded individually by the applicable caption or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the director may approve.
Source:
SL 1966, ch 111, ch 25, §16.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-32 - Occupational change--Policy provision for adjustment of premium or benefits.

58-17-32. Occupational change--Policy provision for adjustment of premium or benefits.
There may be a provision as follows: "Change of occupation: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurer will pay only such portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits fixed by the insurer for such more hazardous occupation. If the insured changes his occupation to one classified by the insurer as less hazardous than that stated in this policy, the insurer, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess prorata unearned premium from the date of change of occupation or from the policy anniversary date immediately preceding receipt of such proof, whichever is the more recent. In applying this provision, the classification of occupational risk and the premium rates shall be such as have been last filed by the insurer prior to the occurrence of the loss for which the insurer is liable or prior to date of proof of change in occupation with the state official having supervision of insurance in the state where the insured resided at the time this policy was issued; but if such filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurer in such state prior to the occurrence of the loss or prior to the date of proof of change in occupation."
Source:
SL 1966, ch 111, ch 25, §17.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-33 - Misstatement of age--Policy provision for adjustment of benefits.

58-17-33. Misstatement of age--Policy provision for adjustment of benefits.
There may be a provision as follows: "Misstatement of age: If the age of the insured has been misstated all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age."
Source:
SL 1966, ch 111, ch 25, §18.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-34 - Earnings of insured--Policy provision for adjustment of benefits.

58-17-34. Earnings of insured--Policy provision for adjustment of benefits.
There may be a provision as follows: "Relation of earnings to insurance: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or his average monthly earnings for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurer will be liable only for such proportionate amount of such benefits under this policy as the amount of such monthly earnings or such average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all such coverage upon the insured at the time such disability commences and for the return of such part of the premiums paid during such two years as shall exceed the prorata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all such coverage upon the insured below the sum of two hundred dollars or the sum of the monthly benefits specified in such coverages, whichever is the lesser, nor shall it operate to reduce benefits other than those payable for loss of time."
Source:
SL 1966, ch 111, ch 25, §19 (1).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-35 - Earnings adjustment clause to be coupled with insured's right to continue policy in force.

58-17-35. Earnings adjustment clause to be coupled with insured's right to continue policy in force.
The policy provision in §58-17-34 may be inserted only in a policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums until at least age fifty, or, in the case of a policy issued after age forty-four, for at least five years from its date of issue.
Source:
SL 1966, ch 111, ch 25, §19 (2).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-36 - Option of insurer to define "valid loss of time coverage".

58-17-36. Option of insurer to define "valid loss of time coverage".
The insurer may, at its option, include in the provision in §58-17-34 a definition of "valid loss of time coverage," approved as to form by the director, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, or to any other coverage the inclusion of which may be approved by the director or any combination of such coverages. In the absence of such definition such term shall not include any coverage provided for such insured pursuant to any compulsory benefit statute, including any workers' compensation or employer's liability statute, or benefits provided by union welfare plans or by employer or employee benefit organizations.
Source:
SL 1966, ch 111, ch 25, §19 (2).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-37 - Unpaid premiums--Deduction from benefits.

58-17-37. Unpaid premiums--Deduction from benefits.
There may be a provision as follows: "Unpaid premiums: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom."
Source:
SL 1966, ch 111, ch 25, §20.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-38 - Conformity with state statutes of insured.

58-17-38. Conformity with state statutes of insured.
There may be a provision as follows: "Conformity with state statutes: Any provision of this policy which, on its effective date is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes."
Source:
SL 1966, ch 111, ch 25, §21.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-39 - Illegal occupation of insured.

58-17-39. Illegal occupation of insured.
There may be a provision as follows: "Illegal occupation: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupation."
Source:
SL 1966, ch 111, ch 25, §22.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-40 - Renewal of policy at option of insurer.

58-17-40. Renewal of policy at option of insurer.
Health insurance policies, other than accident insurance only policies, in which the insurer reserves the right to refuse renewal on an individual basis, shall provide in substance in a provision thereof or in an endorsement thereon or rider attached thereto that subject to the right to terminate the policy upon nonpayment of premium when due, such right to refuse renewal may not be exercised so as to take effect before the renewal date occurring on, or after and nearest, each policy anniversary, or in the case of lapse and reinstatement, at the renewal date occurring on, or after and nearest, each anniversary of the last reinstatement, and that any refusal of renewal shall be without prejudice to any claim originating while the policy is in force. The clause making reference to lapse and reinstatement may be omitted at the insurer's option.
Source:
SL 1966, ch 111, ch 25, §23.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-41 - Order of policy provisions.

58-17-41. Order of policy provisions.
The provisions which are the subject of §§58-17-14 to 58-17-39, inclusive, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections or, at the option of the insurer, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided that the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued.
Source:
SL 1966, ch 111, ch 25, §24.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-42 - Age limit in policy--Effect of acceptance of premiums or misstatement of age.

58-17-42. Age limit in policy--Effect of acceptance of premiums or misstatement of age.
If any policy of health insurance contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
Source:
SL 1966, ch 111, ch 25, §28.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-43 - Third parties taking policy covering insured.

58-17-43. Third parties taking policy covering insured.
The word "insured," as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits, and rights provided therein.
Source:
SL 1966, ch 111, ch 25, §25.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-44 - Foreign or alien insurer--Policy provision required by home state.

58-17-44. Foreign or alien insurer--Policy provision required by home state.
Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this chapter and which is prescribed or required by the law of the state or country under which the insurer is organized.
Source:
SL 1966, ch 111, ch 25, §26 (1).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-45 - Policy of domestic insurer delivered in other state--Compliance with laws of other state.

58-17-45. Policy of domestic insurer delivered in other state--Compliance with laws of other state.
Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of such other state or country.
Source:
SL 1966, ch 111, ch 25, §26 (2).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-46 - Policy provisions not subject to chapter--Conforming to statute required.

58-17-46. Policy provisions not subject to chapter--Conforming to statute required.
No policy provision which is not subject to this chapter shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this chapter.
Source:
SL 1966, ch 111, ch 25, §27 (1).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-47 - Nonconforming and conflicting provisions construed in conformity with statute.

58-17-47. Nonconforming and conflicting provisions construed in conformity with statute.
A policy delivered or issued for delivery to any person in this state in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties, and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this chapter.
Source:
SL 1966, ch 111, ch 25, §27 (2).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-48 - Liability and workers' compensation insurance--Inapplicability of health insurance provisions.

58-17-48. Liability and workers' compensation insurance--Inapplicability of health insurance provisions.
Nothing in §§58-17-1 to 58-17-47, inclusive, shall apply to or affect any policy of liability or workers' compensation and employers liability insurance.
Source:
SL 1966, ch 111, ch 25, §1 (1).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-49 - Health insurance provisions inapplicable to group or blanket policy.

58-17-49. Health insurance provisions inapplicable to group or blanket policy.
Nothing in §§58-17-1 to 58-17-47, inclusive, shall apply to or affect any group or blanket policy.
Source:
SL 1966, ch 111, ch 25, §1 (2).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-50 - Life insurance, endowment or annuity contracts not subject to health insurance provisions.

58-17-50. Life insurance, endowment or annuity contracts not subject to health insurance provisions.
Nothing in §§58-17-1 to 58-17-47, inclusive, shall apply to or affect life insurance, endowment, or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to health insurance as:
(1)Provide additional benefits in case of dismemberment or loss of sight, or of death by accident or accidental means, or as
(2)Operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract.
Source:
SL 1966, ch 111, ch 25, §1 (3).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-51 - Health insurance provisions inapplicable to reinsurance.

58-17-51. Health insurance provisions inapplicable to reinsurance.
Nothing in §§58-17-1 to 58-17-47, inclusive, shall apply to or affect reinsurance.
Source:
SL 1966, ch 111, ch 25, §1 (4).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-52 - Prior contracts or policies excepted.

58-17-52. Prior contracts or policies excepted.
The provisions of §§58-17-1 to 58-17-51, inclusive, shall not apply to any contracts or policies entered into or issued prior to February 8, 1966, nor to any extensions, renewals, or modifications thereof or amendments thereto whenever made.
Source:
SL 1966, ch 111, ch 25, §29.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-53 - Optometric services--Reimbursement, exceptions.

58-17-53. Optometric services--Reimbursement, exceptions.
If an insurer provides by contract, policy, certificate, or any other means whatever, for a service, or for the partial or total reimbursement, payment, or cost of a service to or on behalf of any of its policyholders, group policyholders, subscribers, or group subscribers, or any other person or groups of persons, which service is within the lawful scope of practice of a licensed optometrist, the person rendering the service or the policyholder, subscriber, or other person is entitled to partial or total reimbursement, payment, or cost of that service, whether the service is performed by a licensed physician or by a licensed optometrist. Unless the contract, policy, certificate, or other means employed otherwise provides, there is no reimbursement of payment for ophthalmic materials, lenses, spectacles, eyeglasses, or appurtenances thereto. Reimbursement may be denied to a policyholder treating himself or any member of his family residing in his household, provided, however, that reimbursement for durable medical equipment, pharmaceuticals, and prosthetic devices may not be denied where within policy coverages.
Source:
SL 1966, ch 111, ch 32, §8; SL 1982, ch 363, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-54 - Reimbursement provisions applicable to all healing arts licensees--Self-insurance plans for public employees--Restrictions on policy limitations.

58-17-54. Reimbursement provisions applicable to all healing arts licensees--Self-insurance plans for public employees--Restrictions on policy limitations.
Notwithstanding any provision of any policy of insurance subject to the general provisions of this title, if a policy or contract provides for reimbursement for any service which may be legally performed by a person licensed in this state for the practice of medicine, surgery, anesthesia by a certified registered nurse anesthetist licensed under chapter 36-9, psychology, dentistry, osteopathy, social work by an independent social worker licensed under §36-26-17, optometry, chiropractic, or podiatry, the reimbursement under that policy or contract may not be denied if the service is rendered by a person so licensed. The provisions of this section apply to all practitioners licensed pursuant to chapters 36-4A and 36-9A after July 1, 1980, and to any plan of self-insurance for public employees. Reimbursement may be denied to a policyholder treating himself or any member of his family residing in his household. However, reimbursement for durable medical equipment, pharmaceuticals, and prosthetic devices may not be denied if within policy coverages.
No policy, certificate, or contract may exclude or limit reimbursement for any lawful diagnostic or treatment service by a licensee under chapter 36-5 if the exclusion or limitation is based wholly or in part on any requirement that the service be performed in a place of service not normally used by the licensee.
A policy, certificate, or contract may only limit or make optional the reimbursement for any lawful diagnostic or treatment service by a licensee under chapters 36-4 and 36-5 if the limitation is based on a rational basis which is not solely related to the license under, or practices authorized by, chapter 36-5 or is not dependent upon a method of classification, categorization or description based directly or indirectly upon differences in terminology used by different licensees in describing human ailments or in the diagnosis or treatment of human ailments.
This section does not require reimbursement for any method or service not necessary, not reasonable or not generally accepted by the peers of the particular licensed health care provider.
Source:
SL 1970, ch 273; SL 1980, ch 355, §2; SL 1981, ch 24, §6; SL 1982, ch 363, §2; SL 1986, ch 419, §1; SL 1988, ch 402; SL 1989, ch 427; SL 1993, ch 360.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-54.1 - Copayment or coinsurance amounts for chiropractic, physical therapy, or occupational therapy services.

58-17-54.1. Copayment or coinsurance amounts for chiropractic, physical therapy, or occupational therapy services.
No health insurer may impose any copayment or coinsurance amount on an insured for services rendered by a doctor of chiropractic licensed pursuant to chapter 36-5, an occupational therapist licensed pursuant to chapter 36-31, or a physical therapist licensed pursuant to chapter 36-10 that is greater than the copayment or coinsurance amount imposed on the insured for the services of a primary care physician or practitioner for the same or a similar diagnosed condition even if a different nomenclature is used to describe a condition.
Source:
SL 2011, ch 217, §1; SL 2012, ch 244, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-55 - Reimbursement provisions applicable to licensed hospitals.

58-17-55. Reimbursement provisions applicable to licensed hospitals.
Notwithstanding any provision of any policy of insurance subject to the general provisions of this title, whenever such policy or contract provides for reimbursement for any service which may be legally performed by a hospital licensed in this state which has an organized medical staff with permanent facilities including inpatient beds and which is primarily engaged in providing diagnostic or therapeutic services for medical diagnosis, treatment, or care of injured and disabled, rehabilitation services for the physical rehabilitation of the injured and disabled, either on its premises or in facilities under the supervision of physicians on a pre-arranged basis to inpatients, reimbursement for coverage provided under such policy or contracts shall not be denied.
Source:
SL 1977, ch 409.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-56 - Reimbursement for service rendered or supervised by qualified mental health professional.

58-17-56. Reimbursement for service rendered or supervised by qualified mental health professional.
Notwithstanding any provision of any policy of insurance subject to the general provisions of this title, whenever such policy or contract provides for reimbursement for any service rendered by or directly supervised by a qualified mental health professional as defined in §27A-1-3, which may be legally performed by a mental health center as defined by §27A-1-1, reimbursement for coverage provided under such policy or contracts may not be denied. However, the provisions of this section only apply to the services defined in §58-17-98.
Source:
SL 1987, ch 377; SL 1991, ch 220, §§1 and 2; SL 2003, ch 152, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-57 - "Abuse of health insurance" defined--Violation as misdemeanor.

58-17-57. Abuse of health insurance as misdemeanor.
A person who provides health care commits abuse of health insurance, if, as a regular business practice, he knowingly accepts from any third-party payor, as payment in full for services rendered, the amount the third-party payor covers, or submits a fee to a third-party payor which is higher than the fee he has agreed to accept from the insured with the understanding of waiving the required deductible or co-payment, if the effect of either business practice is to eliminate the need for payment by the insured of any required deductible or co-payment applicable in the insured's health benefit plan. Abuse of health insurance is a Class 1 misdemeanor.
Source:
SL 1989, ch 429, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-58 - Waiver of required deductible or co-payment for charitable purposes permitted.

58-17-58. Waiver of required deductible or co-payment for charitable purposes permitted.
However, a person may waive any required deductible or co-payment for charitable purposes if:
(1)The person who provides the health care determines that the services are necessary for the immediate health and welfare of the insured;
(2)The waiver is made on a case-by-case basis and the person who provides the health care determines that payment of the deductible or co-payment would create a substantial financial hardship for the insured; and
(3)The waiver is not a regular business practice of the person who provides the health care.
Source:
SL 1989, ch 429, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-59 - When waiver presumed.

58-17-59. When waiver presumed.
Any person who provides health care and who waives the deductible or co-payment for more than one-fourth of his patients during any calendar year, excluding waivers under §58-17-58, or who advertises that he will accept from any third-party payor, as payment in full for services rendered, the amount the third-party payor covers, is presumed to be waiving the deductible or co-payment as a regular business practice.
Source:
SL 1989, ch 429, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-60 - Certain payments exempt.

58-17-60. Certain payments exempt.
Payments made pursuant to federal medicare laws or payments made to the health-care provider according to a contract or agreement between an employer and employee which requires a third-party payor to pay the full amount for health-care services are exempt from §§58-17-57 to 58-17-60, inclusive.
Source:
SL 1989, ch 429, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-61 - Assignment of health insurance proceeds to certain hospitals authorized.

58-17-61. Assignment of health insurance proceeds to certain hospitals authorized.
Any person insured by a health insurance company, health maintenance organization, preferred provider organization, individual practice association, or nonprofit hospital service corporation may assign in writing benefits from such policy, contract, or certificate to a hospital licensed pursuant to chapter 34-12. If such assignment is executed and written notice thereof is given, the insurance company, health maintenance organization, preferred provider organization, individual practice association, or nonprofit hospital service corporation shall pay the benefits directly to the hospital.
Nothing in this section modifies the scope of coverage or the amount of benefits payable under a health insurance policy, contract, or certificate.
Source:
SL 1989, ch 430.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-62 - Coverage for phenylketonuria.

58-17-62. Coverage for phenylketonuria.
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 offer coverage for testing, diagnosis, and treatment of phenylketonuria including dietary management, formulas, case management, intake and screening, assessment, comprehensive care planning, and service referral.
Source:
SL 1992, ch 348, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-63 - "Health benefit plan" defined.

58-17-63. Health benefit plan defined.
For the purposes of §§58-17-64, 58-18-63, 58-38-36, and 58-40-33, a health benefit plan is any hospital or medical policy or certificate, hospital or medical service plan, or health maintenance organization subscriber contract. The term does not include specified disease, hospital indemnity, fixed indemnity, fixed duration of one year or less, accident-only, credit, dental, vision, medicare supplement, long-term care, or disability income insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, or automobile medical payment insurance.
Source:
SL 1994, ch 381, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-64 - Minimum loss ratio for individual health benefit plans.

58-17-64. Minimum loss ratio for individual health benefit plans.
Premium rates for individual health benefit plans shall produce a minimum lifetime loss ratio of not less than sixty-five percent. The director may promulgate rules pursuant to chapter 1-26 which modify the minimum loss ratio required based on the specific design of the product or other objective and pertinent criteria.
Source:
SL 1994, ch 381, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-65 - Individual health insurance plan used in conjunction with managed care plan or utilization review organization.

58-17-65. Individual health insurance plan used in conjunction with managed care plan or utilization review organization.
If a managed care plan or utilization review organization is used in conjunction with an individual health insurance plan, the managed care plan or utilization review organization shall establish a written utilization review program, registering a utilization review organization, and requesting information in the same manner as a managed care plan or utilization review organization subject to chapter 58-17H.
Source:
SL 1996, ch 296, §7; SL 2021, ch 210, § 10.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-67 - "Professional association" defined.

58-17-67. Professional association defined.
For purposes of §§58-17-66 to 58-17-87, inclusive, the term, professional association, means any association that meets all of the following criteria:
(1)Serves a single profession that requires a significant amount of education, training, or experience or a license or certificate from a state authority to practice the profession;
(2)Has been actively in existence for five years;
(3)Has a constitution and by-laws or other analogous governing documents;
(4)Has been formed and maintained in good faith for purposes other than obtaining insurance;
(5)Is not owned or controlled by a carrier or affiliated with a carrier;
(6)Does not condition membership in the association on health status of claims experience;
(7)Has at least one thousand members if it is a national association; five hundred members if it is a state association; or two hundred members if it is a local association;
(8)All members and dependents of members are eligible for coverage regardless of health status or claims experience;
(9)Is governed by a board of directors and sponsors annual meetings of its members; and
(10)Does not allow producers to market association memberships, accept applications for memberships, or sign up members.
Source:
SL 1996, ch 286, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-68 - "Professional association plan" defined.

58-17-68. Professional association plan defined.
For purposes of §§58-17-66 to 58-17-87, inclusive, the term, professional association plan, means a health benefit plan offered through a professional association that covers members of a professional association and their dependents, and not others, in this state regardless of the situs of delivery of the policy or contract and which meets all the following criteria:
(1)Conforms with all the provisions of the rate requirements of §§58-17-66 to 58-17-87, inclusive;
(2)Provides renewability of coverage for the members and dependents of members of the professional association that meets the renewability requirements of §§58-17-66 to 58-17-87, inclusive;
(3)Provides availability of coverage for the members and dependents of members of the professional association without regard to health status; and
(4)Is offered by a carrier that offers health benefit plan coverage to any professional association seeking health benefit plan coverage from the carrier.
Source:
SL 1996, ch 286, §3; SL 2003 (SS), ch 1, §28.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-69 - "Creditable coverage" defined.

58-17-69. Creditable coverage defined.
For purposes of §§58-17-66 to 58-17-87, inclusive, the term, creditable coverage, means benefits or coverage provided under:
(1)An employer-based health insurance or health benefit arrangement that provides benefits similar to or exceeding benefits provided under the basic health benefit plan or an employee welfare benefit plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974 as adopted by the director pursuant to chapter 1-26, to the extent that the plan provides directly or through insurance, reimbursement or otherwise to employees or their dependents medical care for the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body and amounts paid for the transportation primarily for and essential to medical care;
(2)An individual health benefit plan, including coverage issued by any health maintenance organization or pre-paid hospital or medical services plan that provides benefits similar to or exceeding the benefits provided under the basic health benefit plan as approved pursuant to chapter 1-26, but excluding limited benefit plans and dread disease plans;
(3)Medicare or medicaid;
(4)Chapter 55 of Title 10, United States Code;
(5)A medical care program of the Indian Health Service or of a tribal organization;
(6)A state health benefits risk pool;
(7)A health plan offered under Chapter 89 of Title 5, United States Code;
(8)A public health plan;
(9)A health benefit plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e));
(10)A church plan;
(11)A college plan;
(12)A short term or limited duration plan; or
(13)An individual health benefit plan, including coverage issued by any health maintenance organization or pre-paid hospital or medical services plan that provided benefits less than the benefits provided under the basic health benefit plan as approved pursuant to chapter 1-26, but excluding the following excepted benefits:
(a)Coverage only for accident including accidental death and dismemberment;
(b)Disability income insurance;
(c)Liability insurance including general liability insurance and automobile liability insurance;
(d)Coverage issued as a supplement to liability insurance;
(e)Workers' compensation or similar insurance;
(f)Automobile medical payment insurance;
(g)Credit only insurance including mortgage insurance;
(h)Coverage for on-site medical clinics; and
(i)Limited scope dental and long-term care insurance, if provided under a separate policy, certificate, or contract of insurance, or not otherwise an integral part of a plan.
Source:
SL 1996, ch 286, §4; SL 1997, ch 289, §2; SL 1998, ch 289, §1; SL 1999, ch 250, §1; SL 2001, ch 275, §1; SL 2004, ch 301, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-70 - Application of 58-17-66 to 58-17-87, inclusive.

58-17-70. Application of 58-17-66 to 58-17-87, inclusive.
Sections 58-17-66 to 58-17-87, inclusive, apply to any individual health benefit plan or certificate delivered or issued for delivery in the state. Sections 58-17-66 to 58-17-87, inclusive, apply to any certificate issued to an eligible person that evidences coverage under a policy or contract issued to a trust or association or other similar grouping of persons, regardless of the situs of delivery of the policy or contract, if the eligible person pays the premium and is not being covered under the policy or contract pursuant to continuation of benefit provisions applicable under federal or state law. The following are not subject to the provisions of §§58-17-66 to 58-17-87, inclusive:
(1)Any medicare supplement policy;
(2)Any long-term care policy;
(3)Any contract or certificate marketed on a group basis that is subject to regulation under chapter 58-18B or §§58-18-42 to 58-18-51.1, inclusive;
(4)Any certificate issued to an eligible person that evidences coverage under a professional association plan;
(5)Any policy or certificate of specified disease, short-term hospital-surgical care of six months or less duration, hospital confinement indemnity, limited benefit health insurance, or other policy or certificate that provide benefits less than as provided for under subdivision 58-17-69(2) if the carrier offering the policy or certificate at the time of filing for policy form approval, submits a statement certifying that policies or certificates described in this section are being offered and marketed as supplemental health insurance or as individual health benefit plans of six-month duration or less and not renewable, and not as a substitute for hospital or medical expense insurance or major medical insurance. For policy forms approved prior to July 1, 1996, the carrier shall submit such a statement with the director. If such a statement certifying that the policies or certificates are being offered as supplemental health insurance and not as a substitute for major medical insurance is either not filed or is withdrawn, the carrier offering such coverage shall, in addition to the policy or certificate providing coverage that is less than major medical, offer and actively market an individual major medical policy to any person who is solicited for coverage for the nonmajor medical products it offers.
Source:
SL 1996, ch 286, §5; SL 1998, ch 289, §2; SL 2003 (SS), ch 1, §29.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 17 - Health Insurance Policies › Section 58-17-71 - Separate classes of individual business--Reasons--Number.

58-17-71. Separate classes of individual business--Reasons--Number.
A carrier may establish a separate class of individual business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons:
(1)The carrier used more than one type of system for the marketing and sale of health benefit plans to individuals; or
(2)The carrier has acquired a class of business from another carrier.
A carrier may establish up to three separate classes of individual business under this section.
Source:
SL 1996, ch 286, §6.