Chapter 17 - Health Insurance Policies
- Section 58-17-1 - Requirements for all health insurance policies delivered in state.
- Section 58-17-1.1 - Policies to cover low-dose mammography--Extent of coverage.
- Section 58-17-1.2 - Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.
- Section 58-17-1.3 - Diabetes coverage not required of certain plans and policies.
- Section 58-17-2 - Persons covered by policy.
- Section 58-17-2.1 - Health insurance on a franchise plan.
- Section 58-17-2.2 - Conversion privileges of insured's spouse upon divorce.
- Section 58-17-2.3 - Health benefit plan--Dependent coverage termination--Age--Full-timestudents.
- Section 58-17-3 - Time of commencement and termination to be set out in policy.
- Section 58-17-4 - Consideration for policy to be stated.
- Section 58-17-4.1 - Filing and prior approval of individual premium rates by director--Notice ofdisapproval or approval.
- Section 58-17-4.2 - Premium rates required to be reasonable--Rules to establish minimumstandards promulgated by director.
- Section 58-17-4.3 - Transferred.
- Section 58-17-5 - Identification of forms, riders and endorsements--Form number, location.
- Section 58-17-6 - Style and arrangement of policy provisions--Printing, size of type.
- Section 58-17-7 - Documents forming part of policy--Setting forth in full, rates andclassifications excepted.
- Section 58-17-8 - Exceptions and reductions of coverage to be clearly set out.
- Section 58-17-9 - Renewal of policy at option of insurer--Statement in policy so informing thepolicyholder.
- Section 58-17-10 - Repealed.
- Section 58-17-10.1 - Reduction of benefits because of increase in statutory disability benefitsprohibited.
- Section 58-17-10.2 - Individual policy for insured's spouse required in policies covering spouse--Eligibility--Coverage--Waiting periods.
- Section 58-17-11 - Return of policy by purchaser--Refund of premium paid--Dissatisfactionwith terms after examination.
- Section 58-17-11.1 - Issuance of policies by insurance company, nonprofit hospital service plan,medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--T
- Section 58-17-12 - Required provisions--Captions--Substitutes, approval by director.
- Section 58-17-13 - Omission from policy of inapplicable provision--Approval of director--Modification of inconsistent provision.
- Section 58-17-14 - Entire contract and change clauses required--Signed acceptance required forendorsements.
- Section 58-17-15 - Incontestability clause--Time limit on certain defenses--Misstatements byapplicant.
- Section 58-17-16 - Incontestability clause--Optional provisions.
- Section 58-17-17 - Grace period on premiums required in policy.
- Section 58-17-18 - Renewal of policy--Restriction on company's right to refuse.
- Section 58-17-19 - Reinstatement when premium not paid within grace period.
- Section 58-17-20 - Omission of provision as to application of premiums accepted in connectionwith reinstatement--Right of insured to continue policy in force by paymentof premiums.
- Section 58-17-21 - Notice of claim--Provision required in policy.
- Section 58-17-22 - Notice of claim--Loss of time benefit--Optional provision, insertion byinsurer.
- Section 58-17-23 - Claim forms--Furnishing by insurer.
- Section 58-17-24 - Proofs of loss--Provision required in policy.
- Section 58-17-25 - Time of payment of claims--Provision required in policy.
- Section 58-17-26 - Payment of claims--Persons to whom benefits payable--Provision requiredin policy.
- Section 58-17-27 - Payment of claims--Optional provisions, insertion by insurer.
- Section 58-17-28 - Physical examination of insured--Autopsy in death claims--Provisionrequired in policy.
- Section 58-17-29 - Action to recover under policy--Time for beginning.
- Section 58-17-30 - Beneficiary--Changes reserved to insured.
- Section 58-17-30.1 - Continuation of coverage for physically handicapped or mentally retardedchild--Proof of dependency.
- Section 58-17-30.2 - Family coverage to include newborn or newly adopted children--Paymentof claim not to be withheld during bonding period of adopted child.
- Section 58-17-30.3 - Premature birth and congenital defects covered--Applicability.
- Section 58-17-30.4 - Notice of birth or adoption required for continued coverage.
- Section 58-17-30.5 - Coverage for inpatient alcoholism treatment required.
- Section 58-17-30.6 - Alcoholism benefits provided--Days of care.
- Section 58-17-30.7 - Policies excluded from alcoholism coverage requirements.
- Section 58-17-30.8 - Exclusion of benefits for injury while under the influence of alcohol or drugsprohibited--Exception for sickness or injury caused in commission of felony.
- Section 58-17-31 - Optional policy provisions.
- Section 58-17-32 - Occupational change--Policy provision for adjustment of premium orbenefits.
- Section 58-17-33 - Misstatement of age--Policy provision for adjustment of benefits.
- Section 58-17-34 - Earnings of insured--Policy provision for adjustment of benefits.
- Section 58-17-35 - Earnings adjustment clause to be coupled with insured's right to continuepolicy in force.
- Section 58-17-36 - Option of insurer to define "valid loss of time coverage".
- Section 58-17-37 - Unpaid premiums--Deduction from benefits.
- Section 58-17-38 - Conformity with state statutes of insured.
- Section 58-17-39 - Illegal occupation of insured.
- Section 58-17-40 - Renewal of policy at option of insurer.
- Section 58-17-41 - Order of policy provisions.
- Section 58-17-42 - Age limit in policy--Effect of acceptance of premiums or misstatement ofage.
- Section 58-17-43 - Third parties taking policy covering insured.
- Section 58-17-44 - Foreign or alien insurer--Policy provision required by home state.
- Section 58-17-45 - Policy of domestic insurer delivered in other state--Compliance with lawsof other state.
- Section 58-17-46 - Policy provisions not subject to chapter--Conforming to statute required.
- Section 58-17-47 - Nonconforming and conflicting provisions construed in conformity withstatute.
- Section 58-17-48 - Liability and workers' compensation insurance--Inapplicability of healthinsurance provisions.
- Sections 58-17-49, 58-17-50 - Health insurance provisions inapplicable to group or blanket policy. Life insurance, endowment or annuity contracts not subject to health insurance provisions
- Section 58-17-51 - Health insurance provisions inapplicable to reinsurance.
- Section 58-17-52 - Prior contracts or policies excepted.
- Section 58-17-53 - Optometric services--Reimbursement, exceptions.
- Section 58-17-54 - Reimbursement provisions applicable to all healing arts licensees--Self-insurance plans for public employees--Restrictions on policylimitations.
- Section 58-17-55 - Reimbursement provisions applicable to licensed hospitals.
- Section 58-17-56 - Reimbursement for service rendered or supervised by qualified mentalhealth professional.
- Section 58-17-57 - "Abuse of health insurance" defined--Violation as misdemeanor.
- Section 58-17-58 - Waiver of required deductible or co-payment for charitable purposespermitted.
- Section 58-17-59 - When waiver presumed.
- Section 58-17-60 - Certain payments exempt.
- Section 58-17-61 - Assignment of health insurance proceeds to certain hospitals authorized.
- Section 58-17-62 - Coverage for phenylketonuria.
- Section 58-17-63 - "Health benefit plan" defined.
- Section 58-17-64 - Minimum loss ratio for individual health benefit plans.
- Section 58-17-65 - Individual health insurance plan used in conjunction with managed care planor utilization review organization.
- Section 58-17-66 - Definitions for 58-17-66 to 58-17-87.
- Section 58-17-67 - "Professional association" defined.
- Section 58-17-68 - "Professional association plan" defined.
- Section 58-17-69 - "Creditable coverage" defined.
- Section 58-17-70 - Application of 58-17-66 to 58-17-87, inclusive.
- Section 58-17-71 - Separate classes of individual business--Reasons--Number.
- Section 58-17-72 - Transitional period when additional class of business acquired.
- Section 58-17-73 - Director approval required to establish additional classes of business--Ratesor rating methodologies.
- Section 58-17-74 - Provisions for premium rates for individual health benefit plans.
- Section 58-17-74.1 - Premium rate limitations.
- Section 58-17-75 - Promulgation of rules for rates charged for individual health benefit plans.
- Section 58-17-76 - Transfer into or out of class of business.
- Section 58-17-77 - Temporary suspension of premium rates for individual health insurance--Reasons.
- Section 58-17-78 - Required disclosure when offering individual health benefit plan.
- Section 58-17-79 - Documentation of rating methods and practices.
- Section 58-17-80 - Repealed.
- Section 58-17-81 - Availability of information on rating methods and practices of carriersoffering individual health benefit plans.
- Section 58-17-82 - Renewal of individual health benefit plans--Exceptions.
- Section 58-17-83 - Election not to renew individual health benefit plan--Future businessrestricted.
- Section 58-17-84 - Provisions of compliance for any individual health benefit plan.
- Section 58-17-84.1 - Anesthesia and hospitalization for dental care to be provided certain coveredpersons.
- Sections 58-17-85, 58-17-85.1 - Acceptance of applicant with prior health benefit plan--Residency requirement--Application deadline. Health carrier to offer additional deductible options
- Section 58-17-86 - Repealed.
- Section 58-17-87 - Director to promulgate rules for individual health insurance--Scope of rules.
- Section 58-17-88 - Minimum inpatient care coverage following delivery.
- Section 58-17-89 - Shorter hospital stay permitted--Follow-up visit within forty-eight hoursrequired.
- Section 58-17-90 - Notice to policyholders--Disclosures.
- Sections 58-17-91 to 58-17-96 - Repealed
- Section 58-17-97 - Provisions covering preexisting conditions.
- Section 58-17-98 - Health insurance policies to provide coverage for biologically-based mentalillnesses.
- Section 58-17-99 - Application of § 58-17-98--Exemptions.
- Section 58-17-100 - Definitions.
- Section 58-17-101 - Insurer may not exclude certain off-label uses of prescription drugs.
- Section 58-17-102 - Exceptions.
- Section 58-17-103 - Provisions limited to cancer or life threatening diseases.
- Section 58-17-104 - Deductibles, copayments, and managed care review not affected.
- Section 58-17-105 - Drugs used in research trials not covered.
- Section 58-17-106 - No reduction or limitation of coverage otherwise required by law.
- Section 58-17-107 - Health insurance policies to provide coverage for prostate cancer screening.
- Section 58-17-108 - "Disability income insurance" defined.
- Section 58-17-109 - Exclusion or reduction of benefits.
- Section 58-17-110 - Commencement of loss.
- Section 58-17-111 - Minimum standards--Exceptions.
- Section 58-17-112 - Promulgation of rules regarding disability income policies--Content.
- Section 58-17-113 - Legislative findings.
- Section 58-17-114 - Definitions.
- Section 58-17-115 - Health insurance coverage risk pool established.
- Section 58-17-116 - Administration of risk pool--Appointment of board--Members--Board maycontract for performance of functions.
- Section 58-17-117 - Board to request bids for administrator of risk pool--Effective date of bid--Board may continue administration in lieu of satisfactory bid--Oversight byboard.
- Section 58-17-118 - Advisory panel established--Members--Terms--Functions.
- Section 58-17-119 - Administrative functions of board--Annual report to Legislature--Contents.
- Section 58-17-120 - South Dakota risk pool fund established--Purpose.
- Section 58-17-121 - Powers and authority of board--Immunity not waived.
- Section 58-17-122 - Third-party liability--Subrogation of third-party payment by risk pool--Waiver of subrogation rights.
- Section 58-17-123 - Notification of coverage status to health care or pharmacy provider--Requestfor payment constitutes agreement--Reimbursement rates--Provider barredfrom billing enrollee for covered
- Section 58-17-124 - Promulgation of rules--Scope of rules.
- Section 58-17-125 - Premium rates to be reasonable--Establishment of rates--Determination ofaverage rates--Actuarial adjustment.
- Section 58-17-126 - Annual fiscal determination of payments, costs and losses--Abatement ordeferral of loss assessments--Initial or interim assessments--Maximumassessments--Gains--Assessment of carrie
- Section 58-17-127 - Audits, periodic and annual.
- Sections 58-17-128, 58-17-129 - Plans--Filing and approval. No fee or tax applicable to pool
- Section 58-17-130 - Pool to offer at least three plan designs--Board to establish coverage andbenefits--Alteration--Mental illness coverage--Additional designs.
- Section 58-17-131 - Disease management programs--Cost containment mechanisms--Enrolleenon-participation and expense responsibility.
- Section 58-17-132 - Pharmacy benefits.
- Section 58-17-133 - Plan-year benefit maximums.
- Section 58-17-134 - Lifetime benefit maximums.
- Section 58-17-135 - Newborn coverage and eligibility.
- Section 58-17-136 - Noneligibility of certain persons--Coverage under risk pool provisions inexcess of other governmentally-provided insurances--Exception--Ineligibility of enrollee at lifetime maximu
- Section 58-17-137 - Rates not to change except on class basis--Disclosure.
- Section 58-17-138 - Limitations on civil actions or criminal liability--Request for hearing.
- Section 58-17-139 - Carrier to provide notice of availability and application form--Format.
- Section 58-17-140 - Recision of policies issued prior to August 1, 2003.
- Section 58-17-141 - Commissions paid to insurance producer not to exceed three percent.
- Section 58-17-142 - Maximum premium rates for plans issued prior to August 1, 2003--Rateprovisions of § 58-17-75 to apply upon carrier's discontinuance of activemarketing.
- Section 58-17-143 - Preferred provider contracts with out-of-state providers--Limitations onpayments by risk pool.
- Section 58-17-144 - Eligibility of otherwise uninsurable persons under age nineteen forenrollment in risk pool--Open enrollment.
- Section 58-17-145 - Six-month waiting period for preexisting conditions.