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South Dakota Laws > Title 58 > Chapter 17 - Health Insurance Policies

^{Current as of: 2010}

^{Check for updates}


§ 58-17-1	Requirements for all health insurance policies delivered in state
§ 58-17-1.1	Policies to cover low-dose mammography--Extent of coverage
§ 58-17-1.2	Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations
§ 58-17-1.3	Diabetes coverage not required of certain plans and policies
§ 58-17-2	Persons covered by policy
§ 58-17-2.1	Health insurance on a franchise plan
§ 58-17-2.2	Conversion privileges of insured's spouse upon divorce
§ 58-17-2.3	Health benefit plan--Dependent coverage termination--Age--Full-time students
§ 58-17-3	Time of commencement and termination to be set out in policy
§ 58-17-4	Consideration for policy to be stated
§ 58-17-4.1	Filing and prior approval of individual premium rates by director--Notice of disapproval or approval
§ 58-17-4.2	Premium rates required to be reasonable--Rules to establish minimum standards promulgated by director
§ 58-17-5	Identification of forms, riders and endorsements--Form number, location
§ 58-17-6	Style and arrangement of policy provisions--Printing, size of type
§ 58-17-7	Documents forming part of policy--Setting forth in full, rates and classifications excepted
§ 58-17-8	Exceptions and reductions of coverage to be clearly set out
§ 58-17-9	Renewal of policy at option of insurer--Statement in policy so informing the policyholder
§ 58-17-10.1	Reduction of benefits because of increase in statutory disability benefits prohibited
§ 58-17-10.2	Individual policy for insured's spouse required in policies covering spouse--Eligibility--Coverage--Waiting periods
§ 58-17-11	Return of policy by purchaser--Refund of premium paid--Dissatisfaction with terms after examination
§ 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--Term of retention
§ 58-17-12	Required provisions--Captions--Substitutes, approval by director
§ 58-17-13	Omission from policy of inapplicable provision--Approval of director--Modification of inconsistent provision
§ 58-17-14	Entire contract and change clauses required--Signed acceptance required for endorsements
§ 58-17-15	Incontestability clause--Time limit on certain defenses--Misstatements by applicant
§ 58-17-16	Incontestability clause--Optional provisions
§ 58-17-17	Grace period on premiums required in policy
§ 58-17-18	Renewal of policy--Restriction on company's right to refuse
§ 58-17-19	Reinstatement when premium not paid within grace period
§ 58-17-20	Omission of provision as to application of premiums accepted in connection with reinstatement--Right of insured to continue policy in force by payment of premiums
§ 58-17-21	Notice of claim--Provision required in policy
§ 58-17-22	Notice of claim--Loss of time benefit--Optional provision, insertion by insurer
§ 58-17-23	Claim forms--Furnishing by insurer
§ 58-17-24	Proofs of loss--Provision required in policy
§ 58-17-25	Time of payment of claims--Provision required in policy
§ 58-17-26	Payment of claims--Persons to whom benefits payable--Provision required in policy
§ 58-17-27	Payment of claims--Optional provisions, insertion by insurer
§ 58-17-28	Physical examination of insured--Autopsy in death claims--Provision required in policy
§ 58-17-29	Action to recover under policy--Time for beginning
§ 58-17-30	Beneficiary--Changes reserved to insured
§ 58-17-30.1	Continuation of coverage for physically handicapped or mentally retarded child--Proof of dependency
§ 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
§ 58-17-30.3	Premature birth and congenital defects covered--Applicability
§ 58-17-30.4	Notice of birth or adoption required for continued coverage
§ 58-17-30.5	Coverage for inpatient alcoholism treatment required
§ 58-17-30.6	Alcoholism benefits provided--Days of care
§ 58-17-30.7	Policies excluded from alcoholism coverage requirements
§ 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
§ 58-17-31	Optional policy provisions
§ 58-17-32	Occupational change--Policy provision for adjustment of premium or benefits
§ 58-17-33	Misstatement of age--Policy provision for adjustment of benefits
§ 58-17-34	Earnings of insured--Policy provision for adjustment of benefits
§ 58-17-35	Earnings adjustment clause to be coupled with insured's right to continue policy in force
§ 58-17-36	Option of insurer to define "valid loss of time coverage"
§ 58-17-37	Unpaid premiums--Deduction from benefits
§ 58-17-38	Conformity with state statutes of insured
§ 58-17-39	Illegal occupation of insured
§ 58-17-40	Renewal of policy at option of insurer
§ 58-17-41	Order of policy provisions
§ 58-17-42	Age limit in policy--Effect of acceptance of premiums or misstatement of age
§ 58-17-43	Third parties taking policy covering insured
§ 58-17-44	Foreign or alien insurer--Policy provision required by home state
§ 58-17-45	Policy of domestic insurer delivered in other state--Compliance with laws of other state
§ 58-17-46	Policy provisions not subject to chapter--Conforming to statute required
§ 58-17-47	Nonconforming and conflicting provisions construed in conformity with statute
§ 58-17-48	Liability and workers' compensation insurance--Inapplicability of health insurance provisions
§ 58-17-49	Health insurance provisions inapplicable to group or blanket policy
§ 58-17-50	Life insurance, endowment or annuity contracts not subject to health insurance provisions
§ 58-17-51	Health insurance provisions inapplicable to reinsurance
§ 58-17-52	Prior contracts or policies excepted
§ 58-17-53	Optometric services--Reimbursement, exceptions
§ 58-17-54	Reimbursement provisions applicable to all healing arts licensees--Self-insurance plans for public employees--Restrictions on policy limitations
§ 58-17-55	Reimbursement provisions applicable to licensed hospitals
§ 58-17-56	Reimbursement for service rendered or supervised by qualified mental health professional
§ 58-17-57	Abuse of health insurance defined--Violation as misdemeanor
§ 58-17-58	Waiver of required deductible or co-payment for charitable purposes permitted
§ 58-17-59	When waiver presumed
§ 58-17-60	Certain payments exempt
§ 58-17-61	Assignment of health insurance proceeds to certain hospitals authorized
§ 58-17-62	Coverage for phenylketonuria
§ 58-17-63	Health benefit plan defined
§ 58-17-64	Minimum loss ratio for individual health benefit plans
§ 58-17-65	Individual health insurance plan used in conjunction with managed care plan or utilization review organization
§ 58-17-66	Definitions for 58-17-66 to 58-17-87
§ 58-17-67	Professional association defined
§ 58-17-68	Professional association plan defined
§ 58-17-69	Creditable coverage defined
§ 58-17-70	Application of 58-17-66 to 58-17-87, inclusive
§ 58-17-71	Separate classes of individual business--Reasons--Number
§ 58-17-72	Transitional period when additional class of business acquired
§ 58-17-73	Director approval required to establish additional classes of business--Rates or rating methodologies
§ 58-17-74	Provisions for premium rates for individual health benefit plans
§ 58-17-74.1	Premium rate limitations
§ 58-17-75	Promulgation of rules for rates charged for individual health benefit plans
§ 58-17-76	Transfer into or out of class of business
§ 58-17-77	Temporary suspension of premium rates for individual health insurance--Reasons
§ 58-17-78	Required disclosure when offering individual health benefit plan
§ 58-17-79	Documentation of rating methods and practices
§ 58-17-81	Availability of information on rating methods and practices of carriers offering individual health benefit plans
§ 58-17-82	Renewal of individual health benefit plans--Exceptions
§ 58-17-83	Election not to renew individual health benefit plan--Future business restricted
§ 58-17-84	Provisions of compliance for any individual health benefit plan
§ 58-17-84.1	Anesthesia and hospitalization for dental care to be provided certain covered persons
§ 58-17-85	Acceptance of applicant with prior health benefit plan--Residency requirement--Application deadline
§ 58-17-85.1	Health carrier to offer additional deductible options
§ 58-17-87	Director to promulgate rules for individual health insurance--Scope of rules
§ 58-17-88	Minimum inpatient care coverage following delivery
§ 58-17-89	Shorter hospital stay permitted--Follow-up visit within forty-eight hours required
§ 58-17-90	Notice to policyholders--Disclosures
§ 58-17-97	Provisions covering preexisting conditions
§ 58-17-98	Health insurance policies to provide coverage for biologically-based mental illnesses
§ 58-17-99	Application of § 58-17-98--Exemptions
§ 58-17-100	Definitions
§ 58-17-101	Insurer may not exclude certain off-label uses of prescription drugs
§ 58-17-102	Exceptions
§ 58-17-103	Provisions limited to cancer or life threatening diseases
§ 58-17-104	Deductibles, copayments, and managed care review not affected
§ 58-17-105	Drugs used in research trials not covered
§ 58-17-106	No reduction or limitation of coverage otherwise required by law
§ 58-17-107	Health insurance policies to provide coverage for prostate cancer screening
§ 58-17-108	Disability income insurance defined
§ 58-17-109	Exclusion or reduction of benefits
§ 58-17-110	Commencement of loss
§ 58-17-111	Minimum standards--Exceptions
§ 58-17-112	Promulgation of rules regarding disability income policies--Content
§ 58-17-113	Legislative findings
§ 58-17-114	Definitions
§ 58-17-115	Health insurance coverage risk pool established
§ 58-17-116	Administration of risk pool--Appointment of board--Members--Board may contract for performance of functions
§ 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 by board
§ 58-17-118	Advisory panel established--Members--Terms--Functions
§ 58-17-119	Administrative functions of board--Annual report to Legislature--Contents
§ 58-17-120	South Dakota risk pool fund established--Purpose
§ 58-17-121	Powers and authority of board--Immunity not waived
§ 58-17-122	Third-party liability--Subrogation of third-party payment by risk pool--Waiver of subrogation rights
§ 58-17-123	Notification of coverage status to health care or pharmacy provider--Request for payment constitutes agreement--Reimbursement rates--Provider barred from billing enrollee for covered services
§ 58-17-124	Promulgation of rules--Scope of rules
§ 58-17-125	Premium rates to be reasonable--Establishment of rates--Determination of average rates--Actuarial adjustment
§ 58-17-126	Annual fiscal determination of payments, costs and losses--Abatement or deferral of loss assessments--Initial or interim assessments--Maximum assessments--Gains--Assessment of carriers
§ 58-17-127	Audits, periodic and annual
§ 58-17-128	Plans--Filing and approval
§ 58-17-129	No fee or tax applicable to pool
§ 58-17-130	Pool to offer at least three plan designs--Board to establish coverage and benefits--Alteration--Mental illness coverage--Additional designs
§ 58-17-131	Disease management programs--Cost containment mechanisms--Enrollee non-participation and expense responsibility
§ 58-17-132	Pharmacy benefits
§ 58-17-133	Plan-year benefit maximums
§ 58-17-134	Lifetime benefit maximums
§ 58-17-135	Newborn coverage and eligibility
§ 58-17-136	Noneligibility of certain persons--Coverage under risk pool provisions in excess of other governmentally-provided insurances--Exception--Ineligibility of enrollee at lifetime maximum--Termination of coverage--Employer-paid premium deemed equivalent covera
§ 58-17-137	Rates not to change except on class basis--Disclosure
§ 58-17-138	Limitations on civil actions or criminal liability--Request for hearing
§ 58-17-139	Carrier to provide notice of availability and application form--Format
§ 58-17-140	Recision of policies issued prior to August 1, 2003
§ 58-17-141	Commissions paid to insurance producer not to exceed three percent
§ 58-17-142	Maximum premium rates for plans issued prior to August 1, 2003--Rate provisions of § 58-17-75 to apply upon carrier's discontinuance of active marketing
§ 58-17-143	Preferred provider contracts with out-of-state providers--Limitations on payments by risk pool
§ 58-17-144	Eligibility of otherwise uninsurable persons under age nineteen for enrollment in risk pool--Open enrollment
§ 58-17-145	Six-month waiting period for preexisting conditions
§ 58-17-146	Dental insurers prohibited from setting fees for noncovered service

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Health Insurance

South Dakota Laws > Title 58 > Chapter 17 - Health Insurance Policies

South Dakota Laws > Title 58 > Chapter 17 - Health Insurance Policies

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