Within sixty days of a request from the department, the department and an insurer shall negotiate an acceptable format for the transmission of information from the insurer’s database of policy holders, sponsors, subscribers, covered individuals in South Dakota, and coverage dates. The format must include the data elements, medium, frequency of reporting, any costs of the insurer to be reimbursed, and procedures that will be followed when a data match is found. The Department of Social Services shall match the name, address, date of birth, and social security number if available, of the insured’s policyholders, sponsors, subscribers, and covered individuals against the medicaid eligible recipients and recipients of support enforcement services as defined in subdivision 25-7A-1(19).

Upon discovery of a match, the department may incorporate the following information into its recipient database:

(1) The name, address, date of birth, social security number if available, and the unique health care identification number of the covered individual;

(2) The name, address, date of birth, social security number if available, policy number, and group identification number of the policyholder, sponsor, or subscriber;

(3) The name and address of the employer if it is an employer-employee benefit plan;

(4) Types of covered services under the plan or policy;

(5) Coverage effective date and termination of coverage date for each covered individual; and

(6) The name and address of the claim administrator for the policy or plan.

The department may not use or disclose any information provided by the insurer other than as permitted or required by law. The insurer may not be held liable for the release of insurance coverage information to the department or the director by any party when done so under the authority of §§ 58-12-22 to 58-12-28, inclusive.

Source: SL 2005, ch 263, § 1; SL 2021, ch 210, § 5.