§ 58-17F-1 Definitions
§ 58-17F-2 Health benefit plan defined
§ 58-17F-3 Medical director required for managed care plans
§ 58-17F-4 Health carrier to provide written information to prospective enrollees–Specificinformation required
§ 58-17F-5 Health carrier to maintain provider network sufficient to assure services withoutunreasonable delay–Emergency services–Determination of sufficiency
§ 58-17F-6 Where provider network is insufficient, covered benefit to be made available at nogreater cost
§ 58-17F-7 Health carrier to ensure provider proximity to covered persons
§ 58-17F-8 Health carrier to monitor provider ability, capacity, and authority–Financialcapability to be monitored in capitated plans
§ 58-17F-9 Factors to consider in determining network adequacy
§ 58-17F-10 Access plan required for managed care plans–Annual update–Contents–Exemptionsfor discounted fee-for-service networks
§ 58-17F-11 Requirements for health carrier and providers in managed care plans
§ 58-17F-12 Provisions governing contractual arrangements between health carriers andintermediaries
§ 58-17F-13 Sample contract forms to be filed with director–Material changes to be submitted–Certain changes not material–Director’s inaction within certain time deemedapproval–Contract copies to be provided upon request
§ 58-17F-14 Contract does not relieve health carrier of liability
§ 58-17F-15 Remedies available to director against health carrier found not in compliance
§ 58-17F-16 Managed care contractor to register with director
§ 58-17F-17 Filing changes in registration information
§ 58-17F-18 Request for information from managed care contractor
§ 58-17F-19 Activities of nonregistered managed care contractor prohibited
§ 58-17F-20 Registration fee for managed care contractor
§ 58-17F-21 Promulgation of rules

Terms Used In South Dakota Codified Laws > Title 58 > Chapter 17F

  • Covered benefits: or "benefits" those health care services to which a covered person is entitled under the terms of a health benefit plan. See South Dakota Codified Laws 58-17F-1
  • Covered person: a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan. See South Dakota Codified Laws 58-17F-1
  • Day: the period from midnight to midnight. See
  • Director: the director of the Division of Insurance. See South Dakota Codified Laws 58-17F-1
  • Director: the director of the Division of Insurance. See South Dakota Codified Laws 58-1-2
  • Division: the Division of Insurance of the Department of Labor and Regulation. See South Dakota Codified Laws 58-1-2
  • Emergency services: with respect to an emergency medical condition:
     . See South Dakota Codified Laws 58-17F-1
  • Good faith: an honest intention to abstain from taking any unconscientious advantage of another, even through the forms or technicalities of law, together with an absence of all information or belief of facts which would render the transaction unconscientious. See
  • Health care services: services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See South Dakota Codified Laws 58-17F-1
  • Health carrier: an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the director, that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services. See South Dakota Codified Laws 58-17F-1
  • Insurance: a contract whereby one undertakes to indemnify another or to pay or provide a specified or determinable amount or benefit upon determinable contingencies. See South Dakota Codified Laws 58-1-2
  • Intermediary: a person authorized to negotiate and execute provider contracts with health carriers on behalf of health care providers or on behalf of a network. See South Dakota Codified Laws 58-17F-1
  • License: permission granted to an agent or broker to engage in those activities permitted by such persons under this title. See South Dakota Codified Laws 58-1-2
  • Managed care contractor: a person who establishes, operates, or maintains a network of participating providers. See South Dakota Codified Laws 58-17F-1
  • Managed care plan: a plan operated by a managed care entity that provides for the financing or delivery of health care services, or both, to persons enrolled in the plan through any of the following:
     . See South Dakota Codified Laws 58-17F-1
  • Network: the group of participating providers providing services to a health carrier. See South Dakota Codified Laws 58-17F-1
  • Participating provider: a provider who, under a contract with the health carrier or with its contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, directly or indirectly, from the health carrier. See South Dakota Codified Laws 58-17F-1
  • Person: an individual, insurer, company, association, organization, Lloyds, society, reciprocal or inter-insurance exchange, partnership, syndicate, business trust, corporation, and any other legal entity. See South Dakota Codified Laws 58-1-2
  • Secretary: the secretary of the Department of Health. See South Dakota Codified Laws 58-17F-1
  • State: when used in context signifying a jurisdiction other than the State of South Dakota, a state, the District of Columbia, a territory, commonwealth, or possession of the United States of America, or a province of the Dominion of Canada. See South Dakota Codified Laws 58-1-2
  • Writing: and "written" include typewriting and typewritten, printing and printed, except in the case of signatures, and where the words are used by way of contrast to typewriting and printing. See
  • written: include typewriting and typewritten, printing and printed, except in the case of signatures, and where the words are used by way of contrast to typewriting and printing. See
  • Year: a calendar year. See