§ 58-17G-1 Definitions
§ 58-17G-2 Health benefit plan defined
§ 58-17G-3 Health carrier to develop and maintain systems to measure quality of services–System requirements–Description of quality assessment program to be filed withdirector
§ 58-17G-4 Health carrier issuing closed plan to develop quality improvement activities–Minimum requirements of quality improvement activities
§ 58-17G-5 Carrier may be deemed in compliance if private accrediting body meets requirements
§ 58-17G-6 Division to monitor complaints regarding managed care policies
§ 58-17G-7 Promulgation of rules

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

  • Closed plan: a managed care plan or health carrier that requires covered persons to use participating providers under the terms of the managed care plan or health carrier and does not provide any benefits for out-of-network services except for emergency services. See South Dakota Codified Laws 58-17G-1
  • Director: the director of the Division of Insurance. See South Dakota Codified Laws 58-1-2
  • Director: the director of the Division of Insurance. See South Dakota Codified Laws 58-17G-1
  • Discounted fee for service: a contractual arrangement between a health carrier and a provider or network of providers under which the provider is compensated in a discounted fashion based upon each service performed and under which there is no contractual responsibility on the part of the provider to manage care, to serve as a gatekeeper or primary care provider, or to provide or assure quality of care. See South Dakota Codified Laws 58-17G-1
  • Division: the Division of Insurance of the Department of Labor and Regulation. See South Dakota Codified Laws 58-1-2
  • 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 58-17G-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 58-17G-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
  • 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
  • Quality assessment: the measurement and evaluation of the quality and outcomes of medical care provided to individuals, groups, or populations. See South Dakota Codified Laws 58-17G-1
  • Quality improvement: the effort to improve the processes and outcomes related to the provision of care within the health plan. See South Dakota Codified Laws 58-17G-1
  • Secretary: the secretary of the Department of Health. See South Dakota Codified Laws 58-17G-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
  • 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