CHAPTER 58-17
HEALTH INSURANCE POLICIES
58-17-1
Requirements for all health insurance policies delivered in state.
58-17-1.1
Grandfathered plans required 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.
58-17-1.4
Policies required to cover occult breast cancer screening.
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
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 approval of individual policy premium rates.
58-17-4.2
Premium rates required to be reasonable--Rules to establish minimum standards
promulgated by director.
58-17-4.3
Transferred.
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
Repealed.
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
Time limit on certain defenses--Application of section.
58-17-16
Repealed.
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.
58-17-54.1
Copayment or coinsurance amounts for chiropractic, physical therapy, or
occupational therapy services.
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.
58-17-80
Repealed.
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 for carriers providing individual coverage other than excepted benefits.
58-17-84.1
Anesthesia and hospitalization for dental care to be provided certain covered persons.
58-17-85
Eligibility requirements for state risk pool--Residency requirement--Application
deadline.
58-17-85.1
Health carrier to offer additional deductible options.
58-17-86
Repealed.
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.
58-17-91 to 58-17-96.
Repealed.
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
Board to administer risk pool--Members--Contracts.
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.
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 coverage.
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.
58-17-147
Elective abortion coverage prohibited in qualified health plan offered through health
insurance exchange.