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58-17 HEALTH INSURANCE POLICIES
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58-17-10      Repealed.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 child with intellectual or physical disability--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.
58-17-30.9      Notice that dependent is no longer eligible for coverage--Premium adjustment.
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.
58-17-148      Qualified health plan sold through exchange to provide for placement through licensed insurance producer--Commissions.
58-17-149      Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period.
58-17-150      Retrospective payment of clean claims for covered services provided by health care professional during credentialing period--Requirements.
58-17-151      Applications to be credentialed.
58-17-152      Application of §§ 58-17-149 to 58-17-151.
58-17-153      Coverage for treatment of hearing impairment for persons under age nineteen.


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