58-12-22. Information from insurer's database to Department of Social Services--Data match against recipients--Disclosure--Liability.
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.
Structure South Dakota Codified Laws
Chapter 12 - Insurance Claims And Benefits
Section 58-12-1 - Forms for proof of loss--Furnishing by insurer on request.
Section 58-12-2 - Acts of insurer not constituting waiver of policy provision or defense.
Section 58-12-4 - Life and health insurance--Exemption of benefits and proceeds from execution.
Section 58-12-5 - "Annuity contract" defined.
Section 58-12-8 - Maximum amount of annuity exemption--Excess subject to levy.
Section 58-12-9 - Application of excess annuities to judgment--Factors considered.
Section 58-12-12 - Use of uniform health insurance claim forms.
Section 58-12-13 - Use of claim forms required by federal law excepted.
Section 58-12-14 - Promulgation of rules for uniform health insurance claim forms.
Section 58-12-15 - "Paintless dent repair" defined.
Section 58-12-18 - Compliance with § 58-12-16.
Section 58-12-19 - Clean claim defined.
Section 58-12-25 - Reimbursement to department for cost of services.
Section 58-12-26 - Insurer defined.
Section 58-12-27 - Department defined.
Section 58-12-28 - Provisions of chapter 1-27 not applicable to insurer records.
Section 58-12-31 - Definitions regarding standards for claims processing.
Section 58-12-32 - Application of standards for claims investigation and disposition.
Section 58-12-34 - Acts constituting unfair claims practices.
Section 58-12-35 - Notice of hearing.
Section 58-12-36 - Cease and desist order--Monetary penalty--Suspension or revocation of license.
Section 58-12-37 - Promulgation of rules regarding definitions and records.