South Dakota Codified Laws
Chapter 17 - Health Insurance Policies
Section 58-17-97 - Provisions covering preexisting conditions.

South Dakota Codified Laws

Title 58 - Insurance

Chapter 17 - Health Insurance Policies

Section 58-17-1 - Requirements for all health insurance policies delivered in state.

Section 58-17-1.1 - Grandfathered plans required to cover low-dose mammography--Extent of coverage.

Section 58-17-1.2 - Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.

Section 58-17-1.3 - Diabetes coverage not required of certain plans and policies.

Section 58-17-1.4 - Policies required to cover occult breast cancer screening.

Section 58-17-2 - Persons covered by policy.

Section 58-17-2.1 - Health insurance on a franchise plan.

Section 58-17-2.2 - Conversion privileges of insured's spouse upon divorce.

Section 58-17-2.3 - Dependent coverage termination--Age--Full-time students.

Section 58-17-3 - Time of commencement and termination to be set out in policy.

Section 58-17-4 - Consideration for policy to be stated.

Section 58-17-4.1 - Filing and approval of individual policy premium rates.

Section 58-17-4.2 - Premium rates required to be reasonable--Rules to establish minimum standards promulgated by director.

Section 58-17-5 - Identification of forms, riders and endorsements--Form number, location.

Section 58-17-6 - Style and arrangement of policy provisions--Printing, size of type.

Section 58-17-7 - Documents forming part of policy--Setting forth in full, rates and classifications excepted.

Section 58-17-8 - Exceptions and reductions of coverage to be clearly set out.

Section 58-17-9 - Renewal of policy at option of insurer--Statement in policy so informing the policyholder.

Section 58-17-10.1 - Reduction of benefits because of increase in statutory disability benefits prohibited.

Section 58-17-10.2 - Individual policy for insured's spouse required in policies covering spouse--Eligibility--Coverage--Waiting periods.

Section 58-17-11 - Return of policy by purchaser--Refund of premium paid--Dissatisfaction with terms after examination.

Section 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.

Section 58-17-12 - Required provisions--Captions--Substitutes, approval by director.

Section 58-17-13 - Omission from policy of inapplicable provision--Approval of director--Modification of inconsistent provision.

Section 58-17-14 - Entire contract and change clauses required--Signed acceptance required for endorsements.

Section 58-17-15 - Time limit on certain defenses--Application of section.

Section 58-17-17 - Grace period on premiums required in policy.

Section 58-17-18 - Renewal of policy--Restriction on company's right to refuse.

Section 58-17-19 - Reinstatement when premium not paid within grace period.

Section 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.

Section 58-17-21 - Notice of claim--Provision required in policy.

Section 58-17-22 - Notice of claim--Loss of time benefit--Optional provision, insertion by insurer.

Section 58-17-23 - Claim forms--Furnishing by insurer.

Section 58-17-24 - Proofs of loss--Provision required in policy.

Section 58-17-25 - Time of payment of claims--Provision required in policy.

Section 58-17-26 - Payment of claims--Persons to whom benefits payable--Provision required in policy.

Section 58-17-27 - Payment of claims--Optional provisions, insertion by insurer.

Section 58-17-28 - Physical examination of insured--Autopsy in death claims--Provision required in policy.

Section 58-17-29 - Action to recover under policy--Time for beginning.

Section 58-17-30.1 - Continuation of coverage for child with intellectual or physical disability--Proof of dependency.

Section 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.

Section 58-17-30.3 - Premature birth and congenital defects covered--Applicability.

Section 58-17-30.4 - Notice of birth or adoption required for continued coverage.

Section 58-17-30.5 - Coverage for inpatient alcoholism treatment required.

Section 58-17-30.6 - Alcoholism benefits provided--Days of care.

Section 58-17-30.7 - Policies excluded from alcoholism coverage requirements.

Section 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.

Section 58-17-30.9 - Notice that dependent is no longer eligible for coverage--Premium adjustment.

Section 58-17-31 - Optional policy provisions.

Section 58-17-32 - Occupational change--Policy provision for adjustment of premium or benefits.

Section 58-17-33 - Misstatement of age--Policy provision for adjustment of benefits.

Section 58-17-34 - Earnings of insured--Policy provision for adjustment of benefits.

Section 58-17-35 - Earnings adjustment clause to be coupled with insured's right to continue policy in force.

Section 58-17-36 - Option of insurer to define "valid loss of time coverage".

Section 58-17-37 - Unpaid premiums--Deduction from benefits.

Section 58-17-38 - Conformity with state statutes of insured.

Section 58-17-39 - Illegal occupation of insured.

Section 58-17-40 - Renewal of policy at option of insurer.

Section 58-17-41 - Order of policy provisions.

Section 58-17-42 - Age limit in policy--Effect of acceptance of premiums or misstatement of age.

Section 58-17-43 - Third parties taking policy covering insured.

Section 58-17-44 - Foreign or alien insurer--Policy provision required by home state.

Section 58-17-45 - Policy of domestic insurer delivered in other state--Compliance with laws of other state.

Section 58-17-46 - Policy provisions not subject to chapter--Conforming to statute required.

Section 58-17-47 - Nonconforming and conflicting provisions construed in conformity with statute.

Section 58-17-48 - Liability and workers' compensation insurance--Inapplicability of health insurance provisions.

Section 58-17-49 - Health insurance provisions inapplicable to group or blanket policy.

Section 58-17-50 - Life insurance, endowment or annuity contracts not subject to health insurance provisions.

Section 58-17-51 - Health insurance provisions inapplicable to reinsurance.

Section 58-17-52 - Prior contracts or policies excepted.

Section 58-17-53 - Optometric services--Reimbursement, exceptions.

Section 58-17-54 - Reimbursement provisions applicable to all healing arts licensees--Self-insurance plans for public employees--Restrictions on policy limitations.

Section 58-17-54.1 - Copayment or coinsurance amounts for chiropractic, physical therapy, or occupational therapy services.

Section 58-17-55 - Reimbursement provisions applicable to licensed hospitals.

Section 58-17-56 - Reimbursement for service rendered or supervised by qualified mental health professional.

Section 58-17-57 - "Abuse of health insurance" defined--Violation as misdemeanor.

Section 58-17-58 - Waiver of required deductible or co-payment for charitable purposes permitted.

Section 58-17-59 - When waiver presumed.

Section 58-17-60 - Certain payments exempt.

Section 58-17-61 - Assignment of health insurance proceeds to certain hospitals authorized.

Section 58-17-62 - Coverage for phenylketonuria.

Section 58-17-63 - "Health benefit plan" defined.

Section 58-17-64 - Minimum loss ratio for individual health benefit plans.

Section 58-17-65 - Individual health insurance plan used in conjunction with managed care plan or utilization review organization.

Section 58-17-66 - Definitions for 58-17-66 through 58-17-87.

Section 58-17-67 - "Professional association" defined.

Section 58-17-68 - "Professional association plan" defined.

Section 58-17-69 - "Creditable coverage" defined.

Section 58-17-70 - Application of 58-17-66 to 58-17-87, inclusive.

Section 58-17-71 - Separate classes of individual business--Reasons--Number.

Section 58-17-72 - Transitional period when additional class of business acquired.

Section 58-17-73 - Director approval required to establish additional classes of business--Rates or rating methodologies.

Section 58-17-74 - Provisions for premium rates for individual health benefit plans.

Section 58-17-74.1 - Premium rate limitations.

Section 58-17-75 - Promulgation of rules for rates charged for individual health benefit plans.

Section 58-17-76 - Transfer into or out of class of business.

Section 58-17-77 - Temporary suspension of premium rates for individual health insurance--Reasons.

Section 58-17-78 - Required disclosure when offering individual health benefit plan.

Section 58-17-79 - Documentation of rating methods and practices.

Section 58-17-81 - Availability of information on rating methods and practices of carriers offering individual health benefit plans.

Section 58-17-82 - Renewal of individual health benefit plans--Exceptions.

Section 58-17-83 - Election not to renew individual health benefit plan--Future business restricted.

Section 58-17-84 - Provisions for carriers providing individual coverage other than excepted benefits.

Section 58-17-84.1 - (Text of section effective until the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospitalization for dental care to be provided certain covered persons.

Section 58-17-87 - Director to promulgate rules for individual health insurance--Scope of rules.

Section 58-17-88 - Minimum inpatient care coverage following delivery.

Section 58-17-89 - Shorter hospital stay permitted--Follow-up visit within forty-eight hours required.

Section 58-17-90 - Notice to policyholders--Disclosures.

Section 58-17-97 - Provisions covering preexisting conditions.

Section 58-17-98 - Health insurance policies to provide coverage for biologically-based mental illnesses.

Section 58-17-99 - Application of § 58-17-98--Exemptions.

Section 58-17-100 - Definitions.

Section 58-17-101 - Insurer may not exclude certain off-label uses of prescription drugs.

Section 58-17-102 - Exceptions.

Section 58-17-103 - Provisions limited to cancer or life threatening diseases.

Section 58-17-104 - Deductibles, copayments, and managed care review not affected.

Section 58-17-105 - Drugs used in research trials not covered.

Section 58-17-106 - No reduction or limitation of coverage otherwise required by law.

Section 58-17-107 - Health insurance policies to provide coverage for prostate cancer screening.

Section 58-17-108 - "Disability income insurance" defined.

Section 58-17-109 - Exclusion or reduction of benefits.

Section 58-17-110 - Commencement of loss.

Section 58-17-111 - Minimum standards--Exceptions.

Section 58-17-112 - Promulgation of rules regarding disability income policies--Content.

Section 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.

Section 58-17-145.1 - Deadline for submission of health claim under risk pool.

Section 58-17-146 - Dental insurers prohibited from setting fees for noncovered service.

Section 58-17-146.1 - Certain contract terms voidable by dentist.

Section 58-17-147 - Elective abortion coverage prohibited in qualified health plan offered through health insurance exchange.

Section 58-17-148 - Qualified health plan sold through exchange to provide for placement through licensed insurance producer--Commissions.

Section 58-17-149 - Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period.

Section 58-17-150 - Retrospective payment of clean claims for covered services provided by health care professional during credentialing period--Requirements.

Section 58-17-151 - Applications to be credentialed.

Section 58-17-152 - Application of §§ 58-17-149 to 58-17-151.

Section 58-17-153 - Coverage for treatment of hearing impairment for persons under age nineteen.

Section 58-17-154 - Definitions for §§ 58-17-155 to 58-17-162.

Section 58-17-155 - Exceptions to application of §§ 58-17-154 to 58-17-162.

Section 58-17-156 - Policies, contracts, certificates, and plans subject to §§ 58-17-154 to 58-17-162.

Section 58-17-157 - Coverage for applied behavior analysis for treatment of autism spectrum disorders.

Section 58-17-158 - Authorization, prior approval, and other care management requirements--Annual maximum benefit.

Section 58-17-159 - Qualifications of person performing or supervising applied behavior analysis.

Section 58-17-160 - Review of treatment.

Section 58-17-161 - Services under individualized service plan, family service plan, or education program.

Section 58-17-162 - Effective date of §§ 58-17-154 to 58-17-161.

Section 58-17-163 - Dental care insurers to honor assignment of benefits.

Section 58-17-164 - Revocation of assignment of dental insurance benefits.

Section 58-17-165 - Reimbursement of payment from insured following receipt of payment from insurer.

Section 58-17-166 - Scope of benefits not affected--Medical benefits not included .

Section 58-17-167 - Definitions pertaining to telehealth coverage.

Section 58-17-168 - Coverage for health care services provided through telehealth.

Section 58-17-169 - Discrimination between coverage for services provided in person and through telehealth prohibited.

Section 58-17-170 - Application of telehealth coverage requirements.

Section 58-17-171 - Payment for dental services--Credit card requirement prohibited.