58-17F-6. Where provider network is insufficient, covered benefit to be made available at no greater cost.
In any case where the health carrier has an insufficient number or type of participating provider to provide a covered benefit, the health carrier shall ensure that the covered person obtains the covered benefit at no greater cost to the covered person than if the benefit were obtained from participating providers, or shall make other arrangements acceptable to the director. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.")
Source: SL 2011, ch 219, §6.
Structure South Dakota Codified Laws
Chapter 17F - Network Adequacy Standards
Section 58-17F-1 - Definitions.
Section 58-17F-2 - Health benefit plan defined.
Section 58-17F-3 - Medical director required for managed care plans.
Section 58-17F-7 - Health carrier to ensure provider proximity to covered persons.
Section 58-17F-9 - Factors to consider in determining network adequacy.
Section 58-17F-11 - Requirements for health carrier and providers in managed care plans.
Section 58-17F-14 - Contract does not relieve health carrier of liability.
Section 58-17F-15 - Remedies available to director against health carrier found not in compliance.
Section 58-17F-16 - Managed care contractor to register with director.
Section 58-17F-17 - Filing changes in registration information.
Section 58-17F-18 - Request for information from managed care contractor.
Section 58-17F-19 - Activities of nonregistered managed care contractor prohibited.
Section 58-17F-20 - Registration fee for managed care contractor.