South Dakota Codified Laws
Chapter 18A - Coordination Of Benefits Of Health Plans
Section 58-18A-75 - Calculation of amount to be paid by secondary plan.

58-18A-75. Calculation of amount to be paid by secondary plan.
In determining the amount to be paid by the secondary plan on a claim, if the plan wishes to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in the absence of other health care coverage and apply that calculated amount to any allowable expense under its plan that is unpaid by the primary plan. The secondary plan may reduce its payment by the amount so that, when combined with the amount paid by the primary plan, the total benefits paid or provided by all plans for the claim do not exceed one hundred percent of the total allowable expense for that claim. In addition, the secondary plan shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage.

Source: SL 2006, ch 259, §23.

Structure South Dakota Codified Laws

South Dakota Codified Laws

Title 58 - Insurance

Chapter 18A - Coordination Of Benefits Of Health Plans

Section 58-18A-53 - Definitions.

Section 58-18A-54 - Allowable expenses defined.

Section 58-18A-55 - Expenses that are not allowable.

Section 58-18A-56 - Exclusion of certain expenses.

Section 58-18A-57 - Plan defined--Types of coverage considered in coordination of benefits to be stated.

Section 58-18A-58 - Contracts and coverages included within definition of plan.

Section 58-18A-59 - Contracts and coverages not included within definition of plan.

Section 58-18A-60 - Application date.

Section 58-18A-61 - Promulgation of rules concerning coordination of health plan benefits.

Section 58-18A-62 - Prohibited grounds for reduction of benefits.

Section 58-18A-63 - Restriction on excess or secondary benefits provisions.

Section 58-18A-64 - Closed panel plans.

Section 58-18A-65 - Prohibition on reduction of benefits for coverage not qualifying as plan.

Section 58-18A-66 - Order of benefit payments.

Section 58-18A-67 - Coordination of benefits only available to secondary plans.

Section 58-18A-68 - Order of benefits determined under §§ 58-18A-69 to 58-18A-74.

Section 58-18A-69 - Plan covering person other than as dependent.

Section 58-18A-70 - Plan covering dependent child.

Section 58-18A-71 - Plan covering person as active employee.

Section 58-18A-72 - Coverage under COBRA or right of continuation.

Section 58-18A-73 - Plan covering person for longer period of time.

Section 58-18A-74 - Sharing of allowable expenses equally.

Section 58-18A-75 - Calculation of amount to be paid by secondary plan.

Section 58-18A-76 - Plan providing benefits as services.

Section 58-18A-77 - Coordination of benefits of complying and noncomplying plans.

Section 58-18A-78 - Noncomplying secondary plan to advance difference covered person would have received if complying plan had been secondary plan.

Section 58-18A-79 - Subrogation distinguished.

Section 58-18A-80 - Paying of claim where plans disagree on order of benefits.

Section 58-18A-81 - Time for bringing existing contract into compliance with statutory requirements.

Section 58-18A-82 - Proceedings not subject to statutory requirements.

Section 58-18A-83 - Duties, rights accrued, and offenses committed prior to July 1, 2007.