58-18A-77. Coordination of benefits of complying and noncomplying plans.
A plan with order of benefit determination provisions that comply with §§58-18A-53 to 58-18A-83, inclusive, may coordinate its benefits with a plan that is excess or always secondary or that uses order of benefit determination provisions that are inconsistent with those contained in §§58-18A-53 to 58-18A-83, inclusive, on the following basis:
(1)If the complying plan is the primary plan, it shall pay or provide its benefits first;
(2)If the complying plan is the secondary plan, it shall pay or provide its benefits first, but the amount of the benefits payable shall be determined as if the complying plan were the secondary plan. In such a situation, the payment shall be the limit of the complying plan's liability; and
(3)If the noncomplying plan does not provide the information needed by the complying plan to determine its benefits within a reasonable time after it is requested to do so, the complying plan shall assume that the benefits of the noncomplying plan are identical to its own, and shall pay its benefits accordingly. If, within two years of payment, the complying plan receives information as to the actual benefits of the noncomplying plan, it shall adjust payments accordingly.
Source: SL 2006, ch 259, §25.
Structure South Dakota Codified Laws
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-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-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.