58-18B-37. Marketing health benefit plans--Denial of coverage to employer.
Each small employer carrier shall actively market health benefit plan coverage, to eligible small employers in the state. A small employer carrier may not deny coverage to a small employer on the basis of the health status or claims experience of the small employer or its employees or dependents. A network plan is not required to offer coverage to an employer whose employees do no work or reside within the carrier's established geographic service. A network plan may deny coverage to employers if it demonstrates it does not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees, and if it is applying this denial of coverage uniformly to all employers without regard to the claims experience of those employers, and their employees and their dependents, or any health status-related factor relating to the employees and dependents.
Source: SL 1995, ch 281, §32; SL 1997, ch 289, §22; SL 1998, ch 289, §20.
Structure South Dakota Codified Laws
Chapter 18B - Regulation Of Small Businesses' Group And Blanket Health Insurance
Section 58-18B-1 - Definition of terms.
Section 58-18B-2 - Chapter applicable to small employer benefit plans.
Section 58-18B-3 - Regulations on premium rates.
Section 58-18B-3.1 - Base rate increase to be filed with director--Approval or disapproval.
Section 58-18B-6 - Disclosure in solicitation and sales materials.
Section 58-18B-7 - Information and documentation required--Disclosure.
Section 58-18B-8 - Suspension of rate requirements.
Section 58-18B-9 - Application of chapter.
Section 58-18B-11 - Health maintenance organization considered separate carrier.
Section 58-18B-13 - Transition period when acquiring additional class of business.
Section 58-18B-14 - Rate changes only for small employer business.
Section 58-18B-15 - Provisions for premium rates.
Section 58-18B-17 - Limit on premium rates.
Section 58-18B-18 - Promulgation of rules for rating practices.
Section 58-18B-23 - Uniform application of requirements used to determine eligibility of employers.
Section 58-18B-27 - Modification to exclude certain diseases prohibited.
Section 58-18B-36 - Rules governing implementation and administration of this chapter.
Section 58-18B-37 - Marketing health benefit plans--Denial of coverage to employer.
Section 58-18B-38 - Prohibited activities of small employer carriers or insurance producers.
Section 58-18B-39 - Information regarding restricted network provision of carrier.
Section 58-18B-41 - Compensation of insurance producer based on percentage of premium.
Section 58-18B-45 - Reasons for denial of coverage to be in writing.
Section 58-18B-47 - Third-party administrator treated as small employer carrier.
Section 58-18B-48 - Chapter not applicable to certain group health insurance plans.
Section 58-18B-49 - Establishing risk adjusters.
Section 58-18B-50 - Minimum inpatient care coverage following delivery.
Section 58-18B-52 - Notice to employees--Disclosures.
Section 58-18B-54 - Application--Exemptions.
Section 58-18B-57 - Diabetes coverage not required of certain plans.
Section 58-18B-58 - Health benefit plans to provide coverage for prostate cancer screening.
Section 58-18B-60 - Coverage for treatment of hearing impairment for persons under age nineteen.