South Dakota Codified Laws
Chapter 29D - Regulation Of Life And Health Administrators
Section 58-29D-2 - Administrator defined--Exceptions.

58-29D-2. Administrator defined--Exceptions.
For the purposes of this chapter, an administrator or third-party administrator or TPA is a person who directly or indirectly solicits or effects coverage of, underwrites, collects charges or premiums from, or adjusts or settles claims on residents of this state, or residents of another state from offices in this state, in connection with workers' compensation, life or health insurance coverage or annuities, except any of the following:
(1)An employer on behalf of its employees or the employees of one or more subsidiary or affiliated corporations of such employer;
(2)A union on behalf of its members;
(3)An insurer which is authorized to transact insurance in this state with respect to a policy lawfully issued and delivered in and pursuant to the laws of this state or another state;
(4)An insurance producer licensed to sell workers' compensation, life or health insurance in this state, whose activities are limited exclusively to the sale of insurance;
(5)A creditor on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtors;
(6)A trust and its trustees, agents and employees acting pursuant to such trust established in conformity with 29 U.S.C. §186;
(7)A trust exempt from taxation under §501(a) of the Internal Revenue Code, its trustees and employees acting pursuant to such trust, or a custodian and the custodian's agents or employees acting pursuant to a custodian account which meets the requirements of §401(f) of the Internal Revenue Code;
(8)A financial institution which is subject to supervision or examination by federal or state banking authorities, or a mortgage lender, to the extent they collect and remit premiums to licensed insurance producers or authorized insurers in connection with loan payments;
(9)A credit card issuing company which advances for and collects premiums or charges from its credit card holders who have authorized collection if the company does not adjust or settle claims;
(10)A person who adjusts or settles claims in the normal course of that person's practice or employment as an attorney at law and who does not collect charges or premiums in connection with workers' compensation, life or health insurance coverage or annuities;
(11)An adjuster whose activities are limited to adjustment of claims;
(12)A person who acts solely as an administrator of one or more bona fide employee benefit plans established by an employer or an employee organization, or both, for which the insurance laws of this state are preempted pursuant to the Employee Retirement Income Security Act of 1974. Such person shall comply with the requirements of §58-29D-27;
(13)A licensed managing general agency;
(14)A licensed reinsurance intermediary; or
(15)A person regulated under the Broker Controlled Act.
This chapter applies to any third party administrator who performs administration functions on behalf of any workers' compensation insurer or employer with a self-funded workers' compensation program.

Source: SL 1992, ch 352, §2; SL 2001, ch 285, §1; SL 2001, ch 286, §152.

Structure South Dakota Codified Laws

South Dakota Codified Laws

Title 58 - Insurance

Chapter 29D - Regulation Of Life And Health Administrators

Section 58-29D-1 - Definition of terms.

Section 58-29D-2 - Administrator defined--Exceptions.

Section 58-29D-3 - Insurer defined.

Section 58-29D-4 - Written agreement between administrator and insurer.

Section 58-29D-5 - Provisions of written agreement.

Section 58-29D-6 - Termination of written agreement--Suspension of underwriting authority--Dispute.

Section 58-29D-7 - Status of payment of premiums and return premiums or claim payments to administrator.

Section 58-29D-8 - Recordkeeping by administrator.

Section 58-29D-9 - Director's access to administrator's records--Confidentiality.

Section 58-29D-10 - Insurer's ownership of administrator's records.

Section 58-29D-11 - Transfer of records to new administrator.

Section 58-29D-12 - Advertising--Approval of insurer.

Section 58-29D-13 - Insurer responsibility for procedures and administration of its programs--Review and audit of administrator.

Section 58-29D-14 - Fiduciary capacity of administrator--Accounting of underwriting transactions.

Section 58-29D-15 - Records of deposits and withdrawals from fiduciary account.

Section 58-29D-16 - Provisions in written agreement as to withdrawals from fiduciary account.

Section 58-29D-18 - Compensation of administrator.

Section 58-29D-19 - Notice of use of administrator to policyholder--Itemized charges--Disclosure of fees or commissions.

Section 58-29D-20 - Delivery of written communications from insurer.

Section 58-29D-20.1 - Annual report to employer of self-funded health benefit plan claims experience.

Section 58-29D-21 - Administrator's license or registration required.

Section 58-29D-22 - Application by administrator--Contents--Fee.

Section 58-29D-22.1 - Annual financial statement--Contents of application--Required audit.

Section 58-29D-23 - Inspection of applicant's contracts.

Section 58-29D-24 - Denial of license.

Section 58-29D-25 - Validity of license.

Section 58-29D-26 - Conditions not requiring license.

Section 58-29D-27 - Servicer of certain employee benefit plans--Exempt from licensure--Requirements.

Section 58-29D-28 - Notice of administrator's change in circumstance.

Section 58-29D-29 - Waiver of application requirements.

Section 58-29D-30 - Annual renewal of administrator--Fee--Lapse of license or registration.

Section 58-29D-31 - Grounds for denial, suspension, or revocation of license or registration.

Section 58-29D-32 - Immediate suspension of license--No notice required.

Section 58-29D-32.1 - Notice of denial of application or renewal--Request for hearing--Hearing on suspension or revocation--Notice.

Section 58-29D-33 - Money penalty in lieu of suspension or revocation.

Section 58-29D-34 - Promulgation of rules.