§ 58-41-1 Definition of terms
§ 58-41-2 Organizations subject to chapter
§ 58-41-3 Certificate of authority required for health maintenance organization or contracts–Violation as misdemeanor
§ 58-41-4 Application for certificate of authority required
§ 58-41-6 Verification and form of application–Contents
§ 58-41-7 Financial statements required with application
§ 58-41-8 Copies of forms required with application
§ 58-41-9 Marketing, charges, and financial plans required with application
§ 58-41-10 Appointment to receive process required of foreign applicant
§ 58-41-11 Surety bond or deposit required–Waiver
§ 58-41-12 Determination of health care qualifications
§ 58-41-13 Coordination with federal professional standards review
§ 58-41-15 Health maintenance not considered practice of healing arts
§ 58-41-15.1 Certain healing arts practitioners to participate in alternate health care delivery systems
§ 58-41-17 Issuance or denial of certificate–Fee–Conditions for issuance
§ 58-41-18 Factors considered in determining financial responsibility
§ 58-41-19 Insurance arrangements permitted
§ 58-41-20 Corporation operating after certification
§ 58-41-21 Foreign corporations qualifying–Exemption from other requirements
§ 58-41-22 Filing of notice of modification of operation–Approval if not disapproved–Exemptions
§ 58-41-23 Composition of governing body–Consumer representation
§ 58-41-24 Mechanisms for enrollee participation in policy and operation of governing body
§ 58-41-25 Fiduciary responsibilities to enrollees
§ 58-41-25.1 Investments
§ 58-41-26 Exemption from insurance laws–Exceptions–Taxation
§ 58-41-28 Solicitation of enrollment not deemed professional advertising
§ 58-41-29 Contracts and necessary activities
§ 58-41-29.1 Notice required for rate increase in health maintenance contract by a health maintenance organization
§ 58-41-30 Sources of payment for enrollee services–Application by medical assistance recipient
§ 58-41-31 Direct payments to enrollees prohibited
§ 58-41-32 Use of words descriptive of insurance, casualty, or surety business as misdemeanor–Exception
§ 58-41-33 Trade practice laws applicable
§ 58-41-34 Evidence of coverage issued to enrollees
§ 58-41-35 Contents required in evidence of coverage
§ 58-41-35.1 Alcoholism coverage to be offered at time contract is negotiated
§ 58-41-35.5 Grandfathered contracts required to cover low-dose mammography–Extent of coverage
§ 58-41-35.6 Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited–Exception for sickness or injury caused in commission of felony
§ 58-41-35.7 Contracts required to cover occult breast cancer screening
§ 58-41-36 Unfair and misleading information in evidence of coverage as misdemeanor
§ 58-41-37 Deceptive advertising or evidence of coverage as misdemeanor
§ 58-41-38 Statements deemed untrue
§ 58-41-39 Statements deemed misleading
§ 58-41-40 Evidence of coverage deemed deceptive
§ 58-41-41 Issuance to enrollees of change in evidence of coverage
§ 58-41-42 Evidence of coverage to be approved before use–Violation as misdemeanor
§ 58-41-43 Filing and approval requirements applicable
§ 58-41-44 Charges to enrollees–Fairness–Actuary’s certificate
§ 58-41-45 Discrimination as misdemeanor
§ 58-41-50 Authorized expenses
§ 58-41-51.1 Individual policy required for covered spouse of insured–Eligibility–Coverage–Waiting periods
§ 58-41-51.2 Conversion privileges of insured’s spouse upon divorce
§ 58-41-51.3 Continuation and conversion coverage to be offered
§ 58-41-52 Contracts with providers of health care services
§ 58-41-52.1 Collection for covered services prohibited
§ 58-41-52.2 Contracts–Hold harmless provision
§ 58-41-52.3 Hold harmless provision–Language of provision
§ 58-41-54 Contracts with insurance companies and nonprofit health service plan corporations authorized–Limitations
§ 58-41-55 Insurance contracts authorized–Group coverage–Benefit payments
§ 58-41-56 Contracts for management and administrative services authorized
§ 58-41-57 Payment of unreasonably high expenses as misdemeanor
§ 58-41-63 General annual report required–Form and contents
§ 58-41-65 Applications, filings and reports as public documents
§ 58-41-66 Annual summary for enrollees required–Contents
§ 58-41-67 Promulgation of rules
§ 58-41-73 Physician-patient privileges
§ 58-41-74 Confidential data–Exceptions
§ 58-41-78 Cease and desist orders
§ 58-41-79 Hearing on cease and desist order–Procedure–Judicial review
§ 58-41-80 Injunctive relief against violations–Venue
§ 58-41-81 Suspension or revocation of certificate of authority on findings by director
§ 58-41-82 Additional grounds for suspension or revocation
§ 58-41-83 Voluntary conference before commencing actions for violation
§ 58-41-84 Informality in voluntary conferences
§ 58-41-85 Money penalty in lieu of suspension or revocation
§ 58-41-86 Requirements for suspension or revocation
§ 58-41-86.1 Suspension without notice or hearing
§ 58-41-87 Notice of grounds for denial, suspension, or revocation of certificate–Time of hearing–Summary proceedings excepted
§ 58-41-88 Administrative procedure and rules
§ 58-41-90 Action of director after hearing–Written findings
§ 58-41-91 Judicial review
§ 58-41-92 Activities prohibited during suspension of certificate
§ 58-41-93 Winding up after revocation of certificate–Continued operation to protect enrollees
§ 58-41-94 Summary proceeding to reorganize organization–Grounds
§ 58-41-95 Rehabilitation, liquidation, or conservation under insurance company laws
§ 58-41-96 Severability of provisions
§ 58-41-97 Citation of chapter
§ 58-41-98 Coverage for phenylketonuria
§ 58-41-99 Formation of voluntary health insurance purchasing organizations
§ 58-41-100 Membership of voluntary health insurance purchasing organizations
§ 58-41-101 Purchasing organization’s responsibility for negotiating terms and conditions
§ 58-41-102 Purchasing organization’s notice of premium charge
§ 58-41-103 Additional chapters applicable to purchasing organization
§ 58-41-104 Approval of purchasing organization by Division of Insurance
§ 58-41-105 Premiums held in trust by purchasing organization
§ 58-41-106 Rates for group health insurance issued to purchasing organizations
§ 58-41-107 Reasonable participation requirements for group members of purchasing organizations
§ 58-41-108 Purchasing organizations exempt from antitrust provisions
§ 58-41-109 Promulgation of rules for purchasing organizations
§ 58-41-110 Application of chapter to provider contracting with state
§ 58-41-111 Application of chapter to provider contracting with licensed health maintenance organization
§ 58-41-112 Minimum inpatient care coverage following delivery
§ 58-41-113 Shorter hospital stay permitted–Follow-up visit within forty-eight hours required
§ 58-41-114 Notice to enrollees–Disclosures
§ 58-41-115 Health insurance policies to provide coverage for biologically-based mental illnesses
§ 58-41-116 Application–Exemptions
§ 58-41-117 Policies to provide coverage for diabetes supplies, equipment, and education–Exceptions–Conditions and limitations
§ 58-41-118 Diabetes coverage not required of certain plans and policies
§ 58-41-119 Contracts to provide coverage for prostate cancer screening
§ 58-41-120 Annual report on risk bearing entities
§ 58-41-121 Documents provided to risk bearing entity by health maintenance organization
§ 58-41-122 Documents provided to health maintenance organization by risk bearing entity
§ 58-41-123 Notice by risk bearing entity of change in conditions–Assignment of contract
§ 58-41-124 Notice to director that risk bearing entity has materially failed to perform contract
§ 58-41-125 Confidentiality of information
§ 58-41-126 Nontransferable responsibilities of health maintenance organization
§ 58-41-127 Coverage for treatment of hearing impairment for persons under age nineteen
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Terms Used In South Dakota Codified Laws > Title 58 > Chapter 41 - Health Maintenance Organizations

  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • Children: includes children by birth and by adoption. See South Dakota Codified Laws 2-14-2
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fiduciary: A trustee, executor, or administrator.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Person: includes natural persons, partnerships, associations, cooperative corporations, limited liability companies, and corporations. See South Dakota Codified Laws 2-14-2
  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
  • Property: includes property, real and personal. See South Dakota Codified Laws 2-14-2
  • Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. Source: FDIC
  • Service of process: The service of writs or summonses to the appropriate party.
  • State: when used in context signifying a jurisdiction other than the State of South Dakota, a state, the District of Columbia, a territory, commonwealth, or possession of the United States of America, or a province of the Dominion of Canada. See South Dakota Codified Laws 58-1-2
  • Statute: A law passed by a legislature.
  • Trustee: A person or institution holding and administering property in trust.
  • written: include typewriting and typewritten, printing and printed, except in the case of signatures, and where the words are used by way of contrast to typewriting and printing. See South Dakota Codified Laws 2-14-2