§ 58-17-1 Requirements for all health insurance policies delivered in state
§ 58-17-1.1 Grandfathered plans required to cover low-dose mammography–Extent of coverage
§ 58-17-1.2 Policies to provide coverage for diabetes supplies, equipment and education–Exceptions–Conditions and limitations
§ 58-17-1.3 Diabetes coverage not required of certain plans and policies
§ 58-17-1.4 Policies required to cover occult breast cancer screening
§ 58-17-2 Persons covered by policy
§ 58-17-2.1 Health insurance on a franchise plan
§ 58-17-2.2 Conversion privileges of insured’s spouse upon divorce
§ 58-17-2.3 Dependent coverage termination–Age–Full-time students
§ 58-17-3 Time of commencement and termination to be set out in policy
§ 58-17-4 Consideration for policy to be stated
§ 58-17-4.1 Filing and approval of individual policy premium rates
§ 58-17-4.2 Premium rates required to be reasonable–Rules to establish minimum standards promulgated by director
§ 58-17-5 Identification of forms, riders and endorsements–Form number, location
§ 58-17-6 Style and arrangement of policy provisions–Printing, size of type
§ 58-17-7 Documents forming part of policy–Setting forth in full, rates and classifications excepted
§ 58-17-8 Exceptions and reductions of coverage to be clearly set out
§ 58-17-9 Renewal of policy at option of insurer–Statement in policy so informing the policyholder
§ 58-17-10.1 Reduction of benefits because of increase in statutory disability benefits prohibited
§ 58-17-10.2 Individual policy for insured’s spouse required in policies covering spouse–Eligibility–Coverage–Waiting periods
§ 58-17-11 Return of policy by purchaser–Refund of premium paid–Dissatisfaction with terms after examination
§ 58-17-11.1 Issuance of policies by insurance company, nonprofit hospital service plan, medical service corporation, or fraternal benefit society–Delivery receipts–Certificates of mailing–Term of retention
§ 58-17-12 Required provisions–Captions–Substitutes, approval by director
§ 58-17-13 Omission from policy of inapplicable provision–Approval of director–Modification of inconsistent provision
§ 58-17-14 Entire contract and change clauses required–Signed acceptance required for endorsements
§ 58-17-15 Time limit on certain defenses–Application of section
§ 58-17-17 Grace period on premiums required in policy
§ 58-17-18 Renewal of policy–Restriction on company’s right to refuse
§ 58-17-19 Reinstatement when premium not paid within grace period
§ 58-17-20 Omission of provision as to application of premiums accepted in connection with reinstatement–Right of insured to continue policy in force by payment of premiums
§ 58-17-21 Notice of claim–Provision required in policy
§ 58-17-22 Notice of claim–Loss of time benefit–Optional provision, insertion by insurer
§ 58-17-23 Claim forms–Furnishing by insurer
§ 58-17-24 Proofs of loss–Provision required in policy
§ 58-17-25 Time of payment of claims–Provision required in policy
§ 58-17-26 Payment of claims–Persons to whom benefits payable–Provision required in policy
§ 58-17-27 Payment of claims–Optional provisions, insertion by insurer
§ 58-17-28 Physical examination of insured–Autopsy in death claims–Provision required in policy
§ 58-17-29 Action to recover under policy–Time for beginning
§ 58-17-30 Beneficiary–Changes reserved to insured
§ 58-17-30.1 Continuation of coverage for child with intellectual or physical disability–Proof of dependency
§ 58-17-30.2 Family coverage to include newborn or newly adopted children–Payment of claim not to be withheld during bonding period of adopted child
§ 58-17-30.3 Premature birth and congenital defects covered–Applicability
§ 58-17-30.4 Notice of birth or adoption required for continued coverage
§ 58-17-30.5 Coverage for inpatient alcoholism treatment required
§ 58-17-30.6 Alcoholism benefits provided–Days of care
§ 58-17-30.7 Policies excluded from alcoholism coverage requirements
§ 58-17-30.8 Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited–Exception for sickness or injury caused in commission of felony
§ 58-17-30.9 Notice that dependent is no longer eligible for coverage–Premium adjustment
§ 58-17-31 Optional policy provisions
§ 58-17-32 Occupational change–Policy provision for adjustment of premium or benefits
§ 58-17-33 Misstatement of age–Policy provision for adjustment of benefits
§ 58-17-34 Earnings of insured–Policy provision for adjustment of benefits
§ 58-17-35 Earnings adjustment clause to be coupled with insured’s right to continue policy in force
§ 58-17-36 Option of insurer to define “valid loss of time coverage”
§ 58-17-37 Unpaid premiums–Deduction from benefits
§ 58-17-38 Conformity with state statutes of insured
§ 58-17-39 Illegal occupation of insured
§ 58-17-40 Renewal of policy at option of insurer
§ 58-17-41 Order of policy provisions
§ 58-17-42 Age limit in policy–Effect of acceptance of premiums or misstatement of age
§ 58-17-43 Third parties taking policy covering insured
§ 58-17-44 Foreign or alien insurer–Policy provision required by home state
§ 58-17-45 Policy of domestic insurer delivered in other state–Compliance with laws of other state
§ 58-17-46 Policy provisions not subject to chapter–Conforming to statute required
§ 58-17-47 Nonconforming and conflicting provisions construed in conformity with statute
§ 58-17-48 Liability and workers’ compensation insurance–Inapplicability of health insurance provisions
§ 58-17-49 Health insurance provisions inapplicable to group or blanket policy
§ 58-17-50 Life insurance, endowment or annuity contracts not subject to health insurance provisions
§ 58-17-51 Health insurance provisions inapplicable to reinsurance
§ 58-17-52 Prior contracts or policies excepted
§ 58-17-53 Optometric services–Reimbursement, exceptions
§ 58-17-54 Reimbursement provisions applicable to all healing arts licensees–Self-insurance plans for public employees–Restrictions on policy limitations
§ 58-17-54.1 Copayment or coinsurance amounts for chiropractic, physical therapy, or occupational therapy services
§ 58-17-55 Reimbursement provisions applicable to licensed hospitals
§ 58-17-56 Reimbursement for service rendered or supervised by qualified mental health professional
§ 58-17-57 “Abuse of health insurance” defined–Violation as misdemeanor
§ 58-17-58 Waiver of required deductible or co-payment for charitable purposes permitted
§ 58-17-59 When waiver presumed
§ 58-17-60 Certain payments exempt
§ 58-17-61 Assignment of health insurance proceeds to certain hospitals authorized
§ 58-17-62 Coverage for phenylketonuria
§ 58-17-63 “Health benefit plan” defined
§ 58-17-64 Minimum loss ratio for individual health benefit plans
§ 58-17-65 Individual health insurance plan used in conjunction with managed care plan or utilization review organization
§ 58-17-67 “Professional association” defined
§ 58-17-68 “Professional association plan” defined
§ 58-17-69 “Creditable coverage” defined
§ 58-17-71 Separate classes of individual business–Reasons–Number
§ 58-17-72 Transitional period when additional class of business acquired
§ 58-17-73 Director approval required to establish additional classes of business–Rates or rating methodologies
§ 58-17-74 Provisions for premium rates for individual health benefit plans
§ 58-17-74.1 Premium rate limitations
§ 58-17-75 Promulgation of rules for rates charged for individual health benefit plans
§ 58-17-76 Transfer into or out of class of business
§ 58-17-77 Temporary suspension of premium rates for individual health insurance–Reasons
§ 58-17-78 Required disclosure when offering individual health benefit plan
§ 58-17-79 Documentation of rating methods and practices
§ 58-17-81 Availability of information on rating methods and practices of carriers offering individual health benefit plans
§ 58-17-82 Renewal of individual health benefit plans–Exceptions
§ 58-17-83 Election not to renew individual health benefit plan–Future business restricted
§ 58-17-84 Provisions for carriers providing individual coverage other than excepted benefits
§ 58-17-84.1 (Text of section effective until the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospitalization for dental care to be provided certain covered persons
§ 58-17-87 Director to promulgate rules for individual health insurance–Scope of rules
§ 58-17-88 Minimum inpatient care coverage following delivery
§ 58-17-89 Shorter hospital stay permitted–Follow-up visit within forty-eight hours required
§ 58-17-90 Notice to policyholders–Disclosures
§ 58-17-97 Provisions covering preexisting conditions
§ 58-17-98 Health insurance policies to provide coverage for biologically-based mental illnesses
§ 58-17-100 Definitions
§ 58-17-101 Insurer may not exclude certain off-label uses of prescription drugs
§ 58-17-102 Exceptions
§ 58-17-103 Provisions limited to cancer or life threatening diseases
§ 58-17-104 Deductibles, copayments, and managed care review not affected
§ 58-17-105 Drugs used in research trials not covered
§ 58-17-106 No reduction or limitation of coverage otherwise required by law
§ 58-17-107 Health insurance policies to provide coverage for prostate cancer screening
§ 58-17-108 “Disability income insurance” defined
§ 58-17-109 Exclusion or reduction of benefits
§ 58-17-110 Commencement of loss
§ 58-17-111 Minimum standards–Exceptions
§ 58-17-112 Promulgation of rules regarding disability income policies–Content
§ 58-17-145.1 Deadline for submission of health claim under risk pool
§ 58-17-146 Dental insurers prohibited from setting fees for noncovered service
§ 58-17-146.1 Certain contract terms voidable by dentist
§ 58-17-147 Elective abortion coverage prohibited in qualified health plan offered through health insurance exchange
§ 58-17-148 Qualified health plan sold through exchange to provide for placement through licensed insurance producer–Commissions
§ 58-17-149 Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period
§ 58-17-150 Retrospective payment of clean claims for covered services provided by health care professional during credentialing period–Requirements
§ 58-17-151 Applications to be credentialed
§ 58-17-153 Coverage for treatment of hearing impairment for persons under age nineteen
§ 58-17-157 Coverage for applied behavior analysis for treatment of autism spectrum disorders
§ 58-17-158 Authorization, prior approval, and other care management requirements–Annual maximum benefit
§ 58-17-159 Qualifications of person performing or supervising applied behavior analysis
§ 58-17-160 Review of treatment
§ 58-17-161 Services under individualized service plan, family service plan, or education program
§ 58-17-163 Dental care insurers to honor assignment of benefits
§ 58-17-164 Revocation of assignment of dental insurance benefits
§ 58-17-165 Reimbursement of payment from insured following receipt of payment from insurer
§ 58-17-166 Scope of benefits not affected–Medical benefits not included
§ 58-17-167 Definitions pertaining to telehealth coverage
§ 58-17-168 Coverage for health care services provided through telehealth
§ 58-17-169 Discrimination between coverage for services provided in person and through telehealth prohibited
§ 58-17-170 Application of telehealth coverage requirements
§ 58-17-171 Payment for dental services–Credit card requirement prohibited
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Terms Used In South Dakota Codified Laws > Title 58 > Chapter 17 - Health Insurance Policies

  • 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.
  • Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
  • 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.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Children: includes children by birth and by adoption. See South Dakota Codified Laws 2-14-2
  • Continuance: Putting off of a hearing ot trial until a later time.
  • 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.
  • Dependent: A person dependent for support upon another.
  • 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.
  • Fraud: Intentional deception resulting in injury to another.
  • Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
  • insured: as used in this chapter , shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits, and rights provided therein. See South Dakota Codified Laws 58-17-43
  • 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.
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • 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.
  • Oversight: Committee review of the activities of a Federal agency or program.
  • 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
  • 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.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • 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