- Home to DLR
- Home to Division of Insurance
- About Us
- Application, Forms & Filing Requirements
- Company Address Service
- Company Rate and Form Filing Search
- Complaint Process
- Enforcement/Administrative Actions
- External Review Process
- Laws, Administrative Rules, Bulletins, Memorandums
- Market Share Reports
- Partners in Education Tax Credit Program
- Premium Tax Information
- Publications (Alerts, Newsletters)
- Report Insurance Fraud
- Securities Regulation
- Sign up for Alerts & Bulletins
- Useful Links
- Workers' Compensation
- Contact the Division of Insurance
Division of Insurance - Discount Medical Plan Organizations
Surety Bond From or Submission of Depository Information
A surety bond form,, DMPO Surety Bond Form (in Adobe .pdf format*), is required to be completed and provided to the Division of Insurance. (Contact information for the Division. If submitting the form by email, please indicate DMPO Application in the subject line).
DMPO Surety Bond Form (Adobe .pdf format*)
Surety Bond Form Information
- Principal/Applicant - The name and address should match that of the applicant on the registration form.
- Signed and Sealed - The completion of the upper half of page 2 for the applicable entity structure is required.
- Acknowledgement of Principal - Principal must complete they type of acknowledgement that is applicable to their entity's structure.
- Individual, Partnership or Corporate Surety - Surety must complete this portion and have it signed by a South Dakota Resident Agent.
- Acknowledgement of Surety - Surety must complete the applicable acknowledgement section.
Submission of Depository Information
In lieu of the bond required, a registered discount medical plan organization may deposit and maintain deposited with the director, or at the discretion of the director, with any organization or trustee acceptable to the director through which a custodial or controlled account is utilized, cash, securities or any combination of these or other measures that are acceptable to the director which at all times have a market value of not less than $35,000. All income from the deposit is an asset of the discount medical plan organization.
For entities that want to meet their financial secuirty by this means instead of the surety bond, written documentation is required from the depository.
*Opening and printing Adobe .pdf files requires Adobe Acrobat Reader. Click here as needed to download the free Adobe Acrobat Reader.