Marcia Hultman

Cabinet Secretary

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Division of Insurance - Health Rate & Form Filing Requirements

Group Major Medical

South Dakota Codified Laws
21-25A-3 Arbitration not permitted.
58-9-3 "Health insurance" defined.
58-11-1 "Premium" defined.
58-11-2 Contents of policy.
58-11-3 Statement of basis and rates for determination of premium included in policy.
58-11-5 Standard or uniform provisions of insurance contracts.
58-11-7 Substitute provisions required by law of domicile of foreign or alien insurer, approval by director.
58-11-8 Assessable policies.
58-11-10 Additional policy provisions.
58-11-11 Charter and bylaws, inclusion as part of contract of insurance.
58-11-12 Policy forms must be submitted for approval.
58-11-22 Identification of contracts issued and forms filed with director.
58-11-23 Execution of policy by authorized representative of insurer.
58-11-26 Jointly issued policies.
58-11-27 Combination policy.
58-11-36 Assignment of policies.
58-11-39 Modification by rider, endorsement, or application made part of policy.
58-11-62 Notice of intent to cease marketing block of business.
58-11A-1 Definitions.
58-11A-2 Policies subject to chapter.
58-11A-3 Reading ease.
58-11A-4 Alternate reading ease tests.
58-11A-5 Certificate concerning reading ease.
58-11A-6 Variation of reading ease requirement.
58-11A-9 Law permitting issuance of policies after form on file for specified period.
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.
58-17H-1 Emergency services defined.
58-17H-5 Emergency services coverage subject to limitations.
58-17H-50 Coverage for cancer treatment medication.
Chapter 58-18A Coordination of benefits.
58-18-1 Group health insurance defined.
58-18-2 Employee group insurance authorized.
58-18-3 Association member and employee group insurance authorized.
58-18-4 Industry fund group insurance authorized.
58-18-5 Issuance to person or organization to which group life insurance policy may be issued.
58-18-7 Continuation without evidence of insurability.
58-18-7.1 Coverage for inpatient treatment of alcoholism to be offered in group policies.
58-18-7.2 Benefits provided under alcoholism coverage - Maximum treatment periods permitted.
58-18-7.4 Coverage upon application by employee or beneficiary with right to convert following notice of termination.
58-18-7.5 Continuation of coverage upon leaving employment or termination of coverage by insurer - Duration.
58-18-7.11 Conversion policy not required to be issued.
58-18-7.12 Conditions for continuation.
58-18-7.13 Premium for conversion policy and continuation policy.
58-18-7.14 Notification of continuation and conversion rights.
58-18-7.17 Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited.
58-18-7.18 Continuation coverage to be same as that available to similarly situated beneficiaries.
58-18-7.19 Probationary period for continuation or conversion coverage prohibited.
58-18-8 Representations by applicant not warranties.
58-18-9 Summary statement of coverage for delivery to member of insured group.
58-18-10 Additions to group originally insured.
58-18-11 Direct payment for hospital, medical, or surgical services--Option of insurer.
58-18-31 Continuation of coverage for child with intellectual or physical disability.
58-18-31.1 Full time student coverage through age 29.
58-18-32 Family coverage to include newborn and newly adopted children.
58-18-33 Premature birth, congenital defects, and birth abnormalities covered - applicability.
58-18-34 Notice of birth or adoption required for continued coverage.
58-18-35 Notice required for rate increase by group health insurance company.
58-18-36 Policies required to cover low-dose mammography.
58-18-36.1 Policies required to cover occult breast cancer screening.
58-18-37 Freedom of choice for pharmacy services.
58-18-41 Coverage for phenylketonuria.
58-18-42 Health benefit plan defined.
58-18-43 Late enrollee defined.
58-18-44 Creditable coverage defined.
58-18-45 Preexisting conditions - Portability of health insurance.
58-18-45.1 Anesthesia and hospitalization for dental care to be provided certain covered persons.
58-18-46 Renewability of health benefit plans.
58-18-47 Nonrenewal of health benefit plans by an employer carrier.
58-18-48 Acceptance of new employees for coverage under employer's existing health benefit plan.
58-18-49 Carrier's offer of coverage to employer - Coverage of all eligible employees.
58-18-63 Minimum loss ratio for employer health benefit plans.
58-18-76 Minimum inpatient care coverage following delivery.
58-18-77 Shorter hospital stay permitted.
58-18-80 Health insurance policies to provide coverage for biologically-based mental illnesses.
58-18-83 Policies to provide coverage for diabetes supplies, equipment and education.
58-18-85 Policies to provide coverage for prostate cancer screening.
Chapter 58-18A Coordination of benefits.
58-18B-1 Definition of terms.
58-18B-3 Regulations on premium rates.
58-18B-15 Provisions for premium rates.
58-18B-17 Limit on premium rates.
58-18B-27 Modification to exclude certain diseases prohibited.
58-18B-27.1 Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited.
58-18B-50 Minimum inpatient care coverage following delivery.
58-18B-51 Shorter hospital stay permitted - Follow-up visit within forty-eight hours required.
58-18B-53 Health insurance policies to provide coverage for biologically-based mental illnesses.
58-18B-55 Supplemental or short term individual health benefit plans exempt from provisions of chapter.
58-18B-56 Policies to provide coverage for diabetes supplies, equipment and education.
58-18B-58 Health benefit plans to provide coverage for prostate cancer screening.
58-18C-1 Continuation of coverage after employer ceases operations, fails to pay premiums, or cancels coverage.
58-18C-3 Eligibility requirements.
58-18C-4 Notice of termination required.
58-18C-5 Exercising continuation rights.
58-18C-7 Continuation policy not required in certain circumstances.
58-18C-8 Premiums for continuation policies.
58-18C-9 Notification of continuation rights.
58-33-13 Unfair discrimination as misdemeanor.
58-33-13.1 Sex or marital status discrimination prohibited.
58-33-13.2 Definition of sex or marital status discrimination terms.
58-33-85 Health insurers prohibited from denying enrollment of dependent child on certain grounds.
62-1-1.3 In regard to exclusions for workers' compensation the word "paid" must be used instead of "payable" or "entitled to" or similar language.
Administrative Rules of South Dakota
20:06:28:01 Filing fees.
20:06:28:03 Filings by third parties.
20:06:28:08 Electronic filings.
20:06:39:34.01 Disclosure Requirements.
20:06:40:01.01 Waiting periods and affiliation periods relating to breaks in coverage.
20:06:40:02 Short-term, limited duration policies.
20:06:40:04 Standards for determinations on length of preexisting waiting periods.
20:06:40:05 Special enrollment periods for marriage, birth, and adoption.
20:06:40:05.01 Special enrollment periods for loss of other coverage.
20:06:40:13 Public health plan defined.
20:06:40:17 Group health plans to offer breast reconstruction options after covered mastectomy.
20:06:50 Model coordination of benefits contract provisions.
20:06:52:02 Discretionary clause not permitted
20:06:54 Preventive services.
20:06:55 Market regulations.
20:06:56 Minimum benefit standards.
20:06:58 Mental health parity.
20:06:42:01 Eligible associations defined.
20:06:42:02 Credit Unions.
Bulletin 98-6 Use of Trusts in Marketing Life and Health Insurance (Replaces 98-4)
Bulletin 07-01 SERFF required for all form and rate filings.
Bulletin 08-04 Health Policy Rate and Form Filing
  • For policies or certificates that provide coverage for hospital stays, benefits may not be restricted in a way that is based upon the number of hours that the insured stays in the hospital.
  • Policies or certificates may not contain an exclusion that excludes all services or charges not specifically covered in the policy or certificate.
  • No policy or certificate may limit coverage to natural or sound teeth.
  • An application or a policy form may not include a statement that indicates that the agent cannot bind the company. An application or a policy form may contain language that indicates that agents or others have no authority to modify or waive any provisions of the policy or certificate.
  • For any policy or certificate exclusions for doctors that are family members must permit coverage for treatment by family members if it is the only doctor in the area provided that the doctor is acting within the scope of practice.
  • Any policy or certificate that contains a precertification or preauthorization provision that must be instituted within a specific time frame must contain an exception that also allows notification as soon as reasonably possible.
  • No policy or certificate may contain a provision that allows for the decision of a insurer selected medical provider to be binding for purposes of determining medical appropriateness or medical necessity of any claimed benefit.
  • A provision of a policy or certificate which has the effect of making the insurance excess or secondary is a coordination of benefits provision and must only be included in compliance with Chapter 58-18A.
  • No health policy or certificate amendment or endorsement filing may contain blank provisions that may be completed upon issuance by the insurer.
  • No policy or certificate may exclude covered sicknesses or injuries caused by alcohol or drug use unless it is in the commission of a felony.

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