Marcia Hultman

Cabinet Secretary

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Division of Insurance - Consumer Information


Creditable Coverage

 

For purposes of South Dakota Codified Law (SDCL) 58-17-66 to 58-17-87, inclusive, the term creditable coverage means benefits or coverage provided under:

  1. An employer-based health insurance or health benefit arrangement that provides benefits similar to or exceeding benefits provided under the basic health benefit plan or an employee welfare benefit plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974 as adopted by the director pursuant to SDCL chapter 1-26, to the extent that the plan provides directly or through insurance, reimbursement or otherwise to employees or their dependents medical care for the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body and amounts paid for the transportation primarily for and essential to medical care;
  2. An individual health benefit plan, including coverage issued by any health maintenance organization (HMO) or pre-paid hospital or medical services plan that provides benefits similar to or exceeding the benefits provided under the basic health benefit plan as approved pursuant to chapter 1-26, but excluding limited benefit plans and dread disease plans;
  3. Medicare or Medicaid (CHIP);
  4. Chapter 55 of Title 10, United States Code (Uniformed Services);
  5. A medical care program of the Indian Health Service or of a tribal organization;
  6. A health plan offered under Chapter 89 of Title 5, United States Code (Government Organizations);
  7. A public health plan;
  8. A health benefit plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e));
  9. A church plan;
  10. A college plan;
  11. A short term or limited duration plan; or
  12. An individual health benefit plan, including coverage issued by any health maintenance organization (HMO) or pre-paid hospital or medical service plan that provided benefits less than the benefits provided under the basic health benefit plan as approved pursuant to chapter 1-26, but excluding the following excepted benefits:
    1. Coverage only for accident including accidental death and dismemberment;
    2. Disability income insurance;
    3. Liability insurance including general liability insurance and automobile insurance;
    4. Coverage issued as a supplement to liability insurance;
    5. Workers' compensation or similar insurance;
    6. Automobile medical payment insurance;
    7. Credit only insurance including mortgage insurance;
    8. Coverage for on-site medical clinics; and
    9. Limited scope dental and long-term care insurance, if provided under a separate policy, certificate, or contract of insurance, or not otherwise an integral part of the plan.

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