Marcia Hultman

Cabinet Secretary

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Division of Insurance


Other License Types Filings and Forms

All entities are subject to Title 58 in South Dakota Codified Law (SDCL) in its entirety unless otherwise stated. For each listing, if applicable, the SDCL or Administrative Rule (ARSD) most associated with the license/registration requirement is cited.

Entity Type Form SDCL

Discount Medical Plan Organization (DMPO)

Application (NIPR)
[Access to NIPR also available through State Based Systems (SBS)]

License Application Requirement Checklist

DMPO Surety Bond Form

Access Attachment Warehouse for Document Submission (NIPR)

DMPO Additional Information

58-17E

 

Independent Review Organization (IRO)

Application (NIPR)
[Access to NIPR also available through SBS]

License Application Requirement Checklist

Access Attachment Warehouse for Document Submission
(NIPR)

IRO Additional Information

20:06:53

 

Managed Care Contractor (MCC)

Application (NIPR)
[Access to NIPR also available through SBS]

License Application Requirement Checklist

Access Attachment Warehouse for Document Submission (NIPR)

MCC Additional Information

58-17F

20:06:33

 

Pharmacy Benefits Manager (PBM)

Application (NIPR)
[Access to NIPR also available through SBS]

License Application Requirement Checklist

Access Attachment Warehouse for Document Submission (NIPR)

PBM Additional Information

58-29E

 

Third Party Administrator (TPA)

Application (NIPR)
[Access to NIPR also available through SBS]

License Application Requirement Checklist

Registration Application Requirement Checklist

Access Attachment Warehouse for Document Submission (NIPR)

TPA Additional Information

58-29D

 

Utilization Review Organization (URO)

Application (NIPR)
[Access to NIPR also available through SBS]

License Application Requirement Checklist

Access Attachment Warehouse for Document Submission (NIPR)

URO Additional Information

58-17H

20:06:33

 

Contact the Division of Insurance