2018 House Bill 1251 - Printed

State of South Dakota  
NINETY-THIRD SESSION
LEGISLATIVE ASSEMBLY, 2018  

855Z0842   HOUSE BILL   NO.  1251  

Introduced by:    Representatives Willadsen, Hawley, Rounds, and Steinhauer and Senators Kolbeck, Solano, and Sutton
 

        FOR AN ACT ENTITLED, An Act to revise certain provisions regarding health maintenance organizations.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:
    Section 1. That ยง 58-41-2 be amended to read:
    58-41-2. As used in this chapter a health maintenance organization is a corporation organized under Title 47, controlled and operated as provided in this chapter, which provides, either directly or through arrangements with providers or other persons, comprehensive health maintenance services, or arranges for the provision of such the services, to enrollees on the basis of a fixed prepaid sum without regard to the frequency or extent of services furnished to any particular enrollee. A health maintenance organization may be organized pursuant to this chapter on a limited health service basis. Nothing in this chapter prohibits a health maintenance organization holding a certificate of authority in this state from issuing contracts to enrollees on a preferred provider, exclusive provider, or closed panel basis. Nothing in this chapter requires a licensed pharmacy benefit manager to obtain a certificate of authority as a health maintenance organization provided that if the pharmacy benefit manager does not assume insurance risk

directly from an insured.

    Nothing in this chapter prohibits a health maintenance organization, that is subject to this chapter, from offering health insurance products, providing administrative services, or otherwise transacting health insurance business that is permitted for insurers holding a certificate of authority as a health insurer pursuant to chapter 58-6. A health maintenance organization may also offer stop loss coverage or other health insurance coverage in conjunction with self-funded health benefit plans.