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CHAPTER 58-17

HEALTH INSURANCE POLICIES

58-17-1    Requirements for all health insurance policies delivered in state.

58-17-1.1    Grandfathered plans required to cover low-dose mammography--Extent of coverage.

58-17-1.2    Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.

58-17-1.3    Diabetes coverage not required of certain plans and policies.

58-17-1.4    Policies required to cover occult breast cancer screening.

58-17-2    Persons covered by policy.

58-17-2.1    Health insurance on a franchise plan.

58-17-2.2    Conversion privileges of insured's spouse upon divorce.

58-17-2.3    Dependent coverage termination--Age--Full-time students.

58-17-3    Time of commencement and termination to be set out in policy.

58-17-4    Consideration for policy to be stated.

58-17-4.1    Filing and approval of individual policy premium rates.

58-17-4.2    Premium rates required to be reasonable--Rules to establish minimum standards promulgated by director.

58-17-4.3    58-17-4.3. Transferred to § 58-17-74.1 by SL 2005, ch 10, § 41.

58-17-5    Identification of forms, riders and endorsements--Form number, location.

58-17-6    Style and arrangement of policy provisions--Printing, size of type.

58-17-7    Documents forming part of policy--Setting forth in full, rates and classifications excepted.

58-17-8    Exceptions and reductions of coverage to be clearly set out.

58-17-9    Renewal of policy at option of insurer--Statement in policy so informing the policyholder.

58-17-10    58-17-10. Repealed by SL 2006, ch 259, § 32.

58-17-10.1    Reduction of benefits because of increase in statutory disability benefits prohibited.

58-17-10.2    Individual policy for insured's spouse required in policies covering spouse--Eligibility--Coverage--Waiting periods.

58-17-11    Return of policy by purchaser--Refund of premium paid--Dissatisfaction with terms after examination.

58-17-11.1    Issuance of policies by insurance company, nonprofit hospital service plan, medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--Term of retention.

58-17-12    Required provisions--Captions--Substitutes, approval by director.

58-17-13    Omission from policy of inapplicable provision--Approval of director--Modification of inconsistent provision.

58-17-14    Entire contract and change clauses required--Signed acceptance required for endorsements.

58-17-15    Time limit on certain defenses--Application of section.

58-17-16    58-17-16. Repealed by SL 2011, ch 216, § 5.

58-17-17    Grace period on premiums required in policy.

58-17-18    Renewal of policy--Restriction on company's right to refuse.

58-17-19    Reinstatement when premium not paid within grace period.

58-17-20    Omission of provision as to application of premiums accepted in connection with reinstatement--Right of insured to continue policy in force by payment of premiums.

58-17-21    Notice of claim--Provision required in policy.

58-17-22    Notice of claim--Loss of time benefit--Optional provision, insertion by insurer.

58-17-23    Claim forms--Furnishing by insurer.

58-17-24    Proofs of loss--Provision required in policy.

58-17-25    Time of payment of claims--Provision required in policy.

58-17-26    Payment of claims--Persons to whom benefits payable--Provision required in policy.

58-17-27    Payment of claims--Optional provisions, insertion by insurer.

58-17-28    Physical examination of insured--Autopsy in death claims--Provision required in policy.

58-17-29    Action to recover under policy--Time for beginning.

58-17-30    Beneficiary--Changes reserved to insured.

58-17-30.1    Continuation of coverage for child with intellectual or physical disability--Proof of dependency.

58-17-30.2    Family coverage to include newborn or newly adopted children--Payment of claim not to be withheld during bonding period of adopted child.

58-17-30.3    Premature birth and congenital defects covered--Applicability.

58-17-30.4    Notice of birth or adoption required for continued coverage.

58-17-30.5    Coverage for inpatient alcoholism treatment required.

58-17-30.6    Alcoholism benefits provided--Days of care.

58-17-30.7    Policies excluded from alcoholism coverage requirements.

58-17-30.8    Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony.

58-17-30.9    Notice that dependent is no longer eligible for coverage--Premium adjustment.

58-17-31    Optional policy provisions.

58-17-32    Occupational change--Policy provision for adjustment of premium or benefits.

58-17-33    Misstatement of age--Policy provision for adjustment of benefits.

58-17-34    Earnings of insured--Policy provision for adjustment of benefits.

58-17-35    Earnings adjustment clause to be coupled with insured's right to continue policy in force.

58-17-36    Option of insurer to define "valid loss of time coverage".

58-17-37    Unpaid premiums--Deduction from benefits.

58-17-38    Conformity with state statutes of insured.

58-17-39    Illegal occupation of insured.

58-17-40    Renewal of policy at option of insurer.

58-17-41    Order of policy provisions.

58-17-42    Age limit in policy--Effect of acceptance of premiums or misstatement of age.

58-17-43    Third parties taking policy covering insured.

58-17-44    Foreign or alien insurer--Policy provision required by home state.

58-17-45    Policy of domestic insurer delivered in other state--Compliance with laws of other state.

58-17-46    Policy provisions not subject to chapter--Conforming to statute required.

58-17-47    Nonconforming and conflicting provisions construed in conformity with statute.

58-17-48    Liability and workers' compensation insurance--Inapplicability of health insurance provisions.

58-17-49    Health insurance provisions inapplicable to group or blanket policy.

58-17-50    Life insurance, endowment or annuity contracts not subject to health insurance provisions.

58-17-51    Health insurance provisions inapplicable to reinsurance.

58-17-52    Prior contracts or policies excepted.

58-17-53    Optometric services--Reimbursement, exceptions.

58-17-54    Reimbursement provisions applicable to all healing arts licensees--Self-insurance plans for public employees--Restrictions on policy limitations.

58-17-54.1    Copayment or coinsurance amounts for chiropractic, physical therapy, or occupational therapy services.

58-17-55    Reimbursement provisions applicable to licensed hospitals.

58-17-56    Reimbursement for service rendered or supervised by qualified mental health professional.

58-17-57    "Abuse of health insurance" defined--Violation as misdemeanor.

58-17-58    Waiver of required deductible or co-payment for charitable purposes permitted.

58-17-59    When waiver presumed.

58-17-60    Certain payments exempt.

58-17-61    Assignment of health insurance proceeds to certain hospitals authorized.

58-17-62    Coverage for phenylketonuria.

58-17-63    "Health benefit plan" defined.

58-17-64    Minimum loss ratio for individual health benefit plans.

58-17-65    Individual health insurance plan used in conjunction with managed care plan or utilization review organization.

58-17-66    Definitions for 58-17-66 through 58-17-87.

58-17-67    "Professional association" defined.

58-17-68    "Professional association plan" defined.

58-17-69    "Creditable coverage" defined.

58-17-70    Application of 58-17-66 to 58-17-87, inclusive.

58-17-71    Separate classes of individual business--Reasons--Number.

58-17-72    Transitional period when additional class of business acquired.

58-17-73    Director approval required to establish additional classes of business--Rates or rating methodologies.

58-17-74    Provisions for premium rates for individual health benefit plans.

58-17-74.1    Premium rate limitations.

58-17-75    Promulgation of rules for rates charged for individual health benefit plans.

58-17-76    Transfer into or out of class of business.

58-17-77    Temporary suspension of premium rates for individual health insurance--Reasons.

58-17-78    Required disclosure when offering individual health benefit plan.

58-17-79    Documentation of rating methods and practices.

58-17-80    58-17-80. Repealed by SL 2009, ch 262, § 1.

58-17-81    Availability of information on rating methods and practices of carriers offering individual health benefit plans.

58-17-82    Renewal of individual health benefit plans--Exceptions.

58-17-83    Election not to renew individual health benefit plan--Future business restricted.

58-17-84    Provisions for carriers providing individual coverage other than excepted benefits.

58-17-84.1    (Text of section effective until the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospitalization for dental care to be provided certain covered persons.

58-17-85    58-17-85, 58-17-85.1. Repealed by SL 2015, ch 249, §§ 2, 3.

58-17-86    58-17-86. Repealed by SL 2003 (SS) ch 1, § 33

58-17-87    Director to promulgate rules for individual health insurance--Scope of rules.

58-17-88    Minimum inpatient care coverage following delivery.

58-17-89    Shorter hospital stay permitted--Follow-up visit within forty-eight hours required.

58-17-90    Notice to policyholders--Disclosures.

58-17-91    58-17-91 to 58-17-96. Repealed by SL 2000, ch 243, §§ 16 to 21

58-17-97    Provisions covering preexisting conditions.

58-17-98    Health insurance policies to provide coverage for biologically-based mental illnesses.

58-17-99    Application of § 58-17-98--Exemptions.

58-17-100    Definitions.

58-17-101    Insurer may not exclude certain off-label uses of prescription drugs.

58-17-102    Exceptions.

58-17-103    Provisions limited to cancer or life threatening diseases.

58-17-104    Deductibles, copayments, and managed care review not affected.

58-17-105    Drugs used in research trials not covered.

58-17-106    No reduction or limitation of coverage otherwise required by law.

58-17-107    Health insurance policies to provide coverage for prostate cancer screening.

58-17-108    "Disability income insurance" defined.

58-17-109    Exclusion or reduction of benefits.

58-17-110    Commencement of loss.

58-17-111    Minimum standards--Exceptions.

58-17-112    Promulgation of rules regarding disability income policies--Content.

58-17-113    58-17-113, 58-17-114. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-115    58-17-115. Repealed by SL 2015, ch 249, § 5.

58-17-116    58-17-116. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-117    58-17-117, 58-17-118. Repealed by SL 2015, ch 249, §§ 6, 7.

58-17-119    58-17-119 to 58-17-124. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-125    58-17-125. Repealed by SL 2015, ch 249, § 10.

58-17-126    58-17-126. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-127    58-17-127 to 58-17-137. Repealed by SL 2015, ch 249, §§ 12 to 22.

58-17-138    58-17-138. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-139    58-17-139 to 58-17-141. Repealed by SL 2015, ch 249, §§ 24 to 26.

58-17-142    Maximum premium rates for plans issued prior to August 1, 2003--Rate provisions of § 58-17-75 to apply upon carrier's discontinuance of active marketing.

58-17-143    58-17-143. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-144    58-17-144, 58-17-145. Repealed by SL 2015, ch 249, §§ 28, 29.

58-17-145.1    Deadline for submission of health claim under risk pool.

58-17-146    Dental insurers prohibited from setting fees for noncovered service.

58-17-147    Elective abortion coverage prohibited in qualified health plan offered through health insurance exchange.

58-17-148    Qualified health plan sold through exchange to provide for placement through licensed insurance producer--Commissions.

58-17-149    Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period.

58-17-150    Retrospective payment of clean claims for covered services provided by health care professional during credentialing period--Requirements.

58-17-151    Applications to be credentialed.

58-17-152    Application of §§ 58-17-149 to 58-17-151.

58-17-153    Coverage for treatment of hearing impairment for persons under age nineteen.

58-17-154    Definitions for §§ 58-17-155 to 58-17-162.

58-17-155    Exceptions to application of §§ 58-17-154 to 58-17-162.

58-17-156    Policies, contracts, certificates, and plans subject to §§ 58-17-154 to 58-17-162.

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.

58-17-159    Qualifications of person performing or supervising applied behavior analysis.

58-17-160    Review of treatment.

58-17-161    Services under individualized service plan, family service plan, or education program.

58-17-162    Effective date of §§ 58-17-154 to 58-17-161.

58-17-163    Dental care insurers to honor assignment of benefits.

58-17-164    Revocation of assignment of dental insurance benefits.

58-17-165    Reimbursement of payment from insured following receipt of payment from insurer.

58-17-166    Scope of benefits not affected--Medical benefits not included .

58-17-167    Definitions pertaining to telehealth coverage.

58-17-168    Coverage for health care services provided through telehealth.

58-17-169    Discrimination between coverage for services provided in person and through telehealth prohibited.

58-17-170    Application of telehealth coverage requirements.


58-17-1Requirements for all health insurance policies delivered in state.

No policy of health insurance may be delivered or issued for delivery to any person in this state unless it otherwise complies with this title, with §§ 58-17-1.1 to 58-17-11, inclusive, and with §§ 58-17-84.1 and 58-18-45.1.

Source: SL 1966, ch 111, ch 25, § 2; SL 1991, ch 400, § 1; SL 1999, ch 248, § 1.


58-17-1.1Grandfathered plans required to cover low-dose mammography--Extent of coverage.

Each policy of health insurance that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a policy that provides coverage for specified disease or other limited benefit coverage, shall provide coverage for screening by low-dose mammography for the presence of occult breast cancer that is subject to the same dollar limits, deductibles, and coinsurance factors as for other radiological examinations. Coverage for the screening shall be provided as follows: ages thirty-five to thirty-nine, one baseline mammography; ages forty to forty-nine, a mammography every other year; and age fifty and older, a mammography every year.

As used in this section, "low-dose mammography" means the X-ray examination of the breast using equipment dedicated specifically for mammography, including the X-ray tube, filter, compression device, screens, films and cassettes, with an average radiation exposure delivery of less than one rad midbreast, with two views for each breast and with interpretation by a qualified radiologist.

The provisions of this section apply only to grandfathered plans pursuant to 75 Fed. Reg. 116 (2010) to be codified at 26 C.F.R. §§ 54 and 602, 29 C.F.R. § 2590, and 45 C.F.R. § 147. (SL 2011, ch 216, § 19 provides: "The provisions of this Act are repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.")

Source: SL 1990, ch 397, §§ 1, 2; SL 1991, ch 400, § 2; SL 2011, ch 216, § 1.


58-17-1.2Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.

Every policy of health insurance delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall provide, in writing, coverage for equipment, supplies, and self-management training and education, including medical nutrition therapy, for treatment of persons diagnosed with diabetes if prescribed by a physician or other licensed health care provider legally authorized to prescribe such treatment. Medical nutrition therapy does not include any food items or nonprescription drugs.

Coverage for medically necessary equipment and supplies shall include blood glucose monitors, blood glucose monitors for the legally blind, test strips for glucose monitors, urine testing strips, insulin, injection aids, lancets, lancet devices, syringes, insulin pumps and all supplies for the pump, insulin infusion devices, prescribed oral agents for controlling blood sugars, glucose agents, glucagon kits, insulin measurement and administration aids for the visually impaired, and other medical devices for treatment of diabetes.

Diabetes self-management training and education shall be covered if: (a) the service is provided by a physician, nurse, dietitian, pharmacist, or other licensed health care provider who satisfies the current academic eligibility requirements of the National Certification Board for Diabetic Educators and has completed a course in diabetes education and training or has been certified as a diabetes educator; and (b) the training and education is based upon a diabetes program recognized by the American Diabetes Association or a diabetes program with a curriculum approved by the American Diabetes Association or the South Dakota Department of Health.

Coverage of diabetes self-management training is limited to (a) persons who are newly diagnosed with diabetes or have received no prior diabetes education; (b) persons who require a change in current therapy; (c) persons who have a co-morbid condition such as heart disease or renal failure; or (d) persons whose diabetes condition is unstable. Under these circumstances, no more than two comprehensive education programs per lifetime and up to eight follow-up visits per year need be covered. Coverage is limited to the closest available qualified education program that provides the necessary management training to accomplish the prescribed treatment.

The benefits provided in this section are subject to the same dollar limits, deductibles, coinsurance, and other restrictions established for all other benefits covered in the policy.

Source: SL 1999, ch 252, § 1.


58-17-1.3Diabetes coverage not required of certain plans and policies.

The provisions of § 58-17-1.2 do not apply to any plan, policy, or contract that provides coverage only for:

(1)    Specified disease;

(2)    Hospital indemnity;

(3)    Fixed indemnity;

(4)    Accident-only;

(5)    Credit;

(6)    Dental;

(7)    Vision;

(8)    Prescription drug;

(9)    Medicare supplement;

(10)    Long-term care;

(11)    Disability income insurance;

(12)    Coverage issued as a supplement to liability insurance;

(13)    Workers' compensation or similar insurance;

(14)    Automobile medical payment insurance;

(15)    Individual health benefit plans of six-months duration or less that are not renewable; or

(16)    Individual nonmajor medical insurance.

Source: SL 1999, ch 252, § 2.


58-17-1.4Policies required to cover occult breast cancer screening.

Each policy of health insurance that covers a female and that is delivered, issued for delivery, or renewed in this state, except for a policy that provides coverage for specified disease or other limited benefit coverage, shall provide coverage for screening for the presence of occult breast cancer.

The provisions of this section apply only to plans that are not grandfathered pursuant to 75 Fed. Reg. 116 (2010) to be codified at 26 C.F.R. §§ 54 and 602, 29 C.F.R. § 2590, and 45 C.F.R. § 147. (SL 2011, ch 216, § 19 provides: "The provisions of this Act are repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.")

Source: SL 2011, ch 216, § 13.


58-17-2Persons covered by policy.

A policy of health insurance shall purport to insure only one person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family, who shall be deemed the policyholder, any two or more eligible members of that family, including husband, wife, dependent children, or any children under a specified age which shall not exceed nineteen years and any other person dependent upon the policyholder or any other person related to and resident in the household of the insured.

Source: SL 1966, ch 111, ch 25, § 2 (3).


58-17-2.1Health insurance on a franchise plan.

Health insurance on a franchise plan is hereby declared to be that form of health insurance issued to:

(1)    Three or more employees of any corporation, copartnership, or individual employer or any governmental corporation, agency, or department thereof; or

(2)    Ten or more members of any trade, occupational, or professional association, or of a labor union, or of any other association having had an active existence for at least two years where such association or union has a constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance; where such persons, with or without their dependents, are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for by such persons, under an arrangement whereby the premiums on such policies may be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association for its members, or by some designated person acting on behalf of such employer or association or by the insured directly to the insurer, if permitted by the insurer. The term, employees, as used in this section may be deemed to include the officers, managers, and employees and retired employees of the employer and the individual proprietor or partnership.

Health insurance may be marketed on a franchise basis to members or employees of an employer, labor union, or association. Except as provided for by § 58-18B-2, health insurance marketed on a franchise basis may have the individual's premiums paid by the employer, labor union, or association. Marketing a policy on a franchise basis does not exempt any policy from any applicable requirement under this title except as provided in § 58-33-13.

Source: SL 1966, ch 111, ch 25, § 30 as added by SL 1968, ch 137; SL 2000, ch 241, §§ 1, 2.


58-17-2.2Conversion privileges of insured's spouse upon divorce.

No accident or health insurance policy providing coverage of hospital or medical expense which in addition to covering the insured also provides coverage to the spouse of the insured shall be issued without a provision that provides that upon divorce of the insured and the insured's spouse, the spouse is entitled to have issued to him or her, without evidence of insurability, upon application to the company within thirty days following the eligibility, and upon payment of the appropriate premium, an individual policy of accident or health insurance. Such policy shall provide the coverage then being issued by the insurer which is most nearly similar to the existing coverages. This obligation can be met by continuation of coverage for spouse under existing policy at the appropriate premium. Any and all probationary or waiting periods set forth in such policy shall be considered as being met to the extent coverage was in force under the prior policy.

Source: SL 1980, ch 354.


58-17-2.3Dependent coverage termination--Age--Full-time students.

No insurer or health carrier issuing health insurance coverage, other than excepted benefits, that provides dependent coverage for any qualifying child, as defined by rules promulgated pursuant to § 58-17-87, may terminate coverage due to attainment of a limiting age below age twenty-six. If the dependent remains a full-time student upon attaining the age of twenty-six, but not exceeding the age of twenty-nine, the insurer shall provide for the continuation of coverage for that dependent at the insured's option. However, the provisions of this section do not apply to any qualifying relative, as defined by rules promulgated pursuant to § 58-17-87, whose gross income is less than the exemption amount as prescribed by the director by rules promulgated pursuant to chapter 1-26. Continuation of coverage for full-time students attaining the age of twenty-four is not required if the dependent has other creditable coverage in force nor required for any full-time students who attained the age of twenty-four prior to July 1, 2007. (SL 2011, ch 216, § 19 provides: "The provisions of this Act are repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.")

Source: SL 2005, ch 265, § 1; SL 2007, ch 288, § 1; SL 2011, ch 216, § 2.


58-17-3Time of commencement and termination to be set out in policy.

The time when the insurance takes effect and terminates shall be expressed in a policy of health insurance.

Source: SL 1966, ch 111, ch 25, § 2 (2).


58-17-4Consideration for policy to be stated.

The entire money and other considerations therefor shall be expressed in a policy of health insurance.

Source: SL 1966, ch 111, ch 25, § 2 (1).


58-17-4.1Filing and approval of individual policy premium rates.

Premium rates charged for any individual accident and health insurance policy issued pursuant to this chapter shall be filed with and are subject to the approval of the director. The rates shall be filed for approval, administered, and reviewed subject to all of the applicable procedures in accordance with §§ 58-11-64 to 58-11-76, inclusive. (SL 2011, ch 216, § 19 provides: "The provisions of this Act are repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.")

Source: SL 1988, ch 399, § 1; SL 2006, ch 254, § 1; SL 2011, ch 216, § 3.


58-17-4.2Premium rates required to be reasonable--Rules to establish minimum standards promulgated by director.

Premium rates charged for any individual accident and health insurance policy pursuant to this chapter shall be reasonable in relation to the benefits available under the policy. The director shall promulgate rules pursuant to chapter 1-26 to establish minimum standards in accordance with accepted actuarial principles and practices, for loss ratios of individual accident and health insurance policies on the basis of incurred claims experience and earned premiums.

Source: SL 1988, ch 399, § 2.


58-17-4.3
     58-17-4.3.   Transferred to § 58-17-74.1 by SL 2005, ch 10, § 41.


58-17-5Identification of forms, riders and endorsements--Form number, location.

Each form for a policy of health insurance, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof.

Source: SL 1966, ch 111, ch 25, § 2 (6).


58-17-6Style and arrangement of policy provisions--Printing, size of type.

The style, arrangement, and overall appearance of a policy of health insurance shall give no undue prominence to any portion of the text, and every printed portion of the text of the policy and of any endorsements or attached papers shall be plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten point with a lower case unspaced alphabet length not less than one hundred twenty point; the "text" shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description, if any, and captions and subcaptions.

Source: SL 1966, ch 111, ch 25, § 2 (4).


58-17-7Documents forming part of policy--Setting forth in full, rates and classifications excepted.

A policy of health insurance shall contain no provision purporting to make any portion of the charter, rules, Constitution, or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the director.

Source: SL 1966, ch 111, ch 25, § 2 (7).


58-17-8Exceptions and reductions of coverage to be clearly set out.

The exceptions and reductions of indemnity shall be set forth in a policy of health insurance and, other than those contained in §§ 58-17-14 to 58-17-39, inclusive, shall be printed, at the insurer's option, either included with the benefit provision to which they apply, or under an appropriate caption such as "Exceptions," or "Exceptions and Reductions," except that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies.

Source: SL 1966, ch 111, ch 25, § 2 (5).


58-17-9Renewal of policy at option of insurer--Statement in policy so informing the policyholder.

In any case where a policy of health insurance is subject to renewal at the option of the insurer there shall be prominently printed both on the cover page and on the first page of such policy a statement so informing the policyholder.

Source: SL 1966, ch 111, ch 25, § 2 (9).


58-17-10
     58-17-10.   Repealed by SL 2006, ch 259, § 32.


58-17-10.1Reduction of benefits because of increase in statutory disability benefits prohibited.

No individual insurance policy for loss of time or disability benefits issued, amended, renewed, or delivered in this state shall contain any provision offsetting, or in any other manner reducing, any benefit under the policy by the amount of, or in proportion to, any increase in disability benefits received or receivable under the federal Social Security Act, the Railroad Retirement Act, any veteran's disability compensation and survivor benefits act, workers' compensation, or any similar federal or state law, as amended subsequent to the date of commencement of such benefit.

Source: SL 1976, ch 312.


58-17-10.2Individual policy for insured's spouse required in policies covering spouse--Eligibility--Coverage--Waiting periods.

No health insurance policy providing coverage of hospital or medical expense which in addition to covering the insured also provides coverage to the spouse of the insured shall be issued without a provision that provides that upon eligibility for medicare or social security disability benefits by one spouse the other spouse shall be entitled to have issued to him or her, without evidence of insurability, upon application to the company within sixty days following the eligibility, and upon payment of the appropriate premium, an individual policy of accident or health insurance. Such policy shall provide the coverage then being issued by the insurer which is most nearly similar to the existing coverages. This obligation can be met by continuation of coverage for spouse under existing policy at the appropriate premium. Any and all probationary or waiting periods set forth in such policy shall be considered as being met to the extent coverage was in force under the prior policy.

Source: SL 1979, ch 343.


58-17-11Return of policy by purchaser--Refund of premium paid--Dissatisfaction with terms after examination.

Every individual health insurance policy or contract, except single premium nonrenewable policies or contracts, issued for delivery in South Dakota on or after December 31, 1966, by an insurance company, nonprofit hospital service plan, or medical service corporation, shall have printed thereon or attached thereto a notice stating in substance that the person to whom the policy or contract is issued shall be permitted to return the policy or contract within ten days of its delivery to said purchaser and to have the premium paid refunded if, after examination of the policy or contract, the purchaser is not satisfied with it for any reason. If a policyholder or purchaser pursuant to such notice, returns the policy or contract to the company or association at its home or branch office or to the insurance producer through whom it was purchased, it is void from the beginning and the parties shall be in the same position as if no policy or contract had been issued.

Source: SL 1966, ch 111, ch 25, § 2 (8); SL 2001, ch 286, § 114.


58-17-11.1Issuance of policies by insurance company, nonprofit hospital service plan, medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--Term of retention.

An insurance company, nonprofit hospital service plan, medical service corporation, health maintenance organization, or fraternal benefit society shall issue policies in this state for which an examination period is required in accordance with one of the following methods:

(1)    If the policy is delivered by an insurance producer, a receipt shall be signed by the policyowner acknowledging delivery of the policy. The receipt shall include the policy number and the date of the delivery;

(2)    If the policy is delivered by mail, it shall be sent by registered or certified mail, return receipt requested, or a certificate of mailing shall be obtained showing the date the policy was mailed to the policyowner. For policy issuances verified by a certificate of mailing, it is presumed that the policy is received by the policyowner ten days from the date of mailing.

The receipts and the certificates of mailing described in this section shall be retained by the insurer for five years. If a producer obtains the delivery receipt, the producer shall forward the signed delivery receipt to the insurer.

Source: SL 1982, ch 28, § 18; SL 1987, ch 374, § 3; SL 2001, ch 286, § 115; SL 2002, ch 232, § 3.


58-17-12Required provisions--Captions--Substitutes, approval by director.

Except as provided in § 58-17-13, each policy of health insurance delivered or issued for delivery to any person in this state shall contain the provisions specified in §§ 58-17-14 to 58-17-29, inclusive, in the words in which the same appear; except, that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the director which are in each instance not less favorable in any respect to the insured or the beneficiary. Each such provision shall be preceded individually by the applicable caption shown, or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the director may approve.

Source: SL 1966, ch 111, ch 25, § 3 (1).


58-17-13Omission from policy of inapplicable provision--Approval of director--Modification of inconsistent provision.

If any such provision is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the director shall omit from such policy any inapplicable provision or part of a provision and shall modify any inconsistent provision or part of a provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.

Source: SL 1966, ch 111, ch 25, § 3 (2).


58-17-14Entire contract and change clauses required--Signed acceptance required for endorsements.

There shall be a provision as follows: "Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy is valid until approved by an executive officer of the insurance company and unless such approval is endorsed or attached to this policy. No insurance producer has authority to change this policy or to waive any of its provisions."Any rider, endorsement, or application added to a policy, upon policy issuance, after the date of issue, or at reinstatement or renewal which reduces or eliminates benefits or coverage in the policy requires signed acceptance by the policyholder. After the date of policy issue, any rider or endorsement which increases benefits or coverage with an accompanying increase in premium during the policy term must be agreed to in writing signed by the insured, unless the increased benefits or coverage is required by law. Coverage as required by § 58-17-98 may be reduced or eliminated by a rider to, or an endorsement on, a new policy if the insurer would reject the application for the policy without the rider or endorsement based upon the applicant's preexisting condition of the type covered by § 58-17-98 and if there is signed acceptance by the policyholder.

Source: SL 1966, ch 111, ch 25, § 4; SL 1974, ch 315; SL 1982, ch 361; SL 2001, ch 286, § 116; SL 2002, ch 234, § 2; SL 2003, ch 247, § 1; SL 2010, ch 237, § 1.


58-17-15Time limit on certain defenses--Application of section.

There shall be a provision as follows: "Time limit on certain defenses: (1) After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability, as defined in the policy, commencing after the expiration of such two-year period."

The foregoing policy provision may not be construed to affect any legal requirement for avoidance of a policy or denial of a claim during such initial two-year period, nor to limit the application of §§ 58-17-32 to 58-17-39, inclusive, in the event of misstatement with respect to age or occupation or other insurance. This section only applies to excepted benefits. This section does not apply to any long-term care insurance policy or certificate. (SL 2011, ch 216, § 19 provides: "The provisions of this Act are repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2