ENTITLED An Act to correct technical errors in statutory cross-references regarding insurance.
Be it enacted by the Legislature of the State of South Dakota:
Section 1. That 58-2-39 be AMENDED.
58-2-39. Promulgation of rules regarding definitions, enrollment, disclosure, notice, claims, and records.
The Division of Insurance may promulgate rules pursuant to chapter 1-26 in the following areas:
(1) Definition of terms used in 58-17-30.2, 58-17-30.4, 58-18-32, 58-18-34, and 58-33-85 to 58-33-88, inclusive;
(2) Insurer enrollment procedures;
(3) Disclosure and notice requirements;
(4) Claim processing procedures; and
(5) Record-keeping requirements for insurers and producers.
Section 2. That 58-5-155 be AMENDED.
58-5-155. Qualified education loan insurer subject to Title 58--Exceptions.
Any qualified education loan insurer is subject to the provisions of Title 58 except as otherwise specifically provided in 58-5-154 to 58-5-160, inclusive. Notwithstanding any other provision of Title 58, a qualified education loan insurer is not subject to the following provisions of Title 58 and any rules promulgated to implement any such provisions:
(1) Sections 58-4-48 and 58-5-85;
(2) Subdivision 58-5-7(5) to the extent that this subdivision permits only one class of authorized voting common stock or otherwise restricts the authorization of preferred stock, with or without voting rights; and
(3) Chapter 58-5A.
Section 3. That 58-6A-14 be AMENDED.
58-6A-14. Countersignature on policy not required.
A policy of insurance issued to a risk retention group or any member of that group is not required to be countersigned.
Section 4. That 58-7-33 be AMENDED.
58-7-33. Duration of deposit of assets and securities.
Every deposit made in this state by an insurer pursuant to this title, including assets and securities held in another state under custodial arrangements, shall be held as long as there is outstanding any liability of the insurer as to which the deposit was so required; or if a deposit required under the retaliatory law, 58-6-70 to 58-6-73, inclusive, the deposit shall be held for so long as the basis of such retaliation exists.
Section 5. That 58-12-22 be AMENDED.
58-12-22. Information from insurer's database to Department of Social Services--Data match against recipients--Disclosure--Liability.
Within sixty days of a request from the department, the department and an insurer shall negotiate an acceptable format for the transmission of information from the insurer's database of policy holders, sponsors, subscribers, covered individuals in South Dakota, and coverage dates. The format must include the data elements, medium, frequency of reporting, any costs of the insurer to be reimbursed, and procedures that will be followed when a data match is found. The Department of Social Services shall match the name, address, date of birth, and social security number if available, of the insured's policyholders, sponsors, subscribers, and covered individuals against the medicaid eligible recipients and recipients of support enforcement services as defined in subdivision 25-7A-1(19).
Upon discovery of a match, the department may incorporate the following information into its recipient database:
(1) The name, address, date of birth, social security number if available, and the unique health care identification number of the covered individual;
(2) The name, address, date of birth, social security number if available, policy number, and group identification number of the policyholder, sponsor, or subscriber;
(3) The name and address of the employer if it is an employer-employee benefit plan;
(4) Types of covered services under the plan or policy;
(5) Coverage effective date and termination of coverage date for each covered individual; and
(6) The name and address of the claim administrator for the policy or plan.
The department may not use or disclose any information provided by the insurer other than as permitted or required by law. The insurer may not be held liable for the release of insurance coverage information to the department or the director by any party when done so under the authority of 58-12-22 to 58-12-28, inclusive.
Section 6. That 58-12-26 be AMENDED.
58-12-26. Insurer defined.
For the purposes of 58-12-22 to 58-12-28, inclusive, the term, insurer, means:
(1) Any commercial insurance company, employer-employee benefit plan, health maintenance organization, professional association, service benefit plan, public self-funded employer or pool, union, or fraternal group selling or otherwise offering individual or group health insurance coverage including self-insured and self-funded plans;
(2) Any profit or nonprofit prepaid plan offering either medical services of full or partial payment for services included in the department's medicaid plan;
(3) Any other entity offering health benefits for which a medicaid recipient may be eligible in addition to public medical assistance;
(4) Any managed care organization, third-party administrator, pharmacy benefits manager, or other entity which processes claims, administers services, or otherwise manages health benefits on behalf of any of the aforementioned insurers; or
(5) Any other party that is by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service including workers' compensation, automobile insurance, and liability insurance plans.
Section 7. That 58-12-27 be AMENDED.
58-12-27. Department defined.
For the purposes of 58-12-22 to 58-12-28, inclusive, the term, department, means the Department of Social Services, or an entity under contract with the Department of Social Services to carry out the functions of 58-12-22 to 58-12-28, inclusive.
Section 8. That 58-15-44 be AMENDED.
58-15-44. Dating back of application for insurance to reduce premium prohibited--Contract not invalidated.
No insurer may knowingly deliver or issue for delivery in this state any life insurance policy that purports to be issued or to take effect as of a date more than six months before the application therefor was made, if thereby the premium on the policy is reduced below the premium that would be payable thereon as determined by the insuring age of the insured at the time when such application was made. No insurance producer or other representative of an insurer may in this state prepare, submit, or accept any application for life insurance that bears a date earlier than the date when the application was made by the insured or applicant, if thereby the premium on the contract is reduced as above stated. Nothing contained in this section invalidates any contract made in violation of this section. This section does not prohibit the exchange, alteration, or conversion of any policy of life insurance.
Section 9. That 58-16-54 be AMENDED.
58-16-54. Responsibilities of prior carrier and succeeding carrier upon discontinuance.
The following provisions dictate the responsibility of the prior carrier and succeeding carrier when coverage is discontinued:
(1) After discontinuance of the policy, contract, or certificate, the prior carrier remains liable only to the extent of its accrued liabilities and extensions of benefits. The position of the prior carrier shall be the same whether the group policyholder or other entity secures replacement coverage from a new carrier, self-insures, or foregoes the provision of coverage;
(2) If the individual was validly covered under the prior plan on the date of discontinuance, each individual who is eligible for coverage in accordance with the succeeding carrier's plan of benefits is, with respect to the class or classes of individuals, eligible and shall be covered under the succeeding carrier's plan if (a) any actively-at-work and nonconfinement rules are met, and (b) if required by the succeeding carrier, the individual requests enrollment;
(3) Each individual not covered under the succeeding carrier's plan of benefits in accordance with subdivision (2) shall nevertheless be covered by the succeeding carrier in accordance with the following rules if the individual was validly covered, including benefit extension, under the prior plan on the date of discontinuance and if the individual is a member of the class or classes of individuals eligible for coverage under the succeeding carrier's plan. Any reference in the following subdivisions to an individual who was or was not totally disabled is a reference to the individual's status immediately prior to the date the succeeding carrier's coverage becomes effective;
(4) The minimum level of benefits to be provided by the succeeding carrier shall be the applicable level of benefits of the prior carrier's plan reduced by any benefits payable by the prior plan;
(5) Coverage shall be provided by the succeeding carrier until the earliest of the following dates:
(a) The date the individual becomes eligible under the succeeding carrier's plan as described in subdivision (1);
(b) The date the individual's coverage would terminate in accordance with the succeeding carrier's plan provisions applicable to individual termination of coverage, such as at termination of employment or ceasing to be an eligible dependent; or
(c) In the case of an individual who was totally disabled, and in the case of a type of coverage for which 58-16-53 requires an extension of benefits or accrued liability, the end of any period of extension benefits or accrued liability that is required of the prior carrier by 58-16-53, or if the prior carrier's policy, contract, or certificate is not subject to that section, but would have been required of the prior carrier had the policy, contract, or certificate been subject to 58-16-53 at the time the prior carrier's plan was discontinued and replaced by the succeeding carrier's plan;
(6) In any situation in which a determination of the prior carrier's benefit is required by the succeeding carrier, at the succeeding carrier's request the prior carrier shall furnish a statement of the benefits available or pertinent information, sufficient to permit verification of the benefit determination or the determination itself by the succeeding carrier. For the purposes of this subdivision, benefits of the prior plan shall be determined in accordance with all of the definitions, conditions, and covered expense provisions of the prior plan rather than those of the succeeding plan. The benefit determination shall be made as if coverage had not been replaced by the succeeding carrier; and
(7) A succeeding carrier's policy may contain a provision limiting benefits to employees who are actively at work. However, any individual who remains as an employee, was covered by the prior carrier, and was disabled as of the date the succeeding carrier coverage became effective for that employer, will continue to be covered by the prior carrier as long as the individual remains an employee. An individual who is not disabled and is not at work on the date the succeeding carrier's coverage commences is considered actively at work as long as the absence from work is an employer-approved absence.