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An Overview on Medical Insurance in South Dakota

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Medical Insurance in South Dakota

Medical Insurance in South Dakota

Introduction: South Dakota heath insurance situation is not so displeasing, in comparison to the overall health insurance situation of America. As per a survey conducted by The Center for Disease Control, almost 11% of the total South Dakota population was uninsured for the state medical insurance per year, between 2001 and 2003.

In the article, we have talked about South Dakota medical insurance regulations and South Dakota medical insurance alternative options.

Regulations for South Dakota Medical Insurance

South Dakota Insurance Department has introduced some regulations that all the South Dakota medical insurance companies must follow. The regulations are as follows:

  • A South Dakota individual getting coverage under a South Dakota medical insurance plan through an employer or group can not be refused or restricted getting coverage under that particular employer or group South Dakota medical insurance plan.
  • South Dakota individuals seeking coverage under an individual South Dakota medical insurance plan can be refused or restricted.
  • All South Dakota medical insurance policies should have a guaranteed provision for renewal. South Dakota individuals can renew his or her existing medical insurance policy through a guaranteed renewability provision, if the individual has disbursed all the premiums, in time and provided no fake information during the term of the policy. Premium rate for the policy can however, rise at the time of renewal.
  • South Dakota health insurance policies can implement elimination riders and pre-existing waiting periods.
  • Elimination riders can exclude any health condition, body systems or body part from coverage, even permanently for the entire duration of policy.
  • South Dakota medical insurance companies can impose waiting period for any pre-existing medical condition for no more than one year in the beginning of coverage.
  • South Dakota medical insurance companies are allowed to investigate an applicant's health record dating back one year before beginning of coverage to know whether the applicant has been treated received medical advice or otherwise diagnosed for an illness. And if so, the insurers can exclude that condition from coverage.
  • South Dakota medical insurance companies are not allowed to implement a pre-existing waiting period, if there was no breakage in coverage for over 63 days.

South Dakota High Risk Pool

South Dakota individual that had continual coverage under South Dakota medical insurance policy for over a year and then gone, are qualified for South Dakota's high risk pool. To avail the program, the individual has to meet certain criteria that are discussed below:

  • The individual should be a resident of South Dakota.
  • He or she must apply for the program within 63 days after losing previous coverage.
  • He or she should have a continual coverage of at least one year under a South Dakota medical insurance policy.
  • The individual should have South Dakota continuation coverage or exhausted COBRA.
  • The individual should have lost his or her prior medical insurance plan for any reason; expect premium failure or fraud.
  • The individual should be ineligible for South Dakota Medicaid, Medicare or other sorts of state medical insurance programs.
  • Pregnancy is considered as a pre-existing condition, in South Dakota and thus subject to a waiting period of one year.
  • All newborns and adopted children should get coverage under their parent's individual medical insurance policy for the initial 31 days from the day of birth or adoption; provided the policy should offer dependant coverage.
  • Disabled or handicapped children should get coverage under their parent's individual South Dakota health insurance policy, even if they cross the decided upper age limit.
  • South Dakota health insurance premium rates are controlled. The medical insurers can not charge an unlimited amount. However, the rates can vary depending on age, health and other criteria.
  • South Dakota individuals between jobs or insurance policies are able to apply for temporary South Dakota medical insurance policy.

South Dakota Medical Insurance Alternative Options

South Dakota individuals having difficulties obtaining medical insurance or otherwise uninsurable can avail alternative medical insurance programs offered by the state.

  • South Dakota High Risk Pool: This program allows HIPAA qualified individuals to access coverage.
  • South Dakota Medicaid: This program is available to all South Dakota individuals who meet all the eligibility criteria including income criteria.
  • South Dakota Child Insurance Program: This program helps children and teens to get medical insurance coverage. However, children from the families, which are not qualified for South Dakota Medicaid or unable to afford the cost of South Dakota medical insurance, are only able to apply for the program.

South Dakota Department of Insurance

For more information on South Dakota health insurance, you can contact at the following address:

South Dakota Division of Insurance

445 East Capitol Avenue
Pierre, SD 57501


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