South Dakota Health Insurance

According to the Center for Disease Control, an annual average of 11.0% of South Dakota residents went uninsured for South Dakota health insurance between 2001 and 2003.

South Dakota Health Insurance Regulations

Any individual covered under group or employer health insurance in South Dakota cannot be denied or limited access to coverage under that insurance policy. Persons looking for individual South Dakota health insurance, however, can be denied or limited access to coverage and policies. All policies, once obtained, are guaranteed renewable which means that any individual is guaranteed the right to renew an existing South Dakota health insurance policy. Rates, however, may increase upon renewal.

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Pre-Existing Conditions

South Dakota medical insurance companies can impose elimination riders and pre-existing exclusion periods for any medical condition. Elimination riders can be imposed to deny coverage for any condition or body part for the duration of the health insurance policy. South Dakota health insurance policies can also impose pre-existing condition exclusion periods which can exclude a pre-existing condition from coverage for up to 12 months in the beginning of the plan.

South Dakota health insurance companies can look back 12 months prior to the beginning of a policy to see if an individual was treated, diagnosed, advised, or should have been treated for a condition and can therefore determine if the condition was pre-existing. Provided there was no break in South Dakota health insurance for more than 63 days, then a health insurance company cannot impose a pre-existing condition period.

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High Risk Pool

Individuals who had continuous coverage under a South Dakota health insurance plan and for more than 12 months and then lost it may be eligible for the state’s high risk pool. Eligibility requirements are:

• Must be a South Dakota resident
• Apply for high risk health insurance within 63 days of losing prior coverage
• Have at least 12 months continuous coverage under a South Dakota health insurance plan
• Have exhausted COBRA or state continuation coverage
• Lost previous health insurance for reasons other than fraud or nonpayment of premiums
• Not eligible for Medicaid, Medicare, or any other form of South Dakota health insurance.

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Pregnancy

Pregnancy can be considered a pre-existing condition and fall into the 12 month pre-existing exclusion period and therefore be denied coverage. Once covered, however, any newborn or adopted child automatically falls under the parent’s South Dakota health insurance policy for the first 31 days after birth or adoption, if the policy covers dependents. Disabled children may remain under the parent’s health insurance policy past the age at which dependents are usually no longer covered. They can, however, still impose an elimination rider to the new policy.

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Rates

South Dakota health insurance rates are regulated somewhat and there are limits on how much a health insurer can charge for individual coverage. They can charge individuals more based on health, age, and other factors.

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Temporary Insurance

Some South Dakota health insurance companies sell temporary insurance. Individuals who are between plans or employers may want to consider coverage between policies with a temporary individual South Dakota health insurance plan.

Alternative South Dakota Health Insurance Options

For individuals unable to obtain individual South Dakota medical insurance, the state has some programs that may help:

• South Dakota Medicaid is available to any qualified individual who meets eligibility criteria
• South Dakota high risk pool is allows HIPAA eligible individuals to gain access to health insurance.
• South Dakota Child Insurance Program is designed to provide health insurance to children up to 19 years of age whose families do not qualify for Medicaid and who may not be able to afford South Dakota health insurance.

South Dakota Division of Insurance

Division of Insurance
445 East Capitol Avenue
Pierre, SD 57501

(Main Phone Line) 605-773-3563
(Producer Licensing) 605-773-3513
(Continuing Education) 605-773-3946
(Fax) 605-773-5369

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For other South Dakota Insurance Resources, See:

• South Dakota Auto Insurance
• South Dakota Home Insurance
• South Dakota Health Insurance

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