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South Dakota Health Insurance

 

All health insurance policies in South Dakota are considered guaranteed renewable as long as your premiums are paid up to date.  So this means your health insurance can not be canceled because you become sick.

 

South Dakota mandates that health insurance companies cover newborns and adopted children for the first 31 days, on their parent’s policy.  But inversely pregnancy is, and can be considered a pre-existing condition, except on group health policies.  Pregnancy is a pre-existing condition but not on group health insurance.   Post pregnancy hospital stays, and treatment for mental illness is also mandated by South Dakota.

 

The South Dakota Risk Pool (SDRP) was designed to help insure people who had been refused coverage, under a private health insurance company, because of their current health.  You must be a resident of South Dakota to qualify.  If you do qualify you will have access to three different plan options. 

 

The South Dakota Department of Insurance is another great resource for additional health insurance information.  If you would like to visit their website click here.

 

                             Request a South Dakota Health Insurance Quote

 

 

 

South Dakota Small Business Health Insurance

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In South Dakota, a group health plan, can not base your health insurance premiums on your health.  This is called non discrimination.  Small Business Health Insurance in South Dakota is also guaranteed issue, meaning that you can not be turn down for coverage, unlike companies of 50+ employees that can be turned down.

 

Pre-existing exclusions are limited on the amount of time they can exclude coverage.  Also if you have current coverage, without lapses, that will be credited against your pre-existing period.  Pregnancy is not considered a pre-existing condition on a group health plan.

 

Insurance companies that insure small businesses in South Dakota use the look back period to decide what is pre-existing and what is not.  The look back period is the period 6 months prior to the start of the new policy.

 

The maximum pre-existing waiting period is 12 months for an employee. If you are a late enrollee your maximum waiting period is 18 months.  Any pre-existing periods must be applied only after written notice.

 

South Dakota does limit the amount of variation between premiums of different group health plans.  Each Small Business Plan will have certain enrollment periods in which employees can sign on to get coverage.

 

For additional information about Small Business Health Insurance in South Dakota click here.

 

                            Request a South Dakota Small Business Health Insurance Quote

 

 

 

South Dakota Individual Health Insurance

 

All South Dakota Health Insurance Policies have to cover disabled children on their parent’s policy into their adulthood.

 

In South Dakota, insurance companies are able to decide if they want to insure you or not.  They can either rate you up or just refuse coverage.  Also South Dakota does not mandate what you buy, so insurance companies are able to design specific policies for specific consumers, rather than make insurance companies offer similar policies.

 

South Dakota allows health insurance companies to include pre-existing conditions and these are the two ways they can do it:

-         With an Elimination Rider which basically changes the policy to deny coverage of anything to do with the pre-existing condition.

-         With a Pre-Existing period, this can not be more than 12 months.

 

Relative to Pre-Existing Conditions, Insurance companies in South Dakota must give credit to prior credible coverage as long as there was not more than a 63 day lapse in coverage.

 

The rates that an individual pays for a South Dakota Health Insurance Plan are based on age, location, health history, family size, sex etc.  Sadly there is no limit on how much an insurance company can charge and individual for coverage.

 

The Childrens Health Insurance Plan is a program South Dakota started a few years ago.  It is designed to help to provide affordable health insurance to all of the children living in South Dakota.  Visit their site to see if you qualify.

 

For additional information about Individual Health Insurance in South Dakota click here.

 

                            Request a South Dakota Individual Health Insurance Quote

 

 

 

South Dakota Self Employed Health Insurance

 

In South Dakota self employed business owners can not buy health insurance like other small business.  A self employed persons rights are protected under the laws protecting individuals, therefore that is the type of policy they have to buy.

 

Another option for affordable South Dakota Self Employed Health Insurance is often associations or self employed groups.  Just keep in mind that not all of these groups or associations are regulated by the state.

 

One benefit for Self Employed people is that they are able to deduct 100% of their health insurance premiums from their taxes!

 

For additional information about Self Employed Health Insurance in South Dakota click here.

 

                             Request a South Dakota Self Employed Health Insurance Quote

 

 

 

Temporary South Dakota Health Insurance

 

Many situations may arise where you find yourself without health insurance, or about to be without health insurance.  These reasons could range from graduating college to being in-between jobs.  Instead of going without health insurance you should look into getting a South Dakota Temporary Health Insurance Policy.  These policies will be cheap, with high deductibles and low coverage, but getting a South Dakota Temporary Health Insurance Policy is much better than going with out health insurance.  Temporary health insurance in not guaranteed renewable!

 

For additional information about Temporary Health Insurance in South Dakota click here.

 

                             Request a South Dakota Temporary Health Insurance Quote

 

 

 

What types of South Dakota Health Insurance are there?

 

HMO- Health Maintenance Organization.  This type of insurance is called managed care.  This means you have certain network of doctors and hospitals in South Dakota that you have to go to for care.  Most South Dakota HMO’s have office visit co-payments that range from $10 to $35, and hospital deductibles that range from $250 to $1,500.  Often the most affordable health insurance plans are HMO’s due to the fact they are managed care.

 

PPO-Preferred Provider Organization.  This type of insurance is also called managed care but it gives the consumer much more freedom; they allow you to visit any doctor or hospital in or out of network.  Most South Dakota PPO’s have an in network and an out of network charge.  If the in network co-insurance is 100% then the out of network co-insurance would be 80%.  If the in network co-insurance is 90% then the out of network co-insurance would be 70%   Typically South Dakota PPO’s offer co-payments for doctor visits as well as hospitalization. 

 

Indemnity Plan - In South Dakota, as health insurance rates continue to rise, many people are finding it more affordable to drop their health insurance and buy a South Dakota Major Medical Health Insurance Plan.  An Indemnity plan can also be called a major medical plan or catastrophic health insurance.  Whatever you call it, typically a South Dakota Indemnity Plan would cover more “major” claims.  An Indemnity plan has an annual deductible and will usually allow you to pick different co-insurance options.  Indemnity plans allow you access to any doctor or hospital, and for this reason they are typically very expensive.

 

Discount Medical Plans – In recent years many Discount Medical Plans have started to surface.  These plans have relatively inexpensive, but consumers must realize that this is not insurance.  All these companies do is to get their customers discounted rates (20-50% off) on certain procedures at certain physicians and hospitals. 

 

 

Federal Mandated Health Insurance Laws

 

HIPAA

Along with South Dakota Health Insurance Laws, there are Federal Laws that regulate Health Insurance companies.   HIPAA (Health Insurance Portability and Accountability Act of 1996). This act mandated federal standards for individual and group health insurance plans.  Some of the standards that it established were relative to guaranteed renew ability, crediting for prior health coverage and pre-existing condition waiting periods.

 

ERISA

Large corporations do not have health insurance policies.  Typically they are self funded, meaning the corporation pays for all of their employee’s medical bills instead of buying health insurance.  Most of these “self funded” companies are regulated by the federal government under ERISA (Employee Retirement Income Security Act)

 

COBRA

In South Dakota it is mandated, by the state, that all companies that offer a South Dakota Group Health Insurance Policy must also enable their employees to extend their health coverage temporarily; called Cobra.  A South Dakota Cobra Insurance is typically available for a time period under 18 months.   In South Dakota you are given 60 days to decide if you are going to take South Dakota Cobra Insurance or not.  Once you have passed on the opportunity to take Cobra, you are not eligible to receive it.

 

Cobra Insurance was introduced in 1985.  Cobra stands for Consolidated Omnibus Budget Reconciliation Act.  If you would like more information about your Cobra Insurance options please contact your companies HR department.

 

Often employees are surprised at the cost of a South Dakota Cobra Insurance.  The reason for this is that they are now responsible for 103% (100% of the premium plus a 3% administration fee) of a monthly health insurance premium when they probably only paid 20% while employed. 

 

Whether nor not to take Cobra is an important question, and you should realize there are alternatives to a South Dakota Cobra Insurance Policy.  One should realize what they plan to do in the future.  If you are looking for another job, and it will be a few months before you get a job, it might make sense to look for anSouth Dakota Temporary Health Insurance Plan.  If you are contemplating working at a consultant, it would be in your best interest to look into a South Dakota Self Employed Health Insurance Policy.    

 

 

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