South Dakota (SD)
Individual Health Insurance Regulations

Learn more about South Dakota Individual Health Insurance

Health insurance is an integral aspect of an individual’s life. Before you buy a particular health policy, you need to make a good evaluation of your budget and your family’s health care needs. If you reside in South Dakota, you can choose from various health insurance alternatives. The South Dakota Division of Insurance supervises the legislature under which the South Dakota health insurers can sell private health insurance to individuals and families.

The State of South Dakota allows individual health insurance policies to be medically underwritten by the health insurance carrier. The process of medical underwriting provides the insurance carrier an opportunity to review the applicant's medical history and determine what coverage, if any, shall be provided under the terms of the health insurance plan. Based upon the applicant's medical history, the insurance carrier may opt to offer full coverage under the terms of the health insurance plan; or offer modified coverage under the terms of the health insurance plan, citing limitations and/or exclusions of specific medical conditions; or deny coverage based upon the applicant's health history. Applicants without prior creditable coverage are subject to a 12 month look back, 12 month exclusionary period limit on pre-existing medical conditions. Health insurance carriers may also attach an elimination rider to the health insurance policy, temporarily or permanently eliminating coverage of specific health conditions. Depending upon health status and age, premium rates for individual health insurance may vary plus or minus 30 percent of the individual market rate.

Request South Dakota Individual Health Insurance Quotes from any of our multiple providers.

South Dakota (SD)
Small Group Health Insurance Regulations

In South Dakota a small group is defined as a company with 2-50 employees. Pursuant to the Health Insurance Portability and Accountability Act of 1996, all small group health insurance is required to be guarantee issue. Guarantee issue coverage provides that no group may be declined coverage based on its health status, past or present. Group applicants lacking prior creditable coverage may, however, be subject to a 6 month look back and a 12 month exclusionary period limit on pre-existing health conditions. Under South Dakota law, credit for prior coverage is required as long as there is no more than a 63 day break in coverage. For purposes of determining small group premium rates, medical underwriting is permitted under state regulations. Medical underwriting provides for the adjustment of rates by plus or minus 25 percent of the indexed rate.

Small business owners can request quotes for South Dakota group health insurance from any of our listed providers.

South Dakota COBRA and Continuation Coverage

Federal COBRA laws apply to all employers with more than 20 employees. Federal COBRA laws apply to companies with more than 20 employees. Your coverage under the COBRA option is the same coverage you had while you were covered under your group plan. Most COBRA plans last for 18 months, but certain qualified beneficiaries may remain on COBRA for 36 months, such as a widow of a primary insured. The premium amount, plus a 2% administration fee will be charged directly to the insured.

South Dakota has implemented a mini-COBRA program which applies to groups with 2-19 employees. Under the state regulated COBRA program, employees who suffer a qualifying event may elect, at their sole expense, to continue their group health benefits for an additional 18 months. Under special circumstances, the group health coverage may be extended up to 36 months. State regulations provide that election of COBRA benefits must be exercised in writing within 30 days of termination of coverage. A 2 percent administration fee will be added to the monthly premium. For those exhausting the COBRA coverage, individual medical insurance is available on a guaranteed issue basis under the state’s high-risk health pool.