South Dakota Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
South Dakota Risk Pool
Insurance Regulation Establishing Risk Pool
South Dakota Legislation
Chapter 20:06:48
South Dakota Risk Pool
The South Dakota Risk Pool, established by the state legislation, provides health care coverage to South Dakota residents who cannot qualify for coverage anywhere else due to pre-existing health conditions.
Funding
The South Dakota Risk Pool is funded by premium dollars collected from persons enrolled inte risk pool health plan. Additional funds come from assessments of commercial insurance carriers, stop-loss, and reinsurance carriers. There are also funds provided from general state revenue and an initial start-up grant from CMS' risk pool grant program.
Plans Offered
Unlike other state high-risk pools the South Dakota Risk Pool only provides coverage to people who have lost their coverage involuntarily and have previous creditable coverage. The program does not provide health insurance coverage to uninsured individuals that are unable to obtain coverage from private insurers, unless they have also recently lost creditable coverage. There is one medical insurance plan offered through the risk pool. The plan is a PPO plan with a variable of three different deductibles and is also available is a Health Savings Account Plan.
Plan Benefits
The SD Risk Pool PPO Plan offers a range of In-Network deductibles, including a $1,000, $3,000 and $10,000 deductible. For most in-patient covered medical expenses, the plan member is required to pay a 25% coinsurance. For most out-patient services, the health plan member is required to pay a 25% coinsurance. The maximum out-of-pocket limit, which includes the deductible, is $3,250 on the $1,000 deductible plan, $5250 on the $3,000 deductible plan and $12,250 on the $10,000 deductible plan. The Health Savings Account plan has a $3,000 deductible. For most in-patient covered medical service, the risk pool member is required to pay a 25% coinsurance. The maximum out-of-pocket limit, which includes the deductible, is $5,100.
South Dakota Risk Pool Plan Brochure
Maximum Benefit Limits
The lifetime maximum, per enrollee, is $2,000,000.
Eligibility
- You must have had 12 months of continuous creditable coverage. Continuous coverage means that you have not had a break in coverage of 63 or more days
- You must apply within 63 days of losing your prior coverage
- You must have used up any COBRA or state continuation coverage for which you were eligible
- You are not covered under a group health plan, Medicare, Medicaid, or any other form of health insurance
- Your most recent coverage was not terminated for nonpayment of premium or fraud
- You must be a resident of the state of South Dakota and be able to provide proof of residency
Enrollment Periods
You may enroll in the South Dakota Risk Pool at anytime. Coverage will be made effective on the first day of the month following the approval of your application. Once enrolled, you may only make changes to your plan selection during the open enrollment period, which occurs during the month of July each year.
Premium Payments
Premium rates for the South Dakota Risk Pool plans are based upon plan selection, age and whether or not you are a tobacco user.
Premium Calculations
The premium cap is 150 percent of the standard average health plan premium charged by the three carriers with the largest number of individual health plan benefit plans in the state of South Dakota for the preceding year.
Pre-Existing Condition Waiting Periods
Since proof of creditable coverage is required to enroll in the South Dakota Risk Pool, there is no waiting period for benefits on pre-existing medical conditions.
South Dakota Risk Pool Contact Information
South Dakota Risk Pool
Capitol Building
500 East Capitol Avenue
Pierre, SD 57501-5070
Phone: (605)773-3148
South Dakota Risk Pool Website
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