§ 58-17H-5 — Health carrier to provide emergency services coverage without requiring prior authorization--Standards for coverage of emergency services.

South Dakota § 58-17H-5

• Jurisdiction: South Dakota
• Title 58: INSURANCE
• Ch. 58-17E: UTILIZATION REVIEW AND BENEFIT DETERMINATIONS

Text

If conducting utilization review or making a benefit determination for emergency services, a health carrier that provides benefits for services in an emergency department of a hospital shall comply with the provisions of §§ to 58-17H-13 , inclusive. A health carrier shall cover emergency services necessary to screen and stabilize a covered person and may not require prior authorization of such services if a prudent layperson would have reasonably believed that an emergency medical condition existed even if the emergency services are provided on an out of-network basis. A health carrier shall cover emergency services whether the health care provider furnishing the services is a participating provider with respect to such services. If the emergency services are provided out-of-network, the services shall be covered without imposing any administrative requirement or limitation on coverage that is more restrictive than the requirements or limitations that apply to emergency services received from network providers. Emergency services are provided out-of-network by complying with the cost sharing requirements set forth in §§ 58-17H-7 to 58-17H-10 , inclusive, and without regard to any other term or condition of coverage other than the exclusion of or coordination of benefits, an affiliation or waiting periods as permitted under section 2704 of the Public Health Service Act, as amended to January 1, 2011, or cost sharing requirements as set forth in §§ 58-17H-6 to 58-17H-10 , inclusive. Commission Note:

Legislative History

SL 2011, ch 219, § 30.