South Dakota § 58-17H-8 Cost-sharing requirements for covered persons--Payments to out-of-network providers.

South Dakota Statutes

§ 58-17H-8 — Cost-sharing requirements for covered persons--Payments to out-of-network providers.

South Dakota § 58-17H-8

Title 58INSURANCE

Ch. 58-17EUTILIZATION REVIEW AND BENEFIT DETERMINATIONS

This text of South Dakota § 58-17H-8 (Cost-sharing requirements for covered persons--Payments to out-of-network providers.) is published on Counsel Stack Legal Research, covering South Dakota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

S.D. Codified Laws § 58-17H-8 (2026).

Text

Notwithstanding § 58-17H-7 , a covered person may be required to pay, in addition to the in-network cost-sharing, the excess of the amount the out-of-network provider charges over the amount the health carrier is required to pay pursuant to this section. A health carrier complies with the requirements of this section if it provides payment of emergency services provided by an out-of-network provider in an amount not less than the greatest of the following:

(1)The amount negotiated with in-network providers for emergency services, excluding any in-network copayment or coinsurance imposed with respect to the covered person;

(2)The amount of the emergency service calculated using the same method the plan uses to determine payments for out-of-network services, but using the in-network

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Notwithstanding § 58-17H-7 , a covered person may be required to pay, in addition to the in-network cost-sharing, the excess of the amount the out-of-network provider charges over the amount the health carrier is required to pay pursuant to this section. A health carrier complies with the requirements of this section if it provides payment of emergency services provided by an out-of-network provider in an amount not less than the greatest of the following: (1) The amount negotiated with in-network providers for emergency services, excluding any in-network copayment or coinsurance imposed with respect to the covered person; (2) The amount of the emergency service calculated using the same method the plan uses to determine payments for out-of-network services, but using the in-network cost-sharing provisions instead of the out-of-network cost-sharing provisions; or (3) The amount that would be paid under Medicare for the emergency services, excluding any in-network copayment or coinsurance requirements. Commission Note: