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·Title 58 INSURANCE·Ch. 58-17E UTILIZATION REVIEW AND BENEFIT DETERMINATIONS

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:

South Dakota § 58-17H-8 (Cost-sharing requirements for covered persons--Payments to out-of-network providers.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.