South Dakota § 58-17K-2 Cost-sharing information described--Required disclosure to enrollees.

South Dakota Statutes

§ 58-17K-2 — Cost-sharing information described--Required disclosure to enrollees.

South Dakota·Title 58 INSURANCE·Ch. 58-17J PATIENT CHOICE IN SELECTION OF HEALTH CARE PROVIDER

At the request of an enrollee, the health insurer shall provide:

(1)An estimate, which is accurate at the time of the request, of the enrollee's cost-sharing liability for a requested covered item or service furnished by a provider reflecting any cost-sharing reductions the enrollee would receive that is calculated based on:

(a)Accumulated amounts;

(b)In-network negotiated rate, reflected as a dollar amount, or underlying fee schedule rate, reflected as a dollar amount, to the extent it is different from the negotiated rate; and (c) Out-of-network allowed amount or any other rate that provides a more accurate estimate of an amount the health insurer will pay for the requested covered item or service, reflected as a dollar amount. In circumstances in which a health insurer re

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At the request of an enrollee, the health insurer shall provide: (1) An estimate, which is accurate at the time of the request, of the enrollee's cost-sharing liability for a requested covered item or service furnished by a provider reflecting any cost-sharing reductions the enrollee would receive that is calculated based on: (a) Accumulated amounts; (b) In-network negotiated rate, reflected as a dollar amount, or underlying fee schedule rate, reflected as a dollar amount, to the extent it is different from the negotiated rate; and (c) Out-of-network allowed amount or any other rate that provides a more accurate estimate of an amount the health insurer will pay for the requested covered item or service, reflected as a dollar amount. In circumstances in which a health insurer reimburses an out-of-network provider a percentage of the billed charge for a covered item or service, the out-of-network allowed amount will be that percentage; (2) Information for an item or service subject to a bundled payment arrangement and a list of the items and services included in the bundled payment arrangement for which cost-sharing information is being disclosed; (3) If applicable, notification that coverage of a specific item or service is subject to a prerequisite; and (4) Further information and consumer notices required for compliance with federal standards as provided under rules promulgated pursuant to chapter 1-26 by the director.

South Dakota § 58-17K-2 (Cost-sharing information described--Required disclosure to enrollees.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.