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 § 58-17K-2

Title 58INSURANCE

Ch. 58-17JPATIENT CHOICE IN SELECTION OF HEALTH CARE PROVIDER

This text of South Dakota § 58-17K-2 (Cost-sharing information described--Required disclosure to enrollees.) 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 § 58-17K-2 (2026).

Text

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.