58-33-103. Due diligence investigation required of insurance producer before submitting stop loss policy application for health benefit plan.
169 words·~1 min read·
/sd/title-58/chapter-58-33/58-33-103A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
An insurance producer, prior to submitting an application for a stop loss policy to an insurer for a health benefit plan offered to employees, employee dependents, or a person located in this state, shall carry out appropriate due diligence to establish that the health benefit plan is not unauthorized health insurance, including measures reasonably appropriate to establish:
(1)For any health benefit plan that is represented as established or maintained pursuant to a collective bargaining agreement, the health benefit plan is established or maintained under or pursuant to a collective bargaining agreement under the criteria provided under 29 CFR 2510.3-40 as of January 1, 2007;
(2)The health benefit plan that is not offered by an employee leasing arrangement or professional employer organization to client employers; or
(3)For any health benefit plan that is represented as established by a single employer, that the health benefit plan is covering solely employees, and dependents of employees, of the employer and the employer controls and directs the work of the employee.