58-33-104. Due diligence investigation required of third party administrator before entering into any administrative contract for health benefit plan.
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/sd/title-58/chapter-58-33/58-33-104·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A third party administrator, prior to entering into any administrative contract for a health benefit plan, and prior to assisting any person with administration of a health benefit plan, covering employees of an employer 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 those measures reasonably appropriate to establish:
(1)Through initial inquiry, contract provisions and measures to monitor and enforce compliance with the contract provisions, that for any insurance coverage that is represented as issued relating to the health benefit plan:
(a)The insurer issued the policy;
(b)The coverage is as represented;
(c)The insurer is an admitted insurer in this state; and
(d)The policy has been filed with, and approved by, the division or is exempt from filing requirements;
(2)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;
(3)For any health benefit plan that is represented as established or maintained by an employee leasing arrangement or professional employer organization, the health benefit plan is fully insured; or
(4)For any health benefit plan that is represented as established by a single employer, that the health benefit plan is covering solely employees and their dependents, and the employer controls and directs the work of the employee.