58-33-105. Due diligence investigation required of insurer before issuing stop loss policy for health benefit plan.
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/sd/title-58/chapter-58-33/58-33-105·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
An insurer, prior to issuing a stop loss policy for a health benefit plan covering employees, employee dependents, or individuals 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)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 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, 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.