South Dakota Medical Insurance

Medical insurance is one of those things you simply can't do without. It is an essential part of life because of the security it brings. If you are thinking of purchasing medical insurance , start by doing two things. Find out what type of insurance your family needs as there are many different options to choose from. Set a budget that is realistically the amount you can afford to spend on coverage. If you live in South Dakota, there is a myriad of insurers with policies to meet every need. The South Dakota Division of Insurance is the group that oversees individual and family medical insurance. Currently 89% of South Dakota's over 777,000 inhabitants are insured.

Regulations For Individual Medical Insurance

Polices in SD can be medically underwritten, meaning that the insurer can take a person's health status into account when determining rates and whether or not to even offer coverage. An insurer can also opt to offer a modified plan based on what a person's health status reveals, using exclusions or limitations. If an applicant has not had creditable uninterrupted coverage for 12 months, the insurer can look back 1 year to check for pre-existing conditions. Such issues can be dealt with by adding an elimination rider to the policy. Rates are also affected by health and can be 30% higher or lower than the regular rate.

Medical Insurance for Small Groups

In South Dakota, small groups are recognized as those having 2 to 50 employees. Such groups are always guarantee issue for medical insurance. This means that they must be offered coverage despite the health or history of its members. However, if there are members without creditable prior coverage, the insurer can look 6 months into their health history and put an exclusion of up to 1 year on claims resulting from pre-existing conditions. According to state law, creditable coverage is when there are no breaks of more than 63 days without medical insurance. Medical underwriting is allowed in SD in order to set small group rates. The premium can only be 25% higher or lower than the indexed rate.

Continuation Coverage and COBRA

If your firm has more than 20 employees, it falls under the federal COBRA regulations, which allow terminated employees to continue their group medical insurance by paying for the employer and employee premiums, as well as a 2% administration fee. The continuation is usually for up to 18 months, but in certain circumstances may continue for 36 months.

There is also a mini-COBRA law in the state of South Dakota for employers who have at least 2 employees, but less than 20. It also allows for 18 months of group medical insurance coverage at the employee's cost. Special circumstances can also mean 36 months of continuation. The terminated employee must activate this coverage within 30 days of termination. When COBRA benefits are used up, guarantee issue coverage can be found with the high-risk pool the state offer.