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South Dakota Health Insurance
Having a suitable health insurance can safeguard you and your family against financial catastrophes arising from the occurrence of illness or injury. Indeed, health insurance does not come cheap; therefore it is wise to evaluate all your future risks and its effect on your financial stability. In the U.S., approximately 47 million people are uninsured, among whom a majority of working families end up paying the price due to lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.
According to the United Health Foundation’s 2008 Health Rankings, South Dakota stood at the 21st position in the healthiest state list. The state plunged five places from its 16th position in 2007; it was on the 18th position in 2006. The overall health of South Dakota is strong due to low violent crime rate and few cases of infectious diseases. The state of South Dakota, with more than seven hundred thousand residents, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-cost coverage to the uninsurable citizens of South Dakota who meet specific eligibility requirements of age and income.
The South Dakota Division of Insurance manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, due to high geographic disparity and limited access to primary care, approximately 11% of the state population remains uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 38.9% of South Dakota’s uninsured citizens come under the above 200% FPL category.
Health insurance is essential for your financial health and your physical wellness. Contact a licensed health insurance agent/broker to select a proper health insurance plan with benefits that suit your family.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of South Dakota. These regulations apply to all insurance companies offering individual or family health insurance in South Dakota:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 12 months |
Look Back Period | 12 months |
Look Back Standard | Prudent person |
Mandatory Benefits | Cancer screening for women including breast cancer screening |
Market Rate Restrictions | Yes |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of South Dakota. These regulations apply to all insurance companies offering small group health insurance in South Dakota:
| Small Group Size | 2-50 |
Employee Qualifications | Two employees must work for at least 6 months out of the year, and work 20 hours per week |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate Bands |
Rate Adjustment Factors | 25% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of South Dakota. For employer groups of more than 20 employees, refer to the federal COBRA guidelines;
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 12 months |
Extension of Benefits Period - Disabled | 12 months |
Maximum Premium Increase | 102% |
State Legislation Reference | Chapter 18C of Title 58 – Continuation and Conversion of Health Care Persons |
Additional Notes | The individual must have been insured under the group policy for at least 6 months. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of South Dakota to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of South Dakota is summarized in the chart below:
| Plan Name | South Dakota Risk Pool |
Website | |
Phone Number | 605-773-3148 |
HIPPA Eligibility Required? | Yes |
Available Carriers | DakotaCare |
Pre-Existing Condition Waiting Period | 0 months |
Enrollment Periods | Currently Open to New Enrollment |
Premium Limits | No more than 150% of standard rate |
Lifetime Maximum Benefit | $1 million |
Special Notes | To be eligible, |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of South Dakota provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | South Dakota’s Children’s Health Insurance Program (CHIP) |
Website | |
Phone Number | 800-305-3064 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier |
|
Length of Coverage | Subject to Periodic Review |
Residency Requirements | South Dakota, U.S. citizen, legal immigrant |
Other Eligibility Requirements | Uninsured children are eligible whose family income is up to 200 percent of FPL. |
Pre-Existing Condition Exclusions | None |
Cost | $0 to minimal share of cost |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of South Dakota:
| Governing Agency | South Dakota Department of Social Services |
Website | |
Phone Number | 800-305-3064 |
Residency Requirements | South Dakota resident, U.S. citizen |
Federal Poverty Line Income Limits | Ages 1-19 - 140% FPL |
Additional Resources
South Dakota Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines South Dakota’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
South Dakota: At-A-Glance
Provides exclusive health data of South Dakota. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
