Free Group Health Insurance Study Guide
South Dakota Accident & Health exam — Group Health Insurance.
Federal COBRA, HIPAA and the ACA are covered in the national Group Health Insurance guide. South Dakota adds its own continuation and conversion rules for smaller employers, a right to continue coverage when an employer closes, and small-employer market rules. The sources are SDCL 58-17, 58-18, 58-18B and 58-18C.
State continuation (SDCL 58-18-7 to 58-18-7.19)
Who it applies to: employers with fewer than 20 employees (58-18-7). Larger employers fall under federal COBRA.
| Item | South Dakota rule |
|---|---|
| Basic period | 18 months at the person's own expense after leaving employment, for the employee and eligible dependents (58-18-7.5) |
| Disability extension | 29 months for a qualified beneficiary found disabled under the Social Security Act during the first 60 days (58-18-7.5) |
| Other qualifying events | Up to 36 months total after events such as the employee's death, or divorce or legal separation (58-18-7.12) |
| Premium | Up to 102% of the group rate. Up to 150% after the 18th month (58-18-7.13) |
| Not eligible | An employee fired for gross misconduct (58-18-7.11) |
| Waiting periods | No new probationary or waiting period may be applied (58-18-7.19) |
Conversion
- A conversion policy must be issued without evidence of insurability when the person applies during the 180 days before continuation coverage expires (58-18-7.4).
- A divorced spouse may get an individual policy without evidence of insurability by applying within 30 days. The insurer may instead continue the spouse's coverage (58-17-2.2).
Employer closure (SDCL 58-18C-1)
- If an employer stops operating and the group policy ends, each employee may continue coverage for themselves and their dependents for 12 months at their own expense.
- The employer must notify employees of nonpayment or cancellation as soon as reasonably possible, and no later than 10 days after cancellation.
Other group rules
- The insurer gives the policyholder written notice 45 days before a premium rate increase takes effect (58-18-35).
- Each employee or member gets a summary statement of the coverage's essential features and who receives benefits (58-18-9).
Small employer market (SDCL 58-18B)
- Small employer: averaged at least 2 and no more than 50 employees, and has at least 2 employees on the first day of the plan year (58-18B-1).
- A carrier can't deny coverage based on the health status or claims experience of the employer, employees or dependents (58-18B-37).
- Prohibited steering: carriers and producers can't encourage an employer to avoid applying, or to go to another carrier, because of health, claims, industry, occupation or location (58-18B-38).
- A carrier or agent can't encourage an employer to exclude an employee from coverage (58-18B-44).
- A denial must be in writing with the reasons (58-18B-45).
- Commissions on an exchange plan must match those on a similar off-exchange plan (58-18B-40; ARSD 20:06:18:22).
Common exam traps
- State continuation applies to employers with fewer than 20 employees.
- The periods are 18 / 29 / 36 months. The premium is 102%, rising to 150% after month 18.
- Conversion: apply within the 180 days before continuation ends. A divorced spouse has 30 days.
- Employer closure gives 12 months of continuation.
- A small employer has 2–50 employees.
Practice Group Health Insurance questions All Accident & Health topics
Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
