Key Takeaways
- South Dakota Division of Insurance regulates health insurance
- South Dakota uses the federally-facilitated exchange (HealthCare.gov)
- Pre-existing condition exclusions are prohibited in ACA-compliant plans
- Essential health benefits are required in individual and small group markets
- Health insurance policies are governed by Title 58, Chapter 17
Last updated: January 2026
South Dakota Health Insurance Policy Requirements
South Dakota has health insurance regulations under Title 58 of the South Dakota Codified Laws.
Regulatory Structure
South Dakota health coverage is regulated by:
| Agency | Responsibility |
|---|---|
| Division of Insurance | Part of Dept. of Labor and Regulation |
| HealthCare.gov | Federal marketplace for individual enrollment |
Division of Insurance
The Division of Insurance:
- Reviews and approves policy forms and rates
- Licenses insurance producers and companies
- Handles consumer complaints
- Enforces insurance laws and regulations
Health Insurance Marketplace
South Dakota uses the federally-facilitated exchange (HealthCare.gov):
Key Features
- Federal marketplace for individual health insurance
- Premium tax credits available for qualifying applicants
- Qualified Health Plans (QHPs) certified by federal government
- Multiple private insurers participate
Enrollment Periods
- Annual open enrollment each fall
- Special enrollment for qualifying life events
- Financial assistance based on income
Required Policy Provisions
Under Section 58-17-15, health insurance policies must include an incontestability clause:
- Time limit on certain defenses
- Misstatements by applicant addressed
- Similar to life insurance incontestability
Required Coverage
South Dakota ACA-compliant plans must cover Essential Health Benefits:
Essential Health Benefits
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
Pre-Existing Condition Protections
For ACA-compliant plans:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual | Prohibited |
| Small Group | Prohibited |
| Large Group | Limited |
Guaranteed Issue and Renewal
ACA requirements provide:
Guaranteed Issue
- Insurers must accept all applicants during open enrollment
- Cannot deny coverage based on health status
Guaranteed Renewal
- Cannot cancel coverage except for non-payment or fraud
- Plan discontinuation requires advance notice
Mental Health Parity
Federal mental health parity requirements apply:
- Mental health benefits must equal medical benefits
- Same copays, deductibles, and limits
- Coverage for substance use disorders required
Test Your Knowledge
Which marketplace does South Dakota use for individual health insurance enrollment?
A
B
C
D
Test Your Knowledge
Are pre-existing condition exclusions prohibited in South Dakota ACA-compliant individual health plans?
A
B
C
D