§ 58-12-26 Insurer defined.

SD Codified L § 58-12-26 (2019) (N/A)

Copy with citation

Copy as parenthetical citation

58-12-26. Insurer defined. For the purposes of §§ 58-12-22 to 58-12-29, inclusive, the term, insurer, means:

(1) Any commercial insurance company, employer-employee benefit plan, health maintenance organization, professional association, service benefit plan, public self-funded employer or pool, union, or fraternal group selling or otherwise offering individual or group health insurance coverage including self-insured and self-funded plans;

(2) Any profit or nonprofit prepaid plan offering either medical services of full or partial payment for services included in the department's medicaid plan;

(3) Any other entity offering health benefits for which a medicaid recipient may be eligible in addition to public medical assistance;

(4) Any managed care organization, third-party administrator, pharmacy benefits manager, or other entity which processes claims, administers services, or otherwise manages health benefits on behalf of any of the aforementioned insurers; or

(5) Any other party that is by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service including workers' compensation, automobile insurance, and liability insurance plans.Source: SL 2005, ch 263, § 5; SL 2007, ch 286, § 3.

Previous Section

§ 58-12-25 Reimbursement to department for cost of services.

Next Section

§ 58-12-27 Department defined.