South Dakota § 58-17K-2 - Cost-sharing information described--Required disclosure to enrollees.

§ 58-17K-2. Cost-sharing information described--Required disclosure to enrollees.

At the request of an enrollee, the health insurer shall provide:

(1)    An estimate, which is accurate at the time of the request, of the enrollee's cost-sharing liability for a requested covered item or service furnished by a provider reflecting any cost-sharing reductions the enrollee would receive that is calculated based on:

(a)    Accumulated amounts;

(b)    In-network negotiated rate, reflected as a dollar amount, or underlying fee schedule rate, reflected as a dollar amount, to the extent it is different from the negotiated rate; and

(c)    Out-of-network allowed amount or any other rate that provides a more accurate estimate of an amount the health insurer will pay for the requested covered item or service, reflected as a dollar amount. In circumstances in which a health insurer reimburses an out-of-network provider a percentage of the billed charge for a covered item or service, the out-of-network allowed amount will be that percentage;

(2)    Information for an item or service subject to a bundled payment arrangement and a list of the items and services included in the bundled payment arrangement for which cost-sharing information is being disclosed;

(3)    If applicable, notification that coverage of a specific item or service is subject to a prerequisite; and

(4)    Further information and consumer notices required for compliance with federal standards as provided under rules promulgated pursuant to chapter 1-26 by the director.

Source: SL 2021, ch 213, § 2.