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South Dakota Risk Pool - Health Insurance Provided for the Uninsurable

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Acronym or name of the risk pool: South Dakota Risk Pool.

Regulation establishing risk pool: South Dakota legislation under chapter 20:06:48.

Funding: The programme receives funds from premium payments by members. It is also received from assessments on health plans of companies and reinsurance agencies operating in South Dakota. Funds are also provided from the general state revenue and a start up grant from the CMs risk pool grant programme.

Plans offered: Unlike other states, South Dakota provides coverage to only those who have involuntarily lost their cover and those who had creditable covers previously. Unless proof of creditable coverage is provided, no covers are offered to people who are unable to get it from private carriers. One plan is offered through the risk pool. It is a PPO plan with three different deductibles. A Health Savings Account plan is also available.

Plan benefit: PPO plans offer deductibles of $1000, $3000, and $10000. The in network medical covers are offered at a coinsurance level of 25%. The member is expected to pay 25% coinsurance rates for out of network services. The $1000 deductible plan has an out of pocket maximum is $3250. The $3000 deductible has an out of pocket limit of $5250. The $10000 deductible plan has a maximum out of pocket is $12250. The HSA plan has a deductible of $3000. The coinsurance rate is 25% for inpatient and outpatient services. The maximum out of pocket limit is$5000.

South Dakota risk pool summary: https://www.hcmti.com/riskpool/.

Maximum benefit limits: The lifetime maximum benefits that can be paid are $1000000.

Eligibility: (1) The person must be a resident of South Dakota for at least 30 days. (2) You must have received a letter rejecting your application or you were offered covers at a higher rate than offered by the state because of a medical condition. (3) The plan being offered to you had a pre existing clause of more than 12 months. (4) Private health insurance was being offered to you but at a rate higher than the amount of premium being charged by the risk pool. (5) Your coverage was not terminated because of nonpayment of premiums. (6) You are not under COBRA coverage or any other state coverage. (6) The cover must be applied for within 63 days of the termination of the previous cover.

Enrollment periods: Applications are accepted for these plans throughout the year. Once approved, coverage begins on the first day of the following month, provided the date falls before the cutoff date. Changes can be made to your plan selection once you are enrolled.

Premium payments: Your age, gender, tobacco usage and plan selection determines the premium you pay.

Premium calculations: The rate capped is 150% of the standard rate charged by 3 of the leading insurance companies in the state.

Pre existing condition waiting period: Since a creditable coverage proof is required to enroll for this plan, there is no waiting period for this plan due to pre existing clause.

Contact information: South Dakota risk pool. C/O Bureau of Personnel. Capitol Hill. Pierre, SD 57501. Phone-6057733148. Official Website.

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