It is necesssary to have health insurance coverage and very important to do enough research and comparing to find a plan that best fits you and is most affordable; Health Plan One can help you.  Today, in the state of South Dakota, the number of uninsured is at 68,910 or 15% of the population.  In a six year period between 2000-2006, individual health insurance premiums increased 47.5% while family health insurance premiums increased 73.5%.  As of 2006 families were paying $10,023 annually for their health insurance coverage or $3,450 for individual health insurance.

 

In South Dakota, state law allows health insurance companies to turn people down for individual health insurance coverage based on the status of their health.  However, you can never be turned down for health insurance offered through an employer.  In South Dakota, medical underwriting is allowed which is the process when health insurance companies review a consumer's medical history and health status to determine if they qualify for health coverage.  There is a 12 month look back and exclusionary period for preexisting conditions.

 

High Risk Pool

South Dakota maintains a high risk pool called the South Dakota Risk Pool. The South Dakota state high-risk pool is a program that allows individual health insurance policies to be sold only to HIPPA-eligible people.  You may be eligible for this coverage based on the following determinants.  You must:

     - Be a resident of South Dakota

     - Apply 63 days of losing your prior coverage

     - Have at least 12 months of continuous creditable coverage

     - Have used up COBRA or state continuation coverage

     - Have not had your most recent coverage terminated due to nonpayment or premiums or fraud.

     - Not be covered or eligible for coverage under a group health plan, Medicare, Medicaid, or any other form of health insurance.

For more on the South Dakota high-risk pool visit: www.diabetes.org

 

Coverage under the SD Risk Pool includes doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and x-rays, skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy.

Group health insurance in South Dakota includes small businesses with 2-50 employees.  Presently, people who receive insurance from their small business employer are paying $310 monthly for individual coverage or $811 monthly for family coverage.  In South Dakota, medical underwriting is allowed with plus or minus 25% of the indexed rate based on the health status of the group.  There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior health coverage.  If a person is uninsured for the previous 1-6 months, a waiting period for coverage of pre-existing conditions may apply.

 

With small businesses, coverage is typically guaranteed but there are some factors that determine the eligibility to receive group health insurance.  These include:

     - Company size 2-50 employees

     - Two employees must work for at least 6 months out of the year, and work 20 hours per week for coverage

     - Owner can count as an employee

     - Owner name on business license must draw wages from the company

For more on small business and group health insurance visit www.coverageforall.org

 

 

 

South Dakota offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce. 

Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.

Children

Children (ages 1-5)-140% of the Federal Poverty Level
Children (Ages 6-19)-140% of the Federal Poverty Level

 

Pregnant Women and Infants

Pregnant Women-133% of the Federal Poverty Level
Infants (ages 0-1)-140% of the Federal Poverty Level

 

Parents

Non Working Parents- 61% of the Federal Poverty Level

Working Parents- 61% of the Federal Poverty Level

 

Other populations

Supplemental Security Income Recipients- 74% of the Federal

Poverty Level

 

Physician and other health services, hospital services, nursing facility services, home health services, adult dental services, podiatric services, optometric and optical services, chiropractic services, rehabilitation, early and periodic screening, family planning services, clinic services, prescription drugs, long-term care supplements, facilities for the mentally impaired, personal care services, transportation services, ambulatory surgical centers, medical equipment, organ transplants, case management, mental health services by independent practitioners, and nutritional therapy and nutritional supplements.

 

Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

 

You may learn more about South Dakota Medicaid at http://dss.sd.gov/

 

South Dakota offers the CHIP program to children up to the age of 19 whose family incomes are up to 200% of the Federal Poverty Level or have too great of an income to qualify for Medicaid but cannot afford to buy individual health insurance. To be eligible, the children must not be covered by any other health insurance for at least 3 months, they must be residents of South Dakota and U.S. citizens, and they must not be eligible for Medicaid. Please visit the CHIP website for more detailed information at   http://dss.sd.gov/medicalservices/chip/