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South Dakota Health Insurance

South Dakota Medical Insurance Overview

South Dakota’s health and health care circumstances have, sadly, disintegrated marginally as of late, and the condition of general health has demonstrated a decrease that will, ideally, be turned around in the coming years.  Health care reform endeavors being realized under the Patient Protection and Affordable Care Act are intended to enhance healthcare and expand access to medically necessary protections for a large number of Americans.

These endeavors at reforming the landscape of healthcare are working to address the way that numerous Americans obtain access to satisfactory health care initiatives.  In South Dakota, and in all states across the U.S., a large part of the populace enough to cause concern requires health insurance protection.  Healthcare legislation will make health insurance coverage all the more accessible and offer help to people battling an assortment of hindrances in their quest for reasonable and affordable healthcare solutions.

South Dakota’s Health Care Issues
Regarding the state’s general health, South Dakota comes in at the 19th position in contrast to the other 49 states as indicated by insights compiled by the United Health Foundation.  South Dakota fell many spots between 2011 and 2014, dropping from 27th spot to 19th position in the rankings, signifying a change for the better for the state’s population.  This drop mirrors the general change in the states health status by and large.

The following is a brief synopsis of some of the significant health care qualities and shortcomings in the state of South Dakota.  The best qualities of the state include its low prevalence of babies born under weight, its lack of poor mental health days and its low percentage of drug related deaths.  Among the state’s shortcomings are its low rate of immunized adolescents, its high rate of infant mortality and its high percentage of people who are employed in occupations that are considered risky.

With the Affordable Care Act coming into play, as many as 30 million Americans will secure insurance coverage before 2020.  It is believed that with this wave of the population getting coverage, South Dakota’s residents would follow the same trend.

While the number of uninsured individuals in this state seems low, it is significant enough to cause concern.  Hopefully, healthcare reform will assist South Dakota’s residents in finding affordable coverage, as the ACA was designed.  The legislation will also hope to offer many state-funded options to people on a wider scale in the country as a whole.

Understanding South Dakota’s Uninsured Population 
Insights uncovered by the Henry J. Kaiser Family Foundation demonstrate that 9 percent of the state’s populace was without insurance coverage in 2014.  Of that number, 7 percent were children under the age of 18 and 13 percent were residents between the ages of 19 and 64.  Moreover, of the aggregate sum of uninsured people in South Dakota, 6 percent earned more than 400% of the Federal Poverty Level, but refused to get health insurance for some unknown reason.

Group Health Plans 
People looking for health insurance ought to consider joining the group plan offered by their employer if their place of employment offers such coverage.  In the state of South Dakota, around 55% of firms provide health insurance benefits to workers.   Larger companies in the state with many employees offer some sort of insurance package.  The bigger a firm, the more probable it is to offer insurance to its pool of workers.  If you are working in the state of South Dakota, it is likely that you are qualified for your organization’s group health plan.

In South Dakota, the South Dakota Department of Revenue and Regulation: Division of Insurance regulates private insurers that offer group insurance plans.  In the event that you are in the market for group health insurance in South Dakota, you might need to become accustomed to your rights under the Division of Insurance’s website so that you are adequately protected.

Signing Up
At most organizations, workers can simply register in the group health insurance policy during assigned enrollment periods.  Your HR representative will be able to offer more information on enrollment dates.  The representative should also be able to offer you a breakdown of the coverage options available through the group plan.  Consider the variables listed below before you take the leap and sign up for your company’s health insurance plan:

  • Are you suffering from a chronic condition that will require a lot of medical coverage in the near future?  Chronic conditions typically require many doctors’ visits, so you will want to be prepared.
  • Does the group health plan have more than one selection of benefits for workers to choose?  Many employers offer different coverage options that vary in cost and services covered.
  • Are you responsible for providing coverage for your dependents or your spouse?  This will increase the cost of your monthly premiums, but you will want to enroll them with you if necessary.

Pre-Existing Condition Exclusion Periods 
Under a group health plan, an insurer cannot decline to offer you insurance coverage if you have a pre-existing medical condition.  However, the insurance company can make you wait through a period of time known as an exclusion period.  This length of time depends on the state in which you reside, but in South Dakota, the length of time is 12 months.  Once the exclusionary period has passed, your insurance benefits are available for use.

HIPAA regulations prohibit the enforcement of an exclusionary period on dependents aged 19 and younger.  Also, insurance companies are given the opportunity to search through your medical records for a six month period of time prior to your enrollment in the group plan.  This gives the insurer the ability to determine whether or not you are suffering from pre-existing conditions.  Also, being predisposed to an illness or condition does not constitute having a pre-existing condition under the HIPAA regulations.

Affiliation or Waiting Periods 
A waiting period with reference to a group health plan is a timeframe that an enrollee must wait before their HMO insurance policy is available for use.  This period of time can be no more than two months, with the exception of a person enrolling into the plan late.  Late enrollees may have to wait for three months as a waiting period before using their insurance coverage.  In the event that both a waiting period and exclusionary period apply to your situation, these timeframes will happen at the same time.

Individual Health Plans 
Individual insurance policies exist to offer medical benefits to people who are self-employed or working for a company that does not offer group health coverage.  As of 2014, seven percent of the state’s population had individual insurance policies.  These plans are available if you cannot obtain coverage under a group policy or because you earn too much money to qualify for a state-sponsored program.

There are pitfalls to individual insurance policies in that they are subject to medical underwriting while the provider determines your eligibility.  From the standpoint of the insurance company, the risk is greater because it falls on the shoulder of one person versus an entire pool of people.  For this reason, individual policies are more expensive than other options.  Because of the risk and expense involved, many insurers opt to not provide this sort of coverage.

If you have a pre-existing medical condition, you can be declined coverage by a provider of an individual plan.  Restrictions apply based on the provider and the monthly premiums may prove to be quite expensive as a result.

Regardless of the restrictions and obstacles listed, a young person who is healthy in South Dakota may be able to obtain an individual policy for roughly $70 every month.

Continuation Coverage
Continuation coverage is available through COBRA on a temporary basis to people who have lost their health insurance for any number of reasons.  COBRA seeks to fill in the gaps of insurance by offering the same level of group coverage for a period of time lasting no longer than 18 months.  The only qualification is that the size of the employer who offered the group plan must have a designated amount of employees before COBRA can be offered.

South Dakota Health Benefits Exchange 
Despite not wishing to create a health benefits exchange, the Governor of South Dakota announced that the state would retain regulatory authority along with the ability to do plan management functions.  When the Affordable Care Act came into play, the state of South Dakota worked to consider the details involved in creating a marketplace sufficient under the ACA’s guidelines.

The state of South Dakota still performs plan management activities, but the benefits exchange is managed through healthcare.gov.  In addition, a law was passed prohibiting any plans operating through the exchange from offering coverage for abortions with the exception of dire situations where the mother’s life may be in jeopardy.

In every state, the Patient Protection and Affordable Care Act was designed to create a one-stop solution for residents to obtain adequate health insurance coverage for themselves and dependents.  Through the marketplaces, consumers should be able to view the available plans and make an educated decision on the best coverage for their situation.

The Henry J. Kaiser Family Foundation’s website provides a wealth of information regarding the health benefits exchange history and planning with regard to the state of South Dakota.

South Dakota State Insurance Programs 
In South Dakota, many programs are provided by the state to increase the healthiness of its residents.  Of these programs, some are based solely on annual earnings while others are geared toward providing benefits to women or seniors.  Below, is a detailed explanation of the available programs and who they benefit:

South Dakota Risk Pool 
People living in this state with pre-existing conditions and cannot otherwise get insurance coverage can use the Risk Pool for benefits.  The downside to this is that, while benefits are good, the premiums can be quite expensive.  Coverage can cost an individual anywhere between $127 and $1,570 every month.

Pre-Existing Condition Insurance Plan (PCIP) 
If you have been denied insurance coverage because of a pre-existing condition, PCIP can be used to obtain medically necessary services.  Approval is given to individuals with qualifying conditions that have been denied coverage because of the condition and can show proof of this in writing.  You also need to have gone without insurance for a period of six months.  Participants can enjoy a wide range of services including doctors’ visits, medications and specialty care services.

South Dakota Medical Assistance 
This program works to provide low income families with full medical coverage.  Covered under the services are hospital stays, doctor’s appointments, dental and vision care, rehab and therapy, and chiropractic services.  In order to qualify, you must part of a household that earns a low income and be a resident of the state of South Dakota.

Children’s Health Insurance Program (CHIP) 
Uninsured kids in the state of South Dakota can get medical benefits under CHIP.  Qualification for this program is largely based on the income level of the household.  Many participants of this program do not pay any fees for participation, but in some cases, the required contribution is minimal.

Women-Infants-Children (WIC) 
The WIC program is managed by the USDA Food and Nutrition Service and is geared toward providing healthy food options for women, infants and children up to the age of five.  Women can also receive breastfeeding education and support.

All Women Count 
This program covers women in South Dakota who don’t have insurance and are in need of various cancer screenings.  It also serves women who have insurance, but cannot afford the costly premiums.  Pap smears, pelvic exams and mammograms are offered to protect the state’s female population from the dangers posed by cancer related illnesses using early detection methods.

Indian Health Services 
Individuals of Native American descent or women who are pregnant by a qualifying Native American can acquire basic medical services through this program.  There are quite a number of IHS supported hospitals in South Dakota that overseen by tribal councils.  These hospitals provide the necessary medical services to those who qualify and the premiums are usually free.

Medicare, the Medicare Prescription Drug Program, and Senior Health Information and Insurance Education (SHINE) 
To be covered under Medicare, you must be a disabled person, a person with end-stage renal disease or a senior over the age of 65.  To qualify, a senior must have worked in a job that was covered by Medicare for at least ten years.  The SHINE program is a counseling service geared toward helping those interested in Medicare learn their options for coverage.

VA Medical Benefits Package 
Veterans who have served out their active duty requirement in any branch of the United States military can receive a comprehensive benefits plan through the VA.  In order to be eligible, you must have served for 24 consecutive months and be in receipt of an honorable discharge.

Partnership for Prescription Assistance 
The PPA offers to connect consumers with nearly 475 programs that are geared toward paying the costs associated with prescription medications.

National Association of Mental Illness (NAMI) Helpline 
The NAMI Helpline is staffed by volunteers geared to provide answers to questions regarding mental illness.  Information is provided to callers on local support groups, educational programs, helping family members get treatment and more.  To reach the Helpline, call 800-950-6264.

The Health Insurance Portability and Accountability Act (HIPAA) 
The main goal of HIPAA was to regulate insurance providers and protect patient data from misuse or unauthorized access.  HIPAA also regulates the ability for insurance companies to deny coverage to people in the event they have a pre-existing medical condition.  Group insurance providers are prohibited from denying coverage, while individual plan providers are able to do so.

Under HIPAA, continuation coverage is also offered in a situation where you have exhausted your benefits under COBRA.  For more information on HIPAA and your rights contained therein, the U.S. Department of Health & Human Services offers a great resource.

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