Department of Labor and Regulation

Title - Division of Insurance email the Division of Insurance

Pre-Existing Condition Insurance Plan - Federal High Risk Pool

Coverage for Medically Uninsurable Available in South Dakota

Quick Facts
Eligibility
Program Details
Additional Information

Quick Facts

  • Provides coverage which can be purchased for eligible uninsurable citizens.
  • Program created by the Patient Protection and Affordable Care Act (PPACA).
  • $11 million allotted for the SD program—July 1, 2010 until December 31, 2014.
  • South Dakota contracted with U.S. Department of Health and Human Services to run the local program.
  • Federal High Risk Pool information (application, rates, plan document, etc.) available by calling 605.773.3148.

Eligibility

  • Have been without health care coverage for the last six months.
  • Have a preexisting medical condition shown by one of the following:
    • Denial of coverage letter from a major insurance carrier.
    • An acceptance letter for health coverage with a disease or condition rider.
    • Medical documentation of a qualified health condition as listed on application or website.
  • Be a South Dakota resident.
  • Be a U.S. citizen or lawfully present in the United States.

Program Details

  • Premiums are similar to the South Dakota individual private insurance market.
  • $2,000 deductible plan:
    • Pharmacy coverage begins on day one, three- tier copay structure.
    • Preventive services not subject to deductible or coinsurance requirements.
    • Max out-of-pocket $5,750 ($4,250 medical and $1,500 pharmacy).
    • Plan year July 1—June 30.
  • Dakotacare Provider Network.

Additional Information

  • Eligible individuals can apply on their own or use a licensed insurance agent.
    • Agents will earn a 3% commission.
  • Enrollment may be capped due to limited federal funds.
  • Separate program from the South Dakota Risk Pool.
    • SD Bureau of Human Resources administers both programs.
    • Rates and network are different for the programs.
    • Eligibility criteria different for the programs.
    • No plans to change current SD Risk Pool program.
    • Both programs will terminate in 2014 pursuant to PPACA.

See a related press release on the state of South Dakota News Web

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Division of Insurance
124 S. Euclid Ave., 2nd Floor
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369