• Home to DLR
• Home to Insurance
• Consumers
• Companies
• Producers
• Administrative Actions
• Flood Insurance
• Healthcare Reform
• Laws, Regulations
  & Bulletins
• License Lookup
• Long-term Care
• Publications
• Sircon Licensing
• Useful Links
• Workers' Compensation
• Contact Us

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

*Opening and printing Adobe .pdf files requires Adobe Acrobat Reader. Click here as needed to download the free Adobe Acrobat Reader.