South Dakota Risk Pool

South Dakota Risk Pool:

During a special session of the South Dakota legislature in June 2003, legislation was passed establishing the South Dakota Risk Pool. Governor M. Michael Rounds signed the enabling bill on June 27, 2003, and the Risk Pool was created. The Risk Pool is designed to provide coverage for individuals who lose their health insurance and are unable to qualify for an individual health insurance policy.

A number of entities share the costs associated with the South Dakota Risk Pool. The enrollees pay a higher than average premium, health care providers accept reduced compensation, the insurance carriers are assessed annually, insurance agents receive a lower than normal commission and the State of South Dakota allocates general funds. It is only through these combined efforts and contributions that the South Dakota Risk Pool exists.

The South Dakota Risk Pool eligibility requirements:

Be a resident of South Dakota
Apply within 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 of premiums or fraud.
Not be covered under a group health plan, Medicare, Medicaid, or any other form of health insurance

Providers and facilities in South Dakota accept Risk Pool enrollees. There are a few providers who do not accept enrollees and the reduced reimbursement rate—please check the list below. Due to the partnership with the South Dakota providers, it is advantageous for enrollees to seek medical treatment within the state. Beginning July 1, 2008, except in the case of a medical emergency, the plan will require all out-of-state care for inpatient and outpatient services to be prior authorized.

Click here to view South Dakota Providers who do not accept Risk Pool Enrollees.

Individual appilicants or any licensed health insurance agent may submit an application to the South Dakota Risk Pool. Agents are not required to have a separate appointment. Licensed agents placing an enrollee in the Risk Pool are entitled to a three percent commission.