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High-Risk Pools

  • The South Dakota Risk Pool was created in 2003 to provide coverage to people who have lost coverage and have previous creditable coverage. However, unlike most high-risk pools, the program does not serve uninsured individuals who have a pre-existing condition or illness that causes them to be declined by private insurers unless the person recently lost creditable coverage.  The program is financed by a combination of premiums paid by individual members, state general revenue, assessments on health insurance carriers, and an initial start-up grant from CMS’ risk pool grant program. The premium cap is set at 150 percent of the average in force premium or payment rate for that classification charged by the three carriers with the largest number of individual health plan benefit plans in the state during the preceding calendar year. As of January 2008, 675 persons were enrolled in the pool.

    In 2006, SB 200 expanded the eligibility of the Risk Pool to include individuals who are covered by a plan which is no longer being marketed in South Dakota and whose premiums are 200% of what their applicable Risk Pool rate would be. Fifty eight (58) persons have been enrolled based on this expansion. These persons are included in the total enrollment of 675 (January 2008).

Dependent Coverage

  • In 2007, the South Dakota Legislature passed SB 108. It states that dependents shall have access to insurance up until their 19th birthday. If the young adult is enrolled in an educational institution, they are eligible for insurance until their 29th birthday.