SDCL § 58-33-99: Circumstances in which licensee should know product is unauthorized health insurance.

Circumstances where a licensee reasonably should know that a product is unauthorized health insurance include the following:

(1) The licensee knows that the product is represented to be a self-funded plan and that it is offered widely to the multiple employers or generally to individuals;

(2) The licensee knows that the product is a professional employer organization self-funded plan and that it is offered widely to multiple client employers; or

(3) The licensee knows that the plan is represented to be a self-funded plan established or maintained pursuant to a collective bargaining agreement and that the plan is offered widely to multiple employers, or generally to individuals, or both, through agents who are compensated on a commission or similar basis.

A licensee may provide other evidence to the division to indicate that the licensee did not reasonably know that a product is unauthorized. In making its determination regarding whether a licensee should have known the product is unauthorized and the appropriateness of any penalty for failing to notify the division of such a product, the division shall consider the prior experience and the existence or lack of training of that licensee.