{"data":{"id":"us-sd/sdcl-58-17k-2","jurisdiction":"us-sd","citation":"SDCL § 58-17K-2","heading":"Cost-sharing information described--Required disclosure to enrollees.","body":"At the request of an enrollee, the health insurer shall provide:\n(1) An estimate, which is accurate at the time of the request, of the enrollee's cost-sharing liability for a requested covered item or service furnished by a provider reflecting any cost-sharing reductions the enrollee would receive that is calculated based on:\n(a) Accumulated amounts;\n(b) In-network negotiated rate, reflected as a dollar amount, or underlying fee schedule rate, reflected as a dollar amount, to the extent it is different from the negotiated rate; and\n(c) Out-of-network allowed amount or any other rate that provides a more accurate estimate of an amount the health insurer will pay for the requested covered item or service, reflected as a dollar amount. In circumstances in which a health insurer reimburses an out-of-network provider a percentage of the billed charge for a covered item or service, the out-of-network allowed amount will be that percentage;\n(2) Information for an item or service subject to a bundled payment arrangement and a list of the items and services included in the bundled payment arrangement for which cost-sharing information is being disclosed;\n(3) If applicable, notification that coverage of a specific item or service is subject to a prerequisite; and\n(4) Further information and consumer notices required for compliance with federal standards as provided under rules promulgated pursuant to chapter 1-26 by the director.","path":["TITLE 58. INSURANCE","CHAPTER 58-17K. HEALTH CARE COST TRANSPARENCY"],"source_url":"https://sdlegislature.gov/Statutes/58-17K-2","current_through":"2026-08-31","vintage":"","retrieved_at":"2026-09-03T15:18:57Z","sha256":"27fc53b4c51c76c23af0f95746bd2ec666cc43bb497b48e61a1da7c946bb37e6","source_id":"us-sd","stale":true,"prev":"us-sd/sdcl-58-17k-1","next":"us-sd/sdcl-58-17k-3"},"notice":"GroundRules: Original legal text. Not legal advice."}