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South Dakota's guaranteed issue health insurance plans provide safety net

Losing your health insurance can be devastating to your health and your finances, particularly if you're already being treated for a serious medical condition. But if you live in South Dakota, you may be able to obtain a "guaranteed issue" health insurance policy.

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Generally, insurers that do business in South Dakota must offer you a guaranteed issue policy — regardless of your past or present health status — if you're:

  • An adult child who no longer qualifies for your parents' individual plan because of age.
  • A Medicaid recipient who becomes ineligible to continue receiving health insurance due to an increase in income.
  • An employee who loses health insurance due to an employerœs termination of group coverage.
  • A COBRA beneficiary who has exhausted his or her continuation coverage.

South Dakota residents also enjoy broader health insurance rights than is afforded consumers under the federal HIPAA law. (See The HIPAA law: Your rights to health insurance portability.) Under HIPAA, you must have 18 months of prior "creditable" health insurance coverage to avoid having to sit out a pre-existing condition waiting period when you go from one health group health insurance plan to another group plan. In South Dakota, you only need 12 months of prior coverage.

In addition, in South Dakota (with the exception of short-term major medical health insurance) any of the creditable coverages involuntarily lost can be used as a trigger for guaranteed issue. This is broader than HIPAA, which requires that the last coverage that you have be group health insurance in order to qualify for guaranteed issue in the individual market. However, in South Dakota you must exhaust COBRA prior to qualifying for guaranteed issue and you cannot have a break in your health insurance coverage in excess of 63 days and still qualify for guaranteed issue.

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