Preventive Care
As of July 1, 2008, the South Dakota Risk Pool covers certain eligible preventive care at 100 percent.
Eligible preventive care includes colonoscopies, immunizations, and vaccinations.
Colonoscopy requirements for 100 percent coverage of eligible expenses include:
- One cancer screening colonoscopy every 10 years beginning at age 50
- Services must be received from a South Dakota provider
Note: Normal physician, facility, and anesthesia charges will also be covered at 100% of eligible expenses for the cancer screening colonoscopy. Laboratory, pathology, and additional procedures will be subject to the deductible and coinsurance requirements.
Immunization and Vaccination Schedule
The South Dakota Risk Pool covers certain vaccinations at 100 percent including the flu vaccination.Coverage is based on the U.S. Centers for Disease Control's (CDC) recommended schedule as of May 2008. Please view the immunization and vaccination schedule attached in this E-mail.
Pre-Authorization Requirements
As of July 1, 2008, the South Dakota Risk Pool requires plan members to obtain pre-authorization for all out-of-state care except in the case of a medical emergency.
- Pre-authorizations for out-of-network care must be made prior to receiving care from the provider in order to receive the highest level of benefits.
- Out-of-state care requests will be declined if the patient care can be effectively provided safely and cost effectively in South Dakota.
Pre-Authorization Procedure
Providers can access HCMTI's website to request pre-authorization at: www.preauthonline.com.
Click here to download a pamphlet about the Risk Pool.
Please contact the South Dakota Risk Pool with any questions at 605-773-3148 or email questions to riskpool@state.sd.us.
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