Health Coverage For Local Governments
A risk-sharing pool created, sponsored, and endorsed by the South Dakota Municipal League.
Welcome to the Health Pool of South Dakota
Caring, Competitive, and Complete Coverage for Your Employees
As a self-insured risk sharing pool, the Health Pool of South Dakota was created for its Members. We exist to offer a variety of health coverage plans to employees of large and small public entities.
Currently serving over 80 public entities and providing health coverage to over 1200 lives, the Health Pool is assisting local governments in their efforts to provide top quality care to their highly valued employees while controlling health care costs and keeping rates stable for the employer.
A risk-sharing pool created, sponsored, and endorsed by the South Dakota Municipal League
Claim charges billed through available networks
Insured lives
Entities are currently members
The year HPSD was started
Providing employee health care since 1995.
Benefit Highlights
- Self-Insured & Self-Funded
- Non-profit
- Locally Administered
- Member Owned
- Multiple Plan Options All Offered Through Wellmark BC/BS
- Protected by Reinsurance for Large Catastrophic Claims
- Meets Affordable Care Act Mandates
Enrollment process
Enrollment is Easy
Collect Claims History
or Individual Health Condition Statements
Determine Plan Parameters
Establish Rates
Submit Employee Applications
Distribute Plan Booklets & Id Cards
FAQs
Questions & Answers
The Health Pool of South Dakota was created to offer local government entities an alternative to traditional health insurance.
The pool is an insuring mechanism which spreads the risk across a large group. Premium dollars are split between BUDGET (expected claims, reinsurance and administration) and RESERVES (for catastrophic claims). The portion of reserves not used to pay claims is traditionally the insurance company’s profit, but in a pool the excess reserves are used to stabilize rates.
A self-funded plan has the look and feel of traditional plans but offers more flexibility in tailoring the benefits to meet the needs of your employees. Any excess dollars received are used by the pool to keep rates stable and enhance benefits.
Claims of less than the reinsurance retention are paid for/shared by the pool. Claims greater than the retention are paid 100% by the reinsurance company.
Yes, we will honor any deductibles and co-insurance that have already been met.
The Health Pool offers two types of prescription drug plans, a co-pay plan and a co-insurance plan. If you choose a $10 Generic; $30 Formulary; $50 Non Formulary co-pay plan the co-pays do not apply to the deductible. If the group wants the prescriptions to go toward the deductible then the group would choose a co-insurance plan and employee pays full price for prescriptions until the deductible is met, at which time co-insurance would apply and would count towards your out-of-pocket maximums.
The pool renews every January 1 and if there is to be any rate action it will happen on the anniversary date.
No, a PPO does not limit you to any doctor or hospital. It simply gives better discounts if you use a network provider. When using the network your copay is 80/20, and out-of-network is 60/40.
Members join for one year at a time. Withdrawal is accomplished by providing a 60-day written notification. Reserves, if any, are returned to the entity one year hence, and the employer is then responsible for ensuing claims.
