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

0 %
Claim charges billed through available networks
1001 +
Insured lives
0 +
Entities are currently members
1920
The year HPSD was started

Providing employee health care since 1995.

Benefit Highlights

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

Why was the health pool created?

The Health Pool of South Dakota was created to offer local government entities an alternative to traditional health insurance.

How does the pool work?

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.

What are the benefits of a self-funded benefit plan?

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.

How does a claim work?

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.

Will our deductibles rollover from our current insurance?

Yes, we will honor any deductibles and co-insurance that have already been met.

Do prescriptions count towards your deductible?

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.

How often can we expect rate increases?

The pool renews every January 1 and if there is to be any rate action it will happen on the anniversary date.

Is a PPO an HMO?

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.

 

How do we withdraw from the pool?

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.

News & Notices