South Dakota Risk Pool
Capitol Building
500 East Capitol Avenue
Pierre, SD 57501-5070
605.773.3148
605.773.6840 fax

Email Us

Forms and Documents

Forms

• Risk Pool Online Application or  Printer Friendly Version
• Automatic Bank Draft (ACH)Online Form or  Printer Friendly Version
• Medical Claim Form
• Prescription Drug Claim Form
• Privacy Authorization Release Form
• Health Assessment

Documents

• Plan Document- effective July 1,  2012 through June 30, 2013
• Premium Rates -effective July 1, 2012 through June 30, 2013
• Premium Rates-effective July 1, 2013 through June 30, 2014
• South Dakota Codified Laws ( Statutes )
• Administrative Rules
• Legislative Reports
• Prescription Drug 2013 SDRP Preauthorization List
• Prescription Maintenaince List
• Formulary List
• Prescription Drug -Non Covered