On Mar. 5, SD INS guidance on entity role and compliance issues.
SD INS published Bulletin 25-01 to clarify the authority and licensing needed by Enhanced Direct Enrollment Entities (EDEs) to achieve regulatory compliance.
Bulletin issued in light of federal guidance, insurance complaints, insurer discussions.
Issues Resolved
A third-party administrator license and an insurance producer license are both required for any person to operate as an EDE in the South Dakota health insurance market.
EDEs may not accept ins business from unlicensed persons/entities; defined exception.
Health insurers that pay transaction or service fees, commissions, or other monetary compensation to an EDE must appoint the EDE as being appointed with the insurer.
Does not apply to payments to EDEs providing white label onboarding platform service.
Any person or entity utilizing an EDE to enroll SD consumers must be licensed and appointed with health insurance issuer unless they are a federally certified Navigator.
Effectiveness
All licensees, persons, and entities discussed in the Bulletin have 90 days from the date of the Bulletin (Jun. 3, 2025) to come into compliance with these requirements.
