Compliance Documents

The South Dakota Employee Benefits Program is required to provide the following notifications to members.

Form 1095-C

• 1095-C FAQ

Affordable Care Act (ACA)

• ACA Eligible Employee FAQ
• Health Insurance Marketplace Exchange Notice

Privacy

• Benefits Program Authorization for Use and Disclosure of Health Information Form
• Notice of Privacy Practices

Wellness Program

• Well-Being Program Notice

Health Insurance Notices

• FY21 Summary of Material Modifications
• Children's Health Insurance Program (CHIP)
• Women's Health and Cancer Rights Act Notice
• Special Enrollment Notice
• General COBRA Notice
• Medicare Part D Notice of Creditable Coverage