South Dakota moves to bar insurers from penalizing living organ donors

South Dakota has barred insurers from discriminating against living organ donors across life, disability, and long-term care policies.

That is the upshot of House Bill 1101, signed into law on March 9, 2026, during the state's 101st Legislative Session, which prohibits insurers from declining or limiting coverage solely on the basis that the applicant or policyholder is a living organ donor. The law further prohibits insurers from discriminating in the offering, issuance, cancellation, amount of coverage, price, or any other policy condition based solely on donor status – provided there is no additional actuarial risk involved. It also stops insurers from conditioning the continuation of an existing policy on an insured individual not becoming a living organ donor in the future.

The legislation is direct in what it prohibits. Under the new law, an insurer may not discriminate in the offering, issuance, cancellation, amount of coverage, price, or any other condition of a life, disability, or long-term care policy – based solely, and without any additional actuarial risk, on a person's status as a living organ donor. That language is broad, touching on the insurance relationship from the application stage through to the ongoing conditions under which a policy is maintained.

Three specific prohibitions sit at the heart of the law. The first prevents an insurer from declining or limiting coverage solely because of a person's donor status. The second stops an insurer from conditioning the continuation of a policy on an insured not becoming a living organ donor. The third prohibits any form of discrimination in the offering, issuance, cancellation, amount of coverage, price, or any other policy condition – where the discrimination is based solely on the individual's status as a living organ donor and there is no additional actuarial risk involved.

The actuarial carve-out is worth noting carefully. The law does not strip insurers of their ability to underwrite based on risk – it simply requires that any risk-based differentiation be tied to something beyond donor status alone. An insurer that can substantiate a genuine actuarial basis for adjusting terms retains the ability to do so. What it cannot do is use donor status as a standalone disqualifier, absent any supporting actuarial justification.

The legislation defines a living organ donor as anyone who has donated all or part of an organ and is not deceased. The law covers only life, disability, and long-term care products sold in the state. The new section is added to chapter 58-1 of South Dakota's codified laws.

For insurers writing those lines of business in South Dakota, any underwriting criteria that treats organ donor status as a disqualifying factor - without an actuarial basis to support it - will warrant a review in light of the new requirements.

The law passed with overwhelming bipartisan support, clearing the Senate 33-0 and the House 64-1. It was backed by 21 lawmakers across both chambers. Senate sponsors include Sen. Sydney Davis, Sen. Kevin Jensen, Sen. Liz Larson, Sen. Michael Rohl, Sen. Glen Vilhauer, and Sen. Brandon Wipf. House sponsors include Rep. Nicole Uhre-Balk, Rep. Bobbi Andera, Rep. Jessica Bahmuller, Rep. Heather Baxter, Rep. Eric Emery, Rep. Josephine Garcia, Rep. Timothy Goodwin, Rep. Erin Healy, Rep. Mellissa Heermann, Rep. Erik Muckey, Rep. Peri Pourier, Rep. Kathy Rice, Rep. Matt Roby, Rep. William Shorma, and Rep. Kadyn Wittman.