South Dakota State Medical Holding Company, operating under the name DAKOTACARE, is a statewide HMO plan. Product offerings include comprehensive group and individual medical plans, flexible spending and COBRA plans, Medicare Advantage coverage, and dental, life, and disability policies. All hospitals and nearly all physicians in South Dakota contract with the firm. In addition to serving some 100,000 customers in its home state, third-party administration (TPA) subsidiary DAKOTACARE Administrative Services is active in over a dozen neighboring states. Founded in 1986, DAKOTACARE is the managed care affiliate of the South Dakota State Medical Association.