S.D. Admin. R. 20:06:21:88

Current through Register Vol. 51, page 67, December 16, 2024

Section 20:06:21:88 - Notice to insured

If an insurer determines that the benefit trigger of a long-term care insurance policy has not been met, the insurer shall provide a clear, written notice to the insured and the insured's authorized representative, if applicable, of all of the following:

(1) The reason that the insurer determined that the insured's benefit trigger has not been met;

(2) The insured's right to internal appeal in accordance with § 20:06:21:89, and the right to submit new or additional information relating to the benefit trigger denial with the appeal request; and

(3) The insured's right, after exhaustion of the insurer's internal appeal process, to have the benefit trigger determination reviewed under the independent review process in accordance with §§ 20:06:21:91 to 20:06:21:100, inclusive.

S.D. Admin. R. 20:06:21:88

36 SDR 209, effective 7/1/2010.

General Authority: SDCL 58-17B-4.

Law Implemented: SDCL 58-17B-4.