<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s1570834a-5386-4774-94cd-76d407bc5dfaNormal { text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000000 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000001 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s1570834a-5386-4774-94cd-76d407bc5dfa000002 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000003 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">    </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:88"><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000000">20:06:21:88</span></a><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000001">.  Notice to insured.</span><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont"> 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:</span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfa000002"> </span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">    (1)  The reason that the insurer determined that the insured's benefit trigger has not been met;</span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfa000002"> </span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">    (2)  The insured's right to internal appeal in accordance with § </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:89"><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000003">20:06:21:89</span></a><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">, and the right to submit new or additional information relating to the benefit trigger denial with the appeal request; and</span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfa000002"> </span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">    (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 §§ </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:91"><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000003">20:06:21:91</span></a><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont"> to </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:100"><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000003">20:06:21:100</span></a><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">, inclusive.</span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfa000002"> </span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">    </span><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000001">Source:</span><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont"> 36 SDR 209, effective July 1, 2010.</span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">    </span><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000001">General Authority:</span><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000003">58-17B-4</span></a><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">.</span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">    </span><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000001">Law Implemented:</span><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont-000003">58-17B-4</span></a><span class="s1570834a-5386-4774-94cd-76d407bc5dfaDefaultParagraphFont">.</span></p><p dir="ltr" class="s1570834a-5386-4774-94cd-76d407bc5dfaNormal"><span xml:space="preserve" class="s1570834a-5386-4774-94cd-76d407bc5dfa000002"> </span></p></div></body></html>