<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.s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal { 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.s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000000 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000001 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s15973c43-5f3d-4c30-aaae-bdce0c04a572000002 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-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="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">    </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:92"><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000000">20:06:21:92</span></a><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000001">.  Independent review process.</span><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont"> Within five business days of receiving a written request for independent review, the insurer shall refer the request to the independent review organization that the insured or the insured's authorized representative has chosen from the list of organizations the insurer has provided to the insured. If the insured or the insured's authorized representative does not choose an approved independent review organization to perform the review, the insurer shall choose an independent review organization approved or certified by the director. The insurer shall vary its selection of authorized independent review organizations on a rotating basis.</span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572000002"> </span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">    The insurer shall refer the request for independent review of a benefit trigger determination to an independent review organization, subject to the following:</span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572000002"> </span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">    (1)  The independent review organization shall be on a list of certified or approved independent review organizations that satisfy the requirements of a qualified long-term care insurance independent review organization contained in §§ </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:87"><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000003">20:06:21:87</span></a><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont"> to </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:104"><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000003">20:06:21:104</span></a><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">, inclusive;</span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572000002"> </span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">    (2)  The independent review organization may not have any conflicts of interest with the insured, the insured's authorized representative, if applicable, or the insurer; and</span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572000002"> </span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">    (3)  Such review shall be limited to the information or documentation provided to and considered by the insurer in making its determination, including any information or documentation considered as part of the internal appeal process.</span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572000002"> </span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">    </span><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000001">Source:</span><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont"> 36 SDR 209, effective July 1, 2010.</span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">    </span><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000001">General Authority:</span><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000003">58-17B-4</span></a><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">.</span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">    </span><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000001">Law Implemented:</span><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont-000003">58-17B-4</span></a><span class="s15973c43-5f3d-4c30-aaae-bdce0c04a572DefaultParagraphFont">.</span></p><p dir="ltr" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572Normal"><span xml:space="preserve" class="s15973c43-5f3d-4c30-aaae-bdce0c04a572000002"> </span></p></div></body></html>