<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.sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal { 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.sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-000000 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-000001 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sf259e0af-f7c3-4c12-88dd-4adf5c540948000002 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-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="sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal"><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont">    </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:98"><span class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-000000">20:06:21:98</span></a><span class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-000001">.  Process if determination overturned.</span><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont"> If the insurer overturns its benefit trigger determination:</span></p><p dir="ltr" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal"><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948000002"> </span></p><p dir="ltr" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal"><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont">    (1)  The insurer shall provide notice to the independent review organization and the insured and the insured's authorized representative, if applicable, and the director of its decision; and</span></p><p dir="ltr" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal"><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont">    (2)  The independent review process shall immediately cease.</span></p><p dir="ltr" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal"><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948000002"> </span></p><p dir="ltr" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal"><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont">    </span><span class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-000001">Source:</span><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont"> 36 SDR 209, effective July 1, 2010.</span></p><p dir="ltr" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal"><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont">    </span><span class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-000001">General Authority:</span><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-000003">58-17B-4</span></a><span class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont">.</span></p><p dir="ltr" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal"><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont">    </span><span class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-000001">Law Implemented:</span><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont-000003">58-17B-4</span></a><span class="sf259e0af-f7c3-4c12-88dd-4adf5c540948DefaultParagraphFont">.</span></p><p dir="ltr" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948Normal"><span xml:space="preserve" class="sf259e0af-f7c3-4c12-88dd-4adf5c540948000002"> </span></p></div></body></html>