<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal { 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.sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-000000 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-000001 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sccc8ed39-2b6f-4186-8b77-9fa47b694898000002 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-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="sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont">    </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:105"><span style="white-space: pre-wrap;" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-000000">20:06:21:105</span></a><span style="white-space: pre-wrap;" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-000001">.  Payment of a clean claim.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont"> Within 30 business days after receipt of a claim for benefits under a long-term care insurance policy or certificate, an insurer shall pay such claim if it is a clean claim, or send a written notice acknowledging the date of receipt of the claim and one of the following:</span></p><p dir="ltr" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898000002"> </span></p><p dir="ltr" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont">    (1)  The insurer is declining to pay all or part of the claim and each specific reason for the denial; or</span></p><p dir="ltr" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont">    (2)  That additional information is necessary to determine if all or any part of the claim is payable and the specific additional information that is necessary.</span></p><p dir="ltr" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898000002"> </span></p><p dir="ltr" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont">    </span><span style="white-space: pre-wrap;" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont"> 36 SDR 209, effective July 1, 2010.</span></p><p dir="ltr" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont">    </span><span style="white-space: pre-wrap;" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span style="white-space: pre-wrap;" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-000003">58-17B-4</span></a><span style="white-space: pre-wrap;" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont">.</span></p><p dir="ltr" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont">    </span><span style="white-space: pre-wrap;" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span style="white-space: pre-wrap;" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont-000003">58-17B-4</span></a><span style="white-space: pre-wrap;" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898DefaultParagraphFont">.</span></p><p dir="ltr" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898Normal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sccc8ed39-2b6f-4186-8b77-9fa47b694898000002"> </span></p></div></body></html>