<html xmlns="http://www.w3.org/1999/xhtml" lang="en-US"><head><meta charset="UTF-8"><meta http-equiv='content-language' content='en-us'/><title>SDLRC - Codified Law 58-17I-8 - Rights of covered person or authorized representative on review--Access to documentation.</title><meta name="Generator" content="PowerTools for Open XML"><style>span { white-space: pre-wrap; } p.s964347f2c85c40ccb6e9a906ae122777Normal { 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.s964347f2c85c40ccb6e9a906ae122777SENU { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s964347f2c85c40ccb6e9a906ae122777CL { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } p.s964347f2c85c40ccb6e9a906ae122777Normal-000000 { text-indent: 0.50in; 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.s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.s964347f2c85c40ccb6e9a906ae122777Normal-000001 { margin-left: 0.70in; text-indent: -0.45in; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-right: 0; margin-bottom: .001pt; } p.s964347f2c85c40ccb6e9a906ae122777Normal-000002 { margin-left: 1.14in; text-indent: -0.44in; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-right: 0; margin-bottom: .001pt; } p.s964347f2c85c40ccb6e9a906ae122777Normal-000003 { text-indent: 0.25in; 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.s964347f2c85c40ccb6e9a906ae122777000004 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s964347f2c85c40ccb6e9a906ae122777SCL { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s964347f2c85c40ccb6e9a906ae122777SCL-000005 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont-000006 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } body { text-decoration-skip-ink: none; } </style><meta name="viewport" content="width=device-width, initial-scale=1"><meta name="twitter:card" content="summary"><meta property="og:title" content="SD 58-17I-8 - Rights of covered person or authorized representative on review--Access to documentation."><meta property="og:description" content="SDLRC Codified Law 58-17I-8 - Rights of covered person or authorized representative on review--Access to documentation."><meta property="og:type" content="website"><meta property="og:url" content="https://sdlegislature.gov/Statutes/58-17I-8"><meta property="og:image" content="https://lawmakerdocuments.blob.core.usgovcloudapi.net/photos/logoshape.webp"><meta property="og:site_name" content="South Dakota Legislature"></head><body><div><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal"><a href="https://sdlegislature.gov/Statutes?Statute=58-17I-8" rel="noopener"><span class="s964347f2c85c40ccb6e9a906ae122777SENU">58-17I-8</span></a><span xml:space="preserve" class="s964347f2c85c40ccb6e9a906ae122777SENU">. </span><span class="s964347f2c85c40ccb6e9a906ae122777CL">Rights of covered person or authorized representative on review--Access to documentation.</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal-000000"><span class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont">No covered person has the right to attend, or to have a representative in attendance, at the first level review. However, the covered person or, if applicable, the covered person's authorized representative may:</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal-000001"><span class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont">(1)    Submit written comments, documents, records, and other material relating to the request for benefits for the review or reviewers to consider when conducting the review; and</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal-000001"><span class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont">(2)    Receive from the health carrier, upon request and free of charge, reasonable access to, and copies of all documents, records and other information relevant to the covered person's request for benefits. A document, record, or other information shall be considered relevant to a covered person's request for benefits if the document, record, or other information:</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal-000002"><span class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont">(a)    Was relied upon in making the benefit determination;</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal-000002"><span class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont">(b)    Was submitted, considered, or generated in the course of making the adverse determination, without regard to whether the document, record, or other information was relied upon in making the benefit determination;</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal-000002"><span class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont">(c)    Demonstrates that, in making the benefit determination, the health carrier, or its designated representatives consistently applied required administrative procedures and safeguards with respect to the covered person as other similarly situated covered persons; or</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal-000002"><span class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont">(d)    Constitutes a statement of policy or guidance with respect to the health benefit plan concerning the denied health care service or treatment for the covered person's diagnosis, without regard to whether the advice or statement was relied upon in making the benefit determination.</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal-000003"><span class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont">The health carrier shall make the provisions of this section known to the covered person or, if applicable, the covered person's authorized representative within three working days after the date of receipt of the grievance.</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal"><span xml:space="preserve" class="s964347f2c85c40ccb6e9a906ae122777000004"> </span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal"><span class="s964347f2c85c40ccb6e9a906ae122777SCL">Source:</span><span xml:space="preserve" class="s964347f2c85c40ccb6e9a906ae122777SCL-000005"> SL 2011, ch 219, § 80.</span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal"><span xml:space="preserve" class="s964347f2c85c40ccb6e9a906ae122777000004"> </span></p><p dir="ltr" class="s964347f2c85c40ccb6e9a906ae122777Normal"><span xml:space="preserve" class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont-000006">Commission Note: </span><span class="s964347f2c85c40ccb6e9a906ae122777DefaultParagraphFont">SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed."</span></p></div></body></html>