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:

1. (1) The reason that the insurer determined that the insured's benefit trigger has not been met;
2. (2) The insured's right to internal appeal in accordance with § 20:06:21:89, and the right to submit new or additional information relating to the benefit trigger denial with the appeal request; and
3. (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 §§ 20:06:21:91 to 20:06:21:100, inclusive.

Source: 36 SDR 209, effective July 1, 2010.

General Authority: SDCL 58-17B-4 .

Law Implemented: SDCL 58-17B-4 .