S.D. Admin. R. 20:06:53:76

Current through Register Vol. 50, page 159, June 17, 2024

Section 20:06:53:76 - Record keeping

Each health insurance issuer offering individual health insurance coverage shall maintain records of all claims and notices associated with its internal claims and appeals processes. The records must be maintained for at least six years. An issuer must make such records available to the director for examination upon request. Any request for a first level review of a grievance involving an adverse benefit determination and any request for a voluntary review of a grievance involving an adverse benefit determination must be included in the health carrier's grievance register, which must be maintained in a reasonably clear and accessible manner and must contain, at a minimum, the following:

(1) A general description of the reason for the grievance;

(2) The date received;

(3) The date of each review or, if applicable, review meeting;

(4) Resolution at each level of the grievance, if applicable;

(5) Date of resolution at each level, if applicable; and

(6) Name of the covered person for whom the grievance was filed.

S.D. Admin. R. 20:06:53:76

37 SDR 63, effective 9/23/2010; 37 SDR 111, effective 12/7/2010.

General Authority: SDCL 58-17-87.

Law Implemented: SDCL 58-17-87.