Rule 20:06:13:72 Complaints and grievances.
20:06:13:72. Complaints and grievances. A Medicare select
issuer must have and use procedures for hearing complaints and resolving
written grievances from subscribers. Such procedures must be aimed at mutual
agreement for settlement and may include arbitration procedures. Grievance
procedures must meet the following requirements:
(1) The grievance procedure
must be described in the policy and certificate and in the outline of coverage;
(2) At the time the policy
or certificate is issued, the issuer must provide detailed information to the
policyholder describing how a grievance may be registered with the issuer;
(3) The issuer must
consider grievances in a timely manner and transmit them to decision-makers who
have authority to investigate the issue fully and take corrective action;
(4) If a grievance is found
to be valid, the issuer must take corrective action promptly;
(5) The issuer must notify
all concerned parties about the results of a grievance;
(6) The issuer must report
no later than March 31 each year to the director regarding its grievance
procedure in a format provided by the director. The report must contain the
number of grievances filed in the past year and a summary of the subject,
nature, and resolution of the grievances.
22 SDR 107, effective February 18, 1996.
Authority: SDCL 58-17A-2(5), 58-17A-2(12), 58-17A-2, 58-17A-7.
Implemented: SDCL 58-17A-2.
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