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Rule 20:06:21:73 Providers in a different state.

          20:06:21:73.  Providers in a different state. No long-term care issuer may deny a claim because services are provided in a state other than the state of policy issue if the following conditions are met:

 

          (1)  If the state other than the state of policy issue does not have the provider licensing, certification, or registration required in the policy, but the provider satisfies the policy requirements outlined for providers in lieu of licensure, certification, or registration; or

 

          (2)  If the state other than the state of policy issue licenses, certifies, or registers the provider under another classification.

 

          For purposes of this section, "state of policy issue" means the state in which the individual policy or certificate was originally issued.

 

          Source: 33 SDR 230, effective July 2, 2007.

          General Authority: SDCL 58-17B-4.

          Law Implemented: SDCL 58-17B-4.

 


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