South Dakota Administrative Rules
Title 55 - Bureau Of Human Resources
Article 55:08 - State employee benefits
Chapter 55:08:06 - Claims review procedure
Section 55:08:06:03 - Appeal procedure

An eligible employee or any other person whose claim has been denied and desires to appeal the adverse determination of the benefits manager may request an external review by filing a request for external review with an independent review organization through the Department of Labor and Regulation, Division of Insurance under ARSD 20:06:53 within four months after receipt of notice of an adverse determination.

An independent review organizations external review decision is binding on the South Dakota State Employee Health Plan except to the extent the South Dakota State Employee Health Plan has other remedies available under applicable state law. An independent review organizations external review decision is binding on the eligible employee or any other person except to the extent the eligible employee or any other person has other remedies available under applicable federal or state law.

General Authority: SDCL 3-6E-13(9).

Law Implemented: SDCL 3-6E-1, 45 C.F.R. § 147.136.