46:30:08:05Application.

The applicant shall submit a completed and signed application on a form provided by the division and shall include the following information: (1) Documentation from the applicant's implant surgeon that one or two cochlear implants is medically recommended; (2) Documentation of a progressive hearing loss which led to deafness, if applicable; (3) A written quote of the provider's usual and customary charge for services listed in § 46:30:08:03; and (4) Proof of creditable coverage as defined in SDCL 58-18-44, if any. The division shall reject an application that fails to provide the required information.

Source: 32 SDR 32, effective August 29, 2005; 34 SDR 179, effective December 24, 2007; 37 SDR 111, effective December 7, 2010.