Virginia Code 38.2-5207: Disclosure
In order to provide for fair disclosure in the sale of long-term care insurance policies:
Terms Used In Virginia Code 38.2-5207
- Applicant: means in the case of an individual long-term care insurance policy, the person who seeks to contract for such benefits, or in the case of a group long-term care insurance policy, the proposed certificateholder. See Virginia Code 38.2-5200
- Certificate: means any certificate or evidence of coverage issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this Commonwealth. See Virginia Code 38.2-5200
- Commission: means the State Corporation Commission. See Virginia Code 38.2-100
- Contract: A legal written agreement that becomes binding when signed.
- federally tax-qualified long-term care insurance contract: means an individual or group insurance policy or contract that meets the requirements of § 7702B (b) of the Internal Revenue Code of 1986, as amended. See Virginia Code 38.2-5200
- Insurer: means an insurance company. See Virginia Code 38.2-100
- Long-term care insurance: means any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than twelve consecutive months for each covered person on an expense incurred, indemnity, prepaid, or other basis, for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, personal care, mental health or substance abuse services, provided in a setting other than an acute care unit of a hospital. See Virginia Code 38.2-5200
- Policy: means any individual or group policy of insurance, contract, subscriber agreement, certificate, rider or endorsement delivered or issued for delivery in this Commonwealth by an insurer, fraternal benefit society, health services plan, health maintenance organization or any similar organization. See Virginia Code 38.2-5200
1. An outline of coverage shall be delivered to an applicant for an individual long-term care insurance policy at the time of application for an individual policy. In the case of direct response solicitation, the insurer shall deliver the outline of coverage upon the applicant’s request, but regardless of request shall make such delivery no later than at the time of policy delivery. The Commission shall prescribe a standard format, including style, arrangement, and overall appearance, and the content of an outline of coverage. In the case of agent solicitations, an agent shall deliver the outline of coverage prior to the presentation of an application or enrollment form. In the case of direct response solicitations, the outline of coverage shall be presented in conjunction with any application or enrollment form.
Such outline of coverage shall include:
a. A description of the principal benefits and coverage provided in the policy;
b. A statement of the exclusions, reductions and limitations contained in the policy;
c. A statement of the renewal provisions, including any reservation in the policy of a right to change premiums. Continuation or conversion provisions of group coverage shall be specifically described;
d. A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions;
e. A description of the terms under which the policy may be returned and premium refunded; and
f. A brief description of the relationship of cost of care and benefits.
2. A certificate delivered or issued for delivery in this Commonwealth shall include:
a. A description of the principal benefits and coverage provided in the policy;
b. A statement of the exclusions, reductions and limitations contained in the policy; and
c. A statement that the group master policy should be consulted to determine governing contractual provisions.
3. The Commission shall adopt and publish a Long-Term Care Insurance Consumer Guide. After adoption and publication by the Commission, a copy of the Consumer Guide shall be provided at the time of delivery of the policy or certificate.
4. No long-term care insurance policy or certificate shall be marketed as a qualified long-term care insurance policy or federally tax-qualified long-term care insurance contract unless the policy or contract contains a statement prominently disclosing that such policy or certificate is a qualified long-term care insurance policy or federally tax-qualified long-term care insurance contract.
1987, c. 586; 1990, c. 285; 2000, c. 559.