Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 200 - RULES GOVERNING LONG-TERM CARE INSURENCE › Section 14VAC5-200-200 - Standard format outline of coverage

Current through Register Vol. 40, No. 24, July 15, 2024
This section of the chapter implements, interprets and makes
				  specific, the provisions of § 38.2-5207 of the Code of Virginia in
				  prescribing a standard format and the content of an outline of coverage.
1. The outline of coverage shall be a
				freestanding document in at least 10-point type.
2. The outline of coverage shall contain no
				material of an advertising nature.
3. Text which is capitalized or underscored
				in the standard format for outline of coverage may be emphasized by other means
				which provide prominence equivalent to such capitalization or
				underscoring.
4. The text and
				sequence of text of the standard format for outline of coverage is mandatory,
				unless otherwise specifically indicated.
5. Format for outline of coverage:
[COMPANY NAME]
[ADDRESS-CITY AND STATE]
[TELEPHONE NUMBER]
LONG-TERM CARE INSURANCE OUTLINE OF COVERAGE
[Policy Number or Group Master Policy and Certificate
				  Number]
[Except for policies or certificates which are guaranteed
				  issue, the following caution statement, or language substantially similar, must
				  appear as follows in the outline of coverage.]
Caution: The issuance of this long-term care insurance
				  [policy] [certificate] is based upon your responses to the questions on your
				  application. A copy of your [application] [enrollment form] [is enclosed] [was
				  retained by you when you applied.] If your answers are incorrect or untrue, the
				  company has the right to deny benefits or rescind your policy. The best time to
				  clear up any questions is now, before a claim arises. If, for any reason, any
				  of your answers are incorrect, contact the company at this address: [insert
				  address]
1. This policy is [an
				individual policy of insurance] ([a group policy] which was issued in the
				[indicate jurisdiction in which the group policy was issued]).
2. PURPOSE OF OUTLINE OF COVERAGE. This
				outline of coverage provides a very brief description of the important features
				of the policy. You should compare this outline of coverage to outlines of
				coverage for other policies available to you. This is not an insurance
				contract, but only a summary of coverage. Only the individual or group policy
				contains governing contractual provisions. This means that the policy or group
				policy sets forth in detail the rights and obligations of both you and the
				insurance company. Therefore, if you purchase this coverage, or any other
				coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE)
				CAREFULLY!
3. FEDERAL TAX
				CONSEQUENCES.
This [POLICY] [CERTIFICATE] is a federally tax-qualified
				  long-term care insurance contract under § 7702B(b) of the Internal Revenue
				  Code of 1986.
OR
Federal Tax Implications of this [POLICY] [CERTIFICATE]. This
				  [POLICY] [CERTIFICATE] is not intended to be a federally tax-qualified
				  long-term care insurance contract under § 7702B(b) of the Internal Revenue
				  Code of 1986. Benefits received under the [POLICY] [CERTIFICATE] may be taxable
				  as income.
4. TERMS UNDER WHICH THE
				POLICY OR CERTIFICATE MAY BE CONTINUED IN FORCE OR DISCONTINUED.
a. [For long-term care health insurance
				policies or certificates describe one of the following permissible policy
				renewability provisions:]
1. [Policies and
				certificates that are guaranteed renewable shall contain the following
				statement:] RENEWABILITY: THIS [POLICY] [CERTIFICATE] IS GUARANTEED RENEWABLE.
				This means you have the right, subject to the terms of your [policy]
				[certificate], to continue this policy as long as you pay your premiums on
				time. [Company name] cannot change any of the terms of your policy on its own,
				except that, in the future, IT MAY INCREASE THE PREMIUM YOU PAY.
2. [Policies and certificates that are
				noncancellable shall contain the following statement:] RENEWABILITY: THIS
				[POLICY] [CERTIFICATE] IS NONCANCELLABLE. This means that you have the right,
				subject to the terms of your policy, to continue this policy as long as you pay
				your premiums on time. [Company name] cannot change any of the terms of your
				policy on its own and cannot change the premium you currently pay. However, if
				your policy contains an inflation protection feature where you choose to
				increase your benefits, [Company name] may increase your premium at that time
				for those additional benefits.