Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 200 - RULES GOVERNING LONG-TERM CARE INSURENCE › Section 14VAC5-200-65 - Unintentional lapse

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Each insurer offering long-term care insurance shall, as a protection against
				unintentional lapse, comply with the following:
1. Notice before lapse or termination. No
				individual long-term care policy or certificate shall be issued until the
				insurer has received from the applicant either a written designation of at
				least one person, in addition to the applicant, who is to receive notice of
				lapse or termination of the policy or certificate for nonpayment of premium, or
				a written waiver dated and signed by the applicant electing not to designate
				additional persons to receive notice. The applicant has the right to designate
				at least one person who is to receive the notice of termination, in addition to
				the insured. Designation shall not constitute acceptance of any liability on
				the third party for services provided to the insured. The form used for the
				written designation must provide space clearly designated for listing at least
				one person. The designation shall include each person's full name and home
				address. In the case of an applicant who elects not to designate an additional
				person, the waiver shall state: "Protection against unintended lapse. I
				understand that I have the right to designate at least one person other than
				myself to receive notice of lapse or termination of this long-term care
				insurance policy for nonpayment of premium. I understand that notice will not
				be given until 30 days after a premium is due and unpaid. I elect NOT to
				designate a person to receive this notice."
The insurer shall notify the insured in writing of the right
				  to change this written designation, no less often than once every two
				  years.
2. When the
				policyholder or certificateholder pays premium for a long-term care insurance
				policy or certificate through a payroll or pension deduction plan, the
				requirements contained in subdivision 1 of this subsection need not be met
				until 60 days after the policyholder or certificateholder is no longer on such
				a payment plan. The application or enrollment form for such policies or
				certificates shall clearly indicate the payment plan selected by the
				applicant.
3. Lapse or termination
				for nonpayment of premium. No individual long-term care policy or certificate
				shall lapse or be terminated for nonpayment of premium unless the insurer, at
				least 30 days before the effective date of the lapse or termination, has given
				notice to the insured and to those persons designated pursuant to subdivision 1
				of this subsection, at the address provided by the insured for purposes of
				receiving notice of lapse or termination. No notice shall be effective unless
				it has been mailed in accordance with one of the following:
a. The notice is sent by certified mail, or
				the insurer obtains a certificate of mailing by the United States Postal
				Service;
b. The notice is sent by a
				commercial delivery service, and the insurer obtains at the time of mailing a
				written receipt from the service showing the date of mailing , the number of
				items mailed , and the name and address of the insured and those persons
				designated pursuant to subdivision 1 of this subsection to whom the notice was
				mailed; or
c. The notice is sent by
				first-class United States mail, and the insurer obtains at the time of mailing
				a written receipt from the United States Postal Service showing the date of
				mailing , the number of items mailed , and the name and address of the insured
				and those persons designated pursuant to subdivision 1 of this subsection to
				whom the notice was mailed.
Notification shall also be provided to the agent of record of
				  the insured, if any, within 72 hours after the notice has been mailed to the
				  insured and those persons designated pursuant to subdivision 1 of this
				  subsection.
There is a presumption that notice is delivered five days
				  after the date of mailing, as evidenced in the written receipt obtained by the
				  insurer pursuant to subdivision 3 a, b, or c of this subsection . The insurer
				  shall retain any and all evidence of mailing the notice, including the list of
				  recipients, as applicable, and a copy of the notice , for at least three years
				  following the date of notice. Notice may not be given until 30 days after a
				  premium is due and unpaid.