Section 3701.20 Definitions
"Act" means the
Viatical Settlements Act of 2009 [215 ILCS 159].
"Code means the Illinois
Insurance Code [215 ILCS 5].
"Department" means the
Illinois Department of Insurance.
"Director" means the
Director of the Illinois Department of Insurance.
"Insured" means the
person covered under the policy being considered for viatication.
"Life Expectancy"
means the mean of the number of months the individual insured under the life
insurance policy to be viaticated can be expected to live as determined by the
viatical settlement provider, considering medical records and appropriate
experiential data.
"Net Death Benefit"
means the amount of the life insurance policy or certificate to be viaticated
less any outstanding debts or liens.
"Patient Identifying
Information" means an insured's address, telephone number, facsimile
number, electronic mail address, photograph or likeness, employer, employment
status, social security number, or any other information that is likely to lead
to the identification of the insured.
"SERFF" means the
System for Electronic Rate and Form Filing used for electronic filings of
participating company policy forms and rating information.
"Viatical
settlement broker" means a licensed insurance producer who has been
issued a license pursuant to Section 500-35(a)(1) or 500-35(a)(2) of the
Insurance Code, who, working exclusively
on behalf of a viator and for a fee, commission, or other valuable
consideration, offers, solicits, promotes, or attempts to negotiate viatical
settlement contracts between a viator and one or more viatical settlement
providers or one or more viatical settlement brokers.
"Viatical
settlement broker" does not include an attorney, certified public
accountant, or a financial planner accredited by a nationally recognized
accreditation agency, who is retained to represent the viator and whose
compensation is not paid directly or indirectly by the viatical settlement
provider or purchaser. [215 ILCS 159/5]
"Viatical
settlement contract" means any of the following:
A written
agreement between a viator and a viatical settlement provider establishing the
terms under which compensation or anything of value is or will be paid, which
compensation or value is less than the expected death benefits of the policy,
in return for the viator's present or future assignment, transfer, sale,
devise, or bequest of the death benefit or ownership of any portion of the
insurance policy.
A written
agreement for a loan or other lending transaction, secured primarily by an
individual life insurance policy or an individual certificate of a group life
insurance policy.
The transfer
for compensation or value of ownership of a beneficial interest in a trust or
other entity that owns such policy, if the trust or other entity was formed or
availed of for the principal purpose of acquiring one or more life insurance
contracts and the life insurance contract insures the life of a person residing
in this State.
A premium
finance loan made for a life insurance policy by a lender to a viator on,
before, or after the date of issuance of the policy in either of the following
situations:
The viator
or the insured receives a guarantee of the viatical settlement value of the
policy.
The viator or the insured
agrees to sell the policy or any portion of the policy's death benefit on any
date before or after issuance of the policy.
"Viatical
settlement contract" does not include any of the following acts,
practices, or arrangements listed in this definition, unless part of a plan,
scheme, device, or artifice to avoid application of the Act; provided, however,
that the list of excluded items contained in this definition is not
intended to be an exhaustive list and that an act, practice, or arrangement
that is not described in this definition does not necessarily constitute
a viatical settlement contract:
A policy loan
or accelerated death benefit made by the insurer pursuant to the policy's
terms;
Loan proceeds
that are used solely to pay:
premiums for
the policy; and
the costs of
the loan, including, without limitation, interest, arrangement fees,
utilization fees and similar fees, closing costs, legal fees and expenses,
trustee fees and expenses, and third party collateral provider fees and
expenses, including fees payable to letter of credit issuers;
A loan made
by a bank or other financial institution in which the lender takes an interest
in a life insurance policy solely to secure repayment of a loan or, if there is
a default on the loan and the policy is transferred, the transfer of such a
policy by the lender, provided that neither the default itself nor the transfer
of the policy in connection with the default is pursuant to an agreement or
understanding with any other person for the purpose of evading regulation under
the Act;
A loan made
by a lender that does not violate Article XXXIIa of the Illinois Insurance
Code, provided that the premium finance loan is not described in the Act;
An agreement
in which all the parties are closely related to the insured by blood or law or
have a lawful substantial economic interest in the continued life, health, and
bodily safety of the person insured, or trusts established primarily for the
benefit of such parties;
Any
designation, consent, or agreement by an insured who is an employee of an
employer in connection with the purchase by the employer, or trust established
by the employer, of life insurance on the life of the employee;
A bona fide
business succession planning arrangement:
between one
or more shareholders in a corporation or between a corporation and one or more
of its shareholders or one or more trusts established by its shareholders;
between one
or more partners in a partnership or between a partnership and one or more of
its partners or one or more trusts established by its partners; or
between one
or more members in a limited liability company or between a limited liability
company and one or more of its members or one or more trusts established by its
members;
An agreement
entered into by a service recipient, or a trust established by the service
recipient, and a service provider, or a trust established by the service
provider who performs significant services for the service recipient's trade or
business; or
Any other
contract, transaction, or arrangement exempted from the definition of viatical
settlement contract by the Director based on the Director's determination that
the contract, transaction, or arrangement is not of the type intended to be
regulated by the Act. [215 ILCS
159/5]
"Viatical
settlement provider" means a person, other than a viator, who enters
into or effectuates a viatical settlement contract with a viator.
"Viatical settlement provider" does not include:
a bank,
savings bank, savings and loan association, credit union, or other financial
institution that takes an assignment of a policy as collateral for a loan;
a financial
institution or premium finance company making premium finance loans and
exempted by the Director from the licensing requirement under the premium
finance laws where the institution or company takes an assignment of a life
insurance policy solely as collateral for a premium finance loan;
the issuer of
the life insurance policy;
an authorized
or eligible insurer that provides stop loss coverage or financial guaranty
insurance to a viatical settlement provider, purchaser, financing entity,
special purpose entity, or related provider trust;
An individual
person who enters into or effectuates no more than one viatical settlement
contract in a calendar year for the transfer of policies for any value less
than the expected death benefit;
a financing
entity;
a special
purpose entity;
a related
provider trust;
a viatical
settlement purchaser; or
any other
person that the Director determines is consistent with the definition of
viatical settlement provider. [215 ILCS 159/5]
"Viator"
means the owner of a life insurance policy or a certificate holder under a
group policy who enters or seeks to enter into a viatical settlement contract.
For the purposes of the Act, a viator is not
limited to an owner of a life insurance policy or a certificate holder under a
group policy insuring the life of an individual with a terminal or chronic
illness or condition, except where specifically addressed.
"Viator"
does not include:
a licensee;
a qualified institutional buyer;
a financing entity;
a special purpose entity; or
a related provider trust. [215 ILCS 159/5]
(Source: Amended at 39 Ill. Reg.
4975, effective March 23, 2015)
 |
TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.30 FILING PROCEDURES FOR VIATICAL SETTLEMENT PROVIDERS
Section 3701.30 Filing Procedures for Viatical
Settlement Providers
a) Forms
Review. Each viatical settlement provider shall file with the Director for
approval each new viatical settlement provider form before it is issued or
delivered. Each filing shall be submitted directly through SERFF. The filing
shall include each of the following:
1) A
letter of submission giving a detailed description of the purpose for the
viatical settlement provider forms and the manner in which they will be
marketed;
2) The
viatical settlement provider forms. The text of each viatical settlement
provider form shall reflect the bracketing of any appropriate variable
material. The form number shall appear in the lower left-hand corner of
the policy form to be approved and shall not exceed 30 characters.
b) Filing
Fee. The viatical settlement provider shall pay $50 per form as provided for
in Section 408 of the Code. Billable forms are viatical settlement contracts
and applications.
(Source: Added at 39 Ill. Reg.
4975, effective March 23, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.40 FILING PROCEDURES FOR VIATICAL SETTLEMENT BROKERS
Section 3701.40 Filing Procedures for Viatical
Settlement Brokers
a) Forms
Review. Each viatical settlement broker shall file with the Director for
approval each new viatical settlement broker form before it is issued or
delivered. Each filing shall be submitted directly through SERFF. The filing
shall include each of the following:
1) A
letter of submission giving a detailed description of the purpose for the
viatical settlement broker forms and the manner in which they will be marketed;
2) The
viatical settlement broker forms. The text of each viatical settlement broker
form shall reflect the bracketing of any appropriate variable material. The
form number shall appear in the lower left-hand corner of the policy form to be
approved and shall not exceed 30 characters.
b) Filing
Fee. The viatical settlement broker will pay $50 per form as provided for in
Section 408 of the Code. Billable forms are viatical settlement broker
applications.
(Source: Added at 39 Ill. Reg.
4975, effective March 23, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.50 STANDARDS FOR EVALUATION OF REASONABLE PAYMENTS FOR TERMINALLY OR CHRONICALLY ILL INSUREDS
Section 3701.50 Standards for Evaluation of Reasonable
Payments for Terminally or Chronically Ill Insureds
a) In
order to assure that viators receive a reasonable return for viaticating an
insurance policy, the return for viaticating a policy shall be no less than the
following payouts for insureds who are terminally or chronically ill:
Insured's Life
Expectancy Minimum Percentage of Face
Value Less Outstanding Loans
Received by Viator
25 months or
less [75%]
b) Except when the cash surrender value is paid, the percentage
may be reduced by 5% for viaticating a policy written by an insurer rated less
than the highest 4 categories by A.M. Best, or a comparable rating by another
rating agency.
(Source: Added at
39 Ill. Reg. 4975, effective March 23, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.60 GENERAL RULES
Section 3701.60 General Rules
a) Payment
of the proceeds of a viatical settlement pursuant to Section 45(2)(j) of the
Act shall be by means of wire transfer to an account designated by the viator
or by certified check or cashier's check.
b) Payment
of the proceeds to the viator pursuant to a viatical settlement shall be made
in a lump sum. Retention of a portion of the proceeds not disclosed or
described in the viatical settlement contract by the viatical settlement
provider or escrow agent is not permissible.
c) A
viatical settlement provider or viatical settlement broker shall not pay or
offer to pay any finder's fee, commission or other compensation to any
insured's physician, or to an attorney, accountant or other person providing
medical, legal or financial planning services to the viator, or to any other
person acting as an agent of the viator, other than a viatical settlement
broker, with respect to the viatical settlement.
d) A
viatical settlement provider (or viatical settlement investment agent) shall
not knowingly solicit purchasers who have treated or have been asked to treat
the illness of the viator whose coverage would be the subject of the
investment.
e) If a
viatical settlement provider enters into a viatical settlement contract that
allows the viator to retain an interest in the policy, the viatical settlement
contract shall contain the following provisions:
1) A
provision that the viatical settlement contract will effect the transfer of the
amount of the death benefit to the extent or portion of the amount viaticated.
Benefits in excess of the amount viaticated shall be paid directly to the
viator's beneficiary by the insurance company;
2) A
provision that the viatical settlement provider will, upon acknowledgment of
the perfection of the transfer, either:
A) Advise
the insured, in writing, that the insurance company has confirmed the viator's
interest in the policy; or
B) Send a
copy of the instrument sent from the insurance company to the viatical
settlement provider that acknowledges the viator's interest in the policy; and
3) A
provision that apportions the premiums to be paid by the viatical settlement
provider and the viator, provided that the contract provides premium payment
terms and nonforfeiture options no less favorable, on a proportional basis,
than those included in the policy.
(Source: Added at
39 Ill. Reg. 4975, effective March 23, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.70 PROHIBITED PRACTICES
Section 3701.70 Prohibited
Practices
a) A viatical settlement provider, viatical settlement broker (or
viatical settlement investment agent) shall obtain from a person that is
provided with patient identifying information a signed affirmation that the
person or entity will not further divulge the information without procuring the
express, written consent of the insured for the disclosure. Notwithstanding the
foregoing, if a viatical settlement provider, viatical settlement broker (or
viatical settlement investment agent) is served with a subpoena and, therefore,
compelled to produce records containing patient identifying information, it
shall notify the viator and the insured in writing at their last known
addresses within 5 business days after receiving notice of the subpoena.
b) A viatical settlement provider shall not act also as a
viatical settlement broker, whether entitled to collect a fee directly or
indirectly, in the same viatical settlement.
c) A viatical settlement broker shall not, without the written
agreement of the viator obtained prior to performing any services in connection
with a viatical settlement, seek or obtain any compensation from the viator.
(Source: Added at
39 Ill. Reg. 4975, effective March 23, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.80 INSURANCE COMPANY PRACTICES
Section 3701.80 Insurance
Company Practices
a) Life insurance companies authorized to do business in this
State shall respond to a request for verification of coverage from a viatical
settlement provider or a viatical settlement broker within 30 calendar days
after the date a request is received, subject to the following conditions:
1) A current authorization consistent with applicable law, signed
by the policy owner or certificate holder, accompanies the request; and
2) In the case of an individual policy or group insurance
coverage in which details with respect to the certificate holder's coverage are
maintained by the insurer, submission of a form substantially similar to
Exhibit H that has been completed by the viatical settlement provider or the
viatical settlement broker in accordance with the instructions on the form.
b) Nothing in this Section shall prohibit a life insurance
company and a viatical settlement provider or a viatical settlement broker from
using another verification of coverage form that has been mutually agreed upon
in writing in advance of submission of the request.
c) A life insurance company may not charge a fee for responding
to a request for information from a viatical settlement provider or viatical
settlement broker in compliance with this Section in excess of any usual and
customary charges to contract holders, certificate holders or insureds for
similar services.
d) The life insurance company may send an acknowledgment of
receipt of the request for verification of coverage to the policy owner or
certificate holder and, when the policy owner or certificate owner is other
than the insured, to the insured. The acknowledgment may contain a general
description of any accelerated death benefit that is available under a provision
of or rider to the life insurance contract.
e) A life insurance company shall not require the viator or
insured to sign any request for change in a policy or a group certificate from
a viatical settlement provider that is the owner or assignee of the insured's
insurance coverage, unless the viator or insured has ownership, assignment or
irrevocable beneficiary rights under the policy. In such a situation, the
viatical settlement provider shall provide timely notice to the insured that a
settlement transaction on the policy has occurred. Timely notice shall be
provided within 15 calendar days after the change in a policy or group
certification.
(Source: Amended
at 39 Ill. Reg. 16161, effective December 3, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.100 REPORTING REQUIREMENTS
Section 3701.100 Reporting Requirements
a) On or
before March 1 of each year, viatical settlement providers must file the
following reports listed as Exhibits to this Part:
1) Viatical
Settlement Provider Report − All States and Territories (Form VSP-001)
(Exhibit A);
2) Viatical
Settlement Provider Report − Illinois Transactions Only (Form VSP-002)
(Exhibit C);
3) Individual
Mortality Report − Illinois Transactions Only (Form VSP-003) (Exhibit E);
and
4) Viatical
Settlement Provider Certification (Form VSP-004) (Exhibit F).
b) All
filings required pursuant to subsection (a) are to be submitted to the
Corporate Regulation Section of the Department.
c) On or before March 1 of each year, viatical
settlement brokers must file the following reports listed as Exhibits to this Part:
1) Viatical Settlement Broker Report −
All States and Territories (Form
VSB-001) (Exhibit B);
2) Viatical Settlement Broker Report −
Illinois Transactions Only (Form
VSB-002) (Exhibit D); and
3) Viatical Settlement Broker Certification
(Form VSB-004) (Exhibit G).
d) All
filings required pursuant to subsection (c) are to be submitted to the Producer
Licensing Section of the Department.
e) The
information required to be reported under this Section shall not include
individual transaction data regarding the business of viatical settlements or
data that compromises the privacy of personal, financial, and health
information of the viator or insured.
(Source: Amended at 39 Ill. Reg.
4975, effective March 23, 2015)
Section 3701.EXHIBIT A Viatical Settlement Provider Report and Instructions – All States and Territories (Form VSP-001)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.EXHIBIT A VIATICAL SETTLEMENT PROVIDER REPORT AND INSTRUCTIONS ALL STATES AND TERRITORIES (FORM VSP-001)
Section 3701.EXHIBIT A Viatical Settlement Provider
Report and Instructions – All States and Territories (Form VSP-001)
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Viatical
Settlement Provider Report
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Calendar year
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Viatical Settlement Provider's Name
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All
States and Territories
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20____
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1
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2
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3
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4
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5
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6
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7
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8
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States
|
Are you doing
business in this state? (Y/N)
|
Total number of
policies reviewed for consideration
|
Total number of
policies where an offer was made
|
Total number of
policies where an offer was not made
|
Total number of
policies purchased
|
Aggregate total
net death benefit
|
Aggregate
amount paid to viators
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Secondary
market transactions
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pur
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sold
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Alabama
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Alaska
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Arizona
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Arkansas
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California
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Colorado
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Connecticut
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Delaware
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Dist.
of Columbia
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Florida
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Georgia
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Hawaii
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Idaho
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Illinois
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Indiana
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Iowa
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Kansas
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Kentucky
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Louisiana
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Maine
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Maryland
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Massachusetts
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Michigan
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Minnesota
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Mississippi
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Missouri
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Montana
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Nebraska
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Nevada
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New
Hampshire
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New
Jersey
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New
Mexico
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New
York
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North
Carolina
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North
Dakota
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Ohio
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Oklahoma
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Oregon
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Pennsylvania
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Rhode
Island
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South
Carolina
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South
Dakota
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Tennessee
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Texas
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Utah
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Vermont
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Virginia
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Washington
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West
Virginia
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Wisconsin
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Wyoming
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American
Samoa
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Guam
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Puerto
Rico
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U.S
Virgin Islands
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Canada
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TOTALS
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Instructions
for Viatical Settlement Provider Report – All States and Territories
|
COLUMN
|
|
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1
|
By a "Y" for yes or
an "N" for no, indicate if you have or have not done business in
the state during the calendar year being reported.
|
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2
|
For each state or territory in
which you have done business during the calendar year being reported,
indicate the total number of policies reviewed for consideration.
|
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3
|
For each state or territory in
which you have done business during the calendar year being reported,
indicate the total number of policies for which an offer was made.
|
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4
|
For each state or territory in
which you have done business during the calendar year being reported,
indicate the total number of policies for which an offer was refused.
|
|
5
|
For each state or territory in
which you have done business during the calendar year being reported, indicate
the total number of policies purchased.
|
|
6
|
For each state or territory in
which you have done business during the calendar year being reported, list the
total aggregate net death benefit of the policies viaticated.
|
|
7
|
For each state or territory in
which you have done business during the calendar year being reported, list the
total aggregate amount paid to viators.
|
|
8
|
For each state or territory in
which you have done business during the calendar year being reported, list the
total number of policies purchased and/or sold in the secondary market.
|
(Source: Amended
at 39 Ill. Reg. 4975, effective March 23, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.EXHIBIT B VIATICAL SETTLEMENT BROKER REPORT AND INSTRUCTIONS - ALL STATES AND TERRITORIES (FORM VSB-001)
Section 3701.EXHIBIT B Viatical Settlement Broker Report and Instructions
− All States and Territories (Form VSB-001)
|
|
Viatical
Settlement Broker Report
|
Calendar year
|
|
Viatical Settlement Broker's Name
|
All
States and Territories
|
20____
|
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
|
States
|
Are you doing
business in this state? (Y/N)
|
Total number of
policies reviewed for consideration
|
Total number of
policies represented for viatication
|
Total number of
policies where representation was refused
|
Total number of
policies sold to provider
|
Aggregate net
death benefit viaticated
|
Aggregate net
amount paid to viators
|
Number of
policies purchased/sold on the secondary market
|
|
Alabama
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Alaska
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Arizona
|
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Arkansas
|
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California
|
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Colorado
|
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Connecticut
|
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Delaware
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Dist.
of Columbia
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Florida
|
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Georgia
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Hawaii
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Idaho
|
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Illinois
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Indiana
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Iowa
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Kansas
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Kentucky
|
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Louisiana
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Maine
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Maryland
|
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Massachusetts
|
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Michigan
|
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Minnesota
|
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Mississippi
|
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Missouri
|
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Montana
|
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Nebraska
|
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Nevada
|
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New
Hampshire
|
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New
Jersey
|
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New
Mexico
|
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|
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New
York
|
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North
Carolina
|
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North
Dakota
|
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Ohio
|
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Oklahoma
|
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Oregon
|
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Pennsylvania
|
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Rhode
Island
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South
Carolina
|
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South
Dakota
|
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Tennessee
|
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Texas
|
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Utah
|
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Vermont
|
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Virginia
|
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Washington
|
|
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|
West
Virginia
|
|
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Wisconsin
|
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Wyoming
|
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American
Samoa
|
|
|
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|
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Guam
|
|
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|
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Puerto
Rico
|
|
|
|
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|
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U.S
Virgin Islands
|
|
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Canada
|
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|
TOTALS
|
|
|
|
|
|
|
|
|
Instructions
for Viatical Settlement Broker Report –
All
States and Territories
|
COLUMN
|
|
|
1
|
By a
"Y" for yes or an "N" for no, indicate if you have or
have not done business in the state during the calendar year being reported.
|
|
2
|
For each state
or territory in which you have done business during the calendar year being
reported, indicate the total number of policies reviewed for consideration.
|
|
3
|
For each state
or territory in which you have done business during the calendar year being reported,
indicate the total number of policies for which an offer was made.
|
|
4
|
For each state
or territory in which you have done business during the calendar year being
reported, indicate the total number of policies for which an offer was
refused.
|
|
5
|
For each state
or territory in which you have done business during the calendar year being
reported, indicate the total number of policies purchased.
|
|
6
|
For each state
or territory in which you have done business during the calendar year being reported,
list the total aggregate net death benefit of the policies viaticated.
|
|
7
|
For each state
or territory in which you have done business during the calendar year being
reported, list the total aggregate amount paid to viators.
|
|
8
|
For each state
or territory in which you have done business during the calendar year being
reported, list the total number of policies purchased and/or sold on the
secondary market.
|
(Source: Amended at 39 Ill.
Reg. 16161, effective December 3, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.EXHIBIT C VIATICAL SETTLEMENT PROVIDER REPORT AND INSTRUCTIONS ILLINOIS TRANSACTIONS ONLY (FORM VSP-002)
Section 3701.EXHIBIT C Viatical Settlement Provider
Report and Instructions – Illinois Transactions Only (Form VSP-002)
|
|
Viatical
Settlement Provider Report
|
Calendar year
|
|
Viatical Settlement Provider's Name
|
Illinois Transactions Only
|
20____
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
|
Viatical settlement
provider settlement number
|
Contract date
purchased
|
Total net death
benefit ($)
|
Age of insured at time
of contract
|
Life expectancy at
time of contract
|
Net amount paid to
viator ($)
|
Policy type:
I or G
|
Funding:
F, P, I, T or RPT
|
Source of policy:
B, D, SM,
P or O
|
Commission
amount ($)
|
Name of source of
policy
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
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|
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
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|
|
|
|
|
|
|
|
|
|
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|
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|
|
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
|
|
|
Instructions
for Viatical Settlement Provider Report − Illinois Transactions Only
|
Column
|
|
|
1
|
List
the settlement number, case number or unique identifying number used to
identify the specific viatical settlement transaction.
|
|
2
|
List
the date the viatical settlement contract was purchased by the provider
during the current calendar year, whether or not the insured is still alive
at the end of the calendar year.
|
|
3
|
List
the net amount (in dollars) being viaticated.
|
|
4
|
List
the age (in years) of the person insured by the policy being viaticated, at
the time of the viatical settlement contract.
|
|
5
|
List
the life expectancy (in months) of the insured individual at the time of the
viatical settlement contract.
|
|
6
|
List
the net amount (in dollars) paid to the viator.
|
|
7
|
Identify
whether the policy was an individual policy (I) or a group policy (G).
|
|
8
|
List
the type of funding for the transaction: "F" for a licensed
financial institution (policies collateralized), "P" for private
(purchaser) funding, "I" for internal funding, "T" for
trust, and "RPT" for related provider trust.
|
|
9
|
Indicate
the purchase source of the policy. Use "B" for viatical settlement
broker, "D" for direct from the viator, "I" for insurance
agent/producer, "SM" for a secondary market or viatical settlement
provider, "P" for private (purchaser) funding or "O" for
other.
|
|
10
|
List
the amount of commissions (in dollars) paid to viator source involved in the
transaction whether that be a viatical settlement broker, an insurance
producer or other licensed entity authorized to be viator source.
|
|
11
|
List
the name of the source of the viatical settlement transaction. If it is a
broker, producer or other licensee, name that person; if it is direct, from a
relative, from the corporation of the insured or any other entity that could
possibly reveal the insured, designate by writing "Direct",
"Relative", "Corporation", or other nondesignating word.
|
(Source:
Former EXHIBIT B renumbered to EXHIBIT C and amended at 39 Ill. Reg. 4975,
effective March 23, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.EXHIBIT D VIATICAL SETTLEMENT BROKER REPORT AND INSTRUCTIONS ILLINOIS TRANSACTIONS ONLY (FORM VSB-002)
Section 3701.EXHIBIT
D Viatical Settlement Broker Report and Instructions – Illinois
Transactions Only (Form VSB-002)
|
|
Viatical
Settlement Broker Report
|
Calendar year
|
|
Viatical Settlement Broker's Name
|
Illinois
Transactions Only
|
20____
|
|
1
|
2
|
3
|
4
|
5
|
6
|
|
Viatical settlement provider's settlement number
|
Contract date sold
to viatical settlement provider
|
Total
net death benefit ($)
|
Net
amount paid to viator ($)
|
Commission amount
($)
|
Viatical Settlement provider's name
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Instructions for Viatical Settlement Broker Report –
Illinois Transactions Only
|
Column
|
|
|
1
|
List the settlement number, case number or unique
identifying number used by the Viatical Settlement Provider (VSP) to identify
the specific viatical settlement transaction.
|
|
2
|
List the date the viatical settlement contract was sold to
the VSP.
|
|
3
|
List the total net death benefit.
|
|
4
|
List the net amount (in dollars) paid to the viator.
|
|
5
|
List the amount of commissions (in dollars) paid to all
viatical settlement brokers involved in the transaction.
|
|
6
|
List the name of the VSP involved in the viatical
settlement.
|
(Source: Former EXHIBIT D
renumbered to EXHIBIT F; new EXHIBIT D added at 39 Ill. Reg. 4975, effective
March 23, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.EXHIBIT E INDIVIDUAL MORTALITY REPORT AND INSTRUCTIONS ILLINOIS TRANSACTIONS ONLY (FORM VSP-003)
Section 3701.EXHIBIT E Individual Mortality Report and
Instructions – Illinois Transactions Only (Form VSP-003)
|
|
Individual
Mortality Report
|
Calendar year
|
|
Viatical Settlement Provider's Name
|
Illinois
Transactions Only
|
20____
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
|
Viatical
settlement provider's settlement number
|
Contract date
|
Age of insured at
time of contract
|
Life expectancy
at time of contract
|
Net amount paid
to viator
|
Date of death
|
Total premiums
paid to maintain policy
|
Death benefit
collected
|
Number of months
between date of contract and date of death
|
Number of months between life
expectancy at contract date and date of death (+ / -)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Instructions for Individual
Mortality Report − Illinois Transactions Only
|
Column
|
|
|
1
|
List
the settlement number, case number, or unique identifying number used to
identify the specific viatical settlement transaction.
|
|
2
|
List
the date of the viatical settlement contract.
|
|
3
|
List
the age of the insured at the time of the contract.
|
|
4
|
List
the life expectancy (in months) of the insured individual at the time of the
viatical settlement contract. For first to die policies, use the shortest
life expectancy of the two lives. For second to die policies, use the longest
life expectancy of the two lives.
|
|
5
|
List
the "Net" amount paid to the viator.
|
|
6
|
Indicate
the insured's date of death. For first to die policies, use the date of the
first insured's death. For second to die policies, use the date of the last
insured's death.
|
|
7
|
List
the total amount of premiums (in dollars) required to be paid to the insurer
to maintain the policy from the date of viatication to the date of death.
|
|
8
|
List
the total death benefit collected from the insurer.
|
|
9
|
List
the number of months between the date of contract and the insured's date of
death.
|
|
10
|
List
the number of months between the life expectancy of the insured at the time
of contract and the insured's date of death. This should be noted as a plus
(+) figure if the insured died after the estimated life expectancy or a minus
(-) if the insured died prior to the estimated life expectancy.
|
(Source: Former EXHIBIT C
renumbered to EXHIBIT E and amended at 39 Ill. Reg. 4975, effective March 23,
2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.EXHIBIT F VIATICAL SETTLEMENT PROVIDER CERTIFICATION (FORM VSP-004)
Section 3701.EXHIBIT F Viatical Settlement Provider
Certification (Form VSP-004)
|
Viatical Settlement Provider
Certification
|
|
|
|
This section should be completed
by viatical settlement providers.
|
|
|
|
Please
check all forms submitted:
|
|
|
|
¨
|
Viatical
Settlement Provider Reporting Form – All States and Territories
|
|
|
|
¨
|
Viatical
Settlement Provider Reporting Form – Illinois Transactions Only
|
|
|
|
¨
|
Individual
Mortality Report – Illinois Transactions Only
|
|
|
|
I
hereby certify that the information contained in the reports indicated above
is true and accurate. I acknowledge that providing false and misleading
information in the reports, or failing to divulge a fact material thereto, is
sufficient grounds for administrative action by the Director and,
potentially, applicable criminal penalties.
|
|
|
|
|
|
Date:
|
/ /
|
|
Signature of
individual that prepared reports
|
|
|
|
|
Print or type
name
|
|
Date:
|
/ /
|
|
Signature of
Authorized Representative
|
|
|
|
|
Print or type
name
|
|
|
|
|
|
|
(Source: Former EXHIBIT D
renumbered to EXHIBIT F and amended at 39 Ill. Reg. 4975, effective March 23,
2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.EXHIBIT G VIATICAL SETTLEMENT BROKER CERTIFICATION (FORM VSB-004)
Section 3701.EXHIBIT G Viatical Settlement Broker
Certification (Form VSB-004)
|
Viatical Settlement Broker
Certification
|
|
|
|
This section should be completed
by viatical settlement brokers.
|
|
|
|
Please
check all forms submitted:
|
|
|
|
¨
|
Viatical
Settlement Broker Reporting Form – All States and Territories
|
|
|
|
¨
|
Viatical
Settlement Broker Reporting Form – Illinois Transactions Only
|
|
|
|
I hereby certify that
the information contained in the reports indicated above is true and
accurate. I acknowledge that providing false and misleading information in
the reports, or failing to divulge a fact material thereto, is sufficient
grounds for administrative action by the Director and, potentially,
applicable criminal penalties.
|
|
|
|
|
|
Date:
|
/ /
|
|
Signature of
individual that prepared reports
|
|
|
|
|
Print or type
name
|
|
Date:
|
/ /
|
|
Signature of
Authorized Representative
|
|
|
|
|
Print or type
name
|
|
|
|
|
|
|
|
|
|
|
(Source: Added at 39 Ill.
Reg. 4975, effective March 23, 2015)
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER oo: VIATICAL SETTLEMENTS
PART 3701
VIATICAL SETTLEMENT PROVIDER AND BROKER REQUIREMENTS
SECTION 3701.EXHIBIT H VERIFICATION OF COVERAGE FOR LIFE INSURANCE POLICIES
Section 3701.EXHIBIT H Verification of Coverage for
Life Insurance Policies
VERIFICATION OF
COVERAGE FOR LIFE INSURANCE POLICIES
|
SUBMITTED TO:
|
|
NAIC #
|
|
|
|
Name of Insurance
Company
|
|
|
|
|
|
POLICY NUMBER:
|
|
|
|
|
SUBMITTED FROM:
|
|
|
|
Name of Viatical Settlement
Broker/Provider
|
|
|
|
ADDRESS:
|
|
|
|
|
TELEPHONE NUMBER:
|
|
|
|
|
|
CONTACT:
|
|
TITLE:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
IF INFORMATION IS CORRECT, INSURER REPRESENTATIVE MAY PLACE
A CHECKMARK IN THE BOX. OTHERWISE, PROVIDE CORRECTED INFORMATION THROUGHOUT THIS
FORM. AN ASTERISK INDICATES INFORMATION THE VIATICAL SETTLEMENT
PROVIDER/BROKER MUST PROVIDE.
POLICY OWNER'S AND
INSURED'S INFORMATION
|
|
This column to be completed by Viatical Settlement Broker/Provider
|
This column to be used by Insurance Company
|
|
Owner's name
|
*
|
|
|
Address
|
*
|
|
|
City, state, ZIP code
|
*
|
|
|
Tax ID or social security
number
|
*
|
|
|
Insured's name
|
*
|
|
|
Insured's date of birth
|
*
|
|
|
Second insured's name (if
applicable)
|
*
|
|
|
Second insured's date of
birth (if applicable)
|
*
|
|
I hereby consent by my signature
below to release of information requested by this form by the insurance company
to the viatical settlement broker/provider.
|
|
|
|
|
Signature of policy
owner
|
|
Date signed
|
|
|
|
|
Form VOC
Page 1 of 4
|
IS THE POLICY IN FORCE?
|
|
YES
|
|
NO
|
IF NO, SIGN AND DATE ON PAGE 4 AND RETURN TO THE VIATICAL
SETTLEMENT BROKER OR PROVIDER THAT SUBMITTED THE VERIFICATION OF COVERAGE.
|
*
|
|
TERM
|
|
WHOLE LIFE
|
|
UNIVERSAL LIFE
|
|
VARIABLE LIFE
|
If a question is not applicable to the type of policy, write
N/A in the column.
|
|
This
column to be completed by Viatical Settlement Broker/Provider
|
This
column to be used by Insurance Company
|
|
Original issue date
|
*
|
|
|
Maturity date of policy
|
|
|
|
State of issue
|
*
|
|
|
Does the policy have an
irrevocable beneficiary?
|
*
|
|
|
Is the policy currently
assigned?
|
*
|
|
|
Was the policy ever
converted or reinstated?
|
|
|
|
Is the policy in the
contestability period?
|
*
|
|
|
Is the policy in the
suicide period?
|
*
|
|
|
Please list all riders and
indicate if any are in the contestable or suicide period.
|
*
|
|
Page 2 of 4
POLICY VALUES
|
|
This column to be completed by Viatical Settlement
Broker/Provider
|
This column to be used by Insurance Company
|
|
Policy values as of (insert
date)
|
|
|
|
Current face amount of
policy
|
*
|
|
|
Amount of accumulated
dividends
|
|
|
|
Current face amount of
riders
|
|
|
|
Amount of any outstanding loans
|
*
|
|
|
Amount of outstanding
interest on policy loans
|
|
|
|
Current net death benefit
|
*
|
|
|
Current account value
|
*
|
|
|
Current cash surrender
value
|
*
|
|
|
Is policy participating?
|
*
|
|
|
If yes, what is the current
dividend option?
|
|
|
PREMIUM INFORMATION
|
|
This column to be completed by Viatical Settlement
Broker/Provider
|
This column to be used by Insurance Company
|
|
Current payment mode
|
*
|
|
|
Current modal premium
|
*
|
|
|
Date last premium paid
|
*
|
|
|
Date next premium due
|
*
|
|
|
Current monthly cost of
insurance as of (insert date)
|
|
|
|
Date of last cost of
insurance deduction
|
|
|
TO BE COMPLETED BY
VIATICAL SETTLEMENT BROKER/PROVIDER
The information submitted for verification by the viatical
settlement broker/provider is correct and accurate to the best of my knowledge
and has been obtained through the policy owner and/or insured.
Page 3 of 4
|
TO BE COMPLETED BY INSURANCE COMPANY
|
|
|
|
The information provided by
verification by the insurance company is correct and accurate to the best
|
|
of my knowledge as of
|
(date)
|
.
|
|
|
|
Insurance
company:
|
|
NAIC #
|
|
|
|
|
|
Printed
name:
|
|
Title:
|
|
|
|
|
|
Telephone
number:
|
|
Fax number:
|
|
|
|
|
|
Signature:
|
|
|
|
|
|
Please provide
information about where the forms listed below should be submitted for
processing.
|
|
|
|
Name:
|
|
Title:
|
|
|
|
|
|
Company
name:
|
|
|
|
|
|
Mailing
address:
|
|
|
|
|
|
City,
state, Zip:
|
|
|
|
|
|
Overnight
address:
|
|
|
|
|
|
City,
state, Zip:
|
|
|
|
|
|
Telephone number:
|
|
Fax number:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
FORMS REQUEST
Please provide the forms checked below:
○ Absolute
Assignment/Change of Ownership/Viatical Assignment
○ Change of Beneficiary
○ Release of Irrevocable Beneficiary
(if applicable)
○ Waiver of Premium Claim
Form
○ Disability Waiver of
Premium Approval Letter
○ Release of Assignment
○ Change of Death Benefit
Option Form (if UL)
○ Allocation Change Form
(if Variable)
○ Annual Report
○ Current In Force Illustration
Page 4 of 4
(Source: Added at 39 Ill. Reg. 16161,
effective December 3, 2015)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|