Section 3701.10  Purpose

 

The purpose of this Part is to implement the Viatical Settlements Act of 2009, which, in part, establishes registration requirements for viatical settlement providers and viatical settlement brokers and requires the Director to prescribe reporting requirements for viatical settlement providers and viatical settlement brokers.

 

(Source:  Amended at 39 Ill. Reg. 4975, effective March 23, 2015)

 

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)

 

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)

 

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)

 

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)

 

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)

 

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)

 

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)

 

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)

 

	Viatical Settlement Provider Report	Calendar year
Viatical Settlement Provider'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 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	Secondary market transactions
								pur	sold
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Puerto Rico
U.S Virgin Islands
Canada
TOTALS

 

Name of Preparer:

 

 

Instructions for Viatical Settlement Provider 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 in the secondary market.

 

(Source:  Amended at 39 Ill. Reg. 4975, effective March 23, 2015)

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
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Puerto Rico
U.S Virgin Islands
Canada
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)

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

 

Name of Preparer:

 

 

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)

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

 

Name of Preparer:

 

 

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)

 

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____

 

 

Name of Preparer:

 

 

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)

 

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)

 

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)

 

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.

 

Signature		Printed Named

 

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)