14 Va. Admin. Code § 5-70-40

Current through Register Vol. 41, No. 9, December 16, 2024

Section 14VAC5-70-40 - Definitions

For the purposes of this chapter:

"Accelerated benefits" means benefits payable under a life insurance contract;

1. To a policyholder or certificateholder, during the lifetime of the insured, in anticipation of death or upon the occurrence of specified life-threatening or catastrophic conditions as defined by the policy or rider; and

2. Which reduce the death benefit otherwise payable under the life insurance contract; and

3. Which are payable upon the occurrence of a single qualifying event which results in the payment of a benefit amount fixed at the time of acceleration.

"Commission" means the Virginia State Corporation Commission.

"Qualifying event" means one or more of the following:

1. A medical condition which would result in a drastically limited life span as specified in the contract, for example, 24 months or less;

2. A medical condition which has required or requires extraordinary medical intervention, such as, but not limited to, major organ transplant or continuous artificial life support, without which the insured would die;

3. Any condition which usually requires continuous confinement in an eligible institution as defined in the contract if the insured is expected to remain there for the rest of his life;

4. A medical condition which would, in the absence of extensive or extraordinary medical treatment, result in a drastically limited life span. Such conditions may include, but are not limited to, one or more of the following:

a. Coronary artery disease resulting in an acute infarction or requiring surgery;

b. Permanent neurological deficit resulting from cerebral vascular accident;

c. End stage renal failure;

d. Acquired Immune Deficiency Syndrome; or

e. Other medical conditions which the commission shall approve for any particular filing;

5. A condition where a qualified health care provider or court of competent jurisdiction has determined that the insured is no longer able to perform at least two of the following activities of daily living:

a. Bathing;

b. Dressing;

c. Continence;

d. Eating;

e. Toileting; or

f. Transferring;

6. A condition for which a qualified health care provider or court of competent jurisdiction has determined that the insured requires direct supervision by another person during the majority of each day to protect the health and safety of the insured or any other person; or

7. Other qualifying events which the commission shall approve for any particular filing.

14 Va. Admin. Code § 5-70-40

Derived from Regulation 44, Case No. INS920076, § 5, eff. June 1, 1992; amended, Virginia Register Volume 18, Issue 22, eff. July 1, 2002.

Statutory Authority

§§ 12.1-13 and 38.2-223 of the Code of Virginia.