VA Life & Health cheat sheet

Insurable interest must exist at policy application or issue; for life insurance it need not continue until the insured's death for a valid claim.

Typical incontestability and suicide clauses run two years from issue; after that, misrepresentation generally cannot void the policy, but nonpayment can.

The grace period is commonly 30 or 31 days; coverage stays in force if the premium is paid within the grace period.

Nonforfeiture options on permanent policies include cash surrender, reduced paid-up insurance, and extended term insurance.

Dividend options include cash, reduce premium, accumulate at interest, paid-up additions, and one-year term.

Settlement options include lump sum, interest only, fixed period, fixed amount, and life income.

Term insurance provides pure death protection with no cash value; whole, universal, and variable life build cash value.

Variable life and variable universal products are securities; selling them requires both insurance and securities registration.

Death benefits are generally income-tax-free; cash value growth is tax-deferred; MEC distributions can be taxable with a 10% penalty before age 59½.

The deductible is paid by the insured before benefits; coinsurance is the percentage split after the deductible; the out-of-pocket maximum caps covered in-network costs.

HMO plans generally require a primary care physician and referrals; PPO plans allow out-of-network care without referrals; EPOs generally do not cover out-of-network care.

COBRA continuation lasts 18 months for termination or hours reduction, 29 months for disability, and 36 months for death, divorce, or Medicare eligibility.

Medicare Part A covers hospital care; Part B covers medical care; Part C is Medicare Advantage; Part D covers prescription drugs; Medigap supplements Original Medicare.

ACA market plans are guaranteed issue, cannot exclude preexisting conditions, cover essential health benefits, and provide preventive services without cost sharing.

Disability income own-occupation coverage pays when the insured cannot perform their own job; any-occupation coverage is stricter.

Long-term care benefits are triggered by inability to perform two of six activities of daily living or by cognitive impairment.

Health policy provisions include entire contract, free look, grace period, reinstatement, incontestability, claim submission, and legal action limits.

Coordination of benefits determines primary and secondary payers; health benefits are generally tax-free when premiums are paid with after-tax dollars.

Virginia insurance is regulated by the State Corporation Commission's Bureau of Insurance, headed by the Commissioner of Insurance.

Producers must hold a Virginia license for each line sold and be appointed by the insurer before soliciting or selling that insurer's products.

Producer licenses renew biennially; Virginia requires continuing education, including ethics hours, and licensees must report address changes.

Unfair trade practices include misrepresentation, twisting, rebating, unfair discrimination, coercion, false advertising, and unfair claim settlement.

Rebating and sharing commissions with unlicensed persons are prohibited; premiums held for insurers must not be commingled with personal funds.

Replacement rules require a producer to provide a replacement notice and comparison when a new life policy or annuity replaces existing coverage.

Annuity sales require suitability review and best-interest conduct, with enhanced disclosure and review for older consumers.

The Virginia Life and Health Insurance Guaranty Association provides statutory protection to policyholders of insolvent insurers, subject to coverage limits.

Licensees must respond to Bureau inquiries and report administrative actions or criminal prosecutions as required by Virginia law.