Vol. 32 Iss. 10 - January 11, 2016

Chapter 200

REGISTRAR'S NOTICE: Forms used in administering the following regulation have been filed by the State Corporation Commission. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, General Assembly Building, 2nd Floor, Richmond, Virginia 23219.

Title of Regulation: 14VAC5-200. Rules Governing Long-Term Care Insurance.

Agency Contact: Robert Grissom, Chief Insurance Market Examiner, Market Regulation, Bureau of Insurance, State Corporation Commission, P.O. Box 1157, Richmond, VA 23218, telephone (804) 371-9152, FAX (804) 371-9944, or email

FORMS (14VAC5-200)

Rescission Reporting Form, Form A (eff. 2/02)

Long-Term Care Insurance Personal Worksheet, Form B (rev. 4/15)

Things You Should Know Before You Buy Long-Term Care Insurance, Form (rev. 9/07)

Long-Term Care Insurance Suitability Letter, Form D (rev. 2/02)

Claims Denial Reporting Form, Form E (rev. 4/15)

Potential Rate Increase Disclosure Form, Form F (rev. 9/07)

Potential Rate Increase Disclosure Form, Form F (rev. 12/2015)

Replacement and Lapse Reporting Form, Form G (eff. 9/07)

Partnership Program Notice, Form 200-A (eff. 9/07)

Partnership Disclosure Notice, Form 200-B (eff. 9/07)

Long-Term Care Partnership Certification Form, Form 200-C (rev. 4/15)

VA.R. Doc. No. R16-4599; Filed December 11, 2015, 12:05 p.m.