1. (a) A life insurance company 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 days after the date the request is received, if the following are submitted with the request:

   1. (1) in the case of an individual policy, a form substantially similar to Appendix A of this section, completed by the viatical settlement provider or the viatical settlement broker in accordance with the instructions on the form;
   2. (2) in the case of group insurance coverage, a form substantially similar to Appendix B of this section, first completed by the group certificate holder to the extent the information is available to the group certificate holder, and then completed by the viatical settlement provider or viatical settlement broker in accordance with the instructions on the form.
2. (b) Nothing in this section prohibits a life insurance company and either 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 the submission of the request.
3. (c) For responding to a request for information from a viatical settlement provider or viatical settlement broker in compliance with this section, a life insurance company may not charge a fee in excess of any usual and customary charges to contract holders, group certificate holders, or insureds for similar services.
4. (d) The life insurance company may send an acknowledgment of receipt of the request for verification of coverage to the policyholder or group certificate holder and, if the policyholder or group certificate holder is other than the insured, to the insured. In the acknowledgment, the life insurance company may include a general description of any accelerated death benefit that is available under a provision of or rider to the life insurance contract.
5. (e) If a viatical settlement provider submits to the insurance company a request to effectuate the transfer of a life insurance policy and includes a copy of a certification signed by a viator or insured that meets at least one of the conditions of 3 AAC 31.395(g), the insurance company shall effectuate the transfer of the life insurance policy in a timely manner. APPENDIX AVERIFICATION OF COVERAGEFOR INDIVIDUAL POLICIES Section One: (To be completed by the Viatical Settlement Provider or Viatical Settlement Broker)Insurance Company: _________ Name of Policyowner: _________ Policy Number: _________ Owner's Social Security Number: _________ Name of Insured: _________ Policyowner's Address: _________ StreetInsured's date of birth: _________ _________ City/StatePlease provide the information requested in Section Two (below) with regard to the policy identified above and in accordance with the attached authorization. In addition, please provide the forms checked below which are avail- able from your company to complete a viatical settlement transaction: * Absolute Assignment/Change of Ownership/Viatical Assignment Form* Change of Beneficiary* Release of Irrevocable Beneficiary (if applicable)* Waiver of Premium Claim Form* Disability Waiver of Premium Approval Letter _______________ _________ DateSignature of a representative of Viatical Settlement Broker or Viatical Settlement Provider _________ _________ _________ Full name and address of Viatical Settle- ment Broker or Viatical Settlement Provider _________ Section Two: (To be completed by the life insurance company)1) Fact amount of policy: $ _______________ 2) Original date of issue: _______________ / _______________ / _______________ (Month/Date/Year)3) Was face amount increased after original issue date? * no * yesa) If yes, when: _______________ / _______________ / _______________ 4)Type of policy: _______________ (Term/Whole Life/Universal Life/Variable Life)5)Is policy participating? * no * yes If yes, what is current dividend election? _______________ 6)Current net death benefit: _______________ (Enter full amount payable, including any additional insurance, and/or dividends accumulated at interest, minus policy loans, out- standing interest on policy loans and/or accelerated death benefits paid)7)a) Current cash value: $ _______________ (Enter full amount, including cash value of any additional insurance and/or dividends accumulated at interest, minus policy loans and outstanding interest on policy loans)b) Current surrender value: $ _________ 8)Terms of policy loans: _________ a) Amount of policy loans: $ _________ b) Amount of outstanding interest on policy loan: $ _________ c) Current interest rate: _________ 9)Has policy lapsed? * no * yes If yes, when did policy lapse? _______________ / _______________ / _______________ If policy has lapsed, is coverage continued under non- forfeiture option? * no * yes If yes, indicate which option, amount of coverage, duration, etc.: _________ _________ 10)Is policy in force? * no * yes If yes, has the policy been reinstated within the last two years? * no * yes If yes, date of reinstatement: _______________ / _______________ / _______________ 11)Amount of contract/scheduled premiums: $ _________ 12)Current premium mode: _______________ (Monthly, semi-annually, etc.)When is next premium due? _______________ / _______________ / _______________ (Month/Day/Year)13)Does the policy include a disability premium waiver provision/rider? * no * yesa) If yes, are premiums currently being waived? * no * yesb) If yes, since when? _______________ / _______________ / _______________ c) How often is continued eligibility reviewed? _________ d) When is next review? _______________ / _______________ / _______________ 14)Can payment of all or part of the death benefit be accelerated under this policy? * no * yesa) If yes, by what method is the benefit calculated, the lien method or the discount method? _________ b) If lien method, what is the interest rate? _________ c) Can any remaining death benefit be assigned? * no * yes15)Has a claim for accelerated death benefit been submitted? * no * yesIf yes, was payment made under this provision? * no * yes Amount paid: _______________ Date paid: _______________ 16)Do current records show any assignments of record? * no * yes17)Do current records show any outstanding liens or encum- brances of record? * no * yes18)Please identify current primary beneficiaries: _________ Are they named irrevocably, or is owner otherwise limited in designation of new beneficiaries? * no * yes19)Have any riders been added to this policy after issue? * no * yesIf yes, please identify: _________ 20)If an ownership or beneficiary change or assignment were to be made on this policy, to whom would the completed forms be sent? Name: Title: Company Name: Department: Address (No P.O. Box please): City: ST: ZIP: Telephone No.: Fax: The answers provided reflect information contained in the company's records as of: _________ (date) Signature: Name (Printed): Title: Company: Direct Telephone No.: Direct FAX No.: APPENDIX BVERIFICATION OF GROUP LIFE INSURANCE BENEFITS Section One: (To be completed by the viatical settlement provider or viatical settlement broker) Insurance Company Name of Employee/Member Employer/Policy Name Insured's Date of Birth Policy Number Insured's Social Security Number Certificate Number Employee/Membership Number Please provide the information requested in Section Two or Section Three, as appropriate, with regard to the individual and coverage described, in accordance with the attached authorization. In addition, please provide the forms checked below which are available from your company to complete a viatical settlement transaction:* Absolute Assignment* Change of beneficiary (irrevocable if applicable)* Disability Waiver of premium claim or* Disability Waiver of premium award letter _______________ _________ DateSignature of a representative of Viatical Settlement Broker or Viatical Settlement Provider _________ _________ _________ Full name and address of Via- tical Settlement Broker or Via- tical Settlement Provider _________ Section Two: (To be completed by the employer/group policyholder and the insurer. Both should indicate the parts they completed.) 1)BASIC COVERAGE:a)Is the plan self-insured or is coverage provided under a group policy issued by a life insurance company? _________ If by a group policy, please provide the name of the insurance company for BASIC life insurance coverage _________ b)Effective date of BASIC life insurance coverage: _________ c)Face amount of BASIC life insurance: _________ d)Does BASIC coverage plan have contestable provisions? * no * yese)Is BASIC coverage subject to a suicide provision? * no * yesf)Monthly premium paid by employer/group policyholder for BASIC life insurance: $ _______________ g)Monthly premium paid by employee/insured for BASIC life insurance: $ _______________ h)Is BASIC life insurance coverage * Term * Universal Life?i) If Universal Life, please indicate each value, if any: _______________ ii) Is this amount payable in addition to the face amount? * no * yesi)Is coverage in force? * no * yesj)When is the next premium due? _______________ / _______________ / _______________ k)Have employee's coverage under the plan ever been reinstated? * no * yes If yes, date of reinstatement: _______________ / _______________ / _______________ 2)SUPPLEMENTAL (OPTIONAL) COVERAGEa)Insurance Company for SUPPLEMENTAL life insurance coverage: _______________ b)Effective date of SUPPLEMENTAL life insurance coverage: _______________ / _______________ / _______________ c)Face amount of SUPPLEMENTAL life insurance: _______________ d)Does SUPPLEMENTAL coverage plan have contestable provisions? * no _______________ * yese)Is SUPPLEMENTAL coverage subject to a suicide provision? * no * yesf)Monthly premium paid by employee/group policyholder for supplemental life insurance: $ _______________ g)Monthly premium paid by employee/insured for SUPPLE- MENTAL life insurance: $ _______________ h)Is SUPPLEMENTAL life insurance * Term * Universal Life?i) If Universal Life, please indicate cash value, if any: _______________ ii) Is this amount payable in addition to the face amount? * no * yesi)Is coverage in force? * no * yes j)When is the next premium due? _______________ / _______________ / _______________ k)Has employee's coverage under this policy been reinstated within the last two years? * no * yes If yes, date of reinstatement: _______________ / _______________ / _______________ 3)DISABILITY WAIVER OF PREMIUMa)Does plan provide for waiver of premium in the event of em- ployee/injured's disability?BASIC * no * yes What is the waiting period? _______________ SUPPLEMENTAL * no * yes What is the waiting period? _______________ b)Are premiums currently being waived under disability premium waiver?BASIC * no * yesSUPPLEMENTAL * no * yesc)Who pays premiums under disability premium waiver?BASIC * Insurance carrier * EmployerSUPPLEMENTAL * Insurance carrier * Employerd)What was the date of approval? _______________ / _______________ / _______________ e)Next review date? _______________ / _______________ / _______________ f)If the insured is no longer eligible for waiver, what amount of coverage can be converted to an individual policy? $ _______________ i) Will a new suicide/contestability clause be in effect for the converted policy? * no * yes ii) Will assignee be notified if insured is no longer eligible for waiver? * no * yes4)BENEFICIARIES, ASSIGNMENTS AND LIMITATIONSa)Who are the primary beneficiaries of the coverage(s)?BASIC _________ SUPPLEMENTAL _________ b)Is any beneficiary under this policy designated irrevocably, or is insured otherwise limited in designation of new benefi- ciaries? * no * yesc)Can this coverage be assigned?BASIC * no * yesIf yes, to a corporation? * no * yesTo someone not related to insured? * no * yesSUPPLEMENTAL * no * yesIf yes, to a corporation? * no * yesTo someone not related to insured? * no * yesd)Do records show any assignments of record? * no * yese)Do records show any outstanding liens or encumbrances of record? * no * yesf)The following parties (as applicable) should indicate whether they will provide notice to the assignee if the master policy is terminated.Group policyholder * no * yesThird party administrator (if any) * no * yesInsurance company * no * yesg)Can Assignee convert the coverage without the permission of insured? * no * yes5)ACCELERATED DEATH BENEFITSa)Is there an Accelerated Death Benefit available under the coverage?BASIC * no * yesSUPPLEMENTAL * no * yesb)Has request for Accelerated Death Benefit been made? * no * yesc)Has payment been made to insured under this provision? * no * yes i) Amount Paid: _______________ Date Paid: _______________ / _______________ / _______________ ii) Is this amount a lien against death proceeds? * no * yes Interest rate _______________ iii) Can the remaining death benefit be assigned? * no * 6)MISCELLANEOUSa)Is coverage portable?BASIC * no * yesSUPPLEMENTAL * no * yesb)If insured is no longer eligible for coverage under the group, will Assignee be notified? * no * yesIf master policy discontinues, what amount can be converted to an individual policy? $ _______________ Is this plan administered by a third party? * no * yesIf yes, please provide the name, address and telephone number of administrator. Name: Title: Company name: Department: Street Address: (No P.O. Box please) City: State: Zip: Telephone number: ( ) Fax: ( ) If a change of beneficiary form or assignment were to be made for this coverage, to whom should the completed forms be sent? Name: Title: Company name: Department: Street Address: (No P.O. Box please) City: State: Zip: Telephone number: ( ) Fax: ( ) The answers provided reflect information contained in the company's records as of: _________ (date)Signature: Name: Date: Title: Company: Direct telephone number: ( ) Direct fax number: ( ) Information not provided by the employer may be obtained from the insurance company if different from administrator identified above:Name: Title: Company name: Department: Address: (No P.O. Box please) City: State: Zip: Telephone number: ( ) Fax: ( ) Section Three: Under the terms of 3 AAC 31.400, the insurance company or the third party administrator named above is requested to complete the information not provided by the employer in Section Two, above, Item numbers: _________ The answers provided to the identified questions reflect information in the files of the insurance company as of _______________ (date) The answers provided reflect information contained in the company's records as of: (date) Signature: Name: Date: Title: Company: Direct telephone number: ( ) Direct fax number: ( )

(Eff. 8/25/2002, Register 163)