                                 CODE OF VIRGINIA

REQUIRED ACCIDENT AND SICKNESS POLICY PROVISIONS (§ 38.2-3503)

A. Except as provided in § 38.2-3505, each individual accident and sickness
insurance policy delivered or issued for delivery in this Commonwealth shall
contain the provisions specified in this section using the same words which
appear in this section. Provisions 1 through 12 shall apply to all such
policies. In addition, provision 13 shall apply to all such policies that are
delivered, issued for delivery, renewed, or extended in this Commonwealth on or
after January 1, 2001. An insurer may substitute corresponding provisions of
different wording approved by the Commission that are in each instance not less
favorable in any respect to the insured or the beneficiary. These provisions
shall be preceded individually by the caption &#8220;REQUIRED PROVISIONS&#8221;
or by such appropriate individual or group captions or subcaptions as the
Commission may approve.

   1. Provision 1:
   				ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the
   attached papers, if any, constitutes the entire contract of insurance. No
   change in this policy shall be valid until approved by an executive officer of
   the Company and unless such approval is endorsed hereon or attached hereto. No
   agent has authority to change this policy or to waive any of its provisions.

   2. Provision 2:
   				TIME LIMIT ON CERTAIN DEFENSES: (a) Misstatements in the application:
   After two years from the date of this policy, only fraudulent misstatements in
   the application may be used to void the policy or deny any claim for loss
   incurred or disability (as defined in the policy) that starts after the
   two-year period.
   				Provision 2 shall not be construed to affect any legal requirement for
   avoidance of a policy or denial of a claim during such initial two-year
   period, nor to limit the application of subdivisions 1, 2, 3, 4, and 5 of §
   38.2-3504 in the event of misstatement with respect to age, occupation or
   other insurance.
   				Instead of Provision 2, a policy which the insured has the right to
   continue in force subject to its terms by the timely payment of premium (i)
   until at least age 50 or, (ii) for a policy issued after age 44, for at least
   five years from its date of issue, may contain the following provision, from
   which the clause in parentheses may be omitted at the insurer&#8217;s option:
   				INCONTESTABLE:

      a. Misstatements in the application: After this policy has been in force for
      two years during the Insured&#8217;s lifetime (excluding any period during
      which the Insured is disabled), the Company cannot contest the statements in
      the application.
      					PREEXISTING CONDITIONS:

      b. No claim for loss incurred or disability (as defined in the policy) that
      starts after one year from the date of issue of this policy will be reduced
      or denied because a sickness or physical condition, not excluded by name or
      specific description before the date of loss, had existed before the
      effective date of coverage.

   3. Provision 3:
   				GRACE PERIOD: This policy has a __________ day grace period. This means
   that if a renewal premium is not paid on or before the date it is due, it may
   be paid during the following __________ days. During the grace period the
   policy shall continue in force.
   				In Provision 3 a number not less than &#8220;7&#8243; for weekly premium
   policies, &#8220;10&#8243; for monthly premium policies and &#8220;31&#8243;
   for all other policies shall be inserted between the words &#8220;a&#8221; and
   &#8220;day,&#8221; and between &#8220;following&#8221; and &#8220;days.&#8221;
   However, if provisions of federal law require a policy to have a grace period
   in excess of one month, the period of time that the policy shall continue in
   force during the grace period shall not be required to exceed one month from
   the beginning of the grace period.
   				A policy that contains a cancellation provision may add, at the end of
   Provision 3: &#8220;subject to the right of the Company to cancel in
   accordance with the cancellation provision.&#8221;
   				A policy in which the insurer reserves the right to refuse any renewal
   shall have, in Provision 3, the following sentence:
   				The grace period will not apply if, at least __________ days before the
   premium due date, the Company has delivered or has mailed to the
   Insured&#8217;s last address shown in the Company&#8217;s records written
   notice of the Company&#8217;s intent not to renew this policy.
   				In the above sentence a number not less than &#8220;7&#8243; for weekly
   premium policies, &#8220;10&#8243; for monthly premium policies and
   &#8220;31&#8243; for all other policies shall be inserted between the words
   &#8220;least&#8221; and &#8220;days.&#8221;

   4. Provision 4:
   				REINSTATEMENT: If the renewal premium is not paid before the grace period
   ends, the policy will lapse. Later acceptance of the premium by the Company or
   by an agent authorized to accept payment, without requiring an application for
   reinstatement, will reinstate the policy. If the Company or its agent requires
   an application for reinstatement, the Insured will be given a conditional
   receipt for the premium. If the application is approved the policy will be
   reinstated as of the approval date. Lacking such approval, the policy will be
   reinstated on the forty-fifth day after the date of the conditional receipt
   unless the Company has previously written the Insured of its disapproval. The
   reinstated policy will cover only loss that results from an injury sustained
   after the date of reinstatement and sickness that starts more than 10 days
   after such date. In all other respects the rights of the Insured and the
   Company will remain the same, subject to any provisions noted or attached to
   the reinstated policy. Any premiums the Company accepts for a reinstatement
   will be applied to a period for which premiums have not been paid. No premiums
   will be applied to any period more than 60 days prior to the date of
   reinstatement.
   				The last sentence of Provision 4 may be omitted from any policy that the
   Insured has the right to continue in force subject to its terms by the timely
   payment of premiums (i) until at least age 50, or (ii) for a policy issued
   after age 44, for at least five years from its effective date.

   5. Provision 5:
   				NOTICE OF CLAIM: Written notice of claim must be given within 20 days
   after a covered loss starts or as soon as reasonably possible. The notice can
   be given to the Company at ____________________ (insert the location of such
   office as the insurer may designate for the purpose), or to the
   Company&#8217;s agent. Notice should include the name of the Insured, and
   Claimant if other than the Insured, and the policy number.
   				Optional paragraph: If the Insured has a disability for which benefits may
   be payable for at least two years, at least once in every six months after the
   Insured has given notice of claim, the Insured must give the Company notice
   that the disability has continued. The Insured need not do this if legally
   incapacitated. The first six months after any filing of proof by the Insured
   or any payment or denial of a claim by the Company will not be counted in
   applying this provision. If the Insured delays in giving this notice, the
   Insured&#8217;s right to any benefits for the six months before the date the
   Insured gives notice will not be impaired.

   6. Provision 6:
   				CLAIM FORMS: When the Company receives the notice of claim, it will send
   the Claimant forms for filing proof of loss. If these forms are not given to
   the Claimant within 15 days after the giving of such notice, the Claimant
   shall meet the proof of loss requirements by giving the Company a written
   statement of the nature and extent of the loss within the time limit stated in
   the Proofs of Loss Section.

   7. Provision 7:
   				PROOFS OF LOSS: If the policy provides for periodic payment for a
   continuing loss, written proof of loss must be given the Company within 90
   days after the end of each period for which the Company is liable. For any
   other loss, written proof must be given within 90 days after such loss. If it
   was not reasonably possible to give written proof in the time required, the
   Company shall not reduce or deny the claim for this reason if the proof is
   filed as soon as reasonably possible. In any event, except in the absence of
   legal capacity, the proof required must be given no later than one year from
   the time specified.

   8. Provision 8:
   				TIME OF PAYMENT OF CLAIMS: After receiving written proof of loss, the
   Company will pay __________ (Insert period for payment which must not be less
   frequently than monthly) all benefits then due for ___________________ (Insert
   type of loss). Benefits for any other loss covered by this policy will be paid
   as soon as the Company receives proper written proof.

   9. Provision 9:
   				PAYMENT OF CLAIMS: Benefits will be paid to the Insured. Loss of life
   benefits are payable in accordance with the beneficiary designation in effect
   at the time of payment. If none is then in effect, the benefits will be paid
   to the Insured&#8217;s estate. Any other benefits unpaid at death may be paid,
   at the Company&#8217;s option, either to the Insured&#8217;s beneficiary or
   the Insured&#8217;s estate.
   				Optional paragraph: If benefits are payable to the Insured&#8217;s estate
   or a beneficiary who cannot execute a valid release, the Company can pay
   benefits up to $ __________ (insert an amount which shall not exceed $2,000),
   to someone related to the Insured or beneficiary by blood or by marriage whom
   the Company considers to be entitled to the benefits. The Company will be
   discharged to the extent of any payment made in good faith.
   				Optional paragraph: The Company may pay all or a portion of any
   indemnities provided for health care services to the health care services
   provider, unless the Insured directs otherwise in writing by the time proofs
   of loss are filed. The Company cannot require that the services be rendered by
   a particular health care services provider.

   10. Provision 10:
   				PHYSICAL EXAMINATIONS AND AUTOPSY: The Company at its own expense has the
   right to have the Insured examined as often as reasonably necessary while a
   claim is pending. It may also have an autopsy made unless prohibited by law.

   11. Provision 11:
   				LEGAL ACTIONS: No legal action may be brought to recover on this policy
   within 60 days after written proof of loss has been given as required by this
   policy. No legal action may be brought after three years from the time written
   proof of loss is required to be given.

   12. Provision 12:
   				CHANGE OF BENEFICIARY: The Insured can change the beneficiary at any time
   by giving the Company written notice. The beneficiary&#8217;s consent is not
   required for this or any other change in the policy, unless the designation of
   the beneficiary is irrevocable.

   13. Provision 13:
   				CANCELLATION BY INSURED: The Insured may cancel this policy at any time by
   written notice delivered or mailed to the Company effective upon receipt or on
   such later date as may be specified in the notice. In the event of
   cancellation, the Company shall return promptly the unearned portion of any
   premium paid. The earned premium shall be computed pro rata. Cancellation
   shall be without prejudice to any claim originating prior to the effective
   date of cancellation.

B. The provisions of this section shall not apply in any instance in which the
provisions of this section are inconsistent or in conflict with a provision of
Article 6 (&#xA7; 38.2-3438 et seq.) of Chapter 34.

HISTORY: 1952, c. 317, § 38.1-349; 1958, c. 452; 1966, c. 101; 1986, c. 562;
1987, c. 520; 1995, c. 522; 2000, c. 540; 2003, c. 377; 2013, c. 751.