TransCare II -TRANSAMERICA LIFE INSURANCE COMPANY INTERSTATE COMPACT STATE State AK Significant State Variation, Processing Notes No DRA Partnership Policy No credit card payments accepted for Cash With App AL CO No SRCBIO for worksite sales; SRCBIO is allowed for association sale GA Domestic Partners applying must submit Declaration of Domestic Partnership form TLC 1 DDP (GA) 0102; form must be completed, notarized, and submitted with the application IA ID IA Senior Health Insurance Information Program Notice, form SHIIP-IA 196, must be given to every applicant No Domestic Partner discounts are available Idaho Senior Health Insurance Benefit Advisors (SHIBA) Notice, form ID SHIBA 100, must be given to every applicant IL No DRA Partnership enacted Illinois SHIP notice, form IL SHIP 0411, must be given to every applicant ICC10 A SV 1011 For Agent/Producer Information Only. Not for public distribution. 1
KS No elimination periods over 100 days allowed (180 day EP not available) Kansas Senior Health insurance Counseling Notice, form SHIC (KS) 407, must be given to every applicant HC/ADC is never subject to or applied to the Elimination Period KY Kentucky State Health Insurance Assistance Program Notice, KY SHIP 311, must be given to each applicant LA No Domestic Partner discount allowed Senior Health Insurance Information Program Notice, SHIIP (LA) 803 must be give to every applicant Delivery Receipt required if agent delivers policy OR if it is mailed MA MD Minimum 24 months of coverage; $36,500 Pool of Money Every applicant must be offered a policy that meets MassHealth qualifications MAXIMUM DAILY BENEFIT of at least $125 ONLY APPLICANT CAN COMPLETE HEALTH SECTION OF APPLICATION MA Bulletin for People with Medicare, form MA Med Sup 2011, must be provided with Guide to Health Insurance for People with Medicare before application is presented MA Serving Health Information Needs of Elders Notice, form SHINE (MA) 507 must be provided to every applicant Long Term Care Insurance Policies Issued in MA form TLC 1-MHN (MA) 404 must be provided to every applicant, signed and returned with the application Your Options for Financing Long Term Care form MG0609 must be provided to every applicant No SRCBIO for worksite sales; SRCIO is allowed in association sales DRA Partnership policy is not available Minimum 24 months of coverage; $36,500 Pool of Money No credit card payments accepted for Cash With App Maryland SHIP Notice, Form MD SHIP 0611, must be given to every applicant 2
ME MI MN Maine Senior Health Insurance Assistance Program notice, ME SHIP 311, must be given to every applicant Commissions are state specific No SRCBIO for any Multi-Life sales (worksite or association) MN Guaranty Association Notice, form MN-GA 108, must be given to every applicant MO MS NC NE NH NM No SRCBIO for worksite sales: SRCBIO is allowed in association sales No credit card payments accepted for Cash With App NC Senior Health Insurance Information Program notice, form NC SHIIP 0511, must be given to every applicant Delivery Receipt required if agent delivers policy or policy is mailed NE Health Insurance Information, Counseling and Assistance Program, form NE SHIIP 1210, must be given to every applicant Only one month s premium collected at time of application BUT SPECIFIC REQUIREMENTS FOR CIVIL UNION PARTNERS 3
OH DRA Partnership Policy available OK OK Senior Health Insurance Counseling Program notice, form OK SHIP 611, must be given to every applicant PA RI SC TN TX UT ; however, DOMESTIC PARTNER CANNOT BE ANY ROOMMATE OR FRIEND WHO DOES NOT OTHERWISE MEET THE GENERIC DEFINITION. If a friend or roommate qualifies under the generic definition, he/she is a domestic partner. PA APPRISE State Health Insurance Assistance Program Notice, form APPRISE PA 0311, must be given to every applicant Delivery Receipt required if agent delivers policy State specific commissions State specific Domestic Partner definition and qualifications apply. Domestic Partner must reside with the Policyholder continuously for at least 2 years. The following requirements were added: (a) the domestic partner must be at least 18 years of age, or legally emancipated; and (b) the domestic partner must be mentally competent to consent to contract; and (c) the domestic partner must also have shared financial assets and obligations the policyholder for at least 2 years. The TX requirements do not include both of You hold Yourselves out to the public as life partners. UT Health insurance Information Program, form HIIP (UT) 407, must be given to every applicant 4
VA DRA Partnership Policy is approved not yet available No Domestic Partner discount is available. DOMESTIC PARTNERS [GENERIC DEFINITION AND REQUIREMENTS APPLY] ARE ELIGIBLE TO PURCHASE SHARED CARE VA Insurance Counseling and Assistance Program, form VICAP (VA) 307, must be given to every applicant VT No DRA Partnership policy is available Specific benefit quotes required: (a) 90 day EP, 5 Year Benefit Period, $200 Maximum Daily Benefit (b) 90 day EP, 3 Year Benefit Period, $150 Maximum Daily Benefit (c) 90 day EP, 2 Year Benefit Period, $100 Maximum Daily Benefit. For (a), (b), and (c) quotes must be given for (1) 5% CBIO, (2) 5% SBIO, and (3) NO INFLATION No EP greater than 100 days allowed No Maximum Daily Benefit under $75 allowed; Minimum Pool of Money is $27,375 No Policy Maximum Amount that is less than one year of benefits allowed Civil Unions recognized. Two people joined in a Civil Union must be of the same sex, and not party to another civil union or marriage. They will have received a certificate of civil union when they are joined. WA All medical questions on the application must be completed by the applicant PLUS if state registered Domestic Partner, additional requirements added to generic definition. In WA, to enter into a state-registered domestic partnership, the two persons must meet the following requirements: (a) must share a common residence; (b) both must be at least 18 years old; (c) must not be married to someone other than the party for domestic partnership and neither is a state-registered domestic partner with someone else; (d) both persons must be capable of consenting to the domestic partnership; (e) both of the following must be true the persons are not nearer kin to each other than second cousins, whether of the whole blood or the half blood and neither person is a sibling, child, grandchild, aunt, niece, uncle, nephew to the other person; and (f) either both persons are members of the same sex or they are members of the opposite sex and at least one of the persons is 62 years old or older. WI Minimum Maximum Daily Benefit is $60; Minimum Pool of Money is $21,900 Maximum Elimination Period is 180 days Guide to Long Term Care booklet, PI-047 (R 10/2010), must be given to every applicant WI Long Term Care Programs Guide, PI-00019 (06/2009), must be given to every applicant if applying for a Partnership policy WI Guide to Health insurance for People with Medicare, PI-002 (R 12/2010), must be given to every applicant who is eligible for Medicare Commissions are state specific 5
WV WY Delivery receipt required if Policy delivered by agent WV Senior Health Insurance Network notice, form SHINE (WV) 795, must be given to every applicant 6