Viatical Settlement Provider License Instructions

Viatical Provider License Requirements

Initial License

Initial License

Renewal License

Renewal License

The following documents are required only if there have been any changes during the past year.

Other General Information or Requirements

Other General Information or Requirements

  • Refer to the Transmittal document for a list of all supporting documentation required to
    be submitted with a license application. A renewal license only requires supporting documentation that has changed throughout the year.
  • A $500 filing fee is required with both an initial application and a renewal application for viatical settlement provider license.
  • Include a self-addressed and stamped envelope with each $500 filing fee so that the approval letter and license can
    be returned to your office.
  • The NC Department of Insurance uses Citrix ShareFile a secure filing method for electronic filing of files and documents. Files can also
    be sent electronically to the Life and Health Inbox at LHinbox@ncdoi.gov
  • The filing fee and
    self-addressed envelope must
    via mail.   

Mailing Address:

Regular UPS Mail:
Life & Health Division
1201 Mail Service Center
Raleigh, NC 27699-1201

Overnight Mail Address (ONLY):
Life & Health Division
325 N. Salisbury Street
Raleigh, NC 27603

Viatical Settlement Contract Forms

Viatical Settlement Contract Forms

NCGS 58-58-220 requires the contract and disclosure statement provided to the viator be filed and approved by the Commissioner, prior to use.  

These forms may be sent to Citrix ShareFile or LHinbox@ncdoi.gov. Once approved we use the National Association of Insurance Commissioner's (NAIC) Search Electronic Rate & Form Filing (SERFF) for archive purposes. SERFF can be accessed through our Life and Health Public Search Portal. 

Life and Health Public Search Portal.

Should the approved forms be revised at anytime, the revised forms must be filed an approved prior to use.