Viatical Settlement Provider License Instructions
Viatical Settlement Provider License Renewal and Annual Report Notice
Viatical Settlement Provider License Renewal and Annual Report Notice
In accordance with the North Carolina General Statute 58-58-210, no person shall act as, offer to act as, or hold himself or herself out as a viatical settlement provider in this State without a valid viatical settlement provider license issued by the Commissioner. Licenses shall be renewed annually. The license renewal process must be completed by June 1. All required documentation must be submitted and the license fee paid no later than May 1.
Effective March 12, 2020, all Viatical Settlement Provider license applications, notice of change of ownership, and/or change of officer or directors and Annual Reports must be submitted electronically to LHinbox@ncdoi.gov or Citrix Sharefile, or other secure electronic filing method, NO ZIP FILES. Payment of license fees must be done separately via USPS or overnight at addresses shown below. Please include a copy of the cover letter, with the check, in order that payment may be attributed accurately. Paper filings or notifications will not be accepted for the immediate future.
Viatical Provider License Requirements
- Viatical Settlement Provider License Transmittal
- Viatical Settlement Provider License Application
- Power of Attorney for Service of Process - required of non-domestic providers
- Power of Attorney for Corporation VSP Power of Attorney for Company
- Power of Attorney for Partnership VSP Power of Attorney for Partnership
- Biographical Affidavit
- NC Biographical Form VSP Biographical Affidavit or
- NAIC Biographical Form
The following documents are required only if there have been any changes during the past year.
- Power of Attorney for Service of Process - required of non-domestic providers
- Power of Attorney for Corporation VSP Power of Attorney for Company
- Power of Attorney for Partnership VSP Power of Attorney for Partnership
- Biographical Affidavit
- NC Biographical form VSP Biographical Affidavit or
- NAIC Biographical form
- Refer to the Transmittal document for a list of all supporting documentation required to
be submitted electoronically, 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. - 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 must be sent to the following:
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
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.
This Public Search Portal will be available after 11/03/2020
Should the approved forms be revised at anytime, the revised forms must be filed an approved prior to use.