Manhattan Beach Unified School District

Transcription

1 The Guardia Life Isurace Compay of America, New York, NY Group Number: Mahatta Beach Uified Schoo District Cass 1 Here you' fid iformatio about your foowig empoyee beefit(s). Be sure to review the ecosed - it provides everythig you eed to sig up for your Guardia beefits. PLAN HIGHLIGHTS Life Disabiity Questios? Cocers? Hepie (888) Ca weekdays, 7:00 AM to 8:30 PM, EST. Ad refer to your pa umber:

2 The Guardia Life Isurace Compay of America, New York, NY Wecome Dear Mahatta Beach Uified Schoo District Empoyee, We re peased to te you that Guardia wi be our coverage provider this year. We have chose Guardia because of its competitive rates, exceet service reputatio, ad extesive pa desigs. We have worked hard to egotiate group rates that wi be affordabe for a empoyees. A coverage is paid through payro deductio. Mahatta Beach Uified Schoo District

3 Mahatta Beach Uified Schoo District Group Number: Life Beefit Summary About Your Beefits: Your famiy depeds o you i may ways ad you ve worked hard to esure their fiacia security. But if somethig happeed to you, wi your famiy be protected? Wi your oved oes be abe to stay i their home, pay bis, ad prepare for the future. Life isurace provides a fiacia beefit that your famiy ca deped o. Ad gettig it at work is easier, more coveiet ad more affordabe tha doig it o your ow. If you have fiacia depedets- a spouse, chidre or agig parets, havig ife isurace is a resposibe ad a smart decisio. Ero today to secure their future! What Your Beefits Cover: BASIC LIFE Empoyee Beefit Your empoyer provides $50,000 Basic Term Life coverage for a fu time empoyees. Accideta Death ad Dismembermet Spouse Beefit Chid Beefit Guaratee Issue: The guaratee meas you are ot required to aswer heath questios to quaify for coverage up to ad icudig the specified amout, whe you sig up for coverage durig the iitia eromet period. Premiums Portabiity: Aows you to take your coverage with you if you termiate empoymet. Coversio: Aows you to cotiue your coverage after your group pa has termiated. Acceerated Life Beefit: Aumpsumbeefitispaidtoyouifyouarediagosedwithatermia coditio, as defied by the pa. Waiver of Premiums: Premium wi ot eed to be paid if you are totay disabed. Your Basic Life coverage icudes Ehaced Accideta Death ad Dismembermet coverage equa to oe times the empoyee s ife beefits to a maximum of $50,000. Your spouse is eigibe for coverage i the amout of $1,500. Your depedet chidre are eigibe for coverage i the amout up to $1,000 uti age 26. See eromet form for detais. Guaratee Issue coverage up to $50,000 per empoyee Covered by your compay if you meet eigibiity requiremets Yes, with age ad other restrictios, icudig evidece of isurabiity Yes,with restrictios;see certificate of beefits Yes For empoyees disabed prior to age 60, with premiums waived uti age 65, if coditios are met Beefit iformatio iustrated withi this materia refects the pa covered by Guardia as of 07/22/2016 Mahatta Beach Uified Schoo District Cass 1 Beefit Summary The Guardia Life Isurace Compay of America, 7 Haover Square, New York, NY

4 BASIC LIFE Beefit Reductios: Beefits are reduced by a certai percetage as a empoyee ages. 50% at age 70 Subject to coverage imits Spouse coverage termiates at age 70. Maage Your Beefits: Go to to access secure iformatio about your Guardia beefits. Your o-ie accout wi be set up withi 30 days after your pa effective date. Need Assistace? Ca the Guardia Hepie (888) , weekdays, 8:00 AM to8:30 PM, EST. Refer to your member ID (socia security umber) ad your pa umber: LIMITATIONS AND EXCLUSIONS: ASUMMARYOFPLANLIMITATIONSANDEXCLUSIONSFORLIFE AND AD&D COVERAGE: You must be workig fu-time o the effective date of your coverage; otherwise, your coverage becomes effective after you have competed a specific waitig period. Empoyees must be egay workig i the Uited States i order to be eigibe for coverage. Uderwritig must approve coverage for empoyees o temporary assigmet: (a) exceedig oe year; or (b) i a area uder trave warig by the US Departmet of State. Subject to state specific variatios. Evidece of Isurabiity is required o a ate eroees. This coverage wi ot be effective uti approved by a Guardia uderwriter. This proposa is hedged subject to satisfactory fiacia evauatio. Pease refer to certificate of coverage for fu pa descriptio. Depedet ife isurace wi ot take effect if a depedet,other tha a ewbor,is cofied to the hospita or other heath care faciity or is uabe to perform the orma activities of someoe of ike age ad sex. Acceerated Life Beefit is ot paid to a empoyee uder the foowig circumstaces: oe who is required by aw to use the beefit to pay creditors; is required by court order to pay the beefit to aother perso; is required by a govermet agecy to use the paymet to receive a govermet beefit; or oses his or her group coverage before a acceerated beefit is paid. For AD&D: We pay o beefits for ay oss caused: by wifu sef-ijury; sickess, disease or medica treatmet; by participatig i a civi disorder or committig a feoy; Traveig o ay type of aircraft whie havig duties er o that aircraft; by decared or udecared act of war or armed aggressio; whie a member of ay armed force (May vary by state); whie drivig a motor vehice without a curret, vaid driver s icese; by ega itoxicatio; or by voutariy usig a o-prescriptio cotroed substace. Cotract #GP-1-R-ADCL1-00 et a. We wo't pay more tha 100% of the Isurace amout for a osses due to the same accidet, except as stated. The oss must occur withi a specific period of time of the accidet. Pease see cotract for specific defiitio; defiitio of oss may vary depedig o the beefit payabe. GP-1-R-LB-90 Ehaced AD&D: Aossmaybedefiedasdeath,quadripegia,ossofspeechad hearig, oss of cogitive fuctio, comatose state i excess of oe moth, hemipegia or parapegia. The oss must occur withi a specific period of time of the accidet. Pease see cotract for specific defiitio; defiitio of oss may vary depedig o the beefit payabe. Mahatta Beach Uified Schoo District Cass 1 Beefit Summary The Guardia Life Isurace Compay of America, 7 Haover Square, New York, NY

5 Mahatta Beach Uified Schoo District Log-Term Disabiity Beefit Summary Group Number: About Your Beefits: You probaby have isurace for your car or home, but what about the source of icome that pays for it? You rey o your paycheck for so may thigs, but what if you were suddey uabe to work due to a accidet or iess? How wi you put food o the tabe, pay your mortgage or heat your home? Disabiity isurace ca hep repace ost icome ad make a difficut time a itte easier. Protect your most vauabe asset, your paycheck-ero today! What Your Beefits Cover:. Coverage amout Maximum paymet period: Maximum egth of time you ca receive disabiity beefits. Accidet beefits begi: The egth of time you must be disabed before beefits begi. Iess beefits begi: The egth of time you must be disabed before beefits begi. Coversio: Aows you to cotiue disabiity coverage after your group pa has termiated. Evidece of Isurabiity: Aheathstatemetrequirigyouto aswer a few medica history questios. Guaratee Issue: The guaratee meas you are ot required to aswer heath questios to quaify for coverage up to ad icudig the specified amout, whe appicat sigs up for coverage durig the iitia eromet period. Miimum work hours/week: Miimum umber of hours you must reguary work each week to be eigibe for coverage. Log-Term Disabiity 66.66% of saary to maximum $10000/moth Socia Security Norma Retiremet Age Day 61 Day 61 Yes Heath Statemet may be required We Guaratee Issue $10000 i coverage Pahoder Determies Pre-existig coditios: Apre-existigcoditioicudesay coditio/symptom for which you, i the specified time period prior to coverage i this pa, cosuted with a physicia, received treatmet, or took prescribed drugs. 3mothsookback;12mothsafterexcusio Survivor beefit: Additioa beefit payabe to your famiy if you die whie disabed. 3moths UNDERSTANDING YOUR BENEFITS DISABILITY (Some iformatio may vary by state) Disabiity (og-term): For first two years of disabiity, you wi receive beefit paymets whie you are uabe to work i your ow occupatio. After two years, you wi cotiue to receive beefits if you caot work i ay occupatio based o traiig, experiece ad educatio. Beefit iformatio iustrated withi this materia refects the pa covered by Guardia as of 07/22/2016 Mahatta Beach Uified Schoo District Cass 1 Beefit Summary The Guardia Life Isurace Compay of America, 7 Haover Square, New York, NY

6 Earigs defiitio: Your covered saary excudes bouses ad commissios. Specia imitatios: Provides a 24-moth beefit imit for meta heath ad substace abuse. Work icetive: Pa beefit wi ot be reduced for a specified amout of moths so that you have part-time earigs whie you remai disabed, uess the combied beefit ad earigs exceed 100% of your previous earigs. Maage Your Beefits: Go to to access secure iformatio about your Guardia beefits. Your o-ie accout wi be set up withi 30 days after your pa effective date. Need Assistace? Ca the Guardia Hepie (888) , weekdays, 8:00 AM to 8:30 PM, EST. Refer to your member ID (socia security umber) ad your pa umber: ASUMMARYOF DISABILITYPLANLIMITATIONS AND EXCLUSIONS Evidece of Isurabiity is required o a ate eroees. This coverage wi ot be effective uti approved by a Guardia uderwriter. This proposa is hedged subject to satisfactory fiacia evauatio. Pease refer to certificate of coverage for fu pa descriptio. You must be workig fu-time o the effective date of your coverage; otherwise, your coverage becomes effective after you have competed a specific waitig period. Empoyees must be egay workig i the Uited States i order to be eigibe for coverage. Uderwritig must approve coverage for empoyees o temporary assigmet: (a) exceedig oe year; or (b) i a area uder trave warig by the US Departmet of State. Subject to state specific variatios. We do ot pay beefits for charges reatig to ega itoxicatio, icudig but ot imited to the operatio of a motor vehice, ad for the voutary use of ay poiso, chemica, prescriptio or o-prescriptio drug or cotroed substace uess it has bee prescribed by a doctor ad is used as prescribed. We imit the duratio of paymets for og term disabiities caused by meta or emotioa coditios, or acoho or drug abuse. We do ot pay beefits durig ay period i which a covered perso is cofied to a correctioa faciity, a empoyee is ot uder the care of a doctor, a empoyee is receivig treatmet outside of the US or Caada, ad the empoyee s oss of earigs is ot soey due to disabiity. This poicy provides disabiity icome isurace oy. It does ot provide "basic hospita", "basic medica", or "medica" isurace as defied by the New York State Isurace Departmet. For Log-Term Disabiity coverage, we pay o beefits for a disabiity caused or cotributed to by a pre-existig coditio uess the disabiity starts after you have bee isured uder this pa for a specified period of time. We imit the duratio of paymets for og term disabiities caused by meta or emotioa coditios, or acoho or drug abuse. We do ot pay beefits for charges reatig to a covered perso: takig part i ay war or act of war (icudig service i the armed forces) committig a feoy or takig part i ay riot or other civi disorder or itetioay ijurig themseves or attemptig suicide whie sae or isae. If this pa is trasferred from aother isurace carrier, the time a isured is covered uder that pa wi cout toward satisfyig Guardia's pre-existig coditio imitatio period. State variatios may appy. Whe appicabe, this coverage wi itegrate with NJ TDB, NY DBL, CA SDI, RI TDI, Hawaii TDI ad Puerto Rico DBA. Cotract #.s GP-1-LTD94-A,B,C-1.0 et a.; GP-1-LTD2K-1.0 et a; GP-1-LTD et a. This hadout is for iustrative purposes oy ad is a approximatio. If ay discrepacies betwee this hadout ad your paycheck stub exist, your paycheck stub prevais. Mahatta Beach Uified Schoo District Cass 1 Beefit Summary The Guardia Life Isurace Compay of America, 7 Haover Square, New York, NY

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9 The Guardia Life Isurace Compay of America Ad its Affiiates ad Subsidiaries Eromet Form Page 1 of 4 Guardia Life, P.O. Box 14319, Lexigto, KY Pease prit ceary ad mark carefuy. Empoyer Name: Mahatta Beach Uified Schoo District Group Pa Number: Beefits Effective: PLEASE CHECK APPROPRIATE BOX q Iitia Eromet q Re-Eromet q Add Empoyee/Depedets q Drop/Refuse Coverage q Iformatio Chage q Icrease Amout q Famiy Status Chage Cass: Cass 1 Divisio: Subtota Code: (Pease obtai this from your Empoyer) About You: Socia Security Number First, MI, Last Name: - - Address City State Zip Geder: q M q F DateofBirth(mm-dd-yy): - - Phoe: ( ) - Emai Address: Are you married or do you have a spouse/domestic parter? q Yes q No Date of marriage/uio: - - Do you have chidre or other depedets? q Yes q No Pacemet date of adopted chid: - - About Your Job: Hours worked per week: Job Tite: Work Status: q Active q Retired q Cobra/State Cotiuatio Date of fu time hire: - - Aua Saary: $ About Your Famiy: Pease icude the ames of the depedets you wish to ero for coverage. A depedet is a perso that you, as a taxpayer, caim; who reies o you for fiacia support; adforwhomyouquaifyforadepedecytaxexceptio. Depedecy tax exemptios are subject to IRS rues ad reguatios. Additioa iformatio may be required for o-stadard depedets such as a gradchid, a iece or a ephew. Spouse/domestic parter (First, MI, Last Name) Address/City/State/Zip: Phoe: ( ) - Chid/Depedet 1: Address/City/State/Zip: Geder q M q F q Add q Drop Geder q M q F Socia Security Number - - Date of Birth (mm-dd-yyyy) - - Socia Security Number - - Status (check a that appy) q Studet (post high schoo) q Disabed q No stadard depedet Phoe: ( ) - Chid/Depedet 2: Address/City/State/Zip: Phoe: ( ) - q Add q Drop Geder q M q F Date of Birth (mm-dd-yyyy) - - Socia Security Number - - Date of Birth (mm-dd-yyyy) - - Status (check a that appy) q Studet (post high schoo) q Disabed q No stadard depedet CEF2014-CA Questios? Ca the Guardia Hepie (888) DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER DATE FORM PUBLISHED: Sep 06,

10 Chid/Depedet 3: Address/City/State/Zip: q Add q Drop Geder q M q F Socia Security Number - - Status (check a that appy) q Studet (post high schoo) q Disabed q No stadard depedet Phoe: ( ) - Chid/Depedet 4: Address/City/State/Zip: Phoe: ( ) - q Add q Drop Geder q M q F Date of Birth (mm-dd-yyyy) - - Socia Security Number - - Date of Birth (mm-dd-yyyy) - - Status (check a that appy) q Studet (post high schoo) q Disabed q No stadard depedet Basic Life Coverage: You must be eroed to cover your depedets. Beefit reductios appy. Pease see pa admiistrator. Poicy Amout Empoyee Oy R $50,000 The Guaratee Issue Amout is $50,000. Spouse/domestic parter R $1,500 *The amout may ot be more tha 50% of the empoyee amout Chid/Depedet R $1,000 *The amout may ot be more tha 10% of the empoyee amout Name your beeficiaries: (Primary beeficiary percetages must tota 100%) Primary Beeficiaries: Name: Socia Security Number: - - % Date of Birth (mm-dd-yy): - - Address/City/State/Zip: Phoe: ( ) - Reatioship to Empoyee:_ Name: Socia Security Number: - - % Date of Birth (mm-dd-yy): - - Address/City/State/Zip: Phoe: ( ) - Reatioship to Empoyee:_ Cotiget Beeficiary: Socia Security Number: - - Date of Birth (mm-dd-yy): - - Address/City/State/Zip: Phoe: ( ) - Reatioship to Empoyee:_ (I the evet the primary beeficiaries are deceased, the cotiget beeficiary wi receive the beefit. Empoyer maitais beeficiary iformatio.) If this Basic Life poicy wi repace your existig ife isurace poicy uder your curret empoyer, provide the amout of the previous poicy $ Importat Notes: Based o your pa beefits ad age, you may be required to compete a evidece of isurabiity form for Basic Life. Log-Term Disabiity (LTD) Coverage: Mothy Beefit R 66.66% of saary to a maximum of $10,000 Sigature I uderstad that ife isurace coverage for a depedet, other tha a ewbor chid, wi ot take effect if that depedet is cofied to a hospita or other heath care faciity, or is home cofied, or is uabe to perform the orma activities of someoe of ike age ad sex. Iuderstadthatmydepedet(s)caotbeeroedforacoverage if I am ot eroed for that coverage. Iuderstadthatthepremiumamoutsshowaboveareestimatios ad are for iustrative purposes oy. Submissio of this form does ot guaratee coverage. Amog other thigs, coverage is cotiget upo uderwritig approva ad meetig the appicabe eigibiity requiremets as set forth i the appicabe beefit booket. I uderstad that I must be activey at work or my eected coverage wi ot take effect uti I have met the eigibiity requiremets (as defied i the beefit booket.) This does ot appy to eigibe retirees. If coverage is waived ad you ater decide to ero, ate etrat peaties may appy. You may aso have to provide, at yourowexpese,proofofeachperso's isurabiity. Guardia or its desigee has the right to reject your request. Pa desig imitatios ad excusios may appy. For compete detais of coverage, pease refer to your beefit booket. State imitatios may appy. Your coverage wi ot be effective uti approved by a Guardia or its desigated uderwriter. 2 DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER

11 Guardia Group Pa Number: Pease prit empoyee ame: Iherebyappyforthegroupbeefit(s)thatIhavechoseabove. IuderstadthatImustmeeteigibiityrequiremetsfora coverages that I have chose above. IagreethatmyempoyermaydeductpremiumsfrommypayiftheyarerequiredforthecoverageIhavechoseabove. Iackowedgeadcosettoreceivigeectroiccopiesofappicabe isurace reated documets, i ieu of paper copies, to the extet permitted by appicabe aw. I may chage this eectio oy by providig thirty (30) day prior writte otice. IuderstadthatCaiforiaawprohibitsaHIVtestfrombeig required or used by heath isurace compaies as a coditio of obtaiig heath isurace coverage. Iattestthattheiformatioprovidedaboveistrueadcorrect to the best of my kowedge. "Caiforia aw prohibits a HIV test from beig required or used by heath isurace compaies as a coditio of obtaiig heath isurace coverage." For your protectio Caiforia aw requires the foowig to appearothisform:thefasityofaystatemetitheappicatio sha ot bar the right to recovery uder the poicy uess such fase statemet was made with actua itet to deceive or uess it materiay affected either the acceptace of the risk or the hazard assumed by the isurer. The state i which you reside may have a specific state fraud warig. Pease refer to the attached Fraud Warig Statemets page. SIGNATURE OF EMPLOYEE X DATE Eromet Kit , 0002, EN Fraud Warig Statemets The aws of severa states require the foowig statemets to appear o the eromet form: Aabama: Ay perso who kowigy presets a fase or frauduet caimforpaymetofaossorbeefitorwhokowigypresetsfase iformatio i a appicatio for isurace is guity of a crime ad may be subject to restitutio fies or cofiemet i priso, or ay combiatio thereof. Arizoa: For your protectio Arizoa aw requires the foowig statemet to appear o this form. Ay perso who kowigy presets a fase or frauduet caim for paymet of a oss is subject to crimia ad civi peaties. Caiforia: For your protectio Caiforia aw requires the foowig to appear o this form:the fasity of ay statemet i the appicatio sha ot bar the right to recovery uder the poicy uess such fase statemet was made with actua itet to deceive or uess it materiay affected either the acceptace of the risk or the hazard assumed by the isurer. Coorado: It is uawfu to kowigy provide fase, icompete, or miseadig facts or iformatio to a isurace compay for the purpose of defraudig or attemptig to defraud the compay. Peaties may icude imprisomet, fies, deia of isurace, ad civi damages. Ay isurace compay or aget of a isurace compay who kowigy provides fase, icompete, or miseadig facts or iformatio to a poicy hoder or caimat for the purpose of defraudig or attemptig to defraud the poicy hoder or caimat with regard to a settemet or award payabe from isurace proceeds sha be reported to the Coorado Divisio of Isurace withi the Departmet of Reguatory Agecies. Coecticut, Iowa, Nebraska, ad Orego: Ay perso who kowigy, ad with itet to defraud ay isurace compay or other perso, fies a appicatio of isurace or statemet of caim cotaiig ay materiay fase iformatio or coceas, for the purpose of miseadig, iformatio cocerig ay fact materia thereto, may be guity of afrauduetisuraceact,whichmaybeacrime,admayasobe subject to civi peaties. Deaware, Idiaa ad Okahoma: WARNING: Ay perso who kowigy, ad with itet to ijure,defraudordeceiveayisurer,makesaycaimfortheproceeds of a isurace poicy cotaiig ay fase, icompete or miseadig iformatio is guity of a feoy. District of Coumbia: WARNING: It is a crime to provide fase or miseadig iformatio to a isurer for the purpose of defraudig the isurer orayotherperso.peaties icude imprisomet ad/or fies. I additio, a isurer may dey isurace beefits, if fase iformatio materiay reated to a caim was provided by the appicat. Forida: Ay perso who kowigy ad with itet to ijure, defraud, or deceive ay isurer fies a statemet of caim or a appicatio cotaiig ay fase, icompete, or miseadig iformatio is guity of a feoy of the third degree. Kasas: Ay perso who kowigy, ad with itet to defraud ay isurace compay or other perso, fies a appicatio of isurace or statemet of caim cotaiig ay materiay fase iformatio or coceas, for the purpose ofmiseadig,iformatiococerigayfactmateriathereto, may be guity of isurace fraud as determied by a court of aw. Ketucky: Ay perso who kowigy ad with itet to defraud ay isurace compay or other perso fies a statemet of caim cotaiig ay materiay fase iformatio or coceas, for the purpose of miseadig, iformatio cocerig ay fact materia thereto commits a frauduet isurace act, which is a crime. Louisiaa ad Texas: Ay perso who kowigy presets a fase or frauduet caimforpaymetofaossorbeefitisguityofacrimeadmaybesubject to fies ad cofiemets i state priso. Maie, Teessee ad Washigto: It is a crime to kowigy provide fase, icompete or miseadig iformatio to a isurace compay for the purpose of defraudig the compay. Peaties may icude imprisomet, fies or a deia of isurace beefits. Maryad : Ay perso who kowigy or wifuy presets a fase or frauduet caim for paymet of a oss or beefit or kowigy or wifuy presets fase iformatio i a appicatio for isurace is guity of a crime ad may be subject to fies ad cofiemet i priso. Questios? Ca the Guardia Hepie (888) DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER

12 Rhode Isad: Ay perso who kowigy ad wifuy presets a fase or frauduet caim for paymet of a oss or beefit or kowigy ad wifuy presets fase iformatio i a appicatio for isurace is guity of a crime ad may be subject to fies ad cofiemet i priso. Miesota: Apersowhofiesacaimwithitettodefraudorhepscommit a fraud agaist a isurer is guity of a crime. New Hampshire: Ay perso who, with a purpose to ijure, defraud or deceive ay isurace compay, fies a statemet of caim cotaiig ay fase, icompete or miseadig iformatio is subject to prosecutio ad puishmet for isurace fraud, as provided i N.H. Rev. Stat. A. 638:20 New Jersey: Ay perso who kowigy fies a statemet of caim cotaiig ay fase or miseadig iformatio is subject to crimiaadcivipeaties. New York: Ay perso who kowigy ad with itet to defraud ay isurace compay or other perso fies a appicatio for isurace or statemet of caim cotaiig ay materiay fase iformatio, or coceas for the purpose of miseadig, iformatio cocerig ay fact materia thereto, commits a frauduet isurace act, which is a crime, ad sha aso be subject to a civi peaty ot to exceed five thousad doars ad the stated vaue of the caim for each such vioatio. (Does ot appy to Life Isurace.) New Mexico: Ay perso who kowigy presets a fase or frauduet caimforpaymetoraossorbeefitorkowigypresetsfaseiformatio i a appicatio for isurace is guity of a crime ad may be subject to civi fiesadcrimiapeatiesordeiaofisuracebeefits. Ohio: Ay perso who with itet to defraud or kowig that he/she isfaciitatigafraudagaistaisurer,submitsaappicatio or fies a caim cotaiig a fase or deceptive statemet is guity of isurace fraud. Pesyvaia: Ay perso who kowigy ad with itet to defraud ay isurace compay or other perso fies a appicatio for isurace or statemet of caim cotaiig ay materiay fase iformatio or coceas forthepurposeofmiseadig,iformatiococerigayfactmateriatheretocommitsafrauduetisuraceact, which is a crime ad subjects such perso to crimia ad civipeaties. Vermot: Ay perso who kowigy presets a fase statemet i a appicatio for isurace may be guity of a crimia offese ad subjecttopeatiesuderstateaw. Virgiia: Ay perso who with itet to defraud or kowig that he/she isfaciitatigafraudagaistaisurer,submitsaappicatio or fies a caim cotaiig a fase or deceptive statemet may have vioated state aw. 4