SF 619 Page 1 SAMPLE
SALARY INCREASE RIDER
This rider is part of Your policy. It is issued based on the information given
in the application and deduction from the Policy Value of the monthly cost of
the benefits provided by this rider. All policy definitions, provisions and
exceptions apply to this rider unless changed by this rider. The Effective Date
of this rider is the same as the Policy Date unless another date is shown on the
current Data Pages.
DEFINITIONS
SALARY REVIEW DATE - means the month and day for the annual increase under this
rider as shown on the current Data Pages.
EMPLOYER - means the person or business for whom the Insured is working, as
shown on the application for this rider. If that business is purchased, the new
business will be considered the employer.
MULTIPLIER - means the Total Face Amount on the Effective Date of this rider
plus the amount of any Other Employer Purchased Insurance reported to Us by the
Employer as of the Effective Date of this rider divided by the Insured's salary
as shown on the application for this rider. This Multiplier may be increased
provided You supply Us with evidence which satisfies Us that the Insured is
qualified for the increase under Our underwriting guidelines then in effect.
OTHER EMPLOYER PURCHASED INSURANCE - means the amount of group and individual
life insurance in force on the life of the Insured (other than the insurance
provided by the policy to which this rider is attached) for which premiums are
paid in whole or in part by the Employer. If this amount exceeds the limits
established by Our underwriting guidelines in effect when the Multiplier is
being calculated, Other Employer Purchased Insurance shall mean the maximum
amount provided in those underwriting guidelines.
If this rider and the policy to which it is attached are integrated with the
Other Employer Purchased Insurance for the Insured's benefit plan, the amount of
the Other Employer Purchased Insurance as of the Effective Date of this rider
will be used in calculating the Multiplier and the amount of increase available
under each increase option.
SALARY - means the Insured's annual compensation as reported to Us by the
Employer and as reportable on the Insured's W-2 Wage and Tax Statement.
THE INCREASE OPTION
You have the right to purchase additional insurance on the Insured's life,
without evidence of insurability, subject to the provisions of this rider, as
long as Your policy and this rider are in force and not in a grace period.
While the Insured is actively engaged in employment at the Employer's usual
place or places of business as noted on the application for this rider, and
while the Insured is performing normal daily job duties, increases are available
on every Salary Review Date from the first Salary Review Date to the Salary
Review Date next following the Insured's 65th birthday, subject to the
provisions of this rider.
Each increase will be made based on the Insured's Attained Age on the current
policy anniversary. The increase will be in a risk class equivalent to that
shown on the current Data Pages.
If the Insured's salary has not changed or has decreased as of the Salary Review
Date, additional insurance will not be offered under this rider on that date.
AMOUNT OF INCREASE
Increases are subject to Your acceptance, to the provisions of this rider and
any other applicable policy provisions, including any exclusions or limitations.
The amount of the increase will be:
1. The Insured's Salary as reported for the current Salary Review Date;
multiplied by
2. The Multiplier shown on the current Data Pages; less
3. Any Other Employer Purchased Insurance which remains in force on the
current Salary Review Date; less
4. The current Total Face Amount of Your policy on the current Salary Review
Date.
EXAMPLE: If Your Total Face Amount is $150,000, the Multiplier is 3, the
Insured's Salary on the Salary Review Date is $60,000, and Other Employer
Purchased Insurance is $15,000, the amount of increase is $15,000.
$60,000 X 3 = $180,000 - $15,000 - $150,000 = $15,000.
The increase will be in the same proportion as the Policy Face Amount to the
Total Face Amount.
LIMITS ON INCREASE
MAXIMUM INCREASE - Any increase We offer You will not exceed the lesser of 1 or
2 below.
1. (10% of A) minus B where:
A equals the Total Face Amount as of the Policy Date or the last
policy anniversary whichever is later plus Other Employer Purchased
Insurance; and
B equals any Total Face Amount increase(s) and any increases in Other
Employer Purchased Insurance since the last Policy Date or the last
policy anniversary, whichever is later.
2. The maximum increase amount shown on the current Data Pages minus any Total
Face Amount increase(s) and any increase in Other Employer Purchased
Insurance since the Policy Date or the last policy anniversary, whichever
is later.
LIFETIME MAXIMUM INCREASE - Notwithstanding anything to the contrary in this
rider, the aggregate Total Face Amount increases may at no time exceed the
Lifetime Maximum Increase amount shown on the current Data Pages.
EFFECTIVE DATE OF INCREASE
Any increase offered under this rider, unless timely rejected, will be effective
on the Monthly Date immediately following the date of Our increase offer.
ACCEPTANCE AND REJECTION OF INCREASE
Your planned periodic premium will be increased for any Total Face Amount
increase made under this rider unless We receive Notice to the contrary. We will
offer any increase of Total Face Amount under this rider by notifying You of the
increase. We will then send You new Data Pages reflecting the changes in Your
policy due to such increase.
You may reject an increase by sending Us Notice prior to the effective date of
the increase.
MONTHLY POLICY CHARGES
The Monthly Policy Charge will be increased to cover the costs and charges for
any increase in protection made under this rider. This increase will be based on
the risk class or classes shown on the current Data Pages.
WAIVER BENEFITS
If Your policy has a rider that provides any benefits due to disability, We will
increase such benefits when an increase occurs under this rider. The Monthly
Policy Charge for the waiver rider will be increased accordingly. No evidence of
insurability will be required. For more information, see the rider providing
those benefits.
Any increases of the specified premium amount will increase the Monthly Policy
Charge for the Waiver of Specified Premium Rider. Increases require no evidence
of insurability.
MISSTATEMENT OF SALARY
If the Insured's Salary is misstated, We may:
1. Reduce any benefits to reflect the correct Salary; or
2. Exercise any other rights available to Us which are not excluded by the
Incontestability provision of the policy.
TERMINATION
This rider ends, with no further increases available, on the first of:
1. The policy anniversary following the Insured's 65th birthday;
2. Your rejection of an increase;
3. The termination of Your policy;
4. Any decrease in insurance which causes the Total Face Amount to be less
than:
a. The Insured's Salary; multiplied by
b. The Multiplier; less
c. Any Other Employer Purchased Insurance;
5. The Insured's leaving the employment of the Employer;
6. Any failure to provide updated Salary information as required by this
rider; or
7. Our receipt of Your Notice to cancel the rider. We may require You to send
Your policy to Our office to record the cancellation.
REINSTATEMENT
In addition to all other policy conditions for reinstatement, if either of the
following conditions exists, this rider may be reinstated as part of Your
policy:
1. Whenever an underwritten increase is made in Your Total Face Amount,
provided that increase is issued at an available risk class; or;
2. Automatically on the policy anniversary following the Insured's 21st
birthday, if terminated prior to that time.
This rider will be reinstated in a risk class We determine based on information
provided in the application for reinstatement.
President and Chief Executive Officer