Exhibit 1.(5)(b)
TERM LIFE INSURANCE RIDER
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THIS RIDER IS ISSUED BY GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY AS PART OF
THE POLICY TO WHICH IT IS ATTACHED. IT IS ISSUED BASED ON THE INFORMATION GIVEN
IN THE APPLICATION AND PAYMENT OF THE PREMIUMS SHOWN ON THE POLICY
SPECIFICATIONS PAGE. EACH PREMIUM FOR THIS RIDER IS PAYABLE ONLY WITH EACH
CORRESPONDING PREMIUM FOR THE POLICY. THE PROVISIONS OF THE POLICY APPLY TO THIS
RIDER UNLESS OTHERWISE STATED HEREIN.
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BENEFIT
This Rider provides Term Life insurance on the Insured. The Insured is the
person insured under the policy to which this Rider is attached. Coverage is
annually renewable to the Insured's Attained Age 100. The amount of coverage
provided under this Rider varies from month to month as described below. The
Company will pay the Rider's Death Benefit to the Beneficiary when the Company
receives satisfactory proof that the death of the Insured occurred while this
Rider was in force.
RIDER DEATH BENEFIT
The Rider's Death Benefit will be determined at the beginning of each Policy
Month in accordance with one of the following options, whichever is in effect on
the date of the Insured's death.
The Rider's Death Benefit Option at all times must be the same as the policy's
Death Benefit Option. The Death Benefit option for the policy and this Rider as
of the Issue Date is shown on the Policy Specifications Page 1. The Rider's
Death Benefit is determined by the option in effect at the Insured's date of
death. The Rider Death Benefit is included in, and will not be an addition to,
the Death Benefit Provision described on page 10 of the policy to which it is
attached.
For each of the options described below, the Death Benefit will be reduced by
any outstanding loans and loan interest accrued.
Option 1: Level Death
The Rider's Death Benefit will be:
o the greater of:
a) the Total Face Amount shown on the Policy Specifications Page 1, less
any partial withdrawals; and
b) the Policy Value Account on the Insured's date of death times the
applicable Factor shown in the Table on the Policy Specifications Page
1b.
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Term Life Insurance Rider (continued)
o less the greater of:
c) the Base Face Amount shown on the Policy Specifications Page 1; and
d) the Policy Value Account of the policy to which this Rider is attached.
Option 2: Coverage Plus
The Rider's Death Benefit will be:
o the greater of:
a) the Total Face Amount shown on the Policy Specifications Page 1, plus
the Policy Value Account on the Insured's date of death; and
b) the Policy Value Account on the Insured's date of death times the
applicable Factor shown in the Table on the Policy Specifications Page
1b.
o less
c) the Base Policy Face Amount shown on the Policy Specifications Page 1;
plus
d) the Policy Value Account of the policy to which this Rider is attached.
Option 3: Premium Accumulation
The Rider's Death Benefit will be:
o the greater of:
a) the Total Face Amount shown on the Policy Specifications Page 1, plus
the accumulated value of all Premiums paid at interest shown on the
Policy Specifications Page 1, less any partial withdrawals; and
b) the Policy Value Account on the Insured's date of death times the
applicable Factor shown in the Table on the Policy Specifications Page
1b.
o less the greater of
c) the Base Policy Face Amount shown on the Policy Specifications Page 1
plus the accumulated value of all premiums paid at the interest shown
on the Policy Specifications Page 1; and
d) the Policy Value Account of the policy to which this Rider is attached.
COVERAGE EFFECTIVE
Coverage under this Rider will take effect on the later of:
o the effective date of the policy to which this Rider is attached; or
o the date this Rider is delivered and the first Rider premium is paid to the
Company.
CHANGE OF FACE AMOUNT
By Request, the Owner may at any time increase or decrease the Rider Face
Amount, subject to the Company's approval. Any change in Rider Face Amount may
be limited to amounts that will not exceed tax guidelines and jeopardize the tax
status of the policy as life insurance.
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Term Life Insurance Rider (continued)
For a decrease in Rider Face Amount:
o The Company must receive a Request.
o The decrease will become effective on the first day of the Policy Month
following receipt of the Request.
o The decrease will apply first to the most recent increase or increases in
Total Face Amount for purposes of the Incontestability Provision.
The minimum decrease amount for the Total Face Amount will be $25,000. The Total
Face Amount may not be decreased below $100,000 unless prior approval is
obtained from the Company.
For an increase in Rider Face Amount:
o The Company must receive a Request.
o The increase will be subject to Evidence of Insurability satisfactory to
the Company.
o The increase will be effective on the Rider anniversary following the
approval of the Request for the increase, subject to the deduction of the
first month's cost of insurance for the Rider from the Policy Value
Account.
The minimum increase amount Total Face Amount will be $25,000.
COST OF INSURANCE
While this Rider is in force, the cost of insurance for the Rider will be
determined on the first day of each Policy Month and added to the policy's
monthly deduction. The monthly cost of insurance charge for this Rider is
determined by multiplying the monthly cost of insurance rate by the Rider Death
Benefit.
Monthly cost of insurance rates for this Rider will be determined by the Company
from time to time, based on the Company's expectations as to future experience
for factors such as mortality, persistency, expenses and taxes. Any change in
the Company's cost of insurance rates will be made uniformly by class.
These rates will never be greater than the Maximum Monthly Cost of Insurance
Rates shown on the Policy Specifications Page. The Company may charge a lower
monthly rate. The maximum risk rates for this Rider are based on the
Sex-Distinct Commissioners 1980 Standard Ordinary Mortality Table, age nearest
birthday.
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Term Life Insurance Rider (continued)
REINSTATEMENT
If the policy to which this Rider is attached is reinstated, the Company will
also reinstate this Rider if the Company receives proof, satisfactory to the
Company, that the Insured is still insurable at the same rates.
INCONTESTABILITY
This Rider will not be contested on the basis of misrepresentation after it has
been in force during the Insured's lifetime for 2 years from its Issue Date.
SUICIDE
If the Insured commits suicide, while sane or insane, within 2 years of the
Issue Date of this Rider, (1 year if issued in Colorado or North Dakota),
payment will be limited to an amount equal to the cost of insurance deducted for
this Rider.
MISSTATEMENT OF AGE AND/OR SEX
If the Insured's age and/or sex has been misstated, the Rider Death Benefit will
be adjusted. The adjusted Rider Death Benefit will be that which the Rider cost
of insurance charge would have purchased, based on the Insured's correct age and
sex on the Effective Date of the Rider. This Rider cost of insurance charge will
be determined on the last Monthly Anniversary Day prior to the death of the
Insured.
NON-PARTICIPATING
This Rider is non-participating; no dividends are payable. It is not eligible to
share in the Company's divisible surplus.
TERMINATION
The Owner may terminate this Rider by Request. In order to terminate this Rider,
the Company has the right to require this policy for endorsement. This Rider
also will also terminate on the earliest of the following dates:
o the date the policy is surrendered or terminated;
o the expiration of the grace period of the policy; or
o the death of the Insured.
Signed for Great-West Life & Annuity Insurance Company on the Issue Date of the
policy (unless a different Issue Date is shown here.)
/s/W.T. McCallum
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W.T. McCallum,
President and Chief Executive Officer
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