GROUP ANNUITY CONTRACT
HARTFORD LIFE INSURANCE COMPANY
P.O. BOX 2999
HARTFORD, CONNECTICUT 06104-2999
(A STOCK INSURANCE COMPANY)
AGREES WITH THE CONTRACT OWNER TO
PROVIDE BENEFITS AS PROVIDED HEREIN.
SIGNED FOR THE COMPANY
/S/ B. GARDNER
B. GARDNER, SECRETARY
/S/ LON A. SMITH
LON A. SMITH, PRESIDENT
NONPARTICIPATING
GROUP ANNUITY CONTRACT
FORM HL-12506
Printed in U.S.A.
TABLE OF CONTENTS
PAGE
Contract Specifications 3
Definitions 4
Purchase Payment 5
Control Provisions 5
General Provisions 6
Crediting of Interest and Guarantee Periods 6
Annual Maintenance Fee 7
Premium Taxes 7
Termination Provisions 7
Purchase of Annuity Benefits 9
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FORM HL-12506
Printed in U.S.A.
DEFINITIONS
The definitions in this section apply to the following words and phrases
whenever and wherever they appear in this contract.
ACCOUNT -- An account established for each Purchase Payment for purposes of
crediting interest, annual maintenance fees, Guarantee Periods and Surrenders.
ACCOUNT VALUE -- The sum of the Purchase Payment and all interest earned to
that date; less the sum of the Gross Surrender Value of any surrenders made
to that date; and less the sum of the annual maintenance fees deducted to
that date.
ACCOUNT YEARS -- Account Years are measured from the applicable Payment Date.
ANNUITANT -- Any Participant for whom the Contract Owner has purchased an
annuity under this contract.
ANNUITY COMMENCEMENT DATE -- The date payment of an annuity is to begin under
this contract. The determination of such date shall be made by the Contract
Owner in accordance with the terms of the plan, but will always be the tenth
day of a calendar month.
BENEFICIARY -- The person named within the Plan documents/enrollment forms by
each Participant entitled to receive benefits as per the terms of the
contract in case of the death of the Participant.
COMPANY -- The Hartford Life Insurance Company.
CONTRACT OWNER -- The person or entity specified on page 3.
CURRENT RATE -- The applicable interest rate contained in a schedule of rates
established by the Company from time to time for various durations.
DUE PROOF OF DEATH -- A certified copy of the death certificate, an order of a
court of competent jurisdiction, a statement from a physician who attended
the deceased, or any other proof acceptable to the Company.
GROSS SURRENDER VALUE -- The portion of the Account Value specified by the
Contract Owner for a full or partial surrender.
GUARANTEE PERIOD -- The period for which either an Initial or Subsequent
Guarantee Rate will be credited with respect to each Account.
INITIAL GUARANTEE PERIOD -- The Guarantee Period chosen by the Contract Owner
on the Payment Date.
INITIAL GUARANTEE RATE -- The rate of interest credited to a Purchase Payment
as described in the Crediting of Interest and Guarantee Periods section. This
rate of interest is specified in each Payment Confirmation.
IN WRITING -- A written form satisfactory to the Company and received at their
Home Office in Hartford, Connecticut. All correspondence should be sent to
P.O. Box 2999, Hartford, Connecticut 06104-2999.
NET SURRENDER VALUE -- The amount payable to the Contract Owner on full
surrender or partial surrender from an Account after the application of any
contract charges and/or Market Value Adjustment. It is described in the
Termination Provisions.
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DEFINITIONS (CONTINUED)
PARTICIPANT -- The person(s) covered by the Plan.
PAYMENT CONFIRMATION -- The confirmation issued by the Company to the Contract
Owner which evidences that a Purchase Payment has been made under this
contract and which indicates the applicable Payment Date, Initial Guarantee
Rate and Guarantee Period.
PAYMENT DATE -- The effective date of each Account under this contract and is
the date shown on each Payment Confirmation.
PLAN -- The pension or profit sharing plan maintained by the contract owner
which is qualified under Section 401 (a) of the Internal Revenue Code, Keogh
Plans and eligible state deferred compensation plans under Section 457 of the
Code.
SUBSEQUENT GUARANTEE RATE -- The rate of interest established by the Company
for the applicable subsequent Guarantee Period, but in no event less than 3%.
SURRENDER DATE -- The date the Company receives the Contract Owner's written
request for a surrender or the date requested for surrender by the Contract
Owner, if later.
PURCHASE PAYMENT
No Purchase Payment will be accepted by the Company unless it equals or
exceeds the Minimum Purchase Payment Amount specified on page 3 and is
accompanied by a properly completed purchase order request. The amount of the
Purchase Payment will be reflected in the Payment Confirmation issued upon
receipt of the payment. The Company reserves the right to limit the amount of
the Purchase Payment which will be accepted. The Company also reserves the
right to cease accepting Purchase Payments altogether after 30 days notice to
the Contract Owner.
ALLOCATION OF PURCHASE PAYMENTS
Each Purchase Payment (less applicable premium taxes, if any) will be
allocated to an Account. The Account Value will be determined in accordance
with the terms of this contract.
CONTROL PROVISIONS
CONTRACT OWNER
The designation of Contract Owner will remain in effect until changed by the
Contract Owner. Changes in the designation of the Contract Owner may be made
by written notice to the Company.
The Contract Owner has the sole power to exercise all the rights, options and
privileges granted by this contract or permitted by the Company and to agree
with the Company to any change in or amendments to the contract. The rights
of the Contract Owner shall be subject to the rights of any assignee of
record with the Company.
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CONTROL PROVISIONS (CONTINUED)
BENEFICIARY
The beneficiary is designated by the Plan to receive the death benefit in the
event of the Participant's death. If a Participant has not designated a
Beneficiary or if the Beneficiary is no longer living, the Contract Owner is
the designated Beneficiary. The Contract Owner is solely responsible for
maintaining records identifying Beneficiaries designated by each Participant.
GENERAL PROVISIONS
ENTIRE CONTRACT
This contract constitutes the entire contract.
MODIFICATION OF THE CONTRACT
This contract may be modified at any time by written agreement between the
Contract Owner and the Company. The modification must be signed by the
President, a Vice President, Secretary or an Assistant Secretary of the
Company. No modification will affect the amount or term of any annuities
begun prior to the effective date of the modification unless it is required to
conform the contract to, or give the Contract Owner the benefit of, any
Federal or State statutes. No modification of this contract will affect the
method by which any then existing Account Value will be determined.
NON-PARTICIPATING
This contract is non-participating. It does not earn dividends.
TRANSFERS BETWEEN GUARANTEE PERIODS
Once each Account Year, the Contract Owner may elect, in writing, to transfer
out of the current Guarantee Period and into a Guarantee Period of different
duration. At that time, a new Guarantee Period will be established for the
duration chosen by the Contract Owner, and the Account Value at the beginning
of the new Guarantee Period will equal the Account Value for the current
Guarantee Period multiplied by the Market Value Adjustment for the current
Guarantee Period. The Company reserves the right to charge for any such
transfer by reducing the Account Value at the beginning of the new Guarantee
Period by an amount not to exceed $50.00.
Surrender charges will continue to be based on the appropriate Account Year as
determined from the original, applicable purchase payment date.
MISSTATEMENT OF AGE
If the age of an Annuitant has been misstated, the amount of the annuity
payable by the Company shall be that provided by that portion of the amounts
allocated to effect such annuity on the basis of the corrected information
without changing the date of the first payment of such annuity. Any
underpayments by the Company shall be made up immediately and any overpayments
shall be charged against future amounts becoming payable.
If the age of the Participant has been misstated, the amount of any death
benefit shall be determined based upon the correct age of the Participant.
CREDITING OF INTEREST AND GUARANTEE PERIODS
Each Purchase Payment (less the Gross Surrender Value of all surrenders made
and less applicable Premium Taxes, if any) will earn interest at the Initial
Guarantee Rate, compounded annually, each Account Year during the initial
Guarantee Period.
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Within 30 days prior to the end of any Guarantee Period, the Company will
notify the Contract Owner of the expiry of the current Guarantee Period, and
that a subsequent Guarantee Period of the same duration will commence, unless
the Contract Owner has:
a) requested, In Writing, a full surrender within 30 days prior to
the end of the current Guarantee Period; or
b) elected, In Writing, a Guarantee Period of a different duration
from among those offered by the Company at any time within 45
days prior to the end of the current Guarantee Rate is determined.
The Account Value at the beginning of any subsequent Guarantee Period will be
equal to the Account Value at the end of the Guarantee Period just ending.
The Account Value will earn interest at the subsequent Guarantee Rate,
compounded annually, in the subsequent Guarantee Period. This rate will be at
least equal to the Initial Guarantee Rates being credited to Purchase Payments
for new contracts at the time the subsequent Guarantee Rate is determined.
ANNUAL MAINTENANCE FEE
With respect to each Account, at the end of each Account Year and in the event
of a full surrender of an Account prior to the end of an Account Year, a fee
will be deducted from each Account. The annual maintenance fee for each
Account Year is shown on page 3.
PREMIUM TAXES
A deduction is also made for premium taxes, if applicable. The tax will be
deducted, as provided under applicable law, from the Purchase Payment when
received, or from the Gross Surrender Value upon surrender, or from the amount
applied to effect an annuity at the time the annuity is purchased.
TERMINATION PROVISIONS
GENERAL SURRENDERS
Full surrenders may be made from an Account at any time. Partial surrenders
may only be made if:
a) the Gross Surrender Value is at least $1,000; and
b) the remaining Account Value after the Gross Surrender Value has
been deducted is at least $5,000.
In the case of all surrenders the Account Value will be reduced by the Gross
Surrender Value on the Surrender Date and the Net Surrender Value will be
payable to the Contract Owner. Except as provided for in the Special
Surrenders Section, the Net Surrender Value is calculated by the Company on a
daily basis as follows:
(A - B) x C, where:
A = the Gross Surrender Value reduced by any applicable annual
maintenance fee;
B = the surrender charge shown on page 3, plus any unpaid
premium taxes;
C = the Market Value Adjustment described below.
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TERMINATION PROVISIONS (CONTINUED)
MARKET VALUE ADJUSTMENT
The formula which will be used to determine the Market Value Adjustment is
calculated by the Company on a daily basis as follows:
-- --
: 1 + I : N/12
: -------- :
: 1 + J :
-- --
I = Guaranteed Rate in effect for the current Guarantee Period
(expressed as a decimal, e.g. - 1% = .01).
J = The Current Rate (expressed as a decimal, e.g. - 1% = .01) in
effect for durations equal to the number of years remaining in
the current Guarantee Period (years are rounded to the next
highest number of years). If not available, the Company will
utilize a rate equal to the most recent Moody's Corporate Bond
Yield Average -- Monthly Average Corporates (for the applicable
duration) as published by Moody's Investors Service, Inc.
N = The number of complete months from the Surrender Date to the end
of the current Guarantee Period.
SPECIAL SURRENDERS
A full or partial surrender made at the end of a Guarantee Period may be
subject to a surrender charge as set forth on page 3. A Market Value
Adjustment will not be applied. A request for a surrender at the end of a
Guarantee Period must be received In Writing at least 30 days prior to the
end of such Guarantee Period.
In addition, if the Contract Owner notifies the Company In Writing, the
Company will send the Contract Owner any interest credited during the twelve
month period prior to the written request. No Surrender Charge or Market
Value Adjustment will be imposed on such interest payments.
PAYMENT UPON SURRENDER -- DEFERRAL OF PAYMENT
The Company may defer payment of any partial or total surrender for the period
permitted by law. In no event will this deferral of payment exceed 6 months
from date of receipt of the election to partially or totally surrender. If
the Company defers payment for more than 30 days, interest of at least 4 1/2%
per annum on the amount deferred will be paid. The Company will not, however,
defer payment for more than 30 days for any surrender effective at the end of
any Guarantee Period or for any surrender applied to purchase an annuity.
DEATH BENEFIT
In order to maintain the death benefit as described, the Company requires that
detailed accounting of cumulative purchase payments, cumulative gross
surrenders and current Account Value attached to each Plan Participant be
submitted to the Company on an annual basis by the Contract Owner. Failure to
submit accurate data satisfactory to the Company will give the Company the
right to terminate this extension of benefits.
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TERMINATION PROVISIONS (CONTINUED)
If the Participant dies before the Annuity Commencement Date established by
the Plan, a death benefit will be payable to the designated beneficiary or
Contract Owner as determined by the Plan. The death benefit equals the
proportional Account Value allocated to the Participant as of the date the
Company receives written notification of Due Proof of Death. Notification
should be accompanied by a detailed accounting of cumulation purchase
payments, cumulation gross surrenders and current Account Values updated for
the Participant from the date of the last annual report to the date of death.
The death benefit will be due and payable within a reasonable period of time
(not to exceed 6 months) after the date the Company receives Due Proof of
Death. The death benefit may be taken in one sum or under any of the
settlement options then being offered by the Company. If accounting
requirements are not provided to the satisfaction of the Company, the
Contract Owner may elect partial surrender of the Account Value, with charges
as applicable, to provide settlement.
PURCHASE OF ANNUITY BENEFITS
ANNUITY BENEFIT
In order to maintain the Annuitization benefit as described, the Company
requires that detailed accounting of cumulative purchase payments, cumulative
gross surrenders and current Account Value attached to each Participant be
submitted on an annual basis by the Contract Owner. Failure to submit
accurate data satisfactory to the Company will give the Company the right to
terminate this extension of benefits.
On the Annuity Commencement Date established by the Plan for each
Participant, the Company will, as directed by the Contract Owner, apply the
proportional Account Value allocated to the Participant multiplied by the
Market Value Adjustment, if any, less applicable premium taxes, if any, to
purchase the monthly income payments according to the Annuity Option elected.
Any annuity benefits payable hereunder are nonassignable.
An annuity election should be accompanied by a detailed accounting of
cumulative purchase payments, cumulative gross surrenders and current Account
Value updated for the Participant from the date of the last semi-annual
report to the date of request for annuity.
If accounting requirements are not provided to the satisfaction of the
Company, the Contract Owner may elect partial surrender of Account Values,
with charges as applicable, to purchase an annuity.
ELECTION
Election of any of these options or any of the settlement options then being
offered by the Company must be made In Writing to the office of the Company
in Hartford, Connecticut at least 30 days prior to the date such election is
to become effective. The amount and form of such annuity shall be determined
by the Contract Owner in accordance with the terms of the Plan. The following
information must be provided with any such request:
a) the Participants name, address, date of birth, social security
number; and
b) the amount which is to be distributed to the Participant in the form
of an annuity; and
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PURCHASE OF ANNUITY BENEFITS (CONTINUED)
c) the form of annuity which is to be purchased for the Participant as
determined in accordance with the provisions of the Annuity Options
and the date annuity payments are to commence; and
d) if the form of annuity applicable to the Participant provides a death
benefit in the event of his death, the name, relationship and address
of the Beneficiary most recently designated by the Participant in
accordance with the provisions of the Plan; and
e) if the form of annuity applicable to the Participant is the Fourth
Option, Joint and Last Survivor Life Annuity, the name, address and
date of birth of the designated secondary payee together with the
percentage (from those percentages then being made available by the
Company) of the annuity payments which are to be continued and paid
to the surviving payee; and
f) any other data that may reasonably be required by the Company.
DATE OF PAYMENT
The first payment under any option shall be made on the tenth day of the
month following the Annuity Commencement Date. Subsequent payments shall be
made on the tenth day of each month in accordance with the manner of payment
selected.
DEATH OF ANNUITANT
In the event of the death of the Annuitant while receiving annuity payments,
the present values at the current dollar amount on the date of death of any
remaining guaranteed payments, or any then remaining balance of proceeds under
the Fifth Option, will be paid in one sum to the Beneficiary unless other
provisions have been requested and approved by the Company. Calculations of
such present value of the guaranteed payments remaining will be based on the
interest rate that is used by the Company to determine the amount of each
certain payment.
TERMINATION AFTER THE ANNUITY COMMENCEMENT DATE
An annuity effected under this Contract may not be surrendered after the
commencement of annuity payments.
ANNUITY OPTIONS
FIRST OPTION -- Life Annuity -- An annuity payable monthly during the lifetime
of Annuitant, ceasing with the last payment due prior to the death of the
Annuitant.
SECOND OPTION -- Life Annuity with 120, 180, or 240 Monthly Payments Certain --
An annuity providing monthly income to the Annuitant for a fixed period of
120 months, 180 months or 240 months (as selected), and for as long
thereafter as the Annuitant shall live.
THIRD OPTION -- Cash Refund Life Annuity -- An annuity payable monthly during
the lifetime of the Annuitant, ceasing with the last payment due prior to the
death of the Annuitant provided that, at the death of the Annuitant, the
Beneficiary will receive an additional payment equal to the excess, if any,
of (a) over (b) where (a) is the Account Value applied on the Annuity
Commencement Date under this option and (b) is the dollar amount of annuity
payments already paid.
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FOURTH OPTION -- Joint and Last Survivor Life Annuity -- An annuity payable
monthly during the joint lifetime of the Annuitant and a secondary payee, and
thereafter during the remaining lifetime of the survivor, ceasing with the
last payment prior to the death of the survivor.
*FIFTH OPTION -- Payments for a Designated Period -- An amount payable monthly
for the number of years selected which may be from 5 to 30 years.
* If this contract is issued to qualify under Section 401, 403, or 408 of the
Internal Revenue Code of 1954 as amended, these options shall be available
only if the guaranteed payment period is less than the life expectancy of the
Annuitant at the time the option becomes effective. Such life expectancy will
be computed under the mortality table then in use by the Company.
ANNUITY TABLES
The attached tables show the dollar amount of the monthly payments for each
$1,000 applied under the five options. Under the First, Second, or Third
Options, the amount of each payment will depend upon the age of the Annuitant
at the time the first payment is due. Under the Fourth Option, the amount of
each payment will depend upon the age of both payees at the time first
payment is due.
DESCRIPTION OF TABLES
The tables for the First, Second, Third and Fourth Options are based on the
1983a Individual Annuity Mortality Table with ages set back one year and a
net investment rate of 4% per annum. The table for the Fifth Option is based
on a net investment rate of 4% per annum.
MINIMUM PAYMENT
The option elected must result in a payment of an amount at least equal to
the minimum payment amount according to Company rules then in effect. If at
any time payments are less than the minimum payment amount, the Company has
the right to change the frequency to an interval resulting in a payment at
least equal to the minimum. If any amount due is less than the minimum per
year, the Company may make other arrangements that are equitable to the
Annuitant.
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AMOUNT OF FIRST MONTHLY PAYMENT
FOR EACH $1,000 APPLIED
FIRST, SECOND AND THIRD OPTIONS--SINGLE LIFE ANNUITIES WITH:
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Payee's Cash
Age Monthly Payments Guaranteed Refund
- ------------------------------------------------------------------------------------------
None 120 180 240
---- ----- ----- -----
35 $3.94 $3.94 $3.93 $3.92 $3.91
40 4.11 4.10 4.09 4.07 4.07
45 4.33 4.31 4.29 4.25 4.25
50 4.61 4.58 4.54 4.48 4.50
51 4.68 4.64 4.59 4.53 4.54
52 4.75 4.70 4.65 4.58 4.60
53 4.82 4.77 4.71 4.63 4.66
54 4.89 4.84 4.78 4.69 4.73
55 4.98 4.92 4.85 4.74 4.79
56 5.06 5.00 4.92 4.80 4.86
57 5.15 5.08 4.99 4.86 4.94
58 5.25 5.17 5.07 4.92 5.02
59 5.35 5.26 5.14 4.98 5.09
60 5.46 5.36 5.23 5.05 5.20
61 5.58 5.46 5.31 5.11 5.27
62 5.70 5.57 5.40 5.18 5.38
63 5.84 5.68 5.49 5.24 5.48
64 5.98 5.80 5.59 5.30 5.60
65 6.13 5.93 5.69 5.37 5.73
66 6.30 6.06 5.78 5.43 5.86
67 6.48 6.20 5.88 5.49 5.97
68 6.66 6.35 5.99 5.55 6.13
69 6.87 6.50 6.09 5.60 6.29
70 7.08 6.66 6.19 5.65 6.47
75 8.44 7.52 6.67 5.85 7.49
80 10.41 8.43 7.03 5.96 8.96
FOURTH OPTION--JOINT AND LAST SURVIVOR ANNUITY
First Payee's Age of Second Payee
Age 35 40 45 50 55 60 65 70 75 80
-----------------------------------------------------------------------------------------------------
35 $3.62 $3.66 $3.70 $3.73 $3.76 $3.78 $3.80 $3.82 $3.83 $3.84
40 3.66 3.73 3.78 3.83 3.87 3.91 3.94 3.96 3.98 3.99
45 3.70 3.78 3.86 3.93 4.00 4.06 4.10 4.14 4.16 4.19
50 3.73 3.83 3.93 4.04 4.13 4.22 4.29 4.35 4.39 4.43
55 3.76 3.87 4.00 4.13 4.27 4.39 4.51 4.60 4.67 4.73
60 3.78 3.91 4.06 4.22 4.39 4.57 4.74 4.90 5.02 5.12
65 3.80 3.94 4.10 4.29 4.51 4.74 4.99 5.23 5.44 5.60
70 3.82 3.96 4.14 4.35 4.60 4.90 5.23 5.57 5.90 6.20
75 3.83 3.98 4.16 4.39 4.67 5.02 5.44 5.90 6.40 6.87
80 3.84 3.99 4.19 4.43 4.73 5.12 5.60 6.20 6.87 7.58
The monthly payment for any combination of ages not shown will be quoted upon
request.
FIFTH OPTION--PAYMENTS FOR A DESIGNATED PERIOD
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Amount Amount Amount Amount Amount Amount
No. of No. of No. of No. of No. of No. of
of Monthly of Monthly of Monthly of Monthly of Monthly of Monthly
Years Payments Years Payments Years Payments Years Payments Years Payments Years Payments
- ---------------------------------------------------------------------------------------------------------------------------------
5 $18.32 10 $10.06 15 $7.34 20 $6.00 25 $5.22 30 $4.72
6 15.56 11 9.31 16 7.00 21 5.81 26 5.10
7 13.59 12 8.69 17 6.71 22 5.64 27 5.00
8 12.12 13 8.17 18 6.44 23 5.49 28 4.90
9 10.97 14 7.72 19 6.21 24 5.35 29 4.80
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[LOGO] THE HARTFORD
DISABILITY RIDER
This rider is issued as a part of the Contract to which it is attached. The
Date of Issue and Contract Date applicable to this rider are the same as that
of the Contract. Except where this rider provides otherwise, it is subject to
all conditions and limitations of such Contract.
WAIVER OF CONTINGENT DEFERRED SALES CHARGE
THE BENEFIT
In order to maintain the Waiver of Contingent Deferred Sales Charge Benefit
as described, the Company requires that detailed accounting of cumulative
purchase payments, cumulative gross surrenders and current Account Value
attached to each Participant be submitted on an annual basis by the Contract
Owner. Failure to submit accurate data satisfactory to the Company will give
the Company the right to terminate this Waiver of Deferred Sales Charge
Benefit.
We will waive the contingent deferred sales charge which would occur as a
result of partial or full surrender of the Contract Values if, prior to age
65, the Participant becomes totally disabled and is totally disabled at the
time of surrender request.
To qualify for this benefit, the Contract Owner must provide written proof,
satisfactory to the Company, that the Participant is totally disabled.
DEFINITION OF TOTAL DISABILITY
Total Disability means a disability which:
(a) results from bodily injury or disease;
(b) begins while this contract and this rider are in force;
(c) has existed continuously for at least 12 months; and
(d) prevents the Participant from engaging in an occupation.
During the first 12 months of disability, occupation means the Participant's
regular occupation. Thereafter, occupation means that for which the
Participant is reasonably fitted by:
(a) education;
(b) training; or
(c) experience.
If accounting requirements are not provided to the satisfaction of the
Company, the Contract Owner may elect partial surrender of Account Values,
with charges as applicable, to provide settlement.
Signed for THE HARTFORD LIFE INSURANCE COMPANY
/s/ Bruce D. Gardner /s/ Lowndes A. Smith
Bruce D. Gardner, SECRETARY Lowndes A. Smith, PRESIDENT