Exhibit 4(b)
HARTFORD LIFE INSURANCE COMPANY
P.O. Box 2999
Hartford, Connecticut 06104-2999
(A stock insurance company)
Certifies that a Group Annuity Contract has been issued to the
Contract Owner specified herein.
This Certificate is a summary
of the provisions of the
Group Annuity Contract
issued to the Contract Owner
named herein.
Signed for the Company
/s/ Lon A. Smith /s/ Bruce D. Gardner
Lon A. Smith, President Bruce D. Gardner, Secretary
TABLE OF CONTENTS
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Page
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Annuity Specifications 3
Definitions 4
Purchase Payment 5
Control Provisions 5
General Provisions 6
Crediting of Interest and Guarantee Periods 7
Premium Taxes 8
Termination Provisions 8
Annuity Options 10
Page 2
ANNUITY SPECIFICATIONS
DESIGNATED BENEFICIARY Mary Doe
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PURCHASE PAYMENT $5,000
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INITIAL GUARANTEE PERIOD 10 Years
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INITIAL GUARANTEE RATE 8%
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PARTICIPANT AND ANNUITANT John Doe
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CONTINGENT ANNUITANT
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CERTIFICATE ANNUITY COMMENCEMENT
NUMBER 1234567 DATE March 1, 2020
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CERTIFICATE ANNUITANT'S AGE
DATE July 1, 1990 ON CERTIFICATE DATE 45
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CONTRACT OWNER Doe and Sons Agency
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GROUP ANNUITY CONTRACT NUMBER Specimen
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Page 3
DEFINITIONS
The definitions in this section apply to the following words and phrases
whenever and wherever they appear in this certificate.
ACCOUNT VALUE - The sum of the Purchase Payment made by or on behalf of a
Participant and all interest earned to that date.
ANNUITANT - The person whose life a Certificate is issued. The Participant
must also be the Annuitant.
ANNUITY COMMENCEMENT DATE - The date shown on page 3.
BENEFICIARY - The person entitled to receive benefits as per the terms of the
Contract in case of the death of the Participant.
CERTIFICATE DATE - The date shown on page 3. Certificate Years are measured from
the Certificate Date.
COMPANY - The Hartford Life Insurance Company.
CONTINGENT ANNUITANT - The spouse of the Participant if designated by the
Participant to, upon the Participant's death prior to the Annuity Commencement
Date, become the Annuitant and also the Participant.
CONTRACT - The group annuity contract issued to the Contract Owner specified on
page 3.
CURRENT RATE - The applicable effective annual interest rate contained in a
schedule of rates established by the Company from time to time for various
durations.
DEPENDENT - The spouse or child of an employee eligible to participate in this
contract.
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 Account Value specified by the Participant for a
full surrender.
GUARANTEE PERIOD - The period for which either an Initial or Subsequent
Guarantee Rate will be credited.
INITIAL GUARANTEE PERIOD - The Guarantee Period chosen by the Participant on the
Participant Enrollment Request Form as shown on the Certificate.
INITIAL GUARANTEE RATE - The effective annual rate of interest credited to a
Purchase Payment made by or on behalf of a Participant as described in the
Crediting of Interest and Guarantee Periods section. This rate of interest is
specified in each Certificate.
Page 4
DEFINITIONS (CONTINUED)
IN WRITING - A written form satisfactory to the Company and filed at their
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 Participant on full surrender
under a certificate after the application of any Market Value Adjustment. It is
described in the Termination Provisions.
PARTICIPANT - The person specified on page 3.
SUBSEQUENT GUARANTEE RATE - The effective annual rate of interest established by
the Company for the applicable subsequent Guarantee Period.
SURRENDER DATE - The date the Company receives the written request for a
surrender.
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 Participant Enrollment Request Form. The Company reserves the
right to limit the amount of the Purchase Payment. The amount of the Purchase
Payment will be reflected in the Certificate issued upon receipt of the payment.
CONTROL PROVISIONS
ANNUITANT, CONTINGENT ANNUITANT AND PARTICIPANT
The Annuitant may not be changed. Changes in the designation of the Contingent
Annuitant who may only be the spouse of the Participant, may be made at any time
prior to the Annuity Commencement Date by written notice to the Company.
The Participant has the sole power to exercise all rights, options and
privileges granted by this Contract or permitted by The Company and to agree
with the Company to any change in or amendment to the Contract. The rights of
the Participant shall be subject to the rights of any assignee of record with
the Company and of any irrevocably designated Beneficiary. No assignment will be
effective against the Company until the assignment has been received in writing.
The Company assumes no responsibility for the validity of any assignment.
BENEFICIARY
The Designated Beneficiary will remain in effect until changed by the
Participant. Changes in the Designated Beneficiary may be made during the
lifetime of the Participant by written notice to the Company. If the Designated
Beneficiary has been designated irrevocably, however, such
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CONTROL PROVISIONS (CONTINUED)
designation cannot be changed or revoked without such Beneficiary's written
consent. Upon receipt of such notice and written consent, if required, at the
offices of the Company, the new designation will take effect as of the date the
notice is signed, whether or not the Participant is alive at the time of receipt
of such notice. The change will be subject to any payments made or other action
taken by the Company before the receipt of the notice.
In the event of the death of the Participant prior to the Annuity Commencement
Date when there is no surviving Contingent Annuitant the Beneficiary will be the
Designated Beneficiary then in effect. If there is no Designated Beneficiary in
effect or if the Designated Beneficiary is no longer living, the Participant's
estate will be the Beneficiary.
GENERAL PROVISIONS
THE CONTRACT
The Contract is an agreement between the Contract Owner and the Company. This
Certificate is a summary of the Group Annuity Contract. The Certificate
constitutes the entire Certificate.
MODIFICATION
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, an Assistant Vice President, a Secretary or an
Assistant Secretary of the Company. No modification will affect the amount or
term of any annuity 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 Participant's Account Value will be
determined.
NON-PARTICIPATING
This certificate is non-participating. It does not earn dividends.
MISSTATEMENT OF AGE
If the age of the Participant is incorrectly stated, death benefits or annuity
payments will be adjusted to the payment which would have been provided at the
correct age adjusted for any overpayments or underpayments which had been made.
Page 6
GENERAL PROVISIONS (CONTINUED)
CHANGE OF ANNUITY COMMENCEMENT DATE
The Participant may change the Annuity Commencement Date provided the
Participant notifies the Company, In Writing, 30 days before the scheduled
Annuity Commencement Date. The Annuity Commencement Date that the Participant
selects must be on or before the later of:
a) the Participant's attained age 90, or
b) the end of the Initial Guarantee Period provided such Initial
Guarantee Period is 10 years or less.
CREDITING OF INTEREST AND GUARANTEE PERIODS
The Purchase Payment (less applicable Premium Taxes, if any) will earn interest
at the Initial Guarantee Rate during the Initial Guarantee Period.
Within 30 days prior to the end of any Guarantee Period, the Company will notify
the Participant of the expiry of the current Guarantee Period, and that a
subsequent Guarantee Period of the same duration will commence, unless the
Company has:
a) received, In Writing, a request for a full surrender within 30
days prior to the end of the current Guarantee Period; or
b) received, In Writing, a request for a full surrender within 5
business days after the end of the current Guarantee Period; or
c) received, In Writing, a request for a Guarantee Period of a
different duration from among those offered by the Company at any
time within 30 calendar days prior to the end of the current
Guarantee Period; or
d) received, In Writing, a request for a Guarantee Period of a
different duration from among those offered by the Company at any
time within 5 business days after the end of the current
Guarantee Period.
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 in the
subsequent Guarantee Period. This rate will be at least equal to the Initial
Guarantee Rates being credited to Purchase Payments for new certificates for the
same duration of Guarantee Period at the time the Subsequent Guarantee Rate is
determined.
Page 7
GENERAL PROVISIONS (CONTINUED)
PREMIUM TAXES
A deduction is made for premium taxes, if applicable. On any Certificate subject
to premium tax, 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 annuity
payments commence.
TERMINATION PROVISIONS
GENERAL SURRENDERS
Full surrenders may be made under a Certificate at any time and will terminate
the Certificate. No partial surrenders may be made.
In the case of full 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 Participant. 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;
B = any unpaid premium taxes;
C = the Market Value Adjustment described below.
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
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[ 1 + J ]
I = Guarantee Rate in effect for the current Guarantee Period (expressed as a
decimal, e.g. 1% = .01).
J = The current Rate plus 0.25% (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) plus 0.25% as published by Moody's Investors Service,
Inc.
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TERMINATION PROVISIONS (CONTINUED)
N = The number of complete months from the Surrender Date to the end of the
current Guarantee Period.
SPECIAL SURRENDERS
A Market Value Adjustment will not be applied to a full surrender made at the
end of the Guarantee Period. A request for a surrender at the end of a Guarantee
Period must be received, In Writing, during the 30 day period preceding the end
of such Guarantee Period. A request for a full surrender received In Writing
within five (5) business days of the beginning of a Subsequent Guarantee Period
will be considered a Special Surrender and a Market Value Adjustment will not be
applied.
If the Participant notifies the Company, In Writing within 30 days prior to the
end of a Certificate Year, the Company will send the Participant any interest
credited during the prior Certificate Year. No Market Value Adjustment will be
imposed on such interest payments.
PAYMENT UPON SURRENDER - DEFERRAL OF PAYMENT
The Company may defer payment of any 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 totally surrender. If the Company defers payment for
more than 30 days the Company will pay interest of at least 4% per annum on the
amount deferred. The Company will not, however, defer payment of more than 30
days for any surrender effective at the end of any Guarantee Period.
DEATH BENEFIT
If the Participant dies prior to the Annuity Commencement Date and there is no
designated Contingent Annuitant surviving, the death benefit will be payable to
the Beneficiary as determined under the Contract Control Provisions. If the
death occurs on or prior to the Participant attaining age 65, then the death
benefit equals the higher of the Account Value or the Net Surrender Value as
each is calculated as of the date the Company receives written notification of
due Proof of Death. If the death occurs after the Participant attains age 65,
then the death benefit equals the Net Surrender Value.
The death benefit will be due and payable within a reasonable period of time
(not to exceed 6 months) after the Company receives Due Proof of Death. The
death benefit may be taken in one sum or under any of the annuity options
available under the contract provided however, that, any annuity option selected
must provide that any amount payable as a death benefit will be distributed
within 5 years of the date of death; or, if the annuity option selected provides
for the death benefit to be payable over a period not extending beyond the life
expectancy of the Beneficiary or over the life of the Beneficiary, such
distribution must commence within one year of the date
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ANNUITY OPTIONS
of death. Notwithstanding the previous sentence, if the Beneficiary is the
spouse of the Participant and is also the Contingent Annuitant, such spouse may
elect, in lieu of receiving the death benefit, to be treated as the Participant.
ANNUITY BENEFIT
On the Annuity Commencement Date, unless directed otherwise, the Company will
apply the Participant's Account Value multiplied by the Market Value Adjustment,
less applicable premium taxes, if any, to purchase the monthly income payments
according to the Annuity Option elected. If the Annuity Commencement Date
coincides with the end of any Guarantee Period, no Market Value Adjustment will
be applied in the determination of the monthly income payments.
ELECTION OF ANNUITY OPTIONS
The Participant may elect to have the Account Value (less applicable premium
taxes, if any) applied on the Annuity Commencement Date under any of the Annuity
Options described below or any other Annuity Option being offered by the Company
at the time of annuitization. In the absence of such election the Account Value
will be applied on the Annuity Commencement Date under the Second Option to
provide a life annuity with 120 monthly payments certain.
Election of any of these options must be made In Writing to the Company at least
30 days prior to the date such election is to become effective.
DATE OF PAYMENT
The first payment under any option shall be due on the Annuity Commencement
Date. Subsequent payments shall be made in accordance with the manner of payment
selected.
The Participant, or in the case the Participant shall have not done so, the
Beneficiary after the death of the Participant may elect in lieu of payment in
one sum, that any amount or part thereof due by the Company under this Contract
to the Beneficiary shall be applied under any one of the options stated below.
Such election must be made within one year after death of the Participant by
written notice to the office of the Company.
DEATH OF PARTICIPANT
In the event of the death of the Participant while receiving annuity payments,
the present values at the current dollar amount on the date of death of any
remaining guaranteed number of payments, or any then remaining balance of
proceeds under the Fifth Option will be paid in one sum to the Beneficiary
unless other provisions shall have been made and approved by the Company.
However, any method of distribution must provide that any amount payable as a
Page 10
ANNUITY OPTIONS (CONTINUED)
death benefit will be distributed at least as rapidly as under the method of
distribution in effect at the time of the Participant's death. 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 a certificate may not be surrendered after the
commencement of annuity payments.
ANNUITY OPTIONS
FIRST OPTION - Life Annuity - An annuity payable monthly during the lifetime of
the Participant, ceasing with the last payment due prior to the death of the
Participant.
SECOND OPTION - Life Annuity with 120, 180, or 240 Monthly Payments Certain - An
Annuity providing monthly income to the Participant for a fixed period of 120
months, 180 months, or 240 months (as selected), and for as long thereafter as
the Participant shall live.
THIRD OPTION - Cash Refund Life Annuity - An annuity payable monthly during the
lifetime of the Participant ceasing with the last payment due prior to the death
of the Participant provided that, at the death of the Participant, 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.
FOURTH OPTION - Joint and Last Survivor Life Annuity - An annuity payable
monthly during the joint lifetime of the Participant 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.
ANNUITY TABLES
The attached tables of guaranteed annuity purchase rates 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 Participant at the time the first payment is due. Under the
Fourth Option, the amount of each payment will depend upon the ages of both
payees at the time first payment is due. Actual payments will be based on
annuity rate tables currently in use, if they produce higher payments than the
guaranteed amounts.
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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 Participant.
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GROUP ANNUITY CERTIFICATE
Issued by Hartford Life Insurance Company
P.O. Box 2999
Hartford, Connecticut 06104-2999
Participant: John Doe Contract Owner: Doe and Sons Agency
Amount of Each
Annuity Payment: $100 Group Contract Number: Specimen
Date of First Payment: July 1, 1990 Frequency of Payments: Monthly
Beneficiary: Jane Doe Form of Annuity Payment: Cash Refund
Life Annuity
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This certificate is evidence that the above named Participant (herein referred
to as "you") has been issued an annuity pursuant to the provisions of a eligible
deferred compensation plan. The amount and form of this annuity is determined by
the Contract Owner specified above. Your plan will specify the method under
which your annuity payments will be made to you.
GENERAL PROVISIONS: The amount and terms of the annuity purchased for you are
subject to the provisions of the Group Annuity Contract. This Certificate
describes certain provisions of the Group Contract, but in no way voids or
alters any of the terms of that Contract.
DEATH OF ANNUITANT: If the type of annuity payment provided to you guarantees
payments to your Beneficiary after your death, the present value, at the current
dollar amount on the date of death, of any remaining payments will be paid in
one sum to the Beneficiary designated by you unless your Plan allows otherwise.
Calculation of such present value of the remaining guaranteed payments will be
based on the interest rate that is used by The Hartford to determine the amount
of each certain payment.
The Beneficiary will be the person you name, provided the name is on file with
The Hartford.
TERMINATION: Once your annuity payments have begun, you may not surrender or
terminate your annuity.
MISSTATEMENT OF AGE: If your age is incorrectly stated, the annuity payment
will be adjusted to that payment which would have been provided at the correct
age taking into account any overpayments or underpayments which had been made.
ASSIGNMENT: The Group Contract annuity provisions provides that annuity
payments, benefits and refunds are not assignable.
Signed for the Company
/s/ L.A. Smith /s/ B. Gardner
Lon A. Smith, President Bruce D. Gardner, Secretary