ADJUSTABLE BENEFIT TERM RIDER
JOINT AND LAST SURVIVOR
Issued by Cova Financial Services Life Insurance Company
Please Read This Rider Carefully.
This rider is a part of the policy to which it is attached and is subject to all
applicable terms and provisions of that policy; except as modified herein. This
rider is indicated on the Policy Specifications page.
Life Insurance This rider provides non-convertible term life insurance on the lives of the insureds shown
Benefit on the policy specifications page. We will pay the face amount of this rider to the
beneficiary if this rider is in force upon the Last Insured's death.
Adjustable On any monthly policy anniversary, while this rider is in force an adjustment in the face
Benefit Term amount of this rider equal to the Adjustable Benefit Term Amount may be requested.
Dates
Adjustable The Adjustable Benefit Term Amount is the amount necessary to conform the total of the
Benefit Term death benefit of the policy and this rider to the benefit provided under your employee
Amount benefit plan. (The policy to which this rider is attached has been issued in conjunction with
an employee benefit plan.) The Adjustable Benefit Term Amount could be an increase, as
well as a decrease.
Each Adjustable Benefit Term Amount that is an increase will be subject to the following
conditions:
1. It must adjust the face amount at least $1,000. If the Adjustable Benefit Term Amount is
less than $1,000, no adjustment will occur.
2. The maximum annual Adjustable Benefit Term Amount is 20% of the total death benefit
of the base policy and this rider on the prior policy anniversary. Depending on our
company rules at the time this rider is issued, we may include the face amounts of
other riders attached to the policy when determining the maximum annual Adjustable
Benefit Term Amount.
Face Amount When an adjustment under this rider is made, the face amount of this rider will increase or
decrease accordingly. The face amount of this rider will expire at the younger Insured's
attained age 100.
Monthly Cost The monthly cost of insurance for the following month is deducted on the monthly
of Insurance anniversary date. The monthly cost of insurance is the monthly cost of insurance rate for
this rider divided by 1,000 times the face amount of this rider.
Monthly Cost The monthly cost of insurance rate for this benefit is based on the attained ages, risk
of Insurance classifications, (in a non-unisex policy) sexes of the insureds and the completed policy
Rates years from the issue date. Monthly cost of insurance rates will be determined by us based
on expectations as to future experience. However, these rates will not exceed those shown
in the Table of Guaranteed Monthly Cost of Insurance Rates for the Adjustable Benefit
Term Rider.
Each monthly anniversary this rider is in force, the monthly cost of insurance for this rider
(as determined above) will be added to the monthly deductions as defined in the Cash
Values section of the policy. This increased monthly deduction will be used to determine
the cash value of the policy on such monthly anniversary.
Monthly Rider Each monthly anniversary this rider is in force, a monthly rider charge will be added to the
Charge monthly deductions of the policy. This increased monthly deduction will be used to
determine the cash value of the policy on such monthly anniversary. The monthly rider
charge will never exceed the Monthly Rider Charge for the Adjustable Benefit Term Rider
shown on the policy specifications page.
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Selection and The selection and issue expense charge for this rider is a monthly charge which equals the
Issue Expense rider's face amount times this rider's selection and issue expense charge rate, divided by
Charge 1,000. Each monthly anniversary this rider is in force, a selection and issue expense charge
will be added to the monthly deductions of the policy. This increased monthly deduction
will be used to determine the cash value of the policy on such monthly anniversary. The
selection and issue expense charge rate for this rider will never exceed the Selection and
Issue Expense Charge rate for the Adjustable Benefit Term Rider shown on the policy
specifications page.
Rejection of You will be notified of each adjustment requested under this rider. Each adjustment will be
Adjustment automatic. However, you may reject an increase by notifying us in writing within 30 days
after the policy anniversary on which the increase is made. If you reject two consecutive
increases, no further increases will be made under this rider. You may not reject an
adjustment which is a decrease.
Evidence of Evidence of insurability satisfactory to us may be required for an adjustment that would
Insurability result in an increase after the younger insured attains age 65. Failure to provide such
evidence will result in the increase being declined and no further increases under this rider
will be made.
Partial If a partial withdrawal of cash from the policy to which this rider is attached is required to
Withdrawal conform to the terms of the employee benefit plan, the maximum withdrawal limits in the
policy will not apply to such partial withdrawal. Any decrease in face amount due to the
partial withdrawal will reduce the face amount of the rider first.
Termination No adjustments that result in an increase under this rider will be made after any of the
following events first occurs:
a) the second consecutive rejection of an increase; or
b) the receipt of your request to decrease the base policy's face amount; or
c) any partial withdrawal not required to conform to the terms of the employee benefit
plan that reduces the face amount.
No adjustments will be made under this rider once you are no longer eligible for
adjustments according to your employee benefit plan.
The issue date and effective date of this rider and the policy are the same.
SECRETARY PRESIDENT
COVA
Cova Financial Services Life Insurance Company
St. Louis, Missouri
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