Exhibit 4(d)
[LOGO OF
JOHN HANCOCK Variable Life Insurance Company
APPEARS HERE]
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NURSING HOME WAIVER OF CONTINGENT DEFERRED SALES LOAD ("CDSL") RIDER WAIVER OF
CDSL IN EVENT OF OWNER'S CONFINEMENT TO NURSING HOME FACILITY AS DEFINED AND
LIMITED
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We agree, subject to the terms and conditions of this Rider and the certificate,
to waive any applicable Contingent Deferred Sales Load ("CDSL") prior to the
date annuity payments have commenced if beginning at least 30 days after the
Date of Issue all of the following conditions have been met:
1. you become confined to a Nursing Home Facility for at least 90 consecutive
days;
2. you are receiving Skilled Nursing Care;
3. such Skilled Nursing Care is based on a Physician's plan in accordance with
accepted standards of medical practice, and is Medically Necessary;
4. such Skilled Nursing Care is needed because of your inability to perform at
least two of the Activities of Daily Living without Human Assistance because
of either Physical Impairment or Cognitive Impairment;
5. such Skilled Nursing Care is received while the certificate is in force, and
is not assigned; and
6. the written request for a withdrawal and adequate proof of confinement on a
form satisfactory to us is received by us no later than 90 days after
discharge from a Nursing Home Facility.
This Rider is made a part of the certificate to which it is attached, in
consideration of: (a) the application, a copy of which is attached to and made a
part of the certificate; and (b) payment of the applicable rider charge as shown
on page 3 of the certificate. This Rider may not be issued subsequent to the
Date of Issue of the certificate.
Definitions
"Activities of Daily Living" means the following activities:
Dressing, which means your ability to get clothes from closets or drawers and
put them on and take them off, including undergarments, outer garments, and the
use of fasteners and braces, if worn. Dressing includes the ability to fasten
your shoes and to put on and take off any artificial limbs.
Eating, which means feeding yourself once the meal has been prepared and made
available. Feeding yourself is specifically the ability to bring food,
including beverages, to your mouth and the ability to chew and swallow food.
Eating includes your ability to administer yourself any tube feedings or
nutrition through a catheter into the blood stream, if required. Eating does
not include the preparation of food.
Toileting, which means your ability to get to and from the toilet, get onto and
off of the toilet, clean oneself after elimination, perform associated personal
hygiene, and adjust your clothing after toileting. If you have an ostomy or
catheter, toileting includes your ability to empty the ostomy equipment.
Transferring from bed to chair, which means your ability to get into or out of a
bed of chair even if you use canes, quad canes, walkers, crutches, grab bars or
other support devices.
Maintaining continence, which means your ability to maintain control of
urination and bowel movements. Maintaining continence includes your ability to
use ostomy supplies or other devices such as catheters.
"Cognitive Impairment" means loss of intellectual functioning (such as thinking,
remembering, and reasoning) which interferes with a person's ability to perform
the Activities of Daily Living. An individual with a Cognitive Impairment would
require Human Assistance in the form of verbal direction and/or supervision in
order to perform the Activities of Daily Living.
NURSC96 VNH01
"Human Assistance" means physical, hands on, assistance in the case of Physical
Impairment or verbal direction or supervision in the case of a Cognitive
Impairment, which helps another person to perform Activities of Daily Living.
"Medically Necessary" means appropriate and consistent with the diagnosis in
accord with accepted standards of practice, and which could not have been
omitted without adversely affecting the individual's condition.
"Nursing Home Facility" means a facility which meets all of the following
requirements:
1. it is located in the United States or its territories;
2. it is licensed and operated to provide Skilled Nursing Care for a charge
including room and board, according to the laws of the jurisdiction in which
it is located;
3. it must administer programs of treatment and observation that are ordered by
and are part of a Physician's plan of care;
4. it provides Skilled Nursing Care under the supervision of a registered nurse
(RN); and
5. can accommodate three or more persons.
Nursing Home Facility does not include any of the following:
. any home health care, including a place owned or operated by your spouse,
children, parents, grandparents, grandchildren, siblings, or in-laws;
. a hospital, regardless of whether it provides Skilled Nursing Care;
. a rest home, adult day care center, or assisted care living facility that
does not provide, as its primary function, Skilled Nursing Care.
"Physical Impairment" means a loss of physical functioning which interferes with
a person's ability to perform the Activities of Daily Living. A person with a
physical impairment would require hands-on Human Assistance in order to perform
the Activities of Daily Living.
"Physician" is a licensed medical doctor (MD) or a licensed doctor of osteopathy
(DO) practicing within the scope of his or her license. Physician does not
include you, a spouse, children, parents, grandparents, grandchildren, siblings,
or in-laws.
"Skilled Nursing Care" means nursing care that meets all of the following
requirements:
1. its primary function is to provide daily professional nursing care for your
benefit.
2. it is performed under the orders of a Physician;
3. it is performed by a registered nurse, licensed vocational nurse, licensed
practical nurse, physical therapist, occupational therapist, speech
therapist, respiratory therapist, or registered dietician;
4. it is available on a 24-hour basis.
"You" and "Your" mean the Participant as shown on page 3 of the certificate.
NURSC96 VNH02
Termination
This Rider will terminate on the earliest of the following:
1. termination of the certificate;
2. the lapse or exchange of the certificate;
3. your written request to discontinue the Rider;
4. the Annuitant's death;
5. the Date of Maturity of the certificate.
Signed for the Company at Boston, Massachusetts.
Secretary
NURSC96 VNH03
[LOGO OF
JOHN HANCOCK Variable Life Insurance Company
APPEARS HERE]
- --------------------------------------------------------------------------------
NURSING HOME WAIVER OF CONTINGENT DEFERRED SALES LOAD ("CDSL") RIDER WAIVER OF
CDSL IN EVENT OF OWNER'S CONFINEMENT TO NURSING HOME FACILITY AS DEFINED AND
LIMITED
- --------------------------------------------------------------------------------
We agree, subject to the terms and conditions of the Rider and the certificate,
to waive any applicable Contingent Deferred Sales Load ("CDSL") prior to the
date annuity payments have commenced if beginning at least 30 days after the
Date of Issue all of the following conditions have been met:
1. the Participant becomes confined to a Nursing Home Facility for at least 90
consecutive days;
2. the Participant is receiving Skilled Nursing Care;
3. such Skilled Nursing Care is based on a Physician's plan in accordance with
accepted standards of medical practice, and is Medically Necessary;
4. such Skilled Nursing Care is needed because of the Participant's inability to
perform at least two of the Activities of Daily Living without Human
Assistance because of either Physical Impairment or Cognitive Impairment;
5. such Skilled Nursing Care is received while the certificate is in force, and
is not assigned; and
6. the written request for a withdrawal and adequate proof of confinement on a
form satisfactory to us is received by us no later than 90 days after
discharge from a Nursing Home Facility.
The Rider is made a part of the certificate to which it is attached, in
consideration of: (a) the application, a copy of which is attached to and made a
part of the certificate; and (b) payment of the applicable rider charge as shown
on page 3 of the certificate. The Rider may not be issued subsequent to the
Date of Issue of the certificate.
Definitions
"Activities of Daily Living" means the following activities:
Dressing, which means the Participant's ability to get clothes from closets or
drawers and put them on and take them off, including undergarments, outer
garments, and the use of fasteners and braces, if worn. Dressing includes the
ability of the Participant to fasten shoes and to put on and take off any
artificial limbs.
Eating, which means feeding oneself once the meal has been prepared and made
available. Feeding oneself is specifically the Participant's ability to bring
food, including beverages, to the Participant's mouth and the ability to chew
and swallow food. Eating includes the Participant's ability to administer to
oneself any tube feedings or nutrition through a catheter into the blood stream,
if required. Eating does not include the preparation of food.
Toileting, which means the Participant's ability to get to and from the toilet,
get onto and off of the toilet, clean oneself after elimination, perform
associated personal hygiene, and adjust one's clothing after toileting. If
Participant has an ostomy or catheter, toileting includes the Participant's
ability to empty the ostomy equipment.
Transferring from bed to chair, which means the Particpant's ability to get into
or out of a bed of chair even if the Participant uses canes, quad canes,
walkers, crutches, grab bars or other support devices.
Maintaining continence, which means the Participant's ability to maintain
control of urination and bowel movements. Maintaining continence includes the
Participant's ability to use ostomy supplies or other devices such as catheters.
"Cognitive Impairment" means loss of intellectual functioning (such as thinking,
remembering, and reasoning) which interferes with a person's ability to perform
the Activities of Daily Living. An individual with a Cognitive Impairment would
require Human Assistance in the form of verbal direction and/or supervision in
order to perform the Activities of Daily Living.
NURSG96 VNH01
"Human Assistance" means physical, hands on, assistance in the case of Physical
Impairment or verbal direction or supervision in the case of a Cognitive
Impairment, which helps another person to perform Activities of Daily Living.
"Medically Necessary" means appropriate and consistent with the diagnosis in
accord with accepted standards of practice, and which could not have been
omitted without adversely affecting the individual's condition.
"Nursing Home Facility" means a facility which meets all of the following
requirements:
1. it is located in the United States or its territories;
2. it is licensed and operated to provide Skilled Nursing Care for a charge
including room and board, according to the laws of the jurisdiction in which
it is located;
3. it must administer programs of treatment and observation that are ordered by
and are part of a Physician's plan of care;
4. it provides Skilled Nursing Care under the supervision of a registered nurse
(RN); and
5. can accommodate three or more persons.
Nursing Home Facility does not include any of the following:
. any home health care, including a place owned or operated by the
Participant's spouse, children, parents, grandparents, grandchildren,
siblings, or in-laws;
. a hospital, regardless of whether it provides Skilled Nursing Care;
. a rest home, adult day care center, or assisted care living facility that
does not provide, as its primary function, Skilled Nursing Care.
"Physical Impairment" means a loss of physical functioning which interferes with
a person's ability to perform the Activities of Daily Living. A person with a
physical impairment would require hands-on Human Assistance in order to perform
the Activities of Daily Living.
"Physician" is a licensed medical doctor (MD) or a licensed doctor of osteopathy
(DO) practicing within the scope of his or her license. Physician does not
include the Participant, the Participant's spouse, children, parents,
grandparents, grandchildren, siblings, or in-laws.
"Skilled Nursing Care" means nursing care that meets all of the following
requirements:
1. its primary function is to provide daily professional nursing care for the
Participant's benefit.
2. it is performed under the orders of a Physician;
3. it is performed by a registered nurse, licensed vocational nurse, licensed
practical nurse, physical therapist, occupational therapist, speech
therapist, respiratory therapist, or registered dietician;
4. it is available on a 24-hour basis.
NURSG96 VNH02
Termination
The Rider will terminate on the earliest of the following:
1. termination of the certificate;
2. the lapse or exchange of the certificate;
3. the Participant's written request to discontinue the Rider;
4. the Annuitant's death;
5. the Date of Maturity of the certificate.
Signed for the Company at Boston, Massachusetts.
Secretary
NURSG96 VNH03