Exhibit 1.A.(5)(b)
3E-5ACC-02
ACCELERATION OF DEATH BENEFIT RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
THE WAITING PERIODS FOR SUICIDE AND INCONTESTABILITY ARE DIFFERENT FROM THOSE IN
THE POLICY AND BEGIN ON THE ISSUE DATE OF THE RIDER.
This Rider is subject to all applicable terms and provisions of the Policy,
except as modified herein. This Rider is a part of the Policy if it is listed on
the Policy Specifications page or on the Policy Specifications page for Policy
Change. A copy of the application for this Rider is attached to and made a part
of the Rider.
IMPORTANT: THE BENEFIT PAYMENTS UNDER THIS RIDER MAY BE TAXABLE OR MAY AFFECT
ELIGIBILITY FOR BENEFITS UNDER STATE OR FEDERAL LAW. YOU SHOULD CONSULT YOUR TAX
ADVISER TO DETERMINE THE EFFECT ON YOU.
DEFINITIONS "Eligible Proceeds" are the Policy Proceeds as defined in
your Policy plus any amount of benefit provided by a rider
that we consent to apply to an Accelerated Death Benefit.
"Accelerated Death Benefit" is the amount we will pay
under this Rider if we receive proof that the Insured is
terminally ill.
We will compute the Accelerated Death Benefit based on the
following:
1. The amount of Eligible Proceeds you choose to
accelerate. (See Amount of Accelerated Death
Benefit);
2. Reduced life expectancy;
3. An Interest Rate no greater than the greater of:
a. The current yield on 90 day treasury bills; and
b. The current maximum statutory adjustable policy
loan interest rate; and
4. A processing charge not to exceed $150.
This method of computation has been filed with the
insurance supervisory official of the state that governs
your Policy. We may change the assumptions we use from
time to time.
"Terminally ill" means having a life expectancy of 12
months or less.
AMOUNT OF You may choose to accelerate all or part of the Eligible
ACCELERATED DEATH Proceeds to your Accelerated Death Benefit subject to the
BENEFIT following conditions:
1. You must apply at least $20,000.
2. You cannot apply more than the greater of:
a. $250,000; and
b. 10% of the Eligible Proceeds under this and all
other similar riders issued by us and our
affiliates.
3. The Face Amount of your Policy after payment of a
partial Accelerated Death Benefit must be at least
$50,000.
CONDITIONS Your right to the Accelerated Death Benefit under this
Rider is subject to the following:
1. You must provide proof satisfactory to us, including
a statement signed by a physician, that the Insured
is terminally ill. The physician may not be you, the
Insured, or a member of the Insured's family. We have
the right to have the Insured examined at our expense
by a physician we choose.
2. You must make a written request for payment in a form
acceptable to us.
3. Any irrevocable beneficiary must give written consent
for payment in a form acceptable to us.
4. Any assignee must give written consent for payment in
a form acceptable to us.
5. We may require the Policy for endorsement.
6. You may request only one Accelerated Death Benefit
under this Rider.
7. Insurance subject to incontestability and suicide
provisions will not be included in the Eligible
Proceeds.
8. Your Policy is not eligible for this benefit if:
a. You are required by law to use this Rider to meet
the claims of creditors, whether in bankruptcy or
otherwise; or
b. You are required by a government agency to use
this Rider to apply for, obtain, or keep a
government benefit or entitlement.
PAYMENT OF Unless otherwise requested, we may pay the Accelerated
ACCELERATED DEATH Death Benefit in one sum or by placing the amount in an
BENEFIT account that earns interest. You will have immediate
access to all or any part of the account.
EFFECT OF BENEFIT If you apply all of the Eligible Proceeds to your
ACCELERATION ON Accelerated Death Benefit, all policy benefits based on
POLICY AND RIDERS the Insured's life, except for any benefit for accidental
death, will end. Any accidental death benefit rider on the
life of the Insured will continue in force for 12 months
from the date of any payment under this Rider. Any riders
that provide a benefit on the life of someone other than
the Insured will stay in effect pursuant to their terms as
if the Insured had died. No further cost for those riders
will be payable.
All policy values and the Death Benefit on the remaining
Policy, if any, will be reduced in the same proportion as
the amount of Eligible Proceeds was applied to the
Accelerated Death Benefit. Upon acceleration, future
premiums and policy charges will be based on the reduced
Death Benefit of the Policy. Insurance not included in the
Eligible Proceeds will not be affected.
INCONTESTABILITY This Rider will not be contestable after it has been in
force during the life of the Insured for two years from
the Issue Date of the Rider.
SUICIDE EXCLUSION This Rider does not apply if the Insured's terminal
illness is the result of an attempt to commit suicide,
while sane or insane, within two years from the Issue Date
of the Rider.
TERMINATION This Rider will terminate at the earliest of:
1. When an Accelerated Death Benefit is paid;
2. The date on which the Policy would be disqualified as
a life insurance contract because this Rider is
attached, under the Internal Revenue Code as
interpreted by the Internal Revenue Service;
3. When the Policy to which this Rider is attached
terminates; and
4. The monthly anniversary on or following receipt by us
at our Home Office or any other office designated by
us of your written request to terminate this Rider.
We may require the Policy for endorsement.
The Issue Date and effective date of this Rider and the Policy are the same
unless another Issue Date is shown below.
_____________
Issue Date
3E-5TT-02
TEMPORARY TERM INSURANCE RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
TERM INSURANCE We agree that the Policy and its Riders will be in force
BENEFIT as temporary term insurance from the Issue Date to the
Policy Date. During that period the amounts of insurance
under the Policy and its Riders will be the same as the
amounts on the Policy Date.
During the temporary term insurance period the Policy will
have no cash or loan value.
This Rider is made a part of the Policy to which it is
attached if the Rider is listed on the Policy
Specifications page.
The premium for this Rider is due on the Issue Date in the
amount shown on the Policy Specifications page.
3E-5TC-02
SUPPLEMENTAL COVERAGE TERM RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
This Rider is subject to all applicable terms and provisions of the Policy,
except as modified herein. This Rider is a part of the Policy if it is listed on
the Policy Specifications page. A copy of the application for this Rider is
attached to and made a part of the Rider.
FACE AMOUNT The Face Amount of this Rider is shown on the Policy
Specifications page.
LIFE INSURANCE This Rider provides non-convertible term life insurance on
BENEFIT the life of the Insured shown on the Policy Specifications
page. We will pay the Death Benefit of this Rider to the
Beneficiary if the Insured dies while this Rider is in
force.
The Death Benefit provision in the Policy is modified so
that where it states "Face Amount" it means the Policy's
Face Amount plus this Rider's Face Amount.
MONTHLY COST OF The Monthly Cost of Insurance for the following month is
INSURANCE charged as part of the Monthly Deduction. The Monthly Cost
of Insurance is equal to the Net Amount at Risk for the
Face Amount of the Rider times the Monthly Cost of
Insurance Rate for the Rider.
The Net Amount at Risk for the Face Amount of this Rider
is equal to:
1. The Face Amount of this Rider divided by the Monthly
Discount Factor shown on the Policy Specifications
page; less
2. Any Cash Value (before the deduction of the Monthly
Cost of Insurance for the base Policy) attributable
to the Face Amount of the Rider.
The Cash Value will be attributable to coverages in the
following order:
1. To the coverage provided by the initial Face Amount
plus any increase in Face Amount due to a Death
Benefit Option change plus all Adjustable Benefit
Term Rider Face Amount increases; then
2. To the Face Amount of this Rider; and then
3. To any increase in Face Amount in the order they were
effective.
MONTHLY COST OF The Monthly Cost of Insurance Rate for this benefit is
INSURANCE RATES based on the Insured's Attained Age, Risk Classification,
sex and completed policy years from the Issue Date.
Monthly Cost of Insurance Rates will be determined by us
based on our expectations as to future mortality, tax,
interest earnings, expense and persistency experience. We
will not adjust such rates as a means of recovering prior
losses nor as a means of distributing prior profits. These
rates will not exceed those shown in the Table of Maximum
Monthly Cost of Insurance Rates for the Supplemental
Coverage Term Rider.
DECREASES IN RIDER After the first policy anniversary, the Face Amount of
FACE AMOUNT this Rider may be decreased by sending us a written
request.
Any requested decrease in the Rider's Face Amount will be
subject to the following conditions:
1. The decrease will become effective on the monthly
anniversary on or following our receipt of the
request at our Home Office or any other office
designated by us; and
2. Any decrease must be at least the Minimum Face Amount
Decrease as shown on the Policy Specifications page.
If you request a change in Death Benefit Option, this
Rider's Face Amount may be decreased. (See the Change in
Death Benefit Option provision in your Policy.)
If you request a partial withdrawal, this Rider's Face
Amount may be decreased. (See the Partial Withdrawal
provision in your Policy.)
TERMINATION This Rider will terminate on the first of the following
events to occur:
1. The lapse of the Policy;
2. The surrender of the Policy;
3. The Insured's date of death;
4. A decrease in Face Amount that causes this Rider's
Face Amount to go to zero;
5. The monthly anniversary on or following receipt by us
at our Home Office or any other office designated by
us of your written request to terminate this Rider.
We may require the Policy for endorsement; and
6. Attained Age 100 of the Insured.
The Issue Date and effective date of this Rider and the Policy are the same.
TABLE OF MAXIMUM MONTHLY COST OF INSURANCE RATES
PER $1,000
INSURED: JOHN DOE
COVERAGE: SUPPLEMENTAL COVERAGE TERM RIDER
RIDER ISSUE DATE: JANUARY 1, 2002
POLICY NUMBER: 16,000,001
ATTAINED ATTAINED
AGE RATE AGE RATE
35 0.2192 71 4.9242
36 0.2342 72 5.3608
37 0.2533 73 5.8525
38 0.2750 74 6.3883
39 0.3000 75 6.9808
40 0.3283 76 7.5917
41 0.3617 77 8.2100
42 0.3958 78 8.8258
43 0.4350 79 9.4575
44 0.4758 80 10.1325
45 0.5225 81 10.8675
46 0.5692 82 11.6833
47 0.6200 83 12.5858
48 0.6733 84 13.5408
49 0.7333 85 14.5167
50 0.7967 86 15.4817
51 0.8700 87 16.4217
52 0.9517 88 17.4475
53 1.0450 89 18.4600
54 1.1500 90 19.4742
55 1.2617 91 20.5100
56 1.3825 92 21.6108
57 1.5075 93 23.0250
58 1.6408 94 24.8458
59 1.7792 95 27.4967
60 1.9325 96 32.0458
61 2.1050 97 40.0167
62 2.2992 98 54.8317
63 2.5192 99 83.3333
64 2.7617
65 3.0242
66 3.2975
67 3.5842
68 3.8792
69 4.1933
70 4.5400
THESE RATES ARE FOR THIS RIDER AT ISSUE. THEY ARE BASED ON THE 1980
COMMISSIONERS STANDARD ORDINARY MORTALITY TABLE FOR A [MALE, SMOKER].
3E-5GI-02
OPTIONS TO PURCHASE ADDITIONAL LIFE INSURANCE RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
This Rider is subject to all applicable terms and provisions of the Policy,
except as modified herein. If this Rider is listed on the Policy Specifications
page it is a part of the Policy. A copy of the application for this Rider is
attached to and made a part of the Rider.
PURCHASE OF Additional life insurance can be purchased on each
ADDITIONAL LIFE Purchase Option Date shown on the Options to Purchase
INSURANCE Additional Life Insurance Rider Schedule. The additional
insurance can be: an increase in Face Amount for the
Policy; or a new policy. (See the Increase in Face Amount
and The New Policy provisions below.) Application for the
additional insurance must be in writing, signed by the
Owner and by the Insured and received at our Home Office
or any other office designated by us within 60 days of the
Purchase Option Date.
MAXIMUM OPTION The Maximum Option Amount is the maximum amount of
AMOUNT additional life insurance that can be purchased on each
Purchase Option Date subject to the Maximum Total Option
Amount below. The Maximum Option Amount is shown on the
Options to Purchase Additional Life Insurance Rider
Schedule. You may purchase less than the Maximum Option
Amount on any Purchase Option Date. Any portion of the
Maximum Option Amount not purchased within 60 days of a
Purchase Option Date will be forfeited.
MAXIMUM TOTAL The Maximum Total Option Amount is the lesser of:
OPTION AMOUNT
1. The number of Purchase Option Dates shown on the
Options to Purchase Additional Life Insurance Rider
Schedule times the Maximum Option Amount shown on the
Options to Purchase Additional Life Insurance Rider
Schedule; and
2. $1,000,000.
PURCHASE OPTION The Purchase Option Dates are shown on the Options to
DATES Purchase Additional Life Insurance Rider Schedule.
ADVANCEMENT OF After the second rider year, at your election, the next
PURCHASE OPTION available Purchase Option Date can be advanced to the date
DATES on which any of the following events occurs:
1. A child is born to the Insured; or
2. A child under 21 is legally adopted by the Insured;
or
3. A home or other real estate is purchased by the
Insured; or
4. The Insured marries; or
5. The Insured divorces; or
6. The Insured's Spouse dies.
Proof, satisfactory to us, of the event may be required
prior to advancement.
INCREASE IN FACE The increase will take effect on the Purchase Option Date
AMOUNT subject to the Change in Face Amount provision in your
Policy, except that proof of
insurability will not be required and the increase will
not be subject to the Maximum Face Amount Increase
Administration Charge. The underwriting class for the
increase in Face Amount will be based on the Underwriting
Class Basis for Purchase Options shown in the Options to
Purchase Additional Life Insurance Rider Schedule.
The Contestable and Suicide periods of each increase
issued under this Rider will be measured from the Issue
Date of this Rider.
THE NEW POLICY The new policy will be issued:
1. With the same Insured as this Rider;
2. With the same underwriting class as the Underwriting
Class Basis for Purchase Options shown in the Options
to Purchase Additional Life Insurance Rider Schedule
for this Rider or the class we determine is the
closest to it if that class is not offered on the new
policy;
3. Subject to any assignments and limitations to which
this Rider is subject;
4. By us or by an affiliate designated by us;
5. On a plan agreed to by the issuing company;
6. At the then current age of the Insured as calculated
for that plan of insurance by the issuing company;
7. On a policy form and at premium rates in use by the
issuing company on the Policy Date of the new policy;
and
8. With a Policy Date and Issue Date the same as the
Purchase Option Date.
The new policy will take effect on the Purchase Option
Date:
1. During the life of the Insured; and
2. Not later than 60 days after the Purchase Option
Date.
The Contestable and Suicide periods of each new policy
issued under this Rider will be measured from the Issue
Date of this Rider. Riders can be attached to a new policy
only with our consent.
MONTHLY COST OF The Monthly Cost of Rider for the following month is
RIDER charged as part of the Monthly Deduction. The Monthly Cost
of Rider is the Guaranteed Monthly Cost of Rider Charge
shown on the Options to Purchase Additional Life Insurance
Rider Schedule.
TERMINATION This Rider will terminate upon the earliest of:
1. Termination of the Policy other than by death;
2. Upon death of the Insured;
3. When the total amount of coverage issued under this
Rider equals the Maximum Total Option Amount;
4. 60 days after the final Purchase Option Date; and
5. The monthly anniversary on or following receipt by us
at our Home Office or any other office designated by
us of your written request to terminate this Rider.
We may require the Policy for endorsement.
The Issue Date and effective date of this Rider and Policy are the same.
OPTIONS TO PURCHASE ADDITIONAL LIFE INSURANCE
RIDER SCHEDULE
INSURED NAME: [JOHN DOE]
ISSUE DATE: [NOVEMBER 1, 2001]
AGE: [35]
MAXIMUM OPTION AMOUNT: [$50,000]
POLICY NUMBER: [16,000,001]
UNDERWRITING CLASS BASIS FOR PURCHASE OPTIONS: [SMOKER STANDARD]
GUARANTEED MONTHLY COST OF RIDER CHARGE: [$5.20]
PURCHASE OPTION DATES: [11/01/2006]
[11/01/2011]
[11/01/2016]
3E-5WMD-02
WAIVER OF MONTHLY DEDUCTION RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
THE WAITING PERIOD FOR INCONTESTABILITY IS DIFFERENT FROM THAT IN THE POLICY AND
BEGINS ON THE ISSUE DATE OF THIS RIDER.
This Rider is subject to all applicable terms and provisions of the Policy,
except as modified herein. This Rider is a part of the Policy if it is listed on
the Policy Specifications page or on the Policy Specifications page for Policy
Change. A copy of the application for this Rider is attached to and made part of
the Rider.
WAIVER OF MONTHLY We will waive the Monthly Deductions for this Policy if:
DEDUCTION BENEFIT
1. You furnish us with written proof that the Insured is
totally disabled, as defined in this Rider;
2. The Insured becomes disabled after age 5 and before
age 65;
3. Disability has continued without interruption for at
least six months; and
4. This Rider is in force.
Monthly Deductions for this Policy will be waived as
follows:
Disability Beginning Before Age 60. If the Insured's
disability begins before age 60, we will waive Monthly
Deductions which were due during the six months of
uninterrupted disability. After that, we will continue to
waive Monthly Deductions. However, the Insured must
continue to be totally disabled.
Disability Beginning Between Ages 60 and 65. If the
Insured's disability begins on or after age 60 but before
age 65, we will waive Monthly Deductions which were due
during the six months of uninterrupted disability. we will
continue to waive Monthly Deductions after that, but no
later than age 65. However, the Insured must continue to
be totally disabled.
DEFINITION OF AGE "Age 5," "Age 60," and "Age 65" begin on the policy
5, AGE 60, AND AGE anniversary nearest the Insured's 5th, 60th, and 65th
65 birthdays, respectively.
INCREASE IN WAIVER Coverage under this Rider can be increased, subject to our
COVERAGE underwriting rules, if the Face Amount of the Policy is
increased and if the Insured is not totally disabled. The
increase in waiver coverage is subject to:
1. The terms for a requested increase in Face Amount as
stated in the Change in Face Amount provision of the
Policy;
2. Our limits for Waiver of Monthly Deduction benefits;
and
3. An increase in the cost of Rider.
Application to increase the Face Amount of the Policy will
also be deemed to be application to increase waiver
coverage under this Rider, unless otherwise stated.
COST OF RIDER The monthly Cost of Rider is the monthly Cost of Rider
Rate times the Policy's Monthly Deduction not including
the cost of this Rider.
The Cost of Rider Rate for this benefit is based on the
Insured's Attained Age. Each monthly anniversary this
Rider is in force, the monthly Cost of Rider (as
determined above) will be added to the Monthly Deduction
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.
TOTAL DISABILITY "Total Disability" means the inability of the Insured to
perform the substantial and material duties of his or her
regular occupation. Such disability must be the result of
an accidental bodily injury or a sickness. The injury or
sickness must first manifest itself after the Issue Date
of this Rider.
However, after this period of disability has continued for
60 months, the Insured will be considered to be totally
disabled only if he or she is unable to perform the
substantial and material duties of any occupation for
which he or she is reasonably fitted by education,
training or experience.
If after this Rider becomes effective, the Insured suffers
the total and irrecoverable loss of:
1. The sight in both eyes;
2. The use of both hands or both feet; or
3. The use of one hand and one foot.
this will be considered total disability as defined in
this Rider. Upon such a loss the Insured will still be
considered disabled even though working at an occupation
RECURRENT TOTAL If, while the Policy and Rider are in force, the Insured
DISABILITY becomes disabled again after having been totally disabled
before, the new disability will be considered a
continuation of the previous period unless:
1. It is due to an entirely different cause; or
2. The Insured has performed all of the material and
substantial duties of a gainful occupation for a
continuous period of six months or more between such
periods of total disability.
RISKS NOT ASSUMED We will not waive Monthly Deductions under this Rider if
disability results from war or any act of war while the
Insured is in the military, naval or air forces of any
country at war. We will also not waive Monthly Deductions
if the Insured becomes disabled while in a civilian
non-combatant unit serving with such forces. "War"
includes undeclared war and "any country" includes any
international organization or combination of countries.
NOTICE OF CLAIM Before we waive any Monthly Deductions, we must receive
AND PROOF OF the following at our Home Office or any other office
DISABILITY designated by us:
1. Written notice of claim for this benefit during the
lifetime of the Insured. This notice must be
submitted during the continuance of total disability.
This notice must be submitted no later than six
months after this Rider terminates; and
2. Written proof of total disability within six months
after we receive written notice of claim. In no event
should this proof be submitted later than the
date when any of the following events first occurs:
a. One year after age 65 of the Insured;
b. Surrender of the Policy; and
c. One year from the due date of the first unpaid
Monthly Deduction.
Failure to give such notice and proof within the time
allowed will not void the claim. We will consider the
claim if you show us that it was not reasonably possible
to file notice and proof on time. However, you must file
notice and proof as soon as reasonably possible. In no
event will any Monthly Deduction be waived or refunded if
its due date was more than one year before we received
notice of claim at our Home Office or any other office
designated by us.
We will require no further proof of disability and we will
automatically waive all further Monthly Deductions if:
1. The Insured is totally disabled at age 65; and
2. All Monthly Deductions for at least the five years
preceding age 65 have been waived.
EXAMINATION OF THE We have the right to have the Insured examined by our
INSURED AND PROOF OF appointed examiner. Such exam will be at our expense. We
CONTINUED DISABILITY also have the right to require written proof of
continuance of disability from the Insured at the
following times:
1. After receipt of notice of claim;
2. At reasonable intervals within two years after we
receive proof of total disability; and
3. Not more than once each year after the first two
years.
We will not waive any further Monthly Deductions if the
Insured refuses to be medically examined. Nor will we
waive further Monthly Deductions if proof of continuance
of disability is not furnished when we request it.
INCONTESTABILITY We cannot contest this Rider after it has been in force
during the lifetime of the Insured, excluding any period
the Insured is totally disabled:
1. With respect to the original waiver coverage under
this rider, for two years from the Issue Date of this
Rider; and
2. With respect to each increase in waiver coverage
under this Rider, for two years from the effective
date of each increase in face amount under the
Policy.
GENERAL PROVISIONS If the Insured becomes totally disabled during the Grace
Period and becomes eligible for the Waiver of Monthly
Deduction Benefit, we will waive the Monthly Deductions
that were due during the Grace Period. However, you will
be liable for any Monthly Deductions that were due prior
to the
Grace Period.
TERMINATION This Rider will terminate on the first of the following
events to occur:
1. Attained Age 65 of the Insured. This will be without
prejudice to any benefits granted for total
disability occurring before age 65;
2. The date the Policy lapses;
3. The date the Policy is surrendered;
4. The date of death of the Insured;
5. The date an increase in Face Amount of the Policy
which does not qualify for an increase in coverage
under this Rider;
6. The date a Waiver of Specified Premium Rider is added
to the Policy to which this Rider is attached; or
7. The monthly anniversary on or following receipt by us
at our Home Office or any other office designated by
us of your written request to terminate this Rider.
We may require the Policy for endorsement.
The Issue Date and effective date of this Rider and the Policy are the same
unless another issue date is shown below.
_____________
Issue Date
McCauley's signature Eichner's signature
GA logo
TABLE OF MAXIMUM MONTHLY COST OF RIDER RATES
PER $1,000
INSURED: JOHN DOE
COVERAGE: WAIVER OF MONTHLY DEDUCTION RIDER
EFFECTIVE DATE OF RIDER: FEBRUARY 1, 2002
POLICY NUMBER: 16,000,001
ATTAINED ATTAINED
AGE RATE AGE RATE
35 71
36 72
37 73
38 74
39 75
40 76
41 77
42 78
43 79
44 80
45 81
46 82
47 83
48 84
49 85
50 86
51 87
52 88
53 89
54 90
55 91
56 92
57 93
58 94
59 95
60 96
61 97
62 98
63 99
64
65
66
67
68
69
70
THESE RATES ARE FOR THIS RIDER WITH THE ABOVE EFFECTIVE DATE. THEY ARE BASED ON
THE 1980 COMMISSIONERS STANDARD ORDINARY MORTALITY TABLE FOR A [MALE, SMOKER].
3E-5WSP-02
WAIVER OF SPECIFIED PREMIUM RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
THE WAITING PERIOD FOR INCONTESTABILITY IS DIFFERENT FROM THAT IN THE POLICY AND
BEGINS ON THE ISSUE DATE OF THIS RIDER.
This Rider is subject to all applicable terms and provisions of the Policy,
except as modified herein. This Rider is a part of the Policy if it is listed on
the Policy Specifications page or on the Policy Specifications page for Policy
Change. A copy of the application for this Rider is attached to and made part of
the Rider.
WAIVER OF We will credit to the Policy, as a premium payment, the
SPECIFIED PREMIUM amount shown as the monthly premium waived on the Policy
BENEFIT Specifications page if:
1. You furnish us with written proof that the Insured is
totally disabled, as defined in this Rider;
2. The Insured becomes disabled after age 5 and before
age 65;
3. Disability has continued without interruption for at
least six months; and
4. This Rider is in force.
The monthly premium waived will be credited as premium to
the Policy as long as the Policy remains in force as
follows:
Disability Beginning Before Age 60. If the Insured's
disability begins before age 60, we will credit the
monthly premiums waived which were due during the six
months of uninterrupted disability. After that, we will
continue to credit the monthly premiums waived. However,
the Insured must continue to be totally disabled.
Disability Beginning Between Ages 60 and 65. If the
Insured's disability begins on or after age 60 but before
age 65, we will credit the monthly premiums waived which
were due during the six months of uninterrupted
disability. We will continue to credit the monthly
premiums waived after that, but no later than age 65.
However, the Insured must continue to be totally disabled.
The Policy to which this Rider is attached is intended to
qualify as a life insurance contract under the Internal
Revenue Code or any applicable successor provision or any
interpretive regulation or rulings by the Internal Revenue
Service. To that end, if you have selected the Guideline
Premium Test for the Policy (See the Definition of Life
Insurance provision of the Policy), premiums on the Policy
are limited to an amount no greater than that allowing the
Policy to continue to qualify. Therefore, the portion of
any monthly premium waived that would disqualify the
Policy will be paid to you in cash.
DEFINITION OF AGE "Age 5," "Age 60," and "Age 65" begin on the Policy
5, AGE 60 AND AGE anniversary nearest the Insured's 5th, 60th and 65th
65 birthdays, respectively.
INCREASE IN WAIVER Coverage under this Rider can be increased, subject to our
underwriting rules, if the Face Amount of the Policy is
increased and if the Insured is not
COVERAGE totally disabled. The increase in waiver coverage is
subject to:
1. The terms for a requested increase in Face Amount as
stated in the Change in Face Amount provision of the
Policy;
2. Our limits for Waiver of Specified Premium benefits;
and
3. An increase in the Cost of Rider.
POLICY LAPSE Crediting of the monthly premium waived to the Policy does
not guarantee that the Policy will remain in force.
COST OF RIDER The cost for this Rider is charged as part of the Monthly
Deductions. The monthly Cost of Rider is calculated as (1)
multiplied by (2) where:
1. Is the Cost of Rider rate for this Rider; and
2. Is the monthly premium waived.
The Cost of Rider Rate for this benefit is based on the
Insured's Attained Age. Each monthly anniversary this
Rider is in force, the monthly Cost of Rider (as
determined above) will be added to the Monthly Deduction
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.
TOTAL DISABILITY "Total Disability" means the inability of the Insured to
perform the substantial and material duties of his or her
regular occupation. Such disability must be the result of
an accidental bodily injury or a sickness. The injury or
sickness must first manifest itself after the Issue Date
of this Rider.
However, after this period of disability has continued for
60 months, the Insured will be considered to be totally
disabled only if he or she is unable to perform the
substantial and material duties of any occupation for
which he or she is reasonably fitted by education,
training or experience.
If, after this Rider becomes effective, the Insured
suffers the total and irrecoverable loss of:
1. The sight in both eyes;
2. The use of both hands or both feet; or
3. The use of one hand and one foot.
this will be considered total disability as defined in
this Rider. Upon such a loss the Insured will still be
considered disabled even though working at an occupation.
RECURRENT TOTAL If, while the Policy and this Rider are in force, the
DISABILITY Insured becomes disabled again after having been totally
disabled before, the new disability will be considered a
continuation of the previous period unless:
1. It is due to an entirely different cause; or
2. The Insured has performed all of the material and
substantial duties of a gainful occupation for a
continuous period of six months or more between such
periods of total disability.
RISKS NOT ASSUMED We will not credit the monthly premium waived under this
Rider to the Policy if disability results from war or any
act of war while the Insured is in the military, naval or
air forces of any country at war. We will also not credit
the monthly premium waived if the Insured becomes disabled
while in a civilian non-combatant unit serving with such
forces. "War" includes undeclared war and "any country"
includes any international organization or combination of
countries.
NOTICE OF CLAIM Before we credit any monthly premium waived to the Policy,
AND PROOF OF we must receive the following at our Home Office or any
DISABILITY other office designated by us:
1. Written notice of claim for this benefit during the
lifetime of the Insured.
This notice must be submitted during the continuance
of total disability. This notice must be submitted no
later than six months after this Rider terminates;
and
2. Written proof of total disability within six months
after we receive written notice of claim. In no event
should this proof be submitted later than the date
when any of the following events first occurs:
a. One year after age 65 of the Insured;
b. Surrender of the Policy; and
c. One year from the due date of the first unpaid
Monthly Deduction.
Failure to give such notice and proof within the time
allowed will not void the claim. We will consider the
claim if you show us that it was not reasonably possible
to file notice and proof on time. However, you must file
notice and proof as soon as reasonably possible. In no
event will we credit any monthly premium waived if its due
date was more than one year before we received notice of
claim at our Home Office or any other office designated by
us.
We will require no further proof of disability and we will
automatically credit further monthly premiums waived if:
1. The Insured is totally disabled at age 65; and
2. All monthly premiums waived for at least the five
years preceding age 65 have been credited.
EXAMINATION OF THE We have the right to have the Insured examined by our
INSURED AND PROOF appointed examiner. Such exam will be at our expense. We
OF CONTINUED also have the right to require written proof of
DISABILITY continuance of disability from the Insured at the
following times:
1. After receipt of notice of claim;
2. At reasonable intervals within two years after we
receive proof of total disability; and
3. Not more than once each year after the first two
years.
We will not credit to the Policy any further monthly
premiums waived if the Insured refuses to be medically
examined. Nor will we credit to the Policy further monthly
premiums waived if proof of continuance of disability is
not furnished when we request it.
INCONTESTABILITY We cannot contest this Rider after it has been in force
during the lifetime of the Insured, excluding any period
the Insured is totally disabled:
1. With respect to the original waiver coverage under
this Rider, for two years from the Issue Date of this
Rider; and
2. With respect to each increase in waiver coverage
under this Rider, for two years from the effective
date of each increase in Face Amount under the
Policy.
GENERAL PROVISIONS If the Insured becomes totally disabled during the Grace
Period and becomes eligible for the Waiver of Specified
Premium Benefit, we will credit
to the Policy any monthly premiums that were due during
the Grace Period. However, you will be liable for any
monthly premiums that were due prior to the Grace Period.
TERMINATION This Rider will terminate on the first of the following
events to occur:
1. Attained Age 65 of the Insured. This will be without
prejudice to any benefits granted for total
disability occurring before age 65;
2. The date the Policy lapses;
3. The date the Policy is surrendered;
4. The date of death of the Insured;
5. The date an increase in Face Amount of the Policy
which does not qualify for an increase in coverage
under this Rider;
6. The date a Waiver of Monthly Deduction Rider is added
to the Policy to which this Rider is attached; or
7. The monthly anniversary on or following receipt by us
at our Home Office or any other office designated by
us of your written request to terminate this Rider.
We may require the Policy for endorsement.
The Issue Date and effective date of this Rider and the Policy are the same
unless another Issue Date is shown below.
_____________
Issue Date
McCauley's signature Eichner's signature
GA logo
TABLE OF MAXIMUM MONTHLY COST OF RIDER RATES
PER $1,000
INSURED: JOHN DOE
COVERAGE: WAIVER OF MONTHLY DEDUCTION RIDER
EFFECTIVE DATE OF RIDER: FEBRUARY 1, 2002
POLICY NUMBER: 16,000,001
ATTAINED ATTAINED
AGE RATE AGE RATE
35 71
36 72
37 73
38 74
39 75
40 76
41 77
42 78
43 79
44 80
45 81
46 82
47 83
48 84
49 85
50 86
51 87
52 88
53 89
54 90
55 91
56 92
57 93
58 94
59 95
60 96
61 97
62 98
63 99
64
65
66
67
68
69
70
THESE RATES ARE FOR THIS RIDER WITH THE ABOVE EFFECTIVE DATE. THEY ARE BASED ON
THE 1980 COMMISSIONERS STANDARD ORDINARY MORTALITY TABLE FOR A [MALE, SMOKER].
3E-E1-02
ANNIVERSARY PARTIAL WITHDRAWAL RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
This Rider is subject to all applicable terms and provisions of the Policy,
except as modified herein. This Rider is a part of the Policy if it is listed on
the Policy Specifications page. A copy of the application for this Rider is
attached to and made part of the Rider.
Prior to the Insured's Attained Age 85, this Rider replaces the Partial
Withdrawals, the General Account Partial Withdrawals and the Separate Account
Partial Withdrawals provisions with the following:
You can make a partial withdrawal of the Policy's Cash Surrender Value
on any policy anniversary date prior to the Insured's Attained Age 85.
The amount of the partial withdrawal may not exceed the greater of:
1. The increase in Cash Surrender Value since the preceding policy
anniversary; or
2. The Cash Surrender Value at the beginning of that policy year
multiplied by the Anniversary Partial Withdrawal Percentage Limit
shown on the Policy Specifications page.
A partial withdrawal will not be processed if the amount requested is greater
than the Cash Surrender Value on the date of the partial withdrawal.
The minimum amount for a partial withdrawal request must be at least the Minimum
Loan and Withdrawal Amount shown on the Policy Specifications page.
This Rider will terminate on the first of the following events to occur:
1. When the Insured reaches Attained Age 85;
2. If a partial withdrawal is made that exceeds the amount determined
above;
3. If a partial withdrawal is made on a date other than a policy
anniversary; or
4. The monthly anniversary on or following receipt by us at our Home
Office or any other office designated by us of your written request
to terminate this Rider. We may require the Policy for endorsement.
If this Rider terminates, the Partial Withdrawals, the General Account Partial
Withdrawals and the Separate Account Partial Withdrawals provisions as described
in the Policy will become effective.
The Issue Date and the effective date of this Rider and the Policy are the same.
McCauley's signature Eichner's signature
GA logo
3E-E3-02
SPLIT DOLLAR PARTIAL WITHDRAWAL ENDORSEMENT
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
This Endorsement is a part of the Policy and is subject to all applicable terms
and provisions of the Policy; except as modified herein.
This Endorsement permits an additional type of partial withdrawal for split
dollar policies. The Partial Withdrawals, General Account Partial Withdrawals,
and the Separate Account Partial Withdrawals provisions of the Policy apply at
all times except when a Split Dollar Partial Withdrawal occurs. The Split Dollar
Partial Withdrawal provision applies only if you request a Split Dollar Partial
Withdrawal and you and the assignee request a release of the assignment of the
Policy.
SPLIT DOLLAR After the first policy year, upon written request to us,
PARTIAL WITHDRAWAL you can make a Split Dollar Partial Withdrawal of Cash
Surrender Value subject to the conditions listed below.
No Split Dollar Partial Withdrawal will be processed which
will result in the Face Amount, excluding riders, being
decreased below the Minimum Face Amount shown on the
Policy Specifications page. The minimum amount of your
Split Dollar Partial Withdrawal request at any one time
must be at least $500.
We reserve the right to change the minimum amount of the
Split Dollar Partial Withdrawal. We may also assess a
transaction charge for such withdrawal.
We reserve the right to limit the amount of the Split
Dollar Partial Withdrawal to 90% of the Cash Surrender
Value of your Policy.
At the time of your request, you must elect one of the
following Withdrawal Options.
a) DOLLAR FOR DOLLAR WITHDRAWAL OPTION:
If the Death Benefit equals the Face Amount,
then a Split Dollar Partial Withdrawal will
decrease the Face Amount by an amount equal to
the Maximum Face Reduction as defined below. If
the Death Benefit equals a percentage of the
Cash Value, then a Split Dollar Partial
Withdrawal will decrease the Face Amount by any
amount by which the Maximum Face Reduction
exceeds the difference between the Death Benefit
and the Face Amount.
The Face Amount will be decreased in the
following order:
1. The initial Face Amount plus any change in Face
Amount provided by a Change in Death Benefit
Option;
2. The Face Amount of any Adjustable Benefit Term
Rider;
3. The Face Amount provided by any Supplemental
Coverage Term Rider; and
4. Any increases in the same order in which they
were issued.
The MAXIMUM FACE REDUCTION under this option is
the amount of the Split Dollar Partial
Withdrawal plus the applicable Surrender Charge.
b) SPLIT DOLLAR ROLLOUT WITHDRAWAL OPTION:
If the Death Benefit equals the Face Amount,
then a Split Dollar Partial Withdrawal will
decrease the Face Amount by an amount equal to
the Maximum Face Reduction as defined below. If
the Death Benefit equals a percentage of the
Cash Value, then a Split Dollar Partial
Withdrawal will decrease the Face Amount by any
amount by which the Maximum Face Reduction
exceeds the difference between the Death Benefit
and the Face Amount.
The Face Amount will be decreased in the
following order:
1. The initial Face Amount plus any change in Face
Amount provided by a Change in Death Benefit
Option;
2. The Face Amount of any Adjustable Benefit Term
Rider;
3. The Face Amount provided by any Supplemental
Coverage Term Rider; and
4. Any increases in the same order in which they
were issued.
The MAXIMUM FACE REDUCTION under this option is
the lesser of:
1. The amount of the Split Dollar Partial
Withdrawal plus the applicable Surrender Charge;
and
2. That amount which would result in a Recapture
Ceiling (as defined in subparagraph (C) or
subparagraph (D) of section 7702(f)(7),
whichever applies, of the Internal Revenue Code
of 1986 or any applicable successor provision)
of zero.
Any Surrender Charge assessed will be allocated among the
General Account and the Divisions of a Separate Account in
the same proportion that the Split Dollar Partial
Withdrawal was allocated among the General Account and the
Divisions of a Separate Account.
The Issue Date and the effective date of this Endorsement and the Policy are the
same.
McCauley's signature Eichner's signature
GA logo
3E-58P0-02
GUARANTEED SURVIVOR PLUS PURCHASE OPTION RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
IF THIS RIDER IS ADDED AFTER THE POLICY IS ISSUED, THE WAITING PERIODS FOR
SUICIDE AND INCONTESTABILITY ARE DIFFERENT FROM THOSE IN THE POLICY AND BEGIN ON
THE EFFECTIVE DATE OF THIS RIDER.
This Rider is subject to all applicable terms and provisions of the Policy,
except as modified herein. This Rider is a part of the Policy if it is listed on
the Policy Specifications page or on the Policy Specifications page for Policy
Change. A copy of the application for this Rider is attached to and made part of
the Rider.
OPTION TO PURCHASE The Owner may purchase an Option Policy on the Designated
INSURANCE Life during an Option Period that begins during the
lifetime of the Insured. The Beneficiary of the Policy may
purchase an Option Policy on the Designated Life during
the Option Period that begins on the date of death of the
Insured. The Owner or Beneficiary may transfer to any
person or entity its right to buy the Option Policy on the
Designated Life. However, we must receive written notice,
in a form satisfactory to us, at our Home Office or any
office designated by us before such transfer will take
effect.
No evidence of insurability will be required for this
Option Policy. The Face Amount of this Option Policy will
not be more than the Current Option Amount.
This Option Policy will be subject to the following:
1. Our receipt of the initial payment during the Option
Period;
2. Our receipt of the written application for the Option
Policy in our Home Office or any office designated by
us during the Option Period. The Designated Life must
consent to the insurance by signing the application
for the Option Policy;
3. This Rider must be in force at the beginning of the
Option Period;
4. The Designated Life must be living at the end of the
Option Period;
5. The person who exercises the option will be the owner
of the Option Policy; and
6. The coverage of the Option Policy will start on the
day after the end of the Option Period.
DESIGNATED LIFE The Designated Life is named in the application for this
Rider. The Designated Life may not be changed.
OPTION PERIODS The Option Periods for this Rider are elected at the time
of application. An Option Period that starts on the date
of death of the Insured will always be provided. Unless
the Owner elects otherwise, Option Periods will also start
on the tenth anniversary of the Rider and on the Rider
anniversary nearest the Designated Life's 65th birthday.
The Option Period ends on the earlier of the following
dates:
1. 270 days after the Option Period begins if the Option
Period begins on the date of the death of the
Insured; otherwise 30 days after the Option Period
begins.
2. The date when the current option or any portion of it
is exercised. We must be notified of this date.
TOTAL OPTION AMOUNT The Total Option Amount is the amount shown on the Policy
Specifications page or, if this Rider is added after
issue, the Policy Specifications page for the Policy
Change.
CURRENT OPTION The Current Option Amount is the Total Option Amount
AMOUNT divided by the number of Option Periods elected in the
application for this Rider. However, in the case of an
Option Period that begins on the date of death of the
Insured, the Current Option Amount is the Total Option
Amount reduced by the Face Amount of any option policies
previously purchased.
MONTHLY EXPENSE The Monthly Expense Charge for this Rider is deducted from
CHARGE the Policy's Cash Value on the monthly anniversary. The
Monthly Expense Charge is the Total Option Amount for this
Rider, divided by 1,000 and multiplied by the Monthly
Expense Charge Rate shown on the Policy Specifications
page or, if this Rider is added after issue, the Policy
Specifications page for the Policy Change.
TEMPORARY INSURANCE We will pay the Current Option Amount to the Beneficiary
upon the death of the Designated Life during the Option
Period with the following exception. If both the Insured
and the Designated Life die and it is not possible to
determine the sequence of deaths, then we will provide
such temporary Insurance for one-half of the Current
Option Amount available at the date of death of the
Insured. If payable, the benefit will become part of the
proceeds of the Policy.
FEATURES OF OPTION At the request of the person authorized to purchase the
POLICY Option Policy, the Option Policy may be any permanent
individual life plan approved by us, or by an affiliate of
ours, on the policy date of the Option Policy, or a level
premium, level Death Benefit whole life plan offered by
us, or by an affiliate of ours, on the issue date of this
Rider. The Option Policy will be subject to our rules in
effect on the issue date of the Option Policy as to the
minimum amount and age at issue. The issue date and the
policy date of the Option Policy will be the same.
1. If the Option Policy is a permanent individual life
plan, it will be subject to the rules in effect at
the time the option is exercised. The premiums or
charges for the policy will be based on the
following:
a. The insurance age and sex of the Designated Life
on the policy date of the Option Policy;
b. The risk class of the Designated Life as of the
Issue Date of this Rider as shown on the Policy
Specifications page or if this Rider is added
after issue, the Policy Specifications page for
the Policy Change; and
c. The rates in use as of the issue date of the
Option Policy.
2. If the Option Policy is a level premium, level Death
Benefit whole life plan the following conditions
apply:
a. The premium rate for the policy will be based on
the following:
1. The issue age of the Designated Life on the
Issue Date of this Rider;
2. The risk class of the Designated Life as of
the Issue Date of this Rider; and
3. The rates in use by us on the issue date of
the Option Policy.
b. The Initial Payment for the Option Policy will
be:
1. The interpolated Cash Value of the Option
Policy as of the end of this Option Period;
plus
2. A pro rata premium for the Option Policy, if
any, for the period from the end of the
Option Period to the next anniversary of the
Option Policy.
All references to Cash Value refer to the
guaranteed Cash Value of the Option Policy.
c. The first regular premium payable under the
Option Policy, if any, is due on the first
policy anniversary following the end of the
Option Period.
d. No dividends will have been earned by the Option
Policy prior to the date of coverage of the
Option Policy.
3. The Face Amount of the Option Policy:
a. Will not be less than the minimum required
amount for the plan requested; and
b. Will not exceed the Current Option Amount.
4. Riders for extra benefits may be added to the Option
Policy with our consent. We may require satisfactory
proof that the Designated Life is insurable for the
riders at the time this option is exercised.
REINSTATEMENT This Rider may be reinstated within three years after the
date of Policy lapse if:
1. The Policy is also being reinstated;
2. You submit proof satisfactory to us that the
Designated Life is insurable by our standards;
3. The Designated Life is alive on the date we approve
the request for reinstatement. If the Designated Life
is not alive, such approval is void and of no effect;
and
4. Payment of a premium large enough to keep this Rider
in force for at least three months
Upon Reinstatement, we will deduct any Monthly Expense
Charge due and unpaid for this rider at the time of lapse.
INCONTESTABILITY This Rider will be incontestable after it has been in
force during the lifetime of the Designated Life for a
period of two years from its Issue Date.
SUICIDE EXCLUSION If the Designated Life dies by suicide, while sane or
insane, during the Option Period and within two years from
the Issue Date of this Rider, the amount payable under
this Rider will be limited to the amount paid for this
Rider
MISSTATEMENT OF AGE If the Face Amount of the Policy to which this Rider is
AND/OR SEX OF THE attached is decreased due to the misstatement of age
INSURED and/or sex of the Insured, then the Option Amount stated
on the Policy Specifications page or if this Rider is
added after issue, the Policy Specifications page for the
Policy Change will also be decreased. The decreased Option
Amount will bear the same ratio to the adjusted Face
Amount of the Policy as the original Option Amount bore to
the original Face Amount.
MISSTATEMENT OF AGE If the age and/or sex of the Designated Life and/or the
AND/OR SEX OF THE Insured has been misstated on the application, we will
DESIGNATED LIFE adjust the Total Option Amount to be the Total Option
AND/OR THE Amount that would have been provided had this information
been correctly stated.
INSURED TERMINATION The right to buy insurance will not extend beyond an
Option Period. This Rider will terminate on the first of
the following events to occur:
1. The monthly anniversary on or following receipt by us
at our Home Office or any other office designated by
us of your written request to terminate this Rider.
We may require the Policy and this Rider for
endorsement;
2. The date the Policy terminates for reasons other than
the death of the Insured;
3. The date of death of the Designated Life; or
4. The date the Option Period that begins on the date of
death of the Insured ends.
When this Rider terminates:
1. All rights under this Rider will cease;
2. No further monthly expense charges will be due for
this Rider; and
3. The Policy will be considered as separate and
complete without this Rider.
The Issue Date and effective date of this Rider and the Policy are the same
unless another Issue Date is shown below.
_____________
Issue Date
McCauley's signature Eichner's signature
GA logo
3E-5SG-02
SECONDARY GUARANTEE RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
If this Rider is listed on the Policy Specifications page, it is part of the
Policy. This Rider is subject to all applicable terms and provisions of the
Policy, except as modified herein. A copy of the application for this Rider is
attached to and made part of the Rider.
SECONDARY GUARANTEE If, on a Monthly Anniversary day prior to the Secondary
BENEFIT Guarantee Date, shown on the Policy Specifications page:
1. The sum of all premiums paid on this Policy; less
2. Any partial withdrawals; less
3. Any outstanding loan and loan interest; less
4. Any pro rata surrender.
is greater than or equal to the sum of the Secondary
Guarantee Premium for each Monthly Anniversary since the
Policy Date, this Policy will not lapse even if Your Cash
Surrender Value is not sufficient to cover the Monthly
Deduction on a Monthly Anniversary day.
DEATH BENEFIT The Death Benefit is the greater of:
1. The Face Amount of the Policy including any
increases; or
2. The Death Benefit otherwise provided by the Policy
including any increases.
Notwithstanding anything in this Policy, the Death Benefit
will in no case be less than the amount necessary to cause
the Policy to meet the requirements for the definition of
life insurance under the Internal Revenue Code of 1986 or
any applicable successor.
COST OF RIDER The monthly Cost of Rider is the monthly Cost of Rider
Rate shown on the Policy Specifications page, divided by
1000, multiplied by 1 below plus the difference between 2
and 3 below:
1. The Face Amount of any term rider not included in the
Policy's Death Benefit; plus
2. An amount as follows:
DEATH BENEFIT OPTION A: The greater of:
a. The Face Amount divided by the Monthly Discount
Factor shown on the Policy Specifications page;
or
b. The Policy's Cash Value at the beginning of the
Policy month, multiplied by the Attained Age
Factor as shown on the Table of Corridor Factors
DEATH BENEFIT OPTION B: The greater of:
a. The Face Amount divided by the Monthly Discount
Factor shown on the Policy Specifications page
plus the Policy's Cash Value at the beginning of
the Policy month; or
b. The Policy's Cash Value at the beginning of the
Policy month, multiplied by the Attained Age
Factor as shown on the Table of Corridor Factors
3. The Policy's Cash Value at the beginning of the
Policy month, before the deduction of the monthly
Cost of this Rider.
POLICY CHANGES The Secondary Guarantee Premium may change if any of the
following events occur prior to the Secondary Guarantee
Date shown on the Policy Specifications page:
1. A change in the Policy's Face Amount;
2. The addition of or an increase to a rider attached to
this Policy;
3. A change in risk classification of the Insured; or
4. A change in death benefit option.
The Secondary Guarantee Date will not change.
GUARANTEE GRACE If on a Monthly Anniversary day prior to the Secondary
PERIOD Guarantee Date, the sum of all premiums paid on this
Policy, reduced by any partial withdrawals, pro rata
surrenders and any outstanding Loan and loan interest, is
less than the sum of the Secondary Guarantee Premiums for
each monthly anniversary since the Policy Date, then the
Guarantee Grace Period of 62 days will be allowed for the
payment of a premium sufficient to keep this Rider in
force. The Secondary Guarantee Date and the Secondary
Guarantee Premium are shown on the Policy Specifications
page.
Notice of the amount of premium required to be paid to
keep this Rider in force will be sent at the beginning of
the Guarantee Grace Period to the last known address of
the Owner and of any assignee of record. If We do not
receive the premium required by the end of the Guarantee
Grace Period, this Rider will terminate and the guarantee
provided by this Rider will no longer be in effect. If the
premium requirement is not met and death occurs during the
Guarantee Grace Period, there is no deduction of the Rider
premium required from the Death Benefit.
MISSTATEMENT OF AGE If there is a misstatement of age or sex in the
OR SEX application and such determination is made prior to the
death of the Insured and while this Rider is in effect,
then the Secondary Guarantee Premium will be that amount
which corresponds to the Face Amount, as adjusted under
the Policy, using the correct age and/or sex. The
Secondary Guarantee Date will change based on the correct
age.
SECONDARY GUARANTEE The date the Secondary Guarantee Rider expires. This date
DATE is shown on the Policy Specifications page.
SECONDARY GUARANTEE The premium required to keep the Secondary Guarantee Rider
PREMIUM in force. This premium is shown on the Policy
Specifications page.
PREMIUM LIMITATIONS We will restrict any premium payment that would cause the
Policy to fail the definition of life insurance as defined
by Section 7702 of the Internal
Revenue Code of 1986 or any applicable successor. This
limitation will not cause this Rider to terminate. We will
not restrict payment of any premium, which is required to
maintain this Rider in force because such payment will
cause the Death Benefit to increase by an amount that
exceeds the premium received.
REINSTATEMENT If this Rider terminates it may not be reinstated.
TERMINATION This Rider will terminate on the first of the following
events to occur:
1. The death of the Insured;
2. The date of termination of the Policy to which this
Rider is attached;
3. The end of the Guarantee Grace Period following Our
notice to You that the premium requirement was not
met;
4. The Secondary Guarantee Date shown on the Policy
Specifications page;
5. The date a Change of Insured, on the Policy to which
this Rider is attached, is executed.
6. The date a term rider on the life of someone other
than the Insured is added if the Death Benefit Option
chosen for the Policy is the Guideline Premium Test.
or
7. The monthly anniversary on or following receipt by us
at our Home Office or any other office designated by
us of your written request to terminate this Rider.
We may require the Policy for endorsement.
CONTINUATION OF Once this Rider has terminated, the base Policy may
INSURANCE continue in accordance with the provisions of the base
Policy but without the benefit provided by this Rider.
The Issue Date and the effective date of this Rider and the Policy are the same.
McCauley's signature Eichner's signature
GA logo
3E-5ABT-02
ADJUSTABLE BENEFIT TERM RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
This Rider is subject to all applicable terms and provisions of the Policy,
except as modified herein. This Rider is a part of the Policy if it is listed on
the Policy Specifications page. A copy of the application for this Rider is
attached to and made part of the Rider.
Face Amount The Face Amount of this Rider is shown on the Policy
Specifications page.
LIFE INSURANCE This Rider provides non-convertible term life insurance on
BENEFIT the Insured shown on the Policy Specifications page. We
will pay the Death Benefit of this Rider to the
Beneficiary if the Insured dies while this Rider is in
force.
The Death Benefit provision in the Policy is modified so
that where it states "Face Amount" it means the Policy's
Face Amount plus this Rider's Face Amount.
ADJUSTABLE BENEFIT While this Rider is in force an adjustment in the Face
TERM DATES Amount of this Rider may be requested. Except with our
consent, such request may be made once each Policy year.
The adjustment will be effective on the Monthly
Anniversary on or after our receipt of the request.
ADJUSTABLE BENEFIT The Face Amount of this Rider may be increased subject to
TERM AMOUNT the following conditions:
1. Written request, subject to our approval, to increase
the Face Amount of this Rider;
2. Proof that the Insured is insurable based on our
underwriting rules for this Rider;
3. An increase of at least $1,000, except with our
consent.
The Face Amount of this Rider may be decreased, subject to
our approval, upon our receipt of a written request.
MONTHLY COST OF The Monthly Cost of Insurance for this Rider for the
INSURANCE following month is deducted as part of the Monthly
Deduction. The Monthly Cost of Insurance is equal to the
Net Amount at Risk for the Face Amount of this Rider times
the Monthly Cost of Insurance Rate for this Rider.
The Net Amount at Risk for the Face Amount of this Rider
is equal to:
1. The Face Amount of this Rider divided by the Monthly
Discount Factor shown on the Policy Specifications
page; less
2. Any Cash Value (before the deduction of the Monthly
Cost of Insurance for the base Policy) attributable
to the Face Amount of this Rider.
The Cash Value will be attributable to coverages in the
following order:
1. To the coverage provided by the initial Face Amount
plus any increase in Face Amount due to a Death
Benefit Option change; then
2. To the Face Amount of this Rider; and then
3. To any increase in Face Amount in the order they were
effective.
This Rider will be considered an increase to the Policy's
Face Amount when
determining the Monthly Cost of Insurance for the Policy.
MONTHLY COST OF The Monthly Cost of Insurance Rate for this benefit is
INSURANCE RATES based on the Insured's Attained Age, risk classification
and sex. Monthly Cost of Insurance Rates will be
determined by us based on expectations as to future
mortality, tax, interest earnings, expense and persistency
experience. We will not adjust such rates as a means of
recovering prior losses nor as a means of distributing
prior profits. These rates will not exceed those shown in
the Table of Maximum 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 Deduction 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.
TERMINATION This Rider will terminate on the first of the following
events to occur:
1. The lapse of the Policy; or
2. The surrender of the Policy; or
3. The Insured's date of death; or
4. Attained Age 100 of the Insured.
The Issue Date and effective date of this Rider and the Policy are the same.
McCauley's signature Eichner's signature
GA logo
TABLE OF MAXIMUM MONTHLY COST OF INSURANCE RATES
PER $1,000
INSURED: JOHN DOE
COVERAGE: ADJUSTABLE BENEFIT TERM RIDER
ISSUE DATE: JANUARY 1, 2002
POLICY NUMBER: 16,000,001
ATTAINED ATTAINED
AGE RATE AGE RATE
35 71
36 72
37 73
38 74
39 75
40 76
41 77
42 78
43 79
44 80
45 81
46 82
47 83
48 84
49 85
50 86
51 87
52 88
53 89
54 90
55 91
56 92
57 93
58 94
59 95
60 96
61 97
62 98
63 99
64
65
66
67
68
69
70
THESE RATES ARE FOR THIS RIDER AT ISSUE. THEY ARE BASED ON THE 1980
COMMISSIONERS STANDARD ORDINARY MORTALITY TABLE FOR A [MALE, SMOKER].
E-3GPO-00
Rider: Option to Purchase Long-Term Care Insurance
THE COMPANY agrees that the Owner of the Policy can purchase long-term care
insurance on the life of the Insured named in the attached Rider Schedule,
without proof of insurability.
PURCHASE OF LONG-TERM CARE INSURANCE
A long-term care policy can be applied for within 60 days of a Purchase Option
Date. Application for the long-term care policy must be in writing signed by the
Owner and by the Insured and received by the company within 60 days of a
Purchase Option Date.
PURCHASE OPTION DATES
The Purchase Option Dates are shown in the Rider Schedule.
THE LONG-TERM CARE POLICY
The long-term care policy will be issued:
- - With the same Insured as this Rider;
- - With the same underwriting class as this Rider or the class we determine
is the closest to it if the class of this Rider is not offered on the
long-term care policy;
- - On any individual plan of long-term care insurance issued by the Company
or by an affiliate designated by the Company on the date of purchase of
the long-term care policy;
- - On a policy form and at premium rates in use by the company on the date of
purchase of the long-term care policy;
- - Subject to any assignments and limitations to which this Rider is subject;
- - At the insurance age of the Insured on the date of purchase of the
long-term care policy;
- - With a Daily Benefit Amount, available at the time you exercise this
Option, up to the Amount shown in the Rider Schedule and with a Lifetime
Benefit Amount up to the Amount shown in the Rider Schedule;
- - With a minimum daily benefit amount based on the company's published
minimum on the date of purchase; or the Maximum Daily Benefit Amount shown
in the Rider Schedule for the Purchase Option Date, if less, except as
otherwise required by law; and
- - Subject to the New Policy Features as shown in the Rider Schedule .
The long-term care policy will take effect on the effective date stated in the
long-term care policy, but only if its initial premium is received by the
company.
The Company reserves the right to offer an option exercise credit. If an option
exercise credit is paid, it will be deducted from the initial premium for the
long-term care policy.
If the long-term care policy is issued on a basis other than daily benefits, the
Amounts shown in the long-term care policy will reflect the chosen benefit
period.
The contestable period of the long-term care policy issued under this Rider will
be measured from the Date of Issue of this Rider. Optional features or riders
can be attached to the long-term care policy only with the consent of the
company.
COST OF RIDER
The monthly cost of insurance charge for this Rider is guaranteed and shown in
the Rider Schedule.
DATE OF ISSUE
The Date of Issue of this Rider is the shown in the Rider Schedule.
NOT CONTESTABLE AFTER TWO YEARS
This Rider will not be contestable after it has been in force during the life of
the Insured for two years from its Date of Issue.
CONTRACT
A copy of the application for this Rider is attached to and made a part of the
Rider. This Rider is made a part of the Policy to which it is attached, if the
Rider is listed on the specifications page. This Rider has no cash value.
TERMINATION
This Rider will terminate upon the earliest of: (a) death of the Insured; (b)
surrender of the policy to which this Rider is attached; (c) 60 days after the
final Purchase Option Date; (d) the effective date of the long-term care policy;
and (e) the Company's recording of a written request signed by the Owner to end
the Rider.
GENERAL AMERICAN LIFE INSURANCE COMPANY
700 Market Street, St. Louis, MO 63101
ABCD ABCD
President Secretary
Rider Schedule
INSURED NAME: John Doe POLICY NUMBER: Specimen
DATE OF ISSUE: March 1, 2001 RIDER CLASS: Standard
AGE: 35 GUARANTEED MONTHLY COST OF $4.17
INSURANCE CHARGE
INITIAL DAILY BENEFIT $110.00
AMOUNT
NEW POLICY FEATURES:
WAITING PERIOD: 100 Days or if less, the minimum number of days required by
law.
PURCHASE MAXIMUM DAILY MAXIMUM LIFETIME
OPTION DATE BENEFIT AMOUNT BENEFIT AMOUNT
----------- -------------- --------------
3/1/2006 120.00 $131,400
3/1/2011 140.00 153,300
3/1/2016 170.00 186,150
3/1/2021 190.00 208,050
3/1/2026 220.00 240,900