Exhibit 99.1.A.5(d)
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: less any Face Amount provided by a
Supplemental Coverage Term Rider; and 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. A processing charge not to exceed $150; and
4. 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.
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 apply all or part of the Eligible
ACCELERATED Proceeds to your Accelerated Death Benefit
DEATH BENEFIT subject to the 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 Benefit in one sum or by placing the amount in an
DEATH BENEFIT account that earns interest. You will have immediate
access to all or any part of the account.
EFFECT OF All policy values and the Death Benefit on the remaining
BENEFIT Policy, if any, will be reduced in the same proportion
ACCELERATION ON as the amount of Eligible Proceeds was applied to the
POLICY AND Accelerated Death Benefit. Upon acceleration, future
RIDERS premiums and policy charges will be based on the reduced
Death Benefit of the Policy.
If you apply all of the Eligible Proceeds to your
Accelerated Death Benefit, all policy benefits based on
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.
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 This Rider does not apply if the Insured's terminal
EXCLUSION 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.
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Issue Date
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
[GENERAL AMERICAN LIFE INSURANCE COMPANY LOGO]
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
BENEFIT on 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 and Net Amount at Risk provisions in
the Policy are modified so that where it states "Face
Amount" it includes this Rider's Face Amount.
ADJUSTABLE While this Rider is in force an adjustment in the Face
BENEFIT TERM Amount of this Rider may be requested. Except with our
DATES 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 The Face Amount of this Rider may be increased subject
BENEFIT TERM to the following conditions:
AMOUNT
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; and
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.
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.)
MONTHLY COST The Monthly Cost of Insurance for this Rider for the
OF INSURANCE following month is charged as part of the Monthly
Deduction and is included in the Total Monthly Cost of
Insurance. The Monthly Cost of Insurance is calculated
as described in the Policy. (See the Monthly Deduction
and the Monthly Cost of Insurance provisions in the
Policy.).
MONTHLY COST The Monthly Cost of Insurance Rate for this benefit is
OF INSURANCE based on the Insured's Attained Age, Risk Classification
RATES 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.
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; and
4. Attained Age 100 of the Insured.
The Issue Date and effective date of this Rider and the Policy are the same.
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
[GENERAL AMERICAN LIFE INSURANCE COMPANY LOGO]
TABLE OF MAXIMUM MONTHLY COST OF INSURANCE RATES
PER $1,000
INSURED: [JOHN DOE]
COVERAGE: [ADJUSTABLE BENEFIT TERM RIDER]
POLICY NUMBER: [16,000,001]
ATTAINED ATTAINED ATTAINED RATE
AGE RATE AGE RATE AGE
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 THE ADJUSTABLE BENEFIT TERM RIDER AS OF THE ISSUE DATE. THEY
ARE BASED ON THE 1980 COMMISSIONERS STANDARD ORDINARY MORTALITY TABLE FOR A
[MALE, SMOKER].
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 95, 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 95.
We must receive your written request for an Anniversary Partial
Withdrawal at our Home Office or any other office designated by us on
or before the policy anniversary on which the withdrawal is to be
effective. The amount of the partial withdrawal may not exceed the
greater of:
1. The increase in Cash Surrender Value since the preceding policy
anniversary; and
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 95;
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; 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.
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.
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
[GENERAL AMERICAN LIFE INSURANCE COMPANY LOGO]
CHILDREN'S LIFE INSURANCE 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 part of
the Rider.
FACE AMOUNT The Face Amount for this Rider on each Insured Child at
and after age 6 months is the Face Amount shown for the
Rider on the Policy Specifications page, or half of that
amount before age 6 months. If the Rider is added after
issue, the Policy Specifications page for Policy Change
shows the Face Amount for the Rider.
LIFE INSURANCE We will pay the Face Amount to the Beneficiary under
BENEFIT this Rider upon the death of the Insured Child while
this Rider is in force. We must receive proof that the
death occurred before the Expiry Date of insurance on
such Insured Child.
DEFINITION OF The Insured, as shown on the Policy Specifications page,
INSURED is the person whose life is covered under the Policy to
which this Rider is attached.
DEFINITION OF Any child, stepchild or legally adopted child of the
INSURED CHILD Insured is an Insured Child if named in the application
for this Rider. Any child of the Insured born after the
date of the application for this Rider will become an
Insured Child at age 15 days. Any child who is legally
adopted by the Insured after the date of the application
for this Rider but before the child's 18th birthday will
become an Insured Child at age 15 days or on the date of
adoption, if later. Each Insured Child will cease to be
an Insured Child on the first to occur of:
1. His or her 25th birthday;
2. The Expiry Date of this Rider;
3. A conversion of the insurance provided by the Rider
on that Insured Child; and
4. The death of the Insured Child.
OWNER Unless otherwise provided, during the lifetime of the
Insured, the Owner of the Policy will be the Owner of
this Rider. Upon the death of the Insured, all such
rights with respect to insurance then in force under
this Rider on the life of an Insured Child, will, unless
otherwise provided, vest in such Insured Child.
THE BENEFICIARY The Beneficiary of any benefit payable as a result of
the death of any Insured Child will be: the Insured, if
living; if not then the estate of the person upon whose
death payment is to be made; unless: otherwise provided
in the application; or changed by you.
You may change the beneficiary designation of the
insurance on the life of
any person insured under this Rider. This change must be
done during the lifetime of such person. To make such a
change you must file a proper written request with us.
This request must be accepted by us at our Home Office
or any other office designated by us. If we accept your
request, the change will take effect as of the date of
the request. This change will be subject to any payment
or action we took before we received your written
request for the change. The beneficiary designation and
any changes made will be subject to any assignment of
the Policy.
MONTHLY COST The Monthly Cost of Rider for the following month is
OF RIDER charged as part of the Monthly Deduction. The Monthly
Cost of Rider for the Children's Life Insurance Rider
is:
1. The Face Amount shown for the Rider on the Policy
Specifications page or Policy Specifications page
for Policy Change divided by $1,000; times
2. The Monthly Cost of Rider Rate - Children's Life
Insurance Rider shown on the Policy Specifications
page or on the Policy Specifications page for Policy
Change
EXTRA AMOUNT We will provide an extra amount of insurance on an
OF INSURANCE Insured Child for 90 days at no extra charge when:
1. That Insured Child marries;
2. A child is born to that Insured Child; and
3. A child is legally adopted by that Insured Child.
The extra amount of insurance will be four times the
Face Amount under this Rider. On receipt of proof that
that Insured Child died within 90 days after the
marriage, birth or adoption, we will pay the extra
amount to the estate of that Insured Child. The extra
insurance will expire at the end of 90 days after the
marriage, birth or adoption. In no event will the amount
of extra insurance on an Insured Child be more than four
times the Face Amount if any 90-day periods overlap. Any
extra amount of insurance provided under this provision
is not convertible under the Conversion Rights
provision.
PAID-UP TERM EXCEPT AS PROVIDED UNDER THE SUICIDE EXCLUSION PROVISION
BENEFIT OF THIS RIDER, IF THE INSURED'S DEATH OCCURS WHILE THIS
RIDER IS IN FORCE, THIS RIDER WILL BE CONTINUED AS IF
THE INSURED HAD NOT DIED AT NO EXTRA COST. THIS FULLY
PAID-UP BENEFIT WILL BE SUBJECT TO THE TERMS OF THIS
RIDER. WE MUST RECEIVE PROOF OF DEATH OF THE INSURED.
Any child who would have become an Insured Child if the
Insured's death had not occurred will become an insured
child in accordance with the provisions of this Rider.
CONVERSION THE OWNER MAY CONVERT THE TERM INSURANCE IN FORCE UNDER
RIGHTS THIS RIDER ON EACH INSURED CHILD FOR A NEW POLICY ON
THAT INSURED CHILD'S DATE OF CONVERSION. THE DATE OF
CONVERSION IS THE 25TH BIRTHDAY OF THAT INSURED CHILD
OR, IF EARLIER, THE EXPIRY DATE OF THIS RIDER. AN
INSURED CHILD'S DATE OF CONVERSION CAN BE ADVANCED TO
THE DATE ANY EXTRA AMOUNT OF INSURANCE ON THAT INSURED
CHILD EXPIRES UNDER THIS RIDER. THE NEW POLICY WILL BE
ISSUED:
1. On the life of the Insured Child;
2. Without proof of insurability;
3. With a Face Amount not more than 5 times the Face
Amount of this Rider on the Insured Child;
4. Based on a standard nonsmoker risk classification or
the risk classification the issuing company
determines is closest to it if that classification
is not available on the new policy;
5. With a current Policy Date;
6. By us or by an affiliate designated by us;
7. On a plan agreed to by the issuing company;
8. At the then current age of the Insured Child as
calculated by the issuing company for that plan of
insurance;
9. Subject to payment of the first premium for the new
policy;
10. On a policy form and at rates in use by the issuing
company on the Policy Date of the new policy; and
11. Subject to any assignments and limitations to which
this Rider is subject.
THE CONVERSION MAY BE MADE ONLY WITH OUR CONSENT IF THE
AMOUNT OF INSURANCE TO BE CONVERTED IS LESS THAN THE
ISSUING COMPANY'S PUBLISHED MINIMUM LIMITS OF ISSUE.
REINSTATEMENT If this Rider lapses, you may reinstate it within three
years after the date of lapse. The Rider cannot be
reinstated, except with our consent, if more than three
years have passed since the date of lapse. To reinstate,
you must submit the following items:
1. A written application for reinstatement;
2. Proof satisfactory to us that each Insured Child is
insurable by our standards; and
3. Payment, while each Insured Child is living, of a
premium large enough to keep the Rider in force for
at least three months.
Upon Reinstatement, we will deduct any Monthly Cost of
Rider due and unpaid at the time of lapse. The Insured
must be alive on the date we approve the request for
Reinstatement. If the Insured is not alive, such
approval is void and of no effect.
The reinstated rider will be in force from the date we
approve the Reinstatement application.
LIMITATIONS ON This Rider can be reinstated only if the Policy is also
REINSTATEMENT reinstated or is in force. If only a portion of the
Policy coverage is reinstated then only a portion of the
Rider coverage may also be reinstated.
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 If the Insured dies by suicide, while sane or insane,
EXCLUSION within two years from the Issue Date of this Rider:
1. The Rider will not become paid-up under the Paid-up
Benefit provision;
2. The Rider will terminate; and
3. The Cost of Rider paid for the Rider will be
included in the Policy Proceeds.
INCORRECT AGE The date that coverage under this Rider ceases, expires
or terminates will be based on the correct age of each
person insured.
EXPIRATION The Expiry Date of this Rider is the policy anniversary
OF INSURANCE nearest the 65th birthday of the Insured. If this Rider
has not already expired or been
cancelled, then insurance on each Insured Child will
cease on the 25th birthday of such child.
TERMINATION This Rider will terminate upon the earliest of:
1. The lapse of the Policy;
2. The surrender of the Policy;
3. The Expiry Date for the Rider; and
4. The monthly anniversary on or following receipt by
us at our Home Office or any other office designated
by us of the Owner's 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 unless
another Issue Date is shown below. The insurance provided by this Rider will be
in force from the Issue Date of the Rider.
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Issue Date
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
[GENERAL AMERICAN LIFE INSURANCE COMPANY LOGO]
CONVERTIBLE SUPPLEMENTAL COVERAGE TERM RIDER
ISSUED BY GENERAL AMERICAN 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 This Rider provides convertible term life insurance on
INSURANCE the life of the Insured shown on the Policy
BENEFIT Specifications page. We will pay the Face Amount of this
Rider to the Beneficiary as part of the Policy Proceeds
if the Insured dies while this Rider is in force.
MONTHLY COST The Monthly Cost of Rider for the following month is
OF RIDER charged as part of the Monthly Deduction. The Monthly
Cost of Rider is the Monthly Cost of Rider Rate for this
Rider times the Face Amount of this Rider divided by
1,000.
MONTHLY COST The Monthly Cost of Rider Rate for this benefit is based
OF RIDER on the Insured's Attained Age, Risk Classification and
RATES sex. Monthly Cost of Rider 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 Rider Rates for
the Convertible Supplemental Coverage Term Rider.
DECREASES IN After the first policy year, the Face Amount of this
RIDER FACE Rider may be decreased by sending us a written request.
AMOUNT
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;
2. The Face Amount after the decrease may not be less
than $10,000; and
3. Any decrease must be at least the Minimum Face
Amount Decrease as shown on the Policy
Specifications page.
CONVERSION After the first policy year, the Owner can, before the
RIGHTS policy anniversary on which the Insured is Attained Age
80, convert any portion of the insurance then in force
under this Rider to: a new policy; or an increase in
Face Amount for the Policy:
1. If the Attained Age of the Insured meets the issuing
company's issue age requirements on the date of the
conversion; and
2. If the issuing company's underwriting class
requirements on the date of the conversion can be
met.
CONVERSION If the conversion is to a new policy, the new policy
TO A NEW will be issued:
POLICY
1. With the same Insured as this Rider;
2. Without proof of insurability;
3. With a Face Amount equal to the amount of term
insurance being converted;
4. With the same underwriting class as this Rider, or
the class we determine is closest to it if the class
of this Rider is not offered on the new policy;
5. With a current Policy Date;
6. By us or by an affiliate designated by us;
7. On a plan agreed to by the issuing company;
8. At the then current age of the Insured as calculated
by the issuing company for that plan of insurance;
9. Subject to payment of the first premium for the new
policy less any conversion credit;
10. Subject to any assignments and limitations to which
this Rider is subject; and
11. On a policy form and at rates in use by the issuing
company on the Policy Date of the new policy.
The conversion may be made only with our consent if:
1. The amount of term insurance you want to convert is
less than the issuing company's published minimum
limits of issue; or
2. Any rider is to be attached to the new policy.
The Contestable and Suicide periods of the new policy
will be measured from the Issue Date of this Rider.
CONVERSION If the conversion is to an increase in Face Amount, any
TO AN increase in Face Amount is subject to:
INCREASE IN
FACE AMOUNT 1. New insurance for the amount of the increase on the
same plan at the Attained Age of the Insured on the
date of the conversion being allowed under the
underwriting rules of the issuing company;
2. The amount of the increase being at least the
Minimum Face Amount Increase shown on the Policy
Specifications page, except with our consent; and
3. A Monthly Deduction for that increase.
An increase will be effective on the date shown in the
Policy Specifications page for Policy Change.
The Contestable and Suicide periods of the increase in
Face Amount will be measured from the Issue Date of
this Rider.
TERMINATION This Rider will terminate upon the earliest of:
1. The lapse of the Policy;
2. The surrender of the Policy;
3. The Insured's date of death;
4. A conversion of the entire Face Amount of the Rider
to new insurance;
5. Attained Age 100 of the Insured; and
6. 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.
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
[GENERAL AMERICAN LIFE INSURANCE COMPANY LOGO]
EXCHANGE TO TERM INSURANCE ENDORSEMENT
As of the Issue Date, this Endorsement is a part of the Policy and is subject to
all applicable terms and provisions except as modified herein.
EXCHANGE OF You can exchange this Policy for a policy which provides
POLICY FOR fixed benefit term insurance:
TERM INSURANCE
1. If the Policy has not lapsed;
2. If the Policy is in force under a corporate plan of
deferred compensation;
3. If the purchase of insurance under the plan was not
at the option of the Insured; and
4. If the exchange is made within three years of the
Policy Date of the Policy.
The new policy:
1. Will be issued by us or by an affiliate designated
by us;
2. Will have the same Insured as this Policy;
3. Will have a Face Amount equal to the amount of
coverage being exchanged; and
4. Will be on a plan agreed to by the issuing company.
The new policy will have the same Issue Age and Policy
Date as this Policy.
This Policy will terminate after an exchange. The
exchange will be subject to: an application to exchange
the Policy; and proof that the Insured is then
insurable. An exchange credit will be paid to you. The
credit will be quoted by us on request.
A detailed statement of the method of computing the
exchange credit has been filed, where required, with the
Insurance Department of the state in which the Policy is
delivered.
If you surrender this Policy for its Cash Surrender
Value at a time when this Exchange of Policy for Term
Insurance would have been available, we will
automatically pay an amount equal to the exchange credit
in lieu of the Cash Surrender Value if we determine that
the exchange credit would be greater.
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
[GENERAL AMERICAN LIFE INSURANCE COMPANY LOGO]
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 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.
OPTION TO The Owner may purchase an Option Policy on the
PURCHASE Designated Life during an Option Period that begins
INSURANCE 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 other
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 other 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 The Designated Life is named in the application for this
LIFE Rider. The Designated Life may not be changed.
OPTION The Option Periods for this Rider are elected at the
time of
PERIODS 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 The Total Option Amount is the amount shown on the
AMOUNT Policy Specifications page or on the Policy
Specifications page for Policy Change.
CURRENT The Current Option Amount is the Total Option Amount
OPTION divided by the number of Option Periods elected in the
AMOUNT 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 The Monthly Expense Charge for this Rider is deducted
EXPENSE from the Policy's Cash Value on the monthly anniversary.
CHARGE 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 on the Policy Specifications page
for Policy Change.
TEMPORARY We will pay the Current Option Amount as temporary
INSURANCE insurance to the Beneficiary if the death of the
Designated Life occurs during the Option Period.
However, 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 Policy Proceeds.
FEATURES OF At the request of the person authorized to purchase the
OPTION POLICY Option Policy, the Option Policy may be any permanent
individual life plan approved by us, or by an affiliate
designated by us, 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 designated
by us, on the issue date of this Rider. The Option
Policy will be subject to any 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 currently offered by us or by an affiliate
designated by us, 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 current age and sex of the Designated Life
as calculated by the issuing company for that
plan of insurance;
b. The Risk Classification of the Designated Life
as of the Issue Date of this Rider as shown on
the Policy Specifications page or on the Policy
Specifications page for Policy Change or the
closest risk classification available; 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 offered by us or an
affiliate designated by us, on the issue date of
this rider 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 Classification of the Designated
Life as of the Issue Date of this Rider as
shown on the Policy Specifications page or
on the Policy Specifications page for Policy
Change or the closest risk classification
available; and
3. The rates in use by the issuing company 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 If this Rider lapses, you may reinstate it within
three years after the date of lapse. The Rider cannot
be reinstated, except with our consent, if more than
three years have passed since the date of lapse. To
reinstate, you must submit the following items:
1. A written application for Reinstatement;
2. Proof satisfactory to us that the Designated Life is
insurable by our standards; and
3. Payment, while the Designated Life is living, of a
premium large enough to keep the Rider in force for
at least three months.
Upon Reinstatement, we will deduct any Monthly Expense
Charges due and unpaid at the time of lapse. The Insured
must be alive on the date we approve the request for
Reinstatement. If the Insured is not alive, such
approval is void and of no effect.
The reinstated rider will be in force from the date we
approve the Reinstatement application.
LIMITATIONS ON This Rider can be reinstated only if the Policy is also
REINSTATEMENT reinstated or is in force. If only a portion of the
Policy coverage is reinstated then only a portion of the
Rider coverage may also be reinstated.
INCONTESTABILITY This Rider will not be contestable after it has been in
force during the lifetime of the Designated Life for two
years from the Issue Date of this Rider.
SUICIDE If the Designated Life dies by suicide, while sane or
EXCLUSION insane, during the Option Period and within two years
from the Issue Date of this Rider:
1. The Face Amount of any Option Policy will not be
paid;
2. This Rider will terminate; and
3. The Monthly Expense Charges paid for this Rider will
be paid in one sum to the Beneficiary of this Rider
if the Option Period began on the date of death of
the Insured otherwise to the Owner.
MISSTATEMENT If the Face Amount of the Policy to which this Rider is
OF AGE AND/OR attached is decreased due to the misstatement of age
SEX OF THE and/or sex of the Insured, then the Option Amount stated
INSURED on the Policy Specifications page or on the Policy
Specifications page for 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 If the age and/or sex of the Designated Life and/or the
OF AGE AND/OR Insured has been misstated on the application, we will
SEX OF THE adjust the Total Option Amount to be the Total Option
DESIGNATED Amount that would have been provided had this
LIFE AND/OR THE 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 date the Policy terminates for reasons other
than the death of the Insured;
2. The date of death of the Designated Life;
3. The date the Option Period that begins on the date
of death of the Insured ends; 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 and this Rider for
endorsement;
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
V.P., GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
[GENERAL AMERICAN LIFE INSURANCE COMPANY LOGO]
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. 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.
PURCHASE OF Additional life insurance can be purchased on each
ADDITIONAL Purchase Option Date shown on the Options to Purchase
LIFE Additional Life Insurance Rider Schedule. The additional
INSURANCE 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 The Maximum Option Amount is the maximum amount of
OPTION additional life insurance that can be purchased on each
AMOUNT 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 The Maximum Total Option Amount is the lesser of:
TOTAL 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 The Purchase Option Dates are shown on the Options to
OPTION DATES Purchase Additional Life Insurance Rider Schedule.
ADVANCEMENT OF After the second rider year, at your election, the next
PURCHASE available Purchase Option Date can be advanced to the
OPTION DATES date on which any of the following events occurs:
1. A child is born to the Insured;
2. A child under 21 is legally adopted by the Insured;
3. A home or other real estate is purchased by the
Insured;
4. The Insured marries;
5. The Insured divorces; and
6. The Insured's Spouse dies.
Proof, satisfactory to us, of the event may be required
prior to advancement.
INCREASE IN The increase will take effect on the Purchase Option
FACE Date subject to the Change in Face Amount provision in
AMOUNT 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 The new policy will be issued:
POLICY
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 The Monthly Cost of Rider for the following month is
COST OF 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. The lapse of the Policy;
2. The surrender of the Policy;
3. The Insured's date of death;
4. When the total amount of coverage issued under this
Rider equals the Maximum Total Option Amount;
5. 60 days after the final Purchase Option Date; and
6. 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.
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
[GENERAL AMERICAN LIFE INSURANCE COMPANY LOGO]
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:
c With the same Insured as this Rider;
c 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;
c 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;
c On a policy form and at premium rates in use by the company on the date of
purchase of the long-term care policy;
c Subject to any assignments and limitations to which this Rider is subject;
c At the insurance age of the Insured on the date of purchase of the
long-term care policy;
c 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;
c 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
c 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.
NEW ENGLAND LIFE INSURANCE COMPANY
501 Boylston Street, Boston, Massachusetts
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 INSURANCE CHARGE $4.17
INITIAL DAILY
BENEFIT AMOUNT $110.00
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
SECONDARY GUARANTEE 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.
SECONDARY If, on a monthly anniversary day prior to the
GUARANTEE BENEFIT Secondary 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 Cash Value paid to you to allow the Policy to
continue to qualify as a life insurance contract;
less
4. Any outstanding Loan and Loan Interest.
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; and
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 a life insurance contract under
the Internal Revenue Code of 1986 or any applicable
successor.
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 Monthly Cost of Rider Rate shown
on the Policy Specifications page, divided by 1000,
multiplied by:
1. The Face Amount of any Convertible Supplemental
Coverage Term Rider; plus
2. The Net Amount at Risk. (See the Net Amount at
Risk and the Allocation of the Net Amount at Risk
to Coverages provisions in the Policy.)
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, any Cash
Value paid to you to allow the Policy to continue to
qualify as a life insurance contract 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 If there is a misstatement of age or sex in the
AGE 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 The date the Secondary Guarantee Rider expires. This
GUARANTEE DATE date is shown on the Policy Specifications page.
SECONDARY The premium required to keep the Secondary Guarantee
GUARANTEE PREMIUM Rider in force. This premium is shown on the Policy
Specifications page.
PREMIUM We will restrict any premium payment that would cause
LIMITATIONS 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 the Term Insurance on Covered Insured
Rider is added if the definition of life insurance
test chosen for the Policy is the Guideline
Premium Test; and
\ 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 Once this Rider has terminated, the base Policy may
OF 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.
V.P., GENERAL COUNSEL,
AND SECRETARY
PRESIDENT AND CEO
GENERAL AMERICAN LIFE INSURANCE COMPANY [LOGO]
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 you can make a Split Dollar Partial Withdrawal of Cash
WITHDRAWAL 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 the Minimum Loan and Withdrawal
Amount shown on the Policy Specifications page.
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 Face Amount of any Adjustable Benefit
Term Rider;
2. The remaining initial Face Amount of the
Policy, plus any change in Face Amount
provided by a Change in Death Benefit Option,
to the Minimum Face Amount shown on the
Policy Specifications page;
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 Face Amount of any Adjustable Benefit
Term Rider;
2. The remaining initial Face Amount of the
Policy, plus any change in Face Amount
provided by a Change in Death Benefit Option,
to the Minimum Face Amount shown on the
Policy Specifications page;
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.
V.P., GENERAL COUNSEL,
AND SECRETARY
PRESIDENT AND CEO
GENERAL
AMERICAN
LIFE INSURANCE COMPANY
ST. LOUIS, MISSOURI 63166
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
BENEFIT on 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 and Net Amount at Risk provisions in
the Policy are modified so that where it states "Face
Amount" it includes 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 and is included
in the Total Monthly Cost of Insurance. The Monthly Cost
of Insurance is calculated as described in the Policy.
(See the Monthly Deduction and the Monthly Cost of
Insurance provisions in 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 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.
MONTHLY An Administration and Issue Expense Charge for this
ADMINISTRATION Rider will be charged as part of the Monthly Deduction.
AND ISSUE The Monthly Administrative and Issue Expense Charge is
EXPENSE CHARGE calculated as described in the Monthly Administrative
and Issue Expense Charge provision in the Policy; except
that the provision is modified so that where it states
"initial Face Amount" it includes this Rider's Face
Amount.
DECREASES IN You can request a decrease in this Rider's Face Amount
RIDER FACE on any policy anniversary date. We must receive the
AMOUNT request in writing at our Home Office or any other
office designated by us no more than 25 days prior to
the policy anniversary on which the decrease is to be
effective. We may consent to a requested decrease in
this Rider's Face Amount that is received more than 25
days prior to a policy anniversary. If we consent to
such a decrease, the decrease will be effective on the
monthly anniversary on or following our receipt of the
written request.
Any requested decrease in the Rider's Face Amount 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 upon the earliest of:
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. Attained Age 100 of the Insured; and
6. 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.
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
GENERAL
AMERICAN
LIFE INSURANCE COMPANY
ST. LOUIS, MISSOURI 63166
TEMPORARY TERM INSURANCE RIDER
ISSUED BY GENERAL AMERICAN LIFE INSURANCE COMPANY
TERM We agree that the Policy and its riders will be in force
INSURANCE as temporary term insurance from the Issue Date to the
BENEFIT 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.
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
GENERAL
AMERICAN
LIFE INSURANCE COMPANY
ST. LOUIS, MISSOURI 63166
TERM INSURANCE ON COVERED INSURED 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 part of
the Rider.
FACE AMOUNT The Face Amount for this Rider is the amount shown on
the Table of Maximum Monthly Cost of Rider Rates per
$1,000.
LIFE INSURANCE If the Covered Insured dies while this Rider is in
BENEFIT force, the Face Amount of the Rider will be paid in one
sum to the Beneficiary of the Rider.
COVERED The Covered Insured is named in the application for this
INSURED Rider.
OWNER OF THIS The Owner of this Rider is the Owner of the Policy and
RIDER cannot be changed.
MONTHLY COST The Monthly Cost of Rider for the following month is
OF RIDER charged as part of the Monthly Deduction. The Monthly
Cost of Rider is the Monthly Rate shown on the Table of
Maximum Monthly Cost of Rider Rates per $1,000 times the
Face Amount of this Rider divided by 1,000.
MONTHLY COST The Monthly Cost of Rider Rate for this benefit is based
OF RIDER RATES on the Insured's Attained Age, Risk Classification and
sex. The rates for the Rider are set by us each year on
the rider anniversary, 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. The rates for the Rider will
never be more than the rates shown in the Table of
Maximum Monthly Cost of Rider Rates per $1,000 for the
Term Insurance on Covered Insured Rider.
DECREASE IN After the first policy year, the Face Amount of this
RIDER FACE Rider can be decreased by sending us a written request;
AMOUNT but only if the Face Amount of the Rider after the
decrease is at least $50,000, except with our consent.
The decrease will become effective on the monthly
anniversary on or following receipt of the request by us
at our Home Office or any other office designated by us.
Upon a decrease, the new Face Amount will be shown on
the Policy Specifications page for Policy Change.
REINSTATEMENT If this Rider lapses, you may reinstate it within three
years after the date of lapse. The Rider cannot be
reinstated, except with our consent, if more than three
years have passed since the date of lapse. To reinstate,
you must submit the following items:
1. A written application for Reinstatement;
2. Proof satisfactory to us that the Covered Insured is
insurable by our standards; and
3. Payment, while the Covered Insured is living, of a
premium large enough to keep the Rider in force for
at least three months.
Upon Reinstatement, we will deduct any Monthly Cost of
Rider due and unpaid at the time of lapse. The Insured
must be alive on the date we approve the request for
Reinstatement. If the Insured is not alive, such
approval is void and of no effect.
The reinstated rider will be in force from the date we
approve the Reinstatement application.
LIMITATIONS ON This Rider can be reinstated only if the Policy is also
REINSTATEMENT reinstated or is in force. If only a portion of the
Policy coverage is reinstated then only a portion of the
Rider coverage may also be reinstated.
CONVERSION The Owner may, before the rider anniversary on which the
RIGHTS Covered Insured is Attained Age 65, or if later, prior
to the end of the fifth rider year, convert any portion
of the insurance then in force under this Rider for a
new policy:
1. If the Attained Age of the Covered Insured meets the
issuing company's issue age requirements on the date
of the conversion; and
2. If the issuing company's underwriting class
requirements on the date of the conversion can be
met.
Except with our consent, any Face Amount of the Rider
that will remain after a conversion must be at least
$50,000.
The new policy will be issued:
1. On the life of the Covered Insured;
2. Without proof of insurability;
3. With a Face Amount equal to the amount of term
insurance being converted;
4. With the same underwriting class as this Rider, or
the class we determine is closest to it if the class
of this Rider is not offered on the new policy;
5. With a current Policy Date;
6. By us or by an affiliate designated by us;
7. On a plan agreed to by the issuing company;
8. At the then current age of the Covered Insured as
calculated by the issuing company for that plan of
insurance;
9. Subject to payment of the first premium for the new
policy;
10. On a policy form and at premium rates in use by the
issuing company on the Policy Date of the new
policy; and
11. Subject to any assignments and limitations to which
this Rider is subject.
The conversion may be made only with our consent if:
1. The amount of term insurance you want to convert is
less than the issuing company's published minimum
limits of issue; or
2. Any rider is to be attached to the new policy.
INCONTESTABILITY The insurance issued under this Rider will not be
contestable after it has been in force during the life
of the Covered Insured for two years from the Issue Date
of the Rider.
SUICIDE If the Covered Insured dies by suicide, while sane or
EXCLUSION insane, within two years from the Issue Date of this
Rider:
1. The Face Amount will not be paid;
2. The Rider will terminate; and
3. The Monthly Deductions paid for the Rider will be
paid in one sum to the Beneficiary of the Rider.
MISSTATEMENT If the age or sex of the Covered Insured has not been
OF AGE OR SEX correctly stated in the application, the Death Benefit
OF COVERED for this Rider will be corrected. The Death Benefit will
INSURED be that which the most recent Monthly Deduction for the
Rider would have purchased for the correct age or sex.
TERMINATION This Rider will terminate upon the earliest of:
1. The conversion of the entire Face Amount of the
Rider to a new policy;
2. The lapse of the Policy;
3. The surrender of the Policy;
4. The Insured's date of death;
5. The Expiry Date shown for the Rider in the Table of
Maximum Monthly Cost of Rider Rates per $1,000 for
the Term Insurance on Covered Insured Rider; and
6. 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. The insurance provided by this Rider
will be in force from the Issue Date of the Rider.
_________________
Issue Date
VP, GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
GENERAL
AMERICAN
LIFE INSURANCE COMPANY
ST. LOUIS, MISSOURI 63166
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 We will waive the Monthly Deductions for this Policy if:
MONTHLY 1. You furnish us with written proof that the Insured
DEDUCTION is totally disabled, as defined in this Rider;
BENEFIT
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 5," "Age 60," and "Age 65" begin on the policy
AGE 5, AGE 60, anniversary nearest the Insured's 5th, 60th, and 65th
AND AGE 65 birthdays, respectively.
INCREASE IN Coverage under this Rider can be increased, subject to
WAIVER COVERAGE our 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.
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 Monthly Cost of Rider Rate divided
by 100 times the Policy's Monthly Deduction not
including the cost of this Rider. The Monthly Cost of
Rider Rate for this benefit is based on the Insured's
Attained Age.
TOTAL "Total Disability" means the inability of the Insured to
DISABILITY 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 We will not waive Monthly Deductions under this Rider if
ASSUMED 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 the claim.
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 We have the right to have the Insured examined by our
THE INSURED AND appointed examiner. Such exam will be at our expense.
PROOF OF
CONTINUED We 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 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 If the Insured becomes totally disabled during the Grace
PROVISIONS Period and becomes eligible for the Waiver of Monthly
Deduction Benefit, we will waive the Monthly Deductions
that were due during 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 of 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;
and
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
V.P., GENERAL COUNSEL, PRESIDENT AND CEO
AND SECRETARY
GENERAL
AMERICAN
LIFE INSURANCE COMPANY
ST. LOUIS, MISSOURI 63166
TABLE OF MAXIMUM MONTHLY COST OF RIDER RATES
PER $100
INSURED: [JOHN DOE]
COVERAGE: [WAIVER OF MONTHLY DEDUCTION RIDER]
POLICY NUMBER: [16,000,001]
ATTAINED ATTAINED ATTAINED
AGE RATE AGE RATE AGE RATE
35 6.30
36 6.80
37 7.10
38 7.60
39 8.09
40 8.51
41 8.93
42 9.77
43 10.23
44 10.93
45 11.50
46 12.00
47 12.50
48 13.00
49 14.00
50 14.50
51 15.00
52 16.28
53 17.50
54 18.00
55 18.50
56 19.43
57 19.95
58 20.33
59 20.48
60 6.20
61 5.50
62 4.75
63 4.00
64 3.00
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 amount shown as the monthly premium waived on the Policy
PREMIUM 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 5," "Age 60," and "Age 65" begin on the policy
AGE 5, AGE 60 anniversary nearest the Insured's 5th, 60th and 65th
AND AGE 65 birthdays, respectively.
INCREASE IN Coverage under this Rider can be increased, subject to
our underwriting
WAIVER COVERAGE 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 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.
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 calculated as (1) multiplied by (2)
where:
1. Is the Monthly Cost of Rider Rate for this Rider
divided by 100; and
2. Is the monthly premium waived.
The Monthly Cost of Rider Rate for this benefit is based
on the Insured's Attained Age.
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 We will not credit the monthly premium waived under this
ASSUMED 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
AND PROOF OF Policy, we must receive the following at our Home Office
DISABILITY or any 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 the claim.
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 We have the right to have the Insured examined by our
THE INSURED AND appointed examiner. Such exam will be at our expense. We
PROOF OF also have the right to require written proof of
CONTINUED continuance of disability from the Insured at the
DISABILITY 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 If the Insured becomes totally disabled during the Grace
PROVISIONS Period and becomes eligible for the Waiver of Specified
Premium Benefit, we will credit to the Policy any
monthly premiums waived during 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 of 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;
and
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
V.P., GENERAL COUNSEL,
AND SECRETARY
PRESIDENT AND CEO
GENERAL
AMERICAN
LIFE INSURANCE COMPANY
ST. LOUIS, MISSOURI 63166
TABLE OF MAXIMUM MONTHLY COST OF RIDER RATES
PER $100
INSURED: [JOHN DOE]
COVERAGE: [WAIVER OF SPECIFIED PREMIUM RIDER]
POLICY NUMBER: [16,000,001]
ATTAINED ATTAINED ATTAINED
AGE RATE AGE RATE AGE RATE
35 3.00
36 3.25
37 3.25
38 3.25
39 3.25
40 3.25
41 3.25
42 3.25
43 3.40
44 3.60
45 3.80
46 4.00
47 4.25
48 4.50
49 5.00
50 5.25
51 5.50
52 6.00
53 6.50
54 6.75
55 7.00
56 7.00
57 7.25
58 7.00
59 6.25
60 5.25
61 4.75
62 4.00
63 3.25
64 2.00