1 EXHIBIT 1.(5)(b) Policy Riders [ACACIA NATIONAL LIFE INSURANCE COMPANY LOGO] DISABILITY BENEFIT RIDER BENEFITS While the Insured is totally disabled, the disability benefit amount will be applied as premium to the policy. The premium will be credited as of the last monthly activity date, prior to the approval date of the claim and will be credited annually thereafter, during continuance of total disability. In addition, while the Insured is totally disabled, the cost of insurance for this rider will not be deducted from the accumulation value. All other monthly deductions will apply. If total disability begins after the grace period, no benefits under this rider will be paid. If any portion of a disability benefit would affect the tax qualifications of this policy as described in Section 7702 of the Internal Revenue Code, as amended, the benefit payable will be reduced by that portion considered to be excess premium. CONSIDERATION This rider is issued in consideration of the application and payment of its cost of insurance. A copy of the application is attached to the policy. The cost of insurance for this rider is deducted from the accumulation value at the same time and in the same manner as the cost of insurance for the policy. DEFINITIONS DISABILITY BENEFIT: For purposes of this rider, the disability benefit is an amount shown on the schedule pages, selected by you on the application. EFFECTIVE DATE: The effective date of all coverage under this rider shall be as follows: 1. The policy date shall be the effective date for all coverage provided in the original application. 2. For any rider issued after the policy date, the effective date shall be the date shown on a supplement to the schedule pages of the policy. 3. For any insurance that has been reinstated, the effective date shall be the monthly activity date on or next following the date we approve the reinstatement. EXPIRATION DATE: This date is also shown in the schedule pages of the policy. It is the date on which this rider is no longer effective. TOTAL DISABILITY: Total disability must begin after the effective date of this rider as shown in the schedule pages and before the policy anniversary nearest the Insured's 65th birthday. It must result from bodily injury which occurs or sickness which first manifests itself while this rider is in force. Total Disability means: 1. Total loss of the sight of both eyes. This loss must be irrecoverable; or 2. Total loss of the use of both hands, both feet, or one hand and one foot. This loss must be irrecoverable; or DBR 8901 2 3. The incapacity of the Insured to engage in any substantial duties of his or her occupation for at least six consecutive months. (Substantial duties includes managerial or supervisory functions.) During the first 24 months of total disability, occupation means the usual work, employment, business or profession in which the Insured was engaged immediately before the date of disability. This includes attendance at school or college as a full-time student. After 24 months of total disability an Insured who is engaged in any occupation for remuneration or profit will not be considered totally disabled. GENERAL PROVISIONS NOTICE OF DISABILITY: To receive this benefit, written notice of claim must be received at the Home Office. It must be received: (a) while the Insured is living; (b) while the Insured is totally disabled; and (c) not later than 9 months after the Insured has become totally disabled. If such notice is not furnished in the required time limit, the claim will not be accepted. But a late claim will be accepted if it can be shown that it was not reasonably possible to meet the requirements and that notice was given as soon as was reasonably possible. In no event, however, will the Insured receive any benefit under this rider for a period prior to one year before the date on which notice was received. PROOF OF TOTAL DISABILITY: Approval of the initial notice of claim will be granted after we receive satisfactory written proof that the Insured is totally disabled. Proof must be presented at the Home Office: (a) while the Insured is living; (b) before total disability has ended or been interrupted; and (c) within 12 months after we receive the notice of total disability. Forms approved by us must be used. Similar proof that the total disability is continuing may be required at reasonable intervals. After the Insured has been totally disabled for 2 years, we will only require proof once per year. If the Insured fails to furnish such proof, the disability benefit will cease. DURATION OF BENEFITS: Upon approval of your claim, we will credit the disability benefit amount. We will start with the monthly anniversary date prior to the date disability began. However, we will not credit any amount for a period of more than 9 months before we receive written notice of disability unless it is shown that notice was given as soon as reasonably possible. We will continue to credit the disability benefit amount while the Insured is totally disabled and the policy is in force until the rider anniversary following the Insured's 100th birthday. However, if disability begins on or after the rider anniversary after the Insured's 60th birthday, we will only credit payment: 1. Until the rider anniversary following the Insured's 65th birthday; or 2. For two years; if later. INCONTESTABILITY: While the Insured is alive, the validity of this rider cannot be contested after it has been in force for a period of 2 years from the effective date of this rider. DBR 8901 3 REINSTATEMENT: Coverage under this rider may be reinstated with the policy if no more than 3 years have passed since the date of termination. Reinstatement must occur before the expiration date of this rider. Such reinstatement may occur any time before the policy anniversary nearest the Insured's 65th birthday. The requirements for reinstatement are: 1. Receipt of evidence of insurability satisfactory to us. 2. Payment of the minimum cost of insurance sufficient to keep this rider in force for 3 months. EXCLUSIONS: The Insured will not be eligible for the disability benefit if the total disability on which the claim is based results from: 1. Self-inflicted bodily injury while sane or insane, other than accidental injury; or 2. War or any act of war, whether declared or not, regardless of whether the Insured is in the armed forces. TERMINATION OF RIDER: This rider will automatically terminate on the earliest of these conditions: 1. On the expiration date of this rider; 2. On the monthly activity date on or next following the date we receive your written request; 3. On surrender of this rider to us; or 4. On termination of the policy. CHANGE OF POLICY: Once the disability benefit commences, you cannot change the specified amount of insurance (except for any increase(s) which result from exercising options under any Guaranteed Insurability Rider), the death benefit option, the mode of the planned periodic premium payments, or change the policy to another form of insurance. NONPARTICIPATING: This rider is nonparticipating. COST OF INSURANCE DEDUCTIONS AFTER TERMINATION OF THIS RIDER: If, after this rider has terminated, we make a deduction from the accumulation value for the cost of insurance for this rider, our only obligation to you under this rider will be to return the cost of insurance deduction. No coverage is available after the termination date of this rider. INCORPORATION OF POLICY PROVISIONS INTO RIDER: The provisions of the policy are hereby referred to and made a part of this rider unless otherwise specified in this rider. If the policy has been issued on a gender-neutral basis, this rider is also considered to be issued on a gender-neutral basis. This rider has no cash or loan value. ACACIA NATIONAL LIFE INSURANCE COMPANY /s/ Robert-John H. Sands /s/ Robert W. Clyde Secretary President DBR 8901 4 This page intentionally left blank. 5 [ACACIA NATIONAL LIFE INSURANCE COMPANY LOGO] TERM COVERAGE RIDER BENEFITS Under the terms of this rider, we agree to pay the Rider Death Benefit to the beneficiary upon receipt of satisfactory proof of the death of the Insured. Death must occur while this rider is in force. Payment is subject to the provisions of the policy and this rider. CONSIDERATION This rider is issued in consideration of the application and the payment of its cost of insurance. A copy of the application is attached to the policy. The cost of insurance for this rider is deducted from the accumulation value at the same time and in the same manner as the cost of insurance for the policy. DEFINITIONS BENEFICIARY: The term "beneficiary" in this rider means the person named as the beneficiary under the policy. INSURED: The term "Insured" in this rider means the person named as the Insured under the policy. EFFECTIVE DATE: The effective date of coverage under this rider shall be the policy date of the policy. The effective date for reinstatement for any insurance coverage provided by this rider is subject to the reinstatement provisions of the policy. EXPIRATION DATE: This date is shown in the schedule pages of the policy. It is the date on which this rider is no longer effective. RIDER DEATH BENEFIT: This is the amount of death benefit provided by this rider. It is the difference between the amount of the Total Death Benefit and the death benefit provided under the policy. The amount of Rider Death Benefit can change daily. It may change to zero but it can never be less than zero. In other words, this rider will remain in effect until you request its termination subject to the provision Termination of Rider. RIDER SPECIFIED AMOUNT OF INSURANCE: The Rider Specified Amount of Insurance is shown in the schedule pages of the policy. You may not increase this amount. After the first policy year, you may decrease this amount. However, you may not decrease the Rider Specified Amount of Insurance to less than $50,000. TOTAL DEATH BENEFIT: The Total Death Benefit depends upon which death benefit option is in effect. If Option A is in effect, the Total Death Benefit is the greater of (1) the Total Specified Amount of Insurance, or (2) the Accumulation Value multiplied by the appropriate death benefit percentage (see the policy provision on Death Benefit). If Option B is in effect, the Total Death Benefit is the greater of (1) the Total Specified Amount of Insurance plus the Accumulation Value, or (2) the Accumulation Value multiplied by the appropriate death benefit percentage (see the policy provision on Death Benefit) TCR 8901 6 TOTAL SPECIFIED AMOUNT OF INSURANCE: This is the specified amount of insurance provided under the policy plus the Rider Specified Amount of Insurance. COST OF INSURANCE The cost of insurance for this rider will be calculated each month. It is equal to the Rider Death Benefit on the monthly activity date multiplied by the monthly cost per $1000 of insurance divided by $1000. The Table of Maximum Annual Term Coverage Rider Cost of Insurance Rates is attached. The cost of insurance rates will not exceed the rates in this table plus an adjustment for any increased rating shown in the schedule pages of the policy. We have the option of charging less than the maximum rates shown in the table. Each year, the current annual cost of insurance rate will be declared for the next policy year. This rate will be based on the Insured's issue age, gender, risk class and the policy duration. The rate will be adjusted for any rating factor shown in the schedule pages of the policy. Any change in the current cost of insurance rates will apply to all Insureds of the same issue age, gender, and risk class and whose policies have been in effect for the same length of time. TERMINATION OF RIDER This rider will automatically terminate on the earliest of these conditions: 1. On the expiration date of this rider. 2. On the monthly activity date on or next following the date we receive your written request. However, you may not terminate this rider within the first policy year. 3. On termination of the policy. GENERAL PROVISIONS AMENDMENT TO POLICY: Item b. in Section 10.3 "Decreasing the Specified Amount" of the policy is amended. The specified amount in effect after any decrease may not be less than $50,000. However, once the Insured reaches attained age 100, the specified amount in effect after any decrease may not be less than $1,000. REINSTATEMENT: This rider may be reinstated with the policy if the Insured is living and application is made within three years from the beginning of any grace period. Reinstatement must occur before the expiration date of this rider. The requirements for reinstatement are: 1. Receipt of evidence satisfactory to us of insurability of the Insured. 2. Payment of the minimum cost of insurance sufficient to keep the rider in force for three months. SUICIDE: If the Insured commits suicide while sane or insane, within two years from the effective date of this rider, we will limit the benefits of this rider. The limited benefits will equal the cost of insurance paid for this rider. TCR 8901 7 INCONTESTABILITY: We cannot contest this rider after it has been in force during the Insured's life for two years from the rider effective date or from any reinstatement of this rider. COST OF INSURANCE DEDUCTIONS AFTER TERMINATION OF THIS RIDER: If, after this rider has terminated, we make a deduction from the accumulation value for the cost of insurance for this rider, our only obligation to you under this rider will be to return the cost of insurance deduction. No coverage is available after the termination date of this rider. INCORPORATION OF POLICY PROVISIONS INTO RIDER: The provisions of the policy are hereby referred to and made a part of this rider unless otherwise specified in this rider. If the policy has been issued on a gender-neutral basis, this rider is also considered to be issued on a gender-neutral basis. This rider has no cash or loan value. CONVERSION: This rider is not convertible to a permanent policy of life insurance. NON-PARTICIPATING: This rider is non-participating. ACACIA NATIONAL LIFE INSURANCE COMPANY /s/ Robert-John H. Sands /s/ Robert W. Clyde Secretary President TCR 8901 8 This page left intentionally blank. 9 TABLE OF MAXIMUM ANNUAL TERM COVERAGE RIDER COST OF INSURANCE RATES ATTAINED AGE MALE RATES FEMALE RATES UNISEX RATES - ------------------------------------------------------------------------------------------------- 18 2.22 1.22 2.02 19 2.32 1.27 2.11 20 2.37 1.31 2.17 21 2.38 1.33 2.18 22 2.36 1.36 2.16 23 2.32 1.38 2.13 24 2.27 1.42 2.11 25 2.21 1.45 2.06 26 2.16 1.48 2.03 27 2.13 1.52 2.01 28 2.12 1.57 2.01 29 2.13 1.62 2.03 30 2.16 1.68 2.06 31 2.22 1.75 2.12 32 2.28 1.81 2.18 33 2.38 1.87 2.28 34 2.50 1.97 2.38 35 2.63 2.06 2.52 36 2.80 2.20 2.67 37 3.00 2.36 2.87 38 3.22 2.55 3.08 39 3.48 2.77 3.35 40 3.77 3.02 3.62 41 4.11 3.30 3.95 42 4.45 3.58 4.27 43 4.83 3.86 4.65 44 5.23 4.15 5.01 45 5.68 4.45 5.43 46 6.15 4.75 5.87 47 6.65 5.06 6.33 48 7.17 5.41 6.81 49 7.76 5.78 7.36 50 8.38 6.20 7.95 51 9.12 6.63 8.62 52 9.95 7.12 9.37 53 10.88 7.68 10.23 54 11.95 8.26 11.20 55 13.08 8.86 12.22 56 14.32 9.46 13.33 57 15.61 10.03 14.47 58 16.98 10.58 15.67 59 18.46 11.17 16.96 (continued) TCR 8901 10 TABLE OF MAXIMUM ANNUAL TERM COVERAGE RIDER COST OF INSURANCE RATES (continued) ATTAINED AGE MALE RATES FEMALE RATES UNISEX RATES - ------------------------------------------------------------------------------------------------- 60 20.10 11.83 18.40 61 21.92 12.66 20.00 62 23.98 13.70 21.83 63 26.32 15.02 23.95 64 28.92 16.56 26.31 65 31.77 18.23 28.88 66 34.81 20.00 31.61 67 38.05 21.78 34.51 68 41.48 23.55 37.53 69 45.21 25.45 40.82 70 49.38 27.63 44.48 71 54.12 30.28 48.68 72 59.56 33.58 53.55 73 65.80 37.63 59.16 74 72.73 42.41 65.46 75 80.23 47.80 72.30 76 88.16 53.71 79.56 77 96.40 60.05 87.12 78 104.87 66.81 94.93 79 113.81 74.18 103.21 80 123.55 82.48 112.28 81 134.35 92.00 122.42 82 146.56 103.00 133.97 83 160.32 115.66 147.06 84 175.31 129.76 161.37 85 191.18 145.12 176.72 86 207.61 161.61 192.71 87 224.43 179.15 209.36 88 241.58 197.72 226.55 89 259.11 217.42 244.42 90 277.21 238.43 263.16 91 296.22 261.08 283.13 92 316.81 286.01 305.16 93 340.13 314.38 330.05 94 369.87 349.13 361.70 95 412.45 396.65 406.11 96 480.68 469.67 476.21 97 600.25 593.71 597.11 98 822.47 819.81 821.72 99 1000.00 1000.00 1000.00 TCR 8901 11 [ACACIA NATIONAL LIFE INSURANCE COMPANY LOGO] WAIVER OF MONTHLY DEDUCTIONS ON DISABILITY BENEFITS While the Insured is totally disabled, the monthly deduction will not be deducted from the accumulation value. During this time, the policy and any rider(s) will continue to be in force. Monthly deductions falling due before we approve a claim for benefits will continue to be deducted from the accumulation value. However, after total disability has continued for six (6) consecutive months and we approve the claim, any disability benefit which otherwise could have been paid under the provisions of this rider will be credited to the accumulation value. If total disability begins after the grace period, no benefit under this rider will be paid. CONSIDERATION This rider is issued in return for the application and payment of its cost of insurance. A copy of the application is attached to the policy. The cost of insurance for this rider is deducted from the accumulation value at the same time and in the same manner as the cost of insurance for the policy. COST OF INSURANCE The calculation of the monthly cost of insurance for this rider is described in the attached table. DEFINITIONS DISABILITY BENEFIT: For purposes of this rider, the disability benefit refers to the monthly deduction on each monthly activity date for the base policy and any riders and is equal to: 1. the current cost of insurance for the base policy and any riders; 2. the expense charges; and 3. the charges for specified amount increases, if any. TOTAL DISABILITY: Total disability must begin after the effective date and before the expiration date of this rider. It must result from bodily injury which occurs or sickness which first manifests itself while this rider is in force. Total Disability means: 1. Total loss of the sight of both eyes. This loss must be irrecoverable; or 2. Total loss of the use of both hands, both feet, or one hand and one foot. This loss must be irrecoverable; or WDIS 8901 12 3. The incapacity of the Insured to engage in any substantial duties of his or her occupation for at least six consecutive months. (Substantial duties includes managerial or supervisory functions.) During the first 24 months of total disability, occupation means the usual work, employment, business or profession in which the Insured was engaged immediately before the date of disability. This includes attendance at school or college as a full-time student. After 24 months of total disability, an Insured who is engaged in any occupation for remuneration or profit will not be considered totally disabled. EFFECTIVE DATE: The effective date of coverage under this rider shall be as follows: 1. The policy date shall be the effective date for all coverage provided in the original application. 2. For any rider issued after the policy date, the effective date shall be the date shown on a supplement to the schedule pages of the policy. 3. For any insurance that has been reinstated, the effective date shall be the monthly activity date on or next following the date we approve the reinstatement. EXPIRATION DATE: This date is also shown in the schedule pages of the policy. It is the date on which this rider is no longer effective. GENERAL PROVISIONS NOTICE OF DISABILITY: To receive this benefit, written notice of claim must be received at the Home Office. It must be received: (a) while the Insured is living; (b) while the Insured is totally disabled; and (c) not later than 9 months after the Insured has become totally disabled. If such notice is not furnished in the required time limit, the claim will not be accepted. But a late claim will be accepted if it can be shown that it was not reasonably possible to meet the requirements and that notice was given as soon as was reasonably possible. In no event, however, will the Insured receive any benefit under this rider for a period beyond one year before the date on which notice was received. PROOF OF TOTAL DISABILITY: The disability benefit will commence once we receive satisfactory written proof that the Insured is totally disabled. Proof must be presented at the Home Office: (a) while the Insured is living; (b) before total disability has ended or been interrupted; and (c) within 12 months after we receive the notice of total disability. Forms approved by us must be used. Similar proof that the total disability is continuing may be required at reasonable intervals. After the Insured has been totally disabled for 2 years, we will only require proof once per year. If the Insured fails to furnish such proof, the disability benefit will cease. DURATION OF BENEFITS: We will begin to provide the disability benefit in the policy month following the date disability began. However, we will not provide the disability benefit for a period of more than 12 months before we receive written notice of disability unless it is shown that notice was given as soon as reasonably possible. WDIS 8901 13 We will continue to provide the disability benefit while the Insured is totally disabled until the rider anniversary following the Insured's 100th birthday. However, if disability begins on or after the rider anniversary following the Insured's 60th birthday, we will only provide the disability benefit: 1. Until the rider anniversary following the Insured's 65th birthday, or 2. For two years, if later. INCONTESTABILITY: While the Insured is alive, the validity of this rider cannot be contested after it has been in force for a period of 2 years from the effective date of this rider. REINSTATEMENT: Coverage under this rider may be reinstated with the policy subject to the policy reinstatement provision. Reinstatement must occur before the expiration date of this rider. Such reinstatement may occur any time before the policy anniversary nearest the Insured's 65th birthday. The requirements for reinstatement are: 1. Receipt of satisfactory evidence of insurability. 2. Payment of the minimum cost of insurance sufficient to keep this rider in force for 3 months. EXCLUSIONS: The Insured will not be eligible for the disability benefit if the total disability on which the claim is based results from: 1. Self-inflicted bodily injury while sane or insane, other than accidental injury; or 2. War or any act of war, whether declared or not, regardless of whether the Insured is in the military, naval or air service. TERMINATION OF RIDER: This rider will automatically terminate on the earliest of these conditions: 1. On the expiration date of this rider; 2. On the monthly activity date on or next following the date we receive your written request; 3. On surrender of the rider to us; or 4. On termination of the policy. TERM RIDERS: If a renewable and convertible term rider is attached to the policy during a benefit period, the cost of insurance for that rider will be waived until the expiration date. If the Owner elects to convert that term rider, no benefits will be paid under this rider on the conversion policy. CHANGE OF POLICY: Once the disability benefit commences, you cannot change the specified amount of insurance (except for any increase(s) which result from exercising options under any Guaranteed Insurability Rider), the death benefit option, or change the policy to another form of insurance. WDIS 8901 14 NONPARTICIPATING: This rider is nonparticipating. COST OF INSURANCE DEDUCTIONS AFTER TERMINATION OF THIS RIDER: If, after this rider has terminated, we make a deduction from the accumulation value for the cost of insurance for this rider, our only obligation to you under this rider will be to return the cost of insurance deduction. No coverage is available after the termination date of this rider. INCORPORATION OF POLICY PROVISIONS INTO RIDER: The provisions of the policy are hereby referred to and made a part of this rider. If the policy has been issued on a gender-neutral basis, this rider is also considered to be issued on a gender-neutral basis. ACACIA NATIONAL LIFE INSURANCE COMPANY /s/ Robert-John H. Sands /s/ Robert W. Clyde Secretary President WDIS 8901 15 COST OF INSURANCE TABLE On each monthly activity date, the monthly cost of insurance for this rider is equal to the product of A times B where: A is a factor based on the attained age and gender of the Insured and is shown in the table below. (Note: If this rider is issued with a special rating, this factor will be increased based on that rating. Any special rating will be shown in the schedule pages of the policy). B is the monthly deduction for the policy, including any table ratings and any riders attached to the policy except for this rider. ISSUE MALE FEMALE UNISEX ISSUE MALE FEMALE UNISEX AGE RATES RATES RATES AGE RATES RATES RATES - ---------------------------------------------------------------------------------------------------------- 18 0.0434 0.0554 0.0458 42 0.0708 0.0691 0.0705 19 0.0422 0.0543 0.0446 43 0.0735 0.0716 0.0731 20 0.0413 0.0530 0.0436 44 0.0765 0.0742 0.0760 21 0.0403 0.0516 0.0426 45 0.0794 0.0770 0.0789 22 0.0419 0.0526 0.0440 46 0.0825 0.0801 0.0820 23 0.0427 0.0528 0.0447 47 0.0866 0.0838 0.0860 24 0.0437 0.0523 0.0454 48 0.0915 0.0881 0.0908 25 0.0448 0.0525 0.0463 49 0.0974 0.0935 0.0966 26 0.0458 0.0521 0.0471 50 0.1054 0.1000 0.1043 27 0.0466 0.0521 0.0477 51 0.1148 0.1082 0.1135 28 0.0475 0.0518 0.0484 52 0.1266 0.1187 0.1250 29 0.0481 0.0517 0.0488 53 0.1405 0.1305 0.1385 30 0.0487 0.0514 0.0492 54 0.1579 0.1465 0.1556 31 0.0489 0.0513 0.0494 55 0.1778 0.1649 0.1752 32 0.0492 0.0512 0.0496 56 0.2034 0.1896 0.2006 33 0.0492 0.0512 0.0496 57 0.2234 0.2106 0.2208 34 0.0492 0.0506 0.0495 58 0.2460 0.2362 0.2440 35 0.0492 0.0509 0.0495 59 0.2684 0.2633 0.2674 36 0.0507 0.0524 0.0510 60 0.2684 0.2633 0.2674 37 0.0562 0.0573 0.0564 61 0.2684 0.2633 0.2674 38 0.0593 0.0600 0.0594 62 0.2684 0.2633 0.2674 39 0.0624 0.0627 0.0625 63 0.2684 0.2633 0.2674 40 0.0655 0.0652 0.0654 64 0.2684 0.2633 0.2674 41 0.0679 0.0670 0.0677 - ---------------------------------------------------------------------------------------------------------- WDIS 8901 16 This page left intentionally blank.