LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK
(A STOCK COMPANY)
Home Office Location: Syracuse, New York
Administrator Mailing Address: Lincoln Life & Annuity Company of New York,
350 Church Street, Hartford, CT 06103-1106
While this Policy is in force, Lincoln Life & Annuity [John Doe
Company of New York ("Lincoln Life") will pay Proceeds Mary Doe]
subject to all of this Policy's provisions. Other rights and
benefits are provided as described in this Policy. The
provisions of this and the following pages are part of this [Policy No.]
Policy.
THIS POLICY IS A LEGAL CONTRACT BETWEEN YOU AND LINCOLN LIFE
PLEASE READ YOUR POLICY CAREFULLY
RIGHT OF POLICY EXAMINATION
This Policy may be returned to Lincoln Life or its representative within 10 days
after its receipt. Return this Policy to Lincoln Life, Corporate Specialty
Markets, at the Administrator Mailing Address. Upon its return, this Policy will
be deemed void from its beginning and all premiums paid will be refunded.
Signed for Lincoln Life on its Date of Issue.
/s/ C. Suzanne Womack /s/ Philip L. Holstein
SECRETARY PRESIDENT
Registrar
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
FLEXIBLE PREMIUMS PAYABLE UNTIL MATURITY DATE OR DEATH
PROCEEDS PAYABLE UPON THE FIRST EVENT TO OCCUR - SURRENDER, MATURITY OR DEATH
NON-PARTICIPATING - NO DIVIDENDS PAYABLE
The amount or duration of the death benefit may be fixed or variable and may
increase or decrease. The death benefit is payable as described in the Death
Benefit Options and Proceeds sections of this Policy.
Values in each Fund held in a Separate Account may increase or decrease daily.
Such values are not guaranteed as to dollar amount. Refer to the Policy Values
section of this Policy for more information.
LN920 NY
Table of Contents
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Page No.
Policy Specifications...................................... PS1
Policy Summary............................................. 1
Definitions................................................ 1
Administrator Mailing Address......................... 1
Annuity Commencement Date............................. 1
Attained Age.......................................... 1
Date of Issue......................................... 1
Death Benefit......................................... 1
Fixed Account Value................................... 1
Fund(s)............................................... 1
General Account....................................... 2
Home Office........................................... 2
Initial Coverage...................................... 2
LLANY Separate Account N for Variable Annuities ...... 2
LLANY Separate Account S for
Flexible Premium Variable Life Insurance .......... 2
Loan Account Value.................................... 2
Maturity Date......................................... 2
Minimum Specified Amount.............................. 2
Monthly Deduction Day................................. 2
Net Premium........................................... 2
Net Single Premium.................................... 2
Policy Month.......................................... 2
Policy Year/Policy Anniversary........................ 2
Premium Accumulation Rate............................. 3
Premium Tax Charge.................................... 3
Proceeds.............................................. 3
Separate Account...................................... 3
Separate Account Value................................ 3
Specified Amount...................................... 3
Subsequent Application(s)............................. 3
Target Premium........................................ 3
Total Account Value................................... 3
Valuation Date........................................ 3
Valuation Period...................................... 3
We, Our, Us, Company.................................. 3
Written Request....................................... 3
You, Your............................................. 3
General Provisions......................................... 4
The Contract.......................................... 4
Owner................................................. 4
Beneficiary........................................... 4
Changes in Owner and Beneficiary...................... 4
Assignment............................................ 4
Non-Participating..................................... 4
Policy Settlement..................................... 4
Age................................................... 4
Change of Address..................................... 5
Annual Report......................................... 5
Projection of Benefits ............................... 5
Proceeds.............................................. 5
Right to Defer Payment................................ 6
Suicide and Incontestability............................... 6
Suicide Exclusion..................................... 6
Incontestability...................................... 6
Premiums and Reinstatement................................. 7
General............................................... 7
Planned Premiums...................................... 7
Additional Premiums................................... 7
Allocation of Premium................................. 7
Changes in Allocation Percentages..................... 7
Grace Period.......................................... 7
Reinstatement......................................... 8
Death Benefit Options...................................... 8
General............................................... 8
Option 1.............................................. 8
Option 2.............................................. 8
Option 3.............................................. 8
Policy Values.............................................. 8
Basis of Calculation.................................. 8
Interest Credited..................................... 9
Fixed Account Value................................... 9
Separate Account Value................................ 9
Charges to Policy Values.............................. 10
Transfers Within Accounts............................. 10
Monthly Deductions.................................... 10
Cost of Insurance..................................... 10
Cost of Insurance Rate................................ 10
Nonforfeiture Provisions................................... 11
Continuation of Coverage ............................. 11
Surrender Value....................................... 11
Partial Surrender..................................... 11
Paid-Up Nonforfeiture Option ......................... 11
Policy Loans............................................... 12
General............................................... 12
Loan Interest Rate Charged............................ 12
Loan Interest Rate Credited........................... 12
Repayment............................................. 13
Changes in Insurance Coverage ............................. 13
General............................................... 13
Increase in Specified Amount.......................... 13
Decrease in Specified Amount.......................... 13
Change in Death Benefit Option........................ 13
Change from Option 1 to 2............................. 13
Change from Option 2 to 1............................. 13
Change from Option 3 to 1............................. 13
Change from Option 3 to 2............................. 14
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Any riders and a copy of the application(s) are at the end of this Policy.
LN920 NY
Table of Contents
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Page No.
Change of Fund(s).......................................... 14
Separate Account........................................... 14
Settlement Options......................................... 14
Conditions................................................. 14
Separate Account........................................... 15
Fund(s) Settlement Option Annuity Units of
LLANY Separate Account N for Variable Annuities ........... 15
Fund(s) Settlement Option Annuity Unit Value of
LLANY Separate Account N for Variable Annuities ........ 15
Fund(s) Settlement Option Accumulation Unit
Value of LLANY Separate Account N for Variable
Annuities............................................... 16
Fund Transfers During the Annuity Period................... 16
Annuity Payment Options.................................... 16
Article 1 - Annuity Purchase Rates Under a
Variable Payment Option................................. 18
Article 2 - Annuity Purchase Rates Under a
Fixed Payment Option.................................... 19
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Any riders and a copy of the application(s) are at the end of this Policy.
LN920 NY
P O L I C Y S P E C I F I C A T I O N S
NAME OF
INSURED JOHN DOE
POLICY
NUMBER: I 1 111 000 MAY 1, 1999 DATE OF ISSUE
SEX AGE PREMIUM CLASS
MALE 35 PREFERRED NONSMOKER
BENEFICIARY - SEE ATTACHED BENEFICIARY AND POLICYOWNER ENDORSEMENTS SHEET.
POLICYOWNER - THE INSURED.
PLAN - FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
INITIAL SPECIFIED AMOUNT: $100,000 DEATH BENEFIT OPTION: 1
PREMIUM ACCUMULATION RATE: N/A
MINIMUM SPECIFIED AMOUNT: $100,000
MATURITY DATE: MAY 1, 2064
INITIAL PLANNED PREMIUM: $3582.76
INITIAL PREMIUM MODE: ANNUAL
TARGET PREMIUM: $3582.76
MONTHLY DEDUCTION DAY: THE 1ST DAY OF EACH MONTH
NET PREMIUM INITIAL ALLOCATION PERCENTAGES:
GENERAL ACCOUNT 100%
MONTHLY POLICY FEE: SEE PAGE PS2
GUARANTEED MAXIMUM PREMIUM LOAD: IN THE FIRST YEAR, 15% ON PREMIUM UP TO
TARGET PREMIUM AND 6% ON PREMIUM IN EXCESS
OF THAT AMOUNT; IN THE SECOND THROUGH FIFTH
YEARS, 10% ON PREMIUM UP TO TARGET PREMIUM
AND 6% ON PREMIUM IN EXCESS OF THAT AMOUNT;
6% ON ALL PREMIUM EACH YEAR THEREAFTER.
GUARANTEED MAXIMUM PREMIUM TAX CHARGE: 5%
POLICY LOAN INTEREST: VARIABLE
GUARANTEED INTEREST RATE FOR FIXED ACCOUNT VALUE: 4.0% PER YEAR ON THE
NON-LOANED PORTION OF THE ACCOUNT VALUE. INTEREST ON THE PORTION OF THE ACCOUNT
VALUE EQUAL TO THE LOAN IS THE POLICY LOAN INTEREST RATE LESS .90%, NEVER TO BE
LESS THAN 4.0%.
THE PLANNED PREMIUM AMOUNT SHOWN ABOVE MAY NOT CONTINUE THE POLICY INFORCE TO
THE MATURITY DATE EVEN IF THIS AMOUNT IS PAID AS SCHEDULED. THE PERIOD FOR WHICH
THE POLICY WILL CONTINUE WILL DEPEND ON:
1) THE AMOUNT, TIMING AND FREQUENCY OF PREMIUM PAYMENTS;
2) CHANGES IN THE SPECIFIED AMOUNT AND THE DEATH BENEFIT OPTIONS;
3) CHANGES IN INTEREST CREDITED, FUND PERFORMANCE AND MORTALITY
DEDUCTIONS;
4) DEDUCTIONS FOR RIDERS AND BENEFITS;
5) PARTIAL SURRENDERS AND POLICY LOANS.
I 1 111 000 JOHN J. DOE PS 1
LN920 NY
TABLE OF
GUARANTEED MAXIMUM INSURANCE RATES
(1980 COMMISSIONERS STANDARD ORDINARY MORTALITY TABLE)
PER $1,000 OF AMOUNT AT RISK
POLICY MONTHLY POLICY MONTHLY POLICY MONTHLY
YEAR RATE YEAR RATE YEAR RATE
1998 0.1367 2020 0.7506 2042 6.6202
1999 0.1442 2021 0.8207 2043 7.2522
2000 0.1525 2022 0.8966 2044 7.9604
2001 0.1634 2023 0.9843 2045 8.7645
2002 0.1750 2024 1.0812 2046 9.6778
2003 0.1875 2025 1.1931 2047 10.6795
2004 0.2025 2026 1.3234 2048 11.7575
2005 0.2167 2027 1.4705 2049 12.8813
2006 0.2342 2028 1.6318 2050 14.0599
2007 0.2509 2029 1.8066 2051 15.2671
2008 0.2717 2030 1.9931 2052 16.5210
2009 0.2926 2031 2.1915 2053 17.8367
2010 0.3151 2032 2.4074 2054 19.2390
2011 0.3409 2033 2.6520 2055 20.7666
2012 0.3676 2034 2.9679 2056 22.4984
2013 0.3968 2035 3.2514 2057 24.7092
2014 0.4319 2036 3.6273 2058 27.8276
2015 0.4711 2037 4.0488 2059 32.7885
2016 0.5161 2038 4.5069 2060 41.4578
2017 0.5678 2039 4.9957 2061 57.9566
2018 0.6237 2040 5.5110 2062 90.9091
2019 0.6846 2041 6.0472 2063 00.0000
THE CURRENT MONTHLY POLICY FEE IS $6.00. IT WILL NEVER EXCEED $10.00.
I 1 111 000 JOHN J. DOE PS 2
LN920 NY
Policy Summary
It is important that You understand Your insurance policy. We have tried to use
understandable language throughout this Policy. However, should You have any
questions after You have read it, please call the representative who sold this
Policy to You or call Us. This summary is not a substitute for the detailed
policy provisions.
This is a flexible premium variable life insurance policy. Proceeds as described
in this Policy will be paid upon surrender, maturity, or death of the Insured.
You may allocate Net Premiums to the General Account, LLANY Separate Account S
for Flexible Premium Variable Life Insurance, or both Accounts. Net Premiums
allocated to LLANY Separate Account S for Flexible Premium Variable Life
Insurance must be allocated to one or more Funds. Shares of these Funds support
the benefits provided by the variable portion of this Policy. The cash value in
each Fund is not guaranteed and will vary with the investment performance of
that Fund.
If the General Account is selected, the Fixed Account Value in that Account will
accumulate at rates of interest We determine. Such rates will not be less than
4.0% a year.
Sufficient premiums must be paid to continue this Policy in force. Premium
reminder notices will be sent for planned premiums and for premiums required to
continue this Policy in force. This Policy may be reinstated.
Other rights and benefits are explained in this Policy.
Definitions
Administrator Mailing Address
Lincoln Life & Annuity Company of New York, 350 Church Street, Hartford, CT
06103-1106.
Annuity Commencement Date
The Valuation Date when the Policy Proceeds are invested for payment of annuity
benefits under the settlement option selected.
Attained Age
Issue age of the Insured as shown in the Policy Specifications, increased by the
number of Policy Years elapsed. Issue age is the Insured's age on his/her
birthday nearest this Policy's Date of Issue.
Date of Issue
The effective date for Initial Coverage is the Date of Issue shown in the Policy
Specifications. The Date of Issue and the effective date for any change in
coverage will be the Date of Coverage Change shown in the supplemental Policy
Specifications which will be sent to You. Coverage is conditional on payment of
the first premium, if any, and issue of this Policy as provided in the
application.
Death Benefit
The amount described in the Death Benefit Options provision which is payable on
the date of death, subject to all provisions contained in this Policy.
Fixed Account Value
The non-loaned portion of this Policy's Total Account Value attributable to the
non-variable portion of this Policy. The Fixed Account Value is held in the
General Account.
Fund(s)
One or more of the open-end management investment companies (mutual funds whose
shares pay for the benefits provided by the variable portion of this Policy).
Shares of the Funds held pursuant to this Policy are held in LLANY Separate
Account S for Flexible Premium Variable Life Insurance except that shares of the
Funds referenced in the Settlement Options section of this Policy are held in
LLANY Separate Account N for Variable Annuities. The Fund(s) held in LLANY
Separate Account S for Flexible Premium Variable Life Insurance may differ from
the Fund(s) held in LLANY Separate Account N for Variable Annuities.
Page 1
LN920 NY
General Account
The account which holds the assets of the Company which are attributable to the
non-variable portion of this Policy. The Fixed Account Value and the Loan
Account Value are held in the General Account.
Home Office
Our main office, located at Syracuse, New York.
Initial Coverage
Coverage provided by this Policy prior to any change in coverage.
LLANY Separate Account N for Variable Annuities
A Separate Account which segregates assets attributable to the variable portion
of annuity contracts and life insurance settlement options from other assets of
the Company. Its assets are invested in shares of the Funds. LLANY Separate
Account N for Variable Annuities holds all or a portion of the Policy's Proceeds
if a variable settlement option is elected.
LLANY Separate Account S for Flexible Premium Variable Life Insurance
A Separate Account which segregates assets attributable to the variable portion
of life insurance from other assets of the Company. Its assets are invested in
shares of the Funds.
Loan Account Value
The sum of all unpaid loans. The amount necessary to repay all loans in full is
the Loan Account Value plus any accrued interest. The Loan Account Value is held
in the General Account.
Maturity Date
The Policy Anniversary on which the Insured reaches Attained Age 100.
Minimum Specified Amount
The Specified Amount for this Policy cannot be decreased below this amount. The
Minimum Specified Amount for this Policy is shown in the Policy Specifications.
Monthly Deduction Day
The first Monthly Deduction Day is the Date of Issue. Monthly Deduction Days
occur each month thereafter on the same day of the month as the Date of Issue.
Net Premium
The Net Premium is equal to:
1. the premium paid; less
2. a Premium Load not to exceed the Guaranteed Maximum Premium Load shown in
the Policy Specifications; less
3. a Premium Tax Charge.
Net Single Premium
The Net Single Premium per dollar is the amount We require to purchase one
dollar of paid up whole life insurance. We determine the Net Single Premium
using the number of elapsed Policy Years, the Insured's premium class and
Attained Age, an interest rate of 4.0% per annum and the guaranteed cost of
insurance rates specified in the Policy Specifications.
Policy Month
The Policy Month begins each month on the same day of the month as the Date of
Issue.
Policy Year/Policy Anniversary
The first Policy Year is the 12 month period beginning on the Date of Issue.
Your Policy Anniversary is equal to the Date of Issue plus 1 year, 2 years, etc.
Page 2
LN920 NY
Premium Accumulation Rate
The annual rate at which premiums paid will be accumulated to determine the
Death Benefit if Death Benefit Option 3 is selected. This rate is chosen by You
at issue. A rate requested in excess of 10% may be subject to additional
underwriting. The Premium Accumulation Rate is shown in the Policy
Specifications.
Premium Tax Charge
A charge equal to the state and municipal taxes associated with premiums
received.
Proceeds
The amount We will pay upon the death of the Insured, the Maturity Date, or upon
surrender of this Policy as described in the Proceeds provision.
Separate Account
LLANY Separate Account S for Flexible Premium Variable Life Insurance; or, when
referring to a settlement option as described in the Settlement Option
provisions of this Policy, LLANY Separate Account N for Variable Annuities.
Separate Account Value
The portion of this Policy's Total Account Value attributable to the variable
portion of this Policy. This Policy's Separate Account Value is held in LLANY
Separate Account S for Flexible Premium Variable Life Insurance.
Specified Amount
The Specified Amount is shown in the Policy Specifications or in the
Supplemental Policy Specifications, if later changed.
Subsequent Application(s)
Any application after the initial application initiated by You or by Us.
Target Premium
The Target Premium is shown in the Policy Specifications or in the Supplemental
Policy Specifications, if later changed.
Total Account Value
The sum of the Fixed Account Value, the Separate Account Value, and the Loan
Account Value. This is the Policy's cash value.
Valuation Date
Any day on which the New York Stock Exchange is open for trading.
Valuation Period
The period of time commencing immediately after the close of business on each
Valuation Date and ending at the close of business on the next Valuation Date.
We, Our, Us, Company
Refers to Lincoln Life & Annuity Company of New York, its successors, or
assigns.
Written Request
A request in writing, in a form satisfactory to Us and received by Us at the
Administrator Mailing Address.
You, Your
Refers to the Owner(s) of this Policy.
Page 3
LN920 NY
General Provisions
The Contract
This Policy, the initial application on the Insured, any Subsequent Applications
and any riders constitute the entire contract. Copies of all applications are
attached to and made a part of this Policy.
Only the President, a Vice President, an Assistant Vice President, a Secretary,
a Director or an Assistant Director of Lincoln Life may agree to a change in
this Policy, and then only in writing.
All statements made by or for the Insured are representations and not
warranties.
No statement will be used to void this Policy or defend against a claim unless
it is contained in the initial application or Subsequent Applications.
Owner
Unless otherwise stated in the application or later changed, this Policy is
owned by the Insured.
During the lifetime of the Insured all rights granted by this Policy or allowed
by Us belong to the Owner.
If this Policy is owned jointly, any exercise of rights granted by this Policy
must be made jointly.
Beneficiary
The individual or entity that will receive any Proceeds on death is the
Beneficiary. The Beneficiary is stated in the application, unless later changed.
If no designated Beneficiary is living at the time of the death of the Insured,
all benefits will be paid to the Owner or the Owner's executors, administrators,
or assigns.
Changes in Owner and Beneficiary
Unless this Policy states otherwise, the Owner or Beneficiary, or both, may be
changed. This may be done as often as desired by the Owner of record during the
lifetime of the Insured and before the Maturity Date.
To change the Owner or Beneficiary, Your Written Request must be sent to Us.
When We give Our written acceptance, the change will take effect as of the date
Your Written Request was signed. The change will be subject to any action We
take before Our written acceptance of the change.
Assignment
A copy of an assignment must be on file with Us. Until We receive such notice at
the Administrator Mailing Address, We will not be required to take notice of, or
be responsible for, any transfer of interest in this Policy by assignment,
agreement, or otherwise.
We will not be responsible for the validity of any assignment.
Non-Participating No dividends will be paid.
Policy Settlement
All amounts payable by Us will be paid from the Administrator Mailing Address.
The Loan Account Value plus any accrued interest will be deducted from the
amount payable at settlement. We may require return of this Policy.
Age
If the Insured's age is misstated, the Death Benefit will be that which would
have been purchased by the most recent monthly deduction at the correct age.
Page 4
LN920 NY
Change of Address
You must notify Us at the Administrator Mailing Address of a change in Your
mailing address.
Annual Report
We will send You a report at least once during each Policy Year. The report will
show the Total Account Value, the Surrender Value and the Death Benefit on the
date of the report. It will also show since the last report at least the
following information:
1. Gross premiums paid;
2. the cost of insurance and the cost of riders;
3. interest and investment return credited to the Total Account Value;
4. the amount of any surrenders or partial surrenders;
5. a summary of loan activity; and
6. any other information required by the jurisdiction in which this Policy was
delivered.
Projection of Benefits
We will provide a projection of illustrative future death benefits and Total
Account Values at any time upon Written Request.
Proceeds
Proceeds on death of the Insured will equal:
1. The Death Benefit; less
2. the Loan Account Value plus any accrued interest; less
3. any overdue deductions.
Proceeds on death are payable after receipt at the Administrator Mailing Address
of due proof of death of the Insured.
Proceeds on maturity of this Policy will equal:
1. The Total Account Value on the Maturity Date; less
2. the Loan Account Value plus any accrued interest.
Proceeds on surrender of this Policy will equal the Surrender Value as described
in the Surrender Value provision.
All Proceeds are subject to adjustment under the Age, Incontestability, Suicide
Exclusion and Grace Period provisions.
Page 5
LN920 NY
Right to Defer Payment
Payments of any Separate Account Value will be made within 7 days after Our
receipt of Your Written Request. However, the Company reserves the right to
suspend or postpone the date of any payment of any benefit or values for any
Valuation Period (1) when the New York Stock Exchange is closed (except holidays
or weekends); (2) when trading on the Exchange is restricted; (3) when an
emergency exists as determined by the SEC so that disposal of the securities
held in the Funds is not reasonably practicable or it is not reasonably
practicable to determine the value of the Funds' net assets; or (4) during any
other period when the SEC, by order, so permits for the protection of security
holders. For payment from the Separate Account in such instances, We may defer
payment of:
1. Surrender or partial surrender values;
2. any Proceeds on death in excess of the current Specified Amount; or
3. any portion of the Loan Value.
Payment of any Fixed Account Value may be deferred for up to six months, except
when used to pay premiums to Us.
Suicide and Incontestability
Suicide Exclusion
If the Insured dies by suicide within two years from the Date of Issue of this
Policy and while this Policy is inforce, We will pay:
1. Premiums paid less amounts allocated to LLANY Separate Account S for
Flexible Premium Variable Life Insurance; plus
2. the Separate Account Value; plus
3. the portion of the monthly deductions that have been deducted from the
Separate Account Value; less
4. the sum of:
(a) the Loan Account Value transferred from the Fixed Account Value; plus
(b) the interest due on the Loan Account Value; plus
(c) the value of any partial surrenders transferred from the Fixed Account
Value; plus
(d) any interest earned on the Loan Account Value transferred to the
Separate Account Value.
If the Insured dies by suicide within 2 years from the Date of Issue of any
increase in coverage, We will pay only the monthly deductions for the increase.
If the Insured dies by suicide more than 2 years from the Date of Issue of this
Policy but within 2 years from the Date of Issue of any increase in coverage, We
will pay:
1. The Proceeds on death for any coverage in effect more than 2 years from the
Date of Issue of this Policy; plus
2. the monthly deductions for the increase in coverage.
All amounts will be calculated as of the date of death.
Incontestability
With respect to statements made in the initial application for the Insured:
We will not contest this Policy after it has been in force during the
lifetime of the Insured for 2 years from its Date of Issue.
With respect to statements made in any Subsequent Applications for the Insured:
We will not contest coverage relating to Subsequent Applications after
coverage has been in force during the lifetime of the Insured for 2
years from the Date of Issue of such coverage or from the effective
date of any reinstatement.
If this Policy is contested, Your rights or the Beneficiary's rights may be
affected.
Page 6
LN920 NY
Premiums and Reinstatement
General
Sufficient premiums must be paid to continue this Policy in force until the
Maturity Date. The first premium is due on the Date of Issue. Premium due dates
are measured from the Date of Issue.
Any premiums after the first premium are payable only at the Administrator
Mailing Address. Send Your check or money order, payable to Lincoln Life, to the
Administrator Mailing Address. Please be sure to write Your policy number on
Your check. A receipt signed by an officer of the Company will be given upon
request.
We may apply limits for Planned Premiums and Additional Premiums as necessary to
preserve the status of this Policy as a life insurance policy under federal tax
law.
We may require satisfactory evidence of insurability if payment of the new
Planned Premium or an Additional Premium during the current Policy Year would
increase the difference between the Death Benefit and the Total Account Value.
Planned Premiums
Planned Premium is the premium amount You intend to pay and the amount that will
be billed. Premium reminder notices for Planned Premiums will be sent at
frequencies of 3, 6 or 12 months, or at any other frequency to which We agree.
Planned premiums as of the Date of Issue are shown in the Policy Specifications.
You may change the amount and frequency of Planned Premiums by Your Written
Request.
Additional Premiums
Additional Premiums are premium payments in excess of planned premiums.
Additional Premiums may be paid at any time while this Policy is in force and
before the Maturity Date.
Allocation of Premium
Each Net Premium will be credited to LLANY Separate Account S for Flexible
Premium Variable Life Insurance (and each of the selected Funds) and/or the
General Account in the percentages indicated in the Policy Specifications,
unless changed as provided in the Changes in Allocation Percentages provision
below.
Changes in Allocation Percentages
Allocation percentages may be changed at any time by Your request to Us.
Percentages must be changed in whole percentages. If these percentages are
changed in accordance with this provision, We will send a letter to You
confirming the change. The change will be effective as of the date of the next
premium payment after You notify Us.
Grace Period
If the Total Account Value less the Loan Account Value is not sufficient to
allow a Monthly Deduction on the Monthly Deduction Day, We will allow You 61
days of grace for payment of an amount sufficient to cover the Monthly
Deduction. We may require payment of the amount necessary to keep this Policy in
force for the current Policy Month plus two additional Policy Months.
Written notice will be mailed to Your last known address, according to Our
records, not less than 61 days before termination of this Policy. This notice
will also be mailed to the last known address of any assignee of record.
During the days of grace this Policy will stay in force. If the Insured's death
occurs during the days of grace, We will deduct an amount sufficient to cover
the overdue Monthly Deduction(s) from the Death Benefit.
If payment is not made within 61 days after the Monthly Deduction Day, the
Policy will terminate without value at the end of the Grace Period.
Page 7
LN920 NY
Reinstatement
If this Policy terminates as provided in the Grace Period provision, We may
allow it to be reinstated within 5 years after the date of termination and
before the Maturity Date. To reinstate this Policy, We will require:
1. satisfactory evidence of insurability on the Insured; and
2. payment of an amount sufficient to cover the current monthly deduction(s)
plus two additional Policy Months.
If this Policy is reinstated, it will be reinstated on the Monthly Deduction Day
following Our approval. This Policy's Total Account Value at reinstatement will
be the Net Premium paid less the monthly deduction for that day. Any Loan
Account Value will not be reinstated.
Death Benefit Options
General
The Proceeds payable upon the Insured's death will be as provided under one of
the following Death Benefit options. The option for this Policy as of the Date
of Issue is shown in the Policy Specifications. If You have changed the Death
Benefit option, the option is shown in the supplemental Policy Specifications
which will be sent to You.
Option 1
The Specified Amount shown in the Policy Specifications includes the Total
Account Value. Under this option, the Death Benefit will be the greater of: (a)
the Specified Amount on the date of death or (b) a percentage of the Total
Account Value. This percentage is one divided by the Net Single Premium per
dollar. The Net Single Premium is based on interest of 4.0% per annum and
guaranteed cost of insurance rates.
Option 2
The Specified Amount is in addition to the Total Account Value. Under this
option, the Death Benefit will be the greater of: (a) the Specified Amount plus
the Total Account Value on the date of death or (b) a percentage of the Total
Account Value. This percentage is one divided by the Net Single Premium per
dollar. The Net Single Premium is based on interest of 4.0% per annum and
guaranteed cost of insurance rates.
Option 3
Under this option, the Death Benefit will be the greater of (a) the Specified
Amount plus the Accumulated Premium(s) on the date of death, or (b) a percentage
of the Total Account Value. This percentage is one divided by the Net Single
Premium per dollar. The Net Single Premium is based on interest of 4.0% per
annum and guaranteed cost of insurance rates. The total death benefit under this
option is limited and will not exceed the total Death Benefit paid under Option
2.
The Accumulated Premium is the sum of all premiums paid from the Date of Issue
accumulated at the Premium Accumulation Rate.
This option may be selected only at issue.
Policy Values
Basis of Calculation
The values of this Policy equal or exceed those required by the Standard
Nonforfeiture Law as provided in the Variable Life Insurance law in the
jurisdiction where this Policy is delivered. A detailed statement has been filed
with the jurisdiction which shows how to compute those values.
Page 8
LN920 NY
Interest Credited
We will credit interest on the Fixed Account Value at the guaranteed rate of
4.0% per year. This guaranteed rate equals 0.32737%, per month, compounded
monthly. We may credit interest in excess of the guaranteed rate. Additional
excess interest at a rate not to exceed 1/2% per year will be credited to
policies in force at least 10 years. The guaranteed interest rate will not be
increased by the additional excess interest rate. This additional rate reflects
a reduction in the insurer's interest rate hold back margin for profit and
expenses.
Interest earned by the Loan Account Value is described in the Loan Interest
Credited provision.
Fixed Account Value
The Fixed Account Value for this Policy will be:
1. The value of the Net Premiums credited to the Fixed Account Value; less
2. the portion of monthly deductions from the Fixed Account Value; plus
3. interest credited; less
4. any transfers of value out of the Fixed Account Value; plus
5. any transfers from the Fund(s) to the Fixed Account Value; plus
6. any loan repayments credited to the Fixed Account Value.
Separate Account Value
The Separate Account Value of this Policy will be the sum of the Fund Account
Values.
A. Fund Account Value
The portion of each Net Premium allocated to a Fund plus any interest
earned on the Loan Account Value which is attributable to that Fund is
credited to this Policy in the form of accumulation units. Accumulation
units measure the net investment result of each Fund. The number of
accumulation units credited is equal to that portion of Net Premium divided
by the accumulation unit value for that Fund for the Valuation Period in
which the premium is received.
The Fund Account Value of each Fund will equal the accumulation unit value
for that Fund multiplied by the number of accumulation units for that Fund
credited to this Policy.
B. Accumulation Unit Value
A Fund accumulation unit value for any Valuation Period after the inception
of the Fund is calculated as follows:
1. The total value of Fund shares held is calculated by multiplying the
number of Fund shares owned at the beginning of the Valuation Period
by the net asset value per share of the Fund at the end of the
Valuation Period and adding any dividend or other distribution of the
Fund earned during the Valuation Period; minus
2. the liabilities of the Fund at the end of the Valuation Period; such
liabilities include daily charges imposed on the Fund and may include
a charge or credit with respect to any taxes paid or reserved for by
Us that We determine result from operations of the Separate Account;
and
3. the result of (2) is divided by the number of accumulation units for
that Fund outstanding at the beginning of the Valuation Period.
The daily charges imposed on a Fund for any Valuation Period are equal to
the mortality and expense risk charge multiplied by the number of calendar
days in the Valuation Period.
The accumulation unit value may increase or decrease from Valuation Period
to Valuation Period.
Page 9
LN920 NY
Charges to Policy Values
Charges and deductions made according to this Policy's provisions will be
deducted from the Separate Account Value and the Fixed Account Value in the same
proportion that these Values bear to the sum of the Fixed Account Value and the
Separate Account Value on the date of the deduction.
The portion of the deduction attributable to the Separate Account Value will
reduce each Fund Account Value in the same proportions that these Fund Account
Values bear to the total Separate Account Value. The number of accumulation
units deducted from each Fund is determined by dividing the amount of the
deduction attributable to the Fund by the Fund's accumulation unit value for the
Valuation Period when the charge was made. The resulting number of Fund
accumulation units will be deducted from the total accumulation units for that
Fund.
The portion of the deduction attributable to the Fixed Account Value will be
deducted from that Value as a dollar amount.
Transfers Within Accounts
You may transfer all or part of each Fund Account Value to any other Fund or to
the Fixed Account Value at any time. There will be no charge for the first 12
transfers within a Policy Year, but we reserve the right to charge a $25
administrative fee for each additional transfer within that Policy Year, unless
a transfer to the General Account is made in response to a change in the
investment policy of a Fund.
Within the forty-five days following the Policy Anniversary, You may request a
transfer of a portion of the Fixed Account Value to one or more of the Funds.
This type of transfer is allowed only once within these forty-five days and We
must receive Your request at the Administrator Mailing Address within the
forty-five days. The transfer will be effective on the Valuation Date that Your
request is received at the Administrator Mailing Address. The amount of such
transfer cannot exceed the greater of 25% of the greatest amount in the Fixed
Account Value during the prior 5 years or $1000.
Accumulation units for each Fund will be added to or subtracted from the total
accumulation units for that Fund, based on each Fund's accumulation unit value
at the end of the Valuation Date when request for such transfer is received by
Us. A dollar amount will be added to or subtracted from the Fixed Account Value
according to the terms of Your request for transfer.
Monthly Deductions
Monthly deductions begin on the Date of Issue and occur on each Monthly
Deduction Day thereafter. The monthly deduction will be deducted from this
Policy's values as described in the Charges to Policy Values provision.
The monthly deduction is equal to:
1. the cost of insurance as calculated below; plus
2. the monthly policy fee, shown in the Policy Specifications.
Cost of Insurance
The Cost of Insurance on any Monthly Deduction Day will be (1) multiplied by the
result of (2) minus (3) where:
(1) is the monthly Cost of Insurance Rate on that date divided by 1,000;
(2) is the death benefit on that date divided by 1.0032737;
(3) is the Total Account Value on that date before computing the monthly
deductions for the cost of insurance for this Policy.
Cost of Insurance Rate
The monthly cost of insurance is based on the Insured's issue age, number of
Policy Years elapsed and premium class. For Initial Coverage, the premium class
on the Date of Issue will be used. For any increase, the premium class for that
increase will be used. If the Insured is assigned a premium class which
designates "smoker" and this classification changes, You may, by Written
Request, reclassify the Insured any time after the first Policy Anniversary.
Upon Our acceptance of the change, supplemental Policy Specifications will be
sent to You.
The monthly Cost of Insurance Rates may be adjusted by Us from time to time.
Adjustments will be on a class basis and will be based on Our estimates for
future factors such as mortality, investment income, expenses, and the length of
time policies stay in force. Any adjustments will be made on a nondiscriminatory
basis.
The rate during any Policy Year will never exceed the rate shown for that year
in the Table of Guaranteed Maximum Insurance Rates in the Policy Specifications.
Guaranteed rates for this Policy are based on the 1980 Commissioner's Standard
Ordinary Mortality Table B.
Page 10
LN920 NY
Any change in the cost factors will be determined in accordance with procedures
and standards on file with the State Insurance Department in which this Policy
was delivered.
Nonforfeiture Provisions
Continuation of Coverage
Coverage of this Policy will continue to the Maturity Date as long as the
Surrender Value is sufficient to cover each monthly deduction. If the Surrender
Value is not sufficient to cover a monthly deduction, the Grace Period provision
will apply.
Surrender Value
By Written Request, the Owner may surrender this Policy for its full surrender
value at any time during the lifetime of the Insured. All or a portion of the
premium load(s) and Premium Tax Charge in the first Policy Year will be refunded
to You within the first two Policy Years upon a full surrender. Decreases in the
Specified Amount will decrease the portion of the premium load(s) and Premium
Tax Charge refunded to you. All insurance coverage under this Policy will end on
the date of the full surrender. Partial surrenders will also be allowed.
The full Surrender Value will equal:
1. The Total Account Value on the date of surrender; less
2. the Loan Account Value plus any accrued interest; plus
3. the premium load refund, if any.
Partial Surrender
Partial surrenders may be made at any time after the first Policy Year while
this Policy is in force.
The minimum amount of any partial surrender is $500.
If the Death Benefit option for this Policy is option 1 or 3, a partial
surrender will reduce the Total Account Value, Death Benefit, and Specified
Amount. However, We will not allow a partial surrender if the Specified Amount
will be reduced below the Minimum Specified Amount.
If the Death Benefit on the date of the partial surrender is determined as a
percentage of the Total Account Value as described in the Death Benefit Options
section, the partial surrender may not reduce the Specified Amount.
If the Death Benefit option for this Policy is Option 2, a partial surrender
will reduce the Total Account Value and the Death Benefit. The Specified Amount
will not be reduced.
Paid-Up Nonforfeiture Option
By Written Request, You may elect, at any time prior to the Maturity Date, to
continue this Policy as paid-up life insurance with no further premiums due.
The Specified Amount of the paid-up insurance will be the amount, up to the
Death Benefit under this Policy as of the effective date of the paid-up
insurance, that the Surrender Value can purchase for a Net Single Premium at the
Insured's Attained Age and premium class on the date this option is elected. The
Net Single Premium will be based on the maximum cost of insurance rates in this
Policy and an interest rate of 4.0% compounded annually. Any excess value will
be refunded to You.
The paid-up insurance may be surrendered at any time for its Surrender Value,
less any outstanding loan balance. The Surrender Value will be equal to the Net
Single Premium for the paid-up insurance on the date of surrender.
The effective date of the paid-up insurance will be the Monthly Deduction Day
which occurs on or immediately after the date Your request is received by Us.
As of the effective date:
No further premium payments, monthly deductions, excess interest credits or
changes in coverage may be made; and
No transfers from the Fixed Account Value back to the Separate Account
Value may be made; and
all extra benefit riders will terminate.
Page 11
LN920 NY
You may, after electing paid-up insurance, surrender the Policy for its Total
Account Value. We will transfer the Separate Account Value to the Fixed Account
Value on the date we receive Your Written Request to elect this option.
Policy Loans
General
We will grant loans while this Policy is in force. The amount of the loan will
not be more than the Loan Value. The Loan Value for this Policy is 90% of the
sum of the Fixed Account Value and the Separate Account Value.
The amount of the loan will be transferred out of the Fixed Account and Separate
Account Values as described in the Charges to Policy Values provision. The loan
amount increases the Loan Account Value.
The Loan Account Value plus accrued interest will reduce any Proceeds under this
Policy. If the Loan Account Value exceeds the sum of the Separate Account Value
and Fixed Account Value, the Grace Period provision will apply.
Loan Interest Rate Charged
Interest, at an effective annual rate, will be charged on this Policy's Loan
Account Value. The rate of interest may change and applies to this Policy's
total Loan Account Value. Changes will be made only on a Policy Anniversary.
Interest is due and payable on the next Policy Anniversary, the date this Policy
ends or upon full repayment of the Loan Account Value. Any interest not paid
when due will be added to the Loan Account Value on the Policy Anniversary and
will itself bear interest on the same terms.
The interest rate is based on a Monthly Average. The Monthly Average will be the
Composite Yield on Corporate Bonds as published by Moody's Investors Service,
Inc., or any successor to that service. If such average is no longer published,
the average used will be determined by law or regulation of the insurance
supervisory official of the jurisdiction where this policy is delivered. In no
event will the interest rate exceed the maximum rate imposed by law or
regulation of the jurisdiction where this policy is delivered.
The interest rate charged during any Policy Year will not exceed the maximum
rate for that year. The maximum rate will be the greater of:
1. the Monthly Average for the calendar month which ends 2 months before the
month in which the Policy Anniversary occurs; or
2. 5.0%
We may increase the rate only when the maximum rate is at least .5% higher than
the rate in effect for the prior Policy Year.
We will reduce the rate only when the maximum rate is at least .5% lower than
the rate in effect for the prior Policy Year.
We will notify You of the current policy loan interest rate for this Policy at
the time a policy loan is taken. If the Policy has a Loan Account Value, We will
notify You of any change in the interest rate before the new rate becomes
effective.
Loan Interest Rate Credited
The Loan Account Value will earn interest at a rate equal to the greater of:
1. the policy loan interest rate less a rate not to exceed .90%; or
2. 4.0%
We will notify You of the current policy loan interest rate for this Policy at
the time a policy loan is taken. If the Policy has Loan Account Value, We will
notify You of any change in the interest rate before the new rate becomes
effective.
The interest earned by the Loan Account Value will be credited to the Fixed
Account Value and the Separate Account Value in the same proportion in which the
loan amount was originally deducted from these values.
Page 12
LN920 NY
Repayment
The Loan Account Value may be repaid in full or in part at any time as long as
this Policy is in force and the Insured is living. The amount necessary to repay
all loans in full is the Loan Account Value plus any accrued interest. Loan
repayments will be allocated to the Fixed Account Value and the Separate Account
Value in the same proportion in which the loan was taken. The proportion
allocated to the Separate Account Value will be further allocated to the Funds
in accordance with current premium allocation. The Loan Account Value will be
reduced by the amount of any loan repayment.
Changes in Insurance Coverage
General
For any change in coverage We will require Your Written Request. Supplemental
Policy Specifications will be sent to You once the change is completed.
Increase in Specified Amount Increases will be allowed at any time.
Satisfactory evidence of insurability on the Insured may be required.
The Date of Issue for any increase will be shown in the Supplemental Policy
Specifications.
Decrease in Specified Amount
Decreases will be allowed at any time with Our consent.
The amount of a decrease cannot reduce this Policy's Specified Amount below the
Minimum Specified Amount.
For a decrease in the Specified Amount, the Date of Issue will be the Monthly
Deduction Date on or next following the date on which Your Written Request is
received.
The decrease will reduce any past increases in the reverse order in which they
occurred.
Change in Death Benefit Option
Any change in the Death Benefit option is subject to the following conditions:
We will not allow a change from Death Benefit Options 1 or 2 to Death Benefit
Option 3.
We will not allow a change in the Death Benefit option if the Specified Amount
will be reduced below the Minimum Specified Amount.
The change will take effect on the Monthly Deduction Day on or next following
the date on which Your Written Request is received.
Evidence of insurability may be required.
Change from Option 1 to 2
Changes from Option 1 to 2 will be allowed at any time. The Specified Amount
will be reduced to equal the Specified Amount less the Total Account Value at
the time of the change.
Change from Option 2 to 1
Changes from Option 2 to 1 will be allowed at any time. The new Specified Amount
will equal the Specified Amount plus the Total Account Value at the time of the
change.
Change from Option 3 to 1
Changes from Option 3 to 1 will be allowed at any time. The Specified Amount
will be increased to equal the Specified Amount prior to the change, plus the
lesser of the accumulated premiums or the Total Account Value at the time of the
change.
Page 13
LN920 NY
Change from Option 3 to 2
Changes from Option 3 to 2 will be allowed at any time. The Specified Amount
will be reduced to equal the Specified Amount prior to the change less the
difference between the Total Account Value and the accumulated premiums at the
time of the change.
Change of Fund(s)
The Company may:
1. Change the Fund(s) which may be invested in a Separate Account; and
2. replace the shares of Funds held in a Separate Account with shares of other
Fund(s).
Changes must be:
1. Approved by a majority vote of persons having an interest in the Separate
Account and its Fund(s); or
2. deemed necessary by Us under the Investment Company Act of 1940; or
3. deemed necessary by Us to accomplish the purpose of the Separate Account.
The investment policy of a Separate Account may not be changed without Our
obtaining any necessary regulatory or other approvals.
We will notify You of any change.
Separate Account
LLANY Separate Account S for Flexible Premium Variable Life Insurance is a
Separate Account established by Us in accordance with the laws of the State of
New York. Income, realized and unrealized gains and losses from the assets of
LLANY Separate Account S for Flexible Premium Variable Life Insurance will be
credited to or charged against LLANY Separate Account S for Flexible Premium
Variable Life Insurance without regard to Our other income, gains, or losses.
LLANY Separate Account S for Flexible Premium Variable Life Insurance
liabilities arise from the variable life insurance policies that it supports.
The assets of LLANY Separate Account S for Flexible Premium Variable Life
Insurance are available to cover the liabilities of the General Account only to
the extent that LLANY Separate Account S for Flexible Premium Variable Life
Insurance assets exceed its liabilities.
The value of the assets of LLANY Separate Account S for Flexible Premium
Variable Life Insurance is determined whenever the policy benefits vary and at
the end of every Valuation Period.
Settlement Options
Conditions
All or part of the Proceeds of this Policy may be applied under one or more of
the options described below. An election shall be made by Written Request filed
at the Administrator Mailing Address. The Payee of Proceeds may make this
election if no prior election has been made. Our consent to the election of an
option is required if:
the Payee is not a natural person receiving payments in his or her own
right; or
the Payee is an assignee of this Policy.
When any option is chosen, the Payee must designate whether the annuity will be:
(a) a fixed annuity
(b) a variable annuity, or
(c) a combination of (a) and (b).
If no designation is made, the Separate Account Value shall be used to provide a
variable annuity payment, and the Fixed Account Value shall be used to provide a
fixed annuity payment.
Page 14
LN920 NY
If a fixed annuity is chosen, the annuity purchase rate for the option chosen
will reflect at least the minimum guaranteed interest rate of 3.0%.
Where a variable annuity is chosen, an assumed annual net return rate of 4.0%
will be used to determine the amount of the first annuity payment under a
variable annuity.
The 4.0% assumed annual net return is the measuring point for subsequent
variable annuity payouts. If the actual net investment rate (annualized) exceeds
4.0%, the variable annuity payments will increase at a rate equal to the amount
of such excess. Conversely, if the actual rate is less than 4.0%, variable
annuity payments will decrease.
Payments will not change due to changes in the mortality or expense results or
administrative charges.
Separate Account
Payments on a variable basis will be made from the Proceeds held in LLANY
Separate Account N for Variable Annuities. LLANY Separate Account N for Variable
Annuities is a Separate Account established by Us in accordance with the laws of
the State of New York. Income, realized and unrealized gains and losses from the
assets of LLANY Separate Account N for Variable Annuities will be credited to or
charged against LLANY Separate Account N for Variable Annuities without regard
to Our other income, gains, or losses. LLANY Separate Account N for Variable
Annuities's liabilities arise from the variable portion of annuity contracts and
life insurance settlement options that it supports. The assets of LLANY Separate
Account N for Variable Annuities are available to cover the liabilities of the
General Account only to the extent that LLANY Separate Account N for Variable
Annuities's assets exceed its liabilities.
Fund(s) Settlement Option Annuity Units of LLANY Separate Account N for Variable
Annuities. If payment on a variable basis is chosen, the first payment is
calculated as follows:
1. the portion of Proceeds applied to make payment on the variable basis;
divided by
2. 1,000; multiplied by
3. the payment rate for the option chosen.
This amount is divided by the Fund settlement option annuity unit value on the
Annuity Commencement Date to determine the number of Fund settlement option
annuity units. The due date of the first annuity payment will be 14 days after
the Annuity Commencement Date. The number of Fund settlement option annuity
units remains fixed unless a Fund transfer occurs. Each future payment is equal
to this number multiplied by the Fund settlement option annuity unit value on
the Valuation Date ending 14 days prior to the due date of the payment.
Fund(s) Settlement Option Annuity Unit Value of LLANY Separate Account N for
Variable Annuities A Fund settlement option annuity unit value for any Valuation
Period after the inception of the Fund is calculated as follows:
1. The Fund settlement option annuity unit value for the immediately preceding
Valuation Period; multiplied by
2. The Fund settlement option accumulation unit value for this Valuation
Period divided by the Fund settlement option accumulation unit value for
the immediately preceding Valuation Period; multiplied by
3. 0.9998926 raised to a power equal to the number of days in the current
Valuation Period. 0.9998926 is the daily factor for the 4.0% assumed annual
net return rate.
The dollar value of the Fund settlement option unit values and payments may
increase or decrease due to investment gain or loss.
Page 15
LN920 NY
Fund(s) Settlement Option Accumulation Unit Value of LLANY Separate Account N
for Variable Annuities A Fund settlement option accumulation unit value for any
Valuation Period after the inception of the Fund is calculated as follows:
1. The total value of Fund shares held is calculated by multiplying the number
of Fund shares owned at the beginning of the Valuation Period by the net
asset value per share of the Fund at the end of the Valuation Period and
adding any dividend or other distribution of the Fund earned during the
Valuation Period; minus
2. The liabilities of the Fund at the end of the Valuation Period; such
liabilities include daily charges imposed on the Fund and may include a
charge or credit with respect to any taxes paid or reserved for by Us that
We determine result from operations of the Separate Account; and
3. The result of (2) is divided by the number of accumulation units for that
Fund outstanding at the beginning of the Valuation Period.
The daily charges imposed on a Fund for any Valuation Period represent the daily
mortality and expense risk charge and the daily administrative charge adjusted
for the number of calendar days in the Valuation Period. On an annual basis this
charge will not exceed 1.40%.
If a variable annuity is chosen, the Payee must allocate the initial payment
amount among the allowable Funds. We require a minimum initial payment per Fund
of $50 and/or a minimum fixed benefit payment of $50.
Fund Transfers During the Annuity Period
At the request of the Payee, all or any portion of the variable annuity payment
amount allocated to a Fund may be transferred from any Fund to any other
allowable Fund or to a fixed benefit payment. A transfer of a fixed benefit
payment to a variable benefit payment is not allowed. During the annuity period,
the maximum number of allowable transfers in a calendar year is three. We
reserve the right to change the number of allowable transfers.
Transfer requests must be expressed as a percentage of the current variable
annuity units per payment allocated among the Funds. Any transfer must result in
a minimum annuity payment per Fund of $50. Transfers will be processed as of the
next Valuation Date following receipt of such request in good order at the
Administrator Mailing Address.
Annuity Payment Options:
Option 1 - Life Annuity / Life Annuity with Guaranteed Period - Fixed and/or
variable annuity payments will be made for the lifetime of the Annuitant with no
certain period, or life and a 10 year certain period, or life and a 20 year
certain period.
Option 2 - Unit Refund Life Annuity - Variable annuity payments will be made for
the lifetime of the Annuitant with the guarantee that upon death, if (a) the
number of Fund settlement option annuity units initially purchased (determined
by dividing the total dollar amount applied to purchase this settlement option
by the Fund settlement option annuity unit value on the Annuity Commencement
Date) is greater than (b) the number of Fund settlement option annuity units
paid as part of each variable annuity benefit payment multiplied by the number
of annuity benefit payments paid prior to death; then a refund payment equal to
the number of Fund settlement option annuity units determined by (a) minus (b)
will be made. The refund payment value will be determined using the Fund
settlement option annuity unit value on the Valuation Date on which the death
claim is approved by Us for payment after We are in receipt of (1) proof of
death acceptable to Us; (2) written authorization for payment; and (3) all claim
forms, fully completed.
Option 3 - Cash Refund Life Annuity - Fixed annuity payments will be made for
the lifetime of the Annuitant with the guarantee that upon death, if (a) the
total dollar amount applied to purchase this option is greater than (b) the
fixed annuity benefit payment multiplied by the number of annuity benefit
payments paid prior to death; then a refund payment equal to the dollar amount
of (a) minus (b) will be made. The refund payment will be made on the Valuation
Date on which the death claim is approved by Us for payment after We are in
receipt of (1) proof of death acceptable to Us; (2) written authorization for
payment; and (3) all claim forms, fully completed.
Option 4 - Joint Life Annuity / Joint Life Annuity with Guaranteed Period -
Fixed and/or variable payments will be made during the joint life of the
Annuitant and a Joint Annuitant of the Owner's choice. Payments will be made for
life with no certain period, or life and a 10 year certain period, or life and a
20 year certain period. Payments continue for the life of the survivor at the
death of the Annuitant or Joint Annuitant.
Other Options - other options may be available as agreed upon in writing by Us.
Page 16
LN920 NY
The amount of annuity payment will depend on the age and sex (except in cases
where unisex rates are required) of the Annuitant as of the Annuity Commencement
Date. A choice may be made to receive payments once each month, four times each
year, twice each year, or once each year. The Proceeds and Fund settlement
option Annuity unit value used to effect benefit payments will be calculated as
of the Annuity Commencement Date. If any portion of the annuity payment will be
made on a variable basis, the first payment will be made fourteen days after the
Annuity Commencement Date.
Article 1 of this Policy illustrates the minimum payment amounts and the age
adjustments which will be used to determine the first monthly payment under a
variable annuity payment option. The tables show the dollar amount of the first
monthly payment which can be purchased with each $1,000 of Proceeds, after
deduction of any applicable premium taxes. Amounts shown use the 1983 `a'
Individual Annuity Mortality Table, modified, with an assumed rate of return of
4.0% per year.
Article 2 of this Policy illustrates the minimum payment amounts and the age
adjustments which will be used to determine the monthly payments under a fixed
annuity payment option. The tables show the dollar amount of the guaranteed
monthly payments which can be purchased with each $1,000 of Proceeds, after
deduction of any applicable premium taxes. Amounts shown use the 1983 `a'
Individual Annuity Mortality Table, modified, with an interest rate of 3.0% per
year and a 2.0% expense load.
Page 17
LN920 NY
ARTICLE 1
ANNUITY PURCHASE RATES UNDER A VARIABLE PAYMENT OPTION
+---------------------------------------------------------------------+
| DOLLAR AMOUNT OF FIRST MONTHLY PAYMENT WHICH IS |
| PURCHASED WITH EACH $1,000 APPLIED |
+---------------------------------------------------------------------+
| SINGLE LIFE ANNUITIES |
+---------+--------------+--------------+--------------+--------------+
| | No Period | 120 Months | 240 Months | Cash |
| | Certain | Certain | Certain | Refund |
| Age |Male Female|Male Female|Male Female|Male Female|
+---------+--------------+--------------+--------------+--------------+
| 60 | $5.29 $4.78| $5.18 $4.73| $4.83 $4.56| $4.88 $4.56|
| 61 | 5.41 4.87| 5.28 4.81| 4.89 4.63| 4.96 4.63|
| 62 | 5.54 4.97| 5.39 4.90| 4.95 4.69| 5.05 4.71|
| 63 | 5.68 5.07| 5.50 5.00| 5.01 4.75| 5.14 4.78|
| 64 | 5.82 5.19| 5.63 5.10| 5.06 4.82| 5.23 4.87|
| | | | | |
| 65 | 5.98 5.30| 5.75 5.21| 5.12 4.88| 5.32 4.95|
| 66 | 6.15 5.43| 5.88 5.32| 5.17 4.95| 5.42 5.04|
| 67 | 6.33 5.57| 6.02 5.44| 5.22 5.01| 5.53 5.14|
| 68 | 6.53 5.72| 6.16 5.56| 5.27 5.08| 5.64 5.24|
| 69 | 6.74 5.88| 6.31 5.70| 5.32 5.14| 5.75 5.34|
| | | | | |
| 70 | 6.96 6.05| 6.46 5.84| 5.36 5.20| 5.87 5.46|
| 71 | 7.19 6.23| 6.61 5.99| 5.40 5.26| 5.99 5.57|
| 72 | 7.44 6.44| 6.77 6.14| 5.44 5.31| 6.12 5.69|
| 73 | 7.71 6.66| 6.93 6.30| 5.47 5.36| 6.25 5.82|
| 74 | 7.99 6.89| 7.09 6.47| 5.50 5.40| 6.39 5.96|
| 75 | 8.30 7.15| 7.25 6.65| 5.53 5.44| 6.53 6.10|
+---------+--------------+--------------+--------------+--------------+
| |
+---------------------------------------------------------------------+
| JOINT AND SURVIVOR ANNUITIES |
+----------------------------+---------+------------------------------+
| Joint and Full to Survivor | | Joint and Two-Thirds Survivor|
+----------------------------+---------+------------------------------+
| Certain Period | | Certain Period |
+----------------------------+---------+------------------------------+
| None | 120 | 240 |Joint Age| None | 120 | 240 |
+--------+---------+---------+---------+---------+---------+----------+
| $4.37 | $4.37 | $4.34 | 60 | $4.78 | $4.74 | $4.57 |
| 4.44 | 4.44 | 4.40 | 61 | 4.88 | 4.82 | 4.63 |
| 4.52 | 4.51 | 4.46 | 62 | 4.97 | 4.91 | 4.69 |
| 4.60 | 4.59 | 4.53 | 63 | 5.08 | 5.00 | 4.76 |
| 4.68 | 4.68 | 4.60 | 64 | 5.19 | 5.10 | 4.82 |
| | | | | | | |
| 4.77 | 4.77 | 4.67 | 65 | 5.31 | 5.21 | 4.88 |
| 4.87 | 4.86 | 4.74 | 66 | 5.44 | 5.32 | 4.95 |
| 4.98 | 4.96 | 4.82 | 67 | 5.57 | 5.44 | 5.01 |
| 5.09 | 5.07 | 4.89 | 68 | 5.72 | 5.56 | 5.08 |
| 5.21 | 5.19 | 4.96 | 69 | 5.87 | 5.69 | 5.14 |
| | | | | | | |
| 5.34 | 5.31 | 5.04 | 70 | 6.04 | 5.83 | 5.20 |
| 5.47 | 5.44 | 5.11 | 71 | 6.22 | 5.97 | 5.25 |
| 5.62 | 5.58 | 5.18 | 72 | 6.42 | 6.12 | 5.31 |
| 5.78 | 5.73 | 5.24 | 73 | 6.62 | 6.28 | 5.36 |
| 5.96 | 5.88 | 5.30 | 74 | 6.85 | 6.44 | 5.40 |
| 6.14 | 6.05 | 5.36 | 75 | 7.09 | 6.61 | 5.44 |
+--------+---------+---------+---------+---------+---------+----------+
Age Adjustment Table
Year of Birth Adjustment to Age Year of Birth Adjustment to Age
------------- ----------------- ------------- -----------------
Before 1920 + 2 1970-1979 - 4
1920-1929 + 1 1980-1989 - 5
1930-1939 0 1990-1999 - 6
1940-1949 - 1 2000-2009 - 7
1950-1959 - 2 2010-2019 - 8
1960-1969 - 3 After 2019 - 9
LN920 NY Page 18
ARTICLE 2
ANNUITY PURCHASE RATES UNDER A FIXED PAYMENT OPTION
+---------------------------------------------------------------------+
| DOLLAR AMOUNT OF FIRST MONTHLY PAYMENT WHICH IS |
| PURCHASED WITH EACH $1,000 APPLIED |
+---------------------------------------------------------------------+
| SINGLE LIFE ANNUITIES |
+---------+--------------+--------------+--------------+--------------+
| | No Period | 120 Months | 240 Months | Cash |
| | Certain | Certain | Certain | Refund |
| Age |Male Female|Male Female|Male Female|Male Female|
+---------+--------------+--------------+--------------+--------------+
| 60 | $4.91 $4.37| $4.81 $4.33| $4.47 $4.17| $4.47 $4.13|
| 61 | 5.03 4.47| 4.92 4.42| 4.53 4.24| 4.56 4.21|
| 62 | 5.17 4.58| 5.04 4.52| 4.60 4.31| 4.65 4.29|
| 63 | 5.32 4.69| 5.16 4.62| 4.67 4.38| 4.75 4.38|
| 64 | 5.48 4.81| 5.30 4.73| 4.73 4.46| 4.85 4.46|
| | | | | |
| 65 | 5.64 4.94| 5.43 4.85| 4.80 4.53| 4.95 4.56|
| 66 | 5.82 5.08| 5.58 4.97| 4.86 4.61| 5.06 4.66|
| 67 | 6.01 5.22| 5.72 5.10| 4.92 4.68| 5.18 4.76|
| 68 | 6.22 5.38| 5.88 5.24| 4.97 4.75| 5.30 4.87|
| 69 | 6.44 5.55| 6.04 5.39| 5.03 4.82| 5.43 4.98|
| | | | | |
| 70 | 6.68 5.73| 6.20 5.54| 5.08 4.89| 5.56 5.11|
| 71 | 6.92 5.93| 6.37 5.70| 5.12 4.95| 5.70 5.23|
| 72 | 7.18 6.14| 6.54 5.87| 5.16 5.02| 5.84 5.37|
| 73 | 7.47 6.38| 6.72 6.04| 5.20 5.07| 6.00 5.51|
| 74 | 7.77 6.63| 6.90 6.23| 5.23 5.12| 6.16 5.66|
| 75 | 8.09 6.90| 7.08 6.42| 5.26 5.17| 6.32 5.82|
+---------+--------------+--------------+--------------+--------------+
| |
+---------------------------------------------------------------------+
| JOINT AND SURVIVOR ANNUITIES |
+----------------------------+---------+------------------------------+
| Joint and Full to Survivor | | Joint and Two-Thirds Survivor|
+----------------------------+---------+------------------------------+
| Certain Period | | Certain Period |
+--------+---------+---------+---------+---------+---------+----------+
| None | 120 | 240 |Joint Age| None | 120 | 240 |
+--------+---------+---------+---------+---------+---------+----------+
| $3.96 | $3.95 | $3.98 | 60 | $4.38 | $4.34 | $4.22 |
| 4.03 | 4.08 | 4.05 | 61 | 4.48 | 4.47 | 4.29 |
| 4.12 | 4.16 | 4.12 | 62 | 4.58 | 4.57 | 4.36 |
| 4.21 | 4.25 | 4.19 | 63 | 4.69 | 4.67 | 4.43 |
| 4.30 | 4.34 | 4.26 | 64 | 4.81 | 4.78 | 4.50 |
| | | | | | | |
| 4.40 | 4.43 | 4.34 | 65 | 4.94 | 4.89 | 4.57 |
| 4.51 | 4.54 | 4.42 | 66 | 5.08 | 5.01 | 4.64 |
| 4.62 | 4.64 | 4.50 | 67 | 5.22 | 5.13 | 4.71 |
| 4.74 | 4.76 | 4.58 | 68 | 5.38 | 5.27 | 4.78 |
| 4.87 | 4.88 | 4.66 | 69 | 5.55 | 5.41 | 4.85 |
| | | | | | | |
| 5.01 | 5.01 | 4.74 | 70 | 5.73 | 5.55 | 4.91 |
| 5.16 | 5.15 | 4.82 | 71 | 5.92 | 5.70 | 4.98 |
| 5.32 | 5.30 | 4.89 | 72 | 6.12 | 5.86 | 5.03 |
| 5.49 | 5.45 | 4.96 | 73 | 6.34 | 6.03 | 5.09 |
| 5.68 | 5.62 | 5.03 | 74 | 6.58 | 6.20 | 5.14 |
| 5.88 | 5.79 | 5.09 | 75 | 6.84 | 6.38 | 5.18 |
+--------+---------+---------+---------+---------+---------+----------+
Age Adjustment Table
Year of Birth Adjustment to Age Year of Birth Adjustment to Age
- ------------- ----------------- ------------- -----------------
Before 1920 + 2 1970-1979 - 4
1920-1929 + 1 1980-1989 - 5
1930-1939 0 1990-1999 - 6
1940-1949 - 1 2000-2009 - 7
1950-1959 - 2 2010-2019 - 8
1960-1969 - 3 After 2019 - 9
LN920 NY Page 19
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
FLEXIBLE PREMIUMS PAYABLE UNTIL MATURITY DATE OR DEATH
PROCEEDS PAYABLE UPON THE FIRST EVENT TO OCCUR - SURRENDER, MATURITY OR DEATH
NON-PARTICIPATING - NO DIVIDENDS PAYABLE
The amount or duration of the death benefit may be fixed or variable and may
increase or decrease. The death benefit is payable as described in the Death
Benefit Options and Proceeds sections of this Policy.
Values in each Fund held in a Separate Account may increase or decrease daily.
Such values are not guaranteed as to dollar amount. Refer to the Policy Values
section of this Policy for more information.
LN920 NY