EXHIBIT 1.(5)(E)
ACCELERATED LIVING BENEFIT RIDER
THIS RIDER IS ATTACHED TO AND MADE PART OF YOUR POLICY.
ISSUE DATE:___________________________________________
POLICY NUMBER:________________________________________
This rider is not meant to cause involuntary access to proceeds ultimately
payable to the beneficiary. Therefore, this benefit is not available:
a) if either the owner or insured is required by law to use this benefit
to meet the claims of creditors, whether in bankruptcy or otherwise; or
b) if either the owner or insured is required by a government agency to
use this benefit in order to apply for, obtain or otherwise keep a
government benefit or entitlement.
Accelerated Benefit
The owner may elect to receive, while the insured is living, a portion of the
policy's proceeds. We will pay an Accelerated Benefit if an insured has been
diagnosed with a noncorrectable terminal illness and has a life expectancy of 6
months or less. There are no restrictions or limitations on the use of the
Accelerated Benefit Payment.
Definitions
Accelerated Benefit Payment is the actual dollar amount of benefit you will
receive under this rider.
Requested Portion is the amount of the policy proceeds the owner requests. The
Requested Portion divided by the Eligible Coverage will be called the Requested
Percentage. The Requested Portion cannot exceed the lesser of a) 50% the
Eligible Coverage, or b) $250,000 for all policies in force with us.
Eligible Coverage is the portion of the policy proceeds, which will quality for
determining the Accelerated Benefit under this rider.
The Eligible Coverage includes:
. the base policy death benefit;
. any paid-up additions; and
. any term rider, term policy, or term coverage on the primary insured that
has at least two years of coverage remaining. For coverage amounts that vary
by year, the lowest coverage amount during the remaining two-year period
will be used.
. Survivor Life policies will be eligible for acceleration only after the
death of the first insured and the surviving insured has been diagnosed as
terminally ill. Any term rider, term policy or term coverage on the surviving
insured that has at least two years of coverage remaining will be eligible
for acceleration. For coverage amounts that vary by year, the lowest coverage
amount during the remaining two-year period will be used.
Eligible Coverage does not include:
. any insurance provided under the policy on the life of someone other than
the insured;
. the face amount of any scheduled increase(s) in insurance as provided
by an additional benefit rider during the 12 month period after the date
the accelerated payment is requested; and
. the amount of any accidental death benefit.
The minimum Accelerated Benefit Payment amount is $500. The Accelerated Benefit
will be paid in a lump sum payment. WE WILL PAY THE ACCELERATED BENEFIT AMOUNT
ONLY ONCE PER INSURED.
Accelerated Benefit Payment
The Accelerated Benefit payment will be determined as of the date we approve
your written request. Your Accelerated Benefit Payment will equal the Requested
Portion less the following adjustments:
1. An actuarial discount will apply to the Requested Portion. This discount
reflects the early payment of the Requested Portion of your policy. The
discount will be based on an annual interest rate declared by us and which
is in effect as of the date we approve your written request.
The interest rate will not be greater than the published monthly average for
the calendar month ending two months before the date the rate is determined
(Moody's Corporate Bond Yield Average - Monthly Average Corporate as
published by Moody's Investors Service Inc.). The rate is determined for
each calendar year on January 1st.
2. If there is a policy loan outstanding on your policy as of the date we
approve your written request, we will reduce the Requested Portion in order
to repay a portion of the outstanding policy loan equal to the Requested
Percentage times the outstanding loan.
3. A reduction to the Requested Portion will be applied to any premiums due
and unpaid if the policy has entered the Grace Period at the time we approve
your request.
4. An administrative charge not to exceed $150.
We will refund the amounts discussed in 1. and 4. above should the death of the
Insured occur within 30 days of the Accelerated Benefit Payment.
R92ALB-NY Page 1
Impact on Policy
After an Accelerated Benefit Payment is made the policy and all riders will
remain in force subject to the following adjustments. The policy death benefit,
any cash value, any paid-up additions, Accumulated Value, if any, and any term
insurance eligible to be accelerated under this rider, and any required premium
payments will be reduced by the Requested Percentage. Such reduced premiums due
after the Accelerated Benefit Payment has been made, will be due at the
scheduled premium due dates. Such premiums must be paid in cash to keep this
policy in force, unless the policy has an automatic premium loan option, which
has been selected by the owner, in which case the premiums will be paid by
automatic premium loan if not paid in cash. Any outstanding policy loan will be
reduced as specified in the Accelerated Benefit Payment Section.
Any adjustment in Accumulated Value will be allocated to the Fixed Account and
Variable Accounts on a prorata basis. Cost of Insurance Charges will be adjusted
to reflect the reduction in the death benefit.
A statement demonstrating how an Accelerated Benefit Payment will impact your
policy values will be sent with your payment.
Eligibility
The following conditions must be met prior to any Accelerated Benefit Payment:
. The policy must be in force on the date the Accelerated Benefit Payment is
approved. If you have a term insurance policy or your policy is on Extended
Term, a minimum period of two years of coverage must be remaining in order to
qualify for an Accelerated Benefit Payment.
We must receive written proof satisfactory to us that the insured's or for
Survivor Life policies the surviving insured's life expectancy is 6 months or
less from the date of the written request. Proof will include the certification
by a licensed physician, who is not yourself or a member of your family. Such
proof should include documentation supported by clinical, radiological or
laboratory evidence of the condition. We reserve the right to obtain a second
medical opinion from a physician of our choice at our expense.
. If the opinions of the insured's physician and the company's physician
conflict, an opinion from a third physician mutually acceptable to both the
insured and the company will be sought. This opinion will prevail in
determining whether the accelerated benefit will be approved.
. Owner or legal guardian must apply in writing for this benefit on a form
supplied by us.
Incontestability
This rider is subject to the Incontestability provision of the base policy to
which it is attached.
Effective Date
This rider is effective on the issue date specified.
General Provisions
There will be an administrative charge, not to exceed $150, which will be
deducted from the Accelerated Benefit.
This rider will terminate:
. on your written request;
. on lapse or termination of the policy; or
. when an Accelerated Benefit is paid under this rider.
Signed for Pacific Life & Annuity Company,
/s/ DAVID W. GARTLEY /s/ AUDREY L. MILFS
- ------------------------------------- --------------------------------------
President and Chief Executive Officer Secretary
R92ALB-NY Page 2