METLIFE INSURANCE COMPANY OF CONNECTICUT
(A Stock Company)
[1300 Hall Boulevard
Bloomfield, Connecticut 06002]
NOTICE
To obtain information about your policy or if you need assistance or need help
in resolving a complaint, you may call [(800)-638-7732].
METLIFE INSURANCE COMPANY OF CONNECTICUT (referred to as "we", "us", "our", and
the "Company") will make Income Payments as described in this Contract beginning
on the Annuity Date.
This Policy is a legal contract between the policyholder and the Company.
FREE LOOK PROVISION - RIGHT TO CANCEL
This Contract may be returned for any reason within [10] days after you receive
it by mailing or delivering the Contract to either us or the agent who sold it.
Return of this Contract by mail is effective on being postmarked, properly
addressed and postage prepaid. We will promptly refund your Account Value as of
the Business Day we receive your Contract. Your Account Value may be more or
less than your Purchase Payment.
Signed for the Company.
/s/ Isaac Torres /s/ Steven A. Kandarian
------------------------ ---------------------------
SECRETARY PRESIDENT]
SINGLE PREMIUM DEFERRED ANNUITY CONTRACT
This Contract contains Shield Options and a Fixed Account. The initial interest
rate for the Fixed Account is guaranteed for one year.
NONPARTICIPATING
READ YOUR CONTRACT CAREFULLY.
VALUES AND DETERMINATION OF ANNUITY PAYMENTS PROVIDED BY THIS CONTRACT, WHEN
BASED ON THE VALUE OF THE SHIELD OPTION(S), ARE VARIABLE, MAY INCREASE OR
DECREASE, AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT.
L-22494 (09/12)-AV
TABLE OF CONTENTS
PAGE
[CONTRACT SCHEDULE 3
DEFINITIONS 4
GENERAL PROVISIONS 5
ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 6
BENEFICIARY PROVISIONS 7
PURCHASE PAYMENT PROVISIONS 7
RENEWAL PROVISIONS 8
ACCOUNT VALUE PROVISIONS 8
WITHDRAWAL PROVISIONS 11
DEATH BENEFIT PROVISIONS 11
ANNUITY PROVISIONS 12]
L-22494 (09/12)-AV
DEFINITIONS
ACCOUNT VALUE
Is the total of the value of the Shield Option(s) under this Contract, adjusted
for any amounts that may be included by rider during the Accumulation Period.
Also referred to as "Contract Value."
ACCUMULATION PERIOD
The period prior to the Annuity Date.
ANNUITY SERVICE OFFICE
The office indicated on the Contract Schedule to which notices and requests must
be sent, or as otherwise changed by notice from us.
ANNUITANT
The natural person listed on the Contract Schedule on whose life
Income Payments are based. Any reference to Annuitant shall also include any
Joint Annuitant under an Annuity Option.
ANNUITY DATE
A date on which you choose to begin receiving Income Payments. If we agree, you
may change the Annuity Date subject to the requirements shown under the Annuity
Option Information section on the Contract Schedule. If you do not choose an
Annuity Date, the Annuity Date will be the Annuity Date described on the
Contract Schedule. Also referred to as "Maturity Date."
ATTAINED AGE
The age of any Owner, Beneficiary or Annuitant on his/her last birthday.
BENEFICIARY
The person(s) or entity(ies) you name to receive a death benefit payable under
this Contract upon the death of the Owner or a Joint Owner, or in certain
circumstances, an Annuitant.
BUSINESS DAY
Any day our Annuity Service Office, shown on the Contract Schedule, is open for
business. For purposes of administrative requests and transactions, a Business
Day ends at 4:00PM Eastern Standard Time.
CODE
The Internal Revenue Code of 1986, as amended.
COMPANY
MetLife Insurance Company of Connecticut.
CONTRACT ANNIVERSARY
An anniversary of the Issue Date of this Contract.
CONTRACT YEAR
A one-year period starting on the Issue Date and on each Contract Anniversary
thereafter.
INCOME PAYMENTS
A series of payments made by us during an Income Period, which we guarantee as
to dollar amount.
INCOME PERIOD
A period starting on an Annuity Date during which Income Payments are payable.
INVESTMENT AMOUNT
The Investment Amount for each Shield Option is the amount that is allocated to
the Shield Option. The Investment Amount will be reduced for any withdrawal by
the same percentage that the withdrawal reduces the Interim Value attributable
to that Shield Option. The Investment Amount is adjusted by the Performance Rate
at the end of the Term.
ISSUE DATE
The date this Contract was issued. The Issue Date is shown on the Contract
Schedule.
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JOINT OWNER
If there is more than one Owner, each Owner shall be a Joint Owner of the
Contract.
NOTICE
Any form of communication providing information we need, either in a signed
writing or another manner that we approve in advance. All Notices to us must be
sent to our Annuity Service Office and received in good order. To be effective
for a Business Day, a Notice must be received in good order prior to the end of
that Business Day.
OWNER
The person(s) entitled to the ownership rights under this Contract. If Joint
Owners are named, all references to Owner shall mean Joint Owners. (Referred to
as "you", "yours" or "policyholder.")
PURCHASE PAYMENT
The amount paid to us under this Contract as consideration for the benefits it
provides.
GENERAL PROVISIONS
THE CONTRACT
The Contract consists of this contract and any attached riders or endorsements.
We may require this Contract to be returned to us prior to the payment of any
benefit. It is important to review any riders or endorsements. In case of
conflict with any other provision of this Contract, the provisions of the Rider
or Endorsement will control.
Notwithstanding any provision of this Contract to the contrary, this Contract
will be construed and administered in accordance with applicable sections of the
Code. To preserve this Contract's status as an annuity and comply with
applicable sections of the Code and applicable Treasury Regulations, we may, if
necessary amend this Contract. We will notify you of any amendments and, when
required by law, we will obtain your approval and the approval of the
appropriate regulatory authority.
NON-PARTICIPATING
This Contract will not share in any distribution by us of Company dividends.
MISSTATEMENT OF AGE OR SEX
We may require proof of the age or sex of the Annuitant, Owner and/or
Beneficiary before making any payments under this Contract that are measured by
the Annuitant's, Owner's or Beneficiary's life. If the age or sex of the
Annuitant, Owner or Beneficiary has been misstated, the amount payable will be
the amount that the Account Value would have provided at the correct age and
sex.
Once Income Payments have begun, any underpayments will be made up in one sum
with the next Income Payment or in any other manner agreed to by us. Any
overpayments will be deducted first from future Income Payments. No interest
will be credited or charged in the event of an underpayment or overpayment.
PROTECTION OF PROCEEDS
The Contract and payments under it will be exempt from the claims of creditors
to the extent permitted by law.
REPORTS
At least once each calendar year we will furnish you with a report showing the
Account Value and any other information as may be required by law. We will send
you confirmations of certain transactions. Reports and confirmations will be
sent to your last known address on our records. You will have 60 days from the
date you receive your report or confirmation to inform us of any errors in the
report or confirmation, otherwise the report or confirmation will be deemed to
be final and correct.
PREMIUM AND OTHER TAXES
We reserve the right to deduct from the Purchase Payment or Account Value any
taxes paid by us to any governmental entity relating to this Contract (including
without limitation: premium taxes, federal, state and local withholding of
income, estate, inheritance and other taxes required by law, and any new or
increased state income taxes that may be enacted into law).
We may determine when taxes relate to the Contract, including for example when
they have resulted from: receipt by us of the Purchase Payment; commencement of
Income Payments, payment of death benefits; or partial and full withdrawals; and
any new or increased taxes which become effective that are imposed on us and
which relate to the Purchase Payment, or interest earnings.
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We may pay taxes when due and make a deduction from the Account Value at a later
date. Payment at an earlier date does not waive any right we may have to deduct
amounts at a later date.
EVIDENCE OF SURVIVAL
We may require proof that any person(s) on whose life Income Payments are based
is alive. We reserve the right to discontinue Income Payments until satisfactory
proof is received.
MODIFICATION OF CONTRACT
This Contract may be changed by us in order to maintain compliance with
applicable state and federal law. This Contract may be changed or altered only
in writing signed by our President, Vice-President, or Secretary.
DEFERRAL OF PAYMENTS
After receipt of a Notice of withdrawal from you, we reserve the right to defer
payment for a withdrawal for the period permitted by law but not for more than
six (6) months.
SUSPENSION OF PAYMENTS OR TRANSFERS
We may be required to suspend or delay the payment of death benefits, the
calculation of income payments, withdrawals, and transfers when we cannot obtain
an Index Value under the following circumstances:
. the New York Stock Exchange is closed (other than customary weekend
and holiday closings);
. trading on the New York Stock Exchange is restricted;
. an emergency exists such that we cannot value Investment Amounts; or
. during any other period when a regulator by order, so permits.
ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
OWNER
You, as the Owner, have all the interest and rights under this Contract. The
Owner is the person designated as such on the Issue Date, unless changed.
You may change the Owner at any time. Any change of Owner is subject to our
underwriting requirements in effect at the time of the request. A change of
Owner will automatically revoke any prior designation of Owner. A request for
change must be:
1. by Notice; and
2. received by us at the Annuity Service Office.
The change will become effective as of the date the Notice is signed by you. A
new designation of Owner will not apply to any payment made or action taken by
us prior to the time the new designation was recorded at our Annuity Service
Office.
JOINT OWNER
A Contract may be owned by Joint Owners, limited to natural persons. Either
Joint Owner can exercise all rights under the Contract unless you inform us
otherwise as indicated on the Contract Schedule or in a Notice to us. Upon the
death of either Owner, the surviving Joint Owner will be deemed to be the
primary Beneficiary unless you inform us otherwise. Any other Beneficiary
designation will be treated as a contingent Beneficiary unless otherwise
indicated on the Contract Schedule or in a Notice to us.
ANNUITANT
The Annuitant is the person designated by you, the events in the life of whom
are of primary importance in affecting the timing or amount of the payout under
the contract. Unless the Contract is owned by a non-natural person, you may
change the Annuitant at any time prior to an Annuity Date. Any change of
Annuitant is subject to our underwriting rules in effect at the time of the
request.
ASSIGNMENT
This Contract may not be assigned without our consent in writing and is subject
to our underwriting requirements. You may not assign your rights under this
Contract after the start of Income Payments. In certain tax markets assignment
of this Contract is prohibited by the Internal Revenue Code. If your contract is
assigned absolutely, we will treat it as a change of ownership and all rights
will be transferred. We are not bound by any assignment request unless it is in
writing. We are not responsible for the validity of any assignment. Assignments,
unless otherwise specified by the Owner, shall
L-22494 (09/12) 6
take effect on the date the notice of assignment is signed, subject to any
payments made or actions taken by us before a signed copy of the assignment form
is received by us at our Annuity Service Office.
BENEFICIARY PROVISIONS
BENEFICIARY
The Beneficiary is the person(s) named on the Contract Schedule or the surviving
Joint Owner, unless changed. Unless you provide otherwise, the death benefit
will be paid to or in equal shares as follows:
1. to the primary Beneficiary(ies) who survive you (or who survive the
Annuitant if the Owner is a non-natural person); or if there are none,
then
2. to the contingent Beneficiary(ies) who survive you (or who survive
the Annuitant if the Owner is a non-natural person); or if there are
none, then
3. to your estate.
CHANGE OF BENEFICIARY
Subject to the rights, including the written consent, of any irrevocable
Beneficiary and any applicable laws or regulations, you may change the primary
Beneficiary or contingent Beneficiary. A change may be made by filing a Notice
with us. The change will take effect as of the date the Notice is signed, but we
will not be liable for any payment made or action taken before we have recorded
the change.
PURCHASE PAYMENT PROVISIONS
SEPARATE ACCOUNT
The Purchase Payment made to this Contract is invested in the Separate Account
shown on the Contract Schedule. We have exclusive and absolute ownership and
control of the assets of the Separate Account. It is a non-unitized separate
account. You do not share in the investment performance of assets allocated to
the Separate Account. All investment income, gains and losses, whether or not
realized, from assets allocated to the Separate Account are borne by the
Company. The obligations under this Contract are independent of the investment
performance of the Separate Account and are the obligations of the Company.
We will maintain in the Separate Account assets with an aggregate value at least
equal to the Contract reserves.
If the aggregate value of such assets should fall below such amount, the Company
will transfer assets into the Separate Account so that the value of the Separate
Account's assets is at least equal to such amount. Assets supporting reserves
for annuity benefits under such contracts, in the course of payment, shall not
be maintained in the Separate Account.
SHIELD OPTIONS
On the Issue Date, you may allocate your Purchase Payment to one or more of the
available Shield Options listed on the Contract Schedule. At the end of each
Term, you may transfer the Account Value attributable to the Shield Option(s) to
one or more of the available Shield Options subject to the Transfer Requirements
shown on the Contract Schedule and the Renewal Provisions.
Each Shield Option has an associated Index, Term, Shield Rate, and either a Cap
Rate or a Step Rate as defined below.
TERM
The initial Term(s) begin on the Issue Date. A Term ends and a subsequent Term
begins, on the Contract Anniversary coinciding with the term duration of the
then current Term for that Shield Option.
INDEX
There is a specific Index associated with each Shield Option. The Index is
the price index of certain securities, excluding dividends, or commodities.
INDEX VALUE
The Index Value of an Index, on a Business Day, is the published closing value
of the Index on that Business Day. We will use consistent sources to obtain
Index Values. If these sources are no longer available for specific indices, we
will select an alternative published source(s) for these Index Values. The Index
Value on any day that is not a Business Day is the value as of the prior
Business Day.
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INDEX PERFORMANCE
Index Performance is the percentage change in an Index Value measured from the
beginning of a Term to any day, including the last day, within the Term. Index
Performance can be positive, negative, or zero.
SHIELD RATE
The Shield Rate is the amount of any negative Index Performance that is absorbed
by us at the end of the Term. Any negative Index Performance beyond the Shield
Rate will reduce the Investment Amount. For example, a -15% Index Performance
with a 10% Shield Rate will result in a -5% Performance Rate; or, a -10% Index
Performance with a 25% Shield Rate will result in a 0% Performance Rate.
The Shield Rate may vary between Shield Options, and it is not an annual rate.
CAP RATE
The Cap Rate is the maximum rate that may be credited at the end of a Term based
on Index Performance. A new Cap Rate is declared for each subsequent Term, and
such rate will not be less than the Minimum Guaranteed Cap Rate on the Contract
Schedule.
The Cap Rate may vary between Shield Options, and it is not an annual rate.
STEP RATE
The Step Rate is the rate credited at the end of a Term if the Index Performance
is greater than or equal to zero. A new Step Rate is declared for each
subsequent Term, and such rate will not be less than the Minimum Guaranteed Step
Rate on the Contract Schedule.
The Step Rate may vary between Shield Options, and it is not an annual rate.
RENEWAL PROVISIONS
For renewals into the same Shield Option, a new Cap Rate or Step Rate, whichever
is applicable, will be declared and will go into effect on the Contract
Anniversary that coincides with the beginning of the new Shield Option.
DISCONTINUATION OR SUBSTANTIAL CHANGE TO AN INDEX
If any Index is discontinued or, we determine that our use of such Index should
be discontinued, or if the calculation of an Index is substantially changed, we
may substitute a comparable index. We will send you a notice in writing before
any such substitution is made. Upon substitution of an Index, we will calculate
your Index Performance on the existing Index up until the date of substitution
and the new Index from the date of substitution to the end of the Term. A
substitute Index will not change the Shield Rate, Cap Rate or Step Rate for an
existing Shield Option.
ADDITION OR DISCONTINUANCE OF A SHIELD OPTION
We can add or discontinue any Shield Option. When a change is made to the Shield
Options or Indices referenced on the Contract Schedule or as changed subsequent
to the Issue Date, we will send notification to you which will describe any
changes to the Shield Options then available under the Contract as required by
law. This change will take effect upon your Contract as of the next Contract
Anniversary for any allowable transfers into the Shield Option(s). If you are
currently invested in a Shield Option which is no longer available, you will
remain in that Shield Option until the end of the Term, but that Shield Option
will not be available thereafter.
ACCOUNT VALUE PROVISIONS
The Account Value attributable to each Shield Option is as determined below and
will be the Interim Value on any day during the Term and the Investment Amount
as adjusted for the Performance Rate at the end of the Term as defined below
subject to any fees as outlined in the Contract Schedule or via any riders or
endorsements.
CHARGES AND FEES
We will deduct charges and fees from your Account Value as described on the
Contract Schedule (or any applicable riders or endorsements).
PERFORMANCE RATE
The Performance Rate is the rate credited at the end of the Term. The
Performance Rate at the end of a particular Term is the Index Performance,
adjusted for the applicable Shield Rate, Cap Rate, or Step Rate. The Performance
Rate can be positive, negative, or equal to zero. At the end of the Term, any
increase or reduction in a particular Shield Option is determined by multiplying
the Performance Rate by the Investment Amount of the Shield Option on the last
day of the
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Term.
The Performance Rate is determined as follows:
SHIELD 100 OPTION WITH A CAP RATE:
If Index Performance is equal to or less than zero, then the Performance Rate
will be zero.
If Index Performance is greater than zero and less than the Cap Rate, then the
Performance Rate will equal the Index Performance.
If the Index Performance is greater than zero and equals or exceeds the Cap
Rate, then the Performance Rate will equal the Cap Rate.
SHIELD 100 OPTION WITH A STEP RATE:
If Index Performance is less than zero then the Performance Rate will equal
zero.
If Index Performance is equal to or greater than zero, the Performance Rate will
equal the Step Rate.
Other Shield Options with a Cap Rate:
If Index Performance is equal to or less than zero, then the Performance Rate
will equal the lesser of zero, or the Index Performance increased by the Shield
Rate. (For example: a -15% Index Performance with a 10% Shield Rate will result
in a -5% Performance Rate.) The Performance Rate can never be greater than zero
if the Index Performance is negative.
If Index Performance is greater than zero and less than the Cap Rate, then the
Performance Rate will equal the Index Performance.
If Index Performance is greater than zero and equals or exceeds the Cap Rate,
then the Performance Rate will equal the Cap Rate.
OTHER SHIELD OPTIONS WITH A STEP RATE:
If Index Performance is less than zero, then the Performance Rate will equal the
lesser of zero or the Index Performance increased by the Shield Rate. (For
example: a -15%Index Performance with a 10% Shield Rate will result in a -5%
Performance Rate.) The Performance Rate can never be greater than zero if the
Index Performance is negative.
If Index Performance is equal to or greater than zero, the Performance Rate will
equal the Step Rate.
INTERIM VALUE
The Interim Value for each Shield Option is the value we assign on any Business
Day prior to the end of the Term. During the Transfer Period set forth in the
Contract Schedule, the Interim Value of each Shield Option will equal the
Investment Amount in that Shield Option. After the Transfer Period, the Interim
Value of that Shield Option is equal to the Investment Amount in the Shield
Option, adjusted for the Index Performance of the associated Index and subject
to the applicable Accrued Shield Rate, Accrued Cap Rate, or Accrued Step Rate,
as defined below.
On the date of a withdrawal from the Shield Option(s), your Interim Value will
be reduced by the amount withdrawn.
ACCRUED SHIELD RATE
The Accrued Shield Rate is the portion of the Shield Rate that has accrued from
the beginning of a Term to any day within the Term. This is the amount that will
be applied in calculating the Interim Value on any day prior to the end of the
Term if Index Performance is less than zero. The Accrued Shield Rate is equal to
the Shield Rate multiplied by the number of days elapsed since the beginning of
the Term, divided by the total number of days in the Term.
ACCRUED CAP RATE
The Accrued Cap Rate is the portion of the Cap Rate that has accrued from the
beginning of a Term to any day within the Term. This is the maximum Index
Performance that may be applied in calculating the Interim Value on any day
prior to the end of the Term if Index Performance is greater than zero. The
Accrued Cap Rate is equal to the Cap Rate multiplied by the number of days
elapsed since the beginning of the Term, divided by the total number of days in
the Term.
ACCRUED STEP RATE
The Accrued Step Rate is the portion of the Step Rate that has accrued from the
beginning of a Term to any day within the Term. This is the rate that will be
applied in calculating the Interim Value on any day prior to the end of the Term
if Index Performance is equal to or greater than zero. The Accrued Step Rate is
equal to the Step Rate multiplied by the number of days elapsed since the
beginning of the Term divided by the total number of days in the Term.
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PERFORMANCE RATE FOR DETERMINATION OF INTERIM VALUE
Except as indicated on the Contract Schedule, the Performance Rate during a
particular Term is the Index Performance, adjusted for the applicable Accrued
Shield Rate, Accrued Cap Rate, or Accrued Step Rate.
For purposes of determining the Accrued Shield Rate, Accrued Cap Rate, and
Accrued Step Rate, the total number of days in each calendar year of a Term is
365.
The following are hypothetical examples that show the determination of the
Interim Value when the Index Performance is greater than zero and less than
zero. These hypothetical examples are rounded for illustrative purposes:
EXAMPLE #1 - INDEX PERFORMANCE IS POSITIVE - INTERIM VALUE CALCULATED 306 DAYS
INTO A TERM OF 3 YEARS.
Issue Date March 1, 2013
Investment Amount $ 100,000
Shield Option XYZ 10
Term 3 Years
Shield Rate 10%
Cap Rate 25%
Index Value at Beginning of Term 1000
Number of Days in Term 1095 (3 X 365 = 1095)
Index Value at close of Business Day on January 1, 2014 1100
Index Performance 10%
Accrued Days 306
The Accrued Cap Rate as of January 1, 2014 is 6.986% 306 days into the 3 year
term (25%*(306/1095)). The Index Performance is calculated at 10% (1100/1000 -
1). Since the Index Performance is positive, the Interim Value is then
determined by multiplying the Investment Amount by the lesser of the Index
Performance or the Accrued Cap Rate and adding that amount to the Investment
Amount. As of the close of the Business Day January 1, 2014, the Interim Value
is $106,986 ($100,000+$100,000 * 6.986%).
EXAMPLE #2 - INDEX PERFORMANCE IS NEGATIVE- INTERIM VALUE CALCULATED 306 DAYS
INTO A TERM OF 3 YEARS.
Issue Date March 1, 2013
Investment Amount $ 100,000
Shield Option XYZ 10
Term 3 Years
Shield Rate 10%
Cap Rate 25%
Index Value at Beginning of Term 1000
Number of Days in Term 1095 (3 X 365 = 1095)
Index Value at close of Business Day on January 1, 2014 950
Index Performance -5%
Accrued Days 306
The Accrued Shield Rate as of January 1, 2014 is 2.795% 306 days into the 3 year
term (10% * (306/1095)). The Index Performance is calculated at -5% (950/1000 -
1). Since the Index Performance is negative, the Interim Value is then
determined by multiplying the Investment Amount by the Index Performance plus
the Accrued Shield Rate (-5% + 2.795% = -2.205%) and adding that amount to the
Investment Amount. As of the close of Business Day January 1, 2014, the Interim
Value is $97,795 ($100,000+$100,000*-2.205%).
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WITHDRAWAL PROVISIONS
WITHDRAWALS
Prior to the Annuity Date, you may, upon Notice to us, request a full or a
partial withdrawal and we will withdraw that amount from the Account Value ("the
amount withdrawn"). A withdrawal will result in a reduction to each Shield
Option in the ratio that each Shield Option bears to the total Account Value, as
determined under the Account Value Provisions above, unless otherwise directed
by you. The amount payable to you will be a net amount equal to the amount
withdrawn adjusted for any applicable Withdrawal Charge and any other fees shown
on the Contract Schedule, Premium and Other Taxes, and any other rider and
endorsement fees.
The total amount withdrawn from the Account Value must not be less than the
Minimum Partial Withdrawal amount shown on the Contract Schedule. If the
withdrawal would result in the remaining Account Value being less than the
Minimum Account Value shown on the Contract Schedule, we will treat the
withdrawal request as a request for a full withdrawal.
If you request a full or partial withdrawal, the amount withdrawn after
adjustments for any Withdrawal Charge will result in our paying you a net
amount. The net amount payable to you is equal to (a)-(b)-(c)-(d), where:
(a) is the amount withdrawn from the Account Value, and
(b) is the Withdrawal Charge and other fees, if any, as described on the
Contract Schedule, and
(c) is the Premium and Other Taxes, if any, and
(d) is the rider and endorsement fees, if any.
The amount withdrawn will reduce the Investment Amount, as defined in the
Definitions section, for each Shield Option by the percentage reduction in the
Interim Value of such Shield Option.
DEATH BENEFIT PROVISIONS
DEATH OF OWNER DURING THE ACCUMULATION PERIOD
During the Accumulation Period, the death benefit will be paid to your
Beneficiary(ies) upon your death, or the first death of a Joint Owner. If the
Contract is owned by a non-natural person, the Annuitant will be deemed the
Owner for purposes of determining the death benefit. If there are Joint Owners,
the age of the oldest will be used to determine the death benefit where
applicable.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD
The "Death Benefit Amount" is the Account Value, as defined under the Account
Value Provisions above, determined as of the end of the Business Day on which we
have received Notice of both due proof of death and the first acceptable
election for the payment method.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD
In the event an Owner (or the Annuitant where the Owner is not an individual)
dies during the Accumulation Period, a Beneficiary must choose payment of the
death benefit under one of the options below (unless the Owner has previously
chosen an option). The death benefit options available under the Contract
include the following and any other options acceptable to you and us:
OPTION 1 - lump sum payment of the death benefit; or
OPTION 2 - the payment of the entire death benefit within five years of the date
of death of the Owner or the first Joint Owner to die; or
OPTION 3 - payment of the death benefit under an Annuity Option or other
periodic payment option acceptable to us in substantially equal periodic
payments (made at least annually) over the lifetime of the Beneficiary or over a
period not extending beyond the life expectancy of the Beneficiary with
distribution beginning within one year of the date of death of the Owner or the
first Joint Owner to die.
Any portion of the death benefit not applied under Option 3 within one (1) year
of the date of the Owner's or Joint Owner's death must be distributed within
five years of the date of death.
BENEFICIARY CONTINUATION OPTIONS DURING ACCUMULATION PERIOD
We offer two types of Beneficiary Continuation Options during the Accumulation
Period: the Spousal Continuation and Non-Spousal Beneficiary Continuation
Options described below. We must receive Notice of the election of one of these
Beneficiary Continuation Options by the end of the 90th day after we receive
Notice of due proof of death. If the surviving spouse qualifies for Spousal
Continuation and has not chosen one of the death benefit options above by the
end of the 90 day period, the Spousal Continuation Option will be automatically
applied on the 90th day. If a Non-Spousal Beneficiary
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qualifies for Non-Spousal Beneficiary Continuation and has not chosen one of the
death benefit options above by the end of the 90 day period, the Non-Spousal
Beneficiary Continuation Option will be automatically applied on the 90th day.
SPOUSAL CONTINUATION DURING ACCUMULATION PERIOD
If the Owner dies during the Accumulation Period and the Beneficiary is his or
her spouse, the spouse may choose to continue the Contract in his or her own
name and exercise all the Owner's rights under the Contract. The Death Benefit
Amount under the continued contract payable upon the continuing spouse's death
will be computed as described above in the Death Benefit Amount During the
Accumulation Period section.
NON-SPOUSAL BENEFICIARY CONTINUATION DURING ACCUMULATION PERIOD
A Beneficiary who is not a spouse can choose to continue the Contract until the
fifth anniversary of the Owner's death. The Contract can be continued by a
Beneficiary only if his or her share of the death benefit is at least equal to
our published minimum for this right. If the Beneficiary continues the Contract
under this provision his or her share will not be paid. It will instead be
continued in the Contract on the date we determine the Death Benefit Amount.
Such Beneficiary will have the right to make partial and full withdrawals of
his/her share of the Contract, not subject to Withdrawal Charges. Such
Beneficiary will also have the right to make transfers at the end of a Term as
described on the Contract Schedule.
During the continuation period the Beneficiary can choose to receive his/her
share of this Contract in a single lump sum payment or apply it to an Annuity
Option or other option acceptable to us that must be payable for the life of the
Beneficiary or for a term no longer than the life expectancy of the Beneficiary
starting within one year after the death of the Owner.
On the fifth anniversary of the Owner's death any Beneficiary will be paid
his/her share of the Account Value that has not been applied to an Annuity
option or other settlement option permissible under the Code, in a single lump
sum payment and this Contract will terminate.
DEATH OF ANNUITANT DURING INCOME PERIOD
Upon the death of the Annuitant during the Income Period, the death benefit, if
any, will be as specified in the Annuity Option chosen. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
DEATH OF OWNER DURING THE INCOME PERIOD
If the Owner (or a Joint Owner), is not the Annuitant, and dies during the
Income Period, any remaining payments under the Annuity Option will continue at
least as rapidly as under the method of distribution in effect at the time of
the Owner's (or Joint Owner's) death. Upon the death of the Owner (or a Joint
Owner) during the Income Period, the Beneficiary becomes entitled to exercise
the rights of the Owner. If an Owner (or Joint Owner) is the Annuitant and dies
during the Income Period, the death benefit, if any, will be as specified in the
Annuity Option chosen and will continue at least as rapidly as under the method
of distribution in effect at the time of the Owner's (or Joint Owner's) death.
DEATH OF ANNUITANT DURING ACCUMULATION PERIOD
Upon the death of an Annuitant, who is not the Owner or Joint Owner, during the
Accumulation Period, the Owner (or Oldest Joint Owner) automatically becomes the
Annuitant, unless the Owner, subject to our underwriting rules in effect at the
time of request, chooses a new Annuitant. If the Owner is a non-natural person,
the death of the Annuitant will be treated as the death of an Owner (see Death
of Owner During the Accumulation Period discussed above).
PAYMENT OF DEATH BENEFIT
We will require Notice of both due proof of death and an acceptable election for
the payment method before any death benefit is paid. Our obligations are subject
to all payments made and actions taken by us before our receipt of Notice of due
proof of death. Any death benefit will be paid in accordance with applicable law
or regulations governing death benefit payments.
ANNUITY PROVISIONS
ELECTION OF ANNUITY OPTION
The Annuity Option is chosen by you or your Beneficiary in a form satisfactory
to us. We will automatically send you information about Annuity Options before
your Annuity Date. If you do not choose an Annuity Option, make a full
withdrawal by the Annuity Date, or ask us to continue the Contract by the
Annuity Date, we will automatically pay you under Option 2: Life Annuity with
Ten (10) Years of Income Payments Guaranteed. You can make, change, or revoke
your Annuity Option choice before the death benefit becomes payable or the
Annuity Date, whichever occurs first.
L-22494 (09/12) 12
ANNUITY OPTIONS
You may choose to receive Income Payments monthly, quarterly, semi-annually or
annually. The following Annuity Options, or any other options acceptable to you
and us, may be chosen:
OPTION 1: LIFE ANNUITY
Income Payments that are paid as long as the Annuitant is living.
OPTION 2: LIFE ANNUITY WITH 10 YEARS OF INCOME PAYMENTS GUARANTEED
Income Payments that continue as long as the Annuitant is living but are
guaranteed to be paid for ten years.
OPTION 3: JOINT AND LAST SURVIVOR LIFE ANNUITY
Income Payments that are paid as long as either of two Annuitants is living.
OPTION 4: JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEARS OF INCOME PAYMENTS
GUARANTEED
Income Payments that continue as long as either of the two Annuitants are living
but are guaranteed to be paid for ten years.
If, as of the Annuity Date, the then current Annuity rates applicable to this
class of contracts provide an Income Payment greater than the one guaranteed
under this Contract for the same Annuity Option, then the greater payment will
be made.
INCOME PAYMENTS
Income Payments are based upon the Annuity Option chosen, the Account Value, as
defined under the Account Value Provisions above, applied to the Annuity Option,
the Annuitant's Attained Age and sex, and the appropriate Fixed Annuity Table.
These payments will be reduced by any applicable charges and fees as described
in the Contract Schedule.
FREQUENCY AND AMOUNT OF INCOME PAYMENTS
Income Payments will be paid as monthly installments or at any frequency
acceptable to you and us. If the amount of the Account Value to be applied under
an Annuity Option is less than $5,000, we reserve the right to make one lump sum
payment equal to the then current Account Value in lieu of Income Payments. If
the amount of the Income Payment would be less than $100, we may reduce the
frequency of payments to an interval which will result in the payment being at
least $100, but with a frequency of no less than annually.
BASIS OF PAYMENTS
The Annuity Tables are based on the tables defined under the Annuity Option
Information described in the Contract Schedule. The amount of each Income
Payment is guaranteed by us.
L-22494 (09/12) 13
[FIXED ANNUITY TABLES
AMOUNT OF MONTHLY INCOME PAYMENT
PER $1000 OF ACCOUNT VALUE
Annuitant Only
OPTION 1: LIFE ANNUITY
ATTAINED AGE
OF ANNUITANT MALE FEMALE
---------------------- ---- ------
55 2.74 2.59
60 3.07 2.89
65 3.50 3.27
70 4.07 3.77
75 4.84 4.45
80 5.93 5.42
85 7.50 6.86
OPTION 2: LIFE ANNUITY WITH 10 YEARS OF INCOME PAYMENTS GUARANTEED
Attained Age
of Annuitant MALE FEMALE
----------------------------------- ---- ------
55 2.73 2.59
60 3.05 2.88
65 3.46 3.24
70 3.99 3.72
75 4.66 4.34
80 5.50 5.16
85 6.45 6.16
OPTION 3: JOINT AND LAST SURVIVOR LIFE ANNUITY
Age of Female Annuitant
-------------------------
ATTAINED AGE 10 YEARS 5 YEARS SAME 5 YEARS 10 YEARS
OF MALE ANNUITANT YOUNGER YOUNGER AGE OLDER OLDER
---------------------------------------------------------------------------------------
55 2.09 2.21 2.34 2.45 2.54
60 2.26 2.42 2.57 2.71 2.82
65 2.48 2.67 2.86 3.04 3.19
70 2.75 3.00 3.25 3.49 3.69
75 3.10 3.42 3.77 4.09 4.37
80 3.55 4.00 4.48 4.95 5.33
85 4.18 4.82 5.51 6.17 6.69
OPTION 4: JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEARS OF INCOME PAYMENTS
GUARANTEED
Age of Female Annuitant
-------------------------
ATTAINED AGE 10 YEARS 5 YEARS SAME 5 YEARS 10 YEARS
OF MALE ANNUITANT YOUNGER YOUNGER AGE OLDER OLDER
--------------------------------------------------------------------------------------
55 2.09 2.21 2.34 2.45 2.54
60 2.26 2.42 2.57 2.71 2.82
65 2.48 2.67 2.86 3.04 3.19
70 2.75 2.99 3.25 3.48 3.68
75 3.09 3.42 3.76 4.08 4.34
80 3.55 3.99 4.45 4.88 5.19
85 4.15 4.76 5.38 5.89 6.22
Monthly installments for ages not shown will be furnished on request]
L-22494 (09/12) 14
THIS PAGE INTENTIONALLY LEFT BLANK
L-22494 (09/12)
SINGLE PREMIUM DEFERRED ANNUITY CONTRACT
NONPARTICIPATING
NO DIVIDENDS
METLIFE INSURANCE COMPANY OF CONNECTICUT
(A Stock Company)
[1300 Hall Boulevard
Bloomfield, Connecticut, 06002]
L-22494 (09/12)
CONTRACT SCHEDULE
OWNER: [John Doe] SEX: [M] AGE AT ISSUE: [35]
JOINT OWNER: [Jane Doe] SEX: [F] AGE AT ISSUE: [35]
ANNUITANT: [John Doe] SEX: [M] AGE AT ISSUE: [35]
CONTRACT NUMBER: [12345678] ISSUE DATE: [February 15, 2013]
PLAN TYPE: [Non-Qualified] ANNUITY DATE: [February 15, 2068]
SINGLE PURCHASE PAYMENT: [$50,000]
SHIELD OPTIONS
SEPARATE ACCOUNT: [MICC Separate Account SA]
SHIELD OPTIONS AND INDICES BY TERM AVAILABLE AT ISSUE:
EACH SHIELD OPTION WILL HAVE AN ASSOCIATED CAP RATE OR A STEP RATE.
[SHIELD OPTIONS
TERM INDEX MINIMUM GUARANTEED CAP/STEP RATE
[SHIELD 100]
[1] Year Term [INDEX A/1/] [1%]
[INDEX A Step Rate] [1%]
[SHIELD 25]
[6] Year Term [INDEX A] [6%]
[SHIELD 15]
[3] Year Term [INDEX A] [3%]
[6] Year Term [INDEX A] [6%]
[SHIELD 10]
[1] Year Term [INDEX A] [1%]
[INDEX A Step Rate] [1%]
[INDEX B/2/] [1%]
[INDEX C/3/] [1%]
[INDEX D/4/] [1%]
[INDEX E/5/] [1%]
[3] Year Term [INDEX A] [3%]
[INDEX A Step Rate] [3%]
[INDEX B] [3%]
[INDEX C] [3%]
[INDEX D] [3%]
[INDEX E] [3%]
[6] Year Term [INDEX A] [6%]]
[RETURN OF PREMIUM DEATH BENEFIT MAXIMUM CAP OR STEP RATE REDUCTION: [60%]]
[FOR THE SHIELD 100 OPTION, THE SHIELD RATE WILL BE TREATED AS FULLY ACCRUED
DURING THE ENTIRE TERM. A SHIELD 100 OPTION WILL BE AVAILABLE FOR AT LEAST THE
FIRST [6] CONTRACT YEARS, SUBJECT TO THE TRANSFER REQUIREMENTS BELOW.]
Index-linked returns do not include the portion of returns generated by
dividends; and the elements used in determining the credited rate from the index
are not guaranteed and can be changed by the Company, subject to any contract
guarantees, and any such changes can affect the return.
L-22495 (09/12)
[FIXED ACCOUNT
MINIMUM GUARANTEED INTEREST RATE: [1.00% annually]
INTEREST RATE TERM: [1 year]]
MINIMUM ALLOCATION: [$500]
[ANNUAL CONTRACT FEE: [The Annual Contract Fee is [$25.00] each Contract
Year. If a total withdrawal is made during the
Accumulation Period, the full Annual Contract Fee will
be deducted at the time of the total withdrawal. For
purposes of determining the Account Value to be applied
to an Annuity Option, a pro-rata portion of the Annual
Contract Fee for the applicable portion of the Contract
Year will be deducted from the Account Value as
described above. During the Income Period, we reserve
the right to deduct the Annual Contract Fee of [$25.00]
each Contract Year, pro-rata from each Income
Payment.]]
TRANSFER REQUIREMENTS:
TRANSFER PERIOD:
[The [5 Calendar Days] following the Contract Anniversary coinciding with the
end of the Term for each applicable Shield Option and/or the end of the Interest
Rate Term for the Fixed Account.]
TRANSFERS:
[During the Accumulation Period you may only make a transfer to the Fixed
Account and to a new Shield Option(s) during the Transfer Period, subject to
availability. The effective date of such transfer is the first day of the Fixed
Account Interest Rate Term and/or Shield Option(s) to which the transfer is
made.
At the end of the Term, the Investment Amount will automatically be renewed into
the same Shield Option unless you elect to transfer into a different Shield
Option or the Fixed Account Option at that time. If the Shield Option is no
longer available at the end of the existing Term, these amounts will
automatically transfer into the Fixed Account at the end of the Term unless
otherwise directed by You. If the Fixed Account is not available, these amounts
will automatically transfer into the Shield Option with, in order of priority,
the shortest Term, the highest Shield Rate, and the lowest Cap Rate from the
Shield Options available at the end of the Term unless otherwise directed by
You.
At the end of the Interest Rate Term, the Fixed Account Value will automatically
be renewed into the Fixed Account unless you elect to transfer into a Shield
Option at that time. If the Fixed Account is no longer available at the end of
the existing Fixed Account Term, these amounts will automatically transfer into
the Shield Option with, in order of priority, the shortest Term, the highest
Shield Rate, and the lowest Cap Rate from the Shield Options available at the
end of the Interest Rate Term unless otherwise directed by You.]
BENEFICIARY: As designated by you as of the Issue Date unless changed in
accordance with the Contract provisions.
WITHDRAWALS:
[FREE WITHDRAWAL AMOUNT: Each Contract Year after the first Contract Year, you
may withdraw a portion of your Account Value free from any Withdrawal Charge.
The Free Withdrawal Amount each Contract Year is equal to [10%] of the Account
Value as of the prior Contract Anniversary less the total amount withdrawn, as
described in the Withdrawal Provisions, from the Account Value in the current
Contract Year. The Free Withdrawal Amount is non-cumulative and is not carried
over to other Contract Years.
WITHDRAWAL CHARGE: The Withdrawal Charge is a percentage of the amount
withdrawn from the Account Value in a Contract Year in excess of the Free
Withdrawal Amount. The Withdrawal Charge is calculated at the time of each
withdrawal using the appropriate withdrawal charge percentage from the following
schedule:
L-22495 (09/12)
WITHDRAWAL CHARGE PERCENTAGES
[NUMBER OF COMPLETE
CONTRACT YEARS SINCE ISSUE % Charge
DATE
[0 9%
1 8%
2 8%
3 7%
4 6%
5 5%
6 or more 0%]
In addition to any waiver of Withdrawal Charges set forth in the Contract or
Rider(s), no Withdrawal Charge will be deducted from the Account Value in the
event of:
1. Maturity of the Contract; or
2. Payment of the Death Benefit; or
3. Application of your Account Value to an Annuity Option; or
4. If the withdrawal is required for you to avoid Federal Income Tax
penalties or to satisfy Federal Income Tax rules concerning minimum
distribution requirements that apply to this annuity (except for RMDs on a
decedent Roth IRA.) For purposes of this exception, we assume that this
annuity is the only contract or funding vehicle from which distributions
are required to be taken, and we will ignore all other Account Values; or
5. If you properly "re-characterize" as permitted under Federal Tax Law your
traditional IRA deferred annuity or Roth IRA deferred annuity issued by us;
or
6. If we agree in writing that none will apply. For example, we may waive the
Withdrawal Charge if you directly transfer the amount withdrawn to a
funding vehicle pre-approved by us.]
MINIMUM PARTIAL WITHDRAWAL: [$500.00]
MINIMUM ACCOUNT VALUE WHICH MUST REMAIN IN THE CONTRACT AFTER A PARTIAL
WITHDRAWAL: [$2,000.00]
ANNUITY OPTION INFORMATION:
1. [The Annuity Date must be the first day of a calendar month. Unless
otherwise directed by you, the Annuity Date is the first day of the
calendar month following the Annuitant's 90th birthday or 10 years from the
Issue Date, whichever is later, or a later date if we agree.]
2. The Annuity Date must not be less than [13] months from the Issue Date.
3. For Income Payments, the Fixed Annuity Tables are based on the Annuity
2000 Mortality Table with 15 years of mortality improvement based upon
projection Scale AA, a 7 year age setback and interest at [1.00%].
ANNUITY SERVICE OFFICE:
MetLife Insurance Company of Connecticut
[P.O. Box 10366
Des Moines, IA 50306-0366
(800) 777-5897]
L-22495 (09/12)
ENDORSEMENTS AND RIDERS ATTACHED TO THIS CONTRACT:
[Fixed Account Rider
Death Benefit Rider - Return of Premium
Waiver of Withdrawal Charge for Nursing Home Confinement Rider - TO BE ATTACHED
AT ISSUE IF LESS THAN AGE 81
Waiver of Withdrawal Charge for Terminal Illness Rider - TO BE ATTACHED AT ISSUE
IF LESS THAN AGE 81
Individual Retirement Annuity Qualification Rider
Roth Individual Retirement Annuity ("Roth IRA") Endorsement
Individual Non-Qualified Annuity Endorsement]
L-22495 (09/12)
------------------------------
/1/ [INDEX A Disclosure
/2/ INDEX B Disclosure
/3/ INDEX C Disclosure
/4/ INDEX D Disclosure
/5/ INDEX E Disclosure]
L-22495 (09/12)
METLIFE INSURANCE COMPANY OF CONNECTICUT
[1300 Hall Boulevard
Bloomfield, CT 06002]
FIXED ACCOUNT RIDER
This Rider is part of the Contract to which it is attached and is effective upon
issuance. In the case of a conflict with any provision of the Contract, the
provisions of this Rider will control. This Rider amends the Contract as
follows:
1. DEFINITIONS
The following replaces the definition of "Account Value" in the
"Definitions" section:
ACCOUNT VALUE
Is the total of the Fixed Account Value and the value of the Shield
Option(s) under this Contract, adjusted for any amounts that may be
included by rider during the Accumulation Period. Also referred to as
"Contract Value."
2. FIXED ACCOUNT - The following is added to the Contract:
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT
We credit interest to the portion of the Account Value allocated to
the Fixed Account. The Fixed Account is part of our General Account.
We guarantee that the interest credited to your initial allocation to
the Fixed Account during the Interest Rate Term beginning on the Issue
Date will not be less than the Minimum Guaranteed Interest Rate shown
on the Contract Schedule. Thereafter, we will declare an interest rate
as of each Contract Anniversary for the duration of the Interest Rate
Term and such rate will not be less than the Minimum Guaranteed
Interest Rate. If the declared interest rate equals the Minimum
Guaranteed Interest Rate, we reserve the right to restrict transfers
and allocations into the Fixed Account.
The initial Fixed Account Value is the amount initially allocated to
the Fixed Account. Thereafter, the Fixed Account Value equals: (a) the
initial Fixed Account Value or the Fixed Account Value on the most
recent Contract Anniversary, whichever is applicable, including any
transfers; plus (b) any interest credited by us; less (c) the amount
of any withdrawals including any Withdrawal Charges; less (d) any
Premium or Other Taxes, if applicable; and less (e) any other fees
shown on the Contract Schedule or associated with riders and
endorsements, if applicable.
INTEREST CREDITING METHOD
Interest will be compounded and credited to the Fixed Account at an
annual effective interest rate declared by Us. Interest will be
credited on amounts allocated to the Fixed Account through the
effective date such amounts are withdrawn or transferred from the
Fixed Account.
INTEREST RATE TERM
The Interest Rate Term is the length of time over which the current
interest rate is guaranteed. At the end of the Interest Rate Term, the
Fixed Account Value will automatically be renewed into the same
Interest Rate Term unless otherwise directed by You. No Interest Rate
Term will extend beyond the Annuity Date.
3. PURCHASE PAYMENT PROVISIONS - Replace the first paragraph of the section
entitled "Shield Options" with the following:
SHIELD OPTIONS
On the Issue Date, you may allocate your Purchase Payment to one or more of
the available Shield Options listed on the Contract Schedule and the Fixed
Account. At the end of each Term or Interest Rate Term, you may transfer
the Account Value attributable to the Shield Option(s) or the Fixed Account
to one or more of the available Shield Options or the Fixed Account (if
available) subject to the Transfer Requirements shown on the Contract
Schedule and the Renewal Provisions.
4. WITHDRAWAL PROVISIONS - The following will replace the section entitled
"Withdrawals" under "Withdrawal Provisions" with the following:
Prior to the Annuity Date, you may, upon Notice to us, request a full or a
partial withdrawal and we will withdraw that amount from the Account Value
("the amount withdrawn"). A withdrawal will result in a reduction to each
Shield Option and the Fixed Account in the ratio that each Shield Option
and the Fixed Account bears to the total Account
L-22496 (09/12)
Value, as determined under the Account Value Provisions above, unless
otherwise directed by you. The amount payable to you will be a net amount
equal to the amount withdrawn adjusted for any applicable Withdrawal Charge
and any other fees shown on the Contract Schedule, Premium and Other Taxes,
and any other rider and endorsement fees.
The total amount withdrawn from the Account Value must not be less than the
Minimum Partial Withdrawal amount shown on the Contract Schedule. If the
withdrawal would result in the remaining Account Value being less than the
Minimum Account Value shown on the Contract Schedule, we will treat the
withdrawal request as a request for a full withdrawal.
If you request a full or partial withdrawal, the amount withdrawn after
adjustments for any Withdrawal Charge will result in our paying you a net
amount. The net amount payable to you is equal to (a)-(b)-(c)-(d), where:
(a) is the amount withdrawn from the Account Value, and
(b) is the Withdrawal Charge and other fees, if any, as described on the
Contract Schedule, and
(c) is the Premium and Other Taxes, if any, and
(d) is the rider and endorsement fees, if any.
The amount withdrawn will reduce the Investment Amount, as defined in the
Definitions section, for each Shield Option by the percentage reduction in
the Interim Value of such Shield Option and the Fixed Account Value as
applicable.
5. DEATH BENEFIT PROVISIONS - The following will replace the first paragraph
of the section entitled "Non-Spousal Beneficiary Continuation During
Accumulation Period" under "Death Benefit Provisions" with the following:
A Beneficiary who is not a spouse can choose to continue the Contract until
the fifth anniversary of the Owner's death. The Contract can be continued
by a Beneficiary only if his or her share of the death benefit is at least
equal to our published minimum for this right. If the Beneficiary continues
the Contract under this provision his or her share will not be paid. It
will instead be continued in the Contract on the date we determine the
Death Benefit Amount. Such Beneficiary will have the right to make partial
and full withdrawals of his/her share of the Contract, not subject to
Withdrawal Charges. Such Beneficiary will also have the right to make
transfers at the end of a Term or Interest Rate Term as described on the
Contract Schedule.
MetLife Insurance Company of Connecticut has caused this Rider to be signed by
its [Secretary].
[
/s/ Isaac Torres
-------------------------
]
[SECRETARY]
L-22496 (09/12)
METLIFE INSURANCE COMPANY OF CONNECTICUT
[1300 Hall Boulevard
Bloomfield, CT 06002]
DEATH BENEFIT RIDER - RETURN OF PREMIUM
This Rider forms a part of the Contract to which it is attached and is effective
upon the Issue Date. In case of a conflict with any provision in the Contract,
the provisions of this Rider will control. Your election of this Rider is
irrevocable. The following amends the "Death Benefit Provisions" of the Contract
as follows:
DEATH BENEFIT PROVISIONS
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD
This provision is amended to provide that the Death Benefit Amount will be
the greater of:
(1) the Account Value; or
(2) Purchase Payment, reduced proportionately by the percentage reduction
in Account Value of the Shield Option(s) and the Fixed Account for
each partial withdrawal.
If a non-natural person owns the Contract, then the Annuitant shall be
deemed to be the Owner for purposes of determining the Death Benefit
Amount. If Joint Owners are named, the age of the oldest Joint Owner will
be used to determine the Death Benefit Amount.
If the Owner is a natural person and the Owner is changed to someone other
than a spouse, the Death Benefit Amount shall be determined as defined
above; however, subsection (2) shall be restated to provide as follows:
"the Account Value as of the effective date of the change of Owner, reduced
proportionately by the percentage reduction in Account Value of the Shield
Option(s) and the Fixed Account for each partial withdrawal made after such
date".
In the event that the Contract is continued under the "Spousal Continuation
During Accumulation Period", the Death Benefit Amount shall be determined
in accordance with (1) or (2) above.
The Death Benefit Amount is determined as of the end of the Business Day on
which we have received both due proof of death and an election for the
payment method.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD
This provision of the Contract is amended to add that if the Contract is
continued under the "Spousal Continuation During Accumulation Period", the
Account Value will be adjusted to an amount equal to the Death Benefit
Amount determined upon such election and receipt of due proof of death of
the Owner. Any excess of the Death Benefit Amount over the Account Value
will be allocated to the Fixed Account, if available. If the Fixed Account
is not available, any excess of the Death Benefit Amount over the Account
Value will be allocated into the Shield Option with, in order of priority,
the shortest Term, the highest Shield Rate, and the lowest Cap Rate from
the Shield Options available at the end of the Term.
DEATH BENEFIT RIDER COST
The cost for this Rider will generally be reflected in lower Cap and Step
Rates for each Shield Option than if this Rider were not elected. The
reduction in the Cap and Step Rates will not exceed the Return of Premium
Death Benefit Maximum Cap or Step Rate Reduction, as shown on the Contract
Schedule, of the Cap and Step Rates that would have applied if this Death
Benefit Rider was not selected. The Cap and Step Rate will never be less
than the Minimum Guaranteed Cap/Step Rates shown on the Contract Schedule.
MetLife Insurance Company of Connecticut has caused this Rider to be signed by
its [Secretary].
METLIFE INSURANCE COMPANY OF CONNECTICUT
[
/s/ Isaac Torres
------------------------------------
]
[SECRETARY]
L-22497 (09/12)
METLIFE INSURANCE COMPANY OF CONNECTICUT
[1300 Hall Boulevard
Bloomfield, CT 06002]
WAIVER OF WITHDRAWAL CHARGE FOR NURSING HOME OR HOSPITAL CONFINEMENT RIDER
This Rider forms a part of the Contract to which it is attached and is effective
as of the Issue Date. In the case of a conflict with any provision in the
Contract, the provisions of this Rider will control. This Rider is irrevocable
and its provisions will remain part of the Contract until the earlier of the
Annuity Date or the date the Contract terminates. This Rider amends the Contract
as follows:
The following provisions are added to the Contract:
WAIVER OF WITHDRAWAL CHARGE FOR NURSING HOME OR HOSPITAL CONFINEMENT
After the first Contract Anniversary, the Withdrawal Charge attributable to such
withdrawal will be waived upon a withdrawal if:
1. you are confined to a Nursing Home and/or Hospital for at least 90
consecutive days or confined for a total of at least 90 days if there is no
more than a 6-month break in the confinement and the confinements are for
related causes;
2. the first confinement referred to in (1) above begins on or after the
first Contract Anniversary;
3. the withdrawal request and proof satisfactory to us of confinement are
received by us at our Annuity Service Office either while you are confined
or within 90 days after such confinement;
4. confinement in a Nursing Home and/or Hospital is prescribed by a Physician
and is Medically Necessary; and
5. you have been the Owner continuously since the Issue Date, or you are a
Spousal Beneficiary who continues the Contract under the Spousal
Continuation During Accumulation Period Option.
In the case of Joint Owners, this Rider applies to either Joint Owner. If the
Owner is not a natural person, this Rider applies to the Annuitant provided the
Annuitant has continuously been the Annuitant since the Issue Date.
DEFINITIONS
HOSPITAL - A facility which:
1. is located in the United States or its territories;
2. is licensed as a hospital by the jurisdiction in which it is located;
3. is supervised by a staff of licensed physicians;
4. provides nursing services 24 hours a day by, or under the supervision of,
a registered nurse (R.N.);
5. operates primarily for the care and treatment of sick and injured persons
as inpatients for a charge; and
6. has access to medical and diagnostic facilities.
INTERMEDIATE CARE FACILITY - A facility which:
1. is located in the United States;
2. is licensed and operated as an Intermediate Care Facility according to the
laws of the jurisdiction in which it is located;
3. provides continuous 24 hours a day nursing service by, or under the
supervision of, a registered graduate professional nurse (R.N.) or a
licensed practical nurse (L.P.N.); and
4. maintains a daily medical record of each patient.
MEDICALLY NECESSARY - Appropriate and consistent with the diagnosis in accord
with accepted standards of practice and which could not have been omitted
without affecting the individual's condition.
L-25005 (09/12)
NURSING HOME - A facility which is a Skilled Nursing Facility, an Intermediate
Care Facility or Residential Care Facility. Nursing Home does not mean:
1. a home for the aged, a community living center or place that primarily
provides domiciliary, residency or retirement care; or
2. a place owned or operated by a member of the Owner's immediate family.
Immediate family members include the Owner's spouse, children, parents,
grandparents, grandchildren, siblings and in-laws.
PHYSICIAN - Any person duly licensed and legally qualified to diagnose and treat
sickness and injuries. A physician must be providing services within the scope
of his or her license. A Physician may not be a member of the Owner's immediate
family.
RESIDENTIAL CARE FACILITY - A facility which:
1. is located in the United States or its territories;
2. is licensed and operated as a Residential Care Facility according to the
laws of the jurisdiction in which it is located; and
3. provides nursing care under the supervision of a registered professional
nurse (R.N.).
SKILLED NURSING FACILITY - A facility which:
1. is located in the United States or its territories;
2. is licensed and operated as a Skilled Nursing Facility according to the
laws of the jurisdiction in which it is located;
3. provides skilled nursing care under the supervision of a licensed
physician;
4. provides continuous 24 hours a day nursing services by, or under the
supervision of, a registered graduate professional nurse (R.N.); and
5. maintains a daily medical record of each patient.
MetLife Insurance Company of Connecticut has caused this Rider to be signed by
its [Secretary].
[
/s/ Isaac Torres
-----------------------
]
[SECRETARY]
L-25005 (09/12)
METLIFE INSURANCE COMPANY OF CONNECTICUT
[1300 Hall Boulevard
Bloomfield, CT 06002]
WAIVER OF WITHDRAWAL CHARGE FOR TERMINAL ILLNESS RIDER
This Rider forms a part of the Contract to which it is attached and is effective
as of the Issue Date. In the case of a conflict with any provision in the
Contract, the provisions of this Rider will control.
After the first Contract Anniversary, the Withdrawal Charge will be waived upon
a withdrawal if:
1. you are terminally ill and not expected to live more than 12 months;
2. a Qualified Physician certifies to your illness and life expectancy;
3. you were not diagnosed with the terminal illness as of the Issue Date; and
4. you have been the Owner continuously since the Issue Date or have become
the Owner as spousal Beneficiary who continues the Contract.
In the case of Joint Owners, this Rider applies to either Joint Owner. If the
Owner is not a natural person, this Rider applies to the Annuitant.
Qualified Physician is any person duly licensed and legally qualified to
diagnose and treat sickness and injuries. A physician must be providing services
within the scope of his or her license. A Physician may not be a member of the
Owner's immediate family. Immediate family members include the Owner's spouse,
children, parents, grandparents, grandchildren, siblings and in-laws.
This Rider will terminate on the Annuity Date.
MetLife Insurance Company of Connecticut has caused this Rider to be signed by
its [Secretary].
[
/s/ Isaac Torres
----------------------------
]
[SECRETARY]
L-22498 (09/12)