EXHIBIT 5(i)
Flexible Premium Group Variable Universal Life Insurance Policy
a contract between
Aetna Life Insurance and Annuity Company
(herein called Aetna)
and
New York State United Teachers
(Policyholder)
Policy Number: [ ] Signed at Aetna's Home Office in
Hartford, Connecticut
Date of issue: [ ] on the date of issue.
To take effect: [ ]
Policy delivered in: New York
This policy will be construed in [
line with the law of the State of delivery. President]
Based on timely premium payments
Aetna agrees with the New York State United
Teachers, to pay benefits in accordance with [
the policy terms. Secretary]
The duties and the rights of the
policyholder will be based solely on
the terms of this policy. This [
policy is non-participating. Registrar]
RIGHT OF EXAMINATION
This policy may be returned to Aetna or its representative within 10 days
after its receipt. Return this policy to Aetna at 000 Xxxxxxxxxx Xxxxxx,
Xxxxxxxx, Xxxxxxxxxxx 00000. Upon its return, all insurance under this
Certificate will then be deemed void from its beginning.
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INDEX
PART I
CONTRACT --
CERTIFICATES
PART II
ELIGIBILITY/ELIGIBLE PERSONS
PART III
CANCELLATION OF POLICY
PART IV
PREMIUM PROVISIONS --
GRACE PERIOD PROVISIONS
PART V
POLICYHOLDER AND INSURANCE
COMPANY MATTERS
PART VI
MISCELLANEOUS PROVISIONS
COPY OF APPLICATION
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PART I
CONTRACT --
CERTIFICATES
CONTRACT
This policy, any attached endorsements, the Policyholder's application and the
Certificate constitute the entire contract. A copy of the Policyholder's
application is attached. All statements made by the New York State United
Teachers or an Insured shall be deemed representations and not warranties.
Aetna will not use such statements to void this contract or defend against a
claim unless it is contained in the initial application or subsequent
applications.
CERTIFICATES
Aetna will prepare a Certificate setting forth a description of coverage for
each Insured under this policy. All such Certificates are hereby incorporated
into and made a part of this policy. Certificates will be issued for delivery
to each Owner.
Each Certificate incorporated into and made a part of this policy will be
identified by:
The form number 70263-96;
The name of the Insured.
If Aetna receives a request from the New York State United Teachers to change
any of the provisions of a Certificate, such change(s) that are agreed to by
Aetna will be made on future Certificates and in accordance with written
instructions from the New York State United Teachers, until a new Certificate
reflecting such change(s) is issued and incorporated into and made a part of
this policy.
PART II
ELIGIBILITY/ELIGIBLE PERSONS
ELIGIBILITY
The New York State United Teachers and the eligible class or classes of
Members will be those which are: (a) designated to Aetna in writing; (b)
accepted by Aetna; and (c) placed on file with Aetna. With Aetna's consent,
any class or classes of eligible Members may be changed without formal
amendment of this policy by written notice from the New York State United
Teachers to Aetna.
Aetna will keep, in a file set up for the New York State United Teachers, a
copy of the rates that apply to its eligible class or classes of Members.
The New York State United Teachers may act on all policy matters. Each such
act, or agreement made between Aetna and the New York State United Teachers,
or notice given by one to the other will be binding.
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ELIGIBLE PERSONS
All Members of the New York State United Teachers and their Domestic Partners
and Dependents are eligible to apply for coverage under this policy. An
eligible person may become insured under only one eligible class at a time,
even if he/she is a member of more than one class. An eligible person may only
become covered for that insurance which he/she elects and for which he/she
pays the required premium and provide evidence of insurability satisfactory to
Aetna.
A Member is eligible on the latest of:
o the Issue Date of the policy; or
o the date he/she enters an eligible class of Members.
The Domestic Partner of an eligible Member is eligible on the later of:
o the date the Member becomes insured under the Certificate; or
o the date he/she becomes the Domestic Partner of an eligible Member;
but only if the Domestic Partner is less than 80 years of age on that date.
The Dependent of an eligible Member is eligible on the later of:
o the date the Member becomes eligible to be insured; and
o the date he/she becomes the Dependent of an eligible Member;
but only if the Dependent is at least 14 days but less than 25 years old,
provided that the Dependent depends mainly on the Member for support because
he/she goes to school on a regular, full time basis or is incapable of
self-sustaining employment due to physical or mental disability.
PART III
CANCELLATION OF POLICY
The New York State United Teachers may cancel this policy with respect to all
or any class or classes of Members by giving Aetna written notice 31 days
before the cancellation date. Coverage under the Certificate will terminate
or, at the option of the Certificate Owner, may be converted.
The New York State United Teachers will provide each of its Members and their
Domestic Partners and/or Dependents with advance notice of policy cancellation
or discontinuance. Such notice must be mailed or delivered to such Member at
least 15 days before the date plan cancellation or discontinuance is to take
effect.
Subject to any applicable laws or regulations, Aetna has the right to cancel
this policy as to all or any class of Members at any time after the end of the
Grace Period if the policy premium has not been paid. Written notice of the
termination date must be given by Aetna.
Aetna reserves the right to discontinue accepting new enrollments under this
policy or as to any or all coverage of all or any class or classes of Members
by giving the New York State United Teachers advance written notice of when it
will be canceled. This date will not be earlier than 31 days after Aetna has
given written notice, unless it is agreed to by the New York State United
Teachers and Aetna.
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PART IV
PREMIUM PROVISIONS--
GRACE PERIOD PROVISIONS
PAYMENT OF PREMIUMS BY INSUREDS
The amount and frequency of each Certificate Owner's premium is shown on
his/her Certificate Specifications. The amount may be adjusted by Aetna from
time to time, as described therein.
GRACE PERIOD FOR CERTIFICATE
The 61-day Grace Period granted to a Certificate Owner for payment of his/her
premium is described in his or her Certificate.
PAYMENT OF PREMIUM BY NEW YORK STATE UNITED TEACHERS
The total policy premium payable by the New York State United Teachers will be
the sum of all premiums remitted for persons insured under this policy,
excluding premiums that are not payable by payroll deduction. The initial
policy premium will be due on the Issue Date of this policy. After that,
policy premiums will be due on each premium due date, which is the first day
of such calendar month, unless the New York State United Teachers and Aetna
agree on some other method of premium payment. The New York State United
Teachers and Aetna may agree to change the method of premium payment from time
to time. The policy premiums are payable at Aetna's Home Office or to an
authorized agent.
If any policy premium is not paid when due, this policy will be canceled as of
the premium due date; except as provided in the section called Policy Grace
Period.
POLICY GRACE PERIOD
A policy Grace Period of 61 days from the premium due date will be granted to
the New York State United Teachers for the payment of premiums required under
this policy. The policy will be in force during such Grace Period. If such
premium is not paid in such Grace Period, this policy will cancel at the end
of that Grace Period. This policy will cancel before that date if the New York
State United Teachers gives written notice of cancellation in advance to
Aetna. If this policy cancels, the New York State United Teachers will be
jointly and severally liable to Aetna for all unpaid premiums for insurance
which was in force.
PART V
POLICYHOLDER AND INSURANCE COMPANY MATTERS
DECLARATIONS
The first "policy month" starts on [ ]. Each subsequent policy month
starts on the [ ] of a calendar month. The first "policy year" starts
on [ ] and ends on [ ]. Each subsequent policy year starts on a
[ ] and ends on a [ ].
DATA REQUIRED
The New York State United Teachers must give Aetna all data required as to
policy matters. All data which may have a bearing on insurance or premiums
will be open for Aetna to inspect while this policy is in force. Also, such
data must be open until the final rights and duties under this policy have
been resolved.
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CLERICAL ERROR
Any clerical error by anyone in keeping records, or a delay in making an
entry, will not be the sole determination of the coverage's validity. A fair
change in premiums will be made when the error or delay is found.
MISSTATEMENTS
If the Insured's age is misstated, the amount of the Death Benefit will be
adjusted to reflect the coverage that would have been purchased by the most
recent Monthly Deduction at the correct age.
INCONTESTABILITY
The validity of this policy shall not be contested, except for non-payment of
premiums, after it has been in force for 2 years. All statements made by or
for the Insured are representations and not warranties. Aetna will not use any
such statement to void the insurance or defend against a claim unless the
statement is attached to and made a part of the policy or Certificate.
NON-DISCRIMINATION
In the management of this policy, the New York State United Teachers will act
so as not to discriminate unfairly between person in like situations at the
time of the action. Aetna can rely on such action.
POLICY CHANGES
This policy may be changed at any time by written agreement between Aetna and
the New York State United Teachers. The consent of any Certificate Owner is
not needed. All agreements made by Aetna are signed by one of its executive
officers. No other person can change or waive any of the policy terms or make
any agreement binding Aetna. The New York State United Teachers will not have
to give written approval of a change in the policy if:
The New York State United Teachers asked for the change and Aetna has
agreed to it.
The change is needed so that the policy will conform to any law,
regulation or ruling of:
A jurisdiction that affects a person covered under this policy; or
The federal government.
DEATH BENEFIT
If the Insured dies while the Certificate is in force, the Aetna will pay a
death benefit based upon the Death Benefit Option in effect on the date of
death, less the Loan Account Value plus any accrued interest less any
outstanding payment required keep the Certificate in force through the date of
death.
The individual(s) or entity(ies) that will receive any Proceeds on the death
of the Insured is the Beneficiary named by the Certificate Owner. If no
Beneficiary has been named, or if no named Beneficiary is living at the time
of the Insured's death, all Proceeds will be paid to the Certificate Owner or
the Certificate Owner's executors, administrators or assigns.
CONVERSION
If a Certificate terminates because (a) an Insured ceases to be a member of
the New York State United Teachers, or (b) the insured is no longer eligible
for coverage under the Certificate as a Domestic Partner or a Dependent and
declines membership in the New York State United Teachers, or (c) the New York
State United Teachers discontinues the group policy, the amount of insurance
which ceases may be converted to any permanent plan of life insurance that the
Aetna makes available for such purpose and according to the Certificate terms.
Aetna will send notice of this right to convert within the statutory
timeframes. No evidence of insurability will be required.
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NONFORFEITURE PROVISIONS
By Written Request the Certificate Owner may, at any time while the policy is
in force and according to the terms of the Certificate, elect to (a) surrender
or partially surrender his/her Certificate in exchange for payment of its full
Surrender Value, (b) continue the coverage in effect as paid up or (c) borrow
up to 90% of the sum of the Certificate's Separate Account Value and Fixed
Account Value. Aetna reserves the right to defer payments as provided under
the Certificate's Right to Defer Payment provision.
THE SEPARATE ACCOUNT
The Separate Account established for the purpose of providing Variable Options
to fund this insurance is Variable Life Account B. Variable Life Account B was
established pursuant to a June 18, 1986, resolution of the Board of Directors
of the Aetna. The Separate Account is registered with the SEC as a unit
investment trust under the Investment Company Act of 1940 and meets the
definition of separate account under the federal securities laws. Such
registration does not involve any approval or disapproval by the Commission of
the Separate Account or the Aetna's management or investment practices or
policies. Aetna does not guarantee the Separate Account's investment
performance.
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