MODIFIED COINSURANCE REINSURANCE AGREEMENT (“the Agreement”) Effective MM/DD/YYYY Between NATIONWIDE FINANCIAL (hereinafter referred to as “the Company”) One Nationwide Plaza Columbus, OH And
MODIFIED
COINSURANCE REINSURANCE AGREEMENT
(“the
Agreement”)
Effective
MM/DD/YYYY
Between
NATIONWIDE
FINANCIAL
(hereinafter
referred to as “the Company”)
Xxx
Xxxxxxxxxx Xxxxx
Xxxxxxxx,
XX
And
1
Table
of Contents
{
Articles and page numbers to
be
finalized
…}
ARTICLES
6.
PAYMENTS
BY THE COMPANY……………………………………………………….8
8.
DEATH
CLAIMS
16.
INSPECTION OF RECORDS…………………………………………………….18
18.
OFFSET
20.
ARBITRATION
25.
DEFINITIONS
27.
EXECUTION
SCHEDULES
A.
POLICY
FORMS REINSURED AND REINSURANCE BASIS
D.
EXPENSE ALLOWANCES……………………………………………………… 35
E.
INVESTMENT INCOME CALCULATION…………………………………… 36
EXHIBITS
A.
UNDERWRITING
GUIDELINES
B.
GUARANTEED
ISSUE UNDERWRITING GUIDELINES
2
3
ARTICLE
1
PREAMBLE/SCOPE
1.01 |
The
Company agrees to cede and the Reinsurer agrees to accept reinsurance
of
Policies as set forth in Schedule A and in accordance with the terms
of
this Agreement. The term Policy/Policies and other terms used in
this
Agreement are defined in Article 25, “Definitions.” Occasionally, certain
terms may be defined in the body of the Agreement as necessary to
promote
readability. In all cases, defined terms will be capitalized throughout
this Agreement. This excludes article headings and
subsections.
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1.02 |
Policies
are reinsured in accordance with the terms contained herein. The
intent of
this Agreement is to pass all of the underlying risks assumed on
the
Policies, including the investment risk, to the Reinsurer without
necessitating the Company to transfer the assets or their cash equivalents
to the Reinsurer. In the event any additional benefits are reinsured,
a
specific addendum shall be attached hereto describing the terms of
reinsurance associated with such benefits.
|
1.03 |
The
parties anticipate and acknowledge that the Reinsurer will cede a
portion
of the Policies reinsured under this Agreement in excess of the
Reinsurer's Retention to one or more
retrocessionaires.
|
1.04 |
The
Company agrees to:
|
a. |
cede
a Policy to the Reinsurer as Automatic Reinsurance in accordance
with
Article 3, “Automatic Reinsurance;”
or
|
b. |
submit
a Policy to the Reinsurer or its facultative underwriting Designee
to
facilitate Facultative Reinsurance consideration in accordance with
Article 4, “Facultative Reinsurance;”
or
|
c. |
cede
a Policy as a Continuation to the Reinsurer, in accordance with Article
12, “Policy Changes, Continuations, Reductions and
Increases.”
|
1.05 |
The
Reinsurer may designate one or more Designees, as per Article 25,
“Definitions”, to perform certain of its obligations and functions under
this Agreement, including, without limitation, claims payments on
the
Reinsurer’s behalf, performing facultative underwriting reviews and
extending facultative offers, and performing claims and underwriting
reviews or audits. The Reinsurer agrees to notify the Company of
each of
its Designees. All Designee functions are more fully described in
the body
of this Agreement.
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ARTICLE
2
TERMS
OF REINSURANCE
2.01 |
Method
of Reinsurance.
The method of reinsurance shall be modified coinsurance and shall
be based
upon the Reinsured Amount of a
Policy.
|
4
2.02 |
Applicable
Policies.
Only those Policies issued by the Company and sold, fully or
partially, through a Member Firm at the time the policy application
is taken and after the effective date of this Agreement, are eligible
for
reinsurance hereunder.
|
2.03 |
License.
This Agreement applies only to the Policies issued and delivered
by the
Company in a jurisdiction in which the Company is properly
licensed.
|
2.04 |
Compliance.
The Company represents that it is, and shall use its best efforts
to
remain in compliance with all laws, regulations, judicial and
administrative orders applicable to the Policies, including, but
not
limited to, sanctions administered by the U.S. Treasury Department's
Office of Foreign Assets Control ("OFAC"), as such sanctions may
be
amended from time to time, and the maintenance of an effective anti-money
laundering policy (collectively “Laws”). Neither the Company nor
the Reinsurer
shall be required to take any action under this Agreement that would
result in it being in violation of said Laws, including making any
payments in violation of the Law. Should either party discover a
reinsurance payment has been made in violation of the Law, it shall
notify
the other party and the parties shall cooperate in order to take
all
necessary corrective actions, including the return of the payments
to the
other party, unless prohibited by
Law.
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2.05 |
Currency.
All amounts expressed in this Agreement and all payments made pursuant
to
the terms of this Agreement shall be in United States of America
dollars.
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ARTICLE
3
AUTOMATIC
REINSURANCE
The
Company agrees to cede and the Reinsurer agrees to assume the Reinsured Amount
of a Policy as Automatic Reinsurance provided all of the following conditions
are satisfied:
3.01 |
Company
Retention.
The Company shall retain, and shall not otherwise reinsure, except
aggregate, catastrophic and stop loss coverage, an amount of insurance
on
each life equal to its Quota Share Percentage Retained up to its
Maximum
Dollar Retention on the basis as set forth in Schedule B. Amounts
retained
by the Company on other individual life insurance policies in force
shall
be taken into account when determining the Company’s retention for
purposes of this Agreement.
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3.02 |
Underwriting
Guidelines.
The Company complies with its Underwriting Guidelines for fully
underwritten and guaranteed issue business, as specified in the attached
Exhibits A and B. Other policies issued pursuant to any modified
or
special underwriting programs, including, but not limited to, simplified
issues, table shaving, short form applications, internal and external
exchanges, or other non-customary non-medical underwriting shall
not
qualify for Automatic Reinsurance. In no event shall any exceptions
be
made to the above without prior written consent from the
Reinsurer.
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3.03 |
Automatic
Acceptance Limits.
The sum of the amount of individual life insurance issued by the
Company
on the life, and the amount of life insurance applied for from the
Company, on the current application shall not exceed the Automatic
Acceptance Limits as set forth in Schedule B. In determining issued
and
applied for amounts to be compared to the Automatic Acceptance Limits,
Ultimate Amounts shall be considered.
|
3.04 |
Automatic
In Force and Applied For Limits (aka Jumbo or Participation
Limits).
The sum of the amount of individual life insurance in
force
on
the life in all companies, including replacements and any known Ultimate
Amounts, and the amount of life insurance applied
for
from all companies, on the current application shall not exceed the
Automatic In Force and Applied For Limits (aka Jumbo or Participation
Limits) as set forth in Schedule B.
|
5
3.05 |
Occupation.
The proposed insured shall not be employed in an excluded occupation
as
shown in Schedule A.
|
3.06 |
Residency
and Travel.
The proposed insured meets the Company’s special underwriting requirements
pertaining to foreign residents at the time of issue, as shown in
Exhibit
F.
|
3.07 |
Compliance.
The Policy is issued and maintained in accordance with all Laws and
the
Company assures the Policy does not involve individuals appearing
on the
OFAC Specifically Designated Nationals or Blocked Persons list or
residing
in a prohibited country.
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3.08 Previous
Facultative Submissions.
The
application cannot be on a life that has been submitted facultatively by the
Company to the Reinsurer or any other reinsurer within the last five (5) years,
unless the reason for any prior facultative submission was solely for capacity
that may now be accommodated within the terms of this Agreement.
ARTICLE
4
FACULTATIVE
REINSURANCE
The
Company shall submit a Policy not satisfying the conditions set forth in Article
3, “Automatic Reinsurance” or Policies it does not wish to cede as Automatic
Reinsurance, for Facultative Reinsurance first to the Reinsurer for
consideration, before applying for Facultative Reinsurance from another
reinsurer, including any facultative underwriting Designee.
4.01 |
Application.
An
application form substantially similar to the “Facultative Reinsurance
Application Form” set forth as Exhibit C shall be used by the Company in
the manner specified in Schedule C.
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4.02 |
Underwriting
Papers.
Copies of the original insurance application, medical examiner’s reports,
attending physician statements, inspection reports, financial information
and all other papers and information obtained by the Company concerning
insurability of the risk shall accompany the Facultative Reinsurance
Application Form. If there are outstanding underwriting requirements
not
yet available, the Company shall notify the Reinsurer and its facultative
underwriting Designee of such requirements. In addition, the Company
agrees to provide any subsequent information received pertinent to
the
risk assessment to the Reinsurer and its facultative underwriting
Designee
as soon as possible following receipt of such information by the
Company.
At the Reinsurer's direction, the Company shall submit the Facultative
Reinsurance Application Form for reinsurance and all supporting and
related documents and information directly to the Reinsurer or the
facultative underwriting Designee.
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6
4.03 |
Reinsurer’s
or Designee’s Actions.
Following receipt of the Facultative Reinsurance Application Form,
as set
forth in Exhibit C, and the information as described above, the Reinsurer
or its facultative underwriting Designee agrees to promptly examine
the
underwriting information and notify the Company of any one of the
following:
|
a. an
offer
to reinsure the Policy;
b. an
offer
to reinsure the Policy other than as applied for;
c. an
offer
to reinsure the Policy subject to additional underwriting
requirements;
d.
|
a
need for additional underwriting information to further consider
making a
facultative reinsurance offer; or
|
e. a
declination to make any facultative reinsurance offer.
The
Reinsurer may elect not to participate in the facultative risk; however, this
shall not prohibit the Company from reinsuring the facultative risk for its
own
accord with the Designee under the terms of any other reinsurance agreement
with
such Designee, subject to the first paragraph of this Article 4.
4.04 |
Expiration
of Facultative Offer.
Any offer from the Reinsurer or its facultative underwriting Designee
to
reinsure the Policy expires one hundred twenty (120) days after the
offer
is made, unless the facultative offer specifies otherwise or the
Reinsurer
extends the offer period in writing. The Company may accept the
facultative reinsurance offer within the offer period and shall notify
the
Reinsurer of such acceptance by following the procedures outlined
in
Schedule C.
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4.05 |
Conflicts.
The terms and conditions of any facultative offer shall supersede
the
terms of the Agreement in case of conflicts between the two; otherwise
reinsurance of a Policy on a Facultative Reinsurance basis shall
comply
with the terms of this Agreement.
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ARTICLE
5
COMMENCEMENT
OF LIABILITY
5.01 Conditional
Receipt or Temporary Insurance Coverage.
a.
|
For
Automatic Reinsurance, if the conditions for Automatic Reinsurance
coverage under Article 3, “Automatic Reinsurance” of this Agreement are
satisfied, the Reinsurer’s liability under the Company’s conditional
receipt or temporary insurance agreement shall commence simultaneously
with the Company's liability.
|
b. |
For
Facultative Reinsurance, the Reinsurer shall only be liable for benefits
paid, pursuant to the terms and conditions of the Company's conditional
receipt or temporary insurance agreement, if the Reinsurer or its
facultative underwriting Designee has made a facultative offer and
the
offer is final and does not include any further underwriting action
to be
satisfied by the Company.
|
c. |
For
all Automatic and Facultative cases, the conditional receipt or temporary
insurance liability applies only once on any given life regardless
of how
many receipts were issued or initial premiums were accepted by the
Company. After a Policy has been issued, no reinsurance benefits
are
payable under this conditional receipt or temporary insurance
provision.
|
7
d.
|
In
the event that the Company’s rules with respect to cash handling and the
issuance of conditional receipt or temporary insurance are not followed,
the Reinsurer shall participate in the liability provided (a), (b),
and
(c) above are satisfied and the Company does not knowingly allow
such
rules to be violated or condone such a
practice.
|
e. |
For
all Automatic and Facultative cases, reinsurance coverage under a
conditional receipt or temporary insurance provision is limited to
the
Reinsurer’s share of the conditional receipt or temporary insurance limits
shown in Schedule B, as well as the Automatic Acceptance Limits.
All
provisions of Article 8, “Death Claims” apply to such a
claim.
|
5.02 |
Automatic
Reinsurance.
The Reinsurer’s liability for its share of a Policy ceded automatically,
as defined in this Agreement, shall commence simultaneously with
the
Company’s liability.
|
5.03 |
Facultative
Reinsurance.
The Reinsurer’s liability for a Policy ceded facultatively, as defined in
this Agreement, facultatively under this Agreement shall commence
when
both:
|
a.
|
the
Company accepts the Reinsurer’s or its facultative underwriting Designee’s
offer to reinsure by making a dated notation of its acceptance in
its
underwriting file; and
|
b. |
the
Policy has been issued.
|
5.04 Termination
of Liability.
The
Reinsurer’s liability for any Policy ceded automatically or facultatively under
this Agreement shall cease simultaneously with the Company’s contractual
liability, or the earliest of:
a. |
the
date the Company's liability on such Policy is terminated under the
terms
of its Policy with the policyholder; or
|
b. |
the
date this Agreement is terminated by the Company or the Reinsurer
as
specifically provided for and limited by this
Agreement.
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ARTICLE
6
PAYMENTS
BY THE COMPANY
6.01 |
Reinsurance
Premiums.
The Company agrees to pay Reinsurance Premiums to the Reinsurer for
each
and every accounting period, for the duration of this Agreement on
a
Policy. For purposes of this Agreement, the term Reinsurance Premiums
shall mean the premium collected by the Company, for such then accounting
period, from the policyholder times the Quota Share Percentage Reinsured
as set forth in Schedule B.
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6.02 |
Decrease
in Modified Coinsurance Reserve.
The Company shall pay the Reinsurer, for each and every accounting
period
for the duration of this Agreement, the amount by which the total
modified
coinsurance reserve, as defined in Article 10, “Reserves”, in the
aggregate on the Policies has declined since the beginning of such
then
current accounting period, if any, as defined in Schedule C. The
amount of
such decrease for such then current accounting period shall be determined
by subtracting the amount of the modified coinsurance reserve on
the
Policies as of the end of the current accounting period, from the
amount
of the modified coinsurance reserve on the Policies as of the end
of the
immediately preceding accounting period. Should such calculation
result in
a positive number, this shall be the amount of the decrease for the
current accounting period. Should such calculation result in a negative
number, the amount of decrease for the current accounting period
shall be
zero or none. The result is further multiplied by the Quota Share
Percentage Reinsured, as set forth in Schedule
B.
|
8
6.03 |
Consideration
for Net Investment Income.
The Reinsurer is obligated, in accordance with Article 7.03, “Increase in
Modified Coinsurance Reserve”, to return all or a portion of the initial
Reinsurance Premium to the Company as an initial modified coinsurance
adjustment. Under coinsurance, the Reinsurer would retain all such
monies
for its own account and enjoyed the investment income thereon to
help
defray the liabilities of the Policies. However, under modified
coinsurance, the Reinsurer has allowed the Company to retain such
assets
but it is not the intent of the parties that the Reinsurer should
be
denied the investment income on such monies. Therefore, the Company
agrees
to remit, for each and every accounting period for the duration of
this
Agreement, as part of the quarterly cash flow settlements to the
Reinsurer, the investment income on such assets as provided for in
Schedule E. Furthermore, the parties agree that retention of the
assets by
the Company is not intended to in any way diminish or dilute the
investment risk transferred to the Reinsurer through the calculation
of
the investment income amount in Schedule E. The result is further
multiplied by the Quota Share Percentage Reinsured, as set forth
in
Schedule B.
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6.04 Quarterly
Cash Flow Settlement.
The
parties agree to pay a quarterly cash flow settlement on the Policies as set
forth in Schedule C.
6.05 Due
Dates.
The
quarterly cash flow settlement shall be due and payable as set forth in Schedule
C.
6.06 Estimates
and Delays.
If the
amount of the quarterly cash flow settlement cannot be determined as of the
due
dates, as defined in Schedule C on an exact basis, such payments will be paid
in
accordance with a mutually acceptable formula which will approximate the actual
payments. Should there be a delay in the payment due, the Reinsurer reserves
the
right to charge an interest penalty for the time period that the amount is
overdue, at an annual effective interest rate based on the thirty (30) day
U.S.
Treasury Xxxx rate as of the due date plus 2% per annum.
9
6.07 Reinsurer’s
Liability Ceases.
If the
quarterly cash flow settlement or estimates pursuant to this Article 6,
including any settlement that becomes past due during a thirty (30) day written
notice period as per Article 23.07, “Notices”, are not paid before the end of
the notice period, the Reinsurer shall be relieved from all liability under
such
Policies as of the last date to which such settlement has been paid. Policies
on
which any settlement becomes due, subsequent to the expiry of the notice period,
shall automatically terminate as of the last date to which the settlement has
been paid. Any termination shall be in accordance with the Special Termination
Settlement, as per Exhibit D.
6.08 Reinstatement
of Reinsurance.
If
reinsurance coverage for Policies is terminated because the quarterly cash
flow
settlement is past due, the Policies may be reinstated, subject to approval
by
the Reinsurer and payment of all settlements past due. The Reinsurer shall
not
be liable for any claims incurred between the date of termination and the date
of reinstatement of the reinsurance. The right to terminate reinsurance shall
not prejudice the Reinsurer’s right to collect any and all settlements for the
period during which reinsurance was in force prior to expiration of the notice
of intent to terminate.
6.09 Unacceptable
Termination.
The
Company agrees to maintain reinsurance of a Policy in force in accordance with
the terms of this Agreement, for as long as the Policy remains in force. The
Company shall not discontinue payment of a quarterly cash flow settlement to
avoid reinsurance.
6.10 Administration
of Reinsurance. Reporting
periods, due dates, reporting requirements, quarterly cash flow settlement
preparation and payments, and responsible parties are more fully described
in
Schedule C attached hereto.
ARTICLE
7
PAYMENTS
BY REINSURER
7.01 |
Commissions.
The Reinsurer shall reimburse the Company for the commissions and
overrides actually paid by the Company for such then current accounting
period on the Policies eligible for commission for each and every
accounting period for the duration of this Agreement, provided no
increase
in the dollar amount of compensation or reimbursement has been made
in any
producer or agency contract without the express written consent of
the
Reinsurer. The Reinsurer shall not unreasonably withhold such consent.
The
result is further multiplied by the Quota Share Percentage Reinsured,
as
set forth in Schedule B.
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7.02 |
Administration
Expense Allowance. The
Reinsurer shall reimburse the Company for the expenses it incurs
from the
on-going cost of administration on the Policies. Such amount shall
be as
defined in Schedule D. Schedule D charges shall remain in effect
for the
first three (3) years of this Agreement, but may be renegotiated
at three
(3) year intervals thereafter.
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7.03 |
Increase
in Modified Coinsurance Reserve.
The Reinsurer shall pay the Company, for each and every accounting
period
for the duration of this Agreement, the amount by which the modified
coinsurance reserve, as defined in Article 10, “Reserves”, in the
aggregate on the Policies has increased since the beginning of such
then
current accounting period, if any, as defined in Schedule C. The
amount of
such increase for such then current accounting period shall be determined
by subtracting the amount of the modified coinsurance reserve on
the
Policies as of the beginning of the then current accounting period,
from
the amount of the modified coinsurance reserve on the Policies as
of the
end of the then current accounting period. Should such calculation
result
in a positive number, this shall be the amount of the increase for
the
current accounting period. Should such calculation result in a negative
number, the amount of the increase for the current accounting period
shall
be zero or none. The result is further multiplied by the Quota Share
Percentage Reinsured, as set forth in Schedule
B.
|
10
7.04 |
Claims.
The Reinsurer shall pay the Company the Reinsured Amount on any claim
paid
by the Company pursuant to a Policy, in accordance with Article 8,
“Death
Claims” and Article 9, “Disputed Claims.” However, for the portion of the
Reinsured Amount in excess of the Reinsurer’s Retention, it is
acknowledged and understood by the parties that such excess payment
shall
be paid by the Reinsurer’s claims paying Designee directly to the Company.
The Reinsurer’s payment along with the payment made by the claims paying
Designee shall constitute the Reinsurer’s full liability and shall release
the Reinsurer from any further liability associated with such claim.
The
Reinsurer’s liability to pay is expressly conditioned on the claim
qualifying for reimbursement as set forth in Exhibit I. If the claim
qualifies for reimbursement pursuant to the conditions as set forth
in
Exhibit I and any claims paying Designee fails to make a payment,
the
Reinsurer must make that payment as if the claims paying Designee
did not
exist. The Reinsurer shall be entitled to recover from the Company,
through offset or otherwise, any amounts paid by the Reinsurer on
claims
that are subsequently determined as not qualifying for
reimbursement.
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7.05 |
Claim
Expenses.
The Reinsurer shall pay its proportionate share of expenses incurred
in
connection with a Policy claim, in accordance with Article 8.06,
“Expenses.”
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7.06 |
Allowances
for Premium Taxes.
The Reinsurer shall reimburse the Company for the state premium taxes
payable by the Company for the Policies in an amount equal to the
Reinsurance Premiums for such then current accounting period, as
defined
in Article 6.01, “Reinsurance Premiums”, multiplied by the state specific
tax, as defined in Exhibit G, for the insured’s state of residence, for
each and every accounting period for the duration of this
Agreement.
|
Not
later
than thirty (30) calendar days after each calendar year-end falling within
the
term of this Agreement, the Company shall provide the Reinsurer with an
accounting of its actual premium tax with respect to the Policies for such
calendar year. Within fifteen (15) business days of receiving the accounting,
if
such accounting reflects amounts owed to the Reinsurer, the Company shall pay
such amounts to the Reinsurer with the accounting. Otherwise, if it reflects
amounts owed to the Company, the Reinsurer shall pay such amounts to the
Company. In no event, will the Reinsurer reimburse more than the amount of
premium taxes paid by the Company for the calendar year.
7.07 |
Quarterly
Cash Flow Settlement
The parties agree to pay a quarterly cash flow settlement on the
Policies
as set forth in Schedule C.
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7.08 Due
Dates.
The
quarterly cash flow settlement shall be due and payable as set forth in Schedule
C.
ARTICLE
8
DEATH
CLAIMS
8.01 |
Proofs.
The Company shall promptly provide the Reinsurer with proper claim
proofs,
including a copy of the proof of payment by the Company, a copy of
the
insured’s death certificate, and the necessary police reports in the event
of an accidental death. In addition, for disputed claims in the
contestable period, the Company shall also send the Reinsurer and
its
claims paying Designee a copy of all claims papers in connection
with the
claim. The Reinsurer or its claims paying Designee reserves the right
to
request additional information on any
claim.
|
11
8.02 |
Claims
Adjudication.
The Company agrees to act in good faith and in accordance with its
standard claims practices applicable for all claims, regardless if
reinsured, when enforcing the terms and conditions of the Policies
in
connection with the administration, negotiation, payment, denial
or
settlement of a claim.
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8.03 |
Payment.
For non-disputed claims, the Reinsurer shall accept the good faith
decision of the Company and shall pay the Company the Reinsured Amount
on
which Reinsurance Premiums have been computed and paid, once the
Company
provides proper claim proofs in accordance with Article 8.01. However,
such payment shall be subject to the terms and conditions specified
in the
attached Exhibit I. Payment of the Reinsured Amount for the reinsured
death proceeds shall be made in one lump sum, regardless of the Company’s
settlement options.
|
8.04 |
Payment
Compliance.
A
claim shall not be payable if said payment would cause Reinsurer
or and
its claims paying Designee to be in violation of Laws applicable
to the
Reinsurer.
|
8.05 |
Maximum
Reinsurance Recoverable.
The total reinsurance recoverable from all reinsurers by the Company,
including the Reinsurer and claims paying Designee, shall not exceed
the
Company’s total contractual liability on the Policy, less the amount
retained by the Company. The maximum reinsurance death benefit payable
to
the Company under this Agreement is the Reinsured Amount specifically
reinsured with the Reinsurer. Any settlement amounts beyond the Reinsured
Amount voluntarily made by the Company are not reinsured hereunder.
The
Reinsurer shall pay its proportionate share of the interest that
the
Company pays on the death proceeds until the Company’s date of settlement,
provided that the interest rate applied does not exceed the amount
provided by state statute.
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8.06 |
Expenses.
The Reinsurer’s liability shall include reimbursement for certain
reasonable documented third-party expenses incurred by the Company
in
connection with, investigating, defending or settling a Policy claim,
provided the Reinsurer has not discharged its liability pursuant
to
Article 9, “Disputed Claims”. In no event shall such expense reimbursement
include any of the following:
|
a. salaries
of employees of the Company or home office expenses;
b.routine
investigative or administrative expenses;
c.expenses
incurred in connection with a dispute or contest arising out of conflicting
claims of entitlement of the Policy proceeds or benefits that the Company may
admit are payable;
d.a
gratuitous or ex gratia payment made by the Company.
8.08
Misrepresentation
or Suicide.
If the
Company returns premium on a Policy to the policyowner or beneficiary as a
result of misrepresentation or suicide of the insured, then all premiums and
considerations paid under this Agreement for such Policy will be returned by
the
Reinsurer and the Company to the other party in lieu of any other form of
reinsurance benefit payable under this Agreement. For survivorship
(second-to-die) Policies, if a single life Policy is issued to the surviving
life where the death of the first insured is by suicide, such resulting Policy
shall be issued with the issue date of the original survivorship Policy and
shall become reinsured hereunder in accordance with the terms of this Agreement.
8.09
Misstatement
of Age or Sex.
In the
event of a change in the amount of the Company’s liability on a Policy due to a
misstatement of age or sex, the Reinsurer’s liability shall change
proportionately. The face amount of the Policy shall be adjusted from the
inception of the Policy, and any difference in premiums and considerations
paid
under this Agreement shall be settled without interest.
12
8.10
Claims
Notice.
Following receipt of notice of a death claim involving a policy or policies
covered by this Agreement, the Company shall notify the Reinsurer,
as soon
as reasonably possible, of the pending claim or claims.
ARTICLE
9
DISPUTED
CLAIMS
9.01 Disputed
Claims Notice.
The
Company shall notify the Reinsurer and its claims paying Designee of its
intention to contest, compromise or litigate a claim involving a Policy
(“Disputed Claim”). The Company shall also promptly disclose all information
involving the Policy claim.
9.02 Opt
Out.
If the
Reinsurer should decline to participate in the contest, compromise or
litigation, with respect to a Disputed Claim (“Opt Out”), the Reinsurer may then
release all of its liability by paying the Company its full share of reinsurance
death benefits for the Policy and will not share in any subsequent increase
or
reduction in liability.
9.03 Reduction
in Liability.
If the
Reinsurer does not Opt Out, and the Company’s contest, compromise, or litigation
results in a reduction in its liability, the Reinsurer shall share in the
reduction in the proportion that the Reinsurer’s liability bears to the total
liability on the insured’s date of death.
9.04
Reinsurer’s
Participation in Expenses.
The
Reinsurer shall pay its share of reasonable documented third-party investigation
and legal expenses, with respect to a Disputed Claim, connected with the
litigation or settlement of contractual liability claims unless the Reinsurer
has released its liability, in which case the Reinsurer shall not participate
in
any expenses after the date of release.
9.05
Exclusions.
Claim
expenses do not include those expenses mentioned in Article 8.06, “Expenses”.
Also, expenses incurred in connection with a dispute or contest arising out
of
conflicting claims of entitlement to Policy proceeds or benefits that the
Company admits are payable are not a claim expense under this
Agreement.
ARTICLE
10
RESERVES
The
modified coinsurance reserves shall be an amount equal to the Gross Statutory
Reserve on that portion of the Policies as of the close of such accounting
period for which this calculation is being made. For the first accounting period
after the effective date of this Agreement, the beginning modified coinsurance
reserve for purposes of the calculation of increase or decrease in modified
coinsurance reserve shall be zero as of the effective date of this
Agreement.
ARTICLE
11
EXTRACONTRACTUAL
DAMAGES
13
11.01
Reinsurer’s
Liability.
It is
understood that the Reinsurer shall not participate in Punitive or Compensatory
Damages that are awarded against the Company as a result of an act, omission,
or
course of conduct committed solely by the Company, its agents, or
representatives in connection with claims covered under this Agreement. The
Reinsurer will, however, pay its share of Statutory Penalties awarded against
the Company in connection with claims covered under this Agreement if the
Reinsurer elected in writing to join in the contest of the coverage in
question.
11.02
Reinsurer’s
Limited Participation.
The
parties recognize that circumstances may arise in which equity would require
the
Reinsurer, to the extent permitted by law, to share proportionately in Punitive
and Compensatory Damages. Such circumstances are difficult to define in advance,
but would generally be those situations in which the Reinsurer was an active
party and, in writing, recommended, consented to, or ratified the act or course
of conduct of the Company that ultimately resulted in the assessment of the
extra-contractual damages. In such situations, the Reinsurer and the Company
may
share such damages so assessed, in equitable proportions. For purposes of this
Article 12, the following are examples of where the Reinsurer’s conduct may give
rise to such responsibility:
a. |
the
Reinsurer has actively taken control of the litigation and is directing
the Company’s action; and
|
b. |
the
Reinsurer is attempting to compel acceptance of its direction by
a
specific written threat of withholding payment of reinsurance proceeds.
|
The
parties further agree that the mere decision to participate in a contest is
not
a sufficiently direct, active, decision making role so as to give rise to
extracontractual damages nor is the provision of advice concerning a claim
that
was solicited by the Company.
ARTICLE
12
POLICY
CHANGES,
CONTINUTATIONS, REDUCTION, AND INCREASES
12.01
Policy
Changes.
Whenever a change is made in the status, plan, amount, risk classification
or
other feature of a Policy, the Reinsurer shall, upon receipt of notification
of
the change, provide adjusted reinsurance coverage in accordance with the
provisions of this Agreement. The Company shall notify the Reinsurer of any
change due to such adjusted reinsurance coverage in the Company’s next billing
statement.
a.
|
Risk
Classification Changes. If
the insured requests a table rating reduction or removal of a flat
extra
premium charge, such change shall be underwritten according to the
Company’s normal underwriting practices. Risk classification changes on
Facultative Policies shall be subject to the Reinsurer’s or facultative
underwriting Designee’s approval. Any reinsurance coverage shall be
adjusted accordingly.
|
b.
|
Reinstatements.
If
the Company terminates a Policy reinsured on an Automatic Reinsurance
basis, due to the policyholder’s actions or directions, and such a Policy
is reinstated in accordance with its terms and the Company’s rules and
procedures as disclosed to the Reinsurer, the Reinsurer shall, upon
notification of reinstatement, reinstate the reinsurance coverage.
If the
Company terminates a Policy reinsured on a Facultative Reinsurance
basis,
due to the policyholder’s actions or directions, and such Policy is
reinstated, the Company shall resubmit the case to the Reinsurer’s and
facultative underwriting Designee for underwriting approval before
the
reinsurance can be reinstated. The Reinsurer shall not be liable
for any
claims incurred between the date of termination and the date of
reinstatement of the reinsurance.
|
14
c.
|
Restorations.
If
a Policy is restored pursuant to any state law or regulation that
requires
reinstatement or restoration of a Policy following a “free look” period
allowed to the policyholder for a proposed replacement policy, and
said
replacement policy is subsequently rejected by the policyholder,
the
Reinsurer agrees to restore reinsurance of the Policy under its original
terms and conditions as set forth herein. The foregoing shall apply
to
Automatic and Facultative
Reinsurance.
|
12.02
Continuations.
If the
Company issues a Continuation of a Policy as defined in this Article 12 and
Article 25 “Definitions”, it agrees to reinsure the Continuation with the
Reinsurer. A policy that is a Continuation of a policy not previously reinsured
with the Reinsurer, shall not be reinsured under this Agreement without the
prior written consent of the original reinsurer and reinsurance terms agreed
upon by the Company and the Reinsurer.
If the Company issues a Policy resulting from an internal replacement or
exchange, the Reinsurer shall continue to reinsure the new Policy, provided
the
replaced or exchanged policy was reinsured.
If the Company treats the Policy as new business, subject to the definition
of a
Policy Continuation in this Article 12 and Article 25, “Definitions”, then the
reinsurance shall also be considered new business. Such policies must be fully
underwritten for the full amount and must be issued with full new business
commissions. Where permitted by law, they must also include full suicide and
contestability provisions. If the previous policy was reinsured on a Facultative
Reinsurance basis, the new policy must be submitted on a facultative basis
as
well.
If
the
above new business provisions do not apply, the Company and the Reinsurer must
specifically agree on terms and procedures for the reinsurance coverage to
continue. Furthermore, unless mutually agreed otherwise, policies that are
not
originally reinsured with the Reinsurer and that are converted or exchanged
to
or replaced by a plan covered under this Agreement will not be reinsured
hereunder unless such conversion, exchange or replacement is new business,
as
defined herein.
If
the
replacement or exchange results in an increase in the risk amount, the increase
shall be underwritten by the Company in accordance with its new business
underwriting and issue standards and procedures. The Reinsurer shall accept
its
proportional share of such increases, subject to the new business provisions
of
this Agreement.
12.03 Reductions.
Whenever
retained individual life insurance coverage on the insured life terminates,
lapses, or reduces, the Reinsured Amount of the Policy shall be reduced
proportionately. The reduction in reinsurance shall be effective on the same
date as the termination, lapse, or reduction of the underlying policy. The
reduction in the reinsurance shall be proportional to the share of risk covered
by the Reinsurer before the reduction.
If
life
insurance retained by the Company on an insured person reduces because any
policy on that life lapses or reduces pursuant to the terms of that policy,
the
Reinsured Net Amount at Risk shall also be reduced effective the same date
of
termination or reduction of that policy to restore, as far as possible, its
Quota Share Percentage on the life.
15
Reinsurance
shall be reduced on the specific Policy that was terminated or reduced. If
there
is a balance available to restore the Company’s retention level to the maximum
amount pursuant to the terms of this Agreement, reinsurance on the other
policies shall reduce beginning with the last policy issued {OR}
the
first policy issued. The reduction shall not include any facultative Policy,
for
which the Company, at the time of issue, retained less than its Quota Share
Percentage on the life, as set forth in Schedule B.
12.04Non-Contractual
Increases.
If the
amount of life insurance on a Policy is increased as the result of a
non-contractual change, the increase is subject to new underwriting and shall
be
underwritten by the Company in accordance with its normal underwriting standards
and practices. For purposes of this Agreement, such an increase shall be
considered as new reinsurance and shall be subject to all terms and conditions
set forth herein. The Reinsurer’s or facultative underwriting Designee’s
approval is required if the original Policy was reinsured on a facultative
basis, or if the new amount of coverage causes the Reinsured Amount on the
insured’s life to exceed either the Automatic Acceptance Limit or the Automatic
In Force and Applied For Limits (aka Jumbo or Participation Limits) as specified
in Schedule B.
12.05Contractual
Increases.
If the
amount of life insurance on a Policy is increased, (a) the increase is not
subject to new underwriting evidence in accordance with the Company’s normal
underwriting standards and practices, and (b) the potential for the projected
increase was known at the time of issue of the Policy, the increase shall be
Automatically reinsured, provided that the Reinsured Amount does not exceed
the
Automatic Acceptance Limits specified in Schedule B. The Company and the
Reinsurer will share the increased amount proportionately. Any other contractual
increase not subject to new underwriting shall not be reinsured under this
Agreement.
ARTICLE
13
TERMINATIONS
BY COMPANY
There
shall be no right of recapture due to increases to the Company’s Maximum Dollar
Retention. However, upon the occurrence of any of the events as described in
this Article 13, the Company may terminate this Agreement for new and in force
business as outlined below and in accordance with the attached Special
Termination Settlement in Exhibit D. As of the termination date, the Reinsurer
will have no further liability under this Agreement.
13.01 Nonpayment
by the Reinsurer
If the
quarterly cash flow settlement is not paid within thirty (30) calendar days
of
the due date, as set forth in Schedule C, for reasons other than those due
to
Error as defined in Article 15, “Errors and Omissions,” the Company may exercise
its right of termination and shall give the Reinsurer a thirty (30) calendar
day
written notice, as per Article 23.07, “Notices”, of its intent to terminate. The
reinsurance automatically terminates at the end of such thirty (30) calendar
day
notice period for all reinsurance on which balances remain due and unpaid,
including reinsurance on which balances become due and unpaid during and after
the 30-day notice period, provided the settlement payment is not received within
that 30-day period. However, the Reinsurer shall remain liable for any
settlement or claim incurred prior to the final date of
termination.
13.02 Breach
of Representations.
Violation by the Reinsurer of any term or condition of this Agreement per
Article 22, “Representations and Covenants”, and failure to remedy the breach
within the stated Notification Period, as defined by Article 22,
“Representations and Covenants”.
16
13.03 Change
in Control.
A change
in control (more than 49% to other than the Reinsurer’s Member Firms or their
affiliated persons) of the common stock of the Reinsurer, without the express
written consent of the Company, except that any reorganization of the
Reinsurer's shares to facilitate a holding company reorganization with such
new
holding company materially controlled by the same entities or individuals as
the
Reinsurer shall not be considered a change in control as contemplated by this
Article 13.
13.04 Change
in Reinsurer’s Financial Conditions.
The
Reinsurer is placed under supervision, conservatorship or receivership as
provided by Colorado law or regulation.
13.05 Change
in Company Action Level.
The
statutory capital and surplus of the Reinsurer is less than 150% of the NAIC
statutory requirements for Risk Based Capital Company Action Level as of any
calendar year ending December 31 as that term is defined as of the Effective
Date of this Agreement or if still applicable as such term is defined for such
then current accounting period.
ARTICLE
14
TERMINATIONS
BY REINSURER
If
the
Company experiences any one of the events as described below, the Reinsurer
may
terminate this Agreement as outlined below, in accordance with the attached
Special Termination Settlement in Exhibit D.
14.01 Nonpayment
by Company.
The
payment of a quarterly cash flow settlement is a condition precedent to the
liability of the Reinsurer. If the settlement is not paid within thirty (30)
calendar days of the due date, for reasons other than those due to Error as
defined in Article 15, “Errors and Omissions,” the Reinsurer may exercise its
right of termination and shall give the Company a thirty (30) calendar day
written notice, as per Article 23.07, “Notices”, of its intent to terminate.
Reinsurance shall automatically terminate at the end of such 30-day notice
period for all reinsurance on which balances remain due and unpaid, including
reinsurance on which balances become due and unpaid during and after the 30-day
notice period, provided the settlement payment is not received within that
30-day period.
14.02 Material
Breach.
Notwithstanding the notice requirement set forth in Article 26.02, “Closure for
New Reinsurance”, the Reinsurer may terminate this Agreement with respect to the
reinsurance of new business immediately upon a material breach of this
Agreement.
ARTICLE
15
ERRORS
AND OMISSIONS
15.01
Errors.
Any
unintentional or accidental failure of the Company or the Reinsurer to comply
with the terms of this Agreement which is shown to be the result of an error,
oversight, omission or misunderstanding in the administration of the reinsurance
(collectively referred to as “Errors”) shall not be deemed a breach of this
Agreement. Upon discovery, however, the Errors shall be corrected so that both
parties are restored to the position they would have occupied had the Error
not
occurred. If it is not possible to restore both parties to such a position,
the
Company and the Reinsurer shall negotiate in good faith to equitably apportion
any resulting liabilities and expenses. This provision does not apply to the
administration of the insurance provided by the Company to its insured or any
other non-reinsurance errors or omissions committed by the Company with regard
to the Policy.
17
15.02
Limitations.
The
Reinsurer shall not provide reinsurance for policies that do not satisfy the
terms and parameters of this Agreement nor shall the Reinsurer be responsible
for negligent or deliberate acts or for repetitive Errors in administration
by
the Company. If either party determines that the Company has failed to comply
with the reporting requirements pursuant to this Agreement, the Reinsurer may
require the Company to audit its records for similar Errors and to make its
best
efforts to avoid similar Errors in the future.
ARTICLE
16
INSPECTION
OF RECORDS
The
Company, the Reinsurer or its Designee may audit, inspect and examine, any
and
all books, records, statements, correspondence, reports, trust accounts and
their related documents or other documents that relate to the Policies provided
that forty eight (48) hour advance notice has been given to the other party.
For
instance, other documents related to the Policies shall include management's
documentation and assessment of internal controls in compliance with the
Sarbanes Oxley Act of 2002 Sec. 404, if applicable.
Inspection
shall be performed during the normal business hours and at the office of the
party where the records to be inspected are routinely housed. The party wishing
to make the inspection shall notify the other party in writing of its desire
to
make such an inspection and of the documents or information it desires to
review. The party whose records are to be inspected shall promptly respond
to
the requesting party and make arrangements for a mutually acceptable time for
the inspection. The audited party agrees to provide a reasonable workspace
for
such audit, inspection or examination and to cooperate fully and to faithfully
disclose the existence of and produce any and all necessary and reasonable
materials requested by such auditors, investigators, or examiners. The expense
of the respective party's employee(s) or authorized representative(s) engaged
in
such activities shall be borne solely by such party.
ARTICLE
17
INSOLVENCY
OF THE COMPANY
17.01 Payments
and Notice Requirements.
In the
event that the Company is deemed Insolvent, all reinsurance payments payable
in
accordance with the terms of this Agreement shall be payable by the Reinsurer
directly to the Company, its liquidator, receiver or statutory successor,
without diminution because of the Insolvency of the Company. It is understood,
however, that in the event of such Insolvency, the liquidator, receiver or
statutory successor of the Company shall give written notice to the Reinsurer
of
the pendency of a claim against the Company on a risk reinsured hereunder within
a reasonable time after such claim is filed in the Insolvency proceeding. Such
notice shall indicate the policy reinsured and whether the claim could involve
a
possible liability on the part of the Reinsurer. During the pendency of such
claim, the Reinsurer may investigate such claim and interpose, at its own
expense, in the proceeding where such claim is to be adjudicated, any defense
or
defenses it may deem available to the Company, its liquidator, receiver or
statutory successor. It is further understood that the expense thus incurred
by
the Reinsurer shall be chargeable, subject to court approval, against the
Company as part of the expense of liquidation to the extent of a proportionate
share of the benefit that may accrue to the Company solely as a result of the
defense undertaken by the Reinsurer. Where two or more reinsurers are
participating in the same claim and multiple reinsurers elect to interpose
a
defense or defenses to any such claim, the expense shall be apportioned among
the reinsurers in the same proportion that the reinsurers’ net liability bears
to the sum of the net liability of all reinsurers participating in the defense.
The Reinsurer shall be liable for the amounts payable under this Agreement
and
shall not be, nor become, liable for any amounts or reserves to be held by
the
Company on the Policies.
18
ARTICLE
18
OFFSET
All
amounts due or otherwise accrued to any of the parties hereto, whether by reason
of premiums, losses, expenses, reversal of claims previously paid or otherwise,
under this Agreement, shall at all times be fully subject to the right of offset
and only the net balance shall be due and payable. The right of offset shall
not
be affected or diminished because of the Insolvency of either
party.
ARTICLE
19
DEFERRED
ACQUISITION COST TAX
The
parties hereby agree to the following in accordance with Internal Revenue
Regulation 1.848(g)(8) issued December 29, 1992 under Section 848 of the
Internal Revenue Code:
· |
to
exchange information pertaining to the amount of net consideration
under
this Agreement not later than May 1st for each and every taxable
year for
which this treaty is in effect; and
|
· |
that
the party with net positive consideration, as defined in the regulations
promulgated under Internal Revenue Code Section 848, will capitalize
specific policy acquisition expenses with respect to this agreement
without regard to the general deductions limitation of Internal Revenue
Code Section 848(c)(1); and
|
· |
that
the other party may challenge such calculation within ten (10) business
days of receipt of the such net positive consideration calculation;
and
|
· |
that
should the other party challenge such calculation and the parties
are
unable to agree as to the appropriate methodology they shall refer
such
dispute to an outside tax consultant neutral to the parties; with
such
incurred expense equally borne by the
parties..
|
Both
the
Company and the Reinsurer represent and warrant that they are subject to U.S.
taxation under either Subchapter L of Chapter 1, or Subpart F of Subchapter
N of
Chapter 1 of the Internal Revenue Code of 1986, as amended.
ARTICLE
20
ARBITRATION
20.01 General.
Any
dispute or other matter in question between the Company and the Reinsurer
arising out of, or relating to, the formation, interpretation, performance,
or
breach of this Agreement, whether such dispute arises before or after
termination of this Agreement, and whether in contract, tort, or otherwise,
shall be settled by arbitration.
19
20.02
Notice.
To
initiate arbitration, either the Company or the Reinsurer shall notify the
other
party in writing of its desire to arbitrate. The notice shall identify the
claimant, the contract at issue, and the nature of the claims and/or issues.
Notice shall be sent via certified mail, with return receipt, or another
service, which produces a receipt. The arbitration shall be deemed to have
been
commenced on the date the notice of arbitration is received.
20.03 Procedure.
There
shall be three neutral arbitrators who shall each have no less than ten (10)
years of insurance or reinsurance industry experience and who are current or
former officers of life insurance or life reinsurance companies other than
the
parties to this Agreement, their affiliates or subsidiaries. The arbitrators
shall not be under the control of any party to the arbitration or to this
Agreement, nor shall any member of the panel have a financial interest in the
outcome of the dispute. Within thirty (30) days following the commencement
of
the arbitration proceedings, each party shall provide the other with the
identification of their appointed arbitrator, and provide a copy of the
arbitrator’s curriculum vitae. If either party refuses or neglects to appoint an
arbitrator within thirty (30) days, the other party may appoint the second
arbitrator to act as the appointed arbitrator for the defaulting party by
providing notice and a copy of the arbitrator’s curriculum vitae. The first two
arbitrators shall appoint a third arbitrator (the “Umpire”). If the two
arbitrators are unable to agree upon the selection of an Umpire within thirty
(30) days following their appointment, each arbitrator shall nominate three
(3)
candidates within ten (10) days thereafter, two of whom the other party shall
decline and the decision shall be made by drawing lots. In the event any
arbitrator fails, refuses, or becomes unable to act as such before an award
has
been rendered, a successor shall be selected in the same manner as the original
arbitrator.
The
claimant and respondent shall each submit initial briefs to the panel outlining
the issues in dispute and the reasons for their respective positions within
thirty (30) days of the notice of the appointment of the Umpire.
The
arbitrators shall consider this Agreement an honorable engagement rather than
merely a legal obligation, and the panel shall make its decision with
consideration given to the custom and usage of the life insurance and life
reinsurance industry. The arbitrators shall have the power to determine all
procedural rules of the arbitration, including, but not limited to inspection
of
documents, examination of witnesses, and any other matter related to the conduct
of the arbitration. The panel and the Umpire shall have the authority to issue
subpoenas (including subpoenas to third party witnesses) and other orders to
enforce their decisions. Ex parte communications with arbitrators shall not
be
permitted at any time after the appointment. The arbitrators shall recognize
the
attorney/client privilege and the attorney work product doctrine. Neither a
party nor an arbitrator may disclose the existence, content, or result of any
arbitration hereunder, except to the extent such disclosure may be required
for
review and enforcement by a court of competent jurisdiction, to support
reinsurance or retrocessional recoveries, or as otherwise agreed by the parties.
The location of all proceedings shall be Chicago, Illinois unless the parties
agree otherwise.
The
panel
may issue orders for interim relief upon showing of good cause, including
pre-award security. Absent good cause for an extension as determined by the
panel, the panel shall render the final award within nine (9) months of the
appointment of the Umpire, unless the parties agree otherwise, and within thirty
(30) days after the date of the closing of the hearing. The panel is authorized
to award any remedy or sanctions allowed by applicable law, including, but
not
limited to monetary damages, equitable relief, pre or post award interest,
costs
of arbitration, attorneys fees, and other final or interim relief; provided
that
arbitrators shall not be empowered to award damages in excess of compensatory
damages. The decision of the arbitrators shall be made by majority rule, and
shall be final and binding on both parties. Either party to the arbitration
may
petition any court having jurisdiction over the parties to reduce the decision
to judgment. Unless the arbitrators decide otherwise, each party shall bear
the
expense of its own arbitration activities, including its appointed arbitrator
and any outside attorney and witness fees. The parties shall jointly and equally
bear the expense of the Umpire and other costs of the arbitration.
20
The
provisions of this Article 20 shall be governed by the XXXX Reinsurance and
Insurance Arbitration Society (XXXXX.XX).
ARTICLE
21
GOOD
FAITH AND CONFIDENTIALITY
21.01 Utmost
Good Faith.
The
parties agree that this Agreement is entered into with the understanding that
the principles of utmost good faith traditional to reinsurance shall be adhered
to in the formation and performance of this Agreement and shall govern the
parties’ rights and obligations. This Agreement is entered into in reliance of
the utmost good faith of the parties including, for example, their warranties,
representations and disclosures.
21.02 Duty
to Disclose.
This
Agreement requires the continuing utmost good faith of the parties, their
representatives, successors, and assigns. This includes, but is not limited
to,
a duty of full and fair disclosure, as reasonably determined by an independent
actuary, of all information respecting the formation and continuation of this
Agreement, and the Policies reinsured hereunder and the duty to make true and
complete representations in such disclosures.
21.03 Affirmation.
The
Company affirms that it has disclosed and shall continue to disclose to the
Reinsurer all matters material to this Agreement, such as its underwriting
and
policy issue practices (i.e. rules and philosophies), its claims practices,
any
changes to product loads, charges, or features, its financial condition, and
any
change in its ownership or control.
21.04 Confidentiality. Any
and
all materials, information, proposals, studies or other documents relative
to
this Agreement are confidential and proprietary. Neither party shall disclose,
directly or indirectly, any information obtained from the other party, relative
to this Agreement, to any third party without the express written consent of
the
other unless applicable statute, law or regulation requires such disclosure.
This restriction shall not apply to information the Reinsurer may disclose
to
its Designee in order to fulfill its obligations pursuant to the terms and
conditions of this Agreement.
ARTICLE
22
REPRESENTATIONS
AND COVENANTS
22.01
Each
party to this Agreement represents the following:
a. |
it
is a corporation duly organized, existing and in good standing under
the
laws of its state of domicile; and
|
b. |
it
has taken all requisite corporate proceedings to authorize it to
enter
into and it is empowered under applicable laws and by its charter
and
bylaws to enter into and perform the duties contemplated in this
Agreement; and
|
c. |
that
data provided, both oral and written, as part of each party’s due
diligence process, is complete and accurately describes the current
financial condition of the party, and the Policies eligible for
reinsurance hereunder.
|
22.02 The
Company agrees to the following:
a. |
it
shall not knowingly permit a person under its control to commit any
action
that would violate any state law or regulation, in those jurisdictions
covered hereunder, governing administration or servicing of insurance
as
defined thereunder;
and
|
b. |
it
has obtained any and all regulatory approvals as may be required
for the
Company to cede the policies covered hereunder and to assure whatever
reserve credits it may wish to take for such cession;
and
|
21
c.
|
it
shall not take any unauthorized action that would encourage the
policyholders covered under this Agreement to surrender, reduce or
otherwise terminate their existing coverage either through direct
or
indirect acts, including but not limited to, a plan of internal
replacement; and
|
d.
|
that
no other reinsurance of any portion of the policies reinsured hereunder
shall be made to any third party without written notification to
the
Reinsurer. Furthermore, the Company shall fully disclose all terms
of any
such reinsurance to the Reinsurer.
|
22.03 The
Reinsurer represents the following:
a. |
it
has obtained any and all regulatory approvals as may be required
for the
Reinsurer to provide the reinsurance covered hereunder;
and
|
b. |
excluding
excess of retention YRT and aggregate catastrophic/stop loss coverages,
no
other retrocessions of any portion of the Policies hereunder shall
be made
to any other third party without written notification to the
Company.
|
22.04 The
Reinsurer and the Company agree to the following:
a. |
to
indemnify, defend and hold harmless the other, its directors, officers,
employees and agents from any and all claims, actions, suits, judgments,
damages (including punitive or exemplary damages), fines and other
proceedings, whether civil, criminal (only to the extent permitted
by law
or public policy), administrative, investigative or otherwise, together
with all costs, expenses and other amounts, including attorney's
fees,
arising or alleged to have arisen out of any act, error or omission
related to or resulting from the performance of the duties, obligations
or
responsibilities of the indemnifying party, its directors, officers,
employees and agents, under this Agreement. This Article 22.04 is
not
intended and shall not be construed to expand the remedies that may
be
awarded by arbitrators for breach of this Agreement in any arbitration
of
a dispute between the Company and Reinsurer pursuant to Article 20,
“Arbitration”; and
|
b. |
the
Reinsurer shall have no obligation arising out of any breach of any
duty
on the part of the Company to any insured covered hereunder. The
Company
shall remain solely liable for all fines, penalties or other assessments
imposed against the Reinsurer by any Insurance Department or other
governmental entity for any conduct of the Company, its employees
or
authorized representatives, which was not expressly authorized, in
writing, by the Reinsurer; and
|
22
c. |
no
commission, fee or compensation is due to any third person by virtue
of
having negotiated or arranged the transactions herein. Each of the
parties
agrees to pay all costs incurred by it for actuarial, legal and other
services received or utilized in connection
herewith.
|
22.05 Notification
Period.
Notwithstanding the provisions of Article 6.07, “Reinsurance Liability Ceases”,
and Article 13, “Terminations by Company”, should the Company or the Reinsurer
be found in violation of any of the provisions of this Article 22, the party
discovering such breach, shall notify, in writing, the other party of the
existence of such breach. The party once notified shall have ninety (90)
calendar days from the date such notification was mailed to provide the other
party evidence that the breach has been remedied.
ARTICLE
23
GENERAL
PROVISIONS
23.01Article
Headings and Subsections.
All
article headings, titles and subsections captured in this Agreement or in any
schedule have been inserted for the reader's convenience only, shall not be
deemed a part of this Agreement and shall not be construed as having specific
meaning with regards to any interpretation of the Agreement.
23.02 Counterparts.
This
Agreement may be executed simultaneously in any number of counterparts, each
of
which shall be deemed an original, but all of which shall constitute one and
the
same instrument.
23.03 Entire
Agreement.
This
Agreement, which includes any Schedules, Exhibits, and Addenda, and any
amendments attached hereto constitute the entire agreement between the parties
with respect to the business reinsured hereunder. There are no understandings
between the parties other than as expressed in this Agreement. Any change or
modification to this Agreement will be null and void unless made by amendment
to
this Agreement and signed by both parties.
23.04 Financial
Reports
The
Company and the Reinsurer each agree to furnish the other, when requested,
with
their respective NAIC Convention Blank Statements, as required by their
respective state laws.
23.05 Governing
Law
This
Agreement is subject to and is to be interpreted in accordance with the laws
of
the State of Massachusetts, except that it is agreed that the provisions of
Article 20, “Arbitration”, shall be governed by the rules of XXXX Reinsurance
and Insurance Arbitration Society (XXXXX.XX).
23.06 Nonwaiver
No
forbearance on the part of either party to insist upon compliance by the other
party with the terms of this Agreement shall be construed as, or constitute
a
waiver of, any of the terms of this Agreement.
23.07Notices.
All
notices and other communications under this Agreement will be effective when
received and sufficient if given in writing and delivered by confirmed facsimile
transmission, by certified or registered mail, or by an overnight delivery
service of general commercial use (such as UPS, Federal Express or Airborne),
addressed to the attention of the applicable party described in Schedule C
attached hereto, or any successor thereof.
23
23.08Severability.
In the
event that any provision or term of this Agreement shall be held by any court
to
be illegal or unenforceable, all of the other terms and provisions shall remain
in full force and effect, except if the provision or term held to be illegal
or
unenforceable is also held to be a material part of this Agreement such that
the
party in whose favor the material term or provision was stipulated herein would
not have entered into this Agreement without such term or provision, then the
party in whose favor the material term or provision was stipulated shall have
the right, upon such holding, to terminate this Agreement, subject to the
Special Termination Settlement provisions detailed in Exhibit D.
23.09 Survival.
The
representations, warrants, covenants and agreements respectively required to
be
made by the Company and the Reinsurer in this Agreement shall survive the
termination or expiration of this Agreement.
ARTICLE
24
PARTIES
TO THE AGREEMENT
24.01No
Third Party Relationship.
This
Agreement is solely between the Reinsurer and the Company. There is no third
party beneficiary to this Agreement. Reinsurance under this Agreement shall
not
create any right or legal relationship between the Reinsurer and any other
person, for example, any insured, policyholder, agent, beneficiary, assignee,
Designee, or other reinsurer. The Company agrees that it shall not make the
Reinsurer a party to any litigation between any such third party and the
Company.
24.02Parties’
Obligations.
The
terms of this Agreement are binding upon the parties, their representatives,
successors, and assigns. The parties to this Agreement are bound by ongoing
and
continuing obligations and liabilities until the underlying Policies are no
longer in force under this Agreement. This Agreement shall not be bifurcated,
partially assigned, or partially assumed.
ARTICLE
25
DEFINITIONS
25.01 Automatic
Acceptance Limits.
The
amount specified in Schedule B used to determine the maximum amount written
by
the Company that may be ceded as Automatic Reinsurance. This maximum amount
that
may be ceded includes all coverage amounts (including Ultimate Amounts) applied
for or issued by the Company with all reinsurers at the time of consideration
of
the current application.
25.02 Automatic
In Force and Applied For Limits (aka Jumbo or Participation
Limits).
The
maximum amount (including replacements and any known Ultimate Amounts) specified
in Schedule B in force with all companies on this life, including the current
amount applied for, as a condition for Automatic Reinsurance.
25.03 Automatic
Reinsurance.
The
submission of reinsurance satisfying certain conditions as set forth in Article
3 “Automatic Reinsurance” of this Agreement that may be ceded to the Reinsurer
without obtaining a specific offer from the Reinsurer to reinsure.
25.04 Compensatory
Damages.
Those
amounts awarded to compensate for the actual damages sustained, and are not
awarded as a penalty, nor fixed in amount by statute.
25.05 Continuations.
A new
Policy replacing an existing Policy or a change to an existing Policy issued
in
compliance with the terms of the original Policy or satisfying any one of the
following conditions:
24
· |
the
continuing Policy is issued without the same new underwriting information
the Company would normally obtain for a newly issued policy;
or
|
· |
the
continuing Policy is issued without a suicide exclusion or contestable
period for the same period of time as those contained in other newly
issued policies, and this suicide exclusion or contestable period
would be
permitted by law; or
|
· |
the
Company does not pay the same commissions to its agent in the first
year
that it would normally pay for a newly issued
policy.
|
25.06 Designee.
A party
designated by the Reinsurer to act on behalf of the Reinsurer in performing
certain functions as more fully described in the body of this Agreement. Such
functions generally include making claims payments on the Reinsurer’s behalf,
performing facultative underwriting reviews and extending facultative offers,
and performing any claims and underwriting reviews, or audits in order for
the
Reinsurer to satisfy its rights and obligations pursuant to the terms and
conditions of this Agreement. Such designated party is typically one or more
of
the Reinsurer’s retrocessionaires. Any other functions the Reinsurer chooses a
Designee to perform that are not expressly described in this Agreement must
receive prior written approval from the Company.
25.07 Errors.
Any
unintentional or accidental failure of the Company or the Reinsurer to comply
with the terms of this Agreement which is shown to be the results of an error,
oversight, omission or misunderstanding in the administration of the
reinsurance.
25.08 Facultative
Reinsurance.
Reinsurance that is ceded to the Reinsurer subject to the Company obtaining
and
accepting a specific offer to reinsure from the Reinsurer or its facultative
underwriting Designee, in accordance with Article 4, “Facultative
Reinsurance”.
25.09
General
Account. An
undivided general investment account in which life insurers maintain funds
(reserves) to support a line of business; i.e. monies that are not invested
in
the separate account, which are investments common to variable universal life
products, characterized by investment performance and risk being passed through
to the policyholder, and being under control or direction of the
policyholder.
25.10 Gross
Statutory Reserve. For
purposes of this Agreement, it shall mean total Separate Account and General
Account Reserves calculated by the Company under (state) insurance regulations
and in accordance with accepted actuarial industry practice.
25.11 Insolvency/Insolvent.
For
purposes of this Agreement, either party to this Agreement shall be considered
insolvent when so declared by the regulatory agency responsible for such
determination.
25.12 Laws.
All
laws, regulations, judicial and administrative orders applicable to the business
reinsured under this Agreement, including, but not limited to, sanctions laws
administered by the U.S. Treasury Department's Office of Foreign Assets Control
("OFAC"), as such laws may be amended from time to time.
25.13 Maximum
Dollar Retention.
The
maximum dollar amount specified in Schedule B that is held by the Company at
its
own risk on a life without the benefit of proportional reinsurance. In
calculating the amount to be retained, the sum of all retained coverage held
by
the Company on the life and in force as of the date of issue of the Policy,
shall be taken into account.
25.14 Member
Firm.
A
Member Firm is any financial services entity that has (a) met the criteria
for
membership and has entered into the Marketing Agreement between and the Member
Firm or (b) is currently completing a provisional Member Firm
period.
25.15 Policy/Policies.
An
individual life insurance policy directly written by the Company on the policy
forms set forth in Schedule A that are the subject of reinsurance hereunder.
Such Policies may include other supplemental riders or endorsements. Reinsurance
of these supplemental benefits is specified in Schedule A or any addendum
attached hereto.
25
25.16 Punitive
Damages.
Those
damages awarded as a penalty, the amount of which is neither governed nor fixed
by statute.
25.17 Quota
Share Basis/Percentage.
A form
of reinsurance in which premiums and losses are shared proportionately between
the Company and the Reinsurer based on those percentages as specified in
Schedule B.
25.18 Reinsured
Amount.
For
Quota Share arrangements, the Reinsured Amount shall equal the Policy face
amount less the Quota Share Percentage Retained by the Company, as set forth
in
Schedule B.
25.19 Reinsurer’s
Retention.
As
specified in Schedule B, with respect to a Policy, this is the amount of the
Reinsured Amount retained by the Reinsurer and not ceded by the Reinsurer to
one
or more retrocessionaires.
25.20 Separate
Account.
This is
an account established by and in the name of the Company in a qualified U.S.
financial institution, the assets which are held apart from the general assets
of that financial institution.
25.21 Statutory
Penalties.
The
fixed amounts awarded by statute as a penalty in conjunction with an act,
omission or course of conduct related to a claim. In no event whatsoever, shall
the term Statutory Penalties include any Punitive Damages awards.
25.22 |
Ultimate
Amount.
The projected maximum face amount of a Policy that could be achieved
based
on certain assumptions made about the operation of the Policy during
the
insured’s lifetime.
|
25.23 Underwriting
Guidelines.
The
Underwriting Guidelines used by the Company to evaluate and assess the potential
insured risk, as specified in the attached Exhibits A and B.
ARTICLE
26
DURATION
AND TERMINATION
26.01 Duration
This
Agreement shall survive until the last benefit to the last policyholder has
occurred and been settled under the terms contained herein, unless all of the
Policies have been otherwise terminated by the Company or terminated by the
Reinsurer, as specifically allowed for and limited by this Agreement.
26.02 Closure
for New Reinsurance.
This
Agreement is for an unlimited duration. The Company or the Reinsurer may
terminate this Agreement with respect to new reinsurance by providing ninety
(90) calendar days written notice of termination, as per Article 23.07,
“Notices”, to the other party. During this notification period, the Company
shall continue to cede and the Reinsurer shall continue to accept Policies
pursuant to the terms of this Agreement.
26
ARTICLE
27
EXECUTION
This
Agreement is effective as of the ____ day of _______, 20__ and applies to all
eligible Policies with issue dates on or after such date. This Agreement has
been made in duplicate and is hereby executed by both parties with authorized
signatures as affixed below.
Nationwide
Financial
By Attest:
Title:
Title:
Date: Date:
Reinsurer
By:
Attest:
Title:
Title:
Date:
Date:
27
SCHEDULE
A
POLICY
FORMS REINSURED AND REINSURANCE BASIS
The
Company agrees to cede risk under the following Policy forms and riders, if
applicable, for the percentage of risk ceded; for Policy issue dates from and
to
the dates shown below.
Policy
Form & Plan Codes
|
Policy
Issue Dates
From
and To
|
Backdating:
Policies that have application dates on or after the above dates, but are only
backdated to save age in accordance with the Company’s standard policy are
covered under this Agreement
Occupation
Exclusions from Automatic Reinsurance
Entertainers
and High Profile Athletes (…to
be defined…)
Foreign
Travel Exclusions from Automatic Reinsurance
TBD
Foreign
Residence Exclusions from Automatic Reinsurance
TBD
28
SCHEDULE
B
REINSURANCE
BASIS AND LIMITS
MAXIMUM
DOLLAR RETENTION:
The
Company agrees to hold the following amounts on each life at its own risk
without the benefit of any other proportional reinsurance. For retention
determination purposes, other amounts retained by the Company on the life for
other individual life insurance policies in force, as of the Policy issue date
shall be taken into account.
Quota
Share Percentage Retained: 50% of Face
Amount
Quota
Share Percentage Reinsured: 50% of Face Amount
REINSURER
RETENTION:
The
Reinsurer agrees to hold the following:
$
per
life
AUTOMATIC
ACCEPTANCE LIMITS:*
Issue
Ages Amounts
and Mortality Distinctions
*The
Automatic Acceptance Limits presented do/do not include the Retention as stated
above.
AUTOMATIC
IN FORCE AND APPLIED FOR LIMITS (aka JUMBO or PARTICIPATION
LIMITS):
Issue
Ages Amounts
and Mortality Distinctions
CONDITIONAL
RECEIPT OR TEMPORARY INSURANCE AGREEMENT LIMIT:
29
SCHEDULE
C
ADMINISTRATION
REPORTS
Automatic
Reinsurance:
The
Company agrees to include all required information with respect to a Policy
on
the new business segment of the report or with a new business identifier on
its
next quarterly report submitted in accordance with this Schedule C following
issuance of the Policy.
Facultative
Reinsurance:
The
Company agrees to submit an application form for Facultative Reinsurance in
substantial accord with the attached form labeled as Exhibit C. If the Company
accepts the Reinsurer or the facultative underwriting Designee’s offer to
reinsure, it shall reinsure the Policy by including all required information
with respect to a Policy on the new business segment of the report or with
a new
business identifier on its next quarterly report submitted in accordance with
this Schedule following issuance of the Policy, but in no event later than
one
hundred twenty (120) days from the date of the final facultative offer or the
date specified in the facultative offer. The Company may request an extension
beyond the one hundred twenty (120) period; however, such an extension shall
require the Reinsurer’s or facultative underwriting Designee’s written
approval.
REINSURANCE
ADMINISTRATION SYSTEM REPORTING:
The
Company agrees to submit the following reports to the Reinsurer within five
(5)
business days following the end of each month {OR} quarter.
*Billing
Report -
providing Policy level detail in a form as mutually agreed upon by the parties
with data requirements as described in Exhibit E. If additional supplemental
benefits are reinsured, similar details shall be provided for such benefits.
The
billing report shall segment or identify the status of Policies and the
corresponding premiums as:
· |
New
Issues - those new Policies being reported for the first time to
the
Reinsurer.
|
· |
Renewals
-those Policies beginning in their 13th
month since issue.
|
· |
Changed
Policies - those Policies that have undergone a change since last
being
reported to the Reinsurer. Such changes shall include: reinstatements,
reissues, conversions, terminations, reductions, changes in retention,
mortality rating changes, increases, decreases,
etc.
|
*Accounting
Summary
- a
summary of all financial transactions during the reporting period. Distinctions
shall be made for first year and renewal activities, basic life versus
supplemental benefits and any adjustments affecting the
billing.
*Policy
Exhibit Summary
- a
policy exhibit substantially similar to the attached form providing in force
reinsurance totals at the beginning and ending of the reporting period and
a
summary of all Policy movements during the period.
*In
force Exhibits - { requirements in Exhibit E }
The
Reinsurer reserves the right to request additional information or change the
reporting requirements in order to properly administer the business under this
Agreement or support the preparation of its financial statements, at any time.
Such a request from the Reinsurer for additional information or a change in
the
requirements shall be reasonable and in a manner that allows the Company
reasonable time to comply or the parties may mutually agree upon alternate
reporting to satisfy the preparation of the Reinsurer’s financial
statements
30
QUARTERLY
CASH FLOW SETTLEMENT/MODIFIED COINSURANCE REPORTING:
Quarterly
Accounting Reports
All
reports and settlements described herein shall be calculated on a quarterly
accounting period, except for the Special Termination Settlement as described
in
Exhibit D. Accounting reports shall be submitted to the Reinsurer by the Company
not later than twenty (20) calendar days after the end of each calendar quarter.
Such reports shall include seriatim Policy information as specified in the
Quarterly Cash Flow Settlement section below for the then current calendar
quarter.
For
purposes of this Agreement, the following terms shall apply:
· |
Whenever
the term “the then current accounting period” is used herein it shall mean
the calendar quarter for which the reports described herein are being
prepared and not the calendar quarter in which the actual preparation
of
the report occurs.
|
· |
Whenever
the term “beginning or opening” accounting period is used herein it shall
be the first day of such then current accounting period or, for the
first
accounting period, the Effective Date of this Agreement.
|
· |
Opening
or beginning reserves shall mean the reserve as of the end of the
immediately preceding calendar quarter.
|
· |
Whenever,
the term “ending or closing” accounting period is used herein it shall
mean the last day of the then current calendar quarter or, in the
event of
the final quarter, the date of expiration or termination of this
Agreement.
|
Quarterly
Cash Flow Settlements
Quarterly cash flow settlements shall be determined on a net basis as of the
last day of each calendar quarter and shall be due and payable as of such date,
as provided below. The quarterly accounting settlement shall be an amount equal
to:
a) the
Reinsurance Premiums as defined in Article 6.01; plus
b) any
decrease in the Modified Coinsurance Reserve as defined in Article 6.02; plus
c) the
Consideration for Net Investment Income as defined in Article 6.03:
less
d) the
Commissions as defined in Article 7.01; less
e) the
Administration Expense Allowances as defined in Article 7.02; less
f) any
Increase in the Modified Coinsurance Reserve as defined in Article 7.03:
less
g) the
Allowance for Premium Tax as defined in Article 7.06; less
h) any
Death
Claims and Expenses as defined in Article 8.
Should
the above calculation result in a net positive cash flow, such net amount is
due
and payable to the Reinsurer. Should the above calculation result in a negative
net cash flow, such net amount is due and payable to the Company.
Due
Dates:
All
payments shall be considered timely if such payment is received within forty
five (45) calendar days after the close of the then current accounting
period.
31
Annual
Accounting Reports and Tax Settlements
The
parties agree to mutually exchange any and all reasonable information, reports,
listings or other data as may be required to properly complete their respective
Annual Statements, or GAAP Statements for such calendar year for the duration
of
this Agreement. All such information shall be made available within twenty
(20)
business days of the date such request for information was first made. The
parties agree that it shall pay to the other party an annual settlement for
DAC
taxes within thirty (30) calendar days after the close of such calendar year
in
accordance with Exhibit H.
NOTICES:
To
the
Reinsurer: To
the
Company:
Name
Title _____________________________
Company ______________________________
Address ______________________________
______________________________
32
SCHEDULE
C (continued)
POLICY
EXHIBIT SUMMARY
(Life
Reinsurance Only)
CEDING
COMPANY:
|
|||||||
REINSURER:
|
|||||||
ACCOUNT
NO:
|
|||||||
PREPARED
BY:
|
Phone:
|
(
)
|
|||||
DATE
PREPARED:
|
TYPE
OF
REINSURANCE:
Yearly
Renewable Term
|
|
Coinsurance
|
|
Modified
Coinsurance
|
|
Other
|
VALUATION
DATE:
NUMBER
OF
AMOUNT
OF
POLICIES
REINSURANCE
A. In
Force
Beginning
of
Period
/ /
B. New
Paid
Reinsurance Ceded
C. Reinstatements
D. Revivals
E. Increases
(Net)
F. Conversion
In
G. Transfers
In
H. Total
Increases (B - G)
I. Deaths
J. Maturities
K. Cancellations
L. Expiries
M. Surrenders
N. Lapses
O. Recaptures
P. Other
Decreases (Net)
Q. Reductions
R. Conversions
Out
S. Transfers
Out
T. Total
Decreases (I - S)
U. Current
In Force / /
(A
+ H - T)
|
33
SCHEDULE
C (continued)
ACCOUNTING
SUMMARY
CEDING
COMPANY:
|
|||||||
REINSURER:
|
|||||||
ACCOUNT
NO:
|
|||||||
PREPARED
BY:
|
Phone:
|
(
)
|
|||||
DATE
PREPARED:
|
TYPE
OF
REINSURANCE:
Yearly
Renewable Term
|
|
Coinsurance
|
|
Modified
Coinsurance
|
|
Other
|
VALUATION
DATE:
LIFE
WP
AD TOTAL
Premiums
First
Year
Renewal
Allowances
First
Year
Renewal
Adjustments
First
Year
Renewal
Net
Due
Reinsurer
First
Year
Renewal
TOTAL
DUE
|
(The
above information should be a summary of the detailed
information
provided to the Reinsurer.)
34
SCHEDULE
D
EXPENSE
ALLOWANCES
35
SCHEDULE
E
INVESTMENT
INCOME CALCULATIONS
The
investment income, for purposes of Article 6.03, shall be calculated for each
and every accounting period for the duration of this Agreement as
follows:
General
Account Assets.
For the
assets underlying the General Account portion of the modified coinsurance
reserves, the investment income shall be calculated according to the following
formula:
(A
+ B) /
2 multiplied by I
WHERE:
A
equals
the portion of the modified coinsurance reserves under the General Account
policyholder option as of the beginning of such then current accounting period;
and
B
equals
the same modified coinsurance reserve as of the end of such accounting period,
and
I
equals
25% of the prior calendar year’s annual investment yield rate. The settlement
will be trued up in the first quarter of each year.
Separate
Account Assets.
For the
assets underlying the separate account portion of the modified coinsurance
reserves, the investment income shall be equal to the sum of the daily
investment experience for each of the sub-accounts within the separate account.
The account value increases or decreases daily depending on the gross investment
experience of the sub-accounts to which the amounts are allocated at the
direction of the policyowner.
Such
separate accounts are operated as unit investment trusts registered under the
Investment Company Act of 1940. Such investment income shall be equal to the
sum
of:
a) |
total
Accrued Investment Income; plus
|
b) |
realized
and unrealized capital gains; less
|
c) |
realized
and unrealized capital losses; less
|
d) |
investment
expenses as defined below; plus
|
Quarterly
accounting settlements will reflect investment income based on the average
portfolio rate for the previous three months, for the pertinent investment
portfolio according to the third-party administrator investment report applied
to the current accounting period’s average modified coinsurance
reserves.
Investment
Expenses.
The term
investment expenses shall be those expenses listed below as they apply to their
respective investment income calculation above:
a) |
Investment
management fee paid by the Company’s General Account to the various
Investment Managers of the sub-accounts; and
|
36
b) |
Investment
expenses paid by the Company’s General Account which pertain to activities
undertaken by the Company;
and
|
c) |
Investment
expenses incurred by the Company’s Separate Account that are paid by the
General Account; and
|
d) |
Investment
expenses paid by the Company.
|
Any
change to the investment expenses described in this paragraph shall be made
only
upon the mutual consent of the parties, but the Reinsurer shall not withhold
its
consent if such changed expense is competitive with the industry charges of
other investment managers and less than loading for such investment expenses
then currently assessed to the policyholder.
37
EXHIBIT
A
UNDERWRITING
GUIDELINES
38
EXHIBIT
B
GUARANTEED
ISSUE UNDERWRITING GUIDELINES
39
EXHIBIT
C
FACULTATIVE
REINSURANCE APPLICATION FORM
40
EXHIBIT
D
SPECIAL
TERMINATION SETTLEMENTS
Special
Accounting and Settlement
In the
event that the reinsurance under this Agreement is prematurely recaptured or
terminated, as provided for herein or if by other mutual agreement of the
parties, other than due to the natural expiration of this Agreement due to
settlement of the last remaining policyholder's benefit, a special accounting
and settlement shall take place.
Special
Accounting Date
The
special accounting date shall be the effective date of recapture or termination
pursuant to any notice of recapture or termination given under this Agreement
or
such other date as shall be mutually agreed to in writing.
Special
Accounting Report
The
Company shall provide the Reinsurer a special accounting report providing all
of
the information contained in the quarterly accounting report and the annual
accounting report as defined in Schedule C, except that for all such reports
the
close of such accounting period shall be the special accounting date as defined
above. All reports shall be made available to the Reinsurer within sixty (60)
calendar days after the special accounting date.
Special
Cash Flow Settlement
The
special cash flow settlement shall consist of:
a) |
the
numeric result of the customary cash flow settlement as provided
for in
Schedule C, except that all amounts will be calculated as of the
instant
in time immediately before this Agreement expires. For example, the
ending
modified coinsurance reserve for purposes of this specific sub-paragraph
a) would be a numerical value and not the value zero, which it will
be
immediately upon the expiration of this Agreement; plus
|
b) |
payment
by the Company to the Reinsurer of an amount equal to the modified
coinsurance reserves on the portion of the Policies as of the instant
in
time immediately before the expiration of this Agreement. This payment
is
the reversal of the initial modified coinsurance adjustment, returning
the
Reinsurer’s assets for the modified coinsurance portion of the reserves.
It is the intent of the parties that under no circumstances should
this
payment not be fully and completely offset by the payment of (c)
below and
that the only reason for making such offsetting payments is to demonstrate
the full release of liability from one another; less
|
c) |
payment
by the Reinsurer to the Company of a final modified coinsurance reserve
adjustment equal to the modified coinsurance reserves on the portion
of
the Policies as of the instant in time immediately before the expiration
of this Agreement only if the Reinsurer has received full credit
for the
payment called for in b) above;
plus
|
d) |
payment
to the Reinsurer for the future profits, if any, defined as: the
present
value of future reinsurance premiums minus the present value of future
claims, benefit payments and expenses as determined in accordance
with the
Assumptions to Calculate Future Profits defined below; less
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e) |
payment
to the Company for any negative future profit, if any, defined as:
the
present value of future reinsurance premiums minus the present value
of
future claims, benefit payments and expenses as determined in accordance
with the Assumptions to Calculate Future Profits defined below;
plus
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41
f) |
payment
to the Reinsurer of an amount equal to the unamortized prior years’ DAC
tax capitalization, determined in accordance with Exhibit
H.
|
Should
the above calculation of subparagraphs (a) through (f) inclusive result in
a
positive cash flow, such net amount is due and payable to the Reinsurer. Should
the above calculation of subparagraphs (a) through (f) inclusive result in
a
negative cash flow, the absolute value of such net amount is due and payable
to
the Company. If only a portion of the Policies are terminated as described
in
Article 14, “Termination by Reinsurer”, then the settlement described above
shall be with respect to only those Policies or percentage of Policies
recaptured. All payments shall be considered timely if such payment is received
within fifteen (15) calendar days after the calculation is completed. Should
there be a delay in such payment, there will be an interest penalty for the
period that the amount is overdue, in accordance with Article 6.06, “Estimates
and Delays”. Any special cash flow settlement made shall be added to, or
subtracted from, any previous quarterly cash flow settlement amount outstanding
as of the special accounting date.
Assumptions
to Calculate Future Profits
The
assumptions used to calculate the future profits of the then existing block
of
business shall be as follows:
a) |
Mortality
The mortality assumption to be used in the calculation for such recaptured
Policies will be based on a blend of the Company's adjusted mortality
pricing assumption and the product of the Reinsurer's actual-to-expected
aggregate mortality ratio on Policies over the last five (5) years
on a
rolling average basis and the sum of the Company's original pricing
mortality table plus 2.5% of the mortality table used in the Company's
adjusted mortality pricing assumption.
|
This
blend shall be accomplished by weighting the Company’s and the Reinsurer’s
mortality assumption as follows: for all business reinsured for a period of
one
year or less a blend of 90% Company and 10% Reinsurer mortality will be used.
The Company's weight will decrease and the Reinsurer's weight will increase
10%
for every year the business has been in force under this Agreement until by
the
10th year the mortality assumption will be wholly the Reinsurer's mortality
and
no weight shall be given to the Company's mortality from that point forward.
This calculation shall be done separately for each underwritten block that
has a
different mortality pricing assumption.
For
the
purpose of the Reinsurer's actual to expected mortality, “actual” is defined as
the Reinsurer's paid claims, as defined in Article 8, “Death Claims” ,and
Article 9, “Disputed Claims”, from the inception of this Agreement and
“expected” is defined as the claims liability that would have emerged had the
Company's original pricing mortality assumption exactly been realized. If the
type of business being measured has been reinsured for less than five (5) years,
then such shorter time period shall be used in lieu of the five (5) years
rolling average period in the previous paragraph. The adjusted mortality pricing
assumption is defined as the Company's original mortality assumption multiplied
42
by
a
factor representing the ratio of the present value of cost of insurance charges
currently applicable to the Policies to the present value of the cost of
insurance charges in effect when such Policies were first reinsured. The Company
will share with the Reinsurer the details of any such modification prior to
its
being implemented for any change in the level of cost of insurance charges
due
under this Agreement. If there are any disagreements in the calculation, then
any disagreements will be settled under the Arbitration provisions, as set
forth
in Article 20 of this Agreement. The initial grade-in period during which the
blend referred to above would apply would be ten (10) calendar years where
yyyy
(e.g. 2006) (or the first year that a particular type of business is first
reinsured, if later) is defined to be the first year.
b) |
Lapse
Assumption
The lapse assumption used in the calculation for such recaptured
Policies
will be based on a blend of the Company's adjusted pricing lapse
assumption and the Reinsurer's actual lapse rate measured over the
last
three (3) years on a rolling average basis. The grade in period would
be
seven (7) years over which the Reinsurer's experience would be one
seventh
after year one, two-sevenths after year two, etc. up to one hundred
percent (100%) after this Agreement has been in effect for seven
(7) full
years.
|
c) |
Special
Cases
If
the profit levels of a single case are different than the underlying
Policy form, either in amount or incidence, then such special case
will be
treated as a unique valuation cell. Determination of such special
cases
will be by mutual agreement between the Company and the Reinsurer.
|
d) |
Expenses
Expenses shall be as defined in Article 7.02 and
7.06.
|
e) |
Interest
Rate Used in the Calculation
In
order to determine the present value, the Company shall use a discount
rate 100 basis points higher than the Company's then current asset
share
target rate of return. For example, as of the effective date of this
Agreement, such asset share target rate of return is _________ for
all
products, and the discount rate for purposes of this paragraph would
be
__________. The Company shall provide notice of any change in its
asset
share target rate of return for any product and such change shall
be
effective for the purposes of this subparagraph six (6) months after
such
notice is received.
|
f) |
Appropriateness
of Assumptions.
In the event that either party believes that any of the above methods
for
determining the mortality and lapse assumptions to be used to calculate
future profits is inappropriate based upon the expectation for future
experience, then that party may recommend that a different assumption
be
used. If the other party does not agree with the recommendation,
then an
independent actuary shall be used to develop the assumption. The
cost of
such actuary shall be borne equally by the
parties.
|
g) |
Calculation
Process
The calculation will be initially done by the Reinsurer, but will
be
subject to review by the Company. At the Company's request, an independent
actuary shall be used to verify that the Reinsurer's calculations
are
accurate, and based on the assumptions described above. Such actuary
must
be satisfactory to both parties, and the cost of such actuary shall
be
borne equally by the parties. Upon such recapture, the Reinsurer's
obligation to the Company under this Agreement shall
terminate.
|
h) |
Reasonability
of Final Calculations
In
doing this calculation a reasonability test will be employed using
current
actuarial principles not inconsistent with this Agreement since not
all
contingencies can be addressed in advance. Such reasonability testing
will
be also subject to review by the independent actuary, if requested.
The
cost of such actuary shall be borne equally by the
parties.
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43
EXHIBIT
E
REINSURANCE
DATA INFORMATION
44
EXHIBIT
F
FOREIGN
NATIONAL COUNTRY CODES
Country
codes classifications may change periodically, but shall not require a formal
amendment to this agreement. Country code classifications shall be considered
during the underwriting assessment at the time of application.
45
EXHIBIT
G
STATE
PREMIUM TAX TABLE
(insert
table)
46
EXHIBIT
H
FORMULA
FOR ANNUAL DAC TAX SETTLEMENT
Within
thirty (30) calendar days of the end of the Company’s taxable year, the Company
shall calculate the DAC Tax Payment for the year and submit such calculations
to
the Reinsurer for review. If, within thirty (30) calendar days of the
Reinsurer’s receipt of such calculations, the Reinsurer shall not have objected
in writing to such calculations, the calculation shall become final. If, within
fifteen (15) business days of any objection in writing to such calculations,
the
Company and the Reinsurer shall not have agreed in writing to such calculations,
any disputed aspects of the calculations shall be resolved by an outside tax
consultant neutral to the parties. The decision of the outside tax consultant
shall be final (and the resulting calculations shall be final), and the costs,
expenses, and fees of the outside tax consultant shall be borne equally by
the
Company and the Reinsurer.
Should
the above calculation for the DAC Tax Payment be positive, such amount is due
and payable to the Company. Should the above calculation for the DAC Tax Payment
be negative, such amount is due and payable to the Reinsurer.
Should
a
material change in the DAC Tax Capitalization Rate (CR), as defined in IRC
Section 848, the Corporate Tax Rate (T) applicable for Life Insurance Companies,
or other factors in the DAC tax formula occur, then this calculation should
be
adjusted accordingly.
47
EXHIBIT
I
UNDERWRITING
AND CLAIMS PROTOCOL
Underwriting
Guidelines in effect, and limited to the facts known, at the time the risk
was
originally underwritten. The following underwriting protocols are set forth
by
the parties in an attempt to provide guidance with regard to the boundaries
in
the use of “underwriting judgment” during the underwriting of a Policy. The
parties acknowledge that no single document can definitively address all the
facts and circumstances that may arise in this area. However, the following
is
intended to express the parties’ intent with regard to the proper application of
underwriting judgment.
1. |
Criteria.
The Reinsurer acknowledges that Underwriting Guidelines are based
on the
Company’s underwriting manual and include the preferred criteria and the
age and amount requirements shown in Exhibits A and B, which have
been
reviewed and agreed to by the Reinsurer.
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2. |
Prudent
Underwriter Standard.
When underwriting a risk to be reinsured under this Agreement, the
Company’s underwriters shall act in good faith and utilize the care, skill
and diligence that would be expected of a reasonably prudent underwriter,
with substantially similar knowledge of and experience in underwriting,
would use in doing the same (the “Prudent Underwriter Standard”).
|
3. |
Controls.
A
control process has been established and will remain in place that
effectively monitors underwriting activity to ensure that i) risks
are
evaluated by appropriate levels of experience and knowledge, ii)
appropriate reviews of underwriting decisions are made and iii) the
Underwriting Guidelines and Prudent Underwriter Standard are followed.
The
Company will not alter its control process without notifying the
Reinsurer.
|
4. |
Claim
Reviews.
A
review by the Reinsurer along with its claims paying Designee of
the
underwriting of a particular risk must be based on the Underwriting
Guidelines of the Company. Further, the review may include facts
that
should have been known as a result of diligent inquiry so long as,
based
upon the known facts, a reasonably prudent underwriter would have
been
expected to make further inquiry.
|
If,
as
part of examining a claim in accordance with Article 8, “Death Claims”, or
inspecting the Company’s records in accordance with Article 16, “Inspection of
Records”, the Reinsurer or its claims paying Designee finds that the
underwriting assessment of a Policy was not consistent with the Underwriting
Guidelines and/or the Prudent Underwriter Standard, the remedy will be a
retroactive adjustment of any premiums and considerations, with interest. The
Reinsurer, along with its claims paying Designee, shall not deny the claim
payment or rescind coverage unless it assesses the risk in question as
uninsurable.
5. |
Audit
of Records.
Should the Company agree with a settlement adjustment sought by the
Reinsurer under Section 4 of this Exhibit, it will, on request, audit
its
own records and retroactively adjust other premiums and considerations
as
appropriate, with interest. The scope of the audit, which will be
agreed
by the parties, will be reasonable and will be limited to policies
that
have similar circumstances to the Policy or Policies in question.
|
6. |
Disputes
of Assessments.
Should the Company dispute the Reinsurer’s assessment, it may hire a
neutral and disinterested underwriter (the “Neutral Underwriter”), whose
decision will be binding on both parties. If the Neutral Underwriter
agrees with the Reinsurer, Section 4 of this Exhibit will apply as
if the
Company had not disputed the Reinsurer’s assessment. Should the Neutral
Underwriter agree with the Company, Article 6, “Payments by the Company”,
Article 8, “Death Claims”, and Article 9, “Disputed Claims”, will apply as
if the Reinsurer had not questioned the
underwriting.
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48
7. |
Nomination
of Neutral Underwriter.
If
a Neutral Underwriter must be appointed to resolve an underwriting
dispute, both parties will nominate three life underwriters with
at least
ten years of experience who are not currently or formerly affiliated
with
either party. Both parties will strike two of the other side’s three
nominees, and the Neutral Underwriter will be chosen from among the
remaining two by drawing lots. The Neutral Underwriter must choose
one
party’s position or the other.
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8. |
Right
of Termination.
Nothing in this Exhibit is intended to limit either party’s ability to
exercise its right to terminate the Agreement in accordance the terms
contained therein.
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49
POLICY
SPLIT OPTION ADDENDUM
The
provisions of the Agreement to which this Addendum is attached shall apply
in
all respects to reinsurance of the Policy Split Option except as specifically
stated herein.