Pacific Life Insurance Company • [45 Enterprise, Aliso Viejo, CA 92656 www.PacificLife.com (800) 347-7787]
Pacific Life Insurance Company • [00 Xxxxxxxxxx, Xxxxx Xxxxx, XX 00000
xxx.XxxxxxxXxxx.xxx (000) 000-0000]
xxx.XxxxxxxXxxx.xxx (000) 000-0000]
READ YOUR POLICY CAREFULLY. This is a legal contract between you, the Owner, and us, Pacific Life
Insurance Company, a stock insurance company. We agree to pay the benefits of this policy
according to its provisions. The consideration for this policy is the Application for it, a copy
of which is attached, and payment of the initial and subsequent premiums.
Variable Account values and cash values are not guaranteed, and may increase or decrease depending
upon Variable Account investment experience.
While policy values may be affected by an external index, the Indexed Fixed Account Options do not
directly participate in any stock or equity investment.
The method for determining the Death Benefit is described in the Death Benefit section of this
policy. The amount of the Death Benefit may be fixed or variable depending on the Death Benefit
Option elected and the investment experience of the Variable Accounts. Please reference the Index
located at the end of this contract to determine the page on which the Death Benefit is described.
Premiums are flexible, subject to minimums required to keep the policy In Force. Even if Planned
Premiums are paid, it is possible that, due to changes in interest credited, the investment
performance of the Variable Accounts and Policy Charges, the policy may not continue In Force; that
is, it may lapse before any death benefit is payable on the death of the Insured. The initial
interest rate for the Fixed Account is guaranteed for the first policy year. Additionally, loans,
withdrawals, and Death Benefit Option changes can affect the length of time the policy stays In
Force.
Signed for Pacific Life Insurance Company,
INDEXED FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE
• | Death Benefit Payable On The Death Of The Insured | |
• | Net Cash Surrender Value Payable Upon Surrender | |
• | Benefits May Vary Based On Investment Experience | |
• | Adjustable Face Amount | |
• | Non-Participating |
INSURED:
|
[XXXXXX XXXXXXXX] | |||||
SEX AND AGE:
|
[MALE 35] | |||||
RISK CLASS:
|
[STANDARD NONSMOKER] | |||||
POLICY NUMBER:
|
[VF99999990] | TOTAL FACE AMOUNT | [$125,000] | |||
POLICY DATE:
|
[November 1, 2012] | OWNER: | [XXXXXX XXXXXXXX] |
Free
Look Right – You may return this policy within [10] days after you receive it. To do so,
deliver it or mail it to us or to the registered representative who delivered it to you. This
policy will then be deemed void from the beginning and we will refund any Premium Load deducted
from the premiums, plus any Net Premiums allocated to available Fixed Options, plus the Accumulated
Value allocated to the Variable Options and the Index Fixed Account Options, plus any monthly
charges and fees deducted from the policy’s Accumulated Value in the Variable Options.
ICC12 P12VUL | PS VUL |
(This Page Intentionally Left Blank)
Page 2
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
BASE POLICY: | INDEXED FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE | |||
PREMIUMS:
|
PLANNED [ANNUAL] PREMIUM | = [$2,747.25] | ||
7-PAY PREMIUM | = [$4,197.83] |
DEATH BENEFIT QUALIFICATION TEST:
|
[CASH VALUE ACCUMULATION TEST] | |
DEATH BENEFIT OPTION: [A] |
MINIMUM GUARANTEED INTEREST RATE FOR FIXED OPTIONS: 2.00% ANNUALLY. ANY EXCESS INTEREST DECLARED
BY US WILL BE GUARANTEED FOR ONE YEAR.
NET AMOUNT AT RISK FACTOR: 1.0016516
MONTHLY DEDUCTION END DATE: POLICY ANNIVERSARY WHEN THE INSURED ATTAINS AGE 121
MAXIMUM PREMIUM LOAD RATE: 6.55%
ADMINISTRATIVE CHARGE PER MONTH: $[7.50]
INDEXED ACCOUNT SEGMENT START DATES: THE 15TH DAY OF EACH CALENDAR MONTH
(SEE INDEXED FIXED ACCOUNT OPTIONS SECTION FOR ADDITIONAL INFORMATION)
[STATE DEPARTMENT OF INSURANCE: (XXX) XXX-XXXX]
ICC12 P12VUL | Page 3.0 |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
SURRENDER CHARGE EFFECTIVE
AT BEGINNING OF COVERAGE YEAR
AT BEGINNING OF COVERAGE YEAR
COVERAGE YEAR |
SURRENDER CHARGE |
REDUCTION FACTOR |
||||
[1 | $243.00 | $24.30 | ||||
2 | 218.70 | 24.30 | ||||
3 | 194.40 | 24.30 | ||||
4 | 170.10 | 24.30 | ||||
5 | 145.80 | 24.30 | ||||
6 | 121.50 | 24.30 | ||||
7 | 97.20 | 24.30 | ||||
8 | 72.90 | 24.30 | ||||
9 | 48.60 | 24.30 | ||||
10 | 24.30 | 24.30 | ||||
11+ | 0 | 0] |
ICC12 P12VUL | Page 3.1 |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
SUMMARY OF COVERAGES EFFECTIVE ON THE POLICY DATE
P12VUL | BASIC LIFE COVERAGE [GUARANTEED ISSUE] | |||||
FACE AMOUNT: | [$25,000] | |||||
INSURED: | [XXXXXX XXXXXXXX] | |||||
SEX AND AGE: | [MALE 35] | |||||
RISK CLASS: | [STANDARD NONSMOKER] | |||||
[R12SVC | SVER TERM INSURANCE RIDER-CORPORATE] [GUARANTEED ISSUE] | |||||
FACE AMOUNT: | [$100,000] | |||||
INSURED: | [XXXXXX XXXXXXXX] | |||||
SEX AND AGE: | [MALE 35] | |||||
RISK CLASS: | [STANDARD NONSMOKER] | |||||
[R12DPR | DOWNSIDE PROTECTION RIDER] | |||||
ADDITIONAL PREMIUM LOAD: | ||||||
æ ç ç ç è |
POLICY YEAR 27 | ö ÷ ÷ ÷ ø |
æ ç ç ç è |
5% | ö ÷ ÷ ÷ ø |
|
POLICY YEAR 28 | 10 | |||||
POLICY YEAR 29 | 15 | |||||
POLICY YEAR 30 | 20 | |||||
ALTERNATE ACCUMULATED VALUE MONTHLY FACTOR: RIDER MATURITY DATE: MINIMUM PREMIUM REQUIREMENT: MINIMUM PREMIUM DATE: MAXIMUM GUARANTEED RIDER MONTHLY CHARGE RATE: |
[1.0000000]
[11-01-2042] [$1,259.35] [11-01-2013] [0.04583]% |
|||
AVERAGING PERIOD: FROM POLICY YEAR [1] THROUGH POLICY YEAR [25] | ||||
[R12SNL
|
SHORT-TERM NO-LAPSE GUARANTEE RIDER] | |
GUARANTEE PERIOD = [20 YEARS] ANNUAL NO-LAPSE GUARANTEE PREMIUM = $[1,262.17] |
||
MONTHLY FACTOR FOR ACCUMULATION OF THE NO-LAPSE CREDIT IF THE NO-LAPSE CREDIT IS POSITIVE: 1.000000 |
ICC12 P12VUL | Page 3.2 |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
[R12CIC
|
ACCELERATED DEATH BENEFIT RIDER FOR CHRONIC ILLNESS] | |||
MAXIMUM LIFETIME ACCELERATED DEATH BENEFIT FOR CHRONIC ILLNESS: | [$1,500,000.00]* | |||
*THE ACCELERATED DEATH BENEFIT WILL NOT EXCEED THE ACTUAL DEATH BENEFIT AT TIME OF RIDER EXERCISE. | ||||
MAXIMUM PER DIEM LIMIT PERCENTAGE: | [125%] | |||
[EFFECTIVE DATE] | [NOVEMBER 1, 2012] | |||
[R12TIC | ACCELERATED DEATH BENEFIT RIDER FOR TERMINAL ILLNESS] | |||
ELIGIBLE COVERAGE: | BASE POLICY | |||
[SVER TERM INSURANCE RIDER-CORPORATE] | ||||
[ANNUAL RENEWABLE TERM RIDER] | ||||
[OTHER] | ||||
[EFFECTIVE DATE] | [NOVEMBER 1, 2012] | |||
ICC12 P12VUL | Page 3.3 |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
TERMINATION CREDIT
MONTHLY TERMINATION CREDIT CHARGE:
|
[$5.04] | |
TERMINATION CREDIT CHARGE PERIOD:
|
[5 YEARS] | |
MAXIMUM ANNUAL TERMINATION CREDIT BASIS:
|
[$4,197.83] |
POLICY YEAR | TERMINATION CREDIT FACTOR |
|||||
[1 – 5 | 0.12% | |||||
6+ | 0%] | |||||
POLICY YEAR | POLICY MONTH | TERMINATION CREDIT PERCENTAGE |
||||
[1 | 1 | 2.50% | ||||
1 | 2 | 3.00% | ||||
1 | 3 | 3.50% | ||||
1 | 4 | 4.00% | ||||
1 | 5 | 4.50% | ||||
1 | 6 | 5.00% | ||||
1 | 7 | 5.50% | ||||
1 | 8 | 6.00% | ||||
1 | 9 | 6.50% | ||||
1 | 10 | 7.00% | ||||
1 | 11 | 7.50% | ||||
1 | 12 | 8.00% | ||||
2 | 1 - 12 | 7.25% | ||||
3 | 1 - 12 | 6.75% | ||||
4 | 1 - 12 | 6.00% | ||||
5 | 1 - 12 | 5.25% | ||||
6 | 1 - 12 | 4.75% | ||||
7 | 1 - 12 | 4.00% | ||||
8 | 1 - 12 | 3.25% | ||||
9 | 1 - 12 | 2.75% | ||||
10 | 1 - 12 | 2.00% | ||||
11 | 1 - 12 | 1.25% | ||||
12 | 1 - 12 | 0.75% | ||||
13+ | 1 - 12 | 0.00%] |
ICC12 P12VUL | Page 3.4 |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
TABLE OF COST OF INSURANCE RATES
FOR BASIC LIFE COVERAGE [GUARANTEED ISSUE]
INSURED:
[XXXXXX XXXXXXXX]
MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000.00 OF NET AMOUNT AT RISK APPLICABLE TO THIS
COVERAGE.
POLICY YEAR |
MONTHLY RATE |
|||||
[1 | 0.10090 | |||||
2 | 0.10670 | |||||
3 | 0.11170 | |||||
4 | 0.12010 | |||||
5 | 0.12840 | |||||
6 | 0.13760 | |||||
7 | 0.14930 | |||||
8 | 0.16350 | |||||
9 | 0.17930 | |||||
10 | 0.19940 | |||||
11 | 0.22110 | |||||
12 | 0.24200 | |||||
13 | 0.26460 | |||||
14 | 0.27790 | |||||
15 | 0.29380 | |||||
16 | 0.31390 | |||||
17 | 0.33900 | |||||
18 | 0.37330 | |||||
19 | 0.41180 | |||||
20 | 0.45950 | |||||
21 | 0.51560 | |||||
22 | 0.57510 | |||||
23 | 0.63890 | |||||
24 | 0.69180 | |||||
25 | 0.75230 | |||||
26 | 0.82540 | |||||
27 | 0.91630 | |||||
28 | 1.02660 | |||||
29 | 1.14970 | |||||
30 | 1.27900 | |||||
31 | 1.41510 | |||||
32 | 1.55240 | |||||
33 | 1.68980 | |||||
34 | 1.83930 | |||||
35 | 1.99170 | |||||
36 | 2.17330 | |||||
37 | 2.37670 | |||||
38 | 2.64820 | |||||
39 | 2.93180 | |||||
40 | 3.23010 | |||||
41 | 3.56140 | |||||
42 | 3.92360 | |||||
43 | 4.34570 | |||||
44 | 4.84010 |
ICC12 P12VUL | Page 4.* |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
TABLE OF COST OF INSURANCE RATES
FOR BASIC LIFE COVERAGE [GUARANTEED ISSUE]
CONTINUED
FOR BASIC LIFE COVERAGE [GUARANTEED ISSUE]
CONTINUED
INSURED:
[XXXXXX XXXXXXXX]
MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000.00 OF NET AMOUNT AT RISK
APPLICABLE TO THIS COVERAGE.
POLICY YEAR |
MONTHLY RATE |
|||||||
45 | 5.41330 | |||||||
46 | 6.04180 | |||||||
47 | 6.76170 | |||||||
48 | 7.51460 | |||||||
49 | 8.33040 | |||||||
50 | 9.24140 | |||||||
51 | 10.27540 | |||||||
52 | 11.43490 | |||||||
53 | 12.71510 | |||||||
54 | 14.10520 | |||||||
55 | 15.59360 | |||||||
56 | 17.17060 | |||||||
57 | 18.67330 | |||||||
58 | 20.26540 | |||||||
59 | 21.97380 | |||||||
60 | 23.81220 | |||||||
61 | 25.79270 | |||||||
62 | 27.64150 | |||||||
63 | 29.65380 | |||||||
64 | 31.85100 | |||||||
65 | 34.25960 | |||||||
66 | 36.90860 | |||||||
67 | 39.06360 | |||||||
68 | 41.41760 | |||||||
69 | 43.99540 | |||||||
70 | 46.82420 | |||||||
71 | 49.93700 | |||||||
72 | 53.37330 | |||||||
73 | 57.18460 | |||||||
74 | 61.42910 | |||||||
75 | 66.18210 | |||||||
76 | 71.53880 | |||||||
77 | 77.62690 | |||||||
78 | 83.33330 | |||||||
79 | 83.33330 | |||||||
80 | 83.33330 | |||||||
81 | 83.33330 | |||||||
82 | 83.33330 | |||||||
83 | 83.33330 | |||||||
84 | 83.33330 | |||||||
85 | 83.33330 | |||||||
86 | 83.33330 | |||||||
87+ | 0] |
ICC12 P12VUL | Page 4.* |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
TABLE OF COST OF INSURANCE RATES
FOR SVER TERM INSURANCE RIDER-CORPORATE [GUARANTEED ISSUE]
FOR SVER TERM INSURANCE RIDER-CORPORATE [GUARANTEED ISSUE]
INSURED:
[XXXXXX XXXXXXXX]
MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000.00 OF NET AMOUNT AT RISK APPLICABLE TO THIS
COVERAGE.
POLICY YEAR |
MONTHLY RATE |
|||||||
[1 | 0.10090 | |||||||
2 | 0.10670 | |||||||
3 | 0.11170 | |||||||
4 | 0.12010 | |||||||
5 | 0.12840 | |||||||
6 | 0.13760 | |||||||
7 | 0.14930 | |||||||
8 | 0.16350 | |||||||
9 | 0.17930 | |||||||
10 | 0.19940 | |||||||
11 | 0.22110 | |||||||
12 | 0.24200 | |||||||
13 | 0.26460 | |||||||
14 | 0.27790 | |||||||
15 | 0.29380 | |||||||
16 | 0.31390 | |||||||
17 | 0.33900 | |||||||
18 | 0.37330 | |||||||
19 | 0.41180 | |||||||
20 | 0.45950 | |||||||
21 | 0.51560 | |||||||
22 | 0.57510 | |||||||
23 | 0.63890 | |||||||
24 | 0.69180 | |||||||
25 | 0.75230 | |||||||
26 | 0.82540 | |||||||
27 | 0.91630 | |||||||
28 | 1.02660 | |||||||
29 | 1.14970 | |||||||
30 | 1.27900 | |||||||
31 | 1.41510 | |||||||
32 | 1.55240 | |||||||
33 | 1.68980 | |||||||
34 | 1.83930 | |||||||
35 | 1.99170 | |||||||
36 | 2.17330 | |||||||
37 | 2.37670 | |||||||
38 | 2.64820 | |||||||
39 | 2.93180 | |||||||
40 | 3.23010 | |||||||
41 | 3.56140 | |||||||
42 | 3.92360 | |||||||
43 | 4.34570 | |||||||
44 | 4.84010 |
ICC12 P12VUL | Page 4.* |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
TABLE OF COST OF INSURANCE RATES
FOR SVER TERM INSURANCE RIDER-CORPORATE [GUARANTEED ISSUE]
CONTINUED
FOR SVER TERM INSURANCE RIDER-CORPORATE [GUARANTEED ISSUE]
CONTINUED
INSURED:
[XXXXXX XXXXXXXX]
MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000.00 OF NET AMOUNT AT RISK
APPLICABLE TO THIS COVERAGE.
POLICY YEAR |
MONTHLY RATE |
|||||||
45 | 5.41330 | |||||||
46 | 6.04180 | |||||||
47 | 6.76170 | |||||||
48 | 7.51460 | |||||||
49 | 8.33040 | |||||||
50 | 9.24140 | |||||||
51 | 10.27540 | |||||||
52 | 11.43490 | |||||||
53 | 12.71510 | |||||||
54 | 14.10520 | |||||||
55 | 15.59360 | |||||||
56 | 17.17060 | |||||||
57 | 18.67330 | |||||||
58 | 20.26540 | |||||||
59 | 21.97380 | |||||||
60 | 23.81220 | |||||||
61 | 25.79270 | |||||||
62 | 27.64150 | |||||||
63 | 29.65380 | |||||||
64 | 31.85100 | |||||||
65 | 34.25960 | |||||||
66 | 36.90860 | |||||||
67 | 39.06360 | |||||||
68 | 41.41760 | |||||||
69 | 43.99540 | |||||||
70 | 46.82420 | |||||||
71 | 49.93700 | |||||||
72 | 53.37330 | |||||||
73 | 57.18460 | |||||||
74 | 61.42910 | |||||||
75 | 66.18210 | |||||||
76 | 71.53880 | |||||||
77 | 77.62690 | |||||||
78 | 83.33330 | |||||||
79 | 83.33330 | |||||||
80 | 83.33330 | |||||||
81 | 83.33330 | |||||||
82 | 83.33330 | |||||||
83 | 83.33330 | |||||||
84 | 83.33330 | |||||||
85 | 83.33330 | |||||||
86 | 83.33330 | |||||||
87+ | 0] |
ICC12 P12VUL | Page 4.* |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
TABLE OF MAXIMUM MONTHLY COVERAGE CHARGES
FOR BASIC LIFE COVERAGE [GUARANTEED ISSUE]
FOR BASIC LIFE COVERAGE [GUARANTEED ISSUE]
INSURED:
[XXXXXX XXXXXXXX]
POLICY YEAR |
BASIC LIFE COVERAGE CHARGE |
|||||||
[1 | $43.18 | |||||||
2 | 43.18 | |||||||
3 | 43.18 | |||||||
4 | 43.18 | |||||||
5 | 43.18 | |||||||
6 | 43.18 | |||||||
7 | 43.18 | |||||||
8 | 43.18 | |||||||
9 | 43.18 | |||||||
10 | 43.18 | |||||||
11 | 43.18 | |||||||
12 | 43.18 | |||||||
13 | 43.18 | |||||||
14 | 43.18 | |||||||
15 | 43.18 | |||||||
16 | 43.18 | |||||||
17 | 43.18 | |||||||
18 | 43.18 | |||||||
19 | 43.18 | |||||||
20 | 43.18 | |||||||
21 | 43.39 | |||||||
22 | 43.60 | |||||||
23 | 43.83 | |||||||
24 | 44.05 | |||||||
25 | 44.29 | |||||||
26 | 44.53 | |||||||
27 | 44.78 | |||||||
28 | 45.04 | |||||||
29 | 45.30 | |||||||
30 | 45.58 | |||||||
31 | 45.86 | |||||||
32 | 46.14 | |||||||
33 | 46.44 | |||||||
34 | 46.75 | |||||||
35 | 47.06 | |||||||
36 | 47.38 | |||||||
37 | 47.72 | |||||||
38 | 48.06 | |||||||
39 | 48.41 | |||||||
40 | 48.78 | |||||||
41 | 49.15 | |||||||
42 | 49.53 | |||||||
43 | 49.93 | |||||||
44 | 50.34 |
ICC12 P12VUL | Page 4.* |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
TABLE OF MAXIMUM MONTHLY COVERAGE CHARGES
FOR BASIC LIFE COVERAGE [GUARANTEED ISSUE]
CONTINUED
FOR BASIC LIFE COVERAGE [GUARANTEED ISSUE]
CONTINUED
INSURED:
[XXXXXX XXXXXXXX]
POLICY | BASIC LIFE COVERAGE | |||||||
YEAR | CHARGE | |||||||
45 | $50.76 | |||||||
46 | 51.19 | |||||||
47 | 51.63 | |||||||
48 | 52.09 | |||||||
49 | 52.56 | |||||||
50 | 53.05 | |||||||
51 | 53.54 | |||||||
52 | 54.06 | |||||||
53 | 54.59 | |||||||
54 | 55.13 | |||||||
55 | 55.69 | |||||||
56 | 56.26 | |||||||
57 | 56.86 | |||||||
58 | 57.47 | |||||||
59 | 58.10 | |||||||
60 | 58.74 | |||||||
61 | 59.41 | |||||||
62 | 60.09 | |||||||
63 | 60.80 | |||||||
64 | 61.52 | |||||||
65 | 62.27 | |||||||
66 | 63.04 | |||||||
67 | 63.83 | |||||||
68 | 64.64 | |||||||
69 | 65.48 | |||||||
70 | 66.34 | |||||||
71 | 67.23 | |||||||
72 | 68.15 | |||||||
73 | 69.09 | |||||||
74 | 70.06 | |||||||
75 | 71.05 | |||||||
76 | 72.08 | |||||||
77 | 73.13 | |||||||
78 | 74.22 | |||||||
79 | 75.34 | |||||||
80 | 76.49 | |||||||
81 | 77.67 | |||||||
82 | 78.89 | |||||||
83 | 80.15 | |||||||
84 | 81.44 | |||||||
85 | 82.77 | |||||||
86 | 84.14 | |||||||
87+ | 0] |
ICC12 P12VUL | Page 4.* |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
TABLE OF MAXIMUM MONTHLY COVERAGE CHARGES
FOR SVER TERM INSURANCE RIDER-CORPORATE [GUARANTEED ISSUE]
FOR SVER TERM INSURANCE RIDER-CORPORATE [GUARANTEED ISSUE]
INSURED:
[XXXXXX XXXXXXXX]
POLICY YEAR |
COVERAGE CHARGE |
|||||||
[1 | 0.00 | |||||||
2 | 29.00 | |||||||
3 | 43.50 | |||||||
4 | 43.50 | |||||||
5 | 43.50 | |||||||
6 | 43.50 | |||||||
7 | 43.50 | |||||||
8 | 43.50 | |||||||
9 | 43.50 | |||||||
10 | 43.50 | |||||||
11 | 43.50 | |||||||
12 | 43.50 | |||||||
13 | 43.50 | |||||||
14 | 43.50 | |||||||
15 | 43.50 | |||||||
16 | 43.50 | |||||||
17 | 43.50 | |||||||
18 | 43.50 | |||||||
19 | 43.50 | |||||||
20 | 43.50 | |||||||
21 | 44.54 | |||||||
22 | 45.61 | |||||||
23 | 46.70 | |||||||
24 | 47.81 | |||||||
25 | 48.95 | |||||||
26 | 50.12 | |||||||
27 | 51.32 | |||||||
28 | 52.54 | |||||||
29 | 53.80 | |||||||
30 | 55.08 | |||||||
31 | 56.40 | |||||||
32 | 57.74 | |||||||
33 | 59.12 | |||||||
34 | 60.53 | |||||||
35 | 61.98 | |||||||
36 | 63.46 | |||||||
37 | 64.97 | |||||||
38 | 66.52 | |||||||
39 | 68.11 | |||||||
40 | 69.74 | |||||||
41 | 71.40 | |||||||
42 | 73.11 | |||||||
43 | 74.85 | |||||||
44 | 76.64 |
ICC12 P12VUL | Page 4.* |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
TABLE OF MAXIMUM MONTHLY COVERAGE CHARGES
FOR SVER TERM INSURANCE RIDER-CORPORATE [GUARANTEED ISSUE]
CONTINUED
FOR SVER TERM INSURANCE RIDER-CORPORATE [GUARANTEED ISSUE]
CONTINUED
INSURED:
[XXXXXX XXXXXXXX]
POLICY YEAR |
COVERAGE CHARGE |
|||||||
45 | $78.47 | |||||||
46 | 80.34 | |||||||
47 | 82.26 | |||||||
48 | 84.22 | |||||||
49 | 86.24 | |||||||
50 | 88.29 | |||||||
51 | 90.40 | |||||||
52 | 92.56 | |||||||
53 | 94.77 | |||||||
54 | 97.03 | |||||||
55 | 99.35 | |||||||
56 | 101.72 | |||||||
57 | 104.15 | |||||||
58 | 106.64 | |||||||
59 | 109.18 | |||||||
60 | 111.79 | |||||||
61 | 114.46 | |||||||
62 | 117.19 | |||||||
63 | 119.99 | |||||||
64 | 122.85 | |||||||
65 | 125.79 | |||||||
66 | 128.79 | |||||||
67 | 131.86 | |||||||
68 | 135.01 | |||||||
69 | 138.24 | |||||||
70 | 141.54 | |||||||
71 | 144.92 | |||||||
72 | 148.38 | |||||||
73 | 151.92 | |||||||
74 | 155.54 | |||||||
75 | 159.26 | |||||||
76 | 163.06 | |||||||
77 | 166.95 | |||||||
78 | 170.94 | |||||||
79 | 175.02 | |||||||
80 | 179.20 | |||||||
81 | 183.48 | |||||||
82 | 187.86 | |||||||
83 | 192.34 | |||||||
84 | 196.94 | |||||||
85 | 201.64 | |||||||
86 | 206.45 | |||||||
87+ | 0] |
ICC12 P12VUL | Page 4.* |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
[1 YEAR INDEXED ACCOUNT
Segment Term: 1 Year
Segment Guaranteed Interest Rate: 1.00%
Cumulative Segment Guaranteed Interest Rate: 1.00%
Guaranteed Minimum Participation Rate: 100% for the Segment Term
Guaranteed Minimum Growth Cap: 3% for the Segment Term
Monthly Indexed Account Charge Rate: 0.025%
Segment Guaranteed Interest Rate: 1.00%
Cumulative Segment Guaranteed Interest Rate: 1.00%
Guaranteed Minimum Participation Rate: 100% for the Segment Term
Guaranteed Minimum Growth Cap: 3% for the Segment Term
Monthly Indexed Account Charge Rate: 0.025%
Overview – This describes the elements and method used in calculating Segment Indexed Interest for
each Segment of this Indexed Account. The Participation Rate and Growth Cap used in determining
the credited rate from the index are not guaranteed and can be changed by us for future segments,
subject to the guarantees in the policy, and any such changes can affect the return. Also, see
Indexed Fixed Account Options.
Index – The Index is the S&P 500® index, excluding dividends. If the S&P 500® index is
discontinued, or if we are unable to use it for reasons beyond our control, we will substitute a
successor index of our choosing. In such case, we will notify you of the change at your last known
address.
Segment Indexed Interest – At Segment Maturity, Segment Indexed Interest will be credited to the
Segment and is equal to the Segment Indexed Interest Rate multiplied by the average of all Segment
Monthly Balances over the entire Segment Term.
Segment Monthly Balance – The Segment Monthly Balance is, as of the end of any Segment Month, the
amount initially transferred to the Segment on the Segment Date minus all Segment Deductions,
excluding any interest that may have been credited to the Segment.
Segment Indexed Interest Rate – The Segment Indexed Interest Rate reflects any growth in the Index
multiplied by the Participation Rate, subject to the Growth Cap, that exceeds the Cumulative
Segment Guaranteed Interest Rate. The Segment Indexed Interest Rate is equal to [the lesser of (a
x b) and c] – d, such result being not less than zero, where:
a = Index Growth Rate
b = Participation Rate
c = Growth Cap
d = Cumulative Segment Guaranteed Interest Rate
b = Participation Rate
c = Growth Cap
d = Cumulative Segment Guaranteed Interest Rate
Index Growth Rate – In calculating the Segment Indexed Interest, the Index Growth Rate for that
Segment Term is first calculated, as (b ÷ a) – 1, where:
a = the Closing Value of the Index as of the day before the beginning of the Segment Term; and
b = the Closing Value of the Index as of the day before the end of the Segment Term.
b = the Closing Value of the Index as of the day before the end of the Segment Term.
Participation Rate – This is the percentage of the Index Growth Rate that is used in calculating
the Segment Indexed Interest Rate. The Guaranteed Minimum Participation Rate is shown above. We
may declare a higher Participation Rate, which will be shown in your Annual Report or other written
notice.
Growth Cap – This is the maximum total interest rate for a Segment over the Segment Term,
including both the Cumulative Segment Guaranteed Interest Rate and the Segment Indexed Interest
Rate. The Guaranteed Minimum Growth Cap is shown above. We may declare a higher Growth Cap, which
will be shown in your Annual Report or other written notice.
Cumulative Segment Guaranteed Interest Rate – The Cumulative Segment Guaranteed Interest Rate is
the Segment Guaranteed Interest Rate compounded annually for the number of years of the Segment
Term.
Product – Refers to the product provided by this policy.
ICC12 P12VUL | Page 4.* |
POLICY NUMBER: [VP999999990]
POLICY SPECIFICATIONS
The Product is not sponsored, endorsed, sold or promoted by Standard & Poor’s® (“S&P”) or its third
party licensors. Neither S&P nor its third party licensors makes any representation or warranty,
express or implied, to the owners of the Product or any member of the public regarding the
advisability of investing in securities generally or in the Product particularly or the ability of
the S&P 500® index (the “Index”) to track general stock market performance. S&P’s and its third
party licensor’s only relationship to Pacific Life Insurance Company is the licensing of certain
trademarks and trade names of S&P and the third party licensors and of the Index which is
determined, composed and calculated by S&P or its third party licensors without regard to Pacific
Life Insurance Company or Product. S&P and its third party licensors have no obligation to take the
needs of Pacific Life Insurance Company or the owners of the Product into consideration in
determining, composing or calculating the Index. Neither S&P nor its third party licensors is
responsible for and has not participated in the determination of the prices and amount of the
Product or the timing of the issuance or sale of the Product or in the determination or calculation
of the equation by which the Product is to be converted into cash. S&P has no obligation or
liability in connection with the administration, marketing or trading of the Product.
NEITHER S&P, ITS AFFILIATES NOR THEIR THIRD PARTY LICENSORS GUARANTEE THE ADEQUACY, ACCURACY,
TIMELINESS OR COMPLETENESS OF THE INDEX OR ANY DATA INCLUDED THEREIN OR ANY COMMUNICATIONS,
INCLUDING BUT NOT LIMITED TO, ORAL OR WRITTEN COMMUNICATIONS (INCLUDING ELECTRONIC COMMUNICATIONS)
WITH RESPECT THERETO. S&P, ITS AFFILIATES AND THEIR THIRD PARTY LICENSORS SHALL NOT BE SUBJECT TO
ANY DAMAGES OR LIABILITY FOR ANY ERRORS, OMISSIONS OR DELAYS THEREIN. S&P MAKES NO EXPRESS OR
IMPLIED WARRANTIES, AND EXPRESSLY DISCLAIMS ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A
PARTICULAR PURPOSE OR USE WITH RESPECT TO THE MARKS, THE INDEX OR ANY DATA INCLUDED THEREIN.
WITHOUT LIMITING ANY OF THE FOREGOING, IN NO EVENT WHATSOEVER SHALL S&P, ITS AFFILIATES OR THEIR
THIRD PARTY LICENSORS BE LIABLE FOR ANY INDIRECT, SPECIAL, INCIDENTAL, PUNITIVE OR CONSEQUENTIAL
DAMAGES, INCLUDING BUT NOT LIMITED TO, LOSS OF PROFITS, TRADING LOSSES, LOST TIME OR GOODWILL, EVEN
IF THEY HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, WHETHER IN CONTRACT, TORT, STRICT
LIABILITY OR OTHERWISE.]
ICC12 P12VUL | Page 4.* |
DEFINITIONS
In this section, we define certain terms used throughout this policy. Other terms may be defined
in other parts of the policy. Defined terms are usually capitalized to provide emphasis.
Accounts – consist of the Fixed Account (see Accumulated Value), the Variable Account (see
Investment Options), the Loan Account (see Loan Account), and the Indexed Account (see Indexed
Account), each of which may be referred to as an Account.
Account Deductions – will reduce the Accumulated Value under the policy (see Accumulated Value).
An Account Deduction is any of the following:
1. | Monthly Deductions under the policy; | |
2. | Any withdrawal from the policy, including the withdrawal fee; | |
3. | Standard Policy Loans; | |
4. | Any distribution in order to maintain tax qualification under Code Section 7702 or to maintain the policy as a non-MEC under Code Section 7702A (see Modified Endowment Contract Tax Status); | |
5. | Payments, charges and fees under certain riders, if any; and | |
6. | Any charge, fee, or distribution that reduces the policy’s Accumulated Value. |
Accumulated Value – The Accumulated Value is defined on each Valuation Day and equals the sum of:
• | The Fixed Accumulated Value; | |
• | The Variable Accumulated Value; | |
• | The Indexed Accumulated Value; and | |
• | The Loan Account Value (see the Accumulated Value section). |
Administrative Office – is the office that administers your policy. The mailing address of the
Administrative Office at the time you applied for this policy is shown in the heading of the
Application. If the address changes, we will send you written notice of the new address.
Age – means the age as of the Insured’s birthday nearest to the Policy Date, increased by the
number of complete policy years elapsed.
Application – consists of the application for this policy, including any Certificate of Health,
Statement of Good Health and Insurability, amendments, and endorsements, and any application for
reinstatement or increase in benefits.
Basic Life Coverage – is insurance coverage on the Insured provided by this policy as shown in the
Policy Specifications and any related Supplemental Schedule of Coverage. Certain riders may
provide life insurance coverage, but such amounts are not included in the Basic Life Coverage.
Basic Face Amount – is the sum of the Face Amounts of all Basic Life Coverage Layers on the
Insured. The Face Amount of the initial Basic Life Coverage is shown in the Policy Specifications.
Business Day – is a day when both we and the New York Stock Exchange are open for business.
Class – is used in determining Policy Charges, and interest credited to the Fixed Options,
features of the Indexed Options, and depends on a number of factors, including (but not limited to)
the Death Benefit, Basic and Total Face Amount, Coverage Layer, Policy Date, policy duration,
premiums paid, the Insured’s Age and Risk Class, requested or scheduled additions of Coverage
Layers, and the presence of optional riders and benefits.
Code – is the U.S. Internal Revenue Code of 1986, as amended, and the rules and regulations issued
thereunder.
ICC12 P12VUL | Page 5 |
Coverage Layer – is a Basic Life Coverage Layer or a layer of insurance coverage on the Insured
under an optional rider.
Coverage Layer Date – is the date that a particular Coverage Layer is effective. Coverage Layer
months, years and anniversaries are measured from this date. The Coverage Layer Date for the
initial Coverage Layer is the Policy Date as shown in the Policy Specifications.
Evidence of Insurability – is information, including medical information, satisfactory to us that
is used to determine insurability and the Insured’s Risk Class, subject to our approval.
Face Amount – is the Face Amount of insurance coverage for each Coverage Layer as shown in the
Policy Specifications and any related Supplemental Schedule of Coverage. The Face Amount is
subject to increase or decrease as provided elsewhere in this policy.
Fixed Account – is an account that is part of our General Account to which all or a portion of Net
Premiums may be allocated for accumulation at a fixed rate of interest declared by us.
Fixed LT Account – is an account that is part of our General Account to which all or a portion of
Net Premiums may be allocated for accumulation at a fixed rate of interest declared by us.
Fixed Options – an Investment Option consisting of one or more Fixed Accounts available under this
policy, and are part of our General Account. The Fixed Accounts available as of the Policy Date
are the Fixed Account and the Fixed LT Account. Net Premiums and Accumulated Value under this
policy may be allocated to one or more Fixed Accounts.
Free Look Transfer Date – the day we transfer Accumulated Value from the Cash Management Variable
Account to the Investment Options you choose. The cover of your policy describes the Free Look
Right provided by your policy. If your policy provides for a full refund of premium upon exercise
of the Free Look Right, then the Free Look Transfer Date will not occur until 15 days after the
policy is placed In Force. If your policy provides for a return of value as described on the
cover, transfers will be processed according to the most recent premium allocation instructions we
have received from you, without a 15 day waiting period.
General Account – consist of all of our assets other than those allocated to the Separate Accounts
or to any of our other segregated asset accounts.
Indexed Account – is an account that is part of our General Account. We credit interest on the
Indexed Account, in part, based on any positive change in an Index.
Indexed Fixed Account Options – an Investment Option consisting of one or more Indexed Accounts
available under this policy, and is part of the General Account. The Indexed Accounts available as
of the Policy Date are shown in the Policy Specifications.
In Force – means a policy is in effect and provides a Death Benefit on the Insured.
Insured – is the person insured under this policy, as shown in the Policy Specifications.
Investment Options – consist of the Variable Options, the Fixed Options, the Indexed Fixed Account
Options, and any additional investment options that we may add.
Monthly Deduction End Date – is shown in the Policy Specifications and is the date when Monthly
Deductions end.
Monthly Payment Date – is the same day each month as the Policy Date and is the date on which
certain Policy Charges are deducted from the Accumulated Value. The first Monthly Payment Date is
the Policy Date.
ICC12 P12VUL | Page 6 |
Net Accumulated Value – is the Accumulated Value less any Policy Debt.
Net Amount at Risk – is the difference between the Death Benefit and the Accumulated Value.
Net Premium – is the premium we receive reduced by any Premium Load.
Owner, you, or your – refers to the Owner of this policy.
Policy Date – is shown on the Cover Page and means the date the policy and associated riders
become effective. Policy months, quarters, years and anniversaries are measured from this date.
Policy Debt – is the sum of the Loan Account and any accrued Loan Interest Charge.
Policy Specifications – is a section of the policy that shows information specific to your policy.
Risk Class – is used in determining Policy Charges and is determined by us during the underwriting
process for each Coverage Layer. Risk Class depends on the Insured’s gender, health, tobacco use,
and other factors. The Risk Class of the Insured for the initial Coverage Layer is shown in the
Policy Specifications. The Risk Class of the Insured for any additional Coverage Layer will be
shown in a Supplemental Schedule of Coverage sent to you at that time. Risk Class may also be
referred to as Risk Classification.
Separate Account – is the Pacific Select Exec Separate Account, which is a Separate Account of
ours that consists of subaccounts, also called Variable Accounts. Each Variable Account may invest
its assets in a separate class of shares of a designated investment company or companies.
Supplemental Schedule of Coverage – is the written notice we will provide you reflecting certain
changes made to your policy after the Policy Date.
Total Face Amount – is the sum of the Face Amount of Basic Life Coverage and the Face Amounts of
any riders providing coverage on the Insured. The Total Face Amount is used in determining the
Death Benefit under this policy and is shown in the Policy Specifications or subsequent
Supplemental Schedule of Coverage.
Valuation Day – is each day required by applicable law and currently includes each day the New
York Stock Exchange is open for trading and our Administrative Office is open.
Valuation Period – is the period of time between successive Valuation Days.
Variable Account – is a Separate Account of ours or a subaccount of a Separate Account of ours in
which assets are segregated from assets in our General Account and our other Separate Accounts.
Net Premiums and Accumulated Value under this policy may be allocated to one or more Variable
Accounts.
Variable Investment Option – a Variable Account.
Variable Options – an Investment Option consisting of one or more Variable Accounts available
under this policy, and are part of the Separate Account.
We, our, ours, and us – refer to Pacific Life Insurance Company.
Written Request – is your signed request in writing, or on a form we provide, and received by us
at our Administrative Office, containing information we need to act on the request.
ICC12 P12VUL | Page 7 |
DEATH BENEFIT
When the Policy is In Force – This policy is In Force as of the Policy Date, subject to your
acceptance of the delivered policy and payment of the initial premium. The policy remains In Force
until the earliest of the following:
• | Surrender, as described in the Surrender and Withdrawal of Values provision; | |
• | Lapse, as described in the Policy Lapse and Reinstatement section; or | |
• | The death of the Insured. |
Coverage under this policy is subject to any changes we have made to the policy at your request,
and may include increases or decreases in Total Face Amount, as described in later sections of this
policy.
Death Benefit – This policy provides a Death Benefit on the death of the Insured while this policy
is In Force. This section describes how the Death Benefit is calculated. The Death Benefit is the
larger of:
• | The Death Benefit calculated under the Death Benefit Option in effect; or | |
• | The Minimum Death Benefit specified below, according to the Death Benefit Qualification Test that applies to your policy. |
The Death Benefit as calculated above is subject to any increase required by the Minimum Death
Benefit provisions set out in General Provisions to satisfy certain federal tax qualification
requirements.
Minimum Death Benefit – The Minimum Death Benefit will be determined based on the Death Benefit
Qualification Test for the policy and at any time will be no less than the minimum amount we
determine to be required for this policy to qualify as a life insurance contract under the Code.
Death Benefit Options – You elected the initial Death Benefit Option in the Application. The
initial Death Benefit Option appears in the Policy Specifications. Some changes in Death Benefit
Option are allowed (see Change of Death Benefit Option). The Death Benefit according to each of
the Death Benefit Options is explained below.
• | Option A – The Death Benefit equals the Total Face Amount. | |
• | Option B – The Death Benefit equals the Total Face Amount plus the Accumulated Value. | |
• | Option C – The Death Benefit equals the Total Face Amount plus the sum of the premiums paid minus the sum of any withdrawals taken and any other distribution that reduces the Accumulated Value, provided that such result is limited to the amount shown in the Policy Specifications as the “Option C Death Benefit Limit”. Under this option, the Death Benefit may be less than the Total Face Amount. |
Death Benefit Qualification Test – In order for your policy to qualify as a life insurance
contract under the Code, it must at all relevant times satisfy one of two Death Benefit
Qualification Tests. The policy provides a Minimum Death Benefit amount, as needed, for the policy
to qualify under either of the Tests. Unless you elected otherwise in the Application, the Death
Benefit Qualification Test that is specified for this policy is the Guideline Premium Test. The
Death Benefit Qualification Test that this policy is designed to satisfy appears in the Policy
Specifications. You
may not change your policy’s specified Death Benefit Qualification Test without our written
consent. The two Death Benefit Qualification Tests and the Minimum Death Benefit amounts applicable
to each are explained in this subsection.
1. | Cash Value Accumulation Test – If this test applies to your policy, the Minimum Death Benefit will be no less than the greater of the minimum amount we determine to be required under the Code or 101% of the Accumulated Value. |
2. | Guideline Premium Test – If this test applies to your policy, the Minimum Death Benefit will be no less than the Accumulated Value multiplied by the Death Benefit Percentage for the Age of the Insured as shown in the following table. |
ICC12 P12VUL | Page 8 |
Death Benefit | Death Benefit | Death Benefit | Death Benefit | |||||||||||||||||||||||||
Age | Percentage | Age | Percentage | Age | Percentage | Age | Percentage | |||||||||||||||||||||
0-40
|
250 | % | 50 | 185 | % | 60 | 130 | % | 70 | 115 | % | |||||||||||||||||
41
|
243 | 51 | 178 | 61 | 128 | 71 | 113 | |||||||||||||||||||||
42
|
236 | 52 | 171 | 62 | 126 | 72 | 111 | |||||||||||||||||||||
43
|
229 | 53 | 164 | 63 | 124 | 73 | 109 | |||||||||||||||||||||
44
|
222 | 54 | 157 | 64 | 122 | 74 | 107 | |||||||||||||||||||||
45
|
215 | 55 | 150 | 65 | 120 | 75-90 | 105 | |||||||||||||||||||||
46
|
209 | 56 | 146 | 66 | 119 | 91 | 104 | |||||||||||||||||||||
47
|
203 | 57 | 142 | 67 | 118 | 92 | 103 | |||||||||||||||||||||
48
|
197 | 58 | 138 | 68 | 117 | 93 | 102 | |||||||||||||||||||||
49
|
191 | 59 | 134 | 69 | 116 | Over 93 | 101 |
Change
of Death Benefit Option – The Death Benefit Option may be changed to Option A or B upon
Written Request no more than once per policy year. Changes to Option C from either Option A or B
are not permitted. The Total Face Amount will be adjusted, if necessary, so that the Death Benefit
immediately after the change of Death Benefit Option will be equal to the Death Benefit immediately
before the change. The change will be effective on the Monthly Payment Date on or next following
the day we receive your Written Request at our Administrative Office.
Unless you specify otherwise by Written Request, any request for a Death Benefit Option change will
not take effect if the requested change would cause the policy to be classified as a Modified
Endowment Contract under the Code.
Death
Benefit Proceeds – The Death Benefit Proceeds (“Proceeds”) are the actual amount payable if
the Insured dies while this policy is In Force. The Proceeds are equal to the Death Benefit, as of
the date of death, less any Policy Debt and less any Monthly Deductions that may be due and unpaid
if death occurs during a Grace Period. We will pay the Proceeds within two months after we receive,
at our Administrative Office:
• | Due proof of the Insured’s death, consisting of a certified copy of the death certificate for the Insured or other lawful evidence providing equivalent information. | |
• | Proof of the claimant’s legal interest in the proceeds. | |
• | Sufficient evidence that any legal impediments to payment of Proceeds that depend on parties other than us have been resolved. Legal impediments to payment include, but are not limited to (a) the establishment of guardianships and conservatorships; (b) the appointment and qualification of trustees, executors and administrators; and (c) submission of information required to satisfy state and federal reporting requirements; and (d) conflicting claims. |
Proceeds paid are subject to the conditions and adjustments defined in other policy provisions,
such as General Provisions, withdrawals, Standard Policy Loans, and Timing of Payments. We will
pay interest on the Proceeds from the date of death at a rate not less than the rate payable for
funds left on deposit (see the Income Benefits section). If payment of Proceeds is delayed more
than 31 calendar days after we receive the above requirements needed to pay the claim, we will pay
additional interest at a rate of
10% annually beginning with the 31st calendar day referenced above. Proceeds are paid
as a lump sum unless you choose another payment method, as described in the Income Benefits
section.
Basic
Face Amount Increase – You may submit an Application to increase the Basic Face Amount by
adding a new Coverage Layer. Your Application must include Evidence of Insurability and is subject
to our approval. The effective date of the increased Basic Face Amount will be the first Monthly
Payment Date on or next following the date all required conditions are met or any other date you
request and we approve. Certain riders may restrict your ability to request unscheduled increases
in Coverage Layers. We reserve the right to limit Basic Face Amount increases to one per policy
year.
ICC12 P12VUL | Page 9 |
Scheduled
Increases in Basic Face Amount – There may be scheduled increases in Basic Life Coverage
Face Amount, and if so, they will be shown in the Policy Specifications. Each such increase is
referred to as a “Scheduled Increase” and comprises a new Coverage Layer when it goes into effect.
There is a Cost of Insurance Charge associated with each such Scheduled Increase that has gone into
effect and continues to be in effect. Such Cost of Insurance Charge is part of the Monthly
Deduction for the policy and is calculated the same as that for other Coverage Layers, subject to
maximum Cost of Insurance Rates that are the same as those applicable to the initial Coverage
Layer. The monthly Cost of Insurance Rates are shown in the Policy Specifications.
There is a Coverage Charge associated with each Scheduled Increase that has gone into effect. Such
Coverage Charge is also part of the Monthly Deduction for the policy. The Total Coverage Charge
for all Scheduled Increases in Basic Life Coverage are shown in the Policy Specifications. The
Coverage Charge for each Scheduled Increase in Basic Life Coverage that has gone into effect does
not decrease or terminate even if the associated Coverage Layer is decreased or terminated.
However, if any Scheduled Increase in Basic Life Coverage does not go into effect as scheduled, the
Coverage Charge for the Scheduled Increase will not go into effect, and we will send you a
Supplemental Schedule of Coverage to reflect the change.
There is a Surrender Charge for Scheduled Increases in Basic Life Coverage, which is also described
in the Policy Specifications and which is deducted from the Accumulated Value if you surrender the
policy. The Surrender Charge for Scheduled Increases in Basic Life Coverage that have gone into
effect do not terminate or decrease even if a Scheduled Increase in Basic Life Coverage that has
gone into effect is later decreased or terminated. However, if any Scheduled Increase in Basic
Life Coverage does not go into effect as scheduled, the Surrender Charge for the Scheduled
Increases in Basic Life Coverage will change and we will send you a Supplemental Schedule of
Coverage to reflect the change.
Upon approval of any such increase, we will send you a Supplemental Schedule of Coverage, which
will include the following information:
• | The increased Face Amount and the effective date of the increase; | |
• | The Risk Class for the increase; | |
• | The Maximum Monthly Cost of Insurance Rates applicable to the increase; | |
• | The Maximum Monthly Coverage Charge for the increase; | |
• | If the Guideline Premium Test is used, the policy’s new Guideline Premiums; and | |
• | The Surrender Charge Factors for the new Coverage Layer. |
Other
Face Amount Increases – An increase in the Total Face Amount may arise when you request a
change in Death Benefit Options. In this case, we will increase the Face Amount of the most
recently issued Coverage Layer. If there are rider and Basic Life Coverage Layers with the same
Coverage Layer Date, we will increase the rider Face Amount first. Certain riders may restrict
your ability to request unscheduled increases in Coverage Layers.
Face
Amount Decrease – You may request a decrease in the Total Face Amount of the policy by
providing a Written Request. A decrease in Total Face Amount is subject to these limits:
• | Only one requested decrease per policy year is allowed. | |
• | A decrease during the first policy year is not allowed. | |
• | The Basic Face Amount remaining after a decrease must be at least $10,000. |
The effective date of the decreased Face Amount will be the first Monthly Payment Date on or next
following the date we approved your Written Request.
Unless and until you specify otherwise by Written Request, any request for a decrease in Total Face
Amount will not take effect if the requested change would cause the policy to be classified as a
Modified Endowment Contract under the Code. We recommend you consult your tax advisor before
requesting a
ICC12 P12VUL | Page 10 |
decrease in Total Face Amount of Coverage Layers as described below. Upon approval of
any decrease, we will send you a Supplemental Schedule of Coverage to reflect the decrease.
The request for a decrease in the Total Face Amount will be subject to the Guideline Premium Limit
(if specified for your policy) as defined in the Code. This may result in one or more refunds of
premiums or required distributions of Accumulated Value in order to maintain compliance with such
limit, in accordance with the Tax Qualification as Life Insurance section of this policy. Such
request will not be allowed to the extent we determine that any resulting Guideline Premium limit
would cause an amount in excess of the Net Cash Surrender Value to be distributed from the policy.
Processing of Face Amount Decreases – Any reduction in the Total Face Amount, whether by Written
Request or due to a withdrawal or change in Death Benefit Option, will affect the Total Face Amount
by reducing the Face Amount of Coverage Layers as described below.
Coverage Layers are reduced or eliminated based on Coverage Layer Date, in order from the latest to
the earliest. If more than one Coverage Layer has the same Coverage Layer Date, we will first
reduce or eliminate the Face Amount of any rider Coverage Layer, and then the Face Amount of any
Basic Life Coverage Layer.
Face Amount Decreases that are a result of a Death Benefit Option Change or Death Benefit
acceleration may result in a Basic Face Amount below $10,000.
Policy Change Limit – We reserve the right to require Evidence of Insurability for any policy
change that would result in an increase in Net Amount at Risk and, if the Evidence of Insurability
is inconsistent with our underwriting rules, we may limit or refuse the policy change.
Change in Benefits – Under the Guideline Premium Test or the Cash Value Accumulation Test,
whichever is specified for your policy, any change in policy or rider benefits or certain other
factors may require an adjustment to the policy’s tax qualification limits.
PREMIUMS
Premiums – The initial premium is payable either at our Administrative Office or to your
registered representative before we can place your policy In Force. At your request, we will give
you a premium receipt signed by one of our officers. Additional premiums are optional and are
payable at any time at our Administrative Office. We will consider any premium paid after the
initial premium, whether delivered to your registered representative or otherwise, to be “received”
when it is delivered to our Administrative Office. Except for the initial premium, we bear no
responsibility for any premium unless it has been received by us. We reserve the right to reject
premium payments less than $50 unless such premium is required to keep the policy In Force.
Premiums may be paid at any time before the Monthly Deduction End Date, subject to the premium
limits below. Any payment we receive from you while you have a loan will be first considered a
loan repayment, unless you tell us by Written Request it is a premium payment.
Planned Premium – The Planned Premium is the amount of premium you have told us you intend to pay
and is shown in the Policy Specifications. We will send you Planned Premium Reminder Notices for
as long as premiums can be paid. You may change the Planned Premium by Written Request. Payment
of the Planned Premium does not guarantee that the policy will continue In Force.
Premium Load – The Premium Load is equal to the premium paid multiplied by the Premium Load Rate.
The Premium Load Rate we use will not exceed the Maximum Premium Load Rate shown in the Policy
Specifications.
Premium Allocation – Any Net Premium we receive before your policy has been placed In Force will
be allocated to the Cash Management Variable Account, or a successor account identified by us for
such purpose. When all outstanding requirements to place your policy In Force have been satisfied,
the Accumulated Value will be transferred according to the most recent premium allocation
instructions we
ICC12 P12VUL | Page 11 |
have received from you. If your policy provides for a full refund of premium upon
exercise of the Free Look Right, then transfer to the Investment Options will occur on the Free
Look Transfer Date. After the initial transfer to the Investment Options, any Net Premium we
receive will be allocated to the Investment Options according to the most recent premium allocation
instructions we have received from you, and per the terms of this policy.
Premium Processing – We deduct the Premium Load at the time we receive the premium payment. We
will credit the resulting Net Premium to the Investment Options based on your instructions on file
with us.
Premium Limitation – We reserve the right to require Evidence of Insurability for any premium
payment that would result in an increase in the Net Amount at Risk. If such Evidence of
Insurability is not satisfactory, we may limit or refuse the premium payment, unless it is
necessary to keep the policy In Force.
Guideline Premium Limit – This subsection applies only if the Guideline Premium Test is the Death
Benefit Qualification Test specified in the Policy Specifications. In order for this policy to
qualify as a life insurance contract under Section 7702 of the Code, the sum of the premiums paid
less a portion of any withdrawals, as specified in the Code, may not exceed the Guideline Premium
Limit, which is the greater of:
• | The Guideline Single Premium; or | |
• | The sum of the annual Guideline Level Premiums to the earlier of the date of payment or the Insured’s Age 100. |
The Guideline Premiums are shown in the Policy Specifications. The Guideline Premiums may change
whenever there is a change in the Total Face Amount of insurance, whether scheduled or otherwise,
or certain other policy benefits or factors. Any such Guideline Premium change will be shown in a
supplemental schedule that we will send to you at the time of the change. The Guideline Premiums
are used to determine the premium limits beyond which this policy would fail to qualify as a life
insurance contract under the Code. Payment of the Guideline Premiums does not guarantee that the
policy will never lapse and additional premiums may be necessary to prevent the policy from lapsing
in the future.
The Guideline Premiums are determined by the rules that apply to this policy as set forth in the
Code. The Guideline Premiums will be adjusted to conform to any changes in the Code. To the
extent that a premium payment would exceed such limits, we will refund the excess payment to you in
accordance with the Tax Qualification as Life Insurance section of this policy, provided that we
may not refuse any premium payment necessary to keep this policy In Force. Further, we reserve the
right to make distributions from the policy to the extent we deem necessary to continue to classify
this policy as a life insurance contract under the Code, in accordance with the Tax Qualification
as Life Insurance section of this policy.
Modified Endowment Contract Premium Limit – In order that this policy not be classified as a
Modified Endowment Contract under Section 7702A of the Code, the
sum of premiums paid less a portion of any withdrawals may not exceed the 7-Pay limit as defined in
the Code. The 7-Pay limit is the cumulative sum of the 7-Pay Premiums during the applicable 7-Pay
testing period. In the event that a premium payment would cause the 7-Pay limit to be exceeded, we
will refund the excess payment to you, unless you have provided a Written Request in which you
accept your policy being classified as a Modified Endowment Contract and indicate that we may
accept such payments and apply them to the policy, in accordance with the Modified Endowment
Contract Tax Status section of this policy.
The 7-Pay Premium may change whenever there is a change in the Total Face Amount of insurance or in
other certain policy benefits or factors. The 7-Pay Premiums are determined according to the rules
applicable to this policy set forth in the Code. The 7-Pay Premium will be adjusted to conform to
any changes in the Code. To the extent that a premium payment would cause such limits to be
exceeded, we will refund the excess payment to you, in accordance with the Modified Endowment
Contract Tax Status section of this policy. Further, as indicated in that section, we will
increase the Death Benefit to the extent we deem necessary to continue to classify this policy as a
non-Modified Endowment Contract under the Code.
ICC12 P12VUL | Page 12 |
INVESTMENT OPTIONS
Investment Options – consist of the Fixed Options, the Variable Options, and the Indexed Fixed
Account Options. We reserve the right to add additional Investment Options or to terminate one or
more of the Investment Options at any time.
Fixed Options – The Fixed Options are comprised of one or more Fixed Accounts. We reserve the
right to add additional Fixed Accounts or to terminate or suspend one or more of the Fixed Accounts
at any time. In such case, we will notify you of the change at your last known address. If we
terminate a Fixed Account, we will transfer the assets held in that Fixed Account to another Fixed
Account that we will identify in the notification.
Variable Options – The Variable Options are comprised of one or more Variable Accounts. We
reserve the right to add additional Variable Accounts or to terminate one or more of the Variable
Accounts at any time. In such case, we will notify you of the change at your last known address.
If we terminate a Variable Account, we will transfer the assets held in that Variable Account to
another Investment Option that we will identify in our notification.
Indexed Fixed Account Options – The Index Fixed Account Options are comprised of one or more
Indexed Accounts. We reserve the right to add additional Indexed Accounts or to terminate one or
more of the Indexed Accounts at any time. In such case, we will notify you of the change at your
last known address. At Segment Maturity, any Segment Maturity Value allocated to the terminated
Indexed Account will be reallocated to another Investment Option that we will identify in our
notice to you.
ACCUMULATED VALUE
Accumulated Value – The Accumulated Value is defined on each Valuation Day and is the sum of:
• | The Fixed Accumulated Value; | |
• | The Variable Accumulated Value; | |
• | The Indexed Accumulated Value; and | |
• | The Loan Account Value. |
Fixed Accumulated Value – The Fixed Accumulated Value is the sum of the Accumulated Value in each
Fixed Account. On the Policy Date, the value of the policy’s allocations to
each Fixed Account is equal to any Net Premium allocated to each Fixed Account less any allocation
of the initial Monthly Deduction to those Fixed Accounts.
After the Policy Date, we calculate the Accumulated Value in each Fixed Account as follows. We
credit interest on a daily basis using a 365-day year, at an annual effective rate not less than
the Minimum Guaranteed Interest Rate for each Fixed Account shown in the Policy Specifications. We
may credit a higher rate of interest. Each Fixed Account may have its own unique rate. While we
expect to credit a higher rate of interest to the Fixed LT Account than to the Fixed Account, we do
not guarantee to do so. The interest rate in effect at the beginning of the policy year will be
effective for the duration of that year.
The Accumulated Value for each Fixed Account on any Valuation Day is the following, including
interest on each:
• | The Accumulated Value for each Fixed Account on the prior Monthly Payment Date; | |
• | Plus the amount of any Net Premium received and allocated to the Fixed Account, since the prior Monthly Payment Date; | |
• | Plus the amount of any transfer to each Fixed Account, including transfers from the Loan Account, or Indexed Accounts, since the prior Monthly Payment Date; |
ICC12 P12VUL | Page 13 |
• | Minus any Account Deductions from each Fixed Account since the prior Monthly Payment Date; and | |
• | Minus the transfers from each Fixed Account, including transfers to the Loan Account or Indexed Accounts, since the prior Monthly Payment Date. |
Variable Accumulated Value – The Variable Accumulated Value is the sum of the Accumulated Value in
each Variable Account.
We calculate the Accumulated Value in each Variable Account as follows. Assets in each Variable
Account are divided into Accumulation Units, which are measures of value for bookkeeping purposes.
We credit Accumulation Units to each Variable Account as a result of:
• | The amount of any Net Premium received and allocated to the Variable Account; and | |
• | Transfers to the Variable Account, including transfers from the Loan Account. |
We debit Accumulation Units from each Variable Account as a result of:
• | Transfers from the Variable Account, including transfers to the Loan Account; and | |
• | Account Deductions from the Variable Account. |
To determine the number of Accumulation Units debited or credited to a Variable Account as a result
of a transaction, we divide the dollar amount of the transaction by the Unit Value of the affected
Variable Account.
To determine your Accumulated Value in each Variable Account, we multiply the number of
Accumulation Units in the Variable Account by the Unit Value of the Variable Account. The number
of Accumulation Units in each Variable Account will not change because of subsequent changes in
Unit Value.
Unit Value – The initial Unit Value of each Variable Account was $10 on the day the Variable
Account began operations. At the end of each subsequent Valuation Day, the Unit Value for each
Variable Account is equal to (Y) times (Z) where:
(Y) | is the Unit Value for that Variable Account as of the end of the prior Valuation Day; and |
(Z) | is the Net Investment Factor for that Variable Account as of the end of the current Valuation Day. |
Net Investment Factor – Each Variable Account’s Net Investment Factor for any Valuation Period is
equal to (A ÷ B), where:
(A) | equals: |
(a) | the Net Asset Value per share of the corresponding portfolio shares held by the Variable Account as of the end of the current Valuation Period; plus | ||
(b) | the per share amount of any dividend or capital gain distributions made during that Valuation Period on the portfolio shares held by the Variable Account; plus or minus | ||
(c) | any per share credit or charge for any income taxes, other taxes, or amounts set aside during that Valuation Period as a reserve for any income and/or any other taxes which we determine to have resulted from the operations of the Variable Account or policy, and/or any taxes attributable, directly or indirectly, to premium payments; and |
(B) | is the Net Asset Value per share of the corresponding portfolio shares held by the Variable Account as of the end of the prior Valuation Period. |
Net Asset Value – is the portfolio shares corresponding to the Variable Account on any Valuation
Day is reported to us as of the end of each Valuation Day by the investment company in whose shares
the Variable Account is invested.
Indexed Accumulated Value – The Indexed Accumulated Value is the sum of the Segment Values for all
Segments in each Indexed Account.
ICC12 P12VUL | Page 14 |
Loan Account Value – The Loan Account Value is a portion of the Accumulated Value set aside to
secure the Policy Debt. The Loan Account Value is equal to the Loan Account plus Loan Interest
Credit.
Processing of Account Deductions – Any Account Deductions will reduce the Investment Options under
the policy. Any such deduction is taken proportionately from the Fixed Accumulated Value and the
Variable Accumulated Value. Any deduction in excess of the Fixed Accumulated Value and Variable
Accumulated Value will be deducted from the Segments of the Indexed Accumulated Value (see Segment
Deductions).
INDEXED FIXED ACCOUNT OPTIONS
Indexed Accounts – You may allocate all or a portion of your policy’s Accumulated Value to one or
more Indexed Accounts, for which values will vary over time based, in part, on the change in value
of an external index (“Index”). The Indexed Accounts available as of the Policy Date, as well as
how credits based on the Index are calculated, are shown in the Policy Specifications. We reserve
the right to add additional Indexed Accounts or to cease offering one or more of the Indexed
Accounts at any time. In such case, we will notify you of the change at your last known address.
Closing Value – By Closing Value of the Index, we mean the value of the Index as of the close of
the New York Stock Exchange, which is usually 4:00 p.m. Eastern time. If no Closing Value is
published for a given day, we will use the Closing Value for the next day for which the Closing
Value is published. In calculating the change in value of the Index, we use the Closing Value of
the Index.
Substitution of Indexes – We reserve the right for any particular Indexed Account to substitute
one or more Indexes for any reason, including if an Index is discontinued or no longer published.
In such case, we will notify you prior to the change at your last known address. Any such
substitution is subject to approval by the Interstate Insurance Product Regulation Commission
(IIPRC).
Segments – Your policy’s value in an Indexed Account is divided into Segments. Each Segment
represents a transfer of policy value from the Fixed Account to an Indexed Account.
Segments are credited with interest and comprise a portion of the policy’s Accumulated Value. This
is a summary of how Segments work:
• | Segment Creation – A new Segment is created when there is an allocation to an Indexed Account. The Segment will continue until the end of the Segment Term. | |
• | Segment Value Change – Over the Segment Term, the Segment will grow with the Segment Guaranteed Interest and be reduced by Segment Deductions. | |
• | Segment Deductions – Over the Segment Term, money may be transferred out of the Segments for Account Deductions. | |
• | Segment Indexed Interest – Based on the performance of the Index, additional interest may be credited to the Segment at the end of the Segment Term. | |
• | Segment Maturity – At the end of a Segment Term, the Segment Value is either transferred to a new Indexed Account Segment, or to the Fixed Account. |
Segment Creation – A new Segment is created when there is a transfer to an Indexed Account. The
date of the transfer is called the Segment Start Date or Segment Date. Segment Months and Segment
Years are measured from this date. Each Segment in each Indexed Account will have its own Growth
Cap and Participation Rate. These values for a particular Segment are the values in effect on the
Segment Date. The values in effect as of the Policy Date are shown in the Policy Specifications.
If these values change, you will be notified in the Annual Report or other written notice.
Segment Start Dates – Segment Start Dates are the dates as of which transfers into the Indexed
Account may occur. The Segment Start Dates are shown in the Policy Specifications. For Policies
that have a Free Look Transfer Date (see the Definitions section to find out if your policy has a
Free Look Transfer Date), the first transfer to an Indexed Account will occur on the first Segment
Start Date following
ICC12 P12VUL | Page 15 |
the Free Look Transfer Date. We reserve the right to change the Segment Start
Dates and to limit transfers into the Indexed Account, but transfers may occur not less frequently
than once per calendar quarter. If we change the Segment Start Dates, you will be notified in the
Annual Report or other written notice.
Payment and Reallocation to the Indexed Accounts – Transfers to the Indexed Accounts will be based
on your latest instructions on file with us. The following explains the payment and reallocation
instructions for transfers to an Indexed Account:
• | Payment Instructions – These are your instructions to us, in which you designate a portion of each Net Premium or loan repayment (“Designated Amount”) to be transferred to an Indexed Account. The Designated Amount will first be deposited in the Fixed Account. Then, on the next Segment Start Date, the Designated Amount, or if less, the Fixed Account balance will be transferred from the Fixed Account to the Indexed Account. If you have given us no instructions or if your policy is in a Lockout Period (see Lockout Period), then no allocation to the Indexed Account will occur. | |
• | Reallocation Instructions – At the end of the Segment Term, if a Segment has a Segment Value other than Segment Guaranteed Interest and Segment Indexed Interest, the Segment Maturity Value can be reallocated to the Fixed Account or an Indexed Account. If you have given us no instructions for such Segment Maturity Value, the value will be reallocated to the same Indexed Account to create a new Segment in the Indexed Account. If Segment Maturity Value is transferred to the Fixed Account, subsequent transfers from the Fixed Account to other Investment Options may be done according to the Transfers provisions of the policy. |
Allocations to the Indexed Fixed Account Options – You may, by Written Request, designate an
amount to be transferred from the Fixed Account to an Indexed Account. If you want to transfer
money from other Investment Options into the Indexed Accounts, you must first transfer money from
those Investment Options to the Fixed Account according to the Transfer provisions in this policy,
and then transfer from the Fixed Account to the Indexed Accounts as described in this paragraph.
The amount you designate for transfer, or if less, the Fixed Account balance, will then be
transferred to the Indexed Account on the next Segment Start Date.
Allocations from the Indexed Fixed Account Options – You may not transfer value out of an Indexed
Account to any other Investment Option before the end of the Segment Term.
Cut-Off Date – For Indexed Fixed Account Option allocations to be effective on a given Segment
Start Date, each of the following must be received at our Administrative Office by 4:00 p.m.
Eastern time of the Cut-Off Date, which is two Business Days prior to the Segment Start Date:
• | Any instructions for transfers to the Indexed Accounts; or | |
• | Any premium payment or loan repayment intended to result in a transfer to an Indexed Account. |
Order of Processing Transfers – Any reallocation of Segment Maturity Value from the Indexed
Accounts to the Fixed Account will occur before any other transfer.
Segment Term and Segment Maturity – The Segment Term is the total length of time that a particular
Segment can exist. The Segment Term begins on the Segment Date and ends at Segment Maturity, which
is the Segment Start Date corresponding to the end of the Segment Term. On that date, we calculate
any Segment Indexed Interest and credit it to the Segment (see Segment Indexed Interest).
Segment Value – The Segment Value on the Segment Date is equal to the amount transferred to the
Indexed Account at such time. At any later date, the Segment Value is equal to:
• | The Segment Value as of the prior day; | |
• | Plus the Segment Guaranteed Interest since the prior day; | |
• | Minus any Segment Deductions since the prior day; | |
• | Plus, at Segment Maturity only, any Segment Indexed Interest credited. |
ICC12 P12VUL | Page 16 |
Segment Guaranteed Interest – We credit interest on a daily basis to each Segment from the Segment
Date to Segment Maturity, using a 365-day year, at an annual rate equal to the Segment Guaranteed
Interest Rate shown in the Policy Specifications. The amount of such interest is called the
Segment Guaranteed Interest.
Segment Deductions – If there is no Fixed Accumulated Value and Variable Accumulated Value, then
Account Deductions are taken from the Indexed Accumulated Value. Among Indexed Accounts,
deductions are taken from the Indexed Accounts in order, according to the length of the Segment
Term, from shortest to longest. If there is more than one Indexed Account with the same Segment
Term, deductions from each such Indexed Account will occur in numeric order according to the number
designation at the end of the name of the Indexed Account, provided that deductions from any
Indexed Account without such a number designation will occur before deductions from any Indexed
Account with a number designation. Within each Indexed Account, deductions are made from all
Segments, proportionate to Segment Value. For each Segment, the deduction is taken first from the
Segment Monthly Balance, then from the Segment Guaranteed Interest.
Lockout Period – This is a 12 month period of time during which no transfers from the Fixed
Account to the Indexed Accounts will be allowed. Reallocation of Segment Maturity Value to an
Indexed Account is allowed during the Lockout Period. A Lockout Period will begin any time there
is a deduction from an Indexed Account as a result of a loan or withdrawal that is not part of a
Systematic Distribution Program.
Systematic Distribution Program – is a program of periodic distribution of policy values that we
designate as a Systematic Distribution Program. We reserve the right to discontinue such a program
at any time. The program includes periodic distribution to you of a portion of the policy’s
Accumulated Value through policy loans and withdrawals while the Insured is alive and the policy is
In Force. Contact the Company for details of how this program works.
Segment Indexed Interest – At Segment Maturity, the Segment Indexed Interest is calculated, as
described in the Policy Specifications, and credited to the Segment, resulting in the Segment
Maturity Value. At Segment Maturity the maturing Segment ends and the Segment Maturity Value will
be reallocated to the Fixed and Indexed Accounts according to
your reallocation instructions on file with us. If you have not given us any such instructions,
the Segment Maturity Value will be reallocated to a new Segment in the same Indexed Account.
However, if the Segment Maturity Value consists only of the Segment Guaranteed Interest and the
Segment Indexed Interest, we will transfer such value into the Fixed Account.
TRANSFERS BETWEEN FIXED OPTIONS AND VARIABLE OPTIONS
Transfers – After your initial Net Premium has been allocated according to your instructions you
may, upon Written Request, transfer your Fixed and Variable Accumulated Value, or a part of it,
among the Fixed Options and Variable Options as provided in this section. No transfer may be made
if the policy is in a Grace Period and the required premium has not been paid. Contact us to find
out what restrictions are in effect at any time on transfers described in this section.
We reserve the right:
• | To limit the size of transfers so that each transfer is at least $500; | |
• | To limit the frequency of transfers, however at least one transfer per quarter will be allowed; | |
• | To require that the remaining balance in any account as a result of a transfer be at least $500; | |
• | To assess a charge of $25 for each transfer exceeding 12 per policy year; | |
• | To impose further restrictions to limit transfers between certain Investment Options, including, but not limited to, the dollar amount, the number of transfers made during a defined period, and the method used to submit transfers; | |
• | To otherwise waive or reduce the restrictions on transfers described in this section; and | |
• | To terminate transfer privileges at any time. |
ICC12 P12VUL | Page 17 |
Transfers from the Variable Options to the Fixed Account – You may transfer Accumulated Value from
the Variable Options to the Fixed Options subject to limitations on allocations to the Fixed
Options.
Transfers from the Variable Options to the Fixed LT Account – You may make one transfer from the
Variable Options to the Fixed LT Account during any twelve-month period, subject to limitations on
allocations to the Fixed Options.
Transfers from the Fixed Account to the Variable Options or Fixed LT Account – You may
make one transfer from the Fixed Account during any twelve-month period. You may transfer to the
Variable Options or Fixed LT Account, or both. You may transfer up to 100% of the value in the
Fixed Account to the Fixed LT Account. You may transfer to the Variable Options the greater of:
1. | $5,000; or | |
2. | 25% of the Accumulated Value in the Fixed Account; or | |
3. | The total amount transferred in the prior policy year from the Fixed Account to the Variable Options. |
Transfers from the Fixed LT Account to the Variable Options or Fixed Account – You may make one
transfer from the Fixed LT Account to the Variable Options or Fixed Account during any twelve-month
period. Such transfer is limited to the greatest of the following:
1. | $5,000; or | |
2. | 10% of the Accumulated Value in the Fixed LT Account; or | |
3. | The total amount transferred in the prior policy year from the Fixed LT Account to either the Fixed Account or the Variable Options. |
Allocations to the Fixed Options – We reserve the right to limit aggregate allocations to the
Fixed Options during the most recent 12 months for all policies in which you have an ownership
interest or to which payments are made by a single payor, to $1,000,000.
Any excess over such limits will be allocated to your other Investment Options according to your
most recent instructions. Allocations include Net Premium payments, transfers and loan repayments.
POLICY CHARGES
Monthly Deduction – The Monthly Deduction provides coverage for the policy month following the
Monthly Payment Date and is deducted from the Accumulated Value on each such date before the
Monthly Deduction End Date. It is equal to the sum of the following items:
• | The Cost of Insurance Charge; | |
• | The Administrative Charge; | |
• | The Coverage Charge; | |
• | The Indexed Fixed Account Option Charge; and | |
• | Rider or benefit charges, if any. |
The maximum for each such charge is described below or in the rider or benefit forms. We may
charge less than such maximum charge. Any lesser charge will apply uniformly to all members of the
same Class. We may profit from such charges, and may use those profits for any lawful purpose,
such as the payment of distribution and administrative expenses. The Monthly Deduction is deducted
from the policy’s Investment Options. Unless you provide otherwise, the Monthly Deduction will be
processed as an Account Deduction. There are no Monthly Deductions on and after the Monthly
Deduction End Date, which is shown in the Policy Specifications.
Cost of Insurance Charge – The Cost of Insurance Charge is the sum of the Cost of Insurance
Charges for all Coverage Layers. The Cost of Insurance Charge for each Coverage Layer is equal to
(1) multiplied by (2), where:
ICC12 P12VUL | Page 18 |
(1) is the Monthly Cost of Insurance Rates per Coverage Layer divided by 1000 as shown in the
Policy Specifications; and
(2) is the Death Benefit divided by the Net Amount at Risk Factor as shown in the Policy
Specifications, reduced by the Accumulated Value as of the beginning of the policy month before the
Monthly Deduction is assessed.
If there are multiple Coverage Layers, the Net Amount at Risk is allocated proportionately to
each Coverage Layer according to Total Face Amount; otherwise the Net Amount at Risk is allocated
fully to the initial Coverage Layer.
Cost of Insurance Rates – The Maximum Monthly Cost of Insurance Rates for the initial Coverage
Layer(s) are shown in the Policy Specifications. The Maximum Monthly Cost of Insurance Rates for
any later Coverage Layers are shown in a Supplemental Schedule of Coverage that will be sent to you
at the time the Coverage Layer becomes effective.
Administrative Charge – The Administrative Charge is shown in the Policy Specifications.
Coverage Charge – The Coverage Charge is the sum of the Coverage Charges for each Coverage Layer.
The Coverage Charge for the initial Coverage Layer will not exceed the Basic Life Coverage Charge
shown in the Policy Specifications. The Coverage Charge for any later Coverage Layer will not
exceed the Basic Life Coverage Charge shown in the Supplemental Schedule of Coverage to be sent to
you when the Coverage Layer is added. This charge is based on the Face Amount of the Coverage
Layer as of its effective date. The Coverage Charge will not change even if the Face Amount of the
associated Coverage Layer is increased or decreased.
Indexed Fixed Account Option Charge – The Index Fixed Account Option Charge is the sum of the
charge for each Indexed Account, which is equal to the Monthly Indexed Account Charge Rate for that
Indexed Account, as shown on the Policy Specifications, multiplied by the value of that Indexed
Account as of the Monthly Payment Date. The Indexed Fixed Account Option Charge is part of the
Monthly Deduction assessed against the policy’s Accumulated Value.
Tax Related Charges – In addition to the charges described in this policy, we reserve the right to
make a charge for federal, state or local taxes generated by this policy, or generated by our
operations with respect to this policy, to the extent such tax was not applicable to the policy or
our operations at the time of policy issuance.
POLICY LAPSE AND REINSTATEMENT
Grace Period – We will use the policy’s Accumulated Value, reduced by Policy Debt, to determine if
the policy will lapse. If that amount is not sufficient to provide for the policy’s Monthly
Deductions, the policy will enter the Grace Period. A Grace Period of 61 days will be allowed for
the payment of sufficient loan repayment or premium to keep your policy In Force. The Grace Period
begins on the Monthly Payment Date on which the insufficiency occurred and ends 61 days thereafter.
At the start of the Grace Period, we will provide a Grace Notice to you, any assignee of record,
and any additional person designated to receive notice of lapse or termination. Any premium
payments sent to us by U.S. mail and postmarked within the Grace Period will be accepted. There is
no penalty for paying a premium during the Grace Period. Your policy will remain In Force during
the Grace Period.
Notification of Termination for Non-Payment – Thirty days after the Monthly Payment Date on which
the insufficiency occurred, we will provide a notification of termination for non-payment to you,
any assignee of record, and any additional person designated to receive notice of lapse or
termination (Xxxxx Xxxxxx). The notice will be provided to each person at their last known
addresses by first class United States mail, postage prepaid, and will state the due date and the
amount of loan repayment or premium required for your policy to remain In Force. A minimum of the
monthly charges not deducted plus three times the Monthly Deduction due when the insufficiency
occurred, plus any applicable Premium Load, must be paid.
ICC12 P12VUL | Page 19 |
Lapse – If sufficient loan repayment or premium is not paid by the end of the Grace Period, a
lapse will occur. If the Insured dies during the Grace Period, the Death Benefit will be equal to
the Death Benefit as of the beginning of the Grace Period reduced by any overdue charges. Upon
lapse, the policy will terminate with no value.
Reinstatement – If it has not been surrendered, this policy may be reinstated within five years
after the end of the Grace Period. To reinstate this policy you must provide us with the
following:
• | A written Application; | |
• | Evidence of Insurability; | |
• | Sufficient premium, after reduction by any Premium Load, to cover all Monthly Deductions and policy Loan Interest Charges due and unpaid during the Grace Period; and | |
• | Sufficient premium, after reduction by any Premium Load, to keep the policy In Force for three months after the date of reinstatement; and | |
• | Sufficient premium to cover any negative Accumulated Value if there was a policy loan or other outstanding Policy Debt at the time of lapse. |
The effective date of the policy reinstatement will be the Monthly Payment Date on or next
following the date we approve your reinstatement Application. At reinstatement:
• | The Net Accumulated Value will be the same as it was at the beginning of the Grace Period. | |
• | The Surrender Charges and Policy Charges (other than Cost of Insurance Charges) for all Coverage Layers under this policy will resume on their schedule as of the Monthly Payment Date when lapse occurred. | |
• | Cost of Insurance Charges will be calculated using Cost of Insurance Rates that resume their original schedule as if lapse had never occurred, reflecting the Insured’s Age at reinstatement and policy duration measured from the original Policy Date. | |
• | If there was a policy loan at time of lapse, upon reinstatement we will eliminate the loan by deducting any Policy Debt from the Accumulated Value. Any negative Accumulated Value will be due in addition to sufficient premium at time of reinstatement. |
After the reinstatement premium has been applied, regular policy processing will occur for the
period of time when coverage was provided during the Grace Period. There will be no Monthly
Deductions between the time of lapse and reinstatement.
SURRENDER AND WITHDRAWAL OF VALUES
Surrender – Upon Written Request while the policy is In Force, you may surrender this policy for
its Net Cash Surrender Value. The policy will terminate on the date the Written Request is
received at our Administrative Office. The policy cannot be surrendered during the Grace Period.
Cash Surrender Value – The Cash Surrender Value is the Accumulated Value less any Surrender
Charge.
Net Cash Surrender Value – The Net Cash Surrender Value is the Cash Surrender Value less any
Policy Debt.
Surrender Charge – If you surrender this policy, there may be a Surrender Charge deducted from the
Accumulated Value. The Surrender Charge as of the beginning of each Coverage Year for your initial
Coverage Layer is shown in the Policy Specifications. On each Monthly Payment Date during the
policy year, the Surrender Charge is reduced by 1/12 of the Reduction Factor as shown in the Policy
Specifications.
If there have been decreases in the Basic Life Coverage Face Amount, including decreases due to
withdrawals, the Surrender Charge will not change as a result of the decrease. The Surrender
Charge
ICC12 P12VUL | Page 20 |
described is the guaranteed maximum charge. We may charge less than such guaranteed maximum
charge. Any lesser charge will apply uniformly to all members of the same Class.
In addition, any Coverage Layer representing an increase in Basic Life Coverage will have an
associated Surrender Charge and Reduction Factor that will be provided in a Supplemental Schedule
of Coverage. The Surrender Charge for any such Coverage Layer will be effective as of the Coverage
Layer Date and as of the beginning of each Coverage Year thereafter, and will decrease in the same
manner as the initial Basic Life Coverage Layer.
Withdrawals – Upon Written Request on or after the first policy anniversary, you may withdraw a
portion of the Net Cash Surrender Value of this policy. We reserve the right to charge a fee not
to exceed $25 for each withdrawal. There is no Surrender Charge imposed for a withdrawal, even if
the Total Face Amount is reduced as a result of the withdrawal. Withdrawals will be subject to the
following conditions:
• | The amount of each withdrawal must be at least $200; | |
• | The Net Cash Surrender Value remaining after a withdrawal must be at least $500; and | |
• | We reserve the right to disallow any withdrawal that would result in a Basic Face Amount of less than $10,000 after the withdrawal. |
Withdrawals will be deducted from the Accumulated Value. When you take a Withdrawal, the amount of
the withdrawal and any withdrawal fee is deducted from the policy’s Investment Options. Unless you
provide otherwise, any such deduction will be deducted from the Accumulated Value as an Account
Deduction.
If Death Benefit Option A is in effect at the time of a withdrawal, and if a requested withdrawal
would increase the Net Amount at Risk, we will decrease the Total Face Amount by the minimum amount
necessary to prevent the Net Amount at Risk from increasing as a result of the withdrawal, except:
1. | During the first 15 policy years, but only in the case of the first withdrawal of a given policy year, the Total Face Amount will be decreased only to the extent that the withdrawal exceeds the lesser of $10,000 or 10% of the Net Cash Surrender Value, or | |
2. | In any policy year, but only if both: |
(a) | the Death Benefit Qualification Test specified for your policy is the Guideline Premium Test, and | ||
(b) | the Guideline Premium Limit, as determinable at the time of the decrease in Total Face Amount, would, as a result of the current withdrawal, fail to remain greater than zero at all times prior to Age 100, we will decrease the Total Face Amount as follows: |
i. | If cumulative withdrawals for the 12-month period ending on the date of the current withdrawal do not exceed 15% of the Total Face Amount, we will limit the Total Face Amount decrease so that the Guideline Premium Limit, as determinable at the time of the decrease in Total Face Amount, would remain greater than zero at all times prior to Age 100. | ||
ii. | If cumulative withdrawals for the 12-month period ending on the date of the current withdrawal exceed 15% of the Total Face Amount, we will decrease the Total Face Amount to the extent of such excess in addition to the Total Face Amount decrease calculated per i. above on the cumulative withdrawals of 15% of the Total Face Amount. | ||
iii. | For the purpose of the 15% test in i. and ii. above, the Total Face Amount will be the highest Total Face Amount in effect during the current policy year through the date of the withdrawal. |
In any instance where both exceptions 1. and 2. above apply, we will decrease the Total Face Amount
by the lesser of the two decrease amounts.
If such a reduction in Total Face Amount would cause the policy to become a Modified Endowment
Contract, we will not process your withdrawal request unless and until we receive your Written
Request to have your policy classified as a Modified Endowment Contract.
If Death Benefit Option B is in effect at the time of a withdrawal, the withdrawal will not reduce
the Total Face Amount. The withdrawal will reduce the Accumulated Value, which has the effect of
reducing the Death Benefit that would be payable (see the Death Benefit section for details).
ICC12 P12VUL | Page 21 |
If Death Benefit Option C is in effect at the time of a withdrawal, the withdrawal will not reduce
the Total Face Amount, but it will increase the sum of the withdrawals, which has the effect of
reducing the Death Benefit (see the Death Benefit section for details).
If the Insured dies after the request for a withdrawal is received by us and prior to the
withdrawal being processed, the withdrawal, if allowed under the provision, will be processed and
paid to the owner, or the owner’s estate before the Death Benefit Proceeds are determined and paid
to the beneficiary.
TIMING OF PAYMENTS AND TRANSFERS
Variable Options – With respect to allocations made to the Variable Options, we will calculate
values for surrenders, withdrawals, loans and, unless transfers are restricted, transfers as of the
end of the Valuation Day on or next following the day on which we receive your instructions. For
any portion of Death Benefit depending on the Variable Accumulated Value, we will calculate such
value as of the end of the Valuation Day on or next following the day on which the Insured’s death
occurs. We will pay such amounts and will process such transfers within seven days after we
receive all the information needed for the transaction. However, we may postpone the calculation,
payment or transfer of any such amounts derived from any of the Variable Accounts, if:
• | The New York Stock Exchange is closed on other than customary weekend and holiday closings; | |
• | Trading on the New York Stock Exchange is restricted as determined by the Securities and Exchange Commission (SEC); | |
• | An emergency exists, as determined by the SEC, as a result of which it is not reasonably practicable to determine the value of the Variable Account assets or corresponding portfolio assets or to dispose of Variable Account securities; or | |
• | The SEC by order permits postponement for the protection of policy owners. |
Other Allocations – With respect to allocations to accounts other than those made to the Variable
Options, we may defer surrenders, withdrawals, loans (except for loans to pay a premium on any
policy issued by us), and transfers from such accounts, for up to six months after we receive your
request.
With respect to transfers, we will disclose in written notice to you, the effective date of the
transfer, the reason for the delay, and the value of the transfer as of the date we received your
transfer request.
Deferral – If we defer payment of surrenders, withdrawals or loans for more than 10 days after we
receive your request, we will pay interest at the rate required by the state in which this policy
is delivered, but not less than an annual rate equal to the guaranteed rate payable on the Fixed
Options.
INCOME BENEFITS
Income Benefits – All or part of any policy proceeds may, instead of being paid in a lump sum, be
left with us under any one, or a combination of the income benefit plans available, subject to our
minimum amount requirements on the date of election. If the payee is not a natural person, the
choice of a payment option will be subject to our approval. We guarantee that the income benefit
will not be less than the income that would be provided by the single premium immediate annuity
purchase rates we offer at the time. We guarantee that we will have at least the following income
benefit plans available.
Fixed Income – Equal payments of the amount chosen with interest of not less than 2% per year
until the funds left on deposit are exhausted.
Life Income – Monthly income will automatically be guaranteed to continue for at least ten years.
If the payee dies before the end of the ten-year period, payments will continue to the end of the
ten-year period to a person designated in writing by that payee. The purchase rates for the
monthly income for a male or female income recipient bought by each $1,000 of benefits are shown
below.
ICC12 P12VUL | Page 22 |
Monthly | Monthly | Monthly | Monthly | Monthly | ||||||||||||||
Age | Income | Age | Income | Age | Income | Age | Income | Age | Income | |||||||||
0-30 | 2.38 | 40 | 2.63 | 50 | 3.00 | 60 | 3.60 | 70 | 4.63 | |||||||||
32 | 2.42 | 42 | 2.69 | 52 | 3.10 | 62 | 3.76 | 72 | 4.92 | |||||||||
34 | 2.47 | 44 | 2.76 | 54 | 3.20 | 64 | 3.94 | 74 | 5.26 | |||||||||
36 | 2.52 | 46 | 2.83 | 56 | 3.32 | 66 | 4.14 | 75+ | 5.45 | |||||||||
38 | 2.57 | 48 | 2.91 | 58 | 3.45 | 68 | 4.37 |
Monthly income amounts for ages not shown are halfway between the two amounts for the nearest two
ages that are shown. Amounts shown are based on an annual interest rate of 2% and the Annuity 2000
female mortality table with five-year age setback. We may require evidence of survival for incomes
that last more than ten years.
STANDARD POLICY LOANS
Standard Policy Loans – You may obtain policy loans by Written Request after the Free Look
Transfer Date (see the Definitions section of your policy to find out if it has a Free Look
Transfer Date), on the sole security of the Loan Account of this policy. We recommend you consult
your tax advisor before requesting a policy loan.
Loan Account – When a policy loan is taken, an amount equal to the loan will be deducted from the
Accumulated Value as an Account Deduction.
Loan Amount Available – The amount of the loan must be at least $200. The maximum amount
available for a loan on any date is equal to the Accumulated Value less:
• | Three times the most recent Monthly Deduction; | |
• | Any Surrender Charge; and | |
• | Any existing Policy Debt. |
Loan Repayment – You may make loan repayments at any time prior to lapse of this policy.
Loan Interest Charge – Interest will accrue daily based on the balance in the Loan Account and
will be due on each policy anniversary. Such interest is calculated using the simple interest
method and is based on the balance in the Loan Account, using a maximum annual interest rate of
2.25%. We may use a lower Loan Interest Charge rate. The corresponding daily interest rate is
equal to the annual rate divided by 365. If the policy terminates before a policy anniversary, the
Loan Interest Charge will be due at such time.
Loan Interest Credit – Loan Interest Credit is based on the balance in the Loan Account, and
accrues daily on a simple interest basis, using the Loan Account Interest rate, which is an annual
interest rate not less than 2.00%. The corresponding daily interest rate is equal to the annual
rate divided by 365.
Policy Debt – The Policy Debt is the amount necessary to repay the policy loan in full and is
equal to the Loan Account plus any accrued Loan Interest Charge. The Policy Debt reduces any
amount otherwise payable under the policy.
Loan Processing on Policy Anniversary – On each policy anniversary we will adjust the values of
the Policy Debt, Loan Account and Loan Account Value so that they are equal to each other. To do
this, we calculate the difference between the Policy Debt and the Loan Account Value. If the Policy
Debt is greater than the Loan Account Value, which is generally the case when the policy Loan
Interest Charge has not been paid, a new loan will be taken for the excess and will be added to the
Loan Account. If the Loan Account Value is greater than the Policy Debt, which is generally the
case when the policy Loan Interest
ICC12 P12VUL | Page 23 |
Charge has been paid, the excess will be transferred according
to your most recent premium allocation instructions.
SEPARATE ACCOUNT PROVISIONS
Separate Account – We established the Separate Account and maintain it under the laws and
regulations of our state of domicile. The assets of the Separate Account shall be valued at least
as often as any policy benefits vary, but at least monthly. The Separate Account is divided into
subaccounts, called Variable Accounts. Xxxxxx and realized and unrealized gains and losses from
the assets of each Variable Account are credited or charged against it without regard to our other
income, gains or losses. Assets may be put in our Separate Account to support this policy and
other variable life policies. Assets may be put in our Separate Account for other purposes, but
not to support contracts or policies other than variable life contracts or policies.
The assets of our Separate Account are our property. The portion of its assets equal to the
reserves and other policy liabilities with respect to our Separate Account will not be chargeable
with liabilities arising out of any other business we conduct. We may transfer assets of a
Variable Account in excess of the reserves and other liabilities with respect to that Variable
Account to another Variable Account or to our General Account. All obligations arising under the
policy are general corporate obligations of ours. We do not hold ourselves out to be trustees of
the Separate Account assets.
Variable Accounts – Each Variable Account may invest its assets in a separate class of shares of a
designated investment company or companies. The Variable Accounts of our Separate Account that
were available for your initial allocations are shown in your Application for this policy. From
time to time, we may make other Variable Accounts available to you. We will provide you with
written notice of all material details including investment objectives and all charges.
We reserve the right, subject to compliance with the law then in effect, to:
• | Change or add designated investment companies; | |
• | Add, remove or combine Variable Accounts; | |
• | Add, delete or make substitutions for the securities that are held or purchased by the Separate Account or any Variable Account; | |
• | Register or deregister any Variable Account under the Investment Company Act of 1940; | |
• | Change the classification of any Variable Account; | |
• | Operate any Variable Account as a managed investment company or as a unit investment trust; | |
• | Combine the assets of any Variable Account with other separate accounts or subaccounts of ours or our affiliates; | |
• | Transfer the assets of any Variable Account to other separate accounts or subaccounts of ours or our affiliates; | |
• | Run any Variable Account under the direction of a committee, board, or other group; | |
• | Restrict or eliminate any voting rights of policy owners with respect to any Variable Account, or other persons who have voting rights as to any Variable Account; | |
• | Change the allocations permitted under the policy; | |
• | Terminate and liquidate any Variable Account; and | |
• | Make any other change needed to comply with law. |
If any of these changes result in a material change in the underlying investment of a Variable
Account of our Separate Account, we will notify you of such change.
Unless required by law or regulation, an investment policy may not be changed without our consent.
We will not change the investment policy of the Separate Account without the approval of the
Insurance Commissioner of our state of domicile. The process for such approval is on file.
ICC12 P12VUL | Page 24 |
OWNER AND BENEFICIARY
Owner – The Owner of this policy is as shown in the Policy Specifications or as later changed by
Written Request. If you change the Owner, the change is effective on the date the Written Request
is signed, unless otherwise specified by the Owner, subject to our receipt of it and subject to any
action taken or payment made by us prior to its receipt. If there are two or more Owners, they
will own this contract as joint tenants with right of survivorship, unless otherwise provided by
Written Request. We recommend you consult your tax advisor before requesting a change of Owner.
Assignment – You may assign this policy by Written Request. An assignment must be recorded at our
Administrative Office. When received, the assignment will take effect as of the date the Written
Request was signed unless otherwise specified by the Owner. Any rights created by the assignment
will be subject to any payments made or actions taken by us before the change is recorded. We will
not be responsible for the validity of any assignment. We recommend you consult your tax advisor
before requesting an assignment.
Beneficiary – The beneficiary is named by you in the Application to receive the Death Benefit
proceeds. You may name one or more beneficiaries. If you name more than one beneficiary, they
will share the Death Benefit proceeds equally or as you may otherwise specify by Written Request.
If you have named a contingent beneficiary, that person becomes the beneficiary if the beneficiary
dies before the Insured. A beneficiary may not, at or after the Insured’s death, assign, transfer
or encumber any benefit payable. To the extent allowed by law, policy benefits will not be subject
to the claims of any creditor of any beneficiary.
You may make a change of beneficiary by Written Request while the policy is In Force. Beneficiary
Change Request forms are available from us. The change will take place as of the date the request
is signed unless otherwise specified by the Owner. Any rights created by the change will be
subject to any payments made or actions taken by us before we have received the Written Request.
You may
designate an irrevocable beneficiary whose rights under the policy cannot be changed without his or
her written consent.
The interest of a beneficiary who does not outlive the Insured will be divided pro-rata among the
surviving beneficiaries. If no beneficiaries survive the Insured, the Death Benefit Proceeds will
pass to the Owner, or the Owner’s estate if the Owner does not survive the Insured. In the event
of a simultaneous death of the Insured and a beneficiary such that it cannot be determined who died
first, it will be assumed, unless proof to the contrary is provided, that the beneficiary died
last.
GENERAL PROVISIONS
Entire Contract – This policy is a contract between you and us. This policy, the attached copy of
the initial Application, including any amendments and endorsements to the Application, any
Applications for reinstatement, all subsequent Applications to change the policy, any endorsements,
benefits, or riders, and all additional policy information sections added to this policy are the
entire contract. Only our president, chief executive officer or secretary is authorized to change
this contract or extend the time for paying premiums. Any such change must be in writing.
All statements in the Application shall, in the absence of fraud, be deemed representations and not
warranties. We will not use any statement to contest this policy or defend a claim on grounds of
misrepresentation unless the statement is in an Application.
Incontestability – We will not contest this policy unless there was a material misrepresentation
in the Application, or, when permitted by applicable state law, where the policy was procured
through fraud. If we determine that the Application contains a material misrepresentation, we will
rescind the policy and return to you the premiums paid less any policy loans and any withdrawals
taken. No Death Benefit will be paid. After the policy has been In Force for two years during the
Insured’s lifetime, this policy cannot be contested except for failure to pay required premiums or
if the policy was procured by fraud.
ICC12 P12VUL | Page 25 |
If this policy lapses and is later reinstated, we will not contest the reinstated policy unless
there was a material misrepresentation in the Application required for reinstatement, or, when
permitted by applicable state law, where the policy was procured through fraud, or for failure to
pay required premiums. If we determine that such Application contains a material
misrepresentation, we will rescind the reinstated policy as of the reinstatement date and return to
you the premiums paid after the reinstatement date less any policy loans and any withdrawals taken
after the reinstatement date. No Death Benefit will be paid. After the reinstated policy has been
In Force for two years during the Insured’s lifetime, this policy cannot be contested except for
failure to pay required premiums or if the policy was procured by fraud.
If there has been a change to the policy for which we required the Insured to submit Evidence of
Insurability, we will not contest such a change unless there was a material misrepresentation in
the Application required for the change, or, when permitted by applicable state law, where the
change was procured through fraud, or for failure to pay required premiums. If we determine that
such Application contains a material misrepresentation, we will rescind the policy change and all
Policy Charges made after the change will be reversed and corrected charges applied so that the
policy’s Accumulated Value will be unaffected by the change. Any Death Benefits or other benefits
that become payable will be determined as though the policy change had never been requested. After
the changed policy has been In Force for two years during the Insured’s lifetime, we will not
contest any such change except for failure to pay required premiums or if the change was procured
by fraud.
Non-Participating – This policy will not share in any of our surplus earnings.
Suicide Exclusion – If the Insured dies by suicide, while sane or insane, within two years of the
Policy Date, the Death Benefit Proceeds will be limited to an amount equal to the sum of the
premiums paid, less the sum of any policy loans and withdrawals. If this policy has been
reinstated and the Insured dies by suicide, while sane or insane, within two years of the latest
reinstatement date,
the Death Benefit Proceeds will be limited to an amount equal to the sum of the premiums paid less
the sum of any policy loans and withdrawals taken since such date.
If the Insured dies by suicide, while sane or insane, after two years from the Policy Date but
within two years after the effective date of any increase in the Total Face Amount or, the Death
Benefit Proceeds will be limited by the following adjustments:
1. | Any such increase in Total Face Amount will be excluded; | |
2. | Refund of the portion of Monthly Deductions associated with any such increase will be included; and | |
3. | Premium Load associated with the portion of Monthly Deductions referred to in 2) above will be included. |
Misstatement – If the Insured’s sex or birth date is misstated in the Application and it is
discovered on or after the death of the Insured, the Death Benefit shall be the Minimum Death
Benefit for the correct sex and birth date, or if greater, a Death Benefit based on a Net Amount at
Risk adjusted by the ratio of the incorrect Cost of Insurance Rate to the correct Cost of Insurance
Rate. The adjusted Net Amount at Risk will result in an adjusted Death Benefit, since the Death
Benefit depends on the Net Amount at Risk.
If the Insured’s sex or birth date is misstated in the Application and it is discovered before the
death of the Insured, we will not recalculate the Accumulated Value, but we will use the correct
sex and birth date of the Insured in calculating future Monthly Deductions.
Maturity – This policy does not mature, but will continue In Force so long as the Insured is alive
and the policy has not been surrendered and lapse has not occurred.
Monthly Deduction End Date – Provided the policy is still In Force, coverage will continue on and
after the Monthly Deduction End Date, subject to all policy provisions, with these exceptions and
clarifications:
• | Monthly Deductions will cease; | |
• | Premiums will not be accepted, except amounts required to keep the policy In Force; | |
• | Loans will be allowed; |
ICC12 P12VUL | Page 26 |
• | Loan repayments will be permitted; | |
• | Loan Interest Charges and Loan Interest Credits will continue to accrue; and | |
• | Withdrawals will not be allowed. |
Timing of Payments – We may defer payments of any Net Cash Surrender Value, withdrawal or loan
(except for loans to pay a premium on any policy issued by us) for up to six months after we
receive your request. If we defer any such payment for more than 30 days after we receive your
request, we will pay interest at least equal to the Minimum Guaranteed Interest Rate for Fixed
Options shown in the Policy Specifications.
Annual Report – A report will be mailed to your last known address no less frequently than
annually. This report will show:
• | The beginning and end dates of the reporting period; | |
• | The Accumulated Value at the beginning and end of the reporting period; | |
• | Amounts that have been credited or debited to the Accumulated Value during the reporting period, identified by type; | |
• | The Death Benefit at the end of the reporting period on each life covered by the policy; | |
• | The Net Cash Surrender Value at the end of the reporting period; | |
• | Any Policy Debt outstanding at the end of the reporting period; | |
• | A notice if the Net Cash Surrender Value will not be sufficient to keep the policy In Force until the end of the next reporting period, unless further premium payments are made; and | |
• | Any other information required by law. |
In addition to the above report, we will also mail you an annual report containing financial
statements for the Separate Account and the designated investment company or companies or other
designated portfolio(s) in which the Separate Account invests. The latter report will include a
list of the portfolio securities of the investment company, or of any other designated portfolio,
as required by the Investment Company Act of 1940. We will also send any other reports as required
by federal securities law.
Policy Illustrations – Upon request we will give you a hypothetical illustration of the future
benefits under this policy based upon both guaranteed and current cost factor assumptions. Such
illustrations reflect assumptions about the policy’s non-guaranteed elements and about how you will
use the policy’s options. Over time the policy’s actual non-guaranteed elements, and your actual
use of the policy’s options, are likely to vary from the assumptions used in such illustrations.
For these reasons, actual policy values will likely be more or less favorable than shown in such
illustrations. We reserve the right to charge a fee not to exceed $25 for each illustration in
excess of one per policy year.
Juvenile Insured – This provision only applies if the Insured was under Age 18 on the Policy Date.
Beginning when the Insured attains Age 18, you will have an opportunity to improve your policy’s
Risk Class as compared with the Risk Class that applied prior to Age 18. This may reduce the
actual Cost of Insurance Charge that is deducted from your policy’s Accumulated Value. At least 60
days prior to the Insured’s Age 18, we will send to your last known address a notice of your right
to apply for an improved Risk Class for the Insured of “Nonsmoker”. In order to qualify for such
improved Risk Class, you will be required to supply Evidence of Insurability. In order for such
improved Risk Class to take effect at Age 18, you must make the Written Request prior to Age 18.
If you do not request an improved Risk Class for the Insured, a Risk Class of “Smoker” will be
assigned.
Basis of Values – All nonforfeiture values for this policy will be at least equal to the minimums
required by the Uniform Standards and Operating Procedures adopted by the Interstate Insurance
Product Regulation Commission. A detailed statement showing how such values are determined has
been filed with the Interstate Insurance Product Regulation Commission. To calculate the minimum
required nonforfeiture values, we use the Minimum Guaranteed Interest Rate for Fixed Options shown
in the Policy Specifications or the rate required by the Interstate Insurance Product Regulation
Commission and mortality rates from the 2001 CSO mortality tables using age nearest birthday. The
rates we use are the
ICC12 P12VUL | Page 27 |
same for both smokers and nonsmokers and are sex-distinct unless this policy
is issued on a unisex basis, in which case male rates are used.
Cash values available under the policy are not less than the minimum values and benefits required
by or pursuant to the NAIC Variable Life Insurance Regulation, model #270 using Actuarial Guideline
XXIV.
Ownership of Assets – We have the exclusive and absolute control of our assets, including all
assets in the Separate or Variable Accounts.
Tax Qualification as Life Insurance – This policy is intended to qualify as a life insurance
contract for federal tax purposes, and the Death Benefit under this policy is intended to qualify
for federal income tax exclusion. The policy, including any rider, benefit or endorsement that
does not specifically override this tax qualification provision, shall be interpreted to ensure and
maintain such tax qualification, despite any other provision to the contrary. At no time shall the
amount of Death Benefit under this policy ever be less than the minimum amount needed to ensure or
maintain such tax qualification. If need be, the Death Benefit shall be increased retroactively
and prospectively to the minimum extent necessary to accomplish that purpose. In addition, the
Accumulated Value will be reduced to reflect the increased Monthly Deductions that result from such
Death Benefit increase(s), starting on the date that each increase is effective. As of the
effective date of the filing of this policy in the state in which it was delivered, the Internal
Revenue Service has not published final guidance on the tax treatment of life insurance policies
that continue coverage beyond Age 100. You should consult your tax advisor, as there may be tax
consequences.
We will not accept a premium payment that would cause the policy to fail to qualify as a life
insurance contract for federal tax purposes. If at any time the premiums paid under the policy
exceed the amount
allowable for such tax qualification, the excess amount, including any interest as determined under
federal tax law, shall be removed from the policy as of the date of its payment, and any
appropriate adjustments in the Death Benefit and/or Accumulated Value shall be made as of such
date. This excess amount, including such interest, shall be refunded no later than 60 days after
the end of the applicable contract year, as determined under federal tax law.
If this excess amount is not refunded by the end of such 60-day period, the Death Benefit shall be
increased retroactively and prospectively to the minimum extent necessary so that at no time is the
Death Benefit ever less than the minimum amount necessary to ensure or maintain such tax
qualification. In addition, the Accumulated Value will be reduced to reflect any increased Monthly
Deductions that result from such Death Benefit increase, starting on the date that the increase is
effective.
If you request a decrease in policy or rider benefits, it may cause a reduction in any applicable
tax limits on premiums or cash values for the policy to maintain such tax qualification. Such a
reduction in these limits may require us to make a distribution from the policy equal to the
greatest amount by which the premiums paid or cash values for the policy, exceed any such reduced
limits, as determined under federal tax law, in order to maintain the policy’s tax qualification.
If such a distribution is made, the distribution will be paid to you and the Accumulated Value will
be reduced by the amount of the distribution. However, no request for a decrease in policy or
rider benefits will be allowed to the extent that we determine that the resulting reduction in such
tax limits would require us to distribute more than the Net Cash Surrender Value for the policy.
Modified Endowment Contract Tax Status – Unless and until you have given us a Written Request to
accept a Modified Endowment Contract (“MEC”) classification for your policy, the provisions of this
Modified Endowment Contract Tax Status subsection apply to your policy.
Under federal tax law, if the funding of a life insurance contract occurs too rapidly, it becomes a
MEC and fails to qualify for certain favorable tax treatment as a result. This policy is intended
to qualify as a life insurance contract that is not a MEC for federal tax purposes. To achieve
these purposes, the provisions of this policy (including any rider or endorsement that does not
specifically override this tax qualification provision) shall be interpreted to prevent this policy
from being subject to such MEC treatment, despite any other provision to the contrary. If and
while the provisions of this subsection apply to your policy, at
ICC12 P12VUL | Page 28 |
no time shall the amount of death
benefit under this policy ever be less than the minimum amount needed to avoid such MEC treatment.
We will not accept a payment as premium or otherwise which would cause the policy to become a MEC.
The 7-Pay Premium, shown on Page 3.0, is used solely to determine the policy’s premium limits to
avoid MEC treatment. Payment of one or more 7-Pay Premium amounts does not guarantee that the
policy will never lapse, and additional premiums may be necessary to prevent the policy from
lapsing in the future.
If at any time the amounts paid under the policy exceed the limit for avoiding such MEC treatment,
this excess amount, including any interest as determined under federal tax law, shall be removed
from the policy as of the date of its payment, and any appropriate adjustment in the Death Benefit
and/or Accumulated Value shall be made as of such date. This excess amount, including any
interest, shall be refunded no later than 60 days after the end of the applicable contract year, as
determined under federal tax law.
If this excess amount is not refunded by the end of such 60-day period, the Death Benefit shall be
increased retroactively and prospectively to the minimum extent necessary (e.g., to the end of any
MEC 7-year test period) so that at no time is the Death Benefit ever less than the minimum amount
necessary to avoid Modified Endowment Contract classification. In addition, the Accumulated Value
will be reduced to reflect any increased Monthly Deductions resulting from such Death Benefit
increase, starting on the date that the increase is effective.
Any request that would change the Death Benefit or any other benefit or rider under the policy will
not be processed if the change would cause the policy to be classified as a Modified Endowment
Contract. Requested changes that could cause the policy to be classified as a Modified Endowment Contract
include, but are not limited to, an elective reduction in the Total Face Amount, a Death Benefit
Option change that would cause a reduction in the Total Face Amount, and a withdrawal that would
cause a reduction in the Total Face Amount.
Other Distributions of Accumulated Value – If the Net Amount at Risk ever exceeds three times the
original Total Face Amount, we reserve the right to make a distribution of Accumulated Value to
make the Net Amount at Risk equal three times the original Total Face Amount. In such case, the
distribution will be treated as a premium refund. Note that while such a distribution will be
treated as a premium refund for certain contract purposes, normal tax rules will apply in
determining the amount of such a distribution, if any, which is taxable.
Additional Services – While this policy is In Force, we may, either directly or through a third
party service provider, provide you with access to independent living-related resources and
discounted independent living-related goods and services.
Right to Add Benefits – From time to time we may offer additional benefits that could be available
to your policy by rider or endorsement. To request such an additional benefit, you must submit to
us a Written Request. You or the proposed Insured may be subject to new underwriting for any
additional benefit requested. If an additional benefit requested is issued pursuant to this
paragraph, a Supplemental Schedule of Coverage will be mailed to your last known address.
Compliance – We reserve the right to make any change to the provisions of this policy to comply
with, or give you the benefit of, any federal or state statute, rule, or regulation, including but
not limited to requirements for life insurance contracts under the Code or of any state. We will
provide you with a copy of any such change, and file such a change with the insurance supervisory
official of the state in which this policy is delivered. You have the right to refuse any such
change.
Conformity with IIPRC Standards – This contract was approved under the authority of the IIPRC and
issued under the IIPRC standards. If there is any contract provision that is in conflict with any
IIPRC standards applicable to this Contract when this Contract was issued, the provision is amended
to conform to that standard. Any such amendment is effective on the Contract Date.
ICC12 P12VUL | Page 29 |
INDEX
Subject | Page | |||
Accumulated Value |
5, 12 | |||
Administrative Charge |
15 | |||
Administrative Office |
5 | |||
After the Monthly Deduction End Date |
22 | |||
Age |
5 | |||
Annual Report |
23 | |||
Application |
5 | |||
Assignment |
21 | |||
Basic Life Coverage |
5 | |||
Basic Life Coverage Layer |
5 | |||
Basic Face Amount |
5 | |||
Basis of Values |
23 | |||
Beneficiary |
21 | |||
Cash Surrender Value |
17 | |||
Cash Value Accumulation Test |
8 | |||
Change of Death Benefit Option |
8 | |||
Class |
5 | |||
Code |
5 | |||
Compliance |
25 | |||
Cost of Insurance Charge |
15 | |||
Cost of Insurance Rates |
15 | |||
Coverage Charge |
15 | |||
Coverage Layer Date |
5 | |||
Coverage Layers |
5 | |||
Death Benefit |
7 | |||
Death Benefit Option |
7 | |||
Death Benefit Proceeds |
8 | |||
Death Benefit Qualification Test |
7 | |||
Entire Contract |
21 | |||
Evidence of Insurability |
5 | |||
Face Amount |
5 | |||
Face Amount Decrease |
9 | |||
Face Amount Increase |
9 | |||
Fixed Accumulated Value |
12 | |||
Fixed Options |
6 | |||
General Account |
6 | |||
Grace Period |
16 | |||
Guideline Premium Limit |
11 | |||
Guideline Premium Test |
8 | |||
In Force |
6 | |||
Income Benefits |
18 | |||
Incontestability |
22 | |||
Insured |
6 | |||
Investment Options |
6 | |||
Juvenile Insured |
23 | |||
Lapse |
16 | |||
Loan Amount Available |
19 |
Subject | Page | |||
Maturity |
22 | |||
MEC |
24 | |||
Misstatement |
22 | |||
Modified Endowment Contract |
11, 12, 13, 24 | |||
Monthly Deduction |
14 | |||
Monthly Deduction End Date |
6, 15 | |||
Monthly Payment Date |
6 | |||
Net Accumulated Value |
6 | |||
Net Amount at Risk |
6 | |||
Net Asset Value |
13 | |||
Net Cash Surrender Value |
17 | |||
Net Investment Factor |
13 | |||
Net Premium |
6 | |||
Non-Participating |
22 | |||
Owner |
21 | |||
Planned Premium |
10 | |||
Policy Change Limit |
10 | |||
Policy Charges |
14, 16 | |||
Policy Date |
6 | |||
Policy Debt |
6 | |||
Policy Illustrations |
23 | |||
Policy Loans |
19 | |||
Policy Specifications |
6 | |||
Premium Allocation |
11 | |||
Premium Limitation |
11 | |||
Premium Load |
11 | |||
Premium Processing |
11 | |||
Premiums |
10 | |||
Reinstatement |
16 | |||
Risk Class |
6 | |||
Separate Account |
6, 20 | |||
Suicide Exclusion |
22 | |||
Surrender |
16 | |||
Surrender Charge |
17 | |||
Tax Qualification as Life Insurance |
24 | |||
Total Face Amount |
6 | |||
Transfers |
14 | |||
Unit Value |
13 | |||
Unloaned Accumulated Value |
15 | |||
Valuation Day |
7 | |||
Valuation Period |
7 | |||
Variable Account |
5, 6, 7, 20 | |||
Variable Accumulated Value |
13 | |||
Variable Options |
7 | |||
Withdrawal |
17 | |||
Written Request |
7 |
ICC12 P12VUL | Page 30 |
Pacific Life Insurance Company • [45 Enterprise, Aliso Viejo, CA 92656]
INDEXED FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE
• | Death Benefit Payable On The Death Of The Insured | |
• | Net Cash Surrender Value Payable Upon Surrender | |
• | Benefits May Vary Based On Investment Experience | |
• | Adjustable Face Amount | |
• | Non-Participating |