EXHIBIT 99.27(d)(4)
NORTHSTAR LIFE SPOUSE COVERAGE RIDER
Northstar Life Insurance Company - University Corporate Centre at Amherst -
Suite 000 - 000 Xxxxxxxxx Xxxxxxx - Xxxxxxx, Xxx Xxxx 00000
READ YOUR POLICY CAREFULLY
This rider amends Group Policy No. 96-19974, and is issued in consideration
of the timely payment of the required premium. Every provision of the group
policy which affects your insurance is summarized in this agreement.
WHAT IS THE PURPOSE OF THIS AGREEMENT?
This agreement makes available variable group universal life insurance on the
life of the insured employee's eligible spouse.
FREE LOOK
It is important to us that you are satisfied with this rider after it is issued.
If you are not satisfied with this rider you may return it to us or our agent
within 10 days after you receive it. Any premiums paid during the 10-day free
look period will be allocated to the money market sub-account. You may also
cancel this rider by delivering or mailing a written notice to Northstar Life
Insurance Company (Northstar Life), University Corporate Centre at Amherst,
Suite 000, 000 Xxxxxxxxx Xxxxxxx, Xxxxxxx, Xxx Xxxx 00000 and returning the
rider before midnight of the 10th day after you receive this rider. Notice given
by mail and return of the rider by mail are effective on being postmarked,
properly addressed and postage prepaid. If you return the rider, you will
receive, within 7 days of the date we receive a notice of cancellation, a full
refund of any premiums you have paid.
/s/ Xxxxxx X. Xxxxxxxxx Xxxxxx X. Xxxxxxx
Secretary President
FOR OPTION A, THE INITIAL DEATH BENEFIT FOR PERSONS INSURED UNDER THIS RIDER
WILL EQUAL THE FACE AMOUNT SHOWN ON EACH CERTIFICATE. FOR OPTION B, THE INITIAL
DEATH BENEFIT FOR PERSONS INSURED UNDER THIS RIDER WILL EQUAL THE FACE AMOUNT
SHOWN ON EACH CERTIFICATE PLUS THE INITIAL ACCOUNT VALUE, IF ANY. FOR OPTION B,
THEREAFTER, THE DEATH BENEFIT MAY INCREASE OR DECREASE DEPENDING UPON SEPARATE
ACCOUNT INVESTMENT EXPERIENCE.
THE ACCOUNT VALUES OF THE CERTIFICATES ISSUED UNDER THIS RIDER WILL VARY FROM
DAY TO DAY. THEY MAY INCREASE OR DECREASE DEPENDING UPON SEPARATE ACCOUNT
INVESTMENT EXPERIENCE. THERE IS NO GUARANTEED MINIMUM ACCOUNT VALUE.
TABLE OF CONTENTS
Definitions....................................................2
General Information............................................3
Death Benefit..................................................4
Payment of Proceeds............................................4
Premiums.......................................................5
Group Policy Charges...........................................5
Separate Account...............................................6
Exchange Privilege.............................................8
Paid-Up Insurance Option.......................................8
Account Values.................................................9
Surrenders and Withdrawals.....................................9
Reports.......................................................10
Loans.........................................................10
Termination...................................................11
Conversion Right..............................................12
Additional Information........................................13
VARIABLE GROUP UNIVERSAL LIFE INSURANCE - NONPARTICIPATING
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DEFINITIONS
ACCOUNT VALUE
The sum of the values under the separate account, the guaranteed account and the
loan principal of a certificate. They are identified as the separate account
value, the guaranteed account value, and the loan principal, respectively.
AGE
Age at last birthday.
CERTIFICATE ANNIVERSARY
The same day in each succeeding year as the certificate date.
CERTIFICATE DATE
The first day of the calendar month on or following a certificate's effective
date of coverage. This is the date from which we determine certificate monthly
anniversaries, certificate months and certificate years.
CERTIFICATE MONTH
A calendar month in which insurance is provided under a certificate of this
rider.
CERTIFICATE YEAR
A period of twelve consecutive months, measured from the certificate date and
each successive certificate anniversary, during which coverage is provided under
a certificate of this rider.
ELIGIBLE INSURED
A spouse is an eligible insured if her or she:
(1) [is under age 70; and
(2) is currently legally married to an individual defined as an insured
employee under the terms of the group policy to which this rider is
attached.]
FACE AMOUNT
The face amount of insurance on the life of the insured as shown on the
specifications page of the owner's certificate.
FUND
The mutual fund or separate investment portfolio within a series mutual fund
which we designate as an eligible investment for the separate account and its
sub-accounts.
GENERAL ACCOUNT
All assets of Northstar Life other than those in the separate account or in
other separate accounts established by us.
GUARANTEED ACCOUNT
Assets other than the loan principal that are held in our general account and
attributable to a certificate issued under this rider, and others of its class.
GUARANTEED ACCOUNT VALUE
The sum of all net premiums and transfers allocated to the guaranteed account
and interest and experience credits declared thereon, minus amounts transferred
to the separate account or removed in connection with a withdrawal or loan and
minus charges assessed against the guaranteed account value.
INSURED
An eligible insured who becomes insured under a certificate issued under this
rider.
ISSUE DATE
The date coverage under this rider may become effective. The issue date is shown
on the group policy specifications page attached to the group policy.
LAPSE
Termination of insurance coverage under a certificate due to non-payment of a
premium during its grace period in an amount that, after the deduction of
premium expense charges, is sufficient to cover the monthly deduction due at the
time the notice was sent.
LOAN PRINCIPAL
The portion of the general account which is attributable to loans under
certificates issued under this rider and others of its class.
MONTHLY ANNIVERSARY
The same day of each succeeding month as the certificate date.
NET CASH VALUE
The account value under a certificate issued under this rider, less any
outstanding loan principal and accrued loan interest charges and any charges
over due, plus accrued loan interest credits. It is the amount an owner may
obtain through surrender of that certificate. The cash surrender value of a
certificate issued under this rider will be determined as often as any
certificate values vary, but at least monthly.
NET PREMIUM
The premium less premium expense charges deducted from the premium. The net
premium is the amount or amounts which are allocated to the guaranteed account
and/or the separate account on behalf of an owner.
OWNER
An owner of a certificate issued under this rider.
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PLANNED PREMIUM
A planned premium is a premium set and paid on a periodic basis. The amount of
the planned premium is shown on the specifications page attached to the insured
spouse's certificate. The amount and frequency of the planned premium can be
changed; however, the actual amount and frequency of premium payments will
affect the account values and term of insurance.
POLICYHOLDER
The owner of the group policy as specified and identified on the specifications
page attached to the group policy.
SEPARATE ACCOUNT
The separate investment account created by us to receive and invest net premiums
received for a certificate issued under this rider. The particular separate
account for this rider is the Northstar Life Variable Universal Life Account. We
established this separate account for this class of policies under New York Law.
The separate account is composed of several sub-accounts. We own the assets of
the separate account. However, those assets not in excess of separate account
liabilities are not subject to claims arising out of any other business in which
we engage.
SEPARATE ACCOUNT VALUE
The sum of all sub-account values.
SUB-ACCOUNT
One or more sub-accounts constituting the separate account.
SUB-ACCOUNT VALUE
The current number of sub-account units credited to a certificate issued under
this rider multiplied by the current sub-account unit value.
UNIT
A measure of the owner's interest in a sub-account of the separate account.
VALUATION DATE
Any date on which a fund is valued.
VALUATION PERIOD
The period between successive valuation dates measured from the time of one
determination to the next.
WE, OUR, US
Northstar Life Insurance Company.
YOU, YOUR
An employer who makes insurance under this rider available to its eligible
employees and is named as the policyholder on the specifications page attached
to the group policy.
GENERAL INFORMATION
WHEN DOES INSURANCE BECOME EFFECTIVE?
Insurance becomes effective on the date that all of the following conditions
have been met:
(1) a prospective insured meets all eligibility requirements; and
(2) if required, the owner applies for the insurance on forms which are
approved by us; and
(3) we are satisfied with the prospective insured's evidence of
insurability, if we require evidence; and
(4) we receive the required premium.
This effective date is shown on the specifications page attached to the owner's
certificate.
MAY THIS RIDER BE AMENDED?
The consent of the owners and insureds is not required to amend this rider or
any certificate issued hereunder if the amendment concerns only administrative
changes to this rider. However, signed acceptance by owners or insureds is
required for any amendment made after the effective date of this rider which
reduces or eliminates coverage for such owners or insureds and for which the
owner or insured is making all required premium contributions. Any amendment
will be without prejudice to any claim in connection with a loss sustained prior
to the effective date of the amendment.
WHEN WILL WE REQUIRE EVIDENCE OF INSURABILITY?
Evidence of insurability will be required if:
(1) the amount of insurance requested is greater than the Maximum
Guaranteed Issue amount shown on the specifications page attached
to the group policy; or
(2) the insurance is contributory and the spouse does not enroll
within [31 days] from the date he or she is first eligible; or
(3) the insurance for which the spouse previously enrolled did not go
into effect or was terminated because of failure to make a required
premium contribution; or
(4) during a previous period of eligibility, the spouse failed to
submit evidence of insurability or that which was submitted was not
satisfactory to us; or
(5) [the insured spouse is covered by an individual policy issued under
the terms of the conversion privilege section, unless he or she
cancels the individual policy without claim.]
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DEATH BENEFIT
WHAT IS THE AMOUNT OF THE DEATH BENEFIT?
[The amount of the death benefit depends on whether Option A or Option B is
selected by you as the death benefit option under the group policy. Option A is
a level death benefit. Option B is an increasing death benefit. The death
benefit option selected by you will be the death benefit option for all
certificates issued under this rider. The death benefit option is shown on the
insured's certificate specifications page and will not change.]
OPTION A -- LEVEL DEATH BENEFIT
The amount of the death benefit for Option A is:
(1) the greater of the face amount of insurance on the date of death or
the minimum death benefit on the date of death; plus
(2) any premium received after the date of death; minus
(3) any unpaid monthly deductions due through the month in which death
occurs, and any loan principal and accrued loan interest charges.
OPTION B -- INCREASING DEATH BENEFIT
The amount of the death benefit for Option B is:
(1) the greater of the face amount of insurance on the date of death
plus the account value as of the date of death, or the minimum
death benefit on the date of death; plus
(2) any premium received after the date of death; plus
(3) any accrued loan interest credits; minus
(4) any unpaid monthly deductions due through the month in which death
occurs, and any loan principal and accrued loan interest charges.
We intend for each certificate under this rider to qualify as a life insurance
policy as defined by Section 7702 of the Internal Revenue Code. We reserve the
right to increase the face amount of insurance, limit the amount of premium we
will accept or refund cash value in order to maintain such qualification.
WHAT IS THE MINIMUM DEATH BENEFIT?
The minimum death benefit is an amount determined by us that is required to
preserve the qualification of the certificate as a life insurance policy as
defined by Section 7702 of the Internal Revenue Code. The minimum death benefit
is a percentage of the account value. The percentage depends on the test used in
determining the qualification of life insurance. If the Cash Value Accumulation
test is used, the percentage is identified in Table B (tobacco use as
appropriate). If the Guideline Premium/Cash Value Corridor test is used, the
percentage is identified in Table D. We reserve the right to change Table B.
CAN THE OWNER CHANGE THE DEATH BENEFIT OPTION?
[No.]
WHAT IS THE FACE AMOUNT OF INSURANCE ON THE LIFE OF AN INSURED SPOUSE?
The face amount of insurance on the life of the insured spouse is as shown on
the specifications page of the owner's certificate. The amount of insurance for
the insured spouse shall not exceed the insured employee's amount of insurance.
MAY THE FACE AMOUNT OF INSURANCE CHANGE?
[Yes. The owner may apply at any time for a change through a written request in
compliance with the limitations on the specifications pages attached to the
group policy and to the certificate. If an increase in the current face amount
is applied for, we reserve the right to require evidence of insurability from
the insured spouse.
If a decrease in the current face amount is requested, we will grant the
request. However, the amount of insurance may not be reduced to less than the
Minimum Face Amount shown on the specifications page attached to the group
policy. If following a decrease in face amount, the certificate would not comply
with the maximum premium limitations required by federal law, the decrease may
be limited or net cash value may be returned to the owner (at the owner's
election), to the extent necessary to meet these requirements.]
WHEN WILL CHANGES IN THE FACE AMOUNT OF INSURANCE BECOME EFFECTIVE?
Increases are effective on the monthly anniversary on or following the date we
approve the change, or any other date mutually agreed upon between you and us.
[Decreases in the face amount of insurance are effective on the monthly
certificate anniversary on or following receipt of the written request by us.]
However, if the owner requests that the decrease become effective on a specified
future date, we will make the decrease effective on the certificate monthly
anniversary on or next following the date requested.
WHEN WILL THE DEATH BENEFIT BE PAID?
We will pay the death benefit upon due proof of death, (typically a certified
copy of the insured's death certificate), that the insured spouse died while
insured under this rider.
We will pay interest on the death benefit from the date of the insured spouse's
death until the date of payment.
Interest shall be computed daily at an annual rate determined by us, but never
less than [3%] per year compounded annually, and shall be added to and be a part
of the total sum paid.
PAYMENT OF PROCEEDS
TO WHOM WILL WE PAY THE DEATH BENEFIT?
We will pay the death proceeds to the beneficiary or beneficiaries who are named
in the owner's application unless the owner subsequently changes the
beneficiary. In that event, we will pay the death proceeds to the
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beneficiary named in the owner's last change of beneficiary request as provided
for in this rider.
WHAT HAPPENS IF ONE OR ALL OF THE BENEFICIARIES DIE BEFORE THE INSURED?
If a beneficiary dies before the insured spouse, that beneficiary's interest in
this group policy ends with that beneficiary's death. Only those beneficiaries
who survive the insured spouse will be eligible to share in the proceeds. If no
beneficiary survives the insured spouse, we will pay the proceeds according to
the following order of priority:
(1) [the insured spouse's lawful spouse, if living; otherwise
(2) the insured spouse's natural or legally adopted child (children) in
equal shares, if living; otherwise
(3) the insured spouse's parents in equal shares, if living; otherwise
(4) the personal representative of the insured spouse's estate.]
MAY THE OWNER CHANGE THE BENEFICIARY?
Yes. If the owner has reserved the right to change the beneficiary, the owner
may file a written request with us to change the beneficiary. If the owner has
not reserved the right to change the beneficiary, the written consent of the
irrevocable beneficiary will be required. The owner's written request will be
effective on the date it is signed by the owner, subject to its receipt in our
home office.
However, if the insured dies before the request has been so recorded, the
request will not be effective as to those proceeds we have paid before the
owner's request was so recorded.
CAN PROCEEDS BE PAID IN OTHER THAN A SINGLE SUM?
The beneficiary can elect any of the settlement options offered by us at the
time of the insured spouse's death.
Upon the insured spouse's death, if a settlement option other than lump sum
payment has been requested, a guaranteed settlement illustration will be sent to
the insured's beneficiary. This guaranteed settlement illustration will be based
on the settlement option selected and the proceeds payable at the time of the
insured spouse's death. The annuity table utilized for the settlement options
tables is the 1983 IAM -- Table A.
Examples of the four available settlement options are shown as part of this
rider. The settlement option examples attached to this rider are intended as
generic examples of the available options and are not intended to be specific to
the insured spouse's coverage.
PREMIUMS
WHEN AND HOW OFTEN ARE PREMIUMS DUE?
A premium must be paid to put a certificate in force. This initial premium must
be of an amount that, after the deduction of premium expense charges, will cover
the first month's deductions. Premiums paid after the initial premium may be in
any amount. A premium must be paid at such time when there is insufficient net
cash value to pay the monthly deduction necessary to keep the certificate in
force. Additional premium contributions are nonforfeitable after crediting.
IS THERE A GRACE PERIOD FOR THE PAYMENT OF PREMIUMS?
Certificates issued under this rider have a 61-day grace period. The grace
period will start on the day we mail the owner a notice of lapse. This will
notify the owner that the certificate will lapse if the premium amount specified
in the notice is not paid by the end of the grace period and the net cash value
is insufficient to cover the monthly deduction. We will mail this notice on any
certificate monthly anniversary date when the net cash value for the insured
under the certificate is insufficient to cover the monthly deduction for that
insured. The certificate of insurance will remain in effect during the 61-day
grace period. If sufficient premium is not paid by the end of the grace period,
the insured's coverage with insufficient net cash value will lapse at the end of
that 61-day period. The grace period does not apply to the first premium
payment.
WHAT IS THE AMOUNT OF THE DEATH BENEFIT DURING THE GRACE PERIOD?
The death benefit amount under the death benefit option in effect for a
certificate at the time of the insured's death will be paid if death occurs
during the grace period.
GROUP POLICY CHARGES
WHAT TYPE OF CHARGES ARE THERE UNDER THIS RIDER?
Charges under this rider are those which we deduct from premium payments
(premium expense charges) and those which we deduct from the account value of
each certificate (account value charges).
WHAT CHARGES ARE DEDUCTED FROM PREMIUM PAYMENTS?
From premiums paid, we will deduct the following premium expense charges: (1) a
sales charge; (2) a premium tax charge; and (3) a federal tax charge. The
remaining amount, or net premium, will be allocated to the guaranteed account
and/or sub-accounts of the separate account, as directed by the owner, and
become part of the certificate's net cash value.
(1) The sales charge is for distribution expenses. This sales charge
shall not exceed [five] percent of each premium paid.
(2) The premium tax charge is to compensate us for the premium tax we
pay to state and local governments, and such other charges or
expenses as we may incur with respect to this group policy,
including guaranty fund assessments. This charge is currently [two]
percent. The charge is not guaranteed and may be increased in the
future, but only as necessary to cover our premium taxes and other
charges or expenses. This premium tax charge shall not exceed
[four] percent of each premium paid.
(3) The federal tax charge is to compensate us for the corporate
federal income taxes that result from a
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sale of this group policy. The federal tax charge is [1.25] percent
of each premium paid if the group policy is deemed to be an
individual contract under the Omnibus Budget Reconciliation Act of
1990, as amended, and [0.25] percent if deemed a group contract
under that Act.
WHAT CHARGES ARE DEDUCTED FROM THE ACCOUNT VALUE OF EACH CERTIFICATE?
From the net cash value of each certificate issued under this rider, we will
deduct a monthly deduction and any applicable transaction charges as account
value charges. If the net cash value is insufficient to cover the account value
charges, the certificate will lapse unless sufficient payment is received within
the grace period.
The monthly deduction will be the sum of: (1) the administration charge; (2) the
cost of insurance charge; and (3) the charge for any additional benefits
provided by rider. The monthly deduction will be deducted on the certificate
date and on each succeeding certificate monthly anniversary.
(1) The administration charge is for administrative expenses, including
those attributable to the records we create and maintain for this
group policy. The maximum administration charge is [$4] per month.
(2) The cost of insurance charge is for providing the death benefit
under each certificate under this group policy. The charge is
calculated by multiplying the net amount at risk (the net amount at
risk for each certificate is the difference between the death
benefit and the account value) under each certificate by a cost of
insurance rate which varies with the insured's age and rate class.
The rate is guaranteed not to exceed rates determined on the basis
of the 1980 Commissioners Standard Ordinary, 75% male, age at last
birthday mortality table (tobacco, non-tobacco or uni-tobacco as
appropriate). The group policy charges described as Table A
attached herein are maximum cost of insurance rates.
(3) The charge for any additional benefits, if any, is for providing
the coverages offered by rider(s).
Transaction charges are to compensate us for the administrative costs incurred
in processing a transaction. Currently, a transaction charge applies to each
withdrawal. The amount of the charge is the [lesser of $25 or two percent] of
the amount withdrawn. We may also deduct a charge for any transfer of funds
between the guaranteed account and the separate account or among the
sub-accounts of the separate account. The amount charged will not exceed $10.
Transaction charges will be deducted at the end of the day on which the
transaction occurs.
Account value charges will be deducted from the guaranteed account value and the
separate account value in the same proportion that those values bear to each
other and, as to the separate account value, from each sub-account in the
proportion that the sub-account value of each such sub-account bears to the
separate account value.
HOW DO WE DETERMINE THE COST OF INSURANCE?
The cost of insurance on the life of a spouse for a certificate month is equal
to a rate multiplied by the net amount at risk for the certificate. The rate is
based on the spouse's age and rate class. The rate is subject to change, but
will never exceed the maximums shown in Table A. These maximum rates are based
on the 1980 CSO 75% male age at last birthday table for tobacco, non-tobacco or
uni-tobacco as appropriate. The calculation of the net amount at risk depends on
the death benefit option in effect for a certificate as follows:
OPTION A -- LEVEL DEATH BENEFIT
The net amount at risk is equal to:
(1) the greater of the face amount of insurance or the minimum death
benefit; minus
(2) the account value immediately prior to the deduction of the cost of
insurance.
OPTION B -- INCREASING DEATH BENEFIT
The net amount at risk is equal to the greater of:
(1) the face amount of insurance; or
(2) the minimum death benefit minus the account value immediately prior
to the deduction of the cost of insurance.
MAY CHARGES BE ASSESSED AGAINST THE SEPARATE ACCOUNT ASSETS?
Yes. We reserve the right to charge or make provision for income taxes payable
by us based on separate account assets.
CAN CHARGES UNDER THIS RIDER CHANGE?
Yes. Changes in the sales charge, premium tax charge, federal tax charge,
monthly administration charge, withdrawal charge, transfer charge and cost of
insurance rate will be made by class and will be based on changes in future
expectations of investment earnings, mortality, persistency and expenses. These
charges will be reviewed annually to determine if any adjustments should be made
and whenever the policy cost factors for new issues are changed.
SEPARATE ACCOUNT
HOW WAS THE SEPARATE ACCOUNT ESTABLISHED?
We established the separate account in accordance with certain provisions of New
York insurance law.
WHAT IS THE PURPOSE OF THE SEPARATE ACCOUNT?
The purpose of the separate account is to hold assets attributable to the
variable portion of this rider and others of its class.
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WHAT SEPARATE ACCOUNT OPTIONS ARE AVAILABLE?
The separate account is divided into sub-accounts. Those available to this rider
are listed on the specifications page attached to this group policy. Net
premiums will be allocated to the various sub-accounts of the separate account
or any other sub-account which we may add in the future, as elected by the owner
of each certificate issued under this rider. We reserve the right to add,
combine or remove any sub-accounts of the separate account.
WHAT ARE THE INVESTMENTS OF THE SEPARATE ACCOUNT?
For each sub-account, there is a fund for the investment of that sub-account's
assets. The assets of the sub-accounts are invested in the funds at net asset
value. If investment in a fund should no longer be possible or if we determine
it becomes inappropriate for the policies of this class, we may substitute
another fund. Substitution may be with respect to both existing policy values
and future premiums. The investment policy of the separate account may not be
changed, however, without the approval of the regulatory authorities of the
State of New York. If required, that approval process will be on file with the
regulatory authorities of the State of New York.
WHAT CHANGES MAY WE MAKE TO THE SEPARATE ACCOUNT?
We reserve the right to transfer assets of the separate account which we
determine to be associated with the class of policies to which this rider
belongs, to another separate account. If such a transfer is made, the term
"separate account" as used in this rider, shall then mean the separate account
to which the assets are transferred. A transfer of this kind may require the
advance approval of state regulatory authorities.
When permitted by law, we reserve the right to:
(1) restrict or eliminate any voting right of owners or other persons
who have voting rights as to the separate account; and
(2) combine the separate account with one or more other separate
accounts; and
(3) de-register the separate account under the Investment Company Act
of 1940.
HOW ARE NET PREMIUMS ALLOCATED?
Net premiums are allocated to the guaranteed account and/or to the sub-accounts
of the separate account. Except as provided for under the Free Look provision,
the initial allocation elected is indicated in the application for a certificate
of insurance issued hereunder. Allocations may be changed for future premiums.
The owner may do this by giving us a written request or through any other method
made available by us under this rider. A change will not take effect until it is
recorded by us in our home office.
Allocations must be expressed in whole percentages. The allocation to the
guaranteed account or to any sub-account of the separate account must be at
least [ten] percent of the net premium. We reserve the right to restrict the
allocation of premium to the guaranteed account. If we do so, no more than
[fifty] percent of the net premium may be allocated to the guaranteed account.
In the event of a material change in the investment policy of the separate
account, all net premiums may be allocated to the guaranteed account.
We reserve the right to delay the allocation of net premiums to named
sub-accounts. Such a delay will be for the free look period of 10 days after the
insured spouse receives his or her certificate. This right will be exercised by
us only when we believe economic conditions make such a delay necessary to
reduce market risk during the free look period of the certificate. If we
exercise this right, net premiums will be allocated to the money market
sub-account until the end of that period.
WHAT IS A TRANSFER?
A transfer is a reallocation of the net cash value between the guaranteed
account and the separate account or among the sub-accounts of the separate
account for a given owner.
MAY THE OWNER MAKE TRANSFERS OF AMOUNTS UNDER THE CERTIFICATE?
Yes. Transfers from a sub-account of the separate account or from the guaranteed
account may be made in writing, by telephone, or through any other method made
available by us under this rider. For transfers out of the separate account or
among the sub-accounts of the separate account, we will credit and cancel units
based on the sub-account unit values as of the end of the valuation period
during which the owner's request is received at our home office. For transfers
out of the guaranteed account, a dollar amount will be transferred based on the
owner's guaranteed account value at the time of transfer.
ARE THERE LIMITATIONS ON TRANSFERS?
Yes. Only one transfer may be made each certificate month for each certificate
issued hereunder. The amount to be transferred to or from a sub-account of the
separate account or the guaranteed account must be at least [$250]. If the
balance in the guaranteed account or in the sub-account from which the transfer
is to be made is less than [$250], the entire account value attributable to that
sub-account or the guaranteed account must be transferred. If a transfer would
reduce the account value in the sub-account from which the transfer is to be
made to less than [$250], we reserve the right to include that remaining amount
in the sub-account with the amount transferred.
The maximum amount of net cash value to be transferred out of the guaranteed
account to the sub-accounts of the separate account is limited to [twenty]
percent (or [$250] if greater) of the guaranteed account value. Transfers to or
from the guaranteed account may be limited to [one] such transfer per
certificate year.
We may modify the transfer privilege in the future by changing the minimum
amount transferable (not to be less than $100 nor more than $500), by imposing a
transfer charge (not to exceed $10), by prohibiting transfers out of the
guaranteed account, or in such other manner as we may determine at our
discretion.
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HOW ARE UNITS DETERMINED?
The number of units credited with respect to each net premium payment is
determined by dividing the portion of the net premium payment allocated to each
sub-account by the then current unit value for that sub-account. This
determination is made as of the end of the valuation period during which the
premium is received at our home office. Once determined, the number of units
will not be affected by changes in the unit value.
HOW ARE UNITS INCREASED OR DECREASED?
The number of units credited to a sub-account under an owner's certificate will
be increased by the allocation of subsequent net premiums, policy experience
credits, loan repayments, loan interest credits and transfers to that
sub-account. The number of units credited to a sub-account under an owner's
certificate will be decreased by deductions to that sub-account, loans and loan
interest charges, transfers from that sub-account and withdrawals from that
sub-account. The number of sub-account units will decrease to zero on
certificate termination.
HOW IS A UNIT VALUED?
The unit value will increase or decrease on each valuation date. The amount of
any increase or decrease will depend on the net investment experience of the
sub-accounts of the separate account. The value of a unit for each sub-account
was originally set at $1.00 on the first valuation date. For any subsequent
valuation date, its value is equal to its value on the preceding valuation date
multiplied by the net investment factor for that sub-account for the valuation
period ending on the subsequent valuation date.
WHAT IS THE NET INVESTMENT FACTOR FOR EACH SUB-ACCOUNT?
The net investment factor is a measure of the net investment experience of a
sub-account during the valuation period.
The net investment factor for a valuation period is the gross investment rate
for such valuation period, less a deduction for the charges under this rider
which are assessed against separate account assets. The gross investment rate is
equal to:
(1) the net asset value per share of a fund share held in the
sub-account of the separate account determined at the end of the
current valuation period; plus
(2) the per-share amount of any dividend or capital gain distributions
by the fund if the "ex-dividend" date occurs during the current
valuation period; divided by
(3) the net asset value per share of that fund share held in the
sub-account determined at the end of the preceding valuation
period.
We reserve the right to deduct a charge against the separate account assets, or
make other provisions for, any additional tax liability we may incur with
respect to the separate account or the policies, to the extent that those
liabilities exceed the amounts recovered through the deduction from premiums for
premium taxes and federal taxes.
EXCHANGE PRIVILEGE
CAN THE OWNER TRANSFER ALL SUB-ACCOUNT VALUES UNDER THIS RIDER TO THE GUARANTEED
ACCOUNT WITHIN THE FIRST 18 MONTHS?
Yes. Within the first 18 policy months of the effective date of coverage under
this rider, an owner may transfer all sub-account values under his or her
certificate to the guaranteed account, without transfer or other restrictions,
provided this rider is in force and the required premiums are fully paid.
CAN THE OWNER EXCHANGE ALL SUB-ACCOUNT VALUES UNDER THIS RIDER TO THE GUARANTEED
ACCOUNT IF THERE IS A MATERIAL CHANGE TO THE INVESTMENT POLICY OF THE SEPARATE
ACCOUNT?
Yes. If there is a material change to the investment policy of the separate
account, an owner may transfer all sub-account values under his or her
certificate to the guaranteed account without transfer or other restrictions
provided this rider is in force and the required premiums are fully paid.
PAID-UP INSURANCE OPTION
Once per certificate year, an owner can apply his or her cash surrender value to
purchase guaranteed fixed paid-up insurance under this rider. If the owner
applies his or her cash surrender value to purchase guaranteed fixed paid-up
insurance under this rider, we will terminate the owner's insurance provided
under his or her original certificate and issue a new certificate specifications
page showing the guaranteed fixed paid-up insurance. Insurance on any dependents
insured by rider will terminate and such insurance can be converted to a policy
of individual life insurance according to the conversion provisions of the
rider.
The death benefit provided by the guaranteed fixed paid-up coverage will be
determined as follows:
(1) We will calculate the net cash value of the certificate on the date
of the change. This will be the initial cash value of the
guaranteed fixed paid-up coverage.
(2) The amount of the paid-up death benefit will be determined by
multiplying the net cash value by a paid-up insurance factor. The
minimum paid-up insurance factors are shown in Table C.
(3) The minimum cash value of the paid-up death benefit is determined
by dividing the paid-up death benefit by the factor in Table C for
the insured's attained age.
The net amount at risk provided by the guaranteed fixed paid-up coverage may not
exceed the net amount at risk immediately prior to the exercise of this paid-up
option. We reserve the right to return any excess net cash value and/or reduce
the death benefit in order to achieve this.
96-19979 Northstar Life 8
Paid-up insurance terminates at age 95.
In no event will we be liable under the original and the guaranteed fixed
paid-up coverages.
A detailed statement of the method of computation of cash surrender values and
other nonforfeiture benefits is on file with the Superintendent of Insurance for
the State of New York.
ACCOUNT VALUES
WILL THE OWNER HAVE ACCESS TO THE NET CASH VALUE?
Yes. The owner has access to the certificate's net cash value. The net cash
value is the account value of the certificate issued under this rider, less the
loan principal and accrued loan interest charges and any charges overdue, plus
accrued loan interest credits. The net cash value is the amount the owner may
apply to purchase guaranteed fixed paid-up insurance under this rider.
HOW IS THE ACCOUNT VALUE DETERMINED?
The account value is determined separately for each certificate. It is the sum
of the values under the separate account, the guaranteed account and the loan
principal of a certificate.
The separate account value is the sum of units of each sub-account, credited to
the certificate, multiplied by the unit value for that sub-account. Once
determined, the number of units credited to a sub-account under an owner's
certificate will not be affected by changes in the unit value. However, the
number of units will be increased by the allocation of subsequent net premiums,
policy experience credits, loan repayments, loan interest credits and transfers
to that sub-account. The number of units credited to a sub-account under an
owner's certificate will be decreased by deductions to that sub-account, loans
and loan interest charges, transfers from that sub-account and withdrawals from
that sub-account. The number of sub-account units will decrease to zero on a
certificate termination.
IS THE SEPARATE ACCOUNT VALUE GUARANTEED?
No. The separate account value of each certificate is not guaranteed. The
assets of the separate account will be valued as often as any certificate values
vary, but at least monthly.
IS THE GUARANTEED ACCOUNT VALUE GUARANTEED?
Yes. The guaranteed account value of each certificate is guaranteed by us. It
cannot be reduced by the investment experience of the guaranteed account.
IS INTEREST CREDITED ON THE GUARANTEED ACCOUNT VALUE?
Yes. Interest is credited on the guaranteed account value of each certificate
under this rider. Interest is credited daily at a rate of not less than [three]
percent per year, compounded annually. We guarantee this minimum rate for the
life of this rider.
MAY ADDITIONAL INTEREST BE CREDITED ON THE GUARANTEED ACCOUNT?
Yes. As conditions permit, we may credit additional amounts of interest to the
guaranteed account value.
SURRENDERS AND WITHDRAWALS
MAY A CERTIFICATE BE SURRENDERED?
Yes. The owner of a certificate may request the surrender of a certificate at
any time while the insured under that certificate is living.
WHAT IS THE SURRENDER VALUE OF THE CERTIFICATE?
The surrender value of a certificate is the net cash value.
The determination of the surrender value is made as of the end of the valuation
period during which we receive the surrender request at our home office.
The cash surrender values and nonforfeiture benefits available under this rider
are not less than the minimum values and benefits required by any statute of the
state in which this rider is delivered. Any certificate delivered or deemed to
be delivered in New York must comply with New York requirements.
The cash surrender value of a certificate will be furnished to the owner within
twenty business days from the date of written request.
A detailed statement of the method of computation of cash surrender values and
other nonforfeiture benefits is on file with the Superintendent of Insurance for
the State of New York.
IS A WITHDRAWAL PERMITTED?
Yes. The owner may make a withdrawal of the net cash value of a certificate. The
amount of a withdrawal must be [$500] or more and it cannot exceed 100% of the
net cash value of the certificate. A withdrawal will cause a decrease in the
face amount equal to the amount withdrawn under those certificates issued with a
level death benefit, Option A. A withdrawal has no effect on the face amount of
an Option B death benefit. However, since the account value is reduced by the
amount of the withdrawal, the death benefit under Option B will be reduced by
this same amount at the time of the withdrawal. We reserve the right to change
the minimum amount for withdrawals or limit the number of times the owner may
make a withdrawal.
MAY THE OWNER DIRECT US AS TO HOW WITHDRAWALS WILL BE TAKEN FROM THE NET CASH
VALUE?
Yes. The owner may tell us the sub-accounts from which a withdrawal is to be
taken or whether it is to be taken in whole or in part from the guaranteed
account. If the owner does not direct us as to how withdrawals will be taken,
they will be deducted from the guaranteed account value and separate account
value in the same proportion that those values bear to each other and, as to the
separate account value, from each sub-account in the
96-19979 Northstar Life 9
proportion that the sub-account value of each such sub-account bears to the
separate account value. We reserve the right to restrict or prohibit withdrawals
from the guaranteed account.
REPORTS
WILL THE OWNER RECEIVE AN ANNUAL STATEMENT OF ACCOUNT?
Yes. Each owner will receive an annual statement of account that shows the
following:
(1) The total of all premiums paid and their allocation; and
(2) The policy charges; and
(3) The amount of any withdrawals; and
(4) The net cash value; and
(5) The amount of any loans outstanding against the account value; and
(6) The current death benefit; and
(7) The beginning and ending account values; and
(8) The investment gain or loss; and
(9) Any other information required by the State of New York
Superintendent of Insurance.
LOANS
CAN THE OWNER XXXXXX AGAINST THE NET CASH VALUE?
Yes. The owner may borrow an amount of at least [$100] and up to the maximum
loan amount. This amount is determined as of the date we receive the request for
a loan. Requests may be made in writing, by telephone, or through any other
method made available by us under this rider. The certificate will be the only
security required for a loan. We will charge interest on the loan principal in
arrears.
When a loan is to come from the guaranteed account value, we have the right to
postpone payment of a loan for up to six months.
If we have not mailed or delivered the loan amount requested by the owner, up to
a maximum of the loan value of his or her certificate, within 10 days of receipt
of the loan request in our home office, we will pay interest on the loan amount.
Interest will be at an annual rate determined by us, but never less than [3%].
Interest is calculated starting on the date the loan request is received in our
home office and will be due starting on the tenth day following receipt of the
loan request in our home office unless the amount of interest is less than
$25.00, in which case, no interest is payable.
WHAT IS THE MAXIMUM LOAN AMOUNT AVAILABLE FOR A LOAN ON ANY CERTIFICATE?
The total amount available for a loan under any certificate is (a) minus (b),
where (a) is ninety percent of the account value and (b) is the loan principal
plus accrued loan interest charges. The maximum loan amount will be determined
as of the date we receive the request for a loan at our home office.
WHAT IS THE EFFECT OF A LOAN?
When a loan is taken on a certificate, we will reduce the net cash value of the
certificate by the amount borrowed. This determination will be made as of the
end of the valuation period during which the loan request is received at our
home office. The amount borrowed continues to be a part of the account value, as
the amount borrowed becomes part of the loan principal where it will accrue loan
interest credits, and will be held in our general account.
HOW DOES A LOAN REDUCE NET CASH VALUE ON A CERTIFICATE?
Unless the owner directs us otherwise, the loan will be taken from a
certificate's guaranteed account value and separate account value in the same
proportion that those values bear to each other and, as to the separate account
value, from each sub-account in the proportion that the sub-account value of
each such sub-account bears to the separate account value. The number of units
to be canceled will be based upon the value of the units as of the end of the
valuation period during which the loan request is received at our home office.
The net cash value of any certificate may decrease from day to day. The net cash
value will decrease by the same amount of any decrease in account value or
increase in the amount borrowed or increase in the difference between the
accrued loan interest charges and the accrued loan interest credits. If a
certificate has a loan principal and no net cash value, the certificate will
lapse.
WHAT IS THE INTEREST RATE CHARGED ON THE LOAN PRINCIPAL?
The interest rate charged on the loan principal will be [eight] percent per
year.
The accrued loan interest charges on the loan principal will reduce the net cash
value. Loan interest charges are due at the end of the certificate month. If the
accrued loan interest charges are not paid at the end of the certificate month,
this interest will be deducted from the account value and added to the loan
principal and charged the same rate of interest as the loan principal in effect.
WHAT IS THE INTEREST RATE CREDITED TO A CERTIFICATE AS A RESULT OF A LOAN?
Interest credits which accrue on the loan principal shall be at a rate which is
not less than [six] percent per year.
WHEN ARE LOAN INTEREST CREDITS AND LOAN INTEREST CHARGES ALLOCATED TO A
CERTIFICATE?
Loan interest charges and loan interest credits are allocated monthly, at loan
repayment, at certificate surrender and at death. Loan interest charges and loan
interest credits are allocated to a certificate's guaranteed account value and
separate account value in the same proportion that those values bear to each
other and, as to the separate account value, to each sub-account in the
proportion that the sub-account value of each such sub-account bears to the
separate account value.
96-19979 Northstar Life 10
WHEN AND IN WHAT AMOUNT SHOULD LOAN REPAYMENTS BE MADE?
The loan principal and the accrued loan interest charges may be repaid in full
or in part at any time before the insured's death so long as the insurance
coverage under the certificate is in force. The loan may also be repaid within
60 days after the date of the insured's death, if we have not paid any of the
death benefits under that certificate. Any loan repayment must be at least
[$100] unless the balance due is less than [$100].
HOW DO LOAN REPAYMENTS AFFECT THE LOAN PRINCIPAL AND THE GUARANTEED ACCOUNT
VALUE?
Loan repayments are allocated to the guaranteed account value and increase the
net cash value of a certificate by the amount of the loan repayment. The loan
repayment will be applied first to reduce the amount of accrued loan interest
charges. Any remaining portion of the repayment will then be used to reduce the
loan principal.
WHAT HAPPENS IF A LOAN ON A CERTIFICATE IS NOT REPAID?
If a certificate has a loan principal, the certificate will remain in force so
long as it has sufficient net cash value. If it does not have sufficient net
cash value, it will lapse.
In this event, to keep a certificate in force, the owner will have to make a
loan repayment. We will give the owner notice of our intent to terminate a
certificate and the loan repayment required to keep it in force. The time for
repayment will be within 61 days after our mailing of the warning notice of
lapse.
Any loan outstanding at the time of the insured's death will reduce the death
benefit and cash value.
TERMINATION
CAN GROUP INSURANCE COVERAGE BE CONTINUED ONCE THE INSURED'S ELIGIBILITY ENDS?
Yes. If the insured spouse's eligibility under this rider ends, the current
group coverage may continue [unless this rider has terminated or been amended to
terminate the insured spouse's insurance and there is a successor plan for the
terminated insurance. Successor plan shall mean another insurer's insurance
policy(ies) with a cash accumulation feature or an annuity contract(s) that
replaces the insurance provided under this rider.]
Insurance for an owner who meets these requirements will be automatically
continued. We will bill the owner and all future premium payments will be paid
directly to us.
The face amount of insurance will not change unless the insured spouse requests
a change. We reserve the right to alter the administration charge not to exceed
[$4.00] per month and the monthly cost of insurance up to the maximum in Table A
if the insurance is continued.
WHEN DOES A CERTIFICATE OF INSURANCE UNDER THIS RIDER TERMINATE?
The insurance on the life of an insured will terminate on the earliest of:
(1) 61 days after we mail a warning notice of lapse on a certificate
monthly anniversary in which the net cash value is insufficient to
pay for the monthly deduction and no premium is paid during the
grace period; or
(2) the date this rider terminates, unless continuation is in effect or
available; or
(3) the date an owner surrenders the certificate or requests that we
terminate the insurance; or
(4) the 95th birthday of the insured; or
(5) this rider is amended to terminate insurance for the insured unless
continuation is in effect or available.
WHEN DOES AN INSURED'S CERTIFICATE UNDER THIS RIDER MATURE?
An insured's certificate under this rider matures in an amount equal to the
certificate's net cash value upon the insured's 95th birthday.
WILL THE OWNER OF A CERTIFICATE RECEIVE NOTICE PRIOR TO THE TERMINATION OF
INSURANCE?
If the owner's insurance will be terminated because the net cash value is less
than that required to pay the monthly deduction, we will give the owner at least
61 days prior written notice of lapse before terminating the insurance.
CAN INSURANCE ON THE LIFE ON AN INSURED BE REINSTATED AFTER TERMINATION?
Insurance terminated due to the insufficiency of the net cash value to pay the
monthly deduction may be reinstated. Reinstatement must occur while the insured
is living, this rider remains in force and at any time within three years from
the date of lapse. Reinstatement is made by payment of an amount that, after the
deduction of percentage-of-premium charges, is large enough to cover all monthly
deductions which have accrued on that certificate up to the effective date of
reinstatement plus the monthly deductions for the two months following the
effective date of reinstatement. If any loans and loan interest charges are not
repaid, this indebtedness will be reinstated along with the insurance. No
evidence of the insured's insurability will be required during the first 31 days
following lapse, but will be required from the 32nd day to 3 years from the date
of lapse.
WHEN DOES THIS RIDER TERMINATE?
You may terminate this rider by giving us 31 days prior written notice. We
reserve the right to terminate this rider on the earliest of the following to
occur:
(1) [the aggregate face amount for all certificates under this rider
decreases by 10% in any 12 month period or below $1,000,000; or
96-19979 Northstar Life 11
(2) the number of certificates under this rider decreases by 10% in
any 12 month period or below 25; or
(3) 61 days after we provide notice of our intent to terminate this
rider.]
No individual may become insured under this rider after the effective date of
such a notice of termination.
WHAT HAPPENS TO ACCOUNT VALUES AT GROUP POLICY TERMINATION?
Account values attributable to the separate account will be valued as of the
close of business on the distribution date or dates mutually agreed upon by you
and us. For account values attributable to the guaranteed account, we reserve
the right to delay the distribution for up to six months. This delayed
distribution does not in any way continue or extend any insurance that has
otherwise terminated due to termination of this rider.
CONVERSION RIGHT
WHAT IS THE CONVERSION PRIVILEGE?
If an insured spouse's eligibility ends or the group policy terminates, the
insured/owner may convert the insurance under this rider to a new individual
life insurance policy with Northstar Life. The insured/owner cannot convert to
an individual policy and continue his or her group insurance under this rider.
[Also, if any portion of an insured spouse's insurance is reduced on or after
the attainment of age sixty in any increment or series of increments totaling
twenty percent or more of the amount of insurance in force under this rider
prior to the first reduction at age sixty, the insured/owner can convert the
amount of the reduction to a new individual life insurance policy.]
The insured/owner may convert the insurance under this rider to any type of
individual policy of life insurance then customarily issued by us. The
individual policy will not include any additional benefits, including, but not
limited to, any disability benefits, accidental death and dismemberment benefits
or accelerated benefits.
CAN THE INSURED/OWNER CONTINUE THE GROUP LIFE INSURANCE PROVIDED BY HIS OR HER
CERTIFICATE PRIOR TO CONVERSION?
Yes. If an insured/owner is eligible to convert the insurance under this rider,
the owner may elect to continue such insurance provided by this rider under the
group policy prior to converting to an individual policy by paying premiums
directly to us. The insured/owner may continue such group life insurance for a
period of up to one year at which time he or she may convert such insurance to
an individual policy of permanent insurance with Northstar Life. Such conversion
shall be subject to the rest of this conversion privilege section. [Except for
insurance that is eligible for conversion as a result of a reduction due to the
age of the insured], insurance may be continued beyond one year according to the
terms of the section entitled "Can group insurance coverage be continued once
the insured's eligibility ends?" The cost of insurance and administration fee
for this continued coverage may be higher.
WHEN MUST ELECTION TO CONTINUE OR CONVERT INSURANCE BE MADE?
The insured/owner will be notified of his or her right to continue or convert
the group life insurance provided by his or her certificate. If notification is
made within 15 days before or after the event that results in termination or
reduction of the group life coverage, the insured/owner will have 31 days from
the date the insurance terminates to elect continuation or conversion. If the
notice is given more than 15 days but less than 90 days after the event, the
time allowed for the exercise of the continuation or conversion privilege shall
be extended to 45 days after such notice is sent. If notice is not given within
90 days, the time allowed for the exercise of the continuation or conversion
privilege expires 90 days after the terminating event. Such notice shall be
mailed to the insured/owner at the insured's/owner's last known address.
The continuation or conversion privilege is not available if the
insured's/owner's] coverage under this rider terminates due to the
insured's/owner's failure to make, when due, required premium contributions.
HOW DOES AN INSURED/OWNER CONVERT THE GROUP LIFE INSURANCE PROVIDED BY HIS OR
HER CERTIFICATE?
An insured/owner converts the group life insurance provided by his or her
certificate by applying for an individual policy and paying the first premium
within the time period allowed for such election. No evidence of insurability
will be required.
HOW IS THE PREMIUM FOR THE INDIVIDUAL POLICY DETERMINED?
We base the premium for the individual policy on the plan of insurance, the
insured spouse's age, and the class of risk to which the insured belongs on the
date of the conversion.
WHAT HAPPENS IF THE INSURED DIES DURING THE PERIOD ALLOWED FOR CONVERSION?
If the insured spouse dies during the period allowed for conversion, we will pay
a death benefit regardless of whether or not an application for coverage under
an individual policy has been submitted. The death benefit will be the amount of
insurance the owner would have been eligible to convert under the terms of the
conversion privilege section.
We will return any premium paid for an individual policy to the insured spouse's
beneficiary named under this rider. In no event will we be liable under both
this rider and the individual policy.
96-19979 Northstar Life 12
ADDITIONAL INFORMATION
MAY AN OWNER ASSIGN ANY INTEREST UNDER THE CERTIFICATE ISSUED UNDER THIS RIDER?
[Yes. The assignment must be in writing and filed at our home office. We
assume no responsibility for the validity or effect of any assignment. Any
claim made by an assignee will be subject to proof of the assignee's interest
and the extent of the assignment.]
WHAT IF AN INSURED'S AGE IS MISSTATED?
If the age of the insured has been misstated, the death benefit and account
value will be adjusted. The adjustment will be the difference between two
amounts accumulated with interest. These two amounts are:
(1) the monthly cost of insurance charges that were paid; and
(2) the monthly cost of insurance charges that should have been paid
based on the insured's correct age.
The interest rates used are the rates that were used in accumulating the
guaranteed account values.
WHEN DOES AN INSURED'S INSURANCE BECOME INCONTESTABLE?
After the insurance has been in force during the insured's lifetime for a two
year period from the certificate date, we cannot contest the insurance for any
loss that is incurred more than two years after the certificate date, unless the
net cash value has dropped below the amount necessary to pay the cost of
insurance on the insured's life. However, if there has been an increase in the
amount of insurance for which we required evidence of insurability, then, to the
extent of the increase, any loss which occurs within two years of the effective
date of the increase will be contestable.
[IS THERE A SUICIDE EXCLUSION?]
[If an insured dies by suicide within two years of the certificate date, our
liability will be limited to an amount equal to the premiums paid for that
insured. If there has been an increase in the face amount of insurance for which
we required evidence of insurability, and if the insured dies by suicide within
two years of the effective date of the increase, our liability with respect to
that increase will be limited to the cost of insurance charge attributable to
such increase. The suicide exclusion period does not begin again upon
reinstatement of an insured's insurance if his or her insurance has been
reinstated.]
WILL THE INSURED RECEIVE A CERTIFICATE OF PARTICIPATION?
Yes. Within 30 days of the effective date of an owner's insurance, we will
furnish the owner with a certificate of insurance.
DOES THE OWNER HAVE ANY ADDITIONAL VOTING RIGHTS?
Yes. If the owner has separate account units under this rider, the owner may
direct us with respect to the voting rights of fund shares held by us and
attributable to this rider.
COULD THE PAYMENT OF PROCEEDS BE POSTPONED?
Normally, we will pay any proceeds within seven days after our receipt of all
the documents required for such a payment. Other than the death proceeds, which
are determined as of the date of death of the insured, the amount of payment
will be determined as of the end of the valuation period during which a request
is received at our home office. If such payments are based upon values which do
not depend on the investment performance of the separate account, however, we
reserve the right to defer payments, including loans, for up to six months from
the date of the owner's request. In that case, if we postpone a payment other
than a loan payment for more than 31 days, we will pay the owner interest at the
greater of [three] percent per year or the rate required by law for the period
beyond that time that payment is postponed. For payments based on account values
which do depend on the investment performance of the separate account, we may
defer payment only: (a) for any period during which the New York Stock Exchange
is closed for trading (except for normal holiday closing); or (b) when the
Securities and Exchange Commission has determined that a state of emergency
exists which may make such payment impractical.
COULD ANY PAYMENTS MADE UNDER THIS RIDER BE SUBJECT TO CLAIMS OF CREDITORS?
To the extent permitted by law, neither this rider, certificates issued under
this rider, nor any payment thereunder will be subject to the claims of
creditors or to any legal process.
WHEN WILL THIS RIDER BE ISSUED?
This rider will be issued upon receipt of a signed policy application signed by
a duly authorized officer of the group policyholder and acceptance by a duly
authorized officer of Northstar Life at our home office.
ARE GROUP POLICY CHANGES LIMITED?
We reserve the right to limit the number of changes to one per certificate year
and to restrict such changes in the first certificate year. For this purpose,
changes include increases or decreases in the face amount of insurance.
96-19979 Northstar Life 13
TABLE A
NORTHSTAR LIFE INSURANCE COMPANY
MAXIMUM MONTHLY RATE
ON A TOBACCO DISTINCT BASIS
PER $1,000 NET AMOUNT AT RISK*
MAXIMUM MAXIMUM MAXIMUM
ATTAINED MONTHLY ATTAINED MONTHLY ATTAINED MONTHLY
AGE** RATE AGE** RATE AGE** RATE
-------- ------ -------- ------- -------- --------
NON-TOBACCO TOBACCO NON-TOBACCO TOBACCO NON-TOBACCO TOBACCO
----------- ------- ----------- ------- ----------- -------
0 0.203 0.203 35 0.139 0.212 70 2.736 4.035
1 0.082 0.082 36 0.148 0.228 71 3.027 4.377
2 0.078 0.078 37 0.158 0.248 72 3.346 4.768
3 0.077 0.077 38 0.168 0.270 73 3.733 5.205
4 0.074 0.074 39 0.180 0.295 74 4.160 5.688
5 0.071 0.071 40 0.194 0.324 75 4.620 6.203
6 0.068 0.068 41 0.208 0.357 76 5.107 6.730
7 0.063 0.063 42 0.224 0.390 77 5.618 7.261
8 0.062 0.062 43 0.242 0.427 78 6.158 7.800
9 0.060 0.060 44 0.260 0.467 79 6.742 8.369
10 0.061 0.061 45 0.280 0.508 80 7.391 8.990
11 0.065 0.065 46 0.302 0.553 81 8.123 9.681
12 0.073 0.073 47 0.326 0.599 82 8.954 10.456
13 0.083 0.083 48 0.351 0.650 83 9.881 11.318
14 0.094 0.094 49 0.379 0.705 84 10.886 12.233
15 0.103 0.131 50 0.411 0.765 85 11.952 13.178
16 0.112 0.144 51 0.448 0.833 86 13.065 14.140
17 0.118 0.154 52 0.489 0.910 87 14.217 15.141
18 0.122 0.162 53 0.536 0.997 88 15.408 16.191
19 0.125 0.167 54 0.588 1.091 89 16.651 17.270
20 0.127 0.170 55 0.646 1.191 90 17.958 18.430
21 0.126 0.170 56 0.708 1.295 91 19.364 19.673
22 0.124 0.168 57 0.773 1.403 92 20.928 21.093
23 0.122 0.166 58 0.844 1.515 93 22.793 22.852
24 0.120 0.163 59 0.923 1.635 94 25.257 25.257
25 0.118 0.160 60 1.013 1.769
26 0.115 0.158 61 1.114 1.922
27 0.114 0.158 62 1.232 2.098
28 0.115 0.158 63 1.367 2.296
29 0.115 0.162 64 1.518 2.513
30 0.117 0.166 65 1.682 2.742
31 0.119 0.172 66 1.857 2.978
32 0.123 0.179 67 2.043 3.219
33 0.127 0.188 68 2.243 3.468
34 0.133 0.199 69 2.466 3.737
* These are the guaranteed rates for standard lives. These maximum rates are
based on the 1980 CSO 75% male age at last birthday table for
tobacco/non-tobacco.
** This is the insured's attained age as of the last certificate anniversary.
96-19979 Northstar Life 14
TABLE A
NORTHSTAR LIFE INSURANCE COMPANY
MAXIMUM MONTHLY RATE
ON A UNI-TOBACCO BASIS
PER $1,000 NET AMOUNT AT RISK*
MAXIMUM MAXIMUM MAXIMUM
ATTAINED MONTHLY ATTAINED MONTHLY ATTAINED MONTHLY
AGE** RATE AGE** RATE AGE** RATE
-------- ------ -------- ------- -------- --------
UNI-TOBACCO UNI-TOBACCO UNI-TOBACCO
----------- ----------- -----------
0 0.203 35 0.171 70 3.022
1 0.082 36 0.183 71 3.314
2 0.078 37 0.196 72 3.653
3 0.077 38 0.212 73 4.040
4 0.074 39 0.230 74 4.468
5 0.071 40 0.250 75 4.928
6 0.068 41 0.272 76 5.412
7 0.063 42 0.294 77 5.914
8 0.062 43 0.318 78 6.440
9 0.060 44 0.344 79 7.008
10 0.061 45 0.373 80 7.638
11 0.065 46 0.402 81 8.350
12 0.073 47 0.433 82 9.159
13 0.083 48 0.466 83 10.061
14 0.094 49 0.503 84 11.038
15 0.108 50 0.544 85 12.073
16 0.119 51 0.591 86 13.156
17 0.128 52 0.643 87 14.278
18 0.134 53 0.703 88 15.446
19 0.139 54 0.768 89 16.668
20 0.142 55 0.837 90 17.963
21 0.142 56 0.909 91 19.364
22 0.141 57 0.984 92 20.928
23 0.139 58 1.064 93 22.793
24 0.137 59 1.153 94 25.257
25 0.134 60 1.250
26 0.133 61 1.360
27 0.133 62 1.488
28 0.133 63 1.634
29 0.135 64 1.793
30 0.138 65 1.967
31 0.142 66 2.149
32 0.147 67 2.340
33 0.154 68 2.543
34 0.162 69 2.768
* These are the guaranteed rates for standard lives. These maximum rates are
based on the 1980 CSO 75% male age at last birthday table for uni-tobacco.
** This is the insured's attained age as of the last certificate anniversary.
96-19979 Northstar Life 15
TABLE B
NORTHSTAR LIFE INSURANCE COMPANY
MINIMUM DEATH BENEFIT AS A PERCENTAGE OF ACCOUNT VALUE FOR THE
CASH VALUE ACCUMULATION TEST ON A TOBACCO-DISTINCT BASIS
ATTAINED MINIMUM ATTAINED MINIMUM ATTAINED MINIMUM
AGE DEATH BENEFIT AGE DEATH BENEFIT AGE DEATH BENEFIT
--- ------------- --- ------------- --- -------------
NON-TOBACCO TOBACCO NON-TOBACCO TOBACCO NON-TOBACCO TOBACCO
----------- ------- ----------- ------- ----------- -------
10 964% 799% 40 366% 308% 70 153% 144%
11 932% 773% 41 354% 298% 71 150% 142%
12 902% 747% 42 343% 289% 72 147% 139%
13 873% 722% 43 332% 280% 73 143% 137%
14 846% 698% 44 321% 272% 74 141% 135%
15 820% 676% 45 311% 264% 75 138% 133%
16 796% 656% 46 301% 256% 76 136% 131%
17 772% 637% 47 292% 249% 77 133% 129%
18 749% 618% 48 282% 242% 78 131% 128%
19 727% 600% 49 274% 235% 79 129% 126%
20 706% 583% 50 265% 229% 80 127% 124%
21 685% 566% 51 257% 223% 81 125% 123%
22 664% 549% 52 249% 217% 82 123% 121%
23 644% 533% 53 242% 211% 83 121% 120%
24 624% 517% 54 234% 205% 84 120% 119%
25 605% 501% 55 227% 200% 85 118% 117%
26 585% 485% 56 221% 195% 86 117% 116%
27 567% 470% 57 215% 190% 87 115% 115%
28 548% 455% 58 208% 186% 88 114% 114%
29 530% 440% 59 203% 182% 89 113% 112%
30 513% 426% 60 197% 177% 90 111% 111%
31 496% 412% 61 192% 173% 91 110% 110%
32 480% 399% 62 186% 169% 92 108% 108%
33 464% 386% 63 182% 166% 93 106% 106%
34 448% 374% 64 177% 162% 94 103% 103%
35 433% 362% 65 172% 159%
36 419% 350% 66 168% 156%
37 405% 339% 67 164% 153%
38 392% 328% 68 160% 150%
39 379% 318% 69 157% 147%
96-19979 Northstar Life 16
TABLE B
NORTHSTAR LIFE INSURANCE COMPANY
MINIMUM DEATH BENEFIT AS A PERCENTAGE OF ACCOUNT VALUE FOR THE
CASH VALUE ACCUMULATION TEST ON A UNI-TOBACCO BASIS
ATTAINED MINIMUM ATTAINED MINIMUM ATTAINED MINIMUM
AGE DEATH BENEFIT AGE DEATH BENEFIT AGE DEATH BENEFIT
-------- ------------- -------- ------------- -------- -------------
UNI-TOBACCO UNI-TOBACCO UNI-TOBACCO
------------- ------------- -------------
10 898% 40 344% 70 151%
11 868% 41 333% 71 148%
12 840% 42 323% 72 145%
13 813% 43 313% 73 142%
14 787% 44 303% 74 140%
15 762% 45 294% 75 137%
16 739% 46 285% 76 135%
17 717% 47 276% 77 133%
18 696% 48 268% 78 130%
19 676% 49 260% 79 128%
20 656% 50 253% 80 126%
21 637% 51 245% 81 125%
22 618% 52 238% 82 123%
23 599% 53 231% 83 121%
24 581% 54 225% 84 120%
25 563% 55 219% 85 118%
26 545% 56 213% 86 117%
27 528% 57 207% 87 115%
28 511% 58 202% 88 114%
29 494% 59 196% 89 113%
30 478% 60 191% 90 111%
31 463% 61 186% 91 110%
32 448% 62 182% 92 108%
33 433% 63 177% 93 106%
34 419% 64 173% 94 103%
35 405% 65 169%
36 392% 66 165%
37 379% 67 161%
38 367% 68 158%
39 355% 69 154%
96-19979 Northstar Life 17
TABLE C
NORTHSTAR LIFE INSURANCE COMPANY
GUARANTEED FIXED PAID-UP FACTORS ON A TOBACCO-DISTINCT BASIS
ATTAINED MINIMUM ATTAINED MINIMUM ATTAINED MINIMUM
AGE DEATH BENEFIT AGE DEATH BENEFIT AGE DEATH BENEFIT
--- ------------- --- ------------- --- -------------
NON-TOBACCO TOBACCO NON-TOBACCO TOBACCO NON-TOBACCO TOBACCO
----------- ------- ----------- ------- ----------- -------
0 12.90095 10.87124 35 4.37152 3.62968 70 1.55583 1.46025
1 12.76865 10.70610 36 4.22663 3.51297 71 1.52317 1.43564
2 12.41790 10.39115 37 4.08685 3.40070 72 1.49235 1.41236
3 12.06720 10.07864 38 3.95217 3.29281 73 1.46332 1.39052
4 11.71999 9.77093 39 3.82242 3.18927 74 1.43634 1.37024
5 11.37555 9.46750 40 3.69740 3.08996 75 1.41139 1.35156
6 11.03336 9.16798 41 3.57713 2.99486 76 1.38841 1.33450
7 10.69412 8.87284 42 3.46130 2.90385 77 1.36728 1.31894
8 10.35755 8.58184 43 3.34981 2.81663 78 1.34789 1.30475
9 10.02718 8.29734 44 3.24252 2.73308 79 1.33020 1.29185
10 9.70328 8.01945 45 3.13922 2.65307 80 1.31426 1.28031
11 9.38848 7.74987 46 3.03978 2.57636 81 1.30026 1.27032
12 9.08559 7.49039 47 2.94406 2.50276 82 1.28853 1.26223
13 8.79673 7.24231 48 2.85195 2.43212 83 1.27958 1.25655
14 8.52281 7.00613 49 2.76325 2.36432 84 1.27403 1.25398
15 8.26379 6.78170 50 2.67790 2.29925 85 1.27272 1.25537
16 8.01608 6.57932 51 2.59581 2.23682 86 1.27681 1.26186
17 7.77939 6.38662 52 2.51698 2.17704 87 1.28807 1.27520
18 7.55086 6.20147 53 2.44134 2.11987 88 1.30940 1.29838
19 7.32907 6.02244 54 2.36881 2.06530 89 1.34576 1.33650
20 7.11330 5.84830 55 2.29933 2.01325 90 1.40626 1.39868
21 6.90251 5.67833 56 2.23278 1.96355 91 1.50934 1.50353
22 6.69544 5.51140 57 2.16900 1.91602 92 1.69807 1.69406
23 6.49184 5.34709 58 2.10782 1.87047 93 2.10158 2.09941
24 6.29151 5.18531 59 2.04913 1.82675 94 3.36457 3.36459
25 6.09497 5.02620 60 1.99286 1.78475 95 0.00000 0.00000
26 5.90203 4.86969 61 1.93897 1.74450
27 5.71283 4.71629 62 1.88745 1.70602
28 5.52800 4.56624 63 1.83832 1.66941
29 5.34806 4.41987 64 1.79159 1.63471
30 5.17271 4.27760 65 1.74722 1.60188
31 5.00232 4.13945 66 1.70507 1.57078
32 4.83697 4.00553 67 1.66499 1.54122
33 4.67671 3.87593 68 1.62682 1.51303
34 4.52152 3.75065 69 1.59045 1.48606
These factors are based on the 1980 CSO 75% male age at last birthday table for
tobacco/non-tobacco and an interest rate of 4%.
96-19979 Northstar Life 18
TABLE C
NORTHSTAR LIFE INSURANCE COMPANY
GUARANTEED FIXED PAID-UP FACTORS ON A UNI-TOBACCO BASIS
ATTAINED MINIMUM ATTAINED MINIMUM ATTAINED MINIMUM
AGE DEATH BENEFIT AGE DEATH BENEFIT AGE DEATH BENEFIT
-------- ------------- -------- ------------- -------- -------------
UNI-TOBACCO UNI-TOBACCO UNI-TOBACCO
------------- ------------- -------------
0 12.10052 35 4.08118 70 1.53550
1 11.95281 36 3.94856 71 1.50508
2 11.61524 37 3.82078 72 1.47629
3 11.27877 38 3.69775 73 1.44926
4 10.94638 39 3.57947 74 1.42408
5 10.61743 40 3.46588 75 1.40077
6 10.29147 41 3.35680 76 1.37929
7 9.96912 42 3.25207 77 1.35953
8 9.65011 43 3.15143 78 1.34138
9 9.33748 44 3.05471 79 1.32479
10 9.03142 45 2.96173 80 1.30981
11 8.73419 46 2.87238 81 1.29665
12 8.44815 47 2.78642 82 1.28566
13 8.17508 48 2.70369 83 1.27734
14 7.91569 49 2.62406 84 1.27235
15 7.66992 50 2.54749 85 1.27150
16 7.43758 51 2.47387 86 1.27596
17 7.21656 52 2.40319 87 1.28754
18 7.00422 53 2.33541 88 1.30910
19 6.79917 54 2.27049 89 1.34563
20 6.60024 55 2.20835 90 1.40623
21 6.40608 56 2.14881 91 1.50933
22 6.21560 57 2.09171 92 1.69808
23 6.02854 58 2.03685 93 2.10157
24 5.84470 59 1.98411 94 3.36457
25 5.66392 60 1.93344 95 0.00000
26 5.48637 61 1.88479
27 5.31242 62 1.83817
28 5.14257 63 1.79365
29 4.97702 64 1.75125
30 4.81593 65 1.71089
31 4.65954 66 1.67248
32 4.50773 67 1.63588
33 4.36065 68 1.60090
34 4.21855 69 1.56745
These factors are based on the 1980 CSO 75% male age at last birthday table for
uni-tobacco and an interest rate of 4%.
96-19979 Northstar Life 19
TABLE D
NORTHSTAR LIFE INSURANCE COMPANY
MINIMUM DEATH BENEFIT AS A PERCENTAGE OF ACCOUNT VALUE FOR THE
GUIDELINE PREMIUM/CASH VALUE CORRIDOR TEST
ATTAINED APPLICABLE ATTAINED APPLICABLE ATTAINED APPLICABLE
AGE PERCENTAGE AGE PERCENTAGE AGE PERCENTAGE
--------- ---------- -------- ---------- -------- ----------
0 250% 32 250% 64 122%
1 250% 33 250% 65 120%
2 250% 34 250% 66 119%
3 250% 35 250% 67 118%
4 250% 36 250% 68 117%
5 250% 37 250% 69 116%
6 250% 38 250% 70 115%
7 250% 39 250% 71 113%
8 250% 40 250% 72 111%
9 250% 41 243% 73 109%
10 250% 42 236% 74 107%
11 250% 43 229% 75 105%
12 250% 44 222% 76 105%
13 250% 45 215% 77 105%
14 250% 46 209% 78 105%
15 250% 47 203% 79 105%
16 250% 48 197% 80 105%
17 250% 49 191% 81 105%
18 250% 50 185% 82 105%
19 250% 51 178% 83 105%
20 250% 52 171% 84 105%
21 250% 53 164% 85 105%
22 250% 54 157% 86 105%
23 250% 55 150% 87 105%
24 250% 56 146% 88 105%
25 250% 57 142% 89 105%
26 250% 58 138% 90 105%
27 250% 59 134% 91 104%
28 250% 60 130% 92 103%
29 250% 61 128% 93 102%
30 250% 62 126% 94 101%
31 250% 63 124%
96-19979 Northstar Life 20
INTEREST PAYMENT SETTLEMENT OPTIONS ILLUSTRATION
VARIABLE GROUP UNIVERSAL LIFE
The beneficiary is entitled to receive payment of the insurance in a lump sum
payment or in any one of the available settlement options. The guaranteed
interest rate is based on [3%]. The current rate is subject to change at any
time but never less than the guaranteed rate.
Payment of interest on the proceeds at such times and for a period as may be
agreed upon between the owner of a certificate and us. Withdrawal of proceeds
may be made in amounts of at least [$500]. At the end of the period, any
remaining proceeds will be paid in either a single sum or under any other method
we approve.
Principal Held At Interest (Withdrawable): Principal will be held by the Company
at interest for [2 years, 5 years or for your lifetime,] with interest payable
monthly, quarterly, semi-annually or annually. Or the interest could be added to
the principal sum and bear interest at the same rate. Interest would be
considered "withdrawable". Withdrawable would mean that any accruing interest
would be reportable for tax purposes. You would, also, have the option of
withdrawing the funds at any time without any interest penalty.
96-19979 Northstar Life 21
FIXED PERIOD ANNUITY SETTLEMENT OPTIONS ILLUSTRATION
VARIABLE GROUP UNIVERSAL LIFE
The beneficiary is entitled to receive payment of the insurance in a lump sum
payment or in any one of the available settlement options. The guaranteed
interest rate is based on [3%]. The current rate is subject to change at any
time but never less than the guaranteed rate.
An annuity payable in monthly installments for a specified number of years, from
one to twenty years.
Principal & Interest Paid In Monthly Payments (Specific Number of
Years): Principal and interest would be held by the Company to be
paid in monthly installments for a specific number of years. The
following is based on the guaranteed rate. (Benefits may be higher
based on the rates currently offered by the company.) The monthly
payment for each $1,000 of insurance would be:
Years Payable Monthly Payment per $1,000
1 $85.15
2 43.42
3 29.52
4 22.58
5 18.42
10 10.12
15 7.40
20 6.06
96-19979 Northstar Life 22
LIFE ANNUITY SETTLEMENT OPTIONS
VARIABLE GROUP UNIVERSAL LIFE
The beneficiary is entitled to receive payment of the insurance in a lump sum
payment or in any one of the available settlement options. The guaranteed
interest rate is based on [3%]. The current rate is subject to change at any
time but never less than the guaranteed rate.
An annuity payable monthly for the lifetime of the annuitant and ending with the
last monthly payment due prior to the annuitant's death.
Annuity: Principal would be used to purchase an annuity. Monthly
installments would be payable to you for as long as you live. You may
choose varying periods certain. In which case, if you should die prior to
the period certain, the commuted value of the remaining payments certain
would be payable to your beneficiary. Monthly payments are dependent upon
your date of birth.
Example:
If the insured elects an annuity as his/her settlement option, the monthly
benefit would be calculated in the following manner:
The principal amount is multiplied by the factor found on the attached
table and divided by 1,000.
For example, assume an annuitant, age 55 with $20,000 of principal who
elects:
(a) a life only annuity
($20,000 * 6.19)/l,000 = $123.80 monthly income
(b) ten year certain and life annuity
($20,000 * 6.13)/l,000 = $122.60 monthly income
The interest rates used to calculate the annuity factors are adjusted as
market interest rates fluctuate. The table provided was calculated
assuming an interest rate of 6.05%.
5 YEAR CERTAIN 10 YEAR CERTAIN 15 YEAR CERTAIN 20 YEAR CERTAIN
AGE LIFE ONLY AND LIFE AND LIFE AND LIFE AND LIFE
--- --------- ------- -------- -------- --------
40 5.43 5.43 5.42 5.40 5.38
41 5.47 5.46 5.45 5.43 5.41
42 5.50 5.50 5.48 5.46 5.44
43 5.54 5.53 5.52 5.50 5.47
44 5.58 5.57 5.56 5.53 5.50
45 5.62 5.61 5.59 5.57 5.53
46 5.66 5.65 5.64 5.60 5.56
47 5.71 5.70 5.68 5.64 5.60
48 5.76 5.75 5.72 5.69 5.64
49 5.81 5.80 5.77 5.73 5.68
50 5.86 5.85 5.82 5.78 5.72
51 5.92 5.91 5.88 5.83 5.76
52 5.98 5.97 5.93 5.88 5.80
53 6.05 6.03 5.99 5.93 5.85
54 6.12 6.10 6.06 5.99 5.90
96-19979 Northstar Life 23
5 YEAR CERTAIN 10 YEAR CERTAIN 15 YEAR CERTAIN 20 YEAR CERTAIN
AGE LIFE ONLY AND LIFE AND LIFE AND LIFE AND LIFE
--- --------- ------- -------- -------- --------
55 6.19 6.18 6.13 6.05 5.95
56 6.27 6.25 6.20 6.11 6.00
57 6.36 6.34 6.27 6.18 6.05
58 6.45 6.42 6.35 6.25 6.11
59 6.54 6.52 6.44 6.32 6.16
60 6.65 6.62 6.53 6.39 6.22
61 6.76 6.73 6.63 6.47 6.28
62 6.88 6.84 6.73 6.56 6.33
63 7.01 6.96 6.84 6.64 6.39
64 7.15 7.10 6.95 6.73 6.45
65 7.30 7.24 7.07 6.82 6.51
66 7.46 7.39 7.20 6.91 6.56
67 7.63 7.55 7.33 7.01 6.62
68 7.81 7.72 7.47 7.10 6.67
69 8.01 7.90 7.62 7.20 6.72
70 8.22 8.10 7.77 7.29 6.77
71 8.46 8.32 7.93 7.39 6.81
72 8.71 8.54 8.09 7.48 6.85
73 8.98 8.79 8.26 7.58 6.89
74 9.28 9.05 8.44 7.66 6.92
75 9.60 9.32 8.62 7.75 6.94
76 9.95 9.62 8.80 7.83 6.97
77 10.32 9.93 8.98 7.90 6.99
78 10.73 10.26 9.16 7.97 7.01
79 11.17 10.61 9.34 8.03 7.02
80 11.65 10.97 9.51 8.08 7.03
81 12.17 11.35 9.67 8.13 7.04
82 12.73 11.75 9.83 8.17 7.05
83 13.33 12.16 9.98 8.20 7.05
84 13.98 12.58 10.11 8.23 7.06
85 14.68 13.00 10.24 8.25 7.06
96-19979 Northstar Life 24
PAYMENTS OF A SPECIFIED AMOUNT SETTLEMENT OPTIONS ILLUSTRATION
VARIABLE GROUP UNIVERSAL LIFE
The beneficiary is entitled to receive payment of the insurance in a lump sum
payment or in any one of the available settlement options. The guaranteed
interest rate is based on [3%]. The current rate is subject to change at any
time but never less than the guaranteed rate.
Monthly payments of a specified amount until the proceeds and interest are fully
paid.
96-19979 Northstar Life 25
NORTHSTAR LIFE
University Corporate Centre at Amherst - Suite 000 - 000 Xxxxxxxxx Xxxxxxx -
Xxxxxxx, Xxx Xxxx 00000
VARIABLE GROUP UNIVERSAL LIFE INSURANCE POLICY - NONPARTICIPATING
