Exhibit 3 (a)
(a) PROPOSED FORM OF GROUP CONTRACT (30023)
This contract is a legal contract between the contract-holder and Paragon Life
Insurance Company. PLEASE READ YOUR CONTRACT CAREFULLY.
This cover sheet provides only a brief outline of some of the important features
of your contract. This cover sheet is not the complete insurance contract and
only the actual contract provisions will control. The contract itself sets
forth, in detail, the rights and obligations of both you and your insurance
company.
IT IS THEREFORE IMPORTANT THAT YOU READ YOUR CONTRACT.
ISSUED BY: PARAGON LIFE INSURANCE COMPANY
A STOCK COMPANY
000 XXXXX XXXXXXXXX
XX. XXXXX, XXXXXXXX 00000
(000) 000-0000
GROUP CONTRACT NUMBER
CONTRACTHOLDER
RIGHT TO EXAMINE CONTRACT
You may return this contract within twenty days after receiving it or within 45
days after the application is signed, whichever period ends later. It may be
delivered or mailed to us or the agent through whom it was purchased. The
contract shall then be deemed void from the start. Any premium paid will be
returned.
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE TO AGE 95
Flexible Premiums are payable during the lifetime of the insured to age 95. The
death benefit is payable at the death of the insured prior to age 95 and while
the contract is in force. Cash surrender value, if any, is payable at the
insured's age 95.
ALPHABETIC GUIDE TO YOUR CONTRACT
Page
2.04 Agency
2.03 Authority
2.03 Certificate of Insurance
2.02 Conversion Privilege
2.01 Definitions
2.02 Effective Date of Dependent Term Insurance and Additional Benefits
2.02 Effective Date of Individual Insurance
2.03 Entire Contract
2.02 Grace Period
2.03 Incontestability
2.04 Monies Payable
2.03 Ownership and Control of This Contract
2.02 Premiums
2.01 Premium Payments
2.03 Records Required
2.04 Sex and Number
2.02 Termination of Insurance
2.03 Termination of This Contract
The Certificate of Insurance will be attached to and made a part of this
Contract.
Contract Specifications
Contract Effective Date:
Contract Anniversary Date:
Contract Jurisdiction State:
Contract Execution Date:
ContracthoIder:
Associated Companies:
Eligible Class or Classes of Employees:
Individual Eligibility Date:
Contract Specifications (continued)
Employee Insurance Benefits:
For Employee:
Guaranteed Issue:
Simplified Issue:
For Spouse:
Simplified Issue:
Additional Benefits:
Premium Due Date:
Contract Specifications (continued)
TABLE OF GUARANTEED MONTHLY COST OF INSURANCE RATES
RATES ARE PER $1,000
ATTAINED ATTAINED ATTAINED
AGE RATE AGE RATE AGE RATE
-------- ------ -------- ------ -------- -------
18 0.155 19 0.161 20 0.163
21 0.165 22 0.163 23 0.163
24 0.161 25 0.159 26 0.158
27 0.158 28 0.159 29 0.163
30 0.167 31 0.172 32 0.178
33 0.187 34 0.196 35 0.207
36 0.221 37 0.238 38 0.257
39 0.278 40 0.303 41 0.329
42 0.357 43 0.386 44 0.416
45 0.449 46 0.483 47 0.520
48 0.559 49 0.603 50 0.651
51 0.705 52 0.767 53 0.836
54 0.911 55 0.988 56 1.071
57 1.155 58 1.244 59 1.342
60 1.450 61 1.576 62 1.723
63 1.891 64 2.078 65 2.276
66 2486 67 2.704 68 2.933
69 3.188 70 3.478 71 3.813
72 4.208 73 4.661 74 5.163
75 5.708 76 6.284 77 6.884
78 7.517 79 8.203 80 8.968
81 9.837 82 10.829 83 11.941
84 13.150 85 14.440 86 15.795
87 17.213 88 18.699 89 20.262
90 21.925 91 23.733 92 25.762
93 28.155 94 31.307
THESE RATES ARE FOR THE BASE COVERAGE AT ISSUE. They are based on 125 percent of
the 1980 Commissioners Standard Ordinary Mortality Table C Age Last Birthday.
Any values guaranteed in this contract are based on these rates.
1. DEFINITIONS IN THIS CONTRACT
We, Us and Our
The Paragon Life Insurance Company.
Employee
A person who is employed and paid for services by the employer on a regular
basis. In no event will the amount of time worked per week be less than 30
hours.
Insured
An employee or an employee's spouse who is insured for life insurance under this
contract.
Spouse
The employee's legal spouse and does not include a spouse who is legally
separated from the employee.
Actively at Work
The employee must work for his employer at his usual place of work or such other
places as required by his employer in the course of such work for the full
number of hours and full rate of pay, as set by the employment practices of his
employer. In no event will the amount of time worked per week be less than 30
hours.
Associated Company
Those companies listed on the contract specifications page that are under common
control through stock ownership, contract or otherwise, with the contractholder.
Employees of each Associated Company will be considered employees of the
contract-holder.
Service with an Associated Company will be considered service with the
contract-holder.
The records of an Associated Company which have a bearing on this contract will
be considered records of the contractholder.
If an Associated Company ceases to be under common control with the
contractholder, the insureds of the Associated Company may continue the
insurance as an individual policy.
The inclusion of any Associated Company will not affect the ownership of this
contract by the contractholder or the rights of ownership of this contract by
the contractholder.
Individual Insurance
Insurance on the employee or the employee's spouse provided through this
contract.
Dependent Term Insurance
Insurance on the dependent of an employee provided by a rider to the
certificate.
2. PROVISIONS RELATING TO INDIVIDUAL AND DEPENDENT TERM INSURANCE
Premium Payments
Premium payments for individual and dependent term insurance coverage may be
made by the employee and/or the contractholder. The employee's premium paid
under this contract is the amount authorized by the employee to be deducted from
his wages. Premiums may be paid in addition to the authorized deductions as set
forth in the contract. The authorization for payroll deduction may be cancelled
at any time upon written request.
If for any reason, premiums for this coverage are no longer being deducted from
the employee's wages, the insurance under the certificate will be continued (in
the form of an individual policy as a result of the conversion privilege) and
planned premiums will be direct billed basis.
Eligibility for Individual Insurance
Within an eligible class, individual insurance is available only if the employee
is actively at work at the time of application for personal insurance.
Effective Date of Individual Insurance
Subject to the conditions listed below, the individual insurance, subject to
eligibility, will be made effective on the latest of the date on which:
1) the application for the certificate is signed;
2) the first premium for the individual insurance is paid to us; and
3) the information provided in the application for the certificate is
determined to be acceptable to us for issuance of coverage under our
current rules and practices.
If individual insurance ends at the request of the owner or, prior to the
maturity date, when a certificate's cash surrender value is insufficient to
cover the monthly deductions, individual insurance will be restored only as
stated in the certificate section titled "Reinstatement."
Effective Date of Dependent Term Insurance and Additional Benefits
Subject to the conditions listed below, the dependent term insurance and
additional benefits, subject to eligibility, will be made effective on the
latest of the date on which:
1) the individual insurance that such coverage is issued in connection with
is effective; and
2) the information provided in the application for the particular coverage
is determined to be acceptable to us for issuance of coverage under our
current rules and practices.
Termination of Insurance
Individual and dependent term insurance will terminate according to the terms of
the certificate.
Conversion Privilege
If an insured's eligibility under this contract ends due to the termination of
this contract or the employment of the employee, such insured's coverage, if not
already in the form of an individual policy, will automatically be converted by
amendment to an individual policy. Such individual policy will provide benefits
which are identical to those provided under the certificate.
An amendment to convert the certificate to an individual policy will be mailed:
1) within 31 days after we receive written notification that the employee's
employment ended, or after the termination date of the contract; and
2) once any planned premium necessary to prevent the policy from lapsing is
paid to us at our home office.
The planned premiums for this individual policy may be paid annually,
semiannually, quarterly or at other intervals we establish from time to time.
Additional premiums may be paid as set forth in the policy.
3. PREMIUMS
Premium Payment
All planned premiums must be remitted in advance by the contractholder to our
home office. This includes any adjustments in premiums.
Grace Period
If planned premium payments after the first such payment are not made in a
timely fashion, this contract will be in default. A grace period of 31 days wijl
be granted for the remittance of the planned premiums after the first payment.
This contract will be in force during the grace period. If such premium is not
paid in the grace period, the contract will terminate at the end of that period.
The contract will terminate before that date if the contractholder gives us
written notice in advance.
Entire Contract
We have issued this contract in consideration of the application of the
contractholder and remittance of premiums by the contractholder. This contract,
with the attached copy of the contractholder's application and other attached
papers, if any, is the entire contract between the contractholder and us. All
statements made by the contractholder, any certificate owner or any insured will
be deemed representations and not warranties. Misstatements will not be used in
any contest or to reduce claim under this contract, unless it is in writing. A
copy of the application containing such misstatement must have been given to the
contractholder or to the insured or to his beneficiary, if any.
Authority
No agent may change this contract or waive any of its provisions. No change in
this contract, other than a change of rates, will be effective until the form
making such change is signed by our executive officer and accepted by the
contractholder.
Incontestability
We cannot contest this contract after it has been in force for two years from
the contract effective date.
Ownership and Control of This Contract
The contractholder owns this contract. This contract may be changed or ended by
agreement between us and the contractholder without the consent of, or notice
to, any person claiming rights or benefits under this contract.
Records Required
The contractholder will promptly give us, at our home office, any facts that we
may need to administer the insurance under this contract and to determine the
premiums. All of the contractholder's records which have a bearing on this
insurance will be ready for us to inspect when and as often as we may, within
reason, require.
Clerical error by the contractholder or us will not make the insurance of an
ineligible person valid nor continue insurance which was ended by valid means.
Certificate of Insurance
We will issue to the contractholder, to give to each insured under this
contract, a certificate of insurance or an individual policy. If an individual
policy is issued, then all reference herein to a certificate will mean an
individual policy. The certificate will state the owner's rights and benefits
under the certificate and to whom benefits are payable. Also, stated are the
limits and requirements in this contract that may apply to the insured and his
insured dependents, if any.
The terms and provisions of the certificate, a copy of which is attached, are
incorporated herein by reference and made a part of this contract. The rights
and benefits of the insured under or owner of the certificate will not inure to
the benefit of the contractholder.
Termination of This Contract
Except as provided in the grace period section of this contract, this contract
will be terminated immediately upon default.
We may end this contract or any of its provisions by giving notice in writing to
the contractholder at least 31 days prior to the termination date.
If this contract is terminated any insurance in effect will remain in force on
an individual basis, provided it is not cancelled or surrendered by the
certificate owner. Any planned premiums will no longer be deducted from the
employee's wages and will be remitted directly to us.
Sex and Number
When used in this contract, the masculine includes the feminine, the singular
the plural, and the plural the singular.
Monies Payable
All monies payable by us as benefits under this contract will be paid, subject
to the laws which govern such payment, at our home office or authorized claim
offices. All monies payable to us or by us will be in the lawful currency of the
United States.
Agency
Neither us nor the contractholder is an agent of the other under this contract
for any purpose
