Exhibit 4(h)(i)(F)
Metropolitan Life Insurance Company
(A Mutual Company Incorporated in New York State)
in consideration of the deposits it receives under this contract, will pay the
benefits of this contract according to its provisions. The contract holder and
MetLife execute this contract in duplicate to take effect as of the issue
date.
By: Metropolitan Life Insurance Company
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Xxxxx X. Xxxxxx, Vice-President and Secretary
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-------------------------------- Xxxxxx X. Xxxxxxxxx, President and Chief
Operating Officer
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Registrar
Date
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City and State
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SPECIFICATIONS
Group Annuity Contract Number S123456789
Contract Date Month xx, 19yy
Contract holder ABC Hospital trust
Market Non-Qualified
ALL VALUES PROVIDED BY THIS CONTRACT WHICH ARE BASED ON THE
INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT ARE VARIABLE AND ARE
NOT GUARANTEED AS TO AMOUNT. AVAILABLE SEPARATE ACCOUNT INVESTMENT
DIVISIONS AS OF THE CONTRACT DATE ARE: [THE METROPOLITAN GROWTH,
INCOME, DIVERSIFIED, AGGRESSIVE GROWTH, MONEY MARKET, INTERNATIONAL
STOCK AND STOCK INDEX DIVISIONS; THE FIDELITY GROWTH, OVERSEAS,
EQUITY INCOME, MONEY MARKET, INVESTMENT GRADE BOND, and ASSET
MANAGER DIVISIONS; and THE XXXXXXX SOCIALLY RESPONSIBLE and ARIEL
DIVISIONS]. A DESCRIPTION OF EACH OF THESE DIVISIONS IS INCLUDED IN
THE PROSPECTUS.
This contract is not eligible for dividends--see item 10.
PLEASE READ THIS CONTRACT CAREFULLY
See Index on Last Page
Cover Page
Form G.3043
1. What do the basic terms in my contract mean?
"Account Balance" is the entire amount we hold under this contract for
you.
"Code" means the Internal Revenue Code of 1986, as amended.
"Contract Year" for the first year is measured from the contract date and
continues to [the next December 31st. Each new contract year begins on
January 1st. For example, if the contract date is May 15, 1995, the first
contract year ends December 31, 1995 and the second contract year begins
January 1, 1996.]
"Deposits" are your payments to us under this annuity contract. We will
only accept deposits into this contract that are made under the Plan.
["Deposit Year" for any deposit, for the first year, is measured from the
date we receive it in our designated office and continues until the last
day of the month in which the anniversary of such receipt occurs. Each
new deposit year begins on the first day of the next month.]
"Designated Office" is the administrative office servicing your contract.
It is currently the Pension and Savings Center, Metropolitan Life
Insurance Company, 0000 00xx Xxxxxx, Xxxxxx, Xx. 00000. If we change it,
we will tell you.
"Employer" is the institution that has adopted the Plan.
"Funding Options" refer to [the Metropolitan Series Fund, Inc., the
Xxxxxxx Socially Responsible Series, the Xxxxxxx Xxxxx Appreciation
Portfolio II, and Fidelity's Variable Insurance Products Fund and
Variable Insurance Products Fund II. All are either mutual funds or
series of mutual funds used only for insurance and annuity contracts such
as this one. The Metropolitan Series Fund and Fidelity's Variable
Insurance Products Fund and Variable Insurance Products Fund II are
divided into portfolios each of which has its own investment objectives].
"Investment Divisions" are part of the Separate Account. Each division
invests in a corresponding portfolio or series of the Funding Options,
rather than investing directly in stocks, bonds or other investments.
Thus, the investment experience of each division will generally be the
same as that of the corresponding portfolio or series, reduced by charges
under this contract for services and benefits we provide. The cover page
shows the available divisions. We
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will tell you about any changes.
"Participant" is any person who participates in the employer's plan.
"Plan" is a plan adopted by the employer which meets the requirements for
Section [457(f) deferred compensation plans] [451 deferred compensation
plans] [457(e)(11) severance and death benefit plans] of the Code.
"We", "Us", "MetLife" and "Our" refer to Metropolitan Life Insurance
Company.
"You", "Your", "Me" "My" and "I" refer to the trustee of the grantor
trust that has been established pursuant to Section [457(f)] [451]
[457(e)(11)] of the Code and that has arranged with us to use this
contract for the purchase of annuities under the Plan. You may exercise
all rights under this contract.
2. How are deposits recorded under this contract?
Deposits and earnings on those deposits are credited to the contract as a
whole, rather than to individual participants. We do not keep individual
participant records under this contract, which is a funding vehicle not a
plan document.
3. How are deposits allocated and how much money can be deposited under my
contract?
You choose how deposits are allocated among the Fixed Interest Account
and the investment divisions of the Separate Account. You may change your
allocation for new deposits by telling us. The change will be made upon
receipt, unless you specify a later date. Allocations must be in whole
number percentages (e.g., 33 1/3% cannot be chosen).
Annuity deposits may be made at any time while this contract is in
effect. All deposits should be sent to our designated office. No deposit
will be credited before the contract date.
We will accept each amount you deposit up to [$500,000 per contract
year.] [The minimum cumulative deposit that we will accept is $15,000
during the first contract year and $5,000 per contract year thereafter.]
We will not accept any deposits after you have requested a full
withdrawal (unless you cancel it) or accept any deposit less than
[$2,000.] We may either return amounts which violate these limits or
agree to take them. We may change them by telling you at least 90 days in
advance.
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4. Can my contract be canceled?
If a deposit has not been made for [12] consecutive months and the
account balance is less than [$2,000], we may, if permitted by law,
cancel this contract by paying you the account balance in a single sum.
5. Can I make withdrawals?
Yes. To request a withdrawal you may contact our designated office. Any
withdrawal request must be signed by you and must clearly state the
account (and investment division, if any) from which the withdrawal is to
be made. The minimum withdrawal is $500 or your entire account or
division balance, if less. There are no early withdrawal charges.
If you make a partial withdrawal from the Fixed Interest Account, we will
first withdraw any amounts from deposits and will then withdraw other
amounts from any interest on deposits, in each case on a "first-in,
first-out" (FIFO) basis. To determine from what amounts a withdrawal is
taken for tax purposes, we will apply tax rules which may be different.
As required by law we have the right to delay paying any cash withdrawals
from the Fixed Interest Account for up to six months. We do not intend to
do this except in an extreme emergency. We would, of course, credit
interest during any delay.
6. What is the Fixed Interest Account and how is interest credited to it?
We credit interest on each deposit from the date it is received at our
designated office or transferred from the Separate Account until the date
you withdraw it or transfer it to the Separate Account or use it to have
income payments made to any person entitled to such payments.
Interest rates for amounts added to the Fixed Interest Account will be
set by us [from time to time] [as of each January 1, April 1, July 1 and
October 1.] The declared rate in effect when an amount is added to the
Fixed Interest Account will be credited on that amount from the date it
is added until the last day of the [contract year in which it is added]
[calendar year following the year in which it is added] [first deposit
year].
Thereafter, we will set interest rates for these amounts (and earnings on
them) on or before the first day of each [calendar] [deposit] [contract
year] year to be credited through the last day of such year.
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We may have one interest rate for deposits resulting from the tax-free
transfer or exchange of Section [457(f)] [451] [457(e)(11)] annuity money
from other contracts and a different interest rate for other amounts
added to the Fixed Interest Account. The rates for such transfers and
exchanges or other amounts added to the Fixed Interest Account may be
different than the rates credited on amounts already in the Fixed
Interest Account. The rates may also vary depending on the amount of the
account balance.
The interest rates we declare are "annual effective yields". The actual
rates we use on a day-to-day basis are slightly lower, but, if the amount
added is left in the Fixed Interest Account for a full year, it will grow
by the full amount of the interest rate we declared, because we compound
interest daily.
7. What is the Separate Account and how does it operate?
It is MetLife Separate Account E, an investment account we maintain
separate from our other assets.
We own the assets in the Separate Account. The Separate Account will not
be charged with liabilities that arise from any other business that we
conduct. We will add amounts to the Separate Account from other contracts
of ours.
The Separate Account is divided into investment divisions, each of which
buys shares in a corresponding portfolio or series of the Funding
Options. Thus, the Separate Account does not invest directly in stocks,
bonds, etc., but leaves such investments to the Funding Options to make.
The Funding Options are also bought by other separate accounts of ours,
our affiliates and other insurance companies.
We keep track of each investment division of the Separate Account
separately using accumulation units. When you put money into an
investment division, we give you accumulation units. When you take money
out of the investment division, we reduce the number of your accumulation
units. In either case, the number of accumulation units you gain or lose
is determined by taking the dollar amount of the deposit, transfer or
withdrawal and dividing it by the value of an accumulation unit at the
time of the transaction. Thus, if you transfer in $5,000, and the value
of an accumulation unit is $100, you will get 50 accumulation units.
Initially, we set the value of each accumulation unit. At the end of each
valuation period, we then revise it by taking the net asset value of a
share in the applicable Funding Option portfolio or series at the end of
the valuation period, add any Funding Option dividend or capital gain
distribution during the valuation period, subtract any
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per share charge for taxes and reserves for taxes, and divide this total
by the net asset value of a share of the same portfolio or series at the
start of the valuation period. Then we subtract a charge not to exceed
[.000025905] per day (an effective annual rate of [.95%]) for
administrative expenses and mortality and expense risks we assume under
the certificate. This calculation results in a factor that we multiply
the previous accumulation unit value by in order to determine the new
accumulation unit value.
A valuation period is the period between one calculation of an
accumulation unit value and the next calculation. Normally, we calculate
accumulation units once each day the New York Stock Exchange is open for
trading, but we can delay this determination if an emergency exists,
making valuation of assets in the Separate Account not reasonably
practicable, or the Securities and Exchange Commission permits such
deferral. We may change when we calculate the accumulation unit value, to
the extent permitted by law, by giving you 30 days notice.
Amounts added to the Separate Account will be credited as of the end of
the valuation period during which we receive them at our designated
office or they are transferred from the Fixed Interest Account. Additions
to or withdrawals from an investment division may only be made as of the
end of a valuation period.
We may make certain changes to the Separate Account if we think they
would best serve the interests of participants in or owners of similar
contracts or would be appropriate in carrying out the purposes of such
contracts. Any changes will be made only to the extent and in the manner
permitted by applicable laws. Also, when required by law, we will obtain
your approval of the changes and approval from any appropriate regulatory
authority.
Examples of the changes to the Separate Account that we may make include:
o To transfer any assets in an investment division to another
investment division, or to one or more other separate accounts, or
to our general account; or to add, combine, or remove investment
divisions in the Separate Account.
o To substitute, for the Funding Option shares held in any investment
division, the shares of another class of the Metropolitan Series
Fund, Inc. or any other investment permitted by law.
If any changes result in material change in the underlying
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investments of an investment division to which an amount is allocated
under this contract, we will notify you of the change. You may then make
a new choice of investment divisions.
B. Can money be transferred within this contract?
Yes. A transfer can be made between investment divisions of the Separate
Account, from an investment division to the Fixed Interest Account, or
from the Fixed Interest Account to an investment division. [You can make
an unlimited number of transfers by telling us.]
If you make a transfer from the Fixed Interest Account, we will determine
which deposits and interest to take it from as if it was a withdrawal
from the contract. [However, only one transfer per contract year can be
made from the Fixed Interest Account to the Separate Account and only up
to 20% of the Fixed Interest Account balance may be transferred.] If you
transfer money from the Fixed Interest Account to the Separate Account
and then you transfer money from the Separate Account to the Fixed
Interest Account within 12 months, this will be treated as a return of
the same money (whether or not it really is). Thus, after the transfer
into the Fixed Interest Account, it will earn the same interest rate that
it would have been earning had neither transfer ever taken place. Any
amounts in excess of the original transfer and any amounts transferred
back to the Fixed Interest Account more than 12 months after the first
transfer will be treated as a new deposit to the Fixed Interest Account
and will earn the current interest rate for new deposits.
9. May I assign or transfer this contract, or use it as collateral for a
loan?
No. This contract and amounts paid under it are not transferrable and may
not be assigned, sold, discounted or pledged as collateral for a loan. To
the extent permitted by law, no amount payable under this contract is
subject to legal process or attachment for payment of any claim against
any payee. This provision will not prevent assignment of this contract to
the sponsor or a trustee of the Plan, or that of another plan if the Plan
is consolidated or merged with such other plan.
10. Are dividends payable under my contract?
No. Your contract is nonparticipating and does not share in any
distribution of our surplus.
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11. Are administrative fees deducted from my contract?
No. We charge no administrative fees under this contract.
12. How can I get information about my contract and its value?
At least twice each contract year (except the first contract year),
before income payments start, we will send you a statement with details
on deposits, values, withdrawals, and other information about your
contract. If you need information at other times, please tell us.
Any time you have to tell us something (e.g., to request additional
information, to make transfers, to change your allocation for new
deposits, to make withdrawals), you must send written notice to our
designated office unless we have set up some other procedure, such as
notice by telephone.
13. Can we guarantee an income for as long as a participant lives?
Yes. We can make income payments guaranteed for the life of a participant
on a monthly, quarterly, semiannual or annual basis. These payments may
also be guaranteed for at least five years, but not beyond the
participant's life expectancy or the joint life expectancy if there is
more than one payee.
Other income plans which provide payments for a stated amount or a stated
number of years are also available to the extent permitted by Federal
income tax rules, under Code Section 72 including regulations thereunder.
The amount of each payment under an income plan must be at least [$50].
When you buy an income plan, we will withdraw the amount you tell us in a
lump sum to pay for it. We will begin making income payments at any date
you choose after the contract date (subject to any applicable federal
rules and regulations), if you tell us at least 30 days in advance. We
will send you information and the necessary forms to sign, upon receipt
of your request at our designated office. Once income payments start, you
will not be able to change the choice of income plan.
Guaranteed income plan payments, which are based on a 3% interest rate
and the 1983 Individual Mortality Table a (Metropolitan adjusted), are
provided on page 10. These payments are at least as high as those
required by the laws of the state where this contract is delivered and
are at least equal to those that we would provide to a person in the same
class as the participant under a single payment immediate annuity bought
at the same time.
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You will be the owner of any income plan purchased.
14. What happens if a participant dies before income payments start?
After we receive proof of death and a properly completed claim form, we
will pay the death benefit (as of the date of settlement) to you. The
death benefit for any participant is the entire account balance held on
behalf of that participant as of the date we receive proof of death and a
properly completed claim form. Proof of death, as well as proof of the
share of the account balance attributable to the participant satisfactory
to us, must be given if we ask for it.
The entire death benefit for a participant under this contract must be
distributed in a single sum within five years of the participant's death.
If, however, you choose on behalf of the payee an income plan for life or
for a period of years not more than his or her life expectancy, the
income payments must begin within one year of the participant's death. If
Treasury regulations allow, we may permit payments to start later.
15. What happens if an annuitant dies after income payments start?
After we receive proof of death and a properly completed claim form,
income payments will continue to the annuitant's beneficiary for the
balance of the guaranteed period, if any, for the income plan you
selected. If the guaranteed period has already ended, no further payments
will be made. If you name no beneficiary (or none is alive when you die),
we will pay the contingent beneficiary. If you name no contingent
beneficiary (or none is alive when you die), we will pay your estate. If
the annuitant's estate (or other non-individual) becomes entitled to
payment, we will pay the value of any remaining payments, computed as of
the date of death using the interest rate we use to set those payments, in
a lump-sum.
16. Will a certificate be provided for persons who receive income payments?
Yes. MetLife will issue to the Contract holder, for delivery to each
person to whom annuity benefits are being paid under this contract, an
individual certificate outlining the benefits payable under the income
plan.
17. Does my contract contain all the provisions that affect me?
Yes, your contract and any riders and endorsements included in it make up
your entire contract with us. We will never
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contest the validity of this contract. Changes in its provisions may only
be made in writing by our President, Secretary, or a Vice-President. No
provision may be waived or changed by any of our other employees,
representatives or agents.
To comply with Section 72 of the Code and applicable Treasury
Regulations, we may, if necessary, amend this contract. We will notify
you of any amendments and, when required by law, we will obtain your
approval and the approval of the appropriate regulatory authority.
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GUARANTEED ANNUITY BENEFITS
Monthly Income Payments Per $1,000 Used to Buy Income Plan
Payee's
Exact Age on Life Income Term Certain and Life Income
Date of Purchase If Term Certain Period is:
of Income Plan 10 Years 15 Years 20 Years
55 $3.85 $3.83 $3.80 $3.75
56 $3.91 $3.89 $3.85 $3.80
57 $3.98 $3.95 $3.91 $3.85
58 $4.05 $4.01 $3.97 $3.91
59 $4.12 $4.08 $4.03 $3.96
60 $4.19 $4.15 $4.10 $4.02
61 $4.27 $4.23 $4.17 $4.08
62 $4.36 $4.31 $4.24 $4.14
63 $4.45 $4.39 $4.31 $4.20
64 $4.54 $4.48 $4.39 $4.26
65 $4.64 $4.57 $4.47 $4.33
66 $4.75 $4.67 $4.55 $4.39
67 $4.86 $4.77 $4.64 $4.46
68 $4.99 $4.88 $4.73 $4.52
69 $5.11 $4.99 $4.82 $4.59
70 $5.25 $5.11 $4.92 $4.65
Joint and Survivor Life Income Plan
Payee's Monthly Income Payment to Primary Payee per $1,000 Used to Buy Income Plan if
Exact Age on Percentage of Monthly Income Payment Payable to the Survivor Payee is:
Date of Purchase
of Income Plan* 50% 66 2/3% 75% 100%
55 and 60 $3.68 $3.63 $3.60 $3.52
60 and 55 $3.83 $3.72 $3.67 $3.52
60 and 60 $3.91 $3.82 $3.78 $3.66
60 and 65 $3.97 $3.91 $3.87 $3.78
65 and 60 $4.16 $4.03 $3.96 $3.78
65 and 65 $4.26 $4.15 $4.10 $3.94
70 and 65 $4.61 $4.43 $4.35 $4.11
70 and 70 $4.76 $4.61 $4.54 $4.35
* In each pair of ages, the first age is the primary payee's age and the
second age is the survivor payee's age.
Term Certain Income Plan
Monthly Income Payment Per $1,000 Used to Buy Income Plan
If Term Certain Period is:
10 Years 15 Years 20 Years
$9.37 $6.70 $5.37
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INDEX
Subject
Administrative Fees
Assignment
Allocation of Deposits
Cancellation
Certificate
Contract and Authority
Death Benefit
Definitions
Dividends
Fixed Interest Account 6
Income Payments 13
Information We Give You 12
Recording Deposits 2
Separate Account and Investment Divisions 7
Transfers 8
Withdrawals 5
NOTICE
When you write to us, please give us your name, address and contract number.
Please notify us promptly of any address changes. We will write to you at your
last known address.
Checks, drafts or money orders must be drawn to the order of MetLife. All
payments must be made in U.S. currency.
Multifunded Annuity Contract
ALL VALUES PROVIDED BY THIS CONTRACT WHICH ARE BASED ON THE INVESTMENT
EXPERIENCE OF THE SEPARATE ACCOUNT ARE VARIABLE AND ARE NOT AMOUNT.
PLEASE READ THIS CONTRACT CAREFULLY
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