The Contract Holder may cancel this Contract within 10 days of receiving it by
Exhibit 16(4)(b): Individual Annuity Contract (Form No. I2-MGA-95)
[AETNA LOGO]
Aetna Insurance Company of America
Home Office: 000 Xxxxxxxxxx Xxxxxx
Xxxxxxxx, Xxxxxxxxxxx 00000
(000) 000-0000 | |
A STOCK COMPANY |
Aetna Insurance Company of America, herein called Aetna, agrees |
to pay the benefits stated in this Contract. |
Specifications |
------------------------------------------------------------------------ |
Plan AETNA MULTI-RATE ANNUITY |
------------------------------------------------------------------------ |
Type of Plan SINGLE PREMIUM MODIFIED GUARANTEED DEFERRED ANNUITY |
------------------------------------------------------------------------ |
Contract Holder(s) ANY INDIVIDUAL |
------------------------------------------------------------------------ |
Contract No. SPECIMEN |
------------------------------------------------------------------------ |
Effective Date DECEMBER 1, 1995 |
------------------------------------------------------------------------ |
This Contract is Delivered in YOUR STATE and is Subject |
to the Laws of that Jurisdiction |
RIGHT TO CANCEL |
------------------------------------------------------------------------ |
The Contract Holder may cancel this Contract within 10 days of receiving it by |
returning this Contract along with a written notice to Aetna at the above
address or to the agent from whom it was purchased. Within 7 days after it
receives the notice of cancellation and this Contract at its Home Office,
Aetna will return the entire consideration paid.
Signed at the Home Office on the Effective Date.
/s/Xxx Xxxxxxx /s/ Xxxxx XxXxxx
President Secretary
Individual Single Premium Modified Guaranteed Deferred Annuity Contract
Nonparticipating
THIS CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT FORMULA. APPLICATION OF A
MARKET VALUE ADJUSTMENT MAY RESULT IN EITHER AN INCREASE OR DECREASE IN THE
CURRENT VALUE. THE MARKET VALUE ADJUSTMENT FORMULA DOES NOT APPLY TO A
GUARANTEED PERIOD AT THE TIME OF ITS MATURITY.
I2-MGA-95
Specifications
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Guaranteed There is a guaranteed interest rate for the Purchase
Interest Rate Payment held in the AMG Account. (See Contract
Schedule I).
-----------------------------------------------------------------------------
Deduction from The Purchase Payment may be subject to a deduction for
Purchase premium taxes, if applicable. (See 3.01.)
Payment
-----------------------------------------------------------------------------
Surrender There may be a charge deducted upon surrender. (See
Fee Contract Schedule 1).
This Contract is a legal contract and constitutes the entire legal
relationship between Aetna and the Contract Holder.
READ THIS CONTRACT CAREFULLY. This Contract sets forth, in detail, all of the
rights and obligations of both you and Aetna. IT IS THEREFORE IMPORTANT THAT
YOU READ THIS CONTRACT CAREFULLY.
2
I2-MGA-95
Contract Schedule I
Accumulation Period
AICA Modified Guaranteed Account (AMG Account)
-----------------------------------------------------------------------------
Minimum Guaranteed | [3.0%] | |
Interest Rate: | ||
(effective annual rate of return) | ||
Maintenance Fee: | The annual Maintenance Fee is [$0.] [If | |
the Current Value is [$50,000] or more | ||
on the date the Maintenance Fee is to | ||
be deducted, the Maintenance Fee is | ||
$0.] | ||
Annuity Date: | The Annuity Date will be the later of | |
the date the Annuitant reaches age [85] | ||
or the [10th] anniversary of the | ||
Purchase Payment. | ||
Minimum Purchase | [$10,000.] | |
Payment: | ||
Maximum Purchase | Purchase Payments exceeding | |
Payment: | [$1,000,000] must be approved by Aetna. | |
Minimum Guaranteed Period | [$1,000.] | |
Allocation Amount: | ||
Maximum Age of | [90.] If there are joint Contract | |
Contract Holder at issue: | Holders, the age of the oldest Contract | |
Holder cannot exceed [90.] | ||
Surrender Fee: | Length of Time from Surrender Fee Contract Effective (Percentage of Date (Years) Net Purchase Payment Withdrawn) | |
Less than 1 year | 7% | |
1 year but less than 2 | 7% | |
2 years but less than 3 | 6% | |
3 years but less than 4 | 6% | |
4 years but less than 5 | 5% | |
5 years but less than 6 | 4% | |
6 years but less than 7 | 2% | |
7 years or more | 0% | |
After seven years have elapsed from the | ||
contract effective date, the Surrender | ||
Fee will no longer be assessed. | ||
Special Withdrawal: | The percentage may not be greater | |
than [10%]. | ||
Systematic Withdrawal | The specified payment or specified | |
Option (SWO): | percentage may not be greater than [10%]. |
See 1. GENERAL DEFINITIONS for explanations.
3
I2-MGA-95
Contract Schedule II
Annuity Period
Fixed Annuity ------------------------------------------------------------------------------
Minimum Guaranteed | [3.0%] |
Interest Rate | |
(effective annual rate of | |
return): |
See 1. GENERAL DEFINITIONS for explanations.
4
I2-MGA-95
TABLE OF CONTENTS
Page
I. GENERAL DEFINITIONS | |
------------------------------------------------------------------------ |
1.01 | Accumulation Period | 7 |
1.02 | Adjusted Current Value | 7 |
1.03 | Annuitant | 7 |
1.04 | Annuity | 7 |
1.05 | Annuity Date | 7 |
1.06 | Beneficiary | 7 |
1.07 | Code | 7 |
1.08 | Contract | 7 |
1.09 | Contract Holder | 7 |
1.10 | Current Value | 7 |
1.11 | Deposit Period | 7 |
1.12 | Entire Contract | 7 |
1.13 | Fixed Annuity | 7 |
1.14 | General Account | 8 |
1.15 | Guaranteed Rates -- AMG Account | 8 |
1.16 | Guaranteed Period | 8 |
1.17 | Guaranteed Period Groups | 8 |
1.18 | Maintenance Fee | 8 |
1.19 | AICA Modified Guaranteed Account (AMG Account) | 8 |
1.20 | Market Value Adjustment (MVA) | 9 |
1.21 | Matured Period Value | 9 |
1.22 | Maturity Date | 9 |
1.23 | Net Purchase Payment | 9 |
1.24 | Nonunitized Separate Account | 9 |
1.25 | Purchase Payment | 9 |
1.26 | Reinvestment | 9 |
1.27 | Surrender Value | 10 |
5 | ||
I2-MGA-95 | ||
II. GENERAL PROVISIONS | |
------------------------------------------------------------------------ |
2.01 | Change of Contract | 10 |
2.02 | Nonparticipating Contract | 10 |
2.03 | Payments and Elections | 10 |
2.04 | State Laws | 10 |
2.05 | Control of Contract | 10 |
2.06 | Designation of Beneficiary | 11 |
2.07 | Misstatements and Adjustments | 11 |
2.08 | Incontestability | 11 |
III. PURCHASE PAYMENT, CURRENT VALUE, AND SURRENDER PROVISIONS | |
------------------------------------------------------------------------ |
3.01 Net Purchase Payment 11
3.02 | Market Value Adjustment | 11 |
3.03 | Notice to the Contract Holder | 12 |
3.04 | Loans | 12 |
3.05 | Systematic Withdrawal Option (SWO) | 13 |
3.06 | Death Benefit Amount | 14 |
3.07 | Death Benefit Options available to Beneficiary | 15 |
3.08 | Liquidation of Surrender Value | 16 |
3.09 | Surrender Fee | 16 |
3.10 | Payment of Surrender Value | 16 |
3.11 | Payment of Adjusted Current Value | 17 |
IV. | ANNUITY PROVISIONS |
----------------------------------------------------------------------
4.01 | Choices to be Made | 17 |
4.02 | Terms of Annuity Options | 17 |
4.03 | Death of Annuitant/ Beneficiary | 18 |
4.04 | Annuity Options | 18 |
6
I2-MGA-95
I. |
GENERAL DEFINITIONS |
------------------------------------------------------------------------ |
1.01 | Accumulation Period: | The period during which the Net | |
Purchase Payment is applied to the | |||
Contract to provide future Annuity | |||
payment(s). | |||
1.02 | Adjusted Current Value: | The Current Value of a Contract plus or | |
minus any aggregate AMG Account MVA, if | |||
applicable. (see 1.20) | |||
1.03 | Annuitant: | The person named by the Contract Holder | |
whose life is measured for purposes of | |||
the guaranteed death benefit and the | |||
duration of Annuity payments under this | |||
Contract. Subject to Aetna's approval, | |||
the Annuitant may be changed by the | |||
Contract Holder by notifying Aetna in | |||
writing prior to the Annuity Date of | |||
this Contract. | |||
1.04 | Annuity: | Payment of an income: | |
(a) | For the life of one or two | ||
persons; | |||
(b) | For a stated period; or | ||
(c) | For some combination of (a) | ||
and (b). | |||
1.05 | Annuity Date: | The date on which Annuity payments | |
begin under an Annuity option elected | |||
by the Contract Holder. (see 4.01). The | |||
Annuity Date is shown on Contract | |||
Schedule I. The Contract Holder may | |||
change this date by notifying Aetna at | |||
least 30 days prior to the Annuity | |||
Date. | |||
1.06 | Beneficiary: | The person(s) entitled to receive death | |
benefits under the terms of this | |||
Contract. | |||
1.07 | Code: | The Internal Revenue Code of 1986, as | |
it may be amended from time to time. | |||
1.08 | Contract: | This agreement between Aetna and the | |
Contract Holder. |
1.09 |
Contract Holder: |
1.10 |
Current Value: |
1.11 |
Deposit Period: |
1.12 |
Entire Contract: |
1.13 |
Fixed Annuity: |
I2-MGA-95
1.14 |
General Account: |
1.15 |
Guaranteed Rates -- AMG Account: |
1.16 Guaranteed Period:
1.17 |
Guaranteed Period Groups: |
7
The entity to which the Contract is
issued. Joint Contract Holders must be
spouses.
The Net Purchase Payment plus any
interest credited; less all Maintenance
Fees deducted, any amounts surrendered
and any amounts applied to an Annuity.
A calendar week, a calendar month, a
calendar quarter, or any other period
of time specified by Aetna during which
the Net Purchase Payment and
Reinvestments are accepted into the AMG
Account for one or more Guaranteed
Periods. Aetna reserves the right to
extend the Deposit Period.
The Contract, all attached pages and
any subsequent endorsements make up the
Entire Contract.
An Annuity with payments that do not
vary in amount based on investment
performance.
The account holding the assets of
Aetna, other than those assets held in
Aetna's separate accounts.
Aetna will declare the interest rate
applicable for each Guaranteed Period
at the start of the Deposit Period for
that applicable Guaranteed Period. The
rate(s) are guaranteed by Aetna for
that Deposit Period and the ensuing
Guaranteed Period(s). The Guaranteed
Rates are effective annual rates of
return. That is, interest is credited
daily at a rate that will produce the
Guaranteed Interest Rate over the
period of a year. No Guaranteed Rate
will ever be less than the Minimum
Guaranteed Interest Rate shown on
Contract Schedule I.
For Guaranteed Periods of one year or
less, one Guaranteed Rate is credited
for the full Guaranteed Period. For
longer Guaranteed Periods, an initial
Guaranteed Rate is credited from the
date of deposit to the end of a
specified period within the Guaranteed
Period. There may be different
Guaranteed Rate(s) declared at the
beginning of the Deposit Period for
subsequent specified time intervals
throughout the Guaranteed Period.
The period of time for which Guaranteed
Rates are guaranteed on the Net
Purchase Payment and Reinvestments made
during a current Deposit Period. Such
period begins on the day following the
close of the Deposit Period and ends on
the designated Maturity Date.
Guaranteed Periods are offered at
Aetna's discretion for various lengths
of time ranging up to and including
twenty years.
During a Deposit Period, Aetna may make
available any number of Guaranteed
Periods. The Contract Holder may
allocate the Net Purchase Payment or
Reinvestment into any or all of the
available Guaranteed Periods.
All Guaranteed Periods with the same
length of time from the close of the
Deposit Period until the designated
1.18 |
Maintenance Fee: |
1.19 |
AICA Modified Guaranteed Account (AMG Account): |
I2-MGA-95
1.20 Market Value Adjustment (MVA):
1.21 |
Matured Period Value: |
1.22 |
Maturity Date: |
1.23 |
Net Purchase Payment: |
1.24 Nonunitized Separate Account:
1.25 |
Purchase Payment: |
1.26 |
Reinvestment: |
Maturity Date.
The Maintenance Fee, if any (see
Contract Schedule I), will be deducted
during the Accumulation Period on each
anniversary of the date the Contract is
established and upon surrender of the
entire Contract.
An accumulation option where Aetna
guarantees rate(s) of interest for
specified periods of time. All assets
of Aetna, including amounts in the
Nonunitized Separate Account, are
available to meet the guarantees under
the AMG Account.
8
An adjustment that may apply to the
amount withdrawn from a Guaranteed
Period prior to the end of that
Guaranteed Period. The adjustment
reflects the change in the value of the
investment due to changes in interest
rates since the date of deposit and is
computed using the formula given in
3.02. The adjustment is expressed as a
percentage or a factor of each dollar
being withdrawn.
The amount payable on Guaranteed
Period's Maturity Date.
The last day of a Guaranteed Period.
The Purchase Payment less premium
taxes, as applicable.
A separate account set up by Aetna
under Title 38, Section 38a-433, of the
Connecticut General Statutes, that
holds assets for AMG Account Guaranteed
Periods. There are no discrete units
for the AMG Account. The Contract
Holder does not participate in the
investment gain or loss from the assets
held in the Nonunitized Separate
Account. Such gain or loss is borne
entirely by Aetna. The assets held in
the AMG Account may be chargeable with
liabilities arising out of any other
business of Aetna.
Payment accepted by Aetna at its Home
Office. Aetna reserves the right to
refuse to accept any Purchase Payment
at any time for any reason.
Aetna will notify the Contract Holder
of the approaching Maturity Date at
least 18 calendar days prior to the end
of any Guaranteed Period. If no
specific direction is given by the
Contract Holder prior to the Maturity
Date, each Matured Period Value will be
reinvested on the Maturity Date for a
Guaranteed Period of the same duration.
If a Guaranteed Period of the same
duration is unavailable, each Matured
Period Value will automatically be
reinvested on the Maturity Date for the
next shortest Guaranteed Period
available. If no shorter Guaranteed
Period is available, the next longer
Guaranteed Period will be used. Aetna
will mail a confirmation statement to
the Contract Holder the next business
day after the Maturity Date.
At any time prior to the Maturity Date,
the Contract Holder may request in
writing a reinvestment of the Matured
Period Value in a different Guaranteed | |||
Period(s) or a surrender of all or a | |||
part of the Matured Period Value | |||
without an MVA or Surrender Fee. Such | |||
request will be executed on the | |||
Maturity Date If reinvesting in a | |||
different Guaranteed Period(s), all or | |||
part of the Matured Period Value will | |||
be reinvested in the elected Guaranteed | |||
Period(s) at the then prevailing | |||
rate(s). This provision only applies to | |||
a written request from the Contract | |||
Holder received at Aetna's Home Office | |||
in good order at least five (5) days | |||
prior to the Maturity Date. 1.27 | |||
Surrender Value: The amount payable by | |||
Aetna upon the surrender of all or any | |||
portion of the Contract. | |||
9 | |||
I2-MGA-95 | |||
1.27 | Surrender Value: | The amount payable by Aetna upon the | |
surrender of all or any portion of the | |||
Contract. | |||
II. | GENERAL PROVISIONS |
------------------------------------------------------------------------
2.01 | Change of Contract: | Only an authorized officer of Aetna may |
change the terms of this Contract. | ||
Aetna reserves the right to modify this | ||
Contract to meet the requirements of | ||
applicable state and federal laws or | ||
regulations. Aetna will notify the | ||
Contract Holder in writing of any | ||
changes. | ||
2.02 | Nonparticipating Contract: | Contract Holders or Beneficiaries will |
not have a right to share in the | ||
earnings of Aetna. | ||
2.03 | Payments and Elections: | While the Contract Holder is living, |
Aetna will pay any Annuity payments as | ||
and when due. After the Contract | ||
Holder's death, or at the death of the | ||
first Contract Holder if the Contract | ||
is owned jointly, any Annuity payments | ||
will be paid in accordance with 4.03. | ||
Aetna will make any other payments | ||
within seven (7) calendar days of | ||
receipt of a written request for | ||
payment, which is in good order, at its | ||
Home Office, except as provided in | ||
3.10. | ||
2.04 | State Laws: | The Contract complies with the laws of |
the state in which it is delivered. Any | ||
surrender, death, or Annuity payments | ||
are equal to or greater than the | ||
minimum required by such laws. Annuity | ||
tables for legal reserve valuation | ||
shall be as required by state law. Such | ||
tables may be different from Annuity | ||
tables used to determine Annuity | ||
payments. | ||
2.05 | Control of Contract: | This is a Contract between the Contract |
Holder and Aetna. The Contract Holder | ||
has all rights, title and interest in | ||
amounts held in this Contract. | ||
Choices made under this Contract must | ||
be in writing. If the Contract is owned | ||
jointly, both Contract Holders must | ||
authorize any choices in writing. Until | ||
receipt of such choices at Aetna's Home | ||
Office, Aetna may rely on any previous | ||
choices made. | ||
The Contract is not subject to the | ||
claims of any creditors of the Contract | ||
Holder, except to the extent permitted | ||
by law. The Contract Holder may assign |
or transfer his or her rights under the
Contract. Aetna reserves the right not
to accept assignment or transfer to a
nonnatural person. Any assignment or
transfer made must be submitted to
Aetna's Home Office in writing and will
not be effective until accepted by
Aetna. Aetna assumes no responsibility
for the validity of any assignment.
10
I2-MGA-95 | ||
2.06 | Designation of Beneficiary: | The Contract Holder shall name his or |
her Beneficiary. The Beneficiary may be | ||
changed at any time. Changes to a | ||
Beneficiary must be submitted to | ||
Aetna's Home Office in writing and will | ||
not be effective until received and | ||
recorded by Aetna. | ||
2.07 | Misstatements and Adjustments: | If Aetna finds the age of any Annuitant |
to be misstated, the correct facts will | ||
be used to adjust payments. | ||
2.08 | Incontestability: | Aetna will not contest this Contract |
from its effective date. |
III. PURCHASE PAYMENT, CURRENT VALUE, AND SURRENDER PROVISIONS | |
------------------------------------------------------------------------ |
3.01 | Net Purchase Payment: | This amount is the actual Purchase | |
Payment less any applicable premium | |||
tax. Aetna reserves the right to deduct | |||
any premium tax at any time from the | |||
Purchase Payment or from the Contract | |||
Holder's Current Value. The Contract | |||
Holder shall tell Aetna the allocation | |||
percentage of the Net Purchase Payment | |||
to be applied to each of the available | |||
Guaranteed Periods during the current | |||
Deposit Period(s). The minimum amount | |||
that may be allocated to any Guaranteed | |||
Period is shown on Contract Schedule l. | |||
3.02 | Market Value Adjustment: | There will be an MVA for any withdrawal | |
before the end of a Guaranteed Period | |||
when the withdrawal is due to: | |||
(a) | Any full or partial surrender, but | ||
not for a partial withdrawal under | |||
the Systematic Withdrawal Option | |||
(see 3.05); or | |||
(b) | Payment made to a Beneficiary as a | ||
death benefit during the | |||
Accumulation Period, but not | |||
payment made within six months of | |||
the date of the Annuitant's death | |||
(see 3.06); or | |||
(c) | An election of an Annuity option. | ||
Only a positive MVA, if any, will | |||
apply upon election of option 2 or | |||
3 (see 4.04). | |||
Market value adjusted amounts will be | |||
equal to the amount withdrawn | |||
multiplied by the following ratio: |
x
---
365
(1 + i)
----------------
x
---
365
(1 + j)
Where:
i is the Deposit Period Yield
j is the Current Yield
x is the number of days remaining,
(computed from Wednesday of the week
of withdrawal) in the Guaranteed
Period.
11
I2-MGA-95 | |||
3.02 | Market Value Adjustment: | The Deposit Period Yield will be | |
(Cont'd) | determined as follows: | ||
(a) | At the close of the last business | ||
day of each week of the Deposit | |||
Period, a yield will be computed | |||
as the average of the yields on | |||
that day of U.S. Treasury Notes | |||
which mature in the last three | |||
months of the Guaranteed Period. | |||
(b) | The Deposit Period Yield is the | ||
average of those yields for the | |||
Deposit Period. If withdrawal is | |||
made before the close of the | |||
Deposit Period, it is the average | |||
of those yields on each week | |||
preceding withdrawal. | |||
The Current Yield is the average of the | |||
yields on the last business day of the | |||
week preceding withdrawal on the same | |||
U.S. Treasury Notes included in the | |||
Deposit Period Yield. | |||
In the event that no U.S. Treasury | |||
Notes which mature in the last three | |||
months of the Guaranteed Period exist, | |||
Aetna reserves the right to use the | |||
U.S. Treasury Notes that mature in the | |||
following quarter. | |||
3.03 | Notice to the Contract | The Contract Holder will receive | |
Holder: | statements at least annually from Aetna | ||
showing the value of any amounts held | |||
in the AMG Account. | |||
Such values will be as of a specific | |||
date no more than 60 days before the | |||
date of the notice. | |||
3.04 | Loans: | Loans are not available under this | |
Contract. | |||
12 | |||
I2-MGA-95 | |||
3.05 | Systematic Withdrawal Option | The Contract Holder may elect a | |
(SWO): | distribution option under which a | ||
portion of the Current Value will | |||
automatically be surrendered and | |||
distributed each year. SWO payments | |||
will be calculated based on the | |||
Contract's full Current Value. The | |||
distributed amount is withdrawn pro | |||
rata from each Guaranteed Period(s). A | |||
Surrender Fee will not be deducted from | |||
any portion of the Current Value which | |||
is paid as a distribution under SWO. | |||
Contract Holders should consult their | |||
tax adviser prior to requesting this | |||
distribution option. | |||
(a) | Amount of Distribution: The | ||
Contract Holder may elect one of | |||
the three payment methods | |||
described below. | |||
(1) Specified Payment: Payments | |||
of a designated dollar | |||
amount. The annual amount may | |||
not be greater than the | |||
percentage shown on Contract | |||
Schedule I times the Current |
Value at time of election. | |||
This annual dollar amount | |||
will remain constant. At its | |||
discretion, Aetna may require | |||
a minimum initial payment | |||
amount; | |||
(2) | Specified Period: Payments | ||
which are made over a period | |||
of time which must be at | |||
least 10 years. The annual | |||
amount paid each year is | |||
calculated by dividing the | |||
Current Value as of December | |||
31 of the prior year by the | |||
number of payment years | |||
remaining; or | |||
(3) | Specified Percentage: | ||
Paymentof a designated | |||
percentage which cannot be | |||
greater than the percentage | |||
shown on Contract Schedule I. | |||
The percentage may be changed | |||
by written request. Aetna | |||
reserves the right to limit | |||
the number of times the | |||
percentage may be changed. | |||
The annual amount is | |||
calculated by multiplying the | |||
Current Value as of | |||
December 31 of the year prior | |||
to the payment by the | |||
designated percentage. | |||
Payments upon the Contract | |||
Holder's or Annuitant's death will | |||
be made to the Beneficiary in the | |||
manner described in 3.07. | |||
(b) | Minimum Initial Current Value: At | ||
its discretion, Aetna may require | |||
a minimum initial Current Value | |||
for election of this option. If | |||
after election of this option the | |||
Current Value is insufficient to | |||
make a scheduled SWO payment, | |||
Aetna will distribute the entire | |||
balance. | |||
13 | |||
I2-MGA-95 | |||
3.05 Systematic Withdrawal Option | (c) | Date of Distribution: The Contract | |
(SWO): (Cont'd) | Holder shall specify the initial | ||
distribution date. As elected by | |||
the Contract Holder, SWO payments | |||
will be made on a monthly or | |||
quarterly basis unless Aetna | |||
allows otherwise. If SWO payments | |||
are made more frequently than | |||
annually, the designated annual | |||
amount is divided by the number of | |||
payments due each calendar year. | |||
Subsequent distributions will be | |||
made on the 15th of any month or | |||
such other date as Aetna may | |||
designate or allow. | |||
(d) | Election and Revocation: SWO may | ||
be elected by submitting a | |||
completed and signed election form | |||
to Aetna's Home Office. Aetna | |||
reserves the right to establish | |||
the date when SWO may first be | |||
elected by a Contract Holder. Once | |||
elected, this option may be | |||
revoked by the Contract Holder or | |||
spousal Beneficiary, if elected | |||
after the Contract Holder's death, | |||
by submitting a written request to | |||
Aetna at its Home Office. Any | |||
revocation will apply only to | |||
amounts not yet paid. SWO may be | |||
elected only once by the Contract |
Holder or by the spousal | ||
Beneficiary. | ||
3.06 Death Benefit Amount: | If the Contract Holder or Annuitant | |
dies before Annuity payments start, the | ||
Beneficiary is entitled to a death | ||
benefit under the Contract. If the | ||
Contract is owned jointly, the death | ||
benefit is paid at the first death of | ||
either of the joint Contract Holders. | ||
If the Contract is held by joint | ||
Contract Holders, the survivor will be | ||
deemed the designated Beneficiary and | ||
any other Beneficiary on record will be | ||
treated as the contingent Beneficiary. | ||
If the Contract Holder is a nonnatural | ||
person, the death benefit will be | ||
payable at the death of the Annuitant. | ||
If paid within 6 months of the date of | ||
the Annuitant's death, the death | ||
benefit will be the Current Value of | ||
the Contract. Otherwise, the death | ||
benefit will be the Adjusted Current | ||
Value determined as of the claim date. | ||
The claim date is the date when proof | ||
of death and the Beneficiary's claim | ||
are received in good order at Aetna's | ||
Home Office. | ||
When the Contract Holder dies and the | ||
Contract Holder is not the Annuitant, | ||
the death benefit payable will be | ||
subject to a Surrender Fee, if | ||
applicable. | ||
14 | ||
I2-MGA-95 | ||
3.07 Death Benefit Options | Prior to any election, or until amounts | |
available to Beneficiary: | must be otherwise distributed under | |
this section, the Current Value will be | ||
retained in the Contract. The following | ||
options are available to the | ||
Beneficiary: | ||
(a) When the Contract Holder dies or | ||
if the Contract Holder is not a | ||
natural person, when the Annuitant | ||
dies: | ||
(1) | If the Beneficiary is the | |
Contract Holder's surviving | ||
spouse, the Beneficiary may | ||
exercise all Contract Holder | ||
rights under the Contract and | ||
continue in the Accumulation | ||
Period, or may elect (i) or | ||
(ii) below. Distributions | ||
from the Contract are not | ||
required until the spousal | ||
Beneficiary's death. The | ||
spousal Beneficiary may elect | ||
to: | ||
(i) Apply some or all of the | ||
death benefit amount to | ||
an Annuity option 1, 2 | ||
or 3 (see 4.04); or | ||
(ii) Receive, at any time, a | ||
lump sum payment equal | ||
to the death benefit | ||
amount. | ||
(2) | If the Beneficiary is an | |
individual who is not the | ||
Contract Holder's surviving | ||
spouse, then options (i) or | ||
(ii) under (1) above apply. | ||
Any portion of the death | ||
benefit amount not applied to | ||
Annuity option 1, 2 or 3 | ||
within one year of the | ||
Contract Holder's death, must | ||
be distributed within five |
years of the date of death. | ||||
(3) | If the Beneficiary is not a | |||
natural person, then only | ||||
option (ii) under (1) above | ||||
applies. | ||||
(4) | If no Beneficiary has been | |||
designated, a lump sum | ||||
payment equal to the death | ||||
benefit amount will be made | ||||
to the Contract Holder's | ||||
estate. | ||||
(b) | If the Contract Holder is a | |||
natural person but is not the | ||||
Annuitant, and the Annuitant dies, | ||||
the Beneficiary may elect either | ||||
to apply the death benefit amount | ||||
to Annuity option 1, 2 or 3 within | ||||
60 days of the Annuitant's date of | ||||
death, or to receive a lump sum | ||||
payment. | ||||
15 | ||||
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3.08 | Liquidation of Surrender | All or any portion of the Contract's | ||
Value: | Current Value may be surrendered at any | |||
time prior to the Annuity Date. | ||||
Surrender requests can be submitted as | ||||
a percentage of the Contract value or | ||||
as a specific dollar amount. Net | ||||
Purchase Payment amounts are withdrawn | ||||
first, and then the excess value, if | ||||
any. For any partial surrender, amounts | ||||
are withdrawn on a pro rata basis from | ||||
the Guaranteed Period(s) Groups of the | ||||
AMG Account in which the Current Value | ||||
is invested. Within a Guaranteed Period | ||||
Group, the amount to be surrendered | ||||
will be withdrawn first from the oldest | ||||
Deposit Period, then from the next | ||||
oldest, and so on until the amount | ||||
requested is satisfied. | ||||
After deduction of the Maintenance Fee | ||||
and any Premium Tax, if applicable, the | ||||
surrendered amount shall be reduced by | ||||
a Surrender Fee, if applicable. An MVA | ||||
may apply to amounts surrendered. | ||||
3.09 | Surrender Fee: | The Surrender Fee only applies to the | ||
Net Purchase Payment portion | ||||
surrendered and varies according to the | ||||
elapsed time from the Contract | ||||
effective date (see Contract Schedule | ||||
I). | ||||
No Surrender Fee is deducted from any | ||||
portion of the Current Value which is | ||||
paid: | ||||
(a) | To a Beneficiary due to the | |||
Annuitant's death before Annuity | ||||
payments start (see 3.06); | ||||
(b) | As a premium for an Annuity option | |||
1, 2 or 3 under this Contract (see | ||||
4.04); | ||||
(c) | As a distribution under the SWO | |||
provision (see 3.05); | ||||
(d) | At least 12 months after the date | |||
of the Purchase Payment, in an | ||||
amount equal to or less than the | ||||
special withdrawal percentage | ||||
shown on Contract Schedule l times | ||||
the current value at the time of | ||||
the withdrawal. This applies to | ||||
the first surrender request, | ||||
partial or full, in a calendar | ||||
year. The Current Value is | ||||
calculated as of the date the | ||||
surrender request is received in |
good order at Aetna's Home Office. | |||
This waiver is not available to | |||
the Contract Holder while SWO is | |||
in effect; | |||
(e) | For a full surrender of the | ||
Contract where the Current Value | |||
is $2,500 or less and no | |||
surrenders have been taken from | |||
the Contract within the prior 12 | |||
months; or | |||
(f) | Upon withdrawal of any Matured | ||
Period Value; or | |||
(g) | By Aetna under 3.11. | ||
3.10 | Payment of Surrender Value: | Under certain emergency conditions, as | |
allowed by law, Aetna may defer payment | |||
for a period of up to 6 months. | |||
16 | |||
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3.11 | Payment of Adjusted Current | Upon 90 days' written notice to the | |
Value: | Contract Holder, Aetna will terminate | ||
any Contract if the Current Value | |||
becomes less than $2,500 immediately | |||
following any partial surrender. A | |||
Surrender Fee will not be deducted from | |||
the Adjusted Current Value. | |||
IV. | ANNUITY PROVISIONS | ||
------------------------------------------------------------------------ | |||
4.01 | Choices to be Made: | The Contract Holder may tell Aetna to | |
apply any portion of the Adjusted | |||
Current Value (minus any premium tax) | |||
for an Annuity under option 1, 2 or 3 | |||
(see 4.04). The first Annuity payment | |||
may not be earlier than twelve months | |||
after the Purchase Payment At least 30 | |||
days prior to the Annuity Date, the | |||
Contract Holder must tell Aetna which | |||
Annuity option is elected. Annuity | |||
payments will be made monthly, unless | |||
the Contract Holder elects otherwise in | |||
writing. In lieu of the election of an | |||
Annuity, the Contract Holder may elect | |||
a lump sum payment. | |||
The Annuity purchase rate for the | |||
option chosen reflects the Minimum | |||
Guaranteed Interest Rate (see Contract | |||
Schedule II), but may reflect a higher | |||
interest rate. | |||
4.02 | Terms of Annuity Options: | (a) | When payments start, the age of |
the Annuitant plus the number of | |||
years for which payments are | |||
guaranteed must not exceed 95. | |||
(b) | An Annuity option may not be | ||
elected if the first payment would | |||
be less than $50 or if the total | |||
payments in a year would be less | |||
than $250 (less if required by | |||
state law). Aetna reserves the | |||
right to increase the minimum | |||
first Annuity payment amount and | |||
the annual minimum Annuity payment | |||
amount based upon increases | |||
reflected in the Consumer Price | |||
Index-Urban, (CPI-U) since July 1, | |||
1993. | |||
(c) | If an Annuity under option 1, 2 or | ||
3 is chosen and a larger payment | |||
would result from applying the | |||
Surrender Value to a current Aetna | |||
single premium immediate Annuity, | |||
Aetna will make the larger | |||
payment. | |||
(d) | For purposes of calculating the |
guaranteed first payment of an | ||
Annuity, the Annuitant's and | ||
second Annuitant's adjusted age | ||
will be used. The Annuitant's and | ||
second Annuitant's adjusted age is | ||
his or her age as of the birthday | ||
closest to the Annuity | ||
commencement date reduced by one | ||
year for Annuity commencement | ||
dates occurring during the period | ||
of time through December 31, 1999. | ||
4.02 Terms of Annuity Options | ||
(Cont'd) The Annuitant's and | ||
second Annuitant's age will be | ||
reduced by two years for Annuity | ||
commencement dates occurring | ||
during the period of time from | ||
January 1, 2000 through | ||
December 31, 2009. The Annuitant's | ||
and second Annuitant's age will be | ||
reduced by one additional year for | ||
Annuity commencement dates | ||
occurring in each succeeding | ||
decade. The Annuity purchase rates | ||
for options 2 and 3 are based on | ||
mortality from 1983 Table a. | ||
17 | ||
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4.02 | Terms of Annuity Options: | (e) Once elected, an Annuity option |
(Cont'd) | may not be revoked and Annuity | |
payments cannot be commuted to a | ||
lump sum. | ||
4.03 | Death of Annuitant/ | If the Annuitant dies after Annuity |
Beneficiary: | payments have begun, the death benefit, | |
if any, will be payable to the | ||
Beneficiary as specified in the Annuity | ||
option elected. Death benefits will be | ||
paid at least as rapidly as under the | ||
method of distribution in effect at the | ||
or Annuitant's death. | ||
If the Contract Holder who is not the | ||
Annuitant dies after Annuity payments | ||
have begun, any remaining payments | ||
under the Annuity option elected will | ||
be made to the Beneficiary at least as | ||
rapidly as under the method of | ||
distribution in effect at the Contract | ||
Holder's death. | ||
If the Contract is held by joint | ||
Contract Holders, the survivor will be | ||
deemed the designated Beneficiary and | ||
any other Beneficiary on record will be | ||
treated as the contingent Beneficiary. | ||
Aetna will require proof of death. | ||
4.04 | Annuity Options: | Option 1 -- Payments for a Stated |
Period of Time -- An Annuity will be | ||
paid for the number of years chosen. | ||
The number of years must be at least 10 | ||
and not more than 30. | ||
If a nonspouse Beneficiary elects this | ||
option at the death of the Contract | ||
Holder, the period selected may not | ||
extend beyond the Beneficiary's life | ||
expectancy. | ||
Option 2 -- Life Income -- An Annuity | ||
will be paid for the life of the | ||
Annuitant, if also chosen, Aetna will | ||
guarantee payments for 60, 120, 180, or | ||
240 months. | ||
Option 3 -- Life Income Based upon the | ||
Lives of Two Annuitants -- An Annuity | ||
will be paid during the lives of the | ||
Annuitant and a second Annuitant. | ||
Payments will continue until both | ||
Annuitants have died. When this option | ||
is chosen, one of the following choices |
must be made:
(a) |
100% of the payment to continue after the first death; |
(b) |
66 2/3% of the payment to continue after the first death; |
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4.04 Annuity Options: | (c) | 50% of the payment to continue |
(Cont'd) | after the first death; | |
(d) | Payments for a minimum of 120 | |
months with 100% of the payment to | ||
continue after the first death; or | ||
(e) | 100% of the payment to continue at | |
the death of the second Annuitant | ||
and 50% of the payment to continue | ||
at the death of the Annuitant. | ||
Other Options -- Aetna may make other | ||
options available as allowed by the | ||
laws of the state in which the Contract | ||
is delivered. | ||
19 | ||
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OPTION 1
Payments for a Stated Period of Time
Amount of First Monthly Payment for Each $1,000 After Deduction of any Charge for Premium Taxes
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
<CAPTION> | |||||
Guaranteed | Monthly | Quarterly | Semi-Annual | Annual | |
Years | Rate | Payment | Payment | Payment | Payment |
5 | 3.00% | 17.91 | 53.59 | 106.78 | 211.99 |
6 | 3.00% | 15.14 | 45.30 | 90.27 | 179.22 |
7 | 3.00% | 13.16 | 39.39 | 78.49 | 155.83 |
8 | 3.00% | 11.68 | 34.96 | 69.66 | 138.31 |
9 | 3.00% | 10.53 | 31.52 | 62.81 | 124.69 |
10 | 3.00% | 9.61 | 28.77 | 57.33 | 113.82 |
11 | 3.00% | 8.86 | 26.52 | 52.85 | 104.93 |
12 | 3.00% | 8.24 | 24.65 | 49.13 | 97.54 |
13 | 3.00% | 7.71 | 23.08 | 45.98 | 91.29 |
14 | 3.00% | 7.26 | 21.73 | 43.29 | 85.95 |
15 | 3.00% | 6.87 | 20.56 | 40.96 | 81.33 |
16 | 3.00% | 6.53 | 19.54 | 38.93 | 77.29 |
17 | 3.00% | 6.23 | 18.64 | 37.14 | 73.74 |
18 | 3.00% | 5.96 | 17.84 | 35.56 | 70.59 |
19 | 3.00% | 5.73 | 17.13 | 34.14 | 67.78 |
20 | 3.00% | 5.51 | 16.50 | 32.87 | 65.26 |
21 | 3.00% | 5.32 | 15.92 | 31.72 | 62.98 |
22 | 3.00% | 5.15 | 15.40 | 30.68 | 60.92 |
23 | 3.00% | 4.99 | 14.92 | 29.74 | 59.04 |
24 | 3.00% | 4.84 | 14.49 | 28.88 | 57.33 |
25 | 3.00% | 4.71 | 14.09 | 28.08 | 55.76 |
26 | 3.00% | 4.59 | 13.73 | 27.36 | 54.31 |
27 | 3.00% | 4.47 | 13.39 | 26.68 | 52.97 |
28 | 3.00% | 4.37 | 13.08 | 26.06 | 51.74 |
29 | 3.00% | 4.27 | 12.79 | 25.49 | 50.60 |
30 | 3.00% | 4.18 | 12.52 | 24.95 | 49.53 |
20 | |||||
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OPTION 2 | |||||
Life Income | |||||
Amount of First Monthly Payment for Each $1,000 |
After Deduction of any Charge for Premium Taxes
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
Payments Guaranteed for a Stated Period of Months
Adjusted Age | |||||
of | None | 60 | 120 | 180 | 240 |
Annuitant | |||||
50 | $4.05 | $4.05 | $4.03 | $3.99 | $3.93 |
51 | 4.12 | 4.11 | 4.09 | 4.05 | 3.99 |
52 | 4.19 | 4.19 | 4.16 | 4.11 | 4.04 |
53 | 4.27 | 4.26 | 4.23 | 4.18 | 4.10 |
54 | 4.35 | 4.34 | 4.31 | 4.25 | 4.16 |
55 | 4.44 | 4.42 | 4.39 | 4.32 | 4.22 |
56 | 4.53 | 4.51 | 4.47 | 4.40 | 4.29 |
57 | 4.62 | 4.61 | 4.56 | 4.48 | 4.35 |
58 | 4.72 | 4.71 | 4.65 | 4.56 | 4.42 |
59 | 4.83 | 4.81 | 4.75 | 4.64 | 4.49 |
60 | 4.95 | 4.93 | 4.86 | 4.73 | 4.55 |
61 | 5.07 | 5.05 | 4.97 | 4.83 | 4.62 |
62 | 5.20 | 5.17 | 5.08 | 4.92 | 4.69 |
63 | 5.34 | 5.31 | 5.20 | 5.02 | 4.76 |
64 | 5.49 | 5.45 | 5.33 | 5.12 | 4.83 |
65 | 5.65 | 5.61 | 5.47 | 5.22 | 4.89 |
66 | 5.82 | 5.77 | 5.61 | 5.33 | 4.96 |
67 | 6.01 | 5.94 | 5.75 | 5.44 | 5.02 |
68 | 6.20 | 6.13 | 5.91 | 5.54 | 5.08 |
69 | 6.41 | 6.33 | 6.07 | 5.65 | 5.14 |
70 | 6.64 | 6.54 | 6.23 | 5.76 | 5.19 |
71 | 6.88 | 6.76 | 6.41 | 5.86 | 5.24 |
72 | 7.14 | 7.00 | 6.59 | 5.97 | 5.28 |
73 | 7.43 | 7.26 | 6.77 | 6.06 | 5.32 |
74 | 7.73 | 7.53 | 6.96 | 6.16 | 5.35 |
75 | 8.06 | 7.82 | 7.14 | 6.25 | 5.38 |
</TABLE> |
Rates are based on mortality from 1983 Table a. The rates do not differ by sex. Rates for ages not shown will be provided on request and will be computed on a basis consistent with the rates in the above tables.
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OPTION 3
Life Income for Two Payees
Amount of First Monthly Payment for Each $1,000 After Deduction of any Charge for Premium Taxes
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
Adjusted Ages | ||||||
Annuitant | Second Annuitant | Option 3a | Option 3b | Option 3c | Option 3d | Option 3e |
--------- | ---------------- | --------- | --------- | --------- | --------- | --------- |
<S> | <C> | <C> | <C> | <C> | <C> | <C> |
55 | 50 | $3.69 | $4.05 | $4.27 | $3.69 | $4.03 |
55 | 55 | 3.88 | 4.25 | 4.47 | 3.87 | 4.14 |
55 | 60 | 3.99 | 4.44 | 4.71 | 3.98 | 4.42 |
60 | 55 | 3.99 | 4.44 | 4.71 | 3.98 | 4.42 |
60 | 60 | 4.24 | 4.71 | 4.99 | 4.23 | 4.57 |
60 | 65 | 4.38 | 4.97 | 5.32 | 4.38 | 4.93 |
65 | 60 | 4.38 | 4.97 | 5.32 | 4.38 | 4.93 |
65 | 65 | 4.72 | 5.33 | 5.70 | 4.71 | 5.14 |
65 | 70 | 4.93 | 5.68 | 6.15 | 4.91 | 5.66 |
70 | 65 | 4.93 | 5.68 | 6.15 | 4.91 | 5.66 |
70 | 70 | 5.40 | 6.21 | 6.70 | 5.36 | 5.96 |
70 | 75 | 5.69 | 6.68 | 7.32 | 5.62 | 6.67 |
75 | 70 | 5.69 | 6.68 | 7.32 | 5.62 | 6.67 |
75 | 75 | 6.37 | 7.45 | 8.15 | 6.23 | 7.12 |
75 | 80 | 6.78 | 8.11 | 8.99 | 6.54 | 8.13 |
--------- | ---------------- | --------- | --------- | --------- | --------- | --------- |
Rates are based on mortality from 1983 Table a. The rates do not differ by sex. Rates for ages not shown will be provided on request and will be computed on a basis consistent with the rates in the above tables.
22
G2-MGA-95
[AETNA LOGO]
Aetna Insurance Company of America
Home Office: 000 Xxxxxxxxxx Xxxxxx
Xxxxxxxx, Xxxxxxxxxxx 00000
(000) 000-0000
Individual Single Premium Modified Guaranteed Deferred Annuity Contract Nonparticipating
THIS CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT FORMULA. APPLICATION OF A MARKET VALUE ADJUSTMENT MAY RESULT IN EITHER AN INCREASE OR DECREASE IN THE CURRENT VALUE. THE MARKET VALUE ADJUSTMENT FORMULA DOES NOT APPLY TO A GUARANTEED PERIOD AT THE TIME OF ITS MATURITY.
G2-MGA-95