Xxxxxxx Xxxxxxx
XX-0123456
LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK
(A Stock Company)
Home Office: 000 Xxxxxxx Xxxxxx, Xxxxx 0000, Xxxxxxxx, Xxx Xxxx 00000
Servicing Office: 0000 Xxxxx Xxxxxxx Xxxxxx, X.X. Box 2348, Fort Xxxxx, Indiana
46802
ANNUITY CONTRACT
Flexible Premium Deferred Variable or
Fixed and Variable Annuity
With Benefit Payment Options
Nonparticipating
Lincoln Life & Annuity Company of New York (LNY) agrees to provide the benefits
and other rights described in this Contract in accordance with the terms of this
Contract.
READ THIS CONTRACT CAREFULLY. This is a legal contract between the Owner and
LNY. We want to be sure you understand the features and benefits contained in
this Contract. IT IS THEREFORE IMPORTANT THAT YOU READ YOUR CONTRACT CAREFULLY.
If you have any questions after reading the Contract, we hope you will contact
your representative or the Servicing Office of LNY.
NOTICE OF 10-DAY RIGHT TO EXAMINE CONTRACT. Within 10 days after this Contract
is first received, it may be cancelled for any reason without penalty by
delivering or mailing it to the representative through whom it was purchased, or
to the Servicing Office of LNY. When the Contract is received at the Servicing
Office, LNY will return the Contract Value as of the date of cancellation where
permitted by law (see Section 1.12 of Article 1). If this Contract is issued as
an IRA, then the entire amount of Purchase Payments made shall be returned.
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED UPON INVESTMENT
EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE (THE AMOUNT MAY INCREASE OR
DECREASE) AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT (SEE PAGES 7 AND 16).
Signed for Lincoln Life & Annuity Company of New York at its Home Office in
Syracuse, New York.
/s/ Xxxxxx X. Xxxxxxx
Xxxxxx X. Xxxxxxx, President
Page 1
Form 30294-NY
Table of Contents
Article Page
1 Definitions........................................................ 4
2 Purchase Payments.................................................. 6
3 Variable Account................................................... 7
4 DCA Fixed Account.................................................. 8
5 Options............................................................ 8
6 Death Benefits..................................................... 10
7 Annuity Payment Options............................................ 12
8 Beneficiary........................................................ 16
9 General Provisions................................................. 16
10 Annuity Purchase Rates Under a Variable Payment Option............. 19
11 Annuity Purchase Rates Under a Fixed Payment Option................ 22
Form 30294-NY Page 2
CONTRACT DATA
Contract Number XX-0123456
Annuitant Xxxxxxx Xxxxxxx
Age at Issue 35
Contract Date April 1, 2000
Purchase Payment $25,000.00
Purchase Payment Frequency Flexible
Maturity Date April 1, 2055
OWNER: Xxxxxxx Xxxxxxx
Xxxx Xxxxxxx
BENEFICIARY DESIGNATION: Please refer to the Client Information Profile for
beneficiary designation.
DOLLAR COST AVERAGING FIXED ACCOUNT
Initial Guaranteed Interest
Period / Interest Rate: [minimum 6 months] / [minimum 4.00%]
VARIABLE ACCOUNT
The Variable Account for this variable annuity Contract is Lincoln Life &
Annuity Variable Annuity Account H. There are currently [eleven] Sub-accounts in
the Variable Account available to the Owner. The Owner may direct Purchase
Payments under the Contract to any of the available Variable Sub-accounts,
subject to limitations. The amounts allocated to each Sub-account will be
invested at net asset value in the shares of one of the Funds of the American
Funds Insurance Series (Series). The Sub-accounts are:
1. [Growth Fund]
2. [International Fund]
3. [Global Growth Fund]
4. [Growth-Income Fund]
5. [Asset Allocation Fund]
6. [High-Yield Bond Fund]
7. [Bond Fund]
8. [U.S. Government/AAA-Rated Securities Fund]
9. [Cash Management Fund]
10. [Global Small Capitalization Fund]
11. [New World Fund]
12. [Other Funds made available by LNY]
See Section 3.01 for provisions governing any limitations, substitutions or
elimination of a Fund.
With a sub-account charge of [1.40%], the smallest rate of investment return
required to ensure that the dollar amount of variable annuity payments does not
decrease is:
. [4.40%] for variable annuity options based on an assumed rate of return of
[3%] per year; or
. [5.40%] for variable annuity options based on an assumed rate of return of
[4%] per year; or
. [6.40%] for variable annuity options based on an assumed rate of return of
[5%] per year.
Form 30294-NY Page 3
ARTICLE 1
DEFINITIONS
1.01
ACCUMULATION UNIT -- A unit of measure used in the calculation of the value of a
Variable Sub-account prior to the Annuity Commencement Date.
1.02
ANNUITANT OR JOINT ANNUITANT -- The person or persons upon whose life or lives
the annuity benefit payments made after the Annuity Commencement Date will be
based.
1.03
ANNUITY COMMENCEMENT DATE -- The Valuation Date on which the Contract Value is
withdrawn for payment of annuity benefits under the Annuity Payment Option
selected.
1.04
ANNUITY PAYMENT DATE -- The date on which the Owner is entitled to the first
annuity benefit payment. Subsequent annuity benefit payments will be made on
the same day of the month as the first annuity benefit payment, at the
applicable frequency.
1.05
ANNUITY PAYMENT OPTION -- An optional form of payment of the annuity benefits
provided for under this Contract.
1.06
ANNUITY UNIT -- A unit of measure used on and after the Annuity Commencement
Date to calculate the amount of a variable annuity benefit payment.
1.07
BENEFICIARY -- The person or entity designated by the Owner to receive the Death
Benefit, if any.
1.08
CODE -- The Internal Revenue Code of 1986, as amended.
1.09
CONTINGENT ANNUITANT -- Prior to the Annuity Commencement Date, the individual
who will become the Annuitant upon the death of the Annuitant.
1.10
CONTRACT -- The agreement, between LNY and the Owner, in which LNY provides a
variable annuity.
1.11
CONTRACT DATE -- The date this Contract became effective. The Contract Date is
shown on the Contract Data page(s).
1.12
CONTRACT VALUE -- Prior to the Annuity Commencement Date, the sum of the values
of the Variable Account and the DCA Fixed Account of this Contract on a given
Valuation Date.
Form 30294-NY Page 4
1.13
CONTRACT YEAR -- Each twelve-month period starting with the Contract Date on the
Contract Data page(s) and starting with each Contract Date anniversary
thereafter.
1.14
DCA FIXED ACCOUNT -- An account under this Contract established by LNY to accept
Purchase Payments or transfers of Contract Value, that may only be used for the
Dollar Cost Averaging program. Funds in the DCA Fixed Account are invested in
the general account of LNY.
1.15
DEATH BENEFIT -- The amount payable upon death of an Owner, Joint Owner, or an
Annuitant.
1.16
DOLLAR COST AVERAGING (DCA) -- An option that allows the automatic transfer of a
portion of the Contract Value in periodic installments from a designated DCA
holding account to one or more of the Variable Sub-accounts available under the
Contract. The periodic installments will be over any DCA period made available
by LNY and selected by the Owner. A designated DCA holding account may be in the
DCA Fixed Account and/or the Variable Account.
1.17
FUND -- Any of the underlying investment options available in the Variable
Account.
1.18
HOME OFFICE -- The principal office of LNY located at 000 Xxxxxxx Xxxxxx, Xxxxx
0000, Xxxxxxxx, Xxx Xxxx 00000.
1.19
LNY -- Lincoln Life & Annuity Company of New York
1.20
MATURITY DATE -- The date specified on the Contract Data page(s) of this
Contract.
1.21
NET ASSET VALUE PER SHARE -- The market value of a Fund share calculated each
day by taking the closing market value of all securities owned, adding the value
of all other assets (such as cash), subtracting all liabilities, and then
dividing the result (total net assets) by the number of shares outstanding.
1.22
OWNER OR JOINT OWNERS -- The one person, two persons or entity who exercise
rights of ownership under this Contract.
1.23
PURCHASE PAYMENTS -- Amounts paid into this Contract by the Owner.
1.24
QUALIFIED PLAN -- A retirement plan qualified for special tax treatment under
the Code, including Sections 401, 403, 408, 408A and 457. All other plans are
considered Non-Qualified.
1.25
SERIES -- American Funds Insurance Series, the mutual fund(s) into which the
Contract Value, or a portion thereof, allocated to the Variable Account is
invested.
Form 30294-NY Page 5
1.26
SERVICING OFFICE -- The office where servicing of this Contract takes place,
located at 0000 Xxxxx Xxxxxxx Xxxxxx, Xxxx Xxxxx, Xxxxxxx, 00000, or an
institution designated by LNY.
1.27
VALUATION DATE -- Close of the market of each day that the New York Stock
Exchange is open for business.
1.28
VALUATION PERIOD -- The period commencing at the close of business on a
particular Valuation Date and ending at the close of business on the next
succeeding Valuation Date.
1.29
VARIABLE ACCOUNT -- The segregated investment account into which LNY sets aside
and invests the assets allocated to the Variable Sub-account(s) made available
by LNY and selected by the Owner. The Variable Account for this variable annuity
Contract is shown on the Contract Data page(s).
1.30
VARIABLE SUB-ACCOUNT -- That portion of the Variable Account which invests in
shares of a particular Fund in the Series. There is a separate Variable Sub-
account for each particular Fund.
ARTICLE 2
PURCHASE PAYMENTS
2.01 WHERE PAYABLE
All Purchase Payments must be made to LNY at its Servicing Office or to an agent
designated by LNY.
2.02 AMOUNT AND FREQUENCY
Purchase Payments are made in the amount and at the frequency shown on the
Contract Data Page(s). The Owner may change the frequency or amount of Purchase
Payments subject to LNY's rules in effect at the time of the change. LNY
reserves the right to limit future Purchase Payments into this Contract.
Purchase Payments may be made until the earliest of the Annuity Commencement
Date, termination of the Contract upon payment of any Death Benefit, surrender
of the Contract, or the Maturity Date.
In the event that Purchase Payments are discontinued by the Owner, this Contract
will continue and Purchase Payments may be resumed at any time prior to the
earlier of:
a. the Annuity Commencement Date;
b. termination of this Contract upon payment of any Death Benefit;
c. surrender of this Contract; or
d. the Maturity Date.
Form 30294-NY Page 6
ARTICLE 3
VARIABLE ACCOUNT
3.01 THE VARIABLE ACCOUNT
Purchase Payments under the Contract may be allocated to the Variable Account.
The Variable Account is for the exclusive benefit of persons entitled to receive
benefits under variable annuity contracts. The Variable Account will not be
charged with the liabilities arising from any other part of LNY's business.
Subject to any required regulatory approvals, LNY reserves the right to
eliminate the shares of any Fund and substitute the securities of a different
Fund or investment company or mutual fund. Such elimination and substitution may
occur if the shares of a Fund are no longer available for investment or, if in
the judgement of LNY, further investment in any Fund should become inappropriate
in view of the purposes of the Contract. LNY may add new Variable Sub-accounts
in which the assets of the Variable Account may be invested. LNY will give the
Owner written notice of the elimination and substitution of any Fund within
fifteen days after such substitution occurs.
3.02 ALLOCATION OF PURCHASE PAYMENTS TO THE VARIABLE ACCOUNT
Any Purchase Payment to this Contract may be allocated to the Variable Account.
Purchase Payments allocated to the Variable Account of the Contract will be
credited to the Variable Sub-account(s) made available by LNY and selected by
the Owner.
The Owner may allocate Purchase Payments to any of the available Variable Sub-
accounts subject to the following limitations:
a. The minimum amount of a Purchase Payment allocated to any one Variable Sub-
account is $20.
b. If the Owner elects to allocate any Purchase Payment to a new Variable
Sub-account not previously selected, that election must be made to LNY in
writing.
Purchase Payments allocated to each Variable Sub-account will be invested at net
asset value in the shares of one of the Funds. LNY will use each Purchase
Payment to buy Accumulation Units in the Variable Sub-account(s) selected by the
Owner. The number of Accumulation Units bought will be determined by dividing
the amount allocated to a Variable Sub-account by the dollar value of an
Accumulation Unit in such Variable Sub-account as of the Valuation Date
immediately following receipt of the Purchase Payment at the Servicing Office.
The number of Accumulation Units held for an Owner in a Variable Sub-account
will not be changed by any change in the dollar value of Accumulation Units in
the Variable Sub-account.
3.03 VALUATION OF THE VARIABLE ACCOUNT ALLOCATIONS
The value of the portion of this Contract allocated to the Variable Account at
any time prior to the Annuity Commencement Date is equal to the sum of the
values allocated under this Contract to the Variable Sub-accounts. The value of
the portion of this Contract allocated to a Variable Sub-account at any time
prior to the Annuity Commencement Date is equal to the Accumulation Units
credited under this Contract to a Variable Sub-account multiplied by the value
of the Accumulation Unit for the respective Variable Sub-account.
Accumulation Units for each Variable Sub-account are valued separately. The
value of a Variable Sub-account Accumulation Unit may increase or decrease from
Valuation Period to Valuation Period. Initially, the value of an Accumulation
Unit was arbitrarily established at the inception of the Variable Sub-account.
The Accumulation Unit value for a Variable Sub-account for any later Valuation
Period is determined as follows:
a. the total value of Fund shares held in the Variable Sub-account is
calculated by multiplying the number of Fund shares owned by the Variable
Sub-account at the beginning of the Valuation Period by the Net Asset Value
Per Share of the Fund at the end of the Valuation Period, and adding any
dividend or other distribution of the Fund if an ex-dividend date occurs
during the Valuation Period; minus
b. the liabilities of the Variable Sub-account at the end of the Valuation
Period (such liabilities include daily charges imposed on the Variable Sub-
account and may include a charge or credit with respect to any taxes paid
or reserved for by LNY that LNY determines is a result of the operation of
the Variable Account); the result divided by
c. the outstanding number of Accumulation Units in the Variable Sub-account at
the beginning of the Valuation Period.
Form 30294-NY Page 7
The daily charge imposed on a Variable Sub-account for any Valuation Period
represents the daily mortality and expense risk charge and the daily
administrative charge adjusted for the number of calendar days in the Valuation
Period. On an annual basis, this daily charge will not exceed the levels
determined by the Death Benefit option (see Section 6.01) in effect:
for any Valuation Period the Enhanced Guaranteed Minimum Death Benefit (EGMDB)
is in effect, on an annual basis the daily charge will not exceed 1.65% of the
average daily net assets of the Variable Sub-account;
for any Valuation Period the Guarantee of Principal Death Benefit is in
effect, on an annual basis the daily charge will not exceed 1.55% of the
average daily net assets of the Variable Sub-account.
For any Valuation Period on or after the Annuity Commencement Date, on an annual
basis the daily charge will not exceed 1.40% of the average daily net assets of
the Variable Sub-account.
The Accumulation Unit value may increase or decrease the dollar value of
benefits under the Contract. Expenses incurred by LNY will not adversely affect
the dollar value of benefits.
ARTICLE 4
DCA FIXED ACCOUNT
4.01 ALLOCATION OF PURCHASE PAYMENTS INTO THE DCA FIXED ACCOUNT
Any Purchase Payment to this Contract may be allocated to the DCA Fixed Account
of the Contract. The Owner may allocate Purchase Payments to the DCA Fixed
Account subject to the following limitations:
a. The minimum amount of a Purchase Payment which may be allocated to the DCA
Fixed Account is $1,500.
b. If the Owner elects to allocate any Purchase Payment to the DCA Fixed
Account and the DCA Fixed Account was not previously selected, that
election must be made to LNY in writing.
4.02 CREDITING OF INTEREST ON DCA FIXED ACCOUNT
Prior to the earlier of:
a. the Annuity Commencement Date;
b. termination of this Contract upon payment of any Death Benefit; or
c. surrender of this Contract;
LNY guarantees that at the end of each Valuation Period an effective annual
interest rate, adjusted for the number of days in the Valuation Period, will be
credited to the portion of Contract Value, if any, in the DCA Fixed Account at
that time. LNY guarantees that it will credit an effective annual rate of not
less than 3.0% during all years. LNY may credit interest at effective annual
rates in excess of 3.0% at any time.
ARTICLE 5
OPTIONS
5.01 TRANSFER OPTION
Prior to the earlier of:
a. the Annuity Commencement Date;
b. termination of this Contract upon payment of any Death Benefit;
c. surrender of this Contract; or
d. the Maturity Date;
Form 30294-NY Page 8
the Owner may direct a transfer of a portion of the Contract Value:
a. from one Variable Sub-account to another Variable Sub-account;
b. from a designated DCA holding account to a Variable Sub-account under a DCA
program;
subject to the restrictions described below.
Such a transfer request must be made in writing to LNY at its Servicing Office.
A transfer from one Variable Sub-account to another Variable Sub-account will
result in the redemption of Accumulation Units in one Variable Sub-account and
the purchase of Accumulation Units in the other Variable Sub-account. A transfer
from a DCA Fixed Account to a Variable Sub-account will result in a withdrawal
of Contract Value from the DCA Fixed Account and the purchase of Accumulation
Units in the Variable Sub-account. Such transfers will be accomplished at
Accumulation Unit values as of the Valuation Date the transfer request is
received in the Servicing Office.
Transfers will be subject to the following restrictions.
a. LNY reserves the right to restrict transfers during the first 30 days after
the Contract Date.
b. Twelve (12) transfers within the Variable Account may be made per Contract
Year. There will be no fee imposed for these twelve (12) transfers.
Transfers in excess of twelve (12) per Contract Year must be authorized by
LNY. Transfers made as a part of an automatic transfer program (such as a
DCA program) will not be counted against these twelve (12) transfers.
c. The minimum single transfer amount from a Variable Sub-account is $300 or
the entire amount in the Variable Sub-account, whichever is less. If,
after the transfer, the amount remaining under this Contract in the
Variable Sub-account from which the transfer is taken is less than $300,
the entire amount held in that Variable Sub-account will be transferred
with the requested transfer amount.
d. The minimum transfer amount to a Variable Sub-account is $300.
If the DCA program is discontinued by the Owner prior to the end of the selected
DCA period, any remaining portion of the Contract Value held in a designated DCA
holding account within the DCA Fixed Account will be transferred automatically
to the Variable Sub-account(s) the Owner selected under the DCA program.
5.02 WITHDRAWAL OPTION
The Owner may withdraw a part of the Contract Value at any time prior to the
earlier of:
a. the Annuity Commencement Date;
b. termination of this Contract upon payment of any Death Benefit;
c. surrender of this Contract; or
d. the Maturity Date.
The minimum withdrawal is $300. A withdrawal will be effective on the Valuation
Date on which LNY receives a written request at its Servicing Office.
The request may specify from which Sub-account the withdrawal will be made. If
no Sub-account is specified, LNY will withdraw the amount requested on a pro-
rata basis from each Variable Sub-account and/or DCA Fixed Account.
Any payment from the Variable Account will be mailed from LNY's Servicing Office
within seven days after the date of withdrawal; however, LNY may be permitted to
defer such payment under the Investment Company Act of 1940, as in effect at the
time such request of withdrawal is received. Any payment from the DCA Fixed
Account may be deferred for a period not to exceed six months after receipt of
the withdrawal request.
Form 30294-NY Page 9
Withdrawals from a Variable Sub-account will result in the redemption of
Accumulation Units from this Variable Sub-account. Such withdrawals will be
accomplished at Accumulation Unit values as of the Valuation Date the withdrawal
request is received in the Servicing Office.
The Withdrawal Option is not available after the Annuity Commencement Date.
A partial withdrawal will result in a proportional reduction in any Death
Benefit payable under this Contract.
5.03 SURRENDER OPTION
The Owner may surrender this Contract for its Contract Value at any time prior
to the earlier of:
a. the Annuity Commencement Date;
b. termination of the Contract upon payment of any Death Benefit; or
c. the Maturity Date.
LNY reserves the right to surrender this Contract if any withdrawal reduces the
total Contract Value to less than $2,000, and Purchase Payments have stopped for
a period of three full years. By payment of the Contract Value, LNY shall be
relieved of any further obligation under this Contract.
This Contract will terminate upon surrender. The surrender will be effective on
the Valuation Date on which LNY receives a written request for surrender at its
Servicing Office.
Any payment from the Variable Account will be mailed from LNY's Servicing Office
within seven days after the date of surrender; however, LNY may be permitted to
defer such payment under the Investment Company Act of 1940, as in effect at the
time a request for surrender is received in its Servicing Office. Any payment
from the DCA Fixed Account may be deferred for a period not to exceed six months
after receipt of the surrender request.
The Surrender Option is not available after the Annuity Commencement Date.
ARTICLE 6
DEATH BENEFITS
6.01 DEATH BEFORE THE ANNUITY COMMENCEMENT DATE
Entitlement.
If there is a single Owner, then upon the death of the Owner LNY will pay a
Death Benefit to the designated Beneficiary(s) in accordance with the terms of
Article 8. If the designated Beneficiary of the Death Benefit is the surviving
spouse of the deceased Owner, the spouse may elect to continue the Contract as
the new Owner. Upon the death of the spouse who continues the Contract as the
new Owner, LNY will pay a Death Benefit to the designated Beneficiary(s) named
by the spouse, as the new Owner, in accordance with the terms of Article 8. If
there are no designated Beneficiaries, LNY will pay a Death Benefit to the
Owner's estate.
If there are Joint Owners, upon the death of the first Joint Owner, LNY will pay
a Death Benefit to the surviving Joint Owner. If the surviving Joint Owner is
the spouse of the deceased Joint Owner, then the spouse may elect to continue
the Contract as sole Owner. Upon the death of the Joint Owner who continues the
Contract, LNY will pay a Death Benefit to the designated Beneficiary(s) in
accordance with the terms of Article 8.
If the Annuitant is also the Owner or a Joint Owner, then the Death Benefit paid
upon the death of the Annuitant will be subject to the Contract provisions
regarding death of the Owner or a Joint Owner. If the surviving spouse of the
deceased Annuitant assumes the Contract, the Contingent Annuitant, if any, will
become the Annuitant. If there is no named Contingent Annuitant, the surviving
spouse will become the Annuitant.
If an Annuitant who is not the Owner or a Joint Owner dies, then the Contingent
Annuitant, if named, becomes the Annuitant and no Death Benefit is payable on
the death of the Annuitant. If no Contingent Annuitant is named, the Owner (or
younger Joint Owner) becomes the Annuitant. In lieu of continuing the Contract,
a Death Benefit may be paid to the Owner (and Joint Owner in equal shares, if
applicable) if the Annuitant named on this Contract has not been changed, except
on death of a prior Annuitant, and written notification of the election to
receive the Death Benefit is received by LNY within 75 days of the death of the
Annuitant. If no Owner is living on the date of death of
Form 30294-NY Page 10
the Annuitant, the Death Benefit will be paid to the Beneficiary in accordance
with Article 8. This Contract will terminate when any Death Benefit is paid due
to the death of the Annuitant.
A Death Benefit payable on the death of the Annuitant will not be paid if the
Annuitant has been changed subsequent to the effective date of this Contract
unless the change occurred because of the death of a prior Annuitant.
If the Owner is a corporation or other non-individual (non-natural person), the
death of the Annuitant will be treated as the death of the Owner.
The Death Benefit will be paid upon approval by LNY, after LNY is in receipt of:
a. due proof, satisfactory to LNY, of the death;
b. written authorization for payment; and
c. all claim forms, fully completed.
Due proof of death may be a certified copy of a death certificate, a certified
copy of a decree of a court of competent jurisdiction as to the findings of
death, or any other proof of death acceptable to LNY.
All Death Benefit payments will be subject to the laws and regulations governing
death benefits.
Notwithstanding any provision of this Contract to the contrary, the payment of
Death Benefits provided under the Contract must be made in compliance with Code
Section 72(s) or 401(a)(9) as applicable, as amended from time to time.
Determination of Amounts.
This Contract provides a Death Benefit called the Enhanced Guaranteed Minimum
Death Benefit (EGMDB), if in effect. If the EGMDB was not available at issue or
was terminated, then the Death Benefit is equal to the Guarantee of Principal.
The Death Benefit options are:
1. Enhanced Guaranteed Minimum Death Benefit (EGMDB).
The EGMDB is equal to the greater of:
a. the current Contract Value as of the date on which the death claim is
approved by LNY for payment; or
b. the highest Contract Value on any Contract Date anniversary (determined
before the allocation of any Purchase Payments on that Contract Date
anniversary) prior to the 81st birthday of the deceased (Owner, Joint
Owner, or Annuitant) and prior to the date of death of the deceased
(Owner, Joint Owner or Annuitant); where the highest Contract Value is
increased by Purchase Payments made on or subsequent to that Contract
Date anniversary on which the highest Contract Value is obtained, and
decreased for partial withdrawals, partial annuitizations, and premium
tax incurred, if any, on or subsequent to that Contract Date
anniversary on which the highest Contract Value is obtained.
2. Guarantee of Principal Death Benefit.
The Guarantee of Principal Death Benefit is equal to the greater of:
a. the current Contract Value as of the date on which the death claim is
approved by LNY for payment; or
b. the sum of all Purchase Payments decreased proportionally by all
withdrawals, partial annuitizations, and premium tax incurred, if any;
or
On or after the Contract Date, but prior to the Annuity Commencement Date, the
Owner (or a spouse who continues the Contract as the Owner) may choose to
terminate the EGMDB option by giving written notice to LNY at its Servicing
Office. The Guarantee of Principal Death Benefit option will then be effective
as of the Valuation Date on which the written notification to change the Death
Benefit option is received at the Home Office. Termination of the EGMDB option
by the Owner or surviving spouse who assumed the Contract will be permanent and
final.
Form 30294-NY Page 11
Upon the death of the Owner, Joint Owner, or Annuitant of this Contract, if a
surviving spouse continues the Contract, the excess, if any, of the Death
Benefit over the current Contract Value as of the date on which the death claim
is approved by LNY for payment will be credited into the Contract. This benefit
will only apply one time for each Contract.
If the Owner is a corporation or other non-individual (non-natural person) and
there are Joint Annuitants, upon the death of the first Joint Annuitant to die,
if the Contract is continued, the excess, if any, of the Death Benefit over the
current Contract Value as of the date on which the death claim is approved by
LNY for payment will be credited into the Contract. This benefit will only
apply one time for each Contract.
Payment of Amounts.
The Death Benefit payable on the death of the Owner, or after the death of the
first Joint Owner, or upon the death of the spouse who continues the Contract,
will be distributed to the designated Beneficiary(s) as follows:
a. the Death Benefit must be completely distributed within five years of the
Owner's date of death; or
b. the designated Beneficiary may elect, within the one year period after the
Owner's date of death, to receive the Death Benefit in substantially equal
installments over the life of such designated Beneficiary or over a period
not extending beyond the life expectancy of such designated Beneficiary;
provided that such distributions begin not later than one year after the
Owner's date of death.
The Death Benefit payable upon the death of the Annuitant, if elected by the
Owner or Joint Owner within 75 days of the death of the Annuitant, will be
distributed to the Owner or Joint Owners in either the form of a lump sum or
under an Annuity Payment Option. An Annuity Payment Option must be selected
within 60 days after LNY approves the death claim.
If a lump sum settlement is elected, the proceeds will be mailed within seven
days of approval by LNY of the claim. This payment may be postponed as permitted
by the Investment Company Act of 1940.
6.02 DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE
The Death Benefit options listed in Section 6.01 are no longer applicable and
the Death Benefit option in effect will terminate.
If the Owner or a Joint Owner dies on or after the Annuity Commencement Date,
any remaining benefits payable will continue to be distributed under the Annuity
Payment Option then in effect. The rights of ownership granted by the Contract
will pass to the Joint Owner, if any, otherwise to the Beneficiary. If there is
no named Beneficiary at the time of the Owner's or last surviving Joint Owner's
death, then the rights of ownership will pass to the Annuitant, if still living;
otherwise to the Joint Annuitant, if applicable. If no named Joint Owner,
Beneficiary, Annuitant, or Joint Annuitant survives the Owner, any remaining
benefits payable will continue to the Owner's estate.
On receipt of due proof of death, as described in Section 6.01, of the Annuitant
or both Joint Annuitants, any remaining benefits payable under the Annuity
Payment Option will be paid to the Owner or Joint Owner, if living; otherwise,
to the Beneficiary. If there is no Beneficiary, any remaining benefits payable
will continue to the Annuitant's estate.
ARTICLE 7
ANNUITY PAYMENT OPTIONS
7.01 ANNUITY BENEFIT PAYMENTS
An election to receive payments under an Annuity Payment Option must be made by
the Maturity Date. If an Annuity Payment Option is not chosen prior to the
Maturity Date, payments will commence to the Owner on the Maturity Date under
the Annuity Payment Option providing a Life Annuity with annuity benefit
payments guaranteed for 10 years. The Maturity Date is set forth on the
Contract Data Page(s). Upon written request by the Owner and any Beneficiary
who cannot be changed, the Maturity Date may be deferred. Purchase Payments may
be made until the new Maturity Date.
If the Maturity Date is extended, LNY reserves the right to restrict the
availability of certain Annuity Payment Options.
Form 30294-NY Page 12
7.02 CHOICE OF ANNUITY PAYMENT OPTION
By Owner
Prior to the Annuity Commencement Date, the Owner may choose or change any
Annuity Payment Option. In addition, the Owner may select an Annuity Payment
Option as the distribution method for payment of the Death Benefit to a
Beneficiary. Such selection of a distribution method must be made in writing to
the Servicing Office and approved by LNY. The Owner may change or revoke, in
writing to the Servicing Office, any such selection, unless such selection was
made irrevocable.
By Beneficiary
If an Annuity Payment Option has not been previously selected by the Owner as
the distribution option for the payment of Death Benefit to the Beneficiary,
then at the time proceeds are payable to a Beneficiary, a Beneficiary may choose
any Annuity Payment Option that meets the requirements of Code Section 72(s) or
401(a)(9). The Beneficiary then becomes the Annuitant.
A choice or change of an Annuity Payment Option must be in writing to LNY.
After the Annuity Commencement Date, the Annuity Payment Option may not be
changed.
7.03 ANNUITY PAYMENT OPTIONS
a. Life Annuity / Life Annuity with Certain Period -- Fixed and/or variable
annuity benefit payments will be made for the lifetime of the Annuitant
with no Certain Period, or life and a 10 year Certain Period, or life and a
20 year Certain Period.
b. Unit Refund Life Annuity -- Variable annuity benefit payments will be made
for the lifetime of the Annuitant with the guarantee that upon death, if:
1) the number of Annuity Units initially purchased (determined by dividing
the total dollar amount applied to purchase this option by the Annuity
Unit value on the Annuity Commencement Date) is greater than;
2) the number of Annuity Units paid as part of each variable annuity
benefit payment multiplied by the number of annuity benefit payments
paid prior to death;
then a refund payment equal to the number of Annuity Units determined by
(1) minus (2) will be made.
The refund payment value will be determined using the Annuity Unit value on
the Valuation Date on which the refund payment is approved by LNY, after
LNY is in receipt of:
(a) due proof of death acceptable to LNY;
(b) written authorization for payment; and
(c) all claim forms, fully completed.
c. Cash Refund Life Annuity -- Fixed annuity benefit payments will be made for
the lifetime of the Annuitant with the guarantee that upon death, if:
1) the total dollar amount applied to purchase this option is greater
than;
2) the fixed annuity benefit payment multiplied by the number of annuity
benefit payments paid prior to death;
then a refund payment equal to the dollar amount of (1) minus (2) will be
made.
The refund payment will be paid upon approval by LNY, after LNY is in
receipt of:
(a) due proof of death acceptable to LNY;
(b) written authorization for payment; and
Form 30294-NY Page 13
(c) all claim forms, fully completed.
d. Joint Life Annuity / Joint Life Annuity with Certain Period -- Fixed and/or
variable annuity benefit payments will be made during the joint life of the
Annuitant and a Joint Annuitant. Payments will be made for joint life with
no Certain Period, or joint life and a 10-year Certain Period, or joint
life and a 20-year Certain Period. Upon the death of either Xxxxxxxxx,
annuity benefit payments continue for the life of the surviving Annuitant.
e. Joint Life and Two-Thirds to Survivor Annuity / Joint Life and Two-Thirds
to Survivor Annuity with Certain Period -- Fixed and/or variable annuity
benefit payments will be made during the joint life of the Annuitant and a
Joint Annuitant. Upon the death of either Xxxxxxxxx, two-thirds of the
annuity benefit payment due while both Annuitants were alive will continue
for the life of the surviving Annuitant. Payments will be made for joint
life with no Certain Period, or joint life and a 10-year Certain Period, or
joint life and a 20-year Certain Period.
f. Other options may be available as agreed upon in writing by LNY.
At the time an Annuity Payment Option is selected under the provisions of this
Contract, the Owner may elect to have the Contract Value, adjusted as described
in Section 7.04, applied to provide a variable annuity benefit payment, a fixed
annuity benefit payment, or a combination fixed and variable annuity benefit
payment. If no election is made, the value of the Owner's Variable Account will
be used to provide a variable annuity benefit payment and the value of the
Owner's DCA Fixed Account will be used to provide a fixed annuity benefit
payment. A fixed annuity benefit payment will be provided by the general
account of LNY.
At the time Income Payments commence, they will not be less than those that
would be provided by a specific amount for any single premium immediate annuity
contract offered by the Company at the time to the same class of annuitants.
The specific amount is the greater of the surrender value or 95% of the
accumulation value.
7.04 DETERMINATION OF THE AMOUNT OF THE FIRST ANNUITY PAYMENT
The amount of annuity benefit payment will depend on the age and sex (except in
cases where unisex rates are required) of the Annuitant(s) as of the Annuity
Commencement Date. A choice may be made to receive payments once each month,
four times each year, twice each year, or once each year.
Article 10 of this Contract illustrates the minimum payment amounts and the age
adjustments which will be used to determine the first monthly payment for a
variable annuity benefit payment based upon the assumed interest rate selected
by the Owner. The tables show the dollar amount of the first monthly payment
which can be purchased with each $1,000 of Contract Value, after deduction of
any applicable premium taxes. Amounts shown use an Individual Annuity Mortality
Table on file with the New York Superintendent of Insurance, with assumed
interest rates of 3.0%, 4.0%, and 5.0% per year. The Owner must select one of
the assumed interest rates for the variable annuity benefit payment prior to the
Annuity Commencement Date. The assumed interest rate may not be changed after
the Annuity Commencement Date.
Article 11 of this Contract illustrates the minimum payment amounts and the age
adjustments which will be used to determine the monthly payments for a fixed
annuity benefit payment. The tables show the dollar amount of the guaranteed
monthly payments which can be purchased with each $1,000 of Contract Value,
after deduction of any applicable premium taxes. Amounts shown use an
Individual Annuity Mortality Table on file with the New York Superintendent of
Insurance, with an interest rate of 2.75% per year.
Minimum payment amounts for ages not shown in Articles 10 and 11 can be obtained
from LNY's Servicing Office. The minimum payment amounts shown for Joint and
Survivor Annuities under both Article 10 and Article 11 are for joint ages; that
is, for a male and a female both of the same age. Minimum payment amounts for
other age and sex combinations on Joint and Survivor Annuities are not
illustrated in Articles 10 and 11, but are available from LNY's Servicing
Office.
For a 100% fixed annuity benefit payment, the Annuity Payment Date must be at
least 30 days after the Annuity Commencement Date.
The Annuity Unit value, if applicable, and Contract Value used to effect annuity
benefit payments will be determined as of the Annuity Commencement Date.
7.05 DETERMINATION OF THE AMOUNT OF VARIABLE ANNUITY PAYMENTS AFTER THE FIRST
PAYMENT
The first variable annuity benefit payment is sub-divided into components, each
of which represents the product of:
Form 30294-NY Page 14
a. the percentage elected by the Owner of a specific Variable Sub-account the
performance of which will determine future variable annuity benefit
payments; and
b. the entire first variable annuity benefit payment.
Each variable annuity benefit payment after the first payment attributable to a
specific Variable Sub-account will be determined by multiplying the Annuity Unit
value for the Variable Sub-account for the date each payment is due by a
constant number of Annuity Units. This constant number for each specific
Variable Sub-account is determined by dividing the component of the first
payment attributable to such Variable Sub-account as described above by the
Annuity Unit value for that Variable Sub-account on the Annuity Commencement
Date. The total variable annuity benefit payment will be the sum of the
payments attributable to each Variable Sub-account. In absence of transfers
between Variable Sub-accounts, the number of Annuity Units attributable to each
Variable Sub-account remains constant, although the Annuity Unit values will
vary with the investment performance of the Funds. The Annuity Unit value may
increase or decrease the dollar value of benefits under the Contract.
The Annuity Unit value for any Valuation Period for any Variable Sub-account is
determined by multiplying the Annuity Unit value for the immediately preceding
Valuation Period by the product of (a) the daily factor raised to a power equal
to the number of days in the current Valuation Period and (b) the Accumulation
Unit value of the same Variable Sub-account for this Valuation Period divided by
the Accumulation Unit value of the same Variable Sub-account for the immediately
preceding Valuation Period. The daily factor is equal to 0.999919020 for a 3%
assumed interest rate, 0.999892552 for a 4% assumed interest rate, and
0.999866337 for a 5% assumed interest rate.
The valuation of all assets in the Variable Sub-account will be determined in
accordance with the provisions of applicable laws, rules, and regulations. The
method of determination by LNY of the value of an Accumulation Unit and of any
Annuity Unit will be conclusive upon the Owner and any Beneficiary.
LNY guarantees that the dollar amount of each installment after the first will
not be affected by variations in mortality experience from mortality assumptions
on which the first installment is based. After the Annuity Commencement Date,
if any portion of the annuity benefit payment is a variable annuity benefit
payment, the Owner may direct a transfer of assets from one Variable Sub-account
to another Variable Sub-account or to a fixed annuity benefit payment. Such
transfers will be limited to three (3) times per Contract Year. Assets may not
be transferred from a fixed annuity benefit payment to a variable annuity
benefit payment.
A transfer from one Variable Sub-account to another Variable Sub-account will
result in the purchase of Annuity Units in one Variable Sub-account and the
redemption of Annuity Units in the other Variable Sub-account. Such a transfer
will be accomplished at relative Annuity Unit values as of the Valuation Date
the transfer request is received. The valuation of Annuity Units is described
above. A transfer from one Variable Sub-account to a fixed annuity benefit
payment will result in the redemption of Annuity Units in one Variable Sub-
account and the purchase of a minimum fixed annuity benefit payment based on the
tables in Article 11.
7.06 PROOF OF AGE
Payment will be subject to proof of age that LNY will accept, such as a
certified copy of a birth certificate.
7.07 MINIMUM ANNUITY BENEFIT PAYMENT REQUIREMENTS
If the Annuity Payment Option chosen results in payments of less than $50 from
any Variable Sub-account and/or a fixed annuity benefit payment of less than
$50, the frequency will be changed so that payments will be at least $50.
7.08 EVIDENCE OF SURVIVAL
LNY has the right to ask for proof that the person (or persons) on whose life
(or lives) the payment is based is alive when each payment is due.
7.09 CHANGE IN ANNUITY PAYMENT OPTION
The Annuity Payment Option may not be changed after the Annuity Commencement
Date.
Form 30294-NY Page 15
ARTICLE 8
BENEFICIARY
8.01 DESIGNATION OF BENEFICIARY
The Owner may designate a Beneficiary(s) and a contingent Beneficiary(s).
If there is a single Owner, the designated Beneficiary(s) will receive the Death
Benefit proceeds upon the death of the Owner unless the Beneficiary as the
surviving spouse elects to continue the Contract.
If there are Joint Owners, upon the death of the first Joint Owner, the
surviving Joint Owner will receive the Death Benefit proceeds. The surviving
Joint Owner will be treated as the primary designated Beneficiary. Any other
Beneficiary designation on record at the time of death will be treated as a
contingent Beneficiary.
If the surviving spouse of the deceased continues the Contract as the sole
Owner, then the designated Beneficiary(s) move up, in the order of their
original designation, to replace the spouse as original Beneficiary, unless the
Beneficiary designation is subsequently changed by the surviving spouse as the
new Owner (see Section 8.02).
If the Annuitant dies and a Death Benefit is paid, the Owner (and Joint Owner if
applicable) will be treated as the primary designated Beneficiary(s). Any other
Beneficiary designation on record at the time of death will be treated as a
contingent Beneficiary.
Unless otherwise stated in the Beneficiary designation, if there is more than
one Beneficiary they are presumed to share equally.
8.02 CHANGE OF BENEFICIARY
The Owner may change any Beneficiary unless otherwise provided in the previous
designation. A change of Beneficiary will revoke any previous designation. A
change may be made by filing a written request, in a form acceptable to LNY, at
its Servicing Office. The change will become effective upon receipt of the
written request by LNY at its Servicing Office.
LNY reserves the right to request the Contract for endorsement of the change.
8.03 DEATH OF BENEFICIARY
Unless otherwise provided in the Beneficiary designation, if any Beneficiary
dies before the Owner, that Beneficiary's interest will go to any other
Beneficiaries named, according to their respective interests. If there are no
Beneficiaries, the Beneficiary's interest will pass to a contingent
Beneficiary(s), if any. Prior to the Annuity Commencement Date, if no
Beneficiary or contingent Beneficiary survives the Owner, the Death Benefits
will be paid to the Owner's estate.
Unless otherwise provided in the Beneficiary designation, once a Beneficiary is
receiving Death Benefits or annuity benefit payments under an Annuity Payment
Option, the Beneficiary may name his or her own Beneficiary(s) to receive any
remaining benefits due under the Contract, should the original Beneficiary die
prior to receipt of all benefits. If no Beneficiary is named or the named
Beneficiary predeceases the original Beneficiary, any remaining benefits will
continue to the original Beneficiary's estate. A Beneficiary designation must be
made in writing to the LNY Servicing Office in a form acceptable to LNY.
ARTICLE 9
GENERAL PROVISIONS
9.01 THE CONTRACT
The Contract, any riders attached, together with the application therefore if a
copy of such application is attached to the Contract when issued, constitute the
entire Contract. Only the President, a Vice President, the Secretary or an
Assistant Secretary of LNY has the power, on behalf of LNY, to change, modify,
or waive any provisions of this Contract.
Form 30294-NY Page 16
LNY reserves the right to unilaterally change the Contract for the purpose of
keeping the Contract in compliance with federal or state law, subject to the
prior approval of the New York Superintendent of Insurance.
Any changes, modifications, or waivers must be in writing. No representative or
person other than the above named officers has authority to change or modify
this Contract or waive any of its provisions. All terms used in this Contract
will have their usual and customary meaning except when specifically defined.
9.02 OWNERSHIP
The Owner is the person who has the ability to exercise the rights within this
Contract.
The Owner may name a Joint Owner. Joint Owners will be treated as having equal,
undivided interests in the Contract, including rights of survivorship. Either
Joint Owner, independently of the other, may exercise any ownership rights in
the Contract. The existence of a Joint Owner will not operate to continue the
Contract upon the death of the first Owner, unless the Joint Owner is the spouse
of the deceased Owner (see Section 6.01 - Entitlement).
Any transfer of ownership, or a revocation of transfer, must be made in writing
to LNY at its Servicing Office. A transfer or revocation will not take effect
until received in writing at LNY's Servicing Office. Any payment made or any
action taken or allowed by LNY before the transfer is received will be without
prejudice to LNY.
9.03 ANNUITANTS
Prior to the Annuity Commencement Date.
The Owner may name only one Annuitant. If the Owner is an exempt organization
under Code Section 501(c), the Owner may name one Annuitant or two Joint
Annuitants.
If the Owner is a natural person, the Owner has the right to change the
Annuitant at any time by notifying LNY in writing of the change. The new
Annuitant must be under the age of 90 as of the effective date of the change. A
Death Benefit may not be payable upon the death of the new Annuitant (see
Section 6.01).
A Contingent Annuitant may be named, or changed, by notifying LNY in writing.
On or After the Annuity Commencement Date.
The Annuitant or Joint Annuitants may not be changed. Any Contingent Annuitant
designation is no longer applicable and is terminated.
9.04 ASSIGNMENTS
If this Contract is used with a Qualified Plan, the Contract will not be
transferable unless allowed under applicable law. In addition, if this Contract
is used with either a Qualified or Non-Qualified Plan, it may not be sold,
discounted or pledged as collateral for a loan or as security for the
performance of an obligation or for any other purpose.
9.05 INCONTESTABILITY
This Contract will not be contested by LNY.
9.06 MISSTATEMENT OF AGE AND/OR SEX
If the age and/or sex of an Annuitant is misstated, the benefits available under
the contract will be adjusted to be those which the actual Purchase Payments
would have purchased for the correct age and/or sex according to the Company's
rates in effect on the Date of Issue. Any overpayment by the Company, with
interest at the rate of 6% per year, compounded annually, will be charged
against the payments to be made next succeeding the adjustment. Any underpayment
by the Company will be paid in a lump sum, with interest at the rate of 6% per
year, compounded annually.
9.07 NONPARTICIPATING
The Contract is nonparticipating and will not share in the surplus earnings of
LNY.
Form 30294-NY Page 17
9.08 VOTING RIGHTS
The Owner will have a right to vote only at the meetings of the Funds of the
Variable Account invested in by the Owner due to the Owner's interest in the
Variable Sub-accounts of the Variable Account. Ownership of this Contract will
not entitle any person to vote at any meeting of shareholders of LNY. Votes
attributable to the Contract will be cast in conformity with applicable law.
9.09 OWNERSHIP OF THE ASSETS
LNY will have exclusive and absolute ownership and control of its assets,
including all assets in the Variable Account.
9.10 REPORTS
Prior to the Annuity Commencement Date, at least once each Contract Year, LNY
will mail a report to the Owner. The report will be mailed to the last address
known to LNY. The report will include a statement of the number of Accumulation
Units credited to the Variable Account under this Contract and the dollar value
of such units as well as a statement of the value of the Fixed Account of this
Contract. The report will also contain such information as may be required by
law or regulation.
The information in the report will be as of a date not more than two months
prior to the date of mailing the report. LNY will also mail to the Owner at
least once in each Contract Year a report of the investments held in the
Variable Sub-accounts under this Contract.
9.11 PREMIUM TAX
State and local government premium tax, if applicable, will be deducted from
Purchase Payments or Contract Value when incurred by LNY or at another time of
LNY's choosing.
9.12 MAXIMUM ISSUE AGE
The Owner (or both Joint Owners, if applicable) and the Annuitant (or both Joint
Annuitants, if applicable) must be under the age of 90 when this Contract is
issued.
9.13 LOANS
Loans are not permitted under this Contract.
9.14 MINIMUM BENEFITS PAYABLE
Any benefits paid under this Contract will not be less than those required by
the New York Insurance Law.
---0---
Form 30294-NY Page 18
ARTICLE 10
ANNUITY PURCHASE RATES UNDER A VARIABLE PAYMENT OPTION
10.01 A VARIABLE PAYMENT OPTION WITH A 3.0% ASSUMED INTEREST RATE
[Need a different table]
Form 30294-NY Page 19
10.02 A VARIABLE PAYMENT OPTION WITH A 4.0% ASSUMED INTEREST RATE
[Need a different table]
Form 30294-NY Page 20
10.03 A VARIABLE PAYMENT OPTION WITH A 5.0% ASSUMED INTEREST RATE
[Need a different table]
Form 30294-NY Page 21
ARTICLE 11
ANNUITY PURCHASE RATES UNDER A FIXED PAYMENT OPTION
[Need a different table]
Form 30294-NY Page 22
ANNUITY
CONTRACT
Flexible Premium Deferred
Variable Annuity or Variable and Fixed Annuity
With Benefit Payment Options
Nonparticipating
If you have any questions concerning
this Contract, please
contact your Lincoln Life & Annuity Company of New York
representative or the Servicing Office of LNY.
LINCOLN LIFE & ANNUITY
COMPANY OF NEW YORK
Servicing Office:
0000 Xxxxx Xxxxxxx Xxxxxx
P.O. Box 2348
Fort Xxxxx, Indiana 46802
000-000-0000
Home Office:
000 Xxxxxxx Xxxxxx, Xxxxx 0000
Xxxxxxxx, Xxx Xxxx 00000
Form 30294-NY Page 23
