[LOGO]
[THE HARTFORD]
HARTFORD LIFE INSURANCE COMPANY
000 Xxxxxxxxx Xxxxxx
Xxxxxxxx, XX 00000
(a stock life insurance company, herein called "We", "Us", "Our")
This Contract is issued to the Contract Owner (herein called "You", "Your") by
Us on the Contract Issue Date, in consideration of the payment of the Premium
Payment. We will provide You with the benefits described in this Contract.
This Contract is subject to the laws of the jurisdiction where it is delivered.
READ THIS CONTRACT CAREFULLY
This is a legal Contract between You and Us.
RIGHT TO EXAMINE CONTRACT: We want You to be satisfied with the Contract you
have purchased. We urge You to examine it closely. If for any reason You are not
satisfied with this Contract, You may cancel it by returning it within ten (10)
days after You receive it. In such an event, We will pay You an amount equal to
the Contract Value on the date of cancellation multiplied by the Market Value
Adjustment.
MARKET VALUE ADJUSTMENT FORMULA
This Contract contains a Market Value Adjustment formula. The formula may result
in either upward or downward adjustments in the Gross Surrender Value. Details
of the Market Value Adjustment are described in the Surrender Provisions on Page
8.
SEPARATE ACCOUNT
The Premium Payment will be deposited in a non-unitized separate account. All
assets of Hartford Life Insurance Company are available to meet the guarantees
under the Contract and are available to meet the general obligations of Hartford
Life Insurance Company.
Signed for Hartford Life Insurance Company by:
[/s/ Xxxxxx X. Xxxx /s/ Xxxx X. Xxxxxxx
------------------------------------ ------------------------------------
XXXXXX X. XXXX, SECRETARY XXXX X. XXXXXXX, PRESIDENT]
NON-PARTICIPATING
INDIVIDUAL SINGLE PREMIUM
MODIFIED GUARANTEED ANNUITY CONTRACT
TABLE OF CONTENTS
PAGE
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Contract Specifications 3
Definitions 4
Premium Payment Provisions 5
Contract Control Provisions 5
General Provisions 6
Guarantee Periods and Interest Crediting Provisions 7
Surrender Provisions 8
Death Benefit Provisions 9
Annuity Provisions 12
Annuity Tables 14
2
CONTRACT SPECIFICATIONS
CONTRACT NUMBER [SAMPLE] CONTRACT ISSUE DATE [MARCH 1, 2008]
ANNUITANT [XXXXXXX XXXXX] ANNUITY COMMENCEMENT DATE [OCTOBER 1, 2038]
ANNUITANT AGE [35] ANNUITANT GENDER [MALE]
CONTRACT OWNER [XXXXXXX XXXXX] PREMIUM PAYMENT [$5,000]
CONTINGENT ANNUITANT GUARANTEE PERIOD [5 YEARS]
BENEFICIARY [XXXXX XXXXX] GUARANTEE RATE [7%]
MINIMUM INTEREST RATE [1%]
SURRENDER CHARGE: This charge is determined by multiplying the applicable rate
specified below by the amount of the Full or Partial Surrender that exceeds the
Annual Withdrawal Amount. This charge does not apply to:
- [Surrenders during the 30 day period at the beginning of a subsequent
Guarantee Period; or
- Surrenders of Contract Value held in the Access Account, if
applicable; or
- Annuitization; or
- The Death Benefit; or
- Transfers from the current Guarantee Period into a new Guarantee
Period made at the end of the then current Guarantee Period;
- Permissible transfers from or to any of the Accounts.]
This charge varies according to initial and subsequent Guarantee Periods and
equals:
INITIAL GUARANTEE PERIOD EACH SUBSEQUENT GUARANTEE PERIOD
YEAR CHARGE YEAR CHARGE
------------------------------------------------------------------
[1 6% [1 4%
2 6% 2 3%
3 5% 3 2%
4 4% 4 2%
5 3% 5 2%
Thereafter 2%] Thereafter 2%]
ANNUAL FREE WITHDRAWAL AMOUNT: The amount which is not subject to the Surrender
Charge. [It equals any interest credited during the 12 months prior to the
Surrender Date that was not previously withdrawn.]
MINIMUM AMOUNT: Partial surrenders may only be made if the remaining Contract
Value after the Gross Surrender Value is deducted is at least the Minimum Amount
of [$500].
ANNUITY PARAMETERS: The Minimum Annuity Payment allowed is: [$100.] The Annuity
Commencement Date will not be deferred beyond the end of the Guarantee Period
immediately following the later of:
a) the Annuitant's [90th] birthday; or
b) the [10th] Contract Year;
unless the Contract Owner elects a later Xxxxxxx Commencement Date In Writing,
subject to laws and regulations then in effect and Our approval.
ADMINISTRATIVE OFFICE OF THE COMPANY: [Currently located at 000 Xxxxxxxxx Xx.,
Xxxxxxxx, XX 00000. All correspondence concerning this Contract should be sent
to Our mailing address:
Hartford Life Insurance Company, P.O. Box 5085,
Hartford, CT 06102-5085.]
3
DEFINITIONS
ADMINISTRATIVE OFFICE OF THE COMPANY. Our administrative office is shown on the
Contract Specifications page.
ANNUITANT. The person on whose life this Contract is issued. Also see Contingent
Annuitant and Joint Annuitant.
ANNUITY COMMENCEMENT DATE. It is the date when Annuity payments are scheduled to
begin as described under Xxxxxxx Provisions in this Contract.
BENEFICIARY. The person(s) entitled to receive benefits pursuant to the terms of
the Contract in case of the death of the Annuitant, or a Contract Owner(s), as
applicable.
BUSINESS DAY. Any day that We, and for so long as the New York Stock Exchange,
are open for business.
CONTINGENT ANNUITANT. The person You designate who, upon the Annuitant's death
prior to the Annuity Commencement Date, may become the Annuitant.
CONTRACT ANNIVERSARY. The anniversary of the Contract Issue Date. If the
Contract Anniversary falls on a non-Business Day, then the Contract Anniversary
will be the preceding Business Day.
CONTRACT ISSUE DATE. The date shown on The Contract Specifications page.
Contract Years are measured from the Contract Issue Date.
CONTRACT OWNER(S). The owner(s) or holder(s) of the Contract.
CONTRACT VALUE. The Contract Value on the Contract Issue Date is equal to the
Premium Payment deposited into the Contract less any applicable Premium Taxes.
Thereafter, it is the Premium Payment increased by interest credited, reduced by
any prior surrenders (including applicable Surrender Charges and Premium Taxes)
and adjusted by any Market Value Adjustments previously applied.
CONTRACT YEAR. Any 12-month period between Contract Anniversaries, beginning on
the Contract Issue Date.
DEATH BENEFIT. The amount We will pay upon the death of the Contract Owner(s) or
Annuitant, as applicable.
DUE PROOF OF DEATH. A certified death certificate, an order of a court of
competent jurisdiction, or any other proof acceptable to Us.
GROSS SURRENDER VALUE. The amount deducted from your Contract Value (including
applicable Surrender Charges, Premium Taxes, and Market Value Adjustments).
GUARANTEE PERIOD. The period offered by Us and elected by you for which either
an initial or renewal interest rate will be credited. The initial Guarantee
Period is shown on the Contract Specifications page.
HCRCIIa COMPOSITE OPTION ADJUSTED SPREAD (OAS) INDEX. This rate is a component
used to determine the Market Value Adjustment.
IN WRITING. A written form or other method satisfactory to Us and received at
Our Administrative Office as defined.
INTERNAL REVENUE CODE. The Internal Revenue Code of 1986, as amended.
JOINT ANNUITANT. Upon annuitization, a person other than the Annuitant on whose
life, Annuity payments may be made. The Contract will have a Joint Annuitant
only if the Annuity Option selected provides for a survivor.
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MARKET VALUE ADJUSTMENT. A positive or negative adjustment applied in the
determination of your Gross Surrender Value after the Annual Free Withdrawal
Amount is taken into consideration, if applicable, and after Surrender Charges
are deducted, if applicable.
NET SURRENDER VALUE. The amount payable to You on a full or partial surrender or
commutation under this Contract after any applicable Surrender Charges, Premium
Taxes, and Market Value Adjustment have been applied.
PAYEE. The person, designated by You, to whom Annuity payments will be made.
PREMIUM PAYMENT. 100% of the dollar amount of the Premium Payment deposited into
the Contract.
PREMIUM TAX. A tax imposed by certain jurisdictions when a Premium Payment is
made, Annuity Payments are made, or when the Contract is surrendered.
SURRENDER CHARGE. A Surrender Charge may be deducted for a full or partial
surrender. The Surrender Charge schedule is shown on the Contract Specifications
page.
SURRENDER DATE. The date We receive Your request In Writing for a surrender or
the date You request for surrender, if later.
U.S. CONSTANT MATURITY TREASURY RATE. Also commonly known as a Treasury Yield
Curve Rate. This rate is a component used to determine the Market Value
Adjustment.
WE, US, OUR. The company referred to on the first page of this Contract.
YOU, YOUR. The Contract Owner(s).
PREMIUM PAYMENT PROVISIONS
PREMIUM PAYMENT. The Premium Payment is shown on The Contract Specifications
page. The Premium Payment is payable at Our designated office(s). A Premium
Payment of $1,000,000 or more will be subject to Our prior approval In Writing.
The Premium Payment (less applicable Premium Taxes, if any) will be credited to
the Contract on the Contract Issue Date.
CONTRACT CONTROL PROVISIONS
ANNUITANT, CONTINGENT ANNUITANT, JOINT ANNUITANT, AND CONTRACT OWNER(S).
The Annuitant may not be changed.
The designations of Contract Owner, Joint Annuitant, and Contingent Annuitant
will remain in effect until You change them. The designation of the Contract
Owner may be changed In Writing during the lifetime of the Annuitant. The
designation of Contingent Annuitant may be changed In Writing at any time during
the lifetime of the Annuitant and prior to the Annuity Commencement Date.
If no Contingent Annuitant has been named, the Contract Owner is the Annuitant,
and the Contract Owner/Xxxxxxxxx's spouse is the Beneficiary, the Contract
Owner/ Annuitant's spouse will be presumed to be the Contingent Annuitant.
In any other situation, if no Contingent Annuitant has been named, the youngest
Contract Owner will be presumed to be the Contingent Annuitant, providing that
the youngest Contract Owner is not the Annuitant. The Contract Owner may waive
this presumption In Writing.
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OWNERSHIP. You have the sole power to exercise all rights, options and
privileges granted by this Contract or permitted by Us and to agree with Us to
any change in or amendment to the Contract. Your rights will be subject to the
rights of any assignee of record with Us and of any irrevocably designated
Beneficiary. In the case of joint Contract Owners, each Contract Owner alone may
exercise all rights, options and privileges, except with respect to a full
surrender, partial surrender, selection of an Annuity Option, and/or change of
Ownership or Beneficiary.
BENEFICIARY. The designated Beneficiary will remain in effect until You change
it. The designated Beneficiary may be changed In Writing during the lifetime of
the Annuitant. If the designated Beneficiary has been designated as an
irrevocable Beneficiary, the designation cannot be changed or revoked without
such Beneficiary's written consent. Upon receipt of written notice and Our
consent, if required by Us, the new designation will take effect as of the date
the notice is processed by the Contract Owner, whether or not the Annuitant or
Contract Owner is alive at the time of receipt. Any payments made or other
action taken by Us before the receipt of the notice will not be subject to the
requested change.
GENERAL PROVISIONS
CONTRACT. This Contract and any amendments, endorsements or riders, constitute
the entire Contract.
CONTRACT MODIFICATION. No modification of this Contract will be made without the
signature of Our President, an Executive Vice President, Senior Vice President,
Vice President or Assistant Vice President. No modification will affect the
amount or term(s) of any Annuity Payment begun prior to the modification, unless
it is required to conform the Contract to any federal or state statute. No
modification will affect the method by which Your Contract Value will be
determined.
INCONTESTABILITY. We cannot contest this Contract.
MINIMUM VALUE STATEMENT. Any values available under the Surrender Provisions of
this Contract equal or exceed those required by the state in which the Contract
is issued.
MISSTATEMENT OF AGE AND GENDER. Prior to the Annuity Commencement Date, if the
age of the Annuitant has been misstated, the Annuity Commencement Date may
change. Once Annuity payments begin, if the age and/or gender of the Annuitant
have been misstated, the amount of the Annuity payable by Us will be adjusted
based on the correct information. Any underpayments by Us will be made up
immediately and any overpayments will be charged against future amounts becoming
payable. In states which require the crediting of interest in the event of an
underpayment, or the deduction of interest in the event of overpayment, we will
apply an annual effective rate of 1%.
NON-PARTICIPATING. This Contract is nonparticipating. It does not earn
dividends.
REPORTS. You will receive a report once each Contract Year showing the Contract
Value of this Contract and any other information required by the state in which
this Contract was issued.
TAX QUALIFICATION. This Contract is intended to qualify as an Annuity Contract
for federal income tax purposes. To that end, the provisions of this Contract
are to be interpreted to ensure and maintain such tax qualification,
notwithstanding any other provisions to the contrary. We reserve the right to
amend this Contract to conform to any changes in the tax qualification
requirements under the applicable provision of the Internal Revenue Code.
6
GUARANTEE PERIOD AND INTEREST CREDITING PROVISIONS
GUARANTEE PERIODS. The Company may offer one or more renewal Guarantee Periods
from time to time. We reserve the right to offer new Guarantee Periods or limit
the Guarantee Periods that are offered in the future, or offer certain Guarantee
Periods to certain classes of investors. The duration of a Guarantee Period may
not extend beyond the maximum Annuity Commencement Date as described under the
Annuity Provisions of this Contract.
GUARANTEE PERIOD EXPIRATION AND RENEWAL. Upon expiration of any Guarantee
Period, a subsequent Guarantee Period of the same duration (provided such
duration is then available), will commence, unless You have elected In
Writing to: 1.) transfer to another permissible Guarantee Period duration;
or 2.) annuitize Your Contract; or 3.) surrender Your Contract; or 4.)
other options made available by Us.
If the same duration is not available, the Contract will be renewed into
the next higher Guarantee Period that is then available. If the only
available Guarantee Period would extend beyond the maximum Annuity
Commencement Date, the only available options are: 1.) annuitize Your
Contract; or 2.) surrender Your Contract; or 3.) other options made
available by Us.
GUARANTEE PERIOD EXCHANGES. Once each Contract Year beginning after the
first Contract Year, You may elect to transfer out of the current Guarantee
Period and into a Guarantee Period of a different then permissible
duration. At that time, a new Guarantee Period will be established which
must be longer than the previous Guarantee Period and a Market Value
Adjustment may apply. However, You may not renew or transfer the Contract
into any Guarantee Period of a duration that extends beyond the Annuity
Commencement Date as described under the Annuity Provisions of this
Contract.
The Contract Value at the beginning of the new Guarantee Period will equal the
Contract Value at the time of transfer adjusted for any applicable Market Value
Adjustment. Transfers from the current Guarantee Period into a new Guarantee
Period made at the end of the then current Guarantee Period are not subject to a
Surrender Charge or Market Value Adjustment.
Surrender Charges applicable to each subsequent Guarantee Period are measured
from the beginning of each subsequent Guarantee Period and are shown on the
Contract Specifications page.
CREDITING OF INTEREST. The Premium Payment (less the Gross Surrender Value of
all surrenders made) will earn interest daily at the effective annual Guarantee
Rate during the Guarantee Period. This rate will never be less than the Minimum
Interest Rate. The Guarantee Rate is set by Us for the applicable Guarantee
Period on the effective date of each Guarantee Period. The initial Guarantee
Rate that We will credit is shown on the Contract Specifications page.
MINIMUM INTEREST RATE. The guaranteed Minimum Interest Rate that will be applied
during a Guarantee Period is determined at the beginning of each Guarantee
Period. The Minimum Interest Rate equals the greater of 1% and an interest rate
calculated as follows:
The interest rate will be such that the Contract Value prior to the
application of the Market-Value-Adjustment (MVA) will never be less than
87.5% of the Contract Value at the beginning of the then effective
Guarantee Period, adjusted for prior withdrawals, accumulated at the
non-forfeiture interest rate required by the Standard Non-forfeiture Law
for individual fixed deferred annuities.
The guaranteed Minimum Interest Rate will be recalculated monthly for Guarantee
Period renewals and new Contracts We issue, based on the formula above. It will
not change during a Guarantee Period.
We may credit additional interest at Our sole discretion.
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SURRENDER PROVISIONS
SURRENDERS. Full surrenders may be made under this Contract at any time. Partial
surrenders may only be made if:
a) the Gross Surrender Value is at least $1,000; and
b) the remaining Contract Value after the Gross Surrender Value has been
deducted is at least the Minimum Amount shown on the Contract
Specifications page.
A full or partial surrender made at the end of a Guarantee Period is not subject
to a Surrender Charge or Market Value Adjustment. A request for a surrender at
the end of a Guarantee Period must be received, In Writing, no later than the
end of the Guarantee Period. In the event of a full surrender, except as
otherwise provided pursuant to applicable rider, We will pay the Contract Owner
an amount equal to the Net Surrender Value as of the end of the then applicable
Guarantee Period.
In the event of a full or partial surrender made at any time other than the end
of a Guarantee Period, no Surrender Charge or Market Value Adjustment will be
imposed on the Annual Free Withdrawal Amount. However, any unpaid Premium Taxes
may apply.
In the case of any surrenders, the Net Surrender Value will be payable to You.
In the event of surrenders in excess of the Annual Free Withdrawal Amount, the
Net Surrender Value is determined by Us as follows:
Assume:
A = the amount you request for a Surrender;
B = Annual Free Withdrawal Amount;
C = the Surrender Charge, plus any unpaid Premium Taxes. The
Surrender Charge equals (A-B) x the applicable Surrender Charge
percentage as shown on the Contract Specifications page.
D = the Market Value Adjustment described below.
The Net Surrender Value equals (A-C) x D.
MARKET VALUE ADJUSTMENT - The formula which will be used to determine the
Market Value Adjustment is calculated by Us as follows:
[1+I / 1+J] TO THE POWER OF N/12 where:
I = the U.S. Constant Maturity Treasury rate as of three business days
prior to the Guarantee Period effective date (expressed as a decimal, e.g.,
1% = .01), with maturity years equal to the length of the then current
Guarantee Period plus the HCRCIIa COMPOSITE OPTION ADJUSTED SPREAD (OAS)
INDEX rate as of three business days prior to the Guarantee Period
effective date; and
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J = the U.S. Constant Maturity Treasury rate as of three business days
prior to the date the interest adjustment is applied (expressed as a
decimal, e.g., 1% = .01), with maturity years equal to the remainder of the
then current Guarantee Period (this will be interpolated when necessary)
plus the HCRCIIa COMPOSITE OPTION ADJUSTED SPREAD (OAS) INDEX rate as of
three business days prior to the date the interest adjustment is applied;
and
N = the number of complete months from the Surrender Date to the end of the
then current Guarantee Period.
In the event that any index or rate is no longer available, We will use a
substantially similar index or rate for determining the Market Value Adjustment.
If a discontinued index or rate is not available for a Guarantee Period renewal
or exchange, We will use a substantially similar index or rate, as applicable.
We will notify You of any changes in the availability of the index or rate, and
the applicable substitute We will use.
PAYMENT UPON SURRENDER - DEFERRAL OF PAYMENT. We may defer payment of any
amounts from the Contract for up to six months from the date of the request to
surrender, subject to obtaining any required approval by the Insurance
Commissioner of the state in which this Contract is issued. If We defer payment
for more than 30 days, We will pay interest per annum of at least the statutory
required minimum interest rate then in effect on the amount deferred.
DEATH BENEFIT PROVISIONS
BENEFICIARY DISPOSITION IN THE EVENT OF DEATH BEFORE THE ANNUITY COMMENCEMENT
DATE. If the Contract Owner dies, and the Annuitant is living, and
a) the joint Contract Owner is living, and then the joint Contract Owner
will also become the Beneficiary. In this case, the rights of such
designated Beneficiary are voided.
b) there is no surviving joint Contract Owner, then the designated
Beneficiary will remain the Beneficiary.
c) there is no surviving joint Contract Owner, and there is no
Beneficiary designation is in effect, or the designated Beneficiary
has predeceased the Contract Owner, then the Contract Owner's estate
shall be the Beneficiary.
If the Annuitant dies, and
a) the Annuitant is also the sole Contract Owner, regardless of any
named Contingent Annuitant, the designated Beneficiary will remain
the Beneficiary.
b) both the Contract Owner and the Contingent Annuitant are living, the
Contingent Annuitant will become the Annuitant, the designated
Beneficiary will remain the Beneficiary.
c) the Contract Owner is living, and there is no Contingent Annuitant or
the Contingent Annuitant is not living, the Contract Owner will be
presumed to be the Contingent Annuitant and the Contract continues.
The Contract Owner may waive this presumption and receive the Death
Benefit. The rights of the designated Beneficiary are automatically
voided.
d) the contract is owned by a corporation or other entity, the Contract
Owner will be the Beneficiary. In this case, the rights of the
designated Beneficiary are automatically voided.
9
BENEFICIARY DISPOSITION IN THE EVENT OF DEATH ON OR AFTER THE ANNUITY
COMMENCEMENT DATE.
a) If the Contract Owner dies, and the Annuitant is living, the
designated Beneficiary will become the Contract Owner and the
payments will continue as scheduled.
b) If the Annuitant dies, the Contract Owner will be the Beneficiary.
Upon Our receipt of Due Proof of Death, the rights of the designated
Beneficiary are automatically voided.
c) If the Annuitant, who is also the sole Contract Owner, dies, the
designated Beneficiary will remain the Beneficiary.
DEATH BENEFIT. The Death Benefit will be calculated as of the date We receive
notification, In Writing, of Due Proof of Death at the Administrative Office of
the Company. If death occurs before the Annuity Commencement Date, the Death
Benefit equals the Contract Value. There is no Surrender Charge or Market Value
Adjustment applied to a Death Benefit. If death occurs on or after the Annuity
Commencement Date, any remaining interest in the Contract will be paid at least
as rapidly as under the method of distribution in effect at the time of death.
SETTLEMENT OF THE DEATH BENEFIT. The Death Benefit may be taken in one sum or
under any of the settlement options then being offered by Us subject, however,
to the distribution requirements below. The Beneficiary may elect any available
settlement option, unless the Contract Owner has designated the settlement
option for that Beneficiary. The available settlement options include any of the
annuity options under this Contract or any other options then being offered or
approved by Us. If payment is taken in one sum, an interest-bearing draft
account ("Safe Haven Account") will be offered and if elected, maintained until
the entire balance is withdrawn. The Safe Haven Account is part of Our General
Account assets. The minimum draft writing amount and remaining balance must be
at least equal to the minimum amounts according to Our rules then in effect. If
the remaining balance falls below Our minimum amount rules, the Safe Haven
Account will terminate and We will pay the remaining balance in one sum.
As of the date of receipt of complete disbursement instructions from the
Beneficiary, the amount to be paid or applied to a selected settlement option
will be computed. When there is more than one Beneficiary, the amount will be
calculated for each Beneficiary's share of the proceeds and paid or applied to a
selected settlement option according to and upon receipt of each Beneficiary's
instructions. If the date of receipt of complete instructions falls on a
non-Business Day, the amount will be computed on the next Business Day.
When payment is taken in one sum, payment will be made within 7 days of Our
receipt of complete instructions.
DISTRIBUTION REQUIREMENTS. Subject to the Alternative Election or Spouse
Beneficiary provisions below:
a) If any Contract Owner dies before the Annuity Commencement Date, the
entire interest in the Contract will be distributed within five years
after such death; and
b) If any Contract Owner dies on or after the Annuity Commencement Date
and before the entire interest in the Contract has been distributed,
the remaining portion of such interest will be distributed at least
as rapidly as under the method of distribution being used as of the
date of such death.
If the Contract Owner is not an individual, then for purposes of the preceding
paragraph a) or b), the primary Annuitant will be treated as the Contract Owner.
If the Contract Owner is not an individual, then for purposes of the preceding
paragraph a) or b), a change of Annuitant is treated as death of Contract Owner.
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ALTERNATIVE ELECTION TO SATISFY DISTRIBUTION REQUIREMENTS. If any portion of the
interest of a Contract Owner described above is payable to or for the benefit of
a designated Beneficiary, and the Beneficiary elects after the Contract Owner's
death to have the benefit distributed over a period that:
a) does not extend beyond the later of such Beneficiary's life or life
expectancy; and
b) does commence within one year of the date of death;
then for purposes of satisfying the distribution requirements above, the benefit
will be treated as distributed entirely on the date such periodic distributions
begin.
SPOUSE BENEFICIARY. In the event of the death of a Contract Owner and there is
no joint Contract Owner and the sole Beneficiary is the Contract Owner's spouse
and the Annuitant (Contingent Annuitant, if applicable) is alive, this Contract
will continue with the spouse as the Contract Owner, unless the spouse elects to
be paid a death benefit option. This provision will apply only once with respect
to this Contract. Spousal continuation is only available if the spouse is listed
as 100% Beneficiary.
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ANNUITY PROVISIONS
ANNUITY COMMENCEMENT DATE. The Annuity Commencement Date is shown on The
Contract Specifications page. You may change the date by notifying Us prior to
the Annuity Commencement Date, subject to the parameters as shown on the
Contract Specifications page and Our approval.
ANNUITY PAYMENT. If the Annuity Commencement Date does not coincide with the end
of a Guarantee Period, We will apply Your Contract Value, less any applicable
Premium Taxes, multiplied by the Market Value Adjustment, if any, to purchase
the modal income payments according to the Annuity Option elected. If the
Annuity Commencement Date coincides with the end of any Guarantee Period, no
Market Value Adjustment will be applied in the determination of the monthly
income payments. No Surrender Charge will be applied upon annuitization at any
time.
ELECTION OF ANNUITY OPTION. You may elect any one of the Annuity Options
described below or any other Annuity Option We offer at the time of
annuitization. In the absence of such election, the Life Annuity with 10 Years
Period Certain will apply. The Annuity Option elected by You may not be changed
on or after the Annuity Commencement Date. Election of any of these options must
be made, In Writing, to Us prior to the Annuity Commencement Date.
Some of the options may not be available if this Contract is issued to qualify
under Section 401, 403, or 408 of the Internal Revenue Code of 1986 as amended.
The third, fifth and sixth options (Life Annuity with Payments for a Period
Certain, Joint and Last Survivor Life Annuity with Payments for a Period
Certain, and Payment for a Period Certain) or any other option with a period
certain segment will be available only if the guaranteed payment period is less
than the life expectancy of the Annuitant at the time the option becomes
effective. Such life expectancy will be computed under the mortality table then
in use by Us.
ELECTION OF ANNUITY PAYMENT FREQUENCY. You may elect the Annuity payment
frequency. Available Annuity payment frequencies include: monthly, quarterly,
semi-annual, and annual. In the event that You do not elect a payment frequency,
Annuity payments will be made monthly. Annuity payments will be made according
to the Annuity payment frequency selected. You may elect to change the Annuity
payment frequency of Your payments within 30 days prior to the scheduled Annuity
Commencement Date.
DATE OF PAYMENT. The first Annuity Payment is payable on the Annuity
Commencement Date. The remaining Annuity payments are computed and payable as of
the same day of the month, or the preceding Business Day, if applicable, as the
Annuity Commencement Date, based on the elected Annuity payment frequency.
MINIMUM ANNUITY PAYMENT. The first Annuity Payment must be at least equal to the
Minimum Annuity Payment amount shown in the Annuity Parameters on the Contract
Specifications page. If at any time, payments become less than the minimum
payment amount, We have the right to change the payment frequency to meet the
minimum payment requirements. If any payment amount is less than the minimum
annual payment amount, We may make an alternative arrangement with You.
TERMINATION AFTER THE ANNUITY COMMENCEMENT DATE. This Contract may not be
surrendered after the commencement of Annuity payments, except with respect to
the Seventh Option.
PROOF OF SURVIVAL. The payment of any Annuity benefit will be subject to
evidence that the Annuitant is alive on the date such payment is otherwise due,
as approved by Us.
DEATH OF ANNUITANT. In the event of the death of the Annuitant while receiving
Annuity payments, the Beneficiary will continue to receive the remaining
guaranteed payments as scheduled. Alternatively, the Beneficiary may elect to
receive a lump sum payment of the Death Benefit equal to the present value of
any remaining guaranteed payments.
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ANNUITY OPTIONS
FIRST OPTION - Life Annuity - An Annuity payable during the lifetime of the
Annuitant, ceasing with the last payment due prior to the death of the
Annuitant.
SECOND OPTION - Life Annuity with a Cash Refund - An Annuity payable during the
lifetime of the Annuitant. At the death of the Annuitant, any remaining value
will be paid to the Beneficiary. The remaining value equals the Contract Value
applied on the Annuity Commencement Date, minus the dollar amount of Annuity
payments already paid and Premium Taxes.
THIRD OPTION - Life Annuity with Payments for a Period Certain (5 years to 100
years minus Annuitant's age) - An Annuity payable for a fixed number of years
and during the lifetime of the Annuitant. If, at the death of the Annuitant,
payments have been made for less than the period selected, the remaining
payments will be made to the Beneficiary or the Beneficiary can elect to receive
the present value of the remaining payments in one sum. To calculate the present
value We will use an interest rate We determine in Our discretion.
FOURTH OPTION - Joint and Last Survivor Life Annuity - An Annuity payable during
the joint lifetime of the Annuitant and a Joint Annuitant, and thereafter during
the remaining lifetime of the survivor Annuitant. At the time of electing this
option, the Contract Owner may elect reduced payments over the remaining
lifetime of the survivor Annuitant. Payments will cease with the last payment
prior to the death of the survivor.
FIFTH OPTION - Joint and Last Survivor Life Annuity with Payments for a Period
Certain (5 years to 100 years-age) - An Annuity payable for a fixed number of
years and during the lifetimes of the Annuitant and the Joint Annuitant and
thereafter during the remaining lifetime of the survivor. At the time of
electing this Annuity Option, the Contract Owner may elect reduced payments over
the remaining lifetime of the survivor. If, at the death of the last surviving
Annuitant, payments have been made for less than the period selected, the
remaining payments will be made to the Beneficiary, or the Beneficiary can elect
to receive the present value of the remaining payments in one sum. To calculate
the present value We will use an interest rate We determine in Our discretion.
SIXTH OPTION - Payments for a Period Certain (5 years to 100 years minus
Xxxxxxxxx's age) - An Annuity payable for a fixed number of years with period of
10 years or greater available at any time and periods of 5 to 10 years available
on or after the second Contract Year. Payments will be made for the period and
frequency selected. If, at the death of the Annuitant, payments have been made
for less than the period selected, the remaining payments will be made to the
Beneficiary or the Beneficiary can elect to receive the present value of the
remaining payments in one sum. To calculate the present value We will use an
interest rate We determine in Our discretion.
SEVENTH OPTION - Annuity Proceeds Annuity Option - Amounts otherwise payable as
a Death Benefit left in the Contract for a period not to exceed five years from
the date of any Contract Owner or Annuitant's death prior to the Annuity
Commencement Date. The amounts otherwise payable as a Death Benefit will remain
in the same Guarantee Period and continue to earn the same interest rate as at
the time of death. If the Guarantee Period ends before the end of the five year
period, the Beneficiary may elect a new Guarantee Period with a duration closest
to, but not to exceed the time remaining in the period of five years from the
date of the Contract Owner's or Annuitant's death. Full or partial surrenders
may be made at any time. In the event of any surrender, the remaining value will
equal the Death Benefit left with Us, minus any Gross Surrender Values, plus any
interest earned.
13
ANNUITY TABLES
DESCRIPTION OF TABLES. The attached Annuity Tables show the minimum dollar
amount of the monthly payments for each $1,000 applied under the first six
options. Under the first, second or third options, the amount of each payment
will depend upon the age and gender of the Annuitant at the time the first
payment is due. Under the fourth and fifth options, the amount of each payment
will depend upon the gender of both Annuitants and their ages at the time the
first payment is due. Gender will not be used to determine the amount of the
Annuity payable if this Contract is issued to qualify under certain sections of
the Internal Revenue Code. If gender is used to determine the amount of Annuity
payable, the Annuity Tables at the end of this Contract will provide rates of
payment for male Annuitants and female Annuitants.
The tables for the first, second, third, fourth and fifth options are based on
the [1983a Individual Annuity Mortality Table projected to the year 2000 using
Projection Scale G] and an interest rate of [2.5%]. The table for the sixth
option is based on an interest rate of [2.5%] per annum.
The Annuity tables for the first through fifth options are age dependent. The
amount of the first payment will be based on an age that is a specified number
of years younger than the Annuitant's then-attained age. The revised age is as
follows:
DATE OF FIRST PAYMENT REVISED AGE
---------------------------------------------------
[Prior to 2015 2 years
2015 - 2019 3 years
2020 - 2029 4 years
2030 - 2039 5 years
2040 or later 6 years]
14
(THIS PAGE INTENTIONALLY LEFT BLANK)
15
ANNUITY TABLES FOR
FIXED PAYMENTS,
BASED ON [2.5%] INTEREST RATE
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Fixed Dollar Annuity payments will not vary and are guaranteed as to fixed
dollar amount. Payments for any available Annuity payment frequency, period
certain, age, or combination of ages not shown will be quoted upon request.
FIRST, SECOND AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
MALE ANNUITANT
MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240
---------------------------------------------------
[35 $3.05 $3.05 $3.04 $3.03
40 3.25 3.24 3.23 3.21
45 3.49 3.48 3.45 3.42
50 3.80 3.77 3.73 3.68
51 3.87 3.84 3.79 3.73
52 3.94 3.91 3.86 3.79
53 4.02 3.98 3.93 3.85
54 4.10 4.06 4.00 3.91
55 4.19 4.14 4.07 3.97
56 4.28 4.22 4.15 4.04
57 4.37 4.31 4.23 4.10
58 4.48 4.41 4.31 4.17
59 4.59 4.51 4.40 4.23
60 4.70 4.61 4.49 4.30
61 4.83 4.72 4.58 4.37
62 4.96 4.84 4.67 4.44
63 5.10 4.96 4.77 4.50
64 5.25 5.09 4.87 4.57
65 5.41 5.23 4.97 4.64
66 5.59 5.37 5.08 4.70
67 5.77 5.51 5.18 4.76
68 5.97 5.66 5.29 4.82
69 6.18 5.82 5.39 4.87
70 6.40 5.98 5.49 4.92
75 7.76 6.85 5.97 5.12
80 9.67 7.73 6.32 5.23
FEMALE ANNUITANT
MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240
---- ----------------------------------------------
[35 $2.88 $2.88 $2.88 $2.87
40 3.04 3.03 3.03 3.02
45 3.23 3.22 3.22 3.20
50 3.47 3.46 3.45 3.42
51 3.53 3.52 3.50 3.47
52 3.59 3.57 3.56 3.52
53 3.65 3.64 3.61 3.58
54 3.72 3.70 3.67 3.63
55 3.79 3.77 3.74 3.69
56 3.86 3.84 3.80 3.75
57 3.94 3.91 3.87 3.81
58 4.02 3.99 3.94 3.88
59 4.10 4.07 4.02 3.94
60 4.20 4.16 4.10 4.01
61 4.29 4.25 4.18 4.08
62 4.40 4.35 4.27 4.15
63 4.51 4.45 4.36 4.22
64 4.62 4.56 4.46 4.30
65 4.75 4.67 4.55 4.37
66 4.88 4.79 4.66 4.45
67 5.03 4.92 4.76 4.52
68 5.18 5.05 4.87 4.59
69 5.34 5.19 4.98 4.66
70 5.52 5.34 5.09 4.73
75 6.64 6.21 5.67 5.02
80 8.29 7.20 6.15 5.19]
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE
OF AGE OF FEMALE
MALE 35 40 45 50 55 60
------------------------------------------------------------------------------------
[35 $2.74 $2.81 $2.87 $2.92 $2.96 $2.99
40 2.78 2.87 2.95 3.02 3.08 3.13
45 2.81 2.92 3.02 3.12 3.22 3.30
50 2.83 2.95 3.08 3.22 3.35 3.46
55 2.85 2.98 3.13 3.29 3.46 3.63
60 2.86 3.00 3.16 3.35 3.56 3.79
65 2.87 3.01 3.19 3.39 3.64 3.92
70 2.87 3.02 3.20 3.42 3.69 4.02
75 2.88 3.03 3.21 3.44 3.73 4.09
80 2.88 3.03 3.22 3.46 3.75 4.13
85 2.88 3.03 3.22 3.46 3.77 4.16
90 2.88 3.04 3.23 3.47 3.77 4.17
AGE
OF AGE OF FEMALE
MALE 65 70 75 80 85 90
------ ------------------------------------------------------------------------
[35 $3.01 $3.03 $3.04 $3.04 $3.05 3.05
40 3.17 3.20 3.22 3.23 3.24 3.24
45 3.36 3.40 3.44 3.46 3.47 3.48
50 3.56 3.64 3.70 3.74 3.76 3.78
55 3.79 3.91 4.01 4.08 4.13 4.15
60 4.01 4.21 4.38 4.51 4.59 4.64
65 4.22 4.52 4.80 5.02 5.18 5.29
70 4.39 4.81 5.23 5.61 5.91 6.12
75 4.52 5.05 5.64 6.23 6.76 7.15
80 4.62 5.23 5.98 6.82 7.66 8.36
85 4.67 5.35 6.24 7.32 8.52 9.66
90 4.71 5.42 6.41 7.69 9.25 10.91]
16
ANNUITY TABLES FOR
FIXED PAYMENTS,
BASED ON [2.5%] INTEREST RATE
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE
OF AGE OF FEMALE
MALE 35 40 45 50 55 60
------------------------------------------------------------------------------------
[35 $2.74 $2.81 $2.87 $2.92 $2.96 $2.99
40 2.78 2.87 2.95 3.02 3.08 3.13
45 2.81 2.92 3.02 3.12 3.22 3.29
50 2.83 2.95 3.08 3.22 3.35 3.46
55 2.85 2.98 3.13 3.29 3.46 3.63
60 2.86 3.00 3.16 3.35 3.56 3.78
65 2.87 3.01 3.19 3.39 3.64 3.91
70 2.87 3.02 3.20 3.42 3.69 4.01
75 2.88 3.03 3.21 3.44 3.72 4.08
80 2.88 3.03 3.22 3.45 3.75 4.12
85 2.88 3.03 3.22 3.46 3.76 4.14
90 2.88 3.03 3.22 3.46 3.76 4.15
AGE
OF AGE OF FEMALE
MALE 65 70 75 80 85 90
------ -----------------------------------------------------------------------
[35 $3.01 $3.02 $3.04 $3.04 $3.05 $3.05
40 3.17 3.20 3.22 3.23 3.23 3.24
45 3.36 3.40 3.43 3.45 3.47 3.47
50 3.56 3.64 3.70 3.73 3.75 3.76
55 3.78 3.91 4.01 4.07 4.11 4.13
60 4.01 4.21 4.37 4.49 4.56 4.59
65 4.21 4.51 4.78 4.98 5.11 5.18
70 4.38 4.79 5.19 5.53 5.76 5.89
75 4.51 5.01 5.56 6.07 6.46 6.68
80 4.59 5.17 5.85 6.54 7.10 7.46
85 4.63 5.27 6.04 6.88 7.61 8.09
90 4.66 5.32 6.14 7.07 7.92 8.51]
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
AMOUNT OF AMOUNT OF
NO. OF MONTHLY NO. OF MONTHLY NO. OF
YEARS PAYMENTS YEARS PAYMENTS YEARS
-------------------------------------------------------------------------------------
[10 $9.39 15 $6.64 20
11 8.64 16 6.30 21
12 8.02 17 6.00 22
13 7.49 18 5.73 23
14 7.03 19 5.49 24
AMOUNT OF AMOUNT OF AMOUNT OF
MONTHLY NO. OF MONTHLY NO. OF MONTHLY
PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
--- -----------------------------------------------------------------------------------
$5.27 25 $4.46 30 $3.93]
5.08 26 4.34
4.90 27 4.22
4.74 28 4.12
4.60 29 4.02
17
ANNUITY TABLES FOR
FIXED PAYMENTS,
BASED ON [2.5%] INTEREST RATE
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Fixed dollar Annuity payments will not vary and are guaranteed as to fixed
dollar amount. Payments for any available Annuity payment frequency, period
certain, age, or combination of ages not shown will be quoted upon request.
FIRST, SECOND AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240
-----------------------------------------------------
[35 $2.97 $2.97 $2.96 $2.95
40 3.15 3.14 3.13 3.12
45 3.36 3.35 3.34 3.31
50 3.64 3.62 3.59 3.55
51 3.70 3.68 3.65 3.60
52 3.77 3.74 3.71 3.66
53 3.84 3.81 3.77 3.72
54 3.91 3.88 3.84 3.77
55 3.99 3.96 3.91 3.83
56 4.07 4.03 3.98 3.90
57 4.16 4.11 4.05 3.96
58 4.25 4.20 4.13 4.03
59 4.35 4.29 4.21 4.09
60 4.45 4.39 4.30 4.16
61 4.56 4.49 4.38 4.23
62 4.68 4.60 4.47 4.30
63 4.81 4.71 4.57 4.36
64 4.94 4.83 4.67 4.44
65 5.08 4.95 4.76 4.51
66 5.24 5.08 4.87 4.58
67 5.40 5.22 4.97 4.64
68 5.58 5.36 5.08 4.71
69 5.76 5.51 5.19 4.77
70 5.96 5.66 5.29 4.83
75 7.20 6.53 5.82 5.07
80 8.98 7.47 6.24 5.21]
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE OF
FIRST AGE OF SECOND ANNUITANT
ANNUITANT 35 40 45 50 55 60
---------------------------------------------------------------------------------------
[35 $2.74 $2.80 $2.84 $2.88 $2.91 $2.93
40 2.80 2.87 2.94 2.99 3.03 3.07
45 2.84 2.94 3.02 3.10 3.18 3.23
50 2.88 2.99 3.10 3.22 3.32 3.41
55 2.91 3.03 3.18 3.32 3.46 3.60
60 2.93 3.07 3.23 3.41 3.60 3.79
65 2.94 3.09 3.28 3.48 3.72 3.97
70 2.95 3.11 3.30 3.53 3.80 4.12
75 2.96 3.13 3.33 3.57 3.87 4.24
80 2.96 3.13 3.34 3.60 3.92 4.32
85 2.97 3.14 3.35 3.61 3.95 4.38
90 2.97 3.14 3.36 3.63 3.96 4.41
AGE OF
FIRST AGE OF SECOND ANNUITANT
ANNUITANT 65 70 75 80 85 90
--------- ------------------------------------------------------------------------
[35 $2.94 $2.95 $2.96 $2.96 $2.97 $2.97
40 3.09 3.11 3.13 3.13 3.14 3.14
45 3.28 3.30 3.33 3.34 3.35 3.36
50 3.48 3.53 3.57 3.60 3.61 3.63
55 3.72 3.80 3.87 3.92 3.95 3.96
60 3.97 4.12 4.24 4.32 4.38 4.41
65 4.22 4.46 4.66 4.82 4.93 5.00
70 4.46 4.81 5.14 5.42 5.63 5.77
75 4.66 5.14 5.64 6.11 6.50 6.78
80 4.82 5.42 6.11 6.82 7.49 8.03
85 4.93 5.63 6.50 7.49 8.52 9.46
90 5.00 5.77 6.78 8.03 9.46 10.91]
18
ANNUITY TABLES FOR
FIXED PAYMENTS,
BASED ON [2.5%] INTEREST RATE
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE OF
FIRST AGE OF SECOND ANNUITANT
ANNUITANT 35 40 45 50 55 60
---------------------------------------------------------------------------------------
[35 $2.74 $2.80 $2.84 $2.88 $2.91 $2.93
40 2.80 2.87 2.94 2.99 3.03 3.07
45 2.84 2.94 3.02 3.10 3.18 3.23
50 2.88 2.99 3.10 3.22 3.32 3.41
55 2.91 3.03 3.18 3.32 3.46 3.60
60 2.93 3.07 3.23 3.41 3.60 3.78
65 2.94 3.09 3.28 3.48 3.71 3.96
70 2.95 3.11 3.30 3.53 3.80 4.11
75 2.96 3.13 3.32 3.57 3.87 4.23
80 2.96 3.13 3.34 3.59 3.91 4.31
85 2.97 3.13 3.35 3.61 3.94 4.35
90 2.97 3.14 3.35 3.61 3.95 4.37
AGE OF
FIRST AGE OF SECOND ANNUITANT
ANNUITANT 65 70 75 80 85 90
--------- -----------------------------------------------------------------------
[35 $2.94 $2.95 $2.96 $2.96 $2.97 $2.97
40 3.09 3.11 3.13 3.13 3.13 3.14
45 3.28 3.30 3.32 3.34 3.35 3.35
50 3.48 3.53 3.57 3.59 3.61 3.61
55 3.71 3.80 3.87 3.91 3.94 3.95
60 3.96 4.11 4.23 4.31 4.35 4.37
65 4.21 4.45 4.65 4.79 4.87 4.92
70 4.45 4.79 5.10 5.35 5.52 5.61
75 4.65 5.10 5.56 5.96 6.25 6.41
80 4.79 5.35 5.96 6.54 6.99 7.27
85 4.87 5.52 6.25 6.99 7.61 8.01
90 4.92 5.61 6.41 7.27 8.01 8.51]
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
AMOUNT OF AMOUNT OF
NO. OF MONTHLY NO. OF MONTHLY NO. OF
YEARS PAYMENTS YEARS PAYMENTS YEARS
--------------------------------------------------------------------------------------
[10 $9.39 15 $6.64 20
11 8.64 16 6.30 21
12 8.02 17 6.00 22
13 7.49 18 5.73 23
14 7.03 19 5.49 24
AMOUNT OF AMOUNT OF AMOUNT OF
MONTHLY NO. OF MONTHLY NO. OF MONTHLY
PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---- ----------------------------------------------------------------------------------
$5.27 25 $4.46 30 $3.93]
5.08 26 4.34
4.90 27 4.22
4.74 28 4.12
4.60 29 4.02
19
HARTFORD LIFE INSURANCE COMPANY
000 XXXXXXXXX XXXXXX
XXXXXXXX, XX 00000
[LOGO]
[HARTFORD]
NONPARTICIPATING
INDIVIDUAL SINGLE PREMIUM
MODIFIED GUARANTEED ANNUITY CONTRACT
