Exhibit 26(d)(12)
ACCIDENTAL DEATH BENEFIT AGREEMENT
This agreement is a part of the policy (7) travel or flight in, or
to which it is attached and is subject descent from or with any
to all its terms and conditions. This aircraft, if the
agreement is effective as of the date insured is aboard that
shown on the policy data pages. aircraft for any purpose
other than that of being
WHAT DOES THIS AGREEMENT PROVIDE? transported as a passenger.
Among those not included as
This agreement provides the "passengers" are pilots,
accidental death benefit amount crew members, flight
shown on the policy data pages which instructors, flight
will be paid to the beneficiary. Before trainees, and persons
we can pay this amount we must operating or assisting in
receive proof satisfactory to us that the operation of the
the insured died as the result of an aircraft; or
accidental injury.
(8) war or any act of war, or
If the accidental injury which leads to service in the military,
the insured's death is sustained while naval or air forces of any
the insured was riding as a fare- country at war, declared or
paying passenger in an aircraft or undeclared, provided the
other public conveyance then being insured's accidental death
commercially operated by a licensed occurs while serving in such
common carrier to transport forces or within six months
passengers for hire, we will pay twice after termination of service
the amount of the accidental death in such forces.
benefit shown on the policy data
pages. We reserve the right to request an
autopsy, at our expense, unless
WHAT DOES DEATH BY ACCIDENTAL prohibited by law.
INJURY MEAN?
WHAT IS THE COST FOR THIS AGREEMENT?
Death by accidental injury as used in
this agreement means that the There is a monthly charge for this
insured's death results directly and agreement shown on the policy data
independently of all other causes from pages.
an accidental drowning or from an
accidental injury. IS THIS AGREEMENT SUBJECT TO THE
INCONTESTABILITY AND SUICIDE
The accidental injury must occur while PROVISIONS OF THE POLICY?
this agreement is in force. The
insured's death must also occur within Yes. Those provisions apply to this
180 days after the date of the injury. agreement. The contestable and
In no event will we pay the accidental suicide periods will be measured
death benefit where the insured's from the effective date of this
death results from, or is caused by, agreement.
any of the following:
If this agreement is issued at a
(1) suicide, whether sane or date later than this policy, then
insane; or this agreement will be contestable
but only as to the evidence of
(2) the insured's commission of, insurability which we required to
or attempt to commit, a issue this agreement.
felony; or
WILL THIS AGREEMENT INCREASE YOUR
(3) bodily or mental infirmity, ACCUMULATION VALUES?
illness or disease; or
No. This agreement will not increase
(4) the result of the use of the accumulation values of the
alcohol or drugs and fixed, indexed, or interim accounts
associated mental health of this policy.
issues, medications, poisons,
gases, fumes or other WHEN WILL THIS AGREEMENT TERMINATE?
substances taken, absorbed,
inhaled, ingested or injected, This agreement will terminate on the
unless taken upon the advice earliest of:
of a licensed physician in the
verifiable prescribed manner (1) the policy anniversary
and dosage; or nearest the insured's 70th
birthday.
(5) the direct result of a motor
vehicle collision or accident (2) the date this policy is
where the insured is the surrendered or terminated;
operator of the motor vehicle or
and his or her blood alcohol
level meets or exceeds the (3) the date we receive your
level at which intoxication is written request to cancel
defined in the state where the this agreement; or
collision or accident occurred,
regardless of the outcome of (4) the date of the insured's
any legal proceedings death.
connected thereto; or
Termination shall not prejudice the
(6) bacterial infection, other than payment of benefit for any accident
infection occurring that occurred while the form was in
simultaneously with, and as a force.
result of, the accidental
injury; or
ICC09-918U Accidental Death Benefit Agreement Minnesota Life Insurance Company
CAN THIS AGREEMENT BE REINSTATED?
Yes. This agreement can be
reinstated under the following
conditions:
(1) all of the reinstatement
conditions stated in your
policy have been satisfied;
and
(2) we receive written request
from you; and
(3) your written request is
received prior to the
anniversary nearest the
insured's 70th birthday.
Xxxxxx X. Xxxxxxxxx Xxxxxx Xxxxxxx
Secretary President]
