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Exhibit 4(b)(i)
ACCIDENTAL DEATH BENEFIT RIDER
RIDER SECTION 1. GENERAL INFORMATION
1.1 WHAT IS OUR AGREEMENT Our agreement with you includes this rider and its
WITH YOU? application, as a part of the policy to which it is
attached. The provisions of the policy apply to this
rider unless they conflict with the rider. If there is a
conflict, the rider provision will apply. The issue date
for this rider is shown on the accidental death benefit
annual cost of insurance rate table.
We promise to provide the proceeds described in this
rider as long as the policy and this rider are in force
and all the terms and conditions of this rider are met.
1.2 WHAT IS THE BENEFIT This rider provides accidental death benefit insurance on
PROVIDED BY THIS RIDER? the life of the person named as insured under this
policy.
1.3 CAN THIS RIDER BE We relied on statements made in the application when we
CONTESTED? issued this rider. In the absence of fraud, we will
accept the statements made in the application or
reinstatement application to be representations and not
warranties. Statements made in the application or
reinstatement application will not be used to contest
this rider or challenge a claim under this rider unless
that statement is material.
A statement is material if, based on correct and complete
information, we would have:
a.) denied coverage;
b.) issued the rider at a higher cost of insurance rate;
or
c.) issued the rider on some other basis than applied
for.
If this rider is void as a result of a contest, the cost
you paid for this rider will be refunded to you.
1.4 WHEN DOES THIS RIDER This rider is incontestable after it has been in force
BECOME INCONTESTABLE? during the insured's lifetime for two years from its
issue date. If this rider is reinstated, it is
incontestable after it has been in force during the
insured's lifetime for two years from the date of its
reinstatement. If reinstatement occurs, it may be
contested on the basis of statements made in the
reinstatement application.
1.5 WHEN WILL THIS RIDER This rider will terminate on the earliest of:
TERMINATE?
a.) the death of the insured;
b.) the lapse or termination of the policy;
c.) the policy anniversary at the insured's age 70; or
d.) the date you choose to end this rider. You may end it
by written request.
RIDER SECTION 2. RIDER INSURANCE CHARGES
2.1 WHAT IS THE COST OF THIS The cost of this rider is paid as part of the insurance
RIDER? charges for the policy to which it is attached. The cost
for this rider is payable until the rider terminates. The
cost of insurance rates are shown on the accidental death
benefit annual cost of insurance rate table.
RIDER SECTION 3. RIDER SPECIFIED AMOUNT
3.1 WHAT IS THE SPECIFIED The rider specified amount is shown on the policy data
ACCIDENTAL DEATH BENEFIT page and on the accidental death benefit annual cost of
AMOUNT PROVIDED BY THIS insurance rate table.
RIDER?
RIDER SECTION 4. RIDER ACCIDENTAL DEATH PROCEEDS
4.1 WHEN ARE RIDER ACCIDENTAL Rider accidental death proceeds are payable while this
DEATH PROCEEDS PAYABLE? xxxxx is in force in the event of the insured's
accidental death due to injury. We will pay the rider
specified amount in addition to the death proceeds of the
policy if:
a.) the insured's death:
1.) is a direct result of accidental bodily injury,
independent of all other causes; and
2.) occurs within 90 days of the injury;
b.) both injury and death occur:
1.) on or after the insured reaches the age of four
weeks;
2.) before the policy anniversary at the insured's
age 70; and
3.) while the policy and rider are in force; and
c.) we receive satisfactory proof of the insured's death
due to accidental bodily injury.
4.2 WHAT IS THE AMOUNT OF The rider accidental death proceeds will be the sum of
ACCIDENTAL DEATH BENEFIT the following amounts:
INSURANCE PROVIDED BY
THIS RIDER? a.) the rider specified amount; plus
b.) the rider cost paid beyond the month in which death
by accidental injury occurs; minus
c.) any rider cost due.
If the insured dies before reaching the age of one year,
the accidental death proceeds will be one-half of the
rider specified amount.
If the death of the insured occurs during a grace period,
the insurance charges for the policy will be deducted
from the rider accidental death proceeds.
4.3 HOW WILL THE RIDER The rider accidental death proceeds will be payable to
ACCIDENTAL DEATH the beneficiary, as stated in the application for this
PROCEEDS BE PAID? xxxxx, when we receive proof satisfactory to us that the
insured died while this rider was in force as a
result of accidental bodily injury. If no
beneficiary is named, the proceeds will be paid
to the insured's spouse, if living, otherwise
to the insured's estate. Rider death proceeds
will be paid according to the provisions of the
policy.
RIDER SECTION 5. LIMITATIONS
5.1 ARE THERE ANY LIMITATIONS Accidental death benefit rider proceeds will not be
TO THIS RIDER BENEFIT? payable if the insured dies as a result of any of the
following causes:
a.) death by suicide, whether sane or insane;
b.) death by intentionally self-inflicted injuries;
c.) death by injuries sustained while committing an
assault or felony;
d.) death by injuries sustained while participating in a
riot or revolt;
e.) death by injuries sustained while in military
service during a time of declared or undeclared war,
and while outside of the United States, the District
of Columbia, or the Dominion of Canada;
f.) death by injuries caused by an act of declared or
undeclared war;
g.) death by injuries sustained while traveling in or
descending from any kind of aircraft if the insured
is:
1.) a pilot, student pilot, flight instructor,
member of the crew, or has other duties related
to the flight of the aircraft;
2.) participating in flight training; or sky diving
from any kind of aircraft; or
3.) aboard an aircraft which is being used
primarily for training, instruction, testing,
or experimental purposes.
CUNA Mutual Insurance Society
A Mutual Insurance Company
/s/ Xxxx Xxxx
-------------------------------------
President
ACCIDENTAL DEATH BENEFIT RIDER
INSURED: Xxxx Xxx RATING: Standard Tobacco
ISSUE DATE: January 15, 2000 ISSUE AGE: 35
EXPIRATION DATE: January 15, 2035 GENDER: Male
SPECIFIED AMOUNT: $50,000 COST OF INSURANCE RATES: Male
The rates shown are annual rates per $1,000 of accidental death benefit. Monthly
rates are one-twelfth of the annual rates.
AGE RATE
--- ----
0 .59
1 .59
2 .57
3 .55
4 .53
5 .51
6 .49
7 .47
8 .46
9 .46
10 .46
11 .48
12 .49
13 .54
14 .64
15 .77
16 .83
17 .88
18 .92
19 .94
20 .95
21 .96
22 .94
23 .89
24 .84
25 .79
26 .75
27 .71
28 .68
29 .68
30 .67
31 .67
32 .67
33 .68
34 .68
AGE RATE
--- ----
35 .69
36 .70
37 .71
38 .72
39 .73
40 .74
41 .75
42 .77
43 .79
44 .81
45 .83
46 .85
47 .87
48 .88
49 .90
50 .91
51 .92
52 .94
53 .96
54 .99
55 1.02
56 1.06
57 1.10
58 1.14
59 1.18
60 1.22
61 1.28
62 1.33
63 1.40
64 1.47
65 1.54
66 1.61
67 1.69
68 1.77
69 1.86
