EXHIBIT 99.d(2)
COUNTRY INVESTORS LIFE ASSURANCE COMPANY DISABILITY WAIVER
0000 X. Xxxxxxx Xxxxxx OF MONTHLY DEDUCTION
X.X. Xxx 0000, Xxxxxxxxxxx, Xxxxxxxx 00000-0000
Supplemental Agreement attached to and made a part of this policy in
consideration of the application and payment of its cost. The cost of this
benefit is defined in (7) herein.
1. BENEFIT: The Company will waive all monthly deductions on this policy as
they become due during the total disability of the insured if:
a) The monthly deduction becomes due on or after the deduction day
coincident with or next following the Insured's 5th birthday; and
b) The monthly deduction does not become due more than one year
prior to the notification to the Company of such disability.
We will make monthly deductions during the six-month period described in (2,c)
herein. These deductions will be returned to the cash value of this policy at
the end of the six-month period if the Insured is still totally disabled. We
will credit the interest to the cash value that would have accrued if we had not
made the six monthly deductions.
If Death Benefit Option B is in effect on the date we begin to waive monthly
deductions, we will change your coverage to Option A, with the contractual
change in the Insured's Specified Amount becoming effective on that date.
2. DEFINITION OF TOTAL DISABILITY: Total Disability means disability which:
a) Resulted from bodily injury or disease;
b) Began
i) after the effective date of this supplemental agreement
ii) and before the policy anniversary coincident with or
following the Insured's 60th birthday;
c) Has continued uninterrupted for a period of at least six (6)
months; and
d) Prevents the Insured from engaging for remuneration or profit in
an occupation.
During the first twenty-four (24) months of disability, occupation means the
occupation of the Insured at the time such disability began; thereafter, it
means any occupation for which the Insured is or becomes reasonably fitted by
education, training or experience.
3. DISMEMBERMENT DISABILITY: The total and irrecoverable loss of the:
a) Sight of both eyes; or
b) Use of both hands; or
c) Use of both feet: or
d) Use of one hand and one foot
shall be considered total disability even if the Insured shall engage in an
occupation. Loss of Sight or Limbs must occur or first manifest itself after the
effective date of this Agreement and while this Agreement is in force with
respect to this Waiver of Monthly Deduction Benefit.
4. RISK NOT COVERED: No benefit is payable for a disability resulting from
intentionally self-inflicted injury.
5. NOTICE OF CLAIM AND PROOF OF DISABILITY: Before any monthly deduction is
waived, written notice of claim and due proof of total disability must be
received by the Company at its Home Office:
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a) During the lifetime of the Insured;
b) During the continuance of total disability of the Insured; and
c) Not later than six (6) months after the policy anniversary
coincident with or following the Insured's 60th birthday.
Failure to give notice within such time shall not invalidate any claim if notice
was given as soon as reasonably possible.
6. PROOF OF CONTINUANCE OF DISABILITY: Due proof of the continuance of total
disability must be furnished upon request until the disability has continued
uninterrupted for two (2) full years. After that time, proof of continuance
shall not be required more often than once per year. If requested proof is not
furnished, no further monthly deductions shall be waived.
If at any time the disabled Insured fails to meet the requirement defined in
(2,d) herein, no further monthly deductions shall be waived.
Any future monthly deductions shall be waived as they fall due without further
proof of continuance of disability if, on the policy anniversary coincident with
or following the Insured's 65th birthday, the Insured is then and has been,
totally and continuously disabled for five (5) or more years since proof of
disability was submitted.
7. COST: The cost of the benefits under this Supplemental Agreement will be
determined as follows:
First, the monthly deduction for the cost of insurance and all other
Supplemental Agreements is determined. The additional monthly cost for this
agreement is then calculated by using the following table. The attained age of
the Insured means the Insured's age on the last birthday prior to the policy
anniversary on or preceding the Monthly Deduction Day.
ADDITIONAL ADDITIONAL ADDITIONAL
MONTHLY COST MONTHLY COST MONTHLY COST
PER $100 OF PER $100 OF PER $100 OF
ATTAINED AGE OF MONTHLY ATTAINED AGE OF MONTHLY ATTAINED AGE OF MONTHLY
INSURED DEDUCTION* INSURED DEDUCTION* INSURED DEDUCTION*
0-21 $ 5.50 34 $ 7.50 47 $ 8.25
22 5.75 35 7.50 48 9.00
23 6.00 36 7.50 49 9.25
24 6.00 37 7.50 50 9.75
25 6.25 38 7.50 51 11.75
26 6.25 39 7.50 52 13.75
27 6.25 40 7.50 53 15.50
28 6.50 41 7.50 54 17.00
29 6.75 42 7.75 55 18.25
30 7.00 43 8.00 56 18.50
31 7.00 44 8.00 57 18.75
32 7.25 45 8.00 58 19.00
33 7.50 46 8.25 59 19.25
*Monthly Deduction for this policy cost of insurance plus cost of all other
Supplemental Agreements.
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8. INCREASE IN COVERAGE UNDER THE POLICY: If the Insured's Specified Amount, as
defined in the policy, increases, this Waiver of Monthly Deduction benefit will
apply to the increase only if the Insured is not totally disabled on the
effective date of the increase.
9. TERMINATION: This benefit will terminate automatically:
a) On the policy anniversary coincident with or following the
Insured's 60th birthday unless the Insured is then totally
disabled (If the Insured is so totally disabled, the benefit will
terminate immediately upon subsequent recovery from total
disability); or
b) The end of the grace period stated in the policy, unless we are
waiving monthly deductions for the policy; or
c) If the policy is surrendered, or otherwise terminated; or
d) Upon proper written request, on any deduction day and
presentation of the policy at the Home Office of the Company
for endorsement.
This Agreement is effective on the Policy Date of Issue of this policy unless
another effective date is stated below.
Effective Date: _______________ COUNTRY INVESTORS LIFE ASSURANCE COMPANY
(if other than Policy Date of Issue) BLOOMINGTON, ILLINOIS
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