EX99.A5N
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MINNESOTA LIFE POLICY RIDER WAIVER AGREEMENT
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Minnesota Life Insurance Company . 000 Xxxxxx Xxxxxx Xxxxx . Xx.
Xxxx, Xxxxxxxxx 00000-0000
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GENERAL INFORMATION
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This agreement amends the group policy to which it is attached, and is issued in
consideration of the required premium. This agreement provides a waiver of
charges for those insured employees whose employer selected the waiver of
premium benefit on its application. This agreement is subject to every term,
condition, exclusion, limitation, and provision of the group policy unless
otherwise expressly provided for herein.
WHAT DOES THE WAIVER OF PREMIUM BENEFIT PROVIDE?
If an insured employee becomes totally and permanently disabled, as hereinafter
defined, while under age 60, upon receipt of due proof of such disability, the
insured employee's insurance under the group policy (including applicable
riders) will be continued in force, subject to the following provisions and
without payment of premiums for such insured employee, during the uninterrupted
continuance of such total and permanent disability.
WHAT IS "TOTAL" DISABILITY?
Total disability is a disability which occurs while the insured employee's
insurance is in force and which results from an accidental injury or a disease
that continuously prevents the insured employee from engaging in an occupation.
The insured employee must be under the care of a licensed physician other than
the insured employee. During the first 24 months of total disability,
"occupation" means the insured employee's regular occupation. After 24 months,
it means any occupation for which the insured employee is reasonably fitted by
education, training or experience.
The insured employee's total and irrevocable loss of the following shall be
considered total disability even if the insured employee engages in an
occupation:
1. the sight of both eyes; or
2. the use of both hands; or
3. the use of both feet; or
4. the use of one hand and one foot.
WHAT IS "PERMANENT" DISABILITY?
Total disability will be considered permanent only after it has existed
continuously for a least six months.
HOW LONG WILL INSURANCE BE CONTINUED?
If the insured employee becomes totally and permanently disabled, insurance will
be continued:
XXX-00-00000 Xxxxxxxxx Life 1
1. until the insured employee's 95th birthday; or
2. until the date the insured employee is no longer totally and permanently
disabled; or
3. until the date the insured employee terminates or surrenders his or her
insurance; or
4. until the date the group policy terminates;
whichever occurs first.
However, the termination of the group policy shall have no effect on the claim
of any insured who is disabled, as set forth in this agreement, at the time the
group policy terminates.
WHAT WILL BE CONSIDERED DUE PROOF OF DISABILITY?
The insured employee must furnish evidence satisfactory to us that his or her
total disability:
1. commenced while his or her insurance under the group policy was in force;
and
2. commenced before the insured employee's 60th birthday; and
3. was continuous for six months or more.
We will, from time to time, also require additional proof satisfactory to us
that the insured employee continues to be totally and permanently disabled. We
may also require the insured employee to submit to one or more medical
examinations at our expense. However, we will not require a medical examination
of the insured employee more frequently than once a year if the total disability
has continued for two years.
ARE THERE ANY LIMITATIONS?
Insurance will not be continued if the insured employee's total disability
results from intentionally self-inflicted injuries or from an act of war while
the insured employee is serving in the military, naval or air forces of any
country at war, declared or undeclared.
WHEN MUST WE BE NOTIFIED?
We must receive written notice of the insured employee's total disability at our
home office:
1. while the insured employee is living and totally disabled; and
2. not later than one year after the termination of the insured employee's
insurance under the group policy; and
3. within one year of the date the insured employee requests as the date for
the commencement of this benefit.
However, the failure to give this notice within the time provided will not
invalidate the claim if it is shown that notice was given as soon as reasonably
possible.
WHAT IS THE INSURED EMPLOYEE'S COST FOR THIS BENEFIT?
The cost of the benefit is included in the planned monthly premium amount shown
on the specifications page attached to the insured's certificate.
XXX-00-00000 Xxxxxxxxx Life 2
WHAT IF THE INSURED EMPLOYEE'S INSURANCE UNDER THE GROUP POLICY LAPSES?
If the insured employee's insurance lapses before notice of the insured
employee's total disability is received at our home office, the insured
employee's insurance will be continued only if the notice is received within one
year after his or her insurance lapses. Also, the total disability must have
commenced prior to the date the net cash value became zero or during the grace
period allowed.
WHEN IS THE BENEFIT UNDER THIS AGREEMENT INCONTESTABLE?
This agreement is subject to the incontestability provision for each insured
employee.
CAN INSURANCE THAT WAS CONTINUED UNDER THIS AGREEMENT BE CONVERTED?
Yes. Insurance under this group policy may be converted during the insured
employee's lifetime and within 31 days after he or she ceases to be totally and
permanently disabled.
IS THIS BENEFIT RETROACTIVE?
Yes. The cost of insurance, cost of riders, and administration fees falling due
before we approve the insured employee's total and permanent disability claim
will be deducted from his or her account value. If the insured employee's claim
for benefits under this agreement is approved, those charges which were deducted
after the total and permanent disability began will be credited to the insured
employee's account value.
WILL THE INSURED EMPLOYEE'S ACCOUNT BE CREDITED WITH PREMIUM CONTRIBUTIONS AS A
RESULT OF THIS BENEFIT?
No. Except for interest which accrues on the account value, the account value
will not increase while insurance is being continued under this agreement.
Nothing contained herein will prohibit an insured employee from making premium
contributions.
This agreement is effective as of the effective date shown on the insured
employee's profile page.
/s/ Xxxxxx X. Xxxxxxxxx /s/ Xxxxxx X. Xxxxxxx
Secretary President
MHC-94-18683 Minnesota Life 3
