Exhibit 99.A5l
Accelerated Benefit Agreement
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General Information
This agreement amends the policy to which it is attached and is subject to all
its terms and conditions.
What does this agreement provide?
This agreement provides for the payment of an accelerated benefit if the insured
has a terminal condition, as described below.
The accelerated benefit will be paid as a loan. The entire amount of the loan
will be due and payable at the death of the insured.
The receipt of any accelerated benefit may be taxable to you. You should seek
assistance from your personal tax advisor.
Definitions
When we use the following words, this is what we mean:
death benefit
The face amount of this policy, plus any additional insurance provided by paid-
up additions, less any existing loans or indebtedness under the policy; we will
adjust the face amount for any policy loan interest paid or payable.
maximum accelerated benefit
The maximum amount of the death benefit we will pay if you are eligible under
this agreement. The maximum accelerated benefit will be 75% of the death
benefit.
physician
An individual who is licensed to practice medicine or treat illness in the state
in which treatment is received. This does not include you, the insured, or a
member of your or the insured's immediate family.
immediate family
The insured's or your spouse, child, parent, grandparent, grandchild, brothers
and sisters and their spouses.
Terminal Condition
What is a terminal condition?
A terminal condition is a condition caused by sickness or accident which
directly results in a life expectancy of 12 months or less.
MHC-92-931 Accelerated Benefit Agreement Minnesota Life
What evidence do we require of the insured's terminal condition?
We must be given evidence that satisfies us that the insured's life expectancy,
because of sickness or accident, is 12 months or less. That evidence must
include certification by a licensed physician.
Do we have the right to obtain independent medical verification?
Yes. We retain the right to have the insured medically examined at our own
expense to verify the insured's medical condition. We may do this as often as
reasonably required while an accelerated benefit is being considered or paid.
Payment of an Accelerated Benefit
What are the conditions for the payment of an accelerated benefit?
We will consider the payment of an accelerated benefit, subject to all of the
following conditions:
(1) your policy must be in force other than as extended term insurance and
all premiums due must be fully paid;
(2) you must apply in writing and in a form satisfactory to us;
(3) the policy must not be assigned, except to us as security for a loan;
(4) if the policy has an irrevocable beneficiary, that beneficiary must
consent to the payment of an accelerated benefit.
Is there a minimum or maximum amount for an accelerated benefit?
Yes. The minimum accelerated benefit we will pay is $10,000. The maximum
accelerated benefit is the less of $1,000,000 and 75% of the death benefit.
How will we pay the accelerated benefit?
We will pay the accelerated benefit in one sum or in any other mutually
agreeable manner.
To whom will we pay accelerated benefits?
All accelerated benefits will be paid to you unless you validly assign them.
How is your policy affected when you receive an accelerated benefit?
The accelerated benefit plus any accrued interest will be considered a loan to
you of a portion of the death benefit. After the accelerated benefit has been
paid, we do not expect that any further dividends will be declared on this
policy.
If the accelerated benefit, plus interest exceeds the loan value of your policy,
you will not be able to surrender the policy, or receive any further policy
loans.
XXX-00-000 Xxxxxxxxx Life
At the death of the insured, the entire amount of the loan and interest will be
due and payable. Any balance of the proceeds will be paid to the beneficiary of
your policy.
Can you repay an accelerated benefit?
Yes. The accelerated benefit may be repaid in full or in part at any time.
Is the request for an accelerated benefit voluntary?
Yes. An accelerated benefit is not intended to cause you to involuntarily reduce
the death proceeds ultimately payable to the named beneficiary. An accelerated
benefit will be made available to you on a voluntary basis only.
If you are required by law to use this option to meet the claims of creditors,
whether in bankruptcy or otherwise, you are not eligible for this benefit. If
you are required by a government agency to use this option to apply for, obtain,
or keep a government benefit or entitlement, you are not eligible for this
benefit.
Interest
Will interest be charged on the amount loaned as an accelerated benefit?
Yes. The accelerated benefit interest rate will be set quarterly on the first
day of each calendar quarter. It will not exceed the greater of the "published
monthly average" for the calendar month ending two months before the beginning
of the calendar quarter, or the policy loan interest rate.
The "published monthly average" means the Moody's Composite Average of Yields on
Bonds as published by the Xxxxx'x Investors Service. In the event this average
is no longer published, we will use a substantially similar average. The
interest rate charged on the portion of the accelerated benefit equal to the
loan value of the policy at the time the accelerated benefit is paid shall not
exceed the policy loan interest rate.
We will not notify you when we process the accelerated benefit what the interest
rate charge will be. The interest rate will not be changed during the course of
the accelerated benefit loan.
Interest is charged daily on the unpaid balance of any accelerated benefit; it
is payable annually in arrears. If you do not pay the interest on the
accelerated benefit when it is due, the unpaid interest will be added to the
accelerated benefit and charged the same rate of interest as your accelerated
benefit.
Additional interest will not accrue if the accelerated benefit plus accrued
interest equals the face amount.
Will it be necessary to continue to pay premiums if I receive an accelerated
benefit?
Yes. Once an accelerated benefit has been paid, you must keep the policy in
force until such time as the death benefit is payable or the entire accelerated
benefit is repaid to us. It will be necessary to continue to pay premiums to do
this. If premiums are not paid when due, we will pay them and add the premium
amounts to the accelerated benefit amount which must be repaid
before any death benefits are payable. If the policy includes a waiver of
premium provision and the insured qualifies under that provision, we will waive
those premiums.
Termination of Agreement
When does this agreement terminate?
This agreement will terminate on the earliest of:
(1) the date any premium due for this policy remains unpaid at the end of
the grace period; or
(2) the date we receive your written request to cancel this agreement; or
(3) the date this policy matures, is surrendered, terminated or continued
in force as extended term or reduced paid-up insurance; or
(4) the date of the insured's death.
This agreement is effective as of the policy date of this policy unless a
different effective date is shown on page 1.
/s/ Xxxxxx X. Xxxxxxx /s/ Xxxxxx X. Xxxxxxxxx
President Secretary
