Exhibit 1A(5)(i)
FLEXIBLE PREMIUM VARIABLE
JOINT AND LAST SURVIVOR
LIFE INSURANCE POLICY
--------------------------------------------------------------------------------
To the Owner:
Please read your Policy carefully. This Policy is a legal contract between you
and the Company. You, the Owner, have benefits and rights described in this
Policy. The Insureds are named in the Policy. The Beneficiary is as named in the
attached application, unless later changed. We will pay the Death Proceeds of
this Policy to the Beneficiary, subject to policy provisions. This is a Flexible
Premium Variable Joint and Last Survivor Life Insurance Policy. You may increase
the Specified Amount. We will allocate premiums to the Separate Account named on
the policy data pages.
ACCOUNT VALUE IN THE SEPARATE ACCOUNT IS BASED ON THE INVESTMENT EXPERIENCE
OF THAT ACCOUNT, AND MAY INCREASE OR DECREASE DAILY. IT IS NOT GUARANTEED AS TO
DOLLAR AMOUNT. ACCOUNT VALUE IN THE GUARANTEE ACCOUNT IS GUARANTEED BY THE
COMPANY AS TO DOLLAR AMOUNT. SEE ACCOUNT VALUE BENEFITS SECTION. THE AMOUNT
OF THE DEATH BENEFIT OR THE DURATION OF THE DEATH BENEFIT MAY VARY UNDER THE
CONDITIONS DESCRIBED IN DEATH PROCEEDS SECTION. THE MAXIMUM LOAN AMOUNT IS
NINETY PERCENT OF THE DIFFERENCE BETWEEN THE ACCOUNT VALUE AND ANY SURRENDER
CHARGE ON THE DATE OF THE LOAN.
Refund Privilege. You may return this Policy to our Home Office or to your agent
within 10 days after its delivery for a refund. The amount of the refund will
equal the total of all premiums paid.
For GE Life and Annuity Assurance Company
A B C D E F G H A B C D E F
I J K L M N O P G H I J K L
Q R S T U V W X
XXXXXX X. XXXXXX XXXXXX X. XXXX
PRESIDENT SECRETARY
--------------------------------------------------------------------------------
. Flexible Premium Variable Joint and Last Survivor Life Insurance Policy
. Death Proceeds payable at the death of the last Insured
. Adjustable Death Benefit
. Flexible premiums payable until the death of the last Insured
. Some benefits reflect investment results
. No dividends
--------------------------------------------------------------------------------
GE LIFE AND ANNUITY
ASSURANCE COMPANY
0000 Xxxx Xxxxx Xxxxxx, Xxxxxxxx, Xxxxxxxx 00000
0-000-000-0000
A Stock Company
POLICY DATA SCHEDULE OF PREMIUMS
SCHEDULE OF BENEFITS AMOUNT PLANNED
LIFE INSURANCE NON-NICOTINE
PLANNED PERIODIC PREMIUM [$1,979,64 ANNUALLY]
LIFE INSURANCE COMPLIANCE TEST: [GUIDELINE PREMIUM TEST] (THIS ELECTION IS
IRREVOCABLE FOR THE LIFE OF THE CONTRACT.)
MINIMUM NET PREMIUM FACTOR: [0.925 (THE MINIMUM NET PREMIUM FACTOR REFLECTS THE
MAXIMUM DEDUCTION OF 7.5% OF EACH PREMIUM RECEIVED)]
MAXIMUM POLICY LOAN INTEREST RATES:
DURING POLICY YEARS 1 THROUGH 10: [4.40% PER ANNUM PAYABLE IN ARREARS]
DURING POLICY YEARS 11 AND THEREAFTER: [4.00% PER ANNUM PAYABLE IN ARREARS]
MINIMUM SPECIFIED AMOUNT: $[200,000]
NOTE: IT IS POSSIBLE THAT COVERAGE WILL EXPIRE IF SUFFICIENT PREMIUMS ARE NOT
PAID. SEE THE GRACE PERIOD PROVISION.
OWNER [THE INSURED]
INSUREDS [XXXX XXX] [MALE] [35] AGE [NEAREST] BIRTHDAY
[NON-NICOTINE STANDARD] RATING CLASS
[XXXX XXX] [FEMALE] [35] AGE [NEAREST] BIRTHDAY
[NON-NICOTINE STANDARD] RATING CLASS
POLICY NUMBER [N00000000]
POLICY DATE [JULY 1, 2001]
MONTHLY ANNIVERSARY DAY [1]
PLAN FLEXIBLE PREMIUM VARIABLE JOINT AND LAST SURVIVOR LIFE INSURANCE
$[150,000] SPECIFIED AMOUNT - DEATH BENEFIT OPTION [B]
[$50,000 INSURANCE AMOUNT - DEATH BENEFIT ENHANCEMENT RIDER]
POLICY NUMBER: N00000000
CHARGES:
MAXIMUM MONTHLY POLICY CHARGE: $ [10.00]
MAXIMUM POLICY INITIAL MONTHLY EXPENSE CHARGE PER $1,000 DURING THE FIRST 10
POLICY YEARS: $ [0.15]
MAXIMUM POLICY INCREASE MONTHLY EXPENSE CHARGE PER $1,000 DURING THE FIRST 10
POLICY YEARS THAT INCREASE IS EFFECTIVE: $ [0.15]
[DEATH BENEFIT ENHANCEMENT RIDER:]
[MAXIMUM INITIAL MONTHLY EXPENSE CHARGE PER $1,000: $ 0.15]
[MAXIMUM INCREASE MONTHLY EXPENSE CHARGE PER $1,000: $ 0.15]
MAXIMUM TRANSFER CHARGE: $ [20.00]
MORTALITY AND EXPENSE RISK CHARGE:
[0.40% ANNUALLY (.033272% MONTHLY) OF THE FIRST $100,000 OF UNLOANED
ACCOUNT
VALUE IN SEPARATE ACCOUNT; PLUS
0.05% ANNUALLY (.004166% MONTHLY) OF THE REMAINING UNLOANED
ACCOUNT VALUE
IN SEPARATE ACCOUNT DURING THE FIRST 20 POLICY YEARS]
SEPARATE ACCOUNT II
SUBACCOUNTS ARE INVESTED IN
[AIM VARIABLE INSURANCE FUNDS
AIM CAPITAL APPRECIATION - B AIM V.I. CAPITAL APPRECIATI0N FUND
AIM GROWTH -B AIM V.I. GROWTH FUND
AIM VALUE - B AIM V.I. VALUE FUND
ALLIANCE VARIABLE PRODUCTS SERIES FUND,INC.
AVP GROWTH & INCOME - B GROWTH AND INCOME PORTFOLIO
AVP PREMIER GROWTH - B PREMIER GROWTH PORTFOLIO
AVP QUASAR - B QUASAR PORTFOLIO
DREYFUS
DRF EMERGING MARKETS - B DREYFUS INVESTMENT PORTFOLIOS - EMERGING
MARKETS PORTFOLIO
DRF SOCIALLY RESPONSIBLE THE DREYFUS SOCIALLY RESPONSIBLE GROWTH FUND, INC.
GROWTH - B
FEDERATED INSURANCE SERIES
FED HIGH INCOME BOND - B FEDERATED HIGH INCOME BOND FUND II
FED INTERNATIONAL SMALL COMPANY - B FEDERATED INTERNATIONAL SMALL COMPANY FUND II
FIDELITY VARIABLE INSURANCE PRODUCTS FUND
FID EQUITY-INCOME - B EQUITY-INCOME PORTFOLIO
FID GROWTH - B GROWTH PORTFOLIO
FIDELITY VARIABLE INSURANCE PRODUCTS FUND II
FID CONTRAFUND - B CONTRAFUND PORTFOLIO
FIDELITY VARIABLE INSURANCE PRODUCTS FUND III
FID GROWTH & INCOME - B GROWTH & INCOME PORTFOLIO
FID MID CAP - B MID CAP PORTFOLIO
GE INVESTMENTS FUNDS, INC.
GEI MID-CAP VALUE EQUITY - B MID-CAP VALUE EQUITY FUND
GEI MONEY MARKET - B MONEY MARKET-FUND
GEI PREMIER GROWTH EQUITY - B PREMIER GROWTH EQUITY FUND
GEI S&P 500 INDEX - B * S&P 500 INDEX FUND
GEI SMALL-CAP VALUE EQUITY - B SMALL-CAP VALUE EQUITY FUND
GEI U.S. EQUITY - B U.S. EQUITY FUND
GEI VALUE EQUITY - B VALUE EQUITY FUND
JANUS ASPEN SERIES
JAN AGGRESSIVE GROWTH - B AGGRESSIVE GROWTH PORTFOLIO
JAN BALANCED - B BALANCED PORTFOLIO
JAN CAPITAL APPRECIATION - B CAPITAL APPRECIATION PORTFOLIO
JAN GLOBAL LIFE SCIENCES - B GLOBAL LIFE SCIENCES PORTFOLIO
JAN GLOBAL TECHNOLOGY - B GLOBAL TECHNOLOGY PORTFOLIO
JAN GROWTH - B GROWTH PORTFOLIO
JAN INTERNATIONAL GROWTH - B INTERNATIONAL GROWTH PORTFOLIO
JAN WORLDWIDE GROWTH - B WORLDWIDE GROWTH PORTFOLIO
P1259 IS CONTINUED EFFECTIVE 7/01/01
MFS VARIABLE INSURANCE TRUST
MFS INVESTORS GROWTH STOCK - B MFS INVESTORS GROWTH STOCK SERIES
MFS INVESTORS TRUST - B MFS INVESTORS TRUST SERIES
MFS NEW DISCOVERY - B MFS NEW DISCOVERY SERIES
MFS UTILITIES - B MFS UTILITIES SERIES
XXXXXXXXXXX VARIABLE ACCOUNT FUNDS
OPP GLOBAL SECURITIES/VA - B XXXXXXXXXXX GLOBAL SECURITIES FUND/VA
OPP MAIN STREET GROWTH & XXXXXXXXXXX MAIN STREET GROWTH & INCOME
INCOME/VA - B FUND/VA
PIMCO VARIABLE INSURANCE TRUST
PIM FOREIGN BOND - B FOREIGN BOND PORTFOLIO
PIM HIGH YIELD BOND - B HIGH YIELD BOND PORTFOLIO
PIM LONG-TERM LONG-TERM U.S. GOVERNMENT BOND
U.S. GOVERNMENT BOND - B PORTFOLIO
PIM TOTAL RETURN BOND - B TOTAL RETURN BOND PORTFOLIO
RYDEX VARIABLE TRUST
RYD OTC - B ** RYDEX OTC FUND]
GUARANTEE ACCOUNT
MINIMUM GUARANTEED INTEREST RATE [4%]
YOU MAY ALLOCATE YOUR PREMIUMS AND ACCOUNT VALUE TO AS MANY AS [TEN] SUBACCOUNTS
IN ADDITION TO ANY GUARANTEE ACCOUNT AT ANY ONE TIME. YOUR ALLOCATIONS OF EACH
PREMIUM MUST TOTAL 100%. EACH PREMIUM ALLOCATION MUST BE A WHOLE PERCENTAGE.
CONSULT YOUR PROSPECTUS FOR INVESTMENT DETAILS.
* "STANDARD & POOR'S," "S&P," "S&P 500," "STANDARD & POOR'S 500," AND "500" ARE
TRADEMARKS OF THE XXXXXX-XXXX COMPANIES, INC. AND HAVE BEEN LICENSED FOR USE BY
GE ASSET MANAGEMENT INCORPORATED. THE S&P 500 INDEX FUND IS NOT SPONSORED,
ENDORSED, SOLD OR PROMOTED BY STANDARD & POOR'S AND STANDARD & POOR'S MAKES NO
REPRESENTATION REGARDING THE ADVISABILITY OF INVESTING IN THE FUND.
** THE NASDAQ 100 INDEX IS AN UNMANAGED INDEX THAT IS A WIDELY RECOGNIZED
INDICATOR OF OTC MARKET PERFORMANCE.
EFFECTIVE 7/01/01
POLICY NUMBER: N00000000
[TABLE OF MAXIMUM PREMIUMS
FOR GUIDELINE PREMIUM LIFE INSURANCE COMPLIANCE TEST
POLICY MAXIMUM POLICY MAXIMUM
YEAR PREMIUM YEAR PREMIUM
1 16,980.44 36 59,533.92
2 16,980.44 37 61,187.64
3 16,980.44 38 62,841.36
4 16,980.44 39 64,495.08
5 16,980.44 40 66,148.80
6 16,980.44 41 67,802.52
7 16,980.44 42 69,456.24
8 16,980.44 43 71,109.96
9 16,980.44 44 72,763.68
10 16,980.44 45 74,417.40
11 18,190.92 46 76,071.12
12 19,844.64 47 77,724.84
13 21,498.36 48 79,378.56
14 23,152.08 49 81,032.28
15 24,805.80 50 82,686.00
16 26,459.52 51 84,339.72
17 28,113.24 52 85,993.44
18 29,766.96 53 87,647.16
19 31,420.68 54 89,300.88
20 33,074.40 55 90,954.60
21 34,728.12 56 92,608.32
22 36,381.84 57 94,262.04
23 38,035.56 58 95,915.76
24 39,689.28 59 97,569.48
25 41,343.00 60 99,223.20
26 42,996.72 61 100,876.92
27 44,650.44 62 102,530.64
28 46,304.16 63 104,184.36
29 47,957.88 64 105,838.08
30 49,611.60 65 & LATER 107,491.80
31 51,265.32
32 52,919.04
33 54,572.76
34 56,226.48
35 57,880.20
MAXIMUM PREMIUMS WILL VARY BASED ON SPECIFIED AMOUNT, RATING CLASS, AGE, GENDER
AND RIDER SELECTION. ACCORDING TO OUR UNDERSTANDING OF CURRENT FEDERAL TAX LAW,
YOU MAY NOT PAY MORE THAN THESE AMOUNTS CUMULATIVELY AND MAINTAIN THE TAX STATUS
OF THIS POLICY AS LIFE INSURANCE. THIS TABLE IS SUBJECT TO CHANGE. THIS TABLE
DOES NOT RELATE TO MODIFIED ENDOWMENT CONTRACT STATUS UNDER FEDERAL TAX LAW.]
P1259DP 7/01
POLICY NUMBER: [N000000000]
[TABLE OF NET SINGLE PREMIUMS AND FACTORS
FOR CASH VALUE ACCUMULATION LIFE INSURANCE COMPLIANCE TEST
ATTAINED AGE ATTAINED AGE BASE POLICY RIDER
XXXX XXX XXXX XXX NET SINGLE NET SINGLE
PREMIUM PREMIUM
FACTOR
35 35 0.15235 0.00
36 36 0.15844 0.00
37 37 0.16477 0.00
38 38 0.17135 0.00
39 39 0.17819 0.00
40 40 0.18529 0.00
41 41 0.19267 0.00
42 42 0.20033 0.00
43 43 0.20828 0.00
44 44 0.21654 0.00
45 45 0.22511 0.00
46 46 0.23401 0.00
47 47 0.24324 0.00
48 48 0.25281 0.00
49 49 0.26273 0.00
50 50 0.27302 0.00
51 51 0.28368 0.00
52 52 0.29473 0.00
53 53 0.30616 0.00
54 54 0.31798 0.00
55 55 0.33020 0.00
56 56 0.34283 0.00
57 57 0.35586 0.00
58 58 0.36931 0.00
59 59 0.38318 0.00
60 60 0.39747 0.00
61 61 0.41217 0.00
62 62 0.42729 0.00
63 63 0.44281 0.00
64 64 0.45870 0.00
65 65 0.47492 0.00
66 66 0.49147 0.00
67 67 0.50830 0.00
CONTINUED
P1259DP 7/01
POLICY NUMBER: [N000000000]
TABLE OF NET SINGLE PREMIUMS AND FACTORS
FOR CASH VALUE ACCUMULATION LIFE INSURANCE COMPLIANCE TEST
ATTAINED AGE ATTAINED AGE BASE POLICY RIDER
XXXX XXX XXXX XXX NET SINGLE NET SINGLE
PREMIUM PREMIUM
FACTOR
68 68 0.52541 0.00
69 69 0.54278 0.00
70 70 0.56039 0.00
71 71 0.57819 0.00
72 72 0.59608 0.00
73 73 0.61405 0.00
74 74 0.63195 0.00
75 75 0.64969 0.00
76 76 0.66716 0.00
77 77 0.68433 0.00
78 78 0.70114 0.00
79 79 0.71759 0.00
80 80 0.73366 0.00
81 81 0.74929 0.00
82 82 0.76441 0.00
83 83 0.77892 0.00
84 84 0.79271 0.00
85 85 0.80573 0.00
86 86 0.81797 0.00
87 87 0.82948 0.00
88 88 0.84033 0.00
89 89 0.85064 0.00
90 90 0.86054 0.00
91 91 0.87021 0.00
92 92 0.87985 0.00
93 93 0.88968 0.00
94 94 0.89999 0.00
95 95 0.91105 0.00
96 96 0.92298 0.00
97 97 0.93571 0.00
98 98 0.94882 0.00
99 99 0.96154 0.00
NET SINGLE PREMIUMS WILL VARY BASED ON RATING CLASS, AGE AND GENDER. ACCORDING
TO OUR UNDERSTANDING OF CURRENT FEDERAL TAX LAW, THE DEATH BENEFIT MUST MAINTAIN
THE RELATIONSHIP TO ACCOUNT VALUE ADJUSTED BY THE NET SINGLE PREMIUM AS
DESCRIBED IN THE DEATH PROCEEDS SECTION FOR THE CASH VALUE ACCUMULATION TEST IN
ORDER TO MAINTAIN THE TAX STATUS OF THIS POLICY AS LIFE INSURANCE. THIS TABLE IS
SUBJECT TO CHANGE. THIS TABLE DOES NOT RELATE TO MODIFIED ENDOWMENT CONTRACT
STATUS UNDER FEDERAL TAX LAW.]
POLICY NUMBER: N00000000
TABLE OF CONTINUATION AMOUNTS
POLICY CONTINUATION POLICY CONTINUATION
MONTH AMOUNT MONTH AMOUNT
[1 164.97 31 5,114.07
2 329.94 32 5,279.04
3 494.91 33 5,444.01
4 659.88 34 5,608.98
5 824.85 35 5,773.95
6 989.82 36 5,938.92
7 1,154.79 37 6,103.89
8 1,319.76 38 6,268.86
9 1,484.73 39 6,433.83
10 1,649.70 40 6,598.80
11 1,814.67 41 6,763.77
12 1,979.64 42 6,928.74
13 2,144.61 43 7,093.71
14 2,309.58 44 7,258.68
15 2,474.55 45 7,423.65
16 2,639.52 46 7,588.62
17 2,804.49 47 7,753.59
18 2,969.46 48 7,918.56
19 3,134.43 49 8,083.53
20 3,299.40 50 8,248.50
21 3,464.37 51 8,413.47
22 3,629.34 52 8,578.44
23 3,794.31 53 8,743.41
24 3,959.28 54 8,908.38
25 4,124.25 55 9,073.35
26 4,289.22 56 9,238.32
27 4,454.19 57 9,403.29
28 4,619.16 58 9,568.26
29 4,784.13 59 9,733.23
30 4,949.10 60 9,898.20]
CONTINUATION AMOUNTS WILL VARY BASED ON SPECIFIED AMOUNT, RATING CLASS, AGE,
GENDER AND RIDER SELECTION. CONTINUATION AMOUNTS ARE DESCRIBED IN THE
CONTINUATION AMOUNT AND CONTINUATION PERIOD PROVISION.
POLICY NUMBER: N00000000
TABLE OF SURRENDER CHARGES
POLICY SURRENDER POLICY SURRENDER POLICY SURRENDER POLICY SURRENDER
MONTH CHARGE MONTH CHARGE MONTH CHARGE MONTH CHARGE
[1 699.00 37 699.00 73 547.55 109 128.15
2 699.00 38 699.00 74 535.90 110 116.50
3 699.00 39 699.00 75 524.25 111 104.85
4 699.00 40 699.00 76 512.60 112 93.20
5 699.00 41 699.00 77 500.95 113 81.55
6 699.00 42 699.00 78 489.30 114 69.90
7 699.00 43 699.00 79 477.65 115 58.25
8 699.00 44 699.00 80 466.00 116 46.60
9 699.00 45 699.00 81 454.35 117 34.95
10 699.00 46 699.00 82 442.70 118 23.30
11 699.00 47 699.00 83 431.05 119 11.65
12 699.00 48 699.00 84 419.40 120 0.00]
13 699.00 49 699.00 85 407.75
14 699.00 50 699.00 86 396.10
15 699.00 51 699.00 87 384.45
16 699.00 52 699.00 88 372.80
17 699.00 53 699.00 89 361.15
18 699.00 54 699.00 90 349.50
19 699.00 55 699.00 91 337.85
20 699.00 56 699.00 92 326.20
21 699.00 57 699.00 93 314.55
22 699.00 58 699.00 94 302.90
23 699.00 59 699.00 95 291.25
24 699.00 60 699.00 96 279.60
25 699.00 61 687.35 97 267.95
26 699.00 62 675.70 98 256.30
27 699.00 63 664.05 99 244.65
28 699.00 64 652.40 100 233.00
29 699.00 65 640.75 101 221.35
30 699.00 66 629.10 102 209.70
31 699.00 67 617.45 103 198.05
32 699.00 68 605.80 104 186.40
33 699.00 69 594.15 105 174.75
34 699.00 70 582.50 106 163.10
35 699.00 71 570.85 107 151.45
36 699.00 72 559.20 108 139.80
SURRENDER CHARGES WILL VARY BASED ON SPECIFIED AMOUNT, RATING CLASS, AGE AND
GENDER.
POLICY NUMBER: N0000000
TABLE OF GUARANTEED MAXIMUM INSURANCE RATES
PER $1,000 OF NET AMOUNT AT RISK
AGE BASE POLICY DEATH BENEFIT
LIFE MONTHLY ENHANCEMENT
RATE RIDER RATE
[35 0.00021 0.00021
36 0.00067 0.00067
37 0.00121 0.00121
38 0.00186 0.00186
39 0.00266 0.00266
40 0.00360 0.00360
41 0.00477 0.00477
42 0.00613 0.00613
43 0.00775 0.00775
44 0.00962 0.00962
45 0.01184 0.01184
46 0.01443 0.01443
47 0.01748 0.01748
48 0.02105 0.02105
49 0.02522 0.02522
50 0.03015 0.03015
51 0.03603 0.03603
52 0.04312 0.04312
53 0.05169 0.05169
54 0.06186 0.06186
55 0.07389 0.07389
56 0.08796 0.08796
57 0.10405 0.10405
58 0.12230 0.12230
59 0.14365 0.14365
60 0.16895 0.16895
61 0.19908 0.19908
62 0.23597 0.23597
63 0.28156 0.28156
64 0.33723 0.33723
65 0.40308 0.40308
66 0.47990 0.47990
67 0.56784 0.56784
68 0.66736 0.66736
69 0.78170 0.78170
CONTINUED
POLICY NUMBER: N0000000
TABLE OF GUARANTEED MAXIMUM INSURANCE RATES
PER $1,000 OF NET AMOUNT AT RISK
AGE BASE POLICY DEATH BENEFIT
LIFE MONTHLY ENHANCEMENT
RATE RIDER RATE
70 0.91701 0.91701
71 1.08841 1.08841
72 1.27876 1.27876
73 1.52262 1.52262
74 1.81657 1.81657
75 2.16058 2.16058
76 2.55596 2.55596
77 3.00219 3.00219
78 3.49949 3.49949
79 4.05867 4.05867
80 4.69924 4.69924
81 5.44086 5.44086
82 6.30715 6.30715
83 7.31754 7.31754
84 8.46288 8.46288
85 9.73941 9.73941
86 11.12947 11.12947
87 12.63400 12.63400
88 14.23436 14.23436
89 15.95027 15.95027
90 17.78897 17.78897
91 19.78599 19.78599
92 22.00633 22.00633
93 24.56619 24.56619
94 27.80325 27.80325
95 32.43368 32.43368
96 40.11855 40.11855
97 55.18812 55.18812
98 83.33333 83.33333
99 83.33333 83.33333]
GUARANTEED MAXIMUM INSURANCE RATES WILL VARY BASED ON RATING CLASS AND GENDER.
TABLE OF CONTENTS
----------------------------------------------------------------------
Policy Data..................................................... 3
Definitions..................................................... 4
Introduction.................................................... 6
The Owner and the Beneficiary................................... 7
Premium Payments................................................ 8
Death Proceeds.................................................. 10
The Guarantee Account........................................... 13
The Separate Account............................................ 14
Account Value Benefits.......................................... 16
Loan Benefits................................................... 19
General Information............................................. 21
Optional Payment Plans.......................................... 22
A copy of the application and any riders and endorsements follow page 24.
DEFINITIONS
Account Value - The sum of the values under the Policy allocated to each
Investment Option and our General Account.
Attained Age - An Insured's age on the Policy Date plus the number of full years
since the Policy Date.
Beneficiary - The person or entity designated by the Owner to receive the Death
Proceeds.
The Company - GE Life and Annuity Assurance Company. "We", "us" or "our" refers
to the Company.
Continuation Amount - A cumulative amount set forth on the Policy data pages for
each month of the Continuation Period representing the minimum Net Total Premium
necessary to keep the Policy in effect.
Continuation Period - The period, shown on the Policy data pages, during which
the Policy will remain in effect if the Net Total Premium is at least equal to
the Continuation Amount for the number of Policy Months that the Policy has been
in effect.
Death Benefit - The benefit payable under the Policy upon the death of the last
Insured as determined as of the date of that Insured's death.
Death Proceeds - The actual amount payable to the Beneficiary.
Fund - Any open-end management investment company or unit investment trust in
which a Subaccount invests.
General Account - The assets of the Company other than those allocated to the
Separate Account or any other separate account of the Company.
4
5
Guarantee Account - A General Account Investment Option we offer under the
Policy. We credit fixed rates of interest on Account Value allocated to the
Guarantee Account for specified periods.
Home Office - The Company's offices at 0000 Xxxx Xxxxx Xxxxxx, Xxxxxxxx,
Xxxxxxxx 00000.
Insured(s) - The persons whose lives are insured under this Policy.
Investment Options - The Guarantee Account and the Subaccount(s) shown on the
Policy data pages.
Monthly Anniversary Day - The same day in each month as the Policy Date. This
day is shown on the Policy data pages.
Net Premium - The portion of each premium paid which is used in determining the
Account Value. It is equal to the premium paid times the Net Premium Factor.
Net Premium Factor - The factor used in determining the Net Premium which
reflects a deduction from each premium paid.
Net Total Premium - On any date, the total of all premiums paid to that date
less (a) divided by (b), where:
(a) is any outstanding Policy Debt, plus the sum of any partial surrenders to
date; and
(b) is the Net Premium Factor.
Optional Payment Plan - A plan whereby any part of Death Proceeds or Surrender
Value can be left with us to provide a series of periodic payments to an Owner
or Beneficiary.
Owner - The Owner of the Policy as named in this Policy. "You" or "your" refers
to the Owner. Contingent Owners may also be named.
Planned Periodic Premium - A level premium amount scheduled for payment at fixed
intervals over a specified period of time.
Policy - This Policy with any attached application(s), and any riders and
endorsements.
Policy Date - The date the Policy is issued and becomes effective. Policy years
and anniversaries are measured from the Policy Date. The Policy Date is shown on
the Policy data pages. If the Policy Date would otherwise fall on the 29th, 30th
or 31st of the month, the Policy Date will be the 28th.
Policy Debt - The amount of any outstanding loans plus accrued interest. Policy
Debt is deducted from proceeds payable at the death of the last Insured, or at
the time of surrender.
Policy Month - A one-month period beginning on a Monthly Anniversary Day and
ending on the day immediately preceding the next Monthly Anniversary Day.
Separate Account - The segregated asset account of the Company shown on the
Policy data pages.
Specified Amount - An amount used in determining the insurance coverage on an
Insured life. The Specified Amount is shown on the Policy data pages.
Subaccount - A subdivision of the Separate Account, the assets of which are
invested exclusively in a corresponding portfolio of a Fund.
Surrender Value - The amount payable to the Owner upon surrender of the Policy.
Unit Value - The unit of measure used to calculate the Account Value for each
Subaccount.
Valuation Day - For each Subaccount, each day on which the New York Stock
Exchange is open for regular trading except for days that the Subaccount's
corresponding Fund does not value its shares.
Valuation Period - The period that starts at the close of regular trading on the
New York Stock Exchange on any Valuation Day and ends at the close of regular
trading on the next succeeding Valuation Day.
INTRODUCTION
This is a flexible premium variable joint and last survivor life insurance
policy. The first premium payment is due on the Policy Date. Additional premiums
may be paid subject to conditions specified in the Premium Payments section. In
return for these premiums and the insurance application, we provide certain
benefits.
The Policy provides Death Proceeds. Proceeds will be paid to a retained benefit
account for lump sum distribution unless an Optional Payment Plan is chosen. No
Death Proceeds are payable until the death of the last Insured. (See Death
Proceeds section.)
The Policy has an Account Value. The Account Value reflects the investment
experience of the Investment Options. Account Value is the basis for certain
benefits you can use before the last Insured's death.
READ YOUR POLICY CAREFULLY.
Inforce Illustrations
We will provide an inforce illustration of future life insurance and Account
Value proceeds. To receive an illustration, send a written request to our Home
Office. You must pay any service fee in effect at that time. The fee will not be
more than $25 per illustration.
The illustration will assume:
. amounts of insurance;
. coverage options;
. future premium payments you specify; and
. other assumptions specified by you or by us.
When This Policy Will Terminate
All coverage under this Policy will terminate when:
. you request that coverage terminate and you return this Policy;
. the last Insured dies; or
. the grace period ends without sufficient premium being paid.
This Policy will also terminate as stated in the Suicide provision.
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THE OWNER AND THE BENEFICIARY
The Owner
You have rights in the Policy during either Insured's life. The Policy names the
Insureds. If you are not an Insured, you may name a contingent Owner who will
become the Owner if you die before either Insured. If you die before either
Insured and there is no contingent Owner, ownership passes to your estate. If
there are multiple Owners, they own the Policy jointly with rights of
survivorship. If the last surviving joint Owner dies before both Insureds,
ownership passes to any contingent Owner or to the estate of that joint Owner.
The Beneficiary
You may name primary and contingent Beneficiaries. Your original Beneficiary
choice is shown in the attached application. Unless an Optional Payment Plan is
chosen, Death Proceeds will be paid to a retained benefit account for the
primary Beneficiary. If the primary Beneficiary dies before the last Insured,
Death Proceeds will be paid to the contingent Beneficiary. If no Beneficiary
survives the last Insured, Death Proceeds will be paid to you or your estate.
You may name more than one primary or contingent Beneficiary. If you do, the
proceeds will be paid in equal shares to the survivors in the appropriate
Beneficiary class who survive the last Insured, unless you have requested
otherwise.
Changing the Owner or Beneficiary
During either Insured's life, you may change the Owner. You may also change the
Beneficiary during either Insured's life if you reserved this right.
How to Change the Owner or Beneficiary. To make a change, send a written request
to our Home Office. The request must be received by us in a form satisfactory to
us. The change will take effect as of the date you sign the request. The change
will be subject to any payment we make before we record the change.
Using the Policy as Collateral for a Loan
This Policy may be assigned as collateral security. We must be notified in
writing if you assign the Policy. Any payment we make before we record the
assignment at our Home Office will not be affected. We are not responsible for
the validity of an assignment. Your rights and the rights of any revocable
Beneficiary may be affected by an assignment.
Trustee
If a trustee is named as the Owner or Beneficiary of this Policy and exercises
ownership rights or claims benefits, we will have no obligation to verify that a
trust is in effect. We are not obligated to verify that the trustee is acting
within the scope of his/her authority. Payment of Policy benefits to the trustee
will release us from all obligations under the Policy to the extent of the
payment. We will have no obligation to ensure that a payment to the trustee is
applied according to the terms of the trust agreement.
PREMIUM PAYMENTS
This Policy's initial premium is due on the Policy Date.
Additional Premium Payments
Any premium payments after the first premium may be made under a periodic plan
or at any time while this Policy is in effect and before the younger Insured's
Attained Age of 100.
Periodic Premium Plan. You may request that we send reminders of your Planned
Periodic Premium. You may choose to send premiums directly to us either
annually, semi-annually, or quarterly. You may also arrange for pre-authorized
payments from your bank account or similar facility either annually, semi-
annually, quarterly or monthly. Planned Periodic Premiums will be subject to our
rules on the minimum amount.
You may change the frequency or amount of your Planned Periodic Premium. We
reserve the right to limit the amount of any increase in Planned Periodic
Premiums.
Unscheduled Payments. You may make an unscheduled premium payment at any time
while this Policy is in effect. Unscheduled payments are applied first to repay
any Policy Debt, unless you direct us otherwise. We reserve the right to limit
the number and amount of any unscheduled premium payments. We reserve the right
to require evidence, satisfactory to us, that the Insured is insurable at the
same rating class used at Policy issue. If satisfactory evidence is not provided
before such premium payment, we reserve the right to refund the premium.
Maximum Premiums. If you have chosen the Guideline Premium Life Insurance
Compliance Test, we will limit the total of all premiums paid to date for this
Policy to the amounts shown in the table of maximum premiums on the Policy data
pages. We may reject any premium, or any portion of a premium, that would result
in the Policy being disqualified as life insurance under the Internal Revenue
Code. We will refund any rejected premium along with any interest it accrued. We
reserve the right to change the table of maximum premiums when necessary as a
result of changes in coverage or to maintain compliance with the Internal
Revenue Code. If we do, we will send you a new table of maximum premiums
reflecting the adjusted amounts. If you have chosen the Cash Value Accumulation
Life Insurance Compliance Test, there are no limits on the amount of premiums
except as specified under the Unscheduled Payments provision above.
We reserve the right to amend this Policy as necessary to maintain compliance
with the Internal Revenue Code. We will send any such amendments to you. You
have the right to refuse such amendments and accept full responsibility for any
consequences as a result of such refusal. We also reserve the right to return
any premium with earnings thereon to maintain such compliance.
Where to Pay Premiums
Send each premium to our Home Office. Make the check payable to GE Life and
Annuity Assurance Company.
Allocation of Premiums
You may allocate the Net Premium to one or more Investment Options. You may not
allocate the Net Premium to more than the maximum number of Investment
Options shown on the Policy data pages. The minimum percentage of each Net
Premium which may be allocated to any particular Investment Option is shown on
the Policy data pages. Net Premiums will initially be allocated in accordance
with the allocations requested by you. You may change the allocation of Net
Premiums at any time without charge. To change your allocations send us a notice
at our Home Office. The notice must be in writing or in any form acceptable to
us. The changed allocation will apply to premiums received after we record the
change.
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Continuation Amount and Continuation Period
On any Monthly Anniversary Day during the Continuation Period, if the Surrender
Value of this Policy is not sufficient to cover the monthly deduction, this
Policy will remain in effect if the Net Total Premium is at least equal to the
Continuation Amount.
At the end of the Continuation Period, you may have to pay an additional premium
to keep the Policy in effect. (See Insufficient Surrender Value provision.)
An increase in Specified Amount will increase the Continuation Amounts. A
decrease in Specified Amount will reduce the Continuation Amounts. Any
termination and subsequent reinstatement of the Policy will reduce the
Continuation Amounts. We will send you a supplemental policy data page
reflecting the adjusted amounts. The Continuation Period will be as though the
Policy had been in effect continuously from its original Policy Date.
Grace Period
On any Monthly Anniversary Day during the Continuation Period, if (1) the
Surrender Value is not sufficient to cover the monthly deduction, and (2) the
Net Total Premium is less than the Continuation Amount, you must pay a premium
sufficient to keep the Policy in effect or coverage will terminate. The amount
of the sufficient premium will equal the lesser of (a) and (b), where:
(a) equals the monthly deduction due minus the Surrender Value, and that
result divided by the Net Premium Factor; and
(b) equals the Continuation Amount minus the Net Total Premium.
All amounts in (a) and (b) above are as of the Monthly Anniversary Day at the
beginning of the grace period. The monthly deduction is described in the ACCOUNT
VALUE BENEFITS section.
On any Monthly Anniversary Day after the Continuation Period, if the Surrender
Value is not sufficient to cover the monthly deduction, you must pay a premium
sufficient to keep the Policy in effect or coverage will terminate. In this
case, the amount of the sufficient premium will equal the monthly deduction due
minus the Surrender Value, and that result divided by the Net Premium Factor. As
used in this paragraph, the monthly deduction due and the Surrender Value are
both as of the Monthly Anniversary Day at the beginning of the grace period.
In either case, we will mail you written notice of the sufficient premium. This
notice will be sent to your last known address. You have a 61-day grace period
from the date we mail the notice to pay the sufficient premium.
Coverage continues during the 61-day grace period. If the death of the last
Insured occurs during the grace period, proceeds will be reduced by the amount
of the sufficient premium (as described in this provision) that would have been
required to keep the Policy in effect.
If the sufficient premium is not paid by the end of the grace period, this
Policy will terminate without value.
How This Policy Can Be Reinstated
You may reinstate this Policy within three years of the end of the grace period
if:
(1) you submit an application for reinstatement;
(2) you provide required evidence of insurability satisfactory to us that
each Insured is insurable at the same rating class used at policy
issue to determine the guaranteed maximum cost of insurance rate
scale;
(3) the Policy has not been surrendered for cash; and
(4) you pay the premium as described in this section.
The Policy will be reinstated effective on the date we approve the
reinstatement. The surrender charge and the Continuation Period will be as
though the Policy had been in effect continuously from its original Policy Date.
On the date of reinstatement, the Account Value will be allocated to the
Investment Options. Unless you tell us otherwise, these allocations will be made
in the same manner that Net Premiums are allocated.
If this Policy terminates and is reinstated before the end of the Continuation
Period, you will have to pay a premium equal to (1) minus (2) minus (3) plus
(4), where:
(1) is the Continuation Amount as of the date of reinstatement;
(2) is the sum of the monthly deductions that would have been made during
the period between termination and reinstatement, divided by the Net
Premium Factor;
(3) is the Net Total Premium on the date of termination; and
(4) is an amount sufficient to keep the Policy in effect for two Policy
Months after the date of reinstatement.
On the date of reinstatement, the Account Value will equal (a) plus (b) minus
(c), where:
(a) is the Account Value on the first day of the grace period;
(b) is the premium paid to reinstate multiplied by the Net Premium Factor;
and
(c) is the monthly deduction for the month following the date of
reinstatement.
If this Policy terminates before the end of the Continuation Period, and is
reinstated after the end of the Continuation Period, you will have to pay a
premium which, after multiplying it by the Net Premium Factor, equals (1) plus
(2) minus (3), where:
(1) is the surrender charge on the date of termination;
(2) is an amount equal to the monthly deductions for two months after the
date of reinstatement; and
(3) is the Account Value on the date of termination.
On the date of reinstatement, the Account Value will equal (a) plus (b) plus
(c), where:
(a) is the surrender charge in effect on the date of reinstatement;
(b) is an amount equal to the monthly deductions for the two months after
the date of reinstatement, minus the monthly deduction for the month
following the date of reinstatement; and
(c) is any premium paid in excess of the required reinstatement premium,
multiplied by the Net Premium Factor.
If this Policy terminates after the end of the Continuation Period and is
reinstated, you will have to pay a premium to keep the Policy in effect for at
least two months.
On the date of reinstatement, the Account Value will equal (a) plus (b) minus
(c), where:
(a) is the surrender charge in effect on the date of reinstatement;
(b) is the premium paid to reinstate multiplied by the Net Premium Factor;
and
(c) is the monthly deduction for the month following the date of
reinstatement.
DEATH PROCEEDS
Death Proceeds are payable at the death of the last Insured. No benefits are
payable at the death of the first Insured. We will process a claim for Death
Proceeds on this Policy when we receive:
. this Policy;
. due proof that both Insureds died while this Policy was in effect; and
. proof of the interest of the claimant.
Proceeds will be paid to a retained benefit account for lump sum distribution
unless an Optional Payment Plan is chosen. Any Death Proceeds that are paid in
one lump sum will include interest from the date of receipt of due proof of the
last Insured's death to the date of payment. Interest will be paid at a rate set
by us, or by law if greater. Interest will not be paid beyond one year or any
longer period set by law.
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How We Determine the Death Benefit
In the application for original coverage, you elected a method of compliance for
this Policy to be treated as life insurance according to the Internal Revenue
Code. The election that was made for this Policy is shown on the Policy data
pages. Once elected, the method cannot be changed at any time.
There are two possible methods:
(a) the Cash Value Accumulation Test, as defined in Internal Revenue Code
Section 7702(b); or
(b) the Guideline Premium Test, as defined in Internal Revenue Code
Section 7702(c).
Cash Value Accumulation Test:
If you elected the Cash Value Accumulation Test, you must also choose one of
three Death Benefit options.
Under option A for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is the Specified Amount plus the Account Value; and
(2) is (a) divided by (b), where:
(a) is the Account Value minus the rider net single premium; and
(b) is the base Policy net single premium factor.
Under option B for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is the Specified Amount; and
(2) is (a) divided by (b), where:
(a) is the Account Value minus the rider net single premium; and
(b) is the base Policy net single premium factor.
Under option C for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is (a) plus (b) minus (c) minus (d), where:
(a) is the Specified Amount;
(b) is the sum of all premiums paid before Attained Age 75 of the
younger Insured;
(c) is the charges for additional benefits, other than qualified
additional benefits as specified in Internal Revenue Code Section
7702(f)(5)(A);
(d) is the sum of all partial surrenders taken; and
(2) is (a) divided by (b), where:
(a) is the Account Value minus the rider net single premium; and
(b) is the base Policy net single premium factor.
Under options A, B and C for Attained Ages 100 and older, the Death Benefit is
the Account Value multiplied by 101%.
The Table of Net Single Premiums and Factors is shown on the Policy data pages.
These values are based on the Attained Age, gender and rating class of each
Insured.
Guideline Premium Test
If you elected the Guideline Premium Test, you must also choose one of two Death
Benefit options.
Under option A for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is the Specified Amount plus the Account Value; and
(2) is the Account Value multiplied by the corridor percentage.
Under option B for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is the Specified Amount; and
(2) is the Account Value multiplied by the corridor percentage.
Under option C for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is (a) plus (b) minus (c) minus (d), where:
(a) is the Specified Amount;
(b) is the sum of all premiums paid before Attained Age 75 of the
younger Insured;
(c) is the charges for additional benefits, other than qualified
additional benefits as specified in Internal Revenue Code Section
7702(f)(5)(A);
(d) is the sum of all partial surrenders taken; and
(2) is the Account Value multiplied by the corridor percentage.
Under options A, B and C for Attained Ages 100 and older, the Death Benefit is
the Account Value multiplied by 101%.
The corridor percentage depends on the Attained Age of the younger Insured. If
the younger Insured was the first to die, the Attained Age for referencing the
corridor percentage is that of the younger Insured as if he/she was still
living.
Younger Younger Younger Younger
Insured's Insured's Insured's Insured's
Attained Corridor Attained Corridor Attained Corridor Attained Corridor
Age Percentage Age Percentage Age Percentage Age Percentage
--- ---------- --- ---------- --- ---------- --- -----------
40 or 50 185% 61 128% 72 111%
younger 250% 51 178 62 126 73 109
41 243 52 171 63 124 74 107
42 236 53 164 64 122 75 105
43 229 54 157 65 120 through
44 222 55 150 66 119 90
45 215 56 146 67 118 91 104
46 209 57 142 68 117 92 103
47 203 58 138 69 116 93 102
48 197 59 134 70 115 94 or older 101
49 191 60 130 71 113
The Specified Amount and Account Value used in calculating the Death Benefit are
amounts in effect on the date of death of the last Insured.
In no event will the Benefit be less than the amount required to keep the Policy
qualified as life insurance.
How We Determine the Death Proceeds
The actual amount of Death Proceeds will depend on:
. the Death Benefit as determined above;
. the use of the Account Value;
. any partial surrenders;
. any Policy Debt plus loan interest accrued and payable to us;
. any additional insurance provided by rider;
. any increase or decrease in the Specified Amount;
. either Insured's suicide during the first two Policy years or during the
first two Policy years following an increase in existing coverage; and
. a misstatement of either Insured's age or gender.
Change in Existing Coverage
You may increase or decrease the Specified Amount as provided below. To make a
change, send a written request along with the Policy to our Home Office. We will
not accept the request for a change if either Insured is over our current
maximum age for issuing this Policy.
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Decrease in Specified Amount. After the Policy has been in effect for one year,
you may decrease the Specified Amount subject to the conditions listed in this
provision. Any decrease will become effective on the next Policy anniversary
after the date we receive the request. The decrease will first apply to coverage
provided by the most recent increase. Then the decrease will apply to the next
most recent increases successively. Next the decrease will apply to the coverage
provided under the original application.
During the Continuation Period, we will not allow a decrease unless the Account
Value less any Policy Debt is greater than the surrender charge. A decrease may
not cause the Specified Amount to be less than the minimum Specified Amount
shown on the Policy data pages. A decrease may cause a surrender charge to be
assessed and may require us to make a payment to you to keep the Policy
qualified as life insurance. If this event occurs, we will send you revised
Policy data pages. (See Surrender Charge on Decrease in Specified Amount in the
Surrender provision.)
Increase in Specified Amount. While both Insureds are living, you may apply for
an increase in Specified Amount using a supplemental application. We reserve the
right to only allow increases after the first Policy anniversary. You will have
to submit evidence satisfactory to us that each Insured is insurable at the same
rating class used at policy issue. An increase in Specified Amount may incur
additional surrender charges except for increases in Specified Amount resulting
from a change in Death Benefit options. Any approved increase will become
effective on the date shown in the supplemental Policy data pages. The approved
increase is subject to deduction of the first month's cost of increased
insurance from the Account Value of this Policy.
Change in Death Benefit Options
You may request a change to Death Benefit option A or B. Changes to Option C are
not permitted. After any such change, the Specified Amount will be that amount
which results in the Death Benefit after the change being equal to the Death
Benefit before the change.
Any change in Death Benefit options will become effective on the first Monthly
Anniversary Day after the date we receive the request in our Home Office. We
will not accept the request for a change if either Insured is over our current
maximum age for issuing this Policy.
THE GUARANTEE ACCOUNT
Amounts allocated to the Guarantee Account earn interest at the rate that
applies to the particular allocation. For each allocation, the applicable rate
will remain in effect for a specified period. The period is the interest rate
guarantee period. You may also make transfers, partial surrenders or loans from
the Guarantee Account. These transactions are described in the Policy.
Amounts allocated to the Guarantee Account become part of our General Account.
The General Account consists of our assets other than those allocated to our
separate accounts. Subject to statutory authority, we have sole discretion over
the investment of the assets of the General Account. Those assets may be charged
with liabilities arising out of any business we may conduct.
Any Surrender Value or Death Benefit under the Guarantee Account will not be
less than required by your state laws.
THE SEPARATE ACCOUNT
The Separate Account supports the operation of this Policy and certain other
variable life insurance policies we may offer. We will not allocate assets to
the Separate Account to support the operation of any contracts or policies that
are not variable life insurance.
We own the assets in the Separate Account. These assets are held separately from
our other assets. They are not part of our General Account.
The Separate Account is registered with the Securities and Exchange Commission
as a unit investment trust under the Investment Company Act of 1940. The
Separate Account is also subject to Xxxxxxxx xxxx which regulate the operations
of insurance companies incorporated in Virginia. The investment policy of the
Separate Account will not be changed without the approval of the Virginia
Insurance Commissioner. The approval process is on file with the Insurance
Commissioner of the state in which this Policy was delivered.
Insulation of Assets
The Separate Account assets equal the reserves and other Policy liabilities
supported by the Separate Account. These assets will not be charged with
liabilities arising from any other business we conduct. We have the right to
transfer to our General Account any assets of the Separate Account which are in
excess of such reserves and other Policy liabilities.
Subaccounts
The Separate Account is divided into Subaccounts. Each Subaccount's income,
gains and losses, realized or unrealized, are credited to or charged against
that Subaccount. This transaction is made without regard to other income, gains
or losses of the Company or any other Subaccount.
The Subaccounts available under this Policy are shown on the Policy data pages.
Each Subaccount invests exclusively in a Fund. Shares of a Fund are purchased
and redeemed at their net asset value. Any income, dividends or gains
attributable to Fund shares are reinvested in additional Fund shares at net
asset value.
Changes to the Separate Account and Subaccounts
Where permitted by applicable law, we may:
. create new separate accounts;
. combine separate accounts, including the Separate Account;
. transfer assets of the Separate Account to another separate account;
. add new Subaccounts to or remove existing Subaccounts from the Separate
Account or combine Subaccounts;
. make Subaccounts (including new Subaccounts) available to such classes
of policies as we may determine;
. add new Funds or remove existing Funds;
. substitute new Funds for any existing Fund whose shares are no longer
available for investment;
. substitute new Funds for any existing Fund which we determine is no
longer appropriate in light of the purposes of the Separate Account;
. deregister the Separate Account under the Investment Company Act of 1940;
and
. operate the Separate Account under the direction of a committee or in any
other form permitted by law.
In the event of any substitution or change, we may make such changes in this and
other policies as may be necessary or appropriate to reflect the substitution or
change.
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Valuation of Separate Account Assets
We will value the assets of the Separate Account each Valuation Day at their
fair market value. The valuation will be done in accordance with accepted
accounting practices and applicable laws and regulations.
Unit Value
Each Subaccount has a Unit Value. When Net Premiums or other amounts are
transferred into a Subaccount, a number of units are purchased based on that
Subaccount's Unit Value as of the end of the Valuation Period during which the
transfer is made. Likewise, when amounts are transferred out of a Subaccount,
units are redeemed in a similar manner.
The Unit Value of each Subaccount was arbitrarily set when the Subaccount began
operations. The Unit Value for each subsequent Valuation Period is the net
investment factor for that period, multiplied by the Unit Value for the
immediately preceding period. The Unit Value for a Valuation Period applies to
each day in the period.
Each Subaccount has its own net investment factor. In the following definition,
"assets" refers to the assets in each Subaccount. "Any amount charged against
the Separate Account" refers to those amounts that are allocated to each
Subaccount.
The net investment factor for a Valuation Period is (a) divided by (b), where:
(a) is the result of:
1. the value of the assets at the end of the preceding Valuation Period;
plus
2. the investment income and capital gains, realized or unrealized,
credited to those assets at the end of the Valuation Period for which
the net investment factor is being determined; minus
3. the capital losses, realized or unrealized, charged against those assets
during the Valuation Period; minus
4. any amount charged against the Separate Account for taxes, or any amount
we set aside during the Valuation Period as a provision for taxes
attributable to the operation or maintenance of the Separate Account;
and
(b) is the value of the assets in the Subaccount at the end of the preceding
Valuation Period.
Transfers
You may transfer Account Value among the Investment Options. The transfer will
be effective as of the end of the Valuation Period during which we receive your
request at our Home Office. You must request a transfer in writing or in any
other form acceptable to us. We do not currently charge for transfers. We
reserve the right to impose a transfer charge for each transfer after the
twelfth transfer in a calendar year. The maximum amount of any transfer charge
is provided on the Policy data pages. When we make transfers, the Account Value
on the date of the transfer will not be affected by the transfer except to the
extent of any transfer charge. Any transfer charge will be taken from the amount
transferred.
Transfers involving the Guarantee Account will be effective on the date we
receive your request at our Home Office. With respect to transfers between the
Guarantee Account and the Separate Account, we reserve the right to impose the
following restrictions:
. For each allocation to the Guarantee Account, you have 30 days following the
end of its interest rate guarantee period to transfer to the Separate
Account.
. We may limit the amount which may be transferred from the Guarantee Account.
We will not limit it to less than 25% of the original allocation,
plus any accrued interest on that allocation.
. No transfers from the Separate Account to the Guarantee Account may be made
during the six month period following the transfer of any amount from the
Guarantee Account to the Separate Account.
We reserve the right to limit, upon written notice, the number of transfers each
calendar year to twelve. Also, we reserve the right to refuse to execute any
transfer:
(1) if any of the Subaccounts that would be affected by the transfer is unable
to purchase or redeem shares of the Fund in which the Subaccount invests;
or
(2) if the transfer is a result of more than one trade involving the same
Subaccount within a 30 day period; or
(3) if necessary for the Policy to be treated as a life insurance policy under
the Internal Revenue Code of 1986, as amended; or
(4) if the transfer would adversely affect accumulation unit values. This may
occur if the transfer would affect one percent or more of the relevant
Fund's total assets.
Where permitted by law, we may accept your authorization of third party
transfers. We may restrict the Subaccounts that will be available to you for
transfers. This restriction may occur during any period such third party is
authorized to act for you. We will give you prior notice of any restrictions. We
will not enforce such restrictions if you provide us with satisfactory evidence
that:
(1) a court of competent jurisdiction has appointed such third party to act for
you; or
(2) you have appointed such third party to act for you for all of your
financial affairs.
ACCOUNT VALUE BENEFITS
How We Determine Account Value
The Account Value of the Policy is equal to:
(a) the Account Value allocated to the Subaccounts; plus
(b) the Account Value allocated to the Guarantee Account; plus
(c) the Account Value held in the General Account to secure Policy Debt.
Account Value in the Separate Account
At the end of the Valuation Period during which the initial premium is received,
the Account Value in each Subaccount is (a) minus (b), where:
(a) is the portion of the initial Net Premium which has been paid and allocated
to that Subaccount; and
(b) is the portion of any due and unpaid monthly deductions allocated to the
Account Value in that Subaccount.
At the end of each Valuation Period after such date, the Account Value
allocated to each Subaccount is (a) plus (b) plus (c) minus (d) minus (e)
minus (f), where:
(a) is the Account Value allocated to the Subaccount at the end of the
preceding Valuation Period, multiplied by the Subaccount's net investment
factor for the current period;
(b) is Net Premiums received during the current Valuation Period that have been
allocated to the Subaccount;
(c) is any other amounts transferred into the Subaccount during the current
Valuation Period;
(d) is the Account Value transferred out of the Subaccount during the current
Valuation Period;
(e) is any partial surrender made from the Subaccount during the current
Valuation Period; and
(f) is any monthly deduction allocated to the Subaccount during the current
Valuation Period.
Account Value in the Guarantee Account
The Account Value in the Guarantee Account is (a) plus (b) minus (c) minus (d),
where:
(a) is the sum of all amounts allocated to it;
(b) is any interest credited on those amounts;
(c) is any amounts removed by transfer, partial surrender or loan; and
(d) is any amounts deducted for charges made under the Policy and any riders.
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17
You may distribute any allocation to one or more of the interest rate guarantee
periods available at the time of your allocation. Unless you choose otherwise,
the initial interest rate guarantee period will be one year. Each interest rate
guarantee period must be at least one year. At the end of each interest rate
guarantee period, a new interest rate guarantee period of one year, with a new
rate, will begin. We will notify you of the new rate.
We determine interest rates that apply to allocations to the Guarantee Account.
This determination is made in our sole discretion. The minimum guaranteed
interest rate is shown on the Policy data pages.
How We Determine Net Premium
To calculate the Net Premium, we multiply the premium paid times the Net Premium
Factor.
The minimum Net Premium Factor is shown on the Policy data pages. We may use a
Net Premium Factor greater than the minimum Net Premium Factor at our sole
discretion.
Monthly Deduction
The monthly deduction is a charge made on the Policy Date and each Policy Month
thereafter against the Account Value allocated to the Investment Options. The
monthly deduction is equal to the sum of:
. the cost of any additional benefits provided by rider;
. monthly Policy charge;
. mortality and expense risk charge;
. Policy initial monthly expense charge;
. Policy increase monthly expense charge; and
. monthly cost of insurance charge.
Monthly Policy Charge. The actual monthly Policy charge will never be greater
than the maximum monthly Policy charge shown on the Policy data pages.
Mortality and Expense Risk Charge. Beginning on the Policy Date and on each
Policy Month thereafter, there will be a charge for the mortality and expense
risk multiplied by the Account Value in the Separate Account prior to taking the
monthly deduction. This charge is shown on the Policy data pages.
Policy Initial Monthly Expense Charge. The initial monthly expense charge will
be included in the monthly deduction for a period of time. The maximum amount of
the charge per $1,000 of initial Specified Amount and the maximum duration for
the charge are shown on the Policy data pages.
Policy Increase Monthly Expense Charge. The increase monthly expense charge will
be included in the monthly deduction for a period of time. The maximum amount of
the charge per $1,000 of increase in Specified Amount and the maximum duration
for the charge are shown on the Policy data pages. The increase charge will not
apply to changes in Death Benefit options.
Cost of Insurance Charge. The monthly deduction will also include a charge for
the cost of insurance. The charge for the cost of insurance will not be deducted
following the Policy anniversary nearest the Insured's 100th birthday.
The monthly deduction for the mortality and expense risk charge will be
allocated among the Subaccounts in the same proportion that the Policy's Account
Value in each Subaccount bears to the total Account Value in all Subaccounts at
the beginning of the Policy Month. The monthly deduction for all other charges
will be taken from each Investment Option in the same proportion that the
Account Value in that Investment Option bears to the total Account Value in all
Investment Options.
Cost of Insurance
Current Cost of insurance Charge. The current cost of insurance charge is
calculated on each Monthly Anniversary Day. The monthly charge is based on each
Insured's gender, issue age, Policy duration and rating class. The cost of
insurance rates are determined according to our expectations of future
experience for mortality, lapses, taxes, interest and expenses. We can change
the charges from time to time, but they will never be more than the guaranteed
maximum charge. A change in charges will apply to all persons of the same age,
gender and rating class and whose policies have been in effect for the same
length of time.
Guaranteed Cost of Insurance Charge. The guaranteed maximum charge is calculated
on each Monthly Anniversary Day. The guaranteed maximum charge is based on the
net amount at risk. The net amount at risk is calculated by dividing the Death
Benefit by 1.0032737, and then subtracting the Account Value. To determine the
guaranteed maximum cost of insurance for a particular Policy Month, we divide
the net amount at risk by 1000 and multiply that result by the applicable cost
of insurance rate shown in the Table of Guaranteed Maximum Insurance Rates.
Insufficient Surrender Value
On a Monthly Anniversary Day, if the Surrender Value is not enough to cover the
monthly deduction for that Monthly Anniversary Day, the Grace Period provision
will apply.
Surrender
You can surrender this Policy by sending a written request and the Policy to our
Home Office. The surrender must take place prior to the death of the second
Insured to die. Unless an Optional Payment Plan is chosen, any proceeds will be
paid to you in a lump sum.
The amount payable on surrender is the Surrender Value. The Surrender Value is
(a) minus (b) minus (c), where:
(a) is the Account Value on the date we receive your request for surrender in
our Home Office;
(b) is any Policy Debt; and
(c) is any surrender charge that applies.
Surrender Charge
We will charge a surrender charge during the surrender charge period in the case
of a full surrender of this Policy, and for decreases in Specified Amount as
described below. An increase in Specified Amount may incur additional surrender
charges. The amount of surrender charge is shown on the Policy data pages. The
surrender charge period is the period of Policy Months for which a surrender
charge is shown on the policy data pages.
Surrender Charge on Increase in Specified Amount. If the Specified Amount is
increased, we may charge additional surrender charges except for increases in
Specified Amount resulting from a change in Death Benefit options. Any approved
increase will be indicated on a supplemental Policy data pages that you will
be sent.
Surrender Charge on Decrease in Specified Amount. If the Specified Amount is
decreased to less than the smallest Specified Amount that had previously been in
effect, we may charge a surrender charge.
The amount of the surrender charge will be based :
(1) first on any charge in effect on the most recent increase and the amount
of reduction to this increase caused by the decrease;
(2) then on any surrender charge in effect on the next most recent increases
successively and the amount of any reduction to each of these increases
caused by the decrease; and
(3) finally on the surrender charge in effect on coverage provided under the
original application and any reduction to this amount caused by the
decrease.
Surrender charges in effect prior to the decrease will be adjusted to reflect
any assessments made.
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19
Partial Surrender
You can make a partial surrender of this Policy. A partial surrender cannot be
less than $200. A partial surrender cannot exceed the lesser of:
. the Surrender Value, less $200; or
. the available loan amount.
We generally will reduce both the Account Value and the Death Proceeds by the
amount of any partial surrender. A partial surrender will not be permitted
during the first Policy year if Death Benefit option B is in effect.
You may tell us how to deduct a partial surrender from the Investment Options.
If you do not, the partial surrender will be taken from each Investment Option
in the same proportion that the Account Value in that Investment Option bears to
the total Account Value in all Investment Options.
We may deduct a charge from the amount of each partial surrender. This charge
will not exceed the lesser of (i) $25, or (ii) 2% of the amount of the partial
surrender.
Postponement of Payments
We will usually pay any amounts payable as a result of surrender, partial
surrender or Policy loan within seven days after we receive written request in
our Home Office, in a form satisfactory to us. We will usually pay any Death
Proceeds within seven days after we receive due proof of death.
Payment of any amount for surrender, partial surrender, Policy loan or Death
Proceeds may be postponed whenever:
. the New York Stock Exchange is closed other than customary week-end and
holiday closings, or trading on the New York Stock Exchange is restricted
as determined by the Securities and Exchange Commission; or
. the Securities and Exchange Commission by order permits postponement for
the protection of policyowners; or
. an emergency exists, as determined by the Securities and Exchange
Commission, as a result of which disposal of securities is not reasonably
practicable or it is not reasonably practicable to determine the value of
the net assets of the Separate Account.
We have the right to defer payment which is derived from any amount recently
paid to us by check or draft, until we are satisfied the check or draft has been
paid by the bank on which it was drawn.
We reserve the right to defer payment of any amounts from the Guarantee Account
for up to six months. We will not defer if the law requires us to pay earlier.
We will not defer if the amount payable is to be used to pay premiums on
policies with us.
LOAN BENEFITS
This Policy has loan benefits that are described below. Any outstanding Policy
Debt will be deducted from Death Proceeds, or on surrender.
Making A Policy Loan
You may obtain a Policy loan from us. This Policy is the only security required.
The minimum loan amount is $500. The maximum loan amount is 90% of the
difference between (a) the Account Value and (b) any surrender charge on the
date of the loan. The available loan amount is the maximum loan amount less any
outstanding Policy Debt.
When a Policy loan is made, an amount of Account Value sufficient to secure the
loan is transferred into our General Account. You may tell us how to deduct this
Account Value from the Investment Options. If you do not, the Account Value will
be taken from each Investment Option in the same proportion that the Account
Value in that Investment Option bears to the total Account Value in all
Investment Options.
Account Value in the General Account will earn interest daily at a minimum
annual rate of 4%.
Any loan transaction will permanently affect the values of the Policy.
Policy Loan Interest
The interest rates charged for Policy loans are shown on the Policy data pages.
Interest accrues daily, and is due and payable on each Policy anniversary or on
surrender or at the death of the last Insured. If interest is not paid when due,
an amount equal to the amount owed will be transferred out of the Investment
Options and into our General Account to become part of the Policy Debt and
interest will be charged on that amount. Interest transferred out of the
Investment Options will be transferred from each Investment Option in the same
proportion that the Account Value in that Investment Option bears to the total
Account Value in all Investment Options at the time of interest transfer.
Repaying Policy Debt
You can repay Policy Debt in part or in full any time during either Insured's
life while this Policy is in effect. When a loan repayment is made, Account
Value in the General Account related to that payment will be transferred into
the Investment Options. You may tell us how to allocate this Account Value among
each Investment Option. If you do not, we will allocate that amount among the
Investment Options in the same proportion that Net Premiums are being allocated.
If you do not repay Policy Debt, it will be deducted from any proceeds or
benefit payable at the death of the last Insured or on surrender. Any Policy
Debt which exists at the end of the 61-day grace period will be deducted from
the Account Value and considered repaid as of the date of termination.
Minimum Loan Payment
During the Continuation Period, if Policy Debt on any Monthly Anniversary Day
exceeds the Account Value less any surrender charge that applies, and the Net
Total Premium is less than the Continuation Amount, your Policy will enter a 61-
day grace period. You will have the 61-day grace period to pay a minimum loan
payment equal to the lesser of (a) and (b), where:
(a) equals the amount by which Policy Debt exceeds the Account Value less
any surrender charge; and
(b) equals the Net Premium Factor times the difference between the
Continuation Amount and the Net Total Premium.
All amounts in (a) and (b) above are as of the Monthly Anniversary Day when
excess Policy Debt first occurs.
After the Continuation Period, if Policy Debt on any Monthly Anniversary Day
exceeds the Account Value less any surrender charge that applies, your Policy
will enter a 61-day grace period. In this case, you will have the 61-day grace
period to pay a minimum loan payment equal to the amount by which Policy Debt
exceeds the Account Value less any surrender charge. As used in this paragraph,
Policy Debt, Account Value and surrender charge are all as of the Monthly
Anniversary Day when excess Policy Debt first occurs.
20
21
We will send written notice of the minimum loan payment to you and any assignee
of record at our Home Office at least 30 days prior to the date of termination.
If you do not pay the minimum loan payment by the end of the grace period, your
Policy will terminate without value.
GENERAL INFORMATION
Annual Statement
On each Policy anniversary, we will send you an annual statement. The statement
will show the Specified Amount, the Account Value, the Surrender Value and
Policy Debt as of the Policy anniversary. The statement will also show premiums
paid and charges made during the Policy year.
Calculation of Values
Our calculations of the guaranteed maximum cost of insurance rates are based on
the Commissioners' 1980 Standard Ordinary Smoker or Nonsmoker Mortality Tables
(age nearest birthday).
The values provided for in this Policy are always at least what is required by
law of the state where the Policy was delivered. A detailed statement of how we
calculate the values in this Policy has been filed with the insurance department
of the state where the Policy was delivered.
Limits on Contesting This Policy
In deciding to issue this Policy, we relied on statements in the application for
the Policy. If we increase the Specified Amount or reinstate the Policy after it
lapses, we rely on statements in a supplemental application or a reinstatement
application. The statements in all such applications are considered
representations and not warranties.
We can contest this Policy, an increase in Specified Amount and/or a
reinstatement of this Policy, if:
. any material misrepresentation of fact was made in the application, a
supplemental application or a reinstatement application; and
. a copy of that application was attached to the Policy when issued or
delivered, or was made a part of the Policy when a change in coverage
or Policy reinstatement went into effect.
With respect to the original Specified Amount, we will not contest this Policy
after it has been in effect during the lifetimes of both Insureds for two years
from its Policy Date. We will not contest an increase in Specified Amount after
that increase has been in effect during the lifetimes of both Insureds for two
years from the effective date of the increase. We will not contest a
reinstatement of this Policy after the reinstated Policy has been in effect
during the lifetimes of both Insureds for two years from the date of
reinstatement.
This provision does not apply to riders that provide disability benefits.
Misstatement of Age or Gender
If either Insured's age or gender was misstated in an application, the Death
Benefit will be adjusted. The Death Benefit after adjustment will be the sum of
(a) and (b), where:
(a) is the Account Value at the time of the death
of the last Insured; and
(b) is the unadjusted Death Benefit, reduced by the Account Value at the
time of the death of the last Insured, and multiplied by the ratio of
(1) the most recent monthly deduction based on each age and gender
shown in the application, to (2) the most recent monthly deduction
based on each true age or gender.
All amounts are those in effect, with respect to each Insured, in the Policy
Month of the death of the last Insured.
In no event will the Death Benefit be less than the amount required to keep the
Policy qualified as life insurance.
Nonparticipating
This is not a participating Policy. No dividends are payable.
The Policy and Its Parts
The Policy with any attached application(s), and any riders and endorsements is
a legal contract. It is the entire contract between you and us. An agent cannot
change this contract. Any change to it must be in writing and approved by us.
Only an authorized officer of the Company can give our approval.
We will not use any statement in the original application to deny a claim unless
a copy of that application was attached to this Policy when issued or delivered.
We will not use any statement in a supplemental application to deny a claim
unless a copy of that application was sent to you when the change in coverage
went into effect. We will not use any statement in a reinstatement application
to deny a claim unless a copy of the reinstatement application was sent to you
when the Policy was reinstated.
Suicide
If either Insured commits suicide, while sane or insane, within two years of the
Policy Date, all coverage under the Policy will end, and we will pay a refund to
the Beneficiary. The amount of the refund will equal all premiums paid on the
Policy, less Policy Debt and partial surrenders.
If the first Insured commits suicide, while sane or insane, more than two years
after the Policy Date and within two years after an increase in the Specified
Amount became effective the Specified Amount will be reduced to the amount in
effect prior to the increase. The amount payable to the Beneficiary with respect
to the increase will equal the monthly deductions that were made for that
increase.
If the last Insured commits suicide, while sane or insane, more than two
years after the Policy Date and within two years after an increase in the
Specified Amount became effective, we will limit the amount of proceeds payable
with respect to the increase. The limited amount of proceeds with respect to the
increase will equal the additional premium payment required for the increase.
Any limited amount payable will be treated as Death Proceeds and paid to the
Beneficiary under the same conditions as the original Specified Amount.
Written Notice
Any written notice to us should be sent to our Home Office at 0000 Xxxx Xxxxx
Xxxxxx, Xxxxxxxx, Xxxxxxxx 00000. Please include the Policy number and each
Insured's full name.
Any notice we send to you will be sent to your last known address. Notify us of
any change of address.
OPTIONAL PAYMENT PLANS
Death Proceeds or Surrender Value will be paid in one lump sum, unless requested
otherwise. Any part of the proceeds can be left with us and paid under a payment
plan. During either Insured's life, you can choose a plan. A Beneficiary can
choose a plan if you have not chosen one at the death of the second Insured to
die.
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23
There are several important payment plan rules:
. The payee under a plan cannot be a corporation, association or fiduciary.
. If you change a Beneficiary, your plan selection will no longer be in
effect unless you request that it continue.
. Any choice or change of a plan must be sent in writing to our Home Office.
. The amount of each payment under a plan must be at least $50.
. Payments will begin either on the date of death of the last Insured or on
surrender, except for payments under Plan 4 which begin at the end of the
first interest period.
. Payments are backed by assets in our General Account.
Plan 1. Income for A Fixed Period. We will make equal periodic payments for a
fixed period, not longer than 30 years. Payments can be annual, semi-annual,
quarterly or monthly. Payments will be made according to the table in
this section. Guaranteed amounts payable under this plan will earn interest at
3% compounded yearly. We may increase the interest and the amount of any
payment. If the payee dies, the amount of the remaining guaranteed payments will
be discounted to the date of the payee's death at a yearly rate of 3%.
Discounted means we will deduct the amount of interest each remaining payment
would have included had it not been paid out early. The discounted amount will
be paid in one sum to the payee's estate unless otherwise provided.
Plan 2. Life Income. We will make equal monthly payments for a guaranteed
minimum period. If the payee lives longer than the minimum period, payments will
continue for his or her life. The minimum period can be 10, 15 or 20 years.
Payments will be according to the table in this section. Guaranteed amounts
payable under this plan will earn interest at 3% compounded yearly. We may
increase the interest rate and the amount of any payment. If the payee dies
before the end of the guaranteed period, the amount of remaining payments for
the minimum period will be discounted at the same interest rate used to
calculate the monthly income. The discounted amounts will be paid in one sum to
the payee's estate unless otherwise provided.
Plan 3. Income of A Definite Amount. We will make equal periodic payments of a
definite amount. Payments can be annual, semi-annual, quarterly or monthly. The
amount paid each year must be at least $120 for each $1,000 of proceeds.
Payments will continue until the proceeds are exhausted. The last payment will
equal the amount of any unpaid proceeds. Unpaid proceeds will earn interest at
3% compounded yearly. We may increase the interest rate. If we do, the payment
period will be extended. If the payee dies, the amount of the remaining proceeds
with earned interest will be paid in one sum to his or her estate unless
otherwise provided.
Plan 4. Interest Income. We will make periodic payments of interest earned from
the proceeds left with us. Payments can be annual, semi-annual, quarterly or
monthly, and will begin at the end of the first period chosen. Proceeds left
under this plan will earn interest at 3% compounded yearly. We may increase the
interest rate and the amount of any payment. If the payee dies, the amount of
remaining proceeds and any earned but unpaid interest will be paid in one sum to
his or her estate unless otherwise provided.
Plan 5. Joint Life and Survivor Income. We will make equal monthly payments to
two payees for a guaranteed minimum of 10 years. Each payee must be at least 35
years old when payments begin. The guaranteed amount payable under this plan
will earn interest at 3% compounded yearly. We may increase the interest rate
and the amount of any payment. Payments will continue as long as either payee is
living. If both payees die before the end of the minimum period, the amount of
the remaining payments for the 10 year period will be discounted at the same
interest rate used to calculate the monthly income. The discounted amount will
be paid in one sum to the survivor's estate unless otherwise provided.
Plan 1 Table: Monthly payment rates for each $1,000 of proceeds under Plan 1.
--------------------------------------------------------------------------------------------------------------------
Years
Payable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
--------------------------------------------------------------------------------------------------------------------
Monthly
Payment $84.47 $42.86 $28.99 $22.06 $17.91 $15.14 $13.16 $11.68 $10.53 $ 9.61 $ 8.86 $ 8.24 $ 7.71 $ 7.26 $ 6.87
====================================================================================================================
Years
Payable 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
--------------------------------------------------------------------------------------------------------------------
Monthly
Payment $ 6.53 $ 6.23 $ 5.96 $ 5.73 $ 5.51 $ 5.32 $ 5.15 $ 4.99 $ 4.84 $ 4.71 $ 4.59 $ 4.47 $ 4.37 $ 4.27 $ 4.18
--------------------------------------------------------------------------------------------------------------------
Annual, semi-annual or quarterly payments are determined by multiplying the
monthly payment by 11.838, 5.963 or 2.992, respectively.
Plan 2 Table: Monthly payment rates each $1,000 of proceeds under Plan 2.
------------------------------------------------------------------------------------------------------------------------------------
Settlement Settlement
Age Male Payee Female Payee Age Male Payee Female Payee
----------------------------------------------------- -------------------------------------------------------
10 Years 15 Years 20 Years 10 Years 15 Years 20 Years 10 Years 15 Years 20 Years 10 Years 15 Years 20 Years
Certain Certain Certain Certain Certain Certain Certain Certain Certain Certain Certain Certain
------------------------------------------------------------------------------------------------------------------------------------
20 $2.90 $2.89 $2.89 $2.80 $2.80 $2.80 65 $5.44 $5.17 $4.83 $4.85 $4.72 $4.54
25 2.99 2.98 2.98 2.88 2.87 2.87 66 5.58 5.28 4.89 4.97 4.83 4.62
30 3.10 3.10 3.09 2.96 2.96 2.96 67 5.74 5.38 4.96 5.10 4.93 4.69
35 3.24 3.24 3.23 3.08 3.07 3.07 68 5.89 5.49 5.02 5.24 5.04 4.77
40 3.43 3.41 3.39 3.22 3.21 3.20 69 6.05 5.60 5.08 5.39 5.16 4.84
45 3.66 3.64 3.60 3.40 3.39 3.37 70 6.22 5.70 5.13 5.55 5.28 4.92
50 3.95 3.91 3.85 3.63 3.61 3.59 71 6.39 5.81 5.18 5.71 5.39 4.99
51 4.02 3.97 3.91 3.68 3.66 3.63 72 6.57 5.91 5.23 5.88 5.51 5.05
52 4.09 4.04 3.96 3.74 3.72 3.68 73 6.75 6.01 5.27 6.06 5.63 5.12
53 4.16 4.11 4.02 3.80 3.77 3.74 74 6.93 6.10 5.31 6.25 5.75 5.17
54 4.24 4.18 4.08 3.86 3.83 3.79 75 7.12 6.19 5.35 6.44 5.87 5.22
55 4.32 4.25 4.15 3.93 3.90 3.85 76 7.30 6.28 5.38 6.64 5.98 5.27
56 4.41 4.33 4.21 4.00 3.96 3.91 77 7.49 6.35 5.40 6.85 6.09 5.31
57 4.50 4.41 4.28 4.07 4.03 3.97 78 7.67 6.43 5.42 7.06 6.19 5.35
58 4.60 4.49 4.34 4.15 4.10 4.03 79 7.85 6.49 5.44 7.27 6.28 5.38
59 4.70 4.58 4.41 4.23 4.18 4.10 80 8.02 6.55 5.46 7.48 6.37 5.41
60 4.81 4.67 4.48 4.32 4.26 4.17 81 8.18 6.61 5.47 7.68 6.45 5.43
61 4.92 4.77 4.55 4.42 4.35 4.24 82 8.34 6.65 5.48 7.88 6.52 5.45
62 5.04 4.86 4.62 4.52 4.43 4.31 83 8.49 6.69 5.49 8.08 6.58 5.47
63 5.17 4.96 4.69 4.62 4.53 4.39 84 8.63 6.73 5.50 8.26 6.63 5.48
64 5.30 5.06 4.76 4.73 4.62 4.46 85 8.76 6.76 5.50 8.43 6.68 5.49
& over
------------------------------------------------------------------------------------------------------------------------------------
Values for ages not shown will be furnished upon request.
Plan 5 Table: Monthly payment rate for each $1000 of proceeds under Plan 5.
-----------------------------------------------------------------------------------------------------------------------------------
Male Settlement Female Settlement Age
--------------------------------------------------------------------------------------------------------------
Age 35 40 45 50 55 60 65 70 75 80 85 & over
-----------------------------------------------------------------------------------------------------------------------------------
35 $ 2.95 $ 3.00 $ 3.06 $ 3.11 $ 3.15 $ 3.18 $ 3.20 $ 3.22 $ 3.23 $ 3.24 $ 3.24
40 2.98 3.06 3.13 3.20 3.26 3.31 3.35 3.38 3.40 3.41 3.42
45 3.01 3.10 3.20 3.30 3.39 3.46 3.53 3.58 3.61 3.64 3.65
50 3.03 3.14 3.25 3.38 3.51 3.63 3.73 3.81 3.87 3.91 3.93
55 3.04 3.16 3.30 3.45 3.62 3.79 3.94 4.08 4.18 4.25 4.29
60 3.05 3.18 3.33 3.51 3.72 3.94 4.16 4.37 4.55 4.67 4.75
65 3.06 3.19 3.36 3.56 3.79 4.07 4.37 4.68 4.96 5.18 5.32
70 3.07 3.20 3.37 3.59 3.85 4.17 4.55 4.97 5.39 5.75 6.00
75 3.07 3.21 3.38 3.61 3.89 4.24 4.68 5.20 5.78 6.32 6.73
80 3.07 3.21 3.39 3.62 3.91 4.28 4.76 5.37 6.08 6.81 7.40
85 & over 3.07 3.22 3.39 3.62 3.92 4.31 4.81 5.47 6.28 7.15 7.91
-----------------------------------------------------------------------------------------------------------------------------------
Figures for intermediate ages, for two males or two females will be furnished
upon request.
Settlement Age: The settlement age is the payee's age nearest birthday on the
date payments begin, minus an age adjustment from the table below. The age
adjustment cannot exceed the age of the payee.
--------------------------------------------------------------
Year Payments Begin Age
After Prior To Adjustment
--------------------------------------------------------------
---- 2001 0
2000 2026 3
2025 2051 7
2050 ---- 10
--------------------------------------------------------------
24
FLEXIBLE PREMIUM VARIABLE
JOINT AND LAST SURVIVOR
LIFE INSURANCE POLICY
--------------------------------------------------------------------------------
. Death Proceeds payable at the death of the last Insured
. Adjustable Death Benefit
. Flexible premiums payable until the death of the last Insured
. Some benefits reflect investment results
. No dividends
--------------------------------------------------------------------------------
GE LIFE AND ANNUITY
ASSURANCE COMPANY
GE LIFE AND ANNUITY ASSURANCE COMPANY
DEATH BENEFIT ENHANCEMENT RIDER
--------------------------------------------------------------------------------
The Death Benefit of the Policy to which this rider is attached is modified to
include the amount of insurance for this rider. The Death Benefit at the death
of the last Insured will be determined by the Death Benefit option that you have
chosen as follows:
Cash Value Accumulation Test:
Under option A for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is the Specified Amount plus this rider's amount of insurance plus the
Account Value; and
(2) is (a) divided by (b), where:
(a) is the Account Value minus the rider net single premium; and
(b) is the base Policy net single premium factor.
Under option B for Attained Ages less than 100, the Death Benefit is the
greater of (1) and (2), where:
(1) is the Specified Amount plus this rider's amount of insurance; and
(2) is (a) divided by (b), where:
(a) is the Account Value minus the rider net single premium; and
(b) is the base Policy net single premium factor.
Under option C for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is (a) plus (b) minus (c) minus (d), where:
(a) is the Specified Amount plus this rider's amount of insurance;
(b) is the sum of all premiums paid before Attained Age 75 of the
younger Insured;
(c) is the charges for additional benefits, other than qualified
additional benefits as specified in Internal Revenue Code Section
7702(f)(5)(A);
(d) is the sum of all partial surrenders taken; and
(2) is (a) divided by (b), where:
(a) is the Account Value minus the rider net single premium; and
(b) is the base Policy net single premium factor.
Under options A, B and C for Attained Ages 100 and older, the Death Benefit is
the Account Value multiplied by 101%.
Guideline Premium Test:
Under option A for Attained Ages less than 100, the Death Benefit is the
greater of (1) and (2), where:
(1) is the Specified Amount plus this rider's amount of insurance plus the
Account Value; and
(2) is the Account Value multiplied by the corridor percentage.
Under option B for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is the Specified Amount plus this rider's amount of insurance; and
(2) is the Account Value multiplied by the corridor percentage.
1
2
Under option C for Attained Ages less than 100, the Death Benefit is the greater
of (1) and (2), where:
(1) is (a) plus (b) minus (c) minus (d), where:
(a) is the Specified Amount plus this rider's amount of insurance;
(b) is the sum of all premiums paid before Attained Age 75 of the
younger Insured;
(c) is the charges for additional benefits, other than qualified
additional benefits as specified in Internal Revenue Code Section
7702(f)(5)(A);
(d) is the sum of all partial surrenders taken; and
(2) is the Account Value multiplied by the corridor percentage.
Under options A, B and C for Attained Ages 100 and older, the Death Benefit is
the Account Value multiplied by 101%.
Amount of Insurance
The amount of insurance for this rider is shown on the Policy data pages. You
may increase or decrease the amount of insurance as provided below. Requested
increases and decreases must maintain the same ratio between the Specified
Amount in your Policy and the amount of insurance under this rider that was in
effect at issue. To make a change, send a written request along with the Policy
to our Home Office.
Increase in Existing Amount of Insurance
While both Insureds are living, you may apply for an increase in the amount of
insurance using a supplemental application. We reserve the right to only allow
increases after the first Policy anniversary. You will have to submit evidence
satisfactory to us that each Insured is insurable in the same rating class used
at Policy issue. Any approved increase will become effective on the date shown
on the supplemental Policy data pages that will be sent to you. The approved
increase is subject to deduction of the first month's cost of increased
insurance from the Account Value of the Policy.
Decrease in Existing Amount of Insurance
After this rider has been in effect for one year, you can decrease the amount of
insurance. Any decrease will become effective on the Monthly Anniversary Day
after the date we receive your request. We will send you supplemental Policy
data pages that reflect the decrease. A decrease may not cause the rider's
amount of insurance plus the Policy's Specified Amount to be less than the
minimum Specified Amount shown on the Policy data pages.
Cost of this Rider
This rider is issued in consideration of the application and the inclusion of
the rider's monthly charges in the Policy's monthly deduction. The rider's
monthly charges are equal to the sum of:
. initial monthly expense charge;
. increase monthly expense charge; and
. monthly cost of insurance charge.
Initial Monthly Expense Charge. The initial monthly expense charge will be
included in the monthly deduction. The maximum amount of the charge per $1,000
of the rider's initial amount of insurance is shown on the Policy data pages.
Increase Monthly Expense Charge. The increase monthly expense charge will be
included in the monthly deduction. The maximum amount of the charge per $1,000
of increase in the rider's amount of insurance is shown on the Policy data
pages.
Cost of Insurance Charge. The monthly cost of insurance for this rider is (1)
multiplied by (2), where:
(1) is the cost of insurance rate for this rider; and
(2) is the rider's amount of insurance divided by 1000.
Cost of Insurance Rate
The monthly rate is based on each Insured's gender, age, rating class, and
Policy duration. The rates are determined by us according to expectations of
future mortality, lapse, interest and expenses. We can change our schedule of
declared rates from time to time but they will never be more than the maximum
rates shown in the Table of Guaranteed Maximum Insurance Rates on the Policy
data pages. A change in declared rates will apply to all persons of the same
age, gender and rating class and whose policies have been in effect for the same
length of time.
Reinstatement
You may reinstate this rider at the same time and under the same conditions as
the Policy. We require evidence satisfactory to us that each Insured is
insurable.
When this Rider is Effective
This rider goes into effect on the Policy Date.
When this Rider Ends
Coverage under this rider will end:
. if the Policy is surrendered; or
. if the Policy ends.
Partial Surrenders
The Partial Surrender provision of your Policy is modified to include this
rider's amount of insurance. For the purposes of the Partial Surrender
provision, the rider's amount of insurance is considered part of the Specified
Amount of the Policy. For details, please see the Partial Surrender provision of
your Policy.
Limits on Contesting this Rider
With respect to the original amount of insurance, we will not contest this rider
after it has been in effect during the lifetimes of both Insureds for two years
from the rider's effective date. We will not contest an increase in the amount
of insurance after that increase has been in effect during the lifetimes of both
Insureds for two years from the effective date of the increase. We will not
contest a reinstatement of this rider after the reinstatement has been in effect
during the lifetimes of both lnsureds for two years from the date of
reinstatement.
Misstatement of Age or Gender
If the age or gender of either Insured was misstated in the application for this
rider, the amount of insurance provided by this rider will be adjusted. The
amount of insurance after adjustment will be (a) times (b), where:
(a) is the unadjusted amount of insurance; and
(b) is the ratio of (1) the most recent monthly cost of insurance deducted
for this rider, to (2) the most recent monthly cost of insurance that
should have been deducted for this rider at each true age or gender.
Suicide
If either Insured commits suicide, while sane or insane, within two years of the
effective date of this rider, coverage under this rider will end. A refund will
be paid to the Beneficiary as specified under the Suicide provision of the base
Policy.
3
4
If the first Insured commits suicide, while sane or insane, more than two years
after the effective date of this rider and within two years after an increase in
the amount of insurance became effective, the amount of insurance will be
reduced to the amount in effect prior to the increase. The amount payable to the
Beneficiary with respect to the increase will equal the monthly deductions that
were made for that increase.
if the last Insured commits suicide, while sane or insane, more than two years
after the effective date of this rider and within two years after an increase in
the amount of insurance became effective, we will limit the amount of proceeds
payable with respect to the increase. The limited amount of proceeds with
respect to the increase will equal the monthly deductions that were made for
that increase. Any limited amount of proceeds will be paid to the Beneficiary
under the same conditions as the original amount of insurance.
General Provisions
This rider has no Account Value.
This rider is subject to the provisions of the Policy.
For GE Life and Annuity Assurance Company
A B C D E F
President
