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EXHIBIT 99.A5N
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MINNESOTA LIFE POLICY RIDER WAIVER AGREEMENT
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Minnesota Life Insurance Company . 000 Xxxxxx Xxxxxx Xxxxx . Xx.
Xxxx, Xxxxxxxxx 00000-0000
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GENERAL INFORMATION
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This agreement amends the group policy to which it is attached, and is issued in
consideration of the required premium. This agreement is subject to every term,
condition, exclusion, limitation, and provision of the group policy unless
otherwise expressly provided for herein.
WHAT DOES THE WAIVER OF PREMIUM BENEFIT PROVIDE?
If an insured becomes totally and permanently disabled, as hereinafter
defined, while under age 60, upon receipt of due proof of such disability, the
insured's insurance under the group policy (including applicable riders) will be
continued in force, subject to the following provisions and without payment of
premiums for such insured, during the uninterrupted continuance of such total
and permanent disability. For purposes of this agreement, "insured" shall mean
an insured employee or a spouse insured for variable universal life insurance
under the policy.
WHAT IS "TOTAL" DISABILITY?
Total disability is a disability which occurs while the insured's insurance is
in force and which results from an accidental injury or a disease that
continuously prevents the insured from engaging in an occupation. The insured
must be under the care of a licensed physician other than the insured. During
the first 24 months of total disability,"occupation" means the insured's regular
occupation. After 24 months, it means any occupation for which the insured is
reasonably fitted by education, training or experience.
The insured's total and irrevocable loss of the following shall be considered
total disability even if the insured engages in an occupation:
1. the sight of both eyes; or
2. the use of both hands; or
3. the use of both feet; or
4. the use of one hand and one foot.
WHAT IS "PERMANENT" DISABILITY?
Total disability will be considered permanent only after it has existed
continuously for a least six months.
HOW LONG WILL INSURANCE BE CONTINUED?
If the insured becomes totally and permanently disabled, insurance will
be continued:
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1. until the insured's 95th birthday; or
2. until the date the insured is no longer totally and permanently
disabled; or
3. until the date the insured terminates or surrenders his or her
insurance; or
4. until the date the group policy terminates;
whichever occurs first.
However, the termination of the group policy shall have no effect on the claim
of any insured who is disabled, as set forth in this agreement, at the time the
group policy terminates.
WHAT WILL BE CONSIDERED DUE PROOF OF DISABILITY?
The insured must furnish evidence satisfactory to us that his or her
total disability:
1. commenced while his or her insurance under the group policy was in force;
and
2. commenced before the insured's 60th birthday; and
3. was continuous for six months or more.
We will, from time to time, also require additional proof satisfactory to us
that the insured continues to be totally and permanently disabled. We
may also require the insured to submit to one or more medical examinations at
our expense. However, we will not require a medical examination of the insured
more frequently than once a year if the total disability has continued for two
years.
ARE THERE ANY LIMITATIONS?
Insurance will not be continued if the insured's total disability
results from intentionally self-inflicted injuries or from an act of war while
the insured is serving in the military, naval or air forces of any country at
war, declared or undeclared.
WHEN MUST WE BE NOTIFIED?
We must receive written notice of the insured's total disability at our
home office:
1. while the insured is living and totally disabled; and
2. not later than one year after the termination of the insured's
insurance under the group policy; and
3. within one year of the date the insured requests as the date for
the commencement of this benefit.
However, the failure to give this notice within the time provided will not
invalidate the claim if it is shown that notice was given as soon as reasonably
possible.
WHAT IS THE INSURED'S COST FOR THIS BENEFIT?
The cost of the benefit is included in the planned monthly premium amount shown
on the specifications page attached to the insured's certificate.
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WHAT IF THE INSURED'S INSURANCE UNDER THE GROUP POLICY LAPSES?
If the insured's insurance lapses before notice of the insured's total
disability is received at our home office, the insured's insurance will be
continued only if the notice is received within one year after his or her
insurance lapses. Also, the total disability must have commenced prior to the
date the net cash value became zero or during the grace period allowed.
WHEN IS THE BENEFIT UNDER THIS AGREEMENT INCONTESTABLE?
This agreement is subject to the incontestability provision for each insured.
CAN INSURANCE THAT WAS CONTINUED UNDER THIS AGREEMENT BE CONVERTED?
Yes. Insurance under this group policy may be converted during the insured's
lifetime and within 31 days after he or she ceases to be totally and
permanently disabled.
IS THIS BENEFIT RETROACTIVE?
Yes. The cost of insurance, cost of riders, and administration fees falling due
before we approve the insured's total and permanent disability claim will be
deducted from his or her account value. If the insured's claim for benefits
under this agreement is approved, those charges which were deducted after the
total and permanent disability began will be credited to the insured's account
value.
WILL THE INSURED'S ACCOUNT BE CREDITED WITH PREMIUM CONTRIBUTIONS AS A
RESULT OF THIS BENEFIT?
No. Except for interest which accrues on the account value, the account value
will not increase while insurance is being continued under this agreement.
Nothing contained herein will prohibit an insured from making premium
contributions.
This agreement is effective as of the effective date shown on the insured's
profile page.
/s/ Xxxxxx X. Xxxxxxxxx /s/ Xxxxxx X. Xxxxxxx
Secretary President
MHC-94-18683 Minnesota Life 3
