Exhibit 1A (5)(i)
FLEXIBLE PREMIUM VARIABLE
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 Insured is named in the Policy. The Beneficiary is as named in the
attached application, unless later changed. We will pay the Life Insurance
Proceeds on this Policy when we receive due proof that the Insured died while
this Policy was in effect. This is a Flexible Premium Variable Life Insurance
Policy. You may increase or decrease the Specified Amount. We will allocate
Net Premiums to the Separate Account named on the policy data pages.
THIS POLICY'S 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. THE AMOUNT OF THE DEATH BENEFIT OR THE
DURATION OF THE DEATH BENEFIT MAY VARY. 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 our
agency within 10 days after its delivery for a refund. The amount of the
refund will equal the sum of all charges deducted from premiums paid, plus the
Net Premiums allocated to the Separate Account adjusted by investment gains
and losses.
For GE Life and Annuity Assurance Company
{Signature TO Come]
PRESIDENT
.Flexible Premium Variable Life Insurance Policy
.Life Insurance Proceeds payable at the Insured's death
.Adjustable death benefit
.Flexible premiums payable for the Insured's life
.Some benefits reflect investment results
.No dividends
GE LIFE AND ANNUITY
ASSURANCE COMPANY
0000 Xxxx Xxxxx Xxxxxx, Xxxxxxxx, Xxxxxxxx 00000
A Stock Company
FORM P1250 9/97
Table of Contents
Policy Data Pages........................................................... 4
Definitions................................................................. 12
Introduction
The Policy and its Parts................................................... 14
When This Policy Will Terminate............................................ 14
The Owner and the Beneficiary
The Owner.................................................................. 15
The Beneficiary............................................................ 15
Changing the Owner or Beneficiary.......................................... 15
Using the Policy as Collateral for a Loan.................................. 15
Trustee.................................................................... 15
Premium Payments
Premiums After the First Premium........................................... 16
When and Where to Pay Premiums............................................. 16
Allocation of Net Premiums................................................. 16
Continuation Amount and Continuation Period................................ 17
Grace Period............................................................... 17
How This Policy Can Be Reinstated.......................................... 18
Life Insurance Proceeds
How We Determine Proceeds.................................................. 20
Corridor Percentage Chart.................................................. 21
Compliance as Life Insurance............................................... 21
Change in Existing Coverage................................................ 21
Change in Death Benefit Options............................................ 22
The Separate Account
Insulation of Assets....................................................... 23
Investment Subdivisions.................................................... 23
Changes to the Separate Account and Investment Subdivisions................ 23
Valuation of Separate Account Assets....................................... 24
Policy Exchange............................................................ 24
Unit Value................................................................. 24
Transfers.................................................................. 25
Account Value Benefits
How We Determine Account Value............................................. 27
How We Determine Net Premium............................................... 27
Monthly Deduction.......................................................... 27
Cost of Insurance.......................................................... 28
Insufficient Account Value................................................. 28
Continuation of Coverage................................................... 29
Surrender.................................................................. 29
Receiving the Surrender Value.............................................. 30
Postponement of Payments................................................... 30
2
Loan Benefits
Making a Policy Loan....................................................... 31
Policy Loan Interest....................................................... 31
Preferred Policy Debt...................................................... 31
Repaying Policy Debt....................................................... 32
Minimum Loan Payment....................................................... 32
General Information
Annual Statement........................................................... 34
Calculation of Values...................................................... 34
Exchange Provision......................................................... 34
Limits on Contesting This Policy........................................... 35
Misstatement of Age or Sex................................................. 35
Nonparticipating........................................................... 35
Suicide.................................................................... 36
Written Notice............................................................. 36
Optional Payment Plans
Plan 1..................................................................... 37
Plan 2..................................................................... 37
Plan 3..................................................................... 37
Plan 4..................................................................... 38
Plan 5..................................................................... 38
Plan 1 Table............................................................... 39
Plan 2 Table............................................................... 39
Plan 5 Table............................................................... 40
Settlement Age Chart....................................................... 40
A copy of the application and any riders and endorsements follow page 41.
3
Policy Data
SCHEDULE OF
PREMIUMS
SCHEDULE OF BENEFITS AMOUNT PAYABLE
--------------------------------------------------------
LIFE INSURANCE PLANNED PERIODIC [[$363.36 ANNUALLY]
PREMIUM
MINIMUM NET PREMIUM FACTOR: [0.95 (THE MINIMUM NET PREMIUM FACTOR
REFLECTS THE MAXIMUM DEDUCTION OF 5%
OF EACH PREMIUM RECEIVED)]
MAXIMUM MONTHLY POLICY CHARGE: [$12.00]
INCREASE CHARGE PER $1,000: [$1.50 PER $1000, MAXIMUM $300 PER
INCREASE]
MAXIMUM TRANSFER CHARGE: [$10.00]
POLICY LOAN INTEREST RATES:
NON-PREFERRED LOANS: [6.00% PER ANNUM PAYABLE IN ARREARS]
PREFERRED LOANS: [4.00% PER ANNUM PAYABLE IN ARREARS]
PREFERRED LOAN AVAILABILITY DATE: [SEPTEMBER 1, 2010]
MINIMUM SPECIFIED AMOUNT: [$100,000]
NOTE: IT IS POSSIBLE THAT COVERAGE WILL EXPIRE IF SUFFICIENT PREMIUMS ARE NOT
PAID. SEE THE GRACE PERIOD PROVISION.
OWNER [THE INSURED]
INSURED [XXXX XXX] [MALE 35] AGE NEAREST
BIRTHDAY
POLICY NUMBER [N00000000] [NO NICOTINE USE STANDARD] RATING CLASS
POLICY DATE [SEPTEMBER 1, 2000] MONTHLY ANNIVERSARY DAY [1]
PLAN FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
[$100,000] INSURED'S SPECIFIED AMOUNT -- DEATH BENEFIT OPTION [B]
P1250DP 7/00
4
Separate Account II
INVESTMENT
SUBDIVISIONS ARE INVESTED IN
[AIM VARIABLE INSURANCE FUNDS
AIM CAPITAL AIM V.I. CAPITAL APPRECIATION FUND
APPRECIATION --
B
AIM GROWTH -- B AIM V.I. GROWTH FUND
AIM VALUE -- B AIM V.I. VALUE FUND
ALLIANCE VARIABLE PRODUCTS SERIES FUND,
INC.
AVP GROWTH & GROWTH AND INCOME PORTFOLIO
INCOME -- B
AVP PREMIER PREMIER GROWTH PORTFOLIO
GROWTH -- B
AVP QUASAR -- B QUASAR PORTFOLIO
DREYFUS
DRF EMERGING DREYFUS INVESTMENT -- EMERGING MARKETS
MARKETS -- B PORTFOLIO
DRF SOCIALLY THE DREYFUS SOCIALLY RESPONSIBLE GROWTH
RESPONSIBLE FUND, INC.
GROWTH -- B
FEDERATED INSURANCE SERIES
FED HIGH INCOME FEDERATED HIGH INCOME BOND FUND II
BOND -- B
FED FEDERATED INTERNATIONAL SMALL COMPANY FUND
INTERNATIONAL II
SMALL
COMPANY -- B
FIDELITY VARIABLE INSURANCE PRODUCTS FUND
FID EQUITY EQUITY INCOME PORTFOLIO
INCOME -- B
FID GROWTH -- B GROWTH PORTFOLIO
FIDELITY VARIABLE INSURANCE PRODUCTS FUND
II
FID CONTRAFUND PORTFOLIO
CONTRAFUND --
B
FIDELITY VARIABLE INSURANCE PRODUCTS FUND
III
FID GROWTH & GROWTH & INCOME PORTFOLIO
INCOME -- B
FID MID CAP -- MID CAP PORTFOLIO
B
GE ASSET MANAGEMENT
GEl MID-CAP MID-CAP VALUE EQUITY FUND
VALUE
EQUITY -- B
GEl MONEY MONEY MARKET FUND
MARKET -- B
GEl PREMIER PREMIER GROWTH EQUITY FUND
GROWTH
EQUITY -- B
GEl S&P 500 S&P 500 INDEX FUND
INDEX -- B*
GEl SMALL-CAP SMALL-CAP VALUE EQUITY FUND
VALUE
EQUITY -- B
GEl U.S. U.S. EQUITY FUND
EQUITY -- B
GEl VALUE VALUE EQUITY FUND
EQUITY -- B
P1250 IS EFFECTIVE [7/01/00]
5
Separate Account II--Continued
INVESTMENT SUBDIVISIONS ARE INVESTED IN
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
MFS VARIABLE INSURANCE TRUST
MFS GROWTH -- B MFS GROWTH SERIES
MFS GROWTH WITH INCOME -- B MFS GROWTH WITH INCOME 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 & INCOME/VA -- XXXXXXXXXXX MAIN STREET GROWTH & INCOME
B FUND/VA
PIMCO VARIABLE INSURANCE TRUST
PIM FOREIGN BOND -- B FOREIGN BOND PORTFOLIO
PIM HIGH YIELD BOND -- B HIGH YIELD BOND PORTFOLIO
PlM LONG TERM U.S. GOVERNMENT BOND -- LONG-TERM U.S. GOVERNMENT BOND PORTFOLIO
B
PIM TOTAL RETURN BOND -- B TOTAL RETURN BOND PORTFOLIO
RYDEX VARIABLE TRUST
RYD OTC -- B** RYDEX OTC FUND]
YOU MAY ALLOCATE YOUR PREMIUMS AND ACCOUNT VALUE TO AS MANY AS [SEVEN]
INVESTMENT SUBDIVISIONS. YOUR ALLOCATIONS MUST BE IN PERCENTAGES TOTALING 100%.
EACH ALLOCATION PERCENTAGE MUST BE A WHOLE NUMBER AND AT LEAST 1%.
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.
P1250 IS EFFECTIVE [7/01/00]
6
Policy Number: N00000000
TABLE OF MAXIMUM PREMIUMS
POLICY MAXIMUM
YEAR PREMIUM
1 [14,304.27
2 14,304.27
3 14,304.27
4 14,304.27
5 14,304.27
6 14,304.27
7 14,304.27
8 14,304.27
9 14,304.27
10 14,304.27
11 14,304.27
12 15,241.56
13 16,511.69
14 17,781.82
15 19,051.95
16 20,322.08
17 21,592.21
18 22,862.34
19 24,132.47
20 25,402.60
21 26,672.73
22 27,942.86
23 29,212.99
24 30,483.12
25 31,753.25
26 33,023.38
27 34,293.51
28 35,563.64
29 36,833.77
30 38,103.90
31 39,374.03
32 40,644.16
33 41,914.29
POLICY MAXIMUM
YEAR PREMIUM
34 43,184.42
35 44,454.55
36 45,724.68
37 46,994.81
38 48,264.94
39 49,535.07
40 50,805.20
41 52,075.33
42 53,345.46
43 54,615.59
44 55,885.72
45 57,155.85
46 58,425.98
47 59,696.11
48 60,966.24
49 62,236.37
50 63,506.50
51 64,776.63
52 66,046.76
53 67,316.89
54 68,587.02
55 69,857.15
56 71,127.28
57 72,397.41
58 73,667.54
59 74,937.67
60 76,207.80
61 77,477.93
62 78,748.06
63 80,018.19
64 81,288.32
65 & LATER 82,558.45]
ACCORDING TO OUR UNDERSTANDING OF CURRENT FEDERAL TAX LAW, YOU MAY NOT PAY MORE
THAN THESE AMOUNTS AND MAINTAIN THE TAX STATUS OF THIS POLICY AS LIFE
INSURANCE. THIS TABLE IS SUBJECT TO CHANGE.
7
Policy Number: N00000000
TABLE OF CONTINUATION AMOUNTS
POLICY CONTINUATION
MONTH AMOUNT
1 [30.28
2 60.56
3 90.84
4 121.12
5 151.40
6 181.68
7 211.96
8 242.24
9 272.52
10 302.80
11 333.08
12 363.36
13 393.64
14 423.92
15 454.20
16 484.48
17 514.76
18 545.04
19 575.32
20 605.60
21 635.88
22 666.16
23 696.44
24 726.72
25 757.00
26 787.28
27 817.56
28 847.84
29 878.12
30 908.40
31 938.68
32 968.96
33 999.24
34 1,029.52
35 1,059.80
36 1,090.08
37 1,120.36
38 1,150.64
39 1,180.92
40 1,211.20
POLICY CONTINUATION
MONTH AMOUNT
41 1,241.48
42 1,271.76
43 1,302.04
44 1,332.32
45 1,362.60
46 1,392.88
47 1,423.16
48 1,453.44
49 1,483.72
50 1,514.00
51 1,544.28
52 1,574.56
53 1,604.84
54 1,635.12
55 1,665.40
56 1,695.68
57 1,725.96
58 1,756.24
59 1,786.52
60 1,816.80
61 1,847.08
62 1,877.36
63 1,907.64
64 1,937.92
65 1,968.20
66 1,998.48
67 2,028.76
68 2,059.04
69 2,089.32
70 2,119.60
71 2,149.88
72 2,180.16
73 2,210.44
74 2,240.72
75 2,271.00
76 2,301.28
77 2,331.56
78 2,361.84
79 2,392.12
80 2,422.40
POLICY CONTINUATION
MONTH AMOUNT
81 2,452.68
82 2,482.96
83 2,513.24
84 2,543.52
85 2,573.80
86 2,604.08
87 2,634.36
88 2,664.64
89 2,694.92
90 2,725.20
91 2,755.48
92 2,785.76
93 2,816.04
94 2,846.32
95 2,876.60
96 2,906.88
97 2,937.16
98 2,967.44
99 2,997.72
100 3,028.00
101 3,058.28
102 3,088.56
103 3,118.84
104 3,149.12
105 3,179.40
106 3,209.68
107 3,239.96
108 3,270.24
109 3,300.52
110 3,330.80
111 3,361.08
112 3,391.36
113 3,421.64
114 3,451.92
115 3,482.20
116 3,512.48
117 3,542.76
118 3,573.04
119 3,603.32
120 3,633.601
CONTINUATION AMOUNTS ARE DESCRIBED IN THE CONTINUATION AMOUNT AND CONTINUATION
PERIOD PROVISION
8
Policy Number: N00000000
TABLE OF SURRENDER AMOUNTS
POLICY SURRENDER
MONTH CHARGE
1 [619.00
2 619.00
3 619.00
4 619.00
5 619.00
6 619.00
7 619.00
8 619.00
9 619.00
10 619.00
11 619.00
12 619.00
13 619.00
14 619.00
15 619.00
16 619.00
17 619.00
18 619.00
19 619.00
20 619.00
21 619.00
22 619.00
23 619.00
24 619.00
25 619.00
26 619.00
27 619.00
28 619.00
29 619.00
30 619.00
31 619.00
32 619.00
33 619.00
34 619.00
35 619.00
36 619.00
37 619.00
38 619.00
39 619.00
40 619.00
POLICY SURRENDER
MONTH CHARGE
41 619.00
42 619.00
43 619.00
44 619.00
45 619.00
46 619.00
47 619.00
48 619.00
49 619.00
50 619.00
51 619.00
52 619.00
53 619.00
54 619.00
55 619.00
56 619.00
57 619.00
58 619.00
59 619.00
60 619.00
61 613.00
62 608.00
63 603.00
64 598.00
65 593.00
66 588.00
67 582.00
68 577.00
69 572.00
70 567.00
71 562.00
72 557.00
73 551.00
74 546.00
75 541.00
76 536.00
77 531.00
78 526.00
79 520.00
80 515.00
POLICY SURRENDER
MONTH CHARGE
81 510.00
82 505.00
83 500.00
84 495.00
85 489.00
86 484.00
87 479.00
88 474.00
89 469.00
90 464.00
91 458.00
92 453.00
93 448.00
94 443.00
95 438.00
96 433.00
97 427.00
98 422.00
99 417.00
100 412.00
101 407.00
102 402.00
103 396.00
104 391.00
105 386.00
106 381.00
107 376.00
108 371.00
109 365.00
110 360.00
111 355.00
112 350.00
113 345.00
114 340.00
115 334.00
116 329.00
117 324.00
118 319.00
119 314.00
120 309.00
9
Policy Number: N00000000
TABLE OF SURRENDER AMOUNTS
POLICY SURRENDER
MONTH CHARGE
121 303.00
122 298.00
123 293.00
124 288.00
125 283.00
126 278.00
127 272.00
128 267.00
129 262.00
130 257.00
131 252.00
132 247.00
133 241.00
134 236.00
135 231.00
136 226.00
137 221.00
138 216.00
139 210.00
140 205.00
POLICY SURRENDER
MONTH CHARGE
141 200.00
142 195.00
143 190.00
144 185.00
145 179.00
146 174.00
147 169.00
148 164.00
149 159.00
150 154.00
151 148.00
152 143.00
153 138.00
154 133.00
155 128.00
156 123.00
157 117.00
158 112.00
159 107.00
160 102.00
POLICY SURRENDER
MONTH CHARGE
161 97.00
162 92.00
163 86.00
164 81.00
165 76.00
166 71.00
167 66.00
168 61.00
169 55.00
170 50.00
171 45.00
172 40.00
173 35.00
174 30.00
175 25.00
176 20.00
177 15.00
178 10.00
179 5.00
180 0.00]
10
Policy Number: N00000000
TABLE OF GUARANTEED MAXIMUM INSURANCE RATES
PER $1,000 OF NET AMOUNT AT RISK
LIFE
MONTHLY
AGE RATE
70 2.94130
71 3.31274
72 3.63092
73 4.05839
74 4.54125
75 5.06274
76 5.62182
77 6.21386
78 6.83323
79 7.49615
LIFE
MONTHLY
AGE RATE
80 8.22966
81 9.05444
82 9.99708
83 11.07331
84 12.26711
85 13.55590
86 14.91786
87 16.34412
88 17.80841
89 19.33266
LIFE
MONTHLY
AGE RATE
90 20.94167
91 22.66794
92 24.57677
93 26.76406
94 29.63735
95 33.93111
96 41.27938
97 56.03985
98 83.33333
99 83.33333]
11
Definitions
Account Value--The total amount under the Policy in each Investment Subdivision
and our General Account.
Age--The Insured's Age on his or her birthday nearest the Policy Date or a
policy anniversary.
Attained Age--The 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 Life
Insurance Proceeds payable at the death of the Insured.
Continuation Amount--A cumulative amount set forth on the policy data pages for
each month of the Continuation Period.
Continuation Period--The period during which the Policy will not lapse 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 force.
The Company--GE Life and Annuity Assurance Company. "We", "us" or "our" refers
to the Company.
Fund--Any open-end management investment company or investment portfolio
thereof, or unit investment trust or series thereof, in which an Investment
Subdivision invests.
General Account--Assets of the Company other than those allocated to the
Separate Account or any other Separate Account of the Company.
Home Office--The Company's offices at 0000 Xxxx Xxxxx Xxxxxx, Xxxxxxxx,
Xxxxxxxx 00000.
Insured--The person upon whose life this Policy is issued.
Investment Subdivision--Subdivision of the Separate Account, the assets of
which are invested exclusively in a corresponding Fund.
Life insurance Proceeds--The amount payable upon the death of the Insured.
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, Net Total Premium means 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.
12
Optional Payment Plan--A plan whereby any part of Life Insurance Proceeds or
Surrender Value proceeds 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--Date as of which the Company issues the Policy and as of which the
Policy becomes effective. Policy years and anniversaries are measured from the
Policy Date. The Policy Date is shown on the policy data pages.
Policy Debt--The amount of outstanding loans plus accrued interest. Policy Debt
is deducted from proceeds payable at the Insured's death or on 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 original Specified Amount is shown on the policy data pages.
Surrender Value--The amount payable to the Owner upon surrender of the Policy.
Unit Value--Unit of measure used to calculate the Account Value for each
Investment Subdivision.
Valuation Day--For each Investment Subdivision, each day on which the New York
Stock Exchange is open for business except for days that the Investment
Subdivision's corresponding Fund does not value its shares.
Valuation Period--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.
13
Introduction
This is a flexible premium variable life insurance policy. The first premium
payment is due on the Policy Date. Subsequent premiums may be paid at any time
while this Policy is in effect, 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 Life insurance Proceeds. Proceeds can be paid in a lump sum
or under an Optional Payment Plan.
During the Insured's life, the Policy has an Account Value. The Account Value
reflects the investment experience of the Separate Account. (See THE SEPARATE
ACCOUNT section.) This Account Value is the basis for certain benefits you can
use before the Insured's death.
We will provide a projection of illustrative future life insurance and Account
Value proceeds. To receive the illustration, send a written request to our Home
Office and pay any service fee in effect at that time, but not 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.
THE POLICY AND ITS PARTS
The Policy 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 our President or one of our Vice-Presidents 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.
When This Policy Will Terminate
READ YOUR POLICY CAREFULLY.
All coverage under this Policy will terminate when:
. you request that coverage terminate and you return this Policy;
. the insured dies; or
. the grace period ends without sufficient premium being paid.
This Policy will also terminate as stated in the Suicide provision.
14
THE OWNER AND THE BENEFICIARY
THE OWNER
You have rights in the Policy during the Insured's life. The Policy names you
or someone else as the Insured. If you are not the Insured, you should name a
contingent owner who will become the Owner if you die before the Insured. If
you die before the Insured and there is no contingent owner, ownership passes
to your estate.
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, the proceeds payable at the Insured's death will be paid in a lump sum
to the primary Beneficiary. If the primary Beneficiary dies before the Insured,
the proceeds will be paid to the contingent Beneficiary. If no Beneficiary
survives the Insured, the 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, unless you have requested otherwise.
CHANGING THE OWNER OR BENEFICIARY
During the Insured's life, you may change the Owner. You may also change the
Beneficiary during the 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 a Beneficiary may
be affected by an assignment.
TRUSTEE
If a trustee is named as the Owner or Beneficiary of this Policy and
subsequently exercises ownership rights or claims benefits hereunder, we will
have no obligation to verify that a trust is in effect or 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. When we make a payment to the trustee, we will have no obligation
to ensure that such payment is applied according to the terms of the trust
agreement.
15
Premium Payments
This Policy's first premium is due on the Policy Date.
PREMIUMS AFTER THE FIRST PREMIUM
Any premium payments after the first premium may be made under a periodic plan
or at any time while this Policy is in effect.
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. We can 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 minimum amount.
You can 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 can 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.
Maximum Premiums. We will limit the total of all premiums paid to date for this
Policy to the amounts shown in the table of maximum premiums in the policy data
pages. Any portion of a premium paid that causes the total of all premiums paid
to date to exceed the maximum premium will be returned to you along with any
earnings thereon. 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.
WHEN AND WHERE TO PAY PREMIUMS
Each premium is payable in advance. Send each premium to our Home Office. Make
the check or money order payable to GE Life and Annuity Assurance Company.
ALLOCATION OF NET PTEMIUMS
You may allocate the Net Premium to one or more Investment Subdivisions of the
Separate Account, but not to more than the maximum number of allocations shown
in the policy data pages. The minimum percentage of each Net Premium which may
be allocated to any particular Investment Subdivision 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, simply by sending written notice to us at our Home
Office. The changed allocation will apply to premiums received after we record
the change.
16
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 inforce. (See Insufficient Account Value provision.)
An increase in Specified Amount will increase the Continuation Amounts while 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 Insured dies during
the grace period, proceeds will be reduced by the amount of the sufficient
premium (as
17
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 the
Insured is insurable;
(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 Subdivisions of the Separate Account. 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 an amount 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.
18
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 by the Net Premium Factor, equals (1) plus (2)
minus (3), where:
(1) is the surrender charge on the date of termination; and
(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 sufficient 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.
19
Life Insurance Proceeds
Life Insurance Proceeds are payable at the death of the Insured. We will pay
the Life Insurance Proceeds on this Policy when we receive:
. this Policy;
. due proof that the Insured died while this Policy was in effect; and
. proof of the interest of the claimant.
Proceeds can be paid in a lump sum or under an Optional Payment Plan.
HOW WE DETERMINE PROCEEDS
In the application for original coverage, the Owner elected one of two death
benefit options.
Under Option A, Life insurance Proceeds are based on 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, Life Insurance Proceeds are based on the greater of (1) and
(2), where:
(1) is the Specified Amount; and
(2) is the Account Value multiplied by the corridor percentage.
For both Option A and Option B, references to Specified Amount and Account
Value in items (1) and (2), are amounts in effect on the date of death.
In no event will Life insurance Proceeds be less than the amount required to
keep the Policy qualified as life insurance.
The corridor percentage will depend on the Attained Age of the Insured on the
date of death. (See the corridor percentage chart in this section.)
Actual Amount of Proceeds. The actual amount of proceeds will depend on:
. the Life Insurance Proceeds as determined in this section;
. the use of the Account Value; any partial surrenders;
. any Policy Debt;
. any additional insurance provided by rider;
. any increase or decrease in existing coverage;
. the Insured's suicide during the first two policy years;
. and a misstatement of the Insured's Age or sex.
20
Corridor
Attained Age Percentage
------------ ----------
40 or younger 250%
41 243
42 236
43 229
44 222
45 215
46 209
47 203
48 197
49 191
50 185
51 178
52 171
53 164
Corridor
Attained Age Percentage
------------ ----------
54 157%
55 150
56 146
57 142
58 138
59 134
60 130
61 128
62 126
63 124
64 122
65 120
66 119
67 118
Corridor
Attained Age Percentage
------------ ----------
68 117%
69 116
70 115
71 113
72 111
73 109
74 107
75 through 90 105
91 104
92 103
93 102
94 or older 101
COMPLIANCE AS LIFE INSURANCE
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.
CHANGE TO EXISTING COVERAGE
After the Policy has been in effect for one year, you can increase or decrease
the Specified Amount. To make a change, send a written request along with the
Policy to our Home Office.
Decrease in Specified Amount. Any decrease will become effective on the Monthly
Anniversary Day after the date we receive the request. The decrease will first
apply to coverage provided by the most recent increase, then to the next most
recent increases successively, then 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 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. You must apply for an increase in Specified
Amount on a supplemental application. You will have to submit evidence
satisfactory to us that the Insured is insurable.
21
Any approved increase will become effective on the date shown in the
supplemental policy data pages, provided that there is sufficient Account Value
to cover the first monthly deduction following the increase. (See Monthly
Deduction provision.)
CHANGE IN DEATH BENEFIT OPTIONS
If you elected death benefit Option A, you can request a change to death
benefit Option B. The Specified Amount after the change will equal the sum of
(1) plus (2), where:
(1)is the Specified Amount on the date your request becomes effective; and
(2)is the Account Value on the date your request becomes effective.
If you elected death benefit Option B, you can request a change to death
benefit Option A. This will decrease the Specified Amount by the amount of
Account Value.
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.
22
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 and 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 laws of the Commonwealth of Virginia 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 Insurance Commissioner of the Commonwealth of Virginia. The
approval process is on file with the Insurance Commissioner of the state in
which this Policy was delivered.
INSULATION OF ASSETS
The portion of the assets of the Separate Account which equals the reserves and
other policy liabilities of the policies which are supported by the Separate
Account 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.
INVESTMENT SUBDIVISIONS
The Separate Account is divided into Investment Subdivisions. The income, gains
and losses, realized or unrealized, from the assets allocated to an Investment
Subdivision are credited to or charged against such Investment Subdivision
without regard to other income, gains or losses of the Company.
The Investment Subdivisions available under this Policy are shown in the policy
data pages. Each Investment Subdivision in the Separate Account invests
exclusively in shares of a designated portfolio of a series type of mutual fund
("a Fund"). Any amounts of income, dividends and gains distributed from the
shares of a Fund are reinvested in additional shares of that Fund.
CHANGES TO THE SEPARATE ACCOUNT AND INVESTMENT SUBDIVISIONS
Where permitted by applicable law, the Company may:
1. create new separate accounts;
2. combine separate accounts, including the Separate Account;
23
3. transfer assets of the Separate Account, which we determine to be
associated with the class of policies to which this Policy belongs, to
another separate account;
4. add new Investment Subdivisions to or remove existing Investment
Subdivisions from the Separate Account or combine Investment Subdivisions;
5. make Investment Subdivisions (including new Investment Subdivisions)
available to such classes of policies as we may determine;
6. add new Funds or remove existing Funds;
7. substitute new Funds for any existing Fund whose shares are no longer
available for investment;
8. substitute new Funds for any existing Fund which we determine is no longer
appropriate in light of the purposes of the Separate Account;
9. deregister the Separate Account under the Investment Company Act of 1940;
and
10. 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, by appropriate endorsement,
make such changes in this and other policies as may be necessary or appropriate
to reflect the substitution or change.
VALUATION OF SEPARATE ACCOUNT ASSETS
We will value the assets of the Separate Account each Valuation Day at their
fair market value in accordance with accepted accounting practices and
applicable laws and regulations.
POLICY EXCHANGE
If you object to a material change in the investment policy of the Separate
Account or any Investment Subdivision, you have the right to exchange this
Policy for a fixed benefit policy. No evidence of insurability will be
required. We will notify you of the options available, and the procedures to
follow if you decide to make an exchange. You must make an exchange within
sixty days after the change in investment policy becomes effective. There will
always be one policy available for exchange.
UNIT VALUE
Each Investment Subdivision has a Unit Value. When Net Premiums or other
amounts are transferred into an Investment Subdivision, a number of units are
purchased
24
based on that Investment Subdivision's Unit Value as of the end of the
Valuation Period during which the transfer is made. Likewise, when amounts are
transferred out of an Investment Subdivision, units are redeemed in a similar
manner.
The Unit Value of each Investment Subdivision was arbitrarily set when the
Investment Subdivision 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 Investment Subdivision has its own net investment factor. In the following
definition, "assets" refers to the assets in each Investment Subdivision. "Any
amount charged against the Separate Account" refers to those amounts that are
allocated to each Investment Subdivision.
The net investment factor for a Valuation Period is (a) divided by (b), minus
(c), 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 Investment Subdivision at the end of the
preceding Valuation Period; and
(c) is a charge no greater than .0024769% for each day in the Valuation
Period. This corresponds to .90% per year.
Transfers
You may transfer Account Value among the Investment Subdivisions of the
Separate Account. 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 reserve
the right to limit the number of transfers to twelve each calendar year. The
first transfer in each calendar month
25
will be made without a transfer charge. A transfer charge will be imposed for
each subsequent transfer in a calendar month. This transfer charge is shown 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 the
transfer charge. The transfer charge will be taken from the amount transferred.
26
Account Value Benefits
HOW WE DETERMINE ACCOUNT VALUE
At the end of the Valuation Period during which the first premium is received,
the Account Value in each Investment Subdivision is equal to (a) minus (b),
where:
(a) is the portion of the Net Premium which has been paid and allocated to that
Investment Subdivision; and
(b) is the portion of any due and unpaid monthly deductions allocated to the
Account Value in that investment Subdivision.
At the end of each Valuation Period after such date, the Account Value
allocated to each Investment Subdivision of the Separate Account is (1) plus
(2) plus (3) minus (4) minus (5) minus (6), where:
(1) is the Account Value allocated to the Investment Subdivision at the end of
the preceding Valuation Period, multiplied by the Investment Subdivision's
net investment factor for the current Valuation Period;
(2) is Net Premiums received during the current Valuation Period and which are
allocated to the Investment Subdivision;
(3) is any other amount transferred into the investment Subdivision during the
current Valuation Period;
(4) is any partial surrender made from the Investment Subdivision during the
current Valuation Period;
(5) is any Account Value transferred out of the Investment Subdivision during
the current Valuation Period;
(6) any monthly deduction allocated to the Investment Subdivision during the
current Valuation Period.
HOW WE DETERMINE NET PREMIUM
To calculate the Net Premium, 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. It is determined by adding the cost of
insurance, the cost of additional benefits provided by rider, and the monthly
policy
27
charge. The monthly deduction for the month when an increase in the Specified
Amount becomes effective will include the increase charge per $1000 for each
$1000 of increase.
The actual monthly policy charge will never be greater than the maximum monthly
policy charge shown on the policy data pages. The increase charge per $1,000 is
also shown on the policy data pages.
The monthly deduction for a Policy Month will be allocated among the Investment
Subdivisions of the Separate Account in the same proportion that the Policy's
Account Value in each Investment Subdivision bears to the total Account Value
in all Investment Subdivisions at the beginning of the Policy Month.
COST OF INSURANCE
The cost of insurance is calculated on each Monthly Anniversary Day and is
based on the net amount at risk. The net amount at risk is calculated by
dividing the Life Insurance Proceeds by 1.0032737, and then subtracting the
Account Value. To determine the 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. If Option B is in effect, and the Specified
Amount has increased, the Account Value is first considered part of the initial
Specified Amount. If the Account Value is more than the initial Specified
Amount, it will be considered part of the increased Specified Amounts resulting
from increases in the order of the increases.
Cost of lnsurance Rate. The monthly rate is based on the Insured's sex, issue
age, policy duration and risk class. The risk class (and therefore the rates)
will be determined separately for the initial Specified Amount and for any
increase in the Specified Amount that requires evidence of insurability. The
rates are determined by us according to our expectations of future experience
for mortality, lapse, taxes, interest, and expenses. We can change the rates
from time to time, but they will never be more than the maximum rates shown in
the table of guaranteed maximum insurance rates. A change in rates will apply
to all persons of the same age, sex and risk class and whose policies have been
in effect for the same length of time.
INSUFFICIENT ACCOUNT VALUE
On a Monthly Anniversary Day, if the Account Value less the surrender charge
and less any Policy Debt is not enough to cover the monthly deduction for that
Monthly Anniversary Day, the Grace Period provision will apply.
28
CONTINUATION OF COVERAGE
This Policy and any riders will remain in effect:
. as long as the Account Value less the surrender charge and less any Policy
Debt covers the monthly deduction; or
. as provided for in the Continuation Amount and Continuation Period provision
under PREMIUM PAYMENTS.
A rider attached to this Policy will not continue beyond its termination date
under any circumstances.
SURRENDER
You can make a full or partial surrender of this Policy by sending a written
request and the Policy to our Home Office. Unless an Optional Payment Plan is
chosen, any proceeds payable will be paid to you in a lump sum. A surrender
must take place during the Insured's life.
Amount Payable on Surrender. The Surrender Value of this Policy is the Account
Value on the date we receive your request for surrender in our Home Office less
any Policy Debt and less 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. The amount of surrender charge is shown in
the policy data pages. The surrender charge period is the period of Policy
Months for which a surrender charge is shown in the policy data pages.
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 surrender charge
will be the charge for a full surrender, multiplied by the ratio of (a) to (b),
where:
(a) is the smallest Specified Amount that was in effect prior to the current
decrease, minus the Specified Amount after the current decrease; and
(b) is the smallest Specified Amount that was in effect prior to the current
decrease.
Surrender charges in effect prior to the decrease will be adjusted to reflect
any assessments made.
Partial Surrender. You can make a partial surrender of this Policy. A partial
surrender cannot be less than $500. A partial surrender cannot exceed the
lesser of:
. the Surrender Value, less $500; or
. the available loan amount.
29
We generally will reduce both the Account Value and the Life Insurance 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 allocate the partial surrender among the Investment
Subdivisions of the Separate Account. If you do not, the partial surrender will
be allocated among each Investment Subdivision in the same proportion that the
Policy's Account Value in each Investment Subdivision bears to the total
Account Value in all investment Subdivisions on the date we receive the request
in our Home Office.
We will deduct a charge from the amount of each partial surrender. This charge
will equal the lesser of (i) $25, or (ii) 2% of the amount of the partial
surrender.
RECEIVING THE SURRENDER VALUE
The Surrender Value is payable in one lump sum unless you choose to receive
periodic payments under an Optional Payment Plan.
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 Life
insurance Proceeds within seven days after we receive due proof of death.
Payment of any amount payable on surrender, partial surrender, policy loan or
Life Insurance 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 is drawn.
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Loan Benefits
This Policy has loan benefits that are described below.
MAKING A POLICY LOAN
You may obtain a policy loan from us. This Policy is the only security
required. 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 out of the Separate Account and into our General Account.
You may tell us how to allocate that Account Value among the Investment
Subdivisions of the Separate Account. If you do not, that Account Value will be
aliocated among each Investment Subdivision in the same proportion that the
Policy's Account Value in each Investment Subdivision bears to the total
Account Value in all Investment Subdivisions on the date we make the loan.
Any loan transaction will permanently affect the values of the Policy.
POLICY LOAN INTEREST
The interest rate paid on policy loans is shown on the policy data pages.
Interest accrues daily, and is due and payable on each policy anniversary. If
interest is not paid when due, an amount equal to the amount owed will be
transferred out of the Separate Account to become part of the Policy Debt and
interest will be charged on that amount. Interest transferred out of the
Separate Account will be transferred from each Investment Subdivision in the
same proportion that the Account Value in that Investment Subdivision bears to
the total Account Value in all Investment Subdivisions at the time of interest
transfer.
PREFERRED POLICY DEBT
Account Value in the General Account will earn interest daily at a minimum
annual rate of 4%. On each policy anniversary day, the interest earned since
the preceding policy anniversary day will be transferred into the Separate
Account. Unless you tell us otherwise, this interest will be allocated to the
Investment Subdivisions in the same manner as Net Premiums.
A portion of policy loans taken and/or existing after the preferred loan
availability date (shown on the policy data pages) will be designated as
preferred policy debt. The amount of preferred policy debt is redetermined each
policy month. Borrowed Account Value that corresponds to preferred policy debt
will earn interest at no less than the minimum annual rate of 4%. At our sole
discretion, we may use an interest rate higher than the guaranteed interest
rate.
31
Preferred policy debt will be at least as large as:
(a) the Account Value less any surrender charge that applies, minus
(b) the total premiums paid.
REPAYING POLICY DEBT
You can repay Policy Debt in part or in full any time during the Insured's life
while this Policy is in effect. Loan payments will first be applied to reduce
the portion of Policy Debt that does not correspond to preferred policy debt.
When a loan repayment is made, Account Value in the General Account related to
that payment will be transferred into the Separate Account. You may tell us how
to allocate this Account Value among each Investment Subdivision of the
Separate Account. If you do not, we will allocate that amount among the
Investment Subdivisions 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 Insured's death 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.
32
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.
33
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 guaranteed maximum cost of insurance rates are based on the
Commissioners' 1980 Standard Ordinary Smoker or Nonsmoker Mortality Table for
issue ages 15 and above. For issue ages O-14, they are based on the
Commissioner's 1980 Standard Ordinary Mortality Tables without distinction for
smoker or nonsmoker status, until attained age 15; then for attained ages 15
and over, they are based on the Commissioner's 1980 Standard Ordinary Nonsmoker
Mortality Table.
If this Policy or an increased Specified Amount is in a special rating class,
the guaranteed maximum insurance rates are increased in the manner described in
the table of guaranteed maximum insurance rates.
If the net investment factor is always equivalent to an effective annual
interest rate of 4%, the values in this Policy will always at least equal the
account values required of an equivalent general account policy by the law
where this Policy was delivered. A detailed statement of how we calculate the
values in this Policy has been filed with the insurance department where this
Policy was delivered.
EXCHANGE PROVISION
During the first 24 policy months, you have the right to exchange this Policy
for a permanent fixed benefit policy. We will not require evidence of
insurability. If you decide to make an exchange, we will notify you of the
policies available for exchange and the procedures to follow. You may elect to
have the amount of the new policy be either (a) or (b) where:
(a) is the Life Insurance Proceeds on the date of exchange, and
(b) is the Life Insurance Proceeds minus the Account Value on the date of
exchange.
The new policy will have the same policy date, sex, issue age and rating class
as this Policy. The new policy will include such riders and endorsements as
were included in this Policy, if such riders and endorsements are available
with the new policy.
The exchange is subject to an equitable adjustment in payments and Account
Values to reflect variances, if any, in the payments and Account Values under
the existing Policy and the new policy.
34
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 lifetime of the Insured 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 lifetime of the Insured 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 lifetime of the insured for two years from the date of
reinstatement.
This provision does not apply to riders that provide disability benefits.
MISSTATEMENT OF AGE OR SEX
If the Insured's Age or sex was misstated in an application, Life Insurance
Proceeds will be adjusted. The Life Insurance Proceeds after adjustment will be
the sum of (a) and (b), where:
(a) is the Account Value at the time of the Insured's death; and
(b) is the unadjusted Life Insurance Proceeds, reduced by the Account Value at
the time of the insured's death, and multiplied by the ratio of (1) the
most recent monthly deduction based on the Age and sex shown in the
application, to (2) the most recent monthly deduction based on the true Age
or sex.
All amounts are those in effect, with respect to the insured, in the Policy
Month of the Insured's death.
In no event will Life Insurance Proceeds 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.
35
SUICIDE
If the 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 limited
amount of proceeds. The limited amount of proceeds will equal all premiums paid
on the Policy, less Policy Debt and partial surrenders.
If the 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 with respect to the increase will
equal the monthly deductions that were made for that increase.
Any limited amount payable will be treated as Life Insurance 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 the
Insured's full name.
Any notice we send to you will be sent to your address shown in the
application. Notify us of any change of address.
36
Optional Payment Plan
Life insurance or surrender value proceeds 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 the Insured's life, you can choose a plan. A
Beneficiary can choose a plan if you have not chosen one at the insured's
death.
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 or on lapse, 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 1O, 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.
37
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.
38
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 for each $1,000 of proceeds under Plan 2.
Male Payee Female Payee Male Payee Female Payee
----------------------- ----------------------- ----------------------- -----------------------
10 15 20 10 15 20 10 15 20 10 15 20
Settlement Years Years Years Years Years Years Settlement Years Years Years Years Years Years
Age Certain Certain Certain Certain Certain Certain Age 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.
39
Plan 5 Table: Monthly payment rates for each $1,000 of proceeds under Plan 5.
Female Settlement Age
Male -----------------------------------------------------------------
Settlement 85 &
Age 35 40 45 50 55 60 65 70 75 80 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
-------------------
Prior Age
After To Adjustment
----- ----- ----------
2001 0
2000 2006 3
2025 2051 7
2050 10
40
Unit Value Endorsement
The Policy to which this endorsement is attached is amended by deleting from
the definition of net investment factor in the Unit Value provision the
following:
(c) is a charge no greater than .0024769% for each day in the Valuation Period.
This corresponds to .90% per year.
and by adding the following:
(c) is a charge no greater than .0019246% for each day in the Valuation Period.
This corresponds to .70% per year.
For GE life and Annuity Assurance Company
(LOGO)
President
41
Bank Draft Preauthorized Premium Payment Plan Agreement
This agreement provides for payment of premiums under our Bank Draft
Preauthorized Premium Payment Plan. You have authorized us to collect premiums
by drawing against a designated bank account, or by electronic fund transfers
from a designated bank account at the frequency shown in the policy data pages.
Subject to the following, we will collect the premiums due under the policy in
the manner authorized.
This agreement will end:
. if you send us a written notice; or
. if we send you a written notice.
We reserve the right to terminate this agreement:
. if a stop payment notice prevents payments of a premium due; or
. if insufficient funds prevent payment of a premium due.
After this agreement ends, premiums will be payable at the rates and mode of
payment that would have been in effect without this agreement.
When this agreement ends, we reserve the right to change the mode of payment to
the next less frequent premium mode.
For GE Life and Annuity Assurance Company
(LOGO)
President
42
Accidental Death Benefit Rider
This rider provides an additional death benefit on the life of the insured. We
will pay this benefit when we receive due proof of the Insured's death, if:
. the death resulted, directly and independently of all other causes, from
bodily injury caused solely by external, violent and accidental means; and
. the injury and death occurred while this rider was in effect; and
. the death occurred within 180 days of the injury; and
. the death occurred after the policy anniversary nearest the insured's 5th
birthday; and
. the death occurred before the policy anniversary nearest the insured's 70th
birthday.
AMOUNT OF BENEFIT
The amount of accidental death benefit is the Specified Amount of Accidental
Death Benefit shown in the policy data pages.
CHANGE IN EXISTING AMOUNT OF BENEFIT
After this rider has been in effect for one year, you can increase or decrease
the Specified Amount of Accidental Death Benefit. To make a change, send a
written request and the Policy to our Home Office.
Decrease. Any decrease will become effective on the Monthly Anniversary Day
after the date we receive the request. The decrease will first apply to
coverage provided by the most recent increase, then to the next most recent
increases successively, then to coverage provided under the original
application. The least Specified Amount of Accidental Death Benefit that may be
in effect after a change is $2,000.
Increase. To apply for an increase you must submit a supplemental application.
You will have to submit evidence satisfactory to us that the insured is
insurable. Any approved increase will become effective on the date shown in the
supplemental policy data page. Any increase will be subject to deduction of the
first month's cost of increased insurance from the Account Value of this
Policy. Any increase will be limited by the Company's rules in effect at the
time of the change.
WHEN THE RIDER IS EFFECTIVE
This rider goes into effect on the Policy Date unless another effective date is
shown in the policy data pages. The effective date of any increase is shown in
the policy data pages.
This rider will end:
. if the grace period ends without sufficient premium being paid; or
43
. if the policy is surrendered; or
. if you send us a written request to end the rider; or
. if the Policy ends; or
. on the policy anniversary nearest the Insured's 70th birthday.
EXCEPTIONS
This benefit will not be paid if death results solely or partly, directly or
indirectly, from:
. suicide, or attempted suicide, while sane or insane; or
. committing or attempting to commit an assault or felony; or
. war, whether or not declared, or any act of war, or insurrection; or
. service in any armed force engaged in a military conflict; or
. participation in maneuvers of an armed force; or
. travel in, flight on, or descent from any aircraft unless the insured is on
the aircraft solely as a passenger (Aircraft includes a rocket or any vehicle
for travel in or beyond the earth's atmosphere); or
. voluntary use of any drug or medication.
. bodily or mental infirmity, disease or infection, or their medical or
surgical treatment. We will cover death from an infection which occurs due to
an accidental cut or wound.
LIMITS ON CONTESTING THIS RIDER
We will not contest this rider after it has been in effect during the Insured's
life for two years. We will not contest an increase in benefit after the
increase has been in effect during the Insured's life for two years from the
effective date of the increase.
COST OF THIS RIDER
This rider is issued in consideration of the application and the inclusion of
its monthly cost of insurance in the Policy's monthly deduction.
The monthly cost of insurance for this rider is (I) multiplied by (2), where:
(1) is the cost of insurance rate for this rider: and
(2) is the Specified Amount of Accidental Death Benefit.
The cost of insurance rates for this rider are shown in the Table of Guaranteed
Maximum Insurance Rates in the policy data pages.
This rider is subject to the provisions of the Policy.
For GE Life and Annuity Assurance Company,
44
Disability Benefit Rider
This rider provides benefits while the insured is totally disabled. However, it
will not provide any benefits until after six months of continuous total
disability.
During the Continuation Period, on each Monthly Anniversary Day while the
insured is totally disabled, we will credit to this Policy a premium equal to
the greater of the monthly deductions or the amount by which the Continuation
Amount for the current Policy Month exceeds the Continuation Amount for the
preceding Policy Month.
After the Continuation Period, on each Monthly Anniversary Day while the
Insured is totally disabled, we will waive the monthly deductions due under
this Policy, including the monthly costs of any benefits provided by rider.
After we receive proof the Insured has been continuously totally disabled for
six months, we will make benefits effective from the commencement of total
disability.
Coverage will continue during any period for which benefits are provided under
this rider.
The total disability must start while this rider is in effect. It also must
start before the policy anniversary nearest the Insured's 65th birthday.
We will not waive any deduction due on or after the policy anniversary nearest
the Insured's 65th birthday, except as provided below.
if the insured is totally disabled and monthly deductions are being waived,
this Policy will not lapse solely because the Account Value becomes less than
the surrender charge.
WHEN THIS RIDER IS EFFECTIVE
Coverage provided as a result of the original application for this rider goes
into effect on the Policy Date unless another effective date is shown in the
policy data pages.
If you increase the Specified Amount under the Policy, the coverage under this
rider will increase at the same time.
Coverage under this rider will end:
. on the policy anniversary nearest the Insured's 65th birthday; or
. if the grace period ends without sufficient premium being paid; or
. if the Policy is surrendered; or
. if you send a written request to end the rider; or
. if the Policy ends.
45
Any monthly deduction due on or after the policy anniversary nearest the
Insured's 65th birthday will be waived only if on that date the Insured:
. is totally disabled; and
. has been continuously totally disabled during the previous five years; and
. was entitled to benefits under this rider.
TOTALLY DISABLED
The Insured will be considered totally disabled if the total disability:
. results from bodily injury or disease; and
. continues uninterrupted for at least six months; and
. during its first two years causes the Insured to be unable to perform the
substantial duties of his or her regular occupation; and
. after its first two years causes the Insured to be unable to perform the
substantial duties of any and every occupation or work for pay or profit for
which he or she is qualified by education, training or experience.
Any of the following are presumed to cause the Insured to be totally disabled:
. The entire, irrevocable loss of sight of both eyes.
. The loss of use of both hands.
. The loss of use of both feet.
. The loss of use of one hand and one foot.
The loss must occur after this rider goes into effect.
EXCEPTIONS
This rider will not provide any benefits if total disability results from:
. an intentionally self-inflicted injury, while sane or insane; or
. an injury that occurred or disease that first became manifest before this
rider went into effect; or with respect to increases in coverage, injury that
occurred or disease that first became manifest before the increase went into
effect; or
. war, whether or not declared, or any act of war, or participation in an
insurrection; or
. service in any armed force engaged in a military conflict.
46
LIMITS ON CONTESTING THIS RIDER
With respect to coverage originally provided by this rider on its effective
date, we will not contest this rider after it has been in effect for two years
during the Insured's life and without the start of total disability. With
respect to increases in coverage due to increases in the Specified Amount under
the Policy, we will not contest an increase in coverage under this rider after
the increase has been in effect for two years during the Insured's life and
without the start of total disability.
CLAIMING BENEFITS UNDER THIS RIDER
Send us written notice and proof of the Insured's total disability. We must
receive proof of claim while the Insured is alive and totally disabled. If this
cannot be done, we will not reduce or deny the claim if we receive notice and
proof as soon as reasonably possible. We will not waive any Continuation Amount
or monthly deduction due prior to the 12 months before we receive notice of
disability, unless it was not reasonably possible to send notice sooner.
We require that proof of continuing total disability be given to us
periodically. We will not require proof more than once a year after total
disability has continued for two years. If the insured fails to give required
proof, we will not waive any future Continuation Amounts or monthly deductions.
COST OF THIS RIDER
This rider is issued in consideration of the application and the inclusion of
the monthly cost of disability benefit in the policy's monthly deduction.
The monthly cost of disability benefit is (1) muLtiplied by (2), where:
(1) is the disability percentage rate; and
(2) is the cost of insurance for the month.
The disability percentage rates are shown in the Table of Guaranteed Maximum
Insurance Rates in the policy data pages. The cost of insurance is the cost of
insurance for the Policy plus the cost of insurance for any rider insuring an
additional life.
This rider is subject to the provisions of the Policy.
For GE Life and Annuity Assurance Company,
(LOGO)
President
47
Children's Insurance Rider
This rider provides level term insurance payable at the death of each insured
child. We will pay the insurance to the Insured unless another beneficiary has
been designated and the designation is effective when the child dies.
Insured child means the Insured's child named in the application for this
rider. Insured child also means any child born to or adopted by the Insured
while this rider is effective. A child may not become an insured child before
the 15th day of the child's life or after the child's 18th birthday. However, a
child who is a full-time student and who has not yet attained his 22nd birthday
may become an insured child.
Insured means the Insured under the Policy.
Full-time student means a child who is currently enrolled as a full-time
student, in a secondary or postsecondary school. Full-time student also
includes a child who is absent from school due to summer vacation and who is
scheduled to return to school when the next school year begins.
AMOUNT OF INSURANCE
The amount of insurance is shown in the policy data pages.
WHEN THIS RIDER IS EFFECTIVE
This rider goes into effect on the Policy Date, unless another effective date
is shown in the policy data pages.
An insured child's coverage goes into effect on the date when this rider goes
into effect, the date of the child's adoption, or the 15th day of the child's
life, whichever is latest. An insured child's coverage ends on the policy
anniversary nearest the child's 25th birthday or when this rider ends, if
earlier.
This rider will end:
. on the death of the Insured; or
. if the Policy is surrendered; or
. if you send us a written request to end the rider; or
. if the Policy ends.
CONTINUATION OF COVERAGE AT DEATH OF INSURED
In addition to providing term insurance on each insured child, this rider
provides for a term insurance benefit on the Insured. This benefit is
automatically applied at the death of the Insured to purchase a new policy
containing the same amount of benefit as this rider on each surviving insured
child. No further premium will be required on
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any new policy. Each new policy will have account values which will be
available to its owner. We will furnish these values on request.
CHILD'S OPTION TO PURCHASE A NEW POLICY
An insured child may purchase a new policy on his own life, on the policy
anniversary nearest his 25th birthday or when the Policy ends, if earlier. No
evidence of insurability will be required.
The insured child must send us a written request within 30 days of the end of
his coverage under this rider. The new policy will go into effect on the date
coverage ends under this rider. However, the full first premium must be paid
before the new policy will go into effect.
The new policy can be a whole life policy or any other policy then offered by
us for exchanges. Premiums for the new policy will be at rates in effect for
the insured child's sex and attained age on its effective date. The new policy
will be subject to our rules on frequency of premium payment, minimum premium
and plan availability on its effective date. There will be at least one plan
available.
The insured child may elect an amount of insurance of from one to five times
the amount of insurance under this rider on the date coverage ends under this
rider.
The new policy will not include any supplementary riders unless we agree.
LIMITS ON EFFECT OF OTHER RIDERS
No benefit rider, other than a Disability Benefit Rider, will affect this
rider. This rider will not increase the benefits paid under any other rider.
LIMITS ON CONTESTING THIS RIDER
With respect to any insured child named in the application, we will not contest
the amount of coverage originally provided by this rider after it has been in
effect during the child's life for two years,
With respect to any insured child who becomes insured after this rider goes
into effect, we will not contest the coverage provided that child by this
rider.
SUICIDE
If the Insured commits suicide, while sane or insane, within two years of the
date this rider goes into effect, this rider will end. We will not issue a
paid-up policy on any surviving insured child. Instead, each surviving insured
child may purchase a new policy, as described under Xxxxx's Option to Purchase
a New Policy.
If, while this rider insures only one child, that insured child commits
suicide, while sane or insane, within two years of the date that his coverage
under this rider goes into effect, the benefit payable under this rider will be
limited to the cost of insurance
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deductions made with respect to this rider. If, while this rider insures more
than one child, one of those insured children commits suicide, while sane or
insane, within two years of the date that his coverage under this rider goes
into effect, no benefits will be paid under this rider with respect to that
child's death.
COST OF THIS RIDER
This rider is issued in consideration of the application and the inclusion of
its monthly cost of insurance in the Policy's monthly deduction.
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 amount of insurance for this rider, divided by 1,000.
The cost of insurance rate for this rider is shown in the policy data pages.
This rider is subject to the provisions of the Policy.
For GE Life and Annuity Assurance Company,
(LOGO)
President
50
Insurance Rider For Additional Insured Person
This rider provides adjustable insurance on an additional insured person. We
will pay the insurance to the beneficiary named in the application for this
rider, unless another beneficiary has been designated and that designation is
effective when the insurance is payable. If no beneficiary survives the
additional insured person, the insurance will be paid to you or your estate.
Additional insured person means the person so named in the application for this
rider and also named in the policy data pages. The insurance is payable at the
death of the additional insured person while this rider is in effect.
AMOUNT OF INSURANCE
The amount of insurance is shown in the policy data pages.
CHANGE IN EXISTING AMOUNT OF INSURANCE
After this rider has been in effect for one year, you can increase or decrease
the amount of insurance. To make a change, send a written request and the
Policy to our Home Office.
DECREASE
Any decrease will become effective on the Monthly Anniversary Day after the
date we receive the request. The decrease will first apply to coverage provided
by the most recent increase, then to the next most recent increases
successively, then to coverage provided under the original application. The
least amount that may be in effect after a change is $10,000.
INCREASE
To apply for an increase you must submit a supplemental application. You will
have to submit evidence satisfactory to us that the additional insured person
is insurable. Any approved increase will become effective on the date shown in
the supplemental policy data page. Any increase will be subject to deduction of
the first month's cost of increased insurance from the Account Value of this
Policy. Any increase will be limited by the company's rules in effect at the
time of the change.
WHEN THIS RIDER IS EFFECTIVE
This rider goes into effect on the policy date, unless another effective date
is shown in the policy data pages.
This rider wiil end:
. on the death of the Insured; or
. if the Policy is surrendered; or
. if you send us a written request to end the rider; or
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. if the Policy ends; or
. on the policy anniversary nearest the additional insured person's 100th
birthday.
MISSTATEMENT OF AGE OR SEX
If the age or sex of the additional insured person was misstated in the
application for this rider, the proceeds and benefits will be adjusted. We will
adjust proceeds and benefits by the difference between the actual monthly cost
of insurance and the monthly cost of insurance that should have been deducted
at the true age or sex.
SUICIDE
If the additional insured person under this rider dies from suicide, while sane
or insane, within two years from the effective date of coverage under this
rider, our liability will be limited to the total cost of insurance for this
rider for the months it is in force.
If the additional insured person under this rider dies from suicide within two
years from the effective date of an increase in the existing amount of
insurance, our liability with respect to that increase will be limited to the
total cost of insurance for that increase for the months the amount of increase
is in force.
EXCHANGING THIS RIDER FOR AN INSURANCE POLICY
While this rider is in effect, you can exchange it for a new policy. We will
not require any new evidence of insurability. To exchange this rider, send us a
written request and the Policy. This rider will end and the new policy will go
into effect on the Monthly Anniversary Day after we receive the request. This
cannot be later than the policy anniversary nearest the additional insured
person's 70th birthday. The full first premium must be paid before the new
policy will go into effect. If the exchange takes place within two years of the
effective date of this rider, we will rely on representations in the
application for this rider. We cannot contest coverage under the new policy if
death occurs after the two-year period following the effective date of coverage
under this rider. The new policy may be any plan of insurance we then offer for
exchanges. There will be at least one plan available. Premiums for the new
policy will be at rates then in effect for the additional insured's sex and
attained age. The new policy will be subject to our rules on frequency of
premium payment, minimum premium and plan availability at the age of exchange.
The amount of insurance under the new policy will be the amount of insurance
under this rider on the effective date. A smaller amount of insurance may be
arranged with our consent. The new policy will include all provisions we
regularly use in such policies on the policy date. The new policy will not
include any supplementary riders unless we agree.
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DEATH OF THE INSURED
If you are not the Insured, and this rider ends because of the death of the
Insured, we will issue to you a new policy on the life of the additional
insured person. The requirements and provisions under Exchanging this Rider for
an Insurance Policy will apply. We must receive a written request within 30
days after the Insured's death. If the Insured's date of death is the 29th,
30th, or 31st day of a calendar month, the new policy will be effective on the
first day of the following calendar month. Otherwise, the new policy will be
effective on the date of the Insured's death.
If you are the Insured and this rider ends because of your death, the
additional insured person may request the new policy. In this case, the
additional insured person will own the new policy.
If the additional insured person dies within 30 days after the Insured, and if
a new policy has not been requested, we will pay the amount of insurance that
would have been paid under this rider had it not ended. Our payment will be
made as if this rider was still in effect.
LIMITS ON EFFECT OF OTHER RIDERS
No benefit rider, other than a Disability Benefit Rider, will affect this
rider. This rider will not increase the benefits paid under any other rider.
LIMITS ON CONTESTING THIS RIDER
We will not contest the amount of insurance originally provided by this rider
after it has been in effect during the additional insured person's life for two
years.
COST OF THIS RIDER
This rider is issued in consideration of the application and the inclusion of
its monthly cost of insurance in the Policy's monthly deduction.
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 amount of insurance for this rider, divided by 1000.
COST OF INSURANCE RATE
The monthly rate is based on the additional insured person's sex, issue age,
policy duration and risk class. The rates are determined by us according to
expectations of future mortality. We can change the rates from time to time,
but they will never be more than the maximum rates shown in the Table of
Guaranteed Maximum Insurance Rates. A change in rates will apply to all persons
of the same age, sex and risk class and whose policies have been in effect for
the same length of time.
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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 the additional insured
person is insurable.
This rider has no account value.
This rider is subject to the provisions of the Policy.
For GE Life and Annuity Assurance Company
(LOGO)
President
54
Accelerated Benefit Rider
This rider adds an accelerated benefit to the Policy, subject to the conditions
described below.
Notice: You may be taxed on benefits received under this rider. Please consult
your personal tax advisor. This statement is required by Virginia law. There
have been revisions to the tax law. In our opinion, an accelerated benefit will
qualify as a life insurance benefit payment under tax law and is not subject to
tax.
Upon your election and subject to the provisions of this rider, we will pay you
an accelerated benefit if the Insured is terminally ill. Payment will be made
in a lump sum.
TERMINAL ILLNESS
Terminal illness is a medical condition, resulting from bodily injury, or
disease, or both:
. which has been diagnosed by a licensed physician; and
. for which the diagnosis is supported by clinical, radiological, laboratory or
other evidence of the medical condition which is satisfactory to us; and
. which a licensed physician certifies is expected to result in death within 12
months of such certification.
Before payment of any accelerated benefit, we will require satisfactory proof
that the Insured has a terminal illness. Satisfactory proof will include a
properly completed claim form and a written statement from a licensed
physician. The licensed physician must be someone other than you or the
insured. We reserve the right to obtain a second medical opinion at our
expense.
TOTAL PROCEEDS
Total Proceeds means the Life Insurance Proceeds of the Policy plus any
additional term insurance on the Insured added to the Policy by rider. (Not
including Children's Insurance Rider.)
Total Proceeds:
. will not have an adjustment for any Policy Debt; but
. will have adjustments for the misstatement of age or sex which would be made
to Life Insurance Proceeds at the death of the Insured, as described in the
Policy; and
. will exclude any Accidental Death Benefit; and
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. will exclude any coverage from the Policy or from any additional term
insurance rider on the Insured that would expire within 24 months of the date
we receive proof of terminal illness.
ELIGIBLE PROCEEDS
Eligible Proceeds is the Total Proceeds subject to a maximum of $250,000 for
the total of all of our policies or certificates covering the Insured.
LIVING BENEFIT
The Living Benefit is the amount of the accelerated benefit that we will pay to
you under this rider.
The Living Benefit is equal to the Eligible Proceeds:
. discounted for the life expectancy of the Insured at the rate of interest
charged for policy loans; and
. minus the product of (1) the ratio of the Eligible Proceeds to the Total
Proceeds, and (2) the amount of the single premium required to keep the
Policy in effect for the life expectancy of the Insured assuming current cost
of insurance rates, current expense charges, and the interest rate stated
above; and
. minus the product of (1) the ratio of the Eligible Proceeds to the Total
Proceeds, and (2) the Policy Debt on the date of the accelerated benefit
payment.
EFFECT OF LIVING BENEFIT ON THE POLICY
If the Eligible Proceeds are equal to the amount which would otherwise be
payable upon the death of the Insured, then upon payment of any benefit under
this rider:
. any insurance under the Policy on the life of someone other than the Insured
will be treated as though the Insured had died; and
. all insurance under the Policy on the life of the Insured, including any
riders, will end.
If the Eligible Proceeds are less than the amount which would otherwise be
payable upon the death of the Insured, then upon payment of any benefit under
this rider:
. the Policy will continue with the Specified Amount, Account Value and any
Policy Debt reduced appropriately, by the ratio of the Eligible Proceeds to
the Total Proceeds; and
. we will waive any surrender charge for the resulting decrease in Specified
Amount; and
. we will waive any minimum Specified Amount requirement for the resulting
decrease in Specified Amount; and
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. any additional term insurance rider on the Insured will continue with the
amount of insurance reduced by the ratio of the Eligible Proceeds to the
Total Proceeds; and
. any other rider benefits will continue with no reduction.
CONDITIONS
Payment of the Living Benefit is subject to the following conditions:
. The Policy and any additional term insurance rider on the Insured must be in
force on the date we receive proof of terminal illness.
. The release of any collateral assignees and the approval of any irrevocable
beneficiaries is required.
. The policy may not be in the grace period on the date we receive proof of the
terminal illness.
. You are not eligible for the Living Benefit:
(a) if you are required by law to use the Living Benefit to meet the claims of
creditors, whether in bankruptcy or otherwise; or
(b) if you are required by a government agency to use the Living Benefit in
order to apply for, obtain, or otherwise keep a government benefit or
entitlement.
EFFECTIVE DATE
This rider is effective on the Policy Date unless a different effective date is
shown on the policy data page.
There is no charge for this rider.
All provisions of the Policy apply to this rider unless otherwise specified.
For GE Life and Annuity Assurance Company,
(LOGO)
President
57
FLEXIBLE PREMIUM VARIABLE
LIFE INSURANCE POLICY
--------------------------------------------------------------------------------
. Life Insurance Proceeds payable at the insured's death
. Adjustable death benefit
. Flexible premiums payable for the Insured's life
. Some benefits reflect investment results
. No dividends
GE LIFE AND ANNUITY
ASSURANCE COMPANY
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Endorsement
The Policy to which this endorsement is attached is amended as follows:
COST OF INSURANCE
Monthly deductions for cost of insurance charges will end on the Policy
anniversary date on which the Insured's Attained Age is 100.
POLICY LOAN INTEREST
The interest rates charged for non-preferred Policy loans and for preferred
Policy loans are shown on the Policy data pages.
TRANSFERS
We do not currently charge for transfers. We reserve the right to impose a
transfer charge. The maximum amount of any transfer charge is provided on the
Policy data pages.
For GE Life and Annuity Assurance Company
(LOGO)
President
59