EXHIBIT 99.27(d)(5)
NORTHSTAR LIFE ACCELERATED BENEFITS RIDER
Northstar Life Insurance Company - University Corporate Centre at Amherst
- Suite 000 - 000 Xxxxxxxxx Xxxxxxx - Xxxxxxx, Xxx Xxxx 00000
Benefits received under this Accelerated Benefits Policy Rider may be taxable
and may affect eligibility for public assistance programs. Certificate holders
should seek assistance from a personal tax advisor prior to requesting an
accelerated payment of death benefits.
GENERAL INFORMATION
This agreement amends the group policy to which it is attached and is subject to
all its terms and conditions.
WHAT DOES THIS AGREEMENT PROVIDE?
This agreement provides for the accelerated payment of the insured's current
death benefits as outlined under the Death Benefit section of the group policy.
If the insured has a terminal condition, as defined in this agreement, the
insured may request an accelerated benefit. If we agree to pay an accelerated
benefit, the cash values, loan values and the death benefit under the insured's
certificate will be reduced.
DEFINITIONS
When we use the following words, this is what we mean:
DEATH BENEFIT
The face amount of the insured's certificate less any existing loans or
indebtedness under the certificate and less any term insurance provided by an
additional benefit agreement.
ACCELERATED BENEFIT
The amount of the death benefit we will pay if the insured is eligible under
this agreement. We will calculate the accelerated benefit amount by multiplying
the death benefit by the accelerated benefit.
PHYSICIAN
An individual who is licensed to practice medicine or treat illness in the state
in which treatment is received. This does not include the insured, or a member
of the insured's immediate family.
IMMEDIATE FAMILY
The insured's spouse, child, parent, grandparent, grandchild, brothers and
sisters and their spouses.
TERMINAL CONDITION
WHAT IS A TERMINAL CONDITION?
A condition caused by sickness or accident which directly results in a life
expectancy of twelve months or less.
WHAT EVIDENCE DO WE REQUIRE OF THE INSURED'S TERMINAL CONDITION?
We must be given evidence that satisfies us that the insured's life expectancy,
because of sickness or accident, is twelve months or less. That evidence must
include certification by a licensed physician. We reserve the right to ask for
independent medical verification of a terminal condition.
PAYMENT OF ACCELERATED BENEFIT
HOW DO WE CALCULATE THE ACCELERATED BENEFIT?
The accelerated benefit will be stated as a percentage of the insured's death
benefit. When we calculate this amount, we will consider the insured's age and
the option applied for. We will also base our calculation on certain
assumptions, which we may change from time to time, including but not limited to
assumptions about:
(1) expected future premiums;
(2) the insured's life expectancy.
IS THERE A PROCESSING CHARGE?
Yes. We will subtract a processing charge of up to $150 from the accelerated
benefit before we pay that benefit.
WHAT ARE THE CONDITIONS FOR THE PAYMENT OF AN ACCELERATED BENEFIT?
We will consider the payment of an accelerated benefit, subject to all of the
following conditions:
(1) Coverage must be in force other than as extended term
insurance and all premiums due must be fully paid.
(2) Application must be made in writing and in a form which is
satisfactory to us. We will tell an applicant what form is
required.
(3) The certificate must not be assigned.
(4) The certificate must not have an irrevocable beneficiary.
IS THE REQUEST FOR AN ACCELERATED BENEFIT VOLUNTARY?
Yes. An accelerated benefit under this agreement is not intended to cause the
insured to involuntarily reduce the death proceeds ultimately payable to the
named beneficiary. An accelerated benefit will be made available on a voluntary
basis only. Therefore:
(1) If an insured is required by law to use this option to meet
the claims of creditors, whether in bankruptcy or otherwise,
the insured is not eligible for this benefit.
(2) If an insured is required by a government agency to use this
option in order to apply for, obtain, or
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keep a government benefit or entitlement, the insured is not
eligible for this benefit.
HOW WILL WE PAY THE ACCELERATED BENEFIT?
We will pay the accelerated benefit in one lump sum or in any other mutually
agreeable manner.
IS THERE A MINIMUM OR MAXIMUM DEATH BENEFIT FOR AN ACCELERATED BENEFIT?
Yes. The minimum death benefit to be eligible for an accelerated benefit under
this rider is the lesser of 25% of the insured's amount of insurance or $50,000.
The maximum death benefit to be eligible for an accelerated benefit is the
[lesser of $1,000,000 or 50% of the insured's death benefit.]
WHAT IS THE EFFECT ON AN INSURED'S COVERAGE OF THE RECEIPT OF AN ACCELERATED
BENEFIT?
If a certificate holder elects to accelerate the full amount of an insured's
death benefit, the insured's coverage and all other benefits under the
certificate based on the insured's life will end. Any insurance under an
insured's certificate on the life of someone other than the insured will stay in
effect; we will waive all future premiums for that insurance, subject to all
applicable provisions of the insured's coverage and of any riders thereto.
If a partial accelerated benefit is chosen, coverage will remain in force and
premiums will be reduced. The face amount, cash value and outstanding loans
under the certificate will be reduced in the same proportion as the reduction in
the death benefit resulting from receipt of accelerated benefits, except any
accidental death benefit which may by payable under the terms of the group
policy.
If an insured elects to receive accelerated benefits, we will send the insured a
statement which illustrates the effects of the accelerated benefit payment on
his or her amount of insurance.
If there is any death benefit remaining after the payment of a partial
accelerated death benefit, any accidental death and dismemberment insurance
covering the insured on whose life the partial accelerated death benefit payment
has been made, shall remain unaffected by any such partial accelerated death
benefit payment.
DOES AN INSURED HAVE TO TAKE THE ENTIRE ACCELERATED BENEFIT?
No. The insured may choose to receive a partial accelerated benefit. If he or
she does so, the insured's remaining coverage will stay in force.
If the owner has elected to accelerate a partial amount of his or her face
amount of insurance, the remaining amount of his or her face amount of insurance
available for a subsequent request for accelerated benefits is the lesser of 25%
of his or her remaining face amount of insurance or $50,000.
The insured may reapply for the payment of the remaining accelerated benefit at
any time. However, we may ask for further satisfactory evidence that the insured
meets all requirements for the accelerated benefit. We reserve the right to
charge an additional processing charge.
TO WHOM WILL WE PAY ACCELERATED BENEFITS?
All accelerated benefits will be paid to the insured unless the insured validly
assign them otherwise. If the insured dies before all payments have been made,
we will pay the remainder to the beneficiary under the certificate in one lump
sum. The one sum we pay will be the present value of the payments that remain.
The interest rate we use to determine the payments shall be no greater than:
(1) The then current yield on the 90-day Treasury Bills available
at the date of application for an accelerated payment; and
(2) The then current maximum adjustable policy loan interest rate
based on the greater of:
(a) Moody's Corporate Bond Yield Averages - Monthly
Average Corporates - published by Xxxxx'x Investors
Service, Inc. or any successor thereto for the
calendar month ending two months before the date of
application for an accelerated payment; and
(b) The policy guaranteed cash value interest rate plus
one centum per annum.
DO WE HAVE THE RIGHT TO OBTAIN INDEPENDENT MEDICAL VERIFICATION?
Yes. We retain the right to have the insured medically examined at our own
expense to verify the insured's medical condition. We may do this as often as
reasonably required while accelerated benefits are being considered or paid.
TERMINATION OF AGREEMENT
WHEN DOES THIS AGREEMENT TERMINATE?
This agreement will end at the earliest of:
(1) the date any premium due under the insured's certificate
remains unpaid at the end of the grace period; or
(2) the date we receive written request to cancel this agreement;
or
(3) the date an insured's certificate matures, is surrendered,
terminated or continued in force as extended term or reduced
paid-up insurance; or
(4) the date of the insured's death; or
(5) when the group policy is surrendered, matures or ends.
This agreement is effective as of the effective date shown on the specifications
page attached to the insured's certificate.
/s/ Xxxxxx X. Xxxxxxxxx /s/ Xxxxxx X. Xxxxxxx
Secretary President
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