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[CAPTION] EXHIBIT 99.A(5)(J)
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MINNESOTA LIFE ACCELERATED BENEFITS AGREEMENT
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Minnesota Life Insurance Company 000 Xxxxxx Xxxxxx Xxxxx Xx.
Xxxx, Xxxxxxxxx 00000-0000
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GENERAL INFORMATION
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This agreement amends the group policy to which it is attached and is subject to
all its terms and conditions.
WHAT DOES THIS AGREEMENT PROVIDE?
This agreement provides for the accelerated payment of the death benefits
provided under 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
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When we use the following words, this is what we mean:
DEATH BENEFIT
The face amount of the insured's life insurance 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 factor.
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
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WHAT IS A TERMINAL CONDITION?
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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
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HOW DO WE CALCULATE THE ACCELERATED BENEFIT FACTOR?
When we calculate this factor, we will consider the insured's age and sex, 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; and
2. the insured's life expectancy.
HOW DO WE CALCULATE THE ACCELERATED BENEFIT?
We will multiply the death benefit by the accelerated benefit factor to
determine the accelerated benefit available.
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:
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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 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. We reserve the right to set a minimum death benefit to be eligible for an
accelerated benefit under this agreement. If we do so, it will be at least
$10,000.
The maximum death benefit to be eligible for an accelerated benefit is
$1,000,000.
WHAT IS THE EFFECT ON AN INSURED'S COVERAGE OF THE RECEIPT OF AN ACCELERATED
BENEFIT?
If an insured elects to receive accelerated benefits which total the entire
accelerated benefit available under this agreement, 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.
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.
The insured may reapply or 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.
If a partial accelerated benefit is chosen, coverage will remain in force and
premiums will be reduced. The face amount, cash values and outstanding loans
under the certificate 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.
If an insured elects to receive only a part of the accelerated benefit amount
available under this agreement, the remaining death benefit under the
certificate must be at least $25,000.
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
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the beneficiary under the certificate in one lump sum. The one sum we pay will
be the present value of the payments that remain, using the interest rate we use
to determine the payments.
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
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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
MHC-94-18677 Minnesota Life 4
