VARIABLE ANNUITY GUARANTEED DEATH BENEFIT REINSURANCE
EFFECTIVE APRIL 1, 1996
between
ITT HARTFORD LIFE & ANNUITY INSURANCE COMPANY
(HARTFORD, CONNECTICUT)
and
Connecticut General Life Insurance Company
(Hartford, Connecticut)
REINSURANCE AGREEMENT, Effective April 1, 1996
between
ITT HARTFORD LIFE & ANNUITY INSURANCE COMPANY
(HARTFORD, CONNECTICUT)
and
Connecticut General Life Insurance Company
(Hartford, Connecticut)
INDEX
ARTICLE PAGE
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Access to Records XII 7
Amounts at Risk II 1
Arbitration XVII 8
Automatic Excess Reinsurance III 2
Claims VII 5
Currency XIV 7
DAC Tax Regulation Election XVIII 9
Delays, Errors, or Omissions XIII 7
Effective Date; Term and Termination XIX 10
Extra Contractual Obligations IX 6
Hold Harmless XV 7
Insolvency XVI 8
Liability of Connecticut General IV 3
Litigation X 6
Notices XX 13
Offset XI 7
Parties to the Agreement I 1
Premium Accounting VI 4
Reinsurance Premiums V 3
Reserves VIII 5
SCHEDULES
A Maximum Limits of Reinsurance in Connecticut General
B Policy Forms and Funds Subject to this
Reinsurance Agreement
C Definition of Guaranteed Minimum Death Benefit
D Reinsurance Premium Rates
E Reporting Format Description
REINSURANCE AGREEMENT
(hereinafter called Agreement)
between
ITT HARTFORD LIFE & ANNUITY INSURANCE COMPANY
(HEREINAFTER CALLED ITT HARTFORD)
and
Connecticut General Life Insurance Company
(hereinafter called Connecticut General or Reinsurer)
It is agreed by the two companies as follows:
ARTICLE I PARTIES TO THE AGREEMENT
This Agreement shall be binding upon and shall inure solely to the benefit of
ITT Hartford and Connecticut General. This Agreement shall not and is not
intended to create any right or interest in any third party and shall not and is
not intended to create any legal relationship between either party and any third
party, including, without limitation, annuitants, insureds, certificate holders,
employees, dependents, beneficiaries, policy owner, applicants or assignees
under any policy or contract issued by ITT Hartford.
ARTICLE II AMOUNTS AT RISK
A. The reinsurance death benefit is the excess of the guaranteed minimum death
benefit over the contract surrender value. At issue, the guaranteed minimum
death benefit is equal to the initial premium. Once every year thereafter, on
the contract anniversary, prior to certificate or contract owner attained age
81, the guaranteed minimum death benefit is reset to the then current contract
value, if this value exceeds the current guaranteed minimum death benefit.
Please refer to Schedule C for a complete description of the guaranteed minimum
death benefit.
B. The Contract Value represent the owner's invested assets in the funds in
Schedule B as it appears in the records of ITT Hartford before application of
any contingent deferred sales charge on any given date. The Surrender Value is
defined as the Contract Value less any contingent deferred sales charge. The
charge is a percentage of the amount surrendered (not to exceed the aggregate
amount of the premium payments made) and equals:
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions; Pathmaker
1
[REDACTED]
C. The Net Amount At Risk, is equal to the guaranteed minimum death benefit less
the Surrender Value at the end of each calendar month. The Net Amount At Risk
cannot fall below zero.
ARTICLE III AUTOMATIC EXCESS REINSURANCE
A. On and after the Effective Date of this Agreement, subject to the terms,
conditions and limitations set forth in this Agreement and the Schedules
attached to and made a part hereof, ITT Hartford shall cede and the Reinsurer
shall accept ITT Hartford's guaranteed death benefit liability under the
Variable Annuity Contracts, as described in Article II A.
B. This Agreement covers only ITT Hartford's liability for claims paid under
Variable Annuity Contracts written on forms and investment in funds which were
reviewed by the Reinsurer prior to their issuance. Forms, as supplemented by
additional materials, and funds available as of the date of this Agreement are
listed on Schedule B, attached hereto and made a part hereof. If ITT Hartford
intends to cede to Reinsurer liability with respect to a new form or fund, or a
revised version of an approved form or fund, the following applies:
a) new or revised forms that do not materially impact the guaranteed
minimum death benefit risk, shall be submitted to Connecticut General
by ITT Hartford as a revised Schedule B to be included in this
Agreement. A form that contains no change in the guaranteed minimum
death benefit calculation and surrender charges no greater than those
shown in Article II paragraph B will be deemed to have no material
impact on the guaranteed minimum death benefit risk;
b) new or revised forms or funds that materially impact the guaranteed
minimum death benefit risk shall be subject to the approval of
Connecticut General. Connecticut General shall have no change in
liability until written notice is provided to ITT Hartford that such
new or revised forms or funds are acceptable. If Connecticut
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
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2
General fails to provide written notice of acceptance within thirty (30)
days, such changes shall be considered to have been approved.
ARTICLE IV LIABILITY OF CONNECTICUT GENERAL
Connecticut General's liability for reinsurance under this Agreement shall
follow that of ITT Hartford in every case, and be subject in all respects to the
general stipulations, terms, clauses, conditions, waivers and modifications of
the Variable Annuity Contracts.
In no event shall Connecticut General have any reinsurance liability unless the
Variable Annuity Contract issued by ITT Hartford is in force and the
underwriting and issuance of coverage by ITT Hartford constitutes the doing of
business in a state of the United States of America or in territories of the
United States of America in which ITT Hartford is properly licensed and
authorized to do business.
ARTICLE V REINSURANCE PREMIUMS
The monthly premiums for reinsurance subject to the terms and conditions of this
Agreement shall be calculated as the average of the reinsurance premiums using
the Net Amount at Risk as of the end of the prior month and the reinsurance
premium using the Net Amount at Risk as of the end of the current month by
applying the YRT rates set forth in Schedule D, subject to the following:
A. The reinsurance premiums shall be based on the older of contract owner and
annuitant at the time the Net Amount at Risk is calculated. ITT Hartford shall
determine the age at the time it prepares the monthly exposure data submission
for the variable annuity guaranteed death benefit, as set forth in Schedule E,
attached hereto.
B. The premium for each calendar month will be at least equivalent to the
Monthly Average Contract Value times the minimum premium rate as shown in
paragraphs D and E below. The Monthly Average Contract Value is the average of
the contract values at the end of the current calendar month and the end of the
prior calendar month. The Monthly Contract Value times the minimum premium rate
will be remitted to Connecticut General in advance for the current month, at the
time of settlement for the prior month.
C. The premium for each calendar month will be no more than the monthly Average
Contract Value times the maximum premium rate as shown in paragraphs D and E
below. Basis points (bps) shown below are monthly.
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
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D. [REDACTED]
E. GMDB MODIFICATION
For policies issued on or after January 1, 1996 in which the reduction in
guaranteed minimum death benefit caused by partial withdrawals is proportionate
to the amount withdrawn, the following minimum and maximum rates will apply:
[REDACTED]
ARTICLE VI PREMIUM ACCOUNTING
ITT Hartford shall forward to Connecticut General within 30 days of the end of
the reporting period a monthly statement substantially similar to that set forth
in Schedule E. Reinsurance premiums submitted by ITT Hartford shall be net of
claims incurred. If a balance is due Connecticut General, ITT Hartford shall
remit any balance due for the prior month along with an advance premium for the
current month, in accordance with Article V.
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
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ARTICLE VII CLAIMS
A. ITT Hartford is solely responsible for payment of its claims under the
Variable Annuity Contracts, policies, master contracts or certificates
identified on Schedule B. ITT Hartford shall provide Connecticut General with
proof of claim, proof of claim payment and any other claim documentation
requested by Connecticut General. Reinsurance premiums submitted by ITT Hartford
shall be net of claims incurred. If a balance is due ITT Hartford, Connecticut
General shall remit payment within thirty (30) calendar days following receipt
of the monthly reinsurance statement, as set forth in Schedule E.
B. ITT Hartford shall notify Connecticut General of its intentions to contest,
compromise, or litigate a claim involving reinsurance.
ARTICLE VIII RESERVES
The reserve held by Connecticut General for reinsurance of the variable annuity
death benefit will be determined as follows:
[REDACTED]
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
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ARTICLE IX EXTRA CONTRACTUAL OBLIGATIONS
A. In no event shall Connecticut General be liable for extra contractual
damages (whether they constitute Compensatory damages, Statutory penalties,
Exemplary or Punitive damages) which are awarded against ITT Hartford as a
result of an act, omission or course of conduct by ITT Hartford in connection
with policies subject to this Agreement, unless the Reinsurer shall have
received notice of and concurred with the actions taken or not taken by ITT
Hartford which led to its liability, in which case the Reinsurer shall pay its
share of such liability. For this purpose, the Reinsurer's share shall be
proportionate with its risk under the business reinsured hereunder.
B. The following definitions shall apply:
(1) Punitive damages and Exemplary damages are those damages awarded as
a penalty, the amount of which is not governed nor fixed by statute.
(2) Statutory penalties are those amounts which are awarded as a penalty
but fixed in amount by statute.
(3) Compensatory damages are those amounts awarded to compensate for the
actual damages sustained and are not awarded as a penalty nor fixed
in amount by statute.
ARTICLE X LITIGATION
A. In the event of any action brought against ITT Hartford related to the
guaranteed minimum death benefit risk under any Underlying Annuity Contract that
is subject to the terms and conditions of this Agreement, ITT Hartford shall
provide a copy of such action and written notice of such action within two (2)
business days to Connecticut General. If Connecticut General is a party to
action brought against ITT Hartford, ITT Hartford shall seek agreement by
Connecticut General on the selection and appointment of local counsel to
represent ITT Hartford in such action.
B. ITT Hartford and Connecticut General agree that all litigation costs,
excluding the salaries of employees of ITT Hartford and Connecticut General,
shall be borne by ITT Hartford. However, if ITT Hartford and Connecticut General
agree to jointly defend any litigation, litigation costs will be borne in
proportion to the net liability borne by each party.
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
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ARTICLE XI OFFSET
Either Party shall have, and may exercise at any time and from time to time, the
right to offset any balance or amounts whether on account of premiums or on
account of losses or otherwise, due from one party to the other under the terms
of this Agreement. However, in the event of insolvency of ITT Hartford subject
to the provisions of Article XVI, offset shall only be allowed in accordance
with the statutes and/or regulations of the state having jurisdiction over the
insolvency.
ARTICLE XII ACCESS TO RECORDS
Connecticut General, or its duly authorized representative, shall have access
(at any reasonable time) to all records of ITT Hartford (including the right to
photocopy documents) which pertain in any way to this reinsurance. The right of
access shall continue for twelve (12) months following the termination of this
Agreement.
ARTICLE XIII DELAYS, ERRORS OR OMISSIONS
No accidental delay, errors or omissions on the part of ITT Hartford shall
relieve Connecticut General of liability provided such delay, errors or
omissions are rectified as soon as possible after discovery. However,
Connecticut General shall not be liable with respect to any reinsurance which
may have been inadvertently included in the premium computation but which ought
not to have been included by reason of the terms and conditions of this
Agreement. It is expressly understood and agreed that if failure to comply with
any terms of this Agreement is hereby shown to be unintentional or the result of
misunderstanding or oversight on the part of either party, both parties shall be
restored to the position they would have occupied had no such error or oversight
occurred, subject always to the correction of the error or oversight.
ARTICLE XIV CURRENCY
All retentions and limits hereunder are expressed in United States dollars and
all premium and loss payments shall be made in United States currency. For the
purposes of this Agreement, amounts paid or received by Connecticut General in
any other currency shall be converted into United States dollars at the rates of
exchange on the date such transactions are entered on the books of Connecticut
General.
ARTICLE XV HOLD HARMLESS
A. Connecticut General shall indemnify and hold ITT Hartford harmless from any
and all liability, loss, damage, fines, punitive damages, penalties and costs,
including expenses and attorney's fees, which results from any negligence or
willful misconduct of Connecticut
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
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General in fulfilling its duties and obligations under this Agreement or which
results from any action which exceeds its authority under this Agreement.
B. ITT Hartford shall indemnify and hold Connecticut General harmless from any
and all liability, loss, damage, fines, punitive damages, penalties and costs,
including expenses and attorney's fees, which results from any negligence or
willful misconduct of ITT Hartford in fulfilling its duties and obligations
under this Agreement or which results from any action which exceeds its
authority under this Agreement.
ARTICLE XVI INSOLVENCY
In the event of insolvency of ITT Hartford, the reinsurance under this Agreement
shall be payable directly by Connecticut General to ITT Hartford or to its
liquidator, receiver, conservator or statutory successor on the basis of
Connecticut General's liability to ITT Hartford without diminution because of
the insolvency of ITT Hartford or because the liquidator, receiver, conservator
or statutory successor of ITT Hartford has failed to pay all or a portion of any
claim. It is agreed, however, that the liquidator, receiver, conservator or
statutory successor of ITT Hartford shall give prompt written notice to
Connecticut General of the pendency of a claim against ITT Hartford within a
reasonable time after such claim is filed in the receivership, conservation,
insolvency or liquidation proceeding and that during the pendency of such claim,
Connecticut General may investigate such claim and interpose, at its own
expense, in the proceeding where such claim is to be adjudicated, any defense or
defenses that it may deem available to ITT Hartford or its liquidator, receiver,
conservator or statutory successor. The expense thus incurred by Connecticut
General shall be chargeable, subject to the approval of the Court, against ITT
Hartford as part of the expense of conservation or liquidation to the extent of
a pro-rata share of the benefit which may accrue to ITT Hartford solely as a
result of the defense undertaken by Connecticut General.
Where two or more reinsurers are involved in the same claim and a majority in
interest elect to interpose defense to such claim, the expense shall be
apportioned in accordance with the terms of this Agreement as though such
expense had been incurred by ITT Hartford.
ARTICLE XVII ARBITRATION
A. As a condition precedent to any right of action hereunder, any dispute
between the parties with respect to the interpretation of this Agreement or any
right, obligation or liability of either party, whether such dispute arises
before or after termination of this Agreement, shall be submitted to arbitration
upon the written request of either party. Each party shall select an arbitrator
within thirty (30) days of the written request for arbitration. If either party
refuses or neglects to appoint an arbitrator within thirty (30) days of the
written request for arbitration, the other party may appoint the second
arbitrator. The two arbitrators shall select an umpire within thirty (30) days
of the appointment of the second arbitrator. If the
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions; Pathmaker
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two arbitrators fail to agree on the selection of the umpire within thirty (30)
days of the appointment of the second arbitrator, each arbitrator shall submit
to the other a list of three umpire candidates, each arbitrator shall select one
name from the list submitted by the other and the umpire shall be selected from
the two names chosen by a lot drawing procedure to be agreed upon by the
arbitrators.
B. The arbitrators and the umpire all shall be active or retired, disinterested
executive officers of insurance or reinsurance companies.
C. The arbitration panel shall interpret this Agreement as an honorable
engagement rather than merely as a legal obligation and shall make its decision
considering the custom and practice of the applicable insurance and reinsurance
business. The arbitration panel is released from judicial formalities and shall
not be bound by strict rules of procedure and evidence.
D. The decision of the arbitration panel shall be final and binding on both
parties. The arbitration panel may, at its discretion, award costs and expenses
as it deems appropriate, including, but not limited to, attorneys' fees and
interest. Judgment may be entered upon the final decision of the arbitration
panel in any court of competent jurisdiction.
E. All meetings and hearings before the arbitration panel shall take place in
Hartford, Connecticut unless some other place is mutually agreed upon the
parties.
F. Each party shall bear the expense of its own arbitrator and shall jointly
and equally bear with the other party the expenses of the umpire and of the
arbitration.
ARTICLE XVIII DAC TAX REGULATION ELECTION
Connecticut General and ITT Hartford hereby agree to make an election pursuant
to Internal Revenue Code Regulation Section 1.848-2(g)(8). This election shall
be effective for all taxable years for which the
Reinsurance Agreement remains
in effect.
The terms used in this article are defined by reference to Regulation Section
1.848-2 promulgated on December 28,1992.
Connecticut General and ITT Hartford agree that the entity with net positive
consideration for the
reinsurance agreement for each taxable year will
capitalize specified policy acquisition expenses with respect to the
reinsurance
agreement without regard to the general deductions limitation of Section
848(c)(l) of the Internal Revenue Code of 1986, as amended.
Connecticut General and ITT Hartford agree to exchange information pertaining to
the amount of net consideration under the
reinsurance agreement each year to
ensure consistency. To achieve this, ITT Hartford shall provide Connecticut
General with a schedule of its calculation of the
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
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net consideration for all
reinsurance agreements in force between them for a
taxable year by no later than April 30 of the succeeding year. Connecticut
General shall advise ITT Hartford if it disagrees with the amounts provided by
no later than May 31, otherwise the amounts will be presumed correct and shall
be reported by both parties in their respective tax returns for such tax year.
If Connecticut General contests ITT Hartford's calculation of the net
consideration, the Parties agree to act in good faith to resolve any differences
within thirty (30) days of the date Connecticut General submits its alternative
calculation and report the amounts agreed upon in their respective tax returns
for such tax year.
Connecticut General represents and warrants that it is subject to U.S. taxation
under either Subchapter L or Subpart F of Part III of Subchapter N of the
Internal Revenue Code of 1986, as amended.
ARTICLE XIX EFFECTIVE DATE; TERM AND TERMINATION
A. The effective date of this Agreement is April 1, 1996. This Agreement remains
effective for all annuity contracts subject to this Agreement written by ITT
Hartford for three (3) years from the effective date, unless terminated pursuant
to the paragraphs listed below:
B. Either Connecticut General or ITT Hartford shall have the option of
terminating this agreement with ninety (90) calendar days written notice to the
other party for new business anytime on or after the end of the three (3) year
period.
C. Once each calendar year, ITT Hartford shall have the option to recapture
existing contracts beginning with the twentieth (20) anniversary of their
reinsurance hereunder. Recapture must be made on an issue year basis, and no
contracts can be recaptured unless all contracts with earlier issue years are
recaptured.
D. Connecticut General shall have the option of terminating this Agreement upon
delivery of thirty (30) calendar days written notice to ITT Hartford, within
thirty (30) days of the happening of any of the following events:
For New and Existing Business:
(1) [REDACTED]
(2) ITT Hartford is placed upon a "watch list" by its domiciliary
state's insurance regulators;
(3) An order appointing a receiver, conservator or trustee for
management of ITT Hartford is entered or a proceeding is commenced
for rehabilitation, liquidation, supervision or conservation of ITT
Hartford;
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
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(4) The Securities and Exchange Commission revokes the authority of ITT
Hartford to conduct business;
(5) Failure by ITT Hartford to pay premium in accordance with Article V.
If, during the thirty (30) days notice period, Reinsurer receives
all premiums in arrears and all premiums which may become due within
the thirty (30) days notice period, the notice of termination shall
be deemed withdrawn. In the event of termination under this
paragraph, this Agreement may be reinstated upon the written consent
of Reinsurer if, at any time within sixty (60) days of termination,
ITT Hartford pays and Reinsurer receives all premiums due with
interest thereon and payable up to the date of reinstatement.
(Please refer to paragraph J below for the interest calculation
description)
E. ITT Hartford shall have the option of terminating this Agreement upon
delivery of thirty (30) calendar days written notice to Connecticut General,
within thirty (30) days of the happening of any of the following events:
For New and Existing Business:
(1) [REDACTED]
(2) Connecticut General is placed upon a "watch list" by its domiciliary
states's insurance regulators;
(3) An order appointing a receiver, conservator or trustee for
management of Connecticut General is entered or a proceeding is
commenced for rehabilitation, liquidation, supervision or
conservation of Connecticut General;
F. If this Agreement is terminated for new and existing business, Connecticut
General shall be relieved of all liability to ITT Hartford for claims incurred
following the termination date of this Agreement under such Underlying Annuity
Contracts issued by ITT Hartford, and
G. If this Agreement is terminated for new business only, Connecticut General
will remain liable, after termination, in accordance with the terms and
conditions of this Agreement, with respect to all reinsurance effective prior to
termination of the Agreement for new business.
H. Both parties shall continue to be entitled to all offset credits provided by
Article XI up to the effective date of termination.
I. ITT Hartford shall not have the right to assign or transfer any portion of
the rights, duties and obligations of ITT Hartford under the terms and
conditions of this Agreement without the written approval of Connecticut
General.
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Putnam Capital Manager; August 23, 1996
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J. In the event of reinstatement as described in paragraph D above, there will
be an interest charge at the three (3) month LIBOR Rate (as published in the
Wall Street Journal), plus 1%, determined on the first business day following
the end of the 30 day notice period. The settlement is considered overdue at the
end of the 30 day notice period and interest shall commence from the overdue
date.
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions; Pathmaker
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ARTICLE XX NOTICES
All notices required to be given hereunder shall be in writing and shall be
deemed delivered if personally delivered, sent via facsimile, or dispatched by
certified or registered mail, return receipt requested, postage prepaid,
addressed to the parties as follows:
Xxxxxxx X. Xxxxxx, FSA
Assistant Vice President & Director
Actuarial
ITT Hartford Life & Annuity Insurance Company
X.X. Xxx 0000
Xxxxxxxx, XX 00000-0000
Phone No. (000) 000-0000 Fax No. (000) 000-0000
Xxxxxxx X. Xxxxx, FSA
Assistant Vice President and Actuary
Connecticut General Life Insurance Company
R-26
000 Xxxxxxx Xxxxx Xxxx
Xxxxxxxx, XX 00000-0000
Phone No. (000) 000-0000 Fax No. (000) 000-0000
Notice shall be deemed given on the date it is received in the mail or sent via
facsimile in accordance with the foregoing. Any party may change the address to
which to send notices by notifying the other party of such change of address in
writing in accordance with the foregoing.
This Agreement constitutes the entire contract between the parties and shall be
deemed to have been made under and governed by the laws of the State of
Connecticut. Any amendment or modification hereto shall be in writing, endorsed
upon or attached hereto and signed by both ITT Hartford and Connecticut General.
In witness whereof, the parties hereto have caused this Agreement to be signed
in duplicate on the dates indicated to be effective as of the date specified
above.
ITT HARTFORD LIFE & ANNUITY INSURANCE COMPANY
Date: August 30, 1996 By: /s/ [ILLEGIBLE]
--------------------------------
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
Date: August 27, 1996 By: /s/ [ILLEGIBLE]
--------------------------------
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
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SCHEDULE A
Maximum Limits of Reinsurance in Connecticut General
The maximum purchase amount issued on the life of each insured*:
[REDACTED]
The total purchase amount is the sum of all premium contributions for each
contract in which the insured is the owner or annuitant. For purchase amounts in
excess of the maximum, Connecticut General's death benefit liability will be
reduced by the ratio of purchase amounts in excess of the maximum to the total
purchase amounts.
* The insured is defined as the first to die of the owner and the annuitant.
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions; Pathmaker SCHEDULE A
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SCHEDULE B
Contracts and Funds Subject to this
Reinsurance Agreement
FORM
NUMBER POLICY DESCRIPTION DATE
-------------------------------------------------------------------------------
HLVA94 The Director, Xxxxxx Capital Manager, Select
Dimensions, Pathmaker and all other group and state
variations thereof.
FUNDS:
a) Fixed Accounts on the above forms
b) Variable Accounts as listed below:
Fund Description
Hartford Bond Fund Money Market Portfolio
Hartford Stock Fund No. American Government Securities
Portfolio
HVA Money Market Fund Diversified Income Portfolio
Hartford Advisers Fund Balanced Portfolio
Hartford U.S. Government Money Market Fund Utilities Portfolio
Hartford Capital Appreciation Fund Dividend Growth Portfolio
Hartford Mortgage Securities Fund Value-Added Market Portfolio
Hartford Index Fund Core Equity Portfolio
Hartford International Opportunities Fund American Value Portfolio
Hartford Dividend & Growth Fund Global Equity Portfolio
Hartford International Advisers Fund Developing Growth Portfolio
PCM Asia Pacific Growth Fund Emerging Markets Portfolio
PCM Diversified Income Fund Xxxxxxxx Balanced Fund
PCM Global Asset Allocation Fund Xxxxxxxx Growth/Value Fund
PCM Global Growth Fund Xxxxxxxx Opportunity Fund
PCM Growth and Income Fund Xxxxxxxx Capital Growth Fund
PCM High Yield Fund Xxxxxxxx Money Market Fund
PCM Money Market Fund
PCM New Opportunities Fund
PCM U.S. Government and High Quality Bond
Fund
PCM Voyager Fund
PCM Utilities Growth and Income Fund
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions; Pathmaker SCHEDULE B
SCHEDULE C
Guaranteed Minimum Death Benefit
A. ITT Hartford will determine the Guaranteed Minimum Death Benefit for each
deceased within seven (7) working days of written notice of death.
The guaranteed minimum death benefit will have the meaning described in the
attached policy form (ILAVA94/N408R0.FRM).
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions; Pathmaker SCHEDULE C
INDIVIDUAL FLEXIBLE PREMIUM
VARIABLE ANNUITY CONTRACT
[LOGO]
ITT HARTFORD
ITT Hartford Life and Annuity Insurance Company
Registered
Office: 00 X. Xxxxxxxx
Xxxxxxx, Xxxxxxxxx 00000
Administrative
Office: X.X. Xxx 0000
Xxxxxxxx, Xxxxxxxxxxx 00000-0000
INDIVIDUAL FLEXIBLE PREMIUM
VARIABLE ANNUITY CONTRACT
ITT Hartford Life and Annuity Insurance Company
X.X. Xxx 0000
Xxxxxxxx, Xxxxxxxxxxx 00000-0000
(a stock life insurance company, herein called the Company)
Unless otherwise directed by the Contract Owner, the Company agrees to pay the
named Annuitant, on the Annuity Commencement Date, if the Annuitant and Contract
Owner are then living, the first of a series of annuity payments the frequency,
period and dollar amounts of which shall be determined on the basis as set forth
herein, in accordance with the Annuity Option selected.
This contract is issued in consideration of the payment of the initial premium
payment.
This contract is subject to the laws of the jurisdiction where it is delivered.
The Contract Specifications on Page 3 and the conditions and provisions on this
and the following pages are part of the contract.
RIGHT TO EXAMINE CONTRACT
We want you to be satisfied with the contract you have purchased. We urge you to
closely examine its provisions. If for any reason you are not satisfied with
your purchase you may surrender the contract by returning the contract within
ten days after you receive it. A written request for cancellation must accompany
the contract. In such event, we will pay to the Contract Owner an amount equal
to the sum of (i) the difference between the premiums paid and the amounts
allocated to any Account under the contract and (ii) the Contract Value on the
date of surrender. The Contract Owner bears only the investment risk during the
period prior to the Company's receipt of request for cancellation.
Signed for the Company
/s/ Xxxxx X. Xxxxxxx /s/ Lowndes X. Xxxxx
------------------------------ -----------------------------------
Xxxxx X. Xxxxxxx, SECRETARY Lowndes X. Xxxxx, PRESIDENT
Premium Payments are flexible as described herein.
Nonparticipating
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED
DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION
PROVISIONS, PAGES 9 AND 10.
[LOGO]
ITT HARTFORD
TABLE OF CONTENTS
PAGE
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Contract Specifications 3
Definition of Certain Terms 4
Premium Payments Provision 5
Contract Control Provisions 6
General Provisions 7
Valuation Provisions 9
Termination Provisions 10
Settlement Provisions 12
Annuity Tables 15
2
CONTRACT SPECIFICATIONS
CONTRACT NUMBER 0000000/ CONTRACT DATE OCTOBER 13, 1994
NAME OF ANNUITANT DATE OF ISSUE OCTOBER 13, 1994
AGE OF ANNUITANT 63 ANNUITY COMMENCEMENT DATE FEBRUARY 23, 2003
SEX OF ANNUITANT MALE INITIAL PREMIUM PAYMENT $28,218.47
MINIMUM SUBSEQUENT PAYMENT $500.00
MINIMUM FIXED ACCOUNT INTEREST 3%
RATE
CONTINGENT ANNUITANT NONE
DESIGNATED BENEFICIARY CONTRACT OWNER (IF OTHER THAN
ANNUITANT) SAME
DESCRIPTION OF BENEFITS
INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT
ANNUAL WITHDRAWAL AMOUNT: CONTRACT YEARS 1-7
10% OF PREMIUM PAYMENTS
AFTER CONTRACT YEAR 7
THE GREATER OF:
100% OF THE CONTRACT VALUE REDUCED BY THE
TOTAL OF ANY PREMIUM PAYMENTS MADE DURING
THE 7 YEARS PRIOR TO WITHDRAWAL; OR
10% OF PREMIUM PAYMENTS MADE DURING THE 7
YEARS PRIOR TO WITHDRAWAL.
ANNUAL CONTRACT MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR
MORE ON THE CONTRACT ANNIVERSARY.
$30 IF THE CONTRACT VALUE IS LESS THAN
$50,000 ON THE CONTRACT ANNIVERSARY.
MORTALITY AND EXPENSE RISK CHARGE: 1.25% PER ANNUM OF THE AVERAGE DAILY
CONTRACT VALUE.
ADMINISTRATION CHARGE: 0% PER ANNUM OF THE AVERAGE DAILY CONTRACT
VALUE.
3
CONTINGENT DEFERRED SALES CHARGES:
SUBJECT TO THE ANNUAL WITHDRAWAL AMOUNT. SURRENDERS OF CONTRACT VALUES
ATTRIBUTABLE TO PREMIUM PAYMENTS MAY BE SUBJECT TO A CONTNGENT DEFERRED SALES
CHARGE ("CHARGE"). THE LENGTH OF TIME FROM RECEIPT OF THE PREMIUM PAYMENT TO THE
TIME OF SURRENDER DETERMINES THE CHARGE.
DURING THE FIRST SEVEN CONTRACT YEARS, ALL SURRENDERS WILL BE FIRST FROM PREMIUM
PAYMENTS AND THEN FROM EARNINGS. IF AN AMOUNT EQUAL TO ALL PREMIUM PAYMENTS HAS
BEEN SURRENDERED, A CHARGE WILL NOT BE ASSESSED AGAINST THE SURRENDER OF THE
REMAINING CONTRACT VALUE.
AFTER THE SEVENTH CONTRACT YEAR ALL SURRENDERS WILL FIRST BE FROM EARNINGS AND
THEN FROM PREMIUM PAYMENTS. A CHARGE WILL NOT BE ASSESSED AGAINST THE SURRENDER
OF EARNINGS. IF AN AMOUNT EQUAL TO ALL EARNINGS HAS BEEN SURRENDERED. A CHARGE
WILL NOT BE ASSESSED AGAINST PREMIUM PAYMENTS RECEIVED LESS THAN SEVEN YEARS
PRIOR TO SURRENDER FOR THIS PURPOSE, PREMIUM PAYMENTS WILL BE DEEMED TO BE
SURRENDERED IN THE ORDER IN WHICH THEY WERE RECEIVED.
THE CHARGE IS A PERCENTAGE OF THE AMOUNT SURRENDERED (NOT TO EXCEED THE
AGGREGATE AMOUNT OF THE PREMIUM PAYMENTS MADE) AND EQUALS:
LENGTH OF TIME FROM PREMIUM PAYMENT
CHARGE (NUMBER OF YEARS)
--------------------------------------------------------------
6% 1
6% 2
5% 3
5% 4
4% 5
3% 6
2% 7
0% 8 AND THEREAFTER
NO CONTINGENT DEERRED SALES CHARGES WILL BE ASSESSED IN THE EVENT THE CONTRACT
TERMINATES DUE TO THE DEATH OF THE ANNUITANT OR CONTRACT OWNER (AS APPLICABLE).
OR IF CONTRACT VALUES ARE APPLIED TO AN ANNUITY OPTION PROVIDED FOR UNDER THIS
CONTRACT (PROVIDED HOWEVER, ANY SURRENDER OUT OF OPTION 4 WILL BE SUBJECT TO
CONTINGENT DEFERRED SALES CHARGES, IF APPLICABLE) OR UPON THE EXERCISE OF THE
ANNUAL WITHDRAWAL AMOUNT.
3 (Continued)
FUND OPTIONS
THE INITIAL PREMIUM PAYMENT WILL BE ALLOCATED AS SPECIFIED IN YOUR APPLICATION.
THE SAME ALLOCATION WILL BE MADE FOR SUBSEQUENT PREMIUM PAYMENTS UNLESS YOU
CHANGE THE ALLOCATION OR, AT THE XXX OF A PREMIUM PAYMENT. YOU INSTRUCT US TO
ALLOCATE THAT PAYMENT DIFFERENTLY.
SEPARATE ACCOUNT: ITT HARTFORD LIFE AND ANNUITY INSURANCE COMPANY SEPARATE
ACCOUNT ONE
SUB-ACCOUNT BASED ON:
-----------------------------------------------------------------------------
ADVISERS FUND HVA ADVISERS FUND, INC.
STOCK FUND HVA STOCK FUND, INC.
AGGRESSIVE GROWTH FUND HVA AGGRESSIVE GROWTH FUND, INC.
INTERNATIONAL OPPORTUNITIES FUND HARTFORD INTERNATIONAL OPPORTUNITIES
FUND, INC.
DIVIDEND AND GROWTH FUND HARTFORD DIVIDEND AND GROWTH FUND, INC.
INDEX FUND HARTFORD INDEX FUND, INC.
GNMA/MORTGAGE SECURITIES FUND HARTFORD GNMA/MORTGAGE SECURITIES FUND,
INC.
BOND/DEBT SECURITIES FUND HVA BOND/DEBT SECURITIES FUND, INC.
MONEY MARKET FUND HVA MONEY MARKET FUND, INC.
OR OTHER FUNDS AS MAY BE MADE AVAILABLE FROM TIME TO TIME.
3 (Continued)
DEFINITION OF CERTAIN TERMS
ACCOUNT -- Any of the Sub-Accounts or the Fixed Account.
ACCUMULATION UNIT -- An accounting unit of measure used to calculate the value
of a Sub-Account of this contract before annuity payments begin.
ADMINISTRATIVE OFFICE OF THE COMPANY -- Currently located at 000 Xxxxxxxxx Xx.
Xxxxxxxx, Xx. All correspondence concerning this contract should be sent to our
mailing address at X.X. Xxx 0000. Attn: Individual Annuity Operations, Xxxxxxxx,
XX 00000-0000.
ANNUAL WITHDRAWAL AMOUNT -- The amount that can be withdrawn in any Contract
Year prior to incurring surrender charges.
ANNUITANT -- The person on whose life this contract is issued.
ANNUITY COMMENCEMENT DATE -- The date on which annuity payments are to begin as
described under Settlement Provisions in this contract.
ANNUITY UNIT -- An accounting unit of measure used to calculate the amount of
annuity payments under the variable annuity option.
BENEFICIARY -- The person entitled to receive benefits as per the terms of the
contract in case of the death of the Contract Owner or Annuitant, as applicable.
COMPANY -- The ITT Hartford Life and Annuity Insurance Company.
CONTINGENT ANNUITANT -- The person so designated by the Contract Owner who, upon
the Annuitant's death, prior to the Annuity Commencement Date, becomes the
Annuitant.
CONTRACT ANNIVERSARY -- An anniversary of the Contract Date. Similarly, Contract
Years are measured from the Contract Date. The Contract Date is shown on Page 3.
CONTRACT MAINTENANCE FEE -- An amount which is deducted from the value of the
contract at the end of the Contract Year or on the date of surrender of this
contract, if earlier.
CONTRACT OWNER -- The owner(s) of the contract.
CONTRACT VALUE -- The value of the Sub-Accounts plus the value of the Fixed
Account on any day.
DATE OF ISSUE -- The date on which an Account is established for the Contract
Owner by the Company.
DOLLAR COST AVERAGING -- Contract Owner initiated systematic transfers from one
or more Accounts to any other available Sub-Accounts.
DUE PROOF OF DEATH -- A certified copy of the death certificate, an order of a
court of competent jurisdiction, a statement from a physician who attended the
deceased, or any other proof acceptable to the Company.
FIXED ACCOUNT -- Part of the Company's General Account to which all or a portion
of the Contract Value may be allocated.
4
DEFINITION OF CERTAIN TERMS (Continued)
FUND(S) -- Currently the Funds specified on Page 3 or any other Fund(s) that may
be added by the Company.
GENERAL ACCOUNT -- All assets of the Company other than those allocated to the
Separate Accounts of the Company.
MAXIMUM ANNIVERSARY VALUE -- A value used in determining the death benefit. It
is based on a series of calculations of Account Values on Contract
Anniversaries. premium payments and partial surrenders.
As of the date of death, the Company will calculate an Anniversary Value for
each Contract Anniversary prior to the deceased's attained age 81. The
Anniversary Value is equal to the Account Value on a Contract Anniversary,
increased by the dollar amount of any premium payments made since that
anniversary and reduced by the dollar amount of any partial surrenders since
that anniversary. The Maximum Anniversary Value is equal to the greatest
Anniversary Value attained from this series of calculations.
PREMIUM TAX -- The amount of tax, if any, charged by a federal, state or
municipal entity on premium payments or Contract Values.
SEPARATE ACCOUNT -- An Account established by the Company to separate the assets
funding the variable benefits for the class of contracts to which this contract
belongs from the other assets of the Company. The assets in the Separate Account
are not chargeable with liabilities arising out of any other business the
Company may conduct. The Separate Account and the Funds, which are the
underlying securities of the Separate Account, are listed on the Contract
Specifications on Page 3 of this contract.
SUB-ACCOUNT -- The subdivisions of the Separate Account which are used to
determine how the Contract Owner's Account is allocated between the Funds.
TERMINATION VALUE -- The value of the contract upon termination, as described in
the section of the contract captioned "Termination Provisions."
VALUATION DAY -- Every day the New York Stock Exchange is open for trading.
PREMIUM PAYMENTS
PREMIUM PAYMENTS
Premium payments are payable at the Administrative Office of the Company
Payments may be made by check payable to ITT Hartford Life and Annuity Insurance
Company or by any other method which the Company deems acceptable.
The Initial Premium Payment is shown on Page 3. This is a flexible premium
annuity. Additional payments may be accepted by the Company. The additional
payments must be at least equal to the minimum subsequent premium payment shown
on Page 3.
ALLOCATION OF PREMIUM PAYMENTS
The Contract Owner shall specify that portion of any premium payments to be
allocated to each Account, provided, however, that the minimum allocation to any
Account may not be less than the Company's minimum amount then in effect.
5
PREMIUM PAYMENTS (Continued)
The Contract Owner may transfer Contract Values held in the Accounts into other
Accounts: however, the Company reserves the right to limit the number of
transfer to no more frequently than 12 per Contract Year with no two transfers
being made on consecutive Valuation Days. Subject to the following two
paragraphs, any such limitations will apply to all Contract Owners.
The right to reallocate Contract Values between the Accounts is subject to
modification if the Company determines, in its sole opinion, that the exercise
of that right by one or more Contract Owners is, or would be, to the
disadvantage of other Contract Owners. Any modification could be applied to
transfers to or from some or all of the Accounts and could include, but not be
limited to, the requirement of a minimum time period between each transfer, not
accepting transfer requests of an agent acting under a power of attorney on
behalf of more than one Contract Owner, or limiting the dollar amount that may
be transferred between the Accounts by a Contract Owner at any one time. Such
restrictions may be applied in any manner reasonably designed to prevent any use
of the transfer right which is considered by the Company to be to the
disadvantage of other Contract Owners.
The maximum amount transferable from the Fixed Account during any Contract Year
is the greater of 30% of the Fixed Account balance as of the last Contract
Anniversary or the greatest of any prior transfer from the Fixed Account. This
limitation does not apply to Dollar Cost Averaging. However, if any interest
rate is renewed at a rate at least one percentage point less than the previous
rate, the Contract Owner may elect to transfer up to 100% of the Funds receiving
that reduced rate within 60 days of notification of the interest rate decrease.
Transfers may not be made from the Sub-Accounts into the Fixed Account for the
six-month period following any transfer from the Fixed Account into the other
Sub-Account. The Company reserves the right to defer transfers from the Fixed
Account for up to six months from the date of request.
CONTRACT CONTROL PROVISIONS
ANNUITANT, CONTINGENT ANNUITANT, CONTRACT OWNER
The Annuitant may not be changed.
The designations of Contract Owner and Contingent Annuitant will remain in
effect until changed by the Contract Owner. Changes in the designation of the
Contract Owner may be made during the lifetime of the Annuitant by written
notice to the Company. Changes in the designation of Contingent Annuitant may be
made at any time prior to the Annuity Commencement Xxxx by written notice to the
Company. Notwithstanding the foregoing, if no Contingent Annuitant has been
named and the Contract Owner/Annuitant's spouse is the Beneficiary it will be
assumed that the Contract Owner/Annuitant's spouse is the Contingent Annuitant.
The Contract Owner has the sole power to exercise all the rights, options and
privileges granted by this contract or permitted by the Company and to agree
with the Company to any change in or amendment to the contract. The rights of
the Contract Owner shall be subject to the rights of any assignee of record with
the Company and of any irrevocably designated Beneficiary. In the case of joint
Contract Owners, each Contract Owner alone may exercise all rights, options and
privileges, except with respect to the Termination and Partial Surrender Annual
Withdrawal Amount Provisions and change of ownership.
6
CONTRACT CONTROL PROVISIONS (Continued)
BENEFICIARY
The Designated Beneficiary will remain in effect until changed by the Contract
Owner. Changes in the Designated Beneficiary may be made during the lifetime of
the Annuitant by written notice to the Administrative Office of the Company. If
the Designated Beneficiary has been designated irrevocably, however, such
designation cannot be changed or revoked without such Beneficiary's written
consent. Upon receipt of such notice and written consent, if required, at the
Administrative Office of the Company, the new designation will take effect as of
the date the notice is signed, whether or not the Annuitant or Contract Owner is
alive at the time of receipt of such notice. The change will be subject to any
payments made or other action taken by the Company before the receipt of the
notice.
In the event of the death of the Annuitant when there is no surviving Contingent
Annuitant, the Beneficiary will be as follows. If the death of the Annuitant
occurs prior to the Annuity Commencement Date, the Beneficiary shall be the
surviving Contract Owner, or joint Contract Owners, if applicable,
notwithstanding that the Designated Beneficiary may be different. Otherwise, the
Beneficiary will be the Designated Beneficiary then in effect. If the Annuitant
is the sole Contract Owner and there is no Designated Beneficiary in effect, the
Annuitant's estate will be the Beneficiary.
In the event of the death of a Contract Owner prior to the Annuity Commencement
Date, the Beneficiary will be as follows. If the owner was the sole Contract
Owner, the Beneficiary shall be the Designated Beneficiary then in effect. If no
Beneficiary designation is in effect or if the Designated Beneficiary has
predeceased the Contract Owner, the Contract Owner's estate shall be the
Beneficiary. At the first death of a joint Contract Owner prior to the Annuity
Commencement Date, the Beneficiary shall be the surviving Contract Owner
notwithstanding that the Designated Beneficiary may be different.
GENERAL PROVISIONS
THE CONTRACT
This contract constitutes the entire contract.
MODIFICATION
No modification of this contract shall be made except over the signature of the
President, a Vice President, a Secretary or an Assistant Secretary of the
Company.
The Company reserves the right to modify the contract, but only if such
modification: (i) is necessary to make the contract or the Separate Account
comply with any law or regulation issued by a governmental agency to which the
Company is subject: (ii) is necessary to assure continued qualification of the
contract under the Internal Revenue Code or other federal or state laws relating
to retirement annuities or annuity contracts: (iii) is necessary to reflect a
change in the operation of the Separate Account or the Sub-Account(s): (iv)
provides additional Account options: or (v) withdraws Account options. In the
event of any such modification, the Company will provide notice to the Contract
Owner or to the payee(s) during the annuity period. The Company may also make
appropriate endorsement in the Contract to reflect such modification.
7
GENERAL PROVISIONS (Continued)
MINIMUM VALUE STATEMENT
Any Termination Values, death benefits or settlement provisions available under
this contract equal or exceed those required by the state in which the contract
is delivered.
NON-PARTICIPATION
This contract does not share in the surplus earnings of the Company. That
portion of the assets of the Separate Account equal to the reserves and other
contract liabilities of the Separate Account shall not be chargeable with
liabilities arising out of any other business the company may conduct.
MISSTATEMENT OF AGE AND SEX
If the age or sex of the Annuitant has been misstated, the amount of the annuity
payable by the Company shall be that provided by that portion of the amounts
allocated to effect such annuity on the basis of the corrected information
without changing the date of the first payment of such annuity. Any
underpayments by the Company shall be made up immediately and any overpayments
shall be charged against future amounts becoming payable.
If the age of the Annuitant or Contract Owner has been misstated. The amount of
any death benefit payable shall be determined based upon the correct age of the
Annuitant or Contract Owner.
INCONTESTABILITY
We cannot contest this Contract.
REPORTS TO THE CONTRACT OWNER
There shall be furnished to each Contract Owner copies of any shareholder
reports of the Funds and of any other notices, reports or documents required by
law to be delivered to Contract Owners. Annually, a statement of the Contract
Value is sent to the Contract Owner.
VOTING RIGHTS
The Company shall notify the Contract Owner of any Fund shareholder's meetings
at which the shares held for the Contract Owner's Account may be voted and shall
also send proxy materials and a form of instruction by means of which the
Contract Owner can instruct the Company with respect to the voting of the shares
held for the Contract Owner's Account. In connection with the voting of Fund
shares held by it, the Company shall arrange for the handling and tallying of
proxies received from Contract Owners. The Company will Vote the Fund shares
held by it in accordance with the instructions received from the Contract Owners
having the right to give voting instructions. If a Contract Owner desires to
attend any meeting which shares held for the Contract Owner's benefit may be
voted, the Contract Owner may request the Company to furnish a proxy or
otherwise arrange for the exercise of voting rights with respect to the Fund
shares held for such Contract Owner's Account.
8
GENERAL PROVISIONS (Continued)
In the event that the Contract Owner gives no instructions or leaves the manner
of voting discretionary, the Company will vote such shares of the appropriate
Fund in the same proportion as shares of that Fund for which instructions have
been received. Also, the Company will vote the Fund Shares in this proportionate
manner which are held by the Company for its own Account. During the annuity
period under a contract the number of votes will decrease as the assets held to
fund annuity benefits decrease.
SUBSTITUTION
The Company reserves the right to substitute the shares of any other registered
investment company for the shares of any Fund already purchased or to be
purchased in the future by the Separate Account provided that the substitution
has been approved by the Securities and Exchange Commission.
CHANGE IN THE OPERATION OF THE SEPARATE ACCOUNT
At the Company's election and subject to any necessary vote by persons having
the right to give instructions with respect to the voting of the Fund shares
held by the Sub-Accounts, the Variable Account may be operated as a management
company under the Investment Company Act of 1940 or it may be deregistered under
the Investment Company Act of 1940 in the event registration is no longer
required. Deregistration of the Variable Account requires an order by the
Securities and Exchange Commission.
PROOF OF SURVIVAL
The payment of any annuity benefit will be subject to evidence that the
Annuitant is alive on the date such payment is otherwise due.
VALUATION PROVISIONS
NET PREMIUM PAYMENTS
The net premium payment is equal to the premium payment minus any applicable
Premium Taxes. The net premium payment is applied to provide Fixed Account
values or Sub-Account Accumulation Units with respect to the Sub-Account(s)
selected by the Contract Owner.
The number of Accumulation Units credited to each Sub-Account is determined by
dividing the net premium payment allocated to a Sub-Account by the dollar value
of one Accumulation Unit for such Sub-Account, next computed after the receipt
of a premium payment by the Company. The number of Accumulation Units so
determined will not be affected by any subsequent change in the value of such
Accumulation Units. The Accumulation Unit value in any Sub-Account may increase
or decrease from day to day as described below.
The Company will determine the value of the Fixed Account by crediting interest
to amounts allocated to the Fixed Account. The minimum Fixed Account interest
rate is the rate shown on Page 3, compounded annually. The Company, at its
discretion, may credit interest rates greater than the minimum Fixed Account
interest rate.
9
VALUATION PROVISIONS (Continued)
NET INVESTMENT FACTOR
The net investment factor for each of the Sub-Accounts is equal to the net asset
value per share of the corresponding Fund at the end of the valuation period
(plus the per share amount of any unpaid dividends or capital gains by that
Fund) divided by the net asset value per share of the corresponding Fund at the
beginning of the valuation period and subtracting from that amount the mortality
and expense risk charge and the administration charge shown on page 3. The
General Account net investment factor is guaranteed to be equal to the Minimum
Fixed Account Interest Rate shown on Page 3.
ACCUMULATION UNIT VALUE
The Accumulation Unit Value for each Sub-Account will vary to reflect the
investment experience of the applicable Fund and will be determined on each
Valuation Day by multiplying the Accumulation Unit Value of the particular
Sub-Account on the preceding Valuation Day by the net investment factor for that
Sub-Account for the valuation period then ended. The value of the Sub-Account on
each Valuation Day is then determined by multiplying the number of Accumulation
Units in that Sub-Account by the Accumulation Unit Value on that Valuation Day.
ANNUITY UNIT VALUE
The value of an Annuity Unit for each Sub-Account of the Separate Account will
vary to reflect the investment experience of the applicable Funds and will be
determined by multiplying the value of the Annuity Unit for that Sub-Account on
the preceding day by the product of (a) the net investment factor for that
Sub-Account for the day for which the Annuity Unit value is being calculated,
and (b) 0.999866, which is a factor that neutralizes an assumed interest rate of
5%.
CONTRACT MAINTENANCE FEE
During each year that contract is in force prior to the Annuity Commencement
Date, a fee will be deducted from the contract at the end of the Contract Year
or on the date of surrender of this contract, if earlier. The fee will be
charged against the Contract Value by reducing the Fixed Account value and. With
respect to the Sub-Accounts, the number of Accumulation Units held on that date
on a pro-rata basis with respect to each active Account.
The number of Accumulation Units deducted from the Sub-Account is determined by
dividing the pro-rata portion of the Contract Maintenance Fee applicable to that
Sub-Account, by the value of an Accumulation Unit for the Sub-Account at the end
of the Contract Year, or on the date of surrender, as applicable.
TERMINATION PROVISIONS
TERMINATION PRIOR TO THE ANNUITY COMMENCEMENT DATE
FULL SURRENDER
At any time prior to the Annuity Commencement Date, the Contract Owner has the
right to terminate the contract by submitting a written request to the
Administrative Office of the Company, In such event. The Termination Value of
the contract may be taken in the form of a cash settlement.
10
TERMINATION PROVISIONS (Continued)
The Termination Value of the contract is equal to the Contract Value less:
(a) any applicable Premium Taxes not previously deducted;
(b) the Contract Maintenance Fee as specified on Page 3; and
(c) any applicable contingent deferred sales charges as specified on Page 3.
The Termination Value provided by the contract is not less than the minimum
values required by the insurance laws of the state in which this contract is
issued.
PARTIAL SURRENDERS/ANNUAL WITHDRAWAL AMOUNT
The Contract Owner may request, in writing, a partial surrender of Contract
Values at any time prior to the Annuity Commencement Date provided the Contract
Value remaining after the surrender is at least equal to the Company's minimum
amount rules then in effect. If the remaining Contract Value following such
surrender is less than the Company's minimum amount rules, the Company will
terminate the contract and pay the Termination Value.
The contingent deferred sales charge will be assessed against any Contract
Values surrendered as described on Page 3. However, on a noncumulative basis,
the Contract Owner may make partial surrenders during any Contract Year, up to
the Annual Withdrawal Amount shown on Page 3 and the contingent deferred sales
charge will not be assessed against such amounts. Surrender of Contract Values
in excess of the Withdrawal Amount and additional surrenders made in any
Contract Year will be subject to the contingent deferred sales charge, as
described on Page 3, if applicable.
For Federal tax purposes, any surrenders will be deemed to be first from
earnings, to the extent that they exist, and then from the premium payments.
TERMINATION AFTER THE ANNUITY COMMENCEMENT DATE
This contract may not be surrendered for its Termination Value after the
commencement of annuity payments, except with respect to Options Four and Five.
PAYMENT ON SURRENDER - DEFERRAL OF PAYMENT
Payment on any request for surrender will be made as soon as possible and, with
respect to the Contract Values in the Sub-Accounts, no later than seven days
after the written request is received by the Company. However, such payment may
be subject to postponement:
(a) for any period during which the New York Stock Exchange is closed or during
which trading on the New York Stock Exchange is restricted;
(b) for any period during which an emergency exists as a result of which (i)
disposal of the securities held in the Sub-Accounts is not reasonably
practicable, or (ii) it is not reasonably practicable for the value of the net
assets of the Separate Account to be fairly determined; and
(c) for such other periods as the Securities and Exchange Commission may by
order, permit for the protection of the Contract Owners. The conditions under
which trading shall be deemed to be restricted or any emergency shall be deemed
to exist shall be determined by rules and regulations of the Securities and
Exchange Commission.
11
TERMINATION PROVISIONS (Continued)
The Company may defer payment of any amounts from the Fixed Account for up to
six months from the date of the request to surrender. If the Company defers
payment for more than 30 days, the Company will pay interest of at least 3% per
annum on the amount deferred.
DEATH BENEFIT
If the Annuitant dies before the Annuity Commencement Date and there is no
designated Contingent Annuitant surviving, or if the Contract Owner dies before
the Annuity Commencement Date, the Death Benefit will be payable as determined
under the Contract Control Provisions. The Death Benefit is calculated as of the
date the Company receives written notification of Due Proof of Death at the
Administrative Office of the Company.
The Death Benefit will be the greatest of:
(a) The Contract Value on the date of receipt of Due Proof of Death at the
Administrative Office of the Company; or
(b) The Maximum Anniversary Value as described on Page 5 of this Contract; or
(c) 100% of all premium payments made under the Contract, reduced by the dollar
amount of any partial surrenders since the Date of Issue.
The Death Benefit may be taken in one sum or under any of the settlement options
then being offered by the Company provided, however, that, in the event of a
Contract Owner's death, any settlement option must provide that any amount
payable as a death benefit will commence upon notification of Due Proof of Death
and be completed within five years of the date of death or, if the benefit is
payable over a period not extending beyond the life expectancy of the
Beneficiary or over the life of the Beneficiary, such distribution must commence
within one year of the date of death. Notwithstanding the foregoing, in the
event of the Contract Owner's death where the sole Beneficiary is the spouse of
the Contract Owner and the Annuitant or Contingent Annuitant is living, such
spouse may elect, in lieu of receiving the death benefit, to be treated as the
Contract Owner.
When payment is taken in one sum, payment will be made within 7 days after the
date Due Proof of Death is received, except when the Company is permitted to
defer such payment under the Investment Company Act of 1940.
SETTLEMENT PROVISIONS
ANNUITY COMMENCEMENT DATE
The Annuity Commencement Date is shown on Page 3. This date may be changed by
the Contract Owner with 30 days advance written notification, and may be the
fifteenth day of any month before or including the month of the Annuitant's 90th
birthday. In the event the Contingent Annuitant becomes the Annuitant and in the
absence of a written election to the contrary, the Annuity Commencement Date
will be the fifteenth day of the month coincident with or next following the
Annuitant's 90th birthday.
12
SETTLEMENT PROVISIONS (Continued)
ELECTION OF ANNUITY OPTION
The Contract Owner may elect to have the Termination Value, without deduction
for any contingent deferred sales charge, applied on the Annuity Commencement
Date under any one of the annuity options described below except the fifth
option or under any of the settlement options then being offered by the Company.
The Termination Value is determined on the basis of the Accumulation Unit value
of each Sub-Account and the value of the Fixed Account no later than the fifth
Valuation Day preceding the date annuity payments are to commence.
DATE OF PAYMENT
The first payment under any option shall be made on the fifteenth day of the
month immediately following approval of claim for settlement. Subsequent
payments shall be made on the fifteenth day of each subsequent month in
accordance with the manner of payment selected.
DEATH OF THE ANNUITANT
In the event of the death of the Annuitant while receiving annuity payments, the
present value of any remaining payments will be paid in one sum to the
Beneficiary unless other provisions shall have been made and approved by the
Company. If the Annuitant was also the Contract Owner, any method of
distribution must provide that any amount payable as a death benefit will be
distributed at least as rapidly as under the method of distribution in effect at
the Contract Owner's death. In the case of the Separate Account calculations,
for such present value of the remaining payments the Company will assume a net
investment rate of 5% per annum. The Annuity Unit value on the date of receipt
of Due Proof of Death shall be used for the purpose of determining such present
value. In the case of the General Account the net investment rate assumed will
be the rate used by the Company to determine the amount of each certain payment.
ALLOCATION OF ANNUITY
The person electing an annuity option may further elect to have the value of the
contract applied to provide a variable annuity, a fixed dollar annuity or a
combination of both. Once every 3 months, following the commencement of annuity
payments, the Contract Owner may elect, in writing, to transfer among any
Sub-Account(s) on which variable annuity payments are based. No transfers may be
made between the Sub-Accounts and the General Account.
If no election is made to the contrary, the value of each Sub-Account shall be
applied to provide a variable annuity based thereon, and the value of the Fixed
Account shall be applied to provide a fixed dollar annuity.
VARIABLE ANNUITY AND FIXED DOLLAR ANNUITY
Variable Annuity -- A variable annuity is an annuity with payments increasing or
decreasing in amount in accordance with the net investment results of the Sub-
Account(s) of the Separate Account (as described in the Valuation Provisions)
After the first monthly payment for a variable annuity has been determined in
accordance with the provisions of this contract, a number of Sub-Account Annuity
Units is determined by dividing that first monthly payment by the appropriate
Sub-Account Annuity Unit value on the effective date of the annuity payments.
13
SETTLEMENT PROVISIONS (Continued)
Once variable annuity payments have begun, the number of Annuity Units remains
fixed with respect to a particular Sub-Account. If the Contract Owner elects
that continuing annuity payments be based on a different Sub-Account, the number
will change effective with that election but will remain fixed in number
following such election. The method of calculating the unit value is described
under Valuation Provisions.
The dollar amount of the second and subsequent variable annuity payments is not
predetermined and may increase or decrease from month to month. The actual
amount of each variable annuity payment after the first is determined by
multiplying the number of Sub-Account Annuity Units by the Sub-Account Annuity
Unit value as described in the Valuation Provisions. The Sub-Account Annuity
Unit value will be determined no earlier than the fifth Valuation Day preceding
the date the annuity payment is due.
The Company guarantees that the dollar amount of variable annuity payments will
not be adversely affected by variations in the expense results and in the actual
mortality experience of payees from the mortality assumptions, including any age
adjustment, used in determining the first monthly payment.
Fixed Dollar Annuity -- A fixed dollar annuity is an annuity with payments which
remain fixed as to dollar amount throughout the payment period.
ANNUITY OPTIONS
FIRST OPTION -- Life Annuity -- An annuity payable monthly during the lifetime
of the payee, ceasing with the last payment due prior to the death of the payee.
SECOND OPTION -- Life Annuity with 120, 180 or 240 Monthly Payments Certain --
An annuity providing monthly income to the payee for a fixed period of 120
months, 180 months, or 240 months (as selected), and for as long thereafter as
the payee shall live.
THIRD OPTION -- Joint and Last Survivor Life Annuity -- An annuity payable
monthly during the joint lifetime of the payee and a secondary payee, and
thereafter during the remaining lifetime of the survivor, ceasing with the last
payment prior to the death of the survivor.
FOURTH OPTION -- Payment for a Designated Period -- An amount payable monthly
for the number of years selected which may be from 5 to 30 years. The remaining
balance of proceeds in the General Account or the Separate Account for any day
is equal to the balance on the previous day decreased by the amount of any
installment paid on that day and the remainder multiplied by the applicable net
investment factor for the day as described in the valuation provisions Any
surrender out of this option will be subject to contingent deferred sales
charges as described on Page 3.
If this contract is issued to quality under Section 401, 403, or 408 of the
Internal Revenue Code of 1954 as amended, the fourth option shall be available
only if the guaranteed payment period is less than the life expectancy of the
Annuitant at the time the option becomes effective. Such life expectancy will be
computed under the mortality table then in use by the Company.
14
SETTLEMENT PROVISIONS (Continued)
FIFTH OPTION -- Death Benefit Remaining with the company -- Proceeds from the
Death Benefit left with the company for a period not to exceed five years from
the date of the Contract Owner's death prior to the Annuity Commencement Date.
The proceeds will remain in the Sub-Account(s) to which they were allocated at
the time of death unless the Beneficiary elects to reallocate them. Full or
partial withdrawals may be made at any time. In the event of withdrawals, the
remaining value will equal the contract value of the proceeds left with the
company, minus any withdrawals.
In the absence of an election by the Contract Owner, the Termination Value.
without deduction for any contingent deferred sales charge, will be applied on
the Annuity Commencement Date under the second option to provide a life annuity
with 120 monthly payments certain.
ANNUITY TABLES
DESCRIPTION OF TABLES
The attached tables show the minimum dollar amount of the first monthly payments
for each $1,000 applied under options. Under the First or Second Options, the
amount of each payment will depend upon the age and sex of the payee at the time
the first payment is due. Under the Third Option, the amount of each payment
will depend upon the sex of both payees and their ages at the time the first
payment is due.
The variable payment annuity tables for the First, Second and Third Options are
based on the 1983a Individual Annuity Mortality Table with ages set back one
year and an interest rate of 5% per annum. The table for the Fourth Option is
based on an interest rate of 5% per annum.
The fixed annuity payment tables for the First, Second and Third Options are
based on the 1983a Individual Annuity Mortality Table with ages set back one
year and an Interest rate of 3% per annum. The table for the Fourth Option is
based on an interest rate of 3% per annum.
Once the Contract Owner has elected an annuity option, that election may not be
changed with respect to any Annuitant following the commencement of annuity
payments.
MINIMUM PAYMENT
No election of any options or combination of options may be made under this
contract unless the first payment for each affected Account would be at least
equal to the minimum payment amount according to company rules then in effect.
If at any time, payments to be made to any payee from each Account are or become
less than the minimum payment amount, the Company shall have the right to change
the frequency of payment to such intervals as will result in a payment at least
equal to the minimum. If any amount due would be less than the minimum payment
amount per annum, the Company may take such other settlement as may be equitable
to the payee.
15
VARIABLE PAYMENT ANNUITY TABLES
AMOUNT OF FIRST MONTHLY PAYMENT
FOR EACH $1,000 APPLIED TO
VARIABLE PAYMENT ANNUITIES
Second and subsequent annuity payments. When based on the investment expenence
of a Separate Account. are variable and are not guaranteed as to fixed dollar
amount.
SINGLE LIFE ANNUITIES
MALE PAYEE FEMALE PAYEE
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
------------------------------------------------------------------------------------------------------------
35 $4.68 $4.67 $4.66 $4.64 $4.52 $4.52 $4.51 $4.50
40 4.86 4.85 4.82 4.79 4.65 4.55 4.64 4.62
45 5.10 5.07 5.03 4.97 4.83 4.82 4.80 4.77
50 5.41 5.35 5.28 5.20 5.06 5.04 5.01 4.97
51 5.48 5.41 5.34 5.24 5.12 5.09 5.06 5.01
52 5.55 5.48 5.40 5.30 5.17 5.14 5.11 5.05
53 5.63 5.55 5.46 5.35 5.23 5.20 5.16 5.10
54 5.71 5.63 5.53 5.40 5.30 5.26 5.22 5.15
55 5.80 5.70 5.60 5.45 5.37 5.33 5.28 5.20
56 5.89 5.79 5.67 5.51 5.44 5.40 5.34 5.26
57 5.99 5.88 5.74 5.57 5.52 5.47 5.40 5.31
58 6.10 5.97 5.82 5.62 5.60 5.54 5.47 5.37
59 6.21 6.07 5.90 5.68 5.69 5.62 5.54 5.43
60 6.33 6.17 5.98 5.74 5.79 5.71 5.52 5.49
61 6.46 6.28 6.07 5.80 5.89 5.80 5.70 5.55
62 6.60 6.40 6.16 5.86 6.00 5.90 5.78 5.61
63 6.75 6.52 6.25 5.91 6.11 6.00 5.86 5.67
64 6.91 6.64 6.34 5.97 6.23 6.11 5.95 5.74
65 7.09 6.78 6.43 6.02 6.37 6.22 6.04 5.80
66 7.27 6.91 6.52 6.08 6.51 6.34 6.14 5.87
67 7.47 7.06 6.62 6.12 6.56 6.47 6.24 5.93
68 7.68 7.21 6.71 6.17 6.82 6.60 6.34 5.99
69 7.91 7.36 6.81 6.22 7.00 6.74 6.44 6.05
70 8.15 7.52 6.90 6.26 7.19 6.89 6.54 6.11
75 9.65 8.35 7.30 6.41 8.41 7.74 7.06 6.34
80 11.78 9.16 7.59 6.48 10.24 8.70 7.46 6.46
85 14.73 9.80 7.74 6.51 13.00 9.55 7.69 6.50
90 18.62 10.21 7.80 6.51 17.00 10.10 7.79 6.51
JOINT AND LAST SURVIVOR ANNUITY
AGE OF AGE OF FEMALE PAYEE
MALE PAYEE 35 40 45 50 55 60
-------------------------------------------------------------------------------------------
35 $4.38 $4.42 $4.47 $4.52 $4.56 $4.59
40 4.41 4.47 4.54 4.60 4.66 4.71
45 4.43 4.51 4.60 4.68 4.77 4.85
50 4.45 4.55 4.65 4.76 4.88 5.00
55 4.47 4.57 4.70 4.84 4.99 5.15
60 4.49 4.60 4.73 4.90 5.09 5.30
65 4.50 4.61 4.76 4.95 5.17 5.43
70 4.50 4.63 4.78 4.98 5.23 5.54
75 4.51 4.64 4.80 5.01 5.28 5.63
80 4.51 4.64 4.81 5.03 5.31 5.69
85 4.52 4.65 4.82 5.04 5.34 5.73
90 4.52 4.65 4.82 5.05 5.35 5.75
AGE OF AGE OF FEMALE PAYEE
MALE PAYEE 65 70 75 80 85 90
------------------- ------------------------------------------------------------------
35 $4.62 $4.64 $4.65 $4.66 $4.67 $4.68
40 4.75 4.79 4.81 4.83 4.85 4.85
45 4.91 4.97 5.01 5.05 5.07 5.08
50 5.10 5.19 5.26 5.31 5.35 5.37
55 5.30 5.44 5.56 5.55 5.71 5.75
60 5.52 5.73 5.92 6.07 6.17 6.24
65 5.73 6.04 6.34 6.59 6.79 6.91
70 5.92 6.34 6.79 7.21 7.55 7.80
75 6.07 6.60 7.22 7.87 8.46 8.91
80 6.18 6.81 7.60 8.52 9.45 10.24
85 6.25 6.96 7.89 9.07 10.40 11.67
90 6.30 7.05 8.09 9.49 11.21 13.03
PAYMENTS FOR A DESIGNATED PERIOD
AMOUNT AMOUNT AMOUNT
NO OF NO OF NO OF
OF MONTHLY OF MONTHLY OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
-----------------------------------------------------------------------------------------------------
5 $18.74 10 $10.51 15 $7.82
6 16.99 11 9.77 16 7.49
7 14.02 12 9.16 17 7.20
8 12.56 13 8.64 18 6.94
9 11.42 14 8.20 19 6.71
AMOUNT AMOUNT AMOUNT
NO OF NO OF NO OF
OF MONTHLY OF MONTHLY OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------------------------------------------------------------------------------------------------
20 $6.51 25 $5.76 30 $5.28
21 6.33 26 5.65
22 6.17 27 5.54
23 6.02 28 5.45
24 5.88 29 5.36
The monthly payment for any combination of ages not shown will be quoted upon
request.
16
FIXED PAYMENT ANNUITY TABLES
AMOUNT OF MONTHLY PAYMENTS
FOR EACH $1,000 APPLIED TO
FIXED PAYMENT ANNUITIES
Payments are fixed and are guaranteed as to fixed dollar amount.
FIRST AND SECOND OPTIONS -- SINGLE LIFE ANNUITIES WITH:
MALE PAYEE FEMALE PAYEE
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
------------------------------------------------------------------------------------------------------------
35 $3.41 $3.40 $3.39 $3.38 $3.23 $3.23 $3.22 $3.22
40 3.61 3.60 3.58 3.56 3.39 3.38 3.38 3.37
45 3.87 3.85 3.82 3.77 3.59 3.58 3.57 3.55
50 4.19 4.15 4.10 4.03 3.84 3.83 3.81 3.77
51 4.27 4.22 4.17 4.08 3.90 3.89 3.86 3.82
52 4.34 4.29 4.23 4.14 3.97 3.95 3.92 3.88
53 4.43 4.37 4.30 4.20 4.03 4.01 3.98 3.93
54 4.51 4.45 4.37 4.26 4.10 4.08 4.04 3.99
55 4.60 4.54 4.45 4.32 4.18 4.15 4.11 4.04
56 4.70 4.62 4.53 4.39 4.25 4.22 4.18 4.11
57 4.80 4.72 4.61 4.45 4.34 4.30 4.25 4.17
58 4.91 4.82 4.69 4.51 4.42 4.38 4.32 4.23
59 5.03 4.92 4.78 4.58 4.52 4.47 4.40 4.30
60 5.15 5.03 4.87 4.64 4.61 4.56 4.48 4.37
61 5.28 5.14 4.96 4.71 4.72 4.66 4.57 4.44
62 5.42 5.26 5.06 4.78 4.83 4.76 4.66 4.51
63 5.57 5.39 5.16 4.84 4.95 4.86 4.75 4.58
64 5.74 5.52 5.26 4.90 5.07 4.98 4.85 4.65
65 5.91 5.66 5.36 4.96 5.21 5.10 4.95 4.72
66 6.10 5.81 5.46 5.02 5.35 5.22 5.05 4.79
67 6.29 5.96 5.56 5.08 5.51 5.36 5.16 4.86
68 6.50 6.11 5.66 5.13 5.67 5.50 5.26 4.93
69 6.73 6.28 5.76 5.18 5.85 5.65 5.37 5.00
70 6.97 6.44 5.86 5.23 6.04 5.80 5.49 5.06
75 8.45 7.32 6.31 5.40 7.26 6.69 6.04 5.32
80 10.55 8.17 6.62 5.48 9.07 7.69 6.48 5.45
THIRD OPTION -- JOINT AND LAST SURVIVOR ANNUITY
AGE OF AGE OF FEMALE PAYEE
MALE PAYEE 35 40 45 50 55
------------------------------------------------------------------------------------
35 $3.07 $3.14 $3.20 $3.25 $3.30
40 3.11 3.20 3.28 3.36 3.42
45 3.15 3.25 3.36 3.46 3.56
50 3.17 3.29 3.42 3.56 3.69
55 3.19 3.32 3.47 3.64 3.81
60 3.20 3.34 3.51 3.70 3.92
65 3.21 3.36 3.54 3.75 4.00
70 3.22 3.37 3.56 3.78 4.06
75 3.22 3.38 3.57 3.81 4.11
80 3.23 3.38 3.58 3.82 4.14
AGE OF AGE OF FEMALE PAYEE
MALE PAYEE 60 65 70 75 80
------------------- ----------------------------------------------------------
35 $3.33 $3.35 $3.37 $3.39 $3.40
40 3.48 3.52 3.55 3.57 3.59
45 3.64 3.71 3.76 3.80 3.63
50 3.82 3.92 4.01 4.08 4.12
55 3.99 4.16 4.29 4.40 4.48
60 4.15 4.39 4.61 4.79 4.93
65 4.29 4.61 4.94 5.24 5.48
70 4.40 4.80 5.25 5.70 6.12
75 4.48 4.95 5.51 6.15 6.90
80 4.54 5.05 5.71 6.52 7.45
FOURTH OPTION -- PAYMENTS FOR A DESIGNATED PERIOD
AMOUNT AMOUNT AMOUNT
NO. OF NO. OF NO. OF
OF MONTHLY OF MONTHLY OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
----------------------------------------------------------------------------------------------------
5 $17.91 10 $9.61 15 $6.87
6 15.14 11 8.86 16 6.53
7 13.16 12 8.24 17 6.23
8 11.68 13 7.71 18 5.95
9 10.53 14 7.26 19 5.73
AMOUNT AMOUNT AMOUNT
NO. OF NO. OF NO. OF
OF MONTHLY OF MONTHLY OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------------------------------------------------------------------------------------------------
20 $5.51 25 $4.71 30 $4.18
21 5.32 26 4.59
22 5.15 27 4.47
23 4.99 28 4.37
24 4.84 29 4.27
The monthly payment for any combination of ages not shown will be quoted upon
request.
17
SCHEDULE D
Monthly Reinsurance Premium Rates
Exposure Based
Per $1,000 Exposed
[REDACTED]
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions; Pathmaker SCHEDULE D
SCHEDULE E
Monthly Reporting Format
1. Following the end of each calendar month, the Monthly Input Page,
Fund/Exposure-Based exhibit (Schedule E-2) and the Monthly Transaction Summary
(Schedule E-3) or an exhibit of similar format must be prepared for each
Qualified plan and Non-Qualified plan separately.
2. The tabulation should be on an Adjusted Basis, which requires a separate
tabulation of contracts with purchase amounts in excess of $5.0 million.
3. The tabulation is on a seriatim basis, with each contract contributing
toward the totals for both exposure and aggregate contract value.
4. An exhibit demonstrating the aggregate allocation of contract values by fund
shall be provided each calendar month.
5. At year end reporting, a tabulation of exposures by age and sex based on a
percentage decrease in account value by fund type as specified by the NAIC must
be submitted for reserve purposes.
If ITT Hartford is unable to obtain and report to Connecticut General all of the
above requested information, but rather reports estimates of this information,
both parties will work together for an equitable settlement as soon as the
actual information becomes available.
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions; Pathmaker SCHEDULE E
VARIABLE ANNUITY DEATH BENEFIT
Monthly Input Page, Fund/Exposure-Based
For Contract Years 1 through 7
CONTRACTS ISSUED ON OR AFTER JANUARY 1, 1996
Calendar Year
Reporting Month
MALE FEMALE MALE
MALE FEMALE SURRENDER SURRENDER ANNUITY
AGE BAND EXPOSURE* EXPOSURE* VALUE VALUE VALUE
-----------------------------------------------------------------------------
0-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Total 0-70 0 0 0 0 0
70+ 0 0 0 0 0
Total Male/Female
0-70 0 0
70+ 0 0
All Ages 0 0
FEMALE
ANNUITY MALE FEMALE MALE FEMALE
AGE BAND VALUE CLAIMS CLAIMS GMDB GMDB
------------------- ---------------------------------------------------------------
0-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Total 0-70 0 0 0 0 0
70+ 0 0 0 0 0
Total Male/Female
0 0 0
0 0 0
0 0 0
Please use end of the period values.
[REDACTED]
------------
* Exposure is defined as the GMDB less the surrender value
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE E-2,
1
VARIABLE ANNUITY DEATH BENEFIT
Monthly Input Page, Fund/Exposure-Based
For Contract Years 1 through 7
CONTRACTS ISSUED ON OR BEFORE DECEMBER 31, 1995
Calendar Year
Reporting Month
MALE FEMALE MALE
MALE FEMALE SURRENDER SURRENDER ANNUITY
AGE BAND EXPOSURE* EXPOSURE* VALUE VALUE VALUE
-----------------------------------------------------------------------------
0-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Total 0-69 0 0 0 0 0
70-79 0 0 0 0 0
80+ 0 0 0 0 0
Total Male/Female
0-69 0 0
70-79 0 0
80+ 0 0
All Ages 0 0
FEMALE
ANNUITY MALE FEMALE MALE FEMALE
AGE BAND VALUE CLAIMS CLAIMS GMDB GMDB
------------------- ---------------------------------------------------------------
0-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Total 0-69 0 0 0 0 0
70-79 0 0 0 0 0
80+ 0 0 0 0 0
Total Male/Female
0 0 0
0 0 0
0 0 0
0 0 0
Use end of the period values.
Male Female
[REDACTED]
------------
* Exposure is defined as the GMDB less the surrender value
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE E-2,
2
VARIABLE ANNUITY DEATH BENEFIT
Monthly Input Page, Fund/Exposure-Based
For Contract Years 8 and Beyond
CONTRACTS ISSUED ON OR AFTER JANUARY 1, 1996
Calendar Year
Reporting Month
MALE FEMALE MALE
MALE FEMALE SURRENDER SURRENDER ANNUITY
AGE BAND EXPOSURE* EXPOSURE* VALUE VALUE VALUE
-------------------------------------------------------------------------
0-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Total 0-70 0 0 0 0 0
70+ 0 0 0 0 0
Total
Male/Female
0-70 0 0
70+ 0 0
All Ages 0 0
FEMALE
ANNUITY MALE FEMALE MALE FEMALE
AGE BAND VALUE CLAIMS CLAIMS GMDB GMDB
--------------- ---------------------------------------------------------------
0-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Total 0-70 0 0 0 0 0
70+ 0 0 0 0 0
Total
Male/Female
0 0 0
0 0 0
0 0 0
Please use end of the period values.
[REDACTED]
------------
* Exposure is defined as the GMDB less the surrender value
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE E-2,
3
VARIABLE ANNUITY DEATH BENEFIT
Monthly Input Page, Fund/Exposure-Based
For Contract Years 8 and Beyond
CONTRACTS ISSUED ON OR BEFORE DECEMBER 31, 1995
Calendar Year
Reporting Month
MALE FEMALE MALE
MALE FEMALE SURRENDER SURRENDER ANNUITY
AGE BAND EXPOSURE* EXPOSURE* VALUE VALUE VALUE
------------------------------------------------------------------------------
0-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Total 0-69 0 0 0 0 0
70-79 0 0 0 0 0
80+ 0 0 0 0 0
Total
Male/Female
0-69 0 0
70-79 0 0
80+ 0 0
All Ages 0 0
FEMALE
ANNUITY MALE FEMALE MALE FEMALE
AGE BAND VALUE CLAIMS CLAIMS GMDB GMDB
--------------- ---------------------------------------------------------------
0-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Total 0-69 0 0 0 0 0
70-79 0 0 0 0 0
80+ 0 0 0 0 0
Total
Male/Female
0 0 0
0 0 0
0 0 0
0 0 0
[ILLEGIBLE] end of the period values.
[REDACTED]
------------
* Exposure is defined as the GMDB less the surrender value
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE E-2,
4
VARIABLE ANNUITY DEATH BENEFIT
Monthly Transcation Summary
For Contract Years 1 through 7
CONTRACTS ISSUED ON OR AFTER JANUARY 1, 1996
Calendar Year
Reporting Month
MONTHLY REINSURANCE PREMIUM CALCULATION
PART I.
A. AGES SUBJECT TO EXPOSURE CALCULATION (TO 70)
1 Aggregate Annuity Value (BOM) Prior X-0
0 Xxxxxxxxx Annuity Value (EOM) 0 Current E-2
3 Average Annuity Value (1+2)/2 0
4 Minimum Fund-Based Premium Rate [REDACTED]
5 Minimum Premium (4*3) 0
6 Maximum Fund-Based Premium Rate [REDACTED]
7 Maximum Premium (6*3) 0
8 Actual Exposure Premium (BOM) Prior E-2
9 Actual Exposure Premium (EOM) 0 Current E-2
10 Average Exposure Premium (8+9)/2 0
11 Earned Premium [max[5,min(10,7)] 0
12 Advance Premium Current Month (4*2) 0
13 Advance Premium Prior Month Prior E-3
14 Net Premium Due (11+12-13) 0
B. AGES NOT SUBJECT TO EXPOSURE CALCULATION (70+)
15 Aggregate Annuity Value (BOM) Prior X-0
00 Xxxxxxxxx Annuity Value (EOM) 0 Current E-2
17 Average Annuity Value [(15+16)/2] 0
18 Monthly Fund Based Premium Rate [REDACTED]
19 Monthly Earned Premium [17*18] 0
20 Advance Premium Current Month [16*18] 0
21 Advance Premium Prior Month Prior E-3
22 Net Premium Due [19+20-21] 0
23 Total Part I. Net Premium Due All Ages [14+22] 0
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE E-3,
1
VARIABLE ANNUITY DEATH BENEFIT
Monthly Transcation Summary
For Contract Years 1 through 7
CONTRACTS ISSUED ON OR BEFORE DECEMBER 31, 1995
Calendar Year
Reporting Month
MONTHLY REINSURANCE PREMIUM CALCULATION
PART II.
A. AGES SUBJECT TO EXPOSURE CALCULATION (TO 70, 70-79)
[LESS THAN]70 70-79
24 Aggregate Annuity Value (BOM) Prior X-0
00 Xxxxxxxxx Annuity Value (EOM) 0 0 Current E-2
26 Average Annuity Value (24+25)/2 0 0
27 Minimum Fund-Based Premium Rate [REDACTED]
28 Minimum Premium (27*26) 0 0
29 Maximum Fund-Based Premium Rate [REDACTED]
30 Maximum Premium (29*26) 0 0
31 Actual Exposure Premium (BOM) Prior E-2
32 Actual Exposure Premium (EOM) 0 0 Current E-2
33 Average Exposure Premium 0 0
(31+32)/2
34 Earned Premium 0 0
[max[28,min(33,30)]
35 Advance Premium Current Month 0 0
(27*25)
36 Advance Premium Prior Month Prior E-3
37 Net Premium Due (34+35-36) 0 0
39 Total Net Premium Due Ages [LESS 0
THAN]80 (sum line 37)
B. AGES NOT SUBJECT TO EXPOSURE CALCULATION (80+)
80+
40 Aggregate Annuity Value (BOM) Prior X-0
00 Xxxxxxxxx Annuity Value (EOM) 0 Current E-2
42 Average Annuity Value [(40+42)/2] 0
43 Minimum Fund-Based Premium Rate [REDACTED]
44 Minimum Premium (43*42) 0
45 Maximum Fund-Based Premium Rate [REDACTED]
46 Maximum Premium (45*42) 0
47 Actual Exposure Premium (BOM)
48 Actual Exposure Premium (EOM) 0
49 Average Exposure Premium 0
(47+48)/2
48 Earned Premium [max[44, 0
min(49,46)]
49 Advance Premium Current Month 0
(43*41)
50 Advance Premium Prior Month
51 Total Net Premium Due Ages 80+ 0
(48+49-50)
52 Total Part II. Net Premium Due 0
All Ages (39+51)
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE E-3,
2
VARIABLE ANNUITY DEATH BENEFIT
Monthly Transcation Summary
For Contract Years 1 through 7
ALL CONTRACTS
Calendar Year
Reporting Month
MONTHLY REINSURANCE PREMIUM CALCULATION
PART III.
ACTUAL CLAIMS
53 Monthly Reinsurance Amount 0 Current E-2
PART IV.
NET TRANSCATIONS
54 Premium Due Reinsurer [23+52] 0
55 Monthly Reinsurance Claims [Sum 53] 0
56 Twelth Month Calendar Year Premium Adjustment Attach explanation
57 Prior Adjustment Attach explanation
58 Amount Due Ceding Company [55-54+56+57] 0
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE E-3,
3
VARIABLE ANNUITY DEATH BENEFIT
Monthly Transcation Summary
For Contract Years 8 and Beyond
CONTRACTS ISSUED ON OR AFTER JANUARY 1, 1996
Calendar Year
Reporting Month
MONTHLY REINSURANCE PREMIUM CALCULATION
PART I.
A. AGES SUBJECT TO EXPOSURE CALCULATION (TO 70)
1 Aggregate Annuity Value (BOM) Prior X-0
0 Xxxxxxxxx Annuity Value (EOM) 0 Current E-2
3 Average Annuity Value (1+2)/2 0
4 Minimum Fund-Based Premium Rate [REDACTED]
5 Minimum Premium (4*3) 0
6 Maximum Fund-Based Premium Rate [REDACTED]
7 Maximum Premium (6*3) 0
8 Actual Exposure Premium (BOM) Prior E-2
9 Actual Exposure Premium (EOM) 0 Current E-2
10 Average Exposure Premium (8+9)/2 0
11 Earned Premium [max[5,min(10,7)] 0
12 Advance Premium Current Month (4*2) 0
13 Advance Premium Prior Month Prior E-3
14 Net Premium Due (11+12-13) 0
B. AGES NOT SUBJECT TO EXPOSURE CALCULATION (70+)
15 Aggregate Annuity Value (BOM) Prior X-0
00 Xxxxxxxxx Annuity Value (EOM) 0 Current E-2
17 Average Annuity Value [(15+16)/2] 0
18 Monthly Fund Based Premium Rate [REDACTED]
19 Monthly Earned Premium [17*18] 0
20 Advance Premium Current Month [16*18] 0
21 Advance Premium Prior Month Prior E-3
22 Net Premium Due [19+20-21] 0
23 Total Part I. Net Premium Due All Ages [14+22] 0
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE E-3,
4
VARIABLE ANNUITY DEATH BENEFIT
Monthly Transcation Summary
For Contract Years 8 and Beyond
CONTRACTS ISSUED ON OR BEFORE DECEMBER 31, 1995
Calendar Year
Reporting Month
MONTHLY REINSURANCE PREMIUM CALCULATION
PART II.
A. AGES SUBJECT TO EXPOSURE CALCULATION (TO 70, 70-79)
[LESS THAN]70 70-79
24 Aggregate Annuity Value (BOM) Prior X-0
00 Xxxxxxxxx Annuity Value (EOM) 0 0 Current E-2
26 Average Annuity Value 0 0
(24+25)/2
27 Minimum Fund-Based Premium [REDACTED]
Rate
28 Minimum Premium (27*26) 0 0
29 Maximum Fund-Based Premium [REDACTED]
Rate
30 Maximum Premium (29*26) 0 0
31 Actual Exposure Premium (BOM) Prior E-2
32 Actual Exposure Premium (EOM) 0 0 Current E-2
33 Average Exposure Premium 0 0
(31+32)/2
34 Earned Premium 0 0
[max[28,min(33,30)]
35 Advance Premium Current Month 0 0
(27*25)
36 Advance Premium Prior Month Prior E-3
37 Net Premium Due (34+35-36) 0 0
39 Total Net Premium Due Ages 0
[LESS THAN]80 (sum line 37)
B. AGES NOT SUBJECT TO EXPOSURE CALCULATION (80+)
80+
40 Aggregate Annuity Value (BOM) Prior X-0
00 Xxxxxxxxx Annuity Value (EOM) 0 Current E-2
42 Average Annuity Value 0
[(40+42)/2]
43 Minimum Fund-Based Premium [REDACTED]
Rate
44 Minimum Premium (43*42) 0
45 Maximum Fund-Based Premium [REDACTED]
Rate
46 Maximum Premium (45*42) 0
47 Actual Exposure Premium (BOM)
48 Actual Exposure Premium (EOM) 0
49 Average Exposure Premium 0
(47+48)/2
48 Earned Premium 0
[max[44,min(49,46)]
49 Advance Premium Current Month 0
(43*41)
50 Advance Premium Prior Month
51 Total Net Premium Due Ages 80+ 0
(48+49-50)
52 Total Part II. Net Premium Due 0
All Ages (39+51)
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE E-3,
5
VARIABLE ANNUITY DEATH BENEFIT
Monthly Transcation Summary
For Contract Years 8 and Beyond
ALL CONTRACTS
Calendar Year
Reporting Month
MONTHLY REINSURANCE PREMIUM CALCULATION
PART III.
ACTUAL CLAIMS
53 Monthly Reinsurance Amount 0 Current E-2
PART IV.
NET TRANSACTIONS
54 Premium Due Reinsurer [23+52] 0
55 Monthly Reinsurance Claims [Sum 53] 0
56 Twelfth Month Calendar Year Premium Adjustment Attach explanation
57 Prior Adjustment Attach explanation
58 Amount Due Ceding Company [55-54+56+57] 0
ITT Hartford Life & Annuity CIGNA Reinsurance
Director; Xxxxxx Capital Manager; August 23, 1996
Select Dimensions, Pathmaker SCHEDULE X-0,
0
XXXXXXXXX XX. 0
TO THE
VARIABLE ANNUITY GUARANTEED DEATH BENEFIT REINSURANCE
Dated April 1, 1996
between
ITT Hartford Life & Annuity Insurance Company
(Hartford, Connecticut)
and
Connecticut General Life Insurance Company
(Hartford, Connecticut)
It is agreed by the two companies:
1. To amend the YRT rates for inforce business; and
2. To amend and substitute the attached Schedule Dfor the corresponding
Schedule D of this Agreement; and
3. This amendment shall be effective on July 1, 1997.
In witness whereof, this Amendment is signed in duplicate on the dates indicated
at the home office of each company.
ITT HARTFORD LIFE & ANNUITY INSURANCE COMPANY
By /s/ [ILLEGIBLE]
------------------------------
Date 12-5, 1997
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
By /s/ [ILLEGIBLE]
------------------------------
Date 7/25, 1997
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Amendment No. 1 Treaty Dated 4/1/96
Effective 7/1/97
SCHEDULE D
Monthly Reinsurance Premium Rates
For Inforce Business as of July 1, 1997
Exposure Based
Per $1.000 Exposed
[REDACTED]
ITT Hartford Life & Annuity Insurance Company CIGNA Reinsurance
Amendment No. 1 Treaty Dated 4/1/96
Effective 7/1/97
SCHEDULE D
AMENDMENT NO. 2
To the
Reinsurance Agreement Effective April 1, 1996
Between
ITT Hartford Life and Annuity Insurance Company
And
Connecticut General Life Insurance Company
Through its Division, CIGNA Reinsurance
It is agreed by the two companies to amend the Agreement as follows:
1. Article II entitled Amounts at Risk shall be amended. Now, therefore, the
following Paragraph A of Article II shall be substituted for the
corresponding Paragraph A of Article II of the Agreement:
ARTICLE II AMOUNTS AT RISK
A. The reinsurance death benefit is the surrender charge plus the excess
of the guaranteed minimum death benefit over the contract account
value, if any. At issue, the guaranteed minimum death benefit is
equal to the initial premium. Once every year thereafter, on the
contract anniversary, prior to certificate or contract owner attained
age 81, the guaranteed minimum death benefit is reset to the then
current contract value, if this value exceeds the current guaranteed
minimum death benefit. Please refer to Schedule C for a complete
description of the guaranteed minimum death benefit.
2. All other terms and conditions of the Agreement shall remain in full force
and effect.
In witness whereof, this amendment is signed in duplicate on the dates indicated
at the home office of each company.
ITT HARTFORD LIFE AND ANNUITY CONNECTICUT GENERAL LIFE INSURANCE
INSURANCE COMPANY COMPANY
By: /s/ [ILLEGIBLE] By: /s/ [ILLEGIBLE]
------------------------------ ------------------------------
Dated: 8/30/99 Dated: 8/19/99
ITT Hartford Life and Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; Amendment No. 2
Select Dimensions; Pathmaker
AMENDMENT NO. 2
To the Reinsurance Agreement Effective April 1, 1996
Between
ITT Hartford Life and Annuity Insurance Company
And
Connecticut General Life Insurance Company
Through its Division, CIGNA Reinsurance
It is agreed by the two companies to amend the Agreement as follows:
1. Article II entitled Amounts at Risk shall be amended. Now, therefore, the
following Paragraph A of Article II shall be substituted for the
corresponding Paragraph A of Article II of the Agreement:
ARTICLE II AMOUNTS AT RISK
A. The reinsurance death benefit is the surrender charge plus the excess
of the guaranteed minimum death benefit over the contract surrender
value, if any. At issue, the guaranteed minimum death benefit is
equal to the initial premium. Once every year thereafter, on the
contract anniversary, prior to certificate or contract owner attained
age 81, the guaranteed minimum death benefit is reset to the then
current contract value, if this value exceeds the current guaranteed
minimum death benefit. Please refer to Schedule C for a complete
description of the guaranteed minimum death benefit.
2. All other terms and conditions of the Agreement shall remain in full force
and effect.
In witness whereof, this amendment is signed in duplicate on the dates indicated
at the home office of each company.
ITT HARTFORD LIFE AND ANNUITY CONNECTICUT GENERAL LIFE INSURANCE
INSURANCE COMPANY COMPANY
By: /s/ Xxxxxxx Xxxxxxxxxxx By: /s/ Xxxx Xxxxxxx
------------------------------ ------------------------------
Dated: 8/10/99 Dated: 7/28/99
ITT Hartford Life and Annuity Insurance Company CIGNA Reinsurance
Director; Xxxxxx Capital Manager; Amendment No. 2
Select Dimensions; Pathmaker
