EX-4.D 6 d448188dex4d.htm EXHIBIT 4(D) Exhibit 4(d)

EXHIBIT 4(d)

FORM OF POLICY RIDER

(ADDITIONAL DEATH DISTRIBUTION)


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Home Office:

4333 Edgewood Road N.E.    

Cedar Rapids, Iowa 52499    

(319)355-8511

A Stock Company (Hereafter called the Company, we, our or us)

  

ADDITIONAL DEATH BENEFIT RIDER

We issued this rider as a part of the policy to which it is attached. All provisions of the policy that do not conflict with this rider apply to this rider. In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy.

This rider will pay an Additional Death Benefit amount equal to a percentage of the gains accumulated in the policy since the rider was added. This Additional Death Benefit, if any, will be paid whenever death proceeds are payable on the base policy to which this rider is attached.

This rider can only be terminated when the policy to which this rider is attached terminates, including when the Policy Value becomes zero, is annuitized, or an Additional Death Benefit is paid or added to the policy under spousal continuation under the terms of this rider. You may also terminate this benefit at any time by notifying us at our service center. Once terminated, this rider may be re-elected. However, a new rider will be issued and the Additional Death Benefit amount will be re-determined.

Rider Data Specifications

 

Policy Number:

   12345   

Rider Date:

   05/01/2013   

Additional Death Benefit Factor:

   40%   

Rider Fee Percentage:*

   0.25%   

*The Rider Fee applies for the life of the rider.

DEFINITIONS

Rider Anniversary

The anniversary of the Rider Date for each year the rider remains in force.

Rider Date

The date that this rider is added to the policy.

Rider Earnings

The policy gains accrued and not previously withdrawn since the Rider Date. On a given date, this amount is equal to: the current Policy Value of the base policy; minus the Policy Value of the base policy on the Rider Date; minus premiums paid after the Rider Date; plus amounts withdrawn from the Policy Value after the Rider Date that exceed the Rider Earnings on the date of the withdrawal.

Rider Fee

The Rider Fee amount is equal to the Rider Fee Percentage above multiplied by the Policy Value on the date the fee is deducted. A Rider Fee is deducted annually on each Rider Anniversary prior to annuitization. We will also deduct this fee upon full Surrender of the policy or other termination of the rider. However, once terminated the Rider Fee will also terminate. The Rider Fee is deducted pro rata from each Investment Option. The Rider Fee is deducted even during periods when the Additional Death Benefit rider would not pay any benefit.

ADDITIONAL DEATH BENEFIT AMOUNT

If death proceeds are payable under the terms of the base policy to which this rider is attached, this rider will pay an Additional Death Benefit equal to the Additional Death Benefit Factor multiplied by the Rider Earnings on the date used to calculate the death proceeds. This amount cannot be withdrawn as a lump sum.

 

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SPOUSAL CONTINUATION

If a death occurs and the base policy gives the surviving spouse the right to continue the policy, the surviving spouse has two options:

 

  1.)

Receive the death benefit attributable to this rider as well as the death benefit attributable to the base policy, at which time both rider and base policy would terminate, or

 

  2.)

Continue the policy and receive a one-time Policy Value increase equal to the amount of the Additional Death Benefit paid by this rider. At this time the rider would terminate.

If the policy is continued, the spouse would have the option of immediately re-electing the rider if they meet issue requirements at the time the rider is re-elected.

REPORTS TO OWNER

The amount of the Additional Death Benefit will be included in a report sent to You at least once each year until the Annuity Commencement Date as described in Section 3, Reports to Owner provision, in the policy.

Additional Death Benefit Example:

 

 

 

Additional Death Benefit Example Assumptions:

 

  

Policy Value at rider issue

  $ 100,000   

Premium Payments after rider issue

  $ 25,000   

Policy Value on base policy

  $     225,000   

Death proceeds on base policy

  $ 250,000   

Additional Death Benefit Factor

    40%   

Withdrawals that exceed Rider Earnings

  $ 0   

 

Additional Death Benefit Calculations:

 

  

Rider Earnings = Policy Value - Policy Value on the Rider Date - Premium Payments after the Rider Date + withdrawals that exceed Rider Earnings on date of withdrawal = $225,000 - $100,000 - $25,000 + $0

  $ 100,000   
   

Additional Death Benefit amount = Additional Death Benefit Factor * Rider Earnings = 40% * $100,000

  $ 40,000   
   

Total death proceeds = death proceeds on base policy + Additional Death Benefit amount = $250,000 + $40,000

 

  $

 

290,000

 

  

 

Signed for us at our Home Office.

 

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   LOGO

SECRETARY

   PRESIDENT

 

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