EX-99.4.A 2 dex994a.htm VARIABLE UNIVERSAL LIFE INSURANCE POLICY Variable Universal Life Insurance Policy

Exhibit (4)(a)

AMERICAN FAMILY LIFE INSURANCE COMPANY

6000 AMERICAN PKWY

MADISON, WI 53783-0001

888-428-5433

A STOCK COMPANY

VARIABLE UNIVERSAL LIFE INSURANCE

This policy is a legal contract between the owner and us. This policy sets forth, in detail, the rights and obligations of the owner and us.

We agree to pay the proceeds or the death benefit of this policy, subject to the conditions and provisions of this policy.

RIGHT TO EXAMINE AND RETURN POLICY WITHIN 30 DAYS

The owner may return this policy at any time before midnight of the 30th day after receipt by delivering it or mailing it to:

 

  1. us at our home office; or

 

  2. the registered representative of American Family Securities, LLC, through whom this policy was purchased.

Upon such mailing or delivery, this policy is deemed void from the start and within seven days from the date we receive this policy, we will refund an amount equal to the greater of the premiums paid or the sum of:

 

  1. the policy value of this policy on the date this policy is received at our home office;

 

  2. any premium charges that were deducted from the premium; and

 

  3. monthly deductions made on the policy date and any monthly deduction day.

The amount of the death benefit or the duration of the death benefit may vary as described in the Death Benefit provisions. The policy value in the variable account is based on the investment experience of that account and may increase or decrease daily. It is not guaranteed as to dollar amount. See page 24 for the variable account provisions of this policy.

This policy has been signed at our home office in Madison, Wisconsin.

 

JACK SALZWEDEL     JAMES ELDRIDGE
PRESIDENT     SECRETARY

DESCRIPTION

FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE POLICY

Premiums are payable until the earlier of the maturity date or the primary insured’s death

Participating

PLEASE READ YOUR POLICY CAREFULLY

ALPHABETIC GUIDE TO THIS POLICY

 

1


PROVISION

  

PAGE

Changes in Insurance Coverage    7

Increase in Specified Amount

   7

Decrease in Specified Amount

   7

Add or Increase Riders

   7

Cancel or Decrease Riders

   7

Change in Primary Insured’s Death Benefit Option

   7
Death Benefit Options    18, 19

Change in Death Benefit Option

   18

Death Benefit Requirement

   18

Table of Policy Value Percentages

   19
Death Benefits Payable    17, 18
Definitions    4, 5, 6

Accumulation Unit

   4

Application

   4

Attained Age

   4

Authorized Request

  

Beneficiary(ies)

   4

Business Day

   4

Death Benefit

   4

Decrease in Specified Amount

   4

Excess Interest

   4

Fixed Account

   4

Fixed Account Policy Value

   4

Fund

   4

General Account

   4

Home Office

   4

Increase in Specified Amount

   4

In Force

   4

Issue Age

   4

Issue Date

   4

Maturity Date

   5

Monthly Deduction

   5

Monthly Deduction Day

   5

Net Policy Value

   5

Net Premium

   5

Non-Preferred Policy Loan

   5

Owner

   5

Policy Date

   5

Policy Loan Balance

   5

Policy Value

   5

Preferred Policy Loan

   5

Premium Charge

   5

Primary Insured

   5

Proceeds

   5

Proof of Death

  

Rider

   5

SEC

   5

Specified Amount

   5

Surrender Value

   5

Target Premium

  

Underwriting Class

   5

Valuation Period

   6

Variable Account

   6

Variable Account Policy Value

   6

We, Us, Our

   6
Effective Date of Coverage    6
Extension of Maturity Date    19
General Provisions    22, 23

Annual Report

   22

Basis of Calculation

   22

Claims of Creditors

   22

Continuation of Insurance Coverage

   22

Dividends

   22

Entire Contract

   22

Error

   23

Grace Period

   23

Incontestability

   23

Misstatement of Age or Gender

   23

Reinstatement

   23

Suicide

   24

Tax Qualification as Life Insurance

   24

Waiver and Change

   24
Maturity    19
Ownership, Beneficiary, Assignment    6, 7

Ownership

   6

Change of Owner

   6

Beneficiary(ies)

   7

Change of Beneficiary

   7

Assignment

   7
Policy Loans    15

Policy Loans

   15

Policy Loan Interest

   15

Policy Loan Allocation

   15

Policy Loan Repayment

   15
Policy Value    14, 15

Accumulation Units

   14

Accumulation Unit Value

   14

Net Investment Factor

   14, 15

Fixed Account Interest

   15
Premiums    7 - 13

Premium

   8

Planned Premium

   8

Minimum Premium

   8

Premium Reminder Notice

   8

Premium Limits

   8

Premium Allocation

   8, 9

Adjusted Policy Value

   9

Cost of Insurance

   9

Cost of Insurance Rates

   9

Table of Guaranteed Cost of Insurance Rates

   10, 11, 12, 13
Right to Examine and Return Policy    1
Settlement Options    19, 20, 21

Settlement Options

   20

Interest

   20

Settlement Option Conditions

   20

Settlement Option Tables

   20, 21

 

2


ALPHABETIC GUIDE TO THIS POLICY (CONTINUED)

 

Surrender    16

Full Surrender

   16

Full Surrender Charge

   16

Partial Surrender

   16

Partial Surrender Charge

   16

Processing Fee

   16
Termination Date of Coverage    6
Variable Account    24

Variable Account

   24

Subaccounts

   24

Investment Options

   24

Transfers

   24

 

3


DEFINITIONS

The following are some of the key words used in this policy. When these words are used they are in bold type. As you read this policy, you can refer to this section for the definition.

Accumulation Unit. A measure of the value of each subaccount used in determining the variable account policy value.

Additional Premium. Premium paid under this policy other than planned premium.

Application. The form completed when applying for coverage under this policy. This includes any:

 

  1. amendments or endorsements;

 

  2. supplemental applications; and

 

  3. applications for reinstatement.

Attained Age. The issue age plus the number of years since the policy date.

Authorized Request. A request in a form satisfactory to us, that is received at our home office. This includes but is not limited to written request signed by the owner.

Beneficiary(ies). The person(s) or entity so named on the application, unless later changed.

Business Day. A day when the New York Stock Exchange is open for trading, except for:

 

  1. the days specified in the prospectus subject to applicable regulatory authority;

 

  2. any day that a subaccount’s corresponding investment option does not value its shares.

Assets are valued at the close of the business day (typically 4:00 P.M. Eastern Time).

Death Benefit. The amount payable to the beneficiary upon the death of the primary insured according to the conditions and provisions of this policy.

Decrease in Specified Amount. A decrease to the specified amount after this policy is issued.

Excess Interest. Any interest credited in addition to the guaranteed interest on the fixed account.

Fixed Account. An account in which the policy value accrues interest at no less than the guaranteed minimum rate shown on the schedule. The fixed account is supported by our general account.

Fixed Account Policy Value. The amount under this policy in the fixed account.

Fund. An open end diversified management investment company or unit investment trust in whose portfolio a subaccount invests as shown on the schedule.

General Account. All our assets other than those allocated to the variable account or any other separate account. We have complete ownership and control of the assets of the general account.

Home Office. Our office at 6000 American Pkwy, Madison, Wisconsin 53783-0001.

Increase in Specified Amount. An increase to the specified amount after this policy is issued. It does not include an increase to the specified amount due to a change in death benefit from option two to option one or any addition of or increase to any rider.

In Force. The status of this policy, as long as it has not terminated according to its conditions and provisions.

Issue Age. The primary insured’s age, calculated on his/her birthday nearest the policy date. A different issue age may apply to any rider or increase in coverage subsequently added to this policy.

Issue Date. The date shown on the schedule that this policy was issued and the premium is credited under this policy. A rider or increase in coverage subsequently added to this policy will have its own issue date.

Maturity Date. The date shown on the schedule that this policy terminates if the primary insured is living and this policy is in force. This date is the policy anniversary date nearest the primary insured’s attained age 100 unless extended under the Extension of Maturity Date provision.

 

4


Minimum Premium. The amount, shown on the schedule or an endorsement or amendment, necessary to keep the policy in force during the continuation of insurance coverage period. It is equal to the minimum monthly premium multiplied by the number of months since the policy date (including the current month).

Monthly Deduction. The amount equal to the sum of:

 

  1. the cost of insurance for this policy; and

 

  2. the cost of any rider; and

 

  3. the separate monthly policy fee shown on the schedule, and the policy issue fee; and

 

  4. the separate administrative charge.

Monthly Deduction Day. The first monthly deduction day is the issue date; thereafter, the monthly deduction day is the same day each month as the policy date.

Net Policy Value. The amount calculated as:

 

  1. the policy value; less

 

  2. the amount of any policy loan balance.

Net Premium. The amount of premium remaining after the premium charge shown on the schedule has been deducted.

Non-Preferred Policy Loan. The loaned amount that is considered premiums paid.

Owner. The person so named on the application, unless later changed.

Planned Premium. The planned premium is shown on the Schedule and is the basis for premium reminder notices. The least amount of any planned premium payment after the initial premium payment is $50.00.

Policy Date. The date shown on the schedule that coverage under this policy becomes effective and that determines each:

 

  1. policy year;

 

  2. policy anniversary;

 

  3. policy month.

If the policy date would otherwise fall on the 29th, 30th or 31st of the month, the policy date will be the 28th of the month.

Policy Loan Balance. The sum of all outstanding policy loans, including preferred policy loans and non-preferred policy loans, plus accrued loan interest.

Policy Value. The total amount under this policy in the variable account and the fixed account.

Preferred Policy Loan. The loaned amount that is excess surrender value over premiums paid.

Premium payments. All payments made under the policy other than repayments of the policy loan balance.

Premium Charge. The percentage of premium shown on the schedule that is assessed against any premium payment.

Primary Insured. The person so named on the application as the primary insured.

Proceeds. The amount payable on the maturity date of this policy or on partial or full surrender of this policy.

Proof of Death. The following are acceptable as proof of death:

 

  1. a certified copy of the death certificate;

 

  2, a statement from the physician in attendance at the time of death;

 

  3. a finding from a court of competent jurisdiction;

 

  4. any other proof of death satisfactory to us.

Rider. A supplement made a part of this policy that provides additional benefits or excludes benefits.

SEC. The Securities and Exchange Commission, a United States government agency.

 

5


Specified Amount. The dollar amount shown on the schedule or shown on an endorsement or amendment, not including any riders, used to determine the primary insured’s death benefit.

Surrender Value. An amount equal to:

 

  1. the policy value; minus

 

  2. the sum of the surrender charge and the policy loan balance.

The surrender value of this policy is never less than zero.

Target Premium. An amount of premium based on the specified amount and the risk characteristics of the primary insured used as a basis for limits for certain riders.

Underwriting Class. The underwriting risk class shown on the schedule or shown on an endorsement or amendment. The underwriting risk class affects the cost of insurance rates , administrative charge, surrender charges and the minimum and target premiums. More than one underwriting class may apply under this policy if an increase in insurance coverage is subsequently issued.

Valuation Period. The time between the close of business on a business day and the close of business on the next business day.

Variable Account. The separate account shown on the schedule. It is registered as a unit investment trust with the SEC under the Investment Company Act of 1940.

Variable Account Policy Value. The amount under this policy in the variable account.

We, Us, Our. American Family Life Insurance Company.

EFFECTIVE DATE OF COVERAGE

The effective date of coverage under this policy is:

 

  1. for all coverage issued based on the original application, the effective date is the issue date;

 

  2. for any rider or increase in specified amount issued after the issue date, the effective date is shown on the rider or on an endorsement or amendment;

 

  3. for any coverage that has been reinstated, the effective date is the business day on or following the date we approve the application for reinstatement.

In order for coverage to be effective the following also must be met:

 

  1. this policy must be accepted by the owner;

 

  2. any required initial premium must be paid in full;

 

  3. any required amendments must be signed and returned to our home office.

If the initial premium is paid in exchange for a Conditional Receipt on the date of application, then coverage under this policy takes effect as provided in the Conditional Receipt.

TERMINATION DATE OF COVERAGE

The termination date of coverage under this policy is the earliest of:

 

  1. 12:00 AM on the maturity date;

 

  2. the primary insured’s date of death;

 

  3. the end of the Grace Period, if sufficient premium is not paid by the end of the Grace Period;

 

  4. the date the owner surrenders this policy.

OWNERSHIP, BENEFICIARY AND ASSIGNMENT

Ownership. The owner, subject to any assignment on file at our home office and subject to the rights of any irrevocable beneficiary, may exercise all rights and options provided by this policy during the primary insured’s lifetime. This includes the right to name a new owner or a new beneficiary. The consent of any beneficiary or any contingent owner will not be required unless the existing designation has been made irrevocable by its terms. If the owner is not the primary insured and the owner dies before the primary insured, the owners estate will become the owner unless prior to the death of the owner and while the primary insured is living, we receive an authorized request naming a contingent owner.

 

6


Change of Owner. Subject to the rights of any assignee of this policy, the owner may name a new owner while the primary insured is living by sending us an authorized request for this purpose. When we receive an authorized request for an ownership change, such change:

 

  1. takes effect on the date the authorized request is signed;

 

  2. will have no effect on any action we took prior to receiving the authorized request at our home office; and

 

  3. terminates all rights under previous owner designations.

Beneficiary(ies). Any death benefit payable upon the death of the primary insured is paid to the beneficiary, subject to the conditions and provisions of this policy.

As used in the beneficiary designation, the terms, “children” or “lawful children” mean and are limited to those children who are born to or legally adopted by the primary insured. The term “children of this marriage” means and is limited to those children who are born to or legally adopted by the primary insured and his/her spouse on the date the designation is made. Other children (such as a step-child) may be designated by full legal name as a beneficiary.

Change of Beneficiary. Unless there is an irrevocable beneficiary, and subject to the rights of any assignee of this policy, the owner may name a new beneficiary while the primary insured is living by sending us an authorized request for this purpose. When we receive an authorized written request for a beneficiary change, such change:

 

  1. takes effect on the date the authorized request is signed; and

 

  2. will have no effect on any action we took prior to receiving the authorized request at our home office; and

 

  3. all prior beneficiary designations and settlement option elections are revoked.

Assignment. The rights of the owner and any beneficiary are subject to the rights of any assignee of this policy unless the beneficiary was effectively designated as an irrevocable beneficiary before the assignment. No assignment is binding on us until the original or a copy of it is filed at our home office and accepted by us. We are not responsible for the validity of any assignment or its legal effect.

CHANGES IN INSURANCE COVERAGE

Subject to any rights of any assignee or irrevocable beneficiary, the owner may make certain changes in insurance coverage. Written application and other requirements will apply. The following changes may be made.

Increase in Specified Amount. Before the primary insured’s attained age 80, the specified amount may be increased. Each increase in specified amount has its own 14 year period of surrender charges and surrender charges will be calculated accordingly. The minimum and target premiums and cost of insurance charges will increase accordingly. Evidence of insurability satisfactory to us is required. Each increase in specified amount is subject to our minimum requirements in effect at the time of the increase.

The cost of insurance and the minimum and target premiums for each increase in specified amount will be based on the primary insured’s attained age and underwriting class at the time the increase in specified amount becomes effective.

Decrease in Specified Amount. Before the maturity date, the specified amount may be decreased. No more than one decrease may be made during any policy year. The minimum premium, target premium, cost of insurance and any administrative charges will decrease accordingly. A decrease in specified amount will be applied:

 

  1. to any past increase in the reverse order in which the increase in specified amount took effect; then

 

  2. after all prior increases in specified amount have been eliminated, a decrease applied to decrease the initial specified amount.

The specified amount cannot be decreased below our published minimum specified amount for this policy or rider at the time of such request.

Add or Increase Riders. Riders may be added or increased as provided under the specific rider conditions and provisions. The minimum and target premiums may increase when a rider is added or increased. The cost of insurance rates for a rider may increase accordingly, but never will be more than the guaranteed cost of insurance rates for a rider as shown on the Schedule.

Cancel or Decrease Riders. Riders may be cancelled or decreased as provided under specific rider conditions and provisions. The minimum and target premiums may decrease when a rider is decreased or cancelled. The cost of insurance rates may decrease accordingly.

 

7


Change in Death Benefit Option. Two death benefit options are available under this policy. Refer to the Death Benefit Options provision for information concerning changing the primary insured’s death benefit option.

We have the right to limit any change if such change would fail to maintain this policy as life insurance as defined under federal tax law definitions.

All changes in insurance coverage are effective on the monthly deduction day on or following the date we approve the request for the change.

PREMIUMS

Premium. The initial premium is charged from and due on the policy date. Additional premium may be paid while this policy is in force, subject to premium limits. All premiums after the initial premium may be paid in advance. All premium payments sent by mail must be sent to our home office.

Planned Premium. Payment of the planned premium may not be sufficient to keep this policy in force.

The minimum premium and the target premium may change if there is a change:

 

  1. as defined under the Change in Insurance Coverage provision; or

 

  2. in underwriting class.

Premium Reminder Notice. We will, subject to our rules then in effect:

 

  1. provide a premium reminder notice:

 

  a. annually;

 

  b. semiannually; or

 

  c. quarterly;

 

  2. arrange billing under our electronic payment plan; or

 

  3. change the timing and premium amount.

We reserve the right to stop any premium reminder notices.

Premium Limits. We have the right to limit the amount and frequency of premium payments.

Any payments made generally will be applied as premium unless there is an outstanding policy loan balance. The premium charge is not applied against any policy loan repayment.

Any payments made in any policy year that exceed the minimum premium for that policy year are first applied to reduce any policy loan balance. The premium charge is not applied against the policy loan repayment.

If mandated by law, we may reject a premium. We may also provide information about an owner’s account to a government agency.

Premium Allocation. The owner determines the percentage of premium that will be allocated to each subaccount of the variable account and to the fixed account. The owner may choose to allocate:

 

  1. all the premium;

 

  2. a percentage of the premium; or

 

  3. nothing

to a particular subaccount or to the fixed account.

Any allocation must be for at least one percent of the premium. A fractional percentage may not be chosen.

The initial premium and any additional premium received during the first 40 days after this policy is issued will be allocated as of the actual date we receive the premium at our home office as follows:

 

  1. all net premium allocated to the variable subaccounts will be directed to the money market account; and

 

  2. all net premium allocated to the fixed account will be directed to such account.

On the 41st day after we issue this policy, we will transfer all or part of the amount in the money market subaccount to the other subaccounts according to the premium allocation percentages shown on the application. This transfer does not count toward the free transfers allowed each year. (See Transfers provision.) Any additional premium will be allocated as of the business day we receive the premium at our home office.

 

8


Except as provided in the preceding paragraph, the premium will be allocated according to:

 

  1. the premium allocation shown on the application; or

 

  2. the most recent written instructions of the owner.

The owner may change the allocation of future premiums at any time, subject to the following:

 

  1. this policy must be in force; and

 

  2. there must be a net policy value.

The change will be effective on the business day on or next following the date we receive the owner’s authorized request at our home office.

The monthly deduction will be taken from the fixed account policy value and the variable subaccounts’ policy value on a proportionate basis as of the close of business on the monthly deduction day. To determine the proportionate basis, the fixed account policy value is first reduced by the amount of any policy loan balance.

Adjusted Policy Value. The adjusted policy value for this policy is the policy value reduced by the monthly cost of any riders (except the Waiver of Monthly Deductions Rider for the Primary Insured), the separate monthly policy fee and administrative charge.

Cost of Insurance. The cost of insurance is the monthly amount charged for this policy. It is determined by:

 

  1. the primary insured’s attained age;

 

  2. the primary insured’s underwriting class; and

 

  3. the policy duration.

For death benefit option one the cost of insurance on any monthly deduction day is:

 

  1. the specified amount on the monthly deduction day, divided by 1.0024662; minus:

 

  2. this policy’s adjusted policy value (as defined above) on the monthly deduction day; multiplied by:

 

  3. the applicable cost of insurance rate on the monthly deduction day divided by 1,000.

For death benefit option two the cost of insurance on any monthly deduction day is:

 

  1. the specified amount on the monthly deduction day plus this policy’s adjusted cash value (as defined above) on the monthly deduction day divided by 1.0024662; minus:

 

  2. this policy’s adjusted policy value on the monthly deduction day; multiplied by:

 

  3. the applicable cost of insurance rate on the monthly deduction day divided by 1,000.

Cost of Insurance Rates. The monthly guaranteed cost of insurance rates are shown on The Table of Guaranteed Cost of Insurance Rates and are based on the mortality table shown on the schedule. We may change the monthly cost of insurance rates from time to time, but We may never increase such rates above the guaranteed rates shown on the Table of Guaranteed Cost of Insurance Rates. The guaranteed and current cost of insurance rates include charges for mortality risk, taxes, issue, maintenance and administrative expenses.

If the primary insured is in an underwriting class other than that shown on the Table of Guaranteed Cost of Insurance Rates the Table of Guaranteed Cost of Insurance Rates will differ from those shown in this policy.

 

9


TABLE OF GUARANTEED COST OF INSURANCE RATES (Preferred Underwriting Classes)

Monthly Rates per Thousand

 

Attained

Age

 

Male

Nicotine

 

Male

Preferred Nicotine

 

Male

Non-Nicotine

 

Male

Preferred

 

Male

Select

 

Male

Super Select

0

  N/A   N/A   0.08   N/A   N/A   N/A

1

  N/A   N/A   0.05   N/A   N/A   N/A

2

  N/A   N/A   0.03   N/A   N/A   N/A

3

  N/A   N/A   0.02   N/A   N/A   N/A

4

  N/A   N/A   0.02   N/A   N/A   N/A

5

  N/A   N/A   0.02   N/A   N/A   N/A

6

  N/A   N/A   0.02   N/A   N/A   N/A

7

  N/A   N/A   0.02   N/A   N/A   N/A

8

  N/A   N/A   0.02   N/A   N/A   N/A

9

  N/A   N/A   0.02   N/A   N/A   N/A

10

  N/A   N/A   0.02   N/A   N/A   N/A

11

  N/A   N/A   0.02   N/A   N/A   N/A

12

  N/A   N/A   0.03   N/A   N/A   N/A

13

  N/A   N/A   0.03   N/A   N/A   N/A

14

  N/A   N/A   0.04   N/A   N/A   N/A

15

  N/A   N/A   0.05   N/A   N/A   N/A

16

  N/A   N/A   0.06   N/A   N/A   N/A

17

  N/A   N/A   0.07   N/A   N/A   N/A

18

  0.09   0.09   0.08   0.08   0.08   0.08

19

  0.10   0.10   0.08   0.08   0.08   0.08

20

  0.11   0.11   0.08   0.08   0.08   0.08

21

  0.11   0.11   0.08   0.08   0.08   0.08

22

  0.12   0.12   0.08   0.08   0.08   0.08

23

  0.12   0.12   0.08   0.08   0.08   0.08

24

  0.13   0.13   0.08   0.08   0.08   0.08

25

  0.14   0.14   0.08   0.08   0.08   0.08

26

  0.14   0.14   0.09   0.09   0.09   0.09

27

  0.15   0.15   0.09   0.09   0.09   0.09

28

  0.15   0.15   0.09   0.09   0.09   0.09

29

  0.15   0.15   0.09   0.09   0.09   0.09

30

  0.15   0.15   0.09   0.09   0.09   0.09

31

  0.15   0.15   0.08   0.08   0.08   0.08

32

  0.15   0.15   0.08   0.08   0.08   0.08

33

  0.16   0.16   0.09   0.09   0.09   0.09

34

  0.16   0.16   0.09   0.09   0.09   0.09

35

  0.17   0.17   0.09   0.09   0.09   0.09

36

  0.18   0.18   0.10   0.10   0.10   0.10

37

  0.19   0.19   0.10   0.10   0.10   0.10

38

  0.02   0.20   0.11   0.11   0.11   0.11

39

  0.21   0.21   0.11   0.11   0.11   0.11

40

  0.23   0.23   0.12   0.12   0.12   0.12

41

  0.25   0.25   0.13   0.13   0.13   0.13

42

  0.28   0.28   0.14   0.14   0.14   0.14

43

  0.31   0.31   0.16   0.16   0.16   0.16

44

  0.34   0.34   0.18   0.18   0.18   0.18

45

  0.38   0.38   0.19   0.19   0.19   0.19

46

  0.42   0.42   0.21   0.21   0.21   0.21

47

  0.46   0.46   0.23   0.23   0.23   0.23

48

  0.48   0.48   0.24   0.24   0.24   0.24

49

  0.50   0.50   0.26   0.26   0.26   0.26

 

10


TABLE OF GUARANTEED COST OF INSURANCE RATES (Preferred Underwriting Classes)

Monthly Rates per Thousand

 

Attained

Age

 

Male

Nicotine

 

Male

Preferred Nicotine

 

Male

Non-Nicotine

 

Male

Preferred

 

Male

Select

 

Male

Super Select

50

  0.54   0.54   0.28   0.28   0.28   0.28

51

  0.58   0.58   0.30   0.30   0.30   0.30

52

  0.64   0.64   0.33   0.33   0.33   0.33

53

  0.70   0.70   0.36   0.36   0.36   0.36

54

  0.79   0.79   0.41   0.41   0.41   0.41

55

  0.88   0.88   0.46   0.46   0.46   0.46

56

  0.98   0.98   0.51   0.51   0.51   0.51

57

  1.08   1.08   0.57   0.57   0.57   0.57

58

  1.16   1.16   0.62   0.62   0.62   0.62

59

  1.25   1.25   0.68   0.68   0.68   0.68

60

  1.36   1.36   0.74   0.74   0.74   0.74

61

  1.50   1.50   0.83   0.83   0.83   0.83

62

  1.66   1.66   0.93   0.93   0.93   0.93

63

  1.85   1.85   1.04   1.04   1.04   1.04

64

  2.03   2.03   1.16   1.16   1.16   1.16

65

  2.22   2.22   1.29   1.29   1.29   1.29

66

  2.40   2.40   1.42   1.42   1.42   1.42

67

  2.57   2.57   1.55   1.55   1.55   1.55

68

  2.76   2.76   1.69   1.69   1.69   1.69

69

  2.94   2.94   1.83   1.83   1.83   1.83

70

  3.16   3.16   2.01   2.01   2.01   2.01

71

  3.40   3.40   2.21   2.21   2.21   2.21

72

  3.73   3.73   2.46   2.46   2.46   2.46

73

  4.06   4.06   2.74   2.74   2.74   2.74

74

  4.39   4.39   3.02   3.02   3.02   3.02

75

  4.77   4.77   3.34   3.34   3.34   3.34

76

  5.19   5.19   3.68   3.68   3.68   3.68

77

  5.66   5.66   4.07   4.07   4.07   4.07

78

  6.21   6.21   4.54   4.54   4.54   4.54

79

  6.84   6.84   5.07   5.07   5.07   5.07

80

  7.51   7.51   5.66   5.66   5.66   5.66

81

  8.25   8.25   6.32   6.32   6.32   6.32

82

  9.01   9.01   7.01   7.01   7.01   7.01

83

  9.80   9.80   7.76   7.76   7.76   7.76

84

  10.66   10.66   8.58   8.58   8.58   8.58

85

  11.67   11.67   9.51   9.51   9.51   9.51

86

  12.78   12.78   10.53   10.53   10.53   10.53

87

  13.97   13.97   11.65   11.65   11.65   11.65

88

  15.23   15.23   12.84   12.84   12.84   12.84

89

  16.52   16.52   14.10   14.10   14.10   14.10

90

  17.84   17.84   15.42   15.42   15.42   15.42

91

  19.04   19.04   16.66   16.66   16.66   16.66

92

  20.25   20.25   17.95   17.95   17.95   17.95

93

  21.51   21.51   19.32   19.32   19.32   19.32

94

  22.81   22.81   20.75   20.75   20.75   20.75

95

  24.25   24.25   22.27   22.27   22.27   22.27

96

  25.53   25.53   23.65   23.65   23.65   23.65

97

  26.87   26.87   25.12   25.12   25.12   25.12

98

  28.29   28.29   26.70   26.70   26.70   26.70

99

  29.79   29.79   28.38   28.38   28.38   28.38

 

11


TABLE OF GUARANTEED COST OF INSURANCE RATES (Preferred Underwriting Classes)

Monthly Rates per Thousand

 

Attained

Age

 

Female

Nicotine

 

Female

Preferred Nicotine

 

Female

Non-Nicotine

 

Female

Preferred

 

Female

Select

 

Female

Super Select

0

  N/A   N/A   0.04   N/A   N/A   N/A

1

  N/A   N/A   0.03   N/A   N/A   N/A

2

  N/A   N/A   0.02   N/A   N/A   N/A

3

  N/A   N/A   0.02   N/A   N/A   N/A

4

  N/A   N/A   0.02   N/A   N/A   N/A

5

  N/A   N/A   0.02   N/A   N/A   N/A

6

  N/A   N/A   0.02   N/A   N/A   N/A

7

  N/A   N/A   0.02   N/A   N/A   N/A

8

  N/A   N/A   0.02   N/A   N/A   N/A

9

  N/A   N/A   0.02   N/A   N/A   N/A

10

  N/A   N/A   0.02   N/A   N/A   N/A

11

  N/A   N/A   0.02   N/A   N/A   N/A

12

  N/A   N/A   0.02   N/A   N/A   N/A

13

  N/A   N/A   0.03   N/A   N/A   N/A

14

  N/A   N/A   0.03   N/A   N/A   N/A

15

  N/A   N/A   0.03   N/A   N/A   N/A

16

  N/A   N/A   0.03   N/A   N/A   N/A

17

  N/A   N/A   0.03   N/A   N/A   N/A

18

  0.04   0.04   0.04   0.04   0.04   0.04

19

  0.05   0.05   0.04   0.04   0.04   0.04

20

  0.05   0.05   0.04   0.04   0.04   0.04

21

  0.05   0.05   0.04   0.04   0.04   0.04

22

  0.05   0.05   0.04   0.04   0.04   0.04

23

  0.06   0.06   0.04   0.04   0.04   0.04

24

  0.06   0.06   0.04   0.04   0.04   0.04

25

  0.06   0.06   0.04   0.04   0.04   0.04

26

  0.07   0.07   0.04   0.04   0.04   0.04

27

  0.07   0.07   0.05   0.05   0.05   0.05

28

  0.08   0.08   0.05   0.05   0.05   0.05

29

  0.08   0.08   0.05   0.05   0.05   0.05

30

  0.09   0.09   0.05   0.05   0.05   0.05

31

  0.09   0.09   0.06   0.06   0.06   0.06

32

  0.10   0.10   0.06   0.06   0.06   0.06

33

  0.11   0.11   0.06   0.06   0.06   0.06

34

  0.12   0.12   0.07   0.07   0.07   0.07

35

  0.13   0.13   0.07   0.07   0.07   0.07

36

  0.14   0.14   0.08   0.08   0.08   0.08

37

  0.15   0.15   0.09   0.09   0.09   0.09

38

  0.16   0.16   0.09   0.09   0.09   0.09

39

  0.17   0.17   0.09   0.09   0.09   0.09

40

  0.18   0.18   0.10   0.10   0.10   0.10

41

  0.19   0.19   0.11   0.11   0.11   0.11

42

  0.20   0.20   0.11   0.11   0.11   0.11

43

  0.22   0.22   0.12   0.12   0.12   0.12

44

  0.24   0.24   0.13   0.13   0.13   0.13

45

  0.26   0.26   0.14   0.14   0.14   0.14

46

  0.29   0.29   0.16   0.16   0.16   0.16

47

  0.32   0.32   0.17   0.17   0.17   0.17

48

  0.36   0.36   0.19   0.19   0.19   0.19

49

  0.40   0.40   0.21   0.21   0.21   0.21

 

12


TABLE OF GUARANTEED COST OF INSURANCE RATES (Preferred Underwriting Classes)

Monthly Rates per Thousand

 

Attained

Age

 

Male

Nicotine

 

Male

Preferred Nicotine

 

Male

Non-Nicotine

 

Male

Preferred

 

Male

Select

 

Male

Super Select

50

  0.45   0.45   0.23   0.23   0.23   0.23

51

  0.50   0.50   0.26   0.26   0.26   0.26

52

  0.56   0.56   0.29   0.29   0.29   0.29

53

  0.62   0.62   0.32   0.32   0.32   0.32

54

  0.69   0.69   0.35   0.35   0.35   0.35

55

  0.76   0.76   0.39   0.39   0.39   0.39

56

  0.83   0.83   0.43   0.43   0.43   0.43

57

  0.91   0.91   0.48   0.48   0.48   0.48

58

  0.99   0.99   0.52   0.52   0.52   0.52

59

  1.08   1.08   0.57   0.57   0.57   0.57

60

  1.16   1.16   0.62   0.62   0.62   0.62

61

  1.26   1.26   0.67   0.67   0.67   0.67

62

  1.36   1.36   0.73   0.73   0.73   0.73

63

  1.47   1.47   0.79   0.79   0.79   0.79

64

  1.58   1.58   0.85   0.85   0.85   0.85

65

  1.70   1.70   0.92   0.92   0.92   0.92

66

  1.82   1.82   1.00   1.00   1.00   1.00

67

  1.97   1.97   1.09   1.09   1.09   1.09

68

  2.12   2.12   1.18   1.18   1.18   1.18

69

  2.29   2.29   1.29   1.29   1.29   1.29

70

  2.49   2.49   1.40   1.40   1.40   1.40

71

  2.70   2.70   1.54   1.54   1.54   1.54

72

  2.94   2.94   1.68   1.68   1.68   1.68

73

  3.20   3.20   1.85   1.85   1.85   1.85

74

  3.48   3.48   2.02   2.02   2.02   2.02

75

  3.77   3.77   2.22   2.22   2.22   2.22

76

  4.08   4.08   2.44   2.44   2.44   2.44

77

  4.41   4.41   2.67   2.67   2.67   2.67

78

  4.77   4.77   2.94   2.94   2.94   2.94

79

  5.16   5.16   3.22   3.22   3.22   3.22

80

  5.58   5.58   3.54   3.54   3.54   3.54

81

  6.17   6.17   3.97   3.97   3.97   3.97

82

  6.81   6.81   4.45   4.45   4.45   4.45

83

  7.44   7.44   4.93   4.93   4.93   4.93

84

  8.11   8.11   5.47   5.47   5.47   5.47

85

  8.78   8.78   6.07   6.07   6.07   6.07

86

  9.35   9.35   6.62   6.62   6.62   6.62

87

  10.24   10.24   7.44   7.44   7.44   7.44

88

  11.13   11.13   8.30   8.30   8.30   8.30

89

  12.03   12.03   9.21   9.21   9.21   9.21

90

  12.75   12.75   10.05   10.05   10.05   10.05

91

  12.91   12.91   10.48   10.48   10.48   10.48

92

  13.56   13.56   11.32   11.32   11.32   11.32

93

  14.59   14.59   12.57   12.57   12.57   12.57

94

  15.91   15.91   14.14   14.14   14.14   14.14

95

  17.91   17.91   16.08   16.08   16.08   16.08

96

  19.74   19.74   17.92   17.92   17.92   17.92

97

  21.58   21.58   19.82   19.82   19.82   19.82

98

  21.67   21.67   20.14   20.14   20.14   20.14

99

  22.56   22.56   21.23   21.23   21.23   21.23

TABLE OF GUARANTEED COST OF INSURANCE RATES (non preferred underwriting classes)

Monthly Rates per Thousand

 

Attained

Age

 

Male Non
Nicotine

B

 

Male Non
Nicotine

C

 

Male Non
Nicotine

D

 

Male Non
Nicotine

E

 

Male Non
Nicotine

F

 

Male Non
Nicotine

H

 

Male Non
Nicotine

J

 

Male Non
Nicotine

L

 

Male Non
Nicotine

P

0

  0.12122   0.14141   0.16159   0.18176   0.20194   0.24226   0.28257   0.32286   0.40338

1

  0.06999   0.08165   0.09331   0.10496   0.11662   0.13992   0.16322   0.18651   0.23307

2

  0.04875   0.05687   0.06499   0.07311   0.08123   0.09746   0.11369   0.12992   0.16237

3

  0.03375   0.03937   0.04499   0.05062   0.05624   0.06748   0.07872   0.08996   0.11244

4

  0.02625   0.03062   0.03500   0.03937   0.04374   0.05249   0.06123   0.06998   0.08746

5

  0.02625   0.03062   0.03500   0.03937   0.04374   0.05249   0.06123   0.06998   0.08746

6

  0.02750   0.03208   0.03666   0.04124   0.04583   0.05499   0.06415   0.07331   0.09163

7

  0.02750   0.03208   0.03666   0.04124   0.04583   0.05499   0.06415   0.07331   0.09163

8

  0.02750   0.03208   0.03666   0.04124   0.04583   0.05499   0.06415   0.07331   0.09163

9

  0.02875   0.03354   0.03833   0.04312   0.04791   0.05749   0.06706   0.07664   0.09579

10

  0.02875   0.03354   0.03833   0.04312   0.04791   0.05749   0.06706   0.07664   0.09579

11

  0.03375   0.03937   0.04499   0.05062   0.05624   0.06748   0.07872   0.08996   0.11244

12

  0.04125   0.04812   0.05499   0.06186   0.06873   0.08247   0.09621   0.10995   0.13741

13

  0.04875   0.05687   0.06499   0.07311   0.08123   0.09746   0.11369   0.12992   0.16237

14

  0.05874   0.06853   0.07831   0.08810   0.09788   0.11744   0.13700   0.15656   0.19565

15

  0.07624   0.08894   0.10164   0.11433   0.12703   0.15241   0.17778   0.20315   0.25386

16

  0.09248   0.10789   0.12329   0.13869   0.15408   0.18486   0.21563   0.24639   0.30788

17

  0.10623   0.12392   0.14161   0.15929   0.17697   0.21232   0.24765   0.28297   0.35357

18

  0.11497   0.13412   0.15326   0.17240   0.19153   0.22979   0.26802   0.30624   0.38263

19

  0.11747   0.13704   0.15659   0.17615   0.19570   0.23478   0.27384   0.31289   0.39093

20

  0.11872   0.13849   0.15826   0.17802   0.19778   0.23727   0.27675   0.31622   0.39508

21

  0.11872   0.13849   0.15826   0.17802   0.19778   0.23727   0.27675   0.31622   0.39508

22

  0.11872   0.13849   0.15826   0.17802   0.19778   0.23727   0.27675   0.31622   0.39508

23

  0.11997   0.13995   0.15992   0.17989   0.19986   0.23977   0.27966   0.31954   0.39923

24

  0.12122   0.14141   0.16159   0.18176   0.20194   0.24226   0.28257   0.32286   0.40338

25

  0.12247   0.14286   0.16325   0.18364   0.20402   0.24476   0.28548   0.32619   0.40753

26

  0.12747   0.14869   0.16991   0.19113   0.21234   0.25474   0.29712   0.33948   0.42413

27

  0.13371   0.15598   0.17824   0.20049   0.22274   0.26721   0.31167   0.35609   0.44488

28

  0.13122   0.15306   0.17491   0.19675   0.21858   0.26222   0.30585   0.34945   0.43658

29

  0.12872   0.15015   0.17158   0.19300   0.21442   0.25723   0.30003   0.34280   0.42828

30

  0.12747   0.14869   0.16991   0.19113   0.21234   0.25474   0.29712   0.33948   0.42413

31

  0.12622   0.14724   0.16825   0.18926   0.21026   0.25225   0.29421   0.33616   0.41998

32

  0.12622   0.14724   0.16825   0.18926   0.21026   0.25225   0.29421   0.33616   0.41998

33

  0.12997   0.15161   0.17324   0.19487   0.21650   0.25973   0.30294   0.34613   0.43243

34

  0.13246   0.15452   0.17657   0.19862   0.22066   0.26472   0.30876   0.35277   0.44073

35

  0.13621   0.15889   0.18157   0.20424   0.22690   0.27220   0.31748   0.36274   0.45318

36

  0.14371   0.16764   0.19156   0.21547   0.23938   0.28717   0.33493   0.38267   0.47807

37

  0.14995   0.17492   0.19988   0.22483   0.24978   0.29964   0.34948   0.39928   0.49880

38

  0.16120   0.18803   0.21486   0.24168   0.26849   0.32208   0.37564   0.42917   0.53612

39

  0.17119   0.19969   0.22818   0.25666   0.28512   0.34203   0.39890   0.45573   0.56927

40

  0.18243   0.21280   0.24316   0.27350   0.30383   0.36447   0.42506   0.48560   0.60656

41

  0.19742   0.23028   0.26313   0.29596   0.32878   0.39438   0.45992   0.52542   0.65626

42

  0.21616   0.25213   0.28808   0.32402   0.35995   0.43175   0.50349   0.57517   0.71834

43

  0.23739   0.27689   0.31637   0.35583   0.39527   0.47410   0.55285   0.63153   0.78866

44

  0.26236   0.30601   0.34963   0.39323   0.43681   0.52390   0.61089   0.69780   0.87133

45

  0.29108   0.33949   0.38788   0.43624   0.48457   0.58114   0.67761   0.77396   0.96632

46

  0.31855   0.37152   0.42446   0.47736   0.53023   0.63588   0.74138   0.84675   1.05710

47

  0.34851   0.40645   0.46435   0.52221   0.58003   0.69556   0.81092   0.92612   1.15603

48

  0.36598   0.42682   0.48762   0.54837   0.60908   0.73036   0.85146   0.97238   1.21370

49

  0.38595   0.45010   0.51420   0.57826   0.64226   0.77012   0.89777   1.02524   1.27957

50

  0.41466   0.48356   0.55241   0.62121   0.68995   0.82725   0.96432   1.10117   1.37418

51

  0.44835   0.52284   0.59726   0.67162   0.74590   0.89428   1.04239   1.19024   1.48513

52

  0.49451   0.57664   0.65869   0.74066   0.82255   0.98608   1.14929   1.31218   1.63698

53

  0.54441   0.63479   0.72508   0.81527   0.90537   1.08525   1.26475   1.44386   1.80089

54

  0.60801   0.70891   0.80969   0.91035   1.01088   1.21158   1.41179   1.61151   2.00950

55

  0.68655   0.80043   0.91415   1.02771   1.14111   1.36745   1.59317   1.81826   2.26660

56

  0.76632   0.89335   1.02019   1.14683   1.27328   1.52559   1.77713   2.02789   2.52711

57

  0.85229   0.99349   1.13445   1.27516   1.41564   1.69586   1.97513   2.25345   2.80722

58

  0.92578   1.07907   1.23208   1.38480   1.53724   1.84127   2.14417   2.44594   3.04613

59

  1.01045   1.17766   1.34453   1.51107   1.67726   2.00864   2.33868   2.66737   3.32077

60

  1.11251   1.29648   1.48004   1.66318   1.84592   2.21017   2.57279   2.93379   3.65095

61

  1.23692   1.44128   1.64513   1.84848   2.05132   2.45548   2.85763   3.25779   4.05214

62

  1.38861   1.61779   1.84633   2.07422   2.30148   2.75409   3.20417   3.65174   4.53940

63

  1.55885   1.81581   2.07196   2.32730   2.58185   3.08854   3.59205   4.09240   5.08370

64

  1.73765   2.02372   2.30878   2.59285   2.87591   3.43908   3.99830   4.55360   5.65258

65

  1.92625   2.24294   2.55839   2.87262   3.18562   3.80798   4.42550   5.03824   6.24946

66

  2.11718   2.46478   2.81089   3.15552   3.49867   4.18058   4.85666   5.52696   6.85045

67

  2.31044   2.68924   3.06626   3.44153   3.81504   4.55682   5.29169   6.01970   7.45542

68

  2.51839   2.93066   3.34083   3.74890   4.15489   4.96068   5.75826   6.54772   8.10263

69

  2.73358   3.18038   3.62470   4.06656   4.50597   5.37750   6.23939   7.09174   8.76830

70

  2.99428   3.48276   3.96827   4.45082   4.93045   5.88096   6.81996   7.74757   9.56918

71

  3.28552   3.82038   4.35166   4.87939   5.40359   6.44151   7.46561   8.47607   10.45679

72

  3.66756   4.26293   4.85385   5.44036   6.02248   7.17370   8.30779   9.42498   11.60971

73

  4.06988   4.72860   5.38185   6.02967   6.67210   7.94100   9.18889   10.41613   12.81000

74

  4.49239   5.21721   5.93537   6.64693   7.35195   8.74260   10.10779   11.44800   14.05528

75

  4.95334   5.74978   6.53813   7.31847   8.09089   9.61225   11.10284   12.56330   15.39622

76

  5.45494   6.32873   7.19271   8.04700   8.89171   10.55280   12.17682   13.76460   16.83467

77

  6.03594   6.99853   7.94915   8.88792   9.81500   11.63468   13.40932   15.14003   18.47400

78

  6.71274   7.77774   8.82793   9.86353   10.88473   12.88475   14.82956   16.72068   20.34774

79

  7.49176   8.67320   9.83624   10.98116   12.10824   14.31001   16.44371   18.51146   22.45716

80

  8.33813   9.64434   10.92781   12.18891   13.42806   15.84197   18.17253   20.42261   24.69236

81

  9.29792   10.74342   12.16069   13.55029   14.91277   17.55842   20.10178   22.54679   27.15684

82

  10.29306   11.88047   13.43337   14.95253   16.43867   19.31475   22.06719   24.70128   29.63458

83

  11.36109   13.09793   14.79285   16.44688   18.06099   21.17329   24.13719   26.95977   32.20758

84

  12.53755   14.43551   16.28258   18.08014   19.82951   23.18881   26.37041   29.38370   34.94051

85

  13.84404   15.91660   17.92734   19.87810   21.77069   25.38820   28.79314   31.99800   37.85382

86

  15.28266   17.54210   19.72652   21.83841   23.88018   27.76260   31.39149   34.78341   40.91721

87

  16.84226   19.29784   21.66273   23.94028   26.13372   30.28058   34.12680   37.69417   44.07179

88

  18.50016   21.15672   23.70443   26.14775   28.49095   32.89325   36.94216   40.66606   47.24109

89

  20.23407   23.09238   25.82120   28.42642   30.91362   35.55513   39.78566   43.64159   50.35942

90

  22.02674   25.08431   27.98940   30.74960   33.37214   38.23135   42.61795   46.57792   53.37988

91

  23.69703   26.93156   29.99067   32.88385   35.62011   40.65547   45.15942   49.18805   56.01472

92

  25.42164   28.82985   32.03749   35.05636   37.89755   43.08816   47.68578   51.75817   58.56041

93

  27.22244   30.80198   34.15317   37.29057   40.22782   45.55215   50.21882   54.30907   61.03631

94

  29.10387   32.85116   36.33951   39.58681   42.60972   48.04332   52.75194   56.83230   63.43238

95

  31.05691   34.96583   38.58246   41.92866   45.02465   50.53944   55.26035   59.30164   65.72267

96

  32.82311   36.86689   40.58694   44.00916   47.15740   52.71794   57.42377   61.40628   67.62896

97

  34.68391   38.85783   42.67365   46.16208   49.35122   54.93214   59.59649   63.49481   69.47593

98

  36.64397   40.94127   44.84305   48.38571   51.60231   57.17457   61.76829   65.55531   71.25104

99

  38.70595   43.11736   47.09271   50.67509   53.90336   59.43409   63.92544   67.57274   72.93985

TABLE OF GUARANTEED COST OF INSURANCE RATES (non preferred underwriting classes)

Monthly Rates per Thousand -

 

Attained

Age

 

Male
Nicotine

B

 

Male Nicotine

C

 

Male Nicotine

D

 

Male Nicotine

E

 

Male Nicotine

F

 

Male Nicotine

H

 

Male Nicotine

J

 

Male Nicotine

L

 

Male Nicotine

P

0 - 17

  Na   Na   Na   Na   Na   Na   Na   Na   Na

18

  0.13871   0.16181   0.18490   0.20798   0.23106   0.27719   0.32330   0.36938   0.46147

19

  0.15120   0.17638   0.20154   0.22670   0.25185   0.30213   0.35238   0.40260   0.50295

20

  0.15870   0.18512   0.21153   0.23794   0.26433   0.31710   0.36983   0.42253   0.52782

21

  0.16619   0.19386   0.22152   0.24917   0.27681   0.33206   0.38727   0.44245   0.55269

22

  0.17494   0.20406   0.23317   0.26227   0.29136   0.34951   0.40762   0.46569   0.58170

23

  0.18243   0.21280   0.24316   0.27350   0.30383   0.36447   0.42506   0.48560   0.60656

24

  0.19243   0.22445   0.25647   0.28847   0.32046   0.38441   0.44830   0.51215   0.63969

25

  0.20367   0.23756   0.27145   0.30531   0.33917   0.40684   0.47445   0.54201   0.67696

26

  0.21366   0.24922   0.28476   0.32028   0.35579   0.42677   0.49768   0.56854   0.71007

27

  0.22615   0.26378   0.30139   0.33899   0.37657   0.45168   0.52672   0.60170   0.75144

28

  0.22740   0.26524   0.30306   0.34086   0.37865   0.45417   0.52963   0.60501   0.75558

29

  0.22615   0.26378   0.30139   0.33899   0.37657   0.45168   0.52672   0.60170   0.75144

30

  0.22490   0.26232   0.29973   0.33712   0.37449   0.44919   0.52382   0.59838   0.74730

31

  0.22490   0.26232   0.29973   0.33712   0.37449   0.44919   0.52382   0.59838   0.74730

32

  0.22740   0.26524   0.30306   0.34086   0.37865   0.45417   0.52963   0.60501   0.75558

33

  0.23364   0.27252   0.31138   0.35022   0.38904   0.46663   0.54414   0.62159   0.77626

34

  0.24238   0.28271   0.32302   0.36331   0.40358   0.48406   0.56446   0.64479   0.80520

35

  0.24987   0.29145   0.33300   0.37453   0.41604   0.49900   0.58188   0.66467   0.83001

36

  0.26361   0.30746   0.35130   0.39510   0.43889   0.52639   0.61380   0.70111   0.87546

37

  0.27859   0.32494   0.37125   0.41754   0.46381   0.55626   0.64861   0.74085   0.92503

38

  0.29982   0.34968   0.39952   0.44933   0.49910   0.59856   0.69790   0.79712   0.99521

39

  0.32104   0.37443   0.42778   0.48110   0.53439   0.64085   0.74718   0.85337   1.06534

40

  0.34601   0.40354   0.46103   0.51848   0.57588   0.69058   0.80512   0.91950   1.14779

41

  0.37846   0.44137   0.50423   0.56705   0.62982   0.75521   0.88041   1.00542   1.25487

42

  0.41590   0.48502   0.55408   0.62308   0.69202   0.82973   0.96721   1.10447   1.37829

43

  0.46082   0.53738   0.61387   0.69028   0.76662   0.91910   1.07129   1.22321   1.52620

44

  0.51447   0.59990   0.68525   0.77051   0.85568   1.02576   1.19549   1.36487   1.70258

45

  0.57060   0.66532   0.75993   0.85443   0.94882   1.13729   1.32532   1.51292   1.88684

46

  0.62297   0.72635   0.82959   0.93271   1.03570   1.24129   1.44636   1.65092   2.05852

47

  0.68157   0.79462   0.90752   1.02026   1.13285   1.35756   1.58166   1.80515   2.25029

48

  0.71398   0.83238   0.95061   1.06867   1.18656   1.42184   1.65644   1.89037   2.35622

49

  0.75137   0.87593   1.00031   1.12451   1.24851   1.49596   1.74266   1.98862   2.47831

50

  0.80495   0.93835   1.07153   1.20450   1.33726   1.60212   1.86613   2.12929   2.65305

51

  0.86848   1.01235   1.15596   1.29933   1.44244   1.72792   2.01240   2.29589   2.85991

52

  0.95566   1.11387   1.27178   1.42938   1.58668   1.90037   2.21286   2.52415   3.14314

53

  1.05402   1.22838   1.40238   1.57601   1.74928   2.09470   2.43866   2.78117   3.46183

54

  1.17721   1.37179   1.56591   1.75957   1.95276   2.33779   2.72100   3.10239   3.85977

55

  1.31651   1.53390   1.75071   1.96694   2.18261   2.61222   3.03956   3.46463   4.30805

56

  1.45821   1.69876   1.93859   2.17772   2.41615   2.89091   3.36288   3.83209   4.76225

57

  1.60853   1.87358   2.13778   2.40111   2.66360   3.18601   3.70504   4.22071   5.24206

58

  1.72648   2.01073   2.29399   2.57626   2.85755   3.41720   3.97295   4.52483   5.61712

59

  1.86299   2.16941   2.47468   2.77881   3.08179   3.68433   4.28235   4.87588   6.04960

60

  2.02793   2.36109   2.69289   3.02332   3.35240   4.00652   4.65529   5.29875   6.56994

61

  2.23241   2.59862   2.96318   3.32609   3.68736   4.40502   5.11621   5.82099   7.21157

62

  2.47880   2.88470   3.28857   3.69041   4.09023   4.88386   5.66954   6.44736   7.97969

63

  2.75212   3.20189   3.64915   4.09391   4.53619   5.41336   6.28076   7.13851   8.82546

64

  3.03132   3.52571   4.01705   4.50537   4.99069   5.95237   6.90225   7.84047   9.68249

65

  3.30649   3.84467   4.37924   4.91021   5.43760   6.48178   7.51197   8.52834   10.52040

66

  3.57149   4.15168   4.72764   5.29942   5.86704   6.98991   8.09652   9.18708   11.32101

67

  3.82882   4.44962   5.06559   5.67674   6.28312   7.48171   8.66166   9.82325   12.09251

68

  4.09938   4.76273   5.42053   6.07282   6.71965   7.99711   9.25326   10.48848   12.89746

69

  4.36719   5.07247   5.77145   6.46419   7.15075   8.50551   9.83618   11.14319   13.68789

70

  4.69110   5.44686   6.19536   6.93667   7.67085   9.11812   10.53770   11.93013   14.63560

71

  5.04517   5.85582   6.65808   7.45203   8.23776   9.78490   11.30016   12.78420   15.66120

72

  5.52581   6.41048   7.28508   8.14975   9.00458   10.68520   12.32782   13.93330   17.03618

73

  6.00790   6.96623   7.91268   8.84741   9.77055   11.58265   13.35012   15.07404   18.39554

74

  6.49385   7.52585   8.54400   9.54847   10.53945   12.48166   14.37205   16.21200   19.74594

75

  7.05768   8.17443   9.27482   10.35911   11.42751   13.51763   15.54700   17.51737   21.28797

76

  7.65645   8.86231   10.04895   11.21669   12.36582   14.60944   16.78213   18.88613   22.89668

77

  8.34658   9.65403   10.93868   12.20093   13.44118   15.85717   18.18965   20.44150   24.71437

78

  9.14165   10.56463   11.96032   13.32923   14.67190   17.28046   19.78992   22.20404   26.76062

79

  10.04290   11.59487   13.11398   14.60092   16.05638   18.87548   21.57645   24.16425   29.01907

80

  11.00129   12.68812   14.33562   15.94469   17.51624   20.55024   23.44438   26.20511   31.35065

81

  12.06940   13.90369   15.69076   17.43183   19.12809   22.39076   25.48762   28.42712   33.86558

82

  13.14164   15.12090   17.04435   18.91356   20.73007   24.21085   27.49811   30.60259   36.30331

83

  14.26013   16.38731   18.44899   20.44718   22.38383   26.08004   29.55210   32.81360   38.75522

84

  15.46951   17.75281   19.95928   22.09151   24.15201   28.06736   31.72367   35.13809   41.30419

85

  16.88283   19.34342   21.71290   23.99464   26.19188   30.34531   34.19683   37.76840   44.15159

86

  18.41852   21.06537   23.60429   26.03970   28.37580   32.76613   36.80574   40.52263   47.08937

87

  20.05625   22.89427   25.60501   28.19416   30.66719   35.28547   39.49877   43.34262   50.04866

88

  21.76250   24.79130   27.67112   30.40927   33.01272   37.84172   42.20730   46.15395   52.94736

89

  23.51133   26.72661   29.76908   32.64803   35.37224   40.38927   44.88148   48.90379   55.73013

90

  25.27764   28.67171   31.86736   34.87619   37.70911   42.88777   47.47862   51.54838   58.35449

91

  26.85502   30.40045   33.72331   36.83758   39.75636   45.05573   49.71065   53.79948   60.54590

92

  28.44938   32.13964   35.58177   38.79247   41.78728   47.18636   51.88380   55.97080   62.62044

93

  30.08122   33.91101   37.46537   40.76410   43.82559   49.30389   54.02254   58.08689   64.60300

94

  31.75623   35.71985   39.37887   42.75670   45.87495   51.41096   56.12881   60.14939   66.49576

95

  33.58917   37.68803   41.44916   44.90037   48.06721   53.63955   58.33141   62.28192   68.40894

96

  35.18867   39.39573   43.23516   46.73909   49.93683   55.51843   60.16718   64.03897   69.94941

97

  36.85609   41.16588   45.07604   48.62361   51.84221   57.41172   61.99621   65.76988   71.43304

98

  38.59526   43.00097   46.97281   50.55351   53.78160   59.31539   63.81293   67.46828   72.85367

99

  40.40841   44.90148   48.92425   52.52594   55.75063   61.22274   65.60924   69.12551   74.20367

TABLE OF GUARANTEED COST OF INSURANCE RATES (non preferred underwriting classes)

Monthly Rates per Thousand

 

Attained

Age

 

Female Non
Nicotine

B

 

Female Non
Nicotine

C

 

Female Non
Nicotine

D

 

Female Non
Nicotine

E

 

Female Non
Nicotine

F

 

Female Non
Nicotine

H

 

Female Non
Nicotine

J

 

Female Non
Nicotine

L

 

Female Non
Nicotine

P

0

  0.05999   0.06999   0.07998   0.08997   0.09996   0.11994   0.13992   0.15988   0.19981

1

  0.04375   0.05103   0.05832   0.06561   0.07290   0.08747   0.10204   0.11661   0.14573

2

  0.03250   0.03791   0.04333   0.04874   0.05416   0.06498   0.07581   0.08663   0.10828

3

  0.02500   0.02916   0.03333   0.03750   0.04166   0.04999   0.05832   0.06665   0.08330

4

  0.02375   0.02771   0.03166   0.03562   0.03958   0.04749   0.05540   0.06332   0.07914

5

  0.02250   0.02625   0.03000   0.03375   0.03749   0.04499   0.05249   0.05998   0.07497

6

  0.02250   0.02625   0.03000   0.03375   0.03749   0.04499   0.05249   0.05998   0.07497

7

  0.02625   0.03062   0.03500   0.03937   0.04374   0.05249   0.06123   0.06998   0.08746

8

  0.02625   0.03062   0.03500   0.03937   0.04374   0.05249   0.06123   0.06998   0.08746

9

  0.02625   0.03062   0.03500   0.03937   0.04374   0.05249   0.06123   0.06998   0.08746

10

  0.02750   0.03208   0.03666   0.04124   0.04583   0.05499   0.06415   0.07331   0.09163

11

  0.02875   0.03354   0.03833   0.04312   0.04791   0.05749   0.06706   0.07664   0.09579

12

  0.03375   0.03937   0.04499   0.05062   0.05624   0.06748   0.07872   0.08996   0.11244

13

  0.03750   0.04375   0.04999   0.05624   0.06249   0.07498   0.08747   0.09996   0.12493

14

  0.04125   0.04812   0.05499   0.06186   0.06873   0.08247   0.09621   0.10995   0.13741

15

  0.04375   0.05103   0.05832   0.06561   0.07290   0.08747   0.10204   0.11661   0.14573

16

  0.04875   0.05687   0.06499   0.07311   0.08123   0.09746   0.11369   0.12992   0.16237

17

  0.05124   0.05978   0.06832   0.07686   0.08539   0.10246   0.11952   0.13658   0.17069

18

  0.05249   0.06124   0.06999   0.07873   0.08747   0.10496   0.12244   0.13991   0.17485

19

  0.05624   0.06561   0.07498   0.08435   0.09372   0.11245   0.13118   0.14990   0.18733

20

  0.05624   0.06561   0.07498   0.08435   0.09372   0.11245   0.13118   0.14990   0.18733

21

  0.05749   0.06707   0.07665   0.08623   0.09580   0.11495   0.13409   0.15323   0.19149

22

  0.05999   0.06999   0.07998   0.08997   0.09996   0.11994   0.13992   0.15988   0.19981

23

  0.05999   0.06999   0.07998   0.08997   0.09996   0.11994   0.13992   0.15988   0.19981

24

  0.06249   0.07290   0.08331   0.09372   0.10413   0.12494   0.14574   0.16654   0.20813

25

  0.06249   0.07290   0.08331   0.09372   0.10413   0.12494   0.14574   0.16654   0.20813

26

  0.06624   0.07728   0.08831   0.09934   0.11037   0.13243   0.15448   0.17653   0.22060

27

  0.07124   0.08311   0.09497   0.10684   0.11870   0.14242   0.16613   0.18984   0.23723

28

  0.07249   0.08456   0.09664   0.10871   0.12078   0.14492   0.16904   0.19317   0.24139

29

  0.07749   0.09040   0.10330   0.11620   0.12911   0.15490   0.18069   0.20647   0.25801

30

  0.07999   0.09331   0.10663   0.11995   0.13327   0.15990   0.18652   0.21313   0.26633

31

  0.08499   0.09914   0.11329   0.12745   0.14159   0.16988   0.19816   0.22644   0.28295

32

  0.08998   0.10497   0.11996   0.13494   0.14992   0.17987   0.20981   0.23974   0.29957

33

  0.09498   0.11080   0.12662   0.14243   0.15824   0.18986   0.22146   0.25304   0.31619

34

  0.10248   0.11955   0.13661   0.15367   0.17073   0.20483   0.23892   0.27300   0.34111

35

  0.11123   0.12975   0.14827   0.16678   0.18529   0.22230   0.25929   0.29627   0.37017

36

  0.11872   0.13849   0.15826   0.17802   0.19778   0.23727   0.27675   0.31622   0.39508

37

  0.12872   0.15015   0.17158   0.19300   0.21442   0.25723   0.30003   0.34280   0.42828

38

  0.13371   0.15598   0.17824   0.20049   0.22274   0.26721   0.31167   0.35609   0.44488

39

  0.14121   0.16472   0.18823   0.21173   0.23522   0.28218   0.32912   0.37603   0.46977

40

  0.14995   0.17492   0.19988   0.22483   0.24978   0.29964   0.34948   0.39928   0.49880

41

  0.15870   0.18512   0.21153   0.23794   0.26433   0.31710   0.36983   0.42253   0.52782

42

  0.16869   0.19678   0.22485   0.25291   0.28097   0.33704   0.39309   0.44909   0.56098

43

  0.18118   0.21134   0.24149   0.27163   0.30175   0.36197   0.42215   0.48228   0.60242

44

  0.19617   0.22882   0.26146   0.29409   0.32670   0.39188   0.45702   0.52210   0.65212

45

  0.21366   0.24922   0.28476   0.32028   0.35579   0.42677   0.49768   0.56854   0.71007

46

  0.23364   0.27252   0.31138   0.35022   0.38904   0.46663   0.54414   0.62159   0.77626

47

  0.25862   0.30164   0.34464   0.38762   0.43058   0.51643   0.60219   0.68786   0.85894

48

  0.28609   0.33367   0.38123   0.42876   0.47626   0.57119   0.66601   0.76072   0.94981

49

  0.31605   0.36861   0.42113   0.47363   0.52608   0.63090   0.73559   0.84014   1.04885

50

  0.35100   0.40936   0.46768   0.52595   0.58418   0.70053   0.81671   0.93273   1.16427

51

  0.38970   0.45447   0.51919   0.58386   0.64848   0.77757   0.90646   1.03514   1.29191

52

  0.43337   0.50538   0.57733   0.64921   0.72104   0.86449   1.00770   1.15066   1.43583

53

  0.48079   0.56065   0.64043   0.72014   0.79977   0.95880   1.11752   1.27594   1.59186

54

  0.53069   0.61880   0.70683   0.79476   0.88260   1.05799   1.23301   1.40766   1.75585

55

  0.58432   0.68130   0.77817   0.87493   0.97158   1.16453   1.35703   1.54908   1.93183

56

  0.64666   0.75395   0.86110   0.96811   1.07498   1.28830   1.50108   1.71330   2.13609

57

  0.71148   0.82947   0.94729   1.06494   1.18243   1.41689   1.65069   1.88382   2.34808

58

  0.78127   0.91077   1.04007   1.16916   1.29805   1.55522   1.81159   2.06715   2.57588

59

  0.85104   0.99204   1.13279   1.27330   1.41357   1.69340   1.97227   2.25018   2.80317

60

  0.92329   1.07617   1.22877   1.38109   1.53312   1.83634   2.13844   2.43942   3.03804

61

  1.00173   1.16751   1.33296   1.49807   1.66286   1.99142   2.31867   2.64460   3.29253

62

  1.08762   1.26751   1.44700   1.62610   1.80480   2.16105   2.51573   2.86887   3.57052

63

  1.17597   1.37034   1.56426   1.75771   1.95071   2.33534   2.71815   3.09915   3.85576

64

  1.27174   1.48181   1.69133   1.90032   2.10877   2.52408   2.93726   3.34833   4.16418

65

  1.37743   1.60477   1.83149   2.05758   2.28304   2.73209   3.17865   3.62273   4.50353

66

  1.49425   1.74067   1.98635   2.23129   2.47550   2.96170   3.44498   3.92536   4.87746

67

  1.62219   1.88947   2.15587   2.42141   2.68607   3.21280   3.73610   4.25597   5.28556

68

  1.76496   2.05546   2.34493   2.63337   2.92078   3.49254   4.06023   4.62388   5.73920

69

  1.92129   2.23717   2.55183   2.86526   3.17748   3.79828   4.41428   5.02551   6.23380

70

  2.09363   2.43742   2.77976   3.12064   3.46009   4.13467   4.80355   5.46679   6.77651

71

  2.29186   2.66767   3.04173   3.41405   3.78465   4.52070   5.24993   5.97243   7.39741

72

  2.51344   2.92492   3.33430   3.74159   4.14681   4.95108   5.74717   6.53518   8.08727

73

  2.75336   3.20333   3.65078   4.09574   4.53821   5.41575   6.28352   7.14162   8.82927

74

  3.01650   3.50853   3.99754   4.48356   4.96659   5.92381   6.86934   7.80332   9.63719

75

  3.30772   3.84610   4.38086   4.91202   5.43960   6.48415   7.51469   8.53142   10.52414

76

  3.62692   4.21587   4.80047   5.38075   5.95674   7.09598   8.21846   9.32440   11.48768

77

  3.97767   4.62190   5.26091   5.89472   6.52340   7.76547   8.98746   10.18969   12.53613

78

  4.36473   5.06963   5.76824   6.46061   7.14680   8.50086   9.83085   11.13720   13.68067

79

  4.78181   5.55167   6.31398   7.06882   7.81626   9.28923   10.73348   12.14956   14.89939

80

  5.24709   6.08890   6.92164   7.74540   8.56029   10.16379   11.73291   13.26837   16.24123

81

  5.87740   6.81585   7.74293   8.65878   9.56353   11.34028   13.07424   14.76643   18.02953

82

  6.58630   7.63225   8.66395   9.68159   10.68535   12.65204   14.56548   16.42713   20.00059

83

  7.29059   8.44210   9.57618   10.69309   11.79308   13.94334   16.02898   18.05192   21.91724

84

  8.06643   9.33278   10.57783   11.80194   13.00544   15.35205   17.62036   19.81298   23.98119

85

  8.93713   10.33054   11.69786   13.03957   14.35615   16.91579   19.38045   21.75364   26.23911

86

  9.72410   11.23069   12.70644   14.15198   15.56794   18.31351   20.94783   23.47543   28.22755

87

  10.90349   12.57667   14.21120   15.80797   17.36786   20.38035   23.25528   25.99891   31.11600

88

  12.12872   13.97110   15.76582   17.51409   19.21714   22.49216   25.59990   28.54890   34.00269

89

  13.42713   15.44447   17.40359   19.30618   21.15386   24.69081   28.02656   31.17257   36.93790

90

  14.61677   16.79041   18.89530   20.93360   22.90743   26.66975   30.19781   33.50621   39.51785

91

  15.21605   17.46696   19.64349   21.74810   23.78316   27.65376   31.27279   34.65658   40.77866

92

  16.38959   18.78894   21.10229   23.33273   25.48323   29.55576   33.34159   36.86090   43.17372

93

  18.11810   20.72904   23.23545   25.64151   27.95125   32.29701   36.30176   39.99227   46.52723

94

  20.27850   23.14186   25.87519   28.48440   30.97512   35.62239   39.85717   43.71607   50.43675

95

  22.91154   26.06391   29.05182   31.88384   34.56811   39.52381   43.97590   47.97554   54.79677

96

  25.37734   28.78122   31.98517   35.00096   37.83962   43.02657   47.62213   51.69373   58.49720

97

  27.87961   31.51906   34.91966   38.09707   41.06595   46.43195   51.11671   55.20673   61.89495

98

  28.30467   31.98213   35.41383   38.61619   41.60455   46.99549   51.68998   55.77799   62.43784

99

  29.71905   33.51864   37.04896   40.32909   43.37676   48.83944   53.55529   57.62642   64.17500

TABLE OF GUARANTEED COST OF INSURANCE RATES (non preferred underwriting classes)

Monthly Rates per Thousand

 

Attained

Age

 

Female
Nicotine

B

 

Female
Nicotine

C

 

Female
Nicotine

D

 

Female
Nicotine

E

 

Female
Nicotine

F

 

Female
Nicotine

H

 

Female
Nicotine

J

 

Female
Nicotine

L

 

Female
Nicotine

P

0 - 17

  Na   Na   Na   Na   Na   Na   Na   Na   Na

18

  0.06249   0.07290   0.08331   0.09372   0.10413   0.12494   0.14574   0.16654   0.20813

19

  0.06749   0.07873   0.08998   0.10122   0.11245   0.13493   0.15739   0.17985   0.22476

20

  0.07249   0.08456   0.09664   0.10871   0.12078   0.14492   0.16904   0.19317   0.24139

21

  0.07624   0.08894   0.10164   0.11433   0.12703   0.15241   0.17778   0.20315   0.25386

22

  0.08124   0.09477   0.10830   0.12183   0.13535   0.16239   0.18943   0.21646   0.27048

23

  0.08374   0.09768   0.11163   0.12557   0.13951   0.16739   0.19525   0.22311   0.27879

24

  0.08998   0.10497   0.11996   0.13494   0.14992   0.17987   0.20981   0.23974   0.29957

25

  0.09623   0.11226   0.12828   0.14431   0.16032   0.19235   0.22437   0.25637   0.32034

26

  0.10123   0.11809   0.13495   0.15180   0.16865   0.20234   0.23601   0.26967   0.33695

27

  0.10873   0.12683   0.14494   0.16304   0.18113   0.21731   0.25347   0.28962   0.36187

28

  0.11497   0.13412   0.15326   0.17240   0.19153   0.22979   0.26802   0.30624   0.38263

29

  0.12372   0.14432   0.16492   0.18551   0.20610   0.24726   0.28839   0.32951   0.41168

30

  0.12872   0.15015   0.17158   0.19300   0.21442   0.25723   0.30003   0.34280   0.42828

31

  0.13996   0.16326   0.18656   0.20985   0.23314   0.27969   0.32621   0.37271   0.46562

32

  0.14871   0.17346   0.19822   0.22296   0.24770   0.29715   0.34657   0.39596   0.49465

33

  0.15995   0.18658   0.21320   0.23981   0.26641   0.31959   0.37274   0.42585   0.53197

34

  0.17369   0.20260   0.23151   0.26040   0.28928   0.34702   0.40471   0.46237   0.57756

35

  0.19118   0.22300   0.25480   0.28660   0.31838   0.38192   0.44540   0.50883   0.63555

36

  0.20616   0.24048   0.27477   0.30906   0.34332   0.41182   0.48026   0.54864   0.68523

37

  0.22365   0.26087   0.29807   0.33525   0.37242   0.44670   0.52092   0.59507   0.74317

38

  0.23489   0.27397   0.31304   0.35209   0.39111   0.46912   0.54705   0.62490   0.78039

39

  0.24987   0.29145   0.33300   0.37453   0.41604   0.49900   0.58188   0.66467   0.83001

40

  0.26486   0.30892   0.35296   0.39697   0.44096   0.52888   0.61670   0.70442   0.87960

41

  0.28234   0.32930   0.37624   0.42315   0.47004   0.56372   0.65731   0.75078   0.93742

42

  0.30357   0.35405   0.40451   0.45493   0.50533   0.60602   0.70660   0.80705   1.00759

43

  0.32853   0.38316   0.43776   0.49231   0.54684   0.65577   0.76456   0.87321   1.09008

44

  0.35724   0.41664   0.47599   0.53529   0.59456   0.71296   0.83119   0.94925   1.18487

45

  0.39094   0.45592   0.52085   0.58573   0.65055   0.78005   0.90935   1.03845   1.29603

46

  0.42838   0.49956   0.57069   0.64175   0.71275   0.85456   0.99613   1.13746   1.41940

47

  0.47580   0.55483   0.63379   0.71267   0.79148   0.94888   1.10597   1.26276   1.57545

48

  0.53443   0.62316   0.71181   0.80035   0.88881   1.06543   1.24167   1.41753   1.76813

49

  0.60053   0.70019   0.79974   0.89916   0.99847   1.19673   1.39450   1.59180   1.98498

50

  0.67284   0.78445   0.89591   1.00722   1.11838   1.34025   1.56152   1.78219   2.22175

51

  0.75137   0.87593   1.00031   1.12451   1.24851   1.49596   1.74266   1.98862   2.47831

52

  0.83734   0.97608   1.11458   1.25285   1.39089   1.66627   1.94072   2.21426   2.75856

53

  0.92827   1.08197   1.23539   1.38852   1.54136   1.84620   2.14989   2.45246   3.05421

54

  1.02788   1.19795   1.36768   1.53705   1.70607   2.04307   2.37868   2.71290   3.37722

55

  1.13242   1.31965   1.50646   1.69285   1.87880   2.24945   2.61841   2.98569   3.71525

56

  1.24438   1.44997   1.65503   1.85959   2.06363   2.47018   2.87470   3.27720   4.07616

57

  1.36375   1.58887   1.81336   2.03724   2.26050   2.70519   3.14744   3.58726   4.45968

58

  1.47934   1.72333   1.96659   2.20913   2.45095   2.93242   3.41102   3.88677   4.82980

59

  1.60729   1.87214   2.13613   2.39927   2.66155   3.18358   3.70222   4.21751   5.23810

60

  1.74014   2.02661   2.31207   2.59653   2.87999   3.44394   4.00393   4.55999   5.66046

61

  1.87788   2.18671   2.49438   2.80088   3.10622   3.71343   4.31605   4.91410   6.09666

62

  2.03289   2.36685   2.69944   3.03067   3.36053   4.01620   4.66649   5.31144   6.58554

63

  2.18781   2.54682   2.90425   3.26009   3.61435   4.31819   5.01581   5.70727   7.07194

64

  2.35130   2.73668   3.12023   3.50196   3.88186   4.63626   5.38349   6.12363   7.58290

65

  2.52953   2.94359   3.35552   3.76535   4.17308   4.98227   5.78320   6.57593   8.13718

66

  2.71875   3.16317   3.60514   4.04468   4.48179   5.34880   6.20627   7.05432   8.72254

67

  2.93129   3.40972   3.88529   4.35804   4.82797   5.75947   6.67992   7.58944   9.37624

68

  3.16462   3.68025   4.19256   4.70158   5.20732   6.20907   7.19797   8.17420   10.08925

69

  3.41746   3.97325   4.52517   5.07326   5.61754   6.69476   7.75706   8.80462   10.85640

70

  3.69957   4.30000   4.89590   5.48730   6.07425   7.23490   8.37812   9.50416   11.70574

71

  4.02070   4.67170   5.31736   5.95771   6.59281   7.84742   9.08151   10.29542   12.66404

72

  4.37456   5.08099   5.78110   6.47495   7.16259   8.51947   9.85218   11.16115   13.70955

73

  4.75485   5.52051   6.27872   7.02954   7.77305   9.23839   10.67532   12.08438   14.82105

74

  5.17124   6.00136   6.82266   7.63524   8.43919   10.02157   11.57052   13.08674   16.02375

75

  5.58933   6.48374   7.36785   8.24180   9.10569   10.80377   12.46301   14.08428   17.21642

76

  6.04447   7.00837   7.96024   8.90025   9.82853   11.65051   13.42733   15.16010   18.49786

77

  6.53278   7.57066   8.59451   9.60453   10.60090   12.55343   14.45354   16.30264   19.85326

78

  7.05768   8.17443   9.27482   10.35911   11.42751   13.51763   15.54700   17.51737   21.28797

79

  7.62376   8.82478   10.00675   11.16996   12.31473   14.55006   16.71504   18.81187   22.80962

80

  8.23190   9.52256   10.79103   12.03770   13.26295   15.65064   17.95696   20.18470   24.41503

81

  9.08512   10.49994   11.88780   13.24922   14.58469   17.17977   19.67690   22.07977   26.61682

82

  10.00817   11.55521   13.06961   14.55206   16.00323   18.81437   21.50814   24.08944   28.93322

83

  10.90349   12.57667   14.21120   15.80797   17.36786   20.38035   23.25528   25.99891   31.11600

84

  11.86167   13.66751   15.42773   17.14347   18.81586   22.03494   25.09341   27.99927   33.38328

85

  12.82267   14.75912   16.64239   18.47395   20.25520   23.67229   26.90426   29.96116   35.58712

86

  13.62038   15.66337   17.64649   19.57149   21.44008   25.01458   28.38265   31.55620   37.36404

87

  14.87917   17.08677   19.22317   21.29068   23.29150   27.10167   30.67005   34.01198   40.07308

88

  16.12797   18.49456   20.77781   22.98066   25.10593   29.13460   32.88453   36.37501   42.64817

89

  17.37602   19.89715   22.32192   24.65401   26.89695   31.12892   35.04355   38.66463   45.11255

90

  18.37941   21.02160   23.55631   25.98791   28.32060   32.70518   36.74030   40.45382   47.01653

91

  18.59671   21.26473   23.82280   26.27544   28.62700   33.04336   37.10320   40.83529   47.41994

92

  19.48177   22.25362   24.90514   27.44156   29.86787   34.40907   38.56456   42.36709   49.03066

93

  20.89940   23.83278   26.62833   29.29254   31.83158   36.55738   40.84954   44.74785   51.50417

94

  22.69243   25.82155   28.78920   31.60373   34.27302   39.20550   43.64207   47.63259   54.45036

95

  25.37070   28.77392   31.97732   34.99265   37.83092   43.01733   47.61258   51.68406   58.48770

96

  27.78355   31.41433   34.80780   37.97948   40.94385   46.30399   50.98634   55.07661   61.77091

97

  30.17272   34.01006   37.57041   40.87376   43.93866   49.42072   54.13991   58.20239   64.71005

98

  30.28674   34.13346   37.70123   41.01029   44.07938   49.56604   54.28580   58.34587   64.84286

99

  31.43952   35.37858   39.01863   42.38239   45.49081   51.01773   55.73743   59.76782   66.14866

 

13


POLICY VALUE

The variable account policy value will vary from business day to business day reflecting changes in the current number of accumulation units and the current accumulation unit value.

Accumulation Units. When transactions are made that affect the variable policy value, dollar amounts are converted to accumulation units. The number of accumulation units for a transaction is:

 

  1. the dollar amount of the transaction; divided by

 

  2. the current accumulation unit value.

The number of accumulation units for a subaccount increases when:

 

  1. net premiums are credited to that subaccount; or

 

  2. transfers from the fixed account or other subaccounts are credited to that subaccount.

The number of accumulation units for a subaccount decreases when:

 

  1. the owner takes out a policy loan from that subaccount;

 

  2. the owner makes a full or partial surrender from that subaccount;

 

  3. we take a pro rata portion of the monthly deduction from that subaccount; or

 

  4. transfers are made from that subaccount to the fixed account or other subaccounts.

Accumulation Unit Value. The accumulation unit value for each subaccount was arbitrarily set initially at $10.00 when the subaccounts first purchased fund shares. The accumulation unit value for each subsequent valuation period is calculated by multiplying A. by B.:

 

  1. where A. is the accumulation unit value for each subaccount for the immediately preceding valuation period; and

 

  2. where B. is the net investment factor for the subaccount during the subsequent valuation period.

The accumulation unit value for a valuation period applies for each day in the valuation period. We will value the net assets in each subaccount at their fair market value according to accepted marketing practices and applicable laws and regulations.

Net Investment Factor. The net investment factor is used to measure the investment performance of a subaccount from one valuation period to the next. The net investment factor for a subaccount for any valuation period is equal to A. divided by B. minus C.:

 

  1. where A. is the net asset value per share held in the subaccount as of the end of the current valuation period; plus or minus the per share amount of any dividend or capital gain distributions if the ex-dividend date occurs in the valuation period; plus or minus a per share charge or credit, as determined by us, as of the end of the current valuation period, for taxes; and

 

  2. where B. is the net asset value per share held in the subaccount as of the end of the prior valuation period; and

 

  3. where C. is the daily mortality and expense risk charge shown on the schedule times the number of days in the current valuation period. The mortality and expense risk charge may increase or decrease. The maximum charge corresponds to a charge of .90% per year of the average daily net assets in the subaccounts for the mortality and expense risk.

The net investment factor may be greater than or less than one.

The variable account policy value of this policy is equal to the sum of the policy value in each subaccount. The policy value in a subaccount is equal to:

 

  1. the current number of accumulation units; multiplied by

 

  2. the current accumulation unit value.

For the first 40 days after the issue date, net premiums are allocated as follows:

 

  1. all premium allocated to the variable subaccounts will be directed to the money market account; and

 

  2. all premium allocated to the fixed account will be directed to that account.

On the 41st day after the issue date, the policy value of the money market account is credited to the subaccounts of the variable account based on the allocations specified by the owner. The policy value of the fixed account will remain in the fixed account.

 

14


On or after the 41st day after the issue date, net premiums will be allocated among the subaccounts of the variable account and the fixed account according to the allocations shown on the application or the most recent instructions received from the owner.

The fixed account policy value is:

 

  1. the fixed account value on the preceding monthly deduction day plus any interest from the preceding monthly deduction day to the date of calculation; plus

 

  2. the total of net premiums credited to the fixed account since the preceding monthly deduction day, plus interest from the date net premiums are credited to the date of calculation; plus

 

  3. the total of the transfers from the variable account to the fixed account since the preceding monthly deduction day, plus interest from the date of transfer to the date of calculation; plus

 

  4. the total amount transferred from the variable account to the fixed account to secure policy loans since the preceding monthly deduction day, plus interest at the credited policy loan interest rate shown on the schedule from the date of transfer to the date of calculation; minus

 

  5. the total of the transfers to the variable account from the fixed account since the preceding monthly deduction day, plus interest from the date of transfer to the date of the calculation; minus

 

  6. the total of full or partial surrenders from the fixed account since the preceding monthly deduction day, plus interest from the date of surrender to the date of calculation.

If the date of calculation is a monthly deduction day, we reduce the fixed account policy value by a pro rata portion of the monthly deduction for the policy month following the monthly deduction day.

Fixed Account Interest. Interest on the fixed account policy value is credited at not less than the guaranteed rate shown in the schedule. Interest in excess of the guaranteed rate may be credited on the amount of the fixed account policy value less any policy loan balance and will be guaranteed for one policy year. We will set the amount of any excess interest and the manner in which it is determined in our sole discretion.

POLICY LOANS

Policy Loans. We will make policy loans to the owner at any time while this policy is in force. The owner may take a preferred loan up to the amount his/her surrender value exceeds premium payments or he/she may take a non-preferred loan. The minimum amount for any loan is $250.00.

This policy and its values are automatically assigned to us as security for a policy loan. The maximum amount available for all outstanding policy loans is 90% of the surrender value.

Any proceeds (except partial surrender proceeds) or death benefit payable under this policy will be reduced by the policy loan balance. The policy loan balance reduces the amount available for any subsequent partial surrender or policy loan and causes the Grace Period provision to be applied if the policy loan balance becomes more than the surrender value.

We have the right to delay making a policy loan from the fixed account for up to six months from the date we receive the owner’s authorized request.

Policy Loan Interest. Interest at the rate shown on the schedule on all policy loans is payable by the owner in arrears. Interest is due on each policy anniversary date. Any interest not paid by the owner when due will be added to the policy loan balance and bear interest at the same rate.

Policy Loan Allocation. When the owner takes out a policy loan, an amount equal to the policy loan will be transferred to the fixed account as security for the policy loan and will earn interest at the credited interest rate on outstanding policy loan balances shown on the schedule. This transfer will not be counted as a transfer for the purpose of a transfer fee.

The owner may tell us how to allocate the policy loan from the subaccounts and the fixed account. If the owner does not tell us how to allocate the policy loan, we will allocate the policy loan from the subaccounts and the fixed account in the same proportion that the policy value of each of the subaccounts and the fixed account policy value reduced by any outstanding policy loans bears to the total policy value reduced by any outstanding policy loans on the date we process the request.

Policy Loan Repayment. All or any part of the policy loan may be repaid at any time during the primary insured’s lifetime or upon election of a settlement option. Policy loan amounts repaid will be allocated according to current premium allocations unless otherwise requested in writing by the owner. The portion of the policy value in the fixed account securing the repaid portion of the policy loan will be reduced by the amount of the policy loan repayment

 

15


The sum of any payments made in any policy year that exceeds the amount of the minimum premium for that policy year is first applied to reduce any policy loan balance. The premium charge is not applied against the policy loan repayment.

We have the right to limit the frequency and the minimum amount of the policy loan repayment.

SURRENDER

Full Surrender. The owner may request to surrender this policy to us for its surrender value as calculated at the end of the business day when we receive the request subject to the following:

 

  1. the primary insured must be alive and the policy must be in force;

 

  2. the request must be before the maturity date; and

 

  3. we must receive an authorized request.

The effective date of a surrender is the latest of:

 

  1. the business day the surrender request is received in our home office; or

 

  2. the business day the owner requests; or

 

  3. the business day we receive all necessary requirements we need to surrender this policy.

We will pay to the owner the surrender value as of the date this policy is surrendered unless the payment is from the fixed account. We may defer payment from the fixed account for the time allowed by law, but not more than six months. If we defer payment of the surrender value, we will pay interest as required by law. The surrender value will be paid in one lump sum unless other arrangements are made in writing or we defer payment of the fixed account. Once this policy is surrendered, it may not be reinstated.

Full Surrender Charge. If this policy terminates as stated under the Grace Period provision or the owner surrenders this policy during the first 14 policy years, (or during the first 14 policy years after an increase in specified amount), a full surrender charge will be subtracted from the policy value as determined by the Table of Surrender Charges shown on the schedule. A decrease in specified amount or change of death benefit option will not change the original or any additional full surrender charge.

Partial Surrender. A partial surrender may be made at any time this policy has surrender value. The owner may request a partial surrender by submitting an authorized request to our home office. The amount available for partial surrender will be 90% of the surrender value. The amount of any partial surrender must be at least $250. The owner may make four partial surrenders during any policy year.

A partial surrender reduces the policy value by its amount and by the amount of any partial surrender charges and processing fees. A partial surrender does not reduce the specified amount. Under death benefit option one however, if the primary insured dies within two years of any partial surrender, we will reduce the death benefit by the amounts of any partial surrenders including any partial surrender charges and processing fees.

Partial Surrender Charge. A charge is made against the policy value when a partial surrender is taken. The charge:

 

  1. is in proportion to the charge that would apply to a full surrender as found on the Table of Surrender Charges shown on the schedule. The proportion is computed as the amount of the policy value surrendered divided by the total amount of surrender value; and

 

  2. reduces future surrender charges in the same proportion.

The owner may tell us how to allocate the partial surrender from the subaccounts and the fixed account. If the owner does not tell us how to allocate the partial surrender, we will allocate the partial surrender among the subaccounts and the fixed account in the same proportion that the policy value of each of the subaccounts and the fixed account policy value reduced by any outstanding policy loans bears to the total policy value reduced by any outstanding policy loans on the business day on or following the date we receive the authorized request.

We have the right to limit any partial surrender if the partial surrender would fail to maintain this policy as life insurance as defined under federal tax law definitions.

Partial Surrender Processing Fee. The partial surrender processing fee shown on the schedule applies to each partial surrender.

 

16


DEATH BENEFITS PAYABLE

If this policy is in force, we will pay the death benefit to the beneficiary when we receive at our home office proof of death of the primary insured.

We will pay interest on the death benefit as required by the law of the state in which this policy is issued.

The amount payable upon the death of the primary insured is

 

  1. the death benefit as described under the Death Benefit provision; plus

 

  2. any additional insurance provided by rider; minus

 

  3. any unpaid monthly deductions; minus

 

  4. any outstanding policy loan balance; minus

 

  5. for Option 1 only, the amount of any partial surrender within two years of the primary insured’s death.

Before the primary insured’s death, the owner may choose a settlement option with payments to begin upon the death of the primary insured. Such request must be in writing and must be sent to our home office.

If the owner does not choose a settlement option, then the beneficiary may choose, after the primary insured’s death and subject to this policy’s conditions and provisions, to have all or any part of the death benefit paid:

 

  1. by means of a settlement option subject to amount minimums; or

 

  2. if the death benefit is $10,000 or more, by means of a retained asset account that is similar to a checking account except that it is not FDIC insured; or

 

  3. in a lump sum.

If the beneficiary does not choose a method of payment for all or any part of the death benefit within 60 days after we receive due proof of death, then:

 

  1. if the death benefit is $10,000 or more, the death benefit will be paid by means of a retained asset account; or

 

  2. if the death benefit is less than $10,000, payment will be made in a lump sum.

Unless otherwise provided in the application or unless the owner sends an authorized request before the primary insured’s death, if more than one primary or contingent beneficiary is named, any death benefit will be paid in equal shares to such primary or contingent beneficiaries. If no beneficiary is designated or surviving at the time of the primary insureds death, the death benefit will be paid to the owner, if living, otherwise to the owner’s estate. If any beneficiary or the owner is not eligible to receive the death benefit, we will pay the death benefit as if the ineligible beneficiary or the ineligible owner died before the primary insured. If no beneficiary is eligible and the owner is not eligible, we will pay the death benefit to the primary insured’s estate.

If any beneficiary dies simultaneously or during the 14 days immediately following the date of death of the primary insured, the death benefit will be paid as if the deceased beneficiary died before the primary insured. If we cannot determine whether a beneficiary or the primary insured died first, we will assume that the beneficiary died first.

Any reference in this policy to a beneficiary living or surviving means living on the 15th day immediately following the date of death of the primary insured.

We have the right to rely solely on any affidavit or other evidence which in our judgment is adequate to determine:

 

  1. the existence of;

 

  2. the identity of;

 

  3. the ages of; or

 

  4. any other facts that relate to those who are the beneficiaries of this policy.

 

17


This right applies whether or not the beneficiary designation was made on a class basis. Any death benefit paid while relying on this evidence will be a valid discharge of our obligations under this policy.

Claim forms may be obtained from our home office and settlement of any amount payable under this policy is made at our home office.

Any death benefit is payable to the primary beneficiary if the primary beneficiary survives the primary insured.

Any death benefit is payable to the contingent beneficiary only if:

 

  1. the contingent beneficiary survives the primary insured; and

 

  2. at the time of the primary insured’s death there is no living primary beneficiary.

DEATH BENEFIT OPTIONS

This policy provides two death benefit options: Option 1 and Option 2. The amount available under each death benefit option is calculated as of the date of the primary insured’s death.

The death benefit under Option 1 is the greater of:

 

  1. the specified amount; or

 

  2. the policy value multiplied by the applicable percentage as determined from the Table of Policy Value Percentages.

The death benefit under Option 2 is the greater of:

 

  1. the specified amount plus the policy value; or

 

  2. the policy value multiplied by the applicable percentage as determined from the Table of Policy Value Percentages.

Change in Death Benefit Option.

A death benefit option change takes effect on the monthly deduction day on or next following the later of:

 

  1. the date we receive the authorized request at our home office; or

 

  2. the date we approve the request.

A change from death benefit option one to death benefit option two will reduce the specified amount by the amount of the policy value at the time of the change. Evidence of insurability satisfactory to us is required. The minimum and target premiums may change.

A change from death benefit option two to death benefit option one will increase the specified amount by the amount of the policy value at the time of such change. The minimum and target premiums may change.

 

18


Limitations. The death benefit option cannot be changed:

 

  1. more than once during any subsequent policy year; or

 

  2. if the change would fail to maintain this policy as life insurance as defined under federal tax law definitions.

Death Benefit Requirement. For this policy to qualify as life insurance under federal tax laws, it must maintain a certain death benefit in relation to its policy value. Tests are conducted to maintain this qualification as life insurance. The minimum death benefit will be at least the percentage of the policy value on the date of the primary insured’s death as determined from the Table of Policy Value Percentages, minus any policy loan balance. Under death benefit option one, if the primary insured dies within two years of any partial surrender, the minimum death benefit will also reflect a deduction for the amount of the partial surrender, including any partial surrender charges and processing fees.

TABLE OF POLICY VALUE PERCENTAGES

The primary insured’s attained age at the start of the policy year in which his/her death occurs is used to determine the percentage of the policy value.

 

Attained

Age

 

Policy

Value %

 

Attained

Age

 

Policy

Value %

 

Attained

Age

 

Policy

Value %

 

Attained

Age

 

Policy

Value %

40 and younger   250   51   178   62   126   73   109
41   243   52   171   63   124   74   107
42   236   53   164   64   122   75-90 inclusive   105
43   229   54   157   65   120   91   104
44   222   55   150   66   119   92   103
45   215   56   146   67   118   93   102
46   209   57   142   68   117   94   101
47   203   58   138   69   116   95-100   100
48   197   59   134   70   115    
49   191   60   130   71   113    
50   185   61   128   72   111    

MATURITY

If the primary insured is living on the maturity date and this policy is in force, we will pay, subject to the conditions and provisions of this policy, the proceeds to the owner, unless the owner has elected to extend the maturity date as provided under the Extension of Maturity Date provision of this policy.

EXTENSION OF MATURITY DATE

At any time during the primary insured’s lifetime, the owner, subject to our approval, may elect to extend the maturity date of this policy beyond the maturity date shown in the schedule. We must receive the owner’s authorized request for such extension before the maturity date shown on the schedule.

Conditions. During the extension of the maturity date period:

 

  1. we will not accept further premium payments;

 

  2. we will not make any monthly deductions for this extension;

 

  3. the death benefit will be the surrender value as of the date of the primary insured’s death;

 

  4. the new maturity date will be the date of the primary insured’s death; and

 

  5. any rider will not continue beyond its termination date.

Surrender. During the extension of the maturity date period, we will allow a full or partial surrender of this policy. We must receive an authorized request from the owner for such surrender at our home office. A partial surrender reduces the surrender value and the death benefit by the amount of the partial surrender, including any partial surrender charges and processing fees. A full surrender will terminate this policy. If the surrender value is less than $2,000 during this extension of the maturity date period, this policy will terminate and we will mail the surrender value, if any to the owner.

 

19


SETTLEMENT OPTIONS

The death benefit may be applied under a settlement option upon the primary insured’s death, subject to the conditions and provisions of this policy.

The proceeds may be applied under a settlement option if this policy has been in force for five years or more, subject to the conditions and provisions of this policy.

The 2000 Annuity Basic Table at 3% is used to calculate the Settlement Options.

Settlement Options. We offer the following settlement options:

 

  1. Fixed Amount.

We will make equal periodic payments of a definite amount. The amount we pay each period must be at least $20 for a fixed period of not less than five years and not longer than 30 years. Payments will continue until the proceeds are exhausted. The last payment will equal the amount of any unpaid proceeds. If the payee dies before all the proceeds are paid, the beneficiary may elect one of the following options: payments for the remainder of the period, a single lump sum payment or another settlement option with a lesser fixed period.

 

  2. Fixed Period.

We will make equal periodic payments for a fixed period of not less than five years and not longer than 30 years. If the payee dies before the period ends the beneficiary may elect one of the following options: payments for the remainder of the period, a single lump sum payment or another settlement option with a lesser fixed period.

 

  3. Fixed Period and Life.

We will make equal periodic payments for a guaranteed minimum period of not less than ten years. If the payee lives longer than the minimum period, payments will continue for his/her life. The minimum period can be 10, 15 or 20 years. If the payee dies before the end of the guaranteed period, the balance of the guaranteed payments will be paid to the beneficiary.

 

  4. Installment Refund.

Equal periodic payments are guaranteed for the lifetime of the payee. Payments are guaranteed to total no less than the proceeds or death benefit at the time that the payments start. If the payee dies before the guaranteed payments have been made, the remaining payments will be made to the beneficiary.

 

  5. Interest Income. The proceeds or the death benefit is left with us to earn interest for a fixed number of years or until the death of the payee or until the payee elects a single lump sum payment or a settlement option. We will pay the interest on the amount of the proceeds or the death benefit left with us to the payee annually or at such other interval as agreed to by us. We determine the rate of interest. The payee may withdraw all or part of the proceeds or the death benefit or accrued interest at any time.

 

  6. Joint and Survivor Lifetime Income.

We will make equal periodic payments for the lifetime of two payees. Payments will continue as long as either payee is living. If both payees die before the end of the guarantee period, the beneficiary may elect one of the following options: payments for the remainder of the period, a single lump sum payment or another settlement option with a lesser fixed period. The minimum guarantee period is ten years.

 

20


  7. Other Settlement Options. We will make any other settlement option agreement that is agreeable to both the person who has a right to elect a settlement option and us.

Interest. Proceeds or the death benefit applied under a settlement option no longer earn interest at the rate applied to the fixed account or participate in the investment experience of the variable account. An interest rate of three percent per year compounded annually is guaranteed on all amounts held under a settlement option. Excess interest may be paid or credited, at our sole option. Such excess interest is in addition to the guaranteed payments under any settlement option. We will set the amount of any excess interest and the manner in which it is determined.

Settlement Option Conditions. The following conditions apply to settlement options:

 

  1. We either endorse or amend this policy or require its surrender in exchange for a supplementary contract covering the settlement option agreement. The effective date of any supplementary contract is the date on which the proceeds or death benefit amount is applied.

 

  2. Settlement options are not available without our consent if the amount to be applied is less than $25,000.

 

  3. Any change of beneficiary while this policy is in force, cancels any previous choice of a settlement option.

 

  4. If this policy is assigned, or if an amount becomes payable to a corporation, association, partnership, trust or other non-natural person, settlement options (other than a lump sum) are available only with our consent.

 

  5. Any policy loan balance at death, maturity or surrender may be repaid to us at time of election to increase payments available

 

  6. If the death benefit is payable to a minor, the settlement option must be chosen by the owner before the primary insured’s death or by a person authorized to act on behalf of the minor.

The Tables that follow illustrate the minimum amount of guaranteed payments for the indicated settlement options.

FIXED PERIOD

MONTHLY INCOME AMOUNTS PER $1,000 OF POLICY PROCEEDS/DEATH BENEFIT

 

Years

Payable

  

Monthly

Amount

  

Years

Payable

  

Monthly

Amount

  

Years

Payable

  

Monthly

Amount

  

Years

Payable

  

Monthly

Amount

  

Years

Payable

  

Monthly

Amount

5

   $ 17.95    11    8.88    17    6.24    23    5.00    29    4.28

6

     15.18    12    8.26    18    5.98    24    4.85    30    4.19

7

     13.20    13    7.73    19    5.74    25    4.72      

8

     11.71    14    7.28    20    5.53    26    4.60      

9

     10.56    15    6.89    21    5.33    27    4.49      

10

     9.64    16    6.54    22    5.16    28    4.38      

 

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FIXED PERIOD AND LIFE

MONTHLY INCOME AMOUNTS PER $1,000 OF POLICY PROCEEDS/DEATH BENEFIT

 

Age

of

Payee

  Number of Years Certain  

Age

of

Payee

  Number of Years Certain
  10   20     10   20
  Male   Female   Male   Female     Male   Female   Male   Female
0   $ 2.75   $ 2.73   $ 2.75   $ 2.73   41   $ 3.64   $ 3.55   $ 3.59   $ 3.52
1     2.76     2.74     2.76     2.74   42     3.68     3.59     3.63     3.56
2     2.77     2.75     2.77     2.75   43     3.73     3.64     3.68     3.60
3     2.78     2.76     2.78     2.76   44     3.78     3.68     3.72     3.64
4     2.80     2.77     2.79     2.77   45     3.84     3.73     3.77     3.68
5     2.81     2.78     2.80     2.78   46     3.89     3.78     3.82     3.73
6     2.82     2.79     2.81     2.79   47     3.95     3.84     3.87     3.78
7     2.83     2.80     2.82     2.80   48     4.01     3.89     3.92     3.82
8     2.84     2.81     2.84     2.81   49     4.07     3.95     3.97     3.88
9     2.85     2.82     2.85     2.82   50     4.14     4.02     4.03     3.93
10     2.86     2.83     2.86     2.83   51     4.21     4.08     4.08     3.98
11     2.88     2.85     2.87     2.84   52     4.28     4.15     4.14     4.04
12     2.89     2.86     2.88     2.85   53     4.36     4.22     4.20     4.10
13     2.90     2.87     2.90     2.87   54     4.44     4.30     4.26     4.16
14     2.92     2.88     2.91     2.88   55     4.53     4.38     4.32     4.22
15     2.93     2.90     2.93     2.89   56     4.62     4.46     4.39     4.28
16     2.95     2.91     2.94     2.91   57     4.71     4.55     4.45     4.35
17     2.96     2.93     2.96     2.92   58     4.81     4.64     4.52     4.41
18     2.98     2.94     2.97     2.94   59     4.92     4.74     4.58     4.48
19     3.00     2.96     2.99     2.95   60     5.03     4.84     4.65     4.55
20     3.01     2.98     3.01     2.97   61     5.14     4.95     4.72     4.62
21     3.03     2.99     3.03     2.99   62     5.27     5.07     4.78     4.69
22     3.05     3.01     3.04     3.00   63     5.39     5.19     4.85     4.76
23     3.07     3.03     3.06     3.02   64     5.53     5.31     4.91     4.82
24     3.09     3.05     3.09     3.04   65     5.67     5.45     4.97     4.89
25     3.12     3.07     3.11     3.06   66     5.82     5.59     5.03     4.96
26     3.14     3.09     3.13     3.08   67     5.97     5.74     5.09     5.02
27     3.16     3.11     3.15     3.10   68     6.12     5.89     5.14     5.08
28     3.19     3.13     3.18     3.13   69     6.29     6.05     5.19     5.14
29     3.21     3.16     3.20     3.15   70     6.45     6.21     5.24     5.19
30     3.24     3.18     3.23     3.17   71     6.62     6.39     5.28     5.24
31     3.27     3.21     3.25     3.20   72     6.80     6.56     5.32     5.28
32     3.30     3.24     3.28     3.23   73     6.97     6.74     5.35     5.32
33     3.33     3.27     3.31     3.25   74     7.15     6.93     5.38     5.36
34     3.36     3.30     3.34     3.28   75     7.33     7.12     5.41     5.39
35     3.39     3.33     3.37     3.31   76     7.51     7.31     5.43     5.42
36     3.43     3.36     3.41     3.34   77     7.69     7.50     5.45     5.44
37     3.47     3.39     3.44     3.37   78     7.86     7.69     5.47     5.46
38     3.51     3.43     3.48     3.41   79     8.03     7.87     5.48     5.47
39     3.55     3.47     3.51     3.44   80     8.20     8.06     5.49     5.49
40     3.59     3.51     3.55     3.48   and over        

Monthly income for other combinations or frequency of payment will be quoted upon request.

VARIABLE ACCOUNT

Variable Account. The variable account is registered with the SEC and is subject to SEC rules and regulations. The variable account is also subject to the laws of the state of Wisconsin that regulate the operations of insurance companies domiciled in Wisconsin. The investment policy of the variable account will not be changed without the approval of the Insurance Commissioner of the state of Wisconsin. The approval process is on file with the Insurance Commissioner of the state of Wisconsin.

We own the assets of the variable account. We will value the assets of the variable account at the close of business on each business day. The assets of the variable account will be kept separate from the assets of our general account and any other separate accounts. Income and realized or unrealized gains or losses from assets in the variable account will be credited to or charged against such account without regard to our other income, gains or losses.

The portion of the assets of the variable account that equals the reserves and other policy liabilities of the policies that are supported by the variable account will not be charged with liabilities arising from any other business we conduct.

We have the right to transfer to our general account any assets of the variable account that are in excess of such reserves and other policy liabilities.

We also reserve the right to transfer assets of the variable account that we determine to be associated with the class of policies to which this policy belongs, to another separate account. If this type of transfer is made, the term “variable account” as used in this policy, will then mean the variable account to which the assets were transferred.

When permitted by law, we also reserve the right to:

 

  1. deregister the variable account under the Investment Company Act of 1940 (the “1940 Act”);

 

22


  2. operate the variable account under the direction of a committee or in any other form permitted by law;

 

  3. restrict or eliminate any voting rights of owners or other persons who have voting rights as to the variable account;

 

  4. combine the variable account with other separate accounts;

 

  5. create new separate accounts;

 

  6. transfer the assets of the variable account to another separate account;

 

  7. operate the variable account or a subaccount as either a unit investment trust or management company under the 1940 Act, or in any other form allowed by law;

 

  8. terminate and/or liquidate the variable account; and

 

  9. make any changes to the variable account to conform with, or required by any change in, federal tax law, the 1940 Act and regulations promulgated thereunder, or any applicable federal or state laws.

Subaccounts. The variable account is divided into subaccounts as shown on the schedule. When permitted by law, we reserve the right to:

 

  1. add new subaccounts;

 

  2. make such subaccounts available to any class or series of policies as we deem appropriate;

 

  3. eliminate or combine any subaccounts; and

 

  4. transfer the assets of one or more subaccounts to any other subaccounts.

Each new subaccount would invest in a new investment option of a fund or in shares of another investment company. The owner will determine the percentage of premium that will be allocated to each subaccount according to the Premium provision.

Investment Options. The funds offer several investment options as shown on the schedule. Each of the investment options corresponds to one of the subaccounts of the variable account.

On or after the 41st day after the issue date, net premiums allocated to a subaccount will automatically be invested in an investment option corresponding to that subaccount.

When permitted by law, we have the right to:

 

  1. add;

 

  2. delete; or

 

  3. substitute

investment options.

We also reserve the right to dispose of an investment option and to substitute another investment option, if:

 

  1. the shares of the investment option are no longer available for investment; or

 

  2. in our judgment further investment in the investment option is inappropriate in view of the purpose of the variable account.

If there is any substitution or change, we may, by endorsement, make such changes in this and other policies as may be necessary or appropriate to reflect the substitution or change.

Transfers. The owner may transfer all or part of the policy value among the subaccounts of the variable account and between the subaccounts and the fixed account, subject to the following:

 

  1. we must receive an authorized request;

 

  2. the transfer is effective as of the end of the valuation period during which we receive the authorized request at our home office;

 

  3. the owner may transfer amounts from the fixed account to the variable account only once in a policy year;

 

  4. the policy value on the date of the transfer will not be affected by the transfer except to the extent of the transfer fee. The transfer fee will be deducted on a pro rata basis from the accounts to which the transfer is made;

 

  5. the fixed account policy value after a transfer from the fixed account must at least equal the policy loan balance;

 

  6. transfers to and from the subaccounts are subject to our published rules for transfers, including the right to limit the number and amount of transfers.

 

  7. transfers in excess of 12 per policy year will be subject to a $25 charge.

We reserve the right to limit transfers in any policy year, or to refuse any transfer request from an owner if:

 

  1. we believe, in our sole discretion, that excessive trading by the owner, or a specific transfer request, or a group of transfer requests, may have a detrimental effect on the accumulation unit values of any subaccount or the share prices of any portfolio, or would be detrimental to other owners; or

 

23


  2. we are informed by one or more portfolios that they intend to restrict the purchase of portfolio shares because of excessive trading or because they believe that a specific transfer or group of transfers would have a detrimental effect on the price of portfolio shares.

We reserve the right to provide to a fund information about owners and their trading activities involving the fund’s portfolio(s) that we deem necessary to:

 

  1. deter fraud or violations of our operating rules or the operating rules of the fund; and

 

  2. as required to comply with applicable state or federal law.

We also reserve the right to revoke or modify the transfer privilege at any time. In addition, certain funds in which the subaccounts invest may impose redemption fees. Any fund redemption fees that you are charged are paid to and retained by the fund, and not us or the variable account.

There may be a delay in completing a transfer if the transfer involves a purchase of shares from a fund that requires the receipt of federal funds before accepting a purchase order, or redemption of shares from a fund that delays making proceeds available.

GENERAL PROVISIONS

Administrative Issues. If the owner has submitted a check or draft to our home office, we have the right to defer payment of surrenders, partial surrenders, death benefits, proceeds, policy loans, or payments under a settlement option, until the check or draft has been honored.

If mandated under applicable law, we may be required to block the owner’s account and thereby refuse to pay any request for transfer, surrender, partial surrender, policy loans or death benefits or payment under a settlement option, until instructions are received from the appropriate regulator. We also may be required to provide information about the owner and his/her account to government regulators.

Annual Report. We provide the owner with a report once each year. The report shows:

 

  1. the policy value including the value in each subaccount and the fixed account, the surrender value, the death benefit; and

 

  2. since the time of the last report:

a. the premiums paid;

b. the cost of insurance;

c. the cost of any riders;

d. any interest credited;

e. any partial surrenders including surrender charges and processing fees;

f. any policy loan balance;

 

  3. any other information that may be required by regulation; and

 

  4. notice of the right to annually request, without charge, an illustration of current benefits and values.

On request, we will provide hypothetical illustrations to demonstrate how this policy works and how performance could affect policy values and the death benefit. If more than one illustration is requested annually, we reserve the right to charge a fee for additional illustrations.

Calculation of Reserves. All reserves for this policy are based on the mortality table shown on the schedule. All calculations are done on the basis described in the statement that is on file with the insurance commissioner’s office. All guaranteed values are equal to or greater than that required by law.

Claims of Creditors. Payment of interest or principal or any payment under a settlement option is exempt from the claims of creditors of any beneficiary to the maximum extent allowed by law. These payments may not be assigned or withdrawn without our consent before becoming payable.

 

24


Continuation of Insurance Coverage. This policy will continue during the primary insured’s lifetime as long as there is enough surrender value to cover each monthly deduction as it falls due and policy loan interest due, if any.

This policy will continue during the first five policy years, if on each monthly deduction day within such period:

 

  1. the sum of the premium paid from the policy date; minus

 

  2. the sum of any partial surrenders plus any increase in the policy loan balance from the policy date,

equals or exceeds the sum of the minimum premium due from the policy date, including the current policy month;

otherwise the Grace Period provision will apply.

Dividends. A dividend is a share of the divisible surplus of our participating insurance policies as may be declared by our Board of Directors. We do not expect to pay dividends on this policy. If a dividend is paid under this policy, it will be paid in cash at the end of a policy year.

Entire Contract. We have issued this policy in consideration of the application and payment of the initial premium. The entire contract is:

 

  1. this policy and its riders, if any;

 

  2. the application; and

 

  3. endorsements and amendments, if any.

Statements made in any application by or for the primary insured in absence of fraud are considered representations and not warranties. We will not use any statement or omission to void this policy or in defense of a claim, unless such statement or omission is contained in or omitted from an application and such application is attached to and made a part of this policy.

Error. If we, the owner or the primary insured makes a clerical error regarding any information given to us or by us, such error will not cause:

 

  1. insurance on the primary insured’s life to be invalid if otherwise valid;

 

  2. any coverage that would otherwise terminate to be reissued or reinstated;

 

  3. any coverage to be issued that otherwise would not be issued; or

 

  4. any coverage or other benefit to be different from that actually provided by policy provision.

If such error affects the premium, the cost of insurance, any coverage under this policy or any riders, we determine any adjustment to be made.

Grace Period. If, on any monthly deduction day, this policy’s surrender value is not sufficient to cover a monthly deduction and any policy loan interest due, and the requirements of the Continuation of Insurance Coverage provision have not been met, we will allow a grace period of 61 days to pay a premium that is sufficient to keep this policy in force. The grace period begins on the date we send the owner written notice of such insufficiency. This policy terminates without value if the required premium is not paid within the grace period to keep this policy in force. If the primary insured dies during the grace period, we will deduct any unpaid monthly deductions and any policy loan interest due, from the death benefit.

Incontestability. We will not contest the validity of this policy except for nonpayment of premium after it has been in force for two years from the policy date during the primary insured’s lifetime.

We will not contest the validity of any coverage that takes effect after the policy date (including any increase in coverage or reinstatement of coverage) after such coverage has been in force for two years from the date such coverage takes effect during the primary insured’s lifetime.

If the owner:

 

  1. converts a policy issued by us to this policy; or

 

  2. replaces a policy issued by us with this policy, then

 

      a. for the amount of coverage that is converted or replaced, the exclusion period of this provision is measured from the policy date of the original policy under which such coverage is converted or replaced; and

 

      b. for the amount of coverage that exceeds the amount of coverage converted or replaced, the exclusion period of this provision is measured from the policy date of this policy.

Misstatement of Age or Gender. If the primary insured’s age or gender is misstated in the application, we will adjust the death benefit based on the correct age and gender.

 

25


Reinstatement. If this policy terminates as stated under the Grace Period provision, it may be reinstated during the primary insured’s lifetime by the owner if:

 

  1. we receive the signed application for reinstatement from the owner within three years after the date this policy terminated. If the owner is not the primary insured, the application for reinstatement also must be signed by:

 

  a. the primary insured if he/she is age 18 or older on the date of the application for reinstatement; or

 

  b. If the primary insured is not age 18 or over on the date of the Application for reinstatement, by the primary insured’s parent/legal guardian;

 

  2. we receive evidence of insurability satisfactory to us for the primary insured;

 

  3. this policy was not surrendered; and

 

  4. sufficient premium is paid to keep this policy in force for the current policy month and the next two policy months. This may include past due minimum premium and policy loan interest due, if any.

If we do not receive evidence of insurability satisfactory to us, this policy will not be reinstated.

The policy value will be based on the net premium used to reinstate this policy.

Suicide. If the primary insured commits suicide while sane or insane, within two years of the policy date, we will pay the beneficiary:

 

  1. no more than the amount of all premiums paid; minus

 

  2. any policy loan balance; minus

 

  3. any partial surrenders under this policy; minus

 

  4. any dividends paid by this policy.

If such death occurs after this policy has been in force for two years and within two years of any increase in specified amount on the primary insured, the amount payable with respect to such increase in specified amount is limited to a refund of the monthly deductions for such increase in specified amount.

If the owner

 

  1. converts a policy issued by us to this policy; or

 

  2. replaces a policy issued by us with this policy, then

 

  a. for the amount of coverage that is converted or replaced, the exclusion period of this provision is measured from the policy date of the original policy under which such coverage is converted or replaced; and

 

  b. for the amount of coverage that exceeds the amount of coverage converted or replaced, the exclusion period of this provision is measured from the policy date of this policy.

Tax Qualification as Life Insurance. Tax laws may, from time to time impose certain requirements to qualify this policy as life insurance for federal tax purposes. We reserve the right to change this policy or refuse to process any transactions authorized by this policy to so qualify, and will notify the owner of any such change and its effects.

Waiver and Change. Only our President, one of our Vice-Presidents, our Secretary or our Assistant Secretary is authorized to waive or change any condition or provision in this policy. Such waiver or change must be in writing. No agent, registered representative or other person may waive or change any condition or provision of this policy.

 

26


AMERICAN FAMILY LIFE INSURANCE COMPANY

6000 AMERICAN PKWY

MADISON, WI 53783-0001

888-428-5433

DESCRIPTION

FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE POLICY

Premiums are payable until the earlier of the maturity date or the primary insured’s death

Participating

 

27


SCHEDULE — PAGE 1

 

Primary Insured   [Doe, John J]                   Issue Age   [35]
Policy Number   [12345678]                   Issue Date   [xxxxx]
Underwriting Class   [Male, Non-Nicotine standard]                   Policy Date   [xxxxx]

 

Description of Benefits

   Specified Amount   Maturity Date
Flexible Premium Variable Life Insurance    [$50,000]   [xxxxx]
Riders [See Page 2] [None]    [Option One – Level]  

 

Premium

   Annual   Semiannual   Quarterly   Monthly

Planned Premiums

        
   [$xxxxx]   [$xxxxx]   [$xxxxx]   [$xxxxx]
Payment of the planned premium may not be sufficient to continue the insurance coverage to the maturity date
Minimum Premium    [$xxxxx]   [$xxxx]   [$xxxx]   [$xxxx]
Minimum Premium includes the premium for the specified amount and for all riders shown on schedule - Page 2
Target Premium    [$xxxx]   [$xxxxx]   [$xxxxx]   [$xxxxx]

 

Target premium includes the premium for the specified amount and for all riders shown on schedule — Page 2 except the premium for the Extended Benefit Protection Rider.
Premium Charge    First 15 Years: 5% assessed on premium paid up to annualized target premium. 3% assessed on premium paid in excess of annualized target premium. 16th year and all years thereafter: 3% assessed on premium paid.
Monthly Policy Fee   

$7.50 per month for the life of the policy

 

[$0.02 per $1,000 for each Additional Insured Rider for ten years]

Policy Issue Fee    $xxx per month for the first five policy years
Administrative Charge    Varies (not to exceed $2.00 per $1,000 of Specified Amount)
Policy Loan Interest Rate    8.0% per year in arrears
Credited Interest Rate on Policy Loan Balances   

xx% in all policy years for non-preferred policy loans

 

xx% in all policy years for preferred policy loans

Fixed Account Guaranteed Interest Rate    xx% per year
   xxxxxxxx% per day
Policy Value Guaranteed Interest Rate    3% per year (0.24663% per month compounded monthly)
Transfer Fee    $xx for each transfer after the first 12 transfers in a policy year
Mortality Table    2001 CSO Mortality Table, male and female for the guaranteed cost of insurance rates and reserves
Current Mortality and Expense Risk Charge    [a percent of the daily net assets of the subaccounts equivalent to xxx% for policy years one through ten
   xxx% for policy years eleven plus]


SCHEDULE – PAGE 2

 

Partial Surrender Charge    A partial surrender charge in proportion to the charge that would apply for a full surrender may be applied if a partial surrender is taken. See the Partial Surrender provision in the policy.
Partial Surrender Processing Fee    $25.00 per partial surrender
Surrender Charge    A surrender charge based on the specified amount and increases in specified amount may be applied if this policy is surrendered. See Table of Surrender Charges below and the Full Surrender provision in the policy.

TABLE OF SURRENDER CHARGES

(per thousand of Specified Amount)

 

Policy Year

1

   $ xx.xx

2

   $ xx.xx

3

   $ xx.xx

4

   $ xx.xx

5

   $ xx.xx

6

   $ xx.xx

7

   $ xx.xx

8

   $ xx.xx

9

   $ xx.xx

10

   $ xx.xx
11    $ xx.xx
12    $ xx.xx
13    $ xx.xx
14    $ xx.xx
15    $ xx.xx
16    $ xx.xx
17    $ xx.xx
18    $ xx.xx
19    $ xx.xx
20    $ 00.00

 

Riders

(Any Rider Benefit Amount shown is separate from the

Specified Amount shown on Page 1.)

  

Rider

Benefit
Amount

 

Rider

Target

Premium

   

Rider

Date

   

Rider

Termination

Date

 
         [Monthly]              

[Waiver of Monthly Deductions]

   See Rider   [$ XXX.XX ]   [MM/DD/YYYY ]   [MM/DD/YYYY ]

[Credit of Specified Premium]

   One and  1/2
times target
premium
     

[Accidental Death Benefit]

   [$XXX,XXX]   [$ XXX.XX ]   [MM/DD/YYYY ]   [MM/DD/YYYY ]

[Children’s Insurance Rider]

[The monthly cost for this rider is $3.00.]

  

$10,000 per
child insured
  [$ XXX.XX ]   [MM/DD/YYYY ]   [MM/DD/YYYY ]

[Cost of Living Adjustment]

   See Rider     NONE     [MM/DD/YYYY ]   [MM/DD/YYYY ]

[Guaranteed Purchase Option]

   [$XX,XXX]   [$ XXX.XX ]   [MM/DD/YYYY ]   [MM/DD/YYYY ]

[Guaranteed Minimum Death Benefit ]

        

[ Extended Benefit Protection Rider]

        

 


SCHEDULE – PAGE 3

 

[Additional Insured Rider]

1.      [First M Last name here]

[Age, Gender, Underwriting Class

   [$

[$

XXX,XXX

XXX,XXX

]

]

  [$

[$

XXX.XX

XXX.XX

]

]

  [MM/DD/YYYY

[MM/DD/YYYY

]

]

  [MM/DD/YYYY

[MM/DD/YYYY

]

]

2.      [First M Last name here]

[Age, Gender, Underwriting Class],

        

See Table of Guaranteed Cost of Insurance Rates. attached

[The rider target premium is included in the target premiums shown on Schedule – Page 1.]

[Table of Guaranteed Cost of Insurance Rates]

SCHEDULE OF INVESTMENT OPTIONS

 

General Account    The general assets of American Family Life Insurance Company
Separate Account    American Family Variable Account I

Subaccounts

   Portfolio

Subaccount A

   Fidelity VIP Contrafund® Portfolio (Service Class 2)

Subaccount B

   Fidelity VIP Equity-Income Portfolio (Service Class 2)

Subaccount C

   Fidelity VIP Growth & Income Portfolio (Service Class 2)

Subaccount D

   Fidelity VIP Growth Portfolio (Service Class 2)

Subaccount E

   Fidelity VIP Investment Grade Bond Portfolio (Service Class)

Subaccount F

   Fidelity VIP Mid Cap Portfolio (Initial Class)

Subaccount G

   Fidelity VIP Money Market Portfolio (Initial Class)

Subaccount H

   Vanguard® VIF International Portfolio

Subaccount I

   Vanguard® VIF Small Company Growth Portfolio