EX-99.(4)(BB) 10 a30132aexv99wx4yxbby.htm EXHIBIT 4(BB) exv99wx4yxbby
SVER TERM INSURANCE-2 RIDER
This Rider (“Rider”) becomes a part of the policy to which it is attached (“the Policy”). If the Rider is effective after the Policy Date, the effective date for this Rider will be shown on the Policy Specifications. If the provisions of this Rider and those of the Policy do not agree, the provisions of this Rider will apply. Please read it carefully.
Rider Benefit Summary – This Rider provides term insurance on the Insured under the Policy as long as the Policy is In Force and this Rider has not terminated. The Face Amount of this Rider contributes to the Total Face Amount, and consequently to the Death Benefit, of the Policy. This rider has no Accumulated Value of its own, but affects the Policy’s Accumulated Value because the charges for the Rider are deducted from the Accumulated Value of the Policy.
Insured – As used in this Rider, the “Insured” means the individual covered under the Policy’s Basic Life Coverage, as shown in the Policy Specifications.
Rider Coverage Layer – is a layer of insurance coverage under this Rider. There may be one or more Rider Coverage Layers. Any elective increase in Rider Face Amount will comprise a new Rider Coverage Layer. Each Rider Coverage Layer has its own Face Amount, Risk Class, effective date, and set of charges. The Face Amount, Risk Class, effective date, and set of charges for the initial Rider Coverage Layer are shown in the Policy Specifications. The Face Amount, Risk Class, effective date, and set of charges for any Rider Coverage Layer added at a later time will be shown in a Supplemental Schedule of Coverage sent to you at that time to your last known address.
Rider Face Amount –The Face Amount of this Rider is the sum of the Face Amounts of all Rider Coverage Layers.
Elective Increases in Rider Face Amount – Elective increases in the Face Amount of this Rider are increases that you apply for after the Policy has been issued. Not all policies allow for such increases. If the Policy allows elective increases in Face Amount, then increases in this Rider are also allowed.
You may submit an application to increase the Rider Face Amount. Your application must include Evidence of Insurability satisfactory to us and is subject to our approval. The effective date of the increased Rider Face Amount will be the first Monthly Payment Date on or next following the date all required conditions are met or any other date you request and we approve. We reserve the right to limit increases to one per policy year and to charge a fee, not to exceed $100, to evaluate insurability. Upon approval of any such increase, we will send you a Supplemental Schedule of Coverage, which will include the following information:
•   The increased Rider Face Amount and the effective date of the increase;
 
•   The Risk Class for the increase;
 
•   The Maximum Monthly Cost of Insurance Rates applicable to the increase;
 
•   The Maximum Monthly Coverage Charge for the increase; and
 
•   If the Guideline Premium Test is used, the new Guideline Premiums.
Decrease in Rider Face Amount – You may decrease the Rider Face Amount, subject to the provisions in the Policy. If there are Coverage Layers with the same effective date, they will be decreased or eliminated in the following order:
•   First, the Face Amount of any other Rider that contributes to the Total Face Amount will be decreased or eliminated;
 
•   Then, the Face Amount of this Rider will be decreased or eliminated; and
 
•   Finally, the Face Amount of Basic Life Coverage under the Policy will be decreased.
Charge for this Rider – On each Monthly Payment Date prior to the Monthly Deduction End Date, there is a charge for this Rider equal to the sum of the Rider Coverage Charge and the Rider Cost of Insurance
         
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Charge. Such charges may vary by Class, and for the purpose of this Rider, Class includes the Policy form to which this Rider is attached.
Rider Coverage Charge – The Coverage Charge for this Rider is the sum of the Coverage Charge for each Rider Coverage Layer. The Coverage Charge for the initial Rider Coverage Layer will not exceed the Coverage Charge shown in the Policy Specifications. The Coverage Charge for any later Rider Coverage Layer will not exceed the Coverage Charge shown in the Supplemental Schedule of Coverage to be sent to you when the Coverage Layer is added. This charge is based on the Face Amount of the Rider Coverage Layer as of its effective date. The Coverage Charge will not decrease even if the Face Amount of the associated Rider Coverage Layer is decreased.
Rider Cost of Insurance Charge – The Cost of Insurance Charge for this Rider is the sum of the Cost of Insurance Charge for each Rider Coverage Layer. The Cost of Insurance Charge for each Rider Coverage Layer is equal to (1) multiplied by (2), where:
(1) Is the Maximum Monthly Cost of Insurance Rate for the Coverage Layer divided by 1000; and
(2) Is the Net Amount at Risk allocated to the Coverage Layer.
The Net Amount at Risk is allocated proportionately to each Coverage Layer, including each Coverage Layer of other Riders that contribute to the Total Face Amount and each Coverage Layer of Basic Life Coverage under the Policy, according to Face Amount.
Termination Dates – This Rider is effective on the Policy Date unless otherwise stated. It will terminate on the earlier of:
•   Your Written Request; or
 
•   The date the Policy ceases to be In Force.
(-S- SIGNATURE)
     
[www.PacificLife.com]   [(800) 347-7787]
         
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POLICY NUMBER: AAAAAAAAAAA
POLICY SPECIFICATIONS
SUMMARY OF COVERAGES EFFECTIVE ON THE POLICY DATE
 
SECTIONS FOR OTHER COVERAGES
 
         
R12SV2
  SVER TERM INSURANCE-2 RIDER
 
        
 
  FACE AMOUNT:    $100,000
 
  INSURED:   LELAND STANFORD
 
  SEX AND AGE:   MALE 35
 
  RISK CLASS:   STANDARD NONSMOKER
 
PAGE 3.1

 

 

TABLE OF COST OF INSURANCE RATES
FOR SVER TERM INSURANCE RIDER
INSURED:                     LELAND STANFORD
MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000.00 OF NET AMOUNT AT RISK APPLICABLE TO THIS COVERAGE.
             
    POLICY   MONTHLY    
    YEAR   RATE    
    1   0.10090    
    2   0.10670    
    3   0.11170    
    4   0.12010    
    5   0.12840    
    6   0.13760    
    7   0.14930    
    8   0.16350    
    9   0.17930    
    10   0.19940    
    11   0.22110    
    12   0.24200    
    13   0.26460    
    14   0.27790    
    15   0.29380    
    16   0.31390    
    17   0.33900    
    18   0.37330    
    19   0.41180    
    20   0.45950    
    21   0.51560    
    22   0.57510    
    23   0.63890    
    24   0.69180    
    25   0.75230    
    26   0.82540    
    27   0.91630    
    28   1.02660    
    29   1.14970    
    30   1.27900    
    31   1.41510    
    32   1.55240    
    33   1.68980    
    34   1.83930    
    35   1.99170    
    36   2.17330    
    37   2.37670    
    38   2.64820    
    39   2.93180    
    40   3.23010    
    41   3.56140    
    42   3.92360    
    43   4.34570    
    44   4.84010    
Page 4.x

 

 

TABLE OF COST OF INSURANCE RATES
FOR SVER TERM INSURANCE RIDER
CONTINUED
INSURED:                     LELAND STANFORD
MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000.00 OF NET AMOUNT AT RISK APPLICABLE TO THIS COVERAGE.
             
    POLICY   MONTHLY    
    YEAR   RATE    
    45   5.41330    
    46   6.04180    
    47   6.76170    
    48   7.51460    
    49   8.33040    
    50   9.24140    
    51   10.27540    
    52   11.43490    
    53   12.71510    
    54   14.10520    
    55   15.59360    
    56   17.17060    
    57   18.67330    
    58   20.26540    
    59   21.97380    
    60   23.81220    
    61   25.79270    
    62   27.64150    
    63   29.65380    
    64   31.85100    
    65   34.25960    
    66   36.90860    
    67   39.06360    
    68   41.41760    
    69   43.99540    
    70   46.82420    
    71   49.93700    
    72   53.37330    
    73   57.18460    
    74   61.42910    
    75   66.18210    
    76   71.53880    
    77   77.62690    
    78   83.33330    
    79   83.33330    
    80   83.33330    
    81   83.33330    
    82   83.33330    
    83   83.33330    
    84   83.33330    
    85   83.33330    
    86   83.33330    
    87+   0    
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TABLE OF MAXIMUM MONTHLY COVERAGE CHARGES
FOR SVER TERM INSURANCE RIDER
INSURED:                     LELAND STANFORD
             
    POLICY   COVERAGE    
    YEAR   CHARGE    
    1   0.00    
    2   18.21    
    3   27.32    
    4   27.32    
    5   27.32    
    6   27.32    
    7   27.32    
    8   27.32    
    9   27.32    
    10   27.32    
    11   27.32    
    12   27.32    
    13   27.32    
    14   27.32    
    15   27.32    
    16   27.32    
    17   27.32    
    18   27.32    
    19   27.32    
    20   27.32    
    21   28.14    
    22   28.99    
    23   29.86    
    24   30.75    
    25   31.67    
    26   32.63    
    27   33.61    
    28   34.61    
    29   35.65    
    30   36.72    
    31   37.83    
    32   38.96    
    33   40.13    
    34   41.34    
    35   42.58    
    36   43.86    
    37   45.17    
    38   46.53    
    39   47.93    
    40   49.37    
    41   50.85    
    42   52.37    
    43   53.95    
    44   55.57    
Page 4.x

 

 

TABLE OF MAXIMUM MONTHLY COVERAGE CHARGES
FOR SVER TERM INSURANCE RIDER
CONTINUED
INSURED:                     LELAND STANFORD
             
    POLICY   COVERAGE    
    YEAR   CHARGE    
    45   $57.23    
    46   58.95    
    47   60.72    
    48   62.55    
    49   64.42    
    50   66.36    
    51   68.35    
    52   70.40    
    53   72.52    
    54   74.69    
    55   76.94    
    56   79.25    
    57   81.63    
    58   84.08    
    59   86.60    
    60   89.20    
    61   91.88    
    62   94.64    
    63   97.48    
    64   100.41    
    65   103.42    
    66   106.53    
    67   109.73    
    68   113.02    
    69   116.42    
    70   119.91    
    71   123.51    
    72   127.22    
    73   131.04    
    74   134.97    
    75   139.03    
    76   143.20    
    77   147.50    
    78   151.93    
    79   156.49    
    80   161.19    
    81   166.03    
    82   171.02    
    83   176.15    
    84   181.44    
    85   186.89    
    86   192.50    
    87+   0    
Page 4.x