EX-99.B(4)(A)(1) 2 a20-20767_1ex99db4a1.htm EX-99.B(4)(A)(1)

Exhibti

POLICY NUMBER:  [VP99999990]

 

POLICY SPECIFICATIONS

 

Base Policy:

 

Flexible Premium Variable Universal Life Insurance with Indexed Option(s) 

Policy Date:

 

[May 1, 2020]

Insured:

 

[JOHN DOE]

Owner:

 

[JOHN DOE]

[State Department of Insurance:

 

(XXX) XXX-XXXX]

 

Premiums

 

Planned [Annual] Premium:

 

$[2,747.25]

7 Pay Premium:

 

$[3,039.58]

[Guideline Single Premium:

 

$[16,505.60]]

[Guideline Level Premium:

 

$[1,320.26]]

[Premium Band:

 

$[61.00]]

Minimum* Premium Payment:

 

$[50.00]

 

*Unless a lower premium payment is required to keep the Policy In Force.

 

Premium Type

 

Basic Premium:

 

This is equal to all premium paid in a policy year, except for any Internal Premium.

[Surplus Premium:

 

This is equal to Basic Premium paid in a policy year that exceeds the Premium Band.]

Internal Premium:

 

This is equal to any premium that is received from a replacement or a conversion of an existing Pacific Life policy.

 

Premium Load Rate

 

Maximum Basic Premium Load
Rate:

 

[6.90]%

[Maximum Surplus Premium Load
Rate:]

 

[20.00]%

Maximum Internal Premium Load Rate:

 

[6.90]%

 

Face Amount Adjustments

 

Maximum Fee per Evaluation of Insurability:

 

$[100.00]

Minimum Basic Face Amount Following Requested Decrease:

 

$[1,000.00]

 

Withdrawal Conditions

 

Maximum Fee for Each Withdrawal:

 

$[25.00]

Minimum Amount of Each Withdrawal:

 

$[200.00]

Minimum Net Cash Surrender Value Remaining After Withdrawal:

 

$[500.00]

Minimum Basic Face Amount After Withdrawal:

 

$[1,000.00]

 

ICC20 S20MADM

 

1

 

Monthly Deduction Factors

 

Monthly Deduction End Date:

 

[May 1, 2105]

Administrative Charge Per Month:

 

$[10.00]

Maximum Monthly Asset Charge Rate:

 

[0.03% (equivalent to 0.36% annually)]

 

Accounts

 

Account Addition Method:

 

[Account Additions will be added to the Investment Options under the Policy according to the Payment Instructions on file, except for:

·                  Additional Credits attributed to the Fixed Options will be added proportionately to the Fixed Options;

·                  Additional Credits attributed to the Variable Options will be added proportionately to the Variable Options.]

Account Addition Factors:

 

[Premium payments;]
[Loan repayments;]
[Any Additional Credits;]
[Monthly Deductions or other policy credits (excluding any interest credits) that increase the Accumulated Value under the policy; and]
[Credits under certain riders, if any, which increase the Accumulated Value under the policy.]

Account Deduction Method:

 

[Account Deductions reduce the Investment Options under the Policy and will be taken proportionately from the Fixed Account Value and the Variable Account Value until each have been reduced to zero. Any remaining deductions will be taken proportionate to each Segment Value across all segments in Indexed Accounts.]

Account Deduction Factors:

 

[Monthly Deductions that reduce the Accumulated Value under the policy;]
[Any Withdrawal from the policy, including any Withdrawal Fee;]
[Standard Policy Loans;]
[Any distribution in order to maintain tax qualification under Code Section 7702 (see Tax Qualification as Life Insurance) or to maintain the policy as a non-MEC under Code Section 7702A (see Modified Endowment Contract Tax Status);]
[Payments, charges and fees under certain riders, if any; and]
[Any charge, fee, or distribution that reduces the policy’s Accumulated Value.]

Indexed Account Segment Start Dates:

 

The [15th] Day of Each Calendar Month

(See Indexed Fixed Options Section For Additional Information)

 

 

Cut-Off Date:

 

[[4:00] p.m. Eastern time] of the Cut-Off Date, which is [two] Business Days prior to the Segment Start Date.

 

2

 

Additional Credit

 

At our discretion, on a non-guaranteed basis, we may credit the Accumulated Value with an additional amount. The additional amount, if any, will be credited no less frequently than annually.  We determine any Additional Credit by calculating an additional credit factor.  The factor will be used to calculate a Fixed Account Additional Credit, Variable Account Additional Credit and an Indexed Account Additional Credit Factor.  Any Fixed Account Additional Credit and Variable Account Additional Credit will be credited [as an Account Addition].  Any Indexed Account Additional Credit Factor will be used to calculate the Segment Indexed Interest. Once credited, any additional amount attributable to the Additional Credit is nonforfeitable except indirectly due to any Surrender Charge.

 

Loan Account Value

 

Minimum Loan Amount:

 

$[200.00]

Guaranteed Annual Loan Account Credit Interest Rate:

 

[1.00]%

Maximum Annual Loan Account Charge Interest Rate:

 

[1.25]%

Interest Calculation Method:

 

[Simple]

 

Basis of Values Conditions

 

Guaranteed Interest Rate for Fixed Options:

 

[1.00]% Annually. Any excess interest declared by us will be guaranteed for one year.

Basis of Value Mortality Table:

 

2017 CSO Mortality Tables adopted by the NAIC on April 6, 2016, ultimate only, age nearest birthday, composite (not smoker distinct), sex distinct with 80% male and 20% female blend for unisex, capped at 0.083333 per month.

 

Transfers Between Accounts

 

Minimum Transfer Amount:

 

$500

Remaining Balance Amount:

 

$500

Excess Transfer Charge:

 

$25 for each transfer exceeding 12 per policy year

Variable Options to Fixed LT

Transfer Period:

 

12 Months

Fixed to Variable Options or Fixed LT Transfer Period:

 

12 Months

 

Transfers From the Fixed Account Conditions:

 

 

You may transfer from the Fixed Account one time during any twelve month period.  Such transfer may be made into the Variable Options, the Fixed LT Account, or into both, subject to the following limits:

1.              You may transfer up to 100% of the value in the Fixed Account to the Fixed LT Account.

2.              You may transfer from the Fixed Account to the Variable Options the lesser of:

a.              100% of the value in the Fixed Account; or

b.              The greater of:

 

3

 

 

 

·                  $5,000;

·                  25% of the Accumulated Value in the Fixed Account and the Indexed Accounts. This amount will be taken from the Fixed Account only and cannot exceed the Fixed Account Value; or

·                  The total amount transferred in the prior Policy year from the Fixed Account to the Variable Options.

Transfers From the Fixed LT Account Conditions:

 

You may transfer from the Fixed LT Account one time during any twelve month period.  Such transfer may be made into the Variable Options, the Fixed Account, or into both.  Transfer is limited to the greater of:

1.              $5,000;

2.              10% of the Accumulated Value in the Fixed LT Account; or

3.              The total amount transferred in the prior Policy year from the Fixed LT Account to either the Fixed Account or the Variable Options.

Allocations to the Fixed Options Limitations:

 

Aggregate allocations to the Fixed Options are limited during the most recent 12 months for all policies in which you have any ownership interest or to which payments are made by a single payor, to $1,000,000.

[Allocations to the Indexed Fixed Options Limitations:

 

We reserve the right to limit transfers and/or allocations to the Indexed Fixed Options to no more than [75%] of your Policy’s total Accumulated Value.]

 

Reinstatement Conditions

 

Reinstatement Period:

 

3 Years

 

Suicide Exclusion

 

Suicide Exclusion Period:

 

2 Years from Policy Date

 

Juvenile Insured Conditions

 

Juvenile Insured Age:

 

Age [18]

Post-Juvenile Risk Class:

 

[Standard Smoker]

 

4

 

Available Death Benefit Options

 

Option A:

 

When elected, the Death Benefit equals the Total Face Amount.  When this Death Benefit Option is In Effect, taking a withdrawal may decrease the Total Face Amount as described in the Withdrawals provision of the Policy.

[Option B:

 

When elected, the Death Benefit equals the Total Face Amount plus the Accumulated Value.  When this Death Benefit Option is In Effect, taking a Withdrawal does not reduce the Total Face Amount, but rather, reduces the Accumulated Value, which has the effect of reducing the Death Benefit that would be payable.]

[Option C:

 

When elected, the Death Benefit equals the Total Face Amount plus the sum of the premiums paid minus the sum of any withdrawals taken and any other distribution that reduces the Accumulated Value, provided that such result is limited to the amount shown as the “Option C Death Benefit Limit”.  When this Death Benefit Option is In Effect, taking a withdrawal does not reduce the Total Face Amount, but rather increases the sum of the withdrawals, which has the effect of reducing the Death Benefit.  For the purpose of Death Benefit Option C calculations, Accelerated Death Benefits are not considered distributions.  Under this option, the Death Benefit may be less than the Total Face Amount.]

 

Death Benefit Qualification Test

 

Death Benefit Qualification Test in Effect: 

 

[Cash Value Accumulation Test]

[Guideline Premium Test]

 

Death Benefit Elements

 

Net Amount At Risk Factor:

 

[1.0008295]

Death Benefit Option In Effect:

 

[A]

 

[Option C Death Benefit Limit:

 

$[XX,XXX,XXX*]

 

 

*In the event that the Death Benefit Option is changed from Option C to

Option A or B, the Option C Death Benefit Limit will no longer apply to

this Policy.]

Permitted Death Benefit Option Change(s):

 

[The Death Benefit Option may be changed to Option A or B.  Changes from either Option A or B to Option C are not permitted.]

 

Illustration Conditions

 

Maximum Fee for Illustration Requests Per Policy Year:

 

$[25.00]

 

5

 

[Distribution Program

 

[Systematic Distribution Program:

 

This is a program of periodic distribution of Policy values that we designate as a Systematic Distribution Program.  We reserve the right to discontinue such a program at any time.  The program includes periodic distribution to you of a portion of the Policy’s Accumulated Value through Policy loans and Withdrawals while the Insured is alive and the Policy is In Force.  A Lockout Period (see Lockout Period) will not begin as a result of a Policy loan or Withdrawal that is distributed to you as a result of this program.  Before entering into any such program, consult with your Producer/Representative and your tax advisor as distributions may have tax ramifications.]]

 

6

 

Summary Of Coverages Effective On The Policy Date

 

P19VUL

S20MADM

Basic Life Coverage [(Guaranteed Issue)]

 

 

 

 

Face Amount:

[$100,000]

 

Insured:

[JOHN DOE]

 

Sex and Age:

[Male 35]

 

Risk Class:

[Standard Nonsmoker]

 

7

 

[Maximum Surrender Charge Effective at

Beginning of Coverage Year [(Guaranteed Issue)]

 

Insured:

 

[John Doe]

 

[Maximum Surrender Charges are reduced by 1/12 of the Reduction Factor on each Monthly Payment Date.]

 

Coverage
Year

 

Surrender
Charge

 

Reduction
Factor

 

[1

 

$

732.00

 

$

0.00

 

2

 

732.00

 

146.40

 

3

 

585.60

 

73.20

 

4

 

512.40

 

73.20

 

5

 

439.20

 

73.20

 

6

 

366.00

 

73.20

 

7

 

292.80

 

73.20

 

8

 

219.60

 

73.20

 

9

 

146.40

 

73.20

 

10

 

73.20

 

73.20

 

11+

 

0

 

0]

 

 

[Note: From time to time, we may provide for a reduction of surrender charges on certain internal exchanges.]]

 

8

 

Table of Cost of Insurance (COI) Rates

for Basic Life Coverage [(Guaranteed Issue)]

 

Insured:

 

[John Doe]

 

Maximum Monthly Cost of Insurance Rates Per $1000.00 of Net Amount at Risk Applicable to this Coverage.

 

Policy
Year

 

COI
Rate

 

Policy
Year

 

COI
Rate

 

Policy
Year

 

COI
Rate

 

[1

 

0.11420

 

30

 

0.80520

 

59

 

20.24350

 

2

 

0.12510

 

31

 

0.89100

 

60

 

21.89610

 

3

 

0.13510

 

32

 

0.98280

 

61

 

23.37870

 

4

 

0.14680

 

33

 

1.07970

 

62

 

25.34290

 

5

 

0.15850

 

34

 

1.18520

 

63

 

27.50320

 

6

 

0.17180

 

35

 

1.30350

 

64

 

29.93860

 

7

 

0.18440

 

36

 

1.44140

 

65

 

32.62170

 

8

 

0.19520

 

37

 

1.60490

 

66

 

35.52070

 

9

 

0.20020

 

38

 

1.79600

 

67

 

38.34190

 

10

 

0.20610

 

39

 

2.01720

 

68

 

41.25060

 

11

 

0.21190

 

40

 

2.26640

 

69

 

44.19530

 

12

 

0.21780

 

41

 

2.54020

 

70

 

47.11980

 

13

 

0.22280

 

42

 

2.83630

 

71

 

49.95900

 

14

 

0.22860

 

43

 

3.15590

 

72

 

52.64660

 

15

 

0.23450

 

44

 

3.50430

 

73

 

56.64960

 

16

 

0.24450

 

45

 

3.89660

 

74

 

61.08170

 

17

 

0.25790

 

46

 

4.34480

 

75

 

66.01940

 

18

 

0.27370

 

47

 

4.86390

 

76

 

71.55390

 

19

 

0.29210

 

48

 

5.43720

 

77

 

77.81150

 

20

 

0.31300

 

49

 

6.15320

 

78

 

83.33330

 

21

 

0.33810

 

50

 

6.98110

 

79

 

83.33330

 

22

 

0.36660

 

51

 

7.94390

 

80

 

83.33330

 

23

 

0.39920

 

52

 

9.06070

 

81

 

83.33330

 

24

 

0.43600

 

53

 

10.33800

 

82

 

83.33330

 

25

 

0.47960

 

54

 

11.78270

 

83

 

83.33330

 

26

 

0.52900

 

55

 

13.34950

 

84

 

83.33330

 

27

 

0.58690

 

56

 

15.02480

 

85

 

83.33330

 

28

 

0.65150

 

57

 

16.75710

 

86

 

83.33330

 

29

 

0.72450

 

58

 

18.50020

 

87+

 

0]

 

 

9

 

Table of Maximum Monthly Coverage Charges

for Basic Life Coverage [(Guaranteed Issue)]

 

Insured:

 

[John Doe]

 

Policy
Year

 

Coverage
Charge

 

Policy
Year

 

Coverage
Charge

 

Policy
Year

 

Coverage
Charge

 

[1

 

$

79.87

 

30

 

$

79.87

 

59

 

$

79.87

 

2

 

$

79.87

 

31

 

$

79.87

 

60

 

$

79.87

 

3

 

$

79.87

 

32

 

$

79.87

 

61

 

$

79.87

 

4

 

$

79.87

 

33

 

$

79.87

 

62

 

$

79.87

 

5

 

$

79.87

 

34

 

$

79.87

 

63

 

$

79.87

 

6

 

$

79.87

 

35

 

$

79.87

 

64

 

$

79.87

 

7

 

$

79.87

 

36

 

$

79.87

 

65

 

$

79.87

 

8

 

$

79.87

 

37

 

$

79.87

 

66

 

$

79.87

 

9

 

$

79.87

 

38

 

$

79.87

 

67

 

$

79.87

 

10

 

$

79.87

 

39

 

$

79.87

 

68

 

$

79.87

 

11

 

$

79.87

 

40

 

$

79.87

 

69

 

$

79.87

 

12

 

$

79.87

 

41

 

$

79.87

 

70

 

$

79.87

 

13

 

$

79.87

 

42

 

$

79.87

 

71

 

$

79.87

 

14

 

$

79.87

 

43

 

$

79.87

 

72

 

$

79.87

 

15

 

$

79.87

 

44

 

$

79.87

 

73

 

$

79.87

 

16

 

$

79.87

 

45

 

$

79.87

 

74

 

$

79.87

 

17

 

$

79.87

 

46

 

$

79.87

 

75

 

$

79.87

 

18

 

$

79.87

 

47

 

$

79.87

 

76

 

$

79.87

 

19

 

$

79.87

 

48

 

$

79.87

 

77

 

$

79.87

 

20

 

$

79.87

 

49

 

$

79.87

 

78

 

$

79.87

 

21

 

$

79.87

 

50

 

$

79.87

 

79

 

$

79.87

 

22

 

$

79.87

 

51

 

$

79.87

 

80

 

$

79.87

 

23

 

$

79.87

 

52

 

$

79.87

 

81

 

$

79.87

 

24

 

$

79.87

 

53

 

$

79.87

 

82

 

$

79.87

 

25

 

$

79.87

 

54

 

$

79.87

 

83

 

$

79.87

 

26

 

$

79.87

 

55

 

$

79.87

 

84

 

$

79.87

 

27

 

$

79.87

 

56

 

$

79.87

 

85

 

$

79.87

 

28

 

$

79.87

 

57

 

$

79.87

 

86

 

$

79.87

 

29

 

$

79.87

 

58

 

$

79.87

 

87+

 

$

0.00]

 

 

10

 

[Table of Minimum Death Benefit Percentages — Cash Value Accumulation Test

Applicable on the Policy Date

 

Insured:

 

[John Doe]

 

Policy
Year

 

Minimum
Death Benefit
Percentage

 

Policy
Year

 

Minimum
Death Benefit
Percentage

 

Policy
Year

 

Minimum
Death Benefit
Percentage

 

[1

 

555

%

23

 

257

%

45

 

141

%

2

 

508

%

24

 

249

%

46

 

138

%

3

 

491

%

25

 

241

%

47

 

135

%

4

 

475

%

26

 

234

%

48

 

132

%

5

 

460

%

27

 

226

%

49

 

130

%

6

 

445

%

28

 

220

%

50

 

127

%

7

 

431

%

29

 

213

%

51

 

125

%

8

 

418

%

30

 

207

%

52

 

123

%

9

 

405

%

31

 

201

%

53

 

121

%

10

 

392

%

32

 

195

%

54

 

120

%

11

 

379

%

33

 

190

%

55

 

118

%

12

 

367

%

34

 

185

%

56

 

117

%

13

 

356

%

35

 

180

%

57

 

115

%

14

 

344

%

36

 

175

%

58

 

114

%

15

 

333

%

37

 

170

%

59

 

113

%

16

 

322

%

38

 

166

%

60

 

112

%

17

 

312

%

39

 

162

%

61

 

111

%

18

 

302

%

40

 

158

%

62

 

110

%

19

 

292

%

41

 

154

%

63

 

108

%

20

 

283

%

42

 

150

%

64

 

106

%

21

 

274

%

43

 

147

%

65

 

104

%

22

 

265

%

44

 

144

%

66+

 

101]]

%

 

11

 

[Table of Minimum Death Benefit Percentages — Guideline Premium Test

Applicable on the Policy Date

 

Insured:

 

[John Doe]

 

 

 

Death Benefit

 

 

 

Death Benefit

 

 

 

Death Benefit

 

 

 

Death Benefit

 

Age

 

Percentage

 

Age

 

Percentage

 

Age

 

Percentage

 

Age

 

Percentage

 

[0-40

 

250

%

50

 

185

%

60

 

130

%

70

 

115

%

41

 

243

%

51

 

178

%

61

 

128

%

71

 

113

%

42

 

236

%

52

 

171

%

62

 

126

%

72

 

111

%

43

 

229

%

53

 

164

%

63

 

124

%

73

 

109

%

44

 

222

%

54

 

157

%

64

 

122

%

74

 

107

%

45

 

215

%

55

 

150

%

65

 

120

%

75-90

 

105

%

46

 

209

%

56

 

146

%

66

 

119

%

91

 

104

%

47

 

203

%

57

 

142

%

67

 

118

%

92

 

103

%

48

 

197

%

58

 

138

%

68

 

117

%

93

 

102

%

49

 

191

%

59

 

134

%

69

 

116

%

94+

 

101]]

%

 

12