EX-99.DIII 3 dex99diii.htm FORM OF DISABILITY BENEFIT RIDER Form of Disability Benefit Rider

Exhibit (d) iii

Disability Benefit Rider

This rider provides benefits if the Insured becomes totally disabled. It provides for waiver of monthly charges and the credit of a Specified Monthly Benefit if the Insured is totally and continuously disabled for four months or more. We discuss this rider, and the rules that apply to it, in the provisions that follow. This rider has no surrender or loan value.

 

Rider Part Of The Policy

This rider is made a part of this policy as of its Rider Issue Date, in return for the application for this rider and the payment of monthly rider charges. The Rider Issue Date is shown in the Policy Specifications for this rider. Monthly rider charges are discussed later in this rider. All the provisions of this policy apply to this rider, except for those that are inconsistent with this rider. This rider is in force from the later of the day the policy becomes in force and the Rider Issue Date.

 

Rider Benefits

This rider provides two types of benefits if the Insured becomes totally disabled. They are described as follows:

 

   

We will credit the Specified Monthly Benefit shown in the Policy Specifications for this rider to the Account Value of this policy on specific Monthly Charge Dates. The Specified Monthly Benefit will be treated as a net premium subject to the terms of the policy; and

 

   

We will waive the monthly charges for the policy due on specific Monthly Charge Dates.

 

  These benefits will be provided after the Insured has been totally disabled for four continuous months or longer and all conditions of this rider are met. Subject to the other provisions of this rider, the Monthly Charge Dates for which each type of benefit will be provided are:

 

   

Any Monthly Charge Date (except the Rider Date) during the first four continuous months of the Insured’s total disability; and

 

   

Any Monthly Charge Date thereafter during the continuance of total disability but before the Insured’s Attained Age reaches 65.

 

  If total disability begins before Attained Age 60 and continues to Attained Age 65 the rider benefit after Attained Age 65 will be the monthly charges for this policy.

 

  Monthly charges will continue to be deducted on each Monthly Charge Date until a claim has been approved. For any of these Monthly Charge Dates that have already passed at the time a claim is approved, the Account Value of this policy will be credited to reflect provision of these monthly benefits. We will not return any premiums paid. The Rider Date is shown in the Policy Specifications for this rider.

 

  If total disability begins during the grace period, an additional amount of premium may be required to prevent this policy from terminating (see the Grace Period And Termination provision of this policy) prior to the approval of a claim.

 

  While benefits under this rider are being provided, this policy will continue in force subject to the terms of this policy and the investment performance of the Separate Account included as part of the Account Value.

 

  If there is any policy debt while the Insured is totally disabled, the allowance of benefits under this rider does not guarantee that this policy will continue in force.

 

When Benefits End

The benefits under this rider will end when any of the following occurs:

 

   

The Insured is no longer totally disabled; or

 

   

Satisfactory proof of continued total disability is not given to us as required; or

 

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Exhibit (d) iii

 

   

The Insured refuses or fails to have an examination we require; or

 

   

For the Specified Monthly Benefit, the day before the Insured’s Attained Age becomes 65; and

 

   

For waiver of monthly charges, the day before the Insured’s Attained Age becomes 65 if total disability began when the Insured’s Attained Age was 60 or older.

 

Exclusions

This rider does not provide any benefit for:

 

   

Any Monthly Charge Date before the Insured’s Attained Age 5; or

 

   

Total disability directly caused by any willfully and intentionally self-inflicted injury; or

 

   

Total disability caused by war while the Insured is in the military forces of any country at war or in any civilian noncombatant unit serving with those forces. “War” includes undeclared war and any act of war. “Country” includes any international organization or group of countries.

 

Limitation On Right To Increase Face Amount

Each increase in the Face Amount of the policy may cause an increase in the benefit amount for this rider. In certain cases, however, benefits under this rider cannot be increased. In those cases, we have the right to refuse an increase in the Face Amount. Those cases are:

 

   

The rider benefits after the increase would exceed our published limits for such benefits;

 

   

The Insured does not meet our underwriting requirements for the additional rider benefits; and

 

   

A higher rating would apply to the additional rider benefits than to the existing benefits.

 

  This limitation does not apply to any increase under the policy not requiring evidence of insurability.

 

Total Disability

Total disability is the incapacity of the Insured that:

 

   

Is caused by sickness or injury; and

 

   

Requires the Insured to be under a doctor’s care; and

 

   

Begins while this rider is in force; and

 

   

For the first 60 months of any period of total disability, prevents the Insured from performing the substantial and material duties of the Insured’s occupation; and

 

   

After total disability has continued for 60 months, prevents the Insured from engaging in any occupation the Insured is or may become qualified to perform.

 

  For the first 60 months of any period of total disability, the Insured’s occupation is the Insured’s usual work, employment, business, or profession at the time total disability began. After total disability has continued for 60 months, any occupation the Insured is or may become qualified to perform means any work, employment, business, or profession the Insured is reasonably qualified to do based on education, training, or experience. Until the Insured reaches an age at which formal education may be legally ended, occupation means attendance at school.

 

  Example: You are a full-time surgeon. You receive an injury to your hands that prevents you from performing surgery, but you can carry on a general medical practice. For the first 60 months, your occupation is surgeon. After that time, your occupation will be any that you are reasonably qualified to do based on your education, training, or experience. Since you can carry on a general medical practice, we would no longer consider you to be totally disabled.

 

  For some conditions, we consider the Insured to be totally disabled even if the Insured is able to work. These conditions are the total loss of sight of both eyes, or the total loss of use of both hands, or both feet, or one hand and one foot. Any of these will be total disability as long as the loss continues.

 

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Exhibit (d) iii

 

Recurrent Disabilities

Periods of recurrent disability may not be used to satisfy the requirements of the initial four continuous month waiting period. After the initial four continuous month waiting period has been satisfied a period of total disability following an earlier period of total disability that was due to the same, or a related, condition may be considered to be a continuation of the earlier period. This depends on how much time passed from the end of the earlier period to the beginning of the current one. If less than six months have passed, we will consider it to be a continuation of the earlier period. If six months or more have passed, we will consider it to be a new period of disability.

 

  Example: You were totally disabled for 10 months because of a severe knee injury. Two weeks after you recover, your knee fails and you are totally disabled again. We consider this to be a continuation of the earlier period of total disability.

 

Notice Of Claim

Notice of claim means written notice that the Insured is totally disabled and that a claim may be made under this rider. We require that this notice identify the Insured. Notice given by or for the Owner shall be notice of claim.

 

  However, there are two time limits for giving notice of claim. First, no benefit will be considered unless notice is given to us while the Insured is living and during the continuance of total disability. Second, if notice is given more than one policy year from the Monthly Charge Date on which charges would have first been waived due to the Insured’s total disability, we will only provide a benefit for the twelve Monthly Charge Dates that immediately precede the date notice is given to us. However, there is an exception to each of these time limits. If it was not reasonably possible to give us notice of claim while the Insured was living and within the same time limits, the delay will not reduce the benefit if notice is given as soon as reasonably possible.

 

Proof Of Claim

Before any benefit is allowed, proof of claim must be given to us at our Home Office or Administrative Office. Proof may be given by or for the Owner. Proof of claim includes written proof from a licensed medical practitioner, other than the Insured or an Insured’s family member satisfactory to us, that:

 

   

The Insured is totally disabled; and

 

   

Total disability began while this rider was in force; and

 

   

Total disability began before the Insured’s Attained Age 65; and

 

   

Total disability has continued for four continuous months.

 

  We have forms that are to be used to make a claim. They will be sent promptly upon request. As part of the proof of claim, we have the right to require an examination of the Insured at our expense by a physician chosen by us.

 

When Proof Of Claim Must Be Furnished

Proof of claim must be received at our Home Office or Administrative Office within one year after the notice of claim was given to us. However, if it was not reasonably possible to give us proof of claim on time, the delay will not reduce the benefit if proof is given as soon as reasonably possible.

 

Proof Of Continued Disability

During the first 24 months after proof of claim is received, we may require satisfactory proof of continued disability not more than once every 30 days. After 24 months, we may require proof not more than once a year. As part of this proof, we have the right to require an examination of the Insured at our expense by a physician chosen by us.

 

  Proof of continued disability will not be required once the Insured has become Attained Age 65 if total disability began before the Insured was Attained Age 60.

 

Rider Charges

Each month while this rider is in force, the rider charge is the sum of the waiver charge and the specified benefit charge. The waiver charge each month equals the sum of the policy monthly charges for the month, excluding the rider charge for this rider, multiplied

 

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Exhibit (d) iii

 

  by the Waiver Charge Rate for the Insured’s Attained Age. The specified benefit charge each month equals the Specified Monthly Benefit multiplied by the Specified Benefit Charge Rate for the Insured’s Attained Age. The Waiver Charge Rates and the Specified Benefit Charge Rates are shown in the Policy Specifications for this rider.

 

  Example: The sum of the policy monthly charges for the month is $200. The Waiver Charge Rate for the Attained Age of the Insured is 0.076. The waiver charge for that month is $15.20 ($200 multiplied by 0.076).

 

  The Specified Monthly Benefit is $500. The Specified Benefit Charge Rate for the Insured’s Attained Age is 0.0276. The specified benefit charge for that month is $13.80 ($500 multiplied by 0.0276).

 

  The rider charge for that month is $29.00 ($15.20 plus $13.80).

 

Rider Premium Expense Factor

The Rider Premium Expense Factor is shown in the Policy Specifications for this rider. It is used to determine the premium expense charge and the net premium. See the Net Premium provision in Part 2 of the policy.

 

  While this rider is in force, premium payments made on this policy will be allocated to each segment of the policy Face Amount and to any benefit rider this policy has, including this rider. This allocation will be made on a pro rata basis using the Premium Expense Factor for each segment of the policy Face Amount, the Rider Premium Expense Factor for each rider, and the Rider Premium Expense Factors for any increases in each rider.

Contestability

We can bring legal action to contest the validity of this rider for any material misrepresentation of a fact made in the application for this rider. However, we cannot, in the absence of fraud, contest the validity of this rider after it has been in force during the lifetime of the Insured and without the occurrence of total disability for two years after its Rider Issue Date. The Rider Issue Date is shown in the Policy Specifications for this rider.

 

Termination Of This Rider

While monthly charges for this rider are being deducted from the Account Value of this policy, this rider will continue in force to, but not including, the Policy Anniversary Date on which the Insured’s Attained Age becomes 65. This rider will terminate before that Date if this policy terminates for any reason. However, any benefits under this rider for which the Insured qualified before termination may be claimed after termination as specified in the Notice Of Claim provision.

 

Cancellation Of This Rider

This rider may be cancelled by the Owner’s Written Request. Such cancellation will take effect on the policy Monthly Charge Date that is on, or precedes, the date we receive the Written Request.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY

 

ABC   ABC
PRESIDENT   SECRETARY

 

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Exhibit (d) iii

 

 

POLICY SPECIFICATIONS

DISABILITY BENEFIT RIDER

 

 

POLICY NUMBER:      123456789
INSURED:      JOHN A. DOE
RIDER ISSUE AGE AND GENDER:      35 MALE
RIDER DATE:      JANUARY 1, 2008
RIDER ISSUE DATE:      JANUARY 1, 2008
DISABILITY BENEFIT CLASS:      NONTOBACCO
RIDER PREMIUM EXPENSE FACTOR:      765.00
SPECIFIED MONTHLY BENEFIT:      $400.00

MONTHLY RIDER CHARGE RATES

PART ONE - WAIVER CHARGE RATES

 

ATTAINED

AGE

   WAIVER
CHARGE
RATE
   ATTAINED
AGE
   WAIVER
CHARGE
RATE
   ATTAINED
AGE
   WAIVER
CHARGE
RATE

35

   0.063    45    0.069    55    0.173

36

   0.063    46    0.072    56    0.197

37

   0.063    47    0.076    57    0.223

38

   0.063    48    0.080    58    0.250

39

   0.063    49    0.086    59    0.198

40

   0.063    50    0.095    60    0.176

41

   0.063    51    0.105    61    0.113

42

   0.064    52    0.118    62    0.063

43

   0.065    53    0.132    63    0.025

44

   0.067    54    0.151    64    0.013

PART TWO - SPECIFIED BENEFIT CHARGE RATES

 

ATTAINED

AGE

   SPECIFIED
BENEFIT
CHARGE
RATE
   ATTAINED
AGE
   SPECIFIED
BENEFIT
CHARGE
RATE
   ATTAINED
AGE
   SPECIFIED
BENEFIT
CHARGE
RATE

35

   0.0176    45    0.0239    55    0.0378

36

   0.0176    46    0.0252    56    0.0378

37

   0.0176    47    0.0265    57    0.0378

38

   0.0176    48    0.0290    58    0.0378

39

   0.0176    49    0.0302    59    0.0378

40

   0.0176    50    0.0315    60    0.0378

41

   0.0176    51    0.0328    61    0.0378

42

   0.0202    52    0.0353    62    0.0378

43

   0.0214    53    0.0365    63    0.0250

44

   0.0227    54    0.0378    64    0.0130