EX-5 8 exhibit164b.htm EXHIBIT 16(4)(B) exhibit164b.htm - Generated by SEC Publisher for SEC Filing

 

Exhibit 16(4)(b):  Individual Annuity Contract (Form No. I2-MGA-95)

[AETNA LOGO]

Aetna Insurance Company of America
Home Office: 151 Farmington Avenue
Hartford, Connecticut 06156

(800) 531-4547
A STOCK COMPANY
Aetna Insurance Company of America, herein called Aetna, agrees
to pay the benefits stated in this Contract.
 
Specifications
------------------------------------------------------------------------
Plan AETNA MULTI-RATE ANNUITY
------------------------------------------------------------------------
Type of Plan SINGLE PREMIUM MODIFIED GUARANTEED DEFERRED ANNUITY
------------------------------------------------------------------------
Contract Holder(s) ANY INDIVIDUAL
------------------------------------------------------------------------
Contract No. SPECIMEN
------------------------------------------------------------------------
Effective Date DECEMBER 1, 1995
------------------------------------------------------------------------
This Contract is Delivered in YOUR STATE and is Subject
to the Laws of that Jurisdiction
 
RIGHT TO CANCEL
------------------------------------------------------------------------
The Contract Holder may cancel this Contract within 10 days of receiving it by

returning this Contract along with a written notice to Aetna at the above
address or to the agent from whom it was purchased. Within 7 days after it
receives the notice of cancellation and this Contract at its Home Office,
Aetna will return the entire consideration paid.

Signed at the Home Office on the Effective Date.

/s/Dan Kearney /s/ Marie McKeon
President Secretary

Individual Single Premium Modified Guaranteed Deferred Annuity Contract
Nonparticipating

THIS CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT FORMULA. APPLICATION OF A
MARKET VALUE ADJUSTMENT MAY RESULT IN EITHER AN INCREASE OR DECREASE IN THE
CURRENT VALUE. THE MARKET VALUE ADJUSTMENT FORMULA DOES NOT APPLY TO A
GUARANTEED PERIOD AT THE TIME OF ITS MATURITY.

I2-MGA-95



Specifications

-----------------------------------------------------------------------------
Guaranteed There is a guaranteed interest rate for the Purchase
Interest Rate Payment held in the AMG Account. (See Contract
Schedule I).

-----------------------------------------------------------------------------
Deduction from The Purchase Payment may be subject to a deduction for
Purchase premium taxes, if applicable. (See 3.01.)
Payment
-----------------------------------------------------------------------------

Surrender There may be a charge deducted upon surrender. (See
Fee Contract Schedule 1).

This Contract is a legal contract and constitutes the entire legal
relationship between Aetna and the Contract Holder.

READ THIS CONTRACT CAREFULLY. This Contract sets forth, in detail, all of the
rights and obligations of both you and Aetna. IT IS THEREFORE IMPORTANT THAT
YOU READ THIS CONTRACT CAREFULLY.

2


I2-MGA-95



Contract Schedule I
Accumulation Period

AICA Modified Guaranteed Account (AMG Account)
-----------------------------------------------------------------------------

 


 

 

Minimum Guaranteed [3.0%]  
Interest Rate:    
(effective annual rate of return)    
 
Maintenance Fee: The annual Maintenance Fee is [$0.] [If
  the Current Value is [$50,000] or more
  on the date the Maintenance Fee is to
  be deducted, the Maintenance Fee is
$0.]
 
Annuity Date: The Annuity Date will be the later of
  the date the Annuitant reaches age [85]
  or the [10th] anniversary of the
  Purchase Payment.  
 
Minimum Purchase [$10,000.]  
Payment:    
 
Maximum Purchase Purchase Payments exceeding
Payment: [$1,000,000] must be approved by Aetna.
 
Minimum Guaranteed Period [$1,000.]  
Allocation Amount:    
 
Maximum Age of [90.] If there are joint Contract
Contract Holder at issue: Holders, the age of the oldest Contract
  Holder cannot exceed [90.]
 
 
 
 
Surrender Fee: Length of Time from Surrender Fee
Contract Effective (Percentage of
Date (Years) Net Purchase
Payment Withdrawn)
 
 
 
 
   
 
  Less than 1 year 7%
  1 year but less than 2 7%
  2 years but less than 3 6%
  3 years but less than 4 6%
  4 years but less than 5 5%
  5 years but less than 6 4%
  6 years but less than 7 2%
  7 years or more 0%
   
 
  After seven years have elapsed from the
  contract effective date, the Surrender
  Fee will no longer be assessed.
 
Special Withdrawal: The percentage may not be greater
  than [10%].  
 
Systematic Withdrawal The specified payment or specified
Option (SWO): percentage may not be greater than [10%].

 

See 1. GENERAL DEFINITIONS for explanations.

3

I2-MGA-95

Contract Schedule II
Annuity Period

Fixed Annuity ------------------------------------------------------------------------------

Minimum Guaranteed [3.0%]
Interest Rate  
(effective annual rate of  
return):  

 

See 1. GENERAL DEFINITIONS for explanations.

4

I2-MGA-95

TABLE OF CONTENTS

Page

 


 

 

I. GENERAL DEFINITIONS
------------------------------------------------------------------------     

1.01 Accumulation Period 7
1.02 Adjusted Current Value 7
1.03 Annuitant 7
1.04 Annuity 7
1.05 Annuity Date 7
1.06 Beneficiary 7
1.07 Code 7
1.08 Contract 7
1.09 Contract Holder 7
1.10 Current Value 7
1.11 Deposit Period 7
1.12 Entire Contract 7
1.13 Fixed Annuity 7
1.14 General Account 8
1.15 Guaranteed Rates -- AMG Account 8
1.16 Guaranteed Period 8
1.17 Guaranteed Period Groups 8
1.18 Maintenance Fee 8
1.19 AICA Modified Guaranteed Account (AMG Account) 8
1.20 Market Value Adjustment (MVA) 9
1.21 Matured Period Value 9
1.22 Maturity Date 9
1.23 Net Purchase Payment 9
1.24 Nonunitized Separate Account 9
1.25 Purchase Payment 9
1.26 Reinvestment 9
1.27 Surrender Value 10
  5  
I2-MGA-95  
   

 

II. GENERAL PROVISIONS
------------------------------------------------------------------------     

2.01 Change of Contract 10
2.02 Nonparticipating Contract 10
2.03 Payments and Elections 10
2.04 State Laws 10
2.05 Control of Contract 10
2.06 Designation of Beneficiary 11
2.07 Misstatements and Adjustments 11
2.08 Incontestability 11

 

III. PURCHASE PAYMENT, CURRENT VALUE, AND SURRENDER PROVISIONS
------------------------------------------------------------------------     

3.01 Net Purchase Payment 11

 



 

 

3.02 Market Value Adjustment 11
3.03 Notice to the Contract Holder 12
3.04 Loans 12
3.05 Systematic Withdrawal Option (SWO) 13
3.06 Death Benefit Amount 14
3.07 Death Benefit Options available to Beneficiary 15
3.08 Liquidation of Surrender Value 16
3.09 Surrender Fee 16
3.10 Payment of Surrender Value 16
3.11 Payment of Adjusted Current Value 17
IV. ANNUITY PROVISIONS  

----------------------------------------------------------------------

4.01 Choices to be Made 17
4.02 Terms of Annuity Options 17
4.03 Death of Annuitant/ Beneficiary 18
4.04 Annuity Options 18

 

6

I2-MGA-95

I.     

GENERAL DEFINITIONS

------------------------------------------------------------------------     

1.01 Accumulation Period: The period during which the Net
    Purchase Payment is applied to the
    Contract to provide future Annuity
    payment(s).
 
1.02 Adjusted Current Value: The Current Value of a Contract plus or
    minus any aggregate AMG Account MVA, if
    applicable. (see 1.20)
 
1.03 Annuitant: The person named by the Contract Holder
    whose life is measured for purposes of
    the guaranteed death benefit and the
    duration of Annuity payments under this
    Contract. Subject to Aetna's approval,
    the Annuitant may be changed by the
    Contract Holder by notifying Aetna in
    writing prior to the Annuity Date of
    this Contract.
 
1.04 Annuity: Payment of an income:
 
    (a) For the life of one or two
      persons;
    (b) For a stated period; or
    (c) For some combination of (a)
      and (b).
 
1.05 Annuity Date: The date on which Annuity payments
    begin under an Annuity option elected
    by the Contract Holder. (see 4.01). The
    Annuity Date is shown on Contract
    Schedule I. The Contract Holder may
    change this date by notifying Aetna at
    least 30 days prior to the Annuity
    Date.  
 
1.06 Beneficiary: The person(s) entitled to receive death
    benefits under the terms of this
    Contract.  
 
1.07 Code: The Internal Revenue Code of 1986, as
    it may be amended from time to time.
 
1.08 Contract: This agreement between Aetna and the
    Contract Holder.

 

 


 

1.09     

Contract Holder:

1.10     

Current Value:

1.11     

Deposit Period:

1.12     

Entire Contract:

1.13     

Fixed Annuity:

I2-MGA-95

1.14     

General Account:

1.15     

Guaranteed Rates -- AMG Account:

1.16 Guaranteed Period:

1.17     

Guaranteed Period Groups:

7

 

The entity to which the Contract is
issued. Joint Contract Holders must be
spouses.

The Net Purchase Payment plus any
interest credited; less all Maintenance
Fees deducted, any amounts surrendered
and any amounts applied to an Annuity.

A calendar week, a calendar month, a
calendar quarter, or any other period
of time specified by Aetna during which
the Net Purchase Payment and
Reinvestments are accepted into the AMG
Account for one or more Guaranteed
Periods. Aetna reserves the right to
extend the Deposit Period.

The Contract, all attached pages and
any subsequent endorsements make up the
Entire Contract.

An Annuity with payments that do not
vary in amount based on investment
performance.

The account holding the assets of
Aetna, other than those assets held in
Aetna's separate accounts.

Aetna will declare the interest rate
applicable for each Guaranteed Period
at the start of the Deposit Period for
that applicable Guaranteed Period. The
rate(s) are guaranteed by Aetna for
that Deposit Period and the ensuing
Guaranteed Period(s). The Guaranteed
Rates are effective annual rates of
return. That is, interest is credited
daily at a rate that will produce the
Guaranteed Interest Rate over the
period of a year. No Guaranteed Rate
will ever be less than the Minimum
Guaranteed Interest Rate shown on
Contract Schedule I.

For Guaranteed Periods of one year or
less, one Guaranteed Rate is credited
for the full Guaranteed Period. For
longer Guaranteed Periods, an initial
Guaranteed Rate is credited from the
date of deposit to the end of a
specified period within the Guaranteed
Period. There may be different
Guaranteed Rate(s) declared at the
beginning of the Deposit Period for
subsequent specified time intervals
throughout the Guaranteed Period.

The period of time for which Guaranteed
Rates are guaranteed on the Net
Purchase Payment and Reinvestments made
during a current Deposit Period. Such
period begins on the day following the
close of the Deposit Period and ends on
the designated Maturity Date.
Guaranteed Periods are offered at
Aetna's discretion for various lengths
of time ranging up to and including
twenty years.

During a Deposit Period, Aetna may make
available any number of Guaranteed
Periods. The Contract Holder may
allocate the Net Purchase Payment or
Reinvestment into any or all of the
available Guaranteed Periods.

All Guaranteed Periods with the same
length of time from the close of the
Deposit Period until the designated

 


 

1.18     

Maintenance Fee:

1.19     

AICA Modified Guaranteed Account (AMG Account):

I2-MGA-95

1.20 Market Value Adjustment (MVA):

1.21     

Matured Period Value:

1.22     

Maturity Date:

1.23     

Net Purchase Payment:

1.24 Nonunitized Separate Account:

1.25     

Purchase Payment:

1.26     

Reinvestment:

 

Maturity Date.

The Maintenance Fee, if any (see
Contract Schedule I), will be deducted
during the Accumulation Period on each
anniversary of the date the Contract is
established and upon surrender of the
entire Contract.

An accumulation option where Aetna
guarantees rate(s) of interest for
specified periods of time. All assets
of Aetna, including amounts in the
Nonunitized Separate Account, are
available to meet the guarantees under
the AMG Account.

8

An adjustment that may apply to the
amount withdrawn from a Guaranteed
Period prior to the end of that
Guaranteed Period. The adjustment
reflects the change in the value of the
investment due to changes in interest
rates since the date of deposit and is
computed using the formula given in
3.02. The adjustment is expressed as a
percentage or a factor of each dollar
being withdrawn.

The amount payable on Guaranteed
Period's Maturity Date.

The last day of a Guaranteed Period.

The Purchase Payment less premium
taxes, as applicable.

A separate account set up by Aetna
under Title 38, Section 38a-433, of the
Connecticut General Statutes, that
holds assets for AMG Account Guaranteed
Periods. There are no discrete units
for the AMG Account. The Contract
Holder does not participate in the
investment gain or loss from the assets
held in the Nonunitized Separate
Account. Such gain or loss is borne
entirely by Aetna. The assets held in
the AMG Account may be chargeable with
liabilities arising out of any other
business of Aetna.

Payment accepted by Aetna at its Home
Office. Aetna reserves the right to
refuse to accept any Purchase Payment
at any time for any reason.

Aetna will notify the Contract Holder
of the approaching Maturity Date at
least 18 calendar days prior to the end
of any Guaranteed Period. If no
specific direction is given by the
Contract Holder prior to the Maturity
Date, each Matured Period Value will be
reinvested on the Maturity Date for a
Guaranteed Period of the same duration.
If a Guaranteed Period of the same
duration is unavailable, each Matured
Period Value will automatically be
reinvested on the Maturity Date for the
next shortest Guaranteed Period
available. If no shorter Guaranteed
Period is available, the next longer
Guaranteed Period will be used. Aetna
will mail a confirmation statement to
the Contract Holder the next business
day after the Maturity Date.

At any time prior to the Maturity Date,
the Contract Holder may request in
writing a reinvestment of the Matured

 


 

 

      Period Value in a different Guaranteed
      Period(s) or a surrender of all or a
      part of the Matured Period Value
      without an MVA or Surrender Fee. Such
      request will be executed on the
      Maturity Date If reinvesting in a
      different Guaranteed Period(s), all or
      part of the Matured Period Value will
      be reinvested in the elected Guaranteed
      Period(s) at the then prevailing
      rate(s). This provision only applies to
      a written request from the Contract
      Holder received at Aetna's Home Office
      in good order at least five (5) days
      prior to the Maturity Date. 1.27
      Surrender Value: The amount payable by
      Aetna upon the surrender of all or any
      portion of the Contract.
 
9
 
I2-MGA-95    
     
 
1.27 Surrender Value:   The amount payable by Aetna upon the
      surrender of all or any portion of the
      Contract.
 
 
II. GENERAL PROVISIONS    

 

------------------------------------------------------------------------

2.01 Change of Contract: Only an authorized officer of Aetna may
    change the terms of this Contract.
    Aetna reserves the right to modify this
    Contract to meet the requirements of
    applicable state and federal laws or
    regulations. Aetna will notify the
    Contract Holder in writing of any
    changes.
 
2.02 Nonparticipating Contract: Contract Holders or Beneficiaries will
    not have a right to share in the
    earnings of Aetna.
 
2.03 Payments and Elections: While the Contract Holder is living,
    Aetna will pay any Annuity payments as
    and when due. After the Contract
    Holder's death, or at the death of the
    first Contract Holder if the Contract
    is owned jointly, any Annuity payments
    will be paid in accordance with 4.03.
    Aetna will make any other payments
    within seven (7) calendar days of
    receipt of a written request for
    payment, which is in good order, at its
    Home Office, except as provided in
    3.10.
 
2.04 State Laws: The Contract complies with the laws of
    the state in which it is delivered. Any
    surrender, death, or Annuity payments
    are equal to or greater than the
    minimum required by such laws. Annuity
    tables for legal reserve valuation
    shall be as required by state law. Such
    tables may be different from Annuity
    tables used to determine Annuity
    payments.
 
2.05 Control of Contract: This is a Contract between the Contract
    Holder and Aetna. The Contract Holder
    has all rights, title and interest in
    amounts held in this Contract.
 
    Choices made under this Contract must
    be in writing. If the Contract is owned
    jointly, both Contract Holders must
    authorize any choices in writing. Until
    receipt of such choices at Aetna's Home
    Office, Aetna may rely on any previous
    choices made.
 
    The Contract is not subject to the
    claims of any creditors of the Contract
    Holder, except to the extent permitted
    by law. The Contract Holder may assign

 

 


 

 

or transfer his or her rights under the
Contract. Aetna reserves the right not
to accept assignment or transfer to a
nonnatural person. Any assignment or
transfer made must be submitted to
Aetna's Home Office in writing and will
not be effective until accepted by
Aetna. Aetna assumes no responsibility
for the validity of any assignment.

10

I2-MGA-95  
 
   
 
2.06 Designation of Beneficiary: The Contract Holder shall name his or
    her Beneficiary. The Beneficiary may be
    changed at any time. Changes to a
    Beneficiary must be submitted to
    Aetna's Home Office in writing and will
    not be effective until received and
    recorded by Aetna.
 
2.07 Misstatements and Adjustments: If Aetna finds the age of any Annuitant
    to be misstated, the correct facts will
    be used to adjust payments.
 
2.08 Incontestability: Aetna will not contest this Contract
    from its effective date.

 

III. PURCHASE PAYMENT, CURRENT VALUE, AND SURRENDER PROVISIONS
------------------------------------------------------------------------     

3.01 Net Purchase Payment: This amount is the actual Purchase
    Payment less any applicable premium
    tax. Aetna reserves the right to deduct
    any premium tax at any time from the
    Purchase Payment or from the Contract
    Holder's Current Value. The Contract
    Holder shall tell Aetna the allocation
    percentage of the Net Purchase Payment
    to be applied to each of the available
    Guaranteed Periods during the current
    Deposit Period(s). The minimum amount
    that may be allocated to any Guaranteed
    Period is shown on Contract Schedule l.
 
 
3.02 Market Value Adjustment: There will be an MVA for any withdrawal
    before the end of a Guaranteed Period
    when the withdrawal is due to:
 
    (a) Any full or partial surrender, but
      not for a partial withdrawal under
      the Systematic Withdrawal Option
      (see 3.05); or
    (b) Payment made to a Beneficiary as a
      death benefit during the
      Accumulation Period, but not
      payment made within six months of
      the date of the Annuitant's death
      (see 3.06); or
    (c) An election of an Annuity option.
      Only a positive MVA, if any, will
      apply upon election of option 2 or
      3 (see 4.04).
 
    Market value adjusted amounts will be
    equal to the amount withdrawn
    multiplied by the following ratio:

 

x
---
365

(1 + i)
----------------
x
---
365
(1 + j)

Where:

i is the Deposit Period Yield
j is the Current Yield

 


 

x is the number of days remaining,
(computed from Wednesday of the week
of withdrawal) in the Guaranteed
Period.

11

I2-MGA-95    
     
 
3.02 Market Value Adjustment: The Deposit Period Yield will be
  (Cont'd) determined as follows:
 
    (a) At the close of the last business
      day of each week of the Deposit
      Period, a yield will be computed
      as the average of the yields on
      that day of U.S. Treasury Notes
      which mature in the last three
      months of the Guaranteed Period.
 
    (b) The Deposit Period Yield is the
      average of those yields for the
      Deposit Period. If withdrawal is
      made before the close of the
      Deposit Period, it is the average
      of those yields on each week
      preceding withdrawal.
 
    The Current Yield is the average of the
    yields on the last business day of the
    week preceding withdrawal on the same
    U.S. Treasury Notes included in the
    Deposit Period Yield.
 
    In the event that no U.S. Treasury
    Notes which mature in the last three
    months of the Guaranteed Period exist,
    Aetna reserves the right to use the
    U.S. Treasury Notes that mature in the
    following quarter.
 
3.03 Notice to the Contract The Contract Holder will receive
  Holder: statements at least annually from Aetna
    showing the value of any amounts held
    in the AMG Account.
 
    Such values will be as of a specific
    date no more than 60 days before the
    date of the notice.
 
3.04 Loans: Loans are not available under this
    Contract.
 
12
 
I2-MGA-95    
     
 
3.05 Systematic Withdrawal Option The Contract Holder may elect a
  (SWO): distribution option under which a
    portion of the Current Value will
    automatically be surrendered and
    distributed each year. SWO payments
    will be calculated based on the
    Contract's full Current Value. The
    distributed amount is withdrawn pro
    rata from each Guaranteed Period(s). A
    Surrender Fee will not be deducted from
    any portion of the Current Value which
    is paid as a distribution under SWO.
 
    Contract Holders should consult their
    tax adviser prior to requesting this
    distribution option.
 
    (a) Amount of Distribution: The
      Contract Holder may elect one of
      the three payment methods
      described below.
 
      (1) Specified Payment: Payments
      of a designated dollar
      amount. The annual amount may
      not be greater than the
      percentage shown on Contract
      Schedule I times the Current

 

 

 


 

      Value at time of election.
      This annual dollar amount
      will remain constant. At its
      discretion, Aetna may require
      a minimum initial payment
      amount;
 
    (2) Specified Period: Payments
      which are made over a period
      of time which must be at
      least 10 years. The annual
      amount paid each year is
      calculated by dividing the
      Current Value as of December
      31 of the prior year by the
      number of payment years
      remaining; or
 
    (3) Specified Percentage:
      Paymentof a designated
      percentage which cannot be
      greater than the percentage
      shown on Contract Schedule I.
      The percentage may be changed
      by written request. Aetna
      reserves the right to limit
      the number of times the
      percentage may be changed.
      The annual amount is
      calculated by multiplying the
      Current Value as of
      December 31 of the year prior
      to the payment by the
      designated percentage.
 
    Payments upon the Contract
    Holder's or Annuitant's death will
    be made to the Beneficiary in the
    manner described in 3.07.
 
  (b) Minimum Initial Current Value: At
    its discretion, Aetna may require
    a minimum initial Current Value
    for election of this option. If
    after election of this option the
    Current Value is insufficient to
    make a scheduled SWO payment,
    Aetna will distribute the entire
    balance.
 
13
 
I2-MGA-95      
     
 
3.05 Systematic Withdrawal Option (c) Date of Distribution: The Contract
(SWO): (Cont'd)   Holder shall specify the initial
    distribution date. As elected by
    the Contract Holder, SWO payments
    will be made on a monthly or
    quarterly basis unless Aetna
    allows otherwise. If SWO payments
    are made more frequently than
    annually, the designated annual
    amount is divided by the number of
    payments due each calendar year.
    Subsequent distributions will be
    made on the 15th of any month or
    such other date as Aetna may
    designate or allow.
 
  (d) Election and Revocation: SWO may
    be elected by submitting a
    completed and signed election form
    to Aetna's Home Office. Aetna
    reserves the right to establish
    the date when SWO may first be
    elected by a Contract Holder. Once
    elected, this option may be
    revoked by the Contract Holder or
    spousal Beneficiary, if elected
    after the Contract Holder's death,
    by submitting a written request to
    Aetna at its Home Office. Any
    revocation will apply only to
    amounts not yet paid. SWO may be
    elected only once by the Contract

 

 

 


 

  Holder or by the spousal
  Beneficiary.
 
3.06 Death Benefit Amount: If the Contract Holder or Annuitant
  dies before Annuity payments start, the
  Beneficiary is entitled to a death
  benefit under the Contract. If the
  Contract is owned jointly, the death
  benefit is paid at the first death of
  either of the joint Contract Holders.
  If the Contract is held by joint
  Contract Holders, the survivor will be
  deemed the designated Beneficiary and
  any other Beneficiary on record will be
  treated as the contingent Beneficiary.
  If the Contract Holder is a nonnatural
  person, the death benefit will be
  payable at the death of the Annuitant.
 
  If paid within 6 months of the date of
  the Annuitant's death, the death
  benefit will be the Current Value of
  the Contract. Otherwise, the death
  benefit will be the Adjusted Current
  Value determined as of the claim date.
  The claim date is the date when proof
  of death and the Beneficiary's claim
  are received in good order at Aetna's
  Home Office.
 
  When the Contract Holder dies and the
  Contract Holder is not the Annuitant,
  the death benefit payable will be
  subject to a Surrender Fee, if
  applicable.
 
14
I2-MGA-95    
   
 
3.07 Death Benefit Options Prior to any election, or until amounts
available to Beneficiary: must be otherwise distributed under
  this section, the Current Value will be
  retained in the Contract. The following
  options are available to the
  Beneficiary:
 
  (a) When the Contract Holder dies or
  if the Contract Holder is not a
  natural person, when the Annuitant
  dies:  
 
  (1) If the Beneficiary is the
    Contract Holder's surviving
    spouse, the Beneficiary may
    exercise all Contract Holder
    rights under the Contract and
    continue in the Accumulation
    Period, or may elect (i) or
    (ii) below. Distributions
    from the Contract are not
    required until the spousal
    Beneficiary's death. The
    spousal Beneficiary may elect
    to:
 
    (i) Apply some or all of the
    death benefit amount to
    an Annuity option 1, 2
    or 3 (see 4.04); or
 
    (ii) Receive, at any time, a
    lump sum payment equal
    to the death benefit
    amount.
 
  (2) If the Beneficiary is an
    individual who is not the
    Contract Holder's surviving
    spouse, then options (i) or
    (ii) under (1) above apply.
    Any portion of the death
    benefit amount not applied to
    Annuity option 1, 2 or 3
    within one year of the
    Contract Holder's death, must
    be distributed within five

 

 


 

        years of the date of death.
 
      (3) If the Beneficiary is not a
        natural person, then only
        option (ii) under (1) above
        applies.
 
      (4) If no Beneficiary has been
        designated, a lump sum
        payment equal to the death
        benefit amount will be made
        to the Contract Holder's
        estate.
 
    (b) If the Contract Holder is a
      natural person but is not the
      Annuitant, and the Annuitant dies,
      the Beneficiary may elect either
      to apply the death benefit amount
      to Annuity option 1, 2 or 3 within
      60 days of the Annuitant's date of
      death, or to receive a lump sum
      payment.
 
15
I2-MGA-95      
       
 
3.08 Liquidation of Surrender All or any portion of the Contract's
  Value: Current Value may be surrendered at any
    time prior to the Annuity Date.
    Surrender requests can be submitted as
    a percentage of the Contract value or
    as a specific dollar amount. Net
    Purchase Payment amounts are withdrawn
    first, and then the excess value, if
    any. For any partial surrender, amounts
    are withdrawn on a pro rata basis from
    the Guaranteed Period(s) Groups of the
    AMG Account in which the Current Value
    is invested. Within a Guaranteed Period
    Group, the amount to be surrendered
    will be withdrawn first from the oldest
    Deposit Period, then from the next
    oldest, and so on until the amount
    requested is satisfied.
 
    After deduction of the Maintenance Fee
    and any Premium Tax, if applicable, the
    surrendered amount shall be reduced by
    a Surrender Fee, if applicable. An MVA
    may apply to amounts surrendered.
 
3.09 Surrender Fee: The Surrender Fee only applies to the
    Net Purchase Payment portion
    surrendered and varies according to the
    elapsed time from the Contract
    effective date (see Contract Schedule
    I).    
 
    No Surrender Fee is deducted from any
    portion of the Current Value which is
    paid:    
 
    (a) To a Beneficiary due to the
      Annuitant's death before Annuity
      payments start (see 3.06);
 
    (b) As a premium for an Annuity option
      1, 2 or 3 under this Contract (see
      4.04);
 
    (c) As a distribution under the SWO
      provision (see 3.05);
 
    (d) At least 12 months after the date
      of the Purchase Payment, in an
      amount equal to or less than the
      special withdrawal percentage
      shown on Contract Schedule l times
      the current value at the time of
      the withdrawal. This applies to
      the first surrender request,
      partial or full, in a calendar
      year. The Current Value is
      calculated as of the date the
      surrender request is received in

 

 

 


 

      good order at Aetna's Home Office.
      This waiver is not available to
      the Contract Holder while SWO is
      in effect;
 
    (e) For a full surrender of the
      Contract where the Current Value
      is $2,500 or less and no
      surrenders have been taken from
      the Contract within the prior 12
      months; or
 
    (f) Upon withdrawal of any Matured
      Period Value; or
 
    (g) By Aetna under 3.11.
 
 
3.10 Payment of Surrender Value: Under certain emergency conditions, as
    allowed by law, Aetna may defer payment
    for a period of up to 6 months.
 
16
I2-MGA-95    
     
 
3.11 Payment of Adjusted Current Upon 90 days' written notice to the
  Value: Contract Holder, Aetna will terminate
    any Contract if the Current Value
    becomes less than $2,500 immediately
    following any partial surrender. A
    Surrender Fee will not be deducted from
    the Adjusted Current Value.
 
IV. ANNUITY PROVISIONS    
------------------------------------------------------------------------
 
4.01 Choices to be Made: The Contract Holder may tell Aetna to
    apply any portion of the Adjusted
    Current Value (minus any premium tax)
    for an Annuity under option 1, 2 or 3
    (see 4.04). The first Annuity payment
    may not be earlier than twelve months
    after the Purchase Payment At least 30
    days prior to the Annuity Date, the
    Contract Holder must tell Aetna which
    Annuity option is elected. Annuity
    payments will be made monthly, unless
    the Contract Holder elects otherwise in
    writing. In lieu of the election of an
    Annuity, the Contract Holder may elect
    a lump sum payment.
 
    The Annuity purchase rate for the
    option chosen reflects the Minimum
    Guaranteed Interest Rate (see Contract
    Schedule II), but may reflect a higher
    interest rate.
 
4.02 Terms of Annuity Options: (a) When payments start, the age of
      the Annuitant plus the number of
      years for which payments are
      guaranteed must not exceed 95.
 
    (b) An Annuity option may not be
      elected if the first payment would
      be less than $50 or if the total
      payments in a year would be less
      than $250 (less if required by
      state law). Aetna reserves the
      right to increase the minimum
      first Annuity payment amount and
      the annual minimum Annuity payment
      amount based upon increases
      reflected in the Consumer Price
      Index-Urban, (CPI-U) since July 1,
      1993.
 
    (c) If an Annuity under option 1, 2 or
      3 is chosen and a larger payment
      would result from applying the
      Surrender Value to a current Aetna
      single premium immediate Annuity,
      Aetna will make the larger
      payment.
 
    (d) For purposes of calculating the

 

 


 

    guaranteed first payment of an
    Annuity, the Annuitant's and
    second Annuitant's adjusted age
    will be used. The Annuitant's and
    second Annuitant's adjusted age is
    his or her age as of the birthday
    closest to the Annuity
    commencement date reduced by one
    year for Annuity commencement
    dates occurring during the period
    of time through December 31, 1999.
    4.02 Terms of Annuity Options
    (Cont'd) The Annuitant's and
    second Annuitant's age will be
    reduced by two years for Annuity
    commencement dates occurring
    during the period of time from
    January 1, 2000 through
    December 31, 2009. The Annuitant's
    and second Annuitant's age will be
    reduced by one additional year for
    Annuity commencement dates
    occurring in each succeeding
    decade. The Annuity purchase rates
    for options 2 and 3 are based on
    mortality from 1983 Table a.
 
17
I2-MGA-95  
   
 
4.02 Terms of Annuity Options: (e) Once elected, an Annuity option
  (Cont'd) may not be revoked and Annuity
    payments cannot be commuted to a
    lump sum.
 
4.03 Death of Annuitant/ If the Annuitant dies after Annuity
  Beneficiary: payments have begun, the death benefit,
    if any, will be payable to the
    Beneficiary as specified in the Annuity
    option elected. Death benefits will be
    paid at least as rapidly as under the
    method of distribution in effect at the
    or Annuitant's death.
 
    If the Contract Holder who is not the
    Annuitant dies after Annuity payments
    have begun, any remaining payments
    under the Annuity option elected will
    be made to the Beneficiary at least as
    rapidly as under the method of
    distribution in effect at the Contract
    Holder's death.
 
    If the Contract is held by joint
    Contract Holders, the survivor will be
    deemed the designated Beneficiary and
    any other Beneficiary on record will be
    treated as the contingent Beneficiary.
 
    Aetna will require proof of death.
 
4.04 Annuity Options: Option 1 -- Payments for a Stated
    Period of Time -- An Annuity will be
    paid for the number of years chosen.
    The number of years must be at least 10
    and not more than 30.
 
    If a nonspouse Beneficiary elects this
    option at the death of the Contract
    Holder, the period selected may not
    extend beyond the Beneficiary's life
    expectancy.
 
    Option 2 -- Life Income -- An Annuity
    will be paid for the life of the
    Annuitant, if also chosen, Aetna will
    guarantee payments for 60, 120, 180, or
    240 months.
 
    Option 3 -- Life Income Based upon the
    Lives of Two Annuitants -- An Annuity
    will be paid during the lives of the
    Annuitant and a second Annuitant.
    Payments will continue until both
    Annuitants have died. When this option
    is chosen, one of the following choices

 

 

 


 

 

must be made:

(a)     

100% of the payment to continue after the first death;

(b)     

66 2/3% of the payment to continue after the first death;

18

I2-MGA-95

4.04 Annuity Options: (c) 50% of the payment to continue
(Cont'd)   after the first death;
 
  (d) Payments for a minimum of 120
    months with 100% of the payment to
    continue after the first death; or
 
  (e) 100% of the payment to continue at
    the death of the second Annuitant
    and 50% of the payment to continue
    at the death of the Annuitant.
 
  Other Options -- Aetna may make other
  options available as allowed by the
  laws of the state in which the Contract
  is delivered.
 
19
 
I2-MGA-95    
   

 

 

OPTION 1

Payments for a Stated Period of Time

Amount of First Monthly Payment for Each $1,000 After Deduction of any Charge for Premium Taxes

Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%

<CAPTION>          
  Guaranteed Monthly Quarterly Semi-Annual Annual
Years Rate Payment Payment Payment Payment
 
5 3.00% 17.91 53.59 106.78 211.99
6 3.00% 15.14 45.30 90.27 179.22
7 3.00% 13.16 39.39 78.49 155.83
8 3.00% 11.68 34.96 69.66 138.31
9 3.00% 10.53 31.52 62.81 124.69
10 3.00% 9.61 28.77 57.33 113.82
11 3.00% 8.86 26.52 52.85 104.93
12 3.00% 8.24 24.65 49.13 97.54
13 3.00% 7.71 23.08 45.98 91.29
14 3.00% 7.26 21.73 43.29 85.95
15 3.00% 6.87 20.56 40.96 81.33
16 3.00% 6.53 19.54 38.93 77.29
17 3.00% 6.23 18.64 37.14 73.74
18 3.00% 5.96 17.84 35.56 70.59
19 3.00% 5.73 17.13 34.14 67.78
20 3.00% 5.51 16.50 32.87 65.26
21 3.00% 5.32 15.92 31.72 62.98
22 3.00% 5.15 15.40 30.68 60.92
23 3.00% 4.99 14.92 29.74 59.04
24 3.00% 4.84 14.49 28.88 57.33
25 3.00% 4.71 14.09 28.08 55.76
26 3.00% 4.59 13.73 27.36 54.31
27 3.00% 4.47 13.39 26.68 52.97
28 3.00% 4.37 13.08 26.06 51.74
29 3.00% 4.27 12.79 25.49 50.60
30 3.00% 4.18 12.52 24.95 49.53
         
 
20
I2-MGA-95          
         
 
         
OPTION 2
 
Life Income
 
Amount of First Monthly Payment for Each $1,000

 

 


 

 

After Deduction of any Charge for Premium Taxes
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%

Payments Guaranteed for a Stated Period of Months

       
 
Adjusted Age          
of None 60 120 180 240
Annuitant          
 
50 $4.05 $4.05 $4.03 $3.99 $3.93
51 4.12 4.11 4.09 4.05 3.99
52 4.19 4.19 4.16 4.11 4.04
53 4.27 4.26 4.23 4.18 4.10
54 4.35 4.34 4.31 4.25 4.16
 
55 4.44 4.42 4.39 4.32 4.22
56 4.53 4.51 4.47 4.40 4.29
57 4.62 4.61 4.56 4.48 4.35
58 4.72 4.71 4.65 4.56 4.42
59 4.83 4.81 4.75 4.64 4.49
 
60 4.95 4.93 4.86 4.73 4.55
61 5.07 5.05 4.97 4.83 4.62
62 5.20 5.17 5.08 4.92 4.69
63 5.34 5.31 5.20 5.02 4.76
64 5.49 5.45 5.33 5.12 4.83
 
65 5.65 5.61 5.47 5.22 4.89
66 5.82 5.77 5.61 5.33 4.96
67 6.01 5.94 5.75 5.44 5.02
68 6.20 6.13 5.91 5.54 5.08
69 6.41 6.33 6.07 5.65 5.14
 
70 6.64 6.54 6.23 5.76 5.19
71 6.88 6.76 6.41 5.86 5.24
72 7.14 7.00 6.59 5.97 5.28
73 7.43 7.26 6.77 6.06 5.32
74 7.73 7.53 6.96 6.16 5.35
 
75 8.06 7.82 7.14 6.25 5.38
</TABLE>          

 

Rates are based on mortality from 1983 Table a. The rates do not differ by sex. Rates for ages not shown will be provided on request and will be computed on a basis consistent with the rates in the above tables.

21

G2-MGA-95

OPTION 3

Life Income for Two Payees

Amount of First Monthly Payment for Each $1,000 After Deduction of any Charge for Premium Taxes

Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%

           
 
Adjusted Ages          
Annuitant Second Annuitant Option 3a Option 3b Option 3c Option 3d Option 3e
--------- ---------------- --------- --------- --------- --------- ---------
 
<S> <C> <C> <C> <C> <C> <C>
55 50 $3.69 $4.05 $4.27 $3.69 $4.03
55 55 3.88 4.25 4.47 3.87 4.14
55 60 3.99 4.44 4.71 3.98 4.42
 
60 55 3.99 4.44 4.71 3.98 4.42
60 60 4.24 4.71 4.99 4.23 4.57
60 65 4.38 4.97 5.32 4.38 4.93
 
65 60 4.38 4.97 5.32 4.38 4.93
65 65 4.72 5.33 5.70 4.71 5.14
65 70 4.93 5.68 6.15 4.91 5.66
 
70 65 4.93 5.68 6.15 4.91 5.66
70 70 5.40 6.21 6.70 5.36 5.96
70 75 5.69 6.68 7.32 5.62 6.67

 

 


 

 

75 70 5.69 6.68 7.32 5.62 6.67
75 75 6.37 7.45 8.15 6.23 7.12
75 80 6.78 8.11 8.99 6.54 8.13
--------- ---------------- --------- --------- --------- --------- ---------
           

 

Rates are based on mortality from 1983 Table a. The rates do not differ by sex. Rates for ages not shown will be provided on request and will be computed on a basis consistent with the rates in the above tables.

22

G2-MGA-95

[AETNA LOGO]

Aetna Insurance Company of America
Home Office: 151 Farmington Avenue
Hartford, Connecticut 06156
(800) 531-4547

Individual Single Premium Modified Guaranteed Deferred Annuity Contract Nonparticipating

THIS CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT FORMULA. APPLICATION OF A MARKET VALUE ADJUSTMENT MAY RESULT IN EITHER AN INCREASE OR DECREASE IN THE CURRENT VALUE. THE MARKET VALUE ADJUSTMENT FORMULA DOES NOT APPLY TO A GUARANTEED PERIOD AT THE TIME OF ITS MATURITY.

G2-MGA-95