Below is a summary of definitions, disclosures and limitations for the Life Insurance and LTC Rider. A full sample policy can be downloaded here. State variations, product features, and terms may differ. Linked is a sample IL policy for illustrative purposes. For your specific state, please contact support.
Death Benefit Proceeds
If the Insured dies prior to the Maturity Date and while this Certificate is in force, We will pay the Death Benefit Proceeds to the Beneficiary. The Death Benefit Proceeds are the Death Benefit Amount less any outstanding Indebtedness.
Death Benefit Amount
If death occurs prior to the anniversary date on or after the Insured’s 70th birth date, the Death Benefit Amount is the greater of:
If death occurs on or after the anniversary date on or after the Insured’s 70th birth date, the Death Benefit Amount is the greater of:
Minimum Death Benefit
The Minimum Death Benefit is determined each month as a factor times the Accumulated Value. The factor varies by the Attained Age of the Insured. The factor is shown on the Minimum Death Benefit Table.
CERTIFICATE CHANGES
Changing the Terms of Your Certificate
You may request Certificate changes at any time. The types of changes allowed are explained below. We will amend Your Certificate to show the effective date of any changes by issuing an endorsement.
Any change in Your Certificate must be approved by one of Our officers. No agent has the authority to make any changes or waive any of the terms of Your Certificate. Requests for Certificate changes will not be deemed to be accepted until processed by Us.
Increasing the Face Amount
For any underwritten increase in the Face Amount We will require a supplemental application and evidence of insurability satisfactory to Us. An increase will be effective on the Monthly Deduction Day on or next following the date the application for increase is approved by Us, or on the date specified on an endorsement.
Decreasing the Face Amount
A decrease in the Face Amount will become effective on the Monthly Deduction Day following Our receipt of the request. Any such decrease will be applied in the following order:
For any decrease:
Any decrease in the Face Amount will be subject to a pro rata Surrender Charge.
PREMIUMS AND GRACE PERIOD
Payment of Premiums
Your first premium is due as of the Certificate Date. While the Insured is living, premiums after the first must be paid to Us. Premiums are payable monthly, or at any other frequency We may arrange with Your employer. The payment mode is subject to Our minimum premium requirements as of the Certificate Date. A premium receipt will be furnished upon request.
All premiums are payable in advance. Premium payments are flexible. This means You may choose the amount and frequency of payments.
The actual amount and frequency of premium payments will affect the Cash Value and the amount and duration of insurance.
Unscheduled Premiums
You may pay premiums at any time before the Maturity Date. We may limit the number and amount of unscheduled premiums.
Grace Period
This Certificate will enter the Grace Period if the Cash Value is insufficient to pay the Monthly Deduction. Once entered, this Certificate will remain in force for the 62-day Grace Period. The Grace Period allows You to pay all past due Monthly Deductions and loan interest charges. There is no Grace Period for the initial Monthly Deduction.
If the required premium is not paid by the end of the Grace Period, this Certificate will terminate without value. However, We will give You at least 31 days notice, prior to termination, that Your Certificate is in the Grace Period. We will advise You of the amount of premium required to keep Your Certificate in force. Such 31 days prior notice will be sent to You at Your last known address and to any assignee of record. If death occurs during the Grace Period, Monthly Deductions through the Certificate month in which death occurred will be deducted from the Death Benefit Proceeds.
If a surrender request is received within 32 days after the Grace Period commences, the Cash Value payable will not be less than the Cash Value on the Monthly Deduction Day the Grace Period started. The Monthly Deduction for the Certificate month following such Monthly Deduction Day will not be subtracted in the calculation of such Cash Value.
Continuation of Coverage
This Certificate will continue in force until the Cash Value on any Monthly Deduction Day (before subtracting the Monthly Deduction) is less than the Monthly Deduction due. At that time, this Certificate will continue to provide coverage according to the Grace Period provision. However, this Certificate will not continue past the Maturity Date.
Initial Guarantee Premium
This Certificate will not terminate before the Initial Guarantee Premium Expiry Date if on each Monthly Deduction Day before the Initial Guarantee Premium Expiry Date, the sum of premiums paid equals or exceeds:
The Monthly Initial Guarantee Premium and Initial Guarantee Premium Expiry Date are shown on the Schedule. The Monthly Initial Guarantee Premium will be adjusted if any of the following occur:
The adjusted Monthly Initial Guarantee Premium will be required on the effective date of the change. The adjusted Monthly Initial Guarantee Premium will be shown on an endorsement to the Certificate.
Reinstatement
A Certificate which terminates in accordance with the Grace Period provision may be reinstated if it has not been surrendered for its Cash Value. To reinstate means to put back in force on a premium-paying basis. We will reinstate this Certificate if We receive:
The reinstated Certificate will be in force from the Monthly Deduction Day on or following the date We approve the application to reinstate.
The period of time during which this Certificate was lapsed will be ignored. No premium will be due for this period. This period will not be included for purposes of determining Certificate years. The length of any remaining period during which a Surrender Charge will apply, and the amount of any such Surrender Charge, will be the same on the date of reinstatement as on the date of lapse.
The Accumulated Value at the time of the reinstatement will be:
Any and all attached riders will be reinstated in accordance with rider provisions.
CERTIFICATE VALUES
Accumulated Value
On the Certificate Date, the Accumulated Value will be determined as follows:
On each Monthly Deduction Day after the Certificate Date, the Accumulated Value will be determined as follows:
All calculations will be done at the end of the day on the Monthly Deduction Day. The Accumulated Value on any day other than a Monthly Deduction Day will be:
The Accumulated Value on any Certificate anniversary will be at least equal to what it would have been if the interest rate credited had always been 1.5% and the Guaranteed Monthly Cost of Insurance Rates multiplied by the Percentage Rating Factor, Guaranteed Maximum Monthly Administrative Fee, Guaranteed Maximum Percentage Expense Charge and Monthly Rider Deductions, if any, had always been in effect.
Cash Value
The Cash Value of this Certificate will be equal to:
Interest Earned
On each Monthly Deduction Day after the Certificate Date, the Interest Earned will be determined as the monthly interest rate times the Accumulated Value as of the last Monthly Deduction Day less Interest on Partial Surrenders since the last Monthly Deduction Day. Interest credited on Indebtedness will not exceed the Loan Interest Rate shown on the Schedule.
Additional interest may be added as follows:
Full Surrender
You may return Your Certificate to Us and request the Cash Value. The Cash Value will be calculated as of the day We receive Your request.
You may make a request for surrender at any time during the Insured’s lifetime before the Maturity Date. Your Certificate will terminate on the Monthly Deduction Day on or next following the date We receive the request for full surrender.
If the Insured dies after the request for Full Surrender but prior to the date payment of the Cash Value was made, the Death Benefit will be payable and the request for Full Surrender will be canceled. If the Cash Value has already been paid, this amount will be subtracted from the Death Benefit payable.
Partial Surrender
At any time after the first Certificate year, You may withdraw a portion of the Cash Value.
A Partial Surrender will result in a reduction, equal to the withdrawal amount, to each of the following:
The Partial Surrender amount is subject to the following:
A Partial Surrender Charge, as shown on the Schedule, will be deducted from Your Accumulated Value each time a Partial Surrender is made.
Payment of Cash Value Benefit
We can delay payment of Cash Values for up to six months or the period allowed by law, whichever is less. However, We cannot delay payment of a Partial Surrender if the amount is to be used to pay a premium to Us.
Monthly Deduction
The Monthly Deduction is equal to the sum of:
Net Amount at Risk is the net amount of insurance protection provided on a monthly basis. The Net Amount at Risk is the greater of:
Monthly Cost of Insurance Rate
At the beginning of each Certificate year, the Monthly Cost of Insurance Rate is determined based on the Insured’s Attained Age, Rate Class, and Certificate year. For the Initial Face Amount, We will use the Rate Class on the Certificate Date. For each increase, We will use the Rate Class applicable to the increase.
Such rates will never be changed to recover losses previously incurred nor to distribute gains previously realized by Us. Any change in the Monthly Cost of Insurance Rates will apply to all persons of the same age and classification whose Certificates have been in force for the same length of time.
Surrender Charge
Surrender Charges for the Initial Face Amount will apply during the first 14 Certificate years. The Surrender Charge in each Certificate year is the lesser of:
Surrender Charges for any increases in Face Amount will apply during the first 14 years following such increase.
Dividends
We will determine the dividend, if any, for this Certificate each year and credit it to this Certificate on the first day of the next Certificate year. This Certificate must be in force for a dividend to be credited to it.
We expect dividends, if any, to be small in amount and to accrue, if at all, in the later Certificate years. Each dividend will be added to the Accumulated Value unless the Owner requests payment in cash.
LOANS
Loan Value
At any time while this Certificate is in force, you may borrow from Us an amount which is equal to or less than the loan value. The loan value will be the Cash Value less:
Loan Interest
The Loan Interest Rate that will be charged for Certificate loans is shown on the Schedule. Loan Interest accrues daily and will be added to this Certificate's Indebtedness and incur interest charges.
How You May Repay a Loan
You may repay part or all of a loan at any time, except that:
At any time Your loan exceeds the Cash Value, this Certificate will lapse. However, at least 31 days prior notice must be mailed by Us to Your last known address and to any assignee of record prior to lapse.
We Can Delay Payment
We can delay loaning You money for up to six months, or the period allowed by law, whichever is less. However, We cannot delay loaning You money if the amount is to be used to pay a premium to Us.
Obtaining a Loan
You may obtain a loan by written request and assignment of this Certificate as sole security for the loan. Each loan must be at least $100.
OWNER AND BENEFICIARY
Owner
The Insured is the original Owner of this Certificate unless someone else is shown as Owner in the application. Ownership may be changed in accordance with the provisions captioned Change of Owner or Beneficiary. During the Insured’s lifetime, the Owner may exercise every right this Certificate gives or We allow. If the Owner and the Insured are not the same person, and the Owner dies during the lifetime of the Insured, the Insured will become the Owner. The Insured must notify Us if the Owner dies. All changes are subject to the rights of any assignee of record, and to any endorsement on this Certificate limiting such rights.
Beneficiary
The Beneficiary named in the application, or later changed by You, will receive the Death Benefit Proceeds upon the death of the Insured after approval of the claim. Unless You have stated otherwise, if any Beneficiary dies before the Insured, that Beneficiary’s interest will pass to any other Beneficiaries according to their respective interest. If no Beneficiary survives the Insured, the Death Benefit Proceeds will be paid to You as Owner if You are then living; otherwise the Death Benefit Proceeds will be paid to the Insured’s estate.
Change of Owner or Beneficiary
You may change the Owner or the Beneficiary at any time during the lifetime of the Insured, unless the previous designation provides otherwise. To do so, send a written request to Us in a form acceptable to Us. The change will go into effect when We have recorded the change. However, after the change is recorded, it will be deemed effective as of the date of Your written request for change. The change will be subject to any payment made or action taken by Us before the request is recorded.
Common Disaster
If We cannot determine whether a Beneficiary or the Insured died first in a common disaster, We will assume that the Beneficiary died first. The Death Benefit Proceeds will be paid on this basis unless an endorsement to this Certificate provides otherwise.
GENERAL PROVISIONS
Assignment
During the lifetime of the Insured You may assign this Certificate as security for an obligation. We will not be bound by an assignment unless it is received in writing in a form acceptable to Us. Two copies of the assignment must be submitted. We will retain one copy and return the other. We will not be responsible for the validity of any assignment.
Incontestability
We rely on the statements made in the application for coverage described in this Certificate and application for any reinstatements or increases in coverage. These statements are considered representations and not warranties. No statement may be used in defense of a claim under this Certificate unless it is in such applications.
We will not contest payment of the Death Benefit Amount after this Certificate has been in force during the Insured’s lifetime for two years from the Certificate Date. We will not contest payment of any Death Benefit Amount represented by an increase in the coverage after such increase had been in effect during the Insured’s lifetime for two years. We will not contest payment of any Death Benefit Amount which was reinstated after this Certificate has been in force during the Insured’s lifetime for two years from the date of such reinstatement.
We can contest a reinstatement or an increase in coverage only on the basis of the information furnished in the application for such reinstatement or increase.
Suicide Exclusion
If the Insured commits suicide, while sane or insane, within two years from the Certificate Date, We will limit the Death Benefit Proceeds to the premiums paid less any loans and less any Partial Surrenders paid. If the Insured commits suicide, while sane or insane, within two years after the effective date of any increase in the coverage or any reinstatement, the Death Benefit Proceeds will be the costs of insurance associated with each increase or the reinstatement.
Misstatement of Age and Corrections
If there is a misstatement of age in the application, the Death Benefit Amount will be that which would be purchased by the most recent mortality charge at the correct age.
If We make any payment or Certificate changes in good faith, relying on Our records, or evidence supplied to Us, Our duty will be fully discharged. We reserve the right, at any time, to correct any errors in this Certificate.
Misstatement of Cigarette Smoking
If the usage of cigarettes is misstated, We will adjust all benefits under this Certificate to the amount that would have been provided using smoking rates.
Entire Contract
We have issued this Certificate in consideration of the application and payment of premiums. The Policy, this Certificate, the application for it, any riders, and any application for an increase in coverage constitute the entire contract. Any application for reinstatement will become part of the contract of reinstatement and of this Certificate. The Certificate may be changed by mutual agreement. Our agents have no authority to alter or modify any terms, conditions, or agreements of this Certificate, or to waive any of its provisions.
Conversion Privilege
If an Insured’s eligibility under the Policy ends, coverage may be continued under this Certificate.
If the Policy terminates, the Insured shall be entitled to have issued to him, without evidence of insurability, an individual policy of life insurance without any riders. This right applies only if the Insured has had continuous coverage under this Certificate for at least five years. The new policy shall not exceed the smaller of:
The new policy will be issued as follows:
An Insured must take the following steps to convert:
An Insured has coverage during the 31 day period for conversion. The amount of such coverage is the amount that can be converted. This amount will be paid as a death benefit if the Insured dies during this 31 day period. Application for conversion need not have been made. If application had been made, any premium paid for the new policy will be refunded.
Conformity With State Statutes
If any provision in this Certificate and any attached riders is in conflict with the laws which govern this Certificate and any attached riders, the provision will be deemed to be amended to conform with such laws.
Annual Report
Each year a report will be sent to You which shows the current Certificate values, premiums paid, and deductions made since the last report and any outstanding Certificate loans.
Projection of Benefits and Values
You may make a written request to Us for a projection of illustrative future Cash Values and death benefits. One projection in each Certificate year will be furnished without charge upon request. We may charge a nominal fee, not to exceed $25.00 for each projection report furnished in excess of one per year.
Payment Provision
The Death Benefit Proceeds or Cash Value at surrender or maturity will be paid in one lump sum.
NOTICE: Benefits paid under this Rider may or may not be taxable. Whether or not You or Your beneficiary incur a tax liability when benefits are paid depends on how the IRS interprets applicable portions of the Tax Code. As with all tax matters, You should consult Your personal tax advisor to assess the impact of this benefit. Trustmark Insurance Company has no responsibility for any tax consequences of any benefits paid under this Rider. This Rider is not intended to be qualified long term care insurance within the meaning of the Internal Revenue Code of 1986.
NOTICE TO BUYER: THIS RIDER MAY NOT COVER ALL OF THE COSTS ASSOCIATED WITH HOME HEALTH CARE OR LONG TERM CARE INCURRED BY THE BUYER DURING THE PERIOD OF COVERAGE. THE BUYER IS ADVISED TO REVIEW CAREFULLY ALL RIDER LIMITATIONS.
THIS RIDER IS NOT APPROVED FOR MEDICAID ASSET PROTECTION UNDER THE ILLINOIS LONG TERM CARE PARTNERSHIP PROGRAM. HOWEVER, THIS RIDER IS AN APPROVED TRADITIONAL LONG TERM CARE RIDER UNDER STATE INSURANCE REGULATIONS. FOR INFORMATION ABOUT POLICIES OR CERTIFICATES APPROVED UNDER THE ILLINOIS TRADITIONAL LONG TERM CARE PARTNERSHIP PROGRAM, CALL THE SENIOR HELPLINE AT THE DEPARTMENT ON AGING AT 1-800-252-8966.
TRUSTMARK INSURANCE COMPANY
“We, Us, and Our”
400 Field Drive
Lake Forest, IL 60045-2581
(800) 918-8877
HOME HEALTH AND LONG TERM CARE BENEFIT RIDER
This Rider provides an accelerated death benefit. Each benefit payment under this Rider will reduce the following Certificate Values: Face Amount, Death Benefit Amount, Accumulated Value, Surrender Charges and any Indebtedness.
This Rider is part of the Certificate to which it is attached. It is issued in consideration of the application and the required payment for this Rider. The premium is shown on the Schedule. The Monthly Rider Deduction for this Rider will be deducted from the Accumulated Value.
This Rider is subject to all of the terms, conditions, exclusions, and limitations of the Certificate, except as herein stated. The Effective Date of this Rider is the same as the Certificate Date, unless otherwise specified. If this Rider is added to the Certificate after the Certificate Date, the Monthly Rider Deduction and Effective Date for this Rider will be shown on an endorsement. The Certificate determines the benefits under this Rider.
If this Rider is added to existing coverage that includes a Home Health and/or Long Term Care Benefits Rider, said rider will terminate on this Rider’s Effective Date.
TERMS UNDER WHICH RIDER MAY BE RETURNED AND PREMIUM REFUNDED
You may return the Rider within 30 days after You receive it, and We will refund any cost of insurance which You paid for the Rider.
CAUTION: The issuance of this Home Health and Long Term Care Rider is based upon Your answers to the questions in Your application. A copy of Your application is enclosed or was retained by You when You applied for this Rider. If Your answers are incorrect or untrue, or if material information was omitted in such answers, then We have the right to deny rider benefits or to rescind Your coverage under this Rider. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of Your answers are incorrect, contact Us at: Trustmark Insurance Company, 400 Field Drive, Lake Forest, IL 60045-7937.
RENEWABILITY
We may not cancel or reduce coverage under this Rider. Only You can request termination of this Rider. Unless You do, it will remain in force for as long as the Certificate remains in force.
DEFINITIONS
Activities of Daily Living means any of the following basic human functional abilities required for the Insured to remain independent. They are as follows:
Adult Day Care means adult day care services which are provided at an Adult Day Care Center. For such Adult Day Care:
Adult Day Care Center means a facility which provides Adult Day Care and meets all of the following tests:
Assisted Living means assisted living services which are provided at an Assisted Living Facility. For such Assisted Living:
Assisted Living Facility means a facility that provides a combination of housing and personalized health care in a professionally managed group-living environment designed to respond to the individual needs of persons who require assistance with Activities of Daily Living. This type of facility is specifically designed to promote maximum independence and dignity in the most residential and homelike setting possible. It may be all or part of a building that houses a few or several hundred persons, or a distinct part of a residential campus.
Benefit Period means continuous or successive terms of Long Term Care Facility confinement, Assisted Living, Home Health Care or Adult Day Care services which:
If separated by six months or more, a new Benefit Period begins, subject to a new Elimination Period.
If more than one Injury or Sickness causes a concurrent Benefit Period, only one monthly benefit amount is payable per month of confinement.
Cognitive Impairment means deterioration or loss of intellectual capacity as measured by clinical evidence and standardized tests which measure impairment in the areas of:
Complications of Pregnancy are conditions whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy. Such conditions include acute nephritis, nephrosis, cardiac decompensation, pre-eclampsia, hyperemesis gravidarum, missed abortion and similar medical and surgical conditions of comparable severity. Complications of Pregnancy also means non-elective caesarean section, ectopic pregnancy which is terminated, and spontaneous termination of pregnancy when a viable birth is not possible.
Complications of Pregnancy does not include false labor, occasional spotting, physician-prescribed rest during the period of pregnancy, morning sickness, and similar conditions associated with the management of a difficult pregnancy and not constituting a distinctly diagnosed Complication of Pregnancy.
Death Benefit Amount means the Death Benefit Amount defined in the Certificate, excluding additional death benefits added by rider, but including such increases as may be necessary to comply with IRS Code Section 7702.
Elimination Period means the first 90 days of Benefit Period for which no benefits are payable.
Home Health Care means health care and other services provided by a Home Health Care Agency. For such Home Health Care services:
Home Health Care Agency means an entity which provides care and services at the Insured’s home or other residence, is primarily engaged in providing residential health care services under policies and procedures established by a group of professionals, including at least one Physician and one nurse, and:
Hospital means a facility which:
Immediate Family means:
Injury means accidental bodily injury that results directly and independently of all other causes in loss covered by this Rider.
Intermediate Care Facility means a facility which:
Intermediate Nursing Care means active nursing and/or restorative rehabilitation services which may be given on less than a daily basis to treat a stabilized health condition. For such Intermediate Nursing Care:
Long Term Care Facility means a Skilled Nursing Facility, an Intermediate Care Facility, or a Residential Care Facility. Long Term Care Facility does NOT mean:
Medically Necessary means a service or supply which:
Medicare means Title XVIII of the Social Security Act, as amended.
Net Amount at Risk means the greater of:
Physician means an individual, other than You, or the Insured or a member of Your or the Insured’s Immediate Family, who is licensed to practice medicine and/or treat Sickness or Injury in the state in which treatment is received.
Pre-existing Condition means during the six (6) months immediately prior to the Effective Date of this Rider:
A Sickness or Injury for which medical care, diagnosis, or advice was received or recommended; or the existence of symptoms which would have caused an ordinarily prudent person to seek medical care, treatment, diagnosis, or advice. If this Rider provides replacement coverage for other long term care coverage, credit will be given for any pre-existing time period satisfied under the prior coverage.
Residential Care Facility means a facility which:
Residential Nursing Care means care designed mainly to help a person in the Activities of Daily Living which does not require the continuous attention of trained medical or paramedical personnel. A Physician must certify that such care is Medically Necessary. Such care may involve:
Such care must be provided in a Residential Care Facility.
Sickness means illness or disease that results in loss covered by this Rider.
Skilled Nursing Care means active nursing care and/or restorative rehabilitation services given to treat an unstable health condition. For such Skilled Nursing Care:
Skilled Nursing Facility means a place which:
CONDITIONS ON ELIGIBILITY FOR BENEFITS
We will pay benefits for Long Term Care Facility confinement, Assisted Living, Home Health Care and Adult Day Care services for the person who is the Insured under the Certificate. It does not cover any other person.
When Benefits Begin: Benefits begin after the Insured has been confined in a Long Term Care or Assisted Living Facility or received Home Health Care or Adult Day Care services for 90 days. The first 90 days of confinement or services is the Elimination Period. No benefits are payable for confinement or services during this time. This 90 day period need not be continuous. It must, however, be entirely within one Benefit Period.
Conditions for Payment: For benefits to be payable, the Insured must:
LONG TERM CARE FACILITY BENEFIT
We will pay benefits for Long Term Care Facility confinement subject to the following conditions. The Insured must:
ASSISTED LIVING BENEFIT
We will pay benefits for Assisted Living provided by an Assisted Living Facility subject to the following conditions. The Insured must:
HOME HEALTH BENEFIT
We will pay benefits for Medically Necessary Home Health Care provided by a Home Health Care Agency subject to the following conditions. The Insured must:
ADULT DAY CARE BENEFIT
We will pay benefits for Adult Day Care provided by an Adult Day Care Center subject to the following conditions. The Insured must:
AMOUNT OF BENEFIT
Long Term Care Facility and Assisted Living Benefit: For each Benefit Period the monthly Long Term Care Facility or Assisted Living Benefit is the greater of 4% of the Face Amount or 4% of the Death Benefit Amount at the end of the Elimination Period for that Benefit Period.
We will pay the Long Term Care Facility or Assisted Living Benefit for each month the Insured remains confined in a Long Term Care or Assisted Living Facility, following the Elimination Period, for up to 25 months for all Benefit Periods combined.
For a partial month of confinement, benefits are payable on a pro-rata basis; One-thirtieth (1/30th) of the monthly benefit will be paid for each 24 hour day of confinement. If a new confinement is within the same Benefit Period as a previous confinement, benefits are resumed at the previous amount of monthly benefit.
Home Health Care and Adult Day Care Benefit: For each Benefit Period, the monthly Home Health Care or Adult Day Care Benefit is the greater of 4% of the Face Amount or 4% of the Death Benefit Amount at the end of the Elimination Period for that Benefit Period.
We will pay a benefit for Home Health Care or Adult Day Care for each month the Insured receives such care, following the Elimination Period, for up to 25 months for all Benefit Periods combined.
Benefits are payable on a pro-rata basis. One thirtieth (1/30th) of the monthly benefit will be paid for each day of Home Health Care or Adult Day Care.
Benefit Exceptions and Limitations
Example of Long Term Care Facility, Assisted Living, Home Health Care or Adult Day Care Benefit: Calculation of monthly benefit amounts is shown in the example below.
Monthly payment if no Indebtedness
| Death Benefit Amount at end of Elimination Period | $100,000 |
| Face Amount at end of Elimination Period | $100,000 |
| 4% of Death Benefit Amount | $4,000 |
| Monthly Payment | $4,000 |
| Death Benefit Amount after 1st monthly payment | $96,000 |
| Death Benefit Amount after 2nd monthly payment | $92,000 |
Monthly payment if Indebtedness
| Death Benefit Amount at end of Elimination Period | $100,000 |
| Face Amount at end of Elimination Period | $100,000 |
| Indebtedness | $ - 6,000 |
| Death Benefit Amount reduced by Indebtedness | $94,000 |
| 4% of Death Benefit Amount reduced by Indebtedness | $3,760 |
| Monthly Payment | $3,760 |
| Death Benefit Amount after 1st monthly payment | $90,240 |
| Indebtedness after 1st monthly payment | $5,760 |
| Death Benefit Amount after 2nd monthly payment | $86,480 |
| Indebtedness after 2nd monthly payment | $5,520 |
Each Long Term Care Facility, Assisted Living, Home Health Care or Adult Day Care monthly benefit payment reduced all Certificate Values 4%. Thus, the Indebtedness is reduced 4% of $6,000 or $240 for each monthly payment.
Reduction of Certificate Values: Each monthly or partial monthly payment under this Rider will reduce the following Certificate Values:
Values will be reduced on a monthly basis by 4% of their value on the date benefits begin. A pro-rata reduction will be made for a partial month of payment.
The Death Benefit Amount will be calculated as described in the Certificate Definitions.
Monthly Rider Deduction: The Monthly Rider Deduction for any rider month is equal to:
The monthly cost per $1,000 of Net Amount at Risk for this Rider is determined on each rider anniversary. Any change we make will be:
Any change in monthly cost will not be a result of deterioration of health.
Waiver of Monthly Deduction: During the period We are paying benefits under this Rider, We will also waive the Monthly Deduction for the Certificate and all riders. The Certificate will remain in force while we are paying benefits under this Rider.
EXCLUSIONS AND LIMITATIONS
This Rider does not pay benefits for loss:
CLAIMS
Written Notice of Claim: Written notice of claim must be given to Us within 30 days after a covered loss begins, or as soon as reasonably possible after that. The notice should contain Your name and Certificate number.
Your notice should identify the Insured, and be sent to Us.
Claim Forms: After We receive written notice of claim, We will furnish claim forms within 15 days. If We do not, the claimant will have met the requirements for written proof of loss upon submitting a written statement of the extent and nature of the loss within the time limit stated in the Written Proof of Loss provision.
Written Proof of Loss: Written proof of loss must be sent to Us within 90 days after the end of a Grace Period for which benefits are claimed. If that is not reasonably possible, the claim will not be affected. Unless the claimant is legally incapacitated, written proof must be given within one year following the 90 day period for submitting written proof of loss.
Rights Not Waived: None of the following actions shall waive or reduce any of Our rights in defense of a claim under this Rider:
Time of Payment of Claims: After We receive written proof of loss, benefits will be paid monthly for the Benefit Period claimed. Any accrued benefits remaining unpaid when Our liability ends will be paid as soon as We receive proper written proof of loss. We will require periodic proof of continued eligibility and confinement during a claim. Claims will be paid without interest within 30 days following receipt of due proof of loss. After 30 days, interest will be paid at the rate of 9% per annum from the 30th day to the date of payment. Interest amounting to less than $1 will not be paid.
Payment of Claims: Benefits will be paid to You unless they have been assigned elsewhere. Any accrued benefits unpaid at Your death will be paid to Your Beneficiary, or to Your estate, if no Beneficiary is named.
Physical Examination: At Our own expense, We have the right to have the Insured examined as often as reasonably necessary while the claim is pending.
Legal Actions: No legal action can be brought against Us within 60 days after the date written proof of loss is given. It cannot be brought after three years from the date written proof of loss is required to be given.
THE CONTRACT
Termination of Rider: This Rider will terminate on the earliest of the following:
Grace Period: The Grace Period in the Certificate also applies to this Rider.
Reinstatement: If the Certificate is reinstated, this Rider may also be reinstated, subject to our approval. The reinstated rider will cover only loss due to Sickness or Injury that occurs after the date of reinstatement. Except for this and any new Certificate provisions added due to reinstatement, both Your rights and Ours will be the same as before the Certificate lapsed.
Incontestability: We cannot contest this Rider after it has been in force during the Insured’s lifetime for two years from its Effective Date, except for nonpayment of premium.
Any increase in coverage or reinstatement of coverage, as requested by application from You, shall begin a new two year contestable period for the amount of the increase or reinstated coverage from the effective date of such coverage