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EX99.A5K
MINNESOTA LIFE CERTIFICATE SUPPLEMENT
ACCELERATED BENEFITS AGREEMENT
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Minnesota Life Insurance Life Company.400 Xxxxxx Xxxxxx Xxxxx.
Xx.
Xxxx, Xxxxxxxxx 00000-0000
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GENERAL INFORMATION
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This certificate supplement amends the certificate to which it is attached and
is subject to all its terms and conditions.
WHAT DOES THIS CERTIFICATE SUPPLEMENT PROVIDE?
This certificate supplement provides for the accelerated payment of the death
benefits provided under the certificate to which it is attached.
If the insured has a terminal condition, as defined in this agreement, the
insured may request an accelerated benefit. If we agree to pay an accelerated
benefit, your cash values, loan values and the death benefit under your
certificate will be reduced.
DEFINITIONS
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When we use the following words, this is what we mean:
DEATH BENEFIT
The face amount of the insured's certificate less any existing loans or
indebtedness under the certificate and less any term insurance provided by an
additional benefit agreement.
ACCELERATED BENEFIT
The amount of the death benefit we will pay if you are eligible under this
certificate supplement. We will calculate the accelerated benefit amount by
multiplying the death benefit by the accelerated benefit factor.
PHYSICIAN
An individual who is licensed to practice medicine or treat illness in the state
in which treatment is received. This does not include you, the insured, or a
member of your or the insured's immediate family.
IMMEDIATE FAMILY
The insured's or your spouse, child, parent, grandparent, grandchild, brothers
and sisters and their spouses.
TERMINAL CONDITION
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XXX-00-00000 Xxxxxxxxx Life 1
WHAT IS A TERMINAL CONDITION?
A condition caused by sickness or accident which directly results in a life
expectancy of twelve months or less.
WHAT EVIDENCE DO WE REQUIRE OF THE INSURED'S TERMINAL CONDITION?
We must be given evidence that satisfies us that the insured's life expectancy,
because of sickness or accident, is twelve months or less. That evidence must
include certification by a licensed physician. We reserve the right to ask for
independent medical verification of a terminal condition.
PAYMENT OF ACCELERATED BENEFIT
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HOW DO WE CALCULATE THE ACCELERATED BENEFIT FACTOR?
When we calculate this factor, we will consider the insured's age and sex, and
the option applied for. We will also base our calculation on certain
assumptions, which we may change from time to time, including but not limited to
assumptions about:
(1) expected future premiums; and
(2) the insured's life expectancy.
HOW DO WE CALCULATE THE ACCELERATED BENEFIT?
We will multiply the death benefit by the accelerated benefit factor to
determine the accelerated benefit available.
IS THERE A PROCESSING CHARGE?
Yes. We will subtract a processing charge of up to $150 from the accelerated
benefit before we pay that benefit to you.
WHAT ARE THE CONDITIONS FOR THE PAYMENT OF AN ACCELERATED BENEFIT?
We will consider the payment of an accelerated benefit, subject to all of the
following conditions:
(1) Your certificate must be in force other than as extended term insurance
and all premiums due must be fully paid.
(2) You must make application in writing and in a form which is satisfactory
to us. We will tell you what form is required.
(3) The certificate must not be assigned.
(4) The certificate must not have an irrevocable beneficiary.
IS THE REQUEST FOR AN ACCELERATED BENEFIT VOLUNTARY?
XXX-00-00000 Xxxxxxxxx Life 2
Yes. An accelerated benefit under this certificate supplement is not intended to
cause you to involuntarily reduce the death proceeds ultimately payable to the
named beneficiary. An accelerated benefit will be made available on a voluntary
basis only. Therefore:
(1) If you are required by law to use this option to meet the claims of
creditor, whether in bankruptcy or otherwise, you are not eligible for
this benefit.
(2) If you are required by a government agency to use this option in order to
apply for, obtain, or keep a government benefit or entitlement, you are
not eligible for this benefit.
HOW WILL WE PAY THE ACCELERATED BENEFIT?
We will pay the accelerated benefit in one lump sum or in any other mutually
agreeable manner.
IS THERE A MINIMUM OR MAXIMUM DEATH BENEFIT FOR AN ACCELERATED BENEFIT?
Yes. We reserve the right to set a minimum death benefit to be eligible for an
accelerated benefit under this certificate supplement. If we do so, it will be
at least $1,000.
The maximum death benefit to be eligible for an accelerated benefit is
$1,000,000.
WHAT IS THE EFFECT ON YOUR CERTIFICATE OF THE RECEIPT OF AN ACCELERATED BENEFIT?
If an insured elects to receive accelerated benefits which total the entire
accelerated benefit available under this certificate supplement, your
certificate and all other benefits under your certificate based on the
insured's life will end. Any insurance under your certificate on the life of
someone other than the insured will stay in effect; we will waive all future
premiums for that insurance, subject to the provision of your certificate and of
any riders thereto.
DO YOU HAVE TO TAKE THE ENTIRE ACCELERATED BENEFIT?
No. You may choose to receive a partial accelerated benefit. If you do so, your
certificate will stay in force.
You may reapply for the payment of the remaining accelerated benefit at any
time. However, we may ask for further satisfactory evidence that the insured
meets all requirements for the accelerated benefit. We reserve the right to
charge an additional processing charge.
If you choose a partial accelerated benefit, your certificate will remain in
force and premiums will be reduced. The face amount, cash values and outstanding
loans of your certificate will be reduced in the same proportion as the
reduction in the death benefit resulting from your receipt of accelerated
benefits.
If you elect to receive only a part of the accelerated benefit amount available
to you under this certificate supplement, the remaining death benefit under your
certificate must be at least $25,000.
TO WHOM WILL WE PAY ACCELERATED BENEFITS?
XXX-00-00000 Xxxxxxxxx Life 3
All accelerated benefits will be paid to you unless you validly assign them
otherwise. If the insured dies before all payments have been made, we will pay
the remainder to the beneficiary under the certificate in one lump sum. The one
sum we pay will be the present value of the payments that remain, using the
interest rate we use to determine the payments.
DO WE HAVE THE RIGHT TO OBTAIN INDEPENDENT MEDICAL VERIFICATION?
Yes. We retain the right to have the insured medically examined at our own
expense to verify the insured's medical condition. We may do this as often as
reasonably required while accelerated benefits are being considered or paid.
TERMINATION OF AGREEMENT
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WHEN DOES THIS AGREEMENT TERMINATE?
This agreement will end at the earliest of:
(1) the date any premium due for your certificate remains unpaid at the end of
the grace period; or
(2) the date we receive written request to cancel this certificate supplement;
or
(3) the date your certificate matures, is surrendered, terminated or
continued in force as extended term or reduced paid-up insurance; or
(4) the date of the insured's death; or
(5) when the group policy is surrendered, matures or ends.
This certificate supplement is effective as of the effective date on the
specifications page attached to your certificate.
/s/ Xxxxxx X. Xxxxxxxxx /s/ Xxxxxx X. Xxxxxxx
Secretary President
MHC-94-18678 Minnesota Life 4
