EX-99.(4)(C) 4 d877621dex994c.htm SCHEDULED ANNUAL RENEWABLE TERM RIDER Scheduled Annual Renewable Term Rider

SCHEDULED ANNUAL RENEWABLE TERM RIDER

This rider (“Rider”) becomes a part of the policy to which it is attached (“Policy”). All terms of the Policy that do not conflict with this Rider’s terms apply to the Rider. If there is a conflict between the terms of this rider and the terms of the policy, the terms of this rider shall prevail.

Rider Benefit Summary – This Rider provides for Scheduled Annual Renewable Term Coverage increases in Face Amount on the Insured’s life as long as the Policy is In Force and this Rider has not terminated.

In this Rider, a scheduled increase is referred to as a Term Increase and is a future increase in the Face Amount of this rider that is scheduled for a particular policy anniversary, as shown in the Policy Specifications. Once a Term Increase goes into effect, it becomes part of the Rider Face Amount. The Face Amount contributes to the Total Face Amount and, consequently, to the Death Benefit of the Policy. This rider has no Accumulated Value of its own, but affects the Policy’s Accumulated Value because the charges for the Rider and the charges for the Rider Face Amount that may result from it are deducted from the Accumulated Value of the Policy.

Rider Coverage Layer – Is a layer of insurance coverage under this Rider. There is one Rider Coverage Layer on this Rider. The Face Amount, Risk Class, Coverage Layer Date, and set of charges for the Rider Coverage Layer are shown in the Policy S pecifications.

Rider Face Amount – Is the Face Amount of insurance coverage provided by this Rider as shown in the Policy Specifications and any Supplemental Schedule of Coverage.

INCREASES

Term Increases – A Term Increase will increase the Face Amount of the Rider Coverage Layer as shown in the Policy Specifications.

Changes in Term Increases – You may request an increase or decrease in the Face Amount of Term Increases by providing a Written Request. Any increase to the Face Amount of the Term Increases may be subject to evidence of insurability and is subject to our approval. If you choose to decrease the Face Amount of or cancel a Term Increase that has been approved, all future Term Increases may be forfeited. We will send you a Supplemental Schedule of Coverage to reflect changes to Term Increases.

Impact of Changes to Policy Benefits on the Rider Face Amount – If the Total Face Amount of the Policy is increased via a policy change other than a requested or scheduled increase, then the Coverage Layer with the most recent Coverage Layer Date will be increased. If more than one Coverage Layer shares the most recent Coverage Layer Date, then the Coverage Layer with the highest priority will be increased.

The priority of Coverage Layers is listed below, in order from highest to lowest:

 

  First, any Annual Renewable Term Rider;
  Second, this Rider;
  Third any rider that contributes to the Total Face Amount; and
  Finally, any Basic Life Coverage Layer.

Decrease in Rider Face Amount – You may request to decrease the Rider Face Amount, subject to the provisions in the Policy.

If the Face Amount of the Policy is decreased via a policy change other than a requested decrease, then the most recently added Coverage Layer will be decreased or eliminated in the following order:

 

  First, the Face Amount of this Rider;

 

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  Then, the Face Amount of any Annual Renewable Term Rider;
  Then, the Face Amount of any other rider that contributes to the Total Face Amount; and
  Finally, the Face Amount of Basic Life Coverage under the Policy.

CHARGES

Charge for this Rider – On each Monthly Payment Date prior to the Monthly Deduction End Date, there is a charge for this Rider equal to the sum of:

 

  The Rider Charge;
  The Rider Coverage Charge; and
  The Rider Cost of Insurance Charge.

Such charges may vary by Class, and for the purpose of this Rider, Class includes the Policy form to which this Rider is attached. The charges described here are maximum charges we guarantee as shown in the Policy Specifications. We may charge less than these maximum charges. Any lesser charge will apply uniformly to all members of the same Class.

Rider Charge – On each Monthly Payment Date, there is a Rider Charge that will be part of the Policy’s Monthly Deduction. Such charges may vary by Class, and for the purpose of this Rider, Class includes the Policy form to which this Rider is attached. The maximum Rider Charge and duration are shown in the Policy Specifications. We may charge less than such maximum charge. All charges will apply uniformly to all members of the same Class. The Rider Charge will apply whether or not a particular Term Increase goes into effect and regardless of whether any Term Increases remain in effect.

Rider Coverage Charge – The Rider Coverage Charge is based on the Rider Face Amount at the time of the charge and will change if the Rider Face Amount changes. The maximum Coverage Charge for this Rider is shown in Policy Specifications. We will send you a Supplemental Schedule of Coverage to reflect any changes to the Rider Coverage Charge.

Depending on the Policy to which this Rider is attached, an alternate Rider Coverage Charge may apply. See the Annual Renewable Term Rider Value Features in your Policy Specifications to determine the Rider Coverage Charge that is applicable to this Rider.

Rider Cost of Insurance Charge – The Cost of Insurance Charge for this Rider will not exceed (1) multiplied by (2), where:

(1) is the Monthly Cost of Insurance Rate for the Rider Coverage Layer divided by 1000; and

(2) is the Net Amount at Risk allocated to the Rider Coverage Layer.

The Maximum Monthly Cost of Insurance Rate is shown in the Policy Specifications. The Net Amount at Risk is allocated proportionately to the Rider Coverage Layer, including each Coverage Layer of other Riders that contribute to the Total Face Amount and each Coverage Layer of Basic Life Coverage under the Policy, according to Face Amount.

GENERAL PROVISIONS OF THIS RIDER

Conversion – This Rider is not convertible.

Insured – As used in this Rider, the Insured means the individual covered under the Policy’s Basic Life Coverage, as shown in the Policy Specifications.

Effective Dates – This Rider is effective on the Policy Date unless otherwise stated. It will terminate on the earlier of:

 

  Your Written Request;

 

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  The date the Rider or the Policy terminates; or
  The death of the Insured.

Reinstatement – If the Policy is reinstated, any Term Increases that would have otherwise occurred when the Policy lapsed will be forfeited. Term Increases that are scheduled to occur after reinstatement will be handled as if the Policy had never lapsed.

Effect of Additional Benefits on Rider Provisions – Your policy may include additional benefits that were added by rider or endorsement. These rider and endorsement forms may include provisions that replace or amend provisions in this Rider. Please read your entire policy, including this Rider and all other forms carefully.

Conformity with IIPRC Standards – This contract was approved under the authority of the IIPRC and issued under the IIPRC standards. If there is any contract provision that is in conflict with any IIPRC standards applicable to this Contract when this Contract was issued, the provision is amended to conform to that standard. Any such amendment is effective on the Contract Date.

Signed for Pacific Life Insurance Company,

 

LOGO

LOGO

LOGO          LOGO

Chairman and Chief Executive Officer

 

Secretary

[www.PacificLife.com]

[(800) 347-7787]

 

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Summary Of Coverages Effective On The Policy Date

 

 

 

LOGO

 

 

R15SRT

 

Scheduled Annual Renewable Term Rider [(Guaranteed Issue)]

LOGO

R15SRT SP

 

Face Amount: Refer to the “Table of Term Coverage Applicable to Scheduled Annual Renewable Term (“S-ART”) Rider
Insured: [John Doe]
Sex and Age: [Male 35]
Risk Class: [Standard Nonsmoker]

 

Rider Charge:

 

[$0.00 Per Month]

  Rider Charge Duration:        

[20 Years]

 

 

 

 

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Policy Number: [VP99999990]

POLICY SPECIFICATIONS

 

Table of Cost of Insurance (COI) Rates

For Scheduled Annual Renewable Term Rider [(Guaranteed Issue)]

                                                                          Insured:                                     [JOHN DOE]

Maximum monthly Cost of Insurance Rates per $1000.00 of Net Amount at Risk applicable to this Coverage.

 

Policy

Year

COI

Rate

Policy

Year

COI

Rate

Policy

Year

COI

Rate

[1

0.10090 30 1.27900 59 21.97380

2

0.10670 31 1.41510 60 23.81220

3

0.11170 32 1.55240 61 25.79270

4

0.12010 33 1.68980 62 27.64150

5

0.12840 34 1.83930 63 29.65380

6

0.13760 35 1.99170 64 31.85100

7

0.14930 36 2.17330 65 34.25960

8

0.16350 37 2.37670 66 36.90860

9

0.17930 38 2.64820 67 39.06360

10

0.19940 39 2.93180 68 41.41760

11

0.22110 40 3.23010 69 43.99540

12

0.24200 41 3.56140 70 46.82420

13

0.26460 42 3.92360 71 49.93700

14

0.27790 43 4.34570 72 53.37330

15

0.29380 44 4.84010 73 57.18460

16

0.31390 45 5.41330 74 61.42910

17

0.33900 46 6.04180 75 66.18210

18

0.37330 47 6.76170 76 71.53880

19

0.41180 48 7.51460 77 77.62690

20

0.45950 49 8.33040 78 83.33330

21

0.51560 50 9.24140 79 83.33330

22

0.57510 51 10.27540 80 83.33330

23

0.63890 52 11.43490 81 83.33330

24

0.69180 53 12.71510 82 83.33330

25

0.75230 54 14.10520 83 83.33330

26

0.82540 55 15.59360 84 83.33330

27

0.91630 56 17.17060 85 83.33330

28

1.02660 57 18.67330 86 83.33330

29

1.14970 58 20.26540 87+ 0]

 

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Policy Number: [VP99999990]

POLICY SPECIFICATIONS

 

Table of Term Coverage Applicable to

Scheduled Annual Renewable Term Rider [(Guaranteed Issue)]

                                                                          Insured:                                     [JOHN DOE]

 

Policy

Year

Rider Increase

Amount

Total Rider

Face Amount

Maximum Monthly

Coverage

Charge

[1

$0 $0 $0

2

10,000 10,000 2.68

3

10,000 20,000 5.36

4

10,000 30,000 8.04

5

10,000 40,000 10.72

6

10,000 50,000 13.41

7

10,000 60,000 16.09

8

10,000 70,000 18.77

9

10,000 80,000 21.45

10

10,000 90,000 24.13

11

10,000 100,000 26.81

12

0 100,000 26.81

13

0 100,000 26.81

14

0 100,000 26.81

15

0 100,000 26.81

16

0 100,000 26.81

17

0 100,000 26.81

18

0 100,000 26.81

19

0 100,000 26.81

20

0 100,000 26.81

21

0 100,000 26.81

22

0 100,000 36.35

23

0 100,000 36.35

24

0 100,000 36.35

25

0 100,000 36.35

26

0 100,000 36.35

27

0 100,000 36.35

28

0 100,000 36.35

29

0 100,000 36.35

30

0 100,000 36.35

31

0 100,000 36.35

32

0 100,000 36.35

33

0 100,000 36.35

34

0 100,000 36.35

35

0 100,000 36.35

36

0 100,000 36.35

37

0 100,000 36.35

38

0 100,000 36.35

39

0 100,000 36.35

40

0 100,000 36.35

41

0 100,000 36.35

42

0 100,000 36.35

43

0 100,000 36.35

44

0 100,000 36.35

 

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Policy Number: [VP99999990]

POLICY SPECIFICATIONS

 

Table of Term Coverage Applicable to

Scheduled Annual Renewable Term Rider [(Guaranteed Issue)]

Continued

                                                                          Insured:                                     [JOHN DOE]

 

Policy

Year

Rider Increase

Amount

Total Rider

Face Amount

Maximum Monthly

Coverage

Charge

45

$0 100,000 36.35

46

0 100,000 36.35

47

0 100,000 36.35

48

0 100,000 36.35

49

0 100,000 36.35

50

0 100,000 36.35

51

0 100,000 36.35

52

0 100,000 36.35

53

0 100,000 36.35

54

0 100,000 36.35

55

0 100,000 36.35

56

0 100,000 36.35

57

0 100,000 36.35

58

0 100,000 36.35

59

0 100,000 36.35

60

0 100,000 36.35

61

0 100,000 36.35

62

0 100,000 36.35

63

0 100,000 36.35

64

0 100,000 36.35

65

0 100,000 36.35

66

0 100,000 36.35

67

0 100,000 36.35

68

0 100,000 36.35

69

0 100,000 36.35

70

0 100,000 36.35

71

0 100,000 36.35

72

0 100,000 36.35

73

0 100,000 36.35

74

0 100,000 36.35

75

0 100,000 36.35

76

0 100,000 36.35

77

0 100,000 36.35

78

0 100,000 36.35

79

0 100,000 36.35

80

0 100,000 36.35

81

0 100,000 36.35

82

0 100,000 36.35

83

0 100,000 36.35

84

0 100,000 36.35

85

0 100,000 36.35

86

0 100,000 36.35

87+

0 100,000 0]

 

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