LIFE INSURANCE POLICY
COVERAGE PROVIDED BY THIS POLICY. We agree to pay the Death Benefit to the
Beneficiary when We receive proof of the death of the Insured while this policy
is in effect, subject to the terms of this policy. The Death Benefit is
explained in the DEATH BENEFIT PROVISIONS section.
THE AMOUNT OR THE DURATION OF THE DEATH BENEFIT MAY BE FIXED OR MAY INCREASE OR
DECREASE DEPENDING UPON THE INVESTMENT RESULTS OF THE SUB-ACCOUNTS YOU SELECT,
AND UPON THE DEATH BENEFIT OPTION SELECTED. THE ACCOUNT VALUE MAY INCREASE OR
DECREASE WITHOUT LIMIT DEPENDING UPON THE INVESTMENT RESULTS OF THE SUB-ACCOUNTS
YOU SELECT. THERE IS NO MINIMUM GUARANTEED ACCOUNT VALUE FOR AMOUNTS YOU
ALLOCATE TO THE SUB-ACCOUNTS.
Premiums are payable on this policy until the day before the policy anniversary
on which the Insured is age 100. If the policy is still in effect at that time,
the insurance coverage provided by this policy will continue until the death of
the Insured, as explained in the EXTENDED MATURITY BENEFIT PROVISION section,
with no further premium payments.
TEN-DAY RIGHT TO EXAMINE THE POLICY (FREE LOOK PERIOD). PLEASE READ YOUR POLICY
CAREFULLY. IF YOU ARE NOT SATISFIED WITH IT, YOU MAY RETURN IT TO US WITHIN 10
DAYS AFTER YOU RECEIVE IT. MAIL OR DELIVER THE POLICY TO US AT OUR HOME OFFICE
(P.O. BOX 2850, CINCINNATI, OHIO 45201-2850) OR TO THE AGENT THROUGH WHOM YOU
PURCHASED IT. THE POLICY WILL BE DEEMED VOID AS THOUGH NO APPLICATION WAS MADE.
WE WILL REFUND TO YOU AN AMOUNT EQUAL TO THE SUM OF (1) THE DIFFERENCE BETWEEN
ANY PREMIUMS YOU HAVE PAID, INCLUDING FEES AND CHARGES, AND THE AMOUNTS
ALLOCATED TO THE VARIABLE ACCOUNT, (2) THE VARIABLE ACCOUNT VALUE ON THE DATE
YOUR CANCELLATION REQUEST IS RECEIVED BY US OR THE AGENT THROUGH WHOM YOU
PURCHASED THIS POLICY, AND (3) ANY FEES OR CHARGES IMPOSED ON AMOUNTS ALLOCATED
TO THE VARIABLE ACCOUNT.
This policy is a legal contract between You, as Owner, and Columbus Life
Insurance Company.
Signed for Columbus Life Insurance Company at Cincinnati, Ohio.
Secretary President
PLEASE READ YOUR POLICY CAREFULLY
Flexible Premium Variable Universal Life Policy
Flexible Premiums Payable During Life of Insured to Age 100
Death Benefit Payable at Death of Insured
Non-Participating
<PAGE>
<TABLE>
<CAPTION>
TABLE OF CONTENTS
<S> <C> <C> <C>
POLICY SCHEDULE 3 POLICY VALUES 16
DEFINITIONS 4 Account Value 16
THIS POLICY IS A CONTRACT 7 Cash Surrender Value 16
OWNERSHIP PROVISIONS 7 Net Cash Surrender Value 16
Owner, Contingent Owner Withdrawal 16
and Joint Owner 7 LOAN PROVISIONS 16
BENEFICIARY PROVISIONS 8 Right to Borrow and
Primary Beneficiary and Maximum Loan 16
Contingent Beneficiary 8 Loan Account 17
DEATH BENEFIT PROVISIONS 8 Loan Interest 17
Death Benefit 8 Policy Termination 17
Death Benefit Options 9 Repaying Loans 17
Option 1 9 POLICY COSTS AND CHARGES 17
Option 2 9 Premium Expense Charge 17
Specified Amount and Death State Tax Charge 18
Benefit Option Changes 9 Monthly Deduction and
Increasing the Specified Amount 9 Monthly Expense Charge 18
Decreasing the Specified Amount 10 Cost of Insurance Charge 18
Changing the Death Per Policy Charge 19
Benefit Option 10 Per $1,000 Charge 19
PREMIUM PAYMENT PROVISIONS 10 Mortality and Expense Risk Charge 19
Payment of Premiums 10 Surrender Charge 19
Planned Premiums 10 PAYMENT OF PROCEEDS 20
Grace Period and Termination Policy Proceeds 20
of Coverage 11 How We Pay 20
REINSTATEMENT 11 How to Claim Death Proceeds 20
GUARANTEE OF CONTINUED COVERAGE 11 Calculation of Death Proceeds 20
MINIMUM ANNUAL PREMIUMS 11
Minimum Annual Premium 11 CHOOSING AN INCOME PLAN 20
Five-Year No-Lapse Guarantee 11 The Income Plans 21
EXTENDED MATURITY BENEFIT PROVISION 12 Adjustment to Age 24
VARIABLE ACCOUNT PROVISIONS 12 GENERAL PROVISIONS 25
Separate Account 12 Annual Report 25
Sub-Accounts 12 Projection of Benefits
Variable Account 12 and Values 25
Valuation Date and Ownership and Insulation
Valuation Period 13 of Assets 25
Accumulation Unit 13 Reliance 25
Net Investment Factor 13 Limits on Our Contesting
Crediting and Deduction of This Policy 25
Accumulation Units 13 Conversion to a Fixed Policy 25
Addition, Deletion or Suicide 26
Substitution of Investments 14 Error in Age or Sex 26
FIXED ACCOUNT PROVISIONS 14 Claims of Creditors 26
Fixed Account 14 Assignment 26
Fixed Account Value 14 Required Note on
Interest Rate 14 Our Computations 26
ALLOCATION OF PREMIUMS 15 Authority to Make Agreements 27
DOLLAR COST AVERAGING 15 Conformity with Laws 27
TRANSFER PROVISIONS 15 Taxes 27
Transfers 15 Termination 27
Limitation on Transfers Notices 27
from the Fixed Account 15 Nonparticipating 27
</TABLE>
--------------------------------------------------------------------------------
Page 2
<PAGE>
POLICY SCHEDULE
<TABLE>
<S> <C> <C> <C>
INSURED: [John Doe] POLICY NUMBER: [CM1234567V]
OWNER: John Doe POLICY DATE: 01-01-2001
INSURED AGE: 35
SPECIFIED AMOUNT: $100,000 INSURED SEX: Male
CLASS: Preferred (Non-Tobacco User) PLANNED PREMIUM: $850.00
Annually
MINIMUM ISSUE LIMIT: $100,000 PAYABLE TO AGE: [100]
DEATH BENEFIT OPTION: [1]
</TABLE>
<TABLE>
<CAPTION>
<S> <C>
Minimum Annual Premium for Five-Year No-Lapse Guarantee: [$850.00]
Maximum Per Policy Charge: $9.00 Per Policy
Maximum Premium Expense Charge: See Maximum Premium
Expense Charge Page
Maximum Per $1,000 Charge: See Maximum Per $1,000
Charge Page
Maximum Mortality and Expense Risk Charge: See Maximum Mortality and
Expense Risk Charge Page
Maximum Loan Interest Rate Charged: 4.00%
Minimum Guaranteed Interest Rate Credited to Fixed Account: 3.00%
Minimum Guaranteed Interest Rate Credited to Loan Account: 3.00%
</TABLE>
NOTE: IT IS POSSIBLE THAT COVERAGE WILL EXPIRE PRIOR TO THE DEATH OF THE INSURED
DUE EITHER TO INSUFFICIENT PREMIUM OR UNFAVORABLE VARIABLE ACCOUNT PERFORMANCE,
OR THE COMBINED EFFECT OF BOTH.
<PAGE>
POLICY SCHEDULE (continued)
ALLOCATION OF NET PREMIUM
(Percentages must be in whole numbers and must total 100%)
SUB-ACCOUNTS OF THE COLUMBUS LIFE INSURANCE COMPANY SEPARATE ACCOUNT 1:
[ AIM V.I. Growth ]
AIM V.I. Government Securities
Alger American Small Captialization
35% Alger American Growth
MFS VIT Emerging Growth
MFS VIT Growth with Income
PIMCO Long-Term U.S. Government Bond
Touchstone Small Cap Value
Touchstone Emerging Growth
Touchstone International Equity
50% Equity 500 Index Fund
Touchstone High Yield
Touchstone Value Plus
Touchstone Enhanced 30
Touchstone Balanced
Touchstone Bond
Touchstone Standby Income
[ 15% Fixed Account ]
--------------------------------------------------------------------------------
Page 3 Allocation of Net Premium
<PAGE>
POLICY SCHEDULE (continued)
GUARANTEED MAXIMUM COST OF INSURANCE CHARGES
PER THOUSAND DOLLARS OF INSURANCE
(Based on 1980 CSO Nonsmoker Mortality Table, Age Last Birthday)
<TABLE>
<CAPTION>
Attained Monthly Attained Monthly Attained Monthly
Age Charge Age Charge Age Charge
------------------------------- ----------------------------- -----------------------------
<S> <C> <C> <C> <C> <C>
0 0.089220 36 0.151820 72 3.839990
1 0.085880 37 0.161840 73 4.293280
2 0.082540 38 0.172690 74 4.794460
3 0.080880 39 0.184390 75 5.333740
4 0.077540 40 0.198590 76 5.907380
5 0.073370 41 0.213630 77 6.511600
6 0.069200 42 0.229510 78 7.150730
7 0.065030 43 0.247060 79 7.845900
8 0.062530 44 0.266290 80 8.620930
9 0.061690 45 0.288040 81 9.498890
10 0.062530 46 0.311460 82 10.501350
11 0.067530 47 0.336570 83 11.628210
12 0.076700 48 0.364190 84 12.862100
13 0.089220 49 0.394340 85 14.178860
14 0.103400 50 0.428690 86 15.565070
15 0.118420 51 0.468090 87 17.002260
16 0.132610 52 0.513380 88 18.486430
17 0.143470 53 0.565410 89 20.041320
18 0.151820 54 0.623350 90 21.693700
19 0.156830 55 0.688070 91 23.488560
20 0.140130 56 0.758730 92 25.504290
21 0.138460 57 0.833670 93 27.961930
22 0.135950 58 0.917110 94 31.383850
23 0.132610 59 1.010780 95 36.798270
24 0.129280 60 1.115550 96 46.588990
25 0.125100 61 1.232310 97 67.043870
26 0.122600 62 1.367070 98 83.333330
27 0.120930 63 1.519910 99 83.333330
28 0.120090 64 1.690090
29 0.120090 65 1.876860
30 0.120930 66 2.079500
31 0.123430 67 2.297270
32 0.126770 68 2.534600
33 0.131780 69 2.798580
34 0.137620 70 3.098170
35 0.144300 71 3.441600
------------------------------- ----------------------------- -----------------------------
</TABLE>
This table shows the guaranteed maximum Cost of Insurance Charges for the
Insured as a non-tobacco user. For any Insured in a special or substandard rate
class, the guaranteed maximum Cost of Insurance Charges shall be the rate shown
in the table multiplied by the appropriate rating factor. Such factor will be
shown in the amendment added to the policy. Attained age is the age of the
Insured on the last anniversary of the Policy Date or of the date of any
increase.
--------------------------------------------------------------------------------
Maximum Cost of Insurance Per $1,000 Charges
Page 3
<PAGE>
POLICY SCHEDULE (continued)
MAXIMUM SURRENDER CHARGES
<TABLE>
<CAPTION>
Policy Month Amount Policy Month Amount
--------------------------------------------- --------------------------------------------
<S> <C> <C> <C>
1-60 $765.00 100 $425.00
61 $756.50 101 $416.50
62 $748.00 102 $408.00
63 $739.50 103 $399.50
64 $731.00 104 $391.00
65 $722.50 105 $382.50
66 $714.00 106 $374.00
67 $705.50 107 $365.50
68 $697.00 108 $357.00
69 $688.50 109 $348.50
70 $680.00 110 $340.00
71 $671.50 111 $331.50
72 $663.00 112 $323.00
73 $654.50 113 $314.50
74 $646.00 114 $306.00
75 $637.50 115 $297.50
76 $629.00 116 $289.00
77 $620.50 117 $280.50
78 $612.00 118 $272.00
79 $603.50 119 $263.50
80 $595.00 120 $255.00
81 $586.50 121 $244.38
82 $578.00 122 $233.75
83 $569.50 123 $223.13
84 $561.00 124 $212.50
85 $552.50 125 $201.88
86 $544.00 126 $191.25
87 $535.50 127 $180.63
88 $527.00 128 $170.00
89 $518.50 129 $159.38
90 $510.00 130 $148.75
91 $501.50 131 $138.13
92 $493.00 132 $127.50
93 $484.50 133 $116.88
94 $476.00 134 $106.25
95 $467.50 135 $ 95.63
96 $459.00 136 $ 85.00
97 $450.50 137 $ 74.38
98 $442.00 138 $ 63.75
99 $433.50 139 $ 53.13
140 $ 42.50
141 $ 31.88
142 $ 21.25
143 $ 10.63
144 $ 0.00
145 or more $ 0.00
</TABLE>
Policy Month begins on the monthly anniversary day in the calendar month and
ends on the day before the monthly anniversary day in the next calendar month.
Policy Month 1 begins on the policy date.
--------------------------------------------------------------------------------
Page 3 Maximum Surrender Charges
<PAGE>
POLICY SCHEDULE (continued)
MAXIMUM PREMIUM EXPENSE CHARGE
Coverage Up To In Excess Of
LAYER MONTH TARGET PREMIUM TARGET PREMIUM
-------------------------- ------------------------ --------------------
1 - 144 7.50% 4.25%
145 + 3.50% 2.75%
TARGET PREMIUM DATE
------------------------ --------------------
COVERAGE LAYER 1 [ $ 850.00 01/01/2001 ]
--------------------------------------------------------------------------------
Page 3 Maximum Premium Expense Charge
<PAGE>
POLICY SCHEDULE (continued)
MAXIMUM PER $1,000 CHARGE
PER THOUSAND DOLLARS OF SPECIFIED AMOUNT
Coverage Layer Month Expense Charge Factor
----------------------------- -----------------------------
COVERAGE LAYER 1 1 - 144 [ .06250 ]
145+ [ .00000 ]
--------------------------------------------------------------------------------
Page 3 Maximum Per $1,000 Charge
<PAGE>
POLICY SCHEDULE (continued)
MAXIMUM MORTALITY AND EXPENSE RISK CHARGE
<TABLE>
<CAPTION>
Expense Charge
POLICY MONTH ACCOUNT VALUE BAND* MONTHLY ANNUALIZED
--------------------- ----------------------------- -------------------------------------
<S> <C> <C> <C>
1 - 144 All 0.075000% 0.90%
145+ First $25,000 0.075000% 0.90%
Next $25,000 0.054167% 0.65%
Next $200,000 0.033333% 0.40%
Excess over $250,000 0.025000% 0.30%
</TABLE>
* Account Value less the value of the Loan Account.
--------------------------------------------------------------------------------
Page 3 Maximum Mortality and Expense Risk Charge
<PAGE>
--------------------------------------------------------------------------------
DEFINITIONS
YOU AND YOUR. In this policy, You and Your refer to the Owner of the policy. In
the application, You and Your refer to the proposed Insured.
WE, OUR AND US. Columbus Life Insurance Company.
BASIC POLICY TERMS
ATTAINED AGE. The Age of the Insured on the last anniversary of the Policy Date
or of the date of any increase.
BENEFICIARY OR PRIMARY BENEFICIARY. The person or persons You have named to
receive the Death Benefit when the Insured dies.
CONTINGENT BENEFICIARY. The person or persons You have named to receive the
Death Benefit if none of the Primary Beneficiaries is living when the Insured
dies.
CONTINGENT OWNER. The person You have named to be the Owner of this policy if
You die before the Insured.
COVERAGE LAYER. A Coverage Layer consists of all base policy and rider coverages
that become effective on a single Monthly Anniversary Day. The first Coverage
Layer includes coverage effective on the Policy Date. An increase in base
coverage or the addition of rider benefits creates another Coverage Layer.
INSURED. The person named on the application on whose life this policy provides
insurance coverage.
MONTHLY ANNIVERSARY DAY. The date each month on which We deduct the Monthly
Deduction and the Monthly Expense Charge. This is generally the same date each
month as the Policy Date, so long as that date falls on a Valuation Date. The
initial Monthly Anniversary Day is the Policy Date.
OWNER OR JOINT OWNER. The person or persons who have all rights under this
policy. If there are Joint Owners, both must consent in writing to the exercise
of any right under this policy.
POLICY DATE. The date from which policy months, years and anniversaries are
measured.
POLICY SCHEDULE. The schedule on page 3 of this policy, or the most recent
amended Policy Schedule We have sent You to replace it.
SPECIFIED AMOUNT. The amount of insurance coverage You have selected, as shown
on the Policy Schedule.
PREMIUMS AND GUARANTEES
NET PREMIUM. The amount of premium paid less the Premium Expense Charge and the
State Tax Charge.
PLANNED PREMIUM. The amount and frequency of the premium You have indicated You
plan to pay, as shown on the Policy Schedule.
TARGET PREMIUM. A cumulative level of premium payment in a coverage year that
determines the rate of the Premium Expense Charge deducted from premium payments
allocated to a Coverage Layer. The Target Premium for each Coverage Layer is
shown on the Policy Schedule.
--------------------------------------------------------------------------------
Page 4
<PAGE>
--------------------------------------------------------------------------------
FIVE-YEAR NO-LAPSE GUARANTEE. Our guarantee that this policy will not terminate
or begin the Grace Period during the five-year period beginning on the Policy
Date, provided certain conditions are met, as described in the GUARANTEE OF
CONTINUED COVERAGE section.
ACCOUNTS AND PORTFOLIOS
FIXED ACCOUNT. An option under this policy which allows You to allocate Your Net
Premiums to Our general account in order to earn interest at an effective annual
rate guaranteed not to be less than 3.00%.
LOAN ACCOUNT. The portion of the Account Value which is collateral for loan
amounts and any interest due which remains unpaid.
PORTFOLIO. A separate investment fund in which a Sub-Account of the Separate
Account invests.
SEPARATE ACCOUNT. Columbus Life Insurance Company Separate Account 1.
SUB-ACCOUNT. A sub-division of the Separate Account. Each Sub-Account invests in
different Portfolio. The Sub-Accounts are shown on the Policy Schedule.
VARIABLE ACCOUNT. An option under this policy which allows You to allocate Your
Net Premiums to one or more Sub-Accounts of the Separate Account.
VALUE AND VALUATION
ACCOUNT VALUE. The sum of Your interest in the Fixed Account, the Variable
Account and the Loan Account. The ACCOUNT VALUE section explains how to
calculate the Account Value.
ACCUMULATION UNIT. An accounting unit of measure that We use to calculate the
Variable Account Value.
AMOUNT AT RISK. The amount by which the Death Benefit plus any Indebtedness
exceeds the Account Value.
CASH SURRENDER VALUE. The Account Value, less any applicable Surrender Charges.
INDEBTEDNESS. Any policy loan plus any accrued loan interest.
NET CASH SURRENDER VALUE. The Account Value, less any applicable Surrender
Charge, less any Indebtedness.
NET INVESTMENT FACTOR. A factor which reflects the investment gain or loss of a
Sub-Account from one Valuation Period to the next.
VALUATION DATE. Any date on which We are open for business and the New York
Stock Exchange is open for trading.
VALUATION PERIOD. A period beginning with the close of business on the New York
Stock Exchange on one Valuation Date and ending at the close of business on the
New York Stock Exchange on the next Valuation Date.
VARIABLE ACCOUNT VALUE. The current value of all Your Accumulation Units in the
Sub-Accounts.
--------------------------------------------------------------------------------
Page 5
<PAGE>
CHARGES
COST OF INSURANCE CHARGE. The amount deducted each Monthly Anniversary Day for
insurance coverage under this policy, as described in the COST OF INSURANCE
CHARGE subsection.
MONTHLY DEDUCTION. The amount deducted each Monthly Anniversary Day for the Cost
of Insurance Charges plus the cost of any additional benefits provided under
this policy by rider.
MONTHLY EXPENSE CHARGE. An amount deducted each Monthly Anniversary Day that
consists of three components: (i) the Per Policy Charge, (ii) the Per $1,000
Charge and (iii) the Mortality and Expense Risk Charge. The maximum Per Policy
Charge, Per $1,000 Charge and Mortality and Expense Risk Charge are shown on the
Policy Schedule.
PREMIUM EXPENSE CHARGE. An amount deducted from each premium payment before it
is allocated. The maximum Premium Expense Charge is shown on the Policy
Schedule.
STATE TAX CHARGE. An amount deducted from each premium payment before it is
allocated to cover any state premium taxes in the applicable state.
SURRENDER CHARGES. An amount deducted from the Account Value if this policy is
surrendered. A Surrender Charge will also be deducted on any date when a Grace
Period ends without sufficient premium being paid to keep the policy in force.
--------------------------------------------------------------------------------
Page 6
<PAGE>
--------------------------------------------------------------------------------
THIS POLICY IS A CONTRACT
This policy is a contract between You and Us to insure the life of the Insured.
We provide insurance coverage and other benefits described in this policy. Our
decision to do this is based on the completed application and payment by You of
premiums.
Whenever We refer to the policy, We mean the entire contract. The entire
contract consists of:
o the basic policy;
o the attached application;
o any attached supplemental applications; and
o any attached riders, endorsements or amendments.
Riders, endorsements and amendments add provisions or change the terms of the
basic policy.
OWNERSHIP PROVISIONS
OWNER, CONTINGENT OWNER AND JOINT OWNER
You have all rights in this policy, subject to any assignment and to the rights
of any irrevocable Beneficiary You have named. During the life of the Insured,
You may exercise the following rights, subject to the terms of this policy:
(1) the right to change the Specified Amount;
(2) the right to change the amount or frequency of Planned Premium;
(3) the right to change the Death Benefit Option;
(4) the right to assign the policy;
(5) the right to change the Owner or Beneficiary;
(6) the right to surrender this policy;
(7) the right to take loans;
(8) the right to take withdrawals;
(9) the right to make transfers;
(10) the right to change Net Premium allocations; and
(11) any other rights under this policy.
If You are not the Insured, You may name a Contingent Owner. If You die before
the Insured, ownership would then pass to the Contingent Owner. If there is no
Contingent Owner, Your estate would become the Owner.
This policy may be owned by two persons as Joint Owners. In that case, both
Joint Owners must consent in writing to the exercise of any rights under the
policy. You must also have the consent of any irrevocable Beneficiary to
exercise Your rights under this policy. You do not need the consent of a
Contingent Owner or a revocable Beneficiary to exercise any of Your rights.
You may change the Owner, or change or revoke any Contingent Owner designation,
at any time by written notice to Us. The change will take effect on the date You
signed the notice, but We will not be liable for any actions We take before We
receive the notice at Our Home Office. A change of Owner automatically revokes
any Contingent Owner designation. A change of Owner, or a change or revocation
of a Contingent Owner designation, does not automatically change or revoke a
prior Beneficiary designation.
--------------------------------------------------------------------------------
Page 7
<PAGE>
--------------------------------------------------------------------------------
BENEFICIARY PROVISIONS
PRIMARY BENEFICIARY AND CONTINGENT BENEFICIARY
The Beneficiary will receive the Death Benefit upon the Insured's death. Unless
You change them later, the Primary and Contingent Beneficiaries are the persons
named in the application. If no Primary Beneficiary is still living when the
Insured dies, We will pay the Death Benefit to any Contingent Beneficiary who is
still living. If there is no surviving Primary or Contingent Beneficiary, We
will pay You. If You were the Insured, We will pay Your estate. The interest of
any Beneficiary is subject to the rights of any assignee reflected on Our
records.
Two or more persons may be named as Primary Beneficiaries or Contingent
Beneficiaries. We will pay equal shares when there is more than one Beneficiary
of the same class, unless You specify otherwise on the Beneficiary designation.
No revocable Beneficiary has rights under this policy until the Insured dies. An
irrevocable Beneficiary cannot be changed without his or her consent.
You may change the Beneficiary at any time before the death of the Insured by
sending written notice to Us. The change will be effective as of the date You
signed the notice, but We will not be liable for any payments We make or other
actions We take before the notice is received at Our Home Office.
Unless You have instructed otherwise, if the Beneficiary is the spouse of the
Insured, both die and We cannot tell who died first, We will pay the Death
Benefit as if the Beneficiary had survived the Insured.
DEATH BENEFIT PROVISIONS
DEATH BENEFIT
We will pay the Death Benefit proceeds as described in the PAYMENT OF PROCEEDS
section when We receive proof that the Insured died while this policy was in
force, and any other proof that We may require in order to investigate the
claim. The Beneficiary should contact Us at the Home Office or contact one of
Our agents for instructions on how to file a claim.
--------------------------------------------------------------------------------
Page 8
<PAGE>
--------------------------------------------------------------------------------
DEATH BENEFIT OPTIONS
The Death Benefit will be one of the following two Options, as selected by You
on the application, or as subsequently changed by You.
OPTION 1
The Death Benefit is the greater of the following, less any Indebtedness as of
the Insured's date of death: (1) the Specified Amount; or (2) the Account Value
times the applicable factor from the table below.
OPTION 2
The Death Benefit is the greater of the following, less any Indebtedness as of
the Insured's date of death: (1) the Account Value plus the Specified Amount; or
(2) the Account Value times the applicable factor from the table below.
<TABLE>
<CAPTION>
Insured's Age Applicable Insured's Age Applicable
Last Policy Anniversary Factor Last Policy Anniversary Factor
<S> <C> <C> <C>
40 and under 2.50 61 1.28
41 2.43 62 1.26
42 2.36 63 1.24
43 2.29 64 1.22
44 2.22 65 1.20
45 2.15 66 1.19
46 2.09 67 1.18
47 2.03 68 1.17
48 1.97 69 1.16
49 1.91 70 1.15
50 1.85 71 1.13
51 1.78 72 1.11
52 1.71 73 1.09
53 1.64 74 1.07
54 1.57 75 through 90 1.05
55 1.50 91 1.04
56 1.46 92 1.03
57 1.42 93 1.02
58 1.38 94 1.01
59 1.34 95 or higher 1.00
60 1.30
</TABLE>
SPECIFIED AMOUNT AND DEATH BENEFIT OPTION CHANGES
You may request a change in the Specified Amount or Death Benefit Option by
sending notice to Us in writing at Our Home Office. Following Our approval of
any such change, We will send You an amended Policy Schedule.
Increasing the Specified Amount. You may apply for an increase in the Specified
Amount on a supplemental application. The requested increase is subject to
evidence of insurability satisfactory to Us. Generally, the minimum increase is
$25,000. Any increase We approve will be effective on the next Monthly
Anniversary Day coinciding with or next following such approval, as shown on an
amended Policy Schedule, subject to deduction of the first month's Cost of
Insurance Charges for the increase from the Net Cash Surrender Value of this
policy. BECAUSE THE NEW MAXIMUM SURRENDER CHARGES WILL INCREASE, THEREBY
REDUCING YOUR NET CASH SURRENDER VALUE, AND BECAUSE THE COST OF INSURANCE
CHARGES WILL BE HIGHER, THE AMOUNT OF PREMIUM YOU MUST PAY TO KEEP YOUR POLICY
FROM TERMINATING MAY INCREASE.
--------------------------------------------------------------------------------
Page 9
<PAGE>
--------------------------------------------------------------------------------
Decreasing the Specified Amount. You may request a decrease in the Specified
Amount at any time after the first policy year. Any decrease in the Specified
Amount which You request will become effective on the first Monthly Anniversary
Day after We receive Your request. The minimum decrease is $25,000. The new
Specified Amount must not be less than the minimum issue limit shown on the
Policy Schedule at issue. We may limit the amount of the decrease to preserve
the tax status of this policy as life insurance.
Any decrease You request will occur in the following order: first against the
most recent increase in Specified Amount, if any; then in order against the next
most recent increases; then finally against the initial Specified Amount.
Changing the Death Benefit Option. You may request a change in the Death Benefit
Option at any time after the first policy year. Except as described below, this
will require a change in the Specified Amount. If You request a change from
Option 1 to Option 2, the Specified Amount will be reduced by the amount, if
any, needed to keep the Death Benefit the same both before and after the change.
If You request a change from Option 2 to Option 1, the Specified Amount will be
increased by the amount, if any, needed to keep the Death Benefit the same both
before and after the change. In either case, the Death Benefit at the time of
change will not be altered, but the Death Benefit from that point on will be
affected. You may not make a change in the Death Benefit Option which would
reduce the Specified Amount below the minimum issue limit shown on the Policy
Schedule.
You can make an election to keep the Specified Amount the same. However, if the
change is from Option 1 to Option 2, Your election must be accompanied by
evidence satisfactory to Us that the Insured is still insurable.
PREMIUM PAYMENT PROVISIONS
PAYMENT OF PREMIUMS
Premium payments under this policy are payable during the lifetime of the
Insured until the day before the policy anniversary on which the Insured is age
100. Any premium You pay generally must be at least $50. If You pay by
pre-authorizing Us to make automatic deductions from Your bank account, however,
We will accept smaller premium payments. We reserve the right not to accept any
premium payment which would, in Our opinion, cause this policy to fail to
qualify as life insurance under federal tax laws.
In order for this policy to take effect, the first premium paid must equal at
least 1/12th of the Minimum Annual Premium for the Five-Year No-Lapse Guarantee,
as shown on the Policy Schedule. Premiums after the first are payable at Our
Home Office.
PLANNED PREMIUMS
The amount and frequency of Your Planned Premiums are shown on the Policy
Schedule, but You are not required to make premium payments according to a set
schedule. You may skip a Planned Premium payment, and You may change the
frequency and the amount of the Planned Premium shown.
Even if premium payments are not continued, insurance coverage under this policy
and any benefits provided by rider will be continued until the value is
insufficient as described below in the GRACE PERIOD section. No rider will be
continued beyond the termination date provided in the rider.
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THE AMOUNT AND FREQUENCY OF YOUR PREMIUM PAYMENTS WILL AFFECT YOUR POLICY VALUES
AND THE LENGTH OF TIME FOR WHICH YOU HAVE INSURANCE COVERAGE. DEPENDING ON THE
INVESTMENT PERFORMANCE OF THE SUB-ACCOUNTS YOU SELECT, THE PLANNED PREMIUM MAY
NOT BE ENOUGH TO KEEP THE POLICY IN FORCE. YOU MAY NEED TO CHANGE YOUR PLANNED
PREMIUM OR MAKE ADDITIONAL PREMIUM PAYMENTS TO KEEP YOUR POLICY FROM
TERMINATING.
GRACE PERIOD AND TERMINATION OF COVERAGE
Except as described below in the GUARANTEE OF CONTINUED COVERAGE section, on any
Monthly Anniversary Day when the Net Cash Surrender Value is less than the sum
of the Monthly Deduction and the Monthly Expense Charge for the following month,
We will allow a Grace Period. We will mail You, and anyone shown on Our records
as holding this policy as collateral, a notice indicating the minimum premium
You must pay in order to keep the policy in effect. You will have 61 days from
the date We mail You this notice to pay enough premium. If You do not pay the
needed premium within the 61 day Grace Period, all coverage provided by this
policy will terminate without value at the end of the 61 day period. If the
Insured dies during the Grace Period, the proceeds paid will be reduced by the
amount of any unpaid charges, not to exceed three times the sum of the Monthly
Deduction and the Monthly Expense Charge. We will not terminate this policy
until at least 61 days after We mail You and anyone shown on Our records as
holding this policy as collateral, notice at the last addresses shown on Our
records.
REINSTATEMENT
If the Grace Period expires and Your policy terminates because You have not paid
the needed premium, You may reinstate the policy within five years after the
expiration of the Grace Period if the Insured is still living. The reinstatement
is subject to evidence of insurability satisfactory to Us. In addition, You must
pay an amount of premium which will result in a Net Cash Surrender Value
sufficient to pay all back costs and charges which would have been subtracted
from the Account Value if there had been sufficient value on each Monthly
Anniversary Day from the date of termination to the date of reinstatement, plus
an amount sufficient to cover the Monthly Deductions and Monthly Expense Charges
for the next three months. You must also repay or reinstate any Indebtedness at
the time of the termination. The Five-Year No-Lapse Guarantee may not be
reinstated.
GUARANTEE OF CONTINUED COVERAGE
MINIMUM ANNUAL PREMIUM
At issue, the Minimum Annual Premium for the Five-Year No-Lapse Guarantee is as
shown on the Policy Schedule. If You make any changes in Your policy which
result in a change of the Minimum Annual Premium, We will send You an amended
Policy Schedule.
FIVE-YEAR NO-LAPSE GUARANTEE
During the five-year period beginning on the Policy Date, We guarantee that this
policy will not terminate or begin the Grace Period if, AT ALL TIMES SINCE THE
POLICY DATE, the sum of the premiums paid, less any withdrawals, less the amount
of any Indebtedness, is equal to or greater than the following:
(1) If You have made no Policy Changes, 1/12th of the Minimum
Annual Premium for the Five-Year No-Lapse Guarantee, as shown
on the Policy Schedule at issue, times the number of months
from the Policy Date to the next Monthly Anniversary Day.
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(2) If You have made Policy Changes, 1/12th of the Minimum Annual
Premium for the Five-Year No-Lapse Guarantee at issue times
the number of months from the Policy Date to the first such
change, plus 1/12th of the Minimum Annual Premium for the
Five-Year No-Lapse Guarantee following each such change times
the number of months from that change to the next change, or,
with respect to the most recent such change, the number of
months from that change to the next Monthly Anniversary Day.
On any Monthly Anniversary Day during the five-year period beginning on the
Policy Date when the sum of the premiums paid, less any withdrawals, less the
amount of any Indebtedness is less than the amount required to meet the
conditions of the Five-Year No-Lapse Guarantee described above, We will allow a
Grace Period. We will mail You, and anyone shown on Our records as holding this
policy as collateral, a notice indicating the minimum premium You must pay in
order to keep the Five-Year No-Lapse Guarantee in effect. You will have 61 days
from the date We mail You this notice to pay enough premium. If You do not pay
the needed premium within the 61 day Grace Period, the Five-Year No-Lapse
Guarantee will terminate at the end of the 61 day period. The Five-Year No-Lapse
Guarantee will not be reinstated.
EXTENDED MATURITY BENEFIT PROVISION
Premium payments under this policy are payable during the lifetime of the
Insured until the day before the policy anniversary on which the Insured is age
100. The current value of all Your Accumulation Units in any Sub-Accounts will
be permanently transferred into the Fixed Account, where they will begin
receiving the current interest rate. The interest rate credited to the Loan
Account will be increased to equal the interest rate charged against any policy
loans. No further loans will be permitted. At all times thereafter, no further
premiums may be paid, no charges will be deducted, and the Death Benefit will be
revised to equal the Net Cash Surrender Value. The policy will continue in
effect until the Insured's death, or until it is surrendered for its Net Cash
Surrender Value.
VARIABLE ACCOUNT PROVISIONS
SEPARATE ACCOUNT
The Separate Account is established under the laws of the State of Ohio. It is a
unit investment trust registered with the Securities and Exchange Commission
under the Investment Company Act of 1940. The assets in the Separate Account are
kept separate from Our general assets and assets of any other separate accounts
We may have. The assets of the Separate Account shall be available to cover the
liabilities of Our general account only to the extent that the assets of the
Separate Account exceed the liabilities arising under the variable life
insurance policies supported by the Separate Account. The investment policy of
the Separate Account shall not be changed without the approval of the insurance
commissioner of the State of Ohio. The approval process is on file with the
insurance commissioner.
SUB-ACCOUNTS
The Separate Account is divided into Sub-Accounts, each of which invests all its
assets in a corresponding Portfolio.
VARIABLE ACCOUNT
The Variable Account of this policy is an option which allows You to allocate
Your Net Premiums to one or more Sub-Accounts of the Separate Account. The
Variable Account Value is equal to the current value of all Your Accumulation
Units in the Sub-Accounts.
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VALUATION DATE AND VALUATION PERIOD
A Valuation Date is any date on which We are open for business and the New York
Stock Exchange is open for business. The assets of each Sub-Account will be
valued on each Valuation Date. A Valuation Period is a period beginning with the
close of business on the New York Stock Exchange on one Valuation Date and
ending at the close of business on the New York Stock Exchange on the next
Valuation Date.
ACCUMULATION UNIT
The value of an Accumulation Unit for each Sub-Account was arbitrarily set at
$10 when funds were first credited to the Sub-Account. The Accumulation Unit
Value for any subsequent Valuation Period is determined by multiplying the
Accumulation Unit value for the immediately preceding Valuation Period by the
Net Investment Factor. The Accumulation Unit value will fluctuate from day to
day depending on the investment performance of the Portfolio in which the
Sub-Account is invested.
NET INVESTMENT FACTOR
The Net Investment Factor reflects the investment performance of a Sub-Account
from one Valuation Period to the next. The Net Investment Factor for each
Sub-Account, for any Valuation Period, is determined by dividing (1) by (2),
where:
(1) equals:
(a) the net asset value per share of the corresponding
Portfolio at the end of the current Valuation Period,
plus
(b) the per share amount of any dividend or capital gain
distribution made by the Portfolio on shares held in the
Sub-Account if the "ex-dividend" date occurs during
the current Valuation Period, plus or minus
(c) a per Accumulation Unit charge or credit for any taxes
incurred by or reserved for in the Sub-Account, which
is determined by Us to have resulted from the investment
operations of the Sub-Account during the current
Valuation Period;
(2) equals:
(a) the net asset value per share of the corresponding
Portfolio at the end of the immediately preceding
Valuation Period, plus or minus
(b) the per Accumulation Unit charge or credit for any taxes
reserved for the immediately preceding Valuation Period.
CREDITING AND DEDUCTION OF ACCUMULATION UNITS
We will credit Net Premiums You have allocated to the Variable Account in the
form of Accumulation Units.
In the case of the initial premium, Accumulation Units will be credited as of
the later of these dates:
(1) the Policy Date; or
(2) the Valuation Date We receive the premium in Our Home Office.
For subsequent premiums, We will credit Accumulation Units as of the Valuation
Date We receive the premium in Our Home Office.
The number of Accumulation Units to be credited to this policy in each
Sub-Account will generally be determined by dividing the Net Premium allocated
to each Sub-Account by the Accumulation Unit Value for that Sub-Account as of
the end of the Valuation Period during which the premium is received.
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Accumulation Units are credited when amounts are transferred into a Sub-Account.
Accumulation Units are deducted when amounts are transferred out of a
Sub-Account, when amounts (including any fees or charges) are withdrawn, and
when the Monthly Deduction and the Monthly Expense Charge are assessed.
ADDITION, DELETION OR SUBSTITUTION OF INVESTMENTS
We reserve the right to make additional Sub-Accounts available. These
Sub-Accounts will invest in investment portfolios that We believe are suitable
for the Separate Account. We also reserve the right to eliminate existing
Sub-Accounts, or to combine two or more Sub-Accounts.
We reserve the right to substitute a new investment portfolio or similar
investment option for the Portfolio in which a Sub-Account invests. This may
happen if the shares of the Portfolio are no longer available, or as a result of
unsatisfactory investment performance, a change in laws or regulations, a change
in a Portfolio's investment objectives or restrictions, or for some other
reason. We will not substitute any shares attributable to Your interest in a
Sub-Account without obtaining the prior approval of the Securities and Exchange
Commission, to the extent required by the Investment Company Act of 1940, and
any other required approvals.
If We make a substitution or change, We may, by rider or endorsement, make any
changes in this policy which may be necessary or appropriate to reflect the
substitution or change.
We reserve the right to operate the Separate Account as a management investment
company under the Investment Company Act of 1940, or in any other form permitted
by law. We reserve the right to deregister the Separate Account under the 1940
Act in the event such registration is no longer required.
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT
The Fixed Account is an option under this policy which allows You to allocate
Your Net Premiums to Our general account.
FIXED ACCOUNT VALUE
At any time, the Fixed Account Value of Your policy equals:
(1) the sum of all Net Premiums allocated to the Fixed Account; plus
(2) all amounts transferred from the Variable Account or the Loan
Account; plus
(3) interest credited to the Fixed Account; minus
(4) all amounts transferred from the Fixed Account to the Variable
Account or the Loan Account; minus
(5) all amounts withdrawn from the Fixed Account for charges,
deductions or withdrawals.
INTEREST RATE
The amounts You allocate to the Fixed Account will earn interest. We guarantee
that this interest rate will never be less than an effective annual rate of 3%.
We may, but are not required to, credit interest in excess of this rate. The
current interest rate applicable to the Fixed Account at the time of issue is
shown on the Policy Schedule.
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ALLOCATION OF PREMIUMS
You may elect to have Net Premiums allocated to the Fixed Account and/or to one
or more Sub-Accounts of the Variable Account. Each allocation must be in whole
percentages. The sum of the allocation percentages must equal 100%. The
allocation You selected for the initial Net Premium is shown on the Policy
Schedule. Additional Net Premiums will be allocated in the same manner as Your
initial Net Premium, unless You request a change in Your allocation.
DOLLAR COST AVERAGING
You may request in writing at any time that We automatically transfer specified
dollar amounts, earnings or specified percentages from the Fixed Account or from
a Sub-Account We designate for this purpose to other Sub-Accounts You select.
You may elect to have these transfers done on a monthly or quarterly basis. We
will process the transfers on the appropriate Monthly Anniversary Days. You must
select this automatic transfer, referred to as "Dollar Cost Averaging," for a
period of at least 12 months. The minimum Dollar Cost Averaging transfer is
$100. You must allocate whole percentages of the total amount transferred to
each Sub-Account You select.
Dollar Cost Averaging will terminate when any of the following occurs: (1) the
number of designated transfers has been completed; (2) the value in the Fixed
Account or the designated Sub-Account is insufficient to complete the next
scheduled transfer; (3) You request termination in writing; or (4) this policy
terminates. We reserve the right to charge a fee for this service. We also
reserve the right to stop offering this service. If We decide to stop offering
this service after Your policy is issued, We will give You 30 days written
notice. This would not affect any Dollar Cost Averaging programs already in
effect.
TRANSFER PROVISIONS
TRANSFERS
You may transfer amounts among the Fixed Account and the Sub-Accounts of the
Variable Account. The minimum transfer amount is $250. Each allocation to a
Sub-Account must be in whole percentages.
Transfers may be made among the Sub-Accounts, or from one or more Sub-Accounts
to the Fixed Account, at any time. There is no limitation on the maximum amount
which may be transferred from the Sub-Accounts to the Fixed Account. There is no
charge for the first twelve transfers among the Sub-Accounts or from one or more
Sub-Accounts to the Fixed Account, in any policy year. A single transfer
involving multiple Sub-Accounts is considered one transfer for purposes of these
limits. Each transfer after the twelfth will be subject to a transfer fee of
$10.
LIMITATION ON TRANSFERS FROM THE FIXED ACCOUNT
Transfers from the Fixed Account are limited to a maximum of 25% of the Fixed
Account Value during each of the first four policy years. After the fourth
policy year, the entire Fixed Account can be transferred at any time.
Transfers from the Fixed Account to one or more Sub-Accounts may be made only
once each policy year. There is no charge for these transfers.
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POLICY VALUES
ACCOUNT VALUE
The Account Value of this policy is the sum of Your interest in the Variable
Account, the Fixed Account and the Loan Account. The Account Value on each
Valuation Date after the Policy Date will be:
1. the Account Value on the prior Valuation Date, less any withdrawal
(including withdrawal fees) paid since that date; plus
2. interest on amounts allocated to the Fixed Account and the Loan
Account; plus or minus
3. the positive or negative investment experience on amounts allocated
to the Variable Account, reflected in the change in
value of the Accumulation Units; plus
4. any Net Premium for the policy received since the prior Valuation
Date; less
5. any Monthly Deduction and Monthly Expense Charge due, if the
Valuation Date is a Monthly Anniversary Day; less
6. any transfer charges assessed.
The Account Value on the Policy Date, or if later, the date We receive the
initial premium, is the initial Net Premium received for this policy less the
Monthly Deduction and Monthly Expense Charge made as of the Policy Date or as of
such later date.
CASH SURRENDER VALUE
The Cash Surrender Value of this policy is the Account Value, less any
applicable Surrender Charge, as described in the SURRENDER CHARGE section.
NET CASH SURRENDER VALUE
The Net Cash Surrender Value of this policy is the Cash Surrender Value less the
amount of any Indebtedness. You may surrender this policy for the Net Cash
Surrender Value by written notice to Us. We will pay proceeds as described in
the Payment of Proceeds section.
WITHDRAWAL
You may withdraw part of this policy for cash after the first policy year by
written notice to Us. We will pay withdrawals as described in the PAYMENT OF
PROCEEDS section. The minimum amount which can be withdrawn is $500. No
withdrawal can be made which would reduce the Net Cash Surrender Value to less
than $250. The fee for each withdrawal after the first in any policy year is
$50. No withdrawal can be made which would reduce the Specified Amount to less
than the minimum issue limit shown on the Policy Schedule.
The amount withdrawn (including any applicable withdrawal fees) will be deducted
from the Account Value. The deduction will be made from the Sub-Accounts and the
Fixed Account in proportion to the amounts in each account. This will reduce the
Death Benefit.
The Specified Amount will be reduced to the extent necessary such that the Death
Benefit less the Account Value is the same both immediately before and after the
withdrawal.
LOAN PROVISIONS
RIGHT TO BORROW AND MAXIMUM LOAN
You may borrow from this policy in any amount not in excess of 90% of the Cash
Surrender Value less the amount of any outstanding Indebtedness on the date the
loan is made and less an amount equal to the Monthly Deductions and Monthly
Expense Charges for the next two months. This policy will be the only security
We require for the loan, as described in the LOAN ACCOUNT section. We will pay
loan proceeds as described in the PAYMENT OF PROCEEDS section.
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LOAN ACCOUNT
If We issue You a loan when there is no outstanding Indebtedness, an amount
equal to the loan is transferred from the Sub-Accounts and the Fixed Account
into a Loan Account as collateral for the loan. The transfer is made in
proportion to the values in each account. If a loan is issued when there is
outstanding Indebtedness, an amount equal to the difference between the total
loan amount and the amount in the Loan Account is transferred from the
Sub-Accounts and the Fixed Account into the Loan Account in proportion to the
values in each account as collateral for the loan. If a loan repayment is
applied and the amount of the Loan Account exceeds the total loan amount after
repayment, the excess is transferred to the Sub-Accounts and the Fixed Account
in proportion to the current premium allocations from You. The Loan Account will
earn interest. The minimum interest rate We will credit to the Loan Account is
shown on the Policy Schedule. We may, but are not required to, credit interest
in excess of this rate. Any loan, whether or not repaid, will have a permanent
effect on the Death Benefit and policy values because the investment results of
the Sub-Accounts and the current interest rates of the Fixed Account will not
apply to amounts in the Loan Account.
LOAN INTEREST
The maximum interest rate We charge on loans is shown on the Policy Schedule.
Loan interest is due on each Policy Anniversary and on the date the loan is
repaid in full. The amount of any Loan interest charged on the loan which is not
paid when due will be treated as an additional loan.
POLICY TERMINATION
If the Indebtedness exceeds the Cash Surrender Value less the Monthly Deduction
and the Monthly Expense Charge for the current month on any Monthly Anniversary
Day, We will terminate this policy. We will not do this, however, until 31 days
after We mail notice to You indicating the minimum amount You must pay in order
to keep this policy in effect. We will notify You, and anyone shown on Our
records as holding this policy as collateral, at the last addresses shown on Our
records.
REPAYING LOANS
Loans can be repaid in whole or in part at any time during the lifetime of the
Insured. Any Indebtedness not repaid will reduce the amounts payable upon
surrender of the policy or at the death of the Insured.
All payments We receive from You will be credited to Your policy as premium
unless You give Us written notice that the payment is for loan repayment. Loan
repayments will first be applied to pay accrued but unpaid interest on the loan,
the balance will reduce the outstanding balance of Your loan.
POLICY COSTS AND CHARGES
PREMIUM EXPENSE CHARGE
As partial compensation for our expenses, a Premium Expense Charge is deducted
from each premium payment received. This charge is deducted before premium
payments are allocated to the Fixed Account or the Sub-Accounts. The maximum
Premium Expense Charge percentages are shown on the Policy Schedule. The maximum
Premium Expense Charge percentages differ based on the following:
o The length of time a Coverage Layer has been in effect.
o The amount of the Target Premium for a Coverage Layer.
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To determine the amount of the Premium Expense Charge deducted from each premium
payment, We do the following:
(1) We allocate the premium payment to each Coverage Layer in the
same proportion as the Target Premium for a Coverage Layer
bears to the total Target Premiums for all Coverage Layers.
(2) We determine the coverage year for each Coverage Layer.
(3) For each Coverage Layer, We determine the portions of the
premium payment allocated to the Coverage Layer in its current
coverage year that are below and above the Target Premium for
that Coverage Layer.
(4) We multiply each portion of premium payment allocated to the
Coverage Layer by the applicable Premium Expense Charge
percentage.
(5) We add together the Premium Expense Charges for all of the
Coverage Layers.
STATE TAX CHARGE
To cover state premium taxes associated with distribution of this policy, We
will deduct a State Tax Charge from all premiums received before they are
credited to the Fixed Account or the Sub-Accounts. The percentage deducted will
vary by state to reflect each state's actual percentage of premium tax charged,
if any.
MONTHLY DEDUCTION AND MONTHLY EXPENSE CHARGE
The Monthly Deduction consists of the Cost of Insurance Charge plus the cost of
any additional benefits provided by rider. The Monthly Expense Charge partially
covers Our expenses for distributing, issuing and administering the policy and
for assuming the mortality risks and the expense risks associated with the
policy. The Monthly Expense Charge consists of three components: (i) the Per
Policy Charge; (ii) the Per $1,000 Charge; and (iii) the Mortality and Expense
Risk Charge. We take the Monthly Deduction and the Monthly Expense Charge from
the Fixed Account and the Sub-Accounts in proportion to the values in each
account on the Monthly Anniversary Day. You may, however, elect to have the
Monthly Deduction and the Monthly Expense Charge taken from the Fixed Account or
from any one Sub-Account You choose. If the Monthly Deduction and the Monthly
Expense Charge exceed the value of the selected account on any Monthly
Anniversary Day, the remainder will be taken pro rata from the other accounts.
You must notify us in writing of this election.
Cost of Insurance Charge. The maximum monthly Cost of Insurance Charges are
shown on the Policy Schedule. Cost of Insurance Charges apply to all Insureds of
the same Attained Age, sex and risk classification whose policies have been in
effect the same length of time. At Our option, We may charge less than the
maximums shown. The actual charges will be determined by Us from time to time.
Any change in the monthly Cost of Insurance Charges will be on a
non-discriminatory basis toward any one Insured and will apply to all Insureds
of the same age, sex and risk classification whose coverage has been in effect
for the same length of time. The maximum monthly Cost of Insurance Charge at the
Insured's Attained Age is determined as follows:
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(1) Divide the Death Benefit plus any Indebtedness at the
beginning of the policy month by 1 plus the guaranteed
monthly interest rate applicable to the Fixed Account.
(2) Subtract the Account Value at the beginning of the policy
month.
(3) Add the cost of additional benefits provided by rider.
(4) Add the Monthly Expense Charge.
(5) Divide the resulting number by 1,000 to determine the number
of thousands of dollars of insurance coverage.
(6) Multiply by the Cost of Insurance Charge shown on the Policy
Schedule.
Per Policy Charge. A Per Policy Charge applies to each policy. The maximum Per
Policy Charge is shown on the Policy Schedule. At Our option, We may charge less
than the maximum shown.
Per $1,000 Charge. A Per $1,000 Charge applies to the original Specified Amount
and to any requested increase in Specified Amount. The charge for each Coverage
Layer of Specified Amount is determined as follows:
(1) Divide the Specified Amount for the Coverage Layer by 1,000.
(2) Multiply by the Per $1,000 Charge shown on the Policy Schedule
applicable to that Coverage Layer.
The maximum Per $1,000 Charge is shown on the Policy Schedule for the initial
Specified Amount. The Policy Schedule will be amended to include the applicable
Per $1,000 Charge following any requested increase in Specified Amount. At Our
option, We may charge less than the maximum shown.
Mortality and Expense Risk Charge. A Mortality and Expense Risk Charge applies
to Your Account Value less the value of the Loan Account. This charge is
calculated as follows:
(1) Determine the amount of the Account Value, less the value of
the Loan Account, at the beginning of a policy month.
(2) Multiply the amount determined in step (1) by the applicable
maximum Mortality and Expense Charge rate shown on the
Policy Schedule for each band.
(3) Add together the Mortality and Expense Risk Charges for each
of the rate bands shown on the Policy Schedule.
At Our option, We may charge less than the maximum shown.
SURRENDER CHARGE
For a certain period following the Policy Date or the date of any increase in
Specified Amount, a Surrender Charge will be deducted from Your Account Value if
any of the following occurs:
(1) You surrender Your policy; or
(2) a Grace Period ends without sufficient premium being received
by Us to keep the policy in effect;
The amount of the Surrender Charge deducted will be the Maximum Surrender Charge
shown on the Policy Schedule. At Our option, We may charge less than the maximum
shown.
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PAYMENT OF PROCEEDS
POLICY PROCEEDS
The proceeds of this policy may be either Death Proceeds, payable to the
Beneficiary upon the death of the Insured, or Net Cash Surrender Value proceeds,
payable to You if this policy is canceled for its Net Cash Surrender Value
during the lifetime of the Insured.
HOW WE PAY
Proceeds may be paid in a lump sum or under one or more Income Plans. The Income
Plans are described in THE INCOME PLANS section.
We may defer the payment of any proceeds or transfer for a period of up to six
months from the date of Our receipt of the notice giving rise to such payment,
if such payment or transfer is based on the Fixed Account. We will not defer any
amounts needed to pay premiums for other policies in force with Us. Proceeds
under the policy that are attributable to the Variable Account are generally
payable within seven days after We receive notice and any additional
requirements are met. We may defer payments or transfers out of the Variable
Account if:
(1) the New York Stock Exchange is closed on other than customary
weekend holiday closings; or
(2) trading on the New York Stock Exchange is restricted as
determined by the SEC; or
(3) an emergency exists, as determined by the SEC, as a result of
which disposal or valuation of assets is not reasonably
practicable; or
(4) the SEC by order permits deferral for the protection of Owners.
We will pay interest from the date of death or other date proceeds are due to
the date of payment. The rate of interest will not be less than that required by
law.
HOW TO CLAIM DEATH PROCEEDS
We must receive proof of the Insured's death before We will pay Death Proceeds.
The Beneficiary should contact Our Home Office or Our nearest agent for
instructions.
CALCULATION OF DEATH PROCEEDS
Death Proceeds include the Death Benefit plus any insurance on the Insured's
life provided by riders.
CHOOSING AN INCOME PLAN
You may choose an Income Plan for Net Cash Surrender Value proceeds or for Death
Proceeds. If You do not choose an Income Plan before the Insured dies, the
Beneficiary can choose one. For each plan We may issue a separate written
agreement putting the plan into effect. The smallest amount which may be applied
under an income plan is $2,000. Each payment must be at least $100. We may make
less frequent payments if payments to be made would be less than $100.
The Beneficiary may be the Payee for payments under the selected Income Plan, or
may name a different Payee to receive the payments under Income Plans. The
Beneficiary may also name a Contingent Payee to receive any amount still due
when the Payee dies.
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THE INCOME PLANS
In addition to the following options, other Income Plans may be available.
OPTION 1 - Payments for a Fixed Period
Equal monthly payments will be made for a stated number of years, which You
select from the Fixed Period Minimum Income Table. The monthly payments will not
be less than those shown in the table.
OPTION 1
FIXED PERIOD MINIMUM INCOME TABLE*
Monthly Payments for each $1,000 applied
<TABLE>
<CAPTION>
---------------------------------------------------------------------------------------------------
OPTION 1
FIXED PERIOD MINIMUM INCOME TABLE*
Monthly Payments for each $1,000 applied
---------------- --------------- ---------------- --------------- ----------------- ---------------
NUMBER OF Monthly NUMBER OF Monthly NUMBER OF Monthly
YEARS Installments YEARS Installments YEARS Installments
---------------- --------------- ---------------- --------------- ----------------- ---------------
<S> <C> <C> <C> <C> <C>
1 $84.47 11 $8.86 21 $5.32
2 42.86 12 8.24 22 5.15
3 28.99 13 7.71 23 4.99
4 22.06 14 7.26 24 4.84
5 17.91 15 6.87 25 4.71
6 15.14 16 6.53 26 4.59
7 13.16 17 6.23 27 4.47
8 11.68 18 5.96 28 4.37
9 10.53 19 5.73 29 4.27
10 9.61 20 5.51 30 4.18
---------------- --------------- ---------------- --------------- ----------------- ----------------
</TABLE>
*Values are based on interest at an effective annual rate of 3%.
OPTION 2 - Payments for Life - Guaranteed Period
Equal monthly payments will be made for the guaranteed period chosen and
thereafter during the life of a designated person. The amount of each monthly
payment depends on that person's age and sex on the date of first payment and on
any guaranteed period chosen. See the One Life Minimum Income Table, below. We
may require proof to Our satisfaction of such age. We may require like proof
that such person is alive on the date any payment is due. The guaranteed period
may be 10 or 20 years.
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<PAGE>
<TABLE>
<CAPTION>
-------------------------------------------------------------------------------------------------------------------------
OPTION 2
ONE LIFE MINIMUM INCOME TABLE*
Monthly Payments for each $1,000 applied
------------- ----------------------- ----------------------- ----------- ----------------------- -----------------------
AGE OF LIFE LIFE AGE OF LIFE LIFE
PAYEE LAST 10 YEARS 10 YEARS PAYEE LAST 10 YEARS 10 YEARS
BIRTHDAY CERTAIN CERTAIN BIRTHDAY CERTAIN CERTAIN
----------------------- ----------------------- ----------------------- -----------------------
MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
------------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- -----------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
15 AND
UNDER $2.81 $2.76 $2.81 $2.75 50 $3.88 $3.64 $3.80 $3.60
16 2.83 2.77 2.82 2.76 51 3.94 3.70 3.85 3.65
17 2.84 2.78 2.83 2.78 52 4.01 3.75 3.91 3.70
18 2.85 2.79 2.85 2.79 53 4.08 3.82 3.96 3.75
19 2.87 2.80 2.86 2.80 54 4.16 3.88 4.02 3.81
20 2.88 2.81 2.88 2.81 55 4.23 3.95 4.09 3.87
21 2.90 2.83 2.89 2.82 56 4.32 4.02 4.15 3.93
22 2.91 2.84 2.91 2.84 57 4.41 4.09 4.21 3.99
23 2.93 2.86 2.93 2.85 58 4.50 4.17 4.28 4.05
24 2.95 2.87 2.94 2.87 59 4.60 4.25 4.35 4.12
25 2.97 2.89 2.96 2.88 60 4.70 4.34 4.42 4.19
26 2.99 2.90 2.98 2.90 61 4.81 4.44 4.49 4.26
27 3.01 2.92 3.00 2.92 62 4.92 4.54 4.56 4.33
28 3.03 2.94 3.02 2.93 63 5.04 4.64 4.63 4.41
29 3.05 2.96 3.04 2.95 64 5.17 4.75 4.70 4.49
30 3.07 2.97 3.07 2.97 65 5.30 4.87 4.76 4.56
31 3.10 3.00 3.09 2.99 66 5.44 5.00 4.83 4.64
32 3.12 3.02 3.11 3.01 67 5.59 5.13 4.90 4.72
33 3.15 3.04 3.14 3.03 68 5.74 5.27 4.96 4.79
34 3.18 3.06 3.17 3.06 69 5.89 5.42 5.03 4.87
35 3.21 3.09 3.20 3.08 70 6.06 5.58 5.08 4.94
36 3.24 3.11 3.22 3.10 71 6.22 5.75 5.14 5.01
37 3.27 3.14 3.26 3.13 72 6.39 5.92 5.19 5.08
38 3.31 3.17 3.29 3.16 73 6.57 6.10 5.24 5.14
39 3.35 3.20 3.32 3.19 74 6.75 6.29 5.28 5.20
40 3.38 3.23 3.36 3.22 75 6.93 6.49 5.32 5.25
41 3.42 3.26 3.39 3.25 76 7.12 6.69 5.35 5.29
42 3.47 3.30 3.43 3.28 77 7.30 6.90 5.38 5.34
43 3.51 3.33 3.47 3.31 78 7.48 7.11 5.41 5.37
44 3.56 3.37 3.51 3.35 79 7.67 7.32 5.43 5.40
45 3.60 3.41 3.56 3.39 80 7.85 7.53 5.45 5.43
46 3.65 3.45 3.60 3.43 81 8.02 7.73 5.47 5.45
47 3.71 3.50 3.65 3.47 82 8.19 7.93 5.48 5.47
48 3.76 3.54 3.70 3.51 83 8.35 8.13 5.49 5.48
49 3.82 3.59 3.75 3.55 84 8.50 8.31 5.50 5.49
85 AND OVER 8.64 8.48 5.50 5.50
------------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- -----------
</TABLE>
*Values are based on the "Annuity 2000 Table," with Projection Scale G, adjusted
for age last birthday, with interest at an effective annual rate of 3%.
OPTION 3 - Payments of a Fixed Amount
Equal monthly payments of a fixed amount will be made until the value applied
under this option, with interest credited at an effective annual rate of 3% on
the unused balance, is exhausted. The amount chosen must be at least $5 per
month for each $1,000 of proceeds placed under this option. The last payment
will be for the balance only. Payments may not be for more than 30 years.
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<PAGE>
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OPTION 4 - Life Annuity - No Guaranteed Period
Equal monthly payments will be made during the life of a designated person. The
amount of each monthly payment depends on that person's sex and age on the date
of the first payment. See the One Life Minimum Income Table, above. We may
require proof to Our satisfaction of such age. We may require like proof that
such person is alive on the date any payment is due. There is no guaranteed
period. This means that when the designated person dies, no further payments
will be made, even if only one payment has been made.
<TABLE>
<CAPTION>
--------------------------------------------------------------------------
OPTION 4
ONE LIFE MINIMUM INCOME TABLE*
Monthly Payments for each $1,000 applied
------------- ----------------------- ----------- ------------------------
AGE OF AGE OF
PAYEE LAST LIFE PAYEE LAST LIFE
BIRTHDAY NO YEARS BIRTHDAY NO YEARS
CERTAIN CERTAIN
----------------------- ------------------------
MALE FEMALE MALE FEMALE
------------- ----------- ----------- ----------- ----------- ------------
<S> <C> <C> <C> <C> <C>
15 AND
UNDER $2.82 $2.76 50 $3.91 $3.66
16 2.83 2.77 51 3.98 3.71
17 2.84 2.78 52 4.05 3.77
18 2.86 2.79 53 4.12 3.83
19 2.87 2.80 54 4.20 3.90
20 2.89 2.82 55 4.28 3.97
21 2.90 2.83 56 4.37 4.04
22 2.92 2.84 57 4.47 4.12
23 2.93 2.86 58 4.57 4.21
24 2.95 2.87 59 4.67 4.30
25 2.97 2.89 60 4.79 4.39
26 2.99 2.90 61 4.91 4.49
27 3.01 2.92 62 5.04 4.60
28 3.03 2.94 63 5.18 4.71
29 3.05 2.96 64 5.33 4.84
30 3.08 2.98 65 5.49 4.97
31 3.10 3.00 66 5.66 5.11
32 3.13 3.02 67 5.85 5.26
33 3.15 3.04 68 6.04 5.43
34 3.18 3.06 69 6.25 5.60
35 3.21 3.09 70 6.48 5.80
36 3.25 3.12 71 6.71 6.00
37 3.28 3.14 72 6.97 6.23
38 3.32 3.17 73 7.24 6.47
39 3.35 3.20 74 7.53 6.73
40 3.39 3.23 75 7.84 7.02
41 3.43 3.27 76 8.18 7.33
42 3.48 3.30 77 8.53 7.66
43 3.52 3.34 78 8.92 8.02
44 3.57 3.38 79 9.33 8.42
45 3.62 3.42 80 9.77 8.85
46 3.67 3.46 81 10.24 9.31
47 3.73 3.51 82 10.75 9.82
48 3.78 3.55 83 11.29 10.37
49 3.84 3.60 84 11.87 10.96
85 AND 12.49 11.61
OVER
------------- ----------- ----------- ----------- ----------- ------------
</TABLE>
*Values are based on the "Annuity 2000 Table," with Projection Scale G, adjusted
for age last birthday, with interest at an effective annual rate of 3%.
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<PAGE>
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OPTION 5 - Joint and Survivor
Equal monthly payments will be made during the lifetimes of two designated
persons. Upon the death of either, payments will continue unchanged throughout
the lifetime of the survivor, or they may be reduced to a pre-selected
percentage (75%, 66 2/3%, or 50%) of the original payment. Payments will cease
upon the death of the survivor. There is no guaranteed period. This means that
when the survivor dies, no further payments will be made, even if only one
payment has been made. The amount of each monthly payment depends on the sexes
and ages of both persons on the date of first payment, and the pre-selected
percentage for continuing payments. See the sample monthly payments in the Joint
and Survivor Minimum Income Table, below. We may require proof to Our
satisfaction of their ages. We may require proof that any designated person is
alive on the date any payment based upon the life of such person is due.
OPTION 5
JOINT AND SURVIVOR
MINIMUM INCOME TABLE*
Sample Monthly Payments for each $1,000 applied
<TABLE>
<CAPTION>
--------------------------------------------------------------------------------------------------------------
OPTION 5
JOINT AND SURVIVOR
MINIMUM INCOME TABLE*
Sample Monthly Payments for each $1,000 applied
------------------- ----------------- ------------------ ----------------- ----------------- -----------------
MALE FEMALE JOINT & 100% JOINT & 75% JOINT & 66 2/3% JOINT & 50%
AGE AGE SURVIVOR SURVIVOR SURVIVOR SURVIVOR
------------------- ----------------- ------------------ ----------------- ----------------- -----------------
<S> <C> <C> <C> <C> <C>
60 60 3.93 4.23 4.34 4.58
60 65 4.14 4.48 4.61 4.88
60 70 4.34 4.75 4.90 5.24
65 60 4.07 4.44 4.58 4.88
65 65 4.36 4.75 4.90 5.22
65 70 4.66 5.10 5.27 5.64
70 60 4.18 4.65 4.83 5.23
70 65 4.56 5.03 5.22 5.62
70 70 4.97 5.48 5.68 6.12
------------------- ----------------- ------------------ ----------------- ----------------- -----------------
</TABLE>
*Values are based on the "Annuity 2000 Table," with Projection Scale G, adjusted
for age last birthday, with interest at an effective annual rate of 3%.
ADJUSTMENT TO AGE
The amounts shown in the monthly life income tables for Option 2, Option 4 and
Option 5 are applied at the ages shown through 2009. Thereafter, an adjusted age
will be determined as follows:
YEAR LIFE INCOME AGE SETBACK
PAYMENT PLAN BEGINS
------------------------------------ ---------------------------------------
2010 - 2019 1 year
2020 - 2029 2 years
2030 - 2039 3 years
2040 - 2049 4 years
2050 and later 5 years
To determine the adjusted age, subtract the age setback from the actual age. For
example, for a 67-year-old person in 2028, use age 65 factor per $1,000 from the
applicable table.
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<PAGE>
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GENERAL PROVISIONS
ANNUAL REPORT
At least once a year We will send You an annual report showing the current
Account Value, Surrender Charge, Cash Surrender Value, Indebtedness, Net Cash
Surrender Value, amount of interest credited to amounts in the Fixed Account and
Loan Account, change in value of amounts in the Variable Account, premiums paid,
loan activity, withdrawals, Monthly Deductions and Monthly Expense Charges since
the date of the last report. Any other information required by applicable law
will also be included in the annual report.
PROJECTION OF BENEFITS AND VALUES
You may request other information about this policy, including a hypothetical
illustration of policy benefits and values. We may make a reasonable charge to
provide this information.
OWNERSHIP AND INSULATION OF ASSETS
We shall have exclusive and absolute ownership and control of the assets of the
Separate Account. The assets of the Separate Account which are equal to reserves
and other liabilities are not chargeable with liabilities arising out of any
other business We may conduct.
RELIANCE
We have issued this policy in reliance on the answers You have provided to Us in
the application and in any supplemental applications. These answers are
considered representations, and not warranties. We have assumed that all these
answers are true and complete. If they are not, We may have the right to void
the policy as if it had not been issued, as explained in the LIMITS ON OUR
CONTESTING THIS POLICY section. If that occurred, We would send back all the
premiums You had paid.
LIMITS ON OUR CONTESTING THIS POLICY
No statement will be used in contesting a claim unless it is in an application
or supplemental application and a copy of such application is attached to this
policy.
We will not contest this policy to the extent of the initial Specified Amount
after it has been in effect during the Insured's lifetime for two years from the
Policy Date. We will not contest the validity of any increase in Specified
Amount after such increase has been in effect during the Insured's lifetime for
two years. Unless otherwise provided in the rider, We will not contest any rider
attached to this policy after the rider has been in effect during the Insured's
lifetime for two years from the effective date of the rider.
We will not contest this policy with respect to statements made in an
application for reinstatement after the policy has been in effect during the
Insured's lifetime for two years from the effective date of the reinstatement.
CONVERSION TO A FIXED POLICY
You may elect to convert this policy to a fixed policy at any time:
(1) within 24 months of the Policy Date; or
(2) within 60 days of the later of notification of a change in the
investment policy of the Separate Account, or the effective
date of such change.
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<PAGE>
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This election will be executed by transferring all Variable Account values into
the Fixed Account without charge. After the date of this election, Net Premiums
may not be allocated, and transfers may not be made, to the Variable Account.
The other terms and charges of this policy continue to apply.
SUICIDE
We will pay only a limited benefit if the Insured commits suicide while sane or
insane, within two years from the Policy Date. If the policy is in effect, We
will return the premiums You paid, less: (1) the amount of any Indebtedness; (2)
any withdrawal amount; and (3) all monthly costs of insurance on all persons
other than the Insured ever covered by rider. If the amount of the Net Cash
Surrender Value is larger, We will pay it instead.
We will not pay with respect to any increases in the Specified Amount if the
Insured commits suicide while sane or insane, within two years from the
effective date of any such increase. If the policy is in effect and the Insured
commits suicide more than two years after the Policy Date and within two years
after the date of an increase in Specified Amount, We will return the monthly
costs of insurance charged for such increase.
This provision also applies to any rider attached to this policy. The two year
period will be measured from the rider's date of issue. If this policy is
reinstated, this provision will run anew from the reinstatement date. Any
premium refund will be limited to those paid on or after the effective date of
the reinstatement.
ERROR IN AGE OR SEX
If the Insured's age or sex as stated in the application is wrong, it could mean
the Monthly Deductions are wrong. The same is true for the age or sex of any
other person insured by this policy or its riders. We will adjust the amount
payable to the amount that the monthly Cost of Insurance for the month of death
would have purchased at the correct age and sex.
CLAIMS OF CREDITORS
The proceeds of this policy will be paid free from the claims of creditors to
the extent allowed by law.
ASSIGNMENT
You may assign this policy by giving Us notice of the assignment. We will not be
responsible for the validity of an assignment. We will not be liable for any
payments We make or actions We take before We receive notice of an assignment.
REQUIRED NOTE ON OUR COMPUTATIONS
Calculations are based on the Mortality Tables shown on the Policy Schedule. We
have filed a detailed statement of Our computations with the applicable State
Insurance Department. The values under this policy are not less than those
required by the law of the applicable state. Any benefit provided by an attached
rider will not increase these values unless stated in the rider.
The method used in calculating policy values will be based on actuarial
procedures that recognize the variable nature of this policy.
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AUTHORITY TO MAKE AGREEMENTS
All agreements made by Us must be in writing and signed by Our president, a vice
president, Our secretary or an assistant secretary. No other person, including
an insurance agent, can change any of this policy's terms, extend the time for
paying premiums, or make any other agreement which would be binding on Us.
CONFORMITY WITH LAWS
We reserve the right to make any changes necessary to comply with any federal or
state statute, rule or regulation. We do not need Your consent to make such
changes.
TAXES
We reserve the right to deduct any taxes levied by any government entity which,
at Our sole discretion, are determined to have resulted from the establishment
or maintenance or operation of the Separate Account, or from the investment
performance of the Separate Account.
TERMINATION
This policy will terminate and all insurance coverage under the policy will
stop: (1) as of the end of the Valuation Period during which We receive notice
from You requesting that this policy be surrendered; (2) as of the date the
Insured dies (although some riders may provide benefits for other covered
persons beyond the Insured's death); (3) as of the date the Grace Period
expires; or (4) as of the date 31 days after We mail You notice that the amount
of the Indebtedness exceeds the Cash Surrender Value less the Monthly Deduction
and the Monthly Expense Charge.
NOTICES
Whenever written notice is required, send it to Our Home Office. The address of
Our Home Office is shown on the front of this policy. Please include the policy
number in Your correspondence.
NONPARTICIPATING
This policy and any riders attached to it are issued at a nonparticipating rate
and shall not share in Our surplus earnings.
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Page 28
<PAGE>
COLUMBUS LIFE INSURANCE COMPANY
Flexible Premium Variable Universal Life Policy
Flexible Premiums Payable During Life of Insured to Age 100
Death Benefit Payable at Death of Insured
Non-Participating
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<PAGE>
