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FIRST PENN-PACIFIC
LIFE INSURANCE CO.
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A MEMBER OF LINCOLN FINANCIAL GROUP
EXHIBIT 1.5(c)
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Fort Wayne, Indiana 46801
Executive Office: 10 North Martingale Road -
Schaumburg, Illinois 60173-2268 - (847) 466-8000
Administrative Office: [P.O. Box 150482 Attention: MXX -
Hartford, Connecticut 06115-0482 - (800) 444-2363]
EXTENSION OF CONVALESCENT CARE BENEFITS RIDER
(Extending the Convalescent Care Benefits)
THIS RIDER EXTENDS THE BENEFITS PROVIDED BY THE CONVALESCENT
CARE BENEFITS RIDER. THE BENEFITS OF THIS RIDER BECOME EFFECTIVE AFTER THE
BENEFIT PAYMENTS UNDER THE CONVALESCENT CARE BENEFITS RIDER END
BECAUSE THE PAYMENTS REDUCED THE POLICY DEATH BENEFIT TO ZERO.
TAXATION: THIS RIDER IS INTENDED TO BE A QUALIFIED LONG-TERM CARE INSURANCE
CONTRACT UNDER SECTION 7702B(b) OF THE INTERNAL REVENUE CODE.
CAUTION: WE ISSUED THIS RIDER BASED ON YOUR AND THE INSURED'S ANSWERS TO THE
QUESTIONS ON YOUR APPLICATION. A COPY OF YOUR APPLICATION IS ENCLOSED. IF YOUR
ANSWERS OR THE INSURED'S ANSWERS ARE INCORRECT OR UNTRUE, WE MAY DENY BENEFITS
OR RESCIND THIS RIDER. THE BEST TIME TO CLEAR UP ANY QUESTION IS NOW, BEFORE A
CLAIM ARISES! IF, FOR ANY REASON, ANY OF YOUR ANSWERS OR THE INSURED'S ANSWERS
ARE INCORRECT, CONTACT US AT THE ADDRESS SHOWN ABOVE.
NOTICE TO OWNER: THIS RIDER MAY NOT COVER ALL OF THE LONG-TERM CARE EXPENSE
INCURRED BY THE INSURED DURING THE PERIOD OF COVERAGE. YOU ARE ADVISED TO
CAREFULLY REVIEW ALL POLICY AND RIDER LIMITATIONS.
RIGHT TO EXAMINE RIDER FOR 30 DAYS. It is important to us that you are satisfied
with this rider and that it meets with your insurance needs. If for any reason
you are not satisfied, you may return it to us within 30 days after its receipt.
It may be returned to us at the address of our Administrative Office listed
above, or to our agent through whom it was purchased. If returned, we will
refund the premiums you have paid and this rider will be void from its Issue
Date.
If this rider was applied for after the effective date of the policy and if you
return it to us within 30 days after its receipt, we will credit to the Policy
Account Value of the policy any premium which may have been deducted for this
rider and this rider will be void from its Issue Date.
WE PROMISE TO PAY the benefits provided by this rider for QUALIFIED LONG-TERM
CARE SERVICES if the Insured becomes CHRONICALLY ILL while this rider is in
force. Our payment will be subject to all of the terms and conditions of this
rider.
WHO IS COVERED. This rider covers the primary Insured under the policy. It does
not cover any other person.
RENEWABILITY. This rider is guaranteed renewable. We may not cancel or reduce
coverage provided by this rider. Renewal is subject to the TERMINATION OF RIDER
provision in Part 3 of this rider.
PREMIUMS. We have issued this rider in consideration of the payment of the first
premium and the statements made in the application, and in consideration of our
issuing to you the Convalescent Care Benefits Rider as part of this policy.
The monthly premium for this rider is shown in the Policy Schedule. Each month
we will deduct the premium for this rider from the Policy Account Value of the
policy. This will be done at the same time that we deduct the monthly charge for
life insurance and the other monthly charges under the policy.
The monthly premium for this rider is guaranteed not to change.
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EFFECTIVE DATE. If this rider is applied for in the application for the policy,
the effective date of this rider will be the Issue Date of the policy. If it is
added to the policy after the Issue Date, the effective date of this rider will
be the date we approve the supplemental application.
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PART 1: BENEFITS
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THIS PART EXPLAINS THE RIDER BENEFITS AND EXPLAINS WHEN THEY BECOME PAYABLE.
BENEFITS. This rider increases the Benefit Limit of the Convalescent Care
Benefits Rider by the amount of the Additional Benefit Limit shown in the Policy
Schedule. The Additional Benefit Limit becomes effective when the Benefit Limit
of the Convalescent Care Benefits Rider is reached. In all other respects, the
terms, exclusions and limitations of the Convalescent Care Benefits Rider
governing the payment of benefits apply to this rider except as follows:
a. The benefits payable under this Extension of Convalescent Care Benefits
Rider are subject to the Daily Maximums shown for this rider in the Policy
Schedule. The Daily Maximums for this rider are not affected by any change
in the Daily Maximums for the Convalescent Care Benefits Rider.
b. The Additional Benefit Limit provided by this rider is not affected by
changes to the policy Net Death Benefit or by changes to the Benefit Limit
of the Convalescent Care Benefits Rider.
c. Benefits will be paid under this rider for as long as:
1. The Benefit Conditions of the Convalescent Care Benefits Rider are
met; and
2. The Additional Benefit Limit is not reached.
d. If the policy, the Convalescent Care Benefits Rider, or this rider lapse
without value after a Benefit Period begins, the Insured will continue to
be eligible for benefits provided by this rider subject to the following
conditions:
1. The Insured's eligibility for benefits will end if a period of 30
consecutive days elapses during which benefits are not payable under
this rider. We will not count as part of that 30 days, any days the
Insured is confined in a legally operated hospital; and
2. We will not pay benefits in excess of those that we would have paid
had this rider remained in force.
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PART 2: BENEFITS AFTER LAPSE
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THIS PART EXPLAINS THE BENEFITS WHICH MAY BE PAYABLE FOR COVERED EXPENSE WHICH
BEGINS AFTER THE POLICY AND THIS RIDER ARE LAPSED.
GUARANTEED BENEFIT. After the policy and this rider have been in force for 3
years, this rider shall cover qualifying claims which begin after the policy and
this rider are lapsed. This guaranteed benefit shall be payable in lieu of the
benefit described in Part 1 of this rider.
The Daily Maximums payable for covered expense shall remain unchanged and shall
be the amount in effect as of the date of lapse. The Additional Benefit Limit,
however, shall be reduced to an amount equal to the greater of:
a. 30 times the Daily Maximum for Nursing Home Care; or
b. An amount equal to the total premium paid for this rider, including the
premium, if any, waived under any waiver of premium provision of the
policy.
In no event shall the Additional Benefit Limit provided under this part be
greater than it would have been had the policy and this rider not lapsed and had
remained in force.
The benefits provided under this part shall become effective on the same date
that they would have become effective had the Convalescent Care Benefits Rider
not lapsed. This would be on the date that the Convalescent Care Benefits Rider
payments would have ended because the policy Death Benefit was reduced to zero.
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PART 3: THE CONTRACT
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THIS PART EXPLAINS OTHER IMPORTANT RULES AND CONDITIONS WHICH WILL AFFECT THIS
RIDER.
TERMINATION OF RIDER. This rider terminates:
a. Upon your written request;
b. Upon termination of the policy or the Convalescent Care Benefits Rider,
unless termination of the policy or the Convalescent Care Benefit Rider was
the result of reaching the Benefit Limit in that rider; or
c. When the Additional Benefit Limit is reached.
However, even if the policy and the Convalescent Care Benefit Rider lapse
without value, benefits may still be provided under Part 2 of this rider.
GRACE PERIOD NOTICE. We shall give you and the "DESIGNATED THIRD PARTY", if any,
a notice of any unpaid and due premium 30 days after such premium becomes due.
The policy and this rider shall then continue in force for an additional 30 days
after such notice has been given. Notice shall be considered to have been given
to you and the "DESIGNATED THIRD PARTY", 5 days after the date of our mailing
via first class United States mail, postage prepaid. If the premium is not paid
by the end of the additional 30 day period, except as provided in Part 2 under
the BENEFITS AFTER LAPSE provision, this rider shall then terminate without any
value.
As used in this provision, the "DESIGNATED THIRD PARTY", if any, is the person
that you have named in a written designation to receive notices of impending
lapses or terminations because of nonpayment of premium.
REINSTATEMENT. If the policy to which this rider is attached is reinstated, then
this rider may also be reinstated. The reinstatement of this rider shall be
subject to evidence of good health and insurability satisfactory to us. The
reinstated rider will only provide benefits for care or confinement which begins
after the date of reinstatement and will be subject to all conditions in the
rider.
If, however, the Insured was CHRONICALLY ILL when this rider lapsed and, if the
reinstatement is requested within 5 months after the date of the lapse, then in
lieu of submitting evidence of good health and insurability, this rider may be
reinstated by submitting to us a statement from the attending PHYSICIAN
certifying that the Insured is CHRONICALLY ILL. The reinstated rider will
provide benefits for care or confinement which begins after the date of the
lapse and will be subject to all conditions in the rider not inconsistent
herewith.
REPRESENTATIONS. In the absence of fraud, any statement made by you or the
Insured will be deemed a representation and not a warranty. Such statement may
not be used in defense of a claim, unless it is contained in a signed, written
application.
INCONTESTABILITY PERIOD. A misstatement by the Insured in any application for
the policy or this rider may be used to void or cancel this rider. During the
first 6 months following the effective date of this rider, we may take this
action only if the misstatement was material to the issuance of this rider.
After the first 6 months, but before the end of the first 24 months, we may take
this action only if the misstatement was material to both the issuance of this
rider and the claim for which benefits are being sought. After this rider has
been in force for 24 months, we can take this action only if we can show that
the Insured knowingly and intentionally misrepresented relevant facts relating
to his or her health. No benefits will be paid under this rider if it is voided
or canceled.
PRE-EXISTING CONDITIONS NOT EXCLUDED. We will NOT deny benefits for Pre-existing
Conditions. "PRE-EXISTING CONDITIONS" are physical or mental conditions which
existed when you applied for this rider. This provision does not preclude us
from exercising other remedies available to us under this rider because of
misrepresentation.
CONFORMITY WITH STATE AND FEDERAL STATUTES. If any provision of this rider is in
conflict with the statutes of the state in which you reside on the rider
effective date or with the Federal statutes which pertain to Qualified Long-Term
Care Insurance
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contracts, the rider provision is automatically amended to meet the minimum
requirements of the state or Federal statute.
GENERAL PROVISION. This rider shall be subject to all the terms and conditions
of the policy which are not inconsistent herewith.
Signed for First Penn-Pacific Life Insurance Company at Schaumburg,
Illinois.
/s/ Marcia L. DuMond /s/ Roland C. Baker
Secretary President
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