CONSECO VARIABLE INSURANCE COMPANY
ADMINISTRATIVE OFFICE: 11815 N. PENNSYLVANIA STREET
CARMEL, INDIANA 46032-4555
READ YOUR POLICY CAREFULLY
CONSECO VARIABLE INSURANCE COMPANY (THE COMPANY) will pay the Death Proceeds to
the beneficiary if the Insured dies while this policy is in force, subject to
the terms of this policy.
THE DURATION OR AMOUNT OF THE DEATH BENEFIT MAY BE FIXED OR MAY VARY DEPENDING
UPON THE INVESTMENT EXPERIENCE AND THE DEATH BENEFIT OPTION SELECTED. THE DEATH
BENEFIT IS DESCRIBED IN THE DEATH BENEFIT SECTION OF THE POLICY.
THE CASH VALUE, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT,
IS VARIABLE AND MAY INCREASE OR DECREASE. NO MINIMUM CASH VALUE IS GUARANTEED.
NOTICE OF 10 DAY RIGHT TO EXAMINE THE POLICY
PLEASE CAREFULLY REVIEW THIS POLICY AND THE ATTACHED APPLICATION. IF YOU ARE
DISSATISFIED FOR ANY REASON, THIS POLICY WILL BE CANCELLED BY YOU DELIVERING OR
MAILING THE POLICY TO CONSECO VARIABLE INSURANCE COMPANY, SERVICE CENTER, 9735
LANDMARK PARKWAY DRIVE, ST. LOUIS, MO 63127-1646, OR TO THE INSURANCE AGENT
THROUGH WHOM IT WAS EFFECTED BEFORE MIDNIGHT OF THE TENTH DAY AFTER RECEIPT OF
SUCH POLICY BY THE APPLICANT. UPON SUCH DELIVERY OR MAILING, THE POLICY SHALL BE
VOID FROM THE BEGINNING. RETURN OF THE POLICY BY MAIL IS EFFECTIVE ON BEING
POSTMARKED, PROPERLY ADDRESSED AND POSTAGE PREPAID. WE WILL REFUND THE
ACCUMULATION VALUE OF THIS POLICY WITHIN SEVEN DAYS AFTER WE RECEIVE THE
RETURNED POLICY.
FLEXIBLE PREMIUM ADJUSTABLE VARIABLE LIFE INSURANCE
PERIOD OF COVERAGE NOT GUARANTEED
THIS POLICY IS A LEGAL CONTRACT BETWEEN THE OWNER AND CONSECO.
Signed for Conseco Variable Insurance Company by
/s/ Illegible /s/ Illegible
------------- -------------
Secretary President
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TABLE OF CONTENTS
PROVISIONS PAGE NUMBER
Policy Data Page............................................................. 3
Definitions.................................................................. 10
Owner, Beneficiary and Assignment............................................ 12
Premium Provisions........................................................... 13
Death Benefit Provisions..................................................... 14
Policy Change Provisions..................................................... 15
Policy Charges Provisions.................................................... 16
Policy Values Provision...................................................... 17
Separate Account Provisions.................................................. 18
Fixed Accounts Provisions.................................................... 19
Transfer Provisions.......................................................... 19
Loan Provisions.............................................................. 20
Surrender Provisions......................................................... 21
Termination of the Policy Provisions......................................... 22
General Policy Provisions.................................................... 23
Settlement Options Provisions................................................ 25
CVIC-1001 2
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POLICY DATA PAGE
OWNER: DOE, JOHN POLICY NUMBER: 0012345
ISSUE DATE: 12-1-00 INITIAL PREMIUM: [$1,171]
POLICY DATE: 12-1-00 INITIAL SPECIFIED AMOUNT: [$100,000]
PLANNED PERIODIC PREMIUM [$1,171]
INSURED: DOE, JOHN PREMIUM FREQUENCY: ANNUAL
ISSUE AGE: 35
SEX: MALE MONTHLY NO LAPSE
GUARANTEE PREMIUM: [$97.58]
PREMIUM CLASS: NONSMOKER NO LAPSE PERIOD: [5 years]
DEATH BENEFIT QUALIFICATION TEST: [GUIDELINE PREMIUM TEST]
(THIS ELECTION IS IRREVOCABLE FOR THE LIFE OF THE POLICY)
DEATH BENEFIT OPTION: A
Earliest Date a Change in the Death Benefit Option may [One Year after
be requested the Issue Date]
IF DEATH BENEFIT OPTION C IS ELECTED, THIS ELECTION IS IRREVOCABLE FOR THE
LIFE OF THE POLICY
SEPARATE ACCOUNT: [Conseco Variable Insurance Company Separate Account L]
MINIMUM SPECIFIED AMOUNT: [$50,000]
MINIMUM SPECIFIED AMOUNT DECREASE: [$10,000]
Earliest Date a decrease in Specified Amount may [One Year after
be requested the Issue Date]
MINIMUM SPECIFIED AMOUNT INCREASE: [$ 25,000]
Earliest Date an increase in Specified Amount may [One Year after
be requested the Issue Date]
ALLOCATION RULES:
Allocations: All allocations must be indicated in whole percentages.
Minimum Premium Allocation to any Investment Portfolio or the Fixed
Account: [5%]
Initial Net Premium: Allocations to the Fixed Account and Separate Account
are made on the Policy Date.
MINIMUM & MAXIMUM PREMIUMS:
Minimum Initial Premium: [$300] annually
Minimum Premium Payment Subsequent To the Initial Premium: [$25]
Maximum Premium: [$2,000,000], or greater with our prior approval
CVIC-1001 3
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POLICY DATA PAGE (CONTINUED)
PREMIUM CHARGES:
EXPENSE CHARGES:
Years 1-10:
[2.25%] premium tax on each premium payment
[1.25%] Federal tax on each premium payment
[2.5%] sales loads on each premium payment
Years 11+:
[2.25%] premium tax on each premium payment
[1.25%] Federal tax on each premium payment
[.5%] sales loads on each premium payment
ADMINISTRATIVE CHARGES:
First year: [$25 per month]
Policy years 2 +: [$5 per month]
MORTALITY AND EXPENSE RISK CHARGE:
Per Policy Month for Policy Years 1-10:
[$.10 per $1,000 of Specified Amount] and
[1/12 of .75% of the Accumulation Value in the Separate Account]
Per Policy Month for Policy Years 11-20:
[1/12 of .25% of the Accumulation Value in the Separate Account]
Per Policy Month for Policy Years 21+
[1/12 of .25% of the Accumulation Value in the Separate Account]
SURRENDER
Surrender Charges For Initial Specified Amount- The Surrender Charge is the
percentage listed in the table below of the lesser of the actual premium
paid in the first year or [$1,768].
Guaranteed Maximum
Surrender Charge
Policy Year Percentages
1 100%
2 100%
3 100%
4 100%
5 100%
6 80%
7 60%
8 40%
9 20%
10 0%
The surrender charges are shown as of the end of each Policy Year. The surrender
charges are pro-rated during the year.
CVIC-1001 4
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POLICY DATA PAGE (CONTINUED)
Minimum Partial Withdrawal Amount: [$500]
Free Partial Withdrawal
Percentage: [10% of the Accumulation Value at the time of
withdrawal, less the amount of free withdrawals taken
to date during the policy year.]
Availability: If you have chosen Death Benefit Option A and after the
first Policy Year and each Policy Year thereafter, on a
non-cumulative basis, You may make a partial withdrawal
without paying imposed surrender charges ("free partial
withdrawal") up to the percentage shown above of the
Accumulation Value.
REBALANCING
[$5,000] Minimum Policy Value
You may elect to automatically rebalance the policy to return to the
percentage allocation within the Investment Portfolios as selected
currently for premium allocation if the value of the policy is at least the
minimum amount shown above.
TRANSFERS
MINIMUM TRANSFER AMOUNT: [$100], or if less, the entire remaining balance
in the account. Applied to transfers from all sub-accounts and Fixed
Account except transfers made under an automatic program sponsored by the
Company, such as the dollar cost averaging program or rebalancing program.
TRANSFER FEE: Current Fee: [$0]: Guaranteed Maximum Transfer Fee: [$0] for
the first [12] transfers in any Policy Year, [$25] per transfer for each
subsequent transfer in the Policy Year. The transfer fee is deducted from
the amount transferred. Multiple transfers executed as part of one request
on a single day will be considered one transfer for purposes of the
transfer fee. Transfers related to dollar cost averaging and rebalancing
programs are free and do not count against the free limit.
NUMBER OF TRANSFERS PERMITTED: [No Limit] per year. We reserve the right to
restrict transfers from being made on consecutive Valuation Dates.
TRANSFER LIMITATIONS: Listed separately below.
FIXED ACCOUNT:
o Minimum Guaranteed Interest Rate: 4%
o Current Interest Rate for Initial Premium Allocated to this
Account: [5%] for the first Policy Year.
o Current Interest is guaranteed for one year from the date of
allocation of premium or transfer.
o Different current interest rates may apply to allocations on
different dates.
o Limits on Transfers Out of Fixed Account: [$500] or [25%]
whichever is greater, of the Fixed Account value as of the
transfer date. One transfer from the Fixed Account may be made in
a Policy Year.
CVIC-1001 5
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POLICY DATA PAGE (CONTINUED)
SEPARATE ACCOUNT:
o No limits
LOAN ACCOUNT:
Minimum Loan Amount: [$500]
Minimum Loan Account Interest Rate (Credited):
Non-Preferred Loan: [4.5% for all years]
Preferred Loan: [4.5% for all years]
Loan Interest Rate (Charged):
Non-Preferred Loan: [5.5% for all years]
Preferred Loan: [4.5% for all years]
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER:
9735 Landmark Parkway Drive
St. Louis, MO 63127-1646
RIDER BENEFIT SCHEDULE
FORM NUMBER BENEFIT DESCRIPTION SPECIFIED INITIAL EXPIRY
AMOUNT MONTHLY DATE
COST OF
INSURANCE
CVIC-1001 6
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TABLE OF MINIMUM INSURANCE FACTORS
Minimum Insurance Percentage
Attained Age Option A, B and C
0-40 250%
41 243%
42 236%
43 229%
44 222%
45 215%
46 209%
47 203%
48 197%
49 191%
50 185%
51 178%
52 171%
53 164%
54 157%
55 150%
56 146%
57 142%
58 138%
59 134%
60 130%
61 128%
62 126%
63 124%
64 122%
65 120%
66 119%
67 118%
68 117%
69 116%
70 115%
71 113%
72 111%
73 109%
74 107%
75 105%
76 105%
77 105%
78 105%
79 105%
80 105%
81 105%
82 105%
83 105%
84 105%
85 105%
86 105%
87 105%
88 105%
89 105%
90 105%
91 104%
92 103%
93 102%
OVER 93 101%
These factors are designed to comply with Section 7702 of the Internal Revenue
Code.
CVIC-1001 7
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TABLE OF NET SINGLE PREMIUMS PER $1 OF SPECIFIED AMOUNT
ATTAINED NET SINGLE ATTAINED NET SINGLE ATTAINED NET SINGLE
AGE PREMIUM AGE PREMIUM AGE PREMIUM
15 0.152587 43 0.365083 71 0.713074
16 0.157207 44 0.376281 72 0.724626
17 0.161853 45 0.387664 73 0.735866
18 0.166577 46 0.399236 74 0.746729
19 0.171409 47 0.411006 75 0.757153
20 0.176387 48 0.422968 76 0.767115
21 0.181544 49 0.435119 77 0.776666
22 0.186919 50 0.447452 78 0.785889
23 0.192555 51 0.459949 79 0.794864
24 0.198462 52 0.472583 80 0.803624
25 0.204667 53 0.485320 81 0.812154
26 0.211189 54 0.498123 82 0.820402
27 0.218018 55 0.510972 83 0.828283
28 0.225150 56 0.523859 84 0.835743
29 0.232583 57 0.536786 85 0.842788
30 0.240306 58 0.549757 86 0.849492
31 0.248317 59 0.562780 87 0.855988
32 0.256614 60 0.575850 88 0.862348
33 0.265196 61 0.588932 89 0.868633
34 0.274054 62 0.601977 90 0.875029
35 0.283189 63 0.614931 91 0.881762
36 0.292592 64 0.627743 92 0.889110
37 0.302258 65 0.640377 93 0.897300
38 0.312168 66 0.652835 94 0.906500
39 0.322317 67 0.665132 95 0.916891
40 0.332694 68 0.677299 96 0.928359
41 0.343283 69 0.689359 97 0.940404
42 0.354082 70 0.701297 98 0.952114
99 0.961538
THE NET SINGLE PREMIUMS SHOWN ABOVE ARE BASED ON THE COMMISSIONER'S 1980
STANDARD ORDINARY MALE SMOKER MORTALITY TABLE, AGE LAST BIRTHDAY AND 4.00%
INTEREST.
FOR AGES OVER 99, THE NET SINGLE PREMIUM FACTOR IS .990099.
CVIC-1001 8 (ms)
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TABLE OF NET SINGLE PREMIUMS PER $1 OF SPECIFIED AMOUNT
ATTAINED NET SINGLE ATTAINED NET SINGLE ATTAINED NET SINGLE
AGE PREMIUM AGE PREMIUM AGE PREMIUM
0 0.079211 33 0.217203 66 0.597465
1 0.079960 34 0.224666 67 0.611806
2 0.082213 35 0.232386 68 0.626123
3 0.084595 36 0.240368 69 0.640409
4 0.087094 37 0.248615 70 0.654636
5 0.089731 38 0.257118 71 0.668750
6 0.092521 39 0.265883 72 0.682684
7 0.095471 40 0.274916 73 0.696342
8 0.098587 41 0.284209 74 0.709646
9 0.101857 42 0.293770 75 0.722556
10 0.105269 43 0.303605 76 0.735075
11 0.108812 44 0.313718 77 0.747229
12 0.112445 45 0.324111 78 0.759065
13 0.116130 46 0.334780 79 0.770631
14 0.119833 47 0.345731 80 0.781935
15 0.123540 48 0.356969 81 0.792946
16 0.127294 49 0.368494 82 0.803600
17 0.131100 50 0.380309 83 0.813807
18 0.134986 51 0.392404 84 0.823495
19 0.138982 52 0.404767 85 0.832639
20 0.143111 53 0.417381 86 0.841270
21 0.147403 54 0.430224 87 0.849451
22 0.151891 55 0.443286 88 0.857290
23 0.156592 56 0.456550 89 0.864928
24 0.161522 57 0.470010 90 0.872511
25 0.166691 58 0.483673 91 0.880215
26 0.172117 59 0.497523 92 0.888250
27 0.177793 60 0.511538 93 0.896886
28 0.183721 61 0.525696 94 0.906385
29 0.189904 62 0.539975 95 0.916891
30 0.196343 63 0.554328 96 0.928359
31 0.203041 64 0.568712 97 0.940404
32 0.209993 65 0.583097 98 0.952114
99 0.961538
THE NET SINGLE PREMIUMS SHOWN ABOVE ARE BASED ON THE COMMISSIONER'S 1980
STANDARD ORDINARY MALE NONSMOKER MORTALITY TABLE, AGE LAST BIRTHDAY AND
4.00% INTEREST.
FOR AGES OVER 99, THE NET SINGLE PREMIUM FACTOR IS .990099.
CVIC-1001 8 (mns)
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TABLE OF NET SINGLE PREMIUMS PER $1 OF SPECIFIED AMOUNT
ATTAINED NET SINGLE ATTAINED NET SINGLE ATTAINED NET SINGLE
AGE PREMIUM AGE PREMIUM AGE PREMIUM
15 0.121675 43 0.302768 71 0.639128
16 0.125703 44 0.312045 72 0.653615
17 0.129852 45 0.321514 73 0.668004
18 0.134129 46 0.331177 74 0.682173
19 0.138538 47 0.341044 75 0.696044
20 0.143102 48 0.351124 76 0.709591
21 0.147829 49 0.361414 77 0.722836
22 0.152734 50 0.371907 78 0.735831
23 0.157816 51 0.382603 79 0.748618
24 0.163083 52 0.393504 80 0.761199
25 0.168542 53 0.404588 81 0.773535
26 0.174202 54 0.415842 82 0.785556
27 0.180055 55 0.427281 83 0.797181
28 0.186117 56 0.438918 84 0.808277
29 0.192391 57 0.450785 85 0.818836
30 0.198877 58 0.462930 86 0.828892
31 0.205577 59 0.475388 87 0.838511
32 0.212508 60 0.488170 88 0.847798
33 0.219674 61 0.501247 89 0.856875
34 0.227070 62 0.514564 90 0.865907
35 0.234699 63 0.528030 91 0.874963
36 0.242564 64 0.541564 92 0.884245
37 0.250633 65 0.555134 93 0.893999
38 0.258895 66 0.568749 94 0.904491
39 0.267338 67 0.582446 95 0.915817
40 0.275961 68 0.596306 96 0.927843
41 0.284739 69 0.610379 97 0.940211
42 0.293671 70 0.624671 98 0.952070
99 0.961538
THE NET SINGLE PREMIUMS SHOWN ABOVE ARE BASED ON THE COMMISSIONER'S 1980
STANDARD ORDINARY FEMALE SMOKER MORTALITY TABLE, AGE LAST BIRTHDAY AND
4.00% INTEREST.
FOR AGES OVER 99, THE NET SINGLE PREMIUM FACTOR IS .990099.
CVIC-1001 8 (fs)
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TABLE OF NET SINGLE PREMIUMS PER $1 OF SPECIFIED AMOUNT
ATTAINED NET SINGLE ATTAINED NET SINGLE ATTAINED NET SINGLE
AGE PREMIUM AGE PREMIUM AGE PREMIUM
0 0.068085 33 0.193641 66 0.540419
1 0.069058 34 0.200283 67 0.555059
2 0.071040 35 0.207152 68 0.569894
3 0.073140 36 0.214252 69 0.584957
4 0.075345 37 0.221569 70 0.600240
5 0.077648 38 0.229098 71 0.615695
6 0.080064 39 0.236842 72 0.631233
7 0.082597 40 0.244805 73 0.646739
8 0.085252 41 0.252977 74 0.662104
9 0.088023 42 0.261360 75 0.677250
10 0.090917 43 0.269967 76 0.692136
11 0.093938 44 0.278812 77 0.706767
12 0.097063 45 0.287906 78 0.721165
13 0.100289 46 0.297251 79 0.735347
14 0.103610 47 0.306853 80 0.749298
15 0.107022 48 0.316716 81 0.762959
16 0.110538 49 0.326846 82 0.776246
17 0.114163 50 0.337243 83 0.789058
18 0.117909 51 0.347902 84 0.801325
19 0.121782 52 0.358824 85 0.813022
20 0.125788 53 0.369996 86 0.824164
21 0.129941 54 0.381412 87 0.834803
22 0.134246 55 0.393087 88 0.845010
23 0.138721 56 0.405027 89 0.854884
24 0.143361 57 0.417254 90 0.864541
25 0.148176 58 0.429799 91 0.874134
26 0.153171 59 0.442688 92 0.883845
27 0.158347 60 0.455918 93 0.893888
28 0.163719 61 0.469470 94 0.904491
29 0.169288 62 0.483304 95 0.915817
30 0.175053 63 0.497363 96 0.927843
31 0.181031 64 0.511582 97 0.940211
32 0.187224 65 0.525935 98 0.952070
99 0.961538
THE NET SINGLE PREMIUMS SHOWN ABOVE ARE BASED ON THE COMMISSIONER'S 1980
STANDARD ORDINARY FEMALE NONSMOKER MORTALITY TABLE, AGE LAST BIRTHDAY AND
4.00% INTEREST.
FOR AGES OVER 99, THE NET SINGLE PREMIUM FACTOR IS .990099.
CVIC-1001 8 (fns)
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TABLE OF MONTHLY GUARANTEED POLICY COST OF INSURANCE RATES
PER $1,000 OF NET AMOUNT AT RISK
ATTAINED POLICY ATTAINED POLICY
AGE YEAR RATE AGE YEAR RATE
35 1 .1142 68 34 2.4933
36 2 .1517 69 35 2.7483
37 3 .1617 70 36 3.0367
39 4 .1725 71 37 3.3658
39 5 .1842 72 38 3.7458
40 6 .1983 73 39 4.1758
41 7 .2133 74 40 4.6483
42 8 .2292 75 41 5.1533
43 9 .2467 76 42 5.6867
44 10 .2658 77 43 6.2442
45 11 .2875 78 44 6.8292
46 12 .3108 79 45 7.4600
47 13 .3358 80 46 8.1567
48 14 .3633 81 47 8.9375
49 15 .3933 82 48 9.8183
50 16 .4275 83 49 10.7950
51 17 .4667 84 50 11.8483
52 18 .5117 85 51 12.9542
53 19 .5633 86 52 14.0983
54 20 .6208 87 53 15.2633
55 21 .6850 88 54 16.4442
56 22 .7550 89 55 17.6575
57 23 .8292 90 56 18.9208
58 24 .9117 91 57 20.2633
59 25 1.0042 92 58 21.7350
60 26 1.1075 93 59 23.4792
61 27 1.2225 94 60 25.8192
62 28 1.3550 95 61 29.3217
63 29 1.5050 96 62 35.0825
64 30 1.6717 97 63 45.0833
65 31 1.8542 98 64 62.0958
66 32 2.0517 99 65 83.3333
67 33 2.2633
THE COST OF INSURANCE RATES SHOWN ABOVE ARE BASED ON THE COMMISSIONER'S 1980
STANDARD ORDINARY MALE NONSMOKER MORTALITY TABLE, AGE LAST BIRTHDAY.
CVIC-1001 9
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DEFINITIONS
(DEFINED TERMS ARE CAPITALIZED THROUGHOUT THIS POLICY)
ACCUMULATION UNIT - A unit of measure used to calculate Your Accumulation Value
in the Separate Account.
ACCUMULATION VALUE - Your Accumulation Value is the sum of Your interest in the
various Investment Portfolios, the Fixed Account, and the Loan Account.
AGE - Issue Age means the age of the Insured as of the Issue Date. Attained age
is the issue age plus the number of completed Policy Years.
CASH SURRENDER VALUE - The Cash Surrender Value is the Cash Value less any
outstanding loans and loan interest.
CASH VALUE - The Cash Value is the Accumulation Value less the surrender charge.
DEATH BENEFIT - The calculated policy benefit amount upon the death of the
Insured.
DEATH PROCEEDS - The Death Proceeds are the Death Benefit plus any benefits
provided by rider, less any outstanding loan and loan interest.
EXPIRY DATE - The date coverage terminates.
FIXED ACCOUNT - Account that is part of the Company's General Account.
INSURED - The Insured is named on the Policy Data Page.
ISSUE DATE - The date from which Monthly Anniversaries, Policy Years, and Policy
Anniversaries are measured. The Issue Date is shown on the Policy Data Page.
INVESTMENT PORTFOLIOS - One or more of the sub-accounts of the Separate Account.
LOAN ACCOUNT - A portion of the Accumulation Value which is used as collateral
for loan amounts.
MINIMUM INSURANCE FACTORS - The minimum insurance percentages required to
qualify the policy as life insurance under the federal tax code for the
guideline premium test.
MODIFIED ENDOWMENT - A classification under the Internal Revenue Code which
affects the tax status of distributions from a policy.
MONTHLY ANNIVERSARY - The same date of each month as the Issue Date. If a
Monthly Anniversary falls on a day which is not a Valuation Date, the Monthly
Anniversary will be the next Valuation Date.
NET AMOUNT AT RISK - The Death Benefit, less the Accumulation Value, divided by
the monthly equivalent of the guaranteed interest rate on the Fixed Account.
NET PREMIUM - The total premium paid less the premium expense charge.
NET SINGLE PREMIUM FACTORS - The factors used to qualify the policy as life
insurance under the federal tax code for the cash value accumulation test.
CVIC-1001 10
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NO LAPSE PREMIUM - The monthly amount that must be paid on a cumulative basis to
keep this policy in force during the no lapse period.
NOTICE, NOTIFYING - Request and information that is received at Our Service
Center in a form acceptable to Us. You may notify Us in writing. We may also
offer the right to notify Us by telephone or other means for certain types of
policy transactions. We will obtain Your authorization prior to accepting
notification in forms other than written notification.
OWNER(S) - The Owner(s) named in the application, unless changed.
POLICY ANNIVERSARY - The same date each year as the Issue Date.
POLICY DATE - The date this policy becomes effective, provided the initial
premium has been paid, premiums are invested and the first charges are deducted.
The Policy Date is shown on the Policy Data Page.
POLICY DATA PAGE - The Policy Data Page or any supplemental Policy Data Page
that We have most recently sent You. A supplemental Policy Data Page will
replace the original Policy Data Page issued with the policy. Any new subsequent
supplemental Policy Data Page will replace the previous sent supplemental Policy
Data Page.
POLICY YEAR - One year from the Issue Date and from each Policy Anniversary.
SEPARATE ACCOUNT - The Separate Account of the Company is identified on the
Policy Data Page. A Separate Account is an account that provides variable
investment options where the assets are held separate from other Company assets.
The Separate Account is not guaranteed as to the dollar amount shown on the
Policy Data Page. You should read the Separate Account provisions for additional
information.
SERVICE CENTER - The office indicated on the Policy Data Page of this policy to
which Notices, requests and premiums must be sent. All sums payable to Us under
the policy are payable only at the Service Center.
SPECIFIED AMOUNT - On the Policy Date, the Specified Amount equals the Initial
Specified Amount. Thereafter it may be changed in accordance with the terms of
the Death Benefit provisions and partial withdrawal provisions, and any attached
rider provisions that affect the Specified Amount.
VALUATION DATE - Valuation Dates are the dates on which the Investment
Portfolios are valued. A Valuation Date is any date on which the New York Stock
Exchange is open for trading and We are open for business.
VALUATION PERIOD - A Valuation Period begins at the close of one Valuation Date
and ends at the close of the next succeeding Valuation Date.
WE, US, OR OUR - "We", "Us" or "Our" means Conseco Variable Insurance Company
(the Company).
YOU - "You" or "Your" means the Owner(s) of this policy.
CVIC-1001 11
<PAGE>
OWNER, BENEFICIARY AND ASSIGNMENT
OWNERSHIP - The Owner means the Owner specified in the application unless
subsequently changed during the Insured's lifetime. The Owner has the right to
receive every benefit, exercise every right and enjoy every privilege granted by
this policy.
The policy can be owned by joint Owners. If there are joint Owners, We require
consent of all Owners to any policy transactions except for transfers, payment
of premiums, or changes in premium allocations.
Your rights, except for payment of premium and repayment of loans, are subject
to the interests of any assignee or irrevocable beneficiary. If You die before
the Insured, the new Owner will be any contingent Owner named in the
application. If there is no contingent Owner, then Your estate becomes the new
Owner.
BENEFICIARY - The beneficiary is the person(s) or entity You name in the
application or by later designation to receive any Death Proceeds provided by
the policy or any rider.
You may make the beneficiary irrevocable. If there is an irrevocable
beneficiary, You must obtain the written consent of that beneficiary to any
policy transactions except for payment of premiums and loan repayments.
If more than one person is named as beneficiary, the Death Proceeds will be paid
in equal shares to the surviving beneficiaries, unless otherwise provided. The
interest of a beneficiary who dies before the Insured will pass to any surviving
beneficiaries unless You specify otherwise. If no beneficiary survives the
Insured, You will be the beneficiary, or Your estate if You are the Insured.
If the beneficiary is "children," this means children born to or legally adopted
by the Insured.
OWNER AND BENEFICIARY CHANGE - You may change the Owner and the beneficiary at
any time during the lifetime of the Insured unless otherwise provided in a
previous designation. Any change must be in written form satisfactory to Us.
The change will take effect on the date the request is signed. The change will
not apply to any payments made or actions taken by Us before We receive the
Notice.
SIMULTANEOUS DEATH - If any beneficiary dies within 15 days after the death of
the Insured, the Death Proceeds will be paid as if the beneficiary died before
such Insured. However, this provision will not apply to any payment We make
before receiving and recording Notice of the beneficiary's death.
ASSIGNMENT - This policy may be assigned. No assignment will be recognized by Us
unless: (1) the original instrument or a certified copy is filed with Us at Our
Service Center; and (2) We send You an acknowledged copy. We will not be
responsible for the validity of any assignment.
The claim of any assignee is subordinate to that of the Company, including any
debt to the Company. The rights of the beneficiary and Owner are subject to the
rights of any assignee.
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PREMIUM PROVISIONS
INITIAL PREMIUM - The initial premium is shown on the Policy Data Page. The
initial premium is due as of the Issue Date. There will be no coverage under
this policy until the later of the date the initial premium is paid or the
Policy Date.
PLANNED PERIODIC PREMIUM - The planned periodic premium is shown on the Policy
Data Page.
GUIDELINE PREMIUM LIMITATION - If You elected the guideline premium test, the
sum of the premiums paid less a portion of any withdrawals, as defined in the
Internal Revenue Code, may not exceed the greater of: (1) the guideline single
premium; or (2) the sum of the guideline level premiums to the date of payment,
in order for this policy to be treated as life insurance under the Internal
Revenue Code. The guideline premiums will change whenever there is a change in
the Specified Amount or in other policy benefits.
The guideline premiums are determined by the rules set forth in the Internal
Revenue Code Section 7702 as may be amended from time to time. The guideline
premiums will be adjusted to conform to any changes in the code. In the event
that a premium payment would exceed these limits, We will refund the excess
premium, along with any interest allocable to that excess premium, within 60
days after the end of the Policy Year in which the excess premium is paid. As a
result, policy values immediately after such refund will be as if the excess
premium had never been paid.
WHERE PAYABLE - The first premium is payable in advance to Us at our Service
Center or through one of our authorized representatives. Any check or money
order should be payable only to the Company and not to any representative. After
the first premium all premiums are to be paid to Us at Our Service Center.
Receipts will be given upon request.
AMOUNT AND FREQUENCY - After the initial premium payment, You may make premium
payments at any time until the Insured's attained Age of 100. No premium will be
accepted after the Insured reaches attained Age 100. You may not make a payment
less than the minimum payment shown on the Policy Data Page. All premiums
combined may not be more than the maximum premium shown on the Policy Data Page.
The amount of premiums You pay will affect the Accumulation Value and the period
of time the policy remains in force. The frequency of premium payment shown on
the Policy Data Page will serve only as an indication of Your preference as to
probable future frequency of payment. You may change the frequency of planned
periodic premium payment at any time.
If You pay premium that would cause an increase in Net Amount At Risk because of
the Minimum Insurance Factors or the Net Single Premium Factors, depending on
the death benefit qualification test elected, We may decide whether or not to
accept the premium based on Our underwriting procedures. If We accept the
premium, We will allocate the Net Premium to Your Accumulation Value on the date
of Our acceptance. If We do not accept the premium, We will refund the premium
without interest to You. We reserve the right to put the premium in suspense
until underwritten.
If You pay a premium which would cause this policy to fail to meet the
definition of a life insurance contract under the Internal Revenue Code, We will
refund the excess premium, along with any interest allocable to that excess
premium, within 60 days after the end of the Policy Year in which the excess
premium is paid. As a result, policy values immediately after such refund will
be as if the excess premium had never been paid.
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MODIFIED ENDOWMENT -The amount of premium You pay may cause the policy to become
a Modified Endowment policy. If all or a portion of a premium payment, other
than the initial premium, would cause the policy to become a Modified Endowment
policy, We will before the policy becomes a Modified Endowment policy:
1. apply the portion of the premium that is under the Modified Endowment
policy limit to the policy, and
2. hold in suspense the portion of the premium that would cause the
policy to become a Modified Endowment policy, and notify You. You may
choose to apply this portion of the premium, or ask for a refund. If
You elect to apply the premium, the Net Premium is allocated as of the
date We receive Your response. If there is no response from You within
30 days, this portion of the premium will be refunded to You.
ALLOCATION OF NET PREMIUM - We allocate the initial Net Premium to the
Accumulation Value in accordance with the provisions on the Policy Data Page
under allocation rules. We allocate subsequent Net Premiums as of the end of the
Valuation Period during which We receive the premium at Our Service Center.
Any allocations You make are subject to the allocation rules on the Policy Data
Page. You may change the allocation of subsequent Net Premiums at any time by
Notice.
DEATH BENEFIT PROVISIONS
DEATH BENEFIT - This policy provides a Death Benefit on the death of the
Insured. The Death Benefit, death benefit option and the two death benefit
qualification tests are described in this section. On the date of death, the
Death Benefit is calculated as the larger of: (a) the guideline minimum death
benefit calculated under the death benefit qualification test elected; and (b)
the Death Benefit as calculated under the death benefit option in effect.
DEATH BENEFIT QUALIFICATION TEST - You elect the death benefit qualification
test in the application. The death benefit qualification test You have elected
is shown on the Policy Data Page. The death benefit qualification test may not
be changed for the life of the policy. The two death benefit qualification tests
are explained below.
1. CASH VALUE ACCUMULATION TEST - The guideline minimum death benefit
will be the greater of the amount required for this policy to be
deemed "life insurance" according to the Internal Revenue Code or 101%
of the Accumulation Value. Such required amount will be equal to the
Accumulation Value divided by the Net Single Premium (NSP), as defined
in Internal Revenue Code Section 7702(b). The NSP for each attained
age, based on the policy as issued, is shown in the Table of NSP's on
the Policy Data Page. If there are any changes to the policy, the
NSP's may also change. If they do change, We will send You a
supplemental Policy Data Page showing the NSP's.
2. GUIDELINE PREMIUM TEST - The guideline minimum death benefit at any
time is the Accumulation Value multiplied by the Death Benefit
percentage shown in the Table of Minimum Insurance Factors on the
Policy Data Page.
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DEATH PROCEEDS - We will pay the Death Proceeds to the beneficiary upon receipt
of proof that the Insured died while this policy was in force. We will pay
interest on Death Proceeds from the date of death to the date payment is made at
a rate of interest not less than the guaranteed rate for the Fixed Account under
this policy. If state law requires payment of a greater amount of interest, We
will pay that amount.
The Death Proceeds are:
1. the Death Benefit in force as of the end of the Valuation Period
during which death occurs; plus
2. any benefits provided by rider payable at the Insured's death; less
3. any outstanding loan and loan interest as of the date of death.
If the Insured dies during the grace period, the proceeds paid on death will be
equal to the Death Benefit immediately prior to the start of the grace period,
plus any benefits provided by rider, less loans and loan interest and overdue
monthly deductions as of the date of death.
DEATH BENEFIT OPTIONS - There are three death benefit options, as described in
this provision. You have elected the death benefit option in the application.
The death benefit option for this policy appears on the Policy Data Page.
OPTION A - The Death Benefit equals the Specified Amount.
OPTION B - The Death Benefit equals the Specified Amount plus the Accumulation
Value on the date of death.
OPTION C - The Death Benefit is the Specified Amount plus the sum of the
premiums paid minus the sum of any partial withdrawals taken. If the sum of
withdrawals is greater than the sum of premiums paid, then the Death Benefit
will be less than the Specified Amount.
POLICY CHANGE PROVISIONS
CHANGE IN SPECIFIED AMOUNT - You may make the following changes to this policy,
as long as the policy is not in the grace period. We will not accept any change
which disqualifies this policy as life insurance under federal tax law. Any
change in Specified Amount will be reflected on a supplemental Policy Data Page.
SPECIFIED AMOUNT INCREASE - You may request an increase once per Policy Year of
the Specified Amount at any time after the date shown on the Policy Data Page,
by providing satisfactory evidence of insurability of the Insured. The minimum
amount of any increase is shown on the Policy Data Page. The increase will be
effective as of the Monthly Anniversary following Our approval of the increase.
SPECIFIED AMOUNT DECREASE - You may request a decrease once per Policy Year of
the Specified Amount by Notice at any time after the date shown on the Policy
Data Page. The minimum amount of any decrease is shown on the Policy Data Page.
You may not make a decrease which reduces the Specified Amount of the policy
below the minimum amount shown on the Policy Data Page. No decrease will be
allowed that requires a force-out of cash under Internal Revenue Code Section
7702(f)(7).
The decrease will be effective as of the Monthly Anniversary following Our
receipt of Notice. If You have made any increases to the policy, the decrease
will first be applied to reduce those increases, starting with the most recent.
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CHANGE IN DEATH BENEFIT OPTION - You may request a change between Option A and
Option B death benefit options by Notice at any time after the date specified on
the Policy Data Page. If You have originally chosen Option C, You may not change
the death benefit option.
If You request a change from Option B to Option A, the Specified Amount will be
increased by the amount of the Accumulation Value on the date of change. The
change will be effective on the Monthly Anniversary following Our receipt of
Notice.
If You request a change from Option A to Option B, the Specified Amount will be
decreased by the amount of the Accumulation Value on the date of change.
Evidence of insurability of the Insured satisfactory to Us must be submitted.
The change will be effective on the Monthly Anniversary following Our approval
of the change. We will not permit any change which would decrease the Specified
Amount below the minimum amount shown on the Policy Data Page.
POLICY CHARGES PROVISIONS
PREMIUM EXPENSE CHARGES - The premium expense charges are deducted when the
premium is received, except the premium expense charges for the initial premium
are deducted on the Policy Date. The premium expense charges are shown on the
Policy Data Page.
MONTHLY DEDUCTION - The monthly deduction is the sum of:
1. the cost of insurance charge;
2. the mortality and expense risk charge;
3. the administrative charge; and
4. the cost for any policy riders.
The monthly deduction is due on the Issue Date and each Monthly Anniversary.
Monthly deductions due on any Monthly Anniversaries prior to the Policy Date are
deducted on the Policy Date. All other monthly deductions are deducted when due.
We deduct the monthly deduction prorata from the Investment Portfolios and the
Fixed Account based on Your amounts in each account. No monthly deduction is
taken after the Insured's attained Age 100.
COST OF INSURANCE CHARGE - The guaranteed maximum cost of insurance rates are
shown on the Policy Data Page. We may choose to use a current cost of insurance
rate less than the guaranteed maximum cost of insurance rate. Current cost of
insurance rates may vary by Issue Age, sex, premium class, Policy Year, and
Specified Amount of the policy. If You have increased the Specified Amount after
issue, each increase may have different applicable current cost of insurance
rates.
The cost of insurance charge is the cost of insurance rate multiplied by the Net
Amount at Risk as of the date of the monthly deduction. If there have been
increases in Specified Amount the Net Amount At Risk is allocated to each
Specified Amount.
MORTALITY AND EXPENSE RISK CHARGE - Each Monthly Anniversary as part of the
monthly deduction We deduct the mortality and expense risk charges that are
shown on the Policy Data Page. The deduction is made prorata from Investment
Portfolios and the Fixed Account. The mortality and expense risk charges
compensate Us for assuming the mortality and expense risk of the policy and if
so elected, to provide for certain riders. There is a new per $1,000 mortality
and expense risk charge on an increase.
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ADMINISTRATIVE CHARGE - The Administrative Charge is shown on the Policy Data
Page. Each Monthly Anniversary as part of the monthly deduction We deduct an
administrative charge from the Investment Portfolios and the Fixed Account based
on Your amounts in each account that is equal to the amount shown on the Policy
Data Page. The administrative charge compensates Us for the costs associated
with the administration of this policy and the Separate Account.
SURRENDER CHARGE - The guaranteed maximum surrender charges are shown on the
Policy Data Page. We will deduct the surrender charge from the Accumulation
Value on the date this policy is surrendered or if there is a decrease in the
Specified Amount, either by request or from a partial withdrawal or death
benefit option change.
If there have been increases in the Specified Amount, each increase will have a
corresponding new surrender charge associated with the increase. If there have
been decreases in the Specified Amount, including decreases in the Specified
Amount due to partial withdrawals, the remaining surrender charge will be based
on the new Specified Amount. New surrender charges will be reflected on a
supplemental Policy Data Page.
CHANGES IN COST FACTORS - We may change the cost of insurance rates up to the
maximum guaranteed amounts stated in this policy. Changes will be made uniformly
by class and will be based on changes in future expectations for experience. We
will periodically review policy cost factors. We bear the mortality and expense
risks of this policy.
INVESTMENT PORTFOLIO EXPENSES - There are deductions from and expenses paid out
of the assets of the various Investment Portfolios, which are described in the
fund prospectuses.
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.
POLICY VALUES PROVISION
ACCUMULATION VALUE - The Accumulation Value is the sum of Your interest in the
various Investment Portfolios, the Fixed Account, and the Loan Account.
On the Policy Date, the Accumulation Value is the initial Net Premium received
for this policy less any monthly deduction charges as of the Policy Date.
The Accumulation Value on each Valuation Date after the Policy Date will be:
1. the Accumulation Value on the prior Valuation Date; plus
2. any Net Premium for the policy allocated since the prior Valuation
Date; plus or minus
3. the positive or negative investment experience on amounts allocated to
the Separate Account, as reflected by the change in value of the
Accumulation Units; plus
4. interest credited to amounts allocated to the Fixed Account and the
Loan Account; less
5. any partial withdrawals paid since the prior Valuation Date; less
6. any monthly deduction or transfer charges assessed; less
7. any surrender charge assessed.
CVIC-1001 17
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SEPARATE ACCOUNT PROVISIONS
SEPARATE ACCOUNT - The Separate Account is an account that provides investment
options where the assets are held separate from all other Company assets. The
assets of the Separate Account equal to reserves and other liabilities will not
be charged with liabilities arising out of any other business the Company may
conduct.
The Separate Account assets are divided into Investment Portfolios. Should the
shares of any such Investment Portfolio become unavailable for investment by the
Separate Account, or the Company's Board of Directors deems further investment
in the shares inappropriate, the Company may limit further purchase of such
shares or substitute shares of another Investment Portfolio for shares already
purchased under this policy.
SEPARATE ACCOUNT VALUE - The Separate Account value of this policy equals the
sum for all Investment Portfolios of the number of Accumulation Units credited
to an Investment Portfolio multiplied by the appropriate Accumulation Unit
value.
ACCUMULATION UNITS - In order to keep track of your Accumulation Value in an
Investment Portfolio, We use a unit of measure called an Accumulation Unit. The
value of Your policy is affected by the investment performance of the
portfolios, the expenses of the portfolios, and the deduction of charges under
the policy. The value of an Accumulation Unit may go up or down without limit.
Initially, the Accumulation Unit value for each account was arbitrarily set at
$10. Every Valuation Date, We determine the value of an Accumulation Unit for
each of the Investment Portfolios by multiplying the Accumulation Unit value for
the previous period by a factor for the current period. The factor is determined
by dividing the value of an Investment Portfolio share at the end of the current
period (and any charges for taxes) by the value of an Investment Portfolio share
for the previous period.
CREDITING OF ACCUMULATION UNITS - We credit amounts allocated to the Investment
Portfolios in the form of Accumulation Units. The number of Accumulation Units
to be credited is determined by dividing:
(1) the dollar amount allocated to the particular Investment Portfolio, by
(2) the Accumulation Unit value for the particular Investment Portfolio at
the end of the Valuation Period during which the allocation is made.
Accumulation Units are credited when Net Premiums are allocated or amounts are
transferred into an Investment Portfolio. Accumulation Units are deducted when
the monthly deduction is assessed or when amounts are partially surrendered or
transferred out of an Investment Portfolio.
ADDITION, DELETION, OR SUBSTITUTION OF INVESTMENTS - We may deem it necessary to
discontinue one or more of the Investment Portfolios or substitute one of the
Investment Portfolios You have selected with another Investment Portfolio. We
will notify You of Our intent to do this. We will obtain prior approval from the
Securities and Exchange Commission before any such change is made.
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The Separate Account may be operated as a management company under the
Investment Company Act of 1940, or it may be deregistered under such Act in the
event such registration is no longer required, or it may be combined with other
of Our Separate Accounts. The investment policy of the Separate Account will not
be changed without the approval of the Insurance Commissioner of the state of
Texas. If required, the approval process is on file with the Commissioner of the
state in which this policy is issued.
We may, by appropriate endorsement, make such changes in this policy as may be
necessary to reflect any substitution or change.
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT VALUES - The Fixed Account Values of this policy at any time
equals:
(a) the total of all Net Premiums allocated to the Fixed Account; plus
(b) interest credited to the Fixed Account; plus
(c) the total of all amounts transferred to the Fixed Account from the
Separate Account or the Loan Account; minus
(d) the total of all amounts transferred from the Fixed Account to the
Separate Account and the Loan Account; minus
(e) the total of all cost of insurance charges, mortality and expense risk
charges, administrative charges, transfer charges assessed and cost
for any policy rider charged against the Fixed Account; minus
(f) the total of all partial withdrawals from the Fixed Account; minus
(g) any surrender charges assessed.
FIXED ACCOUNT INTEREST RATE - The minimum guaranteed interest rate credited to
amounts in the Fixed Account is shown on the Policy Data Page. We may credit
interest rates in excess of the guaranteed rate.
TRANSFER PROVISIONS
You can make a transfer to or from the Fixed Account, and to or from an
Investment Portfolio by Notifying Us. The transfer will be made as of the end of
the Valuation Period during which We receive Notice. No transfers may be made
before the end of the right to examine policy period.
The following apply to any transfer:
1. Transfers from the Fixed Account are limited in total for any Policy
Year to no more than the amount and frequency shown on the Policy Data
Page. Transfers from the Fixed Account are made on a last in first out
basis.
2. The limit on number of transfers that can be made is shown on the
Policy Data Page.
3. The transfer fee is shown on the Policy Data Page. The fee will be
deducted from the amount transferred.
4. The minimum amount which You can transfer is shown on the Policy Data
Page.
5. Your right to make transfers is subject to modification if We
determine, in Our sole opinion, that the exercise of the right by one
or more Owners is, or would be, to the disadvantage of other Owners.
Restrictions may be applied in any manner reasonably designed to
prevent any use of the transfer right which is considered by Us to be
to the disadvantage of other Owners. A modification could be applied
to transfers to, or from, one or more of the Investment Portfolios and
could include, but is not limited to:
a. the requirement of a minimum time period between each transfer;
CVIC-1001 19
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b. not accepting a transfer request from an agent acting under a
power of attorney on behalf of more than one Owner; or
c. limiting the dollar amount that may be transferred between
Investment Portfolios by an Owner at any one time.
6. We reserve the right, at any time, and without prior notice to any
party, to terminate, suspend or modify the transfer privilege.
Transfers are made such that the Accumulation Value on the date of transfer will
not be affected by the transfer, except for the deduction of any transfer fee.
DOLLAR COST AVERAGING PROGRAM - Under dollar cost averaging (DCA), You may
authorize the automatic transfer of a set dollar amount at monthly, quarterly,
semi-annual, or annual intervals. You may elect to have transfers made from the
money market portfolio to one or more Investment Portfolios. You must have at
least $2,000 in the money market portfolio to participate in dollar cost
averaging. The transfers made under DCA are not taken into account in
determining any transfer fee. There is no additional charge for this program. We
may modify the terms of the DCA program at any time, including but not limited
to the right to terminate the program, impose charges for the program, change
the minimum requirements for the program, or change the timing of transfers
under the program.
At certain times, the Company may offer a special DCA program from the Fixed
Account. When instituted, this program will be governed by a separate service
agreement and may have different balance and allocation requirements.
REBALANCING - You may elect to automatically rebalance the policy to return to
the percentage allocation within the Investment Portfolios as selected currently
for premium allocations if the value of the policy is at least the minimum
amount that is shown on the Policy Data Page. You may elect to rebalance
quarterly, semi-annually, or annually. You can discontinue rebalancing at any
time. You can change your rebalancing request at any time by Notice, which We
must receive before the next rebalancing date. The transfers made under
rebalancing are not taken into account in determining any transfer fee. There is
no charge for participating in rebalancing. We may modify the terms of the
rebalancing program at any time, including but not limited to the right to
terminate the program, impose charges for the program, change the minimum
requirement for the program, or change the timing of transfers under the
program.
LOAN PROVISIONS
POLICY LOAN - You may request a loan at any time after the right to examine
policy period. This policy is assigned to Us as sole security for the loan.
LOAN AMOUNT AVAILABLE - The maximum amount of a new loan is equal to:
1. 90% of the Accumulation Value less any surrender charges that would be
imposed if the policy were surrendered on the date the loan is taken;
less
2. any outstanding loans plus loan interest.
INTEREST CHARGED ON LOANS - Interest accrues daily on the outstanding loan at
the applicable preferred or non-preferred rate shown on the Policy Data Page.
Interest is due on each Policy Anniversary.
If You do not pay interest when due, We will add that amount to the loan. We
make a transfer from the Investment Portfolios and the Fixed Account into the
Loan Account as collateral for the interest due. The amount We transfer is the
amount by which the interest due exceeds the interest which has been credited on
the Loan Account. The transfer is made from each account in proportion to the
amount in the account.
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LOAN ACCOUNT - When We issue a loan, We transfer an amount equal to the loan
from the Investment Portfolios and the Fixed Account into a Loan Account as
collateral for the loan. You may specify that the transfer is to be made from
specific Investment Portfolios. If You make no specification, this transfer is
made in proportion to the Accumulation Value in the Investment Portfolios and
the Fixed Account.
INTEREST CREDITED ON LOANS - The Loan Account will be credited with interest
daily that will be at least equal to the applicable non-preferred or preferred
loan interest rate, which is shown on the Policy Data Page. We may credit a
higher rate.
A loan has a permanent effect on Your policy values, since the policy value held
in the Loan Account earns different rates than it might have experienced if it
were invested in the Investment Portfolios or the Fixed Account.
REPAYMENT OF LOANS - You may repay a loan in full or in part at any time while
this policy is in force and the Insured is alive. When a loan repayment is made,
the amount of the Loan Account equivalent to the amount of loan repayment is
transferred prorata to the Investment Portfolios. If You do not currently have
funds in the Investment Portfolios, You must select an Investment Portfolio for
the transfer.
Unless You request otherwise at the time You make any payments to Us, all
amounts received while a loan is outstanding will be considered as premium
payments, not loan repayment.
PREFERRED LOANS - If the Cash Value exceeds the total of all premiums paid since
issue, which have not previously been withdrawn or the policy has passed its
tenth Policy Anniversary, a preferred loan is available. The amount available
for a preferred loan during the first ten Policy Years is the amount by which
the Cash Value exceeds total premiums paid. After the tenth Policy Year, all of
the loan amount available is available as a preferred loan.
The amount of the Loan Account that equals a preferred loan will be credited
with interest at a rate equal to the preferred interest rate shown on the Policy
Data Page. The amount of indebtedness that qualifies as a preferred loan is
determined on each Monthly Anniversary.
SURRENDER PROVISIONS
CASH SURRENDER - You may surrender this policy for the Cash Surrender Value by
Notifying Us at any time while the Insured is living.
PARTIAL WITHDRAWAL - You may surrender part of this policy for cash by Notice to
Us at any time after the end of the right to examine policy period while the
Insured is living. The minimum amount of any partial withdrawal is shown on the
Policy Data Page. The amount withdrawn is deducted from the Accumulation Value.
The deduction will be made prorata from the Investment Portfolios and the Fixed
Account based on Your amounts in each account, unless You request deduction from
specific Investment Portfolios.
A partial withdrawal will affect the Specified Amount, depending on the Death
Benefit Option You have chosen. If Your Death Benefit Option is B or C, the
amount withdrawn will not reduce the Specified Amount. If your Death Benefit
Option is A, then the partial withdrawal will reduce the Specified Amount by the
amount withdrawn, not including surrender charges, which is in
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excess of the free partial withdrawal amount. The remaining Specified Amount
must be at least equal to the minimum Specified Amount shown on the Policy Data
Page.
FREE PARTIAL WITHDRAWAL - Since a partial withdrawal under Death Benefit Option
A will reduce the Specified Amount by the amount of the withdrawal, a free
partial withdrawal is available to You. You may request a free partial
withdrawal by Notice at any time after the date shown on the Policy Data Page up
to the percentage shown on the Policy Data Page of the Accumulation Value. The
free partial withdrawal amount may be taken in one or more withdrawals during
the Policy Year. The free partial withdrawal amount is paid without surrender
charges at the time of withdrawal, but the remaining surrender charge is not
decreased. The free partial withdrawal does not reduce the Specified Amount.
TERMINATION OF THE POLICY PROVISIONS
NO LAPSE GUARANTEE - During the no lapse period shown on the Policy Data Page,
the policy will remain in force if on each Monthly Anniversary after the Policy
Date, the sum of the premiums paid to date, less any partial withdrawals, loans
and loan interest, equals or exceeds the No Lapse Premium multiplied by the
number of policy months since the Issue Date. If this test is failed on any
Monthly Anniversary, the no lapse guarantee terminates.
The No Lapse Premium is shown on the Policy Data Page. If You make changes to
the policy after issue, the No Lapse Premium for subsequent months may change.
We will send You notice of the new No Lapse Premium. We do not reduce the No
Lapse Premium if Specified Amount decreases are made.
GRACE PERIOD - Unless the no lapse period applies, the grace period begins on
the Monthly Anniversary when the Cash Surrender Value is less than the monthly
deduction. This policy goes into default at the start of the grace period. We
will mail You and any assignee notice of the length of the grace period and the
amount of premium due. The amount of premium due is the amount which is required
to keep the policy in force during the grace period plus two additional month's
charges. This notice will be sent to Your last known address and the address of
any assignee of record. The grace period ends 61 days from the date of mailing
of the notice. If the premium due is not paid within the grace period, all
insurance stops and the policy terminates without value.
TERMINATION - This policy will terminate:
1. at the end of the grace period; or
2. as of the end of the Valuation Period during which We receive Notice
from You to surrender the policy; or
3. when the Insured dies.
REINSTATEMENT - If the policy lapses, you may reinstate the policy only if:
1. the policy was not surrendered for cash; and
2. You provide Us with satisfactory evidence of insurability; and
3. You pay sufficient premium to cover past due monthly deductions during
the grace period and to keep this policy in force for three months;
and
4. interest on any loan amount that is reinstated is paid at the annual
rate applicable to policy loans during the period of lapse, from the
date the policy terminated.
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If the policy lapses and is reinstated during the No Lapse Period, you may
reinstate the no lapse guarantee if:
1. the no lapse guarantee was in effect three months prior to the date of
the lapse; and
2. on the date of reinstatement, you pay sufficient premiums such that
the sum of premiums paid to date, less any partial withdrawals, loans
and loan interest, equals or exceeds the No Lapse Premium multiplied
by the number of policy months between the Issue Date and the date of
the lapse.
The effective date of the reinstatement is the next Monthly Anniversary
following Our approval of the reinstatement.
The Accumulation Value on the effective date of reinstatement is equal to the
Accumulation Value at the time of termination, less past due charges during the
grace period, plus the premium paid at the time of reinstatement. The surrender
charge will be based on the number of Policy Years from the original Issue Date.
GENERAL POLICY PROVISIONS
ENTIRE CONTRACT - The entire contract consists of this policy, any riders or
endorsements, the attached copy of the initial application and all supplemental
applications to change this policy. All statements in the application and any
supplemental application will, in the absence of fraud, be deemed
representations and not warranties. No statement will be used to contest this
policy, or to contest a claim under it, unless it appears on the application or
a supplemental application. Any application for modifications in the policy,
which are to be based upon additional evidence of insurability, shall be
attached to the policy in order to become part of the contract between the
parties.
MODIFICATION OF POLICY - Only the President, a Vice President, the Secretary, or
an Assistant Secretary of the Company has power on behalf of the Company to
change, modify, or waive the provisions of the policy and then only in writing
by endorsement. No agent, broker, or person other than the above named officers
has the authority to change or modify this policy or waive any of its
provisions.
RELIANCES - We are not liable for any request made in accordance with Your
instructions. If We make any payments or policy changes in good faith based on
Our records, We have fully discharged Our obligations.
INCONTESTABILITY - Except in the case of fraud, We will not contest this policy
after it has been in force during the lifetime of the Insured for two years from
the Issues Date, or for increases in the Specified Amount, two years from the
effective date of the increase. We will not contest any Specified Amount
increase if it was not requested by You, or if evidence of insurability was not
required. If this policy is reinstated, the incontestable period will start over
again beginning on the effective date of the reinstatement, but only for
statements made in the application for reinstatement.
SUICIDE - If the Insured dies by suicide, while sane or insane, within two years
from the Issue Date or the effective date of any reinstatement, We will not pay
a Death Benefit. We will terminate this policy and refund the premiums paid,
less any loan, loan interest, and any partial withdrawal.
CVIC-1001 23
<PAGE>
If the Insured dies by suicide, while sane or insane, within two years of the
effective date of any increase in the Specified Amount that was subject to
evidence of insurability or the effective date of any reinstatement, We will not
pay a death benefit on that increase. We will refund the monthly deductions for
that increase.
DEFERRAL OF PAYMENTS - We usually make payments for the Death Benefit within
seven days after We receive due proof of claim. We usually make payments for
surrender or loans from the Separate Account within seven days of receiving Your
request. We may suspend or delay making payments or transfers from the Separate
Account when:
1. the New York Stock Exchange is closed, other than customary weekend
and holiday closing, or trading on the New York Stock Exchange is
restricted as determined by the Security and Exchange Commission
(SEC); or
2. The SEC, by order, permits postponement for the protection of policy
owners, or
3. An emergency exists as determined by the SEC, as a result of which
disposal of securities is not reasonably practicable or it is not
reasonably practicable to determine the value of the assets of the
Investment Portfolios.
For payments made from the Fixed Account, We may defer payment for up to six
months. If We do, We will continue to credit interest on the Fixed Account at
the declared rates. We will not defer any amounts needed to pay premiums for
other policies in force with Us.
ANNUAL REPORT - At least once a year, We will send You a report showing premiums
paid, expense charges, interest credited, cost of insurance, outstanding loans,
current Cash Value, cash surrender value, and all charges made since the last
report. Any other information required by the Insurance Department of the State
where the application is signed will also be included in the Annual Report.
PROJECTION OF BENEFITS AND VALUES - We will provide a projection of illustrative
future policy benefits and values at any time upon written request. There will
be no charge for the first projection requested each Policy Year. Additional
projections will be provided for a $25.00 fee.
CONFORMITY WITH STATUTES - This policy is subject to the laws of the state which
govern this policy. We reserve the right to make any changes to this policy
without Your consent which We deem necessary to comply with any federal or state
statute, rule, or regulation.
CLAIMS OF CREDITORS - To the extent permitted by law, no payment or right under
this policy will be subject to the claims of creditors.
ERROR IN AGE OR SEX - If the Insured's Age or sex has been misstated and the
misstatement is discovered after the date of the Insured's death, the amount of
the Death Benefit will be the amount which would have been purchased at the
Insured's correct Age and sex by the most recent cost of insurance charge
assessed prior to the date We receive proof of death.
If the Insured's age or sex has been misstated and the misstatement is
discovered prior to the date of the Insured's death, the policy values will be
corrected to the amounts for the correct Age or sex.
COMPUTATIONS - Calculations are based on the Mortality Table shown on the Policy
Data Page. Interest on amounts allocated to the Fixed Account are compounded
daily.
CVIC-1001 24
<PAGE>
All of the values are the same as or more than the minimums set by the laws of
the state where the application was signed. If required, We have filed a
detailed statement with Your State Insurance Department.
PAYMENT OF PROCEEDS - You may take the Death Benefit or Cash Surrender Value as
a lump sum or select any of the payment options described in the settlement
options provisions. Before the Insured dies, You may choose how the Death
Proceeds are to be paid. If You have not made a choice before the Insured dies,
the beneficiary may choose how the Death Proceeds will be paid. When part or all
of the Death Proceeds are paid in a lump sum, We will include interest from the
date We receive proof of death to the payment date. The interest rate will not
be less than required by law.
SETTLEMENT OPTIONS PROVISIONS
ELECTION OF OPTIONS - Any amount payable at the death of the Insured or any
other termination of this policy will be paid in one sum unless otherwise
provided. All or part of this sum may be applied to any settlement option.
Payment under a combination of options, or payment to joint or successive
payees, or payment to a beneficiary that is not a natural person may be elected
only with Our consent.
Any election must be made in writing to Us. We may require the policy for
endorsement.
ELECTION BY OWNER - During the lifetime of the Insured, the Owner may elect to
have the Death Proceeds paid under one of the payment options in this policy.
ELECTION BY BENEFICIARY - At the time Death Proceeds are payable to the
beneficiary, the beneficiary may elect one of the payment options if proceeds
are available to the beneficiary in a lump sum. The beneficiary has 12 months
after payment becomes due to elect one of the following options.
PAYMENTS - Payments will be made monthly unless otherwise elected.
We have the right to change the frequency of payments in order to make a
periodic payment of at least $25.00.
The option date under Options 1, 2 and 3 is the date the Death Proceeds are
payable or the date of election, whichever is later. Interest under Option 4
will accrue from such date.
Under Option 3, proof of the age of the payee will be required at the time the
first payment is due. We reserve the right to require proof that the payee is
alive at the time of each payment.
CHANGE IN PAYMENTS - Partial withdrawal under Options 1 and 2 may not be made.
All payments under Options 1 and 2 may be paid in one sum only with Our consent.
The value of any one sum payment will be the sum of any remaining guaranteed
payments discounted at the interest rate used to calculate such payment.
Payments under Option 3 will be commuted only in event of death of the payee.
Any payments that remain to be paid under Option 3 at the death of the payee
will be paid in one sum. The value of the one sum payment will be the sum of the
remaining guaranteed payments, discounted at the interest rate used to calculate
such payment.
CVIC-1001 25
<PAGE>
WITHDRAWAL - The minimum Death Proceeds that may be applied under Option 4 is
$1,000. The minimum Death Proceeds that may remain after a withdrawal under
Option 4 is $1,000. The minimum amount that may be withdrawn is $1,000. Death
Proceeds less than this amount will be paid in a lump sum to the payee.
We may postpone payment of any amount to be withdrawn for not more than six
months from the date the written request for withdrawal is received by Us at our
Service Center.
ASSIGNMENT - The proceeds payable under one of these options may not be
assigned.
ADDITIONAL INTEREST - Additional interest, if any, paid over the guaranteed 3%
will be in an amount and by a method determined by Us.
BASIS OF VALUES - Minimum income rates are based on the 1983 Individual Annuity
Mortality Table Improvement Scale G. Interest is assumed at the rate of 3% per
year.
OPTION 1. EQUAL PAYMENTS FOR A GUARANTEED PERIOD - Equal monthly payments for
the number of years elected, not to exceed 25 years. Payments will begin on the
option date.
CVIC-1001 26
<PAGE>
Guaranteed Minimum Payment for each $1,000 of net proceeds
Guaranteed interest rate: 3.00%
ANNUAL SEMI
YEARS ANNUAL ANNUAL QUARTERLY MONTHLY
1 $1,000.00 $503.69 $252.78 $84.47
2 507.39 255.47 128.26 42.86
3 343.23 172.88 86.76 28.99
4 261.19 131.56 66.02 22.06
5 211.99 106.78 53.59 17.91
6 179.22 90.27 45.30 15.14
7 155.83 78.49 39.39 13.16
8 138.31 69.66 34.96 11.68
9 124.69 62.81 31.52 10.53
10 113.82 57.33 28.77 9.61
11 104.93 52.85 26.52 8.86
12 97.54 49.13 24.65 8.24
13 91.29 45.98 23.08 7.71
14 85.95 43.29 21.73 7.26
15 81.33 40.96 20.56 6.87
16 77.29 38.93 19.54 6.53
17 73.74 37.14 18.64 6.23
18 70.59 35.56 17.84 5.96
19 67.78 34.14 17.13 5.73
20 65.26 32.87 16.50 5.51
21 62.98 31.72 15.92 5.32
22 60.92 30.68 15.40 5.15
23 59.04 29.74 14.92 4.99
24 57.33 28.88 14.49 4.84
25 55.76 28.08 14.09 4.71
26 54.31 27.36 13.73 4.59
27 52.97 26.68 13.39 4.47
28 51.74 26.06 13.08 4.37
29 50.60 25.49 12.79 4.27
30 49.53 24.95 12.52 4.18
OPTION 2. EQUAL PAYMENTS OF A SPECIFIED AMOUNT - Equal monthly payments of at
least $4.71 per month for each $1,000 of proceeds. Payments will begin on the
option date and will continue until the proceeds and interest at the rate of
3.00% compounded annually are exhausted.
OPTION 3. EQUAL PAYMENTS FOR LIFE - Equal monthly payments for a guaranteed
period of 10, 15, or 20 years as elected and for life thereafter as shown in the
table below. Amount of each monthly installment per $1,000 net proceeds. Amounts
based on 1983 IAM Table with improvement scale G and 3% per year.
CVIC-1001 27
<PAGE>
MALE
Monthly Income for Life with Monthly Income for Life with
Guaranteed Period of: Guaranteed Period of:
Age of 10 15 20 Age of 10 15 20
Payee Years Years Years Payee Years Years Years
------------------------------- -------------------------------
25 $3.07 $3.07 $3.06 55 $4.38 $4.31 $4.21
26 3.09 3.09 3.08 56 4.46 4.38 4.27
27 3.11 3.11 3.10 57 4.55 4.46 4.34
28 3.14 3.13 3.13 58 4.64 4.54 4.40
29 3.16 3.16 3.15 59 4.73 4.63 4.46
30 3.18 3.18 3.17 60 4.84 4.71 4.53
31 3.21 3.21 3.20 61 4.94 4.80 4.60
32 3.24 3.23 3.23 62 5.06 4.89 4.66
33 3.27 3.26 3.25 63 5.18 4.99 4.73
34 3.30 3.29 3.28 64 5.30 5.09 4.79
35 3.33 3.32 3.31 65 5.43 5.18 4.86
36 3.36 3.35 3.34 66 5.57 5.28 4.92
37 3.40 3.39 3.37 67 5.71 5.39 4.98
38 3.43 3.42 3.41 68 5.85 5.49 5.04
39 3.47 3.46 3.44 69 6.01 5.59 5.09
40 3.51 3.50 3.48 70 6.16 5.69 5.14
41 3.55 3.54 3.52 71 6.33 5.79 5.19
42 3.66 3.58 3.56 72 6.49 5.89 5.24
43 3.64 3.62 3.60 73 6.66 5.98 5.28
44 3.69 3.67 3.64 74 6.83 6.07 5.31
45 3.74 3.72 3.68 75 7.00 6.16 5.35
46 3.79 3.76 3.73 76 7.18 6.24 5.38
47 3.84 3.82 3.78 77 7.36 6.32 5.40
48 3.90 3.87 3.82 78 7.53 6.40 5.42
49 3.67 3.92 3.87 79 7.70 6.46 5.44
50 4.02 3.98 3.93 80 7.87 6.52 5.46
51 4.08 4.04 3.98
52 4.15 4.11 4.04
53 4.22 4.17 4.09
54 4.30 4.24 4.15
CVIC-1001 28
<PAGE>
FEMALE
Monthly Income for Life with Monthly Income for Life with
Guaranteed Period of: Guaranteed Period of:
Age of 10 15 20 Age of 10 15 20
Payee Years Years Years Payee Years Years Years
25 $2.96 $2.96 $2.95 55 $4.01 $3.98 $3.94
26 2.98 2.97 2.97 56 4.08 4.04 3.99
27 2.99 2.99 2.99 57 4.15 4.11 4.05
28 3.01 3.01 3.01 58 4.22 4.18 4.11
29 3.03 3.03 3.03 59 4.30 4.25 4.18
30 3.05 3.05 3.05 60 4.39 4.33 4.24
31 3.07 3.07 3.07 61 4.48 4.41 4.31
32 3.09 3.09 3.09 62 4.57 4.50 4.38
33 3.12 3.12 3.11 63 4.67 4.58 4.45
34 3.14 3.14 3.14 64 4.77 4.67 4.52
35 3.17 3.16 3.16 65 4.88 4.77 4.59
36 3.19 3.19 3.19 66 5.00 4.87 4.67
37 3.22 3.22 3.21 67 5.12 4.97 4.74
38 3.25 3.25 3.24 68 5.25 5.07 4.81
39 3.28 3.28 3.27 69 5.39 5.18 4.88
40 3.31 3.31 3.30 70 5.53 5.29 4.95
41 3.34 3.34 3.33 71 5.69 5.40 5.01
42 3.38 3.37 3.36 72 5.85 5.52 5.07
43 3.41 3.41 3.40 73 6.01 5.63 5.13
44 3.45 3.44 3.43 74 6.19 5.74 5.19
45 3.49 3.48 3.47 75 6.37 5.85 5.24
46 3.53 3.52 3.51 76 6.55 5.96 5.28
47 3.58 3.57 3.55 77 6.74 6.06 5.32
48 3.62 3.61 3.59 78 6.94 6.16 5.35
49 3.67 3.66 3.63 79 7.14 6.25 5.38
50 3.72 3.70 3.68 80 7.34 6.34 5.41
51 3.77 3.75 3.73
52 3.83 3.81 3.78
53 3.89 3.86 3.83
54 3.95 3.92 3.88
OPTION 4. PROCEEDS LEFT AT INTEREST
The proceeds may be left with Us for a period of 1 to 23 years. Interest on the
proceeds will be paid at the rate of 3% compounded annually. The interest may be
left with Us to accumulate or be paid at the following rate for each $1,000 of
net proceeds.
1) Annually $30.00
2) Semiannually $14.89
3) Quarterly $ 7.42
4) Monthly $ 2.47
The payee may withdraw portions of the proceeds by Notifying Us. At the end of
the specified period, any remaining proceeds with accrued interest will be paid
in one sum.
CVIC-1001 29
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
ADMINISTRATIVE OFFICE: 11815 N. PENNSYLVANIA STREET
CARMEL, INDIANA 46032-4555
FLEXIBLE PREMIUM ADJUSTABLE VARIABLE LIFE INSURANCE
PERIOD OF COVERAGE NOT GUARANTEED
CVIC-1001
<PAGE>
INSURED: ISSUE AGE 35
SPOUSE: ISSUE AGE 35
POLICY DATE: 1-1-2001
POLICY DATA PAGE (CONTINUED)
RIDER BENEFIT SCHEDULE
--------------------------------------------------------------------------------
FORM NUMBER BENEFIT DESCRIPTION SPECIFIED MONTHLY EXPIRY DATE
AMOUNT COST OF
INSURANCE
--------------------------------------------------------------------------------
CVIC-3000 NO LAPSE GUARANTEE N/A N/A 1/1/2031
--------------------------------------------------------------------------------
CVIC-3001 ACCELERATED DEATH BENEFIT N/A N/A 1/1/2045
--------------------------------------------------------------------------------
CVIC-3002 LIFE INS. PROTECTION $100,000 ** 1/1/2066
--------------------------------------------------------------------------------
CVIC-3003 SPOUSE RIDER $100,000 ** 1/1/2066
--------------------------------------------------------------------------------
CVIC-3004 CHILDREN'S INSURANCE $10,000 $5.00 ## 1/1/2031
--------------------------------------------------------------------------------
CVIC-3005 UNEMPLOYMENT WAIVER OF COI N/A N/A 1/1/2021
--------------------------------------------------------------------------------
CVIC-3006 WAIVER OF PLANNED N/A $xx.xx 1/1/2026
PERIODIC PREMIUM
Monthly Premium Waived
$---------
Maximum Amount Waived each
Policy Year $25,000
--------------------------------------------------------------------------------
CVIC-3007 ACCIDENTAL DEATH $100,000 ** 1/1/2036
--------------------------------------------------------------------------------
CVIC-3008 EXCHANGE OF INSURED RIDER N/A N/A N/A
--------------------------------------------------------------------------------
CVIC-3009 DISABILITY INCOME
__ MAXIMUM BENEFIT PERIOD N/A $xxx.xx 1/1/2026
__ WAITING PERIOD
$____ MONTHLY BENEFIT
--------------------------------------------------------------------------------
CVIC-3010 GUARANTEED INSURABILITY OPTION N/A $xx.xx 1/1/2006
OPTION DATES:_Age 22, 25, 28,
31, 34, 37 and 40
BENEFIT AMOUNT:$__
--------------------------------------------------------------------------------
CVIC-3012 ESTATE PRESERVATION $5,000 N/A 1/1/2005
--------------------------------------------------------------------------------
CVIC-3013 POLICY SPLIT OPTION N/A $XX.XX 1/1/2046
--------------------------------------------------------------------------------
CVIC-3014 JOINT TERM INS. RIDER $100,000 ** 1/1/2066
--------------------------------------------------------------------------------
CVIC-3015 Reduced Protection Rider N/A N/A N/A
Trigger Year ___
Trigger Level Amount $_____
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
** SEE ATTACHED SCHEDULE
--------------------------------------------------------------------------------
# # THE MONTHLY COST OF INSURANCE RATE IS $.50 PER $1,000
--------------------------------------------------------------------------------
CVIC-1001
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
Service Center: 9735 Landmark Pkwy. Drive, St. Louis, Missouri, 63127-1646
NO LAPSE GUARANTEE RIDER
DEFINITIONS
CONSIDERATION - This rider is part of your policy. It is a nonparticipating
rider and is issued in consideration of an application.
RIDER BENEFIT - This rider provides for a guarantee that the policy will stay in
force if the [30] Year Guarantee Premium Requirement has been met.
During the first [30] policy years, the policy will remain in force if the [30]
Year Guarantee Premium Requirement has been met on each Monthly Anniversary.
[30] YEAR GUARANTEE PREMIUM REQUIREMENT - On each Monthly Anniversary the sum of
all policy premiums paid minus any partial withdrawals, policy loans or
outstanding loan interest must equal or exceed the sum of the [30] Year
Guarantee Premiums required for the number of months the rider has been in
force.
[30] YEAR GUARANTEE PREMIUM - The [30] Year Guarantee Premiums on the effective
date are shown on the Policy Data Page [30] Year Guarantee Minimum Premium
Schedule. Increases or decreases other than those shown on the Policy Data Page,
if any, are based on the riders and benefits attached to the policy on the
effective date and can occur as a result of any one of the following:
1. An increase or decrease in Specified Amount;
2. A change in any Insured's premium class;
3. A change in the cost of any rider attached to the policy;
4. An addition or deletion of any rider; or
5. Change in Death Benefit Option
New Guarantee Premiums are effective on the date the changes occur, and will
remain in effect until changed again. Any changes will be shown on a
supplemental Policy Data Page.
GRACE PERIOD - On a monthly anniversary, if the owner's Cash Surrender Value
does not equal or exceed the monthly deductions, and it does not meet the Death
Benefit Guarantee Rider Premium requirement, then this rider will enter into the
grace period and the following will apply:
1. We will send a written notice before the end of the grace period to the
owner's last known address on record and to any assignee of record if the
premium has not been previously paid, and
2. A grace period of 61 days from mailing of such notice will be allowed to
pay a premium that will cover a monthly deduction.
The rider will remain in force during the grace period, unless the policy is
surrendered.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
COST OF THIS RIDER - There is no cost of insurance for this rider.
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy.
CVIC-3000 1
<PAGE>
TERMINATION - This rider will automatically terminate upon the earliest of the
following:
1. The Insured dies;
2. The [30] Year Guarantee Premium Requirement is not met on any Monthly
Anniversary during the policy years 1 through [30];
3. The end of the [30] guarantee period;
4. The policy terminates for any reason; or
5. The policy is surrendered.
EFFECTIVE DATE - This benefit is effective on the Policy Date shown on the
Policy Data Page of the policy.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3000 2
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
ACCELERATED DEATH BENEFIT RIDER
AN ACCELERATED DEATH BENEFIT RECEIVED UNDER THIS RIDER MAY BE TAXABLE. ADVICE OF
A TAX PROFESSIONAL SHOULD BE SOUGHT PRIOR TO EXERCISING THE RIGHTS UNDER THIS
RIDER.
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application.
RIDER BENEFIT - We will pay an Accelerated Death Benefit to the owner during the
lifetime of the Insured. The benefit will be paid:
1. Upon election of the owner;
2. In lieu of payment of the full death benefit of the policy upon the death
of the Insured; and
3. Subject to the terms of this rider.
QUALIFYING EVENT FOR ACCELERATED BENEFIT - The Qualifying Event for the
Accelerated Death Benefit is the Terminal Illness of the Insured. A Terminal
Illness is an illness:
1. From which the Insured is not expected to recover; and
2. From which the Insured is expected to die within twelve months after the
election of the owner.
REQUESTED PORTION - The Requested Portion is the amount of the policy death
benefit you request. The Requested Portion divided by the Eligible Coverage will
be called the Requested Percentage. The Requested Portion may not exceed the
lesser of:
1. 50% of the Eligible Coverage; or
2. $500,000 for all policies in force with us.
ELIGIBLE COVERAGE - Eligible Coverage is the portion of the policy death benefit
that qualifies for determining the Accelerated Death Benefit amount. The
Eligible Coverage includes:
1. The base policy death benefit; and
2. The death benefit amount of any term rider or term coverage on the Insured
that has at least two years of coverage remaining.
Eligible Coverage does not include:
1. Any insurance provided under the policy on the life of someone other than
the Insured;
2. The specified amount of any scheduled increase(s) in insurance as provided
by an optional benefit rider during the 12-month period from the date you
request acceleration; or
3. Any accidental death benefit.
ACCELERATED AMOUNT - The Accelerated Death Benefit amount will be determined as
of the date we approve your written request. The Accelerated Death Benefit
amount will equal the Requested Portion less the following:
1. An actuarial discount for 12 months interest. This discount reflects the
early payment of the Requested Portion of your policy. The interest used in
the calculation will be as declared by the Board of Directors but not
greater than 6%; and
2. If there is a policy loan on your policy as of the date we approve your
written request, we will reduce the Requested Portion to repay a portion of
the policy loan equal to the Requested Percentage times the policy loan.
3. A reduction to the Requested Portion will be applied to any premium due and
unpaid if the policy has entered the grace period when we approve your
request.
4. An administrative charge not to exceed $150.
CVIV-3001 1
<PAGE>
We will refund the amounts discussed in 1.) and 4.) above should the death of
the Insured occur within 30 days after we pay the Accelerated Death Benefit
amount.
The Accelerated Death Benefit amount may not be less than $5000. The Accelerated
Death Benefit amount will be paid either in a lump sum or under any other
payment plan available at the time the Insured qualifies for payment. We will
pay the Accelerated Death Benefit amount once per Insured. If you choose a
payment plan and the Insured dies before all payments have been made, the
remaining amount will be paid to the beneficiary.
IMPACT OF POLICY - After we pay the Accelerated Death Benefit amount, the policy
and all riders will remain in force, but all of the following will be reduced by
the Requested Percentage:
1. The policy specified amount;
2. Any cash value;
3. Any Accumulation Value;
4. Any term insurance eligible to be accelerated under this rider;
5. Any required premium payments; and
6. If the base policy's Death Benefit Option is C, the specified amount
will further be reduced by:
a the Requested Percentage multiple by the accumulated premium
paid from issue; or
b the date of the last benefit paid under this rider, if
later, paid to current date.
Any policy loan will be reduced as described in the Accelerated Amount section.
Any adjustment in Accumulation Value will be allocated to the Fixed and Separate
Account on a prorata basis. Cost of Insurance Charges will be adjusted to
reflect the reduction in the death benefit.
After the payment of an Accelerated Death Benefit, we will send the owner a
statement showing the effect of the payment on the policy.
ELIGIBILITY - The following conditions must be met prior to the payment of the
Accelerated Benefit amount:
1. The policy and rider must be in force when your request is approved.
2. We must receive written proof satisfactory to us that the Insured is
expected to live 12 months or less from the date of the written
request. A licensed physician, who is not the Insured, the owner, nor
a member of the family of either, must certify to the condition. Such
proof may include clinical, radiological or laboratory evidence. We
reserve the right to obtain a second medical opinion from a physician
of our choice, at our expense.
3. We require written consent from any irrevocable beneficiary and
assignee.
4. Joint life policies will qualify for acceleration only after the death
of one of the Joint Insureds and only if the surviving Insured meets
the requirements for an Accelerated Death Benefit. In the case of
joint life policies, "Insured" in this rider refers to the survivor of
the Joint Insureds under the joint life policy.
5. This benefit is made available to the owner on a voluntary basis. The
owner is not eligible for benefits under this rider if required by law
to use this option to meet the claims of creditors, whether in
bankruptcy or otherwise. The owner is also not eligible for benefits
under this rider if required by a government agency to use this option
in order to apply for, obtain, or keep a government benefit or
entitlement.
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy.
COST OF THIS RIDER - There is no charge for this rider prior to the time that a
benefit is paid under this rider.
CVIV-3001 2
<PAGE>
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. On your written request;
2. On termination of the policy; or
3. When an Accelerated Benefit is paid.
EFFECTIVE DATE - This benefit is effective on the Policy Date shown on the
Policy Data Page of the policy.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3001 3
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
LIFE INSURANCE PROTECTION RIDER
ANNUAL RENEWABLE TERM INSURANCE
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application and payment of the monthly cost of insurance as shown on the
Policy Data Page or supplemental Policy Data Page of the policy.
RIDER DEATH BENEFIT - The Death Benefit amount of this rider is shown on the
Policy Data Page or supplemental Policy Data Page of the policy. We will pay the
Death Benefit amount of this rider upon receipt of due proof of death of the
Insured. Death must occur while the policy and this rider are in force.
BENEFICIARY - The beneficiary of this benefit is the beneficiary of the policy
unless otherwise amended. The benefit will be paid as part of the Death
Proceeds.
COST OF INSURANCE - The cost of insurance of this rider is calculated as (a)
multiplied by (b); where:
(a) is the cost of insurance rate.
(b) is the Death Benefit amount at the beginning of the policy month,
divided by $1,000.
COST OF INSURANCE RATE - The monthly cost of insurance rate for the Death
Benefit amount of this rider is based on the insured's sex, attained Age and
premium class on the effective date of this rider. Attained Age means age on the
prior policy anniversary.
Monthly cost of insurance for any increase in the Death Benefit amount of this
rider is based on the insured's sex, attained Age and premium class on the
effective date of change. Attained Age means age on the prior policy
anniversary.
The cost of insurance rates can never be greater than the rates shown in the
table of Guaranteed Maximum Monthly Cost of Insurance Rates shown on the Policy
Data Page or a supplemental Policy Data Page. These guaranteed rates are based
on the 1980 Commissioner's Standard Ordinary Non-Smoker and Smoker Mortality
Table, Age Last Birthday.
We may change the cost of insurance rates up to the maximum guaranteed amounts
stated in the policy. Changes will be made uniformly by premium class, and will
be based on changes in future expectations for experience.
MONTHLY DEDUCTION - The monthly deduction is the monthly cost of insurance. The
deduction will be made from the Accumulation Value of the policy.
CHANGE IN COVERAGE - Once per policy year after the first policy year, upon
written request, the Death Benefit amount of this rider can be changed subject
to the following conditions, however, no more than one change per year may be
made.
1. Increase in Death Benefit Amount
a. Any increase approved by us will be effective on the date shown on a
supplemental Policy Data Page.
b. A supplemental application must be submitted.
c. Evidence of insurability satisfactory to us must be submitted.
d. The first month's cost of insurance must be paid.
2. Decrease in Death Benefit Amount
a. Any decrease will be effective on the monthly anniversary date on or
next following receipt of the request by us. We will furnish a
supplemental Policy Data Page that reflects the decrease to the Owner.
b. The amount may not be decreased to less than $10,000.
c. Any decrease will first be applied to the most recent increase in
amount. It then will be applied to other increases in reverse order in
which they occurred and then to the original amount.
CVIC-3003 1
<PAGE>
ERROR IN AGE OR SEX - If the Insured's Age or sex has been misstated on the
application or supplemental application, we will adjust the Death Benefit
provided by this rider. The Death Benefit amount of this rider will be changed
to that which the most recent monthly deduction would have purchased at the
correct Age and sex.
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy.
SUICIDE - If the Insured commits suicide, while sane or insane, within two years
after the date of issue of this rider, the amount payable by us will be limited
to the cost of the rider.
If the Insured commits suicide, while sane or insane, within two years after the
date of issue of an increase in the Death Benefit amount of this rider, the
amount payable by us will be limited to the cost of insurance for such increased
amount.
INCONTESTABILITY - This rider will be incontestable after it has been in force
two years from its date of issue.
For any benefit increase, the two-year period will begin on the effective date
of the increase.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. when the policy terminates;
2. on the monthly anniversary day on or next following receipt of a written
request;
3. when the Insured under this rider attains Age 100; or
4. upon the death of the Insured.
EFFECTIVE DATE - This benefit is effective on the Policy Date, unless a
different date is shown on a supplemental Policy Data Page.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3003 2
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
SPOUSE RIDER LEVEL TERM INSURANCE RIDER
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application and payment of the monthly cost of insurance as shown on the
Policy Data Page or supplemental Policy Data Page of the policy.
RIDER DEATH BENEFIT - The Death Benefit amount of this rider is shown on the
Policy Data Page or supplemental Policy Data Page of the policy. We will pay the
Death Benefit amount of this rider upon receipt of due proof of death of the
spouse. Death must occur while the policy and this rider are in force.
SPOUSE - The spouse is identified in the application or supplemental application
which is attached to the policy.
BENEFICIARY - The Insured will receive the proceeds of this rider upon death of
the spouse, unless otherwise amended.
COST OF INSURANCE - The cost of insurance of this rider is calculated as (a)
multiplied by (b); where:
(a) is the cost of insurance rate.
(b) is the Death Benefit amount at the beginning of the policy month,
divided by $1,000.
COST OF INSURANCE RATE - The monthly cost of insurance rate for the Death
Benefit amount of this rider is based on the spouse's sex, attained Age and
premium class on the effective date of this rider. Attained Age means age on the
prior policy anniversary.
The monthly cost of insurance for any increase in the Death Benefit amount of
this rider is based on the spouse's sex, attained Age and premium class on the
effective date of change. Attained Age means age on the prior policy
anniversary.
The guaranteed maximum monthly cost of insurance rates for this rider are shown
in the Spouse Rider Schedule on the Policy Data Page or supplemental Policy Data
Page of the policy. The guaranteed maximum monthly cost of insurance rates are
based on the Commissioner's 1980 Standard Ordinary Mortality Table, Age Last
Birthday.
We may change the cost of insurance rates up to the maximum guaranteed amounts
stated in the policy. Changes will be made uniformly by premium class, and will
be based on changes in future expectations for experience.
MONTHLY DEDUCTION - The monthly deduction is the monthly cost of insurance. The
deduction will be made from the Accumulation Value of the policy.
CHANGE IN COVERAGE - Once per policy year after the first policy year, upon
written request, the Death Benefit amount of this rider can be changed subject
to the following conditions; however, no more than one change per policy year
may be made.
1. Increase in Death Benefit Amount
a. Any increase approved by us will be effective on the date shown on a
supplemental Policy Data Page.
b. A supplemental application must be submitted.
c. Evidence of insurability of the spouse satisfactory to us must be
submitted.
d. The first month's cost of insurance must be paid.
2. Decrease in Death Benefit Amount
a. Any decrease will be effective on the monthly anniversary date on or
next following receipt of the request by us. We will furnish a
supplemental Policy Data Page that reflects the decrease to the Owner.
b. The amount may not be decreased to less than $10,000.
c. Any decrease will first be applied to the most recent increase in
amount. It then will be applied to other increases in reverse order in
which they occurred; then to the original amount.
CVIC-3003 1
<PAGE>
ERROR IN AGE OR SEX - If the Spouse's age or sex has been misstated on the
application or supplemental application, we will adjust the Death Benefit
provided by this rider. The Death Benefit amount of this rider will be changed
to that which the most recent monthly deduction would have purchased at the
correct Age or sex.
CONVERSION - Upon the death of the Insured under the policy, the coverage under
this rider may be converted. The new policy may be on any permanent life
insurance policy issued by us or an affiliate at the time of conversion; and for
an amount not more than the amount of this rider. The premium rate for the new
policy will be the rate in effect on the conversion date. The rate will be based
on the spouse's sex and attained Age on the conversion date and premium class on
the effective date of this rider. No evidence of insurability will be required.
The suicide and contestable periods of the new policy will not start anew on the
new permanent life insurance policy.
Conversion will be made upon receipt of written request and payment of the first
premium on the new policy.
Waiver of Premium for Total and Permanent Disability and/or Accidental Death
Benefits may be included in the new policy only with our consent.
SUICIDE OF SPOUSE - If the spouse commits suicide, while sane or insane, within
two years of the date of issue of this rider, the amount payable by us will be
limited to the cost of the rider.
If the spouse commits suicide, while sane or insane, within two years after the
date of issue of an increase in the Death Benefit amount of this rider, the
amount payable by us will be limited to the cost of insurance for such increased
amount.
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy. We may require evidence of insurability of the spouse.
INCONTESTABILITY - This rider will be incontestable after it has been in force
two years from its date of issue.
For any benefit increase, the two-year period will begin on the effective date
of the increase.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. when the policy terminates;
2. on the monthly anniversary day on or next following receipt of a written
request;
3. when the spouse dies;
4. when the Insured is age 100; or
5. when the spouse is age 100.
EFFECTIVE DATE - This benefit is effective on the Policy Date, unless a
different date is shown on a supplemental Policy Data Page.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3003 2
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
CHILDREN'S LEVEL TERM INSURANCE RIDER
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application and payment of the monthly cost of insurance as shown on the
Policy Data Page or supplemental Policy Data Page of the policy.
RIDER DEATH BENEFIT - The Death Benefit amount of this rider is shown on the
Policy Data Page or supplemental Policy Data Page of the policy. We will pay the
Death Benefit amount of this rider upon receipt of due proof of death of the
covered child. Death must occur before the policy anniversary on which such
child is 25 years of age and while the policy and rider are in force.
COVERED CHILD - A covered child means the Insured's child, stepchild or legally
adopted child, who is at least 15 days old; and
(a) is named in the application and has not reached the age of 18 on the
date of application; or
(b) is born to the Insured after the date of application; or
(c) is legally adopted by the Insured after the date of application but
before the age of 18.
Coverage for each covered child terminates on the policy anniversary on which
the covered child turns age 25.
BENEFICIARY - The Insured will receive the proceeds of this rider upon death of
the covered child, unless otherwise amended.
COST OF INSURANCE - The cost of insurance of this rider is calculated as (a),
multiplied by (b); where:
(a) is the cost of insurance rate.
(b) is the Death Benefit amount at the beginning of the policy month,
divided by $1,000.
COST OF INSURANCE RATE - The cost of insurance rate for this rider is shown on
the Policy Data Page or supplemental Policy Data Page.
MONTHLY DEDUCTION - The monthly deduction is the monthly cost of insurance. The
deduction will be made from the Accumulation Value of the policy.
CHANGE IN COVERAGE - Once per policy year after the first policy year, upon
written request, the death benefit amount of this rider can be change subject to
the following conditions, however, no more than one change per policy year may
be made.
1. Increase in Death Benefit Amount
a) Any increase approved by us will be effective on the date shown
on a supplemental Policy Data Page.
b) The amount may not be changed to more than $10,000.
c) A supplemental application must be submitted.
d) Evidence of insurability satisfactory to us must be submitted.
e) The first month's cost of insurance must be paid.
2. Decrease in Death Benefit Amount
a) Any decrease will be effective on the monthly anniversary date on
or next following receipt of the request by us. We will furnish a
supplemental Policy Data Page that reflects the decrease to the
Owner.
b) The amount may not be decreased to less than $1,000.
c) A decrease will first be applied to the most recent increase in
amount. It then will be applied to other increases in the reverse
order in which they occurred; then to the original amount.
CONVERSION - The insurance on a covered child may be converted either on the
policy anniversary on which the Insured is age 65, or the child is age 25,
whichever is earlier. The amount converted, without evidence of insurability,
may not be more than five times the amount of this rider. The new policy may be
on any permanent life insurance policy issued by us or an affiliate at the time
of conversion. The premium rate for the new policy will be the rate in effect on
the conversion date. The rate will be based on the child's attained age on the
conversion date and on the sex and premium class on the effective date of this
rider. The suicide and contestable periods of the new policy will be measured
from the Effective Date of this rider.
Conversion will be made upon receipt of written request and payment of the first
premium on the new policy.
CVIC-3004 1
<PAGE>
Waiver of Premium for Total and Permanent Disability and/or Accidental Death
Benefits may be included in the new policy only with our consent.
DEATH OF INSURED - Upon the death of the Insured, while this benefit is in
force, we will issue a paid-up policy, issued by us or an affiliate, on the life
of any covered child. The amount of coverage will be the same as under this
benefit. The policy shall continue until the earlier of the covered child's 25th
birthday or the Policy Anniversary following what would have been the Insured's
65th birthday. The paid-up policy shall be incontestable. It shall be owned and
controlled by the covered child or, during any period of legal incapacity, by
such covered child's legally appointed guardian.
Paid-up insurance may be surrendered at any time for its cash value. The amounts
of these cash values will be furnished on request. Paid-up term insurance has no
loan value.
SUICIDE OF COVERED CHILD - If a covered child commits suicide, while sane or
insane, within two years of the effective date of coverage or effective date of
an increase, the death benefit will not be payable.
INCONTESTABILITY - This rider will be incontestable after it has been in force
two years from its date of issue. For any benefit increase, the two-year period
will begin on the effective date of the increase.
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy. We may require evidence of insurability for each covered child.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. the policy anniversary on which the Insured is age 65;
2. on the monthly anniversary day on or next following receipt of a
written request; or
3. when the policy terminates.
EFFECTIVE DATE - This benefit is effective on the Policy Date, unless a
different date is shown on a supplemental Policy Data Page.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3004 2
<PAGE>
CONSECO VARIABLE LIFE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
UNEMPLOYMENT WAIVER OF COST OF INSURANCE RIDER
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application.
RIDER BENEFIT - During a period of unemployment, we will credit to this policy,
beginning on the monthly date next following ninety days of unemployment, an
amount equal to the total monthly deduction for the policy as well as the
monthly deductions for any attached riders.
We will not begin benefits until we have received written notification of the
onset of unemployment and have received satisfactory proof of unemployment. We
must receive written notification that the Insured is unemployed during the
first ninety days of unemployment or as soon after as reasonably possible.
BENEFIT PERIOD - The maximum benefit period for each period of unemployment is
three months. At least one year must separate each period of unemployment. The
maximum lifetime benefit is an accumulation of twelve months.
UNEMPLOYMENT - The Insured is considered unemployed if:
1. The Insured is unemployed for ninety consecutive days; and
2. The Insured has been paid unemployment compensation by his or her
state of residence during the period of unemployment; and
3. The period of unemployment begins six months after the effective date
of this rider.
PROOF OF UNEMPLOYMENT - Unless it is not possible to send proof earlier, we must
receive proof of unemployment:
1. Within one year after notice of unemployment; and
2. During the lifetime of the Insured; and
3. During the continuance of the employment.
TERMINATION OF BENEFITS - We will stop crediting the total monthly deduction
when:
1. The Insured is no longer unemployed; or
2. After the rider has terminated; or
3. The maximum benefit period for current period of unemployment has been
reached.
TERMINATION OF RIDER - This rider terminates on the occurrence of the first of
the following events:
1. The policy anniversary after the Insured attains age 55; or
2. The monthly anniversary day on or next following receipt of a written
request; or
3. When the maximum lifetime benefit for this rider has been paid; or
4. When the policy terminates.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
REINSTATEMENT - The policy to which this rider is attached may be reinstated
with or without this rider. The Company has the right to decide whether to
approve reinstatement of the policy with or without this rider.
COST OF THIS RIDER - There is no charge for this rider.
EFFECTIVE DATE - This benefit is effective on the Policy Date shown on the
Policy Data Page of this policy.
/s/ Illegible
-------------
President
CVIC-3005 2
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
WAIVER OF PLANNED PERIODIC PREMIUM RIDER
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application and payment of the monthly cost of insurance as shown on the
Policy Data Page of the policy.
RIDER BENEFIT - We will waive the planned periodic premium ("premium") for the
policy if:
1. the Insured becomes totally disabled on or before the Policy
Anniversary falling on or next following his 60th birthday;
2. the Insured becomes totally disabled while this rider is in force; and
3. the total disability lasts for at least six (6) months.
After the total disability has continued for six (6) months and the claim is
approved under this rider:
1. Premiums will be waived from the date the total disability began for
as long as it continues, or until the rider terminates, as outlined
below under Termination of Rider.
2. Premiums will be waived on a monthly basis. The monthly premium to be
waived is shown on the Policy Data Page at the time of issue of the
policy. Changes in the premium subsequent to the date of issue will
not affect the benefit provided by this rider.
3. The total amount waived each Policy Year may not exceed the maximum
amount shown on the Policy Data Page.
4. The amount of each waived premium will be credited to the Accumulation
Value of the policy. The monthly deductions will continue to be made.
5. Any actual premium paid during the first six (6) months of total
disability that is eligible for waiver will be refunded.
TOTAL DISABILITY DEFINITION - For the first 24 months of disability, total
disability means the Insured is completely unable as a result of injury or
sickness to perform the main duties of the occupation or service in which the
Insured worked when he or she became disabled. After 24 months of disability,
total disability means the Insured's complete inability to engage in any
occupation for which he or she is reasonably fitted by education, training or
experience.
NOTICE AND PROOF OF TOTAL DISABILITY - We must receive notice and proof of the
Insured's total disability at our Service Center:
1. During the Insured's life;
2. During the period of that total disability; and
3. Within one year after the beginning of total disability.
Failure to give notice and proof within the time required will not invalidate a
claim if the notice and proof were given as soon as was reasonably possible.
Proof of continuance of total disability must be provided as often as we
reasonably require. After the first two years of continuous total disability,
proof will not be required more than once a year. We may require the Insured to
be examined by physicians approved by us as part of any proof. The Waiver of
Planned Periodic Premium benefit will end if proof is not furnished when
required.
EXCLUSIONS - No benefit will be paid if total disability results from any of the
following causes:
1. intentionally self-inflicted injury;
2. war, or act or war, whether or not the Insured is in military service.
Act of war includes any act related to military operations in time of
war, whether declared or undeclared;
CVIC-3006 1
<PAGE>
NOTICE OF RECOVERY - The Owner shall give immediate notice to us when the
Insured recovers from Total Disability.
MONTHLY DEDUCTION - The monthly deduction is the monthly cost of insurance. The
deduction will be made from the Accumulation Value of the policy.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. when the policy terminates;
2. the monthly anniversary day on or next following receipt of a written
request;
3. on the Policy Anniversary falling on or directly following
the Insured's 60th birthday unless he is totally disabled; or
4. if totally disabled at Insured's Age 60, the earlier of:
a) the end of disability; or
b) the Policy Anniversary falling on or directly following the
Insured's 65th birthday.
EFFECTIVE DATE - This benefit is effective on the Policy Date shown on the
Policy Data Page of the policy.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3006 2
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
ACCIDENTAL DEATH BENEFIT RIDER
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application and payment of the monthly cost of insurance as shown on the
Policy Data Page.
RIDER DEATH BENEFIT - The Death Benefit amount of this rider is shown on the
Policy Data Page or supplemental Policy Data Page. We will pay the Accidental
Death Benefit amount of this rider upon receipt of due proof of death of the
Insured. The Insured's death must have:
1. resulted, directly and independently of all other causes, from an
injury caused by an accident within 90 days after such injury; and
2. occurred while the policy and rider were in force.
EXCLUSIONS - This benefit will not be paid if the Insured's death resulted from
any of the following causes:
1. intentionally self-inflicted injury; or suicide, while sane or insane;
2. bodily or mental infirmity or disease;
3. medical or surgical treatment, except such treatment required as a
result of an accident;
4. an act or incident of war, declared or undeclared;
5. riding in or descending from any kind of aircraft if the Insured:
a) was a pilot, officer or member of the crew of such aircraft;
b) was giving or receiving any kind of instruction or training; or
c) had any duties relating to such aircraft in flight or it was
flown for the purpose of descent from such aircraft in flight;
6. commission of an assault or felony; or
7. voluntarily taking of any drug, medication or sedative unless taken as
prescribed by a physician.
AUTOPSY - If it is permitted in the state where the policy is issued, we have
the right to examine the Insured's body or perform an autopsy. Such exam or
autopsy will be done at our expense.
BENEFICIARY - The beneficiary of this benefit is the beneficiary of the policy
unless otherwise amended. This benefit will be paid as part of the Death
Proceeds.
COST OF THIS RIDER - The monthly cost of this rider is shown in the Accidental
Death Benefit Rider Schedule on the Policy Data Page or supplemental Policy Data
Page.
CHANGE IN COVERAGE - Any time after the first policy year, upon written request,
the death benefit amount of this rider can be changed subject to the following
conditions.
1. Increase in Death Benefit Amount
a) Any increase approved by us will be effective on the date shown
on a supplemental Policy Data Page.
b) The new amount may not exceed the current death benefit of the
policy.
c) A supplemental application must be submitted.
d) Evidence of insurability of the Insured satisfactory to us must
be submitted.
e) The first month's cost of insurance must be paid.
2. Decrease in Death Benefit Amount
a) Any decrease will be effective on the monthly anniversary date on
or next following receipt of the request by us. We will furnish
an endorsement and supplemental Policy Data Page that reflects
the decrease to the Owner.
b) A decrease will first be applied to the most recent increase in
amount. It then will be applied to other increases in the reverse
order in which they occurred; then to the original amount.
INCONTESTABILITY - Any benefit increase will be incontestability after it has
been in force two years from the effective date of the increase.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
CVIC-3007 1
<PAGE>
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
be reinstated if the policy is reinstated. The requirements for reinstatement of
this rider are the same as those for reinstatement of the policy.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. the policy anniversary on which the Insured is age 70;
2. the monthly anniversary day on or next following receipt of a
written request; or
3. when the policy terminates.
EFFECTIVE DATE - This benefit is effective on the Policy Date shown on the
Policy Data Page of this policy.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3007 2
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
EXCHANGE OF INSURED RIDER
EXERCISE OF THE EXCHANGE OF INSURED RIDER IS TREATED AS AN EXCHANGE OF COVERAGE,
WHICH FOR TAX PURPOSES IS NOT A TAX-FREE EXCHANGE UNDER CURRENT LAW. ADVICE OF A
TAX PROFESSIONAL SHOULD BE SOUGHT PRIOR TO EXERCISING THE RIGHTS UNDER THIS
RIDER.
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of the application.
RIDER BENEFIT - The named Insured on this policy may be exchanged for a new
Insured, subject to the following conditions:
1. At the time of exchange, the new Insured must have the same business
relationship to the Owner as did the Insured in this policy.
2. The exchange must occur within one year following the termination of
the business relationship which existed between the Owner and the
named Insured at the time that the policy was issued.
3. The new Insured must submit evidence of insurability satisfactory to
us.
4. The policy must be in force and not be in a grace period at the time
of exchange.
5. The Owner must make written application for the exchange.
NEW POLICY - Coverage on the new Insured will become effective on the exchange
date. Coverage on the previous named Insured will terminate on the day before
the exchange date. The exchange date is the first Monthly Anniversary Day on or
next following the date we approve the exchange.
The Policy Date will not be changed unless the new Insured was born after the
Policy Date. In that case, the Policy Date will be the Policy Anniversary on or
next following the birthdate of the Insured.
The policy charges for the new Insured will reflect the new Insured's attained
Age, sex and premium class.
The Specified Amount of the policy will be as stated by the Owner in the
application for exchange subject to the following conditions:
1. The Specified Amount must be such that the new policy will satisfy all
requirements imposed by the Securities and Exchange Commission.
2. The Specified Amount must be such that the new policy still satisfies
the definition of life insurance.
3. The Specified Amount must satisfy policy minimums.
SUICIDE - If the new Insured commits suicide, while sane or insane, within two
years of the exchange date, we will not pay the Death Benefit. Instead, we will
pay an amount equal to the Cash Value as of the exchange date, plus the sum of
premiums paid since the exchange date, less any outstanding loan, loan interest,
any partial withdrawals and the cost of insurance of any riders.
INCONTESTABILITY - We will not contest this policy after it has been in force
during the new Insured's lifetime for two years from the exchange date.
REINSTATEMENT - The policy to which this rider is attached may be reinstated
with or without this rider. The Company has the right to decide whether to
approve reinstatement of the policy with or without this rider.
COST OF THIS RIDER - There is no charge for this rider.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
EFFECTIVE DATE - This benefit is effective on the Policy Date shown on the
policy Data Page of this policy.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3008
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
DISABILITY INCOME INSURANCE RIDER
CONSIDERATION - This rider is issued in consideration of an application and the
payment of the monthly cost of insurance, which is shown on the Policy Data
Page.
RIDER BENEFIT - We will pay a Monthly Benefit, as provided by this rider, for
each month that the Insured is Totally Disabled if:
1. the Insured becomes Totally Disability on or before the Policy
Anniversary falling on or next following this 65th birthday;
2. The Insured becomes Totally Disabled while this rider is in force;
3. The Total Disability lasts beyond the Waiting Period; and
4. The Maximum Benefit Period for a single period of disability has not
been exceeded.
MONTHLY BENEFIT - We will not begin Monthly Benefits until:
1. We have received written notification within thirty days of the onset
of Total Disability; and
2. We have received satisfactory proof of loss within ninety days after
the beginning of a period of disability for which benefits are
claimed.
If the Insured is legally incapacitated, these requirements will be waived.
After the Total Disability has continued beyond the Waiting Period and the claim
is approved under this rider:
1. We will begin payment of the Monthly Benefit due.
2. Periodic payments for continuing loss will be made on a monthly basis.
3. For any partial month we will pay 1/30th of the Monthly Benefit for
each consecutive day the Insured is Totally Disabled. We reserve the
right to require an examination of the Insured by a Physician of our
choice at our expense. Frequency of the examinations will not be more
than is reasonably needed.
BENEFIT PERIOD - The Maximum Benefit Period and Waiting Period for a single
period of Total Disability appear on the Policy Data Page. We will consider
successive periods of Total Disability as a single period unless:
1. The Insured has resumed an occupation for wage or profit for a
continuous period of four months, or
2. The subsequent period of Total Disability results from an unrelated
cause.
EXCLUSIONS- No Monthly Benefit will be paid if Total Disability results from any
of the following causes:
1. War, any act of war, declared or undeclared, or fulltime service in
the military, naval or air forces of any country. Periods of military
training of not more than 30 days will not be considered fulltime
military service. Upon written notice, we will refund any premium paid
for a period, which is not covered due to fulltime military service.
2. Any intentional self-inflicted Injury, while sane or insane.
3. The Insured's attempt or commission of assault or felony or engaging
in an illegal activity.
4. Operating, riding and/or descending from any kind of aircraft if the
Insured:
a. is a pilot, officer or member of the crew; or
b. is being flown for the purpose of descent from such aircraft
while in flight; or
c. is giving or receiving any kind of training or instructions; or
d. has any duty aboard such aircraft.
5. Normal pregnancy, childbirth or voluntary abortion. Complications of
pregnancy are covered.
6. Any Pre-existing Condition that reoccurs within two years of the rider
effective date unless the condition was disclosed on the application
for this rider and it was not excluded by name or specific condition.
CVIC-3009 1
<PAGE>
TERMINATION OF BENEFITS - We will stop paying benefits on the occurrence of the
first of the following events:
1. The Insured is no longer continuously Totally Disabled; or
2. The Maximum Benefit Period for a single period of disability has been
paid; or
3. The rider has been terminated; or
4. The Insured dies.
TERMINATION OF RIDER - This rider terminates on the occurrence of the first of
the following events:
1. On the monthly anniversary day that falls on or next follows the
Insured's 65th birthday; however, such termination will not affect an
eligible claim for disability occurring before age 65;
2. If you request in writing to terminate this rider;
3. At the end of the grace period for any unpaid premium for this rider;
4. When the policy terminates.
MONTHLY DEDUCTION - The monthly deduction is the monthly cost of insurance. The
deduction will be made from the Accumulation Value of the policy.
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy. If this rider is reinstated, it will cover only Injury occurring or
Sickness first manifesting itself after the date of reinstatement. The rights of
the Insured and us will be as they were before the reinstatement unless an
exclusion is placed on the rider as a condition of reinstatement. The effective
date of the reinstated rider will be the monthly anniversary day on or next
following the date we approve the application for reinstatement.
DEFINITIONS - Defined terms are capitalized throughout this rider.
PRE-EXISTING CONDITION - A Pre-Existing Condition will be considered as follows:
1. A Sickness or Injury for which the Insured received advice or
treatment from a Physician within two years before the rider effective
date; or
2. The existence of symptoms within two years before the rider effective
date which would cause an ordinary prudent person to seek diagnosis,
care or treatment from a Physician.
PHYSICIAN - A licensed practitioner of the healing arts acting within the scope
of his or her license. The Physician may not be the Insured or a member of the
Insured's family
INJURY - An accidental bodily injury that occurs while this rider is in force.
SICKNESS - An illness or Injury which first manifests itself while this rider is
in force.
TOTAL DISABILITY OR TOTALLY DISABLED - An Insured is considered Totally Disabled
when due to Injury or Sickness the Insured is:
1. Under the regular care of a Physician; and
2. Unable to engage in the substantial and material duties of any
occupation for wage or profit for which he or she is qualified by
education, training or prior experience.
A period of Total Disability due to more than one cause will be considered as a
single period of Total Disability.
WAITING PERIOD - The period of time at the beginning of a continuous Total
Disability for which no Monthly Benefits are payable. The Waiting Period length
of time is shown on the Policy Data Page of the policy.
CVIC-3009
2
<PAGE>
MAXIMUM BENEFIT PERIOD - During a single period of Total Disability, the maximum
length of time Monthly Benefits may be payable. The length of time for the
Maximum Benefit Period is shown on the Policy Data Page of the policy.
MONTHLY BENEFIT - The amount we will pay for each month of Total Disability.
This amount is shown on the Policy Data Page of the policy.
GENERAL PROVISIONS - This rider is subject to all of the provisions and
conditions of this policy, which are not in conflict with the terms of this
rider.
EFFECTIVE DATE - This benefit is effective on the Policy Date shown on the
Policy Data Page of the policy.
This rider is signed or Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3009 3
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
GUARANTEED INSURABILITY RIDER
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application and the payment of the monthly cost of insurance, which is
shown on the Policy Data Page.
BENEFIT - The Owner may, without providing evidence of insurability, increase
the Specified Amount of this policy on each option date shown on the Policy Data
Page. To do this, the Owner must send a written request to us: (1) while the
rider is in effect; (2) during the Insured's lifetime; and (3) within 31 days of
the Option Date.
AMOUNT OF INCREASE - The amount of each increase is limited to the rider
benefit, which is shown on the Policy Data Page. The increase will be effective
on the option date if the Insured is then living.
OPTION DATE ADVANCEMENT PRIVILEGE - You may advance the next available option
date to any date you state following the Insured's marriage or the birth of any
child of the Insured. Birth includes legal adoption. The date you state will be
an option date and will replace and cancel the option date so advanced.
REINSTATEMENT - If the policy and rider lapse, the Owner can reinstate this
rider prior to its expiration date at the same time the policy is reinstated. We
will however, require acceptable proof of insurability on the Insured.
MONTHLY DEDUCTION - The monthly deduction is the monthly cost of insurance. The
deduction will be made from the Accumulation Value of the policy.
TERMINATION - This rider will terminate upon the earliest of the date:
1. The date this policy terminates.
2. The date of death of the Insured.
3. The receipt of a request from the Owner to terminate this rider; or.
4. The expiry date as shown on the Policy Data Page.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
EFFECTIVE DATE - This benefit is effective on the Policy Date shown on the
Policy Data Page of this policy.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3010
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
ESTATE PRESERVATION RIDER
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application.
RIDER BENEFIT - Upon receipt of due proof that both Insureds died while this
rider is in force and prior to the expiry date of this rider, we will pay in
addition to the death benefit payable under the policy to which this rider is
attached, an amount equal to this rider benefit amount.
The rider benefit amount and the expiry date of this rider are indicated on the
Policy Data Page.
COST OF THIS RIDER - There is no charge for this rider.
BENEFICIARY - The beneficiary for this rider will be the same as the policy to
which this rider is attached.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. When the policy terminates.
2. On the death of both Insureds.
3. On the monthly anniversary day on or next following receipt of a
written request.
4. Upon the expiration date of this rider, as shown on the Policy Data
Page.
REINSTATEMENT - If the policy and this rider lapse, You can reinstate this rider
prior to its expiration date at the same time the policy is reinstated. We will
however, require acceptable proof of insurability on both Joint Insureds.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
EFFECTIVE DATE - This benefit is effective on the Policy Date shown on the
Policy Data Page of this policy.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3012
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
POLICY SPLIT OPTION RIDER
EXERCISE OF THE POLICY SPLIT OPTION WILL INITIATE A REPORTABLE,
TAXABLE EVENT UNDER CURRENT LAW.
ADVICE OF A TAX PROFESSIONAL SHOULD BE SOUGHT
PRIOR TO EXERCISING THE RIGHTS UNDER THIS RIDER.
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application and the payment of the monthly cost of insurance, which is
shown on the Policy Data Page.
RIDER BENEFIT - This rider provides you with an option to surrender this policy
in exchange for separate individual policies on the life of each Insured.
Evidence of insurability will not be required when exercising this option. This
option must be exercised within 180 days after the occurrence of one of the
contingent events listed below.
CONTINGENT EVENTS - The contingent events for exercising this option are as
follows:
1. A final annulment, dissolution, or divorce decree with respect to the
Insureds; or
2. The Federal Estate Tax Martial Deduction is reduced; or
3. The maximum Federal Estate Tax rate is reduced to below 25%.
TERMS OF EXCHANGE - The terms for exercising this option are as follows:
1. This policy and this rider must be in force.
2. A written request in a form satisfactory to us must be received by us
within 180 days of the contingent event under which the option is
being exercised.
3. The exchange must be to a single life flexible premium adjustable
variable life insurance policy, with the same date of issue and issue
age as the original joint life policy.
4. The face amount for each new policy may be up to 50% of the then
current Specified Amount of this policy. The Accumulation Value of the
joint life policy is allocated to the new policies in proportion to
the Specified Amounts. Loans on the joint life policy are allocated to
the new policies in proportion to the Specified Amounts.
5. The new policies will be based on the same premium classification most
recently determined for each Insured under the original policy.
6. Any optional benefits may be attached to the new policies only with
our consent.
MONTHLY DEDUCTION - The monthly deduction is the monthly cost of insurance. The
deduction will be made from the Accumulation Value of the policy.
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. When the policy terminates.
2. The death of the first Insured to die.
3. On the date the policy exchange option provided in this rider is
exercised.
4. On the expiry date shown on the Policy Data Page of the policy.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
EFFECTIVE DATE - This benefit is effective on the Policy Date Shown on the
Policy Data Page of this policy.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3013
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
JOINT TERM INSURANCE RIDER
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application and payment of the monthly cost of insurance as shown on the
Policy Data Page or supplemental Policy Data Page.
RIDER BENEFIT - Upon receipt of due proof of death of the Joint Insureds while
the policy and this rider were in force and before the expiry date of this
rider, we will pay the beneficiary upon the second death the Death Benefit
amount of this rider.
The Death Benefit amount of this rider and the expiry date of this rider are
indicated on the Policy Data Page.
COST OF INSURANCE - The cost of insurance of this rider is calculated as (a)
multiplied by (b); where:
(a) is the cost of insurance rate.
(b) Is the Death Benefit amount at the beginning of the policy month,
divided by $1,000.
COST OF INSURANCE RATE - The monthly cost of insurance rate for the Death
Benefit amount of this rider is based on the sexes, exact ages and premium
classes of the insureds on the effective date of this rider.
The monthly cost of insurance for any increase in the Death Benefit amount of
this rider is based on the sexes, exact ages and premium classes of the insureds
on the effective date of change.
The cost of insurance rates can never be greater than the rates shown in the
policy Table of Guaranteed Maximum Monthly Cost of Insurance Rates shown on the
Policy Data Page or a supplemental Policy Data Page. These guaranteed rates are
based on the 1980 Commissioner's Standard Ordinary Male Smoker or Nonsmoker and
Female Smoker or Nonsmoker Tables, as appropriate, for the Joint Insured's exact
ages as of the last policy anniversary.
We may change the cost of insurance rates up to the maximum guaranteed amounts
stated in the policy. Changes will be made uniformly by premium class, and will
be based on changes in future expectations for experience.
MONTHLY DEDUCTION - The monthly deduction is the monthly cost of insurance. The
deduction will be made from the Accumulation Value of the policy.
CHANGE IN COVERAGE - Once per policy year after the first policy year, upon
written request, the Death Benefit amount of this rider can be changed subject
to the following conditions, however, no more than one change per year may be
made.
1. Increase in Death Benefit Amount
a. Any increase approved by us will be effective on the date shown
on a supplemental Policy Data Page.
b. A supplemental application must be submitted.
c. Evidence of insurability satisfactory to us must be submitted.
d. The first month's cost of insurance must be paid.
2. Decrease in Death Benefit Amount
a. Any decrease will be effective on the monthly anniversary date on
or next following receipt of the request by us. We will furnish a
supplemental Policy Data Page that reflects the decrease to the
Owner.
b. The amount may not be decreased to less than $250,000.
CVIC-3014 1
<PAGE>
c. Any decrease will first be applied to the most recent increase in
amount. It then will be applied to other increases in reverse
order in which they occurred and then to the original amount.
ERROR IN AGE OR SEX - If either Insured's Age or sex has been misstated on the
application or supplemental application, we will adjust the Death Benefit
provided by this rider. The Death Benefit amount of this rider will be changed
to that which the most recent monthly deduction would have purchased at the
Insureds' correct Age or sex.
BENEFICIARY - The beneficiary for this rider will be the same as the policy to
which this rider is attached.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. When the policy terminates.
2. On the death of both Joint Insureds.
3. On the monthly anniversary day on or next following receipt of a
written request.
4. Upon the expiration date of this rider, as shown on the Policy Data
Page.
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy.
SUICIDE - If either Insured commits suicide, while sane or insane, within two
years after the date of issue of this rider, the amount payable by us will be
limited to the cost of the rider.
If either Insured commits suicide, while sane or insane, within two years after
the date of issue of an increase in the Death Benefit amount of this rider, the
amount payable by us will be limited to the cost of insurance for such increased
amount.
INCONTESTABILITY - This rider will be incontestable after it has been in force
two years from its date of issue.
For any benefit increase, the two-year period will begin on the effective date
of the increase.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
EFFECTIVE DATE - This benefit is effective on the Policy Date, unless a
different date is shown on a supplemental Policy Data Page.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3014 2
<PAGE>
CONSECO VARIABLE INSURANCE COMPANY
SERVICE CENTER: 9735 LANDMARK PKWY. DRIVE, ST. LOUIS, MISSOURI 63127-1646
REDUCED PROTECTION RIDER
CONSIDERATION - This rider is part of your policy. It is issued in consideration
of an application.
RIDER BENEFIT - This rider provides you with an option to convert this policy to
a paid-up policy subject to the contingent events listed below. Evidence of
insurability will not be required when exercising this option. This option will
be automatically exercised unless you cancel this rider prior to exercise or
reject the conversion in writing.
CONTINGENT EVENTS - The contingent events for exercising this option are as
follows:
1. The policy is at least in the Trigger Year. The Trigger Year is the
first year that the policy is eligible for conversion under the terms
of this rider. The Trigger Year is shown on the Policy Data Page of
the policy.
2. It has been at least the Trigger Year number of years since the last
specified amount increase.
3. The policy's Cash Surrender Value on a monthly anniversary is below
the Trigger Level amount. The Trigger Level is the Cash Surrender
Value amount you elect. The Trigger Level amount is shown on the
Policy Data Page or Supplemental Data Page.
4. The policy has a positive balance in the Loan Account.
TERMS OF CONVERSION - The terms for exercising this option are as follows:
1. This policy and this rider must be in force.
2. The exchange will be to a paid-up policy, issued on a form approved
and in use by an affiliate or us at the time of conversion.
3. The converted policy will comply with Internal Revenue Code Section
7702.
4. Loans on the paid-up policy will be granted by the same conditions of
this policy.
5. Loans on the paid-up policy will have the same net provisions as the
policy.
6. Outstanding loans of the policy will transfer to the paid-up policy.
7. New loans will not be permitted on the paid-up policy.
8. The paid-up policy will not have a maturity date.
9. The paid-up policy will be based on the insured(s)'s attained age at
the time of conversion and the same premium classification as applied
to each Insured in issuing the most recent insurance coverage on the
policy.
10. The face amount of the new policy will be based on the method
described below.
11. Any optional benefits may be attached to the new policies only with
our consent.
12. A conversion fee not to exceed $250.
FACE AMOUNT OF PAID-UP POLICY - The face amount of the paid-up policy will be:
1. The Cash Value of the policy on the date of conversion; less
2. The then current Conversion Fee;
3. Divided by the appropriate Net Single Premium for the Attained Age of
the Insured on the date of conversion as shown on the Policy Data Page
of the original policy. For joint life policies, divided by the
appropriate Joint Net Single Premium for Joint Attained Age, if both
Insureds are still alive. If only one Insured is alive, we will use
the appropriate Net Single Premium. Upon notification of the first
death, we will provide you with the appropriate Net Single Premium
Table.
The Death Benefit of the paid-up policy will be the face amount of the paid-up
policy less outstanding loans and loan interest.
COST OF THIS RIDER - There is no charge for this rider prior to the time that
the benefit is taken under this rider.
CVIC-3015 1
<PAGE>
REINSTATEMENT - If this rider was in force at the time the policy lapsed, it may
only be reinstated if the policy is reinstated. The requirements for
reinstatement of this rider are the same as those for reinstatement of the
policy.
TERMINATION - This rider will terminate on the occurrence of the first of the
following events:
1. On the monthly anniversary day on or next following receipt of a
written request; or
2. When the policy terminates.
GENERAL PROVISIONS - All provisions of the policy, which are not inconsistent
with this rider, apply to this rider.
EFFECTIVE DATE - This benefit is effective on the Policy Date, unless a
different date is shown on a supplemental Policy Data Page.
This rider is signed for Conseco Variable Insurance Company.
/s/ Illegible
-------------
President
CVIC-3015 2
