EXHIBIT 1.(5)(e)
ADDITIONAL INSURED RIDER (AIR)
This rider is a part of the base policy whose number is shown below. If not
shown below, the Base Policy Number is shown on the Policy Data Page.
RIDER DATA
BASE POLICY NUMBER
DEFINITIONS
THE ADDITIONAL INSURED
The person insured under this rider. The Additional
Insured is shown on the Policy Data Page.
THE INSURED
The person insured under the base policy.
YOU, YOUR
The current owner of the base policy.
WE, US, OUR
Reliastar Life Insurance Company at our home Office
in Minneapolis, Minnesota.
WRITTEN, IN WRITING
A written request or notice, signed and dated, and
received at our Home Office, in a form we accept. You
may get forms for this purpose from us.
BENEFITS
When we have written proof that the Additional Insured died while this
rider was in force, we will pay the AIR Face Amount then in force.
While the Additional Insured is living, you may choose to have the proceeds
applied under any base policy settlement option. After the Additional
Insured's death, a beneficiary may choose to have the proceeds applied
under any base policy settlement option, depending on any prior
restrictions made by you and agreed to by us.
BENEFICIARY
The beneficiary is named to receive the proceeds to be paid at the
Additional Insured's death. You may name one or more beneficiaries on the
application. Later, you may name, add or change beneficiaries by written
request if all of these are true:
1. The base policy is in force;
2. This rider is in force;
3. The Additional Insured is alive; and
4. We have the written consent of all irrevocable beneficiaries of this
rider.
A change of beneficiary will take effect as of the date it is signed but
will not affect any payment we make or action we take before receiving your
notice.
When you name, add, or change a beneficiary, we will assume that this
applies to the base policy unless you tell us that it applies to the
Additional Insured Rider. If you assign the benefits of this rider as
collateral for a debt, this limits the beneficiary's rights to the
proceeds.
[LOGO] RELIASTAR LIFE INSURANCE COMPANY
Box 20
Minneapolis
Minnesota 55440
Executed at our Home Office
Robert C. Salipante President
/s/ Robert C. Salipante
Susan M. Bergen Secretary
/s/ Susan M. Bergen
084-650 1
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COST OF INSURANCE AND MONTHLY AMOUNT CHARGES
The total monthly deduction for this rider includes the sum of 1 plus 2,
where:
1. Is the Monthly Amount Charge per $1,000 (shown on the Policy Data Page)
multiplied by the AIR Face Amount divided by $1,000.
This charge applies to the Initial AIR Face Amount and to any increases in
AIR Face Amount during the Term shown on the Policy Data Page. The Term
applies to the Initial Face Amount from the Policy Date of the policy and
to any increases in Face Amount from the Effective Date of that increase.
2. Is the AIR Face Amount times the monthly cost of insurance rate
described below.
COST OF INSURANCE RATES
The monthly cost of insurance rate is based on the Additional Insured's
sex, issue age, and premium class as shown on the Policy Data Page, and the
policy year of the rider. Issue age means age last birthday on the Rider
Effective Date. Policy years of the rider are measured from the Rider
Effective Date. We will determine monthly cost of insurance rates based
upon expectations as to future cost factors for this rider. Any change in
cost of insurance rates for this rider will apply to all in the same
insurance class.
Except for Face Amounts in a rated premium class the cost of insurance
rates can never be greater than the rates shown in the Table of Monthly
Guaranteed Cost of Insurance Rates shown on the Policy Data Page. For those
in a rated premium class, the cost of insurance rates are calculated by
multiplying the rates shown in the Table of Monthly Guaranteed Cost of
Insurance Rates by the Premium Class Rating Factor shown on the Policy Data
Page. The rates may also be increased by any extra cost of insurance rates
shown on the Policy Data Page.
PAYING PROCEEDS
We pay proceeds in the following order:
1. Collateral assignees, if any, have first priority;
2. The beneficiary, if any, receives any proceeds that remain. If there is
more than one beneficiary, each receives an equal share, unless you have
requested another method in writing. To receive proceeds, a beneficiary
must be living on the 10th day after the Additional Insured's death; then
3. If there are no beneficiaries, you receive any proceeds that remain.
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CONVERSION
The insurance on the life of the Additional Insured may be converted to a
new individual life insurance policy without proof of insurability. This
rider may be converted only:
1. While the Additional Insured is alive;
2. While this rider is in force;
3. Before the Additional Insured reaches age 75; and
4. While the base policy is in force or within 31 days of the insured's
death.
Application for conversion must be in writing. Only you may apply. But if
the insured has died, only the Additional Insured may apply. We may require
that you send us the base policy and this rider so that we can endorse
them.
THE NEW POLICY
The amount of the new policy may be for an amount up to the AIR Face Amount
in force at the time of the conversion. The date of the new policy will be
the date of the conversion. The new policy, which will be in the same
premium class as this rider, can be on any of our plans in use at the time
of the conversion that:
1. We would normally issue;
2. Provide for a level amount of insurance with level premiums;
3. Have level premiums that are at least equal to those of the whole life
plan we offer that has the lowest level premium;
4. Do not participate in our surplus; and
5. Do not contain any benefits or rights involving a greater aggregate
risk, relative to premium, than is insured under this policy. However, the
new policy may contain a disability waiver benefit provision on the
Additional Insured if you give us written proof of the Additional Insured's
insurability.
TERMINATION
This rider ends:
1. On the Rider Expiry Date shown on the Policy Data Page;
2. If this rider is converted;
3. If the base policy is surrendered or ends, other than at the insured's
death;
4. 31 days after the insured's death. During this 31 days we do not charge
you for the continued coverage;
5. If you ask us in writing to end this rider. In this case, we may ask
that you return the policy and this rider so that we can endorse them. This
rider will end on the first Monthly Anniversary Date after we receive your
written request to end this rider; or
6. If the Cash Surrender Value of the base policy is used to purchase
paid-up insurance.
After this rider ends, we are not liable for its benefits, even if we have
included the cost of insurance and monthly amount charges for this rider in
the total monthly deduction for the base policy. We will refund any such
amounts that we deduct after this rider ends.
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REINSTATEMENT
If this rider and the base policy lapse, you can reinstate this rider if:
1. This rider was in effect when the base policy lapsed;
2. This rider would otherwise not have expired during the time it was
lapsed; and
3. You reinstate the base policy.
To reinstate this rider, you must do both of the following:
1. Give us proof of insurability for the Additional Insured; and
2. Pay a premium large enough to keep the policy and this rider in force
for at least 6 months.
The base policy may be reinstated without this rider, in which case proof
and payment for this rider are not needed.
AGE AND SEX
If the Additional Insured's age or sex is misstated, the Death Benefit will
be the amount that the most recent cost of insurance would pur- chase using
the current cost of insurance rates for the correct age and sex.
SUICIDE
The Suicide provision of the base policy is changed to also apply to the
Additional Insured from the Rider Issue Date in the same way that it
applies to the insured from the policy's Issue Date. The Suicide provision
of the base policy also applies in this way to any increases in the AIR
Face Amount for which we require evidence of insurability from the
effective date of each increase.
INCONTESTABILITY
This rider has a 2-year contestable period running from the Rider Issue
Date. During this period, we may ask for information that could lead to our
contesting this rider or refusing to pay its benefits. After this rider has
been in force during the Additional Insured's lifetime for 2 years from the
Rider Issue Date, we cannot claim this rider is void or refuse to pay any
benefits with respect to the initial AIR Face Amount unless this rider has
lapsed
If you make an increase in the AIR Face Amount that requires proof of
insurability, that increase has its own 2 year contestable period running
from the effective date of the increase.
If this rider lapses and is then reinstated, this provision will be
measured from the date of reinstatement.
GENERAL PROVISIONS
This rider does not increase any cash or loan values of the base policy.
All base policy provisions apply to this rider, unless changed by this
rider.
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