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John Hancock(R) Life Insurance Company
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BASE CERTIFICATE VALUE ENHANCEMENT RIDER
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This Rider is made part of the certificate to which it is attached, in
consideration of: (a) the deduction of the applicable rider charge; (b) a
Covered Person's attained age being between 40 and 79, inclusive, on the
Effective Date of the certificate; and (c) the Covered Person not having been
confined to a Nursing Home or Assisted Care Living Facility or received Adult
Day Care, Home Health Care, Hospice Care, or Respite Care within one year before
the Effective Date of the certificate. This Rider may not be issued subsequent
to the Effective Date of the certificate. It is subject to all the provisions of
the certificate unless otherwise provided below.
DEFINITIONS
"Activities of Daily Living" means the following activities:
. Bathing, which means washing oneself by sponge bath; or in either a tub or
shower, including the task of getting into or out of the tub or shower.
. Continence, which means the ability to maintain control of bowel and bladder
functions; and when unable to maintain control of bowel or bladder functions,
the ability to perform associated personal hygiene (including caring for
catheter or colostomy bag).
. Dressing, which means putting on and taking off all items of clothing and any
necessary braces, fasteners, or artificial limbs.
. Eating, which means feeding oneself by getting food into the body from a
receptacle (such as a plate, cup, or table) or by feeding tube or
intravenously. Eating does not include preparing a meal.
. Toileting, which means getting to and from the toilet, getting on and off the
toilet, and performing associated personal hygiene. . Transferring, which
means moving into or out of a bed, chair, or wheelchair. Transferring does
not include the task of getting into or out of the tub or shower.
"Adult Day Care" means a program that provides a protective environment and
preventive, remedial and restorative services for part of the 24-hour day.
"Adult Day Care Center" means a place that is licensed to provide Adult Day Care
by the jurisdiction in which the services are provided. If licensing is not
required, Adult Day Care Center means a place that provides Adult Day Care, has
enough full-time staff to maintain no more than an 8 to 1 client-staff ratio,
and has established procedures for obtaining appropriate aid in the event of a
medical emergency.
"Assisted Care Living Facility" means a facility which:
. is licensed according to the laws of the jurisdiction in which it is
located; or
. meets all of the following --
. has a 24-hour on-site staff to provide Custodial Care;
. provides Custodial Care services for a charge, including room and
board;
. has established procedures for obtaining appropriate aid in the event
of a medical emergency; and
. provides Custodial Care services to 10 or more persons.
"Base Certificate Value" is calculated daily and means (a) minus (b) plus (c),
where (a) is the Base Premium plus all Monthly Benefits paid or applied under
this Rider, (b) is the sum of all Rider Charges deducted prior to the date of
calculation, all Withdrawals of Base Premium, all Withdrawals of Base Premium
interest, and all Withdrawals of any enhancements under this Rider, and (c) is
all interest accumulated on the Base Certificate Value prior to the date of
calculation. The Base Certificate Value accumulates interest on a daily basis
at the same rate earned by the Premium under the certificate. The Base
Certificate Value is used only in the calculation of the Monthly Benefit and the
Rider Charge.
"Base Premium" is the lesser of the Premium paid on the Effective Date and the
Maximum Premium shown in the table below. The Base Premium will be used in the
calculation of the Monthly Benefit and the Rider Charge.
<TABLE>
<CAPTION>
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Covered Person's Age on Effective Date Maximum Premium
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<S> <C>
[40-59 $ 70,000
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60-69 $100,000
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70-79 $200,000]
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</TABLE>
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"Benefit Limit" means the number of Monthly Benefit Payments will not exceed
[36].
In addition, we reserve the right to limit the total amount of Monthly Benefit
payable under this Rider and all similar riders issued by John Hancock Life
Insurance Company and John Hancock Variable Life Insurance Company to the
Covered Person such that:
1. the dollar value of the Monthly Benefit Payment as of the Effective Date of
certificates that use the Certificate Value to calculate the Monthly
Benefit does not exceed [$2100]; and
2. the dollar value of the Monthly Benefit Payment as of the Date of Issue of
certificates that use the Initial Premium to calculate the Monthly Benefit
plus the value determined in 1.) above does not exceed [$3000].
"Care Services" means Confinement Care Services and Non-Confinement Care
Services.
"Cognitive Impairment" means a deficiency in a person's short-term or long-term
memory; orientation as to person, place, and time; deductive or abstract
reasoning; or judgment as it relates to safety awareness. The presence of
Cognitive Impairment must be established by any of the following:
. the Covered Person has a score of 6 or more wrong on the Short
Portable Mental Status Questionnaire (SPMSQ) or its current
equivalent; or
. the Covered Person exhibits behavioral problems which require
supervision in order to protect him or herself or others, and has a
score of 4 or more wrong on the SPMSQ or its current equivalent; or
. the Covered Person requires verbal supervision or cueing in order to
perform at least two of the Activities of Daily Living more than half
of the times that those same Activities of Daily Living are performed
in a calendar week.
"Confinement Care Services" means the Covered Person is confined in a Nursing
Home or an Assisted Care Living Facility and is receiving Nursing Care, Hospice
Care, Custodial Care, or Respite Care. Confinement Care Services must be
received within the 50 states of the United States and the District of Columbia.
"Covered Person" means the Annuitant.
"Custodial Care" means care ordered by a Physician due to the Covered Person's
Cognitive Impairment or need for Human Assistance in the Activities of Daily
Living.
"Deferral Period" means the 6-year waiting period before the Base Certificate
Value may be increased under this Rider. The Deferral Period begins on the
Effective Date and ends on the day that the sixth certificate year has been
completed.
"Elimination Period" means 100 days that the Covered Person is receiving Care
Services. Any day the Covered Person receives Care Services during the Deferral
Period will not count towards satisfaction of the Elimination Period. Only one
complete Elimination Period needs to be met. The days used to satisfy the
Covered Person's Elimination Period do not need to be consecutive and may be
accumulated under separate claims. The Elimination Period starts on the first
day that the Covered Person begins to receive Care Services. No day may be
counted as more than one day towards the satisfaction of the Elimination Period.
"Excess Certificate Value" means a) less b) where a) is the Excess Premium and
b) is Withdrawals of Excess Premium and Withdrawals of Excess Premium interest.
The Excess Certificate Value accumulates interest on a daily basis and becomes
part of the Excess Certificate Value.
"Excess Premium" is the amount of Premium, paid on the Effective Date, in excess
of the Base Premium.
"Exclusion" means any of the following: 1) injury or sickness for which a
benefit is payable under any worker's compensation or occupational disease-law;
2) declared or undeclared war or act thereof; 3) mental, nervous or emotional
disorders without demonstrable organic origin; 4) attempted suicide or
intentionally self-inflicted injury; 5) alcoholism or drug use unless
administered by a physician; or 6) participation in a felony, riot or
insurrection.
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"Home Health Care Provider" means either a Home Health Agency or an Independent
Home Health Care Provider that provides Home Health Care. A Home Health Care
Provider cannot be a member of the Covered Person's Immediate Family.
. A Home Health Agency must meet one of the following requirements:
. it is licensed as a Home Health Agency by the jurisdiction in which
the Home Health Care is provided; or
. it possesses one of the following certifications in the jurisdiction in
which the Home Health Care is provided - Medicare Certification; Joint
Commission of Accreditation of Health Care Organizations (JCAHO)
Certification; or Community Health Accreditation Program (CHAP)
Certification; or
. it is an organization in the business of providing Home Health Care
through its employees, which is functioning according to the laws of the
jurisdiction in which it is located.
. An Independent Home Health Care Provider means a care provider not
employed by a Home Health Agency who meets one of the following
requirements. He or she:
. is a duly licensed registered nurse, licensed vocational nurse, licensed
practical nurse, physical therapist, occupational therapist, speech
therapist, respiratory therapist, licensed social worker, or registered
dietitian; or
. must be currently qualified as a certified home health aide or certified
nurse aide; or
. must be currently included in a government sponsored nurse aide
registry; or
. in the case of a home health aide or nurse aide who does not meet one of
the standards set forth above, such aide must present written proof of
completion of an established training course which must include training
in safely assisting persons with the Activities of Daily Living.
"Home Health Care" means services (including Hospice Care) the primary function
of which is to provide professional care for the Covered Person's benefit and
which meet one of the following requirements:
. they are provided by a Home Health Care Provider or an Adult Day Care
Center; or
. they are performed by a home health aide whose services consist primarily
of assisting the Covered Person in the Activities of Daily Living or
because of a Cognitive Impairment.
"Hospice Care" means a program for meeting the Covered Person's care needs if he
or she is terminally ill. Terminally ill means there is no reasonable prospect
of cure and the Covered Person has a life expectancy, as estimated by a
Physician, of 12 months or less. Hospice Care must be provided by an
organization that is licensed to provide such care according to the laws of the
jurisdiction in which it is located. Hospice Care is limited to those services
received by the Covered Person.
"Human Assistance" means the Covered Person needs hands-on or standby assistance
a majority of the time the Activity of Daily Living is performed. Hands-on
assistance means the physical assistance of another person without which the
Covered Person would be unable to perform the Activity of Daily Living. Standby
assistance means the presence of another person within arm's reach of the
Covered Person that is necessary to prevent, by physical intervention, injury to
such person while he or she is performing the Activity of Daily Living.
"Immediate Family" means the Covered Person or the Covered Person's spouse, or
the following relatives of the Covered Person or the Covered Person's spouse:
parents, grandparents, siblings, children, stepchildren, grandchildren, and
their respective spouses.
"Monthly Benefit" means the greater of (a) the Base Certificate Value and (b)
the Base Premium multiplied by the appropriate percentage according to the
following table:
<TABLE>
<CAPTION>
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Covered Person's Age on Effective Date Benefit Percentage
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<S> <C>
[40-59 3.0
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60-69 2.0
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70-79 1.0]
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</TABLE>
"Non-Confinement Care Services" means the Covered Person is a) receiving Home
Health Care, Hospice Care or Respite Care in his or her home, a rest home or in
an Adult Day Care Center or b) is receiving Adult Day Care in an Adult Day Care
Center. Non-Confinement Care Services must be received within the 50 states of
the United States and the District of Columbia.
"Nursing Care" means skilled or intermediate care provided by one or more of the
following health care professionals: registered nurse, licensed vocational
nurse, licensed practical nurse, physical therapist, occupational therapist,
speech therapist, respiratory therapist, medical social worker, or registered
dietitian.
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"Nursing Home" means a facility which meets all of the following requirements:
. it is licensed and operated to provide Nursing Care for a charge (including
room and board), according to the laws of the jurisdiction in which it is
located;
. has services performed by or under the continual, direct, and immediate
supervision of a registered nurse, licensed practical nurse, or licensed
vocational nurse, on-site twenty-four (24) hours per day.
A Nursing Home may be a freestanding facility or it may be a distinct part of a
facility, including a ward, wing, or swing-bed of a hospital or other facility.
Nursing Home does not mean:
. a hospital or clinic;
. a rehabilitation hospital or facility;
. an assisted care living facility;
. a rest home (a home for the aged or a retirement home) which does not, as its
primary function, provide custodial care;
. your primary place of residence, including your living quarters in a
continuing care retirement community or similar entity;
. a facility for the treatment of alcoholism, drug addiction, or mental
illness.
"Physician" is a licensed medical doctor (MD) or a licensed doctor of osteopathy
(DO) practicing within the scope of his or her license issued by the
jurisdiction in which the services are rendered. Physician does not include a
Covered Person, a Covered Person's spouse, children, parents, grandparents,
grandchildren, siblings, or in-laws.
"Premium" equals Base Premium plus Excess Premium, and is shown on the
application.
"Respite Care" means Nursing Care, Custodial Care or Hospice Care provided to
the Covered Person when those who normally care for the Covered Person at home
(generally family members, friends, neighbors, etc.) need relief from helping
the Covered Person to perform the Activities of Daily Living. Such care
includes confinement in a Nursing Home or an Assisted Care Living Facility, or
Home Health Care.
"Rider Charge" means
. prior to annuitization, a monthly deduction of [.0375%] of the greater of the
Base Certificate Value and the Base Premium.
. on or after annuitization, a monthly deduction of [.0375%] of the greater of
the Base Certificate Value on the Date of Maturity and the Base Premium.
BENEFIT
We will increase the Certificate Value (or the annuity payment after this
certificate is annuitized) by the Monthly Benefit if, after the Deferral Period
and the Elimination Period have been met, we determine that the Covered Person
during a calendar month is both
. unable to perform at least 2 Activities of Daily Living without Human
Assistance or has a deficiency due to the presence of a Cognitive Impairment;
and
. receiving Care Services.
However, we will not increase the Certificate Value after the Benefit Limit has
been reached.
For Confinement Care Services, benefits will be calculated on a monthly basis.
For Non-confinement Care Services, benefits will be calculated on a daily basis.
This means that we will pro-rate the Monthly Benefit to reflect the number of
calendar days in which Non-confinement Care Services were received. The Monthly
Benefit and rider charge will remain unchanged during a benefit payment period.
No Monthly Benefit will be paid if the Covered Person's inability to perform at
least 2 Activities of Daily Living without Human Assistance, the Covered
Person's deficiency due to the presence of a Cognitive Impairment, or the
Covered Person's receipt of Care Services is a result of an Exclusion.
When a benefit payment period ceases and the Benefit Limit has not been reached
(and the certificate has not annuitized), the rider charge will be calculated
based on the greater of the Base Certificate Value at that time and the Base
Premium. The Monthly Benefit for a new benefit payment period will be
recalculated based on the greater of the Base Certificate Value at the time we
receive due proof that the above conditions have been satisfied and the Base
Premium. For certificates which have annuitized, both the Monthly Benefit and
rider charge will remain unchanged.
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Any increase in the Certificate Value will be made to be effective in a calendar
month after receipt of due proof that the above conditions have been satisfied
and all of the procedures described in the Benefit Procedure provision of this
Rider have been completed. Any increase to an annuity payment will be made to be
effective for the next annuity payment made after receipt of due proof that the
above conditions have been satisfied and all of the procedures described in the
Benefit Procedure provision of this Rider have been completed.
BENEFIT PROCEDURE
The Covered Person must notify us that he or she is currently receiving or plans
to receive Care Services by writing or calling us at our Servicing Office. This
notification should be made within 30 days after a covered loss begins or as
soon as reasonably possible.
Once we receive this notification, we will work with the Covered Person, his or
her Physician or care providers, or anyone acting on the Covered Person's
behalf, to: obtain information about the Covered Person's health; confirm his or
her inability to perform 2 of the Activities of Daily Living or Cognitive
Impairment; and confirm that the Covered Person is receiving Care Services. We
will then make an objective review of all the information we receive to
determine whether the Covered Person qualifies for benefits. As part of our
review, we reserve the right to do a telephone interview, perform an on-site
geriatric nursing assessment or require a physical exam when and as often as we
may reasonably require while a claim is pending. We will pay for any interview,
assessment or examination that we request. We will continue to work with the
Covered Person in the manner described above throughout the duration of his or
her claim.
WITHDRAWALS UNDER THE CERTIFICATE
If a Withdrawal is made under the certificate, the Withdrawals will be deducted
first from Excess Premium interest, then from Excess Premium, then from Base
Premium interest, then from Base Premium.
TERMINATION OF THIS RIDER
This Rider will terminate on the earliest of the following:
. the date we receive written notice at our Servicing Office that you elect to
terminate this Rider;
. the date the Benefit Limit is reached;
. the date the Annuity certificate terminates for any reason;
. the date the Covered Person dies;
. the date the Base Certificate Value falls below an amount equal to 25% of the
Base Premium, provided such date occurs before a claim for Monthly Benefits
has been received and before the certificate has been annuitized.
Signed for the Company at Boston, Massachusetts.
/s/ Barry J. Rubenstein
Secretary
