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John Hancock(R) Life Insurance Company
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WAIVER OF WITHDRAWAL CHARGE ENDORSEMENT
WAIVER OF WITHDRAWAL CHARGE UPON OCCURRENCE OF TRIGGERING EVENTS
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We agree to waive any applicable Withdrawal Charge prior to the date annuity
payments have commenced if 1) beginning at least 30 days after the Effective
Date a Triggering Event occurs and 2) the Covered Person's attained age is less
than 80 on the Effective Date of the certificate.
Triggering Events
Triggering Events are:
1. A Covered Person being diagnosed with a first occurrence of any Covered
Condition, subject to the Pre-existing Condition Limitation; and
2. A Covered Person's confinement in a Nursing Home.
For 2. to be a Triggering Event, the following conditions must be met:
a. a Covered Person was not confined to a Nursing Home within two
years prior to the Effective Date of the certificate.
b. a Covered Person's confinement is for at least 90 consecutive
days;
c. a Covered Person is receiving Nursing Care;
d. such Nursing Care is based on a Physician's plan in accordance
with accepted standards of medical practice, and is Medically
Necessary;
e. such Nursing Care is needed because of a Covered Person's
inability to perform at least two of the Activities of Daily
Living without Human Assistance because of either Physical
Impairment or Cognitive Impairment; and
f. such Nursing Care is received while the certificate is in force,
and is not assigned.
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.
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"Cancer" means the manifestation of a malignant tumor (a tumor which is not
encapsulated and has properties to infiltrate and cause metastases) including
leukemia and Hodgkin's Disease other than Stage 1. The diagnosis must be
supported by histological evidence of malignancy. Specifically excluded from the
definition of cancer are all skin cancers except malignant melanomas, Stage 1
Hodgkin's Disease, Stage A prostate cancer, all tumors which are histologically
described as pre-malignant, and carcinoma-in-situ.
"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.
"Covered Condition" means, as defined herein, cancer, heart attack, organ
transplant, renal failure, or stroke.
"Covered Person" means the Certificate Owner and the Certificate Owner's Spouse.
"Covered Person" will mean the Annuitant and the Annuitant's Spouse if the
certificate is owned by a Trust.
"First occurrence" means the first time a Covered Person is diagnosed by a
Physician as having a Covered Condition. We reserve the right to confirm the
diagnosis with a Physician of our election and at our expense.
"Heart attack" means the death of a portion of heart muscle (myocardium)
resulting from a blockage of the coronary arteries. Diagnosis is based on three
criteria being present: 1) a history of typical prolonged chest pain; 2) new EKG
changes; and 3) elevation of cardiac enzymes above standard laboratory levels of
normal.
"Human Assistance" means physical, hands on, assistance in the case of Physical
Impairment or verbal direction or supervision in the case of a Cognitive
Impairment, which helps another person to perform Activities of Daily Living.
"Medically Necessary" means appropriate and consistent with the diagnosis in
accord with accepted standards of practice, and which could not have been
omitted without adversely affecting the individual's condition.
"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.
"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.
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"Organ transplant" means the actual undergoing of transplantation of heart,
lung, liver or bone marrow, but not as the donor.
"Physical Impairment" means a loss of physical functioning which interferes with
a person's ability to perform the Activities of Daily Living. A person with a
physical impairment would require hands-on Human Assistance in order to perform
the Activities of Daily Living.
"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.
"Pre-existing condition" means the existence of symptoms which would cause an
ordinarily prudent person to seek medical diagnosis, care, and treatment within
one year before the Effective Date of this certificate or a condition for which
medical consultation, advice, or treatment was recommended by or received from
or sought from a Physician during the two years immediately preceding the
Effective Date of the certificate.
"Renal failure" means end stage renal failure representing as chronic
irreversible failure of both kidneys to function, as a result of which regular
renal dialysis is instituted or renal transplantation is carried out.
"Stroke" means a cerebrovascular accident or incident producing neurological
impairment and resulting in paralysis or other measurable objective neurological
deficit persisting for at least 30 days. Specifically excluded from the
definition of stroke are Transient Ischemic Attacks and attacks of
Vertebrobasilar Ischemia.
Pre-Existing Condition Limitation
We will not waive any Withdrawal Charge for a diagnosis of a first occurrence of
a Covered Condition during the first two years after the Effective Date of the
certificate if it results from a Pre-existing Condition, as defined herein.
Benefit Procedure
A written request for a withdrawal and adequate proof of a Triggering Event must
be received by us no later than 90 days, or as soon thereafter as reasonably
possible, from the date of diagnosis of a first occurrence of a Covered
Condition or from the date of discharge from a Nursing Home Facility.
Signed for the Company at Boston, Massachusetts.
/s/ Barry J. Rubenstein
Secretary
