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1 choice term insurance 10/20/ year term f r o m For nt/broker Use Only
2 ( Last Birthday) s year level term s year level term s 18 -year level term PRODUCT SPECIFICATIONS Minimum $,000 Band 1 Policy amounts under $100,000 Band 2 Policy amounts $100,000 and over Renewable To age 95 Policy Fee $ Premium Classes Non-Tobacco use Tobacco use Premium Mode Factors Semi-Annual. Quarterly. Monthly.09 (minimum monthly is $) Monthly EFT.085 (minimum EFT is $10) Premiums Premiums are guaranteed for the term as stated in the policy (10-, 20-, or -years). At the end of the term, premiums will go up, but can never be more than the guaranteed rates (including policy fee) stated in the policy. Premiums will be based on the annual renewable rates in Table 4. CONVERSION RIGHTS Conversion Privilege Policy may be converted, without evidence of insurability, to an eligible whole or universal life policy before the end of the initial term or age 70, whichever is earlier. Conversion Credit If the policy is converted after the first policy anniversary but before the sixth policy anniversary (from date of issue), a credit equal to the total annual premium for the term policy will be applied to the first premium on the new policy. If the conversion is for less than the original face amount the credit will be prorated. RIDERS 10-Year Decreasing Term Rider Coverage reduces by 10% each year after the first year. ages: Same as base. See table 5 for rates. Accelerated Death Benefit Rider (Living Benefit I) Provides for an advance of death benefit proceeds if the insured meets conditions of a terminal illness. % of the death benefit, less an administrative fee of $0 and not to exceed $0,000. To be eligible, a physician must certify that the insured is terminally ill with a life expectancy of 12 months or less. There is no cost for this rider however exercising this rider will reduce the death benefit of the policy. Any unused portion of the death benefit will be paid upon death. ages: and under, a $,000 minimum death benefit is required; and older, a $,000 minimum death benefit is required. Accidental Death Benefit Available ages: 18 Benefit ages: Minimum $10,000; maximum two times the amount of insurance; total amount no greater than $200,000 on any one life including all insurers. Terminates at age 65. See table 6 for rates. Children's Term Insurance Primary insured must be between the ages of 18 and. Benefit ages: Children from 15 days through age. Children must be less than age 19 at time of issue. Available amounts: $5,000 or $10,000 Convertible up to 5 times the face amount when a child reaches age, primary insured's age is 65, or upon termination of the policy. Premium rates: $ per year for $5,000 $ per year for $10,000 Other Insured Rider Available ages: Same as for the base. Minimum $,000; maximum up to policy amount. Conversion may be made prior to the end of the initial term period or age 70, whichever is earlier. Rider term must be the same as the base term. Premium rates: Same as base without policy fee. Waiver of Premium Available ages: 18 Coverage expires on the 10 th, 20 th or th year anniversary or age, whichever is earlier. See table 7 for rates.
3 Term to Year Level table 2 Under $100,000 $100,000 and over Term to Year Level Under $100,000 $100,000 and over table 1
4 Term to 95 Annual Renewal table 4 Attained Current Guaranteed Max Term to 95 -Year Level table 3 Under $100,000 $100,000 and over
5 Waive For 10 Years 20 Years Years 10-Year Decreasing Term % of Base Rates Guaranteed for all 10 Years Rates Per $1,000 table 5 table 6 table 7 Male Female NT T NT T Rider face amount decreases 10% each year Accidental Death Benefit Rates Per $1, Waiver of Premium Rates Rates Per $100
6 18 10-Year Decreasing Term Rider Disability Waiver Gross Premiums per Initial $1000 table 8 notes Male Female NT T NT T
7 national mutual benefit P.O. Box 15 Madison, WI 1 15 (8) 8 19 or Form 10, Rev. 4-14
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SSI W M 15 149 1,386 440 8,301 26,612 9,665 11,084 7,216 4,139 69,007 SSI W F 11 64 633 231 6,152 29,430 9,783 15,257 15,477 17,535 94,573 SSI B M 19 345 4,142 806 7,926 16,311 5,292 5,837 3,157 1,369
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SSI W M 18 138 1,308 422 8,093 26,269 9,723 11,293 7,357 4,242 68,863 SSI W F 10 66 632 228 5,935 29,030 9,880 15,406 15,574 17,622 94,383 SSI B M 14 280 3,959 778 7,692 16,013 5,366 5,961 3,180 1,396
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AGE 0-5 6-10 11-18 19-20 21-35 36-59 60-64 65-74 75-84 85+ TOTAL PROGRAM-GRP RACE/SEX SSI W M 15 179 1,516 496 8,672 27,373 9,453 10,992 7,075 4,293 70,064 SSI W F 6 78 722 255 6,562 30,402 9,699 15,185
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