American Century Life Insurance Company of Texas (a stipulated premium company) 9708 Congressional Dr. Plano, TX 75025 Phone (855) 966-1111, Fax (855) 855-0181 THIS IS AN EXACT COPY OF YOUR POLICY EXCEPT FOR YOUR SPECIFIC INFORMATION SUCH AS NAME, ADDRESS, COVERAGE, AND PREMIUMS This is a legal contract between the Owner of this Policy and Us. It is issued in return for Your Application and first premium. We agree to pay the Proceeds of this Policy to the Beneficiary if the Insured dies while this Policy is in force, We receive satisfactory proof of the Insured's death, and this Policy's provisions are met. TEN DAY FREE LOOK You may cancel this Policy within 10 days of receiving it. Return the Policy to us at Our Home Office or to your sales agent. As soon as you deliver or mail the Policy to us it is treated as if it was never issued. We will refund your premium payment when we receive the Policy back. After the 10-day period you may cancel the Policy by notifying us in writing that You wish to do so. Cancellation of Your Policy will be effective on the date We receive your written notice unless Your notice specifies a later date. We will promptly refund any premium paid for coverage after the cancellation date. Cancellation of this Policy will be without prejudice to any claim made prior to the termination of this Policy. Coverage under this Policy and any attached riders will be limited in the event of Suicide by the Insured as described in the Suicide provision. IN WITNESS WHEREOF, the Company has caused this Policy to be executed at Our Home Office as of the Effective Date. The provisions and conditions on this and the following pages are part of this Policy. Roni Ido Secretary Raz Silberman President Premiums payable during the lifetime of the Insured until policy expiration or until the death of the Insured. Nonparticipating Policy. 1
IMPORTANT NOTICE To obtain information or make a complaint: AVISO IMPORTANTE Para obtener información o para presentar una queja: You may call American Century Life Insurance Company of Texas s toll-free telephone number for information or to make a complaint at: Usted puede Ilamar al número de teléfono gratuito de American Century Life Insurance Company of Texas s para obtener información o para presentar una queja al: (855) 966-1111 (855) 966-1111 You may also write to American Century Life Insurance Company of Texas at: American Century Life Insurance Co. of TX (A Stipulated Premium Company) 9708 Congressional Dr. Plano, TX 75025 FAX: (855) 855-0181 customerservice@acl-tx.com Usted también puede escribir a American Century Life Insurance Company of Texas: American Century Life Insurance Co. of TX (A Stipulated Premium Company) 9708 Congressional Dr. Plano, TX 75025 FAX: (855) 855-0181 customerservice@acl-tx.com You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights, or complaints at: Ustede puede comunicarse con el Departamento de Seguros de Texas para obtener información sobre compañías, coberturas, derechos, o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: P.O. Box 149104 Austin, TX 78714-9104 Fax: (512) 490-1007 Web: www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact American Century Life Insurance Company of Texas first. If the dispute is not resolved, you may contact the Texas Department of Insurance. Usted puede escribir al Departamento de Seguros de Texas a: P.O. Box 149104 Austin, TX 78714-9104 Fax: (512) 490-1007 Sitio web: www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov DISPUTAS POR PRIMAS DE SEGUROS O RECLAMACIONES: Si tiene una disputa relacionada con su prima de seguro o con una reclamación, usted debe comunicarse con American Century Life Insurance Company of Texas primero. Si la disputa no es resuelta, usted puede comunicarse con el Departamento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: ADJUNTE ESTE AVISO A SU PÓLIZA : This notice is for information only and does not Este aviso es solamente para propósitos informativos y become a part or condition of the attached no se convierte en parte o condición del documento document. adjunto. 2
TABLE OF CONTENTS Policy Schedule... 4 Definitions... 5 Premiums and Reinstatement... 5 Ownership, Beneficiary & Assignment Rights... 6 Termination... 6 Conversion Privilege... 6 Payment of Proceeds... 7 General Provisions... 7 3
POLICY SCHEDULE BENEFITS OF THIS POLICY UNITS OF COVERAGE AMOUNT OF PROCEEDS ANNUAL PREMIUM TERM LIFE POLICY INSURED AMOUNT: $XX,XXX.XX INSURED: John Smith INSURED'S AGE: XX OWNER: John Smith BENEFICIARY: As stated in the Application unless subsequently changed as provided in this Policy POLICY NUMBER: XXXXXX TOTAL PREMIUMS: $XX.XX EFFECTIVE DATE: POLICY ANNIVERSARY: POLICY EXPIRATION DATE: XXXXXX XXXXXX XXXXXX RESERVE INTEREST RATE: 3.5% REINSTATEMENT INTEREST RATE: 6% MODES OF PREMIUM PAYMENT AVAILABLE: ANNUAL: $XX.XX SEMI-ANNUAL: $XX.XX QUARTERLY: $XX.XX The effective date and Insured's Age for each benefit and unit of coverage is the Effective Date for this Policy unless otherwise specified above. 4
DEFINTIONS AGE: The Insured's Age at the Insured's last birthday. APPLICATION: The paper You signed to get this Policy. A copy is attached. BENEFICIARY: The person named to receive the Proceeds in the event of the Insured's death while this Policy is in force. EFFECTIVE DATE: The effective date of coverage provided by this Policy. See the Policy Schedule. INSURED: The person whose life is insured under this Policy. The Insured is named in the Policy Schedule. LAPSE: Termination of this Policy for non-payment of the required premiums. OWNER, YOU, YOURS: The person who has the right to change the Beneficiary and to exercise all rights under this Policy. The Owner may be someone other than the Insured and is shown in the Policy Schedule unless subsequently changed. POLICY: This Life Insurance Policy. POLICY ANNIVERSARY: The same day and month as the Effective Date for each succeeding year this Policy remains in force. POLICY SCHEDULE: Page 3 of this Policy. PREMIUM: The amount paid for coverage under this Policy. PROCEEDS: The amount We are obligated to pay under the terms of this Policy as shown in the Policy Schedule. WE, OUR, US, THE COMPANY: American Century Life Insurance Company of Texas. PREMIUMS AND REINSTATEMENT: Premium Payments The first premium is due on the Effective Date. Premiums will include rider premiums, if any. All premiums after the first premium are payable on or before the date they are due and must be paid to Us at Our Home Office or to an agent of the Company. If You want a receipt for premium payment, We will give You one upon request. Grace Period You have a 31-day Grace Period to pay each premium due. The Grace Period starts on the date the premium is due and ends 31 days later. Each premium due must be received at Our Home Office within the Grace Period. During the Grace Period this Policy will remain in force. In case of the Insured's death during the Grace Period, premiums due will be deducted from this Policy's Proceeds. When a premium is due and not paid by the end of its Grace Period, this Policy will Lapse. Reinstatement This Policy may be reinstated at any time within three years after it has Lapsed and before the Policy Expiration Date provided: A written application for reinstatement is submitted to Us; Evidence of insurability satisfactory to Us is furnished; and All overdue premiums are paid with interest at the Reinstatement Interest Rate shown in the Policy Schedule. Coverage under any reinstated policy will not begin until We approve the application for reinstatement.
OWNERSHIP, BENEFEIARY & ASSIGNMENT RIGHTS Owner You are the Owner for this Policy unless otherwise stated in the Application. lf a different Owner is stated, such designation will remain in effect until the Owner changes it. The Owner may exercise all the rights under this Policy during the Insured's lifetime by making written request to Us. All the rights of the Owner are subject to the rights of any assignee and of any irrevocable Beneficiary We have on record. If the Owner dies before the Insured, the rights of the Owner may be exercised by the Owner's estate. If the Insured is less than Age 18 on the Effective Date, ownership will automatically pass to the Insured on the Policy Anniversary when the Insured attains Age 18. Beneficiary The Beneficiary is as named in the Application unless changed as provided for in this Policy. If a Beneficiary dies before the Insured, the interest of that Beneficiary will pass to the Owner. If the Owner is not living at that time, all Proceeds will be paid to the Owner's estate. If any Beneficiary dies within 15 days of the Insured's death, We will pay the Proceeds as though that Beneficiary dies before the Insured. We may rely on affidavits or other evidence in identifying the persons in any class named as Beneficiary. Any payment We make in good faith based on this shall satisfy what We owe on this Policy to such extent. Changes in Beneficiary The Owner may change the Beneficiary by filing a written notice with Us. If an irrevocable Beneficiary has been named in this Policy and is still living, that person's written consent will be needed for any Beneficiary change. This change will not take effect until recorded by Us at Our Home Office. Once recorded, the change will be effective as of the date the request was signed; but, this change will be subject to any payment or other action We took before recording it. Assignment This Policy may be assigned. We are not responsible for the validity of any assignment. When an assignment is filed with Us and We have recorded it at our Home Once. The Owner's right and those of any revocable Beneficiary will be subject to it. Any assignment is subject to any action taken by Us before We receive and record it. TERMINATION This Policy and any attached riders will Lapse on the earliest of the following: The end of the Grace Period of any unpaid premiums; When the Owner gives Us a written request to do so; The date of the Insured's death; or The Policy Expiration Date shown in the Policy Schedule. PAYMENT OF PROCEEDS Proof of Death All Proceeds payable because of the Insured's death will be paid when We receive sufficient proof of death. Appropriate forms for giving Us proof of death will be made available to the Beneficiary upon request. In no event will the Proceeds be paid later than two months following the date We receive sufficient proof of death. Premium Adjustment at Death Any portion of the paid premium which applies to a period beyond the date of the Insured's death will be added to the Proceeds of this Policy. Premiums waived under any waiver of premium rider attached to this Policy will not be included in this adjustment. Any Renewal premium which is due and unpaid at the time of death will be deducted from the Proceeds provided that death occurs within the Grace Period for such Renewal premium.
Lump Sum We will pay the Proceeds in a lump sum (cash) unless otherwise agreed. We will pay the benefits at Our Home Office. This Policy must be returned in to Us when We pay the benefit. In case there is more than one beneficiary listed on the policy and no specific instructions were provided to Us, We will split the benefits payment equally among all beneficiaries. Interest on Payment We will add interest to the Proceeds if it is not paid within 30 days after We receive due proof of the death of the Insured. We will figure the interest from the date of receipt of the Insured's dealt until the date of Our payment. The Interest rate will be 3% per year. Protection of Proceeds To the extent permitted by law no payment of Proceeds or interest will be subject to the claims of any creditors of the Beneficiary or to any legal process against the Beneficiary. GENERAL PROVISIONS Entire Policy The contract between the Owner and Us includes this Policy, the Policy Application and any riders or endorsements attached to this Policy by Us. This Policy is issued in return for the Application and the first premium. All statements made in the Application, in the absence of fraud, are representations and not warranties. We cannot use any statement to invalidate this Policy or to defend against a claim unless that statement is contained in the Application. We can only make changes to this Policy if the Owner agrees. Only Our President or any of Our Vice Presidents, Secretaries, or Assistant Secretaries can change or waive the terms of this Policy. No sales agent or any other person can do so. Any changes must be in writing and signed by one of these officers. Incontestability We cannot use any statement to invalidate this Policy or to defend against a claim unless that statement is contained in the Application. The policy shall be incontestable after having been in force during lifetime of each insured for a period of two (2) full years from date of issue or six months from any date of reinstatement thereof except for the failure of the Insureds to pay the specified premiums when due or within the grace period allowed. Any reinstatement for which We require an application showing insurability will be incontestable after this Policy has been in force during the Insured's lifetime for two years from the effective date of reinstatement. Any contest of a reinstatement will be based on material misrepresentation the reinstatement application. Suicide If the Insured, whether sane or insane, dies by suicide or self-destruction within two years from the Effective Date, this Policy and any attached riders will terminate and Our liability will be limited to a refund of the amount equal to the premiums paid for this Policy and any attached riders.
If the Insured, whether sane or Insane, dies by suicide or self-destruction within two years from the effective date of reinstatement, our liability will be limited to a refund of the amount equal to the premiums paid since the effective date of reinstatement. War Exclusion If the Insured dies as a result, directly or indirectly, of war, declared or undeclared; of action by military forces; of any act or hazard of such war or action; of service in the military, naval, or air forces or in civilian forces auxiliary thereto; or from any cause while a member of such military, naval or air forces of any country at war, declared or undeclared, of any country engaged in such military action; Our liability will be limited to a refund of the amount equal to the premiums paid for this Policy and any attached riders. Misstatement of Age If Your Age was misstated in the Application, this Policy's benefits will be changed to those the premium paid would have provided for the correct Age. If the correct Age exceeded Our maximum Age for issuing this Policy, all premiums paid without interest will be returned as full settlement of Our liability. Physical Examination and Autopsy We have the right, at Our expense, to have the Insured examined by physicians when reasonably necessary and to have an autopsy performed when it is not prohibited by law. A claim must be pending. Conformity With State Statutes The law of Your State of residence applies. If this Policy conflicts with Your State's laws on the Effective Date, it is considered changed to meet those laws. The change will be to the law's minimum requirement. Basis of Reserves Reserves are calculated: On the basis of the Commissioner's 2001 Standard Ordinary Mortality Table, age last birthday and the Reserve Interest Rate shown in the Policy Schedule; Calculated according to the Commissioner's Reserve Valuation Method; and On the assumption that the death benefit is paid immediately upon Death. Non Participation This Policy will not participate in any surplus distribution We may make. Terms of Coverage The initial term of this Policy begins on the Effective Date shown in the Policy Schedule at 12:00, noon, Standard Time of the place where the Owner then resides and ends at 12:00, noon, Standard Time of the place where the Owner then resides on the date specified in the Termination provision. Premiums payable during the lifetime of the Insured until Policy expiration or until the death of the Insured Nonparticipating Policy
IMPORTANT INFORMATION ABOUT COVERAGE UNDER THE TEXAS LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION (For insurers declared insolvent or impaired on or after September 1, 2011) Texas law establishes a system to protect Texas policyholders if their life or health insurance company fails. The Texas Life and Health Insurance Guaranty Association ( the Association ) administers this protection system. Only the policyholders of insurance companies that are members of the Association are eligible for this protection which is subject to the terms, limitations, and conditions of the Association law. (The law is found in the Texas Insurance Code, Chapter 463.) It is possible that the Association may not protect all or part of your policy because of statutory limitations. Eligibility for Protection by the Association When a member insurance company is found to be insolvent and placed under an order of liquidation by a court or designated as impaired by the Texas Commissioner of Insurance, the Association provides coverage to policyholders who are: Residents of Texas (regardless of where the policyholder lived when the policy was issued) Residents of other states, ONLY if the following conditions are met: 1. The policyholder has a policy with a company domiciled in Texas; 2. The policyholder s state of residence has a similar guaranty association; and 3. The policyholder is not eligible for coverage by the guaranty association of the policyholder s state of residence. Limits of Protection by the Association Accident, Accident and Health, or Health Insurance: For each individual covered under one or more policies: up to a total of $500,000 for basic hospital, medical-surgical, and major medical insurance, $300,000 for disability or long term care insurance, or $200,000 for other types of health insurance. Life Insurance: Net cash surrender value or net cash withdrawal value up to a total of $100,000 under one or more policies on a single life; or Death benefits up to a total of $300,000 under one or more policies on a single life; or Total benefits up to a total of $5,000,000 to any owner of multiple non-group life policies. Individual Annuities: Present value of benefits up to a total of $250,000 under one or more contracts on any one life. Group Annuities: Present value of allocated benefits up to a total of $250,000 on any one life; or Present value of unallocated benefits up to a total of $5,000,000 for one contractholder regardless of the number of contracts. Aggregate Limit: $300,000 on any one life with the exception of the $500,000 health insurance limit, the $5,000,000 multiple owner life insurance limit, and the $5,000,000 unallocated group annuity limit. These limits are applied for each insolvent insurance company. Insurance companies and agents are prohibited by law from using the existence of the Association for the purpose of sales, solicitation, or inducement to purchase any form of insurance. When you are selecting an insurance company, you should not rely on Association coverage. For additional questions on Association protection or general information about an insurance company, please use the following contact information. Texas Life and Health Insurance Guaranty Association Texas Department of Insurance 515 Congress Avenue, Suite 1875 P.O. Box 149104 Austin, Texas 78701 Austin, Texas 78714-9104 800-982-6362 or www.txlifega.org 800-252-3439 or www.tdi.texas.gov