Colonial Penn Life Insurance Company

Home Office: 399 Market Street, Philadelphia, PA 19181

(215) 928-8000 www.colonialpenn.com

Disclosure for Chronic and Terminal Illness

Accelerated Death Benefit Rider - For Whole Life Insurance Policy

Brief Description:

If the insured is diagnosed as having a Qualifying Event, this rider allows the owner to receive part of the policy's Death Benefit that would otherwise be payable to the beneficiary upon the insured's death. The Accelerated Death Benefit is a lump sum benefit and is in lieu of payment of the full Death Benefit of the policy. Refer to the example below.

Qualifying Events that can trigger payment of the Accelerated Death Benefit.

The Qualifying Event for the Accelerated Death Benefit is the Chronic Illness or Terminal Illness of the insured. The Qualifying Event must occur and be certified by a Licensed Physician while the rider is in force.

  1. Chronic Illness means the insured has been certified within the preceding twelve months by a Licensed Healthcare Practitioner as (a) being unable to perform, without Substantial Assistance from another individual, at least two Activities of Daily Living for a period of at least ninety days due to loss of functional capacity; or (b) requiring Substantial Supervision to protect the insured from threats to health and safety due to Severe Cognitive Impairment.
    Activities of Daily Living include bathing, continence, dressing, eating, toileting and transferring. The Licensed Healthcare Practitioner must Certify that Services are likely to be needed for the rest of the insured's life.
    Severe Cognitive Impairment means deterioration or loss in intellectual capability that is comparable to (and includes) Alzheimer's disease and similar forms of irreversible dementia and is measured by clinical evidence and standardized tests that reliably measure impairment in the insured's:
    1. Short or long memory; and
    2. Orientation as to people, place or time; and
    3. Deductive or abstract reasoning.
  2. Terminal Illness is a medical condition from which the insured is not reasonably expected to recover and from which the insured is expected to die within 12 months from the date of Certification by a Licensed Physician.

Cost of Insurance

The premium for this rider is based on the rider benefit and the gender and age of the insured when the policy takes effect.

Administrative Fee

An Administrative Fee will be charged to you for processing the payment of the Accelerated Death Benefit. It will be automatically deducted from the Accelerated Death Benefit payment.

Impact on Policy Values

The Death Benefit, cash value, policy premium and loan amount, if any, of the policy will be reduced proportionately by the Accelerated Death Benefit. The new premium for the policy will be based on the remaining Death Benefit amount using the same premium rate that applied at issue.

This rider provides an Accelerated Death Benefit which is intended to qualify for tax treatment under Section 101(g)(1)(A) of the Internal Revenue Code, except as provided by Section 101(g)(5), for insureds who are Terminally Ill.

Receipt of an Accelerated Death Benefit may be a taxable event. You should consult your personal tax advisor.

Any benefit received under this rider may impact the recipient's eligibility for Medicaid or other government benefits or entitlements.

This rider is not a qualified long-term care insurance contract under Section 7702B of the Internal Revenue Code, nor is it a non-qualified long-term care insurance contract. This rider does not provide long-term care insurance, nor does it replace long-term care insurance coverage. Carefully review all limitations of this rider, as well as those of the policy to which it is attached.

Only one (1) Accelerated Death Benefit is payable under this rider.

Upon a request to accelerate the policy death benefit and upon the payment of the Accelerated Death Benefit, you and any irrevocable beneficiary shall be given a statement demonstrating the effect of the acceleration of the payment of death benefit on the Death Benefit, cash value, policy premium and policy loans, if any, under the policy.

Hypothetical Example of an Accelerated Death Benefit Payment

Whole Life Insurance Policy with Chronic and Terminal Illness Accelerated Death Benefit Rider

Issue Age 40
Sex Male
Beginning of Policy Year 11
Before Acceleration
Death Benefit $50,000.00
Mode Monthly
Policy Premium $76.04
Rider Premium $7.23
Total Monthly Premium $83.27
Cash Value $4,050.00
Policy Loan and Accrued Loan Interest $1,000.00
Interest Rate 4.20%
Qualifying event Chronic Illness Terminal Illness
Qualifying event Chronic Illness Terminal Illness Acceleration % 50.00% 50.00%
Accelerated death benefit payment calculation
Accelerated Death Benefit $25,000.00 $25,000.00
Acceleration % x Policy Loan and Accrued Loan Interest $500.00 $500.00
12 months interest on Accelerated Death Benefit N/A $1,050.00
Due and unpaid premium on Policy and Rider $0.00 $0.00
Present value of premiums payable on Accelerated Death Benefit N/A $425.46
Administrative Fee $100.00 $100.00
Accelerated Death Benefit payment $24,400.00 $22,924.54
After Acceleration
Death Benefit $25,000.00 $25,000.00
Policy Premium $39.89 $39.89
Rider Premium $0.00 $0.00
Total Premium $39.89 $39.89
Cash Value $2,025.00 $2,025.00
Policy Loan and Accrued Loan Interest $500.00 $500.00

Whole Life Insurance/Living Insuranceā„¢

Find Your Accelerated Death Benefit Rider Additional Monthly Premium based on Your Selected Whole Life Benefit Amount

Male Monthly Rider Premiums
Whole Life Benefit Amount
Issue Age $10,000 $20,000 $30,000 $40,000 $50,000
40 $1.45 $2.89 $4.34 $5.78 $7.23
41 1.52 3.03 4.55 6.07 7.58
42 1.60 3.20 4.80 6.40 8.00
43 1.69 3.38 5.07 6.77 8.46
44 1.79 3.57 5.36 7.15 8.94
45 1.90 3.79 5.69 7.58 9.48
46 2.02 4.03 6.05 8.07 10.08
47 2.15 4.29 6.44 8.58 10.73
48 2.28 4.57 6.85 9.13 11.42
49 2.43 4.86 7.29 9.72 12.15
50 2.59 5.17 7.76 10.35 12.94
51 2.76 5.52 8.27 11.03 13.79
52 2.93 5.87 8.80 11.73 14.67
53 3.12 6.24 9.36 12.48 15.60
54 3.32 6.64 9.96 13.28 16.60
55 3.53 7.06 10.59 14.12 17.65
56 3.75 7.50 11.25 15.00 18.75
57 3.98 7.96 11.94 15.92 19.90
58 4.22 8.43 12.65 16.87 21.08
59 4.46 8.92 13.39 17.85 22.31
60 4.72 9.45 14.17 18.90 23.62
61 5.00 9.99 14.99 19.98 24.98
62 5.29 10.57 15.86 21.15 26.44
63 5.60 11.19 16.79 22.38 27.98
64 5.92 11.84 17.76 23.68 29.60
65* 6.27 12.53 18.80 25.07 31.33
66* 6.64 13.27 19.91 26.55 33.19
67* 7.03 14.07 21.10 28.13 35.17
68* 7.45 14.90 22.35 29.80 37.25
69* 7.90 15.79 23.69 31.58 39.48
70* 8.37 16.74 25.11 33.48 41.85
71* 8.88 17.77 26.65 35.53 44.41
72* 9.44 18.88 28.32 37.77 47.21
73* 10.05 20.10 30.15 40.20 50.25
74* 10.71 21.42 32.14 42.85 53.56
75* 11.45 22.91 34.36 45.81 57.27
Female Monthly Rider Premiums
Whole Life Benefit Amount
Issue Age $10,000 $20,000 $30,000 $40,000 $50,000
40 $1.06 $2.12 $3.17 $4.23 $5.29
41 1.11 2.22 3.32 4.43 5.54
42 1.16 2.32 3.47 4.63 5.79
43 1.21 2.42 3.64 4.85 6.06
44 1.27 2.54 3.81 5.08 6.35
45 1.33 2.67 4.00 5.33 6.67
46 1.40 2.81 4.21 5.62 7.02
47 1.48 2.97 4.45 5.93 7.42
48 1.57 3.13 4.70 6.27 7.83
49 1.65 3.31 4.96 6.62 8.27
50 1.75 3.50 5.25 7.00 8.75
51 1.86 3.72 5.57 7.43 9.29
52 1.97 3.94 5.91 7.88 9.85
53 2.10 4.19 6.29 8.38 10.48
54 2.22 4.45 6.67 8.90 11.12
55 2.37 4.73 7.10 9.47 11.83
56 2.52 5.03 7.55 10.07 12.58
57 2.67 5.35 8.02 10.70 13.37
58 2.85 5.69 8.54 11.38 14.23
59 3.02 6.04 9.06 12.08 15.10
60 3.21 6.42 9.62 12.83 16.04
61 3.40 6.81 10.21 13.62 17.02
62 3.62 7.23 10.85 14.47 18.08
63 3.85 7.69 11.54 15.38 19.23
64 4.10 8.19 12.29 16.38 20.48
65* 4.37 8.73 13.10 17.47 21.83
66* 4.66 9.32 13.99 18.65 23.31
67* 4.99 9.98 14.97 19.97 24.96
68* 5.36 10.72 16.07 21.43 26.79
69* 5.76 11.52 17.27 23.03 28.79
70* 6.19 12.38 18.57 24.77 30.96
71* 6.65 13.30 19.95 26.60 33.25
72* 7.15 14.29 21.44 28.58 35.73
73* 7.70 15.39 23.09 30.78 38.48
74* 8.32 16.63 24.95 33.27 41.58
75* 9.03 18.06 27.09 36.12 45.14

You must be age 40-75 to apply. *The Chronic Illness and Terminal Illness Accelerated Death Benefit Rider is not available for ages 65-75. Your premium is based on your gender and age when coverage takes effect. If approved, coverage will be effective on the date shown on your rider as long as the initial premium has been paid. To calculate other payment options, multiply the monthly rate by 3 (for quarterly), 6 (for semi-annual) or 12 (for annual).

ICC18-30-061
LL29885
SIWL - Chronic