31 Pa. Code § B - Surrender Comparison Index Disclosure Per $1,000 of Face Amount of Basic Insurance

Name of Insurer

____________

Age

____________

Sex

____________

Face Amount of Policy

___

Descriptive Title of Policy (Whole Life, 20 year decreasing term, endowment at age 65)

Policy Number..............

10 Year Surrender Index:

___

*(reflects equivalent level annual dividend and a termination dividend in the total amount of

___

)

20 Year Surrender Index:

___

*(reflects equivalent level annual dividend and a termination dividend in the total amount of

___

)

*Based on 19

___

Dividend Scale. Dividends are not guaranteed and are subject to change.The Surrender Comparison Index was designed to measure the relative cost of life insurance protection and may be useful for comparison of similar policies offered by other companies. Technically, the Index shows the relationship between the amounts paid by the insured (the average annual premiums minus any average annual dividend) and the amounts paid by the insurer (the cash value of the policy in the event of surrender over periods of 10 and 20 years all adjusted for compound interest at the rate of four percent per annum to reflect the timing of the payments).

*The Index reflects illustrative dividends based upon the current year's dividend scale. In the case of participating life insurance policies, the Index may change since future dividends are subject to change depending on the company's experience. If future dividends increase within the 10 or 20 year period, the Index will be lower; if dividends decrease, the Index will be higher.

When comparing similar policies, if all things are equal, the policy with the lower Index is generally the lower cost policy and the better buy in the event that the policy was surrendered at the end of the designated period. If death would occur during the designated period, the policy with the lower Index would not necessarily be the lower cost policy. The Index does not take into account, among other things (1) the value of the services of an agent or company; (2) the relative strength and reputation of the company; and (3) small differences in policy provisions. The Index does assume that annual premiums are paid, *that dividends are taken in cash or applied to premiums, and that no additional benefit provisions are included.

*If inapplicable, section may be deleted entirely or clearly marked "Not Applicable."

Notes

31 Pa. Code § B