[Aetna logo]
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Aetna Life Insurance and Annuity Company
Home Office: ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇
(▇▇▇) ▇▇▇-▇▇▇▇
A Stock Company
Aetna Life Insurance and Annuity Company, herein called Aetna, agrees to pay the
benefits stated in this contract.
Group Single Premium Immediate Fixed, Variable or Combination Annuity
Contract (Nonparticipating)
Right to Cancel
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THE CONTRACT HOLDER MAY CANCEL THIS CONTRACT WITHIN 10 DAYS OF RECEIVING IT BY
RETURNING THIS CONTRACT, ALONG WITH A WRITTEN NOTICE, TO AETNA AT THE ABOVE
ADDRESS OR TO THE AGENT FROM WHOM IT WAS PURCHASED. WITHIN 7 DAYS AFTER AETNA
RECEIVES THE NOTICE OF CANCELLATION AND THIS CONTRACT AT ITS HOME OFFICE, AETNA
WILL RETURN THE AMOUNT OF CERTIFICATE HOLDER PURCHASE PAYMENT(S) RECEIVED PLUS
ANY INCREASE OR MINUS ANY DECREASE IN THE ACCOUNT VALUE OF ANY FUNDS ALLOCATED
TO THE SEPARATE ACCOUNT.
Signed at the Home Office on the Effective Date.
President Secretary
The contract sets forth, in detail, all of the rights and obligations
of both the Contract Holder and Aetna. IT IS THEREFORE IMPORTANT THAT
YOU READ THIS CONTRACT CAREFULLY.
The contract and any attached documents constitute the entire legal relationship
between Aetna and the Contract Holder.
ALL PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO FIXED DOLLAR AMOUNT.
SPIA(GR)-99
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Page 2
Table of Contents
Separate Account ..............................................................6
Charges to Separate Account ................................................6
Variable Annuity Assumed Annual Net Return Rate ............................6
Transfers .....................................................................6
I. DEFINITIONS ................................................................7
1.01 Account...............................................................7
1.02 Annuitant/Joint Annuitant ............................................7
1.03 Annuity ..............................................................7
1.04 Beneficiary(ies) .....................................................7
1.05 Certificate Holder ...................................................7
1.06 Contract .............................................................7
1.07 Contract Holder ......................................................7
1.08 Fixed Annuity ........................................................7
1.09 Fund(s) ..............................................................7
1.10 Guaranteed Payment ...................................................7
1.11 Life Annuity .........................................................7
1.12 Payee ................................................................8
1.13 Period Certain Annuity ...............................................8
1.14 Separate Account .....................................................8
1.15 Survivor .............................................................8
1.16 Valuation Date .......................................................8
1.17 Valuation Period .....................................................8
1.18 Variable Annuity ...................................................
II. GENERAL PROVISIONS ........................................................8
2.01 Premiums .............................................................8
2.02 Payments .............................................................8
2.03 Change of Contract ...................................................9
2.04 Control of Contract ..................................................9
2.05 Misstatements and Adjustments ........................................9
2.06 Incontestability .....................................................9
2.07 Beneficiary Designation ..............................................9
2.08 Nonparticipating Contract ............................................9
2.09 State Laws
III. VARIABLE ANNUITY PROVISIONS ..............................................9
3.01 Fund Annuity Units - Separate Account ................................9
3.02 Fund Annuity Unit Value ..............................................9
3.03 Fund Annuity Net Return Factors .....................................10
3.04 Transfer(s) .........................................................10
3.05 Notice to the Contract Holder .......................................10
3.06 Change of Fund(s) ...................................................10
IV. BENEFIT PROVISIONS .......................................................11
4.01 Death Benefit Provision ..............................................11
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SPECIFICATIONS
Group Certificate No.: [xxxx]
Contract Holder: [xxxx]
Certificate Number: [xxxx] Certificate Number: [xxxx]
Contract Effective
Date: [xxxx] Single Premium:: [xxxx]
Annuitant: [xxxx] Annuitant Issue Age: [xxxx]
Joint Annuitant: [xxxx] Joint Annuitant Issue Age [xxxx]
First Payment Date: [xxxx] Payment Frequency: [xxxx]
Single Premium: [xxxx]
SCHEDULE OF BENEFITS
Joint and 100% Survivor Annuity with Guaranteed Payments: Annuity payments begin
on the First Payment Date and will continue for the lives of the Annuitant and
Joint Annuitant. At the death of either the Annuitant or Joint Annuitant, the
payment amount will continue to be paid for the life of the survivor. If the
survivor dies prior to the payment of all guaranteed payments, any remaining
payments will be paid to the beneficiary.
Payment Information: Payments will be made on a Fixed basis.
Number of Guaranteed Payments: [xxxx]
Fixed Payment from General Account: [xxxx]
Fixed Annuity Present Value Interest Rate: [xxxx]%
FUNDING ELECTIONS
Number of Fund's
Percent Fund Name Annuity Units Per Payment:
[xxxx] [xxxx] [xxxx]
Variable Annuity Assumed Annual Net Return Rate: [xxxx]%
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Contract Schedule
Separate Account
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Charges to Separate Account
A daily charge at an annual effective rate of 1.25% for mortality and
expense risk and profit (M & E) is deducted from any portion of the
account value allocated to a Variable Annuity. A daily charge at an
annual effective rate of up to 0.25% for administration is deducted
from any portion of the account value allocated to a Variable Annuity.
Variable Annuity Assumed Annual Net Return Rate
If a Variable Annuity is chosen, an assumed annual net return rate of
5.0% may be elected. If 5.0% is not elected, Aetna will use an assumed
annual net return rate of 3.5%.
The daily net return rate factor for an assumed annual net return rate
of 3.5% per year is 0.9999058. The daily net return rate factor for an
assumed annual net return rate 5.0% per year is 0.9998663.
If the portion of a Variable Annuity payment for any Fund is not to
decrease, the Annuity return factor under the Separate Account for that
Fund must be:
a) 4.75% on an annual basis plus an annual return of up to 0.25% to
offset the administrative charge set at the time Annuity payments
commence if an assumed annual net return rate of 3.5% is chosen;
or
b) 6.25% on an annual basis plus an annual return of up to 0.25% to
offset the administrative charge set at the time Annuity payments
commence, if an assumed annual net return rate of 5% is chosen.
Transfers
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Maximum Number of Allowable Fund Transfers: Twelve per calendar Year
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I. DEFINITIONS
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1.01 Account
A record that identifies contract values accumulated on each
Certificate ▇▇▇▇▇▇'s behalf.
1.02 Annuitant/Joint Annuitant
An individual named on the Specifications page of this contract (1)
whose death terminates or adjusts the amount of life-contingent
payments, and/or (2) whose death results in the payment of death
benefits; a measured life.
1.03 Annuity
Payment of a specified amount(s) or specified number of units made:
a) On specified dates or intervals for the lifetime of one or more
Annuitants with or without Guaranteed Payments; or
b) On specified dates or intervals for a specified period of time.
Annuity benefits payable under this contract are shown in the Schedule
of Benefits on the Specifications page.
1.04 Beneficiary(ies)
The individual or entity entitled to receive any death benefit due
under the Account.
1.05 Certificate Holder
A person who purchases an interest in this Contract as evidenced by a
certificate. Aetna reserves the right to limit ownership to natural
persons. If more than one Certificate Holder owns an Account each
Certificate Holder will be a joint Certificate Holder. Joint
Certificate Holders have joint ownership rights and both must authorize
exercising any ownership rights unless Aetna allows otherwise.
1.06 Contract
The agreement between Aetna and the Contract Holder.
1.07 Contract Holder
The person to whom this contract is issued.
1.08 Fixed Annuity
An Annuity that is not a Variable Annuity.
1.09 Fund(s)
The open-end registered management investment companies whose shares
are purchased by the Separate Account to fund the benefits provided by
the contract.
1.10 Guaranteed Payment
A payment that is due whether or not the Annuitant, or Joint Annuitant,
if applicable, is alive on the payment due date, as described in the
Schedule of Benefits on the Specifications page.
1.11 Life Annuity
An Annuity with payments that are based solely on whether or not the
Annuitant, or Joint Annuitant, if applicable, is alive on the payment
due date as described in the Schedule of Benefits on the Specifications
page.
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1.12 Payee
A person that receives Annuity payments. The Certficate Holder shall be
the Payee unless the Certificate Holder designates otherwise in
writing.
1.13 Period ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇
An Annuity with a specified number of Guaranteed Payments without a
life contingency.
1.14 Separate Account
An account, established by Aetna under Section 38a-433 of the
Connecticut General Statutes, that buys and holds shares of the Fund(s)
available under this contract. Income, gains or losses, realized or
unrealized are credited or charged to the Separate Account without
regard to other income, gains or losses of Aetna. Aetna owns the assets
held in the Separate Account and is not a trustee of such amounts.
Amounts in the Separate Account are not generally guaranteed and are
held at market value. The assets of the Separate Account, to the extent
of reserves and other contract liabilities of the Separate Account,
cannot be charged with other Aetna liabilities arising out of any other
Aetna business.
1.15 Survivor
With an Annuity based on the lives of an Annuitant and Joint Annuitant,
the individual who is not the first to die.
1.16 Valuation Date
The date and time on which a Fund Annuity Unit Value is calculated.
Currently, this calculation will be determined at the close of business
of the New York Stock Exchange on any normal business day, Monday
through Friday, that the New York Stock Exchange is open.
1.17 Valuation Period
The period of time between successive Valuation Dates.
1.18 Variable Annuity
An Annuity with payments that vary with the net investment results of
the Funds available under this contract. Aetna reserves the right to
limit the Fund(s) available with the Variable Annuity Payment
Guarantee, if applicable.
II. GENERAL PROVISIONS
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2.01 Premium
The amount of the premium applied to this contract will be the premium
received minus a deduction for premium taxes, if any.
2.02 Payments
Aetna will pay to the Payee a Fixed or Variable Annuity or a
combination of the two as selected by the Certificate Holder and as
shown in the Schedule of Benefits on the Specifications page. Aetna
discharges its obligation to pay when it makes payment by check or
electronic funds transfer to the Payee's address or the bank that Aetna
has on record as of 15 business days before the payment due date.
We reserve the right to suspend any life-contingent payments to a Payee
if acceptable proof of life of an Annuitant or Joint Annuitant is not
furnished when requested.
2.03 Change of Contract
Only an authorized officer of Aetna may change the terms of this
contract. Aetna will notify the Contract Holder in writing of any
changes. Aetna reserves the right to modify this contract to meet the
requirements of applicable state and federal laws or regulations.
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2.04 Control of Contract
This is a contract between the Contract Holder and Aetna. The Contract
Holder has title to the contract. Contract Holder rights are limited to
accepting or rejecting contract modifications. The Certificate Holder
has all other rights to amounts held in the contract. Any choice
allowed under this contract must be made by the Certificate Holder in
writing or both Certificate Holders, if jointly owned. Until receipt of
such choices in Aetna's home office, Aetna may rely on any previous
choices made.
The contract is not subject to the claims of any creditors of the
Contract Holder or Certificate Holder, except to the extent permitted
by law.
The Certificate Holder may assign or transfer his or her rights under
the contract. Aetna reserves the right not to accept assignment or
transfer to a nonnatural person. Any assignment or transfer made must
be submitted to Aetna's Home office in writing and will not be
effective until accepted by Aetna.
2.05 Misstatements and Adjustments
If the age, sex, or any relevant fact concerning any Annuitant is found
to be misstated, the correct facts will be used to adjust payments.
2.06 Incontestability
Aetna will not contest this contract from its effective date.
2.07 Beneficiary Designation
If the contract provides for any Guaranteed Payments following the
death of the Annuitant, and the Joint Annuitant if applicable, the
Certificate Holder has the right to name a Beneficiary(ies). If the
Account is owned jointly, both joint Certificate Holders must agree in
writing to the Beneficiary designated.
The Beneficiary designation may be changed by the Certificate Holder
during the lifetime of the Annuitant, and, if applicable, the Joint
Annuitant, by sending written notice of the change in a form acceptable
to Aetna to Aetna's home office. Such change will not be effective
until received and recorded by Aetna.
In all cases, Aetna will pay death benefits based on the last written
Beneficiary designation it has on record on the date of the death.
2.08 Nonparticipating Contract
The Contract Holder, Certificate Holders or Beneficiaries will not have
a right to share in the earnings of Aetna.
2.09 State Laws
The contract and the certificate comply with the laws of the state in
which it is delivered. Annuity payments are equal to or greater than
the minimum required by such laws.
III. VARIABLE ANNUITY PROVISIONS
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3.01 Fund Annuity Units - Separate Account
The initial number of a Fund's Annuity units is stated on the
Specifications page. Each future payment is equal to the sum of the
products of each Fund Annuity unit value multiplied by the appropriate
number of units. The Fund Annuity unit value on the tenth Valuation
Date prior to the due date of the payment is used.
3.02 Fund Annuity Unit Value
For any Valuation Date, a Fund's Annuity unit value is equal to:
a) The value for the preceding Valuation Date; multiplied by
b) The Annuity net return factor(s) for the Valuation Period;
multiplied by
c) A factor to reflect the assumed annual net return rate.
The factors for the assumed annual net return are shown on the Contract
Schedule.
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3.03 Fund Annuity Net Return Factors
The Annuity net return factor(s) are used to compute all Separate
Account Annuity unit values for any Fund. The Annuity net return factor
for each Fund is equal to 1.0000000 plus the net return rate.
The net return rate is equal to:
a) The value of the shares of the Fund held by the Separate Account
at the end of a Valuation Period; minus
b) The value of the shares of the Fund held by the Separate Account
at the start of the Valuation Period; plus or minus
c) Taxes (or reserves for taxes) on the Separate Account (if any);
divided by
d) The total value of the Fund Annuity units of the Separate Account
at the start of the Valuation Period; minus
e) A Separate Account charge at an annual effective rate as shown on
the Contract Schedule for Annuity mortality and expense risks and
profit and a daily administrative charge which will not exceed
the amount shown on the Contract Schedule on an annual basis. The
daily administrative charge will be established on the Effective
Date of this contract.
A net return rate may be more or less than 0%.
The value of a share of the Fund is equal to the net assets of the Fund
divided by the number of shares outstanding.
3.04 Transfer(s)
At the request of a Certificate Holder, all or any portion of the
account value may be transferred from any Fund to any other allowable
Fund. Transfers will be processed as of the Valuation Date next
following when a transfer request is received in good order at Aetna's
home office. The maximum number of allowable transfers in a calendar
year is shown on the Contract Schedule. Aetna reserves the right to
increase the number of allowable transfers.
Transfer requests must be expressed as a percentage of the allocation
among the Funds of the amount upon which the Variable Annuity will be
based. Aetna may establish a minimum transfer amount.
3.05 Notice to the Certificate Holder
Once a year, Aetna will notify the Certificate Holder of:
a) The number of Fund(s) Annuity units; and
b) The value of Fund(s) Annuity units.
Such numbers or values will be as of a date no more than 60 days before
the date of the notice.
3.06 Change of Fund(s)
The assets of the Separate Account are segregated by Fund. If the
shares of any Fund are no longer available for investment by the
Separate Account or if in Aetna's judgment further investment in such
shares should become inappropriate in view of the purpose of the
contract, Aetna may cease to make such Fund shares available for
investment under the contract prospectively, or Aetna may substitute
shares of another Fund for shares already acquired. Aetna may also,
from time to time, add additional Funds. Any elimination, substitution
or addition of Funds will be done in accordance with applicable state
and federal securities laws. Aetna reserves the right to substitute
shares of another Fund for shares already acquired without a proxy
vote.
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IV. BENEFIT PROVISIONS
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4.01 Death Benefit Provision
a) If the Annuitant dies, or under a joint Annuity option the
Survivor dies, any remaining Guaranteed Payments will be paid to
the Beneficiary in the form specified in the Schedule of Benefits
on the Specifications page. Such payments will be paid at least
as rapidly as under the method of distribution then in effect.
Within six months of such death, the Beneficiary may elect to
receive the withdrawal value of any remaining Guaranteed Payments
less any early withdrawal charge. The rate used to determine the
withdrawal value will be the Fixed Annuity Present Value Interest
Rate shown on the Specifications page. No early withdrawal charge
will apply to the withdrawal value in this situation.
If this contract is issued as a Variable Period Certain Annuity,
the Beneficiary may elect to receive the withdrawal value of any
remaining Guaranteed Payments at any time. No early withdrawal
charge will apply to the withdrawal value in this situation.
b) If the Certificate Holder who is not the Annuitant(s) dies,
payments will be paid to the Payee in the form specified in the
Schedule of Benefits on the Specifications page. If no Payee
designated by the Contract Holder survives the death of the
Certificate Holder, payments will be made to the Annuitant. Such
payments will be paid at least as rapidly as under the method of
distribution then in effect.
c) If the Certificate Holder dies before the annuity starting date
the entire interest in the contract must be distributed within
five years of the date of death, or payments may be made over the
life or over a period not extending beyond the life expectancy of
the Beneficiary or Payee, as applicable, provided such payments
begin not later than one year after the date of death. The
annuity starting date is generally defined by the Internal
Revenue Code to mean the first day of the period (month, quarter,
half-year, year depending on whether payments will be made
monthly, quarterly, semi-annually or annually) which ends on the
date of the first annuity payment. This provision will not apply
if the Beneficiary or Payee, as applicable, is the Certificate
Holder's spouse.
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Aetna Life Insurance and Annuity Company
Home Office: ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇
Hartford, Connecticut 06156
(▇▇▇) ▇▇▇-▇▇▇▇
Certificate of Group Annuity Coverage
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ALL PAYMENTS AND VALUES PROVIDED BY THE GROUP CONTRACT, WHEN BASED ON
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO FIXED DOLLAR AMOUNT.
SPIA(GR)-99