Income Benefit Rider Contract Schedule between [John Doe] and Insurer
Summary
This contract schedule outlines the terms for an Income Benefit Rider attached to an annuity contract for John Doe (and potentially Jane Doe as joint owner). It specifies eligibility, minimum and maximum ages for benefit exercise, payment waiting periods, rider fees, and income payment percentages based on age. The agreement guarantees certain income percentages and payment options, including single or joint income payments, with annual increases and level income guarantees. The contract is effective as of April 15, 2022, and includes conditions for additional purchase payments and removal of the rider.
EX-4.HIII 16 exhiii.htm INCOME BENEFIT RIDER CONTRACT SCHEDULE
Income Benefit Rider Contract Schedule
| Owner: | [John Doe] | Contract Number: | [??687456] |
| Owner’s Date of Birth: | [January 15, 1977] | Issue Date: | [04/15/22] |
| Owner’s Gender: | [Male] | Annuitant: | [John Doe] |
| [Joint Owner: | [Jane Doe]] | Annuitant’s Date of Birth: | [January 15, 1977] |
| [Joint Owner’s Date of Birth: | [January 15, 1977]] | Annuitant’s Gender: | [Male] |
| [Joint Owner’s Gender: | [Female]] | ||
| Eligible Person(s): | [John Doe] | ||
| [Jane Doe] |
Minimum Exercise Age: [50]
Maximum Exercise Age: [100]
Maximum Issue Age for Level Income Guarantee: [75] Maximum Exercise Age for Level Income Guarantee: [80]
Income Payment Waiting Period: [[3] Index Year(s)] Minimum Income Payment: $[100]
Annual Increase Age: [45]
Rider Fee: [0.70]% guaranteed for all Contract Years
[Earliest Rider Removal Date: [Third] Index Anniversary]
S40902-02 [Admin. Tracking Identifier]
Income Percentage Table
| Eligible Person’s* Age | Income Percentage | Income Percentage Increase ** | |||
| Level Income | Increasing Income | ||||
| Single Income Payments | Joint Income Payments | Single Income Payments | Joint Income Payments | ||
| [0-50 | 4.40% | 3.90% | 3.40% | 2.90% | 0.25%] |
| [51 | 4.50% | 4.00% | 3.50% | 3.00% | 0.25%] |
| [52 | 4.60% | 4.10% | 3.60% | 3.10% | 0.25%] |
| [53 | 4.70% | 4.20% | 3.70% | 3.20% | 0.25%] |
| [54 | 4.80% | 4.30% | 3.80% | 3.30% | 0.25%] |
| [55 | 4.90% | 4.40% | 3.90% | 3.40% | 0.30%] |
| [56 | 5.00% | 4.50% | 4.00% | 3.50% | 0.30%] |
| [57 | 5.10% | 4.60% | 4.10% | 3.60% | 0.30%] |
| [58 | 5.20% | 4.70% | 4.20% | 3.70% | 0.30%] |
| [59 | 5.30% | 4.80% | 4.30% | 3.80% | 0.30%] |
| [60 | 5.40% | 4.90% | 4.40% | 3.90% | 0.35%] |
| [61 | 5.50% | 5.00% | 4.50% | 4.00% | 0.35%] |
| [62 | 5.60% | 5.10% | 4.60% | 4.10% | 0.35%] |
| [63 | 5.70% | 5.20% | 4.70% | 4.20% | 0.35%] |
| [64 | 5.80% | 5.30% | 4.80% | 4.30% | 0.35%] |
| [65 | 5.90% | 5.40% | 4.90% | 4.40% | 0.40%] |
| [66 | 6.00% | 5.50% | 5.00% | 4.50% | 0.40%] |
| [67 | 6.10% | 5.60% | 5.10% | 4.60% | 0.40%] |
| [68 | 6.20% | 5.70% | 5.20% | 4.70% | 0.40%] |
| [69 | 6.30% | 5.80% | 5.30% | 4.80% | 0.40%] |
| [70 | 6.40% | 5.90% | 5.40% | 4.90% | 0.45%] |
| [71 | 6.50% | 6.00% | 5.50% | 5.00% | 0.45%] |
| [72 | 6.60% | 6.10% | 5.60% | 5.10% | 0.45%] |
| [73 | 6.70% | 6.20% | 5.70% | 5.20% | 0.45%] |
| [74 | 6.80% | 6.30% | 5.80% | 5.30% | 0.45%] |
| [75 | 6.90% | 6.40% | 5.90% | 5.40% | 0.50%] |
| [76 | 7.00% | 6.50% | 6.00% | 5.50% | 0.50%] |
| [77 | 7.10% | 6.60% | 6.10% | 5.60% | 0.50%] |
| [78 | 7.20% | 6.70% | 6.20% | 5.70% | 0.50%] |
| [79 | 7.30% | 6.80% | 6.30% | 5.80% | 0.50%] |
| [80+ | 7.40% | 6.90% | 6.40% | 5.90% | 0.55%] |
*If you select joint Income Payments, we will use the Age of the younger Eligible Person.
**Income Percentage Increase does not apply until the Age of the Eligible Person* is greater than or equal to the Annual Increase Age. For all Purchase Payments received on or before the Index Effective Date, the Age of the Eligible Person* on the Index Effective Date is used to determine the Income Percentage. For any Additional Purchase Payments received after the Index Effective Date, the Age of the Eligible Person* on the Index Anniversary that occurs on or after we receive the Additional Purchase Payments is used to determine the Income Percentage attributable to those Additional Purchase Payments. After the Issue Date, current Lifetime Income Percentages will appear on your Index Options Statement.
Level Income Guarantee Payment Percentage Table
| [Covered Person’s* Age | Level Income Guarantee Payment Percentage |
| 50 | 2.23% |
| 51 | 2.28% |
| 52 | 2.33% |
| 53 | 2.39% |
| 54 | 2.44% |
| 55 | 2.50% |
| 56 | 2.57% |
| 57 | 2.64% |
| 58 | 2.71% |
| 59 | 2.78% |
| 60 | 2.86% |
| 61 | 2.95% |
| 62 | 3.04% |
| 63 | 3.13% |
| 64 | 3.23% |
| 65 | 3.34% |
| 66 | 3.45% |
| 67 | 3.58% |
| 68 | 3.71% |
| 69 | 3.85% |
| 70 | 4.00% |
| 71 | 4.17% |
| 72 | 4.35% |
| 73 | 4.55% |
| 74 | 4.77% |
| 75 | 5.00% |
| 76 | 5.27% |
| 77 | 5.56% |
| 78 | 5.89% |
| 79 | 6.25% |
| 80 | 6.67% |
| 81+ | 0.00%] |
*If you select joint Income Payments, we will use the Age of the younger Covered Person.
