ࡱ>  }bjbj 7ee="a8,\ D&46((6(6(6777zzzzzzz$ȃ*{77777{(6(6~]9]9]97R(6(6z]97z]9]9Jpw(6p84*i7jsBz~0s7ww77]977777{{]97777777777777777 : Department of Consumer & Business Services Oregon Division of Financial Regulation 5 P.O. Box 14480 350 Winter St. NE- Salem, Oregon 97309-38839 Phone (503) 947-7983 STANDARDS FOR PRIOR APPROVAL INDIVIDUAL FIXED DEFERRED ANNUITIES ORS 742.003(1) This checklist (product standards) has been provided as an aid to assist you in preparing your filings. It does not need to be included with a paper submission, nor does it need to be attached in SERFF under the Supporting Documentation tab. However, the reviewer may request the completed checklist (product standards) at any time during their review. ORS 731.296, OAR 836-010-0011(2)(3). This list includes the national standards, relevant statutes, rules, and other documented positions to enforce ORS 731.016. The standards are summaries and review of the entire statute or rule may be necessary. Complete each item to confirm that diligent consideration has been given to each and is certified by the signature on the certificate of compliance form. Compliance with these provisions must be certified by both the filer and an officer of the company signing the Certificate of Compliance form. These signatures certify the filing being submitted meets the requirements of our checklist and statutes. Not applicable can be used only if the item does not apply to the coverage being filed. Not including required information or contract provisions may result in disapproval of the filing. NOTE: Oregon statutes describe annuities as policies, and the national standards use contract. All references to contract are subject to policy statutory references. Bold headings under the description indicate interstate-compact headings. TOI (type of insurance):  FORMCHECKBOX  A02I Individual annuities - Deferred non-variable  FORMCHECKBOX  A07I Individual annuities - Special (equity indexed)  FORMCHECKBOX  A08I Individual annuities - Unallocated  FORMCHECKBOX  A10I Individual annuities - Other (two-tiered annuity) Types of coverage:  FORMCHECKBOX  A02I.001 Fixed premium  FORMCHECKBOX  A02I.004 Modified single premium  FORMCHECKBOX  A02I.002 Flexible premium  FORMCHECKBOX  A02I.005 Limited flexible premium  FORMCHECKBOX  A02I.003 Single premium  FORMCHECKBOX  A07I 001 Equity indexed (attach supplement A)  FORMCHECKBOX  A07I.002 Modified guaranteed  FORMCHECKBOX  A10.000 Other (two-tiered secondary guarantee, attach supplement A, Form 440-2454e) Types of features (provide explanation on checked items in transmittal description):  FORMCHECKBOX  guaranteed interest periods  FORMCHECKBOX  market value adjustment  FORMCHECKBOX  compliance based on 5-year CMT rate  FORMCHECKBOX  bonus of any kind  FORMCHECKBOX  tiered crediting  FORMCHECKBOX  systematic withdrawal  FORMCHECKBOX  guaranteed enhanced benefits Review requirementsReferenceDescription of review standards requirementsCheck answerGENERAL REQUIREMENTS (FOR ALL FILINGS)Submission package requirementsOAR 836-010-0011 As required on SERFF or our websiteRequired forms are located on SERFF or on our website:  HYPERLINK "http://dfr.oregon.gov/rates-forms/annuities/Pages/annuities.aspx" http://dfr.oregon.gov/rates-forms/annuities/Pages/annuities.aspx. These must be submitted with your filing for it to be accepted as complete: Filing description (cover letter). Third-party filers letter of authorization. Certificate of compliance form signed by authorized person. Readability certification. If filing a rider, endorsement, or amendment, include the information listed in the guidelines from Form 440-3602. Statement of variability (see description under variable text). Actuarial memorandum for individual contracts with an overview of the contents of the filing and the reasons and procedures used to demonstrate compliance. The actuarial memo and forms filed must be congruent with each other. Forms filed for approval. (If filing revised forms, include a highlighted copy of the revised form to identify the modification, revision, or replacement language.) For mailed filings, submit two sets of the complete filing and one self-addressed stamped envelope large enough to return approved forms.Yes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX Filing description OAR 836-010-0011The filing description (cover letter) includes the following: 1. Changes made to prior approved forms or variations from other approved forms. 2. Summary of the differences between prior approved like forms and the new form. 3. Application form number(s) that have been approved and the approval date(s). 4. Description of the target market, e.g., qualified, non-qualified, broker-dealer, financial institution, Internet, etc.Yes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX Review requestedORS 742.003(1), OAR 836-010-0011(3)The following are submitted in this filing for review: 1. New contract and/or certificate. 2. Amendment of an approved form. 3. New plan options for a previously approved contract. (Include new specification page for each plan, with a separate form number or revision date.)Yes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX Advertising materialORS 742.009Advertisements for this contract do not include features or a bonus that is not filed and approved in the contract. (See standards for advertisements on our website and instructions for self-certification.) Yes N/A  FORMCHECKBOX   FORMCHECKBOX  Review requirementsReferenceDescription of review standards requirementsCheck answerAdvertising material, continuedORS 746.035All bonuses are guaranteed as part of the contract; bonuses not filed and approved will not be advertised.Yes N/A  FORMCHECKBOX   FORMCHECKBOX ApplicabilityORS 742.023, ORS 746.240Surrenders. If the contract provides a benefit waiving surrender charges contingent on a declared interest rate, the company certifies that the owner will be notified within 30 days when the declared interest rate declines to a point at which benefit is available. The contract provides that the contract owner is given at least 60 days to exercise the option.Yes N/A  FORMCHECKBOX   FORMCHECKBOX ORS 743.278(1)(b)Surrenders. If the contract allows for deferral up to six months of any cash value, withdrawal, or loan value, the company will make a written request at the time the company wishes to exercise a deferral and written approval is received from the director prior to the company exercising any contractual right to defer the payment. Deferral is not available for any income payments (at or after annuitization) or the death benefit.Yes N/A  FORMCHECKBOX   FORMCHECKBOX ORS 743.284(3), ORS 743.293Nonforfeiture. If the contract does not provide any cash surrender benefits or death benefits prior to annuitization, the filing description identifies the appropriate market and need for this type of product. A prominent statement to that effect is included on the cover page. See Supplement B for additional requirements.Confirm N/A  FORMCHECKBOX   FORMCHECKBOX ApplicationForm 440-2442, ORS 742.005(3)(4), ORS 746.015, ORS 743.024, ORS 743.027, ORS 743.030If filing includes an application form that asks medical questions, the product standard for life, AD&D, and annuity applications, Form 440-2442, is included. The extent of medical questions is consistent with the mortality assumptions used in pricing the product. If the contract issued requires consent, the consent form is made part of the contract and is includedYes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX Assumption CertificatesForm 440-3637See standards for Changes to Business Operations that Require a Filing, Form 440-3637.Yes N/A  FORMCHECKBOX   FORMCHECKBOX Clarity, legibility, readabilityORS 742.005(2), ORS 742.023, ORS 743.106(2)(f)(A)Forms are clear and understandable in their presentation of premiums, labels, description of contents, title, headings, backing, and other indications (including restrictions) in the provisions. The information is clear and understandable to the consumer and is not unintelligible, uncertain, ambiguous, abstruse, or likely to mislead. If the contract qualifies for a readability exemption, the filing includes a statement that the contract is subject to federal jurisdiction and meets requirements for exemption under ORS 743.106(2)(f)(A).Yes N/A  FORMCHECKBOX   FORMCHECKBOX  Review requirementsReferenceDescription of review standards requirementsCheck answerCombined plansORS 731.170, ORS 742.041(5)Endorsements for classes of coverage not authorized under ORS 742.041(5) are acceptable only when such endorsements meet the definition of every insurance appertaining to the annuity coverage. An endorsement meets the definition if it does not provide for additional coverage amounts and if provided at no charge, i.e., waiver of premium for involuntary unemployment. Combined classes. The classes of life and health insurance may be combined in which the liability of the company for unearned premiums or the reserve for unpaid, deferred or undetermined loss claims is estimated in a different manner. Insurance under the classes of life and health insurance may be effected in one policy.Yes N/A  FORMCHECKBOX   FORMCHECKBOX Consumer information, ORS 746.140Sale of life insurance with securities. The transmittal explains sale of this contract in correlation with securities and confirms that a clear and unambiguous written proposal is provided to the consumer prior to the consumer signing the application. The written proposal is retained by the company for three years and includes the following: (a) Name of the company. (b) The right of the consumer to purchase the life insurance only, the securities only, or both. (c) All material facts. (d) All matters pertaining to life insurance separately from the securities, including the premium charges. (e) It does not include misrepresentations or false, deceptive, or misleading words, figures, or statements.Yes N/A  FORMCHECKBOX   FORMCHECKBOX CredibilityORS 742.005(2)Fairness. The contract does not contain inconsistent, ambiguous, abstruse, unintelligible or misleading clauses or exceptions and conditions that unreasonably affect the risk purported to be assumed in the general coverage of the contract.Yes  FORMCHECKBOX ORS 731.260The actuarial memorandum, demonstration, application and Statement of Variability (SOV) are consistent/congruent with the contract, and demonstrations illustrate the John Doe form.Yes  FORMCHECKBOX Discretionary clausesORS 742.005A discretionary clause that gives the insurer the unrestrained power to interpret the contract in a manner that could possibly limit benefits, coverage, eligibility or the right to appeal or contest the decision under the contract is prohibitedYes  FORMCHECKBOX DiscriminationORS 746.015, OAR 836-080-0050, OAR 836-080-0055A statement is included in the filing that no assumptions or provisions unfairly discriminate in availability, rates, benefits, or any other way for prospective insureds of the same class, equal expectation of life, and degree of risk or hazard. (For example, sources of funds going into the contract and funds being withdrawn are treated alike.)Yes  FORMCHECKBOX  Review requirementsReferenceDescription of review standards requirementsCheck answerDomestic Partnerships/SpousesORS 106.305(3)(4) (5)(6)(7)Oregon law recognizes and authorizes domestic partnerships. Policy forms should reference Oregons domestic partnership law if the form makes reference to spouse, marriage, husband or wife. There are several exceptions to this and they involve language that specifically limits the definition of spouse to only those relationships that comply with the Federal Defense of Marriage Act (DOMA). These include the spousal continuation option under IRC 72s for annuity contracts and also in the case of annuity contracts that will be used only for qualified plans or for the qualified plan supplemental forms (for example, an endorsement) that are used to make the base contract compliant with the federal law. For more information, please see our January 2009 enotify on domestic partnerships and annuity contracts.Yes  FORMCHECKBOX Form numbersORS 742.106, ORS 742.023(f)The form number is in the lower left corner of the policy and appears on each page. The form provides core coverage with all basic requirements.Yes  FORMCHECKBOX Insurable interestORS 743.024(4), ORS 743.027, ORS 743.030 Oregon does not require insurable interest for the sale of an annuity. However, the consent of the individual annuitant may be required. The consent form is limited to providing information regarding the coverage and requesting consent. A copy of the consent form is included with the filing.Yes  FORMCHECKBOX Non-English contractORS 743.106, ORS 743.104(2)If filing includes forms in a language other than English, readability requirements do not apply if the forms are direct translations of approved contracts that meet product standards. Filing includes certification that it is a direct translation of an approved form.Yes N/A  FORMCHECKBOX   FORMCHECKBOX SuitabilityOAR 836-080-0170 to 0190, OAR 836-080-0090Sets forth standards and procedures for recommendations to consumers that result in annuity transactions Yes N/A  FORMCHECKBOX   FORMCHECKBOX Table of contentsORS 743.106(1)(d), ORS 743.103Contract and certificate contain a table of contents or index of the principal sections, if longer than three pages or 3,000 words.Yes N/A  FORMCHECKBOX   FORMCHECKBOX Unilateral amendmentsORS 742.003(1), ORS 742.005(3)The contract does not provide for unilateral amendments that reduce or eliminate benefits or coverage or impair or invalidate any right granted to an existing contract owner under the contract. Amendments, riders or endorsements are filed only to enhance benefits or contract provisions on an in force contract or to add tax qualified federal requirements on new or an in force contract.Yes N/A  FORMCHECKBOX   FORMCHECKBOX  Review requirementsReferenceDescription of review standards requirementsCheck answerVariable textORS 742.023, ORS 742.003(1), ORS 742.005(3)The company identifies items considered variable only on the specification page. Such items are bracketed or otherwise marked to denote variability. The submission includes a Statement of Variability (SOV) as a form for approval that discusses the conditions under which each variable item may change and the relationship between the variable items. (Only the contract owner information, current initial declared rates, and sub-accounts may be bracketed as variable and changed in accordance with state regulations.)Confirm  FORMCHECKBOX The SOV contains language that any change or modification is limited to new issues of the contract and does not apply to in-force contracts.Confirm  FORMCHECKBOX  The following items are not bracketed and will only be changed upon prior approval. The change shall be submitted in a replacement page or a new contract: Non CMT guaranteed minimum interest rates Guaranteed annuity purchase rates and the interest rate basis and mortality table of the rates Death benefit available under the contract Minimum premium amounts for any contract with a flat contract fee Any other item that may affect the derivation of and compliance of contract values with any required minimum nonforfeiture values. the free look period, including the number of days the Oregon fraud warning or in the absence of an Oregon specific fraud warning, a general fraud warning to be used in Oregon the existence of a fixed account the product name (not the marketing name) the insurer name (a logo may be bracketed but the full name of the insurer must be shown without brackets) amounts or ages that are part of the Internal Revenue Code. optional riders (if approved)Confirm  FORMCHECKBOX  All contract provisions are guaranteed, key terms defined, and all rights to make changes include the specific circumstances and extent of the reserved right with timely notice to the contract owner. (Open-ended provisions do not meet the requirements of ORS 742.005(2) and 742.023(1)(f) and changes require prior approval under ORS 742.003(1))Confirm  FORMCHECKBOX  Items such as the company phone number, address, officer titles, and signatures of officers located in other areas of the contract are denoted as variable and may be changed without notice or prior approval.Confirm  FORMCHECKBOX   Review requirementsReferenceDescription of review standards requirementsCheck answerVariable text, continuedORS 742.023, ORS 742.003(1), ORS 742.005(3)(4)The filing identifies ranges for specific items that may be changed without prior notice or approval, and includes a statement of variability (include the form number of the form being referenced at the top of the page of the SOV and include the SOVs own form number at the lower left hand corner)that presents reasonable and realistic ranges for the item. Items that may be filed with ranges include: current interest rate guarantee periods bonus amounts (not the bonus itself); persistency of anniversary interest rates or credits; tiering levels; current expense charges; minimum premium limits; maximum premium limits; minimum withdrawal amounts; minimum loan amounts(see ORS 743.268); amounts available for any penalty free withdrawals; current charges for supplemental benefits and options; any ages assumed in the calculations of benefits and options; bail out rate; the number of years for subsequent premium in a limited period flexible premium product; the minimum amount for a guaranteed period; the minimum contract value; minimum contract value required after a withdrawal; IRC section numbers; percentages and ages used in calculating guaranteed living benefits; the minimum amount that may be annuitized and/or as an income payment; the percentage interest rate in the Misstatement of Age/Sex provision but the rate cant exceed the statutory rate; and the redetermination period for CMT rates. (continued on next page)Yes N/A  FORMCHECKBOX   FORMCHECKBOX  Review requirementsReferenceDescription of review standards requirementsCheck answerVariable text, continuedORS 742.023, ORS 742.003(1), ORS 742.005(3)(4)(continued from previous page) A zero entry in a range of values on the specifications page for current tiering levels, expense charges, or other fees applicable under the contract is acceptable. A zero entry in a range of values on the specifications page for any benefit or credit provided for in the language of the contract is unacceptable. Both the marketing name and the logo may be bracketed but not the insurer name. While the numerical amount of the bonus may be bracketed, the bonus entry itself may not be bracketed. Text language may be bracketed in some cases but the SOV must include all the alternate language. Any language or numbers not in the SOV cannot be used. The SOV must include this language in regard to bracketing: the range(s) as shown on the SOV and its application shall be actuarially justified and does not discriminate against people of the same risk or degree of hazard and expectation of life. Any change to a range requires a refiling for prior approval and shall be accompanied by a demonstration, if applicable, signed by a member of the American Academy of Actuaries, that the contract continues to comply with the NAIC Standard Nonforfeiture Law of Individual Deferred Annuities, Model 805.Yes N/A  FORMCHECKBOX   FORMCHECKBOX  GENERAL CONTRACT REQUIREMENTSRequirementsReferenceDescription of review standards requirementsCheck answerCover pageORS 742.023(1)(d)(f), OAR 836-051-0915, OAR 836-080-0029(1)(d), OAR 836-080-01651. The full corporate name of the insuring company appears prominently on the first page of the contract and is not bracketed. 2. A marketing name or companys logo, if used on the contract, does not mislead as to the identity of the insuring company. Contract title and subtitles are generic and clearly describe the guaranteed elements; contract title contains no marketing or agency/broker names. The contract title may fall into several groups: single premium deferred annuity; modified single premium deferred annuity (more than one premium may be paid but premiums after the first year are not allowed); limited payment period flexible deferred annuity (premiums after the first year may be paid but not for the entire duration of the contract); and flexible premium deferred annuity. The contract title must include individual fixed, deferred and wording regarding the premium structure. 3. The insuring company address, consisting of at least a city and state, appears on the first page of the contract. 4. A place for the signatures of at least two company officers appear on the first page. The signatures may be blank for filing purposes only if the SOV includes a statement that the issued contract will contain the signatures. 5. The individual contract or certificate includes a right-to-examine provision that appears on the cover page of the contract or certificate. See OAR 836-051-0915 for the number of days for a non-replacement situation. Replacement contracts provide at least a 30-day free-look period. OAR 836-080-0029(1)(d). The free look must either be on the cover page or in an amendment or endorsement. 6. A form-identification number appears in the lower left-hand corner of the forms. The form number is adequate to distinguish the form from all others used by the company. 7. The contract contains a brief caption that appears prominently on the cover page and describes the type of benefits. 8. If a surrender charge is assessed at death, a disclosure appears on the cover page. 9. See OAR 836-080-0165 for the Notice requirement. Instead of appearing on the cover page it could appear on the specifications page or an amendment/endorsement/rider. 10. If no lump sum is provided at maturity, a disclosure appears on the cover page.Yes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  RequirementsReferenceDescription of review standards requirementsCheck answerSpecification pageORS 742.023, ORS 743.156The specification page of the contract is completed with hypothetical data that is realistic and consistent with the other contents of the contract and any required actuarial memorandum in support of nonforfeiture values.Confirm  FORMCHECKBOX  ORS 742.023(1)(f)The specification page includes the maturity or annuity payment date and annuitant/owner age.Confirm  FORMCHECKBOX  ORS 742.003(1), ORS 742.023The surrender charges scale filed for the contract is disclosed on the specification page. If a MVA is applicable a notation on the specifications page appears that a reduction may occur. Any changes to surrender charges are filed for approval.Yes N/A  FORMCHECKBOX   FORMCHECKBOX ORS 742.023, ORS 743.278(1), ORS 743.284, ORS 743.293Contract guaranteed interest rates and nonforfeiture interest rates are disclosed according to the Nonforfeiture Values section of this document. If the guaranteed minimum interest rate (GMIR) is less than the nonforfeiture rate, both rates must be disclosed and include a statement that the interest credited and contract values may be below the minimum nonforfeiture in some or all years. It must also state that upon annuitization, surrender, withdrawal or death that the value will be the greater of the contracts accumulation value and the minimum nonforfeiture amount.Confirm  FORMCHECKBOX ORS 743.153Cash value table. The contract includes a table of guaranteed contract values that illustrates to the age or year the contract matures. The table includes columns showing the premium structure (gross premiums and net premiums, if different), contract accumulation values, cash surrender values, and a column showing the effective annual rate of return percentages based on gross premiums and guaranteed minimum surrender values. (An example of premium structure for a flexible premium contract is an annual payment of $1,000. Flexible payment plans may provide a second table based on a single premium.) This table is not required if the insurer is in compliance with the Annuity Disclosure Model Regulation. Confirm  FORMCHECKBOX  ORS 743.156The specification page states minimum contract premium amount requirements for subsequent premiums if subsequent premiums are allowed. Contract premiums are disclosed for each benefit, and contract fees and charges are disclosed separately on the specification page.Confirm  FORMCHECKBOX  ORS 743.153, ORS 743.156, ORS 742.023All charges and fees are disclosed on the specification page. Current charges and fees disclose maximum charges and fees in proximity. All charges used in the determination of account values, cash surrender values, annuity values and death benefit are disclosed.Confirm  FORMCHECKBOX  ORS 742.023Term periods that guarantee the initial interest rate longer than one year are disclosed on the specification page and available term periods are stated on the application for selection. If term periods are not renewable, the initial term period clearly discloses the limited offer and explains it in the contract (see Guarantees section). Yes N/A  FORMCHECKBOX   FORMCHECKBOX  RequirementsReferenceDescription of review standards requirementsCheck answerSpecification page, continuedORS 746.035Any initial interest bonus included in the contract is disclosed separately on the specification page unless they are added via an amendment/endorsement/rider.Yes N/A  FORMCHECKBOX   FORMCHECKBOX OAR 836-080-0165Notice Requirement. A statement is included to the effect that the Division of Financial Regulation offers assistance to the consumer in the event of a dispute with the insurer. The information must include the phone number and website information for contacting the Division of Financial Regulation. The statement must appear on the cover page, specifications page or another prominent place (amendment or endorsement).Yes N/A  FORMCHECKBOX   FORMCHECKBOX  CONTRACT PROVISIONSRequirementsReferenceDescription of review standards requirementsPage & paragraphAccount valueORS 742.023, ORS 743.278(1)(c)(d), ORS 743.284, ORS 743.293Contract guarantees. 1. Any interest rate used in the determination of the account value, cash surrender value, annuity value, and death benefit are stated in the contract and guaranteed. A current interest rate must be guaranteed for a period stated in the contract. (Nonguaranteed interest rates may not be included in the contract.) 2. Any expense charges, surrender charges, and partial-withdrawal charges used in determination of the account value, cash-surrender value, annuity value, and death benefit are stated in the contract and guaranteed (not bracketed). Nonguaranteed expense charges, surrender charges, and partial withdrawal charges are not included in the contract. 3. The contract defines and describes the method of calculating all values and benefits provided under the contract including, but not limited to, values payable upon death, surrender of the contract for cash, partial surrender, and election of an income option. The contract also includes a complete description of all fees, charges, and credits used to determine these values. 4. The contract states that paid-up annuity benefits, cash surrender benefits, and death benefits are never less than the minimum nonforfeiture values. 5. If the guaranteed minimum interest rate (GMIR) is less than the applicable nonforfeiture interest rate, a complete description of how to calculate the nonforfeiture minimum value is included in the contract.   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      Annuity valueORS 742.023, ORS 743.278(1), ORS 743.284(1), ORS 743.293If the GMIR is less than the nonforfeiture rate, this must be disclosed on the specifications page. See Specifications page for the impact on annuity values. FORMTEXT       RequirementsReferenceDescription of review standards requirementsPage & paragraphArbitrationORS 36.600-36.740Voluntary arbitration is permitted by the Oregon Constitution and statutes after a claimant has exhausted all internal appeals and can be binding upon consent of the covered participant. (If the contract provides for arbitration when claim settlement cannot be reached, the contract owner/annuitant may elect arbitration at the time of the dispute. Arbitration takes place under the laws of Oregon held in the insureds county or any other county agreed upon in this state.) FORMTEXT      Assignment of contractORS 743.0431. Assignments are not allowed if there is an irrevocable beneficiary. 2. The contract describes the terms under which the contract may be assigned and states that assignments, unless otherwise specified by the owner, take effect on the date the notice of change is signed, subject to any payments made or actions taken by the company prior to receipt of such notice. 3. The contract may state that the company is not liable for the validity of the assignment. FORMTEXT      BeneficiariesORS 742.023(1)(f)1. The contract contains a beneficiary provision that describes the terms and conditions for designating or changing the beneficiaries, for selecting default beneficiaries as may be necessary, and when such designation is effective. 2. The contract states that changes in beneficiary, unless otherwise specified by the owner, take effect on the date the notice of change is signed by the owner, subject to any payments made or actions taken by the company prior to receipt of such notice. 3. If irrevocable beneficiaries are referenced in the contract, the contract explains that such a beneficiary cannot be changed without the consent of the irrevocable beneficiary. FORMTEXT      Claim settlementsORS 742.023, ORS 743.153, ORS 743.287(2), ORS 743.278(1), ORS 743.293, ORS 743.284(1)(2)Settlement 1. The provision describes each type of settlement option, the guaranteed minimum payout amounts for each option, and the basis of the settlement options rates which is the guaranteed interest rate (not less than one percent), and mortality table being utilized. 2. If the contract provides for a lump-sum settlement at maturity. At the selected maturity date, annuitization or lump sum are available with no additional charges (including no surrender charges or charges added solely to annuitize the contract are not permitted.) 3. The provision specifies a default settlement option at maturity. 4. A contract with scheduled payments calculates paid-up, cash surrender, and death benefits midterm with allowance for the lapse of time. FORMTEXT       RequirementsReferenceDescription of review standards requirementsPage & paragraphClaim settlementsORS 742.023, ORS 743.153, ORS 743.287(2), ORS 743.278(1), ORS 743.293, ORS 743.284(1)(2)Settlement (continued) 5. If this contract is filed as unisex, the annuitization provision includes a description of the mortality table uses in the contract, the interest rate basis (not less than 1%), and the blend of male and female mortality data used to develop the annuitization rates. 6. The settlement provision describes any limitation to options for non-human beneficiaries/payees. FORMTEXT      Claims of creditorsORS 743.049If the contract includes a provision for  claims of creditors, it may state that it is determined in accordance with applicable law. In the case of fraud, monthly payable amounts exceeding $500 are subject to garnishee execution to the same extent as wages and salaries in a court-ordered judgment. FORMTEXT      Commuted valuesORS 743.278If the contract provides for commuted values after annuitization, the provision describes the values as calculated at the same interest rate used in determining the payments when the annuity was purchased. The applicable interest rate used to calculate payment considers only mortality and interest as specified in the contract. FORMTEXT      Death benefitsORS 742.023(1)(f), ORS 743.293(1), ORS 743.2841. The contract contains a provision that settlement of the death benefit proceeds is made promptly to the beneficiary upon receipt of due proof of death. 2. The death benefit provision specifies that which satisfies proof of death and includes a standard proof (certified death certificate or finding from a court of competent jurisdiction) and other proof satisfactory to the company. 3. If irrevocable beneficiaries are referenced in the contract, the contract explains that such beneficiaries cannot be changed without the consent of the irrevocable beneficiaries. 4. The contract clearly states how the death of the owner or annuitant during the deferral stage affects the continuation of the contract and how an owner (new or existing) annuitant, successor annuitant, etc., are affected. 5. Death proceeds are available as a lump sum. 6. The contract describes how the death benefit is calculated. FORMTEXT      Entire contract provisionORS 742.016, ORS 743.2611. The contract contains a provision that the contract constitutes the entire contract between the company and the owner and does not reference other agreements as a way to incorporate additional terms to the contract. 2. If the application is to be part of the contract, the entire contract provision states that the application is part of the contract. 3. References to federal requirements clearly describe the requirement and the effect on contract provisions. Inclusion of federal requirements does not include limitations that are not part of the federal regulation.  FORMTEXT       RequirementsReferenceDescription of review standards requirementsPage & paragraphExamination of contractORS 742.023, OAR 836-080-0029(1)(d), OAR 836-051-0915Right to examine contract. 1. The right-to-examine-contract provision appears on the cover, allowing the policy owner a minimum of 10 or 15 days in which to examine the contract. The 10 or 15 days begin on the date the contract is received by the owner. Replacement contracts provide at least a 30-day free-look period. 2. A provision includes the requirements and instructions for the return of the contract to the company or the producer of the company. 3. A statement that all monies paid will be refunded if the contract is returned. FORMTEXT      Fees, service charges, taxesORS 731.854, ORS 742.023Premium tax. Oregon does not have a premium tax. No contract issued In Oregon may collect a premium tax charge based on premiums collected and reported in Oregon. If an insurer must pay tax on premium collected outside of Oregon on contracts originally issued in Oregon, the insurer may collect a premium tax charge no greater than the premium tax the insurer was required to pay on the corresponding premium. No premium or retaliatory tax charge may be collected on contracts issued in Oregon whatsoever unless the insurer is actually paying a premium or retaliatory tax on the contract. The amount of any premium or retaliatory tax charge on any contract must not be greater than the premium or retaliatory tax the insurer is required to pay on the contract or corresponding premium. The terms and conditions of the premium or retaliatory tax charge must be the same as those required by the law requiring their payment; for example, if the state charging the premium tax does not allow insurers to defer payment of the tax, the premium tax charge may not be deferred by the insurer. Any reference to assessing or deducting a premium tax charge must state any applicable premium tax charge or any applicable retaliatory tax charge. The statement no premium tax applies to Oregon contracts or no premium tax in Oregon also means the insurer may not deduct premium tax from premiums/policy paid outside this state unless the insurer also adds a statement that they will deduct premium tax after moving to another state that does assess premium tax FORMTEXT       Yes N/A  FORMCHECKBOX   FORMCHECKBOX  RequirementsReferenceDescription of review standards requirementsPage & paragraphFees, service charges, taxes, continuedORS 731.854, ORS 742.023If there is a premium tax statement on the cover page and/or specifications page, it overrides any conflicting statement within the main body of the contract. In accordance with the earlier referenced requirement that forms and the actuarial memo be consistent, the actuarial memo should be congruent with and mirror the contract. There should not be any conflicting statements between the two documents. (check one) Yes N/A  FORMCHECKBOX   FORMCHECKBOX Other taxes. References to other taxes are specific as to type with the specific charge stated on the specifications page. General references are made only for personal income tax deductions and a tax solely on the operation of the separate account. FORMTEXT      Grace periodORS 743.255, ORS 743.271(1)If applicable, the contract contains a provision for a grace period of not less than 30 days during which the contract stays in force to allow for the payment of any premium after the first payment. The premium due and interest may be deducted from any claim proceeds. FORMTEXT      GuaranteesORS 742.005(2), ORS 742.023All contract provisions are guaranteed (no open-ended provisions) and all rights to make changes include the specific circumstances and extent of the reserved right including timely notice to the contract owner. FORMTEXT      If the contract offers term periods that guarantee the initial interest rate beyond one year, the provision describes the renewal requirements for subsequent guaranteed periods and surrender values available during the guaranteed term. (If a market value adjustment is used, see requirements under Requirements for Rates.) FORMTEXT      ORS 743.284For guaranteed periods of at least one year that include a market-value adjustment upon surrender, the guaranteed period is not automatically renewed without signed consent from the contract owner when the maturity date falls during the guaranteed period unless all charges and adjustments are waived on the maturity date. FORMTEXT      ORS 743.156, ORS 743.153Guaranteed Income Benefit/Guaranteed Withdrawal Benefit/Guaranteed Accumulation Benefit If a guaranteed income benefit, guaranteed withdrawal or guaranteed accumulation benefit is included, the contract provides for the following: The cost is shown separately from the contract on the specifications page. FORMTEXT       RequirementsReferenceDescription of review standards requirementsPage & paragraphGuarantees, continuedORS 743.156, ORS 743.153The fixed annuitization rates are not less than those guaranteed under the contract. The rates used at annuitization must be the greater of the current purchase rates or the contract guaranteed option rates unless an actuarial memorandum demonstrates a pricing methodology wherein benefits accumulated under this guaranteed benefit using alternate settlement rates that exceeds the contract guaranteed rates. FORMTEXT      IncontestabilityORS 743.258, ORS 742.0131. The contract contains an incontestability provision and its conditions. 2. The contestable period does not exceed two years during the lifetime of the insured. 3. Coverage may be contested based on a material statement contained in an application only when made part of the contract, except on the basis of age and sex. If the company expects to rely on an application to contest the contract, the company must attach to or endorse the application as a part of the contract. 4. The contract may include only the following exceptions to the incontestability provision listed in ORS 743.258: (a) Non-payment of stipulated payments to the company. (b) At the option of the company, provisions related to benefits in the event of total and permanent disability and provisions that grant accidental-death benefit coverage. FORMTEXT      LoansORS 743.186, ORS 743.187, ORS 743.268(2), ORS 743.278(1)(b)(d), ORS 742.0231. If the contract provides for a loan, it contains a statement that the loan shall be on the sole security of the contract. 2. The provision may contain a statement that the company reserves the right to defer the payment of any loan for a period not to exceed six months if written approval is requested at the time of deferral and received from the appropriate chief insurance regulator prior to the company exercising any contractual right to defer the transfer. The company may not defer a loan for the payment of any premium to the company. 3. The provision describes the loan interest rate. The loan interest rate plus any added administrative fees is not greater than the maximum fixed rate of eight percent in arrears or a variable rate determined not to be the greater of the fixed rate or the Moodys Corporate Bond Yield Average Monthly Average Corporates, as published by Moodys Investors Service, Inc. for the calendar month that precedes by two months the month in which the determination date for the contract loan interest rate falls. The company may not charge any additional fees or expenses for the loan. FORMTEXT        FORMTEXT        FORMTEXT       RequirementsReferenceDescription of review standards requirementsPage & paragraphLoans, continuedORS 743.186, ORS 743.187, ORS 743.268(2), ORS 743.278(1)(b)(d), ORS 742.0234. The contract may provide that if interest on any indebtedness is not paid when due it shall be added to the existing indebtedness and shall bear interest at a rate no greater than the loan rate. 5. The contract may provide that existing indebtedness, including any due and accrued interest, may be deducted from the loan value or the proceeds of the loan. The contract may also provide that interest will be collected in advance to the end of the current contract year. 6. The contract loan value is not less than an amount equal to the cash-surrender values after three full years premiums have been paid, except to comply with federal requirements. 7. Increases to the adjusted rate may be made for not less than one-half of one percent or more than the maximum rate. Decreases must be given when the decrease reaches one-half of one percent. 8. The contract permits repayment of the loan and describe any conditions related thereto. 9. The contract describes the effect of outstanding loans on the death benefit, cash value and maturity value. 10. The contract may provide that if and when the total indebtedness, including interest due and accrued, equals or exceeds the cash value, the contract shall terminate, but not until at least 30 days advance notice of termination shall have been mailed to the owner and any assignee of record. 11. The contract indicates the maximum number of loans allowed at any time, if any. 12. The contract describes how the interest rate credited to the portion of the cash value equal to the indebtedness is determined. In no case will it be less than the credited rate to produce minimum nonforfeiture values for that duration. 13. The minimum loan amount may not exceed $1,000. FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      Maturity dateORS 742.005(2), ORS 743.278 to ORS 743.284(2), ORS 743.2871. Any terms used in the contract to identify the date selected for payout of the accumulated value are consistent, such as maturity value, maturity, or maturity date, and the terms are consistent with references in the nonforfeiture law. 2. If the contract provides the contract owner with the right to change the maturity date and the contract is intended to be tax qualified, the provision contains sufficient latitude to allow the form to be tax qualified. 3. The latest maturity date, if any, is defined in the contract. 4. The insurer may prohibit the selection of a maturity date from occurring before the earlier of the end of the 10th contract year or end of the surrender charge period. FORMTEXT       RequirementsReferenceDescription of review standards requirementsPage & paragraphMisrepresentations & misstatementsORS 742.013The contract contains a provision that all statements made by the insured, in the absence of fraud, are representations, not warranties, and that no statement is used in defense of a claim unless in a written application attached to the contract when issued. FORMTEXT      ORS 743.264Misstatement of age or sex. 1. The contract contains a misstatement-of-age provision or, if the contract is written on a sex-distinct basis, a misstatement-of-age or -sex provision, providing that the amount payable shall be such as the payment(s) to the company would have purchased at the correct age or the correct age and sex. 2. Any overpayment by the company on account of misstatement of age or sex may be charged, with interest at a rate specified in the contract but not exceeding six percent, against the current or next succeeding payment(s) made by the company. 3. If there is more than one life insured, the misstatement provision may state that the amount payable may be adjusted due to the misstatement of age or sex, as appropriate, of any insured. 4. The company may not terminate the contract/benefit and refund premiums if the correct age is outside the issue age ranges of the form. A premium and benefit shall be extrapolated. FORMTEXT      ORS 731.104, ORS 744.078Any provision allowing for modification does not directly or indirectly imply that the company is not bound by statements given to the producer. Knowledge of or information given to the producer is knowledge or information of the company. FORMTEXT      Nonforfeiture valuesORS 743.284, ORS 743.278(1)(d), ORS 743.293, ORS 742.023Nonforfeiture law. Contracts with GMIR (guaranteed minimum interest rate) that equal or exceed the nonforfeiture interest rate for the life of the policy. If the two rates are different, both must be disclosed on the specifications page. If only one rate is listed on the specifications page, it is assumed the rates are the same. The actuarial memo must be congruent with the specifications page. Only one nonforfeiture rate may be used at any one time. If the 5 year CMT calculation is not used for the determination of the nonforfeiture rate for all years, the nonforfeiture rate can be a bracketed rate but must be equal to or greater than 3% for all the years the CMT rate is not used This rate(s) must be listed on the specifications page along with any time period if the CMT rate isnt used for all years. If bracketed, this rate must be on the SOV with a reasonable and realistic range.  Yes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   RequirementsReferenceDescription of review standards requirementsCheck answerNonforfeiture values, continuedORS 743.284, ORS 743.278(1)(d), ORS 743.293, ORS 742.023Nonforfeiture law.(continued) If the 5 year CMT is used for the nonforfeiture rate, the CMT rate may be bracketed for filing purposes on the specifications page (the range on the SOV must indicate 1% to 3%). The actuarial memo must include the CMT calculation formula. The 5 year CMT nonforfeiture rate may be for the life of the contract or the CMT rate may be redetermined if the contract contains language to that effect. The specifications page must indicate the specific time period(s). If redetermined, the contract must include the CMT calculation formula. Any additional amount over and above the CMT must be disclosed as to the amount and the time period. The additional amount may be bracketed if the range is on the SOV with a reasonable and realistic range. The additional amount must be in close proximity to the CMT. If the 5 year CMT nonforfeiture rate is used initially, the rate may change to a bracketed rate equal to or greater than 3%, if the contract contains language to that effect. The specifications page must indicate this rate and the specific time period the nonforfeiture rate changes. This rate must be on the SOV with a reasonable and realistic range. The GMIR may be bracketed for filing purposes as variable but cannot be less than 1%. The GMIR can be for the life of the contract or may be redetermined if the contract contains language to that effect. If redetermined, it must indicate the specific time period(s). The specifications page must include a statement that the redetermined GMIR is at least equal to the 5 year CMT rate or a rate as least as favorable. A provision in the contract that states that interest credited in any year will be sufficient to keep the values under the contract at least as great as the minimum nonforfeiture amount. The relationship between the GMIR and nonforfeiture rate must be explained in the actuarial memo. If filing equity indexed account, Supplement A is included.Yes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  RequirementsReferenceDescription of review standards requirementsCheck answerNonforfeiture values, continuedORS 743.284, ORS 743.278(1)(d), ORS 743.293, ORS 742.023Contracts with GMIR (guaranteed minimum interest rate) that is less than the nonforfeiture interest rate in any year. Both the GMIR and nonforfeiture rate must be disclosed on the specifications page. Only one nonforfiture rate may be used at any one time. If the 5 year CMT calculation is not used for the determination of the nonforfeiture rate for all years, the nonforfeiture rate can be a bracketed rate but must be equal to or greater than 3% for all the years the CMT rate is not used. This rate(s) must be listed on the specifications page along with any time period if the CMT rate isnt used for all years. If bracketed, this rate must be on the SOV with a reasonable and realistic range. If the 5 year CMT is used at any time for the nonforfeiture rate, the CMT rate may be bracketed for filing purposes on the specifications page (the range on the SOV must indicate 1% to 3%). The actuarial memo must include the CMT calculation formula. The 5 year CMT nonforfeiture rate may be for the life of the contract or the CMT rate may be redetermined if the contract contains language to that effect. The specifications page must indicate the specific time period(s). If redetermined, the contract must include the CMT calculation formula. Any additional amount over and above the CMT must be disclosed as to the amount and the time period. The additional amount may be bracketed if the range is on the SOV with a reasonable and realistic range. The additional amount must be in close proximity to the CMT. If the 5 year CMT nonforfeiture rate is used initially, the rate may change to an unbracketed rate equal to or greater than 3%, if the contract contains language to that effect. The specifications page must indicate this rate and the specific time period the nonforfeiture rate changes. This rate must be on the SOV with a reasonable and realistic range. The GMIR may be bracketed as variable but cannot be less than 1%. The GMIR can be for the life of the contract or may be redetermined if the contract contains language to that effect. If redetermined, it must state the specific time period(s). A provision on the specifications page that the interest credited and contract values may be below the minimum nonforfeiture amount in some or all years. It must also state that upon annuitization, surrender, withdrawal or death that the value will be the greater of the contracts accumulation value and the minimum nonforfeiture amount. Yes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   RequirementsReferenceDescription of review standards requirementsCheck answer or enter page & paragraphNonforfeiture values, continuedORS 743.284, ORS 743.278(1)(d), ORS 743.293, ORS 742.023A complete description of how to calculate the minimum nonforfeiture value is included in the contract. The relationship between the GMIR and nonforfeiture rate must be explained in the actuarial memo. If filing equity indexed account, Supplement A is included.Yes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX ORS 743.278, ORS 743.284(1), ORS 743.293(1)If the contract provides for a lump-sum settlement at maturity or at any other time, a provision states that upon surrender of the contract at or prior to the commencement of any annuity payments, the company will pay in lieu of paid-up annuity benefits a cash-surrender benefit not less than the cash-surrender benefit specified in ORS 743.284 and 743.287. FORMTEXT      ORS 743.278(1)(a), ORS 743.284(1), ORS 743.293(1)Regardless of whether or not further premiums are payable, a provision in the contract states that upon cessation of payment of considerations under the contract, the company will grant a paid-up annuity benefit. FORMTEXT      The contract includes a statement of the mortality table, if any, and interest rates used to calculating any minimum paid-up annuity, cash surrender, or death benefits guaranteed under the contract, together with sufficient information to determine the amounts of such benefits, i.e., all expense, partial withdrawal, and surrender charges. FORMTEXT      The contract includes a statement that any paid-up annuity, cash surrender, or death benefits available under the contract are not less than the minimum benefits required by statutes of the state in which the contract is delivered.  FORMTEXT      The contract includes an explanation of the manner in which the paid-up annuity, cash surrender, or death benefits are altered by the existence of any additional amounts credited by the company to the contract, any indebtedness to the company on the contract, or any prior withdrawals from or partial surrenders of the contract. FORMTEXT      The contract may contain a provision that allows that if no payments are received for a period of two full years and the portion of the paid-up annuity benefit at maturity would be less than $20 a month, the contract may be terminated by payment of the contract values of the paid-up annuity benefit. Such payment relieves the company of any further obligation. FORMTEXT      Ownership of contractORS 743.0431. The contract contains an ownership provision. The provision describes the terms and conditions for designating or changing ownership or for designating default ownership as necessary and indicates when such designation is effective. 2. The contract states that changes in owner designation, unless otherwise specified by the owner, take effect on the date the notice of change is signed by the owner, subject to any payments made or actions taken by the company prior to receipt of such notice. FORMTEXT       RequirementsReferenceDescription of review standards requirementsCheck answer or enter page & paragraphParticipating contractORS 743.267If the contract participates in the divisible surplus of the company, the conditions of the participation are included in the contract.  FORMTEXT      Payment plansORS 742.023(1)(e), ORS 743.153, ORS 731.4461. The contract states the dollar amount of any subsequent minimum or maximum contract premium requirements and any cumulative premium limits. 2. Advance premium deposits are not subject to fees or surrender charges and are credited a stated interest rate. 3. The contract contains an address or methods for making premium payments.  FORMTEXT      Qualified plansORS 742.023References to federal requirements clearly describe the requirement and the effect on policy provisions. Federal requirements do not include limitations that are not part of the federal regulation. FORMTEXT      ReinstatementORS 743.2701. If the contract requires a premium payment, it contains a provision for reinstatement of the contract for nonpayment of premiums if the contract has not been surrendered or the extension period has not expired and includes the conditions of the reinstatement. 2. The period of reinstatement may not be more than one year during the life of the annuitant. 3. Evidence of insurability may be required, if it was required when originally issued. 4. Payment of overdue premiums plus six percent interest may be required for reinstatement of the contract. FORMTEXT      Reports & statements to contract ownerORS 742.023, OAR 836-051-09201. The contract provides for at least annual delivery, without charge, of a report to the owner about the status of the contract and other information required under state or federal law, including the following: (a) Accumulation value at the beginning and end of the report period (b) Surrender value in compliance with nonforfeiture values at the beginning and end of the report period (c) Any withdrawals or surrenders (d) The dollar amount of the death benefit (e) Amounts credited, charged to or paid (f) Any outstanding loan(s) and loan balance 2. Information current as of a date not more than four months prior to mailing. FORMTEXT      Requirements not part of a listed categoryORS 742.023References to federal requirements clearly describe the requirement and the affect on contract provisions. Federal requirements do not include limitations that are not part of the federal regulation. FORMTEXT       RequirementsReferenceDescription of review standards requirementsEnter page & paragraphSeparate account(s)ORS 731.156Annuities containing separate accounts shall be considered variable only if the value of the annuity (or portion of the annuity pertaining to the separate account) varies according to the investment experience of the separate account. Annuities (or portion of annuities) which vary with respect to an index or which fluctuate in value on any other basis not directly related to the investment performance of the funds in the separate account are not considered variable. FORMTEXT      SuicideORS 742.023(f), ORS 743,258, ORS 742.005(3)(4)1. The contract may provide for a suicide exclusion that does not exceed two years from the date of issue of the contract. 2. The contract requires a minimum refund of all premiums paid, minus dividends paid, any indebtedness, and withdrawals paid by the company in the event of death by suicide during the suicide-exclusion period. FORMTEXT      SurrendersORS 742.023(1)(f), ORS 743.284(2)1. The contract clearly describes any surrender charges and other fees deducted. 2. Upon surrender or death, a bonus is not recaptured more than 12 months in arrears unless the forfeiture is demonstrated to be within the surrender allowance under ORS 743.284(2). 3. Surrender-value payout is available in a lump sum and is not restricted to payment over a period of time. 4. If the contract includes a market value adjustment (MVA) associated with guaranteed periods, the calculation for adjustment is limited to that guaranteed period. 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(An MVA cannot reduce contract values below the nonforfeiture values.)  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Waiver of surrender charges 1. If a benefit waiving surrender charges is included in a contract, the conditions of the waiver are clearly described in the contract. 2. If the waiver of surrender-charge benefit is not described in a separate provision, such as a bailout, then the reference to the surrender charge waiver is descriptive by name and any time restriction or limit is prominently disclosed. 3. If the contract provides for a benefit waiving surrender charges contingent on a declared interest rate (bailout), the provision requires the company to provide the owner notification within 30 days when the declared interest rate declines to a point at which the waiver of surrender charge benefit is available, and the contract owner is given at least 60 days to exercise the option. FORMTEXT      Partial withdrawal 1. A contract that develops cash values provides for a partial withdrawal. 2. The contract contains the conditions applicable to a partial withdrawal. 3. The value of a partial withdrawal is not less than that provided by the nonforfeiture law. FORMTEXT       RequirementsReferenceDescription of review standards requirementsEnter page & paragraphSurrendersORS 742.023(1)(f), ORS 743.153, ORS 743.278(1)(b)Deferral and valuation of payments. 1. The contract describes any conditions and limitations on amounts payable upon surrender, withdrawal, and election of a loan. There is no deferral of payment to any portion of the death benefit. 2. The company may reserve the right to defer surrenders, withdrawals and loans (if not for payment of premiums) for a period of six months when written approval is requested from the appropriate chief insurance regulator at the time the company wishes to exercise a deferral and approval received from the appropriate chief insurance regulator prior to the company exercising any contractual right to defer the payment of any cash value, withdrawal, or loan value. The contract owner is notified of the specific date on which the deferral will be paid, the reason for the delay, and the value of the requested amount as determined at the time the request is received by the company. 3. Income payments cannot be deferred. 4. Interest must continue to be paid during any deferral period.  FORMTEXT      TransfersORS 742.023(1)(d)(f), ORS 743.278(1)(b)The contract may reserve the right to defer a transfer request for a period not to exceed six months. The contract owner is notified of the specific date on which the transfer will be paid, the reason for the delay, and the value of the transfer as of the date the request is received by the company. Transfers are not subject to surrender charges. FORMTEXT       REQUIREMENTS FOR RATESActuarial filing requirements for demonstrating compliance: Information requested under this section is necessary to evaluate the filing for compliance. ORS 731.296RequirementsReferenceDescription of review standards requirementsCheck answerActuarial memorandum (Ratemaking generally)ORS 731.296Additional submission requirements: A signed actuarial memorandum by a member of the American Academy of Actuaries that includes the following information concerning the calculation of the nonforfeiture values: 1. A description of the contract and contract provisions that affect nonforfeiture values including an explanation of how the contract values are at least equal to the minimum nonforfeiture values. 2. All maximum benefit, surrender, and expense charges. 3. The range of issue ages. 4. The maximum maturity date. For contracts whose maturity date may not be changed at the option of the owner, this date is the fixed maturity date. Yes  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  RequirementsReferenceDescription of review standards requirementsCheck answerActuarial memorandum (Ratemaking generally)ORS 731.296Additional submission requirements: (continued) 5. Certification by a member of the American Academy of Actuaries that filing complies with NAIC Standard Nonforfeiture Law for Individual Deferred Annuities, Model 805. 6. If the CMT is used, an explanation of how its calculated, the number of months as the basis of the calculation, rounding, reduction and if applicable, the timeframe for redetermination.  FORMCHECKBOX   FORMCHECKBOX  BonusORS 746.015, ORS 746.005(7)A bonus is consistent for a class of annuitants/owners. Any initial bonus is not limited to rollover funds. All funding sources are treated equitably. Bonuses may be given for a variety of reasons, including but not limited to for savings in administration or economies of scale.Yes N/A  FORMCHECKBOX   FORMCHECKBOX ORS 743.284(2)Recapture of any part of a bonus more than 12 months in arrears is demonstrated with the surrender charge not to exceed the allowable amount that would support minimum nonforfeiture values under ORS 743.284(2). Yes N/A  FORMCHECKBOX   FORMCHECKBOX ORS 733.030(1)(6)Reserve method includes a narrative that explains reserves for any guaranteed periods and bonus credits. Non-unitized separate accounts hold sufficient reserves to cover the interest rate.Yes N/A  FORMCHECKBOX   FORMCHECKBOX Combination PlansORS 742.041(5), ORS 731.170Combined classes. The classes of life and health insurance may be combined. No other classes are combined in which the liability of the company for unearned premiums or the reserve for unpaid, deferred, or undetermined loss claims is estimated in a different manner. Insurance under the classes of life and health insurance may be effected in one policy.Yes N/A  FORMCHECKBOX   FORMCHECKBOX DiscriminationORS 746.015, OAR 836-080-0050, OAR 836-080-0055Filing includes a statement that no assumptions or provisions unfairly discriminate in availability, rates, benefits, or any other way for individuals of the same class, equal expectation of life, and degree of risk or hazard. (For example, sources of funds going into the contract and funds being withdrawn are treated alike.)Yes N/A  FORMCHECKBOX   FORMCHECKBOX GuaranteesORS 731.296, ORS 742.023, ORS 742.005(3)(4)If this filing guarantees interest periods beyond one year, the filing includes an explanation of how the extended guarantee is supported. Guaranteed Income Benefit/Guaranteed Withdrawal Benefit/Guaranteed Accumulation Benefit. If the filing includes guaranteed living benefits (such as guaranteed income, guaranteed withdrawal or guaranteed accumulation benefits), the rates used at annuitization are the greater of the current purchase option rates or the contract guaranteed option rates, unless a demonstration of the pricing methodology is included showing that alternate settlement rates will produce guaranteed annuitization benefits that exceed those guaranteed under the contract and supporting the added costs for the benefit.Yes No  FORMCHECKBOX   FORMCHECKBOX Interest ratesORS 746.015(1)All extra credits are fair and equitable, do not unfairly discriminate in their application and availability, and are in compliance with the nonforfeiture requirements.Yes No  FORMCHECKBOX   FORMCHECKBOX  RequirementsReferenceDescription of review standards requirementsCheck answerNonforfeiture valuesORS 743.284, ORS 743.293 Nonforfeiture Law demonstrated. Demonstrate values at least as favorable to the owner by providing the requested information: (Selection must be consistent with that selected in the contract provisions of this product standard.) Demonstration includes a comparison of the contracts guaranteed accumulation values to nonforfeiture values, and contract values paid for surrender, maturity, and death for the nonforfeiture rate basis presented in the contract provisions section of this product standard. Net consideration is not less than 87.5% of the gross consideration. Annual maximum contract charge does not exceed $50. Describes how and when the nonforfeiture rate is determined and if applicable, application of the formula for redetermining the nonforfeiture rate. Describes the intervals for redetermination, if applicable. If applicable, describes how the criteria is monitored and values evaluated for compliance for each redetermination period. The penalty free withdrawal is not used in the Nonforfeiture demonstrations. Yes No  FORMCHECKBOX   FORMCHECKBOX ORS 743.284, ORS 743.293 If an equity indexed account is filed, include Supplement A.Yes N/A. FORMCHECKBOX   FORMCHECKBOX ORS 743.284(2), ORS 743.293For the criteria specified in the Nonforfeiture section of the main body of the product standards, in the format prescribed in the NAIC Guidelines and Appendices I-A and I-B, a comparison of the contract guaranteed surrender values with the minimum nonforfeiture values is included, which addresses each of the following. 1. The account value, surrender charge, surrender value, and minimum nonforfeiture amounts. One demonstration is based on the accumulation of percentages of premiums (for the retrospective test), the other on the discounted maturity value (for the prospective test) in compliance with the NAIC Standard Nonforfeiture Law for Individual Deferred Annuities, Model 805. 2. Clear identification of the basis of all values (interest rates, bonuses, fees, surrender charges, etc.) 3. Demonstrates compliance with the prospective test for a maturity period of 10 years based on each premium payment. 4. Demonstrates representative premium patterns and, for flexible premium products, both single premium and level premium payment. (Flexible payment contracts that show compliance on a per-payment basis, the contract must clearly and prominently disclose that each payment is considered separately.) 5. Demonstrates compliance with the law for all allowable premium amounts, in particular lowest and highest premium allowed under the contract. (Narrative may be used to explain why it is enough to demonstrate for a particular premium.) Yes  FORMCHECKBOX  Yes  FORMCHECKBOX  Yes  FORMCHECKBOX  Yes  FORMCHECKBOX  Yes  FORMCHECKBOX   RequirementsReferenceDescription of review standards requirementsCheck answerNonforfeiture, continuedORS 743.284(2), ORS 743.293 6. Sample calculations for representative issue ages, including issue age 35, if within the issue age range, and the highest issue age. (Calculations must properly reflect withdrawal amounts made during the surrender charge period that are not subject to surrender charge.) 7. The free-partial-withdrawal provision, consistent with the contract provisionYes N/A  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX ORS 731.296, ORS 742.023, ORS 743.153, ORS 743.278(1)(d)A description of the relationship of the guaranteed minimum interest rate (GMIR) to the nonforfeiture rate is included.Yes  FORMCHECKBOX If this contract is filed as unisex, the annuitization provision includes a description of the mortality table utilized in the contract, the interest rate, and the percentage for the blend of male and female mortality data used to develop the annuitization rates. Yes N/A  FORMCHECKBOX   FORMCHECKBOX ORS 743.278(1)(b), ORS 743.293, ORS 743.284(2)Market-value adjustment. 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The adjustment cannot reduce the credited interest rate during the guaranteed period below the nonforfeiture value for that period. Guaranteed periods that include a market-value adjustment are not automatically renewed without signed consent from the contract owner when the maturity date falls during the guaranteed period unless all charges and adjustments are waived on the maturity date.)Yes N/A  FORMCHECKBOX   FORMCHECKBOX Separate accountsORS 731.156Annuities containing separate accounts shall be considered variable only if the value of the annuity (or portion of the annuity pertaining to the separate account) varies according to the investment experience of the separate account. Annuities (or portions of annuities) which vary with respect to an index or which fluctuate in value on any other basis not directly related to the investment performance of the funds in the separate account are not considered variable.Variable benefitsORS 742.003(1)A change or modification to any item that may affect the derivation of and compliance of contract values with any required minimum nonforfeiture values are subject to prior approval and refiling of the applicable demonstration.     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L^ `L.x^x`.H^H`.L^`L.^`.^`.L^`L."]*O]*O]*O]*O]*O+C -&8W^T\/z1ni#S!2PBW[IkZ\S:R: U}qfpIy0-[nf@c~5QuD;; rpZCis:                  &pv                          0d                          Hv                                                              @&                                                                       *]Y                          ȓ        <X1K^>_ IC\( i 4 : I >}Nze0 fE }.Ulxvz #!Gu&8'=.(*(*(+U<+ . .fM/N[1(623[4n5E77n:e3;`;<>pC!DzBgD]Ln^09TGd)_6g6l&SUR[$wXHZtApI<?+ cW8rMFA\d.1` .4=6LD %:\pN%6i!J|="?"@ iiii81pqrstuvwnynzn|n}@@@@}}TT""""""""""hhhhhhiiiiiooo===""@xz|@@ @@@,@8@@@H@X@`@t@|@@@@@@@@ @ @4@<@ "H@&(T@4@ D@&(T@p@UnknownG*Ax Times New Roman5Symbol3. *Cx ArialS PalatinoBook Antiqua5. .[`)Tahoma?= *Cx Courier New;WingdingsA$BCambria Math"h&ϚJg;*Q+Q+0!!2QHX  $Ptj*!xx iForm 2454f, Standards for Prior Approval Individual Fixed Deferred Annuities, Form # 440-2454f, rev. 9/05yRates & Forms Filing Requirements Form 2454f, Standards for Prior Approval Individual Fixed Deferred Annuities, rev. 9/05eRates & Forms, Filing, Standards for Prior Approval Individual Fixed Deferred Annuities, 2454f, SERFF4Document: DCBS Insurance Div. (T. Prevett) rev. 9/05Steph                         Oh+'0HTl |    lForm 2454f, Standards for Prior Approval Individual Fixed Deferred Annuities, Form # 440-2454f, rev. 9/05|Rates & Forms Filing Requirements Form 2454f, Standards for Prior Approval Individual Fixed Deferred Annuities, rev. 9/058Document: DCBS Insurance Div. (T. 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The application is responsible for updating this value after each revision. ement ref="dcterms:modified" minOccurs="0" maxOccurs="1"/> ՜.+,D՜.+,$ px $ ,4<D L |Rates & Forms Filing Requirements Form 2454f, Standards for Prior Approval Individual Fixed Deferred Annuities, rev. 9/05DCBS! jForm 2454f, Standards for Prior Approval Individual Fixed Deferred Annuities, Form # 440-2454f, rev. 9/05 Title0 _PID_HLINKS7display_urn:schemas-microsoft-com:office:office#Editor7display_urn:schemas-microsoft-com:office:office#AuthorAL&Ahttp://dfr.oregon.gov/rates-forms/annuities/Pages/annuities.aspxDavid S MohrmanDavid S Mohr