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Overall Rate Impact: Filing Status Changed: 10/28/2011 State Status Changed: 10/28/ PDF

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SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole
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SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole Sub-TOI: L07I.121 Graded Premium - Single Life Product Name: Whole Life insurance plicy Project Name/Number: CWLG 9/11/ Filing at a Glance Company: The Chesapeake Life Insurance Company Product Name: Whole Life insurance plicy SERFF Tr Num: MGCC State: Arkansas TOI: L07I Individual Life - Whole SERFF Status: Closed-Approved- State Tr Num: Closed Sub-TOI: L07I.121 Graded Premium - Single Co Tr Num: CWLG 9/11 State Status: Approved-Closed Life Filing Type: Form Reviewer(s): Linda Bird Author: Jan Spoede Disposition Date: 10/28/2011 Date Submitted: 10/18/2011 Disposition Status: Approved- Closed Implementation Date Requested: On Approval Implementation Date: State Filing Description: General Information Project Name: CWLG 9/11 Status of Filing in Domicile: Pending Project Number: Date Approved in Domicile: Requested Filing Mode: Review & Approval Domicile Status Comments: The domicilary state of Oklahoma is part of an ICC filing. Explanation for Combination/Other: Market Type: Individual Submission Type: New Submission Individual Market Type: Overall Rate Impact: Filing Status Changed: 10/28/2011 State Status Changed: 10/28/2011 Deemer Date: Created By: Jan Spoede Submitted By: Jan Spoede Corresponding Filing Tracking Number: Filing Description: CWLG 9/11, Whole Life Insurance Policy With Graded Death Benefit This filing is for a graded death bebeft whole life policy with full benefit upon accidental death during the first two years. The premiums are payble for the period show in the Policy Specifications or until the prior death of the Insured. The Net Cash Value is payable if the Insured Person is living at the attained age of 100. Tis policy is non-participating and has no annual dividends. This policy will be used with previously filed forms: PDF Pipeline for SERFF Tracking Number MGCC Generated 10/28/ :36 AM SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole Sub-TOI: L07I.121 Graded Premium - Single Life Product Name: Whole Life insurance plicy Project Name/Number: CWLG 9/11/ CTIR 9/11, an Accelerated Benefit Terminal Illness Rider CADB 9/11, an Accidental Death Benefit to Age 100 Rider CWL APP 9/11, an Application All of these forms have been filed with this state and are Pending. The SERFF tracking number of that filing is MGCC Company and Contact Filing Contact Information Kym Glenn, Vice President 9151 Boulevard [Phone] North Richland Hills, TX [FAX] Filing Company Information The Chesapeake Life Insurance Company CoCode: State of Domicile: Oklahoma 9151 Boulevard 26 Group Code: 264 Company Type: Health North Richland Hills, TX Group Name: State ID Number: (817) ext. [Phone] FEIN Number: Filing Fees Fee Required? Yes Fee Amount: $50.00 Retaliatory? Yes Fee Explanation: The domiciliary state of OK requires $50.00 per policy,. Per Company: No COMPANY AMOUNT DATE PROCESSED TRANSACTION # The Chesapeake Life Insurance Company $ /18/ PDF Pipeline for SERFF Tracking Number MGCC Generated 10/28/ :36 AM SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole Sub-TOI: L07I.121 Graded Premium - Single Life Product Name: Whole Life insurance plicy Project Name/Number: CWLG 9/11/ Correspondence Summary Dispositions Status Created By Created On Date Submitted Approved- Linda Bird 10/28/ /28/2011 Closed Objection Letters and Response Letters Objection Letters Response Letters Status Created By Created On Date Submitted Responded By Created On Date Submitted Pending Industry Response Linda Bird 10/24/ /24/2011 Jan Spoede 10/27/ /27/2011 PDF Pipeline for SERFF Tracking Number MGCC Generated 10/28/ :36 AM SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole Sub-TOI: L07I.121 Graded Premium - Single Life Product Name: Whole Life insurance plicy Project Name/Number: CWLG 9/11/ Disposition Disposition Date: 10/28/2011 Implementation Date: Status: Approved-Closed Comment: Rate data does NOT apply to filing. PDF Pipeline for SERFF Tracking Number MGCC Generated 10/28/ :36 AM SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole Sub-TOI: L07I.121 Graded Premium - Single Life Product Name: Whole Life insurance plicy Project Name/Number: CWLG 9/11/ Schedule Schedule Item Schedule Item Status Public Access Supporting Document Flesch Certification Yes Supporting Document Application Yes Supporting Document Life & Annuity - Acturial Memo No Supporting Document Certification for Bulletin Yes Supporting Document Certification for Bulletin 19 Yes Supporting Document No Illustration Certification Yes Supporting Document Statement of Variability Yes Supporting Document Statement of Policy Cost and Benefit Yes Supporting Document Certification for Bulletin 34 Yes Supporting Document Bulletin Notice Yes Form (revised) Graded Death Benefit Whole Life Yes Insurance policy Form Graded Death Benefit Whole Life Insurance policy Replaced Yes PDF Pipeline for SERFF Tracking Number MGCC Generated 10/28/ :36 AM SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole Sub-TOI: L07I.121 Graded Premium - Single Life Product Name: Whole Life insurance plicy Project Name/Number: CWLG 9/11/ Objection Letter Objection Letter Status Pending Industry Response Objection Letter Date 10/24/2011 Submitted Date 10/24/2011 Respond By Date 11/24/2011 Dear Kym Glenn, This will acknowledge receipt of the captioned filing. Objection 1 Comment: Ark. Code Ann requires that certain information accompany every policy. Bulletin further address this issue. Regulation 49 requires that a Life and Health guaranty notice be given to each policy owner. Please review your issue procedures and assure us that you are in compliance with Regulation 49. Life Policies with reduced death benefits in early policy years are subject to Bulletin The contract is in violation of Guideline Two of this bulletin. The policy does not provide for the payment of 8% interest on delayed claim payments as described in Ark. Code Ann A.C.A (1)-(5) sets forth the procedure by which filings may be deemed approved upon the expiration of certain time periods with no affirmative action by the commissioner. If the commissioner determines that additional information is needed to make a decision regarding approval, such request for information will be made to the company. The filing will not be considered complete until said additional information is received. The time periods set forth in this statute will not begin to run until the filing is complete. Please feel free to contact me if you have questions. Sincerely, Linda Bird PDF Pipeline for SERFF Tracking Number MGCC Generated 10/28/ :36 AM SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole Sub-TOI: L07I.121 Graded Premium - Single Life Product Name: Whole Life insurance plicy Project Name/Number: CWLG 9/11/ Response Letter Response Letter Status Submitted to State Response Letter Date 10/27/2011 Submitted Date 10/27/2011 Dear Linda Bird, Comments: Response 1 Comments: We have attached a copy of the notice required by Bulletin All policy owners will receive a copy with their policies. Our procedures require delivery of a Arkansas Life and Health Guaranty Association notice with each policy issued in Arkansas. The section of the policy which conflicted with Guideline Two of Bulletin 8-85 has been removed from the policy. A revised copy is included with this response. We modified the Settlement Provision of the contract to comply with Arkansas Code Related Objection 1 Comment: Ark. Code Ann requires that certain information accompany every policy. Bulletin further address this issue. Regulation 49 requires that a Life and Health guaranty notice be given to each policy owner. Please review your issue procedures and assure us that you are in compliance with Regulation 49. Life Policies with reduced death benefits in early policy years are subject to Bulletin The contract is in violation of Guideline Two of this bulletin. The policy does not provide for the payment of 8% interest on delayed claim payments as described in Ark. Code Ann Changed Items: PDF Pipeline for SERFF Tracking Number MGCC Generated 10/28/ :36 AM SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole Sub-TOI: L07I.121 Graded Premium - Single Life Product Name: Whole Life insurance plicy Project Name/Number: CWLG 9/11/ Supporting Document Schedule Item Changes Satisfied -Name: Bulletin Notice Comment: Form Schedule Item Changes Form Name Form Edition Form Type Action Action Readability Attach Number Date Specific Score Document Data Graded Death Benefit CWLG Policy/Contract/Fraternal Initial Chesapea Whole Life Insurance 9/11 Certificate ke_grade policy d_plan_a R.pdf Previous Version Graded Death Benefit CWLG Policy/Contract/Fraternal Initial CWLG 9- Whole Life Insurance 9/11 Certificate 11.pdf policy No Rate/Rule Schedule items changed. Sincerely, Jan Spoede PDF Pipeline for SERFF Tracking Number MGCC Generated 10/28/ :36 AM SERFF Tracking Number: MGCC State: Arkansas Filing Company: The Chesapeake Life Insurance Company State Tracking Number: Company Tracking Number: CWLG 9/11 TOI: L07I Individual Life - Whole Sub-TOI: L07I.121 Graded Premium - Single Life Product Name: Whole Life insurance plicy Project Name/Number: CWLG 9/11/ Form Schedule Lead Form Number: Schedule Form Form Type Form Name Action Action Specific Readability Attachment Item Status Number Data CWLG 9/11Policy/Cont Graded Death ract/fratern Benefit Whole Life Initial Chesapeake_ Graded_Plan al Certificate Insurance policy _AR.pdf PDF Pipeline for SERFF Tracking Number MGCC Generated 10/28/ :36 AM The Chesapeake Life Insurance Company A Stock Company (Hereinafter called: the Company, We, Our or Us) Home Office: Oklahoma City, Oklahoma [Customer Service Address: 100 Centerview Drive, Suite 100, Nashville, Tennessee Customer Service: ] Administrative Office: P. O. Box , North Richland Hills, Texas [www.thechesapeakelife.com] WHOLE LIFE INSURANCE POLICY WITH GRADED DEATH BENEFIT The Chesapeake Life Insurance Company agrees to pay the Death Benefit of this Policy as shown in the Table of Policy Values Page to the Beneficiary when We receive proper written claim and due proof of the death of the Insured Person while this Policy is in force. Our payment will be subject to the terms and provisions of this Policy. IMPORTANT NOTICE ABOUT STATEMENTS IN THE APPLICATION The attached application is a part of this Policy. Please read it and check it carefully. This Policy is issued on the basis that the Insured Person s answers are correct and complete. If it is not complete or has an error, please let Us know within 30 days. An incorrect application may cause this coverage to be voided, or a claim to be reduced or denied. The insurance under this Policy is granted in consideration of the application and payment of a premium due on the Policy date. It is a legal contract between You and the Company. Premiums must be paid while the Insured Person is alive for the time shown in the Policy Specifications. 30 DAY RIGHT TO EXAMINE POLICY. This life insurance Policy is a legal contract between the Owner and Us. PLEASE READ IT CAREFULLY. It is important to Us that You are satisfied with this Policy. If You are not satisfied, You may return the Policy to Us or to any agent of the Company within 30 days after You receive it. We will refund all the premiums You have paid. The Policy will be deemed void from the Policy Date. GRADED DEATH BENEFIT WHOLE LIFE POLICY Premiums payable for the period shown in the Policy Specifications or until the prior death of the Insured Person Net Cash Value payable if Insured Person is living at attained age 100 NON-PARTICIPATING NO ANNUAL DIVIDENDS THIS IS A LIMITED DEATH BENEFIT POLICY DURING THE FIRST TWO (2) POLICY YEARS CWLG 9/11 AR Page 1 TABLE OF CONTENTS POLICY SPECIFICATIONS...Page 3 TABLE OF POLICY VALUES...Page 4 DEFINITIONS...Page 5 OWNERSHIP PROVISION...Page 5 SETTLEMENT PROVISION Amount of Proceeds...Page 6 GENERAL PROVISIONS Cash Value..... Page 7 Contestability...Page 8 Suicide...Page 8 Change in Plan...Page 8 Non-Participating...Page 8 Beneficiary Change...Page 9 Assignment...Page 9 Misstatement of Age or Sex...Page 9 Contract...Page 9 Unearned Premium Refund...Page 10 PREMIUM PAYMENT PROVISION Where Payable...Page 10 Amount and Frequency...Page 10 Grace Period...Page 10 Policy Years...Page 10 Reinstatement...Page 10 POLICY LOAN PROVISION Amount of Loan Available...Page 11 Cash Loan...Page 11 Automatic Premium Loan...Page 11 Loan Interest...Page 11 Repayment of Loan...Page 12 Termination of the Policy...Page 12 NON-FORFEITURE PROVISION...Page 12 DETERMINATION OF POLICY VALUES Basis of Policy Values...Page 13 Reserves...Page 13 CWLG 9/11 AR Page 2 SETTLEMENT OPTIONS...Page 13 A copy of the Application and any Endorsements or Riders follow page 18. CWLG 9/11 AR Page 3 POLICY SPECIFICATIONS YEARS TOTAL ANNUAL FORM NO. DESCRIPTION OF BENEFITS PAYABLE PREMIUM CWLG 9/11 Graded Death Benefit - Whole Life [ 50] [ $1,324.83] INITIAL MODE PREMIUM: [$1, ANNUALLY] PREMIUM INCLUDES [$36.00] ANNUAL POLICY FEE NAME OF INSURED PERSON: [JOHN DOE] POLICY NUMBER: [123456] POLICY DATE: [AUGUST 1, 2001] PREMIUM CLASS: [NON-NCOTINE] ISSUE AGE: [50] SEX: [MALE] SPECIFIED DEATH BENEFIT: [ $10,000.00] LIMITED DEATH BENEFIT IN YEARS 1-2 SEE TABLE OF POLICY VALUES OWNER: [JOHN DOE] MATURITY DATE: [AUGUST 1, 2051] BENEFICIARY: AS DESIGNATED IN THE APPLICATION UNLESS CHANGED AS PROVIDED BY THE POLICY. YOU MAY DIRECT QUESTIONS CONCERNING THIS COMPANY OR THIS PRODUCT BY CONTACTING THE INSURANCE REGULATORY AUTHORITY FOR YOUR STATE. THE PHONE NUMBER FOR YOUR STATE INSURANCE DEPARTMENT IS: [STATE NAME TOLL FREE NUMBER] CWLG 9/11 AR Page 4 TABLE OF POLICY VALUES NAME OF INSURED PERSON: [JOHN DOE] POLICY NUMBER: [123456] POLICY DATE: [AUGUST 1, 2001] SPECIFIED DEATH BENEFIT: [$10,000.00] LIMITED DEATH BENEFIT IN YEARS 1-2 ISSUE AGE: [ 50] SEX: [MALE] POLICY YEAR CASH VALUE REDUCED* PAID-UP AMOUNT DEATH BENEFIT 1 ($0.00) ($0.00) ($3,000.00) 2 (50.00) (0.00) (7,000.00) 3 (220.00) (180.00) (10,000.00) 4 (390.00) (730.00) (10,000.00) 5 (570.00) (1,240.00) (10,000.00) 6 (750.00) (1,750.00) (10,000.00) 7 (940.00) (2,210.00) (10,000.00) 8 (1,130.00) (2,670.00) (10,000.00) 9 (1,320.00) (3,100.00) (10,000.00) 10 (1,520.00) (3,490.00) (10,000.00) 11 (1,730.00) (3,870.00) (10,000.00) 12 (1,940.00) (4,260.00) (10,000.00) 13 (2,150.00) (4,610.00) (10,000.00) 14 (2,360.00) (4,940.00) (10,000.00) 15 (2,580.00) (5,250.00) (10,000.00) 16 (2,790.00) (5,560.00) (10,000.00) 17 (3,020.00) (5,820.00) (10,000.00) 18 (3,240.00) (6,110.00) (10,000.00) 19 (3,470.00) (6,360.00) (10,000.00) 20 (3,710.00) (6,610.00) (10,000.00) 21 (3,950.00) (6,860.00) (10,000.00) Age 60 (1,520.00) (3,490.00) (10,000.00) Age 65 (2,580.00) (5,250.00) (10,000.00) *Subject to Policy minimums CWLG 9/11 AR Page 5 DEFINITIONS AGE: The Insured Person's age on the Policy Date. BENEFICIARY: The person(s) or entity named in the application to receive the benefits at the Insured Person's death. DEATH BENEFIT: The Death Benefit shown in the Table of Policy Values, payable to the Beneficiary at the death of the Insured Person, less any unpaid premium and benefits previously paid under any accelerated benefit rider. EVIDENCE: Evidence of insurability satisfactory to Us. INSURED PERSON: The person(s) whose life is Insured Person under this Policy as shown in the Policy Specifications Page. OWNER: The Owner of this Policy. The Owner is the person who may exercise all Policy privileges and rights while the Insured Person is living. The initial Owner is named in the Policy Specifications Page. PAYEE: The designated recipient of the Proceeds under a Settlement Option. POLICY: The written description of coverage provided to You by Us. This Policy is a legal contract. POLICY ANNIVERSARY: The same day and month as Your Policy date for each succeeding year Your Policy remains in force. POLICY DATE: The effective date of coverage under this Policy. The date from which Policy Anniversaries, Policy years, Policy months and premium due dates are determined. POLICY SPECIFICATIONS PAGE: Data showing your benefits, cost, Policy Date and Policy Specifications. PREMIUM: Money paid for this insurance coverage. PREMIUM IN DEFAULT: A premium not paid before the end of the grace period is in default. PROCEEDS: The amount We are obligated to pay under the terms of this Policy. WE, OUR, OURS, US: The Chesapeake Life Insurance Company. WRITTEN REQUEST: A request in writing signed by You. We may require that Your Policy be sent in with Your Written Request. YOU, YOUR, YOURS: The owner of this Policy as shown on the application unless subsequently changed. The Owner may be someone other than the Insured Person. CWLG 9/11 AR Page 6 OWNERSHIP PROVISION Unless otherwise stated in the application or later changed, the Owner of the Policy will be the person listed as Insured Person of the Policy on the Policy Specification Page. You may name a contingent owner for the Policy. While this Policy is in effect, unless otherwise provided, You as Owner have all the rights of this Policy. If You die while this Policy is in effect, the Contingent Owner is the new Owner. If both the Owner and contingent owner die before the Insured Person, the ownership of this Policy will automatically pass to the Insured Person. You may change the Owner while the Insured Person is living by Written Request. Such change is subject to any existing assignment of this Policy. The change becomes effective when we record it. When recorded, the effective date is the date the notice was signed. The change is subject to any Proceeds paid or other action taken by Us before the change was recorded. SETTLEMENT PROVISION If the Insured dies prior to the Maturity Date shown in the Policy Specifications and while this policy is in force, We will pay the Proceeds to the Beneficiary upon receipt of due proof of death of the Insured within 30 days. The Proceeds will be paid in one sum unless a Settlement Option is chosen. Proceeds are also subject to the Beneficiary provisions and Settlement Option section and will be reduced by any outstanding Indebtedness. All benefits will be payable at Our Home Office. Surrender of the policy to Us is required on the date the benefits are paid. We will pay the benefits to the Beneficiary as named on the date of death of the Insured, subject to the rights of any person under an assignment of this policy. If payment is not made within 30 days of receipt of due proof of death, We will pay interest on the benefits at a an annual rate of interest equal to the average rate of 8% from the date of the Insured s death. AMOUNT OF PROCEEDS The Proceeds are the sum of: 1. the Death Benefit, as shown in the Policy Specifications Page and Table of Policy Values page; PLUS 2. any insurance on the Insured Person s life that may be provided by riders to this Policy, except for any accelerated benefit rider; PLUS 3. that portion
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