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SPECIMEN as if filed with Securities and Exchange Commission on May 1, 2022.
Registration Nos. 333-00000/811-21581
FORM N-6
Registration Statement
Under the Securities Act of 1933
Pre-Effective Amendment No.
Post-Effective Amendment No. 44
And/Or  
Registration Statement
Under the Investment Company Act of 1940
Amendment No. 333
N6-TST-613

 

KEY INFORMATION

Important Information You Should Consider About the Contract

  FEES AND EXPENSES LOCATION IN PROSPECTUS
Charges for Early Withdrawals

Withdrawal charges vary by class. A Withdrawal Charge of up to 10.00% may be assessed on any premium payment paid up to 12 years before the date of the withdrawal.

For example, if you purchase a B Class for $100,000 and surrender your Contract during the first year, You will pay a Withdrawal Charge of up to $10,000.

Charges and Deductions - Surrender Charge and Partial Withdrawal Service Fee
Transaction Charges In addition to surrender charges, you also may be charged for other transactions. Although we do not currently charge a fee for transfers of cash value among Divisions or between the Divisions and the Fixed Account, We reserve the right to impose a transfer fee of $25. Account reduction loans will incur a $75 account reduction loan initiation fee. Charges and Deductions – Premium Expense and Fee Table - Transaction Fees
Ongoing Fees and Expenses (annual charges) The table below describes the fees and expenses that you may pay each year, depending on the options you choose. Please refer to your Contract specifications page for information about the specific fees you will pay each year based on the options you have elected. Charges and Deductions – Monthly Deduction and Fee Table
  Annual Fee Minimum Maximum  
  Investment Options 0.50(1) 1.45(1)  
 

(1) Portfolio Company fees and expenses

 
  RISKS LOCATION IN PROSPECTUS
Risk of Loss

You can lose money by investing in the Policy.

Principal RIsks of Investing in the Policy
Not a Short-Term Investment

This Policy is not a short-term investment and is not appropriate for an investor who needs ready access to cash. Charges assessed on Premiums and the Surrender Charge imposed on surrenders during the first 10 Policy Years will reduce your surrender proceeds. In addition, a surrender may have adverse tax consequences.

Principal RIsks of Investing in the Policy
Risks Associated with Investment Options

Your Policy Value will vary depending on the investment options you select. Sub-Accounts will vary depending on the performance of the Portfolio Companies in which they invest and are subject to the risk of negative investment performance. Each investment option, including the Fixed Account investment option, will have its own unique risks. You should review these investment options before making an investment decision.

Principal Risks of Investing in the Policy

and

General Description of the Policy

Insurance Company Risks

An investment in the Policy is subject to the risks related to XYZ Assurance Company. Any obligations (including under any fixed account investment options), guarantees, or benefits are subject to the claims-paying ability of XYZ Assurance Company. If XYZ Assurance Company experiences financial distress, it may not be able to meet its obligations to you. More information about XYZ Assurance Company, including its financial strength ratings, is available upon request by calling 1-800-555-5555.

Financial Condition of XYZ
Contract Lapse

Your Policy could lapse (terminate) if the value of your Policy becomes too low to support the Policy’s monthly charges and the Safety Net Premium feature is not in effect. Death benefits will not be paid if the Policy has lapsed. If you have any outstanding Policy loans when your Policy lapses, you may have taxable income as a result.

If the Policy lapses, you may apply for reinstatement by paying to us the reinstatement Premium and any applicable charges required under the Policy. If a Policy loan was outstanding at the time of your Policy’s lapse, you must either repay or reinstate the loan before we reinstate your Policy. All Policy charges continue to be based on your original Issue Date.

How Your Policy Can Lapse
  RESTRICTIONS LOCATION IN PROSPECTUS
Investments

Certain Sub-Accounts may not be available depending on the date you purchased your Policy. In addition, Certain Sub-Accounts are closed to Policy Owners not invested in the specified Sub-Accounts by a designated date. We reserve the right to add, combine, remove or substitute investment options.

We also reserve the right to limit the size of transfers and remaining balances, and to limit the number and frequency of transfers among your investment options and the Fixed Account. We reserve the right to limit transfers in any Policy Year, or to refuse any transfer request for a Policy Owner or certain Policy Owners.

More information about the Portfolio Companies is available in the prospectuses for the Portfolio Companies, which may be amended from time to time and can be found online at https://example.net/products. You can also request this information at no cost by calling 1-800-888-8888 or by sending an email request to help@example.net.

Changes to the Separate Account - Additions, Deletions and Substitutions of the Securities 

 

Market Timing and Excessive Trading and Trading Limitations
Optional Benefits

We may discontinue or modify any of the optional benefits at any time prior to the time you elect to receive it..

Other Benefits Available Under the Policy
  TAXES LOCATION IN PROSPECTUS
Tax Implications
You should consult with a tax professional to determine the tax implications of an investment in and payments received under the Policy. The death benefit of a life insurance policy that was transferred for value may be subject to ordinary income taxes, and subject to tax penalties.
Federal Taxes
  CONFLICTS OF INTEREST LOCATION IN PROSPECTUS
Investment Professional Compensation

Some investment professionals may receive compensation for selling the Policy to investors.

We will pay commissions to broker-dealers that sell the Policies. In addition, certain bonuses and managerial compensation may be paid.

From time to time, we pay asset-based compensation to broker-dealers. We may also pay or allow other promotional incentives or payments in the form of cash or non-cash compensation. These investment professionals may have a financial incentive to offer or recommend the Policy over another investment.

Charges and Deductions - Commissions Paid to Broker-Dealers
Exchanges
Some investment professionals may have a financial incentive to offer an investor a new Policy in place of the one you already own. You should only exchange your Policy if you determine, after comparing the features, fees, and risks of both Policies, that it is preferable for you to purchase the new Policy rather than continue to own your existing Policy.
Charges and Deductions - Commissions Paid to Broker-Dealers

FEE TABLE

The following tables describe the fees and expenses that you will pay when buying, owning, and surrendering or making withdrawals from the Policy. Please refer to your Policy specifications page for information about the specific fees you will pay each year based on the options you have elected.

The first table describes the fees and expenses that you will pay at the time that you buy the Policy, surrender or make withdrawals from the Policy, or transfer cash value between Investment Options.

Transaction Fees

Charge When Charge is Deducted Amount Deducted

Maximum Sales Charge Imposed on Premiums (Load)

When you pay a premium

6% of the Premium amount

Surrender Charge

 

 

Year One for a Representative Investor (1)

Surrender Charge for 45-year Old Male Non-Smoker, $120,000 Face Amount, at issue

When you surrender your Policy during the first 10 Policy Years

  

When you surrender your Policy

Maximum: $47.49 per $1,000 of Face Amount

Minimum: $4.48 per $1,000 of Face Amount

 

$20.88 per $1,000 of Face Amount

Partial Withdrawal Service Fee

When you make a withdrawal

The lesser of 2% of amount withdrawn or $25.00

Transfer Fee(2)

Second and each subsequent transfer in each calendar month

$10.00 Maximum;

$0 current

Accelerated Death Benefit Rider, Terminal Illness

When Benefit Elected

$150

Accelerated Death Benefit Rider, Chronic Illness

When Benefit Elected

$250

Overloan Protection Rider

When Benefit Elected

4.5% of Policy Value

(1) The charge varies based on individual characteristics. The charge shown in the table may not be representative of the charge that a particular investor will pay. You may obtain more information about the particular charges that would apply to you by contacting the number on the cover page.

(2) We are currently waiving this fee.

The next table describes the fees and expenses that you will pay periodically during the time that you own the Policy, not including the Portfolio Company's fees and expenses.

Periodic Charges Other Than Annual Portfolio Company's Expenses

Charge When Charge is Deducted Amount Deducted
Base Policy Charge:    

Cost of Insurance (1)

Maximum and Minimum Charge

 

Charge for a Representative Investor (1)

Cost of Insurance Charge for 45-year old Male Non-Smoker, $120,000 Face Amount, at issue, assuming $1,825.00 annual premium

Monthly

 

 

 

  Monthly

Maximum and current: $83.33 per $1,000 Net Amount at Risk

Minimum and current: $0.01 per $1,000 Net Amount at Risk

 

Guaranteed: $0.16 per $1,000 net Amount at Risk

Current: $0.16 per $1,000 Net Amount at Risk

First Month’s Charge: $18.37 

Policy Fee

Monthly

Maximum: $15; current: $11

Mortality and Expense Risk Fees

Monthly

Years 1-10: 0.85% annually - guaranteed (0.70% annually - current) Sub-Account Policy Value

Years 11+: 0.45% annually - guaranteed (0.30% annually - current) Sub-Account Policy Value

Administrative Expense Charge

 

 

Charge for a Representative Investor (1)

Cost of Insurance Charge for 45-year old Male Non-Smoker, $120,000 Face Amount, at issue

 Monthly for the first 30 Policy Years

Maximum: $0.35 per $1,000 Face Amount

Minimum: $0.06 per $1,000 Face Amount

 

$0.16 per $1,000 on the first $100,000

$0.06 per $1,000 on the amount over $100,000

For Policies with applications signed prior to August 10, 2020:  

 

Loan Interest Rate

Annually

Interest Rate on Preferred Loans 2% annually;

Interest Rate on Standard Loans 3% annually;

For Policies with applications signed on or after August 10, 2020:

 

Loan Interest Rate
Annually

Interest Rate on Preferred Loans 1% annually;

Interest Rate on Standard Loans 2% annually;

Optional Benefit Charges  

 

Children’s Level Term Rider

Monthly

$0.50 per $1,000 unit of coverage

Accidental Death Benefit Rider

 

 

Charge for a Representative Investor (1)

Cost of Insurance Charge for 45-year old Male Non-Smoker, $120,000 Face Amount, at issue

Monthly

Maximum COI: $0.13 per $1,000 of benefit amount

Minimum COI: $0.08 per $1,000 of benefit amount

 

$0.10 per $1,000

Monthly Charge: $12.00

Continuation of Payment Rider

 

Charge for a Representative Investor (1)

Cost of Insurance Charge for 45-year old Male Non-Smoker, $120,000 Face Amount, at issue, assuming $1,825.00 annual premium

Monthly

Maximum COI: $1.54 per $100 of benefit amount

Minimum COI: $0.25 per $100 of benefit amount

 

$0.64 per $1,000

Monthly Charge: $11.68

Guaranteed Insurability Rider

 

Charge for a Representative Investor (1)

Cost of Insurance Charge for 45-year old Male Non-Smoker, $120,000 Face Amount, at issue

Monthly

Maximum COI: $1.12 per $1,000 of benefit amount

Minimum COI: $0.07 per $1,000 of benefit amount

 

$0.11 per $1,000

Monthly Charge: $13.20

(1) The cost of insurance varies based on individual characteristics. The cost of insurance charge or other charge shown in the table may not be representative of the charge that a particular investor will pay. You may obtain more information about the particular cost of insurance or other charges that would apply to you by contacting the number on the cover page.

The next table shows the minimum and maximum total operating expenses charged by the Portfolio Companies that you may pay periodically during the time that you own the Policy. A complete list of the Portfolio Companies available under the Policy, including their annual expenses, is located in the Appendix B at the back of this Prospectus.

The Portfolio Company's Annual Expenses

  Minimum Maximum

Total Annual Operating Expenses (1) (expenses that are deducted from the Portfolio Company's assets, which may include management fees, distribution and/or service (12b-1) fees, and other expenses)

0.15% 1.09%

(1) Expenses are shown as a percentage of the Portfolio Company's average daily net assets (before any waiver or reimbursement) as of December 31, 2021.

 

PRINCIPAL RISKS

Investing in the Contracts involves risks. The following are the principal risks of an investment in the Contract. You should carefully consider the below risks in addition to the other information contained in this Prospectus.

Risk of Loss. You can lose money by investing in the Policy. Amounts you allocate to Sub-Accounts may grow in value, decline in value, or grow less than you expect, depending on the investment performance of the Portfolio Companies in which those Sub-Accounts invest. You bear the investment risk that the Portfolio Companies might not meet their investment objectives. Shares of the Portfolio Companies are not deposits, or obligations of, or guaranteed or endorsed by any bank and are not insured by the Federal Deposit Insurance Corporation, the Federal Reserve Board or any other agency.

Not a Short-Term Investment. This Policy is designed to provide benefits on a long-term basis. It is not suitable as a short-terms savings vehicle. You should not purchase the Policy if you may need to access the Policy Value within a short time. If you are purchasing a Policy for a specialized purpose, you should consider whether the long-term nature of the Policy is consistent with the purpose for which you are purchasing the Policy.

Risks Associated with Investments. An investment in the Policy is subject to the risks related to XYZ Insurance Company. Any obligations (including under any Fixed Account investment options), guarantees, or benefits are subject to the claims-paying ability of XYZ Insurance. If XYZ Insurance experiences financial distress, it may not be able to meet its obligations to you.

Insurance Company Risks. An investment in the Contract is subject to the risks related to the Company. Any obligations (including under the Fixed Account), guarantees, or benefits are subject to the claims-paying ability of the Company, and our long term ability to make such payments, and are not guaranteed by any other party. XYZ Insurance is regulated as an insurance company under state law, which generally includes limits on the amount and type of investments in its general account. However, there is no guarantee that we will be able to meet our claims paying obligations; there are risks to purchasing any insurance product.

Policy Lapse.  Your Policy could lapse (terminate) if the value of your Policy becomes too low to support the Policy’s monthly charges and the Safety Net Premium feature is not in effect. Death benefits will not be paid if the Policy has lapsed. If you have any outstanding Policy loans when your Policy lapses, you may have taxable income as a result.

If the Policy lapses, you may apply for reinstatement by paying to us the reinstate Premium and any applicable charges required under the Policy. If a Policy loan was outstanding at the time of your Policy’s lapse, you must either repay or reinstate the loan before we reinstate your Policy. All Policy charges continue to be based on your original Issue Date.

Access to Cash Value. You may surrender your Policy at any time for its Net Surrender Value. Upon surrender, life insurance coverage under your Policy ends. We will subtract a surrender charge from your surrender proceeds during the first ten Policy Years and the first ten years following an increase to the Face Amount. You also may withdraw a portion of your Policy Value through a partial withdrawal. We deduct a partial withdrawal service fee of the lesser of 2% of the amount withdrawn, or $25, from the remaining Policy Value for a partial withdrawal. Surrenders and withdrawals may have adverse tax consequences.

Tax Consequences. Your Policy is structured to meet the definition of a life insurance policy under the Tax Code. We may need to limit the amount of Premiums you pay under the Policy to ensure that your Policy continues to meet that definition. Current federal tax law generally excludes all Death Benefits from the gross income of the beneficiary of a life insurance policy. In addition, you generally are not subject to taxation on any increase in the Policy Value until it is withdrawn. Generally, you are taxed on surrender proceeds and the proceeds of any partial withdrawals only if those amounts, when added to all previous distributions, exceed the total Premiums paid. Amounts received upon surrender or withdrawal in excess of Premiums paid are treated as ordinary income.

Special rules govern the tax treatment of life insurance policies that meet the federal definition of a modified endowment contract. Depending on the amount and timing of your Premiums, your Policy may meet that definition. Under current tax law, Death Benefit payments under modified endowment contracts, like Death Benefit payments under other life insurance policies, generally are excluded from the gross income of the beneficiary. Withdrawals and Policy loans, however, are treated differently. Amounts withdrawn and Policy loans are treated first as income, to the extent of any gain, and then as a return of Premium. The income portion of the distribution is includible in your taxable income. In addition, an additional 10% federal penalty tax is generally imposed on the taxable portion of amounts received before age 59½. We will not accept any Premium that would cause the Policy not to qualify as a life insurance policy under the Tax Code. For more information on the consequences of a Policy becoming a modified endowment contracts, see Federal Taxes -Modified Endowment Contracts. For more information on the tax treatment of the Policy, in general, see “Federal Taxes".

The death benefit of life insurance policies that were transferred for value may be subject to ordinary income taxes. Estate taxes may apply. Consult your tax adviser for additional information.

Cybersecurity. Cybersecurity breaches can be intentional or unintentional events, and can occur through unauthorized access to computer systems, networks or devices; infection from computer viruses or other malicious software code; or attacks that shut down, disable, slow or otherwise disrupt operations, business processes or website access or functionality. Cybersecurity breaches can interfere with our processing of contract transactions, including the processing of transfer orders from our website or with the Portfolios; impact our ability to calculate Accumulation Unit Values; cause the release and possible destruction of confidential Contract Owner or business information; or impede order processing or cause other operational issues. Although we continually make efforts to identify and reduce our exposure to cybersecurity risk, there is no guarantee that we will be able to successfully manage this risk at all times.

COVID-19 Risk. The pandemic spread of the novel coronavirus COVID-19 is causing illnesses and deaths. This pandemic, other pandemics, and their related major public health issues are having a major impact on the global economy and financial markets. Governmental and non-governmental organizations may not effectively combat the spread and severity of such a pandemic, increasing its harm to the Company. Any of these events could have a material adverse effect on the Company’s operations, business, financial results, or financial condition.

 

Standard Death Benefits

Death Benefits. While your Policy is in force, we pay the Death Benefit proceeds upon the death of the Insured. We will pay the Death Benefit proceeds to the named Beneficiary(ies) or contingent Beneficiary(ies). As described below in “Settlement Options,” we pay the Death Benefit proceeds in one sum or under an optional payment plan.

The Death Benefit proceeds payable to the Beneficiary equal the applicable Death Benefit, less any Policy Debt and less any due and unpaid charges. The proceeds may be increased, if you have added a rider that provides an additional benefit. Riders which may impact the death benefit include the Accidental Death Benefit Rider, the Overloan Protection Rider, and the Accelerated Death Benefit Riders. Please see “Other Benefits Available Under Your Policy”. We determine the amount of the Death Benefit proceeds as of the end of the Valuation Period during which the Insured dies. We usually pay the Death Benefit proceeds within seven days after we have received due proof of death and all other requirements we deem necessary have been satisfied. The amount of the Death Benefit is based on the Death Benefit Option you have selected, any increases or decreases in the Face Amount, and in some instances your Policy Value.

Death Benefit Options. The minimum Death Benefit is equal to the Face Amount. You may choose one of two Death Benefit Options:

Option 1: the Death Benefit is the greater of: (a) the Face Amount of the Policy on the date of death; or (b) the Policy Value multiplied by the applicable corridor percentage as described below, and as set forth in your Policy. Option 1 is designed to provide a specific amount of Death Benefit that generally does not vary with changes in the Policy Value. As your Policy Value increases, the net amount at risk under your Policy generally decreases, unless your Policy Value is sufficiently large to require that the Death Benefit be determined using the applicable corridor percentage.

Option 2: the Death Benefit is the greater of: (a) the Face Amount plus the Policy Value on the date of death; or (b) the Policy Value multiplied by the applicable corridor percentage. Under Option 2, the amount of the Death Benefit generally increases to reflect increases in the Policy Value. Under this option your Policy generally involves a constant net amount at risk. If this Policy is in force on the Policy Anniversary following the insured's 100th birthday and Option 2 has been selected, the death benefit option will change to Option 1.

While your Policy remains in force, we guarantee that the Death Benefit will not be less than the greater of the current Face Amount of the Policy or the Policy Value multiplied by the applicable corridor percentage. We have set forth the applicable corridor percentages in the Policy. The corridor percentages are based upon the age of the Insured. The applicable corridor percentage decreases from 250% at age 40 or less to 100% at age 100 or above.

Since the cost of insurance charge is based upon the net amount at risk, it generally is less under a Policy with an Option 1 Death Benefit than one with an Option 2 Death Benefit. As a result, if the Sub-Accounts you select experience favorable investment results, your Policy Value tends to increase faster under Option 1 than under Option 2, but the total Death Benefit under Option 2 increases or decreases directly with changes in Policy Value. Thus, for a given Premium and Face Amount, you may prefer Option 1 if you are more interested in the possibility of increasing your Policy Value based upon favorable investment experience, while you may prefer Option 2 if you are seeking to increase total Death Benefits.

Example of Applicable Corridor Percentage. The corridor percentages are set so as to seek to ensure that the Policies qualify for favorable federal income tax treatment. An increase in Policy Value due to favorable investment experience may increase the Death Benefit above the Face Amount, and a decrease in Policy Value due to unfavorable investment experience may decrease the Death Benefit (but not below the Face Amount). For example, if in the example below the Policy Owner paid a Net Premium of $40,000 and the Policy Value increased to $48,000 and then decreased to $34,000, the changes in Policy Value would have the following effects on the Death Benefit:

     
EXAMPLES A B
Face Amount $100,000 $100,000
Death Benefit Option 1 1
Insured’s Attained Age 45 45
Policy Value on Date of Death $48,000 $34,000
Applicable Corridor Percentage 215% 215%
Death Benefit $103,200 $100,000

In Example A, the Death Benefit equals $103,200, i.e., the greater of $100,000 (the Face Amount) and $103,200 (the Policy Value at the Date of Death of $48,000, multiplied by the corridor percentage of 215%). This amount, less any Policy Debt and unpaid charges, constitutes the Death Benefit proceeds that we would pay to the Beneficiary.

In Example B, the Death Benefit is $100,000, i.e., the greater of $100,000 (the Face Amount) or $73,100 (the Policy Value of $34,000 multiplied by the corridor percentage of 215%).

Change to Death Benefit Option. After the first Policy Year, you may change the Death Benefit Option by writing to us at the address given on the first page of this Prospectus. If you ask to change from Option 2 to Option 1, we increase the Face Amount of your Policy by the amount of the Policy Value. If you ask to change from Option 1 to Option 2, we decrease the Face Amount of your Policy by the amount of the Policy Value. The change takes effect on the Monthly Activity Day on or immediately following the day we receive your written request. We do not currently require you to prove insurability for a Death Benefit Option change. In addition, changes to the death benefit option may have tax consequences.

Change to Face Amount. You may change the Face Amount after the first Policy Year. You may request the change by writing to us at the address shown on the first page of this Prospectus. You should be aware that a change in the Face Amount changes the net amount at risk and, therefore, changes the cost of insurance charges on your Policy. The change will take effect on the Monthly Activity Day after we approve the request. We do not permit a Face Amount change if the Policy is in the Grace Period.

If you request a decrease in Face Amount, we first apply it to coverage provided by the most recent increase in Face Amount, then to the next most recent increase successively and finally to the coverage under the original application. We do not permit a decrease in the Face Amount of your Policy if afterward the Face Amount remaining in force would be less than $100,000. A decrease in the Face Amount affects the Safety Net Premium, if applicable. A Face Amount decrease will not be subject to a partial withdrawal fee, even if the reduction triggers a mandatory withdrawal of funds from this Policy.

To apply for an increase in the Face Amount, you must submit to us a supplemental application, accompanied by satisfactory evidence that the Insured is insurable. We do not permit any increase in Face Amount after the Insured’s 80th birthday. The minimum amount of a Face Amount increase is $10,000. You may not increase the Face Amount of your Policy more often than once every twelve months.

You should be aware that an increase in the Face Amount of your Policy affects the cost of insurance charges applicable to your Policy. As noted above, we deduct a larger amount of cost of insurance charges, because an increase in the Face Amount also increases the net amount at risk under your Policy. We will not approve a request for a Face Amount increase if the Net Surrender Value is too small to pay the Monthly Deduction for the Policy Month following the increase. As described in “Charges and Deductions - Surrender Charge” of this Prospectus, if you increase the Face Amount of your Policy, your maximum surrender charge also increases. Finally, increases in the Face Amount of your Policy also increase the Safety Net Premium amount. Modifying the Policy’s Face Amount may have tax ramifications. For additional information, please see “Federal Taxes”.

Limit on Right to Contest. We may not contest the insurance coverage under the Policy after the Policy has been in force for two years while the Insured is alive. If the Policy has lapsed and been reinstated, we may not contest the reinstatement after two years from the date of the reinstatement while the Insured is alive. We may not contest any increase in the Face Amount of the Policy after the increase has been in effect for two years while the Insured is alive.

Suicide. In all jurisdictions except Colorado, if the Insured commits suicide while sane or kills him or herself while insane within two years of the Issue Date or within two years of any increase in the Face Amount, we are not required to pay the full Death Benefit that would otherwise be payable. The applicable time period in Colorado is one year. Instead, we will pay an amount equal to the Policy Value less any Policy Debt and the Policy will stop. In all jurisdictions except Colorado, if within two years of the effective date of any increase in the Face Amount the Insured commits suicide while sane or kills him or herself while insane, we will pay a Death Benefit for the increase equal to the total cost of insurance charges. The applicable time period in Colorado is one year.

Misstatement as to Age and Sex. If the age or sex of the Insured is incorrectly stated in the application, we will adjust the Death Benefit appropriately as specified in the Policy.

 

Other Benefits Available Under the Policy

 General. In addition to the standard death benefits associated with the Policy, other standard and/or optional benefits may also be available to you.

The following table summarizes information about those benefits. Information about the fees associated with each benefit included in the table may be found in the Fee Table.

Name of Benefit Purpose Is the Benefit Standard or Optional? Brief Description of Restrictions or Limitations
Children’s Level Term Rider Provides for level term insurance on the Insured’s children. Optional We provide coverage until the earlier of the child’s 25th birthday or the Insured’s age 65. We pay the Death Benefit to the person designated by you.
Accidental Death Benefit Rider Provide additional insurance if the Insured dies from accidental bodily injury. Optional This rider ends when one of the following occurs: (1) the Policy terminates; (2) the next Policy Anniversary after the Insured’s 70th birthday; or (3) you ask to end the rider.
Continuation of Payment Rider Under this rider, we contribute a monthly amount to the Policy Value if the Insured becomes totally disabled as defined in the rider. Optional This rider ends when one of the following occurs: (1) the Policy terminates; (2) the Insured reaches age 60; or (3) you ask to end the rider.
Guaranteed Insurability Rider This rider provides the option to increase the Face Amount of the Policy on the Policy anniversaries following the attainment of certain Insured’s ages without proof of insurability. Optional

Only available at Policy issue ages 38 and younger.

Election of an unscheduled increase due to life event results in forfeiting the next scheduled increase. The option to increase the Face Amount as of any particular option date will, if not exercised, expire at the end of the period during which such option was available.

Accelerated Death Benefit Rider, Terminal Illness Provides for an advance of a portion of the Death Benefit if the Insured is diagnosed with a terminal illness and satisfactory proof of the terminal illness is provided to us. Standard

A terminal illness is a medical condition that, notwithstanding medical care, will result in death within twelve months, or as otherwise provided by applicable state law.

The Death Benefit and Policy Value of your Policy are reduced if an accelerated benefit is paid.

There is a charge when the benefit is elected.

The maximum accelerated death benefit you may receive is less than the Death Benefit and capped and subject to discounting, fees, required unpaid Premiums and any outstanding charges.

Accelerated Death Benefit Rider, Chronic Illness Provides for an acceleration of a portion of the Death Benefit if the Insured has been certified as a chronically ill individual. Standard

This rider is not available in California, Connecticut and Florida.

The Death Benefit and Policy Value of your Policy are reduced if an accelerated benefit is paid.

There is a charge when the benefit is elected.

You can take an accelerated death benefit once every 12 months up to a maximum payout at each election date.

Chronic illness must be certified by a licensed professional as follows:

The Insured is:

a. Permanently unable to perform, without substantial assistance from another individual, at least two activities of daily living for a period of at least 90 consecutive days due to loss of functional capacity; or

b. Requiring substantial supervision to protect such individual from threats to health and safety due to permanent severe cognitive impairment.

The maximum accelerated death benefit you may receive is less than the Death Benefit and capped and subject to discounting, fees, required unpaid Premiums and any outstanding charges.

Overloan Protection Rider Guarantees the Policy will not lapse due to Policy loans exceeding the Surrender Value. Standard

Only available at Policy issue.

No additional premiums, withdrawals or loans are permitted.

There is a one-time charge of 4.5% of the Policy Value upon election.

The rider benefit is only available if certain conditions are met.

Asset Allocation The asset allocation program provides Policy Owners with an assessment questionnaire to help them determine their investment time horizon and tolerance for risk. Policy Value is invested in different asset classes in a way that matches your risk tolerance, time horizon, and investment goals. If you participate in this program, you may select one of the available Zirconium ETF Asset Allocation Series Portfolios. Standard

Each transfer modifying the program counts towards the number of transfers used to determine if there is a transfer fee*.

*We are currently waiving this fee.

Dollar Cost Averaging You may automatically transfer a set amount every month from any Sub-Account or the Fixed Account to any Sub-Account or the Fixed Account. Standard

There is a minimum transfer amount of $100 per transfer.

This cannot be used with Portfolio Rebalancing.

Portfolio Rebalancing We will automatically rebalance the Policy Value in each Sub-Account and return it to the desired percentage allocations each quarter. Standard

If rebalancing is stopped, there is a 30 day waiting period to resume the program.

May not change allocation percentages more than twice in a 12 month period and total change to Fixed Account may not exceed 20%.

This cannot be used with Dollar Cost Averaging.

 

 

Riders

Children’s Level Term Rider  This rider provides for level term insurance on the Insured’s children, as defined in the rider. We provide coverage until the earlier of the child’s 25th birthday or the Insured’s age 65. We pay the Death Benefit to the person designated by you. If the Insured dies while the rider is in effect, we convert the coverage on each child to paid-up term insurance that remains in force until the child reaches age 25. The rider may be exchanged for a new term Policy on the earlier of each child’s 25th birthday, or the Insured’s age 65. We do not require evidence of insurability to exchange the rider. For example, if this rider is selected with a benefit amount of $10,000, and the insured child dies prior to their 25th  birthday when the Insured is 65 or younger, we would pay you the $10,000 benefit.

Accidental Death Benefit Rider - Under this rider, we provide additional insurance if the Insured dies from accidental bodily injury as defined in the rider. This rider ends when one of the following occurs: (1) the Policy terminates; (2) the next Policy Anniversary after the Insured’s 70th birthday; or (3) you ask to end the rider. For example, if this rider is selected with a $100,000 benefit and the Insured dies in an accident, such as a car wreck, prior to their 70th birthday, we would pay the Policy Beneficiary $100,000 in addition to the Death Benefit of the Policy.

Continuation of Payment Rider Under this rider, we contribute a monthly amount to the Policy Value if the Insured becomes totally disabled as defined in the rider. This rider ends when one of the following occurs: (1) the Policy terminates; (2) the Insured reaches age 60; or (3) you ask to end the rider. For example, if this rider is selected with a benefit amount of $750, and the Insured becomes disabled before they reach 60, we will pay $750 to the Policy every month during the Insured’s disability.

Accelerated Death Benefit Rider, Terminal Illness -  This rider provides for an advance of a portion of the Death Benefit if the Insured is diagnosed with a terminal illness and satisfactory proof of the terminal illness is provided to us. A terminal illness is a medical condition of the Insured that, notwithstanding medical care, will result in death within twelve months, or as otherwise provided by applicable state law. You may add this rider after your Policy is issued if the rider is available in your state. There is no additional cost for this rider. The maximum accelerated death benefit you may receive is the lesser of:

80% of the Death Benefit as of the date the first request is paid; or

$250,000, including all other accelerated benefit amounts paid under all policies issued by us on the life of the Insured.

The Death Benefit and Policy Value of your Policy are reduced if an accelerated benefit is paid. The amount of Death Benefit that you request to accelerate is reduced by:

any due and uncollected Monthly Deductions, or unpaid required Premium if a claim occurs during a Grace Period;

if allowed in your state, an administrative expense charge of up to $150 for each accelerated benefit request;

pro-rata amount of any outstanding Policy loan; and

an actuarial discount that reflects the early payment of the accelerated benefit amount. It will be based on an annual interest rate which has been declared by us and the future expected lifetime of the insured. The maximum interest used will be the greater of:

The current yield on 90-day U.S. Treasury Bills; or

The current maximum statutory adjustable Policy loan interest rate.

For example, if the Insured’s Face Amount is $100,000 and they are diagnosed with a terminal illness, such as pancreatic cancer, and their life expectancy is less than twelve months, upon the Policy Owner’s request we will pay the Policy Owner $80,000 less an administrative fee of $150. The remaining Death Benefit for the Policy payable at the Insured’s death is $20,000.

Accelerated Death Benefit Rider, Chronic Illness  -  This rider provides for an acceleration of a portion of the Death Benefit if the Insured has been certified by a licensed health care practitioner as a chronically ill individual who is:

Permanently unable to perform, without substantial assistance from another individual, at least two activities of daily living for a period of at least 90 consecutive days due to loss of functional capacity; or

Requiring substantial supervision to protect such individual from threats to health and safety due to permanent severe cognitive impairment.

You may add this rider after your Policy is issued if the rider is available in your state. There is no additional cost for this rider. The maximum lifetime benefit you may receive is the lesser of:

80% of the Death Benefit as of the initial election date; or

$1,000,000.

You can take an accelerated death benefit once every 12 months up to a maximum payout at each election date.

The minimum payout you may receive is the lesser of:

5% of the eligible death benefit on the initial election date; or $50,000.

The maximum payout you may receive is the lesser of:

20% of the eligible death benefit; or $250,000 at each election date.

The maximum payout will be reduced to comply with the maximum lifetime benefit, if necessary.

The Death Benefit and Policy Value of your Policy are reduced if an accelerated benefit is paid. The amount of Death Benefit that you request to accelerate is reduced by:

any due and uncollected Monthly Deductions, or unpaid required Premium if a claim occurs during a Grace Period; plus

if allowed in your state, an administrative expense charge of up to $250 for each accelerated benefit request; plus

pro-rata amount of any outstanding Policy loan; plus

an actuarial discount that reflects the early payment of the accelerated benefit amount. It will be based on an annual interest rate which has been declared by us and the future expected lifetime of the insured. The maximum interest used will be the greater of:

The current yield on 90-day U.S. Treasury Bills; or

The current maximum statutory adjustable Policy loan interest rate.

This rider is not available in California, Connecticut and Florida.

For example,if the insured’s Face Amount is $100,000 and the Insured is diagnosed with a chronic illness such as Alzheimer’s disease and the Insured has an expected life span of 10 years, upon the Policy Owner’s request we will pay the Policy Owner $20,000 less an administrative fee of $250 and less $198 interest discount assuming a 1% discounting rate. The remaining Death Benefit for the Policy payable at the Insured’s death is $80,000.

Overloan Protection Rider  -  If the benefit is elected under this rider, the Policy will not lapse due to Policy loans exceeding the Surrender Value. Once the overloan protection benefit has been exercised, the Death Benefit will be the greater of: the Face Amount immediately before exercise; the Policy Value multiplied by the applicable corridor percentage; or 101% of the greater of the Policy Value or Policy Debt. No additional premiums, withdrawals or loans are permitted. No additional monthly charges are deducted from your Policy. You are permitted to repay any outstanding loans on the Policy. There is no charge for the rider unless the benefit is elected, when a one-time charge of 4.5% of the Policy Value will be deducted. The rider benefit is only available if certain conditions are met. These conditions are:

the Policy has been in force for at least 15 Policy Years;

the Insured has attained age 75;

the death benefit option for the Policy must be Option 1;

the Policy Debt is greater than the Face Amount;

the Policy Debt has accumulated to at least 90% of the Surrender Value;

the sum of all partial withdrawals must be at least equal to the sum of all Premiums paid;

the Policy must not be a modified endowment contract (MEC) as defined by federal tax laws, and exercising the rider must not cause the Policy to become a MEC; and

the Policy Debt is no more than 99.9% of the Surrender Value after the overloan protection election charge has been deducted from the Policy Value.

For example, if the Policy has a Face Amount of $100,000, the Policy Owner purchased the Policy in 2005, the current year is 2021 and the Insured’s attained age is 95. All Premiums have been withdrawn from the Policy and loans were taken. The Policy Debt currently is greater than the Face Amount and all other rider conditions are met. The Overloan Protection Rider is exercised, the one-time 4.5% charge is taken and the Policy remains in force for the rest of the Insured’s lifetime. Once the rider has been exercised, the Policy Owner can no longer pay premiums or take loans or withdrawals.

Guaranteed Insurability Rider  -  This rider provides the option to increase the Face Amount of the Policy on the Policy anniversaries following the attainment of Insured’s ages 25, 28, 31, 34, 37 and 40 without proof of insurability. Unscheduled increases are allowed in lieu of the attained age increase options at the following life events: birth, marriage and adoption. Election of an unscheduled increase due to life event results in forfeiting the next scheduled increase. The option to increase the Face Amount as of any particular option date will, if not exercised, expire at the end of the period during which such option was available. This rider is available to insureds 38 years old and younger. For example, if the Policy has a Face Amount of $100,000 and this rider is selected, on the Insured’s 31st  birthday, the Policy Owner may increase the Policy Face Amount by $50,000 without additional underwriting. If the Insured gets married the next year, the Policy Owner can again increase the Face Amount without underwriting, but they cannot do another increase at age 34. They will have to wait until age 37 for the next Face Amount increase without underwriting unless they have a new child prior to the Insured’s 37th birthday.

 

Other Benefits

Asset Allocation Program  - As a Policy Owner, you may elect to participate in the optional asset allocation program for no additional charge to you. The asset allocation program can be elected at issue or any time your Policy is in force. The asset allocation program provides Policy Owners with an assessment questionnaire to help them determine their investment time horizon and tolerance for risk. The questions on the questionnaire have been provided by RAB, Inc. and Zirconium Associates and included in the asset allocation program information developed and provided by us. Based on the answers to the questionnaire, one of five asset allocation Sub-Accounts, the Zirconium ETF Asset Allocation Series Portfolios, is recommended. These portfolios are managed such that the allocations between different asset classes remain consistent with the qualities identified during the initial assessment. The objective of each asset allocation Sub-Account is to provide disciplined, diversified access to a variety of asset classes that is consistent with an investor’s risk profile and investment time horizon.

Asset allocation is the process by which your Policy Value is invested in different asset classes in a way that matches your risk tolerance, time horizon, and investment goals. Theoretically, different asset classes tend to

behave differently under various economic and market conditions. By spreading your Policy Value across a range of asset classes, you may, over time, be able to reduce the risk of investment volatility and potentially enhance returns. Asset allocation does not guarantee a profit or protect against loss in a declining market.

If you elect to participate in this program at issue, you may select one of the currently available Zirconium ETF Asset Allocation Series Portfolios. The Portfolios, advised by RAB Advisers, Inc. and sub-advised Zirconium Associates, Inc., represent five different investment styles: Conservative, Income and Growth, Balanced, Growth, and Aggressive Growth. Each of the Zirconium ETF Asset Allocation Series Portfolios is designed to meet the investment goals of the applicable investment style. Once you select a Zirconium ETF Asset Allocation Series Portfolio, your Policy Value will be allocated to the corresponding Zirconium ETF Asset Allocation Series Sub-Account. Additional investment options available with the asset allocation program at issue include the Fixed Account and the Fidelity VIP Government Money Market Sub-Account. We recommend that you consult with your sales representative and obtain and read the prospectus for the Zirconium ETF Asset Allocation Series carefully before participating in the asset allocation program. For example, an investor that is interested in the Asset Allocation Program completes the assessment questionnaire. The questionnaire result suggests that the investor’s investment style is Income and Growth. The investor then discusses this questionnaire result with their sales representative and receives the prospectus for the Zirconium Income and Growth ETF Asset Allocation Portfolio Company, the investment that corresponds to the questionnaire result, to determine if this Portfolio Company is in the best interest and suitable for the investor. After this discussion, the investor may opt to invest in this Sub-Account.

Once your Policy is in force you may elect to participate in the asset allocation program if it was not elected at time of issue. You may also allocate Policy Value among the Zirconium ETF Asset Allocation Series Portfolios and any other investment options offered on your Policy as desired once your Policy is in force. You can discontinue participation in the asset allocation program at any time by submitting a Fund Change form. Each transfer you make to modify your asset allocation program will count towards the number of transfers you can make without paying a transfer fee. You may want to consult with your sales representative before making a change to the asset allocation program to help you determine if the change is appropriate for your needs.

Although it is not advised, the Zirconium ETF Asset Allocation Series Portfolios Sub-Accounts could be invested in without completing the assessment questionnaire. This is not advised because the differing responses to the questionnaire are what have been used to develop the investment styles of the five Zirconium ETF Series Portfolios.

XYZ Insurance Company, the principal underwriter of the Policy and ADLLC, the distributor of the Policy, do not intend to provide any personalized investment advice in connection with the asset allocation program and you should not rely on this program as providing individualized investment recommendations to you. Policy Owners should ultimately rely on their own judgment and/or the judgment of a financial advisor in making their financial decisions.

The asset allocation program can be used in conjunction with our Dollar Cost Averaging program or Portfolio Rebalancing program. We reserve the right to terminate the asset allocation program at any time. If the program is terminated, but the Zirconium ETF Asset Allocation Series Portfolios are still available, the Policyholder’s allocation will remain in the Zirconium ETF Asset Allocation Series Portfolios Sub-Accounts previously elected.

Dollar Cost Averaging - Through our Dollar Cost Averaging Program, at no additional charge, you may automatically transfer a set amount every month (or other intervals we may offer) from any Sub-Account or the Fixed Account to any Sub-Account See “Transfers - Dollar Cost Averaging”. In this example, the owner elects to transfer a specified fixed amount of $1,000 monthly from Sub-Account A to Sub-Account B.

 

Balance of Sub-Account A Prior to Transfer $100,000
Balance of Sub-Account B Prior to Transfer $100,000
Transfer from Sub-Account A to Sub-Account B $1,000
Balance of Sub-Account A After Transfer $99,000
Balance of Sub-Account B After Transfer $101,000

Portfolio Rebalancing - If you select our Portfolio Rebalancing Program, at no additional charge, we will automatically rebalance the Policy Value in each Sub-Account and return it to the desired percentage allocations each quarter. We will not include money you allocate to the Fixed Account in the Portfolio Rebalancing Program.

“See Transfers - Portfolio Rebalancing”. In this example, the owner decides to allocate $100,000 across 3 funds, 60% to Fund A, 25% to Fund B and 15% to Fund C. The owner rebalances on an annual basis. One year after $100,000 is invested in three different portfolio companies, Fund A grew 22%, Fund B grew 9% and the Fund C grew 4%.

               
  Original Allocation Fund Performance Year End Allocation Prior to Rebalance Year End Allocation After Rebalance
Fund A 60% $60,000.00 22% 63.1% $73,200.00 60% $69,630.00
Fund B 25% $25,000.00 9% 23.5% $27,250.00 25% $29,012.50
Fund C 15% $15,000.00 4% 13.4% $15,600.00 15% $17,407.50
Total 100% $100,000.00   100.0% $116,050.00 100% $116,050.00

 

At the end of one year, the percentage of funds allocated to Fund A changed from 60% to 63.1%. Fund B changed from 25% to 23.5% and Fund C changed from 15% to 13.4%. The auto-rebalance feature rebalances the sub-accounts within the Separate Account to reflect the specified allocation. The number of units for each Sub-Account are adjusted to reflect the specified allocation percentages. The rebalanced allocation reflects the specified allocations of 60% in Fund A, 25% in Fund B and 15% in Fund C.

 

Appendix B: Portfolio Companies Available Under the Contract

The following is a list of the Portfolio Companies available under the Policy. More information about the Portfolio Companies is available in the prospectuses for the Portfolio Companies, which may be amended from time to time and can be found online at https://example.net/help. You can also request this information at no cost by calling 1-800-555-5555 or by sending an email request to service@example.net.

The current expenses and performance information below reflects fees and expenses of the Portfolio Companies, but do not reflect the other fees and expenses that your Policy may charge. Expenses would be higher and performance would be lower if these other charges were included. Each Portfolio Company’s past performance is not necessarily an indication of future performance

Investment Objective Portfolio Company Adviser / Subadviser

Current

Expenses

Platform Charge (1) Platform Charge, Expenses + Platform Charge (1) 1 year

Average Annual Returns (as of 12/31/21)

5 year

10 year
Long-term capital appreciation.
XYZ American Value Fund - Series I (2)
XYZ Advisers, Inc.
0.93 % 0.15 % 1.08 % 1.12% 7.00% 8.32%
To seek capital appreciation.
XYZ Discovery Mid–Cap Growth Fund - Series I (3)
XYZ Advisers, Inc.
0.80 % 0.15 % 0.95 % 40.69% 19.40% 15.92%
To provide reasonable current income and long term growth of income and capital.
XYZ Diversified Dividend Fund - Series I
XYZ Advisers, Inc.
0.71 % 0.15 % 0.86 % 0.14% 7.62% 9.99%
Total return, comprised of current income and capital appreciation.
XYZ High Yield Fund - Series I
XYZ Advisers, Inc.
0.94 % 0.15 % 1.09 % 3.32% 6.03% 5.27%
Long-term growth of capital.
XYZ International Growth Fund - Series I
XYZ Advisers, Inc.
0.92 % 0.15 % 1.07 % 14.00 % 8.82% 6.72%
Current income and long-term capital appreciation.
Stumpf Balanced Portfolio - Class I-2 (4)
XYZ Advisers, Inc.
0.57 % 0.15 % 0.72 % 10.23% 9.79% 8.05%

(1) The Investment Platform fee is guaranteed not to increase for the life of your Contract.

(2) Effective April 30, 2021, the XYZ Value Opportunities Fund - Series I is no longer available as an investment alternative. Therefore, the corresponding XYZ Value Opportunities Fund - Series I Sub-Account that invests in this Portfolio is closed and is no longer offered as of May 1, 2021. We will no longer accept purchase payments, permit transfers or any allocations to this Variable Sub-Account. Any amount invested in the XYZ Value Opportunities Fund - Series I as of May 1, 2021, will be transferred to the XYZ American Value Fund - Series I Sub-Account.

(3) Effective April 30, 2021, the XYZ VI Exploration Mid Cap Growth Fund - Series I; is changing its name to the XYZ VI Discovery Mid Cap Growth Fund - Series I.

 

(4) Stumpf Balanced Portfolio - Class I-2 expenses reflect a temporary fee reduction of 0.50%.

Investment Allocation Restrictions For Certain Optional Benefits

If you elect the Lifetime Redemption Guarantee (LRG), you are limited to allocating your purchase payments and Account Balance among the following funding options:

  • XYZ International
  • Stumpf Balanced Portfolio - Class I-2