Hartford Founders Plus UL

Transcription

1 HARTFORD LIFE AD AUITY ISURACE COMPAY Hartford, Connecticut Prepared by: First Heartland 1839 Lake St. Louis Blvd Lake St. Louis, MO (636)625-9 Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/212 State: MO A Life Insurance Policy Illustration Using Hartford Founders Plus UL A Policy with an Optional Index-Linked Interest Crediting Feature Prepared for: Valued Client THIS IS A ILLUSTRATIO OT A COTRACT. The results shown are not a guarantee of future performance. This information is written in connection with the promotion or marketing of the matter(s) addressed in this material. The information cannot be used or relied upon for the purpose of avoiding IRS penalties. These materials are not intended to provide tax, accounting or legal advice. As with all matters of a tax or legal nature, you should consult your own tax or legal counsel for advice. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) Page 1 of 21 ot valid without all pages

2 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO The Company: About this Illustration: "The Hartford" is The Hartford Financial Services Group, Inc., and its subsidiaries, including the issuing companies of Hartford Life Insurance Company (ew York) and Hartford Life and Annuity Insurance Company (outside ew York), Simsbury, CT. The mailing address for both issuers is P.O. Box 2999, Hartford, CT This illustration is intended to help you understand how your policy works, not to predict performance. It assumes that the non-guaranteed elements will not change in future years. This is not likely to occur, and actual results will either be more or less favorable than those shown. Premium payments are assumed to be paid at the beginning of each payment period, while the illustrated Death Benefits, Account Values, Cash Surrender Values and any policy Indebtedness are shown at the end of each policy year. Policy Description: Hartford Founders Plus UL is an individual flexible premium adjustable life insurance policy with an optional index-linked interest crediting feature. It offers you a choice between a Fixed Account or Plus Account option. The Account option you choose determines the interest crediting methodology applied to the policy s Account Value. Under the Plus Account option, interest credits are based, in part, on the performance of the Standard & Poor s 5 Composite Stock Price Index. See the Index Disclaimers section. Founders Plus also includes an extended no-lapse guarantee, which may provide an additional level of death benefit guarantee, even if the policy s Account Value drops to zero. Please see the Policy Protection section of this illustration for details regarding this feature. This policy offers you premium and death benefit flexibility. The policy values depend on a variety of factors, including but not limited to: the frequency, timing and amount of your premium payments, your account selection, the policy charges, and the interest credited to your Account Value. While the policy values may be affected by an external index, the policy does not participate in any stock or equity investments. Interest rates, index-linked interest rate caps and policy charges are subject to change by the Company, but will never be less favorable than those guaranteed in the policy. Premium payments may be made at any time for the life of the policy subject to the minimum and maximum premium requirements explained in your policy. If higher premium payments are made, coverage may continue for a longer period than if lower premium payments are made. Monthly policy charges are deducted from the policy Account Value through age 12 regardless of the premium outlay. Initial Death Benefit: The Initial Death Benefit for this illustration is $5,. In the event of death, the actual amount payable may vary due to the existence of loans, withdrawals, or other insurance benefits. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 2 of 21 ot valid without all pages

3 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Initial Death Benefit Option: Level Planned Premium Outlay: Premium Outlay to Guarantee Initial Death Benefit: Policy Protection: The Initial Death Benefit Option illustrated is the Level Death Benefit Option. Under this option, the Death Benefit used to calculate Death Proceeds equals the Face Amount. The planned premium outlay shown each year in the illustration is the sum of the periodic payments you plan to make each policy year. Your first year planned premium outlay is $8. Monthly. Assuming guaranteed charges and guaranteed interest rates, the monthly premium that would have to be paid in all policy years to guarantee the Initial Death Benefit until the policy anniversary after the insured's age 12 is $1, Loans, withdrawals, policy changes and money received as part of a 135 exchange are excluded in determining this amount. An amount greater than the maximum allowable premium under IRC Sec 772, definition of a Life Insurance Contract, will not be provided. Consequently, the premium amount shown may be limited to the maximum allowable premium, which may be insufficient to maintain the Initial Death Benefit until the policy anniversary after the insured's age 12. Your UL policy allows considerable flexibility in premium payments and provides a primary guarantee that helps ensure that your policy will remain in force as long as there is sufficient value to pay the monthly deductions and charges. Hartford Founders Plus UL also offers a secondary guarantee, through the Policy Protection Rider. If the rider is in effect, it guarantees that your policy will not terminate even if there is insufficient policy value to cover the monthly deductions and charges. This benefit will not prevent the policy from lapse due to excessive Indebtedness. With the rider, the Policy Protection Account is used to determine whether the guarantee is available to protect your coverage. This account is used only to test for the availablity of the guarantee; it has no cash value or cash surrender value, it is not available for loans or withdrawals, and it is not included in the amount of death benefit. Factors that Affect the Policy Protection Test As with all policy values, changes to any of the following factors will impact the Policy Protection Account and could affect the availability of your secondary guarantee: Amount and timing of premium payments Policy loans or withdrawals Face amount, riders, or risk classification All guarantees and benefits within the policy are based on the claims-paying ability of the issuing insurance company. Broker/dealers, insurance agencies and their affiliates who sell the policy make no representations or guarantees regarding such ability. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 3 of 21 ot valid without all pages

4 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Policy Protection: (continued) At the time of sale, the illustration reflects the way you expect to pay your premiums. In your case, the sales illustration shows a Planned Premium of $8. Monthly for 25 years. For the illustrated Face Amount(s), this premium is sufficient to maintain the coverage to age 85. This means that your policy will not lapse nor will the death benefit ever be reduced, as long as: The premiums are paid as shown in the illustration (in both amount and timing), o policy loans or withdrawals are taken other than those reflected in the illustration, and There are no riders added after issue, no increases to riders that were purchased at issue, and riders that accelerate death benefits are not exercised. If you change your premium payment schedule or coverage, or you elect policy provisions not illustrated, you can request a new illustration. This illustration can be used to create hypothetical scenarios that can help you make policy premium payment decisions. The status of the Policy Protection benefit will be reported to you annually and will include: Whether the benefit is then available If it is not available, the amount required to make it available for the policy year How long the benefit will be available as long as you continue to make scheduled premium payments Premium requirements, rates, and charges used in the Policy Protection Account test are stated in the policy contract and are not impacted by changes to the credited interest rate on the Fixed Account or Plus Account Value. Policy Withdrawals: Policy Loans: This illustration assumes no withdrawals. Partial withdrawals reduce the amount of your Account Value, Cash Surrender Value, Death Benefit and benefit amount of Optional Riders that are elected. This illustration assumes no loans. Policy loans will impact your Account Value, Cash Surrender Value and Death Benefit, and may impact the availability of the Policy Protection Rider benefit. An amount equal to each loan is transferred from the Fixed and/or Plus Accounts to a Loan Account. Amounts are transferred first from the Fixed Account, then from the Plus Account. Any time amounts are deducted from the Plus Account to support a loan, a 12 month Transfer Restriction Period is triggered, during which time allocations of Account Value to the Plus Account are prohibited (re-allocations of amounts from a maturing Plus Account Segment to a new Segment are allowed during this time). Because the interest charged on Indebtedness may exceed the interest credited to the Loan Account, Indebtedness may grow faster than the Loan Account. When this happens, additional collateral equal to the difference between the Indebtedness and the value in the Loan Account will be transferred to the Loan Account on each monthly activity date. This transaction will not trigger a Transfer Restriction Period. Any policy Indebtedness will be charged with a variable loan interest rate. This rate will be set annually at the beginning of each calendar year and will be in effect from the policy anniversary in the calendar year until the next policy anniversary in the following calendar year. This illustration assumes an effective annual policy loan interest rate of 4.6%. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 4 of 21 ot valid without all pages

5 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Policy Loans: (continued) The interest rate credited to the Loan Account is equal to the variable loan rate charged, minus: Current Guaranteed Years % 1.% Years 11+.%.25% This illustration assumes that the Loan Account is credited with a rate of 3.6% (3.6% guaranteed) in years 1-1, and 4.6% (4.35% guaranteed) thereafter. Indebtedness: Account Value: This illustration shows the total of all outstanding policy loans plus interest owed on the outstanding loans. The Account Value is equal to the total of the amounts in the Fixed Account, Plus Account and Loan Account. It can also be defined as the sum of premiums paid plus interest credited minus policy charges and any reductions due to withdrawals and other insurance benefits. This illustration shows your Account Value at the end of the policy year. All amounts deducted from the Account Value (including monthly deductions, withdrawals and other insurance benefits) or transferred to the Loan Account are taken first from the Fixed Account, then from the Plus Account if there are insufficient funds in the Fixed Account to satisfy the required deduction. Amounts deducted from the Plus Account are deducted from the most recently opened Segment first, then from the next most recently opened Segment, and continues in that order until the amount required to satisfy the deduction has been met. Cash Surrender Value: et Death Benefit: Account Options: The Cash Surrender Value is the Account Value less surrender charges and any Indebtedness. It is the amount you would receive if you were to surrender your policy at the end of the policy year shown. The et Death Benefit is the amount payable in the event of the insured's death assuming the death occurs at the end of the policy year shown. This is equal to the Death Benefit of the policy minus any Indebtedness. et Death Benefit is referred to as Death Proceeds in your policy. Founders Plus provides a choice between a Fixed Account or Plus Account option. The Account option you choose determines the interest crediting methodology applied to the policy s Account Value. You choose one option at issue and you may change options at a later date. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 5 of 21 ot valid without all pages

6 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Account Options: (continued) Fixed Account Interest: If you choose the Fixed Account option, net premium and loan repayments are allocated to the Fixed Account and remain there. If you choose the Plus Account option, net premium and loan repayments are first allocated to the Fixed Account. Then, the portion of Account Value attributable to those payments in a given month are re-allocated to a new Plus Account Segment on the next available Segment Start Date following the end of that month (Segment Start Dates are currently scheduled for the 3rd day of each month, but are guaranteed to be available no less frequently than once per calendar quarter). Amounts allocated to the Fixed Account earn interest at a rate of no less than 3.% annually. Additional interest may be credited to the Fixed Account at the sole discretion of the Company. Any additional interest credited will depend on the original receipt date of premium payments or loan repayments into the policy. This approach is often referred to as a new money interest crediting approach. An outcome of this approach is that different portions of your Account Value may earn different credited rates (again, tied to the original receipt date of premiums into the policy). As a result, at any given time, the policy s Account Value may be earning more or less than the current rate being credited on new premium payments into the policy. Plus Account Interest: Each re-allocation of Account Value to the Plus Account generates a new Segment with a one year term beginning on the Segment Start Date. Amounts in each Segment earn interest as the sum of two pieces: Basic Interest (BI): is credited daily and equals the rate that would be credited to those amounts had they always been allocated to the Fixed Account less 2.5%. As a result of this connection to the Fixed Account credited rates, Basic Interest rates will also depend on the original receipt date of premium payments or loan repayments into the policy and, at any given time, the policy s Account Value may be earning more or less than the current rate being credited on new premium payments into the policy. Since the credited rate under the Fixed Account option is guaranteed to be no less than 3.%, the Basic Rate will never fall below.5%. Index-linked Interest (II): is credited only at the end of each Segment s one-year term (the Segment maturity date), as described in the Index-linked Interest section below. The amount of credit is based, in part, on the performance of the S&P 5 Index (excluding dividends). It is important to note that for illustration purposes only, it is assumed that under the Plus Account option, amounts are allocated to a new Segment immediately, and therefore begin earning Plus Account interest immediately. Also, for illustration purposes, Segment maturity is assumed to occur the day before the actual maturity date. The combination of these two assumptions means that Index-linked Interest in this illustration may be reflected in the end of year 1 policy values shown. In actuality, any available Index-linked Interest for Segments established during any policy year will be credited in the subsequent policy year. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 6 of 21 ot valid without all pages

7 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Index-linked Interest: The following is an overview of the factors and method used in calculating Index-linked Interest for the Segments in the Plus Account on Segment Maturity Dates. Index-linked Interest - Index-linked Interest equal to the Index-linked Interest Rate multiplied by the Average Segment Value will be credited to a maturing Segment on that Segment's maturity date, provided the policy is in force on that date. Average Segment Value - is the average daily Segment value during the Segment Term for that Segment, excluding Basic Interest. Index-linked Interest Rate - is equal to the lesser of [(A X B) and C], such result being not less than zero, where: A = the Index Growth Rate B = the Index Participation Rate C = the Index-linked Interest Rate Cap Index Growth Rate - is the percentage change in the value of the Index over the Segment Term. It is equal to: (B - A) / A, where: A = the Closing Value of the Index on a Segment Start Date; and B = the Closing Value of the Index on a Segment Maturity Date. Index Participation Rate - is a factor applied to the Index Growth Rate in determining the Index-linked Interest Rate. It is guaranteed at a factor of 5%. Index-linked Interest Rate Cap - is the maximum possible value for the Index-linked Interest Rate. For each Segment, the Index-linked Interest Rate Cap is set by us on the Segment Start Date and will not change during the Segment Term. The cap will never be less than the Guaranteed Minimum Index-linked Interest Rate Cap of 3.%. Closing Value - is the value of an Index as of the Close of Business. If the Closing Value of an Index is not published on any day for which the value is needed because the ew York Stock Exchange is not open on that day or for any other reason, the Closing Value for the next day for which the Closing Value is published will be used. Illustrated Interest Rates: Illustrated non-guaranteed Account Values, including Cash Surrender Values, are based on the various interest rates shown in your illustration. The illustrated Fixed Account and Plus Account interest rates are hypothetical, not guaranteed, and are not intended to predict actual performance. Actual interest rates will vary according to the actual interest rates credited to the Fixed Account, the Basic Interest rates credited to the Plus Account, and the performance of the S&P 5 Index and actual Index-linked Interest rate Caps under the Plus Account option. Actual interest rates may be higher or lower than those illustrated. Even if the actual interest rates averaged the rates shown in the illustration over a period of years, but fluctuated above or below that average for individual policy years, the Death Benefit, Account Value and Cash Surrender Value will be different from those shown. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 7 of 21 ot valid without all pages

8 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Illustrated Interest Rates: (continued) Supplemental Historical Index-linked Interest Information The chart below shows the average annual historical Index-linked Interest Rate for 3 different time periods, all ending on 12/31/11. The average values shown were calculated as follows: -For each month in the specified time period, we calculated the point-to-point Index Growth Rate for the one year period ending on the last day of that month using the actual historical S&P 5 Index performance (excluding dividends) for that period and using the guaranteed Index Participation Rate of 5%, a hypothetical Index-linked Interest Rate Cap of 6.% and our guaranteed minimum rate of %. -We then calculated the average of these values over all the months in the given time period. 2-Year 25-Year 3-Year Average Historical Index-linked Interest Rate 3.72% 3.77% 3.82% o representation can be made by Hartford Life and Annuity Insurance Company, or your Representative, that hypothetical interest rates, including the Average Historical Index-linked interest rates, can be achieved for any one year or sustained over any period of time. Segment Term and Segment Maturity Date: Account Option Changes: Segments within the Plus Account mature at the end of their one year term. On the maturity date, maturing account value in the Segment will be re-allocated to a new Segment, with a new one year term, unless the account option in effect at maturity has been changed to the Fixed Account option. Amounts allocated to a Segment cannot be re-allocated to the Fixed Account until the maturity date of the Segment. A change from the Fixed Account to the Plus Account option is permitted as long as the policy is not in a Transfer Restriction Period. When this change becomes effective: All amounts in the Fixed Account will be re-allocated to a new Plus Account Segment on the next available Segment Start Date following the month in which the change request is received by us. Future net premiums and loan repayments will be allocated to the Plus Account as described in the Plus Account portion of the Account Options section above. A change from the Plus Account to the Fixed Account option is permitted. When this change becomes effective: Future net premiums and loan repayments will be allocated to the Fixed Account and earn interest as described in the Fixed Account Interest section above. Upon maturity of any existing Segments, the value in the maturing Segments will be re-allocated to the Fixed Account at each Segment Maturity Date. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 8 of 21 ot valid without all pages

9 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Index and Plus Account Availability: If the index used to calculate Index-linked Interest is discontinued or the calculation of the index is substantially changed, a comparable index may be made available. The Plus Account option may be discontinued if we determine that this product may be subject to registration under the Securities Act of If so, processing will follow the change from the Plus Account to the Fixed Account procedures as described in the Account Option Changes section above. Index Disclaimers: Standard & Poor s and S&P are registered trademarks of Standard & Poor s Financial Services LLC ( S&P ); Dow Jones is a registered trademark of Dow Jones Trademark Holdings LLC ( Dow Jones ); and these trademarks have been licensed for use by S&P Dow Jones Indices LLC. Standard & Poor s, S&P, S&P 5 and Standard & Poor s 5 are trademarks of S&P and have been licensed for use by S&P Dow Jones Indices LLC and its affiliates and sublicensed for certain purposes by The Hartford. The S&P 5 Composite Stock Price Index (the Index ) is a product of S&P Dow Jones Indices LLC and has been licensed for use by The Hartford. Hartford Founders Plus UL is not sponsored, endorsed, sold or promoted by S&P Dow Jones Indices LLC, Dow Jones, S&P or their respective affiliates and neither S&P Dow Jones Indices LLC, Dow Jones, S&P nor their respective affiliates make any representation regarding the advisability of investing in Hartford Founders Plus UL. The S&P 5 is an unmanaged index which measures broad-based changes in stock market conditions based on the average performance of 5 widely held U.S. common stocks. The S&P 5 does not represent the performance of a specific underlying fund or specific index account of the policy. This index is not available for direct investing. Guaranteed Elements of Your Policy: Your life insurance policy has guaranteed elements. These guaranteed elements include: maximum policy charges, a guaranteed minimum Index-linked Interest Rate Cap of 3.%, a guaranteed Index Participation Rate of 5%, and a minimum interest rate of 3.% credited to the Fixed Account. The Plus Account Index-linked Interest Rate can never be less than zero. on-guaranteed Elements of Your Policy: Your life insurance policy also has non-guaranteed elements. The non-guaranteed values illustrated reflect current company experience. They assume higher interest rates and lower policy charges than those guaranteed. The non-guaranteed elements can increase the value of your life insurance policy in one of two ways: by increasing your policy's cash value and/or death benefit; or by reducing the out-of-pocket cost of your policy. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 9 of 21 ot valid without all pages

10 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Tax Considerations: This information is written in connection with the promotion or marketing of the matter(s) addressed in this material. The information cannot be used or relied upon for the purpose of avoiding IRS penalties. These materials are not intended to provide tax accounting or legal advice. As with all matters of a tax or legal nature, you should consult your own tax or legal counsel for advice. You should consult with your tax advisor as to the tax implications of any policy changes or planned withdrawal, loan or surrender. Definition of Life Insurance (IRC 772) Based on our interpretation, this illustration meets the definition of a life insurance contract under Section 772 of the Internal Revenue Code by complying with the Guideline Premium Test. Guideline Single Premium: $235,574.3 Guideline Level Premium: $24, We will not illustrate a policy that violates these guidelines. The illustrated values will show an increase in Death Benefits, if necessary, to comply with these guidelines. This increase may require evidence of insurability. Special rules apply in the case of withdrawals and/or face amount decreases in the first 15 policy years. In this case, you may be taxed on all or a portion of the withdrawal amount or, in the case of a face decrease, a taxable distribution from the policy may be required. In all cases, a pre-death distribution in excess of basis, by withdrawal from or full surrender of this policy, is taxable. Basis is comprised of premiums paid less any prior untaxed withdrawals. In the case of an exchange pursuant to Section 135 of the Internal Revenue Code, the initial basis on the new contract will equal the basis on the replaced contract. Section 135 Basis /A Modified Endowment Contracts (IRC 772A): In order to receive the most favorable income tax treatment of pre-death policy distributions from your policy (such as loans and withdrawals) under Internal Revenue Code Section 772A, a life insurance policy must satisfy a 7-Pay Premium limitation test during the first 7 policy years and during the 7 years following certain policy changes. Premiums paid in excess of this limitation create a Modified Endowment Contract (MEC) and thereby cause pre-death policy distributions to be taxable to the extent there is a gain in the contract. In addition, there is a Federal Income Tax penalty of 1% of taxable income for pre-death policy distributions from MECs before the policy owner's age 59 ½ with certain exceptions. Initial 7-Pay Premium: $43, Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 1 of 21 ot valid without all pages

11 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Tax Considerations: (continued) Benefits Beyond Age 12*: Based on our interpretation, the premiums illustrated are within the limitations and we do not believe the policy as illustrated is a Modified Endowment Contract (MEC). Any changes to the policy benefits may alter the premium limitation, and may cause the policy to become a Modified Endowment Contract. Please consult your tax advisor for more information. At the policy anniversary after your age 12: The Death Benefit Option will be set to Level, The Face Amount will be set equal to the Death Benefit, o monthly deduction amounts will be taken, Premium payments will not be allowed, ew loans or withdrawals will not be allowed, Loan repayments are allowed, Loan interest will continue to accrue, and the policy may terminate due to excessive indebtedness, Account values, if any, will be credited with interest. This provision will in no way modify the termination provision of any riders attached to the policy. *The tax consequences of continuing a policy beyond age 1 of an insured are uncertain. Consult your tax advisor. Underwriting Class: Compensation: The values in this illustration assume that the insured's underwriting class is: Valued Client: Male, Age 65, Standard on-icotine. The insured's actual underwriting class for this policy will be determined during the underwriting process. The agent's primary function in the sale of an insurance policy is to solicit, negotiate or sell the policy to the purchaser based on that customer's specific needs. The agent is authorized to discuss with the customer the benefits, terms and conditions of the insurance policy and to offer advice concerning the benefits of a particular policy. The agent and/or the firm or business entity that they are affiliated with will receive compensation from The Hartford based upon the sale of any Hartford insurance policies. The amount of compensation paid to an entity, firm or agent is based on the amount and timing of premium payments. In addition, an agent's compensation may vary depending upon the specific type of insurance contract and optional benefits (e.g., riders) the purchaser selects, and the volume of business the agent and/or the agent's affiliated firm or business entity provides to the insurer. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 11 of 21 ot valid without all pages

12 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Compensation: (continued) Important Information Regarding Premiums Received After the Date of Application but Prior to Policy Delivery Important Information about the Extended Value Option: Optional Riders/Benefits: Accelerated Death Benefit Rider (for terminal illness) LA-1191(2) In addition to compensation for each individual policy, Hartford may also make payments to an entity or firm of which the agent is affiliated for administrative and marketing support. The affiliated entity can be a Hartford sales office, a Hartford wholesaler (including their management), a bank, independent broker dealer, stock brokerage firm, or independent marketing organization. We may also provide agents and/or affiliated firms marketing allowances and/or pay for occasional meals, entertainment, and provide nominal gifts. We may sponsor training and education forums and/or participate in joint marketing campaigns where agents may receive additional compensation. These payments help encourage agents to sell our policies and could be viewed as creating conflicts of interest. In addition, an agent's compensation may vary (higher or lower) depending on the election of certain optional benefits or riders. If you send us premium after the date of Application but prior to the delivery of the Policy, no coverage will be provided ULESS: (1) The premium received is at least equal to the first full modal premium; (2) We have documented our final underwriting decision in writing in our underwriting files; and (3) the underwriting approved coverage is the same as that applied for (including supplemental benefits) as reflected in a signed Application or Application Amendment in our files. If (1), (2), and (3) are satisfied, we will provide coverage identical to that of the applied for Policy (including coverage limitations) until the earliest of: (1) the applied for Policy is delivered, or (2) We return the premium. This policy offers the option of electing an alternative premium charge and surrender charge structure with the Extended Value Option. If you elect the Extended Value Option on the life insurance application, we will not assess premium charges on premium payments, but the surrender charge schedule will be higher and extend longer. In addition, generally a policy with the Extended Value Option will have lower cash surrender value in the early years of the policy. However, values will vary depending on the age of the insured at the time of policy issuance and how the policy is funded. You and your agent should discuss the impact of choosing the Extended Value Option in your individual situation and whether the option is in line with your personal insurance needs. Your agent may receive less compensation when this option is elected. Provides an accelerated payment of life insurance proceeds up to 1% of the Death Benefit discounted with interest one year if primary insured s diminished life expectancy is 12 months or less (subject to limitations). The sum of the Benefit you may request under this and any other policies issued by us on the life of an insured may not exceed $5,. The rider must be elected at issue. There is no additional ongoing charge for the rider, but an administrative processing fee of up to $3. applies if the rider is invoked. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 12 of 21 ot valid without all pages

13 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Overloan Protection Rider LA-1319(8) Gives you the option to continue your policy at a reduced Death Benefit with no further monthly deduction amounts in the event your policy is in danger of policy default or termination due to excessive Indebtedness. The Overloan Protection Benefit is available provided all of the conditions below are met: 1. Indebtedness exceeds the Face Amount, or amounts at least equal to all premiums paid have been withdrawn, and 2. the policy has been inforce at least 15 policy years, and 3. insured has attained age 75, and 4. Indebtedness does not exceed 99.5% of the Account Value after deduction of the Transaction Charge as of the Election Effective Date. When the Overloan Protection Benefit is elected: 1. A transaction charge ("Transaction Charge") will be deducted as of the Election Effective Date from the Account Value, not to exceed 7% of the Account Value on the Election Effective Date. 2. The Death Benefit Option will be Option A (Level Option). 3. If Indebtedness does not exceed the Face Amount as of the Election Effective Date, the Face Amount will be decreased to 1.5% of the Account Value as of such date after deduction of the Transaction Charge. 4. All other riders will be terminated. 5. o monthly deductions will be taken as they are treated as prepaid by the Transaction Charge. 6. o further transfers will be allowed. 7. o additional premium payments will be accepted. 8. Interest charged on Indebtedness will continue to accrue. 9. Loan repayments can be made at any time. 1. The Termination Due to Excessive Indebtedness provision in the policy will be suspended. When the Overloan Protection Benefit is elected, the Minimum Death Benefit is equal to the greatest of: 1. the minimum amount determined under the Minimum Death Benefit provision in the policy; 2. Indebtedness; or 3. the minimum amount of Death Benefit necessary for the policy to continue its qualification as a life insurance contract for federal tax purposes. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 13 of 21 ot valid without all pages

14 arrative Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Overloan Protection Rider LA-1319(8) (continued) Policy Protection Rider ICC There is a risk that the Internal Revenue Service could assert that the policy has been effectively terminated when you exercise the Overloan Protection Rider and that the outstanding loan balance should be treated as a distribution. Depending on the circumstances, all or part of such deemed distribution may be taxable as income. In addition, there is uncertainty about whether Indebtedness should be treated as the deemed cash surrender value for purposes of Section 772 of the Internal Revenue Code. Currently, we do not treat Indebtedness as the cash surrender value for purposes of Section 772. You should consult a tax advisor before exercising the Overloan Protection Rider. The Policy Protection Rider can protect your policy, including any attached riders, from terminating, even if there is insufficient policy value to cover the monthly charges. Illustration Benefit Summary Insured/Coverage Amount To Age Illustrated Guaranteed First Year Cost* on-guaranteed First Year Cost** Valued Client Base $5, Lifetime $6,284.1 $6,254.8 Accelerated Death Benefit Rider*** (for terminal illness) /A 12 $. $. Policy Protection Rider /A 12 /A /A Overloan Protection Rider /A 12 /A /A *Based On Guaranteed Interest Rate of.5% on the Plus Account and Guaranteed Policy Charges. **Based On on-guaranteed Interest Rate of % on the Plus Account and on-guaranteed Policy Charges. ***Any benefit amount received under the rider will reduce the death benefit payable to the policy's beneficiaries. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 14 of 21 ot valid without all pages

15 umeric Summary HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Valued Client, Male, Age 65, Standard on-icotine Prepared by: First Heartland Date Prepared: October 23, 212 Summary Age Year Cumulative Premium Periodic Premium Outlay: Monthly... $8. Initial Death Benefit: Face Amount... $5, Death Benefit Option... Level Account Option... Plus Account Illustrated Values Based On Guaranteed on-guaranteed on-guaranteed Interest rate of.5% Interest Rate(s) & Policy Charges Halfway Interest Rate(s) and and Guaranteed Policy Charges Between Guaranteed and on-guaranteed on-guaranteed Policy Charges Cash Surrender Value et Death Benefit Cumulative Premium Cash Surrender Value et Death Benefit Cumulative Premium Cash Surrender Value et Death Benefit ,. 5, 48,. 5, 48, 1,137 5, ,. 5, 96,. 5, 96, 32,112 5, ,.. 192,.. 192, 51,662 5, ,.. 232,.. 232,.. Illustrated to Age Disclosure Acknowledgements I have received a copy of this illustration. I understand that: Any non-guaranteed elements illustrated are subject to change and could either be higher or lower resulting in policy values that will be higher or lower. The agent has told me that they are not guaranteed. To obtain the non-guaranteed values and non-guaranteed death benefit shown on this illustration, I may need to modify my planned premium in the future. This illustration demonstrates how the policy works and is not a guarantee of future performance. Death benefits from a life insurance policy that is an employer-owned life insurance contract may not be fully tax-free. I am applying for a flexible premium universal life insurance policy where interest credits under one of the two available Account options (Plus Account) are based, in part, on the performance of an Index. The policy does not participate in any stock or equity investments. The actual return of the applicable index may be greater than the amount I am credited in the Plus Account due to the Index-linked Interest Rate Cap and Participation Rate. Any past performance of the Index-linked Interest presented in this illustration is no guarantee of future performance of the Plus Account. either Hartford Life and Annuity Insurance Company nor its employees, its agents, or its representatives provide tax or legal advice. Signature of Applicant(s)/Owner(s) Date I certify that: This illustration has been presented to the individual(s) above. I have explained that any non-guaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustration. Signature of Agent Date Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 15 of 21 ot valid without all pages

16 umeric Detail HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Valued Client, Male, Age 65, Standard on-icotine Prepared by: First Heartland Date Prepared: October 23, 212 Periodic Premium Outlay: Monthly... $8. Initial Death Benefit: Face Amount... $5, Death Benefit Option... Level Account Option... Plus Account Illustrated Values Based On Guaranteed Interest Rate and Guaranteed Policy Charges Please refer to the Illustration Benefit Summary for details of policy coverage and riders. This illustration is intended to help you understand how your policy works, not to predict performance. The illustrated values assume that premiums are paid as shown below. Two guaranteed scenarios are presented. The first scenario illustrates values based on the account option selected for this illustration. The second scenario illustrates values based on the alternate account option. Selected Account Option: Plus Account Alternate Account Option: Fixed Account Pol Yr Age Planned Premium Guaranteed Plus Acct Interest Rate* Account Value Cash Surrender Value et Death Benefit otes Planned Premium Guaranteed Fixed Acct Interest Rate Account Value Cash Surrender Value et Death Benefit otes ,6 9,6 9,6 9,6 9, ,325 5, 5, 5, 5, 5, ,6 9,6 9,6 9,6 9, ,37 5, 5, 5, 5, 5, ,6 9,6 9,6 9,6 9, , 5, 5, 5, 5, ,6 9,6 9,6 9,6 9, , 5, 5, 5, 5, ,6 9,6 9,6 9,6 9, , 5, 5, 5, 5, ,6 9,6 9,6 9,6 9, , 5, 5, 5, 5, ,6 9,6 9,6 9,6 7, , 5, 5, 5, LQ 2 9,6 9,6 9,6 9,6 7, , 5, 5, 5, LQ Total 189,6 189,6 Please see page 18 of umeric Detail for definition of otes that may appear. 772:(G).2/.(MO) TCV: TB: TL: MEC: 43,995 TP: 14,15 FCP: 14,15 ECP: FWP_Y1: 9,888 GSP: 235,574 GLP: 24,992 Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 16 of 21 ot valid without all pages

17 umeric Detail HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO Valued Client, Male, Age 65, Standard on-icotine Prepared by: First Heartland Date Prepared: October 23, 212 Periodic Premium Outlay: Monthly... $8. Initial Death Benefit: Face Amount... $5, Death Benefit Option... Level Account Option... Plus Account Illustrated Values Based On Hypothetical on-guaranteed Interest Rate and on-guaranteed Policy Charges Please refer to the Illustration Benefit Summary for details of policy coverage and riders. This illustration is intended to help you understand how your policy works, not to predict performance. The benefits and values illustrated are not guaranteed and assume that premiums are paid as shown below. The assumptions on which the non-guaranteed values are based are subject to change by the Company. Actual results may be more or less favorable. Refer to prior page(s) for guaranteed values. Two non-guaranteed scenarios are presented. The first scenario illustrates values based on the account option selected for this illustration. The second scenario illustrates values based on the alternate account option. Selected Account Option: Plus Account Alternate Account Option: Fixed Account Pol Yr Age Planned Premium Illustrated Plus Acct Interest Rate* Account Value Cash Surrender Value et Death Benefit otes Planned Premium Illustrated Fixed Acct Interest Rate Account Value Cash Surrender Value et Death Benefit otes ,6 9,6 9,6 9,6 9,6 3,383 6,25 8,253 1,13 11,687 1,137 5, 5, 5, 5, 5, ,6 9,6 9,6 9,6 9, ,418 6,44 8,217 1,3 11, , 5, 5, 5, 5, ,6 9,6 9,6 9,6 9,6 13,77 14,154 2,212 26,221 32,112 4,647 7,939 15,682 23,51 32,112 5, 5, 5, 5, 5, ,6 9,6 9,6 9,6 9, ,678 13,577 19,483 25,249 3,81 4,248 7,362 14,953 22,79 3,81 5, 5, 5, 5, 5, ,6 9,6 9,6 9,6 9,6 37,66 42,966 47,772 51,818 55,73 37,66 42,966 47,772 51,818 55,73 5, 5, 5, 5, 5, ,6 9,6 9,6 9,6 9, ,96 4,662 44,83 48,56 5,387 35,96 4,662 44,83 48,56 5,387 5, 5, 5, 5, 5, ,6 9,6 9,6 9,6 9,6 57,341 58,47 58,48 55,935 51,662 57,341 58,47 58,48 55,935 51,662 5, 5, 5, 5, 5, Q 9,6 9,6 9,6 9,6 9, ,593 51,448 49,715 46,52 4,34 51,593 51,448 49,715 46,52 4,34 5, 5, 5, 5, 5, Q ,6 9,6 9,6 9,6 1,6. 44,618 34,68 2,78 2,369 44,618 34,68 2,78 2,369 5, 5, 5, 5, L 9,6 9,6 9,6 1,6 **** ,28 18,849 2,63 31,28 18,849 2,63 5, 5, 5, L Total 232, 222,4 Please see page 18 of umeric Detail for definition of otes that may appear. 772:(G).2/.(MO) TCV: TB: TL: MEC: 43,995 TP: 14,15 FCP: 14,15 ECP: FWP_Y1: 9,888 GSP: 235,574 GLP: 24,992 Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 17 of 21 ot valid without all pages

18 umeric Detail HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO otes L Additional premium would be required to continue the Policy. et Death Benefit as illustrated is guaranteed under the Policy Protection Rider. Q The Policy Protection Guarantee became unavailable because the Policy Protection Account Test was not met. **** Illustrated values assume you choose not to make any out-of-pocket premium outlay for this policy year. Policy charges continue in all years, but are paid from the Account Value. You may be required to resume premium outlays if actual policy results are less favorable than those illustrated. * Plus Account interest rates shown are the sum of Basic and Index-linked interest rates. Both loans and withdrawals from a permanent life insurance policy may be subject to penalties and fees and, along with any accrued loan interest, will reduce the policy's Account Value and Death Benefit. Assuming a policy is not a Modified Endowment Contract (MEC), withdrawals are taxed only to the extent that they exceed the policyowner s cost basis in the policy and usually loans are free from current Federal taxation. A policy loan could result in tax consequences if the policy lapses or is surrendered while a loan is outstanding. Distributions from MECs are subject to Federal income tax to the extent of the gain in the policy and taxable distributions are subject to a 1% additional tax prior to age 59 ½, with certain exceptions. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 18 of 21 ot valid without all pages

19 umeric Detail HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO 5% Interest Adjusted Cost Indices Based on Selected Plus Account Option Guaranteed on-guaranteed 1 Years 2 Years 1 Years 2 Years et Payment Cost Index $19.2 $. $19.2 $19.2 Surrender Cost Index $19.2 $. $14.34 $16.22 The Life Insurance Surrender Cost Index and The Life Insurance et Payment Cost Index are measures of the relative cost of similar plans of insurance, and a low index number represents a lower cost than a higher number. ote to Agent: The Company's illustration actuary used the Fully allocated expense method in his/her certification. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 19 of 21 ot valid without all pages

20 Employer-Owned Form HARTFORD LIFE AD AUITY ISURACE COMPAY Illustrated Policy Date: 1/23/212 Date Prepared: 1/23/12 State: MO EMPLOYER-OWED LIFE ISURACE IFORMATIO FORM Please be aware that this information is being provided to assist you in determining your obligations, if any, under section 11(j) of the Internal Revenue Code. Under section 11(j) of the Internal Revenue Code, death benefits from an "employer-owned life insurance contract" are subject to federal income tax in excess of premiums and other amounts paid, unless the notice and consent requirements of section 11(j)(4) are satisfied and an exception under section 11(j)(2) applies. For the purposes of section 11(j), an "employer-owned life insurance contract" is defined as a life insurance contract which- (i) (ii) is owned by a person engaged in a trade or business ("policyholder") under which the policyholder (or a related person) is directly or indirectly a beneficiary under the contract, and covers the life of an insured who is an employee with respect to the trade or business of the policyholder. For these purposes, the term "employee" means all employees, including officers and highly compensated employees, as well as directors. otice and consent is generally satisfied if, before the contract is issued, the employee - is notified in writing that the policyholder intends to insure the employee s life and the maximum face amount for which the employee could be insured at the time the contract was issued, provides written consent to being insured under the contract and that such coverage may continue after the insured terminates employment, and is informed in writing that the policyholder (or a related party) will be a beneficiary of any proceeds payable upon the death of the employee. If the notice and consent requirements are met, the death benefit of an employer-owned life insurance contract will not be taxable if an exception under section 11(j)(2) applies. Section 11(j)(2) provides exceptions based on the insured s status (e.g., a director or certain highly compensated employees or an insured who was an employee at any time within the 12-month period before the insured s death) with respect to the policyholder, as well as exceptions for death benefit amounts paid to certain of the insured s heirs (e.g., the insured s estate or any individual who is the designated beneficiary of the insured under the contract (other than the policyholder)). Section 11(j) also imposes annual reporting and recordkeeping requirements on employers that own one or more employer-owned life insurance contracts. This material is not intended to provide tax, accounting or legal advice. As with all matters of a tax or legal nature, you should consult your own tax or legal counsel for advice. Policy Form ICC Income Protection (Basic) WFLX(2.51./6.17.) V CV: 3.44t.7m Page 2 of 21 ot valid without all pages