TOI: L04I Individual Life - Term Sub-TOI: L04I.213 Specified Age or Duration - Fixed/Indeterminate Premium - Single Life

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PDF Pipeline for SERFF Tracking Number UUIN-126912366 Generated 11/30/2010 11:39 AM Project Name/Number: 10 Term Rider/LI10

Filing at a Glance

Company: Reliable Life Insurance Company

Product Name: Level Term Insurance Rider SERFF Tr Num: UUIN-126912366 State: Arkansas TOI: L04I Individual Life - Term SERFF Status:

Closed-Approved-Closed

State Tr Num: 47379

SubTOI: L04I.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life

Co Tr Num: REL-LI10-AR State Status: Approved-Closed

Filing Type: Form Reviewer(s): Linda Bird

Author: Audrey Fields Disposition Date: 11/30/2010 Date Submitted: 11/23/2010 Disposition Status:

Approved-Closed

Implementation Date Requested: 03/01/2011 Implementation Date: State Filing Description:

General Information

Project Name: 10 Term Rider Status of Filing in Domicile: Pending

Project Number: LI10 Date Approved in Domicile:

Requested Filing Mode: Review & Approval Domicile Status Comments: Explanation for Combination/Other: Market Type: Individual Submission Type: Resubmission Previous Filing Number: LI10

Group Market Size: Overall Rate Impact:

Group Market Type: Filing Status Changed: 11/30/2010

Explanation for Other Group Market Type:

State Status Changed: 11/30/2010 Deemer Date:

Created By: Audrey Fields Submitted By: Audrey Fields

Corresponding Filing Tracking Number: Filing Description:

Submitted for your approval is a Level Term Insurance Rider. It will be available for a ten year term, issued to

policyholders between the ages of 18 and 65. This rider can be added to any previously approved whole life policy that has a premium-paying period equaling or exceeding the length of the term of the rider, except for our guaranteed issue products. We would like to begin selling this product at the end of the first quarter of 2011 through our captive agents utilizing the Home Service marketing system.

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PDF Pipeline for SERFF Tracking Number UUIN-126912366 Generated 11/30/2010 11:39 AM

SERFF Tracking Number: UUIN-126912366 State: Arkansas

Filing Company: Reliable Life Insurance Company State Tracking Number: 47379 Company Tracking Number: REL-LI10-AR

TOI: L04I Individual Life - Term Sub-TOI: L04I.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life Product Name: Level Term Insurance Rider

Project Name/Number: 10 Term Rider/LI10

This form was previously approved by your office on 8/11/2010 under SERFF Tracking Number UUIN-126759276. We have never marketed this product as some changes to the form were needed.

The changes to the previously approved LI10 are as follows:

1.On page R-1, in the General paragraph, we have inserted the words “and definitions.”

2.On page R-1, in the CONVERSION paragraph, we have deleted “following the Insured’s 75th birthday.”

3.On page R-1, in the CONVERSION paragraph, we have added the sentence “If premiums are being waived under the contract at the time of conversion, the premiums under the converted policy will not be waived.”

4.On page R-2, we have deleted the first paragraph which was part of the CONVERSION provision. 5.We have added an INCONTESTABILITY provision to page R-2.

6.On page R-2, in the TERMINATION paragraph, we have deleted the word “or” from number 3 and added it after number 4. We have renumbered item 4 as number 5 and inserted “the date of conversion of this rider to a permanent plan of insurance or” as number 4.

7.We have corrected the first sentence in the RESERVE BASIS paragraph, to show the valuation method as “Commissioners Reserve”.

We have applied the Flesch Reading Ease Test to this form and achieved a score of 54.

Since we have never marketed this form, we would like to use the same form number, LI10 for this revised rider.

Company and Contact

Filing Contact Information

Audrey Fields, Compliance Specialist [email protected] 12115 Lackland Road 314-819-4627 [Phone] St. Louis, MO 63146 314-819-4768 [FAX]

Filing Company Information

Reliable Life Insurance Company CoCode: 68357 State of Domicile: Missouri 12115 Lackland Rd. Group Code: 215 Company Type: Life & Accident St. Louis, MO 63146 Group Name: Unitrin, Inc. State ID Number:

(314) 819-4627 ext. [Phone] FEIN Number: 43-0476110

---Filing Fees

Fee Required? Yes Fee Amount: $50.00

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Retaliatory? Yes Fee Explanation:

Per Company: No

COMPANY AMOUNT DATE PROCESSED TRANSACTION #

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Correspondence Summary

Dispositions

Status Created By Created On Date Submitted

Approved-Closed

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Disposition

Disposition Date: 11/30/2010 Implementation Date: Status: Approved-Closed Comment:

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Schedule Schedule Item Schedule Item Status Public Access Supporting Document Flesch Certification Yes

Supporting Document Application No

Supporting Document Life & Annuity - Acturial Memo No

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Form Schedule

Lead Form Number: LI10 Schedule

Item Status

Form Number

Form Type Form Name Action Action Specific Data Readability Attachment LI10 Policy/Cont ract/Fratern al Certificate: Amendmen t, Insert Page, Endorseme nt or Rider

Level Term Insurance Rider

Revised Replaced Form #: LI10

Previous Filing #: LI10

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Home Office: St Louis. Missouri

LEVELTERMINSURANCE

RIDER

GENERAL

This rider providesLevelTerm life Insurance.It is part of the policy to which it is attached.It is subjectto all the terms and definationsof the policy exceptas modifiedherein.This rider has no cashor loanvalue.

EFFECTIVEDATE

This rider will be effectiveon the date of issueof the policy.If this rider is issuedafter the policy,the effectivedate of this rider will be endorsedon the policy.

PREMIUMS

The amount of premiumfor this rider is shown on page3 of the policy, or as later endorsedon the policy.The premiumis payableuntil the terminationof this rider.

BENEFIT

We will pay to the beneficiary,upon receiptof due proof of the deathof the Insured,the benefitamount shownon page3 of the policy,or as later endorsedon the policy.

This benefitwill be paidif the deathof the Insuredoccurs:

1. while this rider and the policy are in forceon a premiumpayingbasis; 2. while the Insuredis coveredby this rider;and

3. beforethe terminationof this rider.

CONVERSION

Whilethis rider is in force it may be convertedto a new policy,subjectto the following conditions: 1. No evidenceof insurabilityis required;

2. The new policy may be any permanentplan of insuranceofferedby us at the date of issueof the new policy;

3. The amount of insuranceunder the new policy will not be greaterthan the term insurancebenefitof this rider unlessproof of insurabilityis submittedto us and approvedby us;

4. The date of issueof the new policy will be the sameas the date of conversionand will take effectonly if the Insured is living on the date of issue. We will base the premium rate on the Insured's age, premiumclass,and ratesin useon the dateof conversion;

5. The new policy may includesupplementaryridersonly with our consent.

The conversionwill be madeeffectiveas of a premiumdue date.If premiumsare beingwaivedunderthe contractat the time of conversion.the premiumsunderthe convertedpolicywill not be waived.

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REINSTATEMENT

In additionto the reinstatementrequirementsof the policy, reinstatementof this rider is subject to evidenceof the Insured's insurabilitysatisfactoryto us and paymentof all unpaidpremiumswith interest compoundedannuallyat 5% to the dateof reinstatement.

TERMINATION

Coverageunderthis rider terminateson the earliestof:

1. the end of the grace period of the first unpaid premiumfor the policy or rider, whether or not the policy is continuedundera Non-ForfeitureOption;

2. the expirationdateof this rider as shownon page3 of the policy,or as later endorsedon the policy; 3. the termination,conversion,or maturityof the policyto which the rider is attached;

4. the dateof conversionof this rider to a permanentplanof insurance;or

5. the first premium due date after we receivea signed,written requestto cancelthis rider. We may requirethe policy and rider be returnedto us for endorsement.

We will not be liablefor any benefitshereunderin connectionwith a loss that occurs after this rider terminates.Any premiumfor this rider receivedafter the terminationdatewill be refunded.

RESERVEBASIS

Reservesfor this rider arecalculatedusing the CommissionersReserveValuationmethod.A detailedstatementof the method of computing reserveshas beenfiled with the state in which this rider is delivered.Reservesfor this rider equal or exceedthe minimum values requiredby that state. Reservesare based on the assumptionsthat death benefitsare paid at the momentof deathand net premiumsarepaidcontinuouslyover the premium-payingperiod.

Signedfor The ReliableLife InsuranceCompanyat St. Louis, Missouri,on the Dateof Issue.

Secretary President

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Supporting Document Schedules

Item Status: Status Date: Satisfied - Item: Flesch Certification

Comments: Attachments:

Certificate of Readability.pdf Consumer Notice.pdf Guaranty Assn. Act.pdf R&R 19.pdf

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