Sec. 53-2.2. Policy summary information for policies subject to section 4232(b) of the Insurance Law

(a) A policy summary shall include the following:

(1) a prominently placed title as follows: “STATEMENT OF POLICY COST AND BENEFIT INFORMATION;”

(2) the name and address of the insurance agent or broker, or, if no agent or broker is involved, a statement of the procedure to be followed in order to receive responses to inquiries regarding the policy summary;

(3) the full name and home office, administrative office or branch or agency office address of the insurer in whose name the life insurance policy is to be or has been written;

(4) the generic name of the basic policy and each rider;

(5) tables for the first five policy years and every fifth year thereafter until the maturity date containing the following:

(i) the annual premium or annual planned premium for the basic policy;

(ii) the annual premium or annual planned premium or maximum cost of insurance rate for each rider;

(iii) the death benefit at the beginning of the policy year shown separately for the basic policy and each rider;

(iv) the policy value and cash surrender value at the end of each year with values shown separately for the basic policy and each rider;

(v) the death benefits, policy values and cash surrender values based on the annual premium or annual planned premium using the current, median and guaranteed policy cost factors;

(vi) the interest rate assumptions for each projection of policy values and death benefits based upon current, median and guaranteed policy cost factors;

(vii) the dates the policy will terminate based on the annual premium or annual planned premium and on the current, median and guaranteed policy cost factors; and

(viii) the level annual premium from the issue date that would, based upon guaranteed policy cost factors, continue the policy to the maturity date;

(6) the effective policy loan annual percentage interest rate specifying whether this rate is applied in advance or arrears, adjustable or fixed, and if adjustable, the frequency at which such rate is to be determined and the index upon which the maximum rate is based at the time the policy is issued;

(7) the date on which the policy summary is prepared;

(8) life insurance cost indexes for 10 and 20 years but in no case beyond the premium- paying period. Separate indexes are to be displayed for the basic policy and each optional term life insurance rider. Such indexes need not be included for optional riders which are limited to benefits such as accidental death benefits, disability waiver of premium, preliminary term life insurance coverage of less than 12 months and guaranteed insurability benefits, nor for basic policies or optional riders covering more than one life;

(9) the equivalent level annual dividend, in the case of participating policies and participating optional term life insurance riders, under the same circumstances and for the same durations at which life insurance cost indexes are displayed;

(10) a policy summary which includes dividends shall also include a statement that dividends are based on the company's current dividend scale and are not guaranteed; in addition, the summary shall include a statement in close proximity to the equivalent level annual dividend as follows: “An explanation of the intended use of the equivalent level annual dividend is included in the buyer's guide;” and

(11) a statement in close proximity to the life insurance cost indexes as follows: “AN EXPLANATION OF THE INTENDED USE OF THESE INDEXES IS PROVIDED IN THE BUYER'S GUIDE.”

(b) The table of values and benefits based on guaranteed policy cost factors shall be labeled in a prominent manner “guaranteed” and the table of values and benefits based on current and median policy cost factors shall be labeled in a prominent manner “not guaranteed.”

(c) The annual planned premium used for each table shall be the actual planned premium selected by the applicant in the application without regard to any future unscheduled premium payments but may take into account any additional premium, in excess of the planned premium, paid with the application if identified separately in the application.

(d) The policy summary for life insurance policies which use a market-value adjustment formula in determining cash surrender benefits shall include the information required by section 43.5 of this Title with an appropriate statement that the cash surrender value does not reflect any adjustment based on such formula.

(e) The policy summary shall be a separate document.

(f) If more than one insured is covered under the policy, other than a joint life policy, or any rider, death benefits shall be displayed separately for each insured or for each class of insureds if death benefits do not differ within the class.