Sample Life Insurance Company (Sample Life) will pay the benefits of this Policy according to its provisions.

Long Term Care Insurance Policy

• RENEWABILITY: THIS POLICY IS GUARANTEED RENEWABLE FOR LIFE. PREMIUM RATES ARE SUBJECT TO CHANGE. This means You have the right, subject to the terms of the Policy, to continue this Policy as long as You pay Your premiums on time. We cannot change any of the terms of this Policy without Your consent, except that We may change the premium rates, subject to applicable state insurance department approval. Any such change in premium rates will apply to policies in the same class as Yours in the state where this Policy was issued.
• The Schedule of Benefits provided by this Policy is shown on page 3.
• This Policy is not eligible for dividends.

IMPORTANT NOTICE: Please read the copy of the application attached to this Policy. Carefully check the application and write to Sample Life Insurance Company, P.O. Box 123456, Anytown, NY 22212-7890, within thirty (30) days, if any information shown on it is not correct and complete, or if any past medical history has been left off of the application. This application is part of the Policy and the Policy was issued on the basis that answers to all questions and the information shown on the application are correct and complete.

If the insurance company changes the premium rates on your policy after it is issued and in force, the rates can only be changed on a class basis. In other words, the premium for every policy "in the same class" that was issued in the same state where your policy was issued will be changed based on the same actuarial formula. "Class" means underwriting class, which can mean many things, all based on an insurance risk category determined by the insurance company. This may be something as simple as age group, gender, policy type, occupation, or other special criteria, or it may be a broader, more inclusive, category, based, for example on an over-all risk analysis, such as "Preferred", "Standard" and "Substandard".

Each underwriting class has its own premium level. At time of initial underwriting, the insurance company determines your class based on its assessment of the degree of risk you present to the company. In the example, if your policy was issued as "Preferred", that would mean the company considered you a good (safe) insurance risk.

If the company decides to change insurance premiums on your type of policy, the proposed rate changes must be filed with the insurance departments in the states where the company wants to make the changes. Insurance departments look for two things when they review rate change filings: First, are they reasonable and justifiable; second, does the insurance company plan to apply the rate change to every insured in the classes where the change is proposed. In other words, in the above example, the insurance department will want to make sure that the rate increase will be the same for all those who were issued your type of policy on a "Preferred" basis.

IMPORTANT NOTICE: Please read the copy of the application attached to this Policy. Carefully check the application and write to Sample Life Insurance Company, P.O. Box 123456, Anytown, NY 22212-7890, within thirty (30) days, if any information shown on it is not correct and complete, or if any past medical history has been left off of the application. This application is part of the Policy and the Policy was issued on the basis that answers to all questions and the information shown on the application are correct and complete.

This wording is an attempt to provide the company with a sound basis for rescinding, or canceling your policy if information on the application later is found to be false. False information usually is discovered when a claim is filed and medical records received in connection with the claim contradict information on the application.

NOTICE TO THE BUYER: This Policy may not cover all of the costs associated with long term care incurred by the Buyer during the period of coverage. The Buyer is advised to review carefully ALL policy limitations.

This Policy is intended to be a qualified long term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended. If in the future, it is determined that this Policy does not meet the requirements of the Internal Revenue Code, We will make every reasonable effort to amend the Policy if We are required to do so in order to gain favorable federal income tax treatment. We will offer You an opportunity to receive these amendments, with any appropriate adjustments, as determined by Sample Life, to premium rates and and/or benefits.

Thirty Day Right to Examine Policy

Please read this Policy carefully. It is a legal contract between You and Sample Life. If you are not satisfied for any reason, You may return this Policy to Us or to the sales representative from whom You bought it within thirty (30) days from the date You receive it. If You return it within the thirty (30 ) day period, this Policy will be void from the beginning. We will refund any premium paid within thirty (30) days after We receive the returned Policy.

This is your basic 30-day free look provision which required by every state. It ties in nicely with some of the other provisions.