.04 Policy Summary.

A. A carrier shall include in a policy summary all of the following:

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

(2) The name and address of the insurance producer, or, if an insurance producer is not 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 or administrative office address of the carrier in which the life insurance policy is to be or has been written;

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

(5) The following amounts, when applicable, for the first 5 policy years and representative policy years thereafter sufficient to clearly illustrate the premium and benefit patterns, including at least one age from 60 years old through 65 years old and policy maturity:

(a) The annual premium for the basic policy;

(b) The annual premium for each optional rider;

(c) The amount payable upon death at the beginning of the policy year regardless of the cause of death, other than suicide or other specifically enumerated exclusions, which is provided by the basic policy and each optional rider, with benefits provided under the basic policy and each rider shown separately;

(d) The total guaranteed cash surrender values at the end of the year with values shown separately for the basic policy and each rider; and

(e) Any endowment amounts payable under the policy which are not included under cash surrender values above; and

(6) The date on which the policy summary is prepared.

B. The policy summary shall include the effective policy loan annual interest rate, if the policy contains a policy loan provision, specifying whether the effective policy loan annual interest rate is applied in advance or in arrears.

C. If the policy loan interest rate is adjustable, the policy summary shall also indicate that the annual percentage rate will be determined by the carrier in accordance with the provisions of the policy and the applicable law.