Exhibit 4(m)


 


PROTECTIVE LIFE AND ANNUITY INSURANCE
COMPANY  •  {P. O. BOX 10648  • 
BIRMINGHAM,  ALABAMA  35202-0648}


 


MEDICAL EVALUATION FOR ENHANCED GMWB WITHDRAWAL PERCENTAGES


 


We are amending the Guaranteed Minimum
Withdrawal Benefit Rider included with your Contract to describe the
availability of enhanced GMWB Withdrawal Percentages for Covered Persons with
certain qualifying medical conditions.


 


Enhanced GMWB Withdrawal
Percentage:  If the waiting period has elapsed and you have
not established the Benefit Election Date under your current Guaranteed Minimum
Withdrawal Benefit Rider, you may request a medical evaluation to determine if
the Covered Person – or the older of both of the Covered Persons – qualifies
for a higher GMWB Withdrawal Percentage. We will not medically evaluate any
Covered Person who is older than age { 75 } at the time we receive the request.


 


We, in
our sole discretion, establish the criteria that qualify a Covered Person for
an enhanced GMWB Withdrawal Percentage and determine the associated GWMB
Withdrawal Percentage enhancement.


 


From time to time, we will establish the
criteria for qualification of a Covered Person and the associated GMWB
Withdrawal Percentage enhancement, if any. When establishing these criteria, we
will consider factors such as, our judgment of: 
the Covered Person(s)’ medical condition; the efficacy of current and
future treatment modalities; general market conditions including the
performance of the Benefit Allocation Models; and, our experience and actuarial
assumptions for the GMWB Rider at the time we receive the request for a medical
evaluation. We will apply these criteria equitably to all Covered Persons. Since
each of these factors will vary over time, our decision regarding any
individual request for a medical evaluation is not representative of the
decision we will reach at any time in the future.


 


Waiting Period:  You may not request a medical evaluation prior to the later of { two years } after: a) the
Contract Effective Date; or, b) the date of the most recent change of Owner.


 


Requesting a Medical Evaluation: You must request a medical evaluation by
Written Notice prior to establishing the Benefit Election Date and before the
proposed Covered Person(s)’ { 76th } birthday. We will require proof of the Covered Person(s)’
age and a valid, properly executed Medical Authorization in order to obtain
medical records. We will begin the evaluation process promptly upon our receipt
of the necessary forms in good order. You may, but are not required to, include
any medical records in your possession that you would like us to consider.
After we conclude the medical evaluation, we will send you our decision in
writing. Any enhanced GMWB Withdrawal Percentage we offer expires 6 months
after the date of our written decision notice to you.


 


Accepting the Enhanced GMWB
Withdrawal Percentage:  You accept the enhanced GMWB Withdrawal
Percentage offer by establishing a Benefit Election Date within 6 months of the
date of a written decision notice containing the enhanced GMWB Withdrawal
Percentage offer. If you do not accept our enhanced GMWB Withdrawal Percentage
offer before it expires, you must wait at least one year from the date of our
written decision notice before requesting a subsequent  medical evaluation.


 


Cost of the Medical Evaluation:  If
you request a medical evaluation and accept our offer for an enhanced GMWB
Withdrawal Percentage, we will assess a fee to cover the costs associated with
your request. The fee is currently { $150 } per Covered Person. The fee is subject to change but will
never exceed $300 per Covered Person. The fee will be deducted from the
Contract Value as of the Valuation Period that contains the Benefit Election
Date on which you accept our enhanced GMWB Withdrawal Percentage offer.


 


We will assess the medical evaluation fee for
each medical evaluation you request after the second, regardless of whether we
make an enhanced GMWB Withdrawal Percentage offer or whether it is accepted. In
these cases, we will assess the current fee at the time you request a third or
subsequent medical evaluation.


 


Signed for the Company and made a part of the
Contract as of the GMWB Rider Effective Date.


 


PROTECTIVE LIFE AND ANNUITY INSURANCE COMPANY


	
   

  	
  

  	
   

  
	
   

  	
  {Secretary}