Document:

Fixed Account Rider

 BRIGHTHOUSE LIFE INSURANCE COMPANY OF NY 

[200 Park Avenue 
 New York, NY 10166] 

FIXED ACCOUNT RIDER 
 This Rider is part of the
Contract to which it is attached and is effective upon issuance. In the case of a conflict with any provision of the Contract, the provisions of this Rider will control. This Rider amends the Contract as follows: 

DEFINITIONS 

The following replaces the definition of “Account Value” in the “Definitions” section: 

Account Value 

Is the total of the Fixed Account Value and the value of the Shield Option(s) under this Contract, adjusted for any amounts that may be
included by rider during the Accumulation Period. Also referred to as “Contract Value.” 
 FIXED ACCOUNT - The following is added to the Contract: 

FIXED ACCOUNT PROVISIONS 

Fixed Account 

We credit interest to the portion of the Account Value allocated to the Fixed Account. The Fixed Account is part of our General
Account. We guarantee that the interest credited to any allocation to the Fixed Account on the Issue Date will equal the Initial Interest Rate shown on the Contract Schedule. Thereafter, we will declare an interest rate as of each Contract
Anniversary for the duration of the Interest Rate Term and such rate will not be less than the Minimum Guaranteed Interest Rate. If the declared interest rate equals the Minimum Guaranteed Interest Rate, we reserve the right to restrict
transfers and allocations into the Fixed Account if the Company is unable to support the Minimum Guaranteed Interest Rate. 
 The
initial Fixed Account Value is the amount initially allocated to the Fixed Account. Thereafter, the Fixed Account Value equals: (a) the initial Fixed Account Value or the Fixed Account Value on the most recent Contract Anniversary, whichever is
applicable, including any transfers; plus (b) any interest credited by us; less (c) the amount of any withdrawals including any Withdrawal Charges; and less (d) any Premium or Other Taxes, if applicable.

Interest Crediting Method 

Interest will be compounded and credited to the Fixed Account at an annual effective interest rate declared by Us. Interest will be
credited on amounts allocated to the Fixed Account through the effective date such amounts are withdrawn or transferred from the Fixed Account. 

Interest Rate Term 

The Interest Rate Term is the length of time over which the current interest rate is guaranteed. At the end of the Interest Rate
Term, the Fixed Account Value will automatically be renewed into the same Interest Rate Term, with the then current interest rate for such new term, unless otherwise directed by You. No Interest Rate Term will extend beyond the Annuity
Date.
 PURCHASE PAYMENT PROVISIONS – Replace the first paragraph of the section entitled “Shield Options” with the following: 

Shield Options 

On the Issue Date, you may allocate your Purchase Payment to one or more of the available Shield Options listed on the Contract Schedule
and the Fixed Account. At the end of each Term or Interest Rate Term, you may transfer the Account Value attributable to the Shield Option(s) or the Fixed Account to one or more of the available Shield Options or the Fixed Account (if
available) subject to the Transfer Requirements and Minimum Allocation shown on the Contract Schedule and the Renewal Provisions. 

WITHDRAWAL PROVISIONS – The following will replace the section
entitled “Withdrawals” under “Withdrawal Provisions” with the following: 
 Prior to the Annuity Date, you may,
upon Notice to us, request a full or a partial withdrawal and we will withdraw that amount from the Account Value (“the amount withdrawn”). A withdrawal will result in a reduction to each Shield Option and the Fixed Account in the
ratio that each Shield Option and the Fixed Account bears to the total Account Value, as determined under the Account 

  
 ML-22496 (09/12) 

 
Value Provisions above, unless otherwise directed by you. The amount payable to you will be a net amount equal to the amount withdrawn adjusted for any applicable Withdrawal Charge and
Premium and Other Taxes. The Free Withdrawal Amount shown on the Contract Schedule defines the amount You may withdraw free from any Withdrawal Charge. 

The total amount withdrawn from the Account Value must not be less than the Minimum Partial Withdrawal amount shown on the Contract
Schedule. If the withdrawal would result in the remaining Account Value being less than the Minimum Account Value shown on the Contract Schedule, we will treat the withdrawal request as a request for a full withdrawal. 

If you request a full or partial withdrawal, the amount withdrawn after adjustments for any Withdrawal Charge will result in our paying
you a net amount. The net amount payable to you is equal to (a)-(b)-(c), where: 
  

	 	(a)	is the amount withdrawn from the Account Value, and 

  

	 	(b)	is the Withdrawal Charge if any, as described on the Contract Schedule, and 

  

	 	(c)	is the Premium and Other Taxes, if any. 

 The amount withdrawn will reduce the Investment
Amount, as defined in the Definitions section, for each Shield Option by the percentage reduction in the Interim Value of such Shield Option and the Fixed Account Value as applicable.

DEATH BENEFIT PROVISIONS – The following will replace the first
paragraph of the section entitled “Non-Spousal Beneficiary Continuation During Accumulation Period” under “Death Benefit Provisions” with the following: 

A Beneficiary who is not a spouse can choose to continue the Contract until the fifth anniversary of the Owner’s death. The Contract
can be continued by a Beneficiary only if his or her share of the death benefit is at least equal to the Contract Minimum specified on the Contract Schedule. If the Beneficiary continues the Contract under this provision his or her share will
not be paid. It will instead be continued in the Contract on the date we determine the Death Benefit Amount. Such Beneficiary will have the right to make partial and full withdrawals of his/her share of the Contract, not subject to Withdrawal
Charges. Such Beneficiary will also have the right to make transfers at the end of a Term or Interest Rate Term as described on the Contract Schedule. 

DEFERRAL OF PAYMENTS - After receipt of a Notice of withdrawal from you, we reserve the
right to defer payment for a withdrawal for the period permitted by law but not for more than six (6) months. 
 Brighthouse Life Insurance Company of
NY has caused this Rider to be signed by its [Secretary]. 
  

	
	 [
 

]

	
	[Secretary]

  
 ML-22496 (09/12)Death Benefit Rider - Return of Premium

 BRIGHTHOUSE LIFE INSURANCE COMPANY OF NY 

[200 Park Avenue 
 New York, NY 10166] 

DEATH BENEFIT RIDER – RETURN OF PREMIUM 

This Rider forms a part of the Contract to which it is attached and is effective upon the Issue Date. In case of a conflict with any provision in the
Contract, the provisions of this Rider will control. Your election of this Rider is irrevocable. The following amends the “Death Benefit Provisions” of the Contract as follows: 

DEATH BENEFIT PROVISIONS 

Death Benefit Amount During The Accumulation Period 

This provision is amended to provide that the Death Benefit Amount will be the greater of: 

 

	 	(1)	 the Account Value; or 

  

	 	(2)	 Purchase Payment, reduced proportionately by the percentage reduction in Account Value of the Shield Option(s) and the
Fixed Account for each partial withdrawal. 

 If a non-natural person owns the Contract, then the Annuitant shall be
deemed to be the Owner for purposes of determining the eligibility to purchase this Rider. 
 If the Owner is a natural person and the
Owner is changed to someone other than a spouse, the Death Benefit Amount shall be determined as defined above; however, subsection (2) shall be restated to provide as follows: “the Account Value as of the effective date of the change of Owner,
reduced proportionately by the percentage reduction in Account Value of the Shield Option(s) and the Fixed Account for each partial withdrawal made after such date”. 

In the event that the Contract is continued under the “Spousal Continuation During Accumulation Period”, the Death Benefit
Amount shall be determined in accordance with (1) or (2) above. Upon contract continuation, the Account Value will be adjusted, if necessary, to an amount equal to the Death Benefit Amount. If an adjustment is needed, an amount equal to the excess
of the Death Benefit Amount over the Account Value will be allocated to the Fixed Account. 
 The Death Benefit Amount is determined
as of the end of the Business Day on which we have received both due proof of death and an election for the payment method.
 However,
if Fixed Account transfer and allocation restrictions are in effect at the time this amount is allocated to the Fixed Account, then on the next Contract Anniversary, this amount (excluding interest earned on such amount) will be transferred out of
the Fixed Account into the Shield Option with, in order of priority, the shortest Term, the highest Shield Rate, and the lowest Cap Rate from the Shield Options available unless otherwise directed by You. 

Death Benefit Rider Cost 

The cost for this Rider will generally be reflected in lower Cap and Step Rates for each Shield Option than if this Rider were not
elected. The reduction in the Cap and Step Rates will not exceed the Return of Premium Death Benefit Maximum Cap or Step Rate Reduction, as shown on the Contract Schedule, of the Cap and Step Rates that would have applied if this Death Benefit
Rider was not selected. The Cap and Step Rate will never be less than the Minimum Guaranteed Cap/Step Rates shown on the Contract Schedule.

Brighthouse Life Insurance Company of NY has caused this Rider to be signed by its [Secretary]. 

 

	
	 [
 

]

	
	[Secretary]

  
 ML-22497 (09/12)Waiver of Withdrawal Charge for Nursing Home or Hospital Confinement Rider

 BRIGHTHOUSE LIFE INSURANCE COMPANY OF NY 

[200 Park Avenue 
 New York, New
York   10166] 
 WAIVER OF WITHDRAWAL CHARGE FOR NURSING HOME OR HOSPITAL CONFINEMENT RIDER 

This Rider forms a part of the Contract to which it is attached and is effective as of the Issue Date. In the case of a conflict with any
provision in the Contract, the provisions of this Rider will control. This Rider is irrevocable and its provisions will remain part of the Contract until the earlier of the Annuity Date or the date the Contract terminates. This Rider amends the
Contract as follows: 
 The following provisions are added to the Contract: 

WAIVER OF WITHDRAWAL CHARGE FOR NURSING HOME OR HOSPITAL CONFINEMENT 

After the first Contract Anniversary, the Withdrawal Charge attributable to such withdrawal will be waived upon a withdrawal if: 

 

	1.	 you are confined to a Nursing Home and/or Hospital for at least 90 consecutive days or confined for a total of
at least 90 days if there is no more than a 6-month break in the confinement and the confinements are for related causes; 

  

	2.	 the first confinement referred to in (1) above begins on or after the first Contract Anniversary;

  

	3.	 the withdrawal request and proof satisfactory to us of confinement are received by us at our Annuity Service
Office either while you are confined or within 90 days after such confinement; 

  

	4.	 confinement in a Nursing Home and/or Hospital is prescribed by a Physician and is Medically Necessary;

  

	5.	 you have been the Owner continuously since the Issue Date, or you are a Spousal Beneficiary who continues the
Contract under the Spousal Continuation During Accumulation Period Option; and 

  

	6.	 you were less than the Maximum Nursing Home or Hospital Confinement Rider Issue Age specified on the Contract
Schedule on the Issue Date. 

 In the case of Joint Owners, this Rider applies to either Joint Owner. If the Owner is not
a natural person, this Rider applies to the Annuitant provided the Annuitant has continuously been the Annuitant since the Issue Date. 

DEFINITIONS 
 Hospital
- A facility which: 
  

	1.	 is located in the United States or its territories; 

	2.	 is licensed as a hospital by the jurisdiction in which it is located; 

	3.	 is supervised by a staff of licensed physicians; 

	4.	 provides nursing services 24 hours a day by, or under the supervision of, a registered nurse (R.N.);

	5.	 operates primarily for the care and treatment of sick and injured persons as inpatients for a charge; and

	6.	 has access to medical and diagnostic facilities. 

Intermediate Care Facility - A facility which: 
  

	1.	 is located in the United States; 

	2.	 is licensed and operated as an Intermediate Care Facility according to the laws of the jurisdiction in which
it is located; 

  
 ML-1215 (01/01/02) 

	3.	 provides continuous 24 hours a day nursing service by, or under the supervision of, a registered graduate
professional nurse (R.N.) or a licensed practical nurse (L.P.N.); and 

	4.	 maintains a daily medical record of each patient. 

Medically Necessary - Appropriate and consistent with the diagnosis in accord with accepted standards of practice and which could not
have been omitted without affecting the individual’s condition. 
 Nursing Home - A facility which is a Skilled Nursing Facility, an
Intermediate Care Facility or Residential Care Facility. Nursing Home does not mean: 
  

	1.	a home for the aged, a community living center or place that primarily provides domiciliary, residency or retirement care; or 

	2.	a place owned or operated by a member of the Owner’s immediate family. Immediate family members include the Owner’s spouse, children, parents, grandparents, grandchildren, siblings and in-laws.

 Physician - Any person duly licensed and legally qualified to diagnose and treat sickness and injuries. A physician
must be providing services within the scope of his or her license. A Physician may not be a member of the Owner’s immediate family. 
 Residential
Care Facility - A facility which: 
  

	1.	 is located in the United States or its territories; 

	2.	 is licensed and operated as a Residential Care Facility according to the laws of the jurisdiction in which it
is located; and 

	3.	 provides nursing care under the supervision of a registered professional nurse (R.N.). 

Skilled Nursing Facility - A facility which: 
  

	1.	is located in the United States or its territories; 

	2.	is licensed and operated as a skilled Nursing Facility according to the laws of the jurisdiction in which it is located; 

	3.	provides skilled nursing care under the supervision of a licensed physician; 

	4.	provides continuous 24 hours a day nursing services by, or under the supervision of, a registered graduate professional nurse (R.N.); and 

	5.	maintains a daily medical record of each patient. 

 Brighthouse Life Insurance Company of NY has caused this
Rider to be signed by its [Secretary]. 
 [ 
 

] 
 [Christine M. DeBiase 

Secretary] 

  
 ML-1215 (01/01/02)

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00263-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00263-of-00352.parquet"}], [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00263-of-00352.parquet"}]]