ind wkbk by HC120831103615

VIEWS: 2 PAGES: 43

									                             A                                                         B                                                            C
     The Virginia Bureau of Insurance (BOI) is making this data request for your Company's INDIVIDUAL health insurance products that are subject to the federal
     government Patient Protection and Affordable Care Act ("PPACA"), and as amended by the Health Care and Education Reconciliation Act (or referred to herein as
     the “Affordable Care Act” or "ACA"). Please supply the information requested in the Yellow fields of this and all succeeding tabs of this spreadsheet template.
 1
 2
 3   NAIC Company Code (5 numeric digits):
 4   Company Name:
 5   Company Contact Person's Address:
 6   Company Contact Person's Phone Number:
 7   Company Contact Person's Email Address:
 8   Individual or Small Group:                       INDIVIDUAL (IN)
 9
10
   For this spreadsheet template, the data to be supplied should include those INDIVIDUAL products (as applicable to your Company) included under the following
11 SERFF classification of Types of Insurance (TOI):
12                                                     H15G Group Health - Hospital/Surgical/Medical Expense
13                                                     H15I Individual Health - Hospital/Surgical/Medical Expense
14                                                     H16G Group Health - Major Medical
15                                                     H16I Individual Health - Major Medical
16                                                     H17G Group Health - Prescription Drug
17                                                     H17I Individual Health - Prescription Drug
18                                                     H18G Group Health - Sickness
19                                                     H18I Individual Health - Sickness
20                                                     H21G Group EPO/EPP
21                                                     H21I Individual EPO/EPP
22                                                     Health Maintenance Organization (HMO)
23                                                     Health Service Plans
24                                                     HOrg01 Health Organizations - Assumption Agreement
25                                                     HOrg02G Group Health Organizations - Health Maintenance (HMO)
26                                                     HOrg02I Individual Health Organizations - Health Maintenance (HMO)
27                                                     HOrg03 Health - Other
28                                                     HOrg04G Group Limited Service HMO
29                                                     HOrg04I Individual Limited Service HMO
30                                                     HSP Group Health Services Plan
31                                                     HSPG Group Health Services Plan
32                                                     HSPI Individual Health Services Plan
33                                                     Individual Accident and Sickness
34                                                     Other:
35
   For each applicable INDIVIDUAL product, please fill in the fields (shown in Yellow) for the requested information starting with the Product 1 Tab. Please use
   separate Tabs for each product. (Alternatively, several products can be combined into one Product Grouping and shown in one single Tab. But Product Grouping
   tab should only be used if the Company can provide the requested information for that Product Grouping in a reasonably accurate manner.) Then in the Yellow
   field below, please state the number of tabs filled in (this is equal to the number of products/product groupings where the data are provided).
36
37
   Number of product Tabs with data filled in
38 (starting with the Product 1 Tab) is:
39
   If the Company's total membership as of December 31, 2010 for these INDIVIDUAL products is less than 1000 , you do not need to provide the data requested in
   the product tabs. In this case, please complete the information in the Market Participation Tab and submit per the instructions below.
40
41
   Upon completion, please save this apreadsheet using the filename "IN-#####", where "#####" is the 5-digit NAIC Company code. Then email this spreadsheet
   template to LHDatacalls@scc.virginia.gov. If you have any questions, please send an email to LHDatacalls@scc.virginia.gov with your questions and contact
   information. Please submit your response on or before May 18, 2011.
42




3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls       Company Info
                             A                                 B                           C                       D
 1                                                  Market Participation

   • State the number of accident and sickness policies, certificates or evidences of coverage attributable to
 2 coverage subject to the PPACA and issued in Virginia in 2009 and 2010 in the INDIVIDUAL market:
 3

 4      2009: Number of Policies/Certificates/EOCs:                             covering how many lives:

 5      2010: Number of Policies/Certificates/EOCs:                             covering how many lives:
 6

     If the Company's total membership as of December 31, 2010 for these INDIVIDUAL products is less than 1000 , you do
       not need to provide the data requested in the product tabs. In this case, please complete the information here and
 7                                    submit per the instructions in the Company Info Tab




3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls
                   A                     B          C           D        E                    F


 1
                                    Confidentiality Request
 2       Company Name:


   Is the company identified requesting that the information in this survey be considered confidential
 3 proprietary pursuant to Virginia Code § 38.2-221.1? (check one)
 4                                   YES                   NO

 5            Check one:

     If yes, please detail the reason the information is confidential proprietary, indicating why protection
6                                                is necessary:
7
8
9
10
11
12


13   The Bureau likely will publish aggregated and summarized information regarding data responses.




3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Confidentiality
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 1
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 1
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 2
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 2
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 3
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 3
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 4
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 4
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 5
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 5
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 6
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 6
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 7
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 7
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 8
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 8
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 9
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 9
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 10
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 10
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 11
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 11
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 12
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 12
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 13
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 13
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 14
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 14
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 15
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 15
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 16
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 16
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 17
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 17
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 18
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 18
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 19
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 19
         A              B                 C                  D                 E                F            G             H               I            J        K        L            M             N            O            P            Q            R              S
 1
 2                                           NAIC Company Code (5 numeric digits):
 3                                                       TOI Category (see first Tab):
 4                                                                  Product Name(s):
 5                                                            Policy Form Number(s):
 6                                                   Date of Original Filing with BOI:
 7                            Virginia or SERFF Tracking # of Original Filing with BOI:
                        Virginia or SERFF Tracking #'s of Rate Change Requests made
 8                                  effective between Jan. 2007 to Dec. 2010 (if any):
 9
10
                                                                                                                                                                     Known or estimable Changes (if any) in the membership mix and in various rating factors which occurred
                                                                                                                                                                     between Jan. 2007 to Dec. 2010 and which may have affected the premium and/or claim trends during this
11                                                                                                                                                                   48-month period.
                                                                                                                                    Effective Dates
                                                                                                          Expected    Implemented    of Base Rate   Observed                                                                                            Other         Other
                                                                           Income          Income at      Loss Ratio Past Base Rate    Increases    Base Claim         Average                 Average                  Average          Average     Significant   Significant
                                                                         Adjustment       Current Rates   (Exp LR%) Increase % (In implemented (In Trend % (In         Gender    Average Age Underwriting Average      Contract          Benefit       Rating        Rating
12    Month        # of Members   Incurred Claims Premium Income            Factor           =(4)X(5)       (In %)         %)        MM/DD/YY)          %)              Factor     Factor    Class Factor Area Factor Type Factor         Factor      Factor 1      Factor 2
13     (1)               (2)             (3)            (4)                   (5)               (6)           (7)          (8)             (9)         (10)              (11)        (12)        (13)        (14)         (15)             (16)          (17)          (18)
14
15
16     Jan-2007                                                                                      $0
17    Feb-2007                                                                                       $0
18    Mar-2007                                                                                       $0
19    Apr-2007                                                                                       $0
20    May-2007                                                                                       $0
21    Jun-2007                                                                                       $0
22      Jul-2007                                                                                     $0
23    Aug-2007                                                                                       $0
24    Sep-2007                                                                                       $0
25    Oct-2007                                                                                       $0
26    Nov-2007                                                                                       $0
27    Dec-2007                                                                                       $0
28     Jan-2008                                                                                      $0
29    Feb-2008                                                                                       $0
30    Mar-2008                                                                                       $0
31    Apr-2008                                                                                       $0
32    May-2008                                                                                       $0
33    Jun-2008                                                                                       $0
34      Jul-2008                                                                                     $0
35    Aug-2008                                                                                       $0
36    Sep-2008                                                                                       $0
37    Oct-2008                                                                                       $0
38    Nov-2008                                                                                       $0
39    Dec-2008                                                                                       $0
40     Jan-2009                                                                                      $0
41    Feb-2009                                                                                       $0
42    Mar-2009                                                                                       $0
43    Apr-2009                                                                                       $0
44    May-2009                                                                                       $0
45    Jun-2009                                                                                       $0
46      Jul-2009                                                                                     $0
47    Aug-2009                                                                                       $0
48    Sep-2009                                                                                       $0
49    Oct-2009                                                                                       $0
50    Nov-2009                                                                                       $0
51    Dec-2009                                                                                       $0
52     Jan-2010                                                                                      $0
53    Feb-2010                                                                                       $0
54    Mar-2010                                                                                       $0
55    Apr-2010                                                                                       $0
56    May-2010                                                                                       $0
57    Jun-2010                                                                                       $0
58      Jul-2010                                                                                     $0
59    Aug-2010                                                                                       $0

3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls      Product 20
         A             B                  C                  D                 E               F               G               H                  I              J       K         L            M                N            O            P             Q             R            S
60   Sep-2010                                                                                        $0
61   Oct-2010                                                                                        $0
62   Nov-2010                                                                                        $0
63   Dec-2010                                                                                        $0
64
65
66 Explanation of Data Fields Requested above:
67   Column         Format          Description
68
69      (1)       MMM-YYYY This is the month corresponding to all the values. This will be for the 48-month period from Jan-2007 to Dec-2010.
70      (2)         Integer      The number of members at the end of each month.
        (3)        $ amount      Incurred claims should exclude active life reserve, include capitations and net of drug rebates (where aplicable). They should be based on actual paid claims for that incurral month using claims runout and with application of appropriate completion
71                               factors. Please also state the date of claims runout in row 14 of column 3. (For example, if the claims runout is through 3/31/2011, then enter 03/31/11 in Cell 14.)
72       (4)            $ amount       Premium income for that month.
         (5)         5 decimals (eg,   This is the factor that when multiplied with Premium Income will result in Restated Premium Income at Current Rates (i.e., the rates as of 12/31/2010) for each of the historical months. The Restated Premium Income at Current Rates means the
73                      1.25000)       income that would have been collected for any given month if the current rate table had been in effect at that time.
74       (6)            $ amount       The spreadsheet will automatically calculate this field as Premium income (column 4) times Income Adjustment Factor (column 5) for that month.
         (7)         XXX.XX% (eg,      This should be calculated as the weighted expected durational loss ratio corresponding to the business existing as of that month, weighted using the Premium distribution by duration as of the end of that month.
75                      70.12%)
         (8)         XXX.XX% (eg,
76                      20.00%)        During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the rate change %. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (9)           MM/DD/YY
77                                During the period Jan-2007 to Dec-2010, for each of the months that was the effective date of a rate change %, please fill in the effective date. For those months that were not the effective dates of a rate change %, please leave the field blank.
         (10)        XXX.XX% (eg, If the Company has calculated/estimated the Base Claim Trend % (expressed as Annual Trend %), please provide. If the Company only calculated the Base Claim Trend % on a quarterly (Q) or annual (A) basis, then please enter the same Annual Trend
                         8.00%)   % for all the months within that quarterly period or annual period, and also enter either Q (for quarterly) or A (for annual) in row 14 of column 10 (i.e., Cell J14). For example, if it was determined that the annual Base Claim Trend is 8% for the entire
78                                calendar year 2010, then enter "A" in Cell J14 and enter 8.00% for months Jan-2010 to Dec-2010.
79
     The values for columns (11) to (18) are to be supplied for those significant Changes (if any) in the membership mix and in various rating factors (that are known or had been estimated by the Company) that had occurred between Jan-2007 to Dec-2010 and that would have
     affected the observed premium and/or claim trends during this 48-month period. Please enter this value using 5 decimals (e.g., 1.03000).

     Please note that what is important is the Change in the membership mix and in various rating factors that may have affected the observed premium and/or claim trends during this 48-month period. For example, if the Company’s analysis had concluded that the mix of
     males and females has not significantly changed in the last 48 months and there was no change in the gender rating factors, then it is not necessary to calculate the actual Average Gender Factors and filling in a value of 1.00000 for all 48 months would suffice.

     If the Company has not performed any analysis/study to determine/estimate the impact of changes in these Average rating/benefit factors on the observed premium/claim trends during these 48-months, then:

     a) Enter “NONE” in row 14 of the respective columns (11) to (18). [For example, if the Company has not performed an analysis/study to determine/estimate the impact of changes in gender mix and rating factors on the observed premium/claim trends, then enter “NONE” in Cell
     L14.]

     b) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why no such analysis/study has been performed. And

     c) Provide an explanation (in the “Company’s Comment/Explanation” section below) as to why the Company believes that quantifying/estimating the impact of the changes in these Average rating/benefit Factors is deemed unnecessary in the Company’s rate change
     determination process/methodology (during these 48-month period).

80
         (11)        5 decimals (eg, This is the average gender factor reflecting the gender mix at the respective month. For example, if the male factor was 1.00000 and the female factor was 1.15000 on Jan-2007, and the male/female mix was 50/50, then the Average Gender Factor
81                      1.25000)     for Jan-2007 is 1.07500.
82       (12)          5 decimals      Similar to column (11) reflecting the average factor for age (or age group).
83       (13)          5 decimals      Similar to column (11). Underwriting factors (if any) refer to Tobacco/Nontobacco, or Preferred/Standard, etc.
84       (14)          5 decimals      Similar to column (11) reflecting the average factor for geographic area.
85       (15)          5 decimals      Similar to column (11). Contract type factors (if any) refer to Single/Married with One Child/Family, etc.
86       (16)          5 decimals      Similar as column (11) reflecting the average factor for benefit mix (e.g., different deductibles, copays, benefit schedules).
87       (17)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (16). Please specify that significant factor in row 14, i.e., Cell R14.
88       (18)          5 decimals      Similar as column (11) reflecting another significant factor (if any) that is not mentioned in columns (11) to (17). Please specify that significant factor in row 14, i.e., Cell S14.
89
90
91
     Company's Comments/Explanations/Caveats section (Please provide any relevant or useful information that will help in understanding/explaining the data provided by the Company above. This will minimize the amount of follow up needed with the Company.)
92
93              1.
94              2.
95              3.
96              4.
97              5.
98              6.
99              7.



3b1ca35d-b222-42c4-8a62-b0e4e0513522.xls            Product 20

								
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