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MONTHLY FORMS REVIEWED LIST F REVIEWED FILINGS FOR OCTOBER 2008

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MONTHLY FORMS REVIEWED LIST F REVIEWED FILINGS FOR OCTOBER 2008 Powered By Docstoc
					REVIEWED FILINGS FOR OCTOBER 2008 Name 5 Star Life Insurance Company ACE American Insurance Company ACE American Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Date 10/23/08 10/08/08 10/08/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 Form# ISP WL POLICY R90850793 NE 50717 AH-18159 50717 AH-22240 50867 GR-96173 50-1B 50867 GR-96173 80-5D 50867 GR-96173 90 50867 GR-9N 14-005 02 50867 GR-9N 14-015 01 50867 GR-9N 14-025 03 50867 GR-9N 28-015 05 50867 GR-9N 30-005 03 50867 GR-9N 30-015 04 50867 GR-9N 30-020 01 50867 GR-9N S-14-05 03 50867 GR-9N S-14-10 03 50867 GR-9N S-14-20 03 50867 GR-9N S-14-25 03 50867 GR-9N S-14-30 03 50867 GR-9N S-14-35 03 50867 GR-9N S-14-40 03 Div# Line L H H H H H H H H H H H H H H H H H H H OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH Hlth Type Descrip Special Act I B B G G G G G G G G G G G G G G G G G POL RID RID CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT A A A A A A A A A A A A A A A A A A A A WHOLE POLITICAL EVACUATION AND REPATRIATION KIDNAP AND EXTORTION EXPENSE FACILITY INDEMNITY PLAN GLOSSARY PREMIUM CONTRIBUTIONS PROVISIONS WHAT THE PLAN COVERS WELLNESS PHYSICIAN SERVICES EXCLUSIONS WHEN COVERAGE ENDS FOR EMPLOYEES WHEN COVERAGE ENDS FOR DEPENDENTS PREMIUM CONTRIBUTION PROVISIONS CALENDAR YEAR DEDUCTIBLE [CALENDAR YEAR] [MONTHLY] MAXIMUM BENEFIT TREATING INJURIES RELATED TO AN ACCIDENT ROUTINE PREVENTATIVE CARE EXPENSES PHYSICIAN EXPENSES HOSPITAL/FACILITY EXPENSES COVERAGE FOR EMERGENCY MEDICAL EXPENSES Comments

Page 1 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company Aetna Life Insurance Company ALTERNATIVES TO HOSPITAL STAYS OTHER COVERED HEALTH CARE EXPENSES SPECIALIZED CARE TREATMENT FOR ALCOHOLISM, DRUG ABUSE ORAL AND MAXILLOFACIAL TREATMENT SUPPLEMENTAL EXPENSE BENEFIT CALENDAR YEAR DEDUCTIBLE CALENDAR YEAR AND MONTHLY MAXIMUM BENEFIT LIFETIME MAXIMUM BENEFITS TREATMENT FOR INJURIES RELATED TO AN ACCIDENT EXPENSE BENEFIT ROUTINE PREVENTATIVE CARE EXPENSES PHYSICIAN EXPENSES HOSPITAL/FACILITY EXPENSES COVERAGE FOR EMERGENCY MEDICAL EXPENSES ALTERNATIVES TO HOSPITAL STAYS OTHER COVERED HEALTH CARE EXPENSES SPECIALIZED CARE TREATMENT FOR MENTAL DISORDERS ORAL AND MAXILLOFACIAL TREATMENT SUPPLEMENTAL EXPENSE BENEFIT

10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08

50867 GR-9N S-14-45 03 50867 GR-9N S-14-50 03 50867 GR-9N S-14-55 03 50867 GR-9N S-14-60 03 50867 GR-9N S-14-65 03 50867 GR-9N S-14-70 03 50867 GR-9N S-15-05 03 50867 GR-9N S-15-10 03 50867 GR-9N S-15-15 03 50867 GR-9N S-15-20 03 50867 GR-9N S-15-25 03 50867 GR-9N S-15-30 03 50867 GR-9N S-15-35 03 50867 GR-9N S-15-40 03 50867 GR-9N S-15-45 03 50867 GR-9N S-15-50 03 50867 GR-9N S-15-55 03 50867 GR-9N S-15-60 03 50867 GR-9N S-15-65 03 50867 GR-9N S-15-70 03

H H H H H H H H H H H H H H H H H H H H

OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH

G G G G G G G G G G G G G G G G G G G G

CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT

A A A A A A A A A A A A A A A A A A A A

Page 2 of 101

REVIEWED FILINGS FOR OCTOBER 2008 AIG Annuity Insurance Company AIG Life Insurance Company AIG Life Insurance Company AIG SunAmerica Life Assurance Company AIG SunAmerica Life Assurance Company AIG SunAmerica Life Assurance Company AIG SunAmerica Life Assurance Company AIG SunAmerica Life Assurance Company AIG SunAmerica Life Assurance Company Allianz Life Insurance Company of North America Allianz Life Insurance Company of North America Allianz Life Insurance Company of North America Allianz Life Insurance Company of North America Allianz Life Insurance Company of North America Allstate Life Insurance Company Allstate Life Insurance Company Allstate Life Insurance Company Allstate Life Insurance Company

10/09/08 10/14/08 10/14/08 10/24/08 10/24/08 10/28/08 10/28/08 10/28/08 10/28/08 10/14/08

50741 108-5X 50780 13GVUL08 50780 13GVUL08B 50994 ASE-6232 (3/08) 50994 ASE-6233 (3/08) 51003 ASA-579 (6/08) 51003 ASA-579-1 (6/08) 51003 ASA-579E (6/08) 51003 ASE-6238 (6/08) 50779 N40001-IND-NE-10

A L L A A VA VA VA VA A

I G G G G G G G G I

APP MISC MISC END END APP APP APP END MISC

A A A A A A A A A A ENROLLMENT ENROLLMENT OPTIONAL DEATH BENEFIT BENEFIT BASE OUTLINE 2001 CSO TABLE UPDATE 2001 CSO TABLE UPDATE 403(B) 403(B)

10/14/08

50779 W40008-IND-01

A

I

RID

A

INCOME PROTECTION

10/14/08

50790 PR91023

L

I

RID

A

ENHANCED CASH VALUE REPLACEMENT - 30 DAY FREE LOOK PROVISION REPLACEMENT NOTIFICATION IRA ROTH AMENDATORY

10/23/08

51001 F40342 (7-00)

VA

I

MISC

A

10/24/08 10/01/08 10/01/08 10/06/08 10/21/08

50923 STK-NE 50604 LU10957 50604 LU10958 50653 FIC258AA-1 50882 A-LG-ROTH(1/08)

A/VA A A L VA

I I I I I Page 3 of 101

MISC END END APP END

A A A A A

ROTH IRA

REVIEWED FILINGS FOR OCTOBER 2008 Allstate Life Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company

10/23/08 10/08/08

50951 FIC281SSA-2 50736 33-APHQ 6/08

A H MM

I I

APP APP

A A ABNORMAL PAP/HPV SUPPLEMENT ARTHRITIS SUPP

10/08/08

50736 33-ARQ 6/08

H

MM

I

APP

A

10/08/08

50736 33-CATQ 6/08

H

MM

I

APP

A

CATARACTS SUPP

10/08/08

50736 33-CTUQ 6/08

H

MM

I

APP

A

CARPAL/ULNAR TUNNEL SUPP

10/08/08

50736 33-EAQ 6/08

H

MM

I

APP

A

OTIS MEDIA/EAR SUPP GASTROESOPHAGEAL REFLUX/HIATAL/DIAPHRAGMATI C HERNIA ULCER SUPP GASTROINTESTINAL SUPP

10/08/08

50736 33-GHDUQ 6/08

H

MM

I

APP

A

10/08/08

50736 33-GIQ 6/08

H

MM

I

APP

A

10/08/08

50736 33-HMQ 6/08

H

MM

I

APP

A

HEART MURMUR SUPP

10/08/08

50736 33-HYPQ 6/08

H

MM

I

APP

A

HYPERTENSION SUPP

10/08/08

50736 33-INFQ 6/08

H

MM

I

APP

A

INFERTILITY SUPP

10/08/08

50736 33-JNTQ 6/08

H

MM

I

APP

A

JOINT INJURY SUPP

10/08/08

50736 33-MHQ 6/08

H

MM

I

APP

A

MENTAL HEALTH SUPP

10/08/08

50736 33-MIQ 6/08

H

MM

I

APP

A

MIGRAINE/HEADACHE SUPP

Page 4 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Community Mutual Insurance Company American Equity Investment Life Insurance Company American Equity Investment Life Insurance Company American Equity Investment Life Insurance Company American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus

10/08/08

50736 33-SEQ 6/08

H

MM

I

APP

A

SEIZURE/EPILEPSY SUPP

10/08/08

50736 33-SPQ 6/08

H

MM

I

APP

A

SPINAL SUPP

10/08/08

50736 33-TCQ 6/08

H

MM

I

APP

A

TUMOR/CYST SUPP

10/08/08

50736 33-THQ 6/08

H

MM

I

APP

A

THYROID SUPP

10/20/08

50797 AR-RX-GENERIC09-NE

H

MM

I

RID

A

GENERIC OUTPATIENT DRUG

10/20/08

50797 AR-RX-TIER09-NE

H

MM

I

RID

A

OUTPATIENT DRUG

10/20/08

50797 IND09

H

MM

I

POL

A

EXPENSE

10/21/08

50971 NE RA 8/08

H

OTH

I

APP

A 2001 CSO MORTALITY TABLE UPDATE 2001 CSO MORTALITY TABLE UPDATE

10/02/08

50654 SPL-1

L

I

MISC

INF

10/02/08

50674 SIWL-1

L

I

MISC

INF

10/10/08

50752 SIWL-2

L

I

MISC

INF 2001 CSO MORTALITY TABLE

10/03/08

50702 A72003

H

OTH

I

APP

A

REINSTATEMENT

10/03/08

50702 A72003G

H

OTH

I

APP

A

REINSTATEMENT

10/03/08

50702 A72050

H

OTH

I

RID

A

LUMP SUM CANCER

Page 5 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus

10/03/08

50702 A72051

H

OTH

I

RID

A

RETURN OF PREMIUM

10/03/08

50702 A72052

H

OTH

I

RID

A

SUDDEN CARDIAC DEATH

10/03/08

50702 A72100NE

H

OTH

I

POL

A

LUMP SUM CRITICAL ILLNESS

10/03/08

50702 A72200NE

H

OTH

I

POL

A

LUMP SUM CANCER

10/03/08

50702 A72GAPPNE

H

OTH

I

APP

A

10/03/08

50702 A72GCAPPNE

H

OTH

I

APP

A

10/03/08

50702 A72PAPPNE

H

OTH

I

APP

A

10/03/08

50702 A72PCAPPNE

H

OTH

I

APP

A

10/03/08

50702 A72UAPPNE

H

OTH

I

APP

A

10/03/08

50702 A72UCAPPNE

H

OTH

I

APP

A

10/03/08

50702 ASIGN

H

OTH

I

APP

A

SUPPLEMENT

10/03/08

50702 ASIGNC

H

OTH

I

APP

A

SUPPLEMENT

10/03/08

50702 LSCA

H

OTH

I

APP

A

UNDERWRITING SUPPLEMENT

10/03/08

50702 LSCAG

H

OTH

I

APP

A

UNDERWRITING SUPPLEMENT

Page 6 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus

10/03/08

50702 LSCI

H

OTH

I

APP

A

UNDERWRITING SUPPLEMENT

10/03/08

50702 LSCIG

H

OTH

I

APP

A

UNDERWRITING SUPPLEMENT

10/03/08

50828 A35003

H

OTH

I

APP

A

REINSTATEMENT

10/03/08

50828 A35050

H

OTH

I

RID

A

OFF THE JOB

10/03/08

50828 A35051

H

OTH

I

RID

A

OFF THE JOB

10/03/08

50828 A35052

H

OTH

I

RID

A

SICKNESS DISABILITY

10/03/08

50828 A35053

H

OTH

I

RID

A

SPOUSE OFF THE JOB

10/03/08

50828 A35054

H

OTH

I

RID

A

ACCIDENTAL DEATH BENEFIT

10/03/08

50828 A35100NE

H

OTH

I

POL

A

ACCIDENT

10/03/08

50828 A35200NE

H

OTH

I

POL

A

ACCIDENT ONLY

10/03/08

50828 A35300NE

H

OTH

I

POL

A

OFF-THE-JOB ACCIDENT

10/03/08

50828 A35400NE

H

OTH

I

POL

A

OFF-THE-JOB ACCIDENT

10/03/08

50828 A35AAPPNE

H

OTH

I

APP

A

10/03/08

50828 A35B24NE

H

OTH

I

POL

A

ACCIDENT ONLY

Page 7 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Family Life Assurance Company of Columbus American Fidelity Assurance Company American Fidelity Assurance Company American Fidelity Assurance Company American Fidelity Assurance Company American Fidelity Assurance Company American General Assurance Company

10/03/08

50828 A35BOFNE

H

OTH

I

POL

A

OFF-THE-JOB ACCIDENT

10/03/08

50828 A35NAPPNE

H

OTH

I

APP

A

10/03/08

50828 A35PAPPNE

H

OTH

I

APP

A

10/03/08

50828 A35UAPPNE

H

OTH

I

APP

A

10/03/08

50828 ACCAUW

H

OTH

I

APP

A

SUPPLEMENT

10/03/08

50828 ACCNUW

H

OTH

I

APP

A

SUPPLEMENT

10/03/08

50828 ACCPUW

H

OTH

I

APP

A

SUPPLEMENT

10/03/08

50828 ASIGN

H

OTH

I

APP

A

SUPPLEMENT

10/03/08

50828 ASIGNC

H

OTH

I

APP

A

SUPPLEMENT

10/16/08 10/07/08 10/07/08 10/07/08 10/27/08 10/27/08 10/15/08

51112 A63004RNE 50687 A1194R808 50687 AMDI258 50687 AMDI259 50698 AMDI258 50698 AMDI259 50915 AIG0011NE

L H H H H H H OTH OTH OTH OTH OTH OTH

I I I I I I G

APP APP RID RID MISC MISC APP

A A A A F F A

TERM

ACCIDENT ONLY BENEFIT ENHANCEMENT NON-OCCUPATIONAL ACCIDENT REVISED ACCIDENT ONLY RATE MANUAL REVISED ACCIDENT ONLY RATE MANUAL

Page 8 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American General Assurance Company American General Life and Accident Insurance Company American General Life Insurance Company American General Life Insurance Company American General Life Insurance Company American Heritage Life Insurance Company American Heritage Life Insurance Company American Home Life Insurance Company American Investors Life Insurance Company American Investors Life Insurance Company American Investors Life Insurance Company American National Insurance Company American National Life Insurance Company of Texas American National Life Insurance Company of Texas American National Life Insurance Company of Texas American National Life Insurance Company of Texas American National Life Insurance Company of Texas

10/15/08 10/24/08 10/16/08 10/16/08 10/16/08 10/21/08 10/21/08 10/06/08 10/03/08 10/03/08 10/03/08 10/20/08 10/15/08

50915 AIG2011NE 50986 AGLA 08 AHA 50649 07411JT 50649 08921-28 50649 AGLC103302-2008 50874 G-3272TMJ(NE)-C 50874 G-3272TMJ(NE)-P 50668 FORM 08 LPDT-NE 50661 BPASEL10 (REV. 10/08) 50661 BPASEL12 (REV. 10/08) 50661 BPASEL6 (REV. 10/08) 50860 FORM 9014 50598 ANL-MC05-END-A-REV 8/05 ANL-MC05-END-B-REV 8/05 ANL-MC05-END-C-REV 8/05 ANL-MC05-END-D-REV 8/05 ANL-MC05-END-E-REV 8/05

H L VL VL VL H H L A A A L H

OTH

G I I I I

APP RID RID POL APP CERT POL POL MISC MISC MISC APP RATE SMS

A A A A A A A A A A A A A TMJ CERTIFICATE PROVISIONS TMJ POLICY PROVISIONS TERM TO AGE 100 DATA PAGES 2 AND 2A DATA PAGES 2 AND 2A DATA PAGES 2 AND 2A SUPPLEMENTAL INCREASE - 8% - PLAN A ADDITIONAL INSURED TERM GUARANTEED MINIMUM DEATH BENEFIT JOINT AND LAST SURVIVOR FLEXIBLE PREMIUM

OTH OTH

G G I I I I I

MS

G

10/15/08

50598

H

MS

G

RATE

SMS

A

INCREASE - 8% - PLAN B

10/15/08

50598

H

MS

G

RATE

SMS

A

INCREASE - 8% - PLAN C

10/15/08

50598

H

MS

G

RATE

SMS

A

INCREASE - 8% - PLAN D

10/15/08

50598

H

MS

G

RATE

SMS

A

INCREASE - 8% - PLAN E

Page 9 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American National Life Insurance Company of Texas American National Life Insurance Company of Texas American National Life Insurance Company of Texas American National Life Insurance Company of Texas American National Life Insurance Company of Texas American National Life Insurance Company of Texas American Public Life Insurance Company American Republic Corp Insurance Company American Republic Corp Insurance Company American Republic Corp Insurance Company American Republic Corp Insurance Company American Republic Corp Insurance Company American Republic Corp Insurance Company American Republic Insurance Company American Republic Insurance Company American Republic Insurance Company American Republic Insurance Company American Republic Insurance Company

10/15/08

50598

ANL-MC05-END-F-REV 8/05 ANL-MC05-END-G-REV 8/05

H

MS

G

RATE

SMS

A

INCREASE - 8% - PLAN F

10/15/08

50598

H

MS

G

RATE

SMS

A

INCREASE - 8% - PLAN G

10/15/08

50598 ANL-SS05-C-REV 8/05

H

MS

G

RATE

SMS

A

INCREASE - 8% - PLAN C

10/15/08

50598 ANL-SSU5-C-REV 8/05

H

MS

G

RATE

SMS

A

INCREASE - 8% - PLAN C

10/27/08

50921 ANL-DT08-C

L

G

POL

A

10/27/08 10/28/08 10/08/08 10/08/08 10/08/08 10/08/08 10/09/08 10/09/08 10/27/08 10/27/08 10/27/08 10/27/08 10/27/08

50921 ANL-DT08-P 51016 AO08MASAPP 50835 Z-2347 50835 Z-2348 50908 Z_2364 50908 Z_2365 51013 Z-2346 51025 Z-2326 50764 A-3405NE 50765 A-4023NE 50766 A-3406NE 50767 A-4025NE 50768 A-4026NE

L H H H H H H H H H H H H OTH MS MS MS MS MS MS MS MS MS MS MS

G G I I I I I I G G G G G

CERT APP AD AD AD AD AD AD RATE RATE RATE RATE RATE SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS

A A ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT A A A A A INCREASE - 8.5% - PLAN A INCREASE - 9% - PLAN E INCREASE - 10.2% - PLAN F INCREASE - 0% - PLAN K INCREASE - 8.6% - PLAN L

Page 10 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL

10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08

50313 G 3200.1 50313 G 3200.12D 50313 G 3200.13-1/1A 50313 G 3200.13-2A 50313 G 3200.13-3 50313 G 3200.13-4 50313 G 3200.13D 50313 G 3200.14D 50313 G 3200.16/1 50313 G 3200.16B 50313 G 3200.17C 50313 G 3200.18B 50313 G 3200.19-1 50313 G 3200.19B 50313 G 3200.2 50313 G 3200.22D 50313 G 3200.23B 50313 G 3200.24D 50313 G 3200.24D/1 50313 G 3200.24D-1 50313 G 3200.24D-2

H H H H H H H H H H H H H H H H H H H H H

DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI

G G G G G G G G G G G G G G G G G G G G G

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

F F F F F F F F F F F F F F F F F F F F F

Page 11 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL

10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08

50313 G 3200.25B 50313 G 3200.27B(28) 50313 G 3200.28A 50313 G 3200.29-2 50313 G 3200.29-2/1 50313 G 3200.29B 50313 G 3200.30B 50313 G 3200.31/1A 50313 G 3200.31B 50313 G 3200.32B 50313 G 3200.33A 50313 G 3200.35A 50313 G 3200.36A 50313 G 3200.3C 50313 G 3200.4D 50313 G 3200.5C 50313 G 3200.6C 50313 G 3200.7C 50313 G 3200.8/1B 50313 G 3200.8C 50313 G 3200.9/1A

H H H H H H H H H H H H H H H H H H H H H

DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI

G G G G G G G G G G G G G G G G G G G G G

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

F F F F F F F F F F F F F F F F F F F F F

Page 12 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY RATE MANUAL

10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08

50313 G 3200.9B 50313 GC 3200.1 50313 GC 3200.12D 50313 GC 3200.13-1/1A 50313 GC 3200.13-2A 50313 GC 3200.13-3 50313 GC 3200.13-4 50313 GC 3200.13D 50313 GC 3200.14D 50313 GC 3200.16B 50313 GC 3200.17B 50313 GC 3200.18B 50313 GC 3200.19-1A 50313 GC 3200.19B 50313 GC 3200.2 50313 GC 3200.22/1 50313 GC 3200.22C 50313 GC 3200.23B 50313 GC 3200.24C-1 50313 GC 3200.24D 50313 GC 3200.25B

H H H H H H H H H H H H H H H H H H H H H

DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI

G G G G G G G G G G G G G G G G G G G G G

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

F F F F F F F F F F F F F F F F F F F F F

Page 13 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company American United Life Insurance Company REVISED GROUP DISABILITY RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL REVISED GROUP DISABILITY F RATE MANUAL DISCLOSURE FOR ACCELERATED INF BENEFIT ACCELERATED BENEFIT INF DISCLOSURE STATEMENT F

10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08 10/09/08 10/09/08

50313 GC 3200.27B(28) 50313 GC 3200.28A 50313 GC 3200.29-2 50313 GC 3200.29B 50313 GC 3200.30B 50313 GC 3200.31/1A 50313 GC 3200.31B 50313 GC 3200.32B 50313 GC 3200.33A 50313 GC 3200.35A 50313 GC 3200.36A 50313 GC 3200.3C 50313 GC 3200.4C 50313 GC 3200.5C 50313 GC 3200.6C 50313 GC 3200.7C 50313 GC 3200.8/1A 50313 GC 3200.8C 50313 GC 3200.9B 50746 CLAIM-211/2901 50746 DISC-211/2901

H H H H H H H H H H H H H H H H H H H L L

DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI

G G G G G G G G G G G G G G G G G G G I I

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

Page 14 of 101

REVIEWED FILINGS FOR OCTOBER 2008 American United Life Insurance Company American-Amicable Life Insurance Company of Texas Americo Financial Life and Annuity Insurance Company Americo Financial Life and Annuity Insurance Company Americo Financial Life and Annuity Insurance Company Amica Life Insurance Company Assured Life Association Assurity Life Insurance Company Assurity Life Insurance Company Assurity Life Insurance Company Assurity Life Insurance Company Assurity Life Insurance Company Assurity Life Insurance Company Assurity Life Insurance Company Assurity Life Insurance Company Assurity Life Insurance Company Assurity Life Insurance Company Assurity Life Insurance Company Auto-Owners Life Insurance Company POLICY DELIVERY CONFIRMATION

10/27/08 10/24/08

50997 GC 2535NN(T) 50993 AA9617(REV.6/08)

L L

G I

MISC APP

INF A

10/21/08

50891 AAA4146

L

I/G

END

A

MERGER

10/23/08

50739 ANE259 (08/08)

L

I

POL

A

FLEXIBLE PREMIUM ADJUSTABLE

10/23/08 10/21/08 10/14/08 10/02/08 10/02/08 10/02/08 10/02/08 10/02/08 10/02/08 10/02/08 10/02/08 10/02/08 10/20/08 10/20/08 10/03/08

50946 ANE5089 (2008) 50922 CLT01-01 (REV 09/08) 50724 SPT-2008 NE 50852 75-355-05051 (R09-08) 50852 I L0880 50852 R I0881 50852 R I0882 50852 R I0883 50852 R I0884 50852 R I0885 50852 R I0886 50852 R I0887 51062 G059 (R10-08) 51062 G059 C (R10-08) 50602 61246 (1-08)

L L L L L H H H L L L L H H L OTH OTH OTH OTH DI

I I I I I I I I I I I I G G I Page 15 of 101

APP POL CERT APP POL RID RID RID RID RID RID RID RID RID APP

A INF A A A A A A A A A A A A A WHOLE CRITICAL ILLNESS BENEFIT CRITICAL ILLNESS - OTHER INSURED DISABILITY WAIVER OF PREMIUM LEVEL TERM BENEFIT LEVEL TERM BENEFIT - OTHER INSURED PAYOR BENEFIT PROTECTED INSURABILITY BENEFIT CRITICAL ILLNESS CRITICAL ILLNESS LIFE AND DISABILITY REVISED ACTUARIAL MEMORANDUM SINGLE PREMIUM INCREASING TERM TO AGE 25

REVIEWED FILINGS FOR OCTOBER 2008 Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company

10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08

50602 61247 (1-08) 50602 61379 (1-08) 50602 61452 (1-08) 50602 61462 (1-08) 50602 61463 (1-08) 50602 61464 (1-08) 50602 61467 (1-08) 50602 61473 (1-08) 50602 61483 (1-08) 50602 61485 (1-08) 50602 61486 (1-08) 50602 61487 (1-08) 50602 61490 (1-08) 50602 61491 (1-08) 50602 61500 (1-08) NE 50602 61528 (1-08) NE 50602 61542 (1-08) NE 50602 61550 (1-08) 50602 61551 (1-08) 50602 61554 (1-08) 50602 61557 (1-08)

L L L L L L L L L L L L L L L L L L L L L

I I I I I I I I I I I I I I I I I I I I I Page 16 of 101

APP APP APP RID RID RID RID POL POL POL RID RID POL POL RID RID RID MISC POL POL MISC

A A A A A A A A A A A A A A A A A A A A A

JOINT LIFE

APP-CELERATOR SPOUSE AND CHILDREN'S TERM CHILDREN'S TERM SECONDARY INSURED BENEFIT PREMIUM WAIVER FOR DEATH OR DISABILITY FLEXIBLE PREMIUM ADJUSTABLE POLICY JACKET POLICY PROVISIONS POLICY PROVISIONS COST OF LIVING INCREASE GUARANTEED PURCHASE OPTION COVER PAGE BACK PAGE ACCIDENTAL DEATH BENEFIT DISABILITY INCOME BENEFIT DISABILITY PREMIUM WAIVER SCHEDULE OF BENEFITS TABLE OF GUARANTEED VALUES BACK PAGE SCHEDULE OF BENEFITS

REVIEWED FILINGS FOR OCTOBER 2008 Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Auto-Owners Life Insurance Company Aviva Life and Annuity Company Aviva Life and Annuity Company Aviva Life and Annuity Company Aviva Life and Annuity Company AXA Equitable Life Insurance Company AXA Equitable Life Insurance Company AXA Equitable Life Insurance Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company

10/03/08 10/08/08 10/08/08 10/08/08 10/09/08 10/08/08 10/21/08 10/21/08 10/21/08 10/03/08 10/20/08 10/20/08 10/08/08 10/08/08 10/08/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08

50602 61558 (1-08) 50719 61592 (10-98) 50720 61593 (10-08) 50721 61474 (3-08) 50718 61594 (10-98) 50675 FORM 2ENECA09 50893 3EN1VJ08 50893 3ENAVJ08 50893 LE37000 50660 08-200NE 50855 2008TSA(900) 50855 2008TSAGAC(900) 50730 5202-WC 50730 5202-WC-1 50730 BE-5202 50748 4102-WC 50748 4102-WC-1 50748 4103-WC 50748 4103-WC-1 50748 BE-4102 50748 BE-4103

L L L A L L L/H/A OTH L/H/A OTH L/H/A OTH VL VA VA H H H H H H H H H LTC LTC LTC LTC LTC LTC LTC LTC LTC

I I I I I I I I I I G G I I I I I I I I I

POL APP APP APP APP END END END END MISC END END AD AD AD AD AD AD AD AD AD

A A A A A A A A A INF A A

TABLE OF GUARANTEED COSTS

DEATH BENEFIT PROVISION MERGER MERGER MERGER REVISED ACTUARIAL MEMORANDUM 403(B) 403(B)

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT

Page 17 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company LTC/ MS LTC/ MS LTC/ MS LTC/ MS LTC LTC LTC LTC LTC LTC LTC LTC LTC LTC OTH MS MS MS MS MS MS

10/09/08 10/09/08 10/09/08 10/09/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/15/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08

51015 17484 51015 17484-1 51015 17485 51015 17485-1 50545 GR-7A1 50545 GR-N050 50545 GR-N100 50545 GR-N105 50545 GR-N160 50545 GR-N165 50545 GR-N240 50545 GR-N250 50545 GR-N270 50545 GR-N280 50913 17300A 50599 GR-A06A 50599 GR-A06B 50599 GR-A06C 50599 GR-A06D 50599 GR-A06E 50599 GR-A06F

H H H H H H H H H H H H H H H H H H H H H

I I I I I I I I I I I I I I I I I I I I I

AD AD AD AD RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE APP RATE RATE RATE RATE RATE RATE

SMS SMS SMS SMS

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT A A A A A A A A A A A INCREASE - 35% INCREASE - 35% INCREASE - 35% INCREASE - 35% INCREASE - 35% INCREASE - 35% INCREASE - 35% INCREASE - 35% INCREASE - 35% INCREASE - 35%

SMS SMS SMS SMS SMS SMS

A A A A A A

INCREASE - 15% - PLAN A INCREASE - 10.5% - PLAN B INCREASE - 15% - PLAN C INCREASE - 0% - PLAN D INCREASE - 12% - PLAN E INCREASE - 9.5% - PLAN F

Page 18 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Bankers Life and Casualty Company Banner Life Insurance Company Banner Life Insurance Company BCS Life Insurance Company BCS Life Insurance Company BCS Life Insurance Company BCS Life Insurance Company Berkshire Life Insurance Company of America Berkshire Life Insurance Company of America Berkshire Life Insurance Company of America INCREASE - 0% - PLAN F HIGH DEDUCTIBLE INCREASE - 10.5% - PLAN G INCREASE - 9.5% - PLAN J INCREASE - 5.5% - PLAN K INCREASE - 5.5% - PLAN L INCREASE - 15% - PLAN A INCREASE - 10.5% - PLAN B INCREASE - 15% - PLAN C INCREASE - 0% - PLAN D INCREASE - 12% - PLAN E INCREASE - 9.5% - PLAN F INCREASE - 10.5% - PLAN G MEDICAL HISTORY

10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/14/08 10/14/08 10/20/08 10/20/08 10/20/08 10/20/08 10/15/08 10/15/08 10/15/08

50599 GR-A06FH 50599 GR-A06G 50599 GR-A06J 50599 GR-A06K 50599 GR-A06L 50755 GR-A11A 50755 GR-A11B 50755 GR-A11C 50755 GR-A11D 50755 GR-A11E 50755 GR-A11F 50755 GR-A11G 50831 ICC08 LU-1267 (10/08) 50831 ICC08-LIA (10/08) 50725 26.013 50725 26.213 (NE) 50725 26.413 (NE) 50725 99.991 51104 4185 51104 4186 51104 7324-01-09

H H H H H H H H H H H H L L H H H H H H H

MS MS MS MS MS MS MS MS MS MS MS MS

I I I I I G G G G G G G I I

RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE APP APP APP POL CERT RID AD AD AD

SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS

A A A A A A A A A A A A A A A A A A

OTH OTH OTH OTH LTC LTC LTC

G G G G I I I

VISION VISION DOMESTIC PARTNER

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT

Page 19 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Berkshire Life Insurance Company of America Berkshire Life Insurance Company of America Berkshire Life Insurance Company of America Berkshire Life Insurance Company of America Berkshire Life Insurance Company of America Berkshire Life Insurance Company of America Berkshire Life Insurance Company of America Berkshire Life Insurance Company of America Blue Cross and Blue Shield of Nebraska Blue Cross and Blue Shield of Nebraska Blue Cross and Blue Shield of Nebraska Blue Cross and Blue Shield of Nebraska Blue Cross and Blue Shield of Nebraska Blue Cross and Blue Shield of Nebraska Boston Mutual Life Insurance Company Boston Mutual Life Insurance Company Boston Mutual Life Insurance Company Boston Mutual Life Insurance Company Boston Mutual Life Insurance Company

10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/03/08 10/03/08 10/03/08 10/09/08 10/24/08 10/24/08 10/07/08 10/07/08

51104 8546-01-09 51104 8546-01-09-SCRIPT 51104 8923-01-09 51104 8924-01-09 51104 8925-01-09 51104 8926-01-09 51104 PA187-1-2009 51104 PA188-1-2009 50952 30-009-06 REV. 09-08 50952 30-010-06 REV. 9-08 50953 30-015 REV. 9-2008 50640 96-050 5/1/02 51143 98-289 REV. 06/2008 51208 96-060 10-08 50311 50311 GDP100-COBRA PREMIUM RIDER 5/08 GDP100-OPTIONAL CARE BENEFIT RIDER 5/08 NE GDP100-RETIREMENT CONTRIBUTION RIDER 5/08 GDP100-SPECIAL CONDITIONS LIMITATION RIDER 5/08 GDP100-SUPP. DIS BENEFIT RIDER 5/08

H H H H H H H H H H H H H H H H

LTC LTC LTC LTC LTC LTC LTC LTC MM MM MM MM OTH SL DI DI

I I I I I I I I G G G G G G G G

AD AD AD AD AD AD AD AD APP APP APP RATE CERT POL RID RID

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT A A A F A A A A INCREASE - 8% - GROUP CONVERSION MAJOR MEDICAL TRAVEL AND TRANSPORT STOP LOSS COBRA PREMIUM DISABILITY OPTIONAL CHILD/FAMILY MEMBER CARE EXPENSE BENEFIT RETIREMENT CONTRIBUTION RIDER SPECIAL CONDITIONS LIMITATIONS SUPPLEMENTAL DISABILITY

10/07/08

50311

H

DI

G

RID

A

10/07/08

50311

H

DI

G

RID

A

10/07/08

50311

H

DI

G

RID

A

Page 20 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Boston Mutual Life Insurance Company Boston Mutual Life Insurance Company Boston Mutual Life Insurance Company Central Reserve Life Insurance Company Central Reserve Life Insurance Company Central States Health and Life Company of Omaha Central United Life Insurance Company Central United Life Insurance Company Central United Life Insurance Company Central United Life Insurance Company Central United Life Insurance Company Central United Life Insurance Company Central United Life Insurance Company Central United Life Insurance Company Central United Life Insurance Company Central United Life Insurance Company Central United Life Insurance Company Charter National Life Insurance Company Charter National Life Insurance Company CHIP GDP100-VOC REHAB BENEFIT RIDER 5/08 NE GDP100-VOC 50311 REHAB.SERVICE RIDER 5/08 NE 50311 50806 GROUP APP 08/08 50709 GASBG-12-0001 51150 GASBG-1-0009 50414 C18 NE 50544 1020-1/91 50551 XCEP350MC 50551 XCP1003 50551 XCP1003LA 50551 XCP1003NE 50551 XCP1004 50551 XCP1004NE 50551 XCP1005 50480 1100-F-1/92-NE 50694 CEP350MC 50697 EMP 747-7 50995 CHT2 50995 CHT3 51109 9-2298 1/09 OPTIONAL VOCATIONAL REHABILITATION BENEFIT VOCATIONAL REHABILITATION SERVICES MASTER

10/07/08 10/07/08 10/15/08 10/08/08 10/21/08 10/09/08 10/14/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/22/08 10/22/08 10/24/08 10/27/08 10/27/08 10/20/08

H H L/H H H H H H H H H H H H H H H A A H

DI DI OTH LTC/ MS MS OTH MS OTH OTH OTH OTH OTH OTH OTH MS OTH MS

G G G I I I I I I I I I I I I I I I I

RID RID APP AD AD RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE END END END PMS SMS PMS SMS SMS

A A A

ACK ADVERTISEMENT ACK ADVERTISEMENT F A F F F F F F F A F A A A A INCREASE - AVERAGE - 12.5% CANCER POLICY INCREASE - 8% INCREASE - 8% - CANCER POLICY INCREASE - 8% - CANCER POLICY INCREASE - 8% - CANCER POLICY INCREASE - 8% - CANCER POLICY INCREASE - 8% - CANCER POLICY INCREASE - 8% - CANCER POLICY INCREASE - 8% - CANCER POLICY INCREASE - 8% - PLAN F INCREASE - 12.5% - CANCER POLICY INCREASE - 10% ROTH AMENDATORY IRA AMENDATORY CHIP MATERNITY BENEFIT

MM

I

Page 21 of 101

REVIEWED FILINGS FOR OCTOBER 2008 CHIP HIGH DEDUCTIBLE HEALTH PLAN COMPREHENSIVE HEALTH INSURANCE POOL (CHIP)

CHIP CHIP

10/20/08 10/20/08

51109 9-2299 1/09 51109 96-008 REV. 1/2009 50868 LBMP APP-2

H H H

MM MM OTH

I I G

END POL APP

A A A

Colonial Life and Accident 10/15/08 Insurance Company Colonial Life and Accident 10/21/08 Insurance Company Companion Life Insurance Company Companion Life Insurance Company Companion Life Insurance Company Companion Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company 10/21/08 10/21/08 10/21/08 10/21/08 10/10/08 10/10/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08

50975 ACC AMEND 50918 STM APP 50918 STMC 5100 50918 STMP 5000 50918 STMP 5000 ENR 50458 GM5800 50458 GM6000 49830 NEL-AGG(04-00) 49830 NEL-AP1(02-06) 49830 NEL-CP1(04-00) 49830 NEL-DEF(02-06) 49830 NEL-DS(02-06) 49830 NEL-EX(02-06) 49830 NEL-RA1(04-00) 49830 NEL-RA2(04-00) 49830 NEL-RA3(04-00) 49830 NEL-RA4(04-00)

H H H H H H H H H H H H H H H H H

OTH MM MM MM MM OTH OTH SL SL SL SL SL SL SL SL SL SL

I G G G G G G G G G G G G G G G G

END APP CERT POL APP MISC MISC POL APP POL POL APP POL RID RID RID RID

A INF

OTHER ACCIDENT POLICIES WITH US

INF SHORT TERM INF SHORT TERM INF ENROLLMENT F F A A A A A A A A A A EXCESS LOSS POLICY COVER DEFINITIONS DISCLOSURE SUPP LIMITATIONS AND EXCLUSIONS OF COVERAGE SPECIAL COVERAGE EFFECTIVE DATE COVERAGE EXCLUSION SPECIFIC EXCESS LOSS COVERAGE EXCLUSION REVISED SPECIFIC DEDUCTIBLE AMOUNT REVISED GROUP ACCIDENT AND HEALTH MANUAL REVISED GROUP ACCIDENT AND HEALTH MANUAL AGGREGATE EXCESS LOSS

Page 22 of 101

REVIEWED FILINGS FOR OCTOBER 2008 EXPANDED DEFINITION OF COVERED BENEFITS TO COVER CERTAIN MANAGED CARE FEES AGGREGATING SPECIFIC EXCESS LOSS COVERAGE MULTI-LEVEL REIMBURSEMENT FOR AGGREGATE EXCESS LOSS SPECIFIC CLAIMS INCLUDED IN TERMINAL AGGREGATE EXCESS LOSS AGGREGATE EXCESS LOSS INSURANCE WITH MONTHLY ACCOMMODATION AGGREGATE EXCESS LOSS INSURANCE WITH MONTHLY ACCOMMODATION AGGREGATE EXCESS LOSS INSURANCE WITH MONTHLY ACCOMMODATION AGGREGATE EXCESS LOSS INSURANCE WITH MONTHLY ACCOMMODATION AGGREGATE EXCESS LOSS SIMPLE FUNDING PREFERRED FUNDING AGGREGATE EXCESS LOSS INSURANCE WITH MONTHLY ACCOMMODATION AND TERMINAL PROTECTION REGULAR AGGREGATE EXCESS LOSS INSURANCE REGULAR AGGREGATE EXCESS LOSS INSURANCE REGULAR AGGREGATE EXCESS LOSS INSURANCE REGULAR AGGREGATE EXCESS LOSS INSURANCE

Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company

10/20/08 10/20/08 10/20/08 10/20/08

49830 NEL-RA5(04-00) 49830 NEL-RB1(02-06) 49830 NEL-RC1(04-00) 49830 NEL-RC2(04-00)

H H H H

SL SL SL SL

G G G G

RID RID RID RID

A A A A

10/20/08

49830 NEL-RD1.1(04-00)

H

SL

G

RID

A

10/20/08

49830 NEL-RD1.2(04-00)

H

SL

G

RID

A

10/20/08

49830 NEL-RD2(04-00)

H

SL

G

RID

A

10/20/08 10/20/08 10/20/08 10/20/08

49830 NEL-RD3(04-00) 49830 NEL-RD4(04-00) 49830 NEL-RD5(04-00) 49830 NEL-RD6(04-00)

H H H H

SL SL SL SL

G G G G

RID RID RID RID

A A A A

10/20/08

49830 NEL-RD7(09-07)

H

SL

G

RID

A

10/20/08 10/20/08 10/20/08 10/20/08

49830 NEL-RE1.1(04-00) 49830 NEL-RE1.2(04-00) 49830 NEL-RE2(04-00) 49830 NEL-RE3(02-06)

H H H H

SL SL SL SL

G G G G

RID RID RID RID

A A A A

Page 23 of 101

REVIEWED FILINGS FOR OCTOBER 2008 REGULAR AGGREGATE EXCESS LOSS INSURANCE WITH TERMINAL PROTECTION SCHEDULE SPECIFIC EXCESS LOSS TABLE OF CONTENTS TERMINATION OF THE POLICY, MISCELLANEOUS PROVISIONS, CLAIMS PROVISIONS ROTH IRA AMENDATORY ENROLLMENT ENROLLMENT

Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Connecticut General Life Insurance Company Continental American Insurance Company Continental American Insurance Company Continental General Insurance Company Continental General Insurance Company Continental Life Insurance Company of Brentwood, Tennessee Coventry First LLC Coventry First LLC Coventry First LLC Coventry First LLC Coventry First LLC

10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/21/08 10/28/08 10/28/08 10/08/08 10/21/08 10/21/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08

49830 NEL-RE4(09-07) 49830 NEL-SP(02-06) 49830 NEL-SPEC(02-06) 49830 NEL-TOC(02-06) 49830 NEL-TP(02-06) 50880 A-CG-ROTH(1/08) 50966 CAI2008CNE 50966 CAI2811NE 9/08 50710 GASBG-12-0001 51152 GASBG-1-0009 51149 GEN0008 10/08 49837 49837 49837 49837 NEVSAPP03 NEVSESCROW05 NEVSPURAGR04 NEVSPURAGR04B

H H H H H VA H H H H H V V V V V

SL SL SL SL SL

G G G G G I

RID POL POL POL POL END APP APP AD AD AD APP MISC MISC MISC MISC SMS SMS SMS

A A A A A A A A

OTH OTH LTC/ MS MS MS

I I I I I OTH OTH OTH OTH OTH

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT A A A A A

49837 NEVSPURAGR04C

Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company

10/02/08

50627 CHL-MHSA-BBMI 8/08

H

MM

G

RID

A

10/02/08 10/10/08 10/10/08

50627 CHL-V-RX-8/08 50976 CHCNE.51-99GROUP.08 50976 CHCNE.LRGGROUP.08

H H H

MM MM MM

G G G

RID APP APP

A A A

ESCROW AGREEMENT LIFE PURCHASE AGREEMENT DISCLOSURE / TERMS DISCLOSURE STATEMENT AND INSURED ACKNOWLEDGMENT [MENTAL DISORDERS] [AND] [SUBSTANCE-RELATED DISORDERS] [AND] BIOLOGICALLY BASED MENTAL ILLNESS BENEFITS OUTPATIENT PRESCRIPTION DRUG ENROLLMENT ENROLLMENT

Page 24 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company

10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08

50225 CHL-DEDCROV 2008R 50225 CHL-DOMPART 2008R 50225 CHL-INFRT 2008R 50225 CHL-PPO-NE-EOC 2008 50225 CHL-RETELIG 2008R 50225 CHL-TMJ 2008R 50693 CHC-[0-100%] TMJ 5-04 50693 CHCNE-AMD 6/08 50693 CHCNE-CHL-EEAC10/03 50693 CHCNE-CHL-LEA 2005 50693 CHC-RX 10/04 50693 CHL [EMH} 11.04 50693 50693 50693 50693 50693 CHL [RX] 10/04 EXHIBIT 1 CHL [RX] 10/04 EXHIBIT 2 CHL [RX] 10/04 EXHIBIT 3 CHL [RX] 10/04 EXHIBIT 4 CHL [RX] 10/04 EXHIBIT 5

H H H H H H H H H H H H H H H H H H H H

MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM

G G G G G G G G G G G G G G G G G G G G

RID RID RID CERT RID RID MISC MISC MISC MISC RATE RATE MISC MISC MISC MISC MISC RATE RATE MISC

A A A A A A F F F F F F F F F F F F F F

DEDUCTIBLE CARRYOVER DOMESTIC PARTNER INFERTILITY QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN EVIDENCE OF COVERAGE RETIREE JAW JOINT DISORDER REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL

50693 CHL [RX] 6-05 50693 CHL CHD 11.04 50693 CHL CHD 2-05

Page 25 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL

10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08

50693 CHL CHD 2-05 50693 CHL HD-MH 2-05 50693 CHL HD-MH 2-05 50693 CHL KSTH 5-05 50693 CHL STH 5-05 50693 CHL-103756GR-EZ 50693 CHL-11969GR-EZ 50693 CHL-11970GR-EZ 05 50693 CHL-12226GR-EZ 50693 CHL-2024GR-EZ 01/08 50693 CHL-3316GR-EZ 06 50693 CHL-7024SP-EZ 12-84 50693 CHL-7486GI-CONV-EZ 02

H H H H H H H H H H H H H H H H H H H H H

MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM

G G G G G G G G G G G G G G G G G G G G G

RATE MISC RATE RATE RATE MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

F F F F F F F F F F F F F F F F F F F F F

50693 CHL-8958GR-HIPAA-EZ 50693 CHL-90-70-1000-11/03 50693 CHL-90-70-250-11/03 50693 CHL-BR-11/03 50693 CHL-DEDCROV 2008R 50693 CHL-DEF-CO-INS-022008

50693 CHL-DOMPART-2008R 50693 CHL-G000304E 3/08

Page 26 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL

10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08

50693 CHL-G00041Z7 3/08 50693 CHL-G00074T9 3/08 50693 CHL-INFRT 2008R 50693 CHL-KOCH-1 6/04 50693 CHL-KOCH-2 6/04 50693 CHL-KOCH-3 6/04 50693 CHL-KOCH-4 6/04 50693 CHL-MHRIDER -CL-2005 50693 CHL-MHSA INO 50% 3/04

H H H H H H H H H H H H H H H H H H H H H

MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM

G G G G G G G G G G G G G G G G G G G G G

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

F F F F F F F F F F F F F F F F F F F F F

50693 CHL-MHSA20-10% 12/03 50693 CHL-MHSA20-20% 12/03 50693 CHL-MHSA20-30% 12/03 50693 CHL-MHSA20-50% 12/03 50693 CHL-MHSA-BBMI 8/08 50693 CHL-MHSA-BBMI-PPO 50693 CHL-MHSA-BBMI-PPO 108

50693 CHL-MOO-PPO 10/07 50693 CHL-NE CUSTOM PPO9/03

50693 CHL-NE PPO 7-03 50693 CHL-PPO-NE-EOC 2008 50693 CHL-RETELIG 2008R

Page 27 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health and Life Insurance Company Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. CHL-SCHEDULE-CL2005 REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL GROUP AND LARGE GROUP RATE MANUAL REVISED SMALL AND LARGE GROUP RATE MANUAL MASTER REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES

10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/24/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

50693

H H H H H H H H H H H HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

MM MM MM MM MM MM MM MM MM MM MM

G G G G G G G G G G G G G G G G G G G G G

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC POL MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

F F F F F F F F F F A A A A A A A A A A A

50693 CHL-SPD-CLAIMS 8/07 50693 CHL-TMJ 2008R 50693 CHL-TMJRIDER-CL2005

50693 CHL-VAL-RX 10/07 50693 CHL-V-RX 5/08 50693 CHL-V-RX 8/08 50693 CHL-V-SOB 8/07 50693 CHL-V-SOB 8/08 50693 NE-CHL-MHSA (6-06) 50286 CHL-NE-GMC-INT 2008 50692 70/50-$50 50692 80/60-$20 50692 80/60-$25 50692 80/60-$40 50692 80/60-$50 50692 CHC CHD 2.05 50692 CHC-GOLD.15-9/03 50692 CHCNE [EMH] 11.04 50692 CHCNE [G] 9/04 50692 CHCNE [G10-0] 11.04

Page 28 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES

10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

50692 CHCNE [RX] 10/06 50692 CHCNE [RX] 11-05 50692 CHCNE [RX] 6/04 50692 CHCNE [SPLIT-1] 10/04 50692 CHCNE [SPLIT-2] 10/04 50692 CHCNE [W] 6-05 50692 CHCNE CHD 11.04 50692 CHCNE HD-MH 10.04 50692 CHCNE HDP EOC 2005 50692 CHCNE HD-RX 10.04 50692 CHCNE HMO ID 1-05 50692 CHCNE HMOT 5-05 50692 CHCNE HMOT 9-05 50692 CHCNE NHD 11.04 50692 CHCNE POS ID 1-05 50692 CHCNE POS KT 5-05 50692 CHCNE RX HMO ID 1105

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

G G G G G G G G G G G G G G G G G G G G G Page 29 of 101

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

A A A A A A A A A A A A A A A A A A A A A

50692 CHCNE TPOS 5-05 50692

CHCNE-[0-100%] TMJ 5HMO 04 HMO HMO

50692 CHCNE-15-30 50% 100 50692 CHCNE-2024GR-EZ 01/08

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES

10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

50692 CHCNE-20-40-500 50692 CHCNE-70/50 $50 50692 CHCNE-70/50 $50-9/03 50692 CHCNE-80/60 $20 50692 CHCNE-80/60 $20-9/03 50692 CHCNE-80/60 $25 50692 CHCNE-80/60 $25-9/03 50692 CHCNE-80/60 $40 50692 CHCNE-80/60 $40-9/03 50692 CHCNE-80/60 $50 50692

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

G G G G G G G G G G G G G G G G G G G G G Page 30 of 101

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

A A A A A A A A A A A A A A A A A A A A A

CHCNE-80/60 $50 CONV HMO $25 HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

50692 CHCNE-80/60 $50-9/03 50692 CHCNE-80/60 [$0-50] 50692 CHCNE-AMD 6/08 50692 CHCNE-BBP 7-07 50692 CHCNE-CC 7-07 50692 50692 50692 50692 50692 CHCNE-CHOICE 15-1009/03 CHCNE-CHOICE 15-2509/03 CHCNE-CHOICE 20-5009/03 CHCNE-CHOICE 20-7509/03 CHCNE-CHOICE[$] IANE-08-03

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. CHCNE-CHOICE[15-750]IA/NE-11-02 CHCNE-CHOICE[15750]IANE-6-03 CHCNE-CHOICE20-500IA/NE-06-01 CHCNE-CUSTOM HMO9/03 CHCNE-CUSTOM OPEN ACCESS-9/03 CHCNE-CUSTOM POS9/03 CHCNE-DEDCROV 2008R CHCNE-DEF-CO-INS-022008 CHCNE-DOMPART2008R REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES

10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

50692 50692 50692 50692 50692 50692 50692 50692 50692

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

G G G G G G G G G G G G G G G G G G G G G Page 31 of 101

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50692 CHCNE-DPB 2007 50692 CHC-NE-EOC-2002 50692 CHC-NE-F3TRX-08/02 50692 CHC-NE-FDR-2003 50692 CHCNE-GMC 2007 50692 50692 50692 50692 50692 50692 50692 CHCNE-HMO 15100/10%12.03 CHCNE-HMO 15-1009/03 CHCNE-HMO 15-100-QP2003 CHCNE-HMO 20100/10% 10/03 CHCNE-HMO 20-2509/03 CHCNE-HMO 25-5009/03 CHCNE-HMO 30-7509/03

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. CHC-NE-HMO[10-50} 2000 CHCNE-HMO-15100/10%8-03 CHCNE-HMO-20/40-25009/05 CHCNE-HMO-20-500IA/NE-04/02 CHCNE-HMO30-1000IA/NE-04/02 REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES

10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

50692 50692 50692 50692 50692

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

G G G G G G G G G G G G G G G G G G G G G Page 32 of 101

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50692 CHCNE-HMO-BR-11/03 50692 CHCNE-HMO-EOC 2006 50692 CHCNE-HMO-EOC 2007A

50692 CHCNE-HMO-EOC 2008 50692 50692 50692 50692 50692 50692 50692 50692 50692 CHCNE-HMO-OA-EOC 2006 CHCNE-HMO-OA-EOC 2007A CHCNE-HMO-OA-EOC 2008 CHCNE-HMO-POS-EOC 2006 CHCNE-HMO-POS-EOC 2007A CHCNE-HMO-POS-HDPEOC 2006 CHCNE-HMO-POS-HDPEOC 2007A CHCNE-HMOPOS-OAEOC 2006 CHCNE-HMO-POS-OAEOC 2007A

50692 CHCNE-HRA 2T 6/04 50692 CHCNE-INFRT 2008R 50692 CHCNE-KOCH POS15250-9/03

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES

10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

50692 CHCNE-KOCH[$] 6/04 50692 CHCNE-KOCH-1 6/04 50692 CHCNE-KOCH-2 6/04 50692 CHCNE-KOCH-3 6/04 50692 CHCNE-KOCH-4 6/04 50692 CHCNE-KOCH-5 6/04 CHCNE-KOCH-OP-159/03 CHCNE-KOCH-OP1550692 9/03 50692 50692 CHCNE-KS-011-03 50692 50692 50692 50692 50692 50692 50692 50692 50692 50692 CHCNE-MHRIDER-CHC2005 CHCNE-MHRIDER-CL2005 CHCNE-MHSA 20-50% 12/03 CHCNE-MHSA-BBMI 8/08 CHCNE-MHSA-BBMIHMO CHCNE-MHSA-BBMIPOS CHCNE-MHSA-BBMIPOS F[HD] CHCNE-MHSA-BBMIPOS[HD] CHCNE-MHSA-BBMIPPO CHC-NE-MHSA-POS (XX%)-09/02

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

G G G G G G G G G G G G G G G G G G G G G Page 33 of 101

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50692 CHCNE-NFM-SB-1-07 50692 CHCNE-OA-90-70-100011/03

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. CHCNE-OA-90-70-25011/03 REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES

10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

50692

HMO HMO HMO HMO HMO

G G G G G G G G G G G G G G G G G G G G G Page 34 of 101

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50692 CHCNE-OCA-BR-11/03 50692 CHCNE-POS-9/03 50692 CHCNE-POS-EOC 2008 50692 CHCNE-POS-OA-EOC 2008

50692 CHCNE-RETELIG 2008R HMO CHC-NE-RX-10/20/45100 CHC-NE-RX-10/20/4550692 200 50692 50692 CHC-NE-RX-5/15/45-100 50692 CHC-NE-RX-5/15/45-200 50692 50692 50692 50692 50692 CHCNE-SCHEDULE-CL2005 CHCNE-SCHEDULE-SL2005 CHC-NE-SCS-CHOICE15250-IA/NE-05/03 CHC-NE-SCS-CHOICE15500-IA/NE-05/03 CHC-NE-SCS-CHOICE15750-IA/NE-05/03 HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

50692 CHCNE-SOB-C1002F 50692 CHCNE-SOB-C502F CHCNE-SOB-HRA 10000 7-07 CHCNE-SOB-SBA C1003 50692 (10/05) CHCNE-SOB-SBA C2004 50692 (10/05) CHCNE-SOB-SBA C503 50692 (10/05) 50692

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. CHCNE-SOB-SBA F1003 (10/05) CHCNE-SOB-SBA F2004 50692 (10/05) 50692 50692 CHCNE-SOB-SBA V06 REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES REVISED LARGE AND SMALL GROUP HMO RATES ENROLLMENT ENROLLMENT

10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/10/08 10/10/08

HMO HMO HMO

G G G G G G G G G G G G G G G G G G G MM MM G G

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC APP APP

A A A A A A A A A A A A A A A A A A A A A

50692 CHCNE-SPOS 15-0% 6/04 HMO CHCNE-SPOS 15-250 6/04 CHCNE-SPOS 20-500 50692 6/04 CHCNE-SPOS 80/60/20 50692 6/04 50692 50692 CHCNE-TMJ 2008R 50692 CHCNE-TMJRIDER-CL2005 HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

50692 CHCNE-VPP 7-07 50692 CHCNE-V-RX 8/08 50692 CHCNE-V-RX-5/08 50692 CHCNE-V-SOB 8/08 50692 CHCNE-V-SOB 8-07 50692

CHC-NFM-HMO-OA-4-03HMO IANE HMO HMO HMO HMO H H

50692 CHC-RX-10/04 RX $5/$15/$45, $100 DED. RX $5/$15/$45, $200 50692 DED. 50692 50692 VAL-RX 10/07 50977 CHCNE.51-99GROUP.08 50977 CHCNE.LRGGROUP.08

Page 35 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc.

10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08

50810 70/50-$50 50810 80/60-$20 50810 80/60-$25 50810 80/60-$40 50810 80/60-$50 50810 CHC CHD 2.05 50810 CHC-GOLD.15-9/03 50810 CHCNE [EMH] 11.04 50810 CHCNE [G] 9/04 50810 CHCNE [G10-0] 11.04 50810 CHCNE [RX] 10/06 50810 CHCNE [RX] 11-05 50810 CHCNE [RX] 6/04 50810 CHCNE [SPLIT-1] 10/04 50810 CHCNE [SPLIT-2] 10/04 50810 CHCNE [W] 6-05 50810 CHCNE CHD 11.04 50810 CHCNE HD-MH 10.04 50810 CHCNE HDP EOC 2005 50810 CHCNE HD-RX 10.04 50810 CHCNE HMO ID 1-05

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

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REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc.

10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08

50810 CHCNE HMOT 5-05 50810 CHCNE HMOT 9-05 50810 CHCNE NHD 11.04 50810 CHCNE POS ID 1-05 50810 CHCNE POS KT 5-05 50810 CHCNE RX HMO ID 1105

HMO HMO HMO HMO HMO HMO HMO

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REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL

50810 CHCNE TPOS 5-05 50810

CHCNE-[0-100%] TMJ 5HMO 04 HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

50810 CHCNE-15-30 50% 100 50810 CHCNE-2024GR-EZ 01/08

50810 CHCNE-20-40-500 50810 CHCNE-70/50 $50 50810 CHCNE-70/50 $50-9/03 50810 CHCNE-80/60 $20 50810 CHCNE-80/60 $20-9/03 50810 CHCNE-80/60 $25 50810 CHCNE-80/60 $25-9/03 50810 CHCNE-80/60 $40 50810 CHCNE-80/60 $40-9/03 50810 CHCNE-80/60 $50 50810

CHCNE-80/60 $50 CONV HMO $25

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc.

10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08

50810 CHCNE-80/60 $50-9/03 50810 CHCNE-80/60 [$0-50] 50810 CHCNE-AMD 6/08 50810 CHCNE-BBP 7-07 50810 CHCNE-CC 7-07 50810 50810 50810 50810 50810 50810 50810 50810 50810 50810 50810 50810 50810 50810 CHCNE-CHOICE 15-1009/03 CHCNE-CHOICE 15-2509/03 CHCNE-CHOICE 20-5009/03 CHCNE-CHOICE 20-7509/03 CHCNE-CHOICE[$] IANE-08-03 CHCNE-CHOICE[15-750]IA/NE-11-02 CHCNE-CHOICE[15750]IANE-6-03 CHCNE-CHOICE20-500IA/NE-06-01 CHCNE-CUSTOM HMO9/03 CHCNE-CUSTOM OPEN ACCESS-9/03 CHCNE-CUSTOM POS9/03 CHCNE-DEDCROV 2008R CHCNE-DEF-CO-INS-022008 CHCNE-DOMPART2008R

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

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REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL

50810 CHCNE-DPB 2007 50810 CHC-NE-EOC-2002

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc.

10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08

50810 CHC-NE-F3TRX-08/02 50810 CHC-NE-FDR-2003 50810 CHCNE-GMC 2007 50810 50810 50810 50810 50810 50810 50810 50810 50810 50810 50810 50810 CHCNE-HMO 15100/10%12.03 CHCNE-HMO 15-1009/03 CHCNE-HMO 15-100-QP2003 CHCNE-HMO 20100/10% 10/03 CHCNE-HMO 20-2509/03 CHCNE-HMO 25-5009/03 CHCNE-HMO 30-7509/03 CHC-NE-HMO[10-50} 2000 CHCNE-HMO-15100/10%8-03 CHCNE-HMO-20/40-25009/05 CHCNE-HMO-20-500IA/NE-04/02 CHCNE-HMO30-1000IA/NE-04/02

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

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A A A A A A A A A A A A A A A A A A A A A

REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL

50810 CHCNE-HMO-BR-11/03 50810 CHCNE-HMO-EOC 2006 50810 CHCNE-HMO-EOC 2007A

50810 CHCNE-HMO-EOC 2008 CHCNE-HMO-OA-EOC 2006 CHCNE-HMO-OA-EOC 50810 2007A 50810

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. CHCNE-HMO-OA-EOC 2008 CHCNE-HMO-POS-EOC 2006 CHCNE-HMO-POS-EOC 2007A CHCNE-HMO-POS-HDPEOC 2006 CHCNE-HMO-POS-HDPEOC 2007A CHCNE-HMOPOS-OAEOC 2006 CHCNE-HMO-POS-OAEOC 2007A

10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08

50810 50810 50810 50810 50810 50810 50810

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

G G G G G G G G G G G G G G G G G G G G G Page 40 of 101

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

A A A A A A A A A A A A A A A A A A A A A

REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL

50810 CHCNE-HRA 2T 6/04 50810 CHCNE-INFRT 2008R 50810 CHCNE-KOCH POS15250-9/03

50810 CHCNE-KOCH[$] 6/04 50810 CHCNE-KOCH-1 6/04 50810 CHCNE-KOCH-2 6/04 50810 CHCNE-KOCH-3 6/04 50810 CHCNE-KOCH-4 6/04 50810 CHCNE-KOCH-5 6/04 CHCNE-KOCH-OP-159/03 CHCNE-KOCH-OP1550810 9/03 50810 50810 CHCNE-KS-011-03 50810

CHCNE-MHRIDER-CHCHMO 2005 CHCNE-MHRIDER-CL50810 HMO 2005

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. CHCNE-MHSA 20-50% 12/03 CHCNE-MHSA-BBMI 8/08 CHCNE-MHSA-BBMIHMO CHCNE-MHSA-BBMIPOS CHCNE-MHSA-BBMIPOS F[HD] CHCNE-MHSA-BBMIPOS[HD] CHCNE-MHSA-BBMIPPO CHC-NE-MHSA-POS (XX%)-09/02

10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08

50810 50810 50810 50810 50810 50810 50810 50810

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

G G G G G G G G G G G G G G G G G G G G G Page 41 of 101

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

A A A A A A A A A A A A A A A A A A A A A

REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL

50810 CHCNE-NFM-SB-1-07 CHCNE-OA-90-70-100011/03 CHCNE-OA-90-70-25050810 11/03 50810 50810 CHCNE-OCA-BR-11/03 50810 CHCNE-POS-9/03 50810 CHCNE-POS-EOC 2008 50810 CHCNE-POS-OA-EOC 2008

50810 CHCNE-RETELIG 2008R HMO CHC-NE-RX-10/20/45100 CHC-NE-RX-10/20/4550810 200 50810 50810 CHC-NE-RX-5/15/45-100 50810 CHC-NE-RX-5/15/45-200 50810 HMO HMO HMO HMO

CHCNE-SCHEDULE-CLHMO 2005

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. CHCNE-SCHEDULE-SL2005 CHC-NE-SCS-CHOICE1550810 250-IA/NE-05/03 CHC-NE-SCS-CHOICE1550810 500-IA/NE-05/03 CHC-NE-SCS-CHOICE1550810 750-IA/NE-05/03 50810 50810 CHCNE-SOB-C1002F 50810 CHCNE-SOB-C502F 50810 50810 50810 50810 50810 50810 CHCNE-SOB-HRA 10000 7-07 CHCNE-SOB-SBA C1003 (10/05) CHCNE-SOB-SBA C2004 (10/05) CHCNE-SOB-SBA C503 (10/05) CHCNE-SOB-SBA F1003 (10/05) CHCNE-SOB-SBA F2004 (10/05)

10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

G G G G G G G G G G G G G G G G G G G G G Page 42 of 101

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

A A A A A A A A A A A A A A A A A A A A A

REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL

50810 CHCNE-SOB-SBA V06

50810 CHCNE-SPOS 15-0% 6/04 HMO CHCNE-SPOS 15-250 6/04 CHCNE-SPOS 20-500 50810 6/04 CHCNE-SPOS 80/60/20 50810 6/04 50810 50810 CHCNE-TMJ 2008R 50810 CHCNE-TMJRIDER-CL2005 HMO HMO HMO HMO HMO HMO HMO

50810 CHCNE-VPP 7-07 50810 CHCNE-V-RX 8/08

REVIEWED FILINGS FOR OCTOBER 2008 Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Coventry Health Care of Nebraska, Inc. Cuna Mutual Insurance Society Cuna Mutual Insurance Society Cuna Mutual Insurance Society

10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/20/08 10/24/08 10/03/08 10/03/08 10/03/08

50810 CHCNE-V-RX-5/08 50810 CHCNE-V-SOB 8/08 50810 CHCNE-V-SOB 8-07 50810

HMO HMO HMO

G G G G G G G G G G G G G G G G G G I I I Page 43 of 101

MISC MISC MISC MISC MISC MISC MISC MISC RID RID CERT CERT RID CERT CERT RID RID POL RID RID RID

A A A A A A A A A A A A A A A A A A A A A

REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL REVISED HMO/POS RATE MANUAL DEDUCTIBLE CARRYOVER DOMESTIC PARTNERS ELIGIBILITY EVIDENCE OF COVERAGE OPEN ACCESS EVIDENCE OF COVERAGE INFERTILITY BENEFITS POINT OF SERVICE EVIDENCE OF COVERAGE POINT OF SERVICE OPEN ACCESS EVIDENCE OF COVERAGE RETIREE ELIGIBILITY JAW JOINT DISORDER BENEFITS MASTER GUARANTEED MINIMUM ACCUMULATION WITH 10 YEAR GUARANTEED MINIMUM ACCUMULATION WITH 7 YEAR GUARANTEED LIFETIME WITHDRAWAL BENEFIT

CHC-NFM-HMO-OA-4-03HMO IANE HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

50810 CHC-RX-10/04 RX $5/$15/$45, $100 DED. RX $5/$15/$45, $200 50810 DED. 50810 50810 VAL-RX 10/07 CHCNE-DEDCROV 2008R CHCNE-DOMPART 50203 2008R 50203 50203 CHCNE-HMO-EOC 2008 50203 CHCNE-HMO-OA-EOC 2008

50203 CHCNE-INFRT 2008R 50203 CHCNE-POS-EOC 2008 50203 CHCNE-POS-OA-EOC 2008

50203 CHCNE-RETELIG 2008R HMO 50203 CHCNE-TMJ 2008R 50288 CHCNE-NE-GMC-INT 2008 HMO HMO VA VA VA

50644 2008-GMAB-10 50644 2008-GMAB-7 50644 2008-ILGLWB

REVIEWED FILINGS FOR OCTOBER 2008 GUARANTEED LIFETIME WITHDRAWAL BENEFIT WITH GUARANTEED DEATH BENEFIT GUARANTEED LIFETIME WITHDRAWAL BENEFIT GUARANTEED WITHDRAWAL BENEFIT WITH MINIMUM DEATH BENEFIT CHILDREN'S TERM MONTHLY DISABILITY BENEFIT FLEXIBLE PREMIUM ADJUSTABLE DEATH BENEFIT

Cuna Mutual Insurance Society Cuna Mutual Insurance Society Cuna Mutual Insurance Society Degree of Honor Protection Association Degree of Honor Protection Association Degree of Honor Protection Association Delta Dental Plan of Nebraska, Inc. Delta Dental Plan of Nebraska, Inc. Delta Dental Plan of Nebraska, Inc. Delta Dental Plan of Nebraska, Inc. EMC National Life Company EMC National Life Company EMC National Life Company EMC National Life Company EMC National Life Company Employees Life Company (Mutual) Farm Bureau Life Insurance Company Farmers New World Life Insurance Company First Life America Corporation First Life America Corporation

10/03/08 10/03/08 10/03/08 10/24/08 10/24/08 10/24/08 10/03/08 10/03/08 10/03/08 10/20/08 10/14/08 10/14/08 10/14/08 10/24/08 10/24/08 10/15/08 10/24/08 10/21/08 10/07/08 10/07/08

50644 2008-ILGLWB-MG 50644 2008-INGLWB 50644 2008-INGLWB-MG 50983 CTI_RDR-08 50983 MD 9-08 50983 ULIVZF(NE) 50501 COMPSTND_PPO_JULY 2008

VA VA VA L L L H H H H H H H L L L L L H H OTH OTH DENT DENT DENT DENT OTH OTH OTH

I I I I I I G G G G I I I I I I I I I I

RID RID RID RID RID POL CERT POL CERT CERT RATE RATE RATE APP POL RID END END APP POL

A A A A A A A A A A F F F A A A A A A A

50501 CONTRACT_SEPT2008 50503 COMPENH_PPO_JULY2 008

50502 DISCOVER_JULY2008 50529 AMH 8328 50529 AMH 9372 50529 HP9370 50870 EAP007 (9-08) 50870 ELP002 (9-08) 50791 TIBR-07 50990 434-565(12-03) 50898 2008STENDO 50575 ADD-APP 5-08 50575 ADD-PF-NE 5-08

INCREASE - 55% - CANCER PLAN INCREASE - 55% - CANCER PLAN INCREASE - 55% - CANCER PLAN

WHOLE TERMINAL ILLNESS BENEFIT REPLACEMENT PREMIUMS AND REINSTATEMENT

ACCIDENTAL DEATH AND DISMEMBERMENT

Page 44 of 101

REVIEWED FILINGS FOR OCTOBER 2008 First Life America Corporation Forethought Life Insurance Company Forethought Life Insurance Company Forethought Life Insurance Company Forethought Life Insurance Company Forethought Life Insurance Company Freedom Life Insurance Company of America Freedom Life Insurance Company of America Freedom Life Insurance Company of America Freedom Life Insurance Company of America Genworth Life and Annuity Insurance Company Genworth Life and Annuity Insurance Company Genworth Life and Annuity Insurance Company Genworth Life and Annuity Insurance Company Genworth Life and Annuity Insurance Company Genworth Life and Annuity Insurance Company Genworth Life and Annuity Insurance Company

10/07/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/09/08 10/09/08 10/09/08 10/09/08 10/08/08

50575 OC-ADD 5-08 50996 FA1001FPDA-01 (5YR) 50996 FA1001FPDA-01 (7YR) 50996 FA1001FPDA5-01 50996 FA1001FPDA7-01 50996 FA3003-01 50199 FD2000 50199 FD-95 50199 HRT-4/94 50199 PLAN#C100 50703 TLCVRBFCL05

H A A A A A H H H H L

OTH

I I I I I I

MISC APP MISC POL POL MISC RATE RATE RATE RATE MISC

A A A A A A F F F F INF

OUTLINE OF COVERAGE

DISCLOSURE STATEMENT FLEXIBLE PREMIUM DEFERRED FLEXIBLE PREMIUM DEFERRED DISCLOSURE STATEMENT INCREASE - 9% - CANCER HEART ATTACK INCREASE - 9% - CANCER HEART ATTACK INCREASE - 9% - CANCER HEART ATTACK INCREASE - 9% - CANCER HEART ATTACK UPDATED ACTUARIAL MEMORANDUM UPDATED ACTUARIAL MEMORANDUM UPDATED ACTUARIAL MEMORANDUM REPLACEMENT INFORMATION

OTH OTH OTH OTH

I I I I I

10/08/08

50703 TLCVREFCL05

L

I

MISC

INF

10/08/08

50703 TLNCVFCL05 NE

L

I

MISC

INF

10/16/08

50850 GNW 1800 1107

L

I

MISC

A

10/20/08

50851 MP7175 07/08

VA

G

POL

A

FLEXIBLE DEFERRED WITHDRAWAL START DATE STEPUP

10/20/08

50851 P5408 07/08

VA

G

END

A

10/20/08

50851 P7175 07/08

VA

G

CERT

A

Page 45 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Genworth Life Insurance Company Genworth Life Insurance Company Genworth Life Insurance Company Genworth Life Insurance Company Genworth Life Insurance Company Genworth Life Insurance Company Genworth Life Insurance Company Genworth Life Insurance Company Genworth Life Insurance Company Gerber Life Insurance Company Gerber Life Insurance Company Gerber Life Insurance Company Gerber Life Insurance Company Gerber Life Insurance Company Gleaner Life Insurance Society Globe Life and Accident Insurance Company Globe Life and Accident Insurance Company Government Personnel Mutual Life Insurance Company Government Personnel Mutual Life Insurance Company

10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/20/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/16/08 10/09/08 10/09/08 10/02/08

50875 46464 09/10/08 50875 46465 09/10/08 50875 46466 09/10/08 50875 46467 09/10/08 50875 46467 RC 09/10/08 50875 46473 09/10/08 50875 46476 50909 43388 05/12/08 50836 GNW 1800 1107 50665 AGPP-08 SP 50665 AGPP-08-TWL SP 50665 GPO-08 SP 50665 GPP-08-NE (SP) 50665 GPP-08-TWL-NE (SP) 50743 ULCV-08-NE 50364 GHS1 50481 PR-20/HSEP 50647 59C UL2008

H H H H H H H H L L L L L L L H H L

MS MS MS MS MS MS MS MS

I I I I I I I I I I I I I I I

AD AD AD AD AD AD AD AD MISC APP APP RID POL POL CERT RATE RATE POL

SMS SMS SMS SMS SMS SMS SMS SMS

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT INF NAIC REPLACEMENT ANNUITIES A A A A A A F F A WHOLE - SPANISH WITH INTRO TERM UNIVERSAL INCREASE - 10% - HOSPITAL MEDICAL SURGICAL PLAN INCREASE - 10% - HOSPITAL MEDICAL SURGICAL PLAN UNIVERSAL GUARANTEED PURCHASE OPTION

OTH OTH

I I I

10/15/08

50813 59H AIR08

L

I

RID

A

ADDITIONAL TERM INSURANCE

Page 46 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Government Personnel Mutual Life Insurance Company Government Personnel Mutual Life Insurance Company Government Personnel Mutual Life Insurance Company Government Personnel Mutual Life Insurance Company Great American Life Insurance Company Great American Life Insurance Company Great American Life Insurance Company Great American Life Insurance Company Great American Life Insurance Company Great American Life Insurance Company Great-West Life and Annuity Insurance Company Great-West Life and Annuity Insurance Company Great-West Life and Annuity Insurance Company Great-West Life and Annuity Insurance Company Great-West Life and Annuity Insurance Company Great-West Life and Annuity Insurance Company

10/15/08

50813 59I OIR08

L

I

RID

A

OTHER INSURED TERM WAIVER OF COST OF INSURANCE FOR TOTAL DISABILITY ACCIDENTAL DEATH BENEFIT GUARANTEED BENEFIT INCREASE OPTION

10/15/08

50813 59J COI08

L

I

RID

A

10/15/08

50813 59K UAD08

L

I

RID

A

10/15/08 10/08/08 10/09/08 10/10/08 10/16/08 10/21/08 10/23/08 10/21/08

50813 59L GBI08 50713 GASBG-12-0001 51026 GASB-12-0010 50744 E1069508NW 50817 P2401308NE 51155 GASBG-1-0009 50931 A1030508NE 50884 DB DIGF 08

L H H A L H A A/VA MS LTC/ MS LTC

I I I I I I I G

RID AD AD END POL AD APP RID SMS SMS

A

ACK ADVERTISEMENT ACK ADVERTISEMENT A A ANNUITIZATION BONUS WHOLE

ACK ADVERTISEMENT A A FIXED ACCOUNT

10/21/08

50884 DB GPF 08

A/VA

G

RID

A

FIXED ACCOUNT

10/21/08

50884 GAC A 08 DB

A/VA

G

APP

A

10/21/08

50884 GFVAC DB 08

A/VA

G

POL

A

FIXED AND VARIABLE DEFERRED

10/21/08

50884 JLGP CERT 07-08

A/VA

G

CERT

A

10/21/08

50884 JLO CERT 07-08

A/VA

G

CERT

A

Page 47 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Great-West Life and Annuity Insurance Company Great-West Life and Annuity Insurance Company Great-West Life and Annuity Insurance Company Guardian Life Insurance Company of America

10/21/08

50884 SLGP CERT 07-08

A/VA

G

CERT

A

SINGLE PREMIUM

10/21/08

50884 SLO CERT 07-08

A/VA

G

CERT

A

SINGLE LIFE ONLY

10/21/08 10/02/08

50884 SP CERT 07-08 50635 08-WP GLT NE 50506 GBD-1300 H07 (NE) (REV.)

A/VA L H OTH

G I G

CERT RID CERT

A A A

SPECIFIED PERIOD CONVERTIBLE WAIVER OF PREMIUM CLAIMS TO BE PAID PROVISION BENEFICIARY DESIGNATION PROVISION CLAIM DENIAL PROVISION

Hartford Life and Accident 10/01/08 Insurance Company Hartford Life and Accident 10/01/08 Insurance Company Hartford Life and Accident 10/01/08 Insurance Company Hartford Life and Accident 10/01/08 Insurance Company Hartford Life and Accident 10/01/08 Insurance Company

50506 GBD-1300 H08 (REV.)

H

OTH

G

CERT

A

50506 GBD-1300 H09 (REV.)

H

OTH

G

CERT

A

50506 PA-9221 C03 (REV.)

H

OTH

G

CERT

A

ACTIVELY AT WORK PROVISION

50506 PA-9221 C30 (REV.)

H

OTH

G

CERT

A

PEDESTRIAN PROVISION ACCIDENTAL DEATH AND DISMEMBERMENT [WITH DOUBLE INDEMNITY WITH AN INCREASED BENEFIT] WHILE ON A COMMON CARRIER PROVISION ACCIDENTAL DEATH [AND DISMEMBERMENT] WHILE ON A SCHEDULED AIRCRAFT AND COMMON CARRIER BENEFIT PROVISION ACCIDENTAL DEATH [AND DISMEMBERMENT] WHILE ON A SCHEDULED AIRCRAFT PROVISION

Hartford Life and Accident 10/01/08 Insurance Company

50506 PA-9223 F02 (REV.)

H

OTH

G

CERT

A

Hartford Life and Accident 10/01/08 Insurance Company

50506 PA-9223 F08 (REV.)

H

OTH

G

CERT

A

Hartford Life and Accident 10/01/08 Insurance Company

50506 PA-9223 F09 (REV.)

H

OTH

G

CERT

A

Page 48 of 101

REVIEWED FILINGS FOR OCTOBER 2008

Hartford Life and Accident 10/01/08 Insurance Company Hartford Life and Accident 10/01/08 Insurance Company Hartford Life and Accident 10/01/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company

50506 PA-9223 F14 (REV.)

H

OTH

G

CERT

A

COMMON CARRIER BENEFIT PROVISION CATASTROPHIC LOSS OF USE PROVISION ACCIDENT TOTAL DISABILITY PROVISION PREMIUM PROVISIONS

50506 PA-9223 F44 (REV.)

H

OTH

G

CERT

A

50506 PA-9223 F50

H

OTH

G

CERT

A

50788 GBD-1000 D.1 (REV.)

L

G

POL

A

50788 GBD-1000 F.2 (REV.)

L

G

POL

A

POLICY PROVISIONS EVIDENCE OF INSURABILITY REQUIREMENTS CHANGE IN FAMILY STATUS

50788 GBD-1100 D05 (REV.)

L

G

POL

A

50788 GBD-1100 D06 (REV.)

L

G

POL

A

50788 GBD-1100 D08 (REV.)

L

G

POL

A

CHANGE IN FAMILY STATUS CONTINUITY FROM A PRIOR POLICY INCREASE IN AMOUNT OF LIFE INSURANCE TERMINATION PROVISION

50788 GBD-1100 E05 (REV.)

L

G

POL

A

50788 GBD-1100 E15 (REV.)

L

G

POL

A

50788 GBD-1100 E18 (REV.)

L

G

POL

A

50788 GBD-1100 E21 (REV.)

L

G

POL

A

DEPENDENT TERMINATION

50788 GBD-1100 E29 (REV.)

L

G

POL

A

DISABILITY EXTENSION CONDITIONS FOR QUALIFICATIONS

50788 GBD-1100 E34 (REV.)

L

G Page 49 of 101

POL

A

REVIEWED FILINGS FOR OCTOBER 2008

Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Accident 10/15/08 Insurance Company Hartford Life and Annuity Insurance Company 10/16/08

50788 GBD-1100 E36 (REV.)

L

G

POL

A

WAIVER OF PREMIUM

50788 GBD-1100 E40 (REV.)

L

G

POL

A

DISABILITY EXTENSION CEASES

50788 GBD-1100 E49 (REV.)

L

G

POL

A

HOSPITAL DEFINITION

50788 GBD-1100 F02 (REV.) GBD-1100 F05 (NE) (REV.)

L

G

POL

A

LIFE INSURANCE BENEFIT

50788

L

G

POL

A

EXCLUSIONS

50788 GBD-1100 F06 (REV.-1)

L

G

POL

A

ACCELERATED BENEFITS

50788 GBD-1100 F14 (REV.)

L

G

POL

A

PORTABILITY BENEFITS

50788 GBD-1100 F15 (REV.-1)

L

G

POL

A

QUALIFYING EVENTS

50788 GBD-1100 F16 (REV.-1)

L

G

POL

A

ELECTING PORTABILITY

50788 GBD-1100 F17 (REV.)

L

G

POL

A

LIMITATIONS GUARANTEED PURCHASE OPTION BENEFIT CLAIMS TO BE PAID

50788 GBD-1100 F24

L

G

POL

A

50788 GBD-1100 H07 (REV.) GBD-1100 H13 (NE) (REV.)

L

G

POL

A

50788

L

G

POL

A

INCONTESTABILITY

50804 LA-BV-08(NE)

VA

I Page 50 of 101

POL

A

SINGLE PREMIUM DEFERRED

REVIEWED FILINGS FOR OCTOBER 2008

Hartford Life and Annuity Insurance Company Hartford Life and Annuity Insurance Company Hartford Life and Annuity Insurance Company Hartford Life and Annuity Insurance Company Hartford Life and Annuity Insurance Company Hartford Life and Annuity Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company

10/16/08

50804 LA-BVCRT-08

VA

I

RID

A

CHARITABLE REMAINDER TRUST EXTENDED WITHDRAWAL PRIVILEGE NURSING HOME WAIVER OF SURRENDER CHARGE PREMIUM GUARANTEE

10/16/08

50804 LA-BVEWP-08

VA

I

RID

A

10/16/08

50804 LA-BVNH-08

VA

I

RID

A

10/16/08

50804 LA-BVPG-08

VA

I

RID

A

10/16/08

50804 LA-BVRP-08

VA

I

RID

A

RATE PROTECTION

10/16/08 10/01/08 10/01/08 10/01/08 10/01/08 10/01/08

50804 LA-BVRRA-08 50505 GBD-1300 H07 (NE) (REV.)

VA H H H H H OTH OTH OTH OTH OTH

I G G G G G

RID CERT CERT CERT CERT CERT

A A A A A A

RENEWABLE RATE ACCOUNT CLAIMS TO BE PAID PROVISION BENEFICIARY DESIGNATION PROVISION CLAIM DENIAL PROVISION ACTIVELY AT WORK PROVISION PEDESTRIAN PROVISION ACCIDENTAL DEATH AND DISMEMBERMENT [WITH DOUBLE INDEMNITY WITH AN INCREASED BENEFIT] WHILE ON A COMMON CARRIER PROVISION ACCIDENTAL DEATH [AND DISMEMBERMENT] WHILE ON A SCHEDULED AIRCRAFT AND COMMON CARRIER BENEFIT PROVISION ACCIDENTAL DEATH [AND DISMEMBERMENT] WHILE ON A SCHEDULED AIRCRAFT PROVISION

50505 GBD-1300 H08 (REV.) 50505 GBD-1300 H09 (REV.) 50505 PA-9221 C03 (REV.) 50505 PA-9221 C30 (REV.)

10/01/08

50505 PA-9223 F02 (REV.)

H

OTH

G

CERT

A

Hartford Life Insurance Company

10/01/08

50505 PA-9223 F08 (REV.)

H

OTH

G

CERT

A

Hartford Life Insurance Company

10/01/08

50505 PA-9223 F09 (REV.)

H

OTH

G

CERT

A

Page 51 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company COMMON CARRIER BENEFIT PROVISION CATASTROPHIC LOSS OF USE PROVISION ACCIDENT TOTAL DISABILITY PROVISION GUARANTEED ACCESS ACCOUNT CHARITABLE REMAINDER TRUST EXTENDED WITHDRAWAL PRIVILEDGE NURSING HOME WAIVER OF SURRENDER CHARGE PREMIUM PROVISIONS POLICY PROVISIONS EVIDENCE OF INSURABILITY REQUIREMENTS CHANGE IN FAMILY STATUS CHANGE IN FAMILY STATUS CONTINUITY FROM A PRIOR POLICY INCREASE IN AMOUNT OF LIFE INSURANCE TERMINATION PROVISION DEPENDENT TERMINATION DISABILITY EXTENSION CONDITIONS FOR QUALIFICATIONS WAIVER OF PREMIUM DISABILITY EXTENSION CEASES

10/01/08 10/01/08 10/01/08 10/10/08 10/10/08 10/10/08 10/10/08 10/10/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08

50505 PA-9223 F14 (REV.) 50505 PA-9223 F44 (REV.) 50505 PA-9223 F50 50636 HL-CRCS2-08(NE) 50636 HL-CRCS2AA-08 50636 HL-CRCS2CRT-08 50636 HL-CRCS2EWP-08 50636 HL-CRCS2HN-08 50789 GBD-1000 D.1 (REV.) 50789 GBD-1000 F.2 (REV.) 50789 GBD-1100 D05 (REV.) 50789 GBD-1100 D06 (REV.) 50789 GBD-1100 D08 (REV.) 50789 GBD-1100 E05 (REV.) 50789 GBD-1100 E15 (REV.) 50789 GBD-1100 E18 (REV.) 50789 GBD-1100 E21 (REV.) 50789 GBD-1100 E29 (REV.) 50789 GBD-1100 E34 (REV.) 50789 GBD-1100 E36 (REV.) 50789 GBD-1100 E40 (REV.)

H H H A A A A A L L L L L L L L L L L L L

OTH OTH OTH

G G G I I I I I G G G G G G G G G G G G G

CERT CERT CERT POL RID RID RID RID POL POL POL POL POL POL POL POL POL POL POL POL POL

A A A A A A A A A A A A A A A A A A A A A

Page 52 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company Hartford Life Insurance Company HCC Life Insurance Company

10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/16/08 10/23/08 10/23/08 10/15/08

50789 GBD-1100 E49 (REV.) 50789 GBD-1100 F02 (REV.) 50789 GBD-1100 F05 (NE) (REV.)

L L L L L L L L L L L VA VA VA VA VA VA VA L L H SL

G G G G G G G G G G G I I I I I I I I I I

POL POL POL POL POL POL POL POL POL POL POL POL RID RID RID RID RID RID MISC MISC END

A A A A A A A A A A A A A A A A A A A A A

HOSPITAL DEFINITION LIFE INSURANCE BENEFIT EXCLUSIONS ACCELERATED BENEFITS PORTABILITY BENEFITS QUALIFYING EVENTS ELECTING PORTABILITY LIMITATIONS GUARANTEED PURCHASE OPTION BENEFIT CLAIMS TO BE PAID INCONTESTABILITY SINGLE PREMIUM DEFERRED ACCESS ACCOUNT CHARITABLE REMAINDER TRUST EXTENDED WITHDRAWAL PRIVILEGE NURSING HOME WAIVER RATE PROTECTION RENEWABLE RATE ACCOUNT RATE SPECIFICATIONS PER 2001 CSO UPDATE RATE TABLE PER 2001 CSO MORTALITY STOP LOSS

50789 GBD-1100 F06 (REV.-1) 50789 GBD-1100 F14 (REV.) 50789 GBD-1100 F15 (REV.-1) 50789 GBD-1100 F16 (REV.-1) 50789 GBD-1100 F17 (REV.) 50789 GBD-1100 F24 50789 GBD-1100 H07 (REV.) 50789 GBD-1100 H13 (NE) (REV.)

50803 HL-BV-08(NE) 50803 HL-BVAA-08 50803 HL-BVCRT-08 50803 HL-BVEWP-08 50803 HL-BVNH-08 50803 HL-BVRP-08 50803 HL-BVRRA-08 50097 IVL-99P 50097 IVL-99P 50917 HCCL MSL-2009 51010

Page 53 of 101

REVIEWED FILINGS FOR OCTOBER 2008 HM Life Insurance Company HM Life Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company

10/15/08 10/15/08 10/08/08 10/24/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08

50911 HML0011NE 50911 HML2011NE 50706 GHA02IPRR 50965 NE-70129 MAINT 9/2008 50597 50597 50597 50597 50597 50597 50597 50597 50597 50597 50597 GN-70129 AMEND [AAZZ] 8/2002 GN-70129 COPAY1 [AAZZ] 8/2002 GN-70129 COPAY2 [AAZZ] 8/2002 GN-70129 COPAY3 [AAZZ] 8/2002 GN-70129 DEF [AA-ZZ] 9/2004 GN-70129 EXC [AA-ZZ] 8/2002 GN-70129 MAT [AA-ZZ] 8/2002 GN-70129 MEDGLOS [AA-ZZ] 8/2002 GN-70129 PAY [AA-ZZ] 5/2004 GN-70129 RR [AA-ZZ] 8/2002 GN-70129 TER [AA-ZZ] 8/2002

H H H H H H H H H H H H H H H H H H H H H

OTH OTH MS MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM

G G I I I I I I I I I I I I I I I I I I I

APP APP AD RID MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC SMS

A A ACK ADVERTISEMENT A F F F F F F F F F F F F F F F F F PREVENTIVE CARE REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS

50597 GN-70129 TLR 50597 50597 50597 50597 50597 GN-70129 TRANS [AAZZ] 7/2003 GN-70129 UM [AA-ZZ] 8/2002 NE-70129 BEN [AA-ZZ] 5/2004 NE-70129 CHG [AA-ZZ] 8/2002 NE-70129 CLM [AA-ZZ] 8/2002

Page 54 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Humana Insurance Company Illinois Mutual Life Insurance Company NE-70129 COVER [AAZZ] 8/2002 NE-70129 GP [AA-ZZ] 8/2002 NE-70129 GRIEV [AAZZ] 8/2002 NE-70129 LE [AA-ZZ] 5/2004 NE-70129 PREM [AA-ZZ] 8/2002 NE-70129 PRE-X [AAZZ] 8/2002 NE-70129 SCH [AA-ZZ] 5/2004 NE-70129 TAB [AA-ZZ] 8/2002 REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS REVISED RATES ON PPO MAJOR MEDICAL PLANS WHOLE AFFIDAVIT AND DECLARATION AFFIDAVIT AND DECLARATION CONFIRMING CITIZENSHIP

10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/29/08

50597 50597 50597 50597 50597 50597 50597 50597

H H H H H H H H H H H H H H H H H H L V V

MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM MM

I I I I I I I I I I I I I I I I I I I O O

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC POL MISC MISC

F F F F F F F F F F F F F F F F F F A A A

50597 NE-70132-AB 50597 NE-70132-AG 50597 NE-70132-CG 50597 NE-70132-DM 50597 NE-70132-HS 50597 NE-70132-IH 50597 NE-70132-IP 50597 NE-70132-PA 50597 NE-70132-PH 50597 NE-70132-TL 50989 619 (NE) 49835 CP21 49835 CP22

Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08

Page 55 of 101

REVIEWED FILINGS FOR OCTOBER 2008 AFFIDAVIT CONFIRMING SOCIAL SECURITY NUMBER AFFIDAVIT AND DECLARATION OF SOCIAL SECURITY NUMBER AND ADDRESS AUTHORIZATION FOR SALE OR TRUST TRUST NAME AFFIDAVIT NAME AFFIDAVIT AFFIDAVIT OF LOST DIVORCE DECREE AFFIDAVIT OF DIVORCE DECREE POLICY OWNER AFFIDAVIT OF ADDRESS CHANGE POLICY NUMBER AFFIDAVIT INSUREDS CONSENT TO ANNUITY PURCHASE IRREVOCABLE POWER OF ATTORNEY EARNINGS MULTIPLE DEATH BENEFIT GUARANTEED STANDARD DEATH BENEFIT AND TRANSFER GUARANTEED RATCHET DEATH BENEFIT AND TRANSFER GUARANTEED COMBINATION DEATH BENEFIT AND TRANSFER MINIMUM GUARANTEED INCOME BENEFIT FLEXIBLE PREMIUM DEFERRED ANNUITY DISCLOSURE GUARANTEED MINIMUM DEATH BENEFIT 5% ROLL UP GUARANTEED MINIMUM DEATH BENEFIT

Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 Independent Funding, LLC 10/15/08 ING USA Annuity and Life Insurance Company ING USA Annuity and Life Insurance Company ING USA Annuity and Life Insurance Company ING USA Annuity and Life Insurance Company ING USA Annuity and Life Insurance Company Investors Heritage Life Insurance Company Investors Heritage Life Insurance Company Jackson National Life Insurance Company Jackson National Life Insurance Company 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/29/08 10/29/08 10/01/08 10/01/08

49835 CP23 49835 CP24 49835 CP25 49835 CP26 49835 CP27 49835 CP28 49835 CP29 49835 CP30 49835 CP31 49835 IOP6-NE 49835 IOP7-NE 50883 IU-RA-4005 50883 IU-RA-4006 50883 IU-RA-4007 50883 IU-RA-4008 50890 IU-RA-4009 50929 28700 NE (4-2008) 50929 ANNDIS (6-2008) 50605 7580 50605 7581

V V V V V V V V V V V VA VA VA VA VA A A VA VA

O O O O O O O O O O O I I I I I I I I I Page 56 of 101

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC RID RID RID RID RID POL MISC END END

A A A A A A A A A A A A A A A A A A A A

REVIEWED FILINGS FOR OCTOBER 2008 Jackson National Life Insurance Company Jackson National Life Insurance Company Jackson National Life Insurance Company Jackson National Life Insurance Company Jackson National Life Insurance Company John Hancock Life Insurance Company John Hancock Life Insurance Company John Hancock Life Insurance Company John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) ROLL UP/HIGHEST QUARTER MINIMUM DEATH BENEFIT 6% ROLL UP GUARANTEED MINIMUM DEATH BENEFIT COMBINATION 6% ROLL UP AND HIGHEST QUARTERLY VALUE GUARANTEED MINIMUM DEATH BENEFIT

10/01/08 10/01/08

50605 7582 50605 7583

VA VA

I I

END END

A A

10/01/08

50605 7584

VA

I

END

A

10/27/08 10/27/08 10/23/08 10/23/08 10/23/08 10/08/08

50988 X3300 02/09 50988 X3305 02/09 50960 NB5000NE (10/2008) 50960 NB5011US (12/2007) 50960 PS5107US (01/2005) 50672 ENDIRA.08-REV

L L L L L VA

I I I I I I

APP APP APP APP APP END

A A A A A A REPLACEMENT OF LIFE INSURANCE PARTIAL WITHDRAWAL SUPPLEMENT IRA REINSTATEMENT

10/08/08

50672 ENDROTH.08-REV

VA

I

END

A

ROTH IRA

10/08/08

50672 ENDSIMPLE.08

VA

I

END

A

SIMPLE IRA

10/14/08

50579 CP4000US (09/2008)

L

I

APP

A

MASTER

10/14/08

50579 CP4001US (09/2008)

L

I

APP

A

10/14/08

50579 CP4002US (09/2008)

L

I

APP

A

10/14/08

50579 CP4003US (09/2008)

L

I

APP

A

10/14/08

50579 CP4004US (09/2008)

L

I Page 57 of 101

APP

A

REVIEWED FILINGS FOR OCTOBER 2008 John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Life Insurance Company (U.S.A.) John Hancock Variable Life Insurance Company John Hancock Variable Life Insurance Company John Hancock Variable Life Insurance Company Kanawha Insurance Company Kanawha Insurance Company Kanawha Insurance Company

10/14/08

50579 CP4005US (09/2008)

L

I

APP

A

10/14/08

50579 CP4006US (09/2008)

L

I

APP

A

10/20/08

50738 GP1060.19

VA

G

RID

A

SEPARATE ACCOUNT RIDER (B)

10/20/08

50738 GP1064.12

VA

G

RID

A

SEPARATE ACCOUNT RIDER (F)

10/20/08

50738 GP1068.1

VA

G

RID

A

SEPARATE ACCOUNT RIDER (C)

10/23/08

50959 NB5000NE (10/2008)

L

I

APP

A REPLACEMENT OF LIFE INSURANCE

10/23/08

50959 NB5011US (12/2007)

L

I

APP

A

10/23/08

50959 NB5092NE (10/2008)

L

I

APP

A PARTIAL WITHDRAWAL SUPPLEMENT

10/23/08

50959 PS5107US (01/2005)

L

I

APP

A

10/23/08 10/23/08 10/23/08 10/23/08 10/20/08 10/20/08 10/20/08

50987 08OYT 50961 NB5000NE (10/2008) 50961 NB5011US (12/2007) 50961 PS5107US (01/2005) 50701 1380 11 08 50701 1661 50701 1661 E

L L L L L/H

I I I I

MISC APP APP APP

INF REVISED FREE LOOK PROVISION A A A A A A REPLACEMENT OF LIFE INSURANCE PARTIAL WITHDRAWAL SUPPLEMENT MASTER ENROLLMENT FORM EVIDENCE OF INSURABILITY SUPP

DI/OT G APP H DI/OT L/H G APP H DI/OT L/H G APP H Page 58 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Kanawha Insurance Company Kanawha Insurance Company Kanawha Insurance Company Kanawha Insurance Company Kansas City Life Insurance Company Kansas City Life Insurance Company Knights of Columbus Supreme Council Knights of Columbus Supreme Council Knights of Columbus Supreme Council Lafayette Life Insurance Company Life Insurance Company of North America Life Insurance Company of North America Life Insurance Company of North America Life Insurance Company of Southwest Life Insurance Company of Southwest Life Insurance Company of Southwest Life Settlement Solutions, Inc. Lincoln Benefit Life Company Lincoln Heritage Life Insurance Company Lincoln Heritage Life Insurance Company Loyal American Life Insurance Company DI/OT H DI/OT H DI DI

10/20/08 10/20/08 10/27/08 10/27/08 10/16/08 10/24/08 10/28/08 10/28/08 10/28/08 10/01/08 10/16/08 10/16/08 10/16/08 10/21/08 10/21/08 10/21/08 10/20/08 10/10/08 10/06/08 10/29/08 10/07/08

50701 8014 NE 50701 8114 NE 50700 8014 NE 50700 8114 NE 50659 J171-NE 50731 L5223 51004 550 CONV-EX 1-08 51004 550-DOI 1-08 51004 551 POLICY CHANGE 108

L/H L/H H H A H L L L L L L L A A A V VA L L H

G G G G I

POL CERT MISC MISC POL RATE APP APP APP APP POL APP CERT END END END MISC END MISC APP POL SMS PMS

A A F F A A A A A A A A A A A A A A A A A

DISABILITY INCOME DISABILITY INCOME REVISED GROUP DISABILITY RAE MANUAL REVISED GROUP DISABILITY RAE MANUAL FLEXIBLE PREMIUM - NONPARTICIPATING INCREASE 15% CONVERSION DECLARATION OF INSURABILITY SUPPLEMENT POLICY CHANGE

MS

I I I I I G G G I I I O I I I

50606 1459-F-NE 50722 GL202 50722 GL202-A 50722 INT-GL 50919 7877 50919 7878 50919 7883 50842 NE FORM B-113 SEPT-08 50881 A-LB-ROTH(1/08) 50664 AUTH08-A 51005 PRFREINAPP08 50676 L-6201-NE

TERM

403(B) ROTH 403(B) ERISA 403(B) DISCLOSURE FORM ROTH IRA AMENDATORY AUTHORIZATION FOR PAYMENT REINSTATEMENT PLAN I

MS

I

Page 59 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Loyal American Life Insurance Company Loyal American Life Insurance Company Loyal American Life Insurance Company Loyal American Life Insurance Company Loyal American Life Insurance Company Loyal American Life Insurance Company Loyal American Life Insurance Company Loyal American Life Insurance Company Loyal American Life Insurance Company Loyal American Life Insurance Company Manhattan Life Insurance Company Massachusetts Mutual Life Insurance Company

10/07/08 10/07/08 10/07/08 10/07/08 10/08/08 10/08/08 10/08/08 10/08/08 10/09/08 10/21/08 10/24/08 10/08/08

50677 L-6202-NE 50682 L-5441.V2-NE 50686 L-5451-NE 50686 L-5452-NE 50417 L-6200-NE 50417 L-6203-OC-NE 50704 LOYAL-1-0003-V2 50712 GASBG-12-0001 50907 L-5440-AD 51154 GASBG-1-0009 51052 MPRTERM03 08/08-NE 50904 LTC50957 50679 MSA-AGP-601-MACTRANSPORT

H H H H H H H H H H L H H H H H H H H H

MS LTC LTC LTC MS MS MS LTC/ MS LTC MS

I I I I I I I I I I I

POL APP MISC MISC POL MISC AD AD AD AD POL AD MISC RATE RATE RATE RATE RATE RATE RATE

SMS

A A A A

PLAN J

OUTLINE OF COVERAGE OUTLINE OF COVERAGE PLAN H OUTLINE OF COVERAGE

SMS SMS SMS SMS

A A

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT

SMS

ACK ADVERTISEMENT A LEVEL TERM RENEWABLE TO AGE 95

LTC OTH MS MS MS MS MS MS MS

I G I I I I I I I

ACK ADVERTISEMENT INPATIENT HOSPITAL, SURGICAL, INF MEDICAL EXPENSE BENEFIT PROVISION PMS PMS PMS PMS PMS PMS PMS A A A A A A A INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8%

Medical Savings Insurance 10/03/08 Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08

50456 294 50456 384Y 50456 384Z 50456 397 50456 3986 50456 398E 50456 398F

Page 60 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company Medico Insurance Company

10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08

50456 402Y 50456 402Z 50456 4054 50456 405B 50456 484Y 50456 484Z 50456 485Y 50456 485Z 50456 486Y 50456 486Z 50456 487 50456 488 50456 489 50456 489A 50456 497 50456 990 50456 R405 50756 MP-MS992A 50757 MP-MS992C 50758 MP-MS992F 50759 MP-MS992G

H H H H H H H H H H H H H H H H H H H H H

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

I I I I I I I I I I I I I I I I I I I I I

RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE

PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS SMS SMS SMS SMS

A A A A A A A A A A A A A A A A A A A A A

INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% - PLAN A INCREASE - 8% - PLAN C INCREASE - 8% - PLAN F INCREASE - 8% - PLAN G

Page 61 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company Medico Life Insurance Company

10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08

50457 294 50457 384Y 50457 384Z 50457 402Y 50457 402Z 50457 4054 50457 405B 50457 484Y 50457 484Z 50457 485Y 50457 485Z 50457 486Y 50457 486Z 50457 487 50457 488 50457 489 50457 489A 50457 990 50457 R405 50760 ML-MS992A 50761 ML-MS992C

H H H H H H H H H H H H H H H H H H H H H

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

I I I I I I I I I I I I I I I I I I I I I

RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE

PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS SMS SMS

A A A A A A A A A A A A A A A A A A A A A

INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% INCREASE - 8% - PLAN A INCREASE - 8% - PLAN C

Page 62 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Medico Life Insurance Company Medico Life Insurance Company Mennonite Mutual Aid Association Mennonite Mutual Aid Association Mennonite Mutual Aid Association Mennonite Mutual Aid Association Metropolitan Life Insurance Company Metropolitan Life Insurance Company Metropolitan Life Insurance Company Midland National Life Insurance Company Midland National Life Insurance Company Midland National Life Insurance Company Midland National Life Insurance Company Monumental Life Insurance Company MTL Insurance Company Mutual of America Life Insurance Company Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company

10/09/08 10/09/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/29/08 10/24/08 10/24/08 10/28/08 10/28/08 10/10/08 10/02/08 10/23/08 10/03/08 10/03/08 10/03/08 10/08/08 10/08/08

50762 ML-MS992F 50763 ML-MS992G 50625 2015080 50625 2015081 50625 2015082 50625 2015083 50954 1.GCERT2000 DEN/COB 9/08

H H H H H H H H L L L L L A/VA L VA H H H H H

MS MS MM MM MM MM DENT DENT

I I I I I I G G I I I I I I I G

RATE RATE RATE RATE RATE RATE MISC MISC POL POL POL END END END POL END CERT CERT POL AD AD

SMS SMS

A A F F F F A A A A A A A A A A A A A

INCREASE - 8% - PLAN F INCREASE - 8% - PLAN G INCREASE - 12.8% INCREASE - 12.8% INCREASE - 12.8% INCREASE - 12.8% COORDINATION OF BENEFITS INSERT PAGE COORDINATION OF BENEFITS SINGLE PREMIUM ADJUSTABLE FLEXIBLE PREMIUM ADJUSTABLE FLEXIBLE PREMIUM ADJUSTABLE RETURN OF PREMIUM DEATH BENEFIT RETURN OF PREMIUM DEATH BENEFIT ROTH IRA MODIFIED WHOLE LIFE PAYABLE UPON THE INSURED'S DEATH DISCONTINUANCE NOTIFICATION 403(B) LONG TERM DISABILITY CONTINUATION OF INSURANCE SHORT TERM DISABILITY CONTINUATION OF INSURANCE COMBINED SHORT-TERM AND LONG-TERM DISABILITY MASTER

50954 GCR08-40 DEN/COB 50899 1-35-08 50753 2440 8-08 NE 50871 2430 8-08 NE 51002 TR142 51002 TR144 50750 AE 1287 0608 50727 ICC08 1BP 50984 TDA-2006-A2 50368 9000GC-M-LTD 08 50368 9000GC-M-STD 08 50368 9000GM-M-A-EZ 50864 AFN40101-443 50903 ML11740

DI DI DI LTC MS

G G G I I

ACK ADVERTISEMENT SMS ACK ADVERTISEMENT

Page 63 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company National Guardian Life Insurance Company National States Insurance Company National States Insurance Company National States Insurance Company National States Insurance Company National States Insurance Company National States Insurance Company National Union Fire Insurance Company of Pittsburgh, Pennsylvania Nationwide Life and Annuity Insurance Company Nationwide Life and Annuity Insurance Company Nationwide Life and Annuity Insurance Company

10/10/08 10/10/08 10/10/08 10/10/08 10/10/08 10/10/08 10/24/08 10/15/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/28/08 10/08/08

50885 FORM M243-21410 50885 M243-21410 50885 MBCPNAJ 50885 MCPNAJ 50885 MRPNAJ 50885 MRPNAJD 51237 MA5890 50811 83 LSP 3 1/09 51058 COVERPAGE(2009) 51058 OC-ASM-1(2009) 51058 OC-BSM-1(2009) 51058 OC-DSM-1(2009) 51058 OC-FSM-1(2009) 51058 OC-JSM-2(2009) 50734 C36049DBG

H H H H H H H L/H H H H H H H H

MS MS MS MS MS MS MS OTH MS MS MS MS MS MS OTH

I I I I I I I G I I I I I I G

MISC POL MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC RID

SMS SMS SMS SMS SMS SMS SMS

A A A A A A ACK A

POLICY SCHEDULE PLAN J OUTLINE OF COVERAGE OUTLINE OF COVERAGE OUTLINE OF COVERAGE OUTLINE OF COVERAGE USE ELECTRONIC AND VOICE SIGNATURE POLICY SCHEDULE INITIAL OUTLINE OF COVERAGE OUTLINE OF COVERAGE OUTLINE OF COVERAGE OUTLINE OF COVERAGE OUTLINE OF COVERAGE OUTLINE OF COVERAGE SECURITY EVACUATION BENEFIT

SMS SMS SMS SMS SMS SMS

A A A A A A A

10/02/08

50633 LAA-0108AO

L/VL

I

APP

A

10/02/08

50633 NWLA-344-AO

L/VL

I

RID

A

ACCELERATED DEATH BENEFIT ACCELERATED DEATH BENEFIT DISCLOSURE

10/02/08

50633 NWLA-369-AO

L/VL

I

MISC

A

Page 64 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Nationwide Life and Annuity Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company Nationwide Life Insurance Company New York Life Insurance and Annuity Corporation New York Life Insurance and Annuity Corporation New York Life Insurance and Annuity Corporation New York Life Insurance and Annuity Corporation New York Life Insurance and Annuity Corporation New York Life Insurance Company

10/27/08 10/08/08 10/08/08 10/08/08 10/10/08 10/10/08 10/10/08 10/10/08 10/10/08 10/10/08 10/10/08 10/10/08 10/02/08

50998 NWLA-376-AO 50670 NRA-0100AO.1 50670 NRB-0100AO.1 50670 NRC-0100AO.1 50658 APO-1213 GA-P [1234] 50658 APO-1213 GA-P [2345] 50658 APO-1213-2 50658 APO-1992.1 50658 APO-1993.1 50658 APO-1994.1 50658 APO-1995.1 50658 IAD-0101AO 50376 22783

L VA VA VA A A A A A A A A L

I G G G G G G G G G G G G

END APP MISC POL POL CERT APP CERT CERT CERT CERT MISC APP

A A A A A A A A A A A A A STRAIGHT LIFE PERIOD CERTAIN LAYOUT PERIOD CERTAIN LAYOUT LIFE ANNUITY AMENDMENT SUPPLEMENTARY DEFERRED CONTRACT SPECIFICATIONS PAGE FLEXIBLE PURCHASE PAYMENT MANAGED SEPARATE ACCOUNT

10/02/08

50376 307-44C.37

L

G

CERT

A

PRIVATE PLACEMENT UNIVERSAL

10/02/08

50376 307-803

L

G

RID

A

ADDITION OF WV ACCOUNT

10/06/08

50650 204-186 (06/2008)

A

I

APP

A

10/06/08 10/07/08

50650 208-596 50685 ILTC-5012 (0908)

A H LTC

I I

APP APP

A A POLICY CHANGE

Page 65 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America Nippon Life Insurance Company of America North American Company for Life and Health Insurance North American Company for Life and Health Insurance

10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/27/08

50421 NP 2000 50421 NP 2001 50421 NP 2002 50421 NP 2003 50421 NP 2004 50421 NP 2005 50421 NP 2006 50421 NP 2007 50421 NP 2008 50421 NP 2009 50421 NP 2011 50421 NP 2012 50421 NP 2013 50421 NP 2014 50421 NP 2015 50421 NP 2016 50421 NP 2017 50421 NP 2050 50926 AE512A

H H H H H H H H H H H H H H H H H H A

SL SL SL SL SL SL SL SL SL SL SL SL SL SL SL SL SL SL

G G G G G G G G G G G G G G G G G G I

POL POL POL POL POL POL POL POL POL POL POL END END END END END END APP END

A A A A A A A A A A A A A A A A A A A

STOP LOSS TITLE PAGE TABLE OF CONTENTS DEFINITIONS PREMIUMS REIMBURSEMENT TERMINATION REINSTATEMENT RENEWAL GENERAL PROVISIONS GENERAL EXCLUSIONS SCHEDULE AGGREGATE ACCOMMODATION REIMBURSEMENT AGGREGATE SPECIFIC DEDUCTIBLE AGGREGATE TERMINAL LIABILITY FAMILY DEDUCTIBLE SPECIFIC ADVANCE FUNDING SPECIFIC TERMINAL LIABILITY

GUARANTEED RETURN OF PREMIUM SPECIFICATIONS PAGE

10/27/08

50926 PS160A.10YR.10

A

I Page 66 of 101

MISC

A

REVIEWED FILINGS FOR OCTOBER 2008 North American Company 10/27/08 for Life and Health Insurance North American Company 10/27/08 for Life and Health Insurance North American Company 10/27/08 for Life and Health Insurance North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company 10/06/08

50926 PS160A.14YR.10

A

I

MISC

A

SPECIFICATIONS PAGE

50926 PS160A.7YR.10

A

I

MISC

A

SPECIFICATIONS PAGE ADDITIONAL BENEFITS SPECIFICATIONS PAGE NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY

50926 PS160B.10

A

I

MISC

A

50391 SP 001 214 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 215 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 216 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 217 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 219 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 220 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 221 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 223 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 224 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 225 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 226 1100 NAS

H

SL

G

MISC

F

Page 67 of 101

REVIEWED FILINGS FOR OCTOBER 2008

North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company North American Specialty Insurance Company Northwestern Long Term Care Insurance Company Northwestern Long Term Care Insurance Company Northwestern Long Term Care Insurance Company Northwestern National Insurance Company Occidental Life Insurance Company of North Carolina

10/06/08

50391 SP 001 227 1100 NAS

H

SL

G

MISC

F

NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY NEW RATE FILING ON EXCESS STOP LOSS POLICY

10/06/08

50391 SP 001 230 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 231 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 232 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 233 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 234 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 236 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 241 1100 NAS

H

SL

G

MISC

F

10/06/08

50391 SP 001 242 1100 NAS

H

SL

G

MISC

F

10/06/08 10/08/08 10/08/08 10/09/08 10/10/08 10/24/08

50391 SP 001 243 1100 NAS 50796 90-2243 LTC (0708) 50796 90-2384 LTC (0808) 51027 90-2382 LTC (0108) 50486 27173 50991 OL9617(REV.6/08)

H H H H H L

SL LTC LTC LTC MM

G I I I I I

MISC AD AD AD RATE APP

F

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT F A INCREASE - 25%

Page 68 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Ohio National Life Assurance Corporation Ohio National Life Assurance Corporation Ohio National Life Assurance Corporation Ohio National Life Assurance Corporation Ohio National Life Assurance Corporation Ohio National Life Insurance Company Ohio National Life Insurance Company Ohio National Life Insurance Company Ohio National Life Insurance Company Ohio National Life Insurance Company Ohio National Life Insurance Company Ohio National Life Insurance Company Old American Insurance Company Pacific Life Insurance Company Pan-American Life Insurance Company Pan-American Life Insurance Company Pan-American Life Insurance Company Penn Treaty Network America Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company

10/03/08 10/03/08 10/03/08 10/15/08 10/15/08 10/27/08 10/27/08 10/27/08 10/27/08 10/27/08 10/27/08 10/27/08 10/23/08 10/23/08 10/01/08 10/01/08 10/01/08 10/07/08 10/08/08 10/08/08

50638 FORM 08-QBB-1 50638 FORM 08-QL-19.1 50638 FORM 08-QL-19.1U 50837 FORM 08-QVB-1 50837 FORM 08-QVB-1U 49838 FORM 08-6549R-20-P-A 49838 FORM 08-6553 49838 FORM 08-AD-19.1 49838 FORM 08-AD-19.1U 49838 FORM 08-FRP-1 49838 FORM 6495 REV. 8/08 49838 FORM 6499 REV. 8/08 50945 R8187 51167 25-1157 50287 USH0002C 50287 USH0002C-R(NE) 50287 USHSB0002P/C 50726 1091 50879 PLME04 50879 PLME05

L L L L L A A A A A A A L VA H H H H H H OTH OTH OTH LTC MS MS

I I I I I I I I I I I I I I G G G I I I

END POL POL END END MISC MISC POL POL END APP APP RID APP CERT RID MISC END AD AD SMS SMS

A A A A A A A A A A A A A A

BANK OWNED LIFE INSURANCE POLICY SPECIFICATIONS POLICY SPECIFICATIONS CHANGE NOTIFICATION CHANGE NOTIFICATION REPLACEMENT FREE LOOK PERIOD RIGHT TO RETURN - FREE LOOK SINGLE PREMIUM DEFERRED SINGLE PREMIUM DEFERRED UNISEX RETURN OF PREMIUM

CHILDREN'S TERM

INF HOSPITAL INDEMNITY INF NEBRASKA INF SCHEDULE OF BENEFITS A CHANGE

ACK ADVERTISEMENT ACK ADVERTISEMENT

Page 69 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Pennsylvania Life Insurance Company Philadelphia American Life Insurance Company Philadelphia American Life Insurance Company Philadelphia American Life Insurance Company Philadelphia American Life Insurance Company Philadelphia American Life Insurance Company Philadelphia American Life Insurance Company Philadelphia American Life Insurance Company

10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/29/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08 10/03/08

50769 PMSA-00-PLAN A NE 50769 PMSA-00-PLAN B NE 50769 PMSA-00-PLAN C NE 50769 PMSA-00-PLAN D NE 50769 PMSA-00-PLAN F NE 50769 PMSA-00-PLAN F+ NE 50769 PMSA-00-PLAN G NE 50769 PMSA-06-PLAN A NE 50769 PMSA-06-PLAN B NE 50769 PMSA-06-PLAN C NE 50769 PMSA-06-PLAN D NE 50769 PMSA-06-PLAN F NE 50769 PMSA-06-PLAN F+ NE 50769 PMSA-06-PLAN G NE 50394 526 NE 50394 527 NE 50394 528 NE 50394 565 NE 50394 C01 50394 C02 NE 50394 C09 NE

H H H H H H H H H H H H H H H H H H H H H

MS MS MS MS MS MS MS MS MS MS MS MS MS MS OTH OTH OTH OTH OTH OTH OTH

I I I I I I I I I I I I I I I I I I I I I

RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE

SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS

A A A A A A A A A A A A A A A A A A A A A

INCREASE - 17% - PLAN A INCREASE - 17% - PLAN B INCREASE - 17% - PLAN C INCREASE - 17% - PLAN D INCREASE - 17% - PLAN F INCREASE - 17% - PLAN F HIGH DEDUCTIBLE INCREASE - 17% - PLAN G INCREASE - 17% - PLAN A INCREASE - 17% - PLAN B INCREASE - 17% - PLAN C INCREASE - 17% - PLAN D INCREASE - 17% - PLAN F INCREASE - 17% - PLAN F HIGH DEDUCTIBLE INCREASE - 17% - PLAN G INCREASE - AVERAGE - 15% CANCER POLICY INCREASE - AVERAGE - 15% CANCER POLICY INCREASE - AVERAGE - 15% CANCER POLICY INCREASE - AVERAGE - 15% CANCER POLICY INCREASE - AVERAGE - 15% CANCER POLICY INCREASE - AVERAGE - 15% CANCER POLICY INCREASE - AVERAGE - 15% CANCER POLICY

Page 70 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Philadelphia American Life Insurance Company PHL Variable Insurance Company PHL Variable Insurance Company PHL Variable Insurance Company PHL Variable Insurance Company PHL Variable Insurance Company PHL Variable Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Life Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company INCREASE - 12.5% - CANCER POLICY ANNUAL STEP-UP DEATH BENEFIT EARNINGS ENHANCEMENT DEATH BENEFIT FLEXIBLE DEFERRED CONTRACT SCHEDULE CONTRACT SCHEDULE FINANCIAL QUESTIONNAIRE HIGH DEDUCTIBLE PLAN F

10/06/08 10/10/08 10/10/08 10/10/08 10/10/08 10/10/08 10/27/08 10/02/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08

50413 C18 NE 50645 08ASUE 50645 08EEBE 50645 08VA 50645 VASP-ENH 50645 VASP-STND 50999 OL4322 50916 L267 50801 PMA3035 50801 PMA3036 50900 PMA2932 50900 PMA3032 50900 PMA3033 50906 PMA3038 50906 PMA3039 51014 PMA3034 51028 PRE-65-ACTCUSTINN-A 51028 PRE-65-LAPSEINN-A 51028 PRE-65-NONCUSTINN-A 50395 P297 50395 R985

H A A A A A L H H H H H H H H H H H H H H

OTH

I I I I I I I

RATE END END POL MISC MISC APP POL AD AD AD AD AD AD AD AD AD AD AD RATE RATE SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS

F A A A A A A A

MS MS MS MS MS MS MS MS MS MS MS MS MM MM

I I I I I I I I I I I I I I

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT F F INCREASE - 19% INCREASE - 19%

Page 71 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company Physicians Mutual Insurance Company

10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08 10/22/08

51012 P115 51012 P192 51012 P197 51012 P315 51012 P318/R700 51012 P392 51012 P393/R620 51012 P393/R621 51012 P393/R622 51012 P397/R631 51012 P397/R633 51012 R161 51012 R162 51012 R179 51012 R180 51012 R190 51012 R193 51012 R194 51012 R200 51012 R201 51012 R202

H H H H H H H H H H H H H H H H H H H H H

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

I I I I I I I I I I I I I I I I I I I I I

RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE

PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS

A A A A A A A A A A A A A A A A A A A A A

INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9% INCREASE - 9%

Page 72 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Physicians Mutual Insurance Company Pioneer Mutual Life Insurance Company Pioneer Mutual Life Insurance Company Pioneer Mutual Life Insurance Company Pioneer Security Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/22/08 10/02/08 10/10/08 10/10/08 10/24/08 10/06/08 10/06/08 10/06/08 10/06/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08

51012 R203 50637 2905 50745 CLAIM-211/2901 50745 DISC-211/2901 50992 PS9617(REV.6/08) 50651 SF 812-26 50651 SF 812-27 50651 SF 812-28 50651 SF 870 50577 GC 6000 50577 GC 6001 50577 GC 6002 50577 GC 6003 50577 GC 6004 50577 GC 6004 A 50577 GC 6004 B 50577 GC 6005 50577 GC 6005 A 50577 GC 6006 50577 GC 6007 50577 GC 6008

H L L L L A A A A L L L L L L L L L L L L

MS

I I I I I I I I I G G G G G G G G G G G G

RATE RID MISC MISC APP MISC MISC MISC RID MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

PMS

A A A A A A A A A A A A A A A A A A A A A

INCREASE - 9% PREMIUM DEPOSIT FUND DISCLOSURE FOR ACCELERATED BENEFIT AT TIME OF CLAIM ACCELERATED BENEFIT DISCLOSURE STATEMENT

DATA PAGE DATA PAGE DATA PAGE INTEREST RATE BAIL OUT REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES

Page 73 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES

10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08

50577 GC 6009 50577 GC 6010 50577 GC 6011 50577 GC 6012 50577 GC 6013 50577 GC 6015 50577 GC 6016 50577 GC 6017 50577 GC 6018 50577 GC 6019 50577 GH 106 50577 GH 107 50577 GH 109 50577 GH 110 50577 GH 111 50577 GH 113 50577 GH 114 50577 GH 118 50577 GH 203 50577 GH 252 50577 GH 305

L L L L L L L L L L L L L L L L L L L L L

G G G G G G G G G G G G G G G G G G G G G Page 74 of 101

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

A A A A A A A A A A A A A A A A A A A A A

REVIEWED FILINGS FOR OCTOBER 2008 Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES REVISED ACCIDENTAL DEATH AND DISMEMBERMENT RATES SEPARATE INVESTMENT ACCOUNT SEPARATE INVESTMENT ACCOUNT SEPARATE INVESTMENT ACCOUNT SEPARATE INVESTMENT ACCOUNT SEPARATE INVESTMENT ACCOUNT SEPARATE INVESTMENT ACCOUNT SEPARATE INVESTMENT PREMIER PREMIER SEPARATE ACCOUNT BALANCE PREMIER SEPARATE ACCOUNT BALANCE TITLE PAGE TABLE OF CONTENTS PART IA - SHORT TERM DISABILITY SUMMARY OF BENEFITS PART I - DEFINITIONS PART II - POLICY ADMINISTRATION - SECTION A CONTRACT PART II - POLICY ADMINISTRATION - SECTION B PREMIUMS PART II - POLICY ADMINISTRATION - SECTION C POLICY TERMINATION

10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/21/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08

50577 GH 306 50577 GH 307 50858 40113-15 50858 40114-15 50858 47187-10 50858 48916-10 50858 48917-10 50858 48918-8 50858 48919-8 50858 49523-11 50858 49606-8 50149 GC 4000-1 50149 GC 4001-2 50149 GC 4002-1 50149 GC 4004-2 50149 GC 4006-3

L L A A A A A A A A A H H H H H DI DI DI DI DI

G G G G G G G G G G G G G G G G

MISC MISC RID RID RID RID RID RID RID RID RID POL POL POL POL POL

A A A A A A A A A A A A A A A A

10/24/08

50149 GC 4008-2

H

DI

G

POL

A

10/24/08

50149 GC 4010-3

H

DI

G

POL

A

Page 75 of 101

REVIEWED FILINGS FOR OCTOBER 2008 PART III - INDIVIDUAL REQUIREMENTS AND RIGHTS SECTION A - ELIGIBILITY PART III - INDIVIDUAL REQUIREMENTS AND RIGHTS SECTION B - EFFECTIVE DATES PART III - INDIVIDUAL REQUIREMENTS AND RIGHTS SECTION C - MEMBER TERMINATION, CONTINUATION AND REINSTATEMENT PART IV - BENEFITS - SECTION A BENEFIT QUALIFICATIONS PART IV - BENEFITS - SECTION B BENEFITS PAYABLE PART IV - BENEFITS - SECTION C REHABILITATION [SERVICES AND] BENEFITS PART IV - BENEFITS - SECTION D SURVIVOR BENEFIT PART IV - BENEFITS - SECTION E WEEKLY PAYMENT LIMIT PART IV - BENEFITS - SECTION F BENEFIT PAYMENT PERIOD AND RECURRING DISABILITY PART IV - BENEFITS - SECTION G LIMITATIONS PART IV - BENEFITS - SECTION H SUBROGATION AND REIMBURSEMENT PART IV - BENEFITS - SECTION I CLAIMS PROCEDURES PART V - PARTICIPATING UNIT PROVISIONS INTRODUCTORY PAGE TABLE OF CONTENTS SHORT TERM DISABILITY SUMMARY OF BENEFITS

Principal Life Insurance Company Principal Life Insurance Company

10/24/08

50149 GC 4012-2

H

DI

G

POL

A

10/24/08

50149 GC 4014-1

H

DI

G

POL

A

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/24/08

50149 GC 4016-1

H

DI

G

POL

A

10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08

50149 GC 4018-1 50149 GC 4020-1 50149 GC 4022-1 50149 GC 4026-1 50149 GC 4038-1 50149 GC 4042-2 50149 GC 4046-2 50149 GC 4048 50149 GC 4050-1 50149 GC 4052 50149 GH 850-1 50149 GH 851-1 50149 GH 852-1

H H H H H H H H H H H H H

DI DI DI DI DI DI DI DI DI DI DI DI DI

G G G G G G G G G G G G G

POL POL POL POL POL POL POL POL POL POL CERT CERT CERT

A A A A A A A A A A A A A

Page 76 of 101

REVIEWED FILINGS FOR OCTOBER 2008 HOW TO BE INSURED ELIGIBILITY AND INDIVIDUAL INCONTESTABILITY HOW TO BE INSURED - EFFECTIVE DATES HOW TO BE INSURED TERMINATION, CONTINUATION AND REINSTATEMENT DESCRIPTION OF BENEFITS BENEFIT QUALIFICATION DESCRIPTION OF BENEFITS BENEFITS PAYABLE DESCRIPTION OF BENEFITS REHABILITATION [SERVICES AND] BENEFITS DESCRIPTION OF BENEFITS SURVIVOR BENEFIT DESCRIPTION OF BENEFITS WEELY PAYMENT LIMIT DESCRIPTION OF BENEFITS BENEFIT PAYMENT PERIOD AND RECURRING DISABILITY DESCRIPTION OF BENEFITS LIMITATIONS DESCRIPTION OF BENEFITS SUBROGATION AND REIMBURSEMENT CLAIM PROCEDURES DEFINITIONS TITLE PAGE TABLE OF CONTENTS PART IA - LONG TERM DISABILITY SUMMARY OF BENEFITS PART I - DEFINITIONS

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08

50149 GH 854-2 50149 GH 855-1 50149 GH 856-1 50149 GH 857-1 50149 GH 858-1 50149 GH 859-1 50149 GH 861-1 50149 GH 862-1 50149 GH 863-2 50149 GH 864-2 50149 GH 865 50149 GH 866-1 50149 GH 867-2 50150 GC 3000-1 50150 GC 3001-2 50150 GC 3002-1 50150 GC 3004-2

H H H H H H H H H H H H H H H H H

DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI

G G G G G G G G G G G G G G G G G

CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT CERT POL POL POL POL

A A A A A A A A A A A A A A A A A

Page 77 of 101

REVIEWED FILINGS FOR OCTOBER 2008 PART II - POLICY ADMINISTRATION - SECTION A CONTRACT PART II - POLICY ADMINISTRATION - SECTION B PREMIUMS PART II - POLICY ADMINISTRATION - SECTION C POLICY TERMINATION PART III - INDIVIDUAL REQUIREMENTS AND RIGHTS SECTION A - ELIGIBILITY PART III - INDIVIDUAL REQUIREMENTS AND RIGHTS SECTION B - EFFECTIVE DATES PART III - INDIVIDUAL REQUIREMENTS AND RIGHTS SECTION C - MEMBER TERMINATION, CONTINUATION AND REINSTATEMENT PART IV - BENEFITS - SECTION A BENEFIT QUALIFICATIONS PART IV - BENEFITS - SECTION B BENEFITS PAYABLE PART IV - BENEFITS - SECTION C REHABILITATION [SERVICES AND] BENEFITS PART IV - BENEFITS - SECTION D SPOUSE REHABILITATION BENEFIT PART IV - BENEFITS - SECTION E SURVIVOR BENEFIT [AND ACCELERATED SURVIVOR BENEFIT] PART IV - BENEFITS - SECTION F COST OF LIVING ADJUSTMENT PART IV - BENEFITS - SECTION G ACTIVITIES OF DAILY LIVING (ADL) BENEFIT PART IV - BENEFITS - SECTION H EDUCATION BENEFIT

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/24/08

50150 GC 3006-3

H

DI

G

POL

A

10/24/08

50150 GC 3008-2

H

DI

G

POL

A

10/24/08

50150 GC 3010-3

H

DI

G

POL

A

10/24/08

50150 GC 3012-2

H

DI

G

POL

A

10/24/08

50150 GC 3014-1

H

DI

G

POL

A

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/24/08

50150 GC 3016-1

H

DI

G

POL

A

10/24/08 10/24/08 10/24/08

50150 GC 3018-1 50150 GC 3020-1 50150 GC 3022-1

H H H

DI DI DI

G G G

POL POL POL

A A A

10/24/08

50150 GC 3024-1

H

DI

G

POL

A

10/24/08

50150 GC 3026-1

H

DI

G

POL

A

10/24/08 10/24/08 10/24/08

50150 GC 3028 50150 GC 3030-1 50150 GC 3032

H H H

DI DI DI

G G G

POL POL POL

A A A

Page 78 of 101

REVIEWED FILINGS FOR OCTOBER 2008 PART IV - BENEFITS - SECTION I RETIREMENT PLAN SUPPLEMENT BENEFIT PART IV - BENEFITS - SECTION J ACCIDENTAL DISABILITY BENEFIT PART IV - BENEFITS - SECTION K MONTHLY PAYMENT LIMIT PART IV - BENEFITS - SECTION L CONVERSION PRIVILEGE PART IV - BENEFITS - SECTION M BENEFIT PAYMENT PERIOD AND RECURRING DISABILITY PART IV - BENEFITS-SECTION NTREATMENT OF [ALCOHOL,DRUG OR CHEMICAL ABUSE,DEPENDENCY,OR ADDICTION] [OR A] ]MENTAL HEALTH CONDITION][SPECIAL CONDITION] PART IV - BENEFITS - SECTION O LIMITATIONS PART IV - BENEFITS - SECTION P SUBROGATION AND REIMBURSEMENT PART IV - BENEFITS - SECTION Q CLAIMS PROCEDURES PART V - PARTICIPATING UNIT PROVISIONS PART IV - BENEFITS - SECTION R INFECTIOUS AND CONTAGIOUS DISEASE BENEFIT PART IV - BENEFITS - SECTION S PROGRESSIVE ILLNESS BENEFIT PART IV - BENEFITS - SECTION T EXTENDED EARNINGS PROTECTION BENEFIT PART IV - BENEFITS - SECTION U BUSINESS PROTECTION BENEFIT PART IV - BENEFITS - SECTION V MEDICAL PREMIUM SUPPLEMENT BENEFIT

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/24/08

50150 GC 3034-1

H

DI

G

POL

A

10/24/08 10/24/08 10/24/08 10/24/08

50150 GC 3036-1 50150 GC 3038-1 50150 GC 3040-1 50150 GC 3042-1

H H H H

DI DI DI DI

G G G G

POL POL POL POL

A A A A

Principal Life Insurance Company

10/24/08

50150 GC 3044-1

H

DI

G

POL

A

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08

50150 GC 3046-2 50150 GC 3048 50150 GC 3050-1 50150 GC 3052 50150 GC 3054 50150 GC 3056 50150 GC 3058 50150 GC 3060 50150 GC 3062

H H H H H H H H H

DI DI DI DI DI DI DI DI DI

G G G G G G G G G

POL POL POL POL POL POL POL POL POL

A A A A A A A A A

Page 79 of 101

REVIEWED FILINGS FOR OCTOBER 2008 PART IV - BENEFITS - SECTION X DEPENDENT SPOUSE ACTIVITIES OF DAILY LIVING (ADL) BENEFIT PART IV - BENEFITS - SECTION Y PHYSICIAN EDUCATION BENEFIT INTRODUCTORY PAGE TABLE OF CONTENTS LONG TERM DISABILITY SUMMARY OF BENEFITS HOW TO BE INSURED ELIGIBILITY AND INDIVIDUAL INCONTESTABILITY HOW TO BE INSURED - EFFECTIVE DATES HOW TO BE INSURED TERMINATION, CONTINUATION AND REINSTATEMENT DESCRIPTION OF BENEFITS BENEFIT QUALIFICATION DESCRIPTION OF BENEFITS BENEFITS PAYABLE DESCRIPTION OF BENEFITS REHABILITATION [SERVICES AND] BENEFITS DESCRIPTION OF BENEFITS SPOUSE REHABILITATION BENEFIT DESCRIPTION OF BENEFITS SURVIVOR BENEFIT [AND ACCELERATED SURVIVOR BENEFIT] DESCRIPTION OF BENEFITS - COST OF LIVING ADJUSTMENT DESCRIPTION OF BENEFITS ACTIVITIES OF DAILY LIVING (ADL) BENEFIT DESCRIPTION OF BENEFITS EDUCATION BENEFIT

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08

50150 GC 3066 50150 GC 3068 50150 GH 800-1 50150 GH 801-1 50150 GH 802-1 50150 GH 804-2 50150 GH 805-1 50150 GH 806-1 50150 GH 807-1 50150 GH 808-1 50150 GH 809-1

H H H H H H H H H H H

DI DI DI DI DI DI DI DI DI DI DI

G G G G G G G G G G G

POL POL CERT CERT CERT CERT CERT CERT CERT CERT CERT

A A A A A A A A A A A

10/24/08

50150 GH 810-1

H

DI

G

CERT

A

10/24/08

50150 GH 811-1

H

DI

G

CERT

A

10/24/08 10/24/08 10/24/08

50150 GH 812 50150 GH 813-1 50150 GH 814

H H H

DI DI DI

G G G

CERT CERT CERT

A A A

Page 80 of 101

REVIEWED FILINGS FOR OCTOBER 2008 DESCRIPTION OF BENEFITS RETIREMENT PLAN SUPPLEMENT BENEFIT DESCRIPTION OF BENEFITS ACCIDENTAL DISABILITY BENEFIT DESCRIPTION OF BENEFITS MONTHLY PAYMENT LIMIT DESCRIPTION OF BENEFITS CONVERSION PRIVILEGE DESCRIPTION OF BENEFITS BENEFIT PAYMENT PERIOD AND RECURRING DISABILITY DESCRIPTION OF BENEFITS TREATMENT OF [ALCOHOL,DRUG OR CHEMICAL ABUSE,DEPENDENCY,OR ADDICTION] [OR A] [A ]MENTAL HEALTH CONDITION][SPECIAL CONDITION] DESCRIPTION OF BENEFITS LIMITATIONS DESCRIPTION OF BENEFITS SUBROGATION AND REIMBURSEMENT DESCRIPTION OF BENEFITS CLAIM PROCEDURES DESCRIPTION OF BENEFITS DEFINITIONS DESCRIPTION OF BENEFITS INFECTIOUS AND CONTAGIOUS DISEASE BENEFIT DESCRIPTION OF BENEFITS PROGRESSIVE ILLNESS BENEFIT DESCRIPTION OF BENEFITS EXTENDED EARNINGS PROTECTION BENEFIT DESCRIPTION OF BENEFITS BUSINESS PROTECTION BENEFIT DESCRIPTION OF BENEFITS MEDICAL PREMIUM SUPPLEMENT BENEFIT

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/24/08

50150 GH 815-1

H

DI

G

CERT

A

10/24/08 10/24/08 10/24/08 10/24/08

50150 GH 816-1 50150 GH 817-1 50150 GH 818-1 50150 GH 819-1

H H H H

DI DI DI DI

G G G G

CERT CERT CERT CERT

A A A A

Principal Life Insurance Company

10/24/08

50150 GH 820-1

H

DI

G

CERT

A

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company

10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08

50150 GH 821-2 50150 GH 822 50150 GH 823-1 50150 GH 824-2 50150 GH 825 50150 GH 826 50150 GH 827 50150 GH 828 50150 GH 829

H H H H H H H H H

DI DI DI DI DI DI DI DI DI

G G G G G G G G G

CERT CERT CERT CERT CERT CERT CERT CERT CERT

A A A A A A A A A

Page 81 of 101

REVIEWED FILINGS FOR OCTOBER 2008 DESCRIPTION OF BENEFITS DEPENDENT SPOUSE ACTIVITIES OF DAILY LIVING (ADL) BENEFIT DESCRIPTION OF BENEFITS PHYSICIAN EDUCATION BENEFIT INCREASE - 8% ADJUSTMENT/REINSTATEMENT

Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Principal Life Insurance Company Protective Life Insurance Company Protective Life Insurance Company Provident American Life & Health Insurance Company Provident American Life & Health Insurance Company Provident Life and Accident Insurance Company Provident Life and Accident Insurance Company Provident Life and Accident Insurance Company Provident Life and Accident Insurance Company Pruco Life Insurance Company Prudential Insurance Company of America

10/24/08 10/24/08 10/24/08 10/28/08 10/28/08 10/28/08 10/28/08 10/06/08 10/06/08 10/08/08

50150 GH 831 50150 GH 832 50695 GC 500 (D) 50979 AA 1700-3 50979 AA 1751-3 50979 AA 2150-2 50979 HH 777 50669 IPV-2161 50669 IPV-2161FX 50714 GASBG-12-0001

H H H H H H H A A H

DI DI MS DI DI DI DI

G G G I I I I I I

CERT CERT RATE APP APP APP RID APP APP AD SMS PMS

A A A A A A A A A

OVERHEAD EXPENSE BUSINESS LOAN PROTECTION

LTC/ MS MS

I

ACK ADVERTISEMENT

10/21/08

51151 GASBG-1-0009

H

I

AD

SMS

ACK ADVERTISEMENT

10/09/08

50877 EN-1168 (8-08)

H

LTC

I

AD

ACK ADVERTISEMENT

10/09/08

50877 EN-1169 (8-08)

H

LTC

I

AD

ACK ADVERTISEMENT

10/09/08

50877 EN-1170 (8-08)

H

LTC

I

AD

ACK ADVERTISEMENT

10/21/08 10/06/08 10/06/08

51156 EN-1216 (9-08) 50667 P-END-403(1/09) 50666 PIC-END-403(1/09)

H VA VA

LTC

I G G

AD END END

ACK ADVERTISEMENT A A 403(B) 403(B)

Page 82 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Pyramid Life Insurance Company Pyramid Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company

10/08/08 10/08/08 10/03/08

50878 PYME04 50878 PYME05 49764 LRS-8604-345-0608

H H H

MS MS OTH

I I G

AD AD POL

SMS SMS

ACK ADVERTISEMENT ACK ADVERTISEMENT A CONTINUATION OF MEDICAL COVERAGE BENEFIT POLICY PROVISION HOME ALTERATION AND VEHICLE MODIFICATION BENEFIT POLICY PROVISION BRAIN DAMAGE BENEFIT POLICY PROVISION THERAPEUTIC COUNSELING BENEFIT POLICY PROVISION CRITICAL BURN BENEFIT POLICY PROVISION CONTINUATION OF MEDICAL COVERAGE BENEFIT CERTIFICATE PROVISION HOME ALTERATION AND VEHICLE MODIFICATION BENEFIT CERTIFICATE PROVISION BRAIN DAMAGE BENEFIT CERTIFICATE PROVISION THERAPEUTIC COUNSELING BENEFIT CERTIFICATE PROVISION CRITICAL BURN BENEFIT CERTIFICATE PROVISION REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN

10/03/08 10/03/08 10/03/08 10/03/08 10/03/08

49764 LRS-8604-346-0608 49764 LRS-8604-347-0608 49764 LRS-8604-348-0608 49764 LRS-8604-349-0608 49764 LRS-8605-330-0608

H H H H H

OTH OTH OTH OTH OTH

G G G G G

POL POL POL POL CERT

A A A A A

10/03/08 10/03/08 10/03/08 10/03/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

49764 LRS-8605-331-0608 49764 LRS-8605-332-0608 49764 LRS-8605-333-0608 49764 LRS-8605-334-0608 50393 LRS-6564 ED. 4/06-NE 50393 LRS-6564-1 ED. 2/83 50393 LRS-6564-10-1189 50393 LRS-6564-11-0406 50393 LRS-6564-114-0406 50393 LRS-6564-115-0597 50393 LRS-6564-116-0800

H H H H H H H H H H H

OTH OTH OTH OTH DI DI DI DI DI DI DI

G G G G G G G G G G G

CERT CERT CERT CERT MISC MISC MISC MISC MISC MISC MISC

A A A A F F F F F F F

Page 83 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN

10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

50393 LRS-6564-117-0597 50393 LRS-6564-13 ED. 2/83 50393 LRS-6564-14 ED. 1/00 50393 LRS-6564-143-0698 50393 LRS-6564-15 ED. 2/83 50393 LRS-6564-16 ED. 2/83 50393 LRS-6564-2 ED. 2/83 50393 LRS-6564-205-0501 50393 LRS-6564-3-0690 50393 LRS-6564-390-0905 50393 LRS-6564-4-0406 50393 LRS-6564-5-0394 50393 LRS-6564-60-0406 50393 LRS-6564-6-0394 50393 LRS-6564-64-0292 50393 LRS-6564-65-0394 50393 LRS-6564-7-0208 50393 LRS-6564-72-1193 50393 LRS-6564-73-0199 50393 LRS-6564-8 Ed. 4/06 50393 LRS-6564-82-0994

H H H H H H H H H H H H H H H H H H H H H

DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI

G G G G G G G G G G G G G G G G G G G G G

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

F F F F F F F F F F F F F F F F F F F F F

Page 84 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN

10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08 10/06/08

50393 LRS-6564-9-0406 50393 LRS-6565-2-0406 50393 LRS-6565-6-0406 50393 LRS-6565-65-0292 50393 LRS-6570 ED. 2/83 50393 LRS-6570-10 ED. 1/00 50393 LRS-6570-1-0406 50393 LRS-6570-11 ED. 2/83 50393 LRS-6570-113-0800 50393 LRS-6570-114-0597 50393 LRS-6570-12 ED. 2/83 50393 LRS-6570-139-0698 50393 LRS-6570-199-0501 50393 LRS-6570-3-0394 50393 LRS-6570-393-0905 50393 LRS-6570-4-0394 50393 LRS-6570-5 ED. 2/08 50393 LRS-6570-59-0406 50393 LRS-6570-66-0394 50393 LRS-6570-7-1189 50393 LRS-6570-73-1193

H H H H H H H H H H H H H H H H H H H H H

DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI DI

G G G G G G G G G G G G G G G G G G G G G

MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC MISC

F F F F F F F F F F F F F F F F F F F F F

Page 85 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company ReliaStar Life Insurance Company Renaissance Life & Health Insurance Company of America Reserve National Insurance Company Reserve National Insurance Company Reserve National Insurance Company Reserve National Insurance Company Reserve National Insurance Company Reserve National Insurance Company Riversource Life Insurance Company Royal Neighbors of America S.USA Life Insurance Company, Inc. S.USA Life Insurance Company, Inc. S.USA Life Insurance Company, Inc. S.USA Life Insurance Company, Inc. S.USA Life Insurance Company, Inc. S.USA Life Insurance Company, Inc. REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN REVISED RATES ON GROUP LONG TERM DISABILITY PLAN UPDATED ACTUARIAL MEMORANDUM 2001 CSO TABLE

10/06/08 10/06/08 10/06/08 10/06/08 10/23/08 10/08/08 10/17/08 10/17/08 10/17/08 10/17/08 10/17/08 10/27/08 10/03/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08

50393 LRS-6570-74-0199 50393 LRS-6570-8-0406 50393 LRS-6570-82-0994 50393 LRS-6570-9 ED. 2/83 50896 40-040 50787 INVD-103A V2 50607 MCS-92-A 50608 MCS-92-B 50609 MCS-92-C 50610 MCS-92-F 50623 MCS-05-D 50699 CHS-99 50657 132166 50930 2085 50947 A-106 NE (SP) 50947 A-37J NE (SP) 50947 A-58C NE (SP) 50947 A-60 NE (SP) 50947 A-80B NE (SP) 50947 A-90 NE (SP)

H H H H L H H H H H H H L A L L L L L L

DI DI DI DI

G G G G I

MISC MISC MISC MISC MISC APP RATE RATE RATE RATE RATE RATE END RID APP APP APP APP APP APP SMS SMS SMS SMS SMS

F F F F A A A A A A A F A A A A A A A A

DENT MS MS MS MS MS OTH

I I I I I I I I I I I I I I I

INCREASE - 0% - PLAN A INCREASE - 17% - PLAN B INCREASE - 13% - PLAN C INCREASE - 7% - PLAN F INCREASE - 10% - PLAN D INCREASE - 20% - HOSPITAL SURGICAL POLICY

FLEXIBLE PREMIUM DEFERRED SPANISH VERSION SPANISH VERSION SPANISH VERSION SPANISH VERSION SPANISH VERSION SPANISH VERSION

Page 86 of 101

REVIEWED FILINGS FOR OCTOBER 2008 S.USA Life Insurance Company, Inc. S.USA Life Insurance Company, Inc. S.USA Life Insurance Company, Inc. Security Life of Denver Insurance Company Security Life of Denver Insurance Company Security Life of Denver Insurance Company Security Mutual Life Insurance Company of New York Security Mutual Life Insurance Company of New York Security National Life Insurance Company Security National Life Insurance Company Security National Life Insurance Company Sentry Life Insurance Company Shelter Life Insurance Company Shenandoah Life Insurance Company Shenandoah Life Insurance Company Shenandoah Life Insurance Company Shenandoah Life Insurance Company Shenandoah Life Insurance Company Shenandoah Life Insurance Company

10/23/08 10/23/08 10/23/08 10/01/08 10/01/08 10/01/08 10/30/08

50947 R-39 NE (SP) 50947 R-42C NE (SP) 50947 SB-15C NE (SP) 50729 1177-10/08 50729 ICC08 1177-10/08 50729 ICC08 R1368-10/08 51018 ICC08-2092

L L L L L L L

I I I I I I I

APP APP APP POL POL RID POL

A A A A A A A

SPANISH VERSION SPANISH VERSION SPANISH VERSION POLICY INSERT PAGES FLEXIBLE PREMIUM ADJUSTABLE UNIVERSAL WAIVER OF SURRENDER CHARGE FLEXIBLE PREMIUM ADJUSTABLE ADDITIONAL INSURANCE WITHOUT EVIDENCE OF INSURABILITY WHOLE

10/30/08 10/28/08 10/28/08 10/28/08 10/23/08 10/09/08 10/15/08 10/24/08 10/28/08 10/28/08 10/28/08 10/28/08

51018 ICC08-IO9264 50600 ICC08-ILIFE (01/2009) 50600 ICC08-ILIFE APP (01/2009)

L L L L H L H L H H H H DENT DENT DENT DENT MS DENT

I I I I G I I I G G G G

RID POL APP RID MISC RID AD APP APP APP APP END SMS

A A A A F A

50600 ICC08-IPAYOR (01/2009) 50691 785-3000 50673 L-707.6 51107 MASP-SL 50968 FORM 6004-9/08 REP 50973 FORM 5787-REV. 11/07 50973 FORM 5788-REV. 8/08 50973 FORM 5789-REV. 8/08 50973 FORM 6003-8/08

TERM RIDER WITH ACCIDENTAL DEATH BENEFIT REVISED GROUP DENTAL RATE MANUAL WAIVER OF MONTHLY DEDUCTION

ACK ADVERTISEMENT A A A A A EMPLOYER TRUE SUPPLEMENT VOLUNTEER SUPPLEMENT ACCUMULATED ROLLOVER

Page 87 of 101

REVIEWED FILINGS FOR OCTOBER 2008 GDENC-12/05 NE (REV. 50973 CERT. SCHEDULE PAGES) 50973 GDENCS-8/08 50973 GDENOR-8/08 GDENP-12/05 NE (REV. 50973 POLICY SCHEDULE PAGES) 50928 ICC08 VV26 50928 ICC08 VV26 51053 G1.3(4/01)NE-2001CSO 51053 G1.3(4/01)NE-2001CSO 50944 11-001 APP (REV. 09/08) 50862 HLTH-07-041 50546 MEDSUPP-AA(NE)-01 50547 MEDSUPP-AB(NE)-01 50548 MEDSUPP-AC(NE)-01 50549 MEDSUPP-AD(NE)-01 50550 MEDSUPP-AF(NE)-01 50799 1.2.08 50799 2.3.08 50799 2.3A 50799 3.31.08 50799 M0010_S4802_13609 (8/08)

Shenandoah Life Insurance 10/28/08 Company Shenandoah Life Insurance 10/28/08 Company Shenandoah Life Insurance 10/28/08 Company Shenandoah Life Insurance 10/28/08 Company Sons of Norway Sons of Norway Standard Insurance Company Standard Insurance Company Starmount Life Insurance Company State Farm Mutual Automobile Insurance Company State Mutual Insurance Company State Mutual Insurance Company State Mutual Insurance Company State Mutual Insurance Company State Mutual Insurance Company Sterling Life Insurance Company Sterling Life Insurance Company Sterling Life Insurance Company Sterling Life Insurance Company Sterling Life Insurance Company 10/28/08 10/28/08 10/23/08 10/23/08 10/29/08 10/08/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08

H H H H L L L L L H H H H H H H H H H H

DENT DENT DENT DENT

G G G G I I I I I

MISC RID RID MISC CERT POL MISC MISC APP AD RATE RATE RATE RATE RATE AD AD AD AD AD SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS

A A A A A A A A A

CERTIFICATE SCHEDULE PAGES COSMETIC EXPENSE ORTHODONTIC POLICY SCHEDULE PAGES DATA PAGE TERM TO AGE 26 DATA PAGES - UPDATED WITH 2001 CSO MORTALITY TABLE 2001 CSO MORTALITY UPDATE DIRECT MAIL

MS MS MS MS MS MS LTC/ MS LTC/ MS LTC/ MS LTC/ MS LTC/ MS

I I I I I I I I I I I

ACK ADVERTISEMENT A A A A A INCREASE - 14% - PLAN A INCREASE - 14% - PLAN B INCREASE - 14% - PLAN C INCREASE - 14% - PLAN D INCREASE - 14% - PLAN F

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT

Page 88 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Sterling Life Insurance Company Sterling Life Insurance Company Sterling Life Insurance Company Sterling Life Insurance Company Sterling Life Insurance Company Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) M0010_S4802_14708 (5/08) M0010_S4802_14908 50799 (5/08) 50799 50799 NE1.3 50799 NE2.4 50970 SS4.87 50534 MCAUL-2008 50776 MSULG-2006 50776 MULG-2006 50776 OYT-1999 50776 OYTA-2000 50776 SULG-2006 50776 UL-COLI-94 50776 ULG-2006 50776 ULN-2002 50776 UL-SCOLI-07 50740 MVUL-SIR-2008 LTC/ MS LTC/ MS LTC/ MS LTC/ MS

10/08/08 10/08/08 10/08/08 10/08/08 10/24/08 10/02/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/14/08 10/09/08

H H H H L L L L L L L L L L L VL

I I I I I I I I I I I I I I I I

AD AD AD AD AD POL POL POL POL POL POL POL POL POL POL RID

SMS SMS SMS SMS

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT A INF INF INF INF INF INF INF INF INF A FLEXIBLE PREMIUM UNIVERSAL 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION SUPPLEMENTAL INSURANCE 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION

10/14/08

50777 CVVUL-2001

VL

I

POL

INF

10/14/08

50777 DBVUL-2001

VL

I

POL

INF

10/14/08

50777 FAII-GR-CERT-MVA-02

VL

I Page 89 of 101

POL

INF

REVIEWED FILINGS FOR OCTOBER 2008

Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US)

10/14/08

50777 FIII-GR-CERT-MVA-02

VL

I

POL

INF

30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION

10/14/08

50777 MSG-VUL-2006-NE

VL

I

POL

INF

10/14/08

50777 MSG-VULS-2006-NE

VL

I

POL

INF

10/14/08

50777 MSVUL-2007

VL

I

POL

INF

10/14/08

50777 MVUL-2007

VL

I

POL

INF

10/14/08

50777 OYT-1999A

VL

I

POL

INF

10/14/08

50777 OYTAUS-2000

VL

I

POL

INF

10/14/08

50777 PPVUL-COLI-04

VL

I

POL

INF

10/14/08

50777 PPVUL-GC-98 RCHII-GR-CERT-MVA02

VL

I

POL

INF

10/14/08

50777

VL

I

POL

INF

10/14/08

50777 RFFII-GR-CERT-MVA-02

VL

I

POL

INF

10/14/08

50777 SPIA

VL

I

POL

INF

10/14/08

50777 SVUL-2001

VL

I

POL

INF

10/14/08

50777 VUL-2007

VL

I Page 90 of 101

POL

INF

REVIEWED FILINGS FOR OCTOBER 2008

Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Sun Life Assurance Company of Canada (US) Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company Symetra Life Insurance Company

10/14/08

50777 VUL-COLI-04

VL

I

POL

INF

30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION 30 DAY REPLACEMENT NOTIFICATION SUPPLEMENTAL

10/14/08

50777 VUL-COLI-97NE

VL

I

POL

INF

10/14/08

50777 VULPP2002

VL

I

POL

INF

10/14/08

50777 VUL-SCOLI-07

VL

I

POL

INF

10/23/08

50955 14-704

VL

I

APP

A

10/23/08 10/02/08 10/02/08 10/02/08 10/02/08 10/02/08 10/14/08 10/14/08 10/15/08 10/21/08 10/21/08 10/21/08 10/21/08

50955 MSVUL-SIR-2008 50433 L-10000 4/08 50433 L-10002 4/08 50433 L-10003 4/08 50433 L-10005 4/08 50433 LUC-148 4/08 50781 L-10001 4/08 50781 L-10006 4/08 50872 LGC-10006 9/09 50873 LGC-10002 8/08 50873 LGC-10003 8/08 50873 LGC-10004 8/08 50873 LGC-10005 8/08

VL L L L L L L L H H H H H OTH OTH OTH OTH OTH

I I I I I I I I G G G G G

RID POL RID RID RID APP RID MISC END MISC MISC MISC MISC

A A A A A A A A A A A A A

SUPPLEMENTAL TERM COMMON CARRIER ACCIDENTAL DEATH BENEFIT DISABILITY INCOME WITH ACCIDENTAL INJURY ADDITIONAL TERM INSURANCE

RETURN OF PREMIUM TABLE OF PREMIUM PERCENTAGE SURGICAL BENEFIT SURGICAL SCHEDULE D SURGICAL SCHEDULE E SURGICAL SCHEDULE F SURGICAL SCHEDULE G

Page 91 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Symetra Life Insurance Company Teachers Insurance & Annuity Association of America Teachers Insurance & Annuity Association of America Teachers Insurance & Annuity Association of America Teachers Insurance & Annuity Association of America Teachers Insurance & Annuity Association of America Teachers Insurance & Annuity Association of America Teachers Insurance & Annuity Association of America Thrivent Financial for Lutherans Thrivent Life Insurance Company TIAA-CREF Life Insurance Company TIAA-CREF Life Insurance Company TIAA-CREF Life Insurance Company TIAA-CREF Life Insurance Company TIAA-CREF Life Insurance Company TIAA-CREF Life Insurance Company TIAA-CREF Life Insurance Company UPDATED ACTUARIAL MEMORANDUM REAL ESTATE ACCOUNT - ONE LIFE REAL ESTATE ACCOUNT - TWO LIVES REAL ESTATE ACCOUNT

10/23/08 10/23/08

50969 L-9994 4/08 50933 END-1009.1-SA

L VA

I I

MISC END

INF A

10/23/08

50933 END-1033-SA

VA

I

END

A

10/23/08

50933 END-901.1-SA

VA

I

END

A

10/23/08

50934 TIAA-TA-SA-END

A

I

END

A

TRADITIONAL SEPARATE ACCOUNT - ONE LIFE UNIT

10/24/08

50932 1009.1-SA-NE

VA

I

POL

A

10/24/08

50932 1033-SA-NE

VA

I

POL

A SEPARATE ACCOUNT FIXED PERIOD UNIT TERM CONVERSION CREDIT 403(B) ESTATE PROTECTION LAST SURVIVOR SPLIT OPTION UNIVERSAL OVERLOAN

10/24/08 10/08/08 10/14/08 10/02/08 10/02/08 10/02/08 10/02/08 10/02/08 10/02/08 10/02/08

50932 901.1-SA-NE 50671 LM-TC-TICC (08) 50778 VM-YT-TSA (08) 50530 AM-ESTPROT.1 (2008) 50530 AM-JVSPLIT.2 (2008) 50530 AM-JVUL.3 NE (2008)

VA L VA L L/VL L/VL

I I I I I I I I I I Page 92 of 101

POL END END RID RID POL END APP APP RID

A A A A A A A A A A

50530 AM-OVERLOAN.1 (2008) L/VL 50530 IL-APPUL.1 50530 IL-SUPPAPP.1 50530 TCLSUVCHARBEN.2008 L/VL L/VL L

SUPPLEMENTAL QUESTIONNAIRE CHARITABLE BENEFIT

REVIEWED FILINGS FOR OCTOBER 2008 Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company SUPPLEMENT NICOTINE USE QUESTIONNAIRE SUPPLEMENT DRUG USE QUESTIONNAIRE SUPPLEMENT ALCOHOL USE QUESTIONNAIRE ROTH IRA AMENDMENT AMENDMENT AMENDMENT SINGLE PREMIUM, ALTERNATIVE PAID-UP LIFE TO AGE 121 NONPARTICIPATING CHANGE/CONVERSION MODIFICATION OF POLICY PROVISIONS REINSTATEMENT

10/06/08 10/06/08 10/06/08 10/10/08 10/16/08 10/16/08 10/16/08 10/17/08 10/17/08 10/17/08 10/20/08 10/20/08 10/21/08 10/23/08 10/23/08 10/23/08 10/24/08 10/24/08 10/24/08 10/24/08

50656 APE81008T 50656 MPQ171008T 50656 MPQ181008T 50749 AE 1287 0608 50646 APE 3-1008 50646 APE 4-1008 50646 APE 5-1008 50832 FORM ICC08-101 50832 FORM ICC08MPS11008T 50832 FORM ICC08-NRS01 50861 APR11008T 50892 EM HNW1 TL403 50920 TOS370M1008T 50956 APE 1-1008 50956 APE 2-1008 50957 1-011 06-101 50400 FORM ICC08-180 50400 FORM ICC08APA40TS1008T

L L L A/VA L L L L L L L VL L VL VL VL L L L L

I I I I I I I I I I I I I I I I I I I I Page 93 of 101

APP APP APP END APP APP APP POL APP END APP MISC APP APP APP RID POL APP END END

A A A A A A A A A A A

INF 2001 CSO TABLE UPDATE A A A A A A A A CHANGE OF PLAN OPTION/CONVERSION AMENDMENT AMENDMENT WAIVER PROVISION INTEREST SENSITIVE WHOLE ONE LIFE COVERAGE CONTINUATION OPTION WAIVER OF POLICY FEE

50400 FORM ICC08-CCE01 50400 FORM ICC08-PFW01

REVIEWED FILINGS FOR OCTOBER 2008 Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Transamerica Life Insurance Company Union Labor Life Insurance Company /The Union Labor Life Insurance Company /The Union Labor Life Insurance Company /The Union Security Insurance Company Union Security Insurance Company Union Security Insurance Company Union Security Insurance Company Union Security Insurance Company Union Security Insurance Company Union Security Insurance Company Union Security Insurance Company

10/28/08 10/28/08 10/28/08 10/28/08 10/15/08

50834 ICC08 GIR01 50834 ICC08 NL01 50834 ICC08 NRS02 50834 ICC08-130 50754 9700.LDWP

L L L L L

I I I I G

RID END END POL RID

A A A A A

GUARANTEED INSURABILITY NO LAPSE GUARANTEE MODIFICATION OF POLICY PROVISION FLEXIBLE PREMIUM ADJUSTABLE LABOR DISPUTE WAIVER OF PREMIUM BENEFIT AMENDMENT WAIVER OF PREMIUM AMENDMENT REVISED LONG TERM AND SHORT TERM DISABILITY RATE MANUAL REVISED LONG TERM AND SHORT TERM DISABILITY RATE MANUAL REVISED LONG TERM AND SHORT TERM DISABILITY RATE MANUAL REVISED LONG TERM AND SHORT TERM DISABILITY RATE MANUAL REVISED LONG TERM AND SHORT TERM DISABILITY RATE MANUAL REVISED LONG TERM AND SHORT TERM DISABILITY RATE MANUAL REVISED LONG TERM AND SHORT TERM DISABILITY RATE MANUAL REVISED LONG TERM AND SHORT TERM DISABILITY RATE MANUAL

10/15/08

50754 BR.7

L

G

RID

A

10/15/08

50754 BR.8

L

G

RID

A

10/01/08

50392 DEFLT

H

DI

G

MISC

F

10/01/08

50392 DEFLT99

H

DI

G

MISC

F

10/01/08

50392 DEFST

H

DI

G

MISC

F

10/01/08

50392 DEFST(SE)

H

DI

G

MISC

F

10/01/08

50392 LTD

H

DI

G

MISC

F

10/01/08

50392 LTD99

H

DI

G

MISC

F

10/01/08

50392 STD

H

DI

G

MISC

F

10/01/08

50392 STD(SE)

H

DI

G

MISC

F

Page 94 of 101

REVIEWED FILINGS FOR OCTOBER 2008 United American Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company

10/29/08 10/02/08 10/02/08 10/02/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08

50901 UAIND-PC (WA) 50595 GLBCHC.07.NE 50595 SBN.GLBCHCCP.I.07.NE 50595 SBN.GLBCHCND.I.07.NE 50513 LA 19066 NE (8/08) 50513 LA 19067 NE (8/08) 50513 LA 19068 NE (8/08) 50513 LA 19069 NE (8/08) 50513 LA 19070 NE (8/08) 50513 LA 19071 NE (8/08) 50513 LA 19072 NE (8/08) 50513 LA 19073 NE (8/08) 50513 LA 19074 NE (8/08) 50513 LA 19075 NE (8/08) 50513 LA 19076 NE (8/08) 50513 LA 19077 NE (8/08) 50707 CA1830 (8/08) 50707 CA1831 (8/08) 50771 TV52 (8/08) 50771 TV53 (8/08) 50798 PMMBR08

H H H H H H H H H H H H H H H H H H H H H

MS MM MM MM MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

I G G G G G G G G G G G G G G G G G G G G

AD RID MISC MISC AD AD AD AD AD AD AD AD AD AD AD AD AD AD AD AD AD

SMS

ACK ADVERTISEMENT A A A GLOBAL CHOICE CHOICE PLUS SCHEDULE OF BENEFITS NON DIFFERENTIAL PPO SCHEDULE OF BENEFITS

SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT

Page 95 of 101

REVIEWED FILINGS FOR OCTOBER 2008 United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company

10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/08/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/09/08 10/10/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08 10/15/08

50800 PORTDET_081808_MS-A 50802 PMMBRT08 50863 OA4345 (1/09) 50902 CA1824 (10/08) 50902 S5820S5805S5921_PDP30 61481_001

H H H H H H H H H H H H H H H H H H H H H

MS MS MS MS MS MS MS MS MS MS MS MS MS OTH MS MS MS MS MS MS MS

G G G G G G G G G G G G G G G G G G G G G

AD AD AD AD AD AD AD AD AD AD AD AD AD MISC AD AD AD AD AD AD AD

SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT F REVISED RATES ON CRITICAL ILLNESS POLICIES

50905 SA5126 (7/08) 50910 CA1829 AG (8/08) 49901 PMMB08 49901 PMMBBRC08 49901 PMMBNOBRC08 51031 OA4328 (7/08) 51031 OA4329 (7/08) 51031 SA5127 (7/08) 50475 UCC-POL (02/04) 51105 BA9758 (8/08) 51105 OA4131 (7/08) 51105 OA4131 A (7/08) 51105 OA4131 B (7/08) 51105 OA4131 C (7/08) 51105 OA4131 D (7/08) 51127 PMMBSP108

SMS SMS SMS SMS SMS SMS SMS

ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT ACK ADVERTISEMENT

Page 96 of 101

REVIEWED FILINGS FOR OCTOBER 2008 United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company

10/21/08 10/21/08 10/21/08 10/21/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08

50624 G-36000-4 50689 DCERT.06.NE 50912 UCC-POL-AMEND EVALUATION-NE

H H H H H H H H H H H H H H H H H H H H H

MS DENT OTH OTH MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

G G G G G G G G G G G G G G G G G G G G G

RATE MISC END APP RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE

PMS

A F A A

INCREASE - 4.4% REVISED GROUP DENTAL RATE MANUAL MAXIMUM TRANSPLANT EVALUATION BENEFIT

50912 UHICMTP APP (8/08) 50611 MS1243 50611 MSA1454 50611 MSA2344 50611 MSA2536 50612 MS1244 50612 MSB1455 50612 MSB2345 50612 MSB2537 50613 MS1245 50613 MSC1456 50613 MSC2346 50613 MSC2538 50615 MS1247 50615 MSE1458 50615 MSE2348 50615 MSE2540 50616 MS1248

SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS

A A A A A A A A A A A A A A A A A

INCREASE - 10% - PLAN A INCREASE - 10% - PLAN A INCREASE - 10% - PLAN A INCREASE - 10% - PLAN A INCREASE - 2.9% - PLAN B INCREASE - 2.9% - PLAN B INCREASE - 2.9% - PLAN B INCREASE - 2.9% - PLAN B INCREASE - 6.1% - PLAN C INCREASE - 6.1% - PLAN C INCREASE - 6.1% - PLAN C INCREASE - 6.1% - PLAN C INCREASE - 6.6% - PLAN E INCREASE - 6.6% - PLAN E INCREASE - 6.6% - PLAN E INCREASE - 6.6% - PLAN E INCREASE - 5.9% - PLAN F

Page 97 of 101

REVIEWED FILINGS FOR OCTOBER 2008 United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company

10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/24/08

50616 MSF1459 50616 MSF2349 50616 MSF2541 50617 MS1249 50617 MSG1460 50617 MSG2350 50617 MSG2542 50618 CRA1664 50618 MS1250 50618 MSH1461 50618 MSH2351 50618 MSH2543 50619 CRA1664 50619 MS1251 50619 MSI1462 50619 MSI2352 50619 MSI2544 50620 CRA1664 50620 MS1252 50620 MSJ1463 50620 MSJ2353

H H H H H H H H H H H H H H H H H H H H H

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

G G G G G G G G G G G G G G G G G G G G G

RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE RATE

SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS SMS

A A A A A A A A A A A A A A A A A A A A A

INCREASE - 5.9% - PLAN F INCREASE - 5.9% - PLAN F INCREASE - 5.9% - PLAN F INCREASE - 6.8% - PLAN G INCREASE - 6.8% - PLAN G INCREASE - 6.8% - PLAN G INCREASE - 6.8% - PLAN G INCREASE - 8.1% - PLAN H INCREASE - 8.1% - PLAN H INCREASE - 8.1% - PLAN H INCREASE - 8.1% - PLAN H INCREASE - 8.1% - PLAN H INCREASE - 8.8% - PLAN I INCREASE - 8.8% - PLAN I INCREASE - 8.8% - PLAN I INCREASE - 8.8% - PLAN I INCREASE - 8.8% - PLAN I INCREASE - 10% - PLAN J INCREASE - 10% - PLAN J INCREASE - 10% - PLAN J INCREASE - 10% - PLAN J

Page 98 of 101

REVIEWED FILINGS FOR OCTOBER 2008 United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United HealthCare Insurance Company United Home Life Insurance Company United Life Insurance Company United Life Insurance Company United Life Insurance Company United of Omaha Life Insurance Company United of Omaha Life Insurance Company United of Omaha Life Insurance Company United of Omaha Life Insurance Company United of Omaha Life Insurance Company

10/24/08 10/24/08 10/24/08 10/24/08 10/24/08 10/27/08 10/24/08 10/15/08 10/29/08 10/29/08 10/03/08 10/08/08 10/08/08 10/16/08 10/24/08

50620 MSJ2545 50621 MSK2354 50621 MSK2546 50622 MSL2355 50622 MSL2547 50614 MS1246 50967 200-443 5-06 50812 LIU-119 (10-08) 51006 LIU-754 (8-08) 51006 LIU-757 (8-08) 50927 C646LNA08A 50705 AFN40101-434 50715 LC6839 51074 511-GANC-08 51239 AFN41262 51051 ORGAN08

H H H H H H L A A A L H H L/A H H

MS MS MS MS MS MS

G G G G G G I I I I I

RATE RATE RATE RATE RATE RATE MISC APP POL POL APP AD AD POL AD END

SMS SMS SMS SMS SMS SMS

A A A A A A A A A A A

INCREASE - 10% - PLAN J INCREASE - 9.2% - PLAN K INCREASE - 9.2% - PLAN K INCREASE - 8.2% - PLAN L INCREASE - 8.2% - PLAN L INCREASE - 7% - PLAN D REPLACEMENT NOTICE

SINGLE PREMIUM DEFERRED SINGLE PREMIUM DEFERRED CONVERSION

LTC LTC

I I G

ACK ADVERTISEMENT ACK ADVERTISEMENT A ACK ADVERTISEMENT A HUMAN ORGAN/TISSUE TRANSPLANT INCREASE - 8%

LTC MM

I G

United Security Life and 10/09/08 Health Insurance Company United Teachers Associates Insurance Company United Teachers Associates Insurance Company United Teachers Associates Insurance Company 10/01/08

50356 680

H

MS LTC/ MS OTH

I

RATE

PMS

A

10/08/08

50711 GASBG-12-0001

H

I

AD

SMS

ACK ADVERTISEMENT

10/08/08

50735 CF96APP-UTA.V2

H

I

APP

A

Page 99 of 101

REVIEWED FILINGS FOR OCTOBER 2008 United Teachers Associates Insurance Company United Teachers Associates Insurance Company UnitedHealthcare of the Midlands, Inc. UnitedHealthcare of the Midlands, Inc. UnitedHealthcare of the Midlands, Inc. Universal Guaranty Life Insurance Company Unum Life Insurance Company of America USAA Life Insurance Company USAA Life Insurance Company USAble Life USAble Life Variable Annuity Life Insurance Company Variable Annuity Life Insurance Company Variable Annuity Life Insurance Company West Coast Life Insurance Company West Coast Life Insurance Company West Coast Life Insurance Company West Coast Life Insurance Company Western Reserve Life Assurance Company of Ohio Western Reserve Life Assurance Company of Ohio

10/08/08

50735 CT95APP-UTA.V2

H

OTH

I

APP

A

10/21/08 10/03/08 10/03/08 10/03/08 10/14/08 10/21/08 10/09/08 10/09/08 10/08/08 10/09/08 10/02/08 10/06/08 10/24/08 10/23/08 10/23/08 10/23/08 10/23/08 10/10/08

51153 GASBG-1-0009 50591 INCONVAPP.H.08.NE 50591 POLCNV.H.08.NE 50591 SBN.CONV.CHC.H.08.N E

H HMO HMO HMO L H H H L H L/A A A L L L L A/VA

MS

I G G G I

AD APP POL MISC POL AD AD AD POL RATE APP APP APP RID RID POL APP END

SMS

ACK ADVERTISEMENT A A A A CONVERSION SCHEDULE SINGLE PREMIUM LEVEL TERM

50792 L030985ANE 51157 EN-1216 (9-08) 51030 88303_0908 51030 88304_0908 50723 20PL (5-08) 49739 CSEL (5-94) 50634 VL 17047 VER 1/2008 50655 VL 17425 VER 1/2008 50982 VL 22186 VER 9/2008 51192 WC-509V2-NE 11-08 51192 WC-621 11-08 51192 WC-T16NE-11-08 51192 WC-U-413 (11/08) 50747 AE 1287 0608

LTC MS MS OTH

I I I I I I I I I I I I I

ACK ADVERTISEMENT SMS SMS ACK ADVERTISEMENT ACK ADVERTISEMENT A F A A A A A A A A SINGLE PREMIUM DEFERRED WAIVER OF PREMIUM LUMP SUM BENEFIT TERM SUPPLEMENTAL ROTH IRA LIMITED PAY WHOLE INCREASE - 20% - CANCER POLICY SINGLE PREMIUM DEFERRED

10/15/08

50805 LASUP 309

L

I

MISC

A

PREMIUM ALLOCATION OPTIONS

Page 100 of 101

REVIEWED FILINGS FOR OCTOBER 2008 Western Reserve Life Assurance Company of Ohio World Corp Insurance Company World Corp Insurance Company World Corp Insurance Company World Corp Insurance Company

10/21/08 10/10/08 10/10/08 10/10/08 10/10/08

51022 ICC08 U0000307 50476 A2600-NE 50477 A2605-NE 50478 A2612-NE 50479 A2611-NE 51089 1119 51090 1120 50681 U-VA-111-A CW (08/08)

VL H H H H H H H MS MS MS MS MS MS OTH

I I I I I I I G

APP RATE RATE RATE RATE RATE RATE END SMS SMS SMS SMS SMS SMS

A A A A A A A A INCREASE - 10.3% - PLAN A INCREASE - 11% - PLAN F INCREASE - 8.5% - PLAN F HIGH DEDUCTIBLE INCREASE - 8.6% - PLAN L INCREASE - 3% - PLAN C INCREASE - 3% - PLAN F IDENTITY THEFT RESOLUTION

World Insurance Company 10/23/08 World Insurance Company 10/23/08 Zurich American Insurance 10/03/08 Company

Page 101 of 101


				
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