Filing at a Glance...Product Name: FC-336-PA, FRFC-336-PA Project Name/Number: / PDF Pipeline for...

Filing at a Glance

Company: MedAmerica Insurance Company

Product Name: FC-336-PA, FRFC-336-PA

State: Pennsylvania

TOI: LTC05I Individual Long Term Care - Nursing Home and Home Health Care

Sub-TOI: LTC05I.001 Qualified

Filing Type: Rate - M.U. (Medically underwritten)

Date Submitted: 03/11/2020

SERFF Tr Num: TRIP-132290842

SERFF Status: Assigned

State Tr Num: TRIP-132290842

State Status: Received Review in Progress

Co Tr Num: MEDAMERICA FC 2020 LTC RATE INCREASE

ImplementationDate Requested:

On Approval

Author(s): Beverly Toomey, Dave Krydynski

Reviewer(s): Jim Laverty (primary)

Disposition Date:

Disposition Status:

Implementation Date:

State Filing Description:

Proposed 25.2% increase on 90 policyholders of MedAmerica's LTC forms FC-336-PA and FRFC-336-PA.Product Name: FlexCare; Prior Increases: None; All policies are post-RS

SERFF Tracking #: TRIP-132290842 State Tracking #: TRIP-132290842 Company Tracking #: MEDAMERICA FC 2020 LTCRATE INCREASE

State: Pennsylvania Filing Company: MedAmerica Insurance Company

TOI/Sub-TOI: LTC05I Individual Long Term Care - Nursing Home and Home Health Care/LTC05I.001 Qualified


Project Name/Number: /

PDF Pipeline for SERFF Tracking Number TRIP-132290842 Generated 03/12/2020 02:22 AM

General Information

Project Name: Status of Filing in Domicile:

Project Number: Date Approved in Domicile:

Requested Filing Mode: Review & Approval Domicile Status Comments:

Explanation for Combination/Other: Market Type: Individual

Submission Type: New Submission Individual Market Type:

Overall Rate Impact: 25.217% Filing Status Changed: 03/12/2020

State Status Changed: 03/12/2020

Deemer Date: Created By: Beverly Toomey

Submitted By: Beverly Toomey Corresponding Filing Tracking Number:

State TOI: LTC05I Individual Long Term Care - Nursing Homeand Home Health Care

Filing Description:

Re: Tax-Qualified Long-Term Care Policy Forms: FC-336-PA, FRFC-336-PA

The referenced rate filing is being submitted on behalf of MedAmerica for your review.

These are existing individual products that provide long-term care coverage on an expense incurred basis. These policy formswere originally approved in Pennsylvania on May 23, 2011 and policies were issued in Pennsylvania from October 1, 2012 toNovember 17, 2015. Policies are no longer being marketed in this jurisdiction.

MedAmerica is requesting the approval of a premium rate increase on the above-listed form; including all associated riders.The need for a premium rate increase is due to emerging and projected experience running more adverse than previouslyexpected.

The company is requesting a premium rate increase that varies by issue age and inflation option as shown in Attachment I.The rate increase varies by issue age and inflation option to better align the rate increase with the adverse experience. Weare requesting the same rate increase percentages by pricing cell nationwide so the only differences in average increase bystate are based on the inforce distribution within each state. The requested nationwide average increase is 26.4%, and therequested average increase in Pennsylvania is 25.2%.

There have been no prior increases on these policy forms. The company is seeking this current increase request to helpalleviate the adverse performance on this block of business.

The company will offer insureds affected by the premium increase the option of reducing their policy benefits to provideflexibility of choice for those insureds who wish to maintain a premium level reasonably similar to what they were paying priorto the increase. The company will offer a contingent benefit upon lapse to insureds that trigger a substantial rate increase.Additionally, MedAmerica will voluntarily offer a contingent benefit upon lapse to insureds affected by the rate increase, even ifthe increase is not considered substantial.

The following electronic items are included with this submission:•cover letter•letter from MedAmerica authorizing us to submit this filing on their behalf•claims and administrative processing plan, as provided by MedAmerica•actuarial memorandum







Company and Contact

Filing Fees

•supplement to the actuarial memorandum•numerical exhibits in Excel•current and proposed premium rate schedules•policyholder notification letter and Contingent Non-Forfeiture Benefit Election Form*

*Please note that in the future slight variations in language may occur that do not materially change the information beingprovided to the policyholder. It is our understanding that such variations do not need to be filed with the Department.

Filing Contact InformationBeverly Toomey, Actuarial Analyst [email protected]

2800 South River Road

Suite 440

Des Plaines, IL 60018

224-217-9038 [Phone]

Filing Company Information(This filing was made by a third party - triplus)

MedAmerica Insurance Company

165 Court Street

Rochester, NY 14647

(000) 000-0000 ext. [Phone]

CoCode: 69515

Group Code:

Group Name:

FEIN Number: 34-0977231

State of Domicile:Pennsylvania

Company Type: Life andHealth

State ID Number: 69515

Fee Required? No

Retaliatory? No

Fee Explanation:







Rate Information Rate data applies to filing.

Filing Method: SERFF

Rate Change Type: Increase

Overall Percentage of Last Rate Revision: 0.000%

Effective Date of Last Rate Revision:

Filing Method of Last Filing:

SERFF Tracking Number of Last Filing:

Company Rate Information

Company

Name:

Overall %

Indicated

Change:

Overall %

Rate

Impact:

Written Premium

Change for

this Program:

Number of Policy

Holders Affected

for this Program:

Written

Premium for

this Program:

Maximum %

Change

(where req'd):

Minimum %

Change

(where req'd):MedAmerica InsuranceCompany

25.217% 25.217% $71,760 90 $284,574 50.000% 0.000%

SERFF Tracking #: TRIP-132290842 State Tracking #: TRIP-132290842 Company Tracking #: MEDAMERICA FC 2020 LTC RATEINCREASE






Rate/Rule Schedule

Item

No.

Schedule

Item

Status

Document Name

Affected Form Numbers

(Separated with commas) Rate Action Rate Action Information Attachments

1 2020 LTC Rates - FC FC-336-PA, FRFC-336-PA Revised Previous State Filing Number:

Percent Rate Change Request:25.217

FC-336-PA RateSheets - Proposed2020.pdf, FRFC-336-PA Rate Sheets -Proposed 2020.pdf,







Lifetime Payment Plan Indexing: None100 day Elimination PeriodSingle Rates Comprehensive Coverage

Benefit Period 365 days 730 days 1095 days 1460 days 1825 days 2190 days 2555 days 2920 days 3650 days1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 10 Years

Issue Age

18-29 158.20 208.60 246.40 274.40 294.00 313.60 319.20 345.80 372.40 30 163.80 215.60 257.60 285.60 306.60 327.60 334.60 361.20 389.20 31 168.00 222.60 267.40 296.80 322.00 343.00 350.00 378.00 407.40 32 173.60 231.00 278.60 309.40 336.00 358.40 365.40 396.20 427.00 33 180.60 240.80 289.80 324.80 350.00 373.80 382.20 414.40 448.00 34 186.20 252.00 302.40 338.80 366.80 393.40 401.80 434.00 470.40 35 193.20 263.20 319.20 357.00 387.80 415.80 424.20 460.60 497.00 36 200.20 274.40 333.20 375.20 406.00 435.40 445.20 483.00 523.60 37 207.20 287.00 348.60 392.00 425.60 457.80 467.60 508.20 548.80 38 214.20 298.20 365.40 413.00 446.60 480.20 490.00 533.40 578.20 39 222.60 313.60 383.60 432.60 470.40 505.40 516.60 561.40 609.00 40 231.00 324.80 397.60 449.40 490.00 526.40 539.00 585.20 635.60 41 239.40 340.20 418.60 473.20 515.20 554.40 567.00 617.40 669.20 42 249.20 355.60 439.60 497.00 541.80 582.40 596.40 651.00 707.00 43 259.00 373.80 463.40 523.60 571.20 614.60 628.60 684.60 746.20 44 271.60 392.00 485.80 551.60 602.00 646.80 663.60 722.40 785.40 45 282.80 411.60 512.40 582.40 634.20 683.20 701.40 763.00 830.20 46 295.40 432.60 539.00 614.60 670.60 722.40 739.20 807.80 877.80 47 309.40 455.00 569.80 649.60 708.40 763.00 781.20 854.00 928.20 48 324.80 480.20 602.00 684.60 749.00 807.80 827.40 903.00 982.80 49 335.34 499.56 626.52 714.84 779.70 841.80 862.50 942.54 1,026.72 50 334.56 507.28 641.92 735.76 805.12 870.40 890.80 975.12 1,063.52 51 347.06 529.30 670.00 767.82 840.18 908.52 931.30 1,018.40 1,112.20 52 361.68 551.76 699.60 801.24 879.12 950.40 972.84 1,065.24 1,162.92 53 374.40 574.60 731.90 838.50 919.10 991.90 1,017.90 1,114.10 1,216.80 54 389.12 600.32 764.16 875.52 961.28 1,038.08 1,064.96 1,166.08 1,272.32 55 396.90 614.88 783.72 899.64 987.84 1,067.22 1,093.68 1,198.26 1,307.88 56 414.16 642.32 819.64 941.16 1,032.92 1,116.00 1,144.52 1,253.64 1,368.96 57 430.66 672.22 857.66 985.76 1,082.14 1,168.76 1,199.26 1,312.72 1,433.50 58 448.80 702.00 897.60 1,032.00 1,131.60 1,224.00 1,254.00 1,374.00 1,500.00 59 468.46 733.96 939.28 1,080.88 1,185.90 1,282.66 1,313.34 1,440.78 1,571.76 60 479.08 754.00 965.12 1,111.28 1,219.16 1,317.76 1,351.40 1,480.16 1,615.88 61 499.32 788.88 1,011.18 1,163.94 1,277.94 1,381.68 1,414.74 1,551.54 1,692.90 62 520.80 825.44 1,059.52 1,218.56 1,338.40 1,447.04 1,482.88 1,625.12 1,774.08 63 553.30 880.00 1,130.80 1,302.40 1,431.10 1,547.70 1,585.10 1,738.00 1,898.60 64 587.52 938.52 1,208.52 1,392.12 1,530.36 1,654.56 1,696.68 1,859.76 2,031.48 65 611.10 981.75 1,266.30 1,459.50 1,604.40 1,734.60 1,778.70 1,949.85 2,129.40 66 649.93 1,048.54 1,353.42 1,560.45 1,715.98 1,856.06 1,902.41 2,086.78 2,279.39 67 691.85 1,119.08 1,446.32 1,669.53 1,836.18 1,986.67 2,036.16 2,234.12 2,440.16 68 752.00 1,220.00 1,579.00 1,823.00 2,005.00 2,170.00 2,225.00 2,441.00 2,667.00 69 825.00 1,344.00 1,741.00 2,011.00 2,212.00 2,395.00 2,455.00 2,694.00 2,944.00 70 871.00 1,420.00 1,840.00 2,125.00 2,336.00 2,528.00 2,590.00 2,842.00 3,104.00 71 956.00 1,562.00 2,027.00 2,341.00 2,574.00 2,785.00 2,855.00 3,132.00 3,422.00 72 1,049.00 1,719.00 2,232.00 2,579.00 2,836.00 3,069.00 3,145.00 3,451.00 3,770.00 73 1,138.00 1,871.00 2,431.00 2,809.00 3,089.00 3,342.00 3,425.00 3,759.00 4,106.00 74 1,235.00 2,035.00 2,646.00 3,058.00 3,362.00 3,638.00 3,727.00 4,091.00 4,468.00 75 1,350.00 2,212.00 2,867.00 3,309.00 3,634.00 3,928.00 4,023.00 4,410.00 4,810.00 76 1,459.00 2,396.00 3,108.00 3,586.00 3,939.00 4,256.00 4,359.00 4,778.00 5,211.00 77 1,575.00 2,591.00 3,364.00 3,882.00 4,263.00 4,605.00 4,716.00 5,168.00 5,636.00 78 1,728.00 2,854.00 3,709.00 4,282.00 4,703.00 5,081.00 5,203.00 5,703.00 6,218.00 79 1,898.00 3,143.00 4,090.00 4,724.00 5,189.00 5,606.00 5,740.00 6,292.00 6,861.00 80 2,083.00 3,462.00 4,510.00 5,210.00 5,723.00 6,183.00 6,331.00 NA NA81 2,288.00 3,815.00 4,976.00 5,751.00 6,317.00 6,824.00 6,988.00 NA NA82 2,511.00 4,201.00 5,485.00 6,341.00 6,966.00 7,524.00 7,704.00 NA NA83 2,751.00 4,616.00 6,034.00 6,977.00 7,664.00 8,278.00 8,475.00 NA NA84 3,007.00 5,061.00 6,622.00 7,659.00 8,413.00 9,085.00 9,300.00 NA NA85 3,274.00 5,527.00 7,238.00 8,373.00 9,196.00 9,928.00 10,162.00 NA NA

Base Annual Premiums for 100% HHC, 100% ALF, and 100% Adult Day Care BenefitPremium Rates Per $100 Daily Benefit Amount With Requested Increase

Annual Premiums

MedAmerica Insurance CompanyFlex Care

Form Number: FC-336-PA

1

Lifetime Payment Plan Indexing: 5% Compound No Max100 day Elimination Period Form # FC-CMP5-PASingle Rates Comprehensive Coverage


Issue Age

18-29 1,077.80 1,834.40 2,437.10 2,863.60 3,186.00 3,479.90 3,600.30 3,959.20 4,352.60 30 1,081.20 1,843.90 2,449.90 2,877.90 3,206.40 3,500.40 3,617.90 3,982.80 4,377.80 31 1,096.50 1,871.40 2,483.60 2,920.70 3,248.00 3,548.00 3,668.50 4,036.50 4,437.60 32 1,110.40 1,896.00 2,517.40 2,960.60 3,294.00 3,597.10 3,719.10 4,091.80 4,496.00 33 1,124.40 1,922.20 2,554.20 3,000.70 3,338.50 3,646.20 3,771.30 4,147.10 4,557.50 34 1,139.80 1,947.00 2,588.10 3,040.70 3,384.70 3,697.10 3,822.20 4,207.00 4,620.60 35 1,057.80 1,815.80 2,413.80 2,838.00 3,156.70 3,449.70 3,567.30 3,925.40 4,315.00 36 1,073.30 1,840.60 2,447.80 2,875.30 3,201.50 3,496.10 3,613.80 3,978.00 4,370.90 37 1,087.30 1,864.00 2,480.40 2,915.50 3,244.90 3,542.70 3,664.90 4,030.80 4,432.70 38 1,102.80 1,890.30 2,513.10 2,953.00 3,291.40 3,593.80 3,717.50 4,088.10 4,491.80 39 1,116.90 1,915.40 2,548.90 2,996.40 3,335.10 3,642.10 3,767.40 4,144.10 4,552.50 40 1,039.50 1,787.20 2,380.40 2,799.60 3,117.50 3,403.60 3,520.00 3,874.30 4,257.40 41 1,053.60 1,810.80 2,413.40 2,837.30 3,159.80 3,450.60 3,567.00 3,924.60 4,313.80 42 1,067.80 1,837.40 2,446.40 2,878.00 3,203.70 3,499.10 3,617.10 3,979.50 4,372.00 43 1,083.50 1,862.70 2,479.60 2,917.40 3,247.80 3,547.90 3,668.90 4,037.40 4,433.30 44 1,097.90 1,888.00 2,514.20 2,956.90 3,293.50 3,598.20 3,717.90 4,092.60 4,496.10 45 1,032.70 1,782.90 2,376.60 2,795.60 3,114.30 3,401.30 3,516.60 3,870.50 4,251.80 46 1,048.60 1,806.90 2,408.50 2,832.40 3,155.90 3,446.10 3,565.80 3,921.70 4,309.20 47 1,061.60 1,831.00 2,440.70 2,870.90 3,199.10 3,495.50 3,615.30 3,976.00 4,368.30 48 1,074.70 1,856.80 2,474.50 2,912.40 3,242.50 3,542.20 3,663.60 4,032.00 4,429.20 49 1,076.58 1,856.60 2,475.56 2,914.12 3,247.38 3,546.40 3,667.78 4,034.70 4,431.52 50 1,010.10 1,748.42 2,333.56 2,746.34 3,060.96 3,343.16 3,460.00 3,806.38 4,180.80 51 1,009.42 1,748.78 2,333.84 2,747.22 3,063.66 3,345.24 3,459.26 3,807.04 4,179.80 52 1,008.62 1,747.22 2,333.52 2,748.76 3,061.38 3,345.10 3,460.40 3,806.78 4,180.54 53 1,008.80 1,746.60 2,332.70 2,746.90 3,061.10 3,345.30 3,460.70 3,805.50 4,178.80 54 1,007.44 1,747.06 2,331.18 2,746.98 3,061.42 3,344.80 3,460.06 3,804.68 4,178.68 55 950.86 1,650.88 2,206.92 2,598.28 2,894.96 3,162.38 3,273.28 3,599.82 3,952.60 56 948.62 1,649.08 2,204.74 2,596.44 2,893.28 3,162.62 3,272.12 3,597.16 3,949.50 57 947.42 1,645.70 2,202.10 2,592.76 2,889.74 3,158.20 3,266.30 3,592.40 3,945.50 58 944.80 1,643.20 2,199.00 2,589.80 2,886.70 3,154.40 3,264.80 3,589.40 3,940.50 59 942.10 1,640.44 2,195.44 2,585.04 2,883.22 3,149.98 3,260.10 3,583.22 3,933.52 60 896.84 1,563.14 2,091.64 2,464.60 2,748.58 3,004.04 3,107.74 3,416.20 3,750.46 61 893.20 1,558.44 2,086.34 2,458.10 2,742.14 2,995.52 3,101.34 3,408.46 3,742.02 62 889.52 1,552.34 2,079.54 2,453.64 2,735.18 2,988.88 3,093.34 3,400.06 3,731.78 63 896.30 1,565.60 2,099.60 2,476.40 2,760.50 3,017.10 3,124.90 3,435.20 3,769.00 64 904.00 1,579.60 2,117.90 2,500.70 2,788.44 3,047.74 3,155.48 3,470.30 3,807.16 65 854.94 1,496.61 2,008.92 2,372.04 2,647.80 2,894.94 2,997.90 3,295.29 3,616.20 66 859.83 1,505.06 2,023.38 2,390.91 2,668.82 2,918.50 3,023.35 3,322.82 3,647.65 67 863.55 1,515.42 2,037.38 2,408.17 2,689.22 2,941.33 3,048.04 3,349.48 3,676.94 68 865.84 1,522.12 2,048.72 2,424.64 2,708.12 2,963.24 3,070.24 3,375.88 3,706.08 69 858.28 1,512.70 2,040.02 2,415.56 2,701.10 2,954.82 3,064.42 3,369.20 3,700.08 70 820.04 1,448.32 1,953.92 2,313.72 2,588.40 2,832.16 2,938.64 3,228.48 3,543.68 71 804.52 1,425.58 1,925.50 2,284.70 2,557.62 2,800.52 2,905.96 3,194.04 3,504.82 72 784.00 1,395.00 1,889.00 2,243.00 2,513.00 2,753.00 2,860.00 3,143.00 3,451.00 73 792.00 1,411.00 1,912.00 2,273.00 2,548.00 2,793.00 2,901.00 3,188.00 3,501.00 74 797.00 1,424.00 1,933.00 2,300.00 2,580.00 2,827.00 2,940.00 3,230.00 3,546.00 75 800.00 1,433.00 1,948.00 2,318.00 2,600.00 2,849.00 2,963.00 3,252.00 3,566.00 76 801.00 1,439.00 1,959.00 2,335.00 2,619.00 2,871.00 2,987.00 3,278.00 3,594.00 77 799.00 1,441.00 1,965.00 2,344.00 2,632.00 2,887.00 3,005.00 3,297.00 3,614.00 78 804.00 1,454.00 1,989.00 2,377.00 2,671.00 2,932.00 3,055.00 3,350.00 3,674.00 79 805.00 1,464.00 2,008.00 2,404.00 2,706.00 2,971.00 3,100.00 3,399.00 3,726.00 80 804.00 1,469.00 2,021.00 2,426.00 2,734.00 3,004.00 3,137.00 NA NA81 800.00 1,469.00 2,029.00 2,441.00 2,756.00 3,032.00 3,169.00 NA NA82 791.00 1,462.00 2,028.00 2,447.00 2,767.00 3,048.00 3,190.00 NA NA83 777.00 1,448.00 2,017.00 2,442.00 2,767.00 3,051.00 3,198.00 NA NA84 759.00 1,425.00 1,996.00 2,425.00 2,754.00 3,041.00 3,192.00 NA NA85 736.00 1,394.00 1,964.00 2,395.00 2,727.00 3,015.00 3,171.00 NA NA


Annual Premiums



2



Issue Age

18-29 329.30 545.90 719.60 841.60 934.50 1,021.40 1,053.30 1,157.20 1,273.10 30 337.20 561.40 738.40 866.40 962.40 1,049.40 1,082.90 1,192.80 1,310.30 31 346.50 579.90 761.60 891.20 987.50 1,077.50 1,112.50 1,225.50 1,347.60 32 355.90 597.00 783.40 917.60 1,015.50 1,108.60 1,145.10 1,258.30 1,385.00 33 365.40 611.20 806.70 942.70 1,046.50 1,141.20 1,179.30 1,295.60 1,424.00 34 374.80 627.00 828.60 969.20 1,074.70 1,172.60 1,210.70 1,334.50 1,464.60 35 352.80 594.80 784.80 921.00 1,020.70 1,114.20 1,150.80 1,265.90 1,394.50 36 362.30 610.60 806.80 944.80 1,049.00 1,145.60 1,182.30 1,303.50 1,430.90 37 371.80 628.00 828.90 973.00 1,080.40 1,177.20 1,216.90 1,338.30 1,473.20 38 382.80 645.30 852.60 997.00 1,110.40 1,211.80 1,250.00 1,376.10 1,512.80 39 392.40 662.90 876.40 1,026.90 1,139.10 1,243.60 1,283.40 1,415.60 1,554.00 40 373.50 633.70 841.40 986.10 1,094.00 1,194.10 1,232.50 1,358.80 1,492.90 41 383.10 651.30 863.90 1,013.30 1,124.30 1,227.60 1,267.50 1,394.10 1,534.30 42 394.30 668.90 886.40 1,040.50 1,156.20 1,262.60 1,302.60 1,432.50 1,574.50 43 405.50 688.20 910.60 1,067.90 1,188.30 1,296.40 1,339.40 1,475.40 1,617.80 44 415.40 707.50 937.70 1,099.90 1,222.00 1,333.20 1,376.40 1,515.60 1,664.10 45 396.70 677.40 899.10 1,054.10 1,173.30 1,281.80 1,322.10 1,457.00 1,601.30 46 406.60 696.90 925.00 1,083.40 1,204.40 1,316.10 1,359.30 1,494.70 1,645.20 47 418.10 715.00 948.20 1,111.40 1,238.60 1,352.00 1,396.80 1,535.50 1,689.30 48 429.70 733.30 973.00 1,143.90 1,270.00 1,386.70 1,433.10 1,578.00 1,735.20 49 435.74 743.64 988.16 1,160.32 1,290.82 1,407.80 1,453.70 1,600.10 1,757.16 50 415.88 714.74 949.48 1,114.06 1,240.34 1,353.18 1,398.48 1,540.46 1,691.50 51 421.90 722.06 961.52 1,130.10 1,257.90 1,371.00 1,417.34 1,560.64 1,713.08 52 425.00 731.92 974.58 1,145.58 1,272.18 1,388.34 1,436.90 1,580.22 1,735.30 53 432.00 742.80 985.90 1,159.30 1,290.10 1,409.10 1,454.50 1,600.50 1,756.80 54 436.12 752.08 999.48 1,175.16 1,306.06 1,425.22 1,471.48 1,621.52 1,780.24 55 419.10 722.00 961.16 1,128.12 1,254.80 1,369.90 1,415.52 1,558.46 1,711.32 56 423.34 729.84 971.94 1,142.54 1,270.54 1,387.12 1,433.64 1,576.44 1,730.46 57 427.34 737.54 982.42 1,153.96 1,283.30 1,402.60 1,448.66 1,595.24 1,750.34 58 431.30 746.20 993.90 1,168.90 1,300.70 1,418.90 1,466.90 1,612.10 1,770.80 59 435.22 753.40 1,005.04 1,180.88 1,313.94 1,433.50 1,482.18 1,628.66 1,789.52 60 423.08 732.80 979.06 1,149.16 1,279.42 1,397.54 1,443.28 1,586.68 1,742.02 61 428.20 740.04 987.70 1,161.06 1,291.34 1,410.80 1,457.10 1,601.78 1,759.26 62 432.02 748.36 996.18 1,172.64 1,305.34 1,424.84 1,473.18 1,617.64 1,776.12 63 440.30 764.00 1,019.60 1,200.80 1,334.90 1,457.10 1,507.30 1,656.80 1,817.80 64 450.88 780.74 1,044.10 1,228.66 1,367.72 1,492.50 1,542.42 1,696.76 1,861.34 65 433.14 753.33 1,006.86 1,186.44 1,320.84 1,443.72 1,491.96 1,640.01 1,800.18 66 442.07 768.10 1,027.70 1,211.55 1,349.46 1,473.70 1,524.79 1,676.42 1,838.85 67 449.95 782.82 1,049.58 1,236.67 1,376.92 1,504.73 1,556.44 1,711.58 1,878.44 68 453.28 792.04 1,062.68 1,252.84 1,397.00 1,526.84 1,578.76 1,737.52 1,906.80 69 448.06 785.54 1,055.28 1,246.38 1,390.94 1,519.58 1,573.00 1,731.50 1,900.20 70 424.84 747.36 1,005.44 1,187.40 1,326.88 1,450.00 1,502.40 1,650.80 1,812.08 71 412.84 729.94 983.02 1,163.72 1,300.98 1,423.52 1,473.88 1,621.20 1,778.98 72 396.00 704.00 952.00 1,129.00 1,263.00 1,383.00 1,434.00 1,577.00 1,732.00 73 403.00 717.00 971.00 1,152.00 1,290.00 1,413.00 1,466.00 1,612.00 1,769.00 74 409.00 729.00 988.00 1,174.00 1,316.00 1,441.00 1,496.00 1,644.00 1,805.00 75 413.00 738.00 1,002.00 1,191.00 1,335.00 1,461.00 1,518.00 1,666.00 1,827.00 76 415.00 745.00 1,014.00 1,207.00 1,352.00 1,482.00 1,540.00 1,690.00 1,853.00 77 417.00 752.00 1,023.00 1,219.00 1,367.00 1,499.00 1,558.00 1,711.00 1,874.00 78 422.00 762.00 1,042.00 1,243.00 1,396.00 1,531.00 1,593.00 1,748.00 1,916.00 79 424.00 772.00 1,057.00 1,264.00 1,421.00 1,559.00 1,625.00 1,782.00 1,953.00 80 425.00 777.00 1,068.00 1,281.00 1,442.00 1,584.00 1,652.00 NA NA81 424.00 780.00 1,077.00 1,294.00 1,460.00 1,605.00 1,676.00 NA NA82 421.00 778.00 1,079.00 1,301.00 1,470.00 1,619.00 1,692.00 NA NA83 413.00 772.00 1,075.00 1,301.00 1,474.00 1,624.00 1,701.00 NA NA84 404.00 760.00 1,065.00 1,294.00 1,469.00 1,621.00 1,701.00 NA NA85 391.00 743.00 1,048.00 1,278.00 1,455.00 1,608.00 1,690.00 NA NA


Annual Premiums



3

Lifetime Payment Plan Indexing: 5% Simple No Max100 day Elimination Period Form # FC-SIMP5-PASingle Rates Comprehensive Coverage


Issue Age

18-29 234.80 392.90 523.10 616.60 691.50 761.90 790.80 873.70 968.60 30 244.20 409.90 543.40 644.40 722.40 794.40 824.90 912.30 1,011.80 31 253.50 428.40 569.60 673.70 753.50 828.50 859.00 952.50 1,056.60 32 265.90 445.50 594.40 703.10 786.00 864.10 897.60 992.80 1,101.50 33 275.40 465.70 619.20 731.20 821.50 904.20 936.30 1,036.10 1,149.50 34 286.30 484.50 645.60 763.70 857.20 940.10 976.70 1,082.50 1,197.60 35 277.80 471.80 631.80 750.00 839.20 920.70 957.30 1,060.40 1,177.00 36 288.80 493.60 659.80 779.80 875.00 962.60 999.30 1,105.50 1,225.40 37 301.30 512.50 687.90 814.00 913.90 1,001.70 1,041.40 1,152.30 1,279.70 38 313.80 537.30 716.10 847.00 952.90 1,045.30 1,088.00 1,203.60 1,332.80 39 327.90 557.90 747.40 884.40 992.10 1,090.60 1,133.40 1,253.60 1,390.50 40 318.00 546.70 736.40 870.60 974.00 1,072.60 1,112.50 1,232.80 1,366.90 41 332.10 570.30 764.90 906.80 1,016.30 1,116.60 1,159.50 1,283.10 1,424.80 42 346.30 595.40 797.90 947.50 1,060.20 1,166.60 1,209.60 1,338.00 1,484.50 43 362.00 619.20 831.10 985.40 1,105.80 1,213.90 1,261.40 1,397.40 1,545.80 44 374.90 646.00 868.70 1,027.90 1,153.00 1,268.70 1,314.90 1,455.60 1,613.10 45 368.20 635.40 854.10 1,012.10 1,137.30 1,251.80 1,296.60 1,437.50 1,592.30 46 384.10 662.40 890.50 1,054.90 1,184.90 1,302.60 1,353.30 1,496.20 1,658.70 47 400.10 691.00 928.70 1,100.90 1,234.10 1,358.00 1,410.30 1,558.00 1,726.80 48 414.70 718.30 967.00 1,146.90 1,285.00 1,413.70 1,467.60 1,624.50 1,799.70 49 426.86 739.20 995.56 1,179.56 1,324.86 1,455.16 1,509.94 1,671.14 1,850.40 50 421.72 732.26 984.52 1,168.08 1,310.42 1,440.78 1,496.30 1,655.80 1,834.58 51 431.98 750.86 1,011.92 1,200.66 1,347.18 1,480.44 1,538.30 1,701.76 1,883.00 52 443.46 771.68 1,039.90 1,233.62 1,384.36 1,521.82 1,581.74 1,749.20 1,934.10 53 455.80 794.60 1,067.10 1,267.10 1,421.70 1,564.50 1,622.50 1,795.10 1,985.00 54 466.48 815.56 1,096.08 1,302.12 1,459.24 1,604.62 1,664.68 1,842.32 2,038.30 55 449.02 781.84 1,053.64 1,250.52 1,403.04 1,541.26 1,600.48 1,770.62 1,958.84 56 458.18 800.86 1,081.82 1,283.24 1,439.38 1,582.76 1,642.68 1,816.30 2,007.84 57 470.90 820.70 1,107.82 1,315.00 1,474.70 1,621.72 1,683.62 1,861.88 2,057.90 58 480.70 842.40 1,134.30 1,347.00 1,512.60 1,662.00 1,725.60 1,908.50 2,108.80 59 491.54 862.20 1,163.76 1,380.56 1,549.46 1,701.02 1,768.90 1,952.50 2,159.44 60 494.90 865.10 1,169.32 1,387.30 1,556.62 1,710.02 1,774.66 1,962.16 2,169.16 61 505.08 886.36 1,196.02 1,420.22 1,592.66 1,749.32 1,817.94 2,006.02 2,216.82 62 517.42 906.96 1,223.10 1,453.24 1,629.86 1,789.62 1,858.70 2,053.18 2,266.56 63 535.10 939.20 1,270.40 1,508.00 1,691.30 1,857.90 1,930.90 2,132.00 2,353.00 64 553.54 974.26 1,316.68 1,564.96 1,754.76 1,929.10 2,002.62 2,212.42 2,443.08 65 532.32 938.01 1,269.06 1,510.20 1,694.76 1,864.38 1,936.56 2,139.33 2,362.20 66 549.59 969.70 1,313.30 1,563.23 1,754.90 1,929.54 2,005.27 2,215.14 2,445.89 67 567.65 1,001.72 1,358.68 1,616.17 1,815.82 1,996.43 2,075.64 2,291.28 2,530.74 68 581.80 1,030.72 1,398.56 1,666.48 1,873.28 2,060.36 2,141.44 2,365.00 2,612.04 69 587.98 1,044.18 1,419.92 1,693.70 1,905.04 2,096.22 2,180.38 2,408.84 2,661.28 70 570.44 1,015.68 1,382.96 1,650.20 1,857.28 2,042.80 2,127.44 2,348.64 2,593.12 71 568.90 1,017.58 1,387.96 1,659.44 1,869.12 2,058.98 2,143.00 2,367.84 2,614.36 72 563.00 1,013.00 1,385.00 1,659.00 1,870.00 2,061.00 2,147.00 2,372.00 2,621.00 73 583.00 1,049.00 1,437.00 1,722.00 1,942.00 2,141.00 2,232.00 2,465.00 2,723.00 74 602.00 1,086.00 1,488.00 1,785.00 2,014.00 2,220.00 2,315.00 2,557.00 2,824.00 75 617.00 1,116.00 1,532.00 1,837.00 2,074.00 2,284.00 2,383.00 2,629.00 2,901.00 76 633.00 1,147.00 1,578.00 1,895.00 2,138.00 2,357.00 2,459.00 2,712.00 2,992.00 77 647.00 1,178.00 1,621.00 1,948.00 2,200.00 2,425.00 2,531.00 2,792.00 3,079.00 78 669.00 1,220.00 1,684.00 2,026.00 2,290.00 2,526.00 2,639.00 2,910.00 3,210.00 79 687.00 1,261.00 1,745.00 2,103.00 2,380.00 2,627.00 2,747.00 3,028.00 3,340.00 80 705.00 1,299.00 1,803.00 2,179.00 2,468.00 2,726.00 2,852.00 NA NA81 722.00 1,336.00 1,861.00 2,253.00 2,556.00 2,826.00 2,958.00 NA NA82 735.00 1,368.00 1,913.00 2,322.00 2,638.00 2,919.00 3,060.00 NA NA83 745.00 1,396.00 1,958.00 2,384.00 2,714.00 3,005.00 3,153.00 NA NA84 684.00 1,295.00 1,824.00 2,223.00 2,531.00 2,798.00 2,942.00 NA NA85 656.00 1,256.00 1,780.00 2,180.00 2,489.00 2,756.00 2,904.00 NA NA


Annual Premiums



4



Issue Age

18-29 140.30 229.40 301.10 354.10 394.50 431.90 448.80 492.70 545.60 30 145.20 238.90 313.90 369.90 413.40 450.90 466.40 514.80 569.30 31 151.50 249.90 328.10 387.20 429.50 468.50 487.00 537.00 594.60 32 156.40 261.00 342.40 403.10 447.00 490.60 509.10 560.80 618.50 33 161.40 272.20 358.20 419.20 469.00 512.70 531.30 584.60 645.50 34 169.30 282.00 374.10 438.20 488.20 533.60 553.70 611.50 674.10 35 162.30 273.80 361.80 427.50 476.20 520.20 540.30 595.40 661.00 36 168.80 285.10 379.30 443.80 495.50 544.10 562.80 622.50 686.90 37 175.30 296.50 395.40 466.00 517.90 566.70 586.90 648.30 717.20 38 184.80 310.80 411.60 482.50 540.40 590.80 614.00 675.60 746.30 39 191.40 322.40 429.40 503.40 563.10 616.60 636.90 704.60 780.00 40 186.00 317.20 422.90 498.60 555.50 607.60 628.00 694.30 766.90 41 194.10 330.30 439.40 518.30 578.30 633.60 655.50 723.60 800.80 42 202.30 344.90 458.90 541.00 604.20 661.10 683.10 753.00 833.50 43 212.00 358.20 477.10 563.90 628.80 688.90 713.90 788.40 867.80 44 218.90 374.50 498.20 586.90 655.00 719.70 741.90 821.10 906.60 45 215.20 368.40 491.10 580.10 649.80 710.30 734.10 813.50 897.80 46 225.10 384.90 514.00 603.40 674.90 738.60 766.80 845.20 934.20 47 233.60 400.00 534.20 628.40 703.10 770.00 798.30 880.00 973.80 48 242.20 416.80 556.00 656.40 733.00 803.20 830.10 918.00 1,013.70 49 250.74 428.40 572.28 673.40 755.06 826.16 855.78 944.46 1,042.32 50 247.98 427.12 571.34 671.68 752.70 823.20 855.36 941.86 1,041.80 51 254.86 438.38 587.12 692.34 774.06 846.84 877.34 968.80 1,069.40 52 258.86 450.76 602.54 712.48 793.64 870.04 902.98 996.60 1,099.14 53 268.20 464.20 617.70 730.90 816.90 896.70 926.70 1,023.70 1,128.20 54 276.04 476.08 636.54 751.50 839.62 920.14 951.22 1,050.20 1,160.62 55 265.42 460.88 615.72 726.92 811.44 889.82 921.84 1,017.18 1,121.08 56 271.92 472.56 632.92 747.24 833.70 914.10 945.88 1,044.46 1,151.58 57 279.50 484.10 648.46 764.56 854.30 936.64 969.50 1,069.88 1,178.78 58 285.70 496.60 665.00 785.40 878.20 961.30 995.00 1,098.60 1,210.50 59 291.86 508.92 681.20 804.56 899.22 984.22 1,020.10 1,123.06 1,240.40 60 294.56 512.30 685.48 808.96 903.94 990.56 1,024.96 1,131.82 1,245.58 61 301.72 524.28 702.50 828.74 925.54 1,012.76 1,050.38 1,157.86 1,275.66 62 308.80 536.08 718.02 849.34 947.88 1,038.10 1,075.46 1,185.76 1,305.20 63 319.10 556.40 746.00 881.60 984.50 1,077.90 1,118.50 1,232.00 1,354.60 64 331.70 576.60 775.06 915.96 1,021.98 1,120.80 1,160.10 1,279.04 1,408.22 65 312.30 545.85 733.26 868.38 970.86 1,065.24 1,102.08 1,215.93 1,339.62 66 323.35 564.26 758.90 900.19 1,005.62 1,102.98 1,142.87 1,259.78 1,387.49 67 333.35 583.72 785.58 930.87 1,040.32 1,140.63 1,182.44 1,303.48 1,436.24 68 338.80 595.48 803.48 952.60 1,066.52 1,168.28 1,211.56 1,335.76 1,471.56 69 335.70 591.56 800.88 950.64 1,065.52 1,168.72 1,212.60 1,337.18 1,473.02 70 318.76 564.32 765.20 908.68 1,020.08 1,118.24 1,162.32 1,280.56 1,410.64 71 308.80 551.44 748.42 891.38 1,001.10 1,100.18 1,142.38 1,260.12 1,387.30 72 294.00 530.00 723.00 863.00 971.00 1,067.00 1,111.00 1,225.00 1,350.00 73 303.00 545.00 745.00 890.00 1,002.00 1,102.00 1,147.00 1,265.00 1,394.00 74 310.00 560.00 766.00 916.00 1,032.00 1,135.00 1,182.00 1,303.00 1,436.00 75 316.00 572.00 785.00 939.00 1,058.00 1,163.00 1,212.00 1,334.00 1,469.00 76 321.00 583.00 801.00 961.00 1,082.00 1,190.00 1,241.00 1,366.00 1,503.00 77 324.00 593.00 816.00 979.00 1,103.00 1,215.00 1,267.00 1,395.00 1,534.00 78 331.00 607.00 838.00 1,007.00 1,137.00 1,252.00 1,307.00 1,438.00 1,583.00 79 335.00 619.00 857.00 1,033.00 1,167.00 1,287.00 1,346.00 1,480.00 1,628.00 80 338.00 628.00 873.00 1,055.00 1,195.00 1,318.00 1,379.00 NA NA81 340.00 635.00 886.00 1,074.00 1,219.00 1,346.00 1,410.00 NA NA82 339.00 637.00 894.00 1,087.00 1,236.00 1,368.00 1,435.00 NA NA83 334.00 636.00 896.00 1,094.00 1,248.00 1,381.00 1,452.00 NA NA84 327.00 629.00 892.00 1,094.00 1,250.00 1,387.00 1,460.00 NA NA85 318.00 616.00 881.00 1,086.00 1,245.00 1,383.00 1,459.00 NA NA


Annual Premiums



5

Lifetime Payment Plan Indexing: Guaranteed Purchase Option Rider100 day Elimination Period Form # FC-GPOR-PASingle Rates Comprehensive Coverage


Issue Age

18-29 7.00 7.00 9.80 9.80 12.60 12.60 14.00 12.60 14.00 30 7.00 8.40 8.40 11.20 12.60 12.60 14.00 14.00 15.40 31 7.00 9.80 9.80 12.60 11.20 12.60 14.00 14.00 16.80 32 7.00 9.80 9.80 12.60 12.60 14.00 15.40 15.40 16.80 33 5.60 9.80 11.20 12.60 14.00 15.40 15.40 16.80 16.80 34 5.60 8.40 12.60 14.00 14.00 14.00 15.40 16.80 18.20 35 5.60 8.40 9.80 11.20 11.20 11.20 12.60 12.60 15.40 36 5.60 8.40 9.80 11.20 12.60 12.60 12.60 14.00 14.00 37 5.60 8.40 9.80 12.60 12.60 12.60 14.00 14.00 16.80 38 7.00 9.80 11.20 11.20 14.00 14.00 15.40 15.40 16.80 39 7.00 8.40 9.80 12.60 12.60 14.00 14.00 15.40 16.80 40 5.60 9.80 12.60 14.00 14.00 15.40 15.40 16.80 18.20 41 7.00 9.80 12.60 14.00 15.40 15.40 16.80 16.80 19.60 42 7.00 11.20 12.60 15.40 16.80 18.20 18.20 18.20 19.60 43 8.40 9.80 12.60 15.40 16.80 18.20 19.60 21.00 21.00 44 7.00 11.20 14.00 16.80 16.80 19.60 19.60 22.40 23.80 45 8.40 12.60 14.00 16.80 19.60 21.00 19.60 22.40 25.20 46 8.40 12.60 16.80 16.80 19.60 21.00 22.40 22.40 26.60 47 9.80 14.00 16.80 18.20 21.00 22.40 23.80 23.80 28.00 48 8.40 14.00 16.80 21.00 21.00 22.40 23.80 26.60 29.40 49 9.66 13.80 17.94 20.70 23.46 24.84 26.22 27.60 30.36 50 4.08 5.44 6.80 6.80 8.16 6.80 9.52 9.52 10.88 51 4.02 5.36 6.70 6.70 9.38 8.04 9.38 10.72 10.72 52 2.64 5.28 6.60 7.92 7.92 7.92 10.56 10.56 10.56 53 3.90 6.50 6.50 7.80 9.10 10.40 10.40 10.40 11.70 54 3.84 5.12 6.40 8.96 8.96 10.24 10.24 11.52 12.80 55 5.04 6.30 7.56 8.82 8.82 10.08 11.34 11.34 12.60 56 3.72 7.44 8.68 9.92 9.92 11.16 11.16 12.40 13.64 57 4.88 6.10 8.54 9.76 9.76 10.98 10.98 12.20 13.42 58 4.80 7.20 8.40 9.60 12.00 12.00 13.20 14.40 15.60 59 3.54 7.08 9.44 9.44 11.80 11.80 14.16 12.98 15.34 60 4.64 6.96 10.44 10.44 11.60 12.76 12.76 15.08 16.24 61 4.56 7.98 10.26 11.40 11.40 12.54 14.82 14.82 17.10 62 5.60 7.84 10.08 12.32 13.44 14.56 14.56 15.68 17.92 63 5.50 8.80 12.10 13.20 13.20 14.30 16.50 17.60 17.60 64 5.40 9.72 11.88 14.04 15.12 16.20 16.20 18.36 19.44 65 18.90 29.40 37.80 44.10 47.25 52.50 53.55 58.80 64.05 66 19.57 30.90 40.17 47.38 51.50 55.62 57.68 62.83 69.01 67 21.21 33.33 43.43 50.50 54.54 59.59 61.61 66.66 73.73 68 22.00 37.00 48.00 55.00 60.00 65.00 66.00 73.00 80.00 69 25.00 40.00 53.00 61.00 67.00 72.00 73.00 81.00 89.00 70 17.00 28.00 36.00 42.00 47.00 50.00 52.00 57.00 62.00 71 19.00 32.00 40.00 47.00 52.00 56.00 57.00 63.00 68.00 72 21.00 35.00 45.00 52.00 57.00 61.00 63.00 69.00 76.00 73 23.00 38.00 48.00 56.00 62.00 67.00 68.00 75.00 82.00 74 25.00 41.00 53.00 61.00 68.00 72.00 75.00 81.00 89.00 75 27.00 44.00 58.00 66.00 73.00 78.00 80.00 88.00 96.00 76 29.00 47.00 62.00 72.00 79.00 85.00 87.00 95.00 104.00 77 31.00 52.00 67.00 78.00 85.00 92.00 94.00 104.00 112.00 78 35.00 57.00 74.00 86.00 94.00 101.00 104.00 114.00 125.00 79 37.00 63.00 82.00 95.00 104.00 112.00 115.00 126.00 137.00 80 41.00 69.00 90.00 104.00 114.00 123.00 126.00 NA NA81 46.00 76.00 100.00 115.00 127.00 137.00 139.00 NA NA82 50.00 84.00 110.00 127.00 139.00 151.00 154.00 NA NA83 55.00 93.00 120.00 140.00 154.00 166.00 169.00 NA NA84 60.00 102.00 132.00 153.00 168.00 181.00 186.00 NA NA85 66.00 111.00 145.00 167.00 183.00 198.00 203.00 NA NA


Annual Premiums



6

Lifetime Payment Plan Indexing: Combination Benefit Increase Rider100 day Elimination Period Form # FC-CBIR-PASingle Rates Comprehensive Coverage


Issue Age

18-29 369.80 620.90 830.60 984.10 1,104.00 1,214.90 1,263.30 1,398.70 1,553.60 30 371.70 628.90 840.40 995.40 1,118.40 1,229.40 1,277.90 1,417.80 1,574.30 31 376.50 639.90 851.60 1,009.70 1,130.00 1,244.00 1,292.50 1,434.00 1,593.60 32 379.90 646.50 862.90 1,022.60 1,146.00 1,261.60 1,308.60 1,451.80 1,614.50 33 384.90 654.70 874.20 1,034.20 1,160.50 1,277.70 1,326.30 1,471.10 1,635.50 34 388.30 661.50 884.10 1,048.70 1,175.20 1,292.60 1,342.70 1,490.50 1,653.60 35 364.80 624.80 835.80 991.50 1,112.20 1,223.70 1,273.80 1,411.40 1,570.00 36 368.30 631.60 845.80 1,003.30 1,125.50 1,240.10 1,288.80 1,428.00 1,588.40 37 374.80 638.50 857.40 1,018.00 1,140.40 1,255.20 1,303.90 1,446.30 1,609.70 38 379.80 648.30 867.60 1,027.00 1,155.40 1,271.80 1,322.00 1,466.10 1,628.30 39 383.40 655.40 877.90 1,041.90 1,169.10 1,287.10 1,337.40 1,483.10 1,648.50 40 364.50 624.70 841.40 996.60 1,118.00 1,233.10 1,279.00 1,420.30 1,579.90 41 368.10 631.80 850.40 1,008.80 1,133.30 1,248.60 1,296.00 1,439.10 1,600.30 42 371.80 641.90 860.90 1,022.50 1,147.20 1,265.60 1,314.60 1,456.50 1,619.50 43 378.50 647.70 871.60 1,034.90 1,161.30 1,279.90 1,330.40 1,478.40 1,638.80 44 380.90 656.50 883.70 1,048.90 1,178.50 1,298.70 1,347.90 1,497.60 1,664.10 45 363.70 627.90 846.60 1,004.60 1,131.30 1,247.30 1,295.10 1,439.00 1,599.80 46 367.60 635.40 857.50 1,018.90 1,145.90 1,263.60 1,314.30 1,457.20 1,619.70 47 373.10 646.00 868.70 1,030.40 1,159.10 1,280.00 1,330.80 1,475.50 1,642.80 48 375.70 652.30 878.50 1,046.40 1,177.00 1,295.20 1,347.60 1,495.50 1,663.20 49 375.06 651.88 878.64 1,044.88 1,178.34 1,298.28 1,350.10 1,497.98 1,665.40 50 366.24 635.90 858.96 1,020.62 1,149.82 1,267.04 1,319.64 1,464.54 1,628.72 51 365.74 634.22 857.84 1,022.10 1,151.34 1,268.76 1,320.86 1,467.04 1,629.56 52 363.94 635.36 858.14 1,022.04 1,151.48 1,269.06 1,321.88 1,468.04 1,630.22 53 363.40 636.40 858.50 1,023.50 1,152.90 1,271.90 1,322.90 1,468.90 1,632.20 54 364.36 634.78 857.34 1,026.12 1,152.88 1,273.42 1,325.20 1,469.72 1,635.34 55 344.30 602.32 815.64 973.08 1,094.32 1,209.42 1,259.12 1,396.62 1,553.56 56 342.94 602.54 815.16 973.70 1,096.34 1,211.58 1,260.78 1,399.56 1,556.26 57 342.86 600.26 814.78 973.12 1,095.86 1,212.52 1,261.22 1,401.20 1,557.62 58 341.60 600.60 815.80 973.90 1,099.20 1,213.50 1,265.40 1,404.10 1,560.20 59 340.50 601.08 816.88 974.80 1,100.18 1,215.90 1,265.86 1,404.66 1,562.96 60 334.88 590.42 802.66 957.64 1,081.60 1,194.68 1,245.46 1,383.82 1,537.90 61 333.96 587.52 800.46 956.46 1,079.30 1,193.80 1,245.06 1,381.06 1,536.06 62 330.76 583.66 794.88 951.82 1,074.76 1,188.16 1,240.16 1,376.08 1,530.90 63 332.30 587.60 802.40 960.80 1,086.50 1,201.50 1,255.30 1,392.80 1,549.00 64 332.88 590.76 805.74 967.88 1,092.78 1,211.66 1,262.76 1,404.12 1,561.62 65 274.68 492.27 677.40 818.22 928.68 1,032.18 1,078.14 1,201.11 1,338.48 66 268.47 482.50 667.06 808.35 918.26 1,021.22 1,068.95 1,190.34 1,328.13 67 259.65 470.42 652.48 790.07 900.62 1,002.03 1,050.44 1,169.28 1,306.44 68 242.68 444.28 619.88 756.04 863.48 963.08 1,009.60 1,127.32 1,260.96 69 213.80 396.52 560.26 686.70 788.86 882.52 929.58 1,038.26 1,164.56 70 NA NA NA NA NA NA NA NA NA71 NA NA NA NA NA NA NA NA NA72 NA NA NA NA NA NA NA NA NA73 NA NA NA NA NA NA NA NA NA74 NA NA NA NA NA NA NA NA NA75 NA NA NA NA NA NA NA NA NA76 NA NA NA NA NA NA NA NA NA77 NA NA NA NA NA NA NA NA NA78 NA NA NA NA NA NA NA NA NA79 NA NA NA NA NA NA NA NA NA80 NA NA NA NA NA NA NA NA NA81 NA NA NA NA NA NA NA NA NA82 NA NA NA NA NA NA NA NA NA83 NA NA NA NA NA NA NA NA NA84 NA NA NA NA NA NA NA NA NA85 NA NA NA NA NA NA NA NA NA


Annual Premiums



7

Maximum ALF/HHC 1 year 2 year 3 year 4 year 5 year 6 year 7 years+ Daily Benefit* Plan Plan Plan Plan Plan Plan Plans

125%ALF/125%HHC 1.04 1.06 1.07 1.08 1.09 1.10 1.11

75%ALF/75%HHC 0.96 0.95 0.93 0.91 0.90 0.89 0.89

50%ALF/50%HHC 0.92 0.87 0.83 0.80 0.79 0.77 0.77

*as a Percentage of the Nursing Home Daily Benefit

Assisted Living Facility / Home Health Care Benefit Options Rate Factors to be Applied to the 100% ALF / 100% HHC Base Rates and any Riders

Factors



8

Multiply the annual premium by the appropriate factor below based on the elimination periodselected.

20 Day 30 Day 60 Day 90 day 100 day 180 day 365 day

1.28 1.22 1.14 1.03 1.00 0.82 0.70

Elimination Period Factors

Factors



9

If this rider is selected, multiply the annual premium by the appropriate factor below.


NA 1.06 1.04 1.03 1.01 1.01 1.01 1.01 1.01

Restoration of Benefits RiderForm Number: FC-ROBR-PA

Factors



10


Issue Age Factor

< 60 1.1560+ 1.12


Non-Forfeiture Shortened Benefit Period RiderForm Number: FC-SBPR-PA


11



N/A N/A 1.05 1.09 1.11 1.22 1.36


20 Calendar Day Elimination Period for Assisted Living Facility, Home Health Care and Adult Day Care

Form Number: FC-EPR-PA


12


Issue Age Lifetime 10 Year 20 Year

< 40 1.05 N/A 1.0140-49 1.07 N/A 1.0150-54 1.09 N/A 1.0255-59 1.10 N/A 1.0360-69 1.12 N/A 1.0670-74 1.11 N/A 1.0875-79 1.10 N/A 1.0880+ 1.08 N/A 1.06

Survivor Benefit RiderForm Number: FC-SVR-PA

Payment Term



13


Issue Age< 40 1.0140-49 1.0150-54 1.0155-59 1.0260-69 1.0270-74 1.0375-79 1.0580+ 1.06

Shared Waiver RiderForm Number: FC-SWR-PA

All Payment Terms



14

Issue Age 1 Year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 10 year18-29 NA 65.80 47.60 39.20 NA NA NA NA NA

30 NA 70.00 49.00 42.00 NA NA NA NA NA31 NA 74.20 54.60 46.20 NA NA NA NA NA32 NA 78.40 57.40 49.00 NA NA NA NA NA33 NA 84.00 60.20 49.00 NA NA NA NA NA34 NA 86.80 64.40 54.60 NA NA NA NA NA35 NA 93.80 68.60 58.80 NA NA NA NA NA36 NA 100.80 72.80 60.20 NA NA NA NA NA37 NA 105.00 77.00 65.80 NA NA NA NA NA38 NA 114.80 81.20 67.20 NA NA NA NA NA39 NA 119.00 86.80 72.80 NA NA NA NA NA40 NA 124.60 92.40 77.00 NA NA NA NA NA41 NA 133.00 96.60 81.20 NA NA NA NA NA42 NA 141.40 102.20 85.40 NA NA NA NA NA43 NA 149.80 107.80 91.00 NA NA NA NA NA44 NA 159.60 116.20 95.20 NA NA NA NA NA45 NA 170.80 121.80 100.80 NA NA NA NA NA46 NA 182.00 131.60 107.80 NA NA NA NA NA47 NA 194.60 138.60 113.40 NA NA NA NA NA48 NA 204.40 147.00 123.20 NA NA NA NA NA49 NA 215.28 153.18 126.96 NA NA NA NA NA50 NA 228.48 163.20 134.64 NA NA NA NA NA51 NA 238.52 170.18 140.70 NA NA NA NA NA52 NA 249.48 179.52 149.16 NA NA NA NA NA53 NA 263.90 187.20 153.40 NA NA NA NA NA54 NA 275.20 197.12 162.56 NA NA NA NA NA55 NA 284.76 204.12 167.58 NA NA NA NA NA56 NA 298.84 213.28 174.84 NA NA NA NA NA57 NA 313.54 224.48 183.00 NA NA NA NA NA58 NA 330.00 234.00 192.00 NA NA NA NA NA59 NA 346.92 246.62 201.78 NA NA NA NA NA60 NA 357.28 254.04 206.48 NA NA NA NA NA61 NA 375.06 266.76 217.74 NA NA NA NA NA62 NA 393.12 278.88 228.48 NA NA NA NA NA63 NA 422.40 300.30 245.30 NA NA NA NA NA64 NA 453.60 321.84 262.44 NA NA NA NA NA65 NA 477.75 338.10 275.10 NA NA NA NA NA66 NA 511.91 362.56 295.61 NA NA NA NA NA67 NA 550.45 389.86 317.14 NA NA NA NA NA68 NA 603.00 426.00 347.00 NA NA NA NA NA69 NA 667.00 471.00 384.00 NA NA NA NA NA70 NA 705.00 496.00 403.00 NA NA NA NA NA71 NA 779.00 547.00 444.00 NA NA NA NA NA72 NA 860.00 604.00 490.00 NA NA NA NA NA73 NA 938.00 658.00 533.00 NA NA NA NA NA74 NA 1,023.00 716.00 580.00 NA NA NA NA NA75 NA 1,097.00 767.00 619.00 NA NA NA NA NA76 NA 1,190.00 831.00 670.00 NA NA NA NA NA77 NA 1,291.00 899.00 723.00 NA NA NA NA NA78 NA 1,428.00 994.00 799.00 NA NA NA NA NA79 NA 1,581.00 1,099.00 882.00 NA NA NA NA NA80 NA 1,748.00 1,213.00 973.00 NA NA NA NA NA81 NA 1,936.00 1,341.00 1,073.00 NA NA NA NA NA82 NA 2,140.00 1,481.00 1,183.00 NA NA NA NA NA83 NA 2,361.00 1,630.00 1,301.00 NA NA NA NA NA84 NA 2,598.00 1,791.00 1,426.00 NA NA NA NA NA85 NA 2,846.00 1,958.00 1,555.00 NA NA NA NA NA

2 Year Extended DurationOriginal Benefit Duration Purchased

Extended Benefit RiderForm Number: FC-EBR-PA

The following rates are per $100 daily benefit and are added to the base rates:



15

Issue Age 1 Year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 10 year18-29 NA NA 67.20 44.80 51.80 NA NA NA NA

30 NA NA 70.00 49.00 54.60 NA NA NA NA31 NA NA 75.60 53.20 56.00 NA NA NA NA32 NA NA 79.80 56.00 60.20 NA NA NA NA33 NA NA 84.00 57.40 64.40 NA NA NA NA34 NA NA 91.00 63.00 67.20 NA NA NA NA35 NA NA 96.60 67.20 72.80 NA NA NA NA36 NA NA 102.20 70.00 77.00 NA NA NA NA37 NA NA 109.20 75.60 82.60 NA NA NA NA38 NA NA 114.80 77.00 86.80 NA NA NA NA39 NA NA 121.80 84.00 91.00 NA NA NA NA40 NA NA 128.80 89.60 95.20 NA NA NA NA41 NA NA 135.80 93.80 102.20 NA NA NA NA42 NA NA 142.80 99.40 109.20 NA NA NA NA43 NA NA 151.20 105.00 113.40 NA NA NA NA44 NA NA 161.00 112.00 120.40 NA NA NA NA45 NA NA 170.80 119.00 128.80 NA NA NA NA46 NA NA 183.40 124.60 137.20 NA NA NA NA47 NA NA 193.20 131.60 145.60 NA NA NA NA48 NA NA 205.80 142.80 154.00 NA NA NA NA49 NA NA 215.28 147.66 162.84 NA NA NA NA50 NA NA 228.48 155.04 170.00 NA NA NA NA51 NA NA 238.52 163.48 178.22 NA NA NA NA52 NA NA 250.80 171.60 186.12 NA NA NA NA53 NA NA 260.00 179.40 195.00 NA NA NA NA54 NA NA 273.92 189.44 204.80 NA NA NA NA55 NA NA 283.50 194.04 210.42 NA NA NA NA56 NA NA 296.36 203.36 220.72 NA NA NA NA57 NA NA 311.10 213.50 230.58 NA NA NA NA58 NA NA 326.40 222.00 242.40 NA NA NA NA59 NA NA 343.38 232.46 254.88 NA NA NA NA60 NA NA 352.64 240.12 261.00 NA NA NA NA61 NA NA 370.50 250.80 273.60 NA NA NA NA62 NA NA 387.52 264.32 286.72 NA NA NA NA63 NA NA 416.90 282.70 306.90 NA NA NA NA64 NA NA 446.04 304.56 329.40 NA NA NA NA65 NA NA 468.30 319.20 345.45 NA NA NA NA66 NA NA 502.64 341.96 370.80 NA NA NA NA67 NA NA 540.35 366.63 397.94 NA NA NA NA68 NA NA 591.00 402.00 436.00 NA NA NA NA69 NA NA 654.00 444.00 482.00 NA NA NA NA70 NA NA 688.00 465.00 506.00 NA NA NA NA71 NA NA 758.00 514.00 558.00 NA NA NA NA72 NA NA 837.00 566.00 615.00 NA NA NA NA73 NA NA 911.00 616.00 670.00 NA NA NA NA74 NA NA 992.00 669.00 729.00 NA NA NA NA75 NA NA 1,061.00 714.00 776.00 NA NA NA NA76 NA NA 1,148.00 773.00 839.00 NA NA NA NA77 NA NA 1,241.00 834.00 905.00 NA NA NA NA78 NA NA 1,372.00 921.00 1,000.00 NA NA NA NA79 NA NA 1,516.00 1,016.00 1,103.00 NA NA NA NA80 NA NA 1,673.00 1,121.00 NA NA NA NA NA81 NA NA 1,848.00 1,237.00 NA NA NA NA NA82 NA NA 2,039.00 1,363.00 NA NA NA NA NA83 NA NA 2,244.00 1,498.00 NA NA NA NA NA84 NA NA 2,463.00 1,641.00 NA NA NA NA NA85 NA NA 2,690.00 1,789.00 NA NA NA NA NA


Form Number: FC-EBR-PA


Flex CareForm Number: FC-336-PA

Extended Benefit Rider


16


Form Number: FC-336-PATEN YEAR PREMIUM PAYMENT TERM FACTORS

Premium Factors5% Cmpd 3% Cmpd 5% Simple 3% Simple Combo

Issue No No Max No Max No Max No Max Ben IncAge Inflation Inflation Inflation Inflation Inflation Inflation GPO

18-29 2.77 3.38 3.22 3.12 3.04 3.15 NA30 2.76 3.34 3.18 3.09 3.02 3.12 NA31 2.75 3.30 3.15 3.06 3.00 3.08 NA32 2.74 3.26 3.11 3.04 2.97 3.05 NA33 2.72 3.21 3.08 3.01 2.94 3.01 NA34 2.71 3.17 3.04 2.97 2.92 2.97 NA35 2.69 3.13 3.01 2.94 2.89 2.94 NA36 2.67 3.09 2.97 2.91 2.86 2.90 NA37 2.65 3.04 2.93 2.88 2.83 2.87 NA38 2.63 3.00 2.89 2.84 2.80 2.83 NA39 2.61 2.96 2.86 2.81 2.76 2.79 NA40 2.58 2.91 2.82 2.77 2.73 2.75 NA41 2.56 2.87 2.78 2.74 2.70 2.72 NA42 2.53 2.83 2.74 2.70 2.66 2.68 NA43 2.51 2.78 2.70 2.66 2.63 2.64 NA44 2.48 2.74 2.66 2.63 2.59 2.60 NA45 2.45 2.69 2.62 2.59 2.56 2.56 NA46 2.42 2.65 2.58 2.55 2.52 2.52 NA47 2.39 2.60 2.53 2.51 2.48 2.48 NA48 2.36 2.55 2.49 2.47 2.44 2.44 NA49 2.32 2.51 2.45 2.43 2.40 2.40 NA50 2.33 2.49 2.44 2.42 2.40 2.39 NA51 2.29 2.44 2.39 2.38 2.36 2.34 NA52 2.26 2.39 2.35 2.33 2.31 2.30 NA53 2.22 2.35 2.30 2.29 2.27 2.26 NA54 2.18 2.30 2.26 2.25 2.23 2.22 NA55 2.14 2.25 2.21 2.20 2.19 2.17 NA56 2.10 2.20 2.17 2.16 2.14 2.13 NA57 2.06 2.16 2.12 2.11 2.10 2.08 NA58 2.02 2.11 2.08 2.07 2.06 2.04 NA59 1.98 2.06 2.03 2.02 2.01 2.00 NA60 1.94 2.02 1.99 1.98 1.97 1.95 NA61 1.90 1.97 1.94 1.94 1.93 1.91 NA62 1.85 1.92 1.90 1.89 1.88 1.87 NA63 1.81 1.87 1.85 1.85 1.84 1.82 NA64 1.77 1.83 1.80 1.80 1.79 1.78 NA65 1.72 1.78 1.76 1.76 1.75 1.73 NA66 1.68 1.73 1.71 1.71 1.70 1.69 NA67 1.64 1.69 1.67 1.67 1.66 1.64 NA68 1.59 1.64 1.62 1.62 1.61 1.60 NA69 1.55 1.59 1.58 1.58 1.57 1.56 NA70 1.55 1.59 1.57 1.57 1.57 NA NA71 1.51 1.54 1.53 1.53 1.53 NA NA72 1.47 1.50 1.49 1.49 1.48 NA NA73 1.43 1.46 1.45 1.45 1.45 NA NA74 1.40 1.42 1.41 1.41 1.41 NA NA75 1.39 1.42 1.41 1.41 1.41 NA NA76 1.36 1.38 1.37 1.37 1.37 NA NA77 1.33 1.35 1.34 1.34 1.34 NA NA78 1.30 1.32 1.31 1.31 1.31 NA NA79 1.27 1.29 1.28 1.28 1.28 NA NA80 1.24 1.26 1.25 1.25 1.25 NA NA81 1.22 1.23 1.23 1.23 1.22 NA NA82 1.19 1.21 1.20 1.20 1.20 NA NA83 1.17 1.18 1.18 1.18 1.18 NA NA84 1.15 1.16 1.16 1.16 1.16 NA NA85 1.13 1.14 1.14 1.14 1.14 NA NA

17


Form Number: FC-336-PATWENTY YEAR PREMIUM PAYMENT TERM FACTORS




18



1.05 1.05 1.06 1.06 1.07 1.07 1.08 1.10 1.10

Factors


Monthly Assisted Living Facility, Home Health Care, and Adult Day Care Benefit RiderForm Number: FC-MBR-PA


19


Benefit Period 365 days 730 days 1095 days 1460 days 1825 days 2190 days 2555 days 2920 days 3650 daysIssue Age 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 10 Years

18-29 1.29 1.36 1.39 1.43 1.45 1.47 1.50 1.51 1.5430-34 1.29 1.36 1.39 1.42 1.45 1.46 1.49 1.50 1.5235-39 1.30 1.36 1.39 1.41 1.44 1.45 1.47 1.48 1.5140-44 1.30 1.35 1.38 1.40 1.42 1.44 1.46 1.47 1.4945-49 1.29 1.34 1.37 1.39 1.41 1.42 1.44 1.45 1.4750-54 1.29 1.33 1.36 1.38 1.39 1.41 1.42 1.43 1.4455-59 1.28 1.32 1.34 1.36 1.37 1.38 1.40 1.40 1.4260-64 1.27 1.30 1.32 1.33 1.35 1.36 1.37 1.37 1.3865-69 1.25 1.28 1.30 1.31 1.33 1.33 1.35 1.35 1.3670-74 1.24 1.27 1.28 1.30 1.31 1.32 1.33 1.33 1.3475-79 1.22 1.25 1.26 1.27 1.28 1.29 1.29 1.30 1.3080-84 1.19 1.21 1.22 1.23 1.24 1.25 1.26 NA NA

85 1.16 1.18 1.19 1.19 1.20 1.21 1.22 NA NA

Monthly Cash Benefit RiderForm Number: FC-CASHR-PA



20

Issue Age 1 Year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 10 year

<50 N/A 1.28 1.18 1.11 1.07 1.05 1.02 1.02 N/A50+ N/A 1.33 1.20 1.11 1.07 1.05 1.02 1.02 N/A


<50 N/A N/A 1.22 1.14 1.09 1.06 1.03 N/A N/A50+ N/A N/A 1.24 1.15 1.09 1.06 1.03 N/A N/A


<50 N/A N/A N/A 1.15 1.10 1.07 N/A N/A N/A50+ N/A N/A N/A 1.16 1.10 1.07 N/A N/A N/A


<50 N/A N/A N/A N/A 1.11 N/A N/A N/A N/A50+ N/A N/A N/A N/A 1.11 N/A N/A N/A N/A

5 Year Extended Shared DurationOriginal Benefit Duration Purchased

Original Benefit Duration Purchased



3 Year Extended Shared Duration

Shared Extended Benefit RiderForm Number: FC-SEBR-PA



21

Multiply the annual premium by the appropriate factor below based on maritaland insured status.

10/28/2013

Factors1.000.850.750.70

10/27/2013

Factors1.000.900.750.75

* applies to Employer Sponsored Plans

Underwriting rate class is determined by a point value system. Point values for eachmedical condition indicated from the application process are added together todetermine the underwriting rate class. Multiply the annual premium by the appropriatefactor below.

10/28/2013

RateClass Factors

I 0.90II 1.00

10/27/2013

RateClass Factors

I 0.95II 1.00

Policies with applications submitted after:

Married Both insured

Medical Underwriting

Policies with applications submitted before:

SingleMarried one insured

Married *



Marital Status

SingleMarried one insured

Married *

Marital Status


Marital Status

Flex CareForm Number: FC-336-PA

Risk Classifications


22

Multiply the annual premium by the appropriate factor below based on the modal factorselected.

PaymentMode Factors

Bi-Weekly 0.0415Monthly 0.0900

Quarterly 0.2600Semi-Annually 0.5150

Annually 1.0000

Modal Factors



23



Issue Age

18-29 150.29 198.17 234.08 260.68 279.30 297.92 303.24 328.51 353.78 30 155.61 204.82 244.72 271.32 291.27 311.22 317.87 343.14 369.74 31 159.60 211.47 254.03 281.96 305.90 325.85 332.50 359.10 387.03 32 164.92 219.45 264.67 293.93 319.20 340.48 347.13 376.39 405.65 33 171.57 228.76 275.31 308.56 332.50 355.11 363.09 393.68 425.60 34 176.89 239.40 287.28 321.86 348.46 373.73 381.71 412.30 446.88 35 183.54 250.04 303.24 339.15 368.41 395.01 402.99 437.57 472.15 36 190.19 260.68 316.54 356.44 385.70 413.63 422.94 458.85 497.42 37 196.84 272.65 331.17 372.40 404.32 434.91 444.22 482.79 521.36 38 203.49 283.29 347.13 392.35 424.27 456.19 465.50 506.73 549.29 39 211.47 297.92 364.42 410.97 446.88 480.13 490.77 533.33 578.55 40 219.45 308.56 377.72 426.93 465.50 500.08 512.05 555.94 603.82 41 227.43 323.19 397.67 449.54 489.44 526.68 538.65 586.53 635.74 42 236.74 337.82 417.62 472.15 514.71 553.28 566.58 618.45 671.65 43 246.05 355.11 440.23 497.42 542.64 583.87 597.17 650.37 708.89 44 258.02 372.40 461.51 524.02 571.90 614.46 630.42 686.28 746.13 45 268.66 391.02 486.78 553.28 602.49 649.04 666.33 724.85 788.69 46 280.63 410.97 512.05 583.87 637.07 686.28 702.24 767.41 833.91 47 293.93 432.25 541.31 617.12 672.98 724.85 742.14 811.30 881.79 48 308.56 456.19 571.90 650.37 711.55 767.41 786.03 857.85 933.66 49 318.57 474.58 595.19 679.10 740.72 799.71 819.38 895.41 975.38 50 317.83 481.92 609.82 698.97 764.86 826.88 846.26 926.36 1,010.34 51 329.71 502.84 636.50 729.43 798.17 863.09 884.74 967.48 1,056.59 52 343.60 524.17 664.62 761.18 835.16 902.88 924.20 1,011.98 1,104.77 53 355.68 545.87 695.31 796.58 873.15 942.31 967.01 1,058.40 1,155.96 54 369.66 570.30 725.95 831.74 913.22 986.18 1,011.71 1,107.78 1,208.70 55 377.06 584.14 744.53 854.66 938.45 1,013.86 1,039.00 1,138.35 1,242.49 56 393.45 610.20 778.66 894.10 981.27 1,060.20 1,087.29 1,190.96 1,300.51 57 409.13 638.61 814.78 936.47 1,028.03 1,110.32 1,139.30 1,247.08 1,361.83 58 426.36 666.90 852.72 980.40 1,075.02 1,162.80 1,191.30 1,305.30 1,425.00 59 445.04 697.26 892.32 1,026.84 1,126.61 1,218.53 1,247.67 1,368.74 1,493.17 60 455.13 716.30 916.86 1,055.72 1,158.20 1,251.87 1,283.83 1,406.15 1,535.09 61 474.35 749.44 960.62 1,105.74 1,214.04 1,312.60 1,344.00 1,473.96 1,608.26 62 494.76 784.17 1,006.54 1,157.63 1,271.48 1,374.69 1,408.74 1,543.86 1,685.38 63 525.64 836.00 1,074.26 1,237.28 1,359.55 1,470.32 1,505.85 1,651.10 1,803.67 64 558.14 891.59 1,148.09 1,322.51 1,453.84 1,571.83 1,611.85 1,766.77 1,929.91 65 580.55 932.66 1,202.99 1,386.53 1,524.18 1,647.87 1,689.77 1,852.36 2,022.93 66 617.43 996.11 1,285.75 1,482.43 1,630.18 1,763.26 1,807.29 1,982.44 2,165.42 67 657.26 1,063.13 1,374.00 1,586.05 1,744.37 1,887.34 1,934.35 2,122.41 2,318.15 68 714.40 1,159.00 1,500.05 1,731.85 1,904.75 2,061.50 2,113.75 2,318.95 2,533.65 69 783.75 1,276.80 1,653.95 1,910.45 2,101.40 2,275.25 2,332.25 2,559.30 2,796.80 70 827.45 1,349.00 1,748.00 2,018.75 2,219.20 2,401.60 2,460.50 2,699.90 2,948.80 71 908.20 1,483.90 1,925.65 2,223.95 2,445.30 2,645.75 2,712.25 2,975.40 3,250.90 72 996.55 1,633.05 2,120.40 2,450.05 2,694.20 2,915.55 2,987.75 3,278.45 3,581.50 73 1,081.10 1,777.45 2,309.45 2,668.55 2,934.55 3,174.90 3,253.75 3,571.05 3,900.70 74 1,173.25 1,933.25 2,513.70 2,905.10 3,193.90 3,456.10 3,540.65 3,886.45 4,244.60 75 1,282.50 2,101.40 2,723.65 3,143.55 3,452.30 3,731.60 3,821.85 4,189.50 4,569.50 76 1,386.05 2,276.20 2,952.60 3,406.70 3,742.05 4,043.20 4,141.05 4,539.10 4,950.45 77 1,496.25 2,461.45 3,195.80 3,687.90 4,049.85 4,374.75 4,480.20 4,909.60 5,354.20 78 1,641.60 2,711.30 3,523.55 4,067.90 4,467.85 4,826.95 4,942.85 5,417.85 5,907.10 79 1,803.10 2,985.85 3,885.50 4,487.80 4,929.55 5,325.70 5,453.00 5,977.40 6,517.95 80 1,978.85 3,288.90 4,284.50 4,949.50 5,436.85 5,873.85 6,014.45 NA NA81 2,173.60 3,624.25 4,727.20 5,463.45 6,001.15 6,482.80 6,638.60 NA NA82 2,385.45 3,990.95 5,210.75 6,023.95 6,617.70 7,147.80 7,318.80 NA NA83 2,613.45 4,385.20 5,732.30 6,628.15 7,280.80 7,864.10 8,051.25 NA NA84 2,856.65 4,807.95 6,290.90 7,276.05 7,992.35 8,630.75 8,835.00 NA NA85 3,110.30 5,250.65 6,876.10 7,954.35 8,736.20 9,431.60 9,653.90 NA NA


Annual Premiums


Form Number: FRFC-336-PA

1



Issue Age

18-29 1,023.91 1,742.68 2,315.25 2,720.42 3,026.70 3,305.91 3,420.29 3,761.24 4,134.97 30 1,027.14 1,751.71 2,327.41 2,734.01 3,046.08 3,325.38 3,437.01 3,783.66 4,158.91 31 1,041.68 1,777.83 2,359.42 2,774.67 3,085.60 3,370.60 3,485.08 3,834.68 4,215.72 32 1,054.88 1,801.20 2,391.53 2,812.57 3,129.30 3,417.25 3,533.15 3,887.21 4,271.20 33 1,068.18 1,826.09 2,426.49 2,850.67 3,171.58 3,463.89 3,582.74 3,939.75 4,329.63 34 1,082.81 1,849.65 2,458.70 2,888.67 3,215.47 3,512.25 3,631.09 3,996.65 4,389.57 35 1,004.91 1,725.01 2,293.11 2,696.10 2,998.87 3,277.22 3,388.94 3,729.13 4,099.25 36 1,019.64 1,748.57 2,325.41 2,731.54 3,041.43 3,321.30 3,433.11 3,779.10 4,152.36 37 1,032.94 1,770.80 2,356.38 2,769.73 3,082.66 3,365.57 3,481.66 3,829.26 4,211.07 38 1,047.66 1,795.79 2,387.45 2,805.35 3,126.83 3,414.11 3,531.63 3,883.70 4,267.21 39 1,061.06 1,819.63 2,421.46 2,846.58 3,168.35 3,460.00 3,579.03 3,936.90 4,324.88 40 987.53 1,697.84 2,261.38 2,659.62 2,961.63 3,233.42 3,344.00 3,680.59 4,044.53 41 1,000.92 1,720.26 2,292.73 2,695.44 3,001.81 3,278.07 3,388.65 3,728.37 4,098.11 42 1,014.41 1,745.53 2,324.08 2,734.10 3,043.52 3,324.15 3,436.25 3,780.53 4,153.40 43 1,029.33 1,769.57 2,355.62 2,771.53 3,085.41 3,370.51 3,485.46 3,835.53 4,211.64 44 1,043.01 1,793.60 2,388.49 2,809.06 3,128.83 3,418.29 3,532.01 3,887.97 4,271.30 45 981.07 1,693.76 2,257.77 2,655.82 2,958.59 3,231.24 3,340.77 3,676.98 4,039.21 46 996.17 1,716.56 2,288.08 2,690.78 2,998.11 3,273.80 3,387.51 3,725.62 4,093.74 47 1,008.52 1,739.45 2,318.67 2,727.36 3,039.15 3,320.73 3,434.54 3,777.20 4,149.89 48 1,020.97 1,763.96 2,350.78 2,766.78 3,080.38 3,365.09 3,480.42 3,830.40 4,207.74 49 1,022.75 1,763.77 2,351.78 2,768.41 3,085.01 3,369.08 3,484.39 3,832.97 4,209.94 50 959.60 1,661.00 2,216.88 2,609.02 2,907.91 3,176.00 3,287.00 3,616.06 3,971.76 51 958.95 1,661.34 2,217.15 2,609.86 2,910.48 3,177.98 3,286.30 3,616.69 3,970.81 52 958.19 1,659.86 2,216.84 2,611.32 2,908.31 3,177.85 3,287.38 3,616.44 3,971.51 53 958.36 1,659.27 2,216.07 2,609.56 2,908.05 3,178.04 3,287.67 3,615.23 3,969.86 54 957.07 1,659.71 2,214.62 2,609.63 2,908.35 3,177.56 3,287.06 3,614.45 3,969.75 55 903.32 1,568.34 2,096.57 2,468.37 2,750.21 3,004.26 3,109.62 3,419.83 3,754.97 56 901.19 1,566.63 2,094.50 2,466.62 2,748.62 3,004.49 3,108.51 3,417.30 3,752.03 57 900.05 1,563.42 2,092.00 2,463.12 2,745.25 3,000.29 3,102.99 3,412.78 3,748.23 58 897.56 1,561.04 2,089.05 2,460.31 2,742.37 2,996.68 3,101.56 3,409.93 3,743.48 59 895.00 1,558.42 2,085.67 2,455.79 2,739.06 2,992.48 3,097.10 3,404.06 3,736.84 60 852.00 1,484.98 1,987.06 2,341.37 2,611.15 2,853.84 2,952.35 3,245.39 3,562.94 61 848.54 1,480.52 1,982.02 2,335.20 2,605.03 2,845.74 2,946.27 3,238.04 3,554.92 62 845.04 1,474.72 1,975.56 2,330.96 2,598.42 2,839.44 2,938.67 3,230.06 3,545.19 63 851.49 1,487.32 1,994.62 2,352.58 2,622.48 2,866.25 2,968.66 3,263.44 3,580.55 64 858.80 1,500.62 2,012.01 2,375.67 2,649.02 2,895.35 2,997.71 3,296.79 3,616.80 65 812.19 1,421.78 1,908.47 2,253.44 2,515.41 2,750.19 2,848.01 3,130.53 3,435.39 66 816.84 1,429.81 1,922.21 2,271.36 2,535.38 2,772.58 2,872.18 3,156.68 3,465.27 67 820.37 1,439.65 1,935.51 2,287.76 2,554.76 2,794.26 2,895.64 3,182.01 3,493.09 68 822.55 1,446.01 1,946.28 2,303.41 2,572.71 2,815.08 2,916.73 3,207.09 3,520.78 69 815.37 1,437.07 1,938.02 2,294.78 2,566.05 2,807.08 2,911.20 3,200.74 3,515.08 70 779.04 1,375.90 1,856.22 2,198.03 2,458.98 2,690.55 2,791.71 3,067.06 3,366.50 71 764.29 1,354.30 1,829.23 2,170.47 2,429.74 2,660.49 2,760.66 3,034.34 3,329.58 72 744.80 1,325.25 1,794.55 2,130.85 2,387.35 2,615.35 2,717.00 2,985.85 3,278.45 73 752.40 1,340.45 1,816.40 2,159.35 2,420.60 2,653.35 2,755.95 3,028.60 3,325.95 74 757.15 1,352.80 1,836.35 2,185.00 2,451.00 2,685.65 2,793.00 3,068.50 3,368.70 75 760.00 1,361.35 1,850.60 2,202.10 2,470.00 2,706.55 2,814.85 3,089.40 3,387.70 76 760.95 1,367.05 1,861.05 2,218.25 2,488.05 2,727.45 2,837.65 3,114.10 3,414.30 77 759.05 1,368.95 1,866.75 2,226.80 2,500.40 2,742.65 2,854.75 3,132.15 3,433.30 78 763.80 1,381.30 1,889.55 2,258.15 2,537.45 2,785.40 2,902.25 3,182.50 3,490.30 79 764.75 1,390.80 1,907.60 2,283.80 2,570.70 2,822.45 2,945.00 3,229.05 3,539.70 80 763.80 1,395.55 1,919.95 2,304.70 2,597.30 2,853.80 2,980.15 NA NA81 760.00 1,395.55 1,927.55 2,318.95 2,618.20 2,880.40 3,010.55 NA NA82 751.45 1,388.90 1,926.60 2,324.65 2,628.65 2,895.60 3,030.50 NA NA83 738.15 1,375.60 1,916.15 2,319.90 2,628.65 2,898.45 3,038.10 NA NA84 721.05 1,353.75 1,896.20 2,303.75 2,616.30 2,888.95 3,032.40 NA NA85 699.20 1,324.30 1,865.80 2,275.25 2,590.65 2,864.25 3,012.45 NA NA


Annual Premiums



2



Issue Age

18-29 312.84 518.61 683.62 799.52 887.78 970.33 1,000.64 1,099.34 1,209.45 30 320.34 533.33 701.48 823.08 914.28 996.93 1,028.76 1,133.16 1,244.79 31 329.18 550.91 723.52 846.64 938.13 1,023.63 1,056.88 1,164.23 1,280.22 32 338.11 567.15 744.23 871.72 964.73 1,053.17 1,087.85 1,195.39 1,315.75 33 347.13 580.64 766.37 895.57 994.18 1,084.14 1,120.34 1,230.82 1,352.80 34 356.06 595.65 787.17 920.74 1,020.97 1,113.97 1,150.17 1,267.78 1,391.37 35 335.16 565.06 745.56 874.95 969.67 1,058.49 1,093.26 1,202.61 1,324.78 36 344.19 580.07 766.46 897.56 996.55 1,088.32 1,123.19 1,238.33 1,359.36 37 353.21 596.60 787.46 924.35 1,026.38 1,118.34 1,156.06 1,271.39 1,399.54 38 363.66 613.04 809.97 947.15 1,054.88 1,151.21 1,187.50 1,307.30 1,437.16 39 372.78 629.76 832.58 975.56 1,082.15 1,181.42 1,219.23 1,344.82 1,476.30 40 354.83 602.02 799.33 936.80 1,039.30 1,134.40 1,170.88 1,290.86 1,418.26 41 363.95 618.74 820.71 962.64 1,068.09 1,166.22 1,204.13 1,324.40 1,457.59 42 374.59 635.46 842.08 988.48 1,098.39 1,199.47 1,237.47 1,360.88 1,495.78 43 385.23 653.79 865.07 1,014.51 1,128.89 1,231.58 1,272.43 1,401.63 1,536.91 44 394.63 672.13 890.82 1,044.91 1,160.90 1,266.54 1,307.58 1,439.82 1,580.90 45 376.87 643.53 854.15 1,001.40 1,114.64 1,217.71 1,256.00 1,384.15 1,521.24 46 386.27 662.06 878.75 1,029.23 1,144.18 1,250.30 1,291.34 1,419.97 1,562.94 47 397.20 679.25 900.79 1,055.83 1,176.67 1,284.40 1,326.96 1,458.73 1,604.84 48 408.22 696.64 924.35 1,086.71 1,206.50 1,317.37 1,361.45 1,499.10 1,648.44 49 413.95 706.46 938.75 1,102.30 1,226.28 1,337.41 1,381.02 1,520.10 1,669.30 50 395.09 679.00 902.01 1,058.36 1,178.32 1,285.52 1,328.56 1,463.44 1,606.93 51 400.81 685.96 913.44 1,073.60 1,195.01 1,302.45 1,346.47 1,482.61 1,627.43 52 403.75 695.32 925.85 1,088.30 1,208.57 1,318.92 1,365.06 1,501.21 1,648.54 53 410.40 705.66 936.61 1,101.34 1,225.60 1,338.65 1,381.78 1,520.48 1,668.96 54 414.31 714.48 949.51 1,116.40 1,240.76 1,353.96 1,397.91 1,540.44 1,691.23 55 398.15 685.90 913.10 1,071.71 1,192.06 1,301.41 1,344.74 1,480.54 1,625.75 56 402.17 693.35 923.34 1,085.41 1,207.01 1,317.76 1,361.96 1,497.62 1,643.94 57 405.97 700.66 933.30 1,096.26 1,219.14 1,332.47 1,376.23 1,515.48 1,662.82 58 409.74 708.89 944.21 1,110.46 1,235.67 1,347.96 1,393.56 1,531.50 1,682.26 59 413.46 715.73 954.79 1,121.84 1,248.24 1,361.83 1,408.07 1,547.23 1,700.04 60 401.93 696.16 930.11 1,091.70 1,215.45 1,327.66 1,371.12 1,507.35 1,654.92 61 406.79 703.04 938.32 1,103.01 1,226.77 1,340.26 1,384.25 1,521.69 1,671.30 62 410.42 710.94 946.37 1,114.01 1,240.07 1,353.60 1,399.52 1,536.76 1,687.31 63 418.29 725.80 968.62 1,140.76 1,268.16 1,384.25 1,431.94 1,573.96 1,726.91 64 428.34 741.70 991.90 1,167.23 1,299.33 1,417.88 1,465.30 1,611.92 1,768.27 65 411.48 715.66 956.52 1,127.12 1,254.80 1,371.53 1,417.36 1,558.01 1,710.17 66 419.97 729.70 976.32 1,150.97 1,281.99 1,400.02 1,448.55 1,592.60 1,746.91 67 427.45 743.68 997.10 1,174.84 1,308.07 1,429.49 1,478.62 1,626.00 1,784.52 68 430.62 752.44 1,009.55 1,190.20 1,327.15 1,450.50 1,499.82 1,650.64 1,811.46 69 425.66 746.26 1,002.52 1,184.06 1,321.39 1,443.60 1,494.35 1,644.93 1,805.19 70 403.60 709.99 955.17 1,128.03 1,260.54 1,377.50 1,427.28 1,568.26 1,721.48 71 392.20 693.44 933.87 1,105.53 1,235.93 1,352.34 1,400.19 1,540.14 1,690.03 72 376.20 668.80 904.40 1,072.55 1,199.85 1,313.85 1,362.30 1,498.15 1,645.40 73 382.85 681.15 922.45 1,094.40 1,225.50 1,342.35 1,392.70 1,531.40 1,680.55 74 388.55 692.55 938.60 1,115.30 1,250.20 1,368.95 1,421.20 1,561.80 1,714.75 75 392.35 701.10 951.90 1,131.45 1,268.25 1,387.95 1,442.10 1,582.70 1,735.65 76 394.25 707.75 963.30 1,146.65 1,284.40 1,407.90 1,463.00 1,605.50 1,760.35 77 396.15 714.40 971.85 1,158.05 1,298.65 1,424.05 1,480.10 1,625.45 1,780.30 78 400.90 723.90 989.90 1,180.85 1,326.20 1,454.45 1,513.35 1,660.60 1,820.20 79 402.80 733.40 1,004.15 1,200.80 1,349.95 1,481.05 1,543.75 1,692.90 1,855.35 80 403.75 738.15 1,014.60 1,216.95 1,369.90 1,504.80 1,569.40 NA NA81 402.80 741.00 1,023.15 1,229.30 1,387.00 1,524.75 1,592.20 NA NA82 399.95 739.10 1,025.05 1,235.95 1,396.50 1,538.05 1,607.40 NA NA83 392.35 733.40 1,021.25 1,235.95 1,400.30 1,542.80 1,615.95 NA NA84 383.80 722.00 1,011.75 1,229.30 1,395.55 1,539.95 1,615.95 NA NA85 371.45 705.85 995.60 1,214.10 1,382.25 1,527.60 1,605.50 NA NA


Annual Premiums



3



Issue Age

18-29 223.06 373.26 496.95 585.77 656.93 723.81 751.26 830.02 920.17 30 231.99 389.41 516.23 612.18 686.28 754.68 783.66 866.69 961.21 31 240.83 406.98 541.12 640.02 715.83 787.08 816.05 904.88 1,003.77 32 252.61 423.23 564.68 667.95 746.70 820.90 852.72 943.16 1,046.43 33 261.63 442.42 588.24 694.64 780.43 858.99 889.49 984.30 1,092.03 34 271.99 460.28 613.32 725.52 814.34 893.10 927.87 1,028.38 1,137.72 35 263.91 448.21 600.21 712.50 797.24 874.67 909.44 1,007.38 1,118.15 36 274.36 468.92 626.81 740.81 831.25 914.47 949.34 1,050.23 1,164.13 37 286.24 486.88 653.51 773.30 868.21 951.62 989.33 1,094.69 1,215.72 38 298.11 510.44 680.30 804.65 905.26 993.04 1,033.60 1,143.42 1,266.16 39 311.51 530.01 710.03 840.18 942.50 1,036.07 1,076.73 1,190.92 1,320.98 40 302.10 519.37 699.58 827.07 925.30 1,018.97 1,056.88 1,171.16 1,298.56 41 315.50 541.79 726.66 861.46 965.49 1,060.77 1,101.53 1,218.95 1,353.56 42 328.99 565.63 758.01 900.13 1,007.19 1,108.27 1,149.12 1,271.10 1,410.28 43 343.90 588.24 789.55 936.13 1,050.51 1,153.21 1,198.33 1,327.53 1,468.51 44 356.16 613.70 825.27 976.51 1,095.35 1,205.27 1,249.16 1,382.82 1,532.45 45 349.79 603.63 811.40 961.50 1,080.44 1,189.21 1,231.77 1,365.63 1,512.69 46 364.90 629.28 845.98 1,002.16 1,125.66 1,237.47 1,285.64 1,421.39 1,575.77 47 380.10 656.45 882.27 1,045.86 1,172.40 1,290.10 1,339.79 1,480.10 1,640.46 48 393.97 682.39 918.65 1,089.56 1,220.75 1,343.02 1,394.22 1,543.28 1,709.72 49 405.52 702.24 945.78 1,120.58 1,258.62 1,382.40 1,434.44 1,587.58 1,757.88 50 400.63 695.65 935.29 1,109.68 1,244.90 1,368.74 1,421.49 1,573.01 1,742.85 51 410.38 713.32 961.32 1,140.63 1,279.82 1,406.42 1,461.39 1,616.67 1,788.85 52 421.29 733.10 987.91 1,171.94 1,315.14 1,445.73 1,502.65 1,661.74 1,837.40 53 433.01 754.87 1,013.75 1,203.75 1,350.62 1,486.28 1,541.38 1,705.35 1,885.75 54 443.16 774.78 1,041.28 1,237.01 1,386.28 1,524.39 1,581.45 1,750.20 1,936.39 55 426.57 742.75 1,000.96 1,187.99 1,332.89 1,464.20 1,520.46 1,682.09 1,860.90 56 435.27 760.82 1,027.73 1,219.08 1,367.41 1,503.62 1,560.55 1,725.49 1,907.45 57 447.36 779.67 1,052.43 1,249.25 1,400.97 1,540.63 1,599.44 1,768.79 1,955.01 58 456.67 800.28 1,077.59 1,279.65 1,436.97 1,578.90 1,639.32 1,813.08 2,003.36 59 466.96 819.09 1,105.57 1,311.53 1,471.99 1,615.97 1,680.46 1,854.88 2,051.47 60 470.16 821.85 1,110.85 1,317.94 1,478.79 1,624.52 1,685.93 1,864.05 2,060.70 61 479.83 842.04 1,136.22 1,349.21 1,513.03 1,661.85 1,727.04 1,905.72 2,105.98 62 491.55 861.61 1,161.95 1,380.58 1,548.37 1,700.14 1,765.77 1,950.52 2,153.23 63 508.35 892.24 1,206.88 1,432.60 1,606.74 1,765.01 1,834.36 2,025.40 2,235.35 64 525.86 925.55 1,250.85 1,486.71 1,667.02 1,832.65 1,902.49 2,101.80 2,320.93 65 505.70 891.11 1,205.61 1,434.69 1,610.02 1,771.16 1,839.73 2,032.36 2,244.09 66 522.11 921.22 1,247.64 1,485.07 1,667.16 1,833.06 1,905.01 2,104.38 2,323.60 67 539.27 951.63 1,290.75 1,535.36 1,725.03 1,896.61 1,971.86 2,176.72 2,404.20 68 552.71 979.18 1,328.63 1,583.16 1,779.62 1,957.34 2,034.37 2,246.75 2,481.44 69 558.58 991.97 1,348.92 1,609.02 1,809.79 1,991.41 2,071.36 2,288.40 2,528.22 70 541.92 964.90 1,313.81 1,567.69 1,764.42 1,940.66 2,021.07 2,231.21 2,463.46 71 540.46 966.70 1,318.56 1,576.47 1,775.66 1,956.03 2,035.85 2,249.45 2,483.64 72 534.85 962.35 1,315.75 1,576.05 1,776.50 1,957.95 2,039.65 2,253.40 2,489.95 73 553.85 996.55 1,365.15 1,635.90 1,844.90 2,033.95 2,120.40 2,341.75 2,586.85 74 571.90 1,031.70 1,413.60 1,695.75 1,913.30 2,109.00 2,199.25 2,429.15 2,682.80 75 586.15 1,060.20 1,455.40 1,745.15 1,970.30 2,169.80 2,263.85 2,497.55 2,755.95 76 601.35 1,089.65 1,499.10 1,800.25 2,031.10 2,239.15 2,336.05 2,576.40 2,842.40 77 614.65 1,119.10 1,539.95 1,850.60 2,090.00 2,303.75 2,404.45 2,652.40 2,925.05 78 635.55 1,159.00 1,599.80 1,924.70 2,175.50 2,399.70 2,507.05 2,764.50 3,049.50 79 652.65 1,197.95 1,657.75 1,997.85 2,261.00 2,495.65 2,609.65 2,876.60 3,173.00 80 669.75 1,234.05 1,712.85 2,070.05 2,344.60 2,589.70 2,709.40 NA NA81 685.90 1,269.20 1,767.95 2,140.35 2,428.20 2,684.70 2,810.10 NA NA82 698.25 1,299.60 1,817.35 2,205.90 2,506.10 2,773.05 2,907.00 NA NA83 707.75 1,326.20 1,860.10 2,264.80 2,578.30 2,854.75 2,995.35 NA NA84 649.80 1,230.25 1,732.80 2,111.85 2,404.45 2,658.10 2,794.90 NA NA85 623.20 1,193.20 1,691.00 2,071.00 2,364.55 2,618.20 2,758.80 NA NA


Annual Premiums



4



Issue Age

18-29 133.29 217.93 286.05 336.40 374.78 410.31 426.36 468.07 518.32 30 137.94 226.96 298.21 351.41 392.73 428.36 443.08 489.06 540.84 31 143.93 237.41 311.70 367.84 408.03 445.08 462.65 510.15 564.87 32 148.58 247.95 325.28 382.95 424.65 466.07 483.65 532.76 587.58 33 153.33 258.59 340.29 398.24 445.55 487.07 504.74 555.37 613.23 34 160.84 267.90 355.40 416.29 463.79 506.92 526.02 580.93 640.40 35 154.19 260.11 343.71 406.13 452.39 494.19 513.29 565.63 627.95 36 160.36 270.85 360.34 421.61 470.73 516.90 534.66 591.38 652.56 37 166.54 281.68 375.63 442.70 492.01 538.37 557.56 615.89 681.34 38 175.56 295.26 391.02 458.38 513.38 561.26 583.30 641.82 708.99 39 181.83 306.28 407.93 478.23 534.95 585.77 605.06 669.37 741.00 40 176.70 301.34 401.76 473.67 527.73 577.22 596.60 659.59 728.56 41 184.40 313.79 417.43 492.39 549.39 601.92 622.73 687.42 760.76 42 192.19 327.66 435.96 513.95 573.99 628.05 648.95 715.35 791.83 43 201.40 340.29 453.25 535.71 597.36 654.46 678.21 748.98 824.41 44 207.96 355.78 473.29 557.56 622.25 683.72 704.81 780.05 861.27 45 204.44 349.98 466.55 551.10 617.31 674.79 697.40 772.83 852.91 46 213.85 365.66 488.30 573.23 641.16 701.67 728.46 802.94 887.49 47 221.92 380.00 507.49 596.98 667.95 731.50 758.39 836.00 925.11 48 230.09 395.96 528.20 623.58 696.35 763.04 788.60 872.10 963.02 49 238.20 406.98 543.67 639.73 717.31 784.85 812.99 897.24 990.20 50 235.58 405.76 542.77 638.10 715.07 782.04 812.59 894.77 989.71 51 242.12 416.46 557.76 657.72 735.36 804.50 833.47 920.36 1,015.93 52 245.92 428.22 572.41 676.86 753.96 826.54 857.83 946.77 1,044.18 53 254.79 440.99 586.82 694.36 776.06 851.87 880.37 972.52 1,071.79 54 262.24 452.28 604.71 713.93 797.64 874.13 903.66 997.69 1,102.59 55 252.15 437.84 584.93 690.57 770.87 845.33 875.75 966.32 1,065.03 56 258.32 448.93 601.27 709.88 792.02 868.40 898.59 992.24 1,094.00 57 265.53 459.90 616.04 726.33 811.59 889.81 921.03 1,016.39 1,119.84 58 271.42 471.77 631.75 746.13 834.29 913.24 945.25 1,043.67 1,149.98 59 277.27 483.47 647.14 764.33 854.26 935.01 969.10 1,066.91 1,178.38 60 279.83 486.69 651.21 768.51 858.74 941.03 973.71 1,075.23 1,183.30 61 286.63 498.07 667.38 787.30 879.26 962.12 997.86 1,099.97 1,211.88 62 293.36 509.28 682.12 806.87 900.49 986.20 1,021.69 1,126.47 1,239.94 63 303.15 528.58 708.70 837.52 935.27 1,024.01 1,062.58 1,170.40 1,286.87 64 315.12 547.77 736.31 870.16 970.88 1,064.76 1,102.10 1,215.09 1,337.81 65 296.69 518.56 696.60 824.96 922.32 1,011.98 1,046.98 1,155.13 1,272.64 66 307.18 536.05 720.96 855.18 955.34 1,047.83 1,085.73 1,196.79 1,318.12 67 316.68 554.53 746.30 884.33 988.30 1,083.60 1,123.32 1,238.31 1,364.43 68 321.86 565.71 763.31 904.97 1,013.19 1,109.87 1,150.98 1,268.97 1,397.98 69 318.92 561.98 760.84 903.11 1,012.24 1,110.28 1,151.97 1,270.32 1,399.37 70 302.82 536.10 726.94 863.25 969.08 1,062.33 1,104.20 1,216.53 1,340.11 71 293.36 523.87 711.00 846.81 951.05 1,045.17 1,085.26 1,197.11 1,317.94 72 279.30 503.50 686.85 819.85 922.45 1,013.65 1,055.45 1,163.75 1,282.50 73 287.85 517.75 707.75 845.50 951.90 1,046.90 1,089.65 1,201.75 1,324.30 74 294.50 532.00 727.70 870.20 980.40 1,078.25 1,122.90 1,237.85 1,364.20 75 300.20 543.40 745.75 892.05 1,005.10 1,104.85 1,151.40 1,267.30 1,395.55 76 304.95 553.85 760.95 912.95 1,027.90 1,130.50 1,178.95 1,297.70 1,427.85 77 307.80 563.35 775.20 930.05 1,047.85 1,154.25 1,203.65 1,325.25 1,457.30 78 314.45 576.65 796.10 956.65 1,080.15 1,189.40 1,241.65 1,366.10 1,503.85 79 318.25 588.05 814.15 981.35 1,108.65 1,222.65 1,278.70 1,406.00 1,546.60 80 321.10 596.60 829.35 1,002.25 1,135.25 1,252.10 1,310.05 NA NA81 323.00 603.25 841.70 1,020.30 1,158.05 1,278.70 1,339.50 NA NA82 322.05 605.15 849.30 1,032.65 1,174.20 1,299.60 1,363.25 NA NA83 317.30 604.20 851.20 1,039.30 1,185.60 1,311.95 1,379.40 NA NA84 310.65 597.55 847.40 1,039.30 1,187.50 1,317.65 1,387.00 NA NA85 302.10 585.20 836.95 1,031.70 1,182.75 1,313.85 1,386.05 NA NA


Annual Premiums



5



Issue Age



Annual Premiums



6



Issue Age

18-29 351.31 589.86 789.07 934.90 1,048.80 1,154.16 1,200.14 1,328.77 1,475.92 30 353.12 597.46 798.38 945.63 1,062.48 1,167.93 1,214.01 1,346.91 1,495.59 31 357.68 607.91 809.02 959.22 1,073.50 1,181.80 1,227.88 1,362.30 1,513.92 32 360.91 614.18 819.76 971.47 1,088.70 1,198.52 1,243.17 1,379.21 1,533.78 33 365.66 621.97 830.49 982.49 1,102.48 1,213.82 1,259.99 1,397.55 1,553.73 34 368.89 628.43 839.90 996.27 1,116.44 1,227.97 1,275.57 1,415.98 1,570.92 35 346.56 593.56 794.01 941.93 1,056.59 1,162.52 1,210.11 1,340.83 1,491.50 36 349.89 600.02 803.51 953.14 1,069.23 1,178.10 1,224.36 1,356.60 1,508.98 37 356.06 606.58 814.53 967.10 1,083.38 1,192.44 1,238.71 1,373.99 1,529.22 38 360.81 615.89 824.22 975.65 1,097.63 1,208.21 1,255.90 1,392.80 1,546.89 39 364.23 622.63 834.01 989.81 1,110.65 1,222.75 1,270.53 1,408.95 1,566.08 40 346.28 593.47 799.33 946.77 1,062.10 1,171.45 1,215.05 1,349.29 1,500.91 41 349.70 600.21 807.88 958.36 1,076.64 1,186.17 1,231.20 1,367.15 1,520.29 42 353.21 609.81 817.86 971.38 1,089.84 1,202.32 1,248.87 1,383.68 1,538.53 43 359.58 615.32 828.02 983.16 1,103.24 1,215.91 1,263.88 1,404.48 1,556.86 44 361.86 623.68 839.52 996.46 1,119.58 1,233.77 1,280.51 1,422.72 1,580.90 45 345.52 596.51 804.27 954.37 1,074.74 1,184.94 1,230.35 1,367.05 1,519.81 46 349.22 603.63 814.63 967.96 1,088.61 1,200.42 1,248.59 1,384.34 1,538.72 47 354.45 613.70 825.27 978.88 1,101.15 1,216.00 1,264.26 1,401.73 1,560.66 48 356.92 619.69 834.58 994.08 1,118.15 1,230.44 1,280.22 1,420.73 1,580.04 49 356.31 619.29 834.71 992.64 1,119.42 1,233.37 1,282.60 1,423.08 1,582.13 50 347.93 604.11 816.01 969.59 1,092.33 1,203.69 1,253.66 1,391.31 1,547.28 51 347.45 602.51 814.95 971.00 1,093.77 1,205.32 1,254.82 1,393.69 1,548.08 52 345.74 603.59 815.23 970.94 1,093.91 1,205.61 1,255.79 1,394.64 1,548.71 53 345.23 604.58 815.58 972.33 1,095.26 1,208.31 1,256.76 1,395.46 1,550.59 54 346.14 603.04 814.47 974.81 1,095.24 1,209.75 1,258.94 1,396.23 1,553.57 55 327.09 572.20 774.86 924.43 1,039.60 1,148.95 1,196.16 1,326.79 1,475.88 56 325.79 572.41 774.40 925.02 1,041.52 1,151.00 1,197.74 1,329.58 1,478.45 57 325.72 570.25 774.04 924.46 1,041.07 1,151.89 1,198.16 1,331.14 1,479.74 58 324.52 570.57 775.01 925.21 1,044.24 1,152.83 1,202.13 1,333.90 1,482.19 59 323.48 571.03 776.04 926.06 1,045.17 1,155.11 1,202.57 1,334.43 1,484.81 60 318.14 560.90 762.53 909.76 1,027.52 1,134.95 1,183.19 1,314.63 1,461.01 61 317.26 558.14 760.44 908.64 1,025.34 1,134.11 1,182.81 1,312.01 1,459.26 62 314.22 554.48 755.14 904.23 1,021.02 1,128.75 1,178.15 1,307.28 1,454.36 63 315.69 558.22 762.28 912.76 1,032.18 1,141.43 1,192.54 1,323.16 1,471.55 64 316.24 561.22 765.45 919.49 1,038.14 1,151.08 1,199.62 1,333.91 1,483.54 65 260.95 467.66 643.53 777.31 882.25 980.57 1,024.23 1,141.05 1,271.56 66 255.05 458.38 633.71 767.93 872.35 970.16 1,015.50 1,130.82 1,261.72 67 246.67 446.90 619.86 750.57 855.59 951.93 997.92 1,110.82 1,241.12 68 230.55 422.07 588.89 718.24 820.31 914.93 959.12 1,070.95 1,197.91 69 203.11 376.69 532.25 652.37 749.42 838.39 883.10 986.35 1,106.33 70 NA NA NA NA NA NA NA NA NA71 NA NA NA NA NA NA NA NA NA72 NA NA NA NA NA NA NA NA NA73 NA NA NA NA NA NA NA NA NA74 NA NA NA NA NA NA NA NA NA75 NA NA NA NA NA NA NA NA NA76 NA NA NA NA NA NA NA NA NA77 NA NA NA NA NA NA NA NA NA78 NA NA NA NA NA NA NA NA NA79 NA NA NA NA NA NA NA NA NA80 NA NA NA NA NA NA NA NA NA81 NA NA NA NA NA NA NA NA NA82 NA NA NA NA NA NA NA NA NA83 NA NA NA NA NA NA NA NA NA84 NA NA NA NA NA NA NA NA NA85 NA NA NA NA NA NA NA NA NA


Annual Premiums



7


125%ALF/125%HHC 1.04 1.06 1.07 1.08 1.09 1.10 1.11

75%ALF/75%HHC 0.96 0.95 0.93 0.91 0.90 0.89 0.89

50%ALF/50%HHC 0.92 0.87 0.83 0.80 0.79 0.77 0.77


Assisted Living Facility / Home Health Care Benefit Options Rate Factors to be Applied to the 100% ALF / 100% HHC Base Rates and any Riders

Factors



8



1.28 1.22 1.14 1.03 1.00 0.82 0.70


Factors



9



NA 1.06 1.04 1.03 1.01 1.01 1.01 1.01 1.01


Factors



10


Issue Age Factor

< 60 1.1560+ 1.12




11



N/A N/A 1.05 1.09 1.11 1.22 1.36

20 Calendar Day Elimination Period for Assisted Living Facility, Home Health Care and Adult Day Care

Form Number: FC-EPR-PA



12




Form Number: FC-SVR-PA

Payment Term

Flex CareForm Number: FRFC-336-PA

Survivor Benefit Rider


13


Issue Age< 40 1.0140-49 1.0150-54 1.0155-59 1.0260-69 1.0270-74 1.0375-79 1.0580+ 1.06

Form Number: FC-SWR-PA

All Payment Terms


Shared Waiver Rider


14


30 NA 66.50 46.55 39.90 NA NA NA NA NA31 NA 70.49 51.87 43.89 NA NA NA NA NA32 NA 74.48 54.53 46.55 NA NA NA NA NA33 NA 79.80 57.19 46.55 NA NA NA NA NA34 NA 82.46 61.18 51.87 NA NA NA NA NA35 NA 89.11 65.17 55.86 NA NA NA NA NA36 NA 95.76 69.16 57.19 NA NA NA NA NA37 NA 99.75 73.15 62.51 NA NA NA NA NA38 NA 109.06 77.14 63.84 NA NA NA NA NA39 NA 113.05 82.46 69.16 NA NA NA NA NA40 NA 118.37 87.78 73.15 NA NA NA NA NA41 NA 126.35 91.77 77.14 NA NA NA NA NA42 NA 134.33 97.09 81.13 NA NA NA NA NA43 NA 142.31 102.41 86.45 NA NA NA NA NA44 NA 151.62 110.39 90.44 NA NA NA NA NA45 NA 162.26 115.71 95.76 NA NA NA NA NA46 NA 172.90 125.02 102.41 NA NA NA NA NA47 NA 184.87 131.67 107.73 NA NA NA NA NA48 NA 194.18 139.65 117.04 NA NA NA NA NA49 NA 204.52 145.52 120.61 NA NA NA NA NA50 NA 217.06 155.04 127.91 NA NA NA NA NA51 NA 226.59 161.67 133.67 NA NA NA NA NA52 NA 237.01 170.54 141.70 NA NA NA NA NA53 NA 250.71 177.84 145.73 NA NA NA NA NA54 NA 261.44 187.26 154.43 NA NA NA NA NA55 NA 270.52 193.91 159.20 NA NA NA NA NA56 NA 283.90 202.62 166.10 NA NA NA NA NA57 NA 297.86 213.26 173.85 NA NA NA NA NA58 NA 313.50 222.30 182.40 NA NA NA NA NA59 NA 329.57 234.29 191.69 NA NA NA NA NA60 NA 339.42 241.34 196.16 NA NA NA NA NA61 NA 356.31 253.42 206.85 NA NA NA NA NA62 NA 373.46 264.94 217.06 NA NA NA NA NA63 NA 401.28 285.29 233.04 NA NA NA NA NA64 NA 430.92 305.75 249.32 NA NA NA NA NA65 NA 453.86 321.20 261.35 NA NA NA NA NA66 NA 486.31 344.43 280.83 NA NA NA NA NA67 NA 522.93 370.37 301.28 NA NA NA NA NA68 NA 572.85 404.70 329.65 NA NA NA NA NA69 NA 633.65 447.45 364.80 NA NA NA NA NA70 NA 669.75 471.20 382.85 NA NA NA NA NA71 NA 740.05 519.65 421.80 NA NA NA NA NA72 NA 817.00 573.80 465.50 NA NA NA NA NA73 NA 891.10 625.10 506.35 NA NA NA NA NA74 NA 971.85 680.20 551.00 NA NA NA NA NA75 NA 1,042.15 728.65 588.05 NA NA NA NA NA76 NA 1,130.50 789.45 636.50 NA NA NA NA NA77 NA 1,226.45 854.05 686.85 NA NA NA NA NA78 NA 1,356.60 944.30 759.05 NA NA NA NA NA79 NA 1,501.95 1,044.05 837.90 NA NA NA NA NA80 NA 1,660.60 1,152.35 924.35 NA NA NA NA NA81 NA 1,839.20 1,273.95 1,019.35 NA NA NA NA NA82 NA 2,033.00 1,406.95 1,123.85 NA NA NA NA NA83 NA 2,242.95 1,548.50 1,235.95 NA NA NA NA NA84 NA 2,468.10 1,701.45 1,354.70 NA NA NA NA NA85 NA 2,703.70 1,860.10 1,477.25 NA NA NA NA NA




2 Year Extended Duration




15


30 NA NA 66.50 46.55 51.87 NA NA NA NA31 NA NA 71.82 50.54 53.20 NA NA NA NA32 NA NA 75.81 53.20 57.19 NA NA NA NA33 NA NA 79.80 54.53 61.18 NA NA NA NA34 NA NA 86.45 59.85 63.84 NA NA NA NA35 NA NA 91.77 63.84 69.16 NA NA NA NA36 NA NA 97.09 66.50 73.15 NA NA NA NA37 NA NA 103.74 71.82 78.47 NA NA NA NA38 NA NA 109.06 73.15 82.46 NA NA NA NA39 NA NA 115.71 79.80 86.45 NA NA NA NA40 NA NA 122.36 85.12 90.44 NA NA NA NA41 NA NA 129.01 89.11 97.09 NA NA NA NA42 NA NA 135.66 94.43 103.74 NA NA NA NA43 NA NA 143.64 99.75 107.73 NA NA NA NA44 NA NA 152.95 106.40 114.38 NA NA NA NA45 NA NA 162.26 113.05 122.36 NA NA NA NA46 NA NA 174.23 118.37 130.34 NA NA NA NA47 NA NA 183.54 125.02 138.32 NA NA NA NA48 NA NA 195.51 135.66 146.30 NA NA NA NA49 NA NA 204.52 140.28 154.70 NA NA NA NA50 NA NA 217.06 147.29 161.50 NA NA NA NA51 NA NA 226.59 155.31 169.31 NA NA NA NA52 NA NA 238.26 163.02 176.81 NA NA NA NA53 NA NA 247.00 170.43 185.25 NA NA NA NA54 NA NA 260.22 179.97 194.56 NA NA NA NA55 NA NA 269.33 184.34 199.90 NA NA NA NA56 NA NA 281.54 193.19 209.68 NA NA NA NA57 NA NA 295.55 202.83 219.05 NA NA NA NA58 NA NA 310.08 210.90 230.28 NA NA NA NA59 NA NA 326.21 220.84 242.14 NA NA NA NA60 NA NA 335.01 228.11 247.95 NA NA NA NA61 NA NA 351.98 238.26 259.92 NA NA NA NA62 NA NA 368.14 251.10 272.38 NA NA NA NA63 NA NA 396.06 268.57 291.56 NA NA NA NA64 NA NA 423.74 289.33 312.93 NA NA NA NA65 NA NA 444.89 303.24 328.18 NA NA NA NA66 NA NA 477.51 324.86 352.26 NA NA NA NA67 NA NA 513.33 348.30 378.04 NA NA NA NA68 NA NA 561.45 381.90 414.20 NA NA NA NA69 NA NA 621.30 421.80 457.90 NA NA NA NA70 NA NA 653.60 441.75 480.70 NA NA NA NA71 NA NA 720.10 488.30 530.10 NA NA NA NA72 NA NA 795.15 537.70 584.25 NA NA NA NA73 NA NA 865.45 585.20 636.50 NA NA NA NA74 NA NA 942.40 635.55 692.55 NA NA NA NA75 NA NA 1,007.95 678.30 737.20 NA NA NA NA76 NA NA 1,090.60 734.35 797.05 NA NA NA NA77 NA NA 1,178.95 792.30 859.75 NA NA NA NA78 NA NA 1,303.40 874.95 950.00 NA NA NA NA79 NA NA 1,440.20 965.20 1,047.85 NA NA NA NA80 NA NA 1,589.35 1,064.95 NA NA NA NA NA81 NA NA 1,755.60 1,175.15 NA NA NA NA NA82 NA NA 1,937.05 1,294.85 NA NA NA NA NA83 NA NA 2,131.80 1,423.10 NA NA NA NA NA84 NA NA 2,339.85 1,558.95 NA NA NA NA NA85 NA NA 2,555.50 1,699.55 NA NA NA NA NA







16


Form Number: FRFC-336-PATEN YEAR PREMIUM PAYMENT TERM FACTORS




17


Form Number: FRFC-336-PATWENTY YEAR PREMIUM PAYMENT TERM FACTORS




18



1.05 1.05 1.06 1.06 1.07 1.07 1.08 1.10 1.10

Factors

Monthly Assisted Living Facility, Home Health Care, and Adult Day Care Benefit RiderForm Number: FC-MBR-PA



19



18-29 1.29 1.36 1.39 1.43 1.45 1.47 1.50 1.51 1.5430-34 1.29 1.36 1.39 1.42 1.45 1.46 1.49 1.50 1.5235-39 1.30 1.36 1.39 1.41 1.44 1.45 1.47 1.48 1.5140-44 1.30 1.35 1.38 1.40 1.42 1.44 1.46 1.47 1.4945-49 1.29 1.34 1.37 1.39 1.41 1.42 1.44 1.45 1.4750-54 1.29 1.33 1.36 1.38 1.39 1.41 1.42 1.43 1.4455-59 1.28 1.32 1.34 1.36 1.37 1.38 1.40 1.40 1.4260-64 1.27 1.30 1.32 1.33 1.35 1.36 1.37 1.37 1.3865-69 1.25 1.28 1.30 1.31 1.33 1.33 1.35 1.35 1.3670-74 1.24 1.27 1.28 1.30 1.31 1.32 1.33 1.33 1.3475-79 1.22 1.25 1.26 1.27 1.28 1.29 1.29 1.30 1.3080-84 1.19 1.21 1.22 1.23 1.24 1.25 1.26 NA NA

85 1.16 1.18 1.19 1.19 1.20 1.21 1.22 NA NA

Form Number: FC-CASHR-PA


Monthly Cash Benefit Rider


20


<50 N/A 1.28 1.18 1.11 1.07 1.05 1.02 1.02 N/A50+ N/A 1.33 1.20 1.11 1.07 1.05 1.02 1.02 N/A












Form Number: FC-SEBR-PA



Shared Extended Benefit Rider


21

Multiply the annual premium by the appropriate factor below based on maritaland insured status.

10/28/2013

Factors1.000.850.750.70

10/27/2013

Factors1.000.900.750.75



10/28/2013

RateClass Factors

I 0.90II 1.00

10/27/2013

RateClass Factors

I 0.95II 1.00




Married one insuredMarried *



Marital StatusSingle

Married one insuredMarried *






Marital Status


22


PaymentMode Factors

Bi-Weekly 0.0415Monthly 0.0900

Quarterly 0.2600Semi-Annually 0.5150

Annually 1.0000

Modal Factors



23

Supporting Document Schedules Satisfied - Item: Transmittal Letter (A&H)Comments:Attachment(s): PA Transmittal Form 20200311.pdfItem Status:Status Date:

Bypassed - Item: Actuarial Certification (A&H)Bypass Reason: Not Applicable; this is a rate increase filing.Attachment(s):Item Status:Status Date:

Satisfied - Item: Actuarial Memorandum and Explanatory Information (A&H)Comments:

Attachment(s): PA Flexcare memorandum 20200311.pdfPA Supplement to the FlexCare Actuarial Memorandum 20200311.pdf

Item Status:Status Date:

Bypassed - Item: Advertisements (A&H)Bypass Reason: Not ApplicableAttachment(s):Item Status:Status Date:

Satisfied - Item: Authorization to File (A&H)Comments:Attachment(s): Tri-Plus Authorization to file MedAmerica 20191218.pdfItem Status:Status Date:

Bypassed - Item: Insert Page Explanation (A&H)Bypass Reason: Not ApplicableAttachment(s):Item Status:







Status Date:

Bypassed - Item: Rate Table (A&H)Bypass Reason: Not Applicable; this is a rate increase filing.Attachment(s):Item Status:Status Date:

Bypassed - Item: Replacement Form with Highlighted Changes (A&H)Bypass Reason: Not Applicable; this is a rate increase filing.Attachment(s):Item Status:Status Date:

Bypassed - Item: Advertisement Compliance CertificationBypass Reason: Not Applicable; this is a rate increase filing.Attachment(s):Item Status:Status Date:

Bypassed - Item: Reserve Calculation (A&H)Bypass Reason: Not ApplicableAttachment(s):Item Status:Status Date:

Bypassed - Item: Variability Explanation (A&H)Bypass Reason: Not Applicable; this is a rate increase filing.Attachment(s):Item Status:Status Date:

Satisfied - Item: Cover LetterComments:Attachment(s): PA cover letter 20200311.pdfItem Status:Status Date:







Satisfied - Item: ExhibitsComments:

Attachment(s):FlexCare Experience Exhibits Through 12-31-2019.pdfFlexCare Experience Exhibits Through 12-31-2019 - EXCEL.xlsxPA Flexcare Supplement Exhibits 20200311 - EXCEL.xlsx


Satisfied - Item: Current Rate SheetsComments:

Attachment(s): FC-336-PA Rate Sheets - Current Rates.pdfFRFC-336-PA Rate Sheets - Current Rates.pdf


Satisfied - Item: Additional InformationComments:

Attachment(s): MedAmerica Claims Procedures_20160128.pdfAppendix A.pdf


Satisfied - Item: Sample Policyholder Notification LetterComments:

Attachment(s): TEMPLATE MAPA FlexCare PH Letter 2.5.19.pdfTEMPLATE MAPA FlexCare CNF 2.5.19.pdf








Attachment FlexCare Experience Exhibits Through 12-31-2019 - EXCEL.xlsx is not a PDF document andcannot be reproduced here.

Attachment PA Flexcare Supplement Exhibits 20200311 - EXCEL.xlsx is not a PDF document andcannot be reproduced here.







Effective January 1, 2009

© 2009 National Association of Insurance Commissioners 1

Life, Accident & Health, Annuity, Credit Transmittal Document

1. Prepared for the State of Pennsylvania

2. Department Use Only

State Tracking ID

3. Insurer Name & Address Domicile Insurer License

Type

NAIC Group

#NAIC # FEIN # State #

MedAmerica Insurance Company 165 Court Street Rochester, New York 14647

PA

Health

1186 69515

34-0977231

PA

4. Contact Name & Address Telephone # Fax # E-mail Address

Todd Moltumyr 2800 South River Road Des Plaines, IL 60018

224-217-9037 855-226-2728 [email protected]

5. Requested Filing Mode

Review & Approval File & Use Informational

Combination (please explain):

Other (please explain):

6. Company Tracking Number MEDAMERICA FC 2020 LTC RATE INCREASE

7. New Submission Resubmission Previous file #

8. Market

Individual Franchise

Group

Small Large Small and Large

Employer Association Blanket Discretionary Trust Other:

9. Type of Insurance (TOI) LTC05I Individual Long Term Care-Nursing Home & Home Health Care

10. Sub-Type of Insurance (Sub-TOI) LTC05I.001 Qualified

11. Submitted Documents

FORMS Policy Outline of Coverage Certificate Application/Enrollment Rider/Endorsement Advertising Schedule of Benefits Other

Rates

New Rate Revised Rate

FILING OTHER THAN FORM OR RATE: Please explain: _________________________________________

SUPPORTING DOCUMENTATION

Articles of Incorporation Third Party Authorization Association Bylaws Trust Agreements Statement of Variability Certifications Actuarial Memorandum Other_______________________________________________

LHTD-1, Page 1 of 2



12. Filing Submission Date 03/11/2020

13. Filing Fee (If required)

Amount Check Date

Retaliatory Yes No Check Number

14. Date of Domiciliary Approval PA is the domicile state

15. Filing Description:

Re: Tax-Qualified Long-Term Care Policy Forms: FC-336-PA, FRFC-336-PA

The referenced rate filing is being submitted on behalf of MedAmerica for your review. These are existing individual products that provide long‐term care coverage on an expense incurred basis. These policy forms were originally approved in Pennsylvania on May 23, 2011 and policies were issued in Pennsylvania from October 1, 2012 to November 17, 2015. Policies are no longer being marketed in this jurisdiction. MedAmerica is requesting the approval of a premium rate increase on the above‐listed form; including all associated riders. The need for a premium rate increase is due to emerging and projected experience running more adverse than previously expected. The company is requesting a premium rate increase that varies by issue age and inflation option as shown in Attachment I. The rate increase varies by issue age and inflation option to better align the rate increase with the adverse experience. We are requesting the same rate increase percentages by pricing cell nationwide so the only differences in average increase by state are based on the inforce distribution within each state. The requested nationwide average increase is 26.4%, and the requested average increase in Pennsylvania is 25.2%. There have been no prior increases on these policy forms. The company is seeking this current increase request to help alleviate the adverse performance on this block of business. The company will offer insureds affected by the premium increase the option of reducing their policy benefits to provide flexibility of choice for those insureds who wish to maintain a premium level reasonably similar to what they were paying prior to the increase. The company will offer a contingent benefit upon lapse to insureds that trigger a substantial rate increase. Additionally, MedAmerica will voluntarily offer a contingent benefit upon lapse to insureds affected by the rate increase, even if the increase is not considered substantial. The following electronic items are included with this submission:

cover letter

letter from MedAmerica authorizing us to submit this filing on their behalf

claims and administrative processing plan, as provided by MedAmerica

actuarial memorandum

supplement to the actuarial memorandum

numerical exhibits in Excel

current and proposed premium rate schedules

policyholder notification letter and Contingent Non‐Forfeiture Benefit Election Form*

*Please note that in the future slight variations in language may occur that do not materially change the information being provided to the policyholder. It is our understanding that such variations do not need to be filed with the Department.



16. Certification (If required)

I HEREBY CERTIFY that I have reviewed the applicable filing requirements for this filing, and the filing complies with all applicable statutory and regulatory provisions for the state of Pennsylvania .

Print Name Todd Moltumyr Title Vice President

Signature Date: 03/11/2020

LHTD-1, Page 2 of 2



17. Form Filing Attachment

This filing transmittal is part of company tracking number

This filing corresponds to rate filing company tracking number

Document Name Form Number

Replaced Form Number

Description

Previous State Filing Number

01 None Initial Revised Other ____________

02 Initial Revised Other ____________









LH FFA-1



18. Rate Filing Attachment

This filing transmittal is part of company tracking number MEDAMERICA FC 2020 LTC RATE INCREASE

This filing corresponds to form filing company tracking number FC-336-PA, FRFC-336-PA

Overall percentage rate indication (when applicable) 25.217%

Overall percentage rate impact for this filing 25.217%

Document Name

Affected Form Numbers

Previous State Filing Number

Description

01 Individual Long Term Care Policy

FC-336-PA

New Revised

Request +0% - 50.0% Other ___________

02 Individual Long Term Care Policy

FRFC-336-PA

New Revised +0% - 50.0%

Request Other ___________

03

New Request Other ___________

04

New Revised

Request Other ___________

LH RFA-1

MEDAMERICA INSURANCE COMPANY

Address: 165 Court Street, Rochester, New York 14647

FlexCare Actuarial Memorandum

March 11, 2020

1 Actuarial Memorandum

Product Number Tax‐Qualified Long‐Term Care Policy Form FC‐336‐PA Tax‐Qualified Franchise Long‐Term Care Policy Form FRFC‐336‐PA MedAmerica Insurance Company (MedAmerica) is requesting a rate increase on the above‐listed long‐term care policy forms. The company issued these policy forms in Pennsylvania from October 1, 2012 through November 17, 2015. These forms are no longer being marketed in any jurisdiction.

Nationwide, MedAmerica is requesting a premium rate increase that varies by issue age and inflation option. The intent is to achieve the same rate increase percentages in all jurisdictions, except where limited by regulatory restrictions. This actuarial memorandum captures the pooled nationwide experience of the above‐listed policy forms and similar policy forms issued nationwide by MedAmerica.

1. Purpose of Filing

This actuarial memorandum has been prepared for the purpose of demonstrating that the requested rate increase, as shown in Attachment I, meets the minimum requirements of your jurisdiction and demonstrating compliance with its rate stability regulation. It may not be suitable for other purposes.

2. Requested Rate Increase

The company is requesting a rate increase that varies by issue age and inflation option. The company is seeking this current rate increase request to help alleviate the adverse performance on this block of business. The level of increase ranges from 0%‐50% and averages 26.4% nationwide, and 25.2% in Pennsylvania. The proposed rate increase percentages are shown in Attachment I.

The rate increase levels were determined to vary by issue age and inflation option to better align the rate increase with the adverse experience. MedAmerica’s goal is equity across all jurisdictions, to the extent practical.

Corresponding rate tables reflecting the proposed rate increases for the policy forms affected by this rate increase are enclosed with this filing. Please note that the actual rates implemented may vary from those in the enclosed rate tables slightly due to implementation rounding algorithms.

As the company is not currently marketing new business, the required statement that the renewal premium rate schedules are not greater than the new business premium rate schedules is not applicable.

3. Description of Benefits

Forms FC‐336‐PA and FRFC‐336‐PA are federally tax‐qualified, individually underwritten policy forms that provide comprehensive coverage on an expense incurred basis. Both forms have benefit eligibility requirements that involve activities of daily living (ADL) deficiencies or cognitive impairment. Waiver of premium is provided when certain benefits are being paid. A maximum daily benefit, maximum lifetime benefit, and elimination period were selected at issue.

At issue, the insured may have had the option to choose one of several riders providing inflation protection: simple inflation with no maximum at either 3% or 5%, compound inflation with no maximum at either 3% or 5%, a combination benefit increase that increases benefits at 5% per year up to age 75 and no increases thereafter, and a guarantee purchase option.

At issue, the insured may have had the option of selecting additional riders that provide the following types of coverage: restoration of benefits, return of premium, extension of benefits, shortened benefit period non‐forfeiture, shared care, cash benefit, monthly benefits as opposed to daily, 20 day elimination period for certain benefits, shared waiver, or survivorship benefit.




March 11, 2020


The insured may have had the option to select one of the following premium payment options: lifetime, 10‐year, or 20‐year.

A contingent benefit upon lapse (CBUL) will be available to all insureds.

4. Renewability

These policies are guaranteed renewable for life.

5. Applicability

As these policy forms are no longer being sold in any jurisdiction, this filing is applicable to in‐force policies only. The premium changes will apply to the base forms as well as all applicable options and riders.

6. Actuarial Assumptions

a. Morbidity reflects claim costs using the 2017 Milliman Long‐Term Care Guidelines (Guidelines) with adjustments for underwriting selection, an all‐lives exposure basis, and one year of retrospective improvement to bring claim costs forward to 2018, provided by MedAmerica. The claim costs were further adjusted based on historical claim experience from a morbidity study with runout through December 31, 2018 by attained age, duration, payment type, and coverage type, to the extent credible.

b. Mortality Rates reflect the gender distinct 2012 Individual Annuitant Mortality (IAM) Basic Table using the G2 Scale retroactively to December 31, 2018. These mortality rates are further adjusted based on the historical mortality experience by attained age and duration. The adjusted mortality rates are shown in the following table.




March 11, 2020


FlexCare

2012 IAM Basic Mortality Table with Adjustments

Attained Age

Male Female Attained Age

Male Female Attained Age

Male Female

18 0.034% 0.019% 53 0.251% 0.144% 88 11.266% 7.852%

19 0.033% 0.017% 54 0.272% 0.159% 89 13.375% 9.136%

20 0.032% 0.016% 55 0.290% 0.173% 90 14.617% 10.261%

21 0.037% 0.017% 56 0.311% 0.191% 91 16.071% 11.392%

22 0.038% 0.018% 57 0.334% 0.211% 92 18.405% 13.304%

23 0.041% 0.019% 58 0.359% 0.235% 93 19.889% 14.853%

24 0.045% 0.020% 59 0.386% 0.261% 94 21.366% 16.377%

25 0.048% 0.019% 60 0.416% 0.287% 95 22.403% 18.213%

26 0.049% 0.020% 61 0.439% 0.313% 96 24.140% 20.298%

27 0.055% 0.021% 62 0.475% 0.349% 97 25.839% 22.397%

28 0.056% 0.022% 63 0.517% 0.384% 98 27.977% 24.718%

29 0.058% 0.023% 64 0.563% 0.426% 99 29.822% 26.872%

30 0.058% 0.025% 65 0.618% 0.465% 100 32.182% 29.087%

31 0.060% 0.025% 66 0.658% 0.502% 101 34.459% 31.377%

32 0.061% 0.027% 67 0.696% 0.526% 102 36.248% 33.154%

33 0.060% 0.029% 68 0.785% 0.577% 103 38.408% 35.184%

34 0.060% 0.030% 69 0.900% 0.664% 104 40.532% 37.289%

35 0.058% 0.032% 70 1.020% 0.743% 105 41.309% 39.381%

36 0.059% 0.034% 71 1.170% 0.820% 106 41.309% 41.029%

37 0.062% 0.037% 72 1.358% 0.918% 107 41.309% 41.665%

38 0.066% 0.040% 73 1.562% 1.036% 108 41.309% 41.665%

39 0.072% 0.044% 74 1.795% 1.155% 109 41.309% 41.665%

40 0.078% 0.048% 75 2.071% 1.312% 110 41.309% 41.665%

41 0.085% 0.053% 76 2.446% 1.498% 111 41.309% 41.665%

42 0.091% 0.057% 77 2.884% 1.822% 112 41.309% 41.665%

43 0.098% 0.061% 78 3.207% 2.090% 113 41.309% 41.665%

44 0.105% 0.065% 79 3.597% 2.367% 114 41.309% 41.665%

45 0.112% 0.069% 80 4.148% 2.702% 115 41.309% 41.665%

46 0.122% 0.073% 81 4.813% 3.217% 116 41.309% 41.665%

47 0.135% 0.079% 82 5.269% 3.597% 117 41.309% 41.665%

48 0.150% 0.086% 83 5.866% 4.029% 118 41.309% 41.665%

49 0.169% 0.095% 84 6.370% 4.549% 119 41.309% 41.665%

50 0.189% 0.106% 85 7.585% 5.479% 120 71.519% 71.925%

51 0.210% 0.118% 86 8.530% 6.300% 121 100.000% 100.000%

52 0.231% 0.131% 87 9.678% 6.888%




March 11, 2020


c. Voluntary Lapse Rates vary by duration, issue age, and premium payment option. The lifetime‐pay lapse rates are shown in the following table.

FlexCare

Lifetime‐Pay Voluntary Lapse Rates

5‐Year Issue Age Bracket

Duration* <20 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49 50‐54 55‐59 60‐64 65‐69 70‐74 75‐79 80‐85

1 12.00% 11.88% 11.60% 11.47% 11.27% 9.70% 7.85% 6.11% 5.25% 4.75% 4.55% 4.95% 5.36% 5.38%

2 10.50% 10.35% 10.02% 9.86% 9.50% 7.89% 6.32% 4.98% 4.28% 3.92% 3.84% 4.18% 4.53% 4.55%

3 8.38% 7.85% 7.14% 6.77% 6.21% 4.85% 3.82% 3.05% 2.65% 2.43% 2.44% 2.66% 2.88% 2.89%

4 5.22% 4.72% 4.20% 3.92% 3.39% 2.68% 2.07% 1.68% 1.48% 1.36% 1.39% 1.51% 1.64% 1.65%

5 2.63% 2.38% 2.11% 1.97% 1.61% 1.28% 0.98% 0.81% 0.72% 0.67% 0.69% 0.76% 0.82% 0.82%

6 1.98% 1.79% 1.59% 1.45% 1.15% 0.91% 0.71% 0.59% 0.53% 0.50% 0.52% 0.57% 0.62% 0.62%

7 1.58% 1.43% 1.27% 1.13% 0.88% 0.69% 0.54% 0.45% 0.41% 0.40% 0.42% 0.45% 0.49% 0.49%

8 1.58% 1.43% 1.27% 1.09% 0.84% 0.66% 0.52% 0.44% 0.40% 0.40% 0.42% 0.45% 0.49% 0.49%

9 1.58% 1.43% 1.27% 1.03% 0.81% 0.62% 0.50% 0.43% 0.40% 0.40% 0.42% 0.45% 0.49% 0.49%

10 1.58% 1.43% 1.27% 0.97% 0.77% 0.59% 0.49% 0.42% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

11 1.58% 1.43% 1.25% 0.92% 0.73% 0.56% 0.47% 0.41% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

12 1.58% 1.43% 1.21% 0.88% 0.70% 0.54% 0.45% 0.40% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

13 1.58% 1.43% 1.16% 0.84% 0.66% 0.52% 0.44% 0.39% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

14 1.58% 1.43% 1.09% 0.81% 0.62% 0.50% 0.43% 0.39% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

15 1.58% 1.43% 1.03% 0.78% 0.59% 0.49% 0.42% 0.38% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

20 1.58% 1.14% 0.83% 0.59% 0.49% 0.42% 0.38% 0.38% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

25 1.20% 0.92% 0.63% 0.49% 0.42% 0.38% 0.38% 0.38% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

30 0.99% 0.70% 0.52% 0.43% 0.38% 0.38% 0.38% 0.38% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

35 0.76% 0.58% 0.46% 0.39% 0.38% 0.38% 0.38% 0.38% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

40 0.63% 0.51% 0.41% 0.38% 0.38% 0.38% 0.38% 0.38% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

45 0.56% 0.47% 0.41% 0.38% 0.38% 0.38% 0.38% 0.38% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

50+ 0.52% 0.47% 0.41% 0.38% 0.38% 0.38% 0.38% 0.38% 0.39% 0.40% 0.42% 0.45% 0.49% 0.49%

*The assumption varies by duration for 15+ but is shown every five years for display purposes

The lapse rates in the above table were adjusted for the limited‐pay options based on the following criteria:

For the ten‐pay option, a reduction of 65% of the above lapse rates is assumed for durations one through four, a reduction of 70% of the above lapse rates is assumed for durations five through eight, and 0% thereafter

For the 20‐year payment option, a reduction of 50% of the above lapse rates is assumed for durations one through eight, a reduction of 75% of the above lapse rates is assumed for durations nine through fifteen, and 0% thereafter.




March 11, 2020


d. Benefit Expiry Rates reflect assumed policy termination due to exhaustion of benefits on limited benefit period policies. The rates are based on the Guidelines with adjustments for historical benefit expiry experience and vary by gender, benefit period, and attained age as shown in the following table.

Gender

Benefit Period

in Days Range

Attained Age*

<65 65 70 75 80 85 90 95 100 105 110+

Female 0 0.0% 0.1% 0.2% 0.3% 0.8% 2.3% 5.4% 9.7% 11.3% 19.3% 20.7%

549 0.0% 0.0% 0.1% 0.2% 0.5% 1.6% 4.4% 8.2% 10.7% 19.0% 20.7%

914 0.0% 0.0% 0.1% 0.2% 0.5% 1.3% 3.4% 6.7% 9.3% 19.0% 20.7%

1279 0.0% 0.0% 0.1% 0.1% 0.3% 0.9% 2.5% 4.8% 7.1% 17.0% 20.7%

1644 0.0% 0.0% 0.0% 0.1% 0.2% 0.6% 1.8% 3.7% 6.3% 14.4% 20.7%

2191 0.0% 0.0% 0.0% 0.1% 0.1% 0.3% 0.9% 2.6% 3.9% 8.5% 20.7%

3104 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.2% 0.9% 1.7% 4.0% 14.0%

4381 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Male 0 0.0% 0.1% 0.1% 0.2% 0.5% 1.6% 4.0% 6.9% 7.8% 11.3% 20.7%

549 0.0% 0.0% 0.1% 0.2% 0.4% 1.1% 2.8% 5.1% 6.0% 10.2% 20.7%

914 0.0% 0.0% 0.1% 0.1% 0.3% 0.8% 1.9% 3.8% 4.8% 9.1% 20.7%

1279 0.0% 0.0% 0.0% 0.1% 0.2% 0.4% 1.3% 2.4% 3.4% 7.9% 20.7%

1644 0.0% 0.0% 0.0% 0.1% 0.1% 0.3% 0.8% 2.1% 2.9% 6.8% 20.7%

2191 0.0% 0.0% 0.0% 0.0% 0.1% 0.1% 0.4% 1.2% 2.1% 4.5% 9.4%

3104 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.2% 0.7% 2.1% 5.4%

4381 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

*The assumption varies by attained age, but is shown every five years for display purposes

e. Policyholder Behavior Due to the Rate Increase. At the time of the rate increase, policyholders have the option to elect a CBUL or reduced benefit options (RBO). A CBUL election rate of 4% is assumed for insureds with issue ages 18‐64, and 0% for issue ages 65+. No RBO elections are assumed.

Insureds who elect a CBUL are modeled as a lapse (i.e., the CBUL benefit is not modeled), which results in a slightly lower lifetime loss ratio than if the CBUL benefit had been modeled.

f. Interest Rate of 4.50%

g. Annual Improvement in the mortality and morbidity assumptions is assumed for 10 years starting in 2020. Annual mortality improvement factors vary by attained age based on the G2 improvement scale from the 2012 Individual Annuity Mortality table. Annual morbidity improvement is assumed to be 1.0%

h. Expenses have not been explicitly projected. Original filed expense assumptions are assumed to remain appropriate, except that reductions are made to the renewal commission rates so that the total commissions paid before and after any increase in premium are similar (i.e., commissions are not paid on the increased premium).

The above assumptions are based on the experience of MedAmerica Insurance Company, MedAmerica Insurance Company of New York and MedAmerica Insurance Company of Florida (MedAmerica Companies) that issued the same products, industry experience and judgment. These assumptions are based on the nationwide experience through 2019 of the particular policy forms in this filing and other similar policy forms where appropriate. The above assumptions are deemed reasonable for the particular policy forms in this filing. The assumptions used in this filing are considered “most likely” and do not reflect moderately adverse conditions.




March 11, 2020


In establishing the assumptions described in this section, the policy design, underwriting, and claims adjudication practices for the above‐referenced policy forms were taken into consideration. Appendix A to this memorandum provides a description of the development of and justification for the assumptions used in this filing.

The company is not currently marketing long‐term care products. As a result, the requirement to reflect on any assumptions that deviate from those used for pricing other forms currently available for sale is not applicable.

7. Marketing Method

These policy forms were marketed in Pennsylvania by agents and brokers of MedAmerica.

8. Underwriting Description

These policies were fully underwritten with the use of various underwriting tools in addition to the application, which may have included medical records, an attending physician’s statement, prescription screen, telephone interview, and/or face‐to‐face assessment. Employer sponsored groups were eligible for reduced underwriting for actively at work employees age 65 and less.

9. Premiums

Premiums are unisex and payable for life unless the insured selected a limited premium payment option. The premiums may vary by issue age, cash benefit account, initial monthly benefit, community care level, elimination period, inflation option, premium payment option, medical underwriting, marital status, employer sponsored/multi‐life discounts, and the selection of any riders.

10. Issue Age Range

Issue ages are from 18 to 85.

11. Area Factors

Area factors are not used for this product.

12. Premium Modalization Rules

The following modal factors and nationwide percent distributions (based on in‐force count as of December 31, 2019 of the MedAmerica Companies) are applied to the annual premium (AP):

Premium Mode Modal Factors

Percent Distribution

Annual 1.0000*AP 51%

Semi‐Annual .5150*AP 5%

Quarterly .2600*AP 17%

Monthly .0900*AP 27%

13. Reserves

Active life reserves and reserves for the election of a CBUL have not been used in this rate increase analysis. Claim reserves as of December 31, 2019 have been discounted to the incurral date of each respective claim and included in historical incurred claims. A best estimate of the incurred but not reported (IBNR) reserve balance as of December 31, 2019 has been allocated to the 2019 calendar year of incurral and included in historic incurred claims.

14. Trend Assumptions




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An explicit medical cost trend is not included in the projections.

15. Demonstration of Satisfaction of Loss Ratio Requirements

This filing uses pooled nationwide experience of the above listed forms and similar policy forms issued nationwide by MedAmerica. The pooled experience is appropriate because the products issued are identical, the marketing and distribution is similar, and MedAmerica manages the entire block.

Exhibit I provides actual and projected experience using current assumptions. Actual experience is provided from inception through 2019 and then projected on a seriatim basis for 60 years using the current assumptions described above in Section 6. The actual and projected experience is based on nationwide premiums.

Values in Exhibit I are shown (a) before and (b) after the nationwide requested rate increase. Included are calendar year earned premiums, incurred claims, end of year lives, annual loss ratios, and cumulative loss ratios. The following table provides the lifetime loss ratios by issue age and inflation option before and after the increase.

Nationwide Lifetime Loss Ratios at the Maximum Valuation Interest Rate by Issue Age and Inflation Option

Inflation Option

Issue Age Band

Before Increase After Increase

No Inflation All 66% 62%

With Inflation All 87% 73%

All All 83% 71%

16. Actual to Expected Experience

The following table provides a comparison of actual and projected experience using current assumptions to that expected using original pricing assumptions. Values in the following table are shown (a) before and (b) after the nationwide requested rate increase.

Inflation Option

Issue Age Band

Lifetime Loss Ratio Actual‐to‐Expected

Before Increase

After Increase Expected

Before Increase

After Increase

No Inflation All 59% 55% 43% 1.38 1.29

With Inflation All 73% 62% 50% 1.44 1.23

All All 70% 61% 49% 1.44 1.25

Actual and projected experience in the above table is identical to that described in Exhibit I, using the best estimate interest rate assumption of 4.5%. This rate represents MedAmerica’s expectation of its long‐term investment earnings rate, which is supported by the average net investment earnings rate projected for MedAmerica’s cash flow testing.

Expected experience uses the actual policies sold and projects from issue on a seriatim basis using the original pricing assumptions.

Exhibit III provides a comparison of the current and original pricing assumptions that underlie the actual and expected experience described above.

17. History of Previous Rate Revisions




March 11, 2020


No prior increases have been requested or approved on these policy forms. As part of this rate increase process, an increase has been or is expected to be requested in all jurisdictions. In certain jurisdictions, the requested rate increase may be limited due to regulatory restrictions.

18. Analysis Performed to Consider a Rate Increase

An analysis of the business was performed, as described below, which confirmed that a rate increase could be considered. The product was priced such that the premium rates were sufficient to cover any of five moderately adverse scenarios. The following table provides the lifetime loss ratio using the original pricing assumptions (shown in Exhibit III), the five moderately adverse scenarios defined in original pricing, and the assumed mix of policies sold.

Moderately Adverse Scenario Loss Ratio

Gender mix of up to 100% female for unmarried policyholders 51%

Claims experience up to 28% in excess of expectation 63%

Voluntary lapse as low as 0% of the rates assumed in pricing 58%

Discount rates as low as 200 basis points less than pricing 64%

Mortality rates as low as 62% of selection adjusted 1994 GAM 63%

As the product was priced to cover any of the above scenarios, the most adverse scenario defines the threshold that must be crossed before the company may consider a rate increase, which is 64%. The lifetime loss ratio using current assumptions of 70% exceeds this threshold indicating that experience has been more than moderately adverse and so a rate increase may be considered.

The experience table in Section 16 above demonstrates that experience has been more adverse from expected using the expected pricing assumptions as the A:E loss ratio exceeds 1.0. The adverse experience is due to a combination of higher morbidity, higher persistency, and lower interest.

The following table provides a comparison of actual and projected nationwide experience to that expected in pricing with respect to morbidity, mortality, lapse (combination of voluntary lapse and benefit expiry), interest, and improvement. The current and original pricing assumptions are provided in Exhibit III.

Impact of Changing from Pricing to Current Assumptions

Scenario Lifetime Loss Ratio (LLR)

Incremental Impact on the

LLR [1] Increase Needed [2]

Original pricing assumptions 49% N/A N/A

Historical experience through 2019 & projections with pricing assumptions

50% 0% 5%

Historical experience through 2019 & projections with pricing assumptions except for current:

Interest 60% 19% 36%

Interest, lapse [3] 60% 0% 0%

Interest, lapse, mortality 72% 21% 38%

Interest, lapse, mortality, morbidity 77% 7% 12%

Interest, lapse, mortality, morbidity, improvement 70% ‐9% ‐16%

Historical experience through 2019 & projections with all current most‐likely assumptions [4]

70% 44% 79%

[1] Calculated as the ratio of the lifetime loss ratio in a given row to that in the row immediately above it less one.




March 11, 2020


[2] Shows the rate increase needed to reproduce the lifetime loss ratio in the row immediately above it. Calculated without regard to CBUL, RBO, adverse selection and higher waiver claims due to the needed rate increase. [3] The current lapse assumptions include both changes to the durational lapse rate plus the impact of the new Benefit Expiry Rates assumption. [4] This row is calculated in regard to the pricing lifetime loss ratio of 49%.

19. Average Annual Premium in Pennsylvania (Annualized Premium Based on December 31, 2019 In‐Force)

The number of insureds and the corresponding average annual premium that will be affected by the filing are shown in the table below. The values provided exclude policies assumed to be paid up prior to the implementation of the requested rate increase.

Pennsylvania

Inflation Option

Issue Age Band

Number of Insureds

Before Increase Premium

After Requested Increase Premium

No Inflation All 29 $2,258 $2,518

With Inflation All 61 $3,592 $4,645

All All 90 $3,162 $3,959

Company management has indicated that if the requested rate increase is approved, no future premium rate increases are anticipated unless experience deteriorates beyond a 70% loss ratio. MAE is then defined as a 15% multiplicative increase in the future (2020+) loss ratio. This is equivalent to an 9% additive increase in the lifetime loss ratio, due to any combination of deterioration in the experience from that expected using the current assumptions described in Section 6.

Corresponding rate tables reflecting the proposed rate increases are enclosed with this filing. Please note that actual rates implemented may vary from those in the enclosed rate tables slightly due to implementation rounded algorithms.

Exhibit II‐a provides a demonstration that the expected rate increase meets the 58%/85% test required by rate stability regulation. This exhibit shoes that the sum of the accumulated value of incurred claims without the inclusion of active life reserves, and the present value of future projected incurred claims, without the inclusion of active life reserves, will not be less than the sum of the following:

1. Accumulated value of the initial earned premium times 58% 2. 85% of the accumulated value of prior premium rate schedule increases, 3. Present value of future projected initial earned premium times 58%, and 4. 85% of the present value of future projected premium in excess of the projected initial earned

premium. Present and accumulated values in Exhibit II‐a are determined at the maximum valuation interest rate for contract reserves applicable for the year of issue, which ranges from 3.5%‐4.0%, and averages 3.55%. Exhibit II‐b provides a demonstration that the expected rate increase meets the Prospective Present Value (PPV) approach. The PPV approach (also known as the Texas approach) calculates the required rate increase to fund the prospective deficient premium for active, premium‐paying policyholders brought about by an actuarially supported change in assumption(s). We believe the PPV approach addresses the issue of the recoupment of past losses in LTC rate increase filings.




March 11, 2020


20. Proposed Effective Date

The rate increase will apply to policies on their next premium payment date following at least a 60‐day policyholder notification period following being filed for use by the department of insurance.

21. Nationwide Distribution of Business as of December 31, 2019 (based on in‐force insured count)

The number of insureds and annualized premium that will be affected by this filing are shown in the tables below. The values provided in the tables below exclude policies assumed to be paid in full prior to implementation of the requested rate increase, and the annualized premium reflects all rate increases filed for use.

Issue Ages Percent Distribution

<40 6%

40‐44 4%

45‐49 9%

50‐54 16%

55‐59 22%

60‐64 23%

65‐69 14%

70‐74 4%

75+ 2%

Elimination Period Percent Distribution

20‐day <1%

30‐day 5%

60‐day 5%

90‐day 58%

100‐day 29%

180‐day 3%

365‐day 1%

Benefit Period Percent Distribution

1 Year 4%

2 Years 16%

3 Years 43%

4 Years 13%

5 Years 18%

6 Years 2%

7 Years 1%

8 Years 1%

10 Years 3%

Inflation Option Percent Distribution

None 17%

GPO 8%

3% Simple 2X [1] 2%

3% Simple 6%




March 11, 2020


5% Simple 2x [1] 1%

5% Simple 6%

3% Compound 2X [1] 4%

3% Compound 42%

5% Compound 2X [1] 6%

5% Compound 4%

Combination 5%

[1] This option was not offered in Pennsylvania

Payment Term Percent Distribution

Ten‐Pay 13%

Twenty‐Pay 4%

Lifetime‐Pay 83%

Coverage Type Percent Distribution

Facility Only 2%

Comprehensive 98%

22. Number of Insureds and Annualized Premium

The number of insureds and annualized premium that will be affected by this filing are shown in the tables below. The values provided in the tables below exclude policies assumed to be paid in full prior to implementation of the requested rate increase, and the annualized premium reflects all rate increases filed for use.

Pennsylvania

Inflation Option

Issue Age Band

Number of Insureds

Annualized Premium

No Inflation All 29 65,482

Inflation All 61 219,092

All All 90 284,574

Nationwide

Inflation Option

Issue Age Band

Number of Insureds

Annualized Premium

No Inflation All 1,333 2,709,144

Inflation All 3,998 11,620,964

All All 5,331 14,330,108

23. Actuarial Certification

This memorandum has been prepared in conformity with all applicable Actuarial Standards of Practice, including Actuarial Standards of Practice No. 8, “Regulatory Filings for Health Plan Entities” and 18, “Long‐Term Care Insurance.”

I hereby certify that, to the best of my knowledge and judgment, this rate submission is in compliance with the applicable laws and regulations of this jurisdiction and the rules of the department of insurance.




March 11, 2020


In my opinion, the rates have been calculated in a manner that complies with accepted actuarial practices, are uniformly applied to all policies within each issue age rate class, are not excessive or unfairly discriminatory, and bear reasonable relationship to the benefits based on the loss ratio standards of this jurisdiction. If the requested premium rate schedule increase is implemented and the underlying assumptions, with moderately adverse conditions reflected, are realized, no further premium rate schedule increases are anticipated. Moderately adverse conditions are defined as any combination of deterioration in the experience or assumptions that results in a lifetime loss ratio in excess of 70%.

In forming my opinion, I have used actuarial assumptions and actuarial methods and such tests of the actuarial calculations as I considered necessary. Based on these assumptions, or statutory requirements where necessary, the premium rate filing is in compliance with the loss ratio standards of this jurisdiction.

I have relied on data and information provided by MedAmerica to develop this memorandum, including but not limited to management’s view of when a rate change may be considered, underwriting and claim adjudication process, seriatim in‐force data, claim data, and the company’s long‐term earnings rate. I have not audited or independently verified the data and information provided but have reviewed it for reasonableness.

The basis for contract reserves has been previously filed and there is no anticipation of any changes.

Todd M. Moltumyr, ASA, MAAA TriPlus Services, Inc.

Date: March 11, 2020



Supplement to the FlexCare Actuarial Memorandum

March 11, 2020

1 Supplement to the Actuarial Memorandum MedAmerica Insurance Company

Product Number

Tax‐Qualified Long‐Term Care Policy Form FC‐336‐PA Tax‐Qualified Franchise Long‐Term Care Policy Form FRFC‐336‐PA

1. Purpose of Filing

This actuarial memorandum has been prepared for the purpose of demonstrating the compliance of the requested rate increase with Chapter 18 Section 3803(c) and (e), and Reg. 89.83 of the Insurance Regulations for the state of Pennsylvania. It may not be suitable for other purposes.

2. Demonstration of Compliance with Chapter 18 Section 3803

(c) and (e): We believe that we comply with these subsections of the regulation by submitting these rates before they are being used.

3. Demonstration of Compliance with Reg. 89.83

89.83 (a): This subsection requires no action.

89.83 (b): This subsection is not applicable since this filing is not for rates for a new policy form.

89.83 (c): Revision of Current Rates

(1): This rate increase filing complies with loss ratio requirements (i.e., the 58%/85% test), as specified in Reg. 89a.118.(c)(2). Demonstration of satisfaction of this requirement is discussed in Section 19 of the enclosed actuarial memorandum. (2): Section 3 of the actuarial memorandum provides a description of benefits. A copy of the affected policy forms may be provided upon request. (2)(i): The primary reason why these forms are in need of a premium rate increase is due to emerging experience running more adverse than expected in pricing.

The company is requesting a premium rate increase that varies by issue age and inflation option as shown in Attachment I. The company is seeking this current rate increase request to help alleviate the projected adverse performance on this block of business. The rate increase was determined by issue age and inflation option to better align the rate increase with the adverse experience.

The current rate schedules along with the proposed rate schedules are enclosed with this filing. Please note that the actual rates implemented may vary slightly from those shown due to rounding algorithms.

Exhibit I of the actuarial memorandum provides nationwide earned premium and incurred claim actual and projected experience using current assumptions, as described in Section 6 of the enclosed actuarial memorandum. Attachment 1 to this supplement provides Pennsylvania earned premium and incurred claim actual and projected experience using current assumptions, as described in Section 6 of the enclosed actuarial memorandum. Values in Exhibit I and Attachment 1 are shown both before and after the requested rate increase.




March 11, 2020


Attachment 2 to this supplement displays nationwide experience showing written premium, paid claims, and cumulative loss ratios. Attachment 3 to this supplement displays Pennsylvania experience showing written premium, paid claims, and cumulative loss ratios. Values in Attachments 2 and 3 are shown both before and after the requested rate increase.

Attachments 2 and 3 to this supplement display similar information to Exhibit I and Attachment 1, respectively, for Pennsylvania‐specific experience. Please note that Pennsylvania‐specific experience is not considered credible but is being provided as required.

(2)(ii)(A): There have been no prior rate increases on these policy forms in Pennsylvania.

(2)(ii)(B): Table 1 shows original pricing commission scales by issue age and duration for lifetime‐pay policies. The actual commission scales will differ slightly from those that appear in Table 1 as the company adjusts renewal commission rates so that the total commissions paid before and after any increase in premium are similar (i.e., commissions are not paid on the increased premium).

Table 1: Commission Scales by Issue Age and Duration Forms: FC‐336‐PA, FRFC‐336‐PA

Issue Age Duration 1 Durations 2‐10 Durations 11+

Less than 70 95% 14% 7%

70‐74 75% 14% 7%

75and Older 65% 14% 7%

In compliance with Section 89a.129 of the Long Term Care regulation, the total compensation paid to the writing agent is limited to 50% in the first year and 10% at renewal.

Commissions for limited pay options are reduced to levels that are approximately equivalent to the above commissions for lifetime‐pay policies, on a present value basis, based on original pricing assumptions.

(2)(ii)(C)(I): Premiums earned and written since inception for nationwide and Pennsylvania experience can be found in Exhibit I of the actuarial memorandum and Attachments 1‐3 to this supplement, respectively. Premiums earned and written since inception for Pennsylvania‐specific experience can be found in Attachments 2 and 3 to this supplement, respectively. Attachment 4 to this supplement provides reserve balances and the calculation basis for both nationwide and Pennsylvania‐specific experience.

(2)(ii)(C)(II): Attachment 4 to this supplement provides a breakdown of historical incurred claims and active life reserve balance, including a description of the calculation basis, for both nationwide and Pennsylvania‐specific experience.

Attachment 5 to this supplement provides a comparison of actual and projected nationwide experience on a durational basis using current assumptions. Included are policy year earned premiums, incurred claims, durational loss ratios, end of year lives, and cumulative loss ratios with interest. Values in Attachment 5 are shown both before and after the requested rate increase. The




March 11, 2020


number of durations shown was chosen to capture the number of durations underlying Exhibit I. Similar to Exhibit I and Attachments 1 through 3, the values used to calculate the cumulative loss ratios are accumulated and discounted at the maximum valuation interest rate.

Attachment 6 to this supplement provides similar information to Attachment 5 for Pennsylvania‐specific experience.

(2)(ii)(D): We believe that we have provided information sufficient to support the rate increase requested in this filing.

(2)(iii): We understand that data used in this rate increase filing is in agreement with those used in the annual statement filed with the Department.

89.83 (d): We believe that the proposed rate tables provided with this filing comply with this subsection.

4. Microsoft Excel spreadsheet containing all numerical data

Excel workbooks containing the values shown in Exhibits I and II of the actuarial memorandum and Attachments 1 through 6 of this supplement are enclosed with this filing, as required.

1TriPlusServices.com 2800 South River Road • Suite 440 • Des Plaines, IL 60018

March 11, 2020 Honorable Jessica K. Altman Insurance Commissioner Pennsylvania Department of Insurance (Department) Via SERFF RE: MedAmerica Insurance Company (MedAmerica) Company NAIC #69515 SERFF Tracking TRIP-132290842 Tax‐Qualified Long‐Term Care Policy Form FC‐336‐PA

Tax‐Qualified Long‐Term Care Policy Form FRFC‐336‐PA

Dear Commissioner Altman: The referenced rate filing is being submitted on behalf of MedAmerica for your review. These are existing individual products that provide long‐term care coverage on an expense incurred basis. These policy forms were originally approved in Pennsylvania on May 23, 2011 and policies were issued in Pennsylvania from October 1, 2012 to November 17, 2015. Policies are no longer being marketed in this jurisdiction. MedAmerica is requesting the approval of a premium rate increase on the above‐listed form; including all associated riders. The need for a premium rate increase is due to emerging and projected experience running more adverse than previously expected. The company is requesting a premium rate increase that varies by issue age and inflation option as shown in Attachment I. The rate increase varies by issue age and inflation option to better align the rate increase with the adverse experience. We are requesting the same rate increase percentages by pricing cell nationwide so the only differences in average increase by state are based on the inforce distribution within each state. The requested nationwide average increase is 26.4%, and the requested average increase in Pennsylvania is 25.2%. There have been no prior increases on these policy forms. The company is seeking this current increase request to help alleviate the adverse performance on this block of business. The company will offer insureds affected by the premium increase the option of reducing their policy benefits to provide flexibility of choice for those insureds who wish to maintain a premium level reasonably similar to what they were paying prior to the increase. The company will offer a contingent benefit upon lapse to insureds that trigger a substantial rate increase. Additionally, MedAmerica will voluntarily offer a contingent benefit upon lapse to insureds affected by the rate increase, even if the increase is not considered substantial. The following electronic items are included with this submission:

cover letter

letter from MedAmerica authorizing us to submit this filing on their behalf

claims and administrative processing plan, as provided by MedAmerica

actuarial memorandum

supplement to the actuarial memorandum

numerical exhibits in Excel

Honorable Jessica K. Altman March 11, 2020

2TriPlusServices.com 2800 South River Road • Suite 440 • Des Plaines, IL 60018

current and proposed premium rate schedules

policyholder notification letter and Contingent Non‐Forfeiture Benefit Election Form*

*Please note that in the future slight variations in language may occur that do not materially change the information being provided to the policyholder. It is our understanding that such variations do not need to be filed with the Department.

No filing fee is required for this submission.

The contact person for this filing is:

Todd Moltumyr, ASA, MAAA TriPlus Services, Inc 2800 South River Road Suite 440 Des Plaines, IL 60018 (224) 217‐9037 [email protected]

Thank you for your assistance in reviewing this filing.

Respectfully,

Todd M. Moltumyr, ASA, MAAA Vice President, Actuarial Enclosures

Inforce Inforce Proposed Inforce Inforce Proposed Inforce Inforce AverageIssue Age Policies Premium Increase Policies Premium Increase Policies Premium Increase

18 2 $919 40% 1 $1,581 50% 3 $2,500 46.3%19 0 $0 40% 1 $6,166 50% 1 $6,166 50.0%20 0 $0 40% 0 $0 50% 0 $0 N/A21 0 $0 40% 3 $3,676 50% 3 $3,676 50.0%22 1 $241 40% 1 $2,660 50% 2 $2,901 49.2%23 1 $180 40% 3 $1,024 50% 4 $1,204 48.5%24 4 $1,021 40% 3 $2,681 50% 7 $3,701 47.2%25 2 $496 40% 4 $2,408 50% 6 $2,904 48.3%26 0 $0 40% 1 $848 50% 1 $848 50.0%27 4 $3,079 40% 12 $24,600 50% 16 $27,680 48.9%28 3 $503 40% 10 $21,425 50% 13 $21,928 49.8%29 3 $3,081 40% 7 $20,639 50% 10 $23,719 48.7%30 3 $661 40% 6 $25,303 50% 9 $25,964 49.7%31 2 $97 40% 12 $17,168 50% 14 $17,265 49.9%32 4 $1,060 40% 18 $37,259 50% 22 $38,319 49.7%33 6 $3,313 40% 19 $33,253 50% 25 $36,566 49.1%34 3 $1,081 40% 17 $18,429 50% 20 $19,510 49.4%35 4 $1,737 40% 20 $41,897 50% 24 $43,634 49.6%36 1 $2,247 40% 23 $43,168 50% 24 $45,415 49.5%37 6 $3,014 40% 21 $49,786 50% 27 $52,800 49.4%38 5 $1,559 40% 23 $49,033 50% 28 $50,593 49.7%39 5 $5,572 40% 30 $66,739 50% 35 $72,311 49.2%40 2 $383 40% 26 $48,674 50% 28 $49,057 49.9%41 7 $3,722 40% 38 $118,674 50% 45 $122,396 49.7%42 6 $6,136 40% 35 $73,674 50% 41 $79,810 49.2%43 13 $9,826 40% 41 $118,155 50% 54 $127,982 49.2%44 12 $10,200 40% 52 $156,246 50% 64 $166,446 49.4%45 11 $11,017 40% 77 $143,600 50% 88 $154,617 49.3%46 12 $10,127 40% 63 $198,854 50% 75 $208,981 49.5%47 15 $9,182 40% 71 $159,926 50% 86 $169,108 49.5%48 14 $12,670 40% 85 $218,365 50% 99 $231,035 49.5%49 25 $40,674 38% 125 $347,475 48% 150 $388,149 47.0%50 23 $16,064 36% 127 $344,082 46% 150 $360,147 45.6%51 24 $32,569 34% 135 $375,289 44% 159 $407,858 43.2%52 32 $50,354 32% 139 $422,980 42% 171 $473,333 40.9%53 27 $43,003 30% 144 $401,351 40% 171 $444,354 39.0%54 38 $46,416 28% 190 $515,787 38% 228 $562,202 37.2%55 34 $45,169 26% 196 $519,182 36% 230 $564,351 35.2%56 51 $72,734 24% 172 $502,064 34% 223 $574,798 32.7%57 46 $90,142 22% 160 $441,430 32% 206 $531,572 30.3%58 46 $89,274 20% 177 $509,689 30% 223 $598,963 28.5%59 58 $95,268 18% 227 $650,672 28% 285 $745,940 26.7%60 61 $119,003 16% 196 $588,483 26% 257 $707,486 24.3%61 61 $114,078 14% 178 $543,939 24% 239 $658,017 22.3%62 48 $84,146 12% 192 $581,647 22% 240 $665,793 20.7%63 57 $114,289 10% 166 $494,020 20% 223 $608,309 18.1%64 83 $175,668 8% 171 $557,950 18% 254 $733,617 15.6%65 61 $126,654 5% 146 $465,074 14% 207 $591,728 12.1%66 52 $120,540 3% 130 $443,730 12% 182 $564,270 10.1%67 38 $88,925 1% 93 $329,812 10% 131 $418,737 8.1%68 47 $126,364 0% 55 $214,350 8% 102 $340,714 5.0%69 55 $139,905 0% 48 $166,677 6% 103 $306,582 3.3%70 35 $73,108 0% 31 $117,956 4% 66 $191,064 2.5%71 32 $97,565 0% 22 $91,149 2% 54 $188,714 1.0%72 25 $77,362 0% 19 $82,998 0% 44 $160,360 0.0%73 22 $77,329 0% 6 $29,545 0% 28 $106,874 0.0%74 19 $65,684 0% 8 $30,668 0% 27 $96,353 0.0%75 16 $43,628 0% 4 $14,587 0% 20 $58,215 0.0%76 10 $38,914 0% 3 $10,568 0% 13 $49,482 0.0%77 15 $53,216 0% 4 $20,409 0% 19 $73,625 0.0%78 8 $31,007 0% 3 $19,789 0% 11 $50,796 0.0%79 11 $56,585 0% 2 $11,050 0% 13 $67,636 0.0%80 11 $62,128 0% 2 $21,860 0% 13 $83,989 0.0%81 3 $14,424 0% 2 $26,943 0% 5 $41,367 0.0%82 6 $59,972 0% 1 $4,604 0% 7 $64,576 0.0%83 0 $0 0% 1 $17,240 0% 1 $17,240 0.0%84 2 $23,859 0% 0 $0 0% 2 $23,859 0.0%85 0 $0 0% 0 $0 0% 0 $0 N/A

Total 1,333 $2,709,144 10.4% 3,998 $11,620,964 30.2% 5,331 $14,330,108 26.4%

Attachment IMedAmerica Insurance Company

Proposed Rate Increase Percentages - Nationwide Inforce as of 12/31/2019

Non-Inflation Inflation Total

A B C = B / A D E F G = F / E H I J K = I / J

Actual Expected(Column C) (Column G)

2011 71,745 - 0% 167 72,567 1,477 2% 170 0% 2% 0.002012 631,103 - 0% 774 642,710 11,325 2% 794 0% 2% 0.002013 2,154,381 - 0% 2,238 2,192,132 42,012 2% 2,372 0% 2% 0.002014 6,807,602 19,489 0% 4,254 6,896,918 126,975 2% 4,438 0% 2% 0.082015 12,578,210 24,499 0% 6,193 12,616,641 269,935 2% 6,351 0% 2% 0.082016 15,664,709 9,787 0% 5,910 15,556,432 440,619 3% 6,152 0% 2% 0.052017 15,112,566 919,884 6% 5,582 14,871,924 611,688 4% 5,919 2% 3% 0.552018 14,765,679 1,038,348 7% 5,432 14,367,728 804,745 6% 5,753 3% 3% 0.772019 14,437,483 1,526,437 11% 5,334 13,996,160 1,024,854 7% 5,633 4% 4% 0.962020 14,161,600 1,155,754 8% 5,269 13,754,606 1,269,134 9% 5,536 4% 5% 0.952021 13,989,821 1,431,915 10% 5,209 13,483,821 1,515,296 11% 5,449 5% 5% 0.972022 13,775,397 1,753,062 13% 5,147 13,219,484 1,788,820 14% 5,356 6% 6% 0.992023 13,424,268 2,116,069 16% 5,081 12,831,671 2,093,169 16% 5,257 7% 7% 1.032024 12,181,085 2,503,277 21% 5,011 11,661,013 2,470,647 21% 5,148 8% 8% 1.062025 10,647,927 2,908,376 27% 4,937 10,095,462 2,870,872 28% 5,028 9% 9% 1.102026 9,526,480 3,349,990 35% 4,857 8,902,069 3,256,341 37% 4,897 11% 10% 1.152027 9,310,746 3,845,429 41% 4,772 8,586,401 3,642,587 42% 4,761 13% 11% 1.192028 9,090,521 4,396,892 48% 4,681 8,297,321 4,075,692 49% 4,622 15% 12% 1.252029 8,858,010 5,004,050 56% 4,585 7,957,980 4,509,501 57% 4,479 17% 13% 1.302030 8,613,802 5,699,655 66% 4,482 7,637,538 4,984,802 65% 4,332 19% 14% 1.372031 8,356,257 6,483,914 78% 4,373 7,311,793 5,502,108 75% 4,182 22% 15% 1.432032 8,078,373 7,332,610 91% 4,257 6,993,461 6,081,941 87% 4,028 25% 17% 1.512033 7,757,440 8,240,962 106% 4,134 6,608,999 6,665,572 101% 3,872 29% 18% 1.582034 7,329,020 9,201,675 126% 4,004 6,150,321 7,287,623 118% 3,712 33% 20% 1.662035 6,812,585 10,198,661 150% 3,867 5,642,655 7,929,410 141% 3,550 37% 21% 1.752036 6,348,693 11,208,168 177% 3,723 5,198,944 8,595,268 165% 3,386 41% 22% 1.842037 6,023,128 12,211,732 203% 3,572 4,859,526 9,205,639 189% 3,221 46% 24% 1.932038 5,688,805 13,190,603 232% 3,415 4,537,997 9,828,427 217% 3,054 52% 26% 2.032039 5,347,076 14,111,079 264% 3,252 4,220,530 10,422,093 247% 2,887 57% 27% 2.122040 5,000,118 14,946,968 299% 3,085 3,919,637 10,993,653 280% 2,721 64% 29% 2.222041 4,650,538 15,674,062 337% 2,915 3,603,747 11,442,097 318% 2,556 70% 30% 2.322042 4,301,372 16,282,279 379% 2,742 3,307,486 11,855,874 358% 2,392 76% 32% 2.412043 3,955,800 16,755,236 424% 2,568 3,021,295 12,184,147 403% 2,231 83% 33% 2.512044 3,617,165 17,085,252 472% 2,395 2,754,371 12,441,049 452% 2,074 90% 35% 2.612045 3,288,328 17,293,194 526% 2,223 2,484,591 12,538,065 505% 1,921 97% 36% 2.702046 2,972,074 17,366,672 584% 2,054 2,236,480 12,569,944 562% 1,773 104% 37% 2.792047 2,670,790 17,308,277 648% 1,890 2,003,138 12,520,214 625% 1,630 111% 38% 2.892048 2,386,330 17,101,672 717% 1,730 1,790,333 12,405,287 693% 1,493 118% 40% 2.982049 2,120,308 16,766,576 791% 1,578 1,583,170 12,111,253 765% 1,363 125% 41% 3.072050 1,873,956 16,333,915 872% 1,432 1,397,143 11,772,164 843% 1,240 131% 42% 3.152051 1,647,644 15,794,869 959% 1,294 1,227,092 11,349,603 925% 1,124 137% 42% 3.242052 1,441,338 15,173,503 1053% 1,165 1,075,823 10,893,167 1013% 1,016 144% 43% 3.322053 1,254,716 14,463,201 1153% 1,044 933,596 10,308,528 1104% 915 149% 44% 3.392054 1,087,222 13,668,792 1257% 933 809,020 9,704,357 1200% 822 155% 45% 3.472055 937,902 12,820,668 1367% 830 698,231 9,076,498 1300% 736 160% 45% 3.542056 805,561 11,946,057 1483% 736 602,082 8,458,856 1405% 657 165% 46% 3.612057 689,146 11,070,053 1606% 651 514,410 7,794,575 1515% 585 170% 46% 3.672058 587,378 10,192,674 1735% 574 439,415 7,156,712 1629% 520 174% 47% 3.732059 498,985 9,346,266 1873% 504 374,335 6,541,782 1748% 462 178% 47% 3.782060 422,706 8,556,440 2024% 443 319,076 5,979,593 1874% 409 181% 47% 3.832061 357,274 7,835,091 2193% 388 269,883 5,422,299 2009% 362 184% 48% 3.882062 301,418 7,163,094 2376% 339 228,583 4,924,714 2154% 319 187% 48% 3.922063 253,919 6,525,538 2570% 296 193,373 4,464,220 2309% 282 190% 48% 3.962064 213,703 5,930,732 2775% 258 163,909 4,056,207 2475% 248 192% 48% 4.002065 179,722 5,377,138 2992% 225 138,024 3,664,774 2655% 218 195% 48% 4.032066 151,011 4,867,050 3223% 196 116,475 3,323,880 2854% 191 197% 48% 4.072067 126,725 4,407,427 3478% 170 98,203 3,013,265 3068% 168 198% 48% 4.092068 106,130 3,980,074 3750% 148 82,941 2,742,047 3306% 147 200% 49% 4.122069 88,648 3,583,231 4042% 128 69,531 2,478,626 3565% 128 202% 49% 4.152070 73,798 3,208,655 4348% 110 58,331 2,241,564 3843% 111 203% 49% 4.172071 61,196 2,853,898 4664% 95 48,796 2,024,402 4149% 96 204% 49% 4.192072 50,494 2,520,234 4991% 81 40,796 1,824,706 4473% 83 205% 49% 4.202073 41,411 2,205,877 5327% 69 33,766 1,628,717 4824% 72 206% 49% 4.222074 33,743 1,910,381 5662% 58 27,890 1,447,379 5190% 61 207% 49% 4.232075 27,297 1,634,578 5988% 49 22,906 1,273,671 5560% 52 207% 49% 4.242076 21,899 1,380,957 6306% 41 18,749 1,116,080 5953% 44 208% 49% 4.252077 17,415 1,151,344 6611% 34 15,152 963,385 6358% 37 209% 49% 4.262078 13,726 947,881 6906% 27 12,191 827,042 6784% 31 209% 49% 4.272079 10,718 769,560 7180% 22 9,733 703,255 7226% 25 209% 49% 4.27

93,532,671 3,762,624 4% 95,476,922 3,756,134 4% 4% 4% 1.02147,379,695 165,593,094 112% 122,405,137 102,922,554 84% 112% 84% 1.34240,912,366 169,355,718 70% 217,882,058 106,678,688 49% 70% 49% 1.44

91,021,736 3,714,466 4% 89,985,122 3,595,181 4% 4% 4% 1.02160,288,289 204,229,570 127% 144,023,658 156,391,172 109% 127% 109% 1.17251,310,025 207,944,037 83% 234,008,780 159,986,353 68% 83% 68% 1.21

HistoryFuture

Lifetime

with 4.5% interest with 5.60% interest

Historical Experience

Projected Future

Experience (60 Years)

Incurred Claims

Incurred Loss Ratio

with 4.5% Interest

with 5.60% Interest

Calendar Year Earned Premium Incurred Claims

Incurred Loss Ratio

End of Year Lives

End of Year Lives

Actual-to-Expected

Ratio

All Policies Combined

with valuation interest

Exhibit I-aMedAmerica Insurance Company

Actual to Expected Experience by Calendar YearCombined Nationwide Experience Before Requested Increase

All FlexCare Policy Forms

Actual or Projected Experience using Current Assumptions Expected Experience using Pricing Assumptions Cumulative Loss Ratios

Earned Premium

HistoryFuture

Lifetimewith valuation interest

Actuarial Memorandum MedAmerica Insurance Company



2011 43,992 - 0% 103 44,660 512 1% 105 0% 1% 0.002012 424,943 - 0% 447 428,488 4,905 1% 449 0% 1% 0.002013 1,471,905 - 0% 1,228 1,438,065 19,894 1% 1,230 0% 1% 0.002014 5,234,886 19,489 0% 2,836 5,201,027 68,698 1% 2,859 0% 1% 0.162015 10,067,138 24,499 0% 4,475 9,931,838 154,879 2% 4,440 0% 1% 0.142016 12,699,598 6,732 0% 4,387 12,414,773 261,471 2% 4,309 0% 2% 0.082017 12,250,740 825,237 7% 4,179 11,874,051 370,089 3% 4,143 2% 2% 0.842018 11,972,922 847,969 7% 4,086 11,478,013 496,820 4% 4,026 3% 3% 1.092019 11,718,027 797,108 7% 3,998 11,191,475 647,353 6% 3,941 3% 3% 1.112020 11,507,372 639,330 6% 3,958 11,013,468 819,043 7% 3,877 4% 4% 1.032021 11,393,198 817,147 7% 3,921 10,815,593 993,886 9% 3,821 4% 4% 0.992022 11,239,968 1,033,749 9% 3,882 10,618,500 1,188,474 11% 3,761 5% 5% 0.982023 10,975,738 1,289,553 12% 3,842 10,331,585 1,407,953 14% 3,698 5% 5% 1.002024 9,868,922 1,573,331 16% 3,799 9,295,804 1,684,969 18% 3,629 6% 6% 1.022025 8,491,780 1,881,930 22% 3,753 7,902,659 1,984,446 25% 3,553 7% 7% 1.052026 7,504,111 2,230,040 30% 3,704 6,857,716 2,288,436 33% 3,468 9% 8% 1.092027 7,367,319 2,630,395 36% 3,650 6,641,316 2,608,153 39% 3,380 10% 9% 1.142028 7,227,457 3,086,187 43% 3,593 6,446,063 2,969,128 46% 3,289 12% 10% 1.192029 7,077,353 3,598,088 51% 3,531 6,210,654 3,337,225 54% 3,196 14% 11% 1.252030 6,916,976 4,190,171 61% 3,465 5,988,415 3,743,532 63% 3,100 16% 12% 1.322031 6,744,595 4,865,872 72% 3,394 5,760,089 4,193,091 73% 3,000 19% 14% 1.392032 6,553,757 5,609,138 86% 3,317 5,535,271 4,701,831 85% 2,898 22% 15% 1.472033 6,324,759 6,417,148 101% 3,235 5,255,063 5,223,513 99% 2,793 25% 16% 1.552034 5,989,376 7,284,450 122% 3,146 4,895,918 5,783,353 118% 2,685 29% 18% 1.642035 5,575,022 8,195,803 147% 3,051 4,494,246 6,370,353 142% 2,575 33% 19% 1.732036 5,213,263 9,130,940 175% 2,950 4,150,715 6,986,987 168% 2,462 38% 21% 1.832037 4,972,698 10,074,759 203% 2,843 3,898,338 7,565,346 194% 2,347 43% 22% 1.932038 4,721,639 11,013,505 233% 2,730 3,657,603 8,162,025 223% 2,231 49% 24% 2.032039 4,461,204 11,915,296 267% 2,611 3,417,551 8,741,251 256% 2,114 55% 26% 2.142040 4,193,089 12,749,090 304% 2,487 3,188,363 9,305,213 292% 1,996 61% 27% 2.242041 3,919,309 13,493,706 344% 2,360 2,944,464 9,764,409 332% 1,878 68% 29% 2.352042 3,642,471 14,139,510 388% 2,229 2,714,079 10,196,574 376% 1,761 75% 31% 2.452043 3,365,453 14,668,829 436% 2,095 2,489,590 10,559,234 424% 1,644 83% 32% 2.562044 3,091,247 15,073,412 488% 1,961 2,278,754 10,858,008 476% 1,530 90% 34% 2.662045 2,822,445 15,366,048 544% 1,827 2,063,486 11,015,523 534% 1,418 98% 35% 2.762046 2,561,797 15,537,445 607% 1,694 1,864,253 11,113,249 596% 1,309 105% 37% 2.862047 2,311,624 15,588,613 674% 1,564 1,675,572 11,140,320 665% 1,203 113% 38% 2.962048 2,073,739 15,498,839 747% 1,436 1,502,482 11,100,854 739% 1,101 121% 40% 3.062049 1,849,791 15,287,884 826% 1,313 1,332,712 10,894,607 817% 1,004 129% 41% 3.162050 1,641,087 14,979,046 913% 1,195 1,179,456 10,643,367 902% 912 136% 42% 3.252051 1,448,207 14,561,877 1006% 1,083 1,038,593 10,310,761 993% 825 143% 43% 3.342052 1,271,354 14,058,449 1106% 977 912,690 9,940,385 1089% 744 150% 44% 3.432053 1,110,474 13,459,831 1212% 877 793,669 9,443,468 1190% 668 157% 45% 3.522054 965,295 12,773,446 1323% 785 688,987 8,922,170 1295% 598 164% 45% 3.602055 835,168 12,026,249 1440% 699 595,510 8,372,832 1406% 533 170% 46% 3.682056 719,249 11,243,874 1563% 621 514,093 7,826,853 1522% 474 175% 47% 3.752057 616,800 10,450,739 1694% 549 439,590 7,231,700 1645% 420 181% 47% 3.822058 526,855 9,647,750 1831% 484 375,677 6,655,575 1772% 371 185% 48% 3.892059 448,422 8,868,638 1978% 426 320,076 6,097,180 1905% 327 190% 48% 3.952060 380,494 8,138,271 2139% 373 272,768 5,585,433 2048% 288 194% 48% 4.002061 322,038 7,469,834 2320% 327 230,590 5,075,549 2201% 253 198% 49% 4.062062 271,997 6,843,224 2516% 285 195,137 4,618,463 2367% 222 201% 49% 4.102063 229,334 6,245,747 2723% 249 164,890 4,194,191 2544% 194 204% 49% 4.152064 193,132 5,687,963 2945% 217 139,569 3,818,104 2736% 170 207% 49% 4.192065 162,481 5,166,746 3180% 188 117,332 3,455,304 2945% 148 210% 50% 4.232066 136,539 4,684,026 3431% 163 98,824 3,138,888 3176% 129 212% 50% 4.272067 114,558 4,246,859 3707% 141 83,142 2,848,317 3426% 112 215% 50% 4.302068 95,895 3,839,378 4004% 122 70,052 2,593,114 3702% 97 217% 50% 4.332069 80,042 3,460,657 4324% 105 58,574 2,344,511 4003% 84 218% 50% 4.362070 66,569 3,101,817 4660% 91 49,000 2,120,557 4328% 73 220% 50% 4.382071 55,135 2,760,674 5007% 77 40,867 1,915,200 4686% 63 221% 50% 4.412072 45,431 2,439,157 5369% 66 34,057 1,725,875 5068% 54 223% 50% 4.432073 37,202 2,135,974 5742% 56 28,092 1,540,117 5482% 46 224% 50% 4.442074 30,262 1,850,656 6116% 47 23,121 1,368,565 5919% 39 225% 50% 4.462075 24,435 1,583,965 6482% 39 18,918 1,203,924 6364% 33 225% 50% 4.472076 19,560 1,338,235 6842% 32 15,424 1,055,190 6841% 28 226% 50% 4.482077 15,518 1,115,438 7188% 27 12,414 910,968 7338% 23 227% 50% 4.492078 12,200 918,045 7525% 22 9,946 782,073 7863% 19 227% 50% 4.502079 9,501 745,096 7842% 17 7,906 665,230 8414% 16 227% 50% 4.51

74,815,300 2,704,471 4% 75,061,264 2,272,032 3% 4% 3% 1.19120,027,164 139,300,976 116% 97,440,313 84,826,624 87% 116% 87% 1.33194,842,464 142,005,447 73% 172,501,577 87,098,656 50% 73% 50% 1.44

72,834,307 2,664,974 4% 70,807,899 2,177,943 3% 4% 3% 1.19130,701,842 173,553,632 133% 114,781,018 131,425,524 115% 133% 115% 1.16203,536,149 176,218,606 87% 185,588,917 133,603,466 72% 87% 72% 1.20

HistoryFuture

Lifetime

All Policies at All Issue Ages With Inflation Protection





Incurred Loss Ratio

End of Year Lives

Actual-to-Expected

RatioCalendar

Year Earned Premium Incurred ClaimsIncurred

Loss RatioEnd of

Year LivesEarned

Premium Incurred Claimswith 4.5% Interest

with 5.60% Interest


Projected Future


Lifetimewith valuation interest with valuation interest

with 4.5% interest with 5.60% interestHistoryFuture



2011 27,753 - 0% 64 27,907 965 3% 65 0% 3% 0.002012 206,161 - 0% 327 214,222 6,419 3% 345 0% 3% 0.002013 682,476 - 0% 1,010 754,066 22,118 3% 1,142 0% 3% 0.002014 1,572,715 - 0% 1,418 1,695,891 58,277 3% 1,580 0% 3% 0.002015 2,511,072 - 0% 1,718 2,684,803 115,056 4% 1,910 0% 4% 0.002016 2,965,111 3,055 0% 1,523 3,141,659 179,148 6% 1,842 0% 4% 0.012017 2,861,826 94,646 3% 1,403 2,997,873 241,599 8% 1,775 1% 5% 0.142018 2,792,757 190,380 7% 1,346 2,889,715 307,925 11% 1,728 2% 6% 0.292019 2,719,455 729,329 27% 1,336 2,804,685 377,500 13% 1,691 5% 7% 0.752020 2,654,229 516,424 19% 1,311 2,741,138 450,091 16% 1,659 7% 8% 0.862021 2,596,622 614,767 24% 1,288 2,668,227 521,410 20% 1,628 9% 9% 0.962022 2,535,429 719,313 28% 1,265 2,600,984 600,346 23% 1,595 11% 11% 1.052023 2,448,530 826,515 34% 1,239 2,500,086 685,216 27% 1,559 13% 12% 1.122024 2,312,163 929,946 40% 1,212 2,365,210 785,677 33% 1,519 15% 13% 1.192025 2,156,147 1,026,445 48% 1,184 2,192,803 886,427 40% 1,476 18% 14% 1.252026 2,022,369 1,119,950 55% 1,154 2,044,353 967,905 47% 1,429 20% 16% 1.302027 1,943,428 1,215,034 63% 1,122 1,945,085 1,034,434 53% 1,381 23% 17% 1.362028 1,863,064 1,310,705 70% 1,088 1,851,258 1,106,564 60% 1,332 26% 18% 1.412029 1,780,658 1,405,962 79% 1,053 1,747,326 1,172,276 67% 1,283 29% 20% 1.472030 1,696,827 1,509,484 89% 1,017 1,649,123 1,241,270 75% 1,232 32% 21% 1.532031 1,611,662 1,618,042 100% 979 1,551,703 1,309,017 84% 1,182 35% 22% 1.592032 1,524,616 1,723,471 113% 940 1,458,190 1,380,110 95% 1,130 39% 24% 1.652033 1,432,681 1,823,813 127% 900 1,353,936 1,442,059 107% 1,079 43% 25% 1.712034 1,339,645 1,917,225 143% 858 1,254,403 1,504,270 120% 1,027 47% 26% 1.782035 1,237,563 2,002,857 162% 816 1,148,409 1,559,056 136% 976 51% 27% 1.842036 1,135,430 2,077,228 183% 773 1,048,228 1,608,281 153% 924 55% 29% 1.912037 1,050,430 2,136,974 203% 729 961,188 1,640,293 171% 873 59% 30% 1.982038 967,166 2,177,098 225% 685 880,394 1,666,402 189% 823 64% 31% 2.042039 885,872 2,195,783 248% 641 802,980 1,680,841 209% 773 68% 32% 2.112040 807,030 2,197,878 272% 598 731,274 1,688,441 231% 725 72% 33% 2.182041 731,230 2,180,357 298% 555 659,282 1,677,688 254% 677 77% 34% 2.242042 658,901 2,142,770 325% 513 593,406 1,659,300 280% 631 81% 35% 2.302043 590,346 2,086,408 353% 473 531,706 1,624,913 306% 587 85% 36% 2.362044 525,918 2,011,840 383% 433 475,618 1,583,040 333% 544 90% 37% 2.422045 465,883 1,927,146 414% 396 421,105 1,522,542 362% 503 94% 38% 2.482046 410,277 1,829,227 446% 360 372,226 1,456,695 391% 464 97% 38% 2.532047 359,166 1,719,664 479% 326 327,567 1,379,894 421% 427 101% 39% 2.582048 312,592 1,602,833 513% 294 287,851 1,304,434 453% 392 104% 40% 2.632049 270,517 1,478,693 547% 264 250,459 1,216,646 486% 359 107% 40% 2.672050 232,870 1,354,869 582% 237 217,687 1,128,797 519% 328 110% 41% 2.712051 199,436 1,232,992 618% 211 188,500 1,038,842 551% 299 113% 41% 2.752052 169,984 1,115,054 656% 188 163,133 952,782 584% 272 115% 41% 2.782053 144,242 1,003,370 696% 167 139,927 865,061 618% 247 117% 42% 2.822054 121,927 895,347 734% 148 120,033 782,187 652% 224 119% 42% 2.842055 102,733 794,418 773% 131 102,721 703,666 685% 203 121% 42% 2.872056 86,312 702,183 814% 115 87,989 632,002 718% 184 122% 42% 2.892057 72,346 619,314 856% 102 74,820 562,875 752% 166 123% 42% 2.912058 60,523 544,924 900% 89 63,738 501,137 786% 149 125% 42% 2.932059 50,564 477,628 945% 79 54,259 444,602 819% 135 126% 43% 2.952060 42,212 418,169 991% 69 46,309 394,160 851% 121 126% 43% 2.962061 35,237 365,257 1037% 61 39,293 346,750 882% 109 127% 43% 2.982062 29,420 319,870 1087% 54 33,447 306,251 916% 98 128% 43% 2.992063 24,585 279,791 1138% 48 28,483 270,029 948% 88 129% 43% 3.002064 20,571 242,769 1180% 42 24,340 238,104 978% 78 129% 43% 3.012065 17,241 210,392 1220% 37 20,692 209,469 1012% 70 129% 43% 3.012066 14,472 183,025 1265% 33 17,651 184,992 1048% 63 130% 43% 3.022067 12,167 160,568 1320% 29 15,062 164,948 1095% 56 130% 43% 3.032068 10,235 140,696 1375% 25 12,888 148,933 1156% 49 131% 43% 3.032069 8,606 122,574 1424% 22 10,957 134,115 1224% 44 131% 43% 3.042070 7,229 106,838 1478% 20 9,331 121,008 1297% 38 131% 43% 3.042071 6,062 93,224 1538% 17 7,930 109,203 1377% 34 131% 43% 3.042072 5,063 81,077 1601% 15 6,739 98,831 1466% 29 131% 43% 3.052073 4,209 69,903 1661% 13 5,674 88,599 1562% 26 132% 43% 3.052074 3,481 59,726 1716% 11 4,769 78,813 1653% 22 132% 43% 3.052075 2,862 50,613 1768% 10 3,988 69,747 1749% 19 132% 43% 3.062076 2,339 42,722 1827% 8 3,325 60,890 1831% 16 132% 43% 3.062077 1,897 35,906 1893% 7 2,738 52,417 1915% 14 132% 43% 3.062078 1,526 29,836 1955% 6 2,245 44,969 2003% 12 132% 43% 3.062079 1,217 24,463 2011% 5 1,826 38,025 2082% 10 132% 43% 3.06

18,717,371 1,058,153 6% 20,415,658 1,484,102 7% 6% 7% 0.7827,352,531 26,292,118 96% 24,964,823 18,095,931 72% 96% 72% 1.3346,069,902 27,350,270 59% 45,380,481 19,580,032 43% 59% 43% 1.38

18,187,429 1,049,492 6% 19,177,224 1,417,238 7% 6% 7% 0.7829,586,447 30,675,938 104% 29,242,640 24,965,649 85% 104% 85% 1.2147,773,876 31,725,430 66% 48,419,863 26,382,886 54% 66% 54% 1.22

HistoryFuture

Lifetime

All Policies at All Issue Ages Without Inflation Protection





Incurred Loss Ratio

End of Year Lives

Actual-to-Expected

RatioCalendar


Loss RatioEnd of

Year LivesEarned


with 5.60% Interest


Projected Future






2011 71,745 - 0% 167 72,567 1,477 2% 170 0% 2% 0.002012 631,103 - 0% 774 642,710 11,325 2% 794 0% 2% 0.002013 2,154,381 - 0% 2,238 2,192,132 42,012 2% 2,372 0% 2% 0.002014 6,807,602 19,489 0% 4,254 6,896,918 126,975 2% 4,438 0% 2% 0.082015 12,578,210 24,499 0% 6,193 12,616,641 269,935 2% 6,351 0% 2% 0.082016 15,664,709 9,787 0% 5,910 15,556,432 440,619 3% 6,152 0% 2% 0.052017 15,112,566 919,884 6% 5,582 14,871,924 611,688 4% 5,919 2% 3% 0.552018 14,765,679 1,038,348 7% 5,432 14,367,728 804,745 6% 5,753 3% 3% 0.772019 14,437,483 1,526,437 11% 5,334 13,996,160 1,024,854 7% 5,633 4% 4% 0.962020 14,161,600 1,155,754 8% 5,269 13,754,606 1,269,134 9% 5,536 4% 5% 0.952021 17,148,673 1,412,421 8% 5,041 13,483,821 1,515,296 11% 5,449 5% 5% 0.942022 16,895,375 1,728,019 10% 4,980 13,219,484 1,788,820 14% 5,356 6% 6% 0.942023 16,472,437 2,084,462 13% 4,916 12,831,671 2,093,169 16% 5,257 6% 7% 0.962024 14,915,412 2,464,329 17% 4,847 11,661,013 2,470,647 21% 5,148 8% 8% 0.992025 12,993,576 2,861,220 22% 4,774 10,095,462 2,870,872 28% 5,028 9% 9% 1.012026 11,591,878 3,293,262 28% 4,696 8,902,069 3,256,341 37% 4,897 10% 10% 1.052027 11,345,126 3,777,203 33% 4,613 8,586,401 3,642,587 42% 4,761 12% 11% 1.082028 11,093,844 4,314,960 39% 4,524 8,297,321 4,075,692 49% 4,622 13% 12% 1.132029 10,827,944 4,905,911 45% 4,430 7,957,980 4,509,501 57% 4,479 15% 13% 1.172030 10,547,935 5,581,747 53% 4,330 7,637,538 4,984,802 65% 4,332 17% 14% 1.222031 10,251,595 6,342,128 62% 4,223 7,311,793 5,502,108 75% 4,182 20% 15% 1.282032 9,929,819 7,162,989 72% 4,110 6,993,461 6,081,941 87% 4,028 22% 17% 1.342033 9,553,986 8,039,634 84% 3,990 6,608,999 6,665,572 101% 3,872 25% 18% 1.402034 9,040,605 8,964,866 99% 3,863 6,150,321 7,287,623 118% 3,712 29% 20% 1.472035 8,413,635 9,922,854 118% 3,729 5,642,655 7,929,410 141% 3,550 32% 21% 1.542036 7,853,964 10,890,042 139% 3,589 5,198,944 8,595,268 165% 3,386 36% 22% 1.622037 7,470,504 11,848,267 159% 3,442 4,859,526 9,205,639 189% 3,221 41% 24% 1.692038 7,074,617 12,779,820 181% 3,289 4,537,997 9,828,427 217% 3,054 45% 26% 1.772039 6,667,624 13,653,032 205% 3,131 4,220,530 10,422,093 247% 2,887 50% 27% 1.852040 6,251,899 14,443,271 231% 2,969 3,919,637 10,993,653 280% 2,721 55% 29% 1.932041 5,830,377 15,127,644 259% 2,804 3,603,747 11,442,097 318% 2,556 61% 30% 2.012042 5,406,654 15,697,394 290% 2,637 3,307,486 11,855,874 358% 2,392 66% 32% 2.092043 4,984,616 16,138,025 324% 2,469 3,021,295 12,184,147 403% 2,231 72% 33% 2.172044 4,568,479 16,443,147 360% 2,302 2,754,371 12,441,049 452% 2,074 78% 35% 2.252045 4,162,020 16,632,970 400% 2,136 2,484,591 12,538,065 505% 1,921 84% 36% 2.332046 3,769,041 16,695,396 443% 1,973 2,236,480 12,569,944 562% 1,773 90% 37% 2.412047 3,392,868 16,632,758 490% 1,815 2,003,138 12,520,214 625% 1,630 96% 38% 2.492048 3,036,166 16,429,249 541% 1,662 1,790,333 12,405,287 693% 1,493 101% 40% 2.562049 2,701,312 16,103,674 596% 1,515 1,583,170 12,111,253 765% 1,363 107% 41% 2.642050 2,390,191 15,685,530 656% 1,375 1,397,143 11,772,164 843% 1,240 113% 42% 2.712051 2,103,566 15,166,123 721% 1,243 1,227,092 11,349,603 925% 1,124 118% 42% 2.782052 1,841,660 14,568,354 791% 1,118 1,075,823 10,893,167 1013% 1,016 123% 43% 2.852053 1,604,279 13,885,687 866% 1,003 933,596 10,308,528 1104% 915 128% 44% 2.912054 1,390,887 13,122,593 943% 895 809,020 9,704,357 1200% 822 133% 45% 2.972055 1,200,401 12,308,131 1025% 797 698,231 9,076,498 1300% 736 137% 45% 3.032056 1,031,399 11,468,363 1112% 707 602,082 8,458,856 1405% 657 142% 46% 3.092057 882,613 10,627,325 1204% 625 514,410 7,794,575 1515% 585 145% 46% 3.142058 752,463 9,785,003 1300% 551 439,415 7,156,712 1629% 520 149% 47% 3.192059 639,361 8,972,433 1403% 484 374,335 6,541,782 1748% 462 152% 47% 3.242060 541,717 8,214,191 1516% 425 319,076 5,979,593 1874% 409 155% 47% 3.282061 457,928 7,521,691 1643% 372 269,883 5,422,299 2009% 362 158% 48% 3.322062 386,380 6,876,572 1780% 326 228,583 4,924,714 2154% 319 160% 48% 3.362063 325,521 6,264,517 1924% 284 193,373 4,464,220 2309% 282 163% 48% 3.392064 273,982 5,693,503 2078% 248 163,909 4,056,207 2475% 248 165% 48% 3.422065 230,425 5,162,052 2240% 216 138,024 3,664,774 2655% 218 167% 48% 3.452066 193,616 4,672,368 2413% 188 116,475 3,323,880 2854% 191 168% 48% 3.482067 162,475 4,231,130 2604% 164 98,203 3,013,265 3068% 168 170% 48% 3.502068 136,063 3,820,871 2808% 142 82,941 2,742,047 3306% 147 171% 49% 3.532069 113,643 3,439,902 3027% 123 69,531 2,478,626 3565% 128 172% 49% 3.552070 94,596 3,080,309 3256% 106 58,331 2,241,564 3843% 111 174% 49% 3.572071 78,434 2,739,742 3493% 91 48,796 2,024,402 4149% 96 175% 49% 3.582072 64,708 2,419,425 3739% 78 40,796 1,824,706 4473% 83 175% 49% 3.602073 53,061 2,117,642 3991% 66 33,766 1,628,717 4824% 72 176% 49% 3.612074 43,228 1,833,966 4243% 56 27,890 1,447,379 5190% 61 177% 49% 3.622075 34,964 1,569,195 4488% 47 22,906 1,273,671 5560% 52 178% 49% 3.632076 28,043 1,325,719 4727% 39 18,749 1,116,080 5953% 44 178% 49% 3.642077 22,296 1,105,290 4957% 32 15,152 963,385 6358% 37 178% 49% 3.652078 17,569 909,966 5179% 26 12,191 827,042 6784% 31 179% 49% 3.652079 13,715 738,777 5387% 21 9,733 703,255 7226% 25 179% 49% 3.66

93,532,671 3,762,624 4% 95,476,922 3,756,134 4% 4% 4% 1.02178,164,646 160,285,817 90% 122,405,137 102,922,554 84% 90% 84% 1.07271,697,317 164,048,440 60% 217,882,058 106,678,688 49% 60% 49% 1.23

91,021,736 3,714,466 4% 89,985,122 3,595,181 4% 4% 4% 1.02194,165,791 197,532,419 102% 144,023,658 156,391,172 109% 102% 109% 0.94285,187,527 201,246,885 71% 234,008,780 159,986,353 68% 71% 68% 1.03

HistoryFuture

Lifetime



with 4.5% Interest

with 5.60% Interest


Projected Future


Calendar Year Earned Premium Incurred Claims

Incurred Loss Ratio

End of Year Lives

Earned Premium Incurred Claims


Incurred Loss Ratio

End of Year Lives

Actual-to-Expected

Ratio

All Policies Combined

Exhibit I-bMedAmerica Insurance Company

Actual to Expected Experience by Calendar YearCombined Nationwide Experience After Requested Increase




2011 43,992 - 0% 103 44,660 512 1% 105 0% 1% 0.002012 424,943 - 0% 447 428,488 4,905 1% 449 0% 1% 0.002013 1,471,905 - 0% 1,228 1,438,065 19,894 1% 1,230 0% 1% 0.002014 5,234,886 19,489 0% 2,836 5,201,027 68,698 1% 2,859 0% 1% 0.162015 10,067,138 24,499 0% 4,475 9,931,838 154,879 2% 4,440 0% 1% 0.142016 12,699,598 6,732 0% 4,387 12,414,773 261,471 2% 4,309 0% 2% 0.082017 12,250,740 825,237 7% 4,179 11,874,051 370,089 3% 4,143 2% 2% 0.842018 11,972,922 847,969 7% 4,086 11,478,013 496,820 4% 4,026 3% 3% 1.092019 11,718,027 797,108 7% 3,998 11,191,475 647,353 6% 3,941 3% 3% 1.112020 11,507,372 639,330 6% 3,958 11,013,468 819,043 7% 3,877 4% 4% 1.032021 14,339,413 802,225 6% 3,786 10,815,593 993,886 9% 3,821 4% 4% 0.962022 14,149,715 1,014,425 7% 3,749 10,618,500 1,188,474 11% 3,761 4% 5% 0.932023 13,819,413 1,264,957 9% 3,710 10,331,585 1,407,953 14% 3,698 5% 5% 0.922024 12,409,892 1,542,788 12% 3,668 9,295,804 1,684,969 18% 3,629 6% 6% 0.932025 10,658,234 1,844,710 17% 3,623 7,902,659 1,984,446 25% 3,553 7% 7% 0.952026 9,399,605 2,184,984 23% 3,575 6,857,716 2,288,436 33% 3,468 8% 8% 0.982027 9,234,876 2,575,861 28% 3,523 6,641,316 2,608,153 39% 3,380 9% 9% 1.022028 9,067,077 3,020,278 33% 3,467 6,446,063 2,969,128 46% 3,289 11% 10% 1.062029 8,886,906 3,518,669 40% 3,407 6,210,654 3,337,225 54% 3,196 12% 11% 1.102030 8,694,253 4,094,216 47% 3,343 5,988,415 3,743,532 63% 3,100 14% 12% 1.162031 8,486,847 4,749,810 56% 3,273 5,760,089 4,193,091 73% 3,000 17% 14% 1.222032 8,256,274 5,469,441 66% 3,199 5,535,271 4,701,831 85% 2,898 19% 15% 1.282033 7,977,334 6,250,316 78% 3,118 5,255,063 5,223,513 99% 2,793 22% 16% 1.352034 7,562,406 7,087,017 94% 3,032 4,895,918 5,783,353 118% 2,685 25% 18% 1.422035 7,044,731 7,964,508 113% 2,940 4,494,246 6,370,353 142% 2,575 29% 19% 1.502036 6,594,855 8,862,638 134% 2,842 4,150,715 6,986,987 168% 2,462 33% 21% 1.582037 6,301,895 9,766,402 155% 2,737 3,898,338 7,565,346 194% 2,347 37% 22% 1.662038 5,995,065 10,662,773 178% 2,628 3,657,603 8,162,025 223% 2,231 42% 24% 1.742039 5,675,479 11,521,649 203% 2,513 3,417,551 8,741,251 256% 2,114 47% 26% 1.832040 5,345,004 12,313,546 230% 2,393 3,188,363 9,305,213 292% 1,996 52% 27% 1.922041 5,005,928 13,018,345 260% 2,269 2,944,464 9,764,409 332% 1,878 58% 29% 2.002042 4,661,363 13,627,528 292% 2,143 2,714,079 10,196,574 376% 1,761 64% 31% 2.092043 4,314,826 14,125,222 327% 2,014 2,489,590 10,559,234 424% 1,644 70% 32% 2.172044 3,970,085 14,504,391 365% 1,885 2,278,754 10,858,008 476% 1,530 77% 34% 2.262045 3,630,553 14,777,495 407% 1,755 2,063,486 11,015,523 534% 1,418 83% 35% 2.342046 3,299,915 14,935,477 453% 1,627 1,864,253 11,113,249 596% 1,309 89% 37% 2.432047 2,981,344 14,979,214 502% 1,502 1,675,572 11,140,320 665% 1,203 96% 38% 2.512048 2,677,375 14,888,751 556% 1,379 1,502,482 11,100,854 739% 1,101 102% 40% 2.592049 2,390,354 14,682,989 614% 1,261 1,332,712 10,894,607 817% 1,004 109% 41% 2.672050 2,122,184 14,384,155 678% 1,148 1,179,456 10,643,367 902% 912 115% 42% 2.752051 1,873,818 13,982,038 746% 1,040 1,038,593 10,310,761 993% 825 121% 43% 2.822052 1,645,696 13,497,668 820% 938 912,690 9,940,385 1089% 744 127% 44% 2.892053 1,437,900 12,922,322 899% 842 793,669 9,443,468 1190% 668 133% 45% 2.972054 1,250,193 12,262,992 981% 753 688,987 8,922,170 1295% 598 138% 45% 3.032055 1,081,823 11,545,454 1067% 671 595,510 8,372,832 1406% 533 143% 46% 3.102056 931,757 10,794,249 1158% 596 514,093 7,826,853 1522% 474 148% 47% 3.162057 799,085 10,032,775 1256% 527 439,590 7,231,700 1645% 420 152% 47% 3.222058 682,581 9,261,872 1357% 465 375,677 6,655,575 1772% 371 156% 48% 3.272059 580,976 8,513,908 1465% 409 320,076 6,097,180 1905% 327 160% 48% 3.322060 492,974 7,812,747 1585% 358 272,768 5,585,433 2048% 288 163% 48% 3.372061 417,240 7,171,044 1719% 314 230,590 5,075,549 2201% 253 167% 49% 3.412062 352,407 6,569,497 1864% 274 195,137 4,618,463 2367% 222 169% 49% 3.452063 297,132 5,995,918 2018% 239 164,890 4,194,191 2544% 194 172% 49% 3.492064 250,228 5,460,444 2182% 208 139,569 3,818,104 2736% 170 174% 49% 3.532065 210,516 4,960,076 2356% 181 117,332 3,455,304 2945% 148 177% 50% 3.562066 176,904 4,496,665 2542% 157 98,824 3,138,888 3176% 129 179% 50% 3.592067 148,425 4,076,985 2747% 136 83,142 2,848,317 3426% 112 181% 50% 3.622068 124,245 3,685,803 2967% 117 70,052 2,593,114 3702% 97 182% 50% 3.642069 103,705 3,322,230 3204% 101 58,574 2,344,511 4003% 84 184% 50% 3.672070 86,249 2,977,744 3453% 87 49,000 2,120,557 4328% 73 185% 50% 3.692071 71,434 2,650,247 3710% 74 40,867 1,915,200 4686% 63 186% 50% 3.712072 58,861 2,341,591 3978% 63 34,057 1,725,875 5068% 54 187% 50% 3.722073 48,200 2,050,535 4254% 54 28,092 1,540,117 5482% 46 188% 50% 3.742074 39,208 1,776,629 4531% 45 23,121 1,368,565 5919% 39 189% 50% 3.752075 31,658 1,520,606 4803% 38 18,918 1,203,924 6364% 33 190% 50% 3.762076 25,343 1,284,706 5069% 31 15,424 1,055,190 6841% 28 190% 50% 3.772077 20,106 1,070,820 5326% 26 12,414 910,968 7338% 23 191% 50% 3.782078 15,807 881,323 5576% 21 9,946 782,073 7863% 19 191% 50% 3.782079 12,310 715,292 5811% 17 7,906 665,230 8414% 16 191% 50% 3.79

74,815,300 2,704,471 4% 75,061,264 2,272,032 3% 4% 3% 1.19148,489,072 134,604,444 91% 97,440,313 84,826,624 87% 91% 87% 1.04223,304,372 137,308,915 61% 172,501,577 87,098,656 50% 61% 50% 1.22

72,834,307 2,664,974 4% 70,807,899 2,177,943 3% 4% 3% 1.19162,019,009 167,598,985 103% 114,781,018 131,425,524 115% 103% 115% 0.90234,853,316 170,263,960 72% 185,588,917 133,603,466 72% 72% 72% 1.01

HistoryFuture

Lifetime

All Policies at All Issue Ages With Inflation Protection





Incurred Loss Ratio

End of Year Lives

Actual-to-Expected

RatioCalendar


Loss RatioEnd of

Year LivesEarned


with 5.60% Interest


Projected Future






2011 27,753 - 0% 64 27,907 965 3% 65 0% 3% 0.002012 206,161 - 0% 327 214,222 6,419 3% 345 0% 3% 0.002013 682,476 - 0% 1,010 754,066 22,118 3% 1,142 0% 3% 0.002014 1,572,715 - 0% 1,418 1,695,891 58,277 3% 1,580 0% 3% 0.002015 2,511,072 - 0% 1,718 2,684,803 115,056 4% 1,910 0% 4% 0.002016 2,965,111 3,055 0% 1,523 3,141,659 179,148 6% 1,842 0% 4% 0.012017 2,861,826 94,646 3% 1,403 2,997,873 241,599 8% 1,775 1% 5% 0.142018 2,792,757 190,380 7% 1,346 2,889,715 307,925 11% 1,728 2% 6% 0.292019 2,719,455 729,329 27% 1,336 2,804,685 377,500 13% 1,691 5% 7% 0.752020 2,654,229 516,424 19% 1,311 2,741,138 450,091 16% 1,659 7% 8% 0.862021 2,809,260 610,196 22% 1,254 2,668,227 521,410 20% 1,628 9% 9% 0.952022 2,745,660 713,594 26% 1,231 2,600,984 600,346 23% 1,595 11% 11% 1.032023 2,653,024 819,505 31% 1,206 2,500,086 685,216 27% 1,559 13% 12% 1.102024 2,505,520 921,541 37% 1,180 2,365,210 785,677 33% 1,519 15% 13% 1.162025 2,335,342 1,016,510 44% 1,151 2,192,803 886,427 40% 1,476 17% 14% 1.212026 2,192,274 1,108,278 51% 1,122 2,044,353 967,905 47% 1,429 20% 16% 1.262027 2,110,249 1,201,342 57% 1,090 1,945,085 1,034,434 53% 1,381 22% 17% 1.312028 2,026,766 1,294,682 64% 1,057 1,851,258 1,106,564 60% 1,332 25% 18% 1.352029 1,941,039 1,387,242 71% 1,023 1,747,326 1,172,276 67% 1,283 28% 20% 1.412030 1,853,681 1,487,531 80% 987 1,649,123 1,241,270 75% 1,232 31% 21% 1.462031 1,764,749 1,592,318 90% 950 1,551,703 1,309,017 84% 1,182 34% 22% 1.512032 1,673,545 1,693,548 101% 911 1,458,190 1,380,110 95% 1,130 37% 24% 1.572033 1,576,652 1,789,318 113% 872 1,353,936 1,442,059 107% 1,079 40% 25% 1.622034 1,478,199 1,877,849 127% 831 1,254,403 1,504,270 120% 1,027 44% 26% 1.682035 1,368,904 1,958,346 143% 789 1,148,409 1,559,056 136% 976 48% 27% 1.742036 1,259,109 2,027,403 161% 747 1,048,228 1,608,281 153% 924 52% 29% 1.802037 1,168,609 2,081,865 178% 704 961,188 1,640,293 171% 873 56% 30% 1.862038 1,079,552 2,117,047 196% 662 880,394 1,666,402 189% 823 60% 31% 1.922039 992,146 2,131,383 215% 619 802,980 1,680,841 209% 773 64% 32% 1.982040 906,896 2,129,725 235% 576 731,274 1,688,441 231% 725 68% 33% 2.042041 824,449 2,109,299 256% 535 659,282 1,677,688 254% 677 72% 34% 2.102042 745,290 2,069,866 278% 494 593,406 1,659,300 280% 631 76% 35% 2.152043 669,790 2,012,803 301% 455 531,706 1,624,913 306% 587 80% 36% 2.212044 598,394 1,938,755 324% 417 475,618 1,583,040 333% 544 84% 37% 2.262045 531,467 1,855,475 349% 380 421,105 1,522,542 362% 503 87% 38% 2.312046 469,126 1,759,918 375% 346 372,226 1,456,695 391% 464 91% 38% 2.362047 411,524 1,653,544 402% 313 327,567 1,379,894 421% 427 94% 39% 2.402048 358,791 1,540,498 429% 283 287,851 1,304,434 453% 392 97% 40% 2.442049 310,958 1,420,686 457% 254 250,459 1,216,646 486% 359 100% 40% 2.482050 268,006 1,301,375 486% 227 217,687 1,128,797 519% 328 102% 41% 2.522051 229,748 1,184,085 515% 203 188,500 1,038,842 551% 299 105% 41% 2.552052 195,964 1,070,686 546% 181 163,133 952,782 584% 272 107% 41% 2.582053 166,379 963,364 579% 160 139,927 865,061 618% 247 109% 42% 2.612054 140,695 859,602 611% 142 120,033 782,187 652% 224 110% 42% 2.642055 118,578 762,677 643% 125 102,721 703,666 685% 203 112% 42% 2.662056 99,642 674,114 677% 111 87,989 632,002 718% 184 113% 42% 2.682057 83,528 594,550 712% 98 74,820 562,875 752% 166 114% 42% 2.702058 69,883 523,131 749% 86 63,738 501,137 786% 149 115% 42% 2.722059 58,385 458,525 785% 76 54,259 444,602 819% 135 116% 43% 2.732060 48,743 401,443 824% 67 46,309 394,160 851% 121 117% 43% 2.742061 40,688 350,647 862% 59 39,293 346,750 882% 109 118% 43% 2.762062 33,973 307,076 904% 52 33,447 306,251 916% 98 118% 43% 2.772063 28,389 268,599 946% 46 28,483 270,029 948% 88 119% 43% 2.782064 23,754 233,058 981% 40 24,340 238,104 978% 78 119% 43% 2.782065 19,909 201,976 1014% 36 20,692 209,469 1012% 70 120% 43% 2.792066 16,712 175,704 1051% 31 17,651 184,992 1048% 63 120% 43% 2.802067 14,050 154,145 1097% 28 15,062 164,948 1095% 56 121% 43% 2.802068 11,818 135,068 1143% 24 12,888 148,933 1156% 49 121% 43% 2.812069 9,938 117,671 1184% 21 10,957 134,115 1224% 44 121% 43% 2.812070 8,347 102,565 1229% 19 9,331 121,008 1297% 38 121% 43% 2.822071 7,000 89,495 1279% 17 7,930 109,203 1377% 34 121% 43% 2.822072 5,847 77,834 1331% 14 6,739 98,831 1466% 29 122% 43% 2.822073 4,860 67,107 1381% 12 5,674 88,599 1562% 26 122% 43% 2.822074 4,020 57,337 1426% 11 4,769 78,813 1653% 22 122% 43% 2.832075 3,305 48,588 1470% 9 3,988 69,747 1749% 19 122% 43% 2.832076 2,700 41,013 1519% 8 3,325 60,890 1831% 16 122% 43% 2.832077 2,190 34,470 1574% 7 2,738 52,417 1915% 14 122% 43% 2.832078 1,762 28,643 1625% 6 2,245 44,969 2003% 12 122% 43% 2.832079 1,405 23,485 1672% 5 1,826 38,025 2082% 10 122% 43% 2.83

18,717,371 1,058,153 6% 20,415,658 1,484,102 7% 6% 7% 0.7829,675,574 25,681,373 87% 24,964,823 18,095,931 72% 87% 72% 1.1948,392,945 26,739,525 55% 45,380,481 19,580,032 43% 55% 43% 1.28

18,187,429 1,049,492 6% 19,177,224 1,417,238 7% 6% 7% 0.7832,146,782 29,933,433 93% 29,242,640 24,965,649 85% 93% 85% 1.0950,334,211 30,982,925 62% 48,419,863 26,382,886 54% 62% 54% 1.13

HistoryFuture

Lifetime

All Policies at All Issue Ages Without Inflation Protection





Incurred Loss Ratio

End of Year Lives

Actual-to-Expected

RatioCalendar


Loss RatioEnd of

Year LivesEarned


with 5.60% Interest


Projected Future




1 Accumulated value of initial earned premium 91,021,736 x 58% = 52,792,607

2a Accumulated value of earned premium 91,021,7362b Accumulated value of prior premium rate schedule increases (2a - 1 ) - x 85% = -

3 Present value of future projected initial earned premium 160,288,289 x 58% = 92,967,208

4a Present Value of future projected premium 194,165,7914b Present Value of future projected premium in excess of the projected initial earned premiums (4a - 3) 33,877,502 x 85% = 28,795,876

5 Lifetime Earned Premium Times Prescribed Factor: Sum of 1, 2b, 3, and 4b 174,555,691

6a Accumulated value of incurred claims without the inclusion of active life reserves 3,714,466 6b Present value of future projected incurred claims without the inclusion of active life reserves 197,532,419

7 Lifetime Incurred claims with Rate Increase: Sum of 6a and 6b 201,246,885

8 Test: 7 is not less than 5 Pass

Exhibit II-aDemonstration that the Requested Rate Increase Passes the 58%/85% Loss Ratio Minimum

MedAmerica Insurance Company Nationwide ExperienceFlexCare Policy Forms

All values are accumulated or discounted at the maximum valuation interest rate for contract reserves applicable for the year of issue, which ranges from 3.5 to 4.0% and averages 3.55%. Future projected initial earned premium schedule (i.e., without the requested rate increase) does not reflect the assumed impact of CBUL and RBO.

$204,229,570 - Present Value of Future Benefits (PVFB) for years 2020+ under current assumptions$161,423,114 - PVFB for years 2020+ under prior assumptions

$42,806,457 - Change in PVFB

$160,288,289 - Present value of future premiums (PVFP) for years 2020+ under current assumptions$144,514,685 - PVFP for years 2020+ under prior assumptions

$15,773,603 - Change in PVFP

$146,371,556 - PVFP for years 2021+ under prior assumptions (1/1/2021 is the assumed average effective date of the increase)

These projections include only active policyholders currently paying premium, and do not include any policyholders not paying premium, regardless of the reason.

Maximum Allowable Rate Increase Percentage

where C is the cumulative rate increase percentage to date, which is 0% for this block

max rate increase % = $42,806,457 - {(.58+.85*0) / (1+0)} * $15,773,603 = 27.1% PASSES the test as it is greater than the average rate increase request.85 * $146,371,556

Exhibit II-bDemonstration that the Requested Rate Increase Passes the Prospective Present Value (PPV) Approach

MedAmerica Insurance Company Nationwide ExperienceFlexCare Policy Forms

The PPV approach (also known as the Texas approach) calculates the required rate increase to fund the prospective deficient premium for active, premium-paying policyholders brought about by an actuarially supported change in assumption(s). We believe the PPV approach addresses the issue of the recoupment of past losses in LTC rate increase filings.

< 50 50-69 70+1 10.00% 5.00% 7.50%2 8.50% 4.00% 5.00%3 6.00% 3.00% 3.50%4 4.00% 2.00% 2.50%5 2.00% 1.50% 2.00%

6 + 1.00% 1.00% 1.00%

Benefit expiry was not separated from the lapse assumption.The 2017 Milliman Guidelines is the benefit expiry base assumption. Experience adjustment factors which vary by gender, benefit period, and attained age were applied to the base assumption. The benefit expiry factors by gender, attained age and benefit period in days range are presented in Section 6d.

Lifetime-Pay Lapse Rates

DurationIssue Age Band

For the limited pay options, smoothed scalars are applied to the lifetime-pay lapse rates developed from MedAmerica's organic business for all products. For the 10-year payment option, a reduction of 65% of these lapse rates is assumed for durations 1 to 4, a reduction of 70% of these lapse rates is assumed for durations 5 to 8, and 0% lapse thereafter. For the 20-year payment option, a reduction of 50% of these lapse rates is assumed for durations 1 to 8, a reduction of of 75% of these lapse rates for durations 9 to 15, and 0% lapse thereafter.

For the 10-year payment option, a reduction of 30% of these lapse rates is assumed for durations 1 to 5, and 0% lapse thereafter. For the 20-year payment option, a reduction of 30% of these lapse rates is assumed for durations 1-13, and 0% lapse thereafter.

Durational Lifetime-pay voluntary lapse rates by issue age band are presented in Section 6c of the actuarial memorandum.

Benefit Expiry

Mortality2012 Individual Annuity Mortality (IAM) Static using the G2 Scale to December 31, 2018. These mortality rates are further adjusted based on historical mortality experience by attained age, marital status, duration and gender. Tables providing these adjusted mortality rates are provided in Section 6b of the actuarial memorandum.

1994 Group Annuitant mortality (GAM) Table with selection factors that grade to 100% over 11 years.

Lapse RatesVoluntary lapse rates vary by duration and premium payment option and were developed based on historical experience for MedAmerica's FlexCare individual policies.

Voluntary lapse rates vary by duration, premium payment option, and issue age.

Exhibit IIIMedAmerica

Comparison of Current and Original Pricing AssumptionsFlexCare Policy Forms

Current Assumptions Original Pricing Assumptions

Annual improvement in the mortality and morbidity assumptions is assumed for 10 years starting in 2018. Annual mortality improvement improvement factors vary by attained age based on the G2 improvement scale from the 2012 Individual Annuity Mortality table. Annual morbidity improvement is assumed to be 1.0%.

No mortality or morbidity improvement was assumed.

Investment Return

The current best-estimate earnings rate assumption is 4.5%. This rate represents MedAmerica's expectation of its long-term investment earnings rate, which is supported by the average net investment earnings rate projected for MedAmerica's cash flow testing.

5.60%

The maximum valuation interest rate applicable to the year of issue ranges from 3.5% to 4.0% and averages 3.55%.

Improvement

MorbidityExpected claim costs are developed using the 2017 Milliman Long-Term Care Guidelines (LTCCGs) with adjustments for underwriting selection, an all-lives exposure basis, and four years of retrospective improvement to bring costs forward to 2018. The claim costs are further adjusted based on historical claim experience from a morbidity study with runout through December 31, 2018 by attained age, duration, and coverage-type, to the extent credible. All future projected claims were further adjusted to reflect the most recent emerging experience levels.

Original pricing expected nursing home and home health care incidence rates and continuance tables were taken from the Milliman 2009 Long-Term Care Cost Guidelines LTCCGs. All values were adjusted to reflect the effects of elimination periods, policy maximums, and the eligibility standards.

Exhibit IIIMedAmerica

Comparison of Current and Original Pricing AssumptionsFlexCare Policy Forms

Current Assumptions Original Pricing Assumptions



Issue Age

18-29 113.00 149.00 176.00 196.00 210.00 224.00 228.00 247.00 266.00 30 117.00 154.00 184.00 204.00 219.00 234.00 239.00 258.00 278.00 31 120.00 159.00 191.00 212.00 230.00 245.00 250.00 270.00 291.00 32 124.00 165.00 199.00 221.00 240.00 256.00 261.00 283.00 305.00 33 129.00 172.00 207.00 232.00 250.00 267.00 273.00 296.00 320.00 34 133.00 180.00 216.00 242.00 262.00 281.00 287.00 310.00 336.00 35 138.00 188.00 228.00 255.00 277.00 297.00 303.00 329.00 355.00 36 143.00 196.00 238.00 268.00 290.00 311.00 318.00 345.00 374.00 37 148.00 205.00 249.00 280.00 304.00 327.00 334.00 363.00 392.00 38 153.00 213.00 261.00 295.00 319.00 343.00 350.00 381.00 413.00 39 159.00 224.00 274.00 309.00 336.00 361.00 369.00 401.00 435.00 40 165.00 232.00 284.00 321.00 350.00 376.00 385.00 418.00 454.00 41 171.00 243.00 299.00 338.00 368.00 396.00 405.00 441.00 478.00 42 178.00 254.00 314.00 355.00 387.00 416.00 426.00 465.00 505.00 43 185.00 267.00 331.00 374.00 408.00 439.00 449.00 489.00 533.00 44 194.00 280.00 347.00 394.00 430.00 462.00 474.00 516.00 561.00 45 202.00 294.00 366.00 416.00 453.00 488.00 501.00 545.00 593.00 46 211.00 309.00 385.00 439.00 479.00 516.00 528.00 577.00 627.00 47 221.00 325.00 407.00 464.00 506.00 545.00 558.00 610.00 663.00 48 232.00 343.00 430.00 489.00 535.00 577.00 591.00 645.00 702.00 49 243.00 362.00 454.00 518.00 565.00 610.00 625.00 683.00 744.00 50 246.00 373.00 472.00 541.00 592.00 640.00 655.00 717.00 782.00 51 259.00 395.00 500.00 573.00 627.00 678.00 695.00 760.00 830.00 52 274.00 418.00 530.00 607.00 666.00 720.00 737.00 807.00 881.00 53 288.00 442.00 563.00 645.00 707.00 763.00 783.00 857.00 936.00 54 304.00 469.00 597.00 684.00 751.00 811.00 832.00 911.00 994.00 55 315.00 488.00 622.00 714.00 784.00 847.00 868.00 951.00 1,038.00 56 334.00 518.00 661.00 759.00 833.00 900.00 923.00 1,011.00 1,104.00 57 353.00 551.00 703.00 808.00 887.00 958.00 983.00 1,076.00 1,175.00 58 374.00 585.00 748.00 860.00 943.00 1,020.00 1,045.00 1,145.00 1,250.00 59 397.00 622.00 796.00 916.00 1,005.00 1,087.00 1,113.00 1,221.00 1,332.00 60 413.00 650.00 832.00 958.00 1,051.00 1,136.00 1,165.00 1,276.00 1,393.00 61 438.00 692.00 887.00 1,021.00 1,121.00 1,212.00 1,241.00 1,361.00 1,485.00 62 465.00 737.00 946.00 1,088.00 1,195.00 1,292.00 1,324.00 1,451.00 1,584.00 63 503.00 800.00 1,028.00 1,184.00 1,301.00 1,407.00 1,441.00 1,580.00 1,726.00 64 544.00 869.00 1,119.00 1,289.00 1,417.00 1,532.00 1,571.00 1,722.00 1,881.00 65 582.00 935.00 1,206.00 1,390.00 1,528.00 1,652.00 1,694.00 1,857.00 2,028.00 66 631.00 1,018.00 1,314.00 1,515.00 1,666.00 1,802.00 1,847.00 2,026.00 2,213.00 67 685.00 1,108.00 1,432.00 1,653.00 1,818.00 1,967.00 2,016.00 2,212.00 2,416.00 68 752.00 1,220.00 1,579.00 1,823.00 2,005.00 2,170.00 2,225.00 2,441.00 2,667.00 69 825.00 1,344.00 1,741.00 2,011.00 2,212.00 2,395.00 2,455.00 2,694.00 2,944.00 70 871.00 1,420.00 1,840.00 2,125.00 2,336.00 2,528.00 2,590.00 2,842.00 3,104.00 71 956.00 1,562.00 2,027.00 2,341.00 2,574.00 2,785.00 2,855.00 3,132.00 3,422.00 72 1,049.00 1,719.00 2,232.00 2,579.00 2,836.00 3,069.00 3,145.00 3,451.00 3,770.00 73 1,138.00 1,871.00 2,431.00 2,809.00 3,089.00 3,342.00 3,425.00 3,759.00 4,106.00 74 1,235.00 2,035.00 2,646.00 3,058.00 3,362.00 3,638.00 3,727.00 4,091.00 4,468.00 75 1,350.00 2,212.00 2,867.00 3,309.00 3,634.00 3,928.00 4,023.00 4,410.00 4,810.00 76 1,459.00 2,396.00 3,108.00 3,586.00 3,939.00 4,256.00 4,359.00 4,778.00 5,211.00 77 1,575.00 2,591.00 3,364.00 3,882.00 4,263.00 4,605.00 4,716.00 5,168.00 5,636.00 78 1,728.00 2,854.00 3,709.00 4,282.00 4,703.00 5,081.00 5,203.00 5,703.00 6,218.00 79 1,898.00 3,143.00 4,090.00 4,724.00 5,189.00 5,606.00 5,740.00 6,292.00 6,861.00 80 2,083.00 3,462.00 4,510.00 5,210.00 5,723.00 6,183.00 6,331.00 NA NA81 2,288.00 3,815.00 4,976.00 5,751.00 6,317.00 6,824.00 6,988.00 NA NA82 2,511.00 4,201.00 5,485.00 6,341.00 6,966.00 7,524.00 7,704.00 NA NA83 2,751.00 4,616.00 6,034.00 6,977.00 7,664.00 8,278.00 8,475.00 NA NA84 3,007.00 5,061.00 6,622.00 7,659.00 8,413.00 9,085.00 9,300.00 NA NA85 3,274.00 5,527.00 7,238.00 8,373.00 9,196.00 9,928.00 10,162.00 NA NA

Annual Premiums


Form Number: FC-336-PABase Annual Premiums for 100% HHC, 100% ALF, and 100% Adult Day Care Benefit

Current Rates Per $100 Daily Benefit Amount

1



Issue Age

18-29 711.00 1,213.00 1,613.00 1,896.00 2,110.00 2,305.00 2,385.00 2,623.00 2,884.00 30 713.00 1,219.00 1,621.00 1,905.00 2,123.00 2,318.00 2,396.00 2,638.00 2,900.00 31 723.00 1,237.00 1,643.00 1,933.00 2,150.00 2,349.00 2,429.00 2,673.00 2,939.00 32 732.00 1,253.00 1,665.00 1,959.00 2,180.00 2,381.00 2,462.00 2,709.00 2,977.00 33 741.00 1,270.00 1,689.00 1,985.00 2,209.00 2,413.00 2,496.00 2,745.00 3,017.00 34 751.00 1,286.00 1,711.00 2,011.00 2,239.00 2,446.00 2,529.00 2,784.00 3,058.00 35 696.00 1,198.00 1,594.00 1,875.00 2,086.00 2,280.00 2,358.00 2,595.00 2,853.00 36 706.00 1,214.00 1,616.00 1,899.00 2,115.00 2,310.00 2,388.00 2,629.00 2,889.00 37 715.00 1,229.00 1,637.00 1,925.00 2,143.00 2,340.00 2,421.00 2,663.00 2,929.00 38 725.00 1,246.00 1,658.00 1,949.00 2,173.00 2,373.00 2,455.00 2,700.00 2,967.00 39 734.00 1,262.00 1,681.00 1,977.00 2,201.00 2,404.00 2,487.00 2,736.00 3,006.00 40 682.00 1,176.00 1,568.00 1,845.00 2,055.00 2,244.00 2,321.00 2,555.00 2,808.00 41 691.00 1,191.00 1,589.00 1,869.00 2,082.00 2,274.00 2,351.00 2,587.00 2,844.00 42 700.00 1,208.00 1,610.00 1,895.00 2,110.00 2,305.00 2,383.00 2,622.00 2,881.00 43 710.00 1,224.00 1,631.00 1,920.00 2,138.00 2,336.00 2,416.00 2,659.00 2,920.00 44 719.00 1,240.00 1,653.00 1,945.00 2,167.00 2,368.00 2,447.00 2,694.00 2,960.00 45 675.00 1,169.00 1,560.00 1,836.00 2,046.00 2,235.00 2,311.00 2,544.00 2,795.00 46 685.00 1,184.00 1,580.00 1,859.00 2,072.00 2,263.00 2,342.00 2,576.00 2,831.00 47 693.00 1,199.00 1,600.00 1,883.00 2,099.00 2,294.00 2,373.00 2,610.00 2,868.00 48 701.00 1,215.00 1,621.00 1,909.00 2,126.00 2,323.00 2,403.00 2,645.00 2,906.00 49 711.00 1,230.00 1,642.00 1,934.00 2,156.00 2,355.00 2,436.00 2,680.00 2,944.00 50 675.00 1,172.00 1,566.00 1,844.00 2,056.00 2,246.00 2,325.00 2,558.00 2,810.00 51 683.00 1,187.00 1,586.00 1,868.00 2,084.00 2,276.00 2,354.00 2,591.00 2,845.00 52 691.00 1,201.00 1,606.00 1,893.00 2,109.00 2,305.00 2,385.00 2,624.00 2,882.00 53 700.00 1,216.00 1,626.00 1,916.00 2,136.00 2,335.00 2,416.00 2,657.00 2,918.00 54 708.00 1,232.00 1,646.00 1,941.00 2,164.00 2,365.00 2,447.00 2,691.00 2,956.00 55 676.00 1,178.00 1,577.00 1,858.00 2,071.00 2,263.00 2,343.00 2,577.00 2,830.00 56 683.00 1,192.00 1,596.00 1,881.00 2,097.00 2,293.00 2,373.00 2,609.00 2,865.00 57 691.00 1,205.00 1,615.00 1,903.00 2,122.00 2,320.00 2,400.00 2,640.00 2,900.00 58 698.00 1,219.00 1,634.00 1,926.00 2,148.00 2,348.00 2,431.00 2,673.00 2,935.00 59 705.00 1,233.00 1,653.00 1,948.00 2,174.00 2,376.00 2,460.00 2,704.00 2,969.00 60 679.00 1,189.00 1,594.00 1,880.00 2,098.00 2,294.00 2,374.00 2,610.00 2,866.00 61 685.00 1,201.00 1,611.00 1,900.00 2,121.00 2,318.00 2,401.00 2,639.00 2,898.00 62 691.00 1,212.00 1,627.00 1,922.00 2,144.00 2,344.00 2,427.00 2,668.00 2,929.00 63 705.00 1,238.00 1,664.00 1,965.00 2,192.00 2,397.00 2,484.00 2,731.00 2,997.00 64 720.00 1,265.00 1,700.00 2,010.00 2,243.00 2,453.00 2,541.00 2,795.00 3,067.00 65 704.00 1,239.00 1,667.00 1,971.00 2,202.00 2,409.00 2,496.00 2,744.00 3,012.00 66 717.00 1,262.00 1,701.00 2,013.00 2,249.00 2,461.00 2,551.00 2,804.00 3,079.00 67 729.00 1,287.00 1,735.00 2,054.00 2,296.00 2,513.00 2,606.00 2,864.00 3,145.00 68 746.00 1,319.00 1,780.00 2,110.00 2,359.00 2,583.00 2,678.00 2,945.00 3,234.00 69 763.00 1,351.00 1,826.00 2,165.00 2,423.00 2,652.00 2,752.00 3,026.00 3,324.00 70 755.00 1,338.00 1,808.00 2,143.00 2,399.00 2,626.00 2,726.00 2,995.00 3,288.00 71 770.00 1,367.00 1,848.00 2,194.00 2,457.00 2,691.00 2,793.00 3,070.00 3,369.00 72 784.00 1,395.00 1,889.00 2,243.00 2,513.00 2,753.00 2,860.00 3,143.00 3,451.00 73 792.00 1,411.00 1,912.00 2,273.00 2,548.00 2,793.00 2,901.00 3,188.00 3,501.00 74 797.00 1,424.00 1,933.00 2,300.00 2,580.00 2,827.00 2,940.00 3,230.00 3,546.00 75 800.00 1,433.00 1,948.00 2,318.00 2,600.00 2,849.00 2,963.00 3,252.00 3,566.00 76 801.00 1,439.00 1,959.00 2,335.00 2,619.00 2,871.00 2,987.00 3,278.00 3,594.00 77 799.00 1,441.00 1,965.00 2,344.00 2,632.00 2,887.00 3,005.00 3,297.00 3,614.00 78 804.00 1,454.00 1,989.00 2,377.00 2,671.00 2,932.00 3,055.00 3,350.00 3,674.00 79 805.00 1,464.00 2,008.00 2,404.00 2,706.00 2,971.00 3,100.00 3,399.00 3,726.00 80 804.00 1,469.00 2,021.00 2,426.00 2,734.00 3,004.00 3,137.00 NA NA81 800.00 1,469.00 2,029.00 2,441.00 2,756.00 3,032.00 3,169.00 NA NA82 791.00 1,462.00 2,028.00 2,447.00 2,767.00 3,048.00 3,190.00 NA NA83 777.00 1,448.00 2,017.00 2,442.00 2,767.00 3,051.00 3,198.00 NA NA84 759.00 1,425.00 1,996.00 2,425.00 2,754.00 3,041.00 3,192.00 NA NA85 736.00 1,394.00 1,964.00 2,395.00 2,727.00 3,015.00 3,171.00 NA NA



Annual Premiums

Base Annual Premiums for 100% HHC, 100% ALF, and 100% Adult Day Care BenefitCurrent Rates Per $100 Daily Benefit Amount

2



Issue Age

18-29 212.00 354.00 468.00 548.00 609.00 666.00 687.00 755.00 831.00 30 217.00 364.00 480.00 564.00 627.00 684.00 706.00 778.00 855.00 31 223.00 376.00 495.00 580.00 643.00 702.00 725.00 799.00 879.00 32 229.00 387.00 509.00 597.00 661.00 722.00 746.00 820.00 903.00 33 235.00 396.00 524.00 613.00 681.00 743.00 768.00 844.00 928.00 34 241.00 406.00 538.00 630.00 699.00 763.00 788.00 869.00 954.00 35 226.00 384.00 508.00 597.00 662.00 723.00 747.00 822.00 906.00 36 232.00 394.00 522.00 612.00 680.00 743.00 767.00 846.00 929.00 37 238.00 405.00 536.00 630.00 700.00 763.00 789.00 868.00 956.00 38 245.00 416.00 551.00 645.00 719.00 785.00 810.00 892.00 981.00 39 251.00 427.00 566.00 664.00 737.00 805.00 831.00 917.00 1,007.00 40 238.00 407.00 542.00 636.00 706.00 771.00 796.00 878.00 965.00 41 244.00 418.00 556.00 653.00 725.00 792.00 818.00 900.00 991.00 42 251.00 429.00 570.00 670.00 745.00 814.00 840.00 924.00 1,016.00 43 258.00 441.00 585.00 687.00 765.00 835.00 863.00 951.00 1,043.00 44 264.00 453.00 602.00 707.00 786.00 858.00 886.00 976.00 1,072.00 45 251.00 432.00 575.00 675.00 752.00 822.00 848.00 935.00 1,028.00 46 257.00 444.00 591.00 693.00 771.00 843.00 871.00 958.00 1,055.00 47 264.00 455.00 605.00 710.00 792.00 865.00 894.00 983.00 1,082.00 48 271.00 466.00 620.00 730.00 811.00 886.00 916.00 1,009.00 1,110.00 49 278.00 478.00 637.00 749.00 834.00 910.00 940.00 1,035.00 1,137.00 50 268.00 464.00 618.00 726.00 809.00 883.00 913.00 1,006.00 1,105.00 51 275.00 474.00 633.00 745.00 830.00 905.00 936.00 1,031.00 1,132.00 52 280.00 486.00 649.00 764.00 849.00 927.00 960.00 1,056.00 1,160.00 53 288.00 499.00 664.00 782.00 871.00 952.00 983.00 1,082.00 1,188.00 54 294.00 511.00 681.00 802.00 892.00 974.00 1,006.00 1,109.00 1,218.00 55 285.00 495.00 661.00 777.00 865.00 945.00 977.00 1,076.00 1,182.00 56 291.00 506.00 676.00 796.00 886.00 968.00 1,001.00 1,101.00 1,209.00 57 297.00 517.00 691.00 813.00 905.00 990.00 1,023.00 1,127.00 1,237.00 58 303.00 529.00 707.00 833.00 928.00 1,013.00 1,048.00 1,152.00 1,266.00 59 309.00 540.00 723.00 851.00 948.00 1,035.00 1,071.00 1,177.00 1,294.00 60 303.00 530.00 711.00 836.00 932.00 1,019.00 1,053.00 1,158.00 1,272.00 61 310.00 541.00 725.00 854.00 951.00 1,040.00 1,075.00 1,182.00 1,299.00 62 316.00 553.00 739.00 872.00 972.00 1,062.00 1,099.00 1,207.00 1,326.00 63 325.00 570.00 764.00 902.00 1,004.00 1,097.00 1,136.00 1,249.00 1,371.00 64 336.00 588.00 790.00 932.00 1,039.00 1,135.00 1,174.00 1,292.00 1,418.00 65 334.00 587.00 788.00 931.00 1,038.00 1,136.00 1,175.00 1,292.00 1,419.00 66 344.00 604.00 812.00 960.00 1,071.00 1,171.00 1,213.00 1,334.00 1,464.00 67 353.00 621.00 837.00 989.00 1,103.00 1,207.00 1,250.00 1,375.00 1,510.00 68 364.00 643.00 867.00 1,025.00 1,145.00 1,253.00 1,297.00 1,428.00 1,568.00 69 376.00 665.00 897.00 1,062.00 1,187.00 1,298.00 1,345.00 1,481.00 1,626.00 70 375.00 664.00 896.00 1,060.00 1,186.00 1,297.00 1,345.00 1,478.00 1,623.00 71 386.00 685.00 924.00 1,095.00 1,225.00 1,341.00 1,389.00 1,528.00 1,677.00 72 396.00 704.00 952.00 1,129.00 1,263.00 1,383.00 1,434.00 1,577.00 1,732.00 73 403.00 717.00 971.00 1,152.00 1,290.00 1,413.00 1,466.00 1,612.00 1,769.00 74 409.00 729.00 988.00 1,174.00 1,316.00 1,441.00 1,496.00 1,644.00 1,805.00 75 413.00 738.00 1,002.00 1,191.00 1,335.00 1,461.00 1,518.00 1,666.00 1,827.00 76 415.00 745.00 1,014.00 1,207.00 1,352.00 1,482.00 1,540.00 1,690.00 1,853.00 77 417.00 752.00 1,023.00 1,219.00 1,367.00 1,499.00 1,558.00 1,711.00 1,874.00 78 422.00 762.00 1,042.00 1,243.00 1,396.00 1,531.00 1,593.00 1,748.00 1,916.00 79 424.00 772.00 1,057.00 1,264.00 1,421.00 1,559.00 1,625.00 1,782.00 1,953.00 80 425.00 777.00 1,068.00 1,281.00 1,442.00 1,584.00 1,652.00 NA NA81 424.00 780.00 1,077.00 1,294.00 1,460.00 1,605.00 1,676.00 NA NA82 421.00 778.00 1,079.00 1,301.00 1,470.00 1,619.00 1,692.00 NA NA83 413.00 772.00 1,075.00 1,301.00 1,474.00 1,624.00 1,701.00 NA NA84 404.00 760.00 1,065.00 1,294.00 1,469.00 1,621.00 1,701.00 NA NA85 391.00 743.00 1,048.00 1,278.00 1,455.00 1,608.00 1,690.00 NA NA



Annual Premiums


3



Issue Age

18-29 149.00 252.00 337.00 398.00 447.00 493.00 512.00 566.00 628.00 30 155.00 263.00 350.00 416.00 467.00 514.00 534.00 591.00 656.00 31 161.00 275.00 367.00 435.00 487.00 536.00 556.00 617.00 685.00 32 169.00 286.00 383.00 454.00 508.00 559.00 581.00 643.00 714.00 33 175.00 299.00 399.00 472.00 531.00 585.00 606.00 671.00 745.00 34 182.00 311.00 416.00 493.00 554.00 608.00 632.00 701.00 776.00 35 176.00 302.00 406.00 483.00 541.00 594.00 618.00 685.00 761.00 36 183.00 316.00 424.00 502.00 564.00 621.00 645.00 714.00 792.00 37 191.00 328.00 442.00 524.00 589.00 646.00 672.00 744.00 827.00 38 199.00 344.00 460.00 545.00 614.00 674.00 702.00 777.00 861.00 39 208.00 357.00 480.00 569.00 639.00 703.00 731.00 809.00 898.00 40 201.00 349.00 472.00 559.00 626.00 690.00 716.00 794.00 881.00 41 210.00 364.00 490.00 582.00 653.00 718.00 746.00 826.00 918.00 42 219.00 380.00 511.00 608.00 681.00 750.00 778.00 861.00 956.00 43 229.00 395.00 532.00 632.00 710.00 780.00 811.00 899.00 995.00 44 237.00 412.00 556.00 659.00 740.00 815.00 845.00 936.00 1,038.00 45 232.00 404.00 545.00 647.00 728.00 802.00 831.00 922.00 1,022.00 46 242.00 421.00 568.00 674.00 758.00 834.00 867.00 959.00 1,064.00 47 252.00 439.00 592.00 703.00 789.00 869.00 903.00 998.00 1,107.00 48 261.00 456.00 616.00 732.00 821.00 904.00 939.00 1,040.00 1,153.00 49 272.00 475.00 642.00 762.00 857.00 942.00 978.00 1,083.00 1,200.00 50 272.00 476.00 642.00 763.00 857.00 943.00 980.00 1,085.00 1,203.00 51 282.00 494.00 668.00 794.00 892.00 981.00 1,020.00 1,129.00 1,250.00 52 293.00 514.00 695.00 826.00 928.00 1,021.00 1,062.00 1,175.00 1,300.00 53 305.00 536.00 722.00 859.00 965.00 1,063.00 1,103.00 1,221.00 1,351.00 54 316.00 557.00 751.00 894.00 1,003.00 1,104.00 1,146.00 1,269.00 1,405.00 55 307.00 539.00 729.00 867.00 974.00 1,071.00 1,113.00 1,232.00 1,364.00 56 317.00 559.00 758.00 901.00 1,012.00 1,114.00 1,157.00 1,280.00 1,416.00 57 330.00 580.00 786.00 935.00 1,050.00 1,156.00 1,201.00 1,329.00 1,470.00 58 341.00 603.00 815.00 970.00 1,091.00 1,200.00 1,247.00 1,380.00 1,526.00 59 353.00 625.00 847.00 1,007.00 1,132.00 1,244.00 1,295.00 1,430.00 1,583.00 60 360.00 635.00 862.00 1,025.00 1,152.00 1,267.00 1,316.00 1,456.00 1,611.00 61 372.00 659.00 893.00 1,063.00 1,194.00 1,313.00 1,366.00 1,508.00 1,668.00 62 386.00 683.00 925.00 1,102.00 1,238.00 1,361.00 1,415.00 1,564.00 1,728.00 63 404.00 716.00 973.00 1,158.00 1,301.00 1,431.00 1,489.00 1,645.00 1,817.00 64 423.00 752.00 1,021.00 1,217.00 1,367.00 1,505.00 1,564.00 1,729.00 1,911.00 65 421.00 749.00 1,018.00 1,215.00 1,366.00 1,505.00 1,565.00 1,730.00 1,912.00 66 440.00 784.00 1,067.00 1,274.00 1,433.00 1,578.00 1,642.00 1,815.00 2,006.00 67 460.00 820.00 1,118.00 1,334.00 1,502.00 1,654.00 1,722.00 1,902.00 2,103.00 68 483.00 864.00 1,178.00 1,408.00 1,586.00 1,747.00 1,818.00 2,009.00 2,221.00 69 508.00 909.00 1,241.00 1,484.00 1,672.00 1,842.00 1,918.00 2,120.00 2,344.00 70 515.00 922.00 1,259.00 1,505.00 1,696.00 1,867.00 1,946.00 2,149.00 2,374.00 71 539.00 967.00 1,321.00 1,581.00 1,782.00 1,964.00 2,045.00 2,260.00 2,496.00 72 563.00 1,013.00 1,385.00 1,659.00 1,870.00 2,061.00 2,147.00 2,372.00 2,621.00 73 583.00 1,049.00 1,437.00 1,722.00 1,942.00 2,141.00 2,232.00 2,465.00 2,723.00 74 602.00 1,086.00 1,488.00 1,785.00 2,014.00 2,220.00 2,315.00 2,557.00 2,824.00 75 617.00 1,116.00 1,532.00 1,837.00 2,074.00 2,284.00 2,383.00 2,629.00 2,901.00 76 633.00 1,147.00 1,578.00 1,895.00 2,138.00 2,357.00 2,459.00 2,712.00 2,992.00 77 647.00 1,178.00 1,621.00 1,948.00 2,200.00 2,425.00 2,531.00 2,792.00 3,079.00 78 669.00 1,220.00 1,684.00 2,026.00 2,290.00 2,526.00 2,639.00 2,910.00 3,210.00 79 687.00 1,261.00 1,745.00 2,103.00 2,380.00 2,627.00 2,747.00 3,028.00 3,340.00 80 705.00 1,299.00 1,803.00 2,179.00 2,468.00 2,726.00 2,852.00 NA NA81 722.00 1,336.00 1,861.00 2,253.00 2,556.00 2,826.00 2,958.00 NA NA82 735.00 1,368.00 1,913.00 2,322.00 2,638.00 2,919.00 3,060.00 NA NA83 745.00 1,396.00 1,958.00 2,384.00 2,714.00 3,005.00 3,153.00 NA NA84 684.00 1,295.00 1,824.00 2,223.00 2,531.00 2,798.00 2,942.00 NA NA85 656.00 1,256.00 1,780.00 2,180.00 2,489.00 2,756.00 2,904.00 NA NA

Annual Premiums


Form Number: FC-336-PABase Annual Premiums for 100% HHC, 100% ALF, and 100% Adult Day Care Benefit


4



Issue Age

18-29 86.00 143.00 189.00 223.00 249.00 273.00 284.00 312.00 346.00 30 89.00 149.00 197.00 233.00 261.00 285.00 295.00 326.00 361.00 31 93.00 156.00 206.00 244.00 271.00 296.00 308.00 340.00 377.00 32 96.00 163.00 215.00 254.00 282.00 310.00 322.00 355.00 392.00 33 99.00 170.00 225.00 264.00 296.00 324.00 336.00 370.00 409.00 34 104.00 176.00 235.00 276.00 308.00 337.00 350.00 387.00 427.00 35 99.00 170.00 226.00 268.00 299.00 327.00 340.00 375.00 417.00 36 103.00 177.00 237.00 278.00 311.00 342.00 354.00 392.00 433.00 37 107.00 184.00 247.00 292.00 325.00 356.00 369.00 408.00 452.00 38 113.00 193.00 257.00 302.00 339.00 371.00 386.00 425.00 470.00 39 117.00 200.00 268.00 315.00 353.00 387.00 400.00 443.00 491.00 40 113.00 196.00 263.00 311.00 347.00 380.00 393.00 435.00 481.00 41 118.00 204.00 273.00 323.00 361.00 396.00 410.00 453.00 502.00 42 123.00 213.00 285.00 337.00 377.00 413.00 427.00 471.00 522.00 43 129.00 221.00 296.00 351.00 392.00 430.00 446.00 493.00 543.00 44 133.00 231.00 309.00 365.00 408.00 449.00 463.00 513.00 567.00 45 130.00 226.00 303.00 359.00 403.00 441.00 456.00 506.00 559.00 46 136.00 236.00 317.00 373.00 418.00 458.00 476.00 525.00 581.00 47 141.00 245.00 329.00 388.00 435.00 477.00 495.00 546.00 605.00 48 146.00 255.00 342.00 405.00 453.00 497.00 514.00 569.00 629.00 49 153.00 265.00 356.00 420.00 472.00 517.00 536.00 592.00 654.00 50 153.00 267.00 359.00 423.00 475.00 520.00 541.00 596.00 660.00 51 159.00 277.00 373.00 441.00 494.00 541.00 561.00 620.00 685.00 52 163.00 288.00 387.00 459.00 512.00 562.00 584.00 645.00 712.00 53 171.00 300.00 401.00 476.00 533.00 586.00 606.00 670.00 739.00 54 178.00 311.00 418.00 495.00 554.00 608.00 629.00 695.00 769.00 55 172.00 303.00 407.00 482.00 539.00 592.00 614.00 678.00 748.00 56 178.00 314.00 423.00 501.00 560.00 615.00 637.00 704.00 777.00 57 185.00 325.00 438.00 518.00 580.00 637.00 660.00 729.00 804.00 58 191.00 337.00 454.00 538.00 603.00 661.00 685.00 757.00 835.00 59 197.00 349.00 470.00 557.00 624.00 684.00 710.00 782.00 865.00 60 201.00 355.00 478.00 566.00 634.00 696.00 721.00 797.00 878.00 61 208.00 367.00 495.00 586.00 656.00 719.00 747.00 824.00 909.00 62 215.00 379.00 511.00 607.00 679.00 745.00 773.00 853.00 940.00 63 224.00 397.00 536.00 636.00 712.00 781.00 812.00 895.00 985.00 64 235.00 415.00 562.00 667.00 746.00 820.00 850.00 938.00 1,034.00 65 228.00 405.00 548.00 652.00 731.00 804.00 833.00 920.00 1,015.00 66 238.00 422.00 572.00 682.00 764.00 840.00 872.00 962.00 1,061.00 67 247.00 440.00 597.00 711.00 797.00 876.00 910.00 1,004.00 1,108.00 68 258.00 461.00 627.00 747.00 839.00 921.00 957.00 1,056.00 1,165.00 69 270.00 482.00 657.00 783.00 880.00 967.00 1,005.00 1,109.00 1,223.00 70 273.00 488.00 665.00 792.00 891.00 978.00 1,018.00 1,122.00 1,237.00 71 284.00 510.00 694.00 828.00 931.00 1,024.00 1,064.00 1,174.00 1,293.00 72 294.00 530.00 723.00 863.00 971.00 1,067.00 1,111.00 1,225.00 1,350.00 73 303.00 545.00 745.00 890.00 1,002.00 1,102.00 1,147.00 1,265.00 1,394.00 74 310.00 560.00 766.00 916.00 1,032.00 1,135.00 1,182.00 1,303.00 1,436.00 75 316.00 572.00 785.00 939.00 1,058.00 1,163.00 1,212.00 1,334.00 1,469.00 76 321.00 583.00 801.00 961.00 1,082.00 1,190.00 1,241.00 1,366.00 1,503.00 77 324.00 593.00 816.00 979.00 1,103.00 1,215.00 1,267.00 1,395.00 1,534.00 78 331.00 607.00 838.00 1,007.00 1,137.00 1,252.00 1,307.00 1,438.00 1,583.00 79 335.00 619.00 857.00 1,033.00 1,167.00 1,287.00 1,346.00 1,480.00 1,628.00 80 338.00 628.00 873.00 1,055.00 1,195.00 1,318.00 1,379.00 NA NA81 340.00 635.00 886.00 1,074.00 1,219.00 1,346.00 1,410.00 NA NA82 339.00 637.00 894.00 1,087.00 1,236.00 1,368.00 1,435.00 NA NA83 334.00 636.00 896.00 1,094.00 1,248.00 1,381.00 1,452.00 NA NA84 327.00 629.00 892.00 1,094.00 1,250.00 1,387.00 1,460.00 NA NA85 318.00 616.00 881.00 1,086.00 1,245.00 1,383.00 1,459.00 NA NA



Annual Premiums


5



Issue Age




Annual Premiums


6



Issue Age

18-29 239.00 404.00 542.00 643.00 722.00 795.00 827.00 916.00 1,018.00 30 240.00 409.00 548.00 650.00 731.00 804.00 836.00 928.00 1,031.00 31 243.00 416.00 555.00 659.00 738.00 813.00 845.00 938.00 1,043.00 32 245.00 420.00 562.00 667.00 748.00 824.00 855.00 949.00 1,056.00 33 248.00 425.00 569.00 674.00 757.00 834.00 866.00 961.00 1,069.00 34 250.00 429.00 575.00 683.00 766.00 843.00 876.00 973.00 1,080.00 35 234.00 404.00 542.00 644.00 723.00 796.00 829.00 919.00 1,023.00 36 236.00 408.00 548.00 651.00 731.00 806.00 838.00 929.00 1,034.00 37 240.00 412.00 555.00 660.00 740.00 815.00 847.00 940.00 1,047.00 38 243.00 418.00 561.00 665.00 749.00 825.00 858.00 952.00 1,058.00 39 245.00 422.00 567.00 674.00 757.00 834.00 867.00 962.00 1,070.00 40 232.00 401.00 542.00 643.00 722.00 797.00 827.00 919.00 1,023.00 41 234.00 405.00 547.00 650.00 731.00 806.00 837.00 930.00 1,035.00 42 236.00 411.00 553.00 658.00 739.00 816.00 848.00 940.00 1,046.00 43 240.00 414.00 559.00 665.00 747.00 824.00 857.00 953.00 1,057.00 44 241.00 419.00 566.00 673.00 757.00 835.00 867.00 964.00 1,072.00 45 229.00 399.00 540.00 642.00 724.00 799.00 830.00 923.00 1,027.00 46 231.00 403.00 546.00 650.00 732.00 808.00 841.00 933.00 1,038.00 47 234.00 409.00 552.00 656.00 739.00 817.00 850.00 943.00 1,051.00 48 235.00 412.00 557.00 665.00 749.00 825.00 859.00 954.00 1,062.00 49 237.00 416.00 563.00 671.00 758.00 836.00 870.00 966.00 1,075.00 50 234.00 410.00 556.00 662.00 747.00 824.00 859.00 954.00 1,062.00 51 236.00 413.00 561.00 670.00 756.00 834.00 869.00 966.00 1,074.00 52 237.00 418.00 567.00 677.00 764.00 843.00 879.00 977.00 1,086.00 53 239.00 423.00 573.00 685.00 773.00 854.00 889.00 988.00 1,099.00 54 242.00 426.00 578.00 694.00 781.00 864.00 900.00 999.00 1,113.00 55 230.00 407.00 554.00 663.00 747.00 827.00 862.00 957.00 1,066.00 56 231.00 411.00 559.00 670.00 756.00 837.00 872.00 969.00 1,079.00 57 233.00 413.00 564.00 676.00 763.00 846.00 881.00 980.00 1,091.00 58 234.00 417.00 570.00 683.00 773.00 855.00 893.00 992.00 1,104.00 59 235.00 421.00 576.00 690.00 781.00 865.00 902.00 1,002.00 1,117.00 60 233.00 417.00 571.00 684.00 775.00 858.00 896.00 997.00 1,110.00 61 234.00 418.00 574.00 689.00 780.00 865.00 904.00 1,004.00 1,119.00 62 233.00 418.00 574.00 691.00 783.00 868.00 908.00 1,009.00 1,125.00 63 235.00 423.00 583.00 702.00 797.00 884.00 926.00 1,029.00 1,147.00 64 236.00 427.00 588.00 711.00 806.00 897.00 937.00 1,044.00 1,164.00 65 195.00 358.00 499.00 608.00 694.00 775.00 812.00 907.00 1,014.00 66 189.00 349.00 490.00 600.00 686.00 767.00 806.00 900.00 1,008.00 67 180.00 337.00 476.00 583.00 670.00 750.00 790.00 882.00 990.00 68 169.00 321.00 457.00 565.00 651.00 731.00 770.00 863.00 970.00 69 155.00 298.00 430.00 534.00 619.00 697.00 738.00 827.00 932.00 70 NA NA NA NA NA NA NA NA NA71 NA NA NA NA NA NA NA NA NA72 NA NA NA NA NA NA NA NA NA73 NA NA NA NA NA NA NA NA NA74 NA NA NA NA NA NA NA NA NA75 NA NA NA NA NA NA NA NA NA76 NA NA NA NA NA NA NA NA NA77 NA NA NA NA NA NA NA NA NA78 NA NA NA NA NA NA NA NA NA79 NA NA NA NA NA NA NA NA NA80 NA NA NA NA NA NA NA NA NA81 NA NA NA NA NA NA NA NA NA82 NA NA NA NA NA NA NA NA NA83 NA NA NA NA NA NA NA NA NA84 NA NA NA NA NA NA NA NA NA85 NA NA NA NA NA NA NA NA NA



Annual Premiums


7


125%ALF/125%HHC 1.04 1.06 1.07 1.08 1.09 1.10 1.11

75%ALF/75%HHC 0.96 0.95 0.93 0.91 0.90 0.89 0.89

50%ALF/50%HHC 0.92 0.87 0.83 0.80 0.79 0.77 0.77


Rate Factors to be Applied to the 100% ALF / 100% HHC Base Rates and any Riders

Factors


Form Number: FC-336-PAAssisted Living Facility / Home Health Care Benefit Options

8



1.28 1.22 1.14 1.03 1.00 0.82 0.70

Factors




Flex Care

9



NA 1.06 1.04 1.03 1.01 1.01 1.01 1.01 1.01


Factors



10


Issue Age Factor

< 60 1.1560+ 1.12




Flex Care

11



N/A N/A 1.05 1.09 1.11 1.22 1.36


Form Number: FC-336-PA20 Calendar Day Elimination Period for Assisted Living Facility, Home Health Care and

Adult Day CareForm Number: FC-EPR-PA

Flex Care

12




Payment Term

Flex CareMedAmerica Insurance Company



13


Issue Age< 40 1.01

40-49 1.0150-54 1.0155-59 1.0260-69 1.0270-74 1.0375-79 1.0580+ 1.06

All Payment Terms




Flex Care

14


30 NA 50.00 35.00 30.00 NA NA NA NA NA

31 NA 53.00 39.00 33.00 NA NA NA NA NA

32 NA 56.00 41.00 35.00 NA NA NA NA NA

33 NA 60.00 43.00 35.00 NA NA NA NA NA

34 NA 62.00 46.00 39.00 NA NA NA NA NA

35 NA 67.00 49.00 42.00 NA NA NA NA NA

36 NA 72.00 52.00 43.00 NA NA NA NA NA

37 NA 75.00 55.00 47.00 NA NA NA NA NA

38 NA 82.00 58.00 48.00 NA NA NA NA NA

39 NA 85.00 62.00 52.00 NA NA NA NA NA

40 NA 89.00 66.00 55.00 NA NA NA NA NA

41 NA 95.00 69.00 58.00 NA NA NA NA NA

42 NA 101.00 73.00 61.00 NA NA NA NA NA

43 NA 107.00 77.00 65.00 NA NA NA NA NA

44 NA 114.00 83.00 68.00 NA NA NA NA NA

45 NA 122.00 87.00 72.00 NA NA NA NA NA

46 NA 130.00 94.00 77.00 NA NA NA NA NA

47 NA 139.00 99.00 81.00 NA NA NA NA NA

48 NA 146.00 105.00 88.00 NA NA NA NA NA

49 NA 156.00 111.00 92.00 NA NA NA NA NA

50 NA 168.00 120.00 99.00 NA NA NA NA NA

51 NA 178.00 127.00 105.00 NA NA NA NA NA

52 NA 189.00 136.00 113.00 NA NA NA NA NA

53 NA 203.00 144.00 118.00 NA NA NA NA NA

54 NA 215.00 154.00 127.00 NA NA NA NA NA

55 NA 226.00 162.00 133.00 NA NA NA NA NA

56 NA 241.00 172.00 141.00 NA NA NA NA NA

57 NA 257.00 184.00 150.00 NA NA NA NA NA

58 NA 275.00 195.00 160.00 NA NA NA NA NA

59 NA 294.00 209.00 171.00 NA NA NA NA NA

60 NA 308.00 219.00 178.00 NA NA NA NA NA

61 NA 329.00 234.00 191.00 NA NA NA NA NA

62 NA 351.00 249.00 204.00 NA NA NA NA NA

63 NA 384.00 273.00 223.00 NA NA NA NA NA

64 NA 420.00 298.00 243.00 NA NA NA NA NA

65 NA 455.00 322.00 262.00 NA NA NA NA NA

66 NA 497.00 352.00 287.00 NA NA NA NA NA

67 NA 545.00 386.00 314.00 NA NA NA NA NA

68 NA 603.00 426.00 347.00 NA NA NA NA NA

69 NA 667.00 471.00 384.00 NA NA NA NA NA

70 NA 705.00 496.00 403.00 NA NA NA NA NA

71 NA 779.00 547.00 444.00 NA NA NA NA NA

72 NA 860.00 604.00 490.00 NA NA NA NA NA

73 NA 938.00 658.00 533.00 NA NA NA NA NA

74 NA 1,023.00 716.00 580.00 NA NA NA NA NA

75 NA 1,097.00 767.00 619.00 NA NA NA NA NA

76 NA 1,190.00 831.00 670.00 NA NA NA NA NA

77 NA 1,291.00 899.00 723.00 NA NA NA NA NA

78 NA 1,428.00 994.00 799.00 NA NA NA NA NA

79 NA 1,581.00 1,099.00 882.00 NA NA NA NA NA

80 NA 1,748.00 1,213.00 973.00 NA NA NA NA NA

81 NA 1,936.00 1,341.00 1,073.00 NA NA NA NA NA

82 NA 2,140.00 1,481.00 1,183.00 NA NA NA NA NA

83 NA 2,361.00 1,630.00 1,301.00 NA NA NA NA NA

84 NA 2,598.00 1,791.00 1,426.00 NA NA NA NA NA

85 NA 2,846.00 1,958.00 1,555.00 NA NA NA NA NA







15


30 NA NA 50.00 35.00 39.00 NA NA NA NA

31 NA NA 54.00 38.00 40.00 NA NA NA NA

32 NA NA 57.00 40.00 43.00 NA NA NA NA

33 NA NA 60.00 41.00 46.00 NA NA NA NA

34 NA NA 65.00 45.00 48.00 NA NA NA NA

35 NA NA 69.00 48.00 52.00 NA NA NA NA

36 NA NA 73.00 50.00 55.00 NA NA NA NA

37 NA NA 78.00 54.00 59.00 NA NA NA NA

38 NA NA 82.00 55.00 62.00 NA NA NA NA

39 NA NA 87.00 60.00 65.00 NA NA NA NA

40 NA NA 92.00 64.00 68.00 NA NA NA NA

41 NA NA 97.00 67.00 73.00 NA NA NA NA

42 NA NA 102.00 71.00 78.00 NA NA NA NA

43 NA NA 108.00 75.00 81.00 NA NA NA NA

44 NA NA 115.00 80.00 86.00 NA NA NA NA

45 NA NA 122.00 85.00 92.00 NA NA NA NA

46 NA NA 131.00 89.00 98.00 NA NA NA NA

47 NA NA 138.00 94.00 104.00 NA NA NA NA

48 NA NA 147.00 102.00 110.00 NA NA NA NA

49 NA NA 156.00 107.00 118.00 NA NA NA NA

50 NA NA 168.00 114.00 125.00 NA NA NA NA

51 NA NA 178.00 122.00 133.00 NA NA NA NA

52 NA NA 190.00 130.00 141.00 NA NA NA NA

53 NA NA 200.00 138.00 150.00 NA NA NA NA

54 NA NA 214.00 148.00 160.00 NA NA NA NA

55 NA NA 225.00 154.00 167.00 NA NA NA NA

56 NA NA 239.00 164.00 178.00 NA NA NA NA

57 NA NA 255.00 175.00 189.00 NA NA NA NA

58 NA NA 272.00 185.00 202.00 NA NA NA NA

59 NA NA 291.00 197.00 216.00 NA NA NA NA

60 NA NA 304.00 207.00 225.00 NA NA NA NA

61 NA NA 325.00 220.00 240.00 NA NA NA NA

62 NA NA 346.00 236.00 256.00 NA NA NA NA

63 NA NA 379.00 257.00 279.00 NA NA NA NA

64 NA NA 413.00 282.00 305.00 NA NA NA NA

65 NA NA 446.00 304.00 329.00 NA NA NA NA

66 NA NA 488.00 332.00 360.00 NA NA NA NA

67 NA NA 535.00 363.00 394.00 NA NA NA NA

68 NA NA 591.00 402.00 436.00 NA NA NA NA

69 NA NA 654.00 444.00 482.00 NA NA NA NA

70 NA NA 688.00 465.00 506.00 NA NA NA NA

71 NA NA 758.00 514.00 558.00 NA NA NA NA

72 NA NA 837.00 566.00 615.00 NA NA NA NA

73 NA NA 911.00 616.00 670.00 NA NA NA NA

74 NA NA 992.00 669.00 729.00 NA NA NA NA

75 NA NA 1,061.00 714.00 776.00 NA NA NA NA

76 NA NA 1,148.00 773.00 839.00 NA NA NA NA

77 NA NA 1,241.00 834.00 905.00 NA NA NA NA

78 NA NA 1,372.00 921.00 1,000.00 NA NA NA NA

79 NA NA 1,516.00 1,016.00 1,103.00 NA NA NA NA

80 NA NA 1,673.00 1,121.00 NA NA NA NA NA

81 NA NA 1,848.00 1,237.00 NA NA NA NA NA

82 NA NA 2,039.00 1,363.00 NA NA NA NA NA

83 NA NA 2,244.00 1,498.00 NA NA NA NA NA

84 NA NA 2,463.00 1,641.00 NA NA NA NA NA

85 NA NA 2,690.00 1,789.00 NA NA NA NA NA







16

Issue No 5% Cmpd - No Max 3% Cmpd - No Max 5% Simple - No Max 3% Simple - No Max Combo Ben Inc GPOAge Inflation Inflation Inflation Inflation Inflation Inflation Inflation


Premium Factors


Form Number: FC-336-PATEN YEAR PREMIUM PAYMENT TERM FACTORS

17



Premium Factors


Form Number: FC-336-PATWENTY YEAR PREMIUM PAYMENT TERM FACTORS

18



1.05 1.05 1.06 1.06 1.07 1.07 1.08 1.10 1.10



Monthly Assisted Living Facility, Home Health Care, and Adult Day Care Benefit Rider

Factors

Form Number: FC-MBR-PA

19



18-29 1.29 1.36 1.39 1.43 1.45 1.47 1.50 1.51 1.5430-34 1.29 1.36 1.39 1.42 1.45 1.46 1.49 1.50 1.5235-39 1.30 1.36 1.39 1.41 1.44 1.45 1.47 1.48 1.5140-44 1.30 1.35 1.38 1.40 1.42 1.44 1.46 1.47 1.4945-49 1.29 1.34 1.37 1.39 1.41 1.42 1.44 1.45 1.4750-54 1.29 1.33 1.36 1.38 1.39 1.41 1.42 1.43 1.4455-59 1.28 1.32 1.34 1.36 1.37 1.38 1.40 1.40 1.4260-64 1.27 1.30 1.32 1.33 1.35 1.36 1.37 1.37 1.3865-69 1.25 1.28 1.30 1.31 1.33 1.33 1.35 1.35 1.3670-74 1.24 1.27 1.28 1.30 1.31 1.32 1.33 1.33 1.3475-79 1.22 1.25 1.26 1.27 1.28 1.29 1.29 1.30 1.3080-84 1.19 1.21 1.22 1.23 1.24 1.25 1.26 NA NA

85 1.16 1.18 1.19 1.19 1.20 1.21 1.22 NA NA





20


<50 N/A 1.28 1.18 1.11 1.07 1.05 1.02 1.02 N/A50+ N/A 1.33 1.20 1.11 1.07 1.05 1.02 1.02 N/A















21

Multiply the annual premium by the appropriate factor below based on marital

and insured status.

Factors1.000.850.70


RateClass Factors

I 0.90II 1.00



Married one insuredMarried Both insured




Marital Status

Flex Care

22


Payment

Mode Factors

Bi-Weekly 0.0415

Monthly 0.0900

Quarterly 0.2600

Semi-Annually 0.5150

Annually 1.0000



Modal Factors

Flex Care

23



Issue Age

18-29 107.35 141.55 167.20 186.20 199.50 212.80 216.60 234.65 252.70 30 111.15 146.30 174.80 193.80 208.05 222.30 227.05 245.10 264.10 31 114.00 151.05 181.45 201.40 218.50 232.75 237.50 256.50 276.45 32 117.80 156.75 189.05 209.95 228.00 243.20 247.95 268.85 289.75 33 122.55 163.40 196.65 220.40 237.50 253.65 259.35 281.20 304.00 34 126.35 171.00 205.20 229.90 248.90 266.95 272.65 294.50 319.20 35 131.10 178.60 216.60 242.25 263.15 282.15 287.85 312.55 337.25 36 135.85 186.20 226.10 254.60 275.50 295.45 302.10 327.75 355.30 37 140.60 194.75 236.55 266.00 288.80 310.65 317.30 344.85 372.40 38 145.35 202.35 247.95 280.25 303.05 325.85 332.50 361.95 392.35 39 151.05 212.80 260.30 293.55 319.20 342.95 350.55 380.95 413.25 40 156.75 220.40 269.80 304.95 332.50 357.20 365.75 397.10 431.30 41 162.45 230.85 284.05 321.10 349.60 376.20 384.75 418.95 454.10 42 169.10 241.30 298.30 337.25 367.65 395.20 404.70 441.75 479.75 43 175.75 253.65 314.45 355.30 387.60 417.05 426.55 464.55 506.35 44 184.30 266.00 329.65 374.30 408.50 438.90 450.30 490.20 532.95 45 191.90 279.30 347.70 395.20 430.35 463.60 475.95 517.75 563.35 46 200.45 293.55 365.75 417.05 455.05 490.20 501.60 548.15 595.65 47 209.95 308.75 386.65 440.80 480.70 517.75 530.10 579.50 629.85 48 220.40 325.85 408.50 464.55 508.25 548.15 561.45 612.75 666.90 49 230.85 343.90 431.30 492.10 536.75 579.50 593.75 648.85 706.80 50 233.70 354.35 448.40 513.95 562.40 608.00 622.25 681.15 742.90 51 246.05 375.25 475.00 544.35 595.65 644.10 660.25 722.00 788.50 52 260.30 397.10 503.50 576.65 632.70 684.00 700.15 766.65 836.95 53 273.60 419.90 534.85 612.75 671.65 724.85 743.85 814.15 889.20 54 288.80 445.55 567.15 649.80 713.45 770.45 790.40 865.45 944.30 55 299.25 463.60 590.90 678.30 744.80 804.65 824.60 903.45 986.10 56 317.30 492.10 627.95 721.05 791.35 855.00 876.85 960.45 1,048.80 57 335.35 523.45 667.85 767.60 842.65 910.10 933.85 1,022.20 1,116.25 58 355.30 555.75 710.60 817.00 895.85 969.00 992.75 1,087.75 1,187.50 59 377.15 590.90 756.20 870.20 954.75 1,032.65 1,057.35 1,159.95 1,265.40 60 392.35 617.50 790.40 910.10 998.45 1,079.20 1,106.75 1,212.20 1,323.35 61 416.10 657.40 842.65 969.95 1,064.95 1,151.40 1,178.95 1,292.95 1,410.75 62 441.75 700.15 898.70 1,033.60 1,135.25 1,227.40 1,257.80 1,378.45 1,504.80 63 477.85 760.00 976.60 1,124.80 1,235.95 1,336.65 1,368.95 1,501.00 1,639.70 64 516.80 825.55 1,063.05 1,224.55 1,346.15 1,455.40 1,492.45 1,635.90 1,786.95 65 552.90 888.25 1,145.70 1,320.50 1,451.60 1,569.40 1,609.30 1,764.15 1,926.60 66 599.45 967.10 1,248.30 1,439.25 1,582.70 1,711.90 1,754.65 1,924.70 2,102.35 67 650.75 1,052.60 1,360.40 1,570.35 1,727.10 1,868.65 1,915.20 2,101.40 2,295.20 68 714.40 1,159.00 1,500.05 1,731.85 1,904.75 2,061.50 2,113.75 2,318.95 2,533.65 69 783.75 1,276.80 1,653.95 1,910.45 2,101.40 2,275.25 2,332.25 2,559.30 2,796.80 70 827.45 1,349.00 1,748.00 2,018.75 2,219.20 2,401.60 2,460.50 2,699.90 2,948.80 71 908.20 1,483.90 1,925.65 2,223.95 2,445.30 2,645.75 2,712.25 2,975.40 3,250.90 72 996.55 1,633.05 2,120.40 2,450.05 2,694.20 2,915.55 2,987.75 3,278.45 3,581.50 73 1,081.10 1,777.45 2,309.45 2,668.55 2,934.55 3,174.90 3,253.75 3,571.05 3,900.70 74 1,173.25 1,933.25 2,513.70 2,905.10 3,193.90 3,456.10 3,540.65 3,886.45 4,244.60 75 1,282.50 2,101.40 2,723.65 3,143.55 3,452.30 3,731.60 3,821.85 4,189.50 4,569.50 76 1,386.05 2,276.20 2,952.60 3,406.70 3,742.05 4,043.20 4,141.05 4,539.10 4,950.45 77 1,496.25 2,461.45 3,195.80 3,687.90 4,049.85 4,374.75 4,480.20 4,909.60 5,354.20 78 1,641.60 2,711.30 3,523.55 4,067.90 4,467.85 4,826.95 4,942.85 5,417.85 5,907.10 79 1,803.10 2,985.85 3,885.50 4,487.80 4,929.55 5,325.70 5,453.00 5,977.40 6,517.95 80 1,978.85 3,288.90 4,284.50 4,949.50 5,436.85 5,873.85 6,014.45 NA NA81 2,173.60 3,624.25 4,727.20 5,463.45 6,001.15 6,482.80 6,638.60 NA NA82 2,385.45 3,990.95 5,210.75 6,023.95 6,617.70 7,147.80 7,318.80 NA NA83 2,613.45 4,385.20 5,732.30 6,628.15 7,280.80 7,864.10 8,051.25 NA NA84 2,856.65 4,807.95 6,290.90 7,276.05 7,992.35 8,630.75 8,835.00 NA NA85 3,110.30 5,250.65 6,876.10 7,954.35 8,736.20 9,431.60 9,653.90 NA NA

Annual Premiums


Form Number: FRFC-336-PABase Annual Premiums for 100% HHC, 100% ALF, and 100% Adult Day Care Benefit


1



Issue Age

18-29 675.45 1,152.35 1,532.35 1,801.20 2,004.50 2,189.75 2,265.75 2,491.85 2,739.80 30 677.35 1,158.05 1,539.95 1,809.75 2,016.85 2,202.10 2,276.20 2,506.10 2,755.00 31 686.85 1,175.15 1,560.85 1,836.35 2,042.50 2,231.55 2,307.55 2,539.35 2,792.05 32 695.40 1,190.35 1,581.75 1,861.05 2,071.00 2,261.95 2,338.90 2,573.55 2,828.15 33 703.95 1,206.50 1,604.55 1,885.75 2,098.55 2,292.35 2,371.20 2,607.75 2,866.15 34 713.45 1,221.70 1,625.45 1,910.45 2,127.05 2,323.70 2,402.55 2,644.80 2,905.10 35 661.20 1,138.10 1,514.30 1,781.25 1,981.70 2,166.00 2,240.10 2,465.25 2,710.35 36 670.70 1,153.30 1,535.20 1,804.05 2,009.25 2,194.50 2,268.60 2,497.55 2,744.55 37 679.25 1,167.55 1,555.15 1,828.75 2,035.85 2,223.00 2,299.95 2,529.85 2,782.55 38 688.75 1,183.70 1,575.10 1,851.55 2,064.35 2,254.35 2,332.25 2,565.00 2,818.65 39 697.30 1,198.90 1,596.95 1,878.15 2,090.95 2,283.80 2,362.65 2,599.20 2,855.70 40 647.90 1,117.20 1,489.60 1,752.75 1,952.25 2,131.80 2,204.95 2,427.25 2,667.60 41 656.45 1,131.45 1,509.55 1,775.55 1,977.90 2,160.30 2,233.45 2,457.65 2,701.80 42 665.00 1,147.60 1,529.50 1,800.25 2,004.50 2,189.75 2,263.85 2,490.90 2,736.95 43 674.50 1,162.80 1,549.45 1,824.00 2,031.10 2,219.20 2,295.20 2,526.05 2,774.00 44 683.05 1,178.00 1,570.35 1,847.75 2,058.65 2,249.60 2,324.65 2,559.30 2,812.00 45 641.25 1,110.55 1,482.00 1,744.20 1,943.70 2,123.25 2,195.45 2,416.80 2,655.25 46 650.75 1,124.80 1,501.00 1,766.05 1,968.40 2,149.85 2,224.90 2,447.20 2,689.45 47 658.35 1,139.05 1,520.00 1,788.85 1,994.05 2,179.30 2,254.35 2,479.50 2,724.60 48 665.95 1,154.25 1,539.95 1,813.55 2,019.70 2,206.85 2,282.85 2,512.75 2,760.70 49 675.45 1,168.50 1,559.90 1,837.30 2,048.20 2,237.25 2,314.20 2,546.00 2,796.80 50 641.25 1,113.40 1,487.70 1,751.80 1,953.20 2,133.70 2,208.75 2,430.10 2,669.50 51 648.85 1,127.65 1,506.70 1,774.60 1,979.80 2,162.20 2,236.30 2,461.45 2,702.75 52 656.45 1,140.95 1,525.70 1,798.35 2,003.55 2,189.75 2,265.75 2,492.80 2,737.90 53 665.00 1,155.20 1,544.70 1,820.20 2,029.20 2,218.25 2,295.20 2,524.15 2,772.10 54 672.60 1,170.40 1,563.70 1,843.95 2,055.80 2,246.75 2,324.65 2,556.45 2,808.20 55 642.20 1,119.10 1,498.15 1,765.10 1,967.45 2,149.85 2,225.85 2,448.15 2,688.50 56 648.85 1,132.40 1,516.20 1,786.95 1,992.15 2,178.35 2,254.35 2,478.55 2,721.75 57 656.45 1,144.75 1,534.25 1,807.85 2,015.90 2,204.00 2,280.00 2,508.00 2,755.00 58 663.10 1,158.05 1,552.30 1,829.70 2,040.60 2,230.60 2,309.45 2,539.35 2,788.25 59 669.75 1,171.35 1,570.35 1,850.60 2,065.30 2,257.20 2,337.00 2,568.80 2,820.55 60 645.05 1,129.55 1,514.30 1,786.00 1,993.10 2,179.30 2,255.30 2,479.50 2,722.70 61 650.75 1,140.95 1,530.45 1,805.00 2,014.95 2,202.10 2,280.95 2,507.05 2,753.10 62 656.45 1,151.40 1,545.65 1,825.90 2,036.80 2,226.80 2,305.65 2,534.60 2,782.55 63 669.75 1,176.10 1,580.80 1,866.75 2,082.40 2,277.15 2,359.80 2,594.45 2,847.15 64 684.00 1,201.75 1,615.00 1,909.50 2,130.85 2,330.35 2,413.95 2,655.25 2,913.65 65 668.80 1,177.05 1,583.65 1,872.45 2,091.90 2,288.55 2,371.20 2,606.80 2,861.40 66 681.15 1,198.90 1,615.95 1,912.35 2,136.55 2,337.95 2,423.45 2,663.80 2,925.05 67 692.55 1,222.65 1,648.25 1,951.30 2,181.20 2,387.35 2,475.70 2,720.80 2,987.75 68 708.70 1,253.05 1,691.00 2,004.50 2,241.05 2,453.85 2,544.10 2,797.75 3,072.30 69 724.85 1,283.45 1,734.70 2,056.75 2,301.85 2,519.40 2,614.40 2,874.70 3,157.80 70 717.25 1,271.10 1,717.60 2,035.85 2,279.05 2,494.70 2,589.70 2,845.25 3,123.60 71 731.50 1,298.65 1,755.60 2,084.30 2,334.15 2,556.45 2,653.35 2,916.50 3,200.55 72 744.80 1,325.25 1,794.55 2,130.85 2,387.35 2,615.35 2,717.00 2,985.85 3,278.45 73 752.40 1,340.45 1,816.40 2,159.35 2,420.60 2,653.35 2,755.95 3,028.60 3,325.95 74 757.15 1,352.80 1,836.35 2,185.00 2,451.00 2,685.65 2,793.00 3,068.50 3,368.70 75 760.00 1,361.35 1,850.60 2,202.10 2,470.00 2,706.55 2,814.85 3,089.40 3,387.70 76 760.95 1,367.05 1,861.05 2,218.25 2,488.05 2,727.45 2,837.65 3,114.10 3,414.30 77 759.05 1,368.95 1,866.75 2,226.80 2,500.40 2,742.65 2,854.75 3,132.15 3,433.30 78 763.80 1,381.30 1,889.55 2,258.15 2,537.45 2,785.40 2,902.25 3,182.50 3,490.30 79 764.75 1,390.80 1,907.60 2,283.80 2,570.70 2,822.45 2,945.00 3,229.05 3,539.70 80 763.80 1,395.55 1,919.95 2,304.70 2,597.30 2,853.80 2,980.15 NA NA81 760.00 1,395.55 1,927.55 2,318.95 2,618.20 2,880.40 3,010.55 NA NA82 751.45 1,388.90 1,926.60 2,324.65 2,628.65 2,895.60 3,030.50 NA NA83 738.15 1,375.60 1,916.15 2,319.90 2,628.65 2,898.45 3,038.10 NA NA84 721.05 1,353.75 1,896.20 2,303.75 2,616.30 2,888.95 3,032.40 NA NA85 699.20 1,324.30 1,865.80 2,275.25 2,590.65 2,864.25 3,012.45 NA NA



Annual Premiums


2



Issue Age

18-29 201.40 336.30 444.60 520.60 578.55 632.70 652.65 717.25 789.45 30 206.15 345.80 456.00 535.80 595.65 649.80 670.70 739.10 812.25 31 211.85 357.20 470.25 551.00 610.85 666.90 688.75 759.05 835.05 32 217.55 367.65 483.55 567.15 627.95 685.90 708.70 779.00 857.85 33 223.25 376.20 497.80 582.35 646.95 705.85 729.60 801.80 881.60 34 228.95 385.70 511.10 598.50 664.05 724.85 748.60 825.55 906.30 35 214.70 364.80 482.60 567.15 628.90 686.85 709.65 780.90 860.70 36 220.40 374.30 495.90 581.40 646.00 705.85 728.65 803.70 882.55 37 226.10 384.75 509.20 598.50 665.00 724.85 749.55 824.60 908.20 38 232.75 395.20 523.45 612.75 683.05 745.75 769.50 847.40 931.95 39 238.45 405.65 537.70 630.80 700.15 764.75 789.45 871.15 956.65 40 226.10 386.65 514.90 604.20 670.70 732.45 756.20 834.10 916.75 41 231.80 397.10 528.20 620.35 688.75 752.40 777.10 855.00 941.45 42 238.45 407.55 541.50 636.50 707.75 773.30 798.00 877.80 965.20 43 245.10 418.95 555.75 652.65 726.75 793.25 819.85 903.45 990.85 44 250.80 430.35 571.90 671.65 746.70 815.10 841.70 927.20 1,018.40 45 238.45 410.40 546.25 641.25 714.40 780.90 805.60 888.25 976.60 46 244.15 421.80 561.45 658.35 732.45 800.85 827.45 910.10 1,002.25 47 250.80 432.25 574.75 674.50 752.40 821.75 849.30 933.85 1,027.90 48 257.45 442.70 589.00 693.50 770.45 841.70 870.20 958.55 1,054.50 49 264.10 454.10 605.15 711.55 792.30 864.50 893.00 983.25 1,080.15 50 254.60 440.80 587.10 689.70 768.55 838.85 867.35 955.70 1,049.75 51 261.25 450.30 601.35 707.75 788.50 859.75 889.20 979.45 1,075.40 52 266.00 461.70 616.55 725.80 806.55 880.65 912.00 1,003.20 1,102.00 53 273.60 474.05 630.80 742.90 827.45 904.40 933.85 1,027.90 1,128.60 54 279.30 485.45 646.95 761.90 847.40 925.30 955.70 1,053.55 1,157.10 55 270.75 470.25 627.95 738.15 821.75 897.75 928.15 1,022.20 1,122.90 56 276.45 480.70 642.20 756.20 841.70 919.60 950.95 1,045.95 1,148.55 57 282.15 491.15 656.45 772.35 859.75 940.50 971.85 1,070.65 1,175.15 58 287.85 502.55 671.65 791.35 881.60 962.35 995.60 1,094.40 1,202.70 59 293.55 513.00 686.85 808.45 900.60 983.25 1,017.45 1,118.15 1,229.30 60 287.85 503.50 675.45 794.20 885.40 968.05 1,000.35 1,100.10 1,208.40 61 294.50 513.95 688.75 811.30 903.45 988.00 1,021.25 1,122.90 1,234.05 62 300.20 525.35 702.05 828.40 923.40 1,008.90 1,044.05 1,146.65 1,259.70 63 308.75 541.50 725.80 856.90 953.80 1,042.15 1,079.20 1,186.55 1,302.45 64 319.20 558.60 750.50 885.40 987.05 1,078.25 1,115.30 1,227.40 1,347.10 65 317.30 557.65 748.60 884.45 986.10 1,079.20 1,116.25 1,227.40 1,348.05 66 326.80 573.80 771.40 912.00 1,017.45 1,112.45 1,152.35 1,267.30 1,390.80 67 335.35 589.95 795.15 939.55 1,047.85 1,146.65 1,187.50 1,306.25 1,434.50 68 345.80 610.85 823.65 973.75 1,087.75 1,190.35 1,232.15 1,356.60 1,489.60 69 357.20 631.75 852.15 1,008.90 1,127.65 1,233.10 1,277.75 1,406.95 1,544.70 70 356.25 630.80 851.20 1,007.00 1,126.70 1,232.15 1,277.75 1,404.10 1,541.85 71 366.70 650.75 877.80 1,040.25 1,163.75 1,273.95 1,319.55 1,451.60 1,593.15 72 376.20 668.80 904.40 1,072.55 1,199.85 1,313.85 1,362.30 1,498.15 1,645.40 73 382.85 681.15 922.45 1,094.40 1,225.50 1,342.35 1,392.70 1,531.40 1,680.55 74 388.55 692.55 938.60 1,115.30 1,250.20 1,368.95 1,421.20 1,561.80 1,714.75 75 392.35 701.10 951.90 1,131.45 1,268.25 1,387.95 1,442.10 1,582.70 1,735.65 76 394.25 707.75 963.30 1,146.65 1,284.40 1,407.90 1,463.00 1,605.50 1,760.35 77 396.15 714.40 971.85 1,158.05 1,298.65 1,424.05 1,480.10 1,625.45 1,780.30 78 400.90 723.90 989.90 1,180.85 1,326.20 1,454.45 1,513.35 1,660.60 1,820.20 79 402.80 733.40 1,004.15 1,200.80 1,349.95 1,481.05 1,543.75 1,692.90 1,855.35 80 403.75 738.15 1,014.60 1,216.95 1,369.90 1,504.80 1,569.40 NA NA81 402.80 741.00 1,023.15 1,229.30 1,387.00 1,524.75 1,592.20 NA NA82 399.95 739.10 1,025.05 1,235.95 1,396.50 1,538.05 1,607.40 NA NA83 392.35 733.40 1,021.25 1,235.95 1,400.30 1,542.80 1,615.95 NA NA84 383.80 722.00 1,011.75 1,229.30 1,395.55 1,539.95 1,615.95 NA NA85 371.45 705.85 995.60 1,214.10 1,382.25 1,527.60 1,605.50 NA NA



Annual Premiums


3



Issue Age

18-29 141.55 239.40 320.15 378.10 424.65 468.35 486.40 537.70 596.60 30 147.25 249.85 332.50 395.20 443.65 488.30 507.30 561.45 623.20 31 152.95 261.25 348.65 413.25 462.65 509.20 528.20 586.15 650.75 32 160.55 271.70 363.85 431.30 482.60 531.05 551.95 610.85 678.30 33 166.25 284.05 379.05 448.40 504.45 555.75 575.70 637.45 707.75 34 172.90 295.45 395.20 468.35 526.30 577.60 600.40 665.95 737.20 35 167.20 286.90 385.70 458.85 513.95 564.30 587.10 650.75 722.95 36 173.85 300.20 402.80 476.90 535.80 589.95 612.75 678.30 752.40 37 181.45 311.60 419.90 497.80 559.55 613.70 638.40 706.80 785.65 38 189.05 326.80 437.00 517.75 583.30 640.30 666.90 738.15 817.95 39 197.60 339.15 456.00 540.55 607.05 667.85 694.45 768.55 853.10 40 190.95 331.55 448.40 531.05 594.70 655.50 680.20 754.30 836.95 41 199.50 345.80 465.50 552.90 620.35 682.10 708.70 784.70 872.10 42 208.05 361.00 485.45 577.60 646.95 712.50 739.10 817.95 908.20 43 217.55 375.25 505.40 600.40 674.50 741.00 770.45 854.05 945.25 44 225.15 391.40 528.20 626.05 703.00 774.25 802.75 889.20 986.10 45 220.40 383.80 517.75 614.65 691.60 761.90 789.45 875.90 970.90 46 229.90 399.95 539.60 640.30 720.10 792.30 823.65 911.05 1,010.80 47 239.40 417.05 562.40 667.85 749.55 825.55 857.85 948.10 1,051.65 48 247.95 433.20 585.20 695.40 779.95 858.80 892.05 988.00 1,095.35 49 258.40 451.25 609.90 723.90 814.15 894.90 929.10 1,028.85 1,140.00 50 258.40 452.20 609.90 724.85 814.15 895.85 931.00 1,030.75 1,142.85 51 267.90 469.30 634.60 754.30 847.40 931.95 969.00 1,072.55 1,187.50 52 278.35 488.30 660.25 784.70 881.60 969.95 1,008.90 1,116.25 1,235.00 53 289.75 509.20 685.90 816.05 916.75 1,009.85 1,047.85 1,159.95 1,283.45 54 300.20 529.15 713.45 849.30 952.85 1,048.80 1,088.70 1,205.55 1,334.75 55 291.65 512.05 692.55 823.65 925.30 1,017.45 1,057.35 1,170.40 1,295.80 56 301.15 531.05 720.10 855.95 961.40 1,058.30 1,099.15 1,216.00 1,345.20 57 313.50 551.00 746.70 888.25 997.50 1,098.20 1,140.95 1,262.55 1,396.50 58 323.95 572.85 774.25 921.50 1,036.45 1,140.00 1,184.65 1,311.00 1,449.70 59 335.35 593.75 804.65 956.65 1,075.40 1,181.80 1,230.25 1,358.50 1,503.85 60 342.00 603.25 818.90 973.75 1,094.40 1,203.65 1,250.20 1,383.20 1,530.45 61 353.40 626.05 848.35 1,009.85 1,134.30 1,247.35 1,297.70 1,432.60 1,584.60 62 366.70 648.85 878.75 1,046.90 1,176.10 1,292.95 1,344.25 1,485.80 1,641.60 63 383.80 680.20 924.35 1,100.10 1,235.95 1,359.45 1,414.55 1,562.75 1,726.15 64 401.85 714.40 969.95 1,156.15 1,298.65 1,429.75 1,485.80 1,642.55 1,815.45 65 399.95 711.55 967.10 1,154.25 1,297.70 1,429.75 1,486.75 1,643.50 1,816.40 66 418.00 744.80 1,013.65 1,210.30 1,361.35 1,499.10 1,559.90 1,724.25 1,905.70 67 437.00 779.00 1,062.10 1,267.30 1,426.90 1,571.30 1,635.90 1,806.90 1,997.85 68 458.85 820.80 1,119.10 1,337.60 1,506.70 1,659.65 1,727.10 1,908.55 2,109.95 69 482.60 863.55 1,178.95 1,409.80 1,588.40 1,749.90 1,822.10 2,014.00 2,226.80 70 489.25 875.90 1,196.05 1,429.75 1,611.20 1,773.65 1,848.70 2,041.55 2,255.30 71 512.05 918.65 1,254.95 1,501.95 1,692.90 1,865.80 1,942.75 2,147.00 2,371.20 72 534.85 962.35 1,315.75 1,576.05 1,776.50 1,957.95 2,039.65 2,253.40 2,489.95 73 553.85 996.55 1,365.15 1,635.90 1,844.90 2,033.95 2,120.40 2,341.75 2,586.85 74 571.90 1,031.70 1,413.60 1,695.75 1,913.30 2,109.00 2,199.25 2,429.15 2,682.80 75 586.15 1,060.20 1,455.40 1,745.15 1,970.30 2,169.80 2,263.85 2,497.55 2,755.95 76 601.35 1,089.65 1,499.10 1,800.25 2,031.10 2,239.15 2,336.05 2,576.40 2,842.40 77 614.65 1,119.10 1,539.95 1,850.60 2,090.00 2,303.75 2,404.45 2,652.40 2,925.05 78 635.55 1,159.00 1,599.80 1,924.70 2,175.50 2,399.70 2,507.05 2,764.50 3,049.50 79 652.65 1,197.95 1,657.75 1,997.85 2,261.00 2,495.65 2,609.65 2,876.60 3,173.00 80 669.75 1,234.05 1,712.85 2,070.05 2,344.60 2,589.70 2,709.40 NA NA81 685.90 1,269.20 1,767.95 2,140.35 2,428.20 2,684.70 2,810.10 NA NA82 698.25 1,299.60 1,817.35 2,205.90 2,506.10 2,773.05 2,907.00 NA NA83 707.75 1,326.20 1,860.10 2,264.80 2,578.30 2,854.75 2,995.35 NA NA84 649.80 1,230.25 1,732.80 2,111.85 2,404.45 2,658.10 2,794.90 NA NA85 623.20 1,193.20 1,691.00 2,071.00 2,364.55 2,618.20 2,758.80 NA NA

Annual Premiums


Form Number: FRFC-336-PABase Annual Premiums for 100% HHC, 100% ALF, and 100% Adult Day Care Benefit


4



Issue Age

18-29 81.70 135.85 179.55 211.85 236.55 259.35 269.80 296.40 328.70 30 84.55 141.55 187.15 221.35 247.95 270.75 280.25 309.70 342.95 31 88.35 148.20 195.70 231.80 257.45 281.20 292.60 323.00 358.15 32 91.20 154.85 204.25 241.30 267.90 294.50 305.90 337.25 372.40 33 94.05 161.50 213.75 250.80 281.20 307.80 319.20 351.50 388.55 34 98.80 167.20 223.25 262.20 292.60 320.15 332.50 367.65 405.65 35 94.05 161.50 214.70 254.60 284.05 310.65 323.00 356.25 396.15 36 97.85 168.15 225.15 264.10 295.45 324.90 336.30 372.40 411.35 37 101.65 174.80 234.65 277.40 308.75 338.20 350.55 387.60 429.40 38 107.35 183.35 244.15 286.90 322.05 352.45 366.70 403.75 446.50 39 111.15 190.00 254.60 299.25 335.35 367.65 380.00 420.85 466.45 40 107.35 186.20 249.85 295.45 329.65 361.00 373.35 413.25 456.95 41 112.10 193.80 259.35 306.85 342.95 376.20 389.50 430.35 476.90 42 116.85 202.35 270.75 320.15 358.15 392.35 405.65 447.45 495.90 43 122.55 209.95 281.20 333.45 372.40 408.50 423.70 468.35 515.85 44 126.35 219.45 293.55 346.75 387.60 426.55 439.85 487.35 538.65 45 123.50 214.70 287.85 341.05 382.85 418.95 433.20 480.70 531.05 46 129.20 224.20 301.15 354.35 397.10 435.10 452.20 498.75 551.95 47 133.95 232.75 312.55 368.60 413.25 453.15 470.25 518.70 574.75 48 138.70 242.25 324.90 384.75 430.35 472.15 488.30 540.55 597.55 49 145.35 251.75 338.20 399.00 448.40 491.15 509.20 562.40 621.30 50 145.35 253.65 341.05 401.85 451.25 494.00 513.95 566.20 627.00 51 151.05 263.15 354.35 418.95 469.30 513.95 532.95 589.00 650.75 52 154.85 273.60 367.65 436.05 486.40 533.90 554.80 612.75 676.40 53 162.45 285.00 380.95 452.20 506.35 556.70 575.70 636.50 702.05 54 169.10 295.45 397.10 470.25 526.30 577.60 597.55 660.25 730.55 55 163.40 287.85 386.65 457.90 512.05 562.40 583.30 644.10 710.60 56 169.10 298.30 401.85 475.95 532.00 584.25 605.15 668.80 738.15 57 175.75 308.75 416.10 492.10 551.00 605.15 627.00 692.55 763.80 58 181.45 320.15 431.30 511.10 572.85 627.95 650.75 719.15 793.25 59 187.15 331.55 446.50 529.15 592.80 649.80 674.50 742.90 821.75 60 190.95 337.25 454.10 537.70 602.30 661.20 684.95 757.15 834.10 61 197.60 348.65 470.25 556.70 623.20 683.05 709.65 782.80 863.55 62 204.25 360.05 485.45 576.65 645.05 707.75 734.35 810.35 893.00 63 212.80 377.15 509.20 604.20 676.40 741.95 771.40 850.25 935.75 64 223.25 394.25 533.90 633.65 708.70 779.00 807.50 891.10 982.30 65 216.60 384.75 520.60 619.40 694.45 763.80 791.35 874.00 964.25 66 226.10 400.90 543.40 647.90 725.80 798.00 828.40 913.90 1,007.95 67 234.65 418.00 567.15 675.45 757.15 832.20 864.50 953.80 1,052.60 68 245.10 437.95 595.65 709.65 797.05 874.95 909.15 1,003.20 1,106.75 69 256.50 457.90 624.15 743.85 836.00 918.65 954.75 1,053.55 1,161.85 70 259.35 463.60 631.75 752.40 846.45 929.10 967.10 1,065.90 1,175.15 71 269.80 484.50 659.30 786.60 884.45 972.80 1,010.80 1,115.30 1,228.35 72 279.30 503.50 686.85 819.85 922.45 1,013.65 1,055.45 1,163.75 1,282.50 73 287.85 517.75 707.75 845.50 951.90 1,046.90 1,089.65 1,201.75 1,324.30 74 294.50 532.00 727.70 870.20 980.40 1,078.25 1,122.90 1,237.85 1,364.20 75 300.20 543.40 745.75 892.05 1,005.10 1,104.85 1,151.40 1,267.30 1,395.55 76 304.95 553.85 760.95 912.95 1,027.90 1,130.50 1,178.95 1,297.70 1,427.85 77 307.80 563.35 775.20 930.05 1,047.85 1,154.25 1,203.65 1,325.25 1,457.30 78 314.45 576.65 796.10 956.65 1,080.15 1,189.40 1,241.65 1,366.10 1,503.85 79 318.25 588.05 814.15 981.35 1,108.65 1,222.65 1,278.70 1,406.00 1,546.60 80 321.10 596.60 829.35 1,002.25 1,135.25 1,252.10 1,310.05 NA NA81 323.00 603.25 841.70 1,020.30 1,158.05 1,278.70 1,339.50 NA NA82 322.05 605.15 849.30 1,032.65 1,174.20 1,299.60 1,363.25 NA NA83 317.30 604.20 851.20 1,039.30 1,185.60 1,311.95 1,379.40 NA NA84 310.65 597.55 847.40 1,039.30 1,187.50 1,317.65 1,387.00 NA NA85 302.10 585.20 836.95 1,031.70 1,182.75 1,313.85 1,386.05 NA NA



Annual Premiums


5



Issue Age




Annual Premiums


6



Issue Age

18-29 227.05 383.80 514.90 610.85 685.90 755.25 785.65 870.20 967.10 30 228.00 388.55 520.60 617.50 694.45 763.80 794.20 881.60 979.45 31 230.85 395.20 527.25 626.05 701.10 772.35 802.75 891.10 990.85 32 232.75 399.00 533.90 633.65 710.60 782.80 812.25 901.55 1,003.20 33 235.60 403.75 540.55 640.30 719.15 792.30 822.70 912.95 1,015.55 34 237.50 407.55 546.25 648.85 727.70 800.85 832.20 924.35 1,026.00 35 222.30 383.80 514.90 611.80 686.85 756.20 787.55 873.05 971.85 36 224.20 387.60 520.60 618.45 694.45 765.70 796.10 882.55 982.30 37 228.00 391.40 527.25 627.00 703.00 774.25 804.65 893.00 994.65 38 230.85 397.10 532.95 631.75 711.55 783.75 815.10 904.40 1,005.10 39 232.75 400.90 538.65 640.30 719.15 792.30 823.65 913.90 1,016.50 40 220.40 380.95 514.90 610.85 685.90 757.15 785.65 873.05 971.85 41 222.30 384.75 519.65 617.50 694.45 765.70 795.15 883.50 983.25 42 224.20 390.45 525.35 625.10 702.05 775.20 805.60 893.00 993.70 43 228.00 393.30 531.05 631.75 709.65 782.80 814.15 905.35 1,004.15 44 228.95 398.05 537.70 639.35 719.15 793.25 823.65 915.80 1,018.40 45 217.55 379.05 513.00 609.90 687.80 759.05 788.50 876.85 975.65 46 219.45 382.85 518.70 617.50 695.40 767.60 798.95 886.35 986.10 47 222.30 388.55 524.40 623.20 702.05 776.15 807.50 895.85 998.45 48 223.25 391.40 529.15 631.75 711.55 783.75 816.05 906.30 1,008.90 49 225.15 395.20 534.85 637.45 720.10 794.20 826.50 917.70 1,021.25 50 222.30 389.50 528.20 628.90 709.65 782.80 816.05 906.30 1,008.90 51 224.20 392.35 532.95 636.50 718.20 792.30 825.55 917.70 1,020.30 52 225.15 397.10 538.65 643.15 725.80 800.85 835.05 928.15 1,031.70 53 227.05 401.85 544.35 650.75 734.35 811.30 844.55 938.60 1,044.05 54 229.90 404.70 549.10 659.30 741.95 820.80 855.00 949.05 1,057.35 55 218.50 386.65 526.30 629.85 709.65 785.65 818.90 909.15 1,012.70 56 219.45 390.45 531.05 636.50 718.20 795.15 828.40 920.55 1,025.05 57 221.35 392.35 535.80 642.20 724.85 803.70 836.95 931.00 1,036.45 58 222.30 396.15 541.50 648.85 734.35 812.25 848.35 942.40 1,048.80 59 223.25 399.95 547.20 655.50 741.95 821.75 856.90 951.90 1,061.15 60 221.35 396.15 542.45 649.80 736.25 815.10 851.20 947.15 1,054.50 61 222.30 397.10 545.30 654.55 741.00 821.75 858.80 953.80 1,063.05 62 221.35 397.10 545.30 656.45 743.85 824.60 862.60 958.55 1,068.75 63 223.25 401.85 553.85 666.90 757.15 839.80 879.70 977.55 1,089.65 64 224.20 405.65 558.60 675.45 765.70 852.15 890.15 991.80 1,105.80 65 185.25 340.10 474.05 577.60 659.30 736.25 771.40 861.65 963.30 66 179.55 331.55 465.50 570.00 651.70 728.65 765.70 855.00 957.60 67 171.00 320.15 452.20 553.85 636.50 712.50 750.50 837.90 940.50 68 160.55 304.95 434.15 536.75 618.45 694.45 731.50 819.85 921.50 69 147.25 283.10 408.50 507.30 588.05 662.15 701.10 785.65 885.40 70 NA NA NA NA NA NA NA NA NA71 NA NA NA NA NA NA NA NA NA72 NA NA NA NA NA NA NA NA NA73 NA NA NA NA NA NA NA NA NA74 NA NA NA NA NA NA NA NA NA75 NA NA NA NA NA NA NA NA NA76 NA NA NA NA NA NA NA NA NA77 NA NA NA NA NA NA NA NA NA78 NA NA NA NA NA NA NA NA NA79 NA NA NA NA NA NA NA NA NA80 NA NA NA NA NA NA NA NA NA81 NA NA NA NA NA NA NA NA NA82 NA NA NA NA NA NA NA NA NA83 NA NA NA NA NA NA NA NA NA84 NA NA NA NA NA NA NA NA NA85 NA NA NA NA NA NA NA NA NA



Annual Premiums


7


125%ALF/125%HHC 1.04 1.06 1.07 1.08 1.09 1.10 1.11

75%ALF/75%HHC 0.96 0.95 0.93 0.91 0.90 0.89 0.89

50%ALF/50%HHC 0.92 0.87 0.83 0.80 0.79 0.77 0.77


Rate Factors to be Applied to the 100% ALF / 100% HHC Base Rates and any Riders

Factors


Form Number: FRFC-336-PAAssisted Living Facility / Home Health Care Benefit Options

8



1.28 1.22 1.14 1.03 1.00 0.82 0.70

Factors




Flex Care

9



NA 1.06 1.04 1.03 1.01 1.01 1.01 1.01 1.01


Factors



10


Issue Age Factor

< 60 1.1560+ 1.12




Flex Care

11



N/A N/A 1.05 1.09 1.11 1.22 1.36


Form Number: FRFC-336-PA20 Calendar Day Elimination Period for Assisted Living Facility, Home Health Care and

Adult Day CareForm Number: FC-EPR-PA

Flex Care

12




Payment Term

Flex CareMedAmerica Insurance Company



13


Issue Age< 40 1.01

40-49 1.0150-54 1.0155-59 1.0260-69 1.0270-74 1.0375-79 1.0580+ 1.06

All Payment Terms




Flex Care

14


30 NA 47.50 33.25 28.50 NA NA NA NA NA

31 NA 50.35 37.05 31.35 NA NA NA NA NA

32 NA 53.20 38.95 33.25 NA NA NA NA NA

33 NA 57.00 40.85 33.25 NA NA NA NA NA

34 NA 58.90 43.70 37.05 NA NA NA NA NA

35 NA 63.65 46.55 39.90 NA NA NA NA NA

36 NA 68.40 49.40 40.85 NA NA NA NA NA

37 NA 71.25 52.25 44.65 NA NA NA NA NA

38 NA 77.90 55.10 45.60 NA NA NA NA NA

39 NA 80.75 58.90 49.40 NA NA NA NA NA

40 NA 84.55 62.70 52.25 NA NA NA NA NA

41 NA 90.25 65.55 55.10 NA NA NA NA NA

42 NA 95.95 69.35 57.95 NA NA NA NA NA

43 NA 101.65 73.15 61.75 NA NA NA NA NA

44 NA 108.30 78.85 64.60 NA NA NA NA NA

45 NA 115.90 82.65 68.40 NA NA NA NA NA

46 NA 123.50 89.30 73.15 NA NA NA NA NA

47 NA 132.05 94.05 76.95 NA NA NA NA NA

48 NA 138.70 99.75 83.60 NA NA NA NA NA

49 NA 148.20 105.45 87.40 NA NA NA NA NA

50 NA 159.60 114.00 94.05 NA NA NA NA NA

51 NA 169.10 120.65 99.75 NA NA NA NA NA

52 NA 179.55 129.20 107.35 NA NA NA NA NA

53 NA 192.85 136.80 112.10 NA NA NA NA NA

54 NA 204.25 146.30 120.65 NA NA NA NA NA

55 NA 214.70 153.90 126.35 NA NA NA NA NA

56 NA 228.95 163.40 133.95 NA NA NA NA NA

57 NA 244.15 174.80 142.50 NA NA NA NA NA

58 NA 261.25 185.25 152.00 NA NA NA NA NA

59 NA 279.30 198.55 162.45 NA NA NA NA NA

60 NA 292.60 208.05 169.10 NA NA NA NA NA

61 NA 312.55 222.30 181.45 NA NA NA NA NA

62 NA 333.45 236.55 193.80 NA NA NA NA NA

63 NA 364.80 259.35 211.85 NA NA NA NA NA

64 NA 399.00 283.10 230.85 NA NA NA NA NA

65 NA 432.25 305.90 248.90 NA NA NA NA NA

66 NA 472.15 334.40 272.65 NA NA NA NA NA

67 NA 517.75 366.70 298.30 NA NA NA NA NA

68 NA 572.85 404.70 329.65 NA NA NA NA NA

69 NA 633.65 447.45 364.80 NA NA NA NA NA

70 NA 669.75 471.20 382.85 NA NA NA NA NA

71 NA 740.05 519.65 421.80 NA NA NA NA NA

72 NA 817.00 573.80 465.50 NA NA NA NA NA

73 NA 891.10 625.10 506.35 NA NA NA NA NA

74 NA 971.85 680.20 551.00 NA NA NA NA NA

75 NA 1,042.15 728.65 588.05 NA NA NA NA NA

76 NA 1,130.50 789.45 636.50 NA NA NA NA NA

77 NA 1,226.45 854.05 686.85 NA NA NA NA NA

78 NA 1,356.60 944.30 759.05 NA NA NA NA NA

79 NA 1,501.95 1,044.05 837.90 NA NA NA NA NA

80 NA 1,660.60 1,152.35 924.35 NA NA NA NA NA

81 NA 1,839.20 1,273.95 1,019.35 NA NA NA NA NA

82 NA 2,033.00 1,406.95 1,123.85 NA NA NA NA NA

83 NA 2,242.95 1,548.50 1,235.95 NA NA NA NA NA

84 NA 2,468.10 1,701.45 1,354.70 NA NA NA NA NA

85 NA 2,703.70 1,860.10 1,477.25 NA NA NA NA NA







15


30 NA NA 47.50 33.25 37.05 NA NA NA NA

31 NA NA 51.30 36.10 38.00 NA NA NA NA

32 NA NA 54.15 38.00 40.85 NA NA NA NA

33 NA NA 57.00 38.95 43.70 NA NA NA NA

34 NA NA 61.75 42.75 45.60 NA NA NA NA

35 NA NA 65.55 45.60 49.40 NA NA NA NA

36 NA NA 69.35 47.50 52.25 NA NA NA NA

37 NA NA 74.10 51.30 56.05 NA NA NA NA

38 NA NA 77.90 52.25 58.90 NA NA NA NA

39 NA NA 82.65 57.00 61.75 NA NA NA NA

40 NA NA 87.40 60.80 64.60 NA NA NA NA

41 NA NA 92.15 63.65 69.35 NA NA NA NA

42 NA NA 96.90 67.45 74.10 NA NA NA NA

43 NA NA 102.60 71.25 76.95 NA NA NA NA

44 NA NA 109.25 76.00 81.70 NA NA NA NA

45 NA NA 115.90 80.75 87.40 NA NA NA NA

46 NA NA 124.45 84.55 93.10 NA NA NA NA

47 NA NA 131.10 89.30 98.80 NA NA NA NA

48 NA NA 139.65 96.90 104.50 NA NA NA NA

49 NA NA 148.20 101.65 112.10 NA NA NA NA

50 NA NA 159.60 108.30 118.75 NA NA NA NA

51 NA NA 169.10 115.90 126.35 NA NA NA NA

52 NA NA 180.50 123.50 133.95 NA NA NA NA

53 NA NA 190.00 131.10 142.50 NA NA NA NA

54 NA NA 203.30 140.60 152.00 NA NA NA NA

55 NA NA 213.75 146.30 158.65 NA NA NA NA

56 NA NA 227.05 155.80 169.10 NA NA NA NA

57 NA NA 242.25 166.25 179.55 NA NA NA NA

58 NA NA 258.40 175.75 191.90 NA NA NA NA

59 NA NA 276.45 187.15 205.20 NA NA NA NA

60 NA NA 288.80 196.65 213.75 NA NA NA NA

61 NA NA 308.75 209.00 228.00 NA NA NA NA

62 NA NA 328.70 224.20 243.20 NA NA NA NA

63 NA NA 360.05 244.15 265.05 NA NA NA NA

64 NA NA 392.35 267.90 289.75 NA NA NA NA

65 NA NA 423.70 288.80 312.55 NA NA NA NA

66 NA NA 463.60 315.40 342.00 NA NA NA NA

67 NA NA 508.25 344.85 374.30 NA NA NA NA

68 NA NA 561.45 381.90 414.20 NA NA NA NA

69 NA NA 621.30 421.80 457.90 NA NA NA NA

70 NA NA 653.60 441.75 480.70 NA NA NA NA

71 NA NA 720.10 488.30 530.10 NA NA NA NA

72 NA NA 795.15 537.70 584.25 NA NA NA NA

73 NA NA 865.45 585.20 636.50 NA NA NA NA

74 NA NA 942.40 635.55 692.55 NA NA NA NA

75 NA NA 1,007.95 678.30 737.20 NA NA NA NA

76 NA NA 1,090.60 734.35 797.05 NA NA NA NA

77 NA NA 1,178.95 792.30 859.75 NA NA NA NA

78 NA NA 1,303.40 874.95 950.00 NA NA NA NA

79 NA NA 1,440.20 965.20 1,047.85 NA NA NA NA

80 NA NA 1,589.35 1,064.95 NA NA NA NA NA

81 NA NA 1,755.60 1,175.15 NA NA NA NA NA

82 NA NA 1,937.05 1,294.85 NA NA NA NA NA

83 NA NA 2,131.80 1,423.10 NA NA NA NA NA

84 NA NA 2,339.85 1,558.95 NA NA NA NA NA

85 NA NA 2,555.50 1,699.55 NA NA NA NA NA







16



Premium Factors


Form Number: FRFC-336-PATEN YEAR PREMIUM PAYMENT TERM FACTORS

17



Premium Factors


Form Number: FRFC-336-PATWENTY YEAR PREMIUM PAYMENT TERM FACTORS

18



1.05 1.05 1.06 1.06 1.07 1.07 1.08 1.10 1.10



Monthly Assisted Living Facility, Home Health Care, and Adult Day Care Benefit Rider

Factors

Form Number: FC-MBR-PA

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18-29 1.29 1.36 1.39 1.43 1.45 1.47 1.50 1.51 1.5430-34 1.29 1.36 1.39 1.42 1.45 1.46 1.49 1.50 1.5235-39 1.30 1.36 1.39 1.41 1.44 1.45 1.47 1.48 1.5140-44 1.30 1.35 1.38 1.40 1.42 1.44 1.46 1.47 1.4945-49 1.29 1.34 1.37 1.39 1.41 1.42 1.44 1.45 1.4750-54 1.29 1.33 1.36 1.38 1.39 1.41 1.42 1.43 1.4455-59 1.28 1.32 1.34 1.36 1.37 1.38 1.40 1.40 1.4260-64 1.27 1.30 1.32 1.33 1.35 1.36 1.37 1.37 1.3865-69 1.25 1.28 1.30 1.31 1.33 1.33 1.35 1.35 1.3670-74 1.24 1.27 1.28 1.30 1.31 1.32 1.33 1.33 1.3475-79 1.22 1.25 1.26 1.27 1.28 1.29 1.29 1.30 1.3080-84 1.19 1.21 1.22 1.23 1.24 1.25 1.26 NA NA

85 1.16 1.18 1.19 1.19 1.20 1.21 1.22 NA NA





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<50 N/A 1.28 1.18 1.11 1.07 1.05 1.02 1.02 N/A50+ N/A 1.33 1.20 1.11 1.07 1.05 1.02 1.02 N/A















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Multiply the annual premium by the appropriate factor below based on marital

and insured status.

Factors1.000.850.750.70



RateClass Factors

I 0.90II 1.00

Married *




Marital Status

Flex Care



Married one insured


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Payment

Mode Factors

Bi-Weekly 0.0415

Monthly 0.0900

Quarterly 0.2600

Semi-Annually 0.5150

Annually 1.0000



Modal Factors

Flex Care

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MedAmerica Claim Administration and Processing Documentation

As the majority of policies to which this rate increase is applicable are eligible for a contingent benefit

upon lapse, the following provides a demonstration that MedAmerica Insurance Company

(MedAmerica) has consistently applied appropriate policy administration and claim processing

procedures. These procedures are in place to assure that policyholders’ long‐term care claims are paid

according to the provisions of our contracts.

Personal Care Advisors (PCAs) in our Claims Intake area determine whether a claimant qualifies for initial

benefit eligibility, and create a plan of care for each eligible claimant. Our Rehabilitation/Case

Management team then assigns a PCA to handle all aspects of the insured’s contact with the Company,

including care planning, ongoing care management, and supervision of claim payment.

While the PCAs are knowledgeable about all of the long term care products administered by the

Company, each one specializes in a handful of products to increase claim payment accuracy. For

chronically stable patients for whom rehabilitation is unlikely and site of care changes occur

infrequently, specialized PCAs are assigned whose primary task is timely adjudication of claims and

annual reassessment of benefit eligibility.

All claimants are reassessed at least once per year; claimants in Assisted Living or Home Care status are

reassessed more frequently. All claims are reviewed prior to payment. Monthly claims audit procedures

are in place. Anti‐fraud activities are carried out by the staff of the Special Investigations Unit within our

parent company.

MedAmerica management believes that these claims management practices are designed to pay claims

correctly and help eliminate the potential for further deterioration of the policy form requiring further

premium rate schedule increases.

Appendix A Development and Justification of Current Assumptions

Appendix A 1

Milliman developed the current actuarial assumptions used in this filing.

The assumptions for mortality, voluntary lapse, and morbidity were developed by Milliman based on historical experience and are consistent with those used in MedAmerica’s 2019 cash flow testing. Where actual experience had low credibility or did not exist, industry experience was also used. The experience used to develop these assumptions includes historical experience of MedAmerica Insurance Company (MAPA); MAPA’s two sister companies, MedAmerica Insurance Company of Florida (MAFL) and MedAmerica Insurance Company of New York (MANY) (MAPA, MAFL, and MANY are collectively referred to as MedAmerica). For persistency, policy termination experience through December 31, 2017 was used, with runout through March 31, 2018. For morbidity, claim experience through December 2017 with runout through December 31, 2018 was used.

Improvement (mortality and morbidity) was developed based on individual annuitant or industry experience, along with actuarial judgment. The rate increase dependent assumptions were developed using historical experience and actuarial judgment where experience had low credibility or did not exist.

The rest of this appendix provides details on the development and justification of the current assumptions.

Persistency

The assumptions for mortality and lifetime pay voluntary lapse were developed based on detailed historical experience through December 31, 2017 for MedAmerica’s organic (including affinity partners) and acquired business. For the acquired business, experience prior to acquisition was excluded as it predates MedAmerica’s administration of the block.

The benefit expiry assumption was developed using the 2017 Milliman Long-Term Care Guidelines (Guidelines) with adjustments based on MedAmerica’s actual benefit expiry experience through December 31, 2017 on its organic business.

Mortality Durational Factors

The 2012IAM table is the mortality base assumption. The assumed mortality probabilities were brought forward to 2018 using the 2012IAM attained age mortality improvement scale (i.e., G2 projection scale). Experience adjustment factors by issue age band, duration, attained age and marital status were developed by Milliman. MedAmerica applied the Milliman developed experience adjustment factors to the 2012IAM mortality with retrospective improvement and provided seriatim mortality rates. The 2012IAM mortality table with adjustments is shown in Section 6b of the actuarial memorandum.

Lifetime-Pay Voluntary Lapse Rates

The smoothed durational lapse rates in Table A-1 is the voluntary lapse base assumption.

Experience adjustment factors were developed by Milliman for the following characteristics: 1) cohort ultimate duration, 2) attained age, 3) benefit period and inflation option and 4) marital status. MedAmerica applied the Milliman developed lapse experience adjustment factors and provided seriatim voluntary lapse rates. The Lifetime-Pay voluntary lapse rates are shown in Section 6c of the actuarial memorandum.

In general, the smoothed voluntary lapse rates were set in such a way that the combined


Appendix A 2

duration smoothed rates were close to the derived voluntary lapse rates. The smoothed voluntary lapse rates in the early durations were chosen to reproduce actual history, to the extent possible, so that the transition from historical to projected policy persistency was smooth. In developing the ultimate voluntary lapse rate, the level of credibility of the actual voluntary lapse experience and the experience of other forms were considered, as applicable. The degree of closeness of the smoothed voluntary lapse rate compared to actual experience depends on the level of credibility.

Limited-Pay Voluntary Lapse rates

The algorithm for the limited-pay options is similar to that used in original pricing. The smoothed lapse rates are a scalar of the lifetime-pay lapse rates.

For the ten-pay and twenty-pay options, the scalars were developed from a comparison of the lifetime- pay derived lapse rates to the limited pay option’s derived lapse rates based on MedAmerica’s experience on all products combined. Table A-2 present the scalars applied to the lifetime-pay lapse rates for the 10-year and 20-year payment term options.

Benefit Expiry

Benefit expiry rates reflect assumed policy lapses due to exhaustion of benefits based on the 2017 Milliman Guidelines with adjustments for historical benefit expiry experience and vary by attained age, gender and benefit period. The benefit period for Simplicity ii policies was determined by dividing the cash benefit account by the monthly benefit.

MedAmerica’s actual benefit expiry experience through December 31, 2017 was compared to that expected by the 2017 Milliman Guidelines. Adjustment factors were developed by attained age based on the experience of a subset of MedAmerica’s organic business. Factors were developed by quinquennial age band and then interpolated to produce scalars for each attained age. These scalars were then applied to the benefit expiry rates developed by the 2017 Milliman Guidelines in order to produce the final benefit expiry assumptions shown in Section 6 of the actuarial memorandum.

Morbidity

The claims costs were developed using the 2017 Milliman Guidelines. Experience analyses were performed to develop most likely (with no explicit margin) morbidity experience adjustments to be applied to the 2017 Milliman Guidelines claim costs. The experience used includes historical experience for all products of MedAmerica, its affinity partners, and any acquired business from January 2008 through December 2017, with runout through December 2018. The claim costs were then further adjusted based on historical claim experience by policy duration, attained age, coverage type, benefit payment type, company and product. The adjustment factors were calculated using a Milliman proprietary model that produced multiplicative A:E adjustment factors for these various characteristics. The adjusted expected incurred claims equal the 2017 Milliman Guidelines (with adjustments for historical improvement) multiplied by the A:E adjustment factors.

MedAmerica provided seriatim claim costs with all adjustment factors already applied. For projection purposes, additional improvement was applied to the 2017 experience claim costs to bring them forward to 2018.


Appendix A 3

Improvement

For projected mortality improvement, the G2 improvement scale from the 2012IAM mortality table was used. The G2 improvement scale varies by attained age and is applied beginning in the first projection year and for 10 projection years.

For projected morbidity improvement, a level of 1.0% is assumed for 10 years beginning in calendar year 2020 for both females and males. This assumption is reasonable based on the SOA July 2016 study, Long Term Care Morbidity Improvement Study: Estimates for the Non-Insured U.S. Elderly Population Based on the National Long-Term Care Survey 1984-2004. This study reported population annual morbidity improvement of 2.3% for unisex, 2.5% for males, and 2.1% for females. The SOA July 2016 study uses population data, so it is uncertain how well these findings will translate to an insured population. The SOA June 2011 study suggests that an annuitant cohort has more mortality improvement over the general population, so it is possible that this could be true for morbidity as well. Based on these studies, a reasonable range for morbidity improvement is between 0.0% to 2.5% for males and 0.0% to 2.1% for females for 10 to 20 years.

Rate Increase Dependent Assumptions

At the time of a rate increase, insureds have options to elect a contingent benefit upon lapse (CBUL) or reduced benefit options (RBO). The assumptions are based on MedAmerica CBUL and RBO election rate experience to the extent it exists and is credible, and actuarial judgment.

Contingent Benefit Upon Lapse Election

A CBUL election rate of 4% is assumed for insureds with issue ages 18-64, and 0% for issue ages 65+.

Reduced Benefit Options

No RBO elections are assumed.

Credibility

The company’s credibility percentage for each assumption is determined as (Number of Events / Credibility Threshold) ½, with events defined as deaths, voluntary lapses, benefit expiries, or claims. A credibility standard of a 90% confidence interval for the number of events with an error of plus or minus 7.5% was chosen. Based on these parameters, 481 events is the criterion for full credibility.

Appendix A 5 `

Table A-1 FlexCare

Base Voluntary Lapse Rate for Lifetime Pay

Duration

Smoothed

Lapse Rates 1 6.72% 2 5.66% 31 3.56% 4 2.02% 5 1.01% 6 0.75% 7 0.60% 8 0.60% 9 0.60%

10 0.60% 11 0.60% 12 0.60%

13+ 0.60%

Appendix A 6

Table A-2 FlexCare

Limited Pay Voluntary Lapse Scalars

Duration Payment Option

10 Year 20 Year 1 35% 50% 2 35% 50% 3 35% 50% 4 35% 50% 5 30% 50% 6 30% 50% 7 30% 50% 8 30% 50% 9 0% 25%

10 0% 25% 11 0% 25% 12 0% 25% 13 0% 25% 14 0% 25% 15 0% 25% 16 0% 0% 17 0% 0% 18 0% 0% 19 0% 0% 20 0% 0%

21+ 0% 0%

Administrative Office: 165 Court St. Rochester, NY 14647

Time-Sensitive! Action Needed - Review Options and Make Your Decision

RE: Your Long Term Care Insurance Notice of Premium Increase — Please Read & Retain for Your Records

<<FIRST_NAME>> <<LAST_NAME>> <<STREET_ADDRESS1>> <<STREET_ADDRESS2>> <<CITY>> <<STATE>> <<ZIP>>

<<DATE>> Billing Account ID: <<POLICY_NUMBER>>

Dear <<SALUTATION LAST_NAME>>: We are writing to notify you that we have filed a premium increase of <<INC_AMT>> with the Department of Insurance. This premium change is based on the overall experience of all contracts in your class and has nothing to do with your current age, health status, claims history or any other personal factors. This increase applies to all insureds having the same policy form as you, regardless of the effective date of coverage. Please be advised that premiums are subject to future rate increases. The premium rate increase for your long term care insurance coverage will change on <<NEXT_BILL_DATE>>. Your <<MODAL>> premium payment will change from <<CURRENT_RATE>> to <<FUTURE_RATE>>. We understand this premium increase may affect your ability to afford your current level of benefits. Please review the options regarding your coverage that are outlined below and make the decision that best meets your needs. • Option #1: Continue your coverage at your current level of benefits. You may keep your current

level of benefits by paying the increased premium when it is due on <<NEXT_BILL_DATE>>. If you choose this option, no additional action, other than your premium payment, is required. Please understand that paying the increased premium for coverage through 120 days from the date of the rate increase constitutes your acceptance of the rate increase and voids the offer of the Contingent Non-Forfeiture Benefit outlined in Option #3 below.

• Option #2: Offset the increased premium by reducing your level of benefits. You may be able to adjust your benefits to reduce your premium. Please understand that this option is not always available as you may have selected the state-mandated minimum benefits allowable for long term care insurance. Please call Customer Service toll free at 1-800-240-1675 to discuss your options.

• Option #3: Elect the reduced Contingent Non-Forfeiture Benefit. If you elect the Contingent Non-Forfeiture Benefit Option, no further premium is due. This option becomes effective as of your current paid through date. As of the date of this letter, your Contingent Non-Forfeiture Benefit would be <<RESULT_OF_CNF_FORMULA>>. There are two ways to elect the Contingent Non-Forfeiture Benefit: Choose this option today by signing and dating the enclosed Contingent Non-Forfeiture

Benefit Election Form and returning it in the enclosed postage-paid envelope; OR If you do not pay the increased premium within 120 days of the due date, which is

<<NEXT_BILL_DATE>>, you will be entitled to the Contingent Non-Forfeiture Benefit. We will automatically change your coverage to the Contingent Non-Forfeiture Benefit in lieu of your policy lapsing for non-payment of premium.

Enclosure Administrative Office: 165 Court St. Rochester, NY 14647

IMPORTANT: Paying the increased premium for coverage through 120 days from <<NEXT_BILL_DATE>>, constitutes your acceptance of the rate increase and voids the Contingent Non-Forfeiture Benefit offer. What is the Contingent Non-Forfeiture Benefit? The Contingent Non-Forfeiture Benefit Option allows you to retain reduced long term care insurance benefits in the event you can no longer afford your premium due to a substantial premium increase. Under this option, the same Daily Maximum Nursing Home Benefit amount in effect at the time of the lapse will be payable, but the Current Maximum Lifetime Benefit will be equal to the greater of items a) or b) below:

a) The total amount of premiums paid and applied to Your Policy; OR b) Thirty (30) times Your Daily Maximum Nursing Home Benefit

The total of all benefits paid under your policy will not exceed the Current Maximum Lifetime Benefit that would have been payable if your policy did not lapse. Important facts to know about this reduced benefit are: No future premium is due. The Current Maximum Lifetime Benefit is significantly less than the benefit provided if you

choose to continue paying your premium. All riders will be terminated. All other terms, conditions, limitations and exclusions in your current coverage apply to the

Contingent Non-Forfeiture Benefit.

IMPORTANT NOTE: If your policy includes a Shared Extended Benefit Rider, a Survivor Benefit Rider and/or a Shared Waiver Rider, both you and your spouse must continue to maintain identical coverage. You must both select the same option regarding this rate increase. If you have questions on the above options, please call Customer Service toll free at 1-800-240-1675 between the hours of 8:30 a.m. and 5 p.m. ET, Monday through Friday. If you are currently on claim and your premium is being waived, the increase will be applied when your premium is no longer being waived. Please be assured that your benefits are not affected and that your claims will continue to be paid. As always, thank you for your business with the company.

Sincerely,

Cheryl Bush, RN Senior Vice President, Long Term Care Operations

Administrative Office: 165 Court St. Rochester, NY 14647

Contingent Non-Forfeiture Benefit Election Form <<FIRST_NAME>> <<LAST_NAME>> <<STREET_ADDRESS1>> <<STREET_ADDRESS2>> <<CITY>> <<STATE>> <<ZIP>>

<<DATE>> Billing Account ID: <<POLICY_NUMBER>>

I have decided to stop future premium payments and accept the reduced Contingent Non-Forfeiture Benefit. I understand the following:

• No future premium is due; and • I will have a reduced Current Maximum Lifetime Benefit equal to the sum of all

premiums paid and applied to date, OR thirty (30) times the Daily Maximum Nursing Home Benefit, whichever is greater; and

• The Contingent Non-Forfeiture Benefit is significantly less than the benefit provided if I chose to keep paying my premium; and

• The Contingent Non-Forfeiture Benefit is only available if I satisfy the requirements for Benefit Eligibility as defined in my policy; and

• The Contingent Non-Forfeiture Benefit will be payable up to my Daily Maximum Nursing Home Benefit in effect on the date of this change; and

• All riders will be terminated; and • All other terms, conditions, limitations and exclusions in my current coverage

apply to the Contingent Non-Forfeiture Benefit. Signature: I request my current long term care insurance coverage be reduced to the Contingent Non-Forfeiture Benefit offered by the company. This option becomes effective as of my current paid through date. This option is not a cash refund. A summary of Contingent Non-Forfeiture Benefits will be sent to me when this request is processed. Signature Date Mailing Instructions: Sign and date this form and return in the enclosed postage-paid envelope.

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