4.1

Policy XML

Use the Policy XML reference shown below when you are coding policy templates. Note that this is the standard policy.xml reference structure. If you have a custom developed policy xml, contact your customer service representative for the appropriate reference file.

<PolicyDataSource version="1.0">

  <Record name="Policy Record">

    <MDSLPolicy name="Policy">

      <AccountName>Acme Credit Partners, LLC</AccountName>

      <AccountStreet>1209 Main Street</AccountStreet>

      <AccountStreet2>Ste 100</AccountStreet2>

      <AccountCity>Metropolis</AccountCity>

      <AccountState>GA</AccountState>

      <AccountStateName>Georgia</AccountStateName>

      <AccountZip>12345</AccountZip>

      <AccountType>CORP</AccountType>

      <FederalId>123456789</FederalId>

      <PolicyNo>PN12345-20</PolicyNo>

      <SIC>6799</SIC>

      <SICDescription>Investors, NEC</SICDescription>

      <CarrierName>Acme Insurance Corporation</CarrierName>

      <EffectiveDate>01/01/2020</EffectiveDate>

      <ExpirationDate>12/31/2020</ExpirationDate>

      <AnniversaryDate>01/01/2021</AnniversaryDate>

      <MonthsInContract>12</MonthsInContract>

      <IsRenewal>Y</IsRenewal>

      <GracePeriod>31</GracePeriod>

      <ProducerName>Acme Benefit Systems, Inc.</ProducerName>

      <ProducerStreet>200 West Main Street</ProducerStreet>

      <ProducerStreet2>Suite 500</ProducerStreet2>

      <ProducerCity>Metrocity</ProducerCity>

      <ProducerState>IL</ProducerState>

      <ProducerZip>12345</ProducerZip>

      <ProducerContact>John Adams</ProducerContact>

      <OfficeName>ACME</OfficeName>

      <OfficeStreet>10400 Main Street</OfficeStreet>

      <OfficeStreet2>Suite 440</OfficeStreet2>

      <OfficeCity>Eden Prairie</OfficeCity>

      <OfficeState>MN</OfficeState>

      <OfficeZip>123456789</OfficeZip>

      <OfficePhone>8885551212</OfficePhone>

      <BrokerName>Acme, Inc.</BrokerName>

      <BrokerStreet>123 Main</BrokerStreet>

      <BrokerStreet2>Business Loop</BrokerStreet2>

      <BrokerCity>Metrocity</BrokerCity>

      <BrokerState>GA<BrokerState>

      <BrokerZip>12345</BrokerZip>

      <BrokerPhone>8885551212</BrokerPhone>

      <AgentOfRecordName>John Adams</AgentOfRecordName>

      <AgentOfRecordStreet>123 Main</AgentOfRecordStreet>

      <AgentOfRecordStreet2>Ste 100</AgentOfRecordStreet2>

      <AgentOfRecordCity>Metrocity</AgentOfRecordCity>

      <AgentOfRecordState>CO</AgentOfRecordState>

      <AgentOfRecordZip>80918</AgentOfRecordZip>

      <AgentOfRecordPhone>8885551212</AgentOfRecordPhone>

      <ClaimAdministratorName>Acme Benefit Systems, Inc.</ClaimAdministratorName>

      <ClaimAdministratorStreet>200 West Main Street</ClaimAdministratorStreet>

      <ClaimAdministratorStreet2>Suite 500</ClaimAdministratorStreet2>

      <ClaimAdministratorCity>Chicago</ClaimAdministratorCity>

      <ClaimAdministratorState>IL</ClaimAdministratorState>

      <ClaimAdministratorZip>12345</ClaimAdministratorZip>

      <ClaimAdministratorPhone>8885551212</ClaimAdministratorPhone>

      <PremiumAdministratorName>Acme Benefit Systems, Inc.</PremiumAdministratorName>

      <PremiumAdministratorStreet>200 West Main Street</PremiumAdministratorStreet>

      <PremiumAdministratorStreet2>Suite 500</PremiumAdministratorStreet2>

      <PremiumAdministratorCity>Chicago</PremiumAdministratorCity>

      <PremiumAdministratorState>IL</PremiumAdministratorState>

      <PremiumAdministratorZip>12345</PremiumAdministratorZip>

      <PremiumAdministratorPhone>8885551212</PremiumAdministratorPhone>

      <Underwriter>Calvin Coolidge</Underwriter>

      <BenefitPlanName>Really Awesome Plan</BenefitPlanName>

      <IsRetireeCovered>Y</IsRetireeCovered>

      <IsActivelyAtWorkWaived>N</IsActivelyAtWorkWaived>

      <IsDisabledCovered>N</IsDisabledCovered>

      <IsCOBRACovered>Y</IsCOBRACovered>

      <IsPlanMirroring>N</IsPlanMirroring>

      <PlanMirrorQualification>Y</PlanMirrorQualification>

      <IsExperienceRefund>Y</IsExperienceRefund>

      <ProductCode>AGSP</ProductCode>

      <ProductDescription>Ag and Specific Combined</ProductDescription>

    </MDSLPolicy>

    <Classes>

      <Class>

        <ClassName>Initial Sold Class</ClassName>

        <ClassNo>1</ClassNo>

        <SpIsMedical>Y</SpIsMedical>

        <SpIsRXSAAO>N</SpIsRXSAAO>

        <SpIsRxCard>Y</SpIsRxCard>

        <SpIsOther>Y</SpIsOther>

        <SpOtherDescription>Other Sp Coverage</SpOtherDescription>

        <SpContractType>12/15</SpContractType>

        <SpClaimsIncMonths>12</SpClaimsIncMonths>

        <SpClaimsPaidMonths>15</SpClaimsPaidMonths>

        <SpClaimsIncFrom>2020-01-01T00:00:00</SpClaimsIncFrom>

        <SpClaimsIncTo>2020-12-31T00:00:00</SpClaimsIncTo>

        <SpClaimsPaidFrom>2020-01-01T00:00:00</SpClaimsPaidFrom>

        <SpClaimsPaidTo>2021-03-31T00:00:00</SpClaimsPaidTo>

        <SpDeductible>40000</SpDeductible>

        <SpIsFamilyDeductible>N</SpIsFamilyDeductible>

        <SpIsUnlimitedCoverage>Y</SpIsUnlimitedCoverage>

        <SpMaxCoverageLimit>NONE</SpMaxCoverageLimit>

        <SpMaxCoverage>0</SpMaxCoverage>

        <SpRunInOutLimit>0</SpRunInOutLimit>

        <SpMaxReimbursement>0</SpMaxReimbursement>

        <SpReimbPercent>100</SpReimbPercent>

        <SpAggrInitCarrierLiab>0</SpAggrInitCarrierLiab>

        <SpAggrInitCarrierLiabApplied>0.0000</SpAggrInitCarrierLiabApplied>

        <AgIsMedical>Y</AgIsMedical>

        <AgIsRXSAAO>N</AgIsRXSAAO>

        <AgIsRxCard>Y</AgIsRxCard>

        <AgIsDental>N</AgIsDental>

        <AgIsVision>N</AgIsVision>

        <AgIsWklyInc>N</AgIsWklyInc>

        <AgIsOther1>N</AgIsOther1>

        <AgIsOther2>N</AgIsOther2>

        <AgOtherDescription1 />

        <AgOtherDescription2 />

        <AgContractType>12/15</AgContractType>

        <AgClaimsIncMonths>12</AgClaimsIncMonths>

        <AgClaimsPaidMonths>15</AgClaimsPaidMonths>

        <AgClaimsIncFrom>2020-01-01T00:00:00</AgClaimsIncFrom>

        <AgClaimsIncTo>2020-12-31T00:00:00</AgClaimsIncTo>

        <AgClaimsPaidFrom>2020-01-01T00:00:00</AgClaimsPaidFrom>

        <AgClaimsPaidTo>2021-03-31T00:00:00</AgClaimsPaidTo>

        <AgMaxLiabilityPerson>40000</AgMaxLiabilityPerson>

        <AgCorridor>125</AgCorridor>

        <AgIsUnlimitedCoverage>N</AgIsUnlimitedCoverage>

        <AgMaxReimbursement>1000000</AgMaxReimbursement>

        <AgRunInOutLimit>0</AgRunInOutLimit>

        <AgReimbPercent>100</AgReimbPercent>

      </Class>

      <Class>

        <ClassName>Other Sold Class</ClassName>

        <ClassNo>2</ClassNo>

        <SpIsMedical>Y</SpIsMedical>

        <SpIsRXSAAO>N</SpIsRXSAAO>

        <SpIsRxCard>Y</SpIsRxCard>

        <SpIsOther>N</SpIsOther>

        <SpOtherDescription />

        <SpContractType>12/15</SpContractType>

        <SpClaimsIncMonths>12</SpClaimsIncMonths>

        <SpClaimsPaidMonths>15</SpClaimsPaidMonths>

        <SpClaimsIncFrom>2020-01-01T00:00:00</SpClaimsIncFrom>

        <SpClaimsIncTo>2020-12-31T00:00:00</SpClaimsIncTo>

        <SpClaimsPaidFrom>2020-01-01T00:00:00</SpClaimsPaidFrom>

        <SpClaimsPaidTo>2021-03-31T00:00:00</SpClaimsPaidTo>

        <SpDeductible>40000</SpDeductible>

        <SpIsFamilyDeductible>N</SpIsFamilyDeductible>

        <SpIsUnlimitedCoverage>Y</SpIsUnlimitedCoverage>

        <SpMaxCoverageLimit>NONE</SpMaxCoverageLimit>

        <SpMaxCoverage>0</SpMaxCoverage>

        <SpRunInOutLimit>0</SpRunInOutLimit>

        <SpMaxReimbursement>0</SpMaxReimbursement>

        <SpReimbPercent>100</SpReimbPercent>

        <SpAggrInitCarrierLiab>0</SpAggrInitCarrierLiab>

        <SpAggrInitCarrierLiabApplied>0.0000</SpAggrInitCarrierLiabApplied>

        <AgIsMedical>Y</AgIsMedical>

        <AgIsRXSAAO>N</AgIsRXSAAO>

        <AgIsRxCard>Y</AgIsRxCard>

        <AgIsDental>N</AgIsDental>

        <AgIsVision>N</AgIsVision>

        <AgIsWklyInc>N</AgIsWklyInc>

        <AgIsOther1>N</AgIsOther1>

        <AgIsOther2>N</AgIsOther2>

        <AgOtherDescription1 />

        <AgOtherDescription2 />

        <AgContractType>12/15</AgContractType>

        <AgClaimsIncMonths>12</AgClaimsIncMonths>

        <AgClaimsPaidMonths>15</AgClaimsPaidMonths>

        <AgClaimsIncFrom>2020-01-01T00:00:00</AgClaimsIncFrom>

        <AgClaimsIncTo>2020-12-31T00:00:00</AgClaimsIncTo>

        <AgClaimsPaidFrom>2020-01-01T00:00:00</AgClaimsPaidFrom>

        <AgClaimsPaidTo>2021-03-31T00:00:00</AgClaimsPaidTo>

        <AgMaxLiabilityPerson>40000</AgMaxLiabilityPerson>

        <AgCorridor>125</AgCorridor>

        <AgIsUnlimitedCoverage>N</AgIsUnlimitedCoverage>

        <AgMaxReimbursement>1000000</AgMaxReimbursement>

        <AgRunInOutLimit>0</AgRunInOutLimit>

        <AgReimbPercent>100</AgReimbPercent>

      </Class>

    </Classes>

    <PolicyTags name="Policy Tags">

      <Tag>

        <PolicyTag>*AcmeCare</PolicyTag>

      </Tag>

      <Tag>

        <PolicyTag>90</PolicyTag>

      </Tag>

      <Tag>

        <PolicyTag>AA</PolicyTag>

      </Tag>

      <Tag>

        <PolicyTag>NNL</PolicyTag>

      </Tag>

      <Tag>

        <PolicyTag>OR</PolicyTag>

      </Tag>

      <Tag>

        <PolicyTag>PM</PolicyTag>

      </Tag>

    </PolicyTags>

    <Terms name="Terms">

      <SpIsCoverage>Y</SpIsCoverage>

      <SpIsMDCovered>Y</SpIsMDCovered>

      <SpIsRXCovered>Y</SpIsRXCovered>

      <SpIsOTCovered>Y</SpIsOTCovered>

      <SpOTDescription>Other Specific Coverage</SpOTDescription>

      <SpDeductible>40000</SpDeductible>

      <SpIsFamilyDeductible>N</SpIsFamilyDeductible>

      <SpMaxCoverageLimit>NONE</SpMaxCoverageLimit>

      <SpMaxCoverage>0</SpMaxCoverage>

      <SpMaxReimbursement>0</SpMaxReimbursement>

      <SpReimbPercent>100</SpReimbPercent>

      <SpIsTerminalExtension>Y</SpIsTerminalExtension>

      <SpTerminalExtTerm>0</SpTerminalExtTerm>

      <SpIsAdvanceFunding>Y</SpIsAdvanceFunding>

      <SpIsAddLiability>N</SpIsAddLiability>

      <SpAddLiability>0</SpAddLiability>

      <SpContractBasis>1212</SpContractBasis>

      <SpContractBasisDescription>12/12</SpContractBasisDescription>

      <SpRunInLimit>0</SpRunInLimit>

      <SpClaimIncMonths>12</SpClaimIncMonths>

      <SpClaimPaidMonths>15</SpClaimPaidMonths>

      <SpClaimIncFrom>01/01/2020</SpClaimIncFrom>

      <SpClaimIncTo>12/31/2020</SpClaimIncTo>

      <SpClaimPaidFrom>01/01/2020</SpClaimPaidFrom>

      <SpClaimPaidTo>03/31/2021</SpClaimPaidTo>

      <SpCommission>0.0000</SpCommission>

      <SpEstAnnPremium>397588</SpEstAnnPremium>

      <SpMinAnnPremium>0</SpMinAnnPremium>

      <SpDepositPremium>33132.3000</SpDepositPremium>

      <SpIsTransplantCoverage>N</SpIsTransplantCoverage>

      <SpIsGaplessRenewal>N</SpIsGaplessRenewal>

      <SpIsRenewalRateCap>Y</SpIsRenewalRateCap>

      <SpRenewalRateCap>0.00</SpRenewalRateCap>

      <SpIsLaserFreeRenewal>Y</SpIsLaserFreeRenewal>

      <SpLaserFreeRenewalMaxRateIncrease>50</SpLaserFreeRenewalMaxRateIncrease>

      <AgIsCoverage>Y</AgIsCoverage>

      <AgIsMDCovered>Y</AgIsMDCovered>

      <AgIsRXCovered>Y</AgIsRXCovered>

      <AgIsDNCovered>N</AgIsDNCovered>

      <AgIsVICovered>N</AgIsVICovered>

      <AgIsWICovered>N</AgIsWICovered>

      <AgIsO1Covered>N</AgIsO1Covered>

      <AgIsO2Covered>N</AgIsO2Covered>

      <AgO1Description>Other Coverage 1</AgO1Description>

      <AgO2Description>Other Coverage 2</AgO2Description>

      <AgMaxLiabilityPerPerson>40000</AgMaxLiabilityPerPerson>

      <AgMaxReimbursement>1000000</AgMaxReimbursement>

      <AgReimbPercent>100</AgReimbPercent>

      <AgCorridor>125</AgCorridor>

      <AgMinAttachmentPercent>100</AgMinAttachmentPercent>

      <AgMinAttachmentPoint>1652160.8400</AgMinAttachmentPoint>

      <AgEstAttachmentPoint>1652160.8400</AgEstAttachmentPoint>

      <AgIsAgAdvantage>N</AgIsAgAdvantage>

      <AgIsTerminalExtension>Y</AgIsTerminalExtension>

      <AgTerminalExtTerm>0</AgTerminalExtTerm>

      <AgTerminalRate>0.0000</AgTerminalRate>

      <AgIsAdvanceFunding>Y</AgIsAdvanceFunding>

      <AgAdvanceFundingRate>1.5200</AgAdvanceFundingRate>

      <AgContractBasis>1215</AgContractBasis>

      <AgContractBasisDescription>12/15</AgContractBasisDescription>

      <AgRunInLimit>0</AgRunInLimit>

      <AgClaimIncMonths>12</AgClaimIncMonths>

      <AgClaimPaidMonths>15</AgClaimPaidMonths>

      <AgClaimIncFrom>01/01/2020</AgClaimIncFrom>

      <AgClaimIncTo>12/31/2020</AgClaimIncTo>

      <AgClaimPaidFrom>01/01/2020</AgClaimPaidFrom>

      <AgClaimPaidTo>03/31/2021</AgClaimPaidTo>

      <AgCommission>0.0000</AgCommission>

      <AgEstAnnPremium>20150</AgEstAnnPremium>

      <AgMinAnnPremium>0</AgMinAnnPremium>

      <AgDepositPremium>1679.2000</AgDepositPremium>

      <EnrollmentEE>38</EnrollmentEE>

      <EnrollmentED>42</EnrollmentED>

      <EnrollmentEF>42</EnrollmentEF>

      <Enrollment>80</Enrollment>

      <DepositPremium>34811.5000</DepositPremium>

    </Terms>

    <Affiliates name="Affiliates">

      <Affiliate>

        <AffiliateName>Affiliated Company 1</AffiliateName>

        <AffiliateStreet>123 Main St.</AffiliateStreet>

        <AffiliateCity>Metrocity</AffiliateCity>

        <AffiliateState>NY</AffiliateState>

        <AffiliateZip>12345</AffiliateZip>

        <AffiliateType>Important Affiliate</AffiliateType>

      </Affiliate>

      <Affiliate>

        <AffiliateName>Affiliated Company 2</AffiliateName>

        <AffiliateStreet>123 Main St.</AffiliateStreet>

        <AffiliateCity>Metrocity</AffiliateCity>

        <AffiliateState>NY</AffiliateState>

        <AffiliateZip>12345</AffiliateZip>

        <AffiliateType>Important Affiliate</AffiliateType>

      </Affiliate>

      <Affiliate>

        <AffiliateName>Affiliated Company 3</AffiliateName>

        <AffiliateStreet>123 Main St.</AffiliateStreet>

        <AffiliateCity>Metrocity</AffiliateCity>

        <AffiliateState>NY</AffiliateState>

        <AffiliateZip>12345</AffiliateZip>

        <AffiliateType>Important Affiliate</AffiliateType>

      </Affiliate>

      <Affiliate>

        <AffiliateName>Affiliated Company 4</AffiliateName>

        <AffiliateStreet>123 Main St.</AffiliateStreet>

        <AffiliateCity>Metrocity</AffiliateCity>

        <AffiliateState>NY</AffiliateState>

        <AffiliateZip>12345</AffiliateZip>

        <AffiliateType>Important Affiliate</AffiliateType>

      </Affiliate>

    </Affiliates>

    <DomesticReimbursements name="Domestic Reimbursements">

        <FacilityName>Jane Doe Hospital</FacilityName>

        <ReimbPercent>10</ReimbPercent>

    </DomesticReimbursements>

    <PolicyLimitations name="Policy Limitations">

      <Limitations>

        <Limitation>First Limitation</Limitation>

      </Limitations>

      <Limitations>

        <Limitation>Second Limitation</Limitation>

      </Limitations>

    </PolicyLimitations>

    <Rates name="Rates">

      <Rate>

        <ClassName>Initial Sold Class</ClassName>

        <ClassNo>1</ClassNo>

        <SpRateTierSchedule>TS02</SpRateTierSchedule>

        <SpPaymentSchedule>MNTH</SpPaymentSchedule>

        <SpRateEE>220.2400</SpRateEE>

        <SpRateED>110.0000</SpRateED>

        <SpRateES>438.7300</SpRateES>

        <SpRateEC>388.2900</SpRateEC>

        <SpRateEF>658.9700</SpRateEF>

        <SpCensusEE>38</SpCensusEE>

        <SpCensusED>25</SpCensusED>

        <SpCensusES>12</SpCensusES>

        <SpCensusEC>1</SpCensusEC>

        <SpCensusEF>29</SpCensusEF>

        <SpGrossPremiumEE>8369.1200</SpGrossPremiumEE>

        <SpGrossPremiumES>5264.7600</SpGrossPremiumES>

        <SpGrossPremiumEC>388.2900</SpGrossPremiumEC>

        <SpGrossPremiumEF>19110.1300</SpGrossPremiumEF>

        <AgRateTierSchedule>TS02</AgRateTierSchedule>

        <AgPaymentSchedule>MNTH</AgPaymentSchedule>

        <AgRateEE>19.4700</AgRateEE>

        <AgRateED>20.0000</AgRateED>

        <AgRateES>21.0000</AgRateES>

        <AgRateEC>22.0000</AgRateEC>

        <AgRateEF>23.0000</AgRateEF>

        <AgCensusEE>80</AgCensusEE>

        <AgCensusED>0</AgCensusED>

        <AgCensusES>0</AgCensusES>

        <AgCensusEC>0</AgCensusEC>

        <AgCensusEF>0</AgCensusEF>

        <AgAcRateEE>1.5200</AgAcRateEE>

        <AgAcRateED>2.0000</AgAcRateED>

        <AgAcRateES>3.0000</AgAcRateES>

        <AgAcRateEC>4.0000</AgAcRateEC>

        <AgAcRateEF>5.0000</AgAcRateEF>

        <AgAcCensusEE>80</AgAcCensusEE>

        <AgAcCensusED>0</AgAcCensusED>

        <AgAcCensusES>0</AgAcCensusES>

        <AgAcCensusEC>0</AgAcCensusEC>

        <AgAcCensusEF>0</AgAcCensusEF>

        <AGTLRateEE>10.0000</AGTLRateEE>

        <AGTLRateED>20.0000</AGTLRateED>

        <AGTLRateES>30.0000</AGTLRateES>

        <AGTLRateEC>40.0000</AGTLRateEC>

        <AGTLRateEF>50.0000</AGTLRateEF>

        <AGTLCensusEE>0</AGTLCensusEE>

        <AGTLCensusED>0</AGTLCensusED>

        <AGTLCensusES>0</AGTLCensusES>

        <AGTLCensusEC>0</AGTLCensusEC>

        <AGTLCensusEF>0</AGTLCensusEF>

        <AgGrossPremiumEE>1557.6000</AgGrossPremiumEE>

        <AgGrossPremiumES>0.0000</AgGrossPremiumES>

        <AgGrossPremiumEC>0.0000</AgGrossPremiumEC>

        <AgGrossPremiumEF>0.0000</AgGrossPremiumEF>

      </Rate>

      <Rate>

        <ClassName>Second Sold Class</ClassName>

        <ClassNo>1</ClassNo>

        <SpRateTierSchedule>TS04</SpRateTierSchedule>

        <SpPaymentSchedule>MNTH</SpPaymentSchedule>

        <SpRateEE>220.2400</SpRateEE>

        <SpRateED>110.0000</SpRateED>

        <SpRateES>438.7300</SpRateES>

        <SpRateEC>388.2900</SpRateEC>

        <SpRateEF>658.9700</SpRateEF>

        <SpCensusEE>38</SpCensusEE>

        <SpCensusED>25</SpCensusED>

        <SpCensusES>12</SpCensusES>

        <SpCensusEC>1</SpCensusEC>

        <SpCensusEF>29</SpCensusEF>

        <SpGrossPremiumEE>8369.1200</SpGrossPremiumEE>

        <SpGrossPremiumES>5264.7600</SpGrossPremiumES>

        <SpGrossPremiumEC>388.2900</SpGrossPremiumEC>

        <SpGrossPremiumEF>19110.1300</SpGrossPremiumEF>

        <AgRateTierSchedule>TS04</AgRateTierSchedule>

        <AgPaymentSchedule>MNTH</AgPaymentSchedule>

        <AgRateEE>19.4700</AgRateEE>

        <AgRateED>20.0000</AgRateED>

        <AgRateES>21.0000</AgRateES>

        <AgRateEC>22.0000</AgRateEC>

        <AgRateEF>23.0000</AgRateEF>

        <AgCensusEE>80</AgCensusEE>

        <AgCensusED>0</AgCensusED>

        <AgCensusES>0</AgCensusES>

        <AgCensusEC>0</AgCensusEC>

        <AgCensusEF>0</AgCensusEF>

        <AgAcRateEE>1.5200</AgAcRateEE>

        <AgAcRateED>2.0000</AgAcRateED>

        <AgAcRateES>3.0000</AgAcRateES>

        <AgAcRateEC>4.0000</AgAcRateEC>

        <AgAcRateEF>5.0000</AgAcRateEF>

        <AgAcCensusEE>80</AgAcCensusEE>

        <AgAcCensusED>0</AgAcCensusED>

        <AgAcCensusES>0</AgAcCensusES>

        <AgAcCensusEC>0</AgAcCensusEC>

        <AgAcCensusEF>0</AgAcCensusEF>

        <AGTLRateEE>10.0000</AGTLRateEE>

        <AGTLRateED>20.0000</AGTLRateED>

        <AGTLRateES>30.0000</AGTLRateES>

        <AGTLRateEC>40.0000</AGTLRateEC>

        <AGTLRateEF>50.0000</AGTLRateEF>

        <AGTLCensusEE>0</AGTLCensusEE>

        <AGTLCensusED>0</AGTLCensusED>

        <AGTLCensusES>0</AGTLCensusES>

        <AGTLCensusEC>0</AGTLCensusEC>

        <AGTLCensusEF>0</AGTLCensusEF>

        <AgGrossPremiumEE>1557.6000</AgGrossPremiumEE>

        <AgGrossPremiumES>0.0000</AgGrossPremiumES>

        <AgGrossPremiumEC>0.0000</AgGrossPremiumEC>

        <AgGrossPremiumEF>0.0000</AgGrossPremiumEF>

      </Rate>

   </Rates>

    <AdditionalFees>10000</AdditionalFees>

    <Factors name="Factors">

      <Factor>

        <ClassName>Initial Sold Class</ClassName>

        <ClassNo>1</ClassNo>

        <AgFactorTierSchedule>TS02</AgFactorTierSchedule>

        <AgRXFactorIsInMedical>Y</AgRXFactorIsInMedical>

        <AgDNFactorIsInMedical>N</AgDNFactorIsInMedical>

        <AgVIFactorIsInMedical>N</AgVIFactorIsInMedical>

        <AgWIFactorIsInMedical>N</AgWIFactorIsInMedical>

        <AgO1FactorIsInMedical>N</AgO1FactorIsInMedical>

        <AgO2FactorIsInMedical>N</AgO2FactorIsInMedical>

        <AgMDFactorEE>915.2200</AgMDFactorEE>

        <AgMDFactorED>2423.0000</AgMDFactorED>

        <AgMDFactorES>1823.1000</AgMDFactorES>

        <AgMDFactorEC>1613.5200</AgMDFactorEC>

        <AgMDFactorEF>2738.3100</AgMDFactorEF>

        <AgRXFactorEE>0.0000</AgRXFactorEE>

        <AgRXFactorED>0.0000</AgRXFactorED>

        <AgRXFactorES>0.0000</AgRXFactorES>

        <AgRXFactorEC>0.0000</AgRXFactorEC>

        <AgRXFactorEF>0.0000</AgRXFactorEF>

        <AgDNFactorEE>0.0000</AgDNFactorEE>

        <AgDNFactorED>0.0000</AgDNFactorED>

        <AgDNFactorES>0.0000</AgDNFactorES>

        <AgDNFactorEC>0.0000</AgDNFactorEC>

        <AgDNFactorEF>0.0000</AgDNFactorEF>

        <AgVIFactorEE>0.0000</AgVIFactorEE>

        <AgVIFactorED>0.0000</AgVIFactorED>

        <AgVIFactorES>0.0000</AgVIFactorES>

        <AgVIFactorEC>0.0000</AgVIFactorEC>

        <AgVIFactorEF>0.0000</AgVIFactorEF>

        <AgWIFactorEE>0.0000</AgWIFactorEE>

        <AgWIFactorED>0.0000</AgWIFactorED>

        <AgWIFactorES>0.0000</AgWIFactorES>

        <AgWIFactorEC>0.0000</AgWIFactorEC>

        <AgWIFactorEF>0.0000</AgWIFactorEF>

        <AgO1FactorEE>0.0000</AgO1FactorEE>

        <AgO1FactorED>0.0000</AgO1FactorED>

        <AgO1FactorES>0.0000</AgO1FactorES>

        <AgO1FactorEC>0.0000</AgO1FactorEC>

        <AgO1FactorEF>0.0000</AgO1FactorEF>

        <AgO2FactorEE>0.0000</AgO2FactorEE>

        <AgO2FactorED>0.0000</AgO2FactorED>

        <AgO2FactorES>0.0000</AgO2FactorES>

        <AgO2FactorEC>0.0000</AgO2FactorEC>

        <AgO2FactorEF>0.0000</AgO2FactorEF>

        <AgMDCensusEE>50</AgMDCensusEE>

        <AgMDCensusED>30</AgMDCensusED>

        <AgMDCensusES>20</AgMDCensusES>

        <AgMDCensusEC>10</AgMDCensusEC>

        <AgMDCensusEF>40</AgMDCensusEF>

        <AgRXCensusEE>0</AgRXCensusEE>

        <AgRXCensusED>0</AgRXCensusED>

        <AgRXCensusES>0</AgRXCensusES>

        <AgRXCensusEC>0</AgRXCensusEC>

        <AgRXCensusEF>0</AgRXCensusEF>

        <AgDNCensusEE>0</AgDNCensusEE>

        <AgDNCensusED>0</AgDNCensusED>

        <AgDNCensusES>0</AgDNCensusES>

        <AgDNCensusEC>0</AgDNCensusEC>

        <AgDNCensusEF>0</AgDNCensusEF>

        <AgVICensusEE>0</AgVICensusEE>

        <AgVICensusED>0</AgVICensusED>

        <AgVICensusES>0</AgVICensusES>

        <AgVICensusEC>0</AgVICensusEC>

        <AgVICensusEF>0</AgVICensusEF>

        <AgWICensusEE>0</AgWICensusEE>

        <AgWICensusED>0</AgWICensusED>

        <AgWICensusES>0</AgWICensusES>

        <AgWICensusEC>0</AgWICensusEC>

        <AgWICensusEF>0</AgWICensusEF>

        <AgO1CensusEE>0</AgO1CensusEE>

        <AgO1CensusED>0</AgO1CensusED>

        <AgO1CensusES>0</AgO1CensusES>

        <AgO1CensusEC>0</AgO1CensusEC>

        <AgO1CensusEF>0</AgO1CensusEF>

        <AgO2CensusEE>0</AgO2CensusEE>

        <AgO2CensusED>0</AgO2CensusED>

        <AgO2CensusES>0</AgO2CensusES>

        <AgO2CensusEC>0</AgO2CensusEC>

        <AgO2CensusEF>0</AgO2CensusEF>

      </Factor>

      <Factor>

        <ClassName>Second Sold Class</ClassName>

        <ClassNo>2</ClassNo>

        <AgFactorTierSchedule>TS04</AgFactorTierSchedule>

        <AgRXFactorIsInMedical>Y</AgRXFactorIsInMedical>

        <AgDNFactorIsInMedical>N</AgDNFactorIsInMedical>

        <AgVIFactorIsInMedical>N</AgVIFactorIsInMedical>

        <AgWIFactorIsInMedical>N</AgWIFactorIsInMedical>

        <AgO1FactorIsInMedical>N</AgO1FactorIsInMedical>

        <AgO2FactorIsInMedical>N</AgO2FactorIsInMedical>

        <AgMDFactorEE>348.2200</AgMDFactorEE>

        <AgMDFactorED>35.0000</AgMDFactorED>

        <AgMDFactorES>1200.1000</AgMDFactorES>

        <AgMDFactorEC>1400.5200</AgMDFactorEC>

        <AgMDFactorEF>1600.3100</AgMDFactorEF>

        <AgRXFactorEE>0.0000</AgRXFactorEE>

        <AgRXFactorED>0.0000</AgRXFactorED>

        <AgRXFactorES>0.0000</AgRXFactorES>

        <AgRXFactorEC>0.0000</AgRXFactorEC>

        <AgRXFactorEF>0.0000</AgRXFactorEF>

        <AgDNFactorEE>0.0000</AgDNFactorEE>

        <AgDNFactorED>0.0000</AgDNFactorED>

        <AgDNFactorES>0.0000</AgDNFactorES>

        <AgDNFactorEC>0.0000</AgDNFactorEC>

        <AgDNFactorEF>0.0000</AgDNFactorEF>

        <AgVIFactorEE>0.0000</AgVIFactorEE>

        <AgVIFactorED>0.0000</AgVIFactorED>

        <AgVIFactorES>0.0000</AgVIFactorES>

        <AgVIFactorEC>0.0000</AgVIFactorEC>

        <AgVIFactorEF>0.0000</AgVIFactorEF>

        <AgWIFactorEE>0.0000</AgWIFactorEE>

        <AgWIFactorED>0.0000</AgWIFactorED>

        <AgWIFactorES>0.0000</AgWIFactorES>

        <AgWIFactorEC>0.0000</AgWIFactorEC>

        <AgWIFactorEF>0.0000</AgWIFactorEF>

        <AgO1FactorEE>0.0000</AgO1FactorEE>

        <AgO1FactorED>0.0000</AgO1FactorED>

        <AgO1FactorES>0.0000</AgO1FactorES>

        <AgO1FactorEC>0.0000</AgO1FactorEC>

        <AgO1FactorEF>0.0000</AgO1FactorEF>

        <AgO2FactorEE>0.0000</AgO2FactorEE>

        <AgO2FactorED>0.0000</AgO2FactorED>

        <AgO2FactorES>0.0000</AgO2FactorES>

        <AgO2FactorEC>0.0000</AgO2FactorEC>

        <AgO2FactorEF>0.0000</AgO2FactorEF>

        <AgMDCensusEE>38</AgMDCensusEE>

        <AgMDCensusED>0</AgMDCensusED>

        <AgMDCensusES>12</AgMDCensusES>

        <AgMDCensusEC>1</AgMDCensusEC>

        <AgMDCensusEF>29</AgMDCensusEF>

        <AgRXCensusEE>0</AgRXCensusEE>

        <AgRXCensusED>0</AgRXCensusED>

        <AgRXCensusES>0</AgRXCensusES>

        <AgRXCensusEC>0</AgRXCensusEC>

        <AgRXCensusEF>0</AgRXCensusEF>

        <AgDNCensusEE>0</AgDNCensusEE>

        <AgDNCensusED>0</AgDNCensusED>

        <AgDNCensusES>0</AgDNCensusES>

        <AgDNCensusEC>0</AgDNCensusEC>

        <AgDNCensusEF>0</AgDNCensusEF>

        <AgVICensusEE>0</AgVICensusEE>

        <AgVICensusED>0</AgVICensusED>

        <AgVICensusES>0</AgVICensusES>

        <AgVICensusEC>0</AgVICensusEC>

        <AgVICensusEF>0</AgVICensusEF>

        <AgWICensusEE>0</AgWICensusEE>

        <AgWICensusED>0</AgWICensusED>

        <AgWICensusES>0</AgWICensusES>

        <AgWICensusEC>0</AgWICensusEC>

        <AgWICensusEF>0</AgWICensusEF>

        <AgO1CensusEE>0</AgO1CensusEE>

        <AgO1CensusED>0</AgO1CensusED>

        <AgO1CensusES>0</AgO1CensusES>

        <AgO1CensusEC>0</AgO1CensusEC>

        <AgO1CensusEF>0</AgO1CensusEF>

        <AgO2CensusEE>0</AgO2CensusEE>

        <AgO2CensusED>0</AgO2CensusED>

        <AgO2CensusES>0</AgO2CensusES>

        <AgO2CensusEC>0</AgO2CensusEC>

        <AgO2CensusEF>0</AgO2CensusEF>

      </Factor>

    </Factors>
    <LaseredParticipants name="Lasered Participants">

      <Laser>

        <ClassName>Primary</ClassName>

        <ClassNo>1</ClassNo>

        <Name>Calvin Coolidge</Name>

        <Amount>125000</Amount>

        <Condition>Lasered</Condition>

        <ContractType></ContractType>

        <CoverageLimit>50000</CoverageLimit>

        <AggregateLossLimit>125000</AggregateLossLimit>

      </Laser>

      <Laser>

        <ClassName>Primary</ClassName>

        <ClassNo>1</ClassNo>

        <Name>Millard Fillmore</Name>

        <Amount>15000</Amount>

        <Condition>Lasered</Condition>

        <ContractType></ContractType>

        <CoverageLimit></CoverageLimit>

        <AggregateLossLimit>250000</AggregateLossLimit>

      </Laser>

    </LaseredParticipants>

    <ManagedCare name="Managed Care">

      <Vendor>

        <ServiceType>PPON</ServiceType>

        <Name>Cigna</Name>

        <City>Houston</City>

        <State>TX</State>

        <Zip>77092</Zip>

        <Effective>2020-01-01T00:00:00</Effective>

        <Expiration>1900-01-01T00:00:00</Expiration>

      </Vendor>

      <Vendor>

        <ServiceType>URVW</ServiceType>

        <Name>Acme</Name>

        <City>Houston</City>

        <State>TX</State>

        <Zip>77092</Zip>

        <Effective>2020-01-01T00:00:00</Effective>

        <Expiration>1900-01-01T00:00:00</Expiration>

      </Vendor>

    </ManagedCare>

  </Record>

</PolicyDataSource>