Medical Bound Bordereau

Effective

Policy effective date.

Policy No

Policy number.

Policyholder

Policy holder name.

Status

Policy status.

Policy holder state

Zip

Policy holder zip code

SIC

Standard Industrial Classification code for the policy holder.

Whether the policy is new or a renewal.

Sp Deduct

Specific deductible for the policy.

SP C/B

Specific coverage contract basis.

AG C/B

Aggregate coverage contract basis.

Census

Total policy enrollment.

Specific (Gross)

Total premium for policy specific coverage.

Aggregate (Gross)

Total premium for policy aggregate coverage.

Total (Gross)

Sum of policy gross premiums for specific and aggregate coverage.

Specific (Net)

Net premium for policy specific coverage.

Aggregate (Net)

Net premium for policy aggregate coverage.

Total (Net)

Sum of policy net premiums for specific and aggregate coverage.