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 Service, Inc.</AccountName>
<AccountStreet>1 Main Road</AccountStreet>
<AccountStreet2>Ste 100</AccountStreet2>
<AccountCity>Metrocity</AccountCity>
<AccountState>ID</AccountState>
<AccountStateName>Idaho</AccountStateName>
<AccountZip>15106</AccountZip>
<AccountType>GOVT</AccountType>
<FederalId>123456789</FederalId>
<PolicyNo>48731</PolicyNo>
<SIC>5031</SIC>
<SICDescription>Lumber, Plywood, Millwork, & Wood Panels</SICDescription>
<CarrierName>Pan-American Life Insurance Company</CarrierName>
<EffectiveDate>01/01/2024</EffectiveDate>
<ExpirationDate>12/31/2024</ExpirationDate>
<AnniversaryDate>01/01/2025</AnniversaryDate>
<MonthsInContract>12</MonthsInContract>
<IsRenewal>N</IsRenewal>
<GracePeriod>31</GracePeriod>
<ProducerName>Acme & Associates</ProducerName>
<ProducerStreet>103 Main Road</ProducerStreet>
<ProducerStreet2>Suite 500</ProducerStreet2>
<ProducerCity>Metropolis</ProducerCity>
<ProducerState>PA</ProducerState>
<ProducerZip>15090</ProducerZip>
<OfficeName>Acme Underwriters, LLC</OfficeName>
<OfficeStreet>100 W. Main Street</OfficeStreet>
<OfficeStreet2>Suite B</OfficeStreet2>
<OfficeCity>Southville</OfficeCity>
<OfficeState>SC</OfficeState>
<OfficeZip>29306</OfficeZip>
<OfficePhone>8885551212</OfficePhone>
<BrokerName>Lockton</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>Meritain Health - NY</ClaimAdministratorName>
<ClaimAdministratorStreet>300 Corporate Parkway</ClaimAdministratorStreet>
<ClaimAdministratorStreet2>Suite 500</ClaimAdministratorStreet2>
<ClaimAdministratorCity>Metrocity</ClaimAdministratorCity>
<ClaimAdministratorState>NY</ClaimAdministratorState>
<ClaimAdministratorZip>12345</ClaimAdministratorZip>
<ClaimAdministratorPhone>8885551212</ClaimAdministratorPhone>
<PremiumAdministratorName>Acme Health - NY</PremiumAdministratorName>
<PremiumAdministratorStreet>300 Corporate Way</PremiumAdministratorStreet>
<PremiumAdministratorStreet2>Suite 500</PremiumAdministratorStreet2>
<PremiumAdministratorCity>Metropolis</PremiumAdministratorCity>
<PremiumAdministratorState>NY</PremiumAdministratorState>
<PremiumAdministratorZip>14226</PremiumAdministratorZip>
<PremiumAdministratorPhone>8885551212</PremiumAdministratorPhone>
<ProducerContact>John Smith</ProducerContact>
<Underwriter>Abigail Adams</Underwriter>
<BenefitPlanName>Really Awesome Plan</BenefitPlanName>
<IsRetireeCovered>Y</IsRetireeCovered>
<IsActivelyAtWorkWaived>Y</IsActivelyAtWorkWaived>
<IsDisabledCovered>Y</IsDisabledCovered>
<IsCOBRACovered>Y</IsCOBRACovered>
<IsPlanMirroring>Y</IsPlanMirroring>
<PlanMirrorQualification />
<IsExperienceRefund>Y</IsExperienceRefund>
<ProductCode>Stop Loss </ProductCode>
<ProductDescription>Traditional Stop Loss</ProductDescription>
</MDSLPolicy>
<Classes>
<Class>
<ClassName>Initial Sold Class</ClassName>
<ClassNo>1</ClassNo>
<SpIsMedical>Y</SpIsMedical>
<SpIsRXSAAO>N</SpIsRXSAAO>
<SpIsRxCard>Y</SpIsRxCard>
<SpIsOther>N</SpIsOther>
<SpOtherDescription />
<SpContractType>24/12</SpContractType>
<SpClaimsIncMonths>24</SpClaimsIncMonths>
<SpClaimsPaidMonths>12</SpClaimsPaidMonths>
<SpClaimsIncFrom>2023-01-01T00:00:00</SpClaimsIncFrom>
<SpClaimsIncTo>2024-12-31T00:00:00</SpClaimsIncTo>
<SpClaimsPaidFrom>2024-01-01T00:00:00</SpClaimsPaidFrom>
<SpClaimsPaidTo>2024-12-31T00:00:00</SpClaimsPaidTo>
<SpDeductible>85000</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>24/12</AgContractType>
<AgClaimsIncMonths>24</AgClaimsIncMonths>
<AgClaimsPaidMonths>12</AgClaimsPaidMonths>
<AgClaimsIncFrom>2023-01-01T00:00:00</AgClaimsIncFrom>
<AgClaimsIncTo>2024-12-31T00:00:00</AgClaimsIncTo>
<AgClaimsPaidFrom>2024-01-01T00:00:00</AgClaimsPaidFrom>
<AgClaimsPaidTo>2024-12-31T00:00:00</AgClaimsPaidTo>
<AgMaxLiabilityPerson>85000</AgMaxLiabilityPerson>
<AgCorridor>125</AgCorridor>
<AgIsUnlimitedCoverage>N</AgIsUnlimitedCoverage>
<AgMaxReimbursement>1000000</AgMaxReimbursement>
<AgRunInOutLimit>0</AgRunInOutLimit>
<AgReimbPercent>100</AgReimbPercent>
</Class>
<Class>
<ClassName>Second Sold Class</ClassName>
<ClassNo>2</ClassNo>
<SpIsMedical>Y</SpIsMedical>
<SpIsRXSAAO>N</SpIsRXSAAO>
<SpIsRxCard>Y</SpIsRxCard>
<SpIsOther>N</SpIsOther>
<SpOtherDescription />
<SpContractType>24/12</SpContractType>
<SpClaimsIncMonths>24</SpClaimsIncMonths>
<SpClaimsPaidMonths>12</SpClaimsPaidMonths>
<SpClaimsIncFrom>2023-01-01T00:00:00</SpClaimsIncFrom>
<SpClaimsIncTo>2024-12-31T00:00:00</SpClaimsIncTo>
<SpClaimsPaidFrom>2024-01-01T00:00:00</SpClaimsPaidFrom>
<SpClaimsPaidTo>2024-12-31T00:00:00</SpClaimsPaidTo>
<SpDeductible>95000</SpDeductible>
<SpIsFamilyDeductible>N</SpIsFamilyDeductible>
<SpIsUnlimitedCoverage>Y</SpIsUnlimitedCoverage>
<SpMaxCoverageLimit>1000000.0000</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>24/12</AgContractType>
<AgClaimsIncMonths>24</AgClaimsIncMonths>
<AgClaimsPaidMonths>12</AgClaimsPaidMonths>
<AgClaimsIncFrom>2023-01-01T00:00:00</AgClaimsIncFrom>
<AgClaimsIncTo>2024-12-31T00:00:00</AgClaimsIncTo>
<AgClaimsPaidFrom>2024-01-01T00:00:00</AgClaimsPaidFrom>
<AgClaimsPaidTo>2024-12-31T00:00:00</AgClaimsPaidTo>
<AgMaxLiabilityPerson>85000</AgMaxLiabilityPerson>
<AgCorridor>125</AgCorridor>
<AgIsUnlimitedCoverage>N</AgIsUnlimitedCoverage>
<AgMaxReimbursement>1000000</AgMaxReimbursement>
<AgRunInOutLimit>0</AgRunInOutLimit>
<AgReimbPercent>100</AgReimbPercent>
</Class>
</Classes>
<PolicyTags name="Policy Tags">
<Tag>
<PolicyTag>ENDT - Aggregated Specific Deductible</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Named Aggregated Specific Deductible</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Specific Advance Funding</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Specific Carryover</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Specific Risk Attaching Transplant</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Specific Step-Down Deductible</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Specific Terminal Liability</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Aggregate Terminal Liability</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Monthly Aggregate Reimbursement</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Actively At Work</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Combined Policyholder Minimum Premium</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Experience Refund Provision</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Plan Mirroring Coordination</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Premium Swing Rate</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Renewal Rate Cap</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Retained Corridor</PolicyTag>
</Tag>
<Tag>
<PolicyTag>ENDT - Student Health Plan</PolicyTag>
</Tag>
</PolicyTags>
<Terms name="Terms">
<SpIsCoverage>Y</SpIsCoverage>
<SpIsMDCovered>Y</SpIsMDCovered>
<SpIsRXCovered>Y</SpIsRXCovered>
<SpIsOTCovered>N</SpIsOTCovered>
<SpOTDescription />
<SpDeductible>85000</SpDeductible>
<SpIsFamilyDeductible>N</SpIsFamilyDeductible>
<SpMaxCoverageLimit>NONE</SpMaxCoverageLimit>
<SpMaxCoverage>0</SpMaxCoverage>
<SpMaxReimbursement>0</SpMaxReimbursement>
<SpReimbPercent>100</SpReimbPercent>
<SpIsTerminalExtension>Y</SpIsTerminalExtension>
<SpTerminalExtTerm>3</SpTerminalExtTerm>
<SpIsAdvanceFunding>Y</SpIsAdvanceFunding>
<SpIsAddLiability>N</SpIsAddLiability>
<SpAddLiability>30000</SpAddLiability>
<SpContractBasis>2412</SpContractBasis>
<SpContractBasisDescription>24/12</SpContractBasisDescription>
<SpRunInLimit>15000</SpRunInLimit>
<SpClaimIncMonths>24</SpClaimIncMonths>
<SpClaimPaidMonths>12</SpClaimPaidMonths>
<SpClaimIncFrom>01/01/2023</SpClaimIncFrom>
<SpClaimIncTo>12/31/2024</SpClaimIncTo>
<SpClaimPaidFrom>01/01/2024</SpClaimPaidFrom>
<SpClaimPaidTo>12/31/2024</SpClaimPaidTo>
<SpCommission>0.0000</SpCommission>
<SpEstAnnPremium>255657</SpEstAnnPremium>
<SpMinAnnPremium>255659.0000</SpMinAnnPremium>
<SpDepositPremium>21304.7200</SpDepositPremium>
<SpIsTransplantCoverage>N</SpIsTransplantCoverage>
<SpIsGaplessRenewal>N</SpIsGaplessRenewal>
<SpIsRenewalRateCap>N</SpIsRenewalRateCap>
<SpRenewalRateCap>45.00</SpRenewalRateCap>
<SpIsLaserFreeRenewal>Y</SpIsLaserFreeRenewal>
<SpLaserFreeRenewalMaxRateIncrease>50</SpLaserFreeRenewalMaxRateIncrease>
<AgIsCoverage>N</AgIsCoverage>
<AgIsMDCovered>Y</AgIsMDCovered>
<AgIsRXCovered>Y</AgIsRXCovered>
<AgIsDNCovered>Y</AgIsDNCovered>
<AgIsVICovered>Y</AgIsVICovered>
<AgIsWICovered>Y</AgIsWICovered>
<AgIsO1Covered>Y</AgIsO1Covered>
<AgIsO2Covered>N</AgIsO2Covered>
<AgO1Description>Other Coverage</AgO1Description>
<AgO2Description />
<AgMaxLiabilityPerPerson>85000</AgMaxLiabilityPerPerson>
<AgMaxReimbursement>2000000</AgMaxReimbursement>
<AgReimbPercent>100</AgReimbPercent>
<AgCorridor>125</AgCorridor>
<AgMinAttachmentPercent>100</AgMinAttachmentPercent>
<AgMinAttachmentPoint>1547679.9600</AgMinAttachmentPoint>
<AgEstAttachmentPoint>1547679.9600</AgEstAttachmentPoint>
<AgIsAgAdvantage>Y</AgIsAgAdvantage>
<AgIsTerminalExtension>Y</AgIsTerminalExtension>
<AgTerminalExtTerm>3</AgTerminalExtTerm>
<AgTerminalRate>234.0000</AgTerminalRate>
<AgIsAdvanceFunding>N</AgIsAdvanceFunding>
<AgAdvanceFundingRate>12345.0000</AgAdvanceFundingRate>
<AgContractBasis>2412</AgContractBasis>
<AgContractBasisDescription>24/12</AgContractBasisDescription>
<AgRunInLimit>10000</AgRunInLimit>
<AgClaimIncMonths>24</AgClaimIncMonths>
<AgClaimPaidMonths>12</AgClaimPaidMonths>
<AgClaimIncFrom>01/01/2023</AgClaimIncFrom>
<AgClaimIncTo>12/31/2024</AgClaimIncTo>
<AgClaimPaidFrom>01/01/2024</AgClaimPaidFrom>
<AgClaimPaidTo>12/31/2024</AgClaimPaidTo>
<AgCommission>0.0000</AgCommission>
<AgEstAnnPremium>27194</AgEstAnnPremium>
<AgMinAnnPremium>27194</AgMinAnnPremium>
<AgDepositPremium>2266.1600</AgDepositPremium>
<EnrollmentEE>51</EnrollmentEE>
<EnrollmentED>53</EnrollmentED>
<EnrollmentEF>53</EnrollmentEF>
<Enrollment>104</Enrollment>
<DepositPremium>23570.8800</DepositPremium>
</Terms>
<Affiliates name="Affiliates">
<Affiliate>
<AffiliateName>Acme Group, Inc.</AffiliateName>
<AffiliateStreet>4000 Acme Parkway</AffiliateStreet>
<AffiliateCity>Orlando</AffiliateCity>
<AffiliateState>FL</AffiliateState>
<AffiliateZip>32819</AffiliateZip>
<AffiliateType>Location</AffiliateType>
</Affiliate>
<Affiliate>
<AffiliateName>AcmeSure</AffiliateName>
<AffiliateStreet>3000 Acme Parkway</AffiliateStreet>
<AffiliateCity>Orlando</AffiliateCity>
<AffiliateState>FL</AffiliateState>
<AffiliateZip>32819</AffiliateZip>
<AffiliateType>Location</AffiliateType>
</Affiliate>
<Affiliate>
<AffiliateName>Acme Medical Center</AffiliateName>
<AffiliateStreet>7656 Acme Drive</AffiliateStreet>
<AffiliateCity>Orlando</AffiliateCity>
<AffiliateState>FL</AffiliateState>
<AffiliateZip>32819</AffiliateZip>
<AffiliateType>Location</AffiliateType>
</Affiliate>
<Affiliate>
<AffiliateName>Acme Foundation</AffiliateName>
<AffiliateStreet>701 West Acme Street</AffiliateStreet>
<AffiliateCity>Orlando</AffiliateCity>
<AffiliateState>FL</AffiliateState>
<AffiliateZip>32805</AffiliateZip>
<AffiliateType>Location</AffiliateType>
</Affiliate>
<Affiliate>
<AffiliateName>Acme Aquatic & Fitness Center, Inc.</AffiliateName>
<AffiliateStreet>8422 International Blvd</AffiliateStreet>
<AffiliateCity>Orlando</AffiliateCity>
<AffiliateState>FL</AffiliateState>
<AffiliateZip>32819</AffiliateZip>
<AffiliateType>Location</AffiliateType>
</Affiliate>
</Affiliates>
<DomesticReimbursements name="Domestic Reimbursements">
<Domestic>
<FacilityName>Acme Mental Health Center, Inc.</FacilityName>
<ReimbPercent>20.000</ReimbPercent>
</Domestic>
</DomesticReimbursements>
<PolicyLimitations name="Policy Limitations">
<Limitations>
<Limitation>The final Minimum Attachment Point will be based on the actual enrollment count on the policy effective date.</Limitation>
</Limitations>
<Limitations>
<Limitation>New York Health Care Reform Act's 9.63% assessments will be covered under the Excess Loss Policy.</Limitation>
</Limitations>
<Limitations>
<Limitation>Proposal assumes a minimum of 25 covered lives.</Limitation>
</Limitations>
</PolicyLimitations>
<Rates name="Rates">
<Rate>
<ClassName>Initial Sold Class</ClassName>
<ClassNo>1</ClassNo>
<SpRateTierSchedule>TS04</SpRateTierSchedule>
<SpPaymentSchedule>MNTH</SpPaymentSchedule>
<SpRateEE>110.8800</SpRateEE>
<SpRateED>120.0000</SpRateED>
<SpRateES>130.0000</SpRateES>
<SpRateEC>140.0000</SpRateEC>
<SpRateEF>295.2800</SpRateEF>
<SpCensusEE>51</SpCensusEE>
<SpCensusED>10</SpCensusED>
<SpCensusES>20</SpCensusES>
<SpCensusEC>30</SpCensusEC>
<SpCensusEF>53</SpCensusEF>
<SpGrossPremiumEE>5654.8800</SpGrossPremiumEE>
<SpGrossPremiumES>0.0000</SpGrossPremiumES>
<SpGrossPremiumEC>0.0000</SpGrossPremiumEC>
<SpGrossPremiumEF>15649.8400</SpGrossPremiumEF>
<AgRateTierSchedule>TS04</AgRateTierSchedule>
<AgPaymentSchedule>MNTH</AgPaymentSchedule>
<AgRateEE>21.7900</AgRateEE>
<AgRateED>11.0000</AgRateED>
<AgRateES>12.0000</AgRateES>
<AgRateEC>13.0000</AgRateEC>
<AgRateEF>14.0000</AgRateEF>
<AgCensusEE>104</AgCensusEE>
<AgCensusED>21</AgCensusED>
<AgCensusES>22</AgCensusES>
<AgCensusEC>23</AgCensusEC>
<AgCensusEF>24</AgCensusEF>
<AgAcRateEE>31.0000</AgAcRateEE>
<AgAcRateED>32.0000</AgAcRateED>
<AgAcRateES>33.0000</AgAcRateES>
<AgAcRateEC>34.0000</AgAcRateEC>
<AgAcRateEF>35.0000</AgAcRateEF>
<AgAcCensusEE>41</AgAcCensusEE>
<AgAcCensusED>42</AgAcCensusED>
<AgAcCensusES>43</AgAcCensusES>
<AgAcCensusEC>44</AgAcCensusEC>
<AgAcCensusEF>45</AgAcCensusEF>
<AGTLRateEE>51.0000</AGTLRateEE>
<AGTLRateED>52.0000</AGTLRateED>
<AGTLRateES>53.0000</AGTLRateES>
<AGTLRateEC>54.0000</AGTLRateEC>
<AGTLRateEF>55.0000</AGTLRateEF>
<AGTLCensusEE>61</AGTLCensusEE>
<AGTLCensusED>62</AGTLCensusED>
<AGTLCensusES>63</AGTLCensusES>
<AGTLCensusEC>64</AGTLCensusEC>
<AGTLCensusEF>65</AGTLCensusEF>
<AgGrossPremiumEE>2266.1600</AgGrossPremiumEE>
<AgGrossPremiumES>0.0000</AgGrossPremiumES>
<AgGrossPremiumEC>0.0000</AgGrossPremiumEC>
<AgGrossPremiumEF>0.0000</AgGrossPremiumEF>
</Rate>
</Rates>
<AdditionalFees />
<Factors name="Factors">
<Factor>
<ClassName>Initial Sold Class</ClassName>
<ClassNo>1</ClassNo>
<AgFactorTierSchedule>TS04</AgFactorTierSchedule>
<AgRXFactorIsInMedical>Y</AgRXFactorIsInMedical>
<AgDNFactorIsInMedical>N</AgDNFactorIsInMedical>
<AgVIFactorIsInMedical>N</AgVIFactorIsInMedical>
<AgWIFactorIsInMedical>N</AgWIFactorIsInMedical>
<AgO1FactorIsInMedical>N</AgO1FactorIsInMedical>
<AgO2FactorIsInMedical>N</AgO2FactorIsInMedical>
<AgMDFactorEE>649.5400</AgMDFactorEE>
<AgMDFactorED>101.0000</AgMDFactorED>
<AgMDFactorES>102.0000</AgMDFactorES>
<AgMDFactorEC>103.0000</AgMDFactorEC>
<AgMDFactorEF>1808.4300</AgMDFactorEF>
<AgRXFactorEE>111.0000</AgRXFactorEE>
<AgRXFactorED>112.0000</AgRXFactorED>
<AgRXFactorES>113.0000</AgRXFactorES>
<AgRXFactorEC>114.0000</AgRXFactorEC>
<AgRXFactorEF>115.0000</AgRXFactorEF>
<AgDNFactorEE>121.0000</AgDNFactorEE>
<AgDNFactorED>122.0000</AgDNFactorED>
<AgDNFactorES>123.0000</AgDNFactorES>
<AgDNFactorEC>124.0000</AgDNFactorEC>
<AgDNFactorEF>125.0000</AgDNFactorEF>
<AgVIFactorEE>131.0000</AgVIFactorEE>
<AgVIFactorED>132.0000</AgVIFactorED>
<AgVIFactorES>133.0000</AgVIFactorES>
<AgVIFactorEC>134.0000</AgVIFactorEC>
<AgVIFactorEF>135.0000</AgVIFactorEF>
<AgWIFactorEE>141.0000</AgWIFactorEE>
<AgWIFactorED>142.0000</AgWIFactorED>
<AgWIFactorES>143.0000</AgWIFactorES>
<AgWIFactorEC>144.0000</AgWIFactorEC>
<AgWIFactorEF>145.0000</AgWIFactorEF>
<AgO1FactorEE>151.0000</AgO1FactorEE>
<AgO1FactorED>152.0000</AgO1FactorED>
<AgO1FactorES>153.0000</AgO1FactorES>
<AgO1FactorEC>154.0000</AgO1FactorEC>
<AgO1FactorEF>155.0000</AgO1FactorEF>
<AgO2FactorEE>161.0000</AgO2FactorEE>
<AgO2FactorED>162.0000</AgO2FactorED>
<AgO2FactorES>163.0000</AgO2FactorES>
<AgO2FactorEC>164.0000</AgO2FactorEC>
<AgO2FactorEF>165.0000</AgO2FactorEF>
<AgMDCensusEE>201</AgMDCensusEE>
<AgMDCensusED>202</AgMDCensusED>
<AgMDCensusES>203</AgMDCensusES>
<AgMDCensusEC>204</AgMDCensusEC>
<AgMDCensusEF>205</AgMDCensusEF>
<AgRXCensusEE>211</AgRXCensusEE>
<AgRXCensusED>212</AgRXCensusED>
<AgRXCensusES>213</AgRXCensusES>
<AgRXCensusEC>214</AgRXCensusEC>
<AgRXCensusEF>215</AgRXCensusEF>
<AgDNCensusEE>221</AgDNCensusEE>
<AgDNCensusED>222</AgDNCensusED>
<AgDNCensusES>223</AgDNCensusES>
<AgDNCensusEC>224</AgDNCensusEC>
<AgDNCensusEF>225</AgDNCensusEF>
<AgVICensusEE>231</AgVICensusEE>
<AgVICensusED>232</AgVICensusED>
<AgVICensusES>233</AgVICensusES>
<AgVICensusEC>234</AgVICensusEC>
<AgVICensusEF>235</AgVICensusEF>
<AgWICensusEE>241</AgWICensusEE>
<AgWICensusED>242</AgWICensusED>
<AgWICensusES>243</AgWICensusES>
<AgWICensusEC>244</AgWICensusEC>
<AgWICensusEF>245</AgWICensusEF>
<AgO1CensusEE>251</AgO1CensusEE>
<AgO1CensusED>252</AgO1CensusED>
<AgO1CensusES>253</AgO1CensusES>
<AgO1CensusEC>254</AgO1CensusEC>
<AgO1CensusEF>255</AgO1CensusEF>
<AgO2CensusEE>261</AgO2CensusEE>
<AgO2CensusED>262</AgO2CensusED>
<AgO2CensusES>263</AgO2CensusES>
<AgO2CensusEC>264</AgO2CensusEC>
<AgO2CensusEF>265</AgO2CensusEF>
</Factor>
<Factor>
<ClassName>Second Sold Class</ClassName>
<ClassNo>2</ClassNo>
<AgFactorTierSchedule>TS01</AgFactorTierSchedule>
<AgRXFactorIsInMedical>Y</AgRXFactorIsInMedical>
<AgDNFactorIsInMedical>N</AgDNFactorIsInMedical>
<AgVIFactorIsInMedical>N</AgVIFactorIsInMedical>
<AgWIFactorIsInMedical>N</AgWIFactorIsInMedical>
<AgO1FactorIsInMedical>N</AgO1FactorIsInMedical>
<AgO2FactorIsInMedical>N</AgO2FactorIsInMedical>
<AgMDFactorEE>650.5400</AgMDFactorEE>
<AgMDFactorED>110.0000</AgMDFactorED>
<AgMDFactorES>120.0000</AgMDFactorES>
<AgMDFactorEC>130.0000</AgMDFactorEC>
<AgMDFactorEF>1400.4300</AgMDFactorEF>
<AgRXFactorEE>211.0000</AgRXFactorEE>
<AgRXFactorED>212.0000</AgRXFactorED>
<AgRXFactorES>213.0000</AgRXFactorES>
<AgRXFactorEC>214.0000</AgRXFactorEC>
<AgRXFactorEF>215.0000</AgRXFactorEF>
<AgDNFactorEE>221.0000</AgDNFactorEE>
<AgDNFactorED>222.0000</AgDNFactorED>
<AgDNFactorES>223.0000</AgDNFactorES>
<AgDNFactorEC>224.0000</AgDNFactorEC>
<AgDNFactorEF>225.0000</AgDNFactorEF>
<AgVIFactorEE>231.0000</AgVIFactorEE>
<AgVIFactorED>232.0000</AgVIFactorED>
<AgVIFactorES>233.0000</AgVIFactorES>
<AgVIFactorEC>234.0000</AgVIFactorEC>
<AgVIFactorEF>235.0000</AgVIFactorEF>
<AgWIFactorEE>241.0000</AgWIFactorEE>
<AgWIFactorED>242.0000</AgWIFactorED>
<AgWIFactorES>243.0000</AgWIFactorES>
<AgWIFactorEC>244.0000</AgWIFactorEC>
<AgWIFactorEF>245.0000</AgWIFactorEF>
<AgO1FactorEE>251.0000</AgO1FactorEE>
<AgO1FactorED>252.0000</AgO1FactorED>
<AgO1FactorES>253.0000</AgO1FactorES>
<AgO1FactorEC>254.0000</AgO1FactorEC>
<AgO1FactorEF>255.0000</AgO1FactorEF>
<AgO2FactorEE>261.0000</AgO2FactorEE>
<AgO2FactorED>262.0000</AgO2FactorED>
<AgO2FactorES>263.0000</AgO2FactorES>
<AgO2FactorEC>264.0000</AgO2FactorEC>
<AgO2FactorEF>265.0000</AgO2FactorEF>
<AgMDCensusEE>301</AgMDCensusEE>
<AgMDCensusED>302</AgMDCensusED>
<AgMDCensusES>303</AgMDCensusES>
<AgMDCensusEC>304</AgMDCensusEC>
<AgMDCensusEF>305</AgMDCensusEF>
<AgRXCensusEE>311</AgRXCensusEE>
<AgRXCensusED>312</AgRXCensusED>
<AgRXCensusES>313</AgRXCensusES>
<AgRXCensusEC>314</AgRXCensusEC>
<AgRXCensusEF>315</AgRXCensusEF>
<AgDNCensusEE>321</AgDNCensusEE>
<AgDNCensusED>322</AgDNCensusED>
<AgDNCensusES>323</AgDNCensusES>
<AgDNCensusEC>324</AgDNCensusEC>
<AgDNCensusEF>325</AgDNCensusEF>
<AgVICensusEE>331</AgVICensusEE>
<AgVICensusED>332</AgVICensusED>
<AgVICensusES>333</AgVICensusES>
<AgVICensusEC>334</AgVICensusEC>
<AgVICensusEF>335</AgVICensusEF>
<AgWICensusEE>341</AgWICensusEE>
<AgWICensusED>342</AgWICensusED>
<AgWICensusES>343</AgWICensusES>
<AgWICensusEC>344</AgWICensusEC>
<AgWICensusEF>345</AgWICensusEF>
<AgO1CensusEE>351</AgO1CensusEE>
<AgO1CensusED>352</AgO1CensusED>
<AgO1CensusES>353</AgO1CensusES>
<AgO1CensusEC>354</AgO1CensusEC>
<AgO1CensusEF>355</AgO1CensusEF>
<AgO2CensusEE>361</AgO2CensusEE>
<AgO2CensusED>362</AgO2CensusED>
<AgO2CensusES>363</AgO2CensusES>
<AgO2CensusEC>364</AgO2CensusEC>
<AgO2CensusEF>365</AgO2CensusEF>
</Factor>
</Factors>
<LaseredParticipants name="Lasered Participants">
<Laser>
<ClassName>Primary</ClassName>
<ClassNo>1</ClassNo>
<Name>Calvin Coolidge</Name>
<Amount>60000</Amount>
<Condition>Lasered</Condition>
<ContractType>1212</ContractType>
<CoverageLimit>50000</CoverageLimit>
<AggregateLossLimit>125000</AggregateLossLimit>
</Laser>
<Laser>
<ClassName>Primary</ClassName>
<ClassNo>1</ClassNo>
<Name>Millard Fillmore</Name>
<Amount>80000</Amount>
<Condition>If Cancer Returns</Condition>
<ContractType>1812</ContractType>
<CoverageLimit>
</CoverageLimit>
<AggregateLossLimit>250000</AggregateLossLimit>
</Laser>
</LaseredParticipants>
<ManagedCare name="Managed Care">
<Vendor>
<ServiceType>PPON</ServiceType>
<Name>Acme Choice II</Name>
<City>Metrocity</City>
<State>GA</State>
<Zip>12345</Zip>
<Effective>2024-01-01T00:00:00</Effective>
<Expiration>1900-01-01T00:00:00</Expiration>
</Vendor>
<Vendor>
<ServiceType>URVW</ServiceType>
<Name>Acme Choice III</Name>
<City>Metropolis</City>
<State>RI</State>
<Zip>23456</Zip>
<Effective>2024-01-01T00:00:00</Effective>
<Expiration>1900-01-01T00:00:00</Expiration>
</Vendor>
<Vendor>
<ServiceType>BNFT</ServiceType>
<Name>Acme Choice IV</Name>
<City>Tampa</City>
<State>FL</State>
<Zip>34567</Zip>
<Effective>2024-01-01T00:00:00</Effective>
<Expiration>1900-01-01T00:00:00</Expiration>
</Vendor>
</ManagedCare>
</Record>
</PolicyDataSource>