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{"sheet":"F","index":0,"n_rows":66,"n_cols":10,"rows_kept":66,"cut":false,"hidden":false,"merged":[[6,0,6,2],[10,4,10,8],[12,0,12,3],[13,2,13,3],[14,4,14,7],[15,4,15,8],[17,4,17,5],[17,6,17,7],[22,0,23,3],[29,0,29,3]]}
[null,null,"STATE OF MISSOURI",null,null,null,null,null,null," "]
[null,null,"DEPARTMENT OF INSURANCE"]
[null,null,"MEDICARE SUPPLEMENT RATE FILING DOCUMENT"]
[]
["COMPANY INFORMATION",null,null,null,"POLICY RATE/PREMIUM INFORMATION"]
["Company Name:",null,null,null,"Original Filed Loss Ratio (%):",null,null,null," "]
[null,null,null,null,"Rate Change Requested (%):"]
["NAIC Company Code (9 digits):",null,null,null,"Effective Period (expected):"]
[null,null,null,null,"(these dates may change based on the approval date)"]
["Domicile State:"]
["Date of this Filing:",null,null,null,"RATE INFORMATION"]
[null,null,null,null,"Male/Female rates?"]
["POLICY FORM INFORMATION",null,null,null,"Smoker/Non-Smoker rates?"]
["Policy Form Number(s):"]
["Standardized Plans",null,"F",null,"Number of Missouri Rating Areas:"]
["Pre-Standardized Plans: ",null,null,null,"List Rate Filings in Missouri in Last 5 Years:"]
["Select Plan",null,"No",null,"(list most recent first)"]
["Innovative Plan",null,null,null,"Approved",null,"Implemented",null,"Rate Change Approved"]
["Group Plan",null,"No",null,"(mo)","(yr)","(mo)","(yr)","(%)"]
["Proposed Rate Effective Date"]
["Overall Medical Trend % Increase"]
["Description of Trend Factors"]
["Medical Claim Cost Trend"]
[]
[]
["Marketing Method (choose one):",null,null,"Agent Sold","POLICY DATA"]
["Underwriting Method (choose one):",null,null,"Underwritten",null,null,null,"Missouri","National"]
[null,null,null,null,"Policy Approved in (year)"]
[null,null,null,null,"First Policy Issued in (year)"]
["Premium Rating Basis (select Yes or No)",null,null,null,"Last Policy Issued in (year)*"]
[null,"No","Community (no age) Rated",null,"Policy Withdrawn in (year)*"]
[null,"Yes","Issue Age",null,"Number of Aged Insureds"]
[null,"No","Attained Age",null,"Number of Disabled Insureds"]
[null,null,null,null,"Number of Total Insureds"]
[null,null,null,null,"Insured Data as of:"]
[null,null,null,null,"*-If still being issued, state \"Current\""]
[]
["Supply an illustrative monthly premium rate for a female, "]
["non- smoker, averaged across all geographic and any"]
["other rate factors, for the following age cells:"]
["<65","Age 65","Age 70","Age 75","Age 80"]
[0,0,0,0,0]
["Provide a description in the filing for the method used to calculate the above rate cells, based on the data in the rate"]
["sheets attached to the filing. The above rates will be published in Missouri's Medicare Supplement Rate Guide."]
[]
["ACTUARIAL CERTIFICATION"]
["I hereby certify that to the best of my knowledge and ability, the following are true with respect to this filing:"]
["1.  The assumptions present the actuary's best judgment as to the expected value for each assumption and are consistent "]
["     with the issuer's business plan at the time of the filing."]
["2.  The anticipated lifetime, future, and third-year loss ratios all comply with the regulatory loss ratio requirements. "]
["     For pre-standardized plans, the 1996-and-later (SSA-94) loss ratio also complies with the regulatory loss ratio "]
["     requirements. "]
["3.  The filed rates maintain the proper relationship between policies which have different rating methodologies (if such "]
["     exist).  "]
["4.  The filing was prepared based on the current standards of practice as promulgated by the Actuarial Standards Board."]
["5.  The filing is in compliance with applicable laws and regulations in the state."]
["6.  The rates requested are reasonable in relationship to the benefits provided."]
[]
["DCI will accept this form as an updated alternative to MO Form 375-0065"]
[]
["Form:",{"$f":"C15","v":"F"},null,null,null,"Form Count:",{"$f":"HLOOKUP(F!C15, Compliance!$K$4:$V$12, 9, FALSE)","v":38}]
[]
["<65","Age 65","Age 70","Age 75","Age 80"]
[{"$f":"HLOOKUP(F!C15, Compliance!$K$4:$V$12, 6, FALSE)","v":200.58333333333334},{"$f":"HLOOKUP(F!C15, Compliance!$K$14:$V$22, 6, FALSE)","v":190.29999999999998},{"$f":"HLOOKUP(F!C15, Compliance!$K$24:$V$32, 6, FALSE)","v":203.28},{"$f":"HLOOKUP(F!C15, Compliance!$K$34:$V$42, 6, FALSE)","v":236.20666666666668},{"$f":"HLOOKUP(F!C15, Compliance!$K$44:$V$52, 6, FALSE)","v":272.78500000000003},"Lower 10%"]
[{"$f":"HLOOKUP(F!C15, Compliance!$K$4:$V$12, 8, FALSE)","v":369.12416666666667},{"$f":"HLOOKUP(F!C15, Compliance!$K$14:$V$22, 8, FALSE)","v":303.7},{"$f":"HLOOKUP(F!C15, Compliance!$K$24:$V$32, 8, FALSE)","v":347.58333333333331},{"$f":"HLOOKUP(F!C15, Compliance!$K$34:$V$42, 8, FALSE)","v":386.59666666666664},{"$f":"HLOOKUP(F!C15, Compliance!$K$44:$V$52, 8, FALSE)","v":434.7},"Upper 10%"]
[{"$f":"HLOOKUP(F!C15, Compliance!$K$4:$V$12, 2, FALSE) / 12","v":284.8101373119672},{"$f":"HLOOKUP(F!C15, Compliance!$K$14:$V$22, 2, FALSE) / 12","v":246.99646755548588},{"$f":"HLOOKUP(F!C15, Compliance!$K$24:$V$32, 2, FALSE) / 12","v":274.31110875478396},{"$f":"HLOOKUP(F!C15, Compliance!$K$34:$V$42, 2, FALSE) / 12","v":309.28644760177724},{"$f":"HLOOKUP(F!C15, Compliance!$K$44:$V$52, 2, FALSE) / 12","v":346.18716005384346},"Mean"]

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["The statistics provided below are from Missouri's Medigap Rate Guide as of July 7, 2023"]
[]
[null,null,null,null,null,null,null,null,"Individual:"]
[null,null,null,null,null,null,null,null,null,"Under 65","A","B","C","D","F","F-HI","G","G-HI","K","L","M","N"]
[null,null,null,null,null,null,null,null,null,"Average Annual Premium",2104.9833545901743,2647.5454998557989,3584.3579257865686,3033.048164413015,3417.7216477436064,797.43738036768491,2482.5916635202552,692.16329985386506,1217.3211859527833,1959.5414047208171,2250.5486596957553,2044.1963448766523]
[null,null,null,null,null,null,null,null,null,"Maximum Annual Premium",4555.08,4084.8,5954.7,5248.6,5659.53,1389,4151.82,981,1417,2346,3093.5,3597.18]
[null,null,null,null,null,null,null,null,null,"Minimum Annual Premium",1327.68,1899.24,2247.12,1974,2093,544,1724.23,531,918.84,1363.92,1679.52,1310.43]
[null,null,null,null,null,null,null,null,null,"Lower 10% Annual Premium",1625,2068.08,2567,2014,2407,626,1823,611,918.84,1363.92,1679.52,1450.24]
[null,null,null,null,null,null,null,null,null,"Lower 10% Monthly Premium",135.41666666666666,172.34,213.91666666666666,167.83333333333334,200.58333333333334,52.166666666666664,151.91666666666666,50.916666666666664,76.570000000000007,113.66000000000001,139.96,120.85333333333334]
[null,null,null,null,null,null,null,null,null,"Upper 10% Annual Premium",2614.0100000000002,3552,4619,4564,4429.49,1059.29,3372,822.58764499999995,1417,2346,2690,2799.69]
[null,null,null,null,null,null,null,null,null,"Upper 10% Monthly Premium",217.83416666666668,296,384.91666666666669,380.33333333333331,369.12416666666667,88.274166666666659,281,68.548970416666663,118.08333333333333,195.5,224.16666666666666,233.3075]
[null,null,null,null,null,null,null,null,null,"Form Count",38,10,9,8,38,11,37,9,2,2,4,35]
[]
[null,null,null,null,null,null,null,null,null,"Age 65","A","B","C","D","F","F-HI","G","G-HI","K","L","M","N"]
[null,null,null,null,null,null,null,null,null,"Average Annual Premium",2000.3193311694565,2403.0119245173823,3090.5738430553979,2565.8266089778299,2963.9576106658305,761.98698940642043,2297.2280358996927,656.76667431007388,1125.5014853194707,1741.4927806563558,2200.3530228137147,1849.6548234072327]
[null,null,null,null,null,null,null,null,null,"Maximum Annual Premium",3491.71,3296,4014.65,3538.55,4489.5200000000004,1369,3576,831,1305,2050,3093.5,2994.23]
[null,null,null,null,null,null,null,null,null,"Minimum Annual Premium",1128.0999999999999,1775.28,2100.36,1941.6,2093,500,1707.28,500,858.96,1275,1569.96,1292.04]
[null,null,null,null,null,null,null,null,null,"Lower 10% Annual Premium",1566.57,2024,2525,1974,2283.6,575,1736.39,545.66999999999996,858.96,1275,1569.96,1398]
[null,null,null,null,null,null,null,null,null,"Lower 10% Monthly Premium",130.54749999999999,168.66666666666666,210.41666666666666,164.5,190.29999999999998,47.916666666666664,144.69916666666668,45.472499999999997,71.58,106.25,130.83000000000001,116.5]
[null,null,null,null,null,null,null,null,null,"Upper 10% Annual Premium",2614.0100000000002,2867,3711,3438,3644.4,1059.29,3060.26,747.80695000000003,1305,2050,2690,2511]
[null,null,null,null,null,null,null,null,null,"Upper 10% Monthly Premium",217.83416666666668,238.91666666666666,309.25,286.5,303.7,88.274166666666659,255.02166666666668,62.317245833333338,108.75,170.83333333333334,224.16666666666666,209.25]
[null,null,null,null,null,null,null,null,null,"Form Count",39,10,10,8,38,11,37,9,2,2,4,36]
[]
[null,null,null,null,null,null,null,null,null,"Age 70","A","B","C","D","F","F-HI","G","G-HI","K","L","M","N"]
[null,null,null,null,null,null,null,null,null,"Average Annual Premium",2185.0611314954681,2700.493679055131,3476.4451772997249,2894.0011855057992,3291.7333050574075,834.63541642040764,2546.5252697665815,726.15256886155532,1284.1571905583596,1985.4300172711887,2519.4133269962763,2059.5692363460648]
[null,null,null,null,null,null,null,null,null,"Maximum Annual Premium",3793,3630,4413.7,3939,5186.3999999999996,1526,3935,866,1434,2254,3409.75,3414]
[null,null,null,null,null,null,null,null,null,"Minimum Annual Premium",1392.74,2231.7600000000002,2640.48,2163.96,2207,584,1778.99,584,1079.76,1602.84,1973.64,1362]
[null,null,null,null,null,null,null,null,null,"Lower 10% Annual Premium",1711,2352,2875.2,2246,2439.36,637.78866900000003,1922,661.19,1079.76,1602.84,1973.64,1510.37]
[null,null,null,null,null,null,null,null,null,"Lower 10% Monthly Premium",142.58333333333334,196,239.6,187.16666666666666,203.28,53.149055750000002,160.16666666666666,55.099166666666669,89.98,133.57,164.47,125.86416666666666]
[null,null,null,null,null,null,null,null,null,"Upper 10% Annual Premium",2930.06,3158,4088,3939,4171,1150,3365,803.74740599999996,1434,2254,2965,2763]
[null,null,null,null,null,null,null,null,null,"Upper 10% Monthly Premium",244.17166666666665,263.16666666666669,340.66666666666669,328.25,347.58333333333331,95.833333333333329,280.41666666666669,66.978950499999996,119.5,187.83333333333334,247.08333333333334,230.25]
[null,null,null,null,null,null,null,null,null,"Form Count",39,10,10,8,38,11,37,9,2,2,4,36]
[]
[null,null,null,null,null,null,null,null,null,"Age 75","A","B","C","D","F","F-HI","G","G-HI","K","L","M","N"]
[null,null,null,null,null,null,null,null,null,"Average Annual Premium",2444.6003642279529,2989.9056323826348,3900.0652211749984,3259.7558810166124,3711.4373712213269,940.75041911613448,2890.8523743166561,827.8342295960008,1453.9658031088979,2245.7645941277578,2950.2062832698953,2351.3914111081181]
[null,null,null,null,null,null,null,null,null,"Maximum Annual Premium",4573.49,3630,5278.5,4662.1000000000004,5880.26,1720,4649.34,992.06,1572,2473,4084.8,3922.19]
[null,null,null,null,null,null,null,null,null,"Minimum Annual Premium",1625,2504,3062.74,2429.04,2473,656,2039.36,656,1314.36,1951.2,2402.64,1527.96]
[null,null,null,null,null,null,null,null,null,"Lower 10% Annual Premium",1895,2663,3353.7,2491,2834.48,714.16929749999997,2134.37,754,1314.36,1951.2,2402.64,1733.31]
[null,null,null,null,null,null,null,null,null,"Lower 10% Monthly Premium",157.91666666666666,221.91666666666666,279.47499999999997,207.58333333333334,236.20666666666668,59.514108125,177.86416666666665,62.833333333333336,109.52999999999999,162.6,200.22,144.4425]
[null,null,null,null,null,null,null,null,null,"Upper 10% Annual Premium",3249.79,3408.6,4485,4163,4639.16,1296.1300000000001,3880.49,918,1572,2473,3552,3089.1]
[null,null,null,null,null,null,null,null,null,"Upper 10% Monthly Premium",270.81583333333333,284.05,373.75,346.91666666666669,386.59666666666664,108.01083333333334,323.37416666666667,76.5,131,206.08333333333334,296,257.42500000000001]
[null,null,null,null,null,null,null,null,null,"Form Count",39,10,10,8,38,11,37,9,2,2,4,36]
[]
[null,null,null,null,null,null,null,null,null,"Age 80","A","B","C","D","F","F-HI","G","G-HI","K","L","M","N"]
[null,null,null,null,null,null,null,null,null,"Average Annual Premium",2707.8481998730181,3223.1658023624768,4196.5603891245646,3577.260080043176,4154.2459206461217,1052.5165871994213,3253.8829160497344,946.85411192714139,1604.4591594703145,2475.6352792170069,3327.6859030419105,2643.1934442646761]
[null,null,null,null,null,null,null,null,null,"Maximum Annual Premium",5237.25,3913.45,6058.2,5352.1,6734.19,1856,5324.41,1225.381762,1687.32,2643,4689.7,4491.67]
[null,null,null,null,null,null,null,null,null,"Minimum Annual Premium",1625,2683,3325.8,2688,2770,721,2333.94,721,1549.56,2300.2800000000002,2734,1692]
[null,null,null,null,null,null,null,null,null,"Lower 10% Annual Premium",1949.28,2898,3641.75,2712,3273.42,807.728163,2413,829,1549.56,2300.2800000000002,2734,1980.1]
[null,null,null,null,null,null,null,null,null,"Lower 10% Monthly Premium",162.44,241.5,303.47916666666669,226,272.78500000000003,67.310680250000004,201.08333333333334,69.083333333333329,129.13,191.69000000000003,227.83333333333334,165.00833333333333]
[null,null,null,null,null,null,null,null,null,"Upper 10% Annual Premium",3693.126389,3630,4796,4654,5216.3999999999996,1458.63,4160,1113.98342,1687.32,2643,4078,3476.81]
[null,null,null,null,null,null,null,null,null,"Upper 10% Monthly Premium",307.76053241666665,302.5,399.66666666666669,387.83333333333331,434.7,121.55250000000001,346.66666666666669,92.831951666666669,140.60999999999999,220.25,339.83333333333331,289.73416666666668]
[null,null,null,null,null,null,null,null,null,"Form Count",38,10,10,8,37,11,36,9,2,2,4,35]

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