{"text_format":"1","workbook":"xlsx","n_sheets":59,"sheets":["MasterList","In-Pre","In-Std-A","In-Std-B","In-Std-C","In-Std-D","In-Std-E","In-Std-F","In-Std-G","In-Std-H","In-Std-I","In-Std-J","In-Std-K","In-Std-L","In-Std-M","In-Std-N","In-Sel-A","In-Sel-B","In-Sel-C","In-Sel-D","In-Sel-E","In-Sel-F","In-Sel-G","In-Sel-H","In-Sel-I","In-Sel-J","In-Sel-K","In-Sel-L","In-Sel-M","In-Sel-N","Gr-Pre","Gr-Std-A","Gr-Std-B","Gr-Std-C","Gr-Std-D","Gr-Std-E","Gr-Std-F","Gr-Std-G","Gr-Std-H","Gr-Std-I","Gr-Std-J","Gr-Std-K","Gr-Std-L","Gr-Std-M","Gr-Std-N","Gr-Sel-A","Gr-Sel-B","Gr-Sel-C","Gr-Sel-D","Gr-Sel-E","Gr-Sel-F","Gr-Sel-G","Gr-Sel-H","Gr-Sel-I","Gr-Sel-J","Gr-Sel-K","Gr-Sel-L","Gr-Sel-M","Gr-Sel-N"],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":0,"defined_names":66,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"MasterList","index":0,"n_rows":100,"n_cols":18,"rows_kept":100,"cut":false,"hidden":false,"merged":[[4,16,4,17],[0,12,2,14],[12,16,12,21],[13,17,13,21],[14,17,14,21],[20,17,20,21],[15,17,15,21],[16,17,16,21],[17,17,17,21],[18,17,18,21],[19,17,19,21]]}
[null,null,null,null,"                      OFFICE OF INSURANCE REGULATION",null,null,null,null,null,null,null,"Please use the form below to indicate which plans the company is reporting premiums for.  Then fill out the corresponding OIR-B2-MSR form."]
[null,null,null,null,"                      Life and Health Product Review"]
[]
[]
["Individual or Group","Standard or Select","Plan ID","Sheet Name","Plan Name","Does the Company have Premiums","Goto Sheet",null,"Individual or Group","Standard/Select","Plan ID","Sheet Name","Plan Name","Does the Company have Premiums","Goto Sheet",null,"Sheet Name Abbreviations"]
["Individual",null,"Prestandardized",{"$f":"LEFT(A6,2) & IF(B6<>\"\",IF(B6=\"Standard\",\"-Std-\",\"-Sel-\"),\"-\") & IF(B6=\"\",LEFT(C6,3),C6)","v":"In-Pre"},{"$f":"A6& IF(B6<>\"\",\" \",\"\") & B6 & \" \" & C6","v":"Individual Prestandardized"},"No","In-Pre",null,"Group",null,"Prestandardized",{"$f":"LEFT(I6,2) & IF(J6<>\"\",IF(J6=\"Standard\",\"-Std-\",\"-Sel-\"),\"-\") & IF(J6=\"\",LEFT(K6,3),K6)","v":"Gr-Pre"},{"$f":"I6& IF(J6<>\"\",\" \",\"\") & J6 & \" \" & K6","v":"Group Prestandardized"},"No","Gr-Pre",null,"Individual->","In"]
["Individual","Standard","A",{"$f":"LEFT(A7,2) & IF(B7<>\"\",IF(B7=\"Standard\",\"-Std-\",\"-Sel-\"),\"-\") & IF(B7=\"\",LEFT(C7,3),C7)","v":"In-Std-A"},{"$f":"A7& IF(B7<>\"\",\" \",\"\") & B7 & \" \" & C7","v":"Individual Standard A"},"No","In-Std-A",null,"Group","Standard","A",{"$f":"LEFT(I7,2) & IF(J7<>\"\",IF(J7=\"Standard\",\"-Std-\",\"-Sel-\"),\"-\") & IF(J7=\"\",LEFT(K7,3),K7)","v":"Gr-Std-A"},"Group Standard A","No","Gr-Std-A",null,"Group->","Gr"]
["Individual","Standard","B","In-Std-B",{"$f":"A8& IF(B8<>\"\",\" \",\"\") & B8 & \" \" & C8","v":"Individual Standard B"},"No","In-Std-B",null,"Group","Standard","B","Gr-Std-B","Group Standard B","No","Gr-Std-B",null,"Standard->","Std"]
["Individual","Standard","C","In-Std-C","Individual Standard C","No","In-Std-C",null,"Group","Standard","C","Gr-Std-C","Group Standard C","No","Gr-Std-C",null,"Select->","Sel"]
["Individual","Standard","D","In-Std-D","Individual Standard D","No","In-Std-D",null,"Group","Standard","D","Gr-Std-D","Group Standard D","No","Gr-Std-D",null,"Prestandardized->","Pre"]
["Individual","Standard","E","In-Std-E","Individual Standard E","No","In-Std-E",null,"Group","Standard","E","Gr-Std-E","Group Standard E","No","Gr-Std-E"]
["Individual","Standard","F","In-Std-F","Individual Standard F","No","In-Std-F",null,"Group","Standard","F","Gr-Std-F","Group Standard F","No","Gr-Std-F"]
["Individual","Standard","G","In-Std-G","Individual Standard G","No","In-Std-G",null,"Group","Standard","G","Gr-Std-G","Group Standard G","No","Gr-Std-G",null,"This Table will feed the information to all sheets"]
["Individual","Standard","H","In-Std-H","Individual Standard H","No","In-Std-H",null,"Group","Standard","H","Gr-Std-H","Group Standard H","No","Gr-Std-H",null,"Company Name:"]
["Individual","Standard","I","In-Std-I","Individual Standard I","No","In-Std-I",null,"Group","Standard","I","Gr-Std-I","Group Standard I","No","Gr-Std-I",null,"NAIC Group Code:"]
["Individual","Standard","J","In-Std-J","Individual Standard J","No","In-Std-J",null,"Group","Standard","J","Gr-Std-J","Group Standard J","No","Gr-Std-J",null,"NAIC Company Code:"]
["Individual","Standard","K","In-Std-K","Individual Standard K","No","In-Std-K",null,"Group","Standard","K","Gr-Std-K","Group Standard K","No","Gr-Std-K",null,"Address:"]
["Individual","Standard","L","In-Std-L","Individual Standard L","No","In-Std-L",null,"Group","Standard","L","Gr-Std-L","Group Standard L","No","Gr-Std-L",null,"Person Completing Exhibit:"]
["Individual","Standard","M","In-Std-M","Individual Standard M","No","In-Std-M",null,"Group","Standard","M","Gr-Std-M","Group Standard M","No","Gr-Std-M",null,"Title:"]
["Individual","Standard","N","In-Std-N","Individual Standard N","No","In-Std-N",null,"Group","Standard","N","Gr-Std-N","Group Standard N","No","Gr-Std-N",null,"Telephone Number:"]
["Individual","Select","A","In-Sel-A","Individual Select A","No","In-Sel-A",null,"Group","Select","A","Gr-Sel-A","Group Select A","No","Gr-Sel-A",null,"Calendar Year:"]
["Individual","Select","B","In-Sel-B","Individual Select B","No","In-Sel-B",null,"Group","Select","B","Gr-Sel-B","Group Select B","No","Gr-Sel-B"]
["Individual","Select","C","In-Sel-C","Individual Select C","No","In-Sel-C",null,"Group","Select","C","Gr-Sel-C","Group Select C","No","Gr-Sel-C"]
["Individual","Select","D","In-Sel-D","Individual Select D","No","In-Sel-D",null,"Group","Select","D","Gr-Sel-D","Group Select D","No","Gr-Sel-D"]
["Individual","Select","E","In-Sel-E","Individual Select E","No","In-Sel-E",null,"Group","Select","E","Gr-Sel-E","Group Select E","No","Gr-Sel-E"]
["Individual","Select","F","In-Sel-F","Individual Select F","No","In-Sel-F",null,"Group","Select","F","Gr-Sel-F","Group Select F","No","Gr-Sel-F"]
["Individual","Select","G","In-Sel-G","Individual Select G","No","In-Sel-G",null,"Group","Select","G","Gr-Sel-G","Group Select G","No","Gr-Sel-G",null,"Please save workbook before running macro."]
["Individual","Select","H","In-Sel-H","Individual Select H","No","In-Sel-H",null,"Group","Select","H","Gr-Sel-H","Group Select H","No","Gr-Sel-H",null,"NOTE: This workbook must be uploaded as .xlsm in IRFS."]
["Individual","Select","I","In-Sel-I","Individual Select I","No","In-Sel-I",null,"Group","Select","I","Gr-Sel-I","Group Select I","No","Gr-Sel-I"]
["Individual","Select","J","In-Sel-J","Individual Select J","No","In-Sel-J",null,"Group","Select","J","Gr-Sel-J","Group Select J","No","Gr-Sel-J"]
["Individual","Select","K","In-Sel-K","Individual Select K","No","In-Sel-K",null,"Group","Select","K","Gr-Sel-K","Group Select K","No","Gr-Sel-K"]
["Individual","Select","L","In-Sel-L","Individual Select L","No","In-Sel-L",null,"Group","Select","L","Gr-Sel-L","Group Select L","No","Gr-Sel-L"]
["Individual","Select","M","In-Sel-M","Individual Select M","No","In-Sel-M",null,"Group","Select","M","Gr-Sel-M","Group Select M","No","Gr-Sel-M"]
["Individual","Select","N","In-Sel-N","Individual Select N","No","In-Sel-N",null,"Group","Select","N","Gr-Sel-N","Group Select N","No","Gr-Sel-N"]
[]
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[null,null,null,null,null,1.1000000000000001]

{"sheet":"In-Pre","index":1,"n_rows":67,"n_cols":12,"rows_kept":67,"cut":false,"hidden":false,"merged":[[64,2,64,7],[55,1,55,11],[57,0,57,11],[59,2,61,8],[61,0,61,1],[61,10,61,11],[63,0,63,2],[63,3,63,8],[63,10,63,11],[54,1,54,11],[46,4,46,5],[46,6,46,7],[47,4,47,5],[47,6,47,7],[48,4,48,5],[48,6,48,7],[49,4,49,7],[50,1,50,11],[51,1,51,11],[52,1,52,11],[53,1,53,11],[45,4,45,5],[45,6,45,7],[36,1,36,9],[37,0,37,11],[38,0,38,11],[39,0,39,11],[40,0,40,11],[41,0,41,11],[42,4,42,7],[43,4,43,5],[43,6,43,7],[44,4,44,5],[44,6,44,7],[35,1,35,9],[24,1,24,9],[25,1,25,9],[26,3,26,9],[27,2,27,9],[28,1,28,9],[29,1,29,9],[30,1,30,9],[31,1,31,9],[32,1,32,9],[33,1,33,9],[34,1,34,9],[23,1,23,9],[12,2,12,6],[12,10,12,11],[14,1,14,9],[15,1,15,9],[16,2,16,9],[17,2,17,9],[18,2,18,9],[19,1,19,9],[20,1,20,9],[21,1,21,9],[22,1,22,9],[9,2,9,6],[9,10,9,11],[10,2,10,6],[10,10,10,11],[11,2,11,6],[11,10,11,11],[8,2,8,6],[8,10,8,11],[0,0,3,1],[4,0,4,11],[5,2,5,6],[5,7,5,8],[6,10,6,11]]}
[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual",null,null,null,null,null,"SMSBP:2",null,"P"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

{"sheet":"In-Std-A","index":2,"n_rows":67,"n_cols":12,"rows_kept":67,"cut":false,"hidden":false,"merged":[[64,2,64,7],[55,1,55,11],[57,0,57,11],[59,2,61,8],[61,0,61,1],[61,10,61,11],[63,0,63,2],[63,3,63,8],[63,10,63,11],[54,1,54,11],[46,4,46,5],[46,6,46,7],[47,4,47,5],[47,6,47,7],[48,4,48,5],[48,6,48,7],[49,4,49,7],[50,1,50,11],[51,1,51,11],[52,1,52,11],[53,1,53,11],[45,4,45,5],[45,6,45,7],[36,1,36,9],[37,0,37,11],[38,0,38,11],[39,0,39,11],[40,0,40,11],[41,0,41,11],[42,4,42,7],[43,4,43,5],[43,6,43,7],[44,4,44,5],[44,6,44,7],[35,1,35,9],[24,1,24,9],[25,1,25,9],[26,3,26,9],[27,2,27,9],[28,1,28,9],[29,1,29,9],[30,1,30,9],[31,1,31,9],[32,1,32,9],[33,1,33,9],[34,1,34,9],[23,1,23,9],[12,2,12,6],[12,10,12,11],[14,1,14,9],[15,1,15,9],[16,2,16,9],[17,2,17,9],[18,2,18,9],[19,1,19,9],[20,1,20,9],[21,1,21,9],[22,1,22,9],[9,2,9,6],[9,10,9,11],[10,2,10,6],[10,10,10,11],[11,2,11,6],[11,10,11,11],[8,2,8,6],[8,10,8,11],[0,0,3,1],[4,0,4,11],[5,2,5,6],[5,7,5,8],[6,10,6,11]]}
[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"A"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"B"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"C"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"D"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"E"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"F"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"G"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"H"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"I"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"J"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"K"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"L"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"M"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Standard",null,null,null,null,null,"SMSBP:2",null,"N"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"A"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"B"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"C"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"D"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"E"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"F"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"G"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"H"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"I"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"J"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"K"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"L"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"M"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Individual Select",null,null,null,null,null,"SMSBP:2",null,"N"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group",null,null,null,null,null,"SMSBP:2",null,"P"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"A"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"B"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

{"sheet":"Gr-Std-C","index":33,"n_rows":67,"n_cols":12,"rows_kept":67,"cut":false,"hidden":false,"merged":[[64,2,64,7],[55,1,55,11],[57,0,57,11],[59,2,61,8],[61,0,61,1],[61,10,61,11],[63,0,63,2],[63,3,63,8],[63,10,63,11],[54,1,54,11],[46,4,46,5],[46,6,46,7],[47,4,47,5],[47,6,47,7],[48,4,48,5],[48,6,48,7],[49,4,49,7],[50,1,50,11],[51,1,51,11],[52,1,52,11],[53,1,53,11],[45,4,45,5],[45,6,45,7],[36,1,36,9],[37,0,37,11],[38,0,38,11],[39,0,39,11],[40,0,40,11],[41,0,41,11],[42,4,42,7],[43,4,43,5],[43,6,43,7],[44,4,44,5],[44,6,44,7],[35,1,35,9],[24,1,24,9],[25,1,25,9],[26,3,26,9],[27,2,27,9],[28,1,28,9],[29,1,29,9],[30,1,30,9],[31,1,31,9],[32,1,32,9],[33,1,33,9],[34,1,34,9],[23,1,23,9],[12,2,12,6],[12,10,12,11],[14,1,14,9],[15,1,15,9],[16,2,16,9],[17,2,17,9],[18,2,18,9],[19,1,19,9],[20,1,20,9],[21,1,21,9],[22,1,22,9],[9,2,9,6],[9,10,9,11],[10,2,10,6],[10,10,10,11],[11,2,11,6],[11,10,11,11],[8,2,8,6],[8,10,8,11],[0,0,3,1],[4,0,4,11],[5,2,5,6],[5,7,5,8],[6,10,6,11]]}
[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"C"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"D"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"E"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"F"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"G"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"H"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"I"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"J"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"K"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

{"sheet":"Gr-Std-L","index":42,"n_rows":67,"n_cols":12,"rows_kept":67,"cut":false,"hidden":false,"merged":[[64,2,64,7],[55,1,55,11],[57,0,57,11],[59,2,61,8],[61,0,61,1],[61,10,61,11],[63,0,63,2],[63,3,63,8],[63,10,63,11],[54,1,54,11],[46,4,46,5],[46,6,46,7],[47,4,47,5],[47,6,47,7],[48,4,48,5],[48,6,48,7],[49,4,49,7],[50,1,50,11],[51,1,51,11],[52,1,52,11],[53,1,53,11],[45,4,45,5],[45,6,45,7],[36,1,36,9],[37,0,37,11],[38,0,38,11],[39,0,39,11],[40,0,40,11],[41,0,41,11],[42,4,42,7],[43,4,43,5],[43,6,43,7],[44,4,44,5],[44,6,44,7],[35,1,35,9],[24,1,24,9],[25,1,25,9],[26,3,26,9],[27,2,27,9],[28,1,28,9],[29,1,29,9],[30,1,30,9],[31,1,31,9],[32,1,32,9],[33,1,33,9],[34,1,34,9],[23,1,23,9],[12,2,12,6],[12,10,12,11],[14,1,14,9],[15,1,15,9],[16,2,16,9],[17,2,17,9],[18,2,18,9],[19,1,19,9],[20,1,20,9],[21,1,21,9],[22,1,22,9],[9,2,9,6],[9,10,9,11],[10,2,10,6],[10,10,10,11],[11,2,11,6],[11,10,11,11],[8,2,8,6],[8,10,8,11],[0,0,3,1],[4,0,4,11],[5,2,5,6],[5,7,5,8],[6,10,6,11]]}
[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"L"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"M"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Standard",null,null,null,null,null,"SMSBP:2",null,"N"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

{"sheet":"Gr-Sel-A","index":45,"n_rows":67,"n_cols":12,"rows_kept":67,"cut":false,"hidden":false,"merged":[[64,2,64,7],[55,1,55,11],[57,0,57,11],[59,2,61,8],[61,0,61,1],[61,10,61,11],[63,0,63,2],[63,3,63,8],[63,10,63,11],[54,1,54,11],[46,4,46,5],[46,6,46,7],[47,4,47,5],[47,6,47,7],[48,4,48,5],[48,6,48,7],[49,4,49,7],[50,1,50,11],[51,1,51,11],[52,1,52,11],[53,1,53,11],[45,4,45,5],[45,6,45,7],[36,1,36,9],[37,0,37,11],[38,0,38,11],[39,0,39,11],[40,0,40,11],[41,0,41,11],[42,4,42,7],[43,4,43,5],[43,6,43,7],[44,4,44,5],[44,6,44,7],[35,1,35,9],[24,1,24,9],[25,1,25,9],[26,3,26,9],[27,2,27,9],[28,1,28,9],[29,1,29,9],[30,1,30,9],[31,1,31,9],[32,1,32,9],[33,1,33,9],[34,1,34,9],[23,1,23,9],[12,2,12,6],[12,10,12,11],[14,1,14,9],[15,1,15,9],[16,2,16,9],[17,2,17,9],[18,2,18,9],[19,1,19,9],[20,1,20,9],[21,1,21,9],[22,1,22,9],[9,2,9,6],[9,10,9,11],[10,2,10,6],[10,10,10,11],[11,2,11,6],[11,10,11,11],[8,2,8,6],[8,10,8,11],[0,0,3,1],[4,0,4,11],[5,2,5,6],[5,7,5,8],[6,10,6,11]]}
[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"A"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"B"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"C"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"D"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"E"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"F"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

{"sheet":"Gr-Sel-G","index":51,"n_rows":67,"n_cols":12,"rows_kept":67,"cut":false,"hidden":false,"merged":[[64,2,64,7],[55,1,55,11],[57,0,57,11],[59,2,61,8],[61,0,61,1],[61,10,61,11],[63,0,63,2],[63,3,63,8],[63,10,63,11],[54,1,54,11],[46,4,46,5],[46,6,46,7],[47,4,47,5],[47,6,47,7],[48,4,48,5],[48,6,48,7],[49,4,49,7],[50,1,50,11],[51,1,51,11],[52,1,52,11],[53,1,53,11],[45,4,45,5],[45,6,45,7],[36,1,36,9],[37,0,37,11],[38,0,38,11],[39,0,39,11],[40,0,40,11],[41,0,41,11],[42,4,42,7],[43,4,43,5],[43,6,43,7],[44,4,44,5],[44,6,44,7],[35,1,35,9],[24,1,24,9],[25,1,25,9],[26,3,26,9],[27,2,27,9],[28,1,28,9],[29,1,29,9],[30,1,30,9],[31,1,31,9],[32,1,32,9],[33,1,33,9],[34,1,34,9],[23,1,23,9],[12,2,12,6],[12,10,12,11],[14,1,14,9],[15,1,15,9],[16,2,16,9],[17,2,17,9],[18,2,18,9],[19,1,19,9],[20,1,20,9],[21,1,21,9],[22,1,22,9],[9,2,9,6],[9,10,9,11],[10,2,10,6],[10,10,10,11],[11,2,11,6],[11,10,11,11],[8,2,8,6],[8,10,8,11],[0,0,3,1],[4,0,4,11],[5,2,5,6],[5,7,5,8],[6,10,6,11]]}
[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"G"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"H"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"I"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"J"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"K"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"L"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"M"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]

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[null,null,null,null,null,null,null,null,null," "]
[null,null,"OFFICE OF INSURANCE REGULATION"]
[null,null,"Life and Health Product Review"]
[]
["MEDICARE SUPPLEMENT REFUND CALCULATION FORM"]
[null,null,{"$f":"CalYear","v":0},null,null,null,null,"CALENDAR YEAR  "]
[null,null,null,null,null,null,null,null,null,null,"Go To MasterList"]
[]
["TYPE: 1",null,"Group Select",null,null,null,null,null,"SMSBP:2",null,"N"]
["For the State of ",null,"Florida",null,null,null,null,null,"Company Name:",null,{"$f":"CName","v":0}]
["NAIC Group Code:",null,{"$f":"NAICGroup","v":0},null,null,null,null,null,"NAIC Company Code:",null,{"$f":"NAIC","v":0}]
["Address:",null,{"$f":"Address","v":0},null,null,null,null,null,"Person Completing Exhibit:",null,{"$f":"Contact","v":0}]
["Title:",null,{"$f":"ContactTitle","v":0},null,null,null,null,null,"Telephone Number:",null,{"$f":"ContactPhone","v":0}]
[]
["LINE",null,null,null,null,null,null,null,null,null,"(a)                      EARNED PREMIUM3","(B)                      INCURRED CLAIMS4"]
["1.","CURRENT YEAR'S EXPERIENCE"]
[null,null,"a.   TOTAL (ALL POLICY YEARS)"]
[null,null,"b.   CURRENT YEAR'S ISSUES5"]
[null,null,"c.    NET (FOR REPORTING PURPOSES = 1a-1b",null,null,null,null,null,null,null,{"$f":"K17-K18","v":0},{"$f":"L17-L18","v":0}]
["2.","PAST YEARS' EXPERIENCE (ALL POLICY YEARS)"]
["3.","TOTAL EXPERIENCE (NET CURRENT YEAR + PAST YEARS)",null,null,null,null,null,null,null,null,{"$f":"K19+K20","v":0},{"$f":"L19+L20","v":0}]
["4.","REFUNDS LAST YEAR (EXCLUDING INTEREST)"]
["5.","PREVIOUS SINCE INCEPTION (EXCLUDING INTEREST)"]
["6.","REFUNDS SINCE INCEPTION (EXCLUDING INTEREST)",null,null,null,null,null,null,null,null,null,{"$f":"L22+L23","v":0}]
["7.","BENCHMARK RATIO SINCE INCEPTION (SEE WORKSHEET FOR RATIO 1)"]
["8.","EXPERIENCED RATIO SINCE INCEPTION (RATIO 2)"]
[null,null,null,"TOTAL ACTUAL INCURRED CLAIMS (LINE 3, COL. b)"]
[null,null,"TOTAL EARNED PREM. (LINE 3, COL.a)-REFUNDS SINCE INCEPTION (LINE 6)",null,null,null,null,null,null,null,null,{"$f":"L21/(K21-L24)","v":{"$error":"#DIV/0!"}}]
["9.","LIFE YEARS EXPOSED SINCE INCEPTION (IF THE EXPERIENCED RATIO IS LESS THAN THE"]
[null,"BENCHMARK RATIO, AND THERE ARE MORE THAN 500 LIFE YEARS EXPOSURE, THEN PROCEED"]
[null,"TO CALCULATION OF REFUND.)"]
["10.","TOLERANCE PERMITTED (OBTAINED FROM CREDIBILITY TABLE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(L31),\"\",IF(L31<500,\"No Credibility\", IF(L31<1000,15%,IF(L31<2500,10%,IF(L31<5000,7.5%,IF(L31<10000,5%,0%))))))","v":""}]
["11.","ADJUSTMENT TO INCURRED CLAIMS FOR CREDIBILITY (RATIO 3=RATIO 2 + TOLERANCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",L28+L32)","v":{"$error":"#DIV/0!"}}]
["12.","ADJUSTED INCURRED CLAIMS [TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE"]
[null,"INCEPTION (LINE 6)] X RATIO 3 (LINE 11).",null,null,null,null,null,null,null,null,null,{"$f":"IF(L32=\"No Credibility\",\"\",(K21-L24)*L33)","v":{"$error":"#DIV/0!"}}]
["13.","REFUND = TOTAL EARNED PREMIUMS (LINE 3, COL. a)-REFUNDS SINCE INCEPTION (LINE 6)-"]
[null,"[ADJUSTED INCURRED CLAIMS (LINE12)/BENCHMARK RATIO (RATIO 1)]",null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(L32=\"No Credibility\",L28>L25,L33>L25),0,K21-L24-(L35/L25))","v":{"$error":"#DIV/0!"}}]
["IF RATIO 3 IS MORE THAN BENCHMARK RATIO (RATIO 1), A REFUND OR CREDIT TO PREMIUM IS NOT REQUIRED.  IF RATIO 3 IS LESS THAN"]
["THE BENCHMARK RATIO, THEN PROCEED."]
["IF THE AMOUNT ON LINE 13 IS LESS THAN .005 TIMES THE ANNUALIZED PREMIUM IN FORCE AS OF DECEMBER 31 OF THE REPORTING"]
["YEAR, THEN NO REFUND IS MADE.  OTHERWISE, THE AMOUNT ON LINE 13 IS TO BE REFUNDED OR CREDITED, AND A DESCRIPTION OF "]
["THE REFUND OR CREDIT AGAINST PREMIUMS TO BE USED MUST BE ATTACHED TO THE FORM."]
[null,null,null,null,"LIFE YEARS EXPOSED"]
[null,null,null,null,"SINCE INCEPTION",null,"TOLERANCE"]
[null,null,null,null,"10,000 +",null,0]
[null,null,null,null,"5,000 - 9,999",null,0.05]
[null,null,null,null,"2,500 - 4,999",null,7.4999999999999997E-2]
[null,null,null,null,"1,000 - 2,499",null,0.1]
[null,null,null,null,"500 - 999",null,0.15]
[null,null,null,null,"IF LESS THAN 500, NO CREDIBILITY."]
[1,"INDIVIDUAL, GROUP, INDIVIDUAL MEDICARE SELECT, OR GROUP MEDICARE SELECT ONLY."]
[2,"\"SMSBP\" = STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN - USE \"P\" FOR PRE-STANDARDIZED PLANS."]
[3,"INCLUDES MODAL LOADINGS AND FEES CHARGED"]
[4,"EXCLUDES ACTIVE LIFE RESERVES"]
[5,"THIS IS TO BE USED AS \"ISSUE YEAR EARNED PREMIUM\" FOR YEAR 1 OF NEXT YEAR'S \"WORKSHEET FOR CALCULATION OF "]
[null,"BENCHMARK RATIOS\""]
[]
["I CERTIFY THAT THE ABOVE INFORMATION AND CALCULATIONS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF "]
[]
[]
[]
["SIGNATURE:",null,null,null,null,null,null,null,null,"TITLE- PLEASE TYPE:"]
[]
["NAME - PLEASE TYPE:",null,null,null,null,null,null,null,null,"DATE:"]
[]
["OIR-B2-MSR"]
["REV. 7/02"]