LOYAL AMERICAN LIFE INSURANCE COMPANY

LOYAL AMERICAN LIFE INSURANCE COMPANY?

P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, B, C, D, F, G and N This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan "A" available. Some plans may not be available in your state. See Outline of Coverage sections for details about ALL Plans.

BASIC BENEFITS:

? Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. ? Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved expenses) or co-payments for hospital outpatient services. Plans K, L and N

require insureds to pay a portion of Part B coinsurance or co-payments. ? Blood: First three pints of blood each year. ? Hospice: Part A coinsurance.

A

B

C

D

F

F*

G

K

L

M

N

Basic,

Basic,

Basic,

Basic,

Basic,

Basic,

Hospitalization Hospitalization Basic,

Basic, Including

Including

Including

Including

Including

Including 100% Including 100% and Preventive and Preventive Including

100% Part B

100%

100%

100%

100%

Part B

Part B

Part B

Part B

Part B

Coinsurance*

Coinsurance Coinsurance Coinsurance Coinsurance

Part B Coinsurance

Care Paid at 100%; Other Basic Benefits

Care Paid at 100%; Other Basic Benefits

100% Part B Coinsurance

Coinsurance, Except Up to $20 Copayment

paid at 50%

Paid at 75%

for Office Visit,

and up to $50

Copayment for

ER Visit

Skilled

Skilled

Skilled

Skilled

50% Skilled

75% Skilled

Skilled Nursing Skilled Nursing

Nursing

Nursing

Nursing Facility Nursing Facility Nursing Facility Nursing Facility Facility

Facility

Facility

Facility

Coinsurance Coinsurance Coinsurance Coinsurance Coinsurance Coinsurance

Coinsurance Coinsurance

Part A

Part A

Part A

Part A

Part A

50% Part A

75% Part A

50% Part A Part A

Deductible Deductible Deductible Deductible

Deductible Deductible

Deductible

Deductible

Deductible

Part B

Part B

Deductible

Deductible

Part B

Part B

Excess (100%) Excess (100%)

Foreign

Foreign

Foreign

Foreign

Foreign

Foreign

Travel

Travel

Travel

Travel

Travel

Travel

Emergency Emergency Emergency Emergency

Emergency Emergency

Out-of-Pocket Out-of-Pocket

Limit $4,940; Limit $2,470;

Paid at 100% Paid At 100%

After Reached After Reached

* Plan F also has an option called a high deductible Plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,180 deductible.

Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be

paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan's separate foreign travel emergency deductible.

LOYAL-OC.V2-IA-ID

PAGE 1

01/15

Plan A

1412.07 1412.07 1412.07 1455.34 1494.06 1535.05 1578.32 1621.60 1664.87 1701.31 1736.61 1770.78 1803.80 1834.55 1861.88 1889.21 1915.40 1940.45 1963.23 1982.59 2000.81 2016.75 2030.41 2044.08 2057.74 2074.82 2091.91 2106.71 2120.38 2134.04 2146.57 2157.95 2167.06 2173.90 2179.59

Plan B

1648.93 1648.93 1648.93 1699.03 1744.58 1792.41 1842.52 1892.62 1943.87 1986.00 2028.14 2066.85 2104.43 2140.87 2172.76 2205.78 2235.39 2265.00 2291.19 2313.96 2334.46 2354.96 2370.90 2384.57 2401.65 2422.15 2441.51 2458.59 2474.53 2490.47 2505.28 2517.80 2529.19 2537.16 2542.86

Loyal American Life Insurance Company MEDICARE SUPPLEMENT

Idaho

Issue Age Rates -- Effective 1/1/2015 -- Area I (832-838) PREFERRED ANNUAL RATES

FEMALE RATES

MALE RATES

Plan C

Plan D

Plan F

Plan G

Plan N

Issue Age

Plan A

Plan B

Plan C

Plan D

Plan F

1986.00 1986.00 1986.00 2047.49 2107.85 2168.20 2227.42 2288.91 2349.27 2402.79 2455.17 2500.72 2548.55 2591.82 2631.68 2669.26 2703.42 2738.72 2769.47 2801.36 2830.96 2858.29 2882.21 2899.29 2918.65 2941.42 2963.06 2981.28 2998.36 3013.16 3024.55 3035.94 3045.05 3053.02 3058.72

1728.64

2044.08

1784.44

1430.29

65

1412.07

1648.93

1986.00

1728.64

1728.64

2044.08

1784.44

1430.29

66

1412.07

1648.93

1986.00

1728.64

1728.64

2044.08

1784.44

1430.29

67

1412.07

1648.93

1986.00

1728.64

1781.02

2096.46

1842.52

1467.86

68

1455.34

1699.03

2047.49

1781.02

1828.85

2146.57

1894.90

1503.17

69

1494.06

1744.58

2107.85

1828.85

1878.96

2203.50

1946.14

1541.88

70

1535.05

1792.41

2168.20

1878.96

1931.34

2269.55

1993.97

1588.57

71

1578.32

1842.52

2227.42

1931.34

1983.72

2336.74

2044.08

1635.26

72

1621.60

1892.62

2288.91

1983.72

2037.25

2409.62

2088.49

1686.51

73

1664.87

1943.87

2349.27

2037.25

2082.80

2462.00

2132.90

1724.09

74

1701.31

1986.00

2402.79

2082.80

2126.07

2513.25

2175.04

1759.39

75

1736.61

2028.14

2455.17

2126.07

2167.06

2558.80

2216.03

1791.27

76

1770.78

2066.85

2500.72

2167.06

2206.92

2600.93

2258.17

1820.88

77

1803.80

2104.43

2548.55

2206.92

2244.50

2639.65

2296.88

1848.21

78

1834.55

2140.87

2591.82

2244.50

2277.52

2679.51

2332.19

1875.54

79

1861.88

2172.76

2631.68

2277.52

2311.69

2714.81

2366.35

1899.46

80

1889.21

2205.78

2669.26

2311.69

2343.57

2750.11

2395.96

1925.65

81

1915.40

2235.39

2703.42

2343.57

2374.32

2784.27

2425.56

1949.56

82

1940.45

2265.00

2738.72

2374.32

2401.65

2812.74

2451.76

1968.92

83

1963.23

2291.19

2769.47

2401.65

2425.56

2840.07

2477.95

1988.28

84

1982.59

2313.96

2801.36

2425.56

2448.34

2865.13

2503.00

2006.50

85

2000.81

2334.46

2830.96

2448.34

2468.84

2885.62

2529.19

2019.03

86

2016.75

2354.96

2858.29

2468.84

2485.92

2903.84

2549.69

2032.69

87

2030.41

2370.90

2882.21

2485.92

2499.58

2924.34

2563.35

2047.49

88

2044.08

2384.57

2899.29

2499.58

2517.80

2943.70

2581.57

2061.16

89

2057.74

2401.65

2918.65

2517.80

2539.44

2965.34

2604.35

2075.96

90

2074.82

2422.15

2941.42

2539.44

2558.80

2983.56

2623.71

2088.49

91

2091.91

2441.51

2963.06

2558.80

2577.02

3001.78

2643.07

2101.02

92

2106.71

2458.59

2981.28

2577.02

2594.10

3017.72

2660.15

2112.40

93

2120.38

2474.53

2998.36

2594.10

2611.18

3032.52

2678.37

2122.65

94

2134.04

2490.47

3013.16

2611.18

2625.99

3043.91

2694.31

2130.62

95

2146.57

2505.28

3024.55

2625.99

2640.79

3055.30

2707.98

2138.60

96

2157.95

2517.80

3035.94

2640.79

2651.04

3064.41

2718.23

2145.43

97

2167.06

2529.19

3045.05

2651.04

2660.15

3074.66

2728.47

2152.26

98

2173.90

2537.16

3053.02

2660.15

2666.98

3079.21

2734.17

2155.68

99

2179.59

2542.86

3058.72

2666.98

Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the abovequoted premium by 0.52, for quarterly premiums, multiply the above quoted premium by 0.265 and for monthly premiums, multiply the above-quoted premium by 0.085.

Add one-time enrollment fee of $0.00 to the first premium

2044.08 2044.08 2044.08 2096.46 2146.57 2203.50 2269.55 2336.74 2409.62 2462.00 2513.25 2558.80 2600.93 2639.65 2679.51 2714.81 2750.11 2784.27 2812.74 2840.07 2865.13 2885.62 2903.84 2924.34 2943.70 2965.34 2983.56 3001.78 3017.72 3032.52 3043.91 3055.30 3064.41 3074.66 3079.21

Plan G

1784.44 1784.44 1784.44 1842.52 1894.90 1946.14 1993.97 2044.08 2088.49 2132.90 2175.04 2216.03 2258.17 2296.88 2332.19 2366.35 2395.96 2425.56 2451.76 2477.95 2503.00 2529.19 2549.69 2563.35 2581.57 2604.35 2623.71 2643.07 2660.15 2678.37 2694.31 2707.98 2718.23 2728.47 2734.17

Plan N

1430.29 1430.29 1430.29 1467.86 1503.17 1541.88 1588.57 1635.26 1686.51 1724.09 1759.39 1791.27 1820.88 1848.21 1875.54 1899.46 1925.65 1949.56 1968.92 1988.28 2006.50 2019.03 2032.69 2047.49 2061.16 2075.96 2088.49 2101.02 2112.40 2122.65 2130.62 2138.60 2145.43 2152.26 2155.68

LOYAL-OC.V2-IA-ID

PAGE 2

01/15

Plan A

120.03 120.03 120.03 123.70 127.00 130.48 134.16 137.84 141.51 144.61 147.61 150.52 153.32 155.94 158.26 160.58 162.81 164.94 166.87 168.52 170.07 171.42 172.58 173.75 174.91 176.36 177.81 179.07 180.23 181.39 182.46 183.43 184.20 184.78 185.27

Plan B

140.16 140.16 140.16 144.42 148.29 152.35 156.61 160.87 165.23 168.81 172.39 175.68 178.88 181.97 184.68 187.49 190.01 192.53 194.75 196.69 198.43 200.17 201.53 202.69 204.14 205.88 207.53 208.98 210.34 211.69 212.95 214.01 214.98 215.66 216.14

Loyal American Life Insurance Company MEDICARE SUPPLEMENT

Idaho

Issue Age Rates -- Effective 1/1/2015 -- Area I (832-838) PREFERRED MONTHLY RATES

FEMALE RATES

MALE RATES

Plan C

Plan D

Plan F

Plan G

Plan N

Issue Age

Plan A

Plan B

Plan C

Plan D

Plan F

168.81

146.93

173.75

151.68

121.57

65

120.03

140.16

168.81

146.93

173.75

168.81

146.93

173.75

151.68

121.57

66

120.03

140.16

168.81

146.93

173.75

168.81

146.93

173.75

151.68

121.57

67

120.03

140.16

168.81

146.93

173.75

174.04

151.39

178.20

156.61

124.77

68

123.70

144.42

174.04

151.39

178.20

179.17

155.45

182.46

161.07

127.77

69

127.00

148.29

179.17

155.45

182.46

184.30

159.71

187.30

165.42

131.06

70

130.48

152.35

184.30

159.71

187.30

189.33

164.16

192.91

169.49

135.03

71

134.16

156.61

189.33

164.16

192.91

194.56

168.62

198.62

173.75

139.00

72

137.84

160.87

194.56

168.62

198.62

199.69

173.17

204.82

177.52

143.35

73

141.51

165.23

199.69

173.17

204.82

204.24

177.04

209.27

181.30

146.55

74

144.61

168.81

204.24

177.04

209.27

208.69

180.72

213.63

184.88

149.55

75

147.61

172.39

208.69

180.72

213.63

212.56

184.20

217.50

188.36

152.26

76

150.52

175.68

212.56

184.20

217.50

216.63

187.59

221.08

191.94

154.77

77

153.32

178.88

216.63

187.59

221.08

220.30

190.78

224.37

195.23

157.10

78

155.94

181.97

220.30

190.78

224.37

223.69

193.59

227.76

198.24

159.42

79

158.26

184.68

223.69

193.59

227.76

226.89

196.49

230.76

201.14

161.45

80

160.58

187.49

226.89

196.49

230.76

229.79

199.20

233.76

203.66

163.68

81

162.81

190.01

229.79

199.20

233.76

232.79

201.82

236.66

206.17

165.71

82

164.94

192.53

232.79

201.82

236.66

235.40

204.14

239.08

208.40

167.36

83

166.87

194.75

235.40

204.14

239.08

238.12

206.17

241.41

210.63

169.00

84

168.52

196.69

238.12

206.17

241.41

240.63

208.11

243.54

212.76

170.55

85

170.07

198.43

240.63

208.11

243.54

242.95

209.85

245.28

214.98

171.62

86

171.42

200.17

242.95

209.85

245.28

244.99

211.30

246.83

216.72

172.78

87

172.58

201.53

244.99

211.30

246.83

246.44

212.46

248.57

217.88

174.04

88

173.75

202.69

246.44

212.46

248.57

248.09

214.01

250.21

219.43

175.20

89

174.91

204.14

248.09

214.01

250.21

250.02

215.85

252.05

221.37

176.46

90

176.36

205.88

250.02

215.85

252.05

251.86

217.50

253.60

223.02

177.52

91

177.81

207.53

251.86

217.50

253.60

253.41

219.05

255.15

224.66

178.59

92

179.07

208.98

253.41

219.05

255.15

254.86

220.50

256.51

226.11

179.55

93

180.23

210.34

254.86

220.50

256.51

256.12

221.95

257.76

227.66

180.43

94

181.39

211.69

256.12

221.95

257.76

257.09

223.21

258.73

229.02

181.10

95

182.46

212.95

257.09

223.21

258.73

258.05

224.47

259.70

230.18

181.78

96

183.43

214.01

258.05

224.47

259.70

258.83

225.34

260.47

231.05

182.36

97

184.20

214.98

258.83

225.34

260.47

259.51

226.11

261.35

231.92

182.94

98

184.78

215.66

259.51

226.11

261.35

259.99

226.69

261.73

232.40

183.23

99

185.27

216.14

259.99

226.69

261.73

Policies may be issued on an annual, semi-annual, quarterly or monthly mode To obtain semi-annual premiums, multiply the quoted annual premium by 0.52, and for for quarterly premiums, multiply the above quoted annual premium by 0.265

Add one-time enrollment fee of $0.00 to the first premium

Plan G

151.68 151.68 151.68 156.61 161.07 165.42 169.49 173.75 177.52 181.30 184.88 188.36 191.94 195.23 198.24 201.14 203.66 206.17 208.40 210.63 212.76 214.98 216.72 217.88 219.43 221.37 223.02 224.66 226.11 227.66 229.02 230.18 231.05 231.92 232.40

Plan N

121.57 121.57 121.57 124.77 127.77 131.06 135.03 139.00 143.35 146.55 149.55 152.26 154.77 157.10 159.42 161.45 163.68 165.71 167.36 169.00 170.55 171.62 172.78 174.04 175.20 176.46 177.52 178.59 179.55 180.43 181.10 181.78 182.36 182.94 183.23

LOYAL-OC.V2-IA-ID

PAGE 3

01/15

Plan A

1569.21 1569.21 1569.21 1617.04 1660.32 1707.00 1753.69 1802.66 1850.49 1891.48 1930.20 1967.78 2004.22 2038.38 2069.13 2098.74 2128.35 2155.68 2179.59 2203.50 2222.86 2241.08 2255.89 2270.69 2286.63 2305.99 2324.21 2340.16 2356.10 2370.90 2384.57 2397.09 2407.34 2415.31 2421.01

Plan B

1831.13 1831.13 1831.13 1888.07 1938.17 1991.70 2047.49 2103.29 2159.09 2206.92 2252.47 2296.88 2337.88 2378.87 2414.18 2450.62 2483.64 2516.66 2545.13 2571.33 2594.10 2615.74 2633.96 2649.90 2668.12 2692.03 2712.53 2731.89 2750.11 2768.33 2783.13 2797.94 2810.47 2819.58 2825.27

Loyal American Life Insurance Company MEDICARE SUPPLEMENT

Idaho

Issue Age Rates -- Effective 1/1/2015 -- Area I (832-838) STANDARD ANNUAL RATES

FEMALE RATES

MALE RATES

Plan C

Plan D

Plan F

Plan G

Plan N

Issue Age

Plan A

Plan B

Plan C

Plan D

Plan F

2206.92 2206.92 2206.92 2274.11 2341.30 2408.48 2474.53 2542.86 2610.04 2669.26 2728.47 2778.58 2830.96 2878.79 2924.34 2966.48 3005.19 3042.77 3076.94 3112.24 3145.26 3176.01 3202.20 3220.42 3243.19 3268.25 3292.16 3312.66 3332.02 3346.82 3360.49 3374.15 3383.26 3392.37 3399.21

1919.95

2270.69

1982.59

1589.71

65

1569.21

1831.13

2206.92

1919.95

1919.95

2270.69

1982.59

1589.71

66

1569.21

1831.13

2206.92

1919.95

1919.95

2270.69

1982.59

1589.71

67

1569.21

1831.13

2206.92

1919.95

1979.17

2329.91

2046.36

1630.71

68

1617.04

1888.07

2274.11

1979.17

2032.69

2385.71

2105.57

1669.43

69

1660.32

1938.17

2341.30

2032.69

2088.49

2448.34

2162.51

1713.84

70

1707.00

1991.70

2408.48

2088.49

2145.43

2521.22

2216.03

1765.08

71

1753.69

2047.49

2474.53

2145.43

2205.78

2596.38

2270.69

1817.46

72

1802.66

2103.29

2542.86

2205.78

2263.86

2676.09

2320.80

1873.26

73

1850.49

2159.09

2610.04

2263.86

2313.96

2735.31

2369.76

1914.26

74

1891.48

2206.92

2669.26

2313.96

2361.79

2792.25

2417.59

1954.12

75

1930.20

2252.47

2728.47

2361.79

2408.48

2843.49

2462.00

1990.56

76

1967.78

2296.88

2778.58

2408.48

2451.76

2890.18

2508.69

2022.44

77

2004.22

2337.88

2830.96

2451.76

2493.89

2933.45

2553.10

2053.19

78

2038.38

2378.87

2878.79

2493.89

2531.47

2977.86

2590.68

2085.07

79

2069.13

2414.18

2924.34

2531.47

2569.05

3016.58

2628.26

2111.27

80

2098.74

2450.62

2966.48

2569.05

2604.35

3056.44

2662.43

2138.60

81

2128.35

2483.64

3005.19

2604.35

2638.51

3094.02

2695.45

2165.93

82

2155.68

2516.66

3042.77

2638.51

2668.12

3124.76

2723.92

2187.56

83

2179.59

2545.13

3076.94

2668.12

2695.45

3156.65

2753.53

2210.34

84

2203.50

2571.33

3112.24

2695.45

2719.36

3183.98

2780.86

2228.56

85

2222.86

2594.10

3145.26

2719.36

2742.14

3205.62

2810.47

2244.50

86

2241.08

2615.74

3176.01

2742.14

2761.50

3227.25

2833.24

2259.30

87

2255.89

2633.96

3202.20

2761.50

2778.58

3250.03

2849.18

2274.11

88

2270.69

2649.90

3220.42

2778.58

2797.94

3270.53

2868.54

2290.05

89

2286.63

2668.12

3243.19

2797.94

2820.71

3294.44

2893.59

2305.99

90

2305.99

2692.03

3268.25

2820.71

2843.49

3316.08

2916.37

2320.80

91

2324.21

2712.53

3292.16

2843.49

2863.99

3335.43

2936.87

2334.46

92

2340.16

2731.89

3312.66

2863.99

2882.21

3353.65

2956.23

2348.13

93

2356.10

2750.11

3332.02

2882.21

2901.57

3369.60

2975.59

2358.38

94

2370.90

2768.33

3346.82

2901.57

2918.65

3382.12

2992.67

2367.49

95

2384.57

2783.13

3360.49

2918.65

2933.45

3394.65

3008.61

2375.46

96

2397.09

2797.94

3374.15

2933.45

2944.84

3404.90

3021.14

2383.43

97

2407.34

2810.47

3383.26

2944.84

2956.23

3416.29

3031.39

2391.40

98

2415.31

2819.58

3392.37

2956.23

2963.06

3420.84

3038.22

2394.82

99

2421.01

2825.27

3399.21

2963.06

Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the abovequoted premium by 0.52, for quarterly premiums, multiply the above quoted premium by 0.265 and for monthly premiums, multiply the above-quoted premium by 0.085.

Add one-time enrollment fee of $0.00 to the first premium

2270.69 2270.69 2270.69 2329.91 2385.71 2448.34 2521.22 2596.38 2676.09 2735.31 2792.25 2843.49 2890.18 2933.45 2977.86 3016.58 3056.44 3094.02 3124.76 3156.65 3183.98 3205.62 3227.25 3250.03 3270.53 3294.44 3316.08 3335.43 3353.65 3369.60 3382.12 3394.65 3404.90 3416.29 3420.84

Plan G

1982.59 1982.59 1982.59 2046.36 2105.57 2162.51 2216.03 2270.69 2320.80 2369.76 2417.59 2462.00 2508.69 2553.10 2590.68 2628.26 2662.43 2695.45 2723.92 2753.53 2780.86 2810.47 2833.24 2849.18 2868.54 2893.59 2916.37 2936.87 2956.23 2975.59 2992.67 3008.61 3021.14 3031.39 3038.22

Plan N

1589.71 1589.71 1589.71 1630.71 1669.43 1713.84 1765.08 1817.46 1873.26 1914.26 1954.12 1990.56 2022.44 2053.19 2085.07 2111.27 2138.60 2165.93 2187.56 2210.34 2228.56 2244.50 2259.30 2274.11 2290.05 2305.99 2320.80 2334.46 2348.13 2358.38 2367.49 2375.46 2383.43 2391.40 2394.82

LOYAL-OC.V2-IA-ID

PAGE 4

01/15

Plan A

133.38 133.38 133.38 137.45 141.13 145.10 149.06 153.23 157.29 160.78 164.07 167.26 170.36 173.26 175.88 178.39 180.91 183.23 185.27 187.30 188.94 190.49 191.75 193.01 194.36 196.01 197.56 198.91 200.27 201.53 202.69 203.75 204.62 205.30 205.79

Plan B

155.65 155.65 155.65 160.49 164.74 169.29 174.04 178.78 183.52 187.59 191.46 195.23 198.72 202.20 205.21 208.30 211.11 213.92 216.34 218.56 220.50 222.34 223.89 225.24 226.79 228.82 230.57 232.21 233.76 235.31 236.57 237.82 238.89 239.66 240.15

Loyal American Life Insurance Company MEDICARE SUPPLEMENT

Idaho

Issue Age Rates -- Effective 1/1/2015 -- Area I (832-838) STANDARD MONTHLY RATES

FEMALE RATES

MALE RATES

Plan C

Plan D

Plan F

Plan G

Plan N

Issue Age

Plan A

Plan B

Plan C

Plan D

Plan F

187.59

163.20

193.01

168.52

135.13

65

133.38

155.65

187.59

163.20

193.01

187.59

163.20

193.01

168.52

135.13

66

133.38

155.65

187.59

163.20

193.01

187.59

163.20

193.01

168.52

135.13

67

133.38

155.65

187.59

163.20

193.01

193.30

168.23

198.04

173.94

138.61

68

137.45

160.49

193.30

168.23

198.04

199.01

172.78

202.79

178.97

141.90

69

141.13

164.74

199.01

172.78

202.79

204.72

177.52

208.11

183.81

145.68

70

145.10

169.29

204.72

177.52

208.11

210.34

182.36

214.30

188.36

150.03

71

149.06

174.04

210.34

182.36

214.30

216.14

187.49

220.69

193.01

154.48

72

153.23

178.78

216.14

187.49

220.69

221.85

192.43

227.47

197.27

159.23

73

157.29

183.52

221.85

192.43

227.47

226.89

196.69

232.50

201.43

162.71

74

160.78

187.59

226.89

196.69

232.50

231.92

200.75

237.34

205.50

166.10

75

164.07

191.46

231.92

200.75

237.34

236.18

204.72

241.70

209.27

169.20

76

167.26

195.23

236.18

204.72

241.70

240.63

208.40

245.67

213.24

171.91

77

170.36

198.72

240.63

208.40

245.67

244.70

211.98

249.34

217.01

174.52

78

173.26

202.20

244.70

211.98

249.34

248.57

215.17

253.12

220.21

177.23

79

175.88

205.21

248.57

215.17

253.12

252.15

218.37

256.41

223.40

179.46

80

178.39

208.30

252.15

218.37

256.41

255.44

221.37

259.80

226.31

181.78

81

180.91

211.11

255.44

221.37

259.80

258.64

224.27

262.99

229.11

184.10

82

183.23

213.92

258.64

224.27

262.99

261.54

226.79

265.60

231.53

185.94

83

185.27

216.34

261.54

226.79

265.60

264.54

229.11

268.32

234.05

187.88

84

187.30

218.56

264.54

229.11

268.32

267.35

231.15

270.64

236.37

189.43

85

188.94

220.50

267.35

231.15

270.64

269.96

233.08

272.48

238.89

190.78

86

190.49

222.34

269.96

233.08

272.48

272.19

234.73

274.32

240.83

192.04

87

191.75

223.89

272.19

234.73

274.32

273.74

236.18

276.25

242.18

193.30

88

193.01

225.24

273.74

236.18

276.25

275.67

237.82

278.00

243.83

194.65

89

194.36

226.79

275.67

237.82

278.00

277.80

239.76

280.03

245.96

196.01

90

196.01

228.82

277.80

239.76

280.03

279.83

241.70

281.87

247.89

197.27

91

197.56

230.57

279.83

241.70

281.87

281.58

243.44

283.51

249.63

198.43

92

198.91

232.21

281.58

243.44

283.51

283.22

244.99

285.06

251.28

199.59

93

200.27

233.76

283.22

244.99

285.06

284.48

246.63

286.42

252.93

200.46

94

201.53

235.31

284.48

246.63

286.42

285.64

248.09

287.48

254.38

201.24

95

202.69

236.57

285.64

248.09

287.48

286.80

249.34

288.55

255.73

201.91

96

203.75

237.82

286.80

249.34

288.55

287.58

250.31

289.42

256.80

202.59

97

204.62

238.89

287.58

250.31

289.42

288.35

251.28

290.38

257.67

203.27

98

205.30

239.66

288.35

251.28

290.38

288.93

251.86

290.77

258.25

203.56

99

205.79

240.15

288.93

251.86

290.77

Policies may be issued on an annual, semi-annual, quarterly or monthly mode To obtain semi-annual premiums, multiply the quoted annual premium by 0.52, and for for quarterly premiums, multiply the above quoted annual premium by 0.265

Add one-time enrollment fee of $0.00 to the first premium

Plan G

168.52 168.52 168.52 173.94 178.97 183.81 188.36 193.01 197.27 201.43 205.50 209.27 213.24 217.01 220.21 223.40 226.31 229.11 231.53 234.05 236.37 238.89 240.83 242.18 243.83 245.96 247.89 249.63 251.28 252.93 254.38 255.73 256.80 257.67 258.25

Plan N

135.13 135.13 135.13 138.61 141.90 145.68 150.03 154.48 159.23 162.71 166.10 169.20 171.91 174.52 177.23 179.46 181.78 184.10 185.94 187.88 189.43 190.78 192.04 193.30 194.65 196.01 197.27 198.43 199.59 200.46 201.24 201.91 202.59 203.27 203.56

LOYAL-OC.V2-IA-ID

PAGE 5

01/15

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download