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Request for Quotes

ABC with XYZ Acquisition

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10

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14

Executive Long Term Disability (Plan 3) – Employer Paid

A regular executive working 30+ hours per week.

66 2/3% of the first $37,500 of pre-disability earnings reduced by deductible income (work earnings,

workers’ comp., etc.) to a max benefit of $25,000

180 Day elimination period

Benefits payable to SSNRA (see contract for greater detail)

Voluntary Long Term Disability – Employee Paid

There are 2 plans from which the employee may choose to enroll.

Option 1: 60% of the first $25,000 of pre-disability earnings, reduced by deductible income,

not to exceed $15,000 max monthly benefit

Option 2: 50% of the first $30,000 of pre-disability earnings, reduced by deductible income,

not to exceed $15,000 max monthly benefit

For either option, 180 day elimination period.

Benefits payable to SSNRA.

2 Year own occ period.

90 Day Pre-X limit

NO prudent person language.

ABC, Rates – The Standard:

The rates reflected below were initially guaranteed for 3 years; at the end of the

guarantee period, renewal rates were negotiated to be held flat for an additional 3 years – thru 12/31/2017 – this

differs from the 2015 renewal packet included in the submission – it reflects original renewal request, but includes

experience analysis.

With the increase to the max

benefit for Basic Life, effective

1/1/2016, the basic life rate

increased to $0.065. Rate Guarantee

expires 12/31/2016