claim offset information as of 04/30/2015 13:17 tuesday, may 5, 2015...
TRANSCRIPT
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 1 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VA0012 OP OP F A 08/04/2006 741.79 PD A 423.48 03/07/2007 08/05/2056 F A 08/04/2006 741.79 SD A 701.00 01/01/2007 08/05/2056
VA0015 OP OP F A 05/27/2006 2,358.53 PS A 1,475.25 07/01/2004 11/27/2054 F A 05/27/2006 2,358.53 SD A 1,492.00 11/01/2006 11/27/2054
VA0068 OP OP M A 11/09/2005 2,437.92 PD A 2,062.74 10/05/2006 06/11/2050 M A 11/09/2005 2,437.92 SD A 1,622.00 01/01/2007 06/11/2050 M A 11/09/2005 2,437.92 WP A 779.16 08/18/2007 04/19/2027
VA0090 OP OP M A 05/23/2006 1,557.02 PD A 542.63 11/17/2006 06/12/2052 M A 05/23/2006 1,557.02 SD A 1,207.00 10/01/2007 06/12/2052
VA3003 OP OP M A 08/08/2006 1,050.35 PD A 546.35 10/21/2006 11/23/2056 M A 08/08/2006 1,050.35 SD A 1,016.00 02/01/2007 11/23/2056
VA3016 OP OP F A 02/04/2006 1,443.26 PD A 925.46 01/01/2007 12/11/2057 F A 02/04/2006 1,443.26 SD A 1,018.00 08/01/2006 12/11/2057
VA3038 OP OP M A 07/27/2006 1,578.69 BO A 116.03 02/01/2010 02/13/2031 M A 07/27/2006 1,578.69 PD A 771.99 12/14/2006 02/14/2066 M A 07/27/2006 1,578.69 SD A 308.00 01/01/2007 02/14/2066 M A 07/27/2006 1,578.69 WP A 321.95 01/13/2010 04/15/2041
VA3128 OP OP F A 04/27/2006 2,312.54 PD A 1,117.15 12/19/2006 02/08/2053 F A 04/27/2006 2,312.54 SD A 1,473.00 01/01/2007 02/08/2053
VA3164 OP OP M A 06/23/2006 1,619.59 PD A 688.64 07/13/2007 04/11/2051 M A 06/23/2006 1,619.59 SD A 1,336.00 10/01/2008 04/11/2051 M A 06/23/2006 1,619.59 WP A 721.52 09/29/2008 04/10/2021
VA5343 OP OP M A 09/28/2006 848.38 PD A 296.76 01/03/2007 02/11/2055 M A 09/28/2006 848.38 SD A 652.00 03/01/2007 02/11/2055
VA5344 OP OP F A 09/27/2006 1,560.60 PD A 774.63 12/13/2006 06/17/2068 F A 09/27/2006 1,560.60 PS A 1.21 12/12/2006 06/17/2068 F A 09/27/2006 1,560.60 SD A 1,000.00 03/01/2007 06/17/2068
VA5375 OP OP F A 09/12/2006 989.68 PD A 317.77 05/25/2007 08/06/2053 F A 09/12/2006 989.68 SD A 705.00 03/01/2007 08/06/2053
VA5393 OP OP M A 07/08/2006 1,730.45 PS A 1,056.13 03/03/2007 07/18/2051 M A 07/08/2006 1,730.45 SD A 1,147.00 01/01/2007 07/18/2051
VA6125 OP OP F A 08/03/2006 1,091.73 PD A 545.96 01/12/2007 07/28/2052 F A 08/03/2006 1,091.73 SD A 880.00 02/01/2007 07/28/2052
VA7506 OP OP F A 08/29/2006 2,694.38 PD A 2,800.00 08/17/2007 06/16/2058 F A 08/29/2006 2,694.38 SD A 1,701.00 02/01/2007 06/16/2058
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 2 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VA7595 OP OP M A 12/13/2005 1,586.05 PD A 1,057.93 03/05/2007 09/24/2056 M A 12/13/2005 1,586.05 SD A 1,609.00 12/01/2008 09/24/2056 M A 12/13/2005 1,586.05 WP A 243.25 12/16/2008 04/05/2036
VA7717 OP OP M A 05/11/2006 1,300.06 PD A 342.83 02/02/2007 11/29/2051 M A 05/11/2006 1,300.06 SD A 260.00 12/01/2006 11/29/2051
VA7763 OP OP F A 11/02/2006 2,718.68 PD A 1,582.62 07/04/2007 10/20/2061 F A 11/02/2006 2,718.68 SD A 1,264.00 12/01/2007 10/19/2026
VA8100 OP OP F A 09/27/2006 2,183.08 PD A 1,053.70 01/10/2007 05/16/2057 F A 09/27/2006 2,183.08 SD A 1,180.00 03/01/2007 05/16/2057
VA8138 OP OP F A 10/31/2006 1,271.51 BO A 291.61 04/01/2008 02/05/2017 F A 10/31/2006 1,271.51 SD A 931.00 12/01/2007 02/06/2052
VA8143 OP OP F A 08/25/2006 1,791.26 BO A 15.48 02/01/2007 09/08/2018 F A 08/25/2006 1,791.26 PD A 682.57 01/01/2007 09/09/2053 F A 08/25/2006 1,791.26 PS A 85.32 01/01/2007 09/09/2053 F A 08/25/2006 1,791.26 SD A 939.00 02/01/2007 09/09/2053
VB2747 OP OP M A 05/02/2006 1,648.51 PD A 505.65 03/01/2007 05/26/2050 M A 05/02/2006 1,648.51 SD A 1,391.00 08/01/2007 05/26/2050
VB2817 OP OP F A 11/23/2006 1,372.48 PD A 714.44 09/27/2007 09/23/2052 F A 11/23/2006 1,372.48 SD A 1,041.00 05/01/2007 09/23/2052
VB2837 OP OP F A 01/18/2007 903.99 PD A 441.14 02/20/2008 10/11/2067 F A 01/18/2007 903.99 SD A 854.00 09/01/2007 10/11/2067
VB2897 OP OP M A 06/19/2007 1,787.66 PD A 543.32 09/01/2007 10/03/2051 M A 06/19/2007 1,787.66 SD A 1,380.00 01/01/2008 10/03/2051 M A 06/19/2007 1,787.66 WP A 334.16 01/03/2008 12/02/2031
VB3805 OP OP F A 05/19/2006 1,085.39 BO A 61.64 11/01/2006 05/08/2038 F A 05/19/2006 1,085.39 SD A 982.00 11/01/2006 05/09/2073
VB3808 OP OP M A 09/20/2006 980.41 PD A 338.47 07/01/2007 05/11/2055 M A 09/20/2006 980.41 SD A 951.00 01/01/2007 05/11/2055
VB5263 OP OP F A 02/10/2007 1,235.16 PD A 744.25 04/06/2007 07/08/2062 F A 02/10/2007 1,235.16 SD A 963.00 08/01/2007 07/08/2062
VB5314 OP OP F A 10/30/2006 692.35 SD A 746.00 06/01/2007 01/14/2052
VB5348 OP OP F A 10/24/2006 1,033.88 BO A 122.11 04/01/2007 10/31/2021 F A 10/24/2006 1,033.88 SD A 872.00 04/01/2007 11/01/2056
VB5368 OP OP F A 02/27/2007 584.24 SD A 519.00 08/01/2007 03/15/2059
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 3 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VB7538 OP OP F A 02/01/2007 2,437.50 BO A 237.75 07/01/2007 11/09/2028 F A 02/01/2007 2,437.50 SD A 2,106.00 07/01/2007 11/10/2063
VB7556 OP OP F A 12/20/2006 592.90 PD A 283.33 10/19/2007 03/28/2062 F A 12/20/2006 592.90 SD A 677.00 06/01/2007 03/28/2062
VB7566 OP OP F A 02/17/2007 2,034.34 PD A 1,683.97 06/13/2007 09/15/2054 F A 02/17/2007 2,034.34 SD A 1,420.00 08/01/2007 09/15/2054
VB7570 OP OP M A 10/10/2006 1,616.34 PD A 971.48 02/02/2007 10/03/2057 M A 10/10/2006 1,616.34 SD A 1,082.00 10/01/2007 10/03/2057
VB7583 OP OP F A 02/08/2007 3,075.95 PD A 2,015.22 10/17/2007 05/28/2067 F A 02/08/2007 3,075.95 SD A 1,547.00 02/01/2008 05/28/2067
VB8053 OP OP F A 01/23/2007 2,933.61 PD A 1,843.22 07/07/2007 03/26/2053 F A 01/23/2007 2,933.61 SD A 1,689.00 07/01/2007 03/26/2053
VB8066 OP OP F A 02/24/2007 916.53 BO A 50.29 01/01/2008 06/14/2016 F A 02/24/2007 916.53 PD A 244.99 08/11/2007 06/15/2051 F A 02/24/2007 916.53 SD A 586.00 01/01/2008 06/15/2051
VB8068 OP OP M A 02/03/2007 948.46 SD A 1,195.00 12/01/2008 06/17/2055 M A 02/03/2007 948.46 WP A 149.40 10/22/2008 09/18/2038
VB9358 OP OP M A 03/30/2007 1,405.41 PD A 600.95 08/01/2007 10/27/2060 M A 03/30/2007 1,405.41 SD A 1,171.00 09/01/2007 10/27/2060
VB9373 OP OP F A 05/23/2007 2,482.08 PD A 1,491.54 11/26/2007 08/27/2068 F A 05/23/2007 2,482.08 SD A 1,287.00 12/01/2008 08/27/2068
VC2063 OP OP F A 06/25/2007 05/13/2015 1,146.81 PD A 528.09 12/22/2007 09/11/2059 F A 06/25/2007 05/13/2015 1,146.81 SD A 1,148.00 12/01/2007 09/11/2059
VC3515 OP OP M A 03/16/2007 1,623.43 PD A 724.23 07/13/2007 08/06/2056 M A 03/16/2007 1,623.43 SD A 1,165.00 01/01/2008 08/06/2056
VC3528 OP OP F A 04/14/2007 1,984.72 PD A 1,119.38 07/12/2007 08/17/2057 F A 04/14/2007 1,984.72 SD A 1,313.00 10/01/2008 08/17/2057
VC3822 OP OP M A 04/06/2007 2,571.24 PD A 1,693.69 10/17/2007 04/17/2057 M A 04/06/2007 2,571.24 SD A 1,375.00 10/01/2007 04/17/2057
VC3837 OP OP F A 02/28/2007 2,353.60 PD A 1,244.60 11/30/2007 10/25/2054 F A 02/28/2007 2,353.60 SD A 1,074.00 08/01/2008 10/25/2054
VC3860 OP OP F A 05/12/2007 2,271.36 BO A 71.11 08/01/2008 01/26/2022 F A 05/12/2007 2,271.36 PD A 789.89 07/19/2008 01/27/2057
F A 05/12/2007 2,271.36 SD A 1,323.00 01/01/2008 01/27/2057
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 4 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VC4501 OP OP F A 04/29/2007 1,453.35 PD A 923.74 09/12/2007 12/19/2065 F A 04/29/2007 1,453.35 SD A 1,190.00 10/01/2007 12/19/2065
VC4503 OP OP F A 02/28/2007 2,657.19 BO A 800.00 03/01/2010 02/26/2024 F A 02/28/2007 2,657.19 SD A 1,426.00 03/01/2010 02/27/2059
VC4525 OP OP F A 02/17/2007 998.08 SD A 976.00 12/01/2006 10/14/2050
VC4581 OP OP M A 04/16/2007 1,401.35 PD A 985.69 05/17/2008 07/15/2069 M A 04/16/2007 1,401.35 SD A 1,026.00 10/01/2007 07/15/2069
VC4591 OP OP M A 05/25/2007 1,756.07 PD A 339.78 11/01/2007 06/17/2056 M A 05/25/2007 1,756.07 PS A 971.39 11/01/2007 06/17/2056 M A 05/25/2007 1,756.07 SD A 1,336.00 11/01/2007 06/17/2056
VC6738 OP OP M A 08/26/2007 1,429.14 PD A 647.66 09/26/2007 02/19/2070 M A 08/26/2007 1,429.14 SC A 527.00 03/01/2008 07/31/2025 M A 08/26/2007 1,429.14 SD A 1,054.00 03/01/2008 02/19/2070
VC6753 OP OP F A 08/23/2007 1,369.60 PD A 567.17 12/05/2007 06/23/2054 F A 08/23/2007 1,369.60 SD A 980.00 02/01/2008 06/23/2054
VC6763 OP OP F A 05/30/2007 1,868.66 BO A 718.79 01/01/2008 11/01/2023 F A 05/30/2007 1,868.66 SD A 1,078.00 01/01/2008 11/02/2058
VC6782 OP OP F A 08/23/2007 2,000.93 PD A 1,413.65 10/21/2007 01/04/2060 F A 08/23/2007 2,000.93 SD A 1,198.00 02/01/2008 01/04/2060
VC8401 OP OP M A 08/01/2007 3,932.71 PD A 3,288.96 11/10/2007 04/03/2057 M A 08/01/2007 3,932.71 SD A 1,848.00 01/01/2008 04/03/2057
VC8445 OP OP F A 10/10/2006 1,981.09 PD A 688.76 09/13/2007 03/17/2053 F A 10/10/2006 1,981.09 SD A 1,277.00 09/01/2007 03/17/2053 F A 10/10/2006 1,981.09 WP A 372.64 02/01/2009 04/04/2037
VD1208 OP OP F S 09/13/2007 1,337.91 BO A 6.89 04/01/2010 06/18/2015 F S 09/13/2007 1,337.91 PD A 339.57 06/04/2008 06/19/2050 F S 09/13/2007 1,337.91 SD A 940.00 04/01/2010 06/19/2050
VD1209 OP OP F A 09/07/2007 3,145.35 PD A 2,467.40 02/17/2008 07/26/2061 F A 09/07/2007 3,145.35 SD A 1,710.00 10/01/2007 07/26/2061
VD1250 OP OP F A 04/05/2007 2,031.95 BO A 800.00 11/01/2007 05/25/2023
VD1271 OP OP M A 12/01/2007 3,500.14 PD A 1,825.39 03/06/2008 08/06/2052 M A 12/01/2007 3,500.14 SD A 1,716.00 05/01/2008 08/06/2052
VD1279 OP OP F A 08/01/2007 1,295.72 PD A 785.67 02/23/2008 05/21/2065
F A 08/01/2007 1,295.72 SD A 1,048.00 01/01/2008 05/21/2065
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 5 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VD1306 LT LS F A 01/29/2006 258.07 0.00
VD1310 OP OP F A 10/16/2007 1,085.39 PD A 787.51 05/21/2008 11/18/2056 F A 10/16/2007 1,085.39 SD A 884.00 03/01/2010 11/18/2056
VD1347 OP OP F A 11/28/2007 3,040.38 BO A 142.40 05/01/2008 09/15/2019 F A 11/28/2007 3,040.38 PD A 1,002.04 04/20/2008 09/16/2054 F A 11/28/2007 3,040.38 SD A 1,779.00 05/01/2008 09/16/2054
VD1391 OP OP F A 02/07/2008 2,259.61 PD A 1,207.21 02/07/2009 07/10/2063 F A 02/07/2008 2,259.61 SD A 1,349.00 01/01/2009 07/10/2063
VD2949 OP OP F A 08/16/2007 1,233.70 PD A 689.63 12/20/2007 09/04/2066 F A 08/16/2007 1,233.70 SD A 865.00 02/01/2008 09/04/2066
VD2965 OP OP M A 09/29/2007 1,497.28 PD A 1,204.66 02/12/2008 10/05/2057 M A 09/29/2007 1,497.28 SD A 1,243.00 03/01/2008 10/05/2057
VD4945 OP OP F A 07/21/2007 2,619.23 BO A 328.90 02/01/2008 10/10/2033 F A 07/21/2007 2,619.23 PD A 893.59 01/13/2008 10/11/2068 F A 07/21/2007 2,619.23 SD A 1,296.00 01/01/2008 10/11/2068
VD4950 OP OP M A 10/10/2007 3,099.96 PD A 1,354.72 01/12/2008 04/29/2063 M A 10/10/2007 3,099.96 PS A 1,058.77 01/12/2008 04/29/2063 M A 10/10/2007 3,099.96 SD A 1,669.00 03/01/2009 04/29/2063
VD6621 OP OP F A 09/14/2007 1,055.91 PD A 650.60 03/16/2008 06/05/2072 F A 09/14/2007 1,055.91 SD A 870.00 03/01/2008 06/05/2072
VD6622 OP OP F A 09/11/2007 1,841.66 PD A 895.02 03/27/2008 05/11/2072 F A 09/11/2007 1,841.66 SD A 1,044.00 04/01/2009 05/11/2072
VD6638 OP OP M A 01/16/2007 1,588.96 BO A 347.85 04/01/2008 06/26/2042 M A 01/16/2007 1,588.96 SD A 1,180.00 04/01/2008 06/27/2077
VD6649 OP OP M A 05/04/2007 1,087.94 SD A 1,431.00 11/01/2007 08/09/2054
VD6654 OP OP M A 12/05/2007 1,169.40 BO A 800.00 03/04/2008 11/30/2020
VD6717 OP OP F A 10/23/2007 875.11 BO A 309.46 01/01/2010 07/04/2024 F A 10/23/2007 875.11 SD A 532.00 01/01/2010 07/05/2059
VD6780 OP OP F A 09/08/2007 3,158.19 BO A 800.00 02/01/2008 08/31/2029 F A 09/08/2007 3,158.19 SD A 1,149.00 03/01/2008 09/01/2064
VD6796 OP OP F A 01/12/2008 1,164.98 SD A 1,434.00 07/01/2008 09/06/2051
VD7518 OP OP F A 01/01/2008 3,505.06 PD A 2,343.69 02/27/2010 11/14/2056
F A 01/01/2008 3,505.06 SD A 1,432.00 04/01/2010 11/14/2056
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 6 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VD7537 OP OP F A 01/30/2008 3,178.39 PS A 2,139.72 01/01/2004 02/02/2052 F A 01/30/2008 3,178.39 SD A 1,800.00 07/01/2008 02/02/2052
VD7541 OP OP F A 02/20/2008 2,129.23 PD A 1,200.78 06/19/2008 12/30/2058 F A 02/20/2008 2,129.23 SD A 1,274.00 08/01/2008 12/30/2058
VE0925 OP OP F A 04/09/2008 1,119.74 PD A 428.16 06/03/2008 06/27/2054 F A 04/09/2008 1,119.74 SD A 1,389.00 10/01/2008 06/27/2054
VE0942 OP OP F A 01/01/2008 1,017.67 BO A 800.00 03/31/2008 07/01/2025
VE1543 OP OP F A 04/22/2008 1,096.39 SD A 1,088.00 10/01/2008 06/04/2056
VE1949 OP OP F A 02/11/2008 2,528.45 PD A 1,328.98 10/04/2008 10/06/2056 F A 02/11/2008 2,528.45 SD A 1,344.00 08/01/2008 10/06/2056
VE1996 OP OP M A 03/12/2008 3,096.81 PD A 1,719.65 07/27/2008 01/18/2062 M A 03/12/2008 3,096.81 SD A 1,766.00 12/01/2011 01/18/2062 M A 03/12/2008 3,096.81 WP A 328.31 03/01/2011 02/18/2041
VE2438 OP OP F A 12/31/2007 2,311.51 BO A 72.92 07/01/2008 08/06/2016 F A 12/31/2007 2,311.51 PD A 769.69 06/11/2008 08/07/2051 F A 12/31/2007 2,311.51 SD A 1,380.00 06/01/2008 08/07/2051
VE2439 OP OP F A 11/04/2007 685.37 SD A 657.00 04/01/2008 07/16/2066
VE2448 OP OP F A 12/13/2007 524.96 SD A 785.00 06/01/2008 03/05/2058
VE2487 OP OP M A 01/19/2008 4,213.19 BO A 22.57 07/01/2008 04/25/2029 M A 01/19/2008 4,213.19 PD A 2,215.57 03/28/2008 04/26/2064 M A 01/19/2008 4,213.19 SD A 1,813.00 07/01/2008 04/26/2064
VE2499 OP OP F A 12/04/2007 2,569.50 PD A 1,659.67 09/01/2007 12/01/2056 F A 12/04/2007 2,569.50 SD A 1,520.00 06/01/2008 12/01/2056
VE4307 OP OP F A 02/06/2008 2,485.39 PD A 1,591.42 04/16/2008 07/10/2070 F A 02/06/2008 2,485.39 SD A 1,408.00 08/01/2008 07/10/2070
VE4335 OP OP F A 03/14/2008 1,318.04 PD A 593.96 06/05/2008 01/04/2061 F A 03/14/2008 1,318.04 SD A 1,138.00 09/01/2008 01/04/2061
VE4361 OP OP M A 02/11/2008 1,439.05 SD A 427.00 08/01/2008 07/15/2050
VE4364 OP OP F A 11/29/2007 938.28 BO A 115.19 06/01/2008 12/08/2020 F A 11/29/2007 938.28 SD A 787.00 05/01/2008 12/09/2055
VE4366 OP OP F A 03/21/2008 1,039.46 BO A 308.48 09/01/2008 01/23/2021 F A 03/21/2008 1,039.46 SD A 691.00 09/01/2008 01/24/2056
VE4380 OP OP M A 10/06/2007 2,281.55 PD A 2,530.83 11/10/2007 08/22/2063
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 7 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VE4380 OP OP M A 10/06/2007 2,281.55 SD A 1,574.00 04/01/2008 08/22/2063
VE4466 OP OP F A 11/16/2007 1,846.16 BO A 800.00 02/14/2008 02/09/2017 F A 11/16/2007 1,846.16 SD A 803.00 01/01/2009 02/10/2052
VE4827 OP OP M A 01/12/2008 3,070.71 PD A 1,760.02 01/12/2008 07/14/2052 M A 01/12/2008 3,070.71 SD A 1,674.00 07/01/2008 07/14/2052
VE5251 OP OP M A 03/15/2008 2,171.70 PD A 1,237.60 10/08/2008 08/03/2056 M A 03/15/2008 2,171.70 SD A 1,360.00 09/01/2008 08/03/2056
VE5817 OP OP F A 05/22/2008 1,954.82 PD A 2,077.04 06/01/2008 03/31/2043 F A 05/22/2008 1,954.82 SD A 1,343.00 11/01/2008 03/19/2078
VE5819 OP OP M A 01/22/2008 1,544.56 PD A 576.10 06/28/2008 08/06/2052 M A 01/22/2008 1,544.56 SD A 1,269.00 07/01/2008 08/06/2052
VE5840 OP OP F A 02/12/2008 1,137.24 PD A 547.33 08/06/2008 07/28/2054 F A 02/12/2008 1,137.24 SD A 780.00 01/01/2010 07/28/2054
VE6804 OP OP F A 02/13/2008 1,730.90 PS A 688.10 01/27/2009 09/28/2053 F A 02/13/2008 1,730.90 SD A 1,596.00 08/01/2008 09/28/2053
VE6831 OP OP F A 04/18/2008 672.01 PD A 417.29 08/01/2008 10/18/2060 F A 04/18/2008 672.01 SD A 736.00 10/01/2008 10/18/2060
VE6844 OP OP F A 11/30/2007 1,360.29 PD A 467.28 07/20/2008 07/28/2056 F A 11/30/2007 1,360.29 SD A 1,214.00 05/01/2008 07/28/2056
VE6851 OP OP M A 04/01/2008 4,807.60 PD A 4,099.44 04/01/2008 04/14/2051 M A 04/01/2008 4,807.60 SD A 2,107.00 09/01/2008 04/14/2051
VE6853 OP OP M A 05/30/2008 1,827.91 PD A 737.34 07/02/2008 11/25/2062 M A 05/30/2008 1,827.91 SD A 1,794.00 11/01/2008 11/25/2062
VE6884 OP OP M A 03/10/2008 1,172.44 PD A 666.00 07/09/2008 11/15/2061 M A 03/10/2008 1,172.44 SD A 1,070.00 09/01/2008 11/15/2061
VE7151 OP OP M A 04/20/2008 1,572.73 PD A 557.97 08/16/2008 09/22/2051 M A 04/20/2008 1,572.73 PS A 52.05 08/16/2008 09/22/2051 M A 04/20/2008 1,572.73 SD A 1,861.00 10/01/2008 09/22/2051
VE7163 OP OP M A 03/12/2008 1,376.49 PD A 584.29 09/06/2008 06/03/2053 M A 03/12/2008 1,376.49 SD A 1,193.00 06/01/2009 06/03/2053
VE7189 OP OP F A 06/04/2008 1,269.45 PS A 365.82 07/22/2008 05/08/2051 F A 06/04/2008 1,269.45 SD A 1,280.00 02/01/2009 05/08/2051
VE7265 OP OP F A 04/09/2008 1,084.58 PD A 593.34 09/01/2008 03/21/2068 F A 04/09/2008 1,084.58 SD A 925.00 10/01/2009 03/21/2068
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 8 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VF0525 OP OP M A 04/15/2008 1,470.41 BO A 48.95 10/01/2008 09/29/2016 M A 04/15/2008 1,470.41 PD A 404.91 07/06/2008 09/30/2051 M A 04/15/2008 1,470.41 SD A 960.00 10/01/2008 09/30/2051
VF0609 OP OP F A 03/14/2008 2,638.95 PD A 1,768.29 08/09/2008 09/22/2069 F A 03/14/2008 2,638.95 SD A 1,445.00 09/01/2008 09/22/2069
VF0659 OP OP F A 07/10/2008 1,062.26 SD A 1,046.00 01/01/2009 01/13/2052
VF0670 OP OP F A 02/23/2008 1,740.75 PD A 748.04 09/19/2008 03/11/2055 F A 02/23/2008 1,740.75 SD A 80.60 08/01/2008 03/11/2055 F A 02/23/2008 1,740.75 WP A 212.92 05/01/2012 05/01/2038
VF3315 OP OP M A 06/09/2008 1,672.15 PD A 1,008.84 10/31/2008 07/02/2074 M A 06/09/2008 1,672.15 SD A 1,162.00 12/01/2009 07/02/2074
VF3316 OP OP F A 09/19/2008 1,000.24 BO A 77.77 03/01/2009 02/26/2022 F A 09/19/2008 1,000.24 SD A 884.00 03/01/2009 02/27/2057
VF3320 OP OP F A 06/04/2008 771.82 SD A 770.00 12/01/2008 05/14/2055
VF3335 OP OP F A 08/14/2008 2,400.94 PD A 1,260.39 12/03/2008 03/25/2072 F A 08/14/2008 2,400.94 SD A 1,303.00 02/01/2009 03/25/2072
VF3348 OP OP F A 06/29/2008 1,906.45 PD A 1,064.26 06/02/2009 06/22/2056 F A 06/29/2008 1,906.45 SD A 1,204.00 12/01/2008 06/22/2056
VF3377 OP OP F A 12/14/2007 3,084.69 PD A 1,918.20 02/07/2009 01/20/2059 F A 12/14/2007 3,084.69 SD A 1,696.00 06/01/2008 01/20/2059
VF3397 OP OP F A 09/25/2007 1,052.53 PD A 347.84 04/30/2009 04/14/2059 F A 09/25/2007 1,052.53 SD A 1,199.00 03/01/2010 04/14/2059 F A 09/25/2007 1,052.53 WP A 158.59 04/01/2009 09/24/2039
VF3505 OP OP F A 01/29/2007 1,936.30 BO A 40.83 07/01/2007 09/09/2042 F A 01/29/2007 1,936.30 PD A 709.00 03/29/2007 09/10/2077 F A 01/29/2007 1,936.30 SD A 1,112.00 07/01/2007 09/10/2077
VF3538 OP OP F A 07/24/2008 655.09 SD A 959.00 10/01/2008 06/20/2058
VF3539 OP OP F A 04/17/2008 2,126.43 BO A 127.93 01/01/2009 12/21/2023 F A 04/17/2008 2,126.43 PD A 912.71 10/05/2008 12/22/2058 F A 04/17/2008 2,126.43 SD A 1,004.00 01/01/2009 12/22/2058
VF5109 OP OP F A 07/04/2008 916.83 BO A 581.56 01/01/2009 08/27/2022 F A 07/04/2008 916.83 SD A 300.00 01/01/2009 08/28/2057
VF5162 OP OP F A 06/03/2008 2,708.34 PD A 1,971.56 02/10/2009 09/09/2059
F A 06/03/2008 2,708.34 SD A 1,669.00 01/01/2009 09/09/2059
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 9 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VF5195 OP OP F A 09/17/2008 1,961.38 PD A 1,541.84 02/28/2009 06/20/2055 F A 09/17/2008 1,961.38 SD A 1,062.00 03/01/2009 06/20/2055
VF5210 OP OP F A 06/06/2008 728.33 SD A 424.00 11/01/2009 12/01/2080
VF5215 OP OP F A 07/04/2008 1,437.11 BO A 232.84 01/01/2009 08/27/2044 F A 07/04/2008 1,437.11 SC A 574.00 01/01/2009 09/30/2025 F A 07/04/2008 1,437.11 SD A 1,149.00 01/01/2009 08/28/2079
VF5217 OP OP M A 07/26/2008 3,155.70 PD A 1,399.37 10/18/2008 11/22/2054 M A 07/26/2008 3,155.70 SD A 1,654.00 03/01/2010 11/22/2054
VF5266 OP OP F A 06/05/2008 621.08 PD A 408.24 11/09/2008 09/07/2056 F A 06/05/2008 621.08 SD A 784.00 12/01/2008 09/07/2056
VF5268 OP OP F A 06/03/2008 2,405.76 PD A 988.76 02/08/2009 10/09/2050 F A 06/03/2008 2,405.76 SD A 1,510.00 01/01/2009 10/09/2050
VF6223 OP OP M A 10/18/2008 1,253.15 PD A 1,243.42 01/22/2009 10/29/2060 M A 10/18/2008 1,253.15 SD A 1,090.00 04/01/2009 10/29/2060
VF6248 OP OP F A 08/30/2008 1,539.15 BO A 364.95 02/01/2009 05/20/2038 F A 08/30/2008 1,539.15 SD A 1,115.00 02/01/2009 05/21/2073
VF6273 OP OP F A 07/29/2008 1,395.94 PD A 753.57 12/10/2008 12/02/2065 F A 07/29/2008 1,395.94 SD A 1,002.00 01/01/2009 12/02/2065
VF6284 OP OP M A 10/10/2008 1,171.73 PD A 442.64 12/05/2008 01/06/2052 M A 10/10/2008 1,171.73 SD A 812.00 04/01/2009 01/06/2052
VF6331 OP OP F A 08/01/2008 1,568.61 PD A 780.37 11/08/2008 02/25/2051 F A 08/01/2008 1,568.61 SD A 1,177.00 05/01/2009 02/25/2051
VF6334 OP OP F A 10/01/2008 1,843.84 BO A 800.00 12/30/2008 08/23/2044 F A 10/01/2008 1,843.84 SD A 728.00 03/01/2009 08/24/2079
VF6364 OP OP M A 10/11/2008 6,148.66 BO A 92.95 05/01/2009 01/05/2017 M A 10/11/2008 6,148.66 PS A 3,455.22 10/11/2008 01/06/2052 M A 10/11/2008 6,148.66 SD A 2,364.00 04/01/2009 01/06/2052
VF6384 OP OP F A 09/20/2008 3,512.87 PD A 884.95 06/05/2009 12/17/2050 F A 09/20/2008 3,512.87 SD A 1,932.00 03/01/2009 12/17/2050
VF9196 OP OP M A 01/27/2009 1,664.44 PD A 1,002.31 06/11/2009 11/27/2060 M A 01/27/2009 1,664.44 SD A 1,080.00 07/01/2009 11/27/2060
VF9309 OP OP F A 11/15/2008 2,382.46 PD A 1,478.07 01/17/2009 12/25/2050 F A 11/15/2008 2,382.46 SD A 1,368.00 05/01/2009 12/25/2050
VF9312 OP OP F A 09/25/2008 2,693.49 PD A 1,599.32 02/16/2009 11/26/2074
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 10 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VF9312 OP OP F A 09/25/2008 2,693.49 SD A 1,547.00 03/01/2009 11/26/2074
VF9329 OP OP M A 08/20/2008 2,921.10 PD A 772.53 01/01/2009 12/27/2058 M A 08/20/2008 2,921.10 PS A 611.90 01/01/2009 12/27/2058 M A 08/20/2008 2,921.10 SD A 1,624.00 02/01/2009 12/27/2058
VF9339 OP OP M A 08/22/2008 1,294.30 PD A 747.19 03/27/2009 10/10/2050 M A 08/22/2008 1,294.30 SD A 978.00 02/01/2009 10/10/2050 M A 08/22/2008 1,294.30 WP A 415.21 09/23/2009 10/09/2020
VF9382 OP OP F A 12/10/2008 6,364.59 BO A 800.00 03/10/2009 11/07/2017 F A 12/10/2008 6,364.59 SD A 2,139.00 06/01/2009 11/08/2052
VF9387 OP OP M A 09/03/2008 1,511.33 BO A 115.20 03/01/2009 07/26/2023 M A 09/03/2008 1,511.33 SD A 1,338.00 03/01/2009 07/27/2058
VF9396 OP OP F A 08/07/2008 1,868.92 PS A 1,175.72 08/06/2008 06/15/2050 F A 08/07/2008 1,868.92 SD A 1,138.00 01/01/2009 06/15/2050
VF9401 OP OP F A 03/28/2008 2,032.11 PS A 1,249.21 01/09/2008 03/27/2056 F A 03/28/2008 2,032.11 SD A 1,307.00 04/01/2009 03/27/2056
VF9418 OP OP F A 09/18/2008 1,760.80 PD A 813.83 02/28/2009 03/16/2053 F A 09/18/2008 1,760.80 SD A 1,637.00 03/01/2009 03/16/2053
VF9469 OP OP F A 10/29/2008 5,916.84 PD A 4,423.78 03/06/2009 05/22/2058 F A 10/29/2008 5,916.84 SD A 2,258.00 04/01/2009 05/22/2058
VG1213 OP OP F A 10/01/2008 1,112.83 PD A 868.28 12/12/2008 05/23/2061 F A 10/01/2008 1,112.83 SD A 965.00 03/01/2009 05/23/2061
VG1214 OP OP F A 11/26/2008 1,034.42 PD A 728.92 04/28/2009 06/10/2054 F A 11/26/2008 1,034.42 SD A 976.00 10/01/2009 06/10/2054
VG1216 OP OP M A 01/02/2009 1,629.68 PD A 1,715.51 02/04/2009 11/09/2075 M A 01/02/2009 1,629.68 SD A 1,219.00 06/01/2009 11/09/2075
VG1279 OP OP F A 10/09/2008 1,158.25 BO A 800.00 01/07/2009 09/02/2036
VG1501 OP OP M A 11/27/2008 2,125.06 BO A 737.33 02/25/2009 04/17/2029 M A 11/27/2008 2,125.06 SC A 654.00 01/01/2009 02/28/2017 M A 11/27/2008 2,125.06 SD A 1,306.00 01/01/2009 04/18/2064
VG1504 OP OP F A 12/20/2008 2,991.29 PS A 1,893.76 07/01/2008 12/15/2055 F A 12/20/2008 2,991.29 SD A 1,715.00 06/01/2009 12/15/2055
VG2002 OP OP F A 02/24/2009 2,795.34 PD A 2,000.87 04/05/2009 02/21/2057 F A 02/24/2009 2,795.34 SD A 1,605.00 08/01/2009 02/21/2057
VG2007 OP OP M A 07/19/2008 1,803.80 PD A 926.52 06/16/2009 01/28/2063
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 11 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VG2007 OP OP M A 07/19/2008 1,803.80 SC A 613.00 01/01/2009 06/30/2024 M A 07/19/2008 1,803.80 SD A 1,217.00 01/01/2009 01/28/2063
VG2019 OP OP M A 02/07/2009 949.54 BO A 28.02 08/01/2012 11/08/2017 M A 02/07/2009 949.54 SD A 885.00 08/01/2012 11/09/2052
VG2085 OP OP M A 12/24/2008 1,601.28 BO A 238.69 08/01/2010 02/19/2027 M A 12/24/2008 1,601.28 SD A 1,301.00 07/10/2010 02/20/2062
VG2095 OP OP F A 06/19/2008 1,171.09 SD A 1,162.00 02/01/2009 03/16/2069
VG4796 OP OP F A 12/26/2008 1,917.96 PD A 782.68 07/25/2009 05/14/2054 F A 12/26/2008 1,917.96 SD A 1,635.00 06/01/2009 05/14/2054
VG4827 OP OP M A 07/09/2008 1,400.21 PD A 743.83 06/25/2009 10/02/2078 M A 07/09/2008 1,400.21 SD A 705.00 01/01/2009 10/02/2078
VG4865 OP OP F A 01/06/2009 809.35 PD A 360.87 05/06/2009 07/22/2055 F A 01/06/2009 809.35 SD A 440.00 07/01/2009 07/22/2055
VG4881 OP OP M A 07/02/2008 2,278.52 BO A 800.00 09/30/2008 04/30/2016 M A 07/02/2008 2,278.52 SD A 865.00 01/01/2009 05/01/2051
VG4907 OP OP F A 03/09/2009 975.70 PD A 533.55 11/07/2009 03/19/2057 F A 03/09/2009 975.70 SD A 894.00 09/01/2009 03/19/2057
VG4914 OP OP F A 02/19/2009 1,107.70 BO A 316.10 08/01/2009 12/04/2024 F A 02/19/2009 1,107.70 SD A 749.00 08/01/2009 12/05/2059
VG4918 OP OP M A 03/05/2009 3,291.16 BO A 12.07 09/01/2009 08/15/2018 M A 03/05/2009 3,291.16 PD A 1,394.51 06/25/2009 08/16/2053 M A 03/05/2009 3,291.16 SD A 1,758.00 09/01/2009 08/16/2053
VG4965 OP OP M A 03/25/2009 1,483.18 PD A 698.30 07/30/2009 08/31/2052 M A 03/25/2009 1,483.18 SD A 1,233.00 09/01/2009 08/31/2052
VG4976 OP OP M A 12/23/2008 3,077.75 PD A 2,187.71 01/02/2009 11/13/2060 M A 12/23/2008 3,077.75 PS A 8.38 01/02/2009 11/13/2060 M A 12/23/2008 3,077.75 SD A 1,892.00 06/01/2009 11/13/2060
VG4983 OP OP M A 01/07/2009 1,388.36 PD A 1,086.69 05/30/2009 03/12/2071 M A 01/07/2009 1,388.36 SD A 1,293.00 07/01/2009 03/12/2071
VG6174 OP OP M A 01/05/2009 3,115.89 PS A 2,135.62 07/17/2009 06/29/2055 M A 01/05/2009 3,115.89 SD A 1,915.00 02/01/2009 06/29/2055
VG7945 OP OP M A 03/06/2009 1,640.33 PD A 1,034.26 04/25/2009 11/03/2050 M A 03/06/2009 1,640.33 SD A 1,345.00 09/01/2009 11/03/2050
VG7997 OP OP M A 01/01/2009 3,156.35 PD A 1,486.94 08/18/2009 09/02/2067
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 12 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VG7997 OP OP M A 01/01/2009 3,156.35 SC A 878.00 06/01/2009 07/31/2015 M A 01/01/2009 3,156.35 SD A 1,756.00 06/01/2009 09/02/2067
VG8137 OP OP M A 06/11/2009 1,542.18 PD A 518.55 11/18/2009 06/24/2052 M A 06/11/2009 1,542.18 SD A 1,332.00 11/01/2009 06/24/2052
VG8477 OP OP F A 03/12/2009 2,195.31 SD A 965.00 09/01/2009 01/15/2062
VG8484 OP OP F A 01/30/2009 1,293.71 PD A 355.59 06/27/2009 02/19/2053 F A 01/30/2009 1,293.71 SD A 933.00 07/01/2009 02/19/2053
VG9243 OP OP F A 02/26/2009 1,364.78 PD A 1,616.20 08/02/2009 09/30/2062 F A 02/26/2009 1,364.78 SD A 827.00 05/01/2012 09/30/2062
VG9839 OP OP F A 09/08/2008 2,480.17 BO A 630.78 03/01/2009 12/07/2015 F A 09/08/2008 2,480.17 SD A 1,754.00 03/01/2009 12/08/2050
VG9840 OP OP F A 02/07/2009 3,629.17 BO A 719.17 01/01/2010 02/22/2018 F A 02/07/2009 3,629.17 PD A 1,039.42 08/16/2009 02/23/2053 F A 02/07/2009 3,629.17 SD A 1,731.00 01/01/2010 02/23/2053
VG9859 OP OP F A 01/13/2009 1,118.38 PD A 719.60 07/14/2009 01/25/2055 F A 01/13/2009 1,118.38 SD A 991.00 07/01/2009 01/25/2055
VG9873 OP OP M A 05/15/2009 1,659.76 PS A 1,084.06 12/19/2008 07/19/2055 M A 05/15/2009 1,659.76 SD A 1,039.00 11/01/2009 07/19/2055
VG9893 OP OP F A 01/07/2009 2,212.65 SC A 648.00 07/01/2009 01/31/2021 F A 01/07/2009 2,212.65 SD A 1,300.00 07/01/2009 05/10/2073
VH0439 OP OP F A 05/07/2009 1,935.70 PD A 1,251.80 01/02/2010 08/09/2056 F A 05/07/2009 1,935.70 SD A 1,314.00 01/01/2010 08/09/2056
VH0442 OP OP F A 02/20/2009 1,132.37 BO A 200.82 07/01/2009 01/22/2026 F A 02/20/2009 1,132.37 SD A 888.00 07/01/2009 01/23/2061
VH1475 OP OP M A 05/12/2009 1,845.30 PD A 1,929.95 08/18/2009 12/31/2054 M A 05/12/2009 1,845.30 SD A 1,352.00 02/01/2010 12/31/2054
VH1530 OP OP F A 01/29/2009 1,242.57 PD A 617.27 08/18/2009 03/12/2054 F A 01/29/2009 1,242.57 SD A 1,060.00 07/01/2009 03/12/2054
VH1535 OP OP M A 05/14/2009 1,392.57 PD A 430.00 10/29/2009 04/29/2056 M A 05/14/2009 1,392.57 SD A 1,204.00 11/01/2009 04/29/2056
VH1570 OP OP M A 04/16/2009 1,933.91 PD A 1,144.06 09/23/2009 12/27/2057 M A 04/16/2009 1,933.91 SD A 1,552.00 10/01/2009 12/27/2057
VH1571 OP OP F A 05/30/2009 4,492.05 BO A 800.00 08/28/2009 12/27/2019 F A 05/30/2009 4,492.05 SD A 2,082.00 01/01/2010 12/28/2054
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 13 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VH1659 OP OP F A 06/11/2009 3,347.19 PD A 2,617.62 11/18/2009 08/14/2055 F A 06/11/2009 3,347.19 SD A 1,802.00 12/01/2009 08/14/2055
VH1669 OP OP M A 06/26/2009 1,567.93 SD A 1,381.00 05/01/2013 12/25/2061
VH1672 OP OP F A 06/09/2009 1,829.26 PD A 505.21 09/30/2009 06/03/2050 F A 06/09/2009 1,829.26 SD A 1,486.00 01/01/2010 06/03/2050
VH1674 OP OP F A 06/30/2009 2,072.69 BO A 800.00 09/28/2009 12/15/2018 F A 06/30/2009 2,072.69 SD A 830.00 01/01/2010 12/16/2053
VH1677 OP OP F A 05/09/2009 1,347.15 BO A 170.10 01/01/2010 02/05/2017 F A 05/09/2009 1,347.15 PD A 377.24 11/06/2009 02/06/2052 F A 05/09/2009 1,347.15 SD A 748.00 01/01/2010 02/06/2052
VH1681 OP OP M A 07/08/2009 1,207.80 PD A 584.44 08/23/2009 04/24/2065 M A 07/08/2009 1,207.80 SD A 1,012.00 01/01/2010 04/24/2065
VH2215 OP OP M A 06/06/2009 2,519.61 PD A 1,474.49 09/09/2009 10/21/2065 M A 06/06/2009 2,519.61 SD A 1,654.00 12/01/2009 10/21/2065
VH2292 OP OP F A 05/14/2009 2,088.39 PS A 1,244.57 05/13/2009 08/31/2051 F A 05/14/2009 2,088.39 SD A 1,223.00 10/01/2009 08/31/2051
VH2294 OP OP F A 03/18/2009 1,048.85 SD A 1,054.00 03/01/2010 01/01/2055
VH2299 OP OP M A 04/07/2009 1,724.46 BO A 733.13 09/01/2009 07/24/2031 M A 04/07/2009 1,724.46 SC A 387.00 09/01/2009 05/31/2019 M A 04/07/2009 1,724.46 SD A 925.00 09/01/2009 07/25/2066
VH2310 OP OP M A 04/03/2009 1,446.11 PD A 460.92 07/01/2009 12/06/2051 M A 04/03/2009 1,446.11 SD A 1,216.00 10/01/2009 12/06/2051
VH2312 OP OP F A 05/29/2009 1,510.43 PD A 916.57 09/02/2009 03/27/2063 F A 05/29/2009 1,510.43 SD A 846.00 01/01/2010 03/27/2063
VH3307 OP OP F A 02/24/2009 1,941.60 BO A 800.00 05/25/2009 07/05/2031 F A 02/24/2009 1,941.60 SD A 461.00 01/01/2010 07/06/2066
VH3832 OP OP F A 03/19/2009 1,172.37 PD A 1,020.95 09/01/2009 06/09/2053 F A 03/19/2009 1,172.37 SD A 1,306.00 09/01/2009 09/21/2055
VH3849 OP OP M A 04/04/2009 1,149.11 PD A 667.08 11/10/2009 09/02/2068 M A 04/04/2009 1,149.11 SD A 1,213.00 07/01/2010 09/02/2068
VH3947 OP OP F A 05/16/2009 1,074.40 SD A 1,204.00 11/01/2009 06/24/2021
VH3948 OP OP M A 05/02/2009 1,593.04 PS A 658.67 10/01/2009 02/01/2150
M A 05/02/2009 1,593.04 SD A 1,369.00 10/01/2009 09/15/2050
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 14 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VH4920 OP OP M A 05/09/2009 1,093.95 PD A 343.98 12/09/2009 12/07/2053 M A 05/09/2009 1,093.95 SD A 1,171.00 11/01/2009 12/07/2053
VH4954 OP OP M A 06/29/2009 1,586.52 PD A 517.25 01/06/2010 03/30/2052 M A 06/29/2009 1,586.52 SD A 1,461.00 12/01/2009 03/30/2052
VH4969 OP OP F A 07/23/2009 2,051.73 PD A 1,578.07 10/16/2009 12/01/2056 F A 07/23/2009 2,051.73 SD A 1,370.00 01/01/2010 12/01/2056
VH4990 OP OP F A 06/27/2009 2,989.56 PD A 2,018.87 10/04/2009 11/27/2056 F A 06/27/2009 2,989.56 SD A 1,586.00 01/01/2010 11/27/2056
VH5452 LT LS M A 01/23/2008 1,600.14 PS A 469.02 05/06/2008 07/11/2040
VH5457 LT LS F A 10/15/2006 964.96 SR A 269.00 03/01/2007 10/12/2059
VH5935 OP OP F A 06/13/2009 1,787.38 PD A 1,679.84 09/17/2009 02/03/2158 F A 06/13/2009 1,787.38 SD A 1,227.00 01/01/2010 02/03/2058
VH6009 OP OP F A 10/16/2008 1,255.26 PD A 732.35 08/15/2009 01/28/2073 F A 10/16/2008 1,255.26 SD A 1,061.00 01/01/2010 01/28/2073
VH6020 OP OP M A 06/13/2009 813.85 SD A 1,127.00 12/01/2009 06/14/2062
VH6031 OP OP F A 08/15/2009 1,607.29 PD A 924.17 04/13/2010 02/25/2055 F A 08/15/2009 1,607.29 SD A 1,231.00 07/01/2010 02/25/2055
VH6051 OP OP F A 02/04/2009 2,886.42 BO A 396.41 02/01/2010 09/30/2029 F A 02/04/2009 2,886.42 PD A 1,124.01 01/01/2010 10/01/2064 F A 02/04/2009 2,886.42 SD A 1,037.00 02/01/2010 10/01/2064 F A 02/04/2009 2,886.42 WP A 217.99 01/22/2010 10/28/2043
VH6072 OP OP F A 06/13/2009 1,004.14 PD A 491.42 01/02/2010 08/12/2060 F A 06/13/2009 1,004.14 SD A 741.00 12/01/2009 08/12/2060
VH6080 OP OP F A 07/24/2009 1,530.80 PD A 482.74 09/11/2009 05/04/2082 F A 07/24/2009 1,530.80 SD A 1,078.00 01/01/2010 05/04/2082
VH6094 OP OP F A 07/28/2009 1,455.42 PD A 565.48 02/14/2010 07/10/2050 F A 07/28/2009 1,455.42 SD A 985.00 01/01/2010 07/10/2050
VH6098 OP OP M A 05/13/2009 05/01/2015 1,780.03 PD A 738.27 11/22/2009 02/08/2057 M A 05/13/2009 05/01/2015 1,780.03 SD A 1,356.00 11/01/2009 02/08/2057
VH9005 OP OP M A 07/22/2009 1,448.36 PD A 401.85 10/28/2009 07/21/2059 M A 07/22/2009 1,448.36 PS A 16.68 10/28/2009 07/21/2059 M A 07/22/2009 1,448.36 SD A 1,337.00 01/01/2010 07/21/2059
VH9094 OP OP F A 07/29/2009 1,044.71 PD A 464.50 12/03/2009 07/17/2060 F A 07/29/2009 1,044.71 SD A 818.00 01/01/2010 07/17/2060
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 15 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VI0611 OP OP F A 07/28/2009 1,833.85 PD A 1,185.71 12/01/2009 06/14/2056 F A 07/28/2009 1,833.85 SD A 1,183.00 01/01/2010 06/14/2056
VI0616 OP OP F A 08/06/2009 938.86 PD A 416.31 12/02/2009 01/24/2062 F A 08/06/2009 938.86 SD A 756.00 01/01/2010 01/24/2062
VI0635 OP OP F A 08/02/2009 1,772.76 PD A 1,199.51 01/30/2010 06/28/2053 F A 08/02/2009 1,772.76 SD A 1,307.00 01/01/2010 06/28/2053
VI0797 OP OP M A 05/14/2009 2,206.54 PD A 1,387.98 04/02/2010 03/19/2052 M A 05/14/2009 2,206.54 SD A 1,413.00 10/01/2009 03/19/2052
VI1085 OP OP M A 05/20/2009 2,319.85 PD A 1,637.00 10/31/2009 02/08/2052 M A 05/20/2009 2,319.85 SD A 1,776.00 04/01/2010 02/08/2052
VI1159 OP OP M A 07/30/2009 3,582.75 PD A 2,297.74 06/01/2010 05/25/2061 M A 07/30/2009 3,582.75 SD A 1,950.00 01/01/2010 05/21/2061
VI1313 OP OP F A 10/28/2009 1,239.52 PD A 447.56 01/21/2010 01/10/2053 F A 10/28/2009 1,239.52 SD A 878.00 04/01/2010 01/10/2053
VI1429 OP OP F A 07/03/2009 1,010.10 PD A 1,106.55 08/05/2010 05/19/2055 F A 07/03/2009 1,010.10 SD A 11,330.00 11/01/2010 05/19/2055
VI1468 OP OP F A 03/31/2009 1,089.27 SD A 1,020.00 01/01/2010 09/06/2054
VI1470 OP OP F A 09/15/2009 2,780.53 BO A 800.00 12/14/2009 04/21/2028 F A 09/15/2009 2,780.53 SD A 1,562.00 10/01/2009 04/22/2063
VI1478 OP OP F A 05/12/2009 1,100.89 PD A 458.25 12/20/2009 09/17/2050 F A 05/12/2009 1,100.89 SD A 950.00 11/01/2009 09/17/2050
VI2431 OP OP F A 10/27/2009 1,081.77 PD A 480.72 03/11/2010 10/28/2050 F A 10/27/2009 1,081.77 SD A 840.00 04/01/2010 10/28/2050
VI2444 OP OP F A 08/18/2009 1,131.70 PD A 685.63 02/02/2010 05/15/2062 F A 08/18/2009 1,131.70 SD A 778.00 08/01/2010 05/15/2062
VI2661 OP OP F A 08/19/2009 984.86 PD A 682.47 04/14/2010 05/29/2060 F A 08/19/2009 984.86 SD A 930.00 03/01/2010 05/29/2060
VI2915 OP OP M A 10/13/2009 2,263.30 PD A 1,202.41 03/02/2010 02/27/2060 M A 10/13/2009 2,263.30 SD A 1,295.00 04/01/2010 02/27/2060
VI3067 OP OP F A 12/05/2009 2,339.19 PD A 1,013.61 01/09/2010 08/25/2078 F A 12/05/2009 2,339.19 SD A 1,527.00 01/01/2010 08/25/2078
VI4054 OP OP F A 12/02/2009 1,789.56 PD A 939.62 11/23/2010 10/29/2058
F A 12/02/2009 1,789.56 SD A 838.00 05/01/2010 10/29/2058
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 16 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VI4073 OP OP F A 09/24/2009 667.79 PD A 348.27 01/16/2010 11/27/2053 F A 09/24/2009 667.79 SD A 650.00 03/01/2010 11/27/2053
VI4122 OP OP F A 08/27/2009 1,451.28 BO A 131.46 02/01/2010 01/04/2027 F A 08/27/2009 1,451.28 SD A 1,264.00 02/01/2010 01/05/2062
VI4130 OP OP F A 07/17/2009 1,655.63 BO A 528.96 01/01/2010 03/04/2039 F A 07/17/2009 1,655.63 SD A 1,063.00 01/01/2010 03/05/2074
VI4707 OP OP M A 12/01/2009 2,205.66 PD A 559.02 12/01/2009 01/26/2055 M A 12/01/2009 2,205.66 PS A 846.51 12/01/2009 01/26/2055 M A 12/01/2009 2,205.66 SD A 1,617.00 05/01/2010 01/26/2055
VI4764 OP OP M A 08/14/2009 1,699.20 PD A 1,135.51 04/03/2010 02/05/2056 M A 08/14/2009 1,699.20 SD A 1,139.00 01/01/2011 02/05/2056
VI4809 OP OP M A 06/24/2009 1,150.11 PD A 861.34 04/13/2010 02/13/2051 M A 06/24/2009 1,150.11 SD A 1,478.00 11/01/2009 02/13/2051
VI5711 OP OP F A 12/21/2009 1,810.46 PD A 710.11 04/17/2010 10/23/2050 F A 12/21/2009 1,810.46 SD A 1,741.00 06/01/2010 10/23/2050
VI5721 OP OP F A 01/05/2010 1,641.97 PD A 705.22 03/03/2010 01/01/2064 F A 01/05/2010 1,641.97 SD A 1,154.00 07/01/2010 01/01/2064
VI5749 OP OP M A 10/06/2009 1,567.48 PD A 680.56 03/26/2010 10/19/2050 M A 10/06/2009 1,567.48 SD A 1,030.00 03/01/2010 10/19/2050
VI6218 OP OP F A 09/16/2009 948.88 SD A 772.00 03/01/2010 05/24/2057
VI6602 OP OP M A 07/23/2009 1,746.39 PD A 623.68 03/16/2010 06/29/2054 M A 07/23/2009 1,746.39 SD A 1,350.00 01/01/2010 06/29/2054
VI6636 OP OP M A 11/11/2009 1,319.23 PD A 497.59 03/03/2010 12/27/2061 M A 11/11/2009 1,319.23 SD A 1,249.00 05/01/2010 12/27/2061
VI6654 OP OP F A 12/11/2009 1,593.04 BO A 80.77 05/01/2010 03/21/2027 F A 12/11/2009 1,593.04 SD A 1,451.00 05/01/2010 03/22/2062
VI6695 OP OP F A 10/17/2009 2,238.94 BO A 144.74 05/01/2010 12/09/2019 F A 10/17/2009 2,238.94 PD A 648.09 04/06/2010 12/10/2054 F A 10/17/2009 2,238.94 SD A 1,360.00 04/01/2010 12/10/2054
VI7059 OP OP F A 10/07/2009 933.88 PD A 257.54 01/20/2010 03/31/2053 F A 10/07/2009 933.88 SD A 935.00 04/01/2010 03/31/2053
VI7061 OP OP M A 08/27/2009 1,375.24 PD A 595.54 02/24/2010 10/02/2050 M A 08/27/2009 1,375.24 SD A 953.00 02/01/2010 10/02/2050
VI7071 OP OP M A 11/13/2009 2,754.10 BO A 800.00 02/11/2010 10/12/2018
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 17 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VI7071 OP OP M A 11/13/2009 2,754.10 SD A 462.00 05/01/2010 10/13/2053
VI7807 OP OP M A 01/14/2010 1,477.13 SD A 1,802.00 08/01/2010 10/24/2050
VI7871 OP OP F A 01/15/2010 3,256.71 PD A 2,271.71 07/17/2010 12/03/2056 F A 01/15/2010 3,256.71 SD A 1,678.00 07/01/2010 12/03/2056
VI7889 OP OP F A 01/30/2010 2,637.10 BO A 358.48 07/01/2010 09/28/2019 F A 01/30/2010 2,637.10 PD A 781.20 03/12/2010 09/29/2054 F A 01/30/2010 2,637.10 SD A 1,396.00 07/01/2010 09/29/2054
VI7893 OP OP F A 01/16/2010 3,033.33 PD A 784.40 04/18/2010 08/11/2059 F A 01/16/2010 3,033.33 SD A 2,090.00 07/01/2010 08/11/2059 F A 01/16/2010 3,033.33 WP A 572.17 09/09/2010 06/23/2042
VI7895 OP OP M A 12/18/2009 1,728.36 PD A 1,347.60 02/28/2010 03/20/2064 M A 12/18/2009 1,728.36 PS A 329.35 02/28/2010 03/20/2064 M A 12/18/2009 1,728.36 SD A 1,582.00 06/01/2010 03/20/2064
VI7957 OP OP M A 07/12/2009 2,275.33 PD A 2,573.12 03/10/2010 06/21/2056 M A 07/12/2009 2,275.33 SD A 1,862.00 01/01/2010 06/21/2056
VJ0730 OP OP M A 12/23/2009 2,079.30 PD A 897.83 11/12/2010 07/12/2054 M A 12/23/2009 2,079.30 SD A 1,203.00 06/01/2010 07/12/2054
VJ0766 OP OP M A 12/21/2009 1,542.98 PD A 1,809.17 03/02/2010 11/18/2074 M A 12/21/2009 1,542.98 SD A 1,196.00 05/01/2010 11/18/2074
VJ0915 OP OP F A 02/11/2010 1,931.85 PS A 1,072.26 02/11/2010 11/30/2053 F A 02/11/2010 1,931.85 SD A 1,175.00 08/01/2010 11/30/2053
VJ0926 OP OP F A 12/12/2009 2,942.63 PD A 1,625.56 07/03/2010 09/11/2056 F A 12/12/2009 2,942.63 SD A 1,703.00 06/01/2010 09/11/2056
VJ0968 OP OP M A 02/18/2010 1,655.76 PD A 1,403.63 05/29/2010 10/31/2057 M A 02/18/2010 1,655.76 SD A 1,298.00 08/01/2010 10/31/2057
VJ0973 OP OP F A 01/27/2010 3,201.37 PS A 1,895.32 04/27/2010 02/01/2053 F A 01/27/2010 3,201.37 SD A 1,838.00 07/01/2010 02/01/2053
VJ1603 OP OP M A 12/10/2009 3,313.72 PD A 3,448.96 01/30/2010 03/13/2075 M A 12/10/2009 3,313.72 PS A 4.35 01/30/2010 03/13/2075
VJ2048 OP OP M A 01/04/2010 1,628.77 BO A 419.13 07/01/2010 12/17/2015 M A 01/04/2010 1,628.77 SD A 1,147.00 07/01/2010 12/18/2050
VJ2261 OP OP F A 02/22/2010 643.94 SD A 1,045.00 08/01/2010 11/22/2051
VJ2301 OP OP F A 10/11/2009 1,351.74 PD A 792.32 03/10/2010 08/08/2053 F A 10/11/2009 1,351.74 SD A 1,100.00 04/01/2010 08/08/2053
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 18 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VJ2303 OP OP F A 02/20/2010 1,207.80 SD A 1,249.00 11/01/2011 05/27/2056
VJ2324 OP OP F A 12/19/2009 2,463.07 PD A 1,566.66 08/27/2010 12/17/2061 F A 12/19/2009 2,463.07 SD A 1,642.00 06/01/2010 12/17/2061
VJ2341 OP OP F A 11/25/2009 3,315.36 BO A 27.47 09/01/2010 08/15/2019 F A 11/25/2009 3,315.36 PD A 1,446.38 08/17/2010 08/16/2054 F A 11/25/2009 3,315.36 SD A 1,714.00 05/01/2010 08/16/2054
VJ4256 OP OP F A 04/17/2010 2,325.75 BO A 124.76 08/01/2012 01/18/2032 F A 04/17/2010 2,325.75 PD A 1,010.54 07/02/2010 01/19/2067 F A 04/17/2010 2,325.75 SC A 550.00 08/01/2010 09/30/2020 F A 04/17/2010 2,325.75 SD A 1,101.00 08/01/2012 01/19/2067
VJ4277 OP OP F A 03/05/2010 2,774.84 PD A 1,625.38 07/22/2010 04/28/2054 F A 03/05/2010 2,774.84 SD A 1,015.00 09/01/2010 04/28/2054 F A 03/05/2010 2,774.84 WP A 458.65 12/20/2010 05/03/2037
VJ4285 OP OP F A 01/23/2010 1,703.39 PD A 1,032.45 04/20/2010 07/05/2067 F A 01/23/2010 1,703.39 SD A 1,143.00 07/01/2010 07/02/2067
VJ4301 OP OP M A 01/27/2010 1,343.06 PD A 653.79 06/23/2010 03/10/2058 M A 01/27/2010 1,343.06 SD A 954.00 01/01/2011 03/10/2058
VJ4336 OP OP F A 09/26/2009 2,680.81 BO A 159.79 06/01/2010 04/22/2021 F A 09/26/2009 2,680.81 PD A 1,258.92 05/29/2010 04/23/2056 F A 09/26/2009 2,680.81 SD A 1,159.00 03/01/2010 04/23/2056
VJ5418 OP OP M A 03/27/2010 2,114.45 PD A 702.91 05/02/2011 10/29/2059 M A 03/27/2010 2,114.45 SD A 1,494.00 09/01/2010 10/29/2059
VJ5429 OP OP F A 11/03/2009 2,493.45 PD A 912.55 11/01/2010 08/09/2054 F A 11/03/2009 2,493.45 SD A 1,306.00 07/01/2012 08/09/2054 F A 11/03/2009 2,493.45 WP A 331.53 06/27/2012 12/26/2038
VJ8044 OP OP F A 06/05/2010 1,055.24 BO A 800.00 09/03/2010 06/03/2027 F A 06/05/2010 1,055.24 SD E 731.00 12/01/2010 06/04/2062
VJ8105 OP OP F A 06/04/2010 3,058.64 PD A 2,223.88 09/16/2010 03/07/2053 F A 06/04/2010 3,058.64 SD A 1,662.00 01/01/2011 03/07/2053
VJ8110 OP OP F A 04/01/2010 1,787.01 PD A 1,517.01 08/26/2010 07/15/2062 F A 04/01/2010 1,787.01 SD A 1,254.00 09/01/2010 07/15/2062
VJ8128 OP OP M A 03/04/2010 1,264.14 PD A 329.53 08/05/2010 12/19/2050 M A 03/04/2010 1,264.14 SD A 1,399.00 09/01/2010 12/19/2050
VJ8455 OP OP F A 03/12/2010 1,186.35 PD A 407.68 03/01/2011 10/01/2051
F A 03/12/2010 1,186.35 SD A 1,117.00 09/01/2010 10/01/2051
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 19 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VJ8456 OP OP F A 02/02/2010 1,318.25 BO A 277.54 10/01/2012 03/19/2026 F A 02/02/2010 1,318.25 SD A 990.00 10/01/2012 03/20/2061
VJ8468 OP OP M A 03/26/2010 3,293.24 PD A 1,747.36 03/12/2011 08/01/2055 M A 03/26/2010 3,293.24 SD A 1,575.00 09/01/2010 08/01/2055
VJ8480 OP OP F A 06/08/2010 1,576.47 PD A 327.36 08/05/2010 07/16/2055 F A 06/08/2010 1,576.47 SD A 1,267.00 12/01/2010 07/16/2055
VJ8533 OP OP F A 05/10/2010 816.83 PD A 433.65 12/07/2010 02/10/2062 F A 05/10/2010 816.83 SD A 741.00 11/01/2010 02/10/2062
VK0007 OP OP F A 02/16/2010 1,003.08 SD A 1,055.00 01/01/2011 06/02/2062
VK0019 OP OP M A 03/26/2010 861.37 SD A 747.00 09/01/2010 09/15/2053
VK0025 OP OP M A 03/24/2010 1,497.38 PD A 654.94 09/08/2010 10/23/2057 M A 03/24/2010 1,497.38 SC A 582.00 09/01/2010 05/31/2017 M A 03/24/2010 1,497.38 SD A 1,164.00 09/01/2010 10/23/2057
VK0029 OP OP M A 04/22/2010 1,309.10 PD A 715.12 08/05/2010 08/07/2051 M A 04/22/2010 1,309.10 SD A 914.00 10/01/2010 08/07/2051
VK0038 OP OP F A 10/02/2009 4,784.70 PD A 3,655.48 07/10/2010 12/06/2053 F A 10/02/2009 4,784.70 SD A 2,099.00 04/01/2010 12/06/2053 F A 10/02/2009 4,784.70 WP A 66.86 07/09/2010 10/31/2037
VK0069 OP OP M A 04/20/2010 1,601.70 BO A 562.10 10/01/2010 12/02/2024 M A 04/20/2010 1,601.70 SD A 978.00 10/01/2010 12/03/2059
VK0080 OP OP M A 10/02/2009 1,170.51 SD A 796.00 07/01/2011 05/03/2056
VK0084 OP OP F A 09/10/2009 2,084.50 BO A 126.91 07/01/2010 12/16/2022 F A 09/10/2009 2,084.50 PD A 752.42 06/17/2010 12/17/2057 F A 09/10/2009 2,084.50 SD A 1,125.00 03/01/2010 12/17/2057
VK0092 OP OP M A 05/26/2010 1,696.17 PD A 658.51 12/05/2010 02/25/2082 M A 05/26/2010 1,696.17 SD A 1,173.00 01/01/2011 02/25/2082
VK0093 OP OP F A 02/25/2010 2,905.77 PD A 1,627.01 08/15/2010 09/25/2050 F A 02/25/2010 2,905.77 SD A 1,269.00 10/01/2010 09/25/2060
VK0100 OP OP F A 10/30/2009 893.75 PD A 427.24 08/19/2010 08/15/2052 F A 10/30/2009 893.75 SD A 189.00 04/01/2010 08/15/2052 F A 10/30/2009 893.75 WP A 113.52 09/09/2013 08/15/2052
VK0101 OP OP F A 07/22/2010 2,794.03 PD A 1,550.79 10/06/2010 10/18/2054 F A 07/22/2010 2,794.03 SD A 1,586.00 11/01/2010 10/18/2054
VK0616 OP OP F A 03/25/2010 1,272.12 PD A 839.69 07/23/2010 03/31/2056
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 20 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VK0616 OP OP F A 03/25/2010 1,272.12 SD A 847.00 09/01/2010 03/31/2056
VK0649 OP OP F A 05/16/2010 3,462.34 PD A 2,926.36 06/03/2010 07/26/2059 F A 05/16/2010 3,462.34 SD A 1,977.00 12/01/2010 07/26/2059
VK1987 OP OP F A 06/05/2010 2,471.06 PD A 1,572.27 10/08/2010 01/12/2071 F A 06/05/2010 2,471.06 RO S 209.30 09/01/2014 05/31/2015 F A 06/05/2010 2,471.06 SD A 1,609.00 12/01/2010 01/12/2071
VK2694 OP OP M A 02/26/2010 1,547.21 PD A 615.80 10/23/2010 07/13/2065 M A 02/26/2010 1,547.21 SD A 1,437.00 02/01/2014 07/13/2065 M A 02/26/2010 1,547.21 WP A 374.11 01/30/2014 07/12/2035
VK3507 OP OP M A 06/17/2010 1,055.12 PD A 369.08 11/20/2010 02/22/2051 M A 06/17/2010 1,055.12 SD A 1,222.00 12/01/2010 02/22/2051
VK3547 OP OP F A 05/06/2010 1,978.50 SD A 1,567.00 01/01/2011 01/24/2071
VK6112 OP OP F A 09/04/2010 2,863.73 PD A 2,684.15 11/18/2010 05/12/2058 F A 09/04/2010 2,863.73 SD A 1,649.00 03/01/2011 05/12/2058
VK6122 OP OP F A 07/15/2010 2,295.04 PD A 1,041.21 04/25/2011 03/17/2060 F A 07/15/2010 2,295.04 SD A 1,299.00 09/01/2011 03/17/2060
VK6124 OP OP F A 06/01/2010 1,048.03 BO A 55.73 01/01/2011 11/28/2016 F A 06/01/2010 1,048.03 SD A 952.00 01/01/2011 11/29/2051
VK6154 OP OP F A 06/11/2010 1,720.49 SD A 1,929.00 12/01/2010 06/26/2052
VK6171 OP OP F A 03/19/2010 2,917.85 PD A 643.80 02/17/2011 09/01/2051 F A 03/19/2010 2,917.85 SD A 1,519.00 01/01/2011 09/01/2051 F A 03/19/2010 2,917.85 WP A 353.49 11/14/2012 12/06/2035
VK6173 OP OP M A 03/24/2010 1,543.90 PD A 913.51 06/30/2010 08/27/2028 M A 03/24/2010 1,543.90 SD A 1,283.00 11/01/2010 08/28/2063
VK6185 OP OP F A 09/30/2010 3,047.08 PD A 1,283.09 12/02/2010 09/09/2054 F A 09/30/2010 3,047.08 SD A 1,937.00 03/01/2011 09/09/2054
VK6276 OP OP F A 03/16/2010 1,061.79 PD A 318.10 09/05/2010 02/03/2052 F A 03/16/2010 1,061.79 SD A 1,126.00 09/01/2010 02/03/2052
VK6296 OP OP M A 07/12/2010 1,693.36 PS A 999.13 08/28/2010 06/21/2052 M A 07/12/2010 1,693.36 SC A 630.00 02/01/2011 12/31/2018 M A 07/12/2010 1,693.36 SD A 1,261.00 02/01/2011 06/21/2052
VK6407 OP OP F A 08/19/2010 1,562.38 PD A 539.23 10/06/2010 08/20/2052 F A 08/19/2010 1,562.38 SD A 1,209.00 02/01/2011 08/20/2052
VK6409 OP OP M A 07/01/2010 6,750.25 BO A 800.00 09/29/2010 05/10/2036
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 21 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VK6409 OP OP M A 07/01/2010 6,750.25 SC A 1,200.00 12/01/2011 10/31/2022 M A 07/01/2010 6,750.25 SD A 2,400.00 12/01/2011 05/11/2071
VK6414 OP OP F A 07/08/2010 1,624.40 PD A 997.90 02/03/2011 04/09/2074 F A 07/08/2010 1,624.40 SD A 1,186.00 01/01/2011 04/09/2074
VK6428 OP OP M A 06/15/2010 1,924.98 PD A 1,128.97 06/15/2011 03/08/2074 M A 06/15/2010 1,924.98 SD A 1,235.00 09/01/2011 03/08/2074
VK6430 OP OP F A 05/16/2010 1,044.66 0.00
VK6442 OP OP F A 06/15/2010 1,684.48 PD A 320.20 01/01/2011 08/18/2051 F A 06/15/2010 1,684.48 SD A 1,322.00 12/01/2010 08/18/2051
VK6454 OP OP M A 07/28/2010 1,320.69 PD A 503.62 10/02/2010 12/29/2057 M A 07/28/2010 1,320.69 SD A 1,345.00 12/01/2010 12/29/2057
VK7715 OP OP M A 07/27/2010 1,482.49 SD A 1,437.00 01/01/2011 07/18/2053
VK7724 OP OP M A 07/24/2010 2,081.40 PD A 1,536.78 12/03/2010 03/24/2064 M A 07/24/2010 2,081.40 PS A 271.08 12/03/2010 03/24/2064 M A 07/24/2010 2,081.40 SD A 1,523.00 01/01/2011 03/24/2064
VK7727 OP OP F A 04/20/2010 887.52 PD A 582.63 10/13/2010 04/30/2060 F A 04/20/2010 887.52 SD A 856.00 10/01/2010 04/30/2060
VK7750 LT LS F A 06/28/2008 874.56 0.00
VK7788 OP OP F A 05/22/2010 1,795.82 PD A 805.60 10/24/2010 07/12/2050 F A 05/22/2010 1,795.82 SD A 1,118.00 01/01/2011 07/12/2050
VK7799 OP OP F A 06/06/2010 1,310.04 PD A 554.27 05/07/2011 09/13/2052 F A 06/06/2010 1,310.04 SD A 844.00 01/01/2011 09/13/2052
VK7864 OP OP F A 06/18/2010 2,854.42 PD A 1,658.21 01/27/2011 09/20/2069 F A 06/18/2010 2,854.42 SC A 857.00 01/01/2011 01/31/2023 F A 06/18/2010 2,854.42 SD A 1,714.00 01/01/2011 09/20/2069
VK9421 OP OP F A 09/16/2010 2,380.41 PD A 1,645.38 09/16/2010 07/13/2056 F A 09/16/2010 2,380.41 SD A 1,216.00 03/01/2011 07/13/2056
VK9425 OP OP F A 08/28/2010 2,407.38 PD A 1,752.29 11/05/2010 07/05/2070 F A 08/28/2010 2,407.38 SD A 1,311.00 03/01/2011 07/05/2070
VK9497 OP OP F A 05/29/2010 1,374.70 BO A 569.83 01/01/2011 11/20/2015 F A 05/29/2010 1,374.70 SD A 752.00 01/01/2011 11/21/2050
VL1400 OP OP F A 08/12/2010 1,663.51 PD A 674.18 12/08/2010 08/02/2070
F A 08/12/2010 1,663.51 SD A 1,202.00 02/01/2011 08/02/2070
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 22 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VL1446 OP OP M A 06/19/2010 2,615.59 PS A 1,545.82 04/09/2008 08/15/2051 M A 06/19/2010 2,615.59 SD A 1,633.00 12/01/2010 08/15/2051
VL1449 LT LS F A 11/07/2010 1,056.85 0.00
VL1480 OP OP F A 09/30/2010 1,140.24 SD A 1,151.00 03/01/2011 04/08/2055
VL2715 OP OP F A 11/02/2010 1,120.17 PD A 508.39 01/01/2011 12/31/2050 F A 11/02/2010 1,120.17 SD A 777.00 12/01/2011 12/31/2050
VL2718 OP OP M A 07/20/2010 1,571.75 PD A 937.92 01/14/2011 11/15/2065 M A 07/20/2010 1,571.75 SD A 1,239.00 03/01/2012 11/15/2065 M A 07/20/2010 1,571.75 WP A 176.20 02/07/2011 11/14/2035
VL2774 OP OP M A 10/21/2010 2,178.80 PD A 1,071.25 12/15/2010 01/20/2054 M A 10/21/2010 2,178.80 SC A 921.00 04/01/2011 06/30/2015 M A 10/21/2010 2,178.80 SD A 1,843.00 04/01/2011 01/20/2054
VL3436 OP OP F A 10/01/2010 1,794.00 BO A 774.00 09/01/2012 09/13/2035 F A 10/01/2010 1,794.00 SD A 951.00 09/01/2012 09/14/2070
VL4708 OP OP M A 09/17/2010 3,698.72 SC A 1,092.00 01/01/2012 03/31/2018 M A 09/17/2010 3,698.72 SD A 2,148.00 12/01/2011 08/18/2065
VL4758 OP OP F A 05/04/2010 1,032.23 PD A 500.53 07/15/2010 01/17/2051 F A 05/04/2010 1,032.23 SD A 709.00 11/01/2010 01/17/2051
VL4767 OP OP F A 10/30/2010 1,019.20 PD A 340.90 12/02/2010 01/19/2059 F A 10/30/2010 1,019.20 SD A 1,051.00 05/01/2011 01/19/2059 F A 10/30/2010 1,019.20 WP A 134.84 04/29/2013 06/30/2041
VL4784 LT LS M A 03/28/2009 932.36 0.00
VL4787 OP OP M A 09/01/2010 943.96 BO A 155.66 02/01/2011 12/21/2028 M A 09/01/2010 943.96 SD A 752.00 02/01/2011 12/22/2063
VL6200 OP OP F A 10/08/2010 1,130.66 SD A 1,806.00 04/01/2011 08/11/2059
VL6201 OP OP M A 06/10/2010 899.60 SD A 1,214.00 07/01/2010 02/12/2061
VL6207 OP OP M A 08/18/2010 3,475.93 PD A 2,311.15 02/24/2011 04/04/2051 M A 08/18/2010 3,475.93 SD A 1,787.00 02/01/2011 04/04/2051
VL6240 OP OP F A 09/25/2010 2,588.82 BO A 800.00 12/24/2010 09/26/2049 F A 09/25/2010 2,588.82 SD A 900.00 03/01/2011 09/27/2084
VL6241 OP OP F A 11/16/2010 1,476.20 PD A 1,367.15 04/30/2011 11/20/2049 F A 11/16/2010 1,476.20 SC A 589.00 05/01/2011 05/31/2016
F A 11/16/2010 1,476.20 SD A 1,178.00 05/01/2011 11/20/2069
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 23 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VL6242 OP OP M A 10/16/2010 1,940.13 PS A 1,385.22 01/01/2009 01/24/2057 M A 10/16/2010 1,940.13 SD A 1,412.00 04/01/2011 01/24/2057
VL6248 OP OP M A 12/15/2010 1,270.59 PD A 693.53 03/13/2011 06/11/2056 M A 12/15/2010 1,270.59 SD A 1,233.00 12/01/2011 06/11/2056
VL6310 OP OP M A 12/28/2010 1,520.82 PD A 400.11 04/02/2011 07/17/2051 M A 12/28/2010 1,520.82 SD A 1,263.00 06/01/2011 07/17/2051
VL6323 OP OP M A 11/19/2010 1,604.79 PD A 1,252.71 04/30/2011 05/29/2064 M A 11/19/2010 1,604.79 SD A 1,613.00 05/01/2011 05/29/2064
VL8365 OP OP F A 08/24/2010 1,482.43 BO A 380.41 09/01/2011 02/16/2030 F A 08/24/2010 1,482.43 SD A 1,045.00 09/01/2011 02/17/2065
VL8403 OP OP M A 01/13/2011 1,998.68 BO A 526.82 07/01/2011 12/16/2022 M A 01/13/2011 1,998.68 PD A 574.99 03/03/2011 12/17/2057 M A 01/13/2011 1,998.68 SC A 216.00 01/01/2012 12/31/2015 M A 01/13/2011 1,998.68 SD A 820.00 07/01/2011 12/17/2057
VL8442 OP OP F A 01/18/2011 1,067.63 PD A 226.02 03/26/2011 08/14/2057 F A 01/18/2011 1,067.63 SD A 1,395.00 01/01/2012 08/14/2057 F A 01/18/2011 1,067.63 WP A 79.38 02/01/2011 01/31/2041
VL8463 OP OP F A 11/19/2010 2,185.09 PD A 1,579.43 04/15/2011 03/09/2062 F A 11/19/2010 2,185.09 SD A 1,266.00 05/01/2011 03/09/2062
VL8467 OP OP F A 10/16/2010 1,228.25 PD A 790.05 04/16/2011 07/11/2052 F A 10/16/2010 1,228.25 SD A 959.00 10/01/2011 07/11/2052
VL8482 OP OP F A 10/14/2010 980.93 PD A 210.24 07/13/2011 05/07/2051 F A 10/14/2010 980.93 SD A 1,121.00 04/01/2011 05/07/2051
VL8488 OP OP M A 12/15/2010 2,041.81 PD A 1,572.54 04/02/2011 05/14/2070 M A 12/15/2010 2,041.81 SD A 1,499.00 06/01/2011 05/14/2070
VL8602 OP OP F A 12/15/2010 1,240.10 BO A 233.41 06/01/2011 08/31/2020 F A 12/15/2010 1,240.10 SD A 959.00 06/01/2011 09/01/2055
VM1600 OP OP F A 01/15/2011 985.62 PD A 702.23 03/16/2011 08/31/2059 F A 01/15/2011 985.62 SD A 1,180.00 09/01/2011 08/31/2059
VM1641 OP OP M A 07/05/2010 1,122.88 PD A 664.34 02/11/2011 08/20/2052 M A 07/05/2010 1,122.88 SD A 947.00 01/01/2011 08/20/2052
VM1657 OP OP M A 11/24/2010 1,856.56 PS A 1,154.55 11/24/2010 07/03/2059 M A 11/24/2010 1,856.56 SD A 1,290.00 05/01/2011 07/03/2059
VM1668 OP OP M A 01/22/2011 1,917.83 PD A 651.58 07/23/2011 12/19/2051 M A 01/22/2011 1,917.83 SD A 1,612.00 07/01/2011 12/19/2051
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 24 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VM2502 OP OP F A 01/12/2011 1,068.28 PD A 295.44 03/09/2011 09/25/2054 F A 01/12/2011 1,068.28 SD A 1,170.00 06/01/2011 09/25/2054
VM2530 OP OP F A 02/11/2011 1,558.80 PD A 542.58 04/02/2011 04/26/2059 F A 02/11/2011 1,558.80 SD A 1,475.00 08/01/2011 04/26/2059
VM2540 OP OP M A 09/29/2010 1,369.82 PD A 1,178.04 04/16/2011 10/15/2057 M A 09/29/2010 1,369.82 SD A 1,228.00 03/01/2011 10/15/2057
VM2545 OP OP F A 02/19/2011 3,242.75 PD A 1,992.50 05/07/2011 01/14/2057 F A 02/19/2011 3,242.75 SC A 878.00 08/01/2011 10/31/2016 F A 02/19/2011 3,242.75 SD A 1,757.00 08/01/2011 01/14/2057
VM2705 OP OP F A 06/11/2010 978.46 SD A 1,005.00 12/01/2010 04/11/2066
VM2719 OP OP F A 12/31/2010 1,394.20 PD A 689.30 05/21/2011 09/24/2055 F A 12/31/2010 1,394.20 SD A 995.00 06/01/2011 09/24/2055
VM2756 OP OP M A 09/12/2007 2,113.48 PD A 843.07 09/11/2009 09/29/2059 M A 09/12/2007 2,113.48 SD A 1,476.00 05/01/2008 09/29/2059
VM2772 OP OP F A 12/18/2010 2,668.86 BO A 129.26 07/01/2011 12/03/2015 F A 12/18/2010 2,668.86 PD A 1,261.95 01/15/2011 12/04/2050 F A 12/18/2010 2,668.86 SD A 1,175.00 07/01/2011 12/04/2050
VM3554 OP OP F A 01/08/2011 1,030.16 PD A 533.88 06/09/2011 12/22/2054 F A 01/08/2011 1,030.16 SD A 804.00 07/01/2011 12/22/2054
VM3586 OP OP F A 01/05/2011 2,740.08 PD A 1,530.76 05/16/2011 02/14/2057 F A 01/05/2011 2,740.08 SD A 1,627.00 07/01/2011 02/14/2057
VM3963 OP OP M A 12/27/2010 2,316.14 0.00
VM4732 OP OP F A 12/08/2010 1,092.77 PD A 521.60 06/12/2011 10/02/2058 F A 12/08/2010 1,092.77 SD A 1,134.00 02/01/2011 10/02/2058
VM4742 OP OP M A 12/18/2010 1,386.30 SD A 1,031.00 09/01/2011 10/08/2064
VM4745 OP OP M A 01/09/2011 2,218.64 PD A 1,846.89 04/24/2011 12/22/2060 M A 01/09/2011 2,218.64 SD A 1,471.00 07/01/2011 12/22/2060
VM4751 OP OP M A 01/19/2011 2,743.27 PD A 1,624.23 06/04/2011 08/22/2050 M A 01/19/2011 2,743.27 SD A 1,533.00 07/01/2011 08/22/2050
VM4761 OP OP F A 03/22/2011 2,970.28 PD A 2,737.59 04/13/2011 11/02/2059 F A 03/22/2011 2,970.28 SD A 1,758.00 12/01/2011 11/02/2059
VM4775 OP OP F A 02/05/2011 1,124.50 BO A 179.25 08/01/2011 09/24/2024
F A 02/05/2011 1,124.50 SD A 902.00 08/01/2011 09/25/2059
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 25 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VM5742 OP OP F A 01/15/2011 1,383.42 PD A 513.78 06/12/2011 05/09/2064 F A 01/15/2011 1,383.42 PS A 223.51 06/12/2011 05/09/2064 F A 01/15/2011 1,383.42 SD A 869.00 07/01/2011 05/09/2064
VM5750 OP OP M A 01/15/2011 1,231.00 PD A 630.29 05/21/2011 10/09/2050 M A 01/15/2011 1,231.00 SD A 997.00 07/01/2011 10/09/2050
VM5756 OP OP F A 10/08/2010 1,644.92 PD A 1,138.75 05/28/2011 04/06/2058 F A 10/08/2010 1,644.92 PS A 64.31 05/28/2011 04/06/2058 F A 10/08/2010 1,644.92 SD A 1,327.00 04/01/2011 04/06/2058
VM5796 OP OP F A 01/11/2011 1,108.30 SD A 1,186.00 07/01/2011 04/04/2063
VN0915 OP OP F A 03/05/2011 3,306.36 PD A 1,875.80 08/02/2011 10/02/2063 F A 03/05/2011 3,306.36 SD A 1,506.00 01/01/2012 10/02/2063
VN0990 OP OP F A 12/18/2010 3,472.63 PD A 3,088.75 07/01/2011 11/20/2061 F A 12/18/2010 3,472.63 SD A 1,805.00 01/01/2012 11/20/2061
VN1678 OP OP M A 03/17/2011 1,601.15 PL A 760.50 07/01/2011 11/18/2054 M A 03/17/2011 1,601.15 SD A 1,295.00 09/01/2011 11/18/2054
VN1740 OP OP M A 04/09/2011 2,115.75 PD A 1,642.83 07/20/2011 10/28/2059 M A 04/09/2011 2,115.75 SD A 1,239.00 10/01/2011 10/28/2059
VN1798 OP OP M A 02/01/2011 1,271.56 PD A 344.13 07/30/2011 04/11/2055 M A 02/01/2011 1,271.56 SD A 1,463.00 07/01/2011 04/11/2055
VN2008 OP OP F A 04/30/2011 3,167.13 PD A 2,406.94 06/04/2011 03/24/2053 F A 04/30/2011 3,167.13 SD A 1,676.00 11/01/2011 03/24/2053
VN2018 OP OP F A 03/14/2011 1,003.00 BO A 273.75 09/10/2011 06/11/2029 F A 03/14/2011 1,003.00 SD A 980.00 09/01/2011 06/12/2064
VN2063 OP OP M A 04/01/2011 3,111.23 BO A 255.47 09/01/2011 11/12/2015 M A 04/01/2011 3,111.23 PD A 675.09 05/03/2011 11/13/2050 M A 04/01/2011 3,111.23 SD A 2,061.00 09/01/2011 11/13/2050
VN2761 LT LS F A 10/23/2009 779.48 0.00
VN2939 OP OP M A 04/25/2011 973.10 PD A 467.09 09/01/2011 05/22/2057 M A 04/25/2011 973.10 SD A 920.00 10/01/2011 05/22/2057
VN2973 OP OP M A 07/19/2011 1,971.55 PD A 650.20 07/19/2011 05/14/2050 M A 07/19/2011 1,971.55 SD A 1,351.00 01/01/2012 05/14/2050
VN3900 OP OP F A 03/01/2011 2,740.78 PD A 1,519.68 07/25/2011 05/14/2055 F A 03/01/2011 2,740.78 SD A 1,228.00 08/01/2011 05/14/2055
VN3962 OP OP F A 04/28/2011 2,880.35 PD A 2,707.51 04/28/2011 11/21/2062
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 26 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VN3962 OP OP F A 04/28/2011 2,880.35 SD A 1,773.00 10/01/2011 11/21/2062
VN3965 OP OP M A 04/19/2011 1,184.85 PD A 448.82 08/02/2011 08/24/2063 M A 04/19/2011 1,184.85 SD A 890.00 10/01/2011 08/24/2063
VN3967 OP OP M A 04/05/2011 1,251.90 PD A 370.27 11/29/2011 01/04/2053 M A 04/05/2011 1,251.90 SD A 1,102.00 10/01/2011 01/04/2053
VN3968 OP OP M A 11/10/2010 2,317.59 PD A 1,374.32 08/20/2011 09/22/2050 M A 11/10/2010 2,317.59 SA A 202.57 02/08/2011 09/21/2015 M A 11/10/2010 2,317.59 SD A 1,511.00 02/01/2012 09/22/2050
VN3977 OP OP F A 05/18/2011 2,413.71 PD A 1,561.35 07/02/2011 01/14/2047 F A 05/18/2011 2,413.71 SD A 1,739.00 11/01/2011 07/07/2051
VN3979 OP OP F A 05/21/2011 1,639.30 PD A 637.91 08/07/2011 07/02/2056 F A 05/21/2011 1,639.30 SD A 1,287.00 11/01/2011 07/02/2056
VN4765 OP OP M A 04/29/2011 2,637.61 PD A 1,815.16 07/16/2011 07/21/2057 M A 04/29/2011 2,637.61 SD A 1,662.00 01/01/2012 07/21/2057
VN4788 OP OP F A 06/09/2011 2,418.76 PD A 838.30 08/17/2011 10/17/2057 F A 06/09/2011 2,418.76 PS A 205.84 08/17/2011 10/17/2057 F A 06/09/2011 2,418.76 SD A 1,608.00 12/01/2011 10/17/2057
VN7568 OP OP F A 05/26/2011 1,211.41 PD A 874.07 06/12/2011 11/09/2051 F A 05/26/2011 1,211.41 SD A 1,107.00 11/01/2011 11/09/2051
VN7580 OP OP F A 04/08/2011 3,257.68 BO A 797.66 01/01/2012 10/23/2023 F A 04/08/2011 3,257.68 PD A 931.72 08/24/2011 10/24/2058 F A 04/08/2011 3,257.68 SD A 1,403.00 01/01/2012 10/24/2058
VN7734 OP OP F A 07/07/2011 1,953.58 PS A 1,264.80 07/07/2011 01/17/2054 F A 07/07/2011 1,953.58 SD A 1,165.00 01/01/2012 01/17/2054
VN8101 OP OP F A 07/30/2011 3,585.28 BO A 800.00 10/28/2011 04/07/2017 F A 07/30/2011 3,585.28 PD A 754.47 10/01/2011 04/08/2052 F A 07/30/2011 3,585.28 SD A 1,204.00 01/01/2012 04/08/2052 F A 07/30/2011 3,585.28 WP A 297.12 07/30/2011 04/07/2022
VN8105 OP OP M A 04/29/2011 1,952.98 PD A 719.30 09/01/2011 02/04/2060 M A 04/29/2011 1,952.98 SD A 1,946.00 10/01/2011 02/04/2060
VN8128 OP OP F A 03/16/2011 1,192.75 PD A 792.60 08/01/2011 12/02/2057 F A 03/16/2011 1,192.75 SD A 1,012.00 11/01/2011 12/02/2057
VN8151 OP OP F A 06/21/2011 1,124.40 PD A 312.01 08/16/2011 05/01/2052 F A 06/21/2011 1,124.40 SD A 1,181.00 01/01/2012 05/01/2052
VN8159 OP OP F A 05/14/2011 1,403.68 BO A 142.47 11/01/2011 09/13/2026
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 27 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VN8159 OP OP F A 05/14/2011 1,403.68 PD A 1,207.22 10/05/2011 09/14/2061
VN8177 OP OP M A 04/06/2011 1,543.83 SD A 2,035.00 10/01/2012 09/18/2066
VN8190 OP OP M A 08/01/2011 1,670.02 PD A 622.70 10/08/2011 06/21/2059 M A 08/01/2011 1,670.02 SD A 1,432.00 11/01/2012 06/21/2059
VN8817 OP OP F A 05/05/2011 1,246.97 PD A 531.82 10/30/2011 12/19/2051 F A 05/05/2011 1,246.97 SD A 936.00 11/01/2011 12/19/2051
VN8856 OP OP M A 07/14/2011 1,062.65 SD A 1,441.00 01/01/2012 03/10/2054
VN8857 OP OP M A 06/02/2011 1,497.43 BO A 69.84 12/01/2011 06/23/2016 M A 06/02/2011 1,497.43 SD A 1,370.00 12/01/2011 06/24/2051
VN8876 OP OP F A 08/16/2011 2,081.03 PD A 1,666.27 10/04/2011 01/08/2060 F A 08/16/2011 2,081.03 SD A 1,433.00 02/01/2012 01/08/2060
VN9916 OP OP F A 07/11/2011 2,356.25 BO A 800.00 12/01/2011 10/16/2032 F A 07/11/2011 2,356.25 SD A 967.00 07/11/2011 10/17/2067
VN9968 OP OP M A 04/02/2011 1,909.40 PD A 1,498.69 07/13/2011 07/08/2055 M A 04/02/2011 1,909.40 SD A 1,403.00 09/01/2011 07/08/2055
VN9995 OP OP F A 06/20/2011 2,067.40 BO A 488.89 12/01/2011 03/02/2018 F A 06/20/2011 2,067.40 SD A 1,499.00 12/01/2011 03/03/2053
VO3800 OP OP F A 07/20/2011 1,600.22 PD A 704.24 11/25/2011 06/24/2052 F A 07/20/2011 1,600.22 SD A 1,086.00 03/01/2012 06/24/2052
VO4244 OP OP F A 03/07/2011 2,529.09 PD A 1,322.95 10/22/2011 05/08/2063 F A 03/07/2011 2,529.09 SD A 1,385.00 08/01/2013 05/08/2063
VO4403 OP OP M A 08/12/2011 1,199.58 SD A 1,687.00 02/01/2012 12/19/2051
VO4471 OP OP F A 08/15/2011 1,740.73 PD A 1,108.41 11/26/2011 12/27/2048 F A 08/15/2011 1,740.73 SD A 1,119.00 02/01/2012 12/27/2048
VO4530 OP OP M A 09/13/2011 1,231.15 PD A 600.54 02/08/2012 07/17/2054 M A 09/13/2011 1,231.15 SD A 1,629.00 03/01/2012 07/17/2054
VO4633 OP OP F A 09/07/2011 2,440.76 PD A 1,487.15 05/20/2012 04/29/2074 F A 09/07/2011 2,440.76 SD A 1,491.00 03/01/2012 04/29/2074
VO4695 OP OP F A 10/14/2011 1,190.32 PD A 517.99 01/11/2012 08/24/2053 F A 10/14/2011 1,190.32 SD A 969.00 04/01/2012 08/24/2053
VO4696 OP OP F A 09/02/2011 1,809.32 BO A 800.00 12/01/2011 08/09/2030
F A 09/02/2011 1,809.32 P1 A 804.66 03/30/2012 08/10/2065 F A 09/02/2011 1,809.32 SC E 502.00 02/01/2012 02/28/2021
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 28 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VO4696 OP OP F A 09/02/2011 1,809.32 SD E 1,004.00 02/01/2012 08/10/2065
VO5408 OP OP M A 05/07/2011 2,373.31 BO A 800.00 08/05/2011 03/31/2016 M A 05/07/2011 2,373.31 SD A 1,433.00 02/01/2012 04/01/2051
VO6109 OP OP F A 06/13/2011 1,056.22 SD A 1,160.00 12/01/2011 02/24/2056
VO6134 OP OP F A 06/12/2011 1,487.60 PD A 1,807.94 12/14/2011 07/12/2063
VO6151 OP OP M A 03/19/2011 1,254.89 PD A 414.10 11/01/2011 07/02/2054 M A 03/19/2011 1,254.89 SD A 1,308.00 09/01/2011 07/02/2054
VO6153 OP OP M A 05/20/2011 2,291.33 BO A 800.00 08/18/2011 12/18/2015 M A 05/20/2011 2,291.33 PD A 1,043.03 10/14/2011 12/19/2050 M A 05/20/2011 2,291.33 SD A 168.00 01/01/2012 12/19/2050
VO6162 OP OP M A 08/20/2011 1,092.25 PD A 471.21 10/18/2011 07/28/2056 M A 08/20/2011 1,092.25 SD A 770.00 02/01/2012 07/28/2056
VO6944 OP OP F A 07/13/2011 910.33 SD A 1,147.00 01/01/2012 01/01/2059
VO7611 OP OP M A 07/01/2011 1,540.33 BO A 359.09 01/01/2012 06/12/2047 M A 07/01/2011 1,540.33 SD A 1,122.00 01/01/2012 06/12/2082
VO7630 OP OP F A 08/18/2011 2,582.10 BO A 103.44 03/01/2012 10/17/2032 F A 08/18/2011 2,582.10 PD A 1,384.35 02/26/2012 10/18/2067 F A 08/18/2011 2,582.10 SD A 995.00 02/01/2012 10/18/2067
VO7651 OP OP M A 01/11/2011 1,445.17 PD A 1,107.30 02/01/2012 12/12/2052 M A 01/11/2011 1,445.17 SD A 1,178.00 07/01/2012 12/12/2052
VO7669 OP OP F A 09/20/2011 1,742.98 PD A 907.94 12/07/2011 05/03/2061 F A 09/20/2011 1,742.98 SD A 1,066.00 03/01/2012 05/03/2061
VO7673 OP OP F A 12/16/2010 1,671.49 PD A 1,065.83 10/22/2011 06/30/2054 F A 12/16/2010 1,671.49 SD A 1,217.00 02/01/2012 06/30/2054
VO8708 OP OP F A 09/17/2011 824.27 PD A 787.01 01/18/2012 05/07/2055 F A 09/17/2011 824.27 SD A 1,073.00 03/01/2012 05/07/2055
VO8748 OP OP F A 11/13/2011 1,693.62 BO A 512.91 05/01/2012 04/22/2016 F A 11/13/2011 1,693.62 PD A 894.20 01/12/2012 04/23/2051 F A 11/13/2011 1,693.62 SD A 217.00 05/01/2012 04/23/2051
VO8754 OP OP F A 03/17/2011 3,047.10 PD A 1,753.62 01/28/2012 01/06/2058 F A 03/17/2011 3,047.10 SD A 1,880.00 01/01/2012 01/06/2058
VO8755 OP OP M A 10/16/2011 1,583.30 BO A 800.00 01/14/2012 01/22/2019
M A 10/16/2011 1,583.30 P1 A 372.07 03/03/2012 01/23/2054 M A 10/16/2011 1,583.30 SD E 919.00 04/01/2012 01/23/2054
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 29 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VO8774 OP OP M A 05/06/2011 1,316.35 PD A 853.40 12/21/2011 02/07/2054 M A 05/06/2011 1,316.35 SD A 1,009.00 11/01/2011 02/07/2054
VO8785 OP OP M A 10/05/2011 4,305.71 PD A 2,586.37 01/18/2012 06/27/2053 M A 10/05/2011 4,305.71 SD A 2,057.00 03/01/2012 06/27/2053
VO8791 OP OP F A 11/12/2011 701.52 PD A 521.23 04/21/2012 12/12/2057 F A 11/12/2011 701.52 SD A 772.00 05/01/2012 12/12/2057
VO9436 OP OP M A 07/27/2011 1,142.54 PD A 301.34 11/05/2011 06/12/2051 M A 07/27/2011 1,142.54 SD A 1,058.00 01/01/2012 06/12/2051
VO9752 OP OP M A 06/13/2011 1,241.62 SD A 1,596.00 12/01/2011 04/24/2058
VO9922 OP OP M A 09/04/2011 1,408.77 PL A 551.70 10/31/2011 09/07/2061 M A 09/04/2011 1,408.77 SD A 1,822.00 03/01/2012 09/07/2061
VO9978 OP OP F A 09/26/2011 1,071.38 PD A 323.93 04/19/2012 11/09/2051 F A 09/26/2011 1,071.38 SD A 1,149.00 03/01/2012 11/09/2051
VO9989 OP OP F A 06/16/2011 1,776.71 BO A 591.38 12/01/2011 09/05/2015 F A 06/16/2011 1,776.71 SD A 1,117.00 12/01/2011 09/06/2050
VP0809 OP OP F A 10/22/2011 1,400.36 BO A 86.96 05/01/2012 07/19/2015 F A 10/22/2011 1,400.36 PD A 226.54 04/05/2012 03/18/2049 F A 10/22/2011 1,400.36 SD A 1,033.00 04/01/2012 03/18/2049
VP0883 OP OP M A 09/15/2011 2,346.49 PL A 1,288.14 04/04/2012 04/22/2054 M A 09/15/2011 2,346.49 SD A 1,662.00 03/01/2012 04/22/2054
VP2136 OP OP F A 12/01/2011 4,243.95 PS A 356.00 03/12/2012 03/11/2052 F A 12/01/2011 4,243.95 SD A 2,075.00 05/01/2012 03/11/2052
VP2153 OP OP F A 09/24/2011 1,250.73 BO A 166.63 03/01/2012 08/13/2018 F A 09/24/2011 1,250.73 SD A 1,036.00 03/01/2012 08/14/2053
VP2157 OP OP F A 11/30/2011 1,131.70 BO A 654.96 06/01/2012 02/07/2026 F A 11/30/2011 1,131.70 PD A 433.22 05/30/2012 02/08/2061 F A 11/30/2011 1,131.70 SD E 779.00 05/01/2012 02/08/2061
VP2196 OP OP F A 01/07/2012 2,035.80 BO A 771.62 04/06/2012 10/30/2038 F A 01/07/2012 2,035.80 PD A 1,185.88 03/04/2012 10/31/2073 F A 01/07/2012 2,035.80 SC E 542.00 07/01/2012 01/31/2028 F A 01/07/2012 2,035.80 SD E 1,084.00 07/01/2012 10/31/2073
VP2906 OP OP F A 01/11/2012 1,462.89 PD A 996.63 04/25/2012 01/26/2050 F A 01/11/2012 1,462.89 SD A 1,075.00 07/01/2012 01/26/2050
VP2928 OP OP M A 10/11/2011 1,059.99 SD A 1,114.00 09/01/2012 11/16/2053
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 30 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VP2941 OP OP M A 08/14/2011 3,488.61 BO A 800.00 06/01/2012 05/14/2021 M A 08/14/2011 3,488.61 SD A 1,649.00 08/01/2012 05/15/2056
VP2974 OP OP F A 12/01/2011 950.20 PD A 362.16 03/22/2012 09/14/2060 F A 12/01/2011 950.20 SD A 838.00 06/01/2012 09/14/2060
VP2991 OP OP F A 12/03/2011 1,237.93 PD A 787.69 05/16/2012 12/24/2055 F A 12/03/2011 1,237.93 SD A 1,171.00 06/01/2012 12/24/2055
VP3387 OP OP F A 05/01/2012 2,264.98 PD A 1,578.57 06/16/2012 05/20/2064 F A 05/01/2012 2,264.98 SD A 1,497.00 10/01/2012 05/20/2064
VP4440 OP OP F A 12/17/2011 1,721.33 SD A 1,749.00 06/01/2012 03/04/2071
VP4459 OP OP F A 11/08/2011 1,491.09 BO A 311.74 05/01/2012 07/16/2024 F A 11/08/2011 1,491.09 SD A 1,122.00 05/01/2012 07/17/2059
VP4480 OP OP F A 01/12/2012 2,506.73 PD A 1,481.45 04/28/2012 08/26/2067 F A 01/12/2012 2,506.73 SC A 611.00 07/01/2012 01/31/2018 F A 01/12/2012 2,506.73 SD A 1,222.00 07/01/2012 08/26/2067
VP5138 OP OP F A 10/11/2011 1,234.68 PD A 794.71 03/29/2012 02/28/2056 F A 10/11/2011 1,234.68 SD A 1,034.00 04/01/2012 02/28/2056
VP5161 OP OP M A 02/16/2012 1,451.60 BO A 329.77 08/01/2012 05/02/2016 M A 02/16/2012 1,451.60 SD A 1,066.00 08/01/2012 05/03/2051
VP6674 OP OP F A 01/07/2012 2,811.09 SC E 644.00 07/01/2012 08/31/2022 F A 01/07/2012 2,811.09 SD E 1,288.00 07/01/2012 04/01/2068
VP6934 OP OP F A 11/19/2011 994.50 PD A 795.50 06/02/2012 01/09/2055 F A 11/19/2011 994.50 SD A 829.00 05/01/2012 01/09/2055
VP6985 OP OP M A 07/30/2011 2,064.50 BO A 206.85 03/01/2012 01/14/2019 M A 07/30/2011 2,064.50 PS A 455.25 03/01/2012 01/15/2054 M A 07/30/2011 2,064.50 SD A 1,323.00 01/01/2012 01/15/2054
VP6990 OP OP F A 01/25/2012 741.81 PD A 295.52 04/28/2013 01/08/2070 F A 01/25/2012 741.81 SD A 556.00 01/01/2013 01/08/2070
VP7562 OP OP F A 02/28/2011 1,115.50 PD A 973.30 01/28/2012 08/16/2063 F A 02/28/2011 1,115.50 WP A 144.77 10/25/2013 05/17/2046
VP7604 OP OP F A 11/16/2011 1,706.20 PD A 661.57 05/16/2012 01/08/2050 F A 11/16/2011 1,706.20 SD A 1,178.00 05/01/2012 01/08/2050
VP8304 OP OP F A 01/19/2012 1,091.26 PD A 782.08 05/13/2012 12/30/2072 F A 01/19/2012 1,091.26 SD A 1,350.00 07/01/2012 12/30/2072
VP8361 OP OP F A 12/18/2011 1,015.95 PD A 514.85 06/01/2012 04/07/2051
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 31 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VP8361 OP OP F A 12/18/2011 1,015.95 SD A 854.00 06/01/2012 04/07/2051
VP8364 OP OP F A 02/25/2012 1,085.84 PD A 562.28 09/18/2012 08/16/2067 F A 02/25/2012 1,085.84 SD A 964.00 08/01/2012 08/16/2067
VP8369 OP OP F A 03/08/2012 2,320.50 PL A 1,154.78 08/02/2012 03/12/2063 F A 03/08/2012 2,320.50 SD A 1,379.00 09/01/2012 03/12/2063
VP8522 OP OP F A 01/09/2012 1,157.82 SD A 1,835.00 02/01/2013 12/19/2057
VP8529 OP OP F A 03/20/2012 2,790.13 PD A 1,355.33 05/31/2012 05/22/2077 F A 03/20/2012 2,790.13 SD A 1,522.00 09/01/2012 05/22/2077
VP8576 OP OP F A 03/01/2012 1,129.86 PD A 900.60 08/15/2012 05/24/2065 F A 03/01/2012 1,129.86 SD A 1,139.00 08/01/2012 05/24/2065
VP8606 OP OP F A 05/03/2012 2,989.56 PD A 1,910.39 05/03/2012 05/24/2054 F A 05/03/2012 2,989.56 SD A 1,613.00 10/01/2012 05/24/2054
VQ0236 OP OP F A 01/17/2012 2,051.18 BO A 800.00 04/16/2012 07/10/2033 F A 01/17/2012 2,051.18 SC E 542.00 07/01/2012 01/31/2019 F A 01/17/2012 2,051.18 SD E 1,084.00 07/01/2012 07/11/2068
VQ4402 OP OP M A 03/19/2012 1,487.71 BO A 343.49 11/01/2012 10/31/2020 M A 03/19/2012 1,487.71 SD A 1,087.00 11/01/2012 11/01/2055
VQ4436 OP OP M A 04/30/2012 1,646.01 BO A 236.11 07/29/2012 05/07/2024 M A 04/30/2012 1,646.01 PD A 1,346.59 07/21/2012 05/08/2059 M A 04/30/2012 1,646.01 SD E 962.00 10/01/2012 05/08/2059
VQ4474 OP OP M A 05/26/2012 1,817.56 PD A 1,034.42 09/05/2012 07/20/2063 M A 05/26/2012 1,817.56 SD A 1,328.00 11/01/2012 07/20/2063
VQ5210 OP OP F A 03/31/2012 4,315.03 PD A 1,424.97 07/25/2012 09/11/2053 F A 03/31/2012 4,315.03 SD A 2,183.00 09/01/2012 09/11/2053
VQ5227 OP OP F A 06/21/2012 4,187.30 PS A 3,039.64 06/30/2012 01/03/2057 F A 06/21/2012 4,187.30 SD A 2,112.00 12/01/2012 01/03/2057
VQ5246 OP OP M A 05/08/2012 1,498.35 PD A 350.32 08/26/2012 02/22/2052 M A 05/08/2012 1,498.35 SD A 1,364.00 11/01/2012 02/22/2052
VQ5359 OP OP F A 06/11/2012 1,676.73 BO A 460.67 10/01/2012 10/07/2032 F A 06/11/2012 1,676.73 PD A 1,151.57 09/24/2012 10/08/2067
VQ5382 OP OP F A 06/21/2012 1,449.71 PD A 720.64 08/29/2012 11/12/2059 F A 06/21/2012 1,449.71 SD A 1,032.00 12/01/2012 11/12/2059
VQ6622 OP OP F A 03/27/2012 1,828.72 BO A 491.29 02/01/2013 12/26/2041 F A 03/27/2012 1,828.72 PD A 1,267.10 01/13/2013 12/26/2041
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 32 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VQ6622 OP OP F A 03/27/2012 1,828.72 SC E 502.00 09/01/2012 09/30/2024 F A 03/27/2012 1,828.72 SD E 1,004.00 09/01/2012 12/27/2076
VQ6718 OP OP F A 06/14/2012 3,780.08 BO A 800.00 09/12/2012 01/05/2018 F A 06/14/2012 3,780.08 PS A 928.74 05/02/2013 01/06/2053 F A 06/14/2012 3,780.08 SD E 1,388.00 12/01/2012 01/06/2053
VQ6739 OP OP F A 01/05/2012 2,926.74 PD A 1,664.43 11/01/2012 11/08/2061 F A 01/05/2012 2,926.74 SD A 1,791.00 07/01/2012 11/08/2061
VQ6743 LT LS F A 10/31/2008 100.00 0.00
VQ6770 OP OP F A 06/12/2012 1,194.91 PS A 514.76 02/01/2012 12/23/2049 F A 06/12/2012 1,194.91 SR A 680.00 06/12/2012 12/23/2049
VQ6796 OP OP F A 03/31/2012 871.49 SD A 904.00 09/01/2012 08/16/2078
VQ7979 OP OP F A 09/27/2012 3,828.50 BO A 800.00 12/26/2012 12/25/2015 F A 09/27/2012 3,828.50 SD A 1,852.00 03/01/2013 05/29/2049
VQ8215 OP OP F A 07/14/2012 2,636.67 PD A 2,667.27 12/02/2012 03/05/2059 F A 07/14/2012 2,636.67 SD A 1,495.00 01/01/2013 03/05/2059
VQ8216 OP OP M A 06/02/2012 1,000.51 PD A 440.70 07/25/2012 02/13/2054 M A 06/02/2012 1,000.51 SD A 777.00 01/01/2013 02/13/2054
VQ8246 OP OP M A 04/01/2012 1,613.66 PD A 1,022.94 09/06/2012 05/26/2061 M A 04/01/2012 1,613.66 SD A 1,544.00 09/01/2012 05/26/2061
VQ8247 OP OP F A 07/01/2012 1,046.91 PL A 485.16 10/31/2012 09/24/2063 F A 07/01/2012 1,046.91 SD A 752.00 01/01/2013 09/24/2063
VQ8284 OP OP F A 07/03/2012 2,142.61 BO A 514.79 12/01/2012 03/11/2026 F A 07/03/2012 2,142.61 PD A 704.42 11/17/2012 03/12/2061 F A 07/03/2012 2,142.61 SC A 215.00 11/01/2012 10/31/2015 F A 07/03/2012 2,142.61 SD A 841.00 11/01/2012 03/12/2061
VQ8298 OP OP F A 06/06/2012 2,862.39 PD A 2,013.42 09/15/2012 03/23/2056 F A 06/06/2012 2,862.39 SD A 1,582.00 03/01/2013 03/23/2056
VQ8380 OP OP F A 07/01/2012 2,525.46 BO A 151.85 05/01/2013 11/15/2018 F A 07/01/2012 2,525.46 PD A 1,023.48 12/01/2012 11/16/2053 F A 07/01/2012 2,525.46 SD A 1,253.00 05/01/2013 11/16/2053
VQ8381 OP OP F A 04/17/2012 1,355.61 PD A 456.93 04/12/2013 11/07/2061 F A 04/17/2012 1,355.61 SD A 1,696.00 10/01/2013 11/07/2061
VQ8393 OP OP F A 06/20/2012 2,378.62 BO A 800.00 09/18/2012 05/15/2016
F A 06/20/2012 2,378.62 SD E 1,158.00 12/01/2012 10/10/2062
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 33 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VQ8428 OP OP M A 06/12/2012 1,846.82 BO A 800.00 09/10/2012 04/11/2029 M A 06/12/2012 1,846.82 PD A 786.00 01/26/2013 11/01/2057 M A 06/12/2012 1,846.82 SD E 1,004.00 12/01/2012 11/01/2057
VQ9261 OP OP F A 05/05/2012 1,046.91 PD A 397.27 09/06/2012 04/15/2058 F A 05/05/2012 1,046.91 SD A 693.00 11/01/2012 04/15/2058
VQ9937 OP OP M A 06/03/2012 1,856.23 BO A 254.48 08/01/2014 08/29/2047 M A 06/03/2012 1,856.23 PD A 1,304.39 06/02/2013 08/20/2082 M A 06/03/2012 1,856.23 WP A 225.97 08/01/2014 08/30/2082
VQ9961 OP OP M A 07/20/2012 1,260.01 PD A 429.89 10/18/2012 02/01/2059 M A 07/20/2012 1,260.01 SD A 1,388.00 01/01/2013 02/01/2059
VQ9984 OP OP F A 06/06/2012 802.70 PD A 287.07 10/03/2012 03/30/2059 F A 06/06/2012 802.70 SD A 1,181.00 12/01/2012 03/30/2059
VQ9989 OP OP M A 07/19/2012 1,700.83 PD A 544.11 03/11/2013 05/21/2063 M A 07/19/2012 1,700.83 SD A 1,355.00 01/01/2013 05/21/2063
VR0922 OP OP M A 06/27/2012 1,166.11 PS A 139.93 07/13/2013 09/25/2051 M A 06/27/2012 1,166.11 SD A 2,013.00 12/01/2012 09/25/2051
VR0991 OP OP M A 08/17/2012 1,660.89 PD A 732.92 12/01/2012 03/12/2068 M A 08/17/2012 1,660.89 SD A 1,461.00 02/01/2013 03/12/2068
VR0993 OP OP F A 05/22/2012 2,158.60 PD A 1,851.66 02/20/2013 07/20/2069 F A 05/22/2012 2,158.60 SC A 699.00 02/01/2013 08/31/2020 F A 05/22/2012 2,158.60 SD A 1,399.00 02/01/2013 07/20/2069
VR1443 OP OP F A 06/05/2012 2,940.60 PD A 1,636.06 11/10/2012 06/17/2048 F A 06/05/2012 2,940.60 SD A 1,422.00 01/01/2013 06/17/2048
VR1470 OP OP M A 08/13/2012 1,278.56 SD A 1,671.00 03/01/2013 02/27/2064
VR2059 OP OP M A 08/12/2012 2,261.73 BO A 800.00 11/10/2012 08/30/2016 M A 08/12/2012 2,261.73 PD A 480.35 03/17/2013 08/31/2051 M A 08/12/2012 2,261.73 SD A 433.00 02/01/2013 08/31/2051
VR2703 OP OP F A 07/19/2012 4,631.37 PS A 3,783.99 12/30/2012 05/23/2057 F A 07/19/2012 4,631.37 SD A 1,753.00 01/01/2013 05/23/2057
VR2723 OP OP F A 03/06/2012 5,346.85 BO A 800.00 06/04/2012 12/16/2022 F A 03/06/2012 5,346.85 PS A 3,717.29 06/30/2013 12/17/2057 F A 03/06/2012 5,346.85 SD E 1,394.00 09/01/2012 12/17/2057
VR2741 OP OP M A 10/13/2012 3,003.27 BO A 9.36 04/01/2013 04/01/2017 M A 10/13/2012 3,003.27 PD A 1,147.40 12/02/2012 04/02/2052
M A 10/13/2012 3,003.27 SD A 1,731.00 04/01/2013 04/02/2052
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 34 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VR2747 OP OP F A 10/17/2012 1,398.88 PL A 707.71 02/22/2013 02/02/2065 F A 10/17/2012 1,398.88 SD A 1,152.00 01/01/2014 02/02/2065
VR2762 OP OP M A 08/11/2012 3,547.80 PD A 2,116.58 12/09/2012 11/20/2053 M A 08/11/2012 3,547.80 SD A 1,744.00 01/01/2014 11/20/2053
VR2775 OP OP F A 09/12/2012 2,918.99 PD A 2,014.85 07/11/2013 08/16/2065 F A 09/12/2012 2,918.99 SD A 1,554.00 03/01/2013 08/16/2065
VR2776 OP OP F A 09/11/2012 3,097.52 PD A 1,966.21 12/15/2012 07/10/2058 F A 09/11/2012 3,097.52 SD A 1,795.00 11/01/2012 07/10/2058 F A 09/11/2012 3,097.52 WP A 349.71 11/19/2012 07/10/2028
VR4648 OP OP M A 07/05/2012 2,561.92 BO A 740.77 02/01/2013 05/25/2028 M A 07/05/2012 2,561.92 PD A 1,722.61 01/17/2013 05/26/2063 M A 07/05/2012 2,561.92 SD E 1,226.00 12/01/2012 05/26/2063
VR4663 OP OP F A 12/22/2012 3,081.49 BO A 800.00 03/22/2013 08/23/2026 F A 12/22/2012 3,081.49 PD A 1,158.81 02/06/2013 08/24/2061 F A 12/22/2012 3,081.49 SD E 1,323.00 06/01/2013 08/24/2061
VR4666 OP OP M A 10/10/2012 1,885.11 PD A 860.14 01/24/2013 11/29/2050 M A 10/10/2012 1,885.11 SD A 658.00 04/01/2013 11/29/2050
VR4668 OP OP F A 07/30/2012 1,602.30 BO A 439.68 02/01/2013 08/20/2049 F A 07/30/2012 1,602.30 SD A 1,101.00 02/01/2013 06/21/2084
VR4669 OP OP F A 05/12/2012 2,985.80 PD A 2,469.17 02/01/2013 01/17/2058 F A 05/12/2012 2,985.80 SD A 1,684.00 01/01/2013 01/17/2058
VR4673 OP OP M A 08/15/2012 1,274.38 PD A 375.08 02/19/2013 09/10/2051 M A 08/15/2012 1,274.38 SD A 1,156.00 02/01/2013 09/10/2051
VR4692 LT LS F A 10/20/2007 1,296.44 0.00
VR4694 LT LS M A 05/20/2010 1,286.49 0.00
VR4696 LT LS F A 11/07/2006 100.00 0.00
VR4698 LT LS F A 10/26/2007 100.00 0.00
VR4701 LT LS M A 01/01/2009 1,758.20 0.00
VR4703 LT LS F A 12/21/2009 100.00 0.00
VR4704 LT LS M A 07/05/2007 100.00 0.00
VR4706 LT LS F A 11/12/2005 100.00 0.00
VR4724 OP OP F A 02/02/2013 2,438.42 PD A 1,906.39 05/25/2013 09/30/2058
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 35 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VR4724 OP OP F A 02/02/2013 2,438.42 SD A 1,594.00 11/01/2013 09/30/2058
VR5027 OP OP M A 06/22/2012 1,603.23 BO A 3.56 02/01/2013 09/18/2022 M A 06/22/2012 1,603.23 SC A 769.00 02/01/2013 03/31/2017 M A 06/22/2012 1,603.23 SD A 1,538.00 02/01/2013 09/19/2057
VR5610 OP OP M A 11/01/2012 1,665.79 BO A 149.10 04/01/2013 07/29/2016 M A 11/01/2012 1,665.79 PS A 546.62 11/01/2012 05/25/2051 M A 11/01/2012 1,665.79 SD A 906.00 04/01/2013 05/25/2051
VR5633 OP OP M A 09/01/2012 2,062.83 PD A 790.90 10/16/2012 10/21/2058 M A 09/01/2012 2,062.83 SD A 1,480.00 02/01/2013 10/21/2058
VR5648 OP OP M A 07/17/2012 2,283.02 PD A 824.04 02/10/2013 05/16/2050 M A 07/17/2012 2,283.02 PS A 614.34 02/10/2013 05/16/2050 M A 07/17/2012 2,283.02 SD A 1,486.00 01/01/2013 05/16/2050
VR5649 OP OP M A 10/18/2012 1,218.43 PD A 306.32 02/23/2013 11/15/2057 M A 10/18/2012 1,218.43 SD A 2,066.00 04/01/2013 11/15/2057
VR5650 OP OP F A 08/24/2012 428.84 SD A 1,118.00 02/01/2013 08/15/2068
VR5659 OP OP F A 11/15/2012 2,119.60 BO A 556.16 05/01/2013 12/17/2029 F A 11/15/2012 2,119.60 PD A 646.92 04/25/2013 12/18/2064 F A 11/15/2012 2,119.60 SD A 835.00 05/01/2013 12/18/2064
VR6208 OP OP F A 01/03/2012 2,427.59 PD A 1,688.82 02/01/2013 11/21/2052 F A 01/03/2012 2,427.59 SD A 1,457.00 07/01/2013 11/21/2052
VR6266 OP OP F A 08/07/2012 3,040.50 BO A 800.00 11/05/2012 10/12/2035 F A 08/07/2012 3,040.50 PD A 1,592.94 12/27/2012 10/13/2070 F A 08/07/2012 3,040.50 SD E 1,310.00 02/01/2013 10/13/2070
VR6299 OP OP F A 09/29/2012 788.27 PD A 222.14 03/29/2013 06/13/2057 F A 09/29/2012 788.27 SD A 668.00 12/01/2012 06/13/2057
VR6933 OP OP M A 10/02/2012 937.63 PD A 500.23 03/21/2013 10/10/2066 M A 10/02/2012 937.63 SC A 185.00 04/01/2013 05/31/2017 M A 10/02/2012 937.63 SD A 949.00 04/01/2013 10/10/2066
VR7134 OP OP F A 08/23/2012 599.01 SD A 889.00 02/01/2013 09/13/2051
VR7138 OP OP M A 11/17/2012 4,419.18 PD A 2,443.98 03/10/2013 01/18/2059 M A 11/17/2012 4,419.18 SD A 1,998.00 05/01/2013 02/18/2059
VR7142 OP OP M A 10/13/2012 2,100.57 BO A 429.85 04/01/2013 10/01/2016 M A 10/13/2012 2,100.57 PD A 440.93 01/17/2013 10/02/2051 M A 10/13/2012 2,100.57 SD A 1,149.00 04/01/2013 10/02/2051
VR7174 OP OP F A 10/16/2012 2,296.89 BO A 37.33 01/14/2013 10/31/2028
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 36 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VR7174 OP OP F A 10/16/2012 2,296.89 PD A 2,171.22 01/09/2013 11/01/2063 F A 10/16/2012 2,296.89 SD E 1,158.00 04/01/2013 11/01/2063
VR7549 OP OP M A 10/09/2012 2,734.60 PD S 1,136.53 08/02/2014 04/10/2062 M A 10/09/2012 2,734.60 SC E 629.00 04/01/2013 08/31/2016 M A 10/09/2012 2,734.60 SD S 2,092.00 09/01/2014 04/10/2062 M A 10/09/2012 2,734.60 WT E 971.00 10/09/2012 10/08/2015
VR7705 OP OP M A 01/15/2013 2,632.11 PD A 1,253.30 06/02/2013 11/13/2059 M A 01/15/2013 2,632.11 SD A 1,511.00 07/01/2013 11/13/2059
VR7724 OP OP F A 10/07/2012 1,749.57 BO A 10.80 01/05/2013 07/04/2015 F A 10/07/2012 1,749.57 PS A 381.48 12/15/2012 12/14/2047 F A 10/07/2012 1,749.57 SR A 1,290.00 11/01/2012 12/14/2047
VR7764 OP OP F A 11/09/2012 2,028.38 BO A 800.00 02/07/2013 09/12/2041
VR7841 OP OP F A 11/14/2012 3,379.40 BO A 800.00 02/12/2013 12/09/2027 F A 11/14/2012 3,379.40 PD A 1,289.19 07/11/2013 12/10/2062 F A 11/14/2012 3,379.40 SD E 1,347.00 05/01/2013 12/10/2062
VR8014 OP OP F A 12/20/2012 1,638.21 PD A 774.97 03/15/2013 03/11/2055 F A 12/20/2012 1,638.21 SD A 1,085.00 06/01/2013 03/11/2055
VR8022 OP OP F A 01/05/2013 2,284.80 PD A 1,876.87 01/05/2013 08/29/2060 F A 01/05/2013 2,284.80 SD A 1,347.00 07/01/2013 08/29/2060
VR8038 OP OP M A 01/12/2013 3,529.55 BO A 651.06 07/01/2013 08/22/2017 M A 01/12/2013 3,529.55 PD A 1,214.74 01/13/2013 08/23/2052 M A 01/12/2013 3,529.55 SD A 1,528.00 07/01/2013 08/23/2052
VR8039 OP OP F A 09/25/2012 2,702.00 PD A 1,485.26 03/16/2013 08/28/2053 F A 09/25/2012 2,702.00 SD A 327.00 12/01/2012 08/28/2053 F A 09/25/2012 2,702.00 WT S 2,743.35 09/25/2012 09/24/2015
VR8067 OP OP F A 08/08/2012 2,947.80 PD A 1,881.02 03/07/2013 03/04/2061 F A 08/08/2012 2,947.80 SD A 1,605.00 01/01/2013 03/04/2061
VR8068 OP OP F A 11/01/2012 1,354.16 BO A 610.80 07/01/2013 01/10/2044 F A 11/01/2012 1,354.16 PD A 691.28 06/06/2013 01/11/2079 F A 11/01/2012 1,354.16 SC E 413.50 04/01/2013 08/31/2022 F A 11/01/2012 1,354.16 SD E 827.00 04/01/2013 01/11/2079
VR8089 OP OP M A 12/02/2012 1,999.73 BO A 556.89 05/01/2013 12/16/2031 M A 12/02/2012 1,999.73 PD A 1,365.92 04/03/2013 12/17/2066 M A 12/02/2012 1,999.73 SD E 1,045.00 05/01/2013 12/17/2066
VS0650 OP OP F A 01/19/2013 3,119.51 PS A 1,916.86 06/30/2012 09/18/2057
F A 01/19/2013 3,119.51 SD A 1,712.00 07/01/2013 09/18/2057
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 37 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VS0663 OP OP F A 08/15/2012 2,439.56 PL A 999.54 02/19/2013 06/03/2072 F A 08/15/2012 2,439.56 SC E 596.50 03/01/2013 06/30/2023 F A 08/15/2012 2,439.56 SD E 1,193.00 03/01/2013 06/03/2072
VS0667 OP OP M A 01/15/2013 1,472.39 PD A 572.14 03/22/2013 09/21/2078 M A 01/15/2013 1,472.39 SD A 925.00 07/01/2013 09/21/2078
VS0712 OP OP F A 01/03/2013 2,579.04 BO A 719.84 08/01/2013 07/01/2029 F A 01/03/2013 2,579.04 SD A 1,760.00 08/01/2013 07/02/2064
VS1143 OP OP F A 01/17/2013 1,209.98 PD A 731.95 06/08/2013 01/28/2057 F A 01/17/2013 1,209.98 SD A 1,066.00 07/01/2013 01/28/2057
VS1205 OP OP F A 01/29/2013 2,221.81 BO A 800.00 06/11/2013 09/25/2032 F A 01/29/2013 2,221.81 P1 E 410.18 01/29/2014 09/26/2067 F A 01/29/2013 2,221.81 SC E 561.00 07/01/2013 01/31/2019 F A 01/29/2013 2,221.81 SD E 1,122.00 07/01/2013 09/26/2067
VS1555 OP OP F A 11/17/2012 2,650.54 PD A 1,215.50 09/03/2013 05/29/2057 F A 11/17/2012 2,650.54 SD A 1,360.00 05/01/2013 05/29/2057
VS1564 OP OP F A 09/08/2012 2,604.50 PD A 1,427.00 03/20/2013 10/13/2071 F A 09/08/2012 2,604.50 SD A 1,431.00 03/01/2013 10/13/2071
VS1596 OP OP F A 11/06/2012 2,418.98 PD A 1,885.93 06/02/2013 08/05/2063 F A 11/06/2012 2,418.98 SD A 1,987.00 05/01/2013 08/05/2063
VS1606 OP OP F A 10/05/2012 1,850.03 BO A 800.00 01/03/2013 09/04/2037 F A 10/05/2012 1,850.03 P1 A 821.73 09/19/2013 09/05/2072 F A 10/05/2012 1,850.03 SD E 1,004.00 04/01/2013 09/05/2072
VS1988 OP OP F A 02/05/2013 05/05/2015 2,930.74 BO A 797.30 05/06/2013 05/05/2015 F A 02/05/2013 05/05/2015 2,930.74 PD A 2,020.72 04/21/2013 09/12/2070 F A 02/05/2013 05/05/2015 2,930.74 SC E 655.00 08/01/2013 02/28/2022 F A 02/05/2013 05/05/2015 2,930.74 SD E 1,310.00 08/01/2013 09/12/2070
VS2483 OP OP F A 12/02/2012 1,862.04 PD A 1,546.11 06/01/2013 10/20/2062 F A 12/02/2012 1,862.04 SD A 1,285.00 05/01/2013 10/20/2062
VS2576 OP OP M A 01/15/2013 2,524.98 PD A 1,125.38 03/31/2013 03/26/2052 M A 01/15/2013 2,524.98 SD A 1,560.00 07/01/2013 03/26/2052
VS3112 OP OP F A 11/10/2012 983.22 PD A 181.48 05/17/2013 05/16/2051 F A 11/10/2012 983.22 SD A 1,088.00 05/01/2013 05/16/2051
VS3133 OP OP M A 03/07/2013 2,102.80 PD A 703.55 06/15/2013 02/07/2058 M A 03/07/2013 2,102.80 SD A 1,637.00 09/01/2013 02/07/2058
VS3135 OP OP F A 11/29/2012 1,509.54 BO A 800.00 03/03/2013 10/02/2038 F A 11/29/2012 1,509.54 SC E 459.50 05/01/2013 06/30/2021
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 38 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VS3135 OP OP F A 11/29/2012 1,509.54 SD E 919.00 05/01/2013 10/03/2073
VS3136 OP OP F A 02/06/2013 1,691.19 BO A 800.00 05/07/2013 05/06/2015 F A 02/06/2013 1,691.19 PD S 680.75 10/01/2013 09/12/2062 F A 02/06/2013 1,691.19 SD E 962.00 08/01/2013 09/12/2062
VS3181 OP OP M A 04/20/2013 4,185.29 BO A 800.00 08/01/2013 02/26/2023 M A 04/20/2013 4,185.29 PD A 2,232.89 09/05/2013 02/27/2058 M A 04/20/2013 4,185.29 SC E 697.00 10/01/2013 01/31/2018 M A 04/20/2013 4,185.29 SD E 1,394.00 10/01/2013 02/27/2058
VS3345 OP OP F A 12/20/2012 775.01 PD A 919.05 04/18/2013 06/21/2063 F A 12/20/2012 775.01 SC A 324.00 06/01/2013 04/30/2022 F A 12/20/2012 775.01 SD A 932.00 06/01/2013 06/21/2063
VS3409 OP OP F A 03/23/2013 1,102.89 BO A 83.61 06/21/2013 06/20/2015 F A 03/23/2013 1,102.89 PD A 976.86 05/01/2013 07/31/2060 F A 03/23/2013 1,102.89 RO S 901.70 02/09/2015 07/30/2025
VS3561 OP OP F A 03/09/2013 1,656.41 BO A 649.67 07/01/2013 06/06/2015 F A 03/09/2013 1,656.41 PD A 617.44 06/12/2013 01/05/2060 F A 03/09/2013 1,656.41 PS A 325.59 06/12/2013 01/05/2060 F A 03/09/2013 1,656.41 SD E 962.00 09/01/2013 01/05/2060
VS3605 OP OP F A 02/23/2013 636.46 PD A 177.33 06/02/2013 02/26/2054 F A 02/23/2013 636.46 SD A 511.00 08/01/2013 02/26/2054
VS4455 OP OP M A 03/22/2013 3,119.51 PS A 2,700.47 03/22/2013 07/01/2054 M A 03/22/2013 3,119.51 SD A 2,155.00 09/01/2013 07/01/2054
VS4818 OP OP M A 03/16/2013 2,720.51 BO A 800.00 06/14/2013 10/11/2031 M A 03/16/2013 2,720.51 PD A 1,588.88 07/25/2013 10/12/2066 M A 03/16/2013 2,720.51 SD E 1,258.00 09/01/2013 10/12/2066
VS4839 OP OP F A 01/16/2013 2,888.78 PD A 1,686.24 06/15/2013 10/28/2057 F A 01/16/2013 2,888.78 SD A 1,695.00 08/01/2013 10/28/2057
VS4840 OP OP F A 02/11/2013 1,767.18 BO A 548.85 07/01/2013 05/11/2015 F A 02/11/2013 1,767.18 PD A 1,150.36 06/19/2013 12/26/2066 F A 02/11/2013 1,767.18 SD E 1,004.00 08/01/2013 12/26/2066
VS4961 OP OP F A 02/07/2013 993.86 BO A 407.46 12/01/2013 05/07/2015 F A 02/07/2013 993.86 PD A 548.18 11/08/2013 12/24/2061 F A 02/07/2013 993.86 SC E 365.50 08/01/2013 06/30/2015 F A 02/07/2013 993.86 SD E 731.00 08/01/2013 12/24/2061
VS5123 OP OP F A 03/14/2013 1,124.39 BO A 620.17 09/01/2013 09/15/2037 F A 03/14/2013 1,124.39 PD A 460.97 08/31/2013 09/16/2072
F A 03/14/2013 1,124.39 SD E 779.00 09/01/2013 09/16/2072
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 39 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VS5140 OP OP F S 12/06/2012 0.00 PD A 1,305.79 02/21/2014 01/30/2068 F S 12/06/2012 0.00 SD E 1,362.00 06/01/2013 01/30/2068
VS5147 OP OP F A 04/13/2013 1,728.83 BO A 655.00 10/01/2013 08/13/2036 F A 04/13/2013 1,728.83 PD A 1,007.34 10/01/2013 08/14/2071 F A 04/13/2013 1,728.83 SC E 481.00 10/01/2013 06/30/2019 F A 04/13/2013 1,728.83 SD E 962.00 10/01/2013 08/14/2071
VS5150 OP OP F A 02/02/2013 1,988.62 BO A 112.96 06/01/2013 11/02/2015 F A 02/02/2013 1,988.62 PD A 511.18 05/31/2013 09/12/2048 F A 02/02/2013 1,988.62 SR A 1,288.00 04/01/2013 09/12/2048
VS5153 OP OP F A 02/23/2013 1,515.85 BO A 241.55 09/01/2014 05/23/2015 F A 02/23/2013 1,515.85 SD A 1,216.00 09/01/2014 11/19/2064
VS5177 OP OP F A 04/19/2013 2,535.70 PD A 1,175.69 07/03/2013 05/27/2052 F A 04/19/2013 2,535.70 SD A 1,539.00 10/01/2013 05/27/2052
VS5181 OP OP F A 06/01/2013 2,719.49 PD A 1,818.79 06/01/2013 04/10/2074 F A 06/01/2013 2,719.49 SD A 1,509.00 11/01/2013 04/10/2074
VS5188 OP OP M A 01/26/2013 1,714.81 PD A 442.99 06/05/2013 05/20/2055 M A 01/26/2013 1,714.81 SD A 1,807.00 07/01/2013 05/20/2055
VS5195 OP OP F A 04/30/2013 3,552.79 PD A 1,615.66 10/03/2013 04/27/2056 F A 04/30/2013 3,552.79 SD A 2,207.00 10/01/2013 04/27/2056
VS5541 OP OP M A 03/15/2013 1,976.21 PD S 518.35 12/07/2013 05/06/2061 M A 03/15/2013 1,976.21 SD E 1,045.00 09/01/2013 05/06/2061 M A 03/15/2013 1,976.21 WT S 1,899.50 03/15/2013 03/14/2016
VS5546 OP OP M A 03/05/2013 1,568.66 PD A 626.71 12/03/2013 01/02/2058 M A 03/05/2013 1,568.66 SD A 1,383.00 09/01/2013 01/02/2058
VS6330 OP OP F A 03/27/2013 659.59 PD A 238.06 06/08/2013 03/05/2055 F A 03/27/2013 659.59 SD E 574.00 09/01/2013 03/05/2055
VS6333 OP OP M A 02/03/2013 978.32 BO A 433.54 02/01/2016 02/29/2016 M A 02/03/2013 978.32 BO A 601.90 03/01/2016 10/04/2026 M A 02/03/2013 978.32 PD A 338.79 08/01/2013 10/05/2061 M A 02/03/2013 978.32 SD E 731.00 08/01/2013 10/05/2061 M A 02/03/2013 978.32 WT S 2,441.26 02/03/2013 02/02/2016
VS6363 OP OP F A 02/13/2013 562.79 BO A 325.75 11/01/2013 05/13/2015 F A 02/13/2013 562.79 PD A 215.39 10/09/2013 02/02/2065 F A 02/13/2013 562.79 SC E 259.50 08/01/2013 10/31/2024 F A 02/13/2013 562.79 SD E 519.00 08/01/2013 02/02/2065
VS6364 OP OP F A 06/04/2013 2,107.57 SD A 1,277.00 12/01/2013 04/02/2061
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 40 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VS6374 OP OP F A 04/12/2013 1,352.57 BO A 109.01 10/01/2013 07/10/2015 F A 04/12/2013 1,352.57 PL A 452.53 05/18/2013 02/03/2058 F A 04/12/2013 1,352.57 SD A 739.00 10/01/2013 02/03/2058
VS6388 OP OP M A 12/12/2012 1,477.55 PD A 848.97 07/07/2013 03/12/2062 M A 12/12/2012 1,477.55 SD A 1,378.00 06/01/2013 03/12/2062
VS6393 OP OP M A 02/26/2013 3,520.84 BO A 800.00 08/01/2013 10/25/2027 M A 02/26/2013 3,520.84 PD A 2,412.45 07/27/2013 10/26/2062 M A 02/26/2013 3,520.84 SD E 1,362.00 08/01/2013 10/26/2062
VS6396 OP OP F A 03/07/2013 1,167.04 BO A 800.00 06/05/2013 06/04/2015 F A 03/07/2013 1,167.04 SC E 389.50 09/01/2013 01/31/2030 F A 03/07/2013 1,167.04 SD E 779.00 09/01/2013 07/25/2077
VS7120 OP OP F A 05/13/2013 1,167.94 PD S 295.05 02/16/2014 03/25/2063 F A 05/13/2013 1,167.94 SD A 935.00 11/01/2013 03/25/2063
VS7499 OP OP M A 03/28/2013 2,304.10 BO A 800.00 06/26/2013 06/25/2015 M A 03/28/2013 2,304.10 P1 E 425.37 03/28/2014 09/19/2061 M A 03/28/2013 2,304.10 SD E 1,158.00 09/01/2013 09/19/2061
VS7608 OP OP F A 03/29/2013 1,482.78 PD A 930.46 09/27/2013 06/26/2057 F A 03/29/2013 1,482.78 SD A 1,061.00 09/01/2013 06/26/2057
VS7616 OP OP M A 03/30/2013 1,335.05 BO A 787.75 10/01/2013 06/27/2015 M A 03/30/2013 1,335.05 PD A 495.95 09/18/2013 06/09/2057 M A 03/30/2013 1,335.05 SD E 827.00 09/01/2013 06/09/2057
VS7696 OP OP M A 03/05/2013 2,853.31 BO A 800.00 07/01/2013 06/02/2015 M A 03/05/2013 2,853.31 P1 E 2,000.00 01/01/2014 11/24/2063 M A 03/05/2013 2,853.31 SD E 1,288.00 09/01/2013 11/24/2063
VS7697 OP OP F A 02/26/2013 1,067.63 PD A 329.12 12/10/2013 12/03/2053 F A 02/26/2013 1,067.63 SD A 819.00 01/01/2014 12/03/2053
VS7698 OP OP M A 01/16/2013 1,202.89 SR A 1,338.00 09/01/2014 01/27/2052
VS7812 OP OP F A 04/16/2013 1,017.58 PD A 504.27 07/14/2013 09/08/2061 F A 04/16/2013 1,017.58 SD A 1,260.00 10/01/2013 09/08/2061 F A 04/16/2013 1,017.58 WP A 93.02 10/01/2013 09/07/2031
VS7813 OP OP F A 02/12/2013 3,840.08 BO A 800.00 07/01/2013 05/12/2016 F A 02/12/2013 3,840.08 PD A 812.22 01/01/2013 04/11/2049 F A 02/12/2013 3,840.08 SD A 1,061.00 06/01/2013 04/11/2049
VS7822 OP OP F A 06/01/2013 997.05 BO A 800.00 08/30/2013 08/29/2015 F A 06/01/2013 997.05 SC E 365.50 11/01/2013 05/31/2020
F A 06/01/2013 997.05 SD E 731.00 11/01/2013 04/08/2083
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 41 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VS7841 OP OP F A 03/07/2013 2,977.81 BO A 800.00 02/08/2014 11/30/2015 F A 03/07/2013 2,977.81 SC E 655.00 08/01/2014 04/30/2017 F A 03/07/2013 2,977.81 SD E 1,310.00 08/01/2014 10/26/2065
VS7858 OP OP F A 05/10/2013 2,259.84 PD A 1,034.06 07/07/2013 10/06/2081 F A 05/10/2013 2,259.84 SD A 1,478.00 11/01/2013 10/06/2081
VS7870 OP OP M A 05/10/2013 1,665.73 PD A 846.34 09/26/2013 01/10/2052 M A 05/10/2013 1,665.73 SD A 1,303.00 11/01/2013 01/10/2052
VS7899 OP OP F A 02/09/2013 1,038.78 BO A 203.83 06/01/2013 02/18/2029 F A 02/09/2013 1,038.78 PD A 795.00 06/01/2013 02/19/2064 F A 02/09/2013 1,038.78 SD E 731.00 08/01/2013 02/19/2064
VS8059 OP OP F A 04/22/2013 1,129.00 PD A 244.42 10/04/2013 05/17/2052 F A 04/22/2013 1,129.00 SD A 1,164.00 10/01/2013 05/17/2052
VS8064 OP OP F A 04/09/2013 1,247.79 BO A 795.60 08/01/2013 07/07/2015 F A 04/09/2013 1,247.79 PD A 404.19 07/31/2013 01/31/2083 F A 04/09/2013 1,247.79 SC E 413.50 10/01/2013 07/31/2023 F A 04/09/2013 1,247.79 SD E 827.00 10/01/2013 01/31/2083
VS8087 OP OP M A 06/15/2013 2,834.75 SC E 644.00 12/01/2013 05/31/2020 M A 06/15/2013 2,834.75 SD E 1,288.00 12/01/2013 01/23/2061
VS8194 OP OP M A 02/14/2013 1,381.25 P1 E 255.00 02/14/2014 11/03/2058 M A 02/14/2013 1,381.25 SD E 874.00 08/01/2013 11/03/2058 M A 02/14/2013 1,381.25 WT S 1,659.84 02/14/2013 02/13/2016
VS8304 OP OP F A 04/24/2013 913.89 SD A 1,145.00 10/01/2013 06/29/2052
VS8315 OP OP F A 01/30/2013 2,351.97 BO A 800.00 08/01/2013 08/16/2035 F A 01/30/2013 2,351.97 SC S 647.00 01/01/2014 07/31/2015 F A 01/30/2013 2,351.97 SD A 1,295.00 01/01/2014 08/17/2070
VS8345 OP OP F A 04/09/2013 1,578.69 BO A 800.00 08/01/2013 07/07/2015 F A 04/09/2013 1,578.69 PL A 269.34 05/06/2014 07/25/2071 F A 04/09/2013 1,578.69 SD E 919.00 10/01/2013 07/25/2071
VS8409 OP OP F A 06/01/2013 3,402.21 PD A 1,909.33 07/27/2013 08/14/2052 F A 06/01/2013 3,402.21 SD A 1,999.00 12/01/2013 08/14/2052
VS8456 OP OP M A 03/14/2013 1,808.41 BO A 800.00 06/12/2013 04/27/2019 M A 03/14/2013 1,808.41 PD A 728.20 07/23/2013 04/28/2054 M A 03/14/2013 1,808.41 SC E 502.00 09/01/2013 12/31/2027 M A 03/14/2013 1,808.41 SD E 1,004.00 09/01/2013 04/28/2054
VS8849 OP OP F A 06/15/2013 2,859.32 PD A 2,222.05 07/12/2013 02/06/2058
F A 06/15/2013 2,859.32 SD A 1,944.00 01/01/2014 02/06/2058
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 42 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VS8868 OP OP F A 05/10/2013 866.66 BO A 800.00 08/08/2013 08/07/2015 F A 05/10/2013 866.66 SD E 679.00 11/01/2013 04/02/2060
VS8878 OP OP M A 03/27/2013 1,681.13 BO A 800.00 06/25/2013 06/24/2015 M A 03/27/2013 1,681.13 PD A 801.43 07/27/2013 09/02/2062
VS9443 OP OP F A 12/31/2012 1,141.78 PD A 822.12 08/04/2013 07/20/2056 F A 12/31/2012 1,141.78 SD A 1,061.00 06/01/2013 07/20/2056
VS9459 OP OP M A 04/17/2013 1,954.44 PD A 1,157.63 10/01/2013 05/24/2053 M A 04/17/2013 1,954.44 SD A 1,535.00 10/01/2013 05/24/2053
VS9626 OP OP M A 05/08/2013 2,338.85 BO A 800.00 08/06/2013 05/04/2025 M A 05/08/2013 2,338.85 PD A 1,015.49 12/22/2013 05/05/2060 M A 05/08/2013 2,338.85 SD E 1,158.00 11/01/2013 05/05/2060
VS9640 OP OP F A 04/01/2013 1,472.46 PS A 615.65 10/02/2013 05/25/2055 F A 04/01/2013 1,472.46 SD A 1,187.00 01/01/2014 05/25/2055
VS9677 OP OP F A 03/31/2013 2,141.80 PD A 1,375.26 11/29/2013 10/03/2056 F A 03/31/2013 2,141.80 SD S 1,300.00 09/01/2013 10/03/2056
VS9695 OP OP F A 05/16/2013 4,102.80 BO A 800.00 08/14/2013 08/13/2015 F A 05/16/2013 4,102.80 SD A 1,512.00 01/01/2014 07/08/2052
VS9807 OP OP F A 03/29/2013 1,225.71 BO A 34.56 09/01/2013 05/08/2045 F A 03/29/2013 1,225.71 SD A 1,144.00 09/01/2013 05/09/2080
VS9824 OP OP M A 06/25/2013 2,012.50 BO A 712.53 12/01/2013 07/21/2039 M A 06/25/2013 2,012.50 PD A 1,222.57 11/02/2013 07/22/2074 M A 06/25/2013 2,012.50 SC E 522.50 12/01/2013 10/31/2020 M A 06/25/2013 2,012.50 SD E 1,045.00 12/01/2013 07/22/2074
VS9840 OP OP F A 06/08/2013 1,171.66 PD A 271.31 08/24/2013 10/31/2053 F A 06/08/2013 1,171.66 SD A 1,115.00 01/01/2014 10/31/2053
VS9879 OP OP M A 06/04/2013 1,612.21 P1 E 666.22 03/02/2013 11/08/2057 M A 06/04/2013 1,612.21 SD A 1,629.00 05/01/2013 11/08/2057
VS9896 OP OP F A 08/30/2013 3,216.41 PD A 2,235.28 08/30/2013 12/29/2056 F A 08/30/2013 3,216.41 SD A 1,970.00 02/01/2014 12/29/2056
VS9898 OP OP M A 06/26/2013 2,238.38 BO A 201.82 12/01/2013 09/23/2015 M A 06/26/2013 2,238.38 PD A 1,947.66 11/26/2013 10/31/2065 M A 06/26/2013 2,238.38 PS A 2.81 11/26/2013 10/31/2065 M A 06/26/2013 2,238.38 SC E 579.00 12/01/2013 08/31/2025 M A 06/26/2013 2,238.38 SD E 1,158.00 12/01/2013 10/31/2065
VT0000 OP OP F A 04/26/2013 1,520.61 BO A 246.13 10/01/2013 07/28/2029 F A 04/26/2013 1,520.61 SD A 1,216.00 10/01/2013 07/29/2064
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 43 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VT0242 OP OP M A 05/16/2013 2,596.85 PD S 1,206.79 10/02/2013 11/15/2056 M A 05/16/2013 2,596.85 SD A 2,033.00 11/01/2013 11/15/2056
VT0244 OP OP M A 06/06/2013 1,594.89 BO A 800.00 09/04/2013 07/21/2019 M A 06/06/2013 1,594.89 PS A 238.30 11/20/2013 07/22/2054 M A 06/06/2013 1,594.89 SD E 919.00 12/01/2013 07/22/2054
VT0253 OP OP M A 07/13/2013 2,329.16 BO A 516.99 11/01/2016 09/06/2018 M A 07/13/2013 2,329.16 PS S 505.59 10/10/2014 09/07/2053 M A 07/13/2013 2,329.16 SD A 1,217.00 01/01/2014 09/07/2053 M A 07/13/2013 2,329.16 WT S 2,352.86 10/08/2013 10/07/2016
VT0262 OP OP F A 06/18/2013 1,598.83 BO A 800.00 09/16/2013 09/15/2015 F A 06/18/2013 1,598.83 PS A 434.76 08/17/2013 10/09/2053 F A 06/18/2013 1,598.83 SD E 919.00 12/01/2013 10/09/2053
VT0274 OP OP M A 07/09/2013 1,788.31 BO A 638.07 01/01/2014 10/06/2015 M A 07/09/2013 1,788.31 PD A 1,081.46 12/19/2013 02/28/2064 M A 07/09/2013 1,788.31 SC E 502.00 01/01/2014 01/31/2016 M A 07/09/2013 1,788.31 SD E 1,004.00 01/01/2014 02/28/2064
VT0289 OP OP F A 05/18/2013 3,134.51 PD A 2,315.90 07/16/2013 01/21/2066 F A 05/18/2013 3,134.51 PS A 744.23 07/16/2013 01/21/2066 F A 05/18/2013 3,134.51 SC E 661.50 11/01/2013 02/28/2022 F A 05/18/2013 3,134.51 SD E 1,323.00 11/01/2013 01/21/2066
VT0316 OP OP F A 05/08/2013 1,129.00 PD A 471.88 10/29/2013 01/31/2059 F A 05/08/2013 1,129.00 SD E 779.00 11/01/2013 01/31/2059
VT0345 OP OP F A 04/09/2013 3,885.70 BO A 800.00 07/08/2013 07/07/2015 F A 04/09/2013 3,885.70 PD A 933.44 11/02/2013 11/14/2053 F A 04/09/2013 3,885.70 SD E 1,394.00 10/01/2013 11/14/2053
VT0351 OP OP F A 08/01/2013 1,735.18 PD A 1,145.68 08/14/2013 05/04/2061 F A 08/01/2013 1,735.18 SD A 1,348.00 01/01/2014 05/04/2061
VT0362 OP OP F A 05/25/2013 882.86 PD A 212.38 07/03/2013 10/16/2052 F A 05/25/2013 882.86 SD A 910.00 11/01/2013 10/16/2052
VT0371 OP OP F A 04/15/2013 990.08 SD A 1,513.00 10/01/2013 04/09/2052
VT0378 OP OP M A 08/13/2013 1,705.22 PD A 738.03 09/05/2013 12/04/2066 M A 08/13/2013 1,705.22 SD A 1,505.00 12/01/2013 12/04/2066
VT3291 OP OP M A 10/15/2013 2,805.40 PD A 2,198.64 01/22/2014 08/18/2059 M A 10/15/2013 2,805.40 SD A 1,750.00 07/01/2014 08/18/2059
VT3364 OP OP F A 06/11/2013 2,111.15 BO A 800.00 09/09/2013 07/28/2021
F A 06/11/2013 2,111.15 PD A 943.00 01/01/2014 07/29/2056 F A 06/11/2013 2,111.15 SD E 1,084.00 12/01/2013 07/29/2056
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 44 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VT4251 OP OP M A 07/05/2013 1,779.52 PD A 1,976.68 10/05/2013 10/01/2071
VT4261 OP OP F A 07/23/2013 1,877.74 PD A 1,279.43 12/14/2013 09/17/2057 F A 07/23/2013 1,877.74 SD A 1,199.00 01/01/2014 09/17/2057
VT4271 OP OP M A 05/21/2013 2,955.50 BO A 167.15 11/01/2013 08/18/2015 M A 05/21/2013 2,955.50 PS A 762.68 05/31/2013 11/06/2047 M A 05/21/2013 2,955.50 SR A 1,912.00 07/01/2013 11/06/2047
VT4277 OP OP F A 06/20/2013 3,649.63 BO A 800.00 09/18/2013 09/17/2015 F A 06/20/2013 3,649.63 SR A 1,423.00 10/01/2013 10/09/2047
VT4313 OP OP F A 06/24/2013 2,263.90 BO A 800.00 02/01/2014 02/07/2022 F A 06/24/2013 2,263.90 PD A 1,033.78 11/26/2013 02/08/2057 F A 06/24/2013 2,263.90 SD E 1,122.00 12/01/2013 02/08/2057
VT4341 OP OP F A 03/30/2013 1,124.42 BO A 688.08 08/01/2013 06/27/2015 F A 03/30/2013 1,124.42 PS A 393.09 08/01/2013 12/02/2046 F A 03/30/2013 1,124.42 SR E 779.00 04/01/2013 12/02/2046
VT4366 OP OP F A 04/22/2013 960.32 PS A 118.19 04/21/2013 12/22/2049 F A 04/22/2013 960.32 SR A 924.00 10/01/2013 12/22/2049
VT4373 OP OP F A 06/22/2013 3,168.31 PD A 1,332.90 01/15/2014 09/04/2055 F A 06/22/2013 3,168.31 PS A 439.28 03/29/2014 09/04/2055 F A 06/22/2013 3,168.31 SD A 2,041.00 01/01/2014 09/04/2055
VT4384 OP OP F A 07/12/2013 2,920.72 PD A 2,090.64 02/22/2014 10/29/2053 F A 07/12/2013 2,920.72 SD A 1,775.00 01/01/2014 10/29/2053
VT4527 OP OP F A 05/05/2013 3,879.32 BO A 800.00 08/03/2013 08/02/2015 F A 05/05/2013 3,879.32 PD A 2,149.40 10/10/2013 03/03/2067 F A 05/05/2013 3,879.32 SC E 697.00 11/01/2013 12/31/2023 F A 05/05/2013 3,879.32 SD E 1,394.00 11/01/2013 03/03/2067
VT4548 OP OP F A 03/28/2013 1,300.00 SD A 943.00 09/01/2013 03/15/2064
VT5248 OP OP F A 09/24/2013 2,676.70 PD S 1,786.23 11/19/2013 05/29/2056 F A 09/24/2013 2,676.70 SD A 1,551.00 03/01/2014 05/29/2056
VT5288 OP OP F A 06/01/2013 974.32 PD A 658.67 09/21/2013 01/15/2063 F A 06/01/2013 974.32 SD A 970.00 11/01/2013 01/15/2063
VT5493 OP OP F A 05/21/2013 1,731.90 PD A 723.37 09/07/2013 10/25/2055 F A 05/21/2013 1,731.90 SD A 1,129.00 11/01/2013 10/25/2055
VT5506 OP OP F A 06/01/2013 1,413.21 PD S 1,016.94 11/09/2013 04/18/2053 F A 06/01/2013 1,413.21 SD A 1,531.00 02/01/2014 04/18/2053
VT5525 OP OP M A 07/18/2013 1,099.47 BO A 672.84 11/01/2013 02/24/2025
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 45 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VT5525 OP OP M A 07/18/2013 1,099.47 PD A 384.34 10/31/2013 02/25/2060 M A 07/18/2013 1,099.47 SD E 731.00 01/01/2014 02/25/2060
VT5539 OP OP F A 06/12/2013 2,006.28 BO A 800.00 09/10/2013 12/01/2037 F A 06/12/2013 2,006.28 PD A 713.87 12/30/2013 12/02/2072 F A 06/12/2013 2,006.28 SC E 522.50 12/01/2013 10/31/2021 F A 06/12/2013 2,006.28 SD E 1,045.00 12/01/2013 12/02/2072
VT5569 OP OP F A 03/09/2013 1,636.58 PS A 613.88 07/26/2013 12/26/2057 F A 03/09/2013 1,636.58 SD A 1,147.00 12/01/2014 12/26/2057
VT5570 OP OP M A 09/06/2012 1,426.15 BO A 800.00 09/01/2015 06/04/2016 M A 09/06/2012 1,426.15 P1 E 576.57 12/21/2014 12/21/2049 M A 09/06/2012 1,426.15 SD S 195.00 05/20/2013 12/21/2049 M A 09/06/2012 1,426.15 WT S 2,007.31 08/20/2014 08/19/2015
VT5571 OP OP F A 03/27/2013 1,295.89 BO A 660.38 11/01/2013 06/24/2015 F A 03/27/2013 1,295.89 PD S 585.67 10/09/2013 10/05/2079 F A 03/27/2013 1,295.89 SC E 413.50 09/01/2013 02/29/2024 F A 03/27/2013 1,295.89 SD E 827.00 09/01/2013 10/05/2079
VT5597 OP OP F A 02/11/2013 2,291.73 PD A 1,852.43 10/29/2013 04/09/2063 F A 02/11/2013 2,291.73 SD A 1,440.00 01/01/2014 04/09/2063
VT5598 OP OP F A 07/16/2013 1,808.79 PS A 353.49 01/14/2014 11/21/2048 F A 07/16/2013 1,808.79 SD A 1,602.00 01/01/2014 11/21/2048
VT5610 OP OP M A 05/03/2013 1,235.53 PD A 211.21 12/14/2013 05/09/2049 M A 05/03/2013 1,235.53 SD A 1,004.00 11/01/2013 05/09/2049
VT5642 OP OP F A 05/08/2013 962.65 PD A 590.66 12/06/2013 06/27/2059 F A 05/08/2013 962.65 SC E 339.50 11/01/2013 01/31/2025 F A 05/08/2013 962.65 SD A 795.00 02/01/2015 06/27/2059 F A 05/08/2013 962.65 WP A 74.85 02/09/2015 06/26/2029
VT5643 OP OP F A 07/19/2013 2,940.37 PS A 1,966.49 07/19/2013 02/13/2055 F A 07/19/2013 2,940.37 SD A 1,720.00 12/01/2013 02/13/2055
VT5670 OP OP F A 07/02/2013 686.83 SD S 627.00 11/01/2013 03/06/2054
VT5889 OP OP M A 06/01/2013 1,631.88 BO A 800.00 12/01/2013 08/29/2015 M A 06/01/2013 1,631.88 RO S 1,280.37 11/18/2014 02/02/2018
VT6026 OP OP M A 05/10/2013 2,703.79 BO A 800.00 08/08/2013 04/22/2025 M A 05/10/2013 2,703.79 PD A 1,283.87 07/15/2013 04/23/2060 M A 05/10/2013 2,703.79 SD E 1,258.00 11/01/2013 04/23/2060
VT6065 OP OP M A 06/13/2013 1,978.28 BO A 662.72 02/01/2014 02/28/2018
M A 06/13/2013 1,978.28 PD A 827.47 10/03/2013 03/01/2053 M A 06/13/2013 1,978.28 SD S 412.00 02/01/2014 03/01/2053
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 46 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VT6313 OP OP M A 01/02/2013 2,798.43 PD A 2,140.91 09/11/2013 05/19/2057 M A 01/02/2013 2,798.43 SD A 1,541.00 06/01/2013 05/19/2057
VT6366 OP OP F A 07/26/2013 1,952.70 BO A 800.00 10/24/2013 08/26/2033 F A 07/26/2013 1,952.70 PD A 732.49 09/15/2013 08/27/2068 F A 07/26/2013 1,952.70 SD E 1,045.00 01/01/2014 08/27/2068
VT6394 OP OP F A 08/27/2013 2,386.64 PD S 1,256.64 10/30/2013 01/27/2075 F A 08/27/2013 2,386.64 SC S 736.00 02/01/2014 12/31/2025 F A 08/27/2013 2,386.64 SD A 1,473.00 02/01/2014 01/27/2075
VT6659 OP OP M A 01/10/2013 1,342.20 PD A 720.85 05/01/2013 11/14/2050 M A 01/10/2013 1,342.20 SR A 880.00 04/01/2013 11/14/2050 M A 01/10/2013 1,342.20 WT E 3,054.42 01/10/2013 01/09/2016
VT6684 OP OP F A 10/02/2013 3,203.36 BO A 800.00 02/01/2014 10/18/2022 F A 10/02/2013 3,203.36 PS A 1,566.61 06/06/2014 10/19/2057 F A 10/02/2013 3,203.36 SD E 1,336.00 03/01/2014 10/19/2057
VT6909 OP OP F A 05/31/2013 999.44 BO A 800.00 08/29/2013 08/28/2015 F A 05/31/2013 999.44 P1 E 184.51 05/31/2014 12/21/2064 F A 05/31/2013 999.44 SD E 731.00 11/01/2013 12/21/2064
VT6934 OP OP F A 07/23/2013 1,165.61 PD A 440.30 12/07/2013 12/13/2066 F A 07/23/2013 1,165.61 SD A 1,135.00 01/01/2014 12/13/2066
VT6948 OP OP F A 09/13/2013 3,020.66 PD A 2,119.79 12/01/2013 08/02/2071 F A 09/13/2013 3,020.66 SC A 845.00 03/01/2014 02/14/2022 F A 09/13/2013 3,020.66 SD A 1,691.00 03/01/2014 08/02/2071
VT6949 OP OP F A 08/01/2013 1,584.48 BO A 800.00 10/30/2013 10/29/2015 F A 08/01/2013 1,584.48 PD A 560.32 12/24/2013 07/12/2069 F A 08/01/2013 1,584.48 SC E 459.50 01/01/2014 11/30/2019 F A 08/01/2013 1,584.48 SD E 919.00 01/01/2014 07/12/2069
VT6978 OP OP F A 07/30/2013 1,487.62 PS A 303.04 05/01/2014 01/17/2053 F A 07/30/2013 1,487.62 SD A 931.00 01/01/2014 01/17/2053 F A 07/30/2013 1,487.62 WP A 237.34 02/17/2014 04/26/2037
VT7133 OP OP M A 04/09/2013 2,354.61 PD A 573.59 10/19/2013 07/15/2050 M A 04/09/2013 2,354.61 SD A 2,025.00 10/01/2013 07/15/2050
VT7163 OP OP M A 03/22/2013 4,109.63 BO A 75.18 01/01/2014 04/17/2027 M A 03/22/2013 4,109.63 PD A 1,802.38 08/04/2013 04/18/2062 M A 03/22/2013 4,109.63 SD A 2,074.00 01/01/2014 04/18/2062
VT7165 OP OP M A 09/01/2013 1,886.14 PD A 699.78 10/30/2013 11/29/2016 M A 09/01/2013 1,886.14 SD A 1,632.00 02/01/2014 04/08/2050
VT7166 OP OP M A 09/16/2013 2,288.81 PD A 901.24 11/01/2013 08/02/2060
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 47 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VT7166 OP OP M A 09/16/2013 2,288.81 SD E 1,158.00 03/01/2014 08/02/2060
VT7203 OP OP M A 06/20/2013 1,457.47 BO A 800.00 09/18/2013 04/11/2020 M A 06/20/2013 1,457.47 PD A 313.27 12/17/2013 04/12/2055 M A 06/20/2013 1,457.47 SD E 874.00 12/01/2013 04/12/2055
VT7206 OP OP M A 08/20/2013 1,822.00 BO A 498.11 11/18/2013 10/31/2028 M A 08/20/2013 1,822.00 PD S 1,253.82 11/11/2013 11/01/2063 M A 08/20/2013 1,822.00 SC E 502.00 02/01/2014 08/31/2015 M A 08/20/2013 1,822.00 SD E 1,004.00 02/01/2014 11/01/2063
VT7207 OP OP M A 09/28/2013 1,248.98 PD A 497.11 01/01/2014 08/22/2053 M A 09/28/2013 1,248.98 SD A 1,222.00 03/01/2014 08/22/2053
VT7219 OP OP F S 08/13/2013 3,399.43 PD A 1,263.24 11/22/2013 09/18/2067 F S 08/13/2013 3,399.43 SD A 2,032.00 01/01/2014 09/18/2067
VT7259 OP OP F A 07/29/2013 1,192.54 P1 A 152.15 03/27/2014 06/18/2078 F A 07/29/2013 1,192.54 WP A 18.47 09/19/2014 06/17/2048
VT7261 OP OP F A 06/05/2013 1,329.83 BO A 776.00 09/01/2014 05/16/2021 F A 06/05/2013 1,329.83 P1 A 502.68 08/08/2014 05/17/2056 F A 06/05/2013 1,329.83 SD E 827.00 12/01/2013 05/17/2056
VT7532 OP OP M A 06/04/2013 1,639.79 BO A 627.82 02/01/2014 09/01/2015 M A 06/04/2013 1,639.79 PD A 948.90 01/07/2014 12/04/2056 M A 06/04/2013 1,639.79 SD E 962.00 11/01/2013 12/04/2056
VT7554 OP OP M A 08/19/2013 2,043.48 PD A 668.96 02/09/2014 06/12/2055 M A 08/19/2013 2,043.48 SD A 1,548.00 02/01/2014 06/12/2055
VT7562 OP OP M A 06/03/2013 2,537.72 BO A 800.00 09/15/2013 09/22/2029 M A 06/03/2013 2,537.72 PD A 1,493.13 01/21/2014 09/23/2064 M A 06/03/2013 2,537.72 SD E 1,226.00 11/01/2013 09/23/2064
VT7563 OP OP F A 04/17/2013 1,837.43 BO A 800.00 07/16/2013 01/02/2049 F A 04/17/2013 1,837.43 SD E 1,004.00 10/01/2013 01/03/2084
VT7564 OP OP F A 07/31/2013 1,180.04 BO A 183.62 03/01/2014 10/10/2018 F A 07/31/2013 1,180.04 PD S 951.04 02/25/2014 10/11/2053 F A 07/31/2013 1,180.04 SD E 779.00 01/01/2014 10/11/2053
VT7576 OP OP F A 05/24/2013 3,221.08 PD A 2,457.13 12/14/2013 04/04/2069 F A 05/24/2013 3,221.08 SD A 1,794.00 11/01/2013 04/04/2069
VT7588 OP OP F A 08/12/2013 1,584.97 PD A 966.07 11/02/2013 08/09/2058 F A 08/12/2013 1,584.97 SD A 1,020.00 11/01/2013 08/09/2058
VT7612 OP OP M A 07/31/2013 1,167.73 BO A 496.38 12/01/2013 06/30/2032 M A 07/31/2013 1,167.73 PD A 626.43 11/02/2013 07/01/2067
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 48 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VT7612 OP OP M A 07/31/2013 1,167.73 SC E 389.50 01/01/2014 06/30/2017 M A 07/31/2013 1,167.73 SD E 779.00 01/01/2014 07/01/2067
VT7641 OP OP M A 06/14/2013 2,693.18 PD A 1,490.78 11/27/2013 08/14/2052 M A 06/14/2013 2,693.18 SD A 1,707.00 04/01/2014 08/14/2052
VT7699 OP OP F A 07/17/2013 1,570.84 BO A 314.42 01/01/2014 06/07/2020 F A 07/17/2013 1,570.84 SD A 1,196.00 01/01/2014 06/08/2055
VT8444 OP OP F A 08/13/2013 2,420.22 BO A 800.00 11/11/2013 09/02/2031 F A 08/13/2013 2,420.22 SC A 711.00 01/01/2014 03/31/2019 F A 08/13/2013 2,420.22 SD A 1,422.00 01/01/2014 09/03/2066
VT8480 OP OP F A 05/01/2013 1,376.65 BO A 701.93 03/01/2014 07/29/2015 F A 05/01/2013 1,376.65 PD A 621.77 02/25/2014 05/15/2064 F A 05/01/2013 1,376.65 SD E 874.00 10/01/2013 05/15/2064
VT8521 OP OP F A 09/08/2013 1,500.49 BO A 557.55 02/01/2014 12/16/2031 F A 09/08/2013 1,500.49 PL A 693.44 01/30/2014 12/17/2066 F A 09/08/2013 1,500.49 SD E 919.00 03/01/2014 12/17/2066
VT8546 OP OP M A 08/13/2013 05/13/2015 1,627.15 BO A 800.00 11/11/2013 05/13/2015 M A 08/13/2013 05/13/2015 1,627.15 SC E 481.00 02/01/2014 03/31/2029 M A 08/13/2013 05/13/2015 1,627.15 SD E 962.00 02/01/2014 01/04/2082
VT8547 OP OP F A 09/07/2013 904.42 BO A 613.63 02/01/2014 12/05/2015 F A 09/07/2013 904.42 PD A 256.00 01/22/2014 09/23/2059 F A 09/07/2013 904.42 SD E 679.00 03/01/2014 09/23/2059
VT8563 OP OP F A 08/09/2013 1,416.87 BO A 749.40 01/01/2014 07/06/2038 F A 08/09/2013 1,416.87 PD A 612.98 12/11/2013 07/07/2073 F A 08/09/2013 1,416.87 SC E 437.00 02/01/2014 08/31/2025 F A 08/09/2013 1,416.87 SD E 874.00 02/01/2014 07/07/2073
VT8564 OP OP M A 10/24/2013 05/14/2015 3,650.35 PD A 1,673.58 07/01/2014 10/01/2064 M A 10/24/2013 05/14/2015 3,650.35 SD A 2,006.00 04/01/2014 10/01/2064
VT8574 OP OP F A 07/11/2013 1,261.21 PD S 278.48 08/26/2014 11/29/2055 F A 07/11/2013 1,261.21 SD A 1,466.00 01/01/2014 11/29/2055 F A 07/11/2013 1,261.21 WT S 1,418.36 08/02/2013 07/10/2016
VT8579 OP OP F A 06/25/2013 05/03/2015 738.58 PS A 188.05 01/16/2014 09/27/2051 F A 06/25/2013 05/03/2015 738.58 SD A 781.00 01/01/2014 09/27/2051
VT8717 OP OP M A 08/19/2013 1,165.61 SD A 1,303.00 03/01/2014 06/25/2062
VT8719 OP OP F A 08/07/2013 1,933.75 BO A 800.00 11/05/2013 06/29/2032 F A 08/07/2013 1,933.75 SD E 1,045.00 02/01/2014 06/30/2067
VT8720 OP OP F A 08/20/2013 1,605.50 BO A 800.00 11/18/2013 02/19/2035
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 49 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VT8720 OP OP F A 08/20/2013 1,605.50 SC E 459.50 02/01/2014 01/31/2022 F A 08/20/2013 1,605.50 SD E 919.00 02/01/2014 02/20/2070
VT8737 OP OP F A 07/22/2013 1,104.18 PD S 224.97 12/12/2013 08/27/2050 F A 07/22/2013 1,104.18 SD A 1,245.00 01/01/2014 08/27/2050
VT8749 OP OP F A 10/01/2013 3,041.19 BO A 16.96 12/30/2013 12/29/2015 F A 10/01/2013 3,041.19 PD A 2,907.26 07/01/2013 01/25/2064 F A 10/01/2013 3,041.19 RO S 400.00 01/01/2015 01/24/2029 F A 10/01/2013 3,041.19 SD E 1,310.00 03/01/2014 01/25/2064
VT8773 OP OP F A 08/24/2013 623.44 PD A 664.51 12/14/2013 05/23/2066 F A 08/24/2013 623.44 SC E 287.00 02/01/2014 08/31/2018 F A 08/24/2013 623.44 SD E 574.00 02/01/2014 05/23/2066
VT9060 OP OP M A 11/05/2013 2,345.58 PD A 1,183.19 04/01/2014 05/28/2052 M A 11/05/2013 2,345.58 SD A 1,513.00 05/01/2014 05/28/2052
VT9074 OP OP F A 11/09/2013 809.69 PD A 478.36 12/24/2013 07/19/2063 F A 11/09/2013 809.69 SD A 754.00 05/01/2014 07/19/2063
VT9085 OP OP F A 06/04/2013 1,686.75 BO A 800.00 09/02/2013 03/02/2019 F A 06/04/2013 1,686.75 SD E 962.00 12/01/2013 03/03/2054
VT9129 LT LS F A 10/04/2009 333.39 0.00
VT9131 LT LS M A 10/15/2010 941.62 0.00
VT9133 LT LS F A 01/28/2010 169.30 0.00
VT9135 LT LS M A 12/15/2011 100.00 0.00
VT9672 OP OP F A 10/12/2013 5,157.30 BO A 800.00 01/10/2014 08/13/2018 F A 10/12/2013 5,157.30 SD E 1,394.00 12/01/2014 08/14/2053
VT9678 OP OP F A 07/18/2013 1,582.20 BO A 800.00 10/16/2013 09/19/2023 F A 07/18/2013 1,582.20 PD A 439.50 01/13/2014 09/20/2058 F A 07/18/2013 1,582.20 SD E 919.00 01/01/2014 09/20/2058
VT9684 OP OP F A 08/31/2013 1,191.01 P1 A 587.77 08/31/2013 11/25/2021 F A 08/31/2013 1,191.01 SD A 986.00 02/01/2014 03/14/2056
VT9686 OP OP F A 07/02/2013 2,299.70 BO A 724.90 07/01/2016 07/31/2016 F A 07/02/2013 2,299.70 BO A 796.80 08/01/2016 10/05/2019 F A 07/02/2013 2,299.70 PD A 1,414.45 03/22/2014 10/06/2054 F A 07/02/2013 2,299.70 SD E 1,158.00 12/01/2013 10/06/2054 F A 07/02/2013 2,299.70 WT S 2,228.85 07/02/2013 07/01/2016
VT9697 OP OP F A 08/19/2013 1,874.11 BO A 800.00 12/01/2013 04/23/2021 F A 08/19/2013 1,874.11 PD A 828.72 01/14/2014 04/24/2056
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 50 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VT9697 OP OP F A 08/19/2013 1,874.11 SD E 1,004.00 02/01/2014 04/24/2056
VU0115 OP OP F A 06/01/2013 845.00 PD S 358.54 03/22/2014 08/02/2057 F A 06/01/2013 845.00 SD A 833.00 11/01/2013 08/02/2057
VU0150 OP OP F A 12/21/2013 2,638.89 BO A 800.00 03/21/2014 08/30/2032 F A 12/21/2013 2,638.89 P1 S 1,400.00 03/21/2014 08/31/2067 F A 12/21/2013 2,638.89 SD E 1,226.00 06/01/2014 08/31/2067
VU0152 OP OP F A 09/24/2013 1,063.08 BO A 800.00 12/23/2013 04/23/2024 F A 09/24/2013 1,063.08 SC E 365.50 03/01/2014 04/30/2017 F A 09/24/2013 1,063.08 SD E 731.00 03/01/2014 04/24/2059
VU0181 OP OP F A 07/22/2013 975.76 PD A 429.27 12/04/2013 06/05/2053 F A 07/22/2013 975.76 SD A 715.00 01/01/2014 06/05/2053
VU0192 OP OP M A 09/30/2013 1,621.95 BO A 800.00 12/29/2013 12/28/2015 M A 09/30/2013 1,621.95 SD E 919.00 03/01/2014 09/09/2065
VU0360 OP OP F A 06/08/2013 1,202.01 PD S 799.95 10/30/2013 06/21/2054 F A 06/08/2013 1,202.01 SD A 830.00 01/01/2014 06/21/2054
VU0361 OP OP F A 07/18/2013 1,066.21 BO A 191.04 01/01/2016 01/31/2016 F A 07/18/2013 1,066.21 BO A 749.87 02/01/2016 01/21/2047 F A 07/18/2013 1,066.21 P1 A 275.34 08/13/2014 01/22/2082 F A 07/18/2013 1,066.21 SD E 731.00 12/01/2013 01/22/2082 F A 07/18/2013 1,066.21 WT S 1,082.73 08/13/2013 01/16/2016
VU0371 OP OP M A 08/09/2013 2,042.20 PD A 1,332.08 11/23/2013 01/15/2060 M A 08/09/2013 2,042.20 SD A 1,403.00 01/01/2014 01/15/2060
VU0372 OP OP F A 09/03/2013 1,097.51 PD A 603.02 01/08/2014 01/16/2064 F A 09/03/2013 1,097.51 SD A 1,024.00 07/01/2014 01/16/2064
VU0373 OP OP F A 10/19/2013 2,210.81 PD A 731.26 04/07/2014 07/09/2080 F A 10/19/2013 2,210.81 SC E 561.00 04/01/2014 11/30/2028 F A 10/19/2013 2,210.81 SD E 1,122.00 04/01/2014 07/09/2080
VU0374 OP OP F A 04/16/2013 1,677.75 PD A 324.15 01/11/2014 01/16/2060 F A 04/16/2013 1,677.75 SD E 962.00 10/01/2013 01/16/2060 F A 04/16/2013 1,677.75 WT S 1,891.09 04/16/2013 04/15/2016
VU0403 OP OP M A 10/26/2013 2,040.62 BO A 800.00 01/24/2014 10/03/2043 M A 10/26/2013 2,040.62 P1 E 376.73 10/24/2014 10/04/2078 M A 10/26/2013 2,040.62 SC E 542.00 04/01/2014 06/30/2030 M A 10/26/2013 2,040.62 SD E 1,084.00 04/01/2014 10/04/2078
VU0417 OP OP F A 09/28/2013 2,626.69 BO A 800.00 02/01/2014 05/13/2025
F A 09/28/2013 2,626.69 PD A 1,369.52 01/08/2014 05/14/2060 F A 09/28/2013 2,626.69 SD E 1,226.00 03/01/2014 05/14/2060
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 51 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU0419 OP OP F A 04/12/2013 1,456.23 PS A 373.33 12/27/2013 03/18/2052 F A 04/12/2013 1,456.23 SD E 874.00 10/01/2013 03/18/2052 F A 04/12/2013 1,456.23 SR A 221.00 05/01/2014 03/18/2052 F A 04/12/2013 1,456.23 WT S 1,551.99 07/11/2013 07/10/2016
VU0432 OP OP M A 09/25/2013 2,375.93 BO A 800.00 12/24/2013 03/27/2026 M A 09/25/2013 2,375.93 SD E 1,158.00 03/01/2014 03/28/2061
VU0433 OP OP F A 09/25/2013 1,128.80 PS A 348.18 09/23/2013 09/23/2053 F A 09/25/2013 1,128.80 SD A 1,010.00 03/01/2014 09/23/2053
VU0454 OP OP F A 09/20/2013 2,686.89 PD A 1,479.93 05/19/2014 05/19/2054 F A 09/20/2013 2,686.89 SD A 1,409.00 03/01/2014 05/19/2054
VU0466 OP OP M A 05/25/2013 2,676.59 BO A 800.00 05/01/2014 11/27/2025 M A 05/25/2013 2,676.59 P1 E 494.14 05/25/2014 11/28/2060 M A 05/25/2013 2,676.59 SD E 1,258.00 11/01/2013 11/28/2060 M A 05/25/2013 2,676.59 WP A 27.82 05/02/2014 11/01/2040
VU0476 OP OP M A 08/19/2013 2,631.82 PD A 2,930.86 03/26/2014 06/02/2060
VU0736 OP OP F A 10/03/2013 996.94 PD A 709.74 12/04/2013 10/08/2061 F A 10/03/2013 996.94 SD A 908.00 04/01/2014 10/08/2061
VU0786 OP OP M A 08/26/2013 1,684.59 PD A 584.00 02/22/2014 02/14/2054 M A 08/26/2013 1,684.59 SD A 1,462.00 02/01/2014 02/14/2054
VU0924 OP OP F A 12/12/2013 1,786.47 BO A 800.00 03/12/2014 04/06/2032 F A 12/12/2013 1,786.47 PD A 610.54 01/04/2014 04/07/2067 F A 12/12/2013 1,786.47 SC E 502.00 06/01/2014 06/30/2018 F A 12/12/2013 1,786.47 SD E 1,004.00 06/01/2014 04/07/2067
VU0939 OP OP F A 06/21/2013 1,378.21 BO A 647.53 03/01/2014 05/25/2030 F A 06/21/2013 1,378.21 PD A 572.20 02/25/2014 05/26/2065 F A 06/21/2013 1,378.21 PS A 105.48 02/25/2014 05/26/2065 F A 06/21/2013 1,378.21 SC E 437.00 12/01/2013 11/30/2024 F A 06/21/2013 1,378.21 SD E 874.00 12/01/2013 05/26/2065 F A 06/21/2013 1,378.21 WT E 3,222.54 06/21/2013 06/20/2016
VU0977 OP OP M A 08/21/2013 2,416.55 BO A 800.00 12/01/2013 11/18/2015 M A 08/21/2013 2,416.55 PD S 1,179.67 01/24/2014 05/17/2056 M A 08/21/2013 2,416.55 SD E 1,193.00 02/01/2014 05/17/2056
VU1221 OP OP F A 10/17/2013 1,696.83 BO A 800.00 01/15/2014 01/14/2016 F A 10/17/2013 1,696.83 PD A 663.93 01/17/2014 07/15/2066 F A 10/17/2013 1,696.83 SC E 481.00 04/01/2014 04/30/2017 F A 10/17/2013 1,696.83 SD E 962.00 04/01/2014 07/15/2066
VU1233 OP OP M A 09/18/2013 1,165.61 PD A 332.20 03/05/2014 04/29/2059 M A 09/18/2013 1,165.61 SD A 1,550.00 03/01/2014 04/29/2059
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 52 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU1235 OP OP F A 06/29/2013 1,173.85 PD S 431.16 11/02/2014 04/01/2056 F A 06/29/2013 1,173.85 SD A 1,050.00 12/01/2013 04/01/2056
VU1248 OP OP F A 12/06/2013 3,070.22 BO A 800.00 03/06/2014 03/05/2016 F A 12/06/2013 3,070.22 PD S 1,807.65 04/26/2014 10/18/2062 F A 12/06/2013 3,070.22 SD E 1,323.00 06/01/2014 10/18/2062
VU1249 OP OP M A 10/02/2013 2,136.28 PD A 909.23 11/30/2013 04/15/2053 M A 10/02/2013 2,136.28 SD A 1,151.00 03/01/2014 04/15/2053
VU1273 OP OP M A 10/22/2013 1,799.20 BO A 800.00 01/20/2014 12/18/2036 M A 10/22/2013 1,799.20 SC E 502.00 04/01/2014 11/30/2020 M A 10/22/2013 1,799.20 SD E 1,004.00 04/01/2014 12/19/2071
VU1280 OP OP M A 08/06/2013 2,152.96 PD A 1,952.48 01/25/2014 12/06/2078 M A 08/06/2013 2,152.96 SD A 1,274.00 06/01/2014 12/06/2078
VU1288 OP OP F A 08/22/2013 1,708.46 P1 E 315.41 08/22/2014 08/20/2066 F A 08/22/2013 1,708.46 SD E 962.00 02/01/2014 08/20/2066
VU1914 OP OP M A 11/22/2013 2,336.05 BO A 109.76 05/01/2014 02/19/2016 M A 11/22/2013 2,336.05 PD A 707.44 01/12/2014 07/06/2050 M A 11/22/2013 2,336.05 SD A 1,429.00 05/01/2014 07/06/2050
VU1989 OP OP M A 07/01/2013 1,039.16 BO A 683.63 02/01/2014 09/28/2015 M A 07/01/2013 1,039.16 PS A 315.56 02/01/2014 02/19/2048
VU2171 OP OP M A 08/30/2013 2,744.83 BO A 800.00 11/28/2013 09/05/2035 M A 08/30/2013 2,744.83 SC A 792.00 02/01/2014 11/30/2022 M A 08/30/2013 2,744.83 SD A 1,584.00 02/01/2014 09/06/2070
VU2206 OP OP F A 01/21/2014 07/30/2015 1,332.06 PD A 706.77 02/02/2014 09/07/2062 F A 01/21/2014 07/30/2015 1,332.06 SD S 996.00 03/01/2014 09/07/2062
VU2221 OP OP F A 09/25/2013 1,073.10 BO A 786.11 04/01/2014 12/23/2015 F A 09/25/2013 1,073.10 P1 A 245.72 03/07/2014 09/07/2062 F A 09/25/2013 1,073.10 SD E 731.00 03/01/2014 09/07/2062
VU2227 OP OP M A 01/03/2014 2,843.52 BO A 303.38 09/01/2014 04/02/2017 M A 01/03/2014 2,843.52 PD A 747.77 06/08/2014 11/04/2050 M A 01/03/2014 2,843.52 SD A 1,683.00 07/01/2014 11/04/2050
VU2273 OP OP F A 04/19/2013 1,297.58 PS A 723.26 04/19/2013 01/11/2054 F A 04/19/2013 1,297.58 SD A 1,044.00 10/01/2013 01/11/2054
VU2274 OP OP F A 05/14/2013 3,450.20 BO A 94.96 08/01/2014 08/11/2015 F A 05/14/2013 3,450.20 WT S 3,222.54 07/07/2014 10/01/2016
VU2297 OP OP F A 08/21/2013 1,177.35 BO A 800.00 11/01/2014 11/18/2015 F A 08/21/2013 1,177.35 P1 E 217.36 12/16/2014 08/06/2066
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 53 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU2297 OP OP F A 08/21/2013 1,177.35 SD E 779.00 06/01/2014 08/06/2066 F A 08/21/2013 1,177.35 WP A 31.59 10/23/2014 08/05/2036
VU2503 OP OP F A 12/16/2013 3,063.18 PD A 1,660.75 03/15/2014 01/24/2067 F A 12/16/2013 3,063.18 SD A 1,639.00 06/01/2014 06/01/2050
VU2512 OP OP F A 10/03/2013 2,558.61 PD A 685.45 01/15/2014 02/12/2059 F A 10/03/2013 2,558.61 SD A 1,987.00 04/01/2014 02/12/2059
VU2513 OP OP F A 09/27/2013 1,470.30 BO A 800.00 12/26/2013 12/25/2015 F A 09/27/2013 1,470.30 SD E 874.00 03/01/2014 01/09/2067
VU2537 OP OP F A 10/12/2013 2,835.19 BO A 679.34 01/10/2014 04/11/2035 F A 10/12/2013 2,835.19 PD A 2,046.80 12/18/2013 04/12/2070 F A 10/12/2013 2,835.19 SD E 1,288.00 04/01/2014 04/12/2070
VU2548 OP OP F A 01/11/2014 1,767.83 BO A 332.31 10/01/2014 10/10/2016 F A 01/11/2014 1,767.83 PD S 299.53 01/22/2014 05/18/2049 F A 01/11/2014 1,767.83 SD A 1,068.00 10/01/2014 05/18/2049
VU2550 OP OP F A 09/02/2013 1,078.40 SD E 731.00 03/01/2014 01/11/2066
VU2574 OP OP F A 06/18/2013 1,026.67 BO A 731.83 08/01/2016 08/31/2016 F A 06/18/2013 1,026.67 BO A 797.53 09/01/2016 10/15/2024 F A 06/18/2013 1,026.67 P1 A 189.65 03/22/2014 10/16/2059 F A 06/18/2013 1,026.67 SD E 731.00 12/01/2013 10/16/2059 F A 06/18/2013 1,026.67 WT A 1,018.30 08/02/2013 08/02/2016
VU2583 OP OP F A 11/06/2013 818.95 BO A 787.45 02/04/2014 09/09/2029 F A 11/06/2013 818.95 SD E 627.00 05/01/2014 09/10/2064
VU2824 OP OP F A 11/11/2013 3,119.92 BO A 800.00 05/01/2014 08/08/2016 F A 11/11/2013 3,119.92 PD A 966.14 05/02/2014 05/02/2049 F A 11/11/2013 3,119.92 SD E 1,323.00 05/01/2014 05/02/2049 F A 11/11/2013 3,119.92 SR A 1,037.00 04/01/2014 05/02/2049
VU2856 OP OP M A 01/14/2014 1,464.66 PD S 325.07 04/03/2014 09/01/2066 M A 01/14/2014 1,464.66 SD A 1,160.00 08/01/2014 09/01/2066
VU3315 OP OP F A 10/24/2013 2,782.33 BO A 800.00 01/22/2014 04/27/2028 F A 10/24/2013 2,782.33 P1 E 513.66 10/24/2014 04/28/2063 F A 10/24/2013 2,782.33 SD E 1,258.00 04/01/2014 04/28/2063
VU3317 OP OP M A 11/16/2013 1,672.78 BO A 330.44 05/01/2014 07/02/2019 M A 11/16/2013 1,672.78 SD A 1,278.00 05/01/2014 07/03/2054
VU3319 OP OP F A 07/30/2013 1,301.03 P1 E 240.19 07/31/2014 09/18/2063 F A 07/30/2013 1,301.03 SD E 827.00 01/01/2014 09/18/2063
F A 07/30/2013 1,301.03 WT S 1,401.12 08/02/2013 08/01/2016
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 54 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU3384 OP OP F A 12/07/2013 2,887.72 BO A 800.00 03/07/2014 03/06/2016 F A 12/07/2013 2,887.72 P1 E 200.00 12/07/2014 01/01/2080
VU3391 OP OP M A 10/21/2013 2,173.66 PD A 1,286.00 01/11/2014 12/10/2053 M A 10/21/2013 2,173.66 SD A 1,501.00 04/01/2014 12/10/2053
VU3473 OP OP F A 11/02/2013 2,750.53 BO A 800.00 01/31/2014 08/28/2037 F A 11/02/2013 2,750.53 P1 E 507.79 11/02/2014 08/29/2072 F A 11/02/2013 2,750.53 SC E 629.00 04/01/2014 02/28/2029 F A 11/02/2013 2,750.53 SD E 1,258.00 04/01/2014 08/29/2072
VU3487 OP OP M A 12/02/2013 1,652.35 BO A 535.32 12/01/2016 12/31/2016 M A 12/02/2013 1,652.35 BO A 598.42 01/01/2017 12/19/2033 M A 12/02/2013 1,652.35 PD A 990.38 04/18/2014 12/20/2068 M A 12/02/2013 1,652.35 SD E 962.00 05/01/2014 12/20/2068 M A 12/02/2013 1,652.35 WT S 1,956.09 12/01/2013 12/01/2016
VU3832 OP OP F S 11/04/2013 1,838.61 BO A 399.28 02/02/2014 02/26/2023 F S 11/04/2013 1,838.61 PD A 1,368.61 10/01/2013 02/27/2058 F S 11/04/2013 1,838.61 SD E 1,004.00 04/01/2014 02/27/2058
VU3833 OP OP F A 10/17/2013 2,069.11 BO A 800.00 01/15/2014 01/14/2016 F A 10/17/2013 2,069.11 P1 E 381.99 10/17/2014 08/31/2085 F A 10/17/2013 2,069.11 SD E 1,084.00 04/01/2014 08/31/2085
VU3882 OP OP F A 12/06/2013 2,666.30 P1 E 796.33 12/06/2014 11/26/2047 F A 12/06/2013 2,666.30 WT S 2,780.44 02/14/2014 02/13/2017
VU3884 OP OP F A 08/10/2013 871.08 SD A 861.00 03/01/2014 12/09/2078
VU3897 OP OP F A 01/24/2014 3,219.13 BO A 800.00 04/24/2014 02/12/2019 F A 01/24/2014 3,219.13 SD E 1,336.00 07/01/2014 02/13/2054
VU4612 OP OP F A 12/05/2013 1,559.68 BO A 800.00 03/05/2014 03/31/2039 F A 12/05/2013 1,559.68 P1 E 200.00 12/05/2014 04/01/2074 F A 12/05/2013 1,559.68 SD E 919.00 06/01/2014 04/01/2074
VU4613 OP OP F S 11/15/2013 1,401.08 BO A 800.00 03/01/2014 08/10/2046 F S 11/15/2013 1,401.08 P1 E 258.66 11/12/2014 08/11/2081 F S 11/15/2013 1,401.08 SD E 874.00 05/01/2014 08/11/2081
VU4616 OP OP M A 07/16/2013 1,602.13 BO A 463.07 11/01/2016 11/30/2016 M A 07/16/2013 1,602.13 BO A 797.69 12/01/2016 07/24/2033 M A 07/16/2013 1,602.13 PD A 742.82 05/01/2014 07/25/2068 M A 07/16/2013 1,602.13 WT S 1,673.10 11/07/2013 11/06/2016
VU4637 OP OP M A 01/23/2014 05/06/2015 1,062.98 BO A 800.00 04/23/2014 05/06/2015 M A 01/23/2014 05/06/2015 1,062.98 P1 E 200.00 01/23/2015 10/08/2058
M A 01/23/2014 05/06/2015 1,062.98 SD E 731.00 07/01/2014 10/08/2058
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 55 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU6800 OP OP F A 12/06/2013 893.33 SD A 862.00 06/01/2014 06/28/2056
VU6806 OP OP F A 08/26/2013 4,517.97 BO A 800.00 01/01/2014 11/12/2029 F A 08/26/2013 4,517.97 SD E 1,394.00 02/01/2014 11/13/2064
VU6810 OP OP F A 09/13/2013 8,000.00 BO A 800.00 06/01/2014 06/11/2015 F A 09/13/2013 8,000.00 SR A 2,592.00 06/01/2014 07/12/2046
VU6817 OP OP F A 12/14/2013 1,391.80 PD A 837.59 01/04/2014 02/12/2052 F A 12/14/2013 1,391.80 SD A 1,085.00 06/01/2014 02/12/2052
VU6823 OP OP M A 11/20/2013 1,873.35 PD A 1,494.95 04/17/2014 03/11/2061 M A 11/20/2013 1,873.35 PS A 93.09 04/17/2014 03/11/2061 M A 11/20/2013 1,873.35 SD A 1,830.00 10/01/2014 03/11/2061
VU6846 OP OP M A 10/25/2013 3,334.14 P1 S 2,000.00 03/01/2014 05/16/2055 M A 10/25/2013 3,334.14 SD A 2,147.00 07/01/2014 05/16/2055
VU6848 OP OP F A 09/05/2013 1,109.01 BO A 800.00 10/02/2014 03/04/2019 F A 09/05/2013 1,109.01 P1 E 200.00 09/04/2014 03/05/2054 F A 09/05/2013 1,109.01 SD E 779.00 03/01/2014 03/05/2054 F A 09/05/2013 1,109.01 WP A 60.62 01/26/2015 10/22/2037
VU6850 OP OP M A 11/29/2013 1,625.00 BO A 800.00 04/01/2014 07/14/2038 M A 11/29/2013 1,625.00 SC E 481.00 05/01/2014 03/31/2026 M A 11/29/2013 1,625.00 SD E 962.00 05/01/2014 07/15/2073
VU6857 OP OP M A 08/16/2013 1,102.89 BO A 800.00 11/14/2013 09/09/2047 M A 08/16/2013 1,102.89 P1 E 214.44 03/20/2014 09/10/2082 M A 08/16/2013 1,102.89 SC E 365.50 02/01/2014 09/30/2026 M A 08/16/2013 1,102.89 SD E 731.00 02/01/2014 09/10/2082 M A 08/16/2013 1,102.89 WT E 971.00 08/16/2013 08/15/2016
VU6876 OP OP F A 11/13/2013 4,492.73 BO A 800.00 02/11/2014 05/08/2032 F A 11/13/2013 4,492.73 RO S 3,738.31 03/01/2015 05/08/2032
VU6885 OP OP F A 02/10/2014 2,321.59 BO A 572.98 05/11/2014 11/26/2029 F A 02/10/2014 2,321.59 PD A 1,659.31 05/01/2014 11/27/2064 F A 02/10/2014 2,321.59 SD E 1,158.00 08/01/2014 11/27/2064
VU6887 OP OP F A 01/02/2014 1,873.09 BO A 307.52 04/12/2014 07/01/2048 F A 01/02/2014 1,873.09 P1 A 362.52 03/12/2014 07/02/2083 F A 01/02/2014 1,873.09 SD A 1,131.00 01/01/2014 07/02/2083
VU6890 OP OP F A 02/07/2014 730.72 BO A 702.61 05/08/2014 08/27/2030 F A 02/07/2014 730.72 SD E 627.00 08/01/2014 08/28/2065
VU6899 OP OP F A 11/01/2013 05/02/2015 1,643.87 BO A 223.81 09/01/2014 05/02/2015
F A 11/01/2013 05/02/2015 1,643.87 PD S 1,332.91 08/31/2014 12/09/2076 F A 11/01/2013 05/02/2015 1,643.87 SD E 962.00 04/01/2014 12/09/2076
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 56 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU6899 OP OP F A 11/01/2013 05/02/2015 1,643.87 WP A 23.92 10/07/2013 12/08/2046
VU7427 OP OP F A 03/29/2014 3,063.76 BO A 800.00 06/27/2014 06/26/2016 F A 03/29/2014 3,063.76 PD A 1,621.97 03/29/2014 04/21/2056 F A 03/29/2014 3,063.76 SD E 1,323.00 09/01/2014 04/21/2056
VU7441 OP OP F A 10/24/2013 3,589.06 PD A 2,316.42 11/27/2013 11/13/2054 F A 10/24/2013 3,589.06 SD A 2,090.00 04/01/2014 11/13/2054
VU7448 OP OP F A 02/04/2014 2,351.97 P1 E 434.21 01/31/2015 03/04/2059 F A 02/04/2014 2,351.97 SD E 1,158.00 07/01/2014 03/04/2059
VU7463 OP OP F A 10/29/2013 830.26 P1 E 160.19 10/28/2014 04/29/2060 F A 10/29/2013 830.26 SD E 627.00 04/01/2014 04/29/2060
VU7465 OP OP F A 12/11/2013 1,403.77 PD S 313.62 11/01/2014 10/21/2064 F A 12/11/2013 1,403.77 SC E 437.00 06/01/2014 09/30/2015 F A 12/11/2013 1,403.77 SD A 1,498.00 04/01/2015 10/21/2064
VU7466 OP OP M A 03/21/2014 1,350.53 BO A 180.51 09/01/2014 06/18/2016 M A 03/21/2014 1,350.53 PD A 319.08 04/12/2014 11/10/2050 M A 03/21/2014 1,350.53 SD A 799.00 09/01/2014 11/10/2050
VU7467 OP OP F A 02/20/2014 655.09 BO A 629.89 05/21/2014 01/22/2026 F A 02/20/2014 655.09 SD E 574.00 08/01/2014 01/23/2061
VU7490 OP OP F A 01/17/2014 3,397.64 BO A 800.00 04/17/2014 02/23/2019 F A 01/17/2014 3,397.64 P1 E 652.36 01/17/2015 02/24/2054 F A 01/17/2014 3,397.64 SD E 1,347.00 07/01/2014 02/24/2054
VU7495 OP OP F A 04/02/2014 2,253.99 BO A 10.66 09/01/2014 06/30/2017 F A 04/02/2014 2,253.99 PD A 457.63 04/03/2014 06/02/2050 F A 04/02/2014 2,253.99 SD A 1,699.00 09/01/2014 06/02/2050
VU7506 OP OP F A 10/04/2013 1,169.81 BO A 800.00 10/01/2014 01/01/2016 F A 10/04/2013 1,169.81 P1 E 215.96 10/04/2014 06/22/2062 F A 10/04/2013 1,169.81 SD E 779.00 04/01/2014 06/22/2062 F A 10/04/2013 1,169.81 WP A 140.82 09/18/2014 02/07/2037
VU7508 OP OP F A 09/04/2013 1,561.46 BO A 384.81 05/01/2014 04/12/2034 F A 09/04/2013 1,561.46 PD A 1,116.59 04/29/2014 04/13/2069 F A 09/04/2013 1,561.46 SC E 459.50 03/01/2014 10/31/2019 F A 09/04/2013 1,561.46 SD E 919.00 03/01/2014 04/13/2069
VU7512 OP OP F A 11/08/2013 2,358.51 PD A 1,035.15 05/01/2014 01/13/2055 F A 11/08/2013 2,358.51 SD A 1,269.00 04/01/2014 01/13/2055
VU7513 OP OP M A 10/13/2013 2,941.69 PD A 1,546.31 03/08/2014 09/15/2063
M A 10/13/2013 2,941.69 SD A 1,612.00 04/01/2014 09/15/2063
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 57 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU7524 OP OP M A 04/05/2013 1,411.25 BO A 800.00 06/01/2014 01/01/2037 M A 04/05/2013 1,411.25 P1 A 365.10 01/26/2014 01/02/2072 M A 04/05/2013 1,411.25 SD E 874.00 10/01/2013 01/02/2072
VU7534 OP OP M A 01/17/2014 1,807.16 BO A 800.00 04/17/2014 04/14/2025 M A 01/17/2014 1,807.16 P1 E 200.00 01/17/2015 04/15/2060 M A 01/17/2014 1,807.16 SD E 1,004.00 07/01/2014 04/15/2060
VU7548 OP OP F A 11/23/2013 2,113.96 BO A 800.00 02/21/2014 02/20/2016 F A 11/23/2013 2,113.96 P1 E 390.27 11/23/2014 02/07/2071 F A 11/23/2013 2,113.96 SD E 1,084.00 05/01/2014 02/07/2071
VU7554 OP OP M A 01/25/2014 2,096.85 P1 E 200.00 01/25/2015 07/11/2064 M A 01/25/2014 2,096.85 SD S 1,527.00 07/01/2014 07/11/2064
VU7564 OP OP F A 08/08/2013 1,553.89 BO A 133.13 12/01/2013 11/05/2015 F A 08/08/2013 1,553.89 P1 E 540.02 08/08/2014 01/22/2054 F A 08/08/2013 1,553.89 SD A 1,361.00 12/01/2013 01/22/2054
VU7583 OP OP F A 03/15/2014 1,494.62 BO A 175.14 09/01/2014 12/12/2017 F A 03/15/2014 1,494.62 P1 E 1,132.72 03/14/2015 11/29/2052 F A 03/15/2014 1,494.62 SD A 1,262.00 09/01/2014 11/29/2052
VU7584 OP OP F A 10/07/2013 4,879.24 BO A 800.00 03/01/2015 11/16/2036 F A 10/07/2013 4,879.24 RO S 0.00 02/07/2015 01/25/2016 F A 10/07/2013 4,879.24 SD E 1,394.00 04/01/2014 11/17/2071
VU7585 OP OP F A 11/20/2013 835.97 BO A 800.00 02/25/2014 04/22/2034 F A 11/20/2013 835.97 P1 E 154.33 11/19/2014 04/23/2069 F A 11/20/2013 835.97 SD E 627.00 05/01/2014 04/23/2069
VU7613 OP OP F A 12/21/2013 858.76 SD A 877.00 06/01/2014 12/04/2071
VU7624 OP OP M A 11/12/2013 1,885.79 BO A 580.34 12/01/2014 10/09/2031 M A 11/12/2013 1,885.79 PD S 1,232.92 11/06/2014 10/10/2066 M A 11/12/2013 1,885.79 SD E 1,045.00 05/01/2014 10/10/2066
VU7633 OP OP F A 02/08/2014 1,349.88 BO A 772.98 05/09/2014 05/08/2016 F A 02/08/2014 1,349.88 PD A 524.98 02/08/2014 04/04/2060 F A 02/08/2014 1,349.88 SD E 827.00 08/01/2014 04/04/2060
VU7662 OP OP F A 11/14/2013 1,089.63 BO A 800.00 02/01/2015 04/19/2032 F A 11/14/2013 1,089.63 P1 E 201.16 11/13/2013 04/20/2067 F A 11/14/2013 1,089.63 SD E 731.00 05/01/2014 04/20/2067 F A 11/14/2013 1,089.63 WP A 162.96 02/02/2015 05/24/2050
VU7676 OP OP F A 10/25/2013 3,088.49 BO A 800.00 05/01/2014 01/22/2016 F A 10/25/2013 3,088.49 P1 E 200.00 10/25/2014 05/03/2054
F A 10/25/2013 3,088.49 SD E 1,323.00 04/01/2014 05/03/2054
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 58 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU7678 OP OP F A 12/12/2013 1,345.55 PD S 555.54 11/05/2014 09/28/2059 F A 12/12/2013 1,345.55 SD A 1,071.00 06/01/2014 09/28/2059
VU7692 OP OP M A 02/20/2014 1,634.23 PD S 371.83 05/03/2014 12/15/2075 M A 02/20/2014 1,634.23 SC E 481.00 08/01/2014 07/31/2030 M A 02/20/2014 1,634.23 SD S 1,573.00 08/01/2014 12/15/2075
VU7705 OP OP F A 02/17/2014 2,153.23 BO A 800.00 05/18/2014 07/18/2021 F A 02/17/2014 2,153.23 PS S 889.96 08/23/2014 07/19/2056 F A 02/17/2014 2,153.23 SD E 1,122.00 08/01/2014 07/19/2056
VU7728 OP OP F A 12/19/2013 940.00 BO A 653.14 02/01/2015 06/26/2020 F A 12/19/2013 940.00 P1 E 157.54 12/19/2014 06/27/2055 F A 12/19/2013 940.00 SC E 339.50 06/01/2014 06/30/2017 F A 12/19/2013 940.00 SD E 679.00 06/01/2014 06/27/2055 F A 12/19/2013 940.00 WP A 250.71 02/01/2015 01/27/2037
VU7771 OP OP M A 06/20/2013 3,880.50 BO A 800.00 10/01/2014 05/24/2022 M A 06/20/2013 3,880.50 SD A 1,728.00 01/01/2014 05/25/2057
VU7775 OP OP M A 03/01/2014 1,562.06 PS A 705.98 02/15/2014 01/12/2052 M A 03/01/2014 1,562.06 SD A 1,081.00 08/01/2014 01/12/2052
VU7785 OP OP M A 11/22/2013 3,080.79 P1 S 1,400.00 06/04/2014 06/29/2059 M A 11/22/2013 3,080.79 SD A 1,759.00 05/01/2014 06/29/2059
VU7786 OP OP F A 11/09/2013 446.43 SR E 476.00 12/01/2013 02/25/2046
VU7963 OP OP F A 10/29/2013 815.05 BO A 631.76 08/01/2014 01/26/2016 F A 10/29/2013 815.05 PL A 151.94 07/06/2014 10/03/2074 F A 10/29/2013 815.05 SD E 627.00 04/01/2014 10/03/2074
VU8600 OP OP M A 04/13/2013 1,828.83 BO A 800.00 09/01/2013 07/11/2015 M A 04/13/2013 1,828.83 P1 E 200.00 04/13/2014 02/12/2079 M A 04/13/2013 1,828.83 SC E 502.00 10/01/2013 12/31/2025 M A 04/13/2013 1,828.83 SD E 1,004.00 10/01/2013 02/12/2079 M A 04/13/2013 1,828.83 WT E 971.00 04/13/2013 04/12/2016
VU8606 OP OP F A 02/04/2014 1,523.93 PS A 1,005.58 05/05/2014 07/07/2061 F A 02/04/2014 1,523.93 SD A 1,203.00 08/01/2014 07/07/2061
VU8610 OP OP M A 04/26/2013 1,068.28 P1 E 197.22 04/26/2014 01/18/2065 M A 04/26/2013 1,068.28 SD E 731.00 10/01/2013 01/18/2065 M A 04/26/2013 1,068.28 WT A 1,517.72 10/14/2013 01/17/2030
VU8616 OP OP F A 11/30/2013 1,254.99 BO A 800.00 02/28/2014 01/03/2028 F A 11/30/2013 1,254.99 P1 E 200.00 11/30/2014 01/04/2063 F A 11/30/2013 1,254.99 SD E 827.00 05/01/2014 01/04/2063
VU8621 OP OP F A 12/17/2013 2,405.98 BO A 800.00 04/01/2014 03/16/2016
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 59 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU8621 OP OP F A 12/17/2013 2,405.98 SC E 596.50 06/01/2014 09/30/2016 F A 12/17/2013 2,405.98 SD E 1,193.00 06/01/2014 02/01/2076
VU8635 OP OP M A 12/21/2013 825.50 P1 E 200.00 12/21/2014 02/10/2057 M A 12/21/2013 825.50 SD S 2,099.00 06/01/2014 02/10/2057
VU8637 OP OP M A 03/15/2014 3,288.63 BO A 717.51 06/13/2014 07/12/2027 M A 03/15/2014 3,288.63 PD A 2,444.63 04/26/2014 07/13/2062 M A 03/15/2014 3,288.63 SD E 1,336.00 09/01/2014 07/13/2062
VU8651 OP OP F A 10/15/2013 2,438.10 BO A 272.55 12/01/2014 01/12/2016 F A 10/15/2013 2,438.10 SD A 1,269.00 12/01/2014 01/15/2049 F A 10/15/2013 2,438.10 WP A 802.78 11/10/2014 01/15/2049
VU8695 OP OP F A 02/02/2014 1,609.13 PS A 1,240.28 03/22/2014 11/10/2050 F A 02/02/2014 1,609.13 SD A 1,242.00 07/01/2014 11/10/2050
VU8707 OP OP M A 12/28/2013 3,772.70 BO A 800.00 03/28/2014 02/14/2031 M A 12/28/2013 3,772.70 PD A 2,483.79 12/28/2013 02/15/2066 M A 12/28/2013 3,772.70 SD E 1,388.00 06/01/2014 02/15/2066
VU8728 OP OP M S 12/17/2013 936.07 PD S 202.33 09/06/2014 07/20/2058 M S 12/17/2013 936.07 SC E 339.50 06/01/2014 12/31/2017 M S 12/17/2013 936.07 SD E 1,400.00 11/01/2014 07/20/2058
VU8745 OP OP M A 01/04/2014 1,403.85 PD S 274.30 05/31/2014 12/09/2081 M A 01/04/2014 1,403.85 SD A 1,094.00 07/01/2014 12/09/2081
VU9306 OP OP M A 03/14/2014 1,173.52 PD S 485.18 07/01/2014 05/13/2056 M A 03/14/2014 1,173.52 SD A 1,056.00 07/01/2014 05/13/2056
VU9307 OP OP M A 12/04/2013 1,565.19 BO A 44.94 04/01/2014 03/03/2016 M A 12/04/2013 1,565.19 P1 E 288.96 12/04/2014 11/25/2079 M A 12/04/2013 1,565.19 SD E 919.00 05/01/2014 11/25/2079 M A 12/04/2013 1,565.19 WT A 1,460.05 03/21/2014 11/24/2044
VU9318 OP OP F A 12/28/2013 1,500.64 BO A 800.00 03/28/2014 04/29/2034 F A 12/28/2013 1,500.64 P1 E 277.04 12/27/2014 04/30/2069 F A 12/28/2013 1,500.64 SD E 919.00 06/01/2014 04/30/2069
VU9319 OP OP F A 03/06/2014 3,336.76 BO A 800.00 06/04/2014 06/03/2016 F A 03/06/2014 3,336.76 SR A 1,692.00 04/01/2014 07/26/2048
VU9341 OP OP M A 12/30/2013 2,332.55 PD A 1,865.00 04/22/2014 03/18/2060 M A 12/30/2013 2,332.55 SD A 1,805.00 03/01/2015 03/18/2060
VU9349 OP OP F A 03/12/2014 922.67 P1 E 170.34 03/11/2015 07/15/2035 F A 03/12/2014 922.67 SC E 339.50 09/01/2014 07/31/2018
F A 03/12/2014 922.67 SD E 679.00 09/01/2014 07/16/2070
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 60 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU9359 OP OP F A 10/11/2013 1,007.51 PD A 589.42 01/22/2014 06/17/2054 F A 10/11/2013 1,007.51 SD A 837.00 04/01/2014 06/17/2054
VU9371 OP OP F A 01/21/2014 608.19 BO A 584.80 04/21/2014 01/22/2031 F A 01/21/2014 608.19 SD E 574.00 08/01/2014 01/23/2066
VU9372 OP OP M A 10/31/2013 2,084.16 BO A 800.00 01/01/2018 10/05/2039 M A 10/31/2013 2,084.16 PD A 1,175.75 02/28/2014 10/06/2074 M A 10/31/2013 2,084.16 SC E 542.00 04/01/2014 09/30/2018 M A 10/31/2013 2,084.16 SD E 1,084.00 04/01/2014 10/06/2074 M A 10/31/2013 2,084.16 WT S 2,309.14 01/01/2014 12/31/2017
VU9373 OP OP M A 01/17/2014 3,174.39 BO A 98.64 08/01/2014 09/27/2019 M A 01/17/2014 3,174.39 PD S 961.65 06/03/2014 09/28/2054 M A 01/17/2014 3,174.39 SD A 1,992.00 07/01/2014 09/28/2054
VU9391 OP OP F A 12/27/2013 1,105.18 BO A 800.00 03/27/2014 03/26/2016 F A 12/27/2013 1,105.18 P1 E 204.03 12/24/2014 03/08/2058 F A 12/27/2013 1,105.18 SD E 779.00 06/01/2014 03/08/2058
VU9462 OP OP M A 01/18/2014 649.61 SD A 1,196.00 07/01/2014 01/18/2057
VU9518 OP OP M A 04/19/2014 3,304.93 BO A 800.00 07/18/2014 07/17/2016 M A 04/19/2014 3,304.93 PD A 1,414.52 04/19/2014 07/29/2051 M A 04/19/2014 3,304.93 SD E 1,336.00 10/01/2014 07/29/2051
VU9535 OP OP F A 08/17/2013 1,089.30 SD A 1,101.00 02/01/2014 07/11/2066
VU9540 OP OP M A 03/28/2014 2,223.36 PS A 1,282.13 03/28/2014 11/05/2055 M A 03/28/2014 2,223.36 SD A 1,514.00 09/01/2014 11/05/2055
VU9541 OP OP F A 08/22/2013 3,976.65 SD E 1,394.00 02/01/2014 07/29/2051
VU9562 OP OP F A 03/08/2014 2,091.27 BO A 800.00 06/06/2014 11/16/2026 F A 03/08/2014 2,091.27 P1 E 386.08 03/08/2015 11/17/2061 F A 03/08/2014 2,091.27 SD E 1,084.00 09/01/2014 11/17/2061
VU9564 OP OP F A 11/07/2013 2,465.34 PD S 1,005.09 05/06/2014 02/21/2059 F A 11/07/2013 2,465.34 SD A 1,747.00 10/01/2014 02/21/2059
VU9574 OP OP F A 04/10/2014 2,962.43 PD S 1,128.23 07/15/2014 05/29/2059 F A 04/10/2014 2,962.43 SD A 1,927.00 10/01/2014 05/29/2059
VU9591 OP OP M A 12/20/2013 1,200.60 PD S 222.32 08/01/2014 03/21/2063 M A 12/20/2013 1,200.60 SD A 1,040.00 06/01/2014 03/21/2063
VU9621 OP OP F A 01/11/2014 3,502.59 BO A 800.00 04/11/2014 10/10/2017 F A 01/11/2014 3,502.59 P1 E 660.42 01/11/2015 10/02/2052
F A 01/11/2014 3,502.59 SD E 1,362.00 07/01/2014 10/02/2052
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 61 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU9645 OP OP M A 01/06/2014 1,928.99 PD S 1,071.96 07/03/2014 07/14/2066 M A 01/06/2014 1,928.99 SD A 1,423.00 07/01/2014 07/14/2066
VU9658 OP OP F A 01/30/2014 1,777.83 BO A 800.00 04/30/2014 06/22/2042 F A 01/30/2014 1,777.83 SC E 502.00 07/01/2014 07/31/2025 F A 01/30/2014 1,777.83 SD E 1,004.00 07/01/2014 06/23/2077
VU9667 OP OP F A 03/12/2014 921.09 PD S 173.76 07/31/2014 10/15/2064 F A 03/12/2014 921.09 SD A 840.00 11/01/2014 10/15/2064
VU9672 OP OP M A 03/11/2014 2,451.91 BO A 371.59 08/01/2014 03/13/2032 M A 03/11/2014 2,451.91 PD A 1,986.02 07/02/2014 03/14/2067 M A 03/11/2014 2,451.91 SD E 1,193.00 09/01/2014 03/14/2067
VU9763 OP OP F A 02/24/2014 2,907.73 BO A 800.00 05/25/2014 03/22/2047 F A 02/24/2014 2,907.73 SD E 1,288.00 08/01/2014 03/23/2082
VU9772 OP OP M A 11/07/2013 1,320.15 BO A 800.00 01/01/2015 10/21/2022 M A 11/07/2013 1,320.15 P1 E 362.27 03/06/2015 10/22/2057 M A 11/07/2013 1,320.15 SD E 827.00 08/01/2014 10/22/2057
VU9775 OP OP F A 01/02/2014 2,714.56 BO A 800.00 08/01/2014 04/01/2016 F A 01/02/2014 2,714.56 P1 E 501.15 01/02/2015 05/03/2060 F A 01/02/2014 2,714.56 SD E 1,258.00 06/01/2014 05/03/2060
VU9830 OP OP M A 01/31/2014 1,154.29 BO A 800.00 06/01/2014 07/26/2023 M A 01/31/2014 1,154.29 P1 A 249.76 07/12/2014 07/27/2058 M A 01/31/2014 1,154.29 SD E 779.00 07/01/2014 07/27/2058
VU9834 OP OP F A 01/25/2014 805.29 PD A 285.12 07/08/2014 05/25/2062 F A 01/25/2014 805.29 SD A 796.00 07/01/2014 05/25/2062
VU9838 OP OP M A 05/16/2014 2,803.78 PD S 906.13 06/03/2014 04/04/2060 M A 05/16/2014 2,803.78 SD A 2,112.00 10/01/2014 04/04/2060
VU9840 OP OP M A 03/31/2014 686.21 BO A 659.81 06/29/2014 12/09/2030 M A 03/31/2014 686.21 SC E 287.00 09/01/2014 09/30/2018 M A 03/31/2014 686.21 SD E 574.00 09/01/2014 12/10/2065
VU9852 OP OP F A 04/15/2014 1,339.28 PS A 290.94 06/25/2014 06/25/2054 F A 04/15/2014 1,339.28 SD A 1,080.00 11/01/2014 06/25/2054
VU9864 OP OP F A 01/10/2014 1,374.59 BO A 800.00 04/10/2014 10/09/2017 F A 01/10/2014 1,374.59 WT E 971.00 01/10/2014 01/09/2017
VU9874 OP OP F A 01/02/2014 1,573.79 BO A 800.00 04/02/2014 09/04/2044 F A 01/02/2014 1,573.79 P1 E 200.00 01/02/2015 09/05/2079 F A 01/02/2014 1,573.79 SC E 459.50 06/01/2014 11/30/2029
F A 01/02/2014 1,573.79 SD E 919.00 06/01/2014 09/05/2079
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 62 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VU9877 OP OP F A 02/20/2014 2,050.37 BO A 800.00 06/01/2014 03/16/2024 F A 02/20/2014 2,050.37 P1 E 455.23 02/20/2015 03/17/2059 F A 02/20/2014 2,050.37 SD E 1,084.00 08/01/2014 03/17/2059
VU9899 OP OP M A 03/25/2014 1,758.25 BO A 524.36 07/01/2014 12/05/2036 M A 03/25/2014 1,758.25 PD A 1,166.27 06/24/2014 12/06/2071 M A 03/25/2014 1,758.25 SC E 502.00 09/01/2014 10/31/2024 M A 03/25/2014 1,758.25 SD E 1,004.00 09/01/2014 12/06/2071
VU9900 OP OP F A 01/08/2014 3,765.46 BO A 800.00 04/11/2014 04/10/2016 F A 01/08/2014 3,765.46 SD A 1,867.00 07/01/2014 04/19/2059
VU9937 OP OP F A 02/04/2014 1,690.00 BO A 800.00 05/05/2014 10/04/2039 F A 02/04/2014 1,690.00 SD E 962.00 08/01/2014 10/05/2074
VU9961 OP OP M A 04/08/2014 5,629.75 BO A 800.00 07/07/2014 03/10/2024 M A 04/08/2014 5,629.75 PD A 3,908.20 04/22/2014 03/11/2059 M A 04/08/2014 5,629.75 RO S 0.00 07/07/2014 07/06/2015 M A 04/08/2014 5,629.75 RO S 250.00 07/07/2015 03/10/2024 M A 04/08/2014 5,629.75 SC E 697.00 10/01/2014 01/31/2023 M A 04/08/2014 5,629.75 SD E 1,394.00 10/01/2014 03/11/2059
VU9974 OP OP F A 09/06/2013 3,246.50 BO A 800.00 03/01/2014 06/04/2017 F A 09/06/2013 3,246.50 PS A 236.97 08/05/2014 08/24/2051 F A 09/06/2013 3,246.50 SD A 1,235.00 08/01/2014 08/24/2051
VU9975 OP OP F A 02/08/2014 1,296.59 BO A 800.00 05/09/2014 03/05/2020 F A 02/08/2014 1,296.59 P1 E 510.00 02/08/2015 03/06/2055 F A 02/08/2014 1,296.59 SD E 827.00 08/01/2014 03/06/2055
VU9992 OP OP M A 02/11/2014 1,254.99 BO A 800.00 05/12/2014 05/11/2016 M A 02/11/2014 1,254.99 P1 E 200.00 02/11/2015 08/18/2057
VU9994 OP OP M A 01/17/2014 4,289.79 BO A 800.00 04/17/2014 10/16/2016 M A 01/17/2014 4,289.79 SR A 2,127.00 07/01/2014 05/21/2049
VV0706 OP OP F A 12/16/2013 1,524.30 BO A 564.68 07/01/2014 02/21/2026 F A 12/16/2013 1,524.30 P1 E 283.28 12/13/2013 02/22/2061 F A 12/16/2013 1,524.30 SD A 901.00 06/01/2014 02/22/2061
VV0740 OP OP F A 02/11/2014 1,296.15 PS A 693.82 08/01/2009 04/29/2050 F A 02/11/2014 1,296.15 SD A 987.00 08/01/2014 04/29/2050
VV0747 OP OP F A 03/07/2014 1,478.64 P1 A 271.16 06/30/2014 06/06/2063 F A 03/07/2014 1,478.64 SD A 1,196.00 09/01/2014 06/06/2063
VV0752 OP OP F A 03/06/2013 1,912.24 BO A 573.75 04/01/2016 06/24/2033 F A 03/06/2013 1,912.24 PS A 1,264.94 06/30/2010 06/25/2068
F A 03/06/2013 1,912.24 SD E 1,045.00 03/01/2014 06/25/2068 F A 03/06/2013 1,912.24 WT S 1,810.50 09/17/2013 03/12/2016
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 63 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VV0753 OP OP M A 12/04/2013 2,827.70 BO A 800.00 05/01/2014 12/03/2015 M A 12/04/2013 2,827.70 PS A 735.06 12/04/2013 10/24/2047
VV0781 OP OP M A 12/18/2013 1,581.13 P1 E 200.00 12/18/2014 09/05/2065 M A 12/18/2013 1,581.13 SD E 919.00 06/01/2014 09/05/2065
VV0782 OP OP F A 02/12/2013 1,361.75 BO A 800.00 05/01/2014 05/12/2015 F A 02/12/2013 1,361.75 P1 A 270.32 09/29/2013 12/14/2065 F A 02/12/2013 1,361.75 SC E 413.50 08/01/2013 06/30/2017 F A 02/12/2013 1,361.75 SD E 827.00 08/01/2013 12/14/2065 F A 02/12/2013 1,361.75 WP A 96.15 04/30/2014 12/13/2035
VV0792 OP OP F A 09/20/2013 2,235.51 BO A 286.36 07/01/2014 12/18/2015 F A 09/20/2013 2,235.51 PD A 1,863.17 06/13/2014 03/11/2077 F A 09/20/2013 2,235.51 SC E 561.00 03/01/2014 05/31/2031 F A 09/20/2013 2,235.51 SD E 1,122.00 03/01/2014 03/11/2077
VV0799 OP OP M A 02/21/2014 736.72 BO A 708.39 05/22/2014 12/01/2020 M A 02/21/2014 736.72 P1 E 200.00 02/21/2015 12/02/2055 M A 02/21/2014 736.72 SD E 627.00 08/01/2014 12/02/2055
VV1523 OP OP F A 09/19/2013 1,340.79 BO A 800.00 07/01/2014 01/11/2031 F A 09/19/2013 1,340.79 P1 E 247.53 03/31/2015 01/12/2066 F A 09/19/2013 1,340.79 SD E 827.00 03/01/2014 01/12/2066 F A 09/19/2013 1,340.79 WP A 64.00 07/01/2014 09/30/2045
VV1533 OP OP F A 05/30/2014 1,476.22 BO A 800.00 08/28/2014 08/27/2016 F A 05/30/2014 1,476.22 P1 E 352.99 05/30/2015 11/20/2057 F A 05/30/2014 1,476.22 SD E 874.00 11/01/2014 11/20/2057
VV1564 OP OP F A 07/25/2013 1,181.65 BO A 800.00 08/01/2016 06/07/2022 F A 07/25/2013 1,181.65 P1 E 218.15 07/25/2014 06/08/2057 F A 07/25/2013 1,181.65 SD E 779.00 01/01/2014 06/08/2057 F A 07/25/2013 1,181.65 WT S 1,481.89 07/29/2013 07/28/2016
VV1578 OP OP F A 03/17/2014 1,099.76 BO A 800.00 06/15/2014 01/08/2018 F A 03/17/2014 1,099.76 P1 E 227.91 03/14/2015 01/09/2053 F A 03/17/2014 1,099.76 SD E 731.00 09/01/2014 01/09/2053
VV1590 OP OP M A 03/20/2014 1,632.48 BO A 800.00 04/01/2017 08/18/2019 M A 03/20/2014 1,632.48 P1 E 301.38 03/20/2015 08/19/2054 M A 03/20/2014 1,632.48 SD E 962.00 09/01/2014 08/19/2054 M A 03/20/2014 1,632.48 WT S 1,621.02 04/02/2014 04/01/2017
VV1604 OP OP F A 01/01/2014 06/30/2015 1,538.23 BO A 800.00 04/01/2014 06/30/2015 F A 01/01/2014 06/30/2015 1,538.23 P1 E 200.00 05/28/2015 09/24/2060 F A 01/01/2014 06/30/2015 1,538.23 SD E 919.00 11/01/2014 09/24/2060
VV1691 OP OP F A 01/31/2014 2,812.12 PS A 1,656.89 01/01/2013 11/15/2052 F A 01/31/2014 2,812.12 SD A 1,226.00 12/01/2014 11/15/2052
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 64 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VV1752 OP OP M A 06/24/2014 1,936.36 BO A 800.00 11/01/2014 03/19/2020 M A 06/24/2014 1,936.36 PD S 729.54 11/05/2014 03/20/2055 M A 06/24/2014 1,936.36 SC E 522.50 12/01/2014 04/30/2016 M A 06/24/2014 1,936.36 SD E 1,045.00 12/01/2014 03/20/2055
VV1754 OP OP F A 04/25/2014 1,373.60 BO A 800.00 07/24/2014 12/11/2023 F A 04/25/2014 1,373.60 PD S 309.36 11/02/2014 12/12/2058 F A 04/25/2014 1,373.60 SD A 207.00 10/01/2014 12/12/2058
VV1781 OP OP F A 07/01/2014 3,598.53 BO A 623.82 12/01/2014 02/09/2043 F A 07/01/2014 3,598.53 P1 A 811.31 07/01/2014 02/10/2078 F A 07/01/2014 3,598.53 RO S 0.00 02/11/2015 02/10/2016 F A 07/01/2014 3,598.53 RO S 833.34 02/11/2016 02/09/2043 F A 07/01/2014 3,598.53 SD A 2,025.00 12/01/2014 02/10/2078
VV1815 OP OP M A 12/21/2013 1,031.98 SD A 1,807.00 06/01/2014 09/24/2052
VV1842 OP OP F A 02/28/2014 1,227.72 PD S 532.24 07/01/2014 07/24/2063 F A 02/28/2014 1,227.72 SD A 863.00 07/01/2014 07/24/2063
VV1883 OP OP F A 03/03/2014 1,574.39 BO A 243.76 01/01/2015 05/31/2016 F A 03/03/2014 1,574.39 PS A 228.08 11/02/2012 06/13/2054 F A 03/03/2014 1,574.39 SD A 1,042.00 01/01/2015 06/13/2054
VV1897 OP OP F A 04/12/2014 1,058.80 SR A 1,102.00 05/01/2014 09/05/2050
VV1898 OP OP F A 05/02/2014 2,905.61 BO A 81.87 10/01/2014 12/08/2025 F A 05/02/2014 2,905.61 PD S 980.09 09/13/2014 12/09/2060 F A 05/02/2014 2,905.61 PS S 180.90 09/13/2014 12/09/2060 F A 05/02/2014 2,905.61 SD A 1,551.00 07/01/2014 12/09/2060
VV2003 OP OP M A 03/18/2014 1,165.61 BO A 100.78 09/01/2014 12/15/2017 M A 03/18/2014 1,165.61 P1 E 215.19 03/17/2015 07/09/2051 M A 03/18/2014 1,165.61 SD A 1,020.00 09/01/2014 07/09/2051
VV2920 OP OP F A 04/08/2014 2,656.55 BO A 689.26 07/07/2014 07/06/2017 F A 04/08/2014 2,656.55 PS A 1,865.12 08/01/2012 11/01/2050 F A 04/08/2014 2,656.55 SD E 1,226.00 10/01/2014 11/01/2050
VV2924 OP OP M A 04/22/2014 1,415.26 BO A 800.00 07/21/2014 02/04/2036 M A 04/22/2014 1,415.26 SD E 874.00 10/01/2014 02/05/2071
VV2927 OP OP F A 03/05/2014 1,125.49 BO A 800.00 11/01/2014 06/02/2016
VV2936 OP OP F A 06/19/2014 1,500.58 BO A 800.00 09/17/2014 09/11/2033 F A 06/19/2014 1,500.58 P1 E 277.03 05/07/2015 09/12/2068 F A 06/19/2014 1,500.58 SC E 459.50 11/01/2014 01/31/2020 F A 06/19/2014 1,500.58 SD E 919.00 11/01/2014 09/12/2068
VV2939 OP OP F A 03/25/2013 1,627.15 BO A 124.69 12/01/2014 06/03/2043
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 65 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VV2939 OP OP F A 03/25/2013 1,627.15 PD S 1,439.88 11/01/2014 06/04/2078 F A 03/25/2013 1,627.15 SD E 962.00 09/01/2013 06/04/2078
VV2947 OP OP M A 09/07/2013 1,297.58 PD A 673.11 05/01/2014 12/12/2059 M A 09/07/2013 1,297.58 SD A 1,051.00 03/01/2014 12/12/2059
VV2954 OP OP M A 07/12/2013 2,998.92 BO A 499.59 10/10/2013 06/22/2027 M A 07/12/2013 2,998.92 PD A 2,383.99 10/10/2013 06/23/2062 M A 07/12/2013 2,998.92 SC E 655.00 01/01/2014 03/31/2029 M A 07/12/2013 2,998.92 SD E 1,310.00 01/01/2014 06/23/2062
VV2962 OP OP F A 05/15/2014 782.10 BO A 752.02 08/13/2014 08/12/2016 F A 05/15/2014 782.10 SD E 627.00 11/01/2014 04/21/2065
VV2964 OP OP F A 01/24/2014 1,030.62 BO A 800.00 04/24/2014 04/23/2016 F A 01/24/2014 1,030.62 P1 E 190.27 01/23/2015 04/15/2067 F A 01/24/2014 1,030.62 SC E 365.50 07/01/2014 07/31/2024 F A 01/24/2014 1,030.62 SD E 731.00 07/01/2014 04/15/2067
VV2981 OP OP F A 03/02/2014 672.67 P1 E 124.18 03/02/2015 08/23/2066 F A 03/02/2014 672.67 SD E 574.00 08/01/2014 08/23/2066
VV2984 OP OP M A 02/22/2014 4,736.66 BO A 800.00 08/01/2014 08/24/2036 M A 02/22/2014 4,736.66 P1 E 734.18 02/22/2015 08/25/2071 M A 02/22/2014 4,736.66 SC E 697.00 08/01/2014 09/30/2025 M A 02/22/2014 4,736.66 SD E 1,394.00 08/01/2014 08/25/2071
VV3247 OP OP M A 04/06/2014 1,462.50 BO A 800.00 07/05/2014 12/30/2026 M A 04/06/2014 1,462.50 P1 E 200.00 04/06/2015 12/31/2061 M A 04/06/2014 1,462.50 SD E 874.00 10/01/2014 12/31/2061 M A 04/06/2014 1,462.50 WT E 971.00 04/06/2014 04/05/2017
VV3250 OP OP F A 03/07/2014 8,000.00 BO A 800.00 10/01/2014 05/27/2018 F A 03/07/2014 8,000.00 P1 E 200.00 03/07/2015 05/28/2053 F A 03/07/2014 8,000.00 SD A 2,331.00 09/01/2014 05/28/2053
VV3508 OP OP M A 05/17/2014 1,096.06 BO A 800.00 08/15/2014 05/12/2033 M A 05/17/2014 1,096.06 SD E 731.00 11/01/2014 05/13/2068
VV3551 OP OP F A 06/17/2014 1,261.07 BO A 800.00 09/15/2014 04/28/2021 F A 06/17/2014 1,261.07 P1 E 287.19 06/07/2015 04/29/2056 F A 06/17/2014 1,261.07 SD E 827.00 12/01/2014 04/29/2056
VV3552 OP OP F A 01/14/2014 2,354.56 BO A 800.00 08/01/2014 04/13/2016 F A 01/14/2014 2,354.56 RO S 2,343.69 08/19/2014 08/18/2015 F A 01/14/2014 2,354.56 RO S 1,850.00 08/19/2015 02/15/2021
VV3558 OP OP F A 05/04/2013 2,244.44 PL A 644.43 07/01/2014 01/01/2070
F A 05/04/2013 2,244.44 SD E 1,122.00 11/01/2013 01/01/2070 F A 05/04/2013 2,244.44 WT S 3,222.54 12/14/2013 12/13/2016
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 66 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VV3563 OP OP M A 09/20/2013 914.73 P1 E 200.00 09/20/2014 06/04/2053 M A 09/20/2013 914.73 SD E 679.00 03/01/2014 06/04/2053
VV3566 OP OP F A 08/16/2013 1,096.50 BO A 800.00 11/14/2013 12/09/2032 F A 08/16/2013 1,096.50 P1 E 200.00 08/16/2014 12/10/2067 F A 08/16/2013 1,096.50 SC E 365.50 02/01/2014 02/28/2017 F A 08/16/2013 1,096.50 SD E 731.00 02/01/2014 12/10/2067
VV3578 OP OP M A 04/05/2014 1,916.36 PS S 1,252.93 08/01/2014 02/21/2054 M A 04/05/2014 1,916.36 SD A 1,208.00 10/01/2014 02/21/2054
VV3618 OP OP F A 07/10/2014 2,868.99 BO A 800.00 10/08/2014 08/27/2050 F A 07/10/2014 2,868.99 SD E 1,288.00 11/01/2014 08/28/2085
VV3669 OP OP M A 06/10/2014 1,942.79 BO A 800.00 09/08/2014 06/25/2025 M A 06/10/2014 1,942.79 P1 E 542.96 06/11/2014 06/26/2060 M A 06/10/2014 1,942.79 SD E 1,045.00 12/01/2014 06/26/2060
VV3903 OP OP M A 04/02/2014 1,650.77 BO A 800.00 07/01/2014 03/03/2029 M A 04/02/2014 1,650.77 P1 E 304.76 04/02/2015 03/04/2064 M A 04/02/2014 1,650.77 SD E 962.00 09/01/2014 03/04/2064
VV3931 OP OP M A 06/22/2013 2,307.47 BO A 173.44 11/01/2014 09/19/2015 M A 06/22/2013 2,307.47 PD S 1,929.06 10/17/2014 09/25/2069 M A 06/22/2013 2,307.47 RO A 1,565.65 11/28/2014 09/19/2015 M A 06/22/2013 2,307.47 WP A 116.23 08/22/2014 09/24/2039
VV3995 OP OP F A 03/29/2014 05/13/2015 871.92 BO A 531.39 10/01/2014 05/13/2015 F A 03/29/2014 05/13/2015 871.92 P1 E 160.97 03/29/2015 05/02/2066 F A 03/29/2014 05/13/2015 871.92 SD A 307.00 09/01/2014 05/02/2066
VV4006 OP OP F A 07/15/2014 2,549.27 SC E 613.00 12/01/2014 10/31/2021 F A 07/15/2014 2,549.27 SD E 1,226.00 12/01/2014 01/31/2065
VV4009 OP OP F A 02/03/2014 1,665.46 PD S 347.48 06/06/2014 06/20/2070 F A 02/03/2014 1,665.46 SD A 1,018.00 06/01/2014 06/20/2070
VV4019 OP OP F A 02/28/2014 1,054.57 SD A 1,501.00 08/01/2014 01/11/2057
VV4022 OP OP F A 04/15/2014 1,345.60 BO A 800.00 07/14/2014 05/03/2028 F A 04/15/2014 1,345.60 SD E 827.00 10/01/2014 05/04/2063
VV4038 OP OP F A 04/24/2013 2,112.94 PS A 2,578.71 04/24/2013 05/21/2060
VV4606 OP OP F A 03/14/2014 866.99 SD A 1,004.00 09/01/2014 06/23/2052
VV4612 OP OP F A 04/05/2014 3,439.36 P1 S 3,000.00 02/01/2015 12/28/2063 F A 04/05/2014 3,439.36 SD A 1,963.00 12/01/2014 12/28/2063
VV4615 OP OP F A 06/04/2014 937.63 PD S 169.16 09/03/2014 03/24/2057
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 67 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VV4615 OP OP F A 06/04/2014 937.63 SD A 1,025.00 01/01/2015 03/24/2057
VV4628 OP OP F A 02/21/2014 1,802.71 BO A 800.00 05/22/2014 05/22/2041 F A 02/21/2014 1,802.71 P1 E 200.00 02/21/2015 05/23/2076 F A 02/21/2014 1,802.71 SC E 502.00 08/01/2014 07/31/2020 F A 02/21/2014 1,802.71 SD E 1,004.00 08/01/2014 05/23/2076
VV4629 OP OP F A 01/17/2014 1,665.68 BO A 282.61 07/01/2014 09/22/2026 F A 01/17/2014 1,665.68 P1 E 307.51 01/17/2015 09/23/2061 F A 01/17/2014 1,665.68 SD A 1,319.00 07/01/2014 09/23/2061
VV4649 OP OP F A 06/07/2014 1,091.98 PS A 424.60 07/01/2014 08/07/2052 F A 06/07/2014 1,091.98 SR A 689.00 09/01/2014 08/07/2052
VV4651 OP OP F A 08/02/2014 2,170.29 PS A 845.81 08/02/2014 07/16/2054 F A 08/02/2014 2,170.29 SD A 1,731.00 01/01/2015 07/16/2054
VV4654 OP OP F A 03/28/2014 1,097.74 BO A 582.13 11/01/2014 10/30/2031 F A 03/28/2014 1,097.74 P1 A 473.39 10/12/2014 10/31/2066 F A 03/28/2014 1,097.74 SD E 731.00 09/01/2014 10/31/2066 F A 03/28/2014 1,097.74 WT E 971.00 03/28/2014 03/27/2017
VV4657 OP OP F A 04/19/2014 1,084.09 PD S 357.34 11/07/2014 10/14/2056 F A 04/19/2014 1,084.09 SD A 744.00 10/01/2014 10/14/2056
VV4660 OP OP F A 04/25/2014 1,436.92 BO A 800.00 07/24/2014 05/04/2028 F A 04/25/2014 1,436.92 P1 E 265.28 04/25/2015 05/05/2063 F A 04/25/2014 1,436.92 SC E 437.00 10/01/2014 08/31/2017 F A 04/25/2014 1,436.92 SD E 874.00 10/01/2014 05/05/2063
VV4906 OP OP F A 08/02/2014 2,392.33 PD S 1,540.39 02/24/2015 04/25/2062 F A 08/02/2014 2,392.33 SD A 1,543.00 02/01/2015 04/25/2062
VV4911 OP OP F A 02/22/2014 1,813.81 BO A 457.04 08/01/2014 08/01/2029 F A 02/22/2014 1,813.81 P1 E 334.86 02/22/2015 08/02/2064 F A 02/22/2014 1,813.81 SD A 1,287.00 08/01/2014 08/02/2064
VV4979 OP OP F A 07/09/2014 1,409.58 BO A 800.00 10/07/2014 07/08/2022 F A 07/09/2014 1,409.58 P1 E 463.86 07/09/2015 07/09/2057 F A 07/09/2014 1,409.58 SD E 874.00 01/01/2015 07/09/2057
VV5503 OP OP M A 07/09/2014 1,670.18 PD S 352.99 11/29/2014 01/06/2055 M A 07/09/2014 1,670.18 SC E 481.00 01/01/2015 09/30/2016 M A 07/09/2014 1,670.18 SD A 1,819.00 01/01/2015 01/06/2055
VV5506 OP OP F A 02/02/2014 3,385.20 PS S 878.74 07/04/2014 06/01/2050 F A 02/02/2014 3,385.20 SD E 1,347.00 07/01/2014 06/01/2050 F A 02/02/2014 3,385.20 WT S 3,222.54 02/13/2014 02/12/2017
VV5517 OP OP M A 07/26/2014 1,506.83 BO A 800.00 10/24/2014 10/29/2038
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 68 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VV5517 OP OP M A 07/26/2014 1,506.83 SC E 459.50 01/01/2015 12/31/2024 M A 07/26/2014 1,506.83 SD E 919.00 01/01/2015 10/30/2073
VV5531 OP OP M A 03/08/2014 1,608.52 BO A 800.00 03/01/2017 04/12/2027 M A 03/08/2014 1,608.52 P1 E 296.96 03/08/2015 04/13/2062 M A 03/08/2014 1,608.52 SD E 919.00 09/01/2014 04/13/2062 M A 03/08/2014 1,608.52 WT S 1,952.36 03/08/2014 03/07/2017
VV5554 OP OP F A 12/05/2013 703.20 BO A 676.15 04/01/2014 09/07/2020 F A 12/05/2013 703.20 P1 E 129.82 12/05/2014 09/08/2055 F A 12/05/2013 703.20 SC E 287.00 06/01/2014 08/31/2028 F A 12/05/2013 703.20 SD E 574.00 06/01/2014 09/08/2055 F A 12/05/2013 703.20 WT E 721.26 12/05/2013 12/04/2016
VV5573 OP OP F A 08/16/2014 843.05 BO A 800.00 11/14/2014 04/22/2035 F A 08/16/2014 843.05 P1 E 155.64 08/15/2015 04/23/2070 F A 08/16/2014 843.05 SC E 313.50 02/01/2015 05/31/2015 F A 08/16/2014 843.05 SD E 627.00 02/01/2015 04/23/2070
VV5581 OP OP F A 03/12/2014 3,194.37 BO A 800.00 09/01/2014 03/29/2028 F A 03/12/2014 3,194.37 P1 E 589.73 03/12/2015 03/30/2063 F A 03/12/2014 3,194.37 SD E 1,336.00 09/01/2014 03/30/2063
VV5592 OP OP M A 06/04/2014 4,267.13 BO A 181.84 10/01/2014 09/01/2016 M A 06/04/2014 4,267.13 PS A 1,917.17 08/23/2014 04/19/2050 M A 06/04/2014 4,267.13 SR A 2,004.00 10/01/2014 04/19/2050
VV5599 OP OP F A 06/19/2014 1,078.40 P1 E 200.00 06/19/2015 06/05/2065 F A 06/19/2014 1,078.40 SC E 365.50 12/01/2014 05/31/2023 F A 06/19/2014 1,078.40 SD E 731.00 12/01/2014 06/05/2065
VV5881 OP OP M A 06/25/2014 1,532.75 BO A 800.00 10/01/2014 04/13/2034 M A 06/25/2014 1,532.75 P1 E 282.97 06/24/2015 04/14/2069 M A 06/25/2014 1,532.75 SC E 459.50 12/01/2014 01/31/2025 M A 06/25/2014 1,532.75 SD E 919.00 12/01/2014 04/14/2069
VV5907 OP OP F A 06/27/2014 1,888.38 BO A 800.00 09/25/2014 09/24/2016 F A 06/27/2014 1,888.38 P1 E 200.00 06/28/2015 01/02/2068 F A 06/27/2014 1,888.38 SC E 522.50 12/01/2014 05/31/2024 F A 06/27/2014 1,888.38 SD E 1,045.00 12/01/2014 01/02/2068
VV5945 OP OP F A 06/10/2014 663.14 BO A 637.64 09/08/2014 05/02/2019 F A 06/10/2014 663.14 P1 E 122.43 06/10/2015 05/03/2054 F A 06/10/2014 663.14 SD E 574.00 11/01/2014 05/03/2054
VV6402 OP OP F A 05/09/2014 1,637.50 BO A 800.00 09/01/2014 08/06/2016 F A 05/09/2014 1,637.50 P1 E 302.31 05/09/2015 11/02/2063 F A 05/09/2014 1,637.50 SD E 962.00 11/01/2014 11/02/2063
VV6425 OP OP F A 06/11/2014 2,820.40 BO A 375.73 12/01/2014 07/06/2023
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 69 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VV6425 OP OP F A 06/11/2014 2,820.40 PD S 1,041.20 06/27/2014 07/07/2058 F A 06/11/2014 2,820.40 SD A 1,295.00 12/01/2014 07/07/2058
VV8909 OP OP F A 05/07/2014 930.43 P1 A 431.50 09/01/2014 02/10/2057 F A 05/07/2014 930.43 SD A 1,011.00 08/01/2014 02/10/2057
VV8921 OP OP F A 08/15/2013 711.26 P1 E 131.31 08/14/2014 05/21/2066 F A 08/15/2013 711.26 SC E 287.00 02/01/2014 12/31/2016 F A 08/15/2013 711.26 SD E 574.00 02/01/2014 05/21/2066 F A 08/15/2013 711.26 WT A 924.88 04/24/2014 05/20/2031
VV8939 OP OP M A 08/02/2014 1,352.00 BO A 800.00 10/31/2014 06/19/2029 M A 08/02/2014 1,352.00 P1 E 200.00 08/02/2015 06/20/2064 M A 08/02/2014 1,352.00 SD E 827.00 01/01/2015 06/20/2064
VV8955 OP OP F A 06/27/2014 05/29/2015 1,276.31 BO A 800.00 09/25/2014 05/29/2015 F A 06/27/2014 05/29/2015 1,276.31 P1 E 235.63 06/27/2015 10/26/2061 F A 06/27/2014 05/29/2015 1,276.31 SD E 827.00 12/01/2014 10/26/2061
VV8963 OP OP F A 06/24/2014 1,081.28 P1 E 199.62 06/24/2015 11/23/2053 F A 06/24/2014 1,081.28 SD A 1,340.00 01/01/2015 11/23/2053
VV8964 OP OP F A 06/05/2014 1,637.51 P1 S 800.00 04/01/2015 11/17/2045
VV8996 OP OP F A 06/28/2014 2,364.08 P1 E 200.00 06/28/2015 01/08/2057 F A 06/28/2014 2,364.08 SC E 579.00 12/01/2014 10/31/2020 F A 06/28/2014 2,364.08 SD E 1,158.00 12/01/2014 01/08/2057 F A 06/28/2014 2,364.08 WT S 3,637.05 06/28/2014 06/27/2017
VV9006 OP OP F A 09/11/2014 1,884.24 BO A 800.00 12/10/2014 12/30/2021 F A 09/11/2014 1,884.24 SD E 1,004.00 03/01/2015 12/31/2056
VV9035 OP OP F A 06/14/2014 1,530.59 BO A 800.00 09/12/2014 04/29/2044 F A 06/14/2014 1,530.59 SD E 919.00 12/01/2014 04/30/2079
VV9039 OP OP M A 06/27/2014 2,289.25 BO A 221.67 11/01/2014 09/24/2016 M A 06/27/2014 2,289.25 PD S 1,979.53 11/01/2014 12/26/2078 M A 06/27/2014 2,289.25 SC E 579.00 12/01/2014 01/31/2018 M A 06/27/2014 2,289.25 SD E 1,158.00 12/01/2014 12/26/2078
VV9055 OP OP M A 05/28/2014 804.39 BO A 773.46 08/26/2014 10/23/2026 M A 05/28/2014 804.39 SD E 627.00 11/01/2014 10/24/2061
VV9056 OP OP F A 09/13/2014 3,368.57 BO A 800.00 12/12/2014 11/15/2022 F A 09/13/2014 3,368.57 P1 E 200.00 09/13/2015 11/16/2057 F A 09/13/2014 3,368.57 SD E 1,347.00 03/01/2015 11/16/2057
VV9057 OP OP M A 12/27/2013 1,602.63 BO A 800.00 03/27/2014 01/01/2028
M A 12/27/2013 1,602.63 P1 E 295.87 07/10/2015 01/02/2063
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 70 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VV9083 OP OP F A 06/16/2014 1,465.54 BO A 800.00 09/14/2014 09/13/2016 F A 06/16/2014 1,465.54 P1 E 200.00 06/16/2015 06/07/2055 F A 06/16/2014 1,465.54 SD E 874.00 12/01/2014 06/07/2055
VV9622 OP OP F A 09/05/2014 1,883.32 BO A 800.00 12/04/2014 12/03/2016 F A 09/05/2014 1,883.32 PD S 775.70 12/29/2014 07/12/2061 F A 09/05/2014 1,883.32 SD E 1,004.00 03/01/2015 07/12/2061
VV9633 OP OP M A 06/26/2014 2,390.58 PS A 1,552.46 10/18/2014 08/12/2052 M A 06/26/2014 2,390.58 SD A 1,678.00 12/01/2014 08/12/2052 M A 06/26/2014 2,390.58 SR A 1,258.00 01/01/2015 08/12/2052
VV9635 OP OP M A 05/13/2014 2,847.23 BO A 579.73 11/01/2014 04/18/2019 M A 05/13/2014 2,847.23 SD A 2,158.00 11/01/2014 04/19/2054
VV9654 OP OP F A 06/06/2014 1,263.90 BO A 800.00 12/01/2014 04/20/2030 F A 06/06/2014 1,263.90 P1 E 243.41 06/05/2015 04/21/2065 F A 06/06/2014 1,263.90 RO S 1,319.44 03/22/2015 09/04/2015 F A 06/06/2014 1,263.90 SD E 827.00 12/01/2014 04/21/2065
VV9657 OP OP F A 04/14/2014 1,162.53 BO A 601.14 04/01/2017 04/30/2017 F A 04/14/2014 1,162.53 BO A 800.00 05/01/2017 08/25/2036 F A 04/14/2014 1,162.53 P1 E 214.62 04/13/2015 08/26/2071 F A 04/14/2014 1,162.53 SD E 779.00 10/01/2014 08/26/2071 F A 04/14/2014 1,162.53 WT S 1,192.31 04/15/2014 04/13/2017
VV9670 OP OP F A 07/08/2014 1,548.76 BO A 800.00 10/06/2014 10/05/2016 F A 07/08/2014 1,548.76 P1 E 285.92 07/08/2015 01/25/2067 F A 07/08/2014 1,548.76 SD E 919.00 01/01/2015 01/25/2067
VV9676 OP OP M A 06/10/2014 1,371.89 BO A 800.00 09/01/2017 07/16/2018 M A 06/10/2014 1,371.89 P1 E 253.85 06/09/2015 07/17/2053 M A 06/10/2014 1,371.89 SC E 437.00 12/01/2014 04/30/2018 M A 06/10/2014 1,371.89 SD E 874.00 12/01/2014 07/17/2053 M A 06/10/2014 1,371.89 WT S 1,464.55 09/08/2014 09/07/2017
VV9680 OP OP F A 07/01/2014 5,083.00 BO A 800.00 11/01/2014 11/18/2018 F A 07/01/2014 5,083.00 PS S 1,243.64 12/01/2014 11/19/2053 F A 07/01/2014 5,083.00 SD E 1,394.00 12/01/2014 11/19/2053
VV9689 OP OP F A 08/25/2014 3,143.13 BO A 800.00 11/23/2014 11/22/2017 F A 08/25/2014 3,143.13 P1 E 200.00 08/25/2015 02/06/2051 F A 08/25/2014 3,143.13 SD E 1,323.00 12/01/2014 02/06/2051
VV9690 OP OP F A 08/19/2014 580.94 BO A 558.59 11/17/2014 11/16/2016 F A 08/19/2014 580.94 P1 E 200.00 08/19/2015 10/24/2051 F A 08/19/2014 580.94 SD E 519.00 02/01/2015 10/24/2051
VV9691 OP OP F A 06/06/2014 977.33 BO A 800.00 10/01/2014 10/09/2022 F A 06/06/2014 977.33 P1 E 200.00 06/06/2015 10/10/2057
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 71 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VV9691 OP OP F A 06/06/2014 977.33 SD E 731.00 12/01/2014 10/10/2057
VV9693 OP OP M A 10/02/2014 1,324.32 BO A 800.00 12/31/2014 06/30/2018 M A 10/02/2014 1,324.32 P1 S 2,037.42 11/16/2014 12/14/2052 M A 10/02/2014 1,324.32 SD E 827.00 03/01/2015 12/14/2052
VV9802 OP OP F A 05/12/2014 1,927.46 BO A 800.00 11/01/2014 08/09/2016 F A 05/12/2014 1,927.46 P1 E 200.00 05/12/2015 07/25/2053 F A 05/12/2014 1,927.46 SD E 1,045.00 11/01/2014 07/25/2053
VV9902 OP OP F A 07/03/2014 1,306.74 BO A 23.16 01/01/2015 04/11/2021 F A 07/03/2014 1,306.74 SD A 1,188.00 01/01/2015 04/12/2056
VV9905 OP OP F A 05/25/2014 908.70 BO A 800.00 02/01/2015 09/27/2024 F A 05/25/2014 908.70 P1 E 170.81 05/23/2015 09/28/2059 F A 05/25/2014 908.70 SD E 679.00 11/01/2014 09/28/2059
VV9906 OP OP F A 06/10/2014 1,239.34 BO A 800.00 01/01/2015 09/07/2016 F A 06/10/2014 1,239.34 SD E 827.00 12/01/2014 04/19/2064
VV9944 OP OP F A 07/16/2014 1,657.03 PD S 651.72 12/20/2014 01/17/2066 F A 07/16/2014 1,657.03 SC E 481.00 01/01/2015 08/31/2019 F A 07/16/2014 1,657.03 SD A 1,336.00 01/01/2015 01/17/2066
VV9968 OP OP M A 06/03/2014 1,997.18 BO A 800.00 11/01/2014 06/20/2032 M A 06/03/2014 1,997.18 P1 E 200.00 06/03/2015 06/21/2067 M A 06/03/2014 1,997.18 SD E 1,045.00 12/01/2014 06/21/2067
VV9973 OP OP M A 07/25/2014 1,777.83 BO A 800.00 11/01/2014 06/21/2038 M A 07/25/2014 1,777.83 P1 E 200.00 07/25/2015 06/14/2075 M A 07/25/2014 1,777.83 SD E 1,004.00 01/01/2015 06/14/2075
VV9983 OP OP F A 10/01/2014 3,986.39 BO A 800.00 12/30/2014 10/24/2028 F A 10/01/2014 3,986.39 P1 S 1,239.04 04/01/2015 10/25/2063 F A 10/01/2014 3,986.39 SC E 697.00 03/01/2015 08/31/2024 F A 10/01/2014 3,986.39 SD A 1,659.00 03/01/2015 10/25/2063
VW0000 OP OP F A 05/09/2014 1,285.26 PS A 782.51 07/20/2013 10/25/2059 F A 05/09/2014 1,285.26 SD A 1,168.00 11/01/2014 10/25/2059
VW0017 OP OP F A 03/15/2014 1,157.60 BO A 800.00 06/13/2014 06/12/2016 F A 03/15/2014 1,157.60 P1 E 213.71 03/15/2015 07/05/2065 F A 03/15/2014 1,157.60 SD E 779.00 09/01/2014 07/05/2065
VW0019 OP OP F A 06/07/2014 2,051.17 BO A 340.07 02/01/2015 02/11/2037 F A 06/07/2014 2,051.17 PD S 1,632.21 01/29/2015 02/12/2072 F A 06/07/2014 2,051.17 SD E 1,084.00 12/01/2014 02/12/2072
VW0030 OP OP F A 07/14/2014 2,612.68 BO A 800.00 12/01/2014 01/22/2021 F A 07/14/2014 2,612.68 PS S 1,627.77 10/08/2014 01/23/2056
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 72 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW0030 OP OP F A 07/14/2014 2,612.68 SD E 1,226.00 12/01/2014 01/23/2056
VW0038 OP OP M A 07/29/2014 1,394.64 SD A 1,598.00 01/01/2015 06/22/2053
VW0059 OP OP M A 07/23/2014 2,351.33 BO A 53.10 07/01/2017 07/31/2017 M A 07/23/2014 2,351.33 BO A 800.00 08/01/2017 12/08/2031 M A 07/23/2014 2,351.33 P1 E 200.00 07/23/2015 12/09/2066 M A 07/23/2014 2,351.33 SD E 1,158.00 01/01/2015 12/09/2066 M A 07/23/2014 2,351.33 WT S 3,259.12 07/22/2014 07/21/2017
VW0067 OP OP M A 08/06/2014 2,260.91 BO A 800.00 11/04/2014 05/08/2020 M A 08/06/2014 2,260.91 PD S 757.71 11/01/2014 05/08/2055 M A 08/06/2014 2,260.91 SD E 1,122.00 02/01/2015 05/09/2055 M A 08/06/2014 2,260.91 WT E 971.00 08/06/2014 08/05/2017
VW0087 OP OP F A 07/24/2014 2,715.74 BO A 800.00 10/22/2014 02/25/2040 F A 07/24/2014 2,715.74 SC E 629.00 01/01/2015 01/31/2027 F A 07/24/2014 2,715.74 SD E 1,258.00 01/01/2015 02/26/2075
VW0097 OP OP M A 10/09/2014 2,292.66 BO A 800.00 04/01/2015 04/02/2027 M A 10/09/2014 2,292.66 P1 E 423.26 10/09/2015 04/03/2062 M A 10/09/2014 2,292.66 SD E 1,158.00 04/01/2015 04/03/2062
VW0098 OP OP F A 08/07/2014 1,659.58 BO A 695.54 11/05/2014 05/04/2018 F A 08/07/2014 1,659.58 PS S 900.21 11/01/2014 05/04/2018 F A 08/07/2014 1,659.58 SD E 962.00 02/01/2015 10/21/2052
VW0803 OP OP F A 05/13/2014 2,785.58 BO A 800.00 11/01/2014 06/22/2040 F A 05/13/2014 2,785.58 P1 E 514.26 02/01/2015 06/23/2075 F A 05/13/2014 2,785.58 SD E 1,258.00 02/01/2015 06/23/2075
VW1116 OP OP F A 09/23/2014 4,303.00 BO A 800.00 01/01/2015 12/28/2027 F A 09/23/2014 4,303.00 PS S 3,219.16 01/01/2015 12/29/2062 F A 09/23/2014 4,303.00 SD E 1,394.00 03/01/2015 12/29/2062
VW1121 OP OP F A 03/02/2014 1,093.16 BO A 800.00 01/01/2017 04/02/2018 F A 03/02/2014 1,093.16 P1 E 201.81 03/02/2015 04/03/2053 F A 03/02/2014 1,093.16 SD E 731.00 08/01/2014 04/03/2053 F A 03/02/2014 1,093.16 WT S 1,122.81 01/03/2014 01/02/2017
VW1128 OP OP F A 10/14/2014 1,158.24 P1 E 213.83 10/14/2015 10/02/2069 F A 10/14/2014 1,158.24 SC E 389.50 04/01/2015 11/30/2017 F A 10/14/2014 1,158.24 SD A 1,123.00 04/01/2015 10/02/2069
VW1131 OP OP M A 10/06/2014 1,831.81 BO A 800.00 01/04/2015 01/16/2051 M A 10/06/2014 1,831.81 P1 E 338.18 10/05/2015 01/17/2086 M A 10/06/2014 1,831.81 SC E 502.00 04/01/2015 02/29/2032 M A 10/06/2014 1,831.81 SD E 1,004.00 04/01/2015 01/17/2086
VW1148 OP OP F A 09/11/2014 1,111.50 PD S 277.36 01/17/2015 01/28/2068
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 73 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW1148 OP OP F A 09/11/2014 1,111.50 SD A 866.00 03/01/2015 01/28/2068
VW1154 OP OP M A 04/26/2014 2,104.05 P1 E 391.03 04/25/2015 02/11/2061 M A 04/26/2014 2,104.05 SD E 1,084.00 10/01/2014 02/11/2061 M A 04/26/2014 2,104.05 WT S 2,206.15 04/28/2014 04/26/2017
VW1158 OP OP F A 08/12/2014 1,260.79 BO A 800.00 11/10/2014 12/14/2019 F A 08/12/2014 1,260.79 PS S 317.93 12/15/2014 12/15/2054 F A 08/12/2014 1,260.79 SD E 827.00 02/01/2015 12/15/2054
VW1190 OP OP F A 09/20/2014 3,421.00 BO A 800.00 12/19/2014 07/03/2037 F A 09/20/2014 3,421.00 SC A 419.00 05/01/2014 07/31/2018 F A 09/20/2014 3,421.00 SD A 1,676.00 05/01/2014 07/04/2072
VW1192 OP OP M A 09/02/2014 1,595.41 BO A 800.00 12/01/2014 11/30/2016 M A 09/02/2014 1,595.41 P1 E 294.54 09/02/2015 07/30/2049 M A 09/02/2014 1,595.41 SR E 919.00 08/01/2014 07/30/2049
VW1197 OP OP M A 08/05/2014 788.00 BO A 757.69 11/03/2014 01/17/2026 M A 08/05/2014 788.00 SD E 627.00 02/01/2015 01/18/2061
VW1215 OP OP F A 04/07/2014 2,302.79 P1 E 425.13 07/15/2015 09/05/2082 F A 04/07/2014 2,302.79 SC E 579.00 01/01/2015 08/31/2025 F A 04/07/2014 2,302.79 SD E 1,158.00 01/01/2015 09/05/2082 F A 04/07/2014 2,302.79 WT S 2,790.89 08/22/2014 08/21/2017
VW1249 OP OP F A 08/05/2014 1,092.49 BO A 800.00 11/03/2014 09/10/2029 F A 08/05/2014 1,092.49 P1 E 201.69 06/05/2015 09/11/2064 F A 08/05/2014 1,092.49 SD E 731.00 12/01/2014 09/11/2064
VW1257 OP OP M A 08/29/2014 1,231.11 PD S 239.50 12/01/2014 06/16/2043
VW1661 OP OP F A 11/04/2014 2,778.37 P1 S 1,223.45 03/01/2015 09/03/2058 F A 11/04/2014 2,778.37 SD A 1,486.00 05/01/2015 09/03/2058
VW1921 OP OP M A 08/22/2014 1,487.20 BO A 800.00 11/20/2014 04/18/2038 M A 08/22/2014 1,487.20 SC E 437.00 02/01/2015 02/28/2026 M A 08/22/2014 1,487.20 SD E 874.00 02/01/2015 04/19/2073
VW1926 OP OP F A 10/15/2014 997.05 BO A 800.00 01/13/2015 09/06/2044 F A 10/15/2014 997.05 P1 E 200.00 10/15/2015 09/07/2079 F A 10/15/2014 997.05 SC E 365.50 04/01/2015 10/31/2020 F A 10/15/2014 997.05 SD E 731.00 04/01/2015 09/07/2079
VW1933 OP OP F A 07/03/2014 1,369.02 PS S 334.16 10/01/2014 03/06/2051 F A 07/03/2014 1,369.02 RO S 0.00 10/01/2014 09/30/2015 F A 07/03/2014 1,369.02 SD A 1,232.00 12/01/2014 03/06/2051
VW1936 OP OP F A 08/21/2014 2,991.17 BO A 800.00 11/19/2014 05/18/2018 F A 08/21/2014 2,991.17 PS A 1,798.15 08/21/2014 05/18/2018
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 74 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW1936 OP OP F A 08/21/2014 2,991.17 P1 E 200.00 08/21/2015 06/15/2052 F A 08/21/2014 2,991.17 SD E 1,310.00 02/01/2015 06/15/2052
VW1937 OP OP F A 10/16/2014 3,347.50 BO A 800.00 01/14/2015 06/16/2042 F A 10/16/2014 3,347.50 P1 E 618.00 02/18/2015 06/17/2077 F A 10/16/2014 3,347.50 SD E 1,347.00 08/01/2014 06/17/2077
VW1947 OP OP F A 10/27/2014 1,076.82 BO A 800.00 01/25/2015 10/03/2031 F A 10/27/2014 1,076.82 P1 E 200.00 10/25/2015 10/04/2066 F A 10/27/2014 1,076.82 SD E 731.00 04/01/2015 10/04/2066
VW2210 OP OP F A 08/01/2014 2,681.36 P1 S 2,000.00 08/01/2014 10/16/2059 F A 08/01/2014 2,681.36 SD S 1,669.00 02/01/2015 10/16/2059
VW2223 OP OP M A 06/19/2014 1,667.97 BO A 800.00 09/17/2014 09/16/2016 M A 06/19/2014 1,667.97 P1 E 200.00 06/19/2015 11/15/2061 M A 06/19/2014 1,667.97 SD E 962.00 12/01/2014 11/15/2061
VW2228 OP OP F A 10/22/2014 2,705.09 BO A 800.00 01/20/2015 08/10/2036 F A 10/22/2014 2,705.09 P1 E 200.00 10/22/2015 08/11/2071 F A 10/22/2014 2,705.09 SD E 1,258.00 04/01/2015 08/11/2071
VW2229 OP OP M A 06/18/2014 1,677.75 BO A 526.79 07/01/2017 08/07/2023 M A 06/18/2014 1,677.75 PD S 1,086.44 11/15/2014 08/08/2058 M A 06/18/2014 1,677.75 SD E 962.00 12/01/2014 08/08/2058 M A 06/18/2014 1,677.75 WT S 2,722.42 06/19/2014 06/18/2017
VW2252 OP OP F A 07/11/2014 1,271.45 BO A 800.00 10/09/2014 10/23/2022 F A 07/11/2014 1,271.45 P1 E 522.64 07/09/2015 10/24/2057 F A 07/11/2014 1,271.45 SD E 827.00 01/01/2015 10/24/2057
VW2286 OP OP F A 12/03/2014 1,792.59 BO A 800.00 03/03/2015 03/27/2021 F A 12/03/2014 1,792.59 P1 E 200.00 12/03/2015 03/28/2056 F A 12/03/2014 1,792.59 SD E 1,004.00 06/01/2015 03/28/2056
VW2413 OP OP M A 09/12/2014 585.00 BO A 562.50 12/11/2014 06/02/2033 M A 09/12/2014 585.00 SC E 287.00 03/01/2015 12/31/2017 M A 09/12/2014 585.00 SD E 574.00 03/01/2015 06/03/2068
VW2421 OP OP F A 07/12/2014 1,984.13 BO A 800.00 10/10/2014 12/29/2036 F A 07/12/2014 1,984.13 P1 E 366.30 07/12/2015 12/30/2071 F A 07/12/2014 1,984.13 SC E 522.50 01/01/2015 07/31/2016 F A 07/12/2014 1,984.13 SD E 1,045.00 01/01/2015 12/30/2071
VW2704 OP OP M A 07/11/2014 1,885.79 BO A 800.00 11/01/2014 09/13/2029 M A 07/11/2014 1,885.79 P1 E 348.15 07/01/2015 09/14/2064 M A 07/11/2014 1,885.79 SD E 1,045.00 12/01/2014 09/14/2064
VW2705 OP OP F A 09/24/2014 1,125.48 BO A 800.00 12/23/2014 04/26/2021 F A 09/24/2014 1,125.48 P1 E 200.00 09/24/2015 04/27/2056
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 75 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW2705 OP OP F A 09/24/2014 1,125.48 SD E 779.00 03/01/2015 04/27/2056
VW2763 OP OP F A 11/07/2013 1,019.92 BO A 800.00 12/01/2014 05/03/2021 F A 11/07/2013 1,019.92 P1 E 200.00 11/07/2014 05/04/2056 F A 11/07/2013 1,019.92 SD E 731.00 05/01/2014 05/04/2056
VW2769 OP OP F A 08/13/2014 1,472.46 BO A 708.74 08/01/2017 08/31/2017 F A 08/13/2014 1,472.46 BO A 800.00 09/01/2017 05/31/2034 F A 08/13/2014 1,472.46 P1 E 200.00 08/13/2015 06/01/2069 F A 08/13/2014 1,472.46 SD E 874.00 02/01/2015 06/01/2069 F A 08/13/2014 1,472.46 WT S 1,826.66 08/13/2014 08/12/2017
VW2784 OP OP F A 09/27/2014 1,857.88 BO A 800.00 12/26/2014 11/14/2033 F A 09/27/2014 1,857.88 SD E 1,004.00 03/01/2015 11/15/2068
VW2787 OP OP F A 10/14/2014 2,085.41 BO A 800.00 01/12/2015 06/10/2023 F A 10/14/2014 2,085.41 P1 E 200.00 10/14/2015 06/11/2058 F A 10/14/2014 2,085.41 SD E 1,084.00 04/01/2015 06/11/2058
VW2795 OP OP F A 10/28/2014 1,064.49 BO A 800.00 01/26/2015 12/26/2033 F A 10/28/2014 1,064.49 P1 E 200.00 10/28/2015 12/27/2068 F A 10/28/2014 1,064.49 SC E 365.50 04/01/2015 06/30/2025 F A 10/28/2014 1,064.49 SD E 731.00 04/01/2015 12/27/2068
VW2798 OP OP F A 08/23/2014 694.90 BO A 668.18 01/01/2015 06/03/2021 F A 08/23/2014 694.90 P1 E 157.46 08/21/2015 06/04/2056 F A 08/23/2014 694.90 SD E 574.00 02/01/2015 06/04/2056
VW2814 OP OP M A 09/23/2014 1,812.60 BO A 424.91 12/22/2014 02/26/2039 M A 09/23/2014 1,812.60 PD S 1,317.97 12/13/2014 02/27/2074 M A 09/23/2014 1,812.60 SD E 1,004.00 03/01/2015 02/27/2074
VW2857 OP OP M A 10/16/2014 3,207.63 PD S 2,151.21 05/09/2015 12/10/2055 M A 10/16/2014 3,207.63 SD A 1,983.00 04/01/2015 12/10/2055
VW2885 OP OP F A 11/13/2014 942.92 BO A 800.00 02/11/2015 01/04/2021 F A 11/13/2014 942.92 P1 E 365.05 11/12/2015 01/05/2056 F A 11/13/2014 942.92 SD E 679.00 05/01/2015 01/05/2056
VW2893 OP OP M A 08/21/2014 1,626.24 P1 E 200.00 08/21/2015 08/03/2056 M A 08/21/2014 1,626.24 SD E 962.00 02/01/2015 08/03/2056
VW2933 OP OP F A 10/30/2014 1,083.77 BO A 800.00 01/28/2015 02/18/2029 F A 10/30/2014 1,083.77 SD E 731.00 04/01/2015 02/19/2064
VW2936 OP OP F A 08/06/2014 1,988.35 BO A 800.00 01/01/2015 12/20/2020 F A 08/06/2014 1,988.35 P1 E 545.64 08/06/2015 12/21/2055 F A 08/06/2014 1,988.35 SD E 1,045.00 02/01/2015 12/21/2055
VW2941 OP OP M A 10/06/2014 816.45 BO A 785.05 01/04/2015 07/03/2017
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 76 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW2941 OP OP M A 10/06/2014 816.45 P1 E 200.00 10/06/2015 01/01/2050
VW2958 OP OP F A 08/12/2014 2,512.41 PD S 457.65 02/01/2015 10/05/2058 F A 08/12/2014 2,512.41 SD A 1,562.00 12/01/2014 10/05/2058
VW2970 OP OP F A 10/11/2014 2,110.63 BO A 800.00 01/09/2015 12/08/2027 F A 10/11/2014 2,110.63 P1 E 200.00 10/11/2015 12/09/2062 F A 10/11/2014 2,110.63 SD E 1,084.00 04/01/2015 12/09/2062
VW2983 OP OP F A 09/27/2014 1,191.07 BO A 800.00 12/26/2014 05/22/2019 F A 09/27/2014 1,191.07 P1 E 200.00 09/27/2015 05/23/2054 F A 09/27/2014 1,191.07 SD E 779.00 03/01/2015 05/23/2054
VW3028 OP OP F A 09/05/2014 1,093.95 BO A 48.94 09/01/2017 09/30/2017 F A 09/05/2014 1,093.95 BO A 198.88 10/01/2017 06/03/2018 F A 09/05/2014 1,093.95 P1 E 200.00 09/05/2015 03/27/2052 F A 09/05/2014 1,093.95 SD E 731.00 03/01/2015 03/27/2052 F A 09/05/2014 1,093.95 SR S 853.00 09/24/2014 03/27/2052 F A 09/05/2014 1,093.95 WT S 1,124.54 09/18/2014 09/04/2017
VW3116 OP OP F A 09/27/2014 2,637.75 PD S 1,648.06 03/06/2015 04/12/2056 F A 09/27/2014 2,637.75 SD A 1,715.00 03/01/2015 04/12/2056
VW3161 OP OP F A 12/05/2014 1,320.42 BO A 800.00 03/05/2015 11/30/2031 F A 12/05/2014 1,320.42 P1 E 200.00 12/05/2015 12/01/2066 F A 12/05/2014 1,320.42 SD E 827.00 06/01/2015 12/01/2066
VW3172 OP OP F A 08/12/2014 1,486.60 BO A 800.00 11/10/2014 03/27/2023 F A 08/12/2014 1,486.60 P1 E 301.31 08/12/2015 03/28/2058 F A 08/12/2014 1,486.60 SD E 874.00 02/01/2015 03/28/2058
VW3174 OP OP F A 08/25/2014 1,157.11 BO A 800.00 12/01/2014 06/14/2025 F A 08/25/2014 1,157.11 SD A 944.00 02/01/2015 06/14/2025
VW3177 OP OP M A 09/29/2014 2,252.30 BO A 417.90 03/28/2015 03/25/2043 M A 09/29/2014 2,252.30 PD S 1,747.78 03/03/2015 03/26/2078 M A 09/29/2014 2,252.30 SC E 561.00 03/01/2015 07/31/2024 M A 09/29/2014 2,252.30 SD E 1,122.00 03/01/2015 03/26/2078
VW3314 OP OP F A 04/30/2014 1,313.27 P1 E 200.00 04/30/2015 02/22/2060 F A 04/30/2014 1,313.27 SD E 827.00 10/01/2014 02/22/2060 F A 04/30/2014 1,313.27 WT S 3,222.54 04/30/2014 04/29/2017
VW3325 OP OP F A 09/07/2014 1,949.88 BO A 800.00 01/01/2015 02/03/2023 F A 09/07/2014 1,949.88 P1 E 477.36 09/03/2015 02/04/2058 F A 09/07/2014 1,949.88 SD E 1,045.00 03/01/2015 02/04/2058
VW3331 OP OP F A 08/23/2014 1,017.95 BO A 800.00 03/01/2015 11/20/2016
F A 08/23/2014 1,017.95 P1 E 187.93 08/23/2015 04/02/2065 F A 08/23/2014 1,017.95 SD E 731.00 02/01/2015 04/02/2065
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 77 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW3335 OP OP F A 09/10/2014 05/10/2015 961.66 BO A 96.52 12/09/2014 05/10/2015 F A 09/10/2014 05/10/2015 961.66 P1 E 200.00 09/10/2015 07/05/2055 F A 09/10/2014 05/10/2015 961.66 SD E 679.00 03/01/2015 07/05/2055 F A 09/10/2014 05/10/2015 961.66 WT S 828.17 09/13/2014 09/12/2017
VW3366 OP OP F A 07/20/2014 1,499.39 PD S 401.10 01/15/2015 03/19/2055 F A 07/20/2014 1,499.39 SD S 1,245.00 01/01/2015 03/19/2055
VW3368 OP OP F A 10/01/2014 1,357.58 BO A 800.00 12/30/2014 07/08/2021 F A 10/01/2014 1,357.58 P1 E 200.00 10/01/2015 07/09/2056 F A 10/01/2014 1,357.58 SD E 827.00 03/01/2015 07/09/2056
VW3379 OP OP F A 07/15/2014 1,734.82 BO A 800.00 12/01/2014 07/30/2022 F A 07/15/2014 1,734.82 P1 E 200.00 07/15/2015 07/31/2057 F A 07/15/2014 1,734.82 SD E 962.00 01/01/2015 07/31/2057
VW3380 OP OP M A 02/13/2014 4,626.75 BO A 800.00 04/01/2015 05/13/2016 M A 02/13/2014 4,626.75 PS A 3,039.58 02/13/2014 09/28/2054 M A 02/13/2014 4,626.75 SD E 1,394.00 05/01/2015 09/28/2054
VW3384 OP OP M A 04/08/2014 5,732.04 BO A 800.00 09/01/2014 10/18/2033 M A 04/08/2014 5,732.04 P1 E 1,058.22 04/08/2015 10/19/2068 M A 04/08/2014 5,732.04 SD E 1,394.00 04/01/2015 10/19/2068
VW3440 OP OP F A 08/16/2014 2,859.79 BO A 800.00 11/14/2014 12/27/2036 F A 08/16/2014 2,859.79 P1 E 527.96 08/15/2015 12/28/2071 F A 08/16/2014 2,859.79 SC E 644.00 02/01/2015 06/30/2031 F A 08/16/2014 2,859.79 SD E 1,288.00 02/01/2015 12/28/2071
VW3468 OP OP M A 09/12/2014 1,490.38 BO A 139.12 01/01/2015 11/19/2022 M A 09/12/2014 1,490.38 PS A 1,293.94 09/12/2014 11/20/2057 M A 09/12/2014 1,490.38 SD E 874.00 03/01/2015 11/20/2057
VW3477 OP OP F A 08/12/2014 1,184.36 BO A 800.00 11/10/2014 01/15/2030 F A 08/12/2014 1,184.36 P1 E 200.00 08/12/2015 01/16/2065 F A 08/12/2014 1,184.36 SD E 779.00 02/01/2015 01/16/2065
VW3489 OP OP M A 10/29/2014 4,776.80 BO A 800.00 01/27/2015 07/21/2030 M A 10/29/2014 4,776.80 P1 E 881.87 01/30/2016 07/22/2065 M A 10/29/2014 4,776.80 SD A 2,367.00 07/01/2015 07/22/2065
VW4302 OP OP F A 10/12/2014 1,088.52 BO A 800.00 01/10/2015 11/16/2033 F A 10/12/2014 1,088.52 P1 E 200.96 10/12/2015 11/17/2068 F A 10/12/2014 1,088.52 SD E 731.00 04/01/2015 11/17/2068
VW4303 OP OP F A 11/11/2014 1,272.32 BO A 800.00 02/09/2015 02/06/2019 F A 11/11/2014 1,272.32 P1 E 200.00 11/11/2015 02/07/2054 F A 11/11/2014 1,272.32 SD E 827.00 05/01/2015 02/07/2054
VW4362 OP OP F A 09/13/2014 1,970.54 P1 A 441.03 12/11/2014 11/17/2060
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 78 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW4362 OP OP F A 09/13/2014 1,970.54 SD A 1,477.00 03/01/2015 11/17/2060
VW4368 OP OP M A 06/25/2014 1,112.90 BO A 800.00 09/23/2014 12/05/2034 M A 06/25/2014 1,112.90 SC E 389.50 12/01/2014 07/31/2023 M A 06/25/2014 1,112.90 SD E 779.00 12/01/2014 12/06/2069
VW4430 OP OP F A 08/13/2014 3,035.08 BO A 800.00 11/11/2014 12/18/2044 F A 08/13/2014 3,035.08 P1 E 200.00 08/13/2015 12/19/2079 F A 08/13/2014 3,035.08 SD E 1,310.00 02/01/2015 12/19/2079
VW4443 OP OP F A 10/01/2014 2,652.00 BO A 800.00 12/30/2014 04/17/2041 F A 10/01/2014 2,652.00 P1 E 489.60 10/01/2015 04/18/2076 F A 10/01/2014 2,652.00 SC E 613.00 03/01/2015 10/31/2026 F A 10/01/2014 2,652.00 SD E 1,226.00 03/01/2015 04/18/2076
VW4489 OP OP M A 11/03/2014 2,467.35 BO A 303.26 03/01/2015 11/14/2031 M A 11/03/2014 2,467.35 PD S 2,069.19 02/04/2015 11/15/2066 M A 11/03/2014 2,467.35 SC E 596.50 05/01/2015 08/31/2024 M A 11/03/2014 2,467.35 SD E 1,193.00 05/01/2015 11/15/2066
VW4491 OP OP M A 12/09/2014 1,405.90 BO A 800.00 03/09/2015 02/14/2025 M A 12/09/2014 1,405.90 P1 E 259.55 12/09/2015 02/15/2060 M A 12/09/2014 1,405.90 SD E 874.00 06/01/2015 02/15/2060
VW4613 OP OP F A 09/10/2014 1,388.13 BO A 800.00 12/09/2014 12/06/2047 F A 09/10/2014 1,388.13 P1 E 256.27 09/10/2015 12/07/2082 F A 09/10/2014 1,388.13 SD E 874.00 03/01/2015 12/07/2082
VW4615 OP OP F A 11/18/2014 1,797.30 BO A 373.18 05/01/2015 09/23/2020 F A 11/18/2014 1,797.30 SD A 1,355.00 05/01/2015 09/24/2055
VW4620 OP OP F A 10/07/2014 2,945.05 BO A 800.00 01/05/2015 09/23/2033 F A 10/07/2014 2,945.05 SC E 655.00 04/01/2015 11/30/2016 F A 10/07/2014 2,945.05 SD E 1,310.00 04/01/2015 09/24/2068
VW4621 OP OP M A 07/11/2014 2,082.44 PL A 445.53 02/20/2015 07/31/2067 M A 07/11/2014 2,082.44 SD S 1,601.00 01/01/2015 07/31/2067
VW4645 OP OP M A 09/03/2014 1,673.75 BO A 773.53 10/01/2017 10/31/2017 M A 09/03/2014 1,673.75 BO A 800.00 11/01/2017 09/06/2035 M A 09/03/2014 1,673.75 P1 E 200.00 09/04/2015 09/07/2070 M A 09/03/2014 1,673.75 SC E 481.00 03/01/2015 08/31/2021 M A 09/03/2014 1,673.75 SD E 962.00 03/01/2015 09/07/2070 M A 09/03/2014 1,673.75 WT S 1,619.46 10/17/2014 10/16/2017
VW4666 OP OP F A 10/24/2014 983.17 BO A 800.00 07/01/2015 06/27/2029 F A 10/24/2014 983.17 P1 E 664.36 10/24/2015 06/28/2064 F A 10/24/2014 983.17 SD E 731.00 04/01/2015 06/28/2064
F A 10/24/2014 983.17 SL S 1,718.83 10/24/2014 06/30/2015
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 79 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW4669 OP OP M A 11/15/2014 1,194.43 BO A 800.00 02/13/2015 03/11/2033 M A 11/15/2014 1,194.43 P1 E 200.00 11/15/2015 03/12/2068 M A 11/15/2014 1,194.43 SD E 827.00 05/01/2015 03/12/2068 M A 11/15/2014 1,194.43 WT E 971.00 11/15/2014 11/14/2017
VW4696 OP OP F A 12/06/2014 1,574.74 BO A 800.00 03/06/2015 05/31/2015 F A 12/06/2014 1,574.74 BO A 522.17 06/01/2015 07/26/2023 F A 12/06/2014 1,574.74 P1 E 200.00 12/06/2015 07/27/2058 F A 12/06/2014 1,574.74 SD E 919.00 06/01/2015 07/27/2058
VW4737 OP OP F A 09/17/2014 1,308.50 BO A 800.00 12/16/2014 10/06/2019 F A 09/17/2014 1,308.50 P1 E 200.00 09/17/2015 10/07/2054 F A 09/17/2014 1,308.50 SD E 827.00 03/01/2015 10/07/2054
VW4787 OP OP F A 08/30/2014 963.82 PS S 300.00 07/01/2014 11/30/2043 F A 08/30/2014 963.82 SR S 1,256.00 01/01/2015 11/30/2043
VW4809 OP OP M A 11/15/2014 1,670.18 SD A 2,129.00 05/01/2015 10/31/2060
VW4826 OP OP M A 12/03/2014 4,271.03 BO A 800.00 03/03/2015 11/19/2020 M A 12/03/2014 4,271.03 P1 E 200.00 12/03/2015 11/20/2055 M A 12/03/2014 4,271.03 SD E 1,394.00 06/01/2015 11/20/2055
VW4836 OP OP F A 10/31/2014 1,614.76 BO A 800.00 01/29/2015 03/26/2035 F A 10/31/2014 1,614.76 P1 E 200.00 11/01/2015 03/27/2070 F A 10/31/2014 1,614.76 SD E 919.00 04/01/2015 03/27/2070
VW4859 OP OP F A 08/10/2014 769.60 BO A 740.00 03/01/2015 08/08/2022 F A 08/10/2014 769.60 P1 E 200.00 08/10/2015 08/09/2057 F A 08/10/2014 769.60 SC E 313.50 12/01/2014 04/30/2016 F A 08/10/2014 769.60 SD E 627.00 12/01/2014 08/09/2057
VW4876 OP OP F A 10/31/2014 05/10/2015 702.19 BO A 675.18 01/29/2015 05/10/2015 F A 10/31/2014 05/10/2015 702.19 P1 E 129.63 10/30/2015 04/05/2067 F A 10/31/2014 05/10/2015 702.19 SD E 574.00 04/01/2015 04/05/2067
VW4898 OP OP M A 07/19/2014 993.58 BO A 786.61 10/17/2014 03/28/2024 M A 07/19/2014 993.58 P1 E 200.00 07/19/2015 03/29/2059 M A 07/19/2014 993.58 SD E 731.00 01/01/2015 03/29/2059
VW4912 OP OP F A 11/18/2014 1,752.29 BO A 800.00 02/16/2015 10/31/2029 F A 11/18/2014 1,752.29 P1 E 200.00 10/01/2015 11/01/2064 F A 11/18/2014 1,752.29 RO S 1,806.21 02/16/2015 02/15/2016
VW4920 OP OP F A 10/31/2014 935.86 BO A 800.00 01/29/2015 10/26/2020 F A 10/31/2014 935.86 P1 E 172.77 10/30/2015 10/27/2055 F A 10/31/2014 935.86 SD E 679.00 04/01/2015 10/27/2055
VW4952 OP OP F A 12/20/2014 3,570.03 BO A 800.00 05/01/2015 11/12/2030 F A 12/20/2014 3,570.03 P1 E 200.00 12/20/2015 11/13/2065
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 80 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW4952 OP OP F A 12/20/2014 3,570.03 SD E 1,388.00 06/01/2015 11/13/2065
VW4982 OP OP F A 04/28/2014 2,424.64 BO A 800.00 07/01/2015 08/03/2038 F A 04/28/2014 2,424.64 P1 E 447.63 09/12/2015 08/14/2073 F A 04/28/2014 2,424.64 SD E 1,193.00 03/01/2015 08/14/2073 F A 04/28/2014 2,424.64 SL A 3,882.33 09/13/2014 06/30/2015
VW4989 OP OP F A 09/09/2014 2,491.66 BO A 558.83 03/01/2015 11/11/2023 F A 09/09/2014 2,491.66 P1 E 200.00 09/09/2015 11/12/2058 F A 09/09/2014 2,491.66 SD A 1,837.00 03/01/2015 11/12/2058
VW4996 OP OP F A 12/17/2014 06/06/2015 1,631.34 SD E 962.00 06/01/2015 03/10/2085 F A 12/17/2014 06/06/2015 1,631.34 WT S 1,683.94 01/08/2015 12/16/2017
VW4998 OP OP F A 10/02/2014 2,685.69 P1 S 979.74 12/02/2014 01/10/2051 F A 10/02/2014 2,685.69 SR A 1,395.00 03/01/2015 01/10/2051
VW5030 OP OP M A 08/06/2014 2,369.32 BO A 800.00 11/04/2014 03/01/2041 M A 08/06/2014 2,369.32 P1 E 200.00 08/06/2015 03/02/2076 M A 08/06/2014 2,369.32 RO S 1,224.21 03/24/2015 03/23/2016 M A 08/06/2014 2,369.32 RO S 1,250.00 03/24/2016 03/23/2017 M A 08/06/2014 2,369.32 SC E 596.50 02/01/2015 01/31/2027 M A 08/06/2014 2,369.32 SD E 1,193.00 02/01/2015 03/02/2076
VW5077 OP OP M A 12/15/2014 2,413.18 P1 E 684.20 12/15/2015 02/16/2058 M A 12/15/2014 2,413.18 SD E 1,193.00 06/01/2015 02/16/2058
VW5310 OP OP F A 01/07/2015 768.36 BO A 738.81 04/07/2015 10/20/2024 F A 01/07/2015 768.36 SC E 313.50 07/01/2015 03/31/2019 F A 01/07/2015 768.36 SD E 627.00 07/01/2015 10/21/2059
VW5315 OP OP M A 12/30/2014 2,638.95 BO A 800.00 04/01/2015 03/29/2016 M A 12/30/2014 2,638.95 PD S 487.48 04/04/2015 06/11/2045
VW5330 OP OP M A 12/04/2014 1,627.00 BO A 800.00 03/04/2015 07/27/2024 M A 12/04/2014 1,627.00 P1 E 200.00 12/04/2015 07/28/2059 M A 12/04/2014 1,627.00 SD E 962.00 06/01/2015 07/28/2059
VW5377 OP OP F A 12/20/2014 1,102.89 BO A 800.00 04/01/2015 11/16/2018 F A 12/20/2014 1,102.89 P1 E 203.61 12/20/2015 11/17/2053 F A 12/20/2014 1,102.89 SD E 731.00 06/01/2015 11/17/2053
VW5716 OP OP F A 12/19/2014 05/03/2015 2,627.03 BO A 800.00 03/19/2015 05/03/2015 F A 12/19/2014 05/03/2015 2,627.03 P1 E 200.00 12/19/2015 05/24/2077 F A 12/19/2014 05/03/2015 2,627.03 SD E 1,226.00 06/01/2015 05/24/2077
VW5727 OP OP F A 10/21/2014 1,191.66 BO A 800.00 01/19/2015 07/03/2027 F A 10/21/2014 1,191.66 P1 E 200.00 10/21/2015 07/04/2062
F A 10/21/2014 1,191.66 SD E 779.00 04/01/2015 07/04/2062
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 81 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW5731 OP OP F A 11/22/2014 1,704.95 BO A 800.00 02/20/2015 08/28/2029 F A 11/22/2014 1,704.95 SD E 962.00 05/01/2015 08/29/2064
VW5741 OP OP M A 09/30/2014 1,893.34 BO A 800.00 10/01/2017 05/16/2031 M A 09/30/2014 1,893.34 P1 E 200.00 09/30/2015 05/17/2066 M A 09/30/2014 1,893.34 SD E 1,045.00 03/01/2015 05/17/2066 M A 09/30/2014 1,893.34 WT S 1,900.00 10/01/2014 09/29/2017
VW5758 OP OP F A 01/05/2015 621.73 BO A 597.81 04/05/2015 02/10/2025 F A 01/05/2015 621.73 P1 E 200.00 01/05/2016 02/11/2060 F A 01/05/2015 621.73 SD E 574.00 06/01/2015 02/11/2060
VW5760 OP OP F A 08/29/2014 1,162.04 BO A 800.00 11/27/2014 12/10/2026 F A 08/29/2014 1,162.04 P1 E 328.06 08/28/2015 12/11/2061 F A 08/29/2014 1,162.04 SC E 389.50 02/01/2015 08/31/2021 F A 08/29/2014 1,162.04 SD E 779.00 02/01/2015 12/11/2061
VW5807 OP OP F A 11/15/2014 2,884.05 BO A 583.29 05/01/2015 05/31/2015 F A 11/15/2014 2,884.05 BO A 800.00 06/01/2015 02/12/2017 F A 11/15/2014 2,884.05 P1 E 600.97 11/15/2015 11/17/2058 F A 11/15/2014 2,884.05 SD E 1,288.00 05/01/2015 11/17/2058 F A 11/15/2014 2,884.05 SL A 4,525.67 11/15/2014 05/15/2015
VW5825 OP OP M A 11/13/2014 05/24/2015 1,539.44 BO A 800.00 02/11/2015 05/24/2015 M A 11/13/2014 05/24/2015 1,539.44 P1 E 284.20 11/12/2015 09/03/2072 M A 11/13/2014 05/24/2015 1,539.44 SC E 459.50 05/01/2015 02/28/2030 M A 11/13/2014 05/24/2015 1,539.44 SD E 919.00 05/01/2015 09/03/2072
VW5924 OP OP M A 08/01/2014 1,216.91 BO A 800.00 08/01/2017 10/12/2031 M A 08/01/2014 1,216.91 P1 E 200.00 08/01/2015 10/13/2066 M A 08/01/2014 1,216.91 SD E 827.00 01/01/2015 10/13/2066 M A 08/01/2014 1,216.91 WT S 1,651.61 08/01/2014 07/31/2017
VW5925 OP OP M A 11/01/2014 1,683.38 BO A 800.00 01/30/2015 06/05/2021 M A 11/01/2014 1,683.38 P1 E 200.00 11/01/2015 06/06/2056 M A 11/01/2014 1,683.38 SD E 962.00 04/01/2015 06/06/2056
VW5929 OP OP M A 10/09/2014 2,176.31 BO A 800.00 01/07/2015 10/01/2031 M A 10/09/2014 2,176.31 PD E 401.78 10/08/2014 10/02/2036 M A 10/09/2014 2,176.31 P1 E 200.00 10/09/2015 10/02/2066 M A 10/09/2014 2,176.31 SD E 1,122.00 04/01/2015 10/02/2066
VW5938 OP OP F A 11/04/2014 1,915.50 BO A 800.00 05/01/2015 04/30/2034 F A 11/04/2014 1,915.50 P1 E 200.00 11/04/2015 05/01/2069 F A 11/04/2014 1,915.50 SD E 1,045.00 04/01/2015 05/01/2069
VW5963 OP OP F A 01/01/2015 3,157.71 P1 E 582.96 12/19/2015 09/19/2049 F A 01/01/2015 3,157.71 SR E 1,323.00 01/01/2015 09/19/2049
VW5984 OP OP M A 02/22/2015 2,020.80 BO A 800.00 05/23/2015 09/09/2028
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 82 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW5984 OP OP M A 02/22/2015 2,020.80 P1 E 288.21 02/22/2016 09/10/2063 M A 02/22/2015 2,020.80 SD E 1,084.00 08/01/2015 09/10/2063
VW5989 OP OP F A 01/10/2015 1,216.36 BO A 800.00 04/10/2015 12/11/2042 F A 01/10/2015 1,216.36 SC E 389.50 07/01/2015 12/31/2017 F A 01/10/2015 1,216.36 SD E 779.00 07/01/2015 12/12/2077
VW5992 OP OP M A 04/18/2014 2,210.11 BO A 800.00 11/01/2017 08/25/2020 M A 04/18/2014 2,210.11 P1 E 717.22 04/17/2015 08/26/2055 M A 04/18/2014 2,210.11 SD E 1,122.00 10/01/2014 08/26/2055 M A 04/18/2014 2,210.11 WT S 2,760.99 10/25/2014 10/24/2017
VW5995 OP OP M A 01/16/2015 1,964.50 BO A 800.00 05/01/2015 03/12/2022 M A 01/16/2015 1,964.50 P1 E 200.00 01/16/2016 03/13/2057 M A 01/16/2015 1,964.50 SD E 1,045.00 07/01/2015 03/13/2057
VW6202 OP OP F A 11/13/2014 2,010.75 BO A 800.00 02/11/2015 02/10/2016 F A 11/13/2014 2,010.75 PS A 270.00 02/06/2015 04/26/2044
VW6250 OP OP F A 07/09/2014 1,330.22 BO A 10.06 10/07/2014 10/06/2016 F A 07/09/2014 1,330.22 P1 E 200.00 07/09/2015 12/08/2064 F A 07/09/2014 1,330.22 SD E 827.00 01/01/2015 12/08/2064 F A 07/09/2014 1,330.22 WT S 1,269.00 10/01/2014 09/30/2017
VW6261 OP OP M A 07/22/2014 1,171.95 BO A 776.88 02/01/2015 10/19/2017 M A 07/22/2014 1,171.95 P1 S 350.00 08/01/2014 08/05/2050 M A 07/22/2014 1,171.95 SD E 779.00 01/01/2015 08/05/2050 M A 07/22/2014 1,171.95 WT E 971.00 07/22/2014 07/21/2017
VW6268 OP OP F A 06/24/2014 1,661.40 BO A 800.00 09/22/2014 01/27/2036 F A 06/24/2014 1,661.40 SC E 481.00 12/01/2014 01/31/2024 F A 06/24/2014 1,661.40 SD E 962.00 12/01/2014 01/28/2071
VW6274 OP OP F A 10/24/2014 1,102.89 BO A 800.00 01/22/2015 04/06/2028 F A 10/24/2014 1,102.89 P1 E 203.61 10/24/2015 04/07/2063 F A 10/24/2014 1,102.89 SD E 731.00 04/01/2015 04/07/2063
VW6430 OP OP F A 01/08/2015 1,220.05 BO A 800.00 05/01/2015 09/12/2030 F A 01/08/2015 1,220.05 P1 E 225.24 01/08/2016 09/13/2065 F A 01/08/2015 1,220.05 SD E 779.00 07/01/2015 09/13/2065
VW6473 OP OP F A 01/14/2015 1,507.62 BO A 800.00 04/14/2015 03/04/2025 F A 01/14/2015 1,507.62 P1 E 378.57 01/14/2016 03/05/2060 F A 01/14/2015 1,507.62 SD E 919.00 07/01/2015 03/05/2060
VW6598 OP OP F A 01/24/2015 1,121.85 BO A 800.00 04/24/2015 04/09/2021 F A 01/24/2015 1,121.85 P1 E 207.11 01/24/2016 04/10/2056 F A 01/24/2015 1,121.85 SD E 779.00 07/01/2015 04/10/2056
VW6629 OP OP F A 12/02/2014 1,622.94 BO A 800.00 03/02/2015 01/27/2030
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 83 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW6629 OP OP F A 12/02/2014 1,622.94 P1 E 299.62 11/27/2015 01/28/2065 F A 12/02/2014 1,622.94 SC E 459.50 05/01/2015 05/31/2017 F A 12/02/2014 1,622.94 SD E 919.00 05/01/2015 01/28/2065
VW6636 OP OP F A 11/15/2014 2,348.94 BO A 800.00 04/01/2015 10/30/2026 F A 11/15/2014 2,348.94 P1 E 200.00 11/15/2015 10/31/2061 F A 11/15/2014 2,348.94 SD E 1,158.00 05/01/2015 10/31/2061
VW6643 OP OP M A 11/04/2014 1,245.43 BO A 800.00 02/02/2015 08/01/2017 M A 11/04/2014 1,245.43 P1 E 229.92 11/01/2015 03/27/2050 M A 11/04/2014 1,245.43 SD E 827.00 04/01/2015 03/27/2050
VW6693 OP OP F A 12/07/2014 05/02/2015 1,960.84 BO A 800.00 05/01/2015 05/02/2015 F A 12/07/2014 05/02/2015 1,960.84 P1 E 1,204.22 12/07/2015 01/04/2048
VW6721 OP OP M A 09/22/2014 1,853.93 BO A 800.00 03/01/2015 01/18/2032 M A 09/22/2014 1,853.93 PD S 861.51 02/06/2015 01/19/2067 M A 09/22/2014 1,853.93 SD E 1,004.00 03/01/2015 01/19/2067
VW6743 OP OP F A 06/06/2014 2,909.61 PS S 631.02 11/01/2014 08/23/2052 F A 06/06/2014 2,909.61 SD A 2,029.00 11/01/2014 08/23/2052
VW6760 OP OP F A 12/30/2014 05/03/2015 3,208.13 BO A 800.00 05/01/2015 05/03/2015 F A 12/30/2014 05/03/2015 3,208.13 PS S 1,335.63 07/01/2014 07/18/2056 F A 12/30/2014 05/03/2015 3,208.13 SD E 1,336.00 06/01/2015 07/18/2056
VW6762 OP OP F A 12/12/2014 1,511.08 BO A 800.00 03/12/2015 10/19/2029 F A 12/12/2014 1,511.08 P1 E 200.00 12/12/2015 10/20/2064 F A 12/12/2014 1,511.08 SD E 919.00 06/01/2015 10/20/2064
VW6764 OP OP F A 01/02/2015 1,651.49 P1 E 200.00 01/02/2016 07/18/2057 F A 01/02/2015 1,651.49 SD E 962.00 06/01/2015 07/18/2057
VW7417 OP OP M A 11/08/2014 1,359.75 BO A 800.00 02/06/2015 12/29/2031 M A 11/08/2014 1,359.75 P1 E 200.00 11/08/2015 12/30/2066 M A 11/08/2014 1,359.75 SD E 827.00 05/01/2015 12/30/2066
VW7434 OP OP F A 03/01/2015 3,360.18 P1 E 200.00 03/01/2016 03/05/2050 F A 03/01/2015 3,360.18 SD E 1,347.00 08/01/2015 03/05/2050
VW7485 OP OP M A 02/12/2015 2,994.54 BO A 800.00 05/13/2015 06/22/2032 M A 02/12/2015 2,994.54 P1 E 200.00 02/12/2016 06/23/2067 M A 02/12/2015 2,994.54 SD E 1,310.00 08/01/2015 06/23/2067
VW7498 OP OP F A 01/15/2015 1,442.49 BO A 800.00 04/15/2015 09/19/2034 F A 01/15/2015 1,442.49 P1 E 266.31 01/14/2016 09/20/2069 F A 01/15/2015 1,442.49 SD E 874.00 07/01/2015 09/20/2069
VW7502 OP OP F A 11/22/2014 2,576.44 BO A 800.00 02/20/2015 07/28/2022 F A 11/22/2014 2,576.44 P1 E 200.00 11/22/2015 07/29/2057
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 84 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW7502 OP OP F A 11/22/2014 2,576.44 SD E 1,226.00 05/01/2015 07/29/2057
VW7503 OP OP M A 01/01/2015 2,280.09 BO A 800.00 04/01/2015 06/20/2033 M A 01/01/2015 2,280.09 P1 E 200.00 01/01/2016 06/21/2068 M A 01/01/2015 2,280.09 SD E 1,158.00 06/01/2015 06/21/2068
VW7507 OP OP M A 10/01/2014 1,581.05 BO A 800.00 04/01/2015 12/29/2016 M A 10/01/2014 1,581.05 P1 E 291.89 10/01/2015 01/19/2060 M A 10/01/2014 1,581.05 SD E 919.00 03/01/2015 01/19/2060
VW7508 OP OP F S 02/10/2015 1,002.79 BO A 800.00 05/11/2015 11/08/2025 F S 02/10/2015 1,002.79 P1 E 185.13 02/10/2016 11/09/2060 F S 02/10/2015 1,002.79 SD E 731.00 08/01/2015 11/09/2060
VW7536 OP OP F A 01/06/2015 05/21/2015 843.65 PD S 294.20 01/30/2015 09/16/2067 F A 01/06/2015 05/21/2015 843.65 SD S 822.00 02/01/2015 09/16/2067
VW7813 OP OP F A 11/18/2014 965.90 BO A 800.00 02/16/2015 05/21/2036 F A 11/18/2014 965.90 P1 E 200.00 11/18/2015 05/22/2071 F A 11/18/2014 965.90 SD E 731.00 05/01/2015 05/22/2071
VW7844 OP OP F A 01/22/2015 06/07/2015 2,038.40 BO A 800.00 04/22/2015 06/07/2015 F A 01/22/2015 06/07/2015 2,038.40 P1 E 400.52 01/22/2016 08/01/2060 F A 01/22/2015 06/07/2015 2,038.40 SD E 1,084.00 07/01/2015 08/01/2060
VW7880 OP OP M A 03/13/2015 2,845.65 BO A 800.00 06/11/2015 04/20/2032 M A 03/13/2015 2,845.65 P1 E 200.00 03/13/2016 04/21/2067 M A 03/13/2015 2,845.65 SC E 644.00 09/01/2015 08/31/2017 M A 03/13/2015 2,845.65 SD E 1,288.00 09/01/2015 04/21/2067
VW8024 OP OP M A 02/26/2015 2,121.49 BO A 800.00 05/27/2015 05/26/2017 M A 02/26/2015 2,121.49 P1 E 1,544.45 02/26/2016 05/28/2060 M A 02/26/2015 2,121.49 SD E 1,084.00 08/01/2015 05/28/2060 M A 02/26/2015 2,121.49 WT E 3,259.11 02/26/2015 02/25/2018
VW8109 OP OP F A 12/23/2014 2,868.34 BO A 800.00 03/30/2015 05/08/2019 F A 12/23/2014 2,868.34 P1 E 992.89 12/20/2015 05/09/2054 F A 12/23/2014 2,868.34 SD E 1,288.00 06/01/2015 05/09/2054
VW8126 OP OP F A 01/05/2015 1,601.60 BO A 800.00 04/05/2015 05/23/2021 F A 01/05/2015 1,601.60 P1 E 497.87 01/05/2016 05/24/2056 F A 01/05/2015 1,601.60 SD E 919.00 06/01/2015 05/24/2056
VW8149 OP OP M A 12/17/2014 1,927.52 BO A 800.00 05/01/2015 03/16/2017 M A 12/17/2014 1,927.52 P1 E 355.85 12/17/2015 06/30/2075 M A 12/17/2014 1,927.52 SC E 522.50 06/01/2015 08/31/2021 M A 12/17/2014 1,927.52 SD E 1,045.00 06/01/2015 06/30/2075
VW8153 OP OP F A 11/25/2014 1,946.88 BO A 800.00 03/01/2015 08/22/2018 F A 11/25/2014 1,946.88 P1 E 605.20 11/25/2015 09/23/2052
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 85 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 VW8153 OP OP F A 11/25/2014 1,946.88 SD E 1,045.00 05/01/2015 09/23/2052
VW8177 OP OP F A 01/05/2015 809.82 BO A 778.68 04/05/2015 01/08/2041 F A 01/05/2015 809.82 P1 E 149.41 01/05/2016 01/09/2076 F A 01/05/2015 809.82 SC E 313.50 06/01/2015 11/30/2018 F A 01/05/2015 809.82 SD E 627.00 06/01/2015 01/09/2076
VW8179 OP OP F A 02/27/2015 1,017.14 BO A 800.00 05/28/2015 05/27/2017 F A 02/27/2015 1,017.14 SD E 731.00 08/01/2015 02/10/2056
VW8424 OP OP F A 12/22/2014 1,422.69 BO A 800.00 03/22/2015 10/06/2019 F A 12/22/2014 1,422.69 SD E 874.00 06/01/2015 10/07/2054
VW8456 OP OP M A 12/22/2014 1,551.55 SD E 919.00 06/01/2015 03/11/2058
VW8686 OP OP M A 10/14/2014 1,972.43 BO A 800.00 04/01/2015 06/25/2036 M A 10/14/2014 1,972.43 P1 E 364.14 10/14/2015 06/26/2071 M A 10/14/2014 1,972.43 SC E 522.50 04/01/2015 11/30/2024 M A 10/14/2014 1,972.43 SD E 1,045.00 04/01/2015 06/26/2071
VW8687 OP OP F A 12/22/2014 1,707.51 BO A 800.00 05/01/2015 06/29/2027 F A 12/22/2014 1,707.51 P1 E 315.23 12/22/2015 06/30/2062 F A 12/22/2014 1,707.51 SD E 962.00 06/01/2015 06/30/2062
VX0808 OP OP F A 12/10/2014 693.39 BO A 666.72 03/10/2015 09/12/2039 F A 12/10/2014 693.39 P1 E 128.01 03/10/2016 09/13/2074 F A 12/10/2014 693.39 SC E 287.00 06/01/2015 10/31/2031 F A 12/10/2014 693.39 SD E 574.00 06/01/2015 09/13/2074
VX1023 OP OP F A 12/20/2014 2,038.78 P1 E 200.00 12/20/2015 02/19/2065 F A 12/20/2014 2,038.78 SC E 542.00 06/01/2015 06/30/2017 F A 12/20/2014 2,038.78 SD E 1,084.00 06/01/2015 02/19/2065
VX1056 OP OP M A 03/24/2015 07/03/2015 1,709.77 BO A 800.00 06/22/2015 07/03/2015 M A 03/24/2015 07/03/2015 1,709.77 SC E 481.00 09/01/2015 08/31/2023 M A 03/24/2015 07/03/2015 1,709.77 SD E 962.00 09/01/2015 01/21/2070
VX1058 OP OP F A 11/04/2014 2,548.76 BO A 800.00 02/02/2015 09/25/2042 F A 11/04/2014 2,548.76 P1 E 470.54 11/04/2015 09/26/2077 F A 11/04/2014 2,548.76 SD E 1,226.00 05/01/2015 09/26/2077
040831 OP OP F A 02/08/2003 1,578.00 PD A 788.92 03/01/2003 05/01/2067 F A 02/08/2003 1,578.00 SD A 975.00 08/01/2003 05/01/2067
040849 OP OP F A 09/27/2002 956.54 BO A 219.75 03/01/2003 06/26/2018 F A 09/27/2002 956.54 SD A 700.00 03/01/2003 06/27/2053
046614 OP OP F A 01/04/2003 869.23 SD A 1,127.00 07/01/2003 09/30/2050
046637 OP OP F A 02/04/2003 2,168.44 BO A 666.04 08/01/2003 12/19/2018
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 86 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 046637 OP OP F A 02/04/2003 2,168.44 SD A 1,419.00 08/01/2003 12/20/2053
046643 OP OP F A 03/12/2003 1,541.28 PD A 1,260.18 05/09/2003 10/25/2057 F A 03/12/2003 1,541.28 SD A 1,006.00 09/01/2003 10/25/2057
046673 OP OP F A 05/30/2003 2,507.70 PD A 1,796.22 09/02/2003 06/15/2062 F A 05/30/2003 2,507.70 SD A 1,457.00 11/01/2003 06/15/2062
046688 OP OP F A 01/12/2003 651.34 PD A 294.12 07/13/2003 03/28/2056 F A 01/12/2003 651.34 SD A 675.00 07/01/2003 03/27/2056
049430 OP OP F A 05/23/2003 515.39 PD A 626.80 09/11/2003 11/26/2052 F A 05/23/2003 515.39 SD A 811.00 12/01/2003 11/26/2055
050332 OP OP F A 05/19/2003 786.39 PD A 239.00 11/19/2003 06/25/2050 F A 05/19/2003 786.39 SD A 684.00 11/01/2003 06/26/2050
051240 OP OP M A 10/27/2002 2,316.47 PD A 2,239.27 06/07/2003 10/24/2055 M A 10/27/2002 2,316.47 SD A 1,535.00 07/01/2003 10/24/2055
051270 OP OP F A 04/12/2003 911.48 PD A 282.43 09/04/2003 05/11/2052 F A 04/12/2003 911.48 SD A 1,144.00 10/01/2003 05/11/2052
051273 OP OP M A 04/02/2003 1,297.67 PD A 829.43 05/31/2003 12/27/2060 M A 04/02/2003 1,297.67 SD A 916.00 11/01/2003 12/27/2060
051882 OP OP F A 03/19/2003 2,471.79 PD A 912.05 04/14/2004 05/23/2056 F A 03/19/2003 2,471.79 SD A 1,538.00 07/01/2004 05/23/2056
052222 OP OP M A 03/26/2003 908.32 PD A 661.33 05/10/2003 10/09/2050 M A 03/26/2003 908.32 SD A 897.00 01/01/2005 10/09/2050
052634 OP OP F A 03/15/2003 1,728.36 BO A 487.88 09/01/2003 12/02/2017 F A 03/15/2003 1,728.36 SD A 1,174.00 09/01/2003 12/03/2052
052744 OP OP F A 05/31/2003 1,513.36 BO A 800.00 08/29/2003 08/03/2020 F A 05/31/2003 1,513.36 SD A 363.00 11/01/2003 08/04/2055
055731 OP OP F A 06/20/2003 3,314.73 BO A 316.13 12/01/2003 08/20/2015 F A 06/20/2003 3,314.73 PD A 1,297.11 09/02/2003 08/21/2050 F A 06/20/2003 3,314.73 SD A 1,574.00 12/01/2003 08/21/2050
055953 OP OP F A 05/30/2003 1,817.94 PD A 777.16 08/20/2004 10/16/2055 F A 05/30/2003 1,817.94 SD A 842.00 01/01/2004 10/16/2055 F A 05/30/2003 1,817.94 WP A 185.28 11/10/2005 06/08/2038
058400 OP OP F A 06/17/2003 1,289.16 PD A 976.46 02/04/2004 11/15/2057 F A 06/17/2003 1,289.16 SD A 878.00 12/01/2003 11/15/2057
059048 OP OP M A 05/27/2003 792.68 BO A 269.19 05/01/2004 11/09/2018
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 87 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 059048 OP OP M A 05/27/2003 792.68 SD A 493.00 05/01/2004 11/10/2053
059077 OP OP M A 10/21/2003 1,753.81 PD A 774.37 02/14/2004 05/30/2061 M A 10/21/2003 1,753.81 SD A 1,240.00 04/01/2004 05/30/2061
060458 OP OP F A 09/30/2003 1,895.84 BO A 251.92 05/01/2004 03/02/2023 F A 09/30/2003 1,895.84 SD A 1,571.00 03/01/2004 03/03/2058
060745 OP OP M A 09/12/2003 2,003.45 PD A 1,410.33 01/29/2004 01/10/2052 M A 09/12/2003 2,003.45 SD A 1,602.00 03/01/2004 01/10/2052
062136 OP OP F A 11/25/2003 1,515.59 BO A 582.29 09/01/2008 02/24/2029 F A 11/25/2003 1,515.59 RO S 400.00 08/01/2014 02/25/2064 F A 11/25/2003 1,515.59 SD A 875.00 09/01/2008 02/25/2064
062149 OP OP M A 04/08/2004 1,451.89 PD A 579.14 06/17/2004 09/11/2052 M A 04/08/2004 1,451.89 SD A 1,282.00 12/01/2004 09/11/2052
063307 OP OP F A 03/05/2004 1,888.30 PD A 1,572.64 08/07/2004 07/26/2056 F A 03/05/2004 1,888.30 SD A 1,260.00 09/01/2004 07/26/2056
063352 OP OP F A 09/23/2003 1,234.70 BO A 383.21 03/01/2004 11/09/2023 F A 09/23/2003 1,234.70 SD A 804.00 03/01/2004 11/10/2058
063370 OP OP F A 08/03/2004 6,179.66 PD A 5,308.64 02/26/2005 12/07/2051 F A 08/03/2004 6,179.66 SD A 1,917.00 08/01/2005 12/07/2051
063382 OP OP M A 05/04/2004 1,068.16 PD A 391.99 03/16/2005 06/15/2051 M A 05/04/2004 1,068.16 SD A 1,420.00 12/01/2004 06/15/2051
063584 OP OP F A 06/17/2004 922.09 BO A 139.63 12/01/2004 09/28/2029 F A 06/17/2004 922.09 SD A 747.00 12/01/2004 09/29/2064
066348 OP OP M A 02/04/2004 793.00 PD A 393.24 02/04/2004 11/20/2054 M A 02/04/2004 793.00 SD A 996.00 06/01/2004 11/20/2054
066380 OP OP M A 01/20/2004 2,906.83 PD A 4,212.26 08/25/2004 09/28/2055 M A 01/20/2004 2,906.83 SD A 1,804.00 08/01/2004 09/28/2055
067905 OP OP F A 01/21/2004 2,170.29 PD A 903.73 06/13/2004 08/10/2053 F A 01/21/2004 2,170.29 SD A 1,354.00 07/01/2004 08/10/2057
067922 OP OP M A 01/01/2004 2,179.83 PD A 1,561.04 07/01/2004 08/02/2094 M A 01/01/2004 2,179.83 SD A 1,369.00 06/01/2004 02/12/2052
067934 OP OP F A 01/18/2004 1,085.71 SD A 656.00 11/01/2004 09/26/2077
067964 OP OP M A 01/17/2004 2,123.01 PD A 1,852.15 06/30/2004 01/18/2052
M A 01/17/2004 2,123.01 SD A 1,153.00 07/01/2004 01/18/2052
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 88 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 067986 OP OP M A 04/13/2004 1,573.86 PD A 631.53 07/10/2004 06/26/2053 M A 04/13/2004 1,573.86 SD A 1,270.00 01/01/2005 06/26/2053
067991 OP OP M A 01/06/2004 1,824.55 PD A 825.34 10/13/2004 02/15/2066 M A 01/06/2004 1,824.55 SD A 1,233.00 06/01/2004 06/18/2044 M A 01/06/2004 1,824.55 WP A 269.12 05/01/2005 06/18/2044
067998 OP OP F A 10/30/2003 1,024.19 PD A 628.02 06/19/2004 07/19/2057 F A 10/30/2003 1,024.19 SD A 878.00 04/01/2004 07/19/2057
068742 OP OP F A 11/14/2003 1,079.76 PD A 381.49 04/14/2004 07/01/2054 F A 11/14/2003 1,079.76 SD A 822.00 05/01/2004 07/01/2054
070220 OP OP F A 02/06/2004 1,548.25 PD A 1,045.10 12/22/2004 12/13/2057 F A 02/06/2004 1,548.25 PS A 4.44 12/22/2004 12/13/2057 F A 02/06/2004 1,548.25 SD A 1,089.00 01/01/2005 12/13/2057
070254 OP OP F A 05/28/2004 2,384.58 PD A 1,882.65 11/13/2004 12/30/2057 F A 05/28/2004 2,384.58 SD A 1,342.00 11/01/2004 12/30/2057
070467 OP OP M A 08/19/2004 2,185.46 PD A 1,955.86 03/10/2005 12/06/2054 M A 08/19/2004 2,185.46 SD A 1,303.00 02/01/2005 12/06/2054
070802 OP OP F A 02/07/2004 2,313.84 PD A 2,012.53 07/01/2004 10/02/2050 F A 02/07/2004 2,313.84 SD A 1,310.00 08/01/2004 10/02/2050
070817 OP OP F A 02/28/2004 3,123.41 BO A 734.88 01/01/2005 08/09/2022 F A 02/28/2004 3,123.41 PD A 1,033.40 04/11/2004 08/10/2057 F A 02/28/2004 3,123.41 SD A 1,235.00 01/01/2005 08/10/2057
070844 OP OP F A 03/05/2004 2,843.91 PD A 2,257.17 04/17/2004 08/07/2050 F A 03/05/2004 2,843.91 SD A 1,489.00 09/01/2004 08/07/2050
072212 OP OP M A 10/11/2003 1,287.86 PD A 1,029.22 06/17/2004 10/08/2054 M A 10/11/2003 1,287.86 SD A 1,086.00 04/01/2004 10/08/2054
074640 OP OP F A 05/26/2004 1,006.74 PD A 832.43 09/03/2004 03/07/2057 F A 05/26/2004 1,006.74 SD A 788.00 11/01/2004 03/07/2057
074664 OP OP F A 05/19/2004 1,023.54 PD A 462.67 12/03/2004 04/03/2065 F A 05/19/2004 1,023.54 SD A 986.00 11/01/2004 04/03/2065
076717 OP OP F A 05/26/2004 743.87 PD A 330.74 08/16/2004 09/05/2059 F A 05/26/2004 743.87 SD A 717.00 11/01/2004 09/05/2059
076757 OP OP M A 01/27/2002 1,912.68 BO A 800.00 04/27/2002 07/15/2030 M A 01/27/2002 1,912.68 SD A 971.00 12/01/2002 07/16/2065
077311 OP OP F A 05/25/2004 2,267.96 PD A 1,215.70 08/15/2004 08/14/2051 F A 05/25/2004 2,267.96 SD A 1,131.00 01/01/2005 08/14/2051
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 89 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 077369 OP OP M A 07/23/2004 4,463.34 BO A 800.00 10/21/2004 08/04/2015 M A 07/23/2004 4,463.34 SD A 1,780.00 01/01/2005 08/05/2050
080059 OP OP F A 12/17/2004 950.05 BO A 252.51 06/01/2005 06/19/2017 F A 12/17/2004 950.05 SD A 661.00 06/01/2005 06/20/2052
083431 OP OP F A 09/24/2004 2,507.54 PD A 1,496.08 04/17/2005 02/28/2055 F A 09/24/2004 2,507.54 SD A 1,433.00 11/01/2004 02/28/2055
083433 OP OP F A 09/01/2004 1,476.91 PD A 1,252.45 09/01/2004 06/13/2062 F A 09/01/2004 1,476.91 SD A 1,105.00 02/01/2005 06/13/2062
083440 OP OP M A 09/30/2004 1,594.91 PD A 727.88 03/19/2005 08/26/2067 M A 09/30/2004 1,594.91 SC A 202.00 03/01/2005 10/31/2019 M A 09/30/2004 1,594.91 SD A 404.00 01/01/2008 08/25/2032
083591 OP OP F A 04/01/2005 3,129.59 PD A 1,417.15 04/08/2005 03/26/2055 F A 04/01/2005 3,129.59 SD A 1,615.00 09/01/2005 03/26/2055
083951 OP OP M A 09/13/2004 2,025.67 PD A 1,158.04 04/30/2005 10/28/2064 M A 09/13/2004 2,025.67 SD A 1,331.00 03/01/2005 10/28/2064
084026 OP OP F A 04/17/2004 1,391.21 PD A 776.00 10/15/2004 01/30/2054 F A 04/17/2004 1,391.21 SD A 1,098.00 10/01/2004 01/30/2054
084049 OP OP F A 07/21/2004 1,174.28 PD A 567.04 01/17/2005 08/19/2064 F A 07/21/2004 1,174.28 SD A 873.00 01/01/2005 08/19/2064
084059 OP OP F A 07/07/2004 998.56 PD A 411.64 05/11/2005 03/11/2053 F A 07/07/2004 998.56 SD A 816.00 03/01/2006 03/11/2053
085254 OP OP M A 03/27/2004 1,422.58 PD A 1,349.52 12/17/2004 07/19/2052 M A 03/27/2004 1,422.58 SD A 1,132.00 09/01/2004 07/19/2052
085268 OP OP F A 09/29/2004 820.19 PD A 711.12 02/02/2005 03/17/2056 F A 09/29/2004 820.19 SC A 312.00 03/01/2005 05/31/2015 F A 09/29/2004 820.19 SD A 773.00 03/01/2005 03/17/2056
086856 OP OP M A 10/15/2004 1,416.87 BO A 188.38 04/01/2005 09/28/2018 M A 10/15/2004 1,416.87 SD A 1,174.00 04/01/2005 09/29/2053
087942 OP OP F A 01/26/2005 1,695.80 PD A 1,520.51 03/25/2005 08/12/2059 F A 01/26/2005 1,695.80 SD A 1,093.00 09/01/2005 11/12/2059
088558 OP OP M A 12/10/2004 1,784.98 PD A 1,242.77 03/02/2005 05/16/2068 M A 12/10/2004 1,784.98 SD A 1,188.00 04/01/2006 05/16/2068 M A 12/10/2004 1,784.98 WP A 185.32 04/01/2006 04/07/2047
092053 OP OP F A 01/09/2005 2,516.48 PD A 1,203.43 04/14/2005 10/21/2066 F A 01/09/2005 2,516.48 SD A 1,319.00 07/01/2005 10/21/2066
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 90 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 093629 OP OP F A 02/02/2005 634.02 SD A 739.00 08/01/2005 03/07/2053
093663 OP OP F A 03/09/2005 2,176.25 PD A 1,716.12 06/15/2005 11/23/2053 F A 03/09/2005 2,176.25 SD A 1,200.00 09/01/2005 11/23/2053
095124 OP OP M A 03/05/2005 1,083.53 PD A 492.55 07/01/2005 03/29/2052 M A 03/05/2005 1,083.53 SD A 1,028.00 02/01/2007 03/29/2052
095127 OP OP M A 03/22/2005 1,206.71 BO A 187.30 06/01/2013 06/19/2039 M A 03/22/2005 1,206.71 SD A 973.00 06/01/2013 06/20/2074
095260 OP OP F A 04/26/2005 2,014.51 PD A 1,004.39 06/25/2005 01/19/2073 F A 04/26/2005 2,014.51 SD A 1,062.00 10/01/2005 01/19/2073
095268 OP OP M A 08/10/2004 1,540.33 BO A 332.34 08/01/2010 02/07/2029 M A 08/10/2004 1,540.33 SD S 1,148.75 08/01/2010 02/08/2064
097506 OP OP M A 03/05/2005 1,086.80 PD A 390.44 08/13/2005 05/14/2055 M A 03/05/2005 1,086.80 SD A 918.00 09/01/2005 05/14/2055
097572 OP OP M A 10/27/2004 1,674.38 PD A 2,258.71 07/13/2005 02/21/2053 M A 10/27/2004 1,674.38 SD A 1,657.00 06/01/2005 02/21/2053
097655 OP OP M A 07/27/2004 1,826.75 BO A 27.23 06/01/2006 07/09/2015 M A 07/27/2004 1,826.75 P1 A 472.66 05/10/2006 07/10/2050 M A 07/27/2004 1,826.75 SD A 1,088.00 06/01/2006 07/10/2050 M A 07/27/2004 1,826.75 WP A 168.60 03/28/2006 02/03/2030
097706 OP OP F A 05/27/2005 2,409.34 PD A 1,610.32 12/16/2005 01/29/2066 F A 05/27/2005 2,409.34 SD A 1,251.00 11/01/2005 01/29/2066
097708 OP OP M A 06/10/2005 1,848.44 PD A 960.69 09/08/2005 11/04/2054 M A 06/10/2005 1,848.44 SD A 1,155.00 12/01/2005 11/04/2054
098011 OP OP F A 08/08/2005 772.98 PL A 362.64 10/01/2007 11/29/2053 F A 08/08/2005 772.98 SD A 435.00 01/01/2007 11/29/2053
098049 OP OP M A 07/30/2005 1,756.03 PD A 393.25 09/02/2005 02/23/2052 M A 07/30/2005 1,756.03 PS A 531.18 09/02/2005 02/23/2052 M A 07/30/2005 1,756.03 SD A 1,154.00 01/01/2006 02/23/2052
098569 OP OP F A 03/15/2005 2,060.88 PD A 1,047.60 11/19/2005 01/09/2069 F A 03/15/2005 2,060.88 SD A 1,195.00 01/01/2008 01/09/2069
098599 OP OP F A 07/27/2005 1,115.84 PD A 716.95 11/19/2005 12/13/2058 F A 07/27/2005 1,115.84 SD A 1,048.00 01/01/2006 12/13/2058
098636 OP OP F A 04/18/2005 2,032.66 BO A 152.20 07/01/2006 12/05/2034
F A 04/18/2005 2,032.66 PD A 724.28 07/01/2006 12/06/2069 F A 04/18/2005 2,032.66 SD A 1,078.00 03/01/2006 12/06/2069
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 91 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 098909 OP OP F A 04/17/2005 1,866.53 PD A 1,674.82 12/17/2005 11/05/2069 F A 04/17/2005 1,866.53 SD A 1,054.00 06/01/2006 11/05/2069
098923 OP OP F A 07/29/2005 883.24 BO A 165.85 12/01/2007 05/06/2019 F A 07/29/2005 883.24 SD A 665.00 12/01/2007 05/07/2054 F A 07/29/2005 883.24 WP A 18.42 10/02/2005 05/06/2024
098945 OP OP M A 09/16/2005 1,631.99 PD A 1,526.03 03/08/2006 08/09/2053 M A 09/16/2005 1,631.99 SD A 1,174.00 05/01/2007 08/09/2053
261355 OP OP F A 01/21/1996 862.39 BO A 232.22 07/01/1996 09/30/2021 F A 01/21/1996 862.39 SD A 597.00 07/01/1996 09/03/2056
261943 OP OP F A 02/17/1996 1,047.04 PD A 538.66 06/11/1996 12/06/2050 F A 02/17/1996 1,047.04 SD A 557.00 08/01/1996 12/06/2050
263802 OP OP F A 03/19/1996 1,613.46 BO A 29.86 11/01/1996 07/31/2019 F A 03/19/1996 1,613.46 PD A 657.55 06/13/1996 07/03/2054 F A 03/19/1996 1,613.46 SD A 864.00 11/01/1996 07/03/2054
264657 OP OP F A 03/14/1996 1,218.75 PD A 890.46 07/06/1996 08/21/2051 F A 03/14/1996 1,218.75 SD A 897.00 03/01/2001 08/21/2051 F A 03/14/1996 1,218.75 WP A 231.95 08/15/1998 08/20/2021
264663 OP OP M A 04/08/1996 1,198.17 PD A 760.28 03/05/1997 12/07/2052 M A 04/08/1996 1,198.17 SD A 674.00 10/01/1996 12/07/2052
266835 OP OP F A 07/29/1996 972.32 PD A 411.89 09/25/1997 01/01/2069 F A 07/29/1996 972.32 SD A 698.00 01/01/1997 01/01/2069
266838 OP OP F A 09/13/1996 1,663.74 BO A 114.20 03/01/1997 11/30/2019 F A 09/13/1996 1,663.74 PD A 823.33 12/03/1996 12/01/2054 F A 09/13/1996 1,663.74 SD A 777.00 03/01/1997 12/01/2054
266850 OP OP M A 07/14/1996 1,706.47 PD A 1,069.50 09/10/1996 04/01/2051 M A 07/14/1996 1,706.47 SD A 905.00 01/01/1997 03/31/2016
266851 OP OP F A 05/14/1996 4,225.00 BO A 800.00 08/12/1996 02/29/2020 F A 05/14/1996 4,225.00 SD A 1,272.00 01/01/1997 02/04/2055 F A 05/14/1996 4,225.00 WP A 238.09 05/24/1999 05/23/2033
267795 OP OP F A 04/22/1996 403.33 PD A 227.25 10/22/1996 02/03/2054 F A 04/22/1996 403.33 SD A 434.00 10/01/1996 02/03/2054
267797 OP OP F A 07/25/1996 1,231.25 BO A 671.42 02/01/1997 01/30/2018 F A 07/25/1996 1,231.25 SD A 548.00 01/01/1997 01/01/2053
267869 OP OP F A 10/23/1996 1,038.81 BO A 218.51 05/01/1997 01/31/2024
F A 10/23/1996 1,038.81 SD A 813.00 05/01/1997 01/08/2059
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 92 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 270808 OP OP F A 10/29/1996 1,715.41 PD A 1,345.22 01/16/1997 02/28/2055 F A 10/29/1996 1,715.41 SD A 1,022.00 04/01/1997 02/28/2055
270833 OP OP F A 12/19/1996 1,260.74 PD A 955.69 03/14/1997 06/24/2054 F A 12/19/1996 1,260.74 SD A 781.00 06/01/1997 06/24/2054
272200 OP OP M A 09/25/1996 1,008.91 BO A 31.58 07/01/1998 06/04/2021 M A 09/25/1996 1,008.91 PL A 233.91 07/26/1997 06/05/2056 M A 09/25/1996 1,008.91 SD A 682.00 10/01/1997 06/05/2056 M A 09/25/1996 1,008.91 WP A 55.59 06/15/1998 10/31/2030
272607 OP OP F A 12/07/1996 1,319.18 PD A 580.32 03/05/1997 02/05/2063 F A 12/07/1996 1,319.18 SD A 903.00 06/01/1997 02/05/2063
274145 OP OP F A 12/20/1996 1,539.31 BO A 329.53 08/01/1997 04/30/2017 F A 12/20/1996 1,539.31 PD A 597.89 03/25/1997 04/23/2052 F A 12/20/1996 1,539.31 SD A 603.00 08/01/1997 04/23/2052
274155 OP OP M A 11/15/1996 1,067.30 PD A 611.79 05/14/1997 08/08/2052 M A 11/15/1996 1,067.30 SD A 767.00 05/01/1997 08/08/2052
274160 OP OP M A 09/25/1996 1,501.36 PD A 1,486.81 02/27/1997 09/28/2050 M A 09/25/1996 1,501.36 SD A 827.00 06/01/1997 09/28/2050
274991 OP OP M A 09/13/1996 817.13 PD A 577.35 07/11/1997 06/15/2053 M A 09/13/1996 817.13 SD A 631.00 03/01/1997 06/15/2053
275176 OP OP M A 09/27/1996 1,311.44 PD A 788.14 06/06/1997 07/24/2062 M A 09/27/1996 1,311.44 SD A 869.00 11/01/1997 07/24/2062
275975 OP OP F A 01/31/1997 914.71 PD A 643.85 03/13/1997 11/26/2062 F A 01/31/1997 914.71 SD A 790.00 07/01/1997 11/26/2062
275978 OP OP F A 03/06/1997 1,478.85 BO A 607.98 09/01/1997 07/19/2025 F A 03/06/1997 1,478.85 SD A 814.00 09/01/1997 07/20/2060
277166 OP OP F A 01/17/1997 1,680.25 BO A 800.00 04/17/1997 08/14/2036 F A 01/17/1997 1,680.25 SC A 381.00 10/01/1999 08/31/2019 F A 01/17/1997 1,680.25 SD A 738.00 07/01/1997 08/14/2036
277178 OP OP F A 03/25/1997 1,525.58 PD A 1,149.81 07/26/1997 09/28/2054 F A 03/25/1997 1,525.58 SD A 865.00 09/01/1997 09/28/2054
277830 OP OP F A 06/13/1997 1,746.35 PD A 823.36 06/13/1997 08/31/2057 F A 06/13/1997 1,746.35 SD A 900.00 12/01/1997 08/31/2057
277849 OP OP F A 03/08/1997 1,724.45 PD A 859.03 05/24/1997 07/24/2064 F A 03/08/1997 1,724.45 SD A 993.00 01/01/1998 07/24/2064
277863 OP OP F A 04/18/1997 526.34 BO A 36.09 04/01/1998 05/11/2026
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 93 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 277863 OP OP F A 04/18/1997 526.34 SD A 470.00 04/01/1998 05/12/2061
279434 OP OP F A 03/08/1997 1,260.74 BO A 354.25 09/01/1997 12/07/2019 F A 03/08/1997 1,260.74 SD A 858.00 09/01/1997 12/08/2054
279437 OP OP M A 06/04/1997 677.90 PD A 267.11 07/30/1997 05/23/2063 M A 06/04/1997 677.90 SD A 501.00 12/01/1997 05/23/2063
279459 OP OP F A 04/15/1997 960.43 PD A 356.70 05/31/1997 08/30/2057 F A 04/15/1997 960.43 SD A 694.00 10/01/1997 08/30/2057
279461 OP OP M A 07/04/1997 2,301.33 PD A 1,805.43 08/20/1997 06/25/2059 M A 07/04/1997 2,301.33 SD A 1,206.00 01/01/1998 06/25/2059
279936 OP OP F A 02/28/1997 2,072.20 BO A 800.00 05/29/1997 12/12/2024 F A 02/28/1997 2,072.20 SD A 1,187.00 10/01/1997 12/13/2059
280889 OP OP F A 05/01/1997 1,544.51 PD A 1,092.33 09/18/1997 09/18/2061 F A 05/01/1997 1,544.51 SD A 795.00 01/01/1998 09/18/2061
280891 OP OP F A 04/12/1997 984.26 BO A 134.07 10/01/1997 07/04/2016 F A 04/12/1997 984.26 PD A 367.34 08/01/1997 07/05/2051 F A 04/12/1997 984.26 SD A 445.00 10/01/1997 07/05/2051
281120 OP OP M A 07/01/1997 2,631.96 PD A 1,901.46 10/01/1997 03/03/2054 M A 07/01/1997 2,631.96 SD A 1,291.00 01/01/1999 03/03/2054
281154 OP OP M A 02/14/1997 1,736.26 PD A 523.87 09/09/1997 08/16/2053 M A 02/14/1997 1,736.26 SD A 1,161.00 08/01/1997 08/16/2053
281161 OP OP F A 05/31/1997 2,052.48 PD A 1,251.22 10/08/1997 05/23/2050 F A 05/31/1997 2,052.48 SD A 1,075.00 11/01/1997 05/23/2050
281207 OP OP F A 01/09/1997 1,436.85 PD A 566.78 10/15/1998 09/06/2066 F A 01/09/1997 1,436.85 SD A 818.00 02/01/1998 09/06/2066
283524 OP OP F A 03/29/1997 488.10 PD A 1,205.27 04/29/1997 11/06/2051 F A 03/29/1997 488.10 SD A 952.00 09/01/1997 11/06/2051
283581 OP OP F A 05/09/1997 1,922.91 PD A 1,467.63 10/14/1997 09/11/2052 F A 05/09/1997 1,922.91 SD A 966.00 04/01/1998 09/11/2052
284261 OP OP F A 02/28/1997 2,549.90 PD A 1,076.82 12/02/1997 08/19/2053 F A 02/28/1997 2,549.90 SD A 1,231.00 01/01/1998 08/19/2053 F A 02/28/1997 2,549.90 WP A 334.73 01/17/1999 08/19/2023
284269 OP OP M A 10/09/1997 1,074.56 PD A 493.78 04/01/1998 03/24/2068 M A 10/09/1997 1,074.56 SD A 781.00 06/01/1993 03/24/2068
284345 OP OP F A 08/19/1997 971.80 PD A 374.76 11/19/1997 06/07/2060
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 94 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 284345 OP OP F A 08/19/1997 971.80 SD A 856.00 06/01/2000 06/07/2060
284368 OP OP M A 10/02/1997 1,424.10 PD A 1,067.39 11/25/1997 08/20/2056 M A 10/02/1997 1,424.10 SD A 972.00 03/01/1997 08/20/2056
284415 OP OP F A 09/01/1997 946.83 BO A 403.41 02/01/1998 06/24/2025 F A 09/01/1997 946.83 SD A 507.00 02/01/1998 06/25/2060
288485 OP OP M A 07/15/1999 1,680.04 PD A 639.69 09/05/2002 02/02/2051 M A 07/15/1999 1,680.04 SD A 1,183.00 06/01/2003 02/02/2051 M A 07/15/1999 1,680.04 WP A 315.34 06/04/2003 01/03/2027
289079 OP OP F A 06/03/2002 1,292.05 PD A 930.62 09/19/2002 01/08/2063 F A 06/03/2002 1,292.05 SD A 949.00 09/01/2007 01/08/2063
290365 OP OP M A 06/04/2002 1,257.96 PD A 554.75 12/27/2002 11/19/2056 M A 06/04/2002 1,257.96 SD A 1,085.00 04/01/2003 11/19/2056
290802 OP OP F A 09/16/2002 4,160.65 BO A 626.60 04/01/2003 06/26/2015 F A 09/16/2002 4,160.65 PD A 1,723.03 03/02/2003 06/27/2050 F A 09/16/2002 4,160.65 SD A 1,651.00 03/01/2003 06/27/2050
291055 OP OP M A 12/14/2000 2,091.57 BO A 24.45 01/01/2006 10/05/2022 M A 12/14/2000 2,091.57 PL A 323.44 06/29/2002 10/06/2057 M A 12/14/2000 2,091.57 SD A 1,429.00 01/01/2006 10/06/2057 M A 12/14/2000 2,091.57 WP A 234.24 12/31/2005 10/03/2027
295911 OP OP F A 08/12/2002 1,112.13 PD A 778.95 07/24/2003 03/12/2054 F A 08/12/2002 1,112.13 SD A 839.00 02/01/2003 03/12/2054 F A 08/12/2002 1,112.13 WP A 31.72 08/01/2003 10/31/2033
295918 OP OP M A 07/02/2002 1,178.13 BO A 364.44 12/01/2002 07/26/2028 M A 07/02/2002 1,178.13 SD A 774.00 12/01/2002 07/27/2063
296905 OP OP F A 10/30/2002 1,435.69 BO A 117.47 04/01/2003 05/12/2029 F A 10/30/2002 1,435.69 SD A 1,263.00 04/01/2003 05/13/2064
296951 OP OP F A 12/02/2002 1,011.13 BO A 580.24 11/01/2005 07/29/2027 F A 12/02/2002 1,011.13 SD A 392.00 11/01/2005 07/30/2062
299452 OP OP F A 09/28/2002 1,673.75 BO A 384.12 12/01/2006 01/15/2030 F A 09/28/2002 1,673.75 PD A 727.49 08/21/2003 01/16/2065 F A 09/28/2002 1,673.75 SD A 277.00 01/01/2006 01/15/2030 F A 09/28/2002 1,673.75 WP A 220.77 11/30/2006 03/29/2044
300022 OP OP F A 09/20/2002 793.60 PD A 470.09 01/14/2003 09/03/2056 F A 09/20/2002 793.60 SD A 684.00 04/01/2003 09/03/2056
300039 OP OP F A 11/09/2002 1,150.61 BO A 408.36 05/01/2003 04/01/2031 F A 11/09/2002 1,150.61 SD A 698.00 05/01/2003 04/02/2066
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 95 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 300194 OP OP M A 07/24/2002 2,024.10 PD A 1,343.55 02/23/2003 08/05/2054 M A 07/24/2002 2,024.10 SD A 1,442.00 07/01/2003 08/05/2054
375167 OP OP M A 11/07/2005 2,987.13 PD A 2,303.42 07/01/2006 05/17/2063 M A 11/07/2005 2,987.13 SD A 1,608.00 05/01/2006 05/17/2063
377430 OP OP F A 05/13/2005 1,390.89 BO A 86.93 01/01/2006 07/28/2019 F A 05/13/2005 1,390.89 PD A 468.46 12/10/2005 07/29/2054 F A 05/13/2005 1,390.89 SD A 782.00 12/01/2005 07/29/2054
377553 OP OP F A 06/01/2005 2,115.75 PD A 1,143.90 08/19/2005 05/26/2050 F A 06/01/2005 2,115.75 SD A 1,063.00 11/01/2005 05/26/2050
377561 OP OP F A 06/18/2005 670.80 BO A 14.00 01/01/2006 07/15/2030 F A 06/18/2005 670.80 SD A 631.00 01/01/2006 07/16/2065
377582 OP OP M A 04/24/2005 1,270.91 BO A 575.03 11/01/2006 07/01/2015 M A 04/24/2005 1,270.91 SD A 647.00 11/01/2006 07/02/2050
378288 OP OP F A 05/07/2005 1,150.29 PD A 578.65 08/27/2005 09/18/2064 F A 05/07/2005 1,150.29 SD A 860.00 11/01/2005 09/18/2064
379506 OP OP F A 07/20/2005 2,489.29 PD A 1,941.95 09/10/2005 01/19/2073 F A 07/20/2005 2,489.29 PS A 445.45 09/10/2005 01/19/2073 F A 07/20/2005 2,489.29 SD A 1,408.00 05/01/2006 01/19/2073
379536 OP OP F A 12/20/2004 964.82 PD A 448.24 11/06/2005 07/20/2056 F A 12/20/2004 964.82 SD A 980.00 01/01/2006 07/20/2056
379590 OP OP F A 07/29/2005 2,035.96 PD A 1,198.59 03/01/2006 12/26/2068 F A 07/29/2005 2,035.96 SD A 1,242.00 01/01/2006 12/26/2068
381525 OP OP F A 09/03/2005 1,500.00 SD A 1,153.00 09/01/2006 01/11/2065
381596 OP OP M A 09/17/2005 1,321.50 BO A 701.44 04/01/2006 11/14/2028 M A 09/17/2005 1,321.50 PD A 569.24 03/15/2006 11/15/2063
381607 OP OP F A 09/08/2005 2,541.60 BO A 237.45 04/01/2006 07/22/2020 F A 09/08/2005 2,541.60 PD A 874.39 03/02/2006 07/23/2055 F A 09/08/2005 2,541.60 SD A 1,332.00 03/01/2006 07/23/2055
381785 OP OP M A 07/12/2005 1,512.01 BO A 247.86 01/01/2006 07/13/2033 M A 07/12/2005 1,512.01 SC A 634.00 01/01/2006 10/31/2023 M A 07/12/2005 1,512.01 SD A 1,206.00 01/01/2006 07/14/2068
384255 OP OP F A 01/31/2006 1,784.30 PD A 679.50 03/03/2007 05/17/2075 F A 01/31/2006 1,784.30 SD A 1,136.00 01/01/2007 05/17/2075
384262 OP OP F A 04/08/2006 431.71 SD A 1,000.00 10/01/2006 10/27/2054
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 96 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 384274 OP OP F A 05/13/2006 885.51 BO A 126.46 01/01/2007 01/27/2025 F A 05/13/2006 885.51 SD A 725.00 01/01/2007 01/28/2060
386642 OP OP F A 10/01/2004 1,874.22 PD A 1,179.98 10/01/2005 06/25/2058 F A 10/01/2004 1,874.22 SD A 1,201.00 03/01/2006 06/25/2058
386644 OP OP M A 05/28/2005 2,553.25 PD A 1,545.49 04/06/2006 08/17/2053 M A 05/28/2005 2,553.25 SD A 1,323.00 11/01/2005 08/17/2053 M A 05/28/2005 2,553.25 WP A 947.80 11/01/2006 01/18/2033
389125 OP OP M A 11/25/2005 1,192.91 PD A 460.89 08/03/2006 02/26/2051 M A 11/25/2005 1,192.91 SD A 734.00 05/01/2006 02/26/2051
389733 OP OP F A 10/03/2005 2,642.36 PD A 1,574.18 08/09/2006 12/01/2054 F A 10/03/2005 2,642.36 SD A 1,477.00 05/01/2006 12/01/2054
389735 OP OP F A 11/08/2005 3,068.05 PD A 1,860.26 04/05/2006 07/08/2053 F A 11/08/2005 3,068.05 SD A 1,442.00 05/01/2006 07/08/2053
389736 OP OP F A 12/03/2005 2,012.02 BO A 779.64 06/01/2006 08/17/2043 F A 12/03/2005 2,012.02 SC A 577.00 06/01/2006 10/31/2022 F A 12/03/2005 2,012.02 SD A 1,155.00 06/01/2006 08/18/2078
390415 OP OP F A 11/10/2005 2,011.86 PD A 1,809.52 06/23/2006 06/29/2059 F A 11/10/2005 2,011.86 SD A 1,003.00 01/01/2007 06/29/2059
394857 OP OP M A 07/12/2005 2,153.29 PD A 1,545.25 07/21/2006 05/30/2055 M A 07/12/2005 2,153.29 SD A 1,395.00 01/01/2006 05/30/2055
394890 OP OP M A 05/26/2006 2,313.14 PD A 1,153.85 09/06/2006 05/11/2064 M A 05/26/2006 2,313.14 SC A 636.00 11/01/2006 05/31/2020 M A 05/26/2006 2,313.14 SD A 1,272.00 11/01/2006 05/11/2064
394892 OP OP M A 04/15/2006 1,115.40 BO A 91.50 01/01/2007 10/18/2023 M A 04/15/2006 1,115.40 SD A 981.00 01/01/2007 10/19/2058
394975 OP OP F A 06/02/2005 1,095.14 PD A 577.45 06/29/2006 08/23/2058 F A 06/02/2005 1,095.14 SD A 1,082.00 11/01/2005 08/23/2058
394989 OP OP M A 01/18/2006 1,192.25 PD A 709.71 09/01/2006 02/17/2053 M A 01/18/2006 1,192.25 SD A 821.00 07/01/2006 02/17/2053
395158 OP OP F A 10/11/2005 1,358.40 PD A 985.65 05/11/2006 08/13/2051 F A 10/11/2005 1,358.40 SD A 1,215.00 04/01/2006 08/13/2051
395194 OP OP F A 04/18/2006 1,793.66 PD A 1,240.35 07/07/2006 08/03/2063 F A 04/18/2006 1,793.66 SD A 1,438.00 10/01/2006 08/03/2063
395583 OP OP F A 03/31/2006 1,148.06 PD A 623.67 11/15/2006 10/10/2071 F A 03/31/2006 1,148.06 SC A 351.00 09/01/2006 07/31/2023
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 97 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 395583 OP OP F A 03/31/2006 1,148.06 SD A 842.00 09/01/2006 10/10/2071
395586 OP OP M A 04/21/2006 1,414.62 PD A 665.12 09/03/2006 08/11/2065 M A 04/21/2006 1,414.62 SD A 1,047.00 10/01/2006 08/11/2065
397530 OP OP F A 05/25/2006 786.32 PD A 545.02 12/29/2006 09/04/2065
397552 OP OP F A 08/05/2006 2,095.00 PD A 1,009.82 10/07/2006 02/12/2073 F A 08/05/2006 2,095.00 SC A 574.00 02/01/2007 04/30/2016 F A 08/05/2006 2,095.00 SD A 1,148.00 02/01/2007 02/12/2073
398806 OP OP F A 04/20/2006 998.11 RR A 1,815.00 10/01/2006 10/19/2061
917167 OP OP F A 10/23/1997 1,789.40 BO A 84.12 08/01/1998 12/20/2019 F A 10/23/1997 1,789.40 PD A 832.46 03/04/1998 12/21/2054 F A 10/23/1997 1,789.40 SD A 804.00 08/01/1998 12/21/2054
917192 OP OP F A 11/06/1997 2,045.28 PD A 1,495.11 12/24/1997 07/21/2052 F A 11/06/1997 2,045.28 SD A 1,082.00 04/01/1998 07/21/2052
917265 OP OP M A 12/04/1997 930.48 BO A 800.00 03/01/2003 09/10/2030
917270 OP OP F A 09/20/1997 802.15 PD A 299.87 06/25/1998 02/24/2051 F A 09/20/1997 802.15 SD A 666.00 03/01/1998 02/24/2051
917292 OP OP F A 11/01/1997 930.42 PD A 398.23 02/04/1998 01/15/2052 F A 11/01/1997 930.42 SD A 701.00 04/01/1998 01/15/2052
917333 OP OP F A 12/02/1997 1,971.66 PD A 1,143.02 06/27/1998 05/05/2054 F A 12/02/1997 1,971.66 SD A 1,217.00 01/01/1999 05/05/2054
918906 OP OP M A 01/03/1998 1,732.04 PD A 762.31 03/06/1998 10/26/2063 M A 01/03/1998 1,732.04 SD A 946.00 07/01/1998 10/26/2063
918935 OP OP F A 11/26/1997 1,564.06 PD A 814.10 03/04/1998 03/23/2061 F A 11/26/1997 1,564.06 SD A 796.00 05/01/1998 03/23/2061
919173 OP OP F A 07/15/1997 782.11 BO A 138.03 01/01/1998 06/14/2031 F A 07/15/1997 782.11 SD A 614.00 01/01/1998 06/15/2066
919207 OP OP F A 10/24/1997 1,085.12 BO A 505.39 04/01/1998 07/24/2038 F A 10/24/1997 1,085.12 SD A 538.00 04/01/1998 07/25/2073
919283 OP OP M A 10/11/1997 3,167.56 BO A 224.29 08/01/1998 06/15/2015 M A 10/11/1997 3,167.56 PD A 1,562.44 07/01/1998 06/16/2050 M A 10/11/1997 3,167.56 SD A 1,259.00 08/01/1998 06/16/2050
919348 OP OP F A 01/17/1998 1,438.40 BO A 104.64 02/01/2000 03/26/2035
F A 01/17/1998 1,438.40 PD A 451.44 03/07/1998 03/27/2070 F A 01/17/1998 1,438.40 SD A 827.00 02/01/2000 03/27/2070
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 98 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 922112 OP OP F A 02/07/1998 2,013.16 PD A 1,239.94 05/20/1998 10/20/2051 F A 02/07/1998 2,013.16 SD A 1,105.00 01/01/1999 10/20/2051
922133 OP OP F A 01/09/1998 940.99 PD A 334.89 04/09/1998 07/19/2066 F A 01/09/1998 940.99 SD A 727.00 07/01/1998 07/19/2066
922950 OP OP F A 02/14/1998 598.01 PD A 279.07 05/27/1998 05/24/2056 F A 02/14/1998 598.01 SD A 507.00 01/01/2000 05/24/2056
923278 OP OP M A 02/07/1998 1,515.36 BO A 59.23 11/01/1998 06/29/2017 M A 02/07/1998 1,515.36 PD A 553.85 10/16/1998 06/30/2052 M A 02/07/1998 1,515.36 SD A 844.00 08/01/1998 06/30/2052
924600 OP OP F A 07/03/1998 1,088.70 PD A 529.60 10/09/1998 07/20/2057 F A 07/03/1998 1,088.70 SD A 728.00 01/01/1999 07/20/2057
924823 OP OP F A 06/20/1998 1,335.21 PD A 1,087.16 11/05/1998 06/08/2059 F A 06/20/1998 1,335.21 SD A 899.00 12/01/1998 06/08/2059
926388 OP OP M A 10/07/1997 1,361.77 PD A 1,378.99 09/16/1998 11/17/2055 M A 10/07/1997 1,361.77 SD A 897.00 04/01/1998 11/17/2055 M A 10/07/1997 1,361.77 WP A 217.30 03/13/1999 11/11/2024
926427 OP OP M A 09/03/1998 1,966.95 PD A 1,537.31 10/17/1998 02/26/2053 M A 09/03/1998 1,966.95 SD A 1,162.00 03/01/1999 02/26/2053
927712 OP OP M A 07/24/1998 967.07 BO A 144.94 10/01/2002 12/23/2021 M A 07/24/1998 967.07 SD A 742.00 10/01/2002 12/24/2056 M A 07/24/1998 967.07 WP A 42.94 03/01/2000 07/31/2031
928520 OP OP F A 04/14/1998 1,882.47 BO A 800.00 01/04/2003 05/16/2020 F A 04/14/1998 1,882.47 PD A 932.23 07/01/1999 05/17/2025
929674 OP OP F A 07/15/1998 2,079.56 PD A 1,487.78 08/28/1999 09/22/2057 F A 07/15/1998 2,079.56 SD A 1,093.00 01/01/1999 09/22/2057
929830 OP OP M A 06/26/1998 1,743.19 PD A 1,823.49 10/09/1998 10/02/2058 M A 06/26/1998 1,743.19 SD A 1,012.00 03/01/1999 10/02/2058 M A 06/26/1998 1,743.19 WP A 83.76 09/01/1999 11/01/2032
929884 OP OP F A 08/29/1998 1,441.59 PD A 1,262.69 11/10/1998 11/25/2050 F A 08/29/1998 1,441.59 SD A 930.00 04/01/1999 11/25/2050
931287 OP OP F A 07/03/1998 988.54 BO A 5.18 06/01/1999 06/26/2017 F A 07/03/1998 988.54 PD A 290.07 05/21/1999 06/27/2052 F A 07/03/1998 988.54 PS A 94.27 05/21/1999 06/27/2052 F A 07/03/1998 988.54 SD A 561.00 01/01/1999 06/27/2052
931879 OP OP F A 08/15/1998 1,182.84 PD A 685.75 11/08/1998 12/09/2056 F A 08/15/1998 1,182.84 SD A 800.00 06/01/1999 12/09/2056
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 99 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 932008 OP OP F A 02/02/1998 1,250.93 BO A 420.81 08/01/1998 11/10/2021 F A 02/02/1998 1,250.93 SD A 782.00 08/01/1998 11/11/2056
932233 OP OP F A 09/11/1998 1,912.95 PD A 1,151.26 02/23/1999 05/31/2060 F A 09/11/1998 1,912.95 SD A 1,115.00 05/01/1999 05/31/2060
933931 OP OP F A 12/01/1998 1,662.75 PD A 963.14 05/07/1999 01/11/2057 F A 12/01/1998 1,662.75 SD A 1,100.00 05/01/1999 01/11/2057
934288 OP OP F A 11/24/1998 481.76 PD A 210.79 02/20/1999 04/18/2056 F A 11/24/1998 481.76 SD A 459.00 05/01/1999 04/18/2056
934290 OP OP F A 01/16/1999 2,070.25 BO A 169.23 06/01/2001 11/06/2019 F A 01/16/1999 2,070.25 PD A 928.40 09/24/2000 11/07/2054 F A 01/16/1999 2,070.25 SD A 893.00 06/01/2001 11/07/2054
934875 OP OP F A 12/17/1997 2,648.54 PD A 1,606.45 08/15/1999 02/29/2052 F A 12/17/1997 2,648.54 SD A 1,207.00 01/01/1999 02/29/2052 F A 12/17/1997 2,648.54 WP A 648.37 02/03/2000 04/30/2032
936147 OP OP F A 04/23/1999 846.46 PD A 348.81 05/04/1999 07/10/2058 F A 04/23/1999 846.46 SD A 691.00 06/01/1999 07/10/2058
937312 OP OP F A 08/22/1998 652.60 PD A 341.21 05/21/1999 08/03/2052 F A 08/22/1998 652.60 SD A 580.00 11/01/1999 08/03/2052
941925 OP OP F A 07/29/1999 1,279.09 PD A 1,113.91 10/15/1999 02/17/2054 F A 07/29/1999 1,279.09 SD A 893.00 01/01/2000 02/17/2054
943770 OP OP F A 08/31/1999 602.01 PD A 250.63 11/16/1999 08/14/2056 F A 08/31/1999 602.01 SD A 853.00 01/01/2001 08/14/2056
943856 OP OP F A 06/05/1999 1,910.46 PD A 1,579.50 09/08/1999 12/19/2051 F A 06/05/1999 1,910.46 SD A 1,163.00 12/01/1999 12/19/2051
947151 OP OP F A 05/30/1999 1,543.26 BO A 662.91 01/01/2000 02/27/2029 F A 05/30/1999 1,543.26 SD A 821.00 01/01/2000 02/28/2064
947450 OP OP M A 05/09/1998 1,005.30 PD A 710.28 09/01/2000 09/07/2054 M A 05/09/1998 1,005.30 SD A 890.00 12/01/2000 09/07/2054
949293 OP OP F A 10/02/1999 2,697.45 PD A 2,013.02 02/09/2000 07/19/2053 F A 10/02/1999 2,697.45 SD A 1,387.00 04/01/2000 07/19/2053
950006 OP OP M A 08/24/1999 1,658.70 PD A 1,550.81 02/15/2000 12/05/2051 M A 08/24/1999 1,658.70 SD A 1,150.00 02/01/2000 12/05/2051
950954 OP OP F A 10/28/1999 1,898.60 PD A 1,099.18 03/29/2000 01/20/2064
F A 10/28/1999 1,898.60 SD A 1,147.00 04/01/2000 01/20/2064
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 100 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 951225 OP OP M A 12/04/1999 731.25 SD A 781.00 06/01/2000 08/05/2054
953648 OP OP M A 06/08/2000 1,797.69 BO A 150.54 12/01/2000 10/29/2017 M A 06/08/2000 1,797.69 SD A 1,578.00 12/01/2000 10/30/2052
953692 OP OP F A 02/24/2000 1,286.63 BO A 487.14 01/01/2001 04/06/2037 F A 02/24/2000 1,286.63 SD A 750.00 01/01/2001 04/07/2072
953696 OP OP M A 03/25/2000 1,118.11 PD A 435.80 09/28/2000 09/15/2052 M A 03/25/2000 1,118.11 SD A 1,099.00 09/01/2000 09/15/2052
955414 OP OP F A 04/13/2000 2,368.44 PD A 1,792.64 09/12/2000 05/06/2050 F A 04/13/2000 2,368.44 SD A 1,317.00 10/01/2000 05/06/2050
955452 OP OP F A 04/08/2000 1,592.29 BO A 749.04 10/01/2000 02/19/2036 F A 04/08/2000 1,592.29 SD A 782.00 10/01/2000 02/20/2071
956594 OP OP F A 04/15/2000 1,570.13 PD A 848.58 07/08/2000 07/24/2052 F A 04/15/2000 1,570.13 SD A 757.00 10/01/2000 07/24/2052
957511 OP OP F A 06/04/2000 663.49 PD A 356.52 06/09/2000 01/07/2056 F A 06/04/2000 663.49 SD A 576.00 12/01/2000 01/07/2056
957580 OP OP F A 02/18/2000 527.09 SD A 837.00 05/01/2000 07/23/2067
957638 OP OP F A 06/26/2000 892.18 PD A 434.42 10/24/2000 01/11/2056 F A 06/26/2000 892.18 SD A 611.00 01/01/2001 01/11/2056
957653 OP OP F A 01/03/2000 1,910.51 PD A 1,104.13 09/06/2000 09/07/2054 F A 01/03/2000 1,910.51 SD A 998.00 03/01/2001 09/07/2054
957657 OP OP F A 02/07/2000 609.64 BO A 164.19 09/01/2000 03/01/2028 F A 02/07/2000 609.64 SD A 422.00 07/01/2000 03/02/2063
957667 OP OP M A 04/28/2000 1,313.44 PD A 696.06 06/21/2000 04/11/2057 M A 04/28/2000 1,313.44 SD A 889.00 12/01/2000 04/11/2057
957704 OP OP F A 12/16/2000 1,398.36 PD A 975.93 03/23/2001 04/03/2061 F A 12/16/2000 1,398.36 SD A 924.00 06/01/2001 04/03/2061
957783 OP OP F A 06/02/2000 3,097.58 PD A 1,929.25 09/02/2000 01/25/2053 F A 06/02/2000 3,097.58 SD A 1,470.00 02/01/2001 01/25/2053
960295 OP OP M A 06/10/2000 2,744.74 BO A 800.00 10/01/2000 08/25/2019 M A 06/10/2000 2,744.74 SD A 1,666.00 12/01/2000 08/26/2054
960353 OP OP F A 05/29/2000 610.89 SD A 441.00 07/01/2003 05/11/2057
960367 OP OP M A 06/05/1999 1,932.94 PD A 1,993.38 08/16/2000 04/21/2051 M A 06/05/1999 1,932.94 SD A 1,287.00 01/01/2000 04/21/2051
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 101 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 960367 OP OP M A 06/05/1999 1,932.94 WP A 1,638.39 06/09/2000 02/06/2027
961948 OP OP F A 09/30/2000 1,790.48 PD A 755.15 11/03/2000 05/07/2050 F A 09/30/2000 1,790.48 SD A 1,061.00 03/01/2001 05/07/2050
963359 OP OP M A 05/01/2000 2,313.04 PD A 1,498.56 12/15/2000 09/08/2051 M A 05/01/2000 2,313.04 SD A 999.00 05/01/2001 09/08/2051
963389 OP OP F A 09/15/2000 1,146.11 PD A 615.36 12/13/2000 10/27/2056 F A 09/15/2000 1,146.11 SD A 901.00 03/01/2001 10/27/2056
964201 OP OP M A 08/12/2000 1,012.97 PD A 578.58 01/27/2001 09/03/2068 M A 08/12/2000 1,012.97 SD A 876.00 02/01/2001 09/03/2068
964436 OP OP M A 08/20/2000 919.48 PD A 491.37 01/13/2001 06/15/2068 M A 08/20/2000 919.48 SD A 752.00 02/01/2001 06/15/2068
965638 OP OP F A 11/15/2000 1,767.74 BO A 800.00 02/13/2001 10/26/2018 F A 11/15/2000 1,767.74 SD A 856.00 05/01/2001 10/27/2053
966161 OP OP F A 12/16/2000 1,408.77 PD A 647.33 12/16/2000 01/01/2053 F A 12/16/2000 1,408.77 SD A 831.00 06/01/2001 01/01/2053
966181 OP OP M A 10/11/2000 1,389.70 BO A 411.25 04/01/2001 03/03/2023 M A 10/11/2000 1,389.70 SD A 925.00 04/01/2001 03/14/2058
966206 OP OP F A 10/28/2000 1,765.84 PD A 1,590.78 03/01/2001 02/22/2051 F A 10/28/2000 1,765.84 SD A 1,209.00 04/01/2001 02/22/2051
966788 OP OP M A 01/12/2001 1,420.46 BO A 469.83 07/01/2001 06/07/2019 M A 01/12/2001 1,420.46 SD A 896.00 07/01/2001 06/08/2054
967769 OP OP F A 10/25/2000 1,302.11 PD A 978.99 03/23/2001 07/07/2054 F A 10/25/2000 1,302.11 SD A 903.00 04/01/2001 07/07/2054
967994 OP OP F A 06/09/2000 2,358.74 PD A 2,509.42 05/16/2001 10/13/2051 F A 06/09/2000 2,358.74 SD A 1,473.00 08/01/2001 10/13/2051
968822 OP OP M A 01/09/2001 1,308.56 PD A 461.00 05/17/2001 11/14/2050 M A 01/09/2001 1,308.56 SD A 1,074.00 07/01/2001 11/14/2050
969055 OP OP M A 02/07/2001 731.51 PD A 421.36 06/05/2001 07/31/2055 M A 02/07/2001 731.51 SD A 733.00 07/01/2001 07/31/2055
972049 OP OP F A 10/03/2000 628.93 BO A 604.74 01/01/2001 04/27/2016
972268 OP OP F A 02/27/2001 1,528.69 PD A 1,092.72 08/12/2001 12/07/2058 F A 02/27/2001 1,528.69 SC A 408.00 08/01/2001 10/31/2016
F A 02/27/2001 1,528.69 SD A 817.00 08/01/2001 12/07/2058
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 102 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 972826 OP OP F A 03/29/2001 1,181.65 PD A 970.45 08/17/2001 06/16/2057 F A 03/29/2001 1,181.65 SD A 870.00 06/01/2001 06/16/2057
973458 OP OP F A 03/30/2001 838.88 BO A 301.61 01/01/2002 05/08/2016 F A 03/30/2001 838.88 SD A 505.00 01/01/2002 05/09/2051
974762 OP OP M A 05/04/2001 1,009.34 PD A 796.93 07/19/2001 06/19/2059 M A 05/04/2001 1,009.34 SD A 854.00 11/01/2001 06/19/2059
976264 OP OP M A 09/26/2000 1,094.18 PS S 795.14 04/18/2001 03/12/2059 M A 09/26/2000 1,094.18 SD A 868.00 06/01/2002 03/12/2059 M A 09/26/2000 1,094.18 WP A 61.90 05/24/2002 03/11/2029
980791 OP OP F A 04/18/2001 451.37 SD A 648.00 10/01/2001 09/08/2059
983465 OP OP F A 10/17/2001 1,205.59 BO A 374.22 04/01/2002 05/25/2016 F A 10/17/2001 1,205.59 SD A 785.00 04/01/2002 05/26/2051
983874 OP OP F A 09/25/2001 1,518.13 BO A 574.74 03/01/2002 02/10/2036 F A 09/25/2001 1,518.13 SD A 885.00 03/01/2002 02/11/2071
984550 OP OP M A 09/26/2001 962.33 BO A 257.31 03/01/2002 02/08/2025 M A 09/26/2001 962.33 SD A 668.00 03/01/2002 02/09/2060
985339 OP OP M A 08/24/2001 2,236.16 PD A 1,555.85 03/30/2002 08/25/2054 M A 08/24/2001 2,236.16 SD A 1,516.00 06/01/2002 08/25/2054
985359 OP OP F A 05/25/2001 720.09 PD A 837.06 07/15/2001 06/19/2060 F A 05/25/2001 720.09 SD A 775.00 11/01/2001 06/19/2060
986037 OP OP M A 07/25/2001 1,380.76 SD A 1,370.00 01/01/2002 10/06/2052
986908 OP OP F A 08/04/2001 1,083.66 BO A 261.98 01/01/2002 11/26/2019 F A 08/04/2001 1,083.66 SD A 780.00 01/01/2002 11/27/2054
986944 OP OP F A 08/14/2001 1,440.24 PD A 923.14 01/10/2002 10/14/2051 F A 08/14/2001 1,440.24 SD A 880.00 08/01/2003 10/14/2051
986947 OP OP F A 08/13/2001 682.18 BO A 71.94 02/01/2002 03/10/2023 F A 08/13/2001 682.18 SD A 584.00 02/01/2002 03/11/2058
986985 OP OP F A 10/12/2001 1,382.01 PD A 619.60 02/21/2002 10/26/2061 F A 10/12/2001 1,382.01 SD A 977.00 04/01/2003 10/26/2061
986988 OP OP M A 08/08/2001 1,401.61 PD A 1,042.32 07/19/2002 11/20/2056 M A 08/08/2001 1,401.61 SD A 943.00 02/01/2002 11/20/2056
987235 OP OP M A 10/20/2001 739.10 SD A 775.00 04/01/2002 05/19/2064
987707 OP OP F A 01/08/2002 1,082.95 PD A 426.51 08/09/2002 06/14/2063
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 103 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 987707 OP OP F A 01/08/2002 1,082.95 SD A 727.00 12/01/2002 06/14/2063
988274 OP OP M A 10/18/2001 1,493.59 PD A 513.01 01/17/2002 12/07/2051 M A 10/18/2001 1,493.59 PS A 10.41 01/17/2002 12/07/2051 M A 10/18/2001 1,493.59 SR A 1,457.00 04/01/2002 12/07/2051
988282 OP OP F A 09/29/2001 3,010.64 PD A 2,151.83 05/15/2002 07/07/2055 F A 09/29/2001 3,010.64 SD A 1,514.00 03/01/2002 07/07/2055
988764 OP OP F A 09/18/2001 2,489.12 PD A 2,183.70 04/30/2002 11/21/2052 F A 09/18/2001 2,489.12 SD A 1,405.00 05/01/2003 11/21/2052
989102 OP OP F A 07/12/2001 1,961.70 PD A 691.52 05/30/2002 01/03/2053 F A 07/12/2001 1,961.70 SD A 1,240.00 01/01/2002 01/03/2053 F A 07/12/2001 1,961.70 WP A 267.86 05/01/2004 01/02/2023
991740 OP OP F A 11/10/2001 2,342.22 BO A 762.14 05/01/2002 06/28/2021 F A 11/10/2001 2,342.22 SD A 1,490.00 05/01/2002 06/29/2056
993009 OP OP M A 03/26/2002 2,077.58 PD A 1,369.33 07/02/2002 12/22/2053 M A 03/26/2002 2,077.58 SD A 1,112.00 09/01/2002 12/22/2053
993017 OP OP F A 01/16/2002 1,818.91 BO A 61.77 07/01/2002 11/06/2015 F A 01/16/2002 1,818.91 PD A 789.19 04/05/2002 11/07/2050 F A 01/16/2002 1,818.91 SD A 898.00 07/01/2002 11/07/2050
993041 OP OP M A 03/14/2002 1,783.46 PD A 1,337.22 09/07/2002 05/17/2059 M A 03/14/2002 1,783.46 PS A 238.13 03/20/2003 05/17/2059 M A 03/14/2002 1,783.46 SD A 1,334.00 06/01/2005 05/17/2059 M A 03/14/2002 1,783.46 WP A 50.18 10/01/2002 12/31/2033
994123 OP OP F A 02/19/2002 1,357.47 PD A 914.27 06/12/2002 12/16/2055 F A 02/19/2002 1,357.47 SD A 917.00 08/01/2002 12/16/2055
994133 OP OP F A 10/09/2001 1,744.49 BO A 800.00 01/07/2002 04/28/2018 F A 10/09/2001 1,744.49 SD A 693.00 03/01/2003 04/29/2053
994453 OP OP F A 02/06/2002 1,498.30 PD A 765.52 05/22/2002 04/11/2063 F A 02/06/2002 1,498.30 SD A 977.00 08/01/2002 04/11/2063
995999 OP OP F A 01/03/2002 1,534.44 BO A 800.00 04/03/2002 07/20/2036 F A 01/03/2002 1,534.44 SD A 657.00 03/01/2003 07/21/2071
996924 OP OP M A 03/19/2002 981.66 BO A 18.91 09/01/2002 03/12/2026 M A 03/19/2002 981.66 SD A 925.00 09/01/2002 03/13/2061
996967 OP OP F A 06/01/2002 2,087.04 BO A 215.88 01/01/2003 10/19/2015 F A 06/01/2002 2,087.04 PD A 1,014.89 08/24/2002 10/20/2050
F A 06/01/2002 2,087.04 SD A 776.00 01/01/2003 10/20/2050
CLAIM OFFSET INFORMATION AS OF 04/30/2015 13:17 Tuesday, May 5, 2015 104 STANDARD INSURANCE COMPANY
CLM CLM INCURRAL CLOSE GROSS OFFSET OFFSET OFFSET OFFSET OFFSET CO POLICY CLAIM PROD TYPE GENDER STS DATE DATE BENEFIT ID STATUS AMOUNT EFF DATE LIM DATE
SI 621144 998008 OP OP M A 01/17/1999 2,035.35 PD A 988.08 07/14/2002 12/25/2062 M A 01/17/1999 2,035.35 SD A 1,431.00 05/01/2000 12/25/2062 M A 01/17/1999 2,035.35 WP A 135.42 07/02/1904 07/19/2037
998014 OP OP M A 11/26/2001 1,366.68 PD A 979.07 09/01/2002 07/05/2064 M A 11/26/2001 1,366.68 SD A 208.00 05/01/2002 07/05/2064 M A 11/26/2001 1,366.68 WP A 1,427.81 07/11/2005 07/05/2064