SERFF Tracking #: FHLA-129477086 State Tracking #: Company Tracking #: DCL6RATES State: District of Columbia Filing Company: Family Heritage Life Insurance Company of America TOI/Sub-TOI: Product Name: Project Name/Number: / Filing at a Glance Company: Product Name: State: TOI: Sub-TOI: Filing Type: Family Heritage Life Insurance Company of America Juvenile Life Rates District of Columbia L07I Individual Life - Whole L07I.101 Fixed/Indeterminate Premium - Single Life Rate Date Submitted: 03/28/2014 SERFF Tr Num: SERFF Status: State Tr Num: State Status: Co Tr Num: Implementation Date Requested: Author(s): Reviewer(s): FHLA-129477086 Closed-FILED FOR INFORMATION DCL6RATES On Approval Kevin Wicktora, Kim Scott, Arthur Chu Donghan Xu (primary) Disposition Date: 04/03/2014 Disposition Status: Implementation Date: 04/03/2014 State Filing Description: L07I Individual Life - Whole/L07I.101 Fixed/Indeterminate Premium - Single Life Juvenile Life Rates FILED FOR INFORMATION PDF Pipeline for SERFF Tracking Number FHLA-129477086 Generated 04/10/2014 10:18 AM
SERFF Tracking #: FHLA-129477086 State Tracking #: Company Tracking #: DCL6RATES State: District of Columbia Filing Company: Family Heritage Life Insurance Company of America TOI/Sub-TOI: Product Name: Project Name/Number: / General Information Project Name: Status of Filing in Domicile: Authorized Project Number: Date Approved in Domicile: 12/31/2013 Requested Filing Mode: Review & Approval Explanation for Combination/Other: Submission Type: New Submission Domicile Status Comments: Market Type: Individual Individual Market Type: Overall Rate Impact: Filing Status Changed: 04/03/2014 Deemer Date: Submitted By: Kevin Wicktora Filing Description: L07I Individual Life - Whole/L07I.101 Fixed/Indeterminate Premium - Single Life Juvenile Life Rates State Status Changed: Created By: Kevin Wicktora Corresponding Filing Tracking Number: Family Heritage Life Insurance Company of America would like to submit an actuarial memorandum and premium rates for FORM L4POL-DC when selling the policy as a juvenile life product (ages 15 days to 18 years). The policy form was approved by the Department on 11/6/2008. The rates were approved on 11/6/2008 under SERFF Tracking Number FHLA-125824652. An application for this policy when sold as a juvenile life product was submitted to the Department yesterday under SERFF Tracking Number FHLA-129476456. Also included in this filing is an actuarial memorandum and premium rates for the policy and term insurance rider with return of premium (FORM L4TRR-ST also approved on 11/6/2008) for ages 18 through 22. These are premium rates we did not include with our initial filing of the policy and rider. Company and Contact Filing Contact Information Kevin Wicktora, Compliance Manager 6001 East Royalton Road Suite 200 Cleveland, OH 44147 Filing Company Information Family Heritage Life Insurance Company of America 6001 East Royalton Road Suite 200 Cleveland, OH 44147 (440) 922-5200 ext. [Phone] kevin.wicktora@familyheritagelife.com 440-922-5134 [Phone] CoCode: 77968 Group Code: 290 Group Name: FEIN Number: 34-1626521 State of Domicile: Ohio Company Type: Life & Health State ID Number: Filing Fees Fee Required? Retaliatory? Fee Explanation: No No PDF Pipeline for SERFF Tracking Number FHLA-129477086 Generated 04/10/2014 10:18 AM
SERFF Tracking #: FHLA-129477086 State Tracking #: Company Tracking #: DCL6RATES State: District of Columbia Filing Company: Family Heritage Life Insurance Company of America TOI/Sub-TOI: L07I Individual Life - Whole/L07I.101 Fixed/Indeterminate Premium - Single Life Product Name: Juvenile Life Rates Project Name/Number: / Supporting Document Schedules Satisfied - Item: Comments: Attachment(s): Item Status: Status Date: Actuarial Justification ActMemo-HLE-WL - 2014 - ST.pdf ActMemo-HLE-TROP - 2014 - ST.pdf HLE Premium Ratesheets - ST.pdf PDF Pipeline for SERFF Tracking Number FHLA-129477086 Generated 04/10/2014 10:18 AM
Family Heritage Life Insurance Company of America Individual Whole Life Annual Premium rates per $1,000 Form L4POL Male Female Male Female Issue Nicotine Nicotine Issue Nicotine Nicotine Age Free Nicotine Free Nicotine Age Free Nicotine Free Nicotine 19 9.00 11.64 7.20 9.48 45 20.40 27.00 16.80 22.80 20 9.24 11.88 7.56 10.08 46 21.36 28.20 17.52 23.64 21 9.36 12.24 7.92 10.56 47 22.32 29.40 18.24 24.48 22 9.60 12.48 8.40 11.16 48 23.28 30.60 18.96 25.32 23 9.96 12.96 8.76 11.76 49 24.24 31.80 19.68 26.16 24 10.08 13.08 8.88 11.88 50 25.20 33.00 20.40 27.00 25 10.20 13.20 9.00 12.00 51 26.52 34.80 21.24 28.44 26 10.44 13.56 9.24 12.36 52 27.84 36.60 22.08 29.88 27 10.68 13.92 9.48 12.72 53 29.16 38.40 22.92 31.32 28 10.92 14.28 9.72 13.08 54 30.48 40.20 23.76 32.76 29 11.16 14.64 9.96 13.44 55 31.80 42.00 24.60 34.20 30 11.40 15.00 10.20 13.80 56 33.24 44.40 25.68 35.76 31 11.88 15.60 10.56 14.28 57 34.68 46.92 26.88 37.20 32 12.36 16.20 10.92 14.76 58 36.00 49.32 27.96 38.76 33 12.84 16.80 11.28 15.24 59 37.44 51.84 29.16 40.20 34 13.32 17.40 11.64 15.72 60 38.88 54.24 30.24 41.76 35 13.80 18.00 12.00 16.20 61 41.16 57.36 31.92 44.04 36 14.40 18.84 12.48 16.80 62 43.44 60.60 33.48 46.32 37 15.00 19.68 12.96 17.40 63 45.84 63.72 35.16 48.72 38 15.60 20.52 13.44 18.00 64 48.12 66.96 36.72 51.00 39 16.20 21.36 13.92 18.60 65 50.40 70.08 38.40 53.28 40 16.80 22.20 14.40 19.20 66 53.76 75.60 40.56 57.00 41 17.52 23.16 14.88 19.92 67 57.12 81.24 42.84 60.72 42 18.24 24.12 15.36 20.64 68 60.48 86.76 45.00 64.56 43 18.96 25.08 15.84 21.36 69 63.84 92.40 47.28 68.28 44 19.68 26.04 16.32 22.08 70 67.20 97.92 49.44 72.00 $60 Annual Policy Fee per Household
Family Heritage Life Insurance Company of America Individual Children Whole Life Annual Premium rates per $1,000 Form L4POL Issue Age Male Female 0-5 4.08 3.60 6-10 5.10 4.50 11-15 6.30 5.40 16-18 8.40 7.50 $12 Annual Policy Fee
Family Heritage Life Insurance Company of America Rider Annual Premium Rates per $1,000 Term Insurance Rider with Return of Premium Form L4TRR Male Female Male Female Issue Nicotine Nicotine Issue Nicotine Nicotine Age Free Nicotine Free Nicotine Age Free Nicotine Free Nicotine 19 2.88 5.16 1.92 3.00 38 10.08 16.92 7.32 12.96 20 3.00 5.40 2.04 3.12 39 10.80 18.48 7.92 13.92 21 3.12 5.64 2.16 3.36 40 11.52 19.92 8.40 14.88 22 3.24 5.76 2.28 3.48 41 12.60 21.60 9.24 16.08 23 3.36 6.00 2.40 3.72 42 13.68 23.28 10.08 17.28 24 3.48 6.12 2.52 3.84 43 14.64 24.96 10.80 18.48 25 3.60 6.24 2.64 4.08 44 15.72 26.64 11.64 19.68 26 3.72 6.60 2.76 4.56 45 16.80 28.32 12.48 20.88 27 3.84 6.96 2.88 4.92 46 18.24 30.24 13.32 22.08 28 4.08 7.20 2.88 5.40 47 19.68 32.04 14.16 23.40 29 4.20 7.56 3.00 5.76 48 21.12 33.96 15.12 24.60 30 4.32 7.92 3.12 6.24 49 22.56 35.76 15.96 25.92 31 5.04 8.88 3.60 6.96 50 24.00 37.68 16.80 27.12 32 5.76 9.72 4.20 7.80 51 25.68 39.60 17.88 28.32 33 6.48 10.68 4.68 8.52 52 27.36 41.40 18.96 29.64 34 7.20 11.52 5.28 9.36 53 29.04 43.32 19.92 30.84 35 7.92 12.48 5.76 10.08 54 30.72 45.12 21.00 32.16 36 8.64 13.92 6.24 11.04 55 32.40 47.04 22.08 33.36 37 9.36 15.48 6.84 12.00 Accidental Death Benefit Rider Form L4ADR Issue Rate/ Age 1,000 19-55 1.92 Children Term Insurance Rider Form L4CHR Issue Rate/ Age 1,000 19-55 6.00