SECRETARY OF HOUSING AND ECONOMIC DEVELOPMENT

(1)

CHARLES D. BAKER JAY ASH

GOVERNOR SECRETARY OF HOUSING AND

ECONOMIC DEVELOPMENT

KARYN E. POLITO JOHN C. CHAPMAN

LIEUTENANT GOVERNOR UNDERSECRETARY OF CONSUMER AFFAIRS

AND BUSINESS REGULATION

DANIEL R. JUDSON

COMMISSIONER OF INSURANCE

INDIVIDUAL DISABILITY INCOME INSURANCE POLICIES THAT MEET THE

REQUIREMENTS OF MASSACHUSETTS’ REGULATION 211 CMR 42.00

Company Name

Approval Date

1.

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA

P.O. Box 59060

300 South Highway 169

Minneapolis, MN 55459

(800) 950-5872

Policy #s:

2-P-A

1 disability income policy

06/09/99

2.

ACE AMERICAN INSURANCE COMPANY

P.O. Box 1000

436 Walnut Street – WA09G

Philadelphia, PA 19106

(215) 640-5123

Policy #s:

AH-1400-MA

disability income policy

10/23/06

AH-1500-MA

06/19/13

3.

AMALGAMATED LIFE INSURANCE COMPANY

333 Westchester Avenue

White Plains, NY 10604

(914) 367-5581

Policy #s:

AMINDDI-10 (MA)

10/12/12

1 _{Effective November 6, 2001, Allianz Life Insurance Company of North America ceased offering its approved individual}

disability income policy in Massachusetts.

DIVISION OF INSURANCE

1000 Washington Street, Suite 810 • Boston, MA 02118-6200 (617) 521-7794 Toll-free (877) 563-4467

http://www.mass.gov/doi

(2)

4.

AMERICAN BANKERS LIFE ASSURANCE COMPANY OF FLORIDA

11222 Quail Roost Drive

Miami, FL 33157-6596

(800) 852-2244

Policy #s:

AC6398PH-1098

05/23/00

5.

AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS

1932 Wynnton Road

Columbus, GA 31999

(800) 992-3522

Policy #s:

A-57200-MA

04/28/00

A-57400-MA

09/26/03

A-57500-MA

06/24/09

A57600MA

01/17/13

6.

AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK

One Marcus Boulevard

Albany, New York 12205

(800) 366-3436

Policy #s:

NY-57000 MA

09/03/96

NY-57200 MA

04/13/99

7.

AMERICAN FIDELITY ASSURANCE COMPANY

2000 N. Classen Blvd.

Oklahoma City, Oklahoma 73106

(800) 323-3748

Policy #s:

DI-99(MA)

04/27/00

8.

AMERICAN GENERAL LIFE INSURANCE COMPANY

2727-A Allen Parkway

Houston, Texas 77019

(800) 811-2696

Policy #s:

04500-22

05/23/05

2 _{American Fidelity Assurance Company notified the Division that it has not marketed the approved individual disability income}

policy in Massachusetts.

(3)

9.

AMERICAN GENERAL LIFE AND ACCIDENT INSURANCE COMPANY

American General Center

Nashville, Tennessee 32750

(615) 749-1139

Policy #s:

AGLA 12LSD MA

07/26/13

10.

AMERICAN HERITAGE LIFE INSURANCE COMPANY

1776 American Heritage Life Drive

Jacksonville, FL 32224

(800) 521-3535

Policy #s:

DI-3MA

03/29/89

DI-4MA

10/06/93

DI5WMA

11/27/01

DI61MA

01/31/02

11.

AMERICAN INCOME LIFE INSURANCE COMPANY

P.O. Box 2608

Waco, Tx 76797

(254) 761-6400

Policy #s:

D50000

04/22/81

12.

AMERICAN NETWORK INSURANCE COMPANY

3

AON Select Company

110 Gibraltar Road, Suite #116

Horsham, PA 19044

(800) 343-3133

Policy #s:

GR-78-87-MA

10/27/87

RA-GR-83-87-MA

02/25/88

2GR-90-MA

08/13/90

GRST-91-MA

08/06/91

4GR-94-MA

09/15/93

ANIC-DI (96) MA

08/12/97

5GR-RPD-97-MA

10/08/97

ANIC-DI 2000 (MA)

01/04/00

3_{Effective January 6, 2009, American Network Insurance Company was placed in rehabilitation per order of the Pennsylvania}

Insurance Commissioner and the company is no longer marketing approved individual disability income policies in Massachusetts.

(4)

13. AMERICAN PHOENIX LIFE AND REASSURANCE COMPANY

100 Bright Meadow Boulevard

P.O. Box 1900

Enfield, CT 06083-1900

(860) 403-2360

Policy #s:

ENTDIS97 MA

07/21/98

14.

AMERICAN STATES LIFE INSURANCE COMPANY

P.O. Box 34690

Seattle, WA 98124

(877) 4-SAFECO

Policy #s:

L0071-20 (10-93)

03/24/94

L0060-00 (9-93)

03/20/95

L0076-20 (10-93)

03/20/95

15.

AMERITAS LIFE INSURANCE CORP.

5900 O Street

P. O. Box 81889

Lincoln, NE 68501-1889

(800) 756-1112

Policy #s:

4501NC MA

03/23/12

4502GR MA

03/23/12

4503NCBOE MA

4 overhead expense disability income policy

06/02/15

4504LS MA

02/28/14

16.

ASSURITY LIFE INSURANCE COMPANY

1526 K Street

(800) 627-7212

Policy #s:

A-D 100 MA

07/07/98

A-D 106 MA

disability business expense policy

07/07/98

A-D 103 MA

12/11/01

AAW-D112 MA

04/22/03

AAW-D113 MA

04/22/03

A-D 120 MA

03/18/04

W D210 MA

04/08/09

I H0920 MA

08/18/11

4

Form #4503NCBOE MA replaces Form #4503BOE MA previously approved on March 23, 2012.

(5)

17.

BALBOA LIFE INSURANCE COMPANY

P.O. Box 19702

Irvine, CA 92623-9702

(800) 854-6115

Policy #s:

20A15P E496

06/15/98

18.

BALTIMORE LIFE INSURANCE COMPANY

10075 Red Run Boulevard

Owings Mills, Maryland 21117-4871

(800) 628-5433

Policy #s:

6204S (MA)

02/23/00

6216S (MA)

02/23/00

6219S (MA/RI)

6 disability business expense policy

02/23/00

6248S (MA/RI)

02/23/00

19.

BANKERS FIDELITY LIFE INSURANCE COMPANY

4370 Peachtree Road, N.E.

Atlanta, GA 30319

(404) 266-5600

Policy #s:

B 8721 MA

12/01/06

B 8721 DR MA

12/01/06

20.

BANKERS LIFE & CASUALTY COMPANY

222 Merchandise Mart Plaza

Chicago, IL 60654-2013

(312) 396-6000

Policy #s:

GR-D025

11/04/94

5_{Balboa Life Insurance Company notified the Division that it has not marketed its approved individual disability income policy in}

Massachusetts.

6_{Baltimore Life Insurance Company notified the Division that it has not marketed its approved individual disability income policies}

in Massachusetts.

(6)

21.

BERKSHIRE LIFE INSURANCE COMPANY OF AMERICA

700 South Street

Pittsfield, MA 01201-8285

(413) 499-4321

Policy #s:

0100MA (06/01)

04/11/01

1100MA (06/01)

04/11/01

3100MA (06/01)

disability business buyout policy

04/11/01

4100MA (06/01)

04/11/01

5100MA (06/01)

04/11/01

6100MA (06/01)

04/11/01

755 (7-2001)

02/15/02

1200 (01/11) MA

11/30/10

1500 (03/07) MA

10/31/07

1500 (06/10) MA

04/09/10

3200 (01/10) MA

disability buy-out policy

05/10/10

1600 (06/10) MA

05/25/10

4200 (01/10) MA

overhead expense disability income policy

05/26/10

1400 (06/10) MA

09/01/10

22.

BOSTON MUTUAL LIFE INSURANCE COMPANY

120 Royall Street

Canton, MA 02021-9968

(800) 669-2668

Policy #s:

D.I.-Acc-6/93

09/22/93

D.I.-A&S-6/93

09/22/93

ESO-DIS-1/95

03/02/95

D.I.-IMPR-7/98

04/15/99

23.

CENTRAL STATES HEALTH & LIFE COMPANY OF OMAHA

P.O. Box 34350

Omaha NE 68134-0350

(402) 397-1111

Policy #s:

D03 MA

03/02/95

D05 MA

05/29/96

7 _{Effective September 6, 2005, Berkshire Life Insurance Company of America ceased offering the above-noted approved individual}

8 _{Form #1200 (01/11) MA replaces form #1200 (09/04) MA, previously approved on June 24, 2004.} 9

Form# 1400 (06/10) MA replaces Form# 1400 (03/07) MA previously approved on October 31, 2007.

10 _{Effective December 1, 2002, Central States Health & Life Insurance Company ceased offering the above-noted individual}

11 _{Effective January 2, 2002, Central States Health & Life Insurance Company ceased offering the above-noted individual disability}

income policy in Massachusetts.

(7)

24.

CENTRAL STATES INDEMNITY INSURANCE COMPANY OF OMAHA

1212 N. 96

th

Street

Omaha NE 68134-22748

(888) 642-4340

Policy #s:

11615

08/23/05

25.

THE CHESAPEAKE LIFE INSURANCE COMPANY

9151 Boulevard 26

North Richland Hills, TX 76180

(817) 255-3100

Policy #s:

CH-26115-IP (01/10) MA

05/13/11

26.

THE CINCINNATI LIFE INSURANCE COMPANY

P.O. Box 15496

Cincinnati, OH 45250-5496

(513) 870-2000

Policy #s:

CLI-507-MA (3/01)

11/27/01

27.

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY

1200 Colonial Life Boulevard

Columbia, SC 29202

(800) 325-4368

Policy #s:

SASD-MA

10/12/99

ENHANCE-MA

02/17/00

DIS 1000-MA

02/18/04

(8)

28.

COMBINED INSURANCE COMPANY OF AMERICA

123 North Wacker Drive

Chicago, IL 60606

(312) 701-3242

Policy #s:

12475

08/25/87

19700-MA

11/09/89

19824-MA-809

09/08/97

19819-MA-1208

12/04/97

19841-MA

06/18/98

DI P69003-MA 0401

01/17/02

DI P69004-MA 0401

01/17/02

14135-MA

01/21/15

29.

CONTINENTAL GENERAL INSURANCE COMPANY

8901 Indian Hills Drive

P.O. Box 247007

Omaha, NE 68124-7007

(402) 397-3200

Policy #s:

208

01/07/94

30.

FARM FAMILY LIFE INSURANCE COMPANY

P.O. Box 656

Albany, NY 12201

(518) 431-5000

Policy #s:

40-150

10/03/83

40-151

10/18/84

40-156(MA)

09/24/98

40-182 1101 (MA)

07/08/03

40-183 1101 (MA)

07/08/03

40-184 1101 (MA)

07/08/03

40-185 1101 (MA)

07/08/03

12 _{The original certificate (Form#19824-MA) was originally approved on September 8, 1997. Carrier replaced the original}

certificate with the above-noted revised certificate (Form# 19824-MA 809) on October 28, 2009.

13 _{The original certificate (Form#19819-MA) was originally approved on December 4, 1997. Carrier replaced the original}

certificate with the above-noted revised certificate (Form# 19819-MA-1208) on April 6, 2009.

14 _{Effective June 2008, Continental General Insurance Company ceased offering its above-noted approved individual disability}

(9)

31.

FEDERATED LIFE INSURANCE COMPANY

121 E. Park Square

P.O. Box 328

Owatonna, MN 55060

(800) 533-0472

Policy #s:

DI(MA) (05-96)

03/30/99

DI(MA) (01-01)

05/17/01

32.

GOVERNMENT PERSONNEL MUTUAL LIFE INSURANCE COMPANY

2211 N.E. Loop 410

P.O. Box 659567

San Antonio, TX 78217

(800) 938-4765

Policy #s:

GDI113-MA-R

05/21/14

33.

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA

7 Hanover Square

New York, NY 10004-2616

(800) 441-6455

Policy #s:

AH55-A

05/19/81

NC56-A

05/19/81

AH84

15 disability buyout policy

12/21/86

NC97

03/07/88

NC111-MA

10/06/98

NC112-MA

02/05/99

OE102-MA

03/10/99

34.

HCC LIFE INSURANCE COMPANY

225 TownPark Drive, Suite 145

Kennesaw, GA 30144-5509

(770) 973-9851

Policy #s

HCCSU IND-13-MA

08/18/15

HCCSU TPI-13 SP PTD-MA

08/18/15

HCCSU TPI-13 SP TTD-MA

08/18/15

HCCSU TPI-13 EE PTD-MA

08/18/15

HCCSU TPI-13 MLB TTD-MA

08/18/15

15

Effective July 1, 2001, The Guardian Life Insurance Company of America ceased offering these above-noted approved individual disability income policies in Massachusetts.

16

Policy will be marketed primarily to executives, entertainers and athletes of various sports entities.

(10)

35.

HORACE MANN LIFE INSURANCE COMPANY

1 Horace Mann Plaza

Springfield, IL 62715-0001

(217) 789-2500

Policy #s

GC-S1I01K

10/06/87

GC-S1I02X

02/02/93

36.

ILLINOIS MUTUAL LIFE INSURANCE COMPANY

300 S.W. Adams Street

Peoria, IL 61634

(800) 437-7355

Policy #s:

990 MA

08/24/99

991 MA

08/24/99

992 MA

08/24/99

994 MA

08/24/99

BE21 MA

08/28/00

GR21 MA

08/28/00

NC21 MA

08/28/00

PD21 MA

08/28/00

SR21 MA

08/28/00

SRBE21 MA

06/10/05

DI105 (MA)

09/21/10

37.

KANAWHA INSURANCE COMPANY

210 South White Street

Lancaster, SC 29721-0610

(877) 378-1505

Policy #s:

80315 8/05-MA

06/08/07

38.

KNIGHTS OF COLUMBUS

One Columbus Plaza

New Haven, CT 06510-3326

(203) 752-4658

Policy #s:

(11)

39.

LOYAL AMERICAN LIFE INSURANCE COMPANY

P.O. Box 5418

(800) 633-6752

Policy #s:

L-4187-20

04/30/96

40.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY

18

1295 State Street

Springfield, MA 01111-0001

(800) 272-2216

Policy #s:

DP181-MA-9200

04/02/92

BOE-I-92 MA

06/14/93

BOE-A-92 MA

06/14/93

BOE-G-92 MA

06/14/93

SBOE-I-92 MA

06/14/93

SBOE-A-92 MA

06/14/93

SBOE-G-92 MA

06/14/93

DP188-MA-9500

06/14/95

DP188-MA-9500F

06/14/95

DP288-MA-9500

06/14/95

DP288-MA-9500F

06/14/95

DP388-MA-9500

06/14/95

DP388-MA-9500F

06/14/95

DP488-MA-9500

06/14/95

DP488-MA-9500F

06/14/95

XL-I-95 MA

11/13/95

XL-A-95 MA

11/13/95

XL-G-95 MA

11/13/95

XL-OI-91 MA

12/01/97

XL-OA-91 MA

12/01/97

XL-OG-91 MA

12/01/97

XL-IS-92 MA

12/01/97

XL-AS-92 MA

12/01/97

XL-GS-92 MA

12/01/97

Axis-98 MA

09/23/98

BOE-99 (MA)

10/13/99

BSELL-00(MA)

02/02/00

AP-01 (MA)

05/21/01

XLS-IS-92 (MA)

03/12/04

XLS-ME-04 (MA)

05/17/04

17 _{Effective October 1, 2007, Loyal American Life Insurance Company ceased offering its approved individual disability income}

policy in Massachusetts.

18 _{Effective March 1, 1996, Connecticut Mutual Life Insurance Company merged into Massachusetts Mutual Life Insurance}

Company and acquired the listed individual disability income policies that were approved on November 13, 1995.

(12)

41.

METROPOLITAN LIFE INSURANCE COMPANY

P.O. Box 30591

Tampa, FL 33630

(800) 929-1492

Policy #s:

IDI2000-P/NC-ML

08/07/01

IDI2000-P/NC-(MA)

08/07/01

IDI2000-P/GR (MA)

08/07/01

IDIP12-01-MA

01/29/14

42.

MINNESOTA LIFE INSURANCE COMPANY

400 Robert Street North

St. Paul MN 55101-2098

(651) 665-3500

Policy #s:

MHC-98-560

07/19/90

MHC-98-562

07/19/90

43.

MUTUAL OF OMAHA INSURANCE COMPANY

Mutual of Omaha Plaza

Omaha, NE 68175

(402) 342-7600

Policy #s:

150BE--Series 10343

03/10/80

DM44--Series 15205

08/01/88

D55---Series 16486

08/13/90

DE45---Series 16715

02/01/91

D81-21062

03/25/08

D81-21063

03/25/08

D81-21064

03/25/08

D81-21065

03/25/08

D81-21066

03/25/08

D81-21067

03/25/08

D81-22990

01/13/11

D81-22991

01/13/11

D81-22992

01/13/11

D81-22993

01/13/11

D81-22994

01/13/11

D82-22995

01/13/11

D82-22996

01/13/11

D82-22997

01/13/11

D82-22998

01/13/11

D81-22999

01/13/11

19 _{Effective October 2000, Minnesota Life Insurance Company ceased offering its approved individual disability income policies in}

Massachusetts.

(13)

44.

NATIONWIDE LIFE INSURANCE COMPANY

One Nationwide Plaza

Columbus, Ohio 43215-2220

(800) 535-8600

Policy #s:

HEALTH-2150

02/10/99

45.

NEW ENGLAND LIFE INSURANCE COMPANY

21

Disability Income Administration Center

18 Chestnut Street

Worcester, MA 01608

(508) 799-4441

Policy #s:

949a MA

06/28/90

981 MA

08/20/90

933 MA

12/18/90

908 MA

01/24/91

990 MA

01/24/91

985 MA

06/05/91

986 MA

06/05/91

987 MA

06/05/91

975 MA

06/13/91

998 MA

04/11/95

998 MA PE

04/11/95

46.

NORTHWESTERN MUTUAL LIFE INSURANCE COMPANY

720 East Wisconsin Avenue

P.O. Box 1237

Milwaukee, WI 53202-4797

(414) 271-1444

Policy #s:

RR.GRD1.(0101)

11/29/00

RR.NCD1.(0101)

11/29/00

RR.BUY.(0101)

11/29/00

RR.KEY.(0101)

11/29/00

RR.DOE.(0101)

11/29/00

RR.INT.(0101)

11/29/00

20 _{Effective January 2002 Nationwide Life Insurance Company ceased offering its approved individual disability income policy in}

Massachusetts.

21 _{Effective January 2007, New England Life Insurance Company ceased offering its approved individual disability income policy}

in Massachusetts.

(14)

47.

OHIO NATIONAL LIFE ASSURANCE CORPORATION

P.O. Box 237

Cincinnati OH 45201-0237

(800) 366-6654

Policy #s:

93-DB-23

09/19/96

93-DE-23.1

09/19/96

95-DE-23.2

09/19/96

11DI-1.MA

01/06/12

11DI-2.MA

01/06/12

13DE-1.MA

06/20/13

13DB-1.MA

06/20/13

48.

OHIO NATIONAL LIFE INSURANCE COMPANY

P.O. Box 237

(513) 794-6100

Policy #s:

95-DI-23.1

09/24/96

95-DI-23.2

09/24/96

03-DI-23.1

05/10/07

03-DI-23.2

05/10/07

49.

OLD REPUBLIC LIFE INSURANCE COMPANY

307 North Michigan Avenue

Chicago, IL 60601-5382

(312) 346-8100

Policy #s:

3-8997(MA)

09/24/96

22 _{Old Republic Life Insurance Company notified the Division that it is no longer marketing its individual disability income policy}

in Massachusetts.

(15)

50.

THE PAUL REVERE LIFE INSURANCE COMPANY

18 Chestnut Street

Worcester, MA 01608

(508) 799-4441

Policy #s:

981 MA

23 disability buyout income policy

08/20/90

908 MA

01/24/91

990 MA

01/24/91

975 MA

06/11/91

998 MA

04/11/95

998 MA PE

04/11/95

51.

PRINCIPAL LIFE INSURANCE COMPANY

711 High Street

Des Moines, IA 50309-9979

(515) 247-5111

Policy #s:

HH 700 MA

03/28/00

HH 700 MA U

03/28/00

HH 702 MA

overhead expense policy

03/28/00

HH 703 MA

03/28/00

HH 750 MA

06/16/04

HH 750 MA U

06/16/04

HH 772 MA

03/10/09

HH 789 MA

26 overhead expense policy

01/14/11

52.

PROFESSIONAL INSURANCE COMPANY

100 Bright Meadow Blvd

P.O. Box 1955

Enfield, CT 06083-1955

(800) 289-1122

Policy #s:

HPDI2002 1-02

05/10/05

HPDI2009 MA

07/17/09

23 _{Effective October 1, 1999, Paul Revere Life Insurance Company ceased offering these approved individual disability income}

policies in Massachusetts.

24

Effective January 1, 1998, Paul Revere Life Insurance Company ceased offering these approved individual disability income policies in Massachusetts.

25 _{Effective April 30, 2002, Paul Revere Life Insurance Company ceased offering these approved individual disability income}

policies in Massachusetts.

26

Form #HH 789 MA replaces form #HH 702 MA, previously approved on March 28, 2000.

(16)

53.

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY

One Fountain Square

Chattanooga, TN 37402

(800) 633-7490

Policy #s:

1669

04/19/86

297-NC-MA

06/01/89

297-GR-MA

06/01/89

337-MA

06/01/89

1737-MA

06/21/89

1738-MA

09/20/89

337-B-MA

03/13/92

338-MA

07/09/93

338-GR-MA

11/24/93

338-LE-MA

08/31/94

338-LE-GR-MA

08/31/94

400NC

12/19/95

400GR

12/19/95

409NC

09/19/96

450NC

09/19/96

450GR

09/19/96

L-21637-20

01/09/97

460GR

08/05/97

500-MA

10/06/97

500A-MA

10/06/97

410NC

02/23/98

475NC

06/18/98

975P-MA

10/19/98

975P-MA-G

10/19/98

600-MA

09/12/00

601-MA

09/12/00

600-G-MA

09/12/00

601-G-MA

09/12/00

L-21724

02/14/01

1837-MA

01/04/02

1838-MA

01/04/02

750-MA

05/24/10

(17)

54.

RIVERSOURCE LIFE INSURANCE COMPANY

70100 Ameriprise Financial Center

Minneapolis, MN 55474

1-800-862-7919

Policy #s:

30205G-MA

01/28/08

30203G-MA

01/28/08

30200G-MA

01/28/08

30208G-MA

01/28/08

30207G-MA

01/28/08

30200C-MA

08/12/94

30203C-MA

08/12/94

30207C-MA

08/12/94

30208D-MA

07/16/96

55.

SIRIUS AMERICA INSURANCE COMPANY

140 Broadway, 32

nd

Floor

New York, NY 10005

(212) 312-2500

Policy #s:

SHLD-13-1000MA

high-limit disability income policy

03/20/15

56.

STANDARD INSURANCE COMPANY

P.O. Box 711

Portland, OR 97207

(800) 247-6888

Policy #s:

B130.2(3/01)MA

05/09/01

B128.2(11/03)MA

disability buyout income policy

09/09/05

B152(5/05)MA

08/17/06

B170(7/10)MA

12/28/11

B170GI(7/10)MA

12/28/11

57.

SURETY LIFE INSURANCE COMPANY

P.O. Box 82599

(800) 669-7789

Policy #s:

DI-P00 (09/95) MA

09/15/95

27 _{Effective December 31, 2006, IDS Life Insurance Company changed its name to RiverSource Life Insurance Company}

represented by these above-noted approved individual disability policies.

28 _{Effective August 31, 1999, Surety Life Insurance Company ceased offering its approved individual disability income policy in}

Massachusetts.

(18)

58.

THRIVENT FINANCIAL FOR LUTHERANS

29

(A Fraternal Benefit Society)

4321 North Ballard Road

Appleton, Wisconsin 54919-0001

(800) 225-5225

Policy #s:

MA12124

disability income certificate

10/24/00

MA12125

disability income certificate

10/24/00

H2-GB-GRBOE-1

03/13/01

H2-NB-NCBOE-1

03/13/01

59.

TIME INSURANCE COMPANY

511 West Michigan

P.O. Box 3050

Milwaukee, WI 53201-3050

(800) 800-1212

Policy #s:

8034.POL.MA

12/9/10

60.

TRANSAMERICA ASSURANCE COMPANY

1150 South Olive

Los Angeles, CA 90015

(800) 346-1608

Policy #s:

9-H40 20-195

06/03/96

61.

TRUSTMARK INSURANCE COMPANY

400 Field Drive

Lake Forest, IL 60045

(877) 201-9373

Policy #s:

DI-699A

04/28/00

DI-699B

04/28/00

DI-699C

04/28/00

DI-699D

04/28/00

DI-902(I)

12/29/03

29 _{Effective August 6, 2002, Aid Association for Lutherans and Lutheran Brotherhood merged into the newly named Thrivent}

Financial for Lutherans.

(19)

62.

UNION CENTRAL LIFE INSURANCE COMPANY

1876 Waycross Road

P.O. Box 40888

Cincinnati, OH 45240

(513) 595-2200

Policy #s:

UC 4401 MA

05/24/99

UC 4402 MA

05/24/99

UC 4403 MA

05/24/99

63.

UNIFIED LIFE INSURANCE COMPANY

30

P.O. Box 25326

Overland Park, KS 66225

(800) 237-4463

Policy #s:

DI-98-A

03/01/99

64.

UNIVERSAL UNDERWRITERS LIFE INSURANCE COMPANY

7045 College Boulevard

Overland Park, KS 66211-1523

(800) 634-6780

Policy #s:

DMA1245

07/13/00

65.

UNUM LIFE INSURANCE COMPANY OF AMERICA

2211 Congress Street

Portland, ME 04122-9997

(800) 227-8138

Policy #s:

KP86 MA

01/22/86

BS86 MA

33 disability buyout income policy

06/02/86

OP90 MA

04/25/90

INC95 MA

07/28/95

ISC95 MA

07/28/95

EDP98MA

02/22/99

30 _{Effective September 2001, Concord General Life Insurance Company, Inc. changed its name to Unified Life Insurance Company.} 31 _{Universal Underwriters Life Insurance Company notified the Division its approved individual disability income policy has not}

been marketed in Massachusetts.

32 _{Effective December 2002, Unum Life Insurance Company ceased offering these approved individual disability income policies in}

Massachusetts.

33 _{Effective October 1, 1999, Unum Life Insurance Company ceased offering these approved individual disability income policies in}

Massachusetts.

(20)

66.

WELLCARE HEALTH INSURANCE OF ILLLINOIS

34

200 West Adams

Suite 800

Chicago, IL 60606-4402 USA

(813) 865-1658

Policy #s:

HOL3-2102-MA

11/04/02

34 _{Effective September 27, 2006, Home Owner’s Life Insurance Company’s name was changed to WellCare Health Insurance of}

Illinois, Inc.

35 _{Effective September 27, 2006, WellCare Health Insurance of Illinois, Inc. ceased offering the approved individual disability}