Appendix_C_-_Plan_Experience.pdf
PDF 1 MB Posted
- Attached to
- Group Term Life, Accidental Death, Long and Short Term Disability and Dismemberment Term Contract
- Solicitation number
- Y22-1005
- Issued by
- Orange County, Orlando City, Florida
About this file
This document is a claims experience report from Standard Insurance Company for Orange County Board of County Commissioners, covering multiple insurance products including Short-Term Disability (STD), Long-Term Disability (LTD), and Life Insurance for the period from January 1, 2017 to December 31, 2021. The report provides detailed claim experiences across different insurance segments, including Dependent Life, Basic Life, and Additional Life, with comprehensive data on earned premiums, paid claims, loss ratios, life years, and death claim counts.
The reports reveal significant financial details about the insurance claims, with total earned premiums across all segments reaching $8,614,826 for Additional Life, $2,172,924 for Dependent Life, and $1,062,983 for Basic Life during the five-year period. Loss ratios varied widely, ranging from 39% to 263% depending on the segment and year, with total incurred claims of $3,300,393 for Additional Life, $1,896,923 for Dependent Life, and $2,679,470 for Basic Life. The data shows fluctuating claim patterns, with varying numbers of death claims each year - for instance, the Additional Life segment had 45 total death claims over the five-year period, with a death incidence rate of 1.88 per 1,000 life years.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Form_1_Mandatory_Features.docx | DOCX document | |
| Appendix_B_-_Plan_Documents.pdf | ||
| Form_2_Worksheet.docx | DOCX document | |
| Form_3_Worksheet.xlsx | XLSX spreadsheet | |
| Appendix_D_-_EnterpriseSecurityStandards-InternalApplicationsRev4.pdf | ||
| Appendix_A_-_Census.xlsx | XLSX spreadsheet | |
| RFP_#Y22-1005-KK_FINAL.pdf |
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Text version
STANDARD INSURANCE COMPANY AS OF 12/31/2021
GROUP CLAIM EXPERIENCE RUN DATE 1/26/2022
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
VU4036 M LTD Oct-51 Oct-13 Apr-14 Oct-17 1,000.00 4,200.00 589
B31260 F TPD2 AL Sep-72 Jan-05 Jan-06 30,000.00 19,500.00 19,500.00
B40174 F TPD2 AL May-69 Nov-05 Jan-06 70,000.00 45,500.00 45,500.00
B42359 M TPD2 AL Feb-55 Dec-05 Dec-06 Jun-17 39,000.00
B51110 M TPD2 AL Jul-59 May-06 Oct-06 40,000.00 26,000.00 26,000.00
B68948 F TPD2 AL Jan-61 Jun-06 Apr-07 40,000.00 26,000.00 26,000.00
E25181 M TERM AL Dec-57 Sep-16 Dec-16 Feb-17 10,000.00 10,000.00 10,000.00
E29718 M TERM AL Feb-60 Jan-17 Feb-17 Mar-17 60,000.00 60,000.00
E30600 M TERM AL Jul-62 Feb-17 Jun-17 Dec-17 130,000.00 130,000.00
E31496 M TERM AL Sep-72 Feb-17 Mar-17 Mar-17 16,077.66 16,077.66
E39107 M TERM AL Sep-50 May-17 Jun-17 Jun-17 65,000.00 65,000.00
E40715 F TERM AL Apr-66 Jun-17 Jun-17 Jul-17 110,000.00 110,000.00
E41222 M TERM AL Feb-55 Jun-17 Jul-17 Aug-17 60,000.00 60,000.00
E46363 M TERM AL Feb-72 Aug-17 Jun-18 Jun-18 110,000.00 110,000.00
E51013 M TERM AL Oct-69 Nov-17 Nov-17 Nov-17 90,000.00 90,000.00
E51217 M TERM AL Jun-86 Oct-17 Nov-17 Mar-18 10,000.00 10,000.00
E51774 M TERM AL Dec-62 May-17 Nov-17 Nov-17 36,155.60 36,155.60
E54142 M TERM AL Feb-70 Dec-17 Jan-18 Aug-18 80,000.00 80,000.00
E64995 M TERM AL Nov-77 Apr-18 May-18 Jun-18 60,000.00 60,000.00
E65990 M TERM AL Feb-86 May-18 May-18 Jun-18 100,000.00 100,000.00
E69288 M TERM AL Apr-57 Jun-18 Jun-18 Jun-18 90,000.00 90,000.00
E70020 F TERM AL Aug-58 Jun-18 Jul-18 Jul-18 100,000.00 100,000.00
E73017 M TERM AL Oct-57 Aug-18 Aug-18 Aug-18 200,000.00 200,000.00
E79335 M TERM AL Dec-54 Oct-18 Nov-18 Jan-19 20,000.00 20,000.00
E83858 M TERM AL Jan-63 Jan-19 Jan-19 Feb-19 70,000.00 70,000.00
E88359 M TERM AL Jul-60 Feb-19 Mar-19 Mar-19 30,000.00 30,000.00
F08228 F TERM AL Sep-47 Nov-19 Nov-19 Feb-20 50,000.00 50,000.00
F20658 F TERM AL Jan-76 Apr-20 Apr-20 Apr-20 80,000.00 80,000.00
F21449 F TERM AL Mar-63 Apr-20 Jul-20 Nov-20 80,000.00 80,000.00
F22085 F TERM AL Jan-65 Apr-20 May-20 Apr-21 40,000.00 40,000.00
F23789 M TERM AL Apr-56 May-20 May-20 Jun-20 70,000.00 70,000.00
F24580 F TERM AL Oct-67 May-20 Jun-20 Jun-20 70,000.00 70,000.00
F30568 M TERM AL May-62 Aug-20 Sep-20 Jan-21 70,000.00 70,000.00
F31457 F TERM AL Jul-76 Aug-20 Sep-20 Sep-20 200,000.00 200,000.00
F42855 M TERM AL Sep-69 Dec-20 Jan-21 Jul-21 90,000.00 90,000.00
F48072 M TERM AL Oct-63 Feb-21 Mar-21 Mar-21 42,000.00 42,000.00
F48471 M TERM AL Apr-61 Feb-21 Mar-21 Mar-21 10,000.00 10,000.00
F51846 F TERM AL Nov-75 Mar-21 Apr-21 Apr-21 20,000.00 20,000.00
F54333 M TERM AL Jan-88 Apr-21 May-21 May-21 10,000.00 10,000.00
F54690 M TERM AL Dec-74 May-21 Jun-21 Jun-21 170,000.00 170,000.00
F57320 M TERM AL Sep-88 May-21 Jul-21
F62086 M TERM AL Aug-68 Aug-21 Aug-21 Aug-21 10,000.00 10,000.00
F62091 M TERM AL Oct-66 Aug-21 Aug-21 Aug-21 40,000.00 40,000.00
F62944 M TERM AL Feb-71 Aug-21 Sep-21 Sep-21 50,000.00 50,000.00
F63687 M TERM AL Mar-66 Aug-21 Sep-21 Sep-21 200,000.00 200,000.00
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
F63810 M TERM AL Jul-67 Aug-21 Sep-21 Sep-21 40,000.00 40,000.00
F64614 F TERM AL Oct-63 Aug-21 Sep-21 Sep-21 50,000.00 50,000.00
F66057 M TERM AL Jul-64 Sep-21 Nov-21 Nov-21 20,000.00 20,000.00
F69904 M TERM AL Oct-65 Oct-21 Nov-21 Nov-21 170,000.00 170,000.00
E29089 M TERM BL Sep-70 Jan-17 Mar-17 Mar-17 29,000.00 29,000.00
E29718 M TERM BL Feb-60 Jan-17 Feb-17 Mar-17 65,000.00 65,000.00
E30600 M TERM BL Jul-62 Feb-17 Jun-17 Dec-17 48,000.00 48,000.00
E31496 M TERM BL Sep-72 Feb-17 Mar-17 Mar-17 25,335.64 25,335.64
E33805 M TERM BL Apr-58 Feb-17 Mar-17 Mar-17 49,000.00 49,000.00
E39107 M TERM BL Sep-50 May-17 Jun-17 Jun-17 39,650.00 39,650.00
E40715 F TERM BL Apr-66 Jun-17 Jun-17 Jul-17 39,000.00 39,000.00
E40899 M TERM BL Jun-78 May-17 Jul-17 Jul-17 33,000.00 33,000.00
E41222 M TERM BL Feb-55 Jun-17 Jul-17 Aug-17 33,000.00 33,000.00
E43528 F TERM BL Sep-64 Jul-17 Aug-17 Aug-17 32,000.00 32,000.00
E46312 M TERM BL Nov-62 Jun-17 Mar-18 Mar-18 42,000.00 42,000.00
E46363 M TERM BL Feb-72 Aug-17 Sep-17 Jun-18 70,000.00 70,000.00
E51013 M TERM BL Oct-69 Nov-17 Nov-17 Nov-17 38,000.00 38,000.00
E51217 M TERM BL Jun-86 Oct-17 Nov-17 Mar-18 42,000.00 42,000.00
E51774 M TERM BL Dec-62 May-17 Nov-17 Nov-17 6,655.61 6,655.61
E52908 F TERM BL Jul-54 Nov-17 Dec-17 Jan-18 41,000.00 41,000.00
E54142 M TERM BL Feb-70 Dec-17 Jan-18 Aug-18 45,000.00 45,000.00
E59770 F TERM BL Jan-78 Oct-17 Mar-18 Apr-18 31,000.00 31,000.00
E64995 M TERM BL Nov-77 Apr-18 May-18 Jun-18 55,000.00 55,000.00
E65990 M TERM BL Feb-86 May-18 May-18 Jun-18 42,000.00 42,000.00
E69288 M TERM BL Apr-57 Jun-18 Jun-18 Jun-18 93,000.00 93,000.00
E70020 F TERM BL Aug-58 Jun-18 Jul-18 Jul-18 32,000.00 32,000.00
E73017 M TERM BL Oct-57 Aug-18 Aug-18 Aug-18 43,000.00 43,000.00
E74096 M TERM BL Aug-58 Aug-18 Feb-19 Feb-19 52,000.00 52,000.00
E77917 M TERM BL Aug-63 Oct-18 Oct-18 Nov-18 37,000.00 37,000.00
E79335 M TERM BL Dec-54 Oct-18 Nov-18 Jan-19 36,000.00 36,000.00
E83858 M TERM BL Jan-63 Jan-19 Jan-19 Feb-19 57,000.00 57,000.00
E86795 M TERM BL Jul-54 Feb-19 Feb-19 Feb-19 51,000.00 51,000.00
E88063 M TERM BL Oct-66 Feb-19 Mar-19 Mar-19 40,000.00 40,000.00
E88359 M TERM BL Jul-60 Feb-19 Mar-19 Mar-19 45,000.00 45,000.00
F01766 F TERM BL Jun-60 Jul-19 Aug-19 Aug-19 81,000.00 81,000.00
F05519 M TERM BL Nov-54 Sep-19 Oct-19 Oct-19 30,000.00 30,000.00
F08228 F TERM BL Sep-47 Nov-19 Nov-19 Feb-20 20,500.00 20,500.00
F14955 F TERM BL Dec-59 Jan-20 Feb-20 Feb-20 43,000.00 43,000.00
F20658 F TERM BL Jan-76 Apr-20 Apr-20 Apr-20 40,000.00 40,000.00
F21449 F TERM BL Mar-63 Apr-20 Apr-20 Nov-20 55,000.00 55,000.00
F22085 F TERM BL Jan-65 Apr-20 May-20 Apr-21 38,000.00 38,000.00
F23789 M TERM BL Apr-56 May-20 May-20 Jun-20 83,000.00 83,000.00
F24580 F TERM BL Oct-67 May-20 Jun-20 Jun-20 38,000.00 38,000.00
F30568 M TERM BL May-62 Aug-20 Sep-20 Jan-21 37,000.00 37,000.00
F31457 F TERM BL Jul-76 Aug-20 Sep-20 Sep-20 109,000.00 109,000.00
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
F42855 M TERM BL Sep-69 Dec-20 Jan-21 Jul-21 46,000.00 46,000.00
F48072 M TERM BL Oct-63 Feb-21 Mar-21 Mar-21 20,000.00 20,000.00
F48471 M TERM BL Apr-61 Feb-21 Mar-21 Mar-21 78,000.00 78,000.00
F51846 F TERM BL Nov-75 Mar-21 Apr-21 Apr-21 39,000.00 39,000.00
F54320 M TERM BL Jul-90 Apr-21 Jun-21 Sep-21 49,000.00 49,000.00
F54333 M TERM BL Jan-88 Apr-21 May-21 May-21 44,000.00 44,000.00
F54690 M TERM BL Dec-74 May-21 Jun-21 Jun-21 70,000.00 70,000.00
F57320 M TERM BL Sep-88 May-21 Jul-21 Aug-21 48,000.00 48,000.00
F58959 M TERM BL Sep-78 Jun-21 Jul-21 Aug-21 58,000.00 58,000.00
F60794 F TERM BL Dec-80 Jul-21 Aug-21 54,000.00
F62086 M TERM BL Aug-68 Aug-21 Aug-21 Aug-21 48,000.00 48,000.00
F62091 M TERM BL Oct-66 Aug-21 Aug-21 Aug-21 57,000.00 57,000.00
F62944 M TERM BL Feb-71 Aug-21 Sep-21 Sep-21 59,000.00 59,000.00
F63315 F TERM BL Apr-67 Aug-21 Sep-21 Sep-21 83,000.00 83,000.00
F63687 M TERM BL Mar-66 Aug-21 Sep-21 Sep-21 62,000.00 62,000.00
F64614 F TERM BL Oct-63 Aug-21 Sep-21 Sep-21 50,000.00 50,000.00
F66057 M TERM BL Jul-64 Sep-21 Nov-21 Nov-21 50,000.00 50,000.00
F69904 M TERM BL Oct-65 Oct-21 Nov-21 Nov-21 71,000.00 71,000.00
D89561 F TPD2 Aug-57 Nov-14 Jun-15 44,000.00 28,600.00 28,600.00
A86849 M TPD2 AL May-52 Feb-02 Aug-03 May-17 19,500.00
B31818 M TPD2 AL Jun-53 May-05 Sep-06 Jun-18 32,500.00
B99689 F TPD2 AL Nov-61 Sep-07 Jul-08 Nov-21 26,000.00
C17124 F TPD2 AL Jun-53 May-08 Feb-09 Jun-18 19,500.00
C22052 F TPD2 AL May-54 Feb-09 Apr-09 Jun-19 39,000.00
C29454 F TPD2 AL Jul-55 Mar-08 Sep-09 Jul-20 13,000.00
C42328 M TPD2 AL Dec-54 Jun-09 Jan-10 Nov-18
C73118 F TPD2 AL Oct-56 Jul-10 Mar-11 Nov-17 32,500.00
D24617 M TPD2 AL Jul-62 Apr-12 Dec-12 Feb-17 84,500.00
E22793 M TPD2 AL Apr-56 Oct-15 Jun-17 May-21
E45454 M TPD2 AL Jan-65 Jan-17 Jun-18 Mar-20
E59270 M TPD2 AL Jan-75 Jan-18 Apr-18 60,000.00 39,000.00
E70839 F TPD2 AL Aug-81 Dec-17 Oct-18 Jan-20
F02097 F TPD2 AL Nov-56 Feb-19 Dec-19 Feb-20
F13937 M TPD2 AL Nov-62 Aug-19 May-20 Aug-21
F16337 F TPD2 AL Feb-71 Oct-19 Apr-20 Oct-20
F20432 F TPD2 AL Apr-76 Oct-19 Aug-20 90,000.00 58,500.00
F25379 M TPD2 AL Sep-68 Dec-19 Oct-20 170,000.00 110,500.00
F27075 F TPD2 AL Aug-70 Feb-20 Sep-20 110,000.00 71,500.00
F30619 F TPD2 AL Aug-65 Apr-20 Oct-20 200,000.00 130,000.00
F40434 M TPD2 AL Sep-74 May-20 Mar-21 110,000.00 71,500.00
F42633 M TPD2 AL Nov-58 Sep-20 Feb-21 Sep-21
F53596 M TPD2 AL Jul-54 Oct-20 Jul-21 Nov-21
F58571 M TPD2 AL Jul-73 Aug-20 Aug-21 40,000.00 26,000.00
F62172 F TPD2 AL Dec-62 Mar-21 Sep-21 70,000.00 45,500.00
A86849 M TPD2 BL May-52 Feb-02 Aug-03 May-17 15,600.00
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
B24966 F TPD2 BL May-70 Nov-04 May-05 24,000.00 15,600.00 15,600.00
B31818 M TPD2 BL Jun-53 May-05 Sep-06 Jun-18 24,700.00
B44347 M TPD2 BL Mar-50 Feb-06 Sep-06 Apr-20 21,547.50
B80424 M TPD2 BL Sep-74 Dec-06 Apr-08 Dec-21 23,400.00
B99689 F TPD2 BL Nov-61 Sep-07 Jul-08 Nov-21 14,300.00
C17124 F TPD2 BL Jun-53 May-08 Feb-09 Jun-18 20,150.00
C29454 F TPD2 BL Jul-55 Mar-08 Sep-09 Jul-20 30,550.00
C35382 F TPD2 BL Aug-55 Mar-09 Oct-09 Sep-20 17,550.00
C35440 F TPD2 BL Mar-55 Apr-09 Apr-10 Mar-20 27,300.00
C42328 M TPD2 BL Dec-54 Jun-09 Jan-10 Nov-18
C71830 M TPD2 BL Nov-57 Jun-10 Feb-11 Dec-19 27,300.00
C73118 F TPD2 BL Oct-56 Jul-10 Mar-11 Nov-17 28,600.00
D22909 F TPD2 BL Jul-53 Jun-12 Nov-12 Jul-18 20,150.00
D24617 M TPD2 BL Jul-62 Apr-12 Dec-12 Feb-17 31,200.00
D27176 M TPD2 BL Jul-54 May-12 Jan-13 Feb-19 33,150.00
D54981 M TPD2 BL Oct-52 Aug-13 Jan-14 Oct-17 18,200.00
D59209 M TPD2 BL Feb-57 Nov-13 Jun-14 Aug-17 27,300.00
D66778 F TPD2 BL Sep-57 Jan-14 Jul-14 52,000.00 33,800.00 33,800.00
D76638 M TPD2 BL Mar-68 Jun-14 Jan-17 9,750.00
D78929 M TPD2 BL May-67 Jul-14 Jan-15 Mar-21 20,150.00
D81863 M TPD2 BL Jul-58 Jul-14 Sep-16 37,000.00 24,050.00 24,050.00
D84066 M TPD2 BL Jun-55 Aug-14 Jan-17 19,875.00
D87210 M TPD2 BL Jan-59 Aug-14 Jun-15 49,000.00 31,850.00 31,850.00
D90268 M TPD2 BL Oct-65 Feb-15 Jul-15 Apr-20 39,000.00
D93653 M TPD2 BL Oct-72 Nov-14 Jul-16 Oct-20 29,900.00
E17094 F TPD2 BL May-59 Mar-16 Oct-16 Mar-19 20,800.00
E20117 M TPD2 BL Feb-57 Dec-15 Nov-16 38,000.00 24,700.00 24,700.00
E21022 M TPD2 BL Nov-66 Feb-16 Nov-16 Jul-18 29,900.00
E21144 M TPD2 BL Nov-62 May-16 May-17 Sep-17 15,750.00
E22100 M TPD2 BL Feb-75 Apr-16 Apr-17 13,125.00
E22793 M TPD2 BL Apr-56 Oct-15 Jun-17 May-21 13,500.00
E45454 M TPD2 BL Jan-65 Jan-17 Jun-18 Mar-20
E46662 F TPD2 BL Nov-80 Dec-16 Dec-17
E48454 M TPD2 BL Apr-76 Apr-17 Mar-19 Jun-20
E53178 F TPD2 BL May-71 Feb-17 Mar-18
E54249 F TPD2 BL Aug-62 May-17 Mar-18
E59270 M TPD2 BL Jan-75 Jan-18 Apr-18 57,000.00 37,050.00
E62632 F TPD2 BL May-67 Nov-17 Oct-18 Apr-19
E76111 F TPD2 BL Jun-55 Jan-18 Dec-18
E83458 F TPD2 BL Jun-59 Aug-18 May-19
E84329 F TPD2 BL Aug-59 Jul-18 Apr-19
E99521 M TPD2 BL Dec-63 Nov-16 Jul-19 53,000.00 34,450.00
F02097 F TPD2 BL Nov-56 Feb-19 Dec-19 Feb-20
F13937 M TPD2 BL Nov-62 Aug-19 May-20 Aug-21
F16337 F TPD2 BL Feb-71 Oct-19 Apr-20 Oct-20
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
F17908 M TPD2 BL Feb-62 Jun-19 Jun-20 Oct-20
F20432 F TPD2 BL Apr-76 Oct-19 Aug-20 33,000.00 21,450.00
F23901 M TPD2 BL Oct-73 Dec-19 Jul-20 Oct-21
F24622 F TPD2 BL Mar-62 Jan-20 Aug-20 48,000.00 31,200.00
F25270 F TPD2 BL Jun-51 Nov-19 Sep-20 Jan-21
F25379 M TPD2 BL Sep-68 Dec-19 Oct-20 44,000.00 28,600.00
F27075 F TPD2 BL Aug-70 Feb-20 Sep-20 55,000.00 35,750.00
F29340 F TPD2 BL Mar-56 Mar-20 Dec-20 Feb-21
F30619 F TPD2 BL Aug-65 Apr-20 Oct-20 87,000.00 56,550.00
F40434 M TPD2 BL Sep-74 May-20 Mar-21 46,000.00 29,900.00
F42633 M TPD2 BL Nov-58 Sep-20 Feb-21 Sep-21
F43109 F TPD2 BL May-65 Aug-20 Mar-21 49,000.00 31,850.00
F51693 F TPD2 BL Dec-84 Nov-20 Aug-21 32,000.00 20,800.00
F53596 M TPD2 BL Jul-54 Oct-20 Jul-21 Nov-21
F58571 M TPD2 BL Jul-73 Aug-20 Aug-21 73,000.00 47,450.00
F62172 F TPD2 BL Dec-62 Mar-21 Sep-21 47,000.00 30,550.00
E28984 M DEP XCL Mar-97 Jan-17 Feb-17 Feb-17 10,000.00 10,000.00
E79877 M DEP XCL Jul-18 Oct-18 Nov-18 Nov-18 10,000.00 10,000.00
E81727 M DEP XCL Dec-92 Dec-18 Feb-19 Feb-19 10,000.00 10,000.00
E83261 M DEP XCL Oct-99 Jan-19 Jan-19 Jan-19 10,000.00 10,000.00
F18411 F DEP XCL Dec-97 Mar-20 Mar-20 Mar-20 10,000.00 10,000.00
F23609 M DEP XCL Jun-97 May-20 May-20 May-20 10,000.00 10,000.00
F47879 M DEP XCL Dec-18 Sep-20 Mar-21 Mar-21 10,000.00 10,000.00
F56587 M DEP XSL May-56 May-21 Jun-21 Jun-21 47,000.00 47,000.00
F59498 F DEP XCL Oct-09 Jul-21 Jul-21 Jul-21 5,000.00 5,000.00
F62078 F DEP XCL Feb-08 Aug-21 Oct-21 Oct-21 10,000.00 10,000.00
F62081 F DEP XCL Apr-98 Aug-21 Sep-21 Sep-21 10,000.00 10,000.00
E29842 F DEP XSL Mar-60 Jan-17 Feb-17 Feb-17 10,000.00 10,000.00
E33790 F DEP XSL Aug-66 Mar-17 Mar-17 Mar-17 40,000.00 40,000.00
E39259 M DEP XSL Oct-62 May-17 Jun-17 Jun-17 20,000.00 20,000.00
E41348 M DEP XSL Nov-58 Jun-17 Jul-17 Jul-17 50,000.00 50,000.00
E43530 M DEP XSL Feb-55 Jun-17 Aug-17 Aug-17 40,000.00 40,000.00
E44580 M DEP XSL Oct-49 Jul-17 Aug-17 Aug-17 13,000.00 13,000.00
E45017 M DEP XSL Jun-58 Aug-17 Sep-17 Sep-17 20,000.00 20,000.00
E54244 F DEP XSL May-77 Nov-17 Jan-18 Feb-18 50,000.00 50,000.00
E63504 F DEP XSL Apr-65 Mar-18 May-18 May-18 50,000.00 50,000.00
E63988 M DEP XSL Jun-60 Apr-18 May-18 May-18 10,000.00 10,000.00
E64997 M DEP XSL Nov-77 Apr-18 May-18 May-18 50,000.00 50,000.00
E69890 F DEP XSL Jun-48 Jun-18 Jul-18 Jul-18 20,000.00 20,000.00
E71275 M DEP XSL Oct-64 Jul-18 Jul-18 Jul-18 50,000.00 50,000.00
E73016 F DEP XSL Sep-56 Aug-18 Aug-18 Aug-18 50,000.00 50,000.00
E77911 M DEP XSL Apr-47 Oct-18 Oct-18 Dec-18 10,000.00 10,000.00
E86758 F DEP XSL Jun-50 Jan-19 Feb-19 Feb-19 6,500.00 6,500.00
E87885 M DEP XSL Sep-47 Feb-19 Mar-19 Mar-19 25,000.00 25,000.00
E92994 F DEP XSL Dec-74 Mar-19 Apr-19 Apr-19 50,000.00 50,000.00
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
E93561 M DEP XSL May-52 Apr-19 May-19 May-19 30,000.00 30,000.00
E98584 M DEP XSL Aug-59 Jun-19 Jul-19 Jul-19 10,000.00 10,000.00
E98756 F DEP XSL Dec-47 Jun-19 Jul-19 Jul-19 5,000.00 5,000.00
F19273 M DEP XSL Aug-49 Feb-20 Mar-20 Mar-20 10,000.00 10,000.00
F21264 F DEP XSL Mar-52 Apr-20 Apr-20 Apr-20 32,500.00 32,500.00
F30573 F DEP XSL Jul-58 Jul-20 Aug-20 Aug-20 50,000.00 50,000.00
F31893 F DEP XSL Mar-71 Aug-20 Sep-20 Oct-20 50,000.00 50,000.00
F35680 F DEP XSL Oct-44 Aug-20 Oct-20 Oct-20 17,500.00 17,500.00
F39985 M DEP XSL Dec-57 Nov-20 Dec-20 Jun-21 150,000.00 150,000.00
F49746 F DEP XSL Nov-74 Mar-21 Apr-21 Apr-21 50,000.00 50,000.00
F54337 F DEP XSL Jan-79 Apr-21 Jul-21 Jul-21 50,000.00 50,000.00
F59257 M DEP XSL Jul-65 Jun-21 Jul-21 Jul-21 50,000.00 50,000.00
F61227 M DEP XSL May-62 Jul-21 Aug-21 Aug-21 30,000.00 30,000.00
F62088 M DEP XSL Apr-66 Aug-21 Aug-21 50,000.00
F62093 M DEP XSL Apr-79 Aug-21 Aug-21 Aug-21 50,000.00 50,000.00
F64615 M DEP XSL Jan-57 Aug-21 Sep-21 Sep-21 50,000.00 50,000.00
F66632 M DEP XSL Oct-54 Sep-21 Oct-21 Oct-21 50,000.00 50,000.00
F66732 M DEP XSL Oct-62 Sep-21 Oct-21 Oct-21 20,000.00 20,000.00
F68231 F DEP XSL Feb-68 Oct-21 Nov-21 Nov-21 50,000.00 50,000.00
F70854 M DEP XSL Oct-50 Nov-21 Dec-21 Dec-21 25,000.00 25,000.00
E51217 M AD&D AA Jun-86 Oct-17 Mar-18 Mar-18 20,000.00 20,000.00
E65990 M AD&D AA Feb-86 May-18 Jun-18 Jun-18 200,000.00 200,000.00
F21449 F AD&D AA Mar-63 Apr-20 Apr-20 Jul-20
F30568 M AD&D AA May-62 Aug-20 Jan-21
F30568 M AD&D AA May-62 Aug-20 Jan-21 Jan-21 140,000.00 140,000.00
F31457 F AD&D AA Jul-76 Aug-20 Sep-20 Sep-20 400,000.00 400,000.00
D83471 M AD&D BA Jan-51 Feb-15 Nov-16 Nov-18 11,563.91 15,481.34
E51217 M AD&D BA Jun-86 Oct-17 Jan-18 Mar-18 84,000.00 84,000.00
E51217 M AD&D BA Jun-86 Oct-17 Mar-18
E51217 M AD&D BA Jun-86 Oct-17 Mar-18
E65990 M AD&D BA Feb-86 May-18 Jun-18 Jun-18 84,000.00 84,000.00
F30568 M AD&D BA May-62 Aug-20 Jan-21 Jan-21 74,000.00 74,000.00
F31457 F AD&D BA Jul-76 Aug-20 Sep-20 Sep-20 218,000.00 218,000.00
E44986 M TERM AL Dec-62 May-17
F20188 F TERM AL Sep-59 Mar-20 Apr-20 Apr-20 37,000.00 37,000.00
E44986 M TERM BL Dec-62 May-17
E95239 F TERM BL Dec-59 Mar-19 Feb-20
F20188 F TERM BL Sep-59 Mar-20 Apr-20 Apr-20 180,000.00 180,000.00
F43063 F TERM BL Aug-60 Jun-20 Mar-21 Mar-21 36,000.00 36,000.00
F47876 M TERM BL Dec-59 Nov-20 Apr-21
F63810 M TERM BL Jul-67 Aug-21 Sep-21 Sep-21 37,000.00 37,000.00
F64907 F TERM BL Jul-70 Sep-21 Oct-21 Oct-21 34,000.00 34,000.00
A52809 M TPD2 AL Apr-56 Oct-02 Jan-03 May-20 45,500.00
B52329 F TPD2 AL Jan-56 Jun-06 Jul-06 Aug-21 26,000.00
D96895 M TPD2 AL Sep-72 Apr-15 Feb-16 Feb-17 11,375.00
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
E00104 M TPD2 AL Oct-69 May-15 Mar-16 Nov-17 58,500.00
E11515 M TPD2 AL Dec-62 Jan-16 May-16 Aug-17 24,375.00
E91731 F TPD2 AL Aug-61 Oct-18 Sep-19 100,000.00 65,000.00
A52809 M TPD2 BL Apr-56 Oct-02 Jan-03 May-20 53,950.00
B23372 M TPD2 BL Feb-59 Jul-04 May-05 Jan-18 26,000.00
B52329 F TPD2 BL Jan-56 Jun-06 Jul-06 Aug-21 24,050.00
B85254 F TPD2 BL Aug-60 Mar-07 Sep-10 Jan-21 23,400.00
C86011 F TPD2 BL Jul-70 Feb-11 Aug-11 Sep-21 22,100.00
D37668 M TPD2 BL Oct-66 Dec-12 Jun-13 Feb-19 26,000.00
D40390 F TPD2 BL Nov-69 Oct-12 Mar-14 May-19 24,700.00
D46547 M TPD2 BL Feb-61 Jun-13 Oct-13 40,000.00 26,000.00 26,000.00
D55629 M TPD2 BL Sep-70 Aug-13 Jan-14 Jan-17 18,850.00
D88588 M TPD2 BL Jan-68 Jan-15 Jun-15 Feb-17 29,900.00
D93197 F TPD2 BL Sep-64 Mar-15 Aug-15 Jul-17 20,800.00
D93974 F TPD2 BL Jan-78 Oct-14 Jan-16 Feb-18 20,150.00
D95647 F TPD2 BL Feb-63 Mar-15 Sep-15 Aug-19 27,300.00
D96875 M TPD2 BL Aug-57 Mar-15 Oct-15 50,000.00 32,500.00 32,500.00
D96895 M TPD2 BL Sep-72 Apr-15 Oct-15 Feb-17 7,312.50
E00104 M TPD2 BL Oct-69 May-15 Nov-15 Nov-17 24,700.00
E01601 M TPD2 BL Feb-73 Jun-15 Jun-17 12,000.00
E02934 F TPD2 BL Jun-67 Jun-15 Jan-16 Jan-18 23,400.00
E11515 M TPD2 BL Dec-62 Jan-16 May-16 Aug-17 5,200.00
E13444 F TPD2 BL Sep-73 Dec-15 Aug-16 Jan-20 26,000.00
E17282 F TPD2 BL Jan-69 Mar-16 Oct-16 32,000.00 20,800.00 20,800.00
E19191 F TPD2 BL Jun-60 Sep-13 Oct-16 Jul-17 19,500.00
E42432 M TPD2 BL Jun-49 Sep-16 Aug-18 Aug-18
E53048 M TPD2 BL Jun-77 Sep-17 Jul-18 Oct-19
E60939 M TPD2 BL Sep-61 Sep-17 Jun-18
E63437 F TPD2 BL Jan-61 Jun-17 Jul-18
E63717 F TPD2 BL Jul-57 Nov-17 Jul-18
E66186 M TPD2 BL Jul-82 Aug-16 Aug-18
E68855 F TPD2 BL Apr-61 Dec-17 Jan-19 Jan-19
E70839 F TPD2 BL Aug-81 Dec-17 Oct-18 Jan-20
E71907 F TPD2 BL Mar-52 Feb-18 Nov-18
E74760 F TPD2 BL Dec-62 May-18 May-19 84,000.00 54,600.00
E77808 F TPD2 BL Oct-67 Apr-18 Apr-19
E91731 F TPD2 BL Aug-61 Oct-18 Sep-19 35,000.00 22,750.00
E95238 F TPD2 BL Dec-59 Mar-19 Feb-20
E77220 M DEP XSL Nov-57 Sep-18 Oct-18 Oct-18 40,000.00 40,000.00
F47876 M DEP XSL Dec-59 Nov-20 Apr-21 May-21 50,000.00 50,000.00
F47876 M AD&D BA Dec-59 Nov-20 Apr-21
F47876 M AD&D XSA Dec-59 Nov-20 May-21
E42224 M TERM AL Jul-56 Jul-17 Aug-17 Sep-17 130,000.00 130,000.00
E98188 F TERM AL Dec-61 Jun-19 Jul-19 Aug-19 80,000.00 80,000.00
F63172 F TERM AL Jun-90 Aug-21 Sep-21 Sep-21 20,000.00 20,000.00
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
E42224 M TERM BL Jul-56 Jul-17 Aug-17 Sep-17 38,000.00 38,000.00
E98188 F TERM BL Dec-61 Jun-19 Jul-19 Aug-19 50,000.00 50,000.00
F46218 F TERM BL Mar-68 Feb-21 Feb-21 Feb-21 41,000.00 41,000.00
F63172 F TERM BL Jun-90 Aug-21 Sep-21 Sep-21 32,000.00 32,000.00
E99758 F TPD2 AL Feb-67 Feb-19 Oct-19 40,000.00 26,000.00
E71760 F TPD2 BL Aug-60 Jul-17 Jan-19
E81378 M TPD2 BL Dec-63 Nov-16 Mar-19
E99758 F TPD2 BL Feb-67 Feb-19 Oct-19 43,000.00 27,950.00
E92218 F DEP XCL Jan-96 Apr-19 Apr-19 Apr-19 10,000.00 10,000.00
E53386 M DEP XSL Aug-51 Dec-17 Jan-18 Jan-18 26,000.00 26,000.00
E75990 M DEP XSL Dec-46 Sep-18 Sep-18 Sep-18 5,000.00 5,000.00
E99517 F DEP XSL Nov-50 Jul-19 Jul-19 Jul-19 32,500.00 32,500.00
F49406 M DEP XSL Feb-77 Mar-21 Mar-21 Mar-21 50,000.00 50,000.00
F54208 M DEP XSL Apr-59 Apr-21 May-21 Jun-21 50,000.00 50,000.00
B76176 M TPD2 AL Jan-56 Jan-07 Aug-07 Feb-21 32,500.00
B76176 M TPD2 BL Jan-56 Jan-07 Aug-07 Feb-21 31,200.00
E44584 M DEP XSL Jul-64 Jul-17 Sep-17 Sep-17 30,000.00 30,000.00
F10843 M DEP XSL Apr-52 Nov-19 Dec-19 Dec-19 32,500.00 32,500.00
F07121 M DEP XCL Nov-95 Oct-19 Nov-19 Nov-19 10,000.00 10,000.00
E81414 F TERM AL Dec-56 Nov-18 Dec-18 Dec-18 50,000.00 50,000.00
E81414 F TERM BL Dec-56 Nov-18 Dec-18 Dec-18 87,000.00 87,000.00
F03819 F TERM BL Apr-76 Aug-19 Sep-19 Feb-20 30,000.00 30,000.00
F59463 F TPD2 AL Jul-78 Jan-21 Oct-21 40,000.00 26,000.00
F59463 F TPD2 BL Jul-78 Jan-21 Oct-21 36,000.00 23,400.00
F28301 M DEP XSL Dec-65 Jul-20 Aug-20
F63812 M DEP XSL Dec-65 Aug-21 Sep-21 Sep-21 20,000.00 20,000.00
F03819 F AD&D BA Apr-76 Aug-19 Sep-19 Feb-20 60,000.00 60,000.00
F03819 F AD&D BA Apr-76 Aug-19 Sep-19 Feb-20 20,000.00 20,000.00
A78525 F TPD2 AL Sep-54 Jan-03 Mar-03 Sep-19 45,500.00
D20527 F TPD2 AL Sep-59 Apr-12 Dec-12 Apr-20 117,000.00
A78525 F TPD2 BL Sep-54 Jan-03 Mar-03 Sep-19 24,700.00
C22052 F TPD2 BL May-54 Feb-09 Apr-09 Jun-19 37,700.00
D09219 M TPD2 BL Apr-59 Nov-11 Jun-12 35,000.00 22,750.00 22,750.00
D09846 M TPD2 BL Jan-62 Nov-10 Oct-12 86,000.00 55,900.00 55,900.00
D20527 F TPD2 BL Sep-59 Apr-12 Oct-12 Apr-20 24,050.00
D92626 F TPD2 BL Oct-61 Jan-15 Feb-17 23,250.00
E24486 M TPD2 BL Oct-71 Apr-16 Jul-17 Oct-18
E24859 M TPD2 BL Nov-83 Jun-16 Jun-17 14,625.00
E27534 F TPD2 BL Jul-60 Nov-15 Jun-17
E28009 F TPD2 BL Dec-56 Jul-16 May-17
E28134 M TPD2 BL Jan-55 Mar-16 May-17
E42350 F TPD2 BL Feb-58 Mar-17 Nov-17
E43335 F TPD2 BL Nov-71 Nov-16 Nov-17
E43551 M TPD2 BL Jun-61 Feb-17 Jun-18
E65404 M TPD2 BL Dec-55 Aug-17 Aug-18
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
E83147 F TPD2 BL Nov-87 Jul-18 Apr-19
E85944 F TPD2 BL Dec-54 Aug-18 May-19
E85944 F TPD2 BL Dec-54 Aug-18 May-19 Dec-19
E86738 F TPD2 BL Nov-55 Aug-18 May-19
A88036 M TPD2 AL Nov-51 Oct-02 Sep-03 Feb-17 45,500.00
A99535 M TPD2 AL Dec-56 Sep-03 Mar-04 Dec-21 65,000.00
A88036 M TPD2 BL Nov-51 Oct-02 Sep-03 Feb-17 25,350.00
A99535 M TPD2 BL Dec-56 Sep-03 Mar-04 Dec-21 38,350.00
A47641 F TPD2 BL Oct-58 Aug-02 Sep-02 22,000.00 14,300.00 14,300.00
B22370 F TPD2 BL Feb-61 Jul-04 Apr-05 43,000.00 27,950.00 27,950.00
B31260 F TPD2 BL Sep-72 Jan-05 Jan-06 27,000.00 17,550.00 17,550.00
B40174 F TPD2 BL May-69 Nov-05 Jan-06 38,000.00 24,700.00 24,700.00
B42359 M TPD2 BL Feb-55 Dec-05 Dec-06 Jun-17 21,450.00
B51110 M TPD2 BL Jul-59 May-06 Oct-06 50,000.00 32,500.00 32,500.00
B53708 F TPD2 BL Dec-57 Jun-05 Sep-06 48,000.00 31,200.00 31,200.00
B68948 F TPD2 BL Jan-61 Jun-06 Apr-07 27,000.00 17,550.00 17,550.00
C15808 F TPD2 BL Aug-56 Jun-08 Jan-09 31,000.00 20,150.00 20,150.00
C45953 F TPD2 BL Apr-61 Sep-09 Aug-10 42,000.00 27,300.00 27,300.00
C80054 F TPD2 BL Apr-60 Dec-08 May-11 64,000.00 41,600.00 41,600.00
D04126 F TPD2 BL Feb-65 Aug-10 Mar-12 32,000.00 20,800.00 20,800.00
D13965 M TPD2 BL Mar-72 Nov-11 Jul-12 27,000.00 17,550.00 17,550.00
HA8598 F STD Jan-74 Sep-20 Oct-20 Mar-21 10,425.60 10,425.60
ET0657 F STD Feb-54 Jun-16 Aug-16 Dec-16 455.76 10,938.24
ET1199 F STD Dec-56 Jul-16 Aug-16 Jan-17 1,111.08 8,484.48
EW1823 M STD Oct-65 Oct-16 Nov-16 Feb-17 4,060.76 5,995.32
EW2158 F STD Jan-61 Sep-16 Nov-16 Mar-17 5,796.70 9,203.04
EW6213 F STD Mar-65 Oct-16 Dec-16 Jan-17 1,888.02 5,810.35
EW9660 M STD Apr-83 Nov-16 Dec-16 Feb-17 2,872.76 4,546.81
EX1516 F STD Apr-68 Oct-16 Dec-16 Jan-17 1,280.04 3,840.08
EX1517 M STD Oct-50 Oct-16 Dec-16 Jan-17 1,409.17 2,764.66
EX8633 M STD Sep-59 Dec-16 Jan-17 Feb-17 3,338.58 3,338.58
EX8916 F STD Sep-86 Mar-17 Apr-17 May-17 500.36 500.36
EX9538 F STD Apr-50 Dec-16 Jan-17 Feb-17 5,336.93 5,336.93
EX9564 F STD Aug-52 Nov-16 Jan-17 Dec-16 310.29 310.29
EX9569 F STD Nov-71 Nov-16 Dec-16 May-17 9,679.60 10,828.80
EX9588 F STD Oct-65 Dec-16 Feb-17 Jan-17 1,819.05 1,819.05
EY2600 F STD Jan-63 Dec-16 Jan-17 Feb-17 3,880.64 3,880.64
EY3583 M STD Mar-57 Nov-16 Feb-17 Mar-17 1,543.89 1,543.89
EY4073 F STD Mar-83 Jan-17 Jan-17 Feb-17 2,063.40 2,063.40
EY6829 M STD Dec-53 Jan-17 Feb-17 Feb-17 4,738.68 4,738.68
EZ2867 M STD Jan-65 Jan-17 Feb-17 Jul-17 9,997.68 9,997.68
EZ6803 F STD Sep-90 Jan-17 Mar-17 Mar-17 1,682.00 1,682.00
EZ8294 F STD May-71 Feb-17 Mar-17 Aug-17 12,875.52 12,875.52
EZ8811 F STD Mar-57 Jan-17 Mar-17 Mar-17 2,769.31 2,769.31
FA4332 F STD Jun-69 Dec-16 Apr-17 Mar-17 315.14 315.14
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
FA6877 M STD Oct-57 Feb-17 Apr-17 Apr-17 976.65 976.65
FA6940 F STD Nov-80 Dec-16 Apr-17 Jun-17 8,473.85 8,473.85
FA7072 F STD Jun-85 Mar-17 Apr-17 May-17 2,369.80 2,369.80
FA9344 F STD Mar-58 Mar-17 Mar-17 May-17 3,577.90 3,577.90
FB0142 M STD Dec-53 Mar-17 Apr-17 May-17 3,232.06 3,232.06
FB0430 F STD Feb-63 Apr-17 May-17 May-17 1,243.22 1,243.22
FB1633 F STD Apr-66 Mar-17 Apr-17 Jun-17 3,423.61 3,423.61
FB2924 F STD Feb-58 Mar-17 Apr-17 Sep-17 11,341.44 11,341.44
FB3832 F STD Oct-78 Feb-17 Jun-17 Apr-17 1,568.20 1,568.20
FB4146 F STD Oct-67 Jan-17 Apr-17 May-17 7,060.10 7,060.10
FB7102 F STD Aug-65 Mar-17 Apr-17 May-17 5,369.76 5,369.76
FB7588 M STD Apr-76 Apr-17 Apr-17 Oct-17 11,700.96 11,700.96
FB8256 F STD Oct-83 May-17 Jun-17 Jun-17 1,231.99 1,231.99
FB9469 F STD Sep-76 Mar-17 May-17 Jul-17 6,146.76 6,146.76
FC7342 F STD Jul-86 May-17 Jun-17 Jun-17 1,622.80 1,622.80
FC7735 F STD Aug-56 Apr-17 Jun-17 Jul-17 1,290.05 1,290.05
FC8318 M STD Apr-57 Dec-16 May-17 Apr-17 353.57 353.57
FD1210 M STD Jan-55 May-17 Jun-17 Jul-17 1,122.36 1,122.36
FD1920 M STD Feb-51 May-17 Jun-17 Jun-17 2,838.92 2,838.92
FD3025 M STD Jun-60 Apr-17 Jul-17 Aug-17 668.17 668.17
FD3077 M STD Jan-59 Jun-17 Jun-17 Jul-17 691.21 691.21
FD4285 F STD Oct-54 Jul-17 Aug-17 Sep-17 1,342.49 1,342.49
FD4563 F STD Nov-83 Jun-17 Jun-17 Jul-17 1,494.12 1,494.12
FD5366 F STD Mar-57 Jun-17 Jul-17 Sep-17 5,429.60 5,429.60
FD6309 F STD Jul-71 May-17 Jul-17 Jun-17 2,180.01 2,180.01
FD6835 F STD Apr-79 May-17 Jun-17 Sep-17 7,138.32 7,138.32
FD8543 M STD Dec-72 Jun-17 Jul-17 Aug-17 2,505.61 2,505.61
FE0557 F STD Mar-69 Jun-17 Jul-17 Sep-17 6,171.01 6,171.01
FE0877 M STD Mar-66 May-17 Jul-17 Aug-17 3,742.70 3,742.70
FE2868 M STD Dec-73 Jun-17 Jul-17 Aug-17 3,521.87 3,521.87
FE3627 M STD Apr-62 Jun-17 Jul-17 Jul-17 1,767.71 1,767.71
FE4535 F STD Sep-70 Jun-17 Jul-17 Aug-17 1,803.60 1,803.60
FE5142 F STD Nov-79 Jul-17 Jul-17 Aug-17 236.07 236.07
FE5428 F STD Aug-72 Apr-17 Jul-17 Aug-17 1,810.28 1,810.28
FE5490 M STD Jul-78 Jul-17 Jul-17 Jul-17 290.06 290.06
FE6364 F STD Jun-68 Jun-17 Jul-17 Jul-17 437.23 437.23
FE6381 F STD Nov-02 Jun-17 Jul-17 Aug-17 2,351.78 2,351.78
FE6405 F STD Oct-57 Jun-17 Jul-17 Aug-17 2,837.26 2,837.26
FE8886 F STD Jan-71 Aug-17 Aug-17 Sep-17 2,781.94 2,781.94
FF0824 F STD Sep-60 Aug-17 Aug-17 Sep-17 1,230.26 1,230.26
FF0853 F STD Jun-69 Jul-17 Sep-17 Oct-17 1,385.49 1,385.49
FF1747 F STD Aug-65 Jul-17 Aug-17 Jan-18 19,177.74 19,177.74
FF2215 F STD Aug-62 May-17 Aug-17 Nov-17 3,041.28 3,041.28
FF2610 F STD Sep-70 Oct-17 Oct-17 Nov-17 1,717.69 1,717.69
FF4976 M STD Jan-76 Jun-17 Aug-17 Oct-17 6,001.24 6,001.24
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
FF5092 F STD May-57 Jun-17 Aug-17 Sep-17 3,394.26 3,394.26
FF7005 M STD Sep-84 Jul-17 Aug-17 Nov-17 6,936.94 6,936.94
FF8483 F STD Oct-84 Aug-17 Aug-17 Nov-17 6,492.58 6,492.58
FF9204 F STD Dec-61 Aug-17 Aug-17 Sep-17 2,223.25 2,223.25
FF9459 F STD Feb-67 Aug-17 Sep-17 Sep-17 71.43 71.43
FF9869 M STD Jan-78 Aug-17 Sep-17 Aug-17 478.24 478.24
FG0837 F STD Mar-67 Aug-17 Sep-17 Oct-17 2,334.36 2,334.36
FG2562 F STD Oct-83 Aug-17 Sep-17 Dec-17 7,790.11 7,790.11
FG2986 F STD Dec-83 Aug-17 Sep-17 Oct-17 96.44 96.44
FG4141 F STD Feb-86 Jul-17 Sep-17 Aug-17 745.47 745.47
FG5298 F STD Feb-70 Aug-17 Sep-17 Sep-17 201.86 201.86
FG8466 M STD Sep-76 Oct-17 Oct-17 Nov-17 1,987.67 1,987.67
FG9952 F STD Dec-81 Aug-17 Sep-17 Oct-17 2,011.70 2,011.70
FG9956 F STD Aug-78 Aug-17 Oct-17 Oct-17 1,273.70 1,273.70
FH2255 F STD Jan-87 Oct-17 Oct-17 Nov-17 1,522.56 1,522.56
FH3245 F STD Sep-69 Oct-17 Oct-17 Dec-17 4,906.60 4,906.60
FH4283 M STD Mar-57 Aug-17 Oct-17 Oct-17 3,998.98 3,998.98
FH5813 F STD Aug-60 Aug-17 Nov-17 Jan-18 15,813.49 15,813.49
FH6051 F STD Nov-02 Aug-17 Nov-17 Nov-17 1,080.88 1,080.88
FH8424 F STD Dec-61 Oct-17 Nov-17 Nov-17 2,002.56 2,002.56
FJ0943 F STD Sep-76 Sep-17 Dec-17 Oct-17 1,219.13 1,219.13
FJ2055 F STD Jul-86 Sep-17 Oct-17 Dec-17 3,652.87 3,652.87
FJ5564 F STD May-68 Oct-17 Nov-17 Nov-17 3,132.87 3,132.87
FJ9069 F STD Aug-77 Nov-17 Dec-17 Jan-18 763.36 763.36
FJ9087 F STD Apr-79 Oct-17 Nov-17 Dec-17 1,782.47 1,782.47
FJ9123 F STD Jul-54 Oct-17 Nov-17 Nov-17 1,367.98 1,367.98
FK0639 F STD Mar-73 Nov-17 Jan-18 Jan-18 2,544.18 2,544.18
FK0896 F STD Sep-86 Dec-17 Dec-17 Jan-18 1,603.32 1,603.32
FK1601 F STD Mar-61 Oct-17 Dec-17 Jan-18 5,468.12 5,468.12
FK2357 F STD Aug-52 Dec-17 Jan-18 Feb-18 2,132.22 2,132.22
FK3378 M STD Jul-79 Nov-17 Nov-17 Dec-17 1,923.06 1,923.06
FK4370 F STD Sep-57 Sep-17 Dec-17 Dec-17 5,927.47 5,927.47
FK4857 F STD Jun-83 Dec-17 Dec-17 Feb-18 1,255.48 1,255.48
FK4939 F STD Nov-86 Dec-17 Dec-17 Jan-18 2,638.38 2,638.38
FK5933 F STD Nov-80 Dec-17 Dec-17 Jan-18 1,594.29 1,594.29
FK7655 F STD Jan-69 Sep-17 Dec-17 Nov-17 2,220.11 2,220.11
FK8590 F STD Aug-49 Nov-17 Dec-17 Jan-18 121.43 121.43
FK8619 M STD Jun-56 Nov-17 Dec-17 Feb-18 4,988.21 4,988.21
FK8625 F STD Aug-89 Oct-17 Dec-17 Feb-18 6,698.08 6,698.08
FK8643 F STD May-67 Nov-17 Jan-18 May-18 13,192.44 13,192.44
FL0256 F STD Sep-60 Nov-17 Dec-17 Feb-18 4,931.12 4,931.12
FL1850 F STD Aug-80 Dec-17 Jan-18 Jan-18 2,131.74 2,131.74
FL2812 F STD Nov-83 Dec-17 Jan-18 Jan-18 1,554.29 1,554.29
FL5986 F STD Dec-71 Jan-18 Feb-18 Mar-18 521.7 521.7
FL7700 M STD Apr-76 Nov-17 Jan-18 Feb-18 1,907.63 1,907.63
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
FL8312 F STD Feb-75 Nov-17 Jan-18 Mar-18 4,505.72 4,505.72
FM1813 F STD Jun-59 Jan-18 Feb-18 May-18 20,380.56 20,380.56
FM2612 F STD Feb-65 Feb-18 Feb-18 Mar-18 3,648.81 3,648.81
FM4669 F STD Jun-89 Feb-18 Mar-18 Mar-18 1,895.08 1,895.08
FM4753 M STD Jul-69 Dec-17 Feb-18 Jun-18 10,973.20 10,973.20
FM5209 F STD Oct-73 Nov-17 Jan-18 Mar-18 7,725.74 7,725.74
FM5705 F STD Nov-89 Dec-17 Feb-18 Jan-18 1,846.93 1,846.93
FM5856 F STD Dec-87 Dec-17 Feb-18 Apr-18 5,057.07 5,057.07
FM7434 F STD Dec-54 Jan-18 Feb-18 Mar-18 2,837.33 2,837.33
FM7536 F STD Jul-77 Jun-18 Jun-18 Jul-18 2,242.11 2,242.11
FM7577 M STD Aug-93 Dec-17 Feb-18 Mar-18 3,877.10 3,877.10
FM8512 F STD Jun-86 Feb-18 Feb-18 Apr-18 2,362.98 2,362.98
FM8553 M STD Dec-63 Nov-16 May-18 May-17 1,467.67 1,467.67
FM9500 M STD Jul-56 Feb-18 Mar-18 May-18 6,517.24 6,517.24
FN0182 M STD May-85 Feb-18 Mar-18 Mar-18 82.15 82.15
FN0692 M STD Dec-61 Jan-18 Feb-18 Mar-18 7,827.48 7,827.48
FN1385 F STD Sep-87 Jan-18 Feb-18 Mar-18 2,787.56 2,787.56
FN1445 F STD May-64 Jan-18 Feb-18 Mar-18 3,849.71 3,849.71
FN2797 F STD Apr-57 Feb-18 May-18 Apr-18 2,433.06 2,433.06
FN4830 F STD Jul-53 Feb-18 Mar-18 May-18 3,591.18 3,591.18
FN7088 F STD May-67 Mar-18 Apr-18 May-18 1,602.28 1,602.28
FN7475 F STD Oct-86 Feb-18 Mar-18 Jun-18 4,698.01 4,698.01
FN9865 F STD Aug-63 Feb-18 Mar-18 Mar-18 749.72 749.72
FP1954 F STD Mar-52 Feb-18 Mar-18 Aug-18 11,404.80 11,404.80
FP2512 F STD Oct-67 Mar-18 Apr-18 May-18 4,334.36 4,334.36
FP2679 F STD Jan-72 Mar-18 Apr-18 Apr-18 1,737.14 1,737.14
FP2696 F STD Jun-55 Jan-18 Apr-18 Jul-18 1,632.00 1,632.00
FP3751 F STD Oct-56 Feb-18 Mar-18 Mar-18 395.91 395.91
FP4779 F STD Oct-86 Apr-18 May-18 Jun-18 150 150
FP5725 F STD Jan-72 Feb-18 Apr-18 May-18 3,195.77 3,195.77
FP5984 F STD Aug-61 Feb-18 Apr-18 Apr-18 185.71 185.71
FP6174 F STD Apr-63 Mar-18 Apr-18 May-18 1,319.13 1,319.13
FP8462 F STD Jan-90 May-18 May-18 Jul-18 3,113.46 3,113.46
FP9279 M STD May-64 Mar-18 Apr-18 Jun-18 4,023.76 4,023.76
FP9896 M STD Aug-83 Feb-18 Apr-18 Apr-18 2,246.02 2,246.02
FQ1492 M STD Oct-11 Mar-18 Apr-18 Apr-18 1,280.79 1,280.79
FQ3216 F STD Jun-59 Mar-18 Apr-18 May-18 3,063.53 3,063.53
FQ3980 F STD Feb-84 May-18 May-18 Jun-18 42.86 42.86
FQ4596 M STD May-69 Apr-18 May-18 Apr-18 324.23 324.23
FQ7260 F STD Mar-89 Mar-18 May-18 May-18 96.43 96.43
FQ9323 M STD May-68 Apr-18 May-18 Jun-18 2,511.38 2,511.38
FQ9691 F STD Dec-71 Mar-18 May-18 Jun-18 5,994.26 5,994.26
FQ9774 F STD Aug-69 Mar-18 May-18 May-18 489.52 489.52
FQ9833 F STD Feb-53 Mar-18 May-18 May-18 2,636.40 2,636.40
FR0468 F STD Nov-71 May-18 Jun-18 Jun-18 2,046.76 2,046.76
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
FR5497 M STD Nov-65 Apr-18 May-18 Jul-18 3,460.32 3,460.32
FR7926 F STD Aug-84 Apr-18 May-18 Jun-18 1,989.07 1,989.07
FS0507 F STD Nov-86 Apr-18 Jun-18 May-18 42.86 42.86
FS0517 F STD Apr-69 May-18 Jun-18 Oct-18 11,267.64 11,267.64
FS0543 F STD Oct-67 Apr-18 Jun-18 Oct-18 5,166.72 5,166.72
FS1595 M STD Dec-70 May-18 Jun-18 Jul-18 1,883.50 1,883.50
FS2842 M STD Apr-56 Apr-18 Jun-18 Jul-18 3,495.19 3,495.19
FS3568 F STD Oct-64 Jun-18 Jul-18 Sep-18 7,191.97 7,191.97
FS6577 F STD Mar-89 Jul-18 Jul-18 Aug-18 503.28 503.28
FS7339 M STD Jan-60 Jun-18 Jun-18 Aug-18 1,903.80 1,903.80
FS9458 F STD Mar-93 Jun-18 Jun-18 Aug-18 1,959.55 1,959.55
FT0611 F STD Jan-66 Jun-18 Jun-18 Aug-18 5,941.01 5,941.01
FT0747 F STD Nov-71 Jun-18 Jul-18 Jul-18 443.86 443.86
FT0857 F STD Jun-60 Jun-18 Jul-18 Jul-18 1,138.31 1,138.31
FT0991 F STD Nov-83 Jun-18 Jul-18 Jul-18 342.04 342.04
FT2945 F STD Nov-02 Jun-18 Jul-18 Aug-18 691.61 691.61
FT3186 F STD Jun-85 Jul-18 Jul-18 Sep-18 3,537.73 3,537.73
FT3660 F STD Jan-72 Jun-18 Jul-18 Aug-18 2,167.22 2,167.22
FT4271 F STD Nov-87 Jun-18 Jul-18 Aug-18 4,341.60 4,341.60
FT4758 M STD Jul-58 Jun-18 Jul-18 Jul-18 479.29 479.29
FU0226 F STD Feb-82 Jul-18 Aug-18 Oct-18 4,357.67 4,357.67
FU1718 F STD Nov-94 Aug-18 Aug-18 Oct-18 1,934.75 1,934.75
FU1768 F STD Nov-87 Jul-18 Aug-18 Jan-19 11,755.53 11,755.53
FU3055 F STD Jun-85 Jun-18 Aug-18 Aug-18 4,163.70 4,163.70
FU6641 F STD Dec-53 Jul-18 Aug-18 Aug-18 865.13 865.13
FU6726 F STD Aug-89 Jul-18 Aug-18 Aug-18 1,986.12 1,986.12
FU9083 M STD Nov-02 Jul-18 Aug-18 Aug-18 928.15 928.15
FU9171 F STD Nov-02 Jul-18 Sep-18 Aug-18 392.07 392.07
FU9602 M STD Sep-67 Jun-18 Aug-18 Aug-18 1,200.00 1,200.00
FU9669 M STD Sep-70 Aug-18 Aug-18 Aug-18 88.93 88.93
FV1785 F STD May-61 Jul-18 Sep-18 Oct-18 2,296.96 2,296.96
FV4057 F STD Aug-78 Sep-18 Oct-18 Nov-18 2,451.08 2,451.08
FV5072 M STD Jun-77 Aug-18 Sep-18 Oct-18 1,969.71 1,969.71
FV5129 M STD Jul-58 Jan-17 Oct-18 Feb-17 1,080.48 1,080.48
FV5662 F STD Oct-80 Aug-18 Sep-18 Sep-18 1,076.29 1,076.29
FV6599 F STD May-72 Sep-18 Oct-18 Jan-19 6,270.47 6,270.47
FV8678 F STD Oct-83 Sep-18 Oct-18 Oct-18 1,952.68 1,952.68
FV8986 F STD Aug-76 Aug-18 Oct-18 Nov-18 4,525.16 4,525.16
FV9962 F STD Jan-58 Sep-18 Sep-18 Oct-18 799.9 799.9
FW0356 M STD Jan-58 Aug-18 Oct-18 Oct-18 1,058.37 1,058.37
FW1311 M STD Nov-70 Jun-18 Oct-18 Oct-18 983.87 983.87
FW1958 F STD Mar-86 Aug-18 Oct-18 Oct-18 767.87 767.87
FW2884 F STD Aug-59 Jul-18 Oct-18 Jan-19 10,726.54 10,726.54
FW3202 F STD Nov-55 Aug-18 Oct-18 Feb-19 17,165.79 17,165.79
FW3237 F STD Dec-72 Aug-18 Oct-18 Oct-18 1,852.40 1,852.40
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
FW5168 F STD Sep-60 Oct-18 Nov-18 Dec-18 1,459.16 1,459.16
FW5550 F STD Oct-91 Sep-18 Nov-18 Oct-18 1,896.48 1,896.48
FW8304 F STD Jun-89 Dec-18 Jan-19 Feb-19 96.43 96.43
FW8698 F STD Nov-89 Oct-18 Oct-18 Nov-18 1,960.26 1,960.26
FX3424 F STD Jun-84 Aug-18 Oct-18 Oct-18 4,436.46 4,436.46
FX4980 M STD Dec-56 Sep-18 Nov-18 Oct-18 494.32 494.32
FX5945 F STD May-69 Oct-18 Nov-18 Feb-19 6,409.86 6,409.86
FX6013 F STD Mar-59 Nov-18 Dec-18 Jan-19 71.43 71.43
FX6242 F STD Aug-61 Oct-18 Nov-18 Apr-19 7,391.96 7,391.96
FX6353 M STD Aug-58 Oct-18 Nov-18 Jan-19 82.14 82.14
FX6564 F STD May-78 Jan-19 Feb-19 Mar-19 850.95 850.95
FX6670 F STD May-71 Oct-18 Nov-18 Dec-18 1,925.47 1,925.47
FX8203 F STD Aug-62 Nov-18 Dec-18 Jan-19 1,863.98 1,863.98
FX8457 F STD Jul-75 Nov-18 Dec-18 Jan-19 2,508.38 2,508.38
FX8557 M STD Nov-82 Oct-18 Nov-18 Nov-18 890.8 890.8
FX9736 F STD Aug-59 Nov-18 Dec-18 May-19 18,946.41 18,946.41
FY0377 F STD Jan-68 Oct-18 Nov-18 Feb-19 4,941.35 4,941.35
FY0806 M STD May-66 Oct-18 Nov-18 Nov-18 276.88 276.88
FY0827 F STD Jan-89 Dec-18 Jan-19 Jan-19 1,019.57 1,019.57
FY1238 F STD Jun-54 Nov-18 Nov-18 Dec-18 593.99 593.99
FY1612 F STD Dec-60 Sep-18 Dec-18 Nov-18 1,070.82 1,070.82
FY2637 M STD Mar-63 Oct-18 Nov-18 Jan-19 2,483.28 2,483.28
FY3013 F STD Aug-93 Nov-18 Dec-18 Mar-19 4,957.21 4,957.21
FY4078 M STD Mar-54 Dec-18 Dec-18 Feb-19 3,626.45 3,626.45
FY4558 F STD Oct-64 Jun-18 Nov-18 Jul-18 3,158.73 3,158.73
FY4818 F STD Feb-86 Dec-18 Feb-19 Jan-19 96.43 96.43
FY5058 F STD Aug-84 Nov-18 Dec-18 Feb-19 2,904.29 2,904.29
FY5632 F STD Jun-69 Oct-18 Dec-18 Jan-19 67.91 67.91
FY6144 M STD Mar-68 Nov-18 Dec-18 Mar-19 7,688.16 7,688.16
FY7909 M STD Oct-68 Nov-18 Dec-18 May-19 11,398.00 11,398.00
FZ1342 F STD Dec-54 Aug-18 Jan-19 Feb-19 1,708.04 1,708.04
FZ1817 M STD Apr-87 Jan-19 Feb-19 Mar-19 1,413.63 1,413.63
FZ2583 F STD Mar-69 Dec-18 Jan-19 Feb-19 3,629.74 3,629.74
FZ3701 F STD May-59 Dec-18 Jan-19 Jun-19 8,268.40 8,268.40
FZ3843 M STD Nov-96 Dec-18 Jan-19 Apr-19 5,054.08 5,054.08
FZ4050 F STD Nov-51 Dec-18 Jan-19 Jun-19 21,882.34 21,882.34
FZ4074 F STD Jun-85 Nov-18 Jan-19 Jan-19 937.82 937.82
FZ5351 F STD Oct-82 Feb-19 Feb-19 Mar-19 1,512.96 1,512.96
FZ5365 F STD Jun-80 Feb-19 Feb-19 Mar-19 96.43 96.43
FZ5565 F STD Mar-96 Jan-19 Feb-19 Mar-19 2,041.12 2,041.12
FZ5725 F STD Feb-67 Jan-19 Feb-19 Feb-19 46.44 46.44
FZ6964 M STD Nov-83 Dec-18 Jan-19 Apr-19 6,526.17 6,526.17
FZ7529 F STD Feb-71 Nov-18 Jan-19 Feb-19 4,768.00 4,768.00
FZ7899 F STD Nov-87 Jan-19 Jan-19 Feb-19 2,567.32 2,567.32
FZ9105 F STD Aug-72 Dec-18 Jan-19 Mar-19 4,761.46 4,761.46
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
FZ9459 F STD Feb-89 Mar-19 Apr-19 May-19 3,042.51 3,042.51
GA0976 M STD Mar-57 Dec-18 Jan-19 Apr-19 7,315.11 7,315.11
GA2526 F STD Oct-67 Mar-19 Mar-19 May-19 5,933.48 5,933.48
GA2611 F STD Oct-61 Jan-19 Mar-19 Apr-19 5,264.16 5,264.16
GA2643 F STD Jul-86 May-19 Jun-19 Jun-19 1,764.87 1,764.87
GA2709 F STD Jun-59 Feb-19 Mar-19 Apr-19 8,988.58 8,988.58
GA3235 F STD Apr-59 Jan-19 Jan-19 Feb-19 505.62 505.62
GA3320 F STD Jun-85 Feb-19 Mar-19 Mar-19 501.42 501.42
GA4455 F STD Jun-85 Feb-19 Feb-19 Apr-19 1,618.96 1,618.96
GA5887 F STD Apr-76 Dec-18 Feb-19 Mar-19 1,611.60 1,611.60
GA7035 F STD Jun-81 Dec-18 Feb-19 Jun-19 11,265.28 11,265.28
GA7604 M STD Jun-62 Jan-19 Feb-19 Mar-19 157.14 157.14
GA8019 F STD Aug-90 Jan-19 Feb-19 Mar-19 2,315.95 2,315.95
GA8530 M STD May-97 Jan-19 Feb-19 Mar-19 1,025.73 1,025.73
GA9057 F STD Mar-67 Feb-19 Feb-19 Mar-19 1,199.22 1,199.22
GA9191 F STD May-82 Jan-19 Feb-19 May-19 6,651.09 6,651.09
GB0563 F STD Mar-88 Feb-19 Feb-19 Aug-19 12,844.80 12,844.80
GB2908 F STD May-62 Feb-19 Mar-19 Mar-19 1,713.99 1,713.99
GB3954 F STD Nov-56 Feb-19 Mar-19 Aug-19 12,853.01 12,853.01
GB3985 F STD Jun-96 Feb-19 Mar-19 May-19 6,457.68 6,457.68
GB3993 F STD Jun-84 Mar-19 Mar-19 Apr-19 2,410.78 2,410.78
GB4838 F STD May-61 Jan-19 Mar-19 Mar-19 1,059.05 1,059.05
GB8255 F STD Apr-90 Mar-19 Mar-19 Apr-19 2,685.28 2,685.28
GB8308 F STD Mar-57 Jan-19 Mar-19 Mar-19 1,945.83 1,945.83
GB8599 F STD Jun-90 Feb-19 Mar-19 Apr-19 2,269.73 2,269.73
GB8879 M STD Jan-88 Feb-19 Mar-19 Jun-19 7,512.85 7,512.85
GB9529 F STD Aug-57 Feb-19 Mar-19 Mar-19 212.9 212.9
GC0303 F STD Nov-63 Feb-19 Apr-19 Aug-19 11,744.64 11,744.64
GC0427 M STD May-68 Feb-19 Mar-19 Apr-19 2,697.56 2,697.56
GC0429 F STD Sep-80 Dec-18 Mar-19 Mar-19 1,783.62 1,783.62
GC1007 F STD Mar-75 Feb-19 Mar-19 Mar-19 1,025.33 1,025.33
GC3458 F STD Nov-87 May-19 Jun-19 Jul-19 1,888.67 1,888.67
GC5101 F STD Feb-91 Mar-19 Apr-19 Sep-19 12,095.19 12,095.19
GC5793 M STD Nov-59 Mar-19 Apr-19 Jun-19 4,093.56 4,093.56
GC7082 M STD Apr-62 Mar-19 Apr-19 Apr-19 1,472.18 1,472.18
GC7276 F STD Dec-96 Mar-19 Apr-19 Apr-19 1,415.28 1,415.28
GC7356 M STD Oct-57 Feb-19 May-19 Apr-19 1,054.95 1,054.95
GC8129 F STD Jul-53 Mar-19 Apr-19 Jun-19 3,716.56 3,716.56
GC8461 F STD Feb-69 Apr-19 Apr-19 Oct-19 8,695.96 8,695.96
GC8727 F STD Feb-83 Mar-19 Apr-19 Apr-19 1,481.16 1,481.16
GC8989 F STD Aug-80 Apr-19 Apr-19 May-19 2,007.06 2,007.06
GC9366 F STD Jun-84 Mar-19 Apr-19 Jun-19 4,453.53 4,453.53
GC9539 F STD Mar-69 Apr-19 Apr-19 Jun-19 3,684.55 3,684.55
GD2243 F STD Jun-60 Mar-19 Apr-19 Apr-19 835.36 835.36
GD3136 F STD Sep-88 Apr-19 Apr-19 Jun-19 2,925.86 2,925.86
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY. THESE REPORTS ARE TO BE ACCESSIBLE ONLY TO THOSE COMPANY
PERSONNEL WHO HAVE A LEGITIMATE BUSINESS REASON TO EXAMINE THE INFORMATION. THESE REPORTS MAY NOT BE REDISCLOSED
WITHOUT THE WRITTEN AUTHORIZATION OF STANDARD INSURANCE COMPANY.
Claim Number Gender Coverage Product Birth Date Incurred Date Approved
Date Term Date Pending Benefit
Paid This
Period
Paid This
Claim Ending Reserve
Beginning
Reserve
GD3743 F STD May-57 Mar-19 Apr-19 May-19 2,258.97 2,258.97
GD4358 F STD Mar-90 Apr-19 May-19 Jun-19 2,885.34 2,885.34
GD5312 F STD Jan-74 Mar-19 Apr-19 May-19 2,625.58 2,625.58
GD6557 F STD Jul-81 Jan-19 May-19 Apr-19 4,279.60 4,279.60
GD9133 F STD Nov-71 Apr-19 May-19 Jun-19 2,925.63 2,925.63
GD9362 F STD Jul-64 May-19 Jun-19 Aug-19 3,351.23 3,351.23
GD9809 F STD Oct-84 Apr-19 Apr-19 May-19 302.33 302.33
GE0988 F STD Mar-62 Apr-19 May-19 May-19 21.43 21.43
GE1327 M STD Jul-56 Apr-19 May-19 Jul-19 6,022.53 6,022.53
GE2769 F STD Nov-80 Apr-19 May-19 Jun-19 1,968.52 1,968.52
GE2838 F STD Aug-57 Apr-19 May-19 Aug-19 5,928.45 5,928.45
GE3573 M STD Nov-62 Apr-19 May-19 Aug-19 3,831.11 3,831.11
GE3974 F STD Apr-96 May-19 May-19 Jun-19 1,448.68 1,448.68
GE3976 M STD Dec-89 Apr-19 Jul-19 Jun-19 3,939.70 3,939.70
GE4038 F STD Dec-66 May-19 Jun-19 Jul-19 4,279.56 4,279.56
GE5119 F STD Aug-81 Apr-19 Jun-19 Jul-19 3,812.09 3,812.09
GE7580 M STD Nov-63 Jun-19 Jun-19 Aug-19 2,296.63 2,296.63
GE7978 M STD Jul-71 Apr-19 May-19 May-19 1,946.79 1,946.79
GE8563 F STD Dec-86 May-19 Jun-19 Jul-19 2,469.60 2,469.60
GE9022 F STD Oct-86 May-19 Jun-19 Jun-19 434.1 434.1
GE9991 F STD Dec-63 May-19 Jun-19 Jun-19 2,123.70 2,123.70
GF0161 F STD Apr-57 Apr-19 Jun-19 Jun-19 2,573.89 2,573.89
GF1662 F STD Oct-81 Jul-19 Aug-19 Sep-19 1,832.92 1,832.92
GF1962 M STD Jul-97 Dec-18 Jul-19 Jun-19 5,911.98 5,911.98
GF2417 F STD Jul-81 May-19 Jun-19 Jul-19 96.43 96.43
GF2623 F STD Nov-59 Apr-19 Jun-19 Jun-19 484.1 484.1
GF2700 M STD Jul-89 Jun-19 Jun-19 Sep-19 7,533.27 7,533.27
GF3901 F STD Jan-69 Jun-19 Jul-19 Aug-19 1,382.07 1,382.07
GF4771 M STD Apr-56 Mar-19 Jun-19 Aug-19 5,507.67 5,507.67
GF5176 M STD Oct-89 Jun-19 Jul-19 Aug-19 3,434.41 3,434.41
GF6039 F STD Oct-83 Jun-19 Jun-19 Jul-19 1,859.79 1,859.79
GF6207 M STD Aug-71 May-19 Jun-19 Aug-19 2,943.58 2,943.58
GF7125 F STD Sep-68 May-19 Jul-19 Sep-19 6,456.39 6,456.39
GF7691 F STD Mar-73 Jun-19 Jul-19 Aug-19 2,114.96 2,114.96
GF8187 M STD Aug-85 May-19 Jun-19 Aug-19 4,426.95 4,426.95
GF8476 F STD Aug-59 Sep-19 Sep-19 Jan-20 7,418.21 7,418.21
GF8508 M STD Jan-63 May-19 Jul-19 Oct-19 10,849.63 10,849.63
GF8854 M STD Sep-66 Apr-19 Jul-19 Oct-19 7,906.47 7,906.47
GF9196 M STD Jan-53 Jun-19 Jul-19 Dec-19 13,166.86 13,166.86
GF9357 M STD May-56 Jun-19 Jun-19 Oct-19 6,810.80 6,810.80
GF9741 F STD Oct-84 Jun-19 Jun-19 Jul-19 598.63 598.63
GF9866 F STD Aug-62 Aug-19 Sep-19 Feb-20 13,242.86 13,242.86
GF9917 M STD Dec-55 May-19 Jul-19 Sep-19 3,477.27 3,477.27
GG0212 M STD Jul-60 Jan-19 Jun-19 Mar-19 89.29 89.29
GG0886 F STD Aug-79 Jun-19 Jul-19 Jul-19 1,112.24 1,112.24
FROM 01/2017 THROUGH 12/2021
POLICY 641718 ORANGECOUNTY BOARDOF COUNTY
THE INFORMATION IN THESE REPORTS IS CONFIDENTIAL AND PROPRIETARY.
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