Individual Disability Income Insurance Policies That Meet The Requirements Of Massachusetts' Regulation 211 CMR 42.00

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Allianz Life Insurance Company Of North America
P.O. Box 59060
300 South Highway 169
Minneapolis, MN 55459
(800) 950-5872
Policy #: Approval Date:
2-P-A 1
 
disability income policy06/09/99
Ace American Insurance Company
P.O. Box 1000
436 Walnut Street - WA09G
Philadelphia, PA 19106
(215) 640-5123
 
Policy #: Approval Date:
AH-1400-MAdisability income policy10/23/06
Amalgamated Life Insurance Company
333 Westchester Avenue
White Plains, NY 10604
(914) 367-5581
 
Policy #: Approval Date:
AMINDDI-10 (MA)disability income policy10/12/12
American Bankers Life Assurance Company of Florida
11222 Quail Roost Drive
Miami, FL 33157-6596
(800) 852-2244
Policy #: Approval Date:
AC6398PH-1098disability income policy05/23/00
American Family Life Assurance Company of Columbus
1932 Wynnton Road
Columbus, GA 31999
(800) 992-3522
Policy #: Approval Date:
A-57200-MA
A-57400-MA
A-57500-MA
A57600MA
disability income policy
disability income policy
disability income policy
disability income policy
04/28/00
09/26/03
09/26/09
01/17/13
American Family Life Assurance Company Of New York
One Marcus Boulevard
Albany, New York 12205
(800) 366-3436
Policy #: Approval Date:
NY-57000 MA
NY-57200 MA
disability income policy
disability income policy
09/03/96
04/13/99
American Fidelity Assurance Company
2000 N. Classen Blvd.
Oklahoma City, Oklahoma 73106
(800) 323-3748
Policy #: Approval Date:
DI-99MA 2
 
disability income policy04/27/00
American General Life Insurance Company
2727-A Allen Parkway
Houston, Texas 77019
(800) 811-2696
Policy #: Approval Date:
04500-22disability income policy05/23/05
American Heritage Life Insurance Company
1776 American Heritage Life Drive
Jacksonville, FL 32224
(800) 521-3535
Policy #: Approval Date:
DI-3MA
DI-4MA
DI5WMA
DI61MA
disability income policy
disability income policy
disability income policy
disability income policy
03/29/89
10/06/93
11/27/01
01/31/02
American Income Life Insurance Company
P.O. Box 2608
Waco, TX 76797
(254)-761-6400
 
Policy #: Approval Date:
D50000disability income policy04/22/81
American Network Insurance Company 3
AON Select Company
110 Gibraltar Road, Suite #116
Horsham, PA 19044
(800) 343-3133
Policy #: Approval Date:
GR-78-87-MA
RA-GR-83-87-MA
2GR-90-MA
GRST-91-MA
4GR-94-MA
ANIC-DI (96) MA
5GR-RPD-97-MA
ANIC-DI 2000 (MA)
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
10/27/87
02/25/88
08/13/90
08/06/91
09/15/93
08/12/97
10/08/97
01/04/00
American Phoenix Life And Reassurance Company
100 Bright Meadow Boulevard
P.O. Box 1900
Enfield, CT 06083-1900
(860) 403-2360
Policy #: Approval Date:
ENTDIS97 MAdisability income policy07/21/98
American States Life Insurance Company
P.O. Box 34690
Seattle, WA 98124
(877) 4-SAFECO
Policy #: Approval Date:
L0071-20 (10-93)
L0060-00 (9-93)
L0076-20 (10-93)
disability income policy
disability income policy
disability income policy
03/24/94
03/20/95
03/20/95
Ameritas Life Insurance Corp.
5900 O Street
P.O. Box 81889
Lincoln, NE  68501-1889
(800) 756-1112
Policy #: Approval Date:
4501NC MA
4502GR MA
4503BOE MA
disability income policy
disability income policy
overhead expense disability income policy
03/23/12
03/23/12
03/23/12
Assurity Life Insurance Company
1526 K Street
Lincoln, NE 68501-2533
(800) 627-7212
Policy #: Approval Date:
A-D 100 MA
A-D 106 MA
A-D 103 MA
AAW-D112 MA
AAW-D113 MA
A-D 120 MA
W D210 (MA)
I H0920 MA
disability income policy
disability business expense policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
07/07/98
07/07/98
12/11/01
04/22/03
04/22/03
03/18/04
04/08/09
08/18/11
Balboa Life Insurance Company
P.O. Box 19702
Irvine, CA 92623-9702
(800) 854-6115
Policy #: Approval Date:
20A15P E496 4disability income policy06/15/98
Baltimore Life Insurance Company
10075 Red Run Boulevard
Owings Mills, Maryland 21117-4871
(800) 628-5433
Policy #: Approval Date:
6204S (MA) 5
6216S (MA) 5
6219S (MA/RI) 5
6248S (MA/RI) 5
 
disability income policy
disability income policy
disability business expense
disability business expense policy
02/23/00
02/23/00
02/23/00
02/23/00
Bankers Fidelity Life Insurance Company
4370 Peachtree Rd N. E.
Atlanta GA 30319
(404) 266-5600
Policy #: Approval Date:
B 8721 MA
B 8721 DR MA
disability income policy
disability income policy
 
12/01/06
12/01/06
Bankers Life & Casualty Company
222 Merchandise Mart Plaza
Chicago, IL 60654-2013
(312) 396-6000
Policy #: Approval Date:
GR-D025disability income policy11/04/94
Berkshire Life Insurance Company of America
700 South Street
Pittsfield, MA 01201-8285
(413) 499-4321
Policy #: Approval Date:
0100MA (06/01)
1100MA (06/01)
3100MA (06/01)
4100MA (06/01)
5100MA (06/01) 6
6100MA (06/01)
755 (7-2001)
1200 (01/11) MA 7
1400 (03/07) MA
1500 (06/10) MA

3200 (01/10) MA
1600 (06/10) MA
1400 (06/10) MA 8
disability income policy
disability income policy
disability business buyout policy
disability business expense policy
disability business expense policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability buy-out policy
disability income policy
disability income policy
04/11/01
04/11/01
04/11/01
04/11/01
04/11/01
04/11/01
02/15/02
06/24/04
10/31/07
04/09/10
05/10/10
05/25/10
09/01/10
Boston Mutual Life Insurance Company
120 Royall Street
Canton, MA 02021-9968
(800) 669-2668
Policy #: Approval Date:
D.I.-Acc-6/93
D.I.-A&S-6/93
ESO-DIS-1/95
D.I.-IMPR-7/98
disability income policy
disability income policy
disability income policy
disability income policy
09/22/93
09/22/93
03/02/95
04/15/99
Central States Health & Life Company Of Omaha
P.O. Box 34350
Omaha NE 68134-0350
(402) 397-1111
Policy #: Approval Date:
D03 MA 9
D05 MA 10
 
disability income policy
disability income policy
03/02/95
05/29/96
Central States Indemnity Insurance Company Of Omaha
1212 N. 96th Street
Omaha NE 68134-22748
(888) 642-4340
 
Policy #: Approval Date:
11615disability income policy08/23/05
The Chesapeake Life Insurance Company
9151 Boulevard 26
North Richland Hills, TX 76180
(817) 255-3100
Policy #: Approval Date:
CH-26115-IP (01/10) MAdisability income policy05/13/11
Cincinnati Life Insurance Company
P.O. Box 15496
Cincinnati, OH 45250-5496
(513) 870-2000
Policy #: Approval Date:
CLI-507-MA (3/01)disability income policy11/27/01
Colonial Life & Accident Insurance Company
1200 Colonial Life Boulevard
Columbia, SC 29202
(800) 325-4368
Policy #: Approval Date:
SASD-MA
ENHANCE-MA
DIS 1000-MA
disability income policy
disability income policy
disability income policy
10/12/99
02/17/00
02/18/04
Combined Insurance Company Of America
123 North Wacker Drive
Chicago, IL 60606
(312) 701-3242
Policy #: Approval Date:
12475
19700-MA
19824-MA-809 11
19819-MA-1208 12
19841-MA
DI P69003-MA 0401
DI P69004-MA 0401 02)
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
08/25/87
11/09/89
09/08/97
12/04/97
06/18/98
01/17/02
01/17/02
Continental General Insurance Company
8901 Indian Hills Drive
P.O. Box 247007
Omaha, NE 68124-7007
(402) 397-3200
Policy #: Approval Date:
208 13
 
disability income policy01/07/94
Farm Family Life Insurance Company
P.O. Box 656
Albany, NY 12201
(518) 431-5000
Policy #: Approval Date:
40-150
40-151
40-156(MA)
40-182 1101 (MA)
40-183 1101 (MA)
40-184 1101 (MA)
40-185 1101 (MA)
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability business expense policy
10/03/83
10/18/84
09/24/98
07/08/03
07/08/03
07/08/03
07/08/03
Federated Life Insurance Company
121 E. Park Square
P.O. Box 328
Owatonna, MN 55060
(800) 533-0472
Policy #: Approval Date:
DI(MA) (05/96)
DI(MA) (01-01)
disability income policy
disability income policy
03/30/99
05/17/01
The Guardian Life Insurance Company Of America
7 Hanover Square
New York, NY 10004-2616
(800) 441-6455
Policy #: Approval Date:
AH55-A
NC56-A
AH84 14
NC97 14
NC111-MA 14
NC112-MA 14
OE102-MA 14
 
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability business expense policy
05/19/81
05/19/81
12/21/86
03/07/88
10/06/98
02/05/99
3/10/99
Horace Mann Life Insurance Company
1 Horace Mann Plaza
Springfield, IL 62715-0001
(217) 789-2500
Policy #: Approval Date:
GC-S1I01K
GC-S1I02X
disability income policy
disability income policy
10/06/87
02/02/93
Illinois Mutual Life Insurance Company
300 S.W. Adams Street
Peoria, IL 61634
(800) 437-7355
Policy #: Approval Date:
990 MA
991 MA
992 MA
994 MA
BE21 MA
GR21 MA
NC21 MA
PD21 MA
SR21 MA
SRBE21 (MA)
DI105 (MA)
disability income policy
disability income policy
disability business expense policy
disability income policy
disability business expense policy
disability income policy
disability income policy
disability income policy
disability income policy
disability business expense policy
disability income policy
08/24/99
08/24/99
08/24/99
08/24/99
08/28/00
08/28/00
08/28/00
08/28/00
08/28/00
06/10/05
09/21/10
 
Kanawha Insurance Company
210 South White Street
Lancaster, SC 29721-0610
(877) 378-1505
Policy #: Approval Date:
80315 8/05-MAdisability income policy06/08/07

 
Knights of Columbus
One Columbus Plaza
New Haven, CT 06510-3326
(203) 752-4658
Policy #: Approval Date:
DI01-MA 1-11disability income policy03/25/11
Loyal American Life Insurance Company
P.O. Box 5418
Cincinnati, OH 45201-5418
(800) 633-6752
 
Policy #: Approval Date:
L-4187-20 15disability income policy04/30/96
Massachusetts Mutual Life Insurance Company 16
1295 State Street
Springfield, MA 01111-0001
(800) 272-2216
Policy #: Approval Date:
DP181-MA-9200
BOE-I-92 MA
BOE-A-92 MA
BOE-G-92 MA
SBOE-I-92MA
SBOE-A-92 MA
SBOE-G-92 MA
DP188-MA-9500
DP188-MA-9500F
DP288-MA-9500
DP288-MA-9500F
DP388-MA-9500
DP388-MA-9500F
DP488-MA-9500
DP488-MA-9500F
XL-I-95 MA 16
XL-A-95 MA 16  
XL-G-95 MA 16   
XL-OI-91 MA
XL-OA-91 MA
XL-OG-91 MA
XL-IS-92 MA
XL-AS-92 MA
XL-GS-92 MA
Axis-98 MA
BOE-99 (MA)
BSELL-00(MA)
AP-01 (MA)
XLS-ME-04
disability business expense policy
disability business expense policy
disability business expense policy
disability business expense policy
disability business expense policy
disability business expense policy
disability business expense policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability business expense policy
disability business buyout policy
disability income policy
disability income policy
04/02/92
06/14/93
06/14/93
06/14/93
06/14/93
06/14/93
06/14/93
06/14/95
06/14/95
06/14/95
06/14/95
06/14/95
06/14/95
06/14/95
06/14/95
11/13/95
11/13/95
11/13/95
12/01/97
12/01/97
12/01/97
12/01/97
12/01/97
12/01/97
09/23/98
10/13/99
02/02/00
05/21/01
03/11/04
Metropolitan Life Insurance Company
P.O. Box 30591
Tampa, FL 33630
(800) 929-1492
Policy #: Approval Date:
IDI2000-P/NC-ML
IDI2000-P/NC-(MA)
IDI2000-P/GR (MA)
disability income policy
disability income policy
disability income policy
08/07/01
08/07/01
08/07/01
Minnesota Life Insurance Company
400 Robert Street North
St. Paul, MN 55101-2098
(651) 665-3500
Policy #: Approval Date:
MHC-98-560 17
MHC-98-562 17
disability income policy
disability income policy
07/19/90
07/19/90
Mutual Of Omaha Insurance Company
Mutual of Omaha Plaza
Omaha, NE 68175
(402) 342-7600
Policy #: Approval Date:
150BE--Series 10343
DM44--Series 15205
D55-----Series 16486
DE45---Series 16715
D81-21062
D81-21063
D81-21064
D81-21065
D81-21066
D81-21067
D81-22990
D81-22991
D81-22992
D81-22993
D81-22994
D82-22995
D82-22996
D82-22997
D82-22998
D81-22999
disability business expense policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
03/10/80
08/01/88
08/13/90
02/01/91
03/25/08
03/25/08
03/25/08
03/25/08
03/25/08
03/25/08
01/13/11
01/13/11
01/13/11
01/13/11
01/13/11
01/13/11
01/13/11
01/13/11
01/13/11
01/13/11
Nationwide Life Insurance Company
One Nationwide Plaza
Columbus, Ohio 43215-2220
(800) 535-8600
Policy #: Approval Date:
HEALTH-2150 16disability income policy02/10/99
New England Life Insurance Company
Disability Income Administration Center
18 Chestnut Street
Worcester, MA 01608
(508) 799-4441
Policy #: Approval Date:
949a MA 19
981 MA 19
933 MA 19
908 MA 19
990 MA 19
985 MA 19
986 MA 19
987 MA 19
975 MA 19
998 MA 19
998 MA PE 19
 
disability income policy
disability business buyout policy
disability income policy
disability business expense policy
disability income policy
disability business buyout policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
06/28/90
08/20/90
12/18/90
01/24/91
01/24/91
06/05/91
06/05/91
06/05/91
06/13/91
04/11/95
04/11/95
Northwestern Mutual Life Insurance Company
720 East Wisconsin Avenue
P.O. Box 1237
Milwaukee, WI 53202-4797
(414) 271-1444
Policy #: Approval Date:
RR.GRD1.(0101)
RR.NCD1.(0101)
RR.BUY.(0101)
RR.KEY.(0101)
RR.DOE.(0101)
RR.INT.(0101)
(disability income policy
disability income policy
disability business buyout policy
disability income policy
disability business expense policy
disability income policy
11/29/00
11/29/00
11/29/00
11/29/00
11/29/00
11/29/00
Ohio National Life Assurance Corporation
P.O. Box 237
Cincinnati OH 45201-0237
(800) 366-6654
Policy #: Approval Date:
93-DB-23
93-DE-23.1
95-DE-23.2
11DI-1.MA
11DI-2.MA
disability business buyout policy
disability business expense policy
disability business expense policy
disability income policy
disability income policy
09/19/96
09/19/96
09/19/96
01/06/12
01/06/12
Ohio National Life Insurance Company
P.O. Box 237
Cincinnati, OH 45201-0237
(513) 794-6100
Policy #: Approval Date:
95-DI-23.1
95-DI-23.2 MA
03-DI-23.1
03-DI-23.2
disability income policy
disability income policy
disability income policy
disability income policy
(09/24/96
09/24/96
05/10/07
05/10/07
Old Republic Life Insurance Company
307 North Michigan Avenue
Chicago, IL 60601-5382
(312) 346-8100
Policy #: Approval Date:
3-8997(MA) 20disability income policy09/24/96
The Paul Revere Life Insurance Company
18 Chestnut Street
Worcester, MA 01608
(508) 799-4441
Policy #: Approval Date:
981 MA 21
908 MA 21
990 MA 22
975 MA 23
998 MA 23
998 MA PE 23
 
disability buyout income policy
disability business expense policy
disability income policy
disability income policy
disability income policy
disability income policy
08/20/90
01/24/91
01/24/91
06/11/91
04/11/95
04/11/95
Principal Life Insurance Company
711 High Street
Des Moines, IA 50309-9979
(515) 247-5111
Policy #: Approval Date:
HH 700 MA
HH 700 MA U
HH 702 MA
HH 703 MA
HH 750 MA
HH 750 MA U
HH 772-MA
HH 789 MA 24
disability income policy
disability income policy
overhead expense policy
disability business buyout policy
disability income policy)
disability income policy
disability income policy
overhead expense policy
03/28/00
03/28/00
03/28/00
03/28/00
06/16/04
06/16/04
03/10/09
01/14/11
Professional Insurance Company
100 Bright Meadow Blvd
P.O. Box 1955
Enfield, CT 06083-1955
(800) 289-1122
Policy #: Approval Date:
HPDI2002 1-02
HPDI2009 MA
disability income policy
disability income policy
05/10/05
07/17/09
Provident Life And Accident Insurance Company
One Fountain Square
Chattanooga, TN 37402
(800) 633-7490
Policy #: Approval Date:
297-NC-MA
297-GR-MA
337-MA
1737-MA
1738-MA
337-B-MA
338-MA
338-GR-MA
338-LE-MA
338-LE-GR-MA
400NC
400GR
409NC
450NC
450GR
L-21637-20
460GR
500-MA
500A-MA
410NC
475NC
975P-MA
975P-MA-G
1669
600-MA
601-MA
600-G-MA
601-G-MA
L-21724
1837-MA
1838-MA
750-MA
750-GI-MA
disability income policy
disability income policy
disability income policy
disability business expense policy
disability business buyout policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability business expense policy
disability business expense policy
disability income policy
disability income policy
06/01/89
06/01/89
06/01/89
06/21/89
09/20/89
03/13/92
07/09/93
11/24/93
08/31/94
08/31/94
12/19/95
12/19/95
09/19/96
09/19/96
09/19/96
01/09/97
08/05/97
10/06/97
10/06/97
2/23/98
06/18/98
10/19/98
10/19/98
04/19/86
09/12/00
09/12/00
09/12/00
09/12/00
02/14/01
01/04/02
01/04/02
05/24/10
05/24/10
RiverSource Life Insurance Company
70100 Ameriprise Financial Center
Minneapolis, MN 55474
800-862-7919
 
Policy #: Approval Date:
30205G-MA
30203G-MA
30200G-MA
30208G-MA
30207G-MA
30200C-MA 25
30203C-MA 25
30207C-MA 25
30209C-MA 25
30208D-MA 25
 
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
disability income policy
 
01/28/08
01/28/08
01/28/08
01/28/08
01/28/08
08/12/94
08/12/94
08/12/94
08/12/94
08/12/94
 
Standard Insurance Company
P.O. Box 711
Portland, OR 97207
(800) 247-6888
Policy #: Approval Date:
B130.2(3/01)MA
B128.2(11/03)MA
B152(5/05)MA
B170(7/10)MA
B170GI(7/10)MA
disability income policy
disability buyout income policy
disability income policy
disability income policy
disability income policy
05/09/01
09/09/05
08/17/06
12/28/11
12/28/11
Surety Life Insurance Company
P.O. Box 82599
Lincoln, NE 68501-9502
(800) 669-7789
Policy #: Approval Date:
DI-P00 (09/95) MA 26disability income policy09/15/95
Thrivent Financial For Lutherans (A Fraternal Benefit Society) 27
4321 North Ballard Road
Appleton, Wisconsin 54919-0001
(800) 225-5225
Policy #: Approval Date:
MA12124
MA12125
H2-GB-GRBOE-1
H2-NB-NCBOE-1
disability income certificate
disability income certificate
disability business expense policy
disability business expense policy
10/24/00
10/24/00
03/13/01
03/13/01
Time Insurance Company
511 West Michigan
P.O. Box 3050
Milwaukee, WI 53201-3050
(800) 800-1212
Policy #: Approval Date:
8034.POL.MAdisability income policy12/09/10
Transamerica Assurance Company
1150 South Olive
Los Angeles, CA 90015
(800) 346-1608
Policy #: Approval Date:
9-H40 20-195disability income policy06/03/96
Trustmark Insurance Company
400 Field Drive
Lake Forest, IL 60045
(877) 201-9373
Policy #: Approval Date:
DI-699A
DI-699B
DI-699C
DI-699D
DI-902(I)
 
disability income policy
(disability income policy
disability income policy
disability income policy
disability income policy
 
04/28/00
04/28/00
04/28/00
04/28/00
12/29/03
 
Union Central Life Insurance Company
1876 Waycross Road
P.O. Box 40888
Cincinnati, OH 45240
(513) 595-2200
Policy #: Approval Date:
UC 4401 MA
UC 4402 MA
UC 4403 MA
disability income policy
disability income policy
disability business expense policy
05/24/99
05/24/99
05/24/99
Unified Life Insurance Company 28
P.O. Box 2020
Concord, NH 03302-2020
(603) 244-7746, or (888) 699-2452
 
Policy #: Approval Date:
DI-98-Adisability income policy03/01/99
Universal Underwriters Life Insurance Company
7045 College Boulevard
Overland Park, KS 66211-1523
(800) 634-6780
Policy #: Approval Date:
DMA1245 29disability income policy07/13/00
Unum Life Insurance Company Of America
2211 Congress Street
Portland, ME 04122-9997
(800) 227-8138
Policy #: Approval Date:
KP86 MA 31
BS86 MA 31
OP90 MA 31
INC95 MA 31
ISC95 MA 31
EDP98MA 31
 
disability income policy
disability buyout income policy
disability business expense policy
disability income policy
disability income policy
disability income policy
01/22/86
06/02/86
04/25/90
07/28/95
07/28/95
2/22/99

Wellcare Health Insurance Company of Illinois 32
200 West Adams, Suite 800
Chicago, IL 60606-4402
(813) 865-1658
 

Policy #: Approval Date:
HOL3-2102 MA 33disability income policy11/04/92

1 Effective November 6, 2001, Allianz Life Insurance Company of North America ceased offering its approved disability income policy in Massachusetts.

2 American Fidelity Assurance Company notified the Division that it has not marketed the approved individual disability income policy in Massachusetts.

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 Balboa Life Insurance Company notified the Division that it has not marketed its approved individual disability income policy in Massachusetts.

5 Baltimore Life Insurance Company notified the Division that it has not marketed its approved individual disability
income policies in Massachusetts.

6 Effective September 6, 2005, Berkshire Life Insurance Company of America ceased offering the above-noted approved individual disability income policy in Massachusetts.

7 Form# 1200 (01/11) MA replaces Form# 1400 (09/04) MA previously approved on October 31, 2007.
8 Form# 1400 (06/10) MA replaces Form# 1400 (03/07) MA previously approved on October 31, 2007.
9 Effective December 1, 2002, Central States Health & Life Insurance Company ceased offering the above-noted individual disability income policy in Massachusetts.

10 Effective January 2, 2002, Central States Health & Life Insurance Company ceased offering the above-noted individual disability income policy in Massachusetts.

11 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.

12 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.

13 Effective June 2008, Continental General Insurance Company ceased offering its above-noted approved individual disability income policy in Massachusetts.

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

15 Effective October 1, 2007, Loyal American Life Insurance Company ceased offering its approved individual disability income policy in Massachusetts.

16 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

17 Effective October 2000, Minnesota Life Insurance Company ceased offering its approved individual disability income policies in Massachusetts.

18 Effective January 2002 Nationwide Life Insurance Company ceased offering its approved individual disability income policy in Massachusetts.

19 Effective January 2007, New England Life Insurance Company ceased offering its approved individual disability income policy in Massachusetts.

20 Old Republic Life Insurance Company notified the Division that it is no longer marketing its individual disability income policy in Massachusetts.

21 Effective October 1, 1999, Paul Revere Life Insurance Company ceased offering these approved individual disability income policies in Massachusetts.

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

23 Effective April 30, 2002, Paul Revere Life Insurance Company) ceased offering these approved individual disability income policies in Massachusetts.

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

25 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.

26 Effective August 31, 1999, Surety Life Insurance Company ceased offering its approved individual disability income policy in Massachusetts.

27 Effective August 6, 2002,Aid Association for Lutherans and Lutheran Brotherhood merged into the newly named Thrivent Financial for Lutherans.

28 Effective September 2001, Concord General Life Insurance Company, Inc. changed its name to Unified Life Insurance Company.

29 Universal Underwriters Life Insurance Company notified the Division its approved individual disability income policy has not been marketed in Massachusetts.

30 Effective December 2002, Unum Life Insurance Company ceased offering these approved individual disability income policies in Massachusetts.

31 Effective October 1, 1999, Unum Life Insurance Company ceased offering these approved individual disability income policies in Massachusetts.

32 Effective September 27, 2006, Home Owner's Life Insurance Company's name was changed to WellCare Health Insurance of Illinois, Inc.

33 Effective September 27, 2006, WellCare Health Insurance of Illinois, Inc. ceased offering the approved individual disability
income policy in Massachusetts.