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		<title>Annual Survey - Ohio Health Insurance Business</title>
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                     <div style="margin: 0 auto; border-spacing: 0px; padding: 0px; width: 669px;" class="FrmTable" align="center">
                        <div class="FrmTitleBackGrnd" style="font-weight: bold; color: #000000; padding-left: 5px;" align="left">
                           Annual Report of Ohio Health Insurance Business -
                            <br />
                            Open Enrollment
                          <a style="margin-left: 510px;" class="main" onmouseover="window.status='Context Sensitive Help';return true;" onmouseout="window.status='';return true;"
                              href="Instructions/Help.pdf" target="helpwindow">Help</a>
                        </div>
                        <div class="FrmBackGrnd" style="margin: 5px;">
                            <table width="100%" border="0" role="presentation">
                                <tr>
                                    <td width="14">
                                        <img src="/images/frmBullet.gif" alt=""/></td>
                                    <td class="FrmInfo" height="20">Data for <b>
                                        <asp:Label ID="lblCompanyName" runat="server"></asp:Label>
                                    </b>
                                    </td>
                                </tr>
                                <tr>
                                    <td width="14">
                                        <img src="/images/frmBullet.gif" alt=""/></td>
                                    <td class="FrmInfo" height="20">NAIC Number:<b><asp:Label ID="lblNaicNum" runat="server"></asp:Label></b>
                                    </td>
                                </tr>
                                <tr>
                                    <td width="14">
                                        <img src="/images/frmBullet.gif" alt=""/></td>
                                    <td class="FrmInfo" height="20">
                                        <b>INFORMATION RELATED ONLY TO BUSINESS IN OHIO</b></td>
                                </tr>
                                <tr>
                                    <td width="14">
                                        <img src="/images/frmBullet.gif" alt=""/></td>
                                    <td class="FrmInfo" height="20">Companies with Open Enrollment availability will be listed on the Department 
																		website until either Capacity is met or the Open Enrollment period is ended.
                                    </td>
                                </tr>
                                <tr>
                                    <td width="14">
                                        <img src="/images/frmBullet.gif" alt=""/></td>
                                    <td class="FrmInfo" height="20">Open Enrollment data may be updated at any time during the year.
                                    </td>
                                </tr>
                                <tr>
                                    <td class="FrmInfo" height="30" valign="bottom" colspan="2">
                                        <b>INSTRUCTIONS:</b>
                                    </td>
                                </tr>
                                <tr>
                                    <td width="14">
                                        <img src="/images/frmBullet.gif" alt=""/></td>
                                    <td class="FrmInfo" height="20">Indicate status for each Open Enrollment category.
                                    </td>
                                </tr>
                                </table>
                            <div style="display: block">
                                <div style="display: block;">
                                    <div style="display: inline-block;margin-right:135px;">
                                        <img src="/images/spacer.gif" alt="" />
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                                    <div style="display: inline-block;">
                                        <table role="presentation">
                                            <tr valign="top">
                                                <td width="115" class="FrmInfo">
                                                    <div align="right">NOT APPLICABLE:</div>
                                                </td>
                                                <td width="360" class="FrmInfo">Company is not required to hold Open Enrolment for 
																					this category</td>
                                            </tr>
                                            <tr valign="top">
                                                <td class="FrmInfo">
                                                    <div align="right">EXEMPT:</div>
                                                </td>
                                                <td class="FrmInfo">Company is normally required to hold Open Enrollment for this 
																					category. But has obtained statutory exemption or waiver</td>
                                            </tr>
                                            <tr valign="top">
                                                <td class="FrmInfo">
                                                    <div align="right">NON-EXEMPT:</div>
                                                </td>
                                                <td class="FrmInfo">Company is required to hold Open Enrolment for this category</td>
                                            </tr>
                                        </table>
                                    </div>
                                </div>
                            </div>
                            <table width="100%" border="0" role="presentation">
                                
                                <tr>
                                    <td width="14">
                                        <img src="/images/frmBullet.gif" alt=""/></td>
                                    <td class="FrmInfo" height="20">For "Non-Exempt" categories complete all required fields (marked with *).
                                    </td>
                                </tr>
                                <tr>
                                    <td width="14">
                                        <img src="/images/frmBullet.gif" alt=""/></td>
                                    <td class="FrmInfo" height="20">SAVE DATA BEFORE LEAVING THIS PAGE.
                                    </td>
                                </tr>
                                <tr>
                                    <td class="FrmError" colspan="2">
                                        <asp:ValidationSummary ID="vsError" runat="server" Width="100%" EnableViewState="False" CssClass="frmError"
                                            HeaderText="PLEASE CORRECT THE FOLLOWING ERROR(S):"></asp:ValidationSummary>
                                    </td>
                                </tr>
                                <tr>
                                    <td class="FrmError" colspan="2">
                                        <asp:Label ID="lblError" runat="server" EnableViewState="False"></asp:Label></td>
                                </tr>
                            </table>
                        </div>
                        <div class="FrmBackGrnd" style="padding-top: 10px; margin:5px;" align="left">
                          <span class="FrmTitleTxt">FOR THE PERIOD BEGINNING
                          <asp:label id="lblPeriod" runat="server" EnableViewState="False"></asp:label></span>
                         <div style="border: 2px black solid;"> 
                               <table style="width:100%;" role="presentation">
                                 <tr>
                                     <td bgColor="#cccccc" height="24" width="100%" style="border-bottom: 2px solid black;"><span class="FrmSecHead">HEALTH INSURER</span>
									</td>
                                  </tr>
                                 <tr>
                                     <td  height="1" width="135">
                                         <img src="/images/spacer.gif" alt=""></td>
                                 </tr>
                                 <tr>
                                     <td class="FrmSecHead" width="138">
                                         <div align="left" style="margin-left:30px;"><b>STATUS</b></div>
                                     </td>
                                </tr>
                              </table>
                               <table style="width:100%;" role="presentation">
                                 <tr>
                                     <td width="148">&nbsp;
												<asp:DropDownList CssClass="medfont" ID="cmbHiFeiStatus" runat="server" AutoPostBack="True">
                                                    <asp:ListItem Value=""></asp:ListItem>
                                                    <asp:ListItem Value="NA">Not Applicable</asp:ListItem>
                                                    <asp:ListItem Value="EX">Exempt</asp:ListItem>
                                                    <asp:ListItem Value="NEX">Required</asp:ListItem>
                                                </asp:DropDownList>
                                         <asp:RequiredFieldValidator ID="rfvHiFeiStatus" runat="server" CssClass="frmError" Font-Bold="True" ErrorMessage="Please select Status under HEALTH INSURER - Individual Market - Federally Eligible Individuals."
                                             ControlToValidate="cmbHiFeiStatus" InitialValue=''>?</asp:RequiredFieldValidator>
                                     </td>
                                     <td width="334">
                                         <span class="FrmSecHead">Individual Market - Federally Eligible Individuals<br>
                                             <a href="http://codes.ohio.gov/orc/3923.58" target="_blank" class="FrmSecHead">ORC 
																																Sections 3923.58.1</a> </span>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td height="10">
                                         <img src="/images/spacer.gif" alt=""></td>
                                 </tr>
                                 </table>
                               <table style="width:100%;" role="presentation">
                                 <tr>
                                     <td class="FrmFieldTxt" width="100">
                                         <img src="/images/spacer.gif" alt=""></td>
                                     <td class="FrmFieldTxt"><span class="Required">*</span>&nbsp;Capacity&nbsp;</td>
                                     <td class="FrmInfo">
                                         <uc1:wucNumber runat="server" ID="wucHiFeiCapacity" Size="10" REQUIRED="True" disabled="True" reqErrMsg="Please enter a Capacity under HEALTH INSURER - Individual Market - Federally Eligible Individuals."
                                             invErrMsg="Please enter a NUMBER in Capacity under HEALTH INSURER - Individual Market - Federally Eligible Individuals."></uc1:wucNumber>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td class="FrmFieldTxt" width="10">
                                         <img src="/images/spacer.gif" alt="" /></td>
                                     <td class="FrmFieldTxt">Date Met&nbsp;</td>
                                     <td class="FrmInfo">
                                         <uc1:wucDateSimple runat="server" ID="wucHiFeiDateMet" disabled="True" InvErrMsg="Please enter a DATE in Date Met under HEALTH INSURER - Individual Market - Federally Eligible Individuals."></uc1:wucDateSimple>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td colspan="3" height="10">
                                         <img src="/images/spacer.gif" alt=""/></td>
                                 </tr>
                             </table>
                               <div style="border-top: 2px solid black;">
                                 <img src="/images/spacer.gif" alt="" />
                               </div>
                               <table width="100%" border="0" cellpadding="0" cellspacing="0" role="presentation">
                                 <tr>
                                     <td width="148">&nbsp;
																<asp:DropDownList CssClass="medfont" ID="cmbHiNfeiStatus" runat="server" AutoPostBack="True">
                                                                    <asp:ListItem Value=""></asp:ListItem>
                                                                    <asp:ListItem Value="NA">Not Applicable</asp:ListItem>
                                                                    <asp:ListItem Value="EX">Exempt</asp:ListItem>
                                                                    <asp:ListItem Value="NEX">Required</asp:ListItem>
                                                                </asp:DropDownList>
                                         <asp:RequiredFieldValidator ID="rfvHiNfeiStatus" runat="server" CssClass="frmError" Font-Bold="True" ErrorMessage="Please select Status under HEALTH INSURER - Individual Market - Non-Federally Eligible Individuals."
                                             ControlToValidate="cmbHiNfeiStatus" InitialValue=''>?</asp:RequiredFieldValidator>
                                     </td>
                                     <td width="334">
                                         <span class="FrmSecHead">Individual Market - Non-Federally Eligible Individuals<br />
                                             <a href="http://codes.ohio.gov/orc/3923.58" target="_blank" class="FrmSecHead">ORC 
																																	Sections 3923.58</a> </span>
                                     </td>
                                 </tr>
                             </table>
                               <div>
                                 <img src="/images/spacer.gif" alt="" />
                               </div>
                               <table width="100%" border="0" cellpadding="0" cellspacing="0" role="presentation">
                                 <tr>
                                     <td class="FrmFieldTxt" width="100">
                                         <img src="/images/spacer.gif" alt="" /></td>
                                     <td class="FrmFieldTxt"><span class="Required">*</span>&nbsp;Capacity&nbsp;</td>
                                     <td class="FrmInfo">
                                         <uc1:wucNumber runat="server" ID="wucHiNfeiCapacity" Size="10" REQUIRED="True" disabled="True"
                                             reqErrMsg="Please enter a Capacity under HEALTH INSURER - Individual Policy - Non-Federally Eligible Individuals."
                                             invErrMsg="Please enter a NUMBER in Capacity under HEALTH INSURER - Individual Policy - Non-Federally Eligible Individuals."></uc1:wucNumber>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td class="FrmFieldTxt" width="10">
                                         <img src="/images/spacer.gif" alt="" /></td>
                                     <td class="FrmFieldTxt">Date Met&nbsp;</td>
                                     <td class="FrmInfo">
                                         <uc1:wucDateSimple runat="server" ID="wucHiNfeiDateMet" disabled="True" InvErrMsg="Please enter a DATE in Date Met under HEALTH INSURER - Individual Policy - Non-Federally Eligible Individuals."></uc1:wucDateSimple>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td colspan="3" height="10">
                                         <img src="/images/spacer.gif" alt="" /></td>
                                 </tr>

                               </table>
                          </div> 
                         <div style="border: 2px black solid; margin-top:5px;"> 
                                <table style="width:100%;" role="presentation">
                                 <tr>
                                     <td bgColor="#cccccc" height="24" width="100%" style="border-bottom: 2px solid black;"><span class="FrmSecHead">HEALTH INSURING 
																									CORPORATION (HIC)</span>
									</td>
                                  </tr>
                                 <tr>
                                     <td  height="1" width="135">
                                         <img src="/images/spacer.gif" alt=""></td>
                                 </tr>
                                 <tr>
                                     <td class="FrmSecHead" width="138">
                                         <div align="left" style="margin-left:30px;"><b>STATUS</b></div>
                                     </td>
                                </tr>
                              </table>
                                <table style="width:100%;" role="presentation">
                                 <tr>
                                     <td width="148">&nbsp;
												<asp:DropDownList CssClass="medfont" ID="cmbHicFeiStatus" runat="server" AutoPostBack="True">
                                                    <asp:ListItem Value=""></asp:ListItem>
                                                    <asp:ListItem Value="NA">Not Applicable</asp:ListItem>
                                                    <asp:ListItem Value="EX">Exempt</asp:ListItem>
                                                    <asp:ListItem Value="NEX">Required</asp:ListItem>
                                                </asp:DropDownList>
                                        <asp:RequiredFieldValidator ID="rfvHicFeiStatus" runat="server" CssClass="frmError" Font-Bold="True" ErrorMessage="Please select Status under HEALTH INSURING CORPORATION - Individual Market - Federally Eligible Individuals."
                                                                             ControlToValidate="cmbHicFeiStatus" InitialValue=''>?</asp:RequiredFieldValidator>
                                     </td>
                                     <td width="334">
                                        <span class="FrmSecHead">Individual Market - Federally Eligible Individuals<br>
                                              ORC Sections <a href="http://codes.ohio.gov/orc/3923.58" target="_blank" class="FrmSecHead">3923.58.1</a> and <a href="http://codes.ohio.gov/orc/1751.15" target="_blank" class="FrmSecHead">1751.15(L)</a> </span>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td height="10">
                                         <img src="/images/spacer.gif" alt=""></td>
                                 </tr>
                                 </table>
                                <table style="width:100%;" role="presentation">
                                 <tr>
                                     <td class="FrmFieldTxt" width="100">
                                         <img src="/images/spacer.gif" alt=""></td>
                                     <td class="FrmFieldTxt"><span class="Required">*</span>&nbsp;Capacity&nbsp;</td>
                                     <td class="FrmInfo">
                                         <uc1:wucNumber runat="server" ID="wucHicFeiCapacity" Size="10" REQUIRED="True" disabled="True"
                                                                 reqErrMsg="Please enter a Capacity under HEALTH INSURING CORPORATION - Individual Market - Federally Eligible Individuals."
                                                                 invErrMsg="Please enter a NUMBER in Capacity under HEALTH INSURING CORPORATION - Individual Market - Federally Eligible Individuals."></uc1:wucNumber>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td class="FrmFieldTxt" width="10">
                                         <img src="/images/spacer.gif" alt="" /></td>
                                     <td class="FrmFieldTxt">Date Met&nbsp;</td>
                                     <td class="FrmInfo">
                                          <uc1:wucDateSimple runat="server" ID="wucHicFeiDateMet" disabled="True" InvErrMsg="Please enter a DATE in Date Met under HEALTH INSURING CORPORATION - Individual Market - Federally Eligible Individuals."></uc1:wucDateSimple>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td colspan="3" height="10">
                                         <img src="/images/spacer.gif" alt=""/></td>
                                 </tr>
                             </table>
                                <div style="border-top: 2px solid black;">
                                 <img src="/images/spacer.gif" alt="" />
                                </div>
                                <table width="100%" border="0" cellpadding="0" cellspacing="0" role="presentation">
                                     <tr>
                                         <td width="148">&nbsp;
																<asp:DropDownList CssClass="medfont" ID="cmbHicAoeStatus" runat="server" AutoPostBack="True">
                                                                    <asp:ListItem Value=""></asp:ListItem>
                                                                    <asp:ListItem Value="NA">Not Applicable</asp:ListItem>
                                                                    <asp:ListItem Value="EX">Exempt</asp:ListItem>
                                                                    <asp:ListItem Value="NEX">Required</asp:ListItem>
                                                                </asp:DropDownList>
                                             <asp:RequiredFieldValidator ID="rfvHicAoeStatus" runat="server" CssClass="frmError" Font-Bold="True" ErrorMessage="Please select Status under HEALTH INSURING CORPORATION - Annual Open Enrollment."
                                                 ControlToValidate="cmbHicAoeStatus" InitialValue=''>?</asp:RequiredFieldValidator>
                                         </td>
                                         <td width="334">
                                             <span class="FrmSecHead">Health Insuring Corporation - Annual Open Enrollment<br>
                                                 <a href="http://codes.ohio.gov/orc/1751.15" target="_blank" class="FrmSecHead">ORC 
																																	Section 1751.15</a> </span>
                                         </td>
                                     </tr>
                                 </table>
                                <div>
                                 <img src="/images/spacer.gif" alt="" />
                                </div>
                                <table width="100%" border="0" cellpadding="0" cellspacing="0" role="presentation">
                                    <tr>
                                        <td class="FrmFieldTxt" width="100">
                                            <img src="/images/spacer.gif" alt=""></td>
                                        <td class="FrmFieldTxt"><span class="Required">*</span>&nbsp;Month&nbsp;</td>
                                        <td class="FrmInfo">
                                            <asp:DropDownList CssClass="medfont" ID="cmbHicAoeMonth" Enabled="False" runat="server">
                                                <asp:ListItem></asp:ListItem>
                                                <asp:ListItem Value="JAN">January</asp:ListItem>
                                                <asp:ListItem Value="FEB">February</asp:ListItem>
                                                <asp:ListItem Value="MAR">March</asp:ListItem>
                                                <asp:ListItem Value="APR">April</asp:ListItem>
                                                <asp:ListItem Value="MAY">May</asp:ListItem>
                                                <asp:ListItem Value="JUN">June</asp:ListItem>
                                                <asp:ListItem Value="JUL">July</asp:ListItem>
                                                <asp:ListItem Value="AUG">August</asp:ListItem>
                                                <asp:ListItem Value="SEP">September</asp:ListItem>
                                                <asp:ListItem Value="OCT">October</asp:ListItem>
                                                <asp:ListItem Value="NOV">November</asp:ListItem>
                                                <asp:ListItem Value="DEC">December</asp:ListItem>
                                            </asp:DropDownList>
                                            <asp:RequiredFieldValidator ID="rfvHicAoeMonth" Enabled="False" runat="server" CssClass="frmError" ControlToValidate="cmbHicAoeMonth"
                                                ErrorMessage="Please select Month under HEALTH INSURING CORPORATION - Annual Open Enrollment." Font-Bold="True">?</asp:RequiredFieldValidator>
                                        </td>
                                    </tr>
                                 <tr>
                                     <td class="FrmFieldTxt" width="100">
                                         <img src="/images/spacer.gif" alt="" /></td>
                                     <td class="FrmFieldTxt"><span class="Required">*</span>&nbsp;Capacity&nbsp;</td>
                                     <td class="FrmInfo">
                                         <uc1:wucNumber runat="server" ID="wucHicAoeCapacity" Size="10" REQUIRED="True" disabled="True"
                                                                 reqErrMsg="Please enter a Capacity under HEALTH INSURING CORPORATION - Annual Open Enrollment."
                                                                 invErrMsg="Please enter a NUMBER in Capacity under HEALTH INSURING CORPORATION - Annual Open Enrollment."></uc1:wucNumber>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td class="FrmFieldTxt" width="10">
                                         <img src="/images/spacer.gif" alt="" /></td>
                                     <td class="FrmFieldTxt">Date Met&nbsp;</td>
                                     <td class="FrmInfo">
                                         <uc1:wucDateSimple runat="server" ID="wucHicAoeDateMet" disabled="True" InvErrMsg="Please enter a DATE in Date Met under HEALTH INSURING CORPORATION - Annual Open Enrollment."></uc1:wucDateSimple>
                                     </td>
                                 </tr>
                                 <tr>
                                     <td colspan="3" height="10">
                                         <img src="/images/spacer.gif" alt="" /></td>
                                 </tr>

                               </table>
                          </div>
                        </div>
                        <div class="FrmBackGrnd" style="padding-top: 10px; margin:5px;" align="left">
                            <div align="right">
                                <asp:Button ID="cmdSave" OnClick="cmdSave_Click" Text="Save" runat="server"></asp:Button>&nbsp;&nbsp;&nbsp;
                            </div>
                        </div>
                     </div>
						
						
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