filing at a glance - dfs portal · increase 3.790% 3.790% $7,713,463 5,714 $211,106,382 13.210%...

Filing at a Glance

Company: Independent Health Benefits CorporationProduct Name: 2019 IHBC Small Group Prior ApprovalState: New YorkTOI: H15G Group Health - Hospital/Surgical/Medical ExpenseSub-TOI: H15G.003 Small Group OnlyFiling Type: 2019 Prior Approval ACA RatesDate Submitted: 05/14/2018SERFF Tr Num: NDPD-131469299SERFF Status: Pending State ActionState Tr Num: 2018050212State Status: CP-xx-RRCo Tr Num:

ImplementationDate Requested:

01/01/2019

Disposition Date:Disposition Status:Implementation Date:

State Filing Description:

SERFF Tracking #: NDPD-131469299 State Tracking #: 2018050212 Company Tracking #:

State: New York Filing Company: Independent Health Benefits CorporationTOI/Sub-TOI: H15G Group Health - Hospital/Surgical/Medical Expense/H15G.003 Small Group OnlyProduct Name: 2019 IHBC Small Group Prior ApprovalProject Name/Number: /

PDF Pipeline for SERFF Tracking Number NDPD-131469299 Generated 05/21/2018 08:01 AM

General Information

Company and Contact

Project Name: Status of Filing in Domicile:Project Number: Date Approved in Domicile:Requested Filing Mode: Review & Approval Domicile Status Comments:Explanation for Combination/Other: Market Type: GroupSubmission Type: New Submission Group Market Size: SmallGroup Market Type: Employer Overall Rate Impact:Filing Status Changed: 05/18/2018State Status Changed: 05/18/2018 Deemer Date:

Corresponding Filing Tracking Number:

PPACA: Non-Grandfathered Immed Mkt Reforms

PPACA Notes: nullExchange Intentions: Some plans included in this filing are intended to be sold on

the New York State of Health Insurance Exchange

Filing Description:Independent Health is submitting for your review and approval, our 2019 Small Group rates. Our forms will be submitted in twoseparate submissions (NDPD-131469340 and NDPD-131467740).

The enclosed information contains trade secrets that are maintained for the regulation of Independent Health. If thisinformation is disclosed it will cause substantial injury to Independent Health’s competitive position in the New York Statehealth and insurance markets.

For these reasons, the information being submitted should be excepted from any Freedom of Information Law disclosurepursuant to §87 of the Public Officers Law. Should there be a Freedom of Information Law request for the information beingsubmitted, Independent Health intends to fully exercise any rights it may have pursuant to §89 of the Public Officers Law.

Filing Contact Information

Filing Company InformationIndependent Health BenefitsCorporation511 Farber Lakes DriveBuffalo, NY 14221(716) 631-3001 ext. [Phone]

CoCode: 47034Group Code: -99Group Name:FEIN Number: 16-1483784

State of Domicile: New YorkCompany Type: Health Article43State ID Number: 16-1483784




Filing Fees

State Specific

Fee Required? No

Retaliatory? No

Fee Explanation:

1. Is a parallel filing being submitted for another issuing entity of the same parent organization? Yes/No (If Yes, enter nameof other entity, submission date, and SERFF Tracking Number of the parallel file.): No2. Type of insurer? Article 43, HMO, Commercial, Municipal Coop, or Fraternal Benefit Society: Article 433. Is this filing for Group Remittance, Statutory Individual HMO, Statutory Individual POS, Blanket, or Healthy New York?Yes/No (If Yes, enter which one.): Yes, Healthy New York4. Type of filing? Enter Form and Rate, Form only, Rate only (Form only should be used ONLY when the filing only containsan application, advertisement, administrative form, or is a group prefiling notification, out-of-state, or a report filing. Formsubmissions with no proposed rate impact are considered form and rate filings and require an actuarial memorandum.): RateOnly5. Is this a Rate only filing? Yes/No [If Yes, enter one: Commission/Fee Schedule, Prior Approval Rate Adjustment, DBLLoss Ratio Monitoring, Loss Ratio Experience Monitoring/Reporting, Medicare Supplement Annual Filing (other than rateadjustment), Medicare Supplement Refund Calculation Filing, Timothy's Law Subsidy Filing, Sole Proprietor Rating, 4308(h)Loss Ratio Report, 3231(e) Loss Ratio Report, Experience Rating Formula, or Other with brief explanation).]: Yes, PriorApproval Rate Adjustment6. Does this submission contain a form subject to Regulation 123? Yes/No (If Yes, provide a full explanation in the FilingDescription field.: No7. Did this insurer prefile group coverage for this group under Section 52.32 prior to this filing? Yes/No (If Yes, enter thestate tracking number assigned and the effective date of coverage.): No8. Does this submission contain any form which is subject to review by the Life Bureau, the Property Bureau or both? Yes/No(If Yes, identify the forms, the Bureau, the date submitted, and the SERFF file number.): No9. Does this filing contain forms that replace any other previously approved forms? Yes/No (If Yes, identify the formnumbers, the file number, and the date of approval of the forms being replaced in the Filing Description field.): No10. If this is a rate adjustment filing pursuant to Section 3231(e)(1) or 4308(c), did this insurer submit a "Prior ApprovalPrefiling" containing a draft narrative summary, a draft initial notification letter, and a draft numerical summary associated withthis filing? Yes/No (If Yes, enter the state tracking number and the SERFF tracking number of the prefile.): Yes, 2018050052,NDPD-131469317




Rate Information Rate data applies to filing.

Filing Method: 2019 Prior Approval ACA RatesRate Change Type: IncreaseOverall Percentage of Last Rate Revision: %Effective Date of Last Rate Revision: 01/01/2018Filing Method of Last Filing: 2018 Prior Approval ACA RatesSERFF Tracking Number of Last Filing: NDPD-130994082

Company Rate Information

CompanyName:

CompanyRateChange:

Overall %IndicatedChange:

Overall %RateImpact:

WrittenPremiumChange forthis Program:

Number of PolicyHolders Affectedfor this Program:

WrittenPremium forthis Program:

Maximum %Change(where req'd):

Minimum %Change(where req'd):

Independent HealthBenefits Corporation

Increase 3.790% 3.790% $7,713,463 5,714 $211,106,382 13.210% 0.450%




Rate Review Detail COMPANY:Company Name: Independent Health Benefits CorporationHHS Issuer Id: 18029

PRODUCTS:

Product Name HIOS Product ID HIOS Submission ID Number of CoveredLives

Choice Plus Gold 18029NY1200094 17Choice Plus Gold 18029NY1200083 16Choice Plus Gold 18029NY1200088 302Choice Plus Platinum 18029NY1170097 3Choice Plus Platinum 18029NY1170101 185Choice Plus Platinum 18029NY1170104 8Choice Plus Silver HSAQ 18029NY1240067 32Choice Plus Silver HSAQ 18029NY1240072 832Choice Plus Silver HSAQ 18029NY1240078 33FlexFit Platinum 18029NY1170035 592FlexFit Platinum 18029NY1170037 27FlexFit Platinum 18029NY1170040 12074FlexFit Platinum 18029NY1170043 5FlexFit Platinum 18029NY1170046 255FlexFit Platinum 18029NY1170033 212FlexFit Platinum Copay NYS OON 18029NY1170020 10FlexFit Platinum Copay NYS OON 18029NY1170017 33Healthy New York 18029NY1200194 35Healthy New York 18029NY1200197 1180Healthy New York 18029NY1200200 4iDirect Bronze Enhanced HSAQ 18029NY1300125 39iDirect Bronze Enhanced HSAQ 18029NY1300128 4iDirect Bronze HSAQ 18029NY1300097 8iDirect Bronze HSAQ 18029NY1300099 46iDirect Bronze HSAQ 18029NY1300104 1647iDirect Bronze HSAQ 18029NY1300110 88iDirect Bronze MV HSAQ 18029NY1300113 2iDirect Bronze MV HSAQ 18029NY1300114 10iDirect Bronze MV HSAQ 18029NY1300117 810iDirect Bronze MV HSAQ 18029NY1300120 7iDirect Gold Copay 18029NY1200033 16iDirect Gold Copay 18029NY1200035 79iDirect Gold Copay 18029NY1200037 2iDirect Gold Copay 18029NY1200040 3825iDirect Gold Copay 18029NY1200046 102iDirect Gold Copay HSAQ 18029NY1200178 146iDirect Gold Copay HSAQ 18029NY1200181 1201




Product Name HIOS Product ID HIOS Submission ID Number of CoveredLives

iDirect Gold Copay HSAQ 18029NY1200184 163iDirect Silver Coinsurance HSAQ 18029NY1240035 25iDirect Silver Coinsurance HSAQ 18029NY1240040 1428iDirect Silver Coinsurance HSAQ 18029NY1240046 7iDirect Silver Copay 18029NY1240145 32iDirect Silver Copay 18029NY1240146 169iDirect Silver Copay 18029NY1240149 3959iDirect Silver Copay 18029NY1240152 134iDirect Silver Copay HSAQ 18029NY1240193 34iDirect Silver Copay HSAQ 18029NY1240194 208iDirect Silver Copay HSAQ 18029NY1240197 5236iDirect Silver Copay HSAQ 18029NY1240199 10iDirect Silver Copay HSAQ 18029NY1240200 206Max Gold 18029NY1200189 352Max Gold 18029NY1200192 3Max Gold 18029NY1200186 11Max Silver 18029NY1240181 201Max Silver 18029NY1240184 26Max Silver 18029NY1240178 5NY PA Gold 18029NY1210030 5NY PA Gold 18029NY1210024 75NY PA Silver HSAQ 18029NY1250030 2NY PA Silver HSAQ 18029NY1250024 66Passport Plan Bronze HSAQ 18029NY1270040 5Passport Plan Gold 18029NY1210061 10Passport Plan Platinum 18029NY1410005 4Passport Plan Silver HSAQ 18029NY1250040 14Passport Plan Silver HSAQ 18029NY1250046 2Standard Bronze 18029NY1300008 38Standard Bronze 18029NY1300014 12Standard Bronze 18029NY1300146 4Standard Bronze 18029NY1300149 378Standard Bronze 18029NY1300152 9Standard Bronze 18029NY1300003 5Standard Silver 18029NY1240008 75Standard Silver 18029NY1240014 5Standard Silver 18029NY1240185 11Standard Silver 18029NY1240186 16Standard Silver 18029NY1240189 1110Standard Silver 18029NY1240192 20Standard Silver 18029NY1240003 6

Trend Factors:

FORMS:




New Policy Forms:Affected Forms:Other Affected Forms: IHBC-C1027, IHBC-C1035, IHBC-C1037

REQUESTED RATE CHANGE INFORMATION:Change Period: AnnualMember Months: 455,616Benefit Change: NonePercent Change Requested: Min: 0.45 Max: 13.21 Avg: 3.79

PRIOR RATE:Total Earned Premium: 203,392,918.70Total Incurred Claims: 177,542,086.57Annual $: Min: 299.20 Max: 843.09 Avg: 446.41

REQUESTED RATE:Projected Earned Premium: 211,106,381.94Projected Incurred Claims: 184,934,462.34Annual $: Min: 339.83 Max: 890.59 Avg: 463.34




Rate/Rule Schedule

ItemNo.

ScheduleItemStatus

Document NameAffected Form Numbers(Separated with commas) Rate Action Rate Action Information Attachments

1 Rate Manual IHBC-C1027, IHBC-C1035,IHBC-C1037

New 2019 IHBC SmallGroup RateManual_5_8_18.pdf,2019 IHBC SmallGroup RateManual_5_8_18.xlsx,




Independent Health Benefits Corporation

Independent Health's Small Group Rate Manual

For Plans Offered On and Off New York State's Health Insurance Exchange

Effective January 1, 2019

Section Description Pages

A. 1

B. 2

C. 3

D. 4

E. 5-8

F. 9-64Premium Rates

Independent Health Benefits Corporation511 Farber Lakes Drive

Buffalo, NY 14221


For Plans Offered On and Off the NYS Health Insurance Exchange

Table of Contents

Broker Commissions

Expected Loss Ratio

Counties

Premium Calculation

Benefit Grids

Table of Contents

New Community-Rated Commercial Business

Existing Community-Rated Commercial Business

Additional Schedule A Rules and Regulations

All Commission Payments Shall Comply with Applicable Law


Commission Schedule A



Buffalo, NY 14221

511 Farber Lakes Drive

- Groups in this component move to the Existing Community-Rated Commercial Business component on January 1st of each year.

- Commissions are paid on the entire premium received by Independent Health

- 4% paid on the sale of a new Client (Client refers to an employer group throughout this document) that does not currently offer Independent

Health

- Cap of $300,000 per product offering per Client per year

- Once the commission for a Client is established as Existing Community-Rated Commercial Business, it remains in this component unless the Client

changes to an experience-rated product, even if the Client issues a new Broker of Record letter (BOR).

- Brokers who receive a BOR on an existing Client with no current BOR become eligible on and after the next open enrollment date after which the

BOR is received.

- Broker of Record (BOR) must be received at least 45 days prior to open enrollment date

- 4% paid on entire premium received by Independent Health

- Retro-adjustments of community-rated commissions will be made up to a maximum of 90 days. Experience-rated commissions will be retro-

adjusted without any time limitations. Medicare commissions are not retroactive.

- Independent Health reserves the right to apply this Commission Schedule and to make determinations of eligibility, commission payments and

any other issue arising from this Commission Schedule. A determination made in the sole discretion of Independent Health is final as to Broker.

In the event any commission payments made hereunder are found to be in violation of federal or state laws or regulations, Independent Health

reserves the right to recoup paid commissions and to cease making further commissions. Broker/Agent agrees to repay Independent Health any

commission that is paid in violation of laws or regulations.

- No commissions will be paid unless there is a signed BOR on file with Independent Health.

- Independent Health reserves the right to request an updated BOR at any time.

- Broker must actively work with Client from date of BOR through all subsequent Open Enrollments to continue receiving commissions.

- This commission schedule applies to employer group coverage on and off of the Small Business Marketplace

1

Small Group Market (On & Off Exchange)

The expected loss ratio is calculated using the traditional New York State methodology as outlined in Circular Letter

15 from 2011:

https://www.dfs.ny.gov/insurance/circltr/2011/cl2011_15.pdf

Independent Health's Small Group Market's loss ratio is expected to be 87.7% which is greater than the required minimum

loss ratio of 82%.

Expected Loss Ratio


Buffalo, NY 14221



2

https://www.dfs.ny.gov/insurance/circltr/2011/cl2011_15.pdf

Small Group Market (On & Off Exchange)

The rating region for this rate manual is the Western New York service Area (Buffalo Area).

These counties include Erie, Niagara, Orleans, Genesee, Wyoming, Chautauqua, Cattaraugus and Allegany.

Certain products, as noted in the Benefit Grids, are only available for sale in a subset of the 8 counties.

Rating Region & Applicable Counties


Buffalo, NY 14221



3

Quarterly Trend: 2.00%

Admin PMPM: $45.73

Profit: 2.00%

Health Insurance Provider Fee: 0.16%

2019 Risk Adjustment User Fee PMPM: $0.15

DFS Adjustment Factor: 100.00%

Conversion Factors 1.200 1.70 2.00 2.85

Employee

+ Child

Rates Effective January 1, 2019

18029NY1240001-00 Standard Silver OFSG.DEP25.SNF200.DPN.FPN $368.43 $508.14 $863.84 $1,016.28 $1,448.20

18029NY1240001-01 Standard Silver ONSG.DEP25.SNF200.DPN.FPN $368.43 $508.14 $863.84 $1,016.28 $1,448.20

18029NY1240003-00 Standard Silver OFSG.DEP29.SNF200.DPY.FPY $372.80 $513.50 $872.95 $1,027.00 $1,463.48

18029NY1240003-01 Standard Silver ONSG.DEP29.SNF200.DPY.FPY $372.80 $513.50 $872.95 $1,027.00 $1,463.48

18029NY1240004-00 Standard Silver OFSG.DEP29.SNF200.DPY.FPN $371.98 $512.50 $871.25 $1,025.00 $1,460.63

18029NY1240004-01 Standard Silver ONSG.DEP29.SNF200.DPY.FPN $371.98 $512.50 $871.25 $1,025.00 $1,460.63





18029NY1240011-00 Standard Silver OFSG.DEP29.SNF200.DPN.FPY $372.80 $513.50 $872.95 $1,027.00 $1,463.48

18029NY1240011-01 Standard Silver ONSG.DEP29.SNF200.DPN.FPY $372.80 $513.50 $872.95 $1,027.00 $1,463.48





Rates Effective April 1, 2019

















Rates Effective July 1, 2019

















Rates Effective October 1, 2019

















Double FamilyHIOS ID Rate Manual Product DescriptionNet Claim Cost as of

Jan 1, 2019Single


Premium Calculation Example


511 Farber Lakes Drive


Buffalo, NY 14221

4

FlexFit PlatinumFlexFit Platinum

Copay NYS OONiShare Platinum Choice Plus Platinum

Passport Plan

Platinum

In-Network Deductible $0 $0 $0 A: $0

B: $1,500$0

Integrated Medical and Drug Deductible No No No No No

In-Network Coinsurance 0% 0% 20%A: 0%

B: 50%0%

In-Network OOP Maximum $5,250 $5,250 $7,350 A: $5,250

B: $6,750$5,250

Emergency Room Services $150 $150 20%A: $150

B: $150 $150

All Inpatient Hospital Services (inc.

MHSA)$500 $500 20%

A: $500

B: 50% After Deductible$500

Primary Care Visit to Treat an injury or

Illness (exc. Preventive, and X-ray)$10 $10 20%

A: $10


Specialist Visit $40 $40 20%A: $40


Mental/Behavioral Health and

Substance Abuse Disorder Outpatient

Services

$30 $30 20%A: $30


Imaging (CT/PET Scans, MRIs) $85 $85 20%A: $85


Rehabilitative Speech Therapy $30 $30 20%A: $30


Rehabilitative Occupational and

Rehabilitative Physician Therapy$30 $30 20%

A: $30


Laboratory Outpatient and Professional

Services$0 $0 20%

A: $0


X-ray and Diagnostic Imaging $30 $30 20%A: $30


Skilled Nursing Facility $500 $500 20%A: $500


Outpatient Facility Fee $150 $150 20%A: $75


Outpatient Surgery Physician/Surgical

Services$0 $0 20%

A: $0


Generics $5 $5 $5 $5 $10

Preferred Brand Drugs $30 $30 20% $30 $30

Non-Preferred Brand Drugs 50% 50% 20% 50% 50%

Specialty Drugs (i.e., high cost) 50% 50% 20% 50% 50%

Out-of-Network Deductible $5,000 $5,000 $5,000 $5,000 $5,000

Out-of-Network Coinsurance 40% 20% 40% 50% 40%

Out-of-Network OOP Maximum $10,000 $10,000 $10,000 $10,000 $10,000

Region Available All 8 WNY All 8 WNY All 8 WNY Erie, Niagara All 8 WNY

Platinum Plans

5

iDirect Gold Copay Choice Plus Gold iShare GoldiDirect Gold

Coinsurance HSAQ

iDirect Gold Copay

HSAQMax Gold Healthy New York NY PA Gold Passport Plan Gold

In-Network Deductible $1,250 A: $1,350

B: $2,250$0 $1,500 $1,500 $1,250 $600 $2,000 $2,000

Integrated Medical and Drug Deductible No No No Yes Yes Yes No No No

In-Network Coinsurance 0%A: 0%

B: 50%40% 20% 0% 20% 0% 20% 20%

In-Network OOP Maximum $7,550 A: $7,550

B: $7,550$7,350 $5,500 $5,750 $6,350 $4,000 $7,550 $7,550

Emergency Room Services $150A: $150

B: $150 40% 20% After Deductible $100 After Deductible 20% After Deductible $150 After Deductible 20% After Deductible 20% After Deductible


MHSA)$1,000 After Deductible

A: $1,000 After Deductible

B: 50% After Deductible40% 20% After Deductible $500 After Deductible $750 After Deductible $1,000 After Deductible 20% After Deductible 20% After Deductible


Illness (exc. Preventive, and X-ray)$20

A: $20

B: 50% After Deductible40% 20% After Deductible $15 After Deductible $15 $25 After Deductible 20% 20%

Specialist Visit $50 A: $50

B: 50% After Deductible40% 20% After Deductible $40 After Deductible $40 After Deductible $40 After Deductible 20% After Deductible 20% After Deductible



Services

$50 A: $50


Imaging (CT/PET Scans, MRIs) $100 After DeductibleA: $100 After Deductible

B: 50% After Deductible40% 20% After Deductible $75 After Deductible 20% After Deductible $40 After Deductible 20% After Deductible 20% After Deductible

Rehabilitative Speech Therapy $45 After DeductibleA: $45 After Deductible



Rehabilitative Physician Therapy$45 After Deductible

A: $45 After Deductible



Services$25 After Deductible



X-ray and Diagnostic Imaging $45 After DeductibleA: $50 After Deductible


Skilled Nursing Facility $1,000 After DeductibleA: $1,000 After Deductible

B: 50% After Deductible40% 20% After Deductible $500 After Deductible $750 After Deductible $1,000 After Deductible 20% After Deductible 20% After Deductible

Outpatient Facility Fee $150 After DeductibleA: $150 After Deductible

B:50% After Deductible40% 20% After Deductible $100 After Deductible $150 After Deductible $100 After Deductible 20% After Deductible 20% After Deductible


Services$45 After Deductible



Generics $10 $10 $15 20% After Deductible $4 After Deductible $10 $10 $10 $10

Preferred Brand Drugs $30 $30 40% 20% After Deductible $30 After Deductible $45 After Deductible $35 $50 $50

Non-Preferred Brand Drugs 50% 50% 40% 20% After Deductible 50% After Deductible 50% After Deductible $70 50% 50%

Specialty Drugs (i.e., high cost) 50% 50% 40% 20% After Deductible 50% After Deductible 50% After Deductible $70 50% 50%

Out-of-Network Deductible $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000

Out-of-Network Coinsurance 50% 50% 50% 50% 50% 50% 40% 50% 50%

Out-of-Network OOP Maximum $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000

Region Available All 8 WNY Erie, Niagara All 8 WNY All 8 WNY All 8 WNY All 8 WNY All 8 WNYChautauqua, Cattaraugus

and AlleganyAll 8 WNY

Gold Plans

6

iDirect Silver

Coinsurance HSAQ

Choice Plus Silver

HSAQ

iDirect Silver Blended

HSAQiDirect Silver Copay Max Silver Standard Silver

iDirect Silver Copay

HSAQNY PA Silver HSAQ Passport Plan Silver HSAQ

In-Network Deductible $3,000 A: $2,600

B: $3,750$3,325 $2,250 $2,800 $1,700 $2,250 $3,000 $3,000

Integrated Medical and Drug Deductible Yes Yes No No Yes No Yes Yes Yes

In-Network Coinsurance 20%A: 30%

B:50%25% 0% $0 0% 0% 20% 20%

In-Network OOP Maximum $6,650 A: $6,650

B: $6,650$7,350 $7,550 $7,350 $7,500 $6,650 $6,650 $6,650

Emergency Room Services 20% After DeductibleA: $250 After Deductible

B:$250 After Deductible25% After Deductible $250 After Deductible $225 After Deductible $250 After Deductible $250 After Deductible 20% After Deductible 20% After Deductible


MHSA)20% After Deductible

A: 30% After Deductible

B: 50% After Deductible25% After Deductible $1,000 After Deductible $1,000 After Deductible $1,500 After Deductible $1,000 After Deductible 20% After Deductible 20% After Deductible


Illness (exc. Preventive, and X-ray)20% After Deductible


B: 50% After Deductible$35 After Deductible $35 After Deductible $35 $30 After Deductible $35 After Deductible 20% After Deductible 20% After Deductible

Specialist Visit 20% After DeductibleA: $60 After Deductible

B: 50% After Deductible$50 After Deductible $60 After Deductible $50 After Deductible $50 After Deductible $60 After Deductible 20% After Deductible 20% After Deductible



Services

20% After DeductibleA: $60 After Deductible


Imaging (CT/PET Scans, MRIs) 20% After DeductibleA: $150 After Deductible


Rehabilitative Speech Therapy 20% After DeductibleA: $50 After Deductible



Rehabilitative Physician Therapy20% After Deductible




Services20% After Deductible



X-ray and Diagnostic Imaging 20% After DeductibleA: $60 After Deductible


Skilled Nursing Facility 20% After DeductibleA: 30% After Deductible

B: 50% After Deductible25% After Deductible $1,000 After Deductible $1,000 After Deductible $1,500 After Deductible $1,000 After Deductible 20% After Deductible 20% After Deductible

Outpatient Facility Fee 20% After DeductibleA: $200 After Deductible

B: 50% After Deductible25% After Deductible $200 After Deductible $200 After Deductible $100 After Deductible $200 After Deductible 20% After Deductible 20% After Deductible


Services20% After Deductible


B:50% After Deductible$0 After Deductible $60 After Deductible $50 After Deductible $100 After Deductible $60 After Deductible 20% After Deductible 20% After Deductible

Generics $15 After Deductible $15 After Deductible 25% $10 $10 $10 $15 After Deductible $15 After Deductible $15 After Deductible

Preferred Brand Drugs $50 After Deductible $50 After Deductible 25% $50 $50 After Deductible $35 $50 After Deductible $50 After Deductible $50 After Deductible

Non-Preferred Brand Drugs 50% After Deductible 50% After Deductible 25% 50% 50% After Deductible $70 50% After Deductible 50% After Deductible 50% After Deductible

Specialty Drugs (i.e., high cost) 50% After Deductible 50% After Deductible 25% 50% 50% After Deductible $70 50% After Deductible 50% After Deductible 50% After Deductible

Out-of-Network Deductible $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000

Out-of-Network Coinsurance 50% 50% 50% 50% 50% 50% 50% 50% 50%

Out-of-Network OOP Maximum $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000

Region Available All 8 WNY Erie, Niagara All 8 WNY All 8 WNY All 8 WNY All 8 WNY All 8 WNYChautauqua, Cattaraugus and

AlleganyAll 8 WNY

Silver Plans

7

Passport Plan Bronze Standard Bronze iDirect Bronze HSAQiDirect Bronze MV

HSAQ

iDirect Bronze

Enhanced HSAQIn-Network Deductible $5,150 $4,000 $5,150 $6,650 $3,500

Integrated Medical and Drug Deductible Yes Yes Yes Yes Yes

In-Network Coinsurance 50% 50% 50% $0 30%

In-Network OOP Maximum $6,650 $7,600 $6,650 $6,650 $6,650

Emergency Room Services 50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible


MHSA)50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible


Illness (exc. Preventive, and X-ray)50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Specialist Visit 50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible



Services

50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Imaging (CT/PET Scans, MRIs) 50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Rehabilitative Speech Therapy 50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible


Rehabilitative Physician Therapy50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible


Services50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

X-ray and Diagnostic Imaging 50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Skilled Nursing Facility 50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Outpatient Facility Fee 50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible


Services50% After Deductible 50% After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Generics 50% After Deductible $10 After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Preferred Brand Drugs 50% After Deductible $35 After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Non-Preferred Brand Drugs 50% After Deductible $70 After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Specialty Drugs (i.e., high cost) 50% After Deductible $70 After Deductible 50% After Deductible $0 After Deductible 30% After Deductible

Out-of-Network Deductible $8,000 $5,000 $8,000 $10,000 $5,000

Out-of-Network Coinsurance 50% 50% 50% 50% 50%

Out-of-Network OOP Maximum $10,000 $10,000 $10,000 $15,000 $10,000

Region Available All 8 WNY All 8 WNY All 8 WNY All 8 WNY All 8 WNY

Bronze Plans

8

HIOS Plan ID Marketing Name Product Description SingleEmployee +

Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider

18029NY1170015-01 IHBC-C1027 IHBC-SBP1011 IHBC-R1064 IHBC-R1065 IHBC-R2014 FlexFit Platinum Copay NYS OON ONSG.DEP29.SNF365.DPY.FPN $637.74 $1,084.16 $1,275.48 $1,817.56

18029NY1170016-01 IHBC-C1027 IHBC-SBP1011 IHBC-R1065 IHBC-R2014 FlexFit Platinum Copay NYS OON ONSG.DEP25.SNF365.DPY.FPN $632.19 $1,074.72 $1,264.38 $1,801.74

18029NY1170017-01 IHBC-C1027 IHBC-SBP1011 IHBC-R1065 IHBC-R2014 FlexFit Platinum Copay NYS OON ONSG.DEP25.SNF365.DPY.FPY $633.46 $1,076.88 $1,266.92 $1,805.36

18029NY1170018-01 IHBC-C1027 IHBC-SBP1011 IHBC-R1064 IHBC-R2014 FlexFit Platinum Copay NYS OON ONSG.DEP29.SNF365.DPN.FPN $637.74 $1,084.16 $1,275.48 $1,817.56

18029NY1170019-01 IHBC-C1027 IHBC-SBP1011 IHBC-R1064 IHBC-R2014 FlexFit Platinum Copay NYS OON ONSG.DEP29.SNF365.DPN.FPY $639.02 $1,086.33 $1,278.04 $1,821.21

18029NY1170020-01 IHBC-C1027 IHBC-SBP1011 IHBC-R2014 FlexFit Platinum Copay NYS OON ONSG.DEP25.SNF365.DPN.FPY $633.46 $1,076.88 $1,266.92 $1,805.36

18029NY1170021-01 IHBC-C1027 IHBC-SBP1011 IHBC-R2014 FlexFit Platinum Copay NYS OON ONSG.DEP25.SNF365.DPN.FPN $632.19 $1,074.72 $1,264.38 $1,801.74

18029NY1170022-01 IHBC-C1027 IHBC-SBP1011 IHBC-R1064 IHBC-R1065 IHBC-R2014 FlexFit Platinum Copay NYS OON ONSG.DEP29.SNF365.DPY.FPY $639.02 $1,086.33 $1,278.04 $1,821.21

18029NY1170033-01 IHBC-C1027 IHBC-SBP1003 IHBC-R2014 FlexFit Platinum ONSG.DEP25.SNF365.DPN.FPN $631.98 $1,074.37 $1,263.96 $1,801.14

18029NY1170035-01 IHBC-C1027 IHBC-SBP1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 FlexFit Platinum ONSG.DEP29.SNF365.DPY.FPY $638.82 $1,085.99 $1,277.64 $1,820.64

18029NY1170036-01 IHBC-C1027 IHBC-SBP1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 FlexFit Platinum ONSG.DEP29.SNF365.DPY.FPN $637.53 $1,083.80 $1,275.06 $1,816.96

18029NY1170037-01 IHBC-C1027 IHBC-SBP1003 IHBC-R1065 IHBC-R2014 FlexFit Platinum ONSG.DEP25.SNF365.DPY.FPN $631.98 $1,074.37 $1,263.96 $1,801.14

18029NY1170040-01 IHBC-C1027 IHBC-SBP1003 IHBC-R1065 IHBC-R2014 FlexFit Platinum ONSG.DEP25.SNF365.DPY.FPY $633.26 $1,076.54 $1,266.52 $1,804.79

18029NY1170043-01 IHBC-C1027 IHBC-SBP1003 IHBC-R1064 IHBC-R2014 FlexFit Platinum ONSG.DEP29.SNF365.DPN.FPY $638.82 $1,085.99 $1,277.64 $1,820.64

18029NY1170045-01 IHBC-C1027 IHBC-SBP1003 IHBC-R1064 IHBC-R2014 FlexFit Platinum ONSG.DEP29.SNF365.DPN.FPN $637.53 $1,083.80 $1,275.06 $1,816.96

18029NY1170046-01 IHBC-C1027 IHBC-SBP1003 IHBC-R2014 FlexFit Platinum ONSG.DEP25.SNF365.DPN.FPY $633.26 $1,076.54 $1,266.52 $1,804.79

18029NY1170065-01 IHBC-C1027 IHBC-SBP1013 IHBC-R2014 iShare Platinum ONSG.DEP25.SNF365.DPN.FPN $599.72 $1,019.52 $1,199.44 $1,709.20

18029NY1170066-01 IHBC-C1027 IHBC-SBP1013 IHBC-R1064 IHBC-R1065 IHBC-R2014 iShare Platinum ONSG.DEP29.SNF365.DPY.FPY $606.17 $1,030.49 $1,212.34 $1,727.58

18029NY1170067-01 IHBC-C1027 IHBC-SBP1013 IHBC-R1064 IHBC-R1065 IHBC-R2014 iShare Platinum ONSG.DEP29.SNF365.DPY.FPN $604.97 $1,028.45 $1,209.94 $1,724.16

18029NY1170068-01 IHBC-C1027 IHBC-SBP1013 IHBC-R1065 IHBC-R2014 iShare Platinum ONSG.DEP25.SNF365.DPY.FPN $599.72 $1,019.52 $1,199.44 $1,709.20

18029NY1170069-01 IHBC-C1027 IHBC-SBP1013 IHBC-R1065 IHBC-R2014 iShare Platinum ONSG.DEP25.SNF365.DPY.FPY $600.92 $1,021.56 $1,201.84 $1,712.62

18029NY1170070-01 IHBC-C1027 IHBC-SBP1013 IHBC-R1064 IHBC-R2014 iShare Platinum ONSG.DEP29.SNF365.DPN.FPN $604.97 $1,028.45 $1,209.94 $1,724.16

18029NY1170071-01 IHBC-C1027 IHBC-SBP1013 IHBC-R1064 IHBC-R2014 iShare Platinum ONSG.DEP29.SNF365.DPN.FPY $606.17 $1,030.49 $1,212.34 $1,727.58

18029NY1170072-01 IHBC-C1027 IHBC-SBP1013 IHBC-R2014 iShare Platinum ONSG.DEP25.SNF365.DPN.FPY $600.92 $1,021.56 $1,201.84 $1,712.62

18029NY1170097-01 IHBC-C1036 IHBC-SBP1008 IHBC-R2014 Choice Plus Platinum ONSG.DEP25.SNF365.DPN.FPN $586.37 $996.83 $1,172.74 $1,671.15

18029NY1170098-01 IHBC-C1036 IHBC-SBP1008 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Platinum ONSG.DEP29.SNF365.DPY.FPY $592.65 $1,007.51 $1,185.30 $1,689.05

18029NY1170099-01 IHBC-C1036 IHBC-SBP1008 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Platinum ONSG.DEP29.SNF365.DPY.FPN $591.47 $1,005.50 $1,182.94 $1,685.69

18029NY1170100-01 IHBC-C1036 IHBC-SBP1008 IHBC-R1065 IHBC-R2014 Choice Plus Platinum ONSG.DEP25.SNF365.DPY.FPN $586.37 $996.83 $1,172.74 $1,671.15

18029NY1170101-01 IHBC-C1036 IHBC-SBP1008 IHBC-R1065 IHBC-R2014 Choice Plus Platinum ONSG.DEP25.SNF365.DPY.FPY $587.54 $998.82 $1,175.08 $1,674.49

18029NY1170102-01 IHBC-C1036 IHBC-SBP1008 IHBC-R1064 IHBC-R2014 Choice Plus Platinum ONSG.DEP29.SNF365.DPN.FPY $592.65 $1,007.51 $1,185.30 $1,689.05

18029NY1170103-01 IHBC-C1036 IHBC-SBP1008 IHBC-R1064 IHBC-R2014 Choice Plus Platinum ONSG.DEP29.SNF365.DPN.FPN $591.47 $1,005.50 $1,182.94 $1,685.69

18029NY1170104-01 IHBC-C1036 IHBC-SBP1008 IHBC-R2014 Choice Plus Platinum ONSG.DEP25.SNF365.DPN.FPY $587.54 $998.82 $1,175.08 $1,674.49

Form Numbers

Independent Health Benefits CorporationSmall Group On Exchange Premium Rates Effective January 1, 2019

ON = On Exchange

SG = Small Group

DEP25 = Dependents to 25


SNF200 = Skilled Nursing Facility 200 days max

SNF365 = Unlimited Skilled Nursing Facility

DPY = Domestic Partner

FPY = Family Planning

Platinum Plans

9


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider

Form Numbers


ON = On Exchange

SG = Small Group







18029NY1200033-01 IHBC-C1027 IHBC-SBG1003 IHBC-R2014 iDirect Gold Copay ONSG.DEP25.SNF365.DPN.FPN $557.78 $948.23 $1,115.56 $1,589.67

18029NY1200035-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay ONSG.DEP29.SNF365.DPY.FPY $563.72 $958.32 $1,127.44 $1,606.60

18029NY1200036-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay ONSG.DEP29.SNF365.DPY.FPN $562.61 $956.44 $1,125.22 $1,603.44

18029NY1200037-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1065 IHBC-R2014 iDirect Gold Copay ONSG.DEP25.SNF365.DPY.FPN $557.78 $948.23 $1,115.56 $1,589.67

18029NY1200040-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1065 IHBC-R2014 iDirect Gold Copay ONSG.DEP25.SNF365.DPY.FPY $558.88 $950.10 $1,117.76 $1,592.81

18029NY1200043-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R2014 iDirect Gold Copay ONSG.DEP29.SNF365.DPN.FPY $563.72 $958.32 $1,127.44 $1,606.60

18029NY1200045-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R2014 iDirect Gold Copay ONSG.DEP29.SNF365.DPN.FPN $562.61 $956.44 $1,125.22 $1,603.44

18029NY1200046-01 IHBC-C1027 IHBC-SBG1003 IHBC-R2014 iDirect Gold Copay ONSG.DEP25.SNF365.DPN.FPY $558.88 $950.10 $1,117.76 $1,592.81

18029NY1200081-01 IHBC-C1036 IHBC-SBG1007 IHBC-R2014 Choice Plus Gold ONSG.DEP25.SNF365.DPN.FPN $519.81 $883.68 $1,039.62 $1,481.46

18029NY1200083-01 IHBC-C1036 IHBC-SBG1007 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Gold ONSG.DEP29.SNF365.DPY.FPY $525.30 $893.01 $1,050.60 $1,497.11

18029NY1200084-01 IHBC-C1036 IHBC-SBG1007 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Gold ONSG.DEP29.SNF365.DPY.FPN $524.27 $891.26 $1,048.54 $1,494.17

18029NY1200085-01 IHBC-C1036 IHBC-SBG1007 IHBC-R1065 IHBC-R2014 Choice Plus Gold ONSG.DEP25.SNF365.DPY.FPN $519.81 $883.68 $1,039.62 $1,481.46

18029NY1200088-01 IHBC-C1036 IHBC-SBG1007 IHBC-R1065 IHBC-R2014 Choice Plus Gold ONSG.DEP25.SNF365.DPY.FPY $520.82 $885.39 $1,041.64 $1,484.34

18029NY1200091-01 IHBC-C1036 IHBC-SBG1007 IHBC-R1064 IHBC-R2014 Choice Plus Gold ONSG.DEP29.SNF365.DPN.FPY $525.30 $893.01 $1,050.60 $1,497.11

18029NY1200093-01 IHBC-C1036 IHBC-SBG1007 IHBC-R1064 IHBC-R2014 Choice Plus Gold ONSG.DEP29.SNF365.DPN.FPN $524.27 $891.26 $1,048.54 $1,494.17

18029NY1200094-01 IHBC-C1036 IHBC-SBG1007 IHBC-R2014 Choice Plus Gold ONSG.DEP25.SNF365.DPN.FPY $520.82 $885.39 $1,041.64 $1,484.34

18029NY1200129-01 IHBC-C1027 IHBC-SBG1015 IHBC-R2014 iShare Gold ONSG.DEP25.SNF365.DPN.FPN $524.27 $891.26 $1,048.54 $1,494.17

18029NY1200130-01 IHBC-C1027 IHBC-SBG1015 IHBC-R1064 IHBC-R1065 IHBC-R2014 iShare Gold ONSG.DEP29.SNF365.DPY.FPY $529.82 $900.69 $1,059.64 $1,509.99

18029NY1200131-01 IHBC-C1027 IHBC-SBG1015 IHBC-R1064 IHBC-R1065 IHBC-R2014 iShare Gold ONSG.DEP29.SNF365.DPY.FPN $528.78 $898.93 $1,057.56 $1,507.02

18029NY1200132-01 IHBC-C1027 IHBC-SBG1015 IHBC-R1065 IHBC-R2014 iShare Gold ONSG.DEP25.SNF365.DPY.FPN $524.27 $891.26 $1,048.54 $1,494.17

18029NY1200133-01 IHBC-C1027 IHBC-SBG1015 IHBC-R1065 IHBC-R2014 iShare Gold ONSG.DEP25.SNF365.DPY.FPY $525.30 $893.01 $1,050.60 $1,497.11

18029NY1200134-01 IHBC-C1027 IHBC-SBG1015 IHBC-R1064 IHBC-R2014 iShare Gold ONSG.DEP29.SNF365.DPN.FPN $528.78 $898.93 $1,057.56 $1,507.02

18029NY1200135-01 IHBC-C1027 IHBC-SBG1015 IHBC-R1064 IHBC-R2014 iShare Gold ONSG.DEP29.SNF365.DPN.FPY $529.82 $900.69 $1,059.64 $1,509.99

18029NY1200136-01 IHBC-C1027 IHBC-SBG1015 IHBC-R2014 iShare Gold ONSG.DEP25.SNF365.DPN.FPY $525.30 $893.01 $1,050.60 $1,497.11

Gold Plans

10


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider

Form Numbers


ON = On Exchange

SG = Small Group







18029NY1200137-01 IHBC-C1027 IHBC-SBG1016 IHBC-R2014 iDirect Gold Coinsurance HSAQ ONSG.DEP25.SNF365.DPN.FPN $510.72 $868.22 $1,021.44 $1,455.55

18029NY1200138-01 IHBC-C1027 IHBC-SBG1016 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Coinsurance HSAQ ONSG.DEP29.SNF365.DPY.FPY $516.11 $877.39 $1,032.22 $1,470.91

18029NY1200139-01 IHBC-C1027 IHBC-SBG1016 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Coinsurance HSAQ ONSG.DEP29.SNF365.DPY.FPN $515.09 $875.65 $1,030.18 $1,468.01

18029NY1200140-01 IHBC-C1027 IHBC-SBG1016 IHBC-R1065 IHBC-R2014 iDirect Gold Coinsurance HSAQ ONSG.DEP25.SNF365.DPY.FPN $510.72 $868.22 $1,021.44 $1,455.55

18029NY1200141-01 IHBC-C1027 IHBC-SBG1016 IHBC-R1065 IHBC-R2014 iDirect Gold Coinsurance HSAQ ONSG.DEP25.SNF365.DPY.FPY $511.72 $869.92 $1,023.44 $1,458.40

18029NY1200142-01 IHBC-C1027 IHBC-SBG1016 IHBC-R1064 IHBC-R2014 iDirect Gold Coinsurance HSAQ ONSG.DEP29.SNF365.DPN.FPN $515.09 $875.65 $1,030.18 $1,468.01

18029NY1200143-01 IHBC-C1027 IHBC-SBG1016 IHBC-R1064 IHBC-R2014 iDirect Gold Coinsurance HSAQ ONSG.DEP29.SNF365.DPN.FPY $516.11 $877.39 $1,032.22 $1,470.91

18029NY1200144-01 IHBC-C1027 IHBC-SBG1016 IHBC-R2014 iDirect Gold Coinsurance HSAQ ONSG.DEP25.SNF365.DPN.FPY $511.72 $869.92 $1,023.44 $1,458.40

18029NY1200177-01 IHBC-C1027 IHBC-SBG1013 IHBC-R2014 iDirect Gold Copay HSAQ ONSG.DEP25.SNF365.DPN.FPN $525.64 $893.59 $1,051.28 $1,498.07

18029NY1200178-01 IHBC-C1027 IHBC-SBG1013 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay HSAQ ONSG.DEP29.SNF365.DPY.FPY $531.22 $903.07 $1,062.44 $1,513.98

18029NY1200179-01 IHBC-C1027 IHBC-SBG1013 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay HSAQ ONSG.DEP29.SNF365.DPY.FPN $530.19 $901.32 $1,060.38 $1,511.04

18029NY1200180-01 IHBC-C1027 IHBC-SBG1013 IHBC-R1065 IHBC-R2014 iDirect Gold Copay HSAQ ONSG.DEP25.SNF365.DPY.FPN $525.64 $893.59 $1,051.28 $1,498.07

18029NY1200181-01 IHBC-C1027 IHBC-SBG1013 IHBC-R1065 IHBC-R2014 iDirect Gold Copay HSAQ ONSG.DEP25.SNF365.DPY.FPY $526.68 $895.36 $1,053.36 $1,501.04

18029NY1200182-01 IHBC-C1027 IHBC-SBG1013 IHBC-R1064 IHBC-R2014 iDirect Gold Copay HSAQ ONSG.DEP29.SNF365.DPN.FPN $530.19 $901.32 $1,060.38 $1,511.04

18029NY1200183-01 IHBC-C1027 IHBC-SBG1013 IHBC-R1064 IHBC-R2014 iDirect Gold Copay HSAQ ONSG.DEP29.SNF365.DPN.FPY $531.22 $903.07 $1,062.44 $1,513.98

18029NY1200184-01 IHBC-C1027 IHBC-SBG1013 IHBC-R2014 iDirect Gold Copay HSAQ ONSG.DEP25.SNF365.DPN.FPY $526.68 $895.36 $1,053.36 $1,501.04

18029NY1200185-01 IHBC-C1027 IHBC-SBG1014 IHBC-R2014 Max Gold ONSG.DEP25.SNF365.DPN.FPN $537.29 $913.39 $1,074.58 $1,531.28

18029NY1200186-01 IHBC-C1027 IHBC-SBG1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Gold ONSG.DEP29.SNF365.DPY.FPY $543.01 $923.12 $1,086.02 $1,547.58

18029NY1200187-01 IHBC-C1027 IHBC-SBG1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Gold ONSG.DEP29.SNF365.DPY.FPN $541.94 $921.30 $1,083.88 $1,544.53

18029NY1200188-01 IHBC-C1027 IHBC-SBG1014 IHBC-R1065 IHBC-R2014 Max Gold ONSG.DEP25.SNF365.DPY.FPN $537.29 $913.39 $1,074.58 $1,531.28

18029NY1200189-01 IHBC-C1027 IHBC-SBG1014 IHBC-R1065 IHBC-R2014 Max Gold ONSG.DEP25.SNF365.DPY.FPY $538.36 $915.21 $1,076.72 $1,534.33

18029NY1200190-01 IHBC-C1027 IHBC-SBG1014 IHBC-R1064 IHBC-R2014 Max Gold ONSG.DEP29.SNF365.DPN.FPN $541.94 $921.30 $1,083.88 $1,544.53

18029NY1200191-01 IHBC-C1027 IHBC-SBG1014 IHBC-R1064 IHBC-R2014 Max Gold ONSG.DEP29.SNF365.DPN.FPY $543.01 $923.12 $1,086.02 $1,547.58

18029NY1200192-01 IHBC-C1027 IHBC-SBG1014 IHBC-R2014 Max Gold ONSG.DEP25.SNF365.DPN.FPY $538.36 $915.21 $1,076.72 $1,534.33

18029NY1200193-01 IHBC-C1027 IHBC-SBG1001 Healthy New York ONSG.DEP25.SNF200.DPN.FPN $467.61 $794.94 $935.22 $1,332.69

18029NY1200194-01 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 IHBC-R1065 Healthy New York ONSG.DEP29.SNF200.DPY.FPY $472.48 $803.22 $944.96 $1,346.57

18029NY1200195-01 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 IHBC-R1065 Healthy New York ONSG.DEP29.SNF200.DPY.FPN $471.57 $801.67 $943.14 $1,343.97

18029NY1200196-01 IHBC-C1027 IHBC-SBG1001 IHBC-R1065 Healthy New York ONSG.DEP25.SNF200.DPY.FPN $467.61 $794.94 $935.22 $1,332.69

18029NY1200197-01 IHBC-C1027 IHBC-SBG1001 IHBC-R1065 Healthy New York ONSG.DEP25.SNF200.DPY.FPY $468.51 $796.47 $937.02 $1,335.25

18029NY1200198-01 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 Healthy New York ONSG.DEP29.SNF200.DPN.FPN $471.57 $801.67 $943.14 $1,343.97

18029NY1200199-01 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 Healthy New York ONSG.DEP29.SNF200.DPN.FPY $472.48 $803.22 $944.96 $1,346.57

18029NY1200200-01 IHBC-C1027 IHBC-SBG1001 Healthy New York ONSG.DEP25.SNF200.DPN.FPY $468.51 $796.47 $937.02 $1,335.25

11


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider

Form Numbers


ON = On Exchange

SG = Small Group







18029NY1240001-01 IHBC-C1027 IHBC-SBS1001 Standard Silver ONSG.DEP25.SNF200.DPN.FPN $506.46 $860.98 $1,012.92 $1,443.41

18029NY1240003-01 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 IHBC-R1065 Standard Silver ONSG.DEP29.SNF200.DPY.FPY $511.79 $870.04 $1,023.58 $1,458.60

18029NY1240004-01 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 IHBC-R1065 Standard Silver ONSG.DEP29.SNF200.DPY.FPN $510.80 $868.36 $1,021.60 $1,455.78

18029NY1240005-01 IHBC-C1027 IHBC-SBS1001 IHBC-R1065 Standard Silver ONSG.DEP25.SNF200.DPY.FPN $506.46 $860.98 $1,012.92 $1,443.41

18029NY1240008-01 IHBC-C1027 IHBC-SBS1001 IHBC-R1065 Standard Silver ONSG.DEP25.SNF200.DPY.FPY $507.44 $862.65 $1,014.88 $1,446.20

18029NY1240011-01 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 Standard Silver ONSG.DEP29.SNF200.DPN.FPY $511.79 $870.04 $1,023.58 $1,458.60

18029NY1240013-01 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 Standard Silver ONSG.DEP29.SNF200.DPN.FPN $510.80 $868.36 $1,021.60 $1,455.78

18029NY1240014-01 IHBC-C1027 IHBC-SBS1001 Standard Silver ONSG.DEP25.SNF200.DPN.FPY $507.44 $862.65 $1,014.88 $1,446.20

18029NY1240033-01 IHBC-C1027 IHBC-SBS1015 IHBC-R2014 iDirect Silver Coinsurance HSAQ ONSG.DEP25.SNF365.DPN.FPN $446.32 $758.74 $892.64 $1,272.01

18029NY1240035-01 IHBC-C1027 IHBC-SBS1015 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Coinsurance HSAQ ONSG.DEP29.SNF365.DPY.FPY $450.94 $766.60 $901.88 $1,285.18

18029NY1240036-01 IHBC-C1027 IHBC-SBS1015 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Coinsurance HSAQ ONSG.DEP29.SNF365.DPY.FPN $450.08 $765.14 $900.16 $1,282.73

18029NY1240037-01 IHBC-C1027 IHBC-SBS1015 IHBC-R1065 IHBC-R2014 iDirect Silver Coinsurance HSAQ ONSG.DEP25.SNF365.DPY.FPN $446.32 $758.74 $892.64 $1,272.01

18029NY1240040-01 IHBC-C1027 IHBC-SBS1015 IHBC-R1065 IHBC-R2014 iDirect Silver Coinsurance HSAQ ONSG.DEP25.SNF365.DPY.FPY $447.18 $760.21 $894.36 $1,274.46

18029NY1240043-01 IHBC-C1027 IHBC-SBS1015 IHBC-R1064 IHBC-R2014 iDirect Silver Coinsurance HSAQ ONSG.DEP29.SNF365.DPN.FPY $450.94 $766.60 $901.88 $1,285.18

18029NY1240045-01 IHBC-C1027 IHBC-SBS1015 IHBC-R1064 IHBC-R2014 iDirect Silver Coinsurance HSAQ ONSG.DEP29.SNF365.DPN.FPN $450.08 $765.14 $900.16 $1,282.73

18029NY1240046-01 IHBC-C1027 IHBC-SBS1015 IHBC-R2014 iDirect Silver Coinsurance HSAQ ONSG.DEP25.SNF365.DPN.FPY $447.18 $760.21 $894.36 $1,274.46

18029NY1240065-01 IHBC-C1036 IHBC-SBS1012 IHBC-R2014 Choice Plus Silver HSAQ ONSG.DEP25.SNF365.DPN.FPN $430.39 $731.66 $860.78 $1,226.61

18029NY1240067-01 IHBC-C1036 IHBC-SBS1012 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Silver HSAQ ONSG.DEP29.SNF365.DPY.FPY $434.83 $739.21 $869.66 $1,239.27

18029NY1240068-01 IHBC-C1036 IHBC-SBS1012 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Silver HSAQ ONSG.DEP29.SNF365.DPY.FPN $434.00 $737.80 $868.00 $1,236.90

18029NY1240069-01 IHBC-C1036 IHBC-SBS1012 IHBC-R1065 IHBC-R2014 Choice Plus Silver HSAQ ONSG.DEP25.SNF365.DPY.FPN $430.39 $731.66 $860.78 $1,226.61

18029NY1240072-01 IHBC-C1036 IHBC-SBS1012 IHBC-R1065 IHBC-R2014 Choice Plus Silver HSAQ ONSG.DEP25.SNF365.DPY.FPY $431.22 $733.07 $862.44 $1,228.98

18029NY1240075-01 IHBC-C1036 IHBC-SBS1012 IHBC-R1064 IHBC-R2014 Choice Plus Silver HSAQ ONSG.DEP29.SNF365.DPN.FPY $434.83 $739.21 $869.66 $1,239.27

18029NY1240077-01 IHBC-C1036 IHBC-SBS1012 IHBC-R1064 IHBC-R2014 Choice Plus Silver HSAQ ONSG.DEP29.SNF365.DPN.FPN $434.00 $737.80 $868.00 $1,236.90

18029NY1240078-01 IHBC-C1036 IHBC-SBS1012 IHBC-R2014 Choice Plus Silver HSAQ ONSG.DEP25.SNF365.DPN.FPY $431.22 $733.07 $862.44 $1,228.98

Silver Plans

12


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider

Form Numbers


ON = On Exchange

SG = Small Group







18029NY1240129-01 IHBC-C1027 IHBC-SBS1021 IHBC-R2014 iDirect Silver Blended HSAQ ONSG.DEP25.SNF365.DPN.FPN $432.20 $734.74 $864.40 $1,231.77

18029NY1240130-01 IHBC-C1027 IHBC-SBS1021 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Blended HSAQ ONSG.DEP29.SNF365.DPY.FPY $436.66 $742.32 $873.32 $1,244.48

18029NY1240131-01 IHBC-C1027 IHBC-SBS1021 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Blended HSAQ ONSG.DEP29.SNF365.DPY.FPN $435.82 $740.89 $871.64 $1,242.09

18029NY1240132-01 IHBC-C1027 IHBC-SBS1021 IHBC-R1065 IHBC-R2014 iDirect Silver Blended HSAQ ONSG.DEP25.SNF365.DPY.FPN $432.20 $734.74 $864.40 $1,231.77

18029NY1240133-01 IHBC-C1027 IHBC-SBS1021 IHBC-R1065 IHBC-R2014 iDirect Silver Blended HSAQ ONSG.DEP25.SNF365.DPY.FPY $433.02 $736.13 $866.04 $1,234.11

18029NY1240134-01 IHBC-C1027 IHBC-SBS1021 IHBC-R1064 IHBC-R2014 iDirect Silver Blended HSAQ ONSG.DEP29.SNF365.DPN.FPN $435.82 $740.89 $871.64 $1,242.09

18029NY1240135-01 IHBC-C1027 IHBC-SBS1021 IHBC-R1064 IHBC-R2014 iDirect Silver Blended HSAQ ONSG.DEP29.SNF365.DPN.FPY $436.66 $742.32 $873.32 $1,244.48

18029NY1240136-01 IHBC-C1027 IHBC-SBS1021 IHBC-R2014 iDirect Silver Blended HSAQ ONSG.DEP25.SNF365.DPN.FPY $433.02 $736.13 $866.04 $1,234.11

18029NY1240145-01 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPN.FPN $481.35 $818.30 $962.70 $1,371.85

18029NY1240146-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPY.FPY $486.40 $826.88 $972.80 $1,386.24

18029NY1240147-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPY.FPN $485.47 $825.30 $970.94 $1,383.59

18029NY1240148-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPY.FPN $481.35 $818.30 $962.70 $1,371.85

18029NY1240149-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPY.FPY $482.30 $819.91 $964.60 $1,374.56

18029NY1240150-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPN.FPY $486.40 $826.88 $972.80 $1,386.24

18029NY1240151-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPN.FPN $485.47 $825.30 $970.94 $1,383.59

18029NY1240152-01 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPN.FPY $482.30 $819.91 $964.60 $1,374.56

18029NY1240177-01 IHBC-C1027 IHBC-SBS1018 IHBC-R2014 Max Silver ONSG.DEP25.SNF365.DPN.FPN $466.68 $793.36 $933.36 $1,330.04

18029NY1240178-01 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Silver ONSG.DEP29.SNF365.DPY.FPY $471.55 $801.64 $943.10 $1,343.92

18029NY1240179-01 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Silver ONSG.DEP29.SNF365.DPY.FPN $470.64 $800.09 $941.28 $1,341.32

18029NY1240180-01 IHBC-C1027 IHBC-SBS1018 IHBC-R1065 IHBC-R2014 Max Silver ONSG.DEP25.SNF365.DPY.FPN $466.68 $793.36 $933.36 $1,330.04

18029NY1240181-01 IHBC-C1027 IHBC-SBS1018 IHBC-R1065 IHBC-R2014 Max Silver ONSG.DEP25.SNF365.DPY.FPY $467.58 $794.89 $935.16 $1,332.60

18029NY1240182-01 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R2014 Max Silver ONSG.DEP29.SNF365.DPN.FPY $471.55 $801.64 $943.10 $1,343.92

18029NY1240183-01 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R2014 Max Silver ONSG.DEP29.SNF365.DPN.FPN $470.64 $800.09 $941.28 $1,341.32

18029NY1240184-01 IHBC-C1027 IHBC-SBS1018 IHBC-R2014 Max Silver ONSG.DEP25.SNF365.DPN.FPY $467.58 $794.89 $935.16 $1,332.60

18029NY1240193-01 IHBC-C1027 IHBC-SBS1020 IHBC-R2014 iDirect Silver Copay HSAQ ONSG.DEP25.SNF365.DPN.FPN $465.76 $791.79 $931.52 $1,327.42

18029NY1240194-01 IHBC-C1027 IHBC-SBS1020 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay HSAQ ONSG.DEP29.SNF365.DPY.FPY $470.63 $800.07 $941.26 $1,341.30

18029NY1240195-01 IHBC-C1027 IHBC-SBS1020 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay HSAQ ONSG.DEP29.SNF365.DPY.FPN $469.71 $798.51 $939.42 $1,338.67

18029NY1240196-01 IHBC-C1027 IHBC-SBS1020 IHBC-R1065 IHBC-R2014 iDirect Silver Copay HSAQ ONSG.DEP25.SNF365.DPY.FPN $465.76 $791.79 $931.52 $1,327.42

18029NY1240197-01 IHBC-C1027 IHBC-SBS1020 IHBC-R1065 IHBC-R2014 iDirect Silver Copay HSAQ ONSG.DEP25.SNF365.DPY.FPY $466.67 $793.34 $933.34 $1,330.01

18029NY1240198-01 IHBC-C1027 IHBC-SBS1020 IHBC-R1064 IHBC-R2014 iDirect Silver Copay HSAQ ONSG.DEP29.SNF365.DPN.FPN $469.71 $798.51 $939.42 $1,338.67

18029NY1240199-01 IHBC-C1027 IHBC-SBS1020 IHBC-R1064 IHBC-R2014 iDirect Silver Copay HSAQ ONSG.DEP29.SNF365.DPN.FPY $470.63 $800.07 $941.26 $1,341.30

18029NY1240200-01 IHBC-C1027 IHBC-SBS1020 IHBC-R2014 iDirect Silver Copay HSAQ ONSG.DEP25.SNF365.DPN.FPY $466.67 $793.34 $933.34 $1,330.01

13


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider

Form Numbers


ON = On Exchange

SG = Small Group







18029NY1300001-01 IHBC-C1027 IHBC-SBB1001 Standard Bronze ONSG.DEP25.SNF200.DPN.FPN $409.70 $696.49 $819.40 $1,167.65

18029NY1300003-01 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 IHBC-R1065 Standard Bronze ONSG.DEP29.SNF200.DPY.FPY $413.90 $703.63 $827.80 $1,179.62

18029NY1300004-01 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 IHBC-R1065 Standard Bronze ONSG.DEP29.SNF200.DPY.FPN $413.11 $702.29 $826.22 $1,177.36

18029NY1300005-01 IHBC-C1027 IHBC-SBB1001 IHBC-R1065 Standard Bronze ONSG.DEP25.SNF200.DPY.FPN $409.70 $696.49 $819.40 $1,167.65

18029NY1300008-01 IHBC-C1027 IHBC-SBB1001 IHBC-R1065 Standard Bronze ONSG.DEP25.SNF200.DPY.FPY $410.48 $697.82 $820.96 $1,169.87

18029NY1300011-01 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 Standard Bronze ONSG.DEP29.SNF200.DPN.FPY $413.90 $703.63 $827.80 $1,179.62

18029NY1300013-01 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 Standard Bronze ONSG.DEP29.SNF200.DPN.FPN $413.11 $702.29 $826.22 $1,177.36

18029NY1300014-01 IHBC-C1027 IHBC-SBB1001 Standard Bronze ONSG.DEP25.SNF200.DPN.FPY $410.48 $697.82 $820.96 $1,169.87

18029NY1300097-01 IHBC-C1027 IHBC-SBB1004 IHBC-R2014 iDirect Bronze HSAQ ONSG.DEP25.SNF365.DPN.FPN $409.33 $695.86 $818.66 $1,166.59

18029NY1300099-01 IHBC-C1027 IHBC-SBB1004 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze HSAQ ONSG.DEP29.SNF365.DPY.FPY $413.53 $703.00 $827.06 $1,178.56

18029NY1300100-01 IHBC-C1027 IHBC-SBB1004 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze HSAQ ONSG.DEP29.SNF365.DPY.FPN $412.74 $701.66 $825.48 $1,176.31

18029NY1300101-01 IHBC-C1027 IHBC-SBB1004 IHBC-R1065 IHBC-R2014 iDirect Bronze HSAQ ONSG.DEP25.SNF365.DPY.FPN $409.33 $695.86 $818.66 $1,166.59

18029NY1300104-01 IHBC-C1027 IHBC-SBB1004 IHBC-R1065 IHBC-R2014 iDirect Bronze HSAQ ONSG.DEP25.SNF365.DPY.FPY $410.12 $697.20 $820.24 $1,168.84

18029NY1300107-01 IHBC-C1027 IHBC-SBB1004 IHBC-R1064 IHBC-R2014 iDirect Bronze HSAQ ONSG.DEP29.SNF365.DPN.FPY $413.53 $703.00 $827.06 $1,178.56

18029NY1300109-01 IHBC-C1027 IHBC-SBB1004 IHBC-R1064 IHBC-R2014 iDirect Bronze HSAQ ONSG.DEP29.SNF365.DPN.FPN $412.74 $701.66 $825.48 $1,176.31

18029NY1300110-01 IHBC-C1027 IHBC-SBB1004 IHBC-R2014 iDirect Bronze HSAQ ONSG.DEP25.SNF365.DPN.FPY $410.12 $697.20 $820.24 $1,168.84

18029NY1300113-01 IHBC-C1027 IHBC-SBB1007 IHBC-R2014 iDirect Bronze MV HSAQ ONSG.DEP25.SNF365.DPN.FPN $406.44 $690.95 $812.88 $1,158.35

18029NY1300114-01 IHBC-C1027 IHBC-SBB1007 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze MV HSAQ ONSG.DEP29.SNF365.DPY.FPY $410.60 $698.02 $821.20 $1,170.21

18029NY1300115-01 IHBC-C1027 IHBC-SBB1007 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze MV HSAQ ONSG.DEP29.SNF365.DPY.FPN $409.81 $696.68 $819.62 $1,167.96

18029NY1300116-01 IHBC-C1027 IHBC-SBB1007 IHBC-R1065 IHBC-R2014 iDirect Bronze MV HSAQ ONSG.DEP25.SNF365.DPY.FPN $406.44 $690.95 $812.88 $1,158.35

18029NY1300117-01 IHBC-C1027 IHBC-SBB1007 IHBC-R1065 IHBC-R2014 iDirect Bronze MV HSAQ ONSG.DEP25.SNF365.DPY.FPY $407.20 $692.24 $814.40 $1,160.52

18029NY1300118-01 IHBC-C1027 IHBC-SBB1007 IHBC-R1064 IHBC-R2014 iDirect Bronze MV HSAQ ONSG.DEP29.SNF365.DPN.FPN $409.81 $696.68 $819.62 $1,167.96

18029NY1300119-01 IHBC-C1027 IHBC-SBB1007 IHBC-R1064 IHBC-R2014 iDirect Bronze MV HSAQ ONSG.DEP29.SNF365.DPN.FPY $410.60 $698.02 $821.20 $1,170.21

18029NY1300120-01 IHBC-C1027 IHBC-SBB1007 IHBC-R2014 iDirect Bronze MV HSAQ ONSG.DEP25.SNF365.DPN.FPY $407.20 $692.24 $814.40 $1,160.52

18029NY1300121-01 IHBC-C1027 IHBC-SBB1009 IHBC-R2014 iDirect Bronze Enhanced HSAQ ONSG.DEP25.SNF365.DPN.FPN $426.06 $724.30 $852.12 $1,214.27

18029NY1300122-01 IHBC-C1027 IHBC-SBB1009 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze Enhanced HSAQ ONSG.DEP29.SNF365.DPY.FPY $430.45 $731.77 $860.90 $1,226.78

18029NY1300123-01 IHBC-C1027 IHBC-SBB1009 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze Enhanced HSAQ ONSG.DEP29.SNF365.DPY.FPN $429.64 $730.39 $859.28 $1,224.47

18029NY1300124-01 IHBC-C1027 IHBC-SBB1009 IHBC-R1065 IHBC-R2014 iDirect Bronze Enhanced HSAQ ONSG.DEP25.SNF365.DPY.FPN $426.06 $724.30 $852.12 $1,214.27

18029NY1300125-01 IHBC-C1027 IHBC-SBB1009 IHBC-R1065 IHBC-R2014 iDirect Bronze Enhanced HSAQ ONSG.DEP25.SNF365.DPY.FPY $426.89 $725.71 $853.78 $1,216.64

18029NY1300126-01 IHBC-C1027 IHBC-SBB1009 IHBC-R1064 IHBC-R2014 iDirect Bronze Enhanced HSAQ ONSG.DEP29.SNF365.DPN.FPN $429.64 $730.39 $859.28 $1,224.47

18029NY1300127-01 IHBC-C1027 IHBC-SBB1009 IHBC-R1064 IHBC-R2014 iDirect Bronze Enhanced HSAQ ONSG.DEP29.SNF365.DPN.FPY $430.45 $731.77 $860.90 $1,226.78

18029NY1300128-01 IHBC-C1027 IHBC-SBB1009 IHBC-R2014 iDirect Bronze Enhanced HSAQ ONSG.DEP25.SNF365.DPN.FPY $426.89 $725.71 $853.78 $1,216.64

Bronze Plans

14

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider

























18029NY1170097-01 IHBC-C1036 IHBC-SBP1008 IHBC-R2014 Choice Plus Platinum ONSG.DEP25.SNF365.DPN.FPN $598.10 $1,016.77 $1,196.20 $1,704.59



18029NY1170100-01 IHBC-C1036 IHBC-SBP1008 IHBC-R1065 IHBC-R2014 Choice Plus Platinum ONSG.DEP25.SNF365.DPY.FPN $598.10 $1,016.77 $1,196.20 $1,704.59

18029NY1170101-01 IHBC-C1036 IHBC-SBP1008 IHBC-R1065 IHBC-R2014 Choice Plus Platinum ONSG.DEP25.SNF365.DPY.FPY $599.29 $1,018.79 $1,198.58 $1,707.98



18029NY1170104-01 IHBC-C1036 IHBC-SBP1008 IHBC-R2014 Choice Plus Platinum ONSG.DEP25.SNF365.DPN.FPY $599.29 $1,018.79 $1,198.58 $1,707.98


Small Group On Exchange Premium Rates Effective April 1, 2019

Form Numbers

ON = On Exchange

SG = Small Group







Platinum Plans

15

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group































Gold Plans

16

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group







































17

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group































Silver Plans

18

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group















18029NY1240145-01 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPN.FPN $490.98 $834.67 $981.96 $1,399.29

18029NY1240146-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPY.FPY $496.13 $843.42 $992.26 $1,413.97

18029NY1240147-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPY.FPN $495.18 $841.81 $990.36 $1,411.26

18029NY1240148-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPY.FPN $490.98 $834.67 $981.96 $1,399.29

18029NY1240149-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPY.FPY $491.95 $836.32 $983.90 $1,402.06

18029NY1240150-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPN.FPY $496.13 $843.42 $992.26 $1,413.97

18029NY1240151-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPN.FPN $495.18 $841.81 $990.36 $1,411.26

18029NY1240152-01 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPN.FPY $491.95 $836.32 $983.90 $1,402.06

















19

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group







































Bronze Plans

20

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider


































Small Group On Exchange Premium Rates Effective July 1, 2019

Form Numbers

ON = On Exchange

SG = Small Group







Platinum Plans

21

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group































Gold Plans

22

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group







































23

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group































Silver Plans

24

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group















18029NY1240145-01 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPN.FPN $500.80 $851.36 $1,001.60 $1,427.28

18029NY1240146-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPY.FPY $506.05 $860.29 $1,012.10 $1,442.24

18029NY1240147-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPY.FPN $505.08 $858.64 $1,010.16 $1,439.48

18029NY1240148-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPY.FPN $500.80 $851.36 $1,001.60 $1,427.28

18029NY1240149-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPY.FPY $501.78 $853.03 $1,003.56 $1,430.07

18029NY1240150-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPN.FPY $506.05 $860.29 $1,012.10 $1,442.24

18029NY1240151-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPN.FPN $505.08 $858.64 $1,010.16 $1,439.48

18029NY1240152-01 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPN.FPY $501.78 $853.03 $1,003.56 $1,430.07

















25

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group







































Bronze Plans

26

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider


































Small Group On Exchange Premium Rates Effective October 1, 2019

Form Numbers

ON = On Exchange

SG = Small Group







Platinum Plans

27

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group







18029NY1200033-01 IHBC-C1027 IHBC-SBG1003 IHBC-R2014 iDirect Gold Copay ONSG.DEP25.SNF365.DPN.FPN $591.92 $1,006.26 $1,183.84 $1,686.97

18029NY1200035-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay ONSG.DEP29.SNF365.DPY.FPY $598.22 $1,016.97 $1,196.44 $1,704.93

18029NY1200036-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay ONSG.DEP29.SNF365.DPY.FPN $597.05 $1,014.99 $1,194.10 $1,701.59

18029NY1200037-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1065 IHBC-R2014 iDirect Gold Copay ONSG.DEP25.SNF365.DPY.FPN $591.92 $1,006.26 $1,183.84 $1,686.97

18029NY1200040-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1065 IHBC-R2014 iDirect Gold Copay ONSG.DEP25.SNF365.DPY.FPY $593.09 $1,008.25 $1,186.18 $1,690.31

18029NY1200043-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R2014 iDirect Gold Copay ONSG.DEP29.SNF365.DPN.FPY $598.22 $1,016.97 $1,196.44 $1,704.93

18029NY1200045-01 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R2014 iDirect Gold Copay ONSG.DEP29.SNF365.DPN.FPN $597.05 $1,014.99 $1,194.10 $1,701.59

18029NY1200046-01 IHBC-C1027 IHBC-SBG1003 IHBC-R2014 iDirect Gold Copay ONSG.DEP25.SNF365.DPN.FPY $593.09 $1,008.25 $1,186.18 $1,690.31

















Gold Plans

28

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group
































18029NY1200194-01 IHBC-C1027 IHBC-SBG1001 Healthy New York ONSG.DEP25.SNF200.DPN.FPN $501.40 $852.38 $1,002.80 $1,428.99







29

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group































Silver Plans

30

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group















18029NY1240145-01 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPN.FPN $510.81 $868.38 $1,021.62 $1,455.81

18029NY1240146-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPY.FPY $516.17 $877.49 $1,032.34 $1,471.08

18029NY1240147-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPY.FPN $515.18 $875.81 $1,030.36 $1,468.26

18029NY1240148-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPY.FPN $510.81 $868.38 $1,021.62 $1,455.81

18029NY1240149-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPY.FPY $511.82 $870.09 $1,023.64 $1,458.69

18029NY1240150-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPN.FPY $516.17 $877.49 $1,032.34 $1,471.08

18029NY1240151-01 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay ONSG.DEP29.SNF365.DPN.FPN $515.18 $875.81 $1,030.36 $1,468.26

18029NY1240152-01 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay ONSG.DEP25.SNF365.DPN.FPY $511.82 $870.09 $1,023.64 $1,458.69


18029NY1240178-01 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Silver ONSG.DEP29.SNF365.DPY.FPY $500.41 $850.70 $1,000.82 $1,426.17




18029NY1240182-01 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R2014 Max Silver ONSG.DEP29.SNF365.DPN.FPY $500.41 $850.70 $1,000.82 $1,426.17











31

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

ON = On Exchange

SG = Small Group







































Bronze Plans

32

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider

18029NY1170015-00 IHBC-C1027 IHBC-SBP1011 IHBC-R1064 IHBC-R1065 IHBC-R2014 FlexFit Platinum Copay NYS OON OFSG.DEP29.SNF365.DPY.FPN $637.74 $1,084.16 $1,275.48 $1,817.56

18029NY1170016-00 IHBC-C1027 IHBC-SBP1011 IHBC-R1065 IHBC-R2014 FlexFit Platinum Copay NYS OON OFSG.DEP25.SNF365.DPY.FPN $632.19 $1,074.72 $1,264.38 $1,801.74

18029NY1170017-00 IHBC-C1027 IHBC-SBP1011 IHBC-R1065 IHBC-R2014 FlexFit Platinum Copay NYS OON OFSG.DEP25.SNF365.DPY.FPY $633.46 $1,076.88 $1,266.92 $1,805.36

18029NY1170018-00 IHBC-C1027 IHBC-SBP1011 IHBC-R1064 IHBC-R2014 FlexFit Platinum Copay NYS OON OFSG.DEP29.SNF365.DPN.FPN $637.74 $1,084.16 $1,275.48 $1,817.56

18029NY1170019-00 IHBC-C1027 IHBC-SBP1011 IHBC-R1064 IHBC-R2014 FlexFit Platinum Copay NYS OON OFSG.DEP29.SNF365.DPN.FPY $639.02 $1,086.33 $1,278.04 $1,821.21

18029NY1170020-00 IHBC-C1027 IHBC-SBP1011 IHBC-R2014 FlexFit Platinum Copay NYS OON OFSG.DEP25.SNF365.DPN.FPY $633.46 $1,076.88 $1,266.92 $1,805.36

18029NY1170021-00 IHBC-C1027 IHBC-SBP1011 IHBC-R2014 FlexFit Platinum Copay NYS OON OFSG.DEP25.SNF365.DPN.FPN $632.19 $1,074.72 $1,264.38 $1,801.74

18029NY1170022-00 IHBC-C1027 IHBC-SBP1011 IHBC-R1064 IHBC-R1065 IHBC-R2014 FlexFit Platinum Copay NYS OON OFSG.DEP29.SNF365.DPY.FPY $639.02 $1,086.33 $1,278.04 $1,821.21

18029NY1170033-00 IHBC-C1027 IHBC-SBP1003 IHBC-R2014 FlexFit Platinum OFSG.DEP25.SNF365.DPN.FPN $631.98 $1,074.37 $1,263.96 $1,801.14

18029NY1170035-00 IHBC-C1027 IHBC-SBP1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 FlexFit Platinum OFSG.DEP29.SNF365.DPY.FPY $638.82 $1,085.99 $1,277.64 $1,820.64

18029NY1170036-00 IHBC-C1027 IHBC-SBP1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 FlexFit Platinum OFSG.DEP29.SNF365.DPY.FPN $637.53 $1,083.80 $1,275.06 $1,816.96

18029NY1170037-00 IHBC-C1027 IHBC-SBP1003 IHBC-R1065 IHBC-R2014 FlexFit Platinum OFSG.DEP25.SNF365.DPY.FPN $631.98 $1,074.37 $1,263.96 $1,801.14

18029NY1170040-00 IHBC-C1027 IHBC-SBP1003 IHBC-R1065 IHBC-R2014 FlexFit Platinum OFSG.DEP25.SNF365.DPY.FPY $633.26 $1,076.54 $1,266.52 $1,804.79

18029NY1170043-00 IHBC-C1027 IHBC-SBP1003 IHBC-R1064 IHBC-R2014 FlexFit Platinum OFSG.DEP29.SNF365.DPN.FPY $638.82 $1,085.99 $1,277.64 $1,820.64

18029NY1170045-00 IHBC-C1027 IHBC-SBP1003 IHBC-R1064 IHBC-R2014 FlexFit Platinum OFSG.DEP29.SNF365.DPN.FPN $637.53 $1,083.80 $1,275.06 $1,816.96

18029NY1170046-00 IHBC-C1027 IHBC-SBP1003 IHBC-R2014 FlexFit Platinum OFSG.DEP25.SNF365.DPN.FPY $633.26 $1,076.54 $1,266.52 $1,804.79

18029NY1170065-00 IHBC-C1027 IHBC-SBP1013 IHBC-R2014 iShare Platinum OFSG.DEP25.SNF365.DPN.FPN $599.72 $1,019.52 $1,199.44 $1,709.20

18029NY1170066-00 IHBC-C1027 IHBC-SBP1013 IHBC-R1064 IHBC-R1065 IHBC-R2014 iShare Platinum OFSG.DEP29.SNF365.DPY.FPY $606.17 $1,030.49 $1,212.34 $1,727.58

18029NY1170067-00 IHBC-C1027 IHBC-SBP1013 IHBC-R1064 IHBC-R1065 IHBC-R2014 iShare Platinum OFSG.DEP29.SNF365.DPY.FPN $604.97 $1,028.45 $1,209.94 $1,724.16

18029NY1170068-00 IHBC-C1027 IHBC-SBP1013 IHBC-R1065 IHBC-R2014 iShare Platinum OFSG.DEP25.SNF365.DPY.FPN $599.72 $1,019.52 $1,199.44 $1,709.20

18029NY1170069-00 IHBC-C1027 IHBC-SBP1013 IHBC-R1065 IHBC-R2014 iShare Platinum OFSG.DEP25.SNF365.DPY.FPY $600.92 $1,021.56 $1,201.84 $1,712.62

18029NY1170070-00 IHBC-C1027 IHBC-SBP1013 IHBC-R1064 IHBC-R2014 iShare Platinum OFSG.DEP29.SNF365.DPN.FPN $604.97 $1,028.45 $1,209.94 $1,724.16

18029NY1170071-00 IHBC-C1027 IHBC-SBP1013 IHBC-R1064 IHBC-R2014 iShare Platinum OFSG.DEP29.SNF365.DPN.FPY $606.17 $1,030.49 $1,212.34 $1,727.58

18029NY1170072-00 IHBC-C1027 IHBC-SBP1013 IHBC-R2014 iShare Platinum OFSG.DEP25.SNF365.DPN.FPY $600.92 $1,021.56 $1,201.84 $1,712.62

18029NY1170097-00 IHBC-C1036 IHBC-SBP1008 IHBC-R2014 Choice Plus Platinum OFSG.DEP25.SNF365.DPN.FPN $586.37 $996.83 $1,172.74 $1,671.15

18029NY1170098-00 IHBC-C1036 IHBC-SBP1008 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Platinum OFSG.DEP29.SNF365.DPY.FPY $592.65 $1,007.51 $1,185.30 $1,689.05

18029NY1170099-00 IHBC-C1036 IHBC-SBP1008 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Platinum OFSG.DEP29.SNF365.DPY.FPN $591.47 $1,005.50 $1,182.94 $1,685.69

18029NY1170100-00 IHBC-C1036 IHBC-SBP1008 IHBC-R1065 IHBC-R2014 Choice Plus Platinum OFSG.DEP25.SNF365.DPY.FPN $586.37 $996.83 $1,172.74 $1,671.15

18029NY1170101-00 IHBC-C1036 IHBC-SBP1008 IHBC-R1065 IHBC-R2014 Choice Plus Platinum OFSG.DEP25.SNF365.DPY.FPY $587.54 $998.82 $1,175.08 $1,674.49

18029NY1170102-00 IHBC-C1036 IHBC-SBP1008 IHBC-R1064 IHBC-R2014 Choice Plus Platinum OFSG.DEP29.SNF365.DPN.FPY $592.65 $1,007.51 $1,185.30 $1,689.05

18029NY1170103-00 IHBC-C1036 IHBC-SBP1008 IHBC-R1064 IHBC-R2014 Choice Plus Platinum OFSG.DEP29.SNF365.DPN.FPN $591.47 $1,005.50 $1,182.94 $1,685.69

18029NY1170104-00 IHBC-C1036 IHBC-SBP1008 IHBC-R2014 Choice Plus Platinum OFSG.DEP25.SNF365.DPN.FPY $587.54 $998.82 $1,175.08 $1,674.49

18029NY1410001-00 IHBC-C1037 IHBC-SBP1012 IHBC-R2014 Passport Plan Platinum OFSG.DEP25.SNF365.DPN.FPN $992.60 $1,687.42 $1,985.20 $2,828.91

18029NY1410002-00 IHBC-C1037 IHBC-SBP1012 IHBC-R1064 IHBC-R1065 IHBC-R2014 Passport Plan Platinum OFSG.DEP29.SNF365.DPY.FPY $1,003.71 $1,706.31 $2,007.42 $2,860.57

18029NY1410003-00 IHBC-C1037 IHBC-SBP1012 IHBC-R1064 IHBC-R1065 IHBC-R2014 Passport Plan Platinum OFSG.DEP29.SNF365.DPY.FPN $1,001.63 $1,702.77 $2,003.26 $2,854.65

18029NY1410004-00 IHBC-C1037 IHBC-SBP1012 IHBC-R1065 IHBC-R2014 Passport Plan Platinum OFSG.DEP25.SNF365.DPY.FPN $992.60 $1,687.42 $1,985.20 $2,828.91

18029NY1410005-00 IHBC-C1037 IHBC-SBP1012 IHBC-R1065 IHBC-R2014 Passport Plan Platinum OFSG.DEP25.SNF365.DPY.FPY $994.65 $1,690.91 $1,989.30 $2,834.75

18029NY1410006-00 IHBC-C1037 IHBC-SBP1012 IHBC-R1064 IHBC-R2014 Passport Plan Platinum OFSG.DEP29.SNF365.DPN.FPN $1,001.63 $1,702.77 $2,003.26 $2,854.65

18029NY1410007-00 IHBC-C1037 IHBC-SBP1012 IHBC-R1064 IHBC-R2014 Passport Plan Platinum OFSG.DEP29.SNF365.DPN.FPY $1,003.71 $1,706.31 $2,007.42 $2,860.57

18029NY1410008-00 IHBC-C1037 IHBC-SBP1012 IHBC-R2014 Passport Plan Platinum OFSG.DEP25.SNF365.DPN.FPY $994.65 $1,690.91 $1,989.30 $2,834.75


Small Group Off Exchange Premium Rates Effective January 1, 2019

Form Numbers

OF = Off Exchange

SG = Small Group







Platinum Plans

33

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1200033-00 IHBC-C1027 IHBC-SBG1003 IHBC-R2014 iDirect Gold Copay OFSG.DEP25.SNF365.DPN.FPN $557.78 $948.23 $1,115.56 $1,589.67

18029NY1200035-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay OFSG.DEP29.SNF365.DPY.FPY $563.72 $958.32 $1,127.44 $1,606.60

18029NY1200036-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay OFSG.DEP29.SNF365.DPY.FPN $562.61 $956.44 $1,125.22 $1,603.44

18029NY1200037-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1065 IHBC-R2014 iDirect Gold Copay OFSG.DEP25.SNF365.DPY.FPN $557.78 $948.23 $1,115.56 $1,589.67

18029NY1200040-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1065 IHBC-R2014 iDirect Gold Copay OFSG.DEP25.SNF365.DPY.FPY $558.88 $950.10 $1,117.76 $1,592.81

18029NY1200043-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R2014 iDirect Gold Copay OFSG.DEP29.SNF365.DPN.FPY $563.72 $958.32 $1,127.44 $1,606.60

18029NY1200045-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R2014 iDirect Gold Copay OFSG.DEP29.SNF365.DPN.FPN $562.61 $956.44 $1,125.22 $1,603.44

18029NY1200046-00 IHBC-C1027 IHBC-SBG1003 IHBC-R2014 iDirect Gold Copay OFSG.DEP25.SNF365.DPN.FPY $558.88 $950.10 $1,117.76 $1,592.81

18029NY1200081-00 IHBC-C1036 IHBC-SBG1007 IHBC-R2014 Choice Plus Gold OFSG.DEP25.SNF365.DPN.FPN $519.81 $883.68 $1,039.62 $1,481.46

18029NY1200083-00 IHBC-C1036 IHBC-SBG1007 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Gold OFSG.DEP29.SNF365.DPY.FPY $525.30 $893.01 $1,050.60 $1,497.11

18029NY1200084-00 IHBC-C1036 IHBC-SBG1007 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Gold OFSG.DEP29.SNF365.DPY.FPN $524.27 $891.26 $1,048.54 $1,494.17

18029NY1200085-00 IHBC-C1036 IHBC-SBG1007 IHBC-R1065 IHBC-R2014 Choice Plus Gold OFSG.DEP25.SNF365.DPY.FPN $519.81 $883.68 $1,039.62 $1,481.46

18029NY1200088-00 IHBC-C1036 IHBC-SBG1007 IHBC-R1065 IHBC-R2014 Choice Plus Gold OFSG.DEP25.SNF365.DPY.FPY $520.82 $885.39 $1,041.64 $1,484.34

18029NY1200091-00 IHBC-C1036 IHBC-SBG1007 IHBC-R1064 IHBC-R2014 Choice Plus Gold OFSG.DEP29.SNF365.DPN.FPY $525.30 $893.01 $1,050.60 $1,497.11

18029NY1200093-00 IHBC-C1036 IHBC-SBG1007 IHBC-R1064 IHBC-R2014 Choice Plus Gold OFSG.DEP29.SNF365.DPN.FPN $524.27 $891.26 $1,048.54 $1,494.17

18029NY1200094-00 IHBC-C1036 IHBC-SBG1007 IHBC-R2014 Choice Plus Gold OFSG.DEP25.SNF365.DPN.FPY $520.82 $885.39 $1,041.64 $1,484.34

18029NY1200129-00 IHBC-C1027 IHBC-SBG1015 IHBC-R2014 iShare Gold OFSG.DEP25.SNF365.DPN.FPN $524.27 $891.26 $1,048.54 $1,494.17

18029NY1200130-00 IHBC-C1027 IHBC-SBG1015 IHBC-R1064 IHBC-R1065 IHBC-R2014 iShare Gold OFSG.DEP29.SNF365.DPY.FPY $529.82 $900.69 $1,059.64 $1,509.99

18029NY1200131-00 IHBC-C1027 IHBC-SBG1015 IHBC-R1064 IHBC-R1065 IHBC-R2014 iShare Gold OFSG.DEP29.SNF365.DPY.FPN $528.78 $898.93 $1,057.56 $1,507.02

18029NY1200132-00 IHBC-C1027 IHBC-SBG1015 IHBC-R1065 IHBC-R2014 iShare Gold OFSG.DEP25.SNF365.DPY.FPN $524.27 $891.26 $1,048.54 $1,494.17

18029NY1200133-00 IHBC-C1027 IHBC-SBG1015 IHBC-R1065 IHBC-R2014 iShare Gold OFSG.DEP25.SNF365.DPY.FPY $525.30 $893.01 $1,050.60 $1,497.11

18029NY1200134-00 IHBC-C1027 IHBC-SBG1015 IHBC-R1064 IHBC-R2014 iShare Gold OFSG.DEP29.SNF365.DPN.FPN $528.78 $898.93 $1,057.56 $1,507.02

18029NY1200135-00 IHBC-C1027 IHBC-SBG1015 IHBC-R1064 IHBC-R2014 iShare Gold OFSG.DEP29.SNF365.DPN.FPY $529.82 $900.69 $1,059.64 $1,509.99

18029NY1200136-00 IHBC-C1027 IHBC-SBG1015 IHBC-R2014 iShare Gold OFSG.DEP25.SNF365.DPN.FPY $525.30 $893.01 $1,050.60 $1,497.11

18029NY1200137-00 IHBC-C1027 IHBC-SBG1016 IHBC-R2014 iDirect Gold Coinsurance HSAQ OFSG.DEP25.SNF365.DPN.FPN $510.72 $868.22 $1,021.44 $1,455.55

18029NY1200138-00 IHBC-C1027 IHBC-SBG1016 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Coinsurance HSAQ OFSG.DEP29.SNF365.DPY.FPY $516.11 $877.39 $1,032.22 $1,470.91

18029NY1200139-00 IHBC-C1027 IHBC-SBG1016 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Coinsurance HSAQ OFSG.DEP29.SNF365.DPY.FPN $515.09 $875.65 $1,030.18 $1,468.01

18029NY1200140-00 IHBC-C1027 IHBC-SBG1016 IHBC-R1065 IHBC-R2014 iDirect Gold Coinsurance HSAQ OFSG.DEP25.SNF365.DPY.FPN $510.72 $868.22 $1,021.44 $1,455.55

18029NY1200141-00 IHBC-C1027 IHBC-SBG1016 IHBC-R1065 IHBC-R2014 iDirect Gold Coinsurance HSAQ OFSG.DEP25.SNF365.DPY.FPY $511.72 $869.92 $1,023.44 $1,458.40

18029NY1200142-00 IHBC-C1027 IHBC-SBG1016 IHBC-R1064 IHBC-R2014 iDirect Gold Coinsurance HSAQ OFSG.DEP29.SNF365.DPN.FPN $515.09 $875.65 $1,030.18 $1,468.01

18029NY1200143-00 IHBC-C1027 IHBC-SBG1016 IHBC-R1064 IHBC-R2014 iDirect Gold Coinsurance HSAQ OFSG.DEP29.SNF365.DPN.FPY $516.11 $877.39 $1,032.22 $1,470.91

18029NY1200144-00 IHBC-C1027 IHBC-SBG1016 IHBC-R2014 iDirect Gold Coinsurance HSAQ OFSG.DEP25.SNF365.DPN.FPY $511.72 $869.92 $1,023.44 $1,458.40

Gold Plans

34

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1200177-00 IHBC-C1027 IHBC-SBG1013 IHBC-R2014 iDirect Gold Copay HSAQ OFSG.DEP25.SNF365.DPN.FPN $525.64 $893.59 $1,051.28 $1,498.07

18029NY1200178-00 IHBC-C1027 IHBC-SBG1013 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay HSAQ OFSG.DEP29.SNF365.DPY.FPY $531.22 $903.07 $1,062.44 $1,513.98

18029NY1200179-00 IHBC-C1027 IHBC-SBG1013 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay HSAQ OFSG.DEP29.SNF365.DPY.FPN $530.19 $901.32 $1,060.38 $1,511.04

18029NY1200180-00 IHBC-C1027 IHBC-SBG1013 IHBC-R1065 IHBC-R2014 iDirect Gold Copay HSAQ OFSG.DEP25.SNF365.DPY.FPN $525.64 $893.59 $1,051.28 $1,498.07

18029NY1200181-00 IHBC-C1027 IHBC-SBG1013 IHBC-R1065 IHBC-R2014 iDirect Gold Copay HSAQ OFSG.DEP25.SNF365.DPY.FPY $526.68 $895.36 $1,053.36 $1,501.04

18029NY1200182-00 IHBC-C1027 IHBC-SBG1013 IHBC-R1064 IHBC-R2014 iDirect Gold Copay HSAQ OFSG.DEP29.SNF365.DPN.FPN $530.19 $901.32 $1,060.38 $1,511.04

18029NY1200183-00 IHBC-C1027 IHBC-SBG1013 IHBC-R1064 IHBC-R2014 iDirect Gold Copay HSAQ OFSG.DEP29.SNF365.DPN.FPY $531.22 $903.07 $1,062.44 $1,513.98

18029NY1200184-00 IHBC-C1027 IHBC-SBG1013 IHBC-R2014 iDirect Gold Copay HSAQ OFSG.DEP25.SNF365.DPN.FPY $526.68 $895.36 $1,053.36 $1,501.04

18029NY1200185-00 IHBC-C1027 IHBC-SBG1014 IHBC-R2014 Max Gold OFSG.DEP25.SNF365.DPN.FPN $537.29 $913.39 $1,074.58 $1,531.28

18029NY1200186-00 IHBC-C1027 IHBC-SBG1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Gold OFSG.DEP29.SNF365.DPY.FPY $543.01 $923.12 $1,086.02 $1,547.58

18029NY1200187-00 IHBC-C1027 IHBC-SBG1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Gold OFSG.DEP29.SNF365.DPY.FPN $541.94 $921.30 $1,083.88 $1,544.53

18029NY1200188-00 IHBC-C1027 IHBC-SBG1014 IHBC-R1065 IHBC-R2014 Max Gold OFSG.DEP25.SNF365.DPY.FPN $537.29 $913.39 $1,074.58 $1,531.28

18029NY1200189-00 IHBC-C1027 IHBC-SBG1014 IHBC-R1065 IHBC-R2014 Max Gold OFSG.DEP25.SNF365.DPY.FPY $538.36 $915.21 $1,076.72 $1,534.33

18029NY1200190-00 IHBC-C1027 IHBC-SBG1014 IHBC-R1064 IHBC-R2014 Max Gold OFSG.DEP29.SNF365.DPN.FPN $541.94 $921.30 $1,083.88 $1,544.53

18029NY1200191-00 IHBC-C1027 IHBC-SBG1014 IHBC-R1064 IHBC-R2014 Max Gold OFSG.DEP29.SNF365.DPN.FPY $543.01 $923.12 $1,086.02 $1,547.58

18029NY1200192-00 IHBC-C1027 IHBC-SBG1014 IHBC-R2014 Max Gold OFSG.DEP25.SNF365.DPN.FPY $538.36 $915.21 $1,076.72 $1,534.33

18029NY1200193-00 IHBC-C1027 IHBC-SBG1001 Healthy New York OFSG.DEP25.SNF200.DPN.FPN $467.61 $794.94 $935.22 $1,332.69

18029NY1200194-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 IHBC-R1065 Healthy New York OFSG.DEP29.SNF200.DPY.FPY $472.48 $803.22 $944.96 $1,346.57

18029NY1200195-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 IHBC-R1065 Healthy New York OFSG.DEP29.SNF200.DPY.FPN $471.57 $801.67 $943.14 $1,343.97

18029NY1200196-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1065 Healthy New York OFSG.DEP25.SNF200.DPY.FPN $467.61 $794.94 $935.22 $1,332.69

18029NY1200197-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1065 Healthy New York OFSG.DEP25.SNF200.DPY.FPY $468.51 $796.47 $937.02 $1,335.25

18029NY1200198-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 Healthy New York OFSG.DEP29.SNF200.DPN.FPN $471.57 $801.67 $943.14 $1,343.97

18029NY1200199-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 Healthy New York OFSG.DEP29.SNF200.DPN.FPY $472.48 $803.22 $944.96 $1,346.57

18029NY1200200-00 IHBC-C1027 IHBC-SBG1001 Healthy New York OFSG.DEP25.SNF200.DPN.FPY $468.51 $796.47 $937.02 $1,335.25

18029NY1210017-00 IHBC-C1037 IHBC-SBG1005 IHBC-R2014 NY PA Gold OFSG.DEP25.SNF365.DPN.FPN $532.23 $904.79 $1,064.46 $1,516.86

18029NY1210019-00 IHBC-C1037 IHBC-SBG1005 IHBC-R1064 IHBC-R1065 IHBC-R2014 NY PA Gold OFSG.DEP29.SNF365.DPY.FPY $537.88 $914.40 $1,075.76 $1,532.96

18029NY1210020-00 IHBC-C1037 IHBC-SBG1005 IHBC-R1064 IHBC-R1065 IHBC-R2014 NY PA Gold OFSG.DEP29.SNF365.DPY.FPN $536.84 $912.63 $1,073.68 $1,529.99

18029NY1210021-00 IHBC-C1037 IHBC-SBG1005 IHBC-R1065 IHBC-R2014 NY PA Gold OFSG.DEP25.SNF365.DPY.FPN $532.23 $904.79 $1,064.46 $1,516.86

18029NY1210024-00 IHBC-C1037 IHBC-SBG1005 IHBC-R1065 IHBC-R2014 NY PA Gold OFSG.DEP25.SNF365.DPY.FPY $533.28 $906.58 $1,066.56 $1,519.85

18029NY1210027-00 IHBC-C1037 IHBC-SBG1005 IHBC-R1064 IHBC-R2014 NY PA Gold OFSG.DEP29.SNF365.DPN.FPY $537.88 $914.40 $1,075.76 $1,532.96

18029NY1210029-00 IHBC-C1037 IHBC-SBG1005 IHBC-R1064 IHBC-R2014 NY PA Gold OFSG.DEP29.SNF365.DPN.FPN $536.84 $912.63 $1,073.68 $1,529.99

18029NY1210030-00 IHBC-C1037 IHBC-SBG1005 IHBC-R2014 NY PA Gold OFSG.DEP25.SNF365.DPN.FPY $533.28 $906.58 $1,066.56 $1,519.85

18029NY1210057-00 IHBC-C1037 IHBC-SBG1006 IHBC-R2014 Passport Plan Gold OFSG.DEP25.SNF365.DPN.FPN $771.46 $1,311.48 $1,542.92 $2,198.66

18029NY1210058-00 IHBC-C1037 IHBC-SBG1006 IHBC-R1064 IHBC-R1065 IHBC-R2014 Passport Plan Gold OFSG.DEP29.SNF365.DPY.FPY $779.95 $1,325.92 $1,559.90 $2,222.86

18029NY1210059-00 IHBC-C1037 IHBC-SBG1006 IHBC-R1064 IHBC-R1065 IHBC-R2014 Passport Plan Gold OFSG.DEP29.SNF365.DPY.FPN $778.36 $1,323.21 $1,556.72 $2,218.33

18029NY1210060-00 IHBC-C1037 IHBC-SBG1006 IHBC-R1065 IHBC-R2014 Passport Plan Gold OFSG.DEP25.SNF365.DPY.FPN $771.46 $1,311.48 $1,542.92 $2,198.66

18029NY1210061-00 IHBC-C1037 IHBC-SBG1006 IHBC-R1065 IHBC-R2014 Passport Plan Gold OFSG.DEP25.SNF365.DPY.FPY $773.03 $1,314.15 $1,546.06 $2,203.14

18029NY1210062-00 IHBC-C1037 IHBC-SBG1006 IHBC-R1064 IHBC-R2014 Passport Plan Gold OFSG.DEP29.SNF365.DPN.FPY $779.95 $1,325.92 $1,559.90 $2,222.86

18029NY1210063-00 IHBC-C1037 IHBC-SBG1006 IHBC-R1064 IHBC-R2014 Passport Plan Gold OFSG.DEP29.SNF365.DPN.FPN $778.36 $1,323.21 $1,556.72 $2,218.33

18029NY1210064-00 IHBC-C1037 IHBC-SBG1006 IHBC-R2014 Passport Plan Gold OFSG.DEP25.SNF365.DPN.FPY $773.03 $1,314.15 $1,546.06 $2,203.14

35

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1240001-00 IHBC-C1027 IHBC-SBS1001 Standard Silver OFSG.DEP25.SNF200.DPN.FPN $506.46 $860.98 $1,012.92 $1,443.41

18029NY1240003-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 IHBC-R1065 Standard Silver OFSG.DEP29.SNF200.DPY.FPY $511.79 $870.04 $1,023.58 $1,458.60

18029NY1240004-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 IHBC-R1065 Standard Silver OFSG.DEP29.SNF200.DPY.FPN $510.80 $868.36 $1,021.60 $1,455.78

18029NY1240005-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1065 Standard Silver OFSG.DEP25.SNF200.DPY.FPN $506.46 $860.98 $1,012.92 $1,443.41

18029NY1240008-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1065 Standard Silver OFSG.DEP25.SNF200.DPY.FPY $507.44 $862.65 $1,014.88 $1,446.20

18029NY1240011-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 Standard Silver OFSG.DEP29.SNF200.DPN.FPY $511.79 $870.04 $1,023.58 $1,458.60

18029NY1240013-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 Standard Silver OFSG.DEP29.SNF200.DPN.FPN $510.80 $868.36 $1,021.60 $1,455.78

18029NY1240014-00 IHBC-C1027 IHBC-SBS1001 Standard Silver OFSG.DEP25.SNF200.DPN.FPY $507.44 $862.65 $1,014.88 $1,446.20

18029NY1240033-00 IHBC-C1027 IHBC-SBS1015 IHBC-R2014 iDirect Silver Coinsurance HSAQ OFSG.DEP25.SNF365.DPN.FPN $446.32 $758.74 $892.64 $1,272.01

18029NY1240035-00 IHBC-C1027 IHBC-SBS1015 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Coinsurance HSAQ OFSG.DEP29.SNF365.DPY.FPY $450.94 $766.60 $901.88 $1,285.18

18029NY1240036-00 IHBC-C1027 IHBC-SBS1015 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Coinsurance HSAQ OFSG.DEP29.SNF365.DPY.FPN $450.08 $765.14 $900.16 $1,282.73

18029NY1240037-00 IHBC-C1027 IHBC-SBS1015 IHBC-R1065 IHBC-R2014 iDirect Silver Coinsurance HSAQ OFSG.DEP25.SNF365.DPY.FPN $446.32 $758.74 $892.64 $1,272.01

18029NY1240040-00 IHBC-C1027 IHBC-SBS1015 IHBC-R1065 IHBC-R2014 iDirect Silver Coinsurance HSAQ OFSG.DEP25.SNF365.DPY.FPY $447.18 $760.21 $894.36 $1,274.46

18029NY1240043-00 IHBC-C1027 IHBC-SBS1015 IHBC-R1064 IHBC-R2014 iDirect Silver Coinsurance HSAQ OFSG.DEP29.SNF365.DPN.FPY $450.94 $766.60 $901.88 $1,285.18

18029NY1240045-00 IHBC-C1027 IHBC-SBS1015 IHBC-R1064 IHBC-R2014 iDirect Silver Coinsurance HSAQ OFSG.DEP29.SNF365.DPN.FPN $450.08 $765.14 $900.16 $1,282.73

18029NY1240046-00 IHBC-C1027 IHBC-SBS1015 IHBC-R2014 iDirect Silver Coinsurance HSAQ OFSG.DEP25.SNF365.DPN.FPY $447.18 $760.21 $894.36 $1,274.46

18029NY1240065-00 IHBC-C1036 IHBC-SBS1012 IHBC-R2014 Choice Plus Silver HSAQ OFSG.DEP25.SNF365.DPN.FPN $430.39 $731.66 $860.78 $1,226.61

18029NY1240067-00 IHBC-C1036 IHBC-SBS1012 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Silver HSAQ OFSG.DEP29.SNF365.DPY.FPY $434.83 $739.21 $869.66 $1,239.27

18029NY1240068-00 IHBC-C1036 IHBC-SBS1012 IHBC-R1064 IHBC-R1065 IHBC-R2014 Choice Plus Silver HSAQ OFSG.DEP29.SNF365.DPY.FPN $434.00 $737.80 $868.00 $1,236.90

18029NY1240069-00 IHBC-C1036 IHBC-SBS1012 IHBC-R1065 IHBC-R2014 Choice Plus Silver HSAQ OFSG.DEP25.SNF365.DPY.FPN $430.39 $731.66 $860.78 $1,226.61

18029NY1240072-00 IHBC-C1036 IHBC-SBS1012 IHBC-R1065 IHBC-R2014 Choice Plus Silver HSAQ OFSG.DEP25.SNF365.DPY.FPY $431.22 $733.07 $862.44 $1,228.98

18029NY1240075-00 IHBC-C1036 IHBC-SBS1012 IHBC-R1064 IHBC-R2014 Choice Plus Silver HSAQ OFSG.DEP29.SNF365.DPN.FPY $434.83 $739.21 $869.66 $1,239.27

18029NY1240077-00 IHBC-C1036 IHBC-SBS1012 IHBC-R1064 IHBC-R2014 Choice Plus Silver HSAQ OFSG.DEP29.SNF365.DPN.FPN $434.00 $737.80 $868.00 $1,236.90

18029NY1240078-00 IHBC-C1036 IHBC-SBS1012 IHBC-R2014 Choice Plus Silver HSAQ OFSG.DEP25.SNF365.DPN.FPY $431.22 $733.07 $862.44 $1,228.98

18029NY1240129-00 IHBC-C1027 IHBC-SBS1021 IHBC-R2014 iDirect Silver Blended HSAQ OFSG.DEP25.SNF365.DPN.FPN $432.20 $734.74 $864.40 $1,231.77

18029NY1240130-00 IHBC-C1027 IHBC-SBS1021 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Blended HSAQ OFSG.DEP29.SNF365.DPY.FPY $436.66 $742.32 $873.32 $1,244.48

18029NY1240131-00 IHBC-C1027 IHBC-SBS1021 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Blended HSAQ OFSG.DEP29.SNF365.DPY.FPN $435.82 $740.89 $871.64 $1,242.09

18029NY1240132-00 IHBC-C1027 IHBC-SBS1021 IHBC-R1065 IHBC-R2014 iDirect Silver Blended HSAQ OFSG.DEP25.SNF365.DPY.FPN $432.20 $734.74 $864.40 $1,231.77

18029NY1240133-00 IHBC-C1027 IHBC-SBS1021 IHBC-R1065 IHBC-R2014 iDirect Silver Blended HSAQ OFSG.DEP25.SNF365.DPY.FPY $433.02 $736.13 $866.04 $1,234.11

18029NY1240134-00 IHBC-C1027 IHBC-SBS1021 IHBC-R1064 IHBC-R2014 iDirect Silver Blended HSAQ OFSG.DEP29.SNF365.DPN.FPN $435.82 $740.89 $871.64 $1,242.09

18029NY1240135-00 IHBC-C1027 IHBC-SBS1021 IHBC-R1064 IHBC-R2014 iDirect Silver Blended HSAQ OFSG.DEP29.SNF365.DPN.FPY $436.66 $742.32 $873.32 $1,244.48

18029NY1240136-00 IHBC-C1027 IHBC-SBS1021 IHBC-R2014 iDirect Silver Blended HSAQ OFSG.DEP25.SNF365.DPN.FPY $433.02 $736.13 $866.04 $1,234.11

Silver Plans

36

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1240145-00 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPN.FPN $481.35 $818.30 $962.70 $1,371.85

18029NY1240146-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPY.FPY $486.40 $826.88 $972.80 $1,386.24

18029NY1240147-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPY.FPN $485.47 $825.30 $970.94 $1,383.59

18029NY1240148-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPY.FPN $481.35 $818.30 $962.70 $1,371.85

18029NY1240149-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPY.FPY $482.30 $819.91 $964.60 $1,374.56

18029NY1240150-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPN.FPY $486.40 $826.88 $972.80 $1,386.24

18029NY1240151-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPN.FPN $485.47 $825.30 $970.94 $1,383.59

18029NY1240152-00 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPN.FPY $482.30 $819.91 $964.60 $1,374.56

18029NY1240177-00 IHBC-C1027 IHBC-SBS1018 IHBC-R2014 Max Silver OFSG.DEP25.SNF365.DPN.FPN $466.68 $793.36 $933.36 $1,330.04

18029NY1240178-00 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Silver OFSG.DEP29.SNF365.DPY.FPY $471.55 $801.64 $943.10 $1,343.92

18029NY1240179-00 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Silver OFSG.DEP29.SNF365.DPY.FPN $470.64 $800.09 $941.28 $1,341.32

18029NY1240180-00 IHBC-C1027 IHBC-SBS1018 IHBC-R1065 IHBC-R2014 Max Silver OFSG.DEP25.SNF365.DPY.FPN $466.68 $793.36 $933.36 $1,330.04

18029NY1240181-00 IHBC-C1027 IHBC-SBS1018 IHBC-R1065 IHBC-R2014 Max Silver OFSG.DEP25.SNF365.DPY.FPY $467.58 $794.89 $935.16 $1,332.60

18029NY1240182-00 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R2014 Max Silver OFSG.DEP29.SNF365.DPN.FPY $471.55 $801.64 $943.10 $1,343.92

18029NY1240183-00 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R2014 Max Silver OFSG.DEP29.SNF365.DPN.FPN $470.64 $800.09 $941.28 $1,341.32

18029NY1240184-00 IHBC-C1027 IHBC-SBS1018 IHBC-R2014 Max Silver OFSG.DEP25.SNF365.DPN.FPY $467.58 $794.89 $935.16 $1,332.60


18029NY1240186-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 IHBC-R1065 IHBC-R2014 Standard Silver OFSG.DEP29.SNF365.DPY.FPY $511.79 $870.04 $1,023.58 $1,458.60

18029NY1240187-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 IHBC-R1065 IHBC-R2014 Standard Silver OFSG.DEP29.SNF365.DPY.FPN $510.80 $868.36 $1,021.60 $1,455.78



18029NY1240190-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 IHBC-R2014 Standard Silver OFSG.DEP29.SNF365.DPN.FPN $510.80 $868.36 $1,021.60 $1,455.78

18029NY1240191-00 IHBC-C1027 IHBC-SBS1001 IHBC-R1064 IHBC-R2014 Standard Silver OFSG.DEP29.SNF365.DPN.FPY $511.79 $870.04 $1,023.58 $1,458.60


18029NY1240193-00 IHBC-C1027 IHBC-SBS1020 IHBC-R2014 iDirect Silver Copay HSAQ OFSG.DEP25.SNF365.DPN.FPN $465.76 $791.79 $931.52 $1,327.42

18029NY1240194-00 IHBC-C1027 IHBC-SBS1020 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay HSAQ OFSG.DEP29.SNF365.DPY.FPY $470.63 $800.07 $941.26 $1,341.30

18029NY1240195-00 IHBC-C1027 IHBC-SBS1020 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay HSAQ OFSG.DEP29.SNF365.DPY.FPN $469.71 $798.51 $939.42 $1,338.67

18029NY1240196-00 IHBC-C1027 IHBC-SBS1020 IHBC-R1065 IHBC-R2014 iDirect Silver Copay HSAQ OFSG.DEP25.SNF365.DPY.FPN $465.76 $791.79 $931.52 $1,327.42

18029NY1240197-00 IHBC-C1027 IHBC-SBS1020 IHBC-R1065 IHBC-R2014 iDirect Silver Copay HSAQ OFSG.DEP25.SNF365.DPY.FPY $466.67 $793.34 $933.34 $1,330.01

18029NY1240198-00 IHBC-C1027 IHBC-SBS1020 IHBC-R1064 IHBC-R2014 iDirect Silver Copay HSAQ OFSG.DEP29.SNF365.DPN.FPN $469.71 $798.51 $939.42 $1,338.67

18029NY1240199-00 IHBC-C1027 IHBC-SBS1020 IHBC-R1064 IHBC-R2014 iDirect Silver Copay HSAQ OFSG.DEP29.SNF365.DPN.FPY $470.63 $800.07 $941.26 $1,341.30

18029NY1240200-00 IHBC-C1027 IHBC-SBS1020 IHBC-R2014 iDirect Silver Copay HSAQ OFSG.DEP25.SNF365.DPN.FPY $466.67 $793.34 $933.34 $1,330.01

37

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1250017-00 IHBC-C1037 IHBC-SBS1010 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP25.SNF365.DPN.FPN $466.54 $793.12 $933.08 $1,329.64

18029NY1250019-00 IHBC-C1037 IHBC-SBS1010 IHBC-R1064 IHBC-R1065 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP29.SNF365.DPY.FPY $471.39 $801.36 $942.78 $1,343.46

18029NY1250020-00 IHBC-C1037 IHBC-SBS1010 IHBC-R1064 IHBC-R1065 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP29.SNF365.DPY.FPN $470.49 $799.83 $940.98 $1,340.90

18029NY1250021-00 IHBC-C1037 IHBC-SBS1010 IHBC-R1065 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP25.SNF365.DPY.FPN $466.54 $793.12 $933.08 $1,329.64

18029NY1250024-00 IHBC-C1037 IHBC-SBS1010 IHBC-R1065 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP25.SNF365.DPY.FPY $467.43 $794.63 $934.86 $1,332.18

18029NY1250027-00 IHBC-C1037 IHBC-SBS1010 IHBC-R1064 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP29.SNF365.DPN.FPY $471.39 $801.36 $942.78 $1,343.46

18029NY1250029-00 IHBC-C1037 IHBC-SBS1010 IHBC-R1064 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP29.SNF365.DPN.FPN $470.49 $799.83 $940.98 $1,340.90

18029NY1250030-00 IHBC-C1037 IHBC-SBS1010 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP25.SNF365.DPN.FPY $467.43 $794.63 $934.86 $1,332.18

18029NY1250033-00 IHBC-C1037 IHBC-SBS1011 IHBC-R2014 Passport Plan Silver HSAQ OFSG.DEP25.SNF365.DPN.FPN $681.54 $1,158.62 $1,363.08 $1,942.39

18029NY1250035-00 IHBC-C1037 IHBC-SBS1011 IHBC-R1064 IHBC-R1065 IHBC-R2014 Passport Plan Silver HSAQ OFSG.DEP29.SNF365.DPY.FPY $688.96 $1,171.23 $1,377.92 $1,963.54

18029NY1250036-00 IHBC-C1037 IHBC-SBS1011 IHBC-R1064 IHBC-R1065 IHBC-R2014 Passport Plan Silver HSAQ OFSG.DEP29.SNF365.DPY.FPN $687.57 $1,168.87 $1,375.14 $1,959.57

18029NY1250037-00 IHBC-C1037 IHBC-SBS1011 IHBC-R1065 IHBC-R2014 Passport Plan Silver HSAQ OFSG.DEP25.SNF365.DPY.FPN $681.54 $1,158.62 $1,363.08 $1,942.39

18029NY1250040-00 IHBC-C1037 IHBC-SBS1011 IHBC-R1065 IHBC-R2014 Passport Plan Silver HSAQ OFSG.DEP25.SNF365.DPY.FPY $682.92 $1,160.96 $1,365.84 $1,946.32

18029NY1250043-00 IHBC-C1037 IHBC-SBS1011 IHBC-R1064 IHBC-R2014 Passport Plan Silver HSAQ OFSG.DEP29.SNF365.DPN.FPY $688.96 $1,171.23 $1,377.92 $1,963.54

18029NY1250045-00 IHBC-C1037 IHBC-SBS1011 IHBC-R1064 IHBC-R2014 Passport Plan Silver HSAQ OFSG.DEP29.SNF365.DPN.FPN $687.57 $1,168.87 $1,375.14 $1,959.57

18029NY1250046-00 IHBC-C1037 IHBC-SBS1011 IHBC-R2014 Passport Plan Silver HSAQ OFSG.DEP25.SNF365.DPN.FPY $682.92 $1,160.96 $1,365.84 $1,946.32

38

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1270033-00 IHBC-C1037 IHBC-SBB1006 IHBC-R2014 Passport Plan Bronze HSAQ OFSG.DEP25.SNF365.DPN.FPN $621.42 $1,056.41 $1,242.84 $1,771.05

18029NY1270035-00 IHBC-C1037 IHBC-SBB1006 IHBC-R1064 IHBC-R1065 IHBC-R2014 Passport Plan Bronze HSAQ OFSG.DEP29.SNF365.DPY.FPY $628.13 $1,067.82 $1,256.26 $1,790.17

18029NY1270036-00 IHBC-C1037 IHBC-SBB1006 IHBC-R1064 IHBC-R1065 IHBC-R2014 Passport Plan Bronze HSAQ OFSG.DEP29.SNF365.DPY.FPN $626.87 $1,065.68 $1,253.74 $1,786.58

18029NY1270037-00 IHBC-C1037 IHBC-SBB1006 IHBC-R1065 IHBC-R2014 Passport Plan Bronze HSAQ OFSG.DEP25.SNF365.DPY.FPN $621.42 $1,056.41 $1,242.84 $1,771.05

18029NY1270040-00 IHBC-C1037 IHBC-SBB1006 IHBC-R1065 IHBC-R2014 Passport Plan Bronze HSAQ OFSG.DEP25.SNF365.DPY.FPY $622.67 $1,058.54 $1,245.34 $1,774.61

18029NY1270043-00 IHBC-C1037 IHBC-SBB1006 IHBC-R1064 IHBC-R2014 Passport Plan Bronze HSAQ OFSG.DEP29.SNF365.DPN.FPY $628.13 $1,067.82 $1,256.26 $1,790.17

18029NY1270045-00 IHBC-C1037 IHBC-SBB1006 IHBC-R1064 IHBC-R2014 Passport Plan Bronze HSAQ OFSG.DEP29.SNF365.DPN.FPN $626.87 $1,065.68 $1,253.74 $1,786.58

18029NY1270046-00 IHBC-C1037 IHBC-SBB1006 IHBC-R2014 Passport Plan Bronze HSAQ OFSG.DEP25.SNF365.DPN.FPY $622.67 $1,058.54 $1,245.34 $1,774.61

18029NY1300001-00 IHBC-C1027 IHBC-SBB1001 Standard Bronze OFSG.DEP25.SNF200.DPN.FPN $409.70 $696.49 $819.40 $1,167.65

18029NY1300003-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 IHBC-R1065 Standard Bronze OFSG.DEP29.SNF200.DPY.FPY $413.90 $703.63 $827.80 $1,179.62

18029NY1300004-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 IHBC-R1065 Standard Bronze OFSG.DEP29.SNF200.DPY.FPN $413.11 $702.29 $826.22 $1,177.36

18029NY1300005-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1065 Standard Bronze OFSG.DEP25.SNF200.DPY.FPN $409.70 $696.49 $819.40 $1,167.65

18029NY1300008-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1065 Standard Bronze OFSG.DEP25.SNF200.DPY.FPY $410.48 $697.82 $820.96 $1,169.87

18029NY1300011-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 Standard Bronze OFSG.DEP29.SNF200.DPN.FPY $413.90 $703.63 $827.80 $1,179.62

18029NY1300013-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 Standard Bronze OFSG.DEP29.SNF200.DPN.FPN $413.11 $702.29 $826.22 $1,177.36

18029NY1300014-00 IHBC-C1027 IHBC-SBB1001 Standard Bronze OFSG.DEP25.SNF200.DPN.FPY $410.48 $697.82 $820.96 $1,169.87

18029NY1300097-00 IHBC-C1027 IHBC-SBB1004 IHBC-R2014 iDirect Bronze HSAQ OFSG.DEP25.SNF365.DPN.FPN $409.33 $695.86 $818.66 $1,166.59

18029NY1300099-00 IHBC-C1027 IHBC-SBB1004 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze HSAQ OFSG.DEP29.SNF365.DPY.FPY $413.53 $703.00 $827.06 $1,178.56

18029NY1300100-00 IHBC-C1027 IHBC-SBB1004 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze HSAQ OFSG.DEP29.SNF365.DPY.FPN $412.74 $701.66 $825.48 $1,176.31

18029NY1300101-00 IHBC-C1027 IHBC-SBB1004 IHBC-R1065 IHBC-R2014 iDirect Bronze HSAQ OFSG.DEP25.SNF365.DPY.FPN $409.33 $695.86 $818.66 $1,166.59

18029NY1300104-00 IHBC-C1027 IHBC-SBB1004 IHBC-R1065 IHBC-R2014 iDirect Bronze HSAQ OFSG.DEP25.SNF365.DPY.FPY $410.12 $697.20 $820.24 $1,168.84

18029NY1300107-00 IHBC-C1027 IHBC-SBB1004 IHBC-R1064 IHBC-R2014 iDirect Bronze HSAQ OFSG.DEP29.SNF365.DPN.FPY $413.53 $703.00 $827.06 $1,178.56

18029NY1300109-00 IHBC-C1027 IHBC-SBB1004 IHBC-R1064 IHBC-R2014 iDirect Bronze HSAQ OFSG.DEP29.SNF365.DPN.FPN $412.74 $701.66 $825.48 $1,176.31

18029NY1300110-00 IHBC-C1027 IHBC-SBB1004 IHBC-R2014 iDirect Bronze HSAQ OFSG.DEP25.SNF365.DPN.FPY $410.12 $697.20 $820.24 $1,168.84

18029NY1300113-00 IHBC-C1027 IHBC-SBB1007 IHBC-R2014 iDirect Bronze MV OFSG.DEP25.SNF365.DPN.FPN $406.44 $690.95 $812.88 $1,158.35

18029NY1300114-00 IHBC-C1027 IHBC-SBB1007 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze MV OFSG.DEP29.SNF365.DPY.FPY $410.60 $698.02 $821.20 $1,170.21

18029NY1300115-00 IHBC-C1027 IHBC-SBB1007 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze MV OFSG.DEP29.SNF365.DPY.FPN $409.81 $696.68 $819.62 $1,167.96

18029NY1300116-00 IHBC-C1027 IHBC-SBB1007 IHBC-R1065 IHBC-R2014 iDirect Bronze MV OFSG.DEP25.SNF365.DPY.FPN $406.44 $690.95 $812.88 $1,158.35

18029NY1300117-00 IHBC-C1027 IHBC-SBB1007 IHBC-R1065 IHBC-R2014 iDirect Bronze MV OFSG.DEP25.SNF365.DPY.FPY $407.20 $692.24 $814.40 $1,160.52

18029NY1300118-00 IHBC-C1027 IHBC-SBB1007 IHBC-R1064 IHBC-R2014 iDirect Bronze MV OFSG.DEP29.SNF365.DPN.FPN $409.81 $696.68 $819.62 $1,167.96

18029NY1300119-00 IHBC-C1027 IHBC-SBB1007 IHBC-R1064 IHBC-R2014 iDirect Bronze MV OFSG.DEP29.SNF365.DPN.FPY $410.60 $698.02 $821.20 $1,170.21

18029NY1300120-00 IHBC-C1027 IHBC-SBB1007 IHBC-R2014 iDirect Bronze MV OFSG.DEP25.SNF365.DPN.FPY $407.20 $692.24 $814.40 $1,160.52

Bronze Plans

39

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1300121-00 IHBC-C1027 IHBC-SBB1009 IHBC-R2014 iDirect Bronze Enhanced HSAQ OFSG.DEP25.SNF365.DPN.FPN $426.06 $724.30 $852.12 $1,214.27

18029NY1300122-00 IHBC-C1027 IHBC-SBB1009 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze Enhanced HSAQ OFSG.DEP29.SNF365.DPY.FPY $430.45 $731.77 $860.90 $1,226.78

18029NY1300123-00 IHBC-C1027 IHBC-SBB1009 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Bronze Enhanced HSAQ OFSG.DEP29.SNF365.DPY.FPN $429.64 $730.39 $859.28 $1,224.47

18029NY1300124-00 IHBC-C1027 IHBC-SBB1009 IHBC-R1065 IHBC-R2014 iDirect Bronze Enhanced HSAQ OFSG.DEP25.SNF365.DPY.FPN $426.06 $724.30 $852.12 $1,214.27

18029NY1300125-00 IHBC-C1027 IHBC-SBB1009 IHBC-R1065 IHBC-R2014 iDirect Bronze Enhanced HSAQ OFSG.DEP25.SNF365.DPY.FPY $426.89 $725.71 $853.78 $1,216.64

18029NY1300126-00 IHBC-C1027 IHBC-SBB1009 IHBC-R1064 IHBC-R2014 iDirect Bronze Enhanced HSAQ OFSG.DEP29.SNF365.DPN.FPN $429.64 $730.39 $859.28 $1,224.47

18029NY1300127-00 IHBC-C1027 IHBC-SBB1009 IHBC-R1064 IHBC-R2014 iDirect Bronze Enhanced HSAQ OFSG.DEP29.SNF365.DPN.FPY $430.45 $731.77 $860.90 $1,226.78

18029NY1300128-00 IHBC-C1027 IHBC-SBB1009 IHBC-R2014 iDirect Bronze Enhanced HSAQ OFSG.DEP25.SNF365.DPN.FPY $426.89 $725.71 $853.78 $1,216.64


18029NY1300146-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 IHBC-R1065 IHBC-R2014 Standard Bronze OFSG.DEP29.SNF365.DPY.FPY $413.90 $703.63 $827.80 $1,179.62

18029NY1300147-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 IHBC-R1065 IHBC-R2014 Standard Bronze OFSG.DEP29.SNF365.DPY.FPN $413.11 $702.29 $826.22 $1,177.36



18029NY1300150-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 IHBC-R2014 Standard Bronze OFSG.DEP29.SNF365.DPN.FPN $413.11 $702.29 $826.22 $1,177.36

18029NY1300151-00 IHBC-C1027 IHBC-SBB1001 IHBC-R1064 IHBC-R2014 Standard Bronze OFSG.DEP29.SNF365.DPN.FPY $413.90 $703.63 $827.80 $1,179.62


IHBC-R1066 Direct Pay - Family Planning Buyback $0.13 $0.22 $0.26 $0.37

IHBC-R2054 Medically Necessary Abortion Rider $0.00 $0.00 $0.00 $0.00

Family Planning Rider

40

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider

























18029NY1170097-00 IHBC-C1036 IHBC-SBP1008 IHBC-R2014 Choice Plus Platinum OFSG.DEP25.SNF365.DPN.FPN $598.10 $1,016.77 $1,196.20 $1,704.59



18029NY1170100-00 IHBC-C1036 IHBC-SBP1008 IHBC-R1065 IHBC-R2014 Choice Plus Platinum OFSG.DEP25.SNF365.DPY.FPN $598.10 $1,016.77 $1,196.20 $1,704.59

18029NY1170101-00 IHBC-C1036 IHBC-SBP1008 IHBC-R1065 IHBC-R2014 Choice Plus Platinum OFSG.DEP25.SNF365.DPY.FPY $599.29 $1,018.79 $1,198.58 $1,707.98



18029NY1170104-00 IHBC-C1036 IHBC-SBP1008 IHBC-R2014 Choice Plus Platinum OFSG.DEP25.SNF365.DPN.FPY $599.29 $1,018.79 $1,198.58 $1,707.98

18029NY1410001-00 IHBC-C1037 IHBC-SBP1012 IHBC-R2014 Passport Plan Platinum OFSG.DEP25.SNF365.DPN.FPN $1,012.45 $1,721.17 $2,024.90 $2,885.48



18029NY1410004-00 IHBC-C1037 IHBC-SBP1012 IHBC-R1065 IHBC-R2014 Passport Plan Platinum OFSG.DEP25.SNF365.DPY.FPN $1,012.45 $1,721.17 $2,024.90 $2,885.48

18029NY1410005-00 IHBC-C1037 IHBC-SBP1012 IHBC-R1065 IHBC-R2014 Passport Plan Platinum OFSG.DEP25.SNF365.DPY.FPY $1,014.54 $1,724.72 $2,029.08 $2,891.44



18029NY1410008-00 IHBC-C1037 IHBC-SBP1012 IHBC-R2014 Passport Plan Platinum OFSG.DEP25.SNF365.DPN.FPY $1,014.54 $1,724.72 $2,029.08 $2,891.44


Small Group Off Exchange Premium Rates Effective April 1, 2019

Form Numbers

OF = Off Exchange

SG = Small Group







Platinum Plans

41

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







































Gold Plans

42

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group















































43

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







































Silver Plans

44

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1240145-00 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPN.FPN $490.98 $834.67 $981.96 $1,399.29

18029NY1240146-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPY.FPY $496.13 $843.42 $992.26 $1,413.97

18029NY1240147-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPY.FPN $495.18 $841.81 $990.36 $1,411.26

18029NY1240148-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPY.FPN $490.98 $834.67 $981.96 $1,399.29

18029NY1240149-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPY.FPY $491.95 $836.32 $983.90 $1,402.06

18029NY1240150-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPN.FPY $496.13 $843.42 $992.26 $1,413.97

18029NY1240151-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPN.FPN $495.18 $841.81 $990.36 $1,411.26

18029NY1240152-00 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPN.FPY $491.95 $836.32 $983.90 $1,402.06

























45

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group























46

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group















































Bronze Plans

47

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group


















48

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider










































Small Group Off Exchange Premium Rates Effective July 1, 2019

Form Numbers

OF = Off Exchange

SG = Small Group







Platinum Plans

49

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







































Gold Plans

50

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group















































51

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







































Silver Plans

52

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1240145-00 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPN.FPN $500.80 $851.36 $1,001.60 $1,427.28

18029NY1240146-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPY.FPY $506.05 $860.29 $1,012.10 $1,442.24

18029NY1240147-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPY.FPN $505.08 $858.64 $1,010.16 $1,439.48

18029NY1240148-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPY.FPN $500.80 $851.36 $1,001.60 $1,427.28

18029NY1240149-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPY.FPY $501.78 $853.03 $1,003.56 $1,430.07

18029NY1240150-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPN.FPY $506.05 $860.29 $1,012.10 $1,442.24

18029NY1240151-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPN.FPN $505.08 $858.64 $1,010.16 $1,439.48

18029NY1240152-00 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPN.FPY $501.78 $853.03 $1,003.56 $1,430.07

























53

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group























54

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







































Bronze Plans

55

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group


























56

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider










































Small Group Off Exchange Premium Rates Effective October 1, 2019

Form Numbers

OF = Off Exchange

SG = Small Group







Platinum Plans

57

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1200033-00 IHBC-C1027 IHBC-SBG1003 IHBC-R2014 iDirect Gold Copay OFSG.DEP25.SNF365.DPN.FPN $591.92 $1,006.26 $1,183.84 $1,686.97

18029NY1200035-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay OFSG.DEP29.SNF365.DPY.FPY $598.22 $1,016.97 $1,196.44 $1,704.93

18029NY1200036-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Gold Copay OFSG.DEP29.SNF365.DPY.FPN $597.05 $1,014.99 $1,194.10 $1,701.59

18029NY1200037-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1065 IHBC-R2014 iDirect Gold Copay OFSG.DEP25.SNF365.DPY.FPN $591.92 $1,006.26 $1,183.84 $1,686.97

18029NY1200040-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1065 IHBC-R2014 iDirect Gold Copay OFSG.DEP25.SNF365.DPY.FPY $593.09 $1,008.25 $1,186.18 $1,690.31

18029NY1200043-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R2014 iDirect Gold Copay OFSG.DEP29.SNF365.DPN.FPY $598.22 $1,016.97 $1,196.44 $1,704.93

18029NY1200045-00 IHBC-C1027 IHBC-SBG1003 IHBC-R1064 IHBC-R2014 iDirect Gold Copay OFSG.DEP29.SNF365.DPN.FPN $597.05 $1,014.99 $1,194.10 $1,701.59

18029NY1200046-00 IHBC-C1027 IHBC-SBG1003 IHBC-R2014 iDirect Gold Copay OFSG.DEP25.SNF365.DPN.FPY $593.09 $1,008.25 $1,186.18 $1,690.31

























Gold Plans

58

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group
























18029NY1200194-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 IHBC-R1065 Healthy New York OFSG.DEP29.SNF200.DPY.FPY $501.40 $852.38 $1,002.80 $1,428.99

18029NY1200195-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 IHBC-R1065 Healthy New York OFSG.DEP29.SNF200.DPY.FPN $500.43 $850.73 $1,000.86 $1,426.23



18029NY1200198-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 Healthy New York OFSG.DEP29.SNF200.DPN.FPN $500.43 $850.73 $1,000.86 $1,426.23

18029NY1200199-00 IHBC-C1027 IHBC-SBG1001 IHBC-R1064 Healthy New York OFSG.DEP29.SNF200.DPN.FPY $501.40 $852.38 $1,002.80 $1,428.99


















59

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







































Silver Plans

60

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







18029NY1240145-00 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPN.FPN $510.81 $868.38 $1,021.62 $1,455.81

18029NY1240146-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPY.FPY $516.17 $877.49 $1,032.34 $1,471.08

18029NY1240147-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPY.FPN $515.18 $875.81 $1,030.36 $1,468.26

18029NY1240148-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPY.FPN $510.81 $868.38 $1,021.62 $1,455.81

18029NY1240149-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1065 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPY.FPY $511.82 $870.09 $1,023.64 $1,458.69

18029NY1240150-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPN.FPY $516.17 $877.49 $1,032.34 $1,471.08

18029NY1240151-00 IHBC-C1027 IHBC-SBS1014 IHBC-R1064 IHBC-R2014 iDirect Silver Copay OFSG.DEP29.SNF365.DPN.FPN $515.18 $875.81 $1,030.36 $1,468.26

18029NY1240152-00 IHBC-C1027 IHBC-SBS1014 IHBC-R2014 iDirect Silver Copay OFSG.DEP25.SNF365.DPN.FPY $511.82 $870.09 $1,023.64 $1,458.69


18029NY1240178-00 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R1065 IHBC-R2014 Max Silver OFSG.DEP29.SNF365.DPY.FPY $500.41 $850.70 $1,000.82 $1,426.17




18029NY1240182-00 IHBC-C1027 IHBC-SBS1018 IHBC-R1064 IHBC-R2014 Max Silver OFSG.DEP29.SNF365.DPN.FPY $500.41 $850.70 $1,000.82 $1,426.17



















61

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group








18029NY1250019-00 IHBC-C1037 IHBC-SBS1010 IHBC-R1064 IHBC-R1065 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP29.SNF365.DPY.FPY $500.24 $850.41 $1,000.48 $1,425.68




18029NY1250027-00 IHBC-C1037 IHBC-SBS1010 IHBC-R1064 IHBC-R2014 NY PA Silver HSAQ OFSG.DEP29.SNF365.DPN.FPY $500.24 $850.41 $1,000.48 $1,425.68











62

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group







































Bronze Plans

63

1 1.7 2 2.85


Child(ren)

Employee +

SpouseFamily

Base Form

Schedule of

Benefits

Age 29

Rider

Domestic

Partner

Rider

Unlimited

SNF Rider



Form Numbers

OF = Off Exchange

SG = Small Group


























64

Supporting Document Schedules Satisfied - Item: 2019 Rate Filing ChecklistComments:Attachment(s): 2019_Rate_Filing_Checklist_04182018.pdfItem Status:Status Date:

Satisfied - Item: Actuarial Memorandum and CertificationsComments:

Attachment(s): Actuarial Memorandum - Small Group Market.pdfSmall Group Risk Adjustment Assumption Development.xlsx

Item Status:Status Date:

Satisfied - Item: Actuarial Value CalculationsComments:Attachment(s): 2019 SG Screenshots.pdfItem Status:Status Date:

Satisfied - Item: Exhibit 11: General InformationComments:

Attachment(s): 2019_Exh11_SG.pdf2019_Exh11_SG.xlsm


Satisfied - Item: Exhibit 13(B): Narrative SummaryComments:Attachment(s): Exhibit 13B - IHBC Small Group.pdfItem Status:Status Date:

Satisfied - Item: Exhibit 13(C): Average Premium DetailsComments:

Attachment(s): Exhibit 13C - IHBC Small Group.pdfExhibit 13C - IHBC Small Group.xlsm





Satisfied - Item: Exhibit 13A: Numerical Summary and Rate Indication CalculationComments:

Attachment(s): Exhibit 13A - IHBC Small Group.pdfExhibit 13A - IHBC Small Group.xlsm


Satisfied - Item: Exhibit 14: Summary of Requested Percentage ChangesComments:

Attachment(s): Exhibit 14 - IHBC Small Group.pdfExhibit 14 - IHBC Small Group.xlsm


Satisfied - Item: Exhibit 16: Summary of Policy Form & Product ChangesComments:

Attachment(s): 2019_Exh16_SG.pdf2019_Exh16_SG.xlsm


Satisfied - Item: Exhibit 17: Claims ExperienceComments:



Satisfied - Item: Exhibit 18: Index Rate/Plan-Design Level AdjustmentComments:

Attachment(s): 2019_exh18_04182018 SG.xlsm2019_exh18_04182018 SG.pdf


Satisfied - Item: Exhibit 19: Summary of Average Claim Trend and Admin Expenses and Profit Margin




Comments:

Attachment(s): 2019_exh19_SG.pdf2019_exh19_SG.xlsm


Satisfied - Item: Exhibit 23: Summary of Requested 2019 Premium RatesComments:



Satisfied - Item: Exhibit 25: Summary of Experience by Material Rating VariablesComments:



Bypassed - Item: Consumer Disclosure FormBypass Reason: Documentation is not yet available.Attachment(s):Item Status:Status Date:

Satisfied - Item: Draft Initial NoticeComments:

Attachment(s):Enclosed Notice for IHBC SG Subscribers - 2019 Proposed Premium Rate Change - FINAL 5-16-18.pdfIHBC Small Group Plan Employer – 2019 Proposed Premium Rates Letter - FINAL 5-16-18.pdfIHBC Small Group Plan Subscriber – 2019 Proposed Premium Rates Letter - FINAL 5-16-18.pdf


Bypassed - Item: Final Notice of Proposed Rate Adjustment

Bypass Reason: The Final Notice of Proposed Rate Adjustment letter is now included in the Model Notice for Renewal/Rate Notifications byInsurers. 2019 Model Notice language is not yet available.

Attachment(s):Item Status:




Status Date:

Satisfied - Item: Redacted Documents for Web PostingComments:

Attachment(s):

Exhibit 21A - IHBC Small Group_Redacted.pdfExhibit 21B - IHBC Small Group_Redacted.pdf2019_exh22_04182018 SG_Redacted.pdf2019_Exh11_SG_Redacted.pdfActuarial Memorandum - Small Group Market_Redacted.pdf


Satisfied - Item: Unified Rate Review TemplateComments:

Attachment(s): Unified-Rate-Review-Template-v43 SG.pdfUnified-Rate-Review-Template-v43 SG.xlsm





Rate Filing Checklist – Last updated: 4/18/2018

NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES

Checklist for the Filing of 2019 Individual Premium Rates

For On-Exchange Plans and Off-Exchange Plans

1. Under which Section of the New York State Insurance Law is this filing being made? (3231(e)(1), 4308(c), 3231(d), or 4308(b)) _______

2. For filings made pursuant to 3231(e)(1) and 4308(c):

a. Did the Company submit a combined filing for “On” and “Off” Exchange rates per the instructions along with

a separate form filing that both contain cross references to each other? _______

b. For Individual filings, do the Exhibits only contain Individual plan/experience data per the instructions? _______

c. For Small Group filings, do the Exhibits only contain Small Group plan/experience data per the instructions? _______

3. Does this filing introduce any new plans (i.e., new 14 digit HIOS IDs)? _______

4. Has the Company provided two versions (i.e., PDF and Excel) of all rate filing Exhibits and Rate Manual? _______

5. Do the values in Line 10A of Exhibit 18 match the totals in column 14.7 of Exhibit 17 for the applicable Market Segments? _______

6. Do the values in Line 10B of Exhibit 18 match the totals in column 14.3 of Exhibit 17 for the applicable Market Segments? _______

7. Confirm that the 2019 version (the date they were last updated, “4-18-2018” is included in each of the file names) of the Rate

Filing Exhibits were utilized (Yes/No: Respond “Yes” to confirm). _______

8. With regard to the “Rate Review Detail” screen in SERFF:

a. Was it completed in a manner consistent with 2018 premium rate filings? _______

b. Do the “Average” percentages look reasonable (e.g., do they fall between “Minimum” and “Maximum” percentages? _______

c. Do the “Minimum” and “Maximum” values appear reasonable in light of changes that are being proposed? _______

d. Are the “Minimum”, “Maximum” and “Average” values stated on a PMPM basis (as opposed to annualized)? _______

e. Are all items that are not applicable left blank (i.e., Items that are not applicable should be left blank)? _______

f. Have the “Requested Rate Period” data fields been populated with non-zero values? _______

9. Is the information presented in Exhibit 18 provided at the HIOS SCID level (i.e., are there 14 digits in the HIOS ID?) _______

10. Does Exhibit 23 contain rates for every distinct 14-digit HIOS ID as opposed to only the “Base” plan rates? _______

11. Does the Company’s claim experience for 2017 include two months of run-out? _______

12. Is the rate manual provided in both PDF and Excel format per our instructions?

13. Were adequate details included in the Actuarial Memorandum regarding how DFS should modify the Company’s 2019

assumption for risk adjustment to the extent actual 2017 results are different from expected? _______

14. Does the overall rate change calculated in Exhibit 13c accurately represent the Company’s expectation of the rate change? _______

a. If not, did the Company’s Actuary reach out to DFS and resolve the issue? (Note that any such issues should be _______ resolved prior to submission of the filing by contacting Frank Horn via e-mail at [email protected] or by phoneat (518) 473-5454)

Name of the Chief Actuary responsible for this filing:

Signature: _

Date: __________________________________

E-mail Address: ____

Phone Number: ____________________

3231(e)(1)/4308(c)

Yes

YesYesYesYesYesYes

Yes

YesYesYesYes

YesYes

YesYesYes

YesN/A

Yes

________Yes

05/14/2018

mailto:[email protected]

User Inputs for Plan Parameters

Use Integrated Medical and Drug Deductible?

Apply Inpatient Copay per Day? HSA/HRA Employer Contribution? Tiered Network Plan?

Apply Skilled Nursing Facility Copay per Day? 85%

Use Separate MOOP for Medical and Drug Spending? 15%

Indicate if Plan Meets CSR or Expanded Bronze AV Standard?

Desired Metal Tier

Medical Drug Combined Medical Drug Combined

Deductible ($) $0.00 $0.00 $1,000.00 $0.00

Coinsurance (%, Insurer's Cost Share) 100.00% 100.00% 50.00% 100.00%

MOOP ($)

MOOP if Separate ($)

Click Here for Important Instructions Tier 1 Tier 2

Type of BenefitSubject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical

Emergency Room Services $150.00 $150.00

All Inpatient Hospital Services (inc. MH/SUD) $500.00

Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and

X-rays)$10.00

Specialist Visit $40.00

Mental/Behavioral Health and Substance Use Disorder Outpatient

Services$30.00

Imaging (CT/PET Scans, MRIs) $85.00

Speech Therapy $30.00

Occupational and Physical Therapy$30.00

Preventive Care/Screening/Immunization 100% $0.00 100% $0.00

Laboratory Outpatient and Professional Services $0.00

X-rays and Diagnostic Imaging $30.00

Skilled Nursing Facility $500.00

Outpatient Facility Fee (e.g., Ambulatory Surgery Center) $150.00

Outpatient Surgery Physician/Surgical Services $0.00

Drugs

Generics $5.00 $4.00

Preferred Brand Drugs $30.00 $30.00

Non-Preferred Brand Drugs 50% 50%

Specialty Drugs (i.e. high-cost) 50% 50%

Options for Additional Benefit Design Limits: Plan Description:

Set a Maximum on Specialty Rx Coinsurance Payments? Name: FlexFit Platinum Small Group

Specialty Rx Coinsurance Maximum: Plan HIOS ID: 18029NY1170040

Set a Maximum Number of Days for Charging an IP Copay? Issuer HIOS ID:

# Days (1-10):

Begin Primary Care Cost-Sharing After a Set Number of Visits?

# Visits (1-10):

Begin Primary Care Deductible/Coinsurance After a Set Number of

Copays?

# Copays (1-10):

Output

Status/Error Messages: Calculation Successful.

Actuarial Value: 86.01%

Metal Tier: Platinum

Additional Notes:

Calculation Time: 5.1953 seconds

Final 2019 AV Calculator

NOTE: Service-specific cost-sharing is applying for service(s) with fac/prof components, overriding outpatient inputs for those service(s).

Copay applies only after

deductible?

HSA/HRA Options Tiered Network Option

Annual Contribution Amount:2nd Tier Utilization:

1st Tier Utilization:

Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design

Tier 1 Tier 2

$5,250.00 $6,450.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $0.00 $0.00 $1,500.00 $0.00


MOOP ($)




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$10.00



Services$30.00










Drugs






Set a Maximum on Specialty Rx Coinsurance Payments? Name: Choice Plus Platinum Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output




Additional Notes:





deductible?





Tier 1 Tier 2

$5,250.00 $6,750.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $0.00 $0.00 $1,500.00 $0.00


MOOP ($)




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$10.00



Services$30.00










Drugs






Set a Maximum on Specialty Rx Coinsurance Payments? Name: FlexFit Platinum Copay NYS OON Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output




Additional Notes:





deductible?





Tier 1 Tier 2

$5,250.00 $6,750.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $0.00 $0.00 $1,500.00 $0.00


MOOP ($)




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$30.00



Services$50.00










Drugs

Generics $10.00 $5.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: Passport Plan Platinum Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output




Additional Notes:





deductible?





Tier 1 Tier 2

$5,250.00 $6,750.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $0.00 $0.00 $1,500.00 $0.00


MOOP ($)




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical

Emergency Room Services $150.00

All Inpatient Hospital Services (inc. MH/SUD)


X-rays)

Specialist Visit


Services

Imaging (CT/PET Scans, MRIs)

Speech Therapy

Occupational and Physical Therapy


Laboratory Outpatient and Professional Services

X-rays and Diagnostic Imaging

Skilled Nursing Facility

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

Outpatient Surgery Physician/Surgical Services

Drugs


Preferred Brand Drugs $30.00

Non-Preferred Brand Drugs 50%

Specialty Drugs (i.e. high-cost) 50%


Set a Maximum on Specialty Rx Coinsurance Payments? Name: iShare Platinum Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output




Additional Notes:





deductible?





Tier 1 Tier 2

$7,350.00 $6,750.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $1,250.00 $0.00 $2,000.00 $0.00


MOOP ($)




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical


All Inpatient Hospital Services (inc. MH/SUD) $1,000.00


X-rays)$20.00



Services$50.00







Skilled Nursing Facility $1,000.00



Drugs

Generics $10.00 $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Gold Copay Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:





deductible?





Tier 1 Tier 2

$7,550.00 $7,350.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $1,350.00 $0.00 $2,250.00 $0.00


MOOP ($)




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$20.00



Services$50.00










Drugs

Generics $10.00 $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: Choice Plus Gold Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:





deductible?





Tier 1 Tier 2

$7,550.00 $7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $1,350.00 $0.00 $1,500.00 $2,250.00 $0.00

Coinsurance (%, Insurer's Cost Share) 100.00% 100.00% 100.00% 50.00% 100.00%

MOOP ($) $5,750.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$15.00



Services$40.00










Drugs

Generics $4.00 $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Gold Copay HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:





deductible?





Tier 1 Tier 2

$7,550.00 $7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,000.00 $0.00 $1,500.00 $2,250.00 $0.00


MOOP ($) $5,750.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $10.00 $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: NY PA Gold Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:



NOTE: One or more services are not subject to the deductible and have no copay. Any service with this cost-sharing structure is covered at 100% by the plan in the

deductible range. NOTE: Office-visit-specific cost-sharing is applying to x-rays in office settings.


deductible?





Tier 1 Tier 2

$7,550.00 $7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,000.00 $0.00 $1,500.00 $2,250.00 $0.00


MOOP ($) $5,750.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $10.00 $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: Passport Plan Gold Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:



NOTE: One or more services are not subject to the deductible and have no copay. Any service with this cost-sharing structure is covered at 100% by the plan in the

deductible range. NOTE: Office-visit-specific cost-sharing is applying to x-rays in office settings.


deductible?





Tier 1 Tier 2

$7,550.00 $7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,000.00 $0.00 $1,250.00 $2,250.00 $0.00


MOOP ($) $6,350.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$15.00



Services$0.00


Speech Therapy








Drugs

Generics $10.00 $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: Max Gold Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:



NOTE: Office-visit-specific cost-sharing is applying to x-rays in office settings. NOTE: Service-specific cost-sharing is applying for service(s) with fac/prof

components, overriding outpatient inputs for those service(s).


deductible?





Tier 1 Tier 2

$7,550.00 $7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $0.00 $0.00 $1,250.00 $2,250.00 $0.00


MOOP ($) $6,350.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $15.00 $10.00

Preferred Brand Drugs 60% $30.00




Set a Maximum on Specialty Rx Coinsurance Payments? Name: iShare Gold Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:





deductible?





Tier 1 Tier 2

$7,350.00 $7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $0.00 $0.00 $1,500.00 $2,250.00 $0.00


MOOP ($) $5,500.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Gold Coinsurance HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:




deductible?





Tier 1 Tier 2

$7,350.00 $7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All




Apply Skilled Nursing Facility Copay per Day?

Use Separate MOOP for Medical and Drug Spending?


Desired Metal Tier


Deductible ($) $1,700.00 $0.00 $4,000.00

Coinsurance (%, Insurer's Cost Share) 100.00% 100.00% 50.00%

MOOP ($) $7,600.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$30.00



Services$30.00










Drugs

Generics $10.00


Non-Preferred Brand Drugs $70.00

Specialty Drugs (i.e. high-cost) $70.00


Set a Maximum on Specialty Rx Coinsurance Payments? Name: Standard Silver Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:





deductible?





Tier 1 Tier 2

$7,500.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $3,000.00 $3,425.00

Coinsurance (%, Insurer's Cost Share) 80.00% 50.00%

MOOP ($) $6,650.00 $6,550.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $15.00 $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Silver Coinsurance HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:




deductible?





Tier 1 Tier 2

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $3,000.00 $3,425.00


MOOP ($) $6,650.00 $6,550.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$35.00



Services$60.00










Drugs

Generics $10.00 $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Silver Copay Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:





deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $2,250.00 $3,425.00


MOOP ($) $6,650.00 $6,550.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$35.00



Services$60.00










Drugs

Generics $15.00 $10.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Silver Copay HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:





deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $2,600.00 $3,750.00


MOOP ($) $6,650.00 $6,650.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical


All Inpatient Hospital Services (inc. MH/SUD) 70%


X-rays)$35.00



Services$60.00







Skilled Nursing Facility 70%



Drugs

Generics $15.00 $15.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: Choice Plus Silver HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:





deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $3,000.00 $3,750.00


MOOP ($) $6,650.00 $6,650.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $15.00 $15.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: NY PA Silver HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:




deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $3,000.00 $3,750.00


MOOP ($) $6,650.00 $6,650.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $15.00 $15.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: Passport Plan Silver HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:




deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $2,800.00 $3,750.00


MOOP ($) $7,350.00 $6,650.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$35.00



Services$50.00










Drugs

Generics $10.00 $15.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: Max Silver Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:





deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $3,325.00 $3,750.00


MOOP ($) $7,350.00 $6,650.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$35.00



Services$0.00










Drugs

Generics $15.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Silver Blended HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:





deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All




Apply Skilled Nursing Facility Copay per Day?

Use Separate MOOP for Medical and Drug Spending?


Desired Metal Tier


Deductible ($) $1,700.00 $0.00 $4,000.00

Coinsurance (%, Insurer's Cost Share) 100.00% 100.00% 50.00%

MOOP ($) $7,600.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical

Emergency Room Services



X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $10.00


Non-Preferred Brand Drugs $70.00

Specialty Drugs (i.e. high-cost) $70.00


Set a Maximum on Specialty Rx Coinsurance Payments? Name: Standard Bronze Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Bronze

Additional Notes:




deductible?





Tier 1 Tier 2

$7,500.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $5,150.00 $3,750.00


MOOP ($) $6,650.00 $6,650.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $15.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Bronze HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Bronze

Additional Notes:




deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $5,150.00 $3,750.00


MOOP ($) $6,650.00 $6,650.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $15.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: Passport Plan Bronze HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Bronze

Additional Notes:




deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $2,250.00 $0.00 $6,650.00 $3,750.00


MOOP ($) $6,650.00 $6,650.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)$0.00



Services$0.00










Drugs

Generics $0.00 $15.00


Non-Preferred Brand Drugs $0.00 50%

Specialty Drugs (i.e. high-cost) $0.00 50%


Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Bronze MV HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Bronze

Additional Notes:





deductible?





Tier 1 Tier 2

$7,550.00

Calculate

All

All

All

All

All

All

All

All

All All

All All







Desired Metal Tier


Deductible ($) $3,500.00 $3,750.00

Coinsurance (%, Insurer's Cost Share) 70.00% 50.00%

MOOP ($) $6,650.00 $6,650.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical




X-rays)

Specialist Visit


Services


Speech Therapy








Drugs

Generics $15.00





Set a Maximum on Specialty Rx Coinsurance Payments? Name: iDirect Bronze Enhanced HSAQ Small Group



# Days (1-10):


# Visits (1-10):


Copays?

# Copays (1-10):

Output

Status/Error Messages: Expanded Bronze Standard (56% to 65%), Calculation Successful.


Metal Tier: Bronze

Additional Notes:




deductible?





Tier 1 Tier 2

Calculate

All

All

All

All

All

All

All

All

All All

All All

Exhibit 13b – Narrative Summary Last Updated: 4/18/2018

EXHIBIT 13b: NARRATIVE SUMMARY

Company Name: Independent Health Benefits Corporation NAIC Code: 47034 SERFF Tracking #: NDPD-131469299 Market Segment: Small Group

Summary

Independent Health Benefits Corporation (IHBC) is requesting premium rate increases in 2019 for its

community-rated Small Group Market products. As described in more detail below, IHBC is seeking an

overall rate increase of 3.8% in 2019, primarily due to higher claim expense trends along with a handful

of items to offset the claim expense trend resulting from regulatory changes.

These proposed rate adjustments will be submitted to the New York State Department of Financial

Services on or about May 14, 2018. You will be notified of the final approved premium adjustment at

least 60 days prior to your effective date of renewal.

5,714 policyholders and 37,968 members may be affected by this proposed rate adjustment.

Claim Expense Trends

Premium rates tend to rise each year because of normal inflation of health care claim costs. Moreover,

in addition to cost increases, utilization of healthcare services also tends to rise as new technologies,

services and prescription drugs are introduced to the marketplace.

For 2019, IHBC is projecting an overall claim expense trend of 6.0%. All else being equal, this would

require a corresponding premium rate increase to keep pace with costs. However, because of other

factors described more fully below, IHBC is requesting a rate increase lower than the overall claim

expense trend.

How Your Premium Dollars are Spent

In 2019, IHBC projects that approximately 87.6% of every premium dollar will be spent on paying claim

expenses, which is about 0.6% higher than last year. This is well above the statutory minimum

requirement of 82%. The remainder of each premium dollar is used to cover ACA fees, administrative

expenses, and contributions to reserves:

(1) ACA Taxes & Fees. The provisions included in the 2019 premium rates are as follows:

• Risk Adjustment User Fee: $0.15 Per Member, Per Month

• Health Insurance Tax: 0.16% of Premium

Exhibit 13b – Narrative Summary Last Updated: 4/18/2018

➢ For example, if a member is enrolled in a plan for the entire year with a monthly

premium amount of $400, then IHBC is required to pay the following amounts:

▪ Risk Adjustment User Fee = $1.80 ($0.15 per month for 12 months)

▪ Health Insurance Tax = $7.68 ($400 x 0.16% x 12 months)

➢ How the ACA Taxes & Fees changed from last year:

▪ The Risk Adjustment User Fee increased $0.01 Per Member, Per Month

▪ Due to the suspension of the Health Insurance Tax for calendar year 2019, the

premium impact attributable to this tax decreased significantly, declining from

2.0% last year to 0.16% for 2019

▪ The Patient Centered Outcomes Research Initiative (PCORI) will conclude with

plan years ending 9/30/2018, so the fee associated with this initiative has been

removed from the 2019 premium rates. Last year, the PCORI fee was $0.20 Per

Member, Per Month.

(2) Administrative Expenses. In 2019, 10.1% of every premium dollar will be spent on

administrative expenses, which cover (among other things) activities such as customer service

and claims processing and payment. State-mandated assessments used to fund the operations

of the Department of Financial Services (DFS), which regulates insurance carriers in New York

State, as well as the New York State Department of Health, which oversees the health plan

marketplace, are also included under administrative expenses.

IHBC generates income from invested funds and uses this income to subsidize some of its

administrative expenses. The use of these invested funds is included in the 10.1% number

referenced above.

(3) Contribution to Reserves. All insurance carriers in New York must maintain sufficient cash

reserves necessary to meet solvency requirements. In 2019, approximately 2% of each

premium dollar will be earmarked for contribution to these “rainy day” funds. As noted above,

these funds are invested in safe, relatively liquid securities whose returns are used to minimize

or offset administrative expenses that would otherwise increase premiums.

Risk Adjustment

The ACA introduced several provisions, commonly referred to as the “3Rs” (reinsurance, risk

adjustment, and risk corridors), designed to help level the playing field among insurers and promote

competition based on quality and efficiency. Under the risk adjustment provision, insurance carriers

which cover a population that is less risky than the overall insured population in their region must pay a

certain portion of their premium receipts into a fund, from which carriers that cover higher-risk

populations receive disbursements. IHBC received money from this fund in 2014, 2015, and 2016 for

the Small Group Market and projects to continue being a receiver through 2019. IHBC expects to

receive approximately 2% of revenue required for the Small Group Market from this fund for 2019,

which represents an increase of approximately 0.4% from the 2018 projection.

EXHIBIT 13C ‐ AVERAGE PREMIUM DETAILS

Company Name: IHBCNAIC Code: 47034

SERFF Tracking #: NDPD‐131469299Market Segment: Small Group

1 Please complete all of the shaded boxes in rows 21‐45 below. The goal of this Exhibit is to calculate the rate change being requested in a consistent manner for all insurers. 2 The "Weighted Average Monthly Base Premiums" in cells C22‐G29 should be calculated as a weighted average of the insurer's base premiums (i.e., single adult rates prior to application of tier factors, etc.) using the number of plan subscribers as the weights. 3 Cells L22 ‐ P29, should be a recalculation of cells C22‐G29 where any plans (and associated members enrolled in those plans as of 3/31/2018) that will be discontinued in 2019 are removed.The sum of cells C35‐G42 should be equal to the Company's total membership for the relevant market as of 3/31/2018.

4 Cells L35‐P42 should be equal to cells C35‐G42 less any members that are enrolled in plans that will be discontinued in 2019.5 If the Company is not discontinuing any plans in 2019, then cells C22‐G29 and L22‐P29 should be the same, as should cells C35‐G42 and L35‐P42.6 The "Conversion Factors" should be the factors that were developed in pricing to convert the "Weighted Average Monthly Base Premiums" to "Weighted Average Monthly PMPM Premium Rates". These factors should be adjusted as necessary to reflect any changes that are not reflected in the Base Premiums.

2018 Weighted Average Monthly Base Premiums ‐ CALCULATED BASED ON ACTUAL DISTRIBUTION AS OF 3/31/2018 (Weighted by number 2018 Weighted Average Monthly Base Premiums ‐ RE‐CALCULATED USING ONLY THE SUBSET OF 2018 PLANS THAT WILL STILL 2019 Weighted Average Monthly Proposed Base Premiums ‐ THESE BASE PREMIUMS SHOULD BE CALCULATED USING THE SAME Change in Weighted Average Monthly Base Premiums of subscribers) BE AVAILABLE IN 2019 (weighted by subscribers in those specific plans) POPULATION OF SUBSCRIBERS THAT WAS USED TO CALCULATE CELLS L22 ‐ P29) Average Monthly Base Premium assuming 3/31/2018 membership Average Monthly Base Premium paid assuming 3/31/2018 membership and all policies are paid in full for the entire year) Average Base Premium paid assuming 3/31/2018 membership and all policies are paid in full for the entire year) Average Base Premium paid assuming 3/31/2018 membership and all policies are paid in full for the entire year)

Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals1 ‐ Albany Area 1 ‐ Albany Area 1 ‐ Albany Area 1 ‐ Albany Area 0.00%2 ‐Buffalo Area 635.59 506.84 464.18 384.44 533.04 2 ‐Buffalo Area 650.64 522.94 464.18 384.44 535.17 2 ‐Buffalo Area 653.69 552.29 486.78 424.17 553.61 2 ‐Buffalo Area 0.47% 5.61% 4.87% 10.34% 3.45%

3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area4‐ NYC Area 4‐ NYC Area 4‐ NYC Area 4‐ NYC Area

5‐ Rochester Area 5‐ Rochester Area 5‐ Rochester Area 5‐ Rochester Area6‐ Syracuse Area 6‐ Syracuse Area 6‐ Syracuse Area 6‐ Syracuse Area

7‐ Utica/Watertown Area 7‐ Utica/Watertown Area 7‐ Utica/Watertown Area 7‐ Utica/Watertown Area8‐ Long Island Area 8‐ Long Island Area 8‐ Long Island Area 8‐ Long Island Area

9 ‐ All Regions 635.59 506.84 464.18 384.44 533.04 9 ‐ All Regions 650.64 522.94 464.18 384.44 535.17 To Exhibit 13a (Section A) 9 ‐ All Regions 653.69 552.29 486.78 424.17 553.61 To Exhibit 13a (Section A) 9 ‐ All Regions 0.47% 5.61% 4.87% 10.34% 3.45%

2018 Members ‐ as of 3/31/2018 ‐ Actual Distribution (All members as of 3/31/2018 should be included) Members ‐ as of 3/31/2018 ‐ Only those members currently enrolled in plans that will continue to be offered in 2019 Members ‐ as of 3/31/2018 ‐ Only those members currently enrolled in plans that will continue to be offered in 2019 Change in Members ‐ as of 3/31/2018 ‐ Change due to current 2018 plans not being offered in 2019.

Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals1 ‐ Albany Area 1 ‐ Albany Area 1 ‐ Albany Area 1 ‐ Albany Area2 ‐Buffalo Area 16,994 12,317 13,904 3,112 46,327 2 ‐Buffalo Area 13,408 7,544 13,904 3,112 37,968 2 ‐Buffalo Area 13,408 7,544 13,904 3,112 37,968 2 ‐Buffalo Area ‐21.10% ‐38.75% 0.00% 0.00% ‐18.04%




9 ‐ All Regions 16,994 12,317 13,904 3,112 46,327 9 ‐ All Regions 13,408 7,544 13,904 3,112 37,968 9 ‐ All Regions 13,408 7,544 13,904 3,112 37,968 9 ‐ All Regions ‐21.10% ‐38.75% 0.00% 0.00% ‐18.04%

2018 Conversion Factor ‐ A 0.8326 Must be less than or equal to 1.000 2018 Conversion Factor ‐ B 0.8342 Must be less than or equal to 1.000 2019 Conversion Factor 0.8370 Must be less than or equal to 1.000 Change in Conversion Factor 0.33496%

2018 Estimated Aggregate Annualized Premium by Metal and Region ‐ based on membership as of 3/31/2018 2018 Estimated Aggregate Annualized Premium by Metal and Region ‐ based on membership as of 3/31/2018 2019 Estimated Aggregate Annualized Premium by Metal and Region ‐ based on membership as of 3/31/2018 Change in Aggregate Annualized Premiums ‐ based on membership as of 3/31/2018 (Ignoring any discontinuances) Aggregate premium that would be collected assuming 3/31/2018 membership and all policies are paid in full for the entire year) Aggregate premium that would be collected assuming 3/31/2018 membership and all policies are paid in full for the entire year) ‐ Adjusted for Discontinuances Aggregate premium that would be collected assuming 3/31/2018 membership and all policies are paid in full for the entire year) ‐ Adjusted for Discontinuances

Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals1 ‐ Albany Area 1 ‐ Albany Area 1 ‐ Albany Area 1 ‐ Albany Area2 ‐Buffalo Area 107,922,353 62,376,565 64,485,783 11,953,866 246,738,568 2 ‐Buffalo Area 87,324,603 39,489,898 64,602,850 11,975,567 203,392,919 2 ‐Buffalo Area 88,027,101 41,845,966 67,975,677 13,257,638 211,106,382 2 ‐Buffalo Area ‐18.43% ‐32.91% 5.41% 10.91% ‐14.44%




9 ‐ All Regions 107,922,353 62,376,565 64,485,783 11,953,866 246,738,568 9 ‐ All Regions 87,324,603 39,489,898 64,602,850 11,975,567 203,392,919 Should equal Cell G‐22 of Exhibit 14 9 ‐ All Regions 88,027,101 41,845,966 67,975,677 13,257,638 211,106,382 9 ‐ All Regions ‐18.43% ‐32.91% 5.41% 10.91% ‐14.44%

2018 Weighted Average Monthly PMPM Premium Rates 2018 Weighted Average Monthly PMPM Premium Rates ‐ Reflecting adjustment for discontinued plans 2019 Weighted Average Monthly PMPM Premium Rates ‐Reflecting adjustment for discontinued plans Change in Weighted Average PMPM Premiums

Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals1 ‐ Albany Area 1 ‐ Albany Area 1 ‐ Albany Area 1 ‐ Albany Area2 ‐Buffalo Area 529.22 422.02 386.49 320.10 443.84 2 ‐Buffalo Area 542.74 436.22 387.20 320.68 446.41 2 ‐Buffalo Area 547.11 462.24 407.41 355.01 463.34 2 ‐Buffalo Area 0.80% 5.97% 5.22% 10.71% 3.79%




9 ‐ All Regions 529.22 422.02 386.49 320.10 443.84 9 ‐ All Regions 542.74 436.22 387.20 320.68 446.41 To Exhibit 13a (Section B) 9 ‐ All Regions 547.11 462.24 407.41 355.01 463.34 To Exhibit 13a (Section B) Total 0.80% 5.97% 5.22% 10.71% 3.79%

Exhibit 13c Updated by DFS 3/14/2018 1

EXHIBIT 13a: NUMERICAL SUMMARY AND RATE INDICATION CALCULATION

NUMERICAL SUMMARY

IHBC47034

SERFF Tracking #: NDPD-131469299Market Segment: Small Group

1 Please complete the Numerical Summary below as well as the Narrative Summary (a separate attachment) for each market segment for which a rate filing is being submitted.2 The Narrative Summary must be in plain English and should clearly and simply explain the reasons for the requested rate adjustment (This should be included in the provided blank template "2019 Exhibit 13b - Narrative Summary.docx")3 The purpose of the Narrative Summary is to provide a written explanation to the company's policyholders to help them understand the reasons why a rate increase is needed. 4 The purpose of the Numerical Summary is to provide a clear and simple overview of the requested rate adjustment. 5 These Summaries (with the exception of the Rate Indication Calculation Section) will be public documents and will be posted on DFS’s website and furnished by DFS to the public upon request. 6 The company should submit these Summaries to DFS ten (10) days before submitting a rate adjustment filing.7 A draft of these Summaries and of the Initial Notice must be included in a "Prior Approval Pre-filing" submitted to DFS via SERFF.8 Once reviewed by DFS, these Summaries must be posted to a location on its website that is publicly available and accessible without the need for a user ID/password. 9 Links should be provided on key pages of the company's website so that the information may be easily located.

10 Any change(s) made to the Narrative Summary/Numerical Summary subsequent to the posting must be submitted to DFS with the specific change(s) identified.11 Rate Change Adjustment calculations between Year 2018 and 2019 should be based on the DFS Membership Survey data as of 3/31/2018.12 This exhibit must be submitted as an Excel file and as a PDF file.

A. Average 2018 and 2019 Premium Rates:1 Average Premium Rates are as calculated in Row 30 of the appropriate columns in Exhibit 13c (Columns L-Q for 2018 and Columns U-Z for 2019)2 Premium Rates for 2019 should be Consistent with the Premium Rates reflected in Exhibit 23.

Average Individual Rate Average Individual Rate Average Individual Rate Average Individual Rate Average Individual RatePlatinum Gold Silver Bronze Catastrophic

2018 Weighted Average Base Premium Rates 650.64$ 522.94$ 464.18$ 384.44$ 2019 Weighted Average Base Premium Rates 653.69$ 552.29$ 486.78$ 424.17$

B. Weighted Average Annual Percentage Requested Adjustments:

2018 Weighted Average PMPM Rate 2019 Weighted Average PMPM Rate2018 to 2019 All - Metals All - Metals

Requested Rate Adjustment 3.79240% 446.41$ 463.34$ From Cells Q-72 and Z-72 of Exhibit 13c

C. Weighted Average Annual Percentage Adjustments for each of the Past Two Years [If Applicable]*:2016 to 2017 2017 to 2018

Average Rate Adjustment Requested 11.22631% 14.52416%Average Rate Adjustment Approved 11.52896% 13.89837%

D. Average Medical Loss Ratios [MLR] for All Policies Impacted [Ratios of Incurred Claims to Earned Premiums] [If Applicable]*:2015 2016 2017

MLR 0.8102364 0.8924629 0.9936451

E. Claim Trend Rates and Average Ratios to Earned Premiums [Per Exhibit 19 for 2017‐2019 and Comparable Exhibits for 2017] [If Applicable]*:2017 2018 2019

Annual Claim Trend Rates 10.978% 8.220% 6.042%Expense Ratios 9.528% 10.052% 10.059%Pre Tax Profit Ratios 0.919% 2.000% 2.000%* If product was not offered in a particular year, indicate "N/A" in the applicable box.

Company NAIC Code:

Exhibit 13a Updated by DFS 3/14/2018 1

Company Name: IHBCNAIC Code: 47034 NOTE: THIS EXHIBIT SHOULD NOT INCLUDE MEMBERS THAT ARE CURRENTLY ENROLLED IN PLANS THAT WILL NOT BE AVAILABLE IN 2019SERFF Tracking #: NDPD-131469299Market Segment: Small Group

12345

6789

10111213 The Total Annualized Premium in Column G, Line 22 should equal the total 2018 Aggregate Annualized Premium in Exhibit 13c (Cell Q-59).

Totals $203,392,919 37,968 5,714

Annualized Premiums as of Total # of Members as of Total # of Contracts as of

3/31/2018 3/31/2018 3/31/2018 Decrease No Change 0.1% - 4.9% 5.0% - 9.9% 10.0% - 14.9% 15.0% - 19.9% 20.0% - 24.9% 25.0% - 29.9% 30.0% - 39.9% 40.0% - 49.9% 50.0% or higher Lowest Highest Weighted Avg

Small Group 01/01/19 Platinum 2 -Buffalo AreaFlexFit Platinum Copay NYS

OON FlexFit Platinum Copay NYS OON $69,355 11.00 6.00 0 0 11 0 0 0 0 0 0 0 0 0.46% 0.47% 0.47%Small Group 01/01/19 Platinum 2 -Buffalo Area FlexFit Platinum FlexFit Platinum $24,130,263 3827.00 600.00 0 0 3,827 0 0 0 0 0 0 0 0 0.45% 0.47% 0.47%Small Group 01/01/19 Platinum 2 -Buffalo Area Choice Plus Platinum Choice Plus Platinum $338,981 58.00 23.00 0 0 58 0 0 0 0 0 0 0 0 0.52% 0.53% 0.53%Small Group 01/01/19 Platinum 2 -Buffalo Area Passport Plan Platinum Passport Plan Platinum $0 0.00 0.00 0 0 0 0 0 0 0 0 0 0 0 5.28% 5.29% N/ASmall Group 01/01/19 Gold 2 -Buffalo Area iDirect Gold Copay iDirect Gold Copay $6,696,332 1272.00 236.00 0 0 0 1,272 0 0 0 0 0 0 0 6.17% 6.18% 6.18%Small Group 01/01/19 Gold 2 -Buffalo Area Choice Plus Gold Choice Plus Gold $537,752 109.00 38.00 0 0 0 109 0 0 0 0 0 0 0 5.56% 5.57% 5.57%Small Group 01/01/19 Gold 2 -Buffalo Area iDirect Gold Copay HSAQ iDirect Gold Copay HSAQ $1,152,608 228.00 45.00 0 0 228 0 0 0 0 0 0 0 0 4.18% 4.18% 4.18%Small Group 01/01/19 Gold 2 -Buffalo Area Max Gold Max Gold $406,560 78.00 25.00 0 0 78 0 0 0 0 0 0 0 0 3.34% 3.34% 3.34%Small Group 01/01/19 Gold 2 -Buffalo Area Healthy New York Healthy New York $1,527,452 346.00 110.00 0 0 0 346 0 0 0 0 0 0 0 6.15% 6.16% 6.16%Small Group 01/01/19 Gold 2 -Buffalo Area NY PA Gold NY PA Gold $31,105 6.00 3.00 0 0 6 0 0 0 0 0 0 0 0 2.86% 2.87% 2.87%Small Group 01/01/19 Gold 2 -Buffalo Area Passport Plan Gold Passport Plan Gold $7,167 1.00 1.00 0 0 0 1 0 0 0 0 0 0 0 7.86% 7.86% 7.86%Small Group 01/01/19 Silver 2 -Buffalo Area Standard Silver Standard Silver $825,195 174.00 39.00 0 0 0 174 0 0 0 0 0 0 0 6.99% 7.00% 7.00%

Small Group 01/01/19 Silver 2 -Buffalo AreaiDirect Silver Coinsurance

HSAQ iDirect Silver Coinsurance HSAQ $1,986,730 463.00 92.00 0 0 463 0 0 0 0 0 0 0 0 4.21% 4.22% 4.22%Small Group 01/01/19 Silver 2 -Buffalo Area Choice Plus Silver HSAQ Choice Plus Silver HSAQ $1,439,537 347.00 70.00 0 0 347 0 0 0 0 0 0 0 0 3.98% 3.99% 3.99%Small Group 01/01/19 Silver 2 -Buffalo Area iDirect Silver Copay iDirect Silver Copay $5,842,222 1257.00 216.00 0 0 1,257 0 0 0 0 0 0 0 0 3.78% 3.79% 3.79%Small Group 01/01/19 Silver 2 -Buffalo Area Max Silver Max Silver $632,482 147.00 36.00 0 0 0 147 0 0 0 0 0 0 0 8.67% 8.68% 8.67%Small Group 01/01/19 Silver 2 -Buffalo Area iDirect Silver Copay HSAQ iDirect Silver Copay HSAQ $4,480,328 1012.00 163.00 0 0 0 1,012 0 0 0 0 0 0 0 5.43% 5.44% 5.44%Small Group 01/01/19 Silver 2 -Buffalo Area NY PA Silver HSAQ NY PA Silver HSAQ $105,163 23.00 4.00 0 0 23 0 0 0 0 0 0 0 0 2.22% 2.24% 2.23%Small Group 01/01/19 Silver 2 -Buffalo Area Passport Plan Silver HSAQ Passport Plan Silver HSAQ $0 0.00 0.00 0 0 0 0 0 0 0 0 0 0 0 5.14% 5.15% N/A

Small Group 01/01/19 Bronze 2 -Buffalo Area Passport Plan Bronze HSAQ Passport Plan Bronze HSAQ $0 0.00 0.00 0 0 0 0 0 0 0 0 0 0 0 9.62% 9.63% N/ASmall Group 01/01/19 Bronze 2 -Buffalo Area Standard Bronze Standard Bronze $385,923 101.00 51.00 0 0 0 101 0 0 0 0 0 0 0 7.43% 7.44% 7.44%Small Group 01/01/19 Bronze 2 -Buffalo Area iDirect Bronze HSAQ iDirect Bronze HSAQ $1,356,139 363.00 123.00 0 0 0 363 0 0 0 0 0 0 0 9.82% 9.83% 9.83%

Small Group 01/01/19 Bronze 2 -Buffalo AreaiDirect Bronze Enhanced

HSAQ iDirect Bronze Enhanced HSAQ $166,986 43.00 20.00 0 0 0 43 0 0 0 0 0 0 0 9.92% 9.93% 9.93%Small Group 01/01/19 Bronze 2 -Buffalo Area iDirect Bronze MV HSAQ iDirect Bronze MV HSAQ $525,356 146.00 64.00 0 0 0 0 146 0 0 0 0 0 0 13.20% 13.21% 13.20%


OON FlexFit Platinum Copay NYS OON $12,862 2.00 1.00 0 0 2 0 0 0 0 0 0 0 0 0.46% 0.47% 0.47%Small Group 04/01/19 Platinum 2 -Buffalo Area FlexFit Platinum FlexFit Platinum $14,817,453 2304.00 279.00 0 0 2,304 0 0 0 0 0 0 0 0 0.45% 0.47% 0.47%Small Group 04/01/19 Platinum 2 -Buffalo Area Choice Plus Platinum Choice Plus Platinum $95,381 16.00 7.00 0 0 16 0 0 0 0 0 0 0 0 0.52% 0.53% 0.53%Small Group 04/01/19 Platinum 2 -Buffalo Area Passport Plan Platinum Passport Plan Platinum $0 0.00 0.00 0 0 0 0 0 0 0 0 0 0 0 5.28% 5.29% N/ASmall Group 04/01/19 Gold 2 -Buffalo Area iDirect Gold Copay iDirect Gold Copay $4,032,203 751.00 121.00 0 0 0 751 0 0 0 0 0 0 0 6.17% 6.18% 6.18%Small Group 04/01/19 Gold 2 -Buffalo Area Choice Plus Gold Choice Plus Gold $302,458 60.00 15.00 0 0 0 60 0 0 0 0 0 0 0 5.56% 5.57% 5.57%Small Group 04/01/19 Gold 2 -Buffalo Area iDirect Gold Copay HSAQ iDirect Gold Copay HSAQ $1,526,624 296.00 25.00 0 0 296 0 0 0 0 0 0 0 0 4.18% 4.19% 4.18%Small Group 04/01/19 Gold 2 -Buffalo Area Max Gold Max Gold $154,094 29.00 8.00 0 0 29 0 0 0 0 0 0 0 0 3.34% 3.35% 3.34%Small Group 04/01/19 Gold 2 -Buffalo Area Healthy New York Healthy New York $378,134 84.00 21.00 0 0 0 84 0 0 0 0 0 0 0 6.15% 6.16% 6.16%Small Group 04/01/19 Gold 2 -Buffalo Area NY PA Gold NY PA Gold $132,193 25.00 2.00 0 0 25 0 0 0 0 0 0 0 0 2.86% 2.87% 2.87%Small Group 04/01/19 Gold 2 -Buffalo Area Passport Plan Gold Passport Plan Gold $0 0.00 0.00 0 0 0 0 0 0 0 0 0 0 0 7.86% 7.86% N/ASmall Group 04/01/19 Silver 2 -Buffalo Area Standard Silver Standard Silver $1,320,736 273.00 30.00 0 0 0 273 0 0 0 0 0 0 0 6.99% 7.00% 7.00%

Small Group 04/01/19 Silver 2 -Buffalo AreaiDirect Silver Coinsurance

HSAQ iDirect Silver Coinsurance HSAQ $1,028,701 235.00 44.00 0 0 235 0 0 0 0 0 0 0 0 4.21% 4.23% 4.22%Small Group 04/01/19 Silver 2 -Buffalo Area Choice Plus Silver HSAQ Choice Plus Silver HSAQ $757,116 179.00 34.00 0 0 179 0 0 0 0 0 0 0 0 3.98% 3.99% 3.99%Small Group 04/01/19 Silver 2 -Buffalo Area iDirect Silver Copay iDirect Silver Copay $4,253,065 897.00 110.00 0 0 897 0 0 0 0 0 0 0 0 3.78% 3.79% 3.79%Small Group 04/01/19 Silver 2 -Buffalo Area Max Silver Max Silver $87,809 20.00 8.00 0 0 0 20 0 0 0 0 0 0 0 8.67% 8.68% 8.67%Small Group 04/01/19 Silver 2 -Buffalo Area iDirect Silver Copay HSAQ iDirect Silver Copay HSAQ $6,047,127 1339.00 126.00 0 0 0 1,339 0 0 0 0 0 0 0 5.43% 5.44% 5.44%Small Group 04/01/19 Silver 2 -Buffalo Area NY PA Silver HSAQ NY PA Silver HSAQ $79,285 17.00 5.00 0 0 17 0 0 0 0 0 0 0 0 2.22% 2.23% 2.23%Small Group 04/01/19 Silver 2 -Buffalo Area Passport Plan Silver HSAQ Passport Plan Silver HSAQ $33,125 5.00 1.00 0 0 0 5 0 0 0 0 0 0 0 5.14% 5.15% 5.15%

Small Group 04/01/19 Bronze 2 -Buffalo Area Passport Plan Bronze HSAQ Passport Plan Bronze HSAQ $23,174 4.00 1.00 0 0 0 4 0 0 0 0 0 0 0 9.62% 9.63% 9.63%Small Group 04/01/19 Bronze 2 -Buffalo Area Standard Bronze Standard Bronze $452,064 116.00 26.00 0 0 0 116 0 0 0 0 0 0 0 7.42% 7.44% 7.44%Small Group 04/01/19 Bronze 2 -Buffalo Area iDirect Bronze HSAQ iDirect Bronze HSAQ $1,535,400 403.00 76.00 0 0 0 403 0 0 0 0 0 0 0 9.82% 9.83% 9.83%

Small Group 04/01/19 Bronze 2 -Buffalo AreaiDirect Bronze Enhanced

HSAQ iDirect Bronze Enhanced HSAQ $0 0.00 0.00 0 0 0 0 0 0 0 0 0 0 0 9.92% 9.93% N/ASmall Group 04/01/19 Bronze 2 -Buffalo Area iDirect Bronze MV HSAQ iDirect Bronze MV HSAQ $876,915 239.00 39.00 0 0 0 0 239 0 0 0 0 0 0 13.20% 13.21% 13.20%


OON FlexFit Platinum Copay NYS OON $26,239 4.00 2.00 0 0 4 0 0 0 0 0 0 0 0 0.46% 0.47% 0.47%Small Group 07/01/19 Platinum 2 -Buffalo Area FlexFit Platinum FlexFit Platinum $12,760,314 1945.00 235.00 0 0 1,945 0 0 0 0 0 0 0 0 0.45% 0.47% 0.46%Small Group 07/01/19 Platinum 2 -Buffalo Area Choice Plus Platinum Choice Plus Platinum $109,451 18.00 5.00 0 0 18 0 0 0 0 0 0 0 0 0.52% 0.53% 0.53%

The weighted average percentage should be developed based on annualized premium volume or membership for that metal level, and rating region, including any applicable riders.

EXHIBIT 14: SUMMARY OF REQUESTED PERCENTAGE CHANGES

Use this Exhibit for both Individual and Small Group Market Plans. A separate Exhibit should be provided for Individual and Small Group filings.Market segment refers to Individual (which includes Catastrophic) or Small Group.The requested percentage rate change reflects the expected change in premium rates that would apply to the contract holder (or member for Small Group business) on that contract holder's next rate change date for each contract holder within the indicated combination of metal level, rating region, and product name.The "Product Street Name" is the product name as advertised to consumers (i.e., as consumers are likely to refer to this product/metal level when communicating with DFS). A separate row is to be used for each combination of metal level, rating region and product name.

If the percentage changes (lowest and highest and weighted average) are identical for all the rating regions, then separate rows by rating region need not be used, and "All Regions" can be shown in the Rating Region column. If the rate change range information differs by rating region, then separate rows need to be used for each rating region the insurer uses. Rating region names used on this exhibit are to use the standard rating region names developed by DFS (e.g., Albany Area, Buffalo Area, etc.).The "requested rate change" includes the impact of any riders (such as: age 29, domestic partner, family planning, pediatric dental, etc.)."Lowest" should be the smallest percentage change that could affect any contract holder due to the submitted rate filing with that metal level and rating region, including any applicable riders."Highest" should be the largest percentage change that could affect any contract holder due to the submitted rate filing with that metal level and rating region, including any applicable riders.

The effective date is the earliest date that the proposed new rate would become effective if approved. The Effective Date for Individual is 1/1/2019. Effective Dates for Small Group are 1/1/2019, 4/1/2019, 7/1/2019 and 10/1/2019.

Requested Percentage Rate Change

Percentage Rate Changes should be calculated using membership as of 3/31/2018.This exhibit must be submitted as an Excel file and as a PDF file.

Market Segment Effective Date of New RateMetal Level

(or Catastrophic) Rating Region Product Name Product Street NameDISTRIBUTION OF MEMBERS - Number of Members with Requested Percentage Rate Change at Renewal

Exhibit 14 Updated by DFS 3/14/2018 1

Company Name: IHBCNAIC Code: 47034SERFF Number: NDPD-131469299Market Segment: Small Group

Instructions:1) This Exhibit summarizes all benefit/rate changes filed after the initial rate filing that impacts the rate tables in this current filing.2)3)4) Extend the worksheet to add more rows as needed. Only use the first tab for data entry.5)

Filing Status SERFF # NY State Tracking # Date of Submission Policy Form #Product Name (including Street

Name)Brief Description of Benefit/Rate

Change Approval Date

Submitted NDPD-131259807 2017110055 11/8/2017 All All2017 IHBC Commission Schedule 3/23/2018

Submitted NDPD-131441486 2018030233 3/29/2018 IHBC-ER001 AllIHBC On Exchange Rate Agreement 3/30/2018

Submitted NDPD-131263659 2017110075 11/10/2017 All All2018 IHBC Commission Schedule Pending

EXHIBIT 16: SUMMARY OF POLICY FORM AND PRODUCT CHANGES

The product street name is the product name as advertised to consumers (i.e., as consumers are likely to refer to this product/policy form when communicating with DFS).Enter filing status (approved or pending) using the drop down list. For pending files leave the approval date blank.

This form must be submitted as an Excel file and as a PDF file.

List of rate filings that have been approved since the §3231(d) or §4308(b) initial rate filing, or are currently pending with DFS.


1.a Company Name

1.b NAIC Code 1.c SERFF Number

1d.Base medical

policy form number

1e.Product Name

(per Rate Manual)

1f.Product

Street Name as indicated

to consumers2.

Filing Type

3.Effective date of last rate change

(mm/dd/yy)4.

Market Segment

5.Product Type (see "Instructions"

tab for examples)

6. Is a rolling

rate structure

used for this base

medical policy form? (Yes or No)

7.Is base medical policy form open

(new sales allowed) or closed

(no new sales)

8.Number of

policyholders affected by rate

change. (For group business this is number

of groups.)

9.Number of

covered lives affected by rate

changeIHBC 47034 NDPD-131469299 IHA-C1003 Healthy NY Gold Independent §3231(e)(1) 1/1/2016 SG-ACA-HNY HMO Yes No New sales - - IHBC 47034 NDPD-131469299 IHA-C1003 Healthy NY Gold Independent §3231(e)(1) 1/1/2016 SG-ACA-HNY-FTE HMO Yes No New sales - - IHBC 47034 NDPD-131469299 IHBC-C1027 Small Group Independent §3231(e)(1) 1/1/2016 SG-ACA Non-HMO based POS Yes New sales allowed - - IHBC 47034 NDPD-131469299 IHBC-C1036 Small Group Independent §3231(e)(1) 1/1/2016 SG-ACA Non-HMO based POS Yes New sales allowed - - IHBC 47034 NDPD-131469299 IHBC-C1037 Small Group Independent §3231(e)(1) 1/1/2016 SG-ACA Non-HMO based POS Yes New sales allowed - - IHBC 47034 NDPD-131469299 IHBC-C1039 Small Group Independent §3231(e)(1) 1/1/2016 SG-ACA Non-HMO based POS Yes No New sales - - IHBC 47034 NDPD-131469299 IHBC-C1027 Healthy NY Gold Independent §3231(e)(1) 1/1/2018 SG-ACA-HNY-FTE Non-HMO based POS Yes New sales allowed 302 1,404 IHBC 47034 NDPD-131469299 IHBC-C1027 Small Group Independent §3231(e)(1) 1/1/2018 SG-ACA-FTE Non-HMO based POS Yes New sales allowed 6,093 47,120 IHBC 47034 NDPD-131469299 IHBC-C1036 Small Group Independent §3231(e)(1) 1/1/2018 SG-ACA-FTE Non-HMO based POS Yes New sales allowed 344 1,524 IHBC 47034 NDPD-131469299 IHBC-C1037 Small Group Independent §3231(e)(1) 1/1/2018 SG-ACA-FTE Non-HMO based POS Yes New sales allowed 38 202 IHBC 47034 NDPD-131469299 IHBC-C1039 Small Group Independent §3231(e)(1) 1/1/2016 SG-ACA-FTE Non-HMO based POS Yes No New sales - - IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299IHBC 47034 NDPD-131469299

Data Item for Specified Base Medical Policy Form


14.1Beginning Date

of the experience

period (mm/dd/y)

14.2Ending Date of the experience

period (mm/dd/yy)

14.3Member months for experience period

14.4Earned premiums for experience period ($)

14.5Standardized earned

premiums for experience period ($)

14.6 Claims Paid in calendar year 2017 on claims incurred during calendar year 2017 -

before any adjustment forfederal risk adjustment, federal reinsurance, risk corridors, state stop-loss

pools, or commercial stop-loss payments ($)

14.6a Claims Paid in calendar year 2018

(during the months of January and February

only) on claims incurred during calendar year 2017 - before any

adjustment for federal risk adjustment, federal

reinsurance, risk corridors, state stop-loss


14.6b Estimated claims remaining to be

paid in the future on claims incurred during

2017 - before any adjustment for federal

risk adjustment, federal reinsurance, risk

corridors, state stop-loss pools, or commercial

stop-loss payments ($)

14.6c Rx Rebates associated with claims

reported in Columns 14.6and 14.6a (enter as a

positive value) ($)

14.6d Estimated Rx Rebates associated with

claims reported in Column 14.6b or not otherwise included in

14.6c (enter as a positivevalue) ($)

14.7 Total Incurred Claims for

calendar year 2017 ($)

14.8Adjustment to the

incurred claims for the period due to receipts from state or federal

reinsurance or stop loss pools (enter receipts from

the pool as a negative value) ($)


incurred claims for the period due to receipts

from or payments to the federal risk adjustment

pool (enter receipts as a negative value and

payments to the pool as a positive value) ($)

14.10Administrative expenses

for experience period (including commissions and premium taxes, but excluding federal and

state income taxes) ($)

15.1Beginning date of the

experience period (mm/dd/yy)

15.2Ending Date of the experience period

(mm/dd/yy)1/1/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $ - $ - $ - $ - 1/1/2016 12/31/20161/1/2017 12/31/2017 3353.00 1070073.32 1416092.73 1335483.89 2429.70 3031.19 23381.79 0.00 $ 1,317,563.00 $ (323,954.85) $ 172,902.34 $ 161,520.00 1/1/2016 12/31/20161/1/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $ - $ - $ - $ - 1/1/2016 12/31/20161/1/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $ - $ - $ - $ - 1/1/2016 12/31/20161/1/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $ - $ - $ - $ - 1/1/2016 12/31/20161/1/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $ - $ - $ - $ - 1/1/2016 12/31/20161/1/2017 12/31/2017 13124.00 4391285.51 5265059.59 3752476.43 175090.75 324048.37 88652.10 0.00 $ 4,162,963.45 $ (982,772.74) $ 1,079,731.41 $ 571,775.28 1/1/2016 12/31/20161/1/2017 12/31/2017 523726.00 201468586.49 245497224.16 187593827.77 8358947.57 1651698.44 5927266.60 0.00 $ 191,677,207.17 $ - $ 8,834,066.47 $ 26,192,125.06 1/1/2016 12/31/20161/1/2017 12/31/2017 18481.00 6322698.94 7537516.61 4034951.49 172399.72 24678.55 155631.65 0.00 $ 4,076,398.11 $ - $ 2,384,806.41 $ 821,988.80 1/1/2016 12/31/20161/1/2017 12/31/2017 1822.00 762293.09 815124.48 600989.55 -56276.87 3929.30 16357.93 0.00 $ 532,284.06 $ - $ (73,693.66) $ 99,102.68 1/1/2016 12/31/20161/1/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $ - $ - $ - $ - 1/1/2016 12/31/2016

$ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

2017 Experience Period (NY statewide experience, base medical policy form + associated riders)


15.3Member months for experience period

15.4Earned premiums for experience period ($)

15.5Standardized earned

premiums for experience period ($)

15.6 Claims Paid in calendar year 2016 on claims incurred during calendar year 2016 -

before any adjustment forfederal risk adjustment, federal reinsurance, risk corridors, state stop-loss


15.6a Claims Paid in calendar year 2017

(during the months of January and February

only) on claims incurred during calendar year 2016 - before any

adjustment for federal risk adjustment, federal

reinsurance, risk corridors, state stop-loss


15.6b All other claim amounts associated with claims incurred during the 2016 calendar year that are not included in

15.6 and 15.6a (i.e., Payments through

February of 2018 plus any remaining IBNR

associated with claims that were incurred during

2016) - before any adjustment for federal

risk adjustment, federal reinsurance, risk

corridors, state stop-loss pools, or commercial

stop-loss payments ($)

15.6c Rx Rebates associated with claims

reported in Columns 15.6and 15.6a (enter as a

positive value) ($)

15.6d Estimated Rx Rebates associated with

claims reported in Column 15.6b or not otherwise included in

15.6c (enter as a positivevalue) ($)

15.7 Total Incurred claims for

calendar year 2016 ($)


incurred claims for the period due to receipts from state or federal

reinsurance or stop loss pools (enter receipts from

the pool as a negative value) ($)


incurred claims for the period due to receipts

from or payments to the federal risk adjustment

pool (enter receipts as a negative value and

payments to the pool as a positive value) ($)

15.10Administrative expenses

for experience period (including commissions and premium taxes, but excluding federal and

state income taxes) ($) 142.00 $ 50,587.11 $ 56,126.08 $ 46,720.76 $ - $ - $ 3,137.78 $ - $ 43,582.98 $ (8,594.42) $ 7,995.64 $ 3,571.37 14,087.00 $ 4,124,830.36 $ 5,655,895.92 $ 3,549,561.82 $ 129,341.10 $ (10,423.60) $ 72,965.14 $ - $ 3,595,514.17 $ (852,905.37) $ 657,342.48 $ 291,206.63 81,554.00 $ 32,323,147.35 $ 38,642,862.18 $ 29,415,135.30 $ (2,284.47) $ (3,549.50) $ 779,178.83 $ - $ 28,630,122.49 $ - $ (1,792,989.86) $ 4,846,597.36 7,543.00 $ 2,249,692.10 $ 2,631,014.01 $ 1,112,109.36 $ (9,031.91) $ 2,295.83 $ 27,333.13 $ - $ 1,078,040.15 $ - $ 833,006.37 $ 337,323.33 250.00 $ 94,852.55 $ 100,857.53 $ 98,482.22 $ - $ (41.56) $ 3,660.68 $ - $ 94,779.98 $ - $ 12,597.20 $ 14,222.38 781.00 $ 251,618.14 $ 271,117.34 $ 40,020.04 $ 179.01 $ 0.10 $ 302.17 $ - $ 39,896.97 $ - $ 128,213.02 $ 37,728.13 - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

378,539.00 $ 135,992,089.15 $ 178,134,780.61 $ 124,807,563.63 $ 5,478,941.70 $ 3,919,515.49 $ 3,831,459.89 $ - $ 130,374,560.94 $ - $ (6,429,081.19) $ 20,390,925.83 13,756.00 $ 4,360,913.24 $ 5,648,438.75 $ 2,276,647.94 $ 98,955.04 $ 189,373.59 $ 75,367.75 $ - $ 2,489,608.82 $ - $ 1,257,628.17 $ 653,884.05 1,171.00 $ 416,905.02 $ 503,081.81 $ 421,604.87 $ 12,932.18 $ 8,835.85 $ 7,105.32 $ - $ 436,267.57 $ - $ (1,047.75) $ 62,511.57 1,111.00 $ 363,401.52 $ 419,966.81 $ 91,704.74 $ 707.67 $ 793.59 $ 2,134.68 $ - $ 91,071.32 $ - $ 161,232.59 $ 54,489.15

$ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

2016 Experience Period (NY statewide experience, base medical policy form + associated riders)


Exhibit 18 - Index Rate/Plan-Design Level Adjustment Worksheet


SERFF Number: NDPD-131469299Market Segment : Small Group

A separate column must be used for each base plan design (i.e., for each separate and distinct 14 digit HIOS ID)

Line # GeneralACA Compliant Plans

Only Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 91 Product* XXXXXXX Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum 2 Product ID* XXXXXXX 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY1173 Metal Level (or catastrophic)* XXXXXXX Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum4 AV Metal Value (HHS Calculator)* XXXXXXX 0.86930 0.86930 0.86930 0.86930 0.86930 0.86930 0.86930 0.86930 0.86010 5 AV Pricing Value (total, risk pool experience based)* XXXXXXX 0.93589 0.93589 0.93589 0.93589 0.93589 0.93589 0.93589 0.93589 0.93590 6 Plan Type* XXXXXXX POS POS POS POS POS POS POS POS POS7 Plan Name* XXXXXXX

FlexFit Platinum Copay NYS OON







FlexFit Platinum Copay NYS OON FlexFit Platinum

8 HIOS Plan ID (14 Digits)* XXXXXXX 18029NY1170015 18029NY1170016 18029NY1170017 18029NY1170018 18029NY1170019 18029NY1170020 18029NY1170021 18029NY1170022 18029NY11700339 Exchange Plan?* XXXXXXX Both Both Both Both Both Both Both Both Both

9A 2019 Plan Status (as compared to 2018) XXXXXXX Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod* This field should be the same as used in the Unified Rate Review Template, Worksheet 2

Amounts should be consistent with appropriate categories in Column 14.3 of Exhibit 17Experience Period Index Rate Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9

10A Incurred Claims for Latest Experience Period # 201,766,415.79 0.00 0.00 245,321.29 0.00 0.00 41,279.77 0.00 467.32 1,301,538.1310B Member-Months for Latest Experience Period # 560,506.00 0.00 0.00 459.00 0.00 0.00 129.00 0.00 8.00 3,195.0010C Average PMPM Incurred Claims [(10A)/(10B)] = (Initial Index PMPM) 359.97191 0.00000 0.00000 534.46905 0.00000 0.00000 319.99823 0.00000 58.41454 407.3671811 Average Pricing Actuarial Value reflected in experience period 0.8549812 AV Adjusted Experience Period Index Rate PMPM = [(10C) / (11)] 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912

# Amounts should be prior to any adjustments for Federal Risk Adjustment and Healthy NY Stop-Loss Reimbursements, and should be consistent with the amounts reported in Column 14.7 of Exhibit 17 for the relevant market categories.

Market Wide Adjustments to the AV Adjusted Experience Period Index Rate All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 913 Impact of adjusting experience period data to EHB benefit level ** 0.9887014 Market wide adjustment for changes in provider network ** 1.0000015 Market wide adjustment for fee schedule changes ** 1.0000016 Market wide adjustment for utilization management changes ** 1.0000017 Market wide adjustment for impact on claim costs from quality improvement and cost containment initiatives ** 1.0000018 Claim trend projection factor (midpoint of experience period to mid point of rate applicability period) 1.1455519 Federal Risk Adjustment Program Impact (less than 1.00 to reflect a recovery, more than 1.00 to reflect a payment to the pool) ** 0.9804320 Impact of adjustments due to experience period claim data not being sufficiently credible ** 1.0000021 Adjustment for changes in distribution of risk pool membership by rating regions (i.e., standard rating regions) ** 1.0000022 Impact on risk pool of changes in expected covered membership risk characteristics (Small Group Only) ** 1.0153323 Impact of the individual mandate penalty being reduced to zero ** 1.0000023a Other Federal Government Actions ** 1.0000024 Partial Year Normalization 1.0091425 Other 2 (specify) 1.0000026 Other 3 (specify) 1.0000027 Other 4 (specify) 1.0000028 Impact of Market Wide Adjustments (= Product L13 through L27) 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776

** Not Included in Claim Trend Adjustment# Pending final decision at the federal level

Plan Level Adjustments Average - All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 929 Index Rate - After Marketwide Adjustments 479.0309 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.0308530 Pricing actuarial value (without induced demand factor) # 0.8280 0.93589 0.93589 0.93589 0.93589 0.93589 0.93589 0.93589 0.93589 0.9359031 Pricing actuarial value (only the induced demand factor) # 0.9934 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.0556532 Impact of provider network characteristics ## 0.9887 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.9900333 Impact of delivery system characteristics ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000034 Impact of utilization management practices ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000035 Impact on claim costs from quality improvement and cost containment initiatives ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000036 Benefits in additional to EHB (greater than 1.00) 1.0020 1.00171 1.00171 1.00171 1.00171 1.00171 1.00171 1.00171 1.00171 1.0017137 Impact of eligibility categories (catastrophic plans only) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000038 Addition of Out of Network Benefit Option (e.g., POS or PPO, if applicable) 1.0072 1.00634 1.00634 1.00634 1.00634 1.00634 1.00634 1.00634 1.00634 1.0059639 Impact of Adjustment for NYS Stop Loss reimbursements on SG HNY 0.9934 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000040 Impact of Age 26 / Age 29 1.0004 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.0000041 Impact of Family Planning / No Family Planning 1.0000 0.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.00000 0.9978142 Impact of Dental vs No Dental 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000043 Premium Curve Adjustment 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000043a Impact of loss of CSR Funding (A common factor to be applied uniformly to all silver plans only - if applicable) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000044 Other 1 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000045 Other 2 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000046 Other 3 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000047 Impact of Plan Wide Adjustments (= Weighted Average Factor using Line 55a) 0.81964 0.99332 0.98384 0.98601 0.99332 0.99550 0.98601 0.98384 0.99550 0.98348

# Reflects changes that impact an entire standard population (e.g., cost sharing and other changes that are not based on health status, age, gender or occupation).## Beyond what is reflected in Market Wide adjustments

48a Adjusted Incurred Claims (Excluding Admin Expense and Profit) 220,074,295.29

ExpensesWeighted Average - All

Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 949 Plan Expected Costs 392.64 475.83 471.29 472.33 475.83 476.88 472.33 471.29 476.88 471.1250 FIXED EXPENSE: Administrative Costs (excluding Exchange user fees and profits) - to be expressed as a PMPM Amount ### 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.8800051 VARIABLE EXPENSE: Administrative costs (excluding Exchange user fees and profits) - to be expressed as a percentage ### 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%52 VARIABLE EXPENSE: Profit/Contribution to surplus margins - to be expressed as a percentage ### 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%53 Total Expense Load as a percentage of Premium (= [L50 + (L51 + L52) * L56] / L56) 12.397% 10.764% 10.840% 10.822% 10.764% 10.747% 10.822% 10.840% 10.747% 10.843%

### The combined factors for Administrative Costs (Fixed and Variable) and Profit/Contribution to surplus margins cannot exceed 18% (equivalent to a factor of 1.2195 ( = 1.00 / 0.82) applied to Line 49). The "FIXED EXPENSE" amount in Line 50 must be entered as a PMPM and "VARIABLE EXPENSE" amounts in Lines 51 and 52 must be entered as a percentage of premium.

2018 Premium Rates and Membership All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 954 2018 PMPM Rates (First Quarter 2018 rates for Small Group)*** 431.83 529.02 524.36 525.42 529.02 530.08 525.42 524.36 530.08 524.2155 2018 Members as of 3/31/2018 (The total should tie to the 3/31/2018 Membership Survey Total) 46,327.00 0.00 0.00 33.00 0.00 0.00 10.00 0.00 0.00 212.0055a 2018 Members as of 3/31/2018 - Only those enrolled in plans that will still be available in 2019 37,968.00 0.00 0.00 33.00 0.00 0.00 10.00 0.00 0.00 212.00

Calculation of Final 2019 Rates All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 956 TOTAL PROJECTED INDEX RATE PMPM (= [(L49 + L50) / (1 - L51 - L52)]) 448.20 533.23 528.59 529.65 533.23 534.30 529.65 528.59 534.30 528.4157 Percent Change in Premium Rates (= L56 / L54) 3.79% 0.80% 0.81% 0.81% 0.80% 0.80% 0.81% 0.81% 0.80% 0.80%

*** The information in the "General" Section above should also be completed for any 2018 plans that are expected to be discontinued in 2019.*** The Average PMPM rate for "All Plans" should be used for All Non-ACA Compliant Plans Weighted Average PMPM: 448.20

Difference From Line 56 Col D: 0.00

Overall Average Impact: 3.79% Percentage Difference: 0.0%


Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 16 Plan 17 Plan 18 Plan 19 Plan 20 Plan 21 Plan 22 Plan 23 Plan 24 Plan 25 Plan 26 Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum

18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum

0.86010 0.86010 0.86010 0.86010 0.86010 0.86010 0.86010 0.86210 0.86210 0.86210 0.86210 0.86210 0.86210 0.86210 0.86210 0.86200 0.86200 0.93592 0.93591 0.93590 0.93592 0.93592 0.93591 0.93592 0.88307 0.88308 0.88309 0.88307 0.88307 0.88309 0.88308 0.88307 0.90934 0.90933

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS FlexFit Platinum FlexFit Platinum FlexFit Platinum FlexFit Platinum FlexFit Platinum FlexFit Platinum FlexFit Platinum iShare Platinum iShare Platinum iShare Platinum iShare Platinum iShare Platinum iShare Platinum iShare Platinum iShare Platinum Choice Plus Platinum Choice Plus Platinum 18029NY1170035 18029NY1170036 18029NY1170037 18029NY1170040 18029NY1170043 18029NY1170045 18029NY1170046 18029NY1170065 18029NY1170066 18029NY1170067 18029NY1170068 18029NY1170069 18029NY1170070 18029NY1170071 18029NY1170072 18029NY1170097 18029NY1170098

Both Both Both Both Both Both Both Both Both Both Both Both Both Both Both Off OffUniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod New New New New New New New New Uniform Mod Uniform Mod

Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 16 Plan 17 Plan 18 Plan 19 Plan 20 Plan 21 Plan 22 Plan 23 Plan 24 Plan 25 Plan 263,343,910.16 0.00 338,491.40 73,060,186.94 334,992.05 0.00 1,931,396.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21,457.26 21,776.02

7,689.00 0.00 401.00 151,106.00 513.00 0.00 3,297.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.00 78.00434.89533 0.00000 844.11821 483.50288 653.00594 0.00000 585.80413 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 7152.41999 279.17977

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912

Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 16 Plan 17 Plan 18 Plan 19 Plan 20 Plan 21 Plan 22 Plan 23 Plan 24 Plan 25 Plan 26

1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776

Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 16 Plan 17 Plan 18 Plan 19 Plan 20 Plan 21 Plan 22 Plan 23 Plan 24 Plan 25 Plan 26479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085

0.93592 0.93591 0.93590 0.93592 0.93592 0.93591 0.93592 0.88307 0.88308 0.88309 0.88307 0.88307 0.88309 0.88308 0.88307 0.90934 0.909331.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05567 1.055670.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.99003 0.93927 0.939271.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00171 1.00171 1.00171 1.00171 1.00171 1.00171 1.00171 1.00182 1.00182 1.00182 1.00182 1.00182 1.00182 1.00182 1.00182 1.00173 1.001731.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00596 1.00596 1.00596 1.00596 1.00596 1.00596 1.00596 1.00631 1.00631 1.00631 1.00631 1.00631 1.00631 1.00631 1.00631 1.00483 1.004831.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.009631.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.99516 0.99296 0.98348 0.98567 0.99516 0.99296 0.98567 0.92839 0.93940 0.93735 0.92839 0.93044 0.93735 0.93940 0.93044 0.90559 0.91632


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%10.750% 10.767% 10.843% 10.825% 10.750% 10.767% 10.825% 11.310% 11.212% 11.230% 11.310% 11.291% 11.230% 11.212% 11.291% 11.518% 11.419%

Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 16 Plan 17 Plan 18 Plan 19 Plan 20 Plan 21 Plan 22 Plan 23 Plan 24 Plan 25 Plan 26529.93 528.88 524.21 525.27 529.93 528.88 525.27 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 486.06 491.33592.00 0.00 27.00 12,074.00 5.00 0.00 255.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.00 0.00592.00 0.00 27.00 12,074.00 5.00 0.00 255.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.00 0.00

Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 16 Plan 17 Plan 18 Plan 19 Plan 20 Plan 21 Plan 22 Plan 23 Plan 24 Plan 25 Plan 26534.13 533.05 528.41 529.48 534.13 533.05 529.48 501.44 506.83 505.83 501.44 502.44 505.83 506.83 502.44 490.28 495.530.79% 0.79% 0.80% 0.80% 0.79% 0.79% 0.80% 0.87% 0.86%


Plan 27 Plan 28 Plan 29 Plan 30 Plan 31 Plan 32 Plan 33 Plan 34 Plan 35 Plan 36 Plan 37 Plan 38 Plan 39 Plan 40 Plan 41 Plan 42 Plan 43 Platinum Platinum Platinum Platinum Platinum Platinum Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold

18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120Platinum Platinum Platinum Platinum Platinum Platinum Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold

0.86200 0.86200 0.86200 0.86200 0.86200 0.86200 0.76970 0.76970 0.76970 0.76970 0.76970 0.76970 0.76970 0.76970 0.76350 0.76350 0.76350 0.90932 0.90934 0.90935 0.90933 0.90932 0.90935 0.86548 0.86547 0.86547 0.86548 0.86547 0.86547 0.86547 0.86547 0.84417 0.84416 0.84416

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS Choice Plus Platinum Choice Plus Platinum Choice Plus Platinum Choice Plus Platinum Choice Plus Platinum Choice Plus Platinum iDirect Gold Copay iDirect Gold Copay iDirect Gold Copay iDirect Gold Copay iDirect Gold Copay iDirect Gold Copay iDirect Gold Copay iDirect Gold Copay Choice Plus Gold Choice Plus Gold Choice Plus Gold

18029NY1170099 18029NY1170100 18029NY1170101 18029NY1170102 18029NY1170103 18029NY1170104 18029NY1200033 18029NY1200035 18029NY1200036 18029NY1200037 18029NY1200040 18029NY1200043 18029NY1200045 18029NY1200046 18029NY1200081 18029NY1200083 18029NY1200084Off Off Both Both Both Both Both Both Both Both Off Off Off Off Both Both Both

Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod

Plan 27 Plan 28 Plan 29 Plan 30 Plan 31 Plan 32 Plan 33 Plan 34 Plan 35 Plan 36 Plan 37 Plan 38 Plan 39 Plan 40 Plan 41 Plan 42 Plan 430.00 0.00 746,344.41 0.00 0.00 48,777.56 13,580.58 376,583.29 0.00 6,328.99 15,136,176.63 0.00 0.00 257,038.41 0.00 25,201.04 0.000.00 0.00 2,238.00 0.00 0.00 153.00 162.00 1,074.00 0.00 31.00 47,015.00 0.00 0.00 1,121.00 0.00 254.00 0.00

0.00000 0.00000 333.48723 0.00000 0.00000 318.80759 83.83073 350.63621 0.00000 204.16083 321.94356 0.00000 0.00000 229.29385 0.00000 99.21670 0.00000

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.90932 0.90934 0.90935 0.90933 0.90932 0.90935 0.86548 0.86547 0.86547 0.86548 0.86547 0.86547 0.86547 0.86547 0.84417 0.84416 0.844161.05567 1.05567 1.05567 1.05567 1.05567 1.05567 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99354 0.99354 0.993540.93927 0.93927 0.93927 0.93927 0.93927 0.93927 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.93940 0.93940 0.939401.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00173 1.00173 1.00173 1.00173 1.00173 1.00173 1.00192 1.00192 1.00192 1.00192 1.00192 1.00192 1.00192 1.00192 1.00194 1.00194 1.001941.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00483 1.00483 1.00483 1.00483 1.00483 1.00483 1.00668 1.00668 1.00668 1.00668 1.00668 1.00668 1.00668 1.00668 1.00538 1.00538 1.005381.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.009630.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.997811.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.91430 0.90559 0.90759 0.91632 0.91430 0.90759 0.85677 0.86691 0.86501 0.85677 0.85865 0.86691 0.86501 0.85865 0.79192 0.80130 0.79954


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%11.437% 11.518% 11.499% 11.419% 11.437% 11.499% 11.998% 11.894% 11.913% 11.998% 11.978% 11.894% 11.913% 11.978% 12.716% 12.606% 12.626%

Plan 27 Plan 28 Plan 29 Plan 30 Plan 31 Plan 32 Plan 33 Plan 34 Plan 35 Plan 36 Plan 37 Plan 38 Plan 39 Plan 40 Plan 41 Plan 42 Plan 43490.33 486.06 487.04 491.33 490.33 487.04 437.76 442.45 441.58 437.76 438.63 442.45 441.58 438.63 410.33 414.70 413.880.00 0.00 185.00 0.00 0.00 8.00 16.00 79.00 0.00 2.00 3,825.00 0.00 0.00 102.00 0.00 16.00 0.000.00 0.00 185.00 0.00 0.00 8.00 16.00 79.00 0.00 2.00 3,825.00 0.00 0.00 102.00 0.00 16.00 0.00

Plan 27 Plan 28 Plan 29 Plan 30 Plan 31 Plan 32 Plan 33 Plan 34 Plan 35 Plan 36 Plan 37 Plan 38 Plan 39 Plan 40 Plan 41 Plan 42 Plan 43494.54 490.28 491.25 495.53 494.54 491.25 466.37 471.34 470.41 466.37 467.29 471.34 470.41 467.29 434.62 439.21 438.350.86% 0.87% 0.86% 0.86% 0.86% 0.86% 6.54% 6.53% 6.53% 6.54% 6.53% 6.53% 6.53% 6.53% 5.92% 5.91% 5.91%


Plan 44 Plan 45 Plan 46 Plan 47 Plan 48 Plan 49 Plan 50 Plan 51 Plan 52 Plan 53 Plan 54 Plan 55 Plan 56 Plan 57 Plan 58 Plan 59 Plan 60 Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold

18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold

0.76350 0.76350 0.76350 0.76350 0.76350 0.76880 0.76880 0.76880 0.76880 0.76880 0.76880 0.76880 0.76880 0.76050 0.76050 0.76050 0.76050 0.84417 0.84415 0.84416 0.84416 0.84415 0.80717 0.80717 0.80717 0.80717 0.80717 0.80717 0.80717 0.80717 0.78358 0.78359 0.78357 0.78358

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS Choice Plus Gold Choice Plus Gold Choice Plus Gold Choice Plus Gold Choice Plus Gold iShare Gold iShare Gold iShare Gold iShare Gold iShare Gold iShare Gold iShare Gold iShare Gold

iDirect Gold Coinsurance HSAQ




18029NY1200085 18029NY1200088 18029NY1200091 18029NY1200093 18029NY1200094 18029NY1200129 18029NY1200130 18029NY1200131 18029NY1200132 18029NY1200133 18029NY1200134 18029NY1200135 18029NY1200136 18029NY1200137 18029NY1200138 18029NY1200139 18029NY1200140Both Both Both Both Both Both Both Both Both Both Both Both Both Both Both Both Both

Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod New New New New New New New New New New New New

Plan 44 Plan 45 Plan 46 Plan 47 Plan 48 Plan 49 Plan 50 Plan 51 Plan 52 Plan 53 Plan 54 Plan 55 Plan 56 Plan 57 Plan 58 Plan 59 Plan 600.00 1,284,937.27 3,694.75 0.00 35,580.97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.000.00 3,570.00 84.00 0.00 310.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00000 359.92641 43.98515 0.00000 114.77734 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.84417 0.84415 0.84416 0.84416 0.84415 0.80717 0.80717 0.80717 0.80717 0.80717 0.80717 0.80717 0.80717 0.78358 0.78359 0.78357 0.783580.99354 0.99354 0.99354 0.99354 0.99354 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.993520.93940 0.93940 0.93940 0.93940 0.93940 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.990051.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00194 1.00194 1.00194 1.00194 1.00194 1.00207 1.00207 1.00207 1.00207 1.00207 1.00207 1.00207 1.00207 1.00214 1.00214 1.00214 1.002141.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00538 1.00538 1.00538 1.00538 1.00538 1.00716 1.00716 1.00716 1.00716 1.00716 1.00716 1.00716 1.00716 1.00738 1.00738 1.00738 1.007381.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.000000.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.997811.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.79192 0.79365 0.80130 0.79954 0.79365 0.79954 0.80902 0.80724 0.79954 0.80130 0.80724 0.80902 0.80130 0.77640 0.78561 0.78386 0.77640


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%12.716% 12.696% 12.606% 12.626% 12.696% 12.626% 12.517% 12.537% 12.626% 12.606% 12.537% 12.517% 12.606% 12.904% 12.792% 12.813% 12.904%

Plan 44 Plan 45 Plan 46 Plan 47 Plan 48 Plan 49 Plan 50 Plan 51 Plan 52 Plan 53 Plan 54 Plan 55 Plan 56 Plan 57 Plan 58 Plan 59 Plan 60410.33 411.13 414.70 413.88 411.13 N/A N/A N/A N/A N/A N/A N/A 0.00 0.00 0.00 0.00 0.000.00 302.00 0.00 0.00 17.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.000.00 302.00 0.00 0.00 17.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Plan 44 Plan 45 Plan 46 Plan 47 Plan 48 Plan 49 Plan 50 Plan 51 Plan 52 Plan 53 Plan 54 Plan 55 Plan 56 Plan 57 Plan 58 Plan 59 Plan 60434.62 435.47 439.21 438.35 435.47 438.35 442.99 442.12 438.35 439.21 442.12 442.99 439.21 427.02 431.53 430.68 427.025.92% 5.92% 5.91% 5.91% 5.92%




0.76050 0.76050 0.76050 0.76050 0.76570 0.76570 0.76570 0.76570 0.76570 0.76570 0.76570 0.76570 0.77010 0.77010 0.77010 0.77010 0.77010 0.78358 0.78357 0.78359 0.78358 0.80955 0.80958 0.80960 0.80955 0.80956 0.80960 0.80958 0.80956 0.82982 0.82985 0.82985 0.82982 0.82984

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS iDirect Gold Coinsurance HSAQ



iDirect Gold Coinsurance HSAQ iDirect Gold Copay HSAQ iDirect Gold Copay HSAQ iDirect Gold Copay HSAQ iDirect Gold Copay HSAQ iDirect Gold Copay HSAQ iDirect Gold Copay HSAQ iDirect Gold Copay HSAQ iDirect Gold Copay HSAQ Max Gold Max Gold Max Gold Max Gold Max Gold

18029NY1200141 18029NY1200142 18029NY1200143 18029NY1200144 18029NY1200177 18029NY1200178 18029NY1200179 18029NY1200180 18029NY1200181 18029NY1200182 18029NY1200183 18029NY1200184 18029NY1200185 18029NY1200186 18029NY1200187 18029NY1200188 18029NY1200189Both Both Both Both Off Off Off Off Off Off Off Off Off Off Off Off OffNew New New New Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod

Plan 61 Plan 62 Plan 63 Plan 64 Plan 65 Plan 66 Plan 67 Plan 68 Plan 69 Plan 70 Plan 71 Plan 72 Plan 73 Plan 74 Plan 75 Plan 76 Plan 770.00 0.00 0.00 0.00 0.00 49,168.28 0.00 0.00 3,844,270.82 0.00 0.00 788,890.80 0.00 8,711.14 0.00 0.00 994,765.080.00 0.00 0.00 0.00 0.00 406.00 0.00 0.00 12,775.00 0.00 0.00 1,561.00 0.00 66.00 0.00 0.00 5,854.00

0.00000 0.00000 0.00000 0.00000 0.00000 121.10413 0.00000 0.00000 300.92139 0.00000 0.00000 505.37527 0.00000 131.98691 0.00000 0.00000 169.92912

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.78358 0.78357 0.78359 0.78358 0.80955 0.80958 0.80960 0.80955 0.80956 0.80960 0.80958 0.80956 0.82982 0.82985 0.82985 0.82982 0.829840.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.993520.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.990051.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00214 1.00214 1.00214 1.00214 1.00206 1.00206 1.00206 1.00206 1.00206 1.00206 1.00206 1.00206 1.00201 1.00201 1.00201 1.00201 1.002011.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00738 1.00738 1.00738 1.00738 1.00714 1.00714 1.00714 1.00714 1.00714 1.00714 1.00714 1.00714 1.00697 1.00697 1.00697 1.00697 1.006971.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.000001.00000 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.77811 0.78386 0.78561 0.77811 0.80188 0.81141 0.80965 0.80188 0.80366 0.80965 0.81141 0.80366 0.82177 0.83154 0.82972 0.82177 0.82360


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%12.883% 12.813% 12.792% 12.883% 12.599% 12.490% 12.510% 12.599% 12.579% 12.510% 12.490% 12.579% 12.373% 12.265% 12.285% 12.373% 12.353%

Plan 61 Plan 62 Plan 63 Plan 64 Plan 65 Plan 66 Plan 67 Plan 68 Plan 69 Plan 70 Plan 71 Plan 72 Plan 73 Plan 74 Plan 75 Plan 76 Plan 770.00 0.00 0.00 0.00 420.44 424.93 424.09 420.44 421.28 424.09 424.93 421.28 433.25 437.90 437.03 433.25 434.120.00 0.00 0.00 0.00 0.00 146.00 0.00 0.00 1,201.00 0.00 0.00 163.00 0.00 11.00 0.00 0.00 352.000.00 0.00 0.00 0.00 0.00 146.00 0.00 0.00 1,201.00 0.00 0.00 163.00 0.00 11.00 0.00 0.00 352.00


4.53% 4.53% 4.53% 4.53% 4.53% 4.53% 4.53% 4.53% 3.69% 3.68% 3.68% 3.69% 3.69%




0.77010 0.77010 0.77010 0.79770 0.79770 0.79770 0.79770 0.79770 0.79770 0.79770 0.79770 0.76460 0.76460 0.76460 0.76460 0.76460 0.76460 0.82985 0.82985 0.82984 0.89546 0.89545 0.89545 0.89546 0.89545 0.89545 0.89545 0.89545 0.78221 0.78222 0.78224 0.78221 0.78221 0.78222

POS POS POS POS POS POS POS POS POS POS POS PPO PPO PPO PPO PPO PPO Max Gold Max Gold Max Gold Healthy New York Healthy New York Healthy New York Healthy New York Healthy New York Healthy New York Healthy New York Healthy New York NY PA Gold NY PA Gold NY PA Gold NY PA Gold NY PA Gold NY PA Gold

18029NY1200190 18029NY1200191 18029NY1200192 18029NY1200193 18029NY1200194 18029NY1200195 18029NY1200196 18029NY1200197 18029NY1200198 18029NY1200199 18029NY1200200 18029NY1210017 18029NY1210019 18029NY1210020 18029NY1210021 18029NY1210024 18029NY1210027Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off


Plan 78 Plan 79 Plan 80 Plan 81 Plan 82 Plan 83 Plan 84 Plan 85 Plan 86 Plan 87 Plan 88 Plan 89 Plan 90 Plan 91 Plan 92 Plan 93 Plan 940.00 0.00 0.00 0.00 87,998.23 0.00 0.00 5,546,197.91 0.00 0.00 15,938.43 0.00 0.00 0.00 0.00 222,333.61 0.000.00 0.00 0.00 0.00 449.00 0.00 0.00 15,974.00 0.00 0.00 54.00 0.00 0.00 0.00 0.00 746.00 0.00

0.00000 0.00000 0.00000 0.00000 195.98716 0.00000 0.00000 347.20157 0.00000 0.00000 295.15608 0.00000 0.00000 0.00000 0.00000 298.03432 0.00000

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.82985 0.82985 0.82984 0.89546 0.89545 0.89545 0.89546 0.89545 0.89545 0.89545 0.89545 0.78221 0.78222 0.78224 0.78221 0.78221 0.782220.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.993520.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 0.99005 1.00548 1.00548 1.00548 1.00548 1.00548 1.005481.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00201 1.00201 1.00201 1.00163 1.00163 1.00163 1.00163 1.00163 1.00163 1.00163 1.00163 1.00209 1.00209 1.00209 1.00209 1.00209 1.002091.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00697 1.00697 1.00697 1.00656 1.00656 1.00656 1.00656 1.00656 1.00656 1.00656 1.00656 1.04073 1.04073 1.04073 1.04073 1.04073 1.040731.00000 1.00000 1.00000 0.79313 0.79313 0.79313 0.79313 0.79313 0.79313 0.79313 0.79313 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.009630.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.82972 0.83154 0.82360 0.70278 0.71110 0.70954 0.70278 0.70432 0.70954 0.71110 0.70432 0.81313 0.82278 0.82101 0.81313 0.81493 0.82278


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%12.285% 12.265% 12.353% 13.895% 13.774% 13.796% 13.895% 13.872% 13.796% 13.774% 13.872% 12.470% 12.362% 12.381% 12.470% 12.450% 12.362%

Plan 78 Plan 79 Plan 80 Plan 81 Plan 82 Plan 83 Plan 84 Plan 85 Plan 86 Plan 87 Plan 88 Plan 89 Plan 90 Plan 91 Plan 92 Plan 93 Plan 94437.03 437.90 434.12 367.06 370.93 370.21 367.06 367.78 370.21 370.93 367.78 431.15 435.77 434.92 431.15 432.01 435.770.00 0.00 3.00 0.00 35.00 0.00 0.00 1,180.00 0.00 0.00 4.00 0.00 0.00 0.00 0.00 75.00 0.000.00 0.00 3.00 0.00 35.00 0.00 0.00 1,180.00 0.00 0.00 4.00 0.00 0.00 0.00 0.00 75.00 0.00



Plan 95 Plan 96 Plan 97 Plan 98 Plan 99 Plan 100 Plan 101 Plan 102 Plan 103 Plan 104 Plan 105 Plan 106 Plan 107 Plan 108 Plan 109 Plan 110 Plan 111 Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Silver Silver Silver Silver Silver Silver Silver

18029NY121 18029NY121 18029NY121 18029NY121 18029NY121 18029NY121 18029NY121 18029NY121 18029NY121 18029NY121 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Silver Silver Silver Silver Silver Silver Silver

0.76460 0.76460 0.76460 0.76460 0.76460 0.76460 0.76460 0.76460 0.76460 0.76460 0.71980 0.71980 0.71980 0.71980 0.71980 0.71980 0.71980 0.78224 0.78221 0.76273 0.76274 0.76274 0.76273 0.76272 0.76274 0.76274 0.76272 0.81300 0.81298 0.81300 0.81300 0.81298 0.81298 0.81300

PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO POS POS POS POS POS POS POS NY PA Gold NY PA Gold Passport Plan Gold Passport Plan Gold Passport Plan Gold Passport Plan Gold Passport Plan Gold Passport Plan Gold Passport Plan Gold Passport Plan Gold Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver

18029NY1210029 18029NY1210030 18029NY1210057 18029NY1210058 18029NY1210059 18029NY1210060 18029NY1210061 18029NY1210062 18029NY1210063 18029NY1210064 18029NY1240001 18029NY1240003 18029NY1240004 18029NY1240005 18029NY1240008 18029NY1240011 18029NY1240013Off Off Both Both Both Both Both Both Both Both Both Both Both Both Both Both Both


Plan 95 Plan 96 Plan 97 Plan 98 Plan 99 Plan 100 Plan 101 Plan 102 Plan 103 Plan 104 Plan 105 Plan 106 Plan 107 Plan 108 Plan 109 Plan 110 Plan 1110.00 21,619.04 0.00 0.00 0.00 0.00 62,484.65 0.00 0.00 141.82 0.00 9,700.18 0.00 0.00 374,011.01 0.00 0.000.00 60.00 0.00 0.00 0.00 0.00 214.00 0.00 0.00 7.00 0.00 62.00 0.00 0.00 1,456.00 0.00 0.00

0.00000 360.31735 0.00000 0.00000 0.00000 0.00000 291.98436 0.00000 0.00000 20.25932 0.00000 156.45449 0.00000 0.00000 256.87570 0.00000 0.00000

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.78224 0.78221 0.76273 0.76274 0.76274 0.76273 0.76272 0.76274 0.76274 0.76272 0.81300 0.81298 0.81300 0.81300 0.81298 0.81298 0.813000.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.99352 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.949141.00548 1.00548 1.55985 1.55985 1.55985 1.55985 1.55985 1.55985 1.55985 1.55985 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.990071.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00209 1.00209 1.00153 1.00153 1.00153 1.00153 1.00153 1.00153 1.00153 1.00153 1.00162 1.00162 1.00162 1.00162 1.00162 1.00162 1.001621.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.04073 1.04073 1.03423 1.03423 1.03423 1.03423 1.03423 1.03423 1.03423 1.03423 1.00731 1.00731 1.00731 1.00731 1.00731 1.00731 1.007311.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.009630.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.997811.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.82101 0.81493 1.22168 1.23618 1.23346 1.22168 1.22436 1.23618 1.23346 1.22436 0.76913 0.77823 0.77654 0.76913 0.77080 0.77823 0.77654


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%12.381% 12.450% 9.273% 9.195% 9.210% 9.273% 9.258% 9.195% 9.210% 9.258% 12.995% 12.882% 12.902% 12.995% 12.974% 12.882% 12.902%

Plan 95 Plan 96 Plan 97 Plan 98 Plan 99 Plan 100 Plan 101 Plan 102 Plan 103 Plan 104 Plan 105 Plan 106 Plan 107 Plan 108 Plan 109 Plan 110 Plan 111434.92 432.01 596.02 602.59 601.36 596.02 597.23 602.59 601.36 597.23 394.44 398.63 397.84 394.44 395.21 398.63 397.840.00 5.00 0.00 0.00 0.00 0.00 10.00 0.00 0.00 0.00 0.00 6.00 0.00 0.00 75.00 0.00 0.000.00 5.00 0.00 0.00 0.00 0.00 10.00 0.00 0.00 0.00 0.00 6.00 0.00 0.00 75.00 0.00 0.00



Plan 112 Plan 113 Plan 114 Plan 115 Plan 116 Plan 117 Plan 118 Plan 119 Plan 120 Plan 121 Plan 122 Plan 123 Plan 124 Plan 125 Plan 126 Plan 127 Plan 128 Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver

18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124 18029NY124Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver

0.71980 0.68230 0.68230 0.68230 0.68230 0.68230 0.68230 0.68230 0.68230 0.66740 0.66740 0.66740 0.66740 0.66740 0.66740 0.66740 0.66740 0.81298 0.70305 0.70304 0.70305 0.70305 0.70306 0.70304 0.70305 0.70306 0.71205 0.71206 0.71206 0.71205 0.71207 0.71206 0.71206 0.71207

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS Standard Silver

iDirect Silver Coinsurance HSAQ







iDirect Silver Coinsurance HSAQ Choice Plus Silver HSAQ Choice Plus Silver HSAQ Choice Plus Silver HSAQ Choice Plus Silver HSAQ Choice Plus Silver HSAQ Choice Plus Silver HSAQ Choice Plus Silver HSAQ Choice Plus Silver HSAQ

18029NY1240014 18029NY1240033 18029NY1240035 18029NY1240036 18029NY1240037 18029NY1240040 18029NY1240043 18029NY1240045 18029NY1240046 18029NY1240065 18029NY1240067 18029NY1240068 18029NY1240069 18029NY1240072 18029NY1240075 18029NY1240077 18029NY1240078Both Both Both Both Both Both Both Both Both Both Both Both Both Off Off Off Off


Plan 112 Plan 113 Plan 114 Plan 115 Plan 116 Plan 117 Plan 118 Plan 119 Plan 120 Plan 121 Plan 122 Plan 123 Plan 124 Plan 125 Plan 126 Plan 127 Plan 12870,960.28 0.00 22,651.37 0.00 0.00 3,773,234.22 0.00 0.00 6,956.88 0.00 100,700.50 0.00 0.00 1,681,305.80 0.00 0.00 104,131.81

133.00 0.00 195.00 0.00 0.00 18,921.00 0.00 0.00 97.00 0.00 597.00 0.00 0.00 10,495.00 0.00 0.00 699.00533.53595 0.00000 116.16085 0.00000 0.00000 199.42044 0.00000 0.00000 71.72042 0.00000 168.67756 0.00000 0.00000 160.20065 0.00000 0.00000 148.97254

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.81298 0.70305 0.70304 0.70305 0.70305 0.70306 0.70304 0.70305 0.70306 0.71205 0.71206 0.71206 0.71205 0.71207 0.71206 0.71206 0.712070.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94916 0.94916 0.94916 0.94916 0.94916 0.94916 0.94916 0.949160.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.93950 0.93950 0.93950 0.93950 0.93950 0.93950 0.93950 0.939501.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00162 1.00246 1.00246 1.00246 1.00246 1.00246 1.00246 1.00246 1.00246 1.00238 1.00238 1.00238 1.00238 1.00238 1.00238 1.00238 1.002381.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00731 1.00845 1.00845 1.00845 1.00845 1.00845 1.00845 1.00845 1.00845 1.00652 1.00652 1.00652 1.00652 1.00652 1.00652 1.00652 1.006521.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.000001.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.77080 0.66642 0.67431 0.67284 0.66642 0.66789 0.67431 0.67284 0.66789 0.63922 0.64680 0.64538 0.63922 0.64063 0.64680 0.64538 0.64063


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%12.974% 14.454% 14.328% 14.352% 14.454% 14.431% 14.328% 14.352% 14.431% 14.909% 14.779% 14.803% 14.909% 14.885% 14.779% 14.803% 14.885%

Plan 112 Plan 113 Plan 114 Plan 115 Plan 116 Plan 117 Plan 118 Plan 119 Plan 120 Plan 121 Plan 122 Plan 123 Plan 124 Plan 125 Plan 126 Plan 127 Plan 128395.21 356.86 360.59 359.89 356.86 357.55 360.59 359.89 357.55 344.89 348.48 347.82 344.89 345.56 348.48 347.82 345.565.00 0.00 25.00 0.00 0.00 1,428.00 0.00 0.00 7.00 0.00 32.00 0.00 0.00 832.00 0.00 0.00 33.005.00 0.00 25.00 0.00 0.00 1,428.00 0.00 0.00 7.00 0.00 32.00 0.00 0.00 832.00 0.00 0.00 33.00





0.66030 0.66030 0.66030 0.66030 0.66030 0.66030 0.66030 0.66030 0.69060 0.69060 0.69060 0.69060 0.69060 0.69060 0.69060 0.69060 0.69450 0.67735 0.67735 0.67734 0.67735 0.67733 0.67734 0.67735 0.67733 0.76687 0.76688 0.76691 0.76687 0.76689 0.76688 0.76691 0.76689 0.74015

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS iDirect Silver Blended HSAQ

iDirect Silver Blended HSAQ






iDirect Silver Blended HSAQ iDirect Silver Copay iDirect Silver Copay iDirect Silver Copay iDirect Silver Copay iDirect Silver Copay iDirect Silver Copay iDirect Silver Copay iDirect Silver Copay Max Silver

18029NY1240129 18029NY1240130 18029NY1240131 18029NY1240132 18029NY1240133 18029NY1240134 18029NY1240135 18029NY1240136 18029NY1240145 18029NY1240146 18029NY1240147 18029NY1240148 18029NY1240149 18029NY1240150 18029NY1240151 18029NY1240152 18029NY1240177Both Both Both Both Both Both Both Both Off Off Off Off Off Off Off Off OffNew New New New New New New New Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod

Plan 129 Plan 130 Plan 131 Plan 132 Plan 133 Plan 134 Plan 135 Plan 136 Plan 137 Plan 138 Plan 139 Plan 140 Plan 141 Plan 142 Plan 143 Plan 144 Plan 1450.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 128,265.39 288,790.25 0.00 0.00 16,425,770.76 0.00 0.00 436,817.68 0.000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 711.00 1,320.00 0.00 0.00 58,864.00 0.00 0.00 2,159.00 0.00

0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 180.40139 218.78049 0.00000 0.00000 279.04612 0.00000 0.00000 202.32408 0.00000

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.67735 0.67735 0.67734 0.67735 0.67733 0.67734 0.67735 0.67733 0.76687 0.76688 0.76691 0.76687 0.76689 0.76688 0.76691 0.76689 0.740150.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.949140.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.990071.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00254 1.00254 1.00254 1.00254 1.00254 1.00254 1.00254 1.00254 1.00223 1.00223 1.00223 1.00223 1.00223 1.00223 1.00223 1.00223 1.002321.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00877 1.00877 1.00877 1.00877 1.00877 1.00877 1.00877 1.00877 1.00775 1.00775 1.00775 1.00775 1.00775 1.00775 1.00775 1.00775 1.008031.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.000000.99781 1.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.997811.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.64231 0.64993 0.64849 0.64231 0.64371 0.64849 0.64993 0.64371 0.72624 0.73487 0.73328 0.72624 0.72787 0.73487 0.73328 0.72787 0.70119


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%14.856% 14.726% 14.751% 14.856% 14.832% 14.751% 14.726% 14.832% 13.560% 13.441% 13.463% 13.560% 13.537% 13.441% 13.463% 13.537% 13.918%

Plan 129 Plan 130 Plan 131 Plan 132 Plan 133 Plan 134 Plan 135 Plan 136 Plan 137 Plan 138 Plan 139 Plan 140 Plan 141 Plan 142 Plan 143 Plan 144 Plan 1450.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 386.48 390.58 389.82 386.48 387.23 390.58 389.82 387.23 357.850.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 32.00 169.00 0.00 0.00 3,959.00 0.00 0.00 134.00 0.000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 32.00 169.00 0.00 0.00 3,959.00 0.00 0.00 134.00 0.00


4.14% 4.13% 4.13% 4.14% 4.14% 4.13% 4.13% 4.14% 9.04%




0.69450 0.69450 0.69450 0.69450 0.69450 0.69450 0.69450 0.71980 0.71980 0.71980 0.71980 0.71980 0.71980 0.71980 0.71980 0.67970 0.67970 0.74015 0.74015 0.74015 0.74014 0.74015 0.74015 0.74014 0.81300 0.81298 0.81300 0.81300 0.81298 0.81300 0.81298 0.81298 0.73847 0.73850

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS Max Silver Max Silver Max Silver Max Silver Max Silver Max Silver Max Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver

iDirect Silver Copay HSAQ


18029NY1240178 18029NY1240179 18029NY1240180 18029NY1240181 18029NY1240182 18029NY1240183 18029NY1240184 18029NY1240185 18029NY1240186 18029NY1240187 18029NY1240188 18029NY1240189 18029NY1240190 18029NY1240191 18029NY1240192 18029NY1240193 18029NY1240194Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Both Both


Plan 146 Plan 147 Plan 148 Plan 149 Plan 150 Plan 151 Plan 152 Plan 153 Plan 154 Plan 155 Plan 156 Plan 157 Plan 158 Plan 159 Plan 160 Plan 161 Plan 162988.76 0.00 0.00 192,067.08 0.00 0.00 9,282.71 60,996.27 16,375.68 0.00 0.00 4,564,041.56 0.00 0.00 62,824.43 26,025.43 311,094.0624.00 0.00 0.00 1,700.00 0.00 0.00 75.00 135.00 213.00 0.00 0.00 16,439.00 0.00 0.00 234.00 349.00 2,178.00

41.19844 0.00000 0.00000 112.98063 0.00000 0.00000 123.76944 451.82425 76.88112 0.00000 0.00000 277.63499 0.00000 0.00000 268.48045 74.57143 142.83474

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.74015 0.74015 0.74015 0.74014 0.74015 0.74015 0.74014 0.81300 0.81298 0.81300 0.81300 0.81298 0.81300 0.81298 0.81298 0.73847 0.738500.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.949140.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.99007 0.990071.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00232 1.00232 1.00232 1.00232 1.00232 1.00232 1.00232 1.00162 1.00162 1.00162 1.00162 1.00162 1.00162 1.00162 1.00162 1.00232 1.002321.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00803 1.00803 1.00803 1.00803 1.00803 1.00803 1.00803 1.00731 1.00731 1.00731 1.00731 1.00731 1.00731 1.00731 1.00731 1.00804 1.008041.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.009631.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.70951 0.70795 0.70119 0.70273 0.70951 0.70795 0.70273 0.76913 0.77823 0.77654 0.76913 0.77080 0.77654 0.77823 0.77080 0.69962 0.70794


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%13.797% 13.819% 13.918% 13.895% 13.797% 13.819% 13.895% 12.995% 12.882% 12.902% 12.995% 12.974% 12.902% 12.882% 12.974% 13.941% 13.819%

Plan 146 Plan 147 Plan 148 Plan 149 Plan 150 Plan 151 Plan 152 Plan 153 Plan 154 Plan 155 Plan 156 Plan 157 Plan 158 Plan 159 Plan 160 Plan 161 Plan 162361.61 360.89 357.85 358.55 361.61 360.89 358.55 394.44 398.63 397.84 394.44 395.21 397.84 398.63 395.21 368.13 372.005.00 0.00 0.00 201.00 0.00 0.00 26.00 11.00 16.00 0.00 0.00 1,110.00 0.00 0.00 20.00 34.00 208.005.00 0.00 0.00 201.00 0.00 0.00 26.00 11.00 16.00 0.00 0.00 1,110.00 0.00 0.00 20.00 34.00 208.00





0.67970 0.67970 0.67970 0.67970 0.67970 0.67970 0.68230 0.68230 0.68230 0.68230 0.68230 0.68230 0.68230 0.68230 0.68230 0.68230 0.68230 0.73848 0.73847 0.73849 0.73848 0.73850 0.73849 0.70162 0.70159 0.70161 0.70162 0.70159 0.70159 0.70161 0.70159 0.69539 0.69540 0.69539

POS POS POS POS POS POS PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO iDirect Silver Copay HSAQ





iDirect Silver Copay HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ

Passport Plan Silver HSAQ



18029NY1240195 18029NY1240196 18029NY1240197 18029NY1240198 18029NY1240199 18029NY1240200 18029NY1250017 18029NY1250019 18029NY1250020 18029NY1250021 18029NY1250024 18029NY1250027 18029NY1250029 18029NY1250030 18029NY1250033 18029NY1250035 18029NY1250036Both Both Both Both Both Both Both Both Both Both Both Both Both Both Both Both Both


Plan 163 Plan 164 Plan 165 Plan 166 Plan 167 Plan 168 Plan 169 Plan 170 Plan 171 Plan 172 Plan 173 Plan 174 Plan 175 Plan 176 Plan 177 Plan 178 Plan 1790.00 0.00 10,009,704.48 0.00 1,791.73 760,768.19 0.00 0.00 0.00 0.00 204,059.62 0.00 0.00 13,607.61 0.00 0.00 0.000.00 0.00 44,380.00 0.00 37.00 3,003.00 0.00 0.00 0.00 0.00 638.00 0.00 0.00 24.00 0.00 0.00 0.00

0.00000 0.00000 225.54539 0.00000 48.42514 253.33606 0.00000 0.00000 0.00000 0.00000 319.84266 0.00000 0.00000 566.98363 0.00000 0.00000 0.00000

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.73848 0.73847 0.73849 0.73848 0.73850 0.73849 0.70162 0.70159 0.70161 0.70162 0.70159 0.70159 0.70161 0.70159 0.69539 0.69540 0.695390.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.94914 0.949140.99007 0.99007 0.99007 0.99007 0.99007 0.99007 1.00548 1.00548 1.00548 1.00548 1.00548 1.00548 1.00548 1.00548 1.55890 1.55890 1.558901.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00232 1.00232 1.00232 1.00232 1.00232 1.00232 1.00240 1.00240 1.00240 1.00240 1.00240 1.00240 1.00240 1.00240 1.00173 1.00173 1.001731.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00804 1.00804 1.00804 1.00804 1.00804 1.00804 1.04664 1.04664 1.04664 1.04664 1.04664 1.04664 1.04664 1.04664 1.03860 1.03860 1.038601.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.009630.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.997811.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.70637 0.69962 0.70117 0.70637 0.70794 0.70117 0.70095 0.70923 0.70770 0.70095 0.70247 0.70923 0.70770 0.70247 1.06812 1.08079 1.07841


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%13.842% 13.941% 13.918% 13.842% 13.819% 13.918% 13.922% 13.801% 13.823% 13.922% 13.899% 13.801% 13.823% 13.899% 10.211% 10.125% 10.141%

Plan 163 Plan 164 Plan 165 Plan 166 Plan 167 Plan 168 Plan 169 Plan 170 Plan 171 Plan 172 Plan 173 Plan 174 Plan 175 Plan 176 Plan 177 Plan 178 Plan 179371.28 368.13 368.83 371.28 372.00 368.83 380.28 384.30 383.55 380.28 381.03 384.30 383.55 381.03 540.14 546.06 544.950.00 0.00 5,236.00 0.00 10.00 206.00 0.00 0.00 0.00 0.00 66.00 0.00 0.00 2.00 0.00 0.00 0.000.00 0.00 5,236.00 0.00 10.00 206.00 0.00 0.00 0.00 0.00 66.00 0.00 0.00 2.00 0.00 0.00 0.00



Plan 180 Plan 181 Plan 182 Plan 183 Plan 184 Plan 185 Plan 186 Plan 187 Plan 188 Plan 189 Plan 190 Plan 191 Plan 192 Plan 193 Plan 194 Plan 195 Plan 196 Silver Silver Silver Silver Silver Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze

18029NY125 18029NY125 18029NY125 18029NY125 18029NY125 18029NY127 18029NY127 18029NY127 18029NY127 18029NY127 18029NY127 18029NY127 18029NY127 18029NY130 18029NY130 18029NY130 18029NY130Silver Silver Silver Silver Silver Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze

0.68230 0.68230 0.68230 0.68230 0.68230 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.69539 0.69539 0.69540 0.69539 0.69539 0.64546 0.64547 0.64546 0.64546 0.64547 0.64547 0.64546 0.64547 0.65530 0.65531 0.65530 0.65530

PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO POS POS POS POS Passport Plan Silver HSAQ





Passport Plan Bronze HSAQ







Passport Plan Bronze HSAQ Standard Bronze Standard Bronze Standard Bronze Standard Bronze

18029NY1250037 18029NY1250040 18029NY1250043 18029NY1250045 18029NY1250046 18029NY1270033 18029NY1270035 18029NY1270036 18029NY1270037 18029NY1270040 18029NY1270043 18029NY1270045 18029NY1270046 18029NY1300001 18029NY1300003 18029NY1300004 18029NY1300005Both Both Both Both Both Off Off Off Off Off Off Off Off Both Both Both Both


Plan 180 Plan 181 Plan 182 Plan 183 Plan 184 Plan 185 Plan 186 Plan 187 Plan 188 Plan 189 Plan 190 Plan 191 Plan 192 Plan 193 Plan 194 Plan 195 Plan 1960.00 5,566.16 0.00 0.00 117.56 0.00 0.00 0.00 0.00 1,842.30 0.00 0.00 16.79 0.00 4,344.94 0.00 0.000.00 59.00 0.00 0.00 7.00 0.00 0.00 0.00 0.00 62.00 0.00 0.00 1.00 0.00 97.00 0.00 0.00

0.00000 94.34173 0.00000 0.00000 16.79394 0.00000 0.00000 0.00000 0.00000 29.71453 0.00000 0.00000 16.79394 0.00000 44.79320 0.00000 0.00000

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.69539 0.69539 0.69540 0.69539 0.69539 0.64546 0.64547 0.64546 0.64546 0.64547 0.64547 0.64546 0.64547 0.65530 0.65531 0.65530 0.655300.94914 0.94914 0.94914 0.94914 0.94914 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.922511.55890 1.55890 1.55890 1.55890 1.55890 1.55828 1.55828 1.55828 1.55828 1.55828 1.55828 1.55828 1.55828 0.99008 0.99008 0.99008 0.990081.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00173 1.00173 1.00173 1.00173 1.00173 1.00188 1.00188 1.00188 1.00188 1.00188 1.00188 1.00188 1.00188 1.00194 1.00194 1.00194 1.001941.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.03860 1.03860 1.03860 1.03860 1.03860 1.04083 1.04083 1.04083 1.04083 1.04083 1.04083 1.04083 1.04083 1.00922 1.00922 1.00922 1.009221.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.000000.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.997811.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.06812 1.07047 1.08079 1.07841 1.07047 0.96545 0.97691 0.97475 0.96545 0.96758 0.97691 0.97475 0.96758 0.60388 0.61106 0.60971 0.60388


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%10.211% 10.195% 10.125% 10.141% 10.195% 10.990% 10.896% 10.913% 10.990% 10.972% 10.896% 10.913% 10.972% 15.553% 15.417% 15.443% 15.553%




Plan 197 Plan 198 Plan 199 Plan 200 Plan 201 Plan 202 Plan 203 Plan 204 Plan 205 Plan 206 Plan 207 Plan 208 Plan 209 Plan 210 Plan 211 Plan 212 Plan 213 Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze

18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze

0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.61440 0.61440 0.61440 0.61440 0.61440 0.65530 0.65531 0.65530 0.65530 0.65433 0.65436 0.65435 0.65433 0.65436 0.65436 0.65435 0.65436 0.64988 0.64989 0.64987 0.64988 0.64986

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS Standard Bronze Standard Bronze Standard Bronze Standard Bronze iDirect Bronze HSAQ iDirect Bronze HSAQ iDirect Bronze HSAQ iDirect Bronze HSAQ iDirect Bronze HSAQ iDirect Bronze HSAQ iDirect Bronze HSAQ iDirect Bronze HSAQ iDirect Bronze MV HSAQ iDirect Bronze MV HSAQ iDirect Bronze MV HSAQ iDirect Bronze MV HSAQ iDirect Bronze MV HSAQ 18029NY1300008 18029NY1300011 18029NY1300013 18029NY1300014 18029NY1300097 18029NY1300099 18029NY1300100 18029NY1300101 18029NY1300104 18029NY1300107 18029NY1300109 18029NY1300110 18029NY1300113 18029NY1300114 18029NY1300115 18029NY1300116 18029NY1300117

Both Both Both Both Off Off Off Off Off Off Off Off Off Off Off Off OffUniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod

Plan 197 Plan 198 Plan 199 Plan 200 Plan 201 Plan 202 Plan 203 Plan 204 Plan 205 Plan 206 Plan 207 Plan 208 Plan 209 Plan 210 Plan 211 Plan 212 Plan 21327,706.15 0.00 0.00 5,966.04 4,199.32 32,188.56 0.00 0.00 2,539,854.49 0.00 0.00 198,878.38 1,268.03 3,038.95 11,816.26 0.00 413,408.89

525.00 0.00 0.00 128.00 53.00 440.00 0.00 0.00 23,757.00 0.00 0.00 1,153.00 40.00 109.00 212.00 0.00 4,886.0052.77362 0.00000 0.00000 46.60970 79.23241 73.15581 0.00000 0.00000 106.90973 0.00000 0.00000 172.48775 31.70085 27.88027 55.73708 0.00000 84.61091

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.65530 0.65531 0.65530 0.65530 0.65433 0.65436 0.65435 0.65433 0.65436 0.65436 0.65435 0.65436 0.64988 0.64989 0.64987 0.64988 0.649860.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.922510.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.990081.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00194 1.00194 1.00194 1.00194 1.00267 1.00267 1.00267 1.00267 1.00267 1.00267 1.00267 1.00267 1.00272 1.00272 1.00272 1.00272 1.002721.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00922 1.00922 1.00922 1.00922 1.00891 1.00891 1.00891 1.00891 1.00891 1.00891 1.00891 1.00891 1.00746 1.00746 1.00746 1.00746 1.007461.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.000001.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.60522 0.61106 0.60971 0.60522 0.60325 0.61043 0.60908 0.60325 0.60460 0.61043 0.60908 0.60460 0.59832 0.60542 0.60407 0.59832 0.59962


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%15.528% 15.417% 15.443% 15.528% 15.565% 15.429% 15.455% 15.565% 15.540% 15.429% 15.455% 15.540% 15.661% 15.524% 15.550% 15.661% 15.636%

Plan 197 Plan 198 Plan 199 Plan 200 Plan 201 Plan 202 Plan 203 Plan 204 Plan 205 Plan 206 Plan 207 Plan 208 Plan 209 Plan 210 Plan 211 Plan 212 Plan 213318.39 321.08 320.45 318.39 310.59 313.78 313.18 310.59 311.18 313.78 313.18 311.18 299.20 302.25 301.68 299.20 299.7638.00 0.00 0.00 12.00 8.00 46.00 0.00 0.00 1,647.00 0.00 0.00 88.00 2.00 10.00 0.00 0.00 810.0038.00 0.00 0.00 12.00 8.00 46.00 0.00 0.00 1,647.00 0.00 0.00 88.00 2.00 10.00 0.00 0.00 810.00



Plan 214 Plan 215 Plan 216 Plan 217 Plan 218 Plan 219 Plan 220 Plan 221 Plan 222 Plan 223 Plan 224 Plan 225 Plan 226 Plan 227 Plan 228 Plan 229 Plan 230 Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze

18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130 18029NY130Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze

0.61440 0.61440 0.61440 0.64970 0.64970 0.64970 0.64970 0.64970 0.64970 0.64970 0.64970 0.61990 0.61990 0.61990 0.61990 0.61990 0.61990 0.64987 0.64989 0.64986 0.68547 0.68547 0.68549 0.68547 0.68550 0.68549 0.68547 0.68550 0.65530 0.65531 0.65530 0.65530 0.65530 0.65530

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS iDirect Bronze MV HSAQ iDirect Bronze MV HSAQ iDirect Bronze MV HSAQ

iDirect Bronze Enhanced HSAQ







iDirect Bronze Enhanced HSAQ Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze

18029NY1300118 18029NY1300119 18029NY1300120 18029NY1300121 18029NY1300122 18029NY1300123 18029NY1300124 18029NY1300125 18029NY1300126 18029NY1300127 18029NY1300128 18029NY1300145 18029NY1300146 18029NY1300147 18029NY1300148 18029NY1300149 18029NY1300150Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off


Plan 214 Plan 215 Plan 216 Plan 217 Plan 218 Plan 219 Plan 220 Plan 221 Plan 222 Plan 223 Plan 224 Plan 225 Plan 226 Plan 227 Plan 228 Plan 229 Plan 2300.00 0.00 914.53 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,262.64 0.00 0.00 725,537.06 0.000.00 0.00 50.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 56.00 0.00 0.00 5,360.00 0.00

0.00000 0.00000 18.29055 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 40.40424 0.00000 0.00000 135.36139 0.00000

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.64987 0.64989 0.64986 0.68547 0.68547 0.68549 0.68547 0.68550 0.68549 0.68547 0.68550 0.65530 0.65531 0.65530 0.65530 0.65530 0.655300.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.92251 0.922510.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.99008 0.990081.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00272 1.00272 1.00272 1.00256 1.00256 1.00256 1.00256 1.00256 1.00256 1.00256 1.00256 1.00194 1.00194 1.00194 1.00194 1.00194 1.001941.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00746 1.00746 1.00746 1.00881 1.00881 1.00881 1.00881 1.00881 1.00881 1.00881 1.00881 1.00922 1.00922 1.00922 1.00922 1.00922 1.009221.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.009630.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 0.997811.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.60407 0.60542 0.59962 0.63182 0.63932 0.63794 0.63182 0.63324 0.63794 0.63932 0.63324 0.60388 0.61106 0.60971 0.60388 0.60522 0.60971


45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%15.550% 15.524% 15.636% 15.039% 14.908% 14.932% 15.039% 15.014% 14.932% 14.908% 15.014% 15.553% 15.417% 15.443% 15.553% 15.528% 15.443%




Plan 231 Plan 232 Plan 233 Plan 234 Plan 235 Plan 236 Plan 237 Plan 238 Plan 239 Plan 240 Plan 241 Plan 242 Plan 243 Plan 244 Plan 245 Plan 246 Plan 247 Bronze Bronze Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum

18029NY130 18029NY130 18029NY141 18029NY141 18029NY141 18029NY141 18029NY141 18029NY141 18029NY141 18029NY141 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117Bronze Bronze Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum

0.61990 0.61990 0.86080 0.86080 0.86080 0.86080 0.86080 0.86080 0.86080 0.86080 0.88010 0.88010 0.88010 0.88010 0.88010 0.88010 0.88010 0.65531 0.65530 0.94634 0.94635 0.94635 0.94634 0.94633 0.94635 0.94635 0.94633 - - - - - - -

POS POS PPO PPO PPO PPO PPO PPO PPO PPO POS POS POS POS POS POS POS Standard Bronze Standard Bronze Passport Plan Platinum Passport Plan Platinum Passport Plan Platinum Passport Plan Platinum Passport Plan Platinum Passport Plan Platinum Passport Plan Platinum Passport Plan Platinum Standard Platinum Standard Platinum Standard Platinum Standard Platinum Standard Platinum Standard Platinum Standard Platinum 18029NY1300151 18029NY1300152 18029NY1410001 18029NY1410002 18029NY1410003 18029NY1410004 18029NY1410005 18029NY1410006 18029NY1410007 18029NY1410008 18029NY1170001 18029NY1170003 18029NY1170004 18029NY1170005 18029NY1170008 18029NY1170011 18029NY1170013

Off Off Off Off Off Off Off Off Off Off Both Both Both Both Both Both BothUniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued

Plan 231 Plan 232 Plan 233 Plan 234 Plan 235 Plan 236 Plan 237 Plan 238 Plan 239 Plan 240 Plan 241 Plan 242 Plan 243 Plan 244 Plan 245 Plan 246 Plan 2470.00 99,279.55 0.00 0.00 0.00 0.00 67.18 0.00 0.00 0.00 0.00 11,865.64 0.00 0.00 913,845.59 0.00 0.000.00 225.00 0.00 0.00 0.00 0.00 4.00 0.00 0.00 0.00 0.00 60.00 0.00 0.00 2,162.00 0.00 0.00

0.00000 441.24245 0.00000 0.00000 0.00000 0.00000 16.79394 0.00000 0.00000 0.00000 0.00000 197.76069 0.00000 0.00000 422.68529 0.00000 0.00000

421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912 421.02912


1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776 1.13776


0.65531 0.65530 0.94634 0.94635 0.94635 0.94634 0.94633 0.94635 0.94635 0.94633 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.92251 0.92251 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 1.05565 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.99008 0.99008 1.56105 1.56105 1.56105 1.56105 1.56105 1.56105 1.56105 1.56105 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00194 1.00194 1.00118 1.00118 1.00118 1.00118 1.00118 1.00118 1.00118 1.00118 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00922 1.00922 1.02658 1.02658 1.02658 1.02658 1.02658 1.02658 1.02658 1.02658 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.009631.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.997811.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.61106 0.60522 1.59933 1.61830 1.61475 1.59933 1.60283 1.61475 1.61830 1.60283

Plan 231 Plan 232 Plan 233 Plan 234 Plan 235 Plan 236 Plan 237 Plan 238 Plan 239 Plan 240 Plan 241 Plan 242 Plan 243 Plan 244 Plan 245 Plan 246 Plan 247292.72 289.92 766.13 775.22 773.51 766.13 767.80 773.51 775.22 767.80

45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.88000 45.880000.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160% 0.160%2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000% 2.000%15.417% 15.528% 7.688% 7.627% 7.638% 7.688% 7.677% 7.638% 7.627% 7.677%

Plan 231 Plan 232 Plan 233 Plan 234 Plan 235 Plan 236 Plan 237 Plan 238 Plan 239 Plan 240 Plan 241 Plan 242 Plan 243 Plan 244 Plan 245 Plan 246 Plan 247321.08 318.39 785.63 794.47 792.81 785.63 787.28 792.81 794.47 787.28 527.13 532.89 531.82 527.13 528.19 532.89 531.820.00 9.00 0.00 0.00 0.00 0.00 4.00 0.00 0.00 0.00 0.00 6.00 0.00 0.00 130.00 0.00 0.000.00 9.00 0.00 0.00 0.00 0.00 4.00 0.00 0.00 0.00

Plan 231 Plan 232 Plan 233 Plan 234 Plan 235 Plan 236 Plan 237 Plan 238 Plan 239 Plan 240 Plan 241 Plan 242 Plan 243 Plan 244 Plan 245 Plan 246 Plan 247346.07 343.21 829.93 839.22 837.48 829.93 831.65 837.48 839.22 831.657.78% 7.80% 5.64% 5.63% 5.64% 5.64% 5.64% 5.64% 5.63% 5.64%


Plan 248 Plan 249 Plan 250 Plan 251 Plan 252 Plan 253 Plan 254 Plan 255 Plan 256 Plan 257 Plan 258 Plan 259 Plan 260 Plan 261 Plan 262 Plan 263 Plan 264 Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum

18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117 18029NY117Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum

0.88010 0.86900 0.86900 0.86900 0.86900 0.86900 0.86900 0.86900 0.86900 0.88010 0.88010 0.88010 0.88010 0.88010 0.88010 0.88010 0.88010 - - - - - - - - - - - - - - - - -

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS Standard Platinum iDirect Platinum HSAQ iDirect Platinum HSAQ iDirect Platinum HSAQ iDirect Platinum HSAQ iDirect Platinum HSAQ iDirect Platinum HSAQ iDirect Platinum HSAQ iDirect Platinum HSAQ Standard Platinum Standard Platinum Standard Platinum Standard Platinum Standard Platinum Standard Platinum Standard Platinum Standard Platinum 18029NY1170014 18029NY1170081 18029NY1170082 18029NY1170083 18029NY1170084 18029NY1170085 18029NY1170086 18029NY1170087 18029NY1170088 18029NY1170105 18029NY1170106 18029NY1170107 18029NY1170108 18029NY1170109 18029NY1170110 18029NY1170111 18029NY1170112

Both Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off OffDiscontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued

Plan 248 Plan 249 Plan 250 Plan 251 Plan 252 Plan 253 Plan 254 Plan 255 Plan 256 Plan 257 Plan 258 Plan 259 Plan 260 Plan 261 Plan 262 Plan 263 Plan 264102,153.77 0.00 317,794.56 0.00 0.00 6,512,967.69 53,846.57 0.00 136,210.16 9,289.57 254,791.40 0.00 0.00 15,075,578.01 0.00 796.71 609,926.46

269.00 0.00 495.00 0.00 0.00 8,975.00 68.00 0.00 278.00 12.00 536.00 0.00 0.00 26,623.00 0.00 1.00 2,011.00379.75378 0.00000 642.00922 0.00000 0.00000 725.67885 791.86134 0.00000 489.96461 774.13075 475.35709 0.00000 0.00000 566.26143 0.00000 796.70907 303.29511



0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.000001.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000


Plan 248 Plan 249 Plan 250 Plan 251 Plan 252 Plan 253 Plan 254 Plan 255 Plan 256 Plan 257 Plan 258 Plan 259 Plan 260 Plan 261 Plan 262 Plan 263 Plan 264528.19 475.65 480.79 479.83 475.65 476.60 480.79 479.83 476.60 527.13 532.89 531.82 527.13 528.19 531.82 532.89 528.1926.00 0.00 212.00 0.00 0.00 815.00 0.00 0.00 18.00 1.00 66.00 0.00 0.00 2,278.00 0.00 1.00 33.00





0.79770 0.79770 0.79770 0.79770 0.79770 0.79770 0.79770 0.79770 0.78760 0.78760 0.78760 0.78760 0.78760 0.78760 0.78760 0.78760 0.79770 - - - - - - - - - - - - - - - - -

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ Standard Gold

18029NY1200001 18029NY1200003 18029NY1200004 18029NY1200005 18029NY1200008 18029NY1200011 18029NY1200013 18029NY1200014 18029NY1200153 18029NY1200154 18029NY1200155 18029NY1200156 18029NY1200157 18029NY1200158 18029NY1200159 18029NY1200160 18029NY1200169Both Both Both Both Both Both Both Both Off Off Off Off Off Off Off Off Off

Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued

Plan 265 Plan 266 Plan 267 Plan 268 Plan 269 Plan 270 Plan 271 Plan 272 Plan 273 Plan 274 Plan 275 Plan 276 Plan 277 Plan 278 Plan 279 Plan 280 Plan 2810.00 60,459.36 0.00 0.00 173,919.60 0.00 0.00 102,479.11 645.73 2,024,003.69 0.00 13,052.88 16,596,255.19 0.00 0.00 730,988.84 0.000.00 127.00 0.00 0.00 808.00 0.00 0.00 306.00 10.00 2,442.00 0.00 85.00 39,109.00 0.00 0.00 1,862.00 0.00

0.00000 476.05799 0.00000 0.00000 215.24703 0.00000 0.00000 334.89905 64.57345 828.83034 0.00000 153.56325 424.35898 0.00000 0.00000 392.58262 0.00000



0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.00000 1.000000.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.99781 1.00000 0.99781 0.99781 1.00000 1.00000 0.99781 1.00000 0.997811.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000


Plan 265 Plan 266 Plan 267 Plan 268 Plan 269 Plan 270 Plan 271 Plan 272 Plan 273 Plan 274 Plan 275 Plan 276 Plan 277 Plan 278 Plan 279 Plan 280 Plan 281457.96 462.88 461.98 457.96 458.87 462.88 461.98 458.87 406.38 410.72 409.91 406.38 407.19 410.72 409.91 407.19 457.960.00 7.00 0.00 0.00 76.00 0.00 0.00 14.00 2.00 164.00 0.00 6.00 3,439.00 0.00 0.00 94.00 0.00



Plan 282 Plan 283 Plan 284 Plan 285 Plan 286 Plan 287 Plan 288 Gold Gold Gold Gold Gold Gold Gold

18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120 18029NY120Gold Gold Gold Gold Gold Gold Gold

0.79770 0.79770 0.79770 0.79770 0.79770 0.79770 0.79770 - - - - - - -

POS POS POS POS POS POS POS Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold

18029NY1200170 18029NY1200171 18029NY1200172 18029NY1200173 18029NY1200174 18029NY1200175 18029NY1200176Off Off Off Off Off Off Off

Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued Discontinued

Plan 282 Plan 283 Plan 284 Plan 285 Plan 286 Plan 287 Plan 288123,176.92 0.00 0.00 2,975,327.21 0.00 0.00 1,014,263.35

134.00 0.00 0.00 8,469.00 0.00 0.00 2,246.00919.23073 0.00000 0.00000 351.31978 0.00000 0.00000 451.58653

Plan 282 Plan 283 Plan 284 Plan 285 Plan 286 Plan 287 Plan 288

Plan 282 Plan 283 Plan 284 Plan 285 Plan 286 Plan 287 Plan 288479.03085 479.03085 479.03085 479.03085 479.03085 479.03085 479.03085

0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000000.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.000001.00963 1.00963 1.00000 1.00000 1.00963 1.00963 1.000001.00000 0.99781 0.99781 1.00000 0.99781 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.000001.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000


Plan 282 Plan 283 Plan 284 Plan 285 Plan 286 Plan 287 Plan 288462.88 461.98 457.96 458.87 461.98 462.88 458.8730.00 0.00 0.00 760.00 0.00 3.00 178.00



Exhibit 18 Supplement


SERFF Number: NDPD-131469299Market Segment : Small Group

Expense Data - Small Group 2019 Expected 2018 Expected 2017 Expected 2016 Expected 2017 Actual 2016 ActualPeriod assumed - beginning date 1/1/2019 1/1/2018 1/1/2017 1/1/2016 1/1/2017 1/1/2016

Period assumed - ending date 12/31/2019 12/31/2018 12/31/2017 12/31/2016 12/31/2017 12/31/2016Average annual claim trend assumed 6.04% 8.22% 10.98% 6.00% 10.98% 8.01%

Regulatory authority licenses and fees, including New York State 206 assessment expenses - as a % of gross premium 2.09% 3.68% 0.94% 7.95% 2.30% 4.76%Administrative expenses for activities that improve health care quality as defined in the NAIC Annual Statement Supplement Health Care Exhibit - as a % of gross premium 2.99% 2.60% 2.47% 2.56% 2.79% 3.11%

Commissions and broker fees - as a % of gross premium 1.74% 1.61% 2.15% 1.15% 1.95% 3.32%Premium Taxes - as a % of gross premium 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Other state and federal taxes and assessments (other than income taxes and covered lives assessment) - as a % of gross premium 0.00% 0.04% 0.05% 0.61% 0.05% 0.04%Other administrative expenses - as a % of gross premium 4.14% 3.60% 5.33% -0.39% 3.86% 6.68%

Subtotal 10.966% 11.531% 10.941% 11.880% 10.946% 17.909%

After tax underwriting margin (profit/contribution to surplus) - as a % of gross premium 1.58% 1.32% 0.61% 0.62% 0.61% 0.49%State income tax component - as a % of gross premium 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

State income tax rate assumed (e.g. 3%) 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%Federal income tax component - as a % of gross premium 0.42% 0.68% 0.31% 0.32% 0.31% 0.25%

Federal income tax rate assumed (e.g. 30%) 21.00% 34.00% 34.00% 34.00% 34.00% 34.00%Reduction for assumed net investment income - as a % of gross premium (enter as a negative value) -0.91% -1.48% -1.42% -1.68% -1.42% -1.10%

Subtotal 1.093% 0.522% -0.499% -0.740% -0.499% -0.353%

Total 12.059% 12.052% 10.442% 11.140% 10.447% 17.557%

Exhibit 18 Supplement Last Updated - 4/10/2018 1

A. Company Name B. NAIC Code C. SERFF Number D. Market1.

Metal Level

2. On/Off Exchange Designation and Standard/Non Std

3. Estimated

Membership as of 03/31/2018

4.1 Period assumed -

beginning date (mm/dd/yy)

4.2Period assumed -

ending date (mm/dd/yy)

5. Average annual

claim trend assumed

6.1 Regulatory authority licenses and fees, including New York

State 206 assessment

expenses - as a % of gross premium

6.2 Administrative expenses for activities that

improve health care quality as defined in

the NAIC Annual Statement

Supplement Health Care Exhibit - as a % of gross premium

6.3Commissions and broker fees - as a

% of gross premium

6.4Premium Taxes - as a % of gross

premium

6.5 Other state and

federal taxes and assessments (other than income taxes and covered lives

assessment) - as a % of gross premium

6.6 Other

administrative expenses - as a % of gross premium

6.7Subtotal columns

6.1 through 6.6

7. After tax

underwriting margin (profit/contribution

to surplus) - as a % of gross premium

8. State income tax component - as a

% of gross premium

8.1 State income tax

rate assumed (e.g. 3%)

9.Federal income tax component - as a

% of gross premium

9.1Federal income tax rate assumed (e.g.

30%)

10.Reduction for assumed net

investment income - as a % of gross

premium (enter as a negative value)

11.Subtotal columns

6.7 + 7 + 8 + 9 + 10IHBC 47034 NDPD-131469299 Small Group Platinum Standard on exchange 0.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Platinum Non Standard on exchange 157.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Platinum Standard off exchange 0.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Platinum Non Standard off exchange 13251.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Gold Standard on exchange 0.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Gold Non Standard on exchange 106.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Gold Standard off exchange 0.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Gold Non Standard off exchange 7438.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Silver Standard on exchange 86.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Silver Non Standard on exchange 189.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Silver Standard off exchange 1157.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Silver Non Standard off exchange 12472.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Bronze Standard on exchange 55.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Bronze Non Standard on exchange 97.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Bronze Standard off exchange 391.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group Bronze Non Standard off exchange 2569.00 1/1/2019 12/31/2019 6.04% 2.09% 2.99% 1.74% 0.00% 0.00% 4.14% 10.97% 1.58% 0.00% 0.00% 0.42% 21.00% -0.91% 12.06%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%IHBC 47034 NDPD-131469299 Small Group 0.00% 0.00%

General Information For the rate period included in this rate adjustment filing


14.1 Period assumed -

beginning date (mm/dd/yy)

14.2Period assumed -

ending date (mm/dd/yy)

15. Average annual

claim trend assumed

16.1 Regulatory authority licenses and fees, including New York

State 206 assessment

expenses - as a % of gross premium

16.2 Administrative expenses for activities that

improve health care quality as defined in

the NAIC Annual Statement

Supplement Health Care Exhibit - as a % of gross premium

16.3Commissions and broker fees - as a

% of gross premium

16.4Premium Taxes - as a % of gross

premium

16.5 Other state and

federal taxes and assessments (other than income taxes and covered lives

assessment) - as a % of gross premium

16.6 Other

administrative expenses - as a % of gross premium

16.7Subtotal columns 16.1 through 16.6

17 After tax

underwriting margin (profit/contribution

to surplus) - as a % of gross premium

18State income tax component - as a

% of gross premium

18.1 State income tax

rate assumed (e.g. 3%)

19Federal income tax component - as a

% of gross premium

19.1Federal income tax rate assumed (e.g.

30%)

20Reduction for assumed net

investment income - as a % of gross

premium (enter as a negative value)

21Subtotal columns

16.7 + 17 + 18 + 19 +20

1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%1/1/2018 12/31/2018 10.17% 5.02% 4.73% 0.06% 0.00% 0.04% 6.49% 16.33% 1.32% 0.00% 0.00% 0.68% 34.00% -0.48% 17.84%

0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%0.00% 0.00%

For the rate period included in the prior rate and form filing


1. Company Name 2. NAIC Code 3. SERFF Number 4. Market

5. Current HIOS ID (14 Digits)

6. Previous HIOS ID (14 Digits)

7. Metal Level or Catastrophic

8. Exchange ["On"/"Off"]

9. Plan Type [Std or Non Std]

10.Limiting Child

Age? (26 or 30)

11. Domestic Partner

Coverage Included? (yes,

no)

12. Family

Planning Coverage? (included, excluded)

13. Pediatric

Dental Coverage

Included? (yes, no)

14. Out of Network

Benefits? (yes, no)

15. Includes

Benefits in Addition to

EHB? (yes, no)

16. Healthy New

York (yes, no)

17. Child-Only

Plan (yes, no)

18. Tiered Network Plan (yes, no)

19. HSA Plan (yes,

no)Region 1 - 2016 Rate (Albany)

Region 2 - 2016 Rate (Buffalo)

Region 3 - 2016 Rate (Mid-Hudson)

Region 4 - 2016 Rate (New York)

Region 5 - 2016 Rate (Rochester)

Region 6 - 2016 Rate (Syracuse)

Region 7 - 2016 Rate (Utica)

Region 8 - 2016 Rate (Long

Island)Region 1 - 2016 MMs (Albany)

Region 2 - 2016 MMs (Buffalo)

Region 3 - 2016 MMs (Mid-Hudson)

Region 4 - 2016 MMs (New York)

Region 5 - 2016 MMs (Rochester)

IHBC 47034 NDPD-131469299 Small Group 18029NY1170001 N/A Platinum On Std 26 No Excluded No Yes Yes No No No No 502.96 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170003 N/A Platinum On Std 30 Yes Included No Yes Yes No No No No 508.88 60.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170004 N/A Platinum On Std 30 Yes Excluded No Yes Yes No No No No 507.77 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170005 N/A Platinum On Std 26 Yes Excluded No Yes Yes No No No No 502.96 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170008 N/A Platinum On Std 26 Yes Included No Yes Yes No No No No 504.06 1470.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170011 N/A Platinum On Std 30 No Included No Yes Yes No No No No 508.88 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170013 N/A Platinum On Std 30 No Excluded No Yes Yes No No No No 507.77 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170014 N/A Platinum On Std 26 No Included No Yes Yes No No No No 504.06 360.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170015 N/A Platinum On Non Std 30 Yes Excluded No Yes Yes No No No No 501.49 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170016 N/A Platinum On Non Std 26 Yes Excluded No Yes Yes No No No No 496.74 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170017 N/A Platinum On Non Std 26 Yes Included No Yes Yes No No No No 497.82 215.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170018 N/A Platinum On Non Std 30 No Excluded No Yes Yes No No No No 501.49 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170019 N/A Platinum On Non Std 30 No Included No Yes Yes No No No No 502.59 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170020 N/A Platinum On Non Std 26 No Included No Yes Yes No No No No 497.82 14.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170021 N/A Platinum On Non Std 26 No Excluded No Yes Yes No No No No 496.74 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170022 N/A Platinum On Non Std 30 Yes Included No Yes Yes No No No No 502.59 1.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170033 18029NY1170017 Platinum On Non Std 26 No Excluded No Yes Yes No No No No 497.93 3522.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170035 18029NY1170019 Platinum On Non Std 30 Yes Included No Yes Yes No No No No 503.80 6894.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170036 18029NY1170020 Platinum On Non Std 30 Yes Excluded No Yes Yes No No No No 502.70 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170037 18029NY1170021 Platinum On Non Std 26 Yes Excluded No Yes Yes No No No No 497.93 362.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170040 18029NY1170024 Platinum On Non Std 26 Yes Included No Yes Yes No No No No 499.03 151351.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170043 18029NY1170027 Platinum On Non Std 30 No Included No Yes Yes No No No No 503.80 635.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170045 18029NY1170029 Platinum On Non Std 30 No Excluded No Yes Yes No No No No 502.70 7.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170046 18029NY1170030 Platinum On Non Std 26 No Included No Yes Yes No No No No 499.03 3417.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170081 N/A Platinum Off Non Std 26 No Excluded No Yes Yes No No No Yes 474.09 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170082 N/A Platinum Off Non Std 30 Yes Included No Yes Yes No No No Yes 479.68 24.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170083 N/A Platinum Off Non Std 30 Yes Excluded No Yes Yes No No No Yes 478.63 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170084 N/A Platinum Off Non Std 26 Yes Excluded No Yes Yes No No No Yes 474.09 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170085 N/A Platinum Off Non Std 26 Yes Included No Yes Yes No No No Yes 475.13 7044.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170086 N/A Platinum Off Non Std 30 No Included No Yes Yes No No No Yes 479.68 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170087 N/A Platinum Off Non Std 30 No Excluded No Yes Yes No No No Yes 478.63 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170088 N/A Platinum Off Non Std 26 No Included No Yes Yes No No No Yes 475.13 24.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170097 N/A Platinum Off Non Std 26 No Excluded No Yes Yes No No Yes No 465.40 57.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170098 N/A Platinum Off Non Std 30 Yes Included No Yes Yes No No Yes No 470.87 10.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170099 N/A Platinum Off Non Std 30 Yes Excluded No Yes Yes No No Yes No 469.84 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170100 N/A Platinum Off Non Std 26 Yes Excluded No Yes Yes No No Yes No 465.40 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170101 N/A Platinum On Non Std 26 Yes Included No Yes Yes No No Yes No 466.40 2676.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170102 N/A Platinum On Non Std 30 No Included No Yes Yes No No Yes No 470.87 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170103 N/A Platinum On Non Std 30 No Excluded No Yes Yes No No Yes No 469.84 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170104 N/A Platinum On Non Std 26 No Included No Yes Yes No No Yes No 466.40 185.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170105 N/A Platinum Off Std 26 No Excluded No Yes Yes No No No No 502.96 1.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170106 N/A Platinum Off Std 30 Yes Included No Yes Yes No No No No 508.88 363.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170107 N/A Platinum Off Std 30 Yes Excluded No Yes Yes No No No No 507.77 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170108 N/A Platinum Off Std 26 Yes Excluded No Yes Yes No No No No 502.96 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170109 N/A Platinum Off Std 26 Yes Included No Yes Yes No No No No 504.06 17621.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170110 N/A Platinum Off Std 30 No Excluded No Yes Yes No No No No 507.77 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170111 N/A Platinum Off Std 30 No Included No Yes Yes No No No No 508.88 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170112 N/A Platinum Off Std 26 No Included No Yes Yes No No No No 504.06 584.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200001 N/A Gold On Std 26 No Excluded No Yes Yes No No No No 436.64 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200003 N/A Gold On Std 30 Yes Included No Yes Yes No No No No 441.78 131.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200004 N/A Gold On Std 30 Yes Excluded No Yes Yes No No No No 440.82 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200005 N/A Gold On Std 26 Yes Excluded No Yes Yes No No No No 436.64 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200008 N/A Gold On Std 26 Yes Included No Yes Yes No No No No 437.59 1070.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200011 N/A Gold On Std 30 No Included No Yes Yes No No No No 441.78 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200013 N/A Gold On Std 30 No Excluded No Yes Yes No No No No 440.82 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200014 N/A Gold On Std 26 No Included No Yes Yes No No No No 437.59 172.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200033 18029NY1200017 Gold On Non Std 26 No Excluded No Yes Yes No No No No 440.54 170.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200035 18029NY1200019 Gold On Non Std 30 Yes Included No Yes Yes No No No No 445.72 710.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200036 18029NY1200020 Gold On Non Std 30 Yes Excluded No Yes Yes No No No No 444.75 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200037 18029NY1200021 Gold On Non Std 26 Yes Excluded No Yes Yes No No No No 440.54 47.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200040 18029NY1200024 Gold Off Non Std 26 Yes Included No Yes Yes No No No No 441.50 48745.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200043 18029NY1200027 Gold Off Non Std 30 No Included No Yes Yes No No No No 445.72 186.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200045 18029NY1200029 Gold Off Non Std 30 No Excluded No Yes Yes No No No No 444.75 0.00


IHBC 47034 NDPD-131469299 Small Group 18029NY1200081 18029NY1200065 Gold On Non Std 26 No Excluded No Yes Yes No No Yes No 409.85 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200083 18029NY1200067 Gold On Non Std 30 Yes Included No Yes Yes No No Yes No 414.68 300.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200084 18029NY1200068 Gold On Non Std 30 Yes Excluded No Yes Yes No No Yes No 413.77 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200085 18029NY1200069 Gold On Non Std 26 Yes Excluded No Yes Yes No No Yes No 409.85 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200088 18029NY1200072 Gold On Non Std 26 Yes Included No Yes Yes No No Yes No 410.75 3253.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200091 18029NY1200075 Gold On Non Std 30 No Included No Yes Yes No No Yes No 414.68 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200093 18029NY1200077 Gold On Non Std 30 No Excluded No Yes Yes No No Yes No 413.77 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200094 18029NY1200078 Gold On Non Std 26 No Included No Yes Yes No No Yes No 410.75 327.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200153 N/A Gold Off Non Std 26 No Excluded No Yes Yes No No No Yes 401.72 100.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200154 N/A Gold Off Non Std 30 Yes Included No Yes Yes No No No Yes 406.45 2050.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200155 N/A Gold Off Non Std 30 Yes Excluded No Yes Yes No No No Yes 405.57 0.00



IHBC 47034 NDPD-131469299 Small Group 18029NY1200158 N/A Gold Off Non Std 30 No Included No Yes Yes No No No Yes 406.45 0.00



IHBC 47034 NDPD-131469299 Small Group 18029NY1200169 N/A Gold Off Std 26 No Excluded No Yes Yes No No No No 436.64 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200170 N/A Gold Off Std 30 Yes Included No Yes Yes No No No No 441.78 54.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200171 N/A Gold Off Std 30 Yes Excluded No Yes Yes No No No No 440.82 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200172 N/A Gold Off Std 26 Yes Excluded No Yes Yes No No No No 436.64 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200173 N/A Gold Off Std 26 Yes Included No Yes Yes No No No No 437.59 5764.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200174 N/A Gold Off Std 30 No Excluded No Yes Yes No No No No 440.82 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200175 N/A Gold Off Std 30 No Included No Yes Yes No No No No 441.78 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200176 N/A Gold Off Std 26 No Included No Yes Yes No No No No 437.59 1001.00









IHBC 47034 NDPD-131469299 Small Group 18029NY1200185 N/A Gold Off Non Std 26 No Excluded No Yes Yes No No No No 401.44 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200186 N/A Gold Off Non Std 30 Yes Included No Yes Yes No No No No 406.16 64.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200187 N/A Gold Off Non Std 30 Yes Excluded No Yes Yes No No No No 405.27 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200188 N/A Gold Off Non Std 26 Yes Excluded No Yes Yes No No No No 401.44 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200189 N/A Gold Off Non Std 26 Yes Included No Yes Yes No No No No 402.31 5114.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200190 N/A Gold Off Non Std 30 No Excluded No Yes Yes No No No No 405.27 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200191 N/A Gold Off Non Std 30 No Included No Yes Yes No No No No 406.16 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200192 N/A Gold Off Non Std 26 No Included No Yes Yes No No No No 402.31 22.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200193 N/A Gold Off Non Std 26 No Excluded No Yes Yes Yes No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200194 N/A Gold Off Non Std 30 Yes Included No Yes Yes Yes No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200195 N/A Gold Off Non Std 30 Yes Excluded No Yes Yes Yes No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200196 N/A Gold Off Non Std 26 Yes Excluded No Yes Yes Yes No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200197 N/A Gold Off Non Std 26 Yes Included No Yes Yes Yes No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200198 N/A Gold Off Non Std 30 No Excluded No Yes Yes Yes No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200199 N/A Gold Off Non Std 30 No Included No Yes Yes Yes No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200200 N/A Gold Off Non Std 26 No Included No Yes Yes Yes No No No N/A 0.00


PLAN INFORMATION 2016 PREMIUM RATES 2016 MEMBER MONTHS








10.Limiting Child

Age? (26 or 30)



no)

12. Family


13. Pediatric

Dental Coverage

Included? (yes, no)

14. Out of Network

Benefits? (yes, no)

15. Includes


EHB? (yes, no)

16. Healthy New

York (yes, no)

17. Child-Only

Plan (yes, no)


19. HSA Plan (yes,
















IHBC 47034 NDPD-131469299 Small Group 18029NY1210020 18029NY1210004 Gold Off Non Std 30 Yes Excluded No Yes Yes No No No No 448.05 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1210021 18029NY1210005 Gold Off Non Std 26 Yes Excluded No Yes Yes No No No No 443.81 0.00





IHBC 47034 NDPD-131469299 Small Group 18029NY1210057 N/A Gold On Non Std 26 No Excluded No Yes Yes No No No No 957.77 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1210058 N/A Gold On Non Std 30 Yes Included No Yes Yes No No No No 969.10 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1210059 N/A Gold On Non Std 30 Yes Excluded No Yes Yes No No No No 966.98 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1210060 N/A Gold On Non Std 26 Yes Excluded No Yes Yes No No No No 957.77 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1210061 N/A Gold On Non Std 26 Yes Included No Yes Yes No No No No 959.88 10.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1210062 N/A Gold On Non Std 30 No Included No Yes Yes No No No No 969.10 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1210063 N/A Gold On Non Std 30 No Excluded No Yes Yes No No No No 966.98 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1210064 N/A Gold On Non Std 26 No Included No Yes Yes No No No No 959.88 1.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200129 N/A Gold On Non Std 26 No Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200130 N/A Gold On Non Std 30 Yes Included No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200131 N/A Gold On Non Std 30 Yes Excluded No Yes Yes No No No No N/A 0.00


IHBC 47034 NDPD-131469299 Small Group 18029NY1200133 N/A Gold On Non Std 26 Yes Included No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200134 N/A Gold On Non Std 30 No Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200135 N/A Gold On Non Std 30 No Included No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200136 N/A Gold On Non Std 26 No Included No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200137 N/A Gold On Non Std 26 No Excluded No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200138 N/A Gold On Non Std 30 Yes Included No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200139 N/A Gold On Non Std 30 Yes Excluded No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200140 N/A Gold On Non Std 26 Yes Excluded No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200141 N/A Gold On Non Std 26 Yes Included No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200142 N/A Gold On Non Std 30 No Excluded No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200143 N/A Gold On Non Std 30 No Included No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200144 N/A Gold On Non Std 26 No Included No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240001 N/A Silver On Std 26 No Excluded No Yes Yes No No No No 375.40 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240003 N/A Silver On Std 30 Yes Included No Yes Yes No No No No 379.82 71.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240004 N/A Silver On Std 30 Yes Excluded No Yes Yes No No No No 378.99 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240005 N/A Silver On Std 26 Yes Excluded No Yes Yes No No No No 375.40 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240008 N/A Silver On Std 26 Yes Included No Yes Yes No No No No 376.22 2139.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240011 N/A Silver On Std 30 No Included No Yes Yes No No No No 379.82 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240013 N/A Silver On Std 30 No Excluded No Yes Yes No No No No 378.99 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240014 N/A Silver On Std 26 No Included No Yes Yes No No No No 376.22 211.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240033 18029NY1240017 Silver On Non Std 26 No Excluded No Yes Yes No No No Yes 351.24 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240035 18029NY1240019 Silver On Non Std 30 Yes Included No Yes Yes No No No Yes 355.35 234.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240036 18029NY1240020 Silver On Non Std 30 Yes Excluded No Yes Yes No No No Yes 354.58 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240037 18029NY1240021 Silver On Non Std 26 Yes Excluded No Yes Yes No No No Yes 351.24 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240040 18029NY1240024 Silver On Non Std 26 Yes Included No Yes Yes No No No Yes 352.00 20174.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240043 18029NY1240027 Silver On Non Std 30 No Included No Yes Yes No No No Yes 355.35 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240045 18029NY1240029 Silver On Non Std 30 No Excluded No Yes Yes No No No Yes 354.58 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240046 18029NY1240030 Silver On Non Std 26 No Included No Yes Yes No No No Yes 352.00 249.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240065 18029NY1240049 Silver On Non Std 26 No Excluded No Yes Yes No No Yes Yes 334.86 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240067 18029NY1240051 Silver On Non Std 30 Yes Included No Yes Yes No No Yes Yes 338.79 379.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240068 18029NY1240052 Silver On Non Std 30 Yes Excluded No Yes Yes No No Yes Yes 338.05 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240069 18029NY1240053 Silver On Non Std 26 Yes Excluded No Yes Yes No No Yes Yes 334.86 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240072 18029NY1240056 Silver Off Non Std 26 Yes Included No Yes Yes No No Yes Yes 335.58 11337.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240075 18029NY1240059 Silver Off Non Std 30 No Included No Yes Yes No No Yes Yes 338.79 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240077 18029NY1240061 Silver Off Non Std 30 No Excluded No Yes Yes No No Yes Yes 338.05 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240078 18029NY1240062 Silver Off Non Std 26 No Included No Yes Yes No No Yes Yes 335.58 282.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240145 N/A Silver Off Non Std 26 No Excluded No Yes Yes No No No No 377.59 524.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240146 N/A Silver Off Non Std 30 Yes Included No Yes Yes No No No No 382.03 998.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240147 N/A Silver Off Non Std 30 Yes Excluded No Yes Yes No No No No 381.19 0.00



IHBC 47034 NDPD-131469299 Small Group 18029NY1240150 N/A Silver Off Non Std 30 No Included No Yes Yes No No No No 382.03 35.00











IHBC 47034 NDPD-131469299 Small Group 18029NY1240185 N/A Silver Off Std 26 No Excluded No Yes Yes No No No No 375.40 12.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240186 N/A Silver Off Std 30 Yes Included No Yes Yes No No No No 379.82 111.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240187 N/A Silver Off Std 30 Yes Excluded No Yes Yes No No No No 378.99 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240188 N/A Silver Off Std 26 Yes Excluded No Yes Yes No No No No 375.40 141.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240189 N/A Silver Off Std 26 Yes Included No Yes Yes No No No No 376.22 12302.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240190 N/A Silver Off Std 30 No Excluded No Yes Yes No No No No 378.99 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240191 N/A Silver Off Std 30 No Included No Yes Yes No No No No 379.82 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240192 N/A Silver Off Std 26 No Included No Yes Yes No No No No 376.22 279.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240193 N/A Silver On Non Std 26 No Excluded No Yes Yes No No No Yes 359.27 54.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240194 N/A Silver On Non Std 30 Yes Included No Yes Yes No No No Yes 363.50 1025.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240195 N/A Silver On Non Std 30 Yes Excluded No Yes Yes No No No Yes 362.71 0.00




IHBC 47034 NDPD-131469299 Small Group 18029NY1240199 N/A Silver On Non Std 30 No Included No Yes Yes No No No Yes 363.50 9.00


















IHBC 47034 NDPD-131469299 Small Group 18029NY1240129 N/A Silver On Non Std 26 No Excluded No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240130 N/A Silver On Non Std 30 Yes Included No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240131 N/A Silver On Non Std 30 Yes Excluded No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240132 N/A Silver On Non Std 26 Yes Excluded No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240133 N/A Silver On Non Std 26 Yes Included No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240134 N/A Silver On Non Std 30 No Excluded No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240135 N/A Silver On Non Std 30 No Included No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240136 N/A Silver On Non Std 26 No Included No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170065 N/A Platinum On Non Std 26 No Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170066 N/A Platinum On Non Std 30 Yes Included No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170067 N/A Platinum On Non Std 30 Yes Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170068 N/A Platinum On Non Std 26 Yes Excluded No Yes Yes No No No No N/A 0.00








10.Limiting Child

Age? (26 or 30)



no)

12. Family


13. Pediatric

Dental Coverage

Included? (yes, no)

14. Out of Network

Benefits? (yes, no)

15. Includes


EHB? (yes, no)

16. Healthy New

York (yes, no)

17. Child-Only

Plan (yes, no)


19. HSA Plan (yes,















IHBC 47034 NDPD-131469299 Small Group 18029NY1170069 N/A Platinum On Non Std 26 Yes Included No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170070 N/A Platinum On Non Std 30 No Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170071 N/A Platinum On Non Std 30 No Included No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1170072 N/A Platinum On Non Std 26 No Included No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1270033 N/A Bronze Off Non Std 26 No Excluded No Yes Yes No No No Yes 666.42 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1270035 N/A Bronze Off Non Std 30 Yes Included No Yes Yes No No No Yes 674.28 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1270036 N/A Bronze Off Non Std 30 Yes Excluded No Yes Yes No No No Yes 672.81 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1270037 N/A Bronze Off Non Std 26 Yes Excluded No Yes Yes No No No Yes 666.42 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1270040 N/A Bronze Off Non Std 26 Yes Included No Yes Yes No No No Yes 667.88 20.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1270043 N/A Bronze Off Non Std 30 No Included No Yes Yes No No No Yes 674.28 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1270045 N/A Bronze Off Non Std 30 No Excluded No Yes Yes No No No Yes 672.81 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1270046 N/A Bronze Off Non Std 26 No Included No Yes Yes No No No Yes 667.88 3.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300001 N/A Bronze On Std 26 No Excluded No Yes Yes No No No No 300.99 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300003 N/A Bronze On Std 30 Yes Included No Yes Yes No No No No 304.53 39.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300004 N/A Bronze On Std 30 Yes Excluded No Yes Yes No No No No 303.86 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300005 N/A Bronze On Std 26 Yes Excluded No Yes Yes No No No No 300.99 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300008 N/A Bronze On Std 26 Yes Included No Yes Yes No No No No 301.65 619.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300011 N/A Bronze On Std 30 No Included No Yes Yes No No No No 304.53 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300013 N/A Bronze On Std 30 No Excluded No Yes Yes No No No No 303.86 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300014 N/A Bronze On Std 26 No Included No Yes Yes No No No No 301.65 105.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300097 18029NY1300049 Bronze Off Non Std 26 No Excluded No Yes Yes No No No Yes 297.05 48.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300099 18029NY1300051 Bronze Off Non Std 30 Yes Included No Yes Yes No No No Yes 300.53 431.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300100 18029NY1300052 Bronze Off Non Std 30 Yes Excluded No Yes Yes No No No Yes 299.88 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300101 18029NY1300053 Bronze Off Non Std 26 Yes Excluded No Yes Yes No No No Yes 297.05 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300104 18029NY1300056 Bronze Off Non Std 26 Yes Included No Yes Yes No No No Yes 297.70 22468.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300107 18029NY1300059 Bronze Off Non Std 30 No Included No Yes Yes No No No Yes 300.53 11.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300109 18029NY1300061 Bronze Off Non Std 30 No Excluded No Yes Yes No No No Yes 299.88 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300110 18029NY1300062 Bronze Off Non Std 26 No Included No Yes Yes No No No Yes 297.70 808.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300113 N/A Bronze Off Non Std 26 No Excluded No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300114 N/A Bronze Off Non Std 30 Yes Included No Yes Yes No No No Yes N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300115 N/A Bronze Off Non Std 30 Yes Excluded No Yes Yes No No No Yes N/A 0.00




IHBC 47034 NDPD-131469299 Small Group 18029NY1300119 N/A Bronze Off Non Std 30 No Included No Yes Yes No No No Yes N/A 0.00










IHBC 47034 NDPD-131469299 Small Group 18029NY1300145 N/A Bronze Off Std 26 No Excluded No Yes Yes No No No No 300.99 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300146 N/A Bronze Off Std 30 Yes Included No Yes Yes No No No No 304.53 6.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300147 N/A Bronze Off Std 30 Yes Excluded No Yes Yes No No No No 303.86 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300148 N/A Bronze Off Std 26 Yes Excluded No Yes Yes No No No No 300.99 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300149 N/A Bronze Off Std 26 Yes Included No Yes Yes No No No No 301.65 3232.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300150 N/A Bronze Off Std 30 No Excluded No Yes Yes No No No No 303.86 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300151 N/A Bronze Off Std 30 No Included No Yes Yes No No No No 304.53 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300152 N/A Bronze Off Std 26 No Included No Yes Yes No No No No 301.65 329.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1410001 N/A Platinum Off Non Std 26 No Excluded No Yes Yes No No No No 1136.94 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1410002 N/A Platinum Off Non Std 30 Yes Included No Yes Yes No No No No 1150.38 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1410003 N/A Platinum Off Non Std 30 Yes Excluded No Yes Yes No No No No 1147.85 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1410004 N/A Platinum Off Non Std 26 Yes Excluded No Yes Yes No No No No 1136.94 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1410005 N/A Platinum Off Non Std 26 Yes Included No Yes Yes No No No No 1139.42 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1410006 N/A Platinum Off Non Std 30 No Excluded No Yes Yes No No No No 1147.85 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1410007 N/A Platinum Off Non Std 30 No Included No Yes Yes No No No No 1150.38 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1410008 N/A Platinum Off Non Std 26 No Included No Yes Yes No No No No 1139.42 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1200051 N/A Gold Off Non Std 30 Yes Excluded No Yes Yes No No No No N/A 0.00


IHBC 47034 NDPD-131469299 Small Group 18029NY1200062 N/A Gold Off Non Std 26 No Excluded No Yes Yes No No No No N/A 0.00




IHBC 47034 NDPD-131469299 Small Group 18029NY1240083 N/A Silver On Non Std 30 Yes Excluded No Yes Yes No No No No N/A 0.00


IHBC 47034 NDPD-131469299 Small Group 18029NY1240094 N/A Silver On Non Std 26 No Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240104 N/A Silver Off Non Std 26 Yes Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1240110 N/A Silver Off Non Std 26 No Excluded No Yes Yes No No No No N/A 0.00








IHBC 47034 NDPD-131469299 Small Group 18029NY1250014 N/A Silver On Non Std 26 No Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1270024 N/A Bronze Off Non Std 26 Yes Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300040 N/A Bronze On Non Std 26 Yes Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300065 18029NY1300017 Bronze On Non Std 26 No Excluded No Yes Yes No No Yes No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300067 18029NY1300019 Bronze On Non Std 30 Yes Included No Yes Yes No No Yes No N/A 99.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300068 18029NY1300020 Bronze On Non Std 30 Yes Excluded No Yes Yes No No Yes No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300069 18029NY1300021 Bronze On Non Std 26 Yes Excluded No Yes Yes No No Yes No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300072 18029NY1300024 Bronze On Non Std 26 Yes Included No Yes Yes No No Yes No N/A 2108.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300075 18029NY1300027 Bronze On Non Std 30 No Included No Yes Yes No No Yes No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300077 18029NY1300029 Bronze On Non Std 30 No Excluded No Yes Yes No No Yes No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300078 18029NY1300030 Bronze On Non Std 26 No Included No Yes Yes No No Yes No N/A 286.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300088 N/A Bronze Off Non Std 26 Yes Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300137 N/A Bronze On Non Std 26 No Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300138 N/A Bronze On Non Std 30 Yes Included No Yes Yes No No No No N/A 0.00



IHBC 47034 NDPD-131469299 Small Group 18029NY1300141 N/A Bronze On Non Std 26 Yes Included No Yes Yes No No No No N/A 460.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300142 N/A Bronze On Non Std 30 No Included No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300143 N/A Bronze On Non Std 30 No Excluded No Yes Yes No No No No N/A 0.00

IHBC 47034 NDPD-131469299 Small Group 18029NY1300144 N/A Bronze On Non Std 26 No Included No Yes Yes No No No No N/A 4.00


Region 6 - 2016 MMs (Syracuse)

Region 7 - 2016 MMs (Utica)

Region 8 - 2016 MMs (Long

Island)Region 1 - 2017 Rate (Albany)
























Island)

Region 1 - 2018 Members as of

3/31/2018 (Albany)


3/31/2018 (Buffalo)

Region 3 - 2018 Members as of 3/31/2018 (Mid-

Hudson)

Region 4 - 2018 Members as of 3/31/2018 (New

York)

554.30 0.00 632.56 0.00

560.35 60.00 639.47 6.00

559.21 0.00 638.18 0.00

554.30 0.00 632.56 0.00

555.41 2162.00 633.83 130.00

560.35 0.00 639.47 0.00

559.21 0.00 638.18 0.00

555.41 269.00 633.83 26.00

554.84 0.00 634.82 0.00

549.97 0.00 629.23 0.00

551.09 459.00 630.50 33.00

554.84 0.00 634.82 0.00

555.98 0.00 636.10 0.00

551.09 129.00 630.50 10.00

549.97 0.00 629.23 0.00

555.98 8.00 636.10 0.00

549.38 3195.00 629.05 212.00

555.38 7689.00 635.92 592.00

554.24 0.00 634.65 0.00

549.38 401.00 629.05 27.00

550.49 151106.00 630.32 12074.00

555.38 513.00 635.92 5.00

554.24 0.00 634.65 0.00

550.49 3297.00 630.32 255.00

512.66 0.00 570.78 0.00

518.22 495.00 576.95 212.00

517.17 0.00 575.80 0.00

512.66 0.00 570.78 0.00

513.68 8975.00 571.92 815.00

518.22 68.00 576.95 0.00

517.17 0.00 575.80 0.00

513.68 278.00 571.92 18.00

527.39 3.00 583.27 3.00

533.12 78.00 589.59 0.00

532.06 0.00 588.40 0.00

527.39 0.00 583.27 0.00

528.45 2238.00 584.45 185.00

533.12 0.00 589.59 0.00

532.06 0.00 588.40 0.00

528.45 153.00 584.45 8.00

554.30 12.00 632.56 1.00

560.35 536.00 639.47 66.00

559.21 0.00 638.18 0.00

554.30 0.00 632.56 0.00

555.41 26623.00 633.83 2278.00

559.21 0.00 638.18 0.00

560.35 1.00 639.47 1.00

555.41 2011.00 633.83 33.00

486.31 0.00 549.55 0.00

491.57 127.00 555.46 7.00

490.57 0.00 554.37 0.00

486.31 0.00 549.55 0.00

487.29 808.00 550.64 76.00

491.57 0.00 555.46 0.00

490.57 0.00 554.37 0.00

487.29 306.00 550.64 14.00

485.69 162.00 525.31 16.00

490.93 1074.00 530.94 79.00

489.95 0.00 529.90 0.00

485.69 31.00 525.31 2.00

486.66 47015.00 526.36 3825.00

490.93 0.00 530.94 0.00

489.95 0.00 529.90 0.00

486.66 1121.00 526.36 102.00

456.78 0.00 492.39 0.00

461.68 254.00 497.64 16.00

460.77 0.00 496.65 0.00

456.78 0.00 492.39 0.00

457.69 3570.00 493.35 302.00

461.68 84.00 497.64 0.00

460.77 0.00 496.65 0.00

457.69 310.00 493.35 17.00

434.36 10.00 487.66 2.00

438.99 2442.00 492.86 164.00

438.14 0.00 491.89 0.00

434.36 85.00 487.66 6.00

435.24 39109.00 488.63 3439.00

438.99 0.00 492.86 0.00

438.14 0.00 491.89 0.00

435.24 1862.00 488.63 94.00

486.31 0.00 549.55 0.00

491.57 134.00 555.46 30.00

490.57 0.00 554.37 0.00

486.31 0.00 549.55 0.00

487.29 8469.00 550.64 760.00

490.57 0.00 554.37 0.00

491.57 0.00 555.46 3.00

487.29 2246.00 550.64 178.00

434.19 0.00 504.53 0.00

438.81 406.00 509.92 146.00

437.95 0.00 508.91 0.00

434.19 0.00 504.53 0.00

435.05 12775.00 505.53 1201.00

437.95 0.00 508.91 0.00

438.81 0.00 509.92 0.00

435.05 1561.00 505.53 163.00

467.96 0.00 519.90 0.00

472.99 66.00 525.48 11.00

472.05 0.00 524.43 0.00

467.96 0.00 519.90 0.00

468.89 5854.00 520.94 352.00

472.05 0.00 524.43 0.00

472.99 0.00 525.48 0.00

468.89 0.00 520.94 3.00

387.69 0.00 440.47 0.00

391.76 354.00 445.12 35.00

391.01 0.00 444.25 0.00

387.69 0.00 440.47 0.00

388.44 12716.00 441.34 1180.00

391.01 0.00 444.25 0.00

391.76 0.00 445.12 0.00

388.44 54.00 441.34 4.00

489.63 0.00 517.38 0.00

2018 MEMBERS (per DF2017 PREMIUM RATES 2017 MEMBER MONTHS 2018 PREMIUM RATES





























Island)


3/31/2018 (Albany)


3/31/2018 (Buffalo)


Hudson)


York)


494.91 0.00 522.92 0.00

493.91 0.00 521.90 0.00

489.63 0.00 517.38 0.00

490.61 746.00 518.41 75.00

494.91 0.00 522.92 0.00

493.91 0.00 521.90 0.00

490.61 60.00 518.41 5.00

826.25 0.00 715.22 0.00

835.52 0.00 723.11 0.00

833.78 0.00 721.63 0.00

826.25 0.00 715.22 0.00

827.96 214.00 716.68 10.00

835.52 0.00 723.11 0.00

833.78 0.00 721.63 0.00

827.96 7.00 716.68 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

423.60 0.00 473.33 0.00

428.09 62.00 478.35 6.00

427.25 0.00 477.41 0.00

423.60 0.00 473.33 0.00

424.43 1456.00 474.25 75.00

428.09 0.00 478.35 0.00

427.25 0.00 477.41 0.00

424.43 133.00 474.25 5.00

386.35 0.00 428.23 0.00

390.42 195.00 432.71 25.00

389.66 0.00 431.87 0.00

386.35 0.00 428.23 0.00

387.11 18921.00 429.06 1428.00

390.42 0.00 432.71 0.00

389.66 0.00 431.87 0.00

387.11 97.00 429.06 7.00

377.13 0.00 413.87 0.00

381.09 597.00 418.18 32.00

380.35 0.00 417.38 0.00

377.13 0.00 413.87 0.00

377.87 10495.00 414.67 832.00

381.09 0.00 418.18 0.00

380.35 0.00 417.38 0.00

377.87 699.00 414.67 33.00

422.66 711.00 463.78 32.00

427.13 1320.00 468.69 169.00

426.29 0.00 467.78 0.00

422.66 0.00 463.78 0.00

423.49 58864.00 464.68 3959.00

427.13 0.00 468.69 0.00

426.29 0.00 467.78 0.00

423.49 2159.00 464.68 134.00

415.90 0.00 429.42 0.00

420.32 24.00 433.93 5.00

419.49 0.00 433.07 0.00

415.90 0.00 429.42 0.00

416.71 1700.00 430.26 201.00

420.32 0.00 433.93 0.00

419.49 0.00 433.07 0.00

416.71 75.00 430.26 26.00

423.60 135.00 473.33 11.00

428.09 213.00 478.35 16.00

427.25 0.00 477.41 0.00

423.60 0.00 473.33 0.00

424.43 16439.00 474.25 1110.00

427.25 0.00 477.41 0.00

428.09 0.00 478.35 0.00

424.43 234.00 474.25 20.00

392.06 349.00 441.75 34.00

396.19 2178.00 446.40 208.00

395.42 0.00 445.53 0.00

392.06 0.00 441.75 0.00

392.82 44380.00 442.60 5236.00

395.42 0.00 445.53 0.00

396.19 37.00 446.40 10.00

392.82 3003.00 442.60 206.00

407.60 0.00 456.34 0.00

411.92 0.00 461.16 0.00

411.11 0.00 460.26 0.00

407.60 0.00 456.34 0.00

408.39 638.00 457.23 66.00

411.92 0.00 461.16 0.00

411.11 0.00 460.26 0.00

408.39 24.00 457.23 2.00

692.59 0.00 648.17 0.00

700.29 0.00 655.27 0.00

698.85 0.00 653.94 0.00

692.59 0.00 648.17 0.00

694.03 59.00 649.50 14.00

700.29 0.00 655.27 0.00

698.85 0.00 653.94 0.00

694.03 7.00 649.50 2.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00





























Island)


3/31/2018 (Albany)


3/31/2018 (Buffalo)


Hudson)


York)


N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

577.57 0.00 566.86 0.00

583.90 0.00 573.00 0.00

582.72 0.00 571.83 0.00

577.57 0.00 566.86 0.00

578.75 62.00 567.99 5.00

583.90 0.00 573.00 0.00

582.72 0.00 571.83 0.00

578.75 1.00 567.99 0.00

331.31 0.00 381.35 0.00

334.73 97.00 385.29 5.00

334.09 0.00 384.54 0.00

331.31 0.00 381.35 0.00

331.94 525.00 382.07 38.00

334.73 0.00 385.29 0.00

334.09 0.00 384.54 0.00

331.94 128.00 382.07 12.00

327.50 53.00 372.71 8.00

330.85 440.00 376.54 46.00

330.23 0.00 375.82 0.00

327.50 0.00 372.71 0.00

328.11 23757.00 373.42 1647.00

330.85 0.00 376.54 0.00

330.23 0.00 375.82 0.00

328.11 1153.00 373.42 88.00

310.61 40.00 359.04 2.00

313.78 109.00 362.70 10.00

313.18 212.00 362.02 0.00

310.61 0.00 359.04 0.00

311.19 4886.00 359.71 810.00

313.18 0.00 362.02 0.00

313.78 0.00 362.70 0.00

311.19 50.00 359.71 7.00

N/A 0.00 387.59 0.00

N/A 0.00 391.61 0.00

N/A 0.00 390.86 0.00

N/A 0.00 387.59 0.00

N/A 0.00 388.34 39.00

N/A 0.00 390.86 0.00

N/A 0.00 391.61 0.00

N/A 0.00 388.34 4.00

331.31 0.00 381.35 0.00

334.73 56.00 385.29 4.00

334.09 0.00 384.54 0.00

331.31 0.00 381.35 0.00

331.94 5360.00 382.07 378.00

334.09 0.00 384.54 0.00

334.73 0.00 385.29 0.00

331.94 225.00 382.07 9.00

1037.69 0.00 942.76 0.00

1049.48 0.00 953.36 0.00

1047.27 0.00 951.37 0.00

1037.69 0.00 942.76 0.00

1039.87 4.00 944.73 4.00

1047.27 0.00 951.37 0.00

1049.48 0.00 953.36 0.00

1039.87 0.00 944.73 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00

N/A 0.00 N/A 0.00



3/31/2018 (Rochester)


3/31/2018 (Syracuse)


3/31/2018 (Utica)


3/31/2018 (Long Island)

Region 1 - 2019 Rate (Albany)








Island)


3/31/2018 (Albany)


3/31/2018 (Buffalo)


Hudson)


York)






3/31/2018 (Utica)




3/31/2018 (Albany)


3/31/2018 (Buffalo)


Hudson)


York)






3/31/2018 (Utica)



N/A 0.00 0.00

N/A 0.00 6.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 51.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 8.00

637.74 0.00 0.00

632.19 0.00 0.00

633.46 33.00 9.00

637.74 0.00 0.00

639.02 0.00 0.00

633.46 10.00 2.00

632.19 0.00 0.00

639.02 0.00 0.00

631.98 212.00 16.00

638.82 592.00 145.00

637.53 0.00 0.00

631.98 27.00 0.00

633.26 12074.00 3597.00

638.82 5.00 0.00

637.53 0.00 0.00

633.26 255.00 69.00

N/A 0.00 0.00

N/A 0.00 8.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 208.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

586.37 3.00 0.00

592.65 0.00 0.00

591.47 0.00 0.00

586.37 0.00 0.00

587.54 185.00 53.00

592.65 0.00 0.00

591.47 0.00 0.00

587.54 8.00 5.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 522.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 12.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 25.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 4.00

557.78 16.00 0.00

563.72 79.00 23.00

562.61 0.00 0.00

557.78 2.00 2.00

558.88 3825.00 1235.00

563.72 0.00 0.00

562.61 0.00 0.00

558.88 102.00 12.00

519.81 0.00 0.00

525.30 16.00 0.00

524.27 0.00 0.00

519.81 0.00 0.00

520.82 302.00 108.00

525.30 0.00 0.00

524.27 0.00 0.00

520.82 17.00 1.00

N/A 0.00 0.00

N/A 0.00 32.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 1139.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 79.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 264.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 89.00

525.64 0.00 0.00

531.22 146.00 0.00

530.19 0.00 0.00

525.64 0.00 0.00

526.68 1201.00 206.00

530.19 0.00 0.00

531.22 0.00 0.00

526.68 163.00 22.00

537.29 0.00 0.00

543.01 11.00 5.00

541.94 0.00 0.00

537.29 0.00 0.00

538.36 352.00 70.00

541.94 0.00 0.00

543.01 0.00 0.00

538.36 3.00 3.00

467.61 0.00 0.00

472.48 35.00 11.00

471.57 0.00 0.00

467.61 0.00 0.00

468.51 1180.00 331.00

471.57 0.00 0.00

472.48 0.00 0.00

468.51 4.00 4.00

532.23 0.00 0.00

FS Membership Survey) 2019 PREMIUM RATES2018 MEMBERS (Should be consistent with DFS Membership Survey) ‐ Only those members currently enrolled in 2018 plans that will continue to be offered in 2019

2018 MEMBERS ‐ Only those members currently enrolled in 2018 plans Including plans that will be discontinued in 2019 ***** Columns CD ‐ CK apply to SMALL GROUP ONLY *****







3/31/2018 (Utica)











Island)


3/31/2018 (Albany)


3/31/2018 (Buffalo)


Hudson)


York)






3/31/2018 (Utica)




3/31/2018 (Albany)


3/31/2018 (Buffalo)


Hudson)


York)






3/31/2018 (Utica)





537.88 0.00 0.00

536.84 0.00 0.00

532.23 0.00 0.00

533.28 75.00 6.00

537.88 0.00 0.00

536.84 0.00 0.00

533.28 5.00 0.00

771.46 0.00 0.00

779.95 0.00 0.00

778.36 0.00 0.00

771.46 0.00 0.00

773.03 10.00 1.00

779.95 0.00 0.00

778.36 0.00 0.00

773.03 0.00 0.00

524.27 0.00 0.00

529.82 0.00 0.00

528.78 0.00 0.00

524.27 0.00 0.00

525.30 0.00 0.00

528.78 0.00 0.00

529.82 0.00 0.00

525.30 0.00 0.00

510.72 0.00 0.00

516.11 0.00 0.00

515.09 0.00 0.00

510.72 0.00 0.00

511.72 0.00 0.00

515.09 0.00 0.00

516.11 0.00 0.00

511.72 0.00 0.00

506.46 0.00 0.00

511.79 6.00 0.00

510.80 0.00 0.00

506.46 0.00 0.00

507.44 75.00 32.00

511.79 0.00 0.00

510.80 0.00 0.00

507.44 5.00 2.00

446.32 0.00 0.00

450.94 25.00 5.00

450.08 0.00 0.00

446.32 0.00 0.00

447.18 1428.00 454.00

450.94 0.00 0.00

450.08 0.00 0.00

447.18 7.00 4.00

430.39 0.00 0.00

434.83 32.00 18.00

434.00 0.00 0.00

430.39 0.00 0.00

431.22 832.00 320.00

434.83 0.00 0.00

434.00 0.00 0.00

431.22 33.00 9.00

481.35 32.00 1.00

486.40 169.00 30.00

485.47 0.00 0.00

481.35 0.00 0.00

482.30 3959.00 1226.00

486.40 0.00 0.00

485.47 0.00 0.00

482.30 134.00 0.00

466.68 0.00 0.00

471.55 5.00 0.00

470.64 0.00 0.00

466.68 0.00 0.00

467.58 201.00 126.00

471.55 0.00 0.00

470.64 0.00 0.00

467.58 26.00 21.00

506.46 11.00 0.00

511.79 16.00 0.00

510.80 0.00 0.00

506.46 0.00 0.00

507.44 1110.00 140.00

510.80 0.00 0.00

511.79 0.00 0.00

507.44 20.00 0.00

465.76 34.00 0.00

470.63 208.00 32.00

469.71 0.00 0.00

465.76 0.00 0.00

466.67 5236.00 924.00

469.71 0.00 0.00

470.63 10.00 0.00

466.67 206.00 56.00

466.54 0.00 0.00

471.39 0.00 0.00

470.49 0.00 0.00

466.54 0.00 0.00

467.43 66.00 21.00

471.39 0.00 0.00

470.49 0.00 0.00

467.43 2.00 2.00

681.54 0.00 0.00

688.96 0.00 0.00

687.57 0.00 0.00

681.54 0.00 0.00

682.92 14.00 0.00

688.96 0.00 0.00

687.57 0.00 0.00

682.92 2.00 0.00

432.20 0.00 0.00

436.66 0.00 0.00

435.82 0.00 0.00

432.20 0.00 0.00

433.02 0.00 0.00

435.82 0.00 0.00

436.66 0.00 0.00

433.02 0.00 0.00

599.72 0.00 0.00

606.17 0.00 0.00

604.97 0.00 0.00

599.72 0.00 0.00







3/31/2018 (Utica)











Island)


3/31/2018 (Albany)


3/31/2018 (Buffalo)


Hudson)


York)






3/31/2018 (Utica)




3/31/2018 (Albany)


3/31/2018 (Buffalo)


Hudson)


York)






3/31/2018 (Utica)





600.92 0.00 0.00

604.97 0.00 0.00

606.17 0.00 0.00

600.92 0.00 0.00

621.42 0.00 0.00

628.13 0.00 0.00

626.87 0.00 0.00

621.42 0.00 0.00

622.67 5.00 0.00

628.13 0.00 0.00

626.87 0.00 0.00

622.67 0.00 0.00

409.70 0.00 0.00

413.90 5.00 0.00

413.11 0.00 0.00

409.70 0.00 0.00

410.48 38.00 15.00

413.90 0.00 0.00

413.11 0.00 0.00

410.48 12.00 1.00

409.33 8.00 0.00

413.53 46.00 20.00

412.74 0.00 0.00

409.33 0.00 0.00

410.12 1647.00 334.00

413.53 0.00 0.00

412.74 0.00 0.00

410.12 88.00 9.00

406.44 2.00 0.00

410.60 10.00 6.00

409.81 0.00 0.00

406.44 0.00 0.00

407.20 810.00 138.00

409.81 0.00 0.00

410.60 0.00 0.00

407.20 7.00 2.00

426.06 0.00 0.00

430.45 0.00 0.00

429.64 0.00 0.00

426.06 0.00 0.00

426.89 39.00 39.00

429.64 0.00 0.00

430.45 0.00 0.00

426.89 4.00 4.00

409.70 0.00 0.00

413.90 4.00 1.00

413.11 0.00 0.00

409.70 0.00 0.00

410.48 378.00 76.00

413.11 0.00 0.00

413.90 0.00 0.00

410.48 9.00 8.00

992.60 0.00 0.00

1003.71 0.00 0.00

1001.63 0.00 0.00

992.60 0.00 0.00

994.65 4.00 0.00

1001.63 0.00 0.00

1003.71 0.00 0.00

994.65 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00

N/A 0.00 0.00


EXHIBIT 25: SUMMARY OF EXPERIENCE BY MATERIAL RATING VARIABLES


SERFF Number: NDPD-131469299Market Segment: Small Group

1 The purpose of this Exhibit is to provide a summary of experience broken out by material rating variables.2 Please complete the grey boxes below.3 In instances where explicit factors are not used, the implied factors should be provided.4 Rating Tier factors are as prescribed by DFS.5 "Paid Claims" amounts for all years should be the actual amounts paid through 2/28/2018.6 "Member Months" and "Earned Premiums" should be on a calendar year basis.7 For purposes of the "Special Enrollment Period Analysis", "Special Enrollment" means any enrollment that is outside of "Open Enrollment".8 In instances below where 2018 experience is being requested, any relevant data should be provided as of 2/28/2018.

MAJOR VARIATIONS FROM THE BASE PLAN

Adjustment Factors

Plan Description2016 Adjustment

Factor 2017 Adjustment



Factor With coverage through Age 26 Only 1.0000 1.0000 1.0000 1.0000

With Family Planning Coverage 1.0000 1.0000 1.0000 1.0000With Domestic Partner Coverage 1.0000 1.0000 1.0000 1.0000

Without Pediatric Dental Coverage 1.0000 1.0000 1.0000 1.0000With coverage through Age 29 Only 1.0096 1.0096 1.0096 1.0096Without Family Planning Coverage 0.9978 0.9978 0.9978 0.9978

Without Domestic Partner Coverage 1.0000 1.0000 1.0000 1.0000With Pediatric Dental Coverage N/A N/A N/A N/A

Member Months

Limiting Age Family Planning Dom Partner Dental 2016 Member Months 2017 Member Months 2018 Members (Should

match DFS Survey) 26 No No No 4,488 4,670 321 26 No No Yes N/A N/A N/A 26 No Yes No 561 517 35 26 No Yes Yes N/A N/A N/A 26 Yes No No 14,806 21,652 1,485 26 Yes No Yes N/A N/A N/A 26 Yes Yes No 449,749 510,385 42,577 26 Yes Yes Yes N/A N/A N/A 29 No No No 7 - - 29 No No Yes N/A N/A N/A 29 No Yes No - 212 - 29 No Yes Yes N/A N/A N/A 29 Yes No No 876 703 19 29 Yes No Yes N/A N/A N/A 29 Yes Yes No 14,218 19,014 1,890 29 Yes Yes Yes N/A N/A N/A

Earned Premium

Limiting Age Family Planning Dom Partner Dental 2016 Earned Premium 2017 Earned Premium 2018 Earned Premium 26 No No No $ 1,934,369.48 $ 2,046,690.31 $ 303,715.82 26 No No Yes N/A N/A N/A 26 No Yes No $ 249,959.46 $ 239,636.48 $ 35,498.62 26 No Yes Yes N/A N/A N/A 26 Yes No No $ 5,317,579.44 $ 8,232,994.97 $ 1,220,873.90 26 Yes No Yes N/A N/A N/A 26 Yes Yes No $ 163,418,721.72 $ 195,549,262.80 $ 35,969,739.32 26 Yes Yes Yes N/A N/A N/A 29 No No No $ 2,495.45 $ - $ - 29 No No Yes N/A N/A N/A 29 No Yes No $ - $ 52,661.16 $ - 29 No Yes Yes N/A N/A N/A 29 Yes No No $ 306,438.55 $ 259,817.59 $ 13,002.41 29 Yes No Yes N/A N/A N/A 29 Yes Yes No $ 5,021,426.94 $ 6,988,484.76 $ 1,494,041.95 29 Yes Yes Yes N/A N/A N/A

Paid Claims

Limiting Age Family Planning Dom Partner Dental 2016 Paid Claims 2017 Paid Claims 2018 Paid Claims 26 No No No $ 1,974,303.73 $ 1,617,182.61 $ 206,244.70 26 No No Yes N/A N/A N/A 26 No Yes No $ 323,872.73 $ 386,781.60 $ 43,631.10 26 No Yes Yes N/A N/A N/A 26 Yes No No $ 4,876,470.78 $ 7,788,406.58 $ 858,564.10 26 Yes No Yes N/A N/A N/A 26 Yes Yes No $ 154,543,182.64 $ 186,753,365.23 $ 25,214,674.69 26 Yes Yes Yes N/A N/A N/A 29 No No No $ 8,194.07 $ - $ - 29 No No Yes N/A N/A N/A 29 No Yes No $ - $ 8,603.80 $ - 29 No Yes Yes N/A N/A N/A 29 Yes No No $ 494,684.92 $ 420,450.67 $ 6,841.53 29 Yes No Yes N/A N/A N/A 29 Yes Yes No $ 5,055,447.65 $ 7,687,383.70 $ 1,126,591.74 29 Yes Yes Yes N/A N/A N/A


RATING REGIONS

Adjustment Factors

Region 2016 Rating Region Factor2017 Rating Region

Factor2018 Rating Region

Factor2019 Rating Region

Factor1 - Albany Area N/A N/A N/A N/A 2 - Buffalo Area 1.0000 1.0000 1.0000 1.0000

3 - Mid-Hudson Area N/A N/A N/A N/A 4 - NYC Area N/A N/A N/A N/A

5 - Rochester Area N/A N/A N/A N/A 6 - Syracuse Area N/A N/A N/A N/A

7 - Utica/Watertown Area N/A N/A N/A N/A 8 - Long Island Area N/A N/A N/A N/A

Member Months

Region 2016 Member Months 2017 Member Months2018 Members (Should

match DFS Survey) 2019 Expected

Members 1 - Albany Area N/A N/A N/A N/A 2 - Buffalo Area 484,705 557,153 46,327 38,534

3 - Mid-Hudson Area N/A N/A N/A N/A 4 - NYC Area N/A N/A N/A N/A

5 - Rochester Area N/A N/A N/A N/A 6 - Syracuse Area N/A N/A N/A N/A

7 - Utica/Watertown Area N/A N/A N/A N/A 8 - Long Island Area N/A N/A N/A N/A

Earned Premium

Region 2016 Earned Premium 2017 Earned Premium 2018 Earned Premium1 - Albany Area N/A N/A N/A 2 - Buffalo Area $ 176,250,991.04 $ 213,369,548.07 $ 39,036,872.02

3 - Mid-Hudson Area N/A N/A N/A 4 - NYC Area N/A N/A N/A

5 - Rochester Area N/A N/A N/A 6 - Syracuse Area N/A N/A N/A

7 - Utica/Watertown Area N/A N/A N/A 8 - Long Island Area N/A N/A N/A

Paid Claims

Region 2016 Paid Claims 2017 Paid Claims 2018 Paid Claims1 - Albany Area N/A N/A N/A 2 - Buffalo Area $ 167,276,156.53 $ 204,662,174.19 $ 27,456,547.86

3 - Mid-Hudson Area N/A N/A N/A 4 - NYC Area N/A N/A N/A

5 - Rochester Area N/A N/A N/A 6 - Syracuse Area N/A N/A N/A

7 - Utica/Watertown Area N/A N/A N/A 8 - Long Island Area N/A N/A N/A


RATING TIERS

Adjustment Factors

Rating Tier 2016 Rating Tier Factor 2017 Rating Tier Factor 2018 Rating Tier Factor 2019 Rating Tier FactorIndividual 1.000 1.000 1.000 1.000

Individual + Spouse 2.000 2.000 2.000 2.000Individual + Children 1.700 1.700 1.700 1.700

Family 2.850 2.850 2.850 2.850Child Only 0.412 0.412 0.412 0.412

Member Months

Rating Tier 2016 Member Months 2017 Member Months2018 Members (Should

match DFS Survey) 2019 Expected

Members Individual 151,617 177,791 15,095 12,552

Individual + Spouse 69,613 83,670 7,291 6,081 Individual + Children 42,956 50,060 4,196 3,482

Family 220,519 245,632 19,745 16,419 Child Only N/A N/A N/A N/A

Earned Premium

Rating Tier 2016 Earned Premium 2017 Earned Premium 2018 Earned PremiumIndividual $ 66,058,210.63 $ 80,686,496.66 $ 14,916,695.50

Individual + Spouse $ 30,704,814.14 $ 38,804,010.79 $ 7,420,745.20 Individual + Children $ 11,992,157.18 $ 14,652,498.17 $ 2,723,585.68

Family $ 67,495,809.09 $ 79,226,542.45 $ 13,975,845.64 Child Only N/A N/A N/A

Paid Claims

Rating Tier 2016 Paid Claims 2017 Paid Claims 2018 Paid ClaimsIndividual $ 56,695,520.89 $ 72,820,867.31 $ 10,278,197.65

Individual + Spouse $ 35,841,548.52 $ 46,779,185.08 $ 6,261,199.05 Individual + Children $ 14,360,160.74 $ 12,790,403.00 $ 1,500,069.56

Family $ 60,378,926.38 $ 72,271,718.80 $ 9,417,081.60 Child Only N/A N/A N/A


SPECIAL ENROLLMENT PERIOD ANALYSIS

Member Months

Enrollee Type 2016 Member Months 2017 Member MonthsSEP Enrollees

Non-SEP EnrolleesAll Enrollees

Earned Premium

Enrollee Type 2016 Earned Premium 2017 Earned PremiumSEP Enrollees


Claims (Note that Paid claims should reflect actual amounts paid through 2/28/2018 and incurred claims should be equal to the Paid Claims plus the reserve component for the specific year that is allocated to these specific enrollees)

Enrollee Type 2016 Paid Claims 2016 Incurred Claims 2017 Paid Claims 2017 Incurred ClaimsSEP Enrollees



Small Group Plan Subscriber – 2019 Proposed Premium Rates Letter [Date] Subscriber Number: [Subscriber Name] [Address 1] [Address 2] [City State Zip] Re: Notice of Proposed Premium Rate Change for 2019 Product Name and Health Insurance Oversight System (HIOS) identification number Dear [Subscriber Name]: Independent Health Benefits Corporation is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes Please note that the final approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. The premium amounts listed in the enclosed chart are for the health plan you are currently enrolled in. Why We Are Requesting a Rate Change The requested increase is due in our view to continuing rising medical and pharmacy costs. DFS’s view of these matters may differ. 30‐Day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Independent Health for additional information at:

Independent Health Servicing Department Attn: Proposed Rates Independent Health 511 Farber Lakes Drive Buffalo, NY 14221 (716) 631‐8701 or 1‐800‐501‐3439 [email protected]

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows:

DFS Website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service:

NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY 12257

If you choose to submit comments to DFS, please include the following information:

1. The name of your insurer 2. The name of your plan 3. Whether you have individual or group coverage 4. Your HIOS identification number, which is [Insert the HIOS ID #]

Written comments submitted to DFS may be posted on the DFS website without your personal information. Plain English Summary of Rate Change We have prepared a plain‐English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Independent Health website: www.independenthealth.com (click on the “2019 Proposed Rates” link in the “Help Center” section). DFS website: https://myportal.dfs.ny.gov/web/prior‐approval/independent‐health‐benefits‐corporation

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date. Sincerely,

Paula Kuczkowski Director, Servicing

Premium Rate Comparison This chart compares your current plan’s 2018 monthly premium rate and the proposed 2019 monthly premium rate. These rates do not reflect any contribution that your employer may make toward your plan premium.

[PLAN NAME]

2018 Monthly Premium

Proposed Monthly Premium on your 2019 Effective Date (pending DFS approval)

Premium Rate

Small Group Plan Employer – 2019 Proposed Premium Rates Letter [Date] Group Number: [Contact Name] [Group Name] [Address] [City State Zip] Re: Notice of Proposed Premium Rate Change for 2019 Product Name and Health Insurance Oversight System (HIOS) identification number Dear [Contact Name]: Independent Health Benefits Corporation is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes Please note that the final approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features that your group policyholder selects on renewal. The premium amounts listed in the enclosed chart are for the health plan your group currently offers. Why We Are Requesting a Rate Change The requested increase is due in our view to continuing rising medical and pharmacy costs. DFS’s view of these matters may differ. 30‐Day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Independent Health for additional information at:










Notifying Your Employees Please communicate this information to each individual plan subscriber who receives coverage through this group policy. We have enclosed a sample notice that you can provide to your plan subscribers, along with the enclosed rate chart. We recommend that you also provide any additional information that may help your plan subscribers better understand their health coverage costs, such as expected changes in employee contribution levels. If you wish to have Independent Health notify your plan subscribers directly, please let us know by calling our Sales Department at (716) 631‐5392 or 1‐800‐453‐1910, Monday through Friday from 8 a.m. to 5 p.m., within three (3) days of receipt of this notice. Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date. Sincerely,

Richard Argentieri Vice President, Sales

Premium Rate Comparison The chart below includes your current group plan’s 2018 monthly premium rates and the proposed 2019 monthly premium rates. These rates do not reflect any employer contribution or any additional cost for COBRA administration, if applicable.

[GROUP NAME]

[PLAN NAME]

2018 Monthly Premium

Proposed Monthly Premium on your 2019 Effective Date (pending DFS approval)

Single

Employee and Child

Employee and Spouse

Family

Notice of 2019 Proposed Premium Rate Change Independent Health Benefits Corporation is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes Please note that the final approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. The premium amounts listed in the accompanying chart are for the health plan you are currently enrolled in. Why We Are Requesting a Rate Change The requested increase is due in our view to continuing rising medical and pharmacy costs. DFS’s view of these matters may differ. 30‐Day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Independent Health for additional information at:










Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date.

Company Name: IHBC

NAIC Code: 47034SERFF Tracking #: NDPD-131469299Market Segment: Small Group

A. Insurer Information: Not-For-Profit - 43 Not-for-Profit 47034Company submitting the rate filing request Company Type Org. Type Company NAIC Code

B. Contact Person: Rate filing contact person name, title Contact phone number Contact Email address

C. Actuarial Contact (If different from above): Actuary name, title Actuary phone number Actuary Email address

D. New Rate Information: NDPD-131469299New rate applicability period New rate effective date SERFF Tracking Number

E.

F. Provide responses for the following questions:1.

2.

3.

4.

5.

6

Notes:(1)

(2)

As mentioned in the checklist, this combined non-grandfathered product rate adjustment and form/rate filing can only include minor contract revisions, such as due to changes in the model language, changes to the catastrophic plan due to change in out of pocket maximum, changes to the standard plan designs. Substantial changes need to be submitted as a separate rate and form filing (e.g., a new plan design not replacing an existing plan design, contract language changes not just due to changes in the model language).§3231(e)(1) and §4308(c) of the New York Insurance Law require that the initial notice to policyholders/subscribers/contract holders be sent on or before the date the rate adjustment filing is submitted to the Department ofFinancial Services.

Have all the required exhibits been submitted with this rate filing? If any exhibit is not applicable, has an explanation been provided why such exhibit is not applicable?

YesDid the company submit a "Prior Approval Pre-filing" containing a draft of the initial notice and a draft of the narrative summary and numerical summary associated with this rate filing? Indicate Yes or No, and if Yes, please provide the SERFF number of the pre-filing.

Yes, NDPD-13146931745 CFR 154.215 requires companies to submit rate filings via SERFF and HIOS simultaneously. Did the company submit this rate filing in HIOS? If yes, please provide the HIOS submission tracking number.

No

Have the initial notices already been sent to all policyholders and contract holders affected by this rate submission? Indicate what cohort of policyholders received the initial notice and the mailing date when the initial notice was sent. See note (2).

No

1/1/2019 - 12/31/2019 1/1/2019

Market segment included in filing (e.g., Small Group (including Healthy NY Small Group), Individual - only one market segment per rate adjustment filing): Small Group

ResponseDoes this filing include any revision to contract language that is not yet approved? See note (1). If yes, provide a brief description of the contract language changes included in this filing.

NoAre there any rate filings submitted and not yet approved that if approved would affect the rate tables included in this rate filing? If yes, mention these filings on Exhibit 16.

No

EXHIBIT 11: GENERAL INFORMATION


511 Farber Lakes Drive, Buffalo, NY 14221

Company mailing address


Actuarial Memorandum and Certification

May 14, 2018 1


Small Group Market

2019


May 14, 2018 2

Development of Index Rate and Premium Rates: Overview The purpose of this memorandum is to present and provide support for key assumptions in the

development of the proposed rates for Independent Health Benefits Corporation’s (IHBC’s) Small Group

Market products to be offered for sale both on and off the New York State Small Business Health

Options Programs (SHOP).

IHBC is the Article 43 licensee of Independent Health, and all Independent Health’s 2019 Small Group

products will be sold through this entity. All product offerings on-and-off the exchange are part of the

same risk pool and rates were developed using IHBC’s current small group experience, following the

methodology outlined below.

• Experience Period / Risk Pool Merging

2019 rate projections were developed based on incurred claims for IHBC’s Affordable Care Act

(ACA)-compliant Small Group market products for the 12-month experience period from January

1, 2017 through December 31, 2017, with completion factors based on claims run-out through

February 28, 2018. In 2017, the Healthy NY Gold plan commenced being sold under IHBC, with

groups switching to the IHBC platform upon renewal throughout the year. Prior to 2017, the

Healthy NY Gold plan was sold under Independent Health’s Article 44 licensee, Independent

Health Association (IHA). The portion of the IHA Healthy NY Gold plan data that carried over

into 2017 due to rolling renewal dates was also included in the risk pool. No Regulation 146 or

Stop-Loss Reimbursement Pool monies were included in the experience data. Claims data for

groups that were classified as small in 2017 but have since changed classification to large were

removed from the risk pool. Claims data for groups that were classified as large in 2017 but

have since changed classification to small were included in the risk pool. Claims data for groups

that were enrolled in 2017 but have since terminated their coverage with Independent Health in

2018 were also removed from the risk pool. These adjustments were made to provide the best

estimate of the expected membership and claims experience for the Small Group risk pool in

2019.

• Trend

Utilization and unit cost trends were applied to project experience forward from the base period

of calendar year 2017 to the rate period.

• Risk Adjustment

The projected 2019 claims experience was adjusted to reflect the anticipated impact of the

Federal Risk Adjustment Transfer Formula, using final results from 2014, 2015, and 2016, as well

as forecasted 2017 results to project risk adjustment for 2019. An adjustment was applied to

the projected 2019 risk adjustment to account for regulatory changes promulgated by CMS. No

adjustment was applied to account for regulatory changes from DFS. The CMS adjustment as

well as the methodology used to project risk adjustment to 2019 are described in greater detail

under the Risk Adjustment section of the Supporting Details for Key Assumptions below.


May 14, 2018 3

• Benefit Adjustment

Product-specific pricing was developed using the ratio of each product’s Pricing Actuarial Value

(AV) to the average Pricing AV inherent in the experience period data. This ratio includes the

relative impact of induced demand.

• Administrative Expenses and Profit Margin

An 87.8% medical loss ratio (prior to additional taxes and fees) was used in the development of

the premium rates. The additional taxes and fees include the Risk Adjustment User Fee and a

fraction of the Health Insurance Provider’s Fee (formerly known as the Health Insurance Tax, or

HIT), only to cover the portion of benefit plans that carry over into 2020 since the tax will not

apply to 2019 calendar year premium. There is no fee included for the Patient-Centered

Outcomes Research Initiative (PCORI) since this initiative concluded with plan years ending

9/30/2018. The final expected loss ratio, after including all the above-noted taxes and fees, is

87.6%, well above the minimum 82% Small Group loss ratio required by New York State.

• Conversion / Step-Up Factor

A conversion factor to step up the projected PMPM revenue requirement to the Single

Subscriber rate was developed based on observed contract distributions and sizes from IHBC’s

2017 Small Group market block of business. Census tier relativities as prescribed by DFS were

used in the development of this factor, as well as in establishing the premium rates for each tier.

The new conversion factor has decreased from that which was used in 2018, due to modest

changes in contract mix and family size.

• Area Factors

All of IHBC’s products fall under the Buffalo rating region (Region 2).


May 14, 2018 4

Supporting Details for Key Assumptions • Claim Trend Rates

As described in more detail below, IHBC utilizes a cost-model approach to premium rating, with

claim costs mapped to more than 70 types of medical benefit categories, using proprietary in-

house claims grouping algorithms developed by the company.

Monthly “utilization per 1,000” statistics were calculated for each medical benefit category

encompassing the three-year period from January 2015 through December 2017 (with two

months of claims runout past the end of this period). Both moving average and least-squares

techniques were employed in developing trend picks from these data points. Consideration was

also given to key trend drivers such as benefit richness (both overall and by specific benefit

category), population demographics and morbidity, and macro-economic factors where

appropriate.

Average charge trends by category were developed based on anticipated (or, in most cases,

already contracted) changes to provider fees. The unit cost increases used in the 2019 pricing

are the result of a detailed analysis by IHBC’s Network Contract Management (NCM) function,

which collaborated closely with Actuarial Services to translate the results of their contract

analysis into the actuarial cost and trend model categories. The unit cost trends used in the

2019 pricing also include a factor to account for increases in case mix for facility claims.

To estimate prescription drug trends, prescription drug data from Independent Health’s Small

Group Market membership from January 2015 through December 2017 were analyzed (in a

similar fashion to the medical trend analysis described above) to determine recent prescription

drug trends as well as to project future trends into 2019. Actuarial staff also worked closely with

Independent Health’s Pharmacy function in making several key adjustments to the data:

• Patent expirations of brand drugs: More than thirty drugs are expected to lose patent

protections in 2018 and 2019 which will affect 2019 utilization patterns. IHBC Actuarial

Services developed an in-house model, vetted by IHBC’s Pharmacy area and tested

against historical data, to analyze the impact on utilization and unit cost patterns

projected to the rate period resulting from patent expirations. The results of this model

were used to adjust the projected rate period experience of patent expirations.

• Specialty drugs: Working with IHBC’s Pharmacy function and using publicly available

information regarding upcoming FDA approvals for orphan drugs and breakthrough

therapies, IHBC Actuarial Services developed a list of specialty drugs in the pipeline with

expected costs and availability dates. Adjustments to the projected rate period

experience were made based on the expected utilization, unit costs, and timing of

release of these new drugs.

• Changing statins to preventive: Due to the change in the USPSTF preventive list, low-to-

moderate dose statins are now considered preventive for adults aged 40 to 75 with no

history of cardiovascular disease (CVD), one or more CVD risk factors, and a calculated


May 14, 2018 5

10-year CVD event risk of 10% or greater. This change results in a shift of these low-cost,

highly-utilized drugs from the Rx category of service to the Medical Rx subcategory of the

Professional category of service. The impact is a higher utilization trend and lower unit

cost trend for the Professional category of service.

The resulting average “first dollar” or “allowed” annual trend assumptions by type of service

category are summarized below.

The category of Non-Claims includes items such as Capitation, Care Coordination/Management,

Provider Incentives, Software/Licensing Fees, Wellness, and GME. Starting in 2019, IHBC will

resume its reinsurance coverage with an Independent Health Association (IHBC’s parent

company) wholly-owned subsidiary, Mason Insurance Company, based in Bermuda. The

business proposal has been approved by the Bermuda Monetary Authority. The expected net

impact of this reinsurance contract (premium – expected recoveries) has been included in the

Non-Claims amount for 2019. The reason for resuming this coverage is to mitigate the risk

associated with high cost claims which have increased in both frequency and severity recently.

The Other trend factor is to account for expected changes to COB from 2017 to 2019.

• Administrative Expense / Contribution to Surplus

IHBC is using an 12.2% administrative expense load (before ACA taxes and fees), which includes

a 2% component for risk margin / contribution to surplus. Allocations of administrative expense

by component are detailed in Exhibit 19, and were completed in a manner consistent with

IHBC’s most recent audited financial statements. IHBC is using 100% of the investment income

allocated to this line to partially offset administrative costs.

Premium rates also reflect provisions for various ACA taxes and fees, as follows.

▪ Risk Adjustment User Fee: $0.15 PMPM

▪ Health Insurer Tax (HIT) 0.16% (of Premium)

Category Unit Cost Utilization Mix Other Trend Factor

Inpatient 1.052 1.029 0.998 0.999 1.079

Outpatient 1.044 1.027 0.972 0.999 1.041

Professional 1.020 1.063 0.992 0.999 1.075

Other Medical 1.048 1.006 0.992 0.999 1.046

Rx 1.075 1.010 1.000 1.000 1.086

Non-Claims 1.042 1.000 1.000 1.000 1.042

Total Trend Factor = 1.070


May 14, 2018 6

• Adjustments to Actuarial Values

AV Metal Values were determined by entering product benefit configurations into the most

recent AV Calculator developed by the Department of Health and Human Services (HHS).

• Conversion Factors

As noted earlier, IHBC’s Small Group conversion factor has decreased from that which was used

in developing the 2018 premium rates. The following table outlines the derivation of this factor,

based on Small Group Market membership for 2017 and using the standardized tier ratios

required by DFS.

• Standardized Rating Regions

IHBC is filing these rates solely for the Buffalo rating region (Region 2).

• Determination of AV Pricing Values

As noted above, IHBC utilizes a cost-model approach in developing its premium rating. The basis

for the cost models is a proprietary claims-grouping algorithm developed in-house by IHBC,

which uses claims data to report utilization and unit cost statistics for more than 70 benefit

categories, such as Inpatient Medical, Emergency Room, and Advanced Radiology.

Once utilization and unit cost statistics by benefit category are established, impacts of member

cost-sharing in the form of copays and coinsurance can be modeled by entering these

parameters and observing the impact on unit costs. Note that no “induced demand” or

“utilization deterrent” impacts are included at the benefit category level. For example, a benefit

category with a utilization rate of 200 visits per 1,000, having an average cost of $800 per visit,

will see an expected PMPM cost of $13.33 (200 x 800 / 12000). If a $50 copay is introduced, the

impact will be modeled by reducing the unit cost from $800 to $750, yielding a new expected

PMPM cost of $12.50.

Rather than benefit-level application, induced demand is incorporated globally, using the scale

of induced demand factors by metal level as published in the HHS Notice of Benefit and

Payment Parameters for 2014. These demand factors were first renormalized to reflect the

average metal tier inherent in the experience data (approx. Gold) and then applied uniformly

across all cost models falling under a given metal tier. The induced demand factors used in

Small GroupContract

Distribution Contract Size Rate Ratio Step-Up

Single 59.5% 1.00 1.00

Employee + Child(ren) 6.2% 2.70 1.70

Employee + Spouse 14.0% 2.00 2.00

Single + Spouse + Child(ren) 20.3% 4.05 2.85

Total 1.86 1.56 1.196


May 14, 2018 7

pricing 2019 plans are reported on line 31 of the plan-level adjustment factor section in exhibit

18.

Impacts of other plan features such as deductibles and out-of-pocket maximums were modeled

using continuance tables constructed from IHBC’s own Small Group market experience. These

continuance tables were developed according to the “single risk pool” dictum and were

calibrated to each product based on the expected allowed costs applicable to that product.

• Federal Risk Adjustment

In determining the expected impact of the Federal Risk Adjustment Transfer Payment for 2019,

we relied primarily on the following sources:

▪ 2014 final risk adjustment transfers, as published by CMS. The total transfer

represented an additional receivable of approximately 6% of premium.

▪ 2015 final risk adjustment transfers, as published by CMS. The original total transfer

represented an additional receivable of approximately 4.5% of premium prior to

adjusting for the insolvency of Health Republic. After adjustment, the transfer amount

represented approximately 3% of premium. Since this adjustment appears to only be a

one-time event, the original transfer amount was used for trending purposes.

▪ 2016 final risk adjustment transfers, as published by CMS. The total transfer

represented an additional receivable of approximately 2.9% of premium.

▪ 2017 projected risk adjustment transfers determined using an internally-developed

model. The total transfer determined by this model represents an additional receivable

of approximately 2.3% of premium. The results from this model were adjusted based on

how the 2016 final results compared to model results produced last year. The impact of

this adjustment increased the receivable amount to about 3.2% of premium. These

results were also compared to the preliminary results released by CMS. Absent

knowledge as to whether the preliminary results from CMS reflect other NYS insurers

submitting supplemental files to the EDGE Server, the preliminary results from CMS

could be misleading. In 2015, the preliminary results showed IHBC being a payer into

the pool of approximately 5-6% of premium, while the final results showed IHBC being a

receiver from the pool of approximately 4.5% of premium. Because of the large

variance observed in the past, the internally-developed projections were used to project

to 2019 in lieu of using the preliminary results from CMS. Under Section II. Description

of Data in the Interim Summary Report on Risk Adjustment for the 2017 Benefit Year

published by CMS, CMS provides reasons why the interim results may differ significantly

from the final results that are anticipated to be released at the end of June 2018. CMS

also states that, “… smaller issuers may experience a wide degree of variation, given the

impact larger issuers have on transfers within a state and market.” (Available at:

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-

Programs/Downloads/Interim-RA-Report-BY2017.pdf)

▪ The underlying risk adjustment data was analyzed to gain a better understanding of the

differential transfers generated by metal tier.

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/Downloads/Interim-RA-Report-BY2017.pdf

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/Downloads/Interim-RA-Report-BY2017.pdf


May 14, 2018 8

▪ Analysis of changes in IHBC demographics and product mix during the period from 2014

through Feb 2018, both in absolute terms and relative to statewide averages, as

extracted from the DFS Exchange Enrollment Reports.

▪ Other factors that are simply not known or cannot be quantified at this point include:

(a) Impact of increased maturity (both on the part of carriers as well as CMS) in

understanding the risk adjustment data submission process beyond 2014. This

includes any potential differential impact of enhanced coding initiatives by carriers

via supplemental diagnosis submissions to the EDGE Server.

(b) Potential changes to the Small Group Market composition; e.g. changes in eligibility

definition and migrations to the other markets (Large/Individual/Self-Funded)

(c) Impact of changes to the risk adjustment transfer formula; e.g. the addition of Rx

claims to determine RXCs and durational factors

▪ An adjustment was applied to the best estimate projection to reflect:

▪ 14% CMS adjustment per the 2019 Notice of Benefit and Payment Parameters

▪ Adjustments were not applied to reflect the 26% DFS adjustment per the emergency

amendment to Regulation 146 to create a Statewide Market Stabilization pool, per DFS

instruction. While DFS retains full discretion to reinstitute this emergency amendment

to Regulation 146, premium rates developed and described in this memorandum may

be insufficient should DFS decide to reinstitute this adjustment and not allow issuers to

adjust their premium rates accordingly.

▪ Taking the above into consideration, IHBC is projecting a net receivable of

approximately 2% of revenue in its 2019 Small Group premium rate application.

▪ The details of the development of this assumption are provided in the Risk Adjustment

Assumption Development Excel file submitted with this premium rate application.

• Out-of-Network Benefits

Adjustment factors used in pricing different out-of-network benefit levels among the various

products were developed based on data from IHBC’s Small Group book of business. This data

was analyzed to establish relativities between in-network and out-of-network utilization and

unit costs, as well as to develop out-of-network continuance tables.

• Partial Year Normalization

A market wide adjustment factor was included in row 24 of exhibit 18 to normalize partial

benefit year data contained within calendar year 2017 for high-deductible health plans. High-

deductible health plans follow a unique claims pattern as members begin the year paying most

of the up-front costs due to the deductible. As the benefit year progresses, the percent of

members fulfilling their deductible increases thereby shifting the liability from members to

insurer while the deterrent effect of the deductible decreases. When a benefit year is truncated

due to using a calendar year for the base period claims data, modifications are needed to adjust

claims back to the average. Since adjustments are made in both directions (increasing claims

experience for the beginning of benefit plan years and decreasing claims experience for the end

of benefit plan years), the overall impact of this factor is less than 1%.


May 14, 2018 9

• Significant Premium Differences between Plans in the Same Metal Tier

Additional adjustments to utilization and unit cost have been made to Independent Health’s

Choice Plus products, which utilize a network constructed around the Catholic Health System

(CHS) and Catholic Medical Partners. These adjustments reflect several unique characteristics of

this network:

▪ CHS made available significant discounts for inpatient and outpatient rates at CHS facilities

for this product

▪ CMP/CHS has been a partner in risk-sharing models for all insured populations with

Independent Health for many years with positive results versus plan average. These results

were incorporated into the pricing of this product.

▪ Concurrent review at all CHS facilities that begins when the member presents at the

Emergency Room

▪ Integrated Care between PCP and Specialists

▪ CMP employs hundreds of care managers embedded in the physician offices to help

coordinate appropriate care

• Quarterly Trend

Premium rates were calculated for the first quarter of 2019, to which a quarterly trend was

applied to develop rates for the final three quarters of the year. For 2019, IHBC is using a

quarterly rate trend of 2.0% per quarter. This is the same trend used in developing the 2018

Small Group premium rates.

• Standardized Premium

The methodology used to develop the standardized premium in Exhibit 17 for a rolling rate

structure as well as a numerical example are included in the supporting exhibit, Standardized

Premium – Rolling.

• Plans Being Terminated

The following Small Group plans will be retired prior to the effective date:

- Standard Platinum

- Standard Gold

- iDirect Platinum HSAQ

- iDirect Gold HSAQ


May 14, 2018 10

ACTUARIAL CERTIFICATION

I, John Salciccioli, Director of Actuarial Services for Independent Health, am a Member of the

American Academy of Actuaries, and meet its qualification standards to provide this certification

under 11NYCRR 52.40(a)(1) of New York Laws.

I certify that to the best of my knowledge:

• This filing is in compliance with applicable Federal and New York State laws and regulations.

• This filing complies with the appropriate Actuarial Standards of Practice (ASOP’s) including

but not limited to:

▪ ASOP No. 5, Incurred Health and Disability Claims

▪ ASOP No. 8, Regulatory Filings for Health Plan Entities

▪ ASOP No. 12, Risk Classification

▪ ASOP No. 23, Data Quality

▪ ASOP No. 25, Credibility Procedures Applicable to Accident and Health, Group Term

Life, and Property/Casualty Coverages

▪ ASOP No. 26, Compliance with Statutory and Regulatory Requirements for the

Actuarial Certification of Small Employer Health Benefit Plans

▪ ASOP No. 41, Actuarial Communications

▪ ASOP No. 42, Determining Health and Disability Liabilities other than Liabilities for

Incurred Claims

▪ ASOP No. 45, The Use of Health Status Based Risk Adjustment Methodologies

▪ ASOP No. 50, Determining Actuarial Value and Minimum Value under the ACA

• These rates have been established to produce an expected loss ratio that meets the

minimum requirement of the State of New York.

• The benefits are reasonable in relation to the premiums charged.

• The rates are not unreasonable, excessive, inadequate, or unfairly discriminatory.

• The Index Rates in the Unified Rate Review Template and Exhibit 18 which accompany this

filing were developed in accordance with federal regulations.

• Actuarial Values were determined using the Federal Actuarial Value Calculator.

• The percent of premium representing Essential Health Benefits, and upon which Advance

Premium Tax Credits are based, was calculated in accordance with Actuarial Standards of

Practice.

The Unified Rate Review Template and Exhibit 18 do not represent the process used by IHBC to

develop the rates as described in this actuarial memorandum. Rather, they represent information

required by Federal and State regulation to be provided in support of the review of rate increases,

for certification of qualified health plans and for certification that the index rate is developed in

accordance with Federal and State regulation and only adjusted by the allowable modifiers.


May 14, 2018 11

__________________________________________________

John Salciccioli, ASA, MAAA

Director of Actuarial Services, Commercial Business



May 14, 2018 12

Attachment A: Quality Improvement / Cost Containment Programs Expense Type (per Supplemental Health Care Exhibit)

Improve Health Outcomes

• Nurse line: provides members with access to health solutions

• PCIP: Primary Care Coordination

• Teladoc: provides members with remote access to physicians

Activities to Prevent Hospital Readmissions

• Case management: coordination of patient services

• Care Transitions: program to prepare members with the knowledge and skills to

avoid readmissions to hospitals

Improve Patient Safety and Reduce Medical Errors

• SIU (Special Investigations Unit): recoveries through claims investigations

Wellness & Health Promotion Activities

• Nutrition: program to encourage healthier eating habits

• Limeade / Health Extras: program to encourage healthier, more active lifestyles

• Smoking Cessation: programs to help members quit smoking

HIT Expenses for Health Care Quality Improvements

• P2 Collaborative of WNY: data aggregation

• WNYCIE: Clinical Information Exchange

• HEALTHeNET: optimizes delivery patient information to the healthcarecommunity by leveraging shared infrastructure, technology andintellectual capital.

Note that the above items are considered part of claims expense for Federal MLR purposes; however,

certain of these activities, such as case management and SIU, are considered part of administrative

expense under New York State regulations.

Standardized Premium Calculation

Rolling Rate Example

A1 2015 1Q single approved rate $533.85




B1

Premium change (before benefit &

conversion factor chg) (2015-2016) -6.52%

B2

Premium change (after benefit &

conversion factor chg) (2015-2016) -6.52%

C1 2016 1Q single approved rate $499.03




D1


conversion factor chg) (2016-2017) 10.31%

D2



E1 2017 1Q single approved rate $550.49




F1



F2



G1 2015 Quarterly Premium Trend 2.00%




Group Single Contracts Renewal

Month

2017 Annualized

Actual Earned

Premiums

H1 A- 1Q renewal group renew January 1 January $6,605.88

H2 B- 2Q renewal group renew April 1 April $6,548.16

H3 C- 3Q renewal group renew July 1 July $6,486.90

H4 D- 4Q renewal group renew October 1 October $6,422.10

To calculate the standardized premium in Exhibit 17 for a rolling rate structure, the actual earned

premium for each earned month for every combination of employer group and product is reduced back

to a January level by removing the impact of the quarterly rolling rate trend, where applicable. This

January premium is then adjusted to 2018 by applying the product rate changes implemented from the

premium year to January 2018. The premium is then converted to a 4th quarter 2018 rate by applying

the three 2018 quarterly rolling rate trends.

Step 1: Calculate 2016 and 2017 January Single Premium Rate

2016 Contract

Premium

2016

Premium Rate

Paid in 2017

2016 Premium

Rate Paid in 2017

Adjusted to 1Q

2016 Level

I1 Group A =N/A N/A N/A

I2 Group B =C2/(1+G2) $506.47 $498.99

I3 Group C =C3/((1+G2)^2) $514.02 $498.94

I4 Group D =C4/((1+G2)^3) $521.69 $498.90

2017 Contract

Premium

2017

Premium Rate

Paid in 2017

2017 Premium

Rate Paid in 2017

Adjusted to 1Q

2017 Level

J1 Group A =E1 $550.49 $550.49

J2 Group B =E2/(1+G3) $558.75 $550.49

J3 Group C =E3/((1+G3)^2) $567.13 $550.49

J4 Group D =E4/((1+G3)^3) $575.63 $550.48

Step 2: Calculate the total of 2016/2017 contract premiums from Step1

2016 Contract

Total Premium

# of months

in 2017 at

2016

premium rate

Total Premium

Paid prior

to 2017 renewal

adjusted to 1Q

2016 Level

K1 Group A =N/A 0 N/A

K2 Group B =I2 * 3 3 $1,496.96

K3 Group C =I3 * 6 6 $2,993.64

K4 Group D =I4 * 9 9 $4,490.11

2017 Contract

Total Premium

# of months

in 2017 at

2017

premium rate

Total Premium

Paid after 2017

renewal adjusted

to 1Q 2017 Level

L1 Group A =J1 * 12 12 $6,605.88

L2 Group B =J2 * 9 9 $4,954.43

L3 Group C =J3 * 6 6 $3,302.95

L4 Group D =J4 * 3 3 $1,651.45

Step 3: Calculate the Standardized Premium (2018 1Q) Single Premium

Annual Premium

adjusted

to 1Q 2018 level

M1 Group A $7,563.84

M2 Group B $7,563.70

M3 Group C $7,563.16

M4 Group D $7,562.36

Step 4: % change from 2017 Calculate the Standardized Premium (2014 4Q)

Adjusts 1Q 2018

to 4Q 2018

Level

Annual

Premium

adjusted

to 4Q 2018

level

% Change from

Earned Premium

N1 Group A =M1*((1+G4)^3) $8,026.81 21.51%

N2 Group B =M2*((1+G4)^3) $8,026.66 22.58%

N3 Group C =M3*((1+G4)^3) $8,026.09 23.73%

N4 Group D =M4*((1+G4)^3) $8,025.23 24.96%

=(K4*(1+D1) +L4)*(1+F1)

2017 Premium Adjusted to 1Q

2018 Level

=(K1*(1+D1) +L1)*(1+F1)

=(K2*(1+D1) +L2)*(1+F1)

=(K3*(1+D1) +L3)*(1+F1)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

3839

40

41

42

43

44

45

46

47

48

49

50

A B C D E F G H I J K L M N O P Q R S T U V W X Y

Ac

tioUnified Rate Review v4.3

Company Legal Name: Independent Health Benefits CorporationState: NY

HIOS Issuer ID: 18029 Market: Small Group

Effective Date of Rate Change(s): 1/1/2019

Market Level Calculations (Same for all Plans)

Section I: Experience period data

Experience Period: 1/1/2017 to 12/31/2017

Experience Period

Aggregate Amount PMPM % of Prem

Premiums (net of MLR Rebate) in Experience Period: $210,308,644 $395.17 100.00%

Incurred Claims in Experience Period $194,231,916 364.96 92.36%

Allowed Claims: $228,701,084 429.73 108.75%

Index Rate of Experience Period $422.80

Experience Period Member Months 532,197

Section II: Allowed Claims, PMPM basis

Experience Period Projection Period: 1/1/2019 to 12/31/2019 Mid-point to Mid-point, Experience to Projection: 24 months

on Actual Experience Allowed

Adj't. from Experience to

Projection Period Projections, before credibility Adjustment Credibility Manual

Benefit Category

Utilization

Description

Utilization per

1,000

Average

Cost/Service PMPM

Pop'l risk

Morbidity Other Cost Util

Utilization per

1,000

Average

Cost/Service PMPM

Utilization

per 1,000

Average

Cost/Service PMPM

Inpatient Hospital Admits 59.75 $20,150.60 $100.33 1.000 0.998 1.049 1.029 63.28 $22,135.71 $116.72 63.28 $21,990.26 $115.96

Outpatient Hospital Visits 1,849.44 503.38 77.58 1.000 0.998 1.015 1.027 1,949.67 517.17 84.03 1949.67 513.77 83.47

Professional Visits 12,671.23 131.07 138.40 1.000 0.998 1.012 1.063 14,330.43 133.97 159.98 14235.61 133.08 157.88

Other Medical Visits 606.31 288.35 14.57 1.000 0.998 1.040 1.006 613.97 311.25 15.92 750.83 309.20 19.35

Capitation Benefit Period 12,000.00 16.79 16.79 1.000 1.000 1.042 1.000 12,000.00 18.23 18.23 12000.00 18.23 18.23

Prescription Drug Prescriptions 9,313.33 105.72 82.05 1.000 1.000 1.075 1.010 9,497.63 122.23 96.75 9517.49 121.98 96.75

Total $429.73 $491.63 $491.63

After Credibility Projected Period Totals

Section III: Projected Experience: Projected Allowed Claims PMPM (w/applied credibility if applicable) 100.00% 0.00% $491.63 $227,403,612

Paid to Allowed Average Factor in Projection Period 0.825

Projected Incurred Claims, before ACA rein & Risk Adj't, PMPM $405.53 $187,580,446

Projected Risk Adjustments PMPM 8.14 3,764,789

Projected Incurred Claims, before reinsurance recoveries, net of rein prem, PMPM $397.39 $183,815,657

Projected ACA reinsurance recoveries, net of rein prem, PMPM 0.00 0

Projected Incurred Claims $397.39 $183,815,657

Administrative Expense Load 9.91% 44.80 20,720,625

Profit & Risk Load 1.58% 7.14 3,303,018

Taxes & Fees 0.58% 2.62 1,212,500

Single Risk Pool Gross Premium Avg. Rate, PMPM $451.95 $209,051,801

Index Rate for Projection Period $483.70

% increase over Experience Period 14.37%

% Increase, annualized: 6.94%

Projected Member Months 462,552

Information Not Releasable to the Public Unless Authorized by Law: This information has not been publically disclosed and may be privileged and confidential. It is for internal government use only and must not be

disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Annualized Trend

Factors

1 of 14

Action

Keyboard Product-Plan Data Collection

Company Legal Name: Independent Health Benefits Corporation State: NY

HIOS Issuer ID: 18029 Market: Small Group

Effective Date of Rate Change(s):

Product/Plan Level Calculations

Section I: General Product and Plan Information

Product

Product ID:

Metal: Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum

AV Metal Value 0.869 0.869 0.869 0.869 0.869 0.869 0.869 0.869 0.860 0.860 0.860 0.860 0.860 0.860 0.860 0.860

AV Pricing Value 0.936 0.936 0.936 0.936 0.936 0.936 0.936 0.936 0.936 0.936 0.936 0.936 0.936 0.936 0.936 0.936

Plan Category Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing

Plan Type: POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS

Plan Name FlexFit Platinum

Copay NYS OON

FlexFit Platinum

Copay NYS OON

FlexFit Platinum

Copay NYS OON

FlexFit Platinum

Copay NYS OON

FlexFit Platinum

Copay NYS OON

FlexFit Platinum

Copay NYS OON

FlexFit Platinum

Copay NYS OON

FlexFit Platinum

Copay NYS OON FlexFit Platinum FlexFit Platinum FlexFit Platinum FlexFit Platinum FlexFit Platinum FlexFit Platinum FlexFit Platinum FlexFit Platinum

Plan ID (Standard Component ID): 18029NY1170015 18029NY1170016 18029NY1170017 18029NY1170018 18029NY1170019 18029NY1170020 18029NY1170021 18029NY1170022 18029NY1170033 18029NY1170035 18029NY1170036 18029NY1170037 18029NY1170040 18029NY1170043 18029NY1170045 18029NY1170046

Exchange Plan? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Historical Rate Increase - Calendar Year - 2

Historical Rate Increase - Calendar Year - 1

Historical Rate Increase - Calendar Year 0

Effective Date of Proposed Rates 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

Rate Change % (over prior filing) 0.80% 0.81% 0.81% 0.80% 0.80% 0.81% 0.81% 0.80% 0.80% 0.79% 0.79% 0.80% 0.80% 0.79% 0.79% 0.80%

Cum'tive Rate Change % (over 12 mos prior) 0.80% 0.81% 0.81% 0.80% 0.80% 0.81% 0.81% 0.80% 0.80% 0.79% 0.79% 0.80% 0.80% 0.79% 0.79% 0.80%

Proj'd Per Rate Change % (over Exper. Period) 16.00% 16.01% 16.00% 16.00% 15.99% 16.00% 16.01% 15.99% 16.09% 16.08% 16.09% 16.09% 16.09% 16.08% 16.09% 16.09%

Product Rate Increase %

Section II: Components of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM)

Plan ID (Standard Component ID): Total 18029NY1170015 18029NY1170016 18029NY1170017 18029NY1170018 18029NY1170019 18029NY1170020 18029NY1170021 18029NY1170022 18029NY1170033 18029NY1170035 18029NY1170036 18029NY1170037 18029NY1170040 18029NY1170043 18029NY1170045 18029NY1170046

Inpatient $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Outpatient $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Professional $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Prescription Drug $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Other $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Capitation $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Administration $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Taxes & Fees $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Risk & Profit Charge $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Total Rate Increase $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Member Cost Share Increase $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Average Current Rate PMPM $438.41 $529.02 $524.36 $525.42 $529.02 $530.08 $525.42 $524.36 $530.08 $524.21 $529.93 $528.88 $524.21 $525.27 $529.93 $528.88 $525.27

Projected Member Months 462,552 0 0 411 0 0 124 0 0 2,638 7,367 0 336 150,259 62 0 3,173

Section III: Experience Period Information

Warning Alert Wsht 1 Total Plan ID (Standard Component ID): Total 18029NY1170015 18029NY1170016 18029NY1170017 18029NY1170018 18029NY1170019 18029NY1170020 18029NY1170021 18029NY1170022 18029NY1170033 18029NY1170035 18029NY1170036 18029NY1170037 18029NY1170040 18029NY1170043 18029NY1170045 18029NY1170046

Plan Adjusted Index Rate $380.30 $459.69 $455.65 $456.58 $459.69 $460.63 $456.58 $455.65 $460.63 $455.16 $460.13 $459.19 $455.16 $456.08 $460.13 $459.19 $456.08

OK 532,197 Member Months 532,197 0 0 458 0 0 129 0 8 3,195 7,544 0 359 142,305 513 0 3,249

OK ############ Total Premium (TP) $219,950,014 $0 $0 $214,492 $0 $0 $49,469 $0 $4,203 $1,489,269 $3,171,900 $0 $193,699 $67,617,250 $188,650 $0 $1,531,654

EHB Percent of TP, [see instructions] 98.42% 98.53% 98.52% 98.32% 98.53% 98.33% 98.32% 98.52% 98.33% 98.63% 98.43% 98.63% 98.63% 98.43% 98.43% 98.63% 98.43% state mandated benefits portion of TP that are other

than EHB 1.58% 1.47% 1.48% 1.68% 1.47% 1.67% 1.68% 1.48% 1.67% 1.37% 1.57% 1.37% 1.37% 1.57% 1.57% 1.37% 1.57%

Other benefits portion of TP 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

OK ############ Total Allowed Claims (TAC) $235,815,386 $0 $0 $266,415 $0 $0 $48,947 $0 $569 $1,414,597 $3,639,603 $0 $354,169 $78,859,456 $354,566 $0 $2,081,232

EHB Percent of TAC, [see instructions] 98.39% 98.53% 98.52% 98.32% 98.53% 98.33% 98.32% 98.52% 98.33% 98.63% 98.43% 98.63% 98.63% 98.43% 98.43% 98.63% 98.43% state mandated benefits portion of TAC that are

other than EHB 1.61% 1.47% 1.48% 1.68% 1.47% 1.67% 1.68% 1.48% 1.67% 1.37% 1.57% 1.37% 1.37% 1.57% 1.57% 1.37% 1.57%

Other benefits portion of TAC 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Allowed Claims which are not the issuer's obligation: $34,209,895 $0 $0 $21,143 $0 $0 $7,700 $0 $102 $113,424 $296,218 $0 $15,680 $5,891,647 $19,573 $0 $151,475Portion of above payable by HHS's funds

on behalf of insured person, in dollars $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0Portion of above payable by HHS on

behalf of insured person, as % 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% 0.00% 0.00% #DIV/0! 0.00% 0.00% 0.00% #DIV/0! 0.00%OK ############ Total Incurred claims, payable with issuer funds $201,605,491 $0 $0 $245,272 $0 $0 $41,247 $0 $467 $1,301,173 $3,343,386 $0 $338,490 $72,967,809 $334,994 $0 $1,929,756

Net Amt of Rein $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Risk Adjustment Transfer Amount $6,188,218.50 $0.00 $0.00 $13,802.32 $0.00 $0.00 $34,287.80 $0.00 $3,487.28 $65,730.63 $284,196.48 $0.00 -$16,976.30 $12,179,994.24 $104,752.89 $0.00 $180,308.69

OK 364.96$ Incurred Claims PMPM $378.82 #DIV/0! #DIV/0! $535.53 #DIV/0! #DIV/0! $319.75 #DIV/0! $58.41 $407.25 $443.18 #DIV/0! $942.87 $512.76 $653.01 #DIV/0! $593.95

OK 429.73$ Allowed Claims PMPM $443.10 #DIV/0! #DIV/0! $581.69 #DIV/0! #DIV/0! $379.44 #DIV/0! $71.18 $442.75 $482.45 #DIV/0! $986.54 $554.16 $691.16 #DIV/0! $640.58

EHB portion of Allowed Claims, PMPM $435.95 #DIV/0! #DIV/0! $571.93 #DIV/0! #DIV/0! $373.07 #DIV/0! $69.99 $436.68 $474.88 #DIV/0! $973.01 $545.45 $680.32 #DIV/0! $630.51

Section IV: Projected (12 months following effective date)

Warning Alert Wsht 1 Total Plan ID (Standard Component ID): Total 18029NY1170015 18029NY1170016 18029NY1170017 18029NY1170018 18029NY1170019 18029NY1170020 18029NY1170021 18029NY1170022 18029NY1170033 18029NY1170035 18029NY1170036 18029NY1170037 18029NY1170040 18029NY1170043 18029NY1170045 18029NY1170046

Plan Adjusted Index Rate $454.87 $533.23 $528.59 $529.65 $533.23 $534.30 $529.65 $528.59 $534.30 $528.41 $534.13 $533.05 $528.41 $529.48 $534.13 $533.05 $529.48

OK 462,552 Member Months 462,552 - - 411 - - 124 - - 2,638 7,367 - 336 150,259 62 - 3,173

OK ############ Total Premium (TP) $210,401,152 $0 $0 $217,515 $0 $0 $65,914 $0 $0 $1,394,107 $3,935,114 $0 $177,551 $79,559,178 $33,236 $0 $1,680,271

EHB Percent of TP, [see instructions] 99.80% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83%

state mandated benefits portion of TP that are other

than EHB 0.20% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17%

Other benefits portion of TP 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

OK 227,403,612 Total Allowed Claims (TAC) $227,403,612 $0 $0 $214,120 $0 $0 $64,885 $0 $0 $1,375,558 $3,841,180 $0 $175,189 $78,341,913 $32,442 $0 $1,654,563

EHB Percent of TAC, [see instructions] 99.80% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83%

state mandated benefits portion of TAC that are

other than EHB 0.20% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17%

Other benefits portion of TAC 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Allowed Claims which are not the issuer's obligation $37,863,841 $0 $0 $15,780 $0 $0 $4,782 $0 $0 $101,848 $284,406 $0 $12,971 $5,800,533 $2,402 $0 $122,506

Portion of above payable by HHS's funds

on behalf of insured person, in dollars $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0Portion of above payable by HHS on

behalf of insured person, as % 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% 0.00% #DIV/0! 0.00% 0.00% 0.00% #DIV/0! 0.00%

Total Incurred claims, payable with issuer funds $189,539,771 $0 $0 $198,340 $0 $0 $60,103 $0 $0 $1,273,710 $3,556,775 $0 $162,218 $72,541,380 $30,040 $0 $1,532,057

#DIV/0! - Net Amt of Rein $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

Risk Adjustment Transfer Amount $2,955,759 $0 $0 $33,288 $0 $0 $10,087 $0 $0 $213,848 $597,162 $0 $27,235 $12,179,276 $5,044 $0 $257,223

Incurred Claims PMPM $409.77 #DIV/0! #DIV/0! $482.96 #DIV/0! #DIV/0! $482.96 #DIV/0! #DIV/0! $482.78 $482.78 #DIV/0! $482.78 $482.78 $482.78 #DIV/0! $482.78

OK 491.63$ Allowed Claims PMPM $491.63 #DIV/0! #DIV/0! $521.38 #DIV/0! #DIV/0! $521.38 #DIV/0! #DIV/0! $521.38 $521.38 #DIV/0! $521.38 $521.38 $521.38 #DIV/0! $521.38

EHB portion of Allowed Claims, PMPM $490.66 #DIV/0! #DIV/0! $520.49 #DIV/0! #DIV/0! $520.49 #DIV/0! #DIV/0! $520.49 $520.49 #DIV/0! $520.49 $520.49 $520.49 #DIV/0! $520.49

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1/1/2019

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Platinum

18029NY117

-6.59%

10.25%

14.26%

0.80%

Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum

0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.862 0.880 0.880 0.880 0.880 0.880 0.880 0.880 0.880

0.883 0.883 0.883 0.883 0.883 0.883 0.883 0.883 0.911 0.911 0.911 0.911 0.911 0.911 0.911 0.911 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

New New New New New New New New Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated

POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS

iShare Platinum iShare Platinum iShare Platinum iShare Platinum iShare Platinum iShare Platinum iShare Platinum iShare Platinum

Choice Plus

Platinum

Choice Plus

Platinum

Choice Plus

Platinum

Choice Plus

Platinum

Choice Plus

Platinum

Choice Plus

Platinum

Choice Plus

Platinum

Choice Plus

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

18029NY1170065 18029NY1170066 18029NY1170067 18029NY1170068 18029NY1170069 18029NY1170070 18029NY1170071 18029NY1170072 18029NY1170097 18029NY1170098 18029NY1170099 18029NY1170100 18029NY1170101 18029NY1170102 18029NY1170103 18029NY1170104 18029NY1170001 18029NY1170003 18029NY1170004 18029NY1170005 18029NY1170008 18029NY1170011 18029NY1170013 18029NY1170014

Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.87% 0.86% 0.86% 0.87% 0.86% 0.86% 0.86% 0.86% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.87% 0.86% 0.86% 0.87% 0.86% 0.86% 0.86% 0.86% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00%

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 12.21% 12.19% 12.19% 12.21% 12.20% 12.19% 12.19% 12.20% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $486.06 $491.33 $490.33 $486.06 $487.04 $491.33 $490.33 $487.04 $527.13 $532.89 $531.82 $527.13 $528.19 $532.89 $531.82 $528.19

0 0 0 0 0 0 0 0 37 0 0 0 2,302 0 0 100 0 0 0 0 0 0 0 0


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $436.94 $441.69 $440.81 $436.94 $437.82 $441.69 $440.81 $437.82 $459.24 $464.25 $463.31 $459.24 $460.16 $464.25 $463.31 $460.16

0 0 0 0 0 0 0 0 3 78 0 0 2,032 0 0 153 0 60 0 0 2,139 0 0 269

$0 $0 $0 $0 $0 $0 $0 $0 $1,654 $40,784 $0 $0 $931,144 $0 $0 $62,369 $0 $19,164 $0 $0 $855,876 $0 $0 $121,866

100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.81% 98.61% 98.81% 98.81% 98.61% 98.61% 98.81% 98.61% 99.68% 98.49% 98.69% 98.68% 98.48% 98.49% 98.69% 98.48%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 1.19% 1.39% 1.19% 1.19% 1.39% 1.39% 1.19% 1.39% 0.32% 1.51% 1.31% 1.32% 1.52% 1.51% 1.31% 1.52%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $21,872 $30,358 $0 $0 $832,933 $0 $0 $58,815 $0 $14,309 $0 $0 $992,018 $0 $0 $114,937

100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.81% 98.61% 98.81% 98.81% 98.61% 98.61% 98.81% 98.61% 99.68% 98.49% 98.69% 98.68% 98.48% 98.49% 98.69% 98.48%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 1.19% 1.39% 1.19% 1.19% 1.39% 1.39% 1.19% 1.39% 0.32% 1.51% 1.31% 1.32% 1.52% 1.51% 1.31% 1.52%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $588 $8,582 $0 $0 $86,867 $0 $0 $10,073 $0 $2,444 $0 $0 $78,146 $0 $0 $12,808

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%$0 $0 $0 $0 $0 $0 $0 $0 $21,285 $21,777 $0 $0 $746,066 $0 $0 $48,742 $0 $11,865 $0 $0 $913,872 $0 $0 $102,129

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 -$15,817.42 $0.00 $0.00 $11,267.64 $0.00 $0.00 $4,371.23 $0.00 -$3,395.50 $0.00 $0.00 $47,861.44 $0.00 $0.00 -$14,239.59

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! $7,094.86 $279.19 #DIV/0! #DIV/0! $367.16 #DIV/0! #DIV/0! $318.57 #DIV/0! $197.76 #DIV/0! #DIV/0! $427.24 #DIV/0! #DIV/0! $379.66




$501.44 $506.83 $505.83 $501.44 $502.44 $505.83 $506.83 $502.44 $490.28 $495.53 $494.54 $490.28 $491.25 $495.53 $494.54 $491.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

- - - - - - - - 37 - - - 2,302 - - 100 - - - - - - - -

$0 $0 $0 $0 $0 $0 $0 $0 $18,304 $0 $0 $0 $1,131,009 $0 $0 $48,909 $0 $0 $0 $0 $0 $0 $0 $0

99.82% 99.82% 99.82% 99.82% 99.82% 99.82% 99.82% 99.82% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

0.18% 0.18% 0.18% 0.18% 0.18% 0.18% 0.18% 0.18% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $18,388 $0 $0 $0 $1,133,914 $0 $0 $49,034 $0 $0 $0 $0 $0 $0 $0 $0

99.82% 99.82% 99.82% 99.82% 99.82% 99.82% 99.82% 99.82% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

0.18% 0.18% 0.18% 0.18% 0.18% 0.18% 0.18% 0.18% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $1,832 $0 $0 $0 $112,977 $0 $0 $4,885 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

$0 $0 $0 $0 $0 $0 $0 $0 $16,556 $0 $0 $0 $1,020,937 $0 $0 $44,149 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $3,026 $0 $0 $0 $186,613 $0 $0 $8,070 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! $443.44 #DIV/0! #DIV/0! #DIV/0! $443.44 #DIV/0! #DIV/0! $443.44 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!



Platinum

18029NY117

-6.59%

10.25%

14.26%

0.80%

Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Gold Gold Gold Gold Gold Gold Gold Gold

0.869 0.869 0.869 0.869 0.869 0.869 0.869 0.869 0.880 0.880 0.880 0.880 0.880 0.880 0.880 0.880 0.770 0.770 0.770 0.770 0.770 0.770 0.770 0.770

0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.865 0.865 0.865 0.865 0.865 0.865 0.865 0.865

Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing


iDirect Platinum

HSAQ

iDirect Platinum

HSAQ

iDirect Platinum

HSAQ

iDirect Platinum

HSAQ

iDirect Platinum

HSAQ

iDirect Platinum

HSAQ

iDirect Platinum

HSAQ

iDirect Platinum

HSAQ

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

Standard

Platinum

iDirect Gold

Copay

iDirect Gold

Copay

iDirect Gold

Copay

iDirect Gold

Copay

iDirect Gold

Copay

iDirect Gold

Copay

iDirect Gold

Copay

iDirect Gold

Copay


No No No No No No No No No No No No No No No No Yes Yes Yes Yes No No No No

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

-100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% 6.54% 6.53% 6.53% 6.54% 6.53% 6.53% 6.53% 6.53%

-100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% 6.54% 6.53% 6.53% 6.54% 6.53% 6.53% 6.53% 6.53%

-100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% 15.90% 15.88% 15.89% 15.90% 15.90% 15.88% 15.89% 15.90%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$475.65 $480.79 $479.83 $475.65 $476.60 $480.79 $479.83 $476.60 $527.13 $532.89 $531.82 $527.13 $528.19 $531.82 $532.89 $528.19 $437.76 $442.45 $441.58 $437.76 $438.63 $442.45 $441.58 $438.63

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 283 1,398 0 35 67,707 0 0 1,806


$424.74 $429.35 $428.48 $424.74 $425.58 $429.35 $428.48 $425.58 $459.24 $464.25 $463.31 $459.24 $460.16 $463.31 $464.25 $460.16 $402.39 $406.74 $405.92 $402.39 $403.20 $406.74 $405.92 $403.20

0 495 0 0 8,603 0 0 266 12 536 0 0 24,134 0 1 831 162 1,074 0 31 45,416 0 0 1,109

$0 $200,364 $0 $0 $3,766,270 $34,306 $0 $129,439 $6,363 $210,610 $0 $0 $12,084,864 $0 $586 $896,749 $70,864 $428,435 $0 $13,308 $18,936,588 $0 $0 $460,605

98.60% 98.40% 98.60% 98.60% 98.40% 98.40% 98.60% 98.40% 98.68% 98.49% 98.69% 98.68% 98.48% 98.69% 98.49% 98.48% 98.58% 98.38% 98.58% 98.58% 98.38% 98.38% 98.58% 98.38%

1.40% 1.60% 1.40% 1.40% 1.60% 1.60% 1.40% 1.60% 1.32% 1.51% 1.31% 1.32% 1.52% 1.31% 1.51% 1.52% 1.42% 1.62% 1.42% 1.42% 1.62% 1.62% 1.42% 1.62%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $360,028 $0 $0 $7,062,310 $58,838 $0 $150,591 $10,628 $276,205 $0 $0 $16,159,244 $0 $1,147 $687,728 $16,621 $432,759 $0 $7,149 $17,656,628 $0 $0 $323,537

98.60% 98.40% 98.60% 98.60% 98.40% 98.40% 98.60% 98.40% 98.68% 98.49% 98.69% 98.68% 98.48% 98.69% 98.49% 98.48% 98.58% 98.38% 98.58% 98.58% 98.38% 98.38% 98.58% 98.38%

1.40% 1.60% 1.40% 1.40% 1.60% 1.60% 1.40% 1.60% 1.32% 1.51% 1.31% 1.32% 1.52% 1.31% 1.51% 1.52% 1.42% 1.62% 1.42% 1.42% 1.62% 1.62% 1.42% 1.62%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $42,595 $0 $0 $570,200 $5,004 $0 $15,002 $1,336 $21,428 $0 $0 $1,090,391 $0 $351 $78,083 $3,041 $56,601 $0 $818 $2,534,092 $0 $0 $66,646

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% 0.00% #DIV/0! 0.00% 0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% 0.00% 0.00% 0.00% #DIV/0! 0.00% 0.00% #DIV/0! #DIV/0! 0.00%$0 $317,433 $0 $0 $6,492,110 $53,834 $0 $135,589 $9,291 $254,777 $0 $0 $15,068,852 $0 $797 $609,646 $13,580 $376,159 $0 $6,331 $15,122,536 $0 $0 $256,891

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $56,175.65 $0.00 $0.00 $1,742,238.65 $4,340.42 $0.00 -$5,318.53 $994.04 $31,435.30 $0.00 $0.00 $1,525,116.38 $0.00 $0.00 $148,093.98 -$25,719.46 -$64,415.13 $0.00 $251.23 -$688,513.21 $0.00 $0.00 -$18,842.29

#DIV/0! $641.28 #DIV/0! #DIV/0! $754.63 #DIV/0! #DIV/0! $509.73 $774.27 $475.33 #DIV/0! #DIV/0! $624.38 #DIV/0! $796.71 $733.63 $83.83 $350.24 #DIV/0! $204.21 $332.98 #DIV/0! #DIV/0! $231.64

#DIV/0! $727.33 #DIV/0! #DIV/0! $820.91 #DIV/0! #DIV/0! $566.13 $885.63 $515.31 #DIV/0! #DIV/0! $669.56 #DIV/0! $1,147.32 $827.59 $102.60 $402.94 #DIV/0! $230.60 $388.78 #DIV/0! #DIV/0! $291.74

#DIV/0! $715.73 #DIV/0! #DIV/0! $807.79 #DIV/0! #DIV/0! $557.08 $873.97 $507.51 #DIV/0! #DIV/0! $659.41 #DIV/0! $1,129.95 $815.04 $101.14 $396.43 #DIV/0! $227.33 $382.48 #DIV/0! #DIV/0! $287.01


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $466.37 $471.34 $470.41 $466.37 $467.29 $471.34 $470.41 $467.29

- - - - - - - - - - - - - - - - 283 1,398 - 35 67,707 - - 1,806

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $132,085 $659,116 $0 $16,511 $31,638,886 $0 $0 $843,704

100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $138,772 $685,186 $0 $17,346 $33,175,134 $0 $0 $884,670

100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $19,936 $98,435 $0 $2,492 $4,766,023 $0 $0 $127,094

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% 0.00% #DIV/0! 0.00% 0.00% #DIV/0! #DIV/0! 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $118,836 $586,750 $0 $14,854 $28,409,112 $0 $0 $757,576

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 -$96 -$473 $0 -$12 -$22,923 $0 $0 -$611

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! $419.59 $419.59 #DIV/0! $419.59 $419.59 #DIV/0! #DIV/0! $419.59



Platinum

18029NY117

-6.59%

10.25%

14.26%

0.80% 5.92%

Gold

18029NY120

-5.64%

7.28%

11.18%

Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold

0.764 0.764 0.764 0.764 0.764 0.764 0.764 0.764 0.769 0.769 0.769 0.769 0.769 0.769 0.769 0.769 0.761 0.761 0.761 0.761 0.761 0.761 0.761 0.761

0.845 0.845 0.845 0.845 0.845 0.845 0.845 0.845 0.807 0.807 0.807 0.807 0.807 0.807 0.807 0.807 0.784 0.784 0.784 0.784 0.784 0.784 0.784 0.784

Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing New New New New New New New New New New New New New New New New


Choice Plus Gold Choice Plus Gold Choice Plus Gold Choice Plus Gold Choice Plus Gold Choice Plus Gold Choice Plus Gold Choice Plus Gold iShare Gold iShare Gold iShare Gold iShare Gold iShare Gold iShare Gold iShare Gold iShare Gold

iDirect Gold

Coinsurance

HSAQ

iDirect Gold

Coinsurance

HSAQ

iDirect Gold

Coinsurance

HSAQ

iDirect Gold

Coinsurance

HSAQ

iDirect Gold

Coinsurance

HSAQ

iDirect Gold

Coinsurance

HSAQ

iDirect Gold

Coinsurance

HSAQ

iDirect Gold

Coinsurance

HSAQ


Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

5.92% 5.91% 5.91% 5.92% 5.92% 5.91% 5.91% 5.92% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

5.92% 5.91% 5.91% 5.92% 5.92% 5.91% 5.91% 5.92% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

14.85% 14.83% 14.83% 14.85% 14.84% 14.83% 14.83% 14.84% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$410.33 $414.70 $413.88 $410.33 $411.13 $414.70 $413.88 $411.13 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

0 283 0 0 5,346 0 0 301 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


$378.44 $382.50 $381.75 $378.44 $379.20 $382.50 $381.75 $379.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

0 254 0 0 3,204 0 0 310 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$0 $88,966 $0 $0 $1,411,452 $26,870 $0 $125,200 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

98.80% 98.60% 98.80% 98.80% 98.60% 98.60% 98.80% 98.60% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

1.20% 1.40% 1.20% 1.20% 1.40% 1.40% 1.20% 1.40% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $40,141 $0 $0 $1,525,836 $6,671 $0 $50,736 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

98.80% 98.60% 98.80% 98.80% 98.60% 98.60% 98.80% 98.60% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

1.20% 1.40% 1.20% 1.20% 1.40% 1.40% 1.20% 1.40% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $14,942 $0 $0 $241,344 $2,978 $0 $15,154 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!$0 $25,200 $0 $0 $1,284,492 $3,693 $0 $35,582 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 -$31,320.87 $0.00 $0.00 -$264,106.76 -$9,796.32 $0.00 -$45,154.16 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

#DIV/0! $99.21 #DIV/0! #DIV/0! $400.90 #DIV/0! #DIV/0! $114.78 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!




$434.62 $439.21 $438.35 $434.62 $435.47 $439.21 $438.35 $435.47 $438.35 $442.99 $442.12 $438.35 $439.21 $442.12 $442.99 $439.21 $427.02 $431.53 $430.68 $427.02 $427.86 $430.68 $431.53 $427.86

- 283 - - 5,346 - - 301 - - - - - - - - - - - - - - - -

$0 $124,394 $0 $0 $2,327,908 $0 $0 $131,041 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79%

0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $131,070 $0 $0 $2,473,941 $0 $0 $139,262 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79%

0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $21,545 $0 $0 $406,667 $0 $0 $22,892 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

$0 $109,524 $0 $0 $2,067,275 $0 $0 $116,370 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 -$96 $0 $0 -$1,810 $0 $0 -$102 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0




5.92%

Gold

18029NY120

-5.64%

7.28%

11.18%


0.766 0.766 0.766 0.766 0.766 0.766 0.766 0.766 0.770 0.770 0.770 0.770 0.770 0.770 0.770 0.770 0.798 0.798 0.798 0.798 0.798 0.798 0.798 0.798

0.810 0.810 0.810 0.810 0.810 0.810 0.810 0.810 0.830 0.830 0.830 0.830 0.830 0.830 0.830 0.830 0.895 0.895 0.895 0.895 0.895 0.895 0.895 0.895

Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing


iDirect Gold

Copay HSAQ

iDirect Gold

Copay HSAQ

iDirect Gold

Copay HSAQ

iDirect Gold

Copay HSAQ

iDirect Gold

Copay HSAQ

iDirect Gold

Copay HSAQ

iDirect Gold

Copay HSAQ

iDirect Gold

Copay HSAQ Max Gold Max Gold Max Gold Max Gold Max Gold Max Gold Max Gold Max Gold Healthy New York Healthy New York Healthy New York Healthy New York Healthy New York Healthy New York Healthy New York Healthy New York


No No No No No No No No No No No No No No No No No No No No No No No No

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

4.53% 4.53% 4.53% 4.53% 4.53% 4.53% 4.53% 4.53% 3.69% 3.68% 3.68% 3.69% 3.69% 3.68% 3.68% 3.69% 6.52% 6.50% 6.50% 6.52% 6.51% 6.50% 6.50% 6.51%

4.53% 4.53% 4.53% 4.53% 4.53% 4.53% 4.53% 4.53% 3.69% 3.68% 3.68% 3.69% 3.69% 3.68% 3.68% 3.69% 6.52% 6.50% 6.50% 6.52% 6.51% 6.50% 6.50% 6.51%

22.18% 22.17% 22.18% 22.18% 22.18% 22.18% 22.17% 22.18% 15.87% 15.86% 15.86% 15.87% 15.87% 15.86% 15.86% 15.87% 21.72% 21.71% 21.71% 21.72% 21.72% 21.71% 21.71% 21.72%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$420.44 $424.93 $424.09 $420.44 $421.28 $424.09 $424.93 $421.28 $433.25 $437.90 $437.03 $433.25 $434.12 $437.03 $437.90 $434.12 $367.06 $370.93 $370.21 $367.06 $367.78 $370.21 $370.93 $367.78

0 2,584 0 0 21,259 0 0 2,885 0 195 0 0 6,231 0 0 53 0 403 0 0 13,591 0 0 46


$359.73 $363.55 $362.84 $359.73 $360.44 $362.84 $363.55 $360.44 $387.71 $391.87 $391.09 $387.71 $388.48 $391.09 $391.87 $388.48 $321.20 $324.57 $323.95 $321.20 $321.82 $323.95 $324.57 $321.82

0 370 0 0 10,782 0 0 1,561 0 66 0 0 5,067 0 0 0 0 402 0 0 13,998 0 0 54

$0 $135,258 $0 $0 $4,510,670 $0 $0 $581,731 $0 $11,217 $0 $0 $2,227,703 $0 $0 $0 $0 $143,892 $0 $0 $5,354,617 $0 $0 $20,510

98.53% 98.33% 98.53% 98.53% 98.33% 98.53% 98.33% 98.33% 98.56% 98.37% 98.57% 98.56% 98.36% 98.57% 98.37% 98.36% 98.47% 98.28% 98.48% 98.47% 98.28% 98.48% 98.28% 98.28%

1.47% 1.67% 1.47% 1.47% 1.67% 1.47% 1.67% 1.67% 1.44% 1.63% 1.43% 1.44% 1.64% 1.43% 1.63% 1.64% 1.53% 1.72% 1.52% 1.53% 1.72% 1.52% 1.72% 1.72%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $82,537 $0 $0 $4,913,176 $0 $0 $946,452 $0 $12,565 $0 $0 $1,366,561 $0 $0 $0 $0 $114,665 $0 $0 $6,420,823 $0 $0 $19,979

98.53% 98.33% 98.53% 98.53% 98.33% 98.53% 98.33% 98.33% 98.56% 98.37% 98.57% 98.56% 98.36% 98.57% 98.37% 98.36% 98.47% 98.28% 98.48% 98.47% 98.28% 98.48% 98.28% 98.28%

1.47% 1.67% 1.47% 1.47% 1.67% 1.47% 1.67% 1.67% 1.44% 1.63% 1.43% 1.44% 1.64% 1.43% 1.63% 1.64% 1.53% 1.72% 1.52% 1.53% 1.72% 1.52% 1.72% 1.72%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $33,383 $0 $0 $1,068,710 $0 $0 $157,498 $0 $3,825 $0 $0 $368,692 $0 $0 $0 $0 $26,656 $0 $0 $880,422 $0 $0 $4,034

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%$0 $49,154 $0 $0 $3,844,466 $0 $0 $788,954 $0 $8,740 $0 $0 $997,869 $0 $0 $0 $0 $88,009 $0 $0 $5,540,401 $0 $0 $15,946

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $7,602.06 $0.00 $0.00 -$243,170.25 $0.00 $0.00 $76,780.50 $0.00 -$7,104.22 $0.00 $0.00 -$541,196.80 $0.00 $0.00 $0.00 $0.00 -$32,977.08 $0.00 $0.00 -$559,691.99 $0.00 $0.00 $4,893.49

#DIV/0! $132.85 #DIV/0! #DIV/0! $356.56 #DIV/0! #DIV/0! $505.42 #DIV/0! $132.42 #DIV/0! #DIV/0! $196.93 #DIV/0! #DIV/0! #DIV/0! #DIV/0! $218.93 #DIV/0! #DIV/0! $395.80 #DIV/0! #DIV/0! $295.29




$439.50 $444.16 $443.30 $439.50 $440.37 $443.30 $444.16 $440.37 $449.24 $454.02 $453.13 $449.24 $450.13 $453.13 $454.02 $450.13 $390.98 $395.05 $394.29 $390.98 $391.73 $394.29 $395.05 $391.73

- 2,584 - - 21,259 - - 2,885 - 195 - - 6,231 - - 53 - 403 - - 13,591 - - 46

$0 $1,147,885 $0 $0 $9,361,836 $0 $0 $1,270,591 $0 $88,404 $0 $0 $2,804,701 $0 $0 $23,904 $0 $159,252 $0 $0 $5,323,939 $0 $0 $18,047

99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.80% 99.80% 99.80% 99.80% 99.80% 99.80% 99.80% 99.80% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84%

0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $1,266,293 $0 $0 $10,416,559 $0 $0 $1,413,738 $0 $95,406 $0 $0 $3,052,980 $0 $0 $26,020 $0 $197,520 $0 $0 $6,659,234 $0 $0 $22,574

99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.80% 99.80% 99.80% 99.80% 99.80% 99.80% 99.80% 99.80% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84%

0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.20% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $251,375 $0 $0 $2,067,820 $0 $0 $280,645 $0 $17,043 $0 $0 $545,386 $0 $0 $4,648 $0 $23,272 $0 $0 $784,610 $0 $0 $2,660

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%

$0 $1,014,917 $0 $0 $8,348,738 $0 $0 $1,133,093 $0 $78,362 $0 $0 $2,507,594 $0 $0 $21,372 $0 $174,247 $0 $0 $5,874,624 $0 $0 $19,914

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 -$875 $0 $0 -$7,197 $0 $0 -$977 $0 -$66 $0 $0 -$2,109 $0 $0 -$18 $0 -$136 $0 $0 -$4,601 $0 $0 -$16

#DIV/0! $392.71 #DIV/0! #DIV/0! $392.71 #DIV/0! #DIV/0! $392.71 #DIV/0! $402.45 #DIV/0! #DIV/0! $402.45 #DIV/0! #DIV/0! $402.45 #DIV/0! $432.25 #DIV/0! #DIV/0! $432.25 #DIV/0! #DIV/0! $432.25



5.92%

Gold

18029NY120

-5.64%

7.28%

11.18%


0.798 0.798 0.798 0.798 0.798 0.798 0.798 0.798 0.788 0.788 0.788 0.788 0.788 0.788 0.788 0.788 0.798 0.798 0.798 0.798 0.798 0.798 0.798 0.798

0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated


Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ iDirect Gold HSAQ Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold Standard Gold


Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No No No

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

-100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00%

-100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00%

-100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$457.96 $462.88 $461.98 $457.96 $458.87 $462.88 $461.98 $458.87 $406.38 $410.72 $409.91 $406.38 $407.19 $410.72 $409.91 $407.19 $457.96 $462.88 $461.98 $457.96 $458.87 $461.98 $462.88 $458.87

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


$402.91 $407.27 $406.44 $402.91 $403.72 $407.27 $406.44 $403.72 $359.87 $363.70 $363.00 $359.87 $360.60 $363.70 $363.00 $360.60 $402.91 $407.27 $406.44 $402.91 $403.72 $406.44 $407.27 $403.72

0 93 0 0 723 0 0 296 10 2,012 0 85 38,620 0 0 1,862 0 134 0 0 7,460 0 0 2,231

$0 $38,997 $0 $0 $337,101 $0 $0 $135,750 $4,475 $800,330 $0 $34,336 $13,818,144 $0 $0 $664,586 $0 $59,061 $0 $0 $3,379,404 $0 $0 $892,467

98.64% 98.44% 98.64% 98.64% 98.44% 98.44% 98.64% 98.44% 98.53% 98.33% 98.53% 98.53% 98.33% 98.33% 98.53% 98.33% 98.64% 98.44% 98.64% 98.64% 98.44% 98.64% 98.44% 98.44%

1.36% 1.56% 1.36% 1.36% 1.56% 1.56% 1.36% 1.56% 1.47% 1.67% 1.47% 1.47% 1.67% 1.67% 1.47% 1.67% 1.36% 1.56% 1.36% 1.36% 1.56% 1.36% 1.56% 1.56%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $67,810 $0 $0 $220,588 $0 $0 $126,508 $1,664 $2,252,699 $0 $19,499 $20,071,886 $0 $0 $873,545 $0 $135,420 $0 $0 $3,489,639 $0 $0 $1,145,386

98.64% 98.44% 98.64% 98.64% 98.44% 98.44% 98.64% 98.44% 98.53% 98.33% 98.53% 98.53% 98.33% 98.33% 98.53% 98.33% 98.64% 98.44% 98.64% 98.64% 98.44% 98.64% 98.44% 98.44%

1.36% 1.56% 1.36% 1.36% 1.56% 1.56% 1.36% 1.56% 1.47% 1.67% 1.47% 1.47% 1.67% 1.67% 1.47% 1.67% 1.36% 1.56% 1.36% 1.36% 1.56% 1.36% 1.56% 1.56%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $7,348 $0 $0 $46,761 $0 $0 $24,069 $1,018 $228,795 $0 $6,441 $3,483,880 $0 $0 $142,712 $0 $12,287 $0 $0 $516,078 $0 $0 $131,017

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% 0.00% 0.00% #DIV/0! 0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%$0 $60,462 $0 $0 $173,827 $0 $0 $102,439 $646 $2,023,905 $0 $13,059 $16,588,006 $0 $0 $730,833 $0 $123,133 $0 $0 $2,973,560 $0 $0 $1,014,369

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $9,760.14 $0.00 $0.00 -$64,300.83 $0.00 $0.00 -$14,594.61 $2,053.63 $557,065.76 $0.00 -$2,013.29 $1,604,678.19 $0.00 $0.00 $87,039.35 $0.00 $26,731.31 $0.00 $0.00 -$250,835.90 $0.00 $0.00 $200,960.07

#DIV/0! $650.13 #DIV/0! #DIV/0! $240.42 #DIV/0! #DIV/0! $346.08 $64.59 $1,005.92 #DIV/0! $153.63 $429.52 #DIV/0! #DIV/0! $392.50 #DIV/0! $918.90 #DIV/0! #DIV/0! $398.60 #DIV/0! #DIV/0! $454.67

#DIV/0! $729.14 #DIV/0! #DIV/0! $305.10 #DIV/0! #DIV/0! $427.39 $166.39 $1,119.63 #DIV/0! $229.41 $519.73 #DIV/0! #DIV/0! $469.14 #DIV/0! $1,010.60 #DIV/0! #DIV/0! $467.78 #DIV/0! #DIV/0! $513.40

#DIV/0! $717.78 #DIV/0! #DIV/0! $300.34 #DIV/0! #DIV/0! $420.72 $163.94 $1,100.98 #DIV/0! $226.03 $511.05 #DIV/0! #DIV/0! $461.31 #DIV/0! $994.86 #DIV/0! #DIV/0! $460.48 #DIV/0! #DIV/0! $505.38


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

- - - - - - - - - - - - - - - - - - - - - - - -

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0




5.92%

Gold

18029NY120

-5.64%

7.28%

11.18%

Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Silver Silver Silver Silver Silver Silver Silver Silver

0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.765 0.720 0.720 0.720 0.720 0.720 0.720 0.720 0.720

0.782 0.782 0.782 0.782 0.782 0.782 0.782 0.782 0.763 0.763 0.763 0.763 0.763 0.763 0.763 0.763 0.813 0.813 0.813 0.813 0.813 0.813 0.813 0.813


PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO POS POS POS POS POS POS POS POS

NY PA Gold NY PA Gold NY PA Gold NY PA Gold NY PA Gold NY PA Gold NY PA Gold NY PA Gold

Passport Plan

Gold

Passport Plan

Gold

Passport Plan

Gold

Passport Plan

Gold

Passport Plan

Gold

Passport Plan

Gold

Passport Plan

Gold

Passport Plan

Gold Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver


No No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

3.21% 3.20% 3.21% 3.21% 3.21% 3.20% 3.21% 3.21% 8.22% 8.22% 8.22% 8.22% 8.22% 8.22% 8.22% 8.22% 7.36% 7.35% 7.35% 7.36% 7.36% 7.35% 7.35% 7.36%

3.21% 3.20% 3.21% 3.21% 3.21% 3.20% 3.21% 3.21% 8.22% 8.22% 8.22% 8.22% 8.22% 8.22% 8.22% 8.22% 7.36% 7.35% 7.35% 7.36% 7.36% 7.35% 7.35% 7.36%

9.70% 9.68% 9.69% 9.70% 9.70% 9.68% 9.69% 9.70% -5.77% -5.79% -5.79% -5.77% -5.78% -5.79% -5.79% -5.78% 20.66% 20.65% 20.65% 20.66% 20.66% 20.65% 20.65% 20.66%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$431.15 $435.77 $434.92 $431.15 $432.01 $435.77 $434.92 $432.01 $596.02 $602.59 $601.36 $596.02 $597.23 $602.59 $601.36 $597.23 $394.44 $398.63 $397.84 $394.44 $395.21 $398.63 $397.84 $395.21

0 0 0 0 1,328 0 0 89 0 0 0 0 177 0 0 0 0 60 0 0 749 0 0 50


$405.66 $410.03 $409.20 $405.66 $406.47 $410.03 $409.20 $406.47 $684.55 $692.23 $690.79 $684.55 $685.97 $692.23 $690.79 $685.97 $350.95 $354.67 $353.98 $350.95 $351.64 $354.67 $353.98 $351.64

0 0 0 0 695 0 0 60 0 0 0 0 130 0 0 7 0 54 0 0 1,349 0 0 109

$0 $0 $0 $0 $313,870 $0 $0 $16,635 $0 $0 $0 $0 $131,869 $0 $0 $7,025 $0 $24,507 $0 $0 $526,199 $0 $0 $55,185

98.24% 98.05% 98.25% 98.24% 98.04% 98.05% 98.25% 98.04% 98.96% 98.76% 98.97% 98.96% 98.76% 98.76% 98.97% 98.76% 98.59% 98.39% 98.59% 98.59% 98.39% 98.39% 98.59% 98.39%

1.76% 1.95% 1.75% 1.76% 1.96% 1.95% 1.75% 1.96% 1.04% 1.24% 1.03% 1.04% 1.24% 1.24% 1.03% 1.24% 1.41% 1.61% 1.41% 1.41% 1.61% 1.61% 1.41% 1.61%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $270,674 $0 $0 $27,936 $0 $0 $0 $0 $98,930 $0 $0 $1,074 $0 $16,055 $0 $0 $466,787 $0 $0 $87,977

98.24% 98.05% 98.25% 98.24% 98.04% 98.05% 98.25% 98.04% 98.96% 98.76% 98.97% 98.96% 98.76% 98.76% 98.97% 98.76% 98.59% 98.39% 98.59% 98.59% 98.39% 98.39% 98.59% 98.39%

1.76% 1.95% 1.75% 1.76% 1.96% 1.95% 1.75% 1.96% 1.04% 1.24% 1.03% 1.04% 1.24% 1.24% 1.03% 1.24% 1.41% 1.61% 1.41% 1.41% 1.61% 1.61% 1.41% 1.61%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $48,405 $0 $0 $6,318 $0 $0 $0 $0 $34,302 $0 $0 $933 $0 $6,354 $0 $0 $92,772 $0 $0 $17,012

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%$0 $0 $0 $0 $222,269 $0 $0 $21,619 $0 $0 $0 $0 $64,627 $0 $0 $142 $0 $9,701 $0 $0 $374,015 $0 $0 $70,965

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $45,420.69 $0.00 $0.00 $4,515.66 $0.00 $0.00 $0.00 $0.00 $41,212.00 $0.00 $0.00 -$1,140.61 $0.00 -$2,271.49 $0.00 $0.00 -$9,589.75 $0.00 $0.00 $2,596.00

#DIV/0! #DIV/0! #DIV/0! #DIV/0! $319.81 #DIV/0! #DIV/0! $360.31 #DIV/0! #DIV/0! #DIV/0! #DIV/0! $497.13 #DIV/0! #DIV/0! $20.26 #DIV/0! $179.65 #DIV/0! #DIV/0! $277.25 #DIV/0! #DIV/0! $651.05




$445.01 $449.73 $448.86 $445.01 $445.89 $449.73 $448.86 $445.89 $645.03 $652.13 $650.80 $645.03 $646.35 $652.13 $650.80 $646.35 $423.46 $427.92 $427.09 $423.46 $424.28 $427.92 $427.09 $424.28

- - - - 1,328 - - 89 - - - - 177 - - - - 60 - - 749 - - 50

$0 $0 $0 $0 $591,954 $0 $0 $39,464 $0 $0 $0 $0 $114,411 $0 $0 $0 $0 $25,647 $0 $0 $317,863 $0 $0 $21,191

99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.85% 99.85% 99.85% 99.85% 99.85% 99.85% 99.85% 99.85% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84%

0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.15% 0.15% 0.15% 0.15% 0.15% 0.15% 0.15% 0.15% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $694,579 $0 $0 $46,305 $0 $0 $0 $0 $143,868 $0 $0 $0 $0 $28,022 $0 $0 $350,281 $0 $0 $23,352

99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.79% 99.85% 99.85% 99.85% 99.85% 99.85% 99.85% 99.85% 99.85% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84%

0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.21% 0.15% 0.15% 0.15% 0.15% 0.15% 0.15% 0.15% 0.15% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $165,210 $0 $0 $11,014 $0 $0 $0 $0 $35,743 $0 $0 $0 $0 $5,485 $0 $0 $68,566 $0 $0 $4,571

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%

$0 $0 $0 $0 $529,369 $0 $0 $35,291 $0 $0 $0 $0 $108,125 $0 $0 $0 $0 $22,537 $0 $0 $281,715 $0 $0 $18,781

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 -$449 $0 $0 -$30 $0 $0 $0 $0 -$60 $0 $0 $0 $0 -$3,144 $0 $0 -$39,298 $0 $0 -$2,620

#DIV/0! #DIV/0! #DIV/0! #DIV/0! $398.74 #DIV/0! #DIV/0! $398.74 #DIV/0! #DIV/0! #DIV/0! #DIV/0! $610.83 #DIV/0! #DIV/0! #DIV/0! #DIV/0! $376.03 #DIV/0! #DIV/0! $376.03 #DIV/0! #DIV/0! $376.03



Gold

18029NY121

-11.13%

25.07%

-0.38%

3.95% 5.24%

Silver

18029NY124

-5.01%

10.55%

10.88%

Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver

0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.667 0.667 0.667 0.667 0.667 0.667 0.667 0.667 0.660 0.660 0.660 0.660 0.660 0.660 0.660 0.660

0.703 0.703 0.703 0.703 0.703 0.703 0.703 0.703 0.712 0.712 0.712 0.712 0.712 0.712 0.712 0.712 0.677 0.677 0.677 0.677 0.677 0.677 0.677 0.677

Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing New New New New New New New New


iDirect Silver

Coinsurance

HSAQ

iDirect Silver

Coinsurance

HSAQ

iDirect Silver

Coinsurance

HSAQ

iDirect Silver

Coinsurance

HSAQ

iDirect Silver

Coinsurance

HSAQ

iDirect Silver

Coinsurance

HSAQ

iDirect Silver

Coinsurance

HSAQ

iDirect Silver

Coinsurance

HSAQ

Choice Plus Silver

HSAQ

Choice Plus Silver

HSAQ

Choice Plus Silver

HSAQ

Choice Plus Silver

HSAQ

Choice Plus Silver

HSAQ

Choice Plus Silver

HSAQ

Choice Plus Silver

HSAQ

Choice Plus Silver

HSAQ

iDirect Silver

Blended HSAQ

iDirect Silver

Blended HSAQ

iDirect Silver

Blended HSAQ

iDirect Silver

Blended HSAQ

iDirect Silver

Blended HSAQ

iDirect Silver

Blended HSAQ

iDirect Silver

Blended HSAQ

iDirect Silver

Blended HSAQ


Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

4.57% 4.56% 4.57% 4.57% 4.57% 4.56% 4.57% 4.57% 4.34% 4.33% 4.33% 4.34% 4.34% 4.33% 4.33% 4.34% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

4.57% 4.56% 4.57% 4.57% 4.57% 4.56% 4.57% 4.57% 4.34% 4.33% 4.33% 4.34% 4.34% 4.33% 4.33% 4.34% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

16.58% 16.56% 16.57% 16.58% 16.58% 16.56% 16.57% 16.58% 15.17% 15.15% 15.15% 15.17% 15.17% 15.15% 15.15% 15.17% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$356.86 $360.59 $359.89 $356.86 $357.55 $360.59 $359.89 $357.55 $344.89 $348.48 $347.82 $344.89 $345.56 $348.48 $347.82 $345.56 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

0 250 0 0 14,264 0 0 70 0 320 0 0 8,311 0 0 330 0 0 0 0 0 0 0 0


$320.09 $323.46 $322.83 $320.09 $320.72 $323.46 $322.83 $320.72 $312.45 $315.73 $315.12 $312.45 $313.07 $315.73 $315.12 $313.07 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

0 182 0 0 17,311 0 0 97 0 511 0 0 10,259 0 0 392 0 0 0 0 0 0 0 0

$0 $67,365 $0 $0 $6,238,437 $0 $0 $36,244 $0 $165,919 $0 $0 $3,245,862 $0 $0 $232,634 $0 $0 $0 $0 $0 $0 $0 $0

98.47% 98.28% 98.48% 98.47% 98.27% 98.28% 98.48% 98.27% 98.76% 98.56% 98.76% 98.76% 98.56% 98.56% 98.76% 98.56% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

1.53% 1.72% 1.52% 1.53% 1.73% 1.72% 1.52% 1.73% 1.24% 1.44% 1.24% 1.24% 1.44% 1.44% 1.24% 1.44% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $36,311 $0 $0 $5,379,561 $0 $0 $15,629 $0 $141,220 $0 $0 $2,428,167 $0 $0 $146,570 $0 $0 $0 $0 $0 $0 $0 $0

98.47% 98.28% 98.48% 98.47% 98.27% 98.28% 98.48% 98.27% 98.76% 98.56% 98.76% 98.76% 98.56% 98.56% 98.76% 98.56% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

1.53% 1.72% 1.52% 1.53% 1.73% 1.72% 1.52% 1.73% 1.24% 1.44% 1.24% 1.24% 1.44% 1.44% 1.24% 1.44% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $13,658 $0 $0 $1,607,808 $0 $0 $8,671 $0 $40,539 $0 $0 $747,228 $0 $0 $42,417 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!$0 $22,654 $0 $0 $3,771,753 $0 $0 $6,958 $0 $100,682 $0 $0 $1,680,939 $0 $0 $104,153 $0 $0 $0 $0 $0 $0 $0 $0

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 -$22,819.23 $0.00 $0.00 -$934,838.66 $0.00 $0.00 -$13,249.56 $0.00 -$26,019.52 $0.00 $0.00 -$858,687.07 $0.00 $0.00 -$30,129.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

#DIV/0! $124.47 #DIV/0! #DIV/0! $217.88 #DIV/0! #DIV/0! $71.74 #DIV/0! $197.03 #DIV/0! #DIV/0! $163.85 #DIV/0! #DIV/0! $265.70 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!




$373.18 $377.04 $376.32 $373.18 $373.90 $377.04 $376.32 $373.90 $359.86 $363.57 $362.88 $359.86 $360.55 $363.57 $362.88 $360.55 $361.37 $365.10 $364.40 $361.37 $362.06 $364.40 $365.10 $362.06

- 250 - - 14,264 - - 70 - 320 - - 8,311 - - 330 - - - - - - - -

$0 $94,157 $0 $0 $5,333,403 $0 $0 $26,144 $0 $116,215 $0 $0 $2,996,512 $0 $0 $118,852 $0 $0 $0 $0 $0 $0 $0 $0

99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75%

0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $116,760 $0 $0 $6,669,345 $0 $0 $32,693 $0 $141,142 $0 $0 $3,669,682 $0 $0 $145,552 $0 $0 $0 $0 $0 $0 $0 $0

99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75% 99.75%

0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $35,463 $0 $0 $2,025,636 $0 $0 $9,930 $0 $41,674 $0 $0 $1,083,527 $0 $0 $42,976 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

$0 $81,297 $0 $0 $4,643,709 $0 $0 $22,763 $0 $99,467 $0 $0 $2,586,155 $0 $0 $102,576 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 -$13,099 $0 $0 -$748,239 $0 $0 -$3,668 $0 -$16,767 $0 $0 -$435,949 $0 $0 -$17,291 $0 $0 $0 $0 $0 $0 $0 $0




5.24%

Silver

18029NY124

-5.01%

10.55%

10.88%


0.691 0.691 0.691 0.691 0.691 0.691 0.691 0.691 0.695 0.695 0.695 0.695 0.695 0.695 0.695 0.695 0.720 0.720 0.720 0.720 0.720 0.720 0.720 0.720

0.767 0.767 0.767 0.767 0.767 0.767 0.767 0.767 0.740 0.740 0.740 0.740 0.740 0.740 0.740 0.740 0.813 0.813 0.813 0.813 0.813 0.813 0.813 0.813



iDirect Silver

Copay

iDirect Silver

Copay

iDirect Silver

Copay

iDirect Silver

Copay

iDirect Silver

Copay

iDirect Silver

Copay

iDirect Silver

Copay

iDirect Silver

Copay Max Silver Max Silver Max Silver Max Silver Max Silver Max Silver Max Silver Max Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver Standard Silver



1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

4.14% 4.13% 4.13% 4.14% 4.14% 4.13% 4.13% 4.14% 9.04% 9.03% 9.04% 9.04% 9.04% 9.03% 9.04% 9.04% 7.36% 7.35% 7.35% 7.36% 7.36% 7.35% 7.35% 7.36%

4.14% 4.13% 4.13% 4.14% 4.14% 4.13% 4.13% 4.14% 9.04% 9.03% 9.04% 9.04% 9.04% 9.03% 9.04% 9.04% 7.36% 7.35% 7.35% 7.36% 7.36% 7.35% 7.35% 7.36%

14.93% 14.92% 14.93% 14.93% 14.93% 14.92% 14.93% 14.93% 13.24% 13.22% 13.23% 13.24% 13.24% 13.22% 13.23% 13.24% 20.66% 20.65% 20.65% 20.66% 20.66% 20.65% 20.65% 20.66%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$386.48 $390.58 $389.82 $386.48 $387.23 $390.58 $389.82 $387.23 $357.85 $361.61 $360.89 $357.85 $358.55 $361.61 $360.89 $358.55 $394.44 $398.63 $397.84 $394.44 $395.21 $397.84 $398.63 $395.21

320 1,688 0 0 39,547 0 0 1,339 0 50 0 0 2,008 0 0 260 110 160 0 0 11,088 0 0 200


$350.17 $353.88 $353.18 $350.17 $350.86 $353.88 $353.18 $350.86 $344.57 $348.24 $347.55 $344.57 $345.24 $348.24 $347.55 $345.24 $350.95 $354.67 $353.98 $350.95 $351.64 $353.98 $354.67 $351.64

519 1,231 0 0 54,405 0 0 2,159 0 24 0 0 1,663 0 0 75 135 181 0 0 14,973 0 0 234

$277,754 $457,995 $0 $0 $20,340,351 $0 $0 $721,831 $0 $10,097 $0 $0 $603,809 $0 $0 $24,443 $53,530 $66,850 $0 $0 $5,596,039 $0 $0 $94,743

98.52% 98.32% 98.52% 98.52% 98.32% 98.32% 98.52% 98.32% 98.51% 98.31% 98.51% 98.51% 98.31% 98.31% 98.51% 98.31% 98.59% 98.39% 98.59% 98.59% 98.39% 98.59% 98.39% 98.39%

1.48% 1.68% 1.48% 1.48% 1.68% 1.68% 1.48% 1.68% 1.49% 1.69% 1.49% 1.49% 1.69% 1.69% 1.49% 1.69% 1.41% 1.61% 1.41% 1.41% 1.61% 1.41% 1.61% 1.61%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$193,998 $404,836 $0 $0 $21,098,235 $0 $0 $597,054 $0 $1,148 $0 $0 $273,740 $0 $0 $16,216 $78,013 $24,179 $0 $0 $5,896,765 $0 $0 $85,139

98.52% 98.32% 98.52% 98.52% 98.32% 98.32% 98.52% 98.32% 98.51% 98.31% 98.51% 98.51% 98.31% 98.31% 98.51% 98.31% 98.59% 98.39% 98.59% 98.59% 98.39% 98.59% 98.39% 98.39%

1.48% 1.68% 1.48% 1.48% 1.68% 1.68% 1.48% 1.68% 1.49% 1.69% 1.49% 1.49% 1.69% 1.69% 1.49% 1.69% 1.41% 1.61% 1.41% 1.41% 1.61% 1.41% 1.61% 1.61%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$65,710 $115,465 $0 $0 $4,674,828 $0 $0 $160,235 $0 $159 $0 $0 $81,555 $0 $0 $6,938 $17,013 $7,802 $0 $0 $1,333,411 $0 $0 $22,302

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% 0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%$128,288 $289,371 $0 $0 $16,423,407 $0 $0 $436,819 $0 $989 $0 $0 $192,185 $0 $0 $9,278 $60,999 $16,377 $0 $0 $4,563,354 $0 $0 $62,837

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

-$43,386.73 -$4,090.19 $0.00 $0.00 -$1,573,695.81 $0.00 $0.00 -$122,725.00 $0.00 -$3,709.82 $0.00 $0.00 -$206,467.82 $0.00 $0.00 -$10,618.51 -$11,173.38 -$21,174.00 $0.00 $0.00 -$245,263.90 $0.00 $0.00 -$29,795.71

$247.18 $235.07 #DIV/0! #DIV/0! $301.87 #DIV/0! #DIV/0! $202.32 #DIV/0! $41.19 #DIV/0! #DIV/0! $115.57 #DIV/0! #DIV/0! $123.71 $451.85 $90.48 #DIV/0! #DIV/0! $304.77 #DIV/0! #DIV/0! $268.54




$402.47 $406.69 $405.91 $402.47 $403.26 $406.69 $405.91 $403.26 $390.20 $394.27 $393.51 $390.20 $390.95 $394.27 $393.51 $390.95 $423.46 $427.92 $427.09 $423.46 $424.28 $427.09 $427.92 $424.28

320 1,688 - - 39,547 - - 1,339 - 50 - - 2,008 - - 260 110 160 - - 11,088 - - 200

$128,649 $686,553 $0 $0 $15,947,645 $0 $0 $539,779 $0 $19,692 $0 $0 $784,957 $0 $0 $101,537 $46,530 $68,392 $0 $0 $4,704,370 $0 $0 $84,763

99.78% 99.78% 99.78% 99.78% 99.78% 99.78% 99.78% 99.78% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84%

0.22% 0.22% 0.22% 0.22% 0.22% 0.22% 0.22% 0.22% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$149,453 $789,299 $0 $0 $18,490,153 $0 $0 $625,835 $0 $23,352 $0 $0 $938,752 $0 $0 $121,431 $51,375 $74,727 $0 $0 $5,184,155 $0 $0 $93,408

99.78% 99.78% 99.78% 99.78% 99.78% 99.78% 99.78% 99.78% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84% 99.84%

0.22% 0.22% 0.22% 0.22% 0.22% 0.22% 0.22% 0.22% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16% 0.16%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$36,022 $190,241 $0 $0 $4,456,600 $0 $0 $150,842 $0 $6,242 $0 $0 $250,914 $0 $0 $32,457 $10,056 $14,627 $0 $0 $1,014,770 $0 $0 $18,284

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% 0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%

$113,431 $599,058 $0 $0 $14,033,553 $0 $0 $474,993 $0 $17,110 $0 $0 $687,839 $0 $0 $88,974 $41,318 $60,099 $0 $0 $4,169,385 $0 $0 $75,124

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

-$16,767 -$88,552 $0 $0 -$2,074,425 $0 $0 -$70,213 $0 -$2,620 $0 $0 -$105,319 $0 $0 -$13,623 -$5,764 -$8,384 $0 $0 -$581,615 $0 $0 -$10,480




5.24%

Silver

18029NY124

-5.01%

10.55%

10.88%


0.680 0.680 0.680 0.680 0.680 0.680 0.680 0.680 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682 0.682

0.738 0.738 0.738 0.738 0.738 0.738 0.738 0.738 0.702 0.702 0.702 0.702 0.702 0.702 0.702 0.702 0.695 0.695 0.695 0.695 0.695 0.695 0.695 0.695


POS POS POS POS POS POS POS POS PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO

iDirect Silver

Copay HSAQ

iDirect Silver

Copay HSAQ

iDirect Silver

Copay HSAQ

iDirect Silver

Copay HSAQ

iDirect Silver

Copay HSAQ

iDirect Silver

Copay HSAQ

iDirect Silver

Copay HSAQ

iDirect Silver

Copay HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ NY PA Silver HSAQ

Passport Plan

Silver HSAQ

Passport Plan

Silver HSAQ

Passport Plan

Silver HSAQ

Passport Plan

Silver HSAQ

Passport Plan

Silver HSAQ

Passport Plan

Silver HSAQ

Passport Plan

Silver HSAQ

Passport Plan

Silver HSAQ


Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

5.79% 5.78% 5.78% 5.79% 5.79% 5.78% 5.78% 5.79% 2.58% 2.56% 2.56% 2.58% 2.57% 2.56% 2.56% 2.57% 5.50% 5.49% 5.49% 5.50% 5.50% 5.49% 5.49% 5.50%

5.79% 5.78% 5.78% 5.79% 5.79% 5.78% 5.78% 5.79% 2.58% 2.56% 2.56% 2.58% 2.57% 2.56% 2.56% 2.57% 5.50% 5.49% 5.49% 5.50% 5.50% 5.49% 5.49% 5.50%

19.89% 19.88% 19.88% 19.89% 19.89% 19.88% 19.88% 19.89% 15.51% 15.49% 15.50% 15.51% 15.51% 15.49% 15.50% 15.51% -0.69% -0.71% -0.71% -0.69% -0.70% -0.71% -0.71% -0.70%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$368.13 $372.00 $371.28 $368.13 $368.83 $371.28 $372.00 $368.83 $380.28 $384.30 $383.55 $380.28 $381.03 $384.30 $383.55 $381.03 $540.14 $546.06 $544.95 $540.14 $541.25 $546.06 $544.95 $541.25

340 2,078 0 0 52,303 0 100 2,058 0 0 0 0 659 0 0 20 0 0 0 0 140 0 0 20


$324.82 $328.24 $327.61 $324.82 $325.45 $327.61 $328.24 $325.45 $337.70 $341.28 $340.60 $337.70 $338.35 $341.28 $340.60 $338.35 $573.81 $580.19 $579.00 $573.81 $575.00 $580.19 $579.00 $575.00

349 1,996 0 0 40,882 0 37 2,366 0 0 0 0 638 0 0 24 0 0 0 0 59 0 0 7

$123,717 $672,379 $0 $0 $14,527,618 $0 $8,879 $910,501 $0 $0 $0 $0 $218,870 $0 $0 $9,801 $0 $0 $0 $0 $28,191 $0 $0 $5,913

98.48% 98.28% 98.48% 98.48% 98.28% 98.48% 98.28% 98.28% 98.09% 97.89% 98.09% 98.09% 97.89% 97.89% 98.09% 97.89% 98.96% 98.76% 98.96% 98.96% 98.76% 98.76% 98.96% 98.76%

1.52% 1.72% 1.52% 1.52% 1.72% 1.52% 1.72% 1.72% 1.91% 2.11% 1.91% 1.91% 2.11% 2.11% 1.91% 2.11% 1.04% 1.24% 1.04% 1.04% 1.24% 1.24% 1.04% 1.24%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$60,476 $482,591 $0 $0 $13,525,308 $0 $3,304 $986,064 $0 $0 $0 $0 $273,072 $0 $0 $20,827 $0 $0 $0 $0 $12,140 $0 $0 $118

98.48% 98.28% 98.48% 98.48% 98.28% 98.48% 98.28% 98.28% 98.09% 97.89% 98.09% 98.09% 97.89% 97.89% 98.09% 97.89% 98.96% 98.76% 98.96% 98.96% 98.76% 98.76% 98.96% 98.76%

1.52% 1.72% 1.52% 1.52% 1.72% 1.52% 1.72% 1.72% 1.91% 2.11% 1.91% 1.91% 2.11% 2.11% 1.91% 2.11% 1.04% 1.24% 1.04% 1.04% 1.24% 1.24% 1.04% 1.24%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$34,456 $171,823 $0 $0 $3,520,624 $0 $1,513 $225,104 $0 $0 $0 $0 $68,623 $0 $0 $7,219 $0 $0 $0 $0 $6,579 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0!$26,020 $310,768 $0 $0 $10,004,684 $0 $1,792 $760,960 $0 $0 $0 $0 $204,449 $0 $0 $13,608 $0 $0 $0 $0 $5,562 $0 $0 $118

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

-$41,359.76 -$102,209.22 $0.00 $0.00 -$2,242,372.01 $0.00 -$2,851.52 -$31,842.00 $0.00 $0.00 $0.00 $0.00 $9,398.85 $0.00 $0.00 -$2,506.20 $0.00 $0.00 $0.00 $0.00 -$5,687.62 $0.00 $0.00 -$1,100.95

$74.56 $155.70 #DIV/0! #DIV/0! $244.72 #DIV/0! $48.42 $321.62 #DIV/0! #DIV/0! #DIV/0! #DIV/0! $320.45 #DIV/0! #DIV/0! $567.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0! $94.26 #DIV/0! #DIV/0! $16.79




$389.43 $393.50 $392.73 $389.43 $390.19 $392.73 $393.50 $390.19 $390.08 $394.14 $393.39 $390.08 $390.83 $394.14 $393.39 $390.83 $569.85 $576.05 $574.89 $569.85 $571.00 $576.05 $574.89 $571.00

340 2,078 - - 52,303 - 100 2,058 - - - - 659 - - 20 - - - - 140 - - 20

$132,262 $817,592 $0 $0 $20,408,134 $0 $39,307 $802,917 $0 $0 $0 $0 $257,664 $0 $0 $7,808 $0 $0 $0 $0 $79,853 $0 $0 $11,408

99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83%

0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$158,794 $971,445 $0 $0 $24,454,267 $0 $46,704 $962,104 $0 $0 $0 $0 $329,902 $0 $0 $9,997 $0 $0 $0 $0 $108,654 $0 $0 $15,522

99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.77% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.76% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83% 99.83%

0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.23% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.24% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17% 0.17%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$42,705 $261,254 $0 $0 $6,576,571 $0 $12,560 $258,742 $0 $0 $0 $0 $103,792 $0 $0 $3,145 $0 $0 $0 $0 $33,941 $0 $0 $4,849

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%

$116,089 $710,191 $0 $0 $17,877,695 $0 $34,144 $703,362 $0 $0 $0 $0 $226,110 $0 $0 $6,852 $0 $0 $0 $0 $74,713 $0 $0 $10,673

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

-$17,815 -$108,987 $0 $0 -$2,743,544 $0 -$5,240 -$107,939 $0 $0 $0 $0 -$34,582 $0 $0 -$1,048 $0 $0 $0 $0 -$7,336 $0 $0 -$1,048




5.24%

Silver

18029NY125

-9.71%

9.51%

9.30%

3.30%

Silver

18029NY124

-5.01%

10.55%

10.88%

Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze

0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620

0.645 0.645 0.645 0.645 0.645 0.645 0.645 0.645 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.654 0.654 0.654 0.654 0.654 0.654 0.654 0.654


PPO PPO PPO PPO PPO PPO PPO PPO POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS POS

Passport Plan

Bronze HSAQ

Passport Plan

Bronze HSAQ

Passport Plan

Bronze HSAQ

Passport Plan

Bronze HSAQ

Passport Plan

Bronze HSAQ

Passport Plan

Bronze HSAQ

Passport Plan

Bronze HSAQ

Passport Plan

Bronze HSAQ Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze

iDirect Bronze

HSAQ

iDirect Bronze

HSAQ

iDirect Bronze

HSAQ

iDirect Bronze

HSAQ

iDirect Bronze

HSAQ

iDirect Bronze

HSAQ

iDirect Bronze

HSAQ

iDirect Bronze

HSAQ


No No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

9.99% 9.99% 9.99% 9.99% 9.99% 9.99% 9.99% 9.99% 7.79% 7.78% 7.79% 7.79% 7.80% 7.78% 7.79% 7.80% 10.19% 10.19% 10.19% 10.19% 10.20% 10.19% 10.19% 10.20%

9.99% 9.99% 9.99% 9.99% 9.99% 9.99% 9.99% 9.99% 7.79% 7.78% 7.79% 7.79% 7.80% 7.78% 7.79% 7.80% 10.19% 10.19% 10.19% 10.19% 10.20% 10.19% 10.19% 10.20%

8.58% 8.56% 8.57% 8.58% 8.58% 8.56% 8.57% 8.58% 24.80% 24.79% 24.79% 24.80% 24.80% 24.79% 24.79% 24.80% 26.14% 26.14% 26.14% 26.14% 26.14% 26.14% 26.14% 26.14%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$472.38 $477.50 $476.53 $472.38 $473.33 $477.50 $476.53 $473.33 $317.79 $321.08 $320.45 $317.79 $318.39 $321.08 $320.45 $318.39 $310.59 $313.78 $313.18 $310.59 $311.18 $313.78 $313.18 $311.18

0 0 0 0 49 0 0 0 0 49 0 0 376 0 0 119 79 455 0 0 16,303 0 0 871


$478.52 $483.76 $482.78 $478.52 $479.49 $483.76 $482.78 $479.49 $274.49 $277.32 $276.79 $274.49 $275.01 $277.32 $276.79 $275.01 $271.33 $274.11 $273.60 $271.33 $271.84 $274.11 $273.60 $271.84

0 0 0 0 62 0 0 1 0 73 0 0 395 0 0 126 53 358 0 0 21,336 0 0 1,124

$0 $0 $0 $0 $32,866 $0 $0 $698 $0 $31,329 $0 $0 $153,873 $0 $0 $41,699 $16,875 $125,493 $0 $0 $6,526,147 $0 $0 $328,571

98.95% 98.75% 98.95% 98.95% 98.75% 98.75% 98.95% 98.75% 98.56% 98.36% 98.56% 98.56% 98.36% 98.36% 98.56% 98.36% 98.46% 98.27% 98.47% 98.46% 98.27% 98.27% 98.47% 98.27%

1.05% 1.25% 1.05% 1.05% 1.25% 1.25% 1.05% 1.25% 1.44% 1.64% 1.44% 1.44% 1.64% 1.64% 1.44% 1.64% 1.54% 1.73% 1.53% 1.54% 1.73% 1.73% 1.53% 1.73%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $3,196 $0 $0 $17 $0 $12,285 $0 $0 $59,537 $0 $0 $8,928 $5,318 $68,853 $0 $0 $4,055,694 $0 $0 $270,898

98.95% 98.75% 98.95% 98.95% 98.75% 98.75% 98.95% 98.75% 98.56% 98.36% 98.56% 98.56% 98.36% 98.36% 98.56% 98.36% 98.46% 98.27% 98.47% 98.46% 98.27% 98.27% 98.47% 98.27%

1.05% 1.25% 1.05% 1.05% 1.25% 1.25% 1.05% 1.25% 1.44% 1.64% 1.44% 1.44% 1.64% 1.64% 1.44% 1.64% 1.54% 1.73% 1.53% 1.54% 1.73% 1.73% 1.53% 1.73%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $1,355 $0 $0 $0 $0 $7,939 $0 $0 $31,830 $0 $0 $2,962 $1,118 $36,671 $0 $0 $1,517,354 $0 $0 $72,016

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% 0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%$0 $0 $0 $0 $1,841 $0 $0 $17 $0 $4,346 $0 $0 $27,707 $0 $0 $5,966 $4,200 $32,182 $0 $0 $2,538,339 $0 $0 $198,881

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 -$1,609.79 $0.00 $0.00 -$140.90 $0.00 -$10,739.74 $0.00 $0.00 -$63,017.06 $0.00 $0.00 -$22,058.45 -$8,625.43 -$9,253.67 $0.00 $0.00 -$2,293,499.08 $0.00 $0.00 -$90,190.05

#DIV/0! #DIV/0! #DIV/0! #DIV/0! $29.69 #DIV/0! #DIV/0! $16.79 #DIV/0! $59.53 #DIV/0! #DIV/0! $70.14 #DIV/0! #DIV/0! $47.35 $79.24 $89.89 #DIV/0! #DIV/0! $118.97 #DIV/0! #DIV/0! $176.94




$519.58 $525.19 $524.14 $519.58 $520.63 $525.19 $524.14 $520.63 $342.56 $346.07 $345.41 $342.56 $343.21 $346.07 $345.41 $343.21 $342.25 $345.76 $345.10 $342.25 $342.91 $345.76 $345.10 $342.91

- - - - 49 - - - - 49 - - 376 - - 119 79 455 - - 16,303 - - 871

$0 $0 $0 $0 $25,767 $0 $0 $0 $0 $17,128 $0 $0 $129,096 $0 $0 $40,767 $27,102 $157,435 $0 $0 $5,590,374 $0 $0 $298,696

99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73%

0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $37,390 $0 $0 $0 $0 $22,474 $0 $0 $170,804 $0 $0 $53,938 $35,959 $206,763 $0 $0 $7,403,002 $0 $0 $395,546

99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73%

0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $13,478 $0 $0 $0 $0 $7,891 $0 $0 $59,973 $0 $0 $18,939 $12,667 $72,835 $0 $0 $2,607,824 $0 $0 $139,337

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% 0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%

$0 $0 $0 $0 $23,911 $0 $0 $0 $0 $14,583 $0 $0 $110,831 $0 $0 $34,999 $23,292 $133,927 $0 $0 $4,795,179 $0 $0 $256,209

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 -$5,207 $0 $0 $0 $0 -$5,207 $0 $0 -$39,577 $0 $0 -$12,498 -$8,332 -$47,908 $0 $0 -$1,715,332 $0 $0 -$91,651

#DIV/0! #DIV/0! #DIV/0! #DIV/0! $483.13 #DIV/0! #DIV/0! #DIV/0! #DIV/0! $294.65 #DIV/0! #DIV/0! $294.65 #DIV/0! #DIV/0! $294.65 $294.13 $294.13 #DIV/0! #DIV/0! $294.13 #DIV/0! #DIV/0! $294.13



9.99%

Bronze

18029NY130

-5.34%

9.40%

14.28%

10.71%

Bronze

18029NY127

-12.09%

-13.35%

-1.86%

Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze

0.614 0.614 0.614 0.614 0.614 0.614 0.614 0.614 0.650 0.650 0.650 0.650 0.650 0.650 0.650 0.650 0.620 0.620 0.620 0.620 0.620 0.620 0.620 0.620

0.650 0.650 0.650 0.650 0.650 0.650 0.650 0.650 0.685 0.685 0.685 0.685 0.685 0.685 0.685 0.685 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655



iDirect Bronze MV

HSAQ

iDirect Bronze MV

HSAQ

iDirect Bronze MV

HSAQ

iDirect Bronze MV

HSAQ

iDirect Bronze MV

HSAQ

iDirect Bronze MV

HSAQ

iDirect Bronze MV

HSAQ

iDirect Bronze MV

HSAQ

iDirect Bronze

Enhanced HSAQ

iDirect Bronze

Enhanced HSAQ

iDirect Bronze

Enhanced HSAQ

iDirect Bronze

Enhanced HSAQ

iDirect Bronze

Enhanced HSAQ

iDirect Bronze

Enhanced HSAQ

iDirect Bronze

Enhanced HSAQ

iDirect Bronze

Enhanced HSAQ Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze Standard Bronze



1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

13.58% 13.59% 13.58% 13.58% 13.58% 13.58% 13.59% 13.58% 10.29% 10.29% 10.29% 10.29% 10.29% 10.29% 10.29% 10.29% 7.79% 7.78% 7.79% 7.79% 7.80% 7.79% 7.78% 7.80%

13.58% 13.59% 13.58% 13.58% 13.58% 13.58% 13.59% 13.58% 10.29% 10.29% 10.29% 10.29% 10.29% 10.29% 10.29% 10.29% 7.79% 7.78% 7.79% 7.79% 7.80% 7.79% 7.78% 7.80%

32.06% 32.06% 32.06% 32.06% 32.06% 32.06% 32.06% 32.06% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 24.80% 24.79% 24.79% 24.80% 24.80% 24.79% 24.79% 24.80%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$299.20 $302.25 $301.68 $299.20 $299.76 $301.68 $302.25 $299.76 $322.99 $326.34 $325.72 $322.99 $323.62 $325.72 $326.34 $323.62 $317.79 $321.08 $320.45 $317.79 $318.39 $320.45 $321.08 $318.39

20 99 0 0 8,018 0 0 69 0 0 0 0 386 0 0 40 0 40 0 0 3,742 0 0 89


$257.34 $259.97 $259.47 $257.34 $257.82 $259.47 $259.97 $257.82 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $274.49 $277.32 $276.79 $274.49 $275.01 $276.79 $277.32 $275.01

40 60 212 0 4,818 0 0 50 0 0 0 0 0 0 0 0 0 56 0 0 4,842 0 0 99

$9,114 $33,317 $52,917 $0 $1,346,695 $0 $0 $15,842 $0 $0 $0 $0 $0 $0 $0 $0 $0 $17,762 $0 $0 $1,499,446 $0 $0 $62,188

98.44% 98.24% 98.44% 98.44% 98.24% 98.44% 98.24% 98.24% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.56% 98.36% 98.56% 98.56% 98.36% 98.56% 98.36% 98.36%

1.56% 1.76% 1.56% 1.56% 1.76% 1.56% 1.76% 1.76% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 1.44% 1.64% 1.44% 1.44% 1.64% 1.44% 1.64% 1.64%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$1,981 $7,210 $17,444 $0 $763,018 $0 $0 $3,117 $0 $0 $0 $0 $0 $0 $0 $0 $0 $6,379 $0 $0 $1,071,853 $0 $0 $116,480

98.44% 98.24% 98.44% 98.44% 98.24% 98.44% 98.24% 98.24% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.56% 98.36% 98.56% 98.56% 98.36% 98.56% 98.36% 98.36%

1.56% 1.76% 1.56% 1.56% 1.76% 1.56% 1.76% 1.76% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 1.44% 1.64% 1.44% 1.44% 1.64% 1.44% 1.64% 1.64%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$713 $4,171 $5,627 $0 $350,263 $0 $0 $2,202 $0 $0 $0 $0 $0 $0 $0 $0 $0 $4,117 $0 $0 $346,373 $0 $0 $17,306

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

0.00% 0.00% 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%$1,268 $3,039 $11,817 $0 $412,755 $0 $0 $915 $0 $0 $0 $0 $0 $0 $0 $0 $0 $2,263 $0 $0 $725,480 $0 $0 $99,174

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

-$4,492.32 -$16,827.01 -$13,949.77 $0.00 -$487,235.60 $0.00 $0.00 -$9,004.23 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 -$100.86 $0.00 $0.00 -$344,312.80 $0.00 $0.00 -$35,863.24

$31.70 $50.64 $55.74 #DIV/0! $85.67 #DIV/0! #DIV/0! $18.29 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! $40.41 #DIV/0! #DIV/0! $149.83 #DIV/0! #DIV/0! $1,001.76




$339.83 $343.31 $342.65 $339.83 $340.47 $342.65 $343.31 $340.47 $356.24 $359.91 $359.23 $356.24 $356.93 $359.23 $359.91 $356.93 $342.56 $346.07 $345.41 $342.56 $343.21 $345.41 $346.07 $343.21

20 99 - - 8,018 - - 69 - - - - 386 - - 40 - 40 - - 3,742 - - 89

$6,728 $33,983 $0 $0 $2,729,789 $0 $0 $23,591 $0 $0 $0 $0 $137,790 $0 $0 $14,132 $0 $13,702 $0 $0 $1,284,163 $0 $0 $30,575

99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.74% 99.74% 99.74% 99.74% 99.74% 99.74% 99.74% 99.74% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81%

0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.26% 0.26% 0.26% 0.26% 0.26% 0.26% 0.26% 0.26% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$8,990 $44,948 $0 $0 $3,640,821 $0 $0 $31,464 $0 $0 $0 $0 $175,299 $0 $0 $17,979 $0 $17,979 $0 $0 $1,699,050 $0 $0 $40,454

99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.73% 99.74% 99.74% 99.74% 99.74% 99.74% 99.74% 99.74% 99.74% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81% 99.81%

0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.27% 0.26% 0.26% 0.26% 0.26% 0.26% 0.26% 0.26% 0.26% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$3,215 $16,074 $0 $0 $1,302,023 $0 $0 $11,252 $0 $0 $0 $0 $56,348 $0 $0 $5,779 $0 $6,313 $0 $0 $596,569 $0 $0 $14,204

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

0.00% 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! 0.00%

$5,775 $28,874 $0 $0 $2,338,798 $0 $0 $20,212 $0 $0 $0 $0 $118,951 $0 $0 $12,200 $0 $11,666 $0 $0 $1,102,481 $0 $0 $26,250

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

-$2,083 -$10,415 $0 $0 -$843,606 $0 $0 -$7,290 $0 $0 $0 $0 -$40,618 $0 $0 -$4,166 $0 -$4,166 $0 $0 -$393,683 $0 $0 -$9,373

$291.70 $291.70 #DIV/0! #DIV/0! $291.70 #DIV/0! #DIV/0! $291.70 #DIV/0! #DIV/0! #DIV/0! #DIV/0! $308.13 #DIV/0! #DIV/0! $308.13 #DIV/0! $294.65 #DIV/0! #DIV/0! $294.65 #DIV/0! #DIV/0! $294.65



Bronze

18029NY130

-5.34%

9.40%

14.28%

10.71%

Transition

18029NY999

Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Not Applicable

0.861 0.861 0.861 0.861 0.861 0.861 0.861 0.861 1.000

0.946 0.946 0.946 0.946 0.946 0.946 0.946 0.946 1.000

Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Terminated

PPO PPO PPO PPO PPO PPO PPO PPO POS

Passport Plan

Platinum

Passport Plan

Platinum

Passport Plan

Platinum

Passport Plan

Platinum

Passport Plan

Platinum

Passport Plan

Platinum

Passport Plan

Platinum

Passport Plan

Platinum

Transition Large

to Small

18029NY1410001 18029NY1410002 18029NY1410003 18029NY1410004 18029NY1410005 18029NY1410006 18029NY1410007 18029NY1410008 18029NY9999999

No No No No No No No No No

0.00%

0.00%

0.00%

1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019 1/1/2019

5.64% 5.63% 5.64% 5.64% 5.64% 5.64% 5.63% 5.64% 0.00%

5.64% 5.63% 5.64% 5.64% 5.64% 5.64% 5.63% 5.64% 0.00%

-3.47% -3.48% -3.48% -3.47% -3.47% -3.48% -3.48% -3.47% #DIV/0!

0.00%


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$785.63 $794.47 $792.81 $785.63 $787.28 $792.81 $794.47 $787.28 $0.00

0 0 0 0 50 0 0 0 0


$859.73 $869.49 $867.66 $859.73 $861.53 $867.66 $869.49 $861.53 $0.00

0 0 0 0 4 0 0 0 10,617

$0 $0 $0 $0 $0 $0 $0 $0 $5,304,585

98.97% 98.77% 98.97% 98.97% 98.77% 98.97% 98.77% 98.77% 100.00%

1.03% 1.23% 1.03% 1.03% 1.23% 1.03% 1.23% 1.23%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $67 $0 $0 $0 $0

98.97% 98.77% 98.97% 98.97% 98.77% 98.97% 98.77% 98.77% 100.00%

1.03% 1.23% 1.03% 1.03% 1.23% 1.03% 1.23% 1.23% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!$0 $0 $0 $0 $67 $0 $0 $0 $0

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

#DIV/0! #DIV/0! #DIV/0! #DIV/0! $16.79 #DIV/0! #DIV/0! #DIV/0! $0.00




$829.93 $839.22 $837.48 $829.93 $831.65 $837.48 $839.22 $831.65 $0.00

- - - - 50 - - - -

$0 $0 $0 $0 $41,399 $0 $0 $0 $0

99.88% 99.88% 99.88% 99.88% 99.88% 99.88% 99.88% 99.88% 100.00%

0.12% 0.12% 0.12% 0.12% 0.12% 0.12% 0.12% 0.12% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $42,954 $0 $0 $0 $0

99.88% 99.88% 99.88% 99.88% 99.88% 99.88% 99.88% 99.88% 100.00%

0.12% 0.12% 0.12% 0.12% 0.12% 0.12% 0.12% 0.12% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

$0 $0 $0 $0 $3,243 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0!

$0 $0 $0 $0 $39,711 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $4,035 $0 $0 $0 $0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! $797.73 #DIV/0! #DIV/0! #DIV/0! #DIV/0!



5.63%

Platinum

18029NY141

0.00%

-9.07%

-9.15%