2015 Anthem Small Group 1-1-2015 Rate Filing.pdf
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Transcript of 2015 Anthem Small Group 1-1-2015 Rate Filing.pdf
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Changesfrom2014FilingsTobaccoratingfactorsnowvarybyageseeExhibitJ:AgeandTobaccoFactors.
3.Introduction
Thisfilingincludesanaveragerateincreaseof7.7%,withrangebyplanbetween10.8%and28.2%.MoredetailsareprovidedbelowinSection5:ProposedRateIncrease,andinExhibitI:NonGrandfatheredBenefitPlanFactorsandRateIncreases.
ABCBSMOSGBPOOFFv01ABCBSMOSGPPOOFFv01
PolicyFormNumber(s):ABCBSMOSGPPOONv01
TothebestofAnthem'sknowledgeandcurrentunderstanding,thisfilingcomplieswiththemostrecentregulationsandrelatedguidance.Totheextentrelevantrulesorguidanceontherulesareupdatedorchanged,amendmentstothisfilingmayberequired.
ThepurposeofthisratefilingistoestablishratesthatarereasonablerelativetothebenefitsprovidedandtodemonstratecompliancewithstatelawsandprovisionsoftheAffordableCareAct(ACA).TherateswillbeinforceforeffectivedatesonorafterJanuary1,2015.SubsequentratechangeswillbeimplementedquarterlyasdiscussedinmoredetailinSection16:IndexRate.TheserateswillapplytoplansofferedbothOnExchangeandOffExchange.Thisratefilingisnotintendedtobeusedforotherpurposes.
2.ScopeandPurposeoftheFilingPrimaryContactEmailAddress: [email protected]: (314)9238947
CompanyContactInformationPrimaryContactName: AndyDare
EffectiveDate: January1,2015Market: SmallGroupHIOSIssuerID: 32753State: Missouri
CompanyIdentifyingInformationCompanyLegalName: HealthyAllianceLifeInsuranceCompany
1.GeneralInformation
ACTUARIALMEMORANDUM
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Theprojectionperiodpremiumisadjustedbytheaverageratingfactorsintheprojectionperiodtodeterminethebaserate.Thebaseraterepresentsanaveragebenefitplanandareaforanage21nontobaccouserinMissouri.
Adjustmentsforriskadjustmentandreinsuranceareappliedtotheprojectedclaimscost.
Nonbenefitexpenses,profit,andriskareappliedtotheprojectedclaimscosttodeterminetherequiredprojectionperiodpremium.
Theprojectedclaimscostiscalculatedbyadjustingthenormalizedclaimsfortheimpactofbenefitchanges,populationmorbidity,trendfactors,etc.Adjustmentisnotbasedonthehealthstatusofthemember.
TheprojectionperiodisFebruary1,2015January31,2016.SmallGroupBusinessrenewsonaquarterlybasis;thereforethemiddlemonthofthefirstquarterisFebruary2015.
SmallGroupmanualratesaredevelopedbasedonhistoricalexperienceofGrandfatheredandNonGrandfatheredbusiness.
Theexperiencedataisnormalizedtoreflectanticipatedchangesinage/gender,area/networkandbenefitplanfromtheexperienceperiodtotheprojectionperiodbasedonexpecteddistributionofmembership.
4.DescriptionofHowtheBaseRateIsDetermined
Themethodologyusedtodeveloptheratesthisyearisconsistentwiththemethodologythatwasusedlastyear.ThedevelopmentoftheBaseRateisdetailedinExhibitA:BaseRateDevelopment.FurtherdetailsonhowthebaserateisdevelopedcanbefoundinSection9:CredibilityManualRateDevelopment,Section12:RiskAdjustmentandReinsurance,Section13:NonBenefitExpenses,ProfitandRisk,andSection19:Calibration.Adescriptionofthemethodologyusedtodeterminethebaserateisasfollows:
Areafactorshavebeenadjustedtoreflectmostcurrentexperience.RefertoExhibitK:AreaFactors.
ThisfilingincludesnewexhibitsshowingtheMarketAdjustedIndexRate,PlanAdjustedIndexRate,andConsumerAdjustedPremiumRates,asdefinedinthenewmemoinstructionsfor2015filings.SeeExhibitO:QuarterlyIndex,Base,andMarketAdjustedIndexRateDevelopmentandExhibitP:PlanAdjustedIndexRateandConsumerAdjustedPremiumRates.
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TheserateincreasesbyplanareshowninExhibitI:NonGrandfatheredBenefitPlanFactorsandRateIncreases.
6.ExperiencePeriodPremiumandClaims
Anticipatedchangesduetonetworkcontractingbypricingarea.
In2014,theareafactorsvariedbyplanbasedonactuariallyjustifiednetworkcostdifferencesforeachgeographicratingarea.EffectiveJanuary1,2015,asingleareafactorwillapplytoallplansineachgeographicratingarea.Toretaintheactuariallyjustifiednetworkcostdifferencesforeachgeographicareaandcomplywith45CFRpart147.102,severalnewplanshavebeenadded,eachofwhichisavailableinasinglegeographicratingarea.Newplanshavebeenmappedtocomparable2014plansforpurposesofdeterminingtherateincrease.RefertoExhibitI:NonGrandfatheredBenefitPlanFactorsandRateIncreasesandExhibitK:AreaFactorsfordetails.
ChangesinNonBenefitExpensesthatareappliedonaPMPMbasisChangesintheunderlyingarearatingfactors,whichareincludedintheplanlevelincreaseforplansnotofferedinallareas
ChangesinbenefitdesignthatvarybyplanChangesintheadjustmentfactorforCatastrophiceligibility
TherateincreaseisshowninExhibitI:NonGrandfatheredBenefitPlanFactorsandRateIncreases.
Althoughratesarebasedonthesamesingleriskpoolofexperience,proposedrateincreasesvarybyplanfrom10.8%to28.2%.Factorsthataffectthevariationintheproposedrateincreasebyplaninclude:
AnticipatedchangesinpaymentstotheFederalTransitionalReinsuranceProgramChangesintaxes,fees,andothernonbenefitexpenses
Anticipatedchangesinthemarketwidemorbidityofthecoveredpopulationintheprojectionperiod
Changingtrendsinmedicalcostsandutilizationandothercostofcareimpacts
Theaverageproposedrateincreaseis7.7%.Factorsthataffecttheproposedrateincreaseforallplansinclude:
Changesinbenefitdesign
Premiumsatthememberlevelaredeterminedbymultiplyingthebaseratebytheapplicablefactorforeachoftheallowableratingcriteria:age,tobacco,areaandbenefitplan.AnexampleofthiscalculationisshowninExhibitL:SampleRateCalculation.
5.ProposedRateIncrease
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InpatientHospital:Includesnoncapitatedfacilityservicesformedical,surgical,maternity,mentalhealthandsubstanceabuse,skillednursing,andotherservicesprovidedinaninpatientfacilitysettingandbilledbythefacility.
7.BenefitCategories
ThemethodologyusedtodeterminebenefitcategoriesinWorksheet1,SectionIIoftheUnifiedRateReviewTemplateisasfollows:
TheestimatedNonGrandfatheredgrossearnedpremiumforMissouriSmallGroupis$467,171,983,whereearnedpremiumistheproratashareofpremiumowedtoAnthemduetosubscribersactivelypurchasinginsurancecoverageduringtheexperienceperiod.
ThepreliminaryMLRRebateestimateis$2,549,077,whichisconsistentwiththeDecember31,2013AnthemgeneralledgerestimateallocatedtotheNonGrandfatheredportionofSmallGroup.NotethatthisisanestimateandwillnotbefinaluntilJune1,2014.
Allowedandincurredclaimsarecompletedusingthechainladdermethod,anindustrystandard,byusinghistoricpaidvs.incurredclaimspatterns.Themethodcalculateshistoriccompletionpercentages,representingthepercentofclaimspaidforaparticularmonthafteronemonthofrunout,twomonths,etc.,forafortyeightmonthviewofhistory.Claimbacklogfilesarereviewedonamonthlybasisandareaccountedforinthehistoricalcompletionfactorestimates.
Premiums(netofMLRRebate)inExperiencePeriod
AllowedandIncurredClaimsIncurredDuringtheExperiencePeriodTheallowedclaimsaredeterminedbysubtractingnoncoveredbenefits,providerdiscounts,andcoordinationofbenefitsamountsfromthebilledamount.
PaidThroughDateClaimsshowninWorksheet1,SectionIoftheUnifiedRateReviewTemplatearepaidthroughMarch31,2014.
ExperienceshowninWorksheet1,SectionIoftheUnifiedRateReviewTemplateisfortheMissouriSmallGroupSingleRiskPoolNonGrandfatheredBusiness.Consistentwithlastyear,Anthemisassigning0%credibilitytothesingleriskpoolexperience,thusitisnotusedfordevelopingmanualrates.ThemanualratedevelopmentisfullydetailedinSection9:CredibilityManualRateDevelopment.
ClaimsexperienceinWorksheet1,SectionIoftheUnifiedRateReviewTemplatereflectsdatesofservicefromJanuary1,2013throughDecember31,2013.
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9.CredibilityManualRateDevelopment
Consistentwithlastyear'smethodology,experiencedevelopedandprojectedhereinisAnthem'sSmallGroupBusinessbasedonplanliabilityamounts.TheratedevelopmentisshowninExhibitA:BaseRateDevelopment.
TrendFactors(cost/utilization)n/aseeCredibilityManualRateDevelopment
OtherAdjustmentsn/aseeCredibilityManualRateDevelopment
ChangesinDemographicsn/aseeCredibilityManualRateDevelopment
ChangesinBenefitsn/aseeCredibilityManualRateDevelopment
ChangesintheMorbidityofthePopulationInsuredn/aseeCredibilityManualRateDevelopment
8.ProjectionFactors
Aspreviouslyindicated,thecredibilitylevelassignedtotheexperienceinWorksheet1,SectionIIIoftheUnifiedRateReviewTemplateis0%.Consequently,factorstoprojectexperienceclaimsarenotprovidedastheyarenotapplicable.However,thefactorsusedtodevelopthemanualratesarefullydetailedinSection9:CredibilityManualRateDevelopment.
PrescriptionDrug:Includesdrugsdispensedbyapharmacyandrebatesreceivedfromdrugmanufacturers.
Professional:Includesnoncapitatedprimarycare,specialist,therapy,theprofessionalcomponentoflaboratoryandradiology,andotherprofessionalservices,otherthanhospitalbasedprofessionalswhosepaymentsareincludedinfacilityfees.
OtherMedical:Includesnoncapitatedambulance,homehealthcare,DME,prosthetics,supplies,visionexams,dentalservicesandotherservices.
OutpatientHospital:Includesnoncapitatedfacilityservicesforsurgery,emergencyroom,lab,radiology,therapy,observationandotherservicesprovidedinanoutpatientfacilitysettingandbilledbythefacility.
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Area/Network:TheareaclaimsfactorsaredevelopedbasedonananalysisofSmallGroupandIndividualallowedclaimsbynetwork,mappedtotheprescribed2015ratingareasusing5digitzipcode.
Thesourcedatawasnormalizedtoreflectanticipatedchangesinage/gender,area,network,andbenefitplanfromtheexperienceperiodtotheprojectionperiod.Thepurposeofthesefactorsistoadjustcurrentexperiencetobereflectiveofexpectedclaimexperienceintheprojectionperiod.SeeSection23:MembershipProjectionsforadditionalinformationonmembershipmovement.ThenormalizationfactorsandtheiraggregateimpactontheunderlyingexperiencedataaredetailedinExhibitC:NormalizationFactors.
Age/Gender:Theassumedclaimscostisappliedbyageandgendertotheexperienceperioddistributionandtheprojectionperioddistribution.
Theprojectedclaimscostiscalculatedbymultiplyingthenormalizedclaimscostbytheimpactofbenefitchanges,anticipatedchangesinpopulationmorbidity,andcostofcareimpacts.Theadjustmentsaredescribedbelow,andthefactorsarepresentedinExhibitD:ProjectionPeriodAdjustments.Inaddition,thesourcedataisnormalizedforchangesintheprovidercontracts.
ChangesinDemographics(Normalization)
AdjustmentsMadetotheDataThedevelopmentoftheprojectedclaimsissummarizedinExhibitA:BaseRateDevelopment,items(1)(10),anddescribedindetailbelow.
Otherthancompletingtheincurredclaims,nofurtherexplicitadjustmentsaremadetotheexperiencedata.
Formoredetail,seeExhibitB:ClaimsExperienceforManualRateDevelopment.
ThesourcedataunderlyingthedevelopmentofthemanualrateconsistsofclaimsforallGrandfatheredandNonGrandfatheredSmallGroupbusiness,incurredduringtheperiodJanuary1,2013December31,2013andpaidthroughMarch31,2014.CompletionfactorsarethencalculatedtoreflectadditionalmonthsofrunoutafterMarch31,2014.AnthemexpectsalargeportionoftheGrandfatheredpolicyholderstomigratetoACAcompliantpoliciespriortoandduringtheprojectionperiod.
IndevelopingrateseffectiveJanuary1,2015,onlylimited2014experienceisavailable.Thisexperienceisnotdeemedcredibleforpurposesofratedevelopment.
SourceandAppropriatenessofExperienceDataUsed
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TrendFactors
Theannualpricingtrendusedinthedevelopmentoftheratesis9.4%.Thetrendisdevelopedbynormalizinghistoricalbenefitexpenseforchangesintheunderlyingpopulationandknowncostdrivers,andtheresultisprojectedforward.ThetrendincludesavolatilityprovisioninaccordancewithActuarialStandardsofPractice.Theclaimsaretrended25monthsfromthemidpointoftheexperienceperiod,whichisJuly1,2013,tothemidpointoftheprojectionperiod,whichisAugust1,2015.
Themovementassumptionsabovearebasedonmarketresearchandassumptionsontheemployeroptoutandconsumeruptakerates.Themorbidityimpactsofpopulationmovementarebasedonhealthstatusdeterminedfrominternalriskscoredata.
SmallGroupselectingtoremainontheircurrent(nonACA)productsin2015.SmallGroupmemberselectingtoforegoCOBRAcoverageupontermination
SmallGroupsmovingtoselffundedcoverageSmallGroupmembersmovingtoMedicaid
SmallGroupselectingtodropcoverageSmallGroupmemberselectingtobeuninsured
ChangesintheMorbidityofthePopulationInsured
TheclaimsareadjustedtoreflectshiftsinhealthinsurancecoverageasaresultoftheprovisionsoftheACA.Themarketshifts,orpopulationmovements,affectingthemorbidityoftheSmallGroupmarketintheprojectionperiodinclude:
PreventiveRx(overthecounter):Theclaimsareadjustedfor100%coverageofbenefitsforspecificoverthecounterdrugsobtainedwithaprescriptionfromaphysician.
RxAdjustments:TheclaimsareadjustedfordifferencesintheRxformularyaswellasfortheimpactofmovingdrugsintodifferenttiersintheprojectionperiodrelativetowhatisreflectedinthebaseexperiencedata.
ChangesinBenefits
Benefitchangesincludethefollowing:
BenefitPlan:Theexperienceperiodclaimsarenormalizedtoanaverage2015planusingbenefitrelativities.Thebenefitrelativitiesincludethevalueofcostsharesandanticipatedchangesinutilizationduetothedifferenceinaveragecostsharerequirements.
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11.PaidtoAllowedRatio
ResultingCredibilityLevelAssignedtoBasePeriodExperienceThecredibilitylevelassignedtotheexperienceinWorksheet1,SectionIIIoftheUnifiedRateReviewTemplateis0%.
10.CredibilityofExperience
ThecombinationofbothGrandfatheredandNonGrandfatheredexperiencedatamostreasonablyreflectsSmallGroupclaimsexperienceunderthefutureprojectionperiod.ActuarialjudgmenthasbeenexercisedtodeterminethatrateswillbedevelopedgivingfullcredibilitytothedataunderlyingthemanualrateinSection9:CredibilityManualRateDevelopment.
CapitationPaymentsCapitationarrangementsdonotexistforthisbusiness.
RxRebates:TheprojectedclaimscostisadjustedtoreflectanticipatedRxrebates.Theseprojectionstakeintoaccountthemostuptodateinformationregardinganticipatedrebatecontracts,drugprices,anticipatedpriceinflation,andupcomingpatentexpirations.
Thecostofaddingbenefitsforpediatricdentalandvisionareincluded.
OtherClaimAdjustments
TheadjustmentsdescribedbelowarepresentedinExhibitE:OtherClaimAdjustments.
ChangeinMedicalManagement:medicalmanagementsavingsnotalreadyincludedintheclaimsexperienceandtrend.ChangeinProviderContracts:anticipatedchangesinprovidercontractsarereflectedinthebenefitplanfactorsandtheregionratingfactors.
Utilizationorcostperservicechange:anticipatedchangesarereflectedinthemorbiditychangesandtrend.
Projectedtrendsincludetheestimatedcostduring2014and2015ofthepharmaceuticalSovaldiandotherhighcostdrugsfortreatingHepatitisC.ThesecostestimateswerebasedonclaimsexperienceforMissouriSmallGroupbusiness,togetherwithCDCrecommendationsandIndustryandEnterprisedata.
OtherCostofCareImpacts
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ThequalityimprovementexpenserepresentsAnthem'sdedicationtoprovidingthehigheststandardofcustomercareandconsistentlyseekingtoimprovehealthcarequality,outcomesandvalueinacostefficientmanner.
QualityImprovementExpense
AdministrativeExpenseAdministrativeExpensesareexpectedtobeconsistentwithhistoricallevelsandaredevelopedutilizingthesamemethodologyaspreviousfilings,theyarenotvariedbyproductorplan.Maintenancecostsareassumedtobeflatonapermemberbasiswithsavingsfromadministrativeefficienciesandtheeliminationofunderwritingoffsetbynewexpensesforriskmanagementandregulatorycompliance.
13.NonBenefitExpenses,ProfitandRisk
NonBenefitexpensesaredetailedinExhibitG:NonBenefitExpensesandProfit&Risk.
ProjectedACAReinsuranceRecoveriesNetofReinsurancePremiumThetransitionalreinsuranceriskmitigationprogramcollectsfundsfromallinsuranceissuersandTPAsandredistributesthemtohighcostclaimantsintheNonGrandfatheredIndividualmarket.ThereinsurancecontributionisequaltothenationalpercapitareinsurancecontributionrateasshowninExhibitF:RiskAdjustmentandReinsuranceContributionsandPayments.
TheRiskAdjustmentprogramtransfersfundsfromlowerriskplanstohigherriskplansintheNonGrandfatheredIndividualandSmallGroupmarket.TheHHSoperatedRiskAdjustmentprogramissupportedbyauserfee,asshowninExhibitF:RiskAdjustmentandReinsuranceContributionsandPayments.
Anthemisassumingtheriskfortheplansinthisfilingarenobetterorworsethanotherplansinthemarket,resultinginnoestimatedrisktransfervalueasshowninExhibitF:RiskAdjustmentandReinsuranceContributionsandPayments.
12.RiskAdjustmentandReinsurance
ProjectedRiskAdjustment
ThePaidtoAllowedAverageFactorinProjectionPeriodshowninWorksheet1,SectionIIIoftheUnifiedRateReviewTemplateisdevelopedbymembershipweightedessentialhealthbenefitpaidclaimsdividedbymembershipweightedessentialhealthbenefitallowedclaimsofeachplan.TheprojectedmembershipbyplanisshowninWorksheet2,SectionII.
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ProjectedFederalMLR
Profitisreflectedonaposttaxbasisasapercentthatdoesnotvarybyproductorplan.Theprofitpercentagedoesnotincludeanyassumedriskcorridorpaymentsorreceipts.
14.ProjectedLossRatio
Premiumtaxes,federalincometaxesandstateincometaxesarealsoincludedintheretentionitems.
Profit
ACAInsurerFee:Thehealthinsuranceindustrywillbeassessedapermanentfee,basedonmarketshareofnetpremium,whichisnottaxdeductible.Thetaximpactofnondeductibilityiscapturedinthisfee.ExchangeFee:TheExchangeUserFeeappliestoExchangebusinessonly,butthecostisspreadacrossallSmallGroupplans.Ablendedfee/percentageisdeterminedbasedonanassumed10.0%ofmembersthatwillpurchaseproductsOnExchange.Theresultingfee/percentageisappliedevenlytoallplansintheriskpool,bothOnandOffExchange.
TaxesandFeesPatientCenteredOutcomesResearchInstitute(PCORI)Fee:ThePCORIfeeisafederallymandatedfeedesignedtohelpfundthePatientCenteredOutcomesResearchTrustFund.ForplanyearsendingbeforeOctober1,2014,thefeeis$2permemberperyear.Thereafter,foreveryplanyearendingbeforeOctober1,2019,thefeewillincreasebythepercentageincreaseinNationalHealthcareExpenditures.
SellingExpenseSellingExpenserepresentsbrokercommissionsandbonusesassociatedwiththebrokerdistributionchannelusinghistoricalandprojectedcommissionlevels.CommissionswillbepaidbothOnExchangeandOffExchange.
TheQIExpenseassumptionsarebasedonhistoricalamountsrelatedtothefollowinginitiatives:ImproveHealthOutcomes,ActivitiestoPreventHospitalReadmissions,ImprovePatientSafetyandReduceMedicalErrors,WellnessandHealthPromotionActivities,HITExpensesforHealthCareQualityImprovements,OtherCostContainmentandICD10.
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TheindexraterepresentstheaverageallowedclaimsPMPMofessentialhealthbenefitsforAnthem'sSmallGroupNonGrandfatheredBusiness.TheexperienceperiodindexrateshowninWorksheet1,SectionI(cellG17)oftheUnifiedRateReviewTemplateis$316.00andisthesameastheexperienceperiodallowedclaims(cellG16inthesamelocation).Acomparisontothebenchmarkwasperformed,andonlyessentialhealthbenefitswerecoveredduringtheexperienceperiod.
ProjectionPeriodIndexRate
16.IndexRate
ExperiencePeriodIndexRate
15.SingleRiskPool
AsdescribedaboveinSection4:DescriptionofHowtheBaseRateIsDetermined,theAnthemIndexRateforSmallGroupbusinessinMissouriisbasedontotalcombinedclaimscostsforprovidingessentialhealthbenefitswithinthesingleriskpoolofnongrandfatheredSmallGroupplansinMissouri.TheIndexRateisadjustedonamarketwidebasisforthestatebasedonthetotalexpectedmarketwidepaymentsandchargesundertheriskadjustmentandreinsuranceprogramsandExchangeuserfees.ThepremiumratesforallAnthemnongrandfatheredplansintheSmallGroupmarketusetheapplicablemarketwideadjustedindexrate,subjectonlytothepermittedplanleveladjustments.ThisdemonstratesthattheSingleRiskPoolforAnthemSmallGroupbusinessisestablishedaccordingtotherequirementsin45CFRpart156,156.80(d).
TheprojectedFederalMLRfortheproductsinthisfilingisestimatedinExhibitM:FederalMLREstimatedCalculation.PleasenotethatthiscalculationispurelyanestimateandnotmeanttobeatruemeasureforFederalorStateMLRrebatepurposes.TheproductsinthisfilingrepresentonlyasubsetofAnthem'sSmallGroupbusiness.TheMLRforAnthem'sentirebookofSmallGroupbusinesswillbecomparedtotheminimumFederalbenchmarkforpurposesofdeterminingregulationrelatedpremiumrefunds.AlsonotethattheprojectedFederalMLRpresentedheredoesnotcapturealladjustments,includingbutnotlimitedto:threeyearaveraging,credibility,dualoption,anddeductible.Anthem'sprojectedMLRisexpectedtomeetorexceedtheminimumMLRstandardsatthemarketlevelafterincludingalladjustments.
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19.Calibration
AdjustmentsforBenefitsinAdditiontoEHBs:ThismultiplicativefactoradjustsforadditionalbenefitsthatarenotEHBs.Adjustmentsforadministrativecost:ThisisanadditiveadjustmentthatincludesalltheSellingExpense,AdministrationandOtherRetentionItemsshowninExhibitG:NonBenefitExpensesandProfit&Risk,withtheexceptionoftheExchangeUserFee.
CostSharingAdjustments:Thisisamultiplicativefactorthatadjustsfortheprojectedpaid/allowedratioofeachplan,basedontheAVmetalvaluewithanadjustmentforutilizationdifferencesduetodifferencesincostsharing.ThisalsoincludesanadjustmentfortheaveragetobaccofactorshowninExhibitH:Calibration.ProviderNetworkAdjustments:Thisisamultiplicativefactorthatadjustsfordifferencesinprojectedclaimscostduetodifferentnetworkdiscounts.
ThePlanAdjustedIndexRateiscalculatedastheMarketAdjustedIndexRateadjustedforallallowableplanlevelmodifiersdefinedinthemarketratingrules.ThisdevelopmentispresentedinExhibitP:PlanAdjustedIndexRateandConsumerAdjustedPremiumRates.
PlanLevelModifiers
TheMarketAdjustedIndexrateiscalculatedastheIndexRateadjustedforallallowablemarketwidemodifiersdefinedinthemarketratingrules.ThisdevelopmentispresentedinExhibitN:IndexRateDevelopmentandExhibitO:QuarterlyIndex,Base,andMarketAdjustedIndexRateDevelopment.
18.PlanAdjustedIndexRate
QuarterlyindexandbaseratechangeswillbeimplementedOnExchangeandOffExchange.SeeExhibitO:QuarterlyIndex,Base,andMarketAdjustedIndexRateDevelopment.
17.MarketAdjustedIndexRate
TheindexraterepresentstheaverageallowedclaimsPMPMofessentialhealthbenefitsforAnthem'sSmallGroupNonGrandfatheredBusiness.TheprojectionperiodindexratewasdevelopedasshowninExhibitN:IndexRateDevelopmentbyadjustingtheprojectedincurredclaimsPMPMdescribedinSection9:CredibilityManualRateDevelopmentofthismemorandum.Coveredbenefitsinexcessofessentialhealthbenefitsthatareincludedintheprojectionperiodallowedclaims(cellT30ofWorksheet1,SectionIIoftheUnifiedRateReviewTemplate)butexcludedfromExhibitN:IndexRateDevelopment'sprojectionperiodindexrate(alsoshownincellV44ofWorksheet1,SectionIIIoftheUnifiedRateReviewTemplate)arewellnessbenefitsincludingonlinefitnesstrainers,tobaccofreecertification,andfitnessreimbursement.
QuarterlyIndexandBaseRate
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21.ActuarialValueMetalValues
20.ConsumerAdjustedPremiumRate
TheConsumerAdjustedPremiumRateiscalculatedasthePlanAdjustedIndexRatecalibratedasdescribedintheprevioussection.ThisdevelopmentispresentedinExhibitP:PlanAdjustedIndexRateandConsumerAdjustedPremiumRates.ThecalibrationisshowninExhibitH:Calibration.
In2014,theareafactorsvariedbyplanbasedonactuariallyjustifiednetworkcostdifferencesforeachgeographicratingarea.EffectiveJanuary1,2015,asingleareafactorwillapplytoallplansineachgeographicratingarea.
Areafactorshavebeenadjustedtoreflectthemostcurrentexperience.RefertoExhibitK:AreaFactors.
AgeFactorsAreaFactors
ProviderNetwork:Thisfactoraccountsfordifferencesincontractedratesandnetworkstructure.
RefertoExhibitI:NonGrandfatheredBenefitPlanFactorsandRateIncreases.
PediatricDentalandVisionBenefits:Forplansexcludingthepediatricdentalbenefitandpediatricvisionbenefit,thebenefitplanfactorreflectsreducedbenefits.
NonEHBs:ForplansincludingbenefitsinadditiontoEHBs,thebenefitplanfactorreflectsenhancedbenefits.
Benefitplanfactorsalsoconsiderthefollowingadjustments,asapplicable.
BenefitRichnessFactorAdjustment:Thisadjustmentaccountsformemberbehaviorvariationsdependingontherichnessofthebenefitdesign.
BenefitPlanFactorsThebenefitplanratingfactorsareappliedtotheprojectionperioddistribution.
Therequiredpremiumintheprojectionperiodiscalibratedbytheaverageratingcalibrationfactors(Age,Area,andPlanFactor),whichareusedtodeveloptheConsumerAdjustedPremiumRates.TheaverageratingfactorsareshowninExhibitH:Calibration,ExhibitP:PlanAdjustedIndexRateandConsumerAdjustedPremiumRates,andappliedinlineitem14ofExhibitA:BaseRateDevelopment.
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25.TerminatedProducts
24.WarningAlerts
TherearewarningalertsincellsA80andA82onWorksheet2,SectionIVoftheUnifiedRateReviewTemplate.ThisisbecausetheSmallGroupPlanAdjustedIndexRatesreflectthememberweightedaverageoftheratesforalleffectivedatesinthefiling,whereastheWorksheet1SingleRiskPoolGrossPremiumAvg.RatereflectstheeffectivedateofthechangeintheIndexRate.
Theplandistributionisbasedonassumedmetaltierandnetworkdistributions.Some2014preliminaryenrollmentinformationhasbeenconsideredinprojectingmembershipdistributions.
TheprojectedmorbiditychangesshowninExhibitD:ProjectionPeriodAdjustmentsincludeexpectedmorbiditychangesduetopopulationmovement.
SmallGroupmemberselectingtoforegoCOBRAcoverageupontermination
SmallGroupsdroppingcoverageSmallGroupmembersoptingoutofcoverage
23.MembershipProjections
MembershipprojectionsinWorksheet2oftheUnifiedRateReviewTemplatearedevelopedusingapopulationmovementmodelplusadjustmentsforsalesexpectations.Thismodelprojectsthemembershipintheprojectionperiodbytakingintoaccount:
22.ActuarialValuePricingValues
TheAVPricingValuesforeachProductIDareinWorksheet2,SectionIoftheUnifiedRateReviewTemplate.TheAVPricingValuerepresentsthecumulativeeffectofadjustmentsmadebytheissuertomovefromtheMarketAdjustedIndexRatetothePlanAdjustedIndexRate.ConsistentwithfinalMarketrules,utilizationadjustmentsaremadetoaccountformemberbehaviorvariationsbaseduponcostsharevariationsofthebenefitdesignandnotthehealthstatusofthemember.TheaverageallowablemodifierstotheIndexRatecanbefoundinExhibitP:PlanAdjustedIndexRateandConsumerAdjustedPremiumRates.
TheActuarialValue(AV)MetalValuesincludedinWorksheet2oftheUnifiedRateReviewTemplatearebasedontheAVCalculator.TotheextentacomponentofthebenefitdesignwasnotaccommodatedbyanavailableinputwithintheAVCalculator,thebenefitcharacteristicwasadjustedtobeactuariallyequivalenttoanavailableinputwithintheAVCalculatorforpurposesofutilizingtheAVCalculatorasthebasisfortheAVMetalValues.BenefitsforPlansthatarenotcompatiblewiththeparametersoftheAVCalculatorhavebeenseparatelyidentifiedanddocumentedintheUniquePlanDesignSupportingDocumentationandJustificationthatsupportsthePlan&BenefitsTemplate.
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(4)TheAVCalculatorwasusedtodeterminetheAVMetalValuesshowninWorksheet2ofthePartIUnifiedRateReviewTemplateforallplans.
(2)TheIndexRateandonlytheallowablemodifiersasdescribedin45CFR156.80(d)(1)and45CFR156.80(d)(2)wereusedtogenerateplanlevelrates.
(3)ThepercentoftotalpremiumthatrepresentsessentialhealthbenefitsincludedinWorksheet2,SectionsIIIandIViscalculatedinaccordancewithactuarialstandardsofpractice.
Reasonableinrelationtothebenefitsprovidedandthepopulationanticipatedtobecovered
Neitherexcessivenordeficient.
IncompliancewithallapplicableStateandFederalStatutesandRegulations(45CFR156.80(d)(1)),
DevelopedincompliancewiththeapplicableActuarialStandardsofPractice
I,NicoleStyka,FSA,MAAA,amanactuaryforAnthem.IamamemberoftheAmericanAcademyofActuariesandaFellowoftheSocietyofActuaries.ImeettheQualificationStandardsoftheAmericanAcademyofActuariestorendertheactuarialopinioncontainedherein.Iherebycertifythatthefollowingstatementsaretruetothebestofmyknowledgewithregardstothisfiling:
(1)TheprojectedIndexRateis:
Insupportofthisratedevelopment,variousdataandanalyseswereprovidedbyothermembersofAnthem'sinternalactuarialstaff,includingdataandanalysisrelatedtocostofcare,valuation,andpricing.Ihavereviewedthesedataandanalysesforreasonablenessandconsistency.IhavealsoreliedonBrianRenshaw,FSA,MAAAtoprovidetheactuarialcertificationfortheUniquePlanDesignSupportingDocumentationandJustificationforplansincludedinthisfiling.
28.ActuarialCertification
PlantypesinWorksheet2,SectionIoftheURRTadequatelydescribeAnthem'splans.
27.Reliance
26.PlanTypeThelistofterminatedproductsisshowninExhibitQ:TerminatedProducts.
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DateAugust20,2014
NicoleStyka,FSA,MAAARegionalVicePresidentandActuaryIII
ThePartIUnifiedRateReviewTemplatedoesnotdemonstratetheprocessusedbytheissuertodeveloptherates.RatheritrepresentsinformationrequiredbyFederalregulationtobeprovidedinsupportofthereviewofrateincreases,forcertificationofQualifiedHealthPlansforFederallyFacilitatedExchanges,andforcertificationthattheIndexRateisdevelopedinaccordancewithFederalregulation,usedconsistently,andonlyadjustedbytheallowablemodifiers.However,thisActuarialMemodoesaccuratelydescribetheprocessusedbytheissuertodeveloptherates.
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PaidClaims1) ExperiencePeriodCostPMPM 253.96$ ExhibitB2) xNormalizationFactor 0.8777 ExhibitC3) =NormalizedClaims 222.90$ =(1)x(2)
4) xBenefitChanges 0.9918 ExhibitD5) xMorbidityChanges 1.1022 ExhibitD6) xTrendFactor 1.2057 ExhibitD7) xOtherCostofCareImpacts 1.0000 ExhibitD8) =ProjectedClaimCost 293.79$ =(3)x(4)x(5)x(6)x(7)9) +OtherClaimAdjustments (4.22)$ ExhibitE10) =ClaimsProjectedtoProjectionPeriod 289.57$ =(8)+(9)11) +RiskAdjustmentandReinsuranceContributionsandPayments 3.63$ ExhibitF12) +NonBenefitExpensesandProfit&Risk{1} 83.25$ ExhibitG13) =RequiredPremiuminProjectionPeriod 376.45$ =(10)+(11)+(12)14) CalibrationFactor 1.4006 ExhibitH15) TobaccoAverageRatingFactor 1.0032 ExhibitH16) =RequiredBaseRate(AveragePlanLevelAge21NonTobacco) 267.92$ =(13)(14)(15)
17) ProjectedLossRatio(ConventionalBasis) 77.9% =[(10)+(11)](13)
NOTES:
Exhibit A - Base Rate Development
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
{1}EquivalenttoPMPMexpensesonExhibitG+%ofpremiumexpensesonExhibitGappliedtoRequiredPremium(Row13above).
-
Total Member TotalMedical Drug Medical Drug Medical Drug Capitation BenefitExpense Months PMPM314,414,330$ 112,466,759$ 33,311,813$ 4,155,407$ 347,726,143$ 116,622,166$ $ 464,348,309$ 1,828,457 253.96$
Total Member TotalMedical Drug Medical Drug Medical Drug Capitation BenefitExpense Months PMPM422,452,256$ 138,035,690$ 45,310,539$ 5,079,151$ 467,762,795$ 143,114,841$ $ 610,877,636$ 1,828,457 334.09$
IncurredandPaidClaims: IBNR: FullyIncurredClaims:
PAID CLAIMS:IncurredandPaidClaims: IBNR: FullyIncurredClaims:
ALLOWED CLAIMS:
Exhibit B - Claims Experience for Manual Rate Development
Healthy Alliance Life Insurance CompanySmall Group
Incurred January 1, 2013 through December 31, 2013Paid through March 31, 2014
-
ExperiencePeriodPopulation
FuturePopulation
NormalizationFactor
Age/Gender 0.9696 1.0223 1.0544Area/Network 1.0108 0.9932 0.9826BenefitPlan 0.8098 0.6860 0.8472Total 0.8777
Exhibit C - Normalization Factors
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
AverageClaimFactors
-
AdjustmentFactorBenefitchanges
PreventiveRx(overthecounter) 1.0001RxAdjustments{1} 0.9917TotalBenefitChanges 0.9918
MorbiditychangesTotalMorbidityChanges 1.1022
CostofcareimpactsAnnualMedical/RxTrendRate 9.39%1MonthsofProjection 25TrendFactor 1.2057TotalotherImpacts 1.0000
NOTES:
Exhibit D - Projection Period Adjustments
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
ImpactofChangesBetweenExperiencePeriodandProjectionPeriod:
{1}IncludesRxformularyandimpactsformovingdrugsintodifferenttiers
-
PMPMRxRebates ($6.50)PediatricDental $0.80PediatricVision $0.99CCPPackages $0.49Total ($4.22)
NOTES:
Exhibit E - Other Claim Adjustments
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
Adjustmentstoprojectionperiodclaimstoreflectcoveredbenefitsnotincludedinexperienceperioddata:
AdjustmentsabovereflectONLYadditionalcostsbeyondthosealreadycapturedinlineItem8ofExhibitA.
-
RiskAdjustment:PMPM UserFee NetTransferFederalProgram $0.08 $0.00
Note:
Reinsurance:
PMPM ContributionsMade ExpectedReceipts
FederalProgram $3.55 $0.00Source:
GrandTotalofAllRiskMitigationPrograms $3.63
NOTES:$3.55 =$13.67*(11months/12months)+$12.30*(1month/12months)$3.67 =2015contribution$2.30 =2016contribution
SmallGroupPlanscontributefundsbutonlyIndividualPlansareeligibletoreceivepayments
HHSestimatesanationalpercapitacontributionrateof$13.67permonth($44peryear)inbenefityear2015(perPaymentParameterRule).
Exhibit F - Risk Adjustment and Reinsurance - Contributions and Payments
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
Itisassumedtheriskfortheplansincludedinthisratefilingisnobetter/worsethananyotherplanswithinthismarket.
-
ExpensesAppliedAsaPMPMCost
ExpensesAppliedasa%ofPremium
ExpressedasaPMPM{1}
AdministrativeExpensesAdministrativeCosts $17.42QualityImprovementExpense $3.27SellingExpense $14.52SpecialtyExpenses $0.31
TotalAdministrativeExpenses $35.52 0.00% $35.52TaxesandFees
PCORIFee $0.18ACAInsurerFee 3.55%ExchangeFee 0.35%PremiumTax 0.34%MLRDeductibleFederal/StateIncomeTaxes{2} 2.94%
TotalTaxesandFees $0.18 7.18% $27.21ProfitandRisk{3} 5.45% $20.52TotalNonBenefitExpenses,Profit,andRisk $35.70 12.63% $83.25
NOTES:
{3}Profitshownhereisposttaxprofit,netofthosefederalandstateincometaxeswhicharedeductiblefromtheMLRdenominator.
Exhibit G - Non-Benefit Expenses and Profit & Risk
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
{1}Thesumoftheroundedpercentagesshownmaynotequalthetotalatthebottomofthetableduetorounding.{2}IncludesonlythoseincometaxeswhicharedeductiblefromtheMLRdenominator;inparticular,Federalincometaxesoninvestmentincomeareexcluded.
-
AverageRatingFactorTobacco 1.0032
CalibrationFactorsAge 1.4008Area 0.9999BenefitPlan 1.0000TotalCalibrationFactor 1.4006TotalAverageRatingFactor 1.4051
NOTES:
Thebaserateisdevelopedbydividingtherequiredpremiumintheprojectionperiodbythetotalaverageratingfactorshownabove.
Exhibit H - Calibration
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
Average2015ratingfactorsfor2015population:
SeeLineItem14onExhibitA.
-
HIOSPlanName 2015HIOSPlanIDOn/OffExchange MetalLevel
BenefitPlanFactor NetworkName Area(s)Offered
2014HIOSPlanIDMapping
PlanSpecificRateIncrease*
(excludingaging)AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780011 On/Off Bronze 0.8076 MOSG::BluePreferred 02 32753MO0780003 10.45%AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780012 On/Off Bronze 0.7847 MOSG::BluePreferred 05 32753MO0780003 6.40%AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780013 On/Off Bronze 0.7760 MOSG::BluePreferred 06 32753MO0780003 3.45%AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780014 On/Off Bronze 0.7468 MOSG::BluePreferred 07 32753MO0780003 4.86%AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780015 On/Off Bronze 0.7349 MOSG::BluePreferred 08 32753MO0780003 9.17%AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780016 On/Off Bronze 0.7701 MOSG::BluePreferred 09 32753MO0780003 5.95%AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780017 On/Off Bronze 0.7751 MOSG::BluePreferred 10 32753MO0780003 4.10%AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780018 On/Off Silver 1.0485 MOSG::BluePreferred 02 32753MO0780002 26.06%AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780019 On/Off Silver 1.0187 MOSG::BluePreferred 05 32753MO0780002 21.44%AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780020 On/Off Silver 1.0075 MOSG::BluePreferred 06 32753MO0780002 18.07%AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780021 On/Off Silver 0.9696 MOSG::BluePreferred 07 32753MO0780002 8.59%AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780022 On/Off Silver 0.9541 MOSG::BluePreferred 08 32753MO0780002 3.67%AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780023 On/Off Silver 0.9999 MOSG::BluePreferred 09 32753MO0780002 20.92%AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780024 On/Off Silver 1.0064 MOSG::BluePreferred 10 32753MO0780002 18.81%AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780004 On/Off Gold 1.1668 MOSG::BluePreferred 02 32753MO0780001 12.88%AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780005 On/Off Gold 1.1337 MOSG::BluePreferred 05 32753MO0780001 8.74%AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780006 On/Off Gold 1.1212 MOSG::BluePreferred 06 32753MO0780001 5.73%AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780007 On/Off Gold 1.0790 MOSG::BluePreferred 07 32753MO0780001 2.77%AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780008 On/Off Gold 1.0618 MOSG::BluePreferred 08 32753MO0780001 7.17%AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780009 On/Off Gold 1.1127 MOSG::BluePreferred 09 32753MO0780001 8.28%AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780010 On/Off Gold 1.1199 MOSG::BluePreferred 10 32753MO0780001 6.39%AnthemBronzeBlueAccess4500E/0%/6350w/HSA 32753MO0790260 Off Bronze 0.9067 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790023 8.76%AnthemBronzeBlueAccessChoice4500E/0%/6350w/HSA 32753MO0790261 Off Bronze 0.9067 MOSG::BlueAccessChoice 06 32753MO0790114 10.21%AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790262 Off Bronze 0.8796 MOSG::BluePreferred 02 32753MO0790115 17.68%AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790263 Off Bronze 0.8546 MOSG::BluePreferred 05 32753MO0790115 13.36%AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790264 Off Bronze 0.8452 MOSG::BluePreferred 06 32753MO0790115 10.22%AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790265 Off Bronze 0.8134 MOSG::BluePreferred 07 32753MO0790115 1.36%AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790266 Off Bronze 0.8004 MOSG::BluePreferred 08 32753MO0790115 3.23%AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790267 Off Bronze 0.8388 MOSG::BluePreferred 09 32753MO0790115 12.88%AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790268 Off Bronze 0.8442 MOSG::BluePreferred 10 32753MO0790115 10.91%AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790287 Off Bronze 0.8881 MOSG::BluePreferred 02 32753MO0790185 28.24%AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790288 Off Bronze 0.8629 MOSG::BluePreferred 05 32753MO0790185 23.54%AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790289 Off Bronze 0.8535 MOSG::BluePreferred 06 32753MO0790185 20.11%AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790290 Off Bronze 0.8213 MOSG::BluePreferred 07 32753MO0790185 10.46%AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790291 Off Bronze 0.8082 MOSG::BluePreferred 08 32753MO0790185 5.46%AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790292 Off Bronze 0.8470 MOSG::BluePreferred 09 32753MO0790185 23.01%AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790293 Off Bronze 0.8525 MOSG::BluePreferred 10 32753MO0790185 20.86%AnthemBronzeBlueAccessChoice6000/0%/6600Plus 32753MO0790294 Off Bronze 0.9156 MOSG::BlueAccessChoice 06 32753MO0790184 20.10%AnthemBronzeBlueAccess6000/0%/6600Plus 32753MO0790295 Off Bronze 0.9156 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790071 18.53%
Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
25
-
HIOSPlanName 2015HIOSPlanIDOn/OffExchange MetalLevel
BenefitPlanFactor NetworkName Area(s)Offered
2014HIOSPlanIDMapping
PlanSpecificRateIncrease*
(excludingaging)
Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
AnthemSilverBlueAccessChoice3000/20%/4500Plus 32753MO0790195 Off Silver 1.0241 MOSG::BlueAccessChoice 06 32753MO0790174 15.92%AnthemSilverBlueAccess3000/20%/4500Plus 32753MO0790196 Off Silver 1.0241 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790057 14.40%AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790197 Off Silver 0.9934 MOSG::BluePreferred 02 32753MO0790175 23.78%AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790198 Off Silver 0.9652 MOSG::BluePreferred 05 32753MO0790175 19.24%AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790199 Off Silver 0.9546 MOSG::BluePreferred 06 32753MO0790175 15.93%AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790200 Off Silver 0.9186 MOSG::BluePreferred 07 32753MO0790175 6.61%AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790201 Off Silver 0.9039 MOSG::BluePreferred 08 32753MO0790175 1.78%AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790202 Off Silver 0.9473 MOSG::BluePreferred 09 32753MO0790175 18.72%AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790203 Off Silver 0.9535 MOSG::BluePreferred 10 32753MO0790175 16.66%AnthemSilverBluePreferredOptions2750/40%/6600 32753MO0790259 Off Silver 0.8966 MOSG::BluePreferredOptions 10 None n/aAnthemSilverBlueAccess4000E/0%/5000w/HSA 32753MO0790278 Off Silver 0.9713 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790033 8.12%AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790279 Off Silver 0.9422 MOSG::BluePreferred 02 32753MO0790129 16.98%AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790280 Off Silver 0.9154 MOSG::BluePreferred 05 32753MO0790129 12.69%AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790281 Off Silver 0.9054 MOSG::BluePreferred 06 32753MO0790129 9.56%AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790282 Off Silver 0.8713 MOSG::BluePreferred 07 32753MO0790129 0.76%AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790283 Off Silver 0.8573 MOSG::BluePreferred 08 32753MO0790129 3.81%AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790284 Off Silver 0.8985 MOSG::BluePreferred 09 32753MO0790129 12.20%AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790285 Off Silver 0.9043 MOSG::BluePreferred 10 32753MO0790129 10.25%AnthemSilverBlueAccessChoice4000E/0%/5000w/HSA 32753MO0790286 Off Silver 0.9713 MOSG::BlueAccessChoice 06 32753MO0790128 9.55%AnthemSilverBlueAccessChoice2000/30%/6600 32753MO0790296 Off Silver 1.0079 MOSG::BlueAccessChoice 06 None n/aAnthemSilverBluePreferred2000/30%/6600 32753MO0790297 Off Silver 0.9777 MOSG::BluePreferred 02 32753MO0790149 15.10%AnthemSilverBluePreferred2000/30%/6600 32753MO0790298 Off Silver 0.9500 MOSG::BluePreferred 05 32753MO0790149 10.88%AnthemSilverBluePreferred2000/30%/6600 32753MO0790299 Off Silver 0.9396 MOSG::BluePreferred 06 32753MO0790149 7.81%AnthemSilverBluePreferred2000/30%/6600 32753MO0790300 Off Silver 0.9042 MOSG::BluePreferred 07 32753MO0790149 0.85%AnthemSilverBluePreferred2000/30%/6600 32753MO0790301 Off Silver 0.8897 MOSG::BluePreferred 08 32753MO0790149 5.35%AnthemSilverBluePreferred2000/30%/6600 32753MO0790302 Off Silver 0.9324 MOSG::BluePreferred 09 32753MO0790149 10.41%AnthemSilverBluePreferred2000/30%/6600 32753MO0790303 Off Silver 0.9385 MOSG::BluePreferred 10 32753MO0790149 8.48%AnthemSilverBlueAccess2000/30%/6600 32753MO0790304 Off Silver 1.0079 MOSG::BlueAccess 02,05,07,08,09,10 None n/aAnthemSilverBluePreferred5000/20%/6600 32753MO0790305 Off Silver 0.9244 MOSG::BluePreferred 02 32753MO0790163 14.73%AnthemSilverBluePreferred5000/20%/6600 32753MO0790306 Off Silver 0.8982 MOSG::BluePreferred 05 32753MO0790163 10.52%AnthemSilverBluePreferred5000/20%/6600 32753MO0790307 Off Silver 0.8883 MOSG::BluePreferred 06 32753MO0790163 7.46%AnthemSilverBluePreferred5000/20%/6600 32753MO0790308 Off Silver 0.8548 MOSG::BluePreferred 07 32753MO0790163 1.18%AnthemSilverBluePreferred5000/20%/6600 32753MO0790309 Off Silver 0.8412 MOSG::BluePreferred 08 32753MO0790163 5.65%AnthemSilverBluePreferred5000/20%/6600 32753MO0790310 Off Silver 0.8815 MOSG::BluePreferred 09 32753MO0790163 10.05%AnthemSilverBluePreferred5000/20%/6600 32753MO0790311 Off Silver 0.8873 MOSG::BluePreferred 10 32753MO0790163 8.13%AnthemSilverBlueAccessChoice5000/20%/6600 32753MO0790312 Off Silver 0.9530 MOSG::BlueAccessChoice 06 32753MO0790162 7.45%AnthemSilverBlueAccess5000/20%/6600 32753MO0790313 Off Silver 0.9530 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790051 6.04%AnthemSilverBlueAccess2600E/20%/5500w/HSA 32753MO0790314 Off Silver 0.9649 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790016 0.23%AnthemSilverBlueAccessChoice2600E/20%/5500w/HSA 32753MO0790315 Off Silver 0.9649 MOSG::BlueAccessChoice 06 32753MO0790100 1.56%
26
-
HIOSPlanName 2015HIOSPlanIDOn/OffExchange MetalLevel
BenefitPlanFactor NetworkName Area(s)Offered
2014HIOSPlanIDMapping
PlanSpecificRateIncrease*
(excludingaging)
Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790316 Off Silver 0.9360 MOSG::BluePreferred 02 32753MO0790101 8.44%AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790317 Off Silver 0.9095 MOSG::BluePreferred 05 32753MO0790101 4.47%AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790318 Off Silver 0.8995 MOSG::BluePreferred 06 32753MO0790101 1.57%AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790319 Off Silver 0.8656 MOSG::BluePreferred 07 32753MO0790101 6.59%AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790320 Off Silver 0.8518 MOSG::BluePreferred 08 32753MO0790101 10.82%AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790321 Off Silver 0.8926 MOSG::BluePreferred 09 32753MO0790101 4.02%AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790322 Off Silver 0.8984 MOSG::BluePreferred 10 32753MO0790101 2.21%AnthemGoldBlueAccessChoice1000/20%/2500Plus 32753MO0790186 Off Gold 1.2315 MOSG::BlueAccessChoice 06 32753MO0790166 9.26%AnthemGoldBlueAccess1000/20%/2500Plus 32753MO0790187 Off Gold 1.2315 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790053 7.82%AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790188 Off Gold 1.1946 MOSG::BluePreferred 02 32753MO0790167 16.66%AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790189 Off Gold 1.1607 MOSG::BluePreferred 05 32753MO0790167 12.38%AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790190 Off Gold 1.1480 MOSG::BluePreferred 06 32753MO0790167 9.27%AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790191 Off Gold 1.1048 MOSG::BluePreferred 07 32753MO0790167 0.49%AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790192 Off Gold 1.0871 MOSG::BluePreferred 08 32753MO0790167 4.06%AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790193 Off Gold 1.1393 MOSG::BluePreferred 09 32753MO0790167 11.90%AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790194 Off Gold 1.1466 MOSG::BluePreferred 10 32753MO0790167 9.95%AnthemGoldBluePreferredOptions500/20%/4000 32753MO0790204 Off Gold 1.1425 MOSG::BluePreferredOptions 10 None n/aAnthemGoldBlueAccessChoice1500/30%/5000 32753MO0790205 Off Gold 1.1854 MOSG::BlueAccessChoice 06 32753MO0790140 5.98%AnthemGoldBluePreferred1500/30%/5000 32753MO0790206 Off Gold 1.1499 MOSG::BluePreferred 02 32753MO0790141 13.16%AnthemGoldBluePreferred1500/30%/5000 32753MO0790207 Off Gold 1.1173 MOSG::BluePreferred 05 32753MO0790141 9.01%AnthemGoldBluePreferred1500/30%/5000 32753MO0790208 Off Gold 1.1050 MOSG::BluePreferred 06 32753MO0790141 5.99%AnthemGoldBluePreferred1500/30%/5000 32753MO0790209 Off Gold 1.0634 MOSG::BluePreferred 07 32753MO0790141 2.53%AnthemGoldBluePreferred1500/30%/5000 32753MO0790210 Off Gold 1.0464 MOSG::BluePreferred 08 32753MO0790141 6.94%AnthemGoldBluePreferred1500/30%/5000 32753MO0790211 Off Gold 1.0966 MOSG::BluePreferred 09 32753MO0790141 8.54%AnthemGoldBluePreferred1500/30%/5000 32753MO0790212 Off Gold 1.1037 MOSG::BluePreferred 10 32753MO0790141 6.65%AnthemGoldBlueAccess1500/30%/5000 32753MO0790213 Off Gold 1.1854 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790039 4.59%AnthemGoldBlueAccessChoice5000/0%/5000 32753MO0790214 Off Gold 1.1306 MOSG::BlueAccessChoice 06 32753MO0790158 6.28%AnthemGoldBlueAccess5000/0%/5000 32753MO0790215 Off Gold 1.1306 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790049 4.88%AnthemGoldBluePreferred5000/0%/5000 32753MO0790216 Off Gold 1.0967 MOSG::BluePreferred 02 32753MO0790159 13.48%AnthemGoldBluePreferred5000/0%/5000 32753MO0790217 Off Gold 1.0656 MOSG::BluePreferred 05 32753MO0790159 9.32%AnthemGoldBluePreferred5000/0%/5000 32753MO0790218 Off Gold 1.0539 MOSG::BluePreferred 06 32753MO0790159 6.28%AnthemGoldBluePreferred5000/0%/5000 32753MO0790219 Off Gold 1.0142 MOSG::BluePreferred 07 32753MO0790159 2.26%AnthemGoldBluePreferred5000/0%/5000 32753MO0790220 Off Gold 0.9980 MOSG::BluePreferred 08 32753MO0790159 6.68%AnthemGoldBluePreferred5000/0%/5000 32753MO0790221 Off Gold 1.0459 MOSG::BluePreferred 09 32753MO0790159 8.85%AnthemGoldBluePreferred5000/0%/5000 32753MO0790222 Off Gold 1.0527 MOSG::BluePreferred 10 32753MO0790159 6.95%AnthemGoldBluePreferred3500/0%/4000 32753MO0790223 Off Gold 1.1643 MOSG::BluePreferred 02 32753MO0790157 10.89%AnthemGoldBluePreferred3500/0%/4000 32753MO0790224 Off Gold 1.1312 MOSG::BluePreferred 05 32753MO0790157 6.82%AnthemGoldBluePreferred3500/0%/4000 32753MO0790225 Off Gold 1.1188 MOSG::BluePreferred 06 32753MO0790157 3.86%AnthemGoldBluePreferred3500/0%/4000 32753MO0790226 Off Gold 1.0766 MOSG::BluePreferred 07 32753MO0790157 4.49%
27
-
HIOSPlanName 2015HIOSPlanIDOn/OffExchange MetalLevel
BenefitPlanFactor NetworkName Area(s)Offered
2014HIOSPlanIDMapping
PlanSpecificRateIncrease*
(excludingaging)
Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
AnthemGoldBluePreferred3500/0%/4000 32753MO0790227 Off Gold 1.0594 MOSG::BluePreferred 08 32753MO0790157 8.81%AnthemGoldBluePreferred3500/0%/4000 32753MO0790228 Off Gold 1.1103 MOSG::BluePreferred 09 32753MO0790157 6.36%AnthemGoldBluePreferred3500/0%/4000 32753MO0790229 Off Gold 1.1175 MOSG::BluePreferred 10 32753MO0790157 4.51%AnthemGoldBlueAccess3500/0%/4000 32753MO0790230 Off Gold 1.2002 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790048 2.49%AnthemGoldBlueAccessChoice3500/0%/4000 32753MO0790231 Off Gold 1.2002 MOSG::BlueAccessChoice 06 32753MO0790156 3.85%AnthemGoldBlueAccessChoice1000/20%/3500 32753MO0790232 Off Gold 1.2524 MOSG::BlueAccessChoice 06 None n/aAnthemGoldBlueAccess1000/20%/3500 32753MO0790233 Off Gold 1.2524 MOSG::BlueAccess 02,05,07,08,09,10 None n/aAnthemGoldBluePreferred1000/20%/3500 32753MO0790234 Off Gold 1.2148 MOSG::BluePreferred 02 32753MO0790042 11.13%AnthemGoldBluePreferred1000/20%/3500 32753MO0790235 Off Gold 1.1804 MOSG::BluePreferred 05 32753MO0790042 7.05%AnthemGoldBluePreferred1000/20%/3500 32753MO0790236 Off Gold 1.1674 MOSG::BluePreferred 06 32753MO0790042 4.08%AnthemGoldBluePreferred1000/20%/3500 32753MO0790237 Off Gold 1.1234 MOSG::BluePreferred 07 32753MO0790042 4.28%AnthemGoldBluePreferred1000/20%/3500 32753MO0790238 Off Gold 1.1055 MOSG::BluePreferred 08 32753MO0790042 8.61%AnthemGoldBluePreferred1000/20%/3500 32753MO0790239 Off Gold 1.1585 MOSG::BluePreferred 09 32753MO0790042 6.59%AnthemGoldBluePreferred1000/20%/3500 32753MO0790240 Off Gold 1.1660 MOSG::BluePreferred 10 32753MO0790042 4.74%AnthemGoldBlueAccess2500/20%/4500 32753MO0790241 Off Gold 1.1673 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790041 4.36%AnthemGoldBlueAccessChoice2500/20%/4500 32753MO0790242 Off Gold 1.1673 MOSG::BlueAccessChoice 06 32753MO0790144 5.75%AnthemGoldBluePreferred2500/20%/4500 32753MO0790243 Off Gold 1.1323 MOSG::BluePreferred 02 32753MO0790145 12.91%AnthemGoldBluePreferred2500/20%/4500 32753MO0790244 Off Gold 1.1001 MOSG::BluePreferred 05 32753MO0790145 8.77%AnthemGoldBluePreferred2500/20%/4500 32753MO0790245 Off Gold 1.0881 MOSG::BluePreferred 06 32753MO0790145 5.75%AnthemGoldBluePreferred2500/20%/4500 32753MO0790246 Off Gold 1.0471 MOSG::BluePreferred 07 32753MO0790145 2.74%AnthemGoldBluePreferred2500/20%/4500 32753MO0790247 Off Gold 1.0303 MOSG::BluePreferred 08 32753MO0790145 7.15%AnthemGoldBluePreferred2500/20%/4500 32753MO0790248 Off Gold 1.0798 MOSG::BluePreferred 09 32753MO0790145 8.31%AnthemGoldBluePreferred2500/20%/4500 32753MO0790249 Off Gold 1.0868 MOSG::BluePreferred 10 32753MO0790145 6.42%AnthemGoldBlueAccessChoice1500/20%/4000 32753MO0790250 Off Gold 1.2267 MOSG::BlueAccessChoice 06 32753MO0790154 5.80%AnthemGoldBlueAccess1500/20%/4000 32753MO0790251 Off Gold 1.2267 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790047 4.41%AnthemGoldBluePreferred1500/20%/4000 32753MO0790252 Off Gold 1.1899 MOSG::BluePreferred 02 32753MO0790155 12.96%AnthemGoldBluePreferred1500/20%/4000 32753MO0790253 Off Gold 1.1561 MOSG::BluePreferred 05 32753MO0790155 8.82%AnthemGoldBluePreferred1500/20%/4000 32753MO0790254 Off Gold 1.1435 MOSG::BluePreferred 06 32753MO0790155 5.80%AnthemGoldBluePreferred1500/20%/4000 32753MO0790255 Off Gold 1.1004 MOSG::BluePreferred 07 32753MO0790155 2.70%AnthemGoldBluePreferred1500/20%/4000 32753MO0790256 Off Gold 1.0828 MOSG::BluePreferred 08 32753MO0790155 7.11%AnthemGoldBluePreferred1500/20%/4000 32753MO0790257 Off Gold 1.1348 MOSG::BluePreferred 09 32753MO0790155 8.35%AnthemGoldBluePreferred1500/20%/4000 32753MO0790258 Off Gold 1.1421 MOSG::BluePreferred 10 32753MO0790155 6.47%AnthemGoldBluePreferred500/20%/3500 32753MO0790269 Off Gold 1.2414 MOSG::BluePreferred 02 32753MO0790077 11.53%AnthemGoldBluePreferred500/20%/3500 32753MO0790270 Off Gold 1.2062 MOSG::BluePreferred 05 32753MO0790077 7.44%AnthemGoldBluePreferred500/20%/3500 32753MO0790271 Off Gold 1.1929 MOSG::BluePreferred 06 32753MO0790077 4.46%AnthemGoldBluePreferred500/20%/3500 32753MO0790272 Off Gold 1.1480 MOSG::BluePreferred 07 32753MO0790077 3.93%AnthemGoldBluePreferred500/20%/3500 32753MO0790273 Off Gold 1.1297 MOSG::BluePreferred 08 32753MO0790077 8.28%AnthemGoldBluePreferred500/20%/3500 32753MO0790274 Off Gold 1.1839 MOSG::BluePreferred 09 32753MO0790077 6.98%AnthemGoldBluePreferred500/20%/3500 32753MO0790275 Off Gold 1.1915 MOSG::BluePreferred 10 32753MO0790077 5.12%
28
-
HIOSPlanName 2015HIOSPlanIDOn/OffExchange MetalLevel
BenefitPlanFactor NetworkName Area(s)Offered
2014HIOSPlanIDMapping
PlanSpecificRateIncrease*
(excludingaging)
Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
AnthemGoldBlueAccessChoice500/20%/3500 32753MO0790276 Off Gold 1.2797 MOSG::BlueAccessChoice 06 32753MO0790076 4.45%AnthemGoldBlueAccess500/20%/3500 32753MO0790277 Off Gold 1.2797 MOSG::BlueAccess 02,05,07,08,09,10 32753MO0790004 3.08%AnthemGoldBlueAccess2000/0%/4000 32753MO0790323 Off Gold 1.2607 MOSG::BlueAccess 02,05,07,08,09,10 None n/aAnthemGoldBlueAccessChoice2000/0%/4000 32753MO0790324 Off Gold 1.2607 MOSG::BlueAccessChoice 06 None n/aAnthemGoldBluePreferred2000/0%/4000 32753MO0790325 Off Gold 1.2229 MOSG::BluePreferred 02 None n/aAnthemGoldBluePreferred2000/0%/4000 32753MO0790326 Off Gold 1.1882 MOSG::BluePreferred 05 None n/aAnthemGoldBluePreferred2000/0%/4000 32753MO0790327 Off Gold 1.1751 MOSG::BluePreferred 06 None n/aAnthemGoldBluePreferred2000/0%/4000 32753MO0790328 Off Gold 1.1309 MOSG::BluePreferred 07 None n/aAnthemGoldBluePreferred2000/0%/4000 32753MO0790329 Off Gold 1.1128 MOSG::BluePreferred 08 None n/aAnthemGoldBluePreferred2000/0%/4000 32753MO0790330 Off Gold 1.1662 MOSG::BluePreferred 09 None n/aAnthemGoldBluePreferred2000/0%/4000 32753MO0790331 Off Gold 1.1737 MOSG::BluePreferred 10 None n/a
NOTES:
Planlevelincreasesinratesdonotincludedemographicchangesinthepopulation.
BenefitPlanFactorsabovereflectplanbyplandifferencesfromtheindexrateforallowableadjustmentsasdescribedindetailintheMarketReformandPaymentParametersRegulationsandillustratedinExhibitP.TheweightedaverageoftheseadjustmentsfortheentireriskpoolincludedinthisratefilingisdetailedinExhibitH.
29
-
Age AgeRatingFactor TobaccoRatingFactor017 0.635 1.00018 0.635 1.00019 0.635 1.00020 0.635 1.00021 1.000 1.00022 1.000 1.00023 1.000 1.00024 1.000 1.00025 1.004 1.00026 1.024 1.00027 1.048 1.00028 1.087 1.00029 1.119 1.00030 1.135 1.05031 1.159 1.05032 1.183 1.05033 1.198 1.05034 1.214 1.05035 1.222 1.10036 1.230 1.10037 1.238 1.10038 1.246 1.10039 1.262 1.10040 1.278 1.20041 1.302 1.20042 1.325 1.20043 1.357 1.20044 1.397 1.20045 1.444 1.30046 1.500 1.30047 1.563 1.30048 1.635 1.30049 1.706 1.30050 1.786 1.40051 1.865 1.40052 1.952 1.40053 2.040 1.40054 2.135 1.40055 2.230 1.40056 2.333 1.40057 2.437 1.40058 2.548 1.40059 2.603 1.40060 2.714 1.40061 2.810 1.40062 2.873 1.40063 2.952 1.40064+ 3.000 1.400
NOTES:
Exhibit J - Age and Tobacco Factors
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
{1}TheweightedaveragesofthesefactorsfortheentireriskpoolincludedinthisratefilingisdetailedinExhibitH.
-
RatingAreaDescription AreaRatingFactorRatingArea2Northeast 1.1246RatingArea5Central 1.0305RatingArea6St.LouisMetro 0.9570RatingArea7Joplin 0.9439RatingArea8Springfield 1.0124RatingArea9SouthCentral 1.0789RatingArea10Southeast 1.2519
NOTES:{1}TheweightedaverageofthesefactorsfortheentireriskpoolincludedinthisratefilingisdetailedinExhibitH.
Exhibit K - Area Factors
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
-
GroupName: SampleGroupEffectiveDate: 1/1/2015On/OffExchange: OffMetalLevel: SilverPlanID: 32753MO0790300RatingArea: RatingArea7JoplinGroupCensus:
AgeTobaccoUser Age
TobaccoUser Age
TobaccoUser Age
TobaccoUser Age
TobaccoUser
Employee11 24 Yes 23 No 0 NoEmployee12 26 NoEmployee13 28 NoEmployee14 32 Yes 33 NoEmployee15 30 No 2 No 4 NoEmployee16 45 No 45 No 18 No 15 No 12 NoEmployee17 53 Yes 55 YesEmployee18 41 No 16 No 13 NoEmployee19 56 NoEmployee110 39 No 25 YesEmployee111 62 NoEmployee112 64 No 64 No
CalculationofMonthlyPremium:BaseRate= ExhibitAxBenefitPlanFactor ExhibitIxAreaFactor ExhibitKBaseRateAdjustedforPlan/Area=
Age/TobaccoFactors: ExhibitJ
AgeFactor
TobaccoFactor
AgeFactor
TobaccoFactor
AgeFactor
TobaccoFactor
AgeFactor
TobaccoFactor
AgeFactor
TobaccoFactor
Employee11 1.000 1.0000 1.000 1.0000 0.635 1.0000Employee12 1.024 1.0000Employee13 1.087 1.0000Employee14 1.183 1.0500 1.198 1.0000Employee15 1.135 1.0000 0.635 1.0000 0.635 1.0000Employee16 1.444 1.0000 1.444 1.0000 0.635 1.0000 0.635 1.0000 0.635 1.0000Employee17 2.040 1.4000 2.230 1.4000Employee18 1.302 1.0000 0.635 1.0000 0.635 1.0000Employee19 2.333 1.0000Employee110 1.262 1.0000 1.004 1.0000Employee111 2.873 1.0000Employee112 3.000 1.0000 3.000 1.0000
FinalMonthlyPremiumPMPM:
Employee11Employee12Employee13Employee14Employee15Employee16Employee17Employee18Employee19Employee110Employee111Employee112
NOTES:
{2}ThissamplecalculationignoresthetobaccooffsetunderaWellnessProgramasdescribedintheMarketReformRule.{3}Minorratevariancesmayoccurduetodifferencesinroundingmethodology.
685.98$ 685.98$ 1,371.96$
{1}AspertheMarketReformRule,whencomputingfamilypremiumsnomorethanthethreeoldestcoveredchildrenundertheageof21aretakenintoaccountwhereasthepremiumsassociatedwitheachchildage21+a
533.46$ 533.46$288.57$ 229.57$ 518.14$656.94$ 656.94$
653.05$ 713.88$ 1,366.93$297.72$ 290.40$ 588.12$
259.53$ 290.40$ 549.93$330.19$ 330.19$ 435.60$ 1,095.98$
234.15$ 234.15$248.55$ 248.55$284.03$ 273.93$ 557.96$
Employee Spouse Children Total228.66$ 228.66$ 145.20$ 602.52$
$267.920.90420.9439
$228.66
Employee Spouse Child11 Child12 Child13
Exhibit L - Sample Rate Calculation
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
Employee Spouse Child11 Child12 Child13
-
Numerator:IncurredClaims 289.57$ ExhibitA+QualityImprovementExpense 3.27$ ExhibitG+RiskCorridorContributions $+RiskAdjustmentNetTransfer $ ExhibitF+ReinsuranceReceipts $ ExhibitF+RiskCorridorReceipts $+ReductiontoRxIncurredClaims(ACAMLR) (6.84)$ {5}=Estimated FederalMLRNumerator 286.00$
Denominator:Premiums 376.45$ ExhibitAFederalandStateTaxes 11.07$ ExhibitA(Line13)xExhibitG(IncomeTaxes)PremiumTaxes 1.28$ ExhibitA(Line13)xExhibitG(PremiumTax)RiskAdjustmentUserFee 0.08$ ExhibitFReinsuranceContributions 3.55$ ExhibitFLicensingandRegulatoryFees 14.86$ ExhibitA(Line13)xExhibitG(Fees)=Estimated FederalMLRDenominator 345.60$
Estimated FederalMLR 82.76%
NOTES:
{1}Theabovecalculationrepresentsonlytheproductsinthisfiling.FederalMLRwillbecalculatedatthelegalentityandmarketlevel.{2}Notallnumerator/denominatorcomponentsarecapturedabove(forexample,fraudandpreventionprogramcosts,payrolltaxes,assessmentsforstatehighriskpoolsetc.).{3}OtheradjustmentsmayalsobeappliedwithinthefederalMLRcalculationsuchas3yearaveraging,newbusiness,credibility,deductibleanddualoption.Theseareignoredintheabovecalculation.{4}LicensingandRegulatoryFeesincludeACArelatedfeesasallowedundertheMLRFinalRule.
{5}Thisisthepercentageof2015pharmacyclaimsthatareattributabletoPBMAdministrativeExpenses(i.e.the"retailspread"or"pharmacyclaimsmargin").Itiscalculatedbyapplyingthe3rdpartymarginpercentagetothe2015projectedPharmacyclaimsincludingprojectedrebates.
Exhibit M - Federal MLR Estimated Calculation
Healthy Alliance Life Insurance CompanySmall Group
Rates Effective January 1, 2015
TheabovecalculationispurelyanestimateandnotmeanttobecomparedtotheminimumMLRbenchmarkforfederal/stateMLRrebatepurposes:
-
1) ProjectedPaidClaimCost 293.79$ ExhibitA,LineItem82) NonEHBsEmbeddedinLineItem1)Above $3) =ProjectedPaidClaims,ExcludingALLNonEHBs 293.79$4) +RxRebates (6.50)$ ExhibitE5) +AdditionalEHBs{1} 1.79$ ExhibitE6) =ProjectedPaidClaimsReflectingonlyEHBs 289.08$7) PaidtoAllowedRatio 0.71658) =ProjectedAllowedClaimsReflectingonlyEHBs 403.46$ =IndexRate
NOTE:{1} PediatricDentalandPediatricVision
ExhibitNIndexRateDevelopmentHealthy Alliance Life Insurance Company
Small Group
Rates Effective January 1, 2015
-
1Q15 2Q15 3Q15 4Q15MemberWeighted
AverageRenewingMemberMonths 316,513 322,876 386,061 803,007 1,828,457QuarterlyAllowedTrend 2.19% 2.19% 2.19%IndexRate 403.46$ 412.31$ 421.36$ 430.60$ 420.72$ReinsuranceContribution 3.55$ 3.21$ 2.87$ 2.53$ExpectedReinsurancePayments $ $ $ $RiskAdjustmentFee 0.08$ 0.08$ 0.08$ 0.08$RiskAdjustmentNetTransfer $ $ $ $ExchangeFee 1.32$ 1.35$ 1.38$ 1.41$PaidtoallowedRatio 0.7165 0.7165 0.7165 0.7165
MarketAdjustedIndexRate 410.37$ 418.79$ 427.40$ 436.20$ 426.80$QuarterlyBaseRateTrend 2.17% 2.18% 2.20%BaseRate 267.92$ 273.73$ 279.70$ 285.85$ 279.31$
NOTES:{1}The1Q15indexratewasderivedinExhibitN.{2}The1Q15indexrateisassumedtoincreasewithquarterlyallowedtrendasillustratedabove.
{5}The1Q15baseratewasderivedinExhibitA.
{7}Minorratevariancesmayoccurduetodifferencesinroundingmethodology.
{4}MarketAdjustedIndexRate=IndexRate+((Reinsurance+RiskAdjustmentFee+ExchangeFee)PaidtoallowedRatio)
{6}The1Q15baserateisassumedtoincreasewithquarterlypaidtrendasillustratedabove.ThistrendratediffersfromtheindexratetrendinthatitincludesanticipatedchangesfornonEHBs,deductibleleveraging,fees,andriskmitigationprograms.
Exhibit O - Quarterly Index, Base, and Market Adjusted Index Rate Development
Healthy Alliance Life Insurance CompanySmall Group
RatesEffective:
{3}The1Q15reinsuranceandriskadjustmentfeesandpaymentsareshowninExhibitF.ThereinsurancecontributionforothereffectivedatesiscalculatedbythesamemethodshowninExhibitF.
-
HIOSPlanName HIOSPlanID
MarketAdjustedIndexRate(ExhibitO)
CostSharingAdjustment
ProviderNetwork
Adjustment
AdjustmentforBenefitsin
AdditiontotheEHBS
CatastrophicPlanAdjustment
{1} AdministrativeCosts
PlanAdjustedIndexRate
{2}
CalibrationFactor{3}
Adjustto1Q15effdate
ConsumerAdjustedPremiumRate
{4}AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780011 $426.80 0.5746 0.9968 1.0110 1.0000 $68.82 $315.96 1.4006 0.9592 $216.39AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780012 $426.80 0.5746 0.9685 1.0110 1.0000 $66.88 $307.00 1.4006 0.9592 $210.25AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780013 $426.80 0.5746 0.9578 1.0110 1.0000 $66.15 $303.63 1.4006 0.9592 $207.94AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780014 $426.80 0.5746 0.9217 1.0110 1.0000 $63.66 $292.19 1.4006 0.9592 $200.11AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780015 $426.80 0.5746 0.9070 1.0110 1.0000 $62.65 $287.52 1.4006 0.9592 $196.91AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780016 $426.80 0.5746 0.9505 1.0110 1.0000 $65.64 $301.32 1.4006 0.9592 $206.36AnthemBronzeBluePreferredX3500/20%/6350Plusw/HSA 32753MO0780017 $426.80 0.5746 0.9567 1.0110 1.0000 $66.07 $303.27 1.4006 0.9592 $207.70AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780018 $426.80 0.7479 0.9968 1.0085 1.0000 $89.34 $410.22 1.4006 0.9592 $280.94AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780019 $426.80 0.7479 0.9685 1.0085 1.0000 $86.82 $398.58 1.4006 0.9592 $272.97AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780020 $426.80 0.7479 0.9578 1.0085 1.0000 $85.87 $394.20 1.4006 0.9592 $269.97AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780021 $426.80 0.7479 0.9217 1.0085 1.0000 $82.65 $379.36 1.4006 0.9592 $259.80AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780022 $426.80 0.7479 0.9070 1.0085 1.0000 $81.33 $373.29 1.4006 0.9592 $255.65AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780023 $426.80 0.7479 0.9505 1.0085 1.0000 $85.22 $391.21 1.4006 0.9592 $267.92AnthemSilverBluePreferredX1500/30%/6600Plus 32753MO0780024 $426.80 0.7479 0.9567 1.0085 1.0000 $85.77 $393.74 1.4006 0.9592 $269.65AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780004 $426.80 0.8330 0.9968 1.0076 1.0000 $99.44 $456.51 1.4006 0.9592 $312.64AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780005 $426.80 0.8330 0.9685 1.0076 1.0000 $96.62 $443.56 1.4006 0.9592 $303.77AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780006 $426.80 0.8330 0.9578 1.0076 1.0000 $95.57 $438.69 1.4006 0.9592 $300.44AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780007 $426.80 0.8330 0.9217 1.0076 1.0000 $91.98 $422.17 1.4006 0.9592 $289.12AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780008 $426.80 0.8330 0.9070 1.0076 1.0000 $90.52 $415.42 1.4006 0.9592 $284.50AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780009 $426.80 0.8330 0.9505 1.0076 1.0000 $94.84 $435.35 1.4006 0.9592 $298.15AnthemGoldBluePreferredX1000/20%/5500Plus 32753MO0780010 $426.80 0.8330 0.9567 1.0076 1.0000 $95.46 $438.18 1.4006 0.9592 $300.09AnthemBronzeBlueAccess4500E/0%/6350w/HSA 32753MO0790260 $426.80 0.6328 1.0276 1.0000 1.0000 $77.22 $354.77 1.4006 0.9592 $242.96AnthemBronzeBlueAccessChoice4500E/0%/6350w/HSA 32753MO0790261 $426.80 0.6328 1.0276 1.0000 1.0000 $77.22 $354.77 1.4006 0.9592 $242.96AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790262 $426.80 0.6328 0.9968 1.0000 1.0000 $74.91 $344.13 1.4006 0.9592 $235.68AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790263 $426.80 0.6328 0.9685 1.0000 1.0000 $72.79 $334.37 1.4006 0.9592 $228.99AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790264 $426.80 0.6328 0.9578 1.0000 1.0000 $72.00 $330.70 1.4006 0.9592 $226.48AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790265 $426.80 0.6328 0.9217 1.0000 1.0000 $69.29 $318.24 1.4006 0.9592 $217.95AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790266 $426.80 0.6328 0.9070 1.0000 1.0000 $68.19 $313.15 1.4006 0.9592 $214.46AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790267 $426.80 0.6328 0.9505 1.0000 1.0000 $71.45 $328.18 1.4006 0.9592 $224.76AnthemBronzeBluePreferred4500E/0%/6350w/HSA 32753MO0790268 $426.80 0.6328 0.9567 1.0000 1.0000 $71.91 $330.31 1.4006 0.9592 $226.21AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790287 $426.80 0.6327 0.9968 1.0100 1.0000 $75.63 $347.49 1.4006 0.9592 $237.98AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790288 $426.80 0.6327 0.9685 1.0100 1.0000 $73.49 $337.63 1.4006 0.9592 $231.23AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790289 $426.80 0.6327 0.9578 1.0100 1.0000 $72.69 $333.92 1.4006 0.9592 $228.69AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790290 $426.80 0.6327 0.9217 1.0100 1.0000 $69.96 $321.34 1.4006 0.9592 $220.07AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790291 $426.80 0.6327 0.9070 1.0100 1.0000 $68.84 $316.21 1.4006 0.9592 $216.55AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790292 $426.80 0.6327 0.9505 1.0100 1.0000 $72.14 $331.38 1.4006 0.9592 $226.95AnthemBronzeBluePreferred6000/0%/6600Plus 32753MO0790293 $426.80 0.6327 0.9567 1.0100 1.0000 $72.60 $333.53 1.4006 0.9592 $228.42AnthemBronzeBlueAccessChoice6000/0%/6600Plus 32753MO0790294 $426.80 0.6327 1.0276 1.0100 1.0000 $77.96 $358.23 1.4006 0.9592 $245.33AnthemBronzeBlueAccess6000/0%/6600Plus 32753MO0790295 $426.80 0.6327 1.0276 1.0100 1.0000 $77.96 $358.23 1.4006 0.9592 $245.33AnthemSilverBlueAccessChoice3000/20%/4500Plus 32753MO0790195 $426.80 0.7084 1.0276 1.0089 1.0000 $87.22 $400.67 1.4006 0.9592 $274.40AnthemSilverBlueAccess3000/20%/4500Plus 32753MO0790196 $426.80 0.7084 1.0276 1.0089 1.0000 $87.22 $400.67 1.4006 0.9592 $274.40AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790197 $426.80 0.7084 0.9968 1.0089 1.0000 $84.61 $388.66 1.4006 0.9592 $266.18AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790198 $426.80 0.7084 0.9685 1.0089 1.0000 $82.22 $377.63 1.4006 0.9592 $258.62AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790199 $426.80 0.7084 0.9578 1.0089 1.0000 $81.32 $373.49 1.4006 0.9592 $255.78AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790200 $426.80 0.7084 0.9217 1.0089 1.0000 $78.26 $359.42 1.4006 0.9592 $246.15AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790201 $426.80 0.7084 0.9070 1.0089 1.0000 $77.02 $353.67 1.4006 0.9592 $242.21AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790202 $426.80 0.7084 0.9505 1.0089 1.0000 $80.70 $370.65 1.4006 0.9592 $253.84AnthemSilverBluePreferred3000/20%/4500Plus 32753MO0790203 $426.80 0.7084 0.9567 1.0089 1.0000 $81.22 $373.05 1.4006 0.9592 $255.48AnthemSilverBluePreferredOptions2750/40%/6600 32753MO0790259 $426.80 0.7074 0.9089 1.0000 1.0000 $76.39 $350.79 1.4006 0.9592 $240.24
ExhibitPPlanAdjustedIndexRateandConsumerAdjustedPremiumRatesHealthy Alliance Life Insurance Company
Small Group
Rates Effective January 1, 2015
-
HIOSPlanName HIOSPlanID
MarketAdjustedIndexRate(ExhibitO)
CostSharingAdjustment
ProviderNetwork
Adjustment
AdjustmentforBenefitsin
AdditiontotheEHBS
CatastrophicPlanAdjustment
{1} AdministrativeCosts
PlanAdjustedIndexRate
{2}
CalibrationFactor{3}
Adjustto1Q15effdate
ConsumerAdjustedPremiumRate
{4}
ExhibitPPlanAdjustedIndexRateandConsumerAdjustedPremiumRatesHealthy Alliance Life Insurance Company
Small Group
Rates Effective January 1, 2015
AnthemSilverBlueAccess4000E/0%/5000w/HSA 32753MO0790278 $426.80 0.6779 1.0276 1.0000 1.0000 $82.71 $380.02 1.4006 0.9592 $260.26AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790279 $426.80 0.6779 0.9968 1.0000 1.0000 $80.24 $368.62 1.4006 0.9592 $252.45AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790280 $426.80 0.6779 0.9685 1.0000 1.0000 $77.97 $358.16 1.4006 0.9592 $245.29AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790281 $426.80 0.6779 0.9578 1.0000 1.0000 $77.12 $354.23 1.4006 0.9592 $242.60AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790282 $426.80 0.6779 0.9217 1.0000 1.0000 $74.22 $340.89 1.4006 0.9592 $233.46AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790283 $426.80 0.6779 0.9070 1.0000 1.0000 $73.04 $335.44 1.4006 0.9592 $229.73AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790284 $426.80 0.6779 0.9505 1.0000 1.0000 $76.53 $351.54 1.4006 0.9592 $240.75AnthemSilverBluePreferred4000E/0%/5000w/HSA 32753MO0790285 $426.80 0.6779 0.9567 1.0000 1.0000 $77.03 $353.82 1.4006 0.9592 $242.31AnthemSilverBlueAccessChoice4000E/0%/5000w/HSA 32753MO0790286 $426.80 0.6779 1.0276 1.0000 1.0000 $82.71 $380.02 1.4006 0.9592 $260.26AnthemSilverBlueAccessChoice2000/30%/6600 32753MO0790296 $426.80 0.7033 1.0276 1.0000 1.0000 $85.89 $394.36 1.4006 0.9592 $270.08AnthemSilverBluePreferred2000/30%/6600 32753MO0790297 $426.80 0.7033 0.9968 1.0000 1.0000 $83.32 $382.54 1.4006 0.9592 $261.99AnthemSilverBluePreferred2000/30%/6600 32753MO0790298 $426.80 0.7033 0.9685 1.0000 1.0000 $80.97 $371.69 1.4006 0.9592 $254.55AnthemSilverBluePreferred2000/30%/6600 32753MO0790299 $426.80 0.7033 0.9578 1.0000 1.0000 $80.08 $367.61 1.4006 0.9592 $251.76AnthemSilverBluePreferred2000/30%/6600 32753MO0790300 $426.80 0.7033 0.9217 1.0000 1.0000 $77.08 $353.76 1.4006 0.9592 $242.28AnthemSilverBluePreferred2000/30%/6600 32753MO0790301 $426.80 0.7033 0.9070 1.0000 1.0000 $75.85 $348.11 1.4006 0.9592 $238.41AnthemSilverBluePreferred2000/30%/6600 32753MO0790302 $426.80 0.7033 0.9505 1.0000 1.0000 $79.47 $364.82 1.4006 0.9592 $249.85AnthemSilverBluePreferred2000/30%/6600 32753MO0790303 $426.80 0.7033 0.9567 1.0000 1.0000 $79.99 $367.18 1.4006 0.9592 $251.46AnthemSilverBlueAccess2000/30%/6600 32753MO0790304 $426.80 0.7033 1.0276 1.0000 1.0000 $85.89 $394.36 1.4006 0.9592 $270.08AnthemSilverBluePreferred5000/20%/6600 32753MO0790305 $426.80 0.6651 0.9968 1.0000 1.0000 $78.71 $361.67 1.4006 0.9592 $247.69AnthemSilverBluePreferred5000/20%/6600 32753MO0790306 $426.80 0.6651 0.9685 1.0000 1.0000 $76.49 $351.41 1.4006 0.9592 $240.66AnthemSilverBluePreferred5000/20%/6600 32753MO0790307 $426.80 0.6651 0.9578 1.0000 1.0000 $75.65 $347.55 1.4006 0.9592 $238.02AnthemSilverBluePreferred5000/20%/6600 32753MO0790308 $426.80 0.6651 0.9217 1.0000 1.0000 $72.81 $334.46 1.4006 0.9592 $229.06AnthemSilverBluePreferred5000/20%/6600 32753MO0790309 $426.80 0.6651 0.9070 1.0000 1.0000 $71.65 $329.11 1.4006 0.9592 $225.39AnthemSilverBluePreferred5000/20%/6600 32753MO0790310 $426.80 0.6651 0.9505 1.0000 1.0000 $75.08 $344.91 1.4006 0.9592 $236.21AnthemSilverBluePreferred5000/20%/6600 32753MO0790311 $426.80 0.6651 0.9567 1.0000 1.0000 $75.56 $347.14 1.4006 0.9592 $237.74AnthemSilverBlueAccessChoice5000/20%/6600 32753MO0790312 $426.80 0.6651 1.0276 1.0000 1.0000 $81.14 $372.85 1.4006 0.9592 $255.35AnthemSilverBlueAccess5000/20%/6600 32753MO0790313 $426.80 0.6651 1.0276 1.0000 1.0000 $81.14 $372.85 1.4006 0.9592 $255.35AnthemSilverBlueAccess2600E/20%/5500w/HSA 32753MO0790314 $426.80 0.6734 1.0276 1.0000 1.0000 $82.21 $377.54 1.4006 0.9592 $258.56AnthemSilverBlueAccessChoice2600E/20%/5500w/HSA 32753MO0790315 $426.80 0.6734 1.0276 1.0000 1.0000 $82.21 $377.54 1.4006 0.9592 $258.56AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790316 $426.80 0.6734 0.9968 1.0000 1.0000 $79.75 $366.22 1.4006 0.9592 $250.81AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790317 $426.80 0.6734 0.9685 1.0000 1.0000 $77.50 $355.83 1.4006 0.9592 $243.69AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790318 $426.80 0.6734 0.9578 1.0000 1.0000 $76.65 $351.93 1.4006 0.9592 $241.02AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790319 $426.80 0.6734 0.9217 1.0000 1.0000 $73.77 $338.67 1.4006 0.9592 $231.94AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790320 $426.80 0.6734 0.9070 1.0000 1.0000 $72.60 $333.26 1.4006 0.9592 $228.23AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790321 $426.80 0.6734 0.9505 1.0000 1.0000 $76.07 $349.25 1.4006 0.9592 $239.18AnthemSilverBluePreferred2600E/20%/5500w/HSA 32753MO0790322 $426.80 0.6734 0.9567 1.0000 1.0000 $76.56 $351.51 1.4006 0.9592 $240.73AnthemGoldBlueAccessChoice1000/20%/2500Plus 32753MO0790186 $426.80 0.8530 1.0276 1.0074 1.0000 $104.93 $481.84 1.4006 0.9592 $329.99AnthemGoldBlueAccess1000/20%/2500Plus 32753MO0790187 $426.80 0.8530 1.0276 1.0074 1.0000 $104.93 $481.84 1.4006 0.9592 $329.99AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790188 $426.80 0.8530 0.9968 1.0074 1.0000 $101.80 $467.40 1.4006 0.9592 $320.10AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790189 $426.80 0.8530 0.9685 1.0074 1.0000 $98.92 $454.14 1.4006 0.9592 $311.02AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790190 $426.80 0.8530 0.9578 1.0074 1.0000 $97.84 $449.16 1.4006 0.9592 $307.61AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790191 $426.80 0.8530 0.9217 1.0074 1.0000 $94.17 $432.24 1.4006 0.9592 $296.02AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790192 $426.80 0.8530 0.9070 1.0074 1.0000 $92.67 $425.33 1.4006 0.9592 $291.29AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790193 $426.80 0.8530 0.9505 1.0074 1.0000 $97.10 $445.74 1.4006 0.9592 $305.27AnthemGoldBluePreferred1000/20%/2500Plus 32753MO0790194 $426.80 0.8530 0.9567 1.0074 1.0000 $97.72 $448.63 1.4006 0.9592 $307.24AnthemGoldBluePreferredOptions500/20%/4000 32753MO0790204 $426.80 0.9012 0.9089 1.0000 1.0000 $97.45 $447.03 1.4006 0.9592 $306.15AnthemGoldBlueAccessChoice1500/30%/5000 32753MO0790205 $426.80 0.8273 1.0276 1.0000 1.0000 $100.97 $463.80 1.4006 0.9592 $317.64AnthemGoldBluePreferred1500/30%/5000 32753MO0790206 $426.80 0.8273 0.9968 1.0000 1.0000 $97.96 $449.90 1.4006 0.9592 $308.12AnthemGoldBluePreferred1500/30%/5000 32753MO0790207 $426.80 0.8273 0.9685 1.0000 1.0000 $95.19 $437.13 1.4006 0.9592 $299.37
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HIOSPlanName HIOSPlanID
MarketAdjustedIndexRate(ExhibitO)
CostSharingAdjustment
ProviderNetwork
Adjustment
AdjustmentforBenefitsin
AdditiontotheEHBS
CatastrophicPlanAdjustment
{1} AdministrativeCosts
PlanAdjustedIndexRate
{2}
CalibrationFactor{3}
Adjustto1Q15effdate
ConsumerAdjustedPremiumRate
{4}
ExhibitPPlanAdjustedIndexRateandConsumerAdjustedPremiumRatesHealthy Alliance Life Insurance Company
Small Group
Rates Effective January 1, 2015
AnthemGoldBluePreferred1500/30%/5000 32753MO0790208 $426.80 0.8273 0.9578 1.0000 1.0000 $94.15 $432.34 1.4006 0.9592 $296.09AnthemGoldBluePreferred1500/30%/5000 32753MO0790209 $426.80 0.8273 0.9217 1.0000 1.0000 $90.61 $416.05 1.4006 0.9592 $284.93AnthemGoldBluePreferred1500/30%/5000 32753MO0790210 $426.80 0.8273 0.9070 1.0000 1.0000 $89.17 $409.40 1.4006 0.9592 $280.38AnthemGoldBluePreferred1500/30%/5000 32753MO0790211 $426.80 0.8273 0.9505 1.0000 1.0000 $93.43 $429.05 1.4006 0.9592 $293.84AnthemGoldBluePreferred1500/30%/5000 32753MO0790212 $426.80 0.8273 0.9567 1.0000 1.0000 $94.04 $431.83 1.4006 0.9592 $295.74AnthemGoldBlueAccess1500/30%/5000 32753MO0790213 $426.80 0.8273 1.0276 1.0000 1.0000 $100.97 $463.80 1.4006 0.9592 $317.64AnthemGoldBlueAccessChoice5000/0%/5000 32753MO0790214 $426.80 0.7892 1.0276 1.0000 1.0000 $96.23 $442.37 1.4006 0.9592 $302.96AnthemGoldBlueAccess5000/0%/5000 32753MO0790215 $426.80 0.7892 1.0276 1.0000 1.0000 $96.23 $442.37 1.4006 0.9592 $302.96AnthemGoldBluePreferred5000/0%/5000 32753MO0790216 $426.80 0.7892 0.9968 1.0000 1.0000 $93.35 $429.11 1.4006 0.9592 $293.87AnthemGoldBluePreferred5000/0%/5000 32753MO0790217 $426.80 0.7892 0.9685 1.0000 1.0000 $90.70 $416.93 1.4006 0.9592 $285.53AnthemGoldBluePreferred5000/0%/5000 32753MO0790218 $426.80 0.7892 0.9578 1.0000 1.0000 $89.71 $412.35 1.4006 0.9592 $282.40AnthemGoldBluePreferred5000/0%/5000 32753MO0790219 $426.80 0.7892 0.9217 1.0000 1.0000 $86.34 $396.81 1.4006 0.9592 $271.76AnthemGoldBluePreferred5000/0%/5000 32753MO0790220 $426.80 0.7892 0.9070 1.0000 1.0000 $84.96 $390.47 1.4006 0.9592 $267.41AnthemGoldBluePreferred5000/0%/5000 32753MO0790221 $426.80 0.7892 0.9505 1.0000 1.0000 $89.03 $409.21 1.4006 0.9592 $280.25AnthemGoldBluePreferred5000/0%/5000 32753MO0790222 $426.80 0.7892 0.9567 1.0000 1.0000 $89.61 $411.86 1.4006 0.9592 $282.07AnthemGoldBluePreferred3500/0%/4000 32753MO0790223 $426.80 0.8378 0.9968 1.0000 1.0000 $99.11 $455.52 1.4006 0.9592 $311.96AnthemGoldBluePreferred3500/0%/4000 32753MO0790224 $426.80 0.8378 0.9685 1.0000 1.0000 $96.30 $442.59 1.4006 0.9592 $303.11AnthemGoldBluePreferred3500/0%/4000 32753MO0790225 $426.80 0.8378 0.9578 1.0000 1.0000 $95.25 $437.73 1.4006 0.9592 $299.78AnthemGoldBluePreferred3500/0%/4000 32753MO0790226 $426.80 0.8378 0.9217 1.0000 1.0000 $91.67 $421.24 1.4006 0.9592 $288.49AnthemGoldBluePreferred3500/0%/4000 32753MO0790227 $426.80 0.8378 0.9070 1.0000 1.0000 $90.21 $414.50 1.4006 0.9592 $283.88AnthemGoldBluePreferred3500/0%/4000 32753MO0790228 $426.80 0.8378 0.9505 1.0000 1.0000 $94.53 $434.40 1.4006 0.9592 $297.50AnthemGoldBluePreferred3500/0%/4000 32753MO0790229 $426.80 0.8378 0.9567 1.0000 1.0000 $95.14 $437.22 1.4006 0.9592 $299.43AnthemGoldBlueAccess3500/0%/4000 32753MO0790230 $426.80 0.8378 1.0276 1.0000 1.0000 $102.16 $469.60 1.4006 0.9592 $321.61AnthemGoldBlueAccessChoice3500/0%/4000 32753MO0790231 $426.80 0.8378 1.0276 1.0000 1.0000 $102.16 $469.60 1.4006 0.9592 $321.61AnthemGoldBlueAccessChoice1000/20%/3500 32753MO0790232 $426.80 0.8739 1.0276 1.0000 1.0000 $106.70 $490.00 1.4006 0.9592 $335.58AnthemGoldBlueAccess1000/20%/3500 32753MO0790233 $426.80 0.8739 1.0276 1.0000 1.0000 $106.70 $490.00 1.4006 0.9592 $335.58AnthemGoldBluePreferred1000/20%/3500 32753MO0790234 $426.80 0.8739 0.9968 1.0000 1.0000 $103.52 $475.31 1.4006 0.9592 $325.52AnthemGoldBluePreferred1000/20%/3500 32753MO0790235 $426.80 0.8739 0.9685 1.0000 1.0000 $100.59 $461.82 1.4006 0.9592 $316.28AnthemGoldBluePreferred1000/20%/3500 32753MO0790236 $426.80 0.8739 0.9578 1.0000 1.0000 $99.49 $456.76 1.4006 0.9592 $312.81AnthemGoldBluePreferred1000/20%/3500 32753MO0790237 $426.80 0.8739 0.9217 1.0000 1.0000 $95.75 $439.55 1.4006 0.9592 $301.03AnthemGoldBluePreferred1000/20%/3500 32753MO0790238 $426.80 0.8739 0.9070 1.0000 1.0000 $94.23 $432.53 1.4006 0.9592 $296.22AnthemGoldBluePreferred1000/20%/3500 32753MO0790239 $426.80 0.8739 0.9505 1.0000 1.0000 $98.73 $453.28 1.4006 0.9592 $310.43AnthemGoldBluePreferred1000/20%/3500 32753MO0790240 $426.80 0.8739 0.9567 1.0000 1.0000 $99.37 $456.22 1.4006 0.9592 $312.44AnthemGoldBlueAccess2500/20%/4500 32753MO0790241 $426.80 0.8147 1.0276 1.0000 1.0000 $99.38 $456.69 1.4006 0.9592 $312.77AnthemGoldBlueAccessChoice2500/20%/4500 32753MO0790242 $426.80 0.8147 1.0276 1.0000 1.0000 $99.38 $456.69 1.4006 0.9592 $312.77AnthemGoldBluePreferred2500/20%/4500 32753MO0790243 $426.80 0.8147 0.9968 1.0000 1.0000 $96.41 $443.00 1.4006 0.9592 $303.39AnthemGoldBluePreferred2500/20%/4500 32753MO0790244 $426.80 0.8147 0.9685 1.0000 1.0000 $93.68 $430.43 1.4006 0.9592 $294.78AnthemGoldBluePreferred2500/20%/4500 32753MO0790245 $426.80 0.8147 0.9578 1.0000 1.0000 $92.66 $425.71 1.4006 0.9592 $291.55AnthemGoldBluePreferred2500/20%/4500 32753MO0790246 $426.80 0.8147 0.9217 1.0000 1.0000 $89.18 $409.67 1.4006 0.9592 $280.56AnthemGoldBluePreferred2500/20%/4500 32753MO0790247 $426.80 0.8147 0.9070 1.0000 1.0000 $87.76 $403.12 1.4006 0.9592 $276.08AnthemGoldBluePreferred2500/20%/4500 32753MO0790248 $426.80 0.8147 0.9505 1.0000 1.0000 $91.95 $422.47 1.4006 0.9592 $289.33AnthemGoldBluePreferred2500/20%/4500 32753MO0790249 $426.80 0.8147 0.9567 1.0000 1.0000 $92.55 $425.21 1.4006 0.9592 $291.20AnthemGoldBlueAccessChoice1500/20%/4000 32753MO0790250 $426.80 0.8561 1.0276 1.0000 1.0000 $104.48 $479.94 1.4006 0.9592 $328.69AnthemGoldBlueAccess1500/20%/4000 32753MO0790251 $426.80 0.8561 1.0276 1.0000 1.0000 $104.48 $479.94 1.4006 0.9592 $328.69AnthemGoldBluePreferred1500/20%/4000 32753MO0790252 $426.80 0.8561 0.9968 1.0000 1.0000 $101.35 $465.55 1.4006 0.9592 $318.84AnthemGoldBluePreferred1500/20%/4000 32753MO0790253 $426.80 0.8561 0.9685 1.0000 1.0000 $98.49 $452.34 1.4006 0.9592 $309.79AnthemGoldBluePreferred1500/20%/4000 32753MO0790254 $426.80 0.8561 0.9578 1.0000 1.0000 $97.41 $447.38 1.4006 0.9592 $306.39AnthemGoldBluePreferred1500/20%/4000 32753MO0790255 $426.80 0.8561 0.9217 1.0000 1.0000 $93.75 $430.53 1.4006 0.9592 $294.85AnthemGoldBluePreferred1500/20%/4000 32753MO0790256 $426.80 0.8561 0.9070 1.0000 1.0000 $92.26 $423.64 1.4006 0.9592 $290.13
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HIOSPlanName HIOSPlanID
MarketAdjustedIndexRate(ExhibitO)
CostSharingAdjustment
ProviderNetwork
Adjustment
AdjustmentforBenefitsin
AdditiontotheEHBS
CatastrophicPlanAdjustment
{1} AdministrativeCosts
PlanAdjustedIndexRate
{2}
CalibrationFactor{3}
Adjustto1Q15effdate
ConsumerAdjustedPremiumRate
{4}
ExhibitPPlanAdjustedIndexRateandConsumerAdjustedPremiumRatesHealthy Alliance Life Insurance Company
Small Group
Rates Effective January 1, 2015
AnthemGoldBluePreferred1500/20%/4000 32753MO0790257 $426.80 0.8561 0.9505 1.0000 1.0000 $96.67 $443.98 1.4006 0.9592 $304.06AnthemGoldBluePreferred1500/20%/4000 32753MO0790258 $426.80 0.8561 0.9567 1.0000 1.0000 $97.30 $446.85 1.4006 0.9592 $306.03AnthemGoldBluePreferred500/20%/3500 32753MO0790269 $426.80 0.8929 0.9968 1.0000 1.0000 $105.84 $485.70 1.4006 0.9592 $332.63AnthemGoldBluePreferred500/20%/3500 32753MO0790270 $426.80 0.8929 0.9685 1.0000 1.0000 $102.85 $471.92 1.4006 0.9592 $323.19AnthemGoldBluePreferred500/20%/3500 32753MO0790271 $426.80 0.8929 0.9578 1.0000 1.0000 $101.73 $466.74 1.4006 0.9592 $319.65AnthemGoldBluePreferred500/20%/3500 32753MO0790272 $426.80 0.8929 0.9217 1.0000 1.0000 $97.91 $449.16 1.4006 0.9592 $307.61AnthemGoldBluePreferred500/20%/3500 32753MO0790273 $426.80 0.8929 0.9070 1.0000 1.0000 $96.35 $441.98 1.4006 0.9592 $302.69AnthemGoldBluePreferred500/20%/3500 32753MO0790274 $426.80 0.8929 0.9505 1.0000 1.0000 $100.96 $463.19 1.4006 0.9592 $317.22AnthemGoldBluePreferred500/20%/3500 32753MO0790275 $426.80 0.8929 0.9567 1.0000 1.0000 $101.61 $466.19 1.4006 0.9592 $319.27AnthemGoldBlueAccessChoice500/20%/3500 32753MO0790276 $426.80 0.8929 1.0276 1.0000 1.0000 $109.10 $500.70 1.4006 0.9592 $342.91AnthemGoldBlueAccess500/20%/3500 32753MO0790277 $426.80 0.8929 1.0276 1.0000 1.0000 $109.10 $500.70 1.4006 0.9592 $342.91AnthemGoldBlueAccess2000/0%/4000 32753MO0790323 $426.80 0.8799 1.0276 1.0000 1.0000 $107.34 $493.24 1.4006 0.9592 $337.80AnthemGoldBlueAccessChoice2000/0%/4000 32753MO0790324 $426.80 0.8799 1.0276 1.0000 1.0000 $107.34 $493.24 1.4006 0.9592 $337.80AnthemGoldBluePreferred2000/0%/4000 32753MO0790325 $426.80 0.8799 0.9968 1.0000 1.0000 $104.14 $478.45 1.4006 0.9592 $327.67AnthemGoldBluePreferred2000/0%/4000 32753MO0790326 $426.80 0.8799 0.9685 1.0000 1.0000 $101.19 $464.87 1.4006 0.9592 $318.37AnthemGoldBluePreferred2000/0%/4000 32753MO0790327 $426.80 0.8799 0.9578 1.0000 1.0000 $100.08 $459.77 1.4006 0.9592 $314.88AnthemGoldBluePreferred2000/0%/4000 32753MO0790328 $426.80 0.8799 0.9217 1.0000 1.0000 $96.32 $442.45 1.4006 0.9592 $303.01AnthemGoldBluePreferred2000/0%/4000 32753MO0790329 $426.80 0.8799 0.9070 1.0000 1.0000 $94.79 $435.38 1.4006 0.9592 $298.17AnthemGoldBluePreferred2000/0%/4000 32753MO0790330 $426.80 0.8799 0.9505 1.0000 1.0000 $99.32 $456.27 1.4006 0.9592 $312.48AnthemGoldBluePreferred2000/0%/4000 32753MO0790331 $426.80 0.8799 0.9567 1.0000 1.0000 $99.96 $459.23 1.4006 0.9592 $314.51
Notes:
{2}ThePlanAdjustedIndexRateiscalculatedbymultiplyingtheMarketAdjustedIndexRatebytheAVandcostsharing,providernetwork,benefitsinadditiontotheEHBs,andcatastrophicplanadjustmentsandthenaddingtheadministrativecosts.ThePlanAdjustedIndexRatecanalsobedescribedasaPlanLevelRequiredPremium.{3}SeeExhibitHCalibration.
{4}TheConsumerAdjustedPremiumRateiscalculatedbydividingbyCalibrationFactorandthenmultiplyingbyAdjustto1Q15effectivedatefactor.
{1}Thisadjustmentassumesahealthierthanaveragepopulationwillselectthecatastrophicplan.Thecatastrophicadjustmentfactorisnormalizedto1.0acrossallplansforrevenueneutralityacrosstheentireblock.
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Followingaretheproductsthatwillbeterminatedpriortotheeffectivedate:
HIOSProductID HIOSProductName32753MO076 LumenosBluePreferredSelect
PreACATerminatedProducts
Exhibit Q - Terminated Products
Healthy Alliance Life Insurance CompanySmall Group
Effective January 1, 2015
ThisincludesproductsthathaveexperienceincludedintheURRTduringtheexperienceperiodandanyproductsthatwerenotineffectduringtheexperienceperiodbutweremadeavailablethereafter.
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HIOSProductID HIOSProductNamePostACATerminatedPlans