Filing at a Glance - Pennsylvania at a Glance Company: UPMC Health Benefits, Inc. Product Name: UPMC...
Transcript of Filing at a Glance - Pennsylvania at a Glance Company: UPMC Health Benefits, Inc. Product Name: UPMC...
Filing at a Glance
Company: UPMC Health Benefits, Inc.
Product Name: UPMC HB 2018 GRIP - Value and Goals
State: Pennsylvania
TOI: H16I Individual Health - Major Medical
Sub-TOI: H16I.005C Individual - Other
Filing Type: Rate - M.U. (Medically underwritten)
Date Submitted: 08/08/2017
SERFF Tr Num: UPMC-131136230
SERFF Status: Assigned
State Tr Num: UPMC-131136230
State Status: Received Review in Progress
Co Tr Num:
ImplementationDate Requested:
01/01/2018
Author(s): Michael Lovely, Jacqueline DeCoursey, Adam Pittler, Timothy Gaborek, Kara Stonebraker,Nikki Senrud, Yuna Oh, Nicole Patillo, Julianna Makrinos, Stephanie Dulz, Stephanie Fahy,Dominique Bailey
Reviewer(s): Rashmi Mathur (primary)
Disposition Date:
Disposition Status:
Implementation Date:
State Filing Description:
ind rri=4.09%
SERFF Tracking #: UPMC-131136230 State Tracking #: UPMC-131136230 Company Tracking #:
State: Pennsylvania Filing Company: UPMC Health Benefits, Inc.
TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005C Individual - Other
Product Name: UPMC HB 2018 GRIP - Value and Goals
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number UPMC-131136230 Generated 08/15/2017 11:03 AM
General Information
Company and Contact
Filing Fees
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: Individual
Submission Type: New Submission Individual Market Type: Individual
Overall Rate Impact: 4.09% Filing Status Changed: 08/11/2017
State Status Changed: 08/14/2017
Deemer Date: Created By: Timothy Gaborek
Submitted By: Timothy Gaborek Corresponding Filing Tracking Number: Value: UPMC-127741169, UPMC-129866647, UPMC-130253074 Goal:UPMC-128778648, UPMC-129866621, UPMC-130253081
State TOI: H16I Individual Health - Major Medical
State Sub-TOI: H16I.005C Individual - Other
PPACA: Not PPACA-Related
PPACA Notes: null
Include Exchange Intentions: No
Additional Benefits: No
Filing Description:
UPMC HB 2018 GRIP - Value and Goals
Filing Contact InformationMike Lovely, Manager, Actuarial Services [email protected]
600 Grant St.
Pittsburgh, PA 15212
412-454-7849 [Phone]
Filing Company InformationUPMC Health Benefits, Inc.
US Steel Tower
600 Grant Street
Pittsburgh, PA 15219
(412) 454-5180 ext. [Phone]
CoCode: 11018
Group Code: 1324
Group Name: UPMC
FEIN Number: 25-1844144
State of Domicile:Pennsylvania
Company Type: Property &Casualty
State ID Number:
Fee Required? No
Retaliatory? No
Fee Explanation:
SERFF Tracking #: UPMC-131136230 State Tracking #: UPMC-131136230 Company Tracking #:
State: Pennsylvania Filing Company: UPMC Health Benefits, Inc.
TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005C Individual - Other
Product Name: UPMC HB 2018 GRIP - Value and Goals
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number UPMC-131136230 Generated 08/15/2017 11:03 AM
Rate Information Rate data applies to filing.
Filing Method:
Rate Change Type: Increase
Overall Percentage of Last Rate Revision: 4.460%
Effective Date of Last Rate Revision: 01/01/2017
Filing Method of Last Filing:
Company Rate Information
Company
Name:
Company
Rate
Change:
Overall %
Indicated
Change:
Overall %
Rate
Impact:
Written
Premium
Change for
this Program:
Number of Policy
Holders Affected
for this Program:
Written
Premium for
this Program:
Maximum %
Change
(where req'd):
Minimum %
Change
(where req'd):
UPMC HealthBenefits, Inc.
Increase 4.090% 4.090% $-413,808 1,926 $7,545,328 4.090% 4.090%
SERFF Tracking #: UPMC-131136230 State Tracking #: UPMC-131136230 Company Tracking #:
State: Pennsylvania Filing Company: UPMC Health Benefits, Inc.
TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005C Individual - Other
Product Name: UPMC HB 2018 GRIP - Value and Goals
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number UPMC-131136230 Generated 08/15/2017 11:03 AM
Rate Review Detail
COMPANY:Company Name: UPMC Health Benefits, Inc.
HHS Issuer Id: 67430
PRODUCTS:
Product Name HIOS Product ID HIOS Submission ID Number of Covered
LivesUPMC HB 2018 GRIP - Value and Goals 1926
Trend Factors:
FORMS:New Policy Forms: 0
Affected Forms: 0
Other Affected Forms: 0
REQUESTED RATE CHANGE INFORMATION:Change Period: Annual
Member Months: 26,258
Benefit Change: None
Percent Change Requested: Min: 4.09 Max: 4.09 Avg: 4.09
PRIOR RATE:Total Earned Premium: 7,959,137.00
Total Incurred Claims: 6,506,781.00
Annual $: Min: 89.08 Max: 1,477.68 Avg: 303.11
REQUESTED RATE:Projected Earned Premium: 7,545,328.00
Projected Incurred Claims: 6,187,169.00
Annual $: Min: 92.66 Max: 1,538.90 Avg: 315.45
SERFF Tracking #: UPMC-131136230 State Tracking #: UPMC-131136230 Company Tracking #:
State: Pennsylvania Filing Company: UPMC Health Benefits, Inc.
TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005C Individual - Other
Product Name: UPMC HB 2018 GRIP - Value and Goals
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number UPMC-131136230 Generated 08/15/2017 11:03 AM
Rate/Rule Schedule
Item
No.
Schedule
Item
Status
Document Name
Affected Form Numbers
(Separated with commas) Rate Action Rate Action Information Attachments
1 Rate Table Value: UPMC-127741169,UPMC-129866647, UPMC-130253074 Goal: UPMC-128778648, UPMC-129866621, UPMC-130253081
Revised Previous State Filing Number:UPMC-130671623Percent Rate Change Request:4.46
GRIP_RateFiling_RateTables_ValuesandGoalsPlans (Eff1.1.2018).pdf,GRIP_RateFiling_RateTables_ValuesandGoalsPlans (Eff1.1.2018).xlsx,
SERFF Tracking #: UPMC-131136230 State Tracking #: UPMC-131136230 Company Tracking #:
State: Pennsylvania Filing Company: UPMC Health Benefits, Inc.
TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005C Individual - Other
Product Name: UPMC HB 2018 GRIP - Value and Goals
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number UPMC-131136230 Generated 08/15/2017 11:03 AM
Attachment GRIP_RateFiling_RateTables_ValuesandGoalsPlans (Eff 1.1.2018).xlsx is not a PDFdocument and cannot be reproduced here.
SERFF Tracking #: UPMC-131136230 State Tracking #: UPMC-131136230 Company Tracking #:
State: Pennsylvania Filing Company: UPMC Health Benefits, Inc.
TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005C Individual - Other
Product Name: UPMC HB 2018 GRIP - Value and Goals
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number UPMC-131136230 Generated 08/15/2017 11:03 AM
UPMC Health Benefits, Inc.Monthly Rates by Attained Age, Effective January 1, 2018*
Area 1: Allegheny, Armstrong, Beaver, Butler, Fayette, Washington and Westmoreland
Area 2: Erie
Area 3: Bedford, Blair, Cambria, Cameron, Centre, Clarion, Clearfield, Crawford, Elk, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango and Warren
Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Tier 6Policy Form
Number Plan Area Deductible Age Male Female Male Female Male Female Male Female Male Female Male Female
610 EPO Area 1 $500 00 - 01 269.32$ 269.32$ 309.72$ 309.72$ 403.98$ 403.98$ 511.70$ 511.70$ 632.90$ 632.90$ 754.09$ 754.09$
610 EPO Area 1 $500 02 -19 136.29 136.29 156.74 156.74 204.44 204.44 258.96 258.96 320.29 320.29 381.62 381.62
610 EPO Area 1 $500 20 - 24 131.95 196.65 151.74 226.14 171.54 255.64 197.93 294.97 230.91 344.13 263.90 393.29
610 EPO Area 1 $500 25 - 29 136.76 249.09 157.28 286.46 177.79 323.82 205.14 373.64 239.33 435.91 273.53 498.18
610 EPO Area 1 $500 30 - 34 159.60 305.80 183.54 351.67 207.48 397.54 239.40 458.69 279.30 535.14 319.20 611.59
610 EPO Area 1 $500 35 - 39 193.42 305.87 222.44 351.75 251.45 397.63 290.14 458.80 338.49 535.27 386.85 611.73
610 EPO Area 1 $500 40 - 44 234.54 340.93 269.73 392.06 304.91 443.20 351.82 511.39 410.45 596.62 469.09 681.85
610 EPO Area 1 $500 45 - 49 298.90 382.12 343.73 439.43 388.57 496.75 448.35 573.17 523.07 668.70 597.80 764.23
610 EPO Area 1 $500 50 - 54 389.72 453.28 448.18 521.28 506.64 589.27 584.59 679.93 682.02 793.25 779.45 906.57
610 EPO Area 1 $500 55 - 59 519.58 521.47 597.52 599.69 675.46 677.91 779.37 782.21 909.27 912.57 1,039.17 1,042.94
610 EPO Area 1 $500 60 - 64 712.00 617.00 818.80 709.55 925.60 802.10 1,068.00 925.50 1,246.00 1,079.75 1,424.00 1,234.01
610 EPO Area 1 $1,000 00 - 01 246.59$ 246.59$ 283.58$ 283.58$ 369.89$ 369.89$ 468.53$ 468.53$ 579.50$ 579.50$ 690.46$ 690.46$
610 EPO Area 1 $1,000 02 -19 126.37 126.37 145.33 145.33 189.56 189.56 240.11 240.11 296.98 296.98 353.84 353.84
610 EPO Area 1 $1,000 20 - 24 122.44 179.83 140.81 206.80 159.17 233.77 183.66 269.74 214.27 314.70 244.88 359.65
610 EPO Area 1 $1,000 25 - 29 126.80 226.88 145.82 260.91 164.84 294.94 190.20 340.32 221.90 397.04 253.60 453.76
610 EPO Area 1 $1,000 30 - 34 147.44 277.76 169.55 319.43 191.67 361.09 221.15 416.65 258.01 486.09 294.87 555.53
610 EPO Area 1 $1,000 35 - 39 178.01 277.82 204.71 319.49 231.41 361.17 267.01 416.73 311.52 486.19 356.02 555.64
610 EPO Area 1 $1,000 40 - 44 215.17 311.32 247.44 358.02 279.72 404.71 322.75 466.98 376.55 544.81 430.34 622.64
610 EPO Area 1 $1,000 45 - 49 273.34 348.56 314.34 400.85 355.34 453.13 410.00 522.84 478.34 609.98 546.67 697.12
610 EPO Area 1 $1,000 50 - 54 355.42 412.87 408.73 474.81 462.04 536.74 533.13 619.31 621.98 722.53 710.84 825.75
610 EPO Area 1 $1,000 55 - 59 472.80 474.50 543.72 545.68 614.64 616.85 709.20 711.76 827.40 830.38 945.60 949.01
610 EPO Area 1 $1,000 60 - 64 646.68 560.84 743.69 644.96 840.69 729.09 970.03 841.25 1,131.70 981.46 1,293.37 1,121.67
610 EPO Area 1 $2,500 00 - 01 216.60$ 216.60$ 249.09$ 249.09$ 324.90$ 324.90$ 411.54$ 411.54$ 509.02$ 509.02$ 606.49$ 606.49$
610 EPO Area 1 $2,500 02 -19 113.26 113.26 130.25 130.25 169.89 169.89 215.19 215.19 266.16 266.16 317.12 317.12
610 EPO Area 1 $2,500 20 - 24 109.89 157.94 126.38 181.63 142.86 205.32 164.84 236.91 192.31 276.39 219.79 315.88
610 EPO Area 1 $2,500 25 - 29 113.63 197.97 130.67 227.66 147.71 257.36 170.44 296.95 198.85 346.44 227.25 395.93
610 EPO Area 1 $2,500 30 - 34 131.37 241.26 151.07 277.45 170.78 313.63 197.05 361.89 229.90 422.20 262.74 482.51
610 EPO Area 1 $2,500 35 - 39 157.66 241.31 181.30 277.51 204.95 313.71 236.48 361.97 275.90 422.30 315.31 482.63
610 EPO Area 1 $2,500 40 - 44 189.59 272.24 218.03 313.08 246.47 353.91 284.39 408.36 331.79 476.42 379.18 544.48
610 EPO Area 1 $2,500 45 - 49 239.60 304.25 275.54 349.89 311.48 395.52 359.39 456.37 419.29 532.44 479.19 608.50
610 EPO Area 1 $2,500 50 - 54 310.15 359.53 356.68 413.46 403.20 467.39 465.23 539.30 542.77 629.18 620.31 719.07
610 EPO Area 1 $2,500 55 - 59 411.04 412.52 472.70 474.40 534.36 536.27 616.56 618.78 719.33 721.91 822.09 825.04
610 EPO Area 1 $2,500 60 - 64 560.46 486.69 644.53 559.69 728.60 632.69 840.69 730.03 980.81 851.70 1,120.93 973.37
610 EPO Area 1 $5,000 00 - 01 198.78$ 198.78$ 228.59$ 228.59$ 298.16$ 298.16$ 377.67$ 377.67$ 467.12$ 467.12$ 556.57$ 556.57$
610 EPO Area 1 $5,000 02 -19 105.47 105.47 121.29 121.29 158.20 158.20 200.38 200.38 247.84 247.84 295.30 295.30
610 EPO Area 1 $5,000 20 - 24 102.43 144.77 117.79 166.48 133.16 188.20 153.64 217.15 179.25 253.34 204.86 289.54
610 EPO Area 1 $5,000 25 - 29 105.81 180.59 121.68 207.68 137.55 234.77 158.71 270.89 185.16 316.04 211.61 361.19
610 EPO Area 1 $5,000 30 - 34 121.82 219.33 140.09 252.23 158.36 285.13 182.72 328.99 213.18 383.82 243.63 438.66
610 EPO Area 1 $5,000 35 - 39 145.55 219.37 167.38 252.28 189.21 285.18 218.32 329.06 254.71 383.90 291.10 438.74
610 EPO Area 1 $5,000 40 - 44 174.39 249.01 200.55 286.36 226.71 323.71 261.59 373.51 305.18 435.76 348.78 498.01
610 EPO Area 1 $5,000 45 - 49 219.53 277.91 252.46 319.59 285.38 361.28 329.29 416.86 384.17 486.33 439.05 555.81
610 EPO Area 1 $5,000 50 - 54 283.24 327.82 325.73 377.00 368.22 426.17 424.86 491.74 495.67 573.69 566.48 655.65
610 EPO Area 1 $5,000 55 - 59 374.34 375.66 430.49 432.01 486.64 488.36 561.51 563.49 655.09 657.40 748.68 751.32
610 EPO Area 1 $5,000 60 - 64 509.22 442.60 585.60 508.99 661.98 575.38 763.82 663.90 891.13 774.55 1,018.43 885.20
610 EPO Area 1 $0 00 - 01 267.12$ 267.12$ 307.19$ 307.19$ 400.68$ 400.68$ 507.52$ 507.52$ 627.73$ 627.73$ 747.93$ 747.93$
610 EPO Area 1 $0 02 -19 135.34 135.34 155.64 155.64 203.01 203.01 257.15 257.15 318.06 318.06 378.96 378.96
610 EPO Area 1 $0 20 - 24 131.04 195.31 150.70 224.61 170.36 253.91 196.56 292.97 229.32 341.80 262.09 390.62
610 EPO Area 1 $0 25 - 29 135.81 247.33 156.18 284.43 176.56 321.53 203.72 371.00 237.67 432.83 271.62 494.66
610 EPO Area 1 $0 30 - 34 158.44 303.58 182.20 349.12 205.97 394.66 237.65 455.37 277.26 531.27 316.87 607.16
610 EPO Area 1 $0 35 - 39 191.95 303.65 220.74 349.20 249.53 394.75 287.92 455.48 335.91 531.39 383.90 607.31
610 EPO Area 1 $0 40 - 44 232.68 338.07 267.59 388.78 302.49 439.49 349.03 507.11 407.20 591.63 465.37 676.15
610 EPO Area 1 $0 45 - 49 296.44 378.88 340.91 435.71 385.38 492.54 444.66 568.32 518.77 663.04 592.89 757.76
610 EPO Area 1 $0 50 - 54 386.42 449.39 444.38 516.80 502.34 584.21 579.63 674.09 676.23 786.44 772.83 898.79
610 EPO Area 1 $0 55 - 59 515.07 516.94 592.33 594.48 669.59 672.03 772.60 775.41 901.37 904.65 1,030.14 1,033.89
610 EPO Area 1 $0 60 - 64 705.70 611.59 811.56 703.33 917.41 795.07 1,058.55 917.39 1,234.98 1,070.28 1,411.41 1,223.18
610 EPO Area 2 $500 00 - 01 289.91$ 289.91$ 333.40$ 333.40$ 434.87$ 434.87$ 550.84$ 550.84$ 681.30$ 681.30$ 811.76$ 811.76$
610 EPO Area 2 $500 02 -19 145.31 145.31 167.10 167.10 217.96 217.96 276.08 276.08 341.47 341.47 406.86 406.86
610 EPO Area 2 $500 20 - 24 140.58 210.91 161.67 242.55 182.75 274.18 210.87 316.37 246.02 369.09 281.16 421.82
610 EPO Area 2 $500 25 - 29 145.80 267.91 167.67 308.10 189.55 348.29 218.71 401.87 255.16 468.85 291.61 535.83
610 EPO Area 2 $500 30 - 34 170.64 329.57 196.24 379.01 221.84 428.44 255.96 494.36 298.63 576.75 341.29 659.14
610 EPO Area 2 $500 35 - 39 207.41 329.64 238.52 379.09 269.63 428.53 311.11 494.46 362.96 576.87 414.81 659.28
610 EPO Area 2 $500 40 - 44 252.12 367.75 289.93 422.91 327.75 478.08 378.17 551.63 441.20 643.57 504.23 735.50
610 EPO Area 2 $500 45 - 49 322.08 412.55 370.39 474.43 418.70 536.31 483.11 618.82 563.63 721.96 644.15 825.10
610 EPO Area 2 $500 50 - 54 420.81 489.92 483.93 563.41 547.05 636.89 631.21 734.88 736.41 857.36 841.62 979.84
610 EPO Area 2 $500 55 - 59 561.99 564.04 646.29 648.64 730.59 733.25 842.99 846.06 983.49 987.07 1,123.99 1,128.08
610 EPO Area 2 $500 60 - 64 771.21 667.93 886.89 768.11 1,002.58 868.30 1,156.82 1,001.89 1,349.62 1,168.87 1,542.42 1,335.85
610 EPO Area 2 $1,000 00 - 01 265.20$ 265.20$ 304.98$ 304.98$ 397.80$ 397.80$ 503.88$ 503.88$ 623.22$ 623.22$ 742.57$ 742.57$
610 EPO Area 2 $1,000 02 -19 134.51 134.51 154.68 154.68 201.76 201.76 255.56 255.56 316.09 316.09 376.62 376.62
610 EPO Area 2 $1,000 20 - 24 130.23 192.63 149.77 221.52 169.30 250.42 195.35 288.94 227.91 337.10 260.47 385.26
610 EPO Area 2 $1,000 25 - 29 134.96 243.78 155.20 280.35 175.45 316.92 202.44 365.68 236.18 426.62 269.92 487.57
610 EPO Area 2 $1,000 30 - 34 157.40 299.10 181.01 343.96 204.62 388.83 236.10 448.65 275.45 523.42 314.80 598.19
610 EPO Area 2 $1,000 35 - 39 190.64 299.17 219.24 344.04 247.83 388.92 285.96 448.75 333.62 523.54 381.28 598.34
610 EPO Area 2 $1,000 40 - 44 231.04 335.57 265.69 385.91 300.35 436.25 346.56 503.36 404.32 587.26 462.08 671.15
610 EPO Area 2 $1,000 45 - 49 294.29 376.06 338.43 432.46 382.57 488.87 441.43 564.08 515.00 658.10 588.57 752.11
610 EPO Area 2 $1,000 50 - 54 383.52 445.97 441.05 512.87 498.58 579.77 575.28 668.96 671.16 780.45 767.04 891.95
610 EPO Area 2 $1,000 55 - 59 511.12 512.98 587.79 589.93 664.46 666.88 766.68 769.47 894.47 897.72 1,022.25 1,025.97
610 EPO Area 2 $1,000 60 - 64 700.19 606.85 805.22 697.88 910.25 788.91 1,050.29 910.28 1,225.34 1,062.00 1,400.39 1,213.71
610 EPO Area 2 $2,500 00 - 01 232.60$ 232.60$ 267.49$ 267.49$ 348.90$ 348.90$ 441.94$ 441.94$ 546.61$ 546.61$ 651.28$ 651.28$
610 EPO Area 2 $2,500 02 -19 120.26 120.26 138.29 138.29 180.38 180.38 228.49 228.49 282.60 282.60 336.71 336.71
610 EPO Area 2 $2,500 20 - 24 116.59 168.83 134.08 194.15 151.57 219.47 174.89 253.24 204.04 295.45 233.19 337.65
610 EPO Area 2 $2,500 25 - 29 120.65 212.34 138.75 244.20 156.85 276.05 180.98 318.52 211.14 371.60 241.31 424.69
610 EPO Area 2 $2,500 30 - 34 139.94 259.41 160.93 298.32 181.92 337.23 209.91 389.12 244.90 453.97 279.88 518.82
610 EPO Area 2 $2,500 35 - 39 168.51 259.47 193.79 298.39 219.07 337.31 252.77 389.20 294.90 454.07 337.03 518.94
610 EPO Area 2 $2,500 40 - 44 203.25 293.09 233.73 337.06 264.22 381.02 304.87 439.64 355.68 512.91 406.49 586.19
610 EPO Area 2 $2,500 45 - 49 257.59 327.90 296.23 377.08 334.87 426.26 386.39 491.84 450.79 573.82 515.19 655.79
610 EPO Area 2 $2,500 50 - 54 334.31 387.99 384.46 446.19 434.60 504.39 501.47 581.99 585.05 678.99 668.62 775.98
610 EPO Area 2 $2,500 55 - 59 443.99 445.59 510.58 512.43 577.18 579.27 665.98 668.39 776.98 779.78 887.97 891.18
610 EPO Area 2 $2,500 60 - 64 606.47 526.25 697.44 605.19 788.41 684.12 909.70 789.37 1,061.32 920.94 1,212.94 1,052.50
610 EPO Area 2 $5,000 00 - 01 213.22$ 213.22$ 245.21$ 245.21$ 319.84$ 319.84$ 405.13$ 405.13$ 501.08$ 501.08$ 597.03$ 597.03$
610 EPO Area 2 $5,000 02 -19 111.78 111.78 128.55 128.55 167.67 167.67 212.39 212.39 262.69 262.69 312.99 312.99
610 EPO Area 2 $5,000 20 - 24 108.47 154.52 124.75 177.70 141.02 200.87 162.71 231.78 189.83 270.41 216.95 309.04
610 EPO Area 2 $5,000 25 - 29 112.14 193.45 128.96 222.47 145.78 251.49 168.20 290.18 196.24 338.54 224.27 386.91
610 EPO Area 2 $5,000 30 - 34 129.55 235.57 148.99 270.90 168.42 306.24 194.33 353.35 226.72 412.24 259.10 471.13
610 EPO Area 2 $5,000 35 - 39 155.36 235.61 178.66 270.95 201.96 306.29 233.03 353.41 271.87 412.31 310.71 471.22
610 EPO Area 2 $5,000 40 - 44 186.71 267.83 214.72 308.00 242.72 348.18 280.07 401.74 326.74 468.70 373.42 535.66
610 EPO Area 2 $5,000 45 - 49 235.79 299.25 271.16 344.14 306.53 389.03 353.69 448.88 412.64 523.69 471.59 598.51
610 EPO Area 2 $5,000 50 - 54 305.04 353.52 350.80 406.54 396.56 459.57 457.57 530.27 533.83 618.65 610.09 707.03
610 EPO Area 2 $5,000 55 - 59 404.07 405.52 464.68 466.35 525.30 527.18 606.11 608.28 707.13 709.66 808.15 811.04
610 EPO Area 2 $5,000 60 - 64 550.74 478.33 633.35 550.08 715.96 621.83 826.11 717.49 963.79 837.07 1,101.48 956.66
610 EPO Area 2 $0 00 - 01 287.53$ 287.53$ 330.66$ 330.66$ 431.29$ 431.29$ 546.30$ 546.30$ 675.69$ 675.69$ 805.08$ 805.08$
610 EPO Area 2 $0 02 -19 144.26 144.26 165.90 165.90 216.39 216.39 274.09 274.09 339.00 339.00 403.92 403.92
610 EPO Area 2 $0 20 - 24 139.59 209.46 160.53 240.88 181.46 272.30 209.38 314.19 244.28 366.56 279.17 418.93
610 EPO Area 2 $0 25 - 29 144.77 266.01 166.48 305.91 188.20 345.81 217.15 399.02 253.34 465.52 289.54 532.02
610 EPO Area 2 $0 30 - 34 169.37 327.17 194.77 376.25 220.18 425.32 254.05 490.76 296.39 572.55 338.73 654.34
610 EPO Area 2 $0 35 - 39 205.80 327.24 236.67 376.33 267.54 425.42 308.70 490.86 360.15 572.68 411.60 654.49
610 EPO Area 2 $0 40 - 44 250.09 364.66 287.60 419.36 325.11 474.06 375.13 546.99 437.65 638.15 500.17 729.32
610 EPO Area 2 $0 45 - 49 319.39 409.03 367.30 470.38 415.21 531.74 479.09 613.54 558.94 715.80 638.79 818.06
610 EPO Area 2 $0 50 - 54 417.22 485.67 479.80 558.52 542.38 631.38 625.83 728.51 730.13 849.93 834.43 971.35
610 EPO Area 2 $0 55 - 59 557.08 559.13 640.65 643.00 724.21 726.86 835.62 838.69 974.89 978.47 1,114.17 1,118.25
610 EPO Area 2 $0 60 - 64 764.36 662.03 879.01 761.34 993.66 860.64 1,146.53 993.05 1,337.62 1,158.56 1,528.71 1,324.07
610 EPO Area 3 $500 00 - 01 235.15$ 235.15$ 270.43$ 270.43$ 352.73$ 352.73$ 446.79$ 446.79$ 552.61$ 552.61$ 658.43$ 658.43$
610 EPO Area 3 $500 02 -19 121.38 121.38 139.58 139.58 182.06 182.06 230.62 230.62 285.23 285.23 339.85 339.85
610 EPO Area 3 $500 20 - 24 117.66 172.99 135.31 198.93 152.96 224.88 176.49 259.48 205.90 302.72 235.32 345.97
610 EPO Area 3 $500 25 - 29 121.77 217.85 140.04 250.53 158.31 283.21 182.66 326.78 213.10 381.24 243.55 435.70
610 EPO Area 3 $500 30 - 34 141.30 266.37 162.50 306.32 183.70 346.28 211.96 399.55 247.28 466.14 282.61 532.73
610 EPO Area 3 $500 35 - 39 170.25 266.42 195.78 306.39 221.32 346.35 255.37 399.63 297.93 466.24 340.49 532.85
610 EPO Area 3 $500 40 - 44 205.42 296.41 236.23 340.88 267.04 385.34 308.13 444.62 359.48 518.72 410.84 592.83
610 EPO Area 3 $500 45 - 49 260.46 331.66 299.53 381.41 338.60 431.15 390.69 497.49 455.81 580.40 520.92 663.31
610 EPO Area 3 $500 50 - 54 338.16 392.52 388.88 451.40 439.61 510.28 507.24 588.78 591.78 686.91 676.32 785.04
610 EPO Area 3 $500 55 - 59 449.24 450.86 516.62 518.49 584.01 586.11 673.86 676.28 786.17 789.00 898.48 901.71
610 EPO Area 3 $500 60 - 64 613.79 532.55 705.86 612.43 797.93 692.31 920.68 798.82 1,074.13 931.96 1,227.58 1,065.10
610 EPO Area 3 $1,000 00 - 01 215.72$ 215.72$ 248.08$ 248.08$ 323.58$ 323.58$ 409.87$ 409.87$ 506.95$ 506.95$ 604.02$ 604.02$
610 EPO Area 3 $1,000 02 -19 112.87 112.87 129.81 129.81 169.31 169.31 214.46 214.46 265.26 265.26 316.05 316.05
610 EPO Area 3 $1,000 20 - 24 109.52 158.61 125.95 182.40 142.38 206.19 164.29 237.91 191.67 277.56 219.05 317.21
610 EPO Area 3 $1,000 25 - 29 113.24 198.86 130.23 228.69 147.22 258.52 169.87 298.29 198.18 348.01 226.49 397.72
610 EPO Area 3 $1,000 30 - 34 130.90 242.38 150.54 278.74 170.17 315.09 196.35 363.57 229.08 424.16 261.80 484.76
610 EPO Area 3 $1,000 35 - 39 157.05 242.44 180.60 278.80 204.16 315.17 235.57 363.65 274.83 424.26 314.09 484.87
610 EPO Area 3 $1,000 40 - 44 188.84 271.08 217.17 311.74 245.49 352.40 283.26 406.62 330.47 474.39 377.68 542.16
610 EPO Area 3 $1,000 45 - 49 238.59 302.94 274.38 348.38 310.17 393.83 357.88 454.41 417.53 530.15 477.18 605.89
610 EPO Area 3 $1,000 50 - 54 308.81 357.96 355.13 411.65 401.45 465.35 463.21 536.94 540.41 626.43 617.61 715.92
610 EPO Area 3 $1,000 55 - 59 409.21 410.67 470.59 472.28 531.98 533.88 613.82 616.01 716.12 718.68 818.42 821.35
610 EPO Area 3 $1,000 60 - 64 557.92 484.49 641.61 557.16 725.30 629.83 836.88 726.73 976.36 847.85 1,115.84 968.97
610 EPO Area 3 $2,500 00 - 01 190.06$ 190.06$ 218.57$ 218.57$ 285.09$ 285.09$ 361.11$ 361.11$ 446.64$ 446.64$ 532.17$ 532.17$
610 EPO Area 3 $2,500 02 -19 101.66 101.66 116.91 116.91 152.49 152.49 193.16 193.16 238.90 238.90 284.65 284.65
610 EPO Area 3 $2,500 20 - 24 98.78 139.87 113.60 160.85 128.41 181.83 148.17 209.81 172.87 244.77 197.56 279.74
610 EPO Area 3 $2,500 25 - 29 101.97 174.12 117.27 200.24 132.57 226.36 152.96 261.18 178.45 304.71 203.95 348.24
610 EPO Area 3 $2,500 30 - 34 117.15 211.15 134.72 242.83 152.29 274.50 175.72 316.73 205.01 369.52 234.29 422.30
610 EPO Area 3 $2,500 35 - 39 139.63 211.21 160.57 242.89 181.52 274.57 209.44 316.81 244.35 369.62 279.26 422.42
610 EPO Area 3 $2,500 40 - 44 166.95 237.65 192.00 273.30 217.04 308.95 250.43 356.48 292.17 415.89 333.91 475.30
610 EPO Area 3 $2,500 45 - 49 209.73 265.05 241.19 304.80 272.65 344.56 314.60 397.57 367.03 463.83 419.47 530.09
610 EPO Area 3 $2,500 50 - 54 270.08 312.34 310.60 359.19 351.11 406.04 405.13 468.51 472.65 546.59 540.17 624.68
610 EPO Area 3 $2,500 55 - 59 356.40 357.65 409.86 411.29 463.32 464.94 534.60 536.47 623.69 625.88 712.79 715.29
610 EPO Area 3 $2,500 60 - 64 484.16 421.06 556.79 484.22 629.41 547.38 726.24 631.59 847.28 736.86 968.32 842.12
610 EPO Area 3 $5,000 00 - 01 174.82$ 174.82$ 201.04$ 201.04$ 262.22$ 262.22$ 332.15$ 332.15$ 410.82$ 410.82$ 489.49$ 489.49$
610 EPO Area 3 $5,000 02 -19 95.00 95.00 109.26 109.26 142.51 142.51 180.51 180.51 223.26 223.26 266.01 266.01
610 EPO Area 3 $5,000 20 - 24 92.39 128.62 106.25 147.91 120.11 167.20 138.59 192.92 161.69 225.08 184.79 257.23
610 EPO Area 3 $5,000 25 - 29 95.27 159.26 109.57 183.15 123.86 207.04 142.91 238.89 166.73 278.70 190.55 318.52
610 EPO Area 3 $5,000 30 - 34 108.99 192.39 125.33 221.25 141.68 250.10 163.48 288.58 190.72 336.68 217.97 384.78
610 EPO Area 3 $5,000 35 - 39 129.28 192.43 148.67 221.30 168.07 250.16 193.92 288.65 226.24 336.75 258.57 384.86
610 EPO Area 3 $5,000 40 - 44 153.95 217.78 177.04 250.45 200.14 283.11 230.93 326.67 269.41 381.12 307.90 435.56
610 EPO Area 3 $5,000 45 - 49 192.57 242.51 221.46 278.88 250.34 315.26 288.86 363.76 337.00 424.39 385.15 485.01
610 EPO Area 3 $5,000 50 - 54 247.06 285.20 284.12 327.98 321.18 370.76 370.59 427.80 432.36 499.10 494.12 570.40
610 EPO Area 3 $5,000 55 - 59 324.99 326.12 373.73 375.04 422.48 423.96 487.48 489.18 568.73 570.71 649.97 652.24
610 EPO Area 3 $5,000 60 - 64 440.32 383.36 506.37 440.86 572.42 498.37 660.48 575.04 770.56 670.88 880.64 766.72
610 EPO Area 3 $0 00 - 01 233.28$ 233.28$ 268.27$ 268.27$ 349.92$ 349.92$ 443.23$ 443.23$ 548.21$ 548.21$ 653.18$ 653.18$
610 EPO Area 3 $0 02 -19 120.55 120.55 138.64 138.64 180.83 180.83 229.05 229.05 283.30 283.30 337.55 337.55
610 EPO Area 3 $0 20 - 24 116.88 171.85 134.41 197.63 151.94 223.40 175.32 257.77 204.54 300.74 233.75 343.70
610 EPO Area 3 $0 25 - 29 120.95 216.35 139.09 248.80 157.24 281.25 181.43 324.52 211.66 378.61 241.90 432.69
610 EPO Area 3 $0 30 - 34 140.30 264.48 161.34 304.15 182.39 343.82 210.45 396.72 245.52 462.84 280.59 528.96
610 EPO Area 3 $0 35 - 39 168.97 264.53 194.31 304.22 219.66 343.90 253.45 396.80 295.69 462.94 337.94 529.07
610 EPO Area 3 $0 40 - 44 203.81 293.97 234.39 338.07 264.96 382.16 305.72 440.96 356.67 514.45 407.63 587.95
610 EPO Area 3 $0 45 - 49 258.36 328.89 297.11 378.22 335.87 427.56 387.54 493.33 452.13 575.56 516.72 657.78
610 EPO Area 3 $0 50 - 54 335.32 389.20 385.62 447.58 435.92 505.96 502.98 583.80 586.81 681.10 670.64 778.40
610 EPO Area 3 $0 55 - 59 445.38 446.98 512.18 514.03 578.99 581.08 668.07 670.47 779.41 782.22 890.76 893.96
610 EPO Area 3 $0 60 - 64 608.41 527.91 699.67 607.10 790.93 686.29 912.61 791.87 1,064.71 923.85 1,216.82 1,055.82
630 GOALS Area 1 $1,200 00 - 01 264.83$ 264.83$ 302.23$ 302.23$ 389.49$ 389.49$ 489.22$ 489.22$ 601.42$ 601.42$ 713.61$ 713.61$
630 GOALS Area 1 $1,200 02 - 19 136.68 136.68 154.86 154.86 197.28 197.28 245.75 245.75 300.28 300.28 354.81 354.81
630 GOALS Area 1 $1,200 20 - 24 168.58 168.58 191.54 191.54 214.50 214.50 245.12 245.12 283.39 283.39 321.66 321.66
630 GOALS Area 1 $1,200 25 - 29 193.85 193.85 220.60 220.60 247.35 247.35 283.02 283.02 327.61 327.61 372.20 372.20
630 GOALS Area 1 $1,200 30 - 34 234.51 234.51 267.36 267.36 300.21 300.21 344.01 344.01 398.77 398.77 453.52 453.52
630 GOALS Area 1 $1,200 35 - 39 247.26 247.26 282.02 282.02 316.79 316.79 363.14 363.14 421.08 421.08 479.02 479.02
630 GOALS Area 1 $1,200 40 - 44 290.32 290.32 331.54 331.54 372.76 372.76 427.72 427.72 496.43 496.43 565.13 565.13
630 GOALS Area 1 $1,200 45 - 49 341.44 341.44 390.33 390.33 439.22 439.22 504.40 504.40 585.89 585.89 667.37 667.37
630 GOALS Area 1 $1,200 50 - 54 417.57 417.57 477.88 477.88 538.19 538.19 618.60 618.60 719.12 719.12 819.63 819.63
630 GOALS Area 1 $1,200 55 - 59 507.02 507.02 580.75 580.75 654.48 654.48 752.78 752.78 875.67 875.67 998.55 998.55
630 GOALS Area 1 $1,200 60 - 64 558.97 558.97 640.49 640.49 722.01 722.01 830.70 830.70 966.56 966.56 1,102.43 1,102.43
630 GOALS Area 1 $2,000 00 - 01 245.09$ 245.09$ 279.53$ 279.53$ 359.89$ 359.89$ 451.73$ 451.73$ 555.04$ 555.04$ 658.36$ 658.36$
630 GOALS Area 1 $2,000 02 - 19 127.09 127.09 143.83 143.83 182.89 182.89 227.53 227.53 277.74 277.74 327.96 327.96
630 GOALS Area 1 $2,000 20 - 24 156.46 156.46 177.61 177.61 198.75 198.75 226.94 226.94 262.19 262.19 297.43 297.43
630 GOALS Area 1 $2,000 25 - 29 179.73 179.73 204.37 204.37 229.00 229.00 261.85 261.85 302.91 302.91 343.96 343.96
630 GOALS Area 1 $2,000 30 - 34 217.17 217.17 247.43 247.43 277.68 277.68 318.01 318.01 368.43 368.43 418.85 418.85
630 GOALS Area 1 $2,000 35 - 39 228.92 228.92 260.93 260.93 292.94 292.94 335.63 335.63 388.98 388.98 442.33 442.33
630 GOALS Area 1 $2,000 40 - 44 268.56 268.56 306.52 306.52 344.48 344.48 395.10 395.10 458.36 458.36 521.63 521.63
630 GOALS Area 1 $2,000 45 - 49 315.64 315.64 360.66 360.66 405.68 405.68 465.71 465.71 540.74 540.74 615.78 615.78
630 GOALS Area 1 $2,000 50 - 54 385.74 385.74 441.28 441.28 496.82 496.82 570.86 570.86 663.43 663.43 755.99 755.99
630 GOALS Area 1 $2,000 55 - 59 468.12 468.12 536.01 536.01 603.91 603.91 694.43 694.43 807.58 807.58 920.74 920.74
630 GOALS Area 1 $2,000 60 - 64 515.95 515.95 591.02 591.02 666.09 666.09 766.18 766.18 891.29 891.29 1,016.40 1,016.40
630 GOALS Area 2 $1,200 00 - 01 277.51$ 277.51$ 316.81$ 316.81$ 408.51$ 408.51$ 513.31$ 513.31$ 631.21$ 631.21$ 749.12$ 749.12$
630 GOALS Area 2 $1,200 02 - 19 142.85 142.85 161.95 161.95 206.52 206.52 257.46 257.46 314.76 314.76 372.07 372.07
630 GOALS Area 2 $1,200 20 - 24 177.01 177.01 201.24 201.24 225.47 225.47 257.77 257.77 298.15 298.15 338.53 338.53
630 GOALS Area 2 $1,200 25 - 29 210.58 210.58 239.85 239.85 269.11 269.11 308.13 308.13 356.90 356.90 405.67 405.67
630 GOALS Area 2 $1,200 30 - 34 254.03 254.03 289.81 289.81 325.59 325.59 373.30 373.30 432.93 432.93 492.56 492.56
630 GOALS Area 2 $1,200 35 - 39 267.77 267.77 305.61 305.61 343.45 343.45 393.90 393.90 456.97 456.97 520.04 520.04
630 GOALS Area 2 $1,200 40 - 44 306.92 306.92 350.64 350.64 394.35 394.35 452.63 452.63 525.49 525.49 598.35 598.35
630 GOALS Area 2 $1,200 45 - 49 358.01 358.01 409.39 409.39 460.76 460.76 529.27 529.27 614.90 614.90 700.52 700.52
630 GOALS Area 2 $1,200 50 - 54 438.01 438.01 501.39 501.39 564.77 564.77 649.27 649.27 754.90 754.90 860.53 860.53
630 GOALS Area 2 $1,200 55 - 59 532.02 532.02 609.50 609.50 686.97 686.97 790.28 790.28 919.41 919.41 1,048.54 1,048.54
630 GOALS Area 2 $1,200 60 - 64 586.60 586.60 672.27 672.27 757.93 757.93 872.15 872.15 1,014.93 1,014.93 1,157.71 1,157.71
630 GOALS Area 2 $2,000 00 - 01 256.77$ 256.77$ 292.96$ 292.96$ 377.40$ 377.40$ 473.91$ 473.91$ 582.48$ 582.48$ 691.05$ 691.05$
630 GOALS Area 2 $2,000 02 - 19 132.77 132.77 150.36 150.36 191.40 191.40 238.31 238.31 291.08 291.08 343.85 343.85
630 GOALS Area 2 $2,000 20 - 24 164.23 164.23 186.54 186.54 208.85 208.85 238.60 238.60 275.78 275.78 312.96 312.96
630 GOALS Area 2 $2,000 25 - 29 195.14 195.14 222.09 222.09 249.04 249.04 284.97 284.97 329.88 329.88 374.79 374.79
630 GOALS Area 2 $2,000 30 - 34 235.15 235.15 268.10 268.10 301.05 301.05 344.98 344.98 399.89 399.89 454.80 454.80
630 GOALS Area 2 $2,000 35 - 39 247.80 247.80 282.65 282.65 317.49 317.49 363.95 363.95 422.03 422.03 480.10 480.10
630 GOALS Area 2 $2,000 40 - 44 283.86 283.86 324.11 324.11 364.36 364.36 418.04 418.04 485.13 485.13 552.21 552.21
630 GOALS Area 2 $2,000 45 - 49 330.90 330.90 378.21 378.21 425.52 425.52 488.60 488.60 567.45 567.45 646.30 646.30
630 GOALS Area 2 $2,000 50 - 54 404.57 404.57 462.93 462.93 521.29 521.29 599.11 599.11 696.37 696.37 793.64 793.64
630 GOALS Area 2 $2,000 55 - 59 491.14 491.14 562.48 562.48 633.83 633.83 728.96 728.96 847.86 847.86 966.77 966.77
630 GOALS Area 2 $2,000 60 - 64 541.40 541.40 620.29 620.29 699.17 699.17 804.35 804.35 935.83 935.83 1,067.30 1,067.30
630 GOALS Area 3 $1,200 00 - 01 252.55$ 252.55$ 288.11$ 288.11$ 371.08$ 371.08$ 465.90$ 465.90$ 572.57$ 572.57$ 679.25$ 679.25$
630 GOALS Area 3 $1,200 02 - 19 130.72 130.72 148.00 148.00 188.33 188.33 234.41 234.41 286.26 286.26 338.11 338.11
630 GOALS Area 3 $1,200 20 - 24 161.63 161.63 183.55 183.55 205.47 205.47 234.70 234.70 271.23 271.23 307.76 307.76
630 GOALS Area 3 $1,200 25 - 29 192.00 192.00 218.48 218.48 244.96 244.96 280.26 280.26 324.38 324.38 368.51 368.51
630 GOALS Area 3 $1,200 30 - 34 231.31 231.31 263.69 263.69 296.06 296.06 339.22 339.22 393.17 393.17 447.13 447.13
630 GOALS Area 3 $1,200 35 - 39 243.74 243.74 277.98 277.98 312.21 312.21 357.86 357.86 414.92 414.92 471.98 471.98
630 GOALS Area 3 $1,200 40 - 44 279.17 279.17 318.72 318.72 358.27 358.27 411.00 411.00 476.92 476.92 542.84 542.84
630 GOALS Area 3 $1,200 45 - 49 325.39 325.39 371.87 371.87 418.36 418.36 480.34 480.34 557.81 557.81 635.28 635.28
630 GOALS Area 3 $1,200 50 - 54 397.77 397.77 455.11 455.11 512.46 512.46 588.91 588.91 684.48 684.48 780.05 780.05
630 GOALS Area 3 $1,200 55 - 59 482.83 482.83 552.93 552.93 623.02 623.02 716.49 716.49 833.32 833.32 950.15 950.15
630 GOALS Area 3 $1,200 60 - 64 532.21 532.21 609.72 609.72 687.23 687.23 790.57 790.57 919.75 919.75 1,048.92 1,048.92
630 GOALS Area 3 $2,000 00 - 01 233.79$ 233.79$ 266.53$ 266.53$ 342.94$ 342.94$ 430.25$ 430.25$ 528.48$ 528.48$ 626.71$ 626.71$
630 GOALS Area 3 $2,000 02 - 19 121.60 121.60 137.51 137.51 174.65 174.65 217.09 217.09 264.83 264.83 312.58 312.58
630 GOALS Area 3 $2,000 20 - 24 150.07 150.07 170.25 170.25 190.44 190.44 217.35 217.35 250.99 250.99 284.63 284.63
630 GOALS Area 3 $2,000 25 - 29 178.03 178.03 202.41 202.41 226.79 226.79 259.30 259.30 299.94 299.94 340.57 340.57
630 GOALS Area 3 $2,000 30 - 34 214.23 214.23 244.04 244.04 273.85 273.85 313.60 313.60 363.28 363.28 412.96 412.96
630 GOALS Area 3 $2,000 35 - 39 225.68 225.68 257.20 257.20 288.73 288.73 330.77 330.77 383.31 383.31 435.85 435.85
630 GOALS Area 3 $2,000 40 - 44 258.30 258.30 294.72 294.72 331.14 331.14 379.70 379.70 440.40 440.40 501.10 501.10
630 GOALS Area 3 $2,000 45 - 49 300.86 300.86 343.67 343.67 386.47 386.47 443.55 443.55 514.89 514.89 586.23 586.23
630 GOALS Area 3 $2,000 50 - 54 367.52 367.52 420.32 420.32 473.12 473.12 543.53 543.53 631.53 631.53 719.53 719.53
630 GOALS Area 3 $2,000 55 - 59 445.84 445.84 510.39 510.39 574.94 574.94 661.01 661.01 768.59 768.59 876.18 876.18
630 GOALS Area 3 $2,000 60 - 64 491.31 491.31 562.69 562.69 634.06 634.06 729.22 729.22 848.18 848.18 967.13 967.13
* These rates are monthly; automatic monthly bank withdrawals rates will be the same as monthly rates;
quarterly rates will be three times of the monthly rates.
Supporting Document Schedules Satisfied - Item: Transmittal Letter (A&H)Comments:Attachment(s): UPMC HB GRIP Values & Goals Transmittal Letter UPMC-131136230.pdfItem Status:Status Date:
Satisfied - Item: Actuarial Memorandum and Explanatory Information (A&H)Comments:Attachment(s): Actuarial Memorandum GRIP Values & Goals UPMC-131136230.pdfItem Status:Status Date:
SERFF Tracking #: UPMC-131136230 State Tracking #: UPMC-131136230 Company Tracking #:
State: Pennsylvania Filing Company: UPMC Health Benefits, Inc.
TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005C Individual - Other
Product Name: UPMC HB 2018 GRIP - Value and Goals
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number UPMC-131136230 Generated 08/15/2017 11:03 AM
August 8, 2017
Ms. Johanna Fabian-Marks
Commonwealth of Pennsylvania Insurance Department
Insurance Product Regulation & Market Enforcement
Actuarial Review Division
Bureau of Accident & Health Insurance
1311 Strawberry Square
Harrisburg, PA 17120
Dear Ms. Fabian-Marks:
Guaranteed Renewable Individual Product Rate Filing for January 1, 2018 Effective Date
UPMC Health Benefits, Inc. respectfully requests approval of a rate filing for Individual medical products. The
rates are proposed for effective dates of January 1, 2018 through October 1, 2018, for plan offerings as
implemented under the Patient Protection and Affordable Care Act (PPACA).
The Commissioner has discretion regarding the publication of rate filings in the Pennsylvania Bulletin. If the
Department decides to publish notice of this filing, we suggest the following notice language:
UPMC Health Benefits, Inc.
Guaranteed Renewable Individual Product Rate Filing
On August 8, 2017, UPMC Health Benefits, Inc. submitted for approval a rate filing for use with
Individual customers.
An Actuarial Memorandum and rate development exhibit are included in this rate filing. If you have any
questions or require additional information, please call me at 412-454-1230 or email me at [email protected].
Sincerely,
Stephanie Dulz, FSA, MAAA
Actuarial Memorandum General Info
This actuarial memorandum provides the detail behind the rate filing submitted by UPMC Health
Benefits, Inc. for Individual transitional policies.
Company Identifying Information: Company Legal Name: UPMC Health Benefits, Inc. State: PA HIOS Issuer ID: 67430 Market: Individual Effective Date: 1/1/2018 Company Contact Information: Primary Contact Name: Stephanie Dulz, FSA, MAAA Primary Contact Telephone Number: 412-454-1230 Primary Contact Email Address: [email protected]
Filing Information:
Rate Filing SERFF Tracking #: UPMC-131136230
Form Filing SERFF Tracking #:
Initial Filings: UPMC-127741169, UPMC-128778648
Mental Health Parity Amendments: UPMC-129866647, UPMC-129866621
Spousal Eligibility Amendments: UPMC-130253074, UPMC-130253081
Rate Increase
The rate increase for these plans is 4.09%. This is a flat increase across all plans that does not vary by
age, gender, or area.
Timeframe
This product will be renewed as part of the transitional policy extension as detailed in the CMS bulletin titled ‘Insurance Standards Bulletin Series -- INFORMATION – Extension of Transitional Policy through Calendar Year 2018’ dated February 23, 2017. Per the bulletin, members that have a renewal date between January 1, 2018 and October 1, 2018 will be able to renew with the end date of the renewal
plan as December 31, 2018. No plans will be allowed to renew after October 1, 2018.
Benefits offered
Standard medical benefits are included in these plans. They are slightly different from ACA-compliant plans. The main differences are that private duty nursing and bariatric surgery are covered but fertility treatment is not.
Network
Our Premium network is used for all plans. This is the same Premium network used for ACA-compliant
plans.
Areas Offered
This product will be offered to current members in 29 counties:
ALLEGHENY BUTLER CLEARFIELD FOREST LAWRENCE VENANGO
ARMSTRONG CAMBRIA CRAWFORD GREENE MCKEAN WARREN
BEAVER CAMERON ELK HUNTINGDON MERCER WASHINGTON
BEDFORD CENTRE ERIE INDIANA POTTER WESTMORELAND
BLAIR CLARION FAYETTE JEFFERSON SOMERSET
Experience Period
The experience period for claims data used in the rate development was 6-1-2016 through 5-31-2017
with claim runout period through 6-30-2017.
Trend
Experience period allowed claims are trended to the projected time period. Because of the declining
enrollment and resulting lack of consistency in membership over time, we used our commercial block of
business to develop trend. The same commercial block was used in the Individual ACA filings so we used
the same time period and thus the same trend amount for consistency.
Benefit Design
There are no changes in benefits offered between the experience period and projection period.
Cost Sharing
The actuarial value calculated from the experience period was used for the projection period to
calculate paid amounts from allowed amounts. Given the changing experience and the low actuarial
value overall, we expect leveraging to have a minimal impact and thus did not increase actuarial values
for plans from experience period.
Retention
A target loss ratio of 82% was used to calculate premium from projected paid amount. This exceeds the
80% minimum required for individual plans under PPACA. This results in the following components of
retention:
PMPM % of Premium
Projected 2018 Premium $305.67
Average PMPM quality initiative expense: $1.66 0.54%
PCORI Fee (PMPM): $0.20 0.07%
% Premium Tax: $6.11 2.00%
Admin Expenses PMPM $45.68 14.95%
Projected Incurred PMPM $250.65 82.00%
Profit: $1.36 0.45%
Included in the $1.66 quality improvement PMPM are a number of focused quality improvement
initiatives, including but not limited to rare & chronic disease management, an optimal discharge
planning program, a full-time telephonic nurse advice line, and a congestive heart failure tele-
monitoring program.
These types of medical insurance plans would be subjected to the Health Insurance Tax (HIT) under
PPACA. But the first $25M of revenue is exempt from assessment and we don’t believe UPMC Health
Benefits, Inc. will exceed this threshold. Because of this, we have not included any amounts for HIT.
Actuarial Certification
I, Stephanie Dulz, am a Member of the American Academy of Actuaries. I am currently a Manager in the
Actuarial Services department for UPMC Health Plan. I certify that the methods used in calculating the
rates in this filing were actuarially sound, consistently applied and consistent with generally accepted
actuarial practice. I also certify that, to the best of my knowledge, the data used for these calculations
was sound and reliable; the assumptions were sound and consistently applied; the rates produced are
adequate, not excessive, and are in compliance the Actuarial Standards of Practice.
_____________ ________8/8/2017_
Stephanie Dulz, FSA, MAAA Date
UPMC Health Plan