APPROVED MONTHLY PREMIUM RATES - INDIVIDUAL STANDARD PLANS

Insurer

ON/OFF Exchange

Metal/Tier

AETNA LIFE

ON/OFF

PLATINUM

AFFINITY

ON

PLATINUM

AMERICAN PROG

ON

PLATINUM

ATLANTIS

OFF

PLATINUM

CDPHP HMO

ON/OFF

PLATINUM

EMPIRE HMO

ON/OFF

PLATINUM

EXCELLUS

ON/OFF

PLATINUM

FREELANCERS

ON/OFF

PLATINUM

GHI

OFF

PLATINUM

HEALTHFIRST

ON/OFF

PLATINUM

HEALTHNOW

ON/OFF

PLATINUM

HIP HMO

ON/OFF

PLATINUM

HIPIC

OFF

PLATINUM

IHBC

ON/OFF

PLATINUM

METRO PLUS

ON

PLATINUM

MVPHP-HMO

ON/OFF

PLATINUM

NEW YORK FIDELIS

ON

PLATINUM

NORTHSHORE LIJ

ON/OFF

PLATINUM

OSCAR

ON

PLATINUM

OXFORD HMO

OFF

PLATINUM

UNITED

ON

PLATINUM

Insurer

ON/OFF Exchange

Metal/Tier

AETNA LIFE

ON/OFF

GOLD

AFFINITY

ON

GOLD

AMERICAN PROG

ON

GOLD

ATLANTIS

OFF

GOLD

CDPHP HMO

ON/OFF

GOLD

EMPIRE HMO

ON/OFF

GOLD

EXCELLUS

ON/OFF

GOLD

FREELANCERS

ON/OFF

GOLD

GHI

OFF

GOLD

HEALTHFIRST

ON/OFF

GOLD

HEALTHNOW

ON/OFF

GOLD

HIP HMO

OFF

GOLD

HIPIC

OFF

GOLD

IHBC

ON/OFF

GOLD

METRO PLUS

ON

GOLD

MVPHP-HMO

ON/OFF

GOLD

NEW YORK FIDELIS

ON

GOLD

NORTHSHORE LIJ

ON/OFF

GOLD

OSCAR

ON

GOLD

OXFORD HMO

OFF

GOLD

UNITED

ON

GOLD

ALBANY

632.64

BUFFALO

MID HUDSON

NEW YORK

798.86
601.28

559.66

710.86
586.50
714.02

ROCHESTER

586.49

SYRACUSE

UTICA

592.25

525.39

717.98

689.83
963.75
653.97
375.65
805.42

LONG ISLAND

ALL REGIONS COMB. AVG

798.86
614.40

532.57
568.13
602.75
965.24
913.99

769.53
600.73
601.74
737.05
694.72
706.43
619.49
423.64
809.31
623.30
692.95
580.88
918.13
618.94
443.24
606.23
516.51
568.13
602.75
965.24
913.99

LONG ISLAND

ALL REGIONS COMB. AVG

688.37
520.58

440.79
487.34
517.55
817.98
749.13

663.27
509.07
537.08
638.47
608.09
600.69
534.97
361.05
680.11
526.02
600.59
483.26
757.00
538.05
395.76
514.86
427.50
487.34
517.55
817.98
749.13

LONG ISLAND

ALL REGIONS COMB. AVG

597.44
451.33

575.28
441.41
466.81
546.12
515.80
508.88
461.57
319.47
578.56
450.00
493.24
404.28
626.65
470.81
359.26
428.49
349.14
419.62
446.01
691.69
635.60

737.05
644.42
605.47
653.97
397.25
796.85

635.41
371.87
737.26

737.81

568.41

902.13

834.66
618.94

542.94
506.02

493.30
500.18

ALBANY

564.19

726.66
714.11
653.97
446.23
873.13

650.28
523.23
852.26
623.30

505.26
365.57
720.23

614.36
386.06
771.34

598.53
523.23
918.01
623.30

772.62
555.61
994.34

555.61
994.34

965.24
913.99

443.24
864.34
577.18
568.13
602.75
965.24
913.99

BUFFALO

MID HUDSON

NEW YORK

688.37
509.54

499.11

613.08
497.10
636.76

664.59
510.27

815.36

873.24

911.82

476.36
501.78

620.41
504.96

581.67
499.12

ROCHESTER

SYRACUSE

UTICA

523.03

530.85

468.55

628.54

603.89
819.49
564.75
320.15
676.84

631.43
1,019.18

638.47
563.94
514.85
564.75
338.56
669.64

548.72
316.93
619.56

638.98

494.10

743.80

688.17
538.05

461.10
418.82

418.95
413.99

636.00
607.23
564.75
380.31
733.74

552.95
445.93
716.19
526.02

436.32
311.56
605.24

530.54
329.03
648.19

508.94
445.93
771.45
526.02

668.69
462.24
819.83

462.24
819.83

817.98
749.13

395.76
734.06
477.71
487.34
517.55
817.98
749.13

BUFFALO

MID HUDSON

NEW YORK

597.44
441.81

433.80

530.95
431.10
553.44

564.43
422.34

672.27

719.98

751.79

404.56
415.31

526.90
417.94

494.00
413.11

ROCHESTER

SYRACUSE

UTICA

525.31
840.32

Premiums above are for Single Adults [Employee Only];

Employees with Spouse: Multiply by 2.00;
Employees with Child(ren): Multiply by 1.70;
Employees with Family: Multiply by 2.85;
Insurer

ON/OFF Exchange

Metal/Tier

AETNA LIFE

ON/OFF

SILVER

AFFINITY

ON

SILVER

AMERICAN PROG

ON

SILVER

ATLANTIS

OFF

SILVER

CDPHP HMO

ON/OFF

SILVER

EMPIRE HMO

ON/OFF

SILVER

EXCELLUS

ON/OFF

SILVER

FREELANCERS

ON/OFF

SILVER

GHI

OFF

SILVER

HEALTHFIRST

ON/OFF

SILVER

HEALTHNOW

ON/OFF

SILVER

HIP HMO

OFF

SILVER

HIPIC

OFF

SILVER

IHBC

ON/OFF

SILVER

METRO PLUS

ON

SILVER

MVPHP-HMO

ON/OFF

SILVER

NEW YORK FIDELIS

ON

SILVER

NORTHSHORE LIJ

ON/OFF

SILVER

OSCAR

ON

SILVER

OXFORD HMO

OFF

SILVER

UNITED

ON

SILVER

ALBANY

490.37

454.60

461.39

407.24

533.23

512.32
694.24
487.26
283.29
575.78

546.12
478.22
436.15
487.26
299.57
569.66

473.43
280.43
527.05

524.68

406.36

615.72

569.67
470.81

383.76
342.05

348.68
338.11

539.42
514.41
487.26
336.51
624.18

468.43
394.58
609.27
450.00

376.46
275.68
514.88

457.74
291.14
551.42

431.15
394.58
656.27
450.00

548.68
386.69
678.66

469.74
344.93

691.69
635.60

386.69
678.66
359.26
610.92
390.15
419.62
446.01
691.69
635.60

556.51

596.01

622.34

336.69
339.18

438.52
341.34

411.13
337.39

439.47
695.62

360.00
419.62
446.01
691.69
635.60

APPROVED MONTHLY PREMIUM RATES - INDIVIDUAL STANDARD PLANS

Insurer

ON/OFF Exchange

Metal/Tier

AETNA LIFE

ON/OFF

BRONZE

AFFINITY

ON

BRONZE

AMERICAN PROG

ON

BRONZE

ATLANTIS

OFF

BRONZE

CDPHP HMO

ON/OFF

BRONZE

EMPIRE HMO

ON/OFF

BRONZE

EXCELLUS

ON/OFF

BRONZE

FREELANCERS

ON/OFF

BRONZE

GHI

OFF

BRONZE

HEALTHFIRST

ON/OFF

BRONZE

HEALTHNOW

ON/OFF

BRONZE

HIP HMO

OFF

BRONZE

HIPIC

OFF

BRONZE

IHBC

ON/OFF

BRONZE

METRO PLUS

ON

BRONZE

MVPHP-HMO

ON/OFF

BRONZE

NEW YORK FIDELIS

ON

BRONZE

NORTHSHORE LIJ

ON/OFF

BRONZE

OSCAR

ON

BRONZE

OXFORD HMO

OFF

BRONZE

UNITED

ON

BRONZE

ALBANY

395.24

BUFFALO

MID HUDSON

NEW YORK

513.35
378.58

349.65

456.63
369.49
446.08

ROCHESTER

366.41

SYRACUSE

UTICA

371.88

328.24

449.01

431.33
602.40
377.46
223.84
485.11

LONG ISLAND

ALL REGIONS COMB. AVG

513.35
386.67

284.50
330.13
361.64
589.91
548.06

494.44
378.25
376.25
432.69
433.94
441.56
357.56
252.43
487.45
384.19
410.18
349.49
536.20
395.74
334.44
331.20
275.92
330.13
361.64
589.91
548.06

LONG ISLAND

ALL REGIONS COMB. AVG

370.59
300.85

357.23
294.41
340.73
301.05
406.56
218.67
352.74
173.54

432.69
401.80
378.45
377.46
236.70
479.95

366.75
221.58
444.06

435.48

340.10

526.85

487.45
395.74

296.62
270.32

269.50
267.20

453.62
446.36
377.46
265.89
525.89

406.46
311.77
513.32
384.19

291.62
217.83
433.79

354.59
230.04
464.59

374.11
311.77
552.92
384.19

454.97
334.28
580.70

334.28
580.70

589.91
548.06

334.44
472.21
308.33
330.13
361.64
589.91
548.06

BUFFALO

MID HUDSON

NEW YORK

370.59
294.67

316.63

330.50
287.72
403.96

363.08
272.59

476.18

509.97

532.51

260.24
268.05

338.94
269.75

317.79
266.63

ROCHESTER

SYRACUSE

UTICA

379.90
595.21

Premiums above are for Single Adults [Employee Only];

Employees with Spouse: Multiply by 2.00;
Employees with Child(ren): Multiply by 1.70;
Employees with Family: Multiply by 2.85;
Insurer

ON/OFF Exchange

Metal/Tier

AETNA LIFE

ON/OFF

CATASTROPHIC

AFFINITY

ON

CATASTROPHIC

AMERICAN PROG

ON

CATASTROPHIC

ATLANTIS

OFF

CATASTROPHIC

CDPHP HMO

ON/OFF

CATASTROPHIC

EMPIRE HMO

ON/OFF

CATASTROPHIC

EXCELLUS

ON/OFF

CATASTROPHIC

FREELANCERS

ON/OFF

CATASTROPHIC

GHI

OFF

CATASTROPHIC

HEALTHFIRST

ON/OFF

CATASTROPHIC

HEALTHNOW

ON/OFF

CATASTROPHIC

HIP HMO

OFF

CATASTROPHIC

HIPIC

OFF

CATASTROPHIC

IHBC

ON/OFF

CATASTROPHIC

METRO PLUS

ON

CATASTROPHIC

MVPHP-HMO

ON/OFF

CATASTROPHIC

NEW YORK FIDELIS

ON

CATASTROPHIC

NORTHSHORE LIJ

ON/OFF

CATASTROPHIC

OSCAR

ON

CATASTROPHIC

OXFORD HMO

OFF

CATASTROPHIC

UNITED

ON

CATASTROPHIC

ALBANY

357.93

331.82

336.77

297.25

420.64

404.09
298.33
372.38
153.88

301.05
376.50
187.43
372.38
162.73

361.79
152.33

394.51

309.93

425.02
221.05
372.38
182.79

201.29
214.33

287.70
149.75

349.82
158.15

324.59

185.27
214.33
324.59
231.99

324.59
372.07
213.48

175.19
183.53
226.93

203.66
328.38
171.34
169.91
183.53
226.93

334.94

334.94

411.76
204.22

204.22

203.66
153.45
166.46

139.42
164.54

187.83
167.85

334.94

328.38
244.28
189.86
183.53
226.93
334.94

134.63
165.06

175.34
166.11

164.40
164.19

APPROVED(MONTHLY(PREMIUM(RATES(2(SMALL(GROUP(STANDARD(PLANS
Insurer

ON/OFF((Exchange

Metal/Tier

AETNA(LIFE

OFF

PLATINUM

ATLANTIS

OFF

PLATINUM

CDPHP(HMO

OFF

PLATINUM

CDPHP(UBI

ON/OFF

PLATINUM

EMPIRE(BCBS

OFF

PLATINUM

EMPIRE(HMO

OFF

PLATINUM

EXCELLUS

ON/OFF

PLATINUM

FREELANCERS

ON/OFF

PLATINUM

GHI

OFF

PLATINUM

HEALTHNOW

ON/OFF

PLATINUM

HIP(HMO

OFF

PLATINUM

HIPIC

OFF

PLATINUM

IHA(HMO

OFF

PLATINUM

IHBC

ON/OFF

PLATINUM

MANAGED

OFF

PLATINUM

METROPLUS

ON

PLATINUM

MVP(SERVICES

OFF

PLATINUM

MVPHP2HMO

ON/OFF

PLATINUM

NORTHSHORE(LIJ

ON/OFF

PLATINUM

OXFORD(HMO

OFF

PLATINUM

OXFORD(OHI

ON/OFF

PLATINUM

UNITED

OFF

PLATINUM

ALBANY

BUFFALO

MID(HUDSON

NEW(YORK

ROCHESTER

SYRACUSE

UTICA

LONG(ISLAND

470.41
597.63
562.14
515.40

633.41
582.67

585.73
432.86

569.08
405.21

651.53

532.71

585.73
486.23

570.13

452.52
398.34

624.99
578.03

600.58
555.14

550.24
420.67

585.73
409.33

470.41
597.63
605.28
557.81

570.13

676.57

593.73
446.29

554.84
461.61
620.27

539.34

535.71
539.61

ALL(REGIONS(COMB.(AVG

539.34

733.00
774.73

479.50
767.86
773.42
746.14
733.00
774.73

602.68
607.05

448.10
451.35

582.03
586.25

546.32
550.28

746.14
733.00
774.73
751.88

479.50
595.91
564.89
746.14
733.00
774.73
751.88

690.84

Insurer

ON/OFF((Exchange

Metal/Tier

ALBANY

BUFFALO

MID(HUDSON

NEW(YORK

ROCHESTER

SYRACUSE

UTICA

LONG(ISLAND

ALL(REGIONS(COMB.(AVG

AETNA(LIFE

OFF

GOLD

487.38

534.51

528.85

415.73

469.46

487.38

593.90

ATLANTIS

OFF

GOLD

593.90
517.68

CDPHP(HMO

OFF

GOLD

CDPHP(UBI

ON/OFF

GOLD

562.87
507.32

540.91
487.24

513.89
517.68
545.33
489.58

768.30
506.58
348.93

510.73

475.88
358.60

486.02

593.02
479.86
393.51
510.22
493.46

OFF

GOLD

EMPIRE(HMO

EMPIRE(BCBS

OFF

GOLD

EXCELLUS

ON/OFF

GOLD

FREELANCERS

ON/OFF

GOLD

GHI

OFF

GOLD

HEALTHNOW

ON/OFF

GOLD

HIP(HMO

OFF

GOLD

HIPIC

OFF

GOLD

IHA(HMO

OFF

GOLD

IHBC

ON/OFF

GOLD

MANAGED

OFF

GOLD

METROPLUS

ON

GOLD

MVP(SERVICES

OFF

GOLD

MVPHP2HMO

ON/OFF

GOLD

NORTHSHORE(LIJ

ON/OFF

GOLD

OXFORD(HMO

OFF

GOLD

OXFORD(OHI

ON/OFF

GOLD

UNITED

OFF

GOLD

506.75
452.37

570.78
511.39

516.19
506.58
369.00

492.18
345.42

535.95

438.63

604.61
506.58
414.49

565.27

460.08

460.08

560.22

631.37
427.34
641.96
656.78
651.57
632.80
656.70

631.37

486.02

391.39
339.57

556.08

464.09

447.88
458.22

496.39
378.99

503.87
515.49

693.74

568.84

632.80
656.70
742.34

374.63
383.29

486.60
497.85

635.93

591.17

589.07

651.57
632.80
656.70
605.37

464.09
631.37
427.34
498.21
479.70
651.57
632.80
656.70
632.35

456.75
467.30

577.58

Premiums(above(are(for(Single(Adults([Employee(Only];
Employees(with(Spouse:(MulWply(by(2.00;
Employees(with(Child(ren):(MulWply(by(1.70;
Employees(with(Family:(MulWply(by(2.85;
Insurer

ON/OFF((Exchange

Metal/Tier

ALBANY

BUFFALO

MID(HUDSON

NEW(YORK

ROCHESTER

SYRACUSE

UTICA

LONG(ISLAND

ALL(REGIONS(COMB.(AVG

AETNA(LIFE

OFF

SILVER

421.23

462.55

457.21

359.48

405.99

421.23

513.77

ATLANTIS

OFF

SILVER

513.77
442.81

444.40
442.81

CDPHP(HMO

OFF

SILVER

CDPHP(UBI

ON/OFF

SILVER

431.66

EMPIRE(BCBS

OFF

SILVER

414.57
641.55

426.46

416.56
495.18

EMPIRE(HMO

OFF

SILVER

EXCELLUS

ON/OFF

SILVER

FREELANCERS

ON/OFF

SILVER

437.84
299.46

417.10

414.75
337.71

446.11
550.52

451.16
410.40
541.58

GHI

OFF

SILVER

HEALTHNOW

ON/OFF

SILVER

HIP(HMO

OFF

SILVER

HIPIC

OFF

SILVER

IHA(HMO

OFF

SILVER

IHBC

ON/OFF

SILVER

MANAGED

OFF

SILVER

METROPLUS

ON

SILVER

MVP(SERVICES

OFF

SILVER

MVPHP2HMO

ON/OFF

SILVER

NORTHSHORE(LIJ

ON/OFF

SILVER

OXFORD(HMO

OFF

SILVER

OXFORD(OHI

ON/OFF

SILVER

UNITED

OFF

SILVER

384.89
431.03
437.84
316.68

425.40
296.44

480.68

373.88

435.12
504.86

472.01

437.84
355.72

417.10

392.54
537.11

392.54
537.11

338.27
291.42

411.32
307.76

498.92

400.76

363.15
381.31

402.48
315.38

400.76

408.55
428.99

387.23
520.52
546.56
568.05

488.84

555.48
637.94

555.48

596.18

303.76
318.96

394.55
414.28

546.50

528.52

568.05

387.23
403.96
399.19
568.05

506.23

555.48
509.57

555.48
544.82

370.34
388.86

468.32

Insurer

ON/OFF((Exchange

Metal/Tier

ALBANY

BUFFALO

MID(HUDSON

NEW(YORK

ROCHESTER

SYRACUSE

UTICA

LONG(ISLAND

ALL(REGIONS(COMB.(AVG

AETNA(LIFE

OFF

BRONZE

319.42

350.52

346.60

272.75

307.79

319.42

389.65

ATLANTIS

OFF

BRONZE

389.65
350.84

336.98
350.84

CDPHP(HMO

OFF

BRONZE

CDPHP(UBI

ON/OFF

BRONZE

EMPIRE(BCBS

OFF

BRONZE

EMPIRE(HMO

OFF

BRONZE

EXCELLUS

ON/OFF

BRONZE

FREELANCERS

ON/OFF

BRONZE

GHI

OFF

BRONZE

HEALTHNOW

ON/OFF

BRONZE

HIP(HMO

OFF

BRONZE

HIPIC

OFF

BRONZE

IHA(HMO

OFF

BRONZE

IHBC

ON/OFF

BRONZE

MANAGED

OFF

BRONZE

METROPLUS

ON

BRONZE

MVP(SERVICES

OFF

BRONZE

MVPHP2HMO

ON/OFF

BRONZE

NORTHSHORE(LIJ

ON/OFF

BRONZE

OXFORD(HMO

OFF

BRONZE

OXFORD(OHI

ON/OFF

BRONZE

UNITED

OFF

BRONZE

Premiums(above(are(for(Single(Adults([Employee(Only];
Employees(with(Spouse:(MulWply(by(2.00;
Employees(with(Child(ren):(MulWply(by(1.70;
Employees(with(Family:(MulWply(by(2.85;

328.78
359.65
341.38
257.94
470.91
380.51

331.68
241.46
435.70
319.73

371.69
421.24

393.84

368.73

341.38
289.75
516.00

339.75
503.66

342.74

342.74

263.74
237.37
425.62

320.71
250.68
455.84

354.13
535.30
341.38
243.92
475.98
394.37

365.18

339.75
542.51
389.51

329.21

303.72
294.63

336.60
243.69

355.83
415.04
323.38
275.08
478.28
364.87
358.33

329.21

341.67
331.46

359.97
435.32
422.31
466.81

473.91

473.91

254.04
246.44

329.97
320.10

309.72
300.47

466.81

359.97
337.84
308.44
466.81

473.91

473.91

391.66