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ACTUARIAL MEMORANDUM

1. General Information
Company Identifying Information
Company Legal Name:
State:
HIOS Issuer ID:
Market:
Effective Date:

Company Contact Information

Primary Contact Name:


Primary Contact Telephone Number:
Primary Contact Email Address:

Healthy Alliance Life Insurance Company


Missouri
32753
Small Group
April 1, 2015

Andy Dare
(314) 923-8947
Andy.Dare@wellpoint.com

2. Scope and Purpose of the Filing


To the best of Anthem's knowledge and current understanding, this filing complies with the most recent
regulations and related guidance. To the extent relevant rules or guidance on the rules are updated or
changed, amendments to this filing may be required.
The purpose of this rate filing is to establish rates that are reasonable relative to the benefits provided and
to demonstrate compliance with state laws and provisions of the Affordable Care Act (ACA). The rates will
be in-force for effective dates on or after April 1, 2015. Subsequent rate changes will be implemented
quarterly as discussed in more detail in Section 16: Index Rate. These rates will apply to plans offered both
On-Exchange and Off-Exchange. This rate filing is not intended to be used for other purposes.

Policy Form Number(s):


ABCBS MO - SG PPO - ON - v01
ABCBS MO - SG PPO - OFF - v01
ABCBS MO - SG BPO - OFF - v01

3. Introduction
This filing includes an average rate increase of 4.0%, with range by plan between -13.9% and 23.9%. More
details are provided below in Section 5: Proposed Rate Increase, and in Exhibit I: Non-Grandfathered
Benefit Plan Factors and Rate Increases.

Changes from prior 2015 Small Group ACA filing

Trend has been updated -- see Exhibit D: Projection Period Adjustments and Exhibit O: Quarterly
Index, Base, and Market Adjusted Index Rate Development .
Profit and Risk and assumed Federal Income tax expense have been revised -- see Exhibit G: Non-Benefit
Expenses and Profit & Risk.
The projection period has been moved to May 1, 2015 - April 30, 2016.
The assumed reinsurance contribution for 2016 has been revised -- see Exhibit F: Risk Adjustment and
Reinsurance - Contributions and Payments.

4. Description of How the Base Rate Is Determined


The methodology used to develop the rates this year is consistent with the methodology that was used
last year. The development of the Base Rate is detailed in Exhibit A: Base Rate Development. Further
details on how the base rate is developed can be found in Section 9: Credibility Manual Rate
Development, Section 12: Risk Adjustment and Reinsurance, Section 13: Non-Benefit Expenses, Profit and
Risk, and Section 19: Calibration. A description of the methodology used to determine the base rate is as
follows:

Small Group manual rates are developed based on historical experience of Grandfathered and
Non-Grandfathered business.
The experience data is normalized to reflect anticipated changes in age/gender, area/network
and benefit plan from the experience period to the projection period based on expected
distribution of membership.
The projected claims cost is calculated by adjusting the normalized claims for the impact of
benefit changes, population morbidity, trend factors, etc. Adjustment is not based on the health
status of the member.
The projection period is May 1, 2015 - April 30, 2016. Small Group Business renews on a
quarterly basis; therefore the middle month of the second quarter is May 2015 .
Adjustments for risk adjustment and reinsurance are applied to the projected claims cost.
Non-benefit expenses, profit, and risk are applied to the projected claims cost to determine the
required projection period premium.
The projection period premium is adjusted by the average rating factors in the projection period
to determine the base rate.
The base rate represents an average benefit plan and area for an age 21 non-tobacco user in
Missouri.

Premiums at the member level are determined by multiplying the base rate by the applicable factor for
each of the allowable rating criteria: age, tobacco, area and benefit plan. An example of this calculation is
shown in Exhibit L: Sample Rate Calculation.

5. Proposed Rate Increase


The average proposed rate increase is 4.0%. Factors that affect the proposed rate increase for all plans
include:
Changes in benefit design
Anticipated changes in the market-wide morbidity of the covered population in the projection
period
Changing trends in medical costs and utilization and other cost of care impacts
Anticipated changes in payments to the Federal Transitional Reinsurance Program
Changes in taxes, fees, and other non-benefit expenses
The rate increase is shown in Exhibit I: Non-Grandfathered Benefit Plan Factors and Rate Increases.
Although rates are based on the same single risk pool of experience, proposed rate increases vary by plan
from -13.9% to 23.9%. Factors that affect the variation in the proposed rate increase by plan include:

Changes in benefit design that vary by plan


Changes in the adjustment factor for Catastrophic eligibility
Changes in Non-Benefit Expenses that are applied on a PMPM basis
Changes in the underlying area rating factors, which are included in the plan-level increase for
plans not offered in all areas
Anticipated changes due to network contracting by pricing area.
In 2014, the area factors varied by plan based on actuarially justified network cost differences for each
geographic rating area. Effective January 1, 2015, a single area factor will apply to all plans in each
geographic rating area. To retain the actuarially justified network cost differences for each geographic
area and comply with 45 CFR part 147.102, several new plans have been added, each of which is
available in a single geographic rating area. New plans have been mapped to comparable 2014 plans for
purposes of determining the rate increase. Refer to Exhibit I: Non-Grandfathered Benefit Plan Factors and
Rate Increases and Exhibit K: Area Factors for details.

These rate increases by plan are shown in Exhibit I: Non-Grandfathered Benefit Plan Factors and Rate
Increases.

6. Experience Period Premium and Claims

Experience shown in Worksheet 1, Section I of the Unified Rate Review Template is for the Missouri Small
Group Single Risk Pool Non-Grandfathered Business. Consistent with last year, Anthem is assigning 0%
credibility to the single risk pool experience, thus it is not used for developing manual rates. The manual
rate development is fully detailed in Section 9: Credibility Manual Rate Development.

Claims experience in Worksheet 1, Section I of the Unified Rate Review Template reflects dates of service
from January 1, 2013 through December 31, 2013.

Paid Through Date

Claims shown in Worksheet 1, Section I of the Unified Rate Review Template are paid through March
31, 2014.

Allowed and Incurred Claims Incurred During the Experience Period

The allowed claims are determined by subtracting non-covered benefits, provider discounts, and
coordination of benefits amounts from the billed amount.
Allowed and incurred claims are completed using the chain ladder method, an industry standard, by
using historic paid vs. incurred claims patterns. The method calculates historic completion
percentages, representing the percent of claims paid for a particular month after one month of run
out, two months, etc., for a forty-eight month view of history. Claim backlog files are reviewed on a
monthly basis and are accounted for in the historical completion factor estimates.

Premiums (net of MLR Rebate) in Experience Period

The estimated Non-Grandfathered gross earned premium for Missouri Small Group is $472,782,616
and net of MLR rebates is $471,520,390, where earned premium is the pro-rata share of premium
owed to Anthem due to subscribers actively purchasing insurance coverage during the experience
period.
The MLR Rebate is -$1,262,226. This represents the portion of the final rebate allocated to the NonGrandfathered portion of Small Group.

7. Benefit Categories
The methodology used to determine benefit categories in Worksheet 1, Section II of the Unified Rate
Review Template is as follows:
Inpatient Hospital: Includes non-capitated facility services for medical, surgical, maternity,
mental health and substance abuse, skilled nursing, and other services provided in an inpatient
facility setting and billed by the facility.

Outpatient Hospital: Includes non-capitated facility services for surgery, emergency room, lab,
radiology, therapy, observation and other services provided in an outpatient facility setting and
billed by the facility.
Professional: Includes non-capitated primary care, specialist, therapy, the professional
component of laboratory and radiology, and other professional services, other than hospitalbased professionals whose payments are included in facility fees.
Other Medical: Includes non-capitated ambulance, home health care, DME, prosthetics, supplies,
vision exams, dental services and other services.
Prescription Drug: Includes drugs dispensed by a pharmacy and rebates received from drug
manufacturers.

8. Projection Factors
As previously indicated, the credibility level assigned to the experience in Worksheet 1, Section III of the
Unified Rate Review Template is 0%. Consequently, factors to project experience claims are not provided
as they are not applicable. However, the factors used to develop the manual rates are fully detailed in
Section 9: Credibility Manual Rate Development.

Changes in the Morbidity of the Population Insured


n/a - see Credibility Manual Rate Development

Changes in Benefits

n/a - see Credibility Manual Rate Development

Changes in Demographics

n/a - see Credibility Manual Rate Development

Other Adjustments

n/a - see Credibility Manual Rate Development

Trend Factors (cost/utilization)

n/a - see Credibility Manual Rate Development

9. Credibility Manual Rate Development


Consistent with last year's methodology, experience developed and projected herein is Anthem's Small
Group Business based on plan liability amounts. The rate development is shown in Exhibit A: Base Rate
Development.

Source and Appropriateness of Experience Data Used


The source data underlying the development of the manual rate consists of claims for all
Grandfathered and Non-Grandfathered Small Group business, incurred during the period January 1,
2013 December 31, 2013 and paid through March 31, 2014. Completion factors are then calculated
to reflect additional months of runout after March 31, 2014. Anthem expects a large portion of the
Grandfathered policyholders to migrate to ACA-compliant policies prior to and during the projection
period.

In developing rates effective April 1, 2015, only limited 2014 experience is available. This experience
is not deemed credible for purposes of rate development.
Other than completing the incurred claims, no further explicit adjustments are made to the
experience data.
For more detail, see Exhibit B: Claims Experience for Manual Rate Development.

Adjustments Made to the Data

The development of the projected claims is summarized in Exhibit A: Base Rate Development, items
(1) - (10), and described in detail below.
The projected claims cost is calculated by multiplying the normalized claims cost by the impact of
benefit changes, anticipated changes in population morbidity, and cost of care impacts. The
adjustments are described below, and the factors are presented in Exhibit D: Projection Period
Adjustments. In addition, the source data is normalized for changes in the provider contracts.

Changes in Demographics (Normalization)


The source data was normalized to reflect anticipated changes in age/gender, area, network, and
benefit plan from the experience period to the projection period. The purpose of these factors is to
adjust current experience to be reflective of expected claim experience in the projection period. See
Section 23: Membership Projections for additional information on membership movement. The
normalization factors and their aggregate impact on the underlying experience data are detailed in
Exhibit C: Normalization Factors.

Age/Gender: The assumed claims cost is applied by age and gender to the experience period
distribution and the projection period distribution.
Area/Network: The area claims factors are developed based on an analysis of Small Group and
Individual allowed claims by network, mapped to the prescribed 2015 rating areas using 5-digit
zip code.

Benefit Plan: The experience period claims are normalized to an average 2015 plan using benefit
relativities. The benefit relativities include the value of cost shares and anticipated changes in
utilization due to the difference in average cost share requirements.

Changes in Benefits
Benefit changes include the following:
Preventive Rx (over the counter): The claims are adjusted for 100% coverage of benefits for
specific over the counter drugs obtained with a prescription from a physician.
Rx Adjustments: The claims are adjusted for differences in the Rx formulary as well as for the
impact of moving drugs into different tiers in the projection period relative to what is reflected in
the base experience data.

Changes in the Morbidity of the Population Insured


The claims are adjusted to reflect shifts in health insurance coverage as a result of the provisions of
the ACA. The market shifts, or population movements, affecting the morbidity of the Small Group
market in the projection period include:
Small Groups electing to drop coverage
Small Group members electing to be uninsured
Small Groups moving to self-funded coverage
Small Group members moving to Medicaid
Small Groups electing to remain on their current (non-ACA) products in 2015.
Small Group members electing to forego COBRA coverage upon termination
The movement assumptions above are based on market research and assumptions on the employer
opt-out and consumer uptake rates. The morbidity impacts of population movement are based on
health status determined from internal risk score data.
Trend Factors
The annual pricing trend used in the development of the rates is 8.3%. The trend is developed by
normalizing historical benefit expense for changes in the underlying population and known cost
drivers, and the result is projected forward. The trend includes a volatility provision in
accordance with Actuarial Standards of Practice. The claims are trended 28 months from the
midpoint of the experience period, which is July 1, 2013, to the midpoint of the projection
period, which is November 1, 2015.

Projected trends include the estimated cost during 2014 and 2015 of the pharmaceutical Sovaldi
and other high-cost drugs for treating Hepatitis C. These cost estimates were based on claims
experience for Missouri Small Group business, together with CDC recommendations and Industry
and Enterprise data.
Other Cost of Care Impacts
Utilization or cost-per-service change: anticipated changes are reflected in the morbidity changes
and trend.
Change in Medical Management: medical management savings not already included in the claims
experience and trend.
Change in Provider Contracts: anticipated changes in provider contracts are reflected in the
benefit plan factors and the region rating factors.
Other Claim Adjustments
The adjustments described below are presented in Exhibit E: Other Claim Adjustments.
Rx Rebates: The projected claims cost is adjusted to reflect anticipated Rx rebates. These
projections take into account the most up-to-date information regarding anticipated rebate
contracts, drug prices, anticipated price inflation, and upcoming patent expirations.
The cost of adding benefits for pediatric dental and vision are included.

Capitation Payments

Capitation arrangements do not exist for this business.

10. Credibility of Experience


The combination of both Grandfathered and Non-Grandfathered experience data most reasonably reflects
Small Group claims experience under the future projection period. Actuarial judgment has been exercised
to determine that rates will be developed giving full credibility to the data underlying the manual rate in
Section 9: Credibility Manual Rate Development.

Resulting Credibility Level Assigned to Base Period Experience

The credibility level assigned to the experience in Worksheet 1, Section III of the Unified Rate Review
Template is 0%.

11. Paid to Allowed Ratio

The Paid to Allowed Average Factor in Projection Period shown in Worksheet 1, Section III of the Unified
Rate Review Template is developed by membership-weighted essential health benefit paid claims divided
by membership-weighted essential health benefit allowed claims of each plan. The projected membership
by plan is shown in Worksheet 2, Section II.

12. Risk Adjustment and Reinsurance


Projected Risk Adjustment

The Risk Adjustment program transfers funds from lower risk plans to higher risk plans in the NonGrandfathered Individual and Small Group market. The HHS operated Risk Adjustment program is
supported by a user fee, as shown in Exhibit F: Risk Adjustment and Reinsurance - Contributions and
Payments.
Anthem is assuming the risk for the plans in this filing are no better or worse than other plans in the
market, resulting in no estimated risk transfer value as shown in Exhibit F: Risk Adjustment and
Reinsurance - Contributions and Payments.

Projected ACA Reinsurance Recoveries Net of Reinsurance Premium

The transitional reinsurance risk mitigation program collects funds from all insurance issuers and TPAs
and redistributes them to high cost claimants in the Non-Grandfathered Individual market. The
reinsurance contribution is equal to the national per capita reinsurance contribution rate as shown in
Exhibit F: Risk Adjustment and Reinsurance - Contributions and Payments.

13. Non-Benefit Expenses, Profit and Risk


Non-Benefit expenses are detailed in Exhibit G: Non-Benefit Expenses and Profit & Risk.

Administrative Expense

Administrative Expenses are expected to be consistent with historical levels and are developed
utilizing the same methodology as previous filings, they are not varied by product or
plan.Maintenance costs are assumed to be flat on a per member basis with savings from
administrative efficiencies and the elimination of underwriting offset by new expenses for risk
management and regulatory compliance.

Quality Improvement Expense

The quality improvement expense represents Anthem's dedication to providing the highest standard
of customer care and consistently seeking to improve health care quality, outcomes and value in a
cost efficient manner.

The QI Expense assumptions are based on historical amounts related to the following initiatives:
Improve Health Outcomes, Activities to Prevent Hospital Readmissions, Improve Patient Safety and
Reduce Medical Errors, Wellness and Health Promotion Activities, HIT Expenses for Health Care
Quality Improvements, Other Cost Containment and ICD-10.

Selling Expense

Selling Expense represents broker commissions and bonuses associated with the broker distribution
channel using historical and projected commission levels. Commissions will be paid both On-Exchange
and Off-Exchange.

Taxes and Fees

Patient-Centered Outcomes Research Institute (PCORI) Fee: The PCORI fee is a federallymandated fee designed to help fund the Patient-Centered Outcomes Research Trust Fund. For
plan years ending before October 1, 2014, the fee is $2 per member per year. Thereafter, for
every plan year ending before October 1, 2019, the fee will increase by the percentage increase
in National Healthcare Expenditures.
ACA Insurer Fee: The health insurance industry will be assessed a permanent fee, based on
market share of net premium, which is not tax deductible. The tax impact of non-deductibility is
captured in this fee.
Exchange Fee: The Exchange User Fee applies to Exchange business only, but the cost is spread
across all Small Group plans. A blended fee/percentage is determined based on an assumed
10.0% of members that will purchase products On-Exchange. The resulting fee/percentage is
applied evenly to all plans in the risk pool, both On and Off Exchange.
Premium taxes, federal income taxes and state income taxes are also included in the retention
items.

Profit

Profit is reflected on a post-tax basis as a percent that does not vary by product or plan. The profit
percentage does not include any assumed risk corridor payments or receipts.

14. Projected Loss Ratio


Projected Federal MLR

The projected Federal MLR for the products in this filing is estimated in Exhibit M: Federal MLR
Estimated Calculation. Please note that this calculation is purely an estimate and not meant to be a
true measure for Federal or State MLR rebate purposes. The products in this filing represent only a
subset of Anthem's Small Group business. The MLR for Anthem's entire book of Small Group business
will be compared to the minimum Federal benchmark for purposes of determining regulation-related
premium refunds. Also note that the projected Federal MLR presented here does not capture all
adjustments, including but not limited to: three-year averaging, credibility, dual option, and
deductible. Anthem's projected MLR is expected to meet or exceed the minimum MLR standards at
the market level after including all adjustments.

15. Single Risk Pool


As described above in Section 4: Description of How the Base Rate Is Determined, the Anthem Index Rate
for Small Group business in Missouri is based on total combined claims costs for providing essential health
benefits within the single risk pool of non-grandfathered Small Group plans in Missouri. The Index Rate is
adjusted on a market-wide basis for the state based on the total expected market-wide payments and
charges under the risk adjustment and reinsurance programs and Exchange user fees. The premium rates
for all Anthem non-grandfathered plans in the Small Group market use the applicable market-wide
adjusted index rate, subject only to the permitted plan-level adjustments. This demonstrates that the
Single Risk Pool for Anthem Small Group business is established according to the requirements in 45 CFR
part 156, 156.80(d).

16. Index Rate


Experience Period Index Rate

The index rate represents the average allowed claims PMPM of essential health benefits for Anthem's
Small Group Non-Grandfathered Business. The experience period index rate shown in Worksheet 1,
Section I (cell G17) of the Unified Rate Review Template is $316.00 and is the same, although
rounded, as the experience period allowed claims (cell G16 in the same location). A comparison to
the benchmark was performed, and only essential health benefits were covered during the
experience period.

Projection Period Index Rate

The index rate represents the average allowed claims PMPM of essential health benefits for Anthem's
Small Group Non-Grandfathered Business. The projection period index rate was developed as shown
in Exhibit N: Index Rate Development by adjusting the projected incurred claims PMPM described in
Section 9: Credibility Manual Rate Development of this memorandum. Covered benefits in excess of
essential health benefits that are included in the projection period allowed claims (cell T30 of
Worksheet 1, Section II of the Unified Rate Review Template) but excluded from Exhibit N: Index Rate
Development's projection period index rate (also shown in cell V44 of Worksheet 1, Section III of the
Unified Rate Review Template) are wellness benefits including online fitness trainers, tobacco-free
certification, and fitness reimbursement.

Quarterly Index and Base Rate

Quarterly index and base rate changes will be implemented On-Exchange and Off-Exchange. See
Exhibit O: Quarterly Index, Base, and Market Adjusted Index Rate Development.

17. Market Adjusted Index Rate


The Market Adjusted Index rate is calculated as the Index Rate adjusted for all allowable market wide
modifiers defined in the market rating rules. This development is presented in Exhibit N: Index Rate
Development and Exhibit O: Quarterly Index, Base, and Market Adjusted Index Rate Development.

18. Plan Adjusted Index Rate


The Plan Adjusted Index Rate is calculated as the Market Adjusted Index Rate adjusted for all allowable
plan level modifiers defined in the market rating rules. This development is presented in Exhibit P: Plan
Adjusted Index Rate and Consumer Adjusted Premium Rates.
Plan Level Modifiers
Cost Sharing Adjustments: This is a multiplicative factor that adjusts for the projected
paid/allowed ratio of each plan, based on the AV metal value with an adjustment for utilization
differences due to differences in cost sharing. This also includes an adjustment for the average
tobacco factor shown in Exhibit H: Calibration .
Provider Network Adjustments: This is a multiplicative factor that adjusts for differences in
projected claims cost due to different network discounts.
Adjustments for Benefits in Addition to EHBs: This multiplicative factor adjusts for additional
benefits that are not EHBs.
Adjustments for administrative cost: This is an additive adjustment that includes all the Selling
Expense, Administration and Other Retention Items shown in Exhibit G: Non-Benefit Expenses
and Profit & Risk, with the exception of the Exchange User Fee.

19. Calibration

The required premium in the projection period is calibrated by the average rating calibration factors (Age,
Area, and Plan Factor), which are used to develop the Consumer Adjusted Premium Rates. The average
rating factors are shown in Exhibit H: Calibration, Exhibit P: Plan Adjusted Index Rate and Consumer
Adjusted Premium Rates, and applied in line item 14 of Exhibit A: Base Rate Development.

Benefit Plan Factors

The benefit plan rating factors are applied to the projection period distribution.

Benefit plan factors also consider the following adjustments, as applicable.


Benefit Richness Factor Adjustment: This adjustment accounts for member behavior variations
depending on the richness of the benefit design.
Pediatric Dental and Vision Benefits: For plans excluding the pediatric dental benefit and
pediatric vision benefit, the benefit plan factor reflects reduced benefits.
Non-EHBs: For plans including benefits in addition to EHBs, the benefit plan factor reflects
enhanced benefits.
Provider Network: This factor accounts for differences in contracted rates and network structure.

Refer to Exhibit I: Non-Grandfathered Benefit Plan Factors and Rate Increases.

Age Factors

Area Factors

In 2014, the area factors varied by plan based on actuarially justified network cost differences for
each geographic rating area. Effective January 1, 2015, a single area factor will apply to all plans in
each geographic rating area.
Area factors have been adjusted to reflect the most current experience. Refer to Exhibit K: Area
Factors.

20. Consumer Adjusted Premium Rate


The Consumer Adjusted Premium Rate is calculated as the Plan Adjusted Index Rate calibrated as
described in the previous section. This development is presented in Exhibit P: Plan Adjusted Index Rate
and Consumer Adjusted Premium Rates. The calibration is shown in Exhibit H: Calibration.

21. Actuarial Value Metal Values

The Actuarial Value (AV) Metal Values included in Worksheet 2 of the Unified Rate Review Template are
based on the AV Calculator. To the extent a component of the benefit design was not accommodated by
an available input within the AV Calculator, the benefit characteristic was adjusted to be actuarially
equivalent to an available input within the AV Calculator for purposes of utilizing the AV Calculator as the
basis for the AV Metal Values. Benefits for Plans that are not compatible with the parameters of the AV
Calculator have been separately identified and documented in the Unique Plan Design Supporting
Documentation and Justification that supports the Plan & Benefits Template.

22. Actuarial Value Pricing Values


The AV Pricing Values for each Product ID are in Worksheet 2, Section I of the Unified Rate Review
Template. The AV Pricing Value represents the cumulative effect of adjustments made by the issuer to
move from the Market Adjusted Index Rate to the Plan Adjusted Index Rate. Consistent with final Market
rules, utilization adjustments are made to account for member behavior variations based upon cost-share
variations of the benefit design and not the health status of the member. The average allowable modifiers
to the Index Rate can be found in Exhibit P: Plan Adjusted Index Rate and Consumer Adjusted Premium
Rates.

23. Membership Projections


Membership projections in Worksheet 2 of the Unified Rate Review Template are developed using a
population movement model plus adjustments for sales expectations. This model projects the
membership in the projection period by taking into account:
Small Groups dropping coverage
Small Group members opting out of coverage
Small Group members electing to forego COBRA coverage upon termination
The plan distribution is based on assumed metal tier and network distributions. Some 2014
preliminary enrollment information has been considered in projecting membership distributions.

The projected morbidity changes shown in Exhibit D: Projection Period Adjustments include expected
morbidity changes due to population movement.

24. Warning Alerts


There are no warning alerts in the Unified Rate Review Template.

25. Terminated Products


The list of terminated products is shown in Exhibit Q: Terminated Products.

26. Plan Type

Plan types in Worksheet 2, Section I of the URRT adequately describe Anthem's plans.

27. Reliance
In support of this rate development, various data and analyses were provided by other members of
Anthem's internal actuarial staff, including data and analysis related to cost of care, valuation, and pricing.
I have reviewed these data and analyses for reasonableness and consistency. I have also relied on Brian
Renshaw, FSA, MAAA to provide the actuarial certification for the Unique Plan Design Supporting
Documentation and Justification for plans included in this filing.

28. Actuarial Certification


I, Jennifer Kraus, FSA, MAAA, am an actuary for Anthem. I am a member of the American Academy of
Actuaries and a Fellow of the Society of Actuaries. I meet the Qualification Standards of the American
Academy of Actuaries to render the actuarial opinion contained herein. I hereby certify that the following
statements are true to the best of my knowledge with regards to this filing:

(1) The projected Index Rate is:


In compliance with all applicable State and Federal Statutes and Regulations (45 CFR
156.80(d)(1)),
Developed in compliance with the applicable Actuarial Standards of Practice
Reasonable in relation to the benefits provided and the population anticipated to be covered
Neither excessive nor deficient.
(2) The Index Rate and only the allowable modifiers as described in 45 CFR 156.80(d)(1) and 45 CFR
156.80(d)(2) were used to generate plan level rates.
(3) The percent of total premium that represents essential health benefits included in Worksheet 2,
Sections III and IV is calculated in accordance with actuarial standards of practice.

(4) The AV Calculator was used to determine the AV Metal Values shown in Worksheet 2 of the Part I
Unified Rate Review Template for all plans.

The Part I Unified Rate Review Template does not demonstrate the process used by the issuer to develop
the rates. Rather it represents information required by Federal regulation to be provided in support of the
review of rate increases, for certification of Qualified Health Plans for Federally-Facilitated Exchanges, and
for certification that the Index Rate is developed in accordance with Federal regulation, used consistently,
and only adjusted by the allowable modifiers. However, this Actuarial Memo does accurately describe the
process used by the issuer to develop the rates.

Jennifer Kraus, FSA, MAAA


Director and Actuary III

December 11, 2014


Date

Exhibit A - Base Rate Development


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

1)
Experience Period Cost PMPM
2) x Normalization Factor
3) = Normalized Claims
4)
5)
6)
7)
8)

x Benefit Changes
x Morbidity Changes
x Trend Factor
x Other Cost of Care Impacts
= Projected Claim Cost

Paid Claims
$
253.96
0.8777
$
222.90

0.9918
1.1022
1.2048
1.0000
293.57

Exhibit D
Exhibit D
Exhibit D
Exhibit D
= (3) x (4) x (5) x (6) x (7)

9) + Other Claim Adjustments

10) = Claims Projected to Projection Period

289.35

= (8) + (9)

11) + Risk Adjustment and Reinsurance - Contributions and Payments


12) + Non-Benefit Expenses and Profit & Risk {1}
13) = Required Premium in Projection Period

$
$
$

3.29
80.18
372.82

Exhibit F
Exhibit G
= (10) + (11) + (12)

1.4006
1.0032
265.33

Exhibit H
Exhibit H
= (13) (14) (15)

14) Calibration Factor


15) Tobacco Average Rating Factor
16) = Required Base Rate (Average Plan Level - Age 21 - Non-Tobacco)
17) Projected Loss Ratio (Conventional Basis)

(4.22)

Exhibit B
Exhibit C
= (1) x (2)

78.5%

Exhibit E

= [(10) + (11)] (13)

NOTES:
{1} Equivalent to PMPM expenses on Exhibit G + % of premium expenses on Exhibit G applied to Required Premium (Row 13 above).

Exhibit B - Claims Experience for Manual Rate Development


Healthy Alliance Life Insurance Company
Small Group
Incurred January 1, 2013 through December 31, 2013
Paid through March 31, 2014
PAID CLAIMS:

Incurred and Paid Claims:


Medical
Drug
314,414,330 $ 112,466,759

Incurred and Paid Claims:


Medical
Drug
422,452,256 $ 138,035,690

IBNR:
$

Medical
33,311,813

Drug
4,155,407

Fully Incurred Claims:


Medical
Drug
347,726,143 $ 116,622,166

Capitation
$
-

Total
Benefit Expense
$
464,348,309

Member
Months
1,828,457

Total
PMPM
$
253.96

Capitation
$
-

Total
Benefit Expense
$
610,877,636

Member
Months
1,828,457

Total
PMPM
$
334.09

ALLOWED CLAIMS:

IBNR:
$

Medical
45,310,539

Drug
5,079,151

Fully Incurred Claims:


Medical
Drug
467,762,795 $ 143,114,841

Exhibit C - Normalization Factors


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Age/Gender
Area/Network
Benefit Plan
Total

Average Claim Factors


Experience Period
Future
Population
Population
0.9696
1.0223
1.0108
0.9932
0.8098
0.6860

Normalization
Factor
1.0544
0.9826
0.8472
0.8777

Exhibit D - Projection Period Adjustments


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Impact of Changes Between Experience Period and Projection Period:


Adjustment Factor
Benefit changes
Preventive Rx (over the counter)
Rx Adjustments {1}
Total Benefit Changes

1.0001
0.9917
0.9918

Morbidity changes
Total Morbidity Changes

1.1022

Cost of care impacts


Annual Medical/Rx Trend Rate
1 Months of Projection
Trend Factor

8.31%
28
1.2048

Total other Impacts


NOTES:
{1} Includes Rx formulary and impacts for moving drugs into different tiers

1.0000

Exhibit E - Other Claim Adjustments


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Adjustments to projection period claims to reflect covered benefits not included in experience period data:
PMPM
Rx Rebates
($6.50)
Pediatric Dental
$0.80
Pediatric Vision
$0.99
CCP Packages
$0.49
Total
($4.22)
NOTES:
Adjustments above reflect ONLY additional costs beyond those already captured in line Item 8 of Exhibit A.

Exhibit F - Risk Adjustment and Reinsurance - Contributions and Payments


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Risk Adjustment:
PMPM
Federal Program

User Fee
$0.08

Net Transfer
$0.00

Note:
It is assumed the risk for the plans included in this rate filing is no better/worse than any other plans within this market.

Reinsurance:
PMPM

Contributions Made

Federal Program

$3.21

Expected Receipts
$0.00

Small Group Plans contribute funds but only Individual Plans are
eligible to receive payments

Source:
HHS estimates a national per capita contribution rate of $3.67 per month ($44 per year) in benefit year 2015 (per Payment
Parameter Rule).

Grand Total of All Risk Mitigation Programs


NOTES:
$3.21 = $3.67*(8 months/12 months)+$2.30*(4 months/ 12 months)
$3.67 = 2015 contribution
$2.30 = 2016 contribution

$3.29

Exhibit G - Non-Benefit Expenses and Profit & Risk


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Administrative Expenses
Administrative Costs
Quality Improvement Expense
Selling Expense
Specialty Expenses
Total Administrative Expenses
Taxes and Fees
PCORI Fee
ACA Insurer Fee
Exchange Fee
Premium Tax
MLR-Deductible Federal/State Income Taxes {2}
Total Taxes and Fees
Profit and Risk {3}
Total Non-Benefit Expenses, Profit, and Risk

Expenses Applied As a
PMPM Cost

Expenses Applied as a
% of Premium

Expressed as a
PMPM {1}

$17.42
$3.27
$14.52
$0.31
$35.52

0.00%

$35.52

3.55%
0.35%
0.34%
2.69%
6.93%
5.00%
11.93%

$26.02
$18.64
$80.18

$0.18

$0.18
$35.70

NOTES:
{1} The sum of the rounded percentages shown may not equal the total at the bottom of the table due to rounding.
{2} Includes only those income taxes which are deductible from the MLR denominator; in particular, Federal income taxes on investment income are
excluded.
{3} Profit shown here is post-tax profit, net of those federal and state income taxes which are deductible from the MLR denominator.

Exhibit H - Calibration
Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Average 2015 rating factors for 2015 population:


Tobacco
Age
Area
Benefit Plan
Total Calibration Factor
Total Average Rating Factor

Average Rating Factor


1.0032
Calibration Factors
1.4008
0.9999
1.0000
1.4006
1.4051

NOTES:
See Line Item 14 on Exhibit A.
The base rate is developed by dividing the required premium in the projection period by the total average rating
factor shown above.

Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

HIOS Plan Name

2015 HIOS Plan ID

Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA


Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Bronze Blue Access 4500E/0%/6350 w/HSA
Anthem Bronze Blue Access Choice 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Access Choice 6000/0%/6600 Plus
Anthem Bronze Blue Access 6000/0%/6600 Plus

32753MO0780011
32753MO0780012
32753MO0780013
32753MO0780014
32753MO0780015
32753MO0780016
32753MO0780017
32753MO0780018
32753MO0780019
32753MO0780020
32753MO0780021
32753MO0780022
32753MO0780023
32753MO0780024
32753MO0780004
32753MO0780005
32753MO0780006
32753MO0780007
32753MO0780008
32753MO0780009
32753MO0780010
32753MO0790260
32753MO0790261
32753MO0790262
32753MO0790263
32753MO0790264
32753MO0790265
32753MO0790266
32753MO0790267
32753MO0790268
32753MO0790287
32753MO0790288
32753MO0790289
32753MO0790290
32753MO0790291
32753MO0790292
32753MO0790293
32753MO0790294
32753MO0790295

On/Off
Exchange Metal Level
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
On/Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off

Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze

Benefit Plan
Factor
0.8076
0.7847
0.7760
0.7468
0.7349
0.7701
0.7751
1.0485
1.0187
1.0076
0.9696
0.9541
0.9999
1.0064
1.1668
1.1337
1.1213
1.0790
1.0618
1.1127
1.1199
0.9067
0.9067
0.8796
0.8546
0.8452
0.8134
0.8004
0.8388
0.8442
0.8882
0.8629
0.8535
0.8213
0.8082
0.8470
0.8525
0.9156
0.9156

Network Name
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access
MO SG:-:Blue Access Choice
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access Choice
MO SG:-:Blue Access

Area(s) Offered
02
05
06
07
08
09
10
02
05
06
07
08
09
10
02
05
06
07
08
09
10
02, 05, 07, 08, 09, 10
06
02
05
06
07
08
09
10
02
05
06
07
08
09
10
06
02, 05, 07, 08, 09, 10

2014 HIOS Plan ID


Mapping
32753MO0780003
32753MO0780003
32753MO0780003
32753MO0780003
32753MO0780003
32753MO0780003
32753MO0780003
32753MO0780002
32753MO0780002
32753MO0780002
32753MO0780002
32753MO0780002
32753MO0780002
32753MO0780002
32753MO0780001
32753MO0780001
32753MO0780001
32753MO0780001
32753MO0780001
32753MO0780001
32753MO0780001
32753MO0790023
32753MO0790114
32753MO0790115
32753MO0790115
32753MO0790115
32753MO0790115
32753MO0790115
32753MO0790115
32753MO0790115
32753MO0790185
32753MO0790185
32753MO0790185
32753MO0790185
32753MO0790185
32753MO0790185
32753MO0790185
32753MO0790184
32753MO0790071

Plan Specific Rate


Increase*
(excluding aging)
6.68%
2.77%
-0.08%
-8.11%
-12.27%
2.33%
0.55%
21.76%
17.29%
14.04%
4.88%
0.13%
16.79%
14.76%
9.03%
5.03%
2.11%
-6.09%
-10.34%
4.58%
2.76%
5.05%
6.45%
13.66%
9.49%
6.45%
-2.10%
-6.54%
9.02%
7.12%
23.86%
19.32%
16.01%
6.69%
1.85%
18.81%
16.74%
16.00%
14.48%

Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

HIOS Plan Name

2015 HIOS Plan ID

Anthem Silver Blue Access Choice 3000/20%/4500 Plus


Anthem Silver Blue Access 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred Options 2750/40%/6600
Anthem Silver Blue Access 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Access Choice 4000E/0%/5000 w/HSA
Anthem Silver Blue Access Choice 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Access 2000/30%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Access Choice 5000/20%/6600
Anthem Silver Blue Access 5000/20%/6600
Anthem Silver Blue Access 2600E/20%/5500 w/HSA
Anthem Silver Blue Access Choice 2600E/20%/5500 w/HSA

32753MO0790195
32753MO0790196
32753MO0790197
32753MO0790198
32753MO0790199
32753MO0790200
32753MO0790201
32753MO0790202
32753MO0790203
32753MO0790259
32753MO0790278
32753MO0790279
32753MO0790280
32753MO0790281
32753MO0790282
32753MO0790283
32753MO0790284
32753MO0790285
32753MO0790286
32753MO0790296
32753MO0790297
32753MO0790298
32753MO0790299
32753MO0790300
32753MO0790301
32753MO0790302
32753MO0790303
32753MO0790304
32753MO0790305
32753MO0790306
32753MO0790307
32753MO0790308
32753MO0790309
32753MO0790310
32753MO0790311
32753MO0790312
32753MO0790313
32753MO0790314
32753MO0790315

On/Off
Exchange Metal Level
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off

Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Silver

Benefit Plan
Factor

Network Name

Area(s) Offered

1.0241
1.0241
0.9934
0.9652
0.9546
0.9186
0.9040
0.9473
0.9535
0.8966
0.9713
0.9422
0.9154
0.9054
0.8713
0.8573
0.8985
0.9043
0.9713
1.0079
0.9777
0.9500
0.9396
0.9042
0.8897
0.9324
0.9385
1.0079
0.9244
0.8982
0.8883
0.8548
0.8412
0.8815
0.8873
0.9530
0.9530
0.9649
0.9649

MO SG:-:Blue Access Choice


MO SG:-:Blue Access
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred Options
MO SG:-:Blue Access
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access Choice
MO SG:-:Blue Access Choice
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access Choice
MO SG:-:Blue Access
MO SG:-:Blue Access
MO SG:-:Blue Access Choice

06
02, 05, 07, 08, 09, 10
02
05
06
07
08
09
10
10
02, 05, 07, 08, 09, 10
02
05
06
07
08
09
10
06
06
02
05
06
07
08
09
10
02, 05, 07, 08, 09, 10
02
05
06
07
08
09
10
06
02, 05, 07, 08, 09, 10
02, 05, 07, 08, 09, 10
06

2014 HIOS Plan ID


Mapping
32753MO0790174
32753MO0790057
32753MO0790175
32753MO0790175
32753MO0790175
32753MO0790175
32753MO0790175
32753MO0790175
32753MO0790175
None
32753MO0790033
32753MO0790129
32753MO0790129
32753MO0790129
32753MO0790129
32753MO0790129
32753MO0790129
32753MO0790129
32753MO0790128
None
32753MO0790149
32753MO0790149
32753MO0790149
32753MO0790149
32753MO0790149
32753MO0790149
32753MO0790149
None
32753MO0790163
32753MO0790163
32753MO0790163
32753MO0790163
32753MO0790163
32753MO0790163
32753MO0790163
32753MO0790162
32753MO0790051
32753MO0790016
32753MO0790100

Plan Specific Rate


Increase*
(excluding aging)
11.96%
10.49%
19.55%
15.16%
11.97%
2.97%
-1.69%
14.67%
12.67%
n/a
4.42%
12.98%
8.84%
5.82%
-2.68%
-7.09%
8.37%
6.48%
5.81%
n/a
11.17%
7.09%
4.12%
-4.24%
-8.58%
6.63%
4.78%
n/a
10.81%
6.75%
3.79%
-4.55%
-8.88%
6.29%
4.44%
3.78%
2.42%
-3.20%
-1.91%

Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

HIOS Plan Name

2015 HIOS Plan ID

Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA


Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Gold Blue Access Choice 1000/20%/2500 Plus
Anthem Gold Blue Access 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred Options 500/20%/4000
Anthem Gold Blue Access Choice 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Access 1500/30%/5000
Anthem Gold Blue Access Choice 5000/0%/5000
Anthem Gold Blue Access 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000

32753MO0790316
32753MO0790317
32753MO0790318
32753MO0790319
32753MO0790320
32753MO0790321
32753MO0790322
32753MO0790186
32753MO0790187
32753MO0790188
32753MO0790189
32753MO0790190
32753MO0790191
32753MO0790192
32753MO0790193
32753MO0790194
32753MO0790204
32753MO0790205
32753MO0790206
32753MO0790207
32753MO0790208
32753MO0790209
32753MO0790210
32753MO0790211
32753MO0790212
32753MO0790213
32753MO0790214
32753MO0790215
32753MO0790216
32753MO0790217
32753MO0790218
32753MO0790219
32753MO0790220
32753MO0790221
32753MO0790222
32753MO0790223
32753MO0790224
32753MO0790225
32753MO0790226

On/Off
Exchange Metal Level
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off

Silver
Silver
Silver
Silver
Silver
Silver
Silver
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold

Benefit Plan
Factor

Network Name

Area(s) Offered

0.9360
0.9095
0.8995
0.8656
0.8518
0.8926
0.8984
1.2315
1.2315
1.1946
1.1607
1.1480
1.1048
1.0871
1.1393
1.1467
1.1426
1.1854
1.1499
1.1173
1.1050
1.0634
1.0464
1.0966
1.1037
1.1854
1.1306
1.1306
1.0967
1.0656
1.0539
1.0142
0.9980
1.0459
1.0527
1.1643
1.1312
1.1188
1.0766

MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access Choice
MO SG:-:Blue Access
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred Options
MO SG:-:Blue Access Choice
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access
MO SG:-:Blue Access Choice
MO SG:-:Blue Access
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred

02
05
06
07
08
09
10
06
02, 05, 07, 08, 09, 10
02
05
06
07
08
09
10
10
06
02
05
06
07
08
09
10
02, 05, 07, 08, 09, 10
06
02, 05, 07, 08, 09, 10
02
05
06
07
08
09
10
02
05
06
07

2014 HIOS Plan ID


Mapping
32753MO0790101
32753MO0790101
32753MO0790101
32753MO0790101
32753MO0790101
32753MO0790101
32753MO0790101
32753MO0790166
32753MO0790053
32753MO0790167
32753MO0790167
32753MO0790167
32753MO0790167
32753MO0790167
32753MO0790167
32753MO0790167
None
32753MO0790140
32753MO0790141
32753MO0790141
32753MO0790141
32753MO0790141
32753MO0790141
32753MO0790141
32753MO0790141
32753MO0790039
32753MO0790158
32753MO0790049
32753MO0790159
32753MO0790159
32753MO0790159
32753MO0790159
32753MO0790159
32753MO0790159
32753MO0790159
32753MO0790157
32753MO0790157
32753MO0790157
32753MO0790157

Plan Specific Rate


Increase*
(excluding aging)
4.74%
0.90%
-1.90%
-9.78%
-13.87%
0.46%
-1.29%
5.53%
4.14%
12.68%
8.55%
5.53%
-2.94%
-7.34%
8.08%
6.20%
n/a
2.36%
9.30%
5.29%
2.37%
-5.86%
-10.12%
4.84%
3.01%
1.02%
2.65%
1.30%
9.60%
5.58%
2.65%
-5.60%
-9.87%
5.13%
3.30%
7.10%
3.17%
0.31%
-7.75%

Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

HIOS Plan Name

2015 HIOS Plan ID

Anthem Gold Blue Preferred 3500/0%/4000


Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Access 3500/0%/4000
Anthem Gold Blue Access Choice 3500/0%/4000
Anthem Gold Blue Access Choice 1000/20%/3500
Anthem Gold Blue Access 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Access 2500/20%/4500
Anthem Gold Blue Access Choice 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Access Choice 1500/20%/4000
Anthem Gold Blue Access 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500

32753MO0790227
32753MO0790228
32753MO0790229
32753MO0790230
32753MO0790231
32753MO0790232
32753MO0790233
32753MO0790234
32753MO0790235
32753MO0790236
32753MO0790237
32753MO0790238
32753MO0790239
32753MO0790240
32753MO0790241
32753MO0790242
32753MO0790243
32753MO0790244
32753MO0790245
32753MO0790246
32753MO0790247
32753MO0790248
32753MO0790249
32753MO0790250
32753MO0790251
32753MO0790252
32753MO0790253
32753MO0790254
32753MO0790255
32753MO0790256
32753MO0790257
32753MO0790258
32753MO0790269
32753MO0790270
32753MO0790271
32753MO0790272
32753MO0790273
32753MO0790274
32753MO0790275

On/Off
Exchange Metal Level
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off

Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold

Benefit Plan
Factor
1.0594
1.1103
1.1175
1.2002
1.2002
1.2524
1.2524
1.2148
1.1804
1.1674
1.1234
1.1055
1.1585
1.1660
1.1673
1.1673
1.1323
1.1001
1.0881
1.0471
1.0303
1.0798
1.0868
1.2267
1.2267
1.1899
1.1561
1.1435
1.1004
1.0828
1.1348
1.1421
1.2414
1.2062
1.1929
1.1480
1.1297
1.1839
1.1915

Network Name
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access
MO SG:-:Blue Access Choice
MO SG:-:Blue Access Choice
MO SG:-:Blue Access
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access
MO SG:-:Blue Access Choice
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Access Choice
MO SG:-:Blue Access
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred

Area(s) Offered
08
09
10
02, 05, 07, 08, 09, 10
06
06
02, 05, 07, 08, 09, 10
02
05
06
07
08
09
10
02, 05, 07, 08, 09, 10
06
02
05
06
07
08
09
10
06
02, 05, 07, 08, 09, 10
02
05
06
07
08
09
10
02
05
06
07
08
09
10

2014 HIOS Plan ID


Mapping
32753MO0790157
32753MO0790157
32753MO0790157
32753MO0790048
32753MO0790156
None
None
32753MO0790042
32753MO0790042
32753MO0790042
32753MO0790042
32753MO0790042
32753MO0790042
32753MO0790042
32753MO0790041
32753MO0790144
32753MO0790145
32753MO0790145
32753MO0790145
32753MO0790145
32753MO0790145
32753MO0790145
32753MO0790145
32753MO0790154
32753MO0790047
32753MO0790155
32753MO0790155
32753MO0790155
32753MO0790155
32753MO0790155
32753MO0790155
32753MO0790155
32753MO0790077
32753MO0790077
32753MO0790077
32753MO0790077
32753MO0790077
32753MO0790077
32753MO0790077

Plan Specific Rate


Increase*
(excluding aging)
-11.93%
2.73%
0.94%
-1.01%
0.30%
n/a
n/a
7.33%
3.40%
0.53%
-7.55%
-11.74%
2.95%
1.16%
0.80%
2.14%
9.06%
5.06%
2.14%
-6.06%
-10.32%
4.61%
2.78%
2.18%
0.84%
9.11%
5.10%
2.19%
-6.02%
-10.28%
4.65%
2.83%
7.72%
3.77%
0.89%
-7.21%
-11.42%
3.33%
1.53%

Exhibit I - Non-Grandfathered Benefit Plan Factors and Rate Increases


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

HIOS Plan Name

2015 HIOS Plan ID

Anthem Gold Blue Access Choice 500/20%/3500


Anthem Gold Blue Access 500/20%/3500
Anthem Gold Blue Access 2000/0%/4000
Anthem Gold Blue Access Choice 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000

32753MO0790276
32753MO0790277
32753MO0790323
32753MO0790324
32753MO0790325
32753MO0790326
32753MO0790327
32753MO0790328
32753MO0790329
32753MO0790330
32753MO0790331

On/Off
Exchange Metal Level
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off

Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold
Gold

Benefit Plan
Factor
1.2797
1.2797
1.2607
1.2607
1.2229
1.1882
1.1751
1.1309
1.1128
1.1662
1.1737

Network Name
MO SG:-:Blue Access Choice
MO SG:-:Blue Access
MO SG:-:Blue Access
MO SG:-:Blue Access Choice
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred
MO SG:-:Blue Preferred

Area(s) Offered
06
02, 05, 07, 08, 09, 10
02, 05, 07, 08, 09, 10
06
02
05
06
07
08
09
10

2014 HIOS Plan ID


Mapping
32753MO0790076
32753MO0790004
None
None
None
None
None
None
None
None
None

Plan Specific Rate


Increase*
(excluding aging)
0.88%
-0.44%
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a

NOTES:
Benefit Plan Factors above reflect plan by plan differences from the index rate for allowable adjustments as described in detail in the Market Reform and Payment Parameters Regulations and illustrated in Exhibit P. The weighted average of these adjustments for the
entire risk pool included in this rate filing is detailed in Exhibit H.
Plan level increases in rates do not include demographic changes in the population.

Exhibit J - Age and Tobacco Factors


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Age
0-17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64+

Age Rating Factor


0.635
0.635
0.635
0.635
1.000
1.000
1.000
1.000
1.004
1.024
1.048
1.087
1.119
1.135
1.159
1.183
1.198
1.214
1.222
1.230
1.238
1.246
1.262
1.278
1.302
1.325
1.357
1.397
1.444
1.500
1.563
1.635
1.706
1.786
1.865
1.952
2.040
2.135
2.230
2.333
2.437
2.548
2.603
2.714
2.810
2.873
2.952
3.000

Tobacco Rating Factor


1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.050
1.050
1.050
1.050
1.050
1.100
1.100
1.100
1.100
1.100
1.200
1.200
1.200
1.200
1.200
1.300
1.300
1.300
1.300
1.300
1.400
1.400
1.400
1.400
1.400
1.400
1.400
1.400
1.400
1.400
1.400
1.400
1.400
1.400
1.400

NOTES:

{1} The weighted averages of these factors for the entire risk pool included in this rate filing is detailed in Exhibit H.

Exhibit K - Area Factors


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Rating Area Description


Rating Area 2 - Northeast
Rating Area 5 - Central
Rating Area 6 - St. Louis Metro
Rating Area 7 - Joplin
Rating Area 8 - Springfield
Rating Area 9 - South Central
Rating Area 10 - Southeast

Area Rating Factor


1.1246
1.0305
0.9570
0.9439
1.0124
1.0789
1.2519

NOTES:

{1} The weighted average of these factors for the entire risk pool included
in this rate filing is detailed in Exhibit H.

Exhibit L - Sample Rate Calculation


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Group Name:
Effective Date:
On/Off Exchange:
Metal Level:
Plan ID:
Rating Area:

Sample Group
4/1/2015
Off
Silver
32753MO0790300
Rating Area 7 - Joplin

Group Census:
Age
24
26
28
32
30
45
53
41
56
39
62
64

Employee 11
Employee 12
Employee 13
Employee 14
Employee 15
Employee 16
Employee 17
Employee 18
Employee 19
Employee 110
Employee 111
Employee 112

Employee
Tobacco
User
Yes
No
No
Yes
No
No
Yes
No
No
No
No
No

Spouse
Age
23

Tobacco
User
No

33

No

45
55

No
Yes

64

Calculation of Monthly Premium:


Base Rate =
x Benefit Plan Factor
x Area Factor
Base Rate Adjusted for Plan/Area =

Child 12
Tobacco
Age
User

Child 13
Tobacco
Age
User

2
18

No
No

4
15

No
No

12

16

No

13

No

25

Yes

No

No

$ 265.33
0.9042
0.9439
$ 226.45

Age/Tobacco Factors:

Child 11
Tobacco
Age
User
0
No

Exhibit A
Exhibit I
Exhibit K

Exhibit J
Employee
Age
Tobacco
Factor
Factor
1.000
1.0000
1.024
1.0000
1.087
1.0000
1.183
1.0500
1.135
1.0000
1.444
1.0000
2.040
1.4000
1.302
1.0000
2.333
1.0000
1.262
1.0000
2.873
1.0000
3.000
1.0000

Employee 11
Employee 12
Employee 13
Employee 14
Employee 15
Employee 16
Employee 17
Employee 18
Employee 19
Employee 110
Employee 111
Employee 112

Spouse
Age
Factor
1.000

Tobacco
Factor
1.0000

1.198

1.0000

1.444
2.230

1.0000
1.4000

3.000

Age
Factor
0.635

Child 11
Tobacco
Factor
1.0000

Age
Factor

Child 12
Tobacco
Factor

Age
Factor

Child 13
Tobacco
Factor

0.635
0.635

1.0000
1.0000

0.635
0.635

1.0000
1.0000

0.635

1.0000

0.635

1.0000

0.635

1.0000

1.004

1.0000

1.0000

Final Monthly Premium PMPM:


Employee
Employee 11
Employee 12
Employee 13
Employee 14
Employee 15
Employee 16
Employee 17
Employee 18
Employee 19
Employee 110
Employee 111
Employee 112

$
$
$
$
$
$
$
$
$
$
$
$

Spouse
226.45
231.88
246.15
281.28
257.02
326.99
646.74
294.84
528.31
285.78
650.59
679.35

Children

226.45

271.29

$
$

326.99
706.98

679.35

Total

143.80

$
$

287.60
431.40

287.60

227.36

$
$
$
$
$
$
$
$
$
$
$
$

596.70
231.88
246.15
552.57
544.62
1,085.38
1,353.72
582.44
528.31
513.14
650.59
1,358.70

NOTES:
{1} As per the Market Reform Rule, when computing family premiums no more than the three oldest covered children under the age of 21 are taken into account whereas the premiums associated with each child age 21+ are includ
{2} This sample calculation ignores the tobacco offset under a Wellness Program as described in the Market Reform Rule.
{3} Minor rate variances may occur due to differences in rounding methodology.

Exhibit M - Federal MLR Estimated Calculation


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

Numerator:
Incurred Claims
+ Quality Improvement Expense
+ Risk Corridor Contributions
+ Risk Adjustment Net Transfer
+ Reinsurance Receipts
+ Risk Corridor Receipts
+ Reduction to Rx Incurred Claims (ACA MLR)
= Estimated Federal MLR Numerator

$
$
$
$
$
$
$
$

289.35
3.27
(6.83)
285.79

Exhibit A
Exhibit G

Denominator:
Premiums
- Federal and State Taxes
- Premium Taxes
- Risk Adjustment User Fee
- Reinsurance Contributions
- Licensing and Regulatory Fees
= Estimated Federal MLR Denominator

$
$
$
$
$
$
$

372.82
10.03
1.27
0.08
3.21
14.72
343.51

Exhibit A
Exhibit A (Line 13) x Exhibit G (Income Taxes)
Exhibit A (Line 13) x Exhibit G (Premium Tax)
Exhibit F
Exhibit F
Exhibit A (Line 13) x Exhibit G (Fees)

Estimated Federal MLR

Exhibit F
Exhibit F
{5}

83.20%

NOTES:
The above calculation is purely an estimate and not meant to be compared to the minimum MLR benchmark for federal/state MLR rebate purposes:
{1} The above calculation represents only the products in this filing. Federal MLR will be calculated at the legal entity and market level.
{2} Not all numerator/denominator components are captured above (for example, fraud and prevention program costs, payroll taxes, assessments for
state high risk pools etc.).
{3} Other adjustments may also be applied within the federal MLR calculation such as 3-year averaging, new business, credibility, deductible and dual
option. These are ignored in the above calculation.
{4} Licensing and Regulatory Fees include ACA-related fees as allowed under the MLR Final Rule.
{5} This is the percentage of 2015 pharmacy claims that are attributable to PBM Administrative Expenses (i.e. the "retail spread" or "pharmacy claims
margin"). It is calculated by applying the 3rd party margin percentage to the 2015 projected Pharmacy claims including projected rebates.

Exhibit N - Index Rate Development


Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

1) Projected Paid Claim Cost


2) - Non-EHBs Embedded in Line Item 1) Above

$
$

293.57 Exhibit A, Line Item 8


-

3) = Projected Paid Claims, Excluding ALL Non-EHBs


4) + Rx Rebates
5) + Additional EHBs {1}

$
$
$

293.57
(6.50) Exhibit E
1.79 Exhibit E

6) = Projected Paid Claims Reflecting only EHBs


7) Paid to Allowed Ratio

8) = Projected Allowed Claims Reflecting only EHBs

NOTE:
{1} Pediatric Dental and Pediatric Vision

288.86
0.71651
403.15 = Index Rate

Exhibit O - Quarterly Index, Base, and Market Adjusted Index Rate


Development
Healthy Alliance Life Insurance Company
Small Group
Rates Effective:
2Q15
322,876

Renewing Member Months


Quarterly Allowed Trend
Index Rate
Reinsurance Contribution
Expected Reinsurance Payments
Risk Adjustment Fee
Risk Adjustment Net Transfer
Exchange Fee

1.58%

1.58%

Member Weighted
Average

403.15 $

409.51 $

415.98 $

$
$
$
$
$

3.21
0.08
1.30

2.87
0.08
1.33

2.53
0.08
1.35

$
$
$
$
$

0.71651
$

409.57 $

Quarterly Base Rate Trend


Base Rate

4Q15
803,007

Paid-to-allowed Ratio
Market Adjusted Index Rate

3Q15
386,061

265.33 $

$
$
$
$
$

0.71651

1,511,943
411.59

0.71651

415.49 $

421.50 $

1.63%

1.63%

269.65 $

274.05 $

417.42

271.07

NOTES:
{1} The 2Q15 index rate was derived in Exhibit N.
{2} The 2Q15 index rate is assumed to increase with quarterly allowed trend as illustrated above.
{3} The 2Q15 reinsurance and risk adjustment fees and payments are shown in Exhibit F. The reinsurance contribution for other effective
dates is calculated by the same method shown in Exhibit F.
{4} Market Adjusted Index Rate = Index Rate + ((Reinsurance + Risk Adjustment Fee + Exchange Fee) Paid-to-allowed Ratio)
{5} The 2Q15 base rate was derived in Exhibit A.
{6} The 2Q15 base rate is assumed to increase with quarterly paid trend as illustrated above. This trend rate differs from the index rate
trend in that it includes anticipated changes for non-EHBs, deductible leveraging, fees, and risk mitigation programs.
{7} Minor rate variances may occur due to differences in rounding methodology.

Exhibit P - Plan Adjusted Index Rate and Consumer Adjusted Premium Rates
Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

HIOS Plan Name


Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Bronze Blue Preferred X 3500/20%/6350 Plus w/HSA
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Silver Blue Preferred X 1500/30%/6600 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Gold Blue Preferred X 1000/20%/5500 Plus
Anthem Bronze Blue Access 4500E/0%/6350 w/HSA
Anthem Bronze Blue Access Choice 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 4500E/0%/6350 w/HSA
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Preferred 6000/0%/6600 Plus
Anthem Bronze Blue Access Choice 6000/0%/6600 Plus
Anthem Bronze Blue Access 6000/0%/6600 Plus
Anthem Silver Blue Access Choice 3000/20%/4500 Plus
Anthem Silver Blue Access 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred 3000/20%/4500 Plus
Anthem Silver Blue Preferred Options 2750/40%/6600

HIOS Plan ID
32753MO0780011
32753MO0780012
32753MO0780013
32753MO0780014
32753MO0780015
32753MO0780016
32753MO0780017
32753MO0780018
32753MO0780019
32753MO0780020
32753MO0780021
32753MO0780022
32753MO0780023
32753MO0780024
32753MO0780004
32753MO0780005
32753MO0780006
32753MO0780007
32753MO0780008
32753MO0780009
32753MO0780010
32753MO0790260
32753MO0790261
32753MO0790262
32753MO0790263
32753MO0790264
32753MO0790265
32753MO0790266
32753MO0790267
32753MO0790268
32753MO0790287
32753MO0790288
32753MO0790289
32753MO0790290
32753MO0790291
32753MO0790292
32753MO0790293
32753MO0790294
32753MO0790295
32753MO0790195
32753MO0790196
32753MO0790197
32753MO0790198
32753MO0790199
32753MO0790200
32753MO0790201
32753MO0790202
32753MO0790203
32753MO0790259

Market Adjusted
Index Rate
(Exhibit O)
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42

Cost Sharing
Adjustment
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.7494
0.7494
0.7494
0.7494
0.7494
0.7494
0.7494
0.8346
0.8346
0.8346
0.8346
0.8346
0.8346
0.8346
0.6341
0.6341
0.6341
0.6341
0.6341
0.6341
0.6341
0.6341
0.6341
0.6339
0.6339
0.6339
0.6339
0.6339
0.6339
0.6339
0.6339
0.6339
0.7098
0.7098
0.7098
0.7098
0.7098
0.7098
0.7098
0.7098
0.7098
0.7088

Provider
Network
Adjustment
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
1.0276
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
0.9089

Adjustment for
Benefits in
Addition to the
EHBS
1.0110
1.0110
1.0110
1.0110
1.0110
1.0110
1.0110
1.0085
1.0085
1.0085
1.0085
1.0085
1.0085
1.0085
1.0076
1.0076
1.0076
1.0076
1.0076
1.0076
1.0076
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0100
1.0100
1.0100
1.0100
1.0100
1.0100
1.0100
1.0100
1.0100
1.0090
1.0090
1.0090
1.0090
1.0090
1.0090
1.0090
1.0090
1.0090
1.0000

Catastrophic Plan
Adjustment
{1}
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000

Administrative Costs
$64.45
$62.63
$61.94
$59.62
$58.67
$61.47
$61.87
$83.67
$81.30
$80.41
$77.40
$76.16
$79.80
$80.32
$93.12
$90.48
$89.50
$86.14
$84.77
$88.82
$89.39
$72.31
$72.31
$70.15
$68.16
$67.42
$64.88
$63.85
$66.91
$67.34
$70.82
$68.82
$68.07
$65.51
$64.47
$67.55
$67.99
$73.00
$73.00
$81.67
$81.67
$79.23
$76.99
$76.15
$73.29
$72.12
$75.57
$76.06
$71.54

Plan Adjusted
Index Rate
{2}
$306.64
$297.94
$294.67
$283.57
$279.04
$292.43
$294.32
$398.11
$386.81
$382.57
$368.16
$362.27
$379.66
$382.12
$443.04
$430.47
$425.74
$409.71
$403.16
$422.50
$425.24
$344.29
$344.29
$333.97
$324.49
$320.93
$308.84
$303.91
$318.49
$320.56
$337.23
$327.66
$324.07
$311.86
$306.87
$321.60
$323.68
$347.65
$347.65
$388.84
$388.84
$377.19
$366.49
$362.46
$348.81
$343.23
$359.71
$362.04
$340.43

Calibration
Factor
{3}
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006

Adjust to
2Q15 eff
date
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788

Consumer Adjusted
Premium Rate
{4}
$214.30
$208.22
$205.93
$198.18
$195.01
$204.37
$205.69
$278.22
$270.33
$267.36
$257.29
$253.18
$265.33
$267.05
$309.62
$300.84
$297.54
$286.33
$281.75
$295.27
$297.19
$240.61
$240.61
$233.40
$226.78
$224.29
$215.84
$212.39
$222.58
$224.02
$235.68
$228.99
$226.48
$217.94
$214.46
$224.75
$226.21
$242.96
$242.96
$271.75
$271.75
$263.60
$256.12
$253.31
$243.77
$239.87
$251.39
$253.01
$237.92

Exhibit P - Plan Adjusted Index Rate and Consumer Adjusted Premium Rates
Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

HIOS Plan Name


Anthem Silver Blue Access 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Preferred 4000E/0%/5000 w/HSA
Anthem Silver Blue Access Choice 4000E/0%/5000 w/HSA
Anthem Silver Blue Access Choice 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Preferred 2000/30%/6600
Anthem Silver Blue Access 2000/30%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Preferred 5000/20%/6600
Anthem Silver Blue Access Choice 5000/20%/6600
Anthem Silver Blue Access 5000/20%/6600
Anthem Silver Blue Access 2600E/20%/5500 w/HSA
Anthem Silver Blue Access Choice 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Silver Blue Preferred 2600E/20%/5500 w/HSA
Anthem Gold Blue Access Choice 1000/20%/2500 Plus
Anthem Gold Blue Access 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred 1000/20%/2500 Plus
Anthem Gold Blue Preferred Options 500/20%/4000
Anthem Gold Blue Access Choice 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000

HIOS Plan ID
32753MO0790278
32753MO0790279
32753MO0790280
32753MO0790281
32753MO0790282
32753MO0790283
32753MO0790284
32753MO0790285
32753MO0790286
32753MO0790296
32753MO0790297
32753MO0790298
32753MO0790299
32753MO0790300
32753MO0790301
32753MO0790302
32753MO0790303
32753MO0790304
32753MO0790305
32753MO0790306
32753MO0790307
32753MO0790308
32753MO0790309
32753MO0790310
32753MO0790311
32753MO0790312
32753MO0790313
32753MO0790314
32753MO0790315
32753MO0790316
32753MO0790317
32753MO0790318
32753MO0790319
32753MO0790320
32753MO0790321
32753MO0790322
32753MO0790186
32753MO0790187
32753MO0790188
32753MO0790189
32753MO0790190
32753MO0790191
32753MO0790192
32753MO0790193
32753MO0790194
32753MO0790204
32753MO0790205
32753MO0790206

Market Adjusted
Index Rate
(Exhibit O)
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42

Cost Sharing
Adjustment

Provider
Network
Adjustment

Adjustment for
Benefits in
Addition to the
EHBS

Catastrophic Plan
Adjustment
{1}

0.6792
0.6792
0.6792
0.6792
0.6792
0.6792
0.6792
0.6792
0.6792
0.7047
0.7047
0.7047
0.7047
0.7047
0.7047
0.7047
0.7047
0.7047
0.6664
0.6664
0.6664
0.6664
0.6664
0.6664
0.6664
0.6664
0.6664
0.6747
0.6747
0.6747
0.6747
0.6747
0.6747
0.6747
0.6747
0.6747
0.8547
0.8547
0.8547
0.8547
0.8547
0.8547
0.8547
0.8547
0.8547
0.9030
0.8289
0.8289

1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
1.0276
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
0.9089
1.0276
0.9968

1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0074
1.0074
1.0074
1.0074
1.0074
1.0074
1.0074
1.0074
1.0074
1.0000
1.0000
1.0000

1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000

Administrative Costs

Plan Adjusted
Index Rate
{2}

Calibration
Factor
{3}

Adjust to
2Q15 eff
date

Consumer Adjusted
Premium Rate
{4}

$77.45
$75.14
$73.01
$72.21
$69.50
$68.39
$71.66
$72.13
$77.45
$80.43
$78.02
$75.82
$74.99
$72.18
$71.03
$74.42
$74.90
$80.43
$73.71
$71.62
$70.84
$68.18
$67.09
$70.30
$70.75
$75.98
$75.98
$76.98
$76.98
$74.68
$72.57
$71.77
$69.08
$67.98
$71.23
$71.69
$98.26
$98.26
$95.33
$92.63
$91.62
$88.18
$86.78
$90.93
$91.51
$91.26
$94.55
$91.73

$368.79
$357.74
$347.59
$343.77
$330.82
$325.53
$341.16
$343.37
$368.79
$382.72
$371.25
$360.71
$356.76
$343.32
$337.83
$354.04
$356.34
$382.72
$350.99
$341.03
$337.29
$324.58
$319.39
$334.72
$336.89
$361.84
$361.84
$366.39
$366.39
$355.41
$345.32
$341.53
$328.67
$323.42
$338.94
$341.13
$467.62
$467.62
$453.61
$440.73
$435.90
$419.48
$412.78
$432.58
$435.39
$433.83
$450.11
$436.62

1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006

0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788

$257.74
$250.01
$242.92
$240.25
$231.20
$227.50
$238.42
$239.97
$257.74
$267.47
$259.45
$252.09
$249.32
$239.93
$236.10
$247.43
$249.03
$267.47
$245.30
$238.34
$235.72
$226.84
$223.21
$233.93
$235.44
$252.88
$252.88
$256.06
$256.06
$248.38
$241.33
$238.69
$229.70
$226.02
$236.87
$238.41
$326.80
$326.80
$317.01
$308.01
$304.63
$293.16
$288.47
$302.32
$304.27
$303.19
$314.57
$305.14

Exhibit P - Plan Adjusted Index Rate and Consumer Adjusted Premium Rates
Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

HIOS Plan Name

HIOS Plan ID

Anthem Gold Blue Preferred 1500/30%/5000


Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Preferred 1500/30%/5000
Anthem Gold Blue Access 1500/30%/5000
Anthem Gold Blue Access Choice 5000/0%/5000
Anthem Gold Blue Access 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 5000/0%/5000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Preferred 3500/0%/4000
Anthem Gold Blue Access 3500/0%/4000
Anthem Gold Blue Access Choice 3500/0%/4000
Anthem Gold Blue Access Choice 1000/20%/3500
Anthem Gold Blue Access 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Preferred 1000/20%/3500
Anthem Gold Blue Access 2500/20%/4500
Anthem Gold Blue Access Choice 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Preferred 2500/20%/4500
Anthem Gold Blue Access Choice 1500/20%/4000
Anthem Gold Blue Access 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000

32753MO0790207
32753MO0790208
32753MO0790209
32753MO0790210
32753MO0790211
32753MO0790212
32753MO0790213
32753MO0790214
32753MO0790215
32753MO0790216
32753MO0790217
32753MO0790218
32753MO0790219
32753MO0790220
32753MO0790221
32753MO0790222
32753MO0790223
32753MO0790224
32753MO0790225
32753MO0790226
32753MO0790227
32753MO0790228
32753MO0790229
32753MO0790230
32753MO0790231
32753MO0790232
32753MO0790233
32753MO0790234
32753MO0790235
32753MO0790236
32753MO0790237
32753MO0790238
32753MO0790239
32753MO0790240
32753MO0790241
32753MO0790242
32753MO0790243
32753MO0790244
32753MO0790245
32753MO0790246
32753MO0790247
32753MO0790248
32753MO0790249
32753MO0790250
32753MO0790251
32753MO0790252
32753MO0790253
32753MO0790254

Market Adjusted
Index Rate
(Exhibit O)
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42

Cost Sharing
Adjustment

Provider
Network
Adjustment

Adjustment for
Benefits in
Addition to the
EHBS

Catastrophic Plan
Adjustment
{1}

0.8289
0.8289
0.8289
0.8289
0.8289
0.8289
0.8289
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.8394
0.8394
0.8394
0.8394
0.8394
0.8394
0.8394
0.8394
0.8394
0.8757
0.8757
0.8757
0.8757
0.8757
0.8757
0.8757
0.8757
0.8757
0.8163
0.8163
0.8163
0.8163
0.8163
0.8163
0.8163
0.8163
0.8163
0.8578
0.8578
0.8578
0.8578
0.8578

0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
1.0276
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
0.9968
0.9685
0.9578

1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000

1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000

Administrative Costs

Plan Adjusted
Index Rate
{2}

Calibration
Factor
{3}

Adjust to
2Q15 eff
date

Consumer Adjusted
Premium Rate
{4}

$89.13
$88.16
$84.85
$83.50
$87.49
$88.06
$94.55
$90.10
$90.10
$87.41
$84.93
$84.00
$80.85
$79.56
$83.37
$83.90
$92.80
$90.18
$89.19
$85.84
$84.47
$88.51
$89.08
$95.66
$95.66
$99.92
$99.92
$96.94
$94.19
$93.16
$89.67
$88.24
$92.46
$93.06
$93.06
$93.06
$90.28
$87.72
$86.76
$83.51
$82.17
$86.11
$86.66
$97.83
$97.83
$94.91
$92.22
$91.22

$424.23
$419.57
$403.77
$397.31
$416.38
$419.08
$450.11
$429.31
$429.31
$416.44
$404.62
$400.17
$385.10
$378.94
$397.13
$399.70
$442.07
$429.52
$424.81
$408.80
$402.27
$421.58
$424.31
$455.73
$455.73
$475.53
$475.53
$461.28
$448.19
$443.27
$426.57
$419.76
$439.90
$442.75
$443.21
$443.21
$429.92
$417.72
$413.14
$397.57
$391.22
$409.99
$412.65
$465.77
$465.77
$451.81
$438.99
$434.17

1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006

0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788

$296.48
$293.22
$282.18
$277.67
$290.99
$292.88
$314.57
$300.03
$300.03
$291.03
$282.77
$279.67
$269.13
$264.83
$277.54
$279.34
$308.95
$300.18
$296.88
$285.70
$281.13
$294.62
$296.53
$318.49
$318.49
$332.33
$332.33
$322.37
$313.22
$309.79
$298.12
$293.35
$307.43
$309.42
$309.74
$309.74
$300.46
$291.93
$288.73
$277.85
$273.41
$286.53
$288.39
$325.51
$325.51
$315.75
$306.79
$303.43

Exhibit P - Plan Adjusted Index Rate and Consumer Adjusted Premium Rates
Healthy Alliance Life Insurance Company
Small Group
Rates Effective April 1, 2015

HIOS Plan Name

HIOS Plan ID

Anthem Gold Blue Preferred 1500/20%/4000


Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 1500/20%/4000
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Preferred 500/20%/3500
Anthem Gold Blue Access Choice 500/20%/3500
Anthem Gold Blue Access 500/20%/3500
Anthem Gold Blue Access 2000/0%/4000
Anthem Gold Blue Access Choice 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000
Anthem Gold Blue Preferred 2000/0%/4000

32753MO0790255
32753MO0790256
32753MO0790257
32753MO0790258
32753MO0790269
32753MO0790270
32753MO0790271
32753MO0790272
32753MO0790273
32753MO0790274
32753MO0790275
32753MO0790276
32753MO0790277
32753MO0790323
32753MO0790324
32753MO0790325
32753MO0790326
32753MO0790327
32753MO0790328
32753MO0790329
32753MO0790330
32753MO0790331

Market Adjusted
Index Rate
(Exhibit O)
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42
$417.42

Cost Sharing
Adjustment

Provider
Network
Adjustment

Adjustment for
Benefits in
Addition to the
EHBS

Catastrophic Plan
Adjustment
{1}

0.8578
0.8578
0.8578
0.8578
0.8946
0.8946
0.8946
0.8946
0.8946
0.8946
0.8946
0.8946
0.8946
0.8816
0.8816
0.8816
0.8816
0.8816
0.8816
0.8816
0.8816
0.8816

0.9217
0.9070
0.9505
0.9567
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567
1.0276
1.0276
1.0276
1.0276
0.9968
0.9685
0.9578
0.9217
0.9070
0.9505
0.9567

1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000

1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000

Administrative Costs

Plan Adjusted
Index Rate
{2}

Calibration
Factor
{3}

Adjust to
2Q15 eff
date

Consumer Adjusted
Premium Rate
{4}

$87.79
$86.39
$90.52
$91.11
$99.12
$96.32
$95.26
$91.69
$90.23
$94.54
$95.15
$102.16
$102.16
$100.52
$100.52
$97.51
$94.75
$93.72
$90.20
$88.76
$93.01
$93.61

$417.81
$411.14
$430.87
$433.66
$471.36
$457.98
$452.96
$435.90
$428.94
$449.51
$452.43
$485.92
$485.92
$478.67
$478.67
$464.33
$451.15
$446.20
$429.39
$422.52
$442.80
$445.67

1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006
1.4006

0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788
0.9788

$291.99
$287.33
$301.12
$303.07
$329.41
$320.07
$316.56
$304.63
$299.77
$314.15
$316.18
$339.59
$339.59
$334.53
$334.53
$324.50
$315.29
$311.83
$300.08
$295.29
$309.46
$311.46

Notes:
{1} This adjustment assumes a healthier than average population will select the catastrophic plan. The catastrophic adjustment factor is normalized to 1.0 across all plans for revenue neutrality across the entire block.
{2} The Plan Adjusted Index Rate is calculated by multiplying the Market Adjusted Index Rate by the AV and cost sharing, provider network, benefits in addition to the EHBs, and catastrophic plan adjustments and then adding the administrative costs. The Plan Adjusted Index Rate can also be
described as a Plan Level Required Premium.
{3} See Exhibit H - Calibration.
{4} The Consumer Adjusted Premium Rate is calculated by dividing by Calibration Factor and then multiplying by Adjust to 2Q15 effective date factor.

Exhibit Q - Terminated Products


Healthy Alliance Life Insurance Company
Small Group
Effective April 1, 2015

Following are the products that will be terminated prior to the effective date:
This includes products that have experience included in the URRT during the experience period and
any products that were not in effect during the experience period but were made available
thereafter.
Pre ACA Terminated Products
HIOS Product ID
HIOS Product Name
32753MO076
Lumenos Blue Preferred Select
Post ACA Terminated Plans
HIOS Product ID
HIOS Product Name