September36, 2018 {GROUP 1D: 30004007 ansassi [To SUBGROUP 1): 3605 Page tot HAP RENEWAL PREMIUM RATE NOTIRCATION. Mo 4 ‘avary, 220 trough December 31, 2020, rma Pramiura Pramur Contrats wnt Toes? Renew change Toms? ‘TREE = 05K ETE ° suaes7 05% $u80837 ° suaas 7 “05K $u80837 ° Seozaae 205% ‘sapsas ° somo 205% S23485 sam 30% sist IMPORTANT: Pleas ea al Pramlum Rate Contons on Page 2 Please slg and return to your HAP Account Executive atleen Dev | kevt@hap.og | (230) 6008025, ‘atte tanta Raprzecative of the group tad nov, ry ature eknewadge he Pram Rates face Dats, Pl wd Prem ate ‘Contons a cuted on ths Rats Notfeton ws wel asthe Term nd Condon of my HAP Grup Operating Ageamet. | abo edmowidge Promlumratesincude a 3M Fat Commison ‘toto Signature Printed nae ‘We at Heath Allance Plan tok forward to our continued patnanlp and apprecte your bunt.cceneste courry ‘September 16, 2018 (GROUP D: s0004067 ‘anazasi | To SUBGROUP IDs): 606 Paget? NAP RENEWAL PREMIUM RATE NOTIREATION 090 ‘anewe ete: runt Pramdum Rata Condlons Elective: Janay, 2020 trough December 3, 2020 Peamium Rate Condens RENEWAL; Pramas are based upon ha ly 2019 enrolment. Heath altane in reputed bythe Deparnent of lurance and ancl Seren (DS), Premium rates re condtnal and subject to change based on ‘he anual ate nga ts approval ith DS. Perla xa ar contingent pon an employer group meeting the nkmum contuton of SOK rere of the tral premium. "the quoted produc provides coverage for hearings, plac note tat HAP ncudng AML] wl be moving to 2 new ander, Naina prove ‘earn ald benef face 1/12020, The cox share or members wl be 8 copay per earn al par yar boa on techno eae ‘$0 copay fr Value, S69 copay or i, 888 copey fr Prime 1,538 copay for Advance, $2,035 cope for Premium. HAPs plererting thi change for ‘amber wath ths banat ectiva 1/1/2020. ‘Comet your HAP Aezoun Bescrtve fr HRA ot HSA formation and fee ‘Conenercisl apps to those ot eghe or Maclae Pars Aan); Mediar apples to hse eghlefor Madera (Pars AaB. ‘eat flance Plr/ance Hesi &Lie esrves th ight to recat an emgloyr group te enrolment nd other demographic etn of the group charges ‘bymorethan 10%. Ths appl to nt oly shits wlohe pou’ ul iraredpopulzbon but ao shits fue mechanism for ear « iy red soup ling st tnded fora pordonf ther option. You are carry acd for perl thet exclude apical tes, Such tans ae bing apple to our ec separate ine ers). Iatretve Preis hav ben provided fr informational urpres which inca tes ated upon cert tax esesiments and were developed et hed pont ne. “The nun taxes on your mombly Ince may furtute dueto sis nrmembesp. in adieon perdlng regulary dacons may affect theta appa ‘Tava Medkare Advneage quote, HAP W collet the payment and members mus be enon Meer Pars, Band. ‘Monthly emtance reports and payment should onl be seat othe flowing nares: DEPARTMENT #273101 * HEATH ALIANCE PAN *.0, BOX5SO0* DETROM, MI 48255-2731 Prapred by Underwier: ‘Teresa Bonhars