‘Gpveses COUNTY ‘September 36,2019 ‘GROUP i: 10008007 (9R-32380 [TS SURGROUP Inf: 1208 Page tet Renewal Date: anwar ‘Monthy Premium Rees Eactve: ——_Janusty, 2020 through Decarber 3, 2020, use Pronlurs Premiums corre ype contracts who Tee? wT? ‘Subsea Ory ° $7886 Tse ‘Subscribe Spouse ° s.ags.rt ry $450837 Subseber Chie ° sags. s05% 3130837 ‘Subserber Chen ° seam 05% $2sass ‘Suber, Spoure& Orn) ° S80 05% 5205485 subs (acer) $303 -30% sae * IMPORTANT: Phase red all Premium Rate Condon on Page ‘Please sign and return to your HAP Account Executive atheen Dave | Ios@hopog| (30) 60-0025 ‘the Eacuta Representative of he group ea above, my satus acknowiegas the Praia, Efectve Ones, Plan Pri Rete ‘Conan ecu hs Rata Noteon at well ath Tera and Condon of mw HAP Group Oparring Agree lo acknoatadge ‘Prem ate code 93.5% Fit Comelon ‘Aatored Saratre eed Name ‘We at Heath AllancePlanfook forward to our continued partrarihp and apprecate you baie.cewesee courry ‘September 36,2018 ‘GROUP: 10008047 ‘aps23t0 | _SuNGROUP Di: 1208 Page20t2 HAP RENEWAL PREMIUM RATE NOTIFCATION 90 Roper Dee: Janay Premium ate Condon Eee: Jnuatyi, 2020 trough December 3, 2020, ‘ranlum Rata Contant “FENEWA; Perr rater ae SET Upon Te dy 2019 enrolment. Hea Altace Pan repted by the Department of rsurance nd racial Sevens (DFS), Premium rats aecontonal and subjects chaage bases on ‘he annette Ming ers approval wth DFS. Prema ate re contingent upon an employe group meeting the minknum crtsbuton of 50M or mor othe otal prenur. the quoted produc provides coverage for hear al, leas note ha HAP (ncug AH) wl be moving one vendor, Navona, to prove ‘earg a benets fete 1/1/2020. The cot share for merbas wl be cpey per hearing ad per yar based on technology level: $0 copy or ale $683 cpey for Bas, 8989 cape for Prine, $1538 copay fr Advanced, $2.39 copy fr Premium HAPs knpamantng his chang fra ‘member with this beet fete 11/2020. ‘Contact your HAP count eect fr HRA or HSA formation nfs ‘Commerc applies to ose no elie fr Maccare (Pars A sr; Medicare apps to thoe ele for Mace Pers Aan}. ‘Hest Altace Play/Ataee Hest 8 Life reserves the right to recite in erploye group te rodent end the demographics of he proup charges ‘bymorethen 10K. Tis apples to not elsif win the rc ful Isred population, bu ao shits furl mechanism fr earl «uy red up electing set furdesorsperton af hl population. ‘Yeu a curenty nvicad for premiums tat ence apc aes Such tom are beng apt to your vols a ceparate le Ra. Ruszatve Prius have been proved for nfrrational purposes wich ndude wes based upon cuenta esesmens end were evalopad es aad pin time. ‘Th acu tes on your monthly volemayRutuate dusts sts nmambarthip nado, pening egltory declons rey fet hens eld ‘Thi ex Madara Avntage quot. HAPecoectg the payment arc members must be enol n Macear ars, and. ‘Monthy remittance reports and payment should oly beset tothe follwing are: [DEPARTMENT 271301 *HEATTHALUANCEPLAN* P.O. BOKSSO00* DETROM, Mi 48255272 Prepared by Underatar: ‘Theres Bochan