2014 health insurance premiums for plans sold through the health
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Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
2014 health insurance premiums for plans sold through the Health Insurance MarketplaceAmbetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 0‐20 150.98 181.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 21 237.78 285.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 22 237.78 285.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 23 237.78 285.33
Ambetter of Arkansas from Arkansas Ambetter Bronze 1 1 24 237.78 285.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 25 238.72 286.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 26 243.48 292.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 27 249.18 299.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 28 258.46 310.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 29 266.06 319.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 30 269.87 323.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 31 275.58 330.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 32 281.28 337.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 33 284.85 341.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 34 288.65 346.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 35 290.55 348.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 36 292.46 350.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 37 294.36 353.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 38 296.26 355.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 39 300.07 360.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 40 303.87 364.64
Premiums are listed first by the insurance company, then by each company's plan. Premiums for each plan depend on the rating area, age, and, with some plans, the tobacco use of an individual. Premiums for each scenario are listed below.
These amounts do NOT include Advanced Premium Tax Credits eligible consumers could receive and which could lower their premiumssubstantially.
Depending on a sliding scale based on income, a consumer eligible for tax credits could pay as little as about 10 percent of the listed premium or as much as about 80 percent of the listed premium. To be eligible for these tax credits, an indvidual or family must make less than 400 percent of the Federal Poverty Level.
Consumers earning 400 percent or more of the Federal Poverty Level, may still purchase plans in the Marketplace but are NOT eligible for financial assistance. These consumers would pay the amount listed.
The rates below only apply to those consumers buying insurance in the individual market. Consumers with insurance through their employers or through Medicare are not affected.
Page 1 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 41 309.58 371.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 42 315.05 378.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 43 322.65 387.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 44 332.16 398.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 45 343.34 412
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 46 356.65 427.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 47 371.63 445.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 48 388.75 466.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 49 405.64 486.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 50 424.66 509.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 51 443.44 532.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 52 464.13 556.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 53 485.05 582.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 54 507.64 609.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 55 530.23 636.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 56 554.72 665.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 57 579.45 695.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 58 605.84 727
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 59 618.92 742.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 60 645.31 774.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 61 668.13 801.75
Page 2 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 62 683.11 819.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 63 701.9 842.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 64 713.3 855.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 1 65 and
over
713.3 855.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 0‐20 175.67 210.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 21 276.65 331.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 22 276.65 331.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 23 276.65 331.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 24 276.65 331.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 25 277.75 333.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 26 283.28 339.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 27 289.92 347.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 28 300.71 360.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 29 309.56 371.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 30 313.99 376.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 31 320.63 384.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 32 327.27 392.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 33 331.42 397.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 34 335.84 403
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 35 338.06 405.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 36 340.27 408.32
Page 3 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 37 342.48 410.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 38 344.69 413.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 39 349.12 418.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 40 353.55 424.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 41 360.19 432.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 42 366.55 439.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 43 375.4 450.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 44 386.47 463.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 45 399.47 479.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 46 414.96 497.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 47 432.39 518.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 48 452.31 542.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 49 471.95 566.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 50 494.08 592.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 51 515.94 619.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 52 540 648
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 53 564.35 677.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 54 590.63 708.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 55 616.91 740.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 56 645.4 774.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 57 674.17 809
Page 4 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 58 704.88 845.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 59 720.1 864.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 60 750.8 900.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 61 777.36 932.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 62 794.79 953.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 63 816.64 979.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 64 829.91 995.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 3 65 and
over
829.91 995.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 0‐20 157.56 189.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 21 248.13 297.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 22 248.13 297.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 23 248.13 297.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 24 248.13 297.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 25 249.11 298.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 26 254.07 304.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 27 260.03 312.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 28 269.71 323.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 29 277.64 333.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 30 281.61 337.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 31 287.57 345.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 32 293.52 352.22
Page 5 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 33 297.25 356.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 34 301.22 361.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 35 303.2 363.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 36 305.19 366.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 37 307.17 368.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 38 309.16 370.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 39 313.13 375.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 40 317.1 380.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 41 323.05 387.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 42 328.76 394.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 43 336.7 404.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 44 346.62 415.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 45 358.28 429.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 46 372.18 446.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 47 387.81 465.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 48 405.67 486.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 49 423.29 507.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 50 443.14 531.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 51 462.74 555.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 52 484.33 581.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 53 506.16 607.39
Page 6 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 54 529.73 635.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 55 553.3 663.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 56 578.86 694.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 57 604.67 725.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 58 632.21 758.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 59 645.85 775.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 60 673.39 808.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 61 697.21 836.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 62 712.85 855.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 63 732.45 878.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 64 744.35 893.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 7 65 and
over
744.35 893.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 0‐20 153.42 184.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 21 241.61 289.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 22 241.61 289.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 23 241.61 289.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 24 241.61 289.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 25 242.57 291.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 26 247.4 296.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 27 253.2 303.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 28 262.62 315.14
Page 7 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 29 270.35 324.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 30 274.22 329.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 31 280.02 336.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 32 285.81 342.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 33 289.44 347.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 34 293.3 351.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 35 295.24 354.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 36 297.17 356.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 37 299.1 358.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 38 301.03 361.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 39 304.9 365.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 40 308.77 370.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 41 314.56 377.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 42 320.12 384.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 43 327.85 393.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 44 337.52 405.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 45 348.87 418.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 46 362.4 434.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 47 377.62 453.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 48 395.02 474.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 49 412.17 494.6
Page 8 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 50 431.5 517.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 51 450.59 540.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 52 471.61 565.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 53 492.87 591.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 54 515.82 618.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 55 538.77 646.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 56 563.66 676.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 57 588.78 706.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 58 615.6 738.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 59 628.89 754.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 60 655.71 786.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 61 678.9 814.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 62 694.12 832.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 63 713.21 855.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 64 724.79 869.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 1 65 and
over
724.79 869.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 0‐20 178.5 214.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 21 281.11 337.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 22 281.11 337.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 23 281.11 337.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 24 281.11 337.33
Page 9 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 25 282.22 338.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 26 287.84 345.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 27 294.59 353.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 28 305.55 366.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 29 314.55 377.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 30 319.05 382.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 31 325.79 390.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 32 332.54 399.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 33 336.76 404.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 34 341.25 409.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 35 343.5 412.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 36 345.75 414.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 37 348 417.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 38 350.25 420.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 39 354.75 425.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 40 359.24 431.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 41 365.99 439.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 42 372.46 446.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 43 381.45 457.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 44 392.69 471.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 45 405.91 487.09
Page 10 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 46 421.65 505.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 47 439.36 527.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 48 459.6 551.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 49 479.55 575.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 50 502.04 602.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 51 524.25 629.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 52 548.7 658.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 53 573.44 688.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 54 600.15 720.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 55 626.85 752.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 56 655.8 786.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 57 685.04 822.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 58 716.24 859.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 59 731.7 878.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 60 762.9 915.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 61 789.89 947.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 62 807.6 969.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 63 829.8 995.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 64 843.29 1011.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 3 65 and
over
843.29 1011.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 0‐20 160.09 192.1
Page 11 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 21 252.13 302.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 22 252.13 302.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 23 252.13 302.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 24 252.13 302.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 25 253.13 303.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 26 258.17 309.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 27 264.22 317.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 28 274.05 328.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 29 282.12 338.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 30 286.15 343.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 31 292.2 350.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 32 298.25 357.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 33 302.04 362.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 34 306.07 367.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 35 308.09 369.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 36 310.1 372.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 37 312.12 374.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 38 314.14 376.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 39 318.17 381.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 40 322.2 386.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 41 328.26 393.91
Page 12 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 42 334.05 400.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 43 342.12 410.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 44 352.21 422.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 45 364.06 436.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 46 378.17 453.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 47 394.06 472.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 48 412.21 494.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 49 430.11 516.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 50 450.28 540.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 51 470.2 564.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 52 492.13 590.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 53 514.32 617.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 54 538.27 645.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 55 562.22 674.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 56 588.19 705.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 57 614.41 737.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 58 642.39 770.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 59 656.26 787.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 60 684.24 821.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 61 708.45 850.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 62 724.33 869.19
Page 13 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 63 744.25 893.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 64 756.34 907.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision 7 65 and
over
756.34 907.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 0‐20 161.48 193.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 21 254.31 305.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 22 254.31 305.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 23 254.31 305.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 24 254.31 305.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 25 255.31 306.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 26 260.4 312.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 27 266.5 319.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 28 276.42 331.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 29 284.56 341.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 30 288.63 346.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 31 294.73 353.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 32 300.83 360.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 33 304.65 365.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 34 308.72 370.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 35 310.75 372.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 36 312.79 375.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 37 314.82 377.78
Page 14 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 38 316.85 380.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 39 320.92 385.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 40 324.99 389.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 41 331.1 397.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 42 336.94 404.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 43 345.08 414.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 44 355.25 426.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 45 367.21 440.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 46 381.45 457.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 47 397.47 476.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 48 415.78 498.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 49 433.83 520.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 50 454.18 545.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 51 474.26 569.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 52 496.39 595.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 53 518.77 622.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 54 542.93 651.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 55 567.08 680.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 56 593.28 711.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 57 619.72 743.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 58 647.95 777.54
Page 15 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 59 661.94 794.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 60 690.16 828.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 61 714.58 857.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 62 730.6 876.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 63 750.69 900.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 64 762.88 915.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 1 65 and
over
762.88 915.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 0‐20 187.88 225.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 21 295.88 355.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 22 295.88 355.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 23 295.88 355.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 24 295.88 355.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 25 297.05 356.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 26 302.97 363.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 27 310.07 372.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 28 321.61 385.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 29 331.08 397.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 30 335.81 402.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 31 342.91 411.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 32 350.01 420.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 33 354.45 425.34
Page 16 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 34 359.19 431.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 35 361.55 433.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 36 363.92 436.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 37 366.29 439.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 38 368.65 442.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 39 373.39 448.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 40 378.12 453.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 41 385.22 462.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 42 392.03 470.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 43 401.5 481.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 44 413.33 495.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 45 427.24 512.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 46 443.81 532.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 47 462.45 554.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 48 483.75 580.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 49 504.76 605.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 50 528.42 634.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 51 551.8 662.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 52 577.54 693.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 53 603.58 724.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 54 631.68 758.01
Page 17 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 55 659.79 791.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 56 690.27 828.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 57 721.04 865.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 58 753.88 904.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 59 770.15 924.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 60 802.99 963.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 61 831.4 997.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 62 850.04 1020.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 63 873.41 1048.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 64 887.6 1065.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 3 65 and
over
887.6 1065.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 0‐20 168.51 202.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 21 265.38 318.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 22 265.38 318.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 23 265.38 318.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 24 265.38 318.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 25 266.43 319.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 26 271.73 326.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 27 278.1 333.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 28 288.45 346.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 29 296.94 356.32
Page 18 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 30 301.19 361.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 31 307.56 369.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 32 313.93 376.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 33 317.91 381.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 34 322.15 386.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 35 324.28 389.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 36 326.4 391.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 37 328.52 394.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 38 330.65 396.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 39 334.89 401.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 40 339.14 406.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 41 345.51 414.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 42 351.61 421.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 43 360.1 432.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 44 370.72 444.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 45 383.19 459.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 46 398.05 477.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 47 414.77 497.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 48 433.87 520.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 49 452.71 543.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 50 473.94 568.72
Page 19 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 51 494.91 593.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 52 517.99 621.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 53 541.35 649.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 54 566.56 679.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 55 591.77 710.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 56 619.1 742.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 57 646.7 776.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 58 676.15 811.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 59 690.75 828.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 60 720.2 864.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 61 745.68 894.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 62 762.4 914.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 63 783.36 940.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 64 796.09 955.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 1 + Vision + Adult Dental 7 65 and
over
796.09 955.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 0‐20 137.78 165.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 21 216.99 260.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 22 216.99 260.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 23 216.99 260.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 24 216.99 260.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 25 217.84 261.4
Page 20 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 26 222.18 266.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 27 227.39 272.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 28 235.85 283.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 29 242.8 291.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 30 246.27 295.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 31 251.47 301.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 32 256.68 308.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 33 259.94 311.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 34 263.41 316.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 35 265.14 318.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 36 266.88 320.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 37 268.62 322.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 38 270.35 324.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 39 273.82 328.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 40 277.29 332.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 41 282.5 339
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 42 287.49 344.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 43 294.44 353.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 44 303.11 363.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 45 313.31 375.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 46 325.46 390.55
Page 21 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 47 339.13 406.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 48 354.75 425.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 49 370.16 444.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 50 387.52 465.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 51 404.66 485.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 52 423.54 508.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 53 442.63 531.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 54 463.24 555.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 55 483.86 580.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 56 506.2 607.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 57 528.77 634.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 58 552.85 663.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 59 564.79 677.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 60 588.87 706.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 61 609.7 731.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 62 623.37 748.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 63 640.51 768.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 64 650.92 781.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 1 65 and
over
650.92 781.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 0‐20 160.3 192.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 21 252.46 302.95
Page 22 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 22 252.46 302.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 23 252.46 302.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 24 252.46 302.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 25 253.46 304.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 26 258.51 310.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 27 264.56 317.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 28 274.41 329.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 29 282.49 338.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 30 286.53 343.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 31 292.59 351.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 32 298.64 358.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 33 302.43 362.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 34 306.47 367.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 35 308.49 370.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 36 310.51 372.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 37 312.53 375.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 38 314.55 377.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 39 318.59 382.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 40 322.63 387.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 41 328.69 394.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 42 334.49 401.38
Page 23 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 43 342.57 411.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 44 352.67 423.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 45 364.53 437.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 46 378.67 454.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 47 394.57 473.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 48 412.75 495.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 49 430.67 516.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 50 450.87 541.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 51 470.81 564.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 52 492.78 591.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 53 514.99 617.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 54 538.97 646.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 55 562.96 675.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 56 588.96 706.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 57 615.21 738.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 58 643.23 771.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 59 657.12 788.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 60 685.14 822.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 61 709.38 851.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 62 725.28 870.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 63 745.22 894.26
Page 24 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 64 757.33 908.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 3 65 and
over
757.33 908.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 0‐20 143.78 172.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 21 226.43 271.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 22 226.43 271.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 23 226.43 271.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 24 226.43 271.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 25 227.32 272.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 26 231.85 278.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 27 237.29 284.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 28 246.12 295.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 29 253.36 304.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 30 256.99 308.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 31 262.42 314.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 32 267.85 321.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 33 271.25 325.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 34 274.87 329.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 35 276.68 332.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 36 278.5 334.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 37 280.31 336.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 38 282.12 338.54
Page 25 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 39 285.74 342.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 40 289.36 347.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 41 294.8 353.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 42 300.01 360.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 43 307.25 368.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 44 316.31 379.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 45 326.95 392.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 46 339.63 407.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 47 353.89 424.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 48 370.2 444.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 49 386.27 463.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 50 404.38 485.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 51 422.27 506.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 52 441.97 530.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 53 461.89 554.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 54 483.4 580.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 55 504.91 605.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 56 528.24 633.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 57 551.78 662.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 58 576.92 692.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 59 589.37 707.24
Page 26 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 60 614.5 737.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 61 636.24 763.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 62 650.5 780.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 63 668.39 802.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 64 679.25 815.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 7 65 and
over
679.25 815.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 0‐20 140 168
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 21 220.48 264.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 22 220.48 264.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 23 220.48 264.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 24 220.48 264.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 25 221.35 265.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 26 225.76 270.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 27 231.05 277.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 28 239.65 287.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 29 246.71 296.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 30 250.23 300.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 31 255.53 306.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 32 260.82 312.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 33 264.12 316.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 34 267.65 321.18
Page 27 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 35 269.42 323.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 36 271.18 325.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 37 272.94 327.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 38 274.71 329.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 39 278.23 333.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 40 281.76 338.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 41 287.05 344.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 42 292.12 350.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 43 299.18 359.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 44 308 369.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 45 318.36 382.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 46 330.71 396.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 47 344.6 413.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 48 360.47 432.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 49 376.12 451.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 50 393.76 472.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 51 411.18 493.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 52 430.36 516.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 53 449.76 539.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 54 470.71 564.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 55 491.65 589.98
Page 28 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 56 514.36 617.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 57 537.29 644.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 58 561.76 674.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 59 573.89 688.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 60 598.36 718.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 61 619.52 743.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 62 633.41 760.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 63 650.83 780.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 64 661.4 793.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 1 65 and
over
661.4 793.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 0‐20 162.89 195.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 21 256.52 307.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 22 256.52 307.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 23 256.52 307.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 24 256.52 307.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 25 257.54 309.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 26 262.67 315.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 27 268.83 322.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 28 278.83 334.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 29 287.04 344.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 30 291.14 349.36
Page 29 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 31 297.3 356.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 32 303.46 364.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 33 307.3 368.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 34 311.41 373.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 35 313.46 376.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 36 315.51 378.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 37 317.56 381.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 38 319.62 383.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 39 323.72 388.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 40 327.83 393.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 41 333.98 400.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 42 339.88 407.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 43 348.09 417.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 44 358.35 430.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 45 370.41 444.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 46 384.77 461.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 47 400.93 481.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 48 419.4 503.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 49 437.61 525.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 50 458.13 549.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 51 478.4 574.08
Page 30 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 52 500.72 600.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 53 523.29 627.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 54 547.66 657.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 55 572.03 686.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 56 598.45 718.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 57 625.13 750.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 58 653.6 784.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 59 667.71 801.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 60 696.18 835.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 61 720.81 864.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 62 736.97 884.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 63 757.23 908.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 64 769.53 923.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 3 65 and
over
769.53 923.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 0‐20 146.09 175.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 21 230.08 276.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 22 230.08 276.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 23 230.08 276.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 24 230.08 276.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 25 230.99 277.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 26 235.59 282.7
Page 31 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 27 241.11 289.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 28 250.08 300.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 29 257.45 308.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 30 261.13 313.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 31 266.65 319.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 32 272.17 326.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 33 275.62 330.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 34 279.3 335.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 35 281.14 337.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 36 282.98 339.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 37 284.82 341.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 38 286.66 343.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 39 290.34 348.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 40 294.03 352.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 41 299.55 359.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 42 304.84 365.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 43 312.2 374.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 44 321.4 385.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 45 332.22 398.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 46 345.1 414.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 47 359.6 431.52
Page 32 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 48 376.16 451.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 49 392.49 470.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 50 410.9 493.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 51 429.08 514.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 52 449.09 538.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 53 469.34 563.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 54 491.19 589.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 55 513.05 615.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 56 536.75 644.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 57 560.67 672.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 58 586.21 703.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 59 598.87 718.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 60 624.4 749.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 61 646.49 775.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 62 660.98 793.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 63 679.16 814.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 64 690.19 828.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision 7 65 and
over
690.19 828.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 0‐20 147.36 176.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 21 232.07 278.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 22 232.07 278.48
Page 33 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 23 232.07 278.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 24 232.07 278.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 25 232.99 279.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 26 237.63 285.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 27 243.2 291.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 28 252.25 302.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 29 259.67 311.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 30 263.39 316.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 31 268.95 322.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 32 274.52 329.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 33 278 333.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 34 281.72 338.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 35 283.57 340.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 36 285.43 342.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 37 287.29 344.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 38 289.14 346.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 39 292.86 351.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 40 296.57 355.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 41 302.14 362.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 42 307.48 368.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 43 314.9 377.88
Page 34 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 44 324.18 389.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 45 335.09 402.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 46 348.09 417.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 47 362.71 435.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 48 379.41 455.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 49 395.89 475.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 50 414.45 497.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 51 432.79 519.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 52 452.98 543.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 53 473.4 568.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 54 495.44 594.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 55 517.49 620.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 56 541.39 649.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 57 565.52 678.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 58 591.28 709.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 59 604.05 724.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 60 629.8 755.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 61 652.08 782.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 62 666.7 800.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 63 685.03 822.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 64 696.16 835.39
Page 35 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 1 65 and
over
696.16 835.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 0‐20 171.45 205.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 21 270 324
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 22 270 324
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 23 270 324
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 24 270 324
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 25 271.07 325.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 26 276.47 331.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 27 282.95 339.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 28 293.48 352.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 29 302.12 362.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 30 306.44 367.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 31 312.92 375.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 32 319.4 383.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 33 323.45 388.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 34 327.77 393.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 35 329.93 395.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 36 332.09 398.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 37 334.25 401.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 38 336.41 403.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 39 340.73 408.87
Page 36 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 40 345.05 414.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 41 351.53 421.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 42 357.74 429.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 43 366.38 439.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 44 377.18 452.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 45 389.87 467.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 46 404.99 485.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 47 422 506.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 48 441.44 529.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 49 460.61 552.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 50 482.21 578.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 51 503.54 604.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 52 527.03 632.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 53 550.79 660.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 54 576.44 691.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 55 602.09 722.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 56 629.9 755.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 57 657.98 789.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 58 687.95 825.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 59 702.8 843.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 60 732.77 879.32
Page 37 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 61 758.68 910.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 62 775.69 930.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 63 797.02 956.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 64 809.97 971.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 3 65 and
over
809.97 971.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 0‐20 153.77 184.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 21 242.17 290.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 22 242.17 290.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 23 242.17 290.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 24 242.17 290.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 25 243.13 291.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 26 247.97 297.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 27 253.78 304.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 28 263.23 315.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 29 270.97 325.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 30 274.85 329.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 31 280.66 336.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 32 286.47 343.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 33 290.1 348.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 34 293.98 352.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 35 295.92 355.1
Page 38 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 36 297.85 357.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 37 299.79 359.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 38 301.73 362.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 39 305.6 366.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 40 309.48 371.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 41 315.29 378.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 42 320.86 385.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 43 328.61 394.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 44 338.29 405.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 45 349.68 419.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 46 363.24 435.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 47 378.49 454.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 48 395.93 475.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 49 413.12 495.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 50 432.49 518.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 51 451.62 541.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 52 472.69 567.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 53 494 592.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 54 517.01 620.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 55 540.01 648.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 56 564.95 677.94
Page 39 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 57 590.14 708.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 58 617.02 740.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 59 630.34 756.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 60 657.22 788.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 61 680.46 816.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 62 695.72 834.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 63 714.85 857.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 64 726.46 871.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Bronze 2 + Vision + Adult Dental 7 65 and
over
726.46 871.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 0‐20 199.28 239.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 21 313.84 376.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 22 313.84 376.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 23 313.84 376.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 24 313.84 376.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 25 315.09 378.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 26 321.37 385.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 27 328.9 394.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 28 341.14 409.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 29 351.18 421.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 30 356.2 427.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 31 363.73 436.47
Page 40 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 32 371.27 445.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 33 375.97 451.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 34 381 457.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 35 383.51 460.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 36 386.02 463.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 37 388.53 466.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 38 391.04 469.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 39 396.06 475.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 40 401.08 481.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 41 408.61 490.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 42 415.83 498.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 43 425.87 511.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 44 438.43 526.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 45 453.18 543.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 46 470.75 564.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 47 490.52 588.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 48 513.12 615.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 49 535.4 642.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 50 560.51 672.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 51 585.3 702.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 52 612.6 735.12
Page 41 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 53 640.22 768.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 54 670.04 804.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 55 699.85 839.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 56 732.18 878.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 57 764.81 917.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 58 799.65 959.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 59 816.91 980.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 60 851.75 1022.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 61 881.87 1058.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 62 901.65 1081.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 63 926.44 1111.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 64 941.49 1129.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 1 65 and
over
941.49 1129.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 0‐20 231.86 278.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 21 365.15 438.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 22 365.15 438.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 23 365.15 438.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 24 365.15 438.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 25 366.6 439.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 26 373.9 448.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 27 382.67 459.2
Page 42 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 28 396.91 476.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 29 408.59 490.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 30 414.43 497.31
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 31 423.2 507.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 32 431.96 518.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 33 437.44 524.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 34 443.28 531.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 35 446.2 535.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 36 449.12 538.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 37 452.04 542.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 38 454.97 545.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 39 460.81 552.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 40 466.65 559.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 41 475.41 570.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 42 483.81 580.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 43 495.5 594.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 44 510.1 612.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 45 527.26 632.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 46 547.71 657.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 47 570.71 684.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 48 597.01 716.41
Page 43 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 49 622.93 747.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 50 652.14 782.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 51 680.99 817.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 52 712.75 855.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 53 744.89 893.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 54 779.58 935.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 55 814.26 977.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 56 851.87 1022.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 57 889.85 1067.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 58 930.38 1116.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 59 950.46 1140.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 60 990.99 1189.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 61 1026.05 1231.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 62 1049.05 1258.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 63 1077.9 1293.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 64 1095.41 1314.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 3 65 and
over
1095.41 1314.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 0‐20 207.96 249.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 21 327.5 393
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 22 327.5 393
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 23 327.5 393
Page 44 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 24 327.5 393
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 25 328.8 394.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 26 335.35 402.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 27 343.21 411.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 28 355.99 427.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 29 366.47 439.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 30 371.71 446.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 31 379.57 455.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 32 387.43 464.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 33 392.34 470.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 34 397.58 477.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 35 400.2 480.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 36 402.82 483.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 37 405.44 486.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 38 408.06 489.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 39 413.3 495.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 40 418.54 502.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 41 426.4 511.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 42 433.93 520.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 43 444.41 533.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 44 457.51 549.01
Page 45 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 45 472.9 567.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 46 491.24 589.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 47 511.87 614.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 48 535.45 642.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 49 558.7 670.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 50 584.9 701.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 51 610.78 732.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 52 639.27 767.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 53 668.09 801.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 54 699.2 839.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 55 730.31 876.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 56 764.04 916.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 57 798.1 957.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 58 834.45 1001.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 59 852.47 1022.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 60 888.82 1066.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 61 920.26 1104.31
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 62 940.89 1129.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 63 966.76 1160.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 64 982.47 1178.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 7 65 and
over
982.47 1178.96
Page 46 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 0‐20 202.5 243
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 21 318.9 382.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 22 318.9 382.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 23 318.9 382.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 24 318.9 382.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 25 320.17 384.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 26 326.54 391.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 27 334.2 401.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 28 346.63 415.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 29 356.84 428.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 30 361.94 434.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 31 369.59 443.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 32 377.25 452.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 33 382.03 458.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 34 387.13 464.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 35 389.68 467.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 36 392.24 470.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 37 394.79 473.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 38 397.34 476.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 39 402.44 482.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 40 407.54 489.04
Page 47 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 41 415.2 498.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 42 422.53 507.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 43 432.74 519.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 44 445.49 534.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 45 460.48 552.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 46 478.34 574
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 47 498.43 598.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 48 521.39 625.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 49 544.03 652.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 50 569.54 683.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 51 594.73 713.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 52 622.48 746.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 53 650.54 780.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 54 680.83 816.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 55 711.13 853.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 56 743.97 892.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 57 777.14 932.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 58 812.53 975.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 59 830.07 996.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 60 865.47 1038.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 61 896.08 1075.29
Page 48 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 62 916.17 1099.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 63 941.37 1129.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 64 956.66 1147.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 1 65 and
over
956.66 1147.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 0‐20 235.6 282.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 21 371.03 445.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 22 371.03 445.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 23 371.03 445.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 24 371.03 445.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 25 372.51 447.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 26 379.93 455.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 27 388.83 466.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 28 403.3 483.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 29 415.18 498.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 30 421.11 505.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 31 430.02 516.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 32 438.92 526.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 33 444.49 533.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 34 450.42 540.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 35 453.39 544.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 36 456.36 547.63
Page 49 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 37 459.33 551.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 38 462.3 554.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 39 468.23 561.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 40 474.17 569
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 41 483.07 579.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 42 491.61 589.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 43 503.48 604.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 44 518.32 621.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 45 535.76 642.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 46 556.54 667.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 47 579.91 695.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 48 606.62 727.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 49 632.97 759.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 50 662.65 795.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 51 691.96 830.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 52 724.24 869.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 53 756.89 908.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 54 792.14 950.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 55 827.38 992.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 56 865.6 1038.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 57 904.19 1085.02
Page 50 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 58 945.37 1134.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 59 965.78 1158.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 60 1006.96 1208.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 61 1042.58 1251.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 62 1065.95 1279.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 63 1095.26 1314.31
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 64 1113.06 1335.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 3 65 and
over
1113.06 1335.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 0‐20 211.31 253.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 21 332.78 399.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 22 332.78 399.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 23 332.78 399.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 24 332.78 399.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 25 334.1 400.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 26 340.76 408.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 27 348.74 418.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 28 361.72 434.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 29 372.37 446.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 30 377.69 453.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 31 385.68 462.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 32 393.67 472.4
Page 51 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 33 398.66 478.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 34 403.98 484.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 35 406.65 487.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 36 409.31 491.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 37 411.97 494.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 38 414.63 497.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 39 419.96 503.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 40 425.28 510.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 41 433.27 519.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 42 440.92 529.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 43 451.57 541.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 44 464.88 557.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 45 480.52 576.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 46 499.16 598.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 47 520.12 624.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 48 544.08 652.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 49 567.71 681.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 50 594.33 713.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 51 620.62 744.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 52 649.57 779.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 53 678.85 814.62
Page 52 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 54 710.47 852.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 55 742.08 890.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 56 776.35 931.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 57 810.96 973.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 58 847.9 1017.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 59 866.2 1039.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 60 903.14 1083.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 61 935.09 1122.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 62 956.05 1147.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 63 982.34 1178.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 64 998.3 1197.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision 7 65 and
over
998.3 1197.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 0‐20 213.14 255.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 21 335.66 402.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 22 335.66 402.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 23 335.66 402.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 24 335.66 402.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 25 336.99 404.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 26 343.7 412.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 27 351.76 422.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 28 364.85 437.82
Page 53 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 29 375.59 450.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 30 380.96 457.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 31 389.02 466.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 32 397.07 476.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 33 402.11 482.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 34 407.48 488.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 35 410.16 492.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 36 412.85 495.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 37 415.53 498.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 38 418.22 501.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 39 423.59 508.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 40 428.96 514.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 41 437.02 524.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 42 444.74 533.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 43 455.48 546.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 44 468.9 562.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 45 484.68 581.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 46 503.47 604.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 47 524.62 629.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 48 548.79 658.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 49 572.62 687.14
Page 54 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 50 599.47 719.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 51 625.99 751.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 52 655.19 786.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 53 684.72 821.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 54 716.61 859.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 55 748.5 898.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 56 783.07 939.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 57 817.98 981.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 58 855.23 1026.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 59 873.69 1048.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 60 910.95 1093.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 61 943.17 1131.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 62 964.32 1157.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 63 990.84 1189
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 64 1006.94 1208.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 1 65 and
over
1006.94 1208.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 0‐20 247.98 297.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 21 390.53 468.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 22 390.53 468.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 23 390.53 468.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 24 390.53 468.63
Page 55 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 25 392.08 470.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 26 399.89 479.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 27 409.27 491.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 28 424.5 509.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 29 436.99 524.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 30 443.24 531.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 31 452.61 543.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 32 461.99 554.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 33 467.85 561.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 34 474.09 568.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 35 477.22 572.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 36 480.34 576.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 37 483.47 580.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 38 486.59 583.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 39 492.84 591.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 40 499.09 598.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 41 508.46 610.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 42 517.44 620.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 43 529.94 635.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 44 545.56 654.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 45 563.91 676.69
Page 56 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 46 585.78 702.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 47 610.39 732.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 48 638.5 766.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 49 666.23 799.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 50 697.47 836.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 51 728.32 873.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 52 762.3 914.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 53 796.66 955.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 54 833.76 1000.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 55 870.86 1045.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 56 911.09 1093.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 57 951.7 1142.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 58 995.05 1194.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 59 1016.53 1219.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 60 1059.88 1271.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 61 1097.37 1316.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 62 1121.97 1346.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 63 1152.82 1383.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 64 1171.56 1405.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 3 65 and
over
1171.56 1405.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 0‐20 222.41 266.89
Page 57 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 21 350.27 420.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 22 350.27 420.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 23 350.27 420.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 24 350.27 420.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 25 351.66 421.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 26 358.66 430.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 27 367.07 440.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 28 380.73 456.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 29 391.94 470.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 30 397.54 477.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 31 405.95 487.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 32 414.36 497.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 33 419.61 503.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 34 425.21 510.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 35 428.02 513.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 36 430.82 516.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 37 433.62 520.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 38 436.42 523.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 39 442.03 530.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 40 447.63 537.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 41 456.04 547.24
Page 58 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 42 464.09 556.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 43 475.3 570.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 44 489.31 587.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 45 505.77 606.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 46 525.39 630.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 47 547.45 656.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 48 572.67 687.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 49 597.54 717.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 50 625.56 750.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 51 653.23 783.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 52 683.7 820.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 53 714.53 857.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 54 747.8 897.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 55 781.08 937.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 56 817.15 980.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 57 853.58 1024.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 58 892.46 1070.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 59 911.72 1094.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 60 950.6 1140.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 61 984.23 1181.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 62 1006.29 1207.54
Page 59 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 63 1033.96 1240.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 64 1050.76 1260.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 1 + Vision + Adult Dental 7 65 and
over
1050.76 1260.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 0‐20 206.41 247.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 21 325.06 390.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 22 325.06 390.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 23 325.06 390.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 24 325.06 390.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 25 326.35 391.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 26 332.85 399.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 27 340.66 408.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 28 353.33 423.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 29 363.73 436.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 30 368.93 442.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 31 376.74 452.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 32 384.54 461.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 33 389.41 467.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 34 394.61 473.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 35 397.21 476.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 36 399.81 479.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 37 402.42 482.9
Page 60 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 38 405.02 486.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 39 410.22 492.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 40 415.42 498.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 41 423.22 507.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 42 430.69 516.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 43 441.1 529.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 44 454.1 544.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 45 469.38 563.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 46 487.58 585.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 47 508.06 609.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 48 531.46 637.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 49 554.54 665.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 50 580.54 696.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 51 606.22 727.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 52 634.5 761.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 53 663.11 795.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 54 693.99 832.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 55 724.87 869.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 56 758.35 910.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 57 792.15 950.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 58 828.23 993.87
Page 61 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 59 846.11 1015.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 60 882.19 1058.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 61 913.4 1096.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 62 933.88 1120.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 63 959.56 1151.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 64 975.15 1170.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 1 65 and
over
975.15 1170.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 0‐20 240.15 288.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 21 378.2 453.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 22 378.2 453.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 23 378.2 453.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 24 378.2 453.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 25 379.71 455.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 26 387.27 464.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 27 396.35 475.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 28 411.1 493.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 29 423.2 507.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 30 429.25 515.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 31 438.33 525.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 32 447.4 536.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 33 453.08 543.69
Page 62 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 34 459.13 550.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 35 462.15 554.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 36 465.18 558.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 37 468.2 561.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 38 471.23 565.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 39 477.28 572.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 40 483.33 579.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 41 492.41 590.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 42 501.11 601.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 43 513.21 615.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 44 528.34 634
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 45 546.11 655.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 46 567.29 680.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 47 591.12 709.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 48 618.35 742.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 49 645.2 774.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 50 675.45 810.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 51 705.33 846.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 52 738.23 885.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 53 771.51 925.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 54 807.44 968.92
Page 63 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 55 843.37 1012.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 56 882.32 1058.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 57 921.66 1105.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 58 963.64 1156.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 59 984.44 1181.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 60 1026.42 1231.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 61 1062.72 1275.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 62 1086.55 1303.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 63 1116.43 1339.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 64 1134.57 1361.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 3 65 and
over
1134.57 1361.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 0‐20 215.39 258.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 21 339.21 407.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 22 339.21 407.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 23 339.21 407.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 24 339.21 407.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 25 340.56 408.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 26 347.34 416.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 27 355.48 426.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 28 368.71 442.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 29 379.57 455.48
Page 64 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 30 384.99 461.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 31 393.13 471.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 32 401.27 481.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 33 406.36 487.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 34 411.79 494.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 35 414.5 497.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 36 417.22 500.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 37 419.93 503.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 38 422.64 507.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 39 428.07 513.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 40 433.5 520.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 41 441.64 529.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 42 449.44 539.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 43 460.29 552.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 44 473.86 568.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 45 489.81 587.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 46 508.8 610.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 47 530.17 636.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 48 554.59 665.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 49 578.68 694.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 50 605.81 726.97
Page 65 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 51 632.61 759.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 52 662.12 794.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 53 691.97 830.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 54 724.19 869.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 55 756.42 907.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 56 791.35 949.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 57 826.63 991.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 58 864.28 1037.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 59 882.94 1059.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 60 920.59 1104.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 61 953.15 1143.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 62 974.52 1169.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 63 1001.32 1201.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 64 1017.59 1221.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 7 65 and
over
1017.59 1221.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 0‐20 209.73 251.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 21 330.3 396.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 22 330.3 396.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 23 330.3 396.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 24 330.3 396.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 25 331.61 397.93
Page 66 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 26 338.22 405.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 27 346.14 415.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 28 359.03 430.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 29 369.59 443.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 30 374.88 449.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 31 382.81 459.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 32 390.73 468.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 33 395.69 474.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 34 400.97 481.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 35 403.61 484.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 36 406.26 487.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 37 408.9 490.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 38 411.54 493.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 39 416.83 500.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 40 422.11 506.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 41 430.04 516.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 42 437.63 525.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 43 448.2 537.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 44 461.42 553.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 45 476.94 572.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 46 495.43 594.51
Page 67 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 47 516.24 619.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 48 540.02 648.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 49 563.47 676.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 50 589.9 707.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 51 615.99 739.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 52 644.73 773.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 53 673.79 808.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 54 705.17 846.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 55 736.55 883.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 56 770.57 924.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 57 804.92 965.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 58 841.58 1009.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 59 859.74 1031.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 60 896.41 1075.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 61 928.11 1113.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 62 948.92 1138.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 63 975.02 1170.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 64 990.86 1189.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 1 65 and
over
990.86 1189.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 0‐20 244.02 292.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 21 384.3 461.16
Page 68 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 22 384.3 461.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 23 384.3 461.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 24 384.3 461.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 25 385.82 462.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 26 393.51 472.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 27 402.73 483.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 28 417.72 501.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 29 430.02 516.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 30 436.17 523.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 31 445.39 534.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 32 454.61 545.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 33 460.38 552.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 34 466.52 559.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 35 469.6 563.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 36 472.67 567.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 37 475.75 570.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 38 478.82 574.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 39 484.97 581.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 40 491.12 589.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 41 500.34 600.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 42 509.18 611.01
Page 69 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 43 521.48 625.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 44 536.85 644.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 45 554.91 665.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 46 576.43 691.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 47 600.64 720.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 48 628.31 753.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 49 655.59 786.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 50 686.34 823.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 51 716.69 860.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 52 750.13 900.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 53 783.94 940.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 54 820.45 984.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 55 856.96 1028.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 56 896.54 1075.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 57 936.51 1123.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 58 979.16 1174.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 59 1000.3 1200.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 60 1042.95 1251.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 61 1079.84 1295.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 62 1104.05 1324.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 63 1134.41 1361.29
Page 70 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 64 1152.85 1383.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 3 65 and
over
1152.85 1383.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 0‐20 218.86 262.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 21 344.68 413.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 22 344.68 413.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 23 344.68 413.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 24 344.68 413.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 25 346.04 415.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 26 352.94 423.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 27 361.21 433.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 28 374.65 449.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 29 385.68 462.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 30 391.2 469.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 31 399.47 479.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 32 407.74 489.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 33 412.91 495.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 34 418.42 502.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 35 421.18 505.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 36 423.94 508.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 37 426.7 512.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 38 429.45 515.34
Page 71 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 39 434.97 521.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 40 440.48 528.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 41 448.75 538.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 42 456.68 548.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 43 467.71 561.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 44 481.5 577.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 45 497.7 597.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 46 517 620.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 47 538.71 646.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 48 563.53 676.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 49 588 705.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 50 615.57 738.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 51 642.8 771.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 52 672.79 807.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 53 703.12 843.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 54 735.86 883.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 55 768.6 922.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 56 804.11 964.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 57 839.95 1007.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 58 878.21 1053.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 59 897.16 1076.59
Page 72 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 60 935.42 1122.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 61 968.51 1162.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 62 990.22 1188.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 63 1017.45 1220.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 64 1033.99 1240.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision 7 65 and
over
1033.99 1240.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 0‐20 220.76 264.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 21 347.66 417.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 22 347.66 417.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 23 347.66 417.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 24 347.66 417.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 25 349.04 418.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 26 355.99 427.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 27 364.33 437.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 28 377.89 453.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 29 389.02 466.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 30 394.58 473.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 31 402.92 483.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 32 411.27 493.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 33 416.48 499.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 34 422.04 506.44
Page 73 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 35 424.82 509.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 36 427.61 513.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 37 430.39 516.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 38 433.17 519.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 39 438.73 526.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 40 444.29 533.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 41 452.64 543.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 42 460.63 552.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 43 471.76 566.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 44 485.66 582.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 45 502 602.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 46 521.47 625.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 47 543.37 652.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 48 568.4 682.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 49 593.09 711.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 50 620.9 745.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 51 648.36 778.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 52 678.61 814.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 53 709.2 851.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 54 742.23 890.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 55 775.25 930.3
Page 74 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 56 811.06 973.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 57 847.22 1016.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 58 885.8 1062.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 59 904.93 1085.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 60 943.51 1132.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 61 976.89 1172.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 62 998.79 1198.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 63 1026.25 1231.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 64 1042.93 1251.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 1 65 and
over
1042.93 1251.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 0‐20 256.85 308.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 21 404.49 485.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 22 404.49 485.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 23 404.49 485.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 24 404.49 485.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 25 406.1 487.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 26 414.19 497.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 27 423.9 508.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 28 439.67 527.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 29 452.61 543.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 30 459.09 550.9
Page 75 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 31 468.79 562.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 32 478.5 574.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 33 484.57 581.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 34 491.04 589.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 35 494.28 593.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 36 497.51 597.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 37 500.75 600.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 38 503.98 604.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 39 510.46 612.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 40 516.93 620.31
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 41 526.63 631.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 42 535.94 643.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 43 548.88 658.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 44 565.06 678.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 45 584.07 700.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 46 606.72 728.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 47 632.2 758.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 48 661.33 793.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 49 690.04 828.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 50 722.4 866.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 51 754.36 905.23
Page 76 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 52 789.55 947.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 53 825.14 990.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 54 863.57 1036.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 55 901.99 1082.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 56 943.65 1132.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 57 985.72 1182.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 58 1030.62 1236.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 59 1052.86 1263.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 60 1097.76 1317.31
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 61 1136.59 1363.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 62 1162.07 1394.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 63 1194.03 1432.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 64 1213.43 1456.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 3 65 and
over
1213.43 1456.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 0‐20 230.36 276.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 21 362.79 435.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 22 362.79 435.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 23 362.79 435.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 24 362.79 435.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 25 364.23 437.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 26 371.48 445.77
Page 77 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 27 380.19 456.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 28 394.34 473.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 29 405.95 487.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 30 411.75 494.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 31 420.46 504.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 32 429.17 515
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 33 434.61 521.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 34 440.41 528.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 35 443.32 531.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 36 446.22 535.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 37 449.12 538.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 38 452.02 542.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 39 457.83 549.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 40 463.63 556.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 41 472.34 566.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 42 480.68 576.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 43 492.29 590.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 44 506.8 608.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 45 523.85 628.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 46 544.17 653
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 47 567.02 680.42
Page 78 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 48 593.14 711.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 49 618.9 742.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 50 647.92 777.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 51 676.58 811.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 52 708.14 849.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 53 740.07 888.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 54 774.53 929.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 55 809 970.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 56 846.36 1015.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 57 884.09 1060.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 58 924.36 1109.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 59 944.31 1133.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 60 984.58 1181.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 61 1019.41 1223.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 62 1042.26 1250.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 63 1070.92 1285.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 64 1088.32 1305.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Gold 2 + Vision + Adult Dental 7 65 and
over
1088.32 1305.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 0‐20 173.74 208.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 21 273.62 328.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 22 273.62 328.34
Page 79 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 23 273.62 328.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 24 273.62 328.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 25 274.71 329.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 26 280.18 336.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 27 286.75 344.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 28 297.42 356.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 29 306.17 367.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 30 310.55 372.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 31 317.12 380.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 32 323.68 388.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 33 327.79 393.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 34 332.17 398.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 35 334.36 401.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 36 336.54 403.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 37 338.73 406.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 38 340.92 409.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 39 345.3 414.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 40 349.68 419.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 41 356.24 427.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 42 362.54 435.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 43 371.29 445.54
Page 80 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 44 382.24 458.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 45 395.1 474.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 46 410.42 492.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 47 427.66 513.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 48 447.36 536.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 49 466.78 560.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 50 488.67 586.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 51 510.29 612.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 52 534.09 640.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 53 558.17 669.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 54 584.16 700.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 55 610.16 732.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 56 638.34 766
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 57 666.8 800.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 58 697.17 836.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 59 712.22 854.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 60 742.59 891.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 61 768.85 922.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 62 786.09 943.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 63 807.71 969.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 64 820.83 984.99
Page 81 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 1 65 and
over
820.83 984.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 0‐20 202.15 242.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 21 318.35 382.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 22 318.35 382.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 23 318.35 382.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 24 318.35 382.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 25 319.62 383.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 26 325.98 391.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 27 333.62 400.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 28 346.04 415.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 29 356.23 427.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 30 361.32 433.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 31 368.96 442.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 32 376.6 451.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 33 381.38 457.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 34 386.47 463.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 35 389.02 466.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 36 391.56 469.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 37 394.11 472.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 38 396.66 475.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 39 401.75 482.1
Page 82 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 40 406.84 488.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 41 414.48 497.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 42 421.81 506.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 43 431.99 518.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 44 444.73 533.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 45 459.69 551.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 46 477.52 573.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 47 497.57 597.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 48 520.49 624.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 49 543.1 651.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 50 568.56 682.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 51 593.71 712.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 52 621.41 745.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 53 649.42 779.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 54 679.66 815.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 55 709.91 851.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 56 742.7 891.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 57 775.8 930.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 58 811.14 973.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 59 828.65 994.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 60 863.99 1036.78
Page 83 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 61 894.55 1073.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 62 914.6 1097.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 63 939.75 1127.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 64 955.02 1146.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 3 65 and
over
955.02 1146.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 0‐20 181.31 217.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 21 285.53 342.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 22 285.53 342.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 23 285.53 342.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 24 285.53 342.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 25 286.66 343.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 26 292.37 350.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 27 299.23 359.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 28 310.36 372.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 29 319.5 383.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 30 324.07 388.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 31 330.92 397.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 32 337.77 405.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 33 342.06 410.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 34 346.62 415.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 35 348.91 418.69
Page 84 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 36 351.19 421.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 37 353.48 424.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 38 355.76 426.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 39 360.33 432.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 40 364.9 437.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 41 371.75 446.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 42 378.32 453.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 43 387.45 464.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 44 398.87 478.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 45 412.29 494.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 46 428.28 513.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 47 446.27 535.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 48 466.83 560.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 49 487.1 584.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 50 509.94 611.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 51 532.5 639
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 52 557.34 668.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 53 582.47 698.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 54 609.59 731.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 55 636.71 764.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 56 666.12 799.34
Page 85 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 57 695.82 834.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 58 727.51 873.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 59 743.21 891.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 60 774.91 929.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 61 802.32 962.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 62 820.31 984.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 63 842.86 1011.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 64 856.56 1027.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 7 65 and
over
856.56 1027.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 0‐20 176.54 211.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 21 278.03 333.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 22 278.03 333.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 23 278.03 333.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 24 278.03 333.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 25 279.13 334.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 26 284.69 341.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 27 291.37 349.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 28 302.21 362.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 29 311.11 373.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 30 315.55 378.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 31 322.23 386.67
Page 86 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 32 328.9 394.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 33 333.07 399.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 34 337.52 405.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 35 339.74 407.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 36 341.97 410.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 37 344.19 413.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 38 346.42 415.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 39 350.86 421.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 40 355.31 426.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 41 361.98 434.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 42 368.38 442.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 43 377.28 452.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 44 388.4 466.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 45 401.46 481.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 46 417.03 500.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 47 434.55 521.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 48 454.57 545.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 49 474.31 569.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 50 496.55 595.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 51 518.51 622.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 52 542.7 651.24
Page 87 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 53 567.16 680.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 54 593.58 712.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 55 619.99 743.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 56 648.63 778.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 57 677.54 813.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 58 708.4 850.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 59 723.69 868.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 60 754.55 905.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 61 781.24 937.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 62 798.76 958.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 63 820.72 984.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 64 834.06 1000.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 1 65 and
over
834.06 1000.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 0‐20 205.41 246.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 21 323.48 388.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 22 323.48 388.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 23 323.48 388.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 24 323.48 388.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 25 324.77 389.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 26 331.24 397.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 27 339 406.8
Page 88 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 28 351.62 421.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 29 361.97 434.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 30 367.14 440.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 31 374.91 449.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 32 382.67 459.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 33 387.52 465.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 34 392.7 471.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 35 395.28 474.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 36 397.87 477.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 37 400.46 480.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 38 403.05 483.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 39 408.22 489.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 40 413.4 496.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 41 421.16 505.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 42 428.6 514.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 43 438.95 526.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 44 451.89 542.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 45 467.1 560.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 46 485.21 582.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 47 505.59 606.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 48 528.88 634.65
Page 89 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 49 551.85 662.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 50 577.72 693.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 51 603.28 723.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 52 631.42 757.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 53 659.89 791.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 54 690.62 828.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 55 721.35 865.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 56 754.66 905.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 57 788.3 945.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 58 824.21 989.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 59 842 1010.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 60 877.91 1053.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 61 908.96 1090.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 62 929.34 1115.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 63 954.89 1145.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 64 970.41 1164.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 3 65 and
over
970.41 1164.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 0‐20 184.23 221.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 21 290.13 348.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 22 290.13 348.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 23 290.13 348.15
Page 90 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 24 290.13 348.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 25 291.28 349.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 26 297.09 356.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 27 304.05 364.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 28 315.36 378.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 29 324.65 389.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 30 329.29 395.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 31 336.25 403.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 32 343.22 411.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 33 347.57 417.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 34 352.21 422.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 35 354.53 425.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 36 356.85 428.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 37 359.17 431
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 38 361.49 433.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 39 366.13 439.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 40 370.78 444.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 41 377.74 453.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 42 384.41 461.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 43 393.7 472.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 44 405.3 486.36
Page 91 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 45 418.94 502.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 46 435.18 522.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 47 453.46 544.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 48 474.35 569.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 49 494.95 593.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 50 518.16 621.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 51 541.08 649.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 52 566.32 679.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 53 591.85 710.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 54 619.41 743.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 55 646.97 776.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 56 676.86 812.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 57 707.03 848.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 58 739.23 887.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 59 755.19 906.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 60 787.39 944.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 61 815.24 978.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 62 833.52 1000.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 63 856.44 1027.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 64 870.36 1044.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision 7 65 and
over
870.36 1044.43
Page 92 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 0‐20 185.82 222.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 21 292.64 351.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 22 292.64 351.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 23 292.64 351.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 24 292.64 351.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 25 293.8 352.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 26 299.66 359.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 27 306.68 368.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 28 318.09 381.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 29 327.46 392.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 30 332.14 398.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 31 339.16 406.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 32 346.18 415.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 33 350.57 420.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 34 355.26 426.31
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 35 357.6 429.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 36 359.94 431.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 37 362.28 434.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 38 364.62 437.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 39 369.3 443.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 40 373.98 448.77
Page 93 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 41 381.01 457.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 42 387.74 465.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 43 397.1 476.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 44 408.81 490.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 45 422.56 507.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 46 438.95 526.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 47 457.38 548.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 48 478.45 574.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 49 499.23 599.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 50 522.64 627.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 51 545.76 654.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 52 571.22 685.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 53 596.97 716.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 54 624.77 749.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 55 652.57 783.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 56 682.71 819.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 57 713.14 855.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 58 745.63 894.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 59 761.72 914.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 60 794.2 953.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 61 822.3 986.76
Page 94 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 62 840.73 1008.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 63 863.85 1036.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 64 877.89 1053.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 1 65 and
over
877.89 1053.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 0‐20 216.2 259.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 21 340.48 408.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 22 340.48 408.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 23 340.48 408.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 24 340.48 408.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 25 341.83 410.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 26 348.64 418.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 27 356.82 428.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 28 370.09 444.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 29 380.99 457.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 30 386.44 463.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 31 394.61 473.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 32 402.78 483.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 33 407.89 489.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 34 413.33 495.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 35 416.06 499.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 36 418.78 502.53
Page 95 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 37 421.5 505.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 38 424.23 509.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 39 429.68 515.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 40 435.12 522.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 41 443.3 531.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 42 451.13 541.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 43 462.02 554.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 44 475.64 570.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 45 491.64 589.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 46 510.71 612.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 47 532.16 638.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 48 556.67 668
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 49 580.85 697.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 50 608.08 729.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 51 634.98 761.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 52 664.6 797.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 53 694.56 833.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 54 726.91 872.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 55 759.25 911.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 56 794.32 953.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 57 829.73 995.67
Page 96 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 58 867.52 1041.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 59 886.25 1063.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 60 924.04 1108.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 61 956.73 1148.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 62 978.18 1173.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 63 1005.07 1206.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 64 1021.41 1225.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 3 65 and
over
1021.41 1225.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 0‐20 193.91 232.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 21 305.38 366.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 22 305.38 366.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 23 305.38 366.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 24 305.38 366.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 25 306.59 367.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 26 312.7 375.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 27 320.03 384.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 28 331.94 398.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 29 341.71 410.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 30 346.59 415.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 31 353.92 424.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 32 361.25 433.5
Page 97 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 33 365.83 438.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 34 370.72 444.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 35 373.16 447.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 36 375.6 450.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 37 378.05 453.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 38 380.49 456.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 39 385.38 462.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 40 390.26 468.31
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 41 397.59 477.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 42 404.61 485.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 43 414.39 497.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 44 426.6 511.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 45 440.95 529.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 46 458.05 549.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 47 477.29 572.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 48 499.28 599.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 49 520.96 625.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 50 545.39 654.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 51 569.51 683.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 52 596.08 715.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 53 622.95 747.54
Page 98 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 54 651.96 782.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 55 680.97 817.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 56 712.43 854.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 57 744.18 893.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 58 778.08 933.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 59 794.88 953.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 60 828.77 994.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 61 858.09 1029.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 62 877.32 1052.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 63 901.45 1081.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 64 916.1 1099.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 1 + Vision + Adult Dental 7 65 and
over
916.1 1099.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 0‐20 162.97 195.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 21 256.66 307.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 22 256.66 307.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 23 256.66 307.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 24 256.66 307.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 25 257.68 309.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 26 262.81 315.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 27 268.97 322.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 28 278.98 334.77
Page 99 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 29 287.19 344.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 30 291.3 349.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 31 297.46 356.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 32 303.62 364.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 33 307.47 368.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 34 311.57 373.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 35 313.63 376.35
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 36 315.68 378.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 37 317.73 381.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 38 319.79 383.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 39 323.89 388.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 40 328 393.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 41 334.16 400.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 42 340.06 408.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 43 348.27 417.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 44 358.54 430.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 45 370.6 444.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 46 384.97 461.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 47 401.14 481.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 48 419.62 503.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 49 437.84 525.4
Page 100 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 50 458.38 550.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 51 478.65 574.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 52 500.98 601.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 53 523.56 628.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 54 547.95 657.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 55 572.33 686.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 56 598.76 718.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 57 625.45 750.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 58 653.94 784.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 59 668.06 801.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 60 696.55 835.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 61 721.18 865.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 62 737.35 884.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 63 757.63 909.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 64 769.94 923.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 1 65 and
over
769.94 923.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 0‐20 189.62 227.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 21 298.62 358.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 22 298.62 358.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 23 298.62 358.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 24 298.62 358.34
Page 101 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 25 299.8 359.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 26 305.77 366.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 27 312.94 375.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 28 324.59 389.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 29 334.14 400.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 30 338.92 406.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 31 346.09 415.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 32 353.25 423.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 33 357.73 429.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 34 362.51 435.01
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 35 364.9 437.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 36 367.29 440.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 37 369.68 443.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 38 372.06 446.47
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 39 376.84 452.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 40 381.62 457.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 41 388.79 466.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 42 395.65 474.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 43 405.21 486.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 44 417.15 500.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 45 431.19 517.42
Page 102 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 46 447.91 537.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 47 466.72 560.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 48 488.22 585.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 49 509.42 611.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 50 533.31 639.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 51 556.9 668.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 52 582.88 699.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 53 609.16 730.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 54 637.53 765.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 55 665.89 799.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 56 696.65 835.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 57 727.7 873.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 58 760.85 913.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 59 777.27 932.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 60 810.42 972.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 61 839.09 1006.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 62 857.9 1029.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 63 881.49 1057.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 64 895.81 1074.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 3 65 and
over
895.81 1074.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 0‐20 170.07 204.08
Page 103 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 21 267.83 321.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 22 267.83 321.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 23 267.83 321.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 24 267.83 321.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 25 268.89 322.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 26 274.25 329.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 27 280.68 336.81
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 28 291.12 349.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 29 299.69 359.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 30 303.98 364.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 31 310.4 372.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 32 316.83 380.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 33 320.85 385.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 34 325.13 390.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 35 327.28 392.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 36 329.42 395.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 37 331.56 397.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 38 333.7 400.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 39 337.99 405.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 40 342.27 410.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 41 348.7 418.44
Page 104 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 42 354.86 425.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 43 363.43 436.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 44 374.14 448.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 45 386.73 464.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 46 401.73 482.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 47 418.6 502.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 48 437.89 525.46
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 49 456.9 548.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 50 478.33 573.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 51 499.48 599.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 52 522.78 627.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 53 546.35 655.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 54 571.8 686.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 55 597.24 716.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 56 624.82 749.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 57 652.68 783.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 58 682.4 818.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 59 697.13 836.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 60 726.86 872.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 61 752.57 903.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 62 769.45 923.34
Page 105 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 63 790.6 948.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 64 803.45 964.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 7 65 and
over
803.45 964.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 0‐20 165.6 198.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 21 260.79 312.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 22 260.79 312.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 23 260.79 312.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 24 260.79 312.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 25 261.83 314.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 26 267.04 320.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 27 273.3 327.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 28 283.47 340.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 29 291.82 350.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 30 295.99 355.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 31 302.25 362.7
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 32 308.51 370.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 33 312.42 374.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 34 316.59 379.9
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 35 318.68 382.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 36 320.76 384.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 37 322.85 387.42
Page 106 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 38 324.94 389.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 39 329.11 394.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 40 333.28 399.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 41 339.54 407.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 42 345.54 414.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 43 353.88 424.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 44 364.32 437.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 45 376.57 451.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 46 391.18 469.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 47 407.61 489.13
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 48 426.38 511.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 49 444.9 533.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 50 465.76 558.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 51 486.36 583.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 52 509.05 610.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 53 532 638.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 54 556.77 668.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 55 581.55 697.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 56 608.41 730.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 57 635.53 762.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 58 664.48 797.37
Page 107 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 59 678.82 814.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 60 707.77 849.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 61 732.8 879.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 62 749.23 899.07
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 63 769.84 923.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 64 782.34 938.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 1 65 and
over
782.34 938.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 0‐20 192.67 231.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 21 303.43 364.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 22 303.43 364.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 23 303.43 364.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 24 303.43 364.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 25 304.63 365.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 26 310.7 372.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 27 317.98 381.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 28 329.82 395.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 29 339.52 407.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 30 344.38 413.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 31 351.66 421.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 32 358.94 430.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 33 363.49 436.18
Page 108 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 34 368.35 442.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 35 370.78 444.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 36 373.2 447.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 37 375.63 450.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 38 378.06 453.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 39 382.91 459.49
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 40 387.77 465.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 41 395.05 474.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 42 402.03 482.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 43 411.74 494.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 44 423.88 508.65
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 45 438.14 525.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 46 455.13 546.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 47 474.24 569.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 48 496.09 595.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 49 517.63 621.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 50 541.9 650.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 51 565.87 679.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 52 592.27 710.72
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 53 618.97 742.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 54 647.8 777.36
Page 109 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 55 676.62 811.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 56 707.87 849.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 57 739.43 887.31
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 58 773.11 927.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 59 789.8 947.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 60 823.48 988.17
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 61 852.6 1023.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 62 871.72 1046.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 63 895.69 1074.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 64 910.24 1092.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 3 65 and
over
910.24 1092.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 0‐20 172.81 207.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 21 272.15 326.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 22 272.15 326.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 23 272.15 326.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 24 272.15 326.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 25 273.22 327.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 26 278.67 334.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 27 285.2 342.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 28 295.81 354.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 29 304.52 365.42
Page 110 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 30 308.87 370.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 31 315.4 378.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 32 321.94 386.32
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 33 326.02 391.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 34 330.37 396.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 35 332.55 399.06
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 36 334.73 401.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 37 336.9 404.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 38 339.08 406.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 39 343.43 412.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 40 347.79 417.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 41 354.32 425.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 42 360.58 432.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 43 369.29 443.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 44 380.17 456.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 45 392.96 471.55
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 46 408.2 489.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 47 425.35 510.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 48 444.94 533.92
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 49 464.26 557.11
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 50 486.03 583.23
Page 111 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 51 507.53 609.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 52 531.21 637.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 53 555.16 666.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 54 581.01 697.21
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 55 606.86 728.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 56 634.89 761.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 57 663.19 795.82
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 58 693.4 832.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 59 708.37 850.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 60 738.57 886.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 61 764.7 917.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 62 781.84 938.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 63 803.34 964
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 64 816.4 979.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision 7 65 and
over
816.4 979.68
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 0‐20 174.3 209.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 21 274.5 329.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 22 274.5 329.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 23 274.5 329.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 24 274.5 329.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 25 275.59 330.7
Page 112 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 26 281.08 337.29
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 27 287.66 345.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 28 298.37 358.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 29 307.15 368.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 30 311.55 373.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 31 318.13 381.75
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 32 324.72 389.66
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 33 328.84 394.6
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 34 333.23 399.87
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 35 335.43 402.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 36 337.62 405.14
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 37 339.82 407.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 38 342.01 410.41
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 39 346.41 415.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 40 350.8 420.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 41 357.38 428.85
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 42 363.7 436.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 43 372.48 446.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 44 383.46 460.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 45 396.36 475.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 46 411.73 494.07
Page 113 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 47 429.03 514.83
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 48 448.79 538.54
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 49 468.28 561.93
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 50 490.24 588.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 51 511.92 614.3
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 52 535.8 642.96
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 53 559.96 671.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 54 586.03 703.23
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 55 612.11 734.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 56 640.38 768.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 57 668.93 802.71
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 58 699.4 839.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 59 714.5 857.4
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 60 744.96 893.95
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 61 771.31 925.57
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 62 788.61 946.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 63 810.29 972.34
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 64 823.46 988.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 1 65 and
over
823.46 988.15
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 0‐20 202.8 243.36
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 21 319.37 383.24
Page 114 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 22 319.37 383.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 23 319.37 383.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 24 319.37 383.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 25 320.64 384.76
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 26 327.03 392.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 27 334.69 401.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 28 347.15 416.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 29 357.37 428.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 30 362.48 434.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 31 370.14 444.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 32 377.81 453.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 33 382.6 459.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 34 387.71 465.25
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 35 390.26 468.31
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 36 392.82 471.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 37 395.37 474.44
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 38 397.93 477.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 39 403.04 483.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 40 408.15 489.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 41 415.81 498.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 42 423.16 507.79
Page 115 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 43 433.38 520.05
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 44 446.15 535.38
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 45 461.16 553.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 46 479.04 574.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 47 499.16 598.99
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 48 522.16 626.59
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 49 544.83 653.79
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 50 570.38 684.45
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 51 595.61 714.73
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 52 623.4 748.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 53 651.5 781.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 54 681.84 818.2
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 55 712.18 854.61
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 56 745.07 894.08
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 57 778.29 933.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 58 813.74 976.48
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 59 831.3 997.56
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 60 866.75 1040.1
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 61 897.41 1076.89
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 62 917.53 1101.03
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 63 942.76 1131.31
Page 116 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 64 958.08 1149.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 3 65 and
over
958.08 1149.69
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 0‐20 181.89 218.26
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 21 286.45 343.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 22 286.45 343.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 23 286.45 343.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 24 286.45 343.74
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 25 287.58 345.09
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 26 293.31 351.97
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 27 300.19 360.22
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 28 311.36 373.63
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 29 320.52 384.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 30 325.1 390.12
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 31 331.98 398.37
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 32 338.85 406.62
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 33 343.15 411.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 34 347.73 417.27
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 35 350.02 420.02
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 36 352.32 422.78
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 37 354.61 425.53
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 38 356.9 428.28
Page 117 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 39 361.48 433.77
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 40 366.07 439.28
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 41 372.94 447.52
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 42 379.53 455.43
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 43 388.69 466.42
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 44 400.15 480.18
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 45 413.61 496.33
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 46 429.65 515.58
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 47 447.7 537.24
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 48 468.32 561.98
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 49 488.66 586.39
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 50 511.57 613.88
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 51 534.2 641.04
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 52 559.12 670.94
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 53 584.33 701.19
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 54 611.54 733.84
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 55 638.75 766.5
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 56 668.26 801.91
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 57 698.04 837.64
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 58 729.84 875.8
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 59 745.59 894.7
Page 118 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 60 777.39 932.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 61 804.89 965.86
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 62 822.93 987.51
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 63 845.56 1014.67
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 64 859.3 1031.16
Ambetter of Arkansas from Arkansas
Health and Wellness Solutions
Ambetter Silver 2 + Vision + Adult Dental 7 65 and
over
859.3 1031.16
Arkansas Blue Cross & Blue Shield Bronze 5500 1 0‐20 117.44 117.44
Arkansas Blue Cross & Blue Shield Bronze 5500 1 21 184.94 184.94
Arkansas Blue Cross & Blue Shield Bronze 5500 1 22 184.94 184.94
Arkansas Blue Cross & Blue Shield Bronze 5500 1 23 184.94 184.94
Arkansas Blue Cross & Blue Shield Bronze 5500 1 24 184.94 184.94
Arkansas Blue Cross & Blue Shield Bronze 5500 1 25 185.68 185.68
Arkansas Blue Cross & Blue Shield Bronze 5500 1 26 189.38 189.38
Arkansas Blue Cross & Blue Shield Bronze 5500 1 27 193.82 193.82
Arkansas Blue Cross & Blue Shield Bronze 5500 1 28 201.03 201.03
Arkansas Blue Cross & Blue Shield Bronze 5500 1 29 206.95 206.95
Arkansas Blue Cross & Blue Shield Bronze 5500 1 30 209.91 209.91
Arkansas Blue Cross & Blue Shield Bronze 5500 1 31 214.35 214.35
Arkansas Blue Cross & Blue Shield Bronze 5500 1 32 218.78 218.78
Arkansas Blue Cross & Blue Shield Bronze 5500 1 33 221.56 221.56
Arkansas Blue Cross & Blue Shield Bronze 5500 1 34 224.52 224.52
Arkansas Blue Cross & Blue Shield Bronze 5500 1 35 226 226
Arkansas Blue Cross & Blue Shield Bronze 5500 1 36 227.48 227.48
Arkansas Blue Cross & Blue Shield Bronze 5500 1 37 228.96 228.96
Arkansas Blue Cross & Blue Shield Bronze 5500 1 38 230.44 230.44
Arkansas Blue Cross & Blue Shield Bronze 5500 1 39 233.39 233.39
Arkansas Blue Cross & Blue Shield Bronze 5500 1 40 236.35 236.35
Arkansas Blue Cross & Blue Shield Bronze 5500 1 41 240.79 240.79
Arkansas Blue Cross & Blue Shield Bronze 5500 1 42 245.05 245.05
Arkansas Blue Cross & Blue Shield Bronze 5500 1 43 250.96 250.96
Arkansas Blue Cross & Blue Shield Bronze 5500 1 44 258.36 258.36
Arkansas Blue Cross & Blue Shield Bronze 5500 1 45 267.05 267.05
Arkansas Blue Cross & Blue Shield Bronze 5500 1 46 277.41 277.41
Arkansas Blue Cross & Blue Shield Bronze 5500 1 47 289.06 289.06
Arkansas Blue Cross & Blue Shield Bronze 5500 1 48 302.38 302.38
Arkansas Blue Cross & Blue Shield Bronze 5500 1 49 315.51 315.51
Arkansas Blue Cross & Blue Shield Bronze 5500 1 50 330.3 330.3
Arkansas Blue Cross & Blue Shield Bronze 5500 1 51 344.91 344.91
Arkansas Blue Cross & Blue Shield Bronze 5500 1 52 361 361
Arkansas Blue Cross & Blue Shield Bronze 5500 1 53 377.28 377.28
Arkansas Blue Cross & Blue Shield Bronze 5500 1 54 394.85 394.85
Arkansas Blue Cross & Blue Shield Bronze 5500 1 55 412.42 412.42
Arkansas Blue Cross & Blue Shield Bronze 5500 1 56 431.47 431.47
Arkansas Blue Cross & Blue Shield Bronze 5500 1 57 450.7 450.7
Arkansas Blue Cross & Blue Shield Bronze 5500 1 58 471.23 471.23
Arkansas Blue Cross & Blue Shield Bronze 5500 1 59 481.4 481.4
Arkansas Blue Cross & Blue Shield Bronze 5500 1 60 501.93 501.93
Arkansas Blue Cross & Blue Shield Bronze 5500 1 61 519.68 519.68
Arkansas Blue Cross & Blue Shield Bronze 5500 1 62 531.33 531.33
Arkansas Blue Cross & Blue Shield Bronze 5500 1 63 545.94 545.94
Arkansas Blue Cross & Blue Shield Bronze 5500 1 64 554.82 554.82
Page 119 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 5500 1 65 and
over
554.82 554.82
Arkansas Blue Cross & Blue Shield Bronze 5500 2 0‐20 109.06 109.06
Arkansas Blue Cross & Blue Shield Bronze 5500 2 21 171.75 171.75
Arkansas Blue Cross & Blue Shield Bronze 5500 2 22 171.75 171.75
Arkansas Blue Cross & Blue Shield Bronze 5500 2 23 171.75 171.75
Arkansas Blue Cross & Blue Shield Bronze 5500 2 24 171.75 171.75
Arkansas Blue Cross & Blue Shield Bronze 5500 2 25 172.44 172.44
Arkansas Blue Cross & Blue Shield Bronze 5500 2 26 175.87 175.87
Arkansas Blue Cross & Blue Shield Bronze 5500 2 27 179.99 179.99
Arkansas Blue Cross & Blue Shield Bronze 5500 2 28 186.69 186.69
Arkansas Blue Cross & Blue Shield Bronze 5500 2 29 192.19 192.19
Arkansas Blue Cross & Blue Shield Bronze 5500 2 30 194.94 194.94
Arkansas Blue Cross & Blue Shield Bronze 5500 2 31 199.06 199.06
Arkansas Blue Cross & Blue Shield Bronze 5500 2 32 203.18 203.18
Arkansas Blue Cross & Blue Shield Bronze 5500 2 33 205.76 205.76
Arkansas Blue Cross & Blue Shield Bronze 5500 2 34 208.5 208.5
Arkansas Blue Cross & Blue Shield Bronze 5500 2 35 209.88 209.88
Arkansas Blue Cross & Blue Shield Bronze 5500 2 36 211.25 211.25
Arkansas Blue Cross & Blue Shield Bronze 5500 2 37 212.63 212.63
Arkansas Blue Cross & Blue Shield Bronze 5500 2 38 214 214
Arkansas Blue Cross & Blue Shield Bronze 5500 2 39 216.75 216.75
Arkansas Blue Cross & Blue Shield Bronze 5500 2 40 219.5 219.5
Arkansas Blue Cross & Blue Shield Bronze 5500 2 41 223.62 223.62
Arkansas Blue Cross & Blue Shield Bronze 5500 2 42 227.57 227.57
Arkansas Blue Cross & Blue Shield Bronze 5500 2 43 233.06 233.06
Arkansas Blue Cross & Blue Shield Bronze 5500 2 44 239.93 239.93
Arkansas Blue Cross & Blue Shield Bronze 5500 2 45 248.01 248.01
Arkansas Blue Cross & Blue Shield Bronze 5500 2 46 257.62 257.62
Arkansas Blue Cross & Blue Shield Bronze 5500 2 47 268.45 268.45
Arkansas Blue Cross & Blue Shield Bronze 5500 2 48 280.81 280.81
Arkansas Blue Cross & Blue Shield Bronze 5500 2 49 293.01 293.01
Arkansas Blue Cross & Blue Shield Bronze 5500 2 50 306.75 306.75
Arkansas Blue Cross & Blue Shield Bronze 5500 2 51 320.31 320.31
Arkansas Blue Cross & Blue Shield Bronze 5500 2 52 335.26 335.26
Arkansas Blue Cross & Blue Shield Bronze 5500 2 53 350.37 350.37
Arkansas Blue Cross & Blue Shield Bronze 5500 2 54 366.69 366.69
Arkansas Blue Cross & Blue Shield Bronze 5500 2 55 383 383
Arkansas Blue Cross & Blue Shield Bronze 5500 2 56 400.69 400.69
Arkansas Blue Cross & Blue Shield Bronze 5500 2 57 418.55 418.55
Arkansas Blue Cross & Blue Shield Bronze 5500 2 58 437.62 437.62
Arkansas Blue Cross & Blue Shield Bronze 5500 2 59 447.07 447.07
Arkansas Blue Cross & Blue Shield Bronze 5500 2 60 466.13 466.13
Arkansas Blue Cross & Blue Shield Bronze 5500 2 61 482.62 482.62
Arkansas Blue Cross & Blue Shield Bronze 5500 2 62 493.44 493.44
Arkansas Blue Cross & Blue Shield Bronze 5500 2 63 507.01 507.01
Arkansas Blue Cross & Blue Shield Bronze 5500 2 64 515.25 515.25
Arkansas Blue Cross & Blue Shield Bronze 5500 2 65 and
over
515.25 515.25
Arkansas Blue Cross & Blue Shield Bronze 5500 3 0‐20 110.31 110.31
Arkansas Blue Cross & Blue Shield Bronze 5500 3 21 173.71 173.71
Arkansas Blue Cross & Blue Shield Bronze 5500 3 22 173.71 173.71
Arkansas Blue Cross & Blue Shield Bronze 5500 3 23 173.71 173.71
Arkansas Blue Cross & Blue Shield Bronze 5500 3 24 173.71 173.71
Arkansas Blue Cross & Blue Shield Bronze 5500 3 25 174.4 174.4
Arkansas Blue Cross & Blue Shield Bronze 5500 3 26 177.88 177.88
Arkansas Blue Cross & Blue Shield Bronze 5500 3 27 182.05 182.05
Arkansas Blue Cross & Blue Shield Bronze 5500 3 28 188.82 188.82
Arkansas Blue Cross & Blue Shield Bronze 5500 3 29 194.38 194.38
Arkansas Blue Cross & Blue Shield Bronze 5500 3 30 197.16 197.16
Arkansas Blue Cross & Blue Shield Bronze 5500 3 31 201.33 201.33
Arkansas Blue Cross & Blue Shield Bronze 5500 3 32 205.5 205.5
Arkansas Blue Cross & Blue Shield Bronze 5500 3 33 208.1 208.1
Page 120 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 5500 3 34 210.88 210.88
Arkansas Blue Cross & Blue Shield Bronze 5500 3 35 212.27 212.27
Arkansas Blue Cross & Blue Shield Bronze 5500 3 36 213.66 213.66
Arkansas Blue Cross & Blue Shield Bronze 5500 3 37 215.05 215.05
Arkansas Blue Cross & Blue Shield Bronze 5500 3 38 216.44 216.44
Arkansas Blue Cross & Blue Shield Bronze 5500 3 39 219.22 219.22
Arkansas Blue Cross & Blue Shield Bronze 5500 3 40 222 222
Arkansas Blue Cross & Blue Shield Bronze 5500 3 41 226.17 226.17
Arkansas Blue Cross & Blue Shield Bronze 5500 3 42 230.17 230.17
Arkansas Blue Cross & Blue Shield Bronze 5500 3 43 235.72 235.72
Arkansas Blue Cross & Blue Shield Bronze 5500 3 44 242.67 242.67
Arkansas Blue Cross & Blue Shield Bronze 5500 3 45 250.84 250.84
Arkansas Blue Cross & Blue Shield Bronze 5500 3 46 260.56 260.56
Arkansas Blue Cross & Blue Shield Bronze 5500 3 47 271.51 271.51
Arkansas Blue Cross & Blue Shield Bronze 5500 3 48 284.02 284.02
Arkansas Blue Cross & Blue Shield Bronze 5500 3 49 296.35 296.35
Arkansas Blue Cross & Blue Shield Bronze 5500 3 50 310.25 310.25
Arkansas Blue Cross & Blue Shield Bronze 5500 3 51 323.97 323.97
Arkansas Blue Cross & Blue Shield Bronze 5500 3 52 339.08 339.08
Arkansas Blue Cross & Blue Shield Bronze 5500 3 53 354.37 354.37
Arkansas Blue Cross & Blue Shield Bronze 5500 3 54 370.87 370.87
Arkansas Blue Cross & Blue Shield Bronze 5500 3 55 387.37 387.37
Arkansas Blue Cross & Blue Shield Bronze 5500 3 56 405.27 405.27
Arkansas Blue Cross & Blue Shield Bronze 5500 3 57 423.33 423.33
Arkansas Blue Cross & Blue Shield Bronze 5500 3 58 442.61 442.61
Arkansas Blue Cross & Blue Shield Bronze 5500 3 59 452.17 452.17
Arkansas Blue Cross & Blue Shield Bronze 5500 3 60 471.45 471.45
Arkansas Blue Cross & Blue Shield Bronze 5500 3 61 488.13 488.13
Arkansas Blue Cross & Blue Shield Bronze 5500 3 62 499.07 499.07
Arkansas Blue Cross & Blue Shield Bronze 5500 3 63 512.79 512.79
Arkansas Blue Cross & Blue Shield Bronze 5500 3 64 521.13 521.13
Arkansas Blue Cross & Blue Shield Bronze 5500 3 65 and
over
521.13 521.13
Arkansas Blue Cross & Blue Shield Bronze 5500 4 0‐20 108.38 108.38
Arkansas Blue Cross & Blue Shield Bronze 5500 4 21 170.68 170.68
Arkansas Blue Cross & Blue Shield Bronze 5500 4 22 170.68 170.68
Arkansas Blue Cross & Blue Shield Bronze 5500 4 23 170.68 170.68
Arkansas Blue Cross & Blue Shield Bronze 5500 4 24 170.68 170.68
Arkansas Blue Cross & Blue Shield Bronze 5500 4 25 171.36 171.36
Arkansas Blue Cross & Blue Shield Bronze 5500 4 26 174.78 174.78
Arkansas Blue Cross & Blue Shield Bronze 5500 4 27 178.87 178.87
Arkansas Blue Cross & Blue Shield Bronze 5500 4 28 185.53 185.53
Arkansas Blue Cross & Blue Shield Bronze 5500 4 29 190.99 190.99
Arkansas Blue Cross & Blue Shield Bronze 5500 4 30 193.72 193.72
Arkansas Blue Cross & Blue Shield Bronze 5500 4 31 197.82 197.82
Arkansas Blue Cross & Blue Shield Bronze 5500 4 32 201.91 201.91
Arkansas Blue Cross & Blue Shield Bronze 5500 4 33 204.47 204.47
Arkansas Blue Cross & Blue Shield Bronze 5500 4 34 207.21 207.21
Arkansas Blue Cross & Blue Shield Bronze 5500 4 35 208.57 208.57
Arkansas Blue Cross & Blue Shield Bronze 5500 4 36 209.94 209.94
Arkansas Blue Cross & Blue Shield Bronze 5500 4 37 211.3 211.3
Arkansas Blue Cross & Blue Shield Bronze 5500 4 38 212.67 212.67
Arkansas Blue Cross & Blue Shield Bronze 5500 4 39 215.4 215.4
Arkansas Blue Cross & Blue Shield Bronze 5500 4 40 218.13 218.13
Arkansas Blue Cross & Blue Shield Bronze 5500 4 41 222.23 222.23
Arkansas Blue Cross & Blue Shield Bronze 5500 4 42 226.15 226.15
Arkansas Blue Cross & Blue Shield Bronze 5500 4 43 231.61 231.61
Arkansas Blue Cross & Blue Shield Bronze 5500 4 44 238.44 238.44
Arkansas Blue Cross & Blue Shield Bronze 5500 4 45 246.46 246.46
Arkansas Blue Cross & Blue Shield Bronze 5500 4 46 256.02 256.02
Arkansas Blue Cross & Blue Shield Bronze 5500 4 47 266.77 266.77
Arkansas Blue Cross & Blue Shield Bronze 5500 4 48 279.06 279.06
Arkansas Blue Cross & Blue Shield Bronze 5500 4 49 291.18 291.18
Page 121 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 5500 4 50 304.83 304.83
Arkansas Blue Cross & Blue Shield Bronze 5500 4 51 318.32 318.32
Arkansas Blue Cross & Blue Shield Bronze 5500 4 52 333.17 333.17
Arkansas Blue Cross & Blue Shield Bronze 5500 4 53 348.19 348.19
Arkansas Blue Cross & Blue Shield Bronze 5500 4 54 364.4 364.4
Arkansas Blue Cross & Blue Shield Bronze 5500 4 55 380.62 380.62
Arkansas Blue Cross & Blue Shield Bronze 5500 4 56 398.2 398.2
Arkansas Blue Cross & Blue Shield Bronze 5500 4 57 415.95 415.95
Arkansas Blue Cross & Blue Shield Bronze 5500 4 58 434.89 434.89
Arkansas Blue Cross & Blue Shield Bronze 5500 4 59 444.28 444.28
Arkansas Blue Cross & Blue Shield Bronze 5500 4 60 463.23 463.23
Arkansas Blue Cross & Blue Shield Bronze 5500 4 61 479.61 479.61
Arkansas Blue Cross & Blue Shield Bronze 5500 4 62 490.36 490.36
Arkansas Blue Cross & Blue Shield Bronze 5500 4 63 503.85 503.85
Arkansas Blue Cross & Blue Shield Bronze 5500 4 64 512.04 512.04
Arkansas Blue Cross & Blue Shield Bronze 5500 4 65 and
over
512.04 512.04
Arkansas Blue Cross & Blue Shield Bronze 5500 5 0‐20 116.3 116.3
Arkansas Blue Cross & Blue Shield Bronze 5500 5 21 183.15 183.15
Arkansas Blue Cross & Blue Shield Bronze 5500 5 22 183.15 183.15
Arkansas Blue Cross & Blue Shield Bronze 5500 5 23 183.15 183.15
Arkansas Blue Cross & Blue Shield Bronze 5500 5 24 183.15 183.15
Arkansas Blue Cross & Blue Shield Bronze 5500 5 25 183.88 183.88
Arkansas Blue Cross & Blue Shield Bronze 5500 5 26 187.55 187.55
Arkansas Blue Cross & Blue Shield Bronze 5500 5 27 191.94 191.94
Arkansas Blue Cross & Blue Shield Bronze 5500 5 28 199.08 199.08
Arkansas Blue Cross & Blue Shield Bronze 5500 5 29 204.94 204.94
Arkansas Blue Cross & Blue Shield Bronze 5500 5 30 207.88 207.88
Arkansas Blue Cross & Blue Shield Bronze 5500 5 31 212.27 212.27
Arkansas Blue Cross & Blue Shield Bronze 5500 5 32 216.67 216.67
Arkansas Blue Cross & Blue Shield Bronze 5500 5 33 219.41 219.41
Arkansas Blue Cross & Blue Shield Bronze 5500 5 34 222.34 222.34
Arkansas Blue Cross & Blue Shield Bronze 5500 5 35 223.81 223.81
Arkansas Blue Cross & Blue Shield Bronze 5500 5 36 225.27 225.27
Arkansas Blue Cross & Blue Shield Bronze 5500 5 37 226.74 226.74
Arkansas Blue Cross & Blue Shield Bronze 5500 5 38 228.2 228.2
Arkansas Blue Cross & Blue Shield Bronze 5500 5 39 231.14 231.14
Arkansas Blue Cross & Blue Shield Bronze 5500 5 40 234.07 234.07
Arkansas Blue Cross & Blue Shield Bronze 5500 5 41 238.46 238.46
Arkansas Blue Cross & Blue Shield Bronze 5500 5 42 242.67 242.67
Arkansas Blue Cross & Blue Shield Bronze 5500 5 43 248.53 248.53
Arkansas Blue Cross & Blue Shield Bronze 5500 5 44 255.86 255.86
Arkansas Blue Cross & Blue Shield Bronze 5500 5 45 264.47 264.47
Arkansas Blue Cross & Blue Shield Bronze 5500 5 46 274.72 274.72
Arkansas Blue Cross & Blue Shield Bronze 5500 5 47 286.26 286.26
Arkansas Blue Cross & Blue Shield Bronze 5500 5 48 299.45 299.45
Arkansas Blue Cross & Blue Shield Bronze 5500 5 49 312.45 312.45
Arkansas Blue Cross & Blue Shield Bronze 5500 5 50 327.11 327.11
Arkansas Blue Cross & Blue Shield Bronze 5500 5 51 341.57 341.57
Arkansas Blue Cross & Blue Shield Bronze 5500 5 52 357.51 357.51
Arkansas Blue Cross & Blue Shield Bronze 5500 5 53 373.63 373.63
Arkansas Blue Cross & Blue Shield Bronze 5500 5 54 391.03 391.03
Arkansas Blue Cross & Blue Shield Bronze 5500 5 55 408.42 408.42
Arkansas Blue Cross & Blue Shield Bronze 5500 5 56 427.29 427.29
Arkansas Blue Cross & Blue Shield Bronze 5500 5 57 446.34 446.34
Arkansas Blue Cross & Blue Shield Bronze 5500 5 58 466.67 466.67
Arkansas Blue Cross & Blue Shield Bronze 5500 5 59 476.74 476.74
Arkansas Blue Cross & Blue Shield Bronze 5500 5 60 497.07 497.07
Arkansas Blue Cross & Blue Shield Bronze 5500 5 61 514.65 514.65
Arkansas Blue Cross & Blue Shield Bronze 5500 5 62 526.19 526.19
Arkansas Blue Cross & Blue Shield Bronze 5500 5 63 540.66 540.66
Arkansas Blue Cross & Blue Shield Bronze 5500 5 64 549.45 549.45
Page 122 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 5500 5 65 and
over
549.45 549.45
Arkansas Blue Cross & Blue Shield Bronze 5500 6 0‐20 117.44 117.44
Arkansas Blue Cross & Blue Shield Bronze 5500 6 21 184.94 184.94
Arkansas Blue Cross & Blue Shield Bronze 5500 6 22 184.94 184.94
Arkansas Blue Cross & Blue Shield Bronze 5500 6 23 184.94 184.94
Arkansas Blue Cross & Blue Shield Bronze 5500 6 24 184.94 184.94
Arkansas Blue Cross & Blue Shield Bronze 5500 6 25 185.68 185.68
Arkansas Blue Cross & Blue Shield Bronze 5500 6 26 189.38 189.38
Arkansas Blue Cross & Blue Shield Bronze 5500 6 27 193.82 193.82
Arkansas Blue Cross & Blue Shield Bronze 5500 6 28 201.03 201.03
Arkansas Blue Cross & Blue Shield Bronze 5500 6 29 206.95 206.95
Arkansas Blue Cross & Blue Shield Bronze 5500 6 30 209.91 209.91
Arkansas Blue Cross & Blue Shield Bronze 5500 6 31 214.35 214.35
Arkansas Blue Cross & Blue Shield Bronze 5500 6 32 218.78 218.78
Arkansas Blue Cross & Blue Shield Bronze 5500 6 33 221.56 221.56
Arkansas Blue Cross & Blue Shield Bronze 5500 6 34 224.52 224.52
Arkansas Blue Cross & Blue Shield Bronze 5500 6 35 226 226
Arkansas Blue Cross & Blue Shield Bronze 5500 6 36 227.48 227.48
Arkansas Blue Cross & Blue Shield Bronze 5500 6 37 228.96 228.96
Arkansas Blue Cross & Blue Shield Bronze 5500 6 38 230.44 230.44
Arkansas Blue Cross & Blue Shield Bronze 5500 6 39 233.39 233.39
Arkansas Blue Cross & Blue Shield Bronze 5500 6 40 236.35 236.35
Arkansas Blue Cross & Blue Shield Bronze 5500 6 41 240.79 240.79
Arkansas Blue Cross & Blue Shield Bronze 5500 6 42 245.05 245.05
Arkansas Blue Cross & Blue Shield Bronze 5500 6 43 250.96 250.96
Arkansas Blue Cross & Blue Shield Bronze 5500 6 44 258.36 258.36
Arkansas Blue Cross & Blue Shield Bronze 5500 6 45 267.05 267.05
Arkansas Blue Cross & Blue Shield Bronze 5500 6 46 277.41 277.41
Arkansas Blue Cross & Blue Shield Bronze 5500 6 47 289.06 289.06
Arkansas Blue Cross & Blue Shield Bronze 5500 6 48 302.38 302.38
Arkansas Blue Cross & Blue Shield Bronze 5500 6 49 315.51 315.51
Arkansas Blue Cross & Blue Shield Bronze 5500 6 50 330.3 330.3
Arkansas Blue Cross & Blue Shield Bronze 5500 6 51 344.91 344.91
Arkansas Blue Cross & Blue Shield Bronze 5500 6 52 361 361
Arkansas Blue Cross & Blue Shield Bronze 5500 6 53 377.28 377.28
Arkansas Blue Cross & Blue Shield Bronze 5500 6 54 394.85 394.85
Arkansas Blue Cross & Blue Shield Bronze 5500 6 55 412.42 412.42
Arkansas Blue Cross & Blue Shield Bronze 5500 6 56 431.47 431.47
Arkansas Blue Cross & Blue Shield Bronze 5500 6 57 450.7 450.7
Arkansas Blue Cross & Blue Shield Bronze 5500 6 58 471.23 471.23
Arkansas Blue Cross & Blue Shield Bronze 5500 6 59 481.4 481.4
Arkansas Blue Cross & Blue Shield Bronze 5500 6 60 501.93 501.93
Arkansas Blue Cross & Blue Shield Bronze 5500 6 61 519.68 519.68
Arkansas Blue Cross & Blue Shield Bronze 5500 6 62 531.33 531.33
Arkansas Blue Cross & Blue Shield Bronze 5500 6 63 545.94 545.94
Arkansas Blue Cross & Blue Shield Bronze 5500 6 64 554.82 554.82
Arkansas Blue Cross & Blue Shield Bronze 5500 6 65 and
over
554.82 554.82
Arkansas Blue Cross & Blue Shield Bronze 5500 7 0‐20 105.11 105.11
Arkansas Blue Cross & Blue Shield Bronze 5500 7 21 165.52 165.52
Arkansas Blue Cross & Blue Shield Bronze 5500 7 22 165.52 165.52
Arkansas Blue Cross & Blue Shield Bronze 5500 7 23 165.52 165.52
Arkansas Blue Cross & Blue Shield Bronze 5500 7 24 165.52 165.52
Arkansas Blue Cross & Blue Shield Bronze 5500 7 25 166.18 166.18
Arkansas Blue Cross & Blue Shield Bronze 5500 7 26 169.49 169.49
Arkansas Blue Cross & Blue Shield Bronze 5500 7 27 173.46 173.46
Arkansas Blue Cross & Blue Shield Bronze 5500 7 28 179.92 179.92
Arkansas Blue Cross & Blue Shield Bronze 5500 7 29 185.22 185.22
Arkansas Blue Cross & Blue Shield Bronze 5500 7 30 187.87 187.87
Arkansas Blue Cross & Blue Shield Bronze 5500 7 31 191.84 191.84
Arkansas Blue Cross & Blue Shield Bronze 5500 7 32 195.81 195.81
Arkansas Blue Cross & Blue Shield Bronze 5500 7 33 198.29 198.29
Page 123 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 5500 7 34 200.94 200.94
Arkansas Blue Cross & Blue Shield Bronze 5500 7 35 202.27 202.27
Arkansas Blue Cross & Blue Shield Bronze 5500 7 36 203.59 203.59
Arkansas Blue Cross & Blue Shield Bronze 5500 7 37 204.91 204.91
Arkansas Blue Cross & Blue Shield Bronze 5500 7 38 206.24 206.24
Arkansas Blue Cross & Blue Shield Bronze 5500 7 39 208.89 208.89
Arkansas Blue Cross & Blue Shield Bronze 5500 7 40 211.53 211.53
Arkansas Blue Cross & Blue Shield Bronze 5500 7 41 215.51 215.51
Arkansas Blue Cross & Blue Shield Bronze 5500 7 42 219.31 219.31
Arkansas Blue Cross & Blue Shield Bronze 5500 7 43 224.61 224.61
Arkansas Blue Cross & Blue Shield Bronze 5500 7 44 231.23 231.23
Arkansas Blue Cross & Blue Shield Bronze 5500 7 45 239.01 239.01
Arkansas Blue Cross & Blue Shield Bronze 5500 7 46 248.28 248.28
Arkansas Blue Cross & Blue Shield Bronze 5500 7 47 258.71 258.71
Arkansas Blue Cross & Blue Shield Bronze 5500 7 48 270.63 270.63
Arkansas Blue Cross & Blue Shield Bronze 5500 7 49 282.38 282.38
Arkansas Blue Cross & Blue Shield Bronze 5500 7 50 295.62 295.62
Arkansas Blue Cross & Blue Shield Bronze 5500 7 51 308.69 308.69
Arkansas Blue Cross & Blue Shield Bronze 5500 7 52 323.1 323.1
Arkansas Blue Cross & Blue Shield Bronze 5500 7 53 337.66 337.66
Arkansas Blue Cross & Blue Shield Bronze 5500 7 54 353.39 353.39
Arkansas Blue Cross & Blue Shield Bronze 5500 7 55 369.11 369.11
Arkansas Blue Cross & Blue Shield Bronze 5500 7 56 386.16 386.16
Arkansas Blue Cross & Blue Shield Bronze 5500 7 57 403.37 403.37
Arkansas Blue Cross & Blue Shield Bronze 5500 7 58 421.74 421.74
Arkansas Blue Cross & Blue Shield Bronze 5500 7 59 430.85 430.85
Arkansas Blue Cross & Blue Shield Bronze 5500 7 60 449.22 449.22
Arkansas Blue Cross & Blue Shield Bronze 5500 7 61 465.11 465.11
Arkansas Blue Cross & Blue Shield Bronze 5500 7 62 475.54 475.54
Arkansas Blue Cross & Blue Shield Bronze 5500 7 63 488.62 488.62
Arkansas Blue Cross & Blue Shield Bronze 5500 7 64 496.56 496.56
Arkansas Blue Cross & Blue Shield Bronze 5500 7 65 and
over
496.56 496.56
Arkansas Blue Cross & Blue Shield Bronze 6200 1 0‐20 121.84 121.84
Arkansas Blue Cross & Blue Shield Bronze 6200 1 21 191.87 191.87
Arkansas Blue Cross & Blue Shield Bronze 6200 1 22 191.87 191.87
Arkansas Blue Cross & Blue Shield Bronze 6200 1 23 191.87 191.87
Arkansas Blue Cross & Blue Shield Bronze 6200 1 24 191.87 191.87
Arkansas Blue Cross & Blue Shield Bronze 6200 1 25 192.64 192.64
Arkansas Blue Cross & Blue Shield Bronze 6200 1 26 196.47 196.47
Arkansas Blue Cross & Blue Shield Bronze 6200 1 27 201.08 201.08
Arkansas Blue Cross & Blue Shield Bronze 6200 1 28 208.56 208.56
Arkansas Blue Cross & Blue Shield Bronze 6200 1 29 214.7 214.7
Arkansas Blue Cross & Blue Shield Bronze 6200 1 30 217.77 217.77
Arkansas Blue Cross & Blue Shield Bronze 6200 1 31 222.38 222.38
Arkansas Blue Cross & Blue Shield Bronze 6200 1 32 226.98 226.98
Arkansas Blue Cross & Blue Shield Bronze 6200 1 33 229.86 229.86
Arkansas Blue Cross & Blue Shield Bronze 6200 1 34 232.93 232.93
Arkansas Blue Cross & Blue Shield Bronze 6200 1 35 234.47 234.47
Arkansas Blue Cross & Blue Shield Bronze 6200 1 36 236 236
Arkansas Blue Cross & Blue Shield Bronze 6200 1 37 237.54 237.54
Arkansas Blue Cross & Blue Shield Bronze 6200 1 38 239.07 239.07
Arkansas Blue Cross & Blue Shield Bronze 6200 1 39 242.14 242.14
Arkansas Blue Cross & Blue Shield Bronze 6200 1 40 245.21 245.21
Arkansas Blue Cross & Blue Shield Bronze 6200 1 41 249.81 249.81
Arkansas Blue Cross & Blue Shield Bronze 6200 1 42 254.23 254.23
Arkansas Blue Cross & Blue Shield Bronze 6200 1 43 260.37 260.37
Arkansas Blue Cross & Blue Shield Bronze 6200 1 44 268.04 268.04
Arkansas Blue Cross & Blue Shield Bronze 6200 1 45 277.06 277.06
Arkansas Blue Cross & Blue Shield Bronze 6200 1 46 287.8 287.8
Arkansas Blue Cross & Blue Shield Bronze 6200 1 47 299.89 299.89
Arkansas Blue Cross & Blue Shield Bronze 6200 1 48 313.71 313.71
Arkansas Blue Cross & Blue Shield Bronze 6200 1 49 327.33 327.33
Page 124 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6200 1 50 342.68 342.68
Arkansas Blue Cross & Blue Shield Bronze 6200 1 51 357.84 357.84
Arkansas Blue Cross & Blue Shield Bronze 6200 1 52 374.53 374.53
Arkansas Blue Cross & Blue Shield Bronze 6200 1 53 391.41 391.41
Arkansas Blue Cross & Blue Shield Bronze 6200 1 54 409.64 409.64
Arkansas Blue Cross & Blue Shield Bronze 6200 1 55 427.87 427.87
Arkansas Blue Cross & Blue Shield Bronze 6200 1 56 447.63 447.63
Arkansas Blue Cross & Blue Shield Bronze 6200 1 57 467.59 467.59
Arkansas Blue Cross & Blue Shield Bronze 6200 1 58 488.88 488.88
Arkansas Blue Cross & Blue Shield Bronze 6200 1 59 499.44 499.44
Arkansas Blue Cross & Blue Shield Bronze 6200 1 60 520.74 520.74
Arkansas Blue Cross & Blue Shield Bronze 6200 1 61 539.15 539.15
Arkansas Blue Cross & Blue Shield Bronze 6200 1 62 551.24 551.24
Arkansas Blue Cross & Blue Shield Bronze 6200 1 63 566.4 566.4
Arkansas Blue Cross & Blue Shield Bronze 6200 1 64 575.61 575.61
Arkansas Blue Cross & Blue Shield Bronze 6200 1 65 and
over
575.61 575.61
Arkansas Blue Cross & Blue Shield Bronze 6200 2 0‐20 113.15 113.15
Arkansas Blue Cross & Blue Shield Bronze 6200 2 21 178.19 178.19
Arkansas Blue Cross & Blue Shield Bronze 6200 2 22 178.19 178.19
Arkansas Blue Cross & Blue Shield Bronze 6200 2 23 178.19 178.19
Arkansas Blue Cross & Blue Shield Bronze 6200 2 24 178.19 178.19
Arkansas Blue Cross & Blue Shield Bronze 6200 2 25 178.9 178.9
Arkansas Blue Cross & Blue Shield Bronze 6200 2 26 182.47 182.47
Arkansas Blue Cross & Blue Shield Bronze 6200 2 27 186.74 186.74
Arkansas Blue Cross & Blue Shield Bronze 6200 2 28 193.69 193.69
Arkansas Blue Cross & Blue Shield Bronze 6200 2 29 199.39 199.39
Arkansas Blue Cross & Blue Shield Bronze 6200 2 30 202.25 202.25
Arkansas Blue Cross & Blue Shield Bronze 6200 2 31 206.52 206.52
Arkansas Blue Cross & Blue Shield Bronze 6200 2 32 210.8 210.8
Arkansas Blue Cross & Blue Shield Bronze 6200 2 33 213.47 213.47
Arkansas Blue Cross & Blue Shield Bronze 6200 2 34 216.32 216.32
Arkansas Blue Cross & Blue Shield Bronze 6200 2 35 217.75 217.75
Arkansas Blue Cross & Blue Shield Bronze 6200 2 36 219.17 219.17
Arkansas Blue Cross & Blue Shield Bronze 6200 2 37 220.6 220.6
Arkansas Blue Cross & Blue Shield Bronze 6200 2 38 222.02 222.02
Arkansas Blue Cross & Blue Shield Bronze 6200 2 39 224.88 224.88
Arkansas Blue Cross & Blue Shield Bronze 6200 2 40 227.73 227.73
Arkansas Blue Cross & Blue Shield Bronze 6200 2 41 232 232
Arkansas Blue Cross & Blue Shield Bronze 6200 2 42 236.1 236.1
Arkansas Blue Cross & Blue Shield Bronze 6200 2 43 241.8 241.8
Arkansas Blue Cross & Blue Shield Bronze 6200 2 44 248.93 248.93
Arkansas Blue Cross & Blue Shield Bronze 6200 2 45 257.31 257.31
Arkansas Blue Cross & Blue Shield Bronze 6200 2 46 267.28 267.28
Arkansas Blue Cross & Blue Shield Bronze 6200 2 47 278.51 278.51
Arkansas Blue Cross & Blue Shield Bronze 6200 2 48 291.34 291.34
Arkansas Blue Cross & Blue Shield Bronze 6200 2 49 303.99 303.99
Arkansas Blue Cross & Blue Shield Bronze 6200 2 50 318.25 318.25
Arkansas Blue Cross & Blue Shield Bronze 6200 2 51 332.32 332.32
Arkansas Blue Cross & Blue Shield Bronze 6200 2 52 347.83 347.83
Arkansas Blue Cross & Blue Shield Bronze 6200 2 53 363.51 363.51
Arkansas Blue Cross & Blue Shield Bronze 6200 2 54 380.44 380.44
Arkansas Blue Cross & Blue Shield Bronze 6200 2 55 397.36 397.36
Arkansas Blue Cross & Blue Shield Bronze 6200 2 56 415.72 415.72
Arkansas Blue Cross & Blue Shield Bronze 6200 2 57 434.25 434.25
Arkansas Blue Cross & Blue Shield Bronze 6200 2 58 454.03 454.03
Arkansas Blue Cross & Blue Shield Bronze 6200 2 59 463.83 463.83
Arkansas Blue Cross & Blue Shield Bronze 6200 2 60 483.61 483.61
Arkansas Blue Cross & Blue Shield Bronze 6200 2 61 500.71 500.71
Arkansas Blue Cross & Blue Shield Bronze 6200 2 62 511.94 511.94
Arkansas Blue Cross & Blue Shield Bronze 6200 2 63 526.02 526.02
Arkansas Blue Cross & Blue Shield Bronze 6200 2 64 534.57 534.57
Page 125 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6200 2 65 and
over
534.57 534.57
Arkansas Blue Cross & Blue Shield Bronze 6200 3 0‐20 114.44 114.44
Arkansas Blue Cross & Blue Shield Bronze 6200 3 21 180.22 180.22
Arkansas Blue Cross & Blue Shield Bronze 6200 3 22 180.22 180.22
Arkansas Blue Cross & Blue Shield Bronze 6200 3 23 180.22 180.22
Arkansas Blue Cross & Blue Shield Bronze 6200 3 24 180.22 180.22
Arkansas Blue Cross & Blue Shield Bronze 6200 3 25 180.94 180.94
Arkansas Blue Cross & Blue Shield Bronze 6200 3 26 184.55 184.55
Arkansas Blue Cross & Blue Shield Bronze 6200 3 27 188.87 188.87
Arkansas Blue Cross & Blue Shield Bronze 6200 3 28 195.9 195.9
Arkansas Blue Cross & Blue Shield Bronze 6200 3 29 201.67 201.67
Arkansas Blue Cross & Blue Shield Bronze 6200 3 30 204.55 204.55
Arkansas Blue Cross & Blue Shield Bronze 6200 3 31 208.87 208.87
Arkansas Blue Cross & Blue Shield Bronze 6200 3 32 213.2 213.2
Arkansas Blue Cross & Blue Shield Bronze 6200 3 33 215.9 215.9
Arkansas Blue Cross & Blue Shield Bronze 6200 3 34 218.79 218.79
Arkansas Blue Cross & Blue Shield Bronze 6200 3 35 220.23 220.23
Arkansas Blue Cross & Blue Shield Bronze 6200 3 36 221.67 221.67
Arkansas Blue Cross & Blue Shield Bronze 6200 3 37 223.11 223.11
Arkansas Blue Cross & Blue Shield Bronze 6200 3 38 224.55 224.55
Arkansas Blue Cross & Blue Shield Bronze 6200 3 39 227.44 227.44
Arkansas Blue Cross & Blue Shield Bronze 6200 3 40 230.32 230.32
Arkansas Blue Cross & Blue Shield Bronze 6200 3 41 234.65 234.65
Arkansas Blue Cross & Blue Shield Bronze 6200 3 42 238.79 238.79
Arkansas Blue Cross & Blue Shield Bronze 6200 3 43 244.56 244.56
Arkansas Blue Cross & Blue Shield Bronze 6200 3 44 251.77 251.77
Arkansas Blue Cross & Blue Shield Bronze 6200 3 45 260.24 260.24
Arkansas Blue Cross & Blue Shield Bronze 6200 3 46 270.33 270.33
Arkansas Blue Cross & Blue Shield Bronze 6200 3 47 281.68 281.68
Arkansas Blue Cross & Blue Shield Bronze 6200 3 48 294.66 294.66
Arkansas Blue Cross & Blue Shield Bronze 6200 3 49 307.46 307.46
Arkansas Blue Cross & Blue Shield Bronze 6200 3 50 321.87 321.87
Arkansas Blue Cross & Blue Shield Bronze 6200 3 51 336.11 336.11
Arkansas Blue Cross & Blue Shield Bronze 6200 3 52 351.79 351.79
Arkansas Blue Cross & Blue Shield Bronze 6200 3 53 367.65 367.65
Arkansas Blue Cross & Blue Shield Bronze 6200 3 54 384.77 384.77
Arkansas Blue Cross & Blue Shield Bronze 6200 3 55 401.89 401.89
Arkansas Blue Cross & Blue Shield Bronze 6200 3 56 420.45 420.45
Arkansas Blue Cross & Blue Shield Bronze 6200 3 57 439.2 439.2
Arkansas Blue Cross & Blue Shield Bronze 6200 3 58 459.2 459.2
Arkansas Blue Cross & Blue Shield Bronze 6200 3 59 469.11 469.11
Arkansas Blue Cross & Blue Shield Bronze 6200 3 60 489.12 489.12
Arkansas Blue Cross & Blue Shield Bronze 6200 3 61 506.42 506.42
Arkansas Blue Cross & Blue Shield Bronze 6200 3 62 517.77 517.77
Arkansas Blue Cross & Blue Shield Bronze 6200 3 63 532.01 532.01
Arkansas Blue Cross & Blue Shield Bronze 6200 3 64 540.66 540.66
Arkansas Blue Cross & Blue Shield Bronze 6200 3 65 and
over
540.66 540.66
Arkansas Blue Cross & Blue Shield Bronze 6200 4 0‐20 112.45 112.45
Arkansas Blue Cross & Blue Shield Bronze 6200 4 21 177.08 177.08
Arkansas Blue Cross & Blue Shield Bronze 6200 4 22 177.08 177.08
Arkansas Blue Cross & Blue Shield Bronze 6200 4 23 177.08 177.08
Arkansas Blue Cross & Blue Shield Bronze 6200 4 24 177.08 177.08
Arkansas Blue Cross & Blue Shield Bronze 6200 4 25 177.79 177.79
Arkansas Blue Cross & Blue Shield Bronze 6200 4 26 181.33 181.33
Arkansas Blue Cross & Blue Shield Bronze 6200 4 27 185.58 185.58
Arkansas Blue Cross & Blue Shield Bronze 6200 4 28 192.49 192.49
Arkansas Blue Cross & Blue Shield Bronze 6200 4 29 198.15 198.15
Arkansas Blue Cross & Blue Shield Bronze 6200 4 30 200.99 200.99
Arkansas Blue Cross & Blue Shield Bronze 6200 4 31 205.24 205.24
Arkansas Blue Cross & Blue Shield Bronze 6200 4 32 209.49 209.49
Arkansas Blue Cross & Blue Shield Bronze 6200 4 33 212.14 212.14
Page 126 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6200 4 34 214.98 214.98
Arkansas Blue Cross & Blue Shield Bronze 6200 4 35 216.39 216.39
Arkansas Blue Cross & Blue Shield Bronze 6200 4 36 217.81 217.81
Arkansas Blue Cross & Blue Shield Bronze 6200 4 37 219.23 219.23
Arkansas Blue Cross & Blue Shield Bronze 6200 4 38 220.64 220.64
Arkansas Blue Cross & Blue Shield Bronze 6200 4 39 223.47 223.47
Arkansas Blue Cross & Blue Shield Bronze 6200 4 40 226.31 226.31
Arkansas Blue Cross & Blue Shield Bronze 6200 4 41 230.56 230.56
Arkansas Blue Cross & Blue Shield Bronze 6200 4 42 234.63 234.63
Arkansas Blue Cross & Blue Shield Bronze 6200 4 43 240.3 240.3
Arkansas Blue Cross & Blue Shield Bronze 6200 4 44 247.38 247.38
Arkansas Blue Cross & Blue Shield Bronze 6200 4 45 255.7 255.7
Arkansas Blue Cross & Blue Shield Bronze 6200 4 46 265.62 265.62
Arkansas Blue Cross & Blue Shield Bronze 6200 4 47 276.78 276.78
Arkansas Blue Cross & Blue Shield Bronze 6200 4 48 289.53 289.53
Arkansas Blue Cross & Blue Shield Bronze 6200 4 49 302.1 302.1
Arkansas Blue Cross & Blue Shield Bronze 6200 4 50 316.26 316.26
Arkansas Blue Cross & Blue Shield Bronze 6200 4 51 330.25 330.25
Arkansas Blue Cross & Blue Shield Bronze 6200 4 52 345.66 345.66
Arkansas Blue Cross & Blue Shield Bronze 6200 4 53 361.24 361.24
Arkansas Blue Cross & Blue Shield Bronze 6200 4 54 378.07 378.07
Arkansas Blue Cross & Blue Shield Bronze 6200 4 55 394.89 394.89
Arkansas Blue Cross & Blue Shield Bronze 6200 4 56 413.13 413.13
Arkansas Blue Cross & Blue Shield Bronze 6200 4 57 431.54 431.54
Arkansas Blue Cross & Blue Shield Bronze 6200 4 58 451.2 451.2
Arkansas Blue Cross & Blue Shield Bronze 6200 4 59 460.94 460.94
Arkansas Blue Cross & Blue Shield Bronze 6200 4 60 480.6 480.6
Arkansas Blue Cross & Blue Shield Bronze 6200 4 61 497.59 497.59
Arkansas Blue Cross & Blue Shield Bronze 6200 4 62 508.75 508.75
Arkansas Blue Cross & Blue Shield Bronze 6200 4 63 522.74 522.74
Arkansas Blue Cross & Blue Shield Bronze 6200 4 64 531.24 531.24
Arkansas Blue Cross & Blue Shield Bronze 6200 4 65 and
over
531.24 531.24
Arkansas Blue Cross & Blue Shield Bronze 6200 5 0‐20 120.66 120.66
Arkansas Blue Cross & Blue Shield Bronze 6200 5 21 190.02 190.02
Arkansas Blue Cross & Blue Shield Bronze 6200 5 22 190.02 190.02
Arkansas Blue Cross & Blue Shield Bronze 6200 5 23 190.02 190.02
Arkansas Blue Cross & Blue Shield Bronze 6200 5 24 190.02 190.02
Arkansas Blue Cross & Blue Shield Bronze 6200 5 25 190.78 190.78
Arkansas Blue Cross & Blue Shield Bronze 6200 5 26 194.58 194.58
Arkansas Blue Cross & Blue Shield Bronze 6200 5 27 199.14 199.14
Arkansas Blue Cross & Blue Shield Bronze 6200 5 28 206.55 206.55
Arkansas Blue Cross & Blue Shield Bronze 6200 5 29 212.63 212.63
Arkansas Blue Cross & Blue Shield Bronze 6200 5 30 215.67 215.67
Arkansas Blue Cross & Blue Shield Bronze 6200 5 31 220.23 220.23
Arkansas Blue Cross & Blue Shield Bronze 6200 5 32 224.79 224.79
Arkansas Blue Cross & Blue Shield Bronze 6200 5 33 227.64 227.64
Arkansas Blue Cross & Blue Shield Bronze 6200 5 34 230.68 230.68
Arkansas Blue Cross & Blue Shield Bronze 6200 5 35 232.2 232.2
Arkansas Blue Cross & Blue Shield Bronze 6200 5 36 233.72 233.72
Arkansas Blue Cross & Blue Shield Bronze 6200 5 37 235.24 235.24
Arkansas Blue Cross & Blue Shield Bronze 6200 5 38 236.76 236.76
Arkansas Blue Cross & Blue Shield Bronze 6200 5 39 239.81 239.81
Arkansas Blue Cross & Blue Shield Bronze 6200 5 40 242.85 242.85
Arkansas Blue Cross & Blue Shield Bronze 6200 5 41 247.41 247.41
Arkansas Blue Cross & Blue Shield Bronze 6200 5 42 251.78 251.78
Arkansas Blue Cross & Blue Shield Bronze 6200 5 43 257.86 257.86
Arkansas Blue Cross & Blue Shield Bronze 6200 5 44 265.46 265.46
Arkansas Blue Cross & Blue Shield Bronze 6200 5 45 274.39 274.39
Arkansas Blue Cross & Blue Shield Bronze 6200 5 46 285.03 285.03
Arkansas Blue Cross & Blue Shield Bronze 6200 5 47 297 297
Arkansas Blue Cross & Blue Shield Bronze 6200 5 48 310.68 310.68
Arkansas Blue Cross & Blue Shield Bronze 6200 5 49 324.17 324.17
Page 127 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6200 5 50 339.38 339.38
Arkansas Blue Cross & Blue Shield Bronze 6200 5 51 354.39 354.39
Arkansas Blue Cross & Blue Shield Bronze 6200 5 52 370.92 370.92
Arkansas Blue Cross & Blue Shield Bronze 6200 5 53 387.64 387.64
Arkansas Blue Cross & Blue Shield Bronze 6200 5 54 405.69 405.69
Arkansas Blue Cross & Blue Shield Bronze 6200 5 55 423.74 423.74
Arkansas Blue Cross & Blue Shield Bronze 6200 5 56 443.32 443.32
Arkansas Blue Cross & Blue Shield Bronze 6200 5 57 463.08 463.08
Arkansas Blue Cross & Blue Shield Bronze 6200 5 58 484.17 484.17
Arkansas Blue Cross & Blue Shield Bronze 6200 5 59 494.62 494.62
Arkansas Blue Cross & Blue Shield Bronze 6200 5 60 515.71 515.71
Arkansas Blue Cross & Blue Shield Bronze 6200 5 61 533.96 533.96
Arkansas Blue Cross & Blue Shield Bronze 6200 5 62 545.93 545.93
Arkansas Blue Cross & Blue Shield Bronze 6200 5 63 560.94 560.94
Arkansas Blue Cross & Blue Shield Bronze 6200 5 64 570.06 570.06
Arkansas Blue Cross & Blue Shield Bronze 6200 5 65 and
over
570.06 570.06
Arkansas Blue Cross & Blue Shield Bronze 6200 6 0‐20 121.84 121.84
Arkansas Blue Cross & Blue Shield Bronze 6200 6 21 191.87 191.87
Arkansas Blue Cross & Blue Shield Bronze 6200 6 22 191.87 191.87
Arkansas Blue Cross & Blue Shield Bronze 6200 6 23 191.87 191.87
Arkansas Blue Cross & Blue Shield Bronze 6200 6 24 191.87 191.87
Arkansas Blue Cross & Blue Shield Bronze 6200 6 25 192.64 192.64
Arkansas Blue Cross & Blue Shield Bronze 6200 6 26 196.47 196.47
Arkansas Blue Cross & Blue Shield Bronze 6200 6 27 201.08 201.08
Arkansas Blue Cross & Blue Shield Bronze 6200 6 28 208.56 208.56
Arkansas Blue Cross & Blue Shield Bronze 6200 6 29 214.7 214.7
Arkansas Blue Cross & Blue Shield Bronze 6200 6 30 217.77 217.77
Arkansas Blue Cross & Blue Shield Bronze 6200 6 31 222.38 222.38
Arkansas Blue Cross & Blue Shield Bronze 6200 6 32 226.98 226.98
Arkansas Blue Cross & Blue Shield Bronze 6200 6 33 229.86 229.86
Arkansas Blue Cross & Blue Shield Bronze 6200 6 34 232.93 232.93
Arkansas Blue Cross & Blue Shield Bronze 6200 6 35 234.47 234.47
Arkansas Blue Cross & Blue Shield Bronze 6200 6 36 236 236
Arkansas Blue Cross & Blue Shield Bronze 6200 6 37 237.54 237.54
Arkansas Blue Cross & Blue Shield Bronze 6200 6 38 239.07 239.07
Arkansas Blue Cross & Blue Shield Bronze 6200 6 39 242.14 242.14
Arkansas Blue Cross & Blue Shield Bronze 6200 6 40 245.21 245.21
Arkansas Blue Cross & Blue Shield Bronze 6200 6 41 249.81 249.81
Arkansas Blue Cross & Blue Shield Bronze 6200 6 42 254.23 254.23
Arkansas Blue Cross & Blue Shield Bronze 6200 6 43 260.37 260.37
Arkansas Blue Cross & Blue Shield Bronze 6200 6 44 268.04 268.04
Arkansas Blue Cross & Blue Shield Bronze 6200 6 45 277.06 277.06
Arkansas Blue Cross & Blue Shield Bronze 6200 6 46 287.8 287.8
Arkansas Blue Cross & Blue Shield Bronze 6200 6 47 299.89 299.89
Arkansas Blue Cross & Blue Shield Bronze 6200 6 48 313.71 313.71
Arkansas Blue Cross & Blue Shield Bronze 6200 6 49 327.33 327.33
Arkansas Blue Cross & Blue Shield Bronze 6200 6 50 342.68 342.68
Arkansas Blue Cross & Blue Shield Bronze 6200 6 51 357.84 357.84
Arkansas Blue Cross & Blue Shield Bronze 6200 6 52 374.53 374.53
Arkansas Blue Cross & Blue Shield Bronze 6200 6 53 391.41 391.41
Arkansas Blue Cross & Blue Shield Bronze 6200 6 54 409.64 409.64
Arkansas Blue Cross & Blue Shield Bronze 6200 6 55 427.87 427.87
Arkansas Blue Cross & Blue Shield Bronze 6200 6 56 447.63 447.63
Arkansas Blue Cross & Blue Shield Bronze 6200 6 57 467.59 467.59
Arkansas Blue Cross & Blue Shield Bronze 6200 6 58 488.88 488.88
Arkansas Blue Cross & Blue Shield Bronze 6200 6 59 499.44 499.44
Arkansas Blue Cross & Blue Shield Bronze 6200 6 60 520.74 520.74
Arkansas Blue Cross & Blue Shield Bronze 6200 6 61 539.15 539.15
Arkansas Blue Cross & Blue Shield Bronze 6200 6 62 551.24 551.24
Arkansas Blue Cross & Blue Shield Bronze 6200 6 63 566.4 566.4
Arkansas Blue Cross & Blue Shield Bronze 6200 6 64 575.61 575.61
Page 128 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6200 6 65 and
over
575.61 575.61
Arkansas Blue Cross & Blue Shield Bronze 6200 7 0‐20 109.04 109.04
Arkansas Blue Cross & Blue Shield Bronze 6200 7 21 171.72 171.72
Arkansas Blue Cross & Blue Shield Bronze 6200 7 22 171.72 171.72
Arkansas Blue Cross & Blue Shield Bronze 6200 7 23 171.72 171.72
Arkansas Blue Cross & Blue Shield Bronze 6200 7 24 171.72 171.72
Arkansas Blue Cross & Blue Shield Bronze 6200 7 25 172.41 172.41
Arkansas Blue Cross & Blue Shield Bronze 6200 7 26 175.84 175.84
Arkansas Blue Cross & Blue Shield Bronze 6200 7 27 179.96 179.96
Arkansas Blue Cross & Blue Shield Bronze 6200 7 28 186.66 186.66
Arkansas Blue Cross & Blue Shield Bronze 6200 7 29 192.15 192.15
Arkansas Blue Cross & Blue Shield Bronze 6200 7 30 194.9 194.9
Arkansas Blue Cross & Blue Shield Bronze 6200 7 31 199.02 199.02
Arkansas Blue Cross & Blue Shield Bronze 6200 7 32 203.14 203.14
Arkansas Blue Cross & Blue Shield Bronze 6200 7 33 205.72 205.72
Arkansas Blue Cross & Blue Shield Bronze 6200 7 34 208.47 208.47
Arkansas Blue Cross & Blue Shield Bronze 6200 7 35 209.84 209.84
Arkansas Blue Cross & Blue Shield Bronze 6200 7 36 211.22 211.22
Arkansas Blue Cross & Blue Shield Bronze 6200 7 37 212.59 212.59
Arkansas Blue Cross & Blue Shield Bronze 6200 7 38 213.96 213.96
Arkansas Blue Cross & Blue Shield Bronze 6200 7 39 216.71 216.71
Arkansas Blue Cross & Blue Shield Bronze 6200 7 40 219.46 219.46
Arkansas Blue Cross & Blue Shield Bronze 6200 7 41 223.58 223.58
Arkansas Blue Cross & Blue Shield Bronze 6200 7 42 227.53 227.53
Arkansas Blue Cross & Blue Shield Bronze 6200 7 43 233.02 233.02
Arkansas Blue Cross & Blue Shield Bronze 6200 7 44 239.89 239.89
Arkansas Blue Cross & Blue Shield Bronze 6200 7 45 247.96 247.96
Arkansas Blue Cross & Blue Shield Bronze 6200 7 46 257.58 257.58
Arkansas Blue Cross & Blue Shield Bronze 6200 7 47 268.4 268.4
Arkansas Blue Cross & Blue Shield Bronze 6200 7 48 280.76 280.76
Arkansas Blue Cross & Blue Shield Bronze 6200 7 49 292.95 292.95
Arkansas Blue Cross & Blue Shield Bronze 6200 7 50 306.69 306.69
Arkansas Blue Cross & Blue Shield Bronze 6200 7 51 320.26 320.26
Arkansas Blue Cross & Blue Shield Bronze 6200 7 52 335.2 335.2
Arkansas Blue Cross & Blue Shield Bronze 6200 7 53 350.31 350.31
Arkansas Blue Cross & Blue Shield Bronze 6200 7 54 366.62 366.62
Arkansas Blue Cross & Blue Shield Bronze 6200 7 55 382.94 382.94
Arkansas Blue Cross & Blue Shield Bronze 6200 7 56 400.62 400.62
Arkansas Blue Cross & Blue Shield Bronze 6200 7 57 418.48 418.48
Arkansas Blue Cross & Blue Shield Bronze 6200 7 58 437.54 437.54
Arkansas Blue Cross & Blue Shield Bronze 6200 7 59 446.99 446.99
Arkansas Blue Cross & Blue Shield Bronze 6200 7 60 466.05 466.05
Arkansas Blue Cross & Blue Shield Bronze 6200 7 61 482.53 482.53
Arkansas Blue Cross & Blue Shield Bronze 6200 7 62 493.35 493.35
Arkansas Blue Cross & Blue Shield Bronze 6200 7 63 506.92 506.92
Arkansas Blue Cross & Blue Shield Bronze 6200 7 64 515.16 515.16
Arkansas Blue Cross & Blue Shield Bronze 6200 7 65 and
over
515.16 515.16
Arkansas Blue Cross & Blue Shield Bronze 6300 1 0‐20 114.97 114.97
Arkansas Blue Cross & Blue Shield Bronze 6300 1 21 181.05 181.05
Arkansas Blue Cross & Blue Shield Bronze 6300 1 22 181.05 181.05
Arkansas Blue Cross & Blue Shield Bronze 6300 1 23 181.05 181.05
Arkansas Blue Cross & Blue Shield Bronze 6300 1 24 181.05 181.05
Arkansas Blue Cross & Blue Shield Bronze 6300 1 25 181.77 181.77
Arkansas Blue Cross & Blue Shield Bronze 6300 1 26 185.4 185.4
Arkansas Blue Cross & Blue Shield Bronze 6300 1 27 189.74 189.74
Arkansas Blue Cross & Blue Shield Bronze 6300 1 28 196.8 196.8
Arkansas Blue Cross & Blue Shield Bronze 6300 1 29 202.59 202.59
Arkansas Blue Cross & Blue Shield Bronze 6300 1 30 205.49 205.49
Arkansas Blue Cross & Blue Shield Bronze 6300 1 31 209.84 209.84
Arkansas Blue Cross & Blue Shield Bronze 6300 1 32 214.18 214.18
Arkansas Blue Cross & Blue Shield Bronze 6300 1 33 216.9 216.9
Page 129 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6300 1 34 219.79 219.79
Arkansas Blue Cross & Blue Shield Bronze 6300 1 35 221.24 221.24
Arkansas Blue Cross & Blue Shield Bronze 6300 1 36 222.69 222.69
Arkansas Blue Cross & Blue Shield Bronze 6300 1 37 224.14 224.14
Arkansas Blue Cross & Blue Shield Bronze 6300 1 38 225.59 225.59
Arkansas Blue Cross & Blue Shield Bronze 6300 1 39 228.49 228.49
Arkansas Blue Cross & Blue Shield Bronze 6300 1 40 231.38 231.38
Arkansas Blue Cross & Blue Shield Bronze 6300 1 41 235.73 235.73
Arkansas Blue Cross & Blue Shield Bronze 6300 1 42 239.89 239.89
Arkansas Blue Cross & Blue Shield Bronze 6300 1 43 245.68 245.68
Arkansas Blue Cross & Blue Shield Bronze 6300 1 44 252.93 252.93
Arkansas Blue Cross & Blue Shield Bronze 6300 1 45 261.44 261.44
Arkansas Blue Cross & Blue Shield Bronze 6300 1 46 271.58 271.58
Arkansas Blue Cross & Blue Shield Bronze 6300 1 47 282.98 282.98
Arkansas Blue Cross & Blue Shield Bronze 6300 1 48 296.02 296.02
Arkansas Blue Cross & Blue Shield Bronze 6300 1 49 308.87 308.87
Arkansas Blue Cross & Blue Shield Bronze 6300 1 50 323.36 323.36
Arkansas Blue Cross & Blue Shield Bronze 6300 1 51 337.66 337.66
Arkansas Blue Cross & Blue Shield Bronze 6300 1 52 353.41 353.41
Arkansas Blue Cross & Blue Shield Bronze 6300 1 53 369.34 369.34
Arkansas Blue Cross & Blue Shield Bronze 6300 1 54 386.54 386.54
Arkansas Blue Cross & Blue Shield Bronze 6300 1 55 403.74 403.74
Arkansas Blue Cross & Blue Shield Bronze 6300 1 56 422.39 422.39
Arkansas Blue Cross & Blue Shield Bronze 6300 1 57 441.22 441.22
Arkansas Blue Cross & Blue Shield Bronze 6300 1 58 461.32 461.32
Arkansas Blue Cross & Blue Shield Bronze 6300 1 59 471.27 471.27
Arkansas Blue Cross & Blue Shield Bronze 6300 1 60 491.37 491.37
Arkansas Blue Cross & Blue Shield Bronze 6300 1 61 508.75 508.75
Arkansas Blue Cross & Blue Shield Bronze 6300 1 62 520.16 520.16
Arkansas Blue Cross & Blue Shield Bronze 6300 1 63 534.46 534.46
Arkansas Blue Cross & Blue Shield Bronze 6300 1 64 543.15 543.15
Arkansas Blue Cross & Blue Shield Bronze 6300 1 65 and
over
543.15 543.15
Arkansas Blue Cross & Blue Shield Bronze 6300 2 0‐20 106.77 106.77
Arkansas Blue Cross & Blue Shield Bronze 6300 2 21 168.14 168.14
Arkansas Blue Cross & Blue Shield Bronze 6300 2 22 168.14 168.14
Arkansas Blue Cross & Blue Shield Bronze 6300 2 23 168.14 168.14
Arkansas Blue Cross & Blue Shield Bronze 6300 2 24 168.14 168.14
Arkansas Blue Cross & Blue Shield Bronze 6300 2 25 168.81 168.81
Arkansas Blue Cross & Blue Shield Bronze 6300 2 26 172.18 172.18
Arkansas Blue Cross & Blue Shield Bronze 6300 2 27 176.21 176.21
Arkansas Blue Cross & Blue Shield Bronze 6300 2 28 182.77 182.77
Arkansas Blue Cross & Blue Shield Bronze 6300 2 29 188.15 188.15
Arkansas Blue Cross & Blue Shield Bronze 6300 2 30 190.84 190.84
Arkansas Blue Cross & Blue Shield Bronze 6300 2 31 194.87 194.87
Arkansas Blue Cross & Blue Shield Bronze 6300 2 32 198.91 198.91
Arkansas Blue Cross & Blue Shield Bronze 6300 2 33 201.43 201.43
Arkansas Blue Cross & Blue Shield Bronze 6300 2 34 204.12 204.12
Arkansas Blue Cross & Blue Shield Bronze 6300 2 35 205.47 205.47
Arkansas Blue Cross & Blue Shield Bronze 6300 2 36 206.81 206.81
Arkansas Blue Cross & Blue Shield Bronze 6300 2 37 208.16 208.16
Arkansas Blue Cross & Blue Shield Bronze 6300 2 38 209.5 209.5
Arkansas Blue Cross & Blue Shield Bronze 6300 2 39 212.19 212.19
Arkansas Blue Cross & Blue Shield Bronze 6300 2 40 214.88 214.88
Arkansas Blue Cross & Blue Shield Bronze 6300 2 41 218.92 218.92
Arkansas Blue Cross & Blue Shield Bronze 6300 2 42 222.79 222.79
Arkansas Blue Cross & Blue Shield Bronze 6300 2 43 228.17 228.17
Arkansas Blue Cross & Blue Shield Bronze 6300 2 44 234.89 234.89
Arkansas Blue Cross & Blue Shield Bronze 6300 2 45 242.79 242.79
Arkansas Blue Cross & Blue Shield Bronze 6300 2 46 252.21 252.21
Arkansas Blue Cross & Blue Shield Bronze 6300 2 47 262.8 262.8
Arkansas Blue Cross & Blue Shield Bronze 6300 2 48 274.91 274.91
Arkansas Blue Cross & Blue Shield Bronze 6300 2 49 286.85 286.85
Page 130 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6300 2 50 300.3 300.3
Arkansas Blue Cross & Blue Shield Bronze 6300 2 51 313.58 313.58
Arkansas Blue Cross & Blue Shield Bronze 6300 2 52 328.21 328.21
Arkansas Blue Cross & Blue Shield Bronze 6300 2 53 343.01 343.01
Arkansas Blue Cross & Blue Shield Bronze 6300 2 54 358.98 358.98
Arkansas Blue Cross & Blue Shield Bronze 6300 2 55 374.95 374.95
Arkansas Blue Cross & Blue Shield Bronze 6300 2 56 392.27 392.27
Arkansas Blue Cross & Blue Shield Bronze 6300 2 57 409.76 409.76
Arkansas Blue Cross & Blue Shield Bronze 6300 2 58 428.42 428.42
Arkansas Blue Cross & Blue Shield Bronze 6300 2 59 437.67 437.67
Arkansas Blue Cross & Blue Shield Bronze 6300 2 60 456.33 456.33
Arkansas Blue Cross & Blue Shield Bronze 6300 2 61 472.47 472.47
Arkansas Blue Cross & Blue Shield Bronze 6300 2 62 483.07 483.07
Arkansas Blue Cross & Blue Shield Bronze 6300 2 63 496.35 496.35
Arkansas Blue Cross & Blue Shield Bronze 6300 2 64 504.42 504.42
Arkansas Blue Cross & Blue Shield Bronze 6300 2 65 and
over
504.42 504.42
Arkansas Blue Cross & Blue Shield Bronze 6300 3 0‐20 107.99 107.99
Arkansas Blue Cross & Blue Shield Bronze 6300 3 21 170.06 170.06
Arkansas Blue Cross & Blue Shield Bronze 6300 3 22 170.06 170.06
Arkansas Blue Cross & Blue Shield Bronze 6300 3 23 170.06 170.06
Arkansas Blue Cross & Blue Shield Bronze 6300 3 24 170.06 170.06
Arkansas Blue Cross & Blue Shield Bronze 6300 3 25 170.74 170.74
Arkansas Blue Cross & Blue Shield Bronze 6300 3 26 174.14 174.14
Arkansas Blue Cross & Blue Shield Bronze 6300 3 27 178.22 178.22
Arkansas Blue Cross & Blue Shield Bronze 6300 3 28 184.86 184.86
Arkansas Blue Cross & Blue Shield Bronze 6300 3 29 190.3 190.3
Arkansas Blue Cross & Blue Shield Bronze 6300 3 30 193.02 193.02
Arkansas Blue Cross & Blue Shield Bronze 6300 3 31 197.1 197.1
Arkansas Blue Cross & Blue Shield Bronze 6300 3 32 201.18 201.18
Arkansas Blue Cross & Blue Shield Bronze 6300 3 33 203.73 203.73
Arkansas Blue Cross & Blue Shield Bronze 6300 3 34 206.45 206.45
Arkansas Blue Cross & Blue Shield Bronze 6300 3 35 207.81 207.81
Arkansas Blue Cross & Blue Shield Bronze 6300 3 36 209.17 209.17
Arkansas Blue Cross & Blue Shield Bronze 6300 3 37 210.53 210.53
Arkansas Blue Cross & Blue Shield Bronze 6300 3 38 211.89 211.89
Arkansas Blue Cross & Blue Shield Bronze 6300 3 39 214.62 214.62
Arkansas Blue Cross & Blue Shield Bronze 6300 3 40 217.34 217.34
Arkansas Blue Cross & Blue Shield Bronze 6300 3 41 221.42 221.42
Arkansas Blue Cross & Blue Shield Bronze 6300 3 42 225.33 225.33
Arkansas Blue Cross & Blue Shield Bronze 6300 3 43 230.77 230.77
Arkansas Blue Cross & Blue Shield Bronze 6300 3 44 237.57 237.57
Arkansas Blue Cross & Blue Shield Bronze 6300 3 45 245.57 245.57
Arkansas Blue Cross & Blue Shield Bronze 6300 3 46 255.09 255.09
Arkansas Blue Cross & Blue Shield Bronze 6300 3 47 265.8 265.8
Arkansas Blue Cross & Blue Shield Bronze 6300 3 48 278.05 278.05
Arkansas Blue Cross & Blue Shield Bronze 6300 3 49 290.12 290.12
Arkansas Blue Cross & Blue Shield Bronze 6300 3 50 303.73 303.73
Arkansas Blue Cross & Blue Shield Bronze 6300 3 51 317.16 317.16
Arkansas Blue Cross & Blue Shield Bronze 6300 3 52 331.96 331.96
Arkansas Blue Cross & Blue Shield Bronze 6300 3 53 346.92 346.92
Arkansas Blue Cross & Blue Shield Bronze 6300 3 54 363.08 363.08
Arkansas Blue Cross & Blue Shield Bronze 6300 3 55 379.23 379.23
Arkansas Blue Cross & Blue Shield Bronze 6300 3 56 396.75 396.75
Arkansas Blue Cross & Blue Shield Bronze 6300 3 57 414.44 414.44
Arkansas Blue Cross & Blue Shield Bronze 6300 3 58 433.31 433.31
Arkansas Blue Cross & Blue Shield Bronze 6300 3 59 442.67 442.67
Arkansas Blue Cross & Blue Shield Bronze 6300 3 60 461.54 461.54
Arkansas Blue Cross & Blue Shield Bronze 6300 3 61 477.87 477.87
Arkansas Blue Cross & Blue Shield Bronze 6300 3 62 488.58 488.58
Arkansas Blue Cross & Blue Shield Bronze 6300 3 63 502.02 502.02
Arkansas Blue Cross & Blue Shield Bronze 6300 3 64 510.18 510.18
Page 131 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6300 3 65 and
over
510.18 510.18
Arkansas Blue Cross & Blue Shield Bronze 6300 4 0‐20 106.1 106.1
Arkansas Blue Cross & Blue Shield Bronze 6300 4 21 167.09 167.09
Arkansas Blue Cross & Blue Shield Bronze 6300 4 22 167.09 167.09
Arkansas Blue Cross & Blue Shield Bronze 6300 4 23 167.09 167.09
Arkansas Blue Cross & Blue Shield Bronze 6300 4 24 167.09 167.09
Arkansas Blue Cross & Blue Shield Bronze 6300 4 25 167.76 167.76
Arkansas Blue Cross & Blue Shield Bronze 6300 4 26 171.1 171.1
Arkansas Blue Cross & Blue Shield Bronze 6300 4 27 175.11 175.11
Arkansas Blue Cross & Blue Shield Bronze 6300 4 28 181.63 181.63
Arkansas Blue Cross & Blue Shield Bronze 6300 4 29 186.97 186.97
Arkansas Blue Cross & Blue Shield Bronze 6300 4 30 189.65 189.65
Arkansas Blue Cross & Blue Shield Bronze 6300 4 31 193.66 193.66
Arkansas Blue Cross & Blue Shield Bronze 6300 4 32 197.67 197.67
Arkansas Blue Cross & Blue Shield Bronze 6300 4 33 200.17 200.17
Arkansas Blue Cross & Blue Shield Bronze 6300 4 34 202.85 202.85
Arkansas Blue Cross & Blue Shield Bronze 6300 4 35 204.18 204.18
Arkansas Blue Cross & Blue Shield Bronze 6300 4 36 205.52 205.52
Arkansas Blue Cross & Blue Shield Bronze 6300 4 37 206.86 206.86
Arkansas Blue Cross & Blue Shield Bronze 6300 4 38 208.19 208.19
Arkansas Blue Cross & Blue Shield Bronze 6300 4 39 210.87 210.87
Arkansas Blue Cross & Blue Shield Bronze 6300 4 40 213.54 213.54
Arkansas Blue Cross & Blue Shield Bronze 6300 4 41 217.55 217.55
Arkansas Blue Cross & Blue Shield Bronze 6300 4 42 221.39 221.39
Arkansas Blue Cross & Blue Shield Bronze 6300 4 43 226.74 226.74
Arkansas Blue Cross & Blue Shield Bronze 6300 4 44 233.42 233.42
Arkansas Blue Cross & Blue Shield Bronze 6300 4 45 241.28 241.28
Arkansas Blue Cross & Blue Shield Bronze 6300 4 46 250.64 250.64
Arkansas Blue Cross & Blue Shield Bronze 6300 4 47 261.16 261.16
Arkansas Blue Cross & Blue Shield Bronze 6300 4 48 273.19 273.19
Arkansas Blue Cross & Blue Shield Bronze 6300 4 49 285.06 285.06
Arkansas Blue Cross & Blue Shield Bronze 6300 4 50 298.42 298.42
Arkansas Blue Cross & Blue Shield Bronze 6300 4 51 311.62 311.62
Arkansas Blue Cross & Blue Shield Bronze 6300 4 52 326.16 326.16
Arkansas Blue Cross & Blue Shield Bronze 6300 4 53 340.86 340.86
Arkansas Blue Cross & Blue Shield Bronze 6300 4 54 356.74 356.74
Arkansas Blue Cross & Blue Shield Bronze 6300 4 55 372.61 372.61
Arkansas Blue Cross & Blue Shield Bronze 6300 4 56 389.82 389.82
Arkansas Blue Cross & Blue Shield Bronze 6300 4 57 407.2 407.2
Arkansas Blue Cross & Blue Shield Bronze 6300 4 58 425.75 425.75
Arkansas Blue Cross & Blue Shield Bronze 6300 4 59 434.94 434.94
Arkansas Blue Cross & Blue Shield Bronze 6300 4 60 453.48 453.48
Arkansas Blue Cross & Blue Shield Bronze 6300 4 61 469.52 469.52
Arkansas Blue Cross & Blue Shield Bronze 6300 4 62 480.05 480.05
Arkansas Blue Cross & Blue Shield Bronze 6300 4 63 493.25 493.25
Arkansas Blue Cross & Blue Shield Bronze 6300 4 64 501.27 501.27
Arkansas Blue Cross & Blue Shield Bronze 6300 4 65 and
over
501.27 501.27
Arkansas Blue Cross & Blue Shield Bronze 6300 5 0‐20 113.86 113.86
Arkansas Blue Cross & Blue Shield Bronze 6300 5 21 179.3 179.3
Arkansas Blue Cross & Blue Shield Bronze 6300 5 22 179.3 179.3
Arkansas Blue Cross & Blue Shield Bronze 6300 5 23 179.3 179.3
Arkansas Blue Cross & Blue Shield Bronze 6300 5 24 179.3 179.3
Arkansas Blue Cross & Blue Shield Bronze 6300 5 25 180.02 180.02
Arkansas Blue Cross & Blue Shield Bronze 6300 5 26 183.6 183.6
Arkansas Blue Cross & Blue Shield Bronze 6300 5 27 187.91 187.91
Arkansas Blue Cross & Blue Shield Bronze 6300 5 28 194.9 194.9
Arkansas Blue Cross & Blue Shield Bronze 6300 5 29 200.64 200.64
Arkansas Blue Cross & Blue Shield Bronze 6300 5 30 203.51 203.51
Arkansas Blue Cross & Blue Shield Bronze 6300 5 31 207.81 207.81
Arkansas Blue Cross & Blue Shield Bronze 6300 5 32 212.11 212.11
Arkansas Blue Cross & Blue Shield Bronze 6300 5 33 214.8 214.8
Page 132 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6300 5 34 217.67 217.67
Arkansas Blue Cross & Blue Shield Bronze 6300 5 35 219.1 219.1
Arkansas Blue Cross & Blue Shield Bronze 6300 5 36 220.54 220.54
Arkansas Blue Cross & Blue Shield Bronze 6300 5 37 221.97 221.97
Arkansas Blue Cross & Blue Shield Bronze 6300 5 38 223.41 223.41
Arkansas Blue Cross & Blue Shield Bronze 6300 5 39 226.28 226.28
Arkansas Blue Cross & Blue Shield Bronze 6300 5 40 229.15 229.15
Arkansas Blue Cross & Blue Shield Bronze 6300 5 41 233.45 233.45
Arkansas Blue Cross & Blue Shield Bronze 6300 5 42 237.57 237.57
Arkansas Blue Cross & Blue Shield Bronze 6300 5 43 243.31 243.31
Arkansas Blue Cross & Blue Shield Bronze 6300 5 44 250.48 250.48
Arkansas Blue Cross & Blue Shield Bronze 6300 5 45 258.91 258.91
Arkansas Blue Cross & Blue Shield Bronze 6300 5 46 268.95 268.95
Arkansas Blue Cross & Blue Shield Bronze 6300 5 47 280.25 280.25
Arkansas Blue Cross & Blue Shield Bronze 6300 5 48 293.16 293.16
Arkansas Blue Cross & Blue Shield Bronze 6300 5 49 305.89 305.89
Arkansas Blue Cross & Blue Shield Bronze 6300 5 50 320.23 320.23
Arkansas Blue Cross & Blue Shield Bronze 6300 5 51 334.39 334.39
Arkansas Blue Cross & Blue Shield Bronze 6300 5 52 349.99 349.99
Arkansas Blue Cross & Blue Shield Bronze 6300 5 53 365.77 365.77
Arkansas Blue Cross & Blue Shield Bronze 6300 5 54 382.81 382.81
Arkansas Blue Cross & Blue Shield Bronze 6300 5 55 399.84 399.84
Arkansas Blue Cross & Blue Shield Bronze 6300 5 56 418.31 418.31
Arkansas Blue Cross & Blue Shield Bronze 6300 5 57 436.95 436.95
Arkansas Blue Cross & Blue Shield Bronze 6300 5 58 456.86 456.86
Arkansas Blue Cross & Blue Shield Bronze 6300 5 59 466.72 466.72
Arkansas Blue Cross & Blue Shield Bronze 6300 5 60 486.62 486.62
Arkansas Blue Cross & Blue Shield Bronze 6300 5 61 503.83 503.83
Arkansas Blue Cross & Blue Shield Bronze 6300 5 62 515.13 515.13
Arkansas Blue Cross & Blue Shield Bronze 6300 5 63 529.29 529.29
Arkansas Blue Cross & Blue Shield Bronze 6300 5 64 537.9 537.9
Arkansas Blue Cross & Blue Shield Bronze 6300 5 65 and
over
537.9 537.9
Arkansas Blue Cross & Blue Shield Bronze 6300 6 0‐20 114.97 114.97
Arkansas Blue Cross & Blue Shield Bronze 6300 6 21 181.05 181.05
Arkansas Blue Cross & Blue Shield Bronze 6300 6 22 181.05 181.05
Arkansas Blue Cross & Blue Shield Bronze 6300 6 23 181.05 181.05
Arkansas Blue Cross & Blue Shield Bronze 6300 6 24 181.05 181.05
Arkansas Blue Cross & Blue Shield Bronze 6300 6 25 181.77 181.77
Arkansas Blue Cross & Blue Shield Bronze 6300 6 26 185.4 185.4
Arkansas Blue Cross & Blue Shield Bronze 6300 6 27 189.74 189.74
Arkansas Blue Cross & Blue Shield Bronze 6300 6 28 196.8 196.8
Arkansas Blue Cross & Blue Shield Bronze 6300 6 29 202.59 202.59
Arkansas Blue Cross & Blue Shield Bronze 6300 6 30 205.49 205.49
Arkansas Blue Cross & Blue Shield Bronze 6300 6 31 209.84 209.84
Arkansas Blue Cross & Blue Shield Bronze 6300 6 32 214.18 214.18
Arkansas Blue Cross & Blue Shield Bronze 6300 6 33 216.9 216.9
Arkansas Blue Cross & Blue Shield Bronze 6300 6 34 219.79 219.79
Arkansas Blue Cross & Blue Shield Bronze 6300 6 35 221.24 221.24
Arkansas Blue Cross & Blue Shield Bronze 6300 6 36 222.69 222.69
Arkansas Blue Cross & Blue Shield Bronze 6300 6 37 224.14 224.14
Arkansas Blue Cross & Blue Shield Bronze 6300 6 38 225.59 225.59
Arkansas Blue Cross & Blue Shield Bronze 6300 6 39 228.49 228.49
Arkansas Blue Cross & Blue Shield Bronze 6300 6 40 231.38 231.38
Arkansas Blue Cross & Blue Shield Bronze 6300 6 41 235.73 235.73
Arkansas Blue Cross & Blue Shield Bronze 6300 6 42 239.89 239.89
Arkansas Blue Cross & Blue Shield Bronze 6300 6 43 245.68 245.68
Arkansas Blue Cross & Blue Shield Bronze 6300 6 44 252.93 252.93
Arkansas Blue Cross & Blue Shield Bronze 6300 6 45 261.44 261.44
Arkansas Blue Cross & Blue Shield Bronze 6300 6 46 271.58 271.58
Arkansas Blue Cross & Blue Shield Bronze 6300 6 47 282.98 282.98
Arkansas Blue Cross & Blue Shield Bronze 6300 6 48 296.02 296.02
Arkansas Blue Cross & Blue Shield Bronze 6300 6 49 308.87 308.87
Page 133 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6300 6 50 323.36 323.36
Arkansas Blue Cross & Blue Shield Bronze 6300 6 51 337.66 337.66
Arkansas Blue Cross & Blue Shield Bronze 6300 6 52 353.41 353.41
Arkansas Blue Cross & Blue Shield Bronze 6300 6 53 369.34 369.34
Arkansas Blue Cross & Blue Shield Bronze 6300 6 54 386.54 386.54
Arkansas Blue Cross & Blue Shield Bronze 6300 6 55 403.74 403.74
Arkansas Blue Cross & Blue Shield Bronze 6300 6 56 422.39 422.39
Arkansas Blue Cross & Blue Shield Bronze 6300 6 57 441.22 441.22
Arkansas Blue Cross & Blue Shield Bronze 6300 6 58 461.32 461.32
Arkansas Blue Cross & Blue Shield Bronze 6300 6 59 471.27 471.27
Arkansas Blue Cross & Blue Shield Bronze 6300 6 60 491.37 491.37
Arkansas Blue Cross & Blue Shield Bronze 6300 6 61 508.75 508.75
Arkansas Blue Cross & Blue Shield Bronze 6300 6 62 520.16 520.16
Arkansas Blue Cross & Blue Shield Bronze 6300 6 63 534.46 534.46
Arkansas Blue Cross & Blue Shield Bronze 6300 6 64 543.15 543.15
Arkansas Blue Cross & Blue Shield Bronze 6300 6 65 and
over
543.15 543.15
Arkansas Blue Cross & Blue Shield Bronze 6300 7 0‐20 102.9 102.9
Arkansas Blue Cross & Blue Shield Bronze 6300 7 21 162.04 162.04
Arkansas Blue Cross & Blue Shield Bronze 6300 7 22 162.04 162.04
Arkansas Blue Cross & Blue Shield Bronze 6300 7 23 162.04 162.04
Arkansas Blue Cross & Blue Shield Bronze 6300 7 24 162.04 162.04
Arkansas Blue Cross & Blue Shield Bronze 6300 7 25 162.69 162.69
Arkansas Blue Cross & Blue Shield Bronze 6300 7 26 165.93 165.93
Arkansas Blue Cross & Blue Shield Bronze 6300 7 27 169.82 169.82
Arkansas Blue Cross & Blue Shield Bronze 6300 7 28 176.14 176.14
Arkansas Blue Cross & Blue Shield Bronze 6300 7 29 181.32 181.32
Arkansas Blue Cross & Blue Shield Bronze 6300 7 30 183.92 183.92
Arkansas Blue Cross & Blue Shield Bronze 6300 7 31 187.8 187.8
Arkansas Blue Cross & Blue Shield Bronze 6300 7 32 191.69 191.69
Arkansas Blue Cross & Blue Shield Bronze 6300 7 33 194.12 194.12
Arkansas Blue Cross & Blue Shield Bronze 6300 7 34 196.72 196.72
Arkansas Blue Cross & Blue Shield Bronze 6300 7 35 198.01 198.01
Arkansas Blue Cross & Blue Shield Bronze 6300 7 36 199.31 199.31
Arkansas Blue Cross & Blue Shield Bronze 6300 7 37 200.61 200.61
Arkansas Blue Cross & Blue Shield Bronze 6300 7 38 201.9 201.9
Arkansas Blue Cross & Blue Shield Bronze 6300 7 39 204.49 204.49
Arkansas Blue Cross & Blue Shield Bronze 6300 7 40 207.09 207.09
Arkansas Blue Cross & Blue Shield Bronze 6300 7 41 210.98 210.98
Arkansas Blue Cross & Blue Shield Bronze 6300 7 42 214.7 214.7
Arkansas Blue Cross & Blue Shield Bronze 6300 7 43 219.89 219.89
Arkansas Blue Cross & Blue Shield Bronze 6300 7 44 226.37 226.37
Arkansas Blue Cross & Blue Shield Bronze 6300 7 45 233.99 233.99
Arkansas Blue Cross & Blue Shield Bronze 6300 7 46 243.06 243.06
Arkansas Blue Cross & Blue Shield Bronze 6300 7 47 253.27 253.27
Arkansas Blue Cross & Blue Shield Bronze 6300 7 48 264.94 264.94
Arkansas Blue Cross & Blue Shield Bronze 6300 7 49 276.44 276.44
Arkansas Blue Cross & Blue Shield Bronze 6300 7 50 289.4 289.4
Arkansas Blue Cross & Blue Shield Bronze 6300 7 51 302.2 302.2
Arkansas Blue Cross & Blue Shield Bronze 6300 7 52 316.3 316.3
Arkansas Blue Cross & Blue Shield Bronze 6300 7 53 330.56 330.56
Arkansas Blue Cross & Blue Shield Bronze 6300 7 54 345.96 345.96
Arkansas Blue Cross & Blue Shield Bronze 6300 7 55 361.35 361.35
Arkansas Blue Cross & Blue Shield Bronze 6300 7 56 378.04 378.04
Arkansas Blue Cross & Blue Shield Bronze 6300 7 57 394.89 394.89
Arkansas Blue Cross & Blue Shield Bronze 6300 7 58 412.88 412.88
Arkansas Blue Cross & Blue Shield Bronze 6300 7 59 421.79 421.79
Arkansas Blue Cross & Blue Shield Bronze 6300 7 60 439.78 439.78
Arkansas Blue Cross & Blue Shield Bronze 6300 7 61 455.33 455.33
Arkansas Blue Cross & Blue Shield Bronze 6300 7 62 465.54 465.54
Arkansas Blue Cross & Blue Shield Bronze 6300 7 63 478.34 478.34
Arkansas Blue Cross & Blue Shield Bronze 6300 7 64 486.12 486.12
Page 134 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Bronze 6300 7 65 and
over
486.12 486.12
Arkansas Blue Cross & Blue Shield Catastrophic 1 0‐20 108.71 108.71
Arkansas Blue Cross & Blue Shield Catastrophic 1 21 171.2 171.2
Arkansas Blue Cross & Blue Shield Catastrophic 1 22 171.2 171.2
Arkansas Blue Cross & Blue Shield Catastrophic 1 23 171.2 171.2
Arkansas Blue Cross & Blue Shield Catastrophic 1 24 171.2 171.2
Arkansas Blue Cross & Blue Shield Catastrophic 1 25 171.88 171.88
Arkansas Blue Cross & Blue Shield Catastrophic 1 26 175.31 175.31
Arkansas Blue Cross & Blue Shield Catastrophic 1 27 179.42 179.42
Arkansas Blue Cross & Blue Shield Catastrophic 1 28 186.09 186.09
Arkansas Blue Cross & Blue Shield Catastrophic 1 29 191.57 191.57
Arkansas Blue Cross & Blue Shield Catastrophic 1 30 194.31 194.31
Arkansas Blue Cross & Blue Shield Catastrophic 1 31 198.42 198.42
Arkansas Blue Cross & Blue Shield Catastrophic 1 32 202.53 202.53
Arkansas Blue Cross & Blue Shield Catastrophic 1 33 205.1 205.1
Arkansas Blue Cross & Blue Shield Catastrophic 1 34 207.84 207.84
Arkansas Blue Cross & Blue Shield Catastrophic 1 35 209.21 209.21
Arkansas Blue Cross & Blue Shield Catastrophic 1 36 210.58 210.58
Arkansas Blue Cross & Blue Shield Catastrophic 1 37 211.95 211.95
Arkansas Blue Cross & Blue Shield Catastrophic 1 38 213.32 213.32
Arkansas Blue Cross & Blue Shield Catastrophic 1 39 216.05 216.05
Arkansas Blue Cross & Blue Shield Catastrophic 1 40 218.79 218.79
Arkansas Blue Cross & Blue Shield Catastrophic 1 41 222.9 222.9
Arkansas Blue Cross & Blue Shield Catastrophic 1 42 226.84 226.84
Arkansas Blue Cross & Blue Shield Catastrophic 1 43 232.32 232.32
Arkansas Blue Cross & Blue Shield Catastrophic 1 44 239.17 239.17
Arkansas Blue Cross & Blue Shield Catastrophic 1 45 247.21 247.21
Arkansas Blue Cross & Blue Shield Catastrophic 1 46 256.8 256.8
Arkansas Blue Cross & Blue Shield Catastrophic 1 47 267.59 267.59
Arkansas Blue Cross & Blue Shield Catastrophic 1 48 279.91 279.91
Arkansas Blue Cross & Blue Shield Catastrophic 1 49 292.07 292.07
Arkansas Blue Cross & Blue Shield Catastrophic 1 50 305.76 305.76
Arkansas Blue Cross & Blue Shield Catastrophic 1 51 319.29 319.29
Arkansas Blue Cross & Blue Shield Catastrophic 1 52 334.18 334.18
Arkansas Blue Cross & Blue Shield Catastrophic 1 53 349.25 349.25
Arkansas Blue Cross & Blue Shield Catastrophic 1 54 365.51 365.51
Arkansas Blue Cross & Blue Shield Catastrophic 1 55 381.78 381.78
Arkansas Blue Cross & Blue Shield Catastrophic 1 56 399.41 399.41
Arkansas Blue Cross & Blue Shield Catastrophic 1 57 417.21 417.21
Arkansas Blue Cross & Blue Shield Catastrophic 1 58 436.22 436.22
Arkansas Blue Cross & Blue Shield Catastrophic 1 59 445.63 445.63
Arkansas Blue Cross & Blue Shield Catastrophic 1 60 464.64 464.64
Arkansas Blue Cross & Blue Shield Catastrophic 1 61 481.07 481.07
Arkansas Blue Cross & Blue Shield Catastrophic 1 62 491.86 491.86
Arkansas Blue Cross & Blue Shield Catastrophic 1 63 505.38 505.38
Arkansas Blue Cross & Blue Shield Catastrophic 1 64 513.6 513.6
Arkansas Blue Cross & Blue Shield Catastrophic 1 65 and
over
513.6 513.6
Arkansas Blue Cross & Blue Shield Catastrophic 2 0‐20 100.96 100.96
Arkansas Blue Cross & Blue Shield Catastrophic 2 21 158.99 158.99
Arkansas Blue Cross & Blue Shield Catastrophic 2 22 158.99 158.99
Arkansas Blue Cross & Blue Shield Catastrophic 2 23 158.99 158.99
Arkansas Blue Cross & Blue Shield Catastrophic 2 24 158.99 158.99
Arkansas Blue Cross & Blue Shield Catastrophic 2 25 159.63 159.63
Arkansas Blue Cross & Blue Shield Catastrophic 2 26 162.81 162.81
Arkansas Blue Cross & Blue Shield Catastrophic 2 27 166.62 166.62
Arkansas Blue Cross & Blue Shield Catastrophic 2 28 172.82 172.82
Arkansas Blue Cross & Blue Shield Catastrophic 2 29 177.91 177.91
Arkansas Blue Cross & Blue Shield Catastrophic 2 30 180.45 180.45
Arkansas Blue Cross & Blue Shield Catastrophic 2 31 184.27 184.27
Arkansas Blue Cross & Blue Shield Catastrophic 2 32 188.09 188.09
Arkansas Blue Cross & Blue Shield Catastrophic 2 33 190.47 190.47
Page 135 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Catastrophic 2 34 193.01 193.01
Arkansas Blue Cross & Blue Shield Catastrophic 2 35 194.29 194.29
Arkansas Blue Cross & Blue Shield Catastrophic 2 36 195.56 195.56
Arkansas Blue Cross & Blue Shield Catastrophic 2 37 196.83 196.83
Arkansas Blue Cross & Blue Shield Catastrophic 2 38 198.1 198.1
Arkansas Blue Cross & Blue Shield Catastrophic 2 39 200.65 200.65
Arkansas Blue Cross & Blue Shield Catastrophic 2 40 203.19 203.19
Arkansas Blue Cross & Blue Shield Catastrophic 2 41 207 207
Arkansas Blue Cross & Blue Shield Catastrophic 2 42 210.66 210.66
Arkansas Blue Cross & Blue Shield Catastrophic 2 43 215.75 215.75
Arkansas Blue Cross & Blue Shield Catastrophic 2 44 222.11 222.11
Arkansas Blue Cross & Blue Shield Catastrophic 2 45 229.58 229.58
Arkansas Blue Cross & Blue Shield Catastrophic 2 46 238.48 238.48
Arkansas Blue Cross & Blue Shield Catastrophic 2 47 248.5 248.5
Arkansas Blue Cross & Blue Shield Catastrophic 2 48 259.95 259.95
Arkansas Blue Cross & Blue Shield Catastrophic 2 49 271.24 271.24
Arkansas Blue Cross & Blue Shield Catastrophic 2 50 283.96 283.96
Arkansas Blue Cross & Blue Shield Catastrophic 2 51 296.52 296.52
Arkansas Blue Cross & Blue Shield Catastrophic 2 52 310.35 310.35
Arkansas Blue Cross & Blue Shield Catastrophic 2 53 324.34 324.34
Arkansas Blue Cross & Blue Shield Catastrophic 2 54 339.44 339.44
Arkansas Blue Cross & Blue Shield Catastrophic 2 55 354.55 354.55
Arkansas Blue Cross & Blue Shield Catastrophic 2 56 370.92 370.92
Arkansas Blue Cross & Blue Shield Catastrophic 2 57 387.46 387.46
Arkansas Blue Cross & Blue Shield Catastrophic 2 58 405.11 405.11
Arkansas Blue Cross & Blue Shield Catastrophic 2 59 413.85 413.85
Arkansas Blue Cross & Blue Shield Catastrophic 2 60 431.5 431.5
Arkansas Blue Cross & Blue Shield Catastrophic 2 61 446.76 446.76
Arkansas Blue Cross & Blue Shield Catastrophic 2 62 456.78 456.78
Arkansas Blue Cross & Blue Shield Catastrophic 2 63 469.34 469.34
Arkansas Blue Cross & Blue Shield Catastrophic 2 64 476.97 476.97
Arkansas Blue Cross & Blue Shield Catastrophic 2 65 and
over
476.97 476.97
Arkansas Blue Cross & Blue Shield Catastrophic 3 0‐20 102.11 102.11
Arkansas Blue Cross & Blue Shield Catastrophic 3 21 160.81 160.81
Arkansas Blue Cross & Blue Shield Catastrophic 3 22 160.81 160.81
Arkansas Blue Cross & Blue Shield Catastrophic 3 23 160.81 160.81
Arkansas Blue Cross & Blue Shield Catastrophic 3 24 160.81 160.81
Arkansas Blue Cross & Blue Shield Catastrophic 3 25 161.45 161.45
Arkansas Blue Cross & Blue Shield Catastrophic 3 26 164.67 164.67
Arkansas Blue Cross & Blue Shield Catastrophic 3 27 168.53 168.53
Arkansas Blue Cross & Blue Shield Catastrophic 3 28 174.8 174.8
Arkansas Blue Cross & Blue Shield Catastrophic 3 29 179.95 179.95
Arkansas Blue Cross & Blue Shield Catastrophic 3 30 182.52 182.52
Arkansas Blue Cross & Blue Shield Catastrophic 3 31 186.38 186.38
Arkansas Blue Cross & Blue Shield Catastrophic 3 32 190.24 190.24
Arkansas Blue Cross & Blue Shield Catastrophic 3 33 192.65 192.65
Arkansas Blue Cross & Blue Shield Catastrophic 3 34 195.22 195.22
Arkansas Blue Cross & Blue Shield Catastrophic 3 35 196.51 196.51
Arkansas Blue Cross & Blue Shield Catastrophic 3 36 197.8 197.8
Arkansas Blue Cross & Blue Shield Catastrophic 3 37 199.08 199.08
Arkansas Blue Cross & Blue Shield Catastrophic 3 38 200.37 200.37
Arkansas Blue Cross & Blue Shield Catastrophic 3 39 202.94 202.94
Arkansas Blue Cross & Blue Shield Catastrophic 3 40 205.52 205.52
Arkansas Blue Cross & Blue Shield Catastrophic 3 41 209.37 209.37
Arkansas Blue Cross & Blue Shield Catastrophic 3 42 213.07 213.07
Arkansas Blue Cross & Blue Shield Catastrophic 3 43 218.22 218.22
Arkansas Blue Cross & Blue Shield Catastrophic 3 44 224.65 224.65
Arkansas Blue Cross & Blue Shield Catastrophic 3 45 232.21 232.21
Arkansas Blue Cross & Blue Shield Catastrophic 3 46 241.22 241.22
Arkansas Blue Cross & Blue Shield Catastrophic 3 47 251.35 251.35
Arkansas Blue Cross & Blue Shield Catastrophic 3 48 262.92 262.92
Arkansas Blue Cross & Blue Shield Catastrophic 3 49 274.34 274.34
Page 136 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Catastrophic 3 50 287.21 287.21
Arkansas Blue Cross & Blue Shield Catastrophic 3 51 299.91 299.91
Arkansas Blue Cross & Blue Shield Catastrophic 3 52 313.9 313.9
Arkansas Blue Cross & Blue Shield Catastrophic 3 53 328.05 328.05
Arkansas Blue Cross & Blue Shield Catastrophic 3 54 343.33 343.33
Arkansas Blue Cross & Blue Shield Catastrophic 3 55 358.61 358.61
Arkansas Blue Cross & Blue Shield Catastrophic 3 56 375.17 375.17
Arkansas Blue Cross & Blue Shield Catastrophic 3 57 391.89 391.89
Arkansas Blue Cross & Blue Shield Catastrophic 3 58 409.74 409.74
Arkansas Blue Cross & Blue Shield Catastrophic 3 59 418.59 418.59
Arkansas Blue Cross & Blue Shield Catastrophic 3 60 436.44 436.44
Arkansas Blue Cross & Blue Shield Catastrophic 3 61 451.88 451.88
Arkansas Blue Cross & Blue Shield Catastrophic 3 62 462.01 462.01
Arkansas Blue Cross & Blue Shield Catastrophic 3 63 474.71 474.71
Arkansas Blue Cross & Blue Shield Catastrophic 3 64 482.43 482.43
Arkansas Blue Cross & Blue Shield Catastrophic 3 65 and
over
482.43 482.43
Arkansas Blue Cross & Blue Shield Catastrophic 4 0‐20 100.33 100.33
Arkansas Blue Cross & Blue Shield Catastrophic 4 21 158 158
Arkansas Blue Cross & Blue Shield Catastrophic 4 22 158 158
Arkansas Blue Cross & Blue Shield Catastrophic 4 23 158 158
Arkansas Blue Cross & Blue Shield Catastrophic 4 24 158 158
Arkansas Blue Cross & Blue Shield Catastrophic 4 25 158.63 158.63
Arkansas Blue Cross & Blue Shield Catastrophic 4 26 161.79 161.79
Arkansas Blue Cross & Blue Shield Catastrophic 4 27 165.58 165.58
Arkansas Blue Cross & Blue Shield Catastrophic 4 28 171.75 171.75
Arkansas Blue Cross & Blue Shield Catastrophic 4 29 176.8 176.8
Arkansas Blue Cross & Blue Shield Catastrophic 4 30 179.33 179.33
Arkansas Blue Cross & Blue Shield Catastrophic 4 31 183.12 183.12
Arkansas Blue Cross & Blue Shield Catastrophic 4 32 186.91 186.91
Arkansas Blue Cross & Blue Shield Catastrophic 4 33 189.28 189.28
Arkansas Blue Cross & Blue Shield Catastrophic 4 34 191.81 191.81
Arkansas Blue Cross & Blue Shield Catastrophic 4 35 193.08 193.08
Arkansas Blue Cross & Blue Shield Catastrophic 4 36 194.34 194.34
Arkansas Blue Cross & Blue Shield Catastrophic 4 37 195.6 195.6
Arkansas Blue Cross & Blue Shield Catastrophic 4 38 196.87 196.87
Arkansas Blue Cross & Blue Shield Catastrophic 4 39 199.4 199.4
Arkansas Blue Cross & Blue Shield Catastrophic 4 40 201.92 201.92
Arkansas Blue Cross & Blue Shield Catastrophic 4 41 205.72 205.72
Arkansas Blue Cross & Blue Shield Catastrophic 4 42 209.35 209.35
Arkansas Blue Cross & Blue Shield Catastrophic 4 43 214.41 214.41
Arkansas Blue Cross & Blue Shield Catastrophic 4 44 220.73 220.73
Arkansas Blue Cross & Blue Shield Catastrophic 4 45 228.15 228.15
Arkansas Blue Cross & Blue Shield Catastrophic 4 46 237 237
Arkansas Blue Cross & Blue Shield Catastrophic 4 47 246.95 246.95
Arkansas Blue Cross & Blue Shield Catastrophic 4 48 258.33 258.33
Arkansas Blue Cross & Blue Shield Catastrophic 4 49 269.55 269.55
Arkansas Blue Cross & Blue Shield Catastrophic 4 50 282.19 282.19
Arkansas Blue Cross & Blue Shield Catastrophic 4 51 294.67 294.67
Arkansas Blue Cross & Blue Shield Catastrophic 4 52 308.42 308.42
Arkansas Blue Cross & Blue Shield Catastrophic 4 53 322.32 322.32
Arkansas Blue Cross & Blue Shield Catastrophic 4 54 337.33 337.33
Arkansas Blue Cross & Blue Shield Catastrophic 4 55 352.34 352.34
Arkansas Blue Cross & Blue Shield Catastrophic 4 56 368.61 368.61
Arkansas Blue Cross & Blue Shield Catastrophic 4 57 385.05 385.05
Arkansas Blue Cross & Blue Shield Catastrophic 4 58 402.58 402.58
Arkansas Blue Cross & Blue Shield Catastrophic 4 59 411.27 411.27
Arkansas Blue Cross & Blue Shield Catastrophic 4 60 428.81 428.81
Arkansas Blue Cross & Blue Shield Catastrophic 4 61 443.98 443.98
Arkansas Blue Cross & Blue Shield Catastrophic 4 62 453.93 453.93
Arkansas Blue Cross & Blue Shield Catastrophic 4 63 466.42 466.42
Arkansas Blue Cross & Blue Shield Catastrophic 4 64 474 474
Page 137 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Catastrophic 4 65 and
over
474 474
Arkansas Blue Cross & Blue Shield Catastrophic 5 0‐20 107.66 107.66
Arkansas Blue Cross & Blue Shield Catastrophic 5 21 169.55 169.55
Arkansas Blue Cross & Blue Shield Catastrophic 5 22 169.55 169.55
Arkansas Blue Cross & Blue Shield Catastrophic 5 23 169.55 169.55
Arkansas Blue Cross & Blue Shield Catastrophic 5 24 169.55 169.55
Arkansas Blue Cross & Blue Shield Catastrophic 5 25 170.23 170.23
Arkansas Blue Cross & Blue Shield Catastrophic 5 26 173.62 173.62
Arkansas Blue Cross & Blue Shield Catastrophic 5 27 177.69 177.69
Arkansas Blue Cross & Blue Shield Catastrophic 5 28 184.3 184.3
Arkansas Blue Cross & Blue Shield Catastrophic 5 29 189.73 189.73
Arkansas Blue Cross & Blue Shield Catastrophic 5 30 192.44 192.44
Arkansas Blue Cross & Blue Shield Catastrophic 5 31 196.51 196.51
Arkansas Blue Cross & Blue Shield Catastrophic 5 32 200.58 200.58
Arkansas Blue Cross & Blue Shield Catastrophic 5 33 203.12 203.12
Arkansas Blue Cross & Blue Shield Catastrophic 5 34 205.83 205.83
Arkansas Blue Cross & Blue Shield Catastrophic 5 35 207.19 207.19
Arkansas Blue Cross & Blue Shield Catastrophic 5 36 208.55 208.55
Arkansas Blue Cross & Blue Shield Catastrophic 5 37 209.9 209.9
Arkansas Blue Cross & Blue Shield Catastrophic 5 38 211.26 211.26
Arkansas Blue Cross & Blue Shield Catastrophic 5 39 213.97 213.97
Arkansas Blue Cross & Blue Shield Catastrophic 5 40 216.68 216.68
Arkansas Blue Cross & Blue Shield Catastrophic 5 41 220.75 220.75
Arkansas Blue Cross & Blue Shield Catastrophic 5 42 224.65 224.65
Arkansas Blue Cross & Blue Shield Catastrophic 5 43 230.08 230.08
Arkansas Blue Cross & Blue Shield Catastrophic 5 44 236.86 236.86
Arkansas Blue Cross & Blue Shield Catastrophic 5 45 244.83 244.83
Arkansas Blue Cross & Blue Shield Catastrophic 5 46 254.32 254.32
Arkansas Blue Cross & Blue Shield Catastrophic 5 47 265.01 265.01
Arkansas Blue Cross & Blue Shield Catastrophic 5 48 277.21 277.21
Arkansas Blue Cross & Blue Shield Catastrophic 5 49 289.25 289.25
Arkansas Blue Cross & Blue Shield Catastrophic 5 50 302.82 302.82
Arkansas Blue Cross & Blue Shield Catastrophic 5 51 316.21 316.21
Arkansas Blue Cross & Blue Shield Catastrophic 5 52 330.96 330.96
Arkansas Blue Cross & Blue Shield Catastrophic 5 53 345.88 345.88
Arkansas Blue Cross & Blue Shield Catastrophic 5 54 361.99 361.99
Arkansas Blue Cross & Blue Shield Catastrophic 5 55 378.1 378.1
Arkansas Blue Cross & Blue Shield Catastrophic 5 56 395.56 395.56
Arkansas Blue Cross & Blue Shield Catastrophic 5 57 413.19 413.19
Arkansas Blue Cross & Blue Shield Catastrophic 5 58 432.01 432.01
Arkansas Blue Cross & Blue Shield Catastrophic 5 59 441.34 441.34
Arkansas Blue Cross & Blue Shield Catastrophic 5 60 460.16 460.16
Arkansas Blue Cross & Blue Shield Catastrophic 5 61 476.44 476.44
Arkansas Blue Cross & Blue Shield Catastrophic 5 62 487.12 487.12
Arkansas Blue Cross & Blue Shield Catastrophic 5 63 500.51 500.51
Arkansas Blue Cross & Blue Shield Catastrophic 5 64 508.65 508.65
Arkansas Blue Cross & Blue Shield Catastrophic 5 65 and
over
508.65 508.65
Arkansas Blue Cross & Blue Shield Catastrophic 6 0‐20 108.71 108.71
Arkansas Blue Cross & Blue Shield Catastrophic 6 21 171.2 171.2
Arkansas Blue Cross & Blue Shield Catastrophic 6 22 171.2 171.2
Arkansas Blue Cross & Blue Shield Catastrophic 6 23 171.2 171.2
Arkansas Blue Cross & Blue Shield Catastrophic 6 24 171.2 171.2
Arkansas Blue Cross & Blue Shield Catastrophic 6 25 171.88 171.88
Arkansas Blue Cross & Blue Shield Catastrophic 6 26 175.31 175.31
Arkansas Blue Cross & Blue Shield Catastrophic 6 27 179.42 179.42
Arkansas Blue Cross & Blue Shield Catastrophic 6 28 186.09 186.09
Arkansas Blue Cross & Blue Shield Catastrophic 6 29 191.57 191.57
Arkansas Blue Cross & Blue Shield Catastrophic 6 30 194.31 194.31
Arkansas Blue Cross & Blue Shield Catastrophic 6 31 198.42 198.42
Arkansas Blue Cross & Blue Shield Catastrophic 6 32 202.53 202.53
Arkansas Blue Cross & Blue Shield Catastrophic 6 33 205.1 205.1
Page 138 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Catastrophic 6 34 207.84 207.84
Arkansas Blue Cross & Blue Shield Catastrophic 6 35 209.21 209.21
Arkansas Blue Cross & Blue Shield Catastrophic 6 36 210.58 210.58
Arkansas Blue Cross & Blue Shield Catastrophic 6 37 211.95 211.95
Arkansas Blue Cross & Blue Shield Catastrophic 6 38 213.32 213.32
Arkansas Blue Cross & Blue Shield Catastrophic 6 39 216.05 216.05
Arkansas Blue Cross & Blue Shield Catastrophic 6 40 218.79 218.79
Arkansas Blue Cross & Blue Shield Catastrophic 6 41 222.9 222.9
Arkansas Blue Cross & Blue Shield Catastrophic 6 42 226.84 226.84
Arkansas Blue Cross & Blue Shield Catastrophic 6 43 232.32 232.32
Arkansas Blue Cross & Blue Shield Catastrophic 6 44 239.17 239.17
Arkansas Blue Cross & Blue Shield Catastrophic 6 45 247.21 247.21
Arkansas Blue Cross & Blue Shield Catastrophic 6 46 256.8 256.8
Arkansas Blue Cross & Blue Shield Catastrophic 6 47 267.59 267.59
Arkansas Blue Cross & Blue Shield Catastrophic 6 48 279.91 279.91
Arkansas Blue Cross & Blue Shield Catastrophic 6 49 292.07 292.07
Arkansas Blue Cross & Blue Shield Catastrophic 6 50 305.76 305.76
Arkansas Blue Cross & Blue Shield Catastrophic 6 51 319.29 319.29
Arkansas Blue Cross & Blue Shield Catastrophic 6 52 334.18 334.18
Arkansas Blue Cross & Blue Shield Catastrophic 6 53 349.25 349.25
Arkansas Blue Cross & Blue Shield Catastrophic 6 54 365.51 365.51
Arkansas Blue Cross & Blue Shield Catastrophic 6 55 381.78 381.78
Arkansas Blue Cross & Blue Shield Catastrophic 6 56 399.41 399.41
Arkansas Blue Cross & Blue Shield Catastrophic 6 57 417.21 417.21
Arkansas Blue Cross & Blue Shield Catastrophic 6 58 436.22 436.22
Arkansas Blue Cross & Blue Shield Catastrophic 6 59 445.63 445.63
Arkansas Blue Cross & Blue Shield Catastrophic 6 60 464.64 464.64
Arkansas Blue Cross & Blue Shield Catastrophic 6 61 481.07 481.07
Arkansas Blue Cross & Blue Shield Catastrophic 6 62 491.86 491.86
Arkansas Blue Cross & Blue Shield Catastrophic 6 63 505.38 505.38
Arkansas Blue Cross & Blue Shield Catastrophic 6 64 513.6 513.6
Arkansas Blue Cross & Blue Shield Catastrophic 6 65 and
over
513.6 513.6
Arkansas Blue Cross & Blue Shield Catastrophic 7 0‐20 97.29 97.29
Arkansas Blue Cross & Blue Shield Catastrophic 7 21 153.22 153.22
Arkansas Blue Cross & Blue Shield Catastrophic 7 22 153.22 153.22
Arkansas Blue Cross & Blue Shield Catastrophic 7 23 153.22 153.22
Arkansas Blue Cross & Blue Shield Catastrophic 7 24 153.22 153.22
Arkansas Blue Cross & Blue Shield Catastrophic 7 25 153.83 153.83
Arkansas Blue Cross & Blue Shield Catastrophic 7 26 156.9 156.9
Arkansas Blue Cross & Blue Shield Catastrophic 7 27 160.57 160.57
Arkansas Blue Cross & Blue Shield Catastrophic 7 28 166.55 166.55
Arkansas Blue Cross & Blue Shield Catastrophic 7 29 171.45 171.45
Arkansas Blue Cross & Blue Shield Catastrophic 7 30 173.9 173.9
Arkansas Blue Cross & Blue Shield Catastrophic 7 31 177.58 177.58
Arkansas Blue Cross & Blue Shield Catastrophic 7 32 181.26 181.26
Arkansas Blue Cross & Blue Shield Catastrophic 7 33 183.56 183.56
Arkansas Blue Cross & Blue Shield Catastrophic 7 34 186.01 186.01
Arkansas Blue Cross & Blue Shield Catastrophic 7 35 187.23 187.23
Arkansas Blue Cross & Blue Shield Catastrophic 7 36 188.46 188.46
Arkansas Blue Cross & Blue Shield Catastrophic 7 37 189.69 189.69
Arkansas Blue Cross & Blue Shield Catastrophic 7 38 190.91 190.91
Arkansas Blue Cross & Blue Shield Catastrophic 7 39 193.36 193.36
Arkansas Blue Cross & Blue Shield Catastrophic 7 40 195.82 195.82
Arkansas Blue Cross & Blue Shield Catastrophic 7 41 199.49 199.49
Arkansas Blue Cross & Blue Shield Catastrophic 7 42 203.02 203.02
Arkansas Blue Cross & Blue Shield Catastrophic 7 43 207.92 207.92
Arkansas Blue Cross & Blue Shield Catastrophic 7 44 214.05 214.05
Arkansas Blue Cross & Blue Shield Catastrophic 7 45 221.25 221.25
Arkansas Blue Cross & Blue Shield Catastrophic 7 46 229.83 229.83
Arkansas Blue Cross & Blue Shield Catastrophic 7 47 239.48 239.48
Arkansas Blue Cross & Blue Shield Catastrophic 7 48 250.51 250.51
Arkansas Blue Cross & Blue Shield Catastrophic 7 49 261.39 261.39
Page 139 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Catastrophic 7 50 273.65 273.65
Arkansas Blue Cross & Blue Shield Catastrophic 7 51 285.76 285.76
Arkansas Blue Cross & Blue Shield Catastrophic 7 52 299.09 299.09
Arkansas Blue Cross & Blue Shield Catastrophic 7 53 312.57 312.57
Arkansas Blue Cross & Blue Shield Catastrophic 7 54 327.12 327.12
Arkansas Blue Cross & Blue Shield Catastrophic 7 55 341.68 341.68
Arkansas Blue Cross & Blue Shield Catastrophic 7 56 357.46 357.46
Arkansas Blue Cross & Blue Shield Catastrophic 7 57 373.4 373.4
Arkansas Blue Cross & Blue Shield Catastrophic 7 58 390.4 390.4
Arkansas Blue Cross & Blue Shield Catastrophic 7 59 398.83 398.83
Arkansas Blue Cross & Blue Shield Catastrophic 7 60 415.84 415.84
Arkansas Blue Cross & Blue Shield Catastrophic 7 61 430.55 430.55
Arkansas Blue Cross & Blue Shield Catastrophic 7 62 440.2 440.2
Arkansas Blue Cross & Blue Shield Catastrophic 7 63 452.31 452.31
Arkansas Blue Cross & Blue Shield Catastrophic 7 64 459.66 459.66
Arkansas Blue Cross & Blue Shield Catastrophic 7 65 and
over
459.66 459.66
Arkansas Blue Cross & Blue Shield Gold 1000 1 0‐20 167.15 167.15
Arkansas Blue Cross & Blue Shield Gold 1000 1 21 263.23 263.23
Arkansas Blue Cross & Blue Shield Gold 1000 1 22 263.23 263.23
Arkansas Blue Cross & Blue Shield Gold 1000 1 23 263.23 263.23
Arkansas Blue Cross & Blue Shield Gold 1000 1 24 263.23 263.23
Arkansas Blue Cross & Blue Shield Gold 1000 1 25 264.28 264.28
Arkansas Blue Cross & Blue Shield Gold 1000 1 26 269.55 269.55
Arkansas Blue Cross & Blue Shield Gold 1000 1 27 275.87 275.87
Arkansas Blue Cross & Blue Shield Gold 1000 1 28 286.13 286.13
Arkansas Blue Cross & Blue Shield Gold 1000 1 29 294.55 294.55
Arkansas Blue Cross & Blue Shield Gold 1000 1 30 298.77 298.77
Arkansas Blue Cross & Blue Shield Gold 1000 1 31 305.08 305.08
Arkansas Blue Cross & Blue Shield Gold 1000 1 32 311.4 311.4
Arkansas Blue Cross & Blue Shield Gold 1000 1 33 315.35 315.35
Arkansas Blue Cross & Blue Shield Gold 1000 1 34 319.56 319.56
Arkansas Blue Cross & Blue Shield Gold 1000 1 35 321.67 321.67
Arkansas Blue Cross & Blue Shield Gold 1000 1 36 323.77 323.77
Arkansas Blue Cross & Blue Shield Gold 1000 1 37 325.88 325.88
Arkansas Blue Cross & Blue Shield Gold 1000 1 38 327.98 327.98
Arkansas Blue Cross & Blue Shield Gold 1000 1 39 332.2 332.2
Arkansas Blue Cross & Blue Shield Gold 1000 1 40 336.41 336.41
Arkansas Blue Cross & Blue Shield Gold 1000 1 41 342.73 342.73
Arkansas Blue Cross & Blue Shield Gold 1000 1 42 348.78 348.78
Arkansas Blue Cross & Blue Shield Gold 1000 1 43 357.2 357.2
Arkansas Blue Cross & Blue Shield Gold 1000 1 44 367.73 367.73
Arkansas Blue Cross & Blue Shield Gold 1000 1 45 380.1 380.1
Arkansas Blue Cross & Blue Shield Gold 1000 1 46 394.84 394.84
Arkansas Blue Cross & Blue Shield Gold 1000 1 47 411.43 411.43
Arkansas Blue Cross & Blue Shield Gold 1000 1 48 430.38 430.38
Arkansas Blue Cross & Blue Shield Gold 1000 1 49 449.07 449.07
Arkansas Blue Cross & Blue Shield Gold 1000 1 50 470.13 470.13
Arkansas Blue Cross & Blue Shield Gold 1000 1 51 490.92 490.92
Arkansas Blue Cross & Blue Shield Gold 1000 1 52 513.82 513.82
Arkansas Blue Cross & Blue Shield Gold 1000 1 53 536.99 536.99
Arkansas Blue Cross & Blue Shield Gold 1000 1 54 562 562
Arkansas Blue Cross & Blue Shield Gold 1000 1 55 587 587
Arkansas Blue Cross & Blue Shield Gold 1000 1 56 614.12 614.12
Arkansas Blue Cross & Blue Shield Gold 1000 1 57 641.49 641.49
Arkansas Blue Cross & Blue Shield Gold 1000 1 58 670.71 670.71
Arkansas Blue Cross & Blue Shield Gold 1000 1 59 685.19 685.19
Arkansas Blue Cross & Blue Shield Gold 1000 1 60 714.41 714.41
Arkansas Blue Cross & Blue Shield Gold 1000 1 61 739.68 739.68
Arkansas Blue Cross & Blue Shield Gold 1000 1 62 756.26 756.26
Arkansas Blue Cross & Blue Shield Gold 1000 1 63 777.05 777.05
Arkansas Blue Cross & Blue Shield Gold 1000 1 64 789.69 789.69
Page 140 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 1000 1 65 and
over
789.69 789.69
Arkansas Blue Cross & Blue Shield Gold 1000 2 0‐20 155.23 155.23
Arkansas Blue Cross & Blue Shield Gold 1000 2 21 244.46 244.46
Arkansas Blue Cross & Blue Shield Gold 1000 2 22 244.46 244.46
Arkansas Blue Cross & Blue Shield Gold 1000 2 23 244.46 244.46
Arkansas Blue Cross & Blue Shield Gold 1000 2 24 244.46 244.46
Arkansas Blue Cross & Blue Shield Gold 1000 2 25 245.44 245.44
Arkansas Blue Cross & Blue Shield Gold 1000 2 26 250.33 250.33
Arkansas Blue Cross & Blue Shield Gold 1000 2 27 256.19 256.19
Arkansas Blue Cross & Blue Shield Gold 1000 2 28 265.73 265.73
Arkansas Blue Cross & Blue Shield Gold 1000 2 29 273.55 273.55
Arkansas Blue Cross & Blue Shield Gold 1000 2 30 277.46 277.46
Arkansas Blue Cross & Blue Shield Gold 1000 2 31 283.33 283.33
Arkansas Blue Cross & Blue Shield Gold 1000 2 32 289.2 289.2
Arkansas Blue Cross & Blue Shield Gold 1000 2 33 292.86 292.86
Arkansas Blue Cross & Blue Shield Gold 1000 2 34 296.77 296.77
Arkansas Blue Cross & Blue Shield Gold 1000 2 35 298.73 298.73
Arkansas Blue Cross & Blue Shield Gold 1000 2 36 300.69 300.69
Arkansas Blue Cross & Blue Shield Gold 1000 2 37 302.64 302.64
Arkansas Blue Cross & Blue Shield Gold 1000 2 38 304.6 304.6
Arkansas Blue Cross & Blue Shield Gold 1000 2 39 308.51 308.51
Arkansas Blue Cross & Blue Shield Gold 1000 2 40 312.42 312.42
Arkansas Blue Cross & Blue Shield Gold 1000 2 41 318.29 318.29
Arkansas Blue Cross & Blue Shield Gold 1000 2 42 323.91 323.91
Arkansas Blue Cross & Blue Shield Gold 1000 2 43 331.73 331.73
Arkansas Blue Cross & Blue Shield Gold 1000 2 44 341.51 341.51
Arkansas Blue Cross & Blue Shield Gold 1000 2 45 353 353
Arkansas Blue Cross & Blue Shield Gold 1000 2 46 366.69 366.69
Arkansas Blue Cross & Blue Shield Gold 1000 2 47 382.09 382.09
Arkansas Blue Cross & Blue Shield Gold 1000 2 48 399.69 399.69
Arkansas Blue Cross & Blue Shield Gold 1000 2 49 417.05 417.05
Arkansas Blue Cross & Blue Shield Gold 1000 2 50 436.61 436.61
Arkansas Blue Cross & Blue Shield Gold 1000 2 51 455.92 455.92
Arkansas Blue Cross & Blue Shield Gold 1000 2 52 477.19 477.19
Arkansas Blue Cross & Blue Shield Gold 1000 2 53 498.7 498.7
Arkansas Blue Cross & Blue Shield Gold 1000 2 54 521.92 521.92
Arkansas Blue Cross & Blue Shield Gold 1000 2 55 545.15 545.15
Arkansas Blue Cross & Blue Shield Gold 1000 2 56 570.33 570.33
Arkansas Blue Cross & Blue Shield Gold 1000 2 57 595.75 595.75
Arkansas Blue Cross & Blue Shield Gold 1000 2 58 622.88 622.88
Arkansas Blue Cross & Blue Shield Gold 1000 2 59 636.33 636.33
Arkansas Blue Cross & Blue Shield Gold 1000 2 60 663.46 663.46
Arkansas Blue Cross & Blue Shield Gold 1000 2 61 686.93 686.93
Arkansas Blue Cross & Blue Shield Gold 1000 2 62 702.33 702.33
Arkansas Blue Cross & Blue Shield Gold 1000 2 63 721.65 721.65
Arkansas Blue Cross & Blue Shield Gold 1000 2 64 733.38 733.38
Arkansas Blue Cross & Blue Shield Gold 1000 2 65 and
over
733.38 733.38
Arkansas Blue Cross & Blue Shield Gold 1000 3 0‐20 157 157
Arkansas Blue Cross & Blue Shield Gold 1000 3 21 247.25 247.25
Arkansas Blue Cross & Blue Shield Gold 1000 3 22 247.25 247.25
Arkansas Blue Cross & Blue Shield Gold 1000 3 23 247.25 247.25
Arkansas Blue Cross & Blue Shield Gold 1000 3 24 247.25 247.25
Arkansas Blue Cross & Blue Shield Gold 1000 3 25 248.24 248.24
Arkansas Blue Cross & Blue Shield Gold 1000 3 26 253.18 253.18
Arkansas Blue Cross & Blue Shield Gold 1000 3 27 259.12 259.12
Arkansas Blue Cross & Blue Shield Gold 1000 3 28 268.76 268.76
Arkansas Blue Cross & Blue Shield Gold 1000 3 29 276.67 276.67
Arkansas Blue Cross & Blue Shield Gold 1000 3 30 280.63 280.63
Arkansas Blue Cross & Blue Shield Gold 1000 3 31 286.56 286.56
Arkansas Blue Cross & Blue Shield Gold 1000 3 32 292.5 292.5
Arkansas Blue Cross & Blue Shield Gold 1000 3 33 296.21 296.21
Page 141 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 1000 3 34 300.16 300.16
Arkansas Blue Cross & Blue Shield Gold 1000 3 35 302.14 302.14
Arkansas Blue Cross & Blue Shield Gold 1000 3 36 304.12 304.12
Arkansas Blue Cross & Blue Shield Gold 1000 3 37 306.1 306.1
Arkansas Blue Cross & Blue Shield Gold 1000 3 38 308.07 308.07
Arkansas Blue Cross & Blue Shield Gold 1000 3 39 312.03 312.03
Arkansas Blue Cross & Blue Shield Gold 1000 3 40 315.99 315.99
Arkansas Blue Cross & Blue Shield Gold 1000 3 41 321.92 321.92
Arkansas Blue Cross & Blue Shield Gold 1000 3 42 327.61 327.61
Arkansas Blue Cross & Blue Shield Gold 1000 3 43 335.52 335.52
Arkansas Blue Cross & Blue Shield Gold 1000 3 44 345.41 345.41
Arkansas Blue Cross & Blue Shield Gold 1000 3 45 357.03 357.03
Arkansas Blue Cross & Blue Shield Gold 1000 3 46 370.88 370.88
Arkansas Blue Cross & Blue Shield Gold 1000 3 47 386.45 386.45
Arkansas Blue Cross & Blue Shield Gold 1000 3 48 404.25 404.25
Arkansas Blue Cross & Blue Shield Gold 1000 3 49 421.81 421.81
Arkansas Blue Cross & Blue Shield Gold 1000 3 50 441.59 441.59
Arkansas Blue Cross & Blue Shield Gold 1000 3 51 461.12 461.12
Arkansas Blue Cross & Blue Shield Gold 1000 3 52 482.63 482.63
Arkansas Blue Cross & Blue Shield Gold 1000 3 53 504.39 504.39
Arkansas Blue Cross & Blue Shield Gold 1000 3 54 527.88 527.88
Arkansas Blue Cross & Blue Shield Gold 1000 3 55 551.37 551.37
Arkansas Blue Cross & Blue Shield Gold 1000 3 56 576.83 576.83
Arkansas Blue Cross & Blue Shield Gold 1000 3 57 602.55 602.55
Arkansas Blue Cross & Blue Shield Gold 1000 3 58 629.99 629.99
Arkansas Blue Cross & Blue Shield Gold 1000 3 59 643.59 643.59
Arkansas Blue Cross & Blue Shield Gold 1000 3 60 671.04 671.04
Arkansas Blue Cross & Blue Shield Gold 1000 3 61 694.77 694.77
Arkansas Blue Cross & Blue Shield Gold 1000 3 62 710.35 710.35
Arkansas Blue Cross & Blue Shield Gold 1000 3 63 729.88 729.88
Arkansas Blue Cross & Blue Shield Gold 1000 3 64 741.75 741.75
Arkansas Blue Cross & Blue Shield Gold 1000 3 65 and
over
741.75 741.75
Arkansas Blue Cross & Blue Shield Gold 1000 4 0‐20 154.27 154.27
Arkansas Blue Cross & Blue Shield Gold 1000 4 21 242.94 242.94
Arkansas Blue Cross & Blue Shield Gold 1000 4 22 242.94 242.94
Arkansas Blue Cross & Blue Shield Gold 1000 4 23 242.94 242.94
Arkansas Blue Cross & Blue Shield Gold 1000 4 24 242.94 242.94
Arkansas Blue Cross & Blue Shield Gold 1000 4 25 243.91 243.91
Arkansas Blue Cross & Blue Shield Gold 1000 4 26 248.77 248.77
Arkansas Blue Cross & Blue Shield Gold 1000 4 27 254.6 254.6
Arkansas Blue Cross & Blue Shield Gold 1000 4 28 264.08 264.08
Arkansas Blue Cross & Blue Shield Gold 1000 4 29 271.85 271.85
Arkansas Blue Cross & Blue Shield Gold 1000 4 30 275.74 275.74
Arkansas Blue Cross & Blue Shield Gold 1000 4 31 281.57 281.57
Arkansas Blue Cross & Blue Shield Gold 1000 4 32 287.4 287.4
Arkansas Blue Cross & Blue Shield Gold 1000 4 33 291.04 291.04
Arkansas Blue Cross & Blue Shield Gold 1000 4 34 294.93 294.93
Arkansas Blue Cross & Blue Shield Gold 1000 4 35 296.87 296.87
Arkansas Blue Cross & Blue Shield Gold 1000 4 36 298.82 298.82
Arkansas Blue Cross & Blue Shield Gold 1000 4 37 300.76 300.76
Arkansas Blue Cross & Blue Shield Gold 1000 4 38 302.7 302.7
Arkansas Blue Cross & Blue Shield Gold 1000 4 39 306.59 306.59
Arkansas Blue Cross & Blue Shield Gold 1000 4 40 310.48 310.48
Arkansas Blue Cross & Blue Shield Gold 1000 4 41 316.31 316.31
Arkansas Blue Cross & Blue Shield Gold 1000 4 42 321.9 321.9
Arkansas Blue Cross & Blue Shield Gold 1000 4 43 329.67 329.67
Arkansas Blue Cross & Blue Shield Gold 1000 4 44 339.39 339.39
Arkansas Blue Cross & Blue Shield Gold 1000 4 45 350.81 350.81
Arkansas Blue Cross & Blue Shield Gold 1000 4 46 364.41 364.41
Arkansas Blue Cross & Blue Shield Gold 1000 4 47 379.72 379.72
Arkansas Blue Cross & Blue Shield Gold 1000 4 48 397.21 397.21
Arkansas Blue Cross & Blue Shield Gold 1000 4 49 414.46 414.46
Page 142 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 1000 4 50 433.89 433.89
Arkansas Blue Cross & Blue Shield Gold 1000 4 51 453.08 453.08
Arkansas Blue Cross & Blue Shield Gold 1000 4 52 474.22 474.22
Arkansas Blue Cross & Blue Shield Gold 1000 4 53 495.6 495.6
Arkansas Blue Cross & Blue Shield Gold 1000 4 54 518.68 518.68
Arkansas Blue Cross & Blue Shield Gold 1000 4 55 541.76 541.76
Arkansas Blue Cross & Blue Shield Gold 1000 4 56 566.78 566.78
Arkansas Blue Cross & Blue Shield Gold 1000 4 57 592.04 592.04
Arkansas Blue Cross & Blue Shield Gold 1000 4 58 619.01 619.01
Arkansas Blue Cross & Blue Shield Gold 1000 4 59 632.37 632.37
Arkansas Blue Cross & Blue Shield Gold 1000 4 60 659.34 659.34
Arkansas Blue Cross & Blue Shield Gold 1000 4 61 682.66 682.66
Arkansas Blue Cross & Blue Shield Gold 1000 4 62 697.97 697.97
Arkansas Blue Cross & Blue Shield Gold 1000 4 63 717.16 717.16
Arkansas Blue Cross & Blue Shield Gold 1000 4 64 728.82 728.82
Arkansas Blue Cross & Blue Shield Gold 1000 4 65 and
over
728.82 728.82
Arkansas Blue Cross & Blue Shield Gold 1000 5 0‐20 165.54 165.54
Arkansas Blue Cross & Blue Shield Gold 1000 5 21 260.69 260.69
Arkansas Blue Cross & Blue Shield Gold 1000 5 22 260.69 260.69
Arkansas Blue Cross & Blue Shield Gold 1000 5 23 260.69 260.69
Arkansas Blue Cross & Blue Shield Gold 1000 5 24 260.69 260.69
Arkansas Blue Cross & Blue Shield Gold 1000 5 25 261.73 261.73
Arkansas Blue Cross & Blue Shield Gold 1000 5 26 266.95 266.95
Arkansas Blue Cross & Blue Shield Gold 1000 5 27 273.2 273.2
Arkansas Blue Cross & Blue Shield Gold 1000 5 28 283.37 283.37
Arkansas Blue Cross & Blue Shield Gold 1000 5 29 291.71 291.71
Arkansas Blue Cross & Blue Shield Gold 1000 5 30 295.88 295.88
Arkansas Blue Cross & Blue Shield Gold 1000 5 31 302.14 302.14
Arkansas Blue Cross & Blue Shield Gold 1000 5 32 308.4 308.4
Arkansas Blue Cross & Blue Shield Gold 1000 5 33 312.31 312.31
Arkansas Blue Cross & Blue Shield Gold 1000 5 34 316.48 316.48
Arkansas Blue Cross & Blue Shield Gold 1000 5 35 318.56 318.56
Arkansas Blue Cross & Blue Shield Gold 1000 5 36 320.65 320.65
Arkansas Blue Cross & Blue Shield Gold 1000 5 37 322.73 322.73
Arkansas Blue Cross & Blue Shield Gold 1000 5 38 324.82 324.82
Arkansas Blue Cross & Blue Shield Gold 1000 5 39 328.99 328.99
Arkansas Blue Cross & Blue Shield Gold 1000 5 40 333.16 333.16
Arkansas Blue Cross & Blue Shield Gold 1000 5 41 339.42 339.42
Arkansas Blue Cross & Blue Shield Gold 1000 5 42 345.41 345.41
Arkansas Blue Cross & Blue Shield Gold 1000 5 43 353.76 353.76
Arkansas Blue Cross & Blue Shield Gold 1000 5 44 364.18 364.18
Arkansas Blue Cross & Blue Shield Gold 1000 5 45 376.44 376.44
Arkansas Blue Cross & Blue Shield Gold 1000 5 46 391.04 391.04
Arkansas Blue Cross & Blue Shield Gold 1000 5 47 407.46 407.46
Arkansas Blue Cross & Blue Shield Gold 1000 5 48 426.23 426.23
Arkansas Blue Cross & Blue Shield Gold 1000 5 49 444.74 444.74
Arkansas Blue Cross & Blue Shield Gold 1000 5 50 465.59 465.59
Arkansas Blue Cross & Blue Shield Gold 1000 5 51 486.19 486.19
Arkansas Blue Cross & Blue Shield Gold 1000 5 52 508.87 508.87
Arkansas Blue Cross & Blue Shield Gold 1000 5 53 531.81 531.81
Arkansas Blue Cross & Blue Shield Gold 1000 5 54 556.57 556.57
Arkansas Blue Cross & Blue Shield Gold 1000 5 55 581.34 581.34
Arkansas Blue Cross & Blue Shield Gold 1000 5 56 608.19 608.19
Arkansas Blue Cross & Blue Shield Gold 1000 5 57 635.3 635.3
Arkansas Blue Cross & Blue Shield Gold 1000 5 58 664.24 664.24
Arkansas Blue Cross & Blue Shield Gold 1000 5 59 678.58 678.58
Arkansas Blue Cross & Blue Shield Gold 1000 5 60 707.51 707.51
Arkansas Blue Cross & Blue Shield Gold 1000 5 61 732.54 732.54
Arkansas Blue Cross & Blue Shield Gold 1000 5 62 748.96 748.96
Arkansas Blue Cross & Blue Shield Gold 1000 5 63 769.56 769.56
Arkansas Blue Cross & Blue Shield Gold 1000 5 64 782.07 782.07
Page 143 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 1000 5 65 and
over
782.07 782.07
Arkansas Blue Cross & Blue Shield Gold 1000 6 0‐20 167.15 167.15
Arkansas Blue Cross & Blue Shield Gold 1000 6 21 263.23 263.23
Arkansas Blue Cross & Blue Shield Gold 1000 6 22 263.23 263.23
Arkansas Blue Cross & Blue Shield Gold 1000 6 23 263.23 263.23
Arkansas Blue Cross & Blue Shield Gold 1000 6 24 263.23 263.23
Arkansas Blue Cross & Blue Shield Gold 1000 6 25 264.28 264.28
Arkansas Blue Cross & Blue Shield Gold 1000 6 26 269.55 269.55
Arkansas Blue Cross & Blue Shield Gold 1000 6 27 275.87 275.87
Arkansas Blue Cross & Blue Shield Gold 1000 6 28 286.13 286.13
Arkansas Blue Cross & Blue Shield Gold 1000 6 29 294.55 294.55
Arkansas Blue Cross & Blue Shield Gold 1000 6 30 298.77 298.77
Arkansas Blue Cross & Blue Shield Gold 1000 6 31 305.08 305.08
Arkansas Blue Cross & Blue Shield Gold 1000 6 32 311.4 311.4
Arkansas Blue Cross & Blue Shield Gold 1000 6 33 315.35 315.35
Arkansas Blue Cross & Blue Shield Gold 1000 6 34 319.56 319.56
Arkansas Blue Cross & Blue Shield Gold 1000 6 35 321.67 321.67
Arkansas Blue Cross & Blue Shield Gold 1000 6 36 323.77 323.77
Arkansas Blue Cross & Blue Shield Gold 1000 6 37 325.88 325.88
Arkansas Blue Cross & Blue Shield Gold 1000 6 38 327.98 327.98
Arkansas Blue Cross & Blue Shield Gold 1000 6 39 332.2 332.2
Arkansas Blue Cross & Blue Shield Gold 1000 6 40 336.41 336.41
Arkansas Blue Cross & Blue Shield Gold 1000 6 41 342.73 342.73
Arkansas Blue Cross & Blue Shield Gold 1000 6 42 348.78 348.78
Arkansas Blue Cross & Blue Shield Gold 1000 6 43 357.2 357.2
Arkansas Blue Cross & Blue Shield Gold 1000 6 44 367.73 367.73
Arkansas Blue Cross & Blue Shield Gold 1000 6 45 380.1 380.1
Arkansas Blue Cross & Blue Shield Gold 1000 6 46 394.84 394.84
Arkansas Blue Cross & Blue Shield Gold 1000 6 47 411.43 411.43
Arkansas Blue Cross & Blue Shield Gold 1000 6 48 430.38 430.38
Arkansas Blue Cross & Blue Shield Gold 1000 6 49 449.07 449.07
Arkansas Blue Cross & Blue Shield Gold 1000 6 50 470.13 470.13
Arkansas Blue Cross & Blue Shield Gold 1000 6 51 490.92 490.92
Arkansas Blue Cross & Blue Shield Gold 1000 6 52 513.82 513.82
Arkansas Blue Cross & Blue Shield Gold 1000 6 53 536.99 536.99
Arkansas Blue Cross & Blue Shield Gold 1000 6 54 562 562
Arkansas Blue Cross & Blue Shield Gold 1000 6 55 587 587
Arkansas Blue Cross & Blue Shield Gold 1000 6 56 614.12 614.12
Arkansas Blue Cross & Blue Shield Gold 1000 6 57 641.49 641.49
Arkansas Blue Cross & Blue Shield Gold 1000 6 58 670.71 670.71
Arkansas Blue Cross & Blue Shield Gold 1000 6 59 685.19 685.19
Arkansas Blue Cross & Blue Shield Gold 1000 6 60 714.41 714.41
Arkansas Blue Cross & Blue Shield Gold 1000 6 61 739.68 739.68
Arkansas Blue Cross & Blue Shield Gold 1000 6 62 756.26 756.26
Arkansas Blue Cross & Blue Shield Gold 1000 6 63 777.05 777.05
Arkansas Blue Cross & Blue Shield Gold 1000 6 64 789.69 789.69
Arkansas Blue Cross & Blue Shield Gold 1000 6 65 and
over
789.69 789.69
Arkansas Blue Cross & Blue Shield Gold 1000 7 0‐20 149.6 149.6
Arkansas Blue Cross & Blue Shield Gold 1000 7 21 235.59 235.59
Arkansas Blue Cross & Blue Shield Gold 1000 7 22 235.59 235.59
Arkansas Blue Cross & Blue Shield Gold 1000 7 23 235.59 235.59
Arkansas Blue Cross & Blue Shield Gold 1000 7 24 235.59 235.59
Arkansas Blue Cross & Blue Shield Gold 1000 7 25 236.53 236.53
Arkansas Blue Cross & Blue Shield Gold 1000 7 26 241.24 241.24
Arkansas Blue Cross & Blue Shield Gold 1000 7 27 246.9 246.9
Arkansas Blue Cross & Blue Shield Gold 1000 7 28 256.09 256.09
Arkansas Blue Cross & Blue Shield Gold 1000 7 29 263.63 263.63
Arkansas Blue Cross & Blue Shield Gold 1000 7 30 267.39 267.39
Arkansas Blue Cross & Blue Shield Gold 1000 7 31 273.05 273.05
Arkansas Blue Cross & Blue Shield Gold 1000 7 32 278.7 278.7
Arkansas Blue Cross & Blue Shield Gold 1000 7 33 282.24 282.24
Page 144 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 1000 7 34 286.01 286.01
Arkansas Blue Cross & Blue Shield Gold 1000 7 35 287.89 287.89
Arkansas Blue Cross & Blue Shield Gold 1000 7 36 289.78 289.78
Arkansas Blue Cross & Blue Shield Gold 1000 7 37 291.66 291.66
Arkansas Blue Cross & Blue Shield Gold 1000 7 38 293.55 293.55
Arkansas Blue Cross & Blue Shield Gold 1000 7 39 297.31 297.31
Arkansas Blue Cross & Blue Shield Gold 1000 7 40 301.08 301.08
Arkansas Blue Cross & Blue Shield Gold 1000 7 41 306.74 306.74
Arkansas Blue Cross & Blue Shield Gold 1000 7 42 312.16 312.16
Arkansas Blue Cross & Blue Shield Gold 1000 7 43 319.7 319.7
Arkansas Blue Cross & Blue Shield Gold 1000 7 44 329.12 329.12
Arkansas Blue Cross & Blue Shield Gold 1000 7 45 340.19 340.19
Arkansas Blue Cross & Blue Shield Gold 1000 7 46 353.38 353.38
Arkansas Blue Cross & Blue Shield Gold 1000 7 47 368.23 368.23
Arkansas Blue Cross & Blue Shield Gold 1000 7 48 385.19 385.19
Arkansas Blue Cross & Blue Shield Gold 1000 7 49 401.92 401.92
Arkansas Blue Cross & Blue Shield Gold 1000 7 50 420.76 420.76
Arkansas Blue Cross & Blue Shield Gold 1000 7 51 439.38 439.38
Arkansas Blue Cross & Blue Shield Gold 1000 7 52 459.87 459.87
Arkansas Blue Cross & Blue Shield Gold 1000 7 53 480.6 480.6
Arkansas Blue Cross & Blue Shield Gold 1000 7 54 502.98 502.98
Arkansas Blue Cross & Blue Shield Gold 1000 7 55 525.37 525.37
Arkansas Blue Cross & Blue Shield Gold 1000 7 56 549.63 549.63
Arkansas Blue Cross & Blue Shield Gold 1000 7 57 574.13 574.13
Arkansas Blue Cross & Blue Shield Gold 1000 7 58 600.28 600.28
Arkansas Blue Cross & Blue Shield Gold 1000 7 59 613.24 613.24
Arkansas Blue Cross & Blue Shield Gold 1000 7 60 639.39 639.39
Arkansas Blue Cross & Blue Shield Gold 1000 7 61 662.01 662.01
Arkansas Blue Cross & Blue Shield Gold 1000 7 62 676.85 676.85
Arkansas Blue Cross & Blue Shield Gold 1000 7 63 695.46 695.46
Arkansas Blue Cross & Blue Shield Gold 1000 7 64 706.77 706.77
Arkansas Blue Cross & Blue Shield Gold 1000 7 65 and
over
706.77 706.77
Arkansas Blue Cross & Blue Shield Gold 500 1 0‐20 180.05 180.05
Arkansas Blue Cross & Blue Shield Gold 500 1 21 283.54 283.54
Arkansas Blue Cross & Blue Shield Gold 500 1 22 283.54 283.54
Arkansas Blue Cross & Blue Shield Gold 500 1 23 283.54 283.54
Arkansas Blue Cross & Blue Shield Gold 500 1 24 283.54 283.54
Arkansas Blue Cross & Blue Shield Gold 500 1 25 284.67 284.67
Arkansas Blue Cross & Blue Shield Gold 500 1 26 290.34 290.34
Arkansas Blue Cross & Blue Shield Gold 500 1 27 297.15 297.15
Arkansas Blue Cross & Blue Shield Gold 500 1 28 308.21 308.21
Arkansas Blue Cross & Blue Shield Gold 500 1 29 317.28 317.28
Arkansas Blue Cross & Blue Shield Gold 500 1 30 321.82 321.82
Arkansas Blue Cross & Blue Shield Gold 500 1 31 328.62 328.62
Arkansas Blue Cross & Blue Shield Gold 500 1 32 335.43 335.43
Arkansas Blue Cross & Blue Shield Gold 500 1 33 339.68 339.68
Arkansas Blue Cross & Blue Shield Gold 500 1 34 344.22 344.22
Arkansas Blue Cross & Blue Shield Gold 500 1 35 346.49 346.49
Arkansas Blue Cross & Blue Shield Gold 500 1 36 348.75 348.75
Arkansas Blue Cross & Blue Shield Gold 500 1 37 351.02 351.02
Arkansas Blue Cross & Blue Shield Gold 500 1 38 353.29 353.29
Arkansas Blue Cross & Blue Shield Gold 500 1 39 357.83 357.83
Arkansas Blue Cross & Blue Shield Gold 500 1 40 362.36 362.36
Arkansas Blue Cross & Blue Shield Gold 500 1 41 369.17 369.17
Arkansas Blue Cross & Blue Shield Gold 500 1 42 375.69 375.69
Arkansas Blue Cross & Blue Shield Gold 500 1 43 384.76 384.76
Arkansas Blue Cross & Blue Shield Gold 500 1 44 396.11 396.11
Arkansas Blue Cross & Blue Shield Gold 500 1 45 409.43 409.43
Arkansas Blue Cross & Blue Shield Gold 500 1 46 425.31 425.31
Arkansas Blue Cross & Blue Shield Gold 500 1 47 443.17 443.17
Arkansas Blue Cross & Blue Shield Gold 500 1 48 463.59 463.59
Arkansas Blue Cross & Blue Shield Gold 500 1 49 483.72 483.72
Page 145 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 500 1 50 506.4 506.4
Arkansas Blue Cross & Blue Shield Gold 500 1 51 528.8 528.8
Arkansas Blue Cross & Blue Shield Gold 500 1 52 553.47 553.47
Arkansas Blue Cross & Blue Shield Gold 500 1 53 578.42 578.42
Arkansas Blue Cross & Blue Shield Gold 500 1 54 605.36 605.36
Arkansas Blue Cross & Blue Shield Gold 500 1 55 632.29 632.29
Arkansas Blue Cross & Blue Shield Gold 500 1 56 661.5 661.5
Arkansas Blue Cross & Blue Shield Gold 500 1 57 690.99 690.99
Arkansas Blue Cross & Blue Shield Gold 500 1 58 722.46 722.46
Arkansas Blue Cross & Blue Shield Gold 500 1 59 738.05 738.05
Arkansas Blue Cross & Blue Shield Gold 500 1 60 769.53 769.53
Arkansas Blue Cross & Blue Shield Gold 500 1 61 796.75 796.75
Arkansas Blue Cross & Blue Shield Gold 500 1 62 814.61 814.61
Arkansas Blue Cross & Blue Shield Gold 500 1 63 837.01 837.01
Arkansas Blue Cross & Blue Shield Gold 500 1 64 850.62 850.62
Arkansas Blue Cross & Blue Shield Gold 500 1 65 and
over
850.62 850.62
Arkansas Blue Cross & Blue Shield Gold 500 2 0‐20 167.21 167.21
Arkansas Blue Cross & Blue Shield Gold 500 2 21 263.32 263.32
Arkansas Blue Cross & Blue Shield Gold 500 2 22 263.32 263.32
Arkansas Blue Cross & Blue Shield Gold 500 2 23 263.32 263.32
Arkansas Blue Cross & Blue Shield Gold 500 2 24 263.32 263.32
Arkansas Blue Cross & Blue Shield Gold 500 2 25 264.37 264.37
Arkansas Blue Cross & Blue Shield Gold 500 2 26 269.64 269.64
Arkansas Blue Cross & Blue Shield Gold 500 2 27 275.96 275.96
Arkansas Blue Cross & Blue Shield Gold 500 2 28 286.23 286.23
Arkansas Blue Cross & Blue Shield Gold 500 2 29 294.66 294.66
Arkansas Blue Cross & Blue Shield Gold 500 2 30 298.87 298.87
Arkansas Blue Cross & Blue Shield Gold 500 2 31 305.19 305.19
Arkansas Blue Cross & Blue Shield Gold 500 2 32 311.51 311.51
Arkansas Blue Cross & Blue Shield Gold 500 2 33 315.46 315.46
Arkansas Blue Cross & Blue Shield Gold 500 2 34 319.67 319.67
Arkansas Blue Cross & Blue Shield Gold 500 2 35 321.78 321.78
Arkansas Blue Cross & Blue Shield Gold 500 2 36 323.88 323.88
Arkansas Blue Cross & Blue Shield Gold 500 2 37 325.99 325.99
Arkansas Blue Cross & Blue Shield Gold 500 2 38 328.1 328.1
Arkansas Blue Cross & Blue Shield Gold 500 2 39 332.31 332.31
Arkansas Blue Cross & Blue Shield Gold 500 2 40 336.52 336.52
Arkansas Blue Cross & Blue Shield Gold 500 2 41 342.84 342.84
Arkansas Blue Cross & Blue Shield Gold 500 2 42 348.9 348.9
Arkansas Blue Cross & Blue Shield Gold 500 2 43 357.33 357.33
Arkansas Blue Cross & Blue Shield Gold 500 2 44 367.86 367.86
Arkansas Blue Cross & Blue Shield Gold 500 2 45 380.23 380.23
Arkansas Blue Cross & Blue Shield Gold 500 2 46 394.98 394.98
Arkansas Blue Cross & Blue Shield Gold 500 2 47 411.57 411.57
Arkansas Blue Cross & Blue Shield Gold 500 2 48 430.53 430.53
Arkansas Blue Cross & Blue Shield Gold 500 2 49 449.22 449.22
Arkansas Blue Cross & Blue Shield Gold 500 2 50 470.29 470.29
Arkansas Blue Cross & Blue Shield Gold 500 2 51 491.09 491.09
Arkansas Blue Cross & Blue Shield Gold 500 2 52 514 514
Arkansas Blue Cross & Blue Shield Gold 500 2 53 537.17 537.17
Arkansas Blue Cross & Blue Shield Gold 500 2 54 562.19 562.19
Arkansas Blue Cross & Blue Shield Gold 500 2 55 587.2 587.2
Arkansas Blue Cross & Blue Shield Gold 500 2 56 614.33 614.33
Arkansas Blue Cross & Blue Shield Gold 500 2 57 641.71 641.71
Arkansas Blue Cross & Blue Shield Gold 500 2 58 670.94 670.94
Arkansas Blue Cross & Blue Shield Gold 500 2 59 685.42 685.42
Arkansas Blue Cross & Blue Shield Gold 500 2 60 714.65 714.65
Arkansas Blue Cross & Blue Shield Gold 500 2 61 739.93 739.93
Arkansas Blue Cross & Blue Shield Gold 500 2 62 756.52 756.52
Arkansas Blue Cross & Blue Shield Gold 500 2 63 777.32 777.32
Arkansas Blue Cross & Blue Shield Gold 500 2 64 789.96 789.96
Page 146 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 500 2 65 and
over
789.96 789.96
Arkansas Blue Cross & Blue Shield Gold 500 3 0‐20 169.12 169.12
Arkansas Blue Cross & Blue Shield Gold 500 3 21 266.33 266.33
Arkansas Blue Cross & Blue Shield Gold 500 3 22 266.33 266.33
Arkansas Blue Cross & Blue Shield Gold 500 3 23 266.33 266.33
Arkansas Blue Cross & Blue Shield Gold 500 3 24 266.33 266.33
Arkansas Blue Cross & Blue Shield Gold 500 3 25 267.4 267.4
Arkansas Blue Cross & Blue Shield Gold 500 3 26 272.72 272.72
Arkansas Blue Cross & Blue Shield Gold 500 3 27 279.11 279.11
Arkansas Blue Cross & Blue Shield Gold 500 3 28 289.5 289.5
Arkansas Blue Cross & Blue Shield Gold 500 3 29 298.02 298.02
Arkansas Blue Cross & Blue Shield Gold 500 3 30 302.28 302.28
Arkansas Blue Cross & Blue Shield Gold 500 3 31 308.68 308.68
Arkansas Blue Cross & Blue Shield Gold 500 3 32 315.07 315.07
Arkansas Blue Cross & Blue Shield Gold 500 3 33 319.06 319.06
Arkansas Blue Cross & Blue Shield Gold 500 3 34 323.32 323.32
Arkansas Blue Cross & Blue Shield Gold 500 3 35 325.46 325.46
Arkansas Blue Cross & Blue Shield Gold 500 3 36 327.59 327.59
Arkansas Blue Cross & Blue Shield Gold 500 3 37 329.72 329.72
Arkansas Blue Cross & Blue Shield Gold 500 3 38 331.85 331.85
Arkansas Blue Cross & Blue Shield Gold 500 3 39 336.11 336.11
Arkansas Blue Cross & Blue Shield Gold 500 3 40 340.37 340.37
Arkansas Blue Cross & Blue Shield Gold 500 3 41 346.76 346.76
Arkansas Blue Cross & Blue Shield Gold 500 3 42 352.89 352.89
Arkansas Blue Cross & Blue Shield Gold 500 3 43 361.41 361.41
Arkansas Blue Cross & Blue Shield Gold 500 3 44 372.06 372.06
Arkansas Blue Cross & Blue Shield Gold 500 3 45 384.58 384.58
Arkansas Blue Cross & Blue Shield Gold 500 3 46 399.5 399.5
Arkansas Blue Cross & Blue Shield Gold 500 3 47 416.27 416.27
Arkansas Blue Cross & Blue Shield Gold 500 3 48 435.45 435.45
Arkansas Blue Cross & Blue Shield Gold 500 3 49 454.36 454.36
Arkansas Blue Cross & Blue Shield Gold 500 3 50 475.67 475.67
Arkansas Blue Cross & Blue Shield Gold 500 3 51 496.71 496.71
Arkansas Blue Cross & Blue Shield Gold 500 3 52 519.88 519.88
Arkansas Blue Cross & Blue Shield Gold 500 3 53 543.31 543.31
Arkansas Blue Cross & Blue Shield Gold 500 3 54 568.61 568.61
Arkansas Blue Cross & Blue Shield Gold 500 3 55 593.92 593.92
Arkansas Blue Cross & Blue Shield Gold 500 3 56 621.35 621.35
Arkansas Blue Cross & Blue Shield Gold 500 3 57 649.05 649.05
Arkansas Blue Cross & Blue Shield Gold 500 3 58 678.61 678.61
Arkansas Blue Cross & Blue Shield Gold 500 3 59 693.26 693.26
Arkansas Blue Cross & Blue Shield Gold 500 3 60 722.82 722.82
Arkansas Blue Cross & Blue Shield Gold 500 3 61 748.39 748.39
Arkansas Blue Cross & Blue Shield Gold 500 3 62 765.17 765.17
Arkansas Blue Cross & Blue Shield Gold 500 3 63 786.21 786.21
Arkansas Blue Cross & Blue Shield Gold 500 3 64 798.99 798.99
Arkansas Blue Cross & Blue Shield Gold 500 3 65 and
over
798.99 798.99
Arkansas Blue Cross & Blue Shield Gold 500 4 0‐20 166.17 166.17
Arkansas Blue Cross & Blue Shield Gold 500 4 21 261.68 261.68
Arkansas Blue Cross & Blue Shield Gold 500 4 22 261.68 261.68
Arkansas Blue Cross & Blue Shield Gold 500 4 23 261.68 261.68
Arkansas Blue Cross & Blue Shield Gold 500 4 24 261.68 261.68
Arkansas Blue Cross & Blue Shield Gold 500 4 25 262.73 262.73
Arkansas Blue Cross & Blue Shield Gold 500 4 26 267.96 267.96
Arkansas Blue Cross & Blue Shield Gold 500 4 27 274.24 274.24
Arkansas Blue Cross & Blue Shield Gold 500 4 28 284.45 284.45
Arkansas Blue Cross & Blue Shield Gold 500 4 29 292.82 292.82
Arkansas Blue Cross & Blue Shield Gold 500 4 30 297.01 297.01
Arkansas Blue Cross & Blue Shield Gold 500 4 31 303.29 303.29
Arkansas Blue Cross & Blue Shield Gold 500 4 32 309.57 309.57
Arkansas Blue Cross & Blue Shield Gold 500 4 33 313.49 313.49
Page 147 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 500 4 34 317.68 317.68
Arkansas Blue Cross & Blue Shield Gold 500 4 35 319.77 319.77
Arkansas Blue Cross & Blue Shield Gold 500 4 36 321.87 321.87
Arkansas Blue Cross & Blue Shield Gold 500 4 37 323.96 323.96
Arkansas Blue Cross & Blue Shield Gold 500 4 38 326.05 326.05
Arkansas Blue Cross & Blue Shield Gold 500 4 39 330.24 330.24
Arkansas Blue Cross & Blue Shield Gold 500 4 40 334.43 334.43
Arkansas Blue Cross & Blue Shield Gold 500 4 41 340.71 340.71
Arkansas Blue Cross & Blue Shield Gold 500 4 42 346.73 346.73
Arkansas Blue Cross & Blue Shield Gold 500 4 43 355.1 355.1
Arkansas Blue Cross & Blue Shield Gold 500 4 44 365.57 365.57
Arkansas Blue Cross & Blue Shield Gold 500 4 45 377.87 377.87
Arkansas Blue Cross & Blue Shield Gold 500 4 46 392.52 392.52
Arkansas Blue Cross & Blue Shield Gold 500 4 47 409.01 409.01
Arkansas Blue Cross & Blue Shield Gold 500 4 48 427.85 427.85
Arkansas Blue Cross & Blue Shield Gold 500 4 49 446.43 446.43
Arkansas Blue Cross & Blue Shield Gold 500 4 50 467.36 467.36
Arkansas Blue Cross & Blue Shield Gold 500 4 51 488.03 488.03
Arkansas Blue Cross & Blue Shield Gold 500 4 52 510.8 510.8
Arkansas Blue Cross & Blue Shield Gold 500 4 53 533.83 533.83
Arkansas Blue Cross & Blue Shield Gold 500 4 54 558.69 558.69
Arkansas Blue Cross & Blue Shield Gold 500 4 55 583.55 583.55
Arkansas Blue Cross & Blue Shield Gold 500 4 56 610.5 610.5
Arkansas Blue Cross & Blue Shield Gold 500 4 57 637.71 637.71
Arkansas Blue Cross & Blue Shield Gold 500 4 58 666.76 666.76
Arkansas Blue Cross & Blue Shield Gold 500 4 59 681.15 681.15
Arkansas Blue Cross & Blue Shield Gold 500 4 60 710.2 710.2
Arkansas Blue Cross & Blue Shield Gold 500 4 61 735.32 735.32
Arkansas Blue Cross & Blue Shield Gold 500 4 62 751.81 751.81
Arkansas Blue Cross & Blue Shield Gold 500 4 63 772.48 772.48
Arkansas Blue Cross & Blue Shield Gold 500 4 64 785.04 785.04
Arkansas Blue Cross & Blue Shield Gold 500 4 65 and
over
785.04 785.04
Arkansas Blue Cross & Blue Shield Gold 500 5 0‐20 178.31 178.31
Arkansas Blue Cross & Blue Shield Gold 500 5 21 280.81 280.81
Arkansas Blue Cross & Blue Shield Gold 500 5 22 280.81 280.81
Arkansas Blue Cross & Blue Shield Gold 500 5 23 280.81 280.81
Arkansas Blue Cross & Blue Shield Gold 500 5 24 280.81 280.81
Arkansas Blue Cross & Blue Shield Gold 500 5 25 281.93 281.93
Arkansas Blue Cross & Blue Shield Gold 500 5 26 287.55 287.55
Arkansas Blue Cross & Blue Shield Gold 500 5 27 294.29 294.29
Arkansas Blue Cross & Blue Shield Gold 500 5 28 305.24 305.24
Arkansas Blue Cross & Blue Shield Gold 500 5 29 314.23 314.23
Arkansas Blue Cross & Blue Shield Gold 500 5 30 318.72 318.72
Arkansas Blue Cross & Blue Shield Gold 500 5 31 325.46 325.46
Arkansas Blue Cross & Blue Shield Gold 500 5 32 332.2 332.2
Arkansas Blue Cross & Blue Shield Gold 500 5 33 336.41 336.41
Arkansas Blue Cross & Blue Shield Gold 500 5 34 340.9 340.9
Arkansas Blue Cross & Blue Shield Gold 500 5 35 343.15 343.15
Arkansas Blue Cross & Blue Shield Gold 500 5 36 345.4 345.4
Arkansas Blue Cross & Blue Shield Gold 500 5 37 347.64 347.64
Arkansas Blue Cross & Blue Shield Gold 500 5 38 349.89 349.89
Arkansas Blue Cross & Blue Shield Gold 500 5 39 354.38 354.38
Arkansas Blue Cross & Blue Shield Gold 500 5 40 358.88 358.88
Arkansas Blue Cross & Blue Shield Gold 500 5 41 365.61 365.61
Arkansas Blue Cross & Blue Shield Gold 500 5 42 372.07 372.07
Arkansas Blue Cross & Blue Shield Gold 500 5 43 381.06 381.06
Arkansas Blue Cross & Blue Shield Gold 500 5 44 392.29 392.29
Arkansas Blue Cross & Blue Shield Gold 500 5 45 405.49 405.49
Arkansas Blue Cross & Blue Shield Gold 500 5 46 421.22 421.22
Arkansas Blue Cross & Blue Shield Gold 500 5 47 438.91 438.91
Arkansas Blue Cross & Blue Shield Gold 500 5 48 459.12 459.12
Arkansas Blue Cross & Blue Shield Gold 500 5 49 479.06 479.06
Page 148 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 500 5 50 501.53 501.53
Arkansas Blue Cross & Blue Shield Gold 500 5 51 523.71 523.71
Arkansas Blue Cross & Blue Shield Gold 500 5 52 548.14 548.14
Arkansas Blue Cross & Blue Shield Gold 500 5 53 572.85 572.85
Arkansas Blue Cross & Blue Shield Gold 500 5 54 599.53 599.53
Arkansas Blue Cross & Blue Shield Gold 500 5 55 626.21 626.21
Arkansas Blue Cross & Blue Shield Gold 500 5 56 655.13 655.13
Arkansas Blue Cross & Blue Shield Gold 500 5 57 684.33 684.33
Arkansas Blue Cross & Blue Shield Gold 500 5 58 715.5 715.5
Arkansas Blue Cross & Blue Shield Gold 500 5 59 730.95 730.95
Arkansas Blue Cross & Blue Shield Gold 500 5 60 762.12 762.12
Arkansas Blue Cross & Blue Shield Gold 500 5 61 789.08 789.08
Arkansas Blue Cross & Blue Shield Gold 500 5 62 806.77 806.77
Arkansas Blue Cross & Blue Shield Gold 500 5 63 828.95 828.95
Arkansas Blue Cross & Blue Shield Gold 500 5 64 842.43 842.43
Arkansas Blue Cross & Blue Shield Gold 500 5 65 and
over
842.43 842.43
Arkansas Blue Cross & Blue Shield Gold 500 6 0‐20 180.05 180.05
Arkansas Blue Cross & Blue Shield Gold 500 6 21 283.54 283.54
Arkansas Blue Cross & Blue Shield Gold 500 6 22 283.54 283.54
Arkansas Blue Cross & Blue Shield Gold 500 6 23 283.54 283.54
Arkansas Blue Cross & Blue Shield Gold 500 6 24 283.54 283.54
Arkansas Blue Cross & Blue Shield Gold 500 6 25 284.67 284.67
Arkansas Blue Cross & Blue Shield Gold 500 6 26 290.34 290.34
Arkansas Blue Cross & Blue Shield Gold 500 6 27 297.15 297.15
Arkansas Blue Cross & Blue Shield Gold 500 6 28 308.21 308.21
Arkansas Blue Cross & Blue Shield Gold 500 6 29 317.28 317.28
Arkansas Blue Cross & Blue Shield Gold 500 6 30 321.82 321.82
Arkansas Blue Cross & Blue Shield Gold 500 6 31 328.62 328.62
Arkansas Blue Cross & Blue Shield Gold 500 6 32 335.43 335.43
Arkansas Blue Cross & Blue Shield Gold 500 6 33 339.68 339.68
Arkansas Blue Cross & Blue Shield Gold 500 6 34 344.22 344.22
Arkansas Blue Cross & Blue Shield Gold 500 6 35 346.49 346.49
Arkansas Blue Cross & Blue Shield Gold 500 6 36 348.75 348.75
Arkansas Blue Cross & Blue Shield Gold 500 6 37 351.02 351.02
Arkansas Blue Cross & Blue Shield Gold 500 6 38 353.29 353.29
Arkansas Blue Cross & Blue Shield Gold 500 6 39 357.83 357.83
Arkansas Blue Cross & Blue Shield Gold 500 6 40 362.36 362.36
Arkansas Blue Cross & Blue Shield Gold 500 6 41 369.17 369.17
Arkansas Blue Cross & Blue Shield Gold 500 6 42 375.69 375.69
Arkansas Blue Cross & Blue Shield Gold 500 6 43 384.76 384.76
Arkansas Blue Cross & Blue Shield Gold 500 6 44 396.11 396.11
Arkansas Blue Cross & Blue Shield Gold 500 6 45 409.43 409.43
Arkansas Blue Cross & Blue Shield Gold 500 6 46 425.31 425.31
Arkansas Blue Cross & Blue Shield Gold 500 6 47 443.17 443.17
Arkansas Blue Cross & Blue Shield Gold 500 6 48 463.59 463.59
Arkansas Blue Cross & Blue Shield Gold 500 6 49 483.72 483.72
Arkansas Blue Cross & Blue Shield Gold 500 6 50 506.4 506.4
Arkansas Blue Cross & Blue Shield Gold 500 6 51 528.8 528.8
Arkansas Blue Cross & Blue Shield Gold 500 6 52 553.47 553.47
Arkansas Blue Cross & Blue Shield Gold 500 6 53 578.42 578.42
Arkansas Blue Cross & Blue Shield Gold 500 6 54 605.36 605.36
Arkansas Blue Cross & Blue Shield Gold 500 6 55 632.29 632.29
Arkansas Blue Cross & Blue Shield Gold 500 6 56 661.5 661.5
Arkansas Blue Cross & Blue Shield Gold 500 6 57 690.99 690.99
Arkansas Blue Cross & Blue Shield Gold 500 6 58 722.46 722.46
Arkansas Blue Cross & Blue Shield Gold 500 6 59 738.05 738.05
Arkansas Blue Cross & Blue Shield Gold 500 6 60 769.53 769.53
Arkansas Blue Cross & Blue Shield Gold 500 6 61 796.75 796.75
Arkansas Blue Cross & Blue Shield Gold 500 6 62 814.61 814.61
Arkansas Blue Cross & Blue Shield Gold 500 6 63 837.01 837.01
Arkansas Blue Cross & Blue Shield Gold 500 6 64 850.62 850.62
Page 149 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Gold 500 6 65 and
over
850.62 850.62
Arkansas Blue Cross & Blue Shield Gold 500 7 0‐20 161.14 161.14
Arkansas Blue Cross & Blue Shield Gold 500 7 21 253.76 253.76
Arkansas Blue Cross & Blue Shield Gold 500 7 22 253.76 253.76
Arkansas Blue Cross & Blue Shield Gold 500 7 23 253.76 253.76
Arkansas Blue Cross & Blue Shield Gold 500 7 24 253.76 253.76
Arkansas Blue Cross & Blue Shield Gold 500 7 25 254.78 254.78
Arkansas Blue Cross & Blue Shield Gold 500 7 26 259.85 259.85
Arkansas Blue Cross & Blue Shield Gold 500 7 27 265.94 265.94
Arkansas Blue Cross & Blue Shield Gold 500 7 28 275.84 275.84
Arkansas Blue Cross & Blue Shield Gold 500 7 29 283.96 283.96
Arkansas Blue Cross & Blue Shield Gold 500 7 30 288.02 288.02
Arkansas Blue Cross & Blue Shield Gold 500 7 31 294.11 294.11
Arkansas Blue Cross & Blue Shield Gold 500 7 32 300.2 300.2
Arkansas Blue Cross & Blue Shield Gold 500 7 33 304 304
Arkansas Blue Cross & Blue Shield Gold 500 7 34 308.06 308.06
Arkansas Blue Cross & Blue Shield Gold 500 7 35 310.09 310.09
Arkansas Blue Cross & Blue Shield Gold 500 7 36 312.12 312.12
Arkansas Blue Cross & Blue Shield Gold 500 7 37 314.15 314.15
Arkansas Blue Cross & Blue Shield Gold 500 7 38 316.18 316.18
Arkansas Blue Cross & Blue Shield Gold 500 7 39 320.25 320.25
Arkansas Blue Cross & Blue Shield Gold 500 7 40 324.31 324.31
Arkansas Blue Cross & Blue Shield Gold 500 7 41 330.4 330.4
Arkansas Blue Cross & Blue Shield Gold 500 7 42 336.23 336.23
Arkansas Blue Cross & Blue Shield Gold 500 7 43 344.35 344.35
Arkansas Blue Cross & Blue Shield Gold 500 7 44 354.5 354.5
Arkansas Blue Cross & Blue Shield Gold 500 7 45 366.43 366.43
Arkansas Blue Cross & Blue Shield Gold 500 7 46 380.64 380.64
Arkansas Blue Cross & Blue Shield Gold 500 7 47 396.63 396.63
Arkansas Blue Cross & Blue Shield Gold 500 7 48 414.9 414.9
Arkansas Blue Cross & Blue Shield Gold 500 7 49 432.91 432.91
Arkansas Blue Cross & Blue Shield Gold 500 7 50 453.22 453.22
Arkansas Blue Cross & Blue Shield Gold 500 7 51 473.26 473.26
Arkansas Blue Cross & Blue Shield Gold 500 7 52 495.34 495.34
Arkansas Blue Cross & Blue Shield Gold 500 7 53 517.67 517.67
Arkansas Blue Cross & Blue Shield Gold 500 7 54 541.78 541.78
Arkansas Blue Cross & Blue Shield Gold 500 7 55 565.88 565.88
Arkansas Blue Cross & Blue Shield Gold 500 7 56 592.02 592.02
Arkansas Blue Cross & Blue Shield Gold 500 7 57 618.41 618.41
Arkansas Blue Cross & Blue Shield Gold 500 7 58 646.58 646.58
Arkansas Blue Cross & Blue Shield Gold 500 7 59 660.54 660.54
Arkansas Blue Cross & Blue Shield Gold 500 7 60 688.7 688.7
Arkansas Blue Cross & Blue Shield Gold 500 7 61 713.07 713.07
Arkansas Blue Cross & Blue Shield Gold 500 7 62 729.05 729.05
Arkansas Blue Cross & Blue Shield Gold 500 7 63 749.1 749.1
Arkansas Blue Cross & Blue Shield Gold 500 7 64 761.28 761.28
Arkansas Blue Cross & Blue Shield Gold 500 7 65 and
over
761.28 761.28
Arkansas Blue Cross & Blue Shield Silver 2500 1 0‐20 152.13 152.13
Arkansas Blue Cross & Blue Shield Silver 2500 1 21 239.58 239.58
Arkansas Blue Cross & Blue Shield Silver 2500 1 22 239.58 239.58
Arkansas Blue Cross & Blue Shield Silver 2500 1 23 239.58 239.58
Arkansas Blue Cross & Blue Shield Silver 2500 1 24 239.58 239.58
Arkansas Blue Cross & Blue Shield Silver 2500 1 25 240.54 240.54
Arkansas Blue Cross & Blue Shield Silver 2500 1 26 245.33 245.33
Arkansas Blue Cross & Blue Shield Silver 2500 1 27 251.08 251.08
Arkansas Blue Cross & Blue Shield Silver 2500 1 28 260.42 260.42
Arkansas Blue Cross & Blue Shield Silver 2500 1 29 268.09 268.09
Arkansas Blue Cross & Blue Shield Silver 2500 1 30 271.92 271.92
Arkansas Blue Cross & Blue Shield Silver 2500 1 31 277.67 277.67
Arkansas Blue Cross & Blue Shield Silver 2500 1 32 283.42 283.42
Arkansas Blue Cross & Blue Shield Silver 2500 1 33 287.02 287.02
Page 150 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 2500 1 34 290.85 290.85
Arkansas Blue Cross & Blue Shield Silver 2500 1 35 292.77 292.77
Arkansas Blue Cross & Blue Shield Silver 2500 1 36 294.68 294.68
Arkansas Blue Cross & Blue Shield Silver 2500 1 37 296.6 296.6
Arkansas Blue Cross & Blue Shield Silver 2500 1 38 298.52 298.52
Arkansas Blue Cross & Blue Shield Silver 2500 1 39 302.35 302.35
Arkansas Blue Cross & Blue Shield Silver 2500 1 40 306.18 306.18
Arkansas Blue Cross & Blue Shield Silver 2500 1 41 311.93 311.93
Arkansas Blue Cross & Blue Shield Silver 2500 1 42 317.44 317.44
Arkansas Blue Cross & Blue Shield Silver 2500 1 43 325.11 325.11
Arkansas Blue Cross & Blue Shield Silver 2500 1 44 334.69 334.69
Arkansas Blue Cross & Blue Shield Silver 2500 1 45 345.95 345.95
Arkansas Blue Cross & Blue Shield Silver 2500 1 46 359.37 359.37
Arkansas Blue Cross & Blue Shield Silver 2500 1 47 374.46 374.46
Arkansas Blue Cross & Blue Shield Silver 2500 1 48 391.71 391.71
Arkansas Blue Cross & Blue Shield Silver 2500 1 49 408.72 408.72
Arkansas Blue Cross & Blue Shield Silver 2500 1 50 427.89 427.89
Arkansas Blue Cross & Blue Shield Silver 2500 1 51 446.82 446.82
Arkansas Blue Cross & Blue Shield Silver 2500 1 52 467.66 467.66
Arkansas Blue Cross & Blue Shield Silver 2500 1 53 488.74 488.74
Arkansas Blue Cross & Blue Shield Silver 2500 1 54 511.5 511.5
Arkansas Blue Cross & Blue Shield Silver 2500 1 55 534.26 534.26
Arkansas Blue Cross & Blue Shield Silver 2500 1 56 558.94 558.94
Arkansas Blue Cross & Blue Shield Silver 2500 1 57 583.86 583.86
Arkansas Blue Cross & Blue Shield Silver 2500 1 58 610.45 610.45
Arkansas Blue Cross & Blue Shield Silver 2500 1 59 623.63 623.63
Arkansas Blue Cross & Blue Shield Silver 2500 1 60 650.22 650.22
Arkansas Blue Cross & Blue Shield Silver 2500 1 61 673.22 673.22
Arkansas Blue Cross & Blue Shield Silver 2500 1 62 688.31 688.31
Arkansas Blue Cross & Blue Shield Silver 2500 1 63 707.24 707.24
Arkansas Blue Cross & Blue Shield Silver 2500 1 64 718.74 718.74
Arkansas Blue Cross & Blue Shield Silver 2500 1 65 and
over
718.74 718.74
Arkansas Blue Cross & Blue Shield Silver 2500 2 0‐20 141.29 141.29
Arkansas Blue Cross & Blue Shield Silver 2500 2 21 222.5 222.5
Arkansas Blue Cross & Blue Shield Silver 2500 2 22 222.5 222.5
Arkansas Blue Cross & Blue Shield Silver 2500 2 23 222.5 222.5
Arkansas Blue Cross & Blue Shield Silver 2500 2 24 222.5 222.5
Arkansas Blue Cross & Blue Shield Silver 2500 2 25 223.39 223.39
Arkansas Blue Cross & Blue Shield Silver 2500 2 26 227.84 227.84
Arkansas Blue Cross & Blue Shield Silver 2500 2 27 233.18 233.18
Arkansas Blue Cross & Blue Shield Silver 2500 2 28 241.86 241.86
Arkansas Blue Cross & Blue Shield Silver 2500 2 29 248.98 248.98
Arkansas Blue Cross & Blue Shield Silver 2500 2 30 252.54 252.54
Arkansas Blue Cross & Blue Shield Silver 2500 2 31 257.88 257.88
Arkansas Blue Cross & Blue Shield Silver 2500 2 32 263.22 263.22
Arkansas Blue Cross & Blue Shield Silver 2500 2 33 266.56 266.56
Arkansas Blue Cross & Blue Shield Silver 2500 2 34 270.12 270.12
Arkansas Blue Cross & Blue Shield Silver 2500 2 35 271.9 271.9
Arkansas Blue Cross & Blue Shield Silver 2500 2 36 273.68 273.68
Arkansas Blue Cross & Blue Shield Silver 2500 2 37 275.46 275.46
Arkansas Blue Cross & Blue Shield Silver 2500 2 38 277.24 277.24
Arkansas Blue Cross & Blue Shield Silver 2500 2 39 280.8 280.8
Arkansas Blue Cross & Blue Shield Silver 2500 2 40 284.36 284.36
Arkansas Blue Cross & Blue Shield Silver 2500 2 41 289.7 289.7
Arkansas Blue Cross & Blue Shield Silver 2500 2 42 294.81 294.81
Arkansas Blue Cross & Blue Shield Silver 2500 2 43 301.93 301.93
Arkansas Blue Cross & Blue Shield Silver 2500 2 44 310.83 310.83
Arkansas Blue Cross & Blue Shield Silver 2500 2 45 321.29 321.29
Arkansas Blue Cross & Blue Shield Silver 2500 2 46 333.75 333.75
Arkansas Blue Cross & Blue Shield Silver 2500 2 47 347.77 347.77
Arkansas Blue Cross & Blue Shield Silver 2500 2 48 363.79 363.79
Arkansas Blue Cross & Blue Shield Silver 2500 2 49 379.58 379.58
Page 151 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 2500 2 50 397.38 397.38
Arkansas Blue Cross & Blue Shield Silver 2500 2 51 414.96 414.96
Arkansas Blue Cross & Blue Shield Silver 2500 2 52 434.32 434.32
Arkansas Blue Cross & Blue Shield Silver 2500 2 53 453.9 453.9
Arkansas Blue Cross & Blue Shield Silver 2500 2 54 475.04 475.04
Arkansas Blue Cross & Blue Shield Silver 2500 2 55 496.18 496.18
Arkansas Blue Cross & Blue Shield Silver 2500 2 56 519.09 519.09
Arkansas Blue Cross & Blue Shield Silver 2500 2 57 542.23 542.23
Arkansas Blue Cross & Blue Shield Silver 2500 2 58 566.93 566.93
Arkansas Blue Cross & Blue Shield Silver 2500 2 59 579.17 579.17
Arkansas Blue Cross & Blue Shield Silver 2500 2 60 603.86 603.86
Arkansas Blue Cross & Blue Shield Silver 2500 2 61 625.22 625.22
Arkansas Blue Cross & Blue Shield Silver 2500 2 62 639.24 639.24
Arkansas Blue Cross & Blue Shield Silver 2500 2 63 656.82 656.82
Arkansas Blue Cross & Blue Shield Silver 2500 2 64 667.5 667.5
Arkansas Blue Cross & Blue Shield Silver 2500 2 65 and
over
667.5 667.5
Arkansas Blue Cross & Blue Shield Silver 2500 3 0‐20 142.9 142.9
Arkansas Blue Cross & Blue Shield Silver 2500 3 21 225.04 225.04
Arkansas Blue Cross & Blue Shield Silver 2500 3 22 225.04 225.04
Arkansas Blue Cross & Blue Shield Silver 2500 3 23 225.04 225.04
Arkansas Blue Cross & Blue Shield Silver 2500 3 24 225.04 225.04
Arkansas Blue Cross & Blue Shield Silver 2500 3 25 225.94 225.94
Arkansas Blue Cross & Blue Shield Silver 2500 3 26 230.44 230.44
Arkansas Blue Cross & Blue Shield Silver 2500 3 27 235.84 235.84
Arkansas Blue Cross & Blue Shield Silver 2500 3 28 244.62 244.62
Arkansas Blue Cross & Blue Shield Silver 2500 3 29 251.82 251.82
Arkansas Blue Cross & Blue Shield Silver 2500 3 30 255.42 255.42
Arkansas Blue Cross & Blue Shield Silver 2500 3 31 260.82 260.82
Arkansas Blue Cross & Blue Shield Silver 2500 3 32 266.22 266.22
Arkansas Blue Cross & Blue Shield Silver 2500 3 33 269.6 269.6
Arkansas Blue Cross & Blue Shield Silver 2500 3 34 273.2 273.2
Arkansas Blue Cross & Blue Shield Silver 2500 3 35 275 275
Arkansas Blue Cross & Blue Shield Silver 2500 3 36 276.8 276.8
Arkansas Blue Cross & Blue Shield Silver 2500 3 37 278.6 278.6
Arkansas Blue Cross & Blue Shield Silver 2500 3 38 280.4 280.4
Arkansas Blue Cross & Blue Shield Silver 2500 3 39 284 284
Arkansas Blue Cross & Blue Shield Silver 2500 3 40 287.6 287.6
Arkansas Blue Cross & Blue Shield Silver 2500 3 41 293 293
Arkansas Blue Cross & Blue Shield Silver 2500 3 42 298.18 298.18
Arkansas Blue Cross & Blue Shield Silver 2500 3 43 305.38 305.38
Arkansas Blue Cross & Blue Shield Silver 2500 3 44 314.38 314.38
Arkansas Blue Cross & Blue Shield Silver 2500 3 45 324.96 324.96
Arkansas Blue Cross & Blue Shield Silver 2500 3 46 337.56 337.56
Arkansas Blue Cross & Blue Shield Silver 2500 3 47 351.74 351.74
Arkansas Blue Cross & Blue Shield Silver 2500 3 48 367.94 367.94
Arkansas Blue Cross & Blue Shield Silver 2500 3 49 383.92 383.92
Arkansas Blue Cross & Blue Shield Silver 2500 3 50 401.92 401.92
Arkansas Blue Cross & Blue Shield Silver 2500 3 51 419.7 419.7
Arkansas Blue Cross & Blue Shield Silver 2500 3 52 439.28 439.28
Arkansas Blue Cross & Blue Shield Silver 2500 3 53 459.08 459.08
Arkansas Blue Cross & Blue Shield Silver 2500 3 54 480.46 480.46
Arkansas Blue Cross & Blue Shield Silver 2500 3 55 501.84 501.84
Arkansas Blue Cross & Blue Shield Silver 2500 3 56 525.02 525.02
Arkansas Blue Cross & Blue Shield Silver 2500 3 57 548.42 548.42
Arkansas Blue Cross & Blue Shield Silver 2500 3 58 573.4 573.4
Arkansas Blue Cross & Blue Shield Silver 2500 3 59 585.78 585.78
Arkansas Blue Cross & Blue Shield Silver 2500 3 60 610.76 610.76
Arkansas Blue Cross & Blue Shield Silver 2500 3 61 632.36 632.36
Arkansas Blue Cross & Blue Shield Silver 2500 3 62 646.54 646.54
Arkansas Blue Cross & Blue Shield Silver 2500 3 63 664.32 664.32
Arkansas Blue Cross & Blue Shield Silver 2500 3 64 675.12 675.12
Page 152 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 2500 3 65 and
over
675.12 675.12
Arkansas Blue Cross & Blue Shield Silver 2500 4 0‐20 140.4 140.4
Arkansas Blue Cross & Blue Shield Silver 2500 4 21 221.11 221.11
Arkansas Blue Cross & Blue Shield Silver 2500 4 22 221.11 221.11
Arkansas Blue Cross & Blue Shield Silver 2500 4 23 221.11 221.11
Arkansas Blue Cross & Blue Shield Silver 2500 4 24 221.11 221.11
Arkansas Blue Cross & Blue Shield Silver 2500 4 25 221.99 221.99
Arkansas Blue Cross & Blue Shield Silver 2500 4 26 226.42 226.42
Arkansas Blue Cross & Blue Shield Silver 2500 4 27 231.72 231.72
Arkansas Blue Cross & Blue Shield Silver 2500 4 28 240.35 240.35
Arkansas Blue Cross & Blue Shield Silver 2500 4 29 247.42 247.42
Arkansas Blue Cross & Blue Shield Silver 2500 4 30 250.96 250.96
Arkansas Blue Cross & Blue Shield Silver 2500 4 31 256.27 256.27
Arkansas Blue Cross & Blue Shield Silver 2500 4 32 261.57 261.57
Arkansas Blue Cross & Blue Shield Silver 2500 4 33 264.89 264.89
Arkansas Blue Cross & Blue Shield Silver 2500 4 34 268.43 268.43
Arkansas Blue Cross & Blue Shield Silver 2500 4 35 270.2 270.2
Arkansas Blue Cross & Blue Shield Silver 2500 4 36 271.97 271.97
Arkansas Blue Cross & Blue Shield Silver 2500 4 37 273.73 273.73
Arkansas Blue Cross & Blue Shield Silver 2500 4 38 275.5 275.5
Arkansas Blue Cross & Blue Shield Silver 2500 4 39 279.04 279.04
Arkansas Blue Cross & Blue Shield Silver 2500 4 40 282.58 282.58
Arkansas Blue Cross & Blue Shield Silver 2500 4 41 287.89 287.89
Arkansas Blue Cross & Blue Shield Silver 2500 4 42 292.97 292.97
Arkansas Blue Cross & Blue Shield Silver 2500 4 43 300.05 300.05
Arkansas Blue Cross & Blue Shield Silver 2500 4 44 308.89 308.89
Arkansas Blue Cross & Blue Shield Silver 2500 4 45 319.28 319.28
Arkansas Blue Cross & Blue Shield Silver 2500 4 46 331.66 331.66
Arkansas Blue Cross & Blue Shield Silver 2500 4 47 345.59 345.59
Arkansas Blue Cross & Blue Shield Silver 2500 4 48 361.51 361.51
Arkansas Blue Cross & Blue Shield Silver 2500 4 49 377.21 377.21
Arkansas Blue Cross & Blue Shield Silver 2500 4 50 394.9 394.9
Arkansas Blue Cross & Blue Shield Silver 2500 4 51 412.37 412.37
Arkansas Blue Cross & Blue Shield Silver 2500 4 52 431.61 431.61
Arkansas Blue Cross & Blue Shield Silver 2500 4 53 451.06 451.06
Arkansas Blue Cross & Blue Shield Silver 2500 4 54 472.07 472.07
Arkansas Blue Cross & Blue Shield Silver 2500 4 55 493.08 493.08
Arkansas Blue Cross & Blue Shield Silver 2500 4 56 515.85 515.85
Arkansas Blue Cross & Blue Shield Silver 2500 4 57 538.85 538.85
Arkansas Blue Cross & Blue Shield Silver 2500 4 58 563.39 563.39
Arkansas Blue Cross & Blue Shield Silver 2500 4 59 575.55 575.55
Arkansas Blue Cross & Blue Shield Silver 2500 4 60 600.09 600.09
Arkansas Blue Cross & Blue Shield Silver 2500 4 61 621.32 621.32
Arkansas Blue Cross & Blue Shield Silver 2500 4 62 635.25 635.25
Arkansas Blue Cross & Blue Shield Silver 2500 4 63 652.72 652.72
Arkansas Blue Cross & Blue Shield Silver 2500 4 64 663.33 663.33
Arkansas Blue Cross & Blue Shield Silver 2500 4 65 and
over
663.33 663.33
Arkansas Blue Cross & Blue Shield Silver 2500 5 0‐20 150.67 150.67
Arkansas Blue Cross & Blue Shield Silver 2500 5 21 237.27 237.27
Arkansas Blue Cross & Blue Shield Silver 2500 5 22 237.27 237.27
Arkansas Blue Cross & Blue Shield Silver 2500 5 23 237.27 237.27
Arkansas Blue Cross & Blue Shield Silver 2500 5 24 237.27 237.27
Arkansas Blue Cross & Blue Shield Silver 2500 5 25 238.22 238.22
Arkansas Blue Cross & Blue Shield Silver 2500 5 26 242.96 242.96
Arkansas Blue Cross & Blue Shield Silver 2500 5 27 248.66 248.66
Arkansas Blue Cross & Blue Shield Silver 2500 5 28 257.91 257.91
Arkansas Blue Cross & Blue Shield Silver 2500 5 29 265.51 265.51
Arkansas Blue Cross & Blue Shield Silver 2500 5 30 269.3 269.3
Arkansas Blue Cross & Blue Shield Silver 2500 5 31 275 275
Arkansas Blue Cross & Blue Shield Silver 2500 5 32 280.69 280.69
Arkansas Blue Cross & Blue Shield Silver 2500 5 33 284.25 284.25
Page 153 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 2500 5 34 288.05 288.05
Arkansas Blue Cross & Blue Shield Silver 2500 5 35 289.94 289.94
Arkansas Blue Cross & Blue Shield Silver 2500 5 36 291.84 291.84
Arkansas Blue Cross & Blue Shield Silver 2500 5 37 293.74 293.74
Arkansas Blue Cross & Blue Shield Silver 2500 5 38 295.64 295.64
Arkansas Blue Cross & Blue Shield Silver 2500 5 39 299.43 299.43
Arkansas Blue Cross & Blue Shield Silver 2500 5 40 303.23 303.23
Arkansas Blue Cross & Blue Shield Silver 2500 5 41 308.93 308.93
Arkansas Blue Cross & Blue Shield Silver 2500 5 42 314.38 314.38
Arkansas Blue Cross & Blue Shield Silver 2500 5 43 321.98 321.98
Arkansas Blue Cross & Blue Shield Silver 2500 5 44 331.47 331.47
Arkansas Blue Cross & Blue Shield Silver 2500 5 45 342.62 342.62
Arkansas Blue Cross & Blue Shield Silver 2500 5 46 355.9 355.9
Arkansas Blue Cross & Blue Shield Silver 2500 5 47 370.85 370.85
Arkansas Blue Cross & Blue Shield Silver 2500 5 48 387.94 387.94
Arkansas Blue Cross & Blue Shield Silver 2500 5 49 404.78 404.78
Arkansas Blue Cross & Blue Shield Silver 2500 5 50 423.76 423.76
Arkansas Blue Cross & Blue Shield Silver 2500 5 51 442.51 442.51
Arkansas Blue Cross & Blue Shield Silver 2500 5 52 463.15 463.15
Arkansas Blue Cross & Blue Shield Silver 2500 5 53 484.03 484.03
Arkansas Blue Cross & Blue Shield Silver 2500 5 54 506.57 506.57
Arkansas Blue Cross & Blue Shield Silver 2500 5 55 529.11 529.11
Arkansas Blue Cross & Blue Shield Silver 2500 5 56 553.55 553.55
Arkansas Blue Cross & Blue Shield Silver 2500 5 57 578.23 578.23
Arkansas Blue Cross & Blue Shield Silver 2500 5 58 604.56 604.56
Arkansas Blue Cross & Blue Shield Silver 2500 5 59 617.61 617.61
Arkansas Blue Cross & Blue Shield Silver 2500 5 60 643.95 643.95
Arkansas Blue Cross & Blue Shield Silver 2500 5 61 666.73 666.73
Arkansas Blue Cross & Blue Shield Silver 2500 5 62 681.68 681.68
Arkansas Blue Cross & Blue Shield Silver 2500 5 63 700.42 700.42
Arkansas Blue Cross & Blue Shield Silver 2500 5 64 711.81 711.81
Arkansas Blue Cross & Blue Shield Silver 2500 5 65 and
over
711.81 711.81
Arkansas Blue Cross & Blue Shield Silver 2500 6 0‐20 152.13 152.13
Arkansas Blue Cross & Blue Shield Silver 2500 6 21 239.58 239.58
Arkansas Blue Cross & Blue Shield Silver 2500 6 22 239.58 239.58
Arkansas Blue Cross & Blue Shield Silver 2500 6 23 239.58 239.58
Arkansas Blue Cross & Blue Shield Silver 2500 6 24 239.58 239.58
Arkansas Blue Cross & Blue Shield Silver 2500 6 25 240.54 240.54
Arkansas Blue Cross & Blue Shield Silver 2500 6 26 245.33 245.33
Arkansas Blue Cross & Blue Shield Silver 2500 6 27 251.08 251.08
Arkansas Blue Cross & Blue Shield Silver 2500 6 28 260.42 260.42
Arkansas Blue Cross & Blue Shield Silver 2500 6 29 268.09 268.09
Arkansas Blue Cross & Blue Shield Silver 2500 6 30 271.92 271.92
Arkansas Blue Cross & Blue Shield Silver 2500 6 31 277.67 277.67
Arkansas Blue Cross & Blue Shield Silver 2500 6 32 283.42 283.42
Arkansas Blue Cross & Blue Shield Silver 2500 6 33 287.02 287.02
Arkansas Blue Cross & Blue Shield Silver 2500 6 34 290.85 290.85
Arkansas Blue Cross & Blue Shield Silver 2500 6 35 292.77 292.77
Arkansas Blue Cross & Blue Shield Silver 2500 6 36 294.68 294.68
Arkansas Blue Cross & Blue Shield Silver 2500 6 37 296.6 296.6
Arkansas Blue Cross & Blue Shield Silver 2500 6 38 298.52 298.52
Arkansas Blue Cross & Blue Shield Silver 2500 6 39 302.35 302.35
Arkansas Blue Cross & Blue Shield Silver 2500 6 40 306.18 306.18
Arkansas Blue Cross & Blue Shield Silver 2500 6 41 311.93 311.93
Arkansas Blue Cross & Blue Shield Silver 2500 6 42 317.44 317.44
Arkansas Blue Cross & Blue Shield Silver 2500 6 43 325.11 325.11
Arkansas Blue Cross & Blue Shield Silver 2500 6 44 334.69 334.69
Arkansas Blue Cross & Blue Shield Silver 2500 6 45 345.95 345.95
Arkansas Blue Cross & Blue Shield Silver 2500 6 46 359.37 359.37
Arkansas Blue Cross & Blue Shield Silver 2500 6 47 374.46 374.46
Arkansas Blue Cross & Blue Shield Silver 2500 6 48 391.71 391.71
Arkansas Blue Cross & Blue Shield Silver 2500 6 49 408.72 408.72
Page 154 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 2500 6 50 427.89 427.89
Arkansas Blue Cross & Blue Shield Silver 2500 6 51 446.82 446.82
Arkansas Blue Cross & Blue Shield Silver 2500 6 52 467.66 467.66
Arkansas Blue Cross & Blue Shield Silver 2500 6 53 488.74 488.74
Arkansas Blue Cross & Blue Shield Silver 2500 6 54 511.5 511.5
Arkansas Blue Cross & Blue Shield Silver 2500 6 55 534.26 534.26
Arkansas Blue Cross & Blue Shield Silver 2500 6 56 558.94 558.94
Arkansas Blue Cross & Blue Shield Silver 2500 6 57 583.86 583.86
Arkansas Blue Cross & Blue Shield Silver 2500 6 58 610.45 610.45
Arkansas Blue Cross & Blue Shield Silver 2500 6 59 623.63 623.63
Arkansas Blue Cross & Blue Shield Silver 2500 6 60 650.22 650.22
Arkansas Blue Cross & Blue Shield Silver 2500 6 61 673.22 673.22
Arkansas Blue Cross & Blue Shield Silver 2500 6 62 688.31 688.31
Arkansas Blue Cross & Blue Shield Silver 2500 6 63 707.24 707.24
Arkansas Blue Cross & Blue Shield Silver 2500 6 64 718.74 718.74
Arkansas Blue Cross & Blue Shield Silver 2500 6 65 and
over
718.74 718.74
Arkansas Blue Cross & Blue Shield Silver 2500 7 0‐20 136.16 136.16
Arkansas Blue Cross & Blue Shield Silver 2500 7 21 214.42 214.42
Arkansas Blue Cross & Blue Shield Silver 2500 7 22 214.42 214.42
Arkansas Blue Cross & Blue Shield Silver 2500 7 23 214.42 214.42
Arkansas Blue Cross & Blue Shield Silver 2500 7 24 214.42 214.42
Arkansas Blue Cross & Blue Shield Silver 2500 7 25 215.28 215.28
Arkansas Blue Cross & Blue Shield Silver 2500 7 26 219.57 219.57
Arkansas Blue Cross & Blue Shield Silver 2500 7 27 224.71 224.71
Arkansas Blue Cross & Blue Shield Silver 2500 7 28 233.07 233.07
Arkansas Blue Cross & Blue Shield Silver 2500 7 29 239.94 239.94
Arkansas Blue Cross & Blue Shield Silver 2500 7 30 243.37 243.37
Arkansas Blue Cross & Blue Shield Silver 2500 7 31 248.51 248.51
Arkansas Blue Cross & Blue Shield Silver 2500 7 32 253.66 253.66
Arkansas Blue Cross & Blue Shield Silver 2500 7 33 256.88 256.88
Arkansas Blue Cross & Blue Shield Silver 2500 7 34 260.31 260.31
Arkansas Blue Cross & Blue Shield Silver 2500 7 35 262.02 262.02
Arkansas Blue Cross & Blue Shield Silver 2500 7 36 263.74 263.74
Arkansas Blue Cross & Blue Shield Silver 2500 7 37 265.45 265.45
Arkansas Blue Cross & Blue Shield Silver 2500 7 38 267.17 267.17
Arkansas Blue Cross & Blue Shield Silver 2500 7 39 270.6 270.6
Arkansas Blue Cross & Blue Shield Silver 2500 7 40 274.03 274.03
Arkansas Blue Cross & Blue Shield Silver 2500 7 41 279.17 279.17
Arkansas Blue Cross & Blue Shield Silver 2500 7 42 284.11 284.11
Arkansas Blue Cross & Blue Shield Silver 2500 7 43 290.97 290.97
Arkansas Blue Cross & Blue Shield Silver 2500 7 44 299.54 299.54
Arkansas Blue Cross & Blue Shield Silver 2500 7 45 309.62 309.62
Arkansas Blue Cross & Blue Shield Silver 2500 7 46 321.63 321.63
Arkansas Blue Cross & Blue Shield Silver 2500 7 47 335.14 335.14
Arkansas Blue Cross & Blue Shield Silver 2500 7 48 350.58 350.58
Arkansas Blue Cross & Blue Shield Silver 2500 7 49 365.8 365.8
Arkansas Blue Cross & Blue Shield Silver 2500 7 50 382.95 382.95
Arkansas Blue Cross & Blue Shield Silver 2500 7 51 399.89 399.89
Arkansas Blue Cross & Blue Shield Silver 2500 7 52 418.55 418.55
Arkansas Blue Cross & Blue Shield Silver 2500 7 53 437.42 437.42
Arkansas Blue Cross & Blue Shield Silver 2500 7 54 457.79 457.79
Arkansas Blue Cross & Blue Shield Silver 2500 7 55 478.16 478.16
Arkansas Blue Cross & Blue Shield Silver 2500 7 56 500.24 500.24
Arkansas Blue Cross & Blue Shield Silver 2500 7 57 522.54 522.54
Arkansas Blue Cross & Blue Shield Silver 2500 7 58 546.34 546.34
Arkansas Blue Cross & Blue Shield Silver 2500 7 59 558.14 558.14
Arkansas Blue Cross & Blue Shield Silver 2500 7 60 581.94 581.94
Arkansas Blue Cross & Blue Shield Silver 2500 7 61 602.52 602.52
Arkansas Blue Cross & Blue Shield Silver 2500 7 62 616.03 616.03
Arkansas Blue Cross & Blue Shield Silver 2500 7 63 632.97 632.97
Arkansas Blue Cross & Blue Shield Silver 2500 7 64 643.26 643.26
Page 155 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 2500 7 65 and
over
643.26 643.26
Arkansas Blue Cross & Blue Shield Silver 3500 1 0‐20 145.9 145.9
Arkansas Blue Cross & Blue Shield Silver 3500 1 21 229.77 229.77
Arkansas Blue Cross & Blue Shield Silver 3500 1 22 229.77 229.77
Arkansas Blue Cross & Blue Shield Silver 3500 1 23 229.77 229.77
Arkansas Blue Cross & Blue Shield Silver 3500 1 24 229.77 229.77
Arkansas Blue Cross & Blue Shield Silver 3500 1 25 230.69 230.69
Arkansas Blue Cross & Blue Shield Silver 3500 1 26 235.28 235.28
Arkansas Blue Cross & Blue Shield Silver 3500 1 27 240.8 240.8
Arkansas Blue Cross & Blue Shield Silver 3500 1 28 249.76 249.76
Arkansas Blue Cross & Blue Shield Silver 3500 1 29 257.11 257.11
Arkansas Blue Cross & Blue Shield Silver 3500 1 30 260.79 260.79
Arkansas Blue Cross & Blue Shield Silver 3500 1 31 266.3 266.3
Arkansas Blue Cross & Blue Shield Silver 3500 1 32 271.82 271.82
Arkansas Blue Cross & Blue Shield Silver 3500 1 33 275.26 275.26
Arkansas Blue Cross & Blue Shield Silver 3500 1 34 278.94 278.94
Arkansas Blue Cross & Blue Shield Silver 3500 1 35 280.78 280.78
Arkansas Blue Cross & Blue Shield Silver 3500 1 36 282.62 282.62
Arkansas Blue Cross & Blue Shield Silver 3500 1 37 284.46 284.46
Arkansas Blue Cross & Blue Shield Silver 3500 1 38 286.29 286.29
Arkansas Blue Cross & Blue Shield Silver 3500 1 39 289.97 289.97
Arkansas Blue Cross & Blue Shield Silver 3500 1 40 293.65 293.65
Arkansas Blue Cross & Blue Shield Silver 3500 1 41 299.16 299.16
Arkansas Blue Cross & Blue Shield Silver 3500 1 42 304.45 304.45
Arkansas Blue Cross & Blue Shield Silver 3500 1 43 311.8 311.8
Arkansas Blue Cross & Blue Shield Silver 3500 1 44 320.99 320.99
Arkansas Blue Cross & Blue Shield Silver 3500 1 45 331.79 331.79
Arkansas Blue Cross & Blue Shield Silver 3500 1 46 344.66 344.66
Arkansas Blue Cross & Blue Shield Silver 3500 1 47 359.13 359.13
Arkansas Blue Cross & Blue Shield Silver 3500 1 48 375.67 375.67
Arkansas Blue Cross & Blue Shield Silver 3500 1 49 391.99 391.99
Arkansas Blue Cross & Blue Shield Silver 3500 1 50 410.37 410.37
Arkansas Blue Cross & Blue Shield Silver 3500 1 51 428.52 428.52
Arkansas Blue Cross & Blue Shield Silver 3500 1 52 448.51 448.51
Arkansas Blue Cross & Blue Shield Silver 3500 1 53 468.73 468.73
Arkansas Blue Cross & Blue Shield Silver 3500 1 54 490.56 490.56
Arkansas Blue Cross & Blue Shield Silver 3500 1 55 512.39 512.39
Arkansas Blue Cross & Blue Shield Silver 3500 1 56 536.05 536.05
Arkansas Blue Cross & Blue Shield Silver 3500 1 57 559.95 559.95
Arkansas Blue Cross & Blue Shield Silver 3500 1 58 585.45 585.45
Arkansas Blue Cross & Blue Shield Silver 3500 1 59 598.09 598.09
Arkansas Blue Cross & Blue Shield Silver 3500 1 60 623.6 623.6
Arkansas Blue Cross & Blue Shield Silver 3500 1 61 645.65 645.65
Arkansas Blue Cross & Blue Shield Silver 3500 1 62 660.13 660.13
Arkansas Blue Cross & Blue Shield Silver 3500 1 63 678.28 678.28
Arkansas Blue Cross & Blue Shield Silver 3500 1 64 689.31 689.31
Arkansas Blue Cross & Blue Shield Silver 3500 1 65 and
over
689.31 689.31
Arkansas Blue Cross & Blue Shield Silver 3500 2 0‐20 135.5 135.5
Arkansas Blue Cross & Blue Shield Silver 3500 2 21 213.39 213.39
Arkansas Blue Cross & Blue Shield Silver 3500 2 22 213.39 213.39
Arkansas Blue Cross & Blue Shield Silver 3500 2 23 213.39 213.39
Arkansas Blue Cross & Blue Shield Silver 3500 2 24 213.39 213.39
Arkansas Blue Cross & Blue Shield Silver 3500 2 25 214.24 214.24
Arkansas Blue Cross & Blue Shield Silver 3500 2 26 218.51 218.51
Arkansas Blue Cross & Blue Shield Silver 3500 2 27 223.63 223.63
Arkansas Blue Cross & Blue Shield Silver 3500 2 28 231.95 231.95
Arkansas Blue Cross & Blue Shield Silver 3500 2 29 238.78 238.78
Arkansas Blue Cross & Blue Shield Silver 3500 2 30 242.2 242.2
Arkansas Blue Cross & Blue Shield Silver 3500 2 31 247.32 247.32
Arkansas Blue Cross & Blue Shield Silver 3500 2 32 252.44 252.44
Arkansas Blue Cross & Blue Shield Silver 3500 2 33 255.64 255.64
Page 156 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 3500 2 34 259.06 259.06
Arkansas Blue Cross & Blue Shield Silver 3500 2 35 260.76 260.76
Arkansas Blue Cross & Blue Shield Silver 3500 2 36 262.47 262.47
Arkansas Blue Cross & Blue Shield Silver 3500 2 37 264.18 264.18
Arkansas Blue Cross & Blue Shield Silver 3500 2 38 265.88 265.88
Arkansas Blue Cross & Blue Shield Silver 3500 2 39 269.3 269.3
Arkansas Blue Cross & Blue Shield Silver 3500 2 40 272.71 272.71
Arkansas Blue Cross & Blue Shield Silver 3500 2 41 277.83 277.83
Arkansas Blue Cross & Blue Shield Silver 3500 2 42 282.74 282.74
Arkansas Blue Cross & Blue Shield Silver 3500 2 43 289.57 289.57
Arkansas Blue Cross & Blue Shield Silver 3500 2 44 298.11 298.11
Arkansas Blue Cross & Blue Shield Silver 3500 2 45 308.14 308.14
Arkansas Blue Cross & Blue Shield Silver 3500 2 46 320.08 320.08
Arkansas Blue Cross & Blue Shield Silver 3500 2 47 333.53 333.53
Arkansas Blue Cross & Blue Shield Silver 3500 2 48 348.89 348.89
Arkansas Blue Cross & Blue Shield Silver 3500 2 49 364.04 364.04
Arkansas Blue Cross & Blue Shield Silver 3500 2 50 381.11 381.11
Arkansas Blue Cross & Blue Shield Silver 3500 2 51 397.97 397.97
Arkansas Blue Cross & Blue Shield Silver 3500 2 52 416.54 416.54
Arkansas Blue Cross & Blue Shield Silver 3500 2 53 435.32 435.32
Arkansas Blue Cross & Blue Shield Silver 3500 2 54 455.59 455.59
Arkansas Blue Cross & Blue Shield Silver 3500 2 55 475.86 475.86
Arkansas Blue Cross & Blue Shield Silver 3500 2 56 497.84 497.84
Arkansas Blue Cross & Blue Shield Silver 3500 2 57 520.03 520.03
Arkansas Blue Cross & Blue Shield Silver 3500 2 58 543.72 543.72
Arkansas Blue Cross & Blue Shield Silver 3500 2 59 555.45 555.45
Arkansas Blue Cross & Blue Shield Silver 3500 2 60 579.14 579.14
Arkansas Blue Cross & Blue Shield Silver 3500 2 61 599.63 599.63
Arkansas Blue Cross & Blue Shield Silver 3500 2 62 613.07 613.07
Arkansas Blue Cross & Blue Shield Silver 3500 2 63 629.93 629.93
Arkansas Blue Cross & Blue Shield Silver 3500 2 64 640.17 640.17
Arkansas Blue Cross & Blue Shield Silver 3500 2 65 and
over
640.17 640.17
Arkansas Blue Cross & Blue Shield Silver 3500 3 0‐20 137.05 137.05
Arkansas Blue Cross & Blue Shield Silver 3500 3 21 215.82 215.82
Arkansas Blue Cross & Blue Shield Silver 3500 3 22 215.82 215.82
Arkansas Blue Cross & Blue Shield Silver 3500 3 23 215.82 215.82
Arkansas Blue Cross & Blue Shield Silver 3500 3 24 215.82 215.82
Arkansas Blue Cross & Blue Shield Silver 3500 3 25 216.68 216.68
Arkansas Blue Cross & Blue Shield Silver 3500 3 26 221 221
Arkansas Blue Cross & Blue Shield Silver 3500 3 27 226.18 226.18
Arkansas Blue Cross & Blue Shield Silver 3500 3 28 234.6 234.6
Arkansas Blue Cross & Blue Shield Silver 3500 3 29 241.5 241.5
Arkansas Blue Cross & Blue Shield Silver 3500 3 30 244.96 244.96
Arkansas Blue Cross & Blue Shield Silver 3500 3 31 250.14 250.14
Arkansas Blue Cross & Blue Shield Silver 3500 3 32 255.32 255.32
Arkansas Blue Cross & Blue Shield Silver 3500 3 33 258.55 258.55
Arkansas Blue Cross & Blue Shield Silver 3500 3 34 262.01 262.01
Arkansas Blue Cross & Blue Shield Silver 3500 3 35 263.73 263.73
Arkansas Blue Cross & Blue Shield Silver 3500 3 36 265.46 265.46
Arkansas Blue Cross & Blue Shield Silver 3500 3 37 267.19 267.19
Arkansas Blue Cross & Blue Shield Silver 3500 3 38 268.91 268.91
Arkansas Blue Cross & Blue Shield Silver 3500 3 39 272.36 272.36
Arkansas Blue Cross & Blue Shield Silver 3500 3 40 275.82 275.82
Arkansas Blue Cross & Blue Shield Silver 3500 3 41 281 281
Arkansas Blue Cross & Blue Shield Silver 3500 3 42 285.96 285.96
Arkansas Blue Cross & Blue Shield Silver 3500 3 43 292.87 292.87
Arkansas Blue Cross & Blue Shield Silver 3500 3 44 301.5 301.5
Arkansas Blue Cross & Blue Shield Silver 3500 3 45 311.64 311.64
Arkansas Blue Cross & Blue Shield Silver 3500 3 46 323.73 323.73
Arkansas Blue Cross & Blue Shield Silver 3500 3 47 337.33 337.33
Arkansas Blue Cross & Blue Shield Silver 3500 3 48 352.87 352.87
Arkansas Blue Cross & Blue Shield Silver 3500 3 49 368.19 368.19
Page 157 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 3500 3 50 385.45 385.45
Arkansas Blue Cross & Blue Shield Silver 3500 3 51 402.5 402.5
Arkansas Blue Cross & Blue Shield Silver 3500 3 52 421.28 421.28
Arkansas Blue Cross & Blue Shield Silver 3500 3 53 440.27 440.27
Arkansas Blue Cross & Blue Shield Silver 3500 3 54 460.78 460.78
Arkansas Blue Cross & Blue Shield Silver 3500 3 55 481.28 481.28
Arkansas Blue Cross & Blue Shield Silver 3500 3 56 503.51 503.51
Arkansas Blue Cross & Blue Shield Silver 3500 3 57 525.95 525.95
Arkansas Blue Cross & Blue Shield Silver 3500 3 58 549.91 549.91
Arkansas Blue Cross & Blue Shield Silver 3500 3 59 561.78 561.78
Arkansas Blue Cross & Blue Shield Silver 3500 3 60 585.74 585.74
Arkansas Blue Cross & Blue Shield Silver 3500 3 61 606.45 606.45
Arkansas Blue Cross & Blue Shield Silver 3500 3 62 620.05 620.05
Arkansas Blue Cross & Blue Shield Silver 3500 3 63 637.1 637.1
Arkansas Blue Cross & Blue Shield Silver 3500 3 64 647.46 647.46
Arkansas Blue Cross & Blue Shield Silver 3500 3 65 and
over
647.46 647.46
Arkansas Blue Cross & Blue Shield Silver 3500 4 0‐20 134.66 134.66
Arkansas Blue Cross & Blue Shield Silver 3500 4 21 212.06 212.06
Arkansas Blue Cross & Blue Shield Silver 3500 4 22 212.06 212.06
Arkansas Blue Cross & Blue Shield Silver 3500 4 23 212.06 212.06
Arkansas Blue Cross & Blue Shield Silver 3500 4 24 212.06 212.06
Arkansas Blue Cross & Blue Shield Silver 3500 4 25 212.91 212.91
Arkansas Blue Cross & Blue Shield Silver 3500 4 26 217.15 217.15
Arkansas Blue Cross & Blue Shield Silver 3500 4 27 222.24 222.24
Arkansas Blue Cross & Blue Shield Silver 3500 4 28 230.51 230.51
Arkansas Blue Cross & Blue Shield Silver 3500 4 29 237.3 237.3
Arkansas Blue Cross & Blue Shield Silver 3500 4 30 240.69 240.69
Arkansas Blue Cross & Blue Shield Silver 3500 4 31 245.78 245.78
Arkansas Blue Cross & Blue Shield Silver 3500 4 32 250.87 250.87
Arkansas Blue Cross & Blue Shield Silver 3500 4 33 254.05 254.05
Arkansas Blue Cross & Blue Shield Silver 3500 4 34 257.44 257.44
Arkansas Blue Cross & Blue Shield Silver 3500 4 35 259.14 259.14
Arkansas Blue Cross & Blue Shield Silver 3500 4 36 260.83 260.83
Arkansas Blue Cross & Blue Shield Silver 3500 4 37 262.53 262.53
Arkansas Blue Cross & Blue Shield Silver 3500 4 38 264.23 264.23
Arkansas Blue Cross & Blue Shield Silver 3500 4 39 267.62 267.62
Arkansas Blue Cross & Blue Shield Silver 3500 4 40 271.01 271.01
Arkansas Blue Cross & Blue Shield Silver 3500 4 41 276.1 276.1
Arkansas Blue Cross & Blue Shield Silver 3500 4 42 280.98 280.98
Arkansas Blue Cross & Blue Shield Silver 3500 4 43 287.77 287.77
Arkansas Blue Cross & Blue Shield Silver 3500 4 44 296.25 296.25
Arkansas Blue Cross & Blue Shield Silver 3500 4 45 306.21 306.21
Arkansas Blue Cross & Blue Shield Silver 3500 4 46 318.09 318.09
Arkansas Blue Cross & Blue Shield Silver 3500 4 47 331.45 331.45
Arkansas Blue Cross & Blue Shield Silver 3500 4 48 346.72 346.72
Arkansas Blue Cross & Blue Shield Silver 3500 4 49 361.77 361.77
Arkansas Blue Cross & Blue Shield Silver 3500 4 50 378.74 378.74
Arkansas Blue Cross & Blue Shield Silver 3500 4 51 395.49 395.49
Arkansas Blue Cross & Blue Shield Silver 3500 4 52 413.94 413.94
Arkansas Blue Cross & Blue Shield Silver 3500 4 53 432.6 432.6
Arkansas Blue Cross & Blue Shield Silver 3500 4 54 452.75 452.75
Arkansas Blue Cross & Blue Shield Silver 3500 4 55 472.89 472.89
Arkansas Blue Cross & Blue Shield Silver 3500 4 56 494.74 494.74
Arkansas Blue Cross & Blue Shield Silver 3500 4 57 516.79 516.79
Arkansas Blue Cross & Blue Shield Silver 3500 4 58 540.33 540.33
Arkansas Blue Cross & Blue Shield Silver 3500 4 59 551.99 551.99
Arkansas Blue Cross & Blue Shield Silver 3500 4 60 575.53 575.53
Arkansas Blue Cross & Blue Shield Silver 3500 4 61 595.89 595.89
Arkansas Blue Cross & Blue Shield Silver 3500 4 62 609.25 609.25
Arkansas Blue Cross & Blue Shield Silver 3500 4 63 626 626
Arkansas Blue Cross & Blue Shield Silver 3500 4 64 636.18 636.18
Page 158 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 3500 4 65 and
over
636.18 636.18
Arkansas Blue Cross & Blue Shield Silver 3500 5 0‐20 144.5 144.5
Arkansas Blue Cross & Blue Shield Silver 3500 5 21 227.56 227.56
Arkansas Blue Cross & Blue Shield Silver 3500 5 22 227.56 227.56
Arkansas Blue Cross & Blue Shield Silver 3500 5 23 227.56 227.56
Arkansas Blue Cross & Blue Shield Silver 3500 5 24 227.56 227.56
Arkansas Blue Cross & Blue Shield Silver 3500 5 25 228.47 228.47
Arkansas Blue Cross & Blue Shield Silver 3500 5 26 233.02 233.02
Arkansas Blue Cross & Blue Shield Silver 3500 5 27 238.48 238.48
Arkansas Blue Cross & Blue Shield Silver 3500 5 28 247.36 247.36
Arkansas Blue Cross & Blue Shield Silver 3500 5 29 254.64 254.64
Arkansas Blue Cross & Blue Shield Silver 3500 5 30 258.28 258.28
Arkansas Blue Cross & Blue Shield Silver 3500 5 31 263.74 263.74
Arkansas Blue Cross & Blue Shield Silver 3500 5 32 269.2 269.2
Arkansas Blue Cross & Blue Shield Silver 3500 5 33 272.62 272.62
Arkansas Blue Cross & Blue Shield Silver 3500 5 34 276.26 276.26
Arkansas Blue Cross & Blue Shield Silver 3500 5 35 278.08 278.08
Arkansas Blue Cross & Blue Shield Silver 3500 5 36 279.9 279.9
Arkansas Blue Cross & Blue Shield Silver 3500 5 37 281.72 281.72
Arkansas Blue Cross & Blue Shield Silver 3500 5 38 283.54 283.54
Arkansas Blue Cross & Blue Shield Silver 3500 5 39 287.18 287.18
Arkansas Blue Cross & Blue Shield Silver 3500 5 40 290.82 290.82
Arkansas Blue Cross & Blue Shield Silver 3500 5 41 296.28 296.28
Arkansas Blue Cross & Blue Shield Silver 3500 5 42 301.52 301.52
Arkansas Blue Cross & Blue Shield Silver 3500 5 43 308.8 308.8
Arkansas Blue Cross & Blue Shield Silver 3500 5 44 317.9 317.9
Arkansas Blue Cross & Blue Shield Silver 3500 5 45 328.6 328.6
Arkansas Blue Cross & Blue Shield Silver 3500 5 46 341.34 341.34
Arkansas Blue Cross & Blue Shield Silver 3500 5 47 355.68 355.68
Arkansas Blue Cross & Blue Shield Silver 3500 5 48 372.06 372.06
Arkansas Blue Cross & Blue Shield Silver 3500 5 49 388.22 388.22
Arkansas Blue Cross & Blue Shield Silver 3500 5 50 406.42 406.42
Arkansas Blue Cross & Blue Shield Silver 3500 5 51 424.4 424.4
Arkansas Blue Cross & Blue Shield Silver 3500 5 52 444.2 444.2
Arkansas Blue Cross & Blue Shield Silver 3500 5 53 464.22 464.22
Arkansas Blue Cross & Blue Shield Silver 3500 5 54 485.84 485.84
Arkansas Blue Cross & Blue Shield Silver 3500 5 55 507.46 507.46
Arkansas Blue Cross & Blue Shield Silver 3500 5 56 530.9 530.9
Arkansas Blue Cross & Blue Shield Silver 3500 5 57 554.56 554.56
Arkansas Blue Cross & Blue Shield Silver 3500 5 58 579.82 579.82
Arkansas Blue Cross & Blue Shield Silver 3500 5 59 592.34 592.34
Arkansas Blue Cross & Blue Shield Silver 3500 5 60 617.6 617.6
Arkansas Blue Cross & Blue Shield Silver 3500 5 61 639.44 639.44
Arkansas Blue Cross & Blue Shield Silver 3500 5 62 653.78 653.78
Arkansas Blue Cross & Blue Shield Silver 3500 5 63 671.76 671.76
Arkansas Blue Cross & Blue Shield Silver 3500 5 64 682.68 682.68
Arkansas Blue Cross & Blue Shield Silver 3500 5 65 and
over
682.68 682.68
Arkansas Blue Cross & Blue Shield Silver 3500 6 0‐20 145.9 145.9
Arkansas Blue Cross & Blue Shield Silver 3500 6 21 229.77 229.77
Arkansas Blue Cross & Blue Shield Silver 3500 6 22 229.77 229.77
Arkansas Blue Cross & Blue Shield Silver 3500 6 23 229.77 229.77
Arkansas Blue Cross & Blue Shield Silver 3500 6 24 229.77 229.77
Arkansas Blue Cross & Blue Shield Silver 3500 6 25 230.69 230.69
Arkansas Blue Cross & Blue Shield Silver 3500 6 26 235.28 235.28
Arkansas Blue Cross & Blue Shield Silver 3500 6 27 240.8 240.8
Arkansas Blue Cross & Blue Shield Silver 3500 6 28 249.76 249.76
Arkansas Blue Cross & Blue Shield Silver 3500 6 29 257.11 257.11
Arkansas Blue Cross & Blue Shield Silver 3500 6 30 260.79 260.79
Arkansas Blue Cross & Blue Shield Silver 3500 6 31 266.3 266.3
Arkansas Blue Cross & Blue Shield Silver 3500 6 32 271.82 271.82
Arkansas Blue Cross & Blue Shield Silver 3500 6 33 275.26 275.26
Page 159 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 3500 6 34 278.94 278.94
Arkansas Blue Cross & Blue Shield Silver 3500 6 35 280.78 280.78
Arkansas Blue Cross & Blue Shield Silver 3500 6 36 282.62 282.62
Arkansas Blue Cross & Blue Shield Silver 3500 6 37 284.46 284.46
Arkansas Blue Cross & Blue Shield Silver 3500 6 38 286.29 286.29
Arkansas Blue Cross & Blue Shield Silver 3500 6 39 289.97 289.97
Arkansas Blue Cross & Blue Shield Silver 3500 6 40 293.65 293.65
Arkansas Blue Cross & Blue Shield Silver 3500 6 41 299.16 299.16
Arkansas Blue Cross & Blue Shield Silver 3500 6 42 304.45 304.45
Arkansas Blue Cross & Blue Shield Silver 3500 6 43 311.8 311.8
Arkansas Blue Cross & Blue Shield Silver 3500 6 44 320.99 320.99
Arkansas Blue Cross & Blue Shield Silver 3500 6 45 331.79 331.79
Arkansas Blue Cross & Blue Shield Silver 3500 6 46 344.66 344.66
Arkansas Blue Cross & Blue Shield Silver 3500 6 47 359.13 359.13
Arkansas Blue Cross & Blue Shield Silver 3500 6 48 375.67 375.67
Arkansas Blue Cross & Blue Shield Silver 3500 6 49 391.99 391.99
Arkansas Blue Cross & Blue Shield Silver 3500 6 50 410.37 410.37
Arkansas Blue Cross & Blue Shield Silver 3500 6 51 428.52 428.52
Arkansas Blue Cross & Blue Shield Silver 3500 6 52 448.51 448.51
Arkansas Blue Cross & Blue Shield Silver 3500 6 53 468.73 468.73
Arkansas Blue Cross & Blue Shield Silver 3500 6 54 490.56 490.56
Arkansas Blue Cross & Blue Shield Silver 3500 6 55 512.39 512.39
Arkansas Blue Cross & Blue Shield Silver 3500 6 56 536.05 536.05
Arkansas Blue Cross & Blue Shield Silver 3500 6 57 559.95 559.95
Arkansas Blue Cross & Blue Shield Silver 3500 6 58 585.45 585.45
Arkansas Blue Cross & Blue Shield Silver 3500 6 59 598.09 598.09
Arkansas Blue Cross & Blue Shield Silver 3500 6 60 623.6 623.6
Arkansas Blue Cross & Blue Shield Silver 3500 6 61 645.65 645.65
Arkansas Blue Cross & Blue Shield Silver 3500 6 62 660.13 660.13
Arkansas Blue Cross & Blue Shield Silver 3500 6 63 678.28 678.28
Arkansas Blue Cross & Blue Shield Silver 3500 6 64 689.31 689.31
Arkansas Blue Cross & Blue Shield Silver 3500 6 65 and
over
689.31 689.31
Arkansas Blue Cross & Blue Shield Silver 3500 7 0‐20 130.58 130.58
Arkansas Blue Cross & Blue Shield Silver 3500 7 21 205.64 205.64
Arkansas Blue Cross & Blue Shield Silver 3500 7 22 205.64 205.64
Arkansas Blue Cross & Blue Shield Silver 3500 7 23 205.64 205.64
Arkansas Blue Cross & Blue Shield Silver 3500 7 24 205.64 205.64
Arkansas Blue Cross & Blue Shield Silver 3500 7 25 206.46 206.46
Arkansas Blue Cross & Blue Shield Silver 3500 7 26 210.58 210.58
Arkansas Blue Cross & Blue Shield Silver 3500 7 27 215.51 215.51
Arkansas Blue Cross & Blue Shield Silver 3500 7 28 223.53 223.53
Arkansas Blue Cross & Blue Shield Silver 3500 7 29 230.11 230.11
Arkansas Blue Cross & Blue Shield Silver 3500 7 30 233.4 233.4
Arkansas Blue Cross & Blue Shield Silver 3500 7 31 238.34 238.34
Arkansas Blue Cross & Blue Shield Silver 3500 7 32 243.27 243.27
Arkansas Blue Cross & Blue Shield Silver 3500 7 33 246.36 246.36
Arkansas Blue Cross & Blue Shield Silver 3500 7 34 249.65 249.65
Arkansas Blue Cross & Blue Shield Silver 3500 7 35 251.29 251.29
Arkansas Blue Cross & Blue Shield Silver 3500 7 36 252.94 252.94
Arkansas Blue Cross & Blue Shield Silver 3500 7 37 254.58 254.58
Arkansas Blue Cross & Blue Shield Silver 3500 7 38 256.23 256.23
Arkansas Blue Cross & Blue Shield Silver 3500 7 39 259.52 259.52
Arkansas Blue Cross & Blue Shield Silver 3500 7 40 262.81 262.81
Arkansas Blue Cross & Blue Shield Silver 3500 7 41 267.74 267.74
Arkansas Blue Cross & Blue Shield Silver 3500 7 42 272.47 272.47
Arkansas Blue Cross & Blue Shield Silver 3500 7 43 279.05 279.05
Arkansas Blue Cross & Blue Shield Silver 3500 7 44 287.28 287.28
Arkansas Blue Cross & Blue Shield Silver 3500 7 45 296.94 296.94
Arkansas Blue Cross & Blue Shield Silver 3500 7 46 308.46 308.46
Arkansas Blue Cross & Blue Shield Silver 3500 7 47 321.42 321.42
Arkansas Blue Cross & Blue Shield Silver 3500 7 48 336.22 336.22
Arkansas Blue Cross & Blue Shield Silver 3500 7 49 350.82 350.82
Page 160 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Arkansas Blue Cross & Blue Shield Silver 3500 7 50 367.27 367.27
Arkansas Blue Cross & Blue Shield Silver 3500 7 51 383.52 383.52
Arkansas Blue Cross & Blue Shield Silver 3500 7 52 401.41 401.41
Arkansas Blue Cross & Blue Shield Silver 3500 7 53 419.51 419.51
Arkansas Blue Cross & Blue Shield Silver 3500 7 54 439.04 439.04
Arkansas Blue Cross & Blue Shield Silver 3500 7 55 458.58 458.58
Arkansas Blue Cross & Blue Shield Silver 3500 7 56 479.76 479.76
Arkansas Blue Cross & Blue Shield Silver 3500 7 57 501.14 501.14
Arkansas Blue Cross & Blue Shield Silver 3500 7 58 523.97 523.97
Arkansas Blue Cross & Blue Shield Silver 3500 7 59 535.28 535.28
Arkansas Blue Cross & Blue Shield Silver 3500 7 60 558.11 558.11
Arkansas Blue Cross & Blue Shield Silver 3500 7 61 577.85 577.85
Arkansas Blue Cross & Blue Shield Silver 3500 7 62 590.8 590.8
Arkansas Blue Cross & Blue Shield Silver 3500 7 63 607.05 607.05
Arkansas Blue Cross & Blue Shield Silver 3500 7 64 616.92 616.92
Arkansas Blue Cross & Blue Shield Silver 3500 7 65 and
over
616.92 616.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 0‐20 154.86 154.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 21 243.87 243.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 22 243.87 243.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 23 243.87 243.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 24 243.87 243.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 25 244.85 244.85
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 26 249.72 249.72
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 27 255.58 255.58
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 28 265.09 265.09
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 29 272.89 272.89
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 30 276.79 276.79
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 31 282.65 282.65
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 32 288.5 288.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 33 292.16 292.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 34 296.06 296.06
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 35 298.01 298.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 36 299.96 299.96
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 37 301.91 301.91
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 38 303.86 303.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 39 307.76 307.76
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 40 311.67 311.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 41 317.52 317.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 42 323.13 323.13
Page 161 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 43 330.93 330.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 44 340.69 340.69
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 45 352.15 352.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 46 365.8 365.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 47 381.17 381.17
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 48 398.73 398.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 49 416.04 416.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 50 435.55 435.55
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 51 454.82 454.82
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 52 476.03 476.03
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 53 497.49 497.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 54 520.66 520.66
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 55 543.83 543.83
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 56 568.95 568.95
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 57 594.31 594.31
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 58 621.38 621.38
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 59 634.79 634.79
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 60 661.86 661.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 61 685.27 685.27
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 62 700.64 700.64
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 63 719.9 719.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 64 731.61 731.61
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 65 and
over
731.61 731.61
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 0‐20 143.81 143.81
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 21 226.48 226.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 22 226.48 226.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 23 226.48 226.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 24 226.48 226.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 25 227.39 227.39
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 26 231.92 231.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 27 237.35 237.35
Page 162 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 28 246.18 246.18
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 29 253.43 253.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 30 257.05 257.05
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 31 262.49 262.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 32 267.93 267.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 33 271.32 271.32
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 34 274.95 274.95
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 35 276.76 276.76
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 36 278.57 278.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 37 280.38 280.38
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 38 282.19 282.19
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 39 285.82 285.82
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 40 289.44 289.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 41 294.88 294.88
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 42 300.09 300.09
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 43 307.33 307.33
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 44 316.39 316.39
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 45 327.04 327.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 46 339.72 339.72
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 47 353.99 353.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 48 370.29 370.29
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 49 386.37 386.37
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 50 404.49 404.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 51 422.39 422.39
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 52 442.09 442.09
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 53 462.02 462.02
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 54 483.53 483.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 55 505.05 505.05
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 56 528.38 528.38
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 57 551.93 551.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 58 577.07 577.07
Page 163 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 59 589.53 589.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 60 614.67 614.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 61 636.41 636.41
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 62 650.68 650.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 63 668.57 668.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 64 679.44 679.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 2 65 and
over
679.44 679.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 0‐20 145.46 145.46
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 21 229.07 229.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 22 229.07 229.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 23 229.07 229.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 24 229.07 229.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 25 229.99 229.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 26 234.57 234.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 27 240.07 240.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 28 249 249
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 29 256.33 256.33
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 30 259.99 259.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 31 265.49 265.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 32 270.99 270.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 33 274.43 274.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 34 278.09 278.09
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 35 279.92 279.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 36 281.76 281.76
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 37 283.59 283.59
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 38 285.42 285.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 39 289.09 289.09
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 40 292.75 292.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 41 298.25 298.25
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 42 303.52 303.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 43 310.85 310.85
Page 164 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 44 320.01 320.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 45 330.78 330.78
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 46 343.6 343.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 47 358.04 358.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 48 374.53 374.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 49 390.79 390.79
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 50 409.12 409.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 51 427.22 427.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 52 447.14 447.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 53 467.3 467.3
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 54 489.06 489.06
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 55 510.83 510.83
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 56 534.42 534.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 57 558.24 558.24
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 58 583.67 583.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 59 596.27 596.27
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 60 621.7 621.7
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 61 643.69 643.69
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 62 658.12 658.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 63 676.21 676.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 64 687.21 687.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 65 and
over
687.21 687.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 0‐20 142.92 142.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 21 225.07 225.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 22 225.07 225.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 23 225.07 225.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 24 225.07 225.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 25 225.97 225.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 26 230.47 230.47
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 27 235.87 235.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 28 244.65 244.65
Page 165 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 29 251.85 251.85
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 30 255.45 255.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 31 260.86 260.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 32 266.26 266.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 33 269.63 269.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 34 273.23 273.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 35 275.04 275.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 36 276.84 276.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 37 278.64 278.64
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 38 280.44 280.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 39 284.04 284.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 40 287.64 287.64
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 41 293.04 293.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 42 298.22 298.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 43 305.42 305.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 44 314.42 314.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 45 325 325
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 46 337.6 337.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 47 351.78 351.78
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 48 367.99 367.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 49 383.97 383.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 50 401.98 401.98
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 51 419.76 419.76
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 52 439.34 439.34
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 53 459.14 459.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 54 480.52 480.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 55 501.91 501.91
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 56 525.09 525.09
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 57 548.5 548.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 58 573.48 573.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 59 585.86 585.86
Page 166 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 60 610.84 610.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 61 632.45 632.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 62 646.63 646.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 63 664.41 664.41
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 64 675.21 675.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 4 65 and
over
675.21 675.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 0‐20 153.37 153.37
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 21 241.52 241.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 22 241.52 241.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 23 241.52 241.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 24 241.52 241.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 25 242.49 242.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 26 247.32 247.32
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 27 253.11 253.11
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 28 262.53 262.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 29 270.26 270.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 30 274.13 274.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 31 279.92 279.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 32 285.72 285.72
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 33 289.34 289.34
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 34 293.21 293.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 35 295.14 295.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 36 297.07 297.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 37 299 299
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 38 300.93 300.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 39 304.8 304.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 40 308.66 308.66
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 41 314.46 314.46
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 42 320.01 320.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 43 327.74 327.74
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 44 337.4 337.4
Page 167 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 45 348.75 348.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 46 362.28 362.28
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 47 377.5 377.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 48 394.89 394.89
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 49 412.03 412.03
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 50 431.35 431.35
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 51 450.43 450.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 52 471.45 471.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 53 492.7 492.7
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 54 515.65 515.65
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 55 538.59 538.59
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 56 563.47 563.47
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 57 588.58 588.58
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 58 615.39 615.39
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 59 628.68 628.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 60 655.49 655.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 61 678.67 678.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 62 693.89 693.89
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 63 712.97 712.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 64 724.56 724.56
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 5 65 and
over
724.56 724.56
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 0‐20 154.86 154.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 21 243.87 243.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 22 243.87 243.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 23 243.87 243.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 24 243.87 243.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 25 244.85 244.85
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 26 249.72 249.72
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 27 255.58 255.58
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 28 265.09 265.09
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 29 272.89 272.89
Page 168 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 30 276.79 276.79
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 31 282.65 282.65
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 32 288.5 288.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 33 292.16 292.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 34 296.06 296.06
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 35 298.01 298.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 36 299.96 299.96
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 37 301.91 301.91
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 38 303.86 303.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 39 307.76 307.76
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 40 311.67 311.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 41 317.52 317.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 42 323.13 323.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 43 330.93 330.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 44 340.69 340.69
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 45 352.15 352.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 46 365.8 365.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 47 381.17 381.17
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 48 398.73 398.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 49 416.04 416.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 50 435.55 435.55
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 51 454.82 454.82
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 52 476.03 476.03
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 53 497.49 497.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 54 520.66 520.66
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 55 543.83 543.83
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 56 568.95 568.95
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 57 594.31 594.31
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 58 621.38 621.38
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 59 634.79 634.79
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 60 661.86 661.86
Page 169 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 61 685.27 685.27
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 62 700.64 700.64
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 63 719.9 719.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 64 731.61 731.61
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 6 65 and
over
731.61 731.61
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 0‐20 138.6 138.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 21 218.26 218.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 22 218.26 218.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 23 218.26 218.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 24 218.26 218.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 25 219.13 219.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 26 223.5 223.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 27 228.74 228.74
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 28 237.25 237.25
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 29 244.23 244.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 30 247.73 247.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 31 252.96 252.96
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 32 258.2 258.2
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 33 261.48 261.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 34 264.97 264.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 35 266.71 266.71
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 36 268.46 268.46
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 37 270.21 270.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 38 271.95 271.95
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 39 275.44 275.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 40 278.94 278.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 41 284.17 284.17
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 42 289.19 289.19
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 43 296.18 296.18
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 44 304.91 304.91
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 45 315.17 315.17
Page 170 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 46 327.39 327.39
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 47 341.14 341.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 48 356.86 356.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 49 372.35 372.35
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 50 389.81 389.81
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 51 407.05 407.05
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 52 426.04 426.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 53 445.25 445.25
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 54 465.99 465.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 55 486.72 486.72
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 56 509.2 509.2
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 57 531.9 531.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 58 556.13 556.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 59 568.13 568.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 60 592.36 592.36
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 61 613.31 613.31
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 62 627.06 627.06
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 63 644.3 644.3
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 64 654.78 654.78
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 7 65 and
over
654.78 654.78
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 0‐20 179.6 179.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 21 282.84 282.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 22 282.84 282.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 23 282.84 282.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 24 282.84 282.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 25 283.97 283.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 26 289.63 289.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 27 296.42 296.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 28 307.45 307.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 29 316.5 316.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 30 321.02 321.02
Page 171 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 31 327.81 327.81
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 32 334.6 334.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 33 338.84 338.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 34 343.37 343.37
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 35 345.63 345.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 36 347.89 347.89
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 37 350.16 350.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 38 352.42 352.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 39 356.94 356.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 40 361.47 361.47
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 41 368.26 368.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 42 374.76 374.76
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 43 383.81 383.81
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 44 395.13 395.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 45 408.42 408.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 46 424.26 424.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 47 442.08 442.08
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 48 462.44 462.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 49 482.53 482.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 50 505.15 505.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 51 527.5 527.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 52 552.1 552.1
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 53 576.99 576.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 54 603.86 603.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 55 630.73 630.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 56 659.87 659.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 57 689.28 689.28
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 58 720.68 720.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 59 736.23 736.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 60 767.63 767.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 61 794.78 794.78
Page 172 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 62 812.6 812.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 63 834.94 834.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 64 848.52 848.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 1 65 and
over
848.52 848.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 0‐20 166.8 166.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 21 262.68 262.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 22 262.68 262.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 23 262.68 262.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 24 262.68 262.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 25 263.73 263.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 26 268.98 268.98
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 27 275.29 275.29
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 28 285.53 285.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 29 293.94 293.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 30 298.14 298.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 31 304.45 304.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 32 310.75 310.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 33 314.69 314.69
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 34 318.89 318.89
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 35 320.99 320.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 36 323.1 323.1
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 37 325.2 325.2
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 38 327.3 327.3
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 39 331.5 331.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 40 335.71 335.71
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 41 342.01 342.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 42 348.05 348.05
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 43 356.46 356.46
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 44 366.96 366.96
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 45 379.31 379.31
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 46 394.02 394.02
Page 173 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 47 410.57 410.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 48 429.48 429.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 49 448.13 448.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 50 469.15 469.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 51 489.9 489.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 52 512.75 512.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 53 535.87 535.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 54 560.82 560.82
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 55 585.78 585.78
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 56 612.83 612.83
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 57 640.15 640.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 58 669.31 669.31
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 59 683.76 683.76
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 60 712.91 712.91
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 61 738.13 738.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 62 754.68 754.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 63 775.43 775.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 64 788.04 788.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 2 65 and
over
788.04 788.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 0‐20 168.7 168.7
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 21 265.67 265.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 22 265.67 265.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 23 265.67 265.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 24 265.67 265.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 25 266.73 266.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 26 272.05 272.05
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 27 278.42 278.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 28 288.78 288.78
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 29 297.28 297.28
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 30 301.54 301.54
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 31 307.91 307.91
Page 174 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 32 314.29 314.29
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 33 318.27 318.27
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 34 322.52 322.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 35 324.65 324.65
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 36 326.77 326.77
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 37 328.9 328.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 38 331.02 331.02
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 39 335.28 335.28
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 40 339.53 339.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 41 345.9 345.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 42 352.01 352.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 43 360.51 360.51
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 44 371.14 371.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 45 383.63 383.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 46 398.5 398.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 47 415.24 415.24
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 48 434.37 434.37
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 49 453.23 453.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 50 474.49 474.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 51 495.47 495.47
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 52 518.59 518.59
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 53 541.97 541.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 54 567.21 567.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 55 592.44 592.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 56 619.81 619.81
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 57 647.44 647.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 58 676.93 676.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 59 691.54 691.54
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 60 721.03 721.03
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 61 746.53 746.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 62 763.27 763.27
Page 175 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 63 784.26 784.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 64 797.01 797.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 3 65 and
over
797.01 797.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 0‐20 165.76 165.76
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 21 261.04 261.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 22 261.04 261.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 23 261.04 261.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 24 261.04 261.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 25 262.08 262.08
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 26 267.3 267.3
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 27 273.57 273.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 28 283.75 283.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 29 292.1 292.1
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 30 296.28 296.28
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 31 302.55 302.55
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 32 308.81 308.81
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 33 312.73 312.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 34 316.9 316.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 35 318.99 318.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 36 321.08 321.08
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 37 323.17 323.17
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 38 325.26 325.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 39 329.43 329.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 40 333.61 333.61
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 41 339.87 339.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 42 345.88 345.88
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 43 354.23 354.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 44 364.67 364.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 45 376.94 376.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 46 391.56 391.56
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 47 408.01 408.01
Page 176 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 48 426.8 426.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 49 445.33 445.33
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 50 466.22 466.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 51 486.84 486.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 52 509.55 509.55
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 53 532.52 532.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 54 557.32 557.32
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 55 582.12 582.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 56 609.01 609.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 57 636.15 636.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 58 665.13 665.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 59 679.49 679.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 60 708.46 708.46
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 61 733.52 733.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 62 749.97 749.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 63 770.59 770.59
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 64 783.12 783.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 4 65 and
over
783.12 783.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 0‐20 177.88 177.88
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 21 280.12 280.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 22 280.12 280.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 23 280.12 280.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 24 280.12 280.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 25 281.24 281.24
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 26 286.84 286.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 27 293.57 293.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 28 304.49 304.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 29 313.45 313.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 30 317.94 317.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 31 324.66 324.66
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 32 331.38 331.38
Page 177 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 33 335.58 335.58
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 34 340.07 340.07
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 35 342.31 342.31
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 36 344.55 344.55
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 37 346.79 346.79
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 38 349.03 349.03
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 39 353.51 353.51
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 40 357.99 357.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 41 364.72 364.72
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 42 371.16 371.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 43 380.12 380.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 44 391.33 391.33
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 45 404.49 404.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 46 420.18 420.18
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 47 437.83 437.83
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 48 458 458
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 49 477.88 477.88
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 50 500.29 500.29
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 51 522.42 522.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 52 546.79 546.79
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 53 571.44 571.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 54 598.06 598.06
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 55 624.67 624.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 56 653.52 653.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 57 682.65 682.65
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 58 713.75 713.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 59 729.15 729.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 60 760.25 760.25
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 61 787.14 787.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 62 804.78 804.78
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 63 826.91 826.91
Page 178 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 64 840.36 840.36
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 5 65 and
over
840.36 840.36
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 0‐20 179.6 179.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 21 282.84 282.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 22 282.84 282.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 23 282.84 282.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 24 282.84 282.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 25 283.97 283.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 26 289.63 289.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 27 296.42 296.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 28 307.45 307.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 29 316.5 316.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 30 321.02 321.02
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 31 327.81 327.81
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 32 334.6 334.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 33 338.84 338.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 34 343.37 343.37
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 35 345.63 345.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 36 347.89 347.89
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 37 350.16 350.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 38 352.42 352.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 39 356.94 356.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 40 361.47 361.47
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 41 368.26 368.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 42 374.76 374.76
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 43 383.81 383.81
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 44 395.13 395.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 45 408.42 408.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 46 424.26 424.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 47 442.08 442.08
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 48 462.44 462.44
Page 179 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 49 482.53 482.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 50 505.15 505.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 51 527.5 527.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 52 552.1 552.1
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 53 576.99 576.99
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 54 603.86 603.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 55 630.73 630.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 56 659.87 659.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 57 689.28 689.28
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 58 720.68 720.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 59 736.23 736.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 60 767.63 767.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 61 794.78 794.78
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 62 812.6 812.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 63 834.94 834.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 64 848.52 848.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 6 65 and
over
848.52 848.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 0‐20 160.74 160.74
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 21 253.14 253.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 22 253.14 253.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 23 253.14 253.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 24 253.14 253.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 25 254.15 254.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 26 259.22 259.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 27 265.29 265.29
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 28 275.16 275.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 29 283.26 283.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 30 287.31 287.31
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 31 293.39 293.39
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 32 299.46 299.46
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 33 303.26 303.26
Page 180 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 34 307.31 307.31
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 35 309.34 309.34
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 36 311.36 311.36
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 37 313.39 313.39
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 38 315.41 315.41
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 39 319.46 319.46
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 40 323.51 323.51
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 41 329.59 329.59
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 42 335.41 335.41
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 43 343.51 343.51
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 44 353.64 353.64
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 45 365.53 365.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 46 379.71 379.71
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 47 395.66 395.66
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 48 413.88 413.88
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 49 431.86 431.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 50 452.11 452.11
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 51 472.11 472.11
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 52 494.13 494.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 53 516.41 516.41
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 54 540.45 540.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 55 564.5 564.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 56 590.58 590.58
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 57 616.9 616.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 58 645 645
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 59 658.92 658.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 60 687.02 687.02
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 61 711.32 711.32
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 62 727.27 727.27
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 63 747.27 747.27
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 64 759.42 759.42
Page 181 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 500, a Multi‐State Plan 7 65 and
over
759.42 759.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 0‐20 119.13 119.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 21 187.6 187.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 22 187.6 187.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 23 187.6 187.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 24 187.6 187.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 25 188.35 188.35
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 26 192.1 192.1
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 27 196.6 196.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 28 203.92 203.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 29 209.92 209.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 30 212.93 212.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 31 217.43 217.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 32 221.93 221.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 33 224.74 224.74
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 34 227.75 227.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 35 229.25 229.25
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 36 230.75 230.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 37 232.25 232.25
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 38 233.75 233.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 39 236.75 236.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 40 239.75 239.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 41 244.26 244.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 42 248.57 248.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 43 254.57 254.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 44 262.08 262.08
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 45 270.89 270.89
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 46 281.4 281.4
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 47 293.22 293.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 48 306.73 306.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 49 320.05 320.05
Page 182 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 50 335.05 335.05
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 51 349.87 349.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 52 366.2 366.2
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 53 382.7 382.7
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 54 400.53 400.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 55 418.35 418.35
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 56 437.67 437.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 57 457.18 457.18
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 58 478 478
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 59 488.32 488.32
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 60 509.15 509.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 61 527.16 527.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 62 538.97 538.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 63 553.8 553.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 64 562.8 562.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 1 65 and
over
562.8 562.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 0‐20 110.64 110.64
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 21 174.23 174.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 22 174.23 174.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 23 174.23 174.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 24 174.23 174.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 25 174.93 174.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 26 178.41 178.41
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 27 182.59 182.59
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 28 189.39 189.39
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 29 194.96 194.96
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 30 197.75 197.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 31 201.93 201.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 32 206.11 206.11
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 33 208.73 208.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 34 211.52 211.52
Page 183 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 35 212.91 212.91
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 36 214.3 214.3
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 37 215.7 215.7
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 38 217.09 217.09
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 39 219.88 219.88
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 40 222.67 222.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 41 226.85 226.85
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 42 230.85 230.85
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 43 236.43 236.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 44 243.4 243.4
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 45 251.59 251.59
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 46 261.34 261.34
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 47 272.32 272.32
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 48 284.87 284.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 49 297.24 297.24
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 50 311.17 311.17
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 51 324.94 324.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 52 340.1 340.1
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 53 355.43 355.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 54 371.98 371.98
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 55 388.53 388.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 56 406.48 406.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 57 424.6 424.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 58 443.94 443.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 59 453.52 453.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 60 472.86 472.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 61 489.59 489.59
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 62 500.56 500.56
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 63 514.33 514.33
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 64 522.69 522.69
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 2 65 and
over
522.69 522.69
Page 184 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 0‐20 111.9 111.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 21 176.22 176.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 22 176.22 176.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 23 176.22 176.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 24 176.22 176.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 25 176.92 176.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 26 180.45 180.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 27 184.68 184.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 28 191.55 191.55
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 29 197.19 197.19
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 30 200.01 200.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 31 204.24 204.24
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 32 208.47 208.47
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 33 211.11 211.11
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 34 213.93 213.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 35 215.34 215.34
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 36 216.75 216.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 37 218.16 218.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 38 219.57 219.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 39 222.39 222.39
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 40 225.21 225.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 41 229.44 229.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 42 233.49 233.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 43 239.13 239.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 44 246.18 246.18
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 45 254.46 254.46
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 46 264.33 264.33
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 47 275.43 275.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 48 288.12 288.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 49 300.63 300.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 50 314.73 314.73
Page 185 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 51 328.65 328.65
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 52 343.98 343.98
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 53 359.49 359.49
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 54 376.23 376.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 55 392.97 392.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 56 411.12 411.12
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 57 429.45 429.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 58 449.01 449.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 59 458.7 458.7
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 60 478.26 478.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 61 495.18 495.18
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 62 506.28 506.28
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 63 520.2 520.2
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 64 528.66 528.66
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 3 65 and
over
528.66 528.66
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 0‐20 109.94 109.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 21 173.14 173.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 22 173.14 173.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 23 173.14 173.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 24 173.14 173.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 25 173.83 173.83
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 26 177.3 177.3
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 27 181.45 181.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 28 188.2 188.2
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 29 193.74 193.74
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 30 196.51 196.51
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 31 200.67 200.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 32 204.82 204.82
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 33 207.42 207.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 34 210.19 210.19
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 35 211.58 211.58
Page 186 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 36 212.96 212.96
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 37 214.35 214.35
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 38 215.73 215.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 39 218.5 218.5
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 40 221.27 221.27
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 41 225.43 225.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 42 229.41 229.41
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 43 234.95 234.95
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 44 241.88 241.88
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 45 250.01 250.01
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 46 259.71 259.71
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 47 270.62 270.62
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 48 283.08 283.08
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 49 295.38 295.38
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 50 309.23 309.23
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 51 322.91 322.91
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 52 337.97 337.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 53 353.21 353.21
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 54 369.65 369.65
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 55 386.1 386.1
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 56 403.94 403.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 57 421.94 421.94
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 58 441.16 441.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 59 450.68 450.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 60 469.9 469.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 61 486.52 486.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 62 497.43 497.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 63 511.11 511.11
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 64 519.42 519.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 4 65 and
over
519.42 519.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 0‐20 117.98 117.98
Page 187 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 21 185.8 185.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 22 185.8 185.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 23 185.8 185.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 24 185.8 185.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 25 186.54 186.54
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 26 190.26 190.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 27 194.72 194.72
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 28 201.96 201.96
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 29 207.91 207.91
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 30 210.88 210.88
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 31 215.34 215.34
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 32 219.8 219.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 33 222.59 222.59
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 34 225.56 225.56
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 35 227.05 227.05
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 36 228.53 228.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 37 230.02 230.02
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 38 231.51 231.51
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 39 234.48 234.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 40 237.45 237.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 41 241.91 241.91
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 42 246.18 246.18
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 43 252.13 252.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 44 259.56 259.56
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 45 268.3 268.3
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 46 278.7 278.7
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 47 290.41 290.41
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 48 303.78 303.78
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 49 316.97 316.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 50 331.84 331.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 51 346.52 346.52
Page 188 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 52 362.68 362.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 53 379.03 379.03
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 54 396.68 396.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 55 414.33 414.33
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 56 433.47 433.47
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 57 452.79 452.79
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 58 473.42 473.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 59 483.64 483.64
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 60 504.26 504.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 61 522.1 522.1
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 62 533.8 533.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 63 548.48 548.48
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 64 557.4 557.4
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 5 65 and
over
557.4 557.4
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 0‐20 119.13 119.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 21 187.6 187.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 22 187.6 187.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 23 187.6 187.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 24 187.6 187.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 25 188.35 188.35
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 26 192.1 192.1
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 27 196.6 196.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 28 203.92 203.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 29 209.92 209.92
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 30 212.93 212.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 31 217.43 217.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 32 221.93 221.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 33 224.74 224.74
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 34 227.75 227.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 35 229.25 229.25
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 36 230.75 230.75
Page 189 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 37 232.25 232.25
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 38 233.75 233.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 39 236.75 236.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 40 239.75 239.75
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 41 244.26 244.26
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 42 248.57 248.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 43 254.57 254.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 44 262.08 262.08
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 45 270.89 270.89
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 46 281.4 281.4
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 47 293.22 293.22
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 48 306.73 306.73
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 49 320.05 320.05
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 50 335.05 335.05
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 51 349.87 349.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 52 366.2 366.2
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 53 382.7 382.7
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 54 400.53 400.53
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 55 418.35 418.35
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 56 437.67 437.67
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 57 457.18 457.18
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 58 478 478
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 59 488.32 488.32
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 60 509.15 509.15
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 61 527.16 527.16
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 62 538.97 538.97
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 63 553.8 553.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 64 562.8 562.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 6 65 and
over
562.8 562.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 0‐20 106.62 106.62
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 21 167.9 167.9
Page 190 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 22 167.9 167.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 23 167.9 167.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 24 167.9 167.9
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 25 168.57 168.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 26 171.93 171.93
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 27 175.96 175.96
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 28 182.51 182.51
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 29 187.88 187.88
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 30 190.57 190.57
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 31 194.6 194.6
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 32 198.63 198.63
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 33 201.14 201.14
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 34 203.83 203.83
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 35 205.17 205.17
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 36 206.52 206.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 37 207.86 207.86
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 38 209.2 209.2
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 39 211.89 211.89
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 40 214.58 214.58
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 41 218.61 218.61
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 42 222.47 222.47
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 43 227.84 227.84
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 44 234.56 234.56
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 45 242.45 242.45
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 46 251.85 251.85
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 47 262.43 262.43
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 48 274.52 274.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 49 286.44 286.44
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 50 299.87 299.87
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 51 313.13 313.13
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 52 327.74 327.74
Page 191 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 53 342.52 342.52
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 54 358.47 358.47
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 55 374.42 374.42
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 56 391.71 391.71
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 57 409.17 409.17
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 58 427.81 427.81
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 59 437.04 437.04
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 60 455.68 455.68
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 61 471.8 471.8
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 62 482.38 482.38
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 63 495.64 495.64
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 64 503.7 503.7
Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 5000, a Multi‐State Plan 7 65 and
over
503.7 503.7
QCA Health Plan, Inc. Bronze Basic Plus 1 0‐20 115.36 115.36
QCA Health Plan, Inc. Bronze Basic Plus 1 0‐20 128.17 128.17
QCA Health Plan, Inc. Bronze Basic Plus 1 21 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 1 21 201.85 242.22
QCA Health Plan, Inc. Bronze Basic Plus 1 22 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 1 22 201.85 242.22
QCA Health Plan, Inc. Bronze Basic Plus 1 23 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 1 23 201.85 242.22
QCA Health Plan, Inc. Bronze Basic Plus 1 24 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 1 24 201.85 242.22
QCA Health Plan, Inc. Bronze Basic Plus 1 25 182.39 218.87
QCA Health Plan, Inc. Bronze Basic Plus 1 25 202.66 243.19
QCA Health Plan, Inc. Bronze Basic Plus 1 26 186.02 223.23
QCA Health Plan, Inc. Bronze Basic Plus 1 26 206.69 248.03
QCA Health Plan, Inc. Bronze Basic Plus 1 27 190.38 228.46
QCA Health Plan, Inc. Bronze Basic Plus 1 27 211.54 253.84
QCA Health Plan, Inc. Bronze Basic Plus 1 28 197.47 236.96
QCA Health Plan, Inc. Bronze Basic Plus 1 28 219.41 263.29
QCA Health Plan, Inc. Bronze Basic Plus 1 29 203.28 243.94
QCA Health Plan, Inc. Bronze Basic Plus 1 29 225.87 271.04
QCA Health Plan, Inc. Bronze Basic Plus 1 30 206.19 247.43
QCA Health Plan, Inc. Bronze Basic Plus 1 30 229.1 274.92
QCA Health Plan, Inc. Bronze Basic Plus 1 31 210.55 252.66
QCA Health Plan, Inc. Bronze Basic Plus 1 31 233.94 280.73
QCA Health Plan, Inc. Bronze Basic Plus 1 32 214.91 257.89
QCA Health Plan, Inc. Bronze Basic Plus 1 32 238.79 286.54
QCA Health Plan, Inc. Bronze Basic Plus 1 33 217.63 261.16
QCA Health Plan, Inc. Bronze Basic Plus 1 33 241.81 290.18
QCA Health Plan, Inc. Bronze Basic Plus 1 34 220.54 264.65
QCA Health Plan, Inc. Bronze Basic Plus 1 34 245.04 294.05
QCA Health Plan, Inc. Bronze Basic Plus 1 35 221.99 266.39
QCA Health Plan, Inc. Bronze Basic Plus 1 35 246.66 295.99
QCA Health Plan, Inc. Bronze Basic Plus 1 36 223.45 268.14
QCA Health Plan, Inc. Bronze Basic Plus 1 36 248.27 297.93
QCA Health Plan, Inc. Bronze Basic Plus 1 37 224.9 269.88
QCA Health Plan, Inc. Bronze Basic Plus 1 37 249.89 299.87
QCA Health Plan, Inc. Bronze Basic Plus 1 38 226.35 271.62
Page 192 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Basic Plus 1 38 251.5 301.8
QCA Health Plan, Inc. Bronze Basic Plus 1 39 229.26 275.11
QCA Health Plan, Inc. Bronze Basic Plus 1 39 254.73 305.68
QCA Health Plan, Inc. Bronze Basic Plus 1 40 232.17 278.6
QCA Health Plan, Inc. Bronze Basic Plus 1 40 257.96 309.55
QCA Health Plan, Inc. Bronze Basic Plus 1 41 236.53 283.83
QCA Health Plan, Inc. Bronze Basic Plus 1 41 262.81 315.37
QCA Health Plan, Inc. Bronze Basic Plus 1 42 240.7 288.85
QCA Health Plan, Inc. Bronze Basic Plus 1 42 267.45 320.94
QCA Health Plan, Inc. Bronze Basic Plus 1 43 246.52 295.82
QCA Health Plan, Inc. Bronze Basic Plus 1 43 273.91 328.69
QCA Health Plan, Inc. Bronze Basic Plus 1 44 253.78 304.54
QCA Health Plan, Inc. Bronze Basic Plus 1 44 281.98 338.38
QCA Health Plan, Inc. Bronze Basic Plus 1 45 262.32 314.79
QCA Health Plan, Inc. Bronze Basic Plus 1 45 291.47 349.76
QCA Health Plan, Inc. Bronze Basic Plus 1 46 272.5 326.99
QCA Health Plan, Inc. Bronze Basic Plus 1 46 302.77 363.33
QCA Health Plan, Inc. Bronze Basic Plus 1 47 283.94 340.73
QCA Health Plan, Inc. Bronze Basic Plus 1 47 315.49 378.59
QCA Health Plan, Inc. Bronze Basic Plus 1 48 297.02 356.42
QCA Health Plan, Inc. Bronze Basic Plus 1 48 330.02 396.03
QCA Health Plan, Inc. Bronze Basic Plus 1 49 309.92 371.9
QCA Health Plan, Inc. Bronze Basic Plus 1 49 344.35 413.22
QCA Health Plan, Inc. Bronze Basic Plus 1 50 324.45 389.34
QCA Health Plan, Inc. Bronze Basic Plus 1 50 360.5 432.6
QCA Health Plan, Inc. Bronze Basic Plus 1 51 338.8 406.56
QCA Health Plan, Inc. Bronze Basic Plus 1 51 376.45 451.74
QCA Health Plan, Inc. Bronze Basic Plus 1 52 354.61 425.53
QCA Health Plan, Inc. Bronze Basic Plus 1 52 394.01 472.81
QCA Health Plan, Inc. Bronze Basic Plus 1 53 370.59 444.71
QCA Health Plan, Inc. Bronze Basic Plus 1 53 411.77 494.13
QCA Health Plan, Inc. Bronze Basic Plus 1 54 387.85 465.42
QCA Health Plan, Inc. Bronze Basic Plus 1 54 430.95 517.14
QCA Health Plan, Inc. Bronze Basic Plus 1 55 405.11 486.13
QCA Health Plan, Inc. Bronze Basic Plus 1 55 450.12 540.15
QCA Health Plan, Inc. Bronze Basic Plus 1 56 423.82 508.59
QCA Health Plan, Inc. Bronze Basic Plus 1 56 470.91 565.09
QCA Health Plan, Inc. Bronze Basic Plus 1 57 442.71 531.26
QCA Health Plan, Inc. Bronze Basic Plus 1 57 491.9 590.29
QCA Health Plan, Inc. Bronze Basic Plus 1 58 462.88 555.45
QCA Health Plan, Inc. Bronze Basic Plus 1 58 514.31 617.17
QCA Health Plan, Inc. Bronze Basic Plus 1 59 472.87 567.44
QCA Health Plan, Inc. Bronze Basic Plus 1 59 525.41 630.49
QCA Health Plan, Inc. Bronze Basic Plus 1 60 493.04 591.64
QCA Health Plan, Inc. Bronze Basic Plus 1 60 547.82 657.38
QCA Health Plan, Inc. Bronze Basic Plus 1 61 510.47 612.57
QCA Health Plan, Inc. Bronze Basic Plus 1 61 567.19 680.63
QCA Health Plan, Inc. Bronze Basic Plus 1 62 521.92 626.3
QCA Health Plan, Inc. Bronze Basic Plus 1 62 579.91 695.89
QCA Health Plan, Inc. Bronze Basic Plus 1 63 536.27 643.53
QCA Health Plan, Inc. Bronze Basic Plus 1 63 595.86 715.03
QCA Health Plan, Inc. Bronze Basic Plus 1 64 544.99 653.99
QCA Health Plan, Inc. Bronze Basic Plus 1 64 605.55 726.65
QCA Health Plan, Inc. Bronze Basic Plus 1 65 and
over
544.99 653.99
QCA Health Plan, Inc. Bronze Basic Plus 1 65 and
over
605.55 726.65
QCA Health Plan, Inc. Bronze Basic Plus 2 0‐20 140.99 140.99
QCA Health Plan, Inc. Bronze Basic Plus 2 21 222.03 266.44
QCA Health Plan, Inc. Bronze Basic Plus 2 22 222.03 266.44
QCA Health Plan, Inc. Bronze Basic Plus 2 23 222.03 266.44
QCA Health Plan, Inc. Bronze Basic Plus 2 24 222.03 266.44
QCA Health Plan, Inc. Bronze Basic Plus 2 25 222.92 267.51
Page 193 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Basic Plus 2 26 227.36 272.83
QCA Health Plan, Inc. Bronze Basic Plus 2 27 232.69 279.23
QCA Health Plan, Inc. Bronze Basic Plus 2 28 241.35 289.62
QCA Health Plan, Inc. Bronze Basic Plus 2 29 248.46 298.15
QCA Health Plan, Inc. Bronze Basic Plus 2 30 252.01 302.41
QCA Health Plan, Inc. Bronze Basic Plus 2 31 257.34 308.8
QCA Health Plan, Inc. Bronze Basic Plus 2 32 262.67 315.2
QCA Health Plan, Inc. Bronze Basic Plus 2 33 266 319.2
QCA Health Plan, Inc. Bronze Basic Plus 2 34 269.55 323.46
QCA Health Plan, Inc. Bronze Basic Plus 2 35 271.32 325.59
QCA Health Plan, Inc. Bronze Basic Plus 2 36 273.1 327.72
QCA Health Plan, Inc. Bronze Basic Plus 2 37 274.88 329.85
QCA Health Plan, Inc. Bronze Basic Plus 2 38 276.65 331.98
QCA Health Plan, Inc. Bronze Basic Plus 2 39 280.21 336.25
QCA Health Plan, Inc. Bronze Basic Plus 2 40 283.76 340.51
QCA Health Plan, Inc. Bronze Basic Plus 2 41 289.09 346.9
QCA Health Plan, Inc. Bronze Basic Plus 2 42 294.19 353.03
QCA Health Plan, Inc. Bronze Basic Plus 2 43 301.3 361.56
QCA Health Plan, Inc. Bronze Basic Plus 2 44 310.18 372.22
QCA Health Plan, Inc. Bronze Basic Plus 2 45 320.62 384.74
QCA Health Plan, Inc. Bronze Basic Plus 2 46 333.05 399.66
QCA Health Plan, Inc. Bronze Basic Plus 2 47 347.04 416.45
QCA Health Plan, Inc. Bronze Basic Plus 2 48 363.02 435.63
QCA Health Plan, Inc. Bronze Basic Plus 2 49 378.79 454.55
QCA Health Plan, Inc. Bronze Basic Plus 2 50 396.55 475.86
QCA Health Plan, Inc. Bronze Basic Plus 2 51 414.09 496.91
QCA Health Plan, Inc. Bronze Basic Plus 2 52 433.41 520.09
QCA Health Plan, Inc. Bronze Basic Plus 2 53 452.95 543.54
QCA Health Plan, Inc. Bronze Basic Plus 2 54 474.04 568.85
QCA Health Plan, Inc. Bronze Basic Plus 2 55 495.13 594.16
QCA Health Plan, Inc. Bronze Basic Plus 2 56 518 621.6
QCA Health Plan, Inc. Bronze Basic Plus 2 57 541.1 649.31
QCA Health Plan, Inc. Bronze Basic Plus 2 58 565.74 678.89
QCA Health Plan, Inc. Bronze Basic Plus 2 59 577.95 693.54
QCA Health Plan, Inc. Bronze Basic Plus 2 60 602.6 723.12
QCA Health Plan, Inc. Bronze Basic Plus 2 61 623.91 748.7
QCA Health Plan, Inc. Bronze Basic Plus 2 62 637.9 765.48
QCA Health Plan, Inc. Bronze Basic Plus 2 63 655.44 786.53
QCA Health Plan, Inc. Bronze Basic Plus 2 64 666.1 799.32
QCA Health Plan, Inc. Bronze Basic Plus 2 65 and
over
666.1 799.32
QCA Health Plan, Inc. Bronze Basic Plus 3 0‐20 103.82 103.82
QCA Health Plan, Inc. Bronze Basic Plus 3 0‐20 115.36 115.36
QCA Health Plan, Inc. Bronze Basic Plus 3 21 163.5 196.2
QCA Health Plan, Inc. Bronze Basic Plus 3 21 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 3 22 163.5 196.2
QCA Health Plan, Inc. Bronze Basic Plus 3 22 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 3 23 163.5 196.2
QCA Health Plan, Inc. Bronze Basic Plus 3 23 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 3 24 163.5 196.2
QCA Health Plan, Inc. Bronze Basic Plus 3 24 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 3 25 164.15 196.98
QCA Health Plan, Inc. Bronze Basic Plus 3 25 182.39 218.87
QCA Health Plan, Inc. Bronze Basic Plus 3 26 167.42 200.91
QCA Health Plan, Inc. Bronze Basic Plus 3 26 186.02 223.23
QCA Health Plan, Inc. Bronze Basic Plus 3 27 171.35 205.61
QCA Health Plan, Inc. Bronze Basic Plus 3 27 190.38 228.46
QCA Health Plan, Inc. Bronze Basic Plus 3 28 177.72 213.27
QCA Health Plan, Inc. Bronze Basic Plus 3 28 197.47 236.96
QCA Health Plan, Inc. Bronze Basic Plus 3 29 182.95 219.54
QCA Health Plan, Inc. Bronze Basic Plus 3 29 203.28 243.94
QCA Health Plan, Inc. Bronze Basic Plus 3 30 185.57 222.68
QCA Health Plan, Inc. Bronze Basic Plus 3 30 206.19 247.43
Page 194 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Basic Plus 3 31 189.49 227.39
QCA Health Plan, Inc. Bronze Basic Plus 3 31 210.55 252.66
QCA Health Plan, Inc. Bronze Basic Plus 3 32 193.42 232.1
QCA Health Plan, Inc. Bronze Basic Plus 3 32 214.91 257.89
QCA Health Plan, Inc. Bronze Basic Plus 3 33 195.87 235.04
QCA Health Plan, Inc. Bronze Basic Plus 3 33 217.63 261.16
QCA Health Plan, Inc. Bronze Basic Plus 3 34 198.49 238.18
QCA Health Plan, Inc. Bronze Basic Plus 3 34 220.54 264.65
QCA Health Plan, Inc. Bronze Basic Plus 3 35 199.79 239.75
QCA Health Plan, Inc. Bronze Basic Plus 3 35 221.99 266.39
QCA Health Plan, Inc. Bronze Basic Plus 3 36 201.1 241.32
QCA Health Plan, Inc. Bronze Basic Plus 3 36 223.45 268.14
QCA Health Plan, Inc. Bronze Basic Plus 3 37 202.41 242.89
QCA Health Plan, Inc. Bronze Basic Plus 3 37 224.9 269.88
QCA Health Plan, Inc. Bronze Basic Plus 3 38 203.72 244.46
QCA Health Plan, Inc. Bronze Basic Plus 3 38 226.35 271.62
QCA Health Plan, Inc. Bronze Basic Plus 3 39 206.33 247.6
QCA Health Plan, Inc. Bronze Basic Plus 3 39 229.26 275.11
QCA Health Plan, Inc. Bronze Basic Plus 3 40 208.95 250.74
QCA Health Plan, Inc. Bronze Basic Plus 3 40 232.17 278.6
QCA Health Plan, Inc. Bronze Basic Plus 3 41 212.87 255.45
QCA Health Plan, Inc. Bronze Basic Plus 3 41 236.53 283.83
QCA Health Plan, Inc. Bronze Basic Plus 3 42 216.63 259.96
QCA Health Plan, Inc. Bronze Basic Plus 3 42 240.7 288.85
QCA Health Plan, Inc. Bronze Basic Plus 3 43 221.87 266.24
QCA Health Plan, Inc. Bronze Basic Plus 3 43 246.52 295.82
QCA Health Plan, Inc. Bronze Basic Plus 3 44 228.41 274.09
QCA Health Plan, Inc. Bronze Basic Plus 3 44 253.78 304.54
QCA Health Plan, Inc. Bronze Basic Plus 3 45 236.09 283.31
QCA Health Plan, Inc. Bronze Basic Plus 3 45 262.32 314.79
QCA Health Plan, Inc. Bronze Basic Plus 3 46 245.25 294.3
QCA Health Plan, Inc. Bronze Basic Plus 3 46 272.5 326.99
QCA Health Plan, Inc. Bronze Basic Plus 3 47 255.55 306.66
QCA Health Plan, Inc. Bronze Basic Plus 3 47 283.94 340.73
QCA Health Plan, Inc. Bronze Basic Plus 3 48 267.32 320.78
QCA Health Plan, Inc. Bronze Basic Plus 3 48 297.02 356.42
QCA Health Plan, Inc. Bronze Basic Plus 3 49 278.93 334.71
QCA Health Plan, Inc. Bronze Basic Plus 3 49 309.92 371.9
QCA Health Plan, Inc. Bronze Basic Plus 3 50 292.01 350.41
QCA Health Plan, Inc. Bronze Basic Plus 3 50 324.45 389.34
QCA Health Plan, Inc. Bronze Basic Plus 3 51 304.92 365.91
QCA Health Plan, Inc. Bronze Basic Plus 3 51 338.8 406.56
QCA Health Plan, Inc. Bronze Basic Plus 3 52 319.15 382.98
QCA Health Plan, Inc. Bronze Basic Plus 3 52 354.61 425.53
QCA Health Plan, Inc. Bronze Basic Plus 3 53 333.53 400.24
QCA Health Plan, Inc. Bronze Basic Plus 3 53 370.59 444.71
QCA Health Plan, Inc. Bronze Basic Plus 3 54 349.07 418.88
QCA Health Plan, Inc. Bronze Basic Plus 3 54 387.85 465.42
QCA Health Plan, Inc. Bronze Basic Plus 3 55 364.6 437.52
QCA Health Plan, Inc. Bronze Basic Plus 3 55 405.11 486.13
QCA Health Plan, Inc. Bronze Basic Plus 3 56 381.44 457.73
QCA Health Plan, Inc. Bronze Basic Plus 3 56 423.82 508.59
QCA Health Plan, Inc. Bronze Basic Plus 3 57 398.44 478.13
QCA Health Plan, Inc. Bronze Basic Plus 3 57 442.71 531.26
QCA Health Plan, Inc. Bronze Basic Plus 3 58 416.59 499.91
QCA Health Plan, Inc. Bronze Basic Plus 3 58 462.88 555.45
QCA Health Plan, Inc. Bronze Basic Plus 3 59 425.58 510.7
QCA Health Plan, Inc. Bronze Basic Plus 3 59 472.87 567.44
QCA Health Plan, Inc. Bronze Basic Plus 3 60 443.73 532.48
QCA Health Plan, Inc. Bronze Basic Plus 3 60 493.04 591.64
QCA Health Plan, Inc. Bronze Basic Plus 3 61 459.43 551.31
QCA Health Plan, Inc. Bronze Basic Plus 3 61 510.47 612.57
QCA Health Plan, Inc. Bronze Basic Plus 3 62 469.73 563.67
Page 195 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Basic Plus 3 62 521.92 626.3
QCA Health Plan, Inc. Bronze Basic Plus 3 63 482.64 579.17
QCA Health Plan, Inc. Bronze Basic Plus 3 63 536.27 643.53
QCA Health Plan, Inc. Bronze Basic Plus 3 64 490.49 588.59
QCA Health Plan, Inc. Bronze Basic Plus 3 64 544.99 653.99
QCA Health Plan, Inc. Bronze Basic Plus 3 65 and
over
490.49 588.59
QCA Health Plan, Inc. Bronze Basic Plus 3 65 and
over
544.99 653.99
QCA Health Plan, Inc. Bronze Basic Plus 4 0‐20 128.17 128.17
QCA Health Plan, Inc. Bronze Basic Plus 4 21 201.85 242.22
QCA Health Plan, Inc. Bronze Basic Plus 4 22 201.85 242.22
QCA Health Plan, Inc. Bronze Basic Plus 4 23 201.85 242.22
QCA Health Plan, Inc. Bronze Basic Plus 4 24 201.85 242.22
QCA Health Plan, Inc. Bronze Basic Plus 4 25 202.66 243.19
QCA Health Plan, Inc. Bronze Basic Plus 4 26 206.69 248.03
QCA Health Plan, Inc. Bronze Basic Plus 4 27 211.54 253.84
QCA Health Plan, Inc. Bronze Basic Plus 4 28 219.41 263.29
QCA Health Plan, Inc. Bronze Basic Plus 4 29 225.87 271.04
QCA Health Plan, Inc. Bronze Basic Plus 4 30 229.1 274.92
QCA Health Plan, Inc. Bronze Basic Plus 4 31 233.94 280.73
QCA Health Plan, Inc. Bronze Basic Plus 4 32 238.79 286.54
QCA Health Plan, Inc. Bronze Basic Plus 4 33 241.81 290.18
QCA Health Plan, Inc. Bronze Basic Plus 4 34 245.04 294.05
QCA Health Plan, Inc. Bronze Basic Plus 4 35 246.66 295.99
QCA Health Plan, Inc. Bronze Basic Plus 4 36 248.27 297.93
QCA Health Plan, Inc. Bronze Basic Plus 4 37 249.89 299.87
QCA Health Plan, Inc. Bronze Basic Plus 4 38 251.5 301.8
QCA Health Plan, Inc. Bronze Basic Plus 4 39 254.73 305.68
QCA Health Plan, Inc. Bronze Basic Plus 4 40 257.96 309.55
QCA Health Plan, Inc. Bronze Basic Plus 4 41 262.81 315.37
QCA Health Plan, Inc. Bronze Basic Plus 4 42 267.45 320.94
QCA Health Plan, Inc. Bronze Basic Plus 4 43 273.91 328.69
QCA Health Plan, Inc. Bronze Basic Plus 4 44 281.98 338.38
QCA Health Plan, Inc. Bronze Basic Plus 4 45 291.47 349.76
QCA Health Plan, Inc. Bronze Basic Plus 4 46 302.77 363.33
QCA Health Plan, Inc. Bronze Basic Plus 4 47 315.49 378.59
QCA Health Plan, Inc. Bronze Basic Plus 4 48 330.02 396.03
QCA Health Plan, Inc. Bronze Basic Plus 4 49 344.35 413.22
QCA Health Plan, Inc. Bronze Basic Plus 4 50 360.5 432.6
QCA Health Plan, Inc. Bronze Basic Plus 4 51 376.45 451.74
QCA Health Plan, Inc. Bronze Basic Plus 4 52 394.01 472.81
QCA Health Plan, Inc. Bronze Basic Plus 4 53 411.77 494.13
QCA Health Plan, Inc. Bronze Basic Plus 4 54 430.95 517.14
QCA Health Plan, Inc. Bronze Basic Plus 4 55 450.12 540.15
QCA Health Plan, Inc. Bronze Basic Plus 4 56 470.91 565.09
QCA Health Plan, Inc. Bronze Basic Plus 4 57 491.9 590.29
QCA Health Plan, Inc. Bronze Basic Plus 4 58 514.31 617.17
QCA Health Plan, Inc. Bronze Basic Plus 4 59 525.41 630.49
QCA Health Plan, Inc. Bronze Basic Plus 4 60 547.82 657.38
QCA Health Plan, Inc. Bronze Basic Plus 4 61 567.19 680.63
QCA Health Plan, Inc. Bronze Basic Plus 4 62 579.91 695.89
QCA Health Plan, Inc. Bronze Basic Plus 4 63 595.86 715.03
QCA Health Plan, Inc. Bronze Basic Plus 4 64 605.55 726.65
QCA Health Plan, Inc. Bronze Basic Plus 4 65 and
over
605.55 726.65
QCA Health Plan, Inc. Bronze Basic Plus 7 0‐20 115.36 115.36
QCA Health Plan, Inc. Bronze Basic Plus 7 21 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 7 22 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 7 23 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 7 24 181.66 218
QCA Health Plan, Inc. Bronze Basic Plus 7 25 182.39 218.87
QCA Health Plan, Inc. Bronze Basic Plus 7 26 186.02 223.23
Page 196 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Basic Plus 7 27 190.38 228.46
QCA Health Plan, Inc. Bronze Basic Plus 7 28 197.47 236.96
QCA Health Plan, Inc. Bronze Basic Plus 7 29 203.28 243.94
QCA Health Plan, Inc. Bronze Basic Plus 7 30 206.19 247.43
QCA Health Plan, Inc. Bronze Basic Plus 7 31 210.55 252.66
QCA Health Plan, Inc. Bronze Basic Plus 7 32 214.91 257.89
QCA Health Plan, Inc. Bronze Basic Plus 7 33 217.63 261.16
QCA Health Plan, Inc. Bronze Basic Plus 7 34 220.54 264.65
QCA Health Plan, Inc. Bronze Basic Plus 7 35 221.99 266.39
QCA Health Plan, Inc. Bronze Basic Plus 7 36 223.45 268.14
QCA Health Plan, Inc. Bronze Basic Plus 7 37 224.9 269.88
QCA Health Plan, Inc. Bronze Basic Plus 7 38 226.35 271.62
QCA Health Plan, Inc. Bronze Basic Plus 7 39 229.26 275.11
QCA Health Plan, Inc. Bronze Basic Plus 7 40 232.17 278.6
QCA Health Plan, Inc. Bronze Basic Plus 7 41 236.53 283.83
QCA Health Plan, Inc. Bronze Basic Plus 7 42 240.7 288.85
QCA Health Plan, Inc. Bronze Basic Plus 7 43 246.52 295.82
QCA Health Plan, Inc. Bronze Basic Plus 7 44 253.78 304.54
QCA Health Plan, Inc. Bronze Basic Plus 7 45 262.32 314.79
QCA Health Plan, Inc. Bronze Basic Plus 7 46 272.5 326.99
QCA Health Plan, Inc. Bronze Basic Plus 7 47 283.94 340.73
QCA Health Plan, Inc. Bronze Basic Plus 7 48 297.02 356.42
QCA Health Plan, Inc. Bronze Basic Plus 7 49 309.92 371.9
QCA Health Plan, Inc. Bronze Basic Plus 7 50 324.45 389.34
QCA Health Plan, Inc. Bronze Basic Plus 7 51 338.8 406.56
QCA Health Plan, Inc. Bronze Basic Plus 7 52 354.61 425.53
QCA Health Plan, Inc. Bronze Basic Plus 7 53 370.59 444.71
QCA Health Plan, Inc. Bronze Basic Plus 7 54 387.85 465.42
QCA Health Plan, Inc. Bronze Basic Plus 7 55 405.11 486.13
QCA Health Plan, Inc. Bronze Basic Plus 7 56 423.82 508.59
QCA Health Plan, Inc. Bronze Basic Plus 7 57 442.71 531.26
QCA Health Plan, Inc. Bronze Basic Plus 7 58 462.88 555.45
QCA Health Plan, Inc. Bronze Basic Plus 7 59 472.87 567.44
QCA Health Plan, Inc. Bronze Basic Plus 7 60 493.04 591.64
QCA Health Plan, Inc. Bronze Basic Plus 7 61 510.47 612.57
QCA Health Plan, Inc. Bronze Basic Plus 7 62 521.92 626.3
QCA Health Plan, Inc. Bronze Basic Plus 7 63 536.27 643.53
QCA Health Plan, Inc. Bronze Basic Plus 7 64 544.99 653.99
QCA Health Plan, Inc. Bronze Basic Plus 7 65 and
over
544.99 653.99
QCA Health Plan, Inc. Bronze Premier Plus 1 0‐20 123.37 123.37
QCA Health Plan, Inc. Bronze Premier Plus 1 0‐20 137.08 137.08
QCA Health Plan, Inc. Bronze Premier Plus 1 21 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 1 21 215.87 259.05
QCA Health Plan, Inc. Bronze Premier Plus 1 22 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 1 22 215.87 259.05
QCA Health Plan, Inc. Bronze Premier Plus 1 23 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 1 23 215.87 259.05
QCA Health Plan, Inc. Bronze Premier Plus 1 24 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 1 24 215.87 259.05
QCA Health Plan, Inc. Bronze Premier Plus 1 25 195.06 234.07
QCA Health Plan, Inc. Bronze Premier Plus 1 25 216.73 260.08
QCA Health Plan, Inc. Bronze Premier Plus 1 26 198.95 238.74
QCA Health Plan, Inc. Bronze Premier Plus 1 26 221.05 265.26
QCA Health Plan, Inc. Bronze Premier Plus 1 27 203.61 244.33
QCA Health Plan, Inc. Bronze Premier Plus 1 27 226.23 271.48
QCA Health Plan, Inc. Bronze Premier Plus 1 28 211.19 253.42
QCA Health Plan, Inc. Bronze Premier Plus 1 28 234.65 281.58
QCA Health Plan, Inc. Bronze Premier Plus 1 29 217.4 260.88
QCA Health Plan, Inc. Bronze Premier Plus 1 29 241.56 289.87
QCA Health Plan, Inc. Bronze Premier Plus 1 30 220.51 264.61
QCA Health Plan, Inc. Bronze Premier Plus 1 30 245.01 294.02
QCA Health Plan, Inc. Bronze Premier Plus 1 31 225.17 270.21
Page 197 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Premier Plus 1 31 250.19 300.23
QCA Health Plan, Inc. Bronze Premier Plus 1 32 229.84 275.81
QCA Health Plan, Inc. Bronze Premier Plus 1 32 255.38 306.45
QCA Health Plan, Inc. Bronze Premier Plus 1 33 232.75 279.3
QCA Health Plan, Inc. Bronze Premier Plus 1 33 258.61 310.34
QCA Health Plan, Inc. Bronze Premier Plus 1 34 235.86 283.03
QCA Health Plan, Inc. Bronze Premier Plus 1 34 262.07 314.48
QCA Health Plan, Inc. Bronze Premier Plus 1 35 237.41 284.9
QCA Health Plan, Inc. Bronze Premier Plus 1 35 263.79 316.55
QCA Health Plan, Inc. Bronze Premier Plus 1 36 238.97 286.76
QCA Health Plan, Inc. Bronze Premier Plus 1 36 265.52 318.63
QCA Health Plan, Inc. Bronze Premier Plus 1 37 240.52 288.63
QCA Health Plan, Inc. Bronze Premier Plus 1 37 267.25 320.7
QCA Health Plan, Inc. Bronze Premier Plus 1 38 242.08 290.49
QCA Health Plan, Inc. Bronze Premier Plus 1 38 268.98 322.77
QCA Health Plan, Inc. Bronze Premier Plus 1 39 245.19 294.22
QCA Health Plan, Inc. Bronze Premier Plus 1 39 272.43 326.91
QCA Health Plan, Inc. Bronze Premier Plus 1 40 248.29 297.95
QCA Health Plan, Inc. Bronze Premier Plus 1 40 275.88 331.06
QCA Health Plan, Inc. Bronze Premier Plus 1 41 252.96 303.55
QCA Health Plan, Inc. Bronze Premier Plus 1 41 281.06 337.28
QCA Health Plan, Inc. Bronze Premier Plus 1 42 257.43 308.91
QCA Health Plan, Inc. Bronze Premier Plus 1 42 286.03 343.23
QCA Health Plan, Inc. Bronze Premier Plus 1 43 263.64 316.37
QCA Health Plan, Inc. Bronze Premier Plus 1 43 292.94 351.52
QCA Health Plan, Inc. Bronze Premier Plus 1 44 271.41 325.7
QCA Health Plan, Inc. Bronze Premier Plus 1 44 301.57 361.89
QCA Health Plan, Inc. Bronze Premier Plus 1 45 280.55 336.65
QCA Health Plan, Inc. Bronze Premier Plus 1 45 311.72 374.06
QCA Health Plan, Inc. Bronze Premier Plus 1 46 291.43 349.71
QCA Health Plan, Inc. Bronze Premier Plus 1 46 323.81 388.57
QCA Health Plan, Inc. Bronze Premier Plus 1 47 303.67 364.4
QCA Health Plan, Inc. Bronze Premier Plus 1 47 337.41 404.89
QCA Health Plan, Inc. Bronze Premier Plus 1 48 317.65 381.18
QCA Health Plan, Inc. Bronze Premier Plus 1 48 352.95 423.54
QCA Health Plan, Inc. Bronze Premier Plus 1 49 331.45 397.74
QCA Health Plan, Inc. Bronze Premier Plus 1 49 368.28 441.93
QCA Health Plan, Inc. Bronze Premier Plus 1 50 346.99 416.39
QCA Health Plan, Inc. Bronze Premier Plus 1 50 385.55 462.65
QCA Health Plan, Inc. Bronze Premier Plus 1 51 362.34 434.81
QCA Health Plan, Inc. Bronze Premier Plus 1 51 402.6 483.12
QCA Health Plan, Inc. Bronze Premier Plus 1 52 379.24 455.09
QCA Health Plan, Inc. Bronze Premier Plus 1 52 421.38 505.66
QCA Health Plan, Inc. Bronze Premier Plus 1 53 396.34 475.61
QCA Health Plan, Inc. Bronze Premier Plus 1 53 440.38 528.45
QCA Health Plan, Inc. Bronze Premier Plus 1 54 414.8 497.76
QCA Health Plan, Inc. Bronze Premier Plus 1 54 460.88 553.06
QCA Health Plan, Inc. Bronze Premier Plus 1 55 433.25 519.9
QCA Health Plan, Inc. Bronze Premier Plus 1 55 481.39 577.67
QCA Health Plan, Inc. Bronze Premier Plus 1 56 453.26 543.92
QCA Health Plan, Inc. Bronze Premier Plus 1 56 503.63 604.35
QCA Health Plan, Inc. Bronze Premier Plus 1 57 473.47 568.16
QCA Health Plan, Inc. Bronze Premier Plus 1 57 526.08 631.29
QCA Health Plan, Inc. Bronze Premier Plus 1 58 495.04 594.04
QCA Health Plan, Inc. Bronze Premier Plus 1 58 550.04 660.05
QCA Health Plan, Inc. Bronze Premier Plus 1 59 505.72 606.86
QCA Health Plan, Inc. Bronze Premier Plus 1 59 561.91 674.29
QCA Health Plan, Inc. Bronze Premier Plus 1 60 527.29 632.74
QCA Health Plan, Inc. Bronze Premier Plus 1 60 585.87 703.05
QCA Health Plan, Inc. Bronze Premier Plus 1 61 545.94 655.12
QCA Health Plan, Inc. Bronze Premier Plus 1 61 606.6 727.92
QCA Health Plan, Inc. Bronze Premier Plus 1 62 558.18 669.81
QCA Health Plan, Inc. Bronze Premier Plus 1 62 620.2 744.24
Page 198 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Premier Plus 1 63 573.53 688.23
QCA Health Plan, Inc. Bronze Premier Plus 1 63 637.25 764.7
QCA Health Plan, Inc. Bronze Premier Plus 1 64 582.85 699.42
QCA Health Plan, Inc. Bronze Premier Plus 1 64 647.61 777.14
QCA Health Plan, Inc. Bronze Premier Plus 1 65 and
over
582.85 699.42
QCA Health Plan, Inc. Bronze Premier Plus 1 65 and
over
647.61 777.14
QCA Health Plan, Inc. Bronze Premier Plus 2 0‐20 150.79 150.79
QCA Health Plan, Inc. Bronze Premier Plus 2 21 237.46 284.95
QCA Health Plan, Inc. Bronze Premier Plus 2 22 237.46 284.95
QCA Health Plan, Inc. Bronze Premier Plus 2 23 237.46 284.95
QCA Health Plan, Inc. Bronze Premier Plus 2 24 237.46 284.95
QCA Health Plan, Inc. Bronze Premier Plus 2 25 238.41 286.09
QCA Health Plan, Inc. Bronze Premier Plus 2 26 243.16 291.79
QCA Health Plan, Inc. Bronze Premier Plus 2 27 248.86 298.63
QCA Health Plan, Inc. Bronze Premier Plus 2 28 258.12 309.74
QCA Health Plan, Inc. Bronze Premier Plus 2 29 265.72 318.86
QCA Health Plan, Inc. Bronze Premier Plus 2 30 269.51 323.42
QCA Health Plan, Inc. Bronze Premier Plus 2 31 275.21 330.26
QCA Health Plan, Inc. Bronze Premier Plus 2 32 280.91 337.1
QCA Health Plan, Inc. Bronze Premier Plus 2 33 284.47 341.37
QCA Health Plan, Inc. Bronze Premier Plus 2 34 288.27 345.93
QCA Health Plan, Inc. Bronze Premier Plus 2 35 290.17 348.21
QCA Health Plan, Inc. Bronze Premier Plus 2 36 292.07 350.49
QCA Health Plan, Inc. Bronze Premier Plus 2 37 293.97 352.77
QCA Health Plan, Inc. Bronze Premier Plus 2 38 295.87 355.05
QCA Health Plan, Inc. Bronze Premier Plus 2 39 299.67 359.61
QCA Health Plan, Inc. Bronze Premier Plus 2 40 303.47 364.17
QCA Health Plan, Inc. Bronze Premier Plus 2 41 309.17 371
QCA Health Plan, Inc. Bronze Premier Plus 2 42 314.63 377.56
QCA Health Plan, Inc. Bronze Premier Plus 2 43 322.23 386.68
QCA Health Plan, Inc. Bronze Premier Plus 2 44 331.73 398.07
QCA Health Plan, Inc. Bronze Premier Plus 2 45 342.89 411.47
QCA Health Plan, Inc. Bronze Premier Plus 2 46 356.19 427.42
QCA Health Plan, Inc. Bronze Premier Plus 2 47 371.15 445.38
QCA Health Plan, Inc. Bronze Premier Plus 2 48 388.24 465.89
QCA Health Plan, Inc. Bronze Premier Plus 2 49 405.1 486.12
QCA Health Plan, Inc. Bronze Premier Plus 2 50 424.1 508.92
QCA Health Plan, Inc. Bronze Premier Plus 2 51 442.86 531.43
QCA Health Plan, Inc. Bronze Premier Plus 2 52 463.52 556.22
QCA Health Plan, Inc. Bronze Premier Plus 2 53 484.41 581.3
QCA Health Plan, Inc. Bronze Premier Plus 2 54 506.97 608.37
QCA Health Plan, Inc. Bronze Premier Plus 2 55 529.53 635.44
QCA Health Plan, Inc. Bronze Premier Plus 2 56 553.99 664.79
QCA Health Plan, Inc. Bronze Premier Plus 2 57 578.68 694.42
QCA Health Plan, Inc. Bronze Premier Plus 2 58 605.04 726.05
QCA Health Plan, Inc. Bronze Premier Plus 2 59 618.1 741.72
QCA Health Plan, Inc. Bronze Premier Plus 2 60 644.46 773.35
QCA Health Plan, Inc. Bronze Premier Plus 2 61 667.26 800.71
QCA Health Plan, Inc. Bronze Premier Plus 2 62 682.22 818.66
QCA Health Plan, Inc. Bronze Premier Plus 2 63 700.98 841.17
QCA Health Plan, Inc. Bronze Premier Plus 2 64 712.37 854.85
QCA Health Plan, Inc. Bronze Premier Plus 2 65 and
over
712.37 854.85
QCA Health Plan, Inc. Bronze Premier Plus 3 0‐20 111.03 111.03
QCA Health Plan, Inc. Bronze Premier Plus 3 0‐20 123.37 123.37
QCA Health Plan, Inc. Bronze Premier Plus 3 21 174.86 209.83
QCA Health Plan, Inc. Bronze Premier Plus 3 21 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 3 22 174.86 209.83
QCA Health Plan, Inc. Bronze Premier Plus 3 22 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 3 23 174.86 209.83
QCA Health Plan, Inc. Bronze Premier Plus 3 23 194.28 233.14
Page 199 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Premier Plus 3 24 174.86 209.83
QCA Health Plan, Inc. Bronze Premier Plus 3 24 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 3 25 175.55 210.67
QCA Health Plan, Inc. Bronze Premier Plus 3 25 195.06 234.07
QCA Health Plan, Inc. Bronze Premier Plus 3 26 179.05 214.86
QCA Health Plan, Inc. Bronze Premier Plus 3 26 198.95 238.74
QCA Health Plan, Inc. Bronze Premier Plus 3 27 183.25 219.9
QCA Health Plan, Inc. Bronze Premier Plus 3 27 203.61 244.33
QCA Health Plan, Inc. Bronze Premier Plus 3 28 190.07 228.08
QCA Health Plan, Inc. Bronze Premier Plus 3 28 211.19 253.42
QCA Health Plan, Inc. Bronze Premier Plus 3 29 195.66 234.8
QCA Health Plan, Inc. Bronze Premier Plus 3 29 217.4 260.88
QCA Health Plan, Inc. Bronze Premier Plus 3 30 198.46 238.15
QCA Health Plan, Inc. Bronze Premier Plus 3 30 220.51 264.61
QCA Health Plan, Inc. Bronze Premier Plus 3 31 202.66 243.19
QCA Health Plan, Inc. Bronze Premier Plus 3 31 225.17 270.21
QCA Health Plan, Inc. Bronze Premier Plus 3 32 206.85 248.22
QCA Health Plan, Inc. Bronze Premier Plus 3 32 229.84 275.81
QCA Health Plan, Inc. Bronze Premier Plus 3 33 209.48 251.37
QCA Health Plan, Inc. Bronze Premier Plus 3 33 232.75 279.3
QCA Health Plan, Inc. Bronze Premier Plus 3 34 212.27 254.73
QCA Health Plan, Inc. Bronze Premier Plus 3 34 235.86 283.03
QCA Health Plan, Inc. Bronze Premier Plus 3 35 213.67 256.41
QCA Health Plan, Inc. Bronze Premier Plus 3 35 237.41 284.9
QCA Health Plan, Inc. Bronze Premier Plus 3 36 215.07 258.09
QCA Health Plan, Inc. Bronze Premier Plus 3 36 238.97 286.76
QCA Health Plan, Inc. Bronze Premier Plus 3 37 216.47 259.77
QCA Health Plan, Inc. Bronze Premier Plus 3 37 240.52 288.63
QCA Health Plan, Inc. Bronze Premier Plus 3 38 217.87 261.44
QCA Health Plan, Inc. Bronze Premier Plus 3 38 242.08 290.49
QCA Health Plan, Inc. Bronze Premier Plus 3 39 220.67 264.8
QCA Health Plan, Inc. Bronze Premier Plus 3 39 245.19 294.22
QCA Health Plan, Inc. Bronze Premier Plus 3 40 223.47 268.16
QCA Health Plan, Inc. Bronze Premier Plus 3 40 248.29 297.95
QCA Health Plan, Inc. Bronze Premier Plus 3 41 227.66 273.19
QCA Health Plan, Inc. Bronze Premier Plus 3 41 252.96 303.55
QCA Health Plan, Inc. Bronze Premier Plus 3 42 231.68 278.02
QCA Health Plan, Inc. Bronze Premier Plus 3 42 257.43 308.91
QCA Health Plan, Inc. Bronze Premier Plus 3 43 237.28 284.73
QCA Health Plan, Inc. Bronze Premier Plus 3 43 263.64 316.37
QCA Health Plan, Inc. Bronze Premier Plus 3 44 244.27 293.13
QCA Health Plan, Inc. Bronze Premier Plus 3 44 271.41 325.7
QCA Health Plan, Inc. Bronze Premier Plus 3 45 252.49 302.99
QCA Health Plan, Inc. Bronze Premier Plus 3 45 280.55 336.65
QCA Health Plan, Inc. Bronze Premier Plus 3 46 262.28 314.74
QCA Health Plan, Inc. Bronze Premier Plus 3 46 291.43 349.71
QCA Health Plan, Inc. Bronze Premier Plus 3 47 273.3 327.96
QCA Health Plan, Inc. Bronze Premier Plus 3 47 303.67 364.4
QCA Health Plan, Inc. Bronze Premier Plus 3 48 285.89 343.07
QCA Health Plan, Inc. Bronze Premier Plus 3 48 317.65 381.18
QCA Health Plan, Inc. Bronze Premier Plus 3 49 298.3 357.96
QCA Health Plan, Inc. Bronze Premier Plus 3 49 331.45 397.74
QCA Health Plan, Inc. Bronze Premier Plus 3 50 312.29 374.75
QCA Health Plan, Inc. Bronze Premier Plus 3 50 346.99 416.39
QCA Health Plan, Inc. Bronze Premier Plus 3 51 326.11 391.33
QCA Health Plan, Inc. Bronze Premier Plus 3 51 362.34 434.81
QCA Health Plan, Inc. Bronze Premier Plus 3 52 341.32 409.58
QCA Health Plan, Inc. Bronze Premier Plus 3 52 379.24 455.09
QCA Health Plan, Inc. Bronze Premier Plus 3 53 356.7 428.05
QCA Health Plan, Inc. Bronze Premier Plus 3 53 396.34 475.61
QCA Health Plan, Inc. Bronze Premier Plus 3 54 373.32 447.98
QCA Health Plan, Inc. Bronze Premier Plus 3 54 414.8 497.76
QCA Health Plan, Inc. Bronze Premier Plus 3 55 389.93 467.91
Page 200 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Premier Plus 3 55 433.25 519.9
QCA Health Plan, Inc. Bronze Premier Plus 3 56 407.94 489.53
QCA Health Plan, Inc. Bronze Premier Plus 3 56 453.26 543.92
QCA Health Plan, Inc. Bronze Premier Plus 3 57 426.12 511.35
QCA Health Plan, Inc. Bronze Premier Plus 3 57 473.47 568.16
QCA Health Plan, Inc. Bronze Premier Plus 3 58 445.53 534.64
QCA Health Plan, Inc. Bronze Premier Plus 3 58 495.04 594.04
QCA Health Plan, Inc. Bronze Premier Plus 3 59 455.15 546.18
QCA Health Plan, Inc. Bronze Premier Plus 3 59 505.72 606.86
QCA Health Plan, Inc. Bronze Premier Plus 3 60 474.56 569.47
QCA Health Plan, Inc. Bronze Premier Plus 3 60 527.29 632.74
QCA Health Plan, Inc. Bronze Premier Plus 3 61 491.34 589.61
QCA Health Plan, Inc. Bronze Premier Plus 3 61 545.94 655.12
QCA Health Plan, Inc. Bronze Premier Plus 3 62 502.36 602.83
QCA Health Plan, Inc. Bronze Premier Plus 3 62 558.18 669.81
QCA Health Plan, Inc. Bronze Premier Plus 3 63 516.17 619.41
QCA Health Plan, Inc. Bronze Premier Plus 3 63 573.53 688.23
QCA Health Plan, Inc. Bronze Premier Plus 3 64 524.57 629.48
QCA Health Plan, Inc. Bronze Premier Plus 3 64 582.85 699.42
QCA Health Plan, Inc. Bronze Premier Plus 3 65 and
over
524.57 629.48
QCA Health Plan, Inc. Bronze Premier Plus 3 65 and
over
582.85 699.42
QCA Health Plan, Inc. Bronze Premier Plus 4 0‐20 137.08 137.08
QCA Health Plan, Inc. Bronze Premier Plus 4 21 215.87 259.05
QCA Health Plan, Inc. Bronze Premier Plus 4 22 215.87 259.05
QCA Health Plan, Inc. Bronze Premier Plus 4 23 215.87 259.05
QCA Health Plan, Inc. Bronze Premier Plus 4 24 215.87 259.05
QCA Health Plan, Inc. Bronze Premier Plus 4 25 216.73 260.08
QCA Health Plan, Inc. Bronze Premier Plus 4 26 221.05 265.26
QCA Health Plan, Inc. Bronze Premier Plus 4 27 226.23 271.48
QCA Health Plan, Inc. Bronze Premier Plus 4 28 234.65 281.58
QCA Health Plan, Inc. Bronze Premier Plus 4 29 241.56 289.87
QCA Health Plan, Inc. Bronze Premier Plus 4 30 245.01 294.02
QCA Health Plan, Inc. Bronze Premier Plus 4 31 250.19 300.23
QCA Health Plan, Inc. Bronze Premier Plus 4 32 255.38 306.45
QCA Health Plan, Inc. Bronze Premier Plus 4 33 258.61 310.34
QCA Health Plan, Inc. Bronze Premier Plus 4 34 262.07 314.48
QCA Health Plan, Inc. Bronze Premier Plus 4 35 263.79 316.55
QCA Health Plan, Inc. Bronze Premier Plus 4 36 265.52 318.63
QCA Health Plan, Inc. Bronze Premier Plus 4 37 267.25 320.7
QCA Health Plan, Inc. Bronze Premier Plus 4 38 268.98 322.77
QCA Health Plan, Inc. Bronze Premier Plus 4 39 272.43 326.91
QCA Health Plan, Inc. Bronze Premier Plus 4 40 275.88 331.06
QCA Health Plan, Inc. Bronze Premier Plus 4 41 281.06 337.28
QCA Health Plan, Inc. Bronze Premier Plus 4 42 286.03 343.23
QCA Health Plan, Inc. Bronze Premier Plus 4 43 292.94 351.52
QCA Health Plan, Inc. Bronze Premier Plus 4 44 301.57 361.89
QCA Health Plan, Inc. Bronze Premier Plus 4 45 311.72 374.06
QCA Health Plan, Inc. Bronze Premier Plus 4 46 323.81 388.57
QCA Health Plan, Inc. Bronze Premier Plus 4 47 337.41 404.89
QCA Health Plan, Inc. Bronze Premier Plus 4 48 352.95 423.54
QCA Health Plan, Inc. Bronze Premier Plus 4 49 368.28 441.93
QCA Health Plan, Inc. Bronze Premier Plus 4 50 385.55 462.65
QCA Health Plan, Inc. Bronze Premier Plus 4 51 402.6 483.12
QCA Health Plan, Inc. Bronze Premier Plus 4 52 421.38 505.66
QCA Health Plan, Inc. Bronze Premier Plus 4 53 440.38 528.45
QCA Health Plan, Inc. Bronze Premier Plus 4 54 460.88 553.06
QCA Health Plan, Inc. Bronze Premier Plus 4 55 481.39 577.67
QCA Health Plan, Inc. Bronze Premier Plus 4 56 503.63 604.35
QCA Health Plan, Inc. Bronze Premier Plus 4 57 526.08 631.29
QCA Health Plan, Inc. Bronze Premier Plus 4 58 550.04 660.05
QCA Health Plan, Inc. Bronze Premier Plus 4 59 561.91 674.29
Page 201 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Bronze Premier Plus 4 60 585.87 703.05
QCA Health Plan, Inc. Bronze Premier Plus 4 61 606.6 727.92
QCA Health Plan, Inc. Bronze Premier Plus 4 62 620.2 744.24
QCA Health Plan, Inc. Bronze Premier Plus 4 63 637.25 764.7
QCA Health Plan, Inc. Bronze Premier Plus 4 64 647.61 777.14
QCA Health Plan, Inc. Bronze Premier Plus 4 65 and
over
647.61 777.14
QCA Health Plan, Inc. Bronze Premier Plus 7 0‐20 123.37 123.37
QCA Health Plan, Inc. Bronze Premier Plus 7 21 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 7 22 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 7 23 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 7 24 194.28 233.14
QCA Health Plan, Inc. Bronze Premier Plus 7 25 195.06 234.07
QCA Health Plan, Inc. Bronze Premier Plus 7 26 198.95 238.74
QCA Health Plan, Inc. Bronze Premier Plus 7 27 203.61 244.33
QCA Health Plan, Inc. Bronze Premier Plus 7 28 211.19 253.42
QCA Health Plan, Inc. Bronze Premier Plus 7 29 217.4 260.88
QCA Health Plan, Inc. Bronze Premier Plus 7 30 220.51 264.61
QCA Health Plan, Inc. Bronze Premier Plus 7 31 225.17 270.21
QCA Health Plan, Inc. Bronze Premier Plus 7 32 229.84 275.81
QCA Health Plan, Inc. Bronze Premier Plus 7 33 232.75 279.3
QCA Health Plan, Inc. Bronze Premier Plus 7 34 235.86 283.03
QCA Health Plan, Inc. Bronze Premier Plus 7 35 237.41 284.9
QCA Health Plan, Inc. Bronze Premier Plus 7 36 238.97 286.76
QCA Health Plan, Inc. Bronze Premier Plus 7 37 240.52 288.63
QCA Health Plan, Inc. Bronze Premier Plus 7 38 242.08 290.49
QCA Health Plan, Inc. Bronze Premier Plus 7 39 245.19 294.22
QCA Health Plan, Inc. Bronze Premier Plus 7 40 248.29 297.95
QCA Health Plan, Inc. Bronze Premier Plus 7 41 252.96 303.55
QCA Health Plan, Inc. Bronze Premier Plus 7 42 257.43 308.91
QCA Health Plan, Inc. Bronze Premier Plus 7 43 263.64 316.37
QCA Health Plan, Inc. Bronze Premier Plus 7 44 271.41 325.7
QCA Health Plan, Inc. Bronze Premier Plus 7 45 280.55 336.65
QCA Health Plan, Inc. Bronze Premier Plus 7 46 291.43 349.71
QCA Health Plan, Inc. Bronze Premier Plus 7 47 303.67 364.4
QCA Health Plan, Inc. Bronze Premier Plus 7 48 317.65 381.18
QCA Health Plan, Inc. Bronze Premier Plus 7 49 331.45 397.74
QCA Health Plan, Inc. Bronze Premier Plus 7 50 346.99 416.39
QCA Health Plan, Inc. Bronze Premier Plus 7 51 362.34 434.81
QCA Health Plan, Inc. Bronze Premier Plus 7 52 379.24 455.09
QCA Health Plan, Inc. Bronze Premier Plus 7 53 396.34 475.61
QCA Health Plan, Inc. Bronze Premier Plus 7 54 414.8 497.76
QCA Health Plan, Inc. Bronze Premier Plus 7 55 433.25 519.9
QCA Health Plan, Inc. Bronze Premier Plus 7 56 453.26 543.92
QCA Health Plan, Inc. Bronze Premier Plus 7 57 473.47 568.16
QCA Health Plan, Inc. Bronze Premier Plus 7 58 495.04 594.04
QCA Health Plan, Inc. Bronze Premier Plus 7 59 505.72 606.86
QCA Health Plan, Inc. Bronze Premier Plus 7 60 527.29 632.74
QCA Health Plan, Inc. Bronze Premier Plus 7 61 545.94 655.12
QCA Health Plan, Inc. Bronze Premier Plus 7 62 558.18 669.81
QCA Health Plan, Inc. Bronze Premier Plus 7 63 573.53 688.23
QCA Health Plan, Inc. Bronze Premier Plus 7 64 582.85 699.42
QCA Health Plan, Inc. Bronze Premier Plus 7 65 and
over
582.85 699.42
QCA Health Plan, Inc. Catastrophic Plus 1 0‐20 75.29 75.29
QCA Health Plan, Inc. Catastrophic Plus 1 0‐20 83.65 83.65
QCA Health Plan, Inc. Catastrophic Plus 1 21 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 1 21 131.74 158.08
QCA Health Plan, Inc. Catastrophic Plus 1 22 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 1 22 131.74 158.08
QCA Health Plan, Inc. Catastrophic Plus 1 23 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 1 23 131.74 158.08
QCA Health Plan, Inc. Catastrophic Plus 1 24 118.56 142.28
Page 202 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Catastrophic Plus 1 24 131.74 158.08
QCA Health Plan, Inc. Catastrophic Plus 1 25 119.04 142.84
QCA Health Plan, Inc. Catastrophic Plus 1 25 132.26 158.72
QCA Health Plan, Inc. Catastrophic Plus 1 26 121.41 145.69
QCA Health Plan, Inc. Catastrophic Plus 1 26 134.9 161.88
QCA Health Plan, Inc. Catastrophic Plus 1 27 124.25 149.1
QCA Health Plan, Inc. Catastrophic Plus 1 27 138.06 165.67
QCA Health Plan, Inc. Catastrophic Plus 1 28 128.88 154.65
QCA Health Plan, Inc. Catastrophic Plus 1 28 143.2 171.84
QCA Health Plan, Inc. Catastrophic Plus 1 29 132.67 159.21
QCA Health Plan, Inc. Catastrophic Plus 1 29 147.41 176.9
QCA Health Plan, Inc. Catastrophic Plus 1 30 134.57 161.48
QCA Health Plan, Inc. Catastrophic Plus 1 30 149.52 179.43
QCA Health Plan, Inc. Catastrophic Plus 1 31 137.41 164.9
QCA Health Plan, Inc. Catastrophic Plus 1 31 152.68 183.22
QCA Health Plan, Inc. Catastrophic Plus 1 32 140.26 168.31
QCA Health Plan, Inc. Catastrophic Plus 1 32 155.84 187.01
QCA Health Plan, Inc. Catastrophic Plus 1 33 142.04 170.45
QCA Health Plan, Inc. Catastrophic Plus 1 33 157.82 189.38
QCA Health Plan, Inc. Catastrophic Plus 1 34 143.94 172.72
QCA Health Plan, Inc. Catastrophic Plus 1 34 159.93 191.91
QCA Health Plan, Inc. Catastrophic Plus 1 35 144.88 173.86
QCA Health Plan, Inc. Catastrophic Plus 1 35 160.98 193.18
QCA Health Plan, Inc. Catastrophic Plus 1 36 145.83 175
QCA Health Plan, Inc. Catastrophic Plus 1 36 162.04 194.44
QCA Health Plan, Inc. Catastrophic Plus 1 37 146.78 176.14
QCA Health Plan, Inc. Catastrophic Plus 1 37 163.09 195.71
QCA Health Plan, Inc. Catastrophic Plus 1 38 147.73 177.28
QCA Health Plan, Inc. Catastrophic Plus 1 38 164.14 196.97
QCA Health Plan, Inc. Catastrophic Plus 1 39 149.63 179.55
QCA Health Plan, Inc. Catastrophic Plus 1 39 166.25 199.5
QCA Health Plan, Inc. Catastrophic Plus 1 40 151.52 181.83
QCA Health Plan, Inc. Catastrophic Plus 1 40 168.36 202.03
QCA Health Plan, Inc. Catastrophic Plus 1 41 154.37 185.24
QCA Health Plan, Inc. Catastrophic Plus 1 41 171.52 205.83
QCA Health Plan, Inc. Catastrophic Plus 1 42 157.1 188.52
QCA Health Plan, Inc. Catastrophic Plus 1 42 174.55 209.46
QCA Health Plan, Inc. Catastrophic Plus 1 43 160.89 193.07
QCA Health Plan, Inc. Catastrophic Plus 1 43 178.77 214.52
QCA Health Plan, Inc. Catastrophic Plus 1 44 165.63 198.76
QCA Health Plan, Inc. Catastrophic Plus 1 44 184.04 220.84
QCA Health Plan, Inc. Catastrophic Plus 1 45 171.2 205.45
QCA Health Plan, Inc. Catastrophic Plus 1 45 190.23 228.27
QCA Health Plan, Inc. Catastrophic Plus 1 46 177.84 213.41
QCA Health Plan, Inc. Catastrophic Plus 1 46 197.6 237.13
QCA Health Plan, Inc. Catastrophic Plus 1 47 185.31 222.38
QCA Health Plan, Inc. Catastrophic Plus 1 47 205.9 247.09
QCA Health Plan, Inc. Catastrophic Plus 1 48 193.85 232.62
QCA Health Plan, Inc. Catastrophic Plus 1 48 215.39 258.47
QCA Health Plan, Inc. Catastrophic Plus 1 49 202.27 242.72
QCA Health Plan, Inc. Catastrophic Plus 1 49 224.74 269.69
QCA Health Plan, Inc. Catastrophic Plus 1 50 211.75 254.1
QCA Health Plan, Inc. Catastrophic Plus 1 50 235.28 282.34
QCA Health Plan, Inc. Catastrophic Plus 1 51 221.12 265.34
QCA Health Plan, Inc. Catastrophic Plus 1 51 245.69 294.83
QCA Health Plan, Inc. Catastrophic Plus 1 52 231.43 277.72
QCA Health Plan, Inc. Catastrophic Plus 1 52 257.15 308.58
QCA Health Plan, Inc. Catastrophic Plus 1 53 241.87 290.24
QCA Health Plan, Inc. Catastrophic Plus 1 53 268.74 322.49
QCA Health Plan, Inc. Catastrophic Plus 1 54 253.13 303.76
QCA Health Plan, Inc. Catastrophic Plus 1 54 281.26 337.51
QCA Health Plan, Inc. Catastrophic Plus 1 55 264.4 317.27
QCA Health Plan, Inc. Catastrophic Plus 1 55 293.77 352.53
Page 203 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Catastrophic Plus 1 56 276.61 331.93
QCA Health Plan, Inc. Catastrophic Plus 1 56 307.34 368.81
QCA Health Plan, Inc. Catastrophic Plus 1 57 288.94 346.73
QCA Health Plan, Inc. Catastrophic Plus 1 57 321.04 385.25
QCA Health Plan, Inc. Catastrophic Plus 1 58 302.1 362.52
QCA Health Plan, Inc. Catastrophic Plus 1 58 335.66 402.8
QCA Health Plan, Inc. Catastrophic Plus 1 59 308.62 370.34
QCA Health Plan, Inc. Catastrophic Plus 1 59 342.91 411.49
QCA Health Plan, Inc. Catastrophic Plus 1 60 321.78 386.14
QCA Health Plan, Inc. Catastrophic Plus 1 60 357.53 429.04
QCA Health Plan, Inc. Catastrophic Plus 1 61 333.16 399.79
QCA Health Plan, Inc. Catastrophic Plus 1 61 370.18 444.22
QCA Health Plan, Inc. Catastrophic Plus 1 62 340.63 408.76
QCA Health Plan, Inc. Catastrophic Plus 1 62 378.48 454.17
QCA Health Plan, Inc. Catastrophic Plus 1 63 350 420
QCA Health Plan, Inc. Catastrophic Plus 1 63 388.89 466.66
QCA Health Plan, Inc. Catastrophic Plus 1 64 355.69 426.83
QCA Health Plan, Inc. Catastrophic Plus 1 64 395.21 474.25
QCA Health Plan, Inc. Catastrophic Plus 1 65 and
over
355.69 426.83
QCA Health Plan, Inc. Catastrophic Plus 1 65 and
over
395.21 474.25
QCA Health Plan, Inc. Catastrophic Plus 2 0‐20 92.02 92.02
QCA Health Plan, Inc. Catastrophic Plus 2 21 144.91 173.89
QCA Health Plan, Inc. Catastrophic Plus 2 22 144.91 173.89
QCA Health Plan, Inc. Catastrophic Plus 2 23 144.91 173.89
QCA Health Plan, Inc. Catastrophic Plus 2 24 144.91 173.89
QCA Health Plan, Inc. Catastrophic Plus 2 25 145.49 174.59
QCA Health Plan, Inc. Catastrophic Plus 2 26 148.39 178.07
QCA Health Plan, Inc. Catastrophic Plus 2 27 151.87 182.24
QCA Health Plan, Inc. Catastrophic Plus 2 28 157.52 189.02
QCA Health Plan, Inc. Catastrophic Plus 2 29 162.15 194.59
QCA Health Plan, Inc. Catastrophic Plus 2 30 164.47 197.37
QCA Health Plan, Inc. Catastrophic Plus 2 31 167.95 201.54
QCA Health Plan, Inc. Catastrophic Plus 2 32 171.43 205.71
QCA Health Plan, Inc. Catastrophic Plus 2 33 173.6 208.32
QCA Health Plan, Inc. Catastrophic Plus 2 34 175.92 211.11
QCA Health Plan, Inc. Catastrophic Plus 2 35 177.08 212.5
QCA Health Plan, Inc. Catastrophic Plus 2 36 178.24 213.89
QCA Health Plan, Inc. Catastrophic Plus 2 37 179.4 215.28
QCA Health Plan, Inc. Catastrophic Plus 2 38 180.56 216.67
QCA Health Plan, Inc. Catastrophic Plus 2 39 182.88 219.45
QCA Health Plan, Inc. Catastrophic Plus 2 40 185.2 222.23
QCA Health Plan, Inc. Catastrophic Plus 2 41 188.67 226.41
QCA Health Plan, Inc. Catastrophic Plus 2 42 192.01 230.41
QCA Health Plan, Inc. Catastrophic Plus 2 43 196.64 235.97
QCA Health Plan, Inc. Catastrophic Plus 2 44 202.44 242.93
QCA Health Plan, Inc. Catastrophic Plus 2 45 209.25 251.1
QCA Health Plan, Inc. Catastrophic Plus 2 46 217.37 260.84
QCA Health Plan, Inc. Catastrophic Plus 2 47 226.49 271.79
QCA Health Plan, Inc. Catastrophic Plus 2 48 236.93 284.31
QCA Health Plan, Inc. Catastrophic Plus 2 49 247.22 296.66
QCA Health Plan, Inc. Catastrophic Plus 2 50 258.81 310.57
QCA Health Plan, Inc. Catastrophic Plus 2 51 270.26 324.31
QCA Health Plan, Inc. Catastrophic Plus 2 52 282.86 339.44
QCA Health Plan, Inc. Catastrophic Plus 2 53 295.62 354.74
QCA Health Plan, Inc. Catastrophic Plus 2 54 309.38 371.26
QCA Health Plan, Inc. Catastrophic Plus 2 55 323.15 387.78
QCA Health Plan, Inc. Catastrophic Plus 2 56 338.08 405.69
QCA Health Plan, Inc. Catastrophic Plus 2 57 353.15 423.78
QCA Health Plan, Inc. Catastrophic Plus 2 58 369.23 443.08
QCA Health Plan, Inc. Catastrophic Plus 2 59 377.2 452.64
QCA Health Plan, Inc. Catastrophic Plus 2 60 393.29 471.94
Page 204 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Catastrophic Plus 2 61 407.2 488.64
QCA Health Plan, Inc. Catastrophic Plus 2 62 416.33 499.59
QCA Health Plan, Inc. Catastrophic Plus 2 63 427.77 513.33
QCA Health Plan, Inc. Catastrophic Plus 2 64 434.73 521.68
QCA Health Plan, Inc. Catastrophic Plus 2 65 and
over
434.73 521.68
QCA Health Plan, Inc. Catastrophic Plus 3 0‐20 67.76 67.76
QCA Health Plan, Inc. Catastrophic Plus 3 0‐20 75.29 75.29
QCA Health Plan, Inc. Catastrophic Plus 3 21 106.71 128.05
QCA Health Plan, Inc. Catastrophic Plus 3 21 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 3 22 106.71 128.05
QCA Health Plan, Inc. Catastrophic Plus 3 22 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 3 23 106.71 128.05
QCA Health Plan, Inc. Catastrophic Plus 3 23 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 3 24 106.71 128.05
QCA Health Plan, Inc. Catastrophic Plus 3 24 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 3 25 107.13 128.56
QCA Health Plan, Inc. Catastrophic Plus 3 25 119.04 142.84
QCA Health Plan, Inc. Catastrophic Plus 3 26 109.27 131.12
QCA Health Plan, Inc. Catastrophic Plus 3 26 121.41 145.69
QCA Health Plan, Inc. Catastrophic Plus 3 27 111.83 134.19
QCA Health Plan, Inc. Catastrophic Plus 3 27 124.25 149.1
QCA Health Plan, Inc. Catastrophic Plus 3 28 115.99 139.19
QCA Health Plan, Inc. Catastrophic Plus 3 28 128.88 154.65
QCA Health Plan, Inc. Catastrophic Plus 3 29 119.4 143.29
QCA Health Plan, Inc. Catastrophic Plus 3 29 132.67 159.21
QCA Health Plan, Inc. Catastrophic Plus 3 30 121.11 145.33
QCA Health Plan, Inc. Catastrophic Plus 3 30 134.57 161.48
QCA Health Plan, Inc. Catastrophic Plus 3 31 123.67 148.41
QCA Health Plan, Inc. Catastrophic Plus 3 31 137.41 164.9
QCA Health Plan, Inc. Catastrophic Plus 3 32 126.23 151.48
QCA Health Plan, Inc. Catastrophic Plus 3 32 140.26 168.31
QCA Health Plan, Inc. Catastrophic Plus 3 33 127.83 153.4
QCA Health Plan, Inc. Catastrophic Plus 3 33 142.04 170.45
QCA Health Plan, Inc. Catastrophic Plus 3 34 129.54 155.45
QCA Health Plan, Inc. Catastrophic Plus 3 34 143.94 172.72
QCA Health Plan, Inc. Catastrophic Plus 3 35 130.4 156.47
QCA Health Plan, Inc. Catastrophic Plus 3 35 144.88 173.86
QCA Health Plan, Inc. Catastrophic Plus 3 36 131.25 157.5
QCA Health Plan, Inc. Catastrophic Plus 3 36 145.83 175
QCA Health Plan, Inc. Catastrophic Plus 3 37 132.1 158.52
QCA Health Plan, Inc. Catastrophic Plus 3 37 146.78 176.14
QCA Health Plan, Inc. Catastrophic Plus 3 38 132.96 159.55
QCA Health Plan, Inc. Catastrophic Plus 3 38 147.73 177.28
QCA Health Plan, Inc. Catastrophic Plus 3 39 134.66 161.6
QCA Health Plan, Inc. Catastrophic Plus 3 39 149.63 179.55
QCA Health Plan, Inc. Catastrophic Plus 3 40 136.37 163.65
QCA Health Plan, Inc. Catastrophic Plus 3 40 151.52 181.83
QCA Health Plan, Inc. Catastrophic Plus 3 41 138.93 166.72
QCA Health Plan, Inc. Catastrophic Plus 3 41 154.37 185.24
QCA Health Plan, Inc. Catastrophic Plus 3 42 141.39 169.66
QCA Health Plan, Inc. Catastrophic Plus 3 42 157.1 188.52
QCA Health Plan, Inc. Catastrophic Plus 3 43 144.8 173.76
QCA Health Plan, Inc. Catastrophic Plus 3 43 160.89 193.07
QCA Health Plan, Inc. Catastrophic Plus 3 44 149.07 178.88
QCA Health Plan, Inc. Catastrophic Plus 3 44 165.63 198.76
QCA Health Plan, Inc. Catastrophic Plus 3 45 154.08 184.9
QCA Health Plan, Inc. Catastrophic Plus 3 45 171.2 205.45
QCA Health Plan, Inc. Catastrophic Plus 3 46 160.06 192.07
QCA Health Plan, Inc. Catastrophic Plus 3 46 177.84 213.41
QCA Health Plan, Inc. Catastrophic Plus 3 47 166.78 200.14
QCA Health Plan, Inc. Catastrophic Plus 3 47 185.31 222.38
QCA Health Plan, Inc. Catastrophic Plus 3 48 174.47 209.36
Page 205 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Catastrophic Plus 3 48 193.85 232.62
QCA Health Plan, Inc. Catastrophic Plus 3 49 182.04 218.45
QCA Health Plan, Inc. Catastrophic Plus 3 49 202.27 242.72
QCA Health Plan, Inc. Catastrophic Plus 3 50 190.58 228.69
QCA Health Plan, Inc. Catastrophic Plus 3 50 211.75 254.1
QCA Health Plan, Inc. Catastrophic Plus 3 51 199.01 238.81
QCA Health Plan, Inc. Catastrophic Plus 3 51 221.12 265.34
QCA Health Plan, Inc. Catastrophic Plus 3 52 208.29 249.95
QCA Health Plan, Inc. Catastrophic Plus 3 52 231.43 277.72
QCA Health Plan, Inc. Catastrophic Plus 3 53 217.68 261.22
QCA Health Plan, Inc. Catastrophic Plus 3 53 241.87 290.24
QCA Health Plan, Inc. Catastrophic Plus 3 54 227.82 273.38
QCA Health Plan, Inc. Catastrophic Plus 3 54 253.13 303.76
QCA Health Plan, Inc. Catastrophic Plus 3 55 237.96 285.55
QCA Health Plan, Inc. Catastrophic Plus 3 55 264.4 317.27
QCA Health Plan, Inc. Catastrophic Plus 3 56 248.95 298.74
QCA Health Plan, Inc. Catastrophic Plus 3 56 276.61 331.93
QCA Health Plan, Inc. Catastrophic Plus 3 57 260.04 312.05
QCA Health Plan, Inc. Catastrophic Plus 3 57 288.94 346.73
QCA Health Plan, Inc. Catastrophic Plus 3 58 271.89 326.27
QCA Health Plan, Inc. Catastrophic Plus 3 58 302.1 362.52
QCA Health Plan, Inc. Catastrophic Plus 3 59 277.76 333.31
QCA Health Plan, Inc. Catastrophic Plus 3 59 308.62 370.34
QCA Health Plan, Inc. Catastrophic Plus 3 60 289.6 347.52
QCA Health Plan, Inc. Catastrophic Plus 3 60 321.78 386.14
QCA Health Plan, Inc. Catastrophic Plus 3 61 299.85 359.81
QCA Health Plan, Inc. Catastrophic Plus 3 61 333.16 399.79
QCA Health Plan, Inc. Catastrophic Plus 3 62 306.57 367.88
QCA Health Plan, Inc. Catastrophic Plus 3 62 340.63 408.76
QCA Health Plan, Inc. Catastrophic Plus 3 63 315 378
QCA Health Plan, Inc. Catastrophic Plus 3 63 350 420
QCA Health Plan, Inc. Catastrophic Plus 3 64 320.12 384.14
QCA Health Plan, Inc. Catastrophic Plus 3 64 355.69 426.83
QCA Health Plan, Inc. Catastrophic Plus 3 65 and
over
320.12 384.14
QCA Health Plan, Inc. Catastrophic Plus 3 65 and
over
355.69 426.83
QCA Health Plan, Inc. Catastrophic Plus 4 0‐20 83.65 83.65
QCA Health Plan, Inc. Catastrophic Plus 4 21 131.74 158.08
QCA Health Plan, Inc. Catastrophic Plus 4 22 131.74 158.08
QCA Health Plan, Inc. Catastrophic Plus 4 23 131.74 158.08
QCA Health Plan, Inc. Catastrophic Plus 4 24 131.74 158.08
QCA Health Plan, Inc. Catastrophic Plus 4 25 132.26 158.72
QCA Health Plan, Inc. Catastrophic Plus 4 26 134.9 161.88
QCA Health Plan, Inc. Catastrophic Plus 4 27 138.06 165.67
QCA Health Plan, Inc. Catastrophic Plus 4 28 143.2 171.84
QCA Health Plan, Inc. Catastrophic Plus 4 29 147.41 176.9
QCA Health Plan, Inc. Catastrophic Plus 4 30 149.52 179.43
QCA Health Plan, Inc. Catastrophic Plus 4 31 152.68 183.22
QCA Health Plan, Inc. Catastrophic Plus 4 32 155.84 187.01
QCA Health Plan, Inc. Catastrophic Plus 4 33 157.82 189.38
QCA Health Plan, Inc. Catastrophic Plus 4 34 159.93 191.91
QCA Health Plan, Inc. Catastrophic Plus 4 35 160.98 193.18
QCA Health Plan, Inc. Catastrophic Plus 4 36 162.04 194.44
QCA Health Plan, Inc. Catastrophic Plus 4 37 163.09 195.71
QCA Health Plan, Inc. Catastrophic Plus 4 38 164.14 196.97
QCA Health Plan, Inc. Catastrophic Plus 4 39 166.25 199.5
QCA Health Plan, Inc. Catastrophic Plus 4 40 168.36 202.03
QCA Health Plan, Inc. Catastrophic Plus 4 41 171.52 205.83
QCA Health Plan, Inc. Catastrophic Plus 4 42 174.55 209.46
QCA Health Plan, Inc. Catastrophic Plus 4 43 178.77 214.52
QCA Health Plan, Inc. Catastrophic Plus 4 44 184.04 220.84
QCA Health Plan, Inc. Catastrophic Plus 4 45 190.23 228.27
Page 206 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Catastrophic Plus 4 46 197.6 237.13
QCA Health Plan, Inc. Catastrophic Plus 4 47 205.9 247.09
QCA Health Plan, Inc. Catastrophic Plus 4 48 215.39 258.47
QCA Health Plan, Inc. Catastrophic Plus 4 49 224.74 269.69
QCA Health Plan, Inc. Catastrophic Plus 4 50 235.28 282.34
QCA Health Plan, Inc. Catastrophic Plus 4 51 245.69 294.83
QCA Health Plan, Inc. Catastrophic Plus 4 52 257.15 308.58
QCA Health Plan, Inc. Catastrophic Plus 4 53 268.74 322.49
QCA Health Plan, Inc. Catastrophic Plus 4 54 281.26 337.51
QCA Health Plan, Inc. Catastrophic Plus 4 55 293.77 352.53
QCA Health Plan, Inc. Catastrophic Plus 4 56 307.34 368.81
QCA Health Plan, Inc. Catastrophic Plus 4 57 321.04 385.25
QCA Health Plan, Inc. Catastrophic Plus 4 58 335.66 402.8
QCA Health Plan, Inc. Catastrophic Plus 4 59 342.91 411.49
QCA Health Plan, Inc. Catastrophic Plus 4 60 357.53 429.04
QCA Health Plan, Inc. Catastrophic Plus 4 61 370.18 444.22
QCA Health Plan, Inc. Catastrophic Plus 4 62 378.48 454.17
QCA Health Plan, Inc. Catastrophic Plus 4 63 388.89 466.66
QCA Health Plan, Inc. Catastrophic Plus 4 64 395.21 474.25
QCA Health Plan, Inc. Catastrophic Plus 4 65 and
over
395.21 474.25
QCA Health Plan, Inc. Catastrophic Plus 7 0‐20 75.29 75.29
QCA Health Plan, Inc. Catastrophic Plus 7 21 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 7 22 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 7 23 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 7 24 118.56 142.28
QCA Health Plan, Inc. Catastrophic Plus 7 25 119.04 142.84
QCA Health Plan, Inc. Catastrophic Plus 7 26 121.41 145.69
QCA Health Plan, Inc. Catastrophic Plus 7 27 124.25 149.1
QCA Health Plan, Inc. Catastrophic Plus 7 28 128.88 154.65
QCA Health Plan, Inc. Catastrophic Plus 7 29 132.67 159.21
QCA Health Plan, Inc. Catastrophic Plus 7 30 134.57 161.48
QCA Health Plan, Inc. Catastrophic Plus 7 31 137.41 164.9
QCA Health Plan, Inc. Catastrophic Plus 7 32 140.26 168.31
QCA Health Plan, Inc. Catastrophic Plus 7 33 142.04 170.45
QCA Health Plan, Inc. Catastrophic Plus 7 34 143.94 172.72
QCA Health Plan, Inc. Catastrophic Plus 7 35 144.88 173.86
QCA Health Plan, Inc. Catastrophic Plus 7 36 145.83 175
QCA Health Plan, Inc. Catastrophic Plus 7 37 146.78 176.14
QCA Health Plan, Inc. Catastrophic Plus 7 38 147.73 177.28
QCA Health Plan, Inc. Catastrophic Plus 7 39 149.63 179.55
QCA Health Plan, Inc. Catastrophic Plus 7 40 151.52 181.83
QCA Health Plan, Inc. Catastrophic Plus 7 41 154.37 185.24
QCA Health Plan, Inc. Catastrophic Plus 7 42 157.1 188.52
QCA Health Plan, Inc. Catastrophic Plus 7 43 160.89 193.07
QCA Health Plan, Inc. Catastrophic Plus 7 44 165.63 198.76
QCA Health Plan, Inc. Catastrophic Plus 7 45 171.2 205.45
QCA Health Plan, Inc. Catastrophic Plus 7 46 177.84 213.41
QCA Health Plan, Inc. Catastrophic Plus 7 47 185.31 222.38
QCA Health Plan, Inc. Catastrophic Plus 7 48 193.85 232.62
QCA Health Plan, Inc. Catastrophic Plus 7 49 202.27 242.72
QCA Health Plan, Inc. Catastrophic Plus 7 50 211.75 254.1
QCA Health Plan, Inc. Catastrophic Plus 7 51 221.12 265.34
QCA Health Plan, Inc. Catastrophic Plus 7 52 231.43 277.72
QCA Health Plan, Inc. Catastrophic Plus 7 53 241.87 290.24
QCA Health Plan, Inc. Catastrophic Plus 7 54 253.13 303.76
QCA Health Plan, Inc. Catastrophic Plus 7 55 264.4 317.27
QCA Health Plan, Inc. Catastrophic Plus 7 56 276.61 331.93
QCA Health Plan, Inc. Catastrophic Plus 7 57 288.94 346.73
QCA Health Plan, Inc. Catastrophic Plus 7 58 302.1 362.52
QCA Health Plan, Inc. Catastrophic Plus 7 59 308.62 370.34
QCA Health Plan, Inc. Catastrophic Plus 7 60 321.78 386.14
QCA Health Plan, Inc. Catastrophic Plus 7 61 333.16 399.79
Page 207 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Catastrophic Plus 7 62 340.63 408.76
QCA Health Plan, Inc. Catastrophic Plus 7 63 350 420
QCA Health Plan, Inc. Catastrophic Plus 7 64 355.69 426.83
QCA Health Plan, Inc. Catastrophic Plus 7 65 and
over
355.69 426.83
QCA Health Plan, Inc. Gold Enhanced Plus 1 0‐20 167.45 167.45
QCA Health Plan, Inc. Gold Enhanced Plus 1 0‐20 186.05 186.05
QCA Health Plan, Inc. Gold Enhanced Plus 1 21 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 1 21 292.99 351.59
QCA Health Plan, Inc. Gold Enhanced Plus 1 22 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 1 22 292.99 351.59
QCA Health Plan, Inc. Gold Enhanced Plus 1 23 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 1 23 292.99 351.59
QCA Health Plan, Inc. Gold Enhanced Plus 1 24 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 1 24 292.99 351.59
QCA Health Plan, Inc. Gold Enhanced Plus 1 25 264.75 317.7
QCA Health Plan, Inc. Gold Enhanced Plus 1 25 294.17 353
QCA Health Plan, Inc. Gold Enhanced Plus 1 26 270.02 324.03
QCA Health Plan, Inc. Gold Enhanced Plus 1 26 300.03 360.03
QCA Health Plan, Inc. Gold Enhanced Plus 1 27 276.35 331.62
QCA Health Plan, Inc. Gold Enhanced Plus 1 27 307.06 368.47
QCA Health Plan, Inc. Gold Enhanced Plus 1 28 286.64 343.96
QCA Health Plan, Inc. Gold Enhanced Plus 1 28 318.48 382.18
QCA Health Plan, Inc. Gold Enhanced Plus 1 29 295.07 354.09
QCA Health Plan, Inc. Gold Enhanced Plus 1 29 327.86 393.43
QCA Health Plan, Inc. Gold Enhanced Plus 1 30 299.29 359.15
QCA Health Plan, Inc. Gold Enhanced Plus 1 30 332.55 399.06
QCA Health Plan, Inc. Gold Enhanced Plus 1 31 305.62 366.75
QCA Health Plan, Inc. Gold Enhanced Plus 1 31 339.58 407.5
QCA Health Plan, Inc. Gold Enhanced Plus 1 32 311.95 374.34
QCA Health Plan, Inc. Gold Enhanced Plus 1 32 346.61 415.93
QCA Health Plan, Inc. Gold Enhanced Plus 1 33 315.91 379.09
QCA Health Plan, Inc. Gold Enhanced Plus 1 33 351.01 421.21
QCA Health Plan, Inc. Gold Enhanced Plus 1 34 320.13 384.15
QCA Health Plan, Inc. Gold Enhanced Plus 1 34 355.69 426.83
QCA Health Plan, Inc. Gold Enhanced Plus 1 35 322.23 386.68
QCA Health Plan, Inc. Gold Enhanced Plus 1 35 358.04 429.65
QCA Health Plan, Inc. Gold Enhanced Plus 1 36 324.34 389.21
QCA Health Plan, Inc. Gold Enhanced Plus 1 36 360.38 432.46
QCA Health Plan, Inc. Gold Enhanced Plus 1 37 326.45 391.74
QCA Health Plan, Inc. Gold Enhanced Plus 1 37 362.73 435.27
QCA Health Plan, Inc. Gold Enhanced Plus 1 38 328.56 394.28
QCA Health Plan, Inc. Gold Enhanced Plus 1 38 365.07 438.08
QCA Health Plan, Inc. Gold Enhanced Plus 1 39 332.78 399.34
QCA Health Plan, Inc. Gold Enhanced Plus 1 39 369.76 443.71
QCA Health Plan, Inc. Gold Enhanced Plus 1 40 337 404.4
QCA Health Plan, Inc. Gold Enhanced Plus 1 40 374.45 449.34
QCA Health Plan, Inc. Gold Enhanced Plus 1 41 343.33 412
QCA Health Plan, Inc. Gold Enhanced Plus 1 41 381.48 457.77
QCA Health Plan, Inc. Gold Enhanced Plus 1 42 349.4 419.27
QCA Health Plan, Inc. Gold Enhanced Plus 1 42 388.22 465.86
QCA Health Plan, Inc. Gold Enhanced Plus 1 43 357.83 429.4
QCA Health Plan, Inc. Gold Enhanced Plus 1 43 397.59 477.11
QCA Health Plan, Inc. Gold Enhanced Plus 1 44 368.38 442.06
QCA Health Plan, Inc. Gold Enhanced Plus 1 44 409.31 491.18
QCA Health Plan, Inc. Gold Enhanced Plus 1 45 380.77 456.93
QCA Health Plan, Inc. Gold Enhanced Plus 1 45 423.08 507.7
QCA Health Plan, Inc. Gold Enhanced Plus 1 46 395.54 474.65
QCA Health Plan, Inc. Gold Enhanced Plus 1 46 439.49 527.39
QCA Health Plan, Inc. Gold Enhanced Plus 1 47 412.15 494.59
QCA Health Plan, Inc. Gold Enhanced Plus 1 47 457.95 549.54
QCA Health Plan, Inc. Gold Enhanced Plus 1 48 431.14 517.37
QCA Health Plan, Inc. Gold Enhanced Plus 1 48 479.05 574.85
Page 208 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Enhanced Plus 1 49 449.86 539.84
QCA Health Plan, Inc. Gold Enhanced Plus 1 49 499.85 599.82
QCA Health Plan, Inc. Gold Enhanced Plus 1 50 470.96 565.15
QCA Health Plan, Inc. Gold Enhanced Plus 1 50 523.29 627.94
QCA Health Plan, Inc. Gold Enhanced Plus 1 51 491.79 590.15
QCA Health Plan, Inc. Gold Enhanced Plus 1 51 546.43 655.72
QCA Health Plan, Inc. Gold Enhanced Plus 1 52 514.73 617.68
QCA Health Plan, Inc. Gold Enhanced Plus 1 52 571.92 686.31
QCA Health Plan, Inc. Gold Enhanced Plus 1 53 537.94 645.52
QCA Health Plan, Inc. Gold Enhanced Plus 1 53 597.71 717.25
QCA Health Plan, Inc. Gold Enhanced Plus 1 54 562.99 675.59
QCA Health Plan, Inc. Gold Enhanced Plus 1 54 625.54 750.65
QCA Health Plan, Inc. Gold Enhanced Plus 1 55 588.04 705.65
QCA Health Plan, Inc. Gold Enhanced Plus 1 55 653.38 784.05
QCA Health Plan, Inc. Gold Enhanced Plus 1 56 615.2 738.24
QCA Health Plan, Inc. Gold Enhanced Plus 1 56 683.55 820.27
QCA Health Plan, Inc. Gold Enhanced Plus 1 57 642.62 771.15
QCA Health Plan, Inc. Gold Enhanced Plus 1 57 714.03 856.83
QCA Health Plan, Inc. Gold Enhanced Plus 1 58 671.89 806.27
QCA Health Plan, Inc. Gold Enhanced Plus 1 58 746.55 895.86
QCA Health Plan, Inc. Gold Enhanced Plus 1 59 686.4 823.68
QCA Health Plan, Inc. Gold Enhanced Plus 1 59 762.66 915.2
QCA Health Plan, Inc. Gold Enhanced Plus 1 60 715.67 858.8
QCA Health Plan, Inc. Gold Enhanced Plus 1 60 795.19 954.22
QCA Health Plan, Inc. Gold Enhanced Plus 1 61 740.98 889.18
QCA Health Plan, Inc. Gold Enhanced Plus 1 61 823.31 987.98
QCA Health Plan, Inc. Gold Enhanced Plus 1 62 757.59 909.11
QCA Health Plan, Inc. Gold Enhanced Plus 1 62 841.77 1010.13
QCA Health Plan, Inc. Gold Enhanced Plus 1 63 778.43 934.11
QCA Health Plan, Inc. Gold Enhanced Plus 1 63 864.92 1037.9
QCA Health Plan, Inc. Gold Enhanced Plus 1 64 791.08 949.3
QCA Health Plan, Inc. Gold Enhanced Plus 1 64 878.98 1054.78
QCA Health Plan, Inc. Gold Enhanced Plus 1 65 and
over
791.08 949.3
QCA Health Plan, Inc. Gold Enhanced Plus 1 65 and
over
878.98 1054.78
QCA Health Plan, Inc. Gold Enhanced Plus 2 0‐20 204.66 204.66
QCA Health Plan, Inc. Gold Enhanced Plus 2 21 322.29 386.75
QCA Health Plan, Inc. Gold Enhanced Plus 2 22 322.29 386.75
QCA Health Plan, Inc. Gold Enhanced Plus 2 23 322.29 386.75
QCA Health Plan, Inc. Gold Enhanced Plus 2 24 322.29 386.75
QCA Health Plan, Inc. Gold Enhanced Plus 2 25 323.58 388.3
QCA Health Plan, Inc. Gold Enhanced Plus 2 26 330.03 396.03
QCA Health Plan, Inc. Gold Enhanced Plus 2 27 337.76 405.32
QCA Health Plan, Inc. Gold Enhanced Plus 2 28 350.33 420.4
QCA Health Plan, Inc. Gold Enhanced Plus 2 29 360.65 432.78
QCA Health Plan, Inc. Gold Enhanced Plus 2 30 365.8 438.96
QCA Health Plan, Inc. Gold Enhanced Plus 2 31 373.54 448.25
QCA Health Plan, Inc. Gold Enhanced Plus 2 32 381.27 457.53
QCA Health Plan, Inc. Gold Enhanced Plus 2 33 386.11 463.33
QCA Health Plan, Inc. Gold Enhanced Plus 2 34 391.26 469.52
QCA Health Plan, Inc. Gold Enhanced Plus 2 35 393.84 472.61
QCA Health Plan, Inc. Gold Enhanced Plus 2 36 396.42 475.7
QCA Health Plan, Inc. Gold Enhanced Plus 2 37 399 478.8
QCA Health Plan, Inc. Gold Enhanced Plus 2 38 401.58 481.89
QCA Health Plan, Inc. Gold Enhanced Plus 2 39 406.73 488.08
QCA Health Plan, Inc. Gold Enhanced Plus 2 40 411.89 494.27
QCA Health Plan, Inc. Gold Enhanced Plus 2 41 419.63 503.55
QCA Health Plan, Inc. Gold Enhanced Plus 2 42 427.04 512.45
QCA Health Plan, Inc. Gold Enhanced Plus 2 43 437.35 524.82
QCA Health Plan, Inc. Gold Enhanced Plus 2 44 450.24 540.29
QCA Health Plan, Inc. Gold Enhanced Plus 2 45 465.39 558.47
QCA Health Plan, Inc. Gold Enhanced Plus 2 46 483.44 580.13
Page 209 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Enhanced Plus 2 47 503.74 604.49
QCA Health Plan, Inc. Gold Enhanced Plus 2 48 526.95 632.34
QCA Health Plan, Inc. Gold Enhanced Plus 2 49 549.83 659.8
QCA Health Plan, Inc. Gold Enhanced Plus 2 50 575.62 690.74
QCA Health Plan, Inc. Gold Enhanced Plus 2 51 601.08 721.29
QCA Health Plan, Inc. Gold Enhanced Plus 2 52 629.12 754.94
QCA Health Plan, Inc. Gold Enhanced Plus 2 53 657.48 788.97
QCA Health Plan, Inc. Gold Enhanced Plus 2 54 688.1 825.72
QCA Health Plan, Inc. Gold Enhanced Plus 2 55 718.71 862.46
QCA Health Plan, Inc. Gold Enhanced Plus 2 56 751.91 902.29
QCA Health Plan, Inc. Gold Enhanced Plus 2 57 785.43 942.51
QCA Health Plan, Inc. Gold Enhanced Plus 2 58 821.2 985.44
QCA Health Plan, Inc. Gold Enhanced Plus 2 59 838.93 1006.72
QCA Health Plan, Inc. Gold Enhanced Plus 2 60 874.7 1049.64
QCA Health Plan, Inc. Gold Enhanced Plus 2 61 905.64 1086.77
QCA Health Plan, Inc. Gold Enhanced Plus 2 62 925.95 1111.14
QCA Health Plan, Inc. Gold Enhanced Plus 2 63 951.41 1141.69
QCA Health Plan, Inc. Gold Enhanced Plus 2 64 966.88 1160.26
QCA Health Plan, Inc. Gold Enhanced Plus 2 65 and
over
966.88 1160.26
QCA Health Plan, Inc. Gold Enhanced Plus 3 0‐20 150.7 150.7
QCA Health Plan, Inc. Gold Enhanced Plus 3 0‐20 167.45 167.45
QCA Health Plan, Inc. Gold Enhanced Plus 3 21 237.33 284.79
QCA Health Plan, Inc. Gold Enhanced Plus 3 21 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 3 22 237.33 284.79
QCA Health Plan, Inc. Gold Enhanced Plus 3 22 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 3 23 237.33 284.79
QCA Health Plan, Inc. Gold Enhanced Plus 3 23 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 3 24 237.33 284.79
QCA Health Plan, Inc. Gold Enhanced Plus 3 24 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 3 25 238.27 285.93
QCA Health Plan, Inc. Gold Enhanced Plus 3 25 264.75 317.7
QCA Health Plan, Inc. Gold Enhanced Plus 3 26 243.02 291.63
QCA Health Plan, Inc. Gold Enhanced Plus 3 26 270.02 324.03
QCA Health Plan, Inc. Gold Enhanced Plus 3 27 248.72 298.46
QCA Health Plan, Inc. Gold Enhanced Plus 3 27 276.35 331.62
QCA Health Plan, Inc. Gold Enhanced Plus 3 28 257.97 309.57
QCA Health Plan, Inc. Gold Enhanced Plus 3 28 286.64 343.96
QCA Health Plan, Inc. Gold Enhanced Plus 3 29 265.57 318.68
QCA Health Plan, Inc. Gold Enhanced Plus 3 29 295.07 354.09
QCA Health Plan, Inc. Gold Enhanced Plus 3 30 269.36 323.24
QCA Health Plan, Inc. Gold Enhanced Plus 3 30 299.29 359.15
QCA Health Plan, Inc. Gold Enhanced Plus 3 31 275.06 330.07
QCA Health Plan, Inc. Gold Enhanced Plus 3 31 305.62 366.75
QCA Health Plan, Inc. Gold Enhanced Plus 3 32 280.76 336.91
QCA Health Plan, Inc. Gold Enhanced Plus 3 32 311.95 374.34
QCA Health Plan, Inc. Gold Enhanced Plus 3 33 284.32 341.18
QCA Health Plan, Inc. Gold Enhanced Plus 3 33 315.91 379.09
QCA Health Plan, Inc. Gold Enhanced Plus 3 34 288.11 345.74
QCA Health Plan, Inc. Gold Enhanced Plus 3 34 320.13 384.15
QCA Health Plan, Inc. Gold Enhanced Plus 3 35 290.01 348.01
QCA Health Plan, Inc. Gold Enhanced Plus 3 35 322.23 386.68
QCA Health Plan, Inc. Gold Enhanced Plus 3 36 291.91 350.29
QCA Health Plan, Inc. Gold Enhanced Plus 3 36 324.34 389.21
QCA Health Plan, Inc. Gold Enhanced Plus 3 37 293.81 352.57
QCA Health Plan, Inc. Gold Enhanced Plus 3 37 326.45 391.74
QCA Health Plan, Inc. Gold Enhanced Plus 3 38 295.71 354.85
QCA Health Plan, Inc. Gold Enhanced Plus 3 38 328.56 394.28
QCA Health Plan, Inc. Gold Enhanced Plus 3 39 299.5 359.41
QCA Health Plan, Inc. Gold Enhanced Plus 3 39 332.78 399.34
QCA Health Plan, Inc. Gold Enhanced Plus 3 40 303.3 363.96
QCA Health Plan, Inc. Gold Enhanced Plus 3 40 337 404.4
QCA Health Plan, Inc. Gold Enhanced Plus 3 41 309 370.8
Page 210 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Enhanced Plus 3 41 343.33 412
QCA Health Plan, Inc. Gold Enhanced Plus 3 42 314.46 377.35
QCA Health Plan, Inc. Gold Enhanced Plus 3 42 349.4 419.27
QCA Health Plan, Inc. Gold Enhanced Plus 3 43 322.05 386.46
QCA Health Plan, Inc. Gold Enhanced Plus 3 43 357.83 429.4
QCA Health Plan, Inc. Gold Enhanced Plus 3 44 331.54 397.85
QCA Health Plan, Inc. Gold Enhanced Plus 3 44 368.38 442.06
QCA Health Plan, Inc. Gold Enhanced Plus 3 45 342.7 411.24
QCA Health Plan, Inc. Gold Enhanced Plus 3 45 380.77 456.93
QCA Health Plan, Inc. Gold Enhanced Plus 3 46 355.99 427.19
QCA Health Plan, Inc. Gold Enhanced Plus 3 46 395.54 474.65
QCA Health Plan, Inc. Gold Enhanced Plus 3 47 370.94 445.13
QCA Health Plan, Inc. Gold Enhanced Plus 3 47 412.15 494.59
QCA Health Plan, Inc. Gold Enhanced Plus 3 48 388.03 465.63
QCA Health Plan, Inc. Gold Enhanced Plus 3 48 431.14 517.37
QCA Health Plan, Inc. Gold Enhanced Plus 3 49 404.88 485.85
QCA Health Plan, Inc. Gold Enhanced Plus 3 49 449.86 539.84
QCA Health Plan, Inc. Gold Enhanced Plus 3 50 423.86 508.64
QCA Health Plan, Inc. Gold Enhanced Plus 3 50 470.96 565.15
QCA Health Plan, Inc. Gold Enhanced Plus 3 51 442.61 531.13
QCA Health Plan, Inc. Gold Enhanced Plus 3 51 491.79 590.15
QCA Health Plan, Inc. Gold Enhanced Plus 3 52 463.26 555.91
QCA Health Plan, Inc. Gold Enhanced Plus 3 52 514.73 617.68
QCA Health Plan, Inc. Gold Enhanced Plus 3 53 484.14 580.97
QCA Health Plan, Inc. Gold Enhanced Plus 3 53 537.94 645.52
QCA Health Plan, Inc. Gold Enhanced Plus 3 54 506.69 608.03
QCA Health Plan, Inc. Gold Enhanced Plus 3 54 562.99 675.59
QCA Health Plan, Inc. Gold Enhanced Plus 3 55 529.23 635.08
QCA Health Plan, Inc. Gold Enhanced Plus 3 55 588.04 705.65
QCA Health Plan, Inc. Gold Enhanced Plus 3 56 553.68 664.42
QCA Health Plan, Inc. Gold Enhanced Plus 3 56 615.2 738.24
QCA Health Plan, Inc. Gold Enhanced Plus 3 57 578.36 694.03
QCA Health Plan, Inc. Gold Enhanced Plus 3 57 642.62 771.15
QCA Health Plan, Inc. Gold Enhanced Plus 3 58 604.7 725.65
QCA Health Plan, Inc. Gold Enhanced Plus 3 58 671.89 806.27
QCA Health Plan, Inc. Gold Enhanced Plus 3 59 617.76 741.31
QCA Health Plan, Inc. Gold Enhanced Plus 3 59 686.4 823.68
QCA Health Plan, Inc. Gold Enhanced Plus 3 60 644.1 772.92
QCA Health Plan, Inc. Gold Enhanced Plus 3 60 715.67 858.8
QCA Health Plan, Inc. Gold Enhanced Plus 3 61 666.88 800.26
QCA Health Plan, Inc. Gold Enhanced Plus 3 61 740.98 889.18
QCA Health Plan, Inc. Gold Enhanced Plus 3 62 681.83 818.2
QCA Health Plan, Inc. Gold Enhanced Plus 3 62 757.59 909.11
QCA Health Plan, Inc. Gold Enhanced Plus 3 63 700.58 840.7
QCA Health Plan, Inc. Gold Enhanced Plus 3 63 778.43 934.11
QCA Health Plan, Inc. Gold Enhanced Plus 3 64 711.98 854.37
QCA Health Plan, Inc. Gold Enhanced Plus 3 64 791.08 949.3
QCA Health Plan, Inc. Gold Enhanced Plus 3 65 and
over
711.98 854.37
QCA Health Plan, Inc. Gold Enhanced Plus 3 65 and
over
791.08 949.3
QCA Health Plan, Inc. Gold Enhanced Plus 4 0‐20 186.05 186.05
QCA Health Plan, Inc. Gold Enhanced Plus 4 21 292.99 351.59
QCA Health Plan, Inc. Gold Enhanced Plus 4 22 292.99 351.59
QCA Health Plan, Inc. Gold Enhanced Plus 4 23 292.99 351.59
QCA Health Plan, Inc. Gold Enhanced Plus 4 24 292.99 351.59
QCA Health Plan, Inc. Gold Enhanced Plus 4 25 294.17 353
QCA Health Plan, Inc. Gold Enhanced Plus 4 26 300.03 360.03
QCA Health Plan, Inc. Gold Enhanced Plus 4 27 307.06 368.47
QCA Health Plan, Inc. Gold Enhanced Plus 4 28 318.48 382.18
QCA Health Plan, Inc. Gold Enhanced Plus 4 29 327.86 393.43
QCA Health Plan, Inc. Gold Enhanced Plus 4 30 332.55 399.06
QCA Health Plan, Inc. Gold Enhanced Plus 4 31 339.58 407.5
Page 211 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Enhanced Plus 4 32 346.61 415.93
QCA Health Plan, Inc. Gold Enhanced Plus 4 33 351.01 421.21
QCA Health Plan, Inc. Gold Enhanced Plus 4 34 355.69 426.83
QCA Health Plan, Inc. Gold Enhanced Plus 4 35 358.04 429.65
QCA Health Plan, Inc. Gold Enhanced Plus 4 36 360.38 432.46
QCA Health Plan, Inc. Gold Enhanced Plus 4 37 362.73 435.27
QCA Health Plan, Inc. Gold Enhanced Plus 4 38 365.07 438.08
QCA Health Plan, Inc. Gold Enhanced Plus 4 39 369.76 443.71
QCA Health Plan, Inc. Gold Enhanced Plus 4 40 374.45 449.34
QCA Health Plan, Inc. Gold Enhanced Plus 4 41 381.48 457.77
QCA Health Plan, Inc. Gold Enhanced Plus 4 42 388.22 465.86
QCA Health Plan, Inc. Gold Enhanced Plus 4 43 397.59 477.11
QCA Health Plan, Inc. Gold Enhanced Plus 4 44 409.31 491.18
QCA Health Plan, Inc. Gold Enhanced Plus 4 45 423.08 507.7
QCA Health Plan, Inc. Gold Enhanced Plus 4 46 439.49 527.39
QCA Health Plan, Inc. Gold Enhanced Plus 4 47 457.95 549.54
QCA Health Plan, Inc. Gold Enhanced Plus 4 48 479.05 574.85
QCA Health Plan, Inc. Gold Enhanced Plus 4 49 499.85 599.82
QCA Health Plan, Inc. Gold Enhanced Plus 4 50 523.29 627.94
QCA Health Plan, Inc. Gold Enhanced Plus 4 51 546.43 655.72
QCA Health Plan, Inc. Gold Enhanced Plus 4 52 571.92 686.31
QCA Health Plan, Inc. Gold Enhanced Plus 4 53 597.71 717.25
QCA Health Plan, Inc. Gold Enhanced Plus 4 54 625.54 750.65
QCA Health Plan, Inc. Gold Enhanced Plus 4 55 653.38 784.05
QCA Health Plan, Inc. Gold Enhanced Plus 4 56 683.55 820.27
QCA Health Plan, Inc. Gold Enhanced Plus 4 57 714.03 856.83
QCA Health Plan, Inc. Gold Enhanced Plus 4 58 746.55 895.86
QCA Health Plan, Inc. Gold Enhanced Plus 4 59 762.66 915.2
QCA Health Plan, Inc. Gold Enhanced Plus 4 60 795.19 954.22
QCA Health Plan, Inc. Gold Enhanced Plus 4 61 823.31 987.98
QCA Health Plan, Inc. Gold Enhanced Plus 4 62 841.77 1010.13
QCA Health Plan, Inc. Gold Enhanced Plus 4 63 864.92 1037.9
QCA Health Plan, Inc. Gold Enhanced Plus 4 64 878.98 1054.78
QCA Health Plan, Inc. Gold Enhanced Plus 4 65 and
over
878.98 1054.78
QCA Health Plan, Inc. Gold Enhanced Plus 7 0‐20 167.45 167.45
QCA Health Plan, Inc. Gold Enhanced Plus 7 21 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 7 22 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 7 23 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 7 24 263.69 316.43
QCA Health Plan, Inc. Gold Enhanced Plus 7 25 264.75 317.7
QCA Health Plan, Inc. Gold Enhanced Plus 7 26 270.02 324.03
QCA Health Plan, Inc. Gold Enhanced Plus 7 27 276.35 331.62
QCA Health Plan, Inc. Gold Enhanced Plus 7 28 286.64 343.96
QCA Health Plan, Inc. Gold Enhanced Plus 7 29 295.07 354.09
QCA Health Plan, Inc. Gold Enhanced Plus 7 30 299.29 359.15
QCA Health Plan, Inc. Gold Enhanced Plus 7 31 305.62 366.75
QCA Health Plan, Inc. Gold Enhanced Plus 7 32 311.95 374.34
QCA Health Plan, Inc. Gold Enhanced Plus 7 33 315.91 379.09
QCA Health Plan, Inc. Gold Enhanced Plus 7 34 320.13 384.15
QCA Health Plan, Inc. Gold Enhanced Plus 7 35 322.23 386.68
QCA Health Plan, Inc. Gold Enhanced Plus 7 36 324.34 389.21
QCA Health Plan, Inc. Gold Enhanced Plus 7 37 326.45 391.74
QCA Health Plan, Inc. Gold Enhanced Plus 7 38 328.56 394.28
QCA Health Plan, Inc. Gold Enhanced Plus 7 39 332.78 399.34
QCA Health Plan, Inc. Gold Enhanced Plus 7 40 337 404.4
QCA Health Plan, Inc. Gold Enhanced Plus 7 41 343.33 412
QCA Health Plan, Inc. Gold Enhanced Plus 7 42 349.4 419.27
QCA Health Plan, Inc. Gold Enhanced Plus 7 43 357.83 429.4
QCA Health Plan, Inc. Gold Enhanced Plus 7 44 368.38 442.06
QCA Health Plan, Inc. Gold Enhanced Plus 7 45 380.77 456.93
QCA Health Plan, Inc. Gold Enhanced Plus 7 46 395.54 474.65
QCA Health Plan, Inc. Gold Enhanced Plus 7 47 412.15 494.59
Page 212 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Enhanced Plus 7 48 431.14 517.37
QCA Health Plan, Inc. Gold Enhanced Plus 7 49 449.86 539.84
QCA Health Plan, Inc. Gold Enhanced Plus 7 50 470.96 565.15
QCA Health Plan, Inc. Gold Enhanced Plus 7 51 491.79 590.15
QCA Health Plan, Inc. Gold Enhanced Plus 7 52 514.73 617.68
QCA Health Plan, Inc. Gold Enhanced Plus 7 53 537.94 645.52
QCA Health Plan, Inc. Gold Enhanced Plus 7 54 562.99 675.59
QCA Health Plan, Inc. Gold Enhanced Plus 7 55 588.04 705.65
QCA Health Plan, Inc. Gold Enhanced Plus 7 56 615.2 738.24
QCA Health Plan, Inc. Gold Enhanced Plus 7 57 642.62 771.15
QCA Health Plan, Inc. Gold Enhanced Plus 7 58 671.89 806.27
QCA Health Plan, Inc. Gold Enhanced Plus 7 59 686.4 823.68
QCA Health Plan, Inc. Gold Enhanced Plus 7 60 715.67 858.8
QCA Health Plan, Inc. Gold Enhanced Plus 7 61 740.98 889.18
QCA Health Plan, Inc. Gold Enhanced Plus 7 62 757.59 909.11
QCA Health Plan, Inc. Gold Enhanced Plus 7 63 778.43 934.11
QCA Health Plan, Inc. Gold Enhanced Plus 7 64 791.08 949.3
QCA Health Plan, Inc. Gold Enhanced Plus 7 65 and
over
791.08 949.3
QCA Health Plan, Inc. Gold Premier Plus 1 0‐20 172.3 172.3
QCA Health Plan, Inc. Gold Premier Plus 1 0‐20 191.44 191.44
QCA Health Plan, Inc. Gold Premier Plus 1 21 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 1 21 301.48 361.78
QCA Health Plan, Inc. Gold Premier Plus 1 22 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 1 22 301.48 361.78
QCA Health Plan, Inc. Gold Premier Plus 1 23 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 1 23 301.48 361.78
QCA Health Plan, Inc. Gold Premier Plus 1 24 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 1 24 301.48 361.78
QCA Health Plan, Inc. Gold Premier Plus 1 25 272.42 326.9
QCA Health Plan, Inc. Gold Premier Plus 1 25 302.69 363.22
QCA Health Plan, Inc. Gold Premier Plus 1 26 277.85 333.41
QCA Health Plan, Inc. Gold Premier Plus 1 26 308.72 370.46
QCA Health Plan, Inc. Gold Premier Plus 1 27 284.36 341.23
QCA Health Plan, Inc. Gold Premier Plus 1 27 315.95 379.14
QCA Health Plan, Inc. Gold Premier Plus 1 28 294.94 353.93
QCA Health Plan, Inc. Gold Premier Plus 1 28 327.71 393.25
QCA Health Plan, Inc. Gold Premier Plus 1 29 303.62 364.35
QCA Health Plan, Inc. Gold Premier Plus 1 29 337.36 404.83
QCA Health Plan, Inc. Gold Premier Plus 1 30 307.96 369.56
QCA Health Plan, Inc. Gold Premier Plus 1 30 342.18 410.62
QCA Health Plan, Inc. Gold Premier Plus 1 31 314.48 377.37
QCA Health Plan, Inc. Gold Premier Plus 1 31 349.42 419.3
QCA Health Plan, Inc. Gold Premier Plus 1 32 320.99 385.18
QCA Health Plan, Inc. Gold Premier Plus 1 32 356.65 427.98
QCA Health Plan, Inc. Gold Premier Plus 1 33 325.06 390.07
QCA Health Plan, Inc. Gold Premier Plus 1 33 361.17 433.41
QCA Health Plan, Inc. Gold Premier Plus 1 34 329.4 395.28
QCA Health Plan, Inc. Gold Premier Plus 1 34 366 439.2
QCA Health Plan, Inc. Gold Premier Plus 1 35 331.57 397.88
QCA Health Plan, Inc. Gold Premier Plus 1 35 368.41 442.09
QCA Health Plan, Inc. Gold Premier Plus 1 36 333.74 400.49
QCA Health Plan, Inc. Gold Premier Plus 1 36 370.82 444.99
QCA Health Plan, Inc. Gold Premier Plus 1 37 335.91 403.09
QCA Health Plan, Inc. Gold Premier Plus 1 37 373.23 447.88
QCA Health Plan, Inc. Gold Premier Plus 1 38 338.08 405.7
QCA Health Plan, Inc. Gold Premier Plus 1 38 375.65 450.77
QCA Health Plan, Inc. Gold Premier Plus 1 39 342.42 410.91
QCA Health Plan, Inc. Gold Premier Plus 1 39 380.47 456.56
QCA Health Plan, Inc. Gold Premier Plus 1 40 346.76 416.12
QCA Health Plan, Inc. Gold Premier Plus 1 40 385.29 462.35
QCA Health Plan, Inc. Gold Premier Plus 1 41 353.28 423.93
QCA Health Plan, Inc. Gold Premier Plus 1 41 392.53 471.03
Page 213 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Premier Plus 1 42 359.52 431.42
QCA Health Plan, Inc. Gold Premier Plus 1 42 399.46 479.36
QCA Health Plan, Inc. Gold Premier Plus 1 43 368.2 441.84
QCA Health Plan, Inc. Gold Premier Plus 1 43 409.11 490.93
QCA Health Plan, Inc. Gold Premier Plus 1 44 379.05 454.86
QCA Health Plan, Inc. Gold Premier Plus 1 44 421.17 505.4
QCA Health Plan, Inc. Gold Premier Plus 1 45 391.8 470.17
QCA Health Plan, Inc. Gold Premier Plus 1 45 435.34 522.41
QCA Health Plan, Inc. Gold Premier Plus 1 46 407 488.4
QCA Health Plan, Inc. Gold Premier Plus 1 46 452.22 542.67
QCA Health Plan, Inc. Gold Premier Plus 1 47 424.09 508.91
QCA Health Plan, Inc. Gold Premier Plus 1 47 471.22 565.46
QCA Health Plan, Inc. Gold Premier Plus 1 48 443.63 532.36
QCA Health Plan, Inc. Gold Premier Plus 1 48 492.92 591.51
QCA Health Plan, Inc. Gold Premier Plus 1 49 462.89 555.47
QCA Health Plan, Inc. Gold Premier Plus 1 49 514.33 617.19
QCA Health Plan, Inc. Gold Premier Plus 1 50 484.6 581.52
QCA Health Plan, Inc. Gold Premier Plus 1 50 538.45 646.13
QCA Health Plan, Inc. Gold Premier Plus 1 51 506.04 607.24
QCA Health Plan, Inc. Gold Premier Plus 1 51 562.26 674.71
QCA Health Plan, Inc. Gold Premier Plus 1 52 529.64 635.57
QCA Health Plan, Inc. Gold Premier Plus 1 52 588.49 706.19
QCA Health Plan, Inc. Gold Premier Plus 1 53 553.52 664.22
QCA Health Plan, Inc. Gold Premier Plus 1 53 615.02 738.03
QCA Health Plan, Inc. Gold Premier Plus 1 54 579.3 695.16
QCA Health Plan, Inc. Gold Premier Plus 1 54 643.66 772.39
QCA Health Plan, Inc. Gold Premier Plus 1 55 605.07 726.09
QCA Health Plan, Inc. Gold Premier Plus 1 55 672.3 806.76
QCA Health Plan, Inc. Gold Premier Plus 1 56 633.02 759.62
QCA Health Plan, Inc. Gold Premier Plus 1 56 703.36 844.03
QCA Health Plan, Inc. Gold Premier Plus 1 57 661.24 793.49
QCA Health Plan, Inc. Gold Premier Plus 1 57 734.71 881.65
QCA Health Plan, Inc. Gold Premier Plus 1 58 691.36 829.63
QCA Health Plan, Inc. Gold Premier Plus 1 58 768.17 921.81
QCA Health Plan, Inc. Gold Premier Plus 1 59 706.28 847.54
QCA Health Plan, Inc. Gold Premier Plus 1 59 784.76 941.71
QCA Health Plan, Inc. Gold Premier Plus 1 60 736.4 883.68
QCA Health Plan, Inc. Gold Premier Plus 1 60 818.22 981.86
QCA Health Plan, Inc. Gold Premier Plus 1 61 762.45 914.94
QCA Health Plan, Inc. Gold Premier Plus 1 61 847.16 1016.59
QCA Health Plan, Inc. Gold Premier Plus 1 62 779.54 935.45
QCA Health Plan, Inc. Gold Premier Plus 1 62 866.16 1039.39
QCA Health Plan, Inc. Gold Premier Plus 1 63 800.98 961.17
QCA Health Plan, Inc. Gold Premier Plus 1 63 889.97 1067.97
QCA Health Plan, Inc. Gold Premier Plus 1 64 814 976.8
QCA Health Plan, Inc. Gold Premier Plus 1 64 904.44 1085.33
QCA Health Plan, Inc. Gold Premier Plus 1 65 and
over
814 976.8
QCA Health Plan, Inc. Gold Premier Plus 1 65 and
over
904.44 1085.33
QCA Health Plan, Inc. Gold Premier Plus 2 0‐20 210.58 210.58
QCA Health Plan, Inc. Gold Premier Plus 2 21 331.63 397.96
QCA Health Plan, Inc. Gold Premier Plus 2 22 331.63 397.96
QCA Health Plan, Inc. Gold Premier Plus 2 23 331.63 397.96
QCA Health Plan, Inc. Gold Premier Plus 2 24 331.63 397.96
QCA Health Plan, Inc. Gold Premier Plus 2 25 332.96 399.55
QCA Health Plan, Inc. Gold Premier Plus 2 26 339.59 407.51
QCA Health Plan, Inc. Gold Premier Plus 2 27 347.55 417.06
QCA Health Plan, Inc. Gold Premier Plus 2 28 360.48 432.58
QCA Health Plan, Inc. Gold Premier Plus 2 29 371.09 445.31
QCA Health Plan, Inc. Gold Premier Plus 2 30 376.4 451.68
QCA Health Plan, Inc. Gold Premier Plus 2 31 384.36 461.23
QCA Health Plan, Inc. Gold Premier Plus 2 32 392.32 470.78
Page 214 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Premier Plus 2 33 397.29 476.75
QCA Health Plan, Inc. Gold Premier Plus 2 34 402.6 483.12
QCA Health Plan, Inc. Gold Premier Plus 2 35 405.25 486.3
QCA Health Plan, Inc. Gold Premier Plus 2 36 407.9 489.48
QCA Health Plan, Inc. Gold Premier Plus 2 37 410.56 492.67
QCA Health Plan, Inc. Gold Premier Plus 2 38 413.21 495.85
QCA Health Plan, Inc. Gold Premier Plus 2 39 418.52 502.22
QCA Health Plan, Inc. Gold Premier Plus 2 40 423.82 508.59
QCA Health Plan, Inc. Gold Premier Plus 2 41 431.78 518.14
QCA Health Plan, Inc. Gold Premier Plus 2 42 439.41 527.29
QCA Health Plan, Inc. Gold Premier Plus 2 43 450.02 540.03
QCA Health Plan, Inc. Gold Premier Plus 2 44 463.29 555.94
QCA Health Plan, Inc. Gold Premier Plus 2 45 478.87 574.65
QCA Health Plan, Inc. Gold Premier Plus 2 46 497.44 596.93
QCA Health Plan, Inc. Gold Premier Plus 2 47 518.34 622
QCA Health Plan, Inc. Gold Premier Plus 2 48 542.21 650.66
QCA Health Plan, Inc. Gold Premier Plus 2 49 565.76 678.91
QCA Health Plan, Inc. Gold Premier Plus 2 50 592.29 710.75
QCA Health Plan, Inc. Gold Premier Plus 2 51 618.49 742.19
QCA Health Plan, Inc. Gold Premier Plus 2 52 647.34 776.81
QCA Health Plan, Inc. Gold Premier Plus 2 53 676.52 811.83
QCA Health Plan, Inc. Gold Premier Plus 2 54 708.03 849.63
QCA Health Plan, Inc. Gold Premier Plus 2 55 739.53 887.44
QCA Health Plan, Inc. Gold Premier Plus 2 56 773.69 928.43
QCA Health Plan, Inc. Gold Premier Plus 2 57 808.18 969.82
QCA Health Plan, Inc. Gold Premier Plus 2 58 844.99 1013.99
QCA Health Plan, Inc. Gold Premier Plus 2 59 863.23 1035.88
QCA Health Plan, Inc. Gold Premier Plus 2 60 900.04 1080.05
QCA Health Plan, Inc. Gold Premier Plus 2 61 931.88 1118.25
QCA Health Plan, Inc. Gold Premier Plus 2 62 952.77 1143.33
QCA Health Plan, Inc. Gold Premier Plus 2 63 978.97 1174.76
QCA Health Plan, Inc. Gold Premier Plus 2 64 994.89 1193.87
QCA Health Plan, Inc. Gold Premier Plus 2 65 and
over
994.89 1193.87
QCA Health Plan, Inc. Gold Premier Plus 3 0‐20 155.07 155.07
QCA Health Plan, Inc. Gold Premier Plus 3 0‐20 172.3 172.3
QCA Health Plan, Inc. Gold Premier Plus 3 21 244.2 293.04
QCA Health Plan, Inc. Gold Premier Plus 3 21 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 3 22 244.2 293.04
QCA Health Plan, Inc. Gold Premier Plus 3 22 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 3 23 244.2 293.04
QCA Health Plan, Inc. Gold Premier Plus 3 23 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 3 24 244.2 293.04
QCA Health Plan, Inc. Gold Premier Plus 3 24 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 3 25 245.18 294.21
QCA Health Plan, Inc. Gold Premier Plus 3 25 272.42 326.9
QCA Health Plan, Inc. Gold Premier Plus 3 26 250.06 300.07
QCA Health Plan, Inc. Gold Premier Plus 3 26 277.85 333.41
QCA Health Plan, Inc. Gold Premier Plus 3 27 255.92 307.11
QCA Health Plan, Inc. Gold Premier Plus 3 27 284.36 341.23
QCA Health Plan, Inc. Gold Premier Plus 3 28 265.45 318.53
QCA Health Plan, Inc. Gold Premier Plus 3 28 294.94 353.93
QCA Health Plan, Inc. Gold Premier Plus 3 29 273.26 327.91
QCA Health Plan, Inc. Gold Premier Plus 3 29 303.62 364.35
QCA Health Plan, Inc. Gold Premier Plus 3 30 277.17 332.6
QCA Health Plan, Inc. Gold Premier Plus 3 30 307.96 369.56
QCA Health Plan, Inc. Gold Premier Plus 3 31 283.03 339.63
QCA Health Plan, Inc. Gold Premier Plus 3 31 314.48 377.37
QCA Health Plan, Inc. Gold Premier Plus 3 32 288.89 346.67
QCA Health Plan, Inc. Gold Premier Plus 3 32 320.99 385.18
QCA Health Plan, Inc. Gold Premier Plus 3 33 292.55 351.06
QCA Health Plan, Inc. Gold Premier Plus 3 33 325.06 390.07
QCA Health Plan, Inc. Gold Premier Plus 3 34 296.46 355.75
Page 215 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Premier Plus 3 34 329.4 395.28
QCA Health Plan, Inc. Gold Premier Plus 3 35 298.41 358.09
QCA Health Plan, Inc. Gold Premier Plus 3 35 331.57 397.88
QCA Health Plan, Inc. Gold Premier Plus 3 36 300.37 360.44
QCA Health Plan, Inc. Gold Premier Plus 3 36 333.74 400.49
QCA Health Plan, Inc. Gold Premier Plus 3 37 302.32 362.78
QCA Health Plan, Inc. Gold Premier Plus 3 37 335.91 403.09
QCA Health Plan, Inc. Gold Premier Plus 3 38 304.27 365.13
QCA Health Plan, Inc. Gold Premier Plus 3 38 338.08 405.7
QCA Health Plan, Inc. Gold Premier Plus 3 39 308.18 369.82
QCA Health Plan, Inc. Gold Premier Plus 3 39 342.42 410.91
QCA Health Plan, Inc. Gold Premier Plus 3 40 312.09 374.5
QCA Health Plan, Inc. Gold Premier Plus 3 40 346.76 416.12
QCA Health Plan, Inc. Gold Premier Plus 3 41 317.95 381.54
QCA Health Plan, Inc. Gold Premier Plus 3 41 353.28 423.93
QCA Health Plan, Inc. Gold Premier Plus 3 42 323.56 388.28
QCA Health Plan, Inc. Gold Premier Plus 3 42 359.52 431.42
QCA Health Plan, Inc. Gold Premier Plus 3 43 331.38 397.65
QCA Health Plan, Inc. Gold Premier Plus 3 43 368.2 441.84
QCA Health Plan, Inc. Gold Premier Plus 3 44 341.15 409.38
QCA Health Plan, Inc. Gold Premier Plus 3 44 379.05 454.86
QCA Health Plan, Inc. Gold Premier Plus 3 45 352.62 423.15
QCA Health Plan, Inc. Gold Premier Plus 3 45 391.8 470.17
QCA Health Plan, Inc. Gold Premier Plus 3 46 366.3 439.56
QCA Health Plan, Inc. Gold Premier Plus 3 46 407 488.4
QCA Health Plan, Inc. Gold Premier Plus 3 47 381.68 458.02
QCA Health Plan, Inc. Gold Premier Plus 3 47 424.09 508.91
QCA Health Plan, Inc. Gold Premier Plus 3 48 399.27 479.12
QCA Health Plan, Inc. Gold Premier Plus 3 48 443.63 532.36
QCA Health Plan, Inc. Gold Premier Plus 3 49 416.6 499.93
QCA Health Plan, Inc. Gold Premier Plus 3 49 462.89 555.47
QCA Health Plan, Inc. Gold Premier Plus 3 50 436.14 523.37
QCA Health Plan, Inc. Gold Premier Plus 3 50 484.6 581.52
QCA Health Plan, Inc. Gold Premier Plus 3 51 455.43 546.52
QCA Health Plan, Inc. Gold Premier Plus 3 51 506.04 607.24
QCA Health Plan, Inc. Gold Premier Plus 3 52 476.68 572.01
QCA Health Plan, Inc. Gold Premier Plus 3 52 529.64 635.57
QCA Health Plan, Inc. Gold Premier Plus 3 53 498.17 597.8
QCA Health Plan, Inc. Gold Premier Plus 3 53 553.52 664.22
QCA Health Plan, Inc. Gold Premier Plus 3 54 521.37 625.64
QCA Health Plan, Inc. Gold Premier Plus 3 54 579.3 695.16
QCA Health Plan, Inc. Gold Premier Plus 3 55 544.57 653.48
QCA Health Plan, Inc. Gold Premier Plus 3 55 605.07 726.09
QCA Health Plan, Inc. Gold Premier Plus 3 56 569.72 683.66
QCA Health Plan, Inc. Gold Premier Plus 3 56 633.02 759.62
QCA Health Plan, Inc. Gold Premier Plus 3 57 595.11 714.14
QCA Health Plan, Inc. Gold Premier Plus 3 57 661.24 793.49
QCA Health Plan, Inc. Gold Premier Plus 3 58 622.22 746.67
QCA Health Plan, Inc. Gold Premier Plus 3 58 691.36 829.63
QCA Health Plan, Inc. Gold Premier Plus 3 59 635.65 762.78
QCA Health Plan, Inc. Gold Premier Plus 3 59 706.28 847.54
QCA Health Plan, Inc. Gold Premier Plus 3 60 662.76 795.31
QCA Health Plan, Inc. Gold Premier Plus 3 60 736.4 883.68
QCA Health Plan, Inc. Gold Premier Plus 3 61 686.2 823.44
QCA Health Plan, Inc. Gold Premier Plus 3 61 762.45 914.94
QCA Health Plan, Inc. Gold Premier Plus 3 62 701.59 841.9
QCA Health Plan, Inc. Gold Premier Plus 3 62 779.54 935.45
QCA Health Plan, Inc. Gold Premier Plus 3 63 720.88 865.05
QCA Health Plan, Inc. Gold Premier Plus 3 63 800.98 961.17
QCA Health Plan, Inc. Gold Premier Plus 3 64 732.6 879.12
QCA Health Plan, Inc. Gold Premier Plus 3 64 814 976.8
QCA Health Plan, Inc. Gold Premier Plus 3 65 and
over
732.6 879.12
Page 216 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Premier Plus 3 65 and
over
814 976.8
QCA Health Plan, Inc. Gold Premier Plus 4 0‐20 191.44 191.44
QCA Health Plan, Inc. Gold Premier Plus 4 21 301.48 361.78
QCA Health Plan, Inc. Gold Premier Plus 4 22 301.48 361.78
QCA Health Plan, Inc. Gold Premier Plus 4 23 301.48 361.78
QCA Health Plan, Inc. Gold Premier Plus 4 24 301.48 361.78
QCA Health Plan, Inc. Gold Premier Plus 4 25 302.69 363.22
QCA Health Plan, Inc. Gold Premier Plus 4 26 308.72 370.46
QCA Health Plan, Inc. Gold Premier Plus 4 27 315.95 379.14
QCA Health Plan, Inc. Gold Premier Plus 4 28 327.71 393.25
QCA Health Plan, Inc. Gold Premier Plus 4 29 337.36 404.83
QCA Health Plan, Inc. Gold Premier Plus 4 30 342.18 410.62
QCA Health Plan, Inc. Gold Premier Plus 4 31 349.42 419.3
QCA Health Plan, Inc. Gold Premier Plus 4 32 356.65 427.98
QCA Health Plan, Inc. Gold Premier Plus 4 33 361.17 433.41
QCA Health Plan, Inc. Gold Premier Plus 4 34 366 439.2
QCA Health Plan, Inc. Gold Premier Plus 4 35 368.41 442.09
QCA Health Plan, Inc. Gold Premier Plus 4 36 370.82 444.99
QCA Health Plan, Inc. Gold Premier Plus 4 37 373.23 447.88
QCA Health Plan, Inc. Gold Premier Plus 4 38 375.65 450.77
QCA Health Plan, Inc. Gold Premier Plus 4 39 380.47 456.56
QCA Health Plan, Inc. Gold Premier Plus 4 40 385.29 462.35
QCA Health Plan, Inc. Gold Premier Plus 4 41 392.53 471.03
QCA Health Plan, Inc. Gold Premier Plus 4 42 399.46 479.36
QCA Health Plan, Inc. Gold Premier Plus 4 43 409.11 490.93
QCA Health Plan, Inc. Gold Premier Plus 4 44 421.17 505.4
QCA Health Plan, Inc. Gold Premier Plus 4 45 435.34 522.41
QCA Health Plan, Inc. Gold Premier Plus 4 46 452.22 542.67
QCA Health Plan, Inc. Gold Premier Plus 4 47 471.22 565.46
QCA Health Plan, Inc. Gold Premier Plus 4 48 492.92 591.51
QCA Health Plan, Inc. Gold Premier Plus 4 49 514.33 617.19
QCA Health Plan, Inc. Gold Premier Plus 4 50 538.45 646.13
QCA Health Plan, Inc. Gold Premier Plus 4 51 562.26 674.71
QCA Health Plan, Inc. Gold Premier Plus 4 52 588.49 706.19
QCA Health Plan, Inc. Gold Premier Plus 4 53 615.02 738.03
QCA Health Plan, Inc. Gold Premier Plus 4 54 643.66 772.39
QCA Health Plan, Inc. Gold Premier Plus 4 55 672.3 806.76
QCA Health Plan, Inc. Gold Premier Plus 4 56 703.36 844.03
QCA Health Plan, Inc. Gold Premier Plus 4 57 734.71 881.65
QCA Health Plan, Inc. Gold Premier Plus 4 58 768.17 921.81
QCA Health Plan, Inc. Gold Premier Plus 4 59 784.76 941.71
QCA Health Plan, Inc. Gold Premier Plus 4 60 818.22 981.86
QCA Health Plan, Inc. Gold Premier Plus 4 61 847.16 1016.59
QCA Health Plan, Inc. Gold Premier Plus 4 62 866.16 1039.39
QCA Health Plan, Inc. Gold Premier Plus 4 63 889.97 1067.97
QCA Health Plan, Inc. Gold Premier Plus 4 64 904.44 1085.33
QCA Health Plan, Inc. Gold Premier Plus 4 65 and
over
904.44 1085.33
QCA Health Plan, Inc. Gold Premier Plus 7 0‐20 172.3 172.3
QCA Health Plan, Inc. Gold Premier Plus 7 21 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 7 22 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 7 23 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 7 24 271.33 325.6
QCA Health Plan, Inc. Gold Premier Plus 7 25 272.42 326.9
QCA Health Plan, Inc. Gold Premier Plus 7 26 277.85 333.41
QCA Health Plan, Inc. Gold Premier Plus 7 27 284.36 341.23
QCA Health Plan, Inc. Gold Premier Plus 7 28 294.94 353.93
QCA Health Plan, Inc. Gold Premier Plus 7 29 303.62 364.35
QCA Health Plan, Inc. Gold Premier Plus 7 30 307.96 369.56
QCA Health Plan, Inc. Gold Premier Plus 7 31 314.48 377.37
QCA Health Plan, Inc. Gold Premier Plus 7 32 320.99 385.18
QCA Health Plan, Inc. Gold Premier Plus 7 33 325.06 390.07
Page 217 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Gold Premier Plus 7 34 329.4 395.28
QCA Health Plan, Inc. Gold Premier Plus 7 35 331.57 397.88
QCA Health Plan, Inc. Gold Premier Plus 7 36 333.74 400.49
QCA Health Plan, Inc. Gold Premier Plus 7 37 335.91 403.09
QCA Health Plan, Inc. Gold Premier Plus 7 38 338.08 405.7
QCA Health Plan, Inc. Gold Premier Plus 7 39 342.42 410.91
QCA Health Plan, Inc. Gold Premier Plus 7 40 346.76 416.12
QCA Health Plan, Inc. Gold Premier Plus 7 41 353.28 423.93
QCA Health Plan, Inc. Gold Premier Plus 7 42 359.52 431.42
QCA Health Plan, Inc. Gold Premier Plus 7 43 368.2 441.84
QCA Health Plan, Inc. Gold Premier Plus 7 44 379.05 454.86
QCA Health Plan, Inc. Gold Premier Plus 7 45 391.8 470.17
QCA Health Plan, Inc. Gold Premier Plus 7 46 407 488.4
QCA Health Plan, Inc. Gold Premier Plus 7 47 424.09 508.91
QCA Health Plan, Inc. Gold Premier Plus 7 48 443.63 532.36
QCA Health Plan, Inc. Gold Premier Plus 7 49 462.89 555.47
QCA Health Plan, Inc. Gold Premier Plus 7 50 484.6 581.52
QCA Health Plan, Inc. Gold Premier Plus 7 51 506.04 607.24
QCA Health Plan, Inc. Gold Premier Plus 7 52 529.64 635.57
QCA Health Plan, Inc. Gold Premier Plus 7 53 553.52 664.22
QCA Health Plan, Inc. Gold Premier Plus 7 54 579.3 695.16
QCA Health Plan, Inc. Gold Premier Plus 7 55 605.07 726.09
QCA Health Plan, Inc. Gold Premier Plus 7 56 633.02 759.62
QCA Health Plan, Inc. Gold Premier Plus 7 57 661.24 793.49
QCA Health Plan, Inc. Gold Premier Plus 7 58 691.36 829.63
QCA Health Plan, Inc. Gold Premier Plus 7 59 706.28 847.54
QCA Health Plan, Inc. Gold Premier Plus 7 60 736.4 883.68
QCA Health Plan, Inc. Gold Premier Plus 7 61 762.45 914.94
QCA Health Plan, Inc. Gold Premier Plus 7 62 779.54 935.45
QCA Health Plan, Inc. Gold Premier Plus 7 63 800.98 961.17
QCA Health Plan, Inc. Gold Premier Plus 7 64 814 976.8
QCA Health Plan, Inc. Gold Premier Plus 7 65 and
over
814 976.8
QCA Health Plan, Inc. Silver Basic Plus 1 0‐20 160.06 160.06
QCA Health Plan, Inc. Silver Basic Plus 1 0‐20 177.85 177.85
QCA Health Plan, Inc. Silver Basic Plus 1 21 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 1 21 280.08 336.09
QCA Health Plan, Inc. Silver Basic Plus 1 22 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 1 22 280.08 336.09
QCA Health Plan, Inc. Silver Basic Plus 1 23 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 1 23 280.08 336.09
QCA Health Plan, Inc. Silver Basic Plus 1 24 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 1 24 280.08 336.09
QCA Health Plan, Inc. Silver Basic Plus 1 25 253.08 303.69
QCA Health Plan, Inc. Silver Basic Plus 1 25 281.2 337.44
QCA Health Plan, Inc. Silver Basic Plus 1 26 258.12 309.74
QCA Health Plan, Inc. Silver Basic Plus 1 26 286.8 344.16
QCA Health Plan, Inc. Silver Basic Plus 1 27 264.17 317
QCA Health Plan, Inc. Silver Basic Plus 1 27 293.52 352.23
QCA Health Plan, Inc. Silver Basic Plus 1 28 274 328.8
QCA Health Plan, Inc. Silver Basic Plus 1 28 304.45 365.33
QCA Health Plan, Inc. Silver Basic Plus 1 29 282.07 338.48
QCA Health Plan, Inc. Silver Basic Plus 1 29 313.41 376.09
QCA Health Plan, Inc. Silver Basic Plus 1 30 286.1 343.32
QCA Health Plan, Inc. Silver Basic Plus 1 30 317.89 381.47
QCA Health Plan, Inc. Silver Basic Plus 1 31 292.15 350.58
QCA Health Plan, Inc. Silver Basic Plus 1 31 324.61 389.53
QCA Health Plan, Inc. Silver Basic Plus 1 32 298.2 357.84
QCA Health Plan, Inc. Silver Basic Plus 1 32 331.33 397.6
QCA Health Plan, Inc. Silver Basic Plus 1 33 301.98 362.38
QCA Health Plan, Inc. Silver Basic Plus 1 33 335.53 402.64
QCA Health Plan, Inc. Silver Basic Plus 1 34 306.01 367.22
QCA Health Plan, Inc. Silver Basic Plus 1 34 340.02 408.02
Page 218 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Silver Basic Plus 1 35 308.03 369.64
QCA Health Plan, Inc. Silver Basic Plus 1 35 342.26 410.71
QCA Health Plan, Inc. Silver Basic Plus 1 36 310.05 372.06
QCA Health Plan, Inc. Silver Basic Plus 1 36 344.5 413.4
QCA Health Plan, Inc. Silver Basic Plus 1 37 312.06 374.48
QCA Health Plan, Inc. Silver Basic Plus 1 37 346.74 416.08
QCA Health Plan, Inc. Silver Basic Plus 1 38 314.08 376.9
QCA Health Plan, Inc. Silver Basic Plus 1 38 348.98 418.77
QCA Health Plan, Inc. Silver Basic Plus 1 39 318.11 381.74
QCA Health Plan, Inc. Silver Basic Plus 1 39 353.46 424.15
QCA Health Plan, Inc. Silver Basic Plus 1 40 322.15 386.58
QCA Health Plan, Inc. Silver Basic Plus 1 40 357.94 429.53
QCA Health Plan, Inc. Silver Basic Plus 1 41 328.2 393.84
QCA Health Plan, Inc. Silver Basic Plus 1 41 364.66 437.59
QCA Health Plan, Inc. Silver Basic Plus 1 42 333.99 400.79
QCA Health Plan, Inc. Silver Basic Plus 1 42 371.1 445.32
QCA Health Plan, Inc. Silver Basic Plus 1 43 342.06 410.47
QCA Health Plan, Inc. Silver Basic Plus 1 43 380.07 456.08
QCA Health Plan, Inc. Silver Basic Plus 1 44 352.14 422.57
QCA Health Plan, Inc. Silver Basic Plus 1 44 391.27 469.52
QCA Health Plan, Inc. Silver Basic Plus 1 45 363.99 436.79
QCA Health Plan, Inc. Silver Basic Plus 1 45 404.43 485.32
QCA Health Plan, Inc. Silver Basic Plus 1 46 378.11 453.73
QCA Health Plan, Inc. Silver Basic Plus 1 46 420.12 504.14
QCA Health Plan, Inc. Silver Basic Plus 1 47 393.99 472.78
QCA Health Plan, Inc. Silver Basic Plus 1 47 437.76 525.32
QCA Health Plan, Inc. Silver Basic Plus 1 48 412.14 494.56
QCA Health Plan, Inc. Silver Basic Plus 1 48 457.93 549.51
QCA Health Plan, Inc. Silver Basic Plus 1 49 430.03 516.04
QCA Health Plan, Inc. Silver Basic Plus 1 49 477.81 573.38
QCA Health Plan, Inc. Silver Basic Plus 1 50 450.2 540.24
QCA Health Plan, Inc. Silver Basic Plus 1 50 500.22 600.26
QCA Health Plan, Inc. Silver Basic Plus 1 51 470.11 564.13
QCA Health Plan, Inc. Silver Basic Plus 1 51 522.35 626.82
QCA Health Plan, Inc. Silver Basic Plus 1 52 492.04 590.45
QCA Health Plan, Inc. Silver Basic Plus 1 52 546.71 656.06
QCA Health Plan, Inc. Silver Basic Plus 1 53 514.22 617.07
QCA Health Plan, Inc. Silver Basic Plus 1 53 571.36 685.63
QCA Health Plan, Inc. Silver Basic Plus 1 54 538.17 645.81
QCA Health Plan, Inc. Silver Basic Plus 1 54 597.97 717.56
QCA Health Plan, Inc. Silver Basic Plus 1 55 562.12 674.54
QCA Health Plan, Inc. Silver Basic Plus 1 55 624.58 749.49
QCA Health Plan, Inc. Silver Basic Plus 1 56 588.08 705.7
QCA Health Plan, Inc. Silver Basic Plus 1 56 653.42 784.11
QCA Health Plan, Inc. Silver Basic Plus 1 57 614.3 737.16
QCA Health Plan, Inc. Silver Basic Plus 1 57 682.55 819.06
QCA Health Plan, Inc. Silver Basic Plus 1 58 642.28 770.73
QCA Health Plan, Inc. Silver Basic Plus 1 58 713.64 856.37
QCA Health Plan, Inc. Silver Basic Plus 1 59 656.14 787.37
QCA Health Plan, Inc. Silver Basic Plus 1 59 729.04 874.85
QCA Health Plan, Inc. Silver Basic Plus 1 60 684.12 820.94
QCA Health Plan, Inc. Silver Basic Plus 1 60 760.13 912.16
QCA Health Plan, Inc. Silver Basic Plus 1 61 708.32 849.98
QCA Health Plan, Inc. Silver Basic Plus 1 61 787.02 944.43
QCA Health Plan, Inc. Silver Basic Plus 1 62 724.2 869.04
QCA Health Plan, Inc. Silver Basic Plus 1 62 804.67 965.6
QCA Health Plan, Inc. Silver Basic Plus 1 63 744.11 892.94
QCA Health Plan, Inc. Silver Basic Plus 1 63 826.79 992.15
QCA Health Plan, Inc. Silver Basic Plus 1 64 756.21 907.45
QCA Health Plan, Inc. Silver Basic Plus 1 64 840.24 1008.28
QCA Health Plan, Inc. Silver Basic Plus 1 65 and
over
756.21 907.45
Page 219 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Silver Basic Plus 1 65 and
over
840.24 1008.28
QCA Health Plan, Inc. Silver Basic Plus 2 0‐20 195.63 195.63
QCA Health Plan, Inc. Silver Basic Plus 2 21 308.09 369.7
QCA Health Plan, Inc. Silver Basic Plus 2 22 308.09 369.7
QCA Health Plan, Inc. Silver Basic Plus 2 23 308.09 369.7
QCA Health Plan, Inc. Silver Basic Plus 2 24 308.09 369.7
QCA Health Plan, Inc. Silver Basic Plus 2 25 309.32 371.18
QCA Health Plan, Inc. Silver Basic Plus 2 26 315.48 378.58
QCA Health Plan, Inc. Silver Basic Plus 2 27 322.87 387.45
QCA Health Plan, Inc. Silver Basic Plus 2 28 334.89 401.87
QCA Health Plan, Inc. Silver Basic Plus 2 29 344.75 413.7
QCA Health Plan, Inc. Silver Basic Plus 2 30 349.68 419.61
QCA Health Plan, Inc. Silver Basic Plus 2 31 357.07 428.49
QCA Health Plan, Inc. Silver Basic Plus 2 32 364.47 437.36
QCA Health Plan, Inc. Silver Basic Plus 2 33 369.09 442.91
QCA Health Plan, Inc. Silver Basic Plus 2 34 374.02 448.82
QCA Health Plan, Inc. Silver Basic Plus 2 35 376.48 451.78
QCA Health Plan, Inc. Silver Basic Plus 2 36 378.95 454.74
QCA Health Plan, Inc. Silver Basic Plus 2 37 381.41 457.69
QCA Health Plan, Inc. Silver Basic Plus 2 38 383.88 460.65
QCA Health Plan, Inc. Silver Basic Plus 2 39 388.81 466.57
QCA Health Plan, Inc. Silver Basic Plus 2 40 393.73 472.48
QCA Health Plan, Inc. Silver Basic Plus 2 41 401.13 481.35
QCA Health Plan, Inc. Silver Basic Plus 2 42 408.21 489.86
QCA Health Plan, Inc. Silver Basic Plus 2 43 418.07 501.69
QCA Health Plan, Inc. Silver Basic Plus 2 44 430.4 516.48
QCA Health Plan, Inc. Silver Basic Plus 2 45 444.88 533.85
QCA Health Plan, Inc. Silver Basic Plus 2 46 462.13 554.56
QCA Health Plan, Inc. Silver Basic Plus 2 47 481.54 577.85
QCA Health Plan, Inc. Silver Basic Plus 2 48 503.72 604.47
QCA Health Plan, Inc. Silver Basic Plus 2 49 525.6 630.71
QCA Health Plan, Inc. Silver Basic Plus 2 50 550.24 660.29
QCA Health Plan, Inc. Silver Basic Plus 2 51 574.58 689.5
QCA Health Plan, Inc. Silver Basic Plus 2 52 601.38 721.66
QCA Health Plan, Inc. Silver Basic Plus 2 53 628.5 754.2
QCA Health Plan, Inc. Silver Basic Plus 2 54 657.76 789.32
QCA Health Plan, Inc. Silver Basic Plus 2 55 687.03 824.44
QCA Health Plan, Inc. Silver Basic Plus 2 56 718.77 862.52
QCA Health Plan, Inc. Silver Basic Plus 2 57 750.81 900.97
QCA Health Plan, Inc. Silver Basic Plus 2 58 785 942.01
QCA Health Plan, Inc. Silver Basic Plus 2 59 801.95 962.34
QCA Health Plan, Inc. Silver Basic Plus 2 60 836.15 1003.38
QCA Health Plan, Inc. Silver Basic Plus 2 61 865.72 1038.87
QCA Health Plan, Inc. Silver Basic Plus 2 62 885.13 1062.16
QCA Health Plan, Inc. Silver Basic Plus 2 63 909.47 1091.37
QCA Health Plan, Inc. Silver Basic Plus 2 64 924.26 1109.11
QCA Health Plan, Inc. Silver Basic Plus 2 65 and
over
924.26 1109.11
QCA Health Plan, Inc. Silver Basic Plus 3 0‐20 144.06 144.06
QCA Health Plan, Inc. Silver Basic Plus 3 0‐20 160.06 160.06
QCA Health Plan, Inc. Silver Basic Plus 3 21 226.86 272.24
QCA Health Plan, Inc. Silver Basic Plus 3 21 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 3 22 226.86 272.24
QCA Health Plan, Inc. Silver Basic Plus 3 22 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 3 23 226.86 272.24
QCA Health Plan, Inc. Silver Basic Plus 3 23 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 3 24 226.86 272.24
QCA Health Plan, Inc. Silver Basic Plus 3 24 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 3 25 227.77 273.33
QCA Health Plan, Inc. Silver Basic Plus 3 25 253.08 303.69
QCA Health Plan, Inc. Silver Basic Plus 3 26 232.31 278.77
QCA Health Plan, Inc. Silver Basic Plus 3 26 258.12 309.74
Page 220 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Silver Basic Plus 3 27 237.75 285.3
QCA Health Plan, Inc. Silver Basic Plus 3 27 264.17 317
QCA Health Plan, Inc. Silver Basic Plus 3 28 246.6 295.92
QCA Health Plan, Inc. Silver Basic Plus 3 28 274 328.8
QCA Health Plan, Inc. Silver Basic Plus 3 29 253.86 304.63
QCA Health Plan, Inc. Silver Basic Plus 3 29 282.07 338.48
QCA Health Plan, Inc. Silver Basic Plus 3 30 257.49 308.99
QCA Health Plan, Inc. Silver Basic Plus 3 30 286.1 343.32
QCA Health Plan, Inc. Silver Basic Plus 3 31 262.93 315.52
QCA Health Plan, Inc. Silver Basic Plus 3 31 292.15 350.58
QCA Health Plan, Inc. Silver Basic Plus 3 32 268.38 322.06
QCA Health Plan, Inc. Silver Basic Plus 3 32 298.2 357.84
QCA Health Plan, Inc. Silver Basic Plus 3 33 271.78 326.14
QCA Health Plan, Inc. Silver Basic Plus 3 33 301.98 362.38
QCA Health Plan, Inc. Silver Basic Plus 3 34 275.41 330.49
QCA Health Plan, Inc. Silver Basic Plus 3 34 306.01 367.22
QCA Health Plan, Inc. Silver Basic Plus 3 35 277.23 332.67
QCA Health Plan, Inc. Silver Basic Plus 3 35 308.03 369.64
QCA Health Plan, Inc. Silver Basic Plus 3 36 279.04 334.85
QCA Health Plan, Inc. Silver Basic Plus 3 36 310.05 372.06
QCA Health Plan, Inc. Silver Basic Plus 3 37 280.86 337.03
QCA Health Plan, Inc. Silver Basic Plus 3 37 312.06 374.48
QCA Health Plan, Inc. Silver Basic Plus 3 38 282.67 339.21
QCA Health Plan, Inc. Silver Basic Plus 3 38 314.08 376.9
QCA Health Plan, Inc. Silver Basic Plus 3 39 286.3 343.56
QCA Health Plan, Inc. Silver Basic Plus 3 39 318.11 381.74
QCA Health Plan, Inc. Silver Basic Plus 3 40 289.93 347.92
QCA Health Plan, Inc. Silver Basic Plus 3 40 322.15 386.58
QCA Health Plan, Inc. Silver Basic Plus 3 41 295.38 354.45
QCA Health Plan, Inc. Silver Basic Plus 3 41 328.2 393.84
QCA Health Plan, Inc. Silver Basic Plus 3 42 300.59 360.71
QCA Health Plan, Inc. Silver Basic Plus 3 42 333.99 400.79
QCA Health Plan, Inc. Silver Basic Plus 3 43 307.85 369.42
QCA Health Plan, Inc. Silver Basic Plus 3 43 342.06 410.47
QCA Health Plan, Inc. Silver Basic Plus 3 44 316.93 380.31
QCA Health Plan, Inc. Silver Basic Plus 3 44 352.14 422.57
QCA Health Plan, Inc. Silver Basic Plus 3 45 327.59 393.11
QCA Health Plan, Inc. Silver Basic Plus 3 45 363.99 436.79
QCA Health Plan, Inc. Silver Basic Plus 3 46 340.3 408.35
QCA Health Plan, Inc. Silver Basic Plus 3 46 378.11 453.73
QCA Health Plan, Inc. Silver Basic Plus 3 47 354.59 425.51
QCA Health Plan, Inc. Silver Basic Plus 3 47 393.99 472.78
QCA Health Plan, Inc. Silver Basic Plus 3 48 370.92 445.11
QCA Health Plan, Inc. Silver Basic Plus 3 48 412.14 494.56
QCA Health Plan, Inc. Silver Basic Plus 3 49 387.03 464.44
QCA Health Plan, Inc. Silver Basic Plus 3 49 430.03 516.04
QCA Health Plan, Inc. Silver Basic Plus 3 50 405.18 486.21
QCA Health Plan, Inc. Silver Basic Plus 3 50 450.2 540.24
QCA Health Plan, Inc. Silver Basic Plus 3 51 423.1 507.72
QCA Health Plan, Inc. Silver Basic Plus 3 51 470.11 564.13
QCA Health Plan, Inc. Silver Basic Plus 3 52 442.84 531.41
QCA Health Plan, Inc. Silver Basic Plus 3 52 492.04 590.45
QCA Health Plan, Inc. Silver Basic Plus 3 53 462.8 555.36
QCA Health Plan, Inc. Silver Basic Plus 3 53 514.22 617.07
QCA Health Plan, Inc. Silver Basic Plus 3 54 484.35 581.22
QCA Health Plan, Inc. Silver Basic Plus 3 54 538.17 645.81
QCA Health Plan, Inc. Silver Basic Plus 3 55 505.91 607.09
QCA Health Plan, Inc. Silver Basic Plus 3 55 562.12 674.54
QCA Health Plan, Inc. Silver Basic Plus 3 56 529.27 635.13
QCA Health Plan, Inc. Silver Basic Plus 3 56 588.08 705.7
QCA Health Plan, Inc. Silver Basic Plus 3 57 552.87 663.44
QCA Health Plan, Inc. Silver Basic Plus 3 57 614.3 737.16
QCA Health Plan, Inc. Silver Basic Plus 3 58 578.05 693.66
Page 221 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Silver Basic Plus 3 58 642.28 770.73
QCA Health Plan, Inc. Silver Basic Plus 3 59 590.53 708.63
QCA Health Plan, Inc. Silver Basic Plus 3 59 656.14 787.37
QCA Health Plan, Inc. Silver Basic Plus 3 60 615.71 738.85
QCA Health Plan, Inc. Silver Basic Plus 3 60 684.12 820.94
QCA Health Plan, Inc. Silver Basic Plus 3 61 637.49 764.98
QCA Health Plan, Inc. Silver Basic Plus 3 61 708.32 849.98
QCA Health Plan, Inc. Silver Basic Plus 3 62 651.78 782.14
QCA Health Plan, Inc. Silver Basic Plus 3 62 724.2 869.04
QCA Health Plan, Inc. Silver Basic Plus 3 63 669.7 803.64
QCA Health Plan, Inc. Silver Basic Plus 3 63 744.11 892.94
QCA Health Plan, Inc. Silver Basic Plus 3 64 680.59 816.71
QCA Health Plan, Inc. Silver Basic Plus 3 64 756.21 907.45
QCA Health Plan, Inc. Silver Basic Plus 3 65 and
over
680.59 816.71
QCA Health Plan, Inc. Silver Basic Plus 3 65 and
over
756.21 907.45
QCA Health Plan, Inc. Silver Basic Plus 4 0‐20 177.85 177.85
QCA Health Plan, Inc. Silver Basic Plus 4 21 280.08 336.09
QCA Health Plan, Inc. Silver Basic Plus 4 22 280.08 336.09
QCA Health Plan, Inc. Silver Basic Plus 4 23 280.08 336.09
QCA Health Plan, Inc. Silver Basic Plus 4 24 280.08 336.09
QCA Health Plan, Inc. Silver Basic Plus 4 25 281.2 337.44
QCA Health Plan, Inc. Silver Basic Plus 4 26 286.8 344.16
QCA Health Plan, Inc. Silver Basic Plus 4 27 293.52 352.23
QCA Health Plan, Inc. Silver Basic Plus 4 28 304.45 365.33
QCA Health Plan, Inc. Silver Basic Plus 4 29 313.41 376.09
QCA Health Plan, Inc. Silver Basic Plus 4 30 317.89 381.47
QCA Health Plan, Inc. Silver Basic Plus 4 31 324.61 389.53
QCA Health Plan, Inc. Silver Basic Plus 4 32 331.33 397.6
QCA Health Plan, Inc. Silver Basic Plus 4 33 335.53 402.64
QCA Health Plan, Inc. Silver Basic Plus 4 34 340.02 408.02
QCA Health Plan, Inc. Silver Basic Plus 4 35 342.26 410.71
QCA Health Plan, Inc. Silver Basic Plus 4 36 344.5 413.4
QCA Health Plan, Inc. Silver Basic Plus 4 37 346.74 416.08
QCA Health Plan, Inc. Silver Basic Plus 4 38 348.98 418.77
QCA Health Plan, Inc. Silver Basic Plus 4 39 353.46 424.15
QCA Health Plan, Inc. Silver Basic Plus 4 40 357.94 429.53
QCA Health Plan, Inc. Silver Basic Plus 4 41 364.66 437.59
QCA Health Plan, Inc. Silver Basic Plus 4 42 371.1 445.32
QCA Health Plan, Inc. Silver Basic Plus 4 43 380.07 456.08
QCA Health Plan, Inc. Silver Basic Plus 4 44 391.27 469.52
QCA Health Plan, Inc. Silver Basic Plus 4 45 404.43 485.32
QCA Health Plan, Inc. Silver Basic Plus 4 46 420.12 504.14
QCA Health Plan, Inc. Silver Basic Plus 4 47 437.76 525.32
QCA Health Plan, Inc. Silver Basic Plus 4 48 457.93 549.51
QCA Health Plan, Inc. Silver Basic Plus 4 49 477.81 573.38
QCA Health Plan, Inc. Silver Basic Plus 4 50 500.22 600.26
QCA Health Plan, Inc. Silver Basic Plus 4 51 522.35 626.82
QCA Health Plan, Inc. Silver Basic Plus 4 52 546.71 656.06
QCA Health Plan, Inc. Silver Basic Plus 4 53 571.36 685.63
QCA Health Plan, Inc. Silver Basic Plus 4 54 597.97 717.56
QCA Health Plan, Inc. Silver Basic Plus 4 55 624.58 749.49
QCA Health Plan, Inc. Silver Basic Plus 4 56 653.42 784.11
QCA Health Plan, Inc. Silver Basic Plus 4 57 682.55 819.06
QCA Health Plan, Inc. Silver Basic Plus 4 58 713.64 856.37
QCA Health Plan, Inc. Silver Basic Plus 4 59 729.04 874.85
QCA Health Plan, Inc. Silver Basic Plus 4 60 760.13 912.16
QCA Health Plan, Inc. Silver Basic Plus 4 61 787.02 944.43
QCA Health Plan, Inc. Silver Basic Plus 4 62 804.67 965.6
QCA Health Plan, Inc. Silver Basic Plus 4 63 826.79 992.15
QCA Health Plan, Inc. Silver Basic Plus 4 64 840.24 1008.28
Page 222 of 223
Qualified Health Plan Individual Premium Rates for Arkansas
Company name Plan name Rating
Area
AGE Individual non‐
tobacco rate
Individual
tobacco rate
QCA Health Plan, Inc. Silver Basic Plus 4 65 and
over
840.24 1008.28
QCA Health Plan, Inc. Silver Basic Plus 7 0‐20 160.06 160.06
QCA Health Plan, Inc. Silver Basic Plus 7 21 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 7 22 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 7 23 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 7 24 252.07 302.48
QCA Health Plan, Inc. Silver Basic Plus 7 25 253.08 303.69
QCA Health Plan, Inc. Silver Basic Plus 7 26 258.12 309.74
QCA Health Plan, Inc. Silver Basic Plus 7 27 264.17 317
QCA Health Plan, Inc. Silver Basic Plus 7 28 274 328.8
QCA Health Plan, Inc. Silver Basic Plus 7 29 282.07 338.48
QCA Health Plan, Inc. Silver Basic Plus 7 30 286.1 343.32
QCA Health Plan, Inc. Silver Basic Plus 7 31 292.15 350.58
QCA Health Plan, Inc. Silver Basic Plus 7 32 298.2 357.84
QCA Health Plan, Inc. Silver Basic Plus 7 33 301.98 362.38
QCA Health Plan, Inc. Silver Basic Plus 7 34 306.01 367.22
QCA Health Plan, Inc. Silver Basic Plus 7 35 308.03 369.64
QCA Health Plan, Inc. Silver Basic Plus 7 36 310.05 372.06
QCA Health Plan, Inc. Silver Basic Plus 7 37 312.06 374.48
QCA Health Plan, Inc. Silver Basic Plus 7 38 314.08 376.9
QCA Health Plan, Inc. Silver Basic Plus 7 39 318.11 381.74
QCA Health Plan, Inc. Silver Basic Plus 7 40 322.15 386.58
QCA Health Plan, Inc. Silver Basic Plus 7 41 328.2 393.84
QCA Health Plan, Inc. Silver Basic Plus 7 42 333.99 400.79
QCA Health Plan, Inc. Silver Basic Plus 7 43 342.06 410.47
QCA Health Plan, Inc. Silver Basic Plus 7 44 352.14 422.57
QCA Health Plan, Inc. Silver Basic Plus 7 45 363.99 436.79
QCA Health Plan, Inc. Silver Basic Plus 7 46 378.11 453.73
QCA Health Plan, Inc. Silver Basic Plus 7 47 393.99 472.78
QCA Health Plan, Inc. Silver Basic Plus 7 48 412.14 494.56
QCA Health Plan, Inc. Silver Basic Plus 7 49 430.03 516.04
QCA Health Plan, Inc. Silver Basic Plus 7 50 450.2 540.24
QCA Health Plan, Inc. Silver Basic Plus 7 51 470.11 564.13
QCA Health Plan, Inc. Silver Basic Plus 7 52 492.04 590.45
QCA Health Plan, Inc. Silver Basic Plus 7 53 514.22 617.07
QCA Health Plan, Inc. Silver Basic Plus 7 54 538.17 645.81
QCA Health Plan, Inc. Silver Basic Plus 7 55 562.12 674.54
QCA Health Plan, Inc. Silver Basic Plus 7 56 588.08 705.7
QCA Health Plan, Inc. Silver Basic Plus 7 57 614.3 737.16
QCA Health Plan, Inc. Silver Basic Plus 7 58 642.28 770.73
QCA Health Plan, Inc. Silver Basic Plus 7 59 656.14 787.37
QCA Health Plan, Inc. Silver Basic Plus 7 60 684.12 820.94
QCA Health Plan, Inc. Silver Basic Plus 7 61 708.32 849.98
QCA Health Plan, Inc. Silver Basic Plus 7 62 724.2 869.04
QCA Health Plan, Inc. Silver Basic Plus 7 63 744.11 892.94
QCA Health Plan, Inc. Silver Basic Plus 7 64 756.21 907.45
QCA Health Plan, Inc. Silver Basic Plus 7 65 and
over
756.21 907.45
Page 223 of 223
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