supporting document schedules...in response to #19, table 9 cell k78 ii. in response to #31, table...
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Supporting Document Schedules Satisfied - Item: ACA Public Rate Filing PDFComments:Attachment(s): Public_Filing_PDF_GQO_Indiv_071219.pdfItem Status:Status Date:
SERFF Tracking #: GSHP-131915677 State Tracking #: GSHP-131915677 Company Tracking #: ACTUARIAL GQO INDIV
State: Pennsylvania Filing Company: Geisinger Quality Options
TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical Expense
Product Name: PPO
Project Name/Number: GQO Individual/
PDF Pipeline for SERFF Tracking Number GSHP-131915677 Generated 07/22/2019 02:50 PM
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Attachment I
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Rate Change Summary
Geisinger Quality Options – Individual Plans Rate request filing ID # GSHP-131915677 - This document is prepared by the insurance company submitting the rate filing as a consumer tool to help explain the rate filing. It is not intended to describe or include all factors or information considered in the review process. For more information, see the filing at http://www.insurance.pa.gov/Consumers/ACARelatedFilings/
Overview Initial requested average rate change: 7.1%1 Revised requested average rate change: 7.1%1 Range of requested rate change: 6.2% - 7.3% Effective date: 1/1/2020 Mapped Members: 5,326 Available in: Rating Areas 2, 3, 5, 6, 7 and 9
Key information Jan. 2018-Dec. 2018 financial experience
The company expects its annual medical costs to increase 8.0%.
Explanation of requested rate change
Geisinger Quality Options has proposed an overall base rate increase of 7.1% for Individual PPO members renewing in the Marketplace effective January 1, 2020 through December 1, 2020. The actual range of proposed rate increases vary from a minimum of 6.2% to a maximum of 7.3%. The key drivers of this increase are changes in the expected morbidity of the population, risk adjustment and the paid to allowed ratio. The total projected 2020 administrative costs are slightly higher than those used for the current 2019 rates. As required by federal regulations and using the Federally prescribed MLR methodology, the projected loss ratio exceeds 80%. There were minimal benefit changes proposed for 2020 to maintain the desired metallic level.
1 Note that insurers will have the opportunity to revise their rate change request in July, after they are scheduled to receive updated information about the impact of a federal program called risk adjustment. This document will be updated accordingly at that time.
How it plans to spend your premium This is how the insurance company plans to spend the premium it collects in 2020:
Claims: Administrative: Taxes & fees: Profit:
86.7%4.8%6.5%2.0%
Premiums $2,319,160 Claims $1,560,772 Administrative expenses $96,157 Taxes & fees $105,126
Company made (after taxes) $557,105
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Actuarial Department 100 N. Academy Ave. Danville, PA 17822-5002
Tel. • 800-447-4000 GeisingerHealthPlan.com
Geisinger Health Plan may refer collectively to Geisinger Health Plan, Geisinger Quality Options, Inc., and Geisinger Indemnity Insurance Company, unless otherwise noted.
July 12, 2019 Ms. Tracie Gray – Director Bureau of Life, Accident and Health Insurance Pennsylvania Insurance Department Email [email protected] Phone: 717-705-7257
Dear Ms. Gray:
The following is in response to the Department’s questions on July 5, 2019:
1. Company Name & NAIC#: Geisinger Quality Options – NAIC# 12743 2. Market: Individual 3. On and Off Exchange 4. Effective date of coverage: January 1, 2020 5. Average rate change: 7.1% 6. Range of rate change requested: 6.2% to 7.3% 7. Total additional annual revenue generated from the proposed rate change: $3,198,628 8. Product: PPO 9. Rating areas: 2, 3, 5, 6, 7, and 9 (no changes from 2019) 10. Metal Levels & Catastrophic Plans: Bronze, Silver and Gold plans 11. Current number of covered lives and of policyholders as of 2/1/19: 5,326 covered lives and 3,717
policyholders 12. Number of plans offered in 2020: 13 gold plans, 26 silver plans and 13 bronze plans (for a total of
52 plans); Number of plans offered in 2019: 18 gold plans, 36 silver plans, 18 bronze plans, and 13 catastrophic plans (for a total of 72 plans)
13. Contract form #:M-152-115-F Rev. 1/20; SERFF #: GSHP-131915677; Binder ID #: GSHP-PA20-125092052
14. HIOS issuer ID: 75729; HIOS submission tracking#: 75729-1488619135297932294 15. Summary of changes made in response to questions dates June 18, 2019:
a. Revisions were made the Actuarial Memorandum Exhibits i. In response to #19, Table 9 cell K78 ii. In response to #31, Table 10 cell T6 iii. In response to #46c, Table 5 cell C31 and C32, Table 6 cell C54 and D54 and
Table 10 column S b. Revisions were made to the Actuarial Memorandum in response to the Department’s
questions #6, #23, #43 and #46c. i. These changes are highlighted in yellow ii. The overall increase and range of increases changed as a result to the changes
above. 16. Summary of changes made in response to questions dated July 5, 2019:
a. Revisions were made the Actuarial Memorandum Exhibits i. In response to # 6, Table 5 cell D17 ii. In response to # 7, Table 7 cell K52 and Table 10 column L iii. In response to #9, Table 7 cells K49, K50 and K51 an Table 10 cells T4, T5 and
T6
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Geisinger Health Plan may refer collectively to Geisinger Health Plan, Geisinger Quality Options, Inc., and Geisinger Indemnity Insurance Company, unless otherwise noted.
Place document identifier here
iv. As a result of the above changes the projected premium changed, therefore % of premium figures were also updated, Table 5 cell C32, Table 6 cell C50 and C52 and Table 10 column R
b. Revisions were made to the Actuarial Memorandum in response to the Department’s questions #1 and #2 as well as the items noted above.
i. These changes are highlighted in yellowii. The overall increase and range of increases changed as a result to the changes
above.
For a detailed explanation of our rate development, please refer to the “actuarial memorandum andattestation” uploaded in SERFF under the “supporting documentation” tab.
Thank you for your consideration. Please contact me if you have any additional questions.
Sincerely,
Kurt J. Wrobel, FSA, MAAAChief Financial Officer and Chief Actuary
cc. Sarah MacDerment, FSA, MAAA, Actuarial DirectorEverard Riley, ASA, MAAA, Associate ActuaryDevon Dietrich, Actuarial Analyst
Kurt J WrWWWWWWWWWW obel FSA MAAA
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Page 1 of 10 Devised 5/17/19 Revised 7/12/19
Actuarial Memorandum – Individual GQO 1.Basic Information and Data General Information Company Identifying Information (as included in Table 0) Company Legal Name: Geisinger Quality Options State: Pennsylvania HIOS Issuer ID: 75729 NAIC Number: 12743 Market: Individual Effective Date: 1/1/2020 Company Contact Information Primary Contact Name: Sarah MacDerment Primary Contact Phone: 570-214-2348 Primary Contact email address: [email protected] Filing Information HIOS Submission Tracking Number: 75729-1488619135297932294 Contract Form Number: M-152-115-F Rev. 1/20 SERFF Number: GSHP-131915677 Binder ID Number: GSHP-PA20-125092052 Rate History and Proposed Variations in Rate Changes Rate History The recent historical rate increases are summarized in the table below.
Year SERFF ID Average Increase Minimum
Increase Maximum
Increase 2015 GSHP-129625425 13.7% 7.8% 19.4% 2016 GSHP-130072442 20.0% 15.2% 21.1% 2017 GSHP-130558343 0.0% 0.0% 0.0% 2018 GSHP-131024096 -20.1% -20.1% -20.1% 2019 GSHP-131501975 7.8% 7.8% 7.8%
For 2015 and 2016, the increases were not uniform but varied by plan. For 2017-2019 the increase was uniform by plan since there was only one plan. Proposed Rate Increase This filing applies to PPO products, sold on and off exchange in rating areas 2, 3, 5, 6, 7 and 9. There will be 13 gold plans, 26 silver plans, 13 bronze plans, for a total of 52 plans offered in 2020. For every county in our service area, we will continue to have one silver plan offered Off-Exchange only. These plans do not include the adjustment of the defunding of CSR and therefore are lower priced than a similar plan offered On-Exchange. As of February 2019, 5,326 covered lives and 3,717 policyholders will be impacted by this filing. The proposed overall rate increase is 7.1% but is not uniform by plan. The increases range from 6.2% to 7.3%. Table 10 shows the increases at the plan level. These increases vary by plan due to benefit changes necessary to maintain the desired metal level as well as changes in pricing factors.
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Average Rate Change The average rate change from Table 10, cell AC15 is 7.1% and is entered as the “percent rate change requested” in the SERFF Rate Review Detail Screen. It is the change in the Calibrated Plan-adjusted Index rate (as instructed by the Department). In addition, the change in 21-year-old non-tobacco premium PMPM, as calculated in Table 11, cell AN13, is 7.1%. Membership Count Table 1 shows the average age and the member months in the experience period of calendar year 2018, as well as the average age and the current members as of February 1, 2019 by age range. The projected member months for the rating period are also included. Benefit Changes To maintain current metal tier levels, several existing plans experienced cost sharing adjustments that were necessitated by the 2020 AV calculator. The first item we looked to update was the Maximum Out of Pocket. After that, we looked at the additional cost sharing elements to maintain metallic level. The ‘Benefit Change’ tab in the file “PA_Act_Memo_Additional_Exhibits_GQO_Indiv_051519.xlsx” summarizes the changes made by HIOS ID. Reason for Rate Increase The components of this rate increase are:
Normalization: 5% (Aggregate Calibration Factor on Table 10, 2.107 for 2020 and 1.998 from 2019
Morbidity: -11%, from row 78 on Table 8 Risk Adjustment: 10%, (63.24 – 28.65)/ 336.79 The PMPMs from Table 9, cells J76 and K76, over
the PMPM from 2019 in Table 8, cell C70 Paid to Allowed: 8%, row 70 on Table 9, .864 for 2020 and .806 for 2019 Benefit Richness: -8%, row 82 on Table 9, .745 for 2020 and.814 for 2019 Taxes: 3%, row 86 on Table 9, 3.7% for 2020 and .9% for 2019 Risk Pool experience: -1%, row 72 on Table 8
Experience Period Claims and Premium Paid Through Date The Experience Period data provided in the URRT Worksheet 1, Section I and in Table 2 is incurred in calendar year 2018 and paid through February 2019. The data in Table 2 of the exhibits is consistent with the data provided in the URRT in Worksheet 1, Section 1, except for the incurred claims and the allowed claims, as explained below. This includes only experience for ACA compliant plans and does not include experience for transitional business. Premiums (net of MLR Rebate) in Experience Period Premiums include earned premiums for calendar year 2018 for the Single Risk Pool. Premiums are not reduced by taxes and/or assessments. MLR rebates are not expected to be paid for this block of business. Initial estimates of rebates have been completed utilizing the methodology required for the CY 2018 rebate filing. Estimates suggest that the individual market MLR will be above the minimum MLR target of 80%.
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Allowed and Incurred Claims Incurred During the Experience Period The Experience Period Claims are based on individual ACA compliant business incurred and paid claims with IBNR added for the tail of claims incurred but not paid. Allowed claims are calculated by combining paid claims and estimated member cost share. The Incurred and Allowed Claims in Section I of Worksheet 1 of the URRT are the Incurred or Allowed from Table 2, but also include the Rx Rebates and Capitation. The same IBNR factors were used for both paid and allowed claims. The IBNR factors were based on legal-entity and market segment level claim lag tables. This method is appropriate to assure proper credibility and because timing of claims payment to providers does not vary by market or product. There were no non-EHB benefits in the experience period. Geisinger outsources several benefits and therefore has capitation expenses. The capitated expenses cover chiropractic services, nurse line, mental health services and quality fund/ PQS. The capitation amount for the experience period is displayed on Table 2 and is included in both the Incurred Claims and Allowed Claims on Worksheet 1 of the URRT. The capitation charges are uniform and do not vary by age. The historical capitation amounts are on the “Capitation” tab of the file “PA_Act_Memo_Additional_Exhibits_GQO_Indiv_051519.xlsx”. Pharmacy rebates are listed on Table 2. These rebate dollars would be removed from the Ultimate Incurred Claim liability to the insurer and are removed from the Incurred Claims and the Allowed Claims on Worksheet 1 of the URRT. The estimated risk adjustment for the experience period is based on an external analysis performed by the Pennsylvania Insurance Department. They estimated the Risk Adjustment transfer payment based on the population risk scores relative to an assumed market average risk score and market average premium. The calendar 2018 loss ratio, as displayed on Table 2 is 67.30%. The Federal MLR calculation that determines if a rebate is necessary is more complex than the MLR displayed on Table 2. For example, the Federal MLR calculation allows issuers to combine 3 years of experience when determining if a rebate is necessary. Benefit Categories Benefit categories are determined by the classification of claims in the Milliman Health Cost Guidelines. Credibility of Data The Credibility Manual Rate is a combination of our GHP and GQO experience, giving us an even more credible manual rate than if we determined them separately by product. Combining the GHP and GQO Single Risk Pools also aids in consistency between the products. Historically, we have seen enrollment move between our GHP and GQO products, so it is very important that our premium rates are consistent. To avoid double counting the Experience Period and avoid complicated adjustments to reflect the expected distribution of enrollment in each segment, the credibility of the Experience Period is set to 0.0%. This approach is consistent with the Actuarial Standard of Practice #25.
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The credibility manual data is shown in Table 2b. Since the credibility manual data is given a weight of 100%, the “blended” data would be the same as the data in Table 2b. The experience period data in Table 2 or 4 does not include data for any transitional business. Adjustments Made to the Data The population represented in the Experience Period is expected to continue into the Projection Period. The Projected Allowed Experience Claims are adjusted for changes as described in the section below. The Single Risk Pool Adjustment Factors on Table 5 match those on Worksheet 1 of the URRT. Morbidity Adjustments We have applied a Morbidity adjustment of 1.06 to reflect the removal of the Individual Mandate. Changes in Benefits We have no planned changes to the scope of benefits covered. Changes in Demographics We are applying a 0.8% adjustment factor to account for the favorable demographic shift between CY2018 and February 2019. This adjustment factor is developed on the “Manual_Age_Factor” tab of file “PID_Response_Exhibits_GQO_Indiv_071219.xlsx”. The Change in Demographics factor on Table 5 is 1.008 and is 1.875/1.861. Change in Other The capitation amount paid for our private reinsurance, as well as the recoveries from that program are reflected in the “Other” factor. Only slight changes are expected. This is developed on the “Reinsurance” tab in the file “PA_Act_Memo_Additional_Exhibits_GQO_Indiv_051519.xlsx”. CSR Defunding Adjustment Due to the lack of CSR funding expected in 2020, the PID instructed carriers to use a factor 1.20. This factor is displayed in column P on Table 10. Trend Identification Experience data was trended using an annual trend of 7.44%. Table 3b shows the breakdown between service category and cost vs. utilization. Table 3b uses the PMPM by service category to weight to develop the total composite trend. Trend factors are projected for unit cost and utilization components:
Unit cost trend factors are based on recorded anticipated increases in facility and professional fees from the Experience to Projection Period. These increases are composited across all facilities and provider groups.
Utilization trend projections are based on least-square regression modeling, taking into account historical claims patterns, anticipated economic activity and changes in care patterns.
Seasonality adjustments are made to the claims to account for changes in work days. Further adjustments have been made to the trends to reflect expected changes due to new
medical management initiatives that are expected to yield savings in the projection period.
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Our trends are analyzed at a higher level than these individual segments and are the same for the experience data and the credibility manual data. Due to the lack of stability in the ACA experience, we based our trends on data from our commercial large group experience. Table 4b is provided for this large group experience. The Composite URR Trend in Table 5, Cell C12 is 1.154 and is used to project the experience period data to the rating period. The aggregate URR Trend reported in Worksheet I, Section 2 is 739.58 / 640.75 = 1.154 and matches the Composite Trend in Table 3 of the Department’s rate exhibits. Historical Experience Table 4 includes the most recent 48 months of data with run out through February 2019. Allowed claims are calculated by combining paid claims and estimated member cost share. As mentioned above, Table 4b displays the large group data that was used to determine the trends used. As requested by the Department, the most recent 48 months of data for our transitional (non-ACA non- GF) Individual GQO block is:
Non-ACA PPO 2015 2016 2017 2018 Premium $13,170,691 $8,776,493 $6,830,871 $8,482,653 Incurred Claims $9,340,630 $6,570,137 $4,839,139 $5,963,645 Member Months 47,727 30,765 24,738 23,234
2. Rate Development & Change Development of Projected Index Rate, Market-Adjusted Index Rate & Total Allowed Claims Single Risk Pool The Single Risk Pool has been established in accordance with the requirements in 45 CFR 156.80(d) as was discussed previously in the Experience Period Premium and Claims section. Index Rate The Experience Period Index Rate is based on the manual Allowed Claims PMPM and is the starting value on Table 5. The Credibility Manual Rate is a combination of our GHP and GQO experience, giving us an even more credible manual rate. No benefits were covered in addition to Essential Health benefits in the policies being offered. The Projected Index Rate for this Single Risk Pool is the Adjusted Projected Allowed EHB Claims PMPM and is the manual rate. The projected claims reflect the trend and benefits described earlier in this memorandum. Cell D15 in Table 5 are 1.06 as instructed by the PID to account for the removal of the individual mandate. As discussed above, the Manual Data is weighted 100% since it includes the Actual Experience Data as well as the experience data for our ACA compliant GHP business. If we gave any weight to the Actual Experience Data, it would be double counted since it is also in the Manual Data. Market Adjusted Index Rate The Market Adjusted Index Rate and Market Adjusted Total Allowed Claims are calculated in Table 5. The Projected Index Rate is converted to a paid basis by multiplying by the Projected Paid to Allowed ratio.
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Paid to Allowed Ratio The Projected Paid to Allowed Average Ratio is 0.864 and is displayed on Table 5. It is determined for the Projection Period based on the combination of our GHP and GQO member weighted average Pricing AV for each plan times the CSR Adjustment factor for each plan and the projected member months in each plan. This is consistent with the calculation on Table 10 in cell K15, except that it combines both our GHP and GQO plans. This same factor is used in both our GHP and GQO filings to help maintain appropriate relativities between the plans. There are variations between the AV Pricing Values and the AV Calculator values because of different cost structures and management approaches than what is reflected in the national average data used in the AV Calculator. Projected Risk Adjustments PMPM Our Individual Exchange population had a healthier risk profile than the state average in 2018 resulting in potential payment transfers into the Risk Adjustment program. Premium levels for 2020 need to incorporate the expected payment into the Risk Adjustment program. We have used the Department’s estimated 2018 Risk Adjustment as the starting point for 2020. The risk adjustment model applied to the 2020 contract year will be an updated version of what was used for 2018. Specifically, the coefficients will be changing. We have used a 3rd party consultant’s tool to analyze the impact on our population. The result is an expected increase in transfer payment and is applied to the actual payment transfer from 2018. The expected payment transfer for 2020 is shown on Table 5 as -63.24. The Exchange user fee is 3.0% times the projected premium, times the portion of the enrollment expected to be sold On-Exchange. Due to a circular reference, the formula in cell C32 in Table 5 has a hard-coded value for the projected premium. The formula is .030*809.81*39,798/42,714=$22.64. As of February 2019, GHP and GQO combined had 42,714 members. 39,798 of these members were sold On-Exchange. The allowable market-wide modifiers (risk adjustment of -$63.24 and Exchange User Fees of $22.64) are added to this paid basis PMPM. This PMPM is then converted back to an allowed basis, again using the projected paid to allowed ratio. Any non-EHB claims would then be added to this value if we had some but we don’t so this PMPM is the Market-Adjusted Projected Total Allowed Claims PMPM, $839.08 as shown on Table 5 in cell C42. Retention Items Administration Expense Administration expenses are based on activity-based allocation by product for calendar year 2020. This methodology applies for all variable costs and all fixed costs. For the 2020 plan year, we are combining the GHP and GQO estimates to create one overall PMPM estimate. Again, this helps maintain appropriate relativities between the GHP and GQO plans. The historical administrative exhibits are displayed on the ‘Administrative_Expense’ tab of the file “PA_Act_Memo_Additional_Exhibits_GQO_Indiv_051519.xlsx”. Table 6 provides a breakdown of the administrative expenses, as well as the taxes and fees. The administrative expenses are developed as a PMPM expense, but applied as a consistent percentage of premium and do not vary by plan. The proposed percentage of premium for 2020 is 4.79% and is shown in both Tables 6 and 10.
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Agent/Broker Fees and Commissions No commissions are paid on the Indiv ACA business. Table 6 has 0 for Agent/Broker Fees and Commissions. Quality Improvement Initiatives The Quality Initiatives amount is based on the latest estimate for this product. They are reported on line 6.6 of the Supplement Health Care Exhibit of the Annual Statement. The estimated % of premium is 0.80% and is calculated using the PMPM of $6.46 that is displayed on the ‘Quality_Improvement’ tab of the file ‘PA_Act_Memo_Additional_Exhibits_GQO_Indiv_051519.xlsx’. Profit & Risk Margin The risk margin is set at 2% of premium. This risk margin is applied consistently across all plans. Taxes, Fees, and Subsidies For 2020, the federal government will again collect the Health Insurer Provider Fee. For this product, we include 2.81% in cell C57. Federal Income tax will also be collected. It is calculated on the “Taxes” tab of the file “PA_Act_Memo_Additional_Exhibits_GQO_Indiv_051519.xlsx”. Projected Loss Ratio The anticipated loss ratio is 93.6% in aggregate as shown below using the Federally-prescribed MLR methodology: MLR Numerator = Projected Claims + Quality Initiatives + Risk Adjustment = 638.70 + 6.46 + -63.24 = 708.40 MLR Denominator = Projected Premiums – Taxes and Fees = 809.81 – 22.64 – 30.29 = 756.89 Federal MLR = 708.40 / 756.89 = 93.6% Normalized Market-Adjusted Projected Allowed Total Claims The Market-Adjusted Projected Allowed Total Claims is normalized using the projected average factors for age, geography, tobacco, benefit richness (induced demand) and network. These average factors for 2019 and 2020 are displayed on Table 7. Projected Membership For the overall Individual ACA market, membership is expected to remain approximately at the current levels. February 2019 membership is expected to best represent calendar year 2020 in total for the Individual ACA market. Projected membership is used to calculate the normalization factors discussed below. Normalization Factors Age Factor The federal age curve, as shown in Table 12, is used to determine a normalization factor to account for the age mix of business used in generating the Index Rate. The average age factor includes a factor of 0 for non-billable members. The average factors for 2019 and 2020 are shown on Table 7 and are developed on the ‘Age_Calibration’ tab of the file “PID_Response_Exhibits_GQO_Indiv_071219.xlsx”.
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Geographic Factor The geographic rating area factors used to determine premium rates are shown on Table 13. These factors are consistent with the current approved factors. The normalization factor is determined using these factors weighted using projected membership by area and is shown on the ‘Area_Calibration’ tab of the file “PID_Response_Exhibits_GQO_Indiv_071219.xlsx”. Tobacco Factor A standard 10% load is applied for applicants who indicate tobacco usage by affirmatively answering the question— “Have you used tobacco at least four times a week for the past six months?” This load assumption was validated using the study “Impact of height, weight, and smoking on medical claims costs”, a research report done by Milliman to update their Medical Underwriting Guidelines in April 2009. We utilized the February 2019 ACA compliant population to determine the percentage of members that admit to the use of tobacco and pay the increased premium for their entire contract in 2019. The average tobacco factor is shown on Table 7 and developed on the ‘Tobacco_calibration’ tab of the file “PID_Response_Exhibits_GQO_Indiv_071219.xlsx”. Table 12 shows the age bands, age factors and tobacco factors where it demonstrates that the tobacco factors are uniform across all age bands (for 18+). Benefit Richness (Induced Demand) Induced Demand factors are applied to each metallic to reflect the expected utilization, not the expected health status. To ensure revenue neutrality, a normalization factor is applied. The average benefit richness factor is shown on Table 7. Network Factors There is only one network shown on Table 14. Components of Rate Change Table 8 shows the components of the Rate Change developed in this filing. The key drivers of this increase are changes in the expected morbidity of the population, risk adjustment and the paid to allowed ratio. Table 9 supports the calculations in Table 8. Row A does not approximately equal Row H because Table 8 does not capture all the changes between 2019 and 2020. For 2020, we are combining GHP and GQO plans for many elements. Some of these were considered separately (GHP vs GQO) for 2019, such as the pricing AVs. The amounts shown in the 2019 columns for B, C, D and E match those entered in the 2019 column in the plan year 2019 rate filing. The amounts shown in the 2019 columns for A, E, F and H do not match those entered in the 2019 rate filing due to the shift in enrollment between what was projected in the 2019 rate filing and the Feb 2019 enrollment. 3. Plan Rate Development The projected market-adjusted index rate is used to develop the calibrated plan adjusted index rates in column AA of Table 10. Each plan’s rate is developed as the product of the market-adjusted index rate, the allowable factors and calibration for age, geography and tobacco. Column P of Table 10 has the CSR Defunding Adjustment of 1.20 applied to the on-Exchange silver plans, as instructed by the PID.
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Each plan is identified as either modified or existing. Column G lists the metallic tier. Column H is the value we calculated using the HHS Actuarial Value Calculator. Screen shots of this calculation are provided in the file “AV_Screenshots_GQO_Indiv_050619.pdf.” The Actuarial Certification, at the end of this document, includes attestation that the Federal AV calculator was used to determine the metallic values. Please also refer to the “AV_UniquePlanDesignJust_GQO_Indiv_051419.pdf” document for further details. Columns L and N were normalized using projected (CY2020) membership. The supporting exhibit for column L [“Benefit Richness (induced demand)”] is shown on the ‘Induced_Util_Exhibit’ tab of the file “PID_Response_Exhibits_GQO_Indiv_071219.xlsx”. 4. Plan Premium Development for 21-Year-Old Non-Tobacco User The projected calibrated plan-adjusted index rate is used to develop the 21-year-old non-tobacco premium in the individual market. These rates are displayed on Table 10, column AA. Table 11 uses the 21-year-old non-tobacco premiums from Table 10, adjusted by the current approved geographic factors (from Table 13), to develop the 21-year-old non-tobacco premiums by rating area. 5. Plan Factors The Consumer Adjusted Premium Rates are developed by applying the following allowable rating factors to the calibrated Plan Adjusted Index Rates:
1. Age – reflecting the HHS defined age curve 2. Geographic – as discussed above 3. Tobacco status – as discussed above.
The final Premium rates for all filed benefit plans are displayed in the QHP Rating Template. Network Factors Only one network factor for this market is used and is shown on Table 14. Our established network is not changing, but is now referred to as the “Geisinger Marketplace All-Access PPO” network. Service Area Composition GHP will maintain the same counties of operation from 2019. To preserve flexibility and align with unique regional and network characteristics, counties are grouped with similarly-situated geographies. All counties and service areas are defined in the QHP Service Area template. These service areas are defined on the “Service Areas” tab of the file “PA_Act_Memo_Additional_Exhibits_GQO_Indiv_051519.xlsx”. Composite Rating Composite rating is not used. Plan Type All plan offerings meet the plan type definitions available in the URRT Worksheet 2, Section I. Changes to URRT We acknowledge that each time the URRT is changed in SERFF, it will also be updated in HIOS. Reliance We relied on the Department’s projected risk adjustment payment for 2020. We have relied on Milliman for their classification of benefit categories in the claim data. We have also relied on a 3rd party’s risk adjustment model analysis tool, to model the changes to the model.
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Additional Exhibits The following required exhibits have been uploaded in SERFF under the tabs noted next to the exhibit: • Department Plan Design Summary – submitted under the “Rate/Rule Schedule” tab; • Service Area Map – submitted under the “Supporting Documentation” tab. Actuarial Certification I certify that:
1. I am a member of the American Academy of Actuaries, meet the Qualification Standards for Actuaries Issuing Statements of Actuarial Opinion in the United States promulgated by the American Academy of Actuaries, and have the education and experience necessary to perform this work. 2. The projected Index Rate is:
a. In compliance with all applicable state and Federal regulations including 45 CFR 156.80(d)(1) b. Developed in compliance with the applicable Actuarial Standards of Practice, c. Is reasonable in relation to the benefits provided and the population anticipated to be covered, d. Is neither excessive nor deficient based on available information.
3. The Index Rate is used to develop the plan level rates using only the allowable modifiers in accordance with 45 CFR 156.80(d)(1) and 45 CFR 156.80(d)(2). 4. The essential health benefits are determined in accordance with 45 CFR Part 156. 5. The geographic rating factors reflect only differences in the costs of delivery and do not include differences for population morbidity by geographic area. 6. The Federal AV Calculator was utilized, with an acceptable alternative methodology when appropriate, to determine the AV Metal Values shown on Table 10 and in Worksheet 2, Section I of the URRT, following ASOP 50. Please refer to the “AV_UniquePlanDesignJust_GQO_Indiv_051419.pdf” document for further details. 7. All factor, benefit and other changes from the prior (2019) approved filing have been disclosed in the actuarial memorandum. 8. New plans have not been considered modifications of existing plans under the uniform modification standards in 45 CFR 147.106. 9. The information presented in the PA Actuarial Memorandum and PA Actuarial Memorandum Rate Exhibits is consistent with the information presented in the 2020 Rate Filing Justification.
I confirm that the rates submitted comply with the ACA rating requirements and with the Single Risk Pool per market requirement. The URRT does not demonstrate the process used to develop the rates. Rather it represents information required by Federal regulation to be provided in support of the review of rate increases, for certification of Qualified Health Plans for Federally-facilitated Marketplaces, and for certification that the Index Rate is developed in accordance with Federal regulation and used consistently and only adjusted by the allowable modifiers.
7/12/2019 ______________________________ ___________________ Sarah MacDerment Date FSA, MAAA Attesting Actuary
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PA R
ate
Tem
plat
e Pa
rt I
Data
Rel
evan
t to
the
Rate
Fili
ng
Tabl
e 0.
Iden
tifyi
ng In
form
atio
n
Car
rier N
ame:
Gei
sing
er Q
ualit
y O
ptio
nsPr
oduc
t(s):
PPO
Mar
ket S
egm
ent:
Indi
vidu
alR
ate
Effe
ctiv
e D
ate:
1/1/
2020
to12
/31/
2020
Bas
e Pe
riod
Star
t Dat
e1/
1/20
18to
12/3
1/20
18D
ate
of M
ost R
ecen
t Mem
bers
hip
2/1/
2019
Tabl
e 1.
Num
ber o
f Mem
bers
Mem
ber-
mon
ths
Mem
bers
Mem
ber-
mon
ths
Expe
rienc
e Pe
riod
Curr
ent P
erio
d (a
s of 0
2-01
-201
9)Pr
ojec
ted
Ratin
g Pe
riod
Aver
age
Age
41.0
47.0
47.0
Tota
l3,
258
5,32
663
,912
-
Car
rier N
ame:
Geisi
nger
Qua
lity
Opt
ions
Prod
uct(s
):PP
OM
arke
t Seg
men
t:In
divi
dual
Rat
e Ef
fect
ive
Dat
e:1/
1/20
20
Tabl
e 2b
. Man
ual E
xper
ienc
e Pe
riod
Clai
ms a
nd P
rem
ium
s
Earn
ed P
rem
ium
Paid
Cla
ims
Ultim
ate
Incu
rred
Cla
ims
Mem
ber M
onth
sEs
timat
ed C
ost S
harin
g (M
embe
r & H
HS)
Allo
wed
Cla
ims (
Non-
Capi
tate
d)No
n-EH
B po
rtio
n of
Allo
wed
Cl
aim
sTo
tal P
resc
riptio
n Dr
ug R
ebat
es*
Tota
l EHB
Cap
itatio
nTo
tal N
on-E
HB C
apita
tion
Estim
ated
Risk
Adj
ustm
ent
$
52
9,23
7,55
3.05
$
3
32,6
75,5
32.7
0 $
343,
904,
618.
41
676,
186
$
4
9,62
2,29
4.07
$
3
93,5
26,9
12.4
8 $
-
$
(
6,35
7,51
9.36
) $
13,
842,
754.
65
$
-
(3
3,45
8,09
6.00
)$
Expe
rienc
e Pe
riod
Tota
l Allo
wed
EHB
Cla
ims +
EHB
Cap
itatio
n PM
PM (n
et o
f pre
scrip
tion
drug
reba
tes)
59
3.05
$
Lo
ss R
atio
70.8
8%*E
xpre
ss P
resc
riptio
n Dr
ug R
ebat
es a
s a n
egat
ive
num
ber
Tabl
e 3b
. Man
ual T
rend
Com
pone
nts
Cost
*Ut
iliza
tion*
Indu
ced
Utili
zatio
n*Co
mpo
site
Tren
dW
eigh
t*3.
21%
0.04
%5.
65%
9.08
%21
.19%
0.89
%2.
68%
6.00
%9.
81%
37.6
7%2.
71%
0.77
%1.
32%
4.87
%19
.29%
0.00
%0.
00%
0.00
%0.
00%
1.81
%5.
00%
3.45
%9.
01%
0.62
%-1
.85%
7.66
%16
.59%
8.03
%10
0.00
%24 1.16
7*
Expr
ess C
ost,
Utili
zatio
n, In
duce
d Ut
iliza
tion
and
Wei
ght a
s per
cent
ages
Tabl
e 4b
. Hist
oric
al M
anua
l Exp
erie
nce
Mon
th-Y
ear
Tota
l Ann
ual P
rem
ium
Incu
rred
Cla
ims
Com
plet
ion
Fact
ors*
Ultim
ate
Incu
rred
Cla
ims
Mem
bers
Ultim
ate
Incu
rred
PM
PMEs
timat
ed A
nnua
l Cos
t Sha
ring
(M
embe
r + H
HS)
Pres
crip
tion
Drug
Reb
ates
**Al
low
ed C
laim
s (Ne
t of
Pres
crip
tion
Drug
Reb
ates
)Al
low
ed P
MPM
Jan-
15$2
2,19
4,73
1.72
1.
0000
$
2
2,19
4,73
1.72
6
1,82
2 $
359.
01
($44
1,59
8.18
)$2
5,86
9,27
5.26
$
41
8.45
Fe
b-15
$19,
828,
896.
40
1.00
00 $
19,
828,
896.
40
62,
616
$
31
6.67
($
419,
602.
96)
$23,
263,
515.
05 $
371.
53
Mar
-15
$23,
283,
534.
64
1.00
00 $
23,
283,
534.
64
61,
960
$
37
5.78
($
445,
548.
28)
$26,
915,
994.
92 $
434.
41
Apr-1
5$2
2,19
5,00
4.46
1.
0000
$
2
2,19
5,00
4.46
6
1,31
8 $
361.
97
($45
0,01
1.44
)$2
5,59
7,60
9.73
$
41
7.46
M
ay-1
5$2
1,77
8,37
4.81
1.
0000
$
2
1,77
8,37
4.81
6
0,67
1 $
358.
96
($45
7,82
4.23
)$2
4,92
6,59
8.77
$
41
0.85
Ju
n-15
$20,
811,
308.
46
1.00
00 $
20,
811,
308.
46
59,
625
$
34
9.04
($
471,
798.
03)
$23,
977,
792.
69 $
402.
14
Jul-1
5$2
1,85
5,68
5.99
1.
0000
$
2
1,85
5,68
5.99
5
8,87
1 $
371.
25
($48
1,72
0.32
)$2
4,98
1,24
8.20
$
42
4.34
Au
g-15
$19,
248,
696.
00
1.00
00 $
19,
248,
696.
00
58,
986
$
32
6.33
($
488,
395.
42)
$22,
232,
701.
88 $
376.
91
Sep-
15$2
0,88
0,03
5.73
1.
0000
$
2
0,88
0,03
5.73
5
9,93
2 $
348.
40
($47
4,31
5.90
)$2
3,97
0,35
2.08
$
39
9.96
O
ct-1
5$2
2,91
9,53
5.83
1.
0000
$
2
2,91
9,53
5.83
6
0,62
1 $
378.
08
($51
1,62
5.33
)$2
6,19
8,36
1.96
$
43
2.17
No
v-15
$20,
830,
444.
07
1.00
00 $
20,
830,
444.
07
60,
208
$
34
5.97
($
483,
753.
61)
$23,
844,
001.
18 $
396.
03
Dec-
15$2
1,98
0,38
5.48
1.
0000
$
2
1,98
0,38
5.48
6
0,02
2 $
366.
21
($50
5,05
2.38
)$2
5,12
5,60
3.02
$
41
8.61
Ja
n-16
$20,
943,
767.
43
1.00
00 $
20,
943,
767.
43
60,
868
$
34
4.09
($
494,
504.
69)
$24,
704,
877.
99 $
405.
88
Feb-
16$2
2,31
8,99
7.92
1.
0000
$
2
2,31
8,99
7.92
6
0,62
2 $
368.
17
($51
3,44
3.10
)$2
6,14
0,12
8.25
$
43
1.20
M
ar-1
6$2
5,66
7,75
6.27
1.
0000
$
2
5,66
7,75
6.27
6
0,68
1 $
422.
99
($56
0,38
0.28
)$2
9,78
4,36
9.23
$
49
0.84
Ap
r-16
$23,
660,
286.
00
1.00
00 $
23,
660,
286.
00
61,
476
$
38
4.87
($
502,
049.
23)
$27,
301,
138.
55 $
444.
09
May
-16
$23,
082,
834.
44
1.00
00 $
23,
082,
834.
44
61,
450
$
37
5.64
($
515,
282.
98)
$26,
670,
331.
23 $
434.
02
Jun-
16$2
6,74
9,37
1.56
1.
0000
$
2
6,74
9,37
1.56
6
1,91
1 $
432.
06
($52
0,50
8.52
)$3
0,25
8,22
9.24
$
48
8.74
Ju
l-16
$22,
445,
741.
47
1.00
00 $
22,
445,
741.
47
62,
287
$
36
0.36
($
520,
535.
09)
$25,
776,
383.
24 $
413.
83
Aug-
16$2
3,74
8,61
9.55
1.
0000
$
2
3,74
8,61
9.55
6
2,94
4 $
377.
30
($60
5,97
6.61
)$2
7,44
4,15
5.93
$
43
6.01
Se
p-16
$23,
617,
459.
69
1.00
00 $
23,
617,
459.
69
62,
876
$
37
5.62
($
572,
584.
91)
$27,
102,
216.
82 $
431.
04
Oct
-16
$23,
557,
505.
26
1.00
00 $
23,
557,
505.
26
64,
247
$
36
6.67
($
632,
029.
98)
$27,
526,
924.
03 $
428.
45
Nov-
16$2
5,79
9,40
5.78
1.
0000
$
2
5,79
9,40
5.78
6
4,23
0 $
401.
67
($66
1,16
5.84
)$2
9,45
9,29
6.31
$
45
8.65
De
c-16
$24,
121,
086.
46
1.00
00 $
24,
121,
090.
01
63,
303
$
38
1.04
($
681,
548.
55)
$27,
744,
816.
54 $
438.
29
Jan-
17$2
3,72
3,43
7.61
1.
0000
$
2
3,72
3,43
7.61
6
4,44
6 $
368.
11
($65
7,46
8.69
)$2
8,45
6,58
7.66
$
44
1.56
Fe
b-17
$23,
988,
003.
26
1.00
00 $
23,
988,
003.
26
63,
810
$
37
5.93
($
615,
649.
14)
$28,
303,
933.
85 $
443.
57
Mar
-17
$25,
497,
081.
88
1.00
00 $
25,
497,
081.
88
63,
069
$
40
4.27
($
642,
440.
74)
$29,
900,
678.
28 $
474.
09
Apr-1
7$2
4,70
3,63
2.65
1.
0000
$
2
4,70
3,63
2.65
6
2,94
0 $
392.
49
($47
7,35
4.69
)$2
8,85
9,72
1.21
$
45
8.53
M
ay-1
7$2
8,43
5,02
7.09
1.
0000
$
2
8,43
5,02
7.09
6
2,64
4 $
453.
91
($52
9,72
7.43
)$3
2,75
6,91
5.82
$
52
2.91
Ju
n-17
$26,
950,
873.
93
1.00
00 $
26,
950,
873.
93
62,
597
$
43
0.55
($
507,
845.
99)
$30,
981,
805.
90 $
494.
94
Jul-1
7$2
4,90
5,95
0.61
0.
9996
$
2
4,91
5,39
0.43
6
2,12
6 $
401.
05
($51
3,05
5.01
)$2
8,73
8,30
7.83
$
46
2.58
Au
g-17
$26,
817,
586.
61
0.99
96 $
26,
829,
509.
89
61,
607
$
43
5.49
($
570,
394.
14)
$31,
090,
438.
40 $
504.
66
Sep-
17$2
4,30
5,71
6.19
0.
9811
$
2
4,77
4,13
4.00
5
9,46
1 $
416.
65
($49
9,59
6.59
)$2
8,50
8,45
5.28
$
47
9.45
O
ct-1
7$2
5,62
6,13
0.63
0.
9995
$
2
5,63
7,79
3.40
5
8,79
9 $
436.
02
($51
0,70
3.63
)$2
9,72
8,31
5.40
$
50
5.59
No
v-17
$25,
561,
545.
62
0.99
53 $
25,
683,
248.
27
58,
801
$
43
6.78
($
490,
674.
66)
$29,
474,
065.
64 $
501.
25
Dec-
17$2
4,72
9,49
1.05
0.
9990
$
2
4,75
3,64
0.70
5
8,72
5 $
421.
52
($44
6,06
4.22
)$2
8,25
7,95
0.82
$
48
1.19
Ja
n-18
$25,
600,
999.
62
0.98
90 $
25,
885,
179.
33
55,
844
$
46
3.53
($
461,
088.
62)
$30,
517,
131.
64 $
546.
47
Feb-
18$2
1,62
7,05
6.43
0.
9984
$
2
1,66
2,29
1.93
5
5,08
0 $
393.
29
($41
0,86
3.75
)$2
5,56
5,90
0.89
$
46
4.16
M
ar-1
8$2
3,63
4,89
3.78
0.
9863
$
2
3,96
3,36
1.49
5
4,23
9 $
441.
81
($44
4,28
7.62
)$2
7,99
3,91
9.30
$
51
6.12
Ap
r-18
$22,
765,
578.
64
0.99
85 $
22,
799,
685.
02
53,
656
$
42
4.92
($
437,
939.
47)
$26,
539,
107.
75 $
494.
62
May
-18
$25,
930,
366.
66
0.99
77 $
25,
990,
464.
63
53,
303
$
48
7.60
($
454,
826.
55)
$29,
808,
795.
18 $
559.
23
Jun-
18$2
1,71
5,44
4.84
0.
9881
$
2
1,97
7,53
5.09
5
3,19
1 $
413.
18
($43
8,34
9.98
)$2
5,43
7,40
9.96
$
47
8.23
Ju
l-18
$23,
585,
896.
34
0.99
65 $
23,
668,
463.
27
52,
709
$
44
9.04
($
572,
683.
06)
$27,
179,
632.
90 $
515.
65
Aug-
18$2
4,32
3,03
4.96
0.
9794
$
2
4,83
4,89
5.32
5
1,75
9 $
479.
82
($61
0,86
9.72
)$2
8,54
8,95
8.08
$
55
1.57
Se
p-18
$21,
592,
641.
39
0.97
85 $
22,
065,
991.
85
51,
434
$
42
9.02
($
492,
571.
00)
$25,
764,
783.
72 $
500.
93
Oct
-18
$24,
329,
706.
59
0.95
82 $
25,
390,
706.
58
51,
250
$
49
5.43
($
573,
675.
98)
$29,
539,
589.
99 $
576.
38
Nov-
18$2
2,49
6,87
4.76
0.
9677
$
2
3,24
8,03
2.53
5
0,77
2 $
457.
89
($56
2,35
1.36
)$2
6,68
3,44
3.70
$
52
5.55
De
c-18
$21,
862,
282.
49
0.92
12 $
23,
732,
447.
53
50,
303
$
47
1.79
($
486,
692.
09)
$27,
194,
751.
50 $
540.
62
* Ex
pres
s Com
plet
ion
Fact
or a
s a p
erce
ntag
e**
Expr
ess P
resc
riptio
n Dr
ug R
ebat
es a
s a n
egat
ive
num
ber
$337
,525
,701
.50
$49,
165,
402.
96
$307
,615
,453
.44
$45,
554,
370.
04
Pres
crip
tion
Drug
sTo
tal A
nnua
l Tre
ndM
onth
s of T
rend
Tota
l App
lied
Tren
d Pr
ojec
tion
Fact
or
$319
,193
,255
.27
$44,
200,
031.
98
$297
,321
,129
.91
$39,
096,
421.
15
Capi
tatio
n
Serv
ice C
ateg
ory
Inpa
tient
Hos
pita
lO
utpa
tient
Hos
pita
lPr
ofes
siona
lO
ther
Med
ical
-
PA R
ate
Tem
plat
e Pa
rt II
Rate
Dev
elop
men
t and
Cha
nge
Car
rier N
ame:
Geis
inge
r Qua
lity
Opt
ions
Prod
uct(s
):PP
O
Mar
ket S
egm
ent:
Indi
vidu
al
Rat
e Ef
fect
ive
Dat
e:1/
1/20
20
Tabl
e 5.
Dev
elop
men
t of t
he P
roje
cted
Inde
x Ra
te, M
arke
t-Ad
just
ed In
dex
Rate
, and
Tot
al A
llow
ed C
laim
s
D
evel
opm
ent o
f the
Pro
ject
ed In
dex
Rate
Actu
al E
xper
ienc
e Da
taM
anua
l Dat
a
Tota
l Allo
wed
EHB
Cla
ims +
EHB
Cap
itatio
n PM
PM (n
et o
f pre
scrip
tion
drug
reba
tes)
PM
PM64
0.75
$
59
3.05
$
-
PA R
ate
Tem
plat
e Pa
rt II
ITa
ble
10. P
lan
Rate
s
Age
Calib
ratio
n Fa
ctor
1.95
0C
arrie
r Nam
e:G
eisi
nger
Qua
lity O
ptio
nsGe
ogra
phic
Calib
ratio
n Fa
ctor
1.07
1Pr
oduc
t(s):
PPO
Toba
cco
Calib
ratio
n Fa
ctor
1.00
9M
arke
t Seg
men
t:In
divid
ual
Aggr
egat
e Ca
libra
tion
Fact
or2.
107
Rat
e Ef
fect
ive D
ate:
1/1/
2020
Base
Per
iod
Star
t Dat
e1/
1/20
18D
ate
of M
ost R
ecen
t Mem
bers
hip
2/1/
2019
Mar
ket A
djus
ted
Inde
x R
ate
839.
08$
Plan
Num
ber
HIO
S Pl
an ID
(S
tand
ard
Com
pone
nt)
Plan
Typ
e (H
MO
, PO
S, P
PO, E
PO,
Inde
mni
ty, O
ther
)1/
1/20
19 P
lan
Mar
ketin
g N
ame
Exist
ing,
Mod
ified
, N
ew, D
iscon
tinue
d &
M
appe
d,
Disc
ontin
ued
& N
ot
Map
ped
(E,M
,N,D
M,
DNM
) for
202
0
1/1/
2020
Pla
n HI
OS
Plan
ID (I
f 1/1
/201
9 Pl
an D
iscon
tinue
d &
M
appe
d)M
etal
lic
Tier
Met
allic
Tie
r Ac
tuar
ial
Valu
e
Stan
dard
AV,
Ap
proa
ch (1
), Ap
proa
ch (2
)
Exch
ange
O
n/O
ff or
O
ff
Pric
ing
AV
(com
pany
-de
term
ined
AV
)
Bene
fit
Rich
ness
(in
duce
d de
man
d)
Bene
fits i
n ad
ditio
n to
EH
BPr
ovid
er
Net
wor
kCa
tast
roph
ic
Elig
ibili
ty
Non
-Fun
ding
of
CSR
Ad
just
men
tPu
re P
rem
ium
Adm
in C
osts
Taxe
s & F
ees (
not
incl
udin
g Ex
chan
ge
fees
)Pr
ofit
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0
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Tran
sitio
nal P
lans
TRAN
SITI
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LN/
ATR
ANSI
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NAL
DNM
TRAN
SITI
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AN/
AN/
AN/
AN/
AN/
AN/
AN/
AN/
AN/
AN/
AN/
AN/
AN/
APl
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7572
9PA0
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an 3
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0126
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an 5
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0126
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1.00
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0%Pl
an 6
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0126
35PP
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er M
arke
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7572
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820
1.09
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1.00
01.
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52.1
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0%Pl
an 7
7572
9PA0
0126
36PP
OGe
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er M
arke
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0E
7572
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0126
36Si
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820
1.09
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1.00
01.
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52.1
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0%Pl
an 8
7572
9PA0
0126
37PP
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7572
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37Si
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820
1.09
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1.00
01.
000
1.00
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52.1
34.
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0%Pl
an 9
7572
9PA0
0126
38PP
OGe
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er M
arke
tpla
ce P
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0E
7572
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0126
38Si
lver
0.71
28Ap
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ch (1
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820
1.09
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000
1.00
01.
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an 1
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er0.
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Appr
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(1)
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0.82
01.
093
1.00
01.
000
1.00
01.
000
$752
.13
4.8%
3.7%
2.0%
Plan
11
7572
9PA0
0126
40PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/50
/500
0E
7572
9PA0
0126
40Si
lver
0.71
28Ap
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ch (1
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ff0.
820
1.09
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000
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Appr
oach
(1)
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0.82
01.
093
1.00
01.
000
1.00
01.
000
$752
.13
4.8%
3.7%
2.0%
Plan
13
7572
9PA0
0126
47PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
9PA0
0126
47Go
ld0.
8059
Appr
oach
(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
14
7572
9PA0
0126
48PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
9PA0
0126
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ld0.
8059
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(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
15
7572
9PA0
0126
49PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
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0126
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ld0.
8059
Appr
oach
(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
16
7572
9PA0
0126
50PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
9PA0
0126
50Go
ld0.
8059
Appr
oach
(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
17
7572
9PA0
0126
51PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
9PA0
0126
51Go
ld0.
8059
Appr
oach
(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
18
7572
9PA0
0126
52PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
9PA0
0126
52Go
ld0.
8059
Appr
oach
(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
19
7572
9PA0
0126
53PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
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0126
53Go
ld0.
8059
Appr
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(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
20
7572
9PA0
0126
54PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
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0126
54Go
ld0.
8059
Appr
oach
(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
21
7572
9PA0
0126
55PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
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0126
55Go
ld0.
8059
Appr
oach
(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
22
7572
9PA0
0126
56PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
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0126
56Go
ld0.
8059
Appr
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(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
23
7572
9PA0
0126
57PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
9PA0
0126
57Go
ld0.
8059
Appr
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(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
24
7572
9PA0
0126
58PP
OGe
ising
er M
arke
tpla
ce P
PO 2
0/40
/300
0E
7572
9PA0
0126
58Go
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8059
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(1)
On/
Off
0.88
31.
177
1.00
01.
000
1.00
01.
000
$871
.35
4.8%
3.7%
2.0%
Plan
25
7572
9PA0
0126
64PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/465
0E
7572
9PA0
0126
64Si
lver
0.71
78Ap
proa
ch (1
)O
n/O
ff0.
822
1.09
31.
000
1.00
01.
000
1.20
0$9
04.8
44.
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7%2.
0%Pl
an 2
675
729P
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7178
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0.82
21.
093
1.00
01.
000
1.00
01.
200
$904
.84
4.8%
3.7%
2.0%
Plan
27
7572
9PA0
0126
66PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/465
0E
7572
9PA0
0126
66Si
lver
0.71
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1.20
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an 2
875
729P
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0.82
21.
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1.00
01.
000
1.00
01.
200
$904
.84
4.8%
3.7%
2.0%
Plan
29
7572
9PA0
0126
68PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/465
0E
7572
9PA0
0126
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lver
0.71
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075
729P
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0.82
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200
$904
.84
4.8%
3.7%
2.0%
Plan
31
7572
9PA0
0126
70PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/465
0E
7572
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0126
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0.71
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729P
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0.82
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1.00
01.
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1.00
01.
200
$904
.84
4.8%
3.7%
2.0%
Plan
33
7572
9PA0
0126
72PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/465
0E
7572
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0126
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0.71
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7178
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0.82
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01.
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1.00
01.
200
$904
.84
4.8%
3.7%
2.0%
Plan
35
7572
9PA0
0126
74PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/465
0E
7572
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0126
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lver
0.71
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7178
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0.82
21.
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1.00
01.
000
1.00
01.
200
$904
.84
4.8%
3.7%
2.0%
Plan
37
7572
9PA0
0126
81PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/660
0M
7572
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0126
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0.65
Appr
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(1)
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Off
0.78
40.
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1.00
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1.00
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000
$633
.37
4.8%
3.7%
2.0%
Plan
38
7572
9PA0
0126
82PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/660
0M
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0126
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0.65
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(1)
On/
Off
0.78
40.
963
1.00
01.
000
1.00
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000
$633
.37
4.8%
3.7%
2.0%
Plan
39
7572
9PA0
0126
83PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/660
0M
7572
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0126
83Br
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0.65
Appr
oach
(1)
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Off
0.78
40.
963
1.00
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000
1.00
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000
$633
.37
4.8%
3.7%
2.0%
Plan
40
7572
9PA0
0126
84PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/660
0M
7572
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0126
84Br
onze
0.65
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oach
(1)
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Off
0.78
40.
963
1.00
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000
1.00
01.
000
$633
.37
4.8%
3.7%
2.0%
Plan
41
7572
9PA0
0126
85PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/660
0M
7572
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0126
85Br
onze
0.65
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oach
(1)
On/
Off
0.78
40.
963
1.00
01.
000
1.00
01.
000
$633
.37
4.8%
3.7%
2.0%
Plan
42
7572
9PA0
0126
86PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/660
0M
7572
9PA0
0126
86Br
onze
0.65
Appr
oach
(1)
On/
Off
0.78
40.
963
1.00
01.
000
1.00
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000
$633
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4.8%
3.7%
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Plan
43
7572
9PA0
0126
87PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
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0.78
40.
963
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000
1.00
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000
$633
.37
4.8%
3.7%
2.0%
Plan
44
7572
9PA0
0126
88PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/660
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7572
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On/
Off
0.78
40.
963
1.00
01.
000
1.00
01.
000
$633
.37
4.8%
3.7%
2.0%
Plan
45
7572
9PA0
0126
89PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/660
0M
7572
9PA0
0126
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0.65
Appr
oach
(1)
On/
Off
0.78
40.
963
1.00
01.
000
1.00
01.
000
$633
.37
4.8%
3.7%
2.0%
Plan
46
7572
9PA0
0126
90PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
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7572
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0.78
40.
963
1.00
01.
000
1.00
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000
$633
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4.8%
3.7%
2.0%
Plan
47
7572
9PA0
0126
91PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
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7572
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(1)
On/
Off
0.78
40.
963
1.00
01.
000
1.00
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000
$633
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4.8%
3.7%
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Plan
48
7572
9PA0
0126
92PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
/660
0M
7572
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0.78
40.
963
1.00
01.
000
1.00
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000
$633
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4.8%
3.7%
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Plan
49
7572
9PA0
0126
98PP
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ising
er M
arke
tpla
ce P
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093
1.00
01.
000
1.00
01.
200
$904
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4.8%
3.7%
2.0%
Plan
52
7572
9PA0
0127
01PP
OGe
ising
er M
arke
tpla
ce P
PO 3
0/60
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7572
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0.78
40.
963
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000
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000
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4.8%
3.7%
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Calib
ratio
n
45 C
FR P
art 1
56.8
(d) (
2) A
llow
able
Fac
tors
-
PA R
ate
Tem
plat
e Pa
rt II
ITa
ble
10. P
lan
Rate
s
Car
rier N
ame:
Gei
sing
er Q
uality
Opt
ions
Prod
uct(s
):PP
OM
arke
t Seg
men
t:In
divid
ual
Rat
e Ef
fect
ive D
ate:
1/1/
2020
Base
Per
iod
Star
t Dat
e1/
1/20
18D
ate
of M
ost R
ecen
t Mem
bers
hip
2/1/
2019
Mar
ket A
djus
ted
Inde
x R
ate
839.
08$
Plan
Num
ber
HIO
S Pl
an ID
(S
tand
ard
Com
pone
nt)
Plan
Typ
e (H
MO
, PO
S, P
PO, E
PO,
Inde
mni
ty, O
ther
)
Tota
ls
Tran
sitio
nal P
lans
TRAN
SITI
ONA
LN/
APl
an 1
7572
9PA0
0126
30PP
OPl
an 2
7572
9PA0
0126
31PP
OPl
an 3
7572
9PA0
0126
32PP
OPl
an 4
7572
9PA0
0126
33PP
OPl
an 5
7572
9PA0
0126
34PP
OPl
an 6
7572
9PA0
0126
35PP
OPl
an 7
7572
9PA0
0126
36PP
OPl
an 8
7572
9PA0
0126
37PP
OPl
an 9
7572
9PA0
0126
38PP
OPl
an 1
075
729P
A001
2639
PPO
Plan
11
7572
9PA0
0126
40PP
OPl
an 1
275
729P
A001
2641
PPO
Plan
13
7572
9PA0
0126
47PP
OPl
an 1
475
729P
A001
2648
PPO
Plan
15
7572
9PA0
0126
49PP
OPl
an 1
675
729P
A001
2650
PPO
Plan
17
7572
9PA0
0126
51PP
OPl
an 1
875
729P
A001
2652
PPO
Plan
19
7572
9PA0
0126
53PP
OPl
an 2
075
729P
A001
2654
PPO
Plan
21
7572
9PA0
0126
55PP
OPl
an 2
275
729P
A001
2656
PPO
Plan
23
7572
9PA0
0126
57PP
OPl
an 2
475
729P
A001
2658
PPO
Plan
25
7572
9PA0
0126
64PP
OPl
an 2
675
729P
A001
2665
PPO
Plan
27
7572
9PA0
0126
66PP
OPl
an 2
875
729P
A001
2667
PPO
Plan
29
7572
9PA0
0126
68PP
OPl
an 3
075
729P
A001
2669
PPO
Plan
31
7572
9PA0
0126
70PP
OPl
an 3
275
729P
A001
2671
PPO
Plan
33
7572
9PA0
0126
72PP
OPl
an 3
475
729P
A001
2673
PPO
Plan
35
7572
9PA0
0126
74PP
OPl
an 3
675
729P
A001
2675
PPO
Plan
37
7572
9PA0
0126
81PP
OPl
an 3
875
729P
A001
2682
PPO
Plan
39
7572
9PA0
0126
83PP
OPl
an 4
075
729P
A001
2684
PPO
Plan
41
7572
9PA0
0126
85PP
OPl
an 4
275
729P
A001
2686
PPO
Plan
43
7572
9PA0
0126
87PP
OPl
an 4
475
729P
A001
2688
PPO
Plan
45
7572
9PA0
0126
89PP
OPl
an 4
675
729P
A001
2690
PPO
Plan
47
7572
9PA0
0126
91PP
OPl
an 4
875
729P
A001
2692
PPO
Plan
49
7572
9PA0
0126
98PP
OPl
an 5
075
729P
A001
2699
PPO
Plan
51
7572
9PA0
0127
00PP
OPl
an 5
275
729P
A001
2701
PPO
Tota
l Co
vere
d Li
ves
Map
ped
into
202
0 Pl
ans @
02-
01-
2019
Tota
l Pol
icyh
olde
rs
@ 0
2-01
-201
9
2019
Cal
ibra
ted
Plan
Adj
uste
d In
dex
Rate
PM
PM
2020
Cal
ibra
ted
Plan
Adj
uste
d In
dex
Rate
PM
PM
Prop
osed
Rat
e Ch
ange
Co
mpa
red
to
Prio
r 12
mon
ths
% o
f Tot
al
Cove
red
Live
s1
23
45
67
89
Tota
l
2020
Co
ntin
ued/
Di
scon
tined
Pl
ans
Indi
cato
r
5,32
65,
101
336.
79$
36
0.53
$
7.
1%-
6
3,31
8
-
108
1,96
4
1,
260
-
82
4
7,
480
-
1,38
4
N/A
N/A
N/A
N/A
-
-
1,00
3
-
47
65
1
36
1
-
92
2,
154
0
107
69
$3
74.1
139