bridging the gap between healthcare and health policy -...
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Supporting Document Schedules Satisfied - Item: HBP - Filing DescriptionComments:Attachment(s): Moda SMGR 2016 Filing Description.pdfItem Status:Status Date:
Satisfied - Item: HBP - Appendix II: Cost Containment and Quality Improvement EffortsComments:Attachment(s): Moda Health Small Group Appendix II.pdfItem Status:Status Date:
SERFF Tracking #: ODSV-130056446 State Tracking #: ODSV-130056446 Company Tracking #: 2015-21-01-OR
State: Oregon Filing Company: Moda Health Plan, Inc.
TOI/Sub-TOI: H16G Group Health - Major Medical/H16G.003A Small Group Only - PPO
Product Name: Oregon Small Group Rates 2016
Project Name/Number: Oregon Small Group 2016 Rates/2015-21-01-OR
PDF Pipeline for SERFF Tracking Number ODSV-130056446 Generated 05/01/2015 05:43 PM
FILING DESCRIPTION
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
This filing contains details on the analysis used to determine requested individual rates for Medical/Rx
plans effective January 1, 2016 through December 31, 2016, available both on and off the Exchange.
Included in this filing are complete rate tables, all relevant rating factors, and a detailed discussion of the
assumptions and methods used to determine the rates.
Filing Information
The plans contained in this filing consist of:
• Platinum Tier: Two PPO plans
• Gold Tier: Oregon Standard Plan and six additional PPO plans
• Silver Tier: Oregon Standard Plan, three HSA plans, fourteen additional PPO plans,
• Bronze Tier: Oregon Standard Plan, one HSA plan, and nine additional PPO plans
Plans utilizing the Rose City network will only be available in Multnomah, Clackamas, Washington and
Yamhill counties. Plans utilizing the Synergy network will be available in at least one county in each
rating area. Plans utilizing the Summit network will be available in parts of Region 4 and 6. The
Connexus network will be available statewide. All plans except for the Value 2000 (Rose City) and Moda
Health Rose City Essence 5000 will be offered off the exchange. The PPO Platinum 250, PPO Platinum
500, PPO 500, PPO 1000A, PPO 1500, PPO 3000, Moda Health Connexus Aspire 2500, Moda Health
Connexus Fundamental 3500, Moda Health Connexus HSA 1500, Moda Health Connexus HSA 3250,
Moda Health Connexus Basic 6500, Moda Health Synergy/Summit Exclusive 2000, Moda Health
Synergy/Summit Exclusive 5000, PPO platinum Synergy/Summit Exclusive 250, PPO Synergy/Summit
Exclusive 1000A and all Moda Health Standard Plans will be offered on and off the exchange.
Following federal guidelines, most plans with the exception of the standard plans, PPO 500, PPO 1000A,
PPO 1000B, PPO 1500, PPO 2500, PPO 3000, Value 1500, Value 2000, Value 2500, Value 3000, and Value
3500 are being discontinued. However similar plan designs that falls within the same metallic tier will be
offered and members will be automatically moved to the applicable plan. The plans will be treated as
modifications in all documentation except the URRT to provide meaningful rate increase information.
Prior Filing Information
Rates for January 1, 2015 were filed with SERFF tracking number ODSV-129569436 and were approved
on August 12, 2014. The HIOS submission number for this filing is 39424-410713868361316400.
Comparing projected results for the experience to the actual results shows administrative costs slightly
higher than projected due to increases in taxes and assessments.
FILING DESCRIPTION
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Projected Actual
Claims 76.1% 74.4%
Administrative Costs 22.4% 21.7%
Margin 1.5% 3.9%
Rate Change Summary
The requested rate change will be effective for 12 months, from January 1, 2016 to December 31, 2016
with quarterly rating trend. The weighted average rate change included in this filing is 4.22% with the
minimum change equal to 0.18% and the maximum rate change equal to 24.33%. This does not account
for any changes between age tiers.
Key changes in the filing include:
• Plan relativities and Region rating factors were modified.
• Plans in the platinum metallic tier will be offered.
• This filing includes new plans in all metallic tiers to replace the previous portfolio. Members
were mapped to the new plan designs in way to limit disruption if possible.
• No major benefit changes were made to existing plans. All modifications are detailed in Exhibit
2.
Filing Impact
As of March 31, 2015, there are 16,137 members impacted by the requested rate change. Membership
is projected to increase uniformly over the year to about 29,000.
COST CONTAINMENT AND QUALITY IMPROVEMENT EFFORTS Appendix II
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
1 | P a g e
Moda Health strives to manage costs while providing the highest quality service and care for our members. Our
programs help members meet their health care needs through prevention, wellness and condition specific
programs. We are continually looking for opportunities to help members maximize the effectiveness of their
health care dollars. Here are a few examples of ongoing cost containment and quality improvement efforts at
Moda Health.
Medical Quality Improvement Committee (MQIC) –Comprised of representatives from multiple departments that
oversees Moda Health quality improvement programs. This committee monitors and evaluates the health care
services provided to Moda Health members in Oregon, Washington, and Alaska to ensure that they meet current
medical practice and service standards. The MQIC meets at least six times per year and facilitates communication
among Moda Health departments, providers, employer groups and members to ensure the delivery of healthcare
services in an efficient management of resources.
Pharmacy and Therapeutics Committee – Chaired by a Moda Health medical director, this robust multi-
department committee oversees drug formulary decisions to ensure the availability of safe and effective drug
choices by: promoting evidence-based standards in the formulary decision-making process to ensure clinical
efficacy, patient safety, and cost-effective medication options; establishing policies and procedures to educate and
inform health care providers, members and clients about drug products and appropriate use; as well as developing
protocols and procedures for the ease of and access to non-formulary drugs.
Case Management and Care Coordination - Our programs use evidence-based medicine and best practice clinical
care guidelines. The guidelines are used when prior authorizing inpatient and surgical admissions, durable medical
equipment, outpatient therapies and chiropractic care, acupuncture and massage therapy. In addition, evidence
based-guidelines are used to assign initial length of stay, continued stay, and to confirm the appropriate level of
care for inpatient, acute rehabilitation and skilled nursing facility admissions.
Care coordination nurses follow members through preauthorization of an inpatient admission, inpatient
concurrent review, discharge planning, and the recovery phase of an acute condition, when coordination of
additional services is needed. The care management programs use nationally recognized clinical care guidelines
developed through evidence-based medicine and best practice. This approach supports our readmission
prevention program.
Moda Health has ongoing quality improvement projects for congestive heart failure (CHF), inpatient readmissions,
depression screening, and hospice utilization. These efforts also include communication among case managers,
health coaches, and behavioral healthcare coordinators to ensure the members receive the appropriate level of
care with the appropriate provider.
To ensure quality centers of excellence are available for transplant care, specialized cancer care that is not
available locally, kidney dialysis, and complex neonatal case management.
Utilization management delegation – In an effort to reduce costs and improve efficiencies and quality, Moda
Health delegates some utilization management activities to other entities who are experts in their fields. The
Medical Management Delegation Committee meets quarterly to review utilization and denial reports and other
information submitted by the delegated entity. For Oregon, Moda Health delegates utilization management
activities for advanced imaging and specialty oncology drugs. Using delegated utilization management programs
continues to reduce unwarranted variation and high utilization. This arrangement also provides peer-to-peer
communication with providers.
Advanced Imaging Review – Driven by high-tech services such as CT, MRI, Nuclear Medicine, and PET, outpatient
diagnostic imaging has become the fastest growing medical expenditure in the United States. Imaging services per
COST CONTAINMENT AND QUALITY IMPROVEMENT EFFORTS Appendix II
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
2 | P a g e
Medicare beneficiary increased by 62% between 1999 and 2004. The increase in imaging use has also caused an
equally dramatic increase in the amount of radiation exposure associated with these studies.
At Moda Health our focus is to improve patient safety, enhance quality of health care and facilitate cost effective
evidence-based care. Image management allows these goals to be achieved. The program promotes the
appropriate use of diagnostic imaging through the application of widely accepted clinical guidelines. This leads to
improved clinical quality and appropriate cost management in diagnostic imaging. Utilization of advanced imaging
has decreased ~4% since the implementation of this program without any evidence of compromising the quality of
patient care.
Length of stay review - assignment of initial length of stay days, and concurrent review of hospital, inpatient
rehabilitation and skilled nursing facility stays for extension of the length of stay days, based on evidence based,
best practice targets. This initiative has decreased the average length of stay ~.3%
Inpatient Care Coordination RNs are assigned to facilities, by regions in the states of Oregon, Washington and
Alaska, to review inpatient admission length of stay. The same nurse following hospital admissions in a particular
region of Oregon is also assigned network hospitals regionally that are contiguous to the areas assigned. The
regions are as follows:
• Portland Metro
• North Coast
• Valley
• South Coast/Southwest Oregon
• Central Oregon/ Gorge
• Eastern/South Central Oregon
• Clark County
Advantages to assigning by facility and region:
• Positive provider relationships: The facility nurse knows which nurse to call at Moda Health
• Reduced inpatient length of stay and correct level of care: The facility nurse calls the Moda Health nurse
directly to expedite authorization and transition to a skilled facility, rehabilitation facility, or to home
care, when assistance with discharge planning is needed
• Smooth transitions of care: The same Moda Health nurse follows the member when a transfer to a
neighboring facility in a border state is required for a specialized, or higher, level of care.
Health Promotion and Engagement - Health Promotion and Engagement designs a comprehensive and integrated
suite of programs and services for members at all stages of life and health aimed at improving population health,
as well as members’ experience of care, all while reducing costs. These programs and services assist members in
making informed decisions and promote a wide array of key health promotion and wellness activities including:
• Research/implementation of quality initiatives
• Wellness consulting
• Disease management and health coaching
• Community events
One-on-one disease management and health coaching - Our multidisciplinary team of clinicians, including
registered nurses, registered dieticians, social workers and dental hygienists, provides Moda Health members with
one-on-one support in the following nine health areas: Cardiac care, Dental Care, Depression Care, Respiratory
Care, Women’s Health and Maternity Care, Weight Care, Spine & Joint Care, and Lifestyle Coaching. The purpose
of one-on-one disease management and health coaching is to assist members with self-management of their
condition, prevent development and progression of complications, and improve adherence to their medical care
regime.
COST CONTAINMENT AND QUALITY IMPROVEMENT EFFORTS Appendix II
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
3 | P a g e
Moda Health Post-hospitalization care management - Care coordination nurses follow all members with post
hospital needs (home health, home infusion, palliative and hospice care) and refer to case management if
additional long term or complex needs are identified. Cases are referred to health coaching programs when post
hospital discharge needs are complete and member requires follow up for chronic illness, depression care, or
lifestyle coaching
• All Mental Health hospitalizations and chemical dependency facility discharges trigger both a seven and
thirty day follow up by Moda Health Behavioral Health to assure the member has an outpatient follow up
appointment, before leaving the facility. Behavioral health contacts the member to remind them of the
appointment and confirms with the provider that the member kept the appointment. This is augmented
by trigger diagnosis, internal case review hospital follow up, care coordination and case management
referral, Co-morbid diagnosis and medical management review committee.
• All congestive heart failure (CHF) hospitalizations trigger a follow-up within seven days by Medical
Management & Health Coaching. This is augmented by trigger Diagnosis, internal Case Review- hospital
follow up, Care coordination and Case Management referral, Co-morbid diagnosis and medical
management review committee.
Rate/Rule Schedule
Item
No.
Schedule
Item
Status
Document Name
Affected Form Numbers
(Separated with commas) Rate Action Rate Action Information Attachments
1 Rate Table ModaSG-OR 1-1-2016 Revised Previous State Filing Number:ODSV-129569436Percent Rate Change Request:4.2
Quarter 1 RateTable.pdf, Quarter 2Rate Table.pdf,Quarter 3 RateTable.pdf, Quarter 4Rate Table.pdf, GARArea 1.pdf, GAR Area2.pdf, GAR Area 3.pdf,GAR Area 4.pdf, GARArea 5.pdf, GAR Area6.pdf, GAR Area 7.pdf,
SERFF Tracking #: ODSV-130056446 State Tracking #: ODSV-130056446 Company Tracking #: 2015-21-01-OR
State: Oregon Filing Company: Moda Health Plan, Inc.
TOI/Sub-TOI: H16G Group Health - Major Medical/H16G.003A Small Group Only - PPO
Product Name: Oregon Small Group Rates 2016
Project Name/Number: Oregon Small Group 2016 Rates/2015-21-01-OR
PDF Pipeline for SERFF Tracking Number ODSV-130056446 Generated 05/01/2015 05:42 PM
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Area 1 Area 1Moda Health Plan Inc
Plan
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500HIOS Plan
0-20 $230.25 $227.27 $214.88 $208.81 $208.42 $203.26 $182.67 $179.24 $182.5021 $362.59 $357.91 $338.40 $328.84 $328.23 $320.09 $287.68 $282.28 $287.4022 $362.59 $357.91 $338.40 $328.84 $328.23 $320.09 $287.68 $282.28 $287.4023 $362.59 $357.91 $338.40 $328.84 $328.23 $320.09 $287.68 $282.28 $287.4024 $362.59 $357.91 $338.40 $328.84 $328.23 $320.09 $287.68 $282.28 $287.4025 $364.04 $359.34 $339.75 $330.16 $329.54 $321.37 $288.83 $283.40 $288.5526 $371.30 $366.50 $346.52 $336.73 $336.10 $327.78 $294.58 $289.05 $294.2927 $380.00 $375.09 $354.64 $344.62 $343.98 $335.46 $301.49 $295.82 $301.1928 $394.14 $389.05 $367.84 $357.45 $356.78 $347.94 $312.70 $306.83 $312.4029 $405.74 $400.50 $378.66 $367.97 $367.28 $358.18 $321.91 $315.87 $321.6030 $411.54 $406.23 $384.08 $373.23 $372.54 $363.31 $326.51 $320.38 $326.2031 $420.25 $414.82 $392.20 $381.13 $380.41 $370.99 $333.42 $327.16 $333.0932 $428.95 $423.41 $400.32 $389.02 $388.29 $378.67 $340.32 $333.93 $339.9933 $434.39 $428.78 $405.40 $393.95 $393.21 $383.47 $344.64 $338.17 $344.3034 $440.19 $434.50 $410.81 $399.21 $398.47 $388.59 $349.24 $342.68 $348.9035 $443.09 $437.37 $413.52 $401.84 $401.09 $391.15 $351.54 $344.94 $351.2036 $445.99 $440.23 $416.23 $404.47 $403.72 $393.71 $353.84 $347.20 $353.5037 $448.89 $443.09 $418.93 $407.10 $406.34 $396.28 $356.14 $349.46 $355.8038 $451.79 $445.96 $421.64 $409.74 $408.97 $398.84 $358.45 $351.71 $358.1039 $457.59 $451.68 $427.05 $415.00 $414.22 $403.96 $363.05 $356.23 $362.7040 $463.40 $457.41 $432.47 $420.26 $419.47 $409.08 $367.65 $360.75 $367.2941 $472.10 $466.00 $440.59 $428.15 $427.35 $416.76 $374.56 $367.52 $374.1942 $480.44 $474.23 $448.37 $435.71 $434.90 $424.12 $381.17 $374.01 $380.8043 $492.04 $485.69 $459.20 $446.24 $445.40 $434.37 $390.38 $383.05 $390.0044 $506.54 $500.00 $472.74 $459.39 $458.53 $447.17 $401.88 $394.34 $401.4945 $523.59 $516.82 $488.64 $474.85 $473.96 $462.21 $415.41 $407.61 $415.0046 $543.89 $536.87 $507.59 $493.26 $492.34 $480.14 $431.52 $423.41 $431.1047 $566.73 $559.42 $528.91 $513.98 $513.02 $500.31 $449.64 $441.20 $449.2048 $592.84 $585.19 $553.28 $537.65 $536.65 $523.35 $470.35 $461.52 $469.8949 $618.59 $610.60 $577.30 $561.00 $559.95 $546.08 $490.78 $481.56 $490.3050 $647.59 $639.23 $604.37 $587.31 $586.21 $571.69 $513.79 $504.14 $513.2951 $676.24 $667.50 $631.11 $613.29 $612.14 $596.97 $536.52 $526.44 $536.0052 $707.78 $698.64 $660.55 $641.90 $640.70 $624.82 $561.55 $551.00 $561.0053 $739.69 $730.14 $690.33 $670.83 $669.58 $652.99 $586.86 $575.84 $586.2954 $774.14 $764.14 $722.47 $702.07 $700.76 $683.40 $614.19 $602.66 $613.5955 $808.58 $798.14 $754.62 $733.31 $731.94 $713.81 $641.52 $629.47 $640.9056 $845.93 $835.01 $789.48 $767.19 $765.75 $746.78 $671.15 $658.55 $670.5057 $883.64 $872.23 $824.67 $801.38 $799.88 $780.07 $701.07 $687.90 $700.3958 $923.89 $911.96 $862.23 $837.89 $836.32 $815.60 $733.00 $719.24 $732.2959 $943.83 $931.64 $880.84 $855.97 $854.37 $833.20 $748.82 $734.76 $748.1060 $984.08 $971.37 $918.40 $892.47 $890.80 $868.73 $780.76 $766.09 $780.0061 $1,018.89 $1,005.73 $950.89 $924.04 $922.31 $899.46 $808.37 $793.19 $807.5962 $1,041.73 $1,028.28 $972.21 $944.76 $942.99 $919.63 $826.50 $810.98 $825.6963 $1,070.38 $1,056.55 $998.94 $970.74 $968.92 $944.92 $849.22 $833.28 $848.40
64+ $1,087.77 $1,073.72 $1,015.18 $986.51 $984.67 $960.27 $863.02 $846.82 $862.18
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health Plan Inc
Value 2000
Value 2000
(Rose City) Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
$176.20 $162.75 $171.49 $167.31 $163.49 $154.58 $174.97 $169.90 $148.15$277.47 $256.29 $270.07 $263.47 $257.46 $243.43 $275.54 $267.56 $233.31$277.47 $256.29 $270.07 $263.47 $257.46 $243.43 $275.54 $267.56 $233.31$277.47 $256.29 $270.07 $263.47 $257.46 $243.43 $275.54 $267.56 $233.31$277.47 $256.29 $270.07 $263.47 $257.46 $243.43 $275.54 $267.56 $233.31$278.58 $257.32 $271.15 $264.53 $258.49 $244.40 $276.64 $268.63 $234.24$284.13 $262.44 $276.55 $269.80 $263.64 $249.27 $282.15 $273.98 $238.91$290.79 $268.59 $283.03 $276.12 $269.82 $255.11 $288.76 $280.40 $244.51$301.61 $278.59 $293.57 $286.40 $279.86 $264.61 $299.51 $290.83 $253.60$310.49 $286.79 $302.21 $294.83 $288.10 $272.40 $308.33 $299.39 $261.07$314.93 $290.89 $306.53 $299.04 $292.22 $276.29 $312.74 $303.68 $264.80$321.59 $297.04 $313.01 $305.37 $298.40 $282.13 $319.35 $310.10 $270.40$328.25 $303.19 $319.49 $311.69 $304.58 $287.98 $325.96 $316.52 $276.00$332.41 $307.04 $323.54 $315.64 $308.44 $291.63 $330.09 $320.53 $279.50$336.85 $311.14 $327.87 $319.86 $312.56 $295.52 $334.50 $324.81 $283.23$339.07 $313.19 $330.03 $321.96 $314.62 $297.47 $336.71 $326.95 $285.10$341.29 $315.24 $332.19 $324.07 $316.68 $299.42 $338.91 $329.09 $286.97$343.51 $317.29 $334.35 $326.18 $318.74 $301.37 $341.12 $331.23 $288.83$345.73 $319.34 $336.51 $328.29 $320.80 $303.31 $343.32 $333.37 $290.70$350.17 $323.44 $340.83 $332.50 $324.92 $307.21 $347.73 $337.66 $294.43$354.61 $327.54 $345.15 $336.72 $329.04 $311.10 $352.14 $341.94 $298.17$361.27 $333.69 $351.63 $343.04 $335.22 $316.94 $358.75 $348.36 $303.77$367.65 $339.59 $357.84 $349.10 $341.14 $322.54 $365.09 $354.51 $309.13$376.53 $347.79 $366.49 $357.53 $349.38 $330.33 $373.91 $363.07 $316.60$387.63 $358.04 $377.29 $368.07 $359.68 $340.07 $384.93 $373.78 $325.93$400.67 $370.09 $389.98 $380.46 $371.78 $351.51 $397.88 $386.35 $336.89$416.21 $384.44 $405.11 $395.21 $386.20 $365.14 $413.31 $401.33 $349.96$433.69 $400.58 $422.12 $411.81 $402.42 $380.48 $430.67 $418.19 $364.66$453.67 $419.04 $441.56 $430.78 $420.95 $398.01 $450.50 $437.45 $381.46$473.37 $437.23 $460.74 $449.49 $439.23 $415.29 $470.07 $456.45 $398.02$495.57 $457.74 $482.35 $470.56 $459.83 $434.76 $492.11 $477.85 $416.69$517.49 $477.99 $503.68 $491.38 $480.17 $454.00 $513.88 $498.99 $435.12$541.63 $500.28 $527.18 $514.30 $502.57 $475.17 $537.85 $522.27 $455.41$566.05 $522.84 $550.94 $537.49 $525.23 $496.60 $562.10 $545.81 $475.95$592.41 $547.18 $576.60 $562.52 $549.69 $519.72 $588.27 $571.23 $498.11$618.77 $571.53 $602.26 $587.55 $574.15 $542.85 $614.45 $596.65 $520.27$647.35 $597.93 $630.07 $614.68 $600.66 $567.92 $642.83 $624.21 $544.30$676.21 $624.58 $658.16 $642.09 $627.44 $593.24 $671.49 $652.03 $568.57$707.01 $653.03 $688.14 $671.33 $656.02 $620.26 $702.07 $681.73 $594.47$722.27 $667.13 $702.99 $685.82 $670.18 $633.65 $717.23 $696.45 $607.30$753.07 $695.58 $732.97 $715.07 $698.76 $660.67 $747.81 $726.15 $633.19$779.70 $720.18 $758.90 $740.36 $723.47 $684.04 $774.26 $751.83 $655.59$797.18 $736.33 $775.91 $756.96 $739.69 $699.37 $791.62 $768.69 $670.29$819.10 $756.58 $797.25 $777.77 $760.03 $718.60 $813.39 $789.82 $688.72$832.41 $768.87 $810.20 $790.41 $772.38 $730.28 $826.60 $802.66 $699.91
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 1
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Rose City
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
$137.11 $185.66 $177.42 $170.76 $150.32 $137.43 $126.26 $136.60 $136.91$215.93 $292.38 $279.40 $268.91 $236.72 $216.42 $198.84 $215.11 $215.61$215.93 $292.38 $279.40 $268.91 $236.72 $216.42 $198.84 $215.11 $215.61$215.93 $292.38 $279.40 $268.91 $236.72 $216.42 $198.84 $215.11 $215.61$215.93 $292.38 $279.40 $268.91 $236.72 $216.42 $198.84 $215.11 $215.61$216.79 $293.55 $280.51 $269.98 $237.66 $217.29 $199.64 $215.97 $216.47$221.11 $299.40 $286.10 $275.36 $242.40 $221.62 $203.61 $220.28 $220.78$226.29 $306.41 $292.81 $281.81 $248.08 $226.81 $208.38 $225.44 $225.96$234.71 $317.82 $303.70 $292.30 $257.31 $235.25 $216.14 $233.83 $234.36$241.62 $327.17 $312.64 $300.91 $264.89 $242.18 $222.50 $240.71 $241.26$245.08 $331.85 $317.12 $305.21 $268.67 $245.64 $225.68 $244.15 $244.71$250.26 $338.87 $323.82 $311.66 $274.36 $250.84 $230.46 $249.32 $249.89$255.44 $345.88 $330.53 $318.12 $280.04 $256.03 $235.23 $254.48 $255.06$258.68 $350.27 $334.72 $322.15 $283.59 $259.28 $238.21 $257.71 $258.30$262.13 $354.95 $339.19 $326.45 $287.38 $262.74 $241.39 $261.15 $261.75$263.86 $357.29 $341.42 $328.60 $289.27 $264.47 $242.98 $262.87 $263.47$265.59 $359.63 $343.66 $330.76 $291.16 $266.20 $244.57 $264.59 $265.20$267.32 $361.96 $345.89 $332.91 $293.06 $267.93 $246.16 $266.31 $266.92$269.04 $364.30 $348.13 $335.06 $294.95 $269.66 $247.75 $268.03 $268.65$272.50 $368.98 $352.60 $339.36 $298.74 $273.13 $250.94 $271.47 $272.10$275.95 $373.66 $357.07 $343.66 $302.53 $276.59 $254.12 $274.91 $275.55$281.14 $380.68 $363.77 $350.12 $308.21 $281.78 $258.89 $280.08 $280.72$286.10 $387.40 $370.20 $356.30 $313.65 $286.76 $263.46 $285.02 $285.68$293.01 $396.76 $379.14 $364.91 $321.23 $293.69 $269.83 $291.91 $292.58$301.65 $408.45 $390.32 $375.66 $330.69 $302.35 $277.78 $300.51 $301.20$311.80 $422.19 $403.45 $388.30 $341.82 $312.52 $287.13 $310.62 $311.34$323.89 $438.57 $419.09 $403.36 $355.08 $324.64 $298.26 $322.67 $323.41$337.49 $456.99 $436.70 $420.30 $369.99 $338.27 $310.79 $336.22 $336.99$353.04 $478.04 $456.81 $439.66 $387.03 $353.85 $325.10 $351.71 $352.52$368.37 $498.80 $476.65 $458.75 $403.84 $369.22 $339.22 $366.98 $367.82$385.64 $522.19 $499.00 $480.27 $422.78 $386.53 $355.13 $384.19 $385.07$402.70 $545.29 $521.07 $501.51 $441.48 $403.63 $370.84 $401.19 $402.11$421.49 $570.72 $545.38 $524.91 $462.07 $422.46 $388.14 $419.90 $420.86$440.49 $596.45 $569.97 $548.57 $482.90 $441.51 $405.63 $438.83 $439.84$461.00 $624.23 $596.51 $574.12 $505.39 $462.07 $424.52 $459.27 $460.32$481.52 $652.00 $623.05 $599.66 $527.88 $482.63 $443.41 $479.70 $480.80$503.76 $682.12 $651.83 $627.36 $552.26 $504.92 $463.89 $501.86 $503.01$526.21 $712.53 $680.89 $655.33 $576.88 $527.43 $484.57 $524.23 $525.43$550.18 $744.98 $711.90 $685.17 $603.16 $551.45 $506.64 $548.11 $549.37$562.06 $761.06 $727.27 $699.96 $616.18 $563.35 $517.58 $559.94 $561.22$586.02 $793.51 $758.28 $729.81 $642.45 $587.38 $539.65 $583.82 $585.16$606.75 $821.58 $785.10 $755.63 $665.18 $608.15 $558.74 $604.47 $605.85$620.36 $840.00 $802.71 $772.57 $680.09 $621.79 $571.27 $618.02 $619.44$637.41 $863.10 $824.78 $793.81 $698.79 $638.89 $586.98 $635.01 $636.47$647.77 $877.12 $838.18 $806.71 $710.14 $649.26 $596.51 $645.33 $646.81
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 1 Area 2Moda Health Plan Inc
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500
$156.17 $122.26 $208.87 $188.97 $204.60 $171.64 $139.39 $222.19 $219.32$245.94 $192.53 $328.93 $297.60 $322.21 $270.30 $219.51 $349.90 $345.38$245.94 $192.53 $328.93 $297.60 $322.21 $270.30 $219.51 $349.90 $345.38$245.94 $192.53 $328.93 $297.60 $322.21 $270.30 $219.51 $349.90 $345.38$245.94 $192.53 $328.93 $297.60 $322.21 $270.30 $219.51 $349.90 $345.38$246.92 $193.30 $330.25 $298.79 $323.49 $271.38 $220.39 $351.30 $346.77$251.84 $197.15 $336.82 $304.74 $329.94 $276.79 $224.78 $358.30 $353.67$257.74 $201.77 $344.72 $311.88 $337.67 $283.28 $230.05 $366.70 $361.96$267.34 $209.28 $357.55 $323.49 $350.24 $293.82 $238.61 $380.34 $375.43$275.21 $215.44 $368.07 $333.01 $360.55 $302.47 $245.64 $391.54 $386.49$279.14 $218.52 $373.34 $337.77 $365.70 $306.79 $249.15 $397.14 $392.01$285.04 $223.14 $381.23 $344.91 $373.44 $313.28 $254.42 $405.54 $400.30$290.95 $227.76 $389.12 $352.06 $381.17 $319.77 $259.68 $413.94 $408.59$294.64 $230.65 $394.06 $356.52 $386.00 $323.82 $262.98 $419.18 $413.77$298.57 $233.73 $399.32 $361.28 $391.16 $328.15 $266.49 $424.78 $419.30$300.54 $235.27 $401.95 $363.66 $393.74 $330.31 $268.24 $427.58 $422.06$302.51 $236.81 $404.58 $366.04 $396.31 $332.47 $270.00 $430.38 $424.82$304.47 $238.35 $407.21 $368.42 $398.89 $334.63 $271.76 $433.18 $427.59$306.44 $239.89 $409.85 $370.80 $401.47 $336.80 $273.51 $435.98 $430.35$310.38 $242.97 $415.11 $375.57 $406.62 $341.12 $277.03 $441.58 $435.88$314.31 $246.05 $420.37 $380.33 $411.78 $345.44 $280.54 $447.18 $441.40$320.21 $250.67 $428.27 $387.47 $419.51 $351.93 $285.81 $455.57 $449.69$325.87 $255.10 $435.83 $394.31 $426.92 $358.15 $290.85 $463.62 $457.63$333.74 $261.26 $446.36 $403.84 $437.23 $366.80 $297.88 $474.82 $468.69$343.58 $268.96 $459.51 $415.74 $450.12 $377.61 $306.66 $488.81 $482.50$355.14 $278.01 $474.97 $429.73 $465.27 $390.31 $316.98 $505.26 $498.74$368.91 $288.79 $493.39 $446.39 $483.31 $405.45 $329.27 $524.86 $518.08$384.40 $300.92 $514.12 $465.14 $503.61 $422.48 $343.10 $546.90 $539.84$402.11 $314.78 $537.80 $486.57 $526.81 $441.94 $358.90 $572.09 $564.70$419.57 $328.45 $561.15 $507.70 $549.68 $461.13 $374.49 $596.94 $589.23$439.25 $343.86 $587.47 $531.51 $575.46 $482.76 $392.05 $624.93 $616.86$458.68 $359.06 $613.45 $555.02 $600.91 $504.11 $409.39 $652.57 $644.14$480.07 $375.81 $642.07 $580.91 $628.95 $527.63 $428.49 $683.01 $674.19$501.72 $392.76 $671.02 $607.10 $657.30 $551.41 $447.81 $713.80 $704.58$525.08 $411.05 $702.26 $635.37 $687.91 $577.09 $468.66 $747.04 $737.40$548.45 $429.34 $733.51 $663.64 $718.52 $602.77 $489.51 $780.28 $770.21$573.78 $449.17 $767.39 $694.29 $751.71 $630.61 $512.12 $816.32 $805.78$599.36 $469.19 $801.60 $725.24 $785.22 $658.72 $534.95 $852.71 $841.70$626.65 $490.56 $838.11 $758.28 $820.98 $688.73 $559.32 $891.55 $880.04$640.18 $501.15 $856.20 $774.64 $838.70 $703.59 $571.39 $910.80 $899.04$667.48 $522.52 $892.71 $807.68 $874.47 $733.60 $595.76 $949.64 $937.37$691.09 $541.00 $924.29 $836.25 $905.40 $759.55 $616.83 $983.23 $970.53$706.59 $553.13 $945.01 $854.99 $925.70 $776.57 $630.66 $1,005.27 $992.29$726.01 $568.34 $971.00 $878.50 $951.15 $797.93 $648.00 $1,032.91 $1,019.58$737.81 $577.57 $986.78 $892.78 $966.61 $810.89 $658.53 $1,049.70 $1,036.14
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500
$207.36 $201.51 $201.13 $196.15 $176.28 $172.97 $176.11 $170.03 $165.49$326.55 $317.33 $316.74 $308.89 $277.61 $272.40 $277.34 $267.76 $260.62$326.55 $317.33 $316.74 $308.89 $277.61 $272.40 $277.34 $267.76 $260.62$326.55 $317.33 $316.74 $308.89 $277.61 $272.40 $277.34 $267.76 $260.62$326.55 $317.33 $316.74 $308.89 $277.61 $272.40 $277.34 $267.76 $260.62$327.86 $318.60 $318.00 $310.13 $278.72 $273.49 $278.45 $268.83 $261.66$334.39 $324.95 $324.34 $316.30 $284.27 $278.93 $283.99 $274.19 $266.87$342.23 $332.56 $331.94 $323.72 $290.93 $285.47 $290.65 $280.62 $273.13$354.96 $344.94 $344.29 $335.76 $301.76 $296.09 $301.47 $291.06 $283.29$365.41 $355.09 $354.43 $345.65 $310.64 $304.81 $310.34 $299.63 $291.63$370.64 $360.17 $359.50 $350.59 $315.09 $309.17 $314.78 $303.91 $295.80$378.47 $367.79 $367.10 $358.00 $321.75 $315.71 $321.44 $310.34 $302.06$386.31 $375.40 $374.70 $365.42 $328.41 $322.24 $328.09 $316.76 $308.31$391.21 $380.16 $379.45 $370.05 $332.57 $326.33 $332.25 $320.78 $312.22$396.43 $385.24 $384.52 $374.99 $337.02 $330.69 $336.69 $325.06 $316.39$399.05 $387.78 $387.05 $377.46 $339.24 $332.87 $338.91 $327.21 $318.47$401.66 $390.32 $389.59 $379.93 $341.46 $335.05 $341.13 $329.35 $320.56$404.27 $392.86 $392.12 $382.41 $343.68 $337.23 $343.34 $331.49 $322.64$406.88 $395.39 $394.65 $384.88 $345.90 $339.40 $345.56 $333.63 $324.73$412.11 $400.47 $399.72 $389.82 $350.34 $343.76 $350.00 $337.92 $328.90$417.33 $405.55 $404.79 $394.76 $354.78 $348.12 $354.44 $342.20 $333.07$425.17 $413.17 $412.39 $402.17 $361.45 $354.66 $361.09 $348.63 $339.32$432.68 $420.46 $419.68 $409.28 $367.83 $360.92 $367.47 $354.79 $345.32$443.13 $430.62 $429.81 $419.16 $376.71 $369.64 $376.35 $363.35 $353.66$456.19 $443.31 $442.48 $431.52 $387.82 $380.54 $387.44 $374.06 $364.08$471.54 $458.23 $457.37 $446.04 $400.87 $393.34 $400.48 $386.65 $376.33$489.83 $476.00 $475.11 $463.34 $416.41 $408.59 $416.01 $401.64 $390.93$510.40 $495.99 $495.06 $482.80 $433.90 $425.75 $433.48 $418.51 $407.35$533.91 $518.84 $517.87 $505.04 $453.89 $445.37 $453.45 $437.79 $426.11$557.10 $541.37 $540.35 $526.97 $473.60 $464.71 $473.14 $456.80 $444.61$583.22 $566.75 $565.69 $551.68 $495.81 $486.50 $495.33 $478.22 $465.46$609.02 $591.82 $590.71 $576.08 $517.74 $508.02 $517.24 $499.38 $486.05$637.43 $619.43 $618.27 $602.95 $541.89 $531.72 $541.36 $522.67 $508.73$666.16 $647.36 $646.14 $630.14 $566.32 $555.69 $565.77 $546.24 $531.66$697.19 $677.50 $676.23 $659.48 $592.69 $581.56 $592.12 $571.67 $556.42$728.21 $707.65 $706.32 $688.83 $619.07 $607.44 $618.46 $597.11 $581.18$761.84 $740.33 $738.95 $720.64 $647.66 $635.50 $647.03 $624.69 $608.02$795.81 $773.34 $771.89 $752.77 $676.53 $663.83 $675.87 $652.54 $635.13$832.05 $808.56 $807.05 $787.05 $707.35 $694.06 $706.66 $682.26 $664.05$850.01 $826.01 $824.47 $804.04 $722.61 $709.05 $721.91 $696.99 $678.39$886.26 $861.24 $859.62 $838.33 $753.43 $739.28 $752.70 $726.71 $707.32$917.61 $891.70 $890.03 $867.98 $780.08 $765.43 $779.32 $752.41 $732.34$938.18 $911.69 $909.99 $887.44 $797.57 $782.59 $796.79 $769.28 $748.75$963.98 $936.76 $935.01 $911.84 $819.50 $804.11 $818.70 $790.44 $769.34$979.64 $951.98 $950.20 $926.66 $832.81 $817.18 $832.01 $803.28 $781.84
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
$161.45 $157.77 $149.17 $168.84 $163.95 $142.96 $132.31 $179.16 $171.21$254.25 $248.45 $234.91 $265.89 $258.19 $225.14 $208.37 $282.15 $269.62$254.25 $248.45 $234.91 $265.89 $258.19 $225.14 $208.37 $282.15 $269.62$254.25 $248.45 $234.91 $265.89 $258.19 $225.14 $208.37 $282.15 $269.62$254.25 $248.45 $234.91 $265.89 $258.19 $225.14 $208.37 $282.15 $269.62$255.27 $249.45 $235.85 $266.96 $259.22 $226.04 $209.20 $283.27 $270.70$260.35 $254.42 $240.55 $272.28 $264.39 $230.54 $213.37 $288.92 $276.09$266.46 $260.38 $246.18 $278.66 $270.58 $235.95 $218.37 $295.69 $282.56$276.37 $270.07 $255.35 $289.03 $280.65 $244.73 $226.50 $306.69 $293.07$284.51 $278.02 $262.86 $297.54 $288.92 $251.93 $233.16 $315.72 $301.70$288.58 $281.99 $266.62 $301.79 $293.05 $255.53 $236.50 $320.23 $306.02$294.68 $287.96 $272.26 $308.17 $299.24 $260.94 $241.50 $327.01 $312.49$300.78 $293.92 $277.90 $314.55 $305.44 $266.34 $246.50 $333.78 $318.96$304.59 $297.65 $281.42 $318.54 $309.31 $269.72 $249.63 $338.01 $323.00$308.66 $301.62 $285.18 $322.80 $313.44 $273.32 $252.96 $342.52 $327.32$310.70 $303.61 $287.06 $324.92 $315.51 $275.12 $254.63 $344.78 $329.47$312.73 $305.60 $288.94 $327.05 $317.58 $276.92 $256.29 $347.04 $331.63$314.76 $307.58 $290.82 $329.18 $319.64 $278.72 $257.96 $349.30 $333.79$316.80 $309.57 $292.70 $331.30 $321.71 $280.53 $259.63 $351.55 $335.94$320.87 $313.55 $296.46 $335.56 $325.84 $284.13 $262.96 $356.07 $340.26$324.93 $317.52 $300.21 $339.81 $329.97 $287.73 $266.30 $360.58 $344.57$331.04 $323.49 $305.85 $346.19 $336.17 $293.13 $271.30 $367.35 $351.04$336.88 $329.20 $311.25 $352.31 $342.10 $298.31 $276.09 $373.84 $357.24$345.02 $337.15 $318.77 $360.82 $350.37 $305.52 $282.76 $382.87 $365.87$355.19 $347.09 $328.17 $371.45 $360.69 $314.52 $291.09 $394.16 $376.66$367.14 $358.77 $339.21 $383.95 $372.83 $325.10 $300.88 $407.42 $389.33$381.38 $372.68 $352.36 $398.84 $387.29 $337.71 $312.55 $423.22 $404.43$397.40 $388.33 $367.16 $415.59 $403.55 $351.90 $325.68 $440.99 $421.41$415.70 $406.22 $384.08 $434.74 $422.14 $368.11 $340.68 $461.31 $440.82$433.75 $423.86 $400.76 $453.62 $440.47 $384.09 $355.48 $481.34 $459.97$454.09 $443.74 $419.55 $474.89 $461.13 $402.10 $372.15 $503.91 $481.54$474.18 $463.36 $438.11 $495.89 $481.53 $419.89 $388.61 $526.20 $502.84$496.30 $484.98 $458.54 $519.03 $503.99 $439.47 $406.74 $550.75 $526.29$518.67 $506.84 $479.21 $542.42 $526.71 $459.29 $425.07 $575.58 $550.02$542.83 $530.45 $501.53 $567.68 $551.24 $480.68 $444.87 $602.38 $575.63$566.98 $554.05 $523.85 $592.94 $575.77 $502.06 $464.66 $629.18 $601.25$593.17 $579.64 $548.04 $620.33 $602.36 $525.25 $486.12 $658.24 $629.02$619.61 $605.48 $572.47 $647.98 $629.21 $548.67 $507.80 $687.59 $657.06$647.83 $633.06 $598.55 $677.50 $657.87 $573.66 $530.92 $718.91 $686.99$661.82 $646.72 $611.47 $692.12 $672.07 $586.04 $542.38 $734.42 $701.81$690.04 $674.30 $637.54 $721.64 $700.73 $611.03 $565.51 $765.74 $731.74$714.45 $698.15 $660.10 $747.16 $725.52 $632.65 $585.52 $792.83 $757.63$730.47 $713.81 $674.89 $763.91 $741.78 $646.83 $598.64 $810.60 $774.61$750.55 $733.43 $693.45 $784.92 $762.18 $664.62 $615.11 $832.89 $795.91$762.75 $745.35 $704.72 $797.67 $774.56 $675.41 $625.10 $846.43 $808.84
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
$164.78 $145.05 $132.62 $131.82 $132.12 $150.71 $117.98 $201.56 $182.36$259.49 $228.43 $208.85 $207.58 $208.06 $237.33 $185.79 $317.42 $287.18$259.49 $228.43 $208.85 $207.58 $208.06 $237.33 $185.79 $317.42 $287.18$259.49 $228.43 $208.85 $207.58 $208.06 $237.33 $185.79 $317.42 $287.18$259.49 $228.43 $208.85 $207.58 $208.06 $237.33 $185.79 $317.42 $287.18$260.53 $229.35 $209.69 $208.41 $208.89 $238.28 $186.53 $318.69 $288.33$265.72 $233.91 $213.86 $212.57 $213.05 $243.03 $190.25 $325.04 $294.07$271.95 $239.40 $218.87 $217.55 $218.05 $248.72 $194.71 $332.65 $300.96$282.07 $248.31 $227.02 $225.64 $226.16 $257.98 $201.95 $345.03 $312.17$290.37 $255.62 $233.70 $232.29 $232.82 $265.57 $207.90 $355.19 $321.35$294.53 $259.27 $237.04 $235.61 $236.15 $269.37 $210.87 $360.27 $325.95$300.75 $264.75 $242.06 $240.59 $241.14 $275.07 $215.33 $367.89 $332.84$306.98 $270.24 $247.07 $245.57 $246.14 $280.76 $219.79 $375.50 $339.73$310.87 $273.66 $250.20 $248.69 $249.26 $284.32 $222.58 $380.27 $344.04$315.03 $277.32 $253.54 $252.01 $252.59 $288.12 $225.55 $385.34 $348.64$317.10 $279.14 $255.21 $253.67 $254.25 $290.02 $227.03 $387.88 $350.93$319.18 $280.97 $256.89 $255.33 $255.91 $291.92 $228.52 $390.42 $353.23$321.25 $282.80 $258.56 $256.99 $257.58 $293.82 $230.01 $392.96 $355.53$323.33 $284.63 $260.23 $258.65 $259.24 $295.72 $231.49 $395.50 $357.83$327.48 $288.28 $263.57 $261.97 $262.57 $299.51 $234.47 $400.58 $362.42$331.63 $291.94 $266.91 $265.29 $265.90 $303.31 $237.44 $405.66 $367.02$337.86 $297.42 $271.92 $270.27 $270.89 $309.01 $241.90 $413.28 $373.91$343.83 $302.67 $276.73 $275.05 $275.68 $314.46 $246.17 $420.58 $380.51$352.13 $309.98 $283.41 $281.69 $282.34 $322.06 $252.12 $430.73 $389.70$362.51 $319.12 $291.76 $289.99 $290.66 $331.55 $259.55 $443.43 $401.19$374.71 $329.86 $301.58 $299.75 $300.44 $342.71 $268.28 $458.35 $414.69$389.24 $342.65 $313.27 $311.38 $312.09 $356.00 $278.68 $476.13 $430.77$405.59 $357.04 $326.43 $324.45 $325.20 $370.95 $290.39 $496.12 $448.86$424.27 $373.49 $341.47 $339.40 $340.18 $388.04 $303.77 $518.98 $469.54$442.70 $389.71 $356.30 $354.14 $354.95 $404.89 $316.96 $541.51 $489.93$463.46 $407.98 $373.01 $370.75 $371.60 $423.87 $331.82 $566.91 $512.90$483.96 $426.03 $389.50 $387.14 $388.03 $442.62 $346.50 $591.98 $535.59$506.53 $445.90 $407.67 $405.20 $406.13 $463.27 $362.66 $619.60 $560.58$529.37 $466.00 $426.05 $423.47 $424.44 $484.16 $379.01 $647.53 $585.85$554.02 $487.70 $445.89 $443.19 $444.21 $506.70 $396.66 $677.69 $613.13$578.67 $509.40 $465.73 $462.91 $463.97 $529.25 $414.31 $707.84 $640.41$605.40 $532.93 $487.25 $484.29 $485.40 $553.70 $433.45 $740.53 $669.99$632.39 $556.69 $508.97 $505.88 $507.04 $578.38 $452.77 $773.55 $699.86$661.19 $582.05 $532.15 $528.92 $530.14 $604.72 $473.39 $808.78 $731.74$675.47 $594.61 $543.64 $540.34 $541.58 $617.77 $483.61 $826.24 $747.53$704.27 $619.97 $566.82 $563.38 $564.68 $644.12 $504.23 $861.47 $779.41$729.18 $641.90 $586.87 $583.31 $584.65 $666.90 $522.07 $891.94 $806.98$745.53 $656.29 $600.03 $596.39 $597.76 $681.85 $533.77 $911.94 $825.07$766.03 $674.33 $616.52 $612.79 $614.19 $700.60 $548.45 $937.02 $847.76$778.47 $685.29 $626.54 $622.74 $624.17 $711.99 $557.36 $952.24 $861.53
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3Moda Health Plan Inc
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500
$197.44 $165.63 $134.51 $222.19 $219.32 $207.36 $201.51 $201.13 $196.15$310.93 $260.84 $211.83 $349.90 $345.38 $326.55 $317.33 $316.74 $308.89$310.93 $260.84 $211.83 $349.90 $345.38 $326.55 $317.33 $316.74 $308.89$310.93 $260.84 $211.83 $349.90 $345.38 $326.55 $317.33 $316.74 $308.89$310.93 $260.84 $211.83 $349.90 $345.38 $326.55 $317.33 $316.74 $308.89$312.17 $261.88 $212.68 $351.30 $346.77 $327.86 $318.60 $318.00 $310.13$318.39 $267.10 $216.91 $358.30 $353.67 $334.39 $324.95 $324.34 $316.30$325.85 $273.36 $222.00 $366.70 $361.96 $342.23 $332.56 $331.94 $323.72$337.98 $283.53 $230.26 $380.34 $375.43 $354.96 $344.94 $344.29 $335.76$347.93 $291.88 $237.04 $391.54 $386.49 $365.41 $355.09 $354.43 $345.65$352.90 $296.05 $240.43 $397.14 $392.01 $370.64 $360.17 $359.50 $350.59$360.37 $302.31 $245.51 $405.54 $400.30 $378.47 $367.79 $367.10 $358.00$367.83 $308.57 $250.59 $413.94 $408.59 $386.31 $375.40 $374.70 $365.42$372.49 $312.49 $253.77 $419.18 $413.77 $391.21 $380.16 $379.45 $370.05$377.47 $316.66 $257.16 $424.78 $419.30 $396.43 $385.24 $384.52 $374.99$379.96 $318.75 $258.86 $427.58 $422.06 $399.05 $387.78 $387.05 $377.46$382.44 $320.83 $260.55 $430.38 $424.82 $401.66 $390.32 $389.59 $379.93$384.93 $322.92 $262.25 $433.18 $427.59 $404.27 $392.86 $392.12 $382.41$387.42 $325.01 $263.94 $435.98 $430.35 $406.88 $395.39 $394.65 $384.88$392.39 $329.18 $267.33 $441.58 $435.88 $412.11 $400.47 $399.72 $389.82$397.37 $333.35 $270.72 $447.18 $441.40 $417.33 $405.55 $404.79 $394.76$404.83 $339.61 $275.80 $455.57 $449.69 $425.17 $413.17 $412.39 $402.17$411.98 $345.61 $280.67 $463.62 $457.63 $432.68 $420.46 $419.68 $409.28$421.93 $353.96 $287.45 $474.82 $468.69 $443.13 $430.62 $429.81 $419.16$434.37 $364.39 $295.93 $488.81 $482.50 $456.19 $443.31 $442.48 $431.52$448.98 $376.65 $305.88 $505.26 $498.74 $471.54 $458.23 $457.37 $446.04$466.39 $391.26 $317.75 $524.86 $518.08 $489.83 $476.00 $475.11 $463.34$485.98 $407.69 $331.09 $546.90 $539.84 $510.40 $495.99 $495.06 $482.80$508.37 $426.47 $346.34 $572.09 $564.70 $533.91 $518.84 $517.87 $505.04$530.44 $444.99 $361.38 $596.94 $589.23 $557.10 $541.37 $540.35 $526.97$555.32 $465.86 $378.33 $624.93 $616.86 $583.22 $566.75 $565.69 $551.68$579.88 $486.47 $395.06 $652.57 $644.14 $609.02 $591.82 $590.71 $576.08$606.93 $509.16 $413.49 $683.01 $674.19 $637.43 $619.43 $618.27 $602.95$634.29 $532.11 $432.13 $713.80 $704.58 $666.16 $647.36 $646.14 $630.14$663.83 $556.89 $452.26 $747.04 $737.40 $697.19 $677.50 $676.23 $659.48$693.37 $581.67 $472.38 $780.28 $770.21 $728.21 $707.65 $706.32 $688.83$725.40 $608.54 $494.20 $816.32 $805.78 $761.84 $740.33 $738.95 $720.64$757.73 $635.67 $516.23 $852.71 $841.70 $795.81 $773.34 $771.89 $752.77$792.25 $664.62 $539.74 $891.55 $880.04 $832.05 $808.56 $807.05 $787.05$809.35 $678.97 $551.39 $910.80 $899.04 $850.01 $826.01 $824.47 $804.04$843.86 $707.92 $574.91 $949.64 $937.37 $886.26 $861.24 $859.62 $838.33$873.71 $732.96 $595.24 $983.23 $970.53 $917.61 $891.70 $890.03 $867.98$893.30 $749.39 $608.59 $1,005.27 $992.29 $938.18 $911.69 $909.99 $887.44$917.86 $770.00 $625.32 $1,032.91 $1,019.58 $963.98 $936.76 $935.01 $911.84$932.78 $782.51 $635.48 $1,049.71 $1,036.15 $979.65 $951.99 $950.21 $926.67
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3
PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
$176.28 $172.97 $176.11 $170.03 $165.49 $161.45 $157.77 $149.17 $168.84$277.61 $272.40 $277.34 $267.76 $260.62 $254.25 $248.45 $234.91 $265.89$277.61 $272.40 $277.34 $267.76 $260.62 $254.25 $248.45 $234.91 $265.89$277.61 $272.40 $277.34 $267.76 $260.62 $254.25 $248.45 $234.91 $265.89$277.61 $272.40 $277.34 $267.76 $260.62 $254.25 $248.45 $234.91 $265.89$278.72 $273.49 $278.45 $268.83 $261.66 $255.27 $249.45 $235.85 $266.96$284.27 $278.93 $283.99 $274.19 $266.87 $260.35 $254.42 $240.55 $272.28$290.93 $285.47 $290.65 $280.62 $273.13 $266.46 $260.38 $246.18 $278.66$301.76 $296.09 $301.47 $291.06 $283.29 $276.37 $270.07 $255.35 $289.03$310.64 $304.81 $310.34 $299.63 $291.63 $284.51 $278.02 $262.86 $297.54$315.09 $309.17 $314.78 $303.91 $295.80 $288.58 $281.99 $266.62 $301.79$321.75 $315.71 $321.44 $310.34 $302.06 $294.68 $287.96 $272.26 $308.17$328.41 $322.24 $328.09 $316.76 $308.31 $300.78 $293.92 $277.90 $314.55$332.57 $326.33 $332.25 $320.78 $312.22 $304.59 $297.65 $281.42 $318.54$337.02 $330.69 $336.69 $325.06 $316.39 $308.66 $301.62 $285.18 $322.80$339.24 $332.87 $338.91 $327.21 $318.47 $310.70 $303.61 $287.06 $324.92$341.46 $335.05 $341.13 $329.35 $320.56 $312.73 $305.60 $288.94 $327.05$343.68 $337.23 $343.34 $331.49 $322.64 $314.76 $307.58 $290.82 $329.18$345.90 $339.40 $345.56 $333.63 $324.73 $316.80 $309.57 $292.70 $331.30$350.34 $343.76 $350.00 $337.92 $328.90 $320.87 $313.55 $296.46 $335.56$354.78 $348.12 $354.44 $342.20 $333.07 $324.93 $317.52 $300.21 $339.81$361.45 $354.66 $361.09 $348.63 $339.32 $331.04 $323.49 $305.85 $346.19$367.83 $360.92 $367.47 $354.79 $345.32 $336.88 $329.20 $311.25 $352.31$376.71 $369.64 $376.35 $363.35 $353.66 $345.02 $337.15 $318.77 $360.82$387.82 $380.54 $387.44 $374.06 $364.08 $355.19 $347.09 $328.17 $371.45$400.87 $393.34 $400.48 $386.65 $376.33 $367.14 $358.77 $339.21 $383.95$416.41 $408.59 $416.01 $401.64 $390.93 $381.38 $372.68 $352.36 $398.84$433.90 $425.75 $433.48 $418.51 $407.35 $397.40 $388.33 $367.16 $415.59$453.89 $445.37 $453.45 $437.79 $426.11 $415.70 $406.22 $384.08 $434.74$473.60 $464.71 $473.14 $456.80 $444.61 $433.75 $423.86 $400.76 $453.62$495.81 $486.50 $495.33 $478.22 $465.46 $454.09 $443.74 $419.55 $474.89$517.74 $508.02 $517.24 $499.38 $486.05 $474.18 $463.36 $438.11 $495.89$541.89 $531.72 $541.36 $522.67 $508.73 $496.30 $484.98 $458.54 $519.03$566.32 $555.69 $565.77 $546.24 $531.66 $518.67 $506.84 $479.21 $542.42$592.69 $581.56 $592.12 $571.67 $556.42 $542.83 $530.45 $501.53 $567.68$619.07 $607.44 $618.46 $597.11 $581.18 $566.98 $554.05 $523.85 $592.94$647.66 $635.50 $647.03 $624.69 $608.02 $593.17 $579.64 $548.04 $620.33$676.53 $663.83 $675.87 $652.54 $635.13 $619.61 $605.48 $572.47 $647.98$707.35 $694.06 $706.66 $682.26 $664.05 $647.83 $633.06 $598.55 $677.50$722.61 $709.05 $721.91 $696.99 $678.39 $661.82 $646.72 $611.47 $692.12$753.43 $739.28 $752.70 $726.71 $707.32 $690.04 $674.30 $637.54 $721.64$780.08 $765.43 $779.32 $752.41 $732.34 $714.45 $698.15 $660.10 $747.16$797.57 $782.59 $796.79 $769.28 $748.75 $730.47 $713.81 $674.89 $763.91$819.50 $804.11 $818.70 $790.44 $769.34 $750.55 $733.43 $693.45 $784.92$832.82 $817.19 $832.02 $803.29 $781.85 $762.76 $745.36 $704.73 $797.68
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
$163.95 $142.96 $132.31 $179.16 $171.21 $164.78 $145.05 $132.62 $131.82$258.19 $225.14 $208.37 $282.15 $269.62 $259.49 $228.43 $208.85 $207.58$258.19 $225.14 $208.37 $282.15 $269.62 $259.49 $228.43 $208.85 $207.58$258.19 $225.14 $208.37 $282.15 $269.62 $259.49 $228.43 $208.85 $207.58$258.19 $225.14 $208.37 $282.15 $269.62 $259.49 $228.43 $208.85 $207.58$259.22 $226.04 $209.20 $283.27 $270.70 $260.53 $229.35 $209.69 $208.41$264.39 $230.54 $213.37 $288.92 $276.09 $265.72 $233.91 $213.86 $212.57$270.58 $235.95 $218.37 $295.69 $282.56 $271.95 $239.40 $218.87 $217.55$280.65 $244.73 $226.50 $306.69 $293.07 $282.07 $248.31 $227.02 $225.64$288.92 $251.93 $233.16 $315.72 $301.70 $290.37 $255.62 $233.70 $232.29$293.05 $255.53 $236.50 $320.23 $306.02 $294.53 $259.27 $237.04 $235.61$299.24 $260.94 $241.50 $327.01 $312.49 $300.75 $264.75 $242.06 $240.59$305.44 $266.34 $246.50 $333.78 $318.96 $306.98 $270.24 $247.07 $245.57$309.31 $269.72 $249.63 $338.01 $323.00 $310.87 $273.66 $250.20 $248.69$313.44 $273.32 $252.96 $342.52 $327.32 $315.03 $277.32 $253.54 $252.01$315.51 $275.12 $254.63 $344.78 $329.47 $317.10 $279.14 $255.21 $253.67$317.58 $276.92 $256.29 $347.04 $331.63 $319.18 $280.97 $256.89 $255.33$319.64 $278.72 $257.96 $349.30 $333.79 $321.25 $282.80 $258.56 $256.99$321.71 $280.53 $259.63 $351.55 $335.94 $323.33 $284.63 $260.23 $258.65$325.84 $284.13 $262.96 $356.07 $340.26 $327.48 $288.28 $263.57 $261.97$329.97 $287.73 $266.30 $360.58 $344.57 $331.63 $291.94 $266.91 $265.29$336.17 $293.13 $271.30 $367.35 $351.04 $337.86 $297.42 $271.92 $270.27$342.10 $298.31 $276.09 $373.84 $357.24 $343.83 $302.67 $276.73 $275.05$350.37 $305.52 $282.76 $382.87 $365.87 $352.13 $309.98 $283.41 $281.69$360.69 $314.52 $291.09 $394.16 $376.66 $362.51 $319.12 $291.76 $289.99$372.83 $325.10 $300.88 $407.42 $389.33 $374.71 $329.86 $301.58 $299.75$387.29 $337.71 $312.55 $423.22 $404.43 $389.24 $342.65 $313.27 $311.38$403.55 $351.90 $325.68 $440.99 $421.41 $405.59 $357.04 $326.43 $324.45$422.14 $368.11 $340.68 $461.31 $440.82 $424.27 $373.49 $341.47 $339.40$440.47 $384.09 $355.48 $481.34 $459.97 $442.70 $389.71 $356.30 $354.14$461.13 $402.10 $372.15 $503.91 $481.54 $463.46 $407.98 $373.01 $370.75$481.53 $419.89 $388.61 $526.20 $502.84 $483.96 $426.03 $389.50 $387.14$503.99 $439.47 $406.74 $550.75 $526.29 $506.53 $445.90 $407.67 $405.20$526.71 $459.29 $425.07 $575.58 $550.02 $529.37 $466.00 $426.05 $423.47$551.24 $480.68 $444.87 $602.38 $575.63 $554.02 $487.70 $445.89 $443.19$575.77 $502.06 $464.66 $629.18 $601.25 $578.67 $509.40 $465.73 $462.91$602.36 $525.25 $486.12 $658.24 $629.02 $605.40 $532.93 $487.25 $484.29$629.21 $548.67 $507.80 $687.59 $657.06 $632.39 $556.69 $508.97 $505.88$657.87 $573.66 $530.92 $718.91 $686.99 $661.19 $582.05 $532.15 $528.92$672.07 $586.04 $542.38 $734.42 $701.81 $675.47 $594.61 $543.64 $540.34$700.73 $611.03 $565.51 $765.74 $731.74 $704.27 $619.97 $566.82 $563.38$725.52 $632.65 $585.52 $792.83 $757.63 $729.18 $641.90 $586.87 $583.31$741.78 $646.83 $598.64 $810.60 $774.61 $745.53 $656.29 $600.03 $596.39$762.18 $664.62 $615.11 $832.89 $795.91 $766.03 $674.33 $616.52 $612.79$774.57 $675.42 $625.11 $846.44 $808.85 $778.48 $685.30 $626.55 $622.75
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4Moda Health Plan Inc
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
$132.12 $150.71 $117.98 $201.56 $182.36 $197.44 $165.63 $134.51 $239.46$208.06 $237.33 $185.79 $317.42 $287.18 $310.93 $260.84 $211.83 $377.10$208.06 $237.33 $185.79 $317.42 $287.18 $310.93 $260.84 $211.83 $377.10$208.06 $237.33 $185.79 $317.42 $287.18 $310.93 $260.84 $211.83 $377.10$208.06 $237.33 $185.79 $317.42 $287.18 $310.93 $260.84 $211.83 $377.10$208.89 $238.28 $186.53 $318.69 $288.33 $312.17 $261.88 $212.68 $378.61$213.05 $243.03 $190.25 $325.04 $294.07 $318.39 $267.10 $216.91 $386.15$218.05 $248.72 $194.71 $332.65 $300.96 $325.85 $273.36 $222.00 $395.20$226.16 $257.98 $201.95 $345.03 $312.17 $337.98 $283.53 $230.26 $409.91$232.82 $265.57 $207.90 $355.19 $321.35 $347.93 $291.88 $237.04 $421.97$236.15 $269.37 $210.87 $360.27 $325.95 $352.90 $296.05 $240.43 $428.01$241.14 $275.07 $215.33 $367.89 $332.84 $360.37 $302.31 $245.51 $437.06$246.14 $280.76 $219.79 $375.50 $339.73 $367.83 $308.57 $250.59 $446.11$249.26 $284.32 $222.58 $380.27 $344.04 $372.49 $312.49 $253.77 $451.76$252.59 $288.12 $225.55 $385.34 $348.64 $377.47 $316.66 $257.16 $457.80$254.25 $290.02 $227.03 $387.88 $350.93 $379.96 $318.75 $258.86 $460.81$255.91 $291.92 $228.52 $390.42 $353.23 $382.44 $320.83 $260.55 $463.83$257.58 $293.82 $230.01 $392.96 $355.53 $384.93 $322.92 $262.25 $466.85$259.24 $295.72 $231.49 $395.50 $357.83 $387.42 $325.01 $263.94 $469.86$262.57 $299.51 $234.47 $400.58 $362.42 $392.39 $329.18 $267.33 $475.90$265.90 $303.31 $237.44 $405.66 $367.02 $397.37 $333.35 $270.72 $481.93$270.89 $309.01 $241.90 $413.28 $373.91 $404.83 $339.61 $275.80 $490.98$275.68 $314.46 $246.17 $420.58 $380.51 $411.98 $345.61 $280.67 $499.65$282.34 $322.06 $252.12 $430.73 $389.70 $421.93 $353.96 $287.45 $511.72$290.66 $331.55 $259.55 $443.43 $401.19 $434.37 $364.39 $295.93 $526.81$300.44 $342.71 $268.28 $458.35 $414.69 $448.98 $376.65 $305.88 $544.53$312.09 $356.00 $278.68 $476.13 $430.77 $466.39 $391.26 $317.75 $565.65$325.20 $370.95 $290.39 $496.12 $448.86 $485.98 $407.69 $331.09 $589.40$340.18 $388.04 $303.77 $518.98 $469.54 $508.37 $426.47 $346.34 $616.56$354.95 $404.89 $316.96 $541.51 $489.93 $530.44 $444.99 $361.38 $643.33$371.60 $423.87 $331.82 $566.91 $512.90 $555.32 $465.86 $378.33 $673.50$388.03 $442.62 $346.50 $591.98 $535.59 $579.88 $486.47 $395.06 $703.29$406.13 $463.27 $362.66 $619.60 $560.58 $606.93 $509.16 $413.49 $736.10$424.44 $484.16 $379.01 $647.53 $585.85 $634.29 $532.11 $432.13 $769.28$444.21 $506.70 $396.66 $677.69 $613.13 $663.83 $556.89 $452.26 $805.10$463.97 $529.25 $414.31 $707.84 $640.41 $693.37 $581.67 $472.38 $840.93$485.40 $553.70 $433.45 $740.53 $669.99 $725.40 $608.54 $494.20 $879.77$507.04 $578.38 $452.77 $773.55 $699.86 $757.73 $635.67 $516.23 $918.99$530.14 $604.72 $473.39 $808.78 $731.74 $792.25 $664.62 $539.74 $960.85$541.58 $617.77 $483.61 $826.24 $747.53 $809.35 $678.97 $551.39 $981.59$564.68 $644.12 $504.23 $861.47 $779.41 $843.86 $707.92 $574.91 $1,023.44$584.65 $666.90 $522.07 $891.94 $806.98 $873.71 $732.96 $595.24 $1,059.65$597.76 $681.85 $533.77 $911.94 $825.07 $893.30 $749.39 $608.59 $1,083.40$614.19 $700.60 $548.45 $937.02 $847.76 $917.86 $770.00 $625.32 $1,113.19$624.18 $712.00 $557.37 $952.25 $861.54 $932.79 $782.52 $635.49 $1,131.29
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health Plan Inc
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000
$236.36 $223.48 $217.17 $216.76 $211.39 $189.98 $186.41 $189.80 $183.24$372.23 $351.93 $341.99 $341.35 $332.90 $299.18 $293.57 $298.89 $288.57$372.23 $351.93 $341.99 $341.35 $332.90 $299.18 $293.57 $298.89 $288.57$372.23 $351.93 $341.99 $341.35 $332.90 $299.18 $293.57 $298.89 $288.57$372.23 $351.93 $341.99 $341.35 $332.90 $299.18 $293.57 $298.89 $288.57$373.72 $353.34 $343.36 $342.72 $334.23 $300.38 $294.74 $300.09 $289.73$381.16 $360.38 $350.20 $349.55 $340.89 $306.36 $300.61 $306.07 $295.50$390.09 $368.82 $358.41 $357.74 $348.88 $313.54 $307.66 $313.24 $302.43$404.61 $382.55 $371.75 $371.05 $361.86 $325.21 $319.11 $324.90 $313.68$416.52 $393.81 $382.69 $381.98 $372.51 $334.79 $328.50 $334.46 $322.91$422.48 $399.44 $388.16 $387.44 $377.84 $339.57 $333.20 $339.24 $327.53$431.41 $407.89 $396.37 $395.63 $385.83 $346.75 $340.24 $346.42 $334.46$440.35 $416.33 $404.58 $403.82 $393.82 $353.93 $347.29 $353.59 $341.38$445.93 $421.61 $409.71 $408.94 $398.81 $358.42 $351.69 $358.07 $345.71$451.88 $427.24 $415.18 $414.40 $404.14 $363.21 $356.39 $362.86 $350.33$454.86 $430.06 $417.92 $417.13 $406.80 $365.60 $358.74 $365.25 $352.64$457.84 $432.87 $420.65 $419.87 $409.46 $368.00 $361.09 $367.64 $354.95$460.82 $435.69 $423.39 $422.60 $412.13 $370.39 $363.43 $370.03 $357.25$463.80 $438.51 $426.12 $425.33 $414.79 $372.78 $365.78 $372.42 $359.56$469.75 $444.14 $431.60 $430.79 $420.12 $377.57 $370.48 $377.20 $364.18$475.71 $449.77 $437.07 $436.25 $425.44 $382.36 $375.18 $381.99 $368.80$484.64 $458.21 $445.28 $444.44 $433.43 $389.54 $382.22 $389.16 $375.72$493.20 $466.31 $453.14 $452.29 $441.09 $396.42 $388.98 $396.03 $382.36$505.11 $477.57 $464.09 $463.22 $451.74 $405.99 $398.37 $405.60 $391.59$520.00 $491.65 $477.77 $476.87 $465.06 $417.96 $410.11 $417.55 $403.14$537.50 $508.19 $493.84 $492.92 $480.70 $432.02 $423.91 $431.60 $416.70$558.34 $527.90 $512.99 $512.03 $499.35 $448.78 $440.35 $448.34 $432.86$581.79 $550.07 $534.54 $533.54 $520.32 $467.62 $458.84 $467.17 $451.04$608.59 $575.41 $559.16 $558.11 $544.29 $489.17 $479.98 $488.69 $471.82$635.02 $600.39 $583.44 $582.35 $567.92 $510.41 $500.82 $509.91 $492.31$664.80 $628.55 $610.80 $609.66 $594.55 $534.34 $524.31 $533.82 $515.39$694.21 $656.35 $637.82 $636.63 $620.85 $557.98 $547.50 $557.44 $538.19$726.59 $686.97 $667.57 $666.32 $649.82 $584.01 $573.04 $583.44 $563.30$759.35 $717.94 $697.67 $696.36 $679.11 $610.34 $598.87 $609.74 $588.69$794.71 $751.37 $730.16 $728.79 $710.74 $638.76 $626.76 $638.14 $616.10$830.07 $784.81 $762.65 $761.22 $742.36 $667.18 $654.65 $666.53 $643.52$868.41 $821.05 $797.87 $796.38 $776.65 $698.00 $684.89 $697.32 $673.24$907.12 $857.66 $833.44 $831.88 $811.27 $729.11 $715.42 $728.40 $703.25$948.44 $896.72 $871.40 $869.77 $848.22 $762.32 $748.01 $761.58 $735.29$968.91 $916.08 $890.21 $888.54 $866.53 $778.78 $764.15 $778.02 $751.16
$1,010.23 $955.14 $928.17 $926.43 $903.48 $811.99 $796.74 $811.20 $783.19$1,045.96 $988.93 $961.00 $959.20 $935.44 $840.71 $824.92 $839.89 $810.89$1,069.41 $1,011.10 $982.55 $980.71 $956.41 $859.56 $843.42 $858.72 $829.07$1,098.82 $1,038.90 $1,009.57 $1,007.68 $982.71 $883.19 $866.61 $882.33 $851.87$1,116.68 $1,055.79 $1,025.98 $1,024.06 $998.69 $897.55 $880.70 $896.68 $865.72
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
$178.35 $174.00 $170.03 $160.76 $181.97 $176.69 $154.08 $142.60 $193.09$280.87 $274.01 $267.76 $253.17 $286.56 $278.26 $242.64 $224.56 $304.07$280.87 $274.01 $267.76 $253.17 $286.56 $278.26 $242.64 $224.56 $304.07$280.87 $274.01 $267.76 $253.17 $286.56 $278.26 $242.64 $224.56 $304.07$280.87 $274.01 $267.76 $253.17 $286.56 $278.26 $242.64 $224.56 $304.07$282.00 $275.11 $268.83 $254.18 $287.71 $279.37 $243.61 $225.46 $305.29$287.61 $280.59 $274.19 $259.24 $293.44 $284.94 $248.46 $229.95 $311.37$294.35 $287.17 $280.62 $265.32 $300.31 $291.61 $254.29 $235.34 $318.67$305.31 $297.85 $291.06 $275.19 $311.49 $302.47 $263.75 $244.10 $330.53$314.30 $306.62 $299.63 $283.29 $320.66 $311.37 $271.51 $251.29 $340.26$318.79 $311.00 $303.91 $287.34 $325.25 $315.82 $275.40 $254.88 $345.12$325.53 $317.58 $310.34 $293.42 $332.12 $322.50 $281.22 $260.27 $352.42$332.27 $324.16 $316.76 $299.50 $339.00 $329.18 $287.04 $265.66 $359.72$336.49 $328.27 $320.78 $303.29 $343.30 $333.35 $290.68 $269.03 $364.28$340.98 $332.65 $325.06 $307.34 $347.88 $337.81 $294.56 $272.62 $369.15$343.23 $334.84 $327.21 $309.37 $350.18 $340.03 $296.50 $274.42 $371.58$345.47 $337.04 $329.35 $311.39 $352.47 $342.26 $298.45 $276.21 $374.01$347.72 $339.23 $331.49 $313.42 $354.76 $344.48 $300.39 $278.01 $376.44$349.97 $341.42 $333.63 $315.45 $357.05 $346.71 $302.33 $279.81 $378.88$354.46 $345.80 $337.92 $319.50 $361.64 $351.16 $306.21 $283.40 $383.74$358.96 $350.19 $342.20 $323.55 $366.22 $355.61 $310.09 $286.99 $388.61$365.70 $356.76 $348.63 $329.62 $373.10 $362.29 $315.92 $292.38 $395.90$372.16 $363.07 $354.79 $335.45 $379.69 $368.69 $321.50 $297.55 $402.90$381.14 $371.84 $363.35 $343.55 $388.86 $377.60 $329.26 $304.73 $412.63$392.38 $382.80 $374.06 $353.67 $400.32 $388.73 $338.97 $313.72 $424.79$405.58 $395.67 $386.65 $365.57 $413.79 $401.80 $350.37 $324.27 $439.08$421.31 $411.02 $401.64 $379.75 $429.84 $417.39 $363.96 $336.85 $456.11$439.00 $428.28 $418.51 $395.70 $447.89 $434.92 $379.24 $350.99 $475.27$459.23 $448.01 $437.79 $413.93 $468.53 $454.95 $396.71 $367.16 $497.16$479.17 $467.47 $456.80 $431.90 $488.87 $474.71 $413.94 $383.11 $518.75$501.64 $489.39 $478.22 $452.16 $511.80 $496.97 $433.35 $401.07 $543.08$523.83 $511.03 $499.38 $472.16 $534.43 $518.95 $452.52 $418.81 $567.10$548.26 $534.87 $522.67 $494.18 $559.36 $543.16 $473.63 $438.35 $593.55$572.98 $558.99 $546.24 $516.46 $584.58 $567.65 $494.98 $458.11 $620.31$599.66 $585.02 $571.67 $540.51 $611.81 $594.08 $518.03 $479.44 $649.20$626.35 $611.05 $597.11 $564.56 $639.03 $620.52 $541.08 $500.78 $678.08$655.28 $639.27 $624.69 $590.64 $668.54 $649.18 $566.08 $523.91 $709.40$684.49 $667.77 $652.54 $616.97 $698.35 $678.11 $591.31 $547.26 $741.03$715.66 $698.18 $682.26 $645.07 $730.15 $709.00 $618.24 $572.19 $774.78$731.11 $713.26 $696.99 $658.99 $745.92 $724.31 $631.59 $584.54 $791.50$762.29 $743.67 $726.71 $687.09 $777.72 $755.19 $658.52 $609.47 $825.26$789.25 $769.98 $752.41 $711.40 $805.23 $781.91 $681.82 $631.02 $854.45$806.95 $787.24 $769.28 $727.35 $823.29 $799.44 $697.10 $645.17 $873.60$829.14 $808.89 $790.44 $747.35 $845.92 $821.42 $716.27 $662.91 $897.62$842.62 $822.04 $803.29 $759.50 $859.68 $834.77 $727.92 $673.69 $912.22
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Summit
Exclusive 2000
$184.51 $177.59 $156.33 $142.93 $142.06 $142.39 $162.42 $167.96$290.57 $279.66 $246.19 $225.08 $223.72 $224.23 $255.78 $264.50$290.57 $279.66 $246.19 $225.08 $223.72 $224.23 $255.78 $264.50$290.57 $279.66 $246.19 $225.08 $223.72 $224.23 $255.78 $264.50$290.57 $279.66 $246.19 $225.08 $223.72 $224.23 $255.78 $264.50$291.73 $280.78 $247.17 $225.98 $224.61 $225.13 $256.80 $265.56$297.55 $286.37 $252.09 $230.48 $229.09 $229.61 $261.92 $270.85$304.52 $293.09 $258.00 $235.89 $234.46 $234.99 $268.05 $277.20$315.85 $303.99 $267.60 $244.66 $243.18 $243.74 $278.03 $287.52$325.15 $312.94 $275.48 $251.87 $250.34 $250.91 $286.21 $295.98$329.80 $317.42 $279.42 $255.47 $253.92 $254.50 $290.31 $300.21$336.77 $324.13 $285.33 $260.87 $259.29 $259.88 $296.45 $306.56$343.75 $330.84 $291.24 $266.27 $264.66 $265.26 $302.58 $312.91$348.11 $335.04 $294.93 $269.65 $268.01 $268.63 $306.42 $316.88$352.75 $339.51 $298.87 $273.25 $271.59 $272.22 $310.51 $321.11$355.08 $341.75 $300.84 $275.05 $273.38 $274.01 $312.56 $323.22$357.40 $343.99 $302.81 $276.85 $275.17 $275.80 $314.61 $325.34$359.73 $346.22 $304.78 $278.65 $276.96 $277.60 $316.65 $327.46$362.05 $348.46 $306.75 $280.45 $278.75 $279.39 $318.70 $329.57$366.70 $352.93 $310.69 $284.05 $282.33 $282.98 $322.79 $333.80$371.35 $357.41 $314.63 $287.65 $285.91 $286.57 $326.88 $338.04$378.33 $364.12 $320.53 $293.06 $291.28 $291.95 $333.02 $344.38$385.01 $370.55 $326.20 $298.23 $296.43 $297.11 $338.91 $350.47$394.31 $379.50 $334.07 $305.44 $303.58 $304.28 $347.09 $358.93$405.93 $390.69 $343.92 $314.44 $312.53 $313.25 $357.32 $369.51$419.59 $403.83 $355.49 $325.02 $323.05 $323.79 $369.34 $381.94$435.86 $419.49 $369.28 $337.62 $335.58 $336.35 $383.67 $396.76$454.16 $437.11 $384.79 $351.80 $349.67 $350.47 $399.78 $413.42$475.09 $457.25 $402.51 $368.01 $365.78 $366.62 $418.20 $432.46$495.72 $477.11 $419.99 $383.99 $381.66 $382.54 $436.36 $451.24$518.96 $499.48 $439.69 $402.00 $399.56 $400.48 $456.82 $472.40$541.92 $521.57 $459.14 $419.78 $417.23 $418.19 $477.02 $493.30$567.20 $545.90 $480.56 $439.36 $436.70 $437.70 $499.28 $516.31$592.77 $570.51 $502.22 $459.17 $456.38 $457.43 $521.79 $539.59$620.37 $597.08 $525.61 $480.55 $477.64 $478.73 $546.08 $564.72$647.98 $623.65 $549.00 $501.93 $498.89 $500.03 $570.38 $589.84$677.91 $652.45 $574.35 $525.12 $521.93 $523.13 $596.73 $617.09$708.13 $681.54 $599.96 $548.52 $545.20 $546.45 $623.33 $644.60$740.38 $712.58 $627.28 $573.51 $570.03 $571.34 $651.72 $673.96$756.36 $727.96 $640.82 $585.89 $582.34 $583.67 $665.79 $688.50$788.61 $759.01 $668.15 $610.87 $607.17 $608.56 $694.18 $717.86$816.51 $785.85 $691.78 $632.48 $628.65 $630.09 $718.73 $743.26$834.81 $803.47 $707.29 $646.66 $642.74 $644.21 $734.85 $759.92$857.77 $825.57 $726.74 $664.44 $660.41 $661.93 $755.05 $780.82$871.72 $838.99 $738.56 $675.24 $671.15 $672.69 $767.33 $793.51
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Moda Health
Synergy
Exclusive 5000
Moda Health
Summit
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Platinum
Summit
Exclusive 250
PPO Synergy
Exclusive
1000A
PPO Summit
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
$127.15 $131.19 $217.23 $225.09 $196.53 $203.57 $212.78 $178.51 $144.97$200.23 $206.60 $342.09 $354.48 $309.50 $320.59 $335.09 $281.11 $228.29$200.23 $206.60 $342.09 $354.48 $309.50 $320.59 $335.09 $281.11 $228.29$200.23 $206.60 $342.09 $354.48 $309.50 $320.59 $335.09 $281.11 $228.29$200.23 $206.60 $342.09 $354.48 $309.50 $320.59 $335.09 $281.11 $228.29$201.03 $207.43 $343.46 $355.90 $310.74 $321.87 $336.43 $282.24 $229.21$205.03 $211.56 $350.30 $362.98 $316.93 $328.28 $343.14 $287.86 $233.77$209.84 $216.52 $358.51 $371.49 $324.36 $335.97 $351.18 $294.61 $239.25$217.65 $224.57 $371.85 $385.32 $336.43 $348.48 $364.25 $305.57 $248.16$224.06 $231.18 $382.80 $396.66 $346.33 $358.74 $374.97 $314.57 $255.46$227.26 $234.49 $388.27 $402.33 $351.28 $363.87 $380.33 $319.06 $259.11$232.07 $239.45 $396.48 $410.84 $358.71 $371.56 $388.37 $325.81 $264.59$236.87 $244.41 $404.69 $419.35 $366.14 $379.25 $396.42 $332.56 $270.07$239.87 $247.51 $409.82 $424.66 $370.78 $384.06 $401.44 $336.77 $273.50$243.08 $250.81 $415.29 $430.34 $375.73 $389.19 $406.80 $341.27 $277.15$244.68 $252.46 $418.03 $433.17 $378.21 $391.76 $409.49 $343.52 $278.97$246.28 $254.12 $420.77 $436.01 $380.69 $394.32 $412.17 $345.77 $280.80$247.88 $255.77 $423.50 $438.84 $383.16 $396.89 $414.85 $348.02 $282.63$249.49 $257.42 $426.24 $441.68 $385.64 $399.45 $417.53 $350.27 $284.45$252.69 $260.73 $431.71 $447.35 $390.59 $404.58 $422.89 $354.76 $288.11$255.89 $264.03 $437.19 $453.02 $395.54 $409.71 $428.25 $359.26 $291.76$260.70 $268.99 $445.40 $461.53 $402.97 $417.40 $436.29 $366.01 $297.24$265.30 $273.74 $453.27 $469.68 $410.09 $424.78 $444.00 $372.47 $302.49$271.71 $280.35 $464.21 $481.03 $419.99 $435.04 $454.72 $381.47 $309.79$279.72 $288.62 $477.90 $495.20 $432.37 $447.86 $468.13 $392.71 $318.93$289.13 $298.33 $493.97 $511.87 $446.92 $462.93 $483.88 $405.93 $329.66$300.34 $309.90 $513.13 $531.72 $464.25 $480.88 $502.64 $421.67 $342.44$312.96 $322.91 $534.68 $554.05 $483.75 $501.08 $523.75 $439.38 $356.82$327.37 $337.79 $559.31 $579.57 $506.03 $524.16 $547.88 $459.62 $373.26$341.59 $352.46 $583.60 $604.74 $528.01 $546.92 $571.67 $479.58 $389.47$357.61 $368.99 $610.97 $633.10 $552.77 $572.57 $598.48 $502.07 $407.73$373.43 $385.31 $637.99 $661.10 $577.22 $597.89 $624.95 $524.28 $425.77$390.85 $403.28 $667.75 $691.94 $604.14 $625.79 $654.10 $548.73 $445.63$408.47 $421.46 $697.86 $723.13 $631.38 $654.00 $683.59 $573.47 $465.72$427.49 $441.09 $730.36 $756.81 $660.78 $684.45 $715.43 $600.18 $487.41$446.51 $460.72 $762.85 $790.48 $690.19 $714.91 $747.26 $626.88 $509.09$467.13 $481.99 $798.09 $827.00 $722.06 $747.93 $781.77 $655.84 $532.61$487.96 $503.48 $833.67 $863.86 $754.25 $781.27 $816.62 $685.07 $556.35$510.18 $526.41 $871.64 $903.21 $788.61 $816.86 $853.82 $716.28 $581.69$521.20 $537.78 $890.45 $922.70 $805.63 $834.49 $872.25 $731.74 $594.25$543.42 $560.71 $928.42 $962.05 $839.98 $870.07 $909.45 $762.94 $619.59$562.64 $580.54 $961.26 $996.08 $869.70 $900.85 $941.61 $789.93 $641.50$575.26 $593.56 $982.82 $1,018.41 $889.19 $921.05 $962.73 $807.64 $655.89$591.08 $609.88 $1,009.84 $1,046.42 $913.64 $946.37 $989.20 $829.85 $673.92$600.69 $619.80 $1,026.26 $1,063.43 $928.50 $961.76 $1,005.28 $843.34 $684.88
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5Moda Health Plan Inc
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500
$230.25 $227.27 $214.88 $208.81 $208.42 $203.26 $182.67 $179.24 $182.50$362.59 $357.91 $338.40 $328.84 $328.23 $320.09 $287.68 $282.28 $287.40$362.59 $357.91 $338.40 $328.84 $328.23 $320.09 $287.68 $282.28 $287.40$362.59 $357.91 $338.40 $328.84 $328.23 $320.09 $287.68 $282.28 $287.40$362.59 $357.91 $338.40 $328.84 $328.23 $320.09 $287.68 $282.28 $287.40$364.04 $359.34 $339.75 $330.16 $329.54 $321.37 $288.83 $283.40 $288.55$371.30 $366.50 $346.52 $336.73 $336.10 $327.78 $294.58 $289.05 $294.29$380.00 $375.09 $354.64 $344.62 $343.98 $335.46 $301.49 $295.82 $301.19$394.14 $389.05 $367.84 $357.45 $356.78 $347.94 $312.70 $306.83 $312.40$405.74 $400.50 $378.66 $367.97 $367.28 $358.18 $321.91 $315.87 $321.60$411.54 $406.23 $384.08 $373.23 $372.54 $363.31 $326.51 $320.38 $326.20$420.25 $414.82 $392.20 $381.13 $380.41 $370.99 $333.42 $327.16 $333.09$428.95 $423.41 $400.32 $389.02 $388.29 $378.67 $340.32 $333.93 $339.99$434.39 $428.78 $405.40 $393.95 $393.21 $383.47 $344.64 $338.17 $344.30$440.19 $434.50 $410.81 $399.21 $398.47 $388.59 $349.24 $342.68 $348.90$443.09 $437.37 $413.52 $401.84 $401.09 $391.15 $351.54 $344.94 $351.20$445.99 $440.23 $416.23 $404.47 $403.72 $393.71 $353.84 $347.20 $353.50$448.89 $443.09 $418.93 $407.10 $406.34 $396.28 $356.14 $349.46 $355.80$451.79 $445.96 $421.64 $409.74 $408.97 $398.84 $358.45 $351.71 $358.10$457.59 $451.68 $427.05 $415.00 $414.22 $403.96 $363.05 $356.23 $362.70$463.40 $457.41 $432.47 $420.26 $419.47 $409.08 $367.65 $360.75 $367.29$472.10 $466.00 $440.59 $428.15 $427.35 $416.76 $374.56 $367.52 $374.19$480.44 $474.23 $448.37 $435.71 $434.90 $424.12 $381.17 $374.01 $380.80$492.04 $485.69 $459.20 $446.24 $445.40 $434.37 $390.38 $383.05 $390.00$506.54 $500.00 $472.74 $459.39 $458.53 $447.17 $401.88 $394.34 $401.49$523.59 $516.82 $488.64 $474.85 $473.96 $462.21 $415.41 $407.61 $415.00$543.89 $536.87 $507.59 $493.26 $492.34 $480.14 $431.52 $423.41 $431.10$566.73 $559.42 $528.91 $513.98 $513.02 $500.31 $449.64 $441.20 $449.20$592.84 $585.19 $553.28 $537.65 $536.65 $523.35 $470.35 $461.52 $469.89$618.59 $610.60 $577.30 $561.00 $559.95 $546.08 $490.78 $481.56 $490.30$647.59 $639.23 $604.37 $587.31 $586.21 $571.69 $513.79 $504.14 $513.29$676.24 $667.50 $631.11 $613.29 $612.14 $596.97 $536.52 $526.44 $536.00$707.78 $698.64 $660.55 $641.90 $640.70 $624.82 $561.55 $551.00 $561.00$739.69 $730.14 $690.33 $670.83 $669.58 $652.99 $586.86 $575.84 $586.29$774.14 $764.14 $722.47 $702.07 $700.76 $683.40 $614.19 $602.66 $613.59$808.58 $798.14 $754.62 $733.31 $731.94 $713.81 $641.52 $629.47 $640.90$845.93 $835.01 $789.48 $767.19 $765.75 $746.78 $671.15 $658.55 $670.50$883.64 $872.23 $824.67 $801.38 $799.88 $780.07 $701.07 $687.90 $700.39$923.89 $911.96 $862.23 $837.89 $836.32 $815.60 $733.00 $719.24 $732.29$943.83 $931.64 $880.84 $855.97 $854.37 $833.20 $748.82 $734.76 $748.10$984.08 $971.37 $918.40 $892.47 $890.80 $868.73 $780.76 $766.09 $780.00
$1,018.89 $1,005.73 $950.89 $924.04 $922.31 $899.46 $808.37 $793.19 $807.59$1,041.73 $1,028.28 $972.21 $944.76 $942.99 $919.63 $826.50 $810.98 $825.69$1,070.38 $1,056.55 $998.94 $970.74 $968.92 $944.92 $849.22 $833.28 $848.40$1,087.78 $1,073.73 $1,015.19 $986.52 $984.68 $960.28 $863.03 $846.83 $862.19
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5
Value 2000 Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
$176.20 $171.49 $167.31 $163.49 $154.58 $174.97 $169.90 $148.15 $137.11$277.47 $270.07 $263.47 $257.46 $243.43 $275.54 $267.56 $233.31 $215.93$277.47 $270.07 $263.47 $257.46 $243.43 $275.54 $267.56 $233.31 $215.93$277.47 $270.07 $263.47 $257.46 $243.43 $275.54 $267.56 $233.31 $215.93$277.47 $270.07 $263.47 $257.46 $243.43 $275.54 $267.56 $233.31 $215.93$278.58 $271.15 $264.53 $258.49 $244.40 $276.64 $268.63 $234.24 $216.79$284.13 $276.55 $269.80 $263.64 $249.27 $282.15 $273.98 $238.91 $221.11$290.79 $283.03 $276.12 $269.82 $255.11 $288.76 $280.40 $244.51 $226.29$301.61 $293.57 $286.40 $279.86 $264.61 $299.51 $290.83 $253.60 $234.71$310.49 $302.21 $294.83 $288.10 $272.40 $308.33 $299.39 $261.07 $241.62$314.93 $306.53 $299.04 $292.22 $276.29 $312.74 $303.68 $264.80 $245.08$321.59 $313.01 $305.37 $298.40 $282.13 $319.35 $310.10 $270.40 $250.26$328.25 $319.49 $311.69 $304.58 $287.98 $325.96 $316.52 $276.00 $255.44$332.41 $323.54 $315.64 $308.44 $291.63 $330.09 $320.53 $279.50 $258.68$336.85 $327.87 $319.86 $312.56 $295.52 $334.50 $324.81 $283.23 $262.13$339.07 $330.03 $321.96 $314.62 $297.47 $336.71 $326.95 $285.10 $263.86$341.29 $332.19 $324.07 $316.68 $299.42 $338.91 $329.09 $286.97 $265.59$343.51 $334.35 $326.18 $318.74 $301.37 $341.12 $331.23 $288.83 $267.32$345.73 $336.51 $328.29 $320.80 $303.31 $343.32 $333.37 $290.70 $269.04$350.17 $340.83 $332.50 $324.92 $307.21 $347.73 $337.66 $294.43 $272.50$354.61 $345.15 $336.72 $329.04 $311.10 $352.14 $341.94 $298.17 $275.95$361.27 $351.63 $343.04 $335.22 $316.94 $358.75 $348.36 $303.77 $281.14$367.65 $357.84 $349.10 $341.14 $322.54 $365.09 $354.51 $309.13 $286.10$376.53 $366.49 $357.53 $349.38 $330.33 $373.91 $363.07 $316.60 $293.01$387.63 $377.29 $368.07 $359.68 $340.07 $384.93 $373.78 $325.93 $301.65$400.67 $389.98 $380.46 $371.78 $351.51 $397.88 $386.35 $336.89 $311.80$416.21 $405.11 $395.21 $386.20 $365.14 $413.31 $401.33 $349.96 $323.89$433.69 $422.12 $411.81 $402.42 $380.48 $430.67 $418.19 $364.66 $337.49$453.67 $441.56 $430.78 $420.95 $398.01 $450.50 $437.45 $381.46 $353.04$473.37 $460.74 $449.49 $439.23 $415.29 $470.07 $456.45 $398.02 $368.37$495.57 $482.35 $470.56 $459.83 $434.76 $492.11 $477.85 $416.69 $385.64$517.49 $503.68 $491.38 $480.17 $454.00 $513.88 $498.99 $435.12 $402.70$541.63 $527.18 $514.30 $502.57 $475.17 $537.85 $522.27 $455.41 $421.49$566.05 $550.94 $537.49 $525.23 $496.60 $562.10 $545.81 $475.95 $440.49$592.41 $576.60 $562.52 $549.69 $519.72 $588.27 $571.23 $498.11 $461.00$618.77 $602.26 $587.55 $574.15 $542.85 $614.45 $596.65 $520.27 $481.52$647.35 $630.07 $614.68 $600.66 $567.92 $642.83 $624.21 $544.30 $503.76$676.21 $658.16 $642.09 $627.44 $593.24 $671.49 $652.03 $568.57 $526.21$707.01 $688.14 $671.33 $656.02 $620.26 $702.07 $681.73 $594.47 $550.18$722.27 $702.99 $685.82 $670.18 $633.65 $717.23 $696.45 $607.30 $562.06$753.07 $732.97 $715.07 $698.76 $660.67 $747.81 $726.15 $633.19 $586.02$779.70 $758.90 $740.36 $723.47 $684.04 $774.26 $751.83 $655.59 $606.75$797.18 $775.91 $756.96 $739.69 $699.37 $791.62 $768.69 $670.29 $620.36$819.10 $797.25 $777.77 $760.03 $718.60 $813.39 $789.82 $688.72 $637.41$832.42 $810.21 $790.42 $772.39 $730.29 $826.61 $802.67 $699.92 $647.78
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
$185.66 $177.42 $170.76 $150.32 $137.43 $136.60 $136.91 $156.17 $122.26$292.38 $279.40 $268.91 $236.72 $216.42 $215.11 $215.61 $245.94 $192.53$292.38 $279.40 $268.91 $236.72 $216.42 $215.11 $215.61 $245.94 $192.53$292.38 $279.40 $268.91 $236.72 $216.42 $215.11 $215.61 $245.94 $192.53$292.38 $279.40 $268.91 $236.72 $216.42 $215.11 $215.61 $245.94 $192.53$293.55 $280.51 $269.98 $237.66 $217.29 $215.97 $216.47 $246.92 $193.30$299.40 $286.10 $275.36 $242.40 $221.62 $220.28 $220.78 $251.84 $197.15$306.41 $292.81 $281.81 $248.08 $226.81 $225.44 $225.96 $257.74 $201.77$317.82 $303.70 $292.30 $257.31 $235.25 $233.83 $234.36 $267.34 $209.28$327.17 $312.64 $300.91 $264.89 $242.18 $240.71 $241.26 $275.21 $215.44$331.85 $317.12 $305.21 $268.67 $245.64 $244.15 $244.71 $279.14 $218.52$338.87 $323.82 $311.66 $274.36 $250.84 $249.32 $249.89 $285.04 $223.14$345.88 $330.53 $318.12 $280.04 $256.03 $254.48 $255.06 $290.95 $227.76$350.27 $334.72 $322.15 $283.59 $259.28 $257.71 $258.30 $294.64 $230.65$354.95 $339.19 $326.45 $287.38 $262.74 $261.15 $261.75 $298.57 $233.73$357.29 $341.42 $328.60 $289.27 $264.47 $262.87 $263.47 $300.54 $235.27$359.63 $343.66 $330.76 $291.16 $266.20 $264.59 $265.20 $302.51 $236.81$361.96 $345.89 $332.91 $293.06 $267.93 $266.31 $266.92 $304.47 $238.35$364.30 $348.13 $335.06 $294.95 $269.66 $268.03 $268.65 $306.44 $239.89$368.98 $352.60 $339.36 $298.74 $273.13 $271.47 $272.10 $310.38 $242.97$373.66 $357.07 $343.66 $302.53 $276.59 $274.91 $275.55 $314.31 $246.05$380.68 $363.77 $350.12 $308.21 $281.78 $280.08 $280.72 $320.21 $250.67$387.40 $370.20 $356.30 $313.65 $286.76 $285.02 $285.68 $325.87 $255.10$396.76 $379.14 $364.91 $321.23 $293.69 $291.91 $292.58 $333.74 $261.26$408.45 $390.32 $375.66 $330.69 $302.35 $300.51 $301.20 $343.58 $268.96$422.19 $403.45 $388.30 $341.82 $312.52 $310.62 $311.34 $355.14 $278.01$438.57 $419.09 $403.36 $355.08 $324.64 $322.67 $323.41 $368.91 $288.79$456.99 $436.70 $420.30 $369.99 $338.27 $336.22 $336.99 $384.40 $300.92$478.04 $456.81 $439.66 $387.03 $353.85 $351.71 $352.52 $402.11 $314.78$498.80 $476.65 $458.75 $403.84 $369.22 $366.98 $367.82 $419.57 $328.45$522.19 $499.00 $480.27 $422.78 $386.53 $384.19 $385.07 $439.25 $343.86$545.29 $521.07 $501.51 $441.48 $403.63 $401.19 $402.11 $458.68 $359.06$570.72 $545.38 $524.91 $462.07 $422.46 $419.90 $420.86 $480.07 $375.81$596.45 $569.97 $548.57 $482.90 $441.51 $438.83 $439.84 $501.72 $392.76$624.23 $596.51 $574.12 $505.39 $462.07 $459.27 $460.32 $525.08 $411.05$652.00 $623.05 $599.66 $527.88 $482.63 $479.70 $480.80 $548.45 $429.34$682.12 $651.83 $627.36 $552.26 $504.92 $501.86 $503.01 $573.78 $449.17$712.53 $680.89 $655.33 $576.88 $527.43 $524.23 $525.43 $599.36 $469.19$744.98 $711.90 $685.17 $603.16 $551.45 $548.11 $549.37 $626.65 $490.56$761.06 $727.27 $699.96 $616.18 $563.35 $559.94 $561.22 $640.18 $501.15$793.51 $758.28 $729.81 $642.45 $587.38 $583.82 $585.16 $667.48 $522.52$821.58 $785.10 $755.63 $665.18 $608.15 $604.47 $605.85 $691.09 $541.00$840.00 $802.71 $772.57 $680.09 $621.79 $618.02 $619.44 $706.59 $553.13$863.10 $824.78 $793.81 $698.79 $638.89 $635.01 $636.47 $726.01 $568.34$877.13 $838.19 $806.72 $710.15 $649.27 $645.34 $646.82 $737.82 $577.58
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5 Area 6Moda Health Plan Inc
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A
$208.87 $188.97 $204.60 $171.64 $139.39 $237.15 $234.09 $221.33 $215.08$328.93 $297.60 $322.21 $270.30 $219.51 $373.47 $368.65 $348.55 $338.71$328.93 $297.60 $322.21 $270.30 $219.51 $373.47 $368.65 $348.55 $338.71$328.93 $297.60 $322.21 $270.30 $219.51 $373.47 $368.65 $348.55 $338.71$328.93 $297.60 $322.21 $270.30 $219.51 $373.47 $368.65 $348.55 $338.71$330.25 $298.79 $323.49 $271.38 $220.39 $374.97 $370.12 $349.94 $340.06$336.82 $304.74 $329.94 $276.79 $224.78 $382.44 $377.50 $356.91 $346.83$344.72 $311.88 $337.67 $283.28 $230.05 $391.40 $386.34 $365.28 $354.96$357.55 $323.49 $350.24 $293.82 $238.61 $405.96 $400.72 $378.87 $368.17$368.07 $333.01 $360.55 $302.47 $245.64 $417.92 $412.52 $390.02 $379.01$373.34 $337.77 $365.70 $306.79 $249.15 $423.89 $418.42 $395.60 $384.43$381.23 $344.91 $373.44 $313.28 $254.42 $432.85 $427.26 $403.97 $392.56$389.12 $352.06 $381.17 $319.77 $259.68 $441.82 $436.11 $412.33 $400.69$394.06 $356.52 $386.00 $323.82 $262.98 $447.42 $441.64 $417.56 $405.77$399.32 $361.28 $391.16 $328.15 $266.49 $453.39 $447.54 $423.14 $411.19$401.95 $363.66 $393.74 $330.31 $268.24 $456.38 $450.49 $425.92 $413.90$404.58 $366.04 $396.31 $332.47 $270.00 $459.37 $453.44 $428.71 $416.61$407.21 $368.42 $398.89 $334.63 $271.76 $462.36 $456.39 $431.50 $419.32$409.85 $370.80 $401.47 $336.80 $273.51 $465.35 $459.34 $434.29 $422.03$415.11 $375.57 $406.62 $341.12 $277.03 $471.32 $465.23 $439.87 $427.45$420.37 $380.33 $411.78 $345.44 $280.54 $477.30 $471.13 $445.44 $432.87$428.27 $387.47 $419.51 $351.93 $285.81 $486.26 $479.98 $453.81 $440.99$435.83 $394.31 $426.92 $358.15 $290.85 $494.85 $488.46 $461.82 $448.79$446.36 $403.84 $437.23 $366.80 $297.88 $506.80 $500.26 $472.98 $459.62$459.51 $415.74 $450.12 $377.61 $306.66 $521.74 $515.00 $486.92 $473.17$474.97 $429.73 $465.27 $390.31 $316.98 $539.29 $532.33 $503.30 $489.09$493.39 $446.39 $483.31 $405.45 $329.27 $560.21 $552.97 $522.82 $508.06$514.12 $465.14 $503.61 $422.48 $343.10 $583.74 $576.20 $544.78 $529.40$537.80 $486.57 $526.81 $441.94 $358.90 $610.63 $602.74 $569.87 $553.78$561.15 $507.70 $549.68 $461.13 $374.49 $637.14 $628.91 $594.62 $577.83$587.47 $531.51 $575.46 $482.76 $392.05 $667.02 $658.41 $622.50 $604.93$613.45 $555.02 $600.91 $504.11 $409.39 $696.53 $687.53 $650.04 $631.69$642.07 $580.91 $628.95 $527.63 $428.49 $729.02 $719.60 $680.36 $661.15$671.02 $607.10 $657.30 $551.41 $447.81 $761.88 $752.04 $711.04 $690.96$702.26 $635.37 $687.91 $577.09 $468.66 $797.36 $787.07 $744.15 $723.14$733.51 $663.64 $718.52 $602.77 $489.51 $832.84 $822.09 $777.26 $755.31$767.39 $694.29 $751.71 $630.61 $512.12 $871.31 $860.06 $813.16 $790.20$801.60 $725.24 $785.22 $658.72 $534.95 $910.15 $898.40 $849.41 $825.43$838.11 $758.28 $820.98 $688.73 $559.32 $951.61 $939.32 $888.10 $863.02$856.20 $774.64 $838.70 $703.59 $571.39 $972.15 $959.59 $907.27 $881.65$892.71 $807.68 $874.47 $733.60 $595.76 $1,013.60 $1,000.51 $945.96 $919.25$924.29 $836.25 $905.40 $759.55 $616.83 $1,049.46 $1,035.90 $979.42 $951.76$945.01 $854.99 $925.70 $776.57 $630.66 $1,072.99 $1,059.13 $1,001.38 $973.10$971.00 $878.50 $951.15 $797.93 $648.00 $1,102.49 $1,088.25 $1,028.91 $999.86$986.79 $892.79 $966.62 $810.90 $658.54 $1,120.42 $1,105.95 $1,045.64 $1,016.12
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500
$214.68 $209.36 $188.16 $184.62 $187.97 $181.48 $176.64 $172.33 $168.39$338.07 $329.70 $296.31 $290.74 $296.02 $285.80 $278.17 $271.38 $265.19$338.07 $329.70 $296.31 $290.74 $296.02 $285.80 $278.17 $271.38 $265.19$338.07 $329.70 $296.31 $290.74 $296.02 $285.80 $278.17 $271.38 $265.19$338.07 $329.70 $296.31 $290.74 $296.02 $285.80 $278.17 $271.38 $265.19$339.42 $331.01 $297.49 $291.91 $297.20 $286.94 $279.28 $272.46 $266.25$346.19 $337.61 $303.42 $297.72 $303.12 $292.66 $284.85 $277.89 $271.55$354.30 $345.52 $310.53 $304.70 $310.23 $299.52 $291.52 $284.40 $277.92$367.48 $358.38 $322.09 $316.04 $321.77 $310.66 $302.37 $294.99 $288.26$378.30 $368.93 $331.57 $325.34 $331.25 $319.81 $311.27 $303.67 $296.75$383.71 $374.21 $336.31 $329.99 $335.98 $324.38 $315.73 $308.01 $300.99$391.83 $382.12 $343.42 $336.97 $343.09 $331.24 $322.40 $314.53 $307.35$399.94 $390.03 $350.53 $343.95 $350.19 $338.10 $329.08 $321.04 $313.72$405.01 $394.98 $354.98 $348.31 $354.63 $342.39 $333.25 $325.11 $317.70$410.42 $400.25 $359.72 $352.96 $359.37 $346.96 $337.70 $329.45 $321.94$413.12 $402.89 $362.09 $355.29 $361.74 $349.25 $339.93 $331.62 $324.06$415.83 $405.53 $364.46 $357.61 $364.10 $351.53 $342.15 $333.79 $326.18$418.53 $408.16 $366.83 $359.94 $366.47 $353.82 $344.38 $335.97 $328.30$421.24 $410.80 $369.20 $362.27 $368.84 $356.11 $346.60 $338.14 $330.42$426.65 $416.08 $373.94 $366.92 $373.58 $360.68 $351.05 $342.48 $334.67$432.06 $421.35 $378.68 $371.57 $378.31 $365.25 $355.50 $346.82 $338.91$440.17 $429.26 $385.79 $378.55 $385.42 $372.11 $362.18 $353.33 $345.27$447.95 $436.85 $392.61 $385.23 $392.23 $378.68 $368.58 $359.58 $351.37$458.76 $447.40 $402.09 $394.54 $401.70 $387.83 $377.48 $368.26 $359.86$472.29 $460.59 $413.94 $406.17 $413.54 $399.26 $388.61 $379.12 $370.47$488.18 $476.08 $427.87 $419.83 $427.45 $412.69 $401.68 $391.87 $382.93$507.11 $494.54 $444.46 $436.12 $444.03 $428.70 $417.26 $407.07 $397.78$528.41 $515.32 $463.13 $454.43 $462.68 $446.70 $434.78 $424.16 $414.49$552.75 $539.05 $484.46 $475.37 $483.99 $467.28 $454.81 $443.70 $433.58$576.75 $562.46 $505.50 $496.01 $505.01 $487.57 $474.56 $462.97 $452.41$603.80 $588.84 $529.20 $519.27 $528.69 $510.44 $496.82 $484.68 $473.63$630.50 $614.88 $552.61 $542.24 $552.08 $533.01 $518.79 $506.12 $494.58$659.92 $643.57 $578.39 $567.53 $577.83 $557.88 $542.99 $529.73 $517.65$689.67 $672.58 $604.47 $593.12 $603.88 $583.03 $567.47 $553.61 $540.98$721.78 $703.90 $632.62 $620.74 $632.00 $610.18 $593.90 $579.39 $566.18$753.90 $735.22 $660.77 $648.36 $660.12 $637.33 $620.32 $605.17 $591.37$788.72 $769.18 $691.28 $678.30 $690.61 $666.77 $648.98 $633.12 $618.68$823.88 $803.47 $722.10 $708.54 $721.40 $696.49 $677.91 $661.35 $646.26$861.41 $840.07 $754.99 $740.81 $754.26 $728.22 $708.78 $691.47 $675.70$880.00 $858.20 $771.29 $756.80 $770.54 $743.93 $724.08 $706.40 $690.28$917.53 $894.80 $804.18 $789.08 $803.40 $775.66 $754.96 $736.52 $719.72$949.98 $926.45 $832.62 $816.99 $831.81 $803.09 $781.66 $762.57 $745.18$971.28 $947.22 $851.29 $835.31 $850.46 $821.10 $799.19 $779.67 $761.89$997.99 $973.26 $874.70 $858.27 $873.85 $843.68 $821.16 $801.11 $782.84
$1,014.22 $989.09 $888.92 $872.23 $888.06 $857.40 $834.52 $814.13 $795.56
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
$159.21 $180.22 $174.99 $152.59 $141.23 $191.23 $182.74 $175.88 $154.83$250.73 $283.80 $275.58 $240.31 $222.40 $301.15 $287.78 $276.97 $243.82$250.73 $283.80 $275.58 $240.31 $222.40 $301.15 $287.78 $276.97 $243.82$250.73 $283.80 $275.58 $240.31 $222.40 $301.15 $287.78 $276.97 $243.82$250.73 $283.80 $275.58 $240.31 $222.40 $301.15 $287.78 $276.97 $243.82$251.74 $284.94 $276.68 $241.27 $223.29 $302.35 $288.93 $278.08 $244.79$256.75 $290.62 $282.20 $246.07 $227.74 $308.38 $294.69 $283.62 $249.67$262.77 $297.43 $288.81 $251.84 $233.08 $315.60 $301.59 $290.27 $255.52$272.55 $308.50 $299.56 $261.21 $241.75 $327.35 $312.82 $301.07 $265.03$280.57 $317.58 $308.38 $268.90 $248.87 $336.99 $322.02 $309.93 $272.83$284.58 $322.12 $312.79 $272.75 $252.43 $341.80 $326.63 $314.37 $276.73$290.60 $328.93 $319.40 $278.51 $257.77 $349.03 $333.54 $321.01 $282.59$296.62 $335.74 $326.01 $284.28 $263.10 $356.26 $340.44 $327.66 $288.44$300.38 $340.00 $330.15 $287.89 $266.44 $360.78 $344.76 $331.81 $292.10$304.39 $344.54 $334.56 $291.73 $270.00 $365.60 $349.36 $336.25 $296.00$306.39 $346.81 $336.76 $293.65 $271.78 $368.00 $351.67 $338.46 $297.95$308.40 $349.08 $338.97 $295.58 $273.56 $370.41 $353.97 $340.68 $299.90$310.41 $351.35 $341.17 $297.50 $275.34 $372.82 $356.27 $342.89 $301.85$312.41 $353.62 $343.38 $299.42 $277.12 $375.23 $358.57 $345.11 $303.80$316.42 $358.16 $347.79 $303.27 $280.67 $380.05 $363.18 $349.54 $307.70$320.44 $362.70 $352.19 $307.11 $284.23 $384.87 $367.78 $353.97 $311.60$326.45 $369.51 $358.81 $312.88 $289.57 $392.10 $374.69 $360.62 $317.45$332.22 $376.04 $365.15 $318.41 $294.69 $399.02 $381.31 $366.99 $323.06$340.24 $385.12 $373.97 $326.09 $301.80 $408.66 $390.52 $375.85 $330.86$350.27 $396.47 $384.99 $335.71 $310.70 $420.71 $402.03 $386.93 $340.62$362.06 $409.81 $397.94 $347.00 $321.15 $434.86 $415.55 $399.95 $352.07$376.10 $425.71 $413.37 $360.46 $333.61 $451.72 $431.67 $415.46 $365.73$391.89 $443.59 $430.74 $375.60 $347.62 $470.70 $449.80 $432.91 $381.09$409.95 $464.02 $450.58 $392.90 $363.63 $492.38 $470.52 $452.85 $398.64$427.75 $484.17 $470.14 $409.96 $379.42 $513.76 $490.95 $472.52 $415.96$447.81 $506.87 $492.19 $429.19 $397.21 $537.85 $513.97 $494.68 $435.46$467.62 $529.30 $513.96 $448.17 $414.78 $561.64 $536.71 $516.56 $454.72$489.43 $553.99 $537.94 $469.08 $434.13 $587.84 $561.74 $540.65 $475.94$511.49 $578.96 $562.19 $490.22 $453.70 $614.35 $587.07 $565.03 $497.39$535.31 $605.92 $588.37 $513.05 $474.83 $642.95 $614.41 $591.34 $520.55$559.13 $632.88 $614.55 $535.88 $495.96 $671.56 $641.75 $617.65 $543.72$584.96 $662.12 $642.93 $560.63 $518.87 $702.58 $671.39 $646.18 $568.83$611.03 $691.63 $671.59 $585.63 $542.00 $733.90 $701.32 $674.99 $594.19$638.87 $723.13 $702.18 $612.30 $566.69 $767.33 $733.26 $705.73 $621.25$652.66 $738.74 $717.34 $625.52 $578.92 $783.89 $749.09 $720.96 $634.66$680.49 $770.25 $747.93 $652.19 $603.61 $817.32 $781.03 $751.71 $661.73$704.56 $797.49 $774.39 $675.26 $624.96 $846.23 $808.66 $778.30 $685.13$720.35 $815.37 $791.75 $690.40 $638.97 $865.20 $826.79 $795.75 $700.49$740.16 $837.79 $813.52 $709.38 $656.54 $888.99 $849.52 $817.63 $719.75$752.20 $851.41 $826.75 $720.92 $667.21 $903.45 $863.34 $830.92 $731.46
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Summit
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
Moda Health
Summit
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Platinum
Summit
Exclusive 250
$141.55 $140.69 $141.02 $160.86 $166.34 $125.92 $129.93 $215.14 $222.93$222.92 $221.57 $222.07 $253.32 $261.96 $198.30 $204.61 $338.80 $351.07$222.92 $221.57 $222.07 $253.32 $261.96 $198.30 $204.61 $338.80 $351.07$222.92 $221.57 $222.07 $253.32 $261.96 $198.30 $204.61 $338.80 $351.07$222.92 $221.57 $222.07 $253.32 $261.96 $198.30 $204.61 $338.80 $351.07$223.81 $222.45 $222.96 $254.33 $263.01 $199.10 $205.43 $340.15 $352.47$228.27 $226.88 $227.40 $259.40 $268.25 $203.06 $209.52 $346.93 $359.49$233.62 $232.20 $232.73 $265.48 $274.53 $207.82 $214.43 $355.06 $367.92$242.31 $240.84 $241.40 $275.36 $284.75 $215.56 $222.41 $368.27 $381.61$249.44 $247.93 $248.50 $283.46 $293.13 $221.90 $228.96 $379.11 $392.85$253.01 $251.48 $252.05 $287.52 $297.33 $225.07 $232.23 $384.54 $398.46$258.36 $256.80 $257.38 $293.60 $303.61 $229.83 $237.15 $392.67 $406.89$263.71 $262.11 $262.71 $299.68 $309.90 $234.59 $242.06 $400.80 $415.31$267.05 $265.44 $266.05 $303.47 $313.83 $237.57 $245.13 $405.88 $420.58$270.62 $268.98 $269.60 $307.53 $318.02 $240.74 $248.40 $411.30 $426.20$272.40 $270.75 $271.38 $309.55 $320.12 $242.33 $250.04 $414.01 $429.01$274.19 $272.53 $273.15 $311.58 $322.21 $243.91 $251.67 $416.72 $431.81$275.97 $274.30 $274.93 $313.61 $324.31 $245.50 $253.31 $419.43 $434.62$277.75 $276.07 $276.71 $315.63 $326.40 $247.09 $254.95 $422.14 $437.43$281.32 $279.62 $280.26 $319.69 $330.59 $250.26 $258.22 $427.56 $443.05$284.89 $283.16 $283.81 $323.74 $334.79 $253.43 $261.49 $432.98 $448.67$290.24 $288.48 $289.14 $329.82 $341.07 $258.19 $266.41 $441.11 $457.09$295.37 $293.58 $294.25 $335.65 $347.10 $262.75 $271.11 $448.91 $465.17$302.50 $300.67 $301.36 $343.75 $355.48 $269.10 $277.66 $459.75 $476.40$311.42 $309.53 $310.24 $353.89 $365.96 $277.03 $285.84 $473.30 $490.44$321.89 $319.94 $320.68 $365.79 $378.27 $286.35 $295.46 $489.22 $506.94$334.38 $332.35 $333.11 $379.98 $392.94 $297.46 $306.92 $508.20 $526.60$348.42 $346.31 $347.10 $395.94 $409.44 $309.95 $319.81 $529.54 $548.72$364.47 $362.26 $363.09 $414.17 $428.31 $324.23 $334.54 $553.93 $574.00$380.30 $377.99 $378.86 $432.16 $446.90 $338.31 $349.07 $577.99 $598.92$398.13 $395.72 $396.63 $452.43 $467.86 $354.17 $365.44 $605.09 $627.01$415.74 $413.22 $414.17 $472.44 $488.56 $369.84 $381.60 $631.86 $654.74$435.13 $432.50 $433.49 $494.48 $511.35 $387.09 $399.40 $661.33 $685.29$454.75 $452.00 $453.03 $516.77 $534.40 $404.54 $417.41 $691.15 $716.18$475.93 $473.04 $474.13 $540.83 $559.29 $423.38 $436.85 $723.33 $749.53$497.11 $494.09 $495.23 $564.90 $584.17 $442.22 $456.29 $755.52 $782.88$520.07 $516.91 $518.10 $590.99 $611.15 $462.64 $477.36 $790.41 $819.04$543.25 $539.96 $541.20 $617.34 $638.40 $483.27 $498.64 $825.65 $855.56$567.99 $564.55 $565.85 $645.45 $667.48 $505.28 $521.35 $863.26 $894.52$580.25 $576.74 $578.06 $659.39 $681.88 $516.18 $532.61 $881.89 $913.83$605.00 $601.33 $602.71 $687.51 $710.96 $538.20 $555.32 $919.50 $952.80$626.40 $622.60 $624.03 $711.82 $736.11 $557.23 $574.96 $952.02 $986.50$640.44 $636.56 $638.02 $727.78 $752.61 $569.73 $587.85 $973.37 $1,008.62$658.05 $654.06 $655.56 $747.79 $773.31 $585.39 $604.02 $1,000.13 $1,036.36$668.75 $664.70 $666.22 $759.95 $785.88 $594.91 $613.84 $1,016.39 $1,053.21
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7Moda Health Plan Inc
PPO Synergy
Exclusive
1000A
PPO Summit
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A
$194.64 $201.62 $210.74 $176.79 $143.57 $239.46 $236.36 $223.48 $217.17$306.52 $317.50 $331.87 $278.41 $226.10 $377.10 $372.23 $351.93 $341.99$306.52 $317.50 $331.87 $278.41 $226.10 $377.10 $372.23 $351.93 $341.99$306.52 $317.50 $331.87 $278.41 $226.10 $377.10 $372.23 $351.93 $341.99$306.52 $317.50 $331.87 $278.41 $226.10 $377.10 $372.23 $351.93 $341.99$307.75 $318.77 $333.20 $279.52 $227.00 $378.61 $373.72 $353.34 $343.36$313.88 $325.12 $339.84 $285.09 $231.52 $386.15 $381.16 $360.38 $350.20$321.24 $332.74 $347.80 $291.77 $236.95 $395.20 $390.09 $368.82 $358.41$333.19 $345.13 $360.75 $302.63 $245.77 $409.91 $404.61 $382.55 $371.75$343.00 $355.29 $371.36 $311.54 $253.00 $421.97 $416.52 $393.81 $382.69$347.90 $360.37 $376.67 $316.00 $256.62 $428.01 $422.48 $399.44 $388.16$355.26 $367.99 $384.64 $322.68 $262.05 $437.06 $431.41 $407.89 $396.37$362.62 $375.61 $392.60 $329.36 $267.47 $446.11 $440.35 $416.33 $404.58$367.22 $380.37 $397.58 $333.54 $270.87 $451.76 $445.93 $421.61 $409.71$372.12 $385.45 $402.89 $337.99 $274.48 $457.80 $451.88 $427.24 $415.18$374.57 $387.99 $405.55 $340.22 $276.29 $460.81 $454.86 $430.06 $417.92$377.02 $390.53 $408.20 $342.44 $278.10 $463.83 $457.84 $432.87 $420.65$379.48 $393.07 $410.86 $344.67 $279.91 $466.85 $460.82 $435.69 $423.39$381.93 $395.61 $413.51 $346.90 $281.72 $469.86 $463.80 $438.51 $426.12$386.83 $400.69 $418.82 $351.35 $285.34 $475.90 $469.75 $444.14 $431.60$391.74 $405.77 $424.13 $355.81 $288.95 $481.93 $475.71 $449.77 $437.07$399.09 $413.39 $432.10 $362.49 $294.38 $490.98 $484.64 $458.21 $445.28$406.14 $420.69 $439.73 $368.89 $299.58 $499.65 $493.20 $466.31 $453.14$415.95 $430.85 $450.35 $377.80 $306.82 $511.72 $505.11 $477.57 $464.09$428.21 $443.55 $463.63 $388.94 $315.86 $526.81 $520.00 $491.65 $477.77$442.62 $458.48 $479.22 $402.02 $326.49 $544.53 $537.50 $508.19 $493.84$459.79 $476.26 $497.81 $417.62 $339.15 $565.65 $558.34 $527.90 $512.99$479.10 $496.26 $518.72 $435.15 $353.39 $589.40 $581.79 $550.07 $534.54$501.17 $519.12 $542.61 $455.20 $369.67 $616.56 $608.59 $575.41 $559.16$522.93 $541.66 $566.17 $474.97 $385.72 $643.33 $635.02 $600.39 $583.44$547.45 $567.06 $592.72 $497.24 $403.81 $673.50 $664.80 $628.55 $610.80$571.67 $592.15 $618.94 $519.23 $421.67 $703.29 $694.21 $656.35 $637.82$598.34 $619.77 $647.81 $543.46 $441.34 $736.10 $726.59 $686.97 $667.57$625.31 $647.71 $677.02 $567.96 $461.24 $769.28 $759.35 $717.94 $697.67$654.43 $677.87 $708.55 $594.41 $482.72 $805.10 $794.71 $751.37 $730.16$683.55 $708.03 $740.08 $620.85 $504.20 $840.93 $830.07 $784.81 $762.65$715.12 $740.74 $774.26 $649.53 $527.49 $879.77 $868.41 $821.05 $797.87$747.00 $773.76 $808.77 $678.49 $551.00 $918.99 $907.12 $857.66 $833.44$781.02 $809.00 $845.61 $709.39 $576.10 $960.85 $948.44 $896.72 $871.40$797.88 $826.46 $863.86 $724.70 $588.53 $981.59 $968.91 $916.08 $890.21$831.91 $861.71 $900.70 $755.60 $613.63 $1,023.44 $1,010.23 $955.14 $928.17$861.33 $892.19 $932.56 $782.33 $635.34 $1,059.65 $1,045.96 $988.93 $961.00$880.64 $912.19 $953.47 $799.87 $649.58 $1,083.40 $1,069.41 $1,011.10 $982.55$904.86 $937.27 $979.69 $821.87 $667.44 $1,113.19 $1,098.82 $1,038.90 $1,009.57$919.57 $952.51 $995.62 $835.23 $678.30 $1,131.29 $1,116.68 $1,055.79 $1,025.98
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7
PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500
$216.76 $211.39 $189.98 $186.41 $189.80 $183.24 $178.35 $174.00 $170.03$341.35 $332.90 $299.18 $293.57 $298.89 $288.57 $280.87 $274.01 $267.76$341.35 $332.90 $299.18 $293.57 $298.89 $288.57 $280.87 $274.01 $267.76$341.35 $332.90 $299.18 $293.57 $298.89 $288.57 $280.87 $274.01 $267.76$341.35 $332.90 $299.18 $293.57 $298.89 $288.57 $280.87 $274.01 $267.76$342.72 $334.23 $300.38 $294.74 $300.09 $289.73 $282.00 $275.11 $268.83$349.55 $340.89 $306.36 $300.61 $306.07 $295.50 $287.61 $280.59 $274.19$357.74 $348.88 $313.54 $307.66 $313.24 $302.43 $294.35 $287.17 $280.62$371.05 $361.86 $325.21 $319.11 $324.90 $313.68 $305.31 $297.85 $291.06$381.98 $372.51 $334.79 $328.50 $334.46 $322.91 $314.30 $306.62 $299.63$387.44 $377.84 $339.57 $333.20 $339.24 $327.53 $318.79 $311.00 $303.91$395.63 $385.83 $346.75 $340.24 $346.42 $334.46 $325.53 $317.58 $310.34$403.82 $393.82 $353.93 $347.29 $353.59 $341.38 $332.27 $324.16 $316.76$408.94 $398.81 $358.42 $351.69 $358.07 $345.71 $336.49 $328.27 $320.78$414.40 $404.14 $363.21 $356.39 $362.86 $350.33 $340.98 $332.65 $325.06$417.13 $406.80 $365.60 $358.74 $365.25 $352.64 $343.23 $334.84 $327.21$419.87 $409.46 $368.00 $361.09 $367.64 $354.95 $345.47 $337.04 $329.35$422.60 $412.13 $370.39 $363.43 $370.03 $357.25 $347.72 $339.23 $331.49$425.33 $414.79 $372.78 $365.78 $372.42 $359.56 $349.97 $341.42 $333.63$430.79 $420.12 $377.57 $370.48 $377.20 $364.18 $354.46 $345.80 $337.92$436.25 $425.44 $382.36 $375.18 $381.99 $368.80 $358.96 $350.19 $342.20$444.44 $433.43 $389.54 $382.22 $389.16 $375.72 $365.70 $356.76 $348.63$452.29 $441.09 $396.42 $388.98 $396.03 $382.36 $372.16 $363.07 $354.79$463.22 $451.74 $405.99 $398.37 $405.60 $391.59 $381.14 $371.84 $363.35$476.87 $465.06 $417.96 $410.11 $417.55 $403.14 $392.38 $382.80 $374.06$492.92 $480.70 $432.02 $423.91 $431.60 $416.70 $405.58 $395.67 $386.65$512.03 $499.35 $448.78 $440.35 $448.34 $432.86 $421.31 $411.02 $401.64$533.54 $520.32 $467.62 $458.84 $467.17 $451.04 $439.00 $428.28 $418.51$558.11 $544.29 $489.17 $479.98 $488.69 $471.82 $459.23 $448.01 $437.79$582.35 $567.92 $510.41 $500.82 $509.91 $492.31 $479.17 $467.47 $456.80$609.66 $594.55 $534.34 $524.31 $533.82 $515.39 $501.64 $489.39 $478.22$636.63 $620.85 $557.98 $547.50 $557.44 $538.19 $523.83 $511.03 $499.38$666.32 $649.82 $584.01 $573.04 $583.44 $563.30 $548.26 $534.87 $522.67$696.36 $679.11 $610.34 $598.87 $609.74 $588.69 $572.98 $558.99 $546.24$728.79 $710.74 $638.76 $626.76 $638.14 $616.10 $599.66 $585.02 $571.67$761.22 $742.36 $667.18 $654.65 $666.53 $643.52 $626.35 $611.05 $597.11$796.38 $776.65 $698.00 $684.89 $697.32 $673.24 $655.28 $639.27 $624.69$831.88 $811.27 $729.11 $715.42 $728.40 $703.25 $684.49 $667.77 $652.54$869.77 $848.22 $762.32 $748.01 $761.58 $735.29 $715.66 $698.18 $682.26$888.54 $866.53 $778.78 $764.15 $778.02 $751.16 $731.11 $713.26 $696.99$926.43 $903.48 $811.99 $796.74 $811.20 $783.19 $762.29 $743.67 $726.71$959.20 $935.44 $840.71 $824.92 $839.89 $810.89 $789.25 $769.98 $752.41$980.71 $956.41 $859.56 $843.42 $858.72 $829.07 $806.95 $787.24 $769.28
$1,007.68 $982.71 $883.19 $866.61 $882.33 $851.87 $829.14 $808.89 $790.44$1,024.06 $998.69 $897.55 $880.70 $896.68 $865.72 $842.62 $822.04 $803.29
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
$160.76 $181.97 $176.69 $154.08 $142.60 $193.09 $184.51 $177.59 $156.33$253.17 $286.56 $278.26 $242.64 $224.56 $304.07 $290.57 $279.66 $246.19$253.17 $286.56 $278.26 $242.64 $224.56 $304.07 $290.57 $279.66 $246.19$253.17 $286.56 $278.26 $242.64 $224.56 $304.07 $290.57 $279.66 $246.19$253.17 $286.56 $278.26 $242.64 $224.56 $304.07 $290.57 $279.66 $246.19$254.18 $287.71 $279.37 $243.61 $225.46 $305.29 $291.73 $280.78 $247.17$259.24 $293.44 $284.94 $248.46 $229.95 $311.37 $297.55 $286.37 $252.09$265.32 $300.31 $291.61 $254.29 $235.34 $318.67 $304.52 $293.09 $258.00$275.19 $311.49 $302.47 $263.75 $244.10 $330.53 $315.85 $303.99 $267.60$283.29 $320.66 $311.37 $271.51 $251.29 $340.26 $325.15 $312.94 $275.48$287.34 $325.25 $315.82 $275.40 $254.88 $345.12 $329.80 $317.42 $279.42$293.42 $332.12 $322.50 $281.22 $260.27 $352.42 $336.77 $324.13 $285.33$299.50 $339.00 $329.18 $287.04 $265.66 $359.72 $343.75 $330.84 $291.24$303.29 $343.30 $333.35 $290.68 $269.03 $364.28 $348.11 $335.04 $294.93$307.34 $347.88 $337.81 $294.56 $272.62 $369.15 $352.75 $339.51 $298.87$309.37 $350.18 $340.03 $296.50 $274.42 $371.58 $355.08 $341.75 $300.84$311.39 $352.47 $342.26 $298.45 $276.21 $374.01 $357.40 $343.99 $302.81$313.42 $354.76 $344.48 $300.39 $278.01 $376.44 $359.73 $346.22 $304.78$315.45 $357.05 $346.71 $302.33 $279.81 $378.88 $362.05 $348.46 $306.75$319.50 $361.64 $351.16 $306.21 $283.40 $383.74 $366.70 $352.93 $310.69$323.55 $366.22 $355.61 $310.09 $286.99 $388.61 $371.35 $357.41 $314.63$329.62 $373.10 $362.29 $315.92 $292.38 $395.90 $378.33 $364.12 $320.53$335.45 $379.69 $368.69 $321.50 $297.55 $402.90 $385.01 $370.55 $326.20$343.55 $388.86 $377.60 $329.26 $304.73 $412.63 $394.31 $379.50 $334.07$353.67 $400.32 $388.73 $338.97 $313.72 $424.79 $405.93 $390.69 $343.92$365.57 $413.79 $401.80 $350.37 $324.27 $439.08 $419.59 $403.83 $355.49$379.75 $429.84 $417.39 $363.96 $336.85 $456.11 $435.86 $419.49 $369.28$395.70 $447.89 $434.92 $379.24 $350.99 $475.27 $454.16 $437.11 $384.79$413.93 $468.53 $454.95 $396.71 $367.16 $497.16 $475.09 $457.25 $402.51$431.90 $488.87 $474.71 $413.94 $383.11 $518.75 $495.72 $477.11 $419.99$452.16 $511.80 $496.97 $433.35 $401.07 $543.08 $518.96 $499.48 $439.69$472.16 $534.43 $518.95 $452.52 $418.81 $567.10 $541.92 $521.57 $459.14$494.18 $559.36 $543.16 $473.63 $438.35 $593.55 $567.20 $545.90 $480.56$516.46 $584.58 $567.65 $494.98 $458.11 $620.31 $592.77 $570.51 $502.22$540.51 $611.81 $594.08 $518.03 $479.44 $649.20 $620.37 $597.08 $525.61$564.56 $639.03 $620.52 $541.08 $500.78 $678.08 $647.98 $623.65 $549.00$590.64 $668.54 $649.18 $566.08 $523.91 $709.40 $677.91 $652.45 $574.35$616.97 $698.35 $678.11 $591.31 $547.26 $741.03 $708.13 $681.54 $599.96$645.07 $730.15 $709.00 $618.24 $572.19 $774.78 $740.38 $712.58 $627.28$658.99 $745.92 $724.31 $631.59 $584.54 $791.50 $756.36 $727.96 $640.82$687.09 $777.72 $755.19 $658.52 $609.47 $825.26 $788.61 $759.01 $668.15$711.40 $805.23 $781.91 $681.82 $631.02 $854.45 $816.51 $785.85 $691.78$727.35 $823.29 $799.44 $697.10 $645.17 $873.60 $834.81 $803.47 $707.29$747.35 $845.92 $821.42 $716.27 $662.91 $897.62 $857.77 $825.57 $726.74$759.50 $859.68 $834.77 $727.92 $673.69 $912.22 $871.72 $838.99 $738.56
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
$142.93 $142.06 $142.39 $162.42 $127.15 $217.23 $196.53 $212.78 $178.51$225.08 $223.72 $224.23 $255.78 $200.23 $342.09 $309.50 $335.09 $281.11$225.08 $223.72 $224.23 $255.78 $200.23 $342.09 $309.50 $335.09 $281.11$225.08 $223.72 $224.23 $255.78 $200.23 $342.09 $309.50 $335.09 $281.11$225.08 $223.72 $224.23 $255.78 $200.23 $342.09 $309.50 $335.09 $281.11$225.98 $224.61 $225.13 $256.80 $201.03 $343.46 $310.74 $336.43 $282.24$230.48 $229.09 $229.61 $261.92 $205.03 $350.30 $316.93 $343.14 $287.86$235.89 $234.46 $234.99 $268.05 $209.84 $358.51 $324.36 $351.18 $294.61$244.66 $243.18 $243.74 $278.03 $217.65 $371.85 $336.43 $364.25 $305.57$251.87 $250.34 $250.91 $286.21 $224.06 $382.80 $346.33 $374.97 $314.57$255.47 $253.92 $254.50 $290.31 $227.26 $388.27 $351.28 $380.33 $319.06$260.87 $259.29 $259.88 $296.45 $232.07 $396.48 $358.71 $388.37 $325.81$266.27 $264.66 $265.26 $302.58 $236.87 $404.69 $366.14 $396.42 $332.56$269.65 $268.01 $268.63 $306.42 $239.87 $409.82 $370.78 $401.44 $336.77$273.25 $271.59 $272.22 $310.51 $243.08 $415.29 $375.73 $406.80 $341.27$275.05 $273.38 $274.01 $312.56 $244.68 $418.03 $378.21 $409.49 $343.52$276.85 $275.17 $275.80 $314.61 $246.28 $420.77 $380.69 $412.17 $345.77$278.65 $276.96 $277.60 $316.65 $247.88 $423.50 $383.16 $414.85 $348.02$280.45 $278.75 $279.39 $318.70 $249.49 $426.24 $385.64 $417.53 $350.27$284.05 $282.33 $282.98 $322.79 $252.69 $431.71 $390.59 $422.89 $354.76$287.65 $285.91 $286.57 $326.88 $255.89 $437.19 $395.54 $428.25 $359.26$293.06 $291.28 $291.95 $333.02 $260.70 $445.40 $402.97 $436.29 $366.01$298.23 $296.43 $297.11 $338.91 $265.30 $453.27 $410.09 $444.00 $372.47$305.44 $303.58 $304.28 $347.09 $271.71 $464.21 $419.99 $454.72 $381.47$314.44 $312.53 $313.25 $357.32 $279.72 $477.90 $432.37 $468.13 $392.71$325.02 $323.05 $323.79 $369.34 $289.13 $493.97 $446.92 $483.88 $405.93$337.62 $335.58 $336.35 $383.67 $300.34 $513.13 $464.25 $502.64 $421.67$351.80 $349.67 $350.47 $399.78 $312.96 $534.68 $483.75 $523.75 $439.38$368.01 $365.78 $366.62 $418.20 $327.37 $559.31 $506.03 $547.88 $459.62$383.99 $381.66 $382.54 $436.36 $341.59 $583.60 $528.01 $571.67 $479.58$402.00 $399.56 $400.48 $456.82 $357.61 $610.97 $552.77 $598.48 $502.07$419.78 $417.23 $418.19 $477.02 $373.43 $637.99 $577.22 $624.95 $524.28$439.36 $436.70 $437.70 $499.28 $390.85 $667.75 $604.14 $654.10 $548.73$459.17 $456.38 $457.43 $521.79 $408.47 $697.86 $631.38 $683.59 $573.47$480.55 $477.64 $478.73 $546.08 $427.49 $730.36 $660.78 $715.43 $600.18$501.93 $498.89 $500.03 $570.38 $446.51 $762.85 $690.19 $747.26 $626.88$525.12 $521.93 $523.13 $596.73 $467.13 $798.09 $722.06 $781.77 $655.84$548.52 $545.20 $546.45 $623.33 $487.96 $833.67 $754.25 $816.62 $685.07$573.51 $570.03 $571.34 $651.72 $510.18 $871.64 $788.61 $853.82 $716.28$585.89 $582.34 $583.67 $665.79 $521.20 $890.45 $805.63 $872.25 $731.74$610.87 $607.17 $608.56 $694.18 $543.42 $928.42 $839.98 $909.45 $762.94$632.48 $628.65 $630.09 $718.73 $562.64 $961.26 $869.70 $941.61 $789.93$646.66 $642.74 $644.21 $734.85 $575.26 $982.82 $889.19 $962.73 $807.64$664.44 $660.41 $661.93 $755.05 $591.08 $1,009.84 $913.64 $989.20 $829.85$675.24 $671.15 $672.69 $767.33 $600.69 $1,026.26 $928.50 $1,005.28 $843.34
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health
Oregon
Standard
Bronze
$144.97$228.29$228.29$228.29$228.29$229.21$233.77$239.25$248.16$255.46$259.11$264.59$270.07$273.50$277.15$278.97$280.80$282.63$284.45$288.11$291.76$297.24$302.49$309.79$318.93$329.66$342.44$356.82$373.26$389.47$407.73$425.77$445.63$465.72$487.41$509.09$532.61$556.35$581.69$594.25$619.59$641.50$655.89$673.92$684.88
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Area 1 Area 1Moda Health Plan Inc
Plan
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500HIOS Plan Id
0-20 $233.15 $230.14 $217.59 $211.45 $211.05 $205.82 $184.98 $181.51 $184.8021 $367.17 $362.43 $342.66 $332.99 $332.37 $324.13 $291.31 $285.84 $291.0222 $367.17 $362.43 $342.66 $332.99 $332.37 $324.13 $291.31 $285.84 $291.0223 $367.17 $362.43 $342.66 $332.99 $332.37 $324.13 $291.31 $285.84 $291.0224 $367.17 $362.43 $342.66 $332.99 $332.37 $324.13 $291.31 $285.84 $291.0225 $368.64 $363.88 $344.03 $334.32 $333.69 $325.43 $292.47 $286.98 $292.1926 $375.98 $371.12 $350.89 $340.98 $340.34 $331.91 $298.30 $292.70 $298.0127 $384.79 $379.82 $359.11 $348.97 $348.32 $339.69 $305.29 $299.56 $304.9928 $399.11 $393.96 $372.48 $361.96 $361.28 $352.33 $316.65 $310.70 $316.3429 $410.86 $405.55 $383.44 $372.61 $371.92 $362.70 $325.97 $319.85 $325.6530 $416.74 $411.35 $388.92 $377.94 $377.23 $367.89 $330.63 $324.42 $330.3131 $425.55 $420.05 $397.15 $385.93 $385.21 $375.67 $337.62 $331.28 $337.2932 $434.36 $428.75 $405.37 $393.93 $393.19 $383.45 $344.61 $338.14 $344.2833 $439.87 $434.19 $410.51 $398.92 $398.17 $388.31 $348.98 $342.43 $348.6434 $445.74 $439.99 $415.99 $404.25 $403.49 $393.49 $353.64 $347.00 $353.3035 $448.68 $442.88 $418.73 $406.91 $406.15 $396.09 $355.98 $349.29 $355.6336 $451.62 $445.78 $421.48 $409.58 $408.81 $398.68 $358.31 $351.58 $357.9637 $454.55 $448.68 $424.22 $412.24 $411.47 $401.27 $360.64 $353.86 $360.2938 $457.49 $451.58 $426.96 $414.90 $414.13 $403.87 $362.97 $356.15 $362.6139 $463.37 $457.38 $432.44 $420.23 $419.44 $409.05 $367.63 $360.72 $367.2740 $469.24 $463.18 $437.92 $425.56 $424.76 $414.24 $372.29 $365.30 $371.9341 $478.05 $471.88 $446.15 $433.55 $432.74 $422.02 $379.28 $372.16 $378.9142 $486.50 $480.21 $454.03 $441.21 $440.38 $429.47 $385.98 $378.73 $385.6043 $498.25 $491.81 $464.99 $451.87 $451.02 $439.85 $395.30 $387.88 $394.9244 $512.93 $506.31 $478.70 $465.18 $464.31 $452.81 $406.95 $399.31 $406.5645 $530.19 $523.34 $494.81 $480.84 $479.94 $468.04 $420.65 $412.75 $420.2446 $550.75 $543.64 $513.99 $499.48 $498.55 $486.20 $436.96 $428.75 $436.5347 $573.88 $566.47 $535.58 $520.46 $519.49 $506.62 $455.31 $446.76 $454.8748 $600.32 $592.57 $560.25 $544.44 $543.42 $529.95 $476.28 $467.34 $475.8249 $626.39 $618.30 $584.58 $568.08 $567.01 $552.97 $496.97 $487.64 $496.4850 $655.76 $647.29 $612.00 $594.72 $593.60 $578.90 $520.27 $510.50 $519.7751 $684.77 $675.92 $639.07 $621.02 $619.86 $604.50 $543.28 $533.08 $542.7652 $716.71 $707.46 $668.88 $649.99 $648.78 $632.70 $568.63 $557.95 $568.0853 $749.02 $739.35 $699.03 $679.30 $678.02 $661.23 $594.26 $583.10 $593.6954 $783.90 $773.78 $731.59 $710.93 $709.60 $692.02 $621.94 $610.26 $621.3355 $818.78 $808.21 $764.14 $742.56 $741.17 $722.81 $649.61 $637.41 $648.9856 $856.60 $845.54 $799.43 $776.86 $775.41 $756.20 $679.62 $666.85 $678.9657 $894.79 $883.23 $835.07 $811.49 $809.97 $789.91 $709.91 $696.58 $709.2258 $935.54 $923.46 $873.11 $848.45 $846.87 $825.89 $742.25 $728.31 $741.5259 $955.74 $943.39 $891.95 $866.77 $865.15 $843.71 $758.27 $744.03 $757.5360 $996.49 $983.62 $929.99 $903.73 $902.04 $879.69 $790.60 $775.76 $789.8361 $1,031.74 $1,018.42 $962.88 $935.70 $933.95 $910.81 $818.57 $803.20 $817.7762 $1,054.87 $1,041.25 $984.47 $956.68 $954.88 $931.23 $836.92 $821.21 $836.1163 $1,083.88 $1,069.88 $1,011.54 $982.98 $981.14 $956.83 $859.93 $843.79 $859.10
64+ $1,101.49 $1,087.27 $1,027.98 $998.95 $997.09 $972.38 $873.91 $857.50 $873.06
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health Plan Inc
Value 2000
Value 2000
(Rose City) Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
$178.42 $164.80 $173.66 $169.42 $165.55 $156.53 $177.17 $172.04 $150.02$280.97 $259.53 $273.48 $266.80 $260.71 $246.50 $279.01 $270.93 $236.25$280.97 $259.53 $273.48 $266.80 $260.71 $246.50 $279.01 $270.93 $236.25$280.97 $259.53 $273.48 $266.80 $260.71 $246.50 $279.01 $270.93 $236.25$280.97 $259.53 $273.48 $266.80 $260.71 $246.50 $279.01 $270.93 $236.25$282.10 $260.56 $274.57 $267.86 $261.75 $247.49 $280.13 $272.01 $237.19$287.72 $265.75 $280.04 $273.20 $266.97 $252.42 $285.71 $277.43 $241.92$294.46 $271.98 $286.60 $279.60 $273.23 $258.33 $292.41 $283.94 $247.59$305.42 $282.10 $297.27 $290.01 $283.39 $267.95 $303.29 $294.50 $256.80$314.41 $290.41 $306.02 $298.55 $291.74 $275.83 $312.22 $303.17 $264.36$318.91 $294.56 $310.40 $302.81 $295.91 $279.78 $316.68 $307.51 $268.14$325.65 $300.79 $316.96 $309.22 $302.16 $285.69 $323.38 $314.01 $273.81$332.39 $307.02 $323.52 $315.62 $308.42 $291.61 $330.07 $320.51 $279.48$336.61 $310.91 $327.62 $319.62 $312.33 $295.31 $334.26 $324.57 $283.03$341.10 $315.06 $332.00 $323.89 $316.50 $299.25 $338.72 $328.91 $286.81$343.35 $317.14 $334.19 $326.03 $318.59 $301.22 $340.95 $331.08 $288.70$345.60 $319.22 $336.38 $328.16 $320.68 $303.19 $343.19 $333.24 $290.59$347.85 $321.29 $338.56 $330.29 $322.76 $305.17 $345.42 $335.41 $292.48$350.09 $323.37 $340.75 $332.43 $324.85 $307.14 $347.65 $337.58 $294.37$354.59 $327.52 $345.13 $336.70 $329.02 $311.08 $352.12 $341.91 $298.15$359.09 $331.67 $349.50 $340.97 $333.19 $315.03 $356.58 $346.25 $301.93$365.83 $337.90 $356.07 $347.37 $339.45 $320.94 $363.28 $352.75 $307.60$372.29 $343.87 $362.36 $353.51 $345.44 $326.61 $369.69 $358.98 $313.03$381.28 $352.18 $371.11 $362.04 $353.79 $334.50 $378.62 $367.65 $320.59$392.52 $362.56 $382.05 $372.72 $364.21 $344.36 $389.78 $378.49 $330.04$405.73 $374.75 $394.90 $385.25 $376.47 $355.95 $402.90 $391.22 $341.14$421.46 $389.29 $410.21 $400.20 $391.07 $369.75 $418.52 $406.40 $354.37$439.16 $405.64 $427.44 $417.00 $407.49 $385.28 $436.10 $423.46 $369.26$459.39 $424.32 $447.13 $436.21 $426.26 $403.03 $456.19 $442.97 $386.27$479.34 $442.75 $466.55 $455.16 $444.77 $420.53 $476.00 $462.21 $403.04$501.82 $463.51 $488.43 $476.50 $465.63 $440.25 $498.32 $483.88 $421.94$524.02 $484.01 $510.03 $497.58 $486.23 $459.72 $520.36 $505.29 $440.61$548.46 $506.59 $533.83 $520.79 $508.91 $481.17 $544.63 $528.86 $461.16$573.19 $529.43 $557.89 $544.27 $531.85 $502.86 $569.19 $552.70 $481.95$599.88 $554.09 $583.87 $569.61 $556.62 $526.28 $595.69 $578.44 $504.39$626.57 $578.74 $609.85 $594.96 $581.39 $549.69 $622.20 $604.18 $526.84$655.51 $605.47 $638.02 $622.44 $608.24 $575.08 $650.94 $632.08 $551.17$684.73 $632.46 $666.46 $650.18 $635.35 $600.72 $679.96 $660.26 $575.74$715.92 $661.27 $696.82 $679.80 $664.29 $628.08 $710.93 $690.33 $601.96$731.38 $675.54 $711.86 $694.47 $678.63 $641.64 $726.27 $705.23 $614.96$762.56 $704.35 $742.22 $724.09 $707.57 $669.00 $757.24 $735.31 $641.18$789.54 $729.27 $768.47 $749.70 $732.60 $692.66 $784.03 $761.31 $663.86$807.24 $745.62 $785.70 $766.51 $749.02 $708.19 $801.61 $778.38 $678.74$829.44 $766.12 $807.30 $787.58 $769.62 $727.67 $823.65 $799.79 $697.41$842.91 $778.57 $820.42 $800.38 $782.12 $739.49 $837.03 $812.78 $708.74
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 1
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Rose City
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
$138.84 $188.00 $179.65 $172.91 $152.21 $139.16 $127.86 $138.32 $138.64$218.65 $296.07 $282.92 $272.30 $239.70 $219.15 $201.35 $217.83 $218.33$218.65 $296.07 $282.92 $272.30 $239.70 $219.15 $201.35 $217.83 $218.33$218.65 $296.07 $282.92 $272.30 $239.70 $219.15 $201.35 $217.83 $218.33$218.65 $296.07 $282.92 $272.30 $239.70 $219.15 $201.35 $217.83 $218.33$219.52 $297.25 $284.05 $273.39 $240.66 $220.03 $202.15 $218.70 $219.20$223.90 $303.17 $289.71 $278.83 $245.46 $224.41 $206.18 $223.05 $223.57$229.15 $310.28 $296.50 $285.37 $251.21 $229.67 $211.01 $228.28 $228.81$237.67 $321.82 $307.53 $295.99 $260.56 $238.22 $218.87 $236.78 $237.32$244.67 $331.30 $316.59 $304.70 $268.23 $245.23 $225.31 $243.75 $244.31$248.17 $336.04 $321.11 $309.06 $272.06 $248.74 $228.53 $247.23 $247.80$253.42 $343.14 $327.91 $315.59 $277.82 $254.00 $233.36 $252.46 $253.04$258.66 $350.25 $334.70 $322.13 $283.57 $259.26 $238.19 $257.69 $258.28$261.94 $354.69 $338.94 $326.21 $287.16 $262.55 $241.22 $260.96 $261.55$265.44 $359.42 $343.47 $330.57 $291.00 $266.05 $244.44 $264.44 $265.05$267.19 $361.79 $345.73 $332.75 $292.92 $267.81 $246.05 $266.18 $266.79$268.94 $364.16 $347.99 $334.93 $294.84 $269.56 $247.66 $267.93 $268.54$270.69 $366.53 $350.26 $337.11 $296.75 $271.31 $249.27 $269.67 $270.29$272.44 $368.90 $352.52 $339.28 $298.67 $273.07 $250.88 $271.41 $272.03$275.94 $373.64 $357.05 $343.64 $302.51 $276.57 $254.10 $274.90 $275.53$279.43 $378.37 $361.57 $348.00 $306.34 $280.08 $257.32 $278.38 $279.02$284.68 $385.48 $368.36 $354.53 $312.09 $285.34 $262.16 $283.61 $284.26$289.71 $392.29 $374.87 $360.80 $317.61 $290.38 $266.79 $288.62 $289.28$296.71 $401.76 $383.92 $369.51 $325.28 $297.39 $273.23 $295.59 $296.27$305.45 $413.60 $395.24 $380.40 $334.87 $306.16 $281.28 $304.30 $305.00$315.73 $427.52 $408.54 $393.20 $346.13 $316.46 $290.75 $314.54 $315.26$327.97 $444.10 $424.38 $408.45 $359.56 $328.73 $302.02 $326.74 $327.49$341.75 $462.75 $442.21 $425.60 $374.66 $342.54 $314.71 $340.46 $341.24$357.49 $484.07 $462.58 $445.21 $391.92 $358.32 $329.20 $356.15 $356.96$373.02 $505.09 $482.66 $464.54 $408.93 $373.88 $343.50 $371.61 $372.46$390.51 $528.77 $505.30 $486.33 $428.11 $391.41 $359.61 $389.04 $389.93$407.78 $552.16 $527.65 $507.84 $447.05 $408.72 $375.51 $406.25 $407.18$426.80 $577.92 $552.26 $531.53 $467.90 $427.79 $393.03 $425.20 $426.17$446.05 $603.97 $577.16 $555.49 $489.00 $447.07 $410.75 $444.37 $445.38$466.82 $632.10 $604.04 $581.36 $511.77 $467.89 $429.88 $465.06 $466.13$487.59 $660.23 $630.91 $607.23 $534.54 $488.71 $449.01 $485.75 $486.87$510.11 $690.72 $660.05 $635.27 $559.23 $511.29 $469.75 $508.19 $509.35$532.85 $721.51 $689.48 $663.59 $584.16 $534.08 $490.69 $530.84 $532.06$557.12 $754.38 $720.88 $693.82 $610.76 $558.41 $513.04 $555.02 $556.29$569.15 $770.66 $736.44 $708.79 $623.95 $570.46 $524.11 $567.00 $568.30$593.42 $803.52 $767.85 $739.02 $650.56 $594.78 $546.46 $591.18 $592.54$614.41 $831.95 $795.01 $765.16 $673.57 $615.82 $565.79 $612.09 $613.50$628.18 $850.60 $812.83 $782.31 $688.67 $629.63 $578.47 $625.81 $627.25$645.45 $873.99 $835.18 $803.83 $707.60 $646.94 $594.38 $643.02 $644.50$655.94 $888.19 $848.75 $816.89 $719.10 $657.45 $604.03 $653.47 $654.97
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 1 Area 2Moda Health Plan Inc
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500
$158.14 $123.80 $211.50 $191.36 $207.18 $173.81 $141.15 $224.99 $222.09$249.04 $194.96 $333.08 $301.35 $326.27 $273.71 $222.28 $354.32 $349.74$249.04 $194.96 $333.08 $301.35 $326.27 $273.71 $222.28 $354.32 $349.74$249.04 $194.96 $333.08 $301.35 $326.27 $273.71 $222.28 $354.32 $349.74$249.04 $194.96 $333.08 $301.35 $326.27 $273.71 $222.28 $354.32 $349.74$250.04 $195.74 $334.41 $302.56 $327.58 $274.81 $223.17 $355.73 $351.14$255.02 $199.64 $341.07 $308.58 $334.10 $280.28 $227.62 $362.82 $358.13$261.00 $204.31 $349.07 $315.81 $341.93 $286.85 $232.95 $371.32 $366.53$270.71 $211.92 $362.06 $327.57 $354.66 $297.52 $241.62 $385.14 $380.17$278.68 $218.16 $372.71 $337.21 $365.10 $306.28 $248.73 $396.48 $391.36$282.66 $221.28 $378.04 $342.03 $370.32 $310.66 $252.29 $402.15 $396.96$288.64 $225.95 $386.04 $349.26 $378.15 $317.23 $257.62 $410.65 $405.35$294.62 $230.63 $394.03 $356.50 $385.98 $323.80 $262.96 $419.16 $413.74$298.35 $233.56 $399.03 $361.02 $390.87 $327.90 $266.29 $424.47 $418.99$302.34 $236.68 $404.36 $365.84 $396.09 $332.28 $269.85 $430.14 $424.59$304.33 $238.24 $407.02 $368.25 $398.70 $334.47 $271.63 $432.98 $427.38$306.32 $239.80 $409.69 $370.66 $401.31 $336.66 $273.41 $435.81 $430.18$308.31 $241.36 $412.35 $373.07 $403.92 $338.85 $275.18 $438.64 $432.98$310.31 $242.92 $415.02 $375.48 $406.53 $341.04 $276.96 $441.48 $435.78$314.29 $246.04 $420.35 $380.30 $411.75 $345.42 $280.52 $447.15 $441.37$318.28 $249.15 $425.67 $385.13 $416.97 $349.80 $284.08 $452.82 $446.97$324.25 $253.83 $433.67 $392.36 $424.80 $356.37 $289.41 $461.32 $455.36$329.98 $258.32 $441.33 $399.29 $432.31 $362.67 $294.52 $469.47 $463.41$337.95 $264.56 $451.99 $408.93 $442.75 $371.42 $301.64 $480.81 $474.60$347.91 $272.35 $465.31 $420.99 $455.80 $382.37 $310.53 $494.98 $488.59$359.62 $281.52 $480.97 $435.15 $471.13 $395.24 $320.97 $511.63 $505.03$373.56 $292.43 $499.62 $452.02 $489.41 $410.57 $333.42 $531.48 $524.61$389.25 $304.72 $520.60 $471.01 $509.96 $427.81 $347.43 $553.80 $546.65$407.18 $318.75 $544.58 $492.71 $533.45 $447.52 $363.43 $579.31 $571.83$424.87 $332.60 $568.23 $514.10 $556.62 $466.95 $379.21 $604.46 $596.66$444.79 $348.19 $594.88 $538.21 $582.72 $488.85 $397.00 $632.81 $624.64$464.46 $363.59 $621.19 $562.02 $608.49 $510.47 $414.56 $660.80 $652.27$486.13 $380.55 $650.17 $588.23 $636.88 $534.28 $433.89 $691.63 $682.69$508.05 $397.71 $679.48 $614.75 $665.59 $558.37 $453.45 $722.81 $713.47$531.70 $416.23 $711.12 $643.38 $696.59 $584.37 $474.57 $756.47 $746.70$555.36 $434.75 $742.77 $672.01 $727.58 $610.37 $495.69 $790.13 $779.92$581.01 $454.83 $777.07 $703.05 $761.19 $638.57 $518.58 $826.62 $815.95$606.92 $475.11 $811.71 $734.39 $795.12 $667.03 $541.70 $863.47 $852.32$634.56 $496.75 $848.68 $767.84 $831.34 $697.41 $566.37 $902.80 $891.14$648.26 $507.47 $867.00 $784.41 $849.28 $712.47 $578.60 $922.29 $910.38$675.90 $529.11 $903.97 $817.86 $885.50 $742.85 $603.27 $961.62 $949.20$699.81 $547.83 $935.95 $846.79 $916.82 $769.13 $624.61 $995.63 $982.77$715.50 $560.11 $956.93 $865.78 $937.37 $786.37 $638.62 $1,017.95 $1,004.81$735.17 $575.51 $983.25 $889.58 $963.15 $807.99 $656.18 $1,045.94 $1,032.44$747.12 $584.86 $999.23 $904.04 $978.80 $821.12 $666.84 $1,062.94 $1,049.21
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500
$209.98 $204.05 $203.66 $198.62 $178.50 $175.15 $178.33 $172.17 $167.58$330.67 $321.33 $320.73 $312.79 $281.11 $275.83 $280.84 $271.14 $263.90$330.67 $321.33 $320.73 $312.79 $281.11 $275.83 $280.84 $271.14 $263.90$330.67 $321.33 $320.73 $312.79 $281.11 $275.83 $280.84 $271.14 $263.90$330.67 $321.33 $320.73 $312.79 $281.11 $275.83 $280.84 $271.14 $263.90$331.99 $322.62 $322.02 $314.04 $282.23 $276.93 $281.96 $272.22 $264.96$338.61 $329.05 $328.43 $320.29 $287.86 $282.45 $287.58 $277.65 $270.24$346.54 $336.76 $336.13 $327.80 $294.60 $289.07 $294.32 $284.15 $276.57$359.44 $349.29 $348.64 $340.00 $305.57 $299.83 $305.27 $294.73 $286.86$370.02 $359.57 $358.90 $350.01 $314.56 $308.66 $314.26 $303.41 $295.31$375.31 $364.71 $364.03 $355.01 $319.06 $313.07 $318.75 $307.74 $299.53$383.25 $372.43 $371.73 $362.52 $325.81 $319.69 $325.49 $314.25 $305.87$391.18 $380.14 $379.43 $370.03 $332.55 $326.31 $332.23 $320.76 $312.20$396.14 $384.96 $384.24 $374.72 $336.77 $330.45 $336.44 $324.83 $316.16$401.43 $390.10 $389.37 $379.72 $341.27 $334.86 $340.94 $329.16 $320.38$404.08 $392.67 $391.93 $382.22 $343.52 $337.07 $343.18 $331.33 $322.49$406.72 $395.24 $394.50 $384.73 $345.77 $339.27 $345.43 $333.50 $324.60$409.37 $397.81 $397.07 $387.23 $348.01 $341.48 $347.68 $335.67 $326.71$412.01 $400.38 $399.63 $389.73 $350.26 $343.69 $349.92 $337.84 $328.83$417.31 $405.52 $404.76 $394.74 $354.76 $348.10 $354.42 $342.18 $333.05$422.60 $410.66 $409.90 $399.74 $359.26 $352.51 $358.91 $346.52 $337.27$430.53 $418.38 $417.59 $407.25 $366.00 $359.13 $365.65 $353.02 $343.60$438.14 $425.77 $424.97 $414.44 $372.47 $365.48 $372.11 $359.26 $349.67$448.72 $436.05 $435.23 $424.45 $381.47 $374.30 $381.10 $367.94 $358.12$461.95 $448.90 $448.06 $436.96 $392.71 $385.34 $392.33 $378.78 $368.68$477.49 $464.01 $463.14 $451.66 $405.92 $398.30 $405.53 $391.53 $381.08$496.01 $482.00 $481.10 $469.18 $421.66 $413.75 $421.25 $406.71 $395.86$516.84 $502.24 $501.30 $488.88 $439.37 $431.12 $438.95 $423.79 $412.48$540.65 $525.38 $524.40 $511.41 $459.61 $450.98 $459.17 $443.31 $431.48$564.12 $548.20 $547.17 $533.61 $479.57 $470.57 $479.11 $462.57 $450.22$590.58 $573.90 $572.83 $558.64 $502.06 $492.63 $501.57 $484.26 $471.33$616.70 $599.29 $598.17 $583.35 $524.27 $514.43 $523.76 $505.68 $492.18$645.47 $627.24 $626.07 $610.56 $548.73 $538.42 $548.19 $529.27 $515.14$674.57 $655.52 $654.29 $638.08 $573.46 $562.70 $572.91 $553.13 $538.37$705.98 $686.05 $684.76 $667.80 $600.17 $588.90 $599.59 $578.88 $563.44$737.39 $716.57 $715.23 $697.51 $626.87 $615.10 $626.27 $604.64 $588.51$771.45 $749.67 $748.27 $729.73 $655.83 $643.51 $655.19 $632.57 $615.69$805.84 $783.09 $781.62 $762.26 $685.06 $672.20 $684.40 $660.77 $643.14$842.55 $818.76 $817.23 $796.98 $716.27 $702.82 $715.57 $690.87 $672.43$860.73 $836.43 $834.87 $814.18 $731.73 $717.99 $731.02 $705.78 $686.94$897.44 $872.10 $870.47 $848.90 $762.93 $748.61 $762.19 $735.87 $716.24$929.18 $902.95 $901.26 $878.93 $789.92 $775.09 $789.15 $761.90 $741.57$950.02 $923.19 $921.46 $898.63 $807.63 $792.46 $806.84 $778.99 $758.20$976.14 $948.58 $946.80 $923.34 $829.84 $814.25 $829.03 $800.41 $779.05$992.00 $963.99 $962.19 $938.35 $843.32 $827.48 $842.50 $813.41 $791.70
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
$163.49 $159.76 $151.05 $170.97 $166.02 $144.77 $133.98 $181.42 $173.37$257.46 $251.59 $237.87 $269.25 $261.45 $227.98 $211.00 $285.70 $273.02$257.46 $251.59 $237.87 $269.25 $261.45 $227.98 $211.00 $285.70 $273.02$257.46 $251.59 $237.87 $269.25 $261.45 $227.98 $211.00 $285.70 $273.02$257.46 $251.59 $237.87 $269.25 $261.45 $227.98 $211.00 $285.70 $273.02$258.49 $252.59 $238.82 $270.33 $262.49 $228.89 $211.84 $286.85 $274.11$263.64 $257.62 $243.58 $275.71 $267.72 $233.45 $216.06 $292.56 $279.57$269.82 $263.66 $249.29 $282.17 $274.00 $238.92 $221.13 $299.42 $286.12$279.86 $273.47 $258.57 $292.67 $284.19 $247.81 $229.35 $310.56 $296.77$288.10 $281.53 $266.18 $301.29 $292.56 $255.11 $236.11 $319.70 $305.51$292.22 $285.55 $269.98 $305.60 $296.74 $258.76 $239.48 $324.27 $309.88$298.40 $291.59 $275.69 $312.06 $303.02 $264.23 $244.55 $331.13 $316.43$304.57 $297.63 $281.40 $318.52 $309.29 $269.70 $249.61 $337.99 $322.98$308.44 $301.40 $284.97 $322.56 $313.21 $273.12 $252.77 $342.27 $327.08$312.56 $305.43 $288.78 $326.87 $317.40 $276.77 $256.15 $346.84 $331.44$314.62 $307.44 $290.68 $329.02 $319.49 $278.59 $257.84 $349.13 $333.63$316.67 $309.45 $292.58 $331.18 $321.58 $280.42 $259.53 $351.42 $335.81$318.73 $311.46 $294.49 $333.33 $323.67 $282.24 $261.21 $353.70 $338.00$320.79 $313.48 $296.39 $335.48 $325.76 $284.06 $262.90 $355.99 $340.18$324.91 $317.50 $300.19 $339.79 $329.95 $287.71 $266.28 $360.56 $344.55$329.03 $321.53 $304.00 $344.10 $334.13 $291.36 $269.65 $365.13 $348.92$335.21 $327.57 $309.71 $350.56 $340.41 $296.83 $274.72 $371.99 $355.47$341.13 $333.35 $315.18 $356.75 $346.42 $302.07 $279.57 $378.56 $361.75$349.37 $341.40 $322.79 $365.37 $354.78 $309.37 $286.32 $387.70 $370.49$359.67 $351.47 $332.31 $376.14 $365.24 $318.49 $294.76 $399.13 $381.41$371.77 $363.29 $343.49 $388.79 $377.53 $329.20 $304.68 $412.56 $394.24$386.19 $377.38 $356.81 $403.87 $392.17 $341.97 $316.50 $428.56 $409.53$402.41 $393.23 $371.79 $420.83 $408.64 $356.33 $329.79 $446.55 $426.73$420.95 $411.34 $388.92 $440.22 $427.47 $372.75 $344.98 $467.13 $446.39$439.23 $429.21 $405.81 $459.34 $446.03 $388.93 $359.96 $487.41 $465.77$459.82 $449.33 $424.84 $480.88 $466.95 $407.17 $376.84 $510.27 $487.61$480.16 $469.21 $443.63 $502.15 $487.60 $425.18 $393.51 $532.84 $509.18$502.56 $491.10 $464.33 $525.57 $510.35 $445.02 $411.87 $557.69 $532.93$525.22 $513.24 $485.26 $549.27 $533.35 $465.08 $430.43 $582.84 $556.96$549.68 $537.14 $507.86 $574.84 $558.19 $486.74 $450.48 $609.98 $582.89$574.13 $561.04 $530.46 $600.42 $583.03 $508.40 $470.52 $637.12 $608.83$600.65 $586.95 $554.96 $628.16 $609.96 $531.88 $492.26 $666.55 $636.95$627.43 $613.12 $579.69 $656.16 $637.15 $555.59 $514.20 $696.26 $665.35$656.01 $641.04 $606.10 $686.04 $666.17 $580.89 $537.62 $727.97 $695.65$670.17 $654.88 $619.18 $700.85 $680.55 $593.43 $549.23 $743.69 $710.67$698.74 $682.81 $645.59 $730.74 $709.57 $618.74 $572.65 $775.40 $740.97$723.46 $706.96 $668.42 $756.59 $734.67 $640.63 $592.90 $802.83 $767.18$739.68 $722.81 $683.41 $773.55 $751.14 $654.99 $606.19 $820.83 $784.38$760.02 $742.68 $702.20 $794.82 $771.79 $673.00 $622.86 $843.40 $805.95$772.37 $754.75 $713.61 $807.73 $784.33 $683.93 $632.98 $857.10 $819.05
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
$166.86 $146.88 $134.29 $133.48 $133.78 $152.61 $119.46 $204.10 $184.66$262.77 $231.31 $211.48 $210.20 $210.68 $240.33 $188.13 $321.42 $290.80$262.77 $231.31 $211.48 $210.20 $210.68 $240.33 $188.13 $321.42 $290.80$262.77 $231.31 $211.48 $210.20 $210.68 $240.33 $188.13 $321.42 $290.80$262.77 $231.31 $211.48 $210.20 $210.68 $240.33 $188.13 $321.42 $290.80$263.82 $232.24 $212.33 $211.04 $211.53 $241.29 $188.89 $322.71 $291.97$269.07 $236.87 $216.56 $215.25 $215.74 $246.09 $192.65 $329.13 $297.78$275.38 $242.42 $221.64 $220.29 $220.80 $251.86 $197.16 $336.85 $304.76$285.63 $251.44 $229.88 $228.49 $229.01 $261.23 $204.50 $349.38 $316.10$294.04 $258.84 $236.65 $235.22 $235.76 $268.92 $210.52 $359.67 $325.41$298.24 $262.54 $240.03 $238.58 $239.13 $272.77 $213.53 $364.81 $330.06$304.55 $268.09 $245.11 $243.62 $244.18 $278.54 $218.05 $372.53 $337.04$310.85 $273.64 $250.19 $248.67 $249.24 $284.31 $222.56 $380.24 $344.02$314.80 $277.11 $253.36 $251.82 $252.40 $287.91 $225.38 $385.06 $348.38$319.00 $280.81 $256.74 $255.19 $255.77 $291.76 $228.39 $390.20 $353.03$321.10 $282.67 $258.43 $256.87 $257.46 $293.68 $229.90 $392.78 $355.36$323.20 $284.52 $260.13 $258.55 $259.14 $295.60 $231.40 $395.35 $357.69$325.31 $286.37 $261.82 $260.23 $260.83 $297.52 $232.91 $397.92 $360.01$327.41 $288.22 $263.51 $261.91 $262.51 $299.45 $234.41 $400.49 $362.34$331.61 $291.92 $266.89 $265.28 $265.88 $303.29 $237.42 $405.63 $366.99$335.82 $295.62 $270.28 $268.64 $269.25 $307.14 $240.43 $410.78 $371.65$342.12 $301.17 $275.35 $273.68 $274.31 $312.90 $244.95 $418.49 $378.63$348.17 $306.49 $280.22 $278.52 $279.16 $318.43 $249.28 $425.88 $385.31$356.58 $313.89 $286.98 $285.24 $285.90 $326.12 $255.30 $436.17 $394.62$367.09 $323.15 $295.44 $293.65 $294.33 $335.73 $262.82 $449.02 $406.25$379.44 $334.02 $305.38 $303.53 $304.23 $347.03 $271.66 $464.13 $419.92$394.15 $346.97 $317.23 $315.30 $316.03 $360.49 $282.20 $482.13 $436.20$410.71 $361.54 $330.55 $328.55 $329.30 $375.63 $294.05 $502.38 $454.52$429.63 $378.20 $345.78 $343.68 $344.47 $392.93 $307.60 $525.52 $475.46$448.28 $394.62 $360.79 $358.61 $359.43 $410.00 $320.95 $548.34 $496.11$469.30 $413.13 $377.71 $375.42 $376.28 $429.22 $336.01 $574.06 $519.37$490.06 $431.40 $394.42 $392.03 $392.93 $448.21 $350.87 $599.45 $542.35$512.92 $451.52 $412.82 $410.32 $411.26 $469.12 $367.24 $627.41 $567.65$536.05 $471.88 $431.43 $428.81 $429.80 $490.26 $383.79 $655.70 $593.24$561.01 $493.86 $451.52 $448.78 $449.81 $513.09 $401.66 $686.23 $620.86$585.97 $515.83 $471.61 $468.75 $469.83 $535.93 $419.54 $716.77 $648.49$613.04 $539.66 $493.39 $490.40 $491.53 $560.68 $438.91 $749.87 $678.44$640.37 $563.71 $515.39 $512.26 $513.44 $585.67 $458.48 $783.30 $708.69$669.53 $589.39 $538.86 $535.60 $536.82 $612.35 $479.36 $818.98 $740.97$683.99 $602.11 $550.49 $547.16 $548.41 $625.57 $489.71 $836.66 $756.96$713.15 $627.79 $573.97 $570.49 $571.80 $652.24 $510.59 $872.34 $789.24$738.38 $649.99 $594.27 $590.67 $592.02 $675.31 $528.65 $903.19 $817.16$754.93 $664.56 $607.59 $603.91 $605.30 $690.46 $540.51 $923.44 $835.48$775.69 $682.84 $624.30 $620.52 $621.94 $709.44 $555.37 $948.83 $858.45$788.29 $693.93 $634.44 $630.60 $632.04 $720.97 $564.39 $964.25 $872.40
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3Moda Health Plan Inc
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500
$199.93 $167.72 $136.21 $224.99 $222.09 $209.98 $204.05 $203.66 $198.62$314.85 $264.13 $214.50 $354.32 $349.74 $330.67 $321.33 $320.73 $312.79$314.85 $264.13 $214.50 $354.32 $349.74 $330.67 $321.33 $320.73 $312.79$314.85 $264.13 $214.50 $354.32 $349.74 $330.67 $321.33 $320.73 $312.79$314.85 $264.13 $214.50 $354.32 $349.74 $330.67 $321.33 $320.73 $312.79$316.11 $265.19 $215.36 $355.73 $351.14 $331.99 $322.62 $322.02 $314.04$322.41 $270.47 $219.65 $362.82 $358.13 $338.61 $329.05 $328.43 $320.29$329.96 $276.81 $224.80 $371.32 $366.53 $346.54 $336.76 $336.13 $327.80$342.24 $287.11 $233.16 $385.14 $380.17 $359.44 $349.29 $348.64 $340.00$352.32 $295.56 $240.03 $396.48 $391.36 $370.02 $359.57 $358.90 $350.01$357.36 $299.79 $243.46 $402.15 $396.96 $375.31 $364.71 $364.03 $355.01$364.91 $306.13 $248.61 $410.65 $405.35 $383.25 $372.43 $371.73 $362.52$372.47 $312.47 $253.76 $419.16 $413.74 $391.18 $380.14 $379.43 $370.03$377.19 $316.43 $256.97 $424.47 $418.99 $396.14 $384.96 $384.24 $374.72$382.23 $320.65 $260.41 $430.14 $424.59 $401.43 $390.10 $389.37 $379.72$384.75 $322.77 $262.12 $432.98 $427.38 $404.08 $392.67 $391.93 $382.22$387.27 $324.88 $263.84 $435.81 $430.18 $406.72 $395.24 $394.50 $384.73$389.79 $326.99 $265.55 $438.64 $432.98 $409.37 $397.81 $397.07 $387.23$392.30 $329.11 $267.27 $441.48 $435.78 $412.01 $400.38 $399.63 $389.73$397.34 $333.33 $270.70 $447.15 $441.37 $417.31 $405.52 $404.76 $394.74$402.38 $337.56 $274.13 $452.82 $446.97 $422.60 $410.66 $409.90 $399.74$409.94 $343.90 $279.28 $461.32 $455.36 $430.53 $418.38 $417.59 $407.25$417.18 $349.97 $284.22 $469.47 $463.41 $438.14 $425.77 $424.97 $414.44$427.25 $358.43 $291.08 $480.81 $474.60 $448.72 $436.05 $435.23 $424.45$439.85 $368.99 $299.66 $494.98 $488.59 $461.95 $448.90 $448.06 $436.96$454.64 $381.40 $309.74 $511.63 $505.03 $477.49 $464.01 $463.14 $451.66$472.28 $396.20 $321.75 $531.48 $524.61 $496.01 $482.00 $481.10 $469.18$492.11 $412.84 $335.27 $553.80 $546.65 $516.84 $502.24 $501.30 $488.88$514.78 $431.85 $350.71 $579.31 $571.83 $540.65 $525.38 $524.40 $511.41$537.14 $450.61 $365.94 $604.46 $596.66 $564.12 $548.20 $547.17 $533.61$562.32 $471.74 $383.10 $632.81 $624.64 $590.58 $573.90 $572.83 $558.64$587.20 $492.60 $400.05 $660.80 $652.27 $616.70 $599.29 $598.17 $583.35$614.59 $515.58 $418.71 $691.63 $682.69 $645.47 $627.24 $626.07 $610.56$642.30 $538.83 $437.58 $722.81 $713.47 $674.57 $655.52 $654.29 $638.08$672.21 $563.92 $457.96 $756.47 $746.70 $705.98 $686.05 $684.76 $667.80$702.12 $589.01 $478.34 $790.13 $779.92 $737.39 $716.57 $715.23 $697.51$734.55 $616.22 $500.43 $826.62 $815.95 $771.45 $749.67 $748.27 $729.73$767.29 $643.69 $522.74 $863.47 $852.32 $805.84 $783.09 $781.62 $762.26$802.24 $673.00 $546.55 $902.80 $891.14 $842.55 $818.76 $817.23 $796.98$819.56 $687.53 $558.35 $922.29 $910.38 $860.73 $836.43 $834.87 $814.18$854.50 $716.85 $582.16 $961.62 $949.20 $897.44 $872.10 $870.47 $848.90$884.73 $742.21 $602.75 $995.63 $982.77 $929.18 $902.95 $901.26 $878.93$904.57 $758.85 $616.26 $1,017.95 $1,004.81 $950.02 $923.19 $921.46 $898.63$929.44 $779.71 $633.21 $1,045.94 $1,032.44 $976.14 $948.58 $946.80 $923.34$944.54 $792.38 $643.50 $1,062.95 $1,049.22 $992.01 $964.00 $962.20 $938.36
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3
PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
$178.50 $175.15 $178.33 $172.17 $167.58 $163.49 $159.76 $151.05 $170.97$281.11 $275.83 $280.84 $271.14 $263.90 $257.46 $251.59 $237.87 $269.25$281.11 $275.83 $280.84 $271.14 $263.90 $257.46 $251.59 $237.87 $269.25$281.11 $275.83 $280.84 $271.14 $263.90 $257.46 $251.59 $237.87 $269.25$281.11 $275.83 $280.84 $271.14 $263.90 $257.46 $251.59 $237.87 $269.25$282.23 $276.93 $281.96 $272.22 $264.96 $258.49 $252.59 $238.82 $270.33$287.86 $282.45 $287.58 $277.65 $270.24 $263.64 $257.62 $243.58 $275.71$294.60 $289.07 $294.32 $284.15 $276.57 $269.82 $263.66 $249.29 $282.17$305.57 $299.83 $305.27 $294.73 $286.86 $279.86 $273.47 $258.57 $292.67$314.56 $308.66 $314.26 $303.41 $295.31 $288.10 $281.53 $266.18 $301.29$319.06 $313.07 $318.75 $307.74 $299.53 $292.22 $285.55 $269.98 $305.60$325.81 $319.69 $325.49 $314.25 $305.87 $298.40 $291.59 $275.69 $312.06$332.55 $326.31 $332.23 $320.76 $312.20 $304.57 $297.63 $281.40 $318.52$336.77 $330.45 $336.44 $324.83 $316.16 $308.44 $301.40 $284.97 $322.56$341.27 $334.86 $340.94 $329.16 $320.38 $312.56 $305.43 $288.78 $326.87$343.52 $337.07 $343.18 $331.33 $322.49 $314.62 $307.44 $290.68 $329.02$345.77 $339.27 $345.43 $333.50 $324.60 $316.67 $309.45 $292.58 $331.18$348.01 $341.48 $347.68 $335.67 $326.71 $318.73 $311.46 $294.49 $333.33$350.26 $343.69 $349.92 $337.84 $328.83 $320.79 $313.48 $296.39 $335.48$354.76 $348.10 $354.42 $342.18 $333.05 $324.91 $317.50 $300.19 $339.79$359.26 $352.51 $358.91 $346.52 $337.27 $329.03 $321.53 $304.00 $344.10$366.00 $359.13 $365.65 $353.02 $343.60 $335.21 $327.57 $309.71 $350.56$372.47 $365.48 $372.11 $359.26 $349.67 $341.13 $333.35 $315.18 $356.75$381.47 $374.30 $381.10 $367.94 $358.12 $349.37 $341.40 $322.79 $365.37$392.71 $385.34 $392.33 $378.78 $368.68 $359.67 $351.47 $332.31 $376.14$405.92 $398.30 $405.53 $391.53 $381.08 $371.77 $363.29 $343.49 $388.79$421.66 $413.75 $421.25 $406.71 $395.86 $386.19 $377.38 $356.81 $403.87$439.37 $431.12 $438.95 $423.79 $412.48 $402.41 $393.23 $371.79 $420.83$459.61 $450.98 $459.17 $443.31 $431.48 $420.95 $411.34 $388.92 $440.22$479.57 $470.57 $479.11 $462.57 $450.22 $439.23 $429.21 $405.81 $459.34$502.06 $492.63 $501.57 $484.26 $471.33 $459.82 $449.33 $424.84 $480.88$524.27 $514.43 $523.76 $505.68 $492.18 $480.16 $469.21 $443.63 $502.15$548.73 $538.42 $548.19 $529.27 $515.14 $502.56 $491.10 $464.33 $525.57$573.46 $562.70 $572.91 $553.13 $538.37 $525.22 $513.24 $485.26 $549.27$600.17 $588.90 $599.59 $578.88 $563.44 $549.68 $537.14 $507.86 $574.84$626.87 $615.10 $626.27 $604.64 $588.51 $574.13 $561.04 $530.46 $600.42$655.83 $643.51 $655.19 $632.57 $615.69 $600.65 $586.95 $554.96 $628.16$685.06 $672.20 $684.40 $660.77 $643.14 $627.43 $613.12 $579.69 $656.16$716.27 $702.82 $715.57 $690.87 $672.43 $656.01 $641.04 $606.10 $686.04$731.73 $717.99 $731.02 $705.78 $686.94 $670.17 $654.88 $619.18 $700.85$762.93 $748.61 $762.19 $735.87 $716.24 $698.74 $682.81 $645.59 $730.74$789.92 $775.09 $789.15 $761.90 $741.57 $723.46 $706.96 $668.42 $756.59$807.63 $792.46 $806.84 $778.99 $758.20 $739.68 $722.81 $683.41 $773.55$829.84 $814.25 $829.03 $800.41 $779.05 $760.02 $742.68 $702.20 $794.82$843.33 $827.49 $842.51 $813.42 $791.71 $772.38 $754.76 $713.62 $807.74
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
$166.02 $144.77 $133.98 $181.42 $173.37 $166.86 $146.88 $134.29 $133.48$261.45 $227.98 $211.00 $285.70 $273.02 $262.77 $231.31 $211.48 $210.20$261.45 $227.98 $211.00 $285.70 $273.02 $262.77 $231.31 $211.48 $210.20$261.45 $227.98 $211.00 $285.70 $273.02 $262.77 $231.31 $211.48 $210.20$261.45 $227.98 $211.00 $285.70 $273.02 $262.77 $231.31 $211.48 $210.20$262.49 $228.89 $211.84 $286.85 $274.11 $263.82 $232.24 $212.33 $211.04$267.72 $233.45 $216.06 $292.56 $279.57 $269.07 $236.87 $216.56 $215.25$274.00 $238.92 $221.13 $299.42 $286.12 $275.38 $242.42 $221.64 $220.29$284.19 $247.81 $229.35 $310.56 $296.77 $285.63 $251.44 $229.88 $228.49$292.56 $255.11 $236.11 $319.70 $305.51 $294.04 $258.84 $236.65 $235.22$296.74 $258.76 $239.48 $324.27 $309.88 $298.24 $262.54 $240.03 $238.58$303.02 $264.23 $244.55 $331.13 $316.43 $304.55 $268.09 $245.11 $243.62$309.29 $269.70 $249.61 $337.99 $322.98 $310.85 $273.64 $250.19 $248.67$313.21 $273.12 $252.77 $342.27 $327.08 $314.80 $277.11 $253.36 $251.82$317.40 $276.77 $256.15 $346.84 $331.44 $319.00 $280.81 $256.74 $255.19$319.49 $278.59 $257.84 $349.13 $333.63 $321.10 $282.67 $258.43 $256.87$321.58 $280.42 $259.53 $351.42 $335.81 $323.20 $284.52 $260.13 $258.55$323.67 $282.24 $261.21 $353.70 $338.00 $325.31 $286.37 $261.82 $260.23$325.76 $284.06 $262.90 $355.99 $340.18 $327.41 $288.22 $263.51 $261.91$329.95 $287.71 $266.28 $360.56 $344.55 $331.61 $291.92 $266.89 $265.28$334.13 $291.36 $269.65 $365.13 $348.92 $335.82 $295.62 $270.28 $268.64$340.41 $296.83 $274.72 $371.99 $355.47 $342.12 $301.17 $275.35 $273.68$346.42 $302.07 $279.57 $378.56 $361.75 $348.17 $306.49 $280.22 $278.52$354.78 $309.37 $286.32 $387.70 $370.49 $356.58 $313.89 $286.98 $285.24$365.24 $318.49 $294.76 $399.13 $381.41 $367.09 $323.15 $295.44 $293.65$377.53 $329.20 $304.68 $412.56 $394.24 $379.44 $334.02 $305.38 $303.53$392.17 $341.97 $316.50 $428.56 $409.53 $394.15 $346.97 $317.23 $315.30$408.64 $356.33 $329.79 $446.55 $426.73 $410.71 $361.54 $330.55 $328.55$427.47 $372.75 $344.98 $467.13 $446.39 $429.63 $378.20 $345.78 $343.68$446.03 $388.93 $359.96 $487.41 $465.77 $448.28 $394.62 $360.79 $358.61$466.95 $407.17 $376.84 $510.27 $487.61 $469.30 $413.13 $377.71 $375.42$487.60 $425.18 $393.51 $532.84 $509.18 $490.06 $431.40 $394.42 $392.03$510.35 $445.02 $411.87 $557.69 $532.93 $512.92 $451.52 $412.82 $410.32$533.35 $465.08 $430.43 $582.84 $556.96 $536.05 $471.88 $431.43 $428.81$558.19 $486.74 $450.48 $609.98 $582.89 $561.01 $493.86 $451.52 $448.78$583.03 $508.40 $470.52 $637.12 $608.83 $585.97 $515.83 $471.61 $468.75$609.96 $531.88 $492.26 $666.55 $636.95 $613.04 $539.66 $493.39 $490.40$637.15 $555.59 $514.20 $696.26 $665.35 $640.37 $563.71 $515.39 $512.26$666.17 $580.89 $537.62 $727.97 $695.65 $669.53 $589.39 $538.86 $535.60$680.55 $593.43 $549.23 $743.69 $710.67 $683.99 $602.11 $550.49 $547.16$709.57 $618.74 $572.65 $775.40 $740.97 $713.15 $627.79 $573.97 $570.49$734.67 $640.63 $592.90 $802.83 $767.18 $738.38 $649.99 $594.27 $590.67$751.14 $654.99 $606.19 $820.83 $784.38 $754.93 $664.56 $607.59 $603.91$771.79 $673.00 $622.86 $843.40 $805.95 $775.69 $682.84 $624.30 $620.52$784.34 $683.94 $632.99 $857.11 $819.06 $788.30 $693.94 $634.45 $630.61
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4Moda Health Plan Inc
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
$133.78 $152.61 $119.46 $204.10 $184.66 $199.93 $167.72 $136.21 $242.48$210.68 $240.33 $188.13 $321.42 $290.80 $314.85 $264.13 $214.50 $381.85$210.68 $240.33 $188.13 $321.42 $290.80 $314.85 $264.13 $214.50 $381.85$210.68 $240.33 $188.13 $321.42 $290.80 $314.85 $264.13 $214.50 $381.85$210.68 $240.33 $188.13 $321.42 $290.80 $314.85 $264.13 $214.50 $381.85$211.53 $241.29 $188.89 $322.71 $291.97 $316.11 $265.19 $215.36 $383.38$215.74 $246.09 $192.65 $329.13 $297.78 $322.41 $270.47 $219.65 $391.02$220.80 $251.86 $197.16 $336.85 $304.76 $329.96 $276.81 $224.80 $400.18$229.01 $261.23 $204.50 $349.38 $316.10 $342.24 $287.11 $233.16 $415.08$235.76 $268.92 $210.52 $359.67 $325.41 $352.32 $295.56 $240.03 $427.30$239.13 $272.77 $213.53 $364.81 $330.06 $357.36 $299.79 $243.46 $433.40$244.18 $278.54 $218.05 $372.53 $337.04 $364.91 $306.13 $248.61 $442.57$249.24 $284.31 $222.56 $380.24 $344.02 $372.47 $312.47 $253.76 $451.73$252.40 $287.91 $225.38 $385.06 $348.38 $377.19 $316.43 $256.97 $457.46$255.77 $291.76 $228.39 $390.20 $353.03 $382.23 $320.65 $260.41 $463.57$257.46 $293.68 $229.90 $392.78 $355.36 $384.75 $322.77 $262.12 $466.63$259.14 $295.60 $231.40 $395.35 $357.69 $387.27 $324.88 $263.84 $469.68$260.83 $297.52 $232.91 $397.92 $360.01 $389.79 $326.99 $265.55 $472.74$262.51 $299.45 $234.41 $400.49 $362.34 $392.30 $329.11 $267.27 $475.79$265.88 $303.29 $237.42 $405.63 $366.99 $397.34 $333.33 $270.70 $481.90$269.25 $307.14 $240.43 $410.78 $371.65 $402.38 $337.56 $274.13 $488.01$274.31 $312.90 $244.95 $418.49 $378.63 $409.94 $343.90 $279.28 $497.17$279.16 $318.43 $249.28 $425.88 $385.31 $417.18 $349.97 $284.22 $505.96$285.90 $326.12 $255.30 $436.17 $394.62 $427.25 $358.43 $291.08 $518.18$294.33 $335.73 $262.82 $449.02 $406.25 $439.85 $368.99 $299.66 $533.45$304.23 $347.03 $271.66 $464.13 $419.92 $454.64 $381.40 $309.74 $551.40$316.03 $360.49 $282.20 $482.13 $436.20 $472.28 $396.20 $321.75 $572.78$329.30 $375.63 $294.05 $502.38 $454.52 $492.11 $412.84 $335.27 $596.84$344.47 $392.93 $307.60 $525.52 $475.46 $514.78 $431.85 $350.71 $624.33$359.43 $410.00 $320.95 $548.34 $496.11 $537.14 $450.61 $365.94 $651.44$376.28 $429.22 $336.01 $574.06 $519.37 $562.32 $471.74 $383.10 $681.99$392.93 $448.21 $350.87 $599.45 $542.35 $587.20 $492.60 $400.05 $712.16$411.26 $469.12 $367.24 $627.41 $567.65 $614.59 $515.58 $418.71 $745.38$429.80 $490.26 $383.79 $655.70 $593.24 $642.30 $538.83 $437.58 $778.98$449.81 $513.09 $401.66 $686.23 $620.86 $672.21 $563.92 $457.96 $815.26$469.83 $535.93 $419.54 $716.77 $648.49 $702.12 $589.01 $478.34 $851.54$491.53 $560.68 $438.91 $749.87 $678.44 $734.55 $616.22 $500.43 $890.87$513.44 $585.67 $458.48 $783.30 $708.69 $767.29 $643.69 $522.74 $930.58$536.82 $612.35 $479.36 $818.98 $740.97 $802.24 $673.00 $546.55 $972.96$548.41 $625.57 $489.71 $836.66 $756.96 $819.56 $687.53 $558.35 $993.97$571.80 $652.24 $510.59 $872.34 $789.24 $854.50 $716.85 $582.16 $1,036.35$592.02 $675.31 $528.65 $903.19 $817.16 $884.73 $742.21 $602.75 $1,073.01$605.30 $690.46 $540.51 $923.44 $835.48 $904.57 $758.85 $616.26 $1,097.07$621.94 $709.44 $555.37 $948.83 $858.45 $929.44 $779.71 $633.21 $1,127.23$632.05 $720.98 $564.40 $964.26 $872.41 $944.55 $792.39 $643.51 $1,145.56
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health Plan Inc
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000
$239.35 $226.29 $219.91 $219.49 $214.06 $192.38 $188.77 $192.19 $185.56$376.92 $356.37 $346.31 $345.66 $337.10 $302.96 $297.27 $302.66 $292.21$376.92 $356.37 $346.31 $345.66 $337.10 $302.96 $297.27 $302.66 $292.21$376.92 $356.37 $346.31 $345.66 $337.10 $302.96 $297.27 $302.66 $292.21$376.92 $356.37 $346.31 $345.66 $337.10 $302.96 $297.27 $302.66 $292.21$378.43 $357.80 $347.69 $347.04 $338.44 $304.17 $298.46 $303.87 $293.38$385.97 $364.92 $354.62 $353.96 $345.19 $310.23 $304.40 $309.93 $299.23$395.02 $373.48 $362.93 $362.25 $353.28 $317.50 $311.54 $317.19 $306.24$409.72 $387.37 $376.44 $375.73 $366.42 $329.32 $323.13 $328.99 $317.64$421.78 $398.78 $387.52 $386.79 $377.21 $339.01 $332.64 $338.68 $326.99$427.81 $404.48 $393.06 $392.32 $382.60 $343.86 $337.40 $343.52 $331.66$436.85 $413.03 $401.37 $400.62 $390.69 $351.13 $344.53 $350.79 $338.68$445.90 $421.59 $409.68 $408.92 $398.78 $358.40 $351.67 $358.05 $345.69$451.55 $426.93 $414.88 $414.10 $403.84 $362.94 $356.13 $362.59 $350.07$457.58 $432.63 $420.42 $419.63 $409.23 $367.79 $360.88 $367.43 $354.75$460.60 $435.48 $423.19 $422.40 $411.93 $370.21 $363.26 $369.85 $357.08$463.62 $438.33 $425.96 $425.16 $414.63 $372.64 $365.64 $372.28 $359.42$466.63 $441.19 $428.73 $427.93 $417.32 $375.06 $368.02 $374.70 $361.76$469.65 $444.04 $431.50 $430.69 $420.02 $377.49 $370.40 $377.12 $364.10$475.68 $449.74 $437.04 $436.22 $425.42 $382.33 $375.15 $381.96 $368.77$481.71 $455.44 $442.58 $441.75 $430.81 $387.18 $379.91 $386.80 $373.45$490.75 $463.99 $450.89 $450.05 $438.90 $394.45 $387.04 $394.07 $380.46$499.42 $472.19 $458.86 $458.00 $446.65 $401.42 $393.88 $401.03 $387.18$511.48 $483.59 $469.94 $469.06 $457.44 $411.11 $403.39 $410.71 $396.53$526.56 $497.85 $483.79 $482.89 $470.92 $423.23 $415.28 $422.82 $408.22$544.28 $514.60 $500.07 $499.13 $486.77 $437.47 $429.26 $437.05 $421.96$565.38 $534.55 $519.46 $518.49 $505.64 $454.44 $445.90 $453.99 $438.32$589.13 $557.01 $541.28 $540.27 $526.88 $473.52 $464.63 $473.06 $456.73$616.27 $582.66 $566.21 $565.15 $551.15 $495.34 $486.03 $494.85 $477.77$643.03 $607.97 $590.80 $589.70 $575.09 $516.85 $507.14 $516.34 $498.52$673.18 $636.48 $618.51 $617.35 $602.05 $541.08 $530.92 $540.56 $521.89$702.96 $664.63 $645.86 $644.66 $628.68 $565.02 $554.41 $564.47 $544.98$735.75 $695.63 $675.99 $674.73 $658.01 $591.37 $580.27 $590.80 $570.40$768.92 $726.99 $706.47 $705.15 $687.68 $618.03 $606.43 $617.43 $596.12$804.73 $760.85 $739.37 $737.98 $719.70 $646.81 $634.67 $646.19 $623.88$840.54 $794.70 $772.27 $770.82 $751.72 $675.60 $662.91 $674.94 $651.64$879.36 $831.41 $807.94 $806.42 $786.45 $706.80 $693.53 $706.11 $681.73$918.56 $868.47 $843.95 $842.37 $821.50 $738.31 $724.44 $737.59 $712.12$960.40 $908.03 $882.39 $880.74 $858.92 $771.94 $757.44 $771.19 $744.56$981.13 $927.63 $901.44 $899.75 $877.46 $788.60 $773.79 $787.83 $760.63
$1,022.97 $967.19 $939.88 $938.12 $914.88 $822.23 $806.79 $821.43 $793.07$1,059.15 $1,001.40 $973.13 $971.30 $947.24 $851.31 $835.33 $850.48 $821.12$1,082.90 $1,023.85 $994.94 $993.08 $968.48 $870.40 $854.05 $869.55 $839.53$1,112.68 $1,052.00 $1,022.30 $1,020.39 $995.11 $894.33 $877.54 $893.46 $862.61$1,130.77 $1,069.11 $1,038.92 $1,036.98 $1,011.29 $908.87 $891.81 $907.99 $876.64
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
$180.60 $176.19 $172.17 $162.79 $184.26 $178.92 $156.02 $144.40 $195.52$284.42 $277.47 $271.14 $256.36 $290.17 $281.77 $245.70 $227.40 $307.91$284.42 $277.47 $271.14 $256.36 $290.17 $281.77 $245.70 $227.40 $307.91$284.42 $277.47 $271.14 $256.36 $290.17 $281.77 $245.70 $227.40 $307.91$284.42 $277.47 $271.14 $256.36 $290.17 $281.77 $245.70 $227.40 $307.91$285.55 $278.58 $272.22 $257.39 $291.33 $282.89 $246.68 $228.31 $309.14$291.24 $284.13 $277.65 $262.51 $297.14 $288.53 $251.60 $232.85 $315.30$298.07 $290.79 $284.15 $268.66 $304.10 $295.29 $257.49 $238.31 $322.69$309.16 $301.61 $294.73 $278.66 $315.42 $306.28 $267.08 $247.18 $334.70$318.26 $310.49 $303.41 $286.87 $324.70 $315.30 $274.94 $254.46 $344.55$322.81 $314.93 $307.74 $290.97 $329.35 $319.81 $278.87 $258.09 $349.48$329.64 $321.59 $314.25 $297.12 $336.31 $326.57 $284.77 $263.55 $356.87$336.46 $328.25 $320.76 $303.27 $343.28 $333.33 $290.66 $269.01 $364.26$340.73 $332.41 $324.83 $307.12 $347.63 $337.56 $294.35 $272.42 $368.87$345.28 $336.85 $329.16 $311.22 $352.27 $342.07 $298.28 $276.06 $373.80$347.56 $339.07 $331.33 $313.27 $354.59 $344.32 $300.24 $277.88 $376.26$349.83 $341.29 $333.50 $315.32 $356.91 $346.57 $302.21 $279.70 $378.73$352.11 $343.51 $335.67 $317.37 $359.24 $348.83 $304.18 $281.52 $381.19$354.38 $345.73 $337.84 $319.42 $361.56 $351.08 $306.14 $283.34 $383.65$358.93 $350.17 $342.18 $323.53 $366.20 $355.59 $310.07 $286.97 $388.58$363.48 $354.61 $346.52 $327.63 $370.84 $360.10 $314.00 $290.61 $393.51$370.31 $361.26 $353.02 $333.78 $377.81 $366.86 $319.90 $296.07 $400.90$376.85 $367.65 $359.26 $339.68 $384.48 $373.34 $325.55 $301.30 $407.98$385.95 $376.53 $367.94 $347.88 $393.77 $382.36 $333.41 $308.58 $417.83$397.33 $387.62 $378.78 $358.13 $405.37 $393.63 $343.24 $317.67 $430.15$410.70 $400.67 $391.53 $370.18 $419.01 $406.87 $354.79 $328.36 $444.62$426.62 $416.20 $406.71 $384.54 $435.26 $422.65 $368.55 $341.09 $461.86$444.54 $433.68 $423.79 $400.69 $453.54 $440.40 $384.03 $355.42 $481.26$465.02 $453.66 $443.31 $419.15 $474.43 $460.69 $401.72 $371.79 $503.43$485.21 $473.36 $462.57 $437.35 $495.04 $480.70 $419.16 $387.94 $525.29$507.97 $495.56 $484.26 $457.86 $518.25 $503.24 $438.82 $406.13 $549.92$530.43 $517.48 $505.68 $478.11 $541.17 $525.50 $458.23 $424.09 $574.25$555.18 $541.62 $529.27 $500.41 $566.42 $550.01 $479.61 $443.88 $601.04$580.21 $566.04 $553.13 $522.97 $591.96 $574.81 $501.23 $463.89 $628.13$607.23 $592.40 $578.88 $547.33 $619.52 $601.57 $524.57 $485.49 $657.39$634.25 $618.76 $604.64 $571.68 $647.09 $628.34 $547.91 $507.09 $686.64$663.54 $647.33 $632.57 $598.09 $676.98 $657.36 $573.22 $530.51 $718.35$693.12 $676.19 $660.77 $624.75 $707.15 $686.67 $598.77 $554.16 $750.37$724.69 $706.99 $690.87 $653.20 $739.36 $717.94 $626.04 $579.40 $784.55$740.33 $722.25 $705.78 $667.30 $755.32 $733.44 $639.56 $591.91 $801.49$771.90 $753.05 $735.87 $695.76 $787.53 $764.72 $666.83 $617.15 $835.66$799.21 $779.69 $761.90 $720.37 $815.39 $791.77 $690.42 $638.98 $865.22$817.13 $797.17 $778.99 $736.52 $833.67 $809.52 $705.89 $653.31 $884.62$839.59 $819.09 $800.41 $756.77 $856.59 $831.78 $725.30 $671.27 $908.95$853.25 $832.41 $813.42 $769.08 $870.52 $845.30 $737.10 $682.19 $923.73
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Summit
Exclusive 2000
$186.84 $179.83 $158.30 $144.73 $143.85 $144.18 $164.47 $170.08$294.24 $283.19 $249.29 $227.92 $226.54 $227.06 $259.00 $267.84$294.24 $283.19 $249.29 $227.92 $226.54 $227.06 $259.00 $267.84$294.24 $283.19 $249.29 $227.92 $226.54 $227.06 $259.00 $267.84$294.24 $283.19 $249.29 $227.92 $226.54 $227.06 $259.00 $267.84$295.41 $284.32 $250.29 $228.83 $227.45 $227.97 $260.04 $268.91$301.30 $289.99 $255.27 $233.39 $231.98 $232.51 $265.22 $274.27$308.36 $296.78 $261.26 $238.86 $237.41 $237.96 $271.44 $280.70$319.84 $307.83 $270.98 $247.75 $246.25 $246.81 $281.54 $291.14$329.25 $316.89 $278.96 $255.04 $253.50 $254.08 $289.83 $299.71$333.96 $321.42 $282.95 $258.69 $257.12 $257.71 $293.97 $304.00$341.02 $328.22 $288.93 $264.16 $262.56 $263.16 $300.19 $310.43$348.08 $335.01 $294.91 $269.63 $268.00 $268.61 $306.40 $316.85$352.50 $339.26 $298.65 $273.05 $271.39 $272.02 $310.29 $320.87$357.20 $343.79 $302.64 $276.70 $275.02 $275.65 $314.43 $325.16$359.56 $346.06 $304.63 $278.52 $276.83 $277.47 $316.50 $327.30$361.91 $348.32 $306.63 $280.34 $278.64 $279.28 $318.57 $329.44$364.27 $350.59 $308.62 $282.17 $280.46 $281.10 $320.65 $331.59$366.62 $352.86 $310.62 $283.99 $282.27 $282.92 $322.72 $333.73$371.33 $357.39 $314.61 $287.64 $285.89 $286.55 $326.86 $338.01$376.04 $361.92 $318.59 $291.28 $289.52 $290.18 $331.01 $342.30$383.10 $368.71 $324.58 $296.75 $294.95 $295.63 $337.22 $348.73$389.86 $375.23 $330.31 $301.99 $300.16 $300.85 $343.18 $354.89$399.28 $384.29 $338.29 $309.29 $307.41 $308.12 $351.47 $363.46$411.05 $395.62 $348.26 $318.40 $316.48 $317.20 $361.83 $374.17$424.88 $408.93 $359.98 $329.12 $327.12 $327.87 $374.00 $386.76$441.36 $424.79 $373.94 $341.88 $339.81 $340.59 $388.51 $401.76$459.89 $442.63 $389.64 $356.24 $354.08 $354.89 $404.82 $418.63$481.08 $463.02 $407.59 $372.65 $370.39 $371.24 $423.47 $437.92$501.97 $483.12 $425.29 $388.83 $386.48 $387.36 $441.86 $456.94$525.51 $505.78 $445.23 $407.07 $404.60 $405.53 $462.58 $478.36$548.75 $528.15 $464.93 $425.07 $422.50 $423.47 $483.04 $499.52$574.35 $552.79 $486.62 $444.90 $442.20 $443.22 $505.58 $522.82$600.24 $577.71 $508.55 $464.96 $462.14 $463.20 $528.37 $546.39$628.20 $604.61 $532.24 $486.61 $483.66 $484.77 $552.97 $571.84$656.15 $631.51 $555.92 $508.26 $505.18 $506.34 $577.58 $597.28$686.46 $660.68 $581.60 $531.74 $528.52 $529.73 $604.26 $624.87$717.06 $690.14 $607.52 $555.44 $552.08 $553.34 $631.19 $652.73$749.72 $721.57 $635.19 $580.74 $577.22 $578.55 $659.94 $682.46$765.90 $737.14 $648.91 $593.28 $589.68 $591.03 $674.19 $697.19$798.56 $768.58 $676.58 $618.58 $614.83 $616.24 $702.94 $726.92$826.81 $795.77 $700.51 $640.46 $636.58 $638.04 $727.80 $752.63$845.34 $813.61 $716.21 $654.82 $650.85 $652.34 $744.12 $769.50$868.59 $835.98 $735.91 $672.82 $668.74 $670.28 $764.58 $790.66$882.71 $849.57 $747.87 $683.76 $679.62 $681.18 $777.01 $803.52
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Moda Health
Synergy
Exclusive 5000
Moda Health
Summit
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Platinum
Summit
Exclusive 250
PPO Synergy
Exclusive
1000A
PPO Summit
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
$128.75 $132.84 $219.97 $227.93 $199.01 $206.14 $215.47 $180.76 $146.79$202.75 $209.20 $346.40 $358.95 $313.40 $324.63 $339.32 $284.66 $231.17$202.75 $209.20 $346.40 $358.95 $313.40 $324.63 $339.32 $284.66 $231.17$202.75 $209.20 $346.40 $358.95 $313.40 $324.63 $339.32 $284.66 $231.17$202.75 $209.20 $346.40 $358.95 $313.40 $324.63 $339.32 $284.66 $231.17$203.57 $210.04 $347.79 $360.38 $314.66 $325.93 $340.68 $285.80 $232.10$207.62 $214.23 $354.72 $367.56 $320.93 $332.42 $347.46 $291.49 $236.72$212.49 $219.25 $363.03 $376.18 $328.45 $340.21 $355.61 $298.32 $242.27$220.39 $227.41 $376.54 $390.18 $340.67 $352.87 $368.84 $309.42 $251.29$226.88 $234.10 $387.62 $401.66 $350.70 $363.26 $379.70 $318.53 $258.68$230.13 $237.45 $393.17 $407.41 $355.71 $368.46 $385.13 $323.09 $262.38$234.99 $242.47 $401.48 $416.02 $363.24 $376.25 $393.27 $329.92 $267.93$239.86 $247.49 $409.79 $424.64 $370.76 $384.04 $401.42 $336.75 $273.48$242.90 $250.63 $414.99 $430.02 $375.46 $388.91 $406.51 $341.02 $276.95$246.14 $253.97 $420.53 $435.76 $380.47 $394.10 $411.94 $345.58 $280.64$247.77 $255.65 $423.30 $438.64 $382.98 $396.70 $414.65 $347.85 $282.49$249.39 $257.32 $426.07 $441.51 $385.49 $399.30 $417.36 $350.13 $284.34$251.01 $259.00 $428.85 $444.38 $387.99 $401.89 $420.08 $352.41 $286.19$252.63 $260.67 $431.62 $447.25 $390.50 $404.49 $422.79 $354.68 $288.04$255.88 $264.02 $437.16 $452.99 $395.52 $409.68 $428.22 $359.24 $291.74$259.12 $267.36 $442.70 $458.74 $400.53 $414.88 $433.65 $363.79 $295.44$263.99 $272.38 $451.01 $467.35 $408.05 $422.67 $441.80 $370.63 $300.99$268.65 $277.20 $458.98 $475.61 $415.26 $430.14 $449.60 $377.17 $306.30$275.14 $283.89 $470.07 $487.09 $425.29 $440.52 $460.46 $386.28 $313.70$283.25 $292.26 $483.92 $501.45 $437.83 $453.51 $474.03 $397.67 $322.95$292.78 $302.09 $500.20 $518.32 $452.56 $468.77 $489.98 $411.05 $333.81$304.13 $313.81 $519.60 $538.42 $470.11 $486.95 $508.98 $426.99 $346.76$316.91 $326.99 $541.43 $561.04 $489.85 $507.40 $530.36 $444.92 $361.32$331.50 $342.05 $566.37 $586.88 $512.42 $530.77 $554.79 $465.42 $377.97$345.90 $356.90 $590.96 $612.37 $534.67 $553.82 $578.88 $485.63 $394.38$362.12 $373.64 $618.67 $641.08 $559.74 $579.79 $606.03 $508.40 $412.88$378.14 $390.17 $646.04 $669.44 $584.50 $605.44 $632.83 $530.89 $431.14$395.78 $408.37 $676.18 $700.67 $611.76 $633.68 $662.35 $555.65 $451.25$413.62 $426.78 $706.66 $732.26 $639.34 $662.25 $692.21 $580.70 $471.59$432.88 $446.65 $739.57 $766.36 $669.12 $693.09 $724.45 $607.75 $493.55$452.14 $466.53 $772.48 $800.46 $698.89 $723.93 $756.69 $634.79 $515.52$473.03 $488.07 $808.15 $837.43 $731.17 $757.36 $791.64 $664.11 $539.33$494.11 $509.83 $844.18 $874.76 $763.77 $791.12 $826.92 $693.71 $563.37$516.62 $533.05 $882.63 $914.60 $798.55 $827.16 $864.59 $725.31 $589.03$527.77 $544.56 $901.68 $934.34 $815.79 $845.01 $883.25 $740.97 $601.74$550.28 $567.78 $940.13 $974.19 $850.58 $881.05 $920.92 $772.56 $627.40$569.74 $587.87 $973.39 $1,008.65 $880.66 $912.21 $953.49 $799.89 $649.60$582.51 $601.04 $995.21 $1,031.26 $900.41 $932.66 $974.87 $817.82 $664.16$598.53 $617.57 $1,022.58 $1,059.62 $925.17 $958.31 $1,001.68 $840.31 $682.42$608.26 $627.61 $1,039.20 $1,076.85 $940.21 $973.89 $1,017.96 $853.98 $693.52
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5Moda Health Plan Inc
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500
$233.15 $230.14 $217.59 $211.45 $211.05 $205.82 $184.98 $181.51 $184.80$367.17 $362.43 $342.66 $332.99 $332.37 $324.13 $291.31 $285.84 $291.02$367.17 $362.43 $342.66 $332.99 $332.37 $324.13 $291.31 $285.84 $291.02$367.17 $362.43 $342.66 $332.99 $332.37 $324.13 $291.31 $285.84 $291.02$367.17 $362.43 $342.66 $332.99 $332.37 $324.13 $291.31 $285.84 $291.02$368.64 $363.88 $344.03 $334.32 $333.69 $325.43 $292.47 $286.98 $292.19$375.98 $371.12 $350.89 $340.98 $340.34 $331.91 $298.30 $292.70 $298.01$384.79 $379.82 $359.11 $348.97 $348.32 $339.69 $305.29 $299.56 $304.99$399.11 $393.96 $372.48 $361.96 $361.28 $352.33 $316.65 $310.70 $316.34$410.86 $405.55 $383.44 $372.61 $371.92 $362.70 $325.97 $319.85 $325.65$416.74 $411.35 $388.92 $377.94 $377.23 $367.89 $330.63 $324.42 $330.31$425.55 $420.05 $397.15 $385.93 $385.21 $375.67 $337.62 $331.28 $337.29$434.36 $428.75 $405.37 $393.93 $393.19 $383.45 $344.61 $338.14 $344.28$439.87 $434.19 $410.51 $398.92 $398.17 $388.31 $348.98 $342.43 $348.64$445.74 $439.99 $415.99 $404.25 $403.49 $393.49 $353.64 $347.00 $353.30$448.68 $442.88 $418.73 $406.91 $406.15 $396.09 $355.98 $349.29 $355.63$451.62 $445.78 $421.48 $409.58 $408.81 $398.68 $358.31 $351.58 $357.96$454.55 $448.68 $424.22 $412.24 $411.47 $401.27 $360.64 $353.86 $360.29$457.49 $451.58 $426.96 $414.90 $414.13 $403.87 $362.97 $356.15 $362.61$463.37 $457.38 $432.44 $420.23 $419.44 $409.05 $367.63 $360.72 $367.27$469.24 $463.18 $437.92 $425.56 $424.76 $414.24 $372.29 $365.30 $371.93$478.05 $471.88 $446.15 $433.55 $432.74 $422.02 $379.28 $372.16 $378.91$486.50 $480.21 $454.03 $441.21 $440.38 $429.47 $385.98 $378.73 $385.60$498.25 $491.81 $464.99 $451.87 $451.02 $439.85 $395.30 $387.88 $394.92$512.93 $506.31 $478.70 $465.18 $464.31 $452.81 $406.95 $399.31 $406.56$530.19 $523.34 $494.81 $480.84 $479.94 $468.04 $420.65 $412.75 $420.24$550.75 $543.64 $513.99 $499.48 $498.55 $486.20 $436.96 $428.75 $436.53$573.88 $566.47 $535.58 $520.46 $519.49 $506.62 $455.31 $446.76 $454.87$600.32 $592.57 $560.25 $544.44 $543.42 $529.95 $476.28 $467.34 $475.82$626.39 $618.30 $584.58 $568.08 $567.01 $552.97 $496.97 $487.64 $496.48$655.76 $647.29 $612.00 $594.72 $593.60 $578.90 $520.27 $510.50 $519.77$684.77 $675.92 $639.07 $621.02 $619.86 $604.50 $543.28 $533.08 $542.76$716.71 $707.46 $668.88 $649.99 $648.78 $632.70 $568.63 $557.95 $568.08$749.02 $739.35 $699.03 $679.30 $678.02 $661.23 $594.26 $583.10 $593.69$783.90 $773.78 $731.59 $710.93 $709.60 $692.02 $621.94 $610.26 $621.33$818.78 $808.21 $764.14 $742.56 $741.17 $722.81 $649.61 $637.41 $648.98$856.60 $845.54 $799.43 $776.86 $775.41 $756.20 $679.62 $666.85 $678.96$894.79 $883.23 $835.07 $811.49 $809.97 $789.91 $709.91 $696.58 $709.22$935.54 $923.46 $873.11 $848.45 $846.87 $825.89 $742.25 $728.31 $741.52$955.74 $943.39 $891.95 $866.77 $865.15 $843.71 $758.27 $744.03 $757.53$996.49 $983.62 $929.99 $903.73 $902.04 $879.69 $790.60 $775.76 $789.83
$1,031.74 $1,018.42 $962.88 $935.70 $933.95 $910.81 $818.57 $803.20 $817.77$1,054.87 $1,041.25 $984.47 $956.68 $954.88 $931.23 $836.92 $821.21 $836.11$1,083.88 $1,069.88 $1,011.54 $982.98 $981.14 $956.83 $859.93 $843.79 $859.10$1,101.50 $1,087.28 $1,027.99 $998.96 $997.10 $972.39 $873.92 $857.51 $873.07
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5
Value 2000 Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
$178.42 $173.66 $169.42 $165.55 $156.53 $177.17 $172.04 $150.02 $138.84$280.97 $273.48 $266.80 $260.71 $246.50 $279.01 $270.93 $236.25 $218.65$280.97 $273.48 $266.80 $260.71 $246.50 $279.01 $270.93 $236.25 $218.65$280.97 $273.48 $266.80 $260.71 $246.50 $279.01 $270.93 $236.25 $218.65$280.97 $273.48 $266.80 $260.71 $246.50 $279.01 $270.93 $236.25 $218.65$282.10 $274.57 $267.86 $261.75 $247.49 $280.13 $272.01 $237.19 $219.52$287.72 $280.04 $273.20 $266.97 $252.42 $285.71 $277.43 $241.92 $223.90$294.46 $286.60 $279.60 $273.23 $258.33 $292.41 $283.94 $247.59 $229.15$305.42 $297.27 $290.01 $283.39 $267.95 $303.29 $294.50 $256.80 $237.67$314.41 $306.02 $298.55 $291.74 $275.83 $312.22 $303.17 $264.36 $244.67$318.91 $310.40 $302.81 $295.91 $279.78 $316.68 $307.51 $268.14 $248.17$325.65 $316.96 $309.22 $302.16 $285.69 $323.38 $314.01 $273.81 $253.42$332.39 $323.52 $315.62 $308.42 $291.61 $330.07 $320.51 $279.48 $258.66$336.61 $327.62 $319.62 $312.33 $295.31 $334.26 $324.57 $283.03 $261.94$341.10 $332.00 $323.89 $316.50 $299.25 $338.72 $328.91 $286.81 $265.44$343.35 $334.19 $326.03 $318.59 $301.22 $340.95 $331.08 $288.70 $267.19$345.60 $336.38 $328.16 $320.68 $303.19 $343.19 $333.24 $290.59 $268.94$347.85 $338.56 $330.29 $322.76 $305.17 $345.42 $335.41 $292.48 $270.69$350.09 $340.75 $332.43 $324.85 $307.14 $347.65 $337.58 $294.37 $272.44$354.59 $345.13 $336.70 $329.02 $311.08 $352.12 $341.91 $298.15 $275.94$359.09 $349.50 $340.97 $333.19 $315.03 $356.58 $346.25 $301.93 $279.43$365.83 $356.07 $347.37 $339.45 $320.94 $363.28 $352.75 $307.60 $284.68$372.29 $362.36 $353.51 $345.44 $326.61 $369.69 $358.98 $313.03 $289.71$381.28 $371.11 $362.04 $353.79 $334.50 $378.62 $367.65 $320.59 $296.71$392.52 $382.05 $372.72 $364.21 $344.36 $389.78 $378.49 $330.04 $305.45$405.73 $394.90 $385.25 $376.47 $355.95 $402.90 $391.22 $341.14 $315.73$421.46 $410.21 $400.20 $391.07 $369.75 $418.52 $406.40 $354.37 $327.97$439.16 $427.44 $417.00 $407.49 $385.28 $436.10 $423.46 $369.26 $341.75$459.39 $447.13 $436.21 $426.26 $403.03 $456.19 $442.97 $386.27 $357.49$479.34 $466.55 $455.16 $444.77 $420.53 $476.00 $462.21 $403.04 $373.02$501.82 $488.43 $476.50 $465.63 $440.25 $498.32 $483.88 $421.94 $390.51$524.02 $510.03 $497.58 $486.23 $459.72 $520.36 $505.29 $440.61 $407.78$548.46 $533.83 $520.79 $508.91 $481.17 $544.63 $528.86 $461.16 $426.80$573.19 $557.89 $544.27 $531.85 $502.86 $569.19 $552.70 $481.95 $446.05$599.88 $583.87 $569.61 $556.62 $526.28 $595.69 $578.44 $504.39 $466.82$626.57 $609.85 $594.96 $581.39 $549.69 $622.20 $604.18 $526.84 $487.59$655.51 $638.02 $622.44 $608.24 $575.08 $650.94 $632.08 $551.17 $510.11$684.73 $666.46 $650.18 $635.35 $600.72 $679.96 $660.26 $575.74 $532.85$715.92 $696.82 $679.80 $664.29 $628.08 $710.93 $690.33 $601.96 $557.12$731.38 $711.86 $694.47 $678.63 $641.64 $726.27 $705.23 $614.96 $569.15$762.56 $742.22 $724.09 $707.57 $669.00 $757.24 $735.31 $641.18 $593.42$789.54 $768.47 $749.70 $732.60 $692.66 $784.03 $761.31 $663.86 $614.41$807.24 $785.70 $766.51 $749.02 $708.19 $801.61 $778.38 $678.74 $628.18$829.44 $807.30 $787.58 $769.62 $727.67 $823.65 $799.79 $697.41 $645.45$842.92 $820.43 $800.39 $782.13 $739.50 $837.04 $812.79 $708.75 $655.95
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
$188.00 $179.65 $172.91 $152.21 $139.16 $138.32 $138.64 $158.14 $123.80$296.07 $282.92 $272.30 $239.70 $219.15 $217.83 $218.33 $249.04 $194.96$296.07 $282.92 $272.30 $239.70 $219.15 $217.83 $218.33 $249.04 $194.96$296.07 $282.92 $272.30 $239.70 $219.15 $217.83 $218.33 $249.04 $194.96$296.07 $282.92 $272.30 $239.70 $219.15 $217.83 $218.33 $249.04 $194.96$297.25 $284.05 $273.39 $240.66 $220.03 $218.70 $219.20 $250.04 $195.74$303.17 $289.71 $278.83 $245.46 $224.41 $223.05 $223.57 $255.02 $199.64$310.28 $296.50 $285.37 $251.21 $229.67 $228.28 $228.81 $261.00 $204.31$321.82 $307.53 $295.99 $260.56 $238.22 $236.78 $237.32 $270.71 $211.92$331.30 $316.59 $304.70 $268.23 $245.23 $243.75 $244.31 $278.68 $218.16$336.04 $321.11 $309.06 $272.06 $248.74 $247.23 $247.80 $282.66 $221.28$343.14 $327.91 $315.59 $277.82 $254.00 $252.46 $253.04 $288.64 $225.95$350.25 $334.70 $322.13 $283.57 $259.26 $257.69 $258.28 $294.62 $230.63$354.69 $338.94 $326.21 $287.16 $262.55 $260.96 $261.55 $298.35 $233.56$359.42 $343.47 $330.57 $291.00 $266.05 $264.44 $265.05 $302.34 $236.68$361.79 $345.73 $332.75 $292.92 $267.81 $266.18 $266.79 $304.33 $238.24$364.16 $347.99 $334.93 $294.84 $269.56 $267.93 $268.54 $306.32 $239.80$366.53 $350.26 $337.11 $296.75 $271.31 $269.67 $270.29 $308.31 $241.36$368.90 $352.52 $339.28 $298.67 $273.07 $271.41 $272.03 $310.31 $242.92$373.64 $357.05 $343.64 $302.51 $276.57 $274.90 $275.53 $314.29 $246.04$378.37 $361.57 $348.00 $306.34 $280.08 $278.38 $279.02 $318.28 $249.15$385.48 $368.36 $354.53 $312.09 $285.34 $283.61 $284.26 $324.25 $253.83$392.29 $374.87 $360.80 $317.61 $290.38 $288.62 $289.28 $329.98 $258.32$401.76 $383.92 $369.51 $325.28 $297.39 $295.59 $296.27 $337.95 $264.56$413.60 $395.24 $380.40 $334.87 $306.16 $304.30 $305.00 $347.91 $272.35$427.52 $408.54 $393.20 $346.13 $316.46 $314.54 $315.26 $359.62 $281.52$444.10 $424.38 $408.45 $359.56 $328.73 $326.74 $327.49 $373.56 $292.43$462.75 $442.21 $425.60 $374.66 $342.54 $340.46 $341.24 $389.25 $304.72$484.07 $462.58 $445.21 $391.92 $358.32 $356.15 $356.96 $407.18 $318.75$505.09 $482.66 $464.54 $408.93 $373.88 $371.61 $372.46 $424.87 $332.60$528.77 $505.30 $486.33 $428.11 $391.41 $389.04 $389.93 $444.79 $348.19$552.16 $527.65 $507.84 $447.05 $408.72 $406.25 $407.18 $464.46 $363.59$577.92 $552.26 $531.53 $467.90 $427.79 $425.20 $426.17 $486.13 $380.55$603.97 $577.16 $555.49 $489.00 $447.07 $444.37 $445.38 $508.05 $397.71$632.10 $604.04 $581.36 $511.77 $467.89 $465.06 $466.13 $531.70 $416.23$660.23 $630.91 $607.23 $534.54 $488.71 $485.75 $486.87 $555.36 $434.75$690.72 $660.05 $635.27 $559.23 $511.29 $508.19 $509.35 $581.01 $454.83$721.51 $689.48 $663.59 $584.16 $534.08 $530.84 $532.06 $606.92 $475.11$754.38 $720.88 $693.82 $610.76 $558.41 $555.02 $556.29 $634.56 $496.75$770.66 $736.44 $708.79 $623.95 $570.46 $567.00 $568.30 $648.26 $507.47$803.52 $767.85 $739.02 $650.56 $594.78 $591.18 $592.54 $675.90 $529.11$831.95 $795.01 $765.16 $673.57 $615.82 $612.09 $613.50 $699.81 $547.83$850.60 $812.83 $782.31 $688.67 $629.63 $625.81 $627.25 $715.50 $560.11$873.99 $835.18 $803.83 $707.60 $646.94 $643.02 $644.50 $735.17 $575.51$888.20 $848.76 $816.90 $719.11 $657.46 $653.48 $654.98 $747.13 $584.87
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5 Area 6Moda Health Plan Inc
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A
$211.50 $191.36 $207.18 $173.81 $141.15 $240.15 $237.04 $224.12 $217.79$333.08 $301.35 $326.27 $273.71 $222.28 $378.18 $373.30 $352.94 $342.98$333.08 $301.35 $326.27 $273.71 $222.28 $378.18 $373.30 $352.94 $342.98$333.08 $301.35 $326.27 $273.71 $222.28 $378.18 $373.30 $352.94 $342.98$333.08 $301.35 $326.27 $273.71 $222.28 $378.18 $373.30 $352.94 $342.98$334.41 $302.56 $327.58 $274.81 $223.17 $379.70 $374.79 $354.35 $344.35$341.07 $308.58 $334.10 $280.28 $227.62 $387.26 $382.26 $361.41 $351.21$349.07 $315.81 $341.93 $286.85 $232.95 $396.34 $391.22 $369.88 $359.44$362.06 $327.57 $354.66 $297.52 $241.62 $411.08 $405.78 $383.65 $372.82$372.71 $337.21 $365.10 $306.28 $248.73 $423.19 $417.72 $394.94 $383.79$378.04 $342.03 $370.32 $310.66 $252.29 $429.24 $423.69 $400.59 $389.28$386.04 $349.26 $378.15 $317.23 $257.62 $438.31 $432.65 $409.06 $397.51$394.03 $356.50 $385.98 $323.80 $262.96 $447.39 $441.61 $417.53 $405.74$399.03 $361.02 $390.87 $327.90 $266.29 $453.06 $447.21 $422.83 $410.89$404.36 $365.84 $396.09 $332.28 $269.85 $459.11 $453.18 $428.47 $416.38$407.02 $368.25 $398.70 $334.47 $271.63 $462.14 $456.17 $431.30 $419.12$409.69 $370.66 $401.31 $336.66 $273.41 $465.16 $459.16 $434.12 $421.86$412.35 $373.07 $403.92 $338.85 $275.18 $468.19 $462.14 $436.94 $424.61$415.02 $375.48 $406.53 $341.04 $276.96 $471.22 $465.13 $439.77 $427.35$420.35 $380.30 $411.75 $345.42 $280.52 $477.27 $471.10 $445.41 $432.84$425.67 $385.13 $416.97 $349.80 $284.08 $483.32 $477.08 $451.06 $438.33$433.67 $392.36 $424.80 $356.37 $289.41 $492.39 $486.03 $459.53 $446.56$441.33 $399.29 $432.31 $362.67 $294.52 $501.09 $494.62 $467.65 $454.45$451.99 $408.93 $442.75 $371.42 $301.64 $513.19 $506.57 $478.94 $465.42$465.31 $420.99 $455.80 $382.37 $310.53 $528.32 $521.50 $493.06 $479.14$480.97 $435.15 $471.13 $395.24 $320.97 $546.10 $539.04 $509.65 $495.26$499.62 $452.02 $489.41 $410.57 $333.42 $567.27 $559.95 $529.41 $514.47$520.60 $471.01 $509.96 $427.81 $347.43 $591.10 $583.47 $551.65 $536.07$544.58 $492.71 $533.45 $447.52 $363.43 $618.33 $610.34 $577.06 $560.77$568.23 $514.10 $556.62 $466.95 $379.21 $645.18 $636.85 $602.12 $585.12$594.88 $538.21 $582.72 $488.85 $397.00 $675.43 $666.71 $630.36 $612.56$621.19 $562.02 $608.49 $510.47 $414.56 $705.31 $696.20 $658.24 $639.65$650.17 $588.23 $636.88 $534.28 $433.89 $738.21 $728.68 $688.95 $669.49$679.48 $614.75 $665.59 $558.37 $453.45 $771.49 $761.53 $720.00 $699.68$711.12 $643.38 $696.59 $584.37 $474.57 $807.42 $796.99 $753.53 $732.26$742.77 $672.01 $727.58 $610.37 $495.69 $843.35 $832.46 $787.06 $764.84$777.07 $703.05 $761.19 $638.57 $518.58 $882.30 $870.91 $823.42 $800.17$811.71 $734.39 $795.12 $667.03 $541.70 $921.63 $909.73 $860.12 $835.84$848.68 $767.84 $831.34 $697.41 $566.37 $963.61 $951.17 $899.30 $873.91$867.00 $784.41 $849.28 $712.47 $578.60 $984.41 $971.70 $918.71 $892.77$903.97 $817.86 $885.50 $742.85 $603.27 $1,026.39 $1,013.13 $957.89 $930.84$935.95 $846.79 $916.82 $769.13 $624.61 $1,062.69 $1,048.97 $991.77 $963.77$956.93 $865.78 $937.37 $786.37 $638.62 $1,086.52 $1,072.49 $1,014.01 $985.38$983.25 $889.58 $963.15 $807.99 $656.18 $1,116.40 $1,101.98 $1,041.89 $1,012.47$999.24 $904.05 $978.81 $821.13 $666.85 $1,134.55 $1,119.90 $1,058.83 $1,028.93
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500
$217.38 $212.00 $190.53 $186.95 $190.34 $183.77 $178.87 $174.50 $170.52$342.34 $333.85 $300.04 $294.41 $299.75 $289.40 $281.68 $274.80 $268.53$342.34 $333.85 $300.04 $294.41 $299.75 $289.40 $281.68 $274.80 $268.53$342.34 $333.85 $300.04 $294.41 $299.75 $289.40 $281.68 $274.80 $268.53$342.34 $333.85 $300.04 $294.41 $299.75 $289.40 $281.68 $274.80 $268.53$343.71 $335.19 $301.24 $295.59 $300.95 $290.56 $282.81 $275.90 $269.61$350.55 $341.87 $307.25 $301.48 $306.95 $296.35 $288.44 $281.40 $274.98$358.77 $349.88 $314.45 $308.54 $314.14 $303.29 $295.20 $287.99 $281.42$372.12 $362.90 $326.15 $320.02 $325.83 $314.58 $306.19 $298.71 $291.90$383.07 $373.58 $335.75 $329.45 $335.42 $323.84 $315.20 $307.50 $300.49$388.55 $378.93 $340.55 $334.16 $340.22 $328.47 $319.71 $311.90 $304.78$396.77 $386.94 $347.75 $341.22 $347.41 $335.42 $326.47 $318.49 $311.23$404.98 $394.95 $354.95 $348.29 $354.61 $342.36 $333.23 $325.09 $317.67$410.12 $399.96 $359.45 $352.70 $359.10 $346.71 $337.45 $329.21 $321.70$415.60 $405.30 $364.25 $357.41 $363.90 $351.34 $341.96 $333.61 $326.00$418.33 $407.97 $366.65 $359.77 $366.30 $353.65 $344.21 $335.81 $328.15$421.07 $410.64 $369.05 $362.13 $368.70 $355.97 $346.47 $338.01 $330.30$423.81 $413.31 $371.46 $364.48 $371.09 $358.28 $348.72 $340.20 $332.44$426.55 $415.98 $373.86 $366.84 $373.49 $360.60 $350.97 $342.40 $334.59$432.03 $421.32 $378.66 $371.55 $378.29 $365.23 $355.48 $346.80 $338.89$437.51 $426.67 $383.46 $376.26 $383.08 $369.86 $359.99 $351.20 $343.19$445.72 $434.68 $390.66 $383.32 $390.28 $376.80 $366.75 $357.79 $349.63$453.60 $442.36 $397.56 $390.09 $397.17 $383.46 $373.23 $364.11 $355.81$464.55 $453.04 $407.16 $399.52 $406.76 $392.72 $382.24 $372.90 $364.40$478.24 $466.40 $419.16 $411.29 $418.75 $404.30 $393.51 $383.90 $375.14$494.33 $482.09 $433.26 $425.13 $432.84 $417.90 $406.75 $396.81 $387.76$513.50 $500.78 $450.07 $441.62 $449.63 $434.11 $422.52 $412.20 $402.80$535.07 $521.81 $468.97 $460.16 $468.51 $452.34 $440.27 $429.51 $419.72$559.72 $545.85 $490.57 $481.36 $490.10 $473.17 $460.55 $449.30 $439.05$584.03 $569.56 $511.88 $502.26 $511.38 $493.72 $480.55 $468.81 $458.12$611.41 $596.26 $535.88 $525.82 $535.36 $516.87 $503.08 $490.79 $479.60$638.46 $622.64 $559.58 $549.08 $559.04 $539.74 $525.33 $512.50 $500.81$668.24 $651.68 $585.69 $574.69 $585.12 $564.92 $549.84 $536.41 $524.18$698.37 $681.06 $612.09 $600.60 $611.50 $590.38 $574.63 $560.59 $547.81$730.89 $712.78 $640.60 $628.57 $639.97 $617.88 $601.39 $586.70 $573.32$763.41 $744.50 $669.10 $656.54 $668.45 $645.37 $628.15 $612.81 $598.83$798.67 $778.88 $700.00 $686.86 $699.32 $675.18 $657.16 $641.11 $626.49$834.27 $813.60 $731.21 $717.48 $730.50 $705.28 $686.46 $669.69 $654.41$872.27 $850.66 $764.51 $750.16 $763.77 $737.40 $717.72 $700.19 $684.22$891.10 $869.02 $781.02 $766.35 $780.26 $753.32 $733.22 $715.31 $698.99$929.10 $906.08 $814.32 $799.03 $813.53 $785.44 $764.48 $745.81 $728.80$961.96 $938.13 $843.13 $827.29 $842.31 $813.22 $791.52 $772.19 $754.58$983.53 $959.16 $862.03 $845.84 $861.19 $831.46 $809.27 $789.50 $771.50
$1,010.58 $985.54 $885.73 $869.10 $884.87 $854.32 $831.52 $811.21 $792.71$1,027.01 $1,001.56 $900.13 $883.23 $899.26 $868.21 $845.04 $824.40 $805.60
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
$161.22 $182.49 $177.20 $154.52 $143.01 $193.64 $185.04 $178.10 $156.78$253.89 $287.38 $279.06 $243.34 $225.21 $304.95 $291.41 $280.47 $246.89$253.89 $287.38 $279.06 $243.34 $225.21 $304.95 $291.41 $280.47 $246.89$253.89 $287.38 $279.06 $243.34 $225.21 $304.95 $291.41 $280.47 $246.89$253.89 $287.38 $279.06 $243.34 $225.21 $304.95 $291.41 $280.47 $246.89$254.91 $288.53 $280.17 $244.31 $226.11 $306.17 $292.57 $281.59 $247.88$259.99 $294.28 $285.76 $249.18 $230.61 $312.27 $298.40 $287.20 $252.82$266.08 $301.18 $292.45 $255.02 $236.02 $319.59 $305.40 $293.93 $258.75$275.98 $312.39 $303.34 $264.51 $244.80 $331.48 $316.76 $304.87 $268.37$284.11 $321.58 $312.27 $272.29 $252.01 $341.24 $326.09 $313.84 $276.28$288.17 $326.18 $316.73 $276.19 $255.61 $346.12 $330.75 $318.33 $280.23$294.26 $333.08 $323.43 $282.03 $261.02 $353.43 $337.74 $325.06 $286.15$300.36 $339.98 $330.13 $287.87 $266.42 $360.75 $344.74 $331.79 $292.08$304.17 $344.29 $334.31 $291.52 $269.80 $365.33 $349.11 $336.00 $295.78$308.23 $348.88 $338.78 $295.41 $273.40 $370.21 $353.77 $340.49 $299.73$310.26 $351.18 $341.01 $297.36 $275.21 $372.65 $356.10 $342.73 $301.71$312.29 $353.48 $343.24 $299.30 $277.01 $375.09 $358.43 $344.97 $303.68$314.32 $355.78 $345.47 $301.25 $278.81 $377.53 $360.76 $347.22 $305.66$316.35 $358.08 $347.71 $303.20 $280.61 $379.97 $363.09 $349.46 $307.63$320.42 $362.68 $352.17 $307.09 $284.21 $384.84 $367.76 $353.95 $311.58$324.48 $367.28 $356.64 $310.98 $287.82 $389.72 $372.42 $358.44 $315.53$330.57 $374.17 $363.33 $316.82 $293.22 $397.04 $379.41 $365.17 $321.46$336.41 $380.78 $369.75 $322.42 $298.40 $404.06 $386.12 $371.62 $327.14$344.54 $389.98 $378.68 $330.21 $305.61 $413.81 $395.44 $380.59 $335.04$354.69 $401.48 $389.84 $339.94 $314.62 $426.01 $407.10 $391.81 $344.91$366.62 $414.98 $402.96 $351.38 $325.20 $440.35 $420.79 $405.00 $356.52$380.84 $431.08 $418.59 $365.01 $337.81 $457.42 $437.11 $420.70 $370.34$396.84 $449.18 $436.17 $380.34 $352.00 $476.63 $455.47 $438.37 $385.90$415.12 $469.87 $456.26 $397.86 $368.22 $498.59 $476.45 $458.56 $403.67$433.14 $490.28 $476.07 $415.13 $384.21 $520.24 $497.14 $478.48 $421.20$453.46 $513.27 $498.40 $434.60 $402.22 $544.64 $520.46 $500.91 $440.95$473.51 $535.97 $520.44 $453.82 $420.02 $568.73 $543.48 $523.07 $460.46$495.60 $560.97 $544.72 $474.99 $439.61 $595.26 $568.83 $547.47 $481.94$517.95 $586.26 $569.28 $496.41 $459.43 $622.09 $594.47 $572.15 $503.66$542.07 $613.56 $595.79 $519.52 $480.82 $651.06 $622.16 $598.80 $527.12$566.19 $640.87 $622.30 $542.64 $502.22 $680.03 $649.84 $625.44 $550.57$592.34 $670.47 $651.04 $567.70 $525.41 $711.44 $679.86 $654.33 $576.00$618.74 $700.35 $680.07 $593.01 $548.84 $743.16 $710.16 $683.50 $601.68$646.92 $732.25 $711.04 $620.02 $573.83 $777.01 $742.51 $714.63 $629.09$660.89 $748.06 $726.39 $633.41 $586.22 $793.78 $758.54 $730.06 $642.67$689.07 $779.96 $757.36 $660.42 $611.22 $827.63 $790.88 $761.19 $670.07$713.44 $807.55 $784.15 $683.78 $632.84 $856.90 $818.86 $788.11 $693.77$729.44 $825.65 $801.73 $699.11 $647.03 $876.12 $837.22 $805.78 $709.33$749.50 $848.36 $823.78 $718.33 $664.82 $900.21 $860.24 $827.94 $728.83$761.68 $862.15 $837.18 $730.01 $675.63 $914.84 $874.22 $841.40 $740.68
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Summit
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
Moda Health
Summit
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Platinum
Summit
Exclusive 250
$143.34 $142.47 $142.80 $162.89 $168.44 $127.51 $131.57 $217.85 $225.74$225.73 $224.36 $224.88 $256.51 $265.26 $200.81 $207.19 $343.07 $355.50$225.73 $224.36 $224.88 $256.51 $265.26 $200.81 $207.19 $343.07 $355.50$225.73 $224.36 $224.88 $256.51 $265.26 $200.81 $207.19 $343.07 $355.50$225.73 $224.36 $224.88 $256.51 $265.26 $200.81 $207.19 $343.07 $355.50$226.63 $225.26 $225.78 $257.54 $266.33 $201.61 $208.02 $344.44 $356.92$231.15 $229.75 $230.27 $262.67 $271.63 $205.62 $212.17 $351.30 $364.03$236.56 $235.13 $235.67 $268.83 $278.00 $210.44 $217.14 $359.54 $372.56$245.37 $243.88 $244.44 $278.83 $288.34 $218.28 $225.22 $372.92 $386.43$252.59 $251.06 $251.64 $287.04 $296.83 $224.70 $231.85 $383.90 $397.80$256.20 $254.65 $255.23 $291.14 $301.08 $227.91 $235.16 $389.39 $403.49$261.62 $260.03 $260.63 $297.30 $307.44 $232.73 $240.14 $397.62 $412.02$267.04 $265.42 $266.03 $303.46 $313.81 $237.55 $245.11 $405.85 $420.55$270.42 $268.78 $269.40 $307.30 $317.79 $240.56 $248.22 $411.00 $425.89$274.03 $272.37 $273.00 $311.41 $322.03 $243.78 $251.53 $416.49 $431.57$275.84 $274.17 $274.80 $313.46 $324.15 $245.38 $253.19 $419.23 $434.42$277.65 $275.96 $276.60 $315.51 $326.28 $246.99 $254.85 $421.98 $437.26$279.45 $277.76 $278.40 $317.56 $328.40 $248.60 $256.50 $424.72 $440.11$281.26 $279.55 $280.20 $319.62 $330.52 $250.20 $258.16 $427.47 $442.95$284.87 $283.14 $283.79 $323.72 $334.76 $253.42 $261.48 $432.96 $448.64$288.48 $286.73 $287.39 $327.82 $339.01 $256.63 $264.79 $438.44 $454.33$293.90 $292.12 $292.79 $333.98 $345.37 $261.45 $269.77 $446.68 $462.86$299.09 $297.28 $297.96 $339.88 $351.48 $266.07 $274.53 $454.57 $471.03$306.31 $304.46 $305.16 $348.09 $359.96 $272.49 $281.16 $465.55 $482.41$315.34 $313.43 $314.15 $358.35 $370.57 $280.52 $289.45 $479.27 $496.63$325.95 $323.98 $324.72 $370.41 $383.04 $289.96 $299.19 $495.39 $513.34$338.59 $336.54 $337.31 $384.77 $397.90 $301.21 $310.79 $514.61 $533.25$352.81 $350.68 $351.48 $400.93 $414.61 $313.86 $323.84 $536.22 $555.64$369.07 $366.83 $367.67 $419.40 $433.71 $328.32 $338.76 $560.92 $581.24$385.09 $382.76 $383.64 $437.61 $452.54 $342.57 $353.47 $585.28 $606.48$403.15 $400.71 $401.63 $458.13 $473.76 $358.64 $370.05 $612.72 $634.92$420.98 $418.43 $419.39 $478.40 $494.72 $374.50 $386.42 $639.83 $663.00$440.62 $437.95 $438.96 $500.71 $517.80 $391.97 $404.44 $669.67 $693.93$460.49 $457.70 $458.75 $523.29 $541.14 $409.64 $422.67 $699.86 $725.21$481.93 $479.01 $480.11 $547.66 $566.34 $428.72 $442.36 $732.46 $758.99$503.38 $500.33 $501.47 $572.02 $591.54 $447.80 $462.04 $765.05 $792.76$526.63 $523.43 $524.64 $598.45 $618.86 $468.48 $483.38 $800.38 $829.37$550.10 $546.77 $548.02 $625.12 $646.45 $489.36 $504.93 $836.06 $866.35$575.16 $571.67 $572.98 $653.60 $675.89 $511.65 $527.93 $874.14 $905.81$587.57 $584.01 $585.35 $667.70 $690.48 $522.70 $539.32 $893.01 $925.36$612.63 $608.92 $610.31 $696.18 $719.93 $544.99 $562.32 $931.09 $964.82$634.30 $630.45 $631.90 $720.80 $745.39 $564.26 $582.21 $964.03 $998.95$648.52 $644.59 $646.07 $736.96 $762.11 $576.91 $595.27 $985.64 $1,021.34$666.35 $662.31 $663.83 $757.23 $783.06 $592.78 $611.63 $1,012.75 $1,049.43$677.19 $673.08 $674.63 $769.54 $795.79 $602.42 $621.58 $1,029.21 $1,066.49
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7Moda Health Plan Inc
PPO Synergy
Exclusive
1000A
PPO Summit
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A
$197.10 $204.16 $213.40 $179.02 $145.38 $242.48 $239.35 $226.29 $219.91$310.39 $321.51 $336.06 $281.92 $228.95 $381.85 $376.92 $356.37 $346.31$310.39 $321.51 $336.06 $281.92 $228.95 $381.85 $376.92 $356.37 $346.31$310.39 $321.51 $336.06 $281.92 $228.95 $381.85 $376.92 $356.37 $346.31$310.39 $321.51 $336.06 $281.92 $228.95 $381.85 $376.92 $356.37 $346.31$311.63 $322.79 $337.40 $283.05 $229.87 $383.38 $378.43 $357.80 $347.69$317.84 $329.23 $344.12 $288.69 $234.45 $391.02 $385.97 $364.92 $354.62$325.29 $336.94 $352.19 $295.45 $239.94 $400.18 $395.02 $373.48 $362.93$337.39 $349.48 $365.30 $306.45 $248.87 $415.08 $409.72 $387.37 $376.44$347.33 $359.77 $376.05 $315.47 $256.20 $427.30 $421.78 $398.78 $387.52$352.29 $364.91 $381.43 $319.98 $259.86 $433.40 $427.81 $404.48 $393.06$359.74 $372.63 $389.49 $326.75 $265.35 $442.57 $436.85 $413.03 $401.37$367.19 $380.35 $397.56 $333.51 $270.85 $451.73 $445.90 $421.59 $409.68$371.85 $385.17 $402.60 $337.74 $274.28 $457.46 $451.55 $426.93 $414.88$376.81 $390.31 $407.97 $342.25 $277.95 $463.57 $457.58 $432.63 $420.42$379.30 $392.88 $410.66 $344.51 $279.78 $466.63 $460.60 $435.48 $423.19$381.78 $395.46 $413.35 $346.76 $281.61 $469.68 $463.62 $438.33 $425.96$384.26 $398.03 $416.04 $349.02 $283.44 $472.74 $466.63 $441.19 $428.73$386.75 $400.60 $418.73 $351.27 $285.27 $475.79 $469.65 $444.04 $431.50$391.71 $405.74 $424.11 $355.79 $288.94 $481.90 $475.68 $449.74 $437.04$396.68 $410.89 $429.48 $360.30 $292.60 $488.01 $481.71 $455.44 $442.58$404.13 $418.60 $437.55 $367.06 $298.09 $497.17 $490.75 $463.99 $450.89$411.27 $426.00 $445.28 $373.55 $303.36 $505.96 $499.42 $472.19 $458.86$421.20 $436.29 $456.03 $382.57 $310.69 $518.18 $511.48 $483.59 $469.94$433.62 $449.15 $469.47 $393.84 $319.84 $533.45 $526.56 $497.85 $483.79$448.20 $464.26 $485.27 $407.09 $330.60 $551.40 $544.28 $514.60 $500.07$465.59 $482.26 $504.09 $422.88 $343.43 $572.78 $565.38 $534.55 $519.46$485.14 $502.52 $525.26 $440.64 $357.85 $596.84 $589.13 $557.01 $541.28$507.49 $525.67 $549.46 $460.94 $374.33 $624.33 $616.27 $582.66 $566.21$529.53 $548.49 $573.32 $480.96 $390.59 $651.44 $643.03 $607.97 $590.80$554.36 $574.22 $600.20 $503.51 $408.91 $681.99 $673.18 $636.48 $618.51$578.88 $599.61 $626.75 $525.78 $426.99 $712.16 $702.96 $664.63 $645.86$605.88 $627.59 $655.99 $550.31 $446.91 $745.38 $735.75 $695.63 $675.99$633.20 $655.88 $685.56 $575.12 $467.06 $778.98 $768.92 $726.99 $706.47$662.68 $686.42 $717.48 $601.90 $488.81 $815.26 $804.73 $760.85 $739.37$692.17 $716.96 $749.41 $628.69 $510.56 $851.54 $840.54 $794.70 $772.27$724.14 $750.08 $784.02 $657.72 $534.14 $890.87 $879.36 $831.41 $807.94$756.42 $783.52 $818.97 $687.04 $557.95 $930.58 $918.56 $868.47 $843.95$790.87 $819.20 $856.28 $718.34 $583.37 $972.96 $960.40 $908.03 $882.39$807.95 $836.89 $874.76 $733.84 $595.96 $993.97 $981.13 $927.63 $901.44$842.40 $872.58 $912.06 $765.14 $621.37 $1,036.35 $1,022.97 $967.19 $939.88$872.20 $903.44 $944.32 $792.20 $643.35 $1,073.01 $1,059.15 $1,001.40 $973.13$891.75 $923.70 $965.50 $809.96 $657.77 $1,097.07 $1,082.90 $1,023.85 $994.94$916.27 $949.09 $992.04 $832.23 $675.86 $1,127.23 $1,112.68 $1,052.00 $1,022.30$931.17 $964.53 $1,008.17 $845.76 $686.85 $1,145.56 $1,130.77 $1,069.11 $1,038.92
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7
PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500
$219.49 $214.06 $192.38 $188.77 $192.19 $185.56 $180.60 $176.19 $172.17$345.66 $337.10 $302.96 $297.27 $302.66 $292.21 $284.42 $277.47 $271.14$345.66 $337.10 $302.96 $297.27 $302.66 $292.21 $284.42 $277.47 $271.14$345.66 $337.10 $302.96 $297.27 $302.66 $292.21 $284.42 $277.47 $271.14$345.66 $337.10 $302.96 $297.27 $302.66 $292.21 $284.42 $277.47 $271.14$347.04 $338.44 $304.17 $298.46 $303.87 $293.38 $285.55 $278.58 $272.22$353.96 $345.19 $310.23 $304.40 $309.93 $299.23 $291.24 $284.13 $277.65$362.25 $353.28 $317.50 $311.54 $317.19 $306.24 $298.07 $290.79 $284.15$375.73 $366.42 $329.32 $323.13 $328.99 $317.64 $309.16 $301.61 $294.73$386.79 $377.21 $339.01 $332.64 $338.68 $326.99 $318.26 $310.49 $303.41$392.32 $382.60 $343.86 $337.40 $343.52 $331.66 $322.81 $314.93 $307.74$400.62 $390.69 $351.13 $344.53 $350.79 $338.68 $329.64 $321.59 $314.25$408.92 $398.78 $358.40 $351.67 $358.05 $345.69 $336.46 $328.25 $320.76$414.10 $403.84 $362.94 $356.13 $362.59 $350.07 $340.73 $332.41 $324.83$419.63 $409.23 $367.79 $360.88 $367.43 $354.75 $345.28 $336.85 $329.16$422.40 $411.93 $370.21 $363.26 $369.85 $357.08 $347.56 $339.07 $331.33$425.16 $414.63 $372.64 $365.64 $372.28 $359.42 $349.83 $341.29 $333.50$427.93 $417.32 $375.06 $368.02 $374.70 $361.76 $352.11 $343.51 $335.67$430.69 $420.02 $377.49 $370.40 $377.12 $364.10 $354.38 $345.73 $337.84$436.22 $425.42 $382.33 $375.15 $381.96 $368.77 $358.93 $350.17 $342.18$441.75 $430.81 $387.18 $379.91 $386.80 $373.45 $363.48 $354.61 $346.52$450.05 $438.90 $394.45 $387.04 $394.07 $380.46 $370.31 $361.26 $353.02$458.00 $446.65 $401.42 $393.88 $401.03 $387.18 $376.85 $367.65 $359.26$469.06 $457.44 $411.11 $403.39 $410.71 $396.53 $385.95 $376.53 $367.94$482.89 $470.92 $423.23 $415.28 $422.82 $408.22 $397.33 $387.62 $378.78$499.13 $486.77 $437.47 $429.26 $437.05 $421.96 $410.70 $400.67 $391.53$518.49 $505.64 $454.44 $445.90 $453.99 $438.32 $426.62 $416.20 $406.71$540.27 $526.88 $473.52 $464.63 $473.06 $456.73 $444.54 $433.68 $423.79$565.15 $551.15 $495.34 $486.03 $494.85 $477.77 $465.02 $453.66 $443.31$589.70 $575.09 $516.85 $507.14 $516.34 $498.52 $485.21 $473.36 $462.57$617.35 $602.05 $541.08 $530.92 $540.56 $521.89 $507.97 $495.56 $484.26$644.66 $628.68 $565.02 $554.41 $564.47 $544.98 $530.43 $517.48 $505.68$674.73 $658.01 $591.37 $580.27 $590.80 $570.40 $555.18 $541.62 $529.27$705.15 $687.68 $618.03 $606.43 $617.43 $596.12 $580.21 $566.04 $553.13$737.98 $719.70 $646.81 $634.67 $646.19 $623.88 $607.23 $592.40 $578.88$770.82 $751.72 $675.60 $662.91 $674.94 $651.64 $634.25 $618.76 $604.64$806.42 $786.45 $706.80 $693.53 $706.11 $681.73 $663.54 $647.33 $632.57$842.37 $821.50 $738.31 $724.44 $737.59 $712.12 $693.12 $676.19 $660.77$880.74 $858.92 $771.94 $757.44 $771.19 $744.56 $724.69 $706.99 $690.87$899.75 $877.46 $788.60 $773.79 $787.83 $760.63 $740.33 $722.25 $705.78$938.12 $914.88 $822.23 $806.79 $821.43 $793.07 $771.90 $753.05 $735.87$971.30 $947.24 $851.31 $835.33 $850.48 $821.12 $799.21 $779.69 $761.90$993.08 $968.48 $870.40 $854.05 $869.55 $839.53 $817.13 $797.17 $778.99
$1,020.39 $995.11 $894.33 $877.54 $893.46 $862.61 $839.59 $819.09 $800.41$1,036.98 $1,011.29 $908.87 $891.81 $907.99 $876.64 $853.25 $832.41 $813.42
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
$162.79 $184.26 $178.92 $156.02 $144.40 $195.52 $186.84 $179.83 $158.30$256.36 $290.17 $281.77 $245.70 $227.40 $307.91 $294.24 $283.19 $249.29$256.36 $290.17 $281.77 $245.70 $227.40 $307.91 $294.24 $283.19 $249.29$256.36 $290.17 $281.77 $245.70 $227.40 $307.91 $294.24 $283.19 $249.29$256.36 $290.17 $281.77 $245.70 $227.40 $307.91 $294.24 $283.19 $249.29$257.39 $291.33 $282.89 $246.68 $228.31 $309.14 $295.41 $284.32 $250.29$262.51 $297.14 $288.53 $251.60 $232.85 $315.30 $301.30 $289.99 $255.27$268.66 $304.10 $295.29 $257.49 $238.31 $322.69 $308.36 $296.78 $261.26$278.66 $315.42 $306.28 $267.08 $247.18 $334.70 $319.84 $307.83 $270.98$286.87 $324.70 $315.30 $274.94 $254.46 $344.55 $329.25 $316.89 $278.96$290.97 $329.35 $319.81 $278.87 $258.09 $349.48 $333.96 $321.42 $282.95$297.12 $336.31 $326.57 $284.77 $263.55 $356.87 $341.02 $328.22 $288.93$303.27 $343.28 $333.33 $290.66 $269.01 $364.26 $348.08 $335.01 $294.91$307.12 $347.63 $337.56 $294.35 $272.42 $368.87 $352.50 $339.26 $298.65$311.22 $352.27 $342.07 $298.28 $276.06 $373.80 $357.20 $343.79 $302.64$313.27 $354.59 $344.32 $300.24 $277.88 $376.26 $359.56 $346.06 $304.63$315.32 $356.91 $346.57 $302.21 $279.70 $378.73 $361.91 $348.32 $306.63$317.37 $359.24 $348.83 $304.18 $281.52 $381.19 $364.27 $350.59 $308.62$319.42 $361.56 $351.08 $306.14 $283.34 $383.65 $366.62 $352.86 $310.62$323.53 $366.20 $355.59 $310.07 $286.97 $388.58 $371.33 $357.39 $314.61$327.63 $370.84 $360.10 $314.00 $290.61 $393.51 $376.04 $361.92 $318.59$333.78 $377.81 $366.86 $319.90 $296.07 $400.90 $383.10 $368.71 $324.58$339.68 $384.48 $373.34 $325.55 $301.30 $407.98 $389.86 $375.23 $330.31$347.88 $393.77 $382.36 $333.41 $308.58 $417.83 $399.28 $384.29 $338.29$358.13 $405.37 $393.63 $343.24 $317.67 $430.15 $411.05 $395.62 $348.26$370.18 $419.01 $406.87 $354.79 $328.36 $444.62 $424.88 $408.93 $359.98$384.54 $435.26 $422.65 $368.55 $341.09 $461.86 $441.36 $424.79 $373.94$400.69 $453.54 $440.40 $384.03 $355.42 $481.26 $459.89 $442.63 $389.64$419.15 $474.43 $460.69 $401.72 $371.79 $503.43 $481.08 $463.02 $407.59$437.35 $495.04 $480.70 $419.16 $387.94 $525.29 $501.97 $483.12 $425.29$457.86 $518.25 $503.24 $438.82 $406.13 $549.92 $525.51 $505.78 $445.23$478.11 $541.17 $525.50 $458.23 $424.09 $574.25 $548.75 $528.15 $464.93$500.41 $566.42 $550.01 $479.61 $443.88 $601.04 $574.35 $552.79 $486.62$522.97 $591.96 $574.81 $501.23 $463.89 $628.13 $600.24 $577.71 $508.55$547.33 $619.52 $601.57 $524.57 $485.49 $657.39 $628.20 $604.61 $532.24$571.68 $647.09 $628.34 $547.91 $507.09 $686.64 $656.15 $631.51 $555.92$598.09 $676.98 $657.36 $573.22 $530.51 $718.35 $686.46 $660.68 $581.60$624.75 $707.15 $686.67 $598.77 $554.16 $750.37 $717.06 $690.14 $607.52$653.20 $739.36 $717.94 $626.04 $579.40 $784.55 $749.72 $721.57 $635.19$667.30 $755.32 $733.44 $639.56 $591.91 $801.49 $765.90 $737.14 $648.91$695.76 $787.53 $764.72 $666.83 $617.15 $835.66 $798.56 $768.58 $676.58$720.37 $815.39 $791.77 $690.42 $638.98 $865.22 $826.81 $795.77 $700.51$736.52 $833.67 $809.52 $705.89 $653.31 $884.62 $845.34 $813.61 $716.21$756.77 $856.59 $831.78 $725.30 $671.27 $908.95 $868.59 $835.98 $735.91$769.08 $870.52 $845.30 $737.10 $682.19 $923.73 $882.71 $849.57 $747.87
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
$144.73 $143.85 $144.18 $164.47 $128.75 $219.97 $199.01 $215.47 $180.76$227.92 $226.54 $227.06 $259.00 $202.75 $346.40 $313.40 $339.32 $284.66$227.92 $226.54 $227.06 $259.00 $202.75 $346.40 $313.40 $339.32 $284.66$227.92 $226.54 $227.06 $259.00 $202.75 $346.40 $313.40 $339.32 $284.66$227.92 $226.54 $227.06 $259.00 $202.75 $346.40 $313.40 $339.32 $284.66$228.83 $227.45 $227.97 $260.04 $203.57 $347.79 $314.66 $340.68 $285.80$233.39 $231.98 $232.51 $265.22 $207.62 $354.72 $320.93 $347.46 $291.49$238.86 $237.41 $237.96 $271.44 $212.49 $363.03 $328.45 $355.61 $298.32$247.75 $246.25 $246.81 $281.54 $220.39 $376.54 $340.67 $368.84 $309.42$255.04 $253.50 $254.08 $289.83 $226.88 $387.62 $350.70 $379.70 $318.53$258.69 $257.12 $257.71 $293.97 $230.13 $393.17 $355.71 $385.13 $323.09$264.16 $262.56 $263.16 $300.19 $234.99 $401.48 $363.24 $393.27 $329.92$269.63 $268.00 $268.61 $306.40 $239.86 $409.79 $370.76 $401.42 $336.75$273.05 $271.39 $272.02 $310.29 $242.90 $414.99 $375.46 $406.51 $341.02$276.70 $275.02 $275.65 $314.43 $246.14 $420.53 $380.47 $411.94 $345.58$278.52 $276.83 $277.47 $316.50 $247.77 $423.30 $382.98 $414.65 $347.85$280.34 $278.64 $279.28 $318.57 $249.39 $426.07 $385.49 $417.36 $350.13$282.17 $280.46 $281.10 $320.65 $251.01 $428.85 $387.99 $420.08 $352.41$283.99 $282.27 $282.92 $322.72 $252.63 $431.62 $390.50 $422.79 $354.68$287.64 $285.89 $286.55 $326.86 $255.88 $437.16 $395.52 $428.22 $359.24$291.28 $289.52 $290.18 $331.01 $259.12 $442.70 $400.53 $433.65 $363.79$296.75 $294.95 $295.63 $337.22 $263.99 $451.01 $408.05 $441.80 $370.63$301.99 $300.16 $300.85 $343.18 $268.65 $458.98 $415.26 $449.60 $377.17$309.29 $307.41 $308.12 $351.47 $275.14 $470.07 $425.29 $460.46 $386.28$318.40 $316.48 $317.20 $361.83 $283.25 $483.92 $437.83 $474.03 $397.67$329.12 $327.12 $327.87 $374.00 $292.78 $500.20 $452.56 $489.98 $411.05$341.88 $339.81 $340.59 $388.51 $304.13 $519.60 $470.11 $508.98 $426.99$356.24 $354.08 $354.89 $404.82 $316.91 $541.43 $489.85 $530.36 $444.92$372.65 $370.39 $371.24 $423.47 $331.50 $566.37 $512.42 $554.79 $465.42$388.83 $386.48 $387.36 $441.86 $345.90 $590.96 $534.67 $578.88 $485.63$407.07 $404.60 $405.53 $462.58 $362.12 $618.67 $559.74 $606.03 $508.40$425.07 $422.50 $423.47 $483.04 $378.14 $646.04 $584.50 $632.83 $530.89$444.90 $442.20 $443.22 $505.58 $395.78 $676.18 $611.76 $662.35 $555.65$464.96 $462.14 $463.20 $528.37 $413.62 $706.66 $639.34 $692.21 $580.70$486.61 $483.66 $484.77 $552.97 $432.88 $739.57 $669.12 $724.45 $607.75$508.26 $505.18 $506.34 $577.58 $452.14 $772.48 $698.89 $756.69 $634.79$531.74 $528.52 $529.73 $604.26 $473.03 $808.15 $731.17 $791.64 $664.11$555.44 $552.08 $553.34 $631.19 $494.11 $844.18 $763.77 $826.92 $693.71$580.74 $577.22 $578.55 $659.94 $516.62 $882.63 $798.55 $864.59 $725.31$593.28 $589.68 $591.03 $674.19 $527.77 $901.68 $815.79 $883.25 $740.97$618.58 $614.83 $616.24 $702.94 $550.28 $940.13 $850.58 $920.92 $772.56$640.46 $636.58 $638.04 $727.80 $569.74 $973.39 $880.66 $953.49 $799.89$654.82 $650.85 $652.34 $744.12 $582.51 $995.21 $900.41 $974.87 $817.82$672.82 $668.74 $670.28 $764.58 $598.53 $1,022.58 $925.17 $1,001.68 $840.31$683.76 $679.62 $681.18 $777.01 $608.26 $1,039.20 $940.21 $1,017.96 $853.98
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health
Oregon
Standard
Bronze
$146.79$231.17$231.17$231.17$231.17$232.10$236.72$242.27$251.29$258.68$262.38$267.93$273.48$276.95$280.64$282.49$284.34$286.19$288.04$291.74$295.44$300.99$306.30$313.70$322.95$333.81$346.76$361.32$377.97$394.38$412.88$431.14$451.25$471.59$493.55$515.52$539.33$563.37$589.03$601.74$627.40$649.60$664.16$682.42$693.52
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Area 1 Area 1Moda Health Plan Inc
Plan
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500HIOS Plan Id
0-20 $236.09 $233.04 $220.34 $214.11 $213.71 $208.42 $187.31 $183.80 $187.1321 $371.80 $367.00 $346.99 $337.19 $336.56 $328.22 $294.98 $289.44 $294.6922 $371.80 $367.00 $346.99 $337.19 $336.56 $328.22 $294.98 $289.44 $294.6923 $371.80 $367.00 $346.99 $337.19 $336.56 $328.22 $294.98 $289.44 $294.6924 $371.80 $367.00 $346.99 $337.19 $336.56 $328.22 $294.98 $289.44 $294.6925 $373.29 $368.47 $348.37 $338.54 $337.90 $329.53 $296.16 $290.60 $295.8726 $380.72 $375.81 $355.31 $345.28 $344.64 $336.10 $302.06 $296.39 $301.7727 $389.65 $384.61 $363.64 $353.37 $352.71 $343.97 $309.14 $303.33 $308.8428 $404.15 $398.93 $377.17 $366.52 $365.84 $356.77 $320.64 $314.62 $320.3329 $416.04 $410.67 $388.28 $377.31 $376.61 $367.28 $330.08 $323.88 $329.7630 $421.99 $416.54 $393.83 $382.71 $381.99 $372.53 $334.80 $328.52 $334.4831 $430.92 $425.35 $402.16 $390.80 $390.07 $380.41 $341.88 $335.46 $341.5532 $439.84 $434.16 $410.48 $398.89 $398.15 $388.28 $348.96 $342.41 $348.6233 $445.42 $439.66 $415.69 $403.95 $403.20 $393.21 $353.39 $346.75 $353.0434 $451.36 $445.54 $421.24 $409.35 $408.58 $398.46 $358.11 $351.38 $357.7635 $454.34 $448.47 $424.02 $412.04 $411.27 $401.08 $360.47 $353.70 $360.1236 $457.31 $451.41 $426.79 $414.74 $413.97 $403.71 $362.83 $356.01 $362.4737 $460.29 $454.34 $429.57 $417.44 $416.66 $406.34 $365.19 $358.33 $364.8338 $463.26 $457.28 $432.34 $420.14 $419.35 $408.96 $367.55 $360.64 $367.1939 $469.21 $463.15 $437.90 $425.53 $424.74 $414.21 $372.27 $365.27 $371.9040 $475.16 $469.02 $443.45 $430.93 $430.12 $419.46 $376.98 $369.91 $376.6241 $484.08 $477.83 $451.78 $439.02 $438.20 $427.34 $384.06 $376.85 $383.6942 $492.63 $486.27 $459.76 $446.78 $445.94 $434.89 $390.85 $383.51 $390.4743 $504.53 $498.02 $470.86 $457.57 $456.71 $445.39 $400.29 $392.77 $399.9044 $519.40 $512.70 $484.74 $471.05 $470.17 $458.52 $412.09 $404.35 $411.6945 $536.88 $529.94 $501.05 $486.90 $485.99 $473.95 $425.95 $417.95 $425.5446 $557.70 $550.50 $520.48 $505.78 $504.84 $492.33 $442.47 $434.16 $442.0447 $581.12 $573.62 $542.34 $527.03 $526.04 $513.01 $461.05 $452.40 $460.6148 $607.89 $600.04 $567.32 $551.30 $550.27 $536.64 $482.29 $473.24 $481.8249 $634.29 $626.10 $591.96 $575.24 $574.17 $559.94 $503.24 $493.79 $502.7550 $664.03 $655.46 $619.72 $602.22 $601.09 $586.20 $526.83 $516.94 $526.3251 $693.41 $684.45 $647.13 $628.86 $627.68 $612.13 $550.14 $539.81 $549.6052 $725.75 $716.38 $677.32 $658.19 $656.96 $640.68 $575.80 $564.99 $575.2453 $758.47 $748.68 $707.85 $687.87 $686.58 $669.57 $601.76 $590.46 $601.1754 $793.79 $783.54 $740.81 $719.90 $718.55 $700.75 $629.78 $617.96 $629.1755 $829.11 $818.41 $773.78 $751.93 $750.52 $731.93 $657.81 $645.45 $657.1756 $867.41 $856.21 $809.52 $786.66 $785.19 $765.74 $688.19 $675.27 $687.5257 $906.07 $894.37 $845.60 $821.73 $820.19 $799.87 $718.87 $705.37 $718.1758 $947.34 $935.11 $884.12 $859.16 $857.55 $836.30 $751.61 $737.50 $750.8859 $967.79 $955.30 $903.20 $877.70 $876.06 $854.36 $767.83 $753.42 $767.0960 $1,009.06 $996.03 $941.72 $915.13 $913.42 $890.79 $800.58 $785.54 $799.8061 $1,044.76 $1,031.26 $975.03 $947.50 $945.73 $922.30 $828.89 $813.33 $828.0962 $1,068.18 $1,054.38 $996.89 $968.74 $966.93 $942.97 $847.48 $831.56 $846.6563 $1,097.55 $1,083.38 $1,024.30 $995.38 $993.52 $968.90 $870.78 $854.43 $869.94
64+ $1,115.39 $1,100.98 $1,040.95 $1,011.56 $1,009.66 $984.65 $884.93 $868.31 $884.07
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health Plan Inc
Value 2000
Value 2000
(Rose City) Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
$180.67 $166.88 $175.85 $171.55 $167.64 $158.50 $179.41 $174.21 $151.91$284.52 $262.80 $276.93 $270.16 $264.00 $249.61 $282.53 $274.35 $239.23$284.52 $262.80 $276.93 $270.16 $264.00 $249.61 $282.53 $274.35 $239.23$284.52 $262.80 $276.93 $270.16 $264.00 $249.61 $282.53 $274.35 $239.23$284.52 $262.80 $276.93 $270.16 $264.00 $249.61 $282.53 $274.35 $239.23$285.66 $263.85 $278.03 $271.24 $265.06 $250.61 $283.66 $275.45 $240.19$291.35 $269.11 $283.57 $276.65 $270.34 $255.60 $289.31 $280.93 $244.97$298.18 $275.41 $290.22 $283.13 $276.67 $261.59 $296.09 $287.52 $250.71$309.27 $285.66 $301.02 $293.67 $286.97 $271.33 $307.11 $298.22 $260.04$318.38 $294.07 $309.88 $302.31 $295.42 $279.31 $316.15 $307.00 $267.70$322.93 $298.28 $314.31 $306.63 $299.64 $283.31 $320.68 $311.39 $271.53$329.76 $304.58 $320.96 $313.12 $305.98 $289.30 $327.46 $317.97 $277.27$336.59 $310.89 $327.60 $319.60 $312.31 $295.29 $334.24 $324.55 $283.01$340.85 $314.83 $331.76 $323.65 $316.27 $299.03 $338.47 $328.67 $286.60$345.41 $319.04 $336.19 $327.98 $320.50 $303.03 $343.00 $333.06 $290.42$347.68 $321.14 $338.40 $330.14 $322.61 $305.02 $345.26 $335.25 $292.34$349.96 $323.24 $340.62 $332.30 $324.72 $307.02 $347.52 $337.45 $294.25$352.23 $325.34 $342.83 $334.46 $326.83 $309.02 $349.78 $339.64 $296.17$354.51 $327.45 $345.05 $336.62 $328.94 $311.01 $352.04 $341.84 $298.08$359.06 $331.65 $349.48 $340.95 $333.17 $315.01 $356.56 $346.23 $301.91$363.61 $335.86 $353.91 $345.27 $337.39 $319.00 $361.08 $350.62 $305.74$370.44 $342.16 $360.56 $351.75 $343.73 $324.99 $367.86 $357.20 $311.48$376.99 $348.21 $366.93 $357.97 $349.80 $330.73 $374.36 $363.51 $316.98$386.09 $356.62 $375.79 $366.61 $358.25 $338.72 $383.40 $372.29 $324.63$397.47 $367.13 $386.87 $377.42 $368.81 $348.70 $394.70 $383.26 $334.20$410.85 $379.48 $399.88 $390.11 $381.22 $360.44 $407.98 $396.16 $345.45$426.78 $394.20 $415.39 $405.24 $396.00 $374.41 $423.80 $411.52 $358.84$444.70 $410.75 $432.84 $422.26 $412.63 $390.14 $441.60 $428.81 $373.92$465.19 $429.68 $452.77 $441.72 $431.64 $408.11 $461.94 $448.56 $391.14$485.39 $448.33 $472.44 $460.90 $450.38 $425.83 $482.00 $468.04 $408.13$508.15 $469.36 $494.59 $482.51 $471.50 $445.80 $504.60 $489.99 $427.26$530.63 $490.12 $516.47 $503.85 $492.36 $465.52 $526.92 $511.66 $446.16$555.38 $512.98 $540.56 $527.36 $515.33 $487.24 $551.51 $535.53 $466.98$580.42 $536.11 $564.93 $551.13 $538.56 $509.20 $576.37 $559.67 $488.03$607.45 $561.08 $591.24 $576.80 $563.64 $532.92 $603.21 $585.73 $510.76$634.48 $586.04 $617.55 $602.46 $588.72 $556.63 $630.05 $611.80 $533.48$663.78 $613.11 $646.07 $630.29 $615.91 $582.34 $659.15 $640.05 $558.12$693.37 $640.44 $674.87 $658.39 $643.37 $608.30 $688.53 $668.59 $583.00$724.95 $669.61 $705.61 $688.37 $672.67 $636.00 $719.89 $699.04 $609.56$740.60 $684.07 $720.84 $703.23 $687.19 $649.73 $735.43 $714.13 $622.71$772.18 $713.24 $751.58 $733.22 $716.50 $677.44 $766.80 $744.58 $649.27$799.50 $738.46 $778.16 $759.16 $741.84 $701.40 $793.92 $770.92 $672.24$817.42 $755.02 $795.61 $776.18 $758.47 $717.13 $811.72 $788.20 $687.31$839.90 $775.78 $817.49 $797.52 $779.33 $736.85 $834.04 $809.88 $706.21$853.55 $788.39 $830.77 $810.48 $791.99 $748.82 $847.59 $823.03 $717.68
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 1
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Rose City
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
$140.59 $190.37 $181.92 $175.09 $154.13 $140.92 $129.47 $140.06 $140.39$221.41 $299.80 $286.49 $275.73 $242.73 $221.92 $203.89 $220.57 $221.08$221.41 $299.80 $286.49 $275.73 $242.73 $221.92 $203.89 $220.57 $221.08$221.41 $299.80 $286.49 $275.73 $242.73 $221.92 $203.89 $220.57 $221.08$221.41 $299.80 $286.49 $275.73 $242.73 $221.92 $203.89 $220.57 $221.08$222.29 $301.00 $287.64 $276.84 $243.70 $222.81 $204.70 $221.46 $221.96$226.72 $307.00 $293.37 $282.35 $248.55 $227.24 $208.78 $225.87 $226.39$232.04 $314.19 $300.24 $288.97 $254.38 $232.57 $213.67 $231.16 $231.69$240.67 $325.88 $311.41 $299.72 $263.84 $241.23 $221.63 $239.76 $240.31$247.76 $335.48 $320.58 $308.55 $271.61 $248.33 $228.15 $246.82 $247.39$251.30 $340.27 $325.17 $312.96 $275.50 $251.88 $231.41 $250.35 $250.93$256.61 $347.47 $332.04 $319.58 $281.32 $257.20 $236.31 $255.65 $256.23$261.93 $354.66 $338.92 $326.19 $287.15 $262.53 $241.20 $260.94 $261.54$265.25 $359.16 $343.21 $330.33 $290.79 $265.86 $244.26 $264.25 $264.85$268.79 $363.96 $347.80 $334.74 $294.67 $269.41 $247.52 $267.78 $268.39$270.56 $366.36 $350.09 $336.95 $296.61 $271.18 $249.15 $269.54 $270.16$272.33 $368.76 $352.38 $339.15 $298.55 $272.96 $250.78 $271.31 $271.93$274.10 $371.15 $354.67 $341.36 $300.50 $274.74 $252.41 $273.07 $273.70$275.87 $373.55 $356.97 $343.56 $302.44 $276.51 $254.04 $274.84 $275.47$279.42 $378.35 $361.55 $347.98 $306.32 $280.06 $257.31 $278.36 $279.00$282.96 $383.15 $366.13 $352.39 $310.21 $283.61 $260.57 $281.89 $282.54$288.27 $390.34 $373.01 $359.00 $316.03 $288.94 $265.46 $287.19 $287.85$293.37 $397.24 $379.60 $365.35 $321.61 $294.04 $270.15 $292.26 $292.93$300.45 $406.83 $388.77 $374.17 $329.38 $301.14 $276.68 $299.32 $300.01$309.31 $418.82 $400.23 $385.20 $339.09 $310.02 $284.83 $308.14 $308.85$319.71 $432.91 $413.69 $398.16 $350.50 $320.45 $294.41 $318.51 $319.24$332.11 $449.70 $429.73 $413.60 $364.09 $332.88 $305.83 $330.86 $331.62$346.06 $468.59 $447.78 $430.97 $379.38 $346.86 $318.68 $344.76 $345.55$362.00 $490.17 $468.41 $450.82 $396.86 $362.84 $333.36 $360.64 $361.47$377.72 $511.46 $488.75 $470.40 $414.09 $378.59 $347.83 $376.30 $377.16$395.43 $535.44 $511.67 $492.46 $433.51 $396.35 $364.14 $393.95 $394.85$412.93 $559.13 $534.30 $514.24 $452.69 $413.88 $380.25 $411.37 $412.31$432.19 $585.21 $559.23 $538.23 $473.80 $433.19 $397.99 $430.56 $431.55$451.67 $611.59 $584.44 $562.50 $495.16 $452.71 $415.93 $449.97 $451.00$472.71 $640.07 $611.66 $588.69 $518.22 $473.80 $435.30 $470.93 $472.01$493.74 $668.56 $638.87 $614.89 $541.28 $494.88 $454.67 $491.88 $493.01$516.55 $699.44 $668.38 $643.29 $566.28 $517.74 $475.67 $514.60 $515.78$539.57 $730.61 $698.18 $671.96 $591.53 $540.82 $496.88 $537.54 $538.77$564.15 $763.89 $729.98 $702.57 $618.47 $565.45 $519.51 $562.02 $563.31$576.33 $780.38 $745.73 $717.73 $631.82 $577.65 $530.72 $574.15 $575.47$600.90 $813.66 $777.53 $748.34 $658.76 $602.29 $553.35 $598.64 $600.01$622.16 $842.44 $805.04 $774.81 $682.06 $623.59 $572.93 $619.81 $621.23$636.11 $861.33 $823.08 $792.18 $697.36 $637.57 $585.77 $633.71 $635.16$653.60 $885.01 $845.72 $813.97 $716.53 $655.10 $601.88 $651.13 $652.63$664.21 $899.39 $859.46 $827.19 $728.17 $665.75 $611.65 $661.71 $663.23
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 1 Area 2Moda Health Plan Inc
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500
$160.14 $125.36 $214.17 $193.77 $209.80 $176.00 $142.93 $227.83 $224.89$252.18 $197.42 $337.28 $305.15 $330.39 $277.16 $225.09 $358.79 $354.15$252.18 $197.42 $337.28 $305.15 $330.39 $277.16 $225.09 $358.79 $354.15$252.18 $197.42 $337.28 $305.15 $330.39 $277.16 $225.09 $358.79 $354.15$252.18 $197.42 $337.28 $305.15 $330.39 $277.16 $225.09 $358.79 $354.15$253.19 $198.21 $338.63 $306.37 $331.71 $278.27 $225.99 $360.22 $355.57$258.24 $202.15 $345.37 $312.47 $338.32 $283.82 $230.49 $367.40 $362.65$264.29 $206.89 $353.47 $319.80 $346.24 $290.47 $235.89 $376.01 $371.15$274.12 $214.59 $366.62 $331.70 $359.13 $301.28 $244.67 $390.00 $384.96$282.19 $220.91 $377.42 $341.46 $369.70 $310.15 $251.87 $401.48 $396.30$286.23 $224.07 $382.81 $346.35 $374.99 $314.58 $255.47 $407.22 $401.96$292.28 $228.80 $390.91 $353.67 $382.92 $321.23 $260.87 $415.83 $410.46$298.33 $233.54 $399.00 $360.99 $390.85 $327.88 $266.28 $424.44 $418.96$302.12 $236.50 $404.06 $365.57 $395.80 $332.04 $269.65 $429.83 $424.28$306.15 $239.66 $409.46 $370.45 $401.09 $336.48 $273.25 $435.57 $429.94$308.17 $241.24 $412.16 $372.89 $403.73 $338.69 $275.05 $438.44 $432.77$310.19 $242.82 $414.85 $375.34 $406.37 $340.91 $276.86 $441.31 $435.61$312.20 $244.40 $417.55 $377.78 $409.02 $343.13 $278.66 $444.18 $438.44$314.22 $245.98 $420.25 $380.22 $411.66 $345.35 $280.46 $447.05 $441.27$318.26 $249.14 $425.65 $385.10 $416.95 $349.78 $284.06 $452.79 $446.94$322.29 $252.30 $431.04 $389.98 $422.23 $354.21 $287.66 $458.53 $452.61$328.34 $257.04 $439.14 $397.31 $430.16 $360.87 $293.06 $467.14 $461.11$334.14 $261.58 $446.90 $404.33 $437.76 $367.24 $298.24 $475.39 $469.25$342.21 $267.89 $457.69 $414.09 $448.33 $376.11 $305.44 $486.87 $480.59$352.30 $275.79 $471.18 $426.30 $461.55 $387.20 $314.44 $501.22 $494.75$364.15 $285.07 $487.03 $440.64 $477.08 $400.22 $325.02 $518.09 $511.40$378.28 $296.12 $505.92 $457.73 $495.58 $415.74 $337.63 $538.18 $531.23$394.16 $308.56 $527.17 $476.95 $516.39 $433.21 $351.81 $560.78 $553.54$412.32 $322.77 $551.45 $498.92 $540.18 $453.16 $368.02 $586.62 $579.04$430.23 $336.79 $575.40 $520.59 $563.64 $472.84 $384.00 $612.09 $604.18$450.40 $352.58 $602.38 $545.00 $590.07 $495.01 $402.00 $640.79 $632.52$470.32 $368.18 $629.03 $569.11 $616.17 $516.91 $419.79 $669.14 $660.50$492.26 $385.36 $658.37 $595.66 $644.91 $541.02 $439.37 $700.35 $691.31$514.45 $402.73 $688.05 $622.51 $673.99 $565.41 $459.18 $731.92 $722.47$538.41 $421.48 $720.09 $651.50 $705.37 $591.74 $480.56 $766.01 $756.12$562.37 $440.24 $752.13 $680.49 $736.76 $618.07 $501.94 $800.09 $789.76$588.34 $460.57 $786.87 $711.92 $770.79 $646.62 $525.13 $837.05 $826.24$614.57 $481.10 $821.95 $743.65 $805.15 $675.45 $548.53 $874.36 $863.07$642.56 $503.02 $859.39 $777.53 $841.82 $706.21 $573.52 $914.19 $902.38$656.43 $513.87 $877.94 $794.31 $859.99 $721.46 $585.90 $933.92 $921.86$684.43 $535.79 $915.38 $828.18 $896.67 $752.22 $610.88 $973.75 $961.17$708.64 $554.74 $947.76 $857.48 $928.38 $778.83 $632.49 $1,008.19 $995.17$724.52 $567.18 $969.01 $876.70 $949.20 $796.29 $646.67 $1,030.79 $1,017.48$744.45 $582.77 $995.65 $900.81 $975.30 $818.19 $664.45 $1,059.14 $1,045.46$756.54 $592.24 $1,011.83 $915.44 $991.15 $831.48 $675.25 $1,076.35 $1,062.45
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500
$212.62 $206.62 $206.23 $201.12 $180.76 $177.36 $180.58 $174.35 $169.69$334.84 $325.39 $324.78 $316.73 $284.66 $279.31 $284.38 $274.56 $267.23$334.84 $325.39 $324.78 $316.73 $284.66 $279.31 $284.38 $274.56 $267.23$334.84 $325.39 $324.78 $316.73 $284.66 $279.31 $284.38 $274.56 $267.23$334.84 $325.39 $324.78 $316.73 $284.66 $279.31 $284.38 $274.56 $267.23$336.18 $326.69 $326.08 $318.00 $285.79 $280.43 $285.52 $275.66 $268.30$342.88 $333.20 $332.57 $324.33 $291.49 $286.01 $291.20 $281.15 $273.65$350.91 $341.01 $340.37 $331.94 $298.32 $292.72 $298.03 $287.74 $280.06$363.97 $353.70 $353.03 $344.29 $309.42 $303.61 $309.12 $298.45 $290.48$374.69 $364.11 $363.43 $354.42 $318.53 $312.55 $318.22 $307.23 $299.03$380.04 $369.31 $368.62 $359.49 $323.08 $317.02 $322.77 $311.63 $303.31$388.08 $377.12 $376.42 $367.09 $329.92 $323.72 $329.60 $318.22 $309.72$396.12 $384.93 $384.21 $374.69 $336.75 $330.42 $336.42 $324.81 $316.14$401.14 $389.81 $389.08 $379.44 $341.02 $334.61 $340.69 $328.92 $320.15$406.50 $395.02 $394.28 $384.51 $345.57 $339.08 $345.24 $333.32 $324.42$409.18 $397.62 $396.88 $387.05 $347.85 $341.32 $347.51 $335.51 $326.56$411.85 $400.23 $399.48 $389.58 $350.13 $343.55 $349.79 $337.71 $328.70$414.53 $402.83 $402.08 $392.11 $352.40 $345.79 $352.06 $339.91 $330.84$417.21 $405.43 $404.67 $394.65 $354.68 $348.02 $354.34 $342.10 $332.97$422.57 $410.64 $409.87 $399.72 $359.24 $352.49 $358.89 $346.50 $337.25$427.93 $415.84 $415.07 $404.78 $363.79 $356.96 $363.44 $350.89 $341.52$435.96 $423.65 $422.86 $412.38 $370.62 $363.66 $370.26 $357.48 $347.94$443.66 $431.14 $430.33 $419.67 $377.17 $370.09 $376.80 $363.79 $354.08$454.38 $441.55 $440.72 $429.81 $386.28 $379.02 $385.90 $372.58 $362.64$467.77 $454.57 $453.72 $442.47 $397.66 $390.20 $397.28 $383.56 $373.33$483.51 $469.86 $468.98 $457.36 $411.04 $403.32 $410.64 $396.47 $385.89$502.26 $488.08 $487.17 $475.10 $426.98 $418.97 $426.57 $411.84 $400.85$523.36 $508.58 $507.63 $495.05 $444.92 $436.56 $444.48 $429.14 $417.69$547.47 $532.01 $531.01 $517.86 $465.41 $456.67 $464.96 $448.91 $436.93$571.24 $555.11 $554.07 $540.34 $485.62 $476.50 $485.15 $468.40 $455.90$598.03 $581.14 $580.05 $565.68 $508.40 $498.85 $507.90 $490.37 $477.28$624.48 $606.85 $605.71 $590.71 $530.88 $520.91 $530.37 $512.06 $498.39$653.61 $635.16 $633.97 $618.26 $555.65 $545.21 $555.11 $535.94 $521.64$683.08 $663.79 $662.55 $646.13 $580.70 $569.79 $580.13 $560.10 $545.16$714.89 $694.70 $693.40 $676.22 $607.74 $596.33 $607.15 $586.19 $570.54$746.70 $725.61 $724.26 $706.31 $634.78 $622.86 $634.17 $612.27 $595.93$781.18 $759.13 $757.71 $738.94 $664.10 $651.63 $663.46 $640.55 $623.46$816.01 $792.97 $791.48 $771.88 $693.71 $680.68 $693.03 $669.10 $651.25$853.18 $829.09 $827.53 $807.03 $725.30 $711.68 $724.60 $699.58 $680.91$871.59 $846.98 $845.40 $824.45 $740.96 $727.05 $740.24 $714.68 $695.61$908.76 $883.10 $881.45 $859.61 $772.56 $758.05 $771.81 $745.16 $725.27$940.90 $914.34 $912.63 $890.02 $799.88 $784.86 $799.11 $771.52 $750.93$962.00 $934.84 $933.09 $909.97 $817.82 $802.46 $817.02 $788.81 $767.76$988.45 $960.54 $958.75 $934.99 $840.30 $824.53 $839.49 $810.50 $788.87
$1,004.51 $976.15 $974.32 $950.19 $853.96 $837.92 $853.13 $823.67 $801.69
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
$165.55 $161.77 $152.95 $173.13 $168.11 $146.59 $135.67 $183.71 $175.55$260.71 $254.76 $240.87 $272.64 $264.75 $230.86 $213.66 $289.31 $276.46$260.71 $254.76 $240.87 $272.64 $264.75 $230.86 $213.66 $289.31 $276.46$260.71 $254.76 $240.87 $272.64 $264.75 $230.86 $213.66 $289.31 $276.46$260.71 $254.76 $240.87 $272.64 $264.75 $230.86 $213.66 $289.31 $276.46$261.75 $255.78 $241.84 $273.74 $265.81 $231.78 $214.51 $290.47 $277.57$266.96 $260.87 $246.65 $279.19 $271.10 $236.40 $218.79 $296.25 $283.10$273.22 $266.99 $252.43 $285.73 $277.45 $241.94 $223.91 $303.19 $289.73$283.39 $276.92 $261.83 $296.36 $287.78 $250.94 $232.25 $314.48 $300.51$291.73 $285.08 $269.54 $305.09 $296.25 $258.33 $239.08 $323.74 $309.36$295.90 $289.15 $273.39 $309.45 $300.49 $262.02 $242.50 $328.36 $313.78$302.16 $295.27 $279.17 $316.00 $306.84 $267.56 $247.63 $335.31 $320.42$308.42 $301.38 $284.95 $322.54 $313.19 $273.10 $252.76 $342.25 $327.06$312.33 $305.20 $288.57 $326.63 $317.17 $276.57 $255.96 $346.59 $331.20$316.50 $309.28 $292.42 $330.99 $321.40 $280.26 $259.38 $351.22 $335.63$318.58 $311.32 $294.35 $333.17 $323.52 $282.11 $261.09 $353.53 $337.84$320.67 $313.36 $296.27 $335.35 $325.64 $283.95 $262.80 $355.85 $340.05$322.76 $315.39 $298.20 $337.53 $327.76 $285.80 $264.51 $358.16 $342.26$324.84 $317.43 $300.13 $339.72 $329.87 $287.65 $266.22 $360.48 $344.47$329.01 $321.51 $303.98 $344.08 $334.11 $291.34 $269.64 $365.11 $348.90$333.18 $325.58 $307.84 $348.44 $338.35 $295.03 $273.06 $369.74 $353.32$339.44 $331.70 $313.62 $354.98 $344.70 $300.58 $278.18 $376.68 $359.95$345.44 $337.56 $319.16 $361.25 $350.79 $305.88 $283.10 $383.33 $366.31$353.78 $345.71 $326.86 $369.98 $359.26 $313.27 $289.94 $392.59 $375.16$364.21 $355.90 $336.50 $380.88 $369.85 $322.51 $298.48 $404.16 $386.22$376.46 $367.87 $347.82 $393.70 $382.29 $333.36 $308.52 $417.76 $399.21$391.06 $382.14 $361.31 $408.97 $397.12 $346.28 $320.49 $433.96 $414.69$407.48 $398.19 $376.48 $426.14 $413.80 $360.83 $333.95 $452.19 $432.11$426.26 $416.53 $393.83 $445.77 $432.86 $377.45 $349.33 $473.02 $452.02$444.77 $434.62 $410.93 $465.13 $451.66 $393.84 $364.50 $493.56 $471.65$465.62 $455.00 $430.20 $486.94 $472.84 $412.31 $381.59 $516.70 $493.76$486.22 $475.13 $449.23 $508.48 $493.75 $430.55 $398.47 $539.56 $515.60$508.90 $497.29 $470.18 $532.20 $516.78 $450.63 $417.06 $564.73 $539.65$531.84 $519.71 $491.38 $556.20 $540.08 $470.95 $435.86 $590.19 $563.98$556.61 $543.91 $514.26 $582.10 $565.23 $492.88 $456.16 $617.67 $590.25$581.38 $568.12 $537.15 $608.00 $590.38 $514.81 $476.46 $645.16 $616.51$608.23 $594.36 $561.96 $636.08 $617.65 $538.59 $498.47 $674.96 $644.99$635.34 $620.85 $587.01 $664.43 $645.19 $562.60 $520.69 $705.04 $673.74$664.28 $649.13 $613.74 $694.70 $674.57 $588.22 $544.40 $737.16 $704.43$678.62 $663.14 $626.99 $709.69 $689.13 $600.92 $556.15 $753.07 $719.63$707.56 $691.42 $653.73 $739.96 $718.52 $626.54 $579.87 $785.18 $750.32$732.59 $715.88 $676.85 $766.13 $743.94 $648.71 $600.38 $812.95 $776.86$749.01 $731.93 $692.03 $783.31 $760.62 $663.25 $613.84 $831.18 $794.28$769.61 $752.05 $711.06 $804.85 $781.53 $681.49 $630.72 $854.04 $816.12$782.11 $764.27 $722.61 $817.92 $794.23 $692.56 $640.97 $867.91 $829.38
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
$168.96 $148.74 $135.99 $135.16 $135.47 $154.53 $120.97 $206.68 $186.99$266.08 $234.23 $214.15 $212.85 $213.34 $243.36 $190.51 $325.48 $294.47$266.08 $234.23 $214.15 $212.85 $213.34 $243.36 $190.51 $325.48 $294.47$266.08 $234.23 $214.15 $212.85 $213.34 $243.36 $190.51 $325.48 $294.47$266.08 $234.23 $214.15 $212.85 $213.34 $243.36 $190.51 $325.48 $294.47$267.15 $235.17 $215.01 $213.71 $214.20 $244.33 $191.27 $326.78 $295.65$272.47 $239.85 $219.29 $217.96 $218.46 $249.20 $195.08 $333.29 $301.54$278.85 $245.47 $224.43 $223.07 $223.58 $255.04 $199.65 $341.10 $308.61$289.23 $254.61 $232.78 $231.37 $231.90 $264.53 $207.08 $353.79 $320.09$297.75 $262.11 $239.64 $238.18 $238.73 $272.32 $213.18 $364.21 $329.51$302.00 $265.85 $243.06 $241.59 $242.14 $276.21 $216.22 $369.41 $334.22$308.39 $271.47 $248.20 $246.70 $247.26 $282.05 $220.80 $377.23 $341.29$314.78 $277.10 $253.34 $251.81 $252.38 $287.89 $225.37 $385.04 $348.36$318.77 $280.61 $256.55 $255.00 $255.58 $291.54 $228.23 $389.92 $352.78$323.02 $284.36 $259.98 $258.40 $259.00 $295.44 $231.27 $395.13 $357.49$325.15 $286.23 $261.69 $260.11 $260.70 $297.38 $232.80 $397.73 $359.84$327.28 $288.11 $263.41 $261.81 $262.41 $299.33 $234.32 $400.33 $362.20$329.41 $289.98 $265.12 $263.51 $264.12 $301.28 $235.85 $402.94 $364.56$331.54 $291.85 $266.83 $265.22 $265.82 $303.22 $237.37 $405.54 $366.91$335.80 $295.60 $270.26 $268.62 $269.24 $307.12 $240.42 $410.75 $371.62$340.05 $299.35 $273.69 $272.03 $272.65 $311.01 $243.47 $415.96 $376.33$346.44 $304.97 $278.83 $277.14 $277.77 $316.85 $248.04 $423.77 $383.40$352.56 $310.36 $283.75 $282.03 $282.68 $322.45 $252.42 $431.25 $390.17$361.07 $317.85 $290.60 $288.84 $289.51 $330.24 $258.52 $441.67 $399.60$371.72 $327.22 $299.17 $297.36 $298.04 $339.97 $266.14 $454.69 $411.38$384.22 $338.23 $309.24 $307.36 $308.07 $351.41 $275.09 $469.99 $425.22$399.12 $351.35 $321.23 $319.28 $320.01 $365.04 $285.76 $488.21 $441.71$415.89 $366.10 $334.72 $332.69 $333.45 $380.37 $297.76 $508.72 $460.26$435.05 $382.97 $350.14 $348.02 $348.81 $397.89 $311.48 $532.15 $481.46$453.94 $399.60 $365.34 $363.13 $363.96 $415.17 $325.00 $555.26 $502.37$475.22 $418.34 $382.48 $380.16 $381.03 $434.64 $340.24 $581.30 $525.93$496.24 $436.84 $399.39 $396.97 $397.88 $453.86 $355.29 $607.01 $549.19$519.39 $457.22 $418.02 $415.49 $416.44 $475.03 $371.87 $635.33 $574.81$542.81 $477.83 $436.87 $434.22 $435.22 $496.45 $388.63 $663.97 $600.72$568.09 $500.08 $457.21 $454.44 $455.49 $519.57 $406.73 $694.89 $628.70$593.36 $522.34 $477.56 $474.66 $475.75 $542.69 $424.83 $725.81 $656.67$620.77 $546.46 $499.62 $496.59 $497.73 $567.75 $444.45 $759.33 $687.00$648.44 $570.82 $521.89 $518.73 $519.92 $593.06 $464.26 $793.18 $717.63$677.98 $596.82 $545.66 $542.35 $543.60 $620.07 $485.41 $829.31 $750.31$692.61 $609.71 $557.44 $554.06 $555.33 $633.46 $495.89 $847.21 $766.51$722.15 $635.71 $581.21 $577.69 $579.01 $660.47 $517.03 $883.34 $799.19$747.69 $658.19 $601.77 $598.12 $599.49 $683.83 $535.32 $914.59 $827.46$764.46 $672.95 $615.26 $611.53 $612.93 $699.16 $547.32 $935.09 $846.02$785.48 $691.45 $632.18 $628.34 $629.79 $718.39 $562.37 $960.80 $869.28$798.24 $702.69 $642.45 $638.55 $640.02 $730.06 $571.51 $976.42 $883.40
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3Moda Health Plan Inc
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500
$202.45 $169.84 $137.93 $227.83 $224.89 $212.62 $206.62 $206.23 $201.12$318.82 $267.46 $217.21 $358.79 $354.15 $334.84 $325.39 $324.78 $316.73$318.82 $267.46 $217.21 $358.79 $354.15 $334.84 $325.39 $324.78 $316.73$318.82 $267.46 $217.21 $358.79 $354.15 $334.84 $325.39 $324.78 $316.73$318.82 $267.46 $217.21 $358.79 $354.15 $334.84 $325.39 $324.78 $316.73$320.10 $268.53 $218.08 $360.22 $355.57 $336.18 $326.69 $326.08 $318.00$326.47 $273.88 $222.42 $367.40 $362.65 $342.88 $333.20 $332.57 $324.33$334.13 $280.30 $227.63 $376.01 $371.15 $350.91 $341.01 $340.37 $331.94$346.56 $290.73 $236.10 $390.00 $384.96 $363.97 $353.70 $353.03 $344.29$356.76 $299.29 $243.06 $401.48 $396.30 $374.69 $364.11 $363.43 $354.42$361.86 $303.57 $246.53 $407.22 $401.96 $380.04 $369.31 $368.62 $359.49$369.52 $309.99 $251.74 $415.83 $410.46 $388.08 $377.12 $376.42 $367.09$377.17 $316.41 $256.96 $424.44 $418.96 $396.12 $384.93 $384.21 $374.69$381.95 $320.42 $260.21 $429.83 $424.28 $401.14 $389.81 $389.08 $379.44$387.05 $324.70 $263.69 $435.57 $429.94 $406.50 $395.02 $394.28 $384.51$389.60 $326.84 $265.43 $438.44 $432.77 $409.18 $397.62 $396.88 $387.05$392.15 $328.98 $267.17 $441.31 $435.61 $411.85 $400.23 $399.48 $389.58$394.70 $331.12 $268.90 $444.18 $438.44 $414.53 $402.83 $402.08 $392.11$397.25 $333.26 $270.64 $447.05 $441.27 $417.21 $405.43 $404.67 $394.65$402.35 $337.54 $274.12 $452.79 $446.94 $422.57 $410.64 $409.87 $399.72$407.45 $341.82 $277.59 $458.53 $452.61 $427.93 $415.84 $415.07 $404.78$415.11 $348.24 $282.80 $467.14 $461.11 $435.96 $423.65 $422.86 $412.38$422.44 $354.39 $287.80 $475.39 $469.25 $443.66 $431.14 $430.33 $419.67$432.64 $362.95 $294.75 $486.87 $480.59 $454.38 $441.55 $440.72 $429.81$445.39 $373.64 $303.44 $501.22 $494.75 $467.77 $454.57 $453.72 $442.47$460.38 $386.22 $313.65 $518.09 $511.40 $483.51 $469.86 $468.98 $457.36$478.23 $401.19 $325.81 $538.18 $531.23 $502.26 $488.08 $487.17 $475.10$498.32 $418.04 $339.50 $560.78 $553.54 $523.36 $508.58 $507.63 $495.05$521.27 $437.30 $355.13 $586.62 $579.04 $547.47 $532.01 $531.01 $517.86$543.91 $456.29 $370.56 $612.09 $604.18 $571.24 $555.11 $554.07 $540.34$569.42 $477.69 $387.93 $640.79 $632.52 $598.03 $581.14 $580.05 $565.68$594.60 $498.82 $405.09 $669.14 $660.50 $624.48 $606.85 $605.71 $590.71$622.34 $522.09 $423.99 $700.35 $691.31 $653.61 $635.16 $633.97 $618.26$650.40 $545.62 $443.10 $731.92 $722.47 $683.08 $663.79 $662.55 $646.13$680.69 $571.03 $463.74 $766.01 $756.12 $714.89 $694.70 $693.40 $676.22$710.97 $596.44 $484.37 $800.09 $789.76 $746.70 $725.61 $724.26 $706.31$743.81 $623.99 $506.75 $837.05 $826.24 $781.18 $759.13 $757.71 $738.94$776.97 $651.81 $529.34 $874.36 $863.07 $816.01 $792.97 $791.48 $771.88$812.36 $681.49 $553.45 $914.19 $902.38 $853.18 $829.09 $827.53 $807.03$829.89 $696.20 $565.39 $933.92 $921.86 $871.59 $846.98 $845.40 $824.45$865.28 $725.89 $589.50 $973.75 $961.17 $908.76 $883.10 $881.45 $859.61$895.89 $751.57 $610.35 $1,008.19 $995.17 $940.90 $914.34 $912.63 $890.02$915.98 $768.42 $624.04 $1,030.79 $1,017.48 $962.00 $934.84 $933.09 $909.97$941.16 $789.55 $641.20 $1,059.14 $1,045.46 $988.45 $960.54 $958.75 $934.99$956.46 $802.38 $651.61 $1,076.36 $1,062.46 $1,004.52 $976.16 $974.33 $950.20
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3
PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
$180.76 $177.36 $180.58 $174.35 $169.69 $165.55 $161.77 $152.95 $173.13$284.66 $279.31 $284.38 $274.56 $267.23 $260.71 $254.76 $240.87 $272.64$284.66 $279.31 $284.38 $274.56 $267.23 $260.71 $254.76 $240.87 $272.64$284.66 $279.31 $284.38 $274.56 $267.23 $260.71 $254.76 $240.87 $272.64$284.66 $279.31 $284.38 $274.56 $267.23 $260.71 $254.76 $240.87 $272.64$285.79 $280.43 $285.52 $275.66 $268.30 $261.75 $255.78 $241.84 $273.74$291.49 $286.01 $291.20 $281.15 $273.65 $266.96 $260.87 $246.65 $279.19$298.32 $292.72 $298.03 $287.74 $280.06 $273.22 $266.99 $252.43 $285.73$309.42 $303.61 $309.12 $298.45 $290.48 $283.39 $276.92 $261.83 $296.36$318.53 $312.55 $318.22 $307.23 $299.03 $291.73 $285.08 $269.54 $305.09$323.08 $317.02 $322.77 $311.63 $303.31 $295.90 $289.15 $273.39 $309.45$329.92 $323.72 $329.60 $318.22 $309.72 $302.16 $295.27 $279.17 $316.00$336.75 $330.42 $336.42 $324.81 $316.14 $308.42 $301.38 $284.95 $322.54$341.02 $334.61 $340.69 $328.92 $320.15 $312.33 $305.20 $288.57 $326.63$345.57 $339.08 $345.24 $333.32 $324.42 $316.50 $309.28 $292.42 $330.99$347.85 $341.32 $347.51 $335.51 $326.56 $318.58 $311.32 $294.35 $333.17$350.13 $343.55 $349.79 $337.71 $328.70 $320.67 $313.36 $296.27 $335.35$352.40 $345.79 $352.06 $339.91 $330.84 $322.76 $315.39 $298.20 $337.53$354.68 $348.02 $354.34 $342.10 $332.97 $324.84 $317.43 $300.13 $339.72$359.24 $352.49 $358.89 $346.50 $337.25 $329.01 $321.51 $303.98 $344.08$363.79 $356.96 $363.44 $350.89 $341.52 $333.18 $325.58 $307.84 $348.44$370.62 $363.66 $370.26 $357.48 $347.94 $339.44 $331.70 $313.62 $354.98$377.17 $370.09 $376.80 $363.79 $354.08 $345.44 $337.56 $319.16 $361.25$386.28 $379.02 $385.90 $372.58 $362.64 $353.78 $345.71 $326.86 $369.98$397.66 $390.20 $397.28 $383.56 $373.33 $364.21 $355.90 $336.50 $380.88$411.04 $403.32 $410.64 $396.47 $385.89 $376.46 $367.87 $347.82 $393.70$426.98 $418.97 $426.57 $411.84 $400.85 $391.06 $382.14 $361.31 $408.97$444.92 $436.56 $444.48 $429.14 $417.69 $407.48 $398.19 $376.48 $426.14$465.41 $456.67 $464.96 $448.91 $436.93 $426.26 $416.53 $393.83 $445.77$485.62 $476.50 $485.15 $468.40 $455.90 $444.77 $434.62 $410.93 $465.13$508.40 $498.85 $507.90 $490.37 $477.28 $465.62 $455.00 $430.20 $486.94$530.88 $520.91 $530.37 $512.06 $498.39 $486.22 $475.13 $449.23 $508.48$555.65 $545.21 $555.11 $535.94 $521.64 $508.90 $497.29 $470.18 $532.20$580.70 $569.79 $580.13 $560.10 $545.16 $531.84 $519.71 $491.38 $556.20$607.74 $596.33 $607.15 $586.19 $570.54 $556.61 $543.91 $514.26 $582.10$634.78 $622.86 $634.17 $612.27 $595.93 $581.38 $568.12 $537.15 $608.00$664.10 $651.63 $663.46 $640.55 $623.46 $608.23 $594.36 $561.96 $636.08$693.71 $680.68 $693.03 $669.10 $651.25 $635.34 $620.85 $587.01 $664.43$725.30 $711.68 $724.60 $699.58 $680.91 $664.28 $649.13 $613.74 $694.70$740.96 $727.05 $740.24 $714.68 $695.61 $678.62 $663.14 $626.99 $709.69$772.56 $758.05 $771.81 $745.16 $725.27 $707.56 $691.42 $653.73 $739.96$799.88 $784.86 $799.11 $771.52 $750.93 $732.59 $715.88 $676.85 $766.13$817.82 $802.46 $817.02 $788.81 $767.76 $749.01 $731.93 $692.03 $783.31$840.30 $824.53 $839.49 $810.50 $788.87 $769.61 $752.05 $711.06 $804.85$853.97 $837.93 $853.14 $823.68 $801.70 $782.12 $764.28 $722.62 $817.93
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
$168.11 $146.59 $135.67 $183.71 $175.55 $168.96 $148.74 $135.99 $135.16$264.75 $230.86 $213.66 $289.31 $276.46 $266.08 $234.23 $214.15 $212.85$264.75 $230.86 $213.66 $289.31 $276.46 $266.08 $234.23 $214.15 $212.85$264.75 $230.86 $213.66 $289.31 $276.46 $266.08 $234.23 $214.15 $212.85$264.75 $230.86 $213.66 $289.31 $276.46 $266.08 $234.23 $214.15 $212.85$265.81 $231.78 $214.51 $290.47 $277.57 $267.15 $235.17 $215.01 $213.71$271.10 $236.40 $218.79 $296.25 $283.10 $272.47 $239.85 $219.29 $217.96$277.45 $241.94 $223.91 $303.19 $289.73 $278.85 $245.47 $224.43 $223.07$287.78 $250.94 $232.25 $314.48 $300.51 $289.23 $254.61 $232.78 $231.37$296.25 $258.33 $239.08 $323.74 $309.36 $297.75 $262.11 $239.64 $238.18$300.49 $262.02 $242.50 $328.36 $313.78 $302.00 $265.85 $243.06 $241.59$306.84 $267.56 $247.63 $335.31 $320.42 $308.39 $271.47 $248.20 $246.70$313.19 $273.10 $252.76 $342.25 $327.06 $314.78 $277.10 $253.34 $251.81$317.17 $276.57 $255.96 $346.59 $331.20 $318.77 $280.61 $256.55 $255.00$321.40 $280.26 $259.38 $351.22 $335.63 $323.02 $284.36 $259.98 $258.40$323.52 $282.11 $261.09 $353.53 $337.84 $325.15 $286.23 $261.69 $260.11$325.64 $283.95 $262.80 $355.85 $340.05 $327.28 $288.11 $263.41 $261.81$327.76 $285.80 $264.51 $358.16 $342.26 $329.41 $289.98 $265.12 $263.51$329.87 $287.65 $266.22 $360.48 $344.47 $331.54 $291.85 $266.83 $265.22$334.11 $291.34 $269.64 $365.11 $348.90 $335.80 $295.60 $270.26 $268.62$338.35 $295.03 $273.06 $369.74 $353.32 $340.05 $299.35 $273.69 $272.03$344.70 $300.58 $278.18 $376.68 $359.95 $346.44 $304.97 $278.83 $277.14$350.79 $305.88 $283.10 $383.33 $366.31 $352.56 $310.36 $283.75 $282.03$359.26 $313.27 $289.94 $392.59 $375.16 $361.07 $317.85 $290.60 $288.84$369.85 $322.51 $298.48 $404.16 $386.22 $371.72 $327.22 $299.17 $297.36$382.29 $333.36 $308.52 $417.76 $399.21 $384.22 $338.23 $309.24 $307.36$397.12 $346.28 $320.49 $433.96 $414.69 $399.12 $351.35 $321.23 $319.28$413.80 $360.83 $333.95 $452.19 $432.11 $415.89 $366.10 $334.72 $332.69$432.86 $377.45 $349.33 $473.02 $452.02 $435.05 $382.97 $350.14 $348.02$451.66 $393.84 $364.50 $493.56 $471.65 $453.94 $399.60 $365.34 $363.13$472.84 $412.31 $381.59 $516.70 $493.76 $475.22 $418.34 $382.48 $380.16$493.75 $430.55 $398.47 $539.56 $515.60 $496.24 $436.84 $399.39 $396.97$516.78 $450.63 $417.06 $564.73 $539.65 $519.39 $457.22 $418.02 $415.49$540.08 $470.95 $435.86 $590.19 $563.98 $542.81 $477.83 $436.87 $434.22$565.23 $492.88 $456.16 $617.67 $590.25 $568.09 $500.08 $457.21 $454.44$590.38 $514.81 $476.46 $645.16 $616.51 $593.36 $522.34 $477.56 $474.66$617.65 $538.59 $498.47 $674.96 $644.99 $620.77 $546.46 $499.62 $496.59$645.19 $562.60 $520.69 $705.04 $673.74 $648.44 $570.82 $521.89 $518.73$674.57 $588.22 $544.40 $737.16 $704.43 $677.98 $596.82 $545.66 $542.35$689.13 $600.92 $556.15 $753.07 $719.63 $692.61 $609.71 $557.44 $554.06$718.52 $626.54 $579.87 $785.18 $750.32 $722.15 $635.71 $581.21 $577.69$743.94 $648.71 $600.38 $812.95 $776.86 $747.69 $658.19 $601.77 $598.12$760.62 $663.25 $613.84 $831.18 $794.28 $764.46 $672.95 $615.26 $611.53$781.53 $681.49 $630.72 $854.04 $816.12 $785.48 $691.45 $632.18 $628.34$794.24 $692.57 $640.98 $867.92 $829.39 $798.25 $702.70 $642.46 $638.56
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4Moda Health Plan Inc
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
$135.47 $154.53 $120.97 $206.68 $186.99 $202.45 $169.84 $137.93 $245.54$213.34 $243.36 $190.51 $325.48 $294.47 $318.82 $267.46 $217.21 $386.67$213.34 $243.36 $190.51 $325.48 $294.47 $318.82 $267.46 $217.21 $386.67$213.34 $243.36 $190.51 $325.48 $294.47 $318.82 $267.46 $217.21 $386.67$213.34 $243.36 $190.51 $325.48 $294.47 $318.82 $267.46 $217.21 $386.67$214.20 $244.33 $191.27 $326.78 $295.65 $320.10 $268.53 $218.08 $388.22$218.46 $249.20 $195.08 $333.29 $301.54 $326.47 $273.88 $222.42 $395.95$223.58 $255.04 $199.65 $341.10 $308.61 $334.13 $280.30 $227.63 $405.23$231.90 $264.53 $207.08 $353.79 $320.09 $346.56 $290.73 $236.10 $420.31$238.73 $272.32 $213.18 $364.21 $329.51 $356.76 $299.29 $243.06 $432.69$242.14 $276.21 $216.22 $369.41 $334.22 $361.86 $303.57 $246.53 $438.87$247.26 $282.05 $220.80 $377.23 $341.29 $369.52 $309.99 $251.74 $448.15$252.38 $287.89 $225.37 $385.04 $348.36 $377.17 $316.41 $256.96 $457.43$255.58 $291.54 $228.23 $389.92 $352.78 $381.95 $320.42 $260.21 $463.23$259.00 $295.44 $231.27 $395.13 $357.49 $387.05 $324.70 $263.69 $469.42$260.70 $297.38 $232.80 $397.73 $359.84 $389.60 $326.84 $265.43 $472.51$262.41 $299.33 $234.32 $400.33 $362.20 $392.15 $328.98 $267.17 $475.61$264.12 $301.28 $235.85 $402.94 $364.56 $394.70 $331.12 $268.90 $478.70$265.82 $303.22 $237.37 $405.54 $366.91 $397.25 $333.26 $270.64 $481.79$269.24 $307.12 $240.42 $410.75 $371.62 $402.35 $337.54 $274.12 $487.98$272.65 $311.01 $243.47 $415.96 $376.33 $407.45 $341.82 $277.59 $494.17$277.77 $316.85 $248.04 $423.77 $383.40 $415.11 $348.24 $282.80 $503.45$282.68 $322.45 $252.42 $431.25 $390.17 $422.44 $354.39 $287.80 $512.34$289.51 $330.24 $258.52 $441.67 $399.60 $432.64 $362.95 $294.75 $524.71$298.04 $339.97 $266.14 $454.69 $411.38 $445.39 $373.64 $303.44 $540.18$308.07 $351.41 $275.09 $469.99 $425.22 $460.38 $386.22 $313.65 $558.35$320.01 $365.04 $285.76 $488.21 $441.71 $478.23 $401.19 $325.81 $580.01$333.45 $380.37 $297.76 $508.72 $460.26 $498.32 $418.04 $339.50 $604.37$348.81 $397.89 $311.48 $532.15 $481.46 $521.27 $437.30 $355.13 $632.21$363.96 $415.17 $325.00 $555.26 $502.37 $543.91 $456.29 $370.56 $659.66$381.03 $434.64 $340.24 $581.30 $525.93 $569.42 $477.69 $387.93 $690.59$397.88 $453.86 $355.29 $607.01 $549.19 $594.60 $498.82 $405.09 $721.14$416.44 $475.03 $371.87 $635.33 $574.81 $622.34 $522.09 $423.99 $754.78$435.22 $496.45 $388.63 $663.97 $600.72 $650.40 $545.62 $443.10 $788.81$455.49 $519.57 $406.73 $694.89 $628.70 $680.69 $571.03 $463.74 $825.54$475.75 $542.69 $424.83 $725.81 $656.67 $710.97 $596.44 $484.37 $862.28$497.73 $567.75 $444.45 $759.33 $687.00 $743.81 $623.99 $506.75 $902.10$519.92 $593.06 $464.26 $793.18 $717.63 $776.97 $651.81 $529.34 $942.32$543.60 $620.07 $485.41 $829.31 $750.31 $812.36 $681.49 $553.45 $985.24$555.33 $633.46 $495.89 $847.21 $766.51 $829.89 $696.20 $565.39 $1,006.51$579.01 $660.47 $517.03 $883.34 $799.19 $865.28 $725.89 $589.50 $1,049.43$599.49 $683.83 $535.32 $914.59 $827.46 $895.89 $751.57 $610.35 $1,086.55$612.93 $699.16 $547.32 $935.09 $846.02 $915.98 $768.42 $624.04 $1,110.91$629.79 $718.39 $562.37 $960.80 $869.28 $941.16 $789.55 $641.20 $1,141.45$640.03 $730.07 $571.52 $976.43 $883.41 $956.47 $802.39 $651.62 $1,160.01
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health Plan Inc
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000
$242.37 $229.15 $222.68 $222.26 $216.76 $194.80 $191.15 $194.62 $187.90$381.68 $360.87 $350.68 $350.02 $341.35 $306.78 $301.02 $306.48 $295.90$381.68 $360.87 $350.68 $350.02 $341.35 $306.78 $301.02 $306.48 $295.90$381.68 $360.87 $350.68 $350.02 $341.35 $306.78 $301.02 $306.48 $295.90$381.68 $360.87 $350.68 $350.02 $341.35 $306.78 $301.02 $306.48 $295.90$383.20 $362.31 $352.08 $351.42 $342.71 $308.01 $302.22 $307.71 $297.08$390.84 $369.53 $359.09 $358.42 $349.54 $314.14 $308.24 $313.84 $303.00$400.00 $378.19 $367.51 $366.82 $357.73 $321.50 $315.47 $321.19 $310.10$414.88 $392.26 $381.19 $380.47 $371.05 $333.47 $327.21 $333.15 $321.64$427.10 $403.81 $392.41 $391.67 $381.97 $343.29 $336.84 $342.95 $331.11$433.20 $409.58 $398.02 $397.27 $387.43 $348.19 $341.66 $347.86 $335.85$442.36 $418.24 $406.43 $405.67 $395.62 $355.56 $348.88 $355.21 $342.95$451.52 $426.90 $414.85 $414.07 $403.82 $362.92 $356.11 $362.57 $350.05$457.25 $432.32 $420.11 $419.32 $408.94 $367.52 $360.62 $367.16 $354.49$463.36 $438.09 $425.72 $424.92 $414.40 $372.43 $365.44 $372.07 $359.22$466.41 $440.98 $428.53 $427.72 $417.13 $374.88 $367.85 $374.52 $361.59$469.46 $443.86 $431.33 $430.52 $419.86 $377.34 $370.25 $376.97 $363.96$472.52 $446.75 $434.14 $433.32 $422.59 $379.79 $372.66 $379.42 $366.32$475.57 $449.64 $436.94 $436.12 $425.32 $382.25 $375.07 $381.88 $368.69$481.68 $455.41 $442.55 $441.73 $430.78 $387.16 $379.89 $386.78 $373.43$487.78 $461.19 $448.16 $447.33 $436.24 $392.06 $384.70 $391.68 $378.16$496.94 $469.85 $456.58 $455.73 $444.44 $399.43 $391.93 $399.04 $385.26$505.72 $478.15 $464.65 $463.78 $452.29 $406.48 $398.85 $406.09 $392.07$517.94 $489.69 $475.87 $474.98 $463.21 $416.30 $408.48 $415.90 $401.54$533.20 $504.13 $489.89 $488.98 $476.86 $428.57 $420.52 $428.15 $413.37$551.14 $521.09 $506.38 $505.43 $492.91 $442.99 $434.67 $442.56 $427.28$572.52 $541.30 $526.01 $525.03 $512.02 $460.17 $451.53 $459.72 $443.85$596.56 $564.03 $548.11 $547.08 $533.53 $479.50 $470.49 $479.03 $462.49$624.04 $590.01 $573.36 $572.28 $558.10 $501.58 $492.17 $501.10 $483.80$651.14 $615.64 $598.25 $597.13 $582.34 $523.37 $513.54 $522.86 $504.80$681.68 $644.51 $626.31 $625.14 $609.65 $547.91 $537.62 $547.38 $528.48$711.83 $673.01 $654.01 $652.79 $636.61 $572.14 $561.40 $571.59 $551.85$745.03 $704.41 $684.52 $683.24 $666.31 $598.83 $587.59 $598.25 $577.60$778.62 $736.17 $715.38 $714.04 $696.35 $625.83 $614.08 $625.22 $603.63$814.88 $770.45 $748.69 $747.29 $728.78 $654.97 $642.68 $654.34 $631.75$851.14 $804.73 $782.01 $780.54 $761.21 $684.12 $671.27 $683.45 $659.86$890.45 $841.90 $818.13 $816.60 $796.37 $715.72 $702.28 $715.02 $690.33$930.15 $879.43 $854.60 $853.00 $831.87 $747.62 $733.58 $746.89 $721.11$972.51 $919.48 $893.52 $891.85 $869.76 $781.67 $767.00 $780.91 $753.95$993.51 $939.33 $912.81 $911.10 $888.53 $798.55 $783.55 $797.77 $770.23
$1,035.87 $979.39 $951.74 $949.95 $926.42 $832.60 $816.97 $831.79 $803.07$1,072.51 $1,014.03 $985.40 $983.56 $959.19 $862.05 $845.86 $861.21 $831.48$1,096.56 $1,036.77 $1,007.49 $1,005.61 $980.69 $881.38 $864.83 $880.52 $850.12$1,126.71 $1,065.27 $1,035.20 $1,033.26 $1,007.66 $905.61 $888.61 $904.73 $873.50$1,145.03 $1,082.60 $1,052.03 $1,050.06 $1,024.05 $920.34 $903.06 $919.44 $887.70
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
$182.88 $178.42 $174.35 $164.84 $186.58 $181.18 $157.99 $146.22 $197.99$288.00 $280.97 $274.56 $259.59 $293.83 $285.32 $248.80 $230.26 $311.79$288.00 $280.97 $274.56 $259.59 $293.83 $285.32 $248.80 $230.26 $311.79$288.00 $280.97 $274.56 $259.59 $293.83 $285.32 $248.80 $230.26 $311.79$288.00 $280.97 $274.56 $259.59 $293.83 $285.32 $248.80 $230.26 $311.79$289.16 $282.09 $275.66 $260.63 $295.01 $286.46 $249.79 $231.19 $313.04$294.92 $287.71 $281.15 $265.82 $300.89 $292.17 $254.77 $235.79 $319.28$301.83 $294.46 $287.74 $272.05 $307.94 $299.02 $260.74 $241.32 $326.76$313.06 $305.41 $298.45 $282.18 $319.40 $310.15 $270.44 $250.30 $338.92$322.28 $314.40 $307.23 $290.49 $328.80 $319.28 $278.41 $257.67 $348.90$326.88 $318.90 $311.63 $294.64 $333.50 $323.84 $282.39 $261.35 $353.88$333.80 $325.64 $318.22 $300.87 $340.55 $330.69 $288.36 $266.88 $361.37$340.71 $332.39 $324.81 $307.10 $347.61 $337.54 $294.33 $272.40 $368.85$345.03 $336.60 $328.92 $310.99 $352.01 $341.82 $298.06 $275.86 $373.53$349.64 $341.10 $333.32 $315.15 $356.72 $346.38 $302.04 $279.54 $378.52$351.94 $343.34 $335.51 $317.22 $359.07 $348.66 $304.03 $281.38 $381.01$354.24 $345.59 $337.71 $319.30 $361.42 $350.95 $306.02 $283.23 $383.51$356.55 $347.84 $339.91 $321.38 $363.77 $353.23 $308.01 $285.07 $386.00$358.85 $350.09 $342.10 $323.45 $366.12 $355.51 $310.00 $286.91 $388.49$363.46 $354.58 $346.50 $327.61 $370.82 $360.08 $313.98 $290.59 $393.48$368.07 $359.08 $350.89 $331.76 $375.52 $364.64 $317.96 $294.28 $398.47$374.98 $365.82 $357.48 $337.99 $382.57 $371.49 $323.94 $299.80 $405.95$381.60 $372.28 $363.79 $343.96 $389.33 $378.05 $329.66 $305.10 $413.13$390.82 $381.28 $372.58 $352.27 $398.73 $387.18 $337.62 $312.47 $423.10$402.34 $392.51 $383.56 $362.65 $410.49 $398.60 $347.57 $321.68 $435.57$415.88 $405.72 $396.47 $374.85 $424.30 $412.01 $359.27 $332.50 $450.23$432.01 $421.45 $411.84 $389.39 $440.75 $427.98 $373.20 $345.40 $467.69$450.15 $439.15 $429.14 $405.74 $459.26 $445.96 $388.87 $359.90 $487.33$470.89 $459.38 $448.91 $424.44 $480.42 $466.50 $406.79 $376.48 $509.78$491.33 $479.33 $468.40 $442.87 $501.28 $486.76 $424.45 $392.83 $531.92$514.37 $501.81 $490.36 $463.63 $524.79 $509.59 $444.35 $411.25 $556.86$537.13 $524.01 $512.06 $484.14 $548.00 $532.13 $464.01 $429.44 $581.49$562.18 $548.45 $535.94 $506.73 $573.57 $556.95 $485.66 $449.48 $608.62$587.53 $573.18 $560.10 $529.57 $599.42 $582.06 $507.55 $469.74 $636.06$614.89 $599.87 $586.19 $554.23 $627.34 $609.16 $531.19 $491.61 $665.68$642.25 $626.56 $612.27 $578.89 $655.25 $636.27 $554.82 $513.49 $695.30$671.91 $655.50 $640.55 $605.63 $685.52 $665.66 $580.45 $537.21 $727.41$701.86 $684.72 $669.10 $632.63 $716.08 $695.33 $606.32 $561.15 $759.84$733.83 $715.91 $699.58 $661.44 $748.69 $727.00 $633.94 $586.71 $794.45$749.67 $731.36 $714.68 $675.72 $764.85 $742.69 $647.62 $599.38 $811.60$781.64 $762.55 $745.16 $704.54 $797.47 $774.36 $675.24 $624.94 $846.21$809.29 $789.52 $771.51 $729.46 $825.68 $801.76 $699.12 $647.04 $876.14$827.43 $807.22 $788.81 $745.81 $844.19 $819.73 $714.80 $661.55 $895.78$850.19 $829.42 $810.50 $766.32 $867.40 $842.27 $734.45 $679.74 $920.41$864.01 $842.91 $823.68 $778.78 $881.50 $855.97 $746.40 $690.79 $935.38
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Summit
Exclusive 2000
$189.20 $182.09 $160.30 $146.56 $145.67 $146.00 $166.54 $172.22$297.95 $286.76 $252.44 $230.80 $229.40 $229.92 $262.27 $271.22$297.95 $286.76 $252.44 $230.80 $229.40 $229.92 $262.27 $271.22$297.95 $286.76 $252.44 $230.80 $229.40 $229.92 $262.27 $271.22$297.95 $286.76 $252.44 $230.80 $229.40 $229.92 $262.27 $271.22$299.14 $287.91 $253.45 $231.72 $230.31 $230.84 $263.32 $272.30$305.10 $293.65 $258.49 $236.33 $234.90 $235.44 $268.57 $277.73$312.25 $300.53 $264.55 $241.87 $240.41 $240.96 $274.86 $284.24$323.87 $311.71 $274.40 $250.87 $249.35 $249.93 $285.09 $294.81$333.41 $320.89 $282.48 $258.26 $256.70 $257.28 $293.48 $303.49$338.17 $325.48 $286.52 $261.95 $260.37 $260.96 $297.68 $307.83$345.32 $332.36 $292.57 $267.49 $265.87 $266.48 $303.97 $314.34$352.47 $339.24 $298.63 $273.03 $271.38 $272.00 $310.27 $320.85$356.94 $343.54 $302.42 $276.49 $274.82 $275.45 $314.20 $324.92$361.71 $348.13 $306.46 $280.19 $278.49 $279.13 $318.40 $329.26$364.09 $350.42 $308.48 $282.03 $280.32 $280.97 $320.49 $331.43$366.48 $352.72 $310.50 $283.88 $282.16 $282.81 $322.59 $333.60$368.86 $355.01 $312.52 $285.73 $283.99 $284.64 $324.69 $335.77$371.24 $357.31 $314.54 $287.57 $285.83 $286.48 $326.79 $337.94$376.01 $361.89 $318.57 $291.26 $289.50 $290.16 $330.99 $342.28$380.78 $366.48 $322.61 $294.96 $293.17 $293.84 $335.18 $346.62$387.93 $373.37 $328.67 $300.50 $298.67 $299.36 $341.48 $353.13$394.78 $379.96 $334.48 $305.80 $303.95 $304.65 $347.51 $359.36$404.32 $389.14 $342.56 $313.19 $311.29 $312.01 $355.90 $368.04$416.24 $400.61 $352.65 $322.42 $320.47 $321.20 $366.39 $378.89$430.24 $414.09 $364.52 $333.27 $331.25 $332.01 $378.72 $391.64$446.92 $430.14 $378.65 $346.19 $344.10 $344.88 $393.41 $406.83$465.69 $448.21 $394.56 $360.73 $358.55 $359.37 $409.93 $423.92$487.15 $468.86 $412.73 $377.35 $375.06 $375.92 $428.81 $443.44$508.30 $489.22 $430.66 $393.74 $391.35 $392.25 $447.43 $462.70$532.14 $512.16 $450.85 $412.20 $409.70 $410.64 $468.42 $484.40$555.68 $534.81 $470.79 $430.43 $427.83 $428.81 $489.14 $505.82$581.60 $559.76 $492.76 $450.51 $447.78 $448.81 $511.95 $529.42$607.82 $585.00 $514.97 $470.82 $467.97 $469.04 $535.03 $553.29$636.12 $612.24 $538.95 $492.75 $489.76 $490.89 $559.95 $579.05$664.43 $639.48 $562.93 $514.67 $511.56 $512.73 $584.86 $604.82$695.12 $669.02 $588.93 $538.45 $535.18 $536.41 $611.88 $632.75$726.10 $698.84 $615.19 $562.45 $559.04 $560.32 $639.15 $660.96$759.17 $730.67 $643.21 $588.07 $584.50 $585.84 $668.27 $691.07$775.56 $746.44 $657.09 $600.76 $597.12 $598.49 $682.69 $705.98$808.63 $778.27 $685.11 $626.38 $622.58 $624.01 $711.80 $736.09$837.24 $805.80 $709.35 $648.54 $644.61 $646.08 $736.98 $762.13$856.01 $823.87 $725.25 $663.08 $659.06 $660.57 $753.50 $779.21$879.55 $846.52 $745.19 $681.31 $677.18 $678.73 $774.22 $800.64$893.85 $860.29 $757.31 $692.39 $688.19 $689.77 $786.81 $813.66
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Moda Health
Synergy
Exclusive 5000
Moda Health
Summit
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Platinum
Summit
Exclusive 250
PPO Synergy
Exclusive
1000A
PPO Summit
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
$130.37 $134.52 $222.74 $230.81 $201.52 $208.74 $218.19 $183.04 $148.65$205.31 $211.84 $350.77 $363.48 $317.36 $328.73 $343.60 $288.25 $234.09$205.31 $211.84 $350.77 $363.48 $317.36 $328.73 $343.60 $288.25 $234.09$205.31 $211.84 $350.77 $363.48 $317.36 $328.73 $343.60 $288.25 $234.09$205.31 $211.84 $350.77 $363.48 $317.36 $328.73 $343.60 $288.25 $234.09$206.13 $212.69 $352.17 $364.93 $318.63 $330.04 $344.98 $289.40 $235.03$210.24 $216.93 $359.19 $372.20 $324.97 $336.61 $351.85 $295.17 $239.71$215.17 $222.01 $367.61 $380.92 $332.59 $344.50 $360.09 $302.09 $245.33$223.17 $230.27 $381.29 $395.10 $344.97 $357.32 $373.49 $313.33 $254.46$229.74 $237.05 $392.51 $406.73 $355.12 $367.84 $384.49 $322.55 $261.95$233.03 $240.44 $398.13 $412.55 $360.20 $373.10 $389.99 $327.16 $265.69$237.96 $245.53 $406.54 $421.27 $367.82 $380.99 $398.23 $334.08 $271.31$242.88 $250.61 $414.96 $429.99 $375.43 $388.88 $406.48 $341.00 $276.93$245.96 $253.79 $420.22 $435.44 $380.19 $393.81 $411.63 $345.32 $280.44$249.25 $257.18 $425.84 $441.26 $385.27 $399.07 $417.13 $349.94 $284.18$250.89 $258.87 $428.64 $444.17 $387.81 $401.70 $419.88 $352.24 $286.06$252.53 $260.57 $431.45 $447.08 $390.35 $404.33 $422.63 $354.55 $287.93$254.18 $262.26 $434.25 $449.98 $392.89 $406.96 $425.38 $356.85 $289.80$255.82 $263.96 $437.06 $452.89 $395.43 $409.59 $428.13 $359.16 $291.68$259.10 $267.35 $442.67 $458.71 $400.50 $414.85 $433.62 $363.77 $295.42$262.39 $270.74 $448.29 $464.52 $405.58 $420.11 $439.12 $368.38 $299.17$267.32 $275.82 $456.70 $473.25 $413.20 $428.00 $447.37 $375.30 $304.78$272.04 $280.69 $464.77 $481.61 $420.50 $435.56 $455.27 $381.93 $310.17$278.61 $287.47 $476.00 $493.24 $430.65 $446.08 $466.27 $391.15 $317.66$286.82 $295.95 $490.03 $507.78 $443.35 $459.23 $480.01 $402.68 $327.02$296.47 $305.90 $506.51 $524.86 $458.26 $474.68 $496.16 $416.23 $338.02$307.97 $317.77 $526.16 $545.21 $476.04 $493.09 $515.40 $432.37 $351.13$320.90 $331.11 $548.26 $568.11 $496.03 $513.80 $537.05 $450.53 $365.88$335.69 $346.36 $573.51 $594.28 $518.88 $537.47 $561.79 $471.29 $382.74$350.26 $361.41 $598.42 $620.09 $541.41 $560.81 $586.18 $491.75 $399.36$366.69 $378.35 $626.48 $649.17 $566.80 $587.10 $613.67 $514.81 $418.08$382.91 $395.09 $654.19 $677.88 $591.87 $613.07 $640.82 $537.59 $436.58$400.77 $413.52 $684.71 $709.51 $619.48 $641.67 $670.71 $562.66 $456.94$418.84 $432.16 $715.57 $741.49 $647.41 $670.60 $700.95 $588.03 $477.54$438.34 $452.29 $748.90 $776.02 $677.56 $701.83 $733.59 $615.41 $499.78$457.85 $472.41 $782.22 $810.55 $707.71 $733.06 $766.23 $642.80 $522.02$478.99 $494.23 $818.35 $847.99 $740.39 $766.92 $801.62 $672.49 $546.13$500.35 $516.26 $854.83 $885.79 $773.40 $801.10 $837.36 $702.46 $570.48$523.14 $539.78 $893.77 $926.14 $808.63 $837.59 $875.50 $734.46 $596.46$534.43 $551.43 $913.06 $946.13 $826.08 $855.67 $894.39 $750.31 $609.33$557.22 $574.94 $951.99 $986.48 $861.31 $892.16 $932.53 $782.31 $635.32$576.93 $595.28 $985.67 $1,021.37 $891.77 $923.72 $965.52 $809.98 $657.79$589.86 $608.63 $1,007.77 $1,044.27 $911.77 $944.43 $987.17 $828.14 $672.54$606.08 $625.36 $1,035.48 $1,072.98 $936.84 $970.40 $1,014.31 $850.91 $691.03$615.94 $635.53 $1,052.31 $1,090.43 $952.07 $986.18 $1,030.80 $864.75 $702.27
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5Moda Health Plan Inc
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500
$236.09 $233.04 $220.34 $214.11 $213.71 $208.42 $187.31 $183.80 $187.13$371.80 $367.00 $346.99 $337.19 $336.56 $328.22 $294.98 $289.44 $294.69$371.80 $367.00 $346.99 $337.19 $336.56 $328.22 $294.98 $289.44 $294.69$371.80 $367.00 $346.99 $337.19 $336.56 $328.22 $294.98 $289.44 $294.69$371.80 $367.00 $346.99 $337.19 $336.56 $328.22 $294.98 $289.44 $294.69$373.29 $368.47 $348.37 $338.54 $337.90 $329.53 $296.16 $290.60 $295.87$380.72 $375.81 $355.31 $345.28 $344.64 $336.10 $302.06 $296.39 $301.77$389.65 $384.61 $363.64 $353.37 $352.71 $343.97 $309.14 $303.33 $308.84$404.15 $398.93 $377.17 $366.52 $365.84 $356.77 $320.64 $314.62 $320.33$416.04 $410.67 $388.28 $377.31 $376.61 $367.28 $330.08 $323.88 $329.76$421.99 $416.54 $393.83 $382.71 $381.99 $372.53 $334.80 $328.52 $334.48$430.92 $425.35 $402.16 $390.80 $390.07 $380.41 $341.88 $335.46 $341.55$439.84 $434.16 $410.48 $398.89 $398.15 $388.28 $348.96 $342.41 $348.62$445.42 $439.66 $415.69 $403.95 $403.20 $393.21 $353.39 $346.75 $353.04$451.36 $445.54 $421.24 $409.35 $408.58 $398.46 $358.11 $351.38 $357.76$454.34 $448.47 $424.02 $412.04 $411.27 $401.08 $360.47 $353.70 $360.12$457.31 $451.41 $426.79 $414.74 $413.97 $403.71 $362.83 $356.01 $362.47$460.29 $454.34 $429.57 $417.44 $416.66 $406.34 $365.19 $358.33 $364.83$463.26 $457.28 $432.34 $420.14 $419.35 $408.96 $367.55 $360.64 $367.19$469.21 $463.15 $437.90 $425.53 $424.74 $414.21 $372.27 $365.27 $371.90$475.16 $469.02 $443.45 $430.93 $430.12 $419.46 $376.98 $369.91 $376.62$484.08 $477.83 $451.78 $439.02 $438.20 $427.34 $384.06 $376.85 $383.69$492.63 $486.27 $459.76 $446.78 $445.94 $434.89 $390.85 $383.51 $390.47$504.53 $498.02 $470.86 $457.57 $456.71 $445.39 $400.29 $392.77 $399.90$519.40 $512.70 $484.74 $471.05 $470.17 $458.52 $412.09 $404.35 $411.69$536.88 $529.94 $501.05 $486.90 $485.99 $473.95 $425.95 $417.95 $425.54$557.70 $550.50 $520.48 $505.78 $504.84 $492.33 $442.47 $434.16 $442.04$581.12 $573.62 $542.34 $527.03 $526.04 $513.01 $461.05 $452.40 $460.61$607.89 $600.04 $567.32 $551.30 $550.27 $536.64 $482.29 $473.24 $481.82$634.29 $626.10 $591.96 $575.24 $574.17 $559.94 $503.24 $493.79 $502.75$664.03 $655.46 $619.72 $602.22 $601.09 $586.20 $526.83 $516.94 $526.32$693.41 $684.45 $647.13 $628.86 $627.68 $612.13 $550.14 $539.81 $549.60$725.75 $716.38 $677.32 $658.19 $656.96 $640.68 $575.80 $564.99 $575.24$758.47 $748.68 $707.85 $687.87 $686.58 $669.57 $601.76 $590.46 $601.17$793.79 $783.54 $740.81 $719.90 $718.55 $700.75 $629.78 $617.96 $629.17$829.11 $818.41 $773.78 $751.93 $750.52 $731.93 $657.81 $645.45 $657.17$867.41 $856.21 $809.52 $786.66 $785.19 $765.74 $688.19 $675.27 $687.52$906.07 $894.37 $845.60 $821.73 $820.19 $799.87 $718.87 $705.37 $718.17$947.34 $935.11 $884.12 $859.16 $857.55 $836.30 $751.61 $737.50 $750.88$967.79 $955.30 $903.20 $877.70 $876.06 $854.36 $767.83 $753.42 $767.09
$1,009.06 $996.03 $941.72 $915.13 $913.42 $890.79 $800.58 $785.54 $799.80$1,044.76 $1,031.26 $975.03 $947.50 $945.73 $922.30 $828.89 $813.33 $828.09$1,068.18 $1,054.38 $996.89 $968.74 $966.93 $942.97 $847.48 $831.56 $846.65$1,097.55 $1,083.38 $1,024.30 $995.38 $993.52 $968.90 $870.78 $854.43 $869.94$1,115.40 $1,100.99 $1,040.96 $1,011.57 $1,009.67 $984.66 $884.94 $868.32 $884.08
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5
Value 2000 Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
$180.67 $175.85 $171.55 $167.64 $158.50 $179.41 $174.21 $151.91 $140.59$284.52 $276.93 $270.16 $264.00 $249.61 $282.53 $274.35 $239.23 $221.41$284.52 $276.93 $270.16 $264.00 $249.61 $282.53 $274.35 $239.23 $221.41$284.52 $276.93 $270.16 $264.00 $249.61 $282.53 $274.35 $239.23 $221.41$284.52 $276.93 $270.16 $264.00 $249.61 $282.53 $274.35 $239.23 $221.41$285.66 $278.03 $271.24 $265.06 $250.61 $283.66 $275.45 $240.19 $222.29$291.35 $283.57 $276.65 $270.34 $255.60 $289.31 $280.93 $244.97 $226.72$298.18 $290.22 $283.13 $276.67 $261.59 $296.09 $287.52 $250.71 $232.04$309.27 $301.02 $293.67 $286.97 $271.33 $307.11 $298.22 $260.04 $240.67$318.38 $309.88 $302.31 $295.42 $279.31 $316.15 $307.00 $267.70 $247.76$322.93 $314.31 $306.63 $299.64 $283.31 $320.68 $311.39 $271.53 $251.30$329.76 $320.96 $313.12 $305.98 $289.30 $327.46 $317.97 $277.27 $256.61$336.59 $327.60 $319.60 $312.31 $295.29 $334.24 $324.55 $283.01 $261.93$340.85 $331.76 $323.65 $316.27 $299.03 $338.47 $328.67 $286.60 $265.25$345.41 $336.19 $327.98 $320.50 $303.03 $343.00 $333.06 $290.42 $268.79$347.68 $338.40 $330.14 $322.61 $305.02 $345.26 $335.25 $292.34 $270.56$349.96 $340.62 $332.30 $324.72 $307.02 $347.52 $337.45 $294.25 $272.33$352.23 $342.83 $334.46 $326.83 $309.02 $349.78 $339.64 $296.17 $274.10$354.51 $345.05 $336.62 $328.94 $311.01 $352.04 $341.84 $298.08 $275.87$359.06 $349.48 $340.95 $333.17 $315.01 $356.56 $346.23 $301.91 $279.42$363.61 $353.91 $345.27 $337.39 $319.00 $361.08 $350.62 $305.74 $282.96$370.44 $360.56 $351.75 $343.73 $324.99 $367.86 $357.20 $311.48 $288.27$376.99 $366.93 $357.97 $349.80 $330.73 $374.36 $363.51 $316.98 $293.37$386.09 $375.79 $366.61 $358.25 $338.72 $383.40 $372.29 $324.63 $300.45$397.47 $386.87 $377.42 $368.81 $348.70 $394.70 $383.26 $334.20 $309.31$410.85 $399.88 $390.11 $381.22 $360.44 $407.98 $396.16 $345.45 $319.71$426.78 $415.39 $405.24 $396.00 $374.41 $423.80 $411.52 $358.84 $332.11$444.70 $432.84 $422.26 $412.63 $390.14 $441.60 $428.81 $373.92 $346.06$465.19 $452.77 $441.72 $431.64 $408.11 $461.94 $448.56 $391.14 $362.00$485.39 $472.44 $460.90 $450.38 $425.83 $482.00 $468.04 $408.13 $377.72$508.15 $494.59 $482.51 $471.50 $445.80 $504.60 $489.99 $427.26 $395.43$530.63 $516.47 $503.85 $492.36 $465.52 $526.92 $511.66 $446.16 $412.93$555.38 $540.56 $527.36 $515.33 $487.24 $551.51 $535.53 $466.98 $432.19$580.42 $564.93 $551.13 $538.56 $509.20 $576.37 $559.67 $488.03 $451.67$607.45 $591.24 $576.80 $563.64 $532.92 $603.21 $585.73 $510.76 $472.71$634.48 $617.55 $602.46 $588.72 $556.63 $630.05 $611.80 $533.48 $493.74$663.78 $646.07 $630.29 $615.91 $582.34 $659.15 $640.05 $558.12 $516.55$693.37 $674.87 $658.39 $643.37 $608.30 $688.53 $668.59 $583.00 $539.57$724.95 $705.61 $688.37 $672.67 $636.00 $719.89 $699.04 $609.56 $564.15$740.60 $720.84 $703.23 $687.19 $649.73 $735.43 $714.13 $622.71 $576.33$772.18 $751.58 $733.22 $716.50 $677.44 $766.80 $744.58 $649.27 $600.90$799.50 $778.16 $759.16 $741.84 $701.40 $793.92 $770.92 $672.24 $622.16$817.42 $795.61 $776.18 $758.47 $717.13 $811.72 $788.20 $687.31 $636.11$839.90 $817.49 $797.52 $779.33 $736.85 $834.04 $809.88 $706.21 $653.60$853.56 $830.78 $810.49 $792.00 $748.83 $847.60 $823.04 $717.69 $664.22
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
$190.37 $181.92 $175.09 $154.13 $140.92 $140.06 $140.39 $160.14 $125.36$299.80 $286.49 $275.73 $242.73 $221.92 $220.57 $221.08 $252.18 $197.42$299.80 $286.49 $275.73 $242.73 $221.92 $220.57 $221.08 $252.18 $197.42$299.80 $286.49 $275.73 $242.73 $221.92 $220.57 $221.08 $252.18 $197.42$299.80 $286.49 $275.73 $242.73 $221.92 $220.57 $221.08 $252.18 $197.42$301.00 $287.64 $276.84 $243.70 $222.81 $221.46 $221.96 $253.19 $198.21$307.00 $293.37 $282.35 $248.55 $227.24 $225.87 $226.39 $258.24 $202.15$314.19 $300.24 $288.97 $254.38 $232.57 $231.16 $231.69 $264.29 $206.89$325.88 $311.41 $299.72 $263.84 $241.23 $239.76 $240.31 $274.12 $214.59$335.48 $320.58 $308.55 $271.61 $248.33 $246.82 $247.39 $282.19 $220.91$340.27 $325.17 $312.96 $275.50 $251.88 $250.35 $250.93 $286.23 $224.07$347.47 $332.04 $319.58 $281.32 $257.20 $255.65 $256.23 $292.28 $228.80$354.66 $338.92 $326.19 $287.15 $262.53 $260.94 $261.54 $298.33 $233.54$359.16 $343.21 $330.33 $290.79 $265.86 $264.25 $264.85 $302.12 $236.50$363.96 $347.80 $334.74 $294.67 $269.41 $267.78 $268.39 $306.15 $239.66$366.36 $350.09 $336.95 $296.61 $271.18 $269.54 $270.16 $308.17 $241.24$368.76 $352.38 $339.15 $298.55 $272.96 $271.31 $271.93 $310.19 $242.82$371.15 $354.67 $341.36 $300.50 $274.74 $273.07 $273.70 $312.20 $244.40$373.55 $356.97 $343.56 $302.44 $276.51 $274.84 $275.47 $314.22 $245.98$378.35 $361.55 $347.98 $306.32 $280.06 $278.36 $279.00 $318.26 $249.14$383.15 $366.13 $352.39 $310.21 $283.61 $281.89 $282.54 $322.29 $252.30$390.34 $373.01 $359.00 $316.03 $288.94 $287.19 $287.85 $328.34 $257.04$397.24 $379.60 $365.35 $321.61 $294.04 $292.26 $292.93 $334.14 $261.58$406.83 $388.77 $374.17 $329.38 $301.14 $299.32 $300.01 $342.21 $267.89$418.82 $400.23 $385.20 $339.09 $310.02 $308.14 $308.85 $352.30 $275.79$432.91 $413.69 $398.16 $350.50 $320.45 $318.51 $319.24 $364.15 $285.07$449.70 $429.73 $413.60 $364.09 $332.88 $330.86 $331.62 $378.28 $296.12$468.59 $447.78 $430.97 $379.38 $346.86 $344.76 $345.55 $394.16 $308.56$490.17 $468.41 $450.82 $396.86 $362.84 $360.64 $361.47 $412.32 $322.77$511.46 $488.75 $470.40 $414.09 $378.59 $376.30 $377.16 $430.23 $336.79$535.44 $511.67 $492.46 $433.51 $396.35 $393.95 $394.85 $450.40 $352.58$559.13 $534.30 $514.24 $452.69 $413.88 $411.37 $412.31 $470.32 $368.18$585.21 $559.23 $538.23 $473.80 $433.19 $430.56 $431.55 $492.26 $385.36$611.59 $584.44 $562.50 $495.16 $452.71 $449.97 $451.00 $514.45 $402.73$640.07 $611.66 $588.69 $518.22 $473.80 $470.93 $472.01 $538.41 $421.48$668.56 $638.87 $614.89 $541.28 $494.88 $491.88 $493.01 $562.37 $440.24$699.44 $668.38 $643.29 $566.28 $517.74 $514.60 $515.78 $588.34 $460.57$730.61 $698.18 $671.96 $591.53 $540.82 $537.54 $538.77 $614.57 $481.10$763.89 $729.98 $702.57 $618.47 $565.45 $562.02 $563.31 $642.56 $503.02$780.38 $745.73 $717.73 $631.82 $577.65 $574.15 $575.47 $656.43 $513.87$813.66 $777.53 $748.34 $658.76 $602.29 $598.64 $600.01 $684.43 $535.79$842.44 $805.04 $774.81 $682.06 $623.59 $619.81 $621.23 $708.64 $554.74$861.33 $823.08 $792.18 $697.36 $637.57 $633.71 $635.16 $724.52 $567.18$885.01 $845.72 $813.97 $716.53 $655.10 $651.13 $652.63 $744.45 $582.77$899.40 $859.47 $827.20 $728.18 $665.76 $661.72 $663.24 $756.55 $592.25
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5 Area 6Moda Health Plan Inc
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A
$214.17 $193.77 $209.80 $176.00 $142.93 $243.18 $240.03 $226.95 $220.54$337.28 $305.15 $330.39 $277.16 $225.09 $382.95 $378.01 $357.40 $347.30$337.28 $305.15 $330.39 $277.16 $225.09 $382.95 $378.01 $357.40 $347.30$337.28 $305.15 $330.39 $277.16 $225.09 $382.95 $378.01 $357.40 $347.30$337.28 $305.15 $330.39 $277.16 $225.09 $382.95 $378.01 $357.40 $347.30$338.63 $306.37 $331.71 $278.27 $225.99 $384.49 $379.52 $358.83 $348.69$345.37 $312.47 $338.32 $283.82 $230.49 $392.14 $387.08 $365.97 $355.64$353.47 $319.80 $346.24 $290.47 $235.89 $401.34 $396.15 $374.55 $363.98$366.62 $331.70 $359.13 $301.28 $244.67 $416.27 $410.89 $388.49 $377.52$377.42 $341.46 $369.70 $310.15 $251.87 $428.52 $422.99 $399.93 $388.63$382.81 $346.35 $374.99 $314.58 $255.47 $434.65 $429.04 $405.64 $394.19$390.91 $353.67 $382.92 $321.23 $260.87 $443.84 $438.11 $414.22 $402.53$399.00 $360.99 $390.85 $327.88 $266.28 $453.03 $447.18 $422.80 $410.86$404.06 $365.57 $395.80 $332.04 $269.65 $458.78 $452.85 $428.16 $416.07$409.46 $370.45 $401.09 $336.48 $273.25 $464.91 $458.90 $433.88 $421.63$412.16 $372.89 $403.73 $338.69 $275.05 $467.97 $461.93 $436.74 $424.41$414.85 $375.34 $406.37 $340.91 $276.86 $471.03 $464.95 $439.60 $427.18$417.55 $377.78 $409.02 $343.13 $278.66 $474.10 $467.97 $442.46 $429.96$420.25 $380.22 $411.66 $345.35 $280.46 $477.16 $471.00 $445.31 $432.74$425.65 $385.10 $416.95 $349.78 $284.06 $483.29 $477.05 $451.03 $438.30$431.04 $389.98 $422.23 $354.21 $287.66 $489.41 $483.09 $456.75 $443.86$439.14 $397.31 $430.16 $360.87 $293.06 $498.61 $492.17 $465.33 $452.19$446.90 $404.33 $437.76 $367.24 $298.24 $507.41 $500.86 $473.55 $460.18$457.69 $414.09 $448.33 $376.11 $305.44 $519.67 $512.96 $484.99 $471.29$471.18 $426.30 $461.55 $387.20 $314.44 $534.99 $528.08 $499.28 $485.18$487.03 $440.64 $477.08 $400.22 $325.02 $552.98 $545.84 $516.08 $501.51$505.92 $457.73 $495.58 $415.74 $337.63 $574.43 $567.01 $536.09 $520.96$527.17 $476.95 $516.39 $433.21 $351.81 $598.56 $590.83 $558.61 $542.84$551.45 $498.92 $540.18 $453.16 $368.02 $626.13 $618.04 $584.34 $567.84$575.40 $520.59 $563.64 $472.84 $384.00 $653.32 $644.88 $609.72 $592.50$602.38 $545.00 $590.07 $495.01 $402.00 $683.95 $675.12 $638.31 $620.29$629.03 $569.11 $616.17 $516.91 $419.79 $714.21 $704.98 $666.54 $647.72$658.37 $595.66 $644.91 $541.02 $439.37 $747.52 $737.87 $697.64 $677.94$688.05 $622.51 $673.99 $565.41 $459.18 $781.22 $771.14 $729.09 $708.50$720.09 $651.50 $705.37 $591.74 $480.56 $817.61 $807.05 $763.04 $741.50$752.13 $680.49 $736.76 $618.07 $501.94 $853.99 $842.96 $796.99 $774.49$786.87 $711.92 $770.79 $646.62 $525.13 $893.43 $881.89 $833.80 $810.26$821.95 $743.65 $805.15 $675.45 $548.53 $933.26 $921.20 $870.97 $846.38$859.39 $777.53 $841.82 $706.21 $573.52 $975.77 $963.16 $910.64 $884.93$877.94 $794.31 $859.99 $721.46 $585.90 $996.83 $983.95 $930.30 $904.03$915.38 $828.18 $896.67 $752.22 $610.88 $1,039.34 $1,025.91 $969.97 $942.58$947.76 $857.48 $928.38 $778.83 $632.49 $1,076.10 $1,062.20 $1,004.28 $975.93$969.01 $876.70 $949.20 $796.29 $646.67 $1,100.22 $1,086.02 $1,026.80 $997.81$995.65 $900.81 $975.30 $818.19 $664.45 $1,130.48 $1,115.88 $1,055.03 $1,025.24
$1,011.84 $915.45 $991.16 $831.49 $675.26 $1,148.86 $1,134.02 $1,072.19 $1,041.91
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500
$220.13 $214.67 $192.93 $189.31 $192.74 $186.09 $181.12 $176.70 $172.67$346.65 $338.07 $303.83 $298.12 $303.53 $293.05 $285.23 $278.27 $271.92$346.65 $338.07 $303.83 $298.12 $303.53 $293.05 $285.23 $278.27 $271.92$346.65 $338.07 $303.83 $298.12 $303.53 $293.05 $285.23 $278.27 $271.92$346.65 $338.07 $303.83 $298.12 $303.53 $293.05 $285.23 $278.27 $271.92$348.04 $339.42 $305.04 $299.32 $304.75 $294.23 $286.38 $279.38 $273.01$354.97 $346.18 $311.12 $305.28 $310.82 $300.09 $292.08 $284.95 $278.45$363.29 $354.29 $318.41 $312.43 $318.10 $307.12 $298.93 $291.62 $284.97$376.81 $367.48 $330.26 $324.06 $329.94 $318.55 $310.05 $302.48 $295.58$387.91 $378.30 $339.99 $333.60 $339.65 $327.93 $319.18 $311.38 $304.28$393.45 $383.71 $344.85 $338.37 $344.51 $332.62 $323.74 $315.83 $308.63$401.77 $391.82 $352.14 $345.53 $351.80 $339.65 $330.59 $322.51 $315.16$410.09 $399.93 $359.43 $352.68 $359.08 $346.68 $337.43 $329.19 $321.68$415.29 $405.00 $363.99 $357.15 $363.63 $351.08 $341.71 $333.36 $325.76$420.84 $410.41 $368.85 $361.92 $368.49 $355.77 $346.27 $337.82 $330.11$423.61 $413.12 $371.28 $364.31 $370.92 $358.11 $348.56 $340.04 $332.29$426.38 $415.82 $373.71 $366.69 $373.35 $360.46 $350.84 $342.27 $334.46$429.16 $418.53 $376.14 $369.08 $375.78 $362.80 $353.12 $344.50 $336.64$431.93 $421.23 $378.57 $371.46 $378.20 $365.15 $355.40 $346.72 $338.81$437.48 $426.64 $383.43 $376.23 $383.06 $369.83 $359.97 $351.17 $343.16$443.02 $432.05 $388.29 $381.00 $387.92 $374.52 $364.53 $355.63 $347.51$451.34 $440.16 $395.59 $388.16 $395.20 $381.56 $371.37 $362.30 $354.04$459.32 $447.94 $402.57 $395.01 $402.18 $388.30 $377.94 $368.70 $360.29$470.41 $458.76 $412.30 $404.55 $411.90 $397.67 $387.06 $377.61 $369.00$484.28 $472.28 $424.45 $416.48 $424.04 $409.40 $398.47 $388.74 $379.87$500.57 $488.17 $438.73 $430.49 $438.30 $423.17 $411.88 $401.82 $392.65$519.98 $507.10 $455.74 $447.19 $455.30 $439.58 $427.85 $417.40 $407.88$541.82 $528.40 $474.89 $465.97 $474.42 $458.04 $445.82 $434.93 $425.01$566.78 $552.74 $496.76 $487.43 $496.28 $479.14 $466.36 $454.97 $444.59$591.39 $576.74 $518.33 $508.60 $517.83 $499.95 $486.61 $474.72 $463.90$619.12 $603.79 $542.64 $532.45 $542.11 $523.40 $509.43 $496.99 $485.65$646.51 $630.49 $566.64 $556.00 $566.09 $546.55 $531.96 $518.97 $507.13$676.67 $659.91 $593.08 $581.94 $592.50 $572.04 $556.78 $543.18 $530.79$707.18 $689.66 $619.81 $608.17 $619.21 $597.83 $581.88 $567.67 $554.72$740.11 $721.77 $648.68 $636.50 $648.05 $625.67 $608.97 $594.10 $580.55$773.04 $753.89 $677.54 $664.82 $676.88 $653.51 $636.07 $620.54 $606.38$808.74 $788.71 $708.83 $695.52 $708.15 $683.70 $665.45 $649.20 $634.39$844.80 $823.87 $740.43 $726.53 $739.71 $714.17 $695.12 $678.14 $662.67$883.28 $861.39 $774.16 $759.62 $773.41 $746.70 $726.78 $709.03 $692.85$902.34 $879.99 $790.87 $776.02 $790.10 $762.82 $742.46 $724.33 $707.81$940.82 $917.51 $824.59 $809.11 $823.79 $795.35 $774.13 $755.22 $737.99$974.10 $949.97 $853.76 $837.73 $852.93 $823.48 $801.51 $781.93 $764.10$995.94 $971.26 $872.90 $856.51 $872.05 $841.95 $819.48 $799.46 $781.23
$1,023.32 $997.97 $896.91 $880.06 $896.03 $865.10 $842.01 $821.45 $802.71$1,039.96 $1,014.20 $911.49 $894.37 $910.60 $879.16 $855.70 $834.80 $815.76
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
$163.26 $184.79 $179.44 $156.47 $144.81 $196.08 $187.38 $180.34 $158.76$257.10 $291.01 $282.58 $246.41 $228.05 $308.79 $295.08 $284.01 $250.01$257.10 $291.01 $282.58 $246.41 $228.05 $308.79 $295.08 $284.01 $250.01$257.10 $291.01 $282.58 $246.41 $228.05 $308.79 $295.08 $284.01 $250.01$257.10 $291.01 $282.58 $246.41 $228.05 $308.79 $295.08 $284.01 $250.01$258.13 $292.17 $283.71 $247.39 $228.96 $310.03 $296.26 $285.14 $251.01$263.27 $297.99 $289.36 $252.32 $233.52 $316.21 $302.17 $290.82 $256.01$269.44 $304.98 $296.14 $258.23 $239.00 $323.62 $309.25 $297.64 $262.01$279.46 $316.33 $307.16 $267.84 $247.89 $335.66 $320.76 $308.71 $271.76$287.69 $325.64 $316.21 $275.73 $255.19 $345.54 $330.20 $317.80 $279.76$291.81 $330.30 $320.73 $279.67 $258.84 $350.48 $334.92 $322.35 $283.76$297.98 $337.28 $327.51 $285.59 $264.31 $357.89 $342.00 $329.16 $289.76$304.15 $344.26 $334.29 $291.50 $269.78 $365.30 $349.08 $335.98 $295.76$308.00 $348.63 $338.53 $295.19 $273.20 $369.94 $353.51 $340.24 $299.51$312.12 $353.29 $343.05 $299.14 $276.85 $374.88 $358.23 $344.78 $303.51$314.17 $355.61 $345.31 $301.11 $278.68 $377.35 $360.59 $347.05 $305.51$316.23 $357.94 $347.57 $303.08 $280.50 $379.82 $362.95 $349.33 $307.51$318.29 $360.27 $349.83 $305.05 $282.33 $382.29 $365.31 $351.60 $309.51$320.34 $362.60 $352.09 $307.02 $284.15 $384.76 $367.68 $353.87 $311.51$324.46 $367.25 $356.61 $310.96 $287.80 $389.70 $372.40 $358.41 $315.51$328.57 $371.91 $361.14 $314.91 $291.45 $394.64 $377.12 $362.96 $319.51$334.74 $378.89 $367.92 $320.82 $296.92 $402.05 $384.20 $369.78 $325.51$340.65 $385.59 $374.42 $326.49 $302.17 $409.15 $390.99 $376.31 $331.26$348.88 $394.90 $383.46 $334.37 $309.46 $419.03 $400.43 $385.40 $339.26$359.17 $406.54 $394.76 $344.23 $318.59 $431.39 $412.23 $396.76 $349.26$371.25 $420.22 $408.04 $355.81 $329.30 $445.90 $426.10 $410.10 $361.01$385.65 $436.51 $423.87 $369.61 $342.08 $463.19 $442.63 $426.01 $375.01$401.84 $454.85 $441.67 $385.13 $356.44 $482.65 $461.22 $443.90 $390.76$420.35 $475.80 $462.02 $402.87 $372.86 $504.88 $482.46 $464.35 $408.76$438.61 $496.46 $482.08 $420.37 $389.05 $526.80 $503.41 $484.51 $426.52$459.18 $519.74 $504.69 $440.08 $407.30 $551.51 $527.02 $507.23 $446.52$479.49 $542.73 $527.01 $459.55 $425.31 $575.90 $550.33 $529.67 $466.27$501.85 $568.05 $551.59 $480.99 $445.15 $602.77 $576.00 $554.38 $488.02$524.48 $593.66 $576.46 $502.67 $465.22 $629.94 $601.97 $579.37 $510.02$548.90 $621.30 $603.31 $526.08 $486.89 $659.28 $630.01 $606.35 $533.77$573.33 $648.95 $630.15 $549.49 $508.55 $688.61 $658.04 $633.33 $557.52$599.81 $678.92 $659.26 $574.87 $532.04 $720.42 $688.43 $662.58 $583.27$626.55 $709.19 $688.64 $600.49 $555.76 $752.53 $719.12 $692.12 $609.27$655.08 $741.49 $720.01 $627.84 $581.07 $786.81 $751.87 $723.65 $637.02$669.22 $757.50 $735.55 $641.40 $593.62 $803.79 $768.10 $739.27 $650.77$697.76 $789.80 $766.92 $668.75 $618.93 $838.07 $800.86 $770.79 $678.52$722.44 $817.74 $794.05 $692.40 $640.82 $867.71 $829.19 $798.06 $702.53$738.64 $836.07 $811.85 $707.93 $655.19 $887.17 $847.78 $815.95 $718.28$758.95 $859.06 $834.17 $727.39 $673.20 $911.56 $871.09 $838.38 $738.03$771.29 $873.03 $847.74 $739.22 $684.15 $926.38 $885.25 $852.02 $750.03
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Summit
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
Moda Health
Summit
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Platinum
Summit
Exclusive 250
$145.15 $144.27 $144.60 $164.94 $170.57 $129.12 $133.23 $220.60 $228.59$228.58 $227.19 $227.71 $259.75 $268.61 $203.34 $209.81 $347.40 $359.98$228.58 $227.19 $227.71 $259.75 $268.61 $203.34 $209.81 $347.40 $359.98$228.58 $227.19 $227.71 $259.75 $268.61 $203.34 $209.81 $347.40 $359.98$228.58 $227.19 $227.71 $259.75 $268.61 $203.34 $209.81 $347.40 $359.98$229.49 $228.10 $228.62 $260.79 $269.69 $204.15 $210.65 $348.79 $361.42$234.06 $232.64 $233.18 $265.98 $275.06 $208.22 $214.84 $355.74 $368.62$239.55 $238.10 $238.64 $272.22 $281.50 $213.10 $219.88 $364.07 $377.26$248.46 $246.96 $247.52 $282.35 $291.98 $221.03 $228.06 $377.62 $391.30$255.78 $254.23 $254.81 $290.66 $300.58 $227.54 $234.77 $388.74 $402.82$259.43 $257.86 $258.45 $294.82 $304.87 $230.79 $238.13 $394.30 $408.58$264.92 $263.31 $263.92 $301.05 $311.32 $235.67 $243.17 $402.63 $417.22$270.41 $268.77 $269.38 $307.28 $317.77 $240.55 $248.20 $410.97 $425.86$273.83 $272.18 $272.80 $311.18 $321.80 $243.60 $251.35 $416.18 $431.26$277.49 $275.81 $276.44 $315.34 $326.09 $246.85 $254.71 $421.74 $437.02$279.32 $277.63 $278.26 $317.41 $328.24 $248.48 $256.38 $424.52 $439.90$281.15 $279.45 $280.09 $319.49 $330.39 $250.11 $258.06 $427.30 $442.78$282.98 $281.26 $281.91 $321.57 $332.54 $251.73 $259.74 $430.08 $445.66$284.81 $283.08 $283.73 $323.65 $334.69 $253.36 $261.42 $432.86 $448.54$288.46 $286.72 $287.37 $327.80 $338.99 $256.61 $264.78 $438.42 $454.30$292.12 $290.35 $291.02 $331.96 $343.28 $259.87 $268.13 $443.98 $460.06$297.61 $295.80 $296.48 $338.19 $349.73 $264.75 $273.17 $452.31 $468.70$302.86 $301.03 $301.72 $344.17 $355.91 $269.42 $277.99 $460.30 $476.98$310.18 $308.30 $309.01 $352.48 $364.51 $275.93 $284.71 $471.42 $488.49$319.32 $317.39 $318.11 $362.87 $375.25 $284.06 $293.10 $485.32 $502.89$330.06 $328.06 $328.82 $375.08 $387.87 $293.62 $302.96 $501.64 $519.81$342.86 $340.79 $341.57 $389.62 $402.92 $305.01 $314.71 $521.10 $539.97$357.27 $355.10 $355.91 $405.99 $419.84 $317.82 $327.93 $542.98 $562.65$373.72 $371.46 $372.31 $424.69 $439.18 $332.46 $343.03 $568.00 $588.57$389.95 $387.59 $388.48 $443.13 $458.25 $346.89 $357.93 $592.66 $614.13$408.24 $405.76 $406.69 $463.91 $479.74 $363.16 $374.71 $620.45 $642.93$426.30 $423.71 $424.68 $484.43 $500.96 $379.23 $391.29 $647.90 $671.37$446.18 $443.48 $444.49 $507.03 $524.33 $396.92 $409.54 $678.12 $702.68$466.30 $463.47 $464.53 $529.89 $547.97 $414.81 $428.01 $708.69 $734.36$488.01 $485.05 $486.17 $554.56 $573.48 $434.13 $447.94 $741.70 $768.56$509.73 $506.64 $507.80 $579.24 $599.00 $453.44 $467.87 $774.70 $802.76$533.27 $530.04 $531.25 $605.99 $626.67 $474.39 $489.48 $810.48 $839.84$557.04 $553.67 $554.94 $633.01 $654.60 $495.54 $511.30 $846.61 $877.28$582.41 $578.88 $580.21 $661.84 $684.42 $518.11 $534.59 $885.17 $917.23$594.98 $591.38 $592.74 $676.13 $699.19 $529.29 $546.13 $904.28 $937.03$620.36 $616.60 $618.01 $704.96 $729.01 $551.86 $569.42 $942.84 $976.99$642.30 $638.41 $639.87 $729.89 $754.80 $571.38 $589.56 $976.19 $1,011.55$656.70 $652.72 $654.22 $746.26 $771.72 $584.19 $602.77 $998.08 $1,034.23$674.76 $670.67 $672.21 $766.78 $792.94 $600.25 $619.35 $1,025.52 $1,062.67$685.73 $681.57 $683.14 $779.25 $805.83 $610.01 $629.42 $1,042.20 $1,079.94
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7Moda Health Plan Inc
PPO Synergy
Exclusive
1000A
PPO Summit
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A
$199.58 $206.73 $216.09 $181.28 $147.22 $245.54 $242.37 $229.15 $222.68$314.31 $325.56 $340.30 $285.48 $231.84 $386.67 $381.68 $360.87 $350.68$314.31 $325.56 $340.30 $285.48 $231.84 $386.67 $381.68 $360.87 $350.68$314.31 $325.56 $340.30 $285.48 $231.84 $386.67 $381.68 $360.87 $350.68$314.31 $325.56 $340.30 $285.48 $231.84 $386.67 $381.68 $360.87 $350.68$315.56 $326.87 $341.66 $286.62 $232.77 $388.22 $383.20 $362.31 $352.08$321.85 $333.38 $348.46 $292.33 $237.40 $395.95 $390.84 $369.53 $359.09$329.39 $341.19 $356.63 $299.18 $242.97 $405.23 $400.00 $378.19 $367.51$341.65 $353.89 $369.90 $310.31 $252.01 $420.31 $414.88 $392.26 $381.19$351.71 $364.31 $380.79 $319.45 $259.43 $432.69 $427.10 $403.81 $392.41$356.74 $369.52 $386.24 $324.02 $263.14 $438.87 $433.20 $409.58 $398.02$364.28 $377.33 $394.40 $330.87 $268.70 $448.15 $442.36 $418.24 $406.43$371.82 $385.14 $402.57 $337.72 $274.26 $457.43 $451.52 $426.90 $414.85$376.54 $390.03 $407.68 $342.00 $277.74 $463.23 $457.25 $432.32 $420.11$381.57 $395.24 $413.12 $346.57 $281.45 $469.42 $463.36 $438.09 $425.72$384.08 $397.84 $415.84 $348.85 $283.31 $472.51 $466.41 $440.98 $428.53$386.60 $400.44 $418.57 $351.14 $285.16 $475.61 $469.46 $443.86 $431.33$389.11 $403.05 $421.29 $353.42 $287.02 $478.70 $472.52 $446.75 $434.14$391.63 $405.65 $424.01 $355.71 $288.87 $481.79 $475.57 $449.64 $436.94$396.65 $410.86 $429.46 $360.27 $292.58 $487.98 $481.68 $455.41 $442.55$401.68 $416.07 $434.90 $364.84 $296.29 $494.17 $487.78 $461.19 $448.16$409.23 $423.89 $443.07 $371.69 $301.85 $503.45 $496.94 $469.85 $456.58$416.46 $431.37 $450.89 $378.26 $307.19 $512.34 $505.72 $478.15 $464.65$426.51 $441.79 $461.78 $387.39 $314.60 $524.71 $517.94 $489.69 $475.87$439.09 $454.81 $475.40 $398.81 $323.88 $540.18 $533.20 $504.13 $489.89$453.86 $470.12 $491.39 $412.23 $334.77 $558.35 $551.14 $521.09 $506.38$471.46 $488.35 $510.45 $428.22 $347.76 $580.01 $572.52 $541.30 $526.01$491.26 $508.86 $531.88 $446.20 $362.36 $604.37 $596.56 $564.03 $548.11$513.89 $532.30 $556.39 $466.76 $379.06 $632.21 $624.04 $590.01 $573.36$536.21 $555.41 $580.55 $487.03 $395.52 $659.66 $651.14 $615.64 $598.25$561.35 $581.46 $607.77 $509.86 $414.06 $690.59 $681.68 $644.51 $626.31$586.18 $607.18 $634.65 $532.42 $432.38 $721.14 $711.83 $673.01 $654.01$613.52 $635.50 $664.26 $557.25 $452.55 $754.78 $745.03 $704.41 $684.52$641.18 $664.15 $694.21 $582.38 $472.95 $788.81 $778.62 $736.17 $715.38$671.04 $695.08 $726.54 $609.50 $494.97 $825.54 $814.88 $770.45 $748.69$700.90 $726.01 $758.86 $636.62 $517.00 $862.28 $851.14 $804.73 $782.01$733.28 $759.54 $793.91 $666.02 $540.88 $902.10 $890.45 $841.90 $818.13$765.96 $793.40 $829.30 $695.71 $564.99 $942.32 $930.15 $879.43 $854.60$800.85 $829.54 $867.08 $727.40 $590.72 $985.24 $972.51 $919.48 $893.52$818.14 $847.44 $885.79 $743.10 $603.48 $1,006.51 $993.51 $939.33 $912.81$853.03 $883.58 $923.57 $774.79 $629.21 $1,049.43 $1,035.87 $979.39 $951.74$883.20 $914.84 $956.24 $802.19 $651.47 $1,086.55 $1,072.51 $1,014.03 $985.40$903.00 $935.35 $977.67 $820.18 $666.07 $1,110.91 $1,096.56 $1,036.77 $1,007.49$927.83 $961.07 $1,004.56 $842.73 $684.39 $1,141.45 $1,126.71 $1,065.27 $1,035.20$942.92 $976.69 $1,020.89 $856.43 $695.52 $1,160.01 $1,145.03 $1,082.60 $1,052.03
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7
PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500
$222.26 $216.76 $194.80 $191.15 $194.62 $187.90 $182.88 $178.42 $174.35$350.02 $341.35 $306.78 $301.02 $306.48 $295.90 $288.00 $280.97 $274.56$350.02 $341.35 $306.78 $301.02 $306.48 $295.90 $288.00 $280.97 $274.56$350.02 $341.35 $306.78 $301.02 $306.48 $295.90 $288.00 $280.97 $274.56$350.02 $341.35 $306.78 $301.02 $306.48 $295.90 $288.00 $280.97 $274.56$351.42 $342.71 $308.01 $302.22 $307.71 $297.08 $289.16 $282.09 $275.66$358.42 $349.54 $314.14 $308.24 $313.84 $303.00 $294.92 $287.71 $281.15$366.82 $357.73 $321.50 $315.47 $321.19 $310.10 $301.83 $294.46 $287.74$380.47 $371.05 $333.47 $327.21 $333.15 $321.64 $313.06 $305.41 $298.45$391.67 $381.97 $343.29 $336.84 $342.95 $331.11 $322.28 $314.40 $307.23$397.27 $387.43 $348.19 $341.66 $347.86 $335.85 $326.88 $318.90 $311.63$405.67 $395.62 $355.56 $348.88 $355.21 $342.95 $333.80 $325.64 $318.22$414.07 $403.82 $362.92 $356.11 $362.57 $350.05 $340.71 $332.39 $324.81$419.32 $408.94 $367.52 $360.62 $367.16 $354.49 $345.03 $336.60 $328.92$424.92 $414.40 $372.43 $365.44 $372.07 $359.22 $349.64 $341.10 $333.32$427.72 $417.13 $374.88 $367.85 $374.52 $361.59 $351.94 $343.34 $335.51$430.52 $419.86 $377.34 $370.25 $376.97 $363.96 $354.24 $345.59 $337.71$433.32 $422.59 $379.79 $372.66 $379.42 $366.32 $356.55 $347.84 $339.91$436.12 $425.32 $382.25 $375.07 $381.88 $368.69 $358.85 $350.09 $342.10$441.73 $430.78 $387.16 $379.89 $386.78 $373.43 $363.46 $354.58 $346.50$447.33 $436.24 $392.06 $384.70 $391.68 $378.16 $368.07 $359.08 $350.89$455.73 $444.44 $399.43 $391.93 $399.04 $385.26 $374.98 $365.82 $357.48$463.78 $452.29 $406.48 $398.85 $406.09 $392.07 $381.60 $372.28 $363.79$474.98 $463.21 $416.30 $408.48 $415.90 $401.54 $390.82 $381.28 $372.58$488.98 $476.86 $428.57 $420.52 $428.15 $413.37 $402.34 $392.51 $383.56$505.43 $492.91 $442.99 $434.67 $442.56 $427.28 $415.88 $405.72 $396.47$525.03 $512.02 $460.17 $451.53 $459.72 $443.85 $432.01 $421.45 $411.84$547.08 $533.53 $479.50 $470.49 $479.03 $462.49 $450.15 $439.15 $429.14$572.28 $558.10 $501.58 $492.17 $501.10 $483.80 $470.89 $459.38 $448.91$597.13 $582.34 $523.37 $513.54 $522.86 $504.80 $491.33 $479.33 $468.40$625.14 $609.65 $547.91 $537.62 $547.38 $528.48 $514.37 $501.81 $490.36$652.79 $636.61 $572.14 $561.40 $571.59 $551.85 $537.13 $524.01 $512.06$683.24 $666.31 $598.83 $587.59 $598.25 $577.60 $562.18 $548.45 $535.94$714.04 $696.35 $625.83 $614.08 $625.22 $603.63 $587.53 $573.18 $560.10$747.29 $728.78 $654.97 $642.68 $654.34 $631.75 $614.89 $599.87 $586.19$780.54 $761.21 $684.12 $671.27 $683.45 $659.86 $642.25 $626.56 $612.27$816.60 $796.37 $715.72 $702.28 $715.02 $690.33 $671.91 $655.50 $640.55$853.00 $831.87 $747.62 $733.58 $746.89 $721.11 $701.86 $684.72 $669.10$891.85 $869.76 $781.67 $767.00 $780.91 $753.95 $733.83 $715.91 $699.58$911.10 $888.53 $798.55 $783.55 $797.77 $770.23 $749.67 $731.36 $714.68$949.95 $926.42 $832.60 $816.97 $831.79 $803.07 $781.64 $762.55 $745.16$983.56 $959.19 $862.05 $845.86 $861.21 $831.48 $809.29 $789.52 $771.51
$1,005.61 $980.69 $881.38 $864.83 $880.52 $850.12 $827.43 $807.22 $788.81$1,033.26 $1,007.66 $905.61 $888.61 $904.73 $873.50 $850.19 $829.42 $810.50$1,050.06 $1,024.05 $920.34 $903.06 $919.44 $887.70 $864.01 $842.91 $823.68
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
$164.84 $186.58 $181.18 $157.99 $146.22 $197.99 $189.20 $182.09 $160.30$259.59 $293.83 $285.32 $248.80 $230.26 $311.79 $297.95 $286.76 $252.44$259.59 $293.83 $285.32 $248.80 $230.26 $311.79 $297.95 $286.76 $252.44$259.59 $293.83 $285.32 $248.80 $230.26 $311.79 $297.95 $286.76 $252.44$259.59 $293.83 $285.32 $248.80 $230.26 $311.79 $297.95 $286.76 $252.44$260.63 $295.01 $286.46 $249.79 $231.19 $313.04 $299.14 $287.91 $253.45$265.82 $300.89 $292.17 $254.77 $235.79 $319.28 $305.10 $293.65 $258.49$272.05 $307.94 $299.02 $260.74 $241.32 $326.76 $312.25 $300.53 $264.55$282.18 $319.40 $310.15 $270.44 $250.30 $338.92 $323.87 $311.71 $274.40$290.49 $328.80 $319.28 $278.41 $257.67 $348.90 $333.41 $320.89 $282.48$294.64 $333.50 $323.84 $282.39 $261.35 $353.88 $338.17 $325.48 $286.52$300.87 $340.55 $330.69 $288.36 $266.88 $361.37 $345.32 $332.36 $292.57$307.10 $347.61 $337.54 $294.33 $272.40 $368.85 $352.47 $339.24 $298.63$310.99 $352.01 $341.82 $298.06 $275.86 $373.53 $356.94 $343.54 $302.42$315.15 $356.72 $346.38 $302.04 $279.54 $378.52 $361.71 $348.13 $306.46$317.22 $359.07 $348.66 $304.03 $281.38 $381.01 $364.09 $350.42 $308.48$319.30 $361.42 $350.95 $306.02 $283.23 $383.51 $366.48 $352.72 $310.50$321.38 $363.77 $353.23 $308.01 $285.07 $386.00 $368.86 $355.01 $312.52$323.45 $366.12 $355.51 $310.00 $286.91 $388.49 $371.24 $357.31 $314.54$327.61 $370.82 $360.08 $313.98 $290.59 $393.48 $376.01 $361.89 $318.57$331.76 $375.52 $364.64 $317.96 $294.28 $398.47 $380.78 $366.48 $322.61$337.99 $382.57 $371.49 $323.94 $299.80 $405.95 $387.93 $373.37 $328.67$343.96 $389.33 $378.05 $329.66 $305.10 $413.13 $394.78 $379.96 $334.48$352.27 $398.73 $387.18 $337.62 $312.47 $423.10 $404.32 $389.14 $342.56$362.65 $410.49 $398.60 $347.57 $321.68 $435.57 $416.24 $400.61 $352.65$374.85 $424.30 $412.01 $359.27 $332.50 $450.23 $430.24 $414.09 $364.52$389.39 $440.75 $427.98 $373.20 $345.40 $467.69 $446.92 $430.14 $378.65$405.74 $459.26 $445.96 $388.87 $359.90 $487.33 $465.69 $448.21 $394.56$424.44 $480.42 $466.50 $406.79 $376.48 $509.78 $487.15 $468.86 $412.73$442.87 $501.28 $486.76 $424.45 $392.83 $531.92 $508.30 $489.22 $430.66$463.63 $524.79 $509.59 $444.35 $411.25 $556.86 $532.14 $512.16 $450.85$484.14 $548.00 $532.13 $464.01 $429.44 $581.49 $555.68 $534.81 $470.79$506.73 $573.57 $556.95 $485.66 $449.48 $608.62 $581.60 $559.76 $492.76$529.57 $599.42 $582.06 $507.55 $469.74 $636.06 $607.82 $585.00 $514.97$554.23 $627.34 $609.16 $531.19 $491.61 $665.68 $636.12 $612.24 $538.95$578.89 $655.25 $636.27 $554.82 $513.49 $695.30 $664.43 $639.48 $562.93$605.63 $685.52 $665.66 $580.45 $537.21 $727.41 $695.12 $669.02 $588.93$632.63 $716.08 $695.33 $606.32 $561.15 $759.84 $726.10 $698.84 $615.19$661.44 $748.69 $727.00 $633.94 $586.71 $794.45 $759.17 $730.67 $643.21$675.72 $764.85 $742.69 $647.62 $599.38 $811.60 $775.56 $746.44 $657.09$704.54 $797.47 $774.36 $675.24 $624.94 $846.21 $808.63 $778.27 $685.11$729.46 $825.68 $801.76 $699.12 $647.04 $876.14 $837.24 $805.80 $709.35$745.81 $844.19 $819.73 $714.80 $661.55 $895.78 $856.01 $823.87 $725.25$766.32 $867.40 $842.27 $734.45 $679.74 $920.41 $879.55 $846.52 $745.19$778.78 $881.50 $855.97 $746.40 $690.79 $935.38 $893.85 $860.29 $757.31
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
$146.56 $145.67 $146.00 $166.54 $130.37 $222.74 $201.52 $218.19 $183.04$230.80 $229.40 $229.92 $262.27 $205.31 $350.77 $317.36 $343.60 $288.25$230.80 $229.40 $229.92 $262.27 $205.31 $350.77 $317.36 $343.60 $288.25$230.80 $229.40 $229.92 $262.27 $205.31 $350.77 $317.36 $343.60 $288.25$230.80 $229.40 $229.92 $262.27 $205.31 $350.77 $317.36 $343.60 $288.25$231.72 $230.31 $230.84 $263.32 $206.13 $352.17 $318.63 $344.98 $289.40$236.33 $234.90 $235.44 $268.57 $210.24 $359.19 $324.97 $351.85 $295.17$241.87 $240.41 $240.96 $274.86 $215.17 $367.61 $332.59 $360.09 $302.09$250.87 $249.35 $249.93 $285.09 $223.17 $381.29 $344.97 $373.49 $313.33$258.26 $256.70 $257.28 $293.48 $229.74 $392.51 $355.12 $384.49 $322.55$261.95 $260.37 $260.96 $297.68 $233.03 $398.13 $360.20 $389.99 $327.16$267.49 $265.87 $266.48 $303.97 $237.96 $406.54 $367.82 $398.23 $334.08$273.03 $271.38 $272.00 $310.27 $242.88 $414.96 $375.43 $406.48 $341.00$276.49 $274.82 $275.45 $314.20 $245.96 $420.22 $380.19 $411.63 $345.32$280.19 $278.49 $279.13 $318.40 $249.25 $425.84 $385.27 $417.13 $349.94$282.03 $280.32 $280.97 $320.49 $250.89 $428.64 $387.81 $419.88 $352.24$283.88 $282.16 $282.81 $322.59 $252.53 $431.45 $390.35 $422.63 $354.55$285.73 $283.99 $284.64 $324.69 $254.18 $434.25 $392.89 $425.38 $356.85$287.57 $285.83 $286.48 $326.79 $255.82 $437.06 $395.43 $428.13 $359.16$291.26 $289.50 $290.16 $330.99 $259.10 $442.67 $400.50 $433.62 $363.77$294.96 $293.17 $293.84 $335.18 $262.39 $448.29 $405.58 $439.12 $368.38$300.50 $298.67 $299.36 $341.48 $267.32 $456.70 $413.20 $447.37 $375.30$305.80 $303.95 $304.65 $347.51 $272.04 $464.77 $420.50 $455.27 $381.93$313.19 $311.29 $312.01 $355.90 $278.61 $476.00 $430.65 $466.27 $391.15$322.42 $320.47 $321.20 $366.39 $286.82 $490.03 $443.35 $480.01 $402.68$333.27 $331.25 $332.01 $378.72 $296.47 $506.51 $458.26 $496.16 $416.23$346.19 $344.10 $344.88 $393.41 $307.97 $526.16 $476.04 $515.40 $432.37$360.73 $358.55 $359.37 $409.93 $320.90 $548.26 $496.03 $537.05 $450.53$377.35 $375.06 $375.92 $428.81 $335.69 $573.51 $518.88 $561.79 $471.29$393.74 $391.35 $392.25 $447.43 $350.26 $598.42 $541.41 $586.18 $491.75$412.20 $409.70 $410.64 $468.42 $366.69 $626.48 $566.80 $613.67 $514.81$430.43 $427.83 $428.81 $489.14 $382.91 $654.19 $591.87 $640.82 $537.59$450.51 $447.78 $448.81 $511.95 $400.77 $684.71 $619.48 $670.71 $562.66$470.82 $467.97 $469.04 $535.03 $418.84 $715.57 $647.41 $700.95 $588.03$492.75 $489.76 $490.89 $559.95 $438.34 $748.90 $677.56 $733.59 $615.41$514.67 $511.56 $512.73 $584.86 $457.85 $782.22 $707.71 $766.23 $642.80$538.45 $535.18 $536.41 $611.88 $478.99 $818.35 $740.39 $801.62 $672.49$562.45 $559.04 $560.32 $639.15 $500.35 $854.83 $773.40 $837.36 $702.46$588.07 $584.50 $585.84 $668.27 $523.14 $893.77 $808.63 $875.50 $734.46$600.76 $597.12 $598.49 $682.69 $534.43 $913.06 $826.08 $894.39 $750.31$626.38 $622.58 $624.01 $711.80 $557.22 $951.99 $861.31 $932.53 $782.31$648.54 $644.61 $646.08 $736.98 $576.93 $985.67 $891.77 $965.52 $809.98$663.08 $659.06 $660.57 $753.50 $589.86 $1,007.77 $911.77 $987.17 $828.14$681.31 $677.18 $678.73 $774.22 $606.08 $1,035.48 $936.84 $1,014.31 $850.91$692.39 $688.19 $689.77 $786.81 $615.94 $1,052.31 $952.07 $1,030.80 $864.75
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health
Oregon
Standard
Bronze
$148.65$234.09$234.09$234.09$234.09$235.03$239.71$245.33$254.46$261.95$265.69$271.31$276.93$280.44$284.18$286.06$287.93$289.80$291.68$295.42$299.17$304.78$310.17$317.66$327.02$338.02$351.13$365.88$382.74$399.36$418.08$436.58$456.94$477.54$499.78$522.02$546.13$570.48$596.46$609.33$635.32$657.79$672.54$691.03$702.27
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Area 1 Area 1Moda Health Plan Inc
Plan
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500HIOS Plan Id
0-20 $239.07 $235.98 $223.12 $216.82 $216.41 $211.05 $189.68 $186.11 $189.4921 $376.49 $371.63 $351.36 $341.44 $340.80 $332.36 $298.70 $293.09 $298.4122 $376.49 $371.63 $351.36 $341.44 $340.80 $332.36 $298.70 $293.09 $298.4123 $376.49 $371.63 $351.36 $341.44 $340.80 $332.36 $298.70 $293.09 $298.4124 $376.49 $371.63 $351.36 $341.44 $340.80 $332.36 $298.70 $293.09 $298.4125 $378.00 $373.11 $352.77 $342.81 $342.17 $333.69 $299.90 $294.27 $299.6026 $385.53 $380.55 $359.80 $349.64 $348.98 $340.34 $305.87 $300.13 $305.5727 $394.56 $389.47 $368.23 $357.83 $357.16 $348.31 $313.04 $307.16 $312.7428 $409.24 $403.96 $381.93 $371.15 $370.45 $361.28 $324.69 $318.59 $324.3729 $421.29 $415.85 $393.18 $382.07 $381.36 $371.91 $334.25 $327.97 $333.9230 $427.32 $421.80 $398.80 $387.54 $386.81 $377.23 $339.03 $332.66 $338.7031 $436.35 $430.72 $407.23 $395.73 $394.99 $385.21 $346.20 $339.69 $345.8632 $445.39 $439.64 $415.66 $403.93 $403.17 $393.18 $353.36 $346.73 $353.0233 $451.03 $445.21 $420.93 $409.05 $408.28 $398.17 $357.84 $351.13 $357.5034 $457.06 $451.16 $426.56 $414.51 $413.74 $403.49 $362.62 $355.81 $362.2735 $460.07 $454.13 $429.37 $417.24 $416.46 $406.14 $365.01 $358.16 $364.6636 $463.08 $457.10 $432.18 $419.97 $419.19 $408.80 $367.40 $360.50 $367.0537 $466.09 $460.08 $434.99 $422.71 $421.92 $411.46 $369.79 $362.85 $369.4338 $469.11 $463.05 $437.80 $425.44 $424.64 $414.12 $372.18 $365.19 $371.8239 $475.13 $468.99 $443.42 $430.90 $430.09 $419.44 $376.96 $369.88 $376.6040 $481.15 $474.94 $449.04 $436.36 $435.55 $424.76 $381.74 $374.57 $381.3741 $490.19 $483.86 $457.48 $444.56 $443.73 $432.73 $388.91 $381.61 $388.5342 $498.85 $492.41 $465.56 $452.41 $451.56 $440.38 $395.78 $388.35 $395.4043 $510.90 $504.30 $476.80 $463.34 $462.47 $451.01 $405.34 $397.73 $404.9444 $525.96 $519.16 $490.85 $477.00 $476.10 $464.31 $417.29 $409.45 $416.8845 $543.65 $536.63 $507.37 $493.04 $492.12 $479.93 $431.33 $423.23 $430.9146 $564.73 $557.44 $527.05 $512.16 $511.21 $498.54 $448.05 $439.64 $447.6247 $588.45 $580.85 $549.18 $533.68 $532.68 $519.48 $466.87 $458.10 $466.4248 $615.56 $607.61 $574.48 $558.26 $557.21 $543.41 $488.38 $479.21 $487.9049 $642.29 $634.00 $599.43 $582.50 $581.41 $567.01 $509.59 $500.02 $509.0950 $672.41 $663.73 $627.54 $609.82 $608.68 $593.60 $533.48 $523.46 $532.9651 $702.15 $693.09 $655.29 $636.79 $635.60 $619.85 $557.08 $546.62 $556.5452 $734.91 $725.42 $685.86 $666.50 $665.25 $648.77 $583.07 $572.12 $582.5053 $768.04 $758.12 $716.78 $696.54 $695.24 $678.02 $609.35 $597.91 $608.7654 $803.81 $793.43 $750.16 $728.98 $727.62 $709.59 $637.73 $625.75 $637.1155 $839.57 $828.73 $783.54 $761.42 $759.99 $741.16 $666.10 $653.60 $665.4656 $878.35 $867.01 $819.73 $796.59 $795.10 $775.40 $696.87 $683.79 $696.1957 $917.51 $905.66 $856.27 $832.10 $830.54 $809.96 $727.94 $714.27 $727.2358 $959.30 $946.91 $895.27 $870.00 $868.37 $846.85 $761.09 $746.80 $760.3559 $980.00 $967.35 $914.60 $888.78 $887.11 $865.13 $777.52 $762.92 $776.7660 $1,021.79 $1,008.60 $953.60 $926.68 $924.94 $902.03 $810.68 $795.45 $809.8961 $1,057.94 $1,044.27 $987.33 $959.45 $957.66 $933.93 $839.35 $823.59 $838.5462 $1,081.66 $1,067.69 $1,009.47 $980.97 $979.13 $954.87 $858.17 $842.06 $857.3463 $1,111.40 $1,097.05 $1,037.22 $1,007.94 $1,006.05 $981.13 $881.77 $865.21 $880.91
64+ $1,129.46 $1,114.87 $1,054.08 $1,024.32 $1,022.40 $997.07 $896.10 $879.27 $895.22
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health Plan Inc
Value 2000
Value 2000
(Rose City) Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
$182.95 $168.98 $178.07 $173.72 $169.76 $160.50 $181.67 $176.41 $153.83$288.11 $266.11 $280.42 $273.57 $267.33 $252.76 $286.10 $277.81 $242.25$288.11 $266.11 $280.42 $273.57 $267.33 $252.76 $286.10 $277.81 $242.25$288.11 $266.11 $280.42 $273.57 $267.33 $252.76 $286.10 $277.81 $242.25$288.11 $266.11 $280.42 $273.57 $267.33 $252.76 $286.10 $277.81 $242.25$289.26 $267.18 $281.54 $274.67 $268.40 $253.77 $287.24 $278.92 $243.22$295.02 $272.50 $287.15 $280.14 $273.75 $258.82 $292.96 $284.48 $248.06$301.94 $278.89 $293.88 $286.70 $280.16 $264.89 $299.83 $291.14 $253.88$313.17 $289.27 $304.82 $297.37 $290.59 $274.75 $310.99 $301.98 $263.32$322.39 $297.78 $313.79 $306.13 $299.14 $282.84 $320.14 $310.87 $271.08$327.00 $302.04 $318.28 $310.50 $303.42 $286.88 $324.72 $315.31 $274.95$333.92 $308.43 $325.01 $317.07 $309.84 $292.95 $331.59 $321.98 $280.77$340.83 $314.81 $331.74 $323.63 $316.25 $299.01 $338.45 $328.65 $286.58$345.15 $318.80 $335.94 $327.74 $320.26 $302.80 $342.75 $332.82 $290.21$349.76 $323.06 $340.43 $332.12 $324.54 $306.85 $347.32 $337.26 $294.09$352.07 $325.19 $342.67 $334.30 $326.68 $308.87 $349.61 $339.48 $296.03$354.37 $327.32 $344.92 $336.49 $328.82 $310.89 $351.90 $341.71 $297.96$356.68 $329.45 $347.16 $338.68 $330.96 $312.91 $354.19 $343.93 $299.90$358.98 $331.58 $349.40 $340.87 $333.09 $314.94 $356.48 $346.15 $301.84$363.59 $335.84 $353.89 $345.25 $337.37 $318.98 $361.06 $350.60 $305.72$368.20 $340.09 $358.38 $349.62 $341.65 $323.03 $365.63 $355.04 $309.59$375.12 $346.48 $365.11 $356.19 $348.07 $329.09 $372.50 $361.71 $315.41$381.74 $352.60 $371.56 $362.48 $354.21 $334.90 $379.08 $368.10 $320.98$390.96 $361.12 $380.53 $371.24 $362.77 $342.99 $388.23 $376.99 $328.73$402.49 $371.76 $391.75 $382.18 $373.46 $353.10 $399.68 $388.10 $338.42$416.03 $384.27 $404.93 $395.04 $386.03 $364.98 $413.13 $401.16 $349.81$432.16 $399.17 $420.63 $410.36 $401.00 $379.14 $429.15 $416.71 $363.37$450.31 $415.94 $438.30 $427.59 $417.84 $395.06 $447.17 $434.22 $378.63$471.06 $435.10 $458.49 $447.29 $437.09 $413.26 $467.77 $454.22 $396.07$491.51 $453.99 $478.40 $466.71 $456.07 $431.21 $488.08 $473.94 $413.27$514.56 $475.28 $500.83 $488.60 $477.45 $451.43 $510.97 $496.17 $432.65$537.32 $496.30 $522.98 $510.21 $498.57 $471.39 $533.57 $518.11 $451.79$562.39 $519.46 $547.38 $534.01 $521.83 $493.38 $558.46 $542.28 $472.87$587.74 $542.87 $572.06 $558.08 $545.36 $515.63 $583.64 $566.73 $494.19$615.11 $568.15 $598.70 $584.07 $570.75 $539.64 $610.82 $593.12 $517.20$642.48 $593.43 $625.34 $610.06 $596.15 $563.65 $638.00 $619.52 $540.21$672.16 $620.84 $654.22 $638.24 $623.68 $589.69 $667.47 $648.13 $565.16$702.12 $648.52 $683.38 $666.69 $651.49 $615.97 $697.22 $677.02 $590.36$734.10 $678.06 $714.51 $697.06 $681.16 $644.03 $728.98 $707.86 $617.25$749.95 $692.70 $729.93 $712.11 $695.86 $657.93 $744.71 $723.14 $630.57$781.93 $722.23 $761.06 $742.47 $725.54 $685.99 $776.47 $753.97 $657.46$809.58 $747.78 $787.98 $768.73 $751.20 $710.25 $803.93 $780.64 $680.72$827.73 $764.55 $805.65 $785.97 $768.04 $726.17 $821.96 $798.15 $695.98$850.50 $785.57 $827.80 $807.58 $789.16 $746.14 $844.56 $820.09 $715.12$864.31 $798.33 $841.25 $820.70 $801.98 $758.26 $858.28 $833.42 $726.73
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 1
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Rose City
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
$142.37 $192.78 $184.22 $177.30 $156.08 $142.70 $131.10 $141.83 $142.16$224.20 $303.58 $290.10 $279.21 $245.79 $224.72 $206.46 $223.36 $223.87$224.20 $303.58 $290.10 $279.21 $245.79 $224.72 $206.46 $223.36 $223.87$224.20 $303.58 $290.10 $279.21 $245.79 $224.72 $206.46 $223.36 $223.87$224.20 $303.58 $290.10 $279.21 $245.79 $224.72 $206.46 $223.36 $223.87$225.10 $304.80 $291.26 $280.33 $246.77 $225.62 $207.29 $224.25 $224.76$229.58 $310.87 $297.07 $285.91 $251.69 $230.11 $211.42 $228.72 $229.24$234.96 $318.16 $304.03 $292.61 $257.59 $235.51 $216.37 $234.08 $234.61$243.71 $329.99 $315.34 $303.50 $267.17 $244.27 $224.42 $242.79 $243.35$250.88 $339.71 $324.63 $312.44 $275.04 $251.46 $231.03 $249.94 $250.51$254.47 $344.57 $329.27 $316.91 $278.97 $255.06 $234.33 $253.51 $254.09$259.85 $351.85 $336.23 $323.61 $284.87 $260.45 $239.29 $258.87 $259.46$265.23 $359.14 $343.19 $330.31 $290.77 $265.84 $244.24 $264.23 $264.84$268.59 $363.69 $347.54 $334.50 $294.46 $269.21 $247.34 $267.58 $268.20$272.18 $368.55 $352.19 $338.96 $298.39 $272.81 $250.64 $271.16 $271.78$273.97 $370.98 $354.51 $341.20 $300.35 $274.61 $252.29 $272.94 $273.57$275.77 $373.41 $356.83 $343.43 $302.32 $276.40 $253.95 $274.73 $275.36$277.56 $375.84 $359.15 $345.66 $304.29 $278.20 $255.60 $276.52 $277.15$279.35 $378.26 $361.47 $347.90 $306.25 $280.00 $257.25 $278.30 $278.94$282.94 $383.12 $366.11 $352.37 $310.19 $283.59 $260.55 $281.88 $282.52$286.53 $387.98 $370.75 $356.83 $314.12 $287.19 $263.86 $285.45 $286.10$291.91 $395.27 $377.72 $363.53 $320.02 $292.58 $268.81 $290.81 $291.48$297.07 $402.25 $384.39 $369.96 $325.67 $297.75 $273.56 $295.95 $296.63$304.24 $411.96 $393.67 $378.89 $333.54 $304.94 $280.17 $303.10 $303.79$313.21 $424.11 $405.28 $390.06 $343.37 $313.93 $288.43 $312.03 $312.75$323.75 $438.37 $418.91 $403.18 $354.92 $324.49 $298.13 $322.53 $323.27$336.30 $455.37 $435.16 $418.82 $368.68 $337.08 $309.69 $335.04 $335.80$350.43 $474.50 $453.43 $436.41 $384.17 $351.24 $322.70 $349.11 $349.91$366.57 $496.36 $474.32 $456.51 $401.87 $367.41 $337.56 $365.19 $366.03$382.49 $517.91 $494.92 $476.34 $419.32 $383.37 $352.22 $381.05 $381.92$400.42 $542.20 $518.13 $498.67 $438.98 $401.35 $368.74 $398.92 $399.83$418.14 $566.18 $541.04 $520.73 $458.40 $419.10 $385.05 $416.56 $417.52$437.64 $592.59 $566.28 $545.02 $479.78 $438.65 $403.01 $435.99 $436.99$457.37 $619.31 $591.81 $569.59 $501.41 $458.43 $421.18 $455.65 $456.69$478.67 $648.15 $619.37 $596.12 $524.76 $479.77 $440.79 $476.87 $477.96$499.97 $676.99 $646.93 $622.64 $548.11 $501.12 $460.41 $498.09 $499.23$523.06 $708.26 $676.81 $651.40 $573.43 $524.27 $481.67 $521.09 $522.29$546.38 $739.83 $706.98 $680.44 $598.99 $547.64 $503.14 $544.32 $545.57$571.27 $773.53 $739.18 $711.43 $626.27 $572.58 $526.06 $569.11 $570.42$583.60 $790.23 $755.14 $726.79 $639.79 $584.94 $537.42 $581.40 $582.73$608.48 $823.92 $787.34 $757.78 $667.07 $609.89 $560.33 $606.19 $607.58$630.01 $853.07 $815.19 $784.59 $690.67 $631.46 $580.15 $627.63 $629.07$644.13 $872.19 $833.47 $802.18 $706.15 $645.62 $593.16 $641.70 $643.18$661.84 $896.18 $856.39 $824.23 $725.57 $663.37 $609.47 $659.35 $660.86$672.59 $910.74 $870.30 $837.63 $737.36 $674.15 $619.37 $670.06 $671.60
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 1 Area 2Moda Health Plan Inc
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500
$162.16 $126.94 $216.87 $196.22 $212.44 $178.22 $144.73 $230.70 $227.72$255.37 $199.91 $341.54 $309.00 $334.55 $280.66 $227.93 $363.31 $358.62$255.37 $199.91 $341.54 $309.00 $334.55 $280.66 $227.93 $363.31 $358.62$255.37 $199.91 $341.54 $309.00 $334.55 $280.66 $227.93 $363.31 $358.62$255.37 $199.91 $341.54 $309.00 $334.55 $280.66 $227.93 $363.31 $358.62$256.39 $200.71 $342.90 $310.24 $335.89 $281.78 $228.84 $364.77 $360.06$261.49 $204.70 $349.73 $316.42 $342.58 $287.40 $233.40 $372.03 $367.23$267.62 $209.50 $357.93 $323.83 $350.61 $294.13 $238.87 $380.75 $375.83$277.58 $217.30 $371.25 $335.88 $363.66 $305.08 $247.76 $394.92 $389.82$285.75 $223.70 $382.18 $345.77 $374.37 $314.06 $255.05 $406.55 $401.30$289.84 $226.89 $387.64 $350.72 $379.72 $318.55 $258.70 $412.36 $407.03$295.97 $231.69 $395.84 $358.13 $387.75 $325.28 $264.17 $421.08 $415.64$302.10 $236.49 $404.04 $365.55 $395.78 $332.02 $269.64 $429.80 $424.25$305.93 $239.49 $409.16 $370.18 $400.80 $336.23 $273.05 $435.25 $429.63$310.01 $242.69 $414.62 $375.13 $406.15 $340.72 $276.70 $441.06 $435.37$312.06 $244.29 $417.36 $377.60 $408.82 $342.97 $278.52 $443.97 $438.23$314.10 $245.88 $420.09 $380.07 $411.50 $345.21 $280.35 $446.87 $441.10$316.14 $247.48 $422.82 $382.54 $414.18 $347.46 $282.17 $449.78 $443.97$318.18 $249.08 $425.55 $385.02 $416.85 $349.70 $284.00 $452.69 $446.84$322.27 $252.28 $431.02 $389.96 $422.21 $354.19 $287.64 $458.50 $452.58$326.36 $255.48 $436.48 $394.90 $427.56 $358.68 $291.29 $464.31 $458.32$332.49 $260.28 $444.68 $402.32 $435.59 $365.42 $296.76 $473.03 $466.92$338.36 $264.88 $452.53 $409.43 $443.28 $371.87 $302.00 $481.39 $475.17$346.53 $271.27 $463.46 $419.31 $453.99 $380.86 $309.29 $493.02 $486.65$356.74 $279.27 $477.12 $431.67 $467.37 $392.08 $318.41 $507.55 $500.99$368.75 $288.66 $493.18 $446.20 $483.10 $405.27 $329.12 $524.62 $517.85$383.05 $299.86 $512.30 $463.50 $501.83 $420.99 $341.89 $544.97 $537.93$399.14 $312.45 $533.82 $482.97 $522.91 $438.67 $356.25 $567.86 $560.52$417.52 $326.85 $558.41 $505.22 $547.00 $458.88 $372.66 $594.02 $586.35$435.65 $341.04 $582.66 $527.16 $570.75 $478.81 $388.84 $619.81 $611.81$456.08 $357.03 $609.98 $551.88 $597.51 $501.26 $407.07 $648.88 $640.50$476.26 $372.83 $636.96 $576.29 $623.94 $523.43 $425.08 $677.58 $668.83$498.47 $390.22 $666.68 $603.17 $653.05 $547.85 $444.91 $709.19 $700.03$520.94 $407.81 $696.73 $630.36 $682.49 $572.55 $464.97 $741.16 $731.59$545.20 $426.80 $729.18 $659.72 $714.27 $599.21 $486.62 $775.67 $765.66$569.46 $445.79 $761.62 $689.07 $746.06 $625.87 $508.27 $810.19 $799.72$595.77 $466.38 $796.80 $720.90 $780.51 $654.78 $531.75 $847.61 $836.66$622.32 $487.17 $832.32 $753.04 $815.31 $683.97 $555.45 $885.39 $873.96$650.67 $509.36 $870.23 $787.33 $852.44 $715.12 $580.75 $925.72 $913.77$664.72 $520.36 $889.02 $804.33 $870.84 $730.56 $593.29 $945.70 $933.49$693.06 $542.55 $926.93 $838.63 $907.98 $761.71 $618.59 $986.03 $973.30$717.58 $561.74 $959.71 $868.29 $940.10 $788.65 $640.47 $1,020.91 $1,007.72$733.66 $574.33 $981.23 $887.76 $961.17 $806.34 $654.83 $1,043.80 $1,030.32$753.84 $590.12 $1,008.21 $912.17 $987.60 $828.51 $672.84 $1,072.50 $1,058.65$766.09 $599.71 $1,024.60 $926.99 $1,003.65 $841.97 $683.77 $1,089.93 $1,075.85
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500
$215.31 $209.23 $208.84 $203.66 $183.04 $179.60 $182.86 $176.55 $171.83$339.07 $329.49 $328.88 $320.73 $288.25 $282.83 $287.97 $278.02 $270.61$339.07 $329.49 $328.88 $320.73 $288.25 $282.83 $287.97 $278.02 $270.61$339.07 $329.49 $328.88 $320.73 $288.25 $282.83 $287.97 $278.02 $270.61$339.07 $329.49 $328.88 $320.73 $288.25 $282.83 $287.97 $278.02 $270.61$340.42 $330.81 $330.19 $322.01 $289.40 $283.97 $289.12 $279.14 $271.69$347.20 $337.40 $336.77 $328.43 $295.17 $289.62 $294.88 $284.70 $277.10$355.34 $345.31 $344.66 $336.12 $302.08 $296.41 $301.79 $291.37 $283.59$368.56 $358.16 $357.49 $348.63 $313.32 $307.44 $313.02 $302.21 $294.15$379.41 $368.70 $368.01 $358.89 $322.55 $316.49 $322.23 $311.11 $302.81$384.84 $373.97 $373.27 $364.03 $327.16 $321.02 $326.84 $315.56 $307.14$392.98 $381.88 $381.17 $371.72 $334.08 $327.81 $333.75 $322.23 $313.63$401.11 $389.79 $389.06 $379.42 $341.00 $334.59 $340.66 $328.90 $320.13$406.20 $394.73 $393.99 $384.23 $345.32 $338.84 $344.98 $333.07 $324.19$411.63 $400.00 $399.25 $389.36 $349.93 $343.36 $349.59 $337.52 $328.51$414.34 $402.64 $401.89 $391.93 $352.24 $345.62 $351.90 $339.75 $330.68$417.05 $405.28 $404.52 $394.50 $354.54 $347.89 $354.20 $341.97 $332.84$419.76 $407.91 $407.15 $397.06 $356.85 $350.15 $356.50 $344.19 $335.01$422.48 $410.55 $409.78 $399.63 $359.16 $352.41 $358.81 $346.42 $337.17$427.90 $415.82 $415.04 $404.76 $363.77 $356.94 $363.41 $350.87 $341.50$433.33 $421.09 $420.30 $409.89 $368.38 $361.46 $368.02 $355.32 $345.83$441.46 $429.00 $428.20 $417.59 $375.30 $368.25 $374.93 $361.99 $352.33$449.26 $436.58 $435.76 $424.96 $381.93 $374.76 $381.56 $368.38 $358.55$460.11 $447.12 $446.28 $435.23 $391.15 $383.81 $390.77 $377.28 $367.21$473.67 $460.30 $459.44 $448.06 $402.68 $395.12 $402.29 $388.40 $378.04$489.61 $475.79 $474.90 $463.13 $416.23 $408.41 $415.82 $401.47 $390.75$508.60 $494.24 $493.31 $481.09 $432.37 $424.25 $431.95 $417.04 $405.91$529.96 $515.00 $514.03 $501.30 $450.53 $442.07 $450.09 $434.55 $422.96$554.37 $538.72 $537.71 $524.39 $471.28 $462.43 $470.83 $454.57 $442.44$578.45 $562.11 $561.06 $547.16 $491.75 $482.52 $491.27 $474.31 $461.65$605.57 $588.47 $587.37 $572.82 $514.81 $505.14 $514.31 $496.55 $483.30$632.36 $614.50 $613.35 $598.16 $537.58 $527.49 $537.06 $518.52 $504.68$661.86 $643.17 $641.97 $626.06 $562.66 $552.09 $562.11 $542.70 $528.22$691.69 $672.16 $670.91 $654.28 $588.02 $576.98 $587.45 $567.17 $552.03$723.91 $703.47 $702.15 $684.75 $615.41 $603.85 $614.81 $593.58 $577.74$756.12 $734.77 $733.39 $715.22 $642.79 $630.72 $642.17 $619.99 $603.45$791.04 $768.71 $767.27 $748.26 $672.48 $659.85 $671.83 $648.63 $631.32$826.30 $802.97 $801.47 $781.61 $702.46 $689.27 $701.78 $677.55 $659.47$863.94 $839.55 $837.98 $817.21 $734.45 $720.66 $733.74 $708.41 $689.50$882.59 $857.67 $856.06 $834.85 $750.31 $736.22 $749.58 $723.70 $704.39$920.22 $894.24 $892.57 $870.46 $782.30 $767.61 $781.54 $754.56 $734.42$952.77 $925.87 $924.14 $901.25 $809.97 $794.77 $809.19 $781.25 $760.40$974.14 $946.63 $944.86 $921.45 $828.13 $812.58 $827.33 $798.76 $777.45
$1,000.92 $972.66 $970.84 $946.79 $850.91 $834.93 $850.08 $820.73 $798.83$1,017.19 $988.47 $986.62 $962.17 $864.73 $848.49 $863.89 $834.06 $811.81
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
$167.64 $163.81 $154.88 $175.31 $170.23 $148.44 $137.39 $186.03 $177.77$264.00 $257.97 $243.91 $276.08 $268.09 $233.77 $216.35 $292.96 $279.95$264.00 $257.97 $243.91 $276.08 $268.09 $233.77 $216.35 $292.96 $279.95$264.00 $257.97 $243.91 $276.08 $268.09 $233.77 $216.35 $292.96 $279.95$264.00 $257.97 $243.91 $276.08 $268.09 $233.77 $216.35 $292.96 $279.95$265.05 $259.01 $244.89 $277.19 $269.16 $234.70 $217.22 $294.13 $281.07$270.33 $264.17 $249.77 $282.71 $274.52 $239.38 $221.55 $299.99 $286.67$276.67 $270.36 $255.62 $289.34 $280.95 $244.99 $226.74 $307.02 $293.39$286.96 $280.42 $265.13 $300.10 $291.41 $254.11 $235.18 $318.45 $304.31$295.41 $288.67 $272.94 $308.94 $299.99 $261.59 $242.10 $327.82 $313.26$299.64 $292.80 $276.84 $313.36 $304.28 $265.33 $245.56 $332.51 $317.74$305.97 $298.99 $282.69 $319.98 $310.71 $270.94 $250.75 $339.54 $324.46$312.31 $305.18 $288.55 $326.61 $317.15 $276.55 $255.95 $346.57 $331.18$316.27 $309.05 $292.21 $330.75 $321.17 $280.06 $259.19 $350.96 $335.38$320.49 $313.18 $296.11 $335.17 $325.46 $283.80 $262.65 $355.65 $339.86$322.60 $315.24 $298.06 $337.38 $327.60 $285.67 $264.39 $357.99 $342.10$324.72 $317.31 $300.01 $339.58 $329.75 $287.54 $266.12 $360.34 $344.34$326.83 $319.37 $301.96 $341.79 $331.89 $289.41 $267.85 $362.68 $346.58$328.94 $321.44 $303.91 $344.00 $334.04 $291.28 $269.58 $365.03 $348.82$333.16 $325.56 $307.82 $348.42 $338.32 $295.02 $273.04 $369.71 $353.30$337.39 $329.69 $311.72 $352.84 $342.61 $298.76 $276.50 $374.40 $357.78$343.72 $335.88 $317.57 $359.46 $349.05 $304.37 $281.69 $381.43 $364.50$349.79 $341.82 $323.18 $365.81 $355.21 $309.74 $286.67 $388.17 $370.93$358.24 $350.07 $330.99 $374.65 $363.79 $317.22 $293.59 $397.54 $379.89$368.80 $360.39 $340.74 $385.69 $374.52 $326.58 $302.25 $409.26 $391.09$381.21 $372.52 $352.21 $398.67 $387.12 $337.56 $312.42 $423.03 $404.25$395.99 $386.96 $365.87 $414.13 $402.13 $350.65 $324.53 $439.44 $419.93$412.63 $403.21 $381.23 $431.52 $419.02 $365.38 $338.16 $457.89 $437.56$431.63 $421.79 $398.80 $451.40 $438.32 $382.21 $353.74 $478.99 $457.72$450.38 $440.10 $416.11 $471.00 $457.35 $398.81 $369.10 $499.79 $477.60$471.50 $460.74 $435.63 $493.09 $478.80 $417.51 $386.41 $523.22 $499.99$492.35 $481.12 $454.90 $514.90 $499.98 $435.98 $403.50 $546.37 $522.11$515.32 $503.57 $476.12 $538.92 $523.30 $456.32 $422.32 $571.85 $546.46$538.55 $526.27 $497.58 $563.21 $546.90 $476.89 $441.36 $597.63 $571.10$563.63 $550.78 $520.75 $589.44 $572.36 $499.10 $461.92 $625.46 $597.69$588.71 $575.28 $543.92 $615.67 $597.83 $521.30 $482.47 $653.30 $624.29$615.90 $601.85 $569.05 $644.10 $625.44 $545.38 $504.75 $683.47 $653.12$643.36 $628.68 $594.41 $672.82 $653.33 $569.70 $527.26 $713.94 $682.24$672.66 $657.32 $621.49 $703.46 $683.08 $595.64 $551.27 $746.46 $713.31$687.18 $671.51 $634.90 $718.65 $697.83 $608.50 $563.17 $762.57 $728.71$716.49 $700.14 $661.98 $749.29 $727.59 $634.45 $587.19 $795.09 $759.79$741.83 $724.91 $685.39 $775.80 $753.32 $656.89 $607.96 $823.21 $786.66$758.46 $741.16 $700.76 $793.19 $770.21 $671.62 $621.59 $841.67 $804.30$779.32 $761.54 $720.03 $815.00 $791.39 $690.09 $638.68 $864.81 $826.41$791.98 $773.91 $731.73 $828.24 $804.25 $701.30 $649.05 $878.86 $839.84
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 2
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
$171.09 $150.61 $137.70 $136.87 $137.18 $156.48 $122.50 $209.28 $189.35$269.44 $237.19 $216.85 $215.54 $216.03 $246.43 $192.91 $329.58 $298.19$269.44 $237.19 $216.85 $215.54 $216.03 $246.43 $192.91 $329.58 $298.19$269.44 $237.19 $216.85 $215.54 $216.03 $246.43 $192.91 $329.58 $298.19$269.44 $237.19 $216.85 $215.54 $216.03 $246.43 $192.91 $329.58 $298.19$270.52 $238.14 $217.72 $216.40 $216.90 $247.41 $193.68 $330.90 $299.38$275.91 $242.88 $222.06 $220.71 $221.22 $252.34 $197.54 $337.49 $305.34$282.37 $248.57 $227.26 $225.89 $226.40 $258.26 $202.17 $345.40 $312.50$292.88 $257.82 $235.72 $234.29 $234.83 $267.87 $209.69 $358.26 $324.13$301.50 $265.41 $242.66 $241.19 $241.74 $275.75 $215.87 $368.80 $333.67$305.81 $269.21 $246.13 $244.64 $245.20 $279.69 $218.95 $374.08 $338.44$312.28 $274.90 $251.33 $249.81 $250.38 $285.61 $223.58 $381.98 $345.60$318.75 $280.59 $256.54 $254.98 $255.57 $291.52 $228.21 $389.89 $352.75$322.79 $284.15 $259.79 $258.22 $258.81 $295.22 $231.11 $394.84 $357.23$327.10 $287.94 $263.26 $261.66 $262.27 $299.16 $234.19 $400.11 $362.00$329.26 $289.84 $264.99 $263.39 $263.99 $301.13 $235.74 $402.75 $364.38$331.41 $291.74 $266.73 $265.11 $265.72 $303.11 $237.28 $405.39 $366.77$333.57 $293.64 $268.46 $266.84 $267.45 $305.08 $238.82 $408.02 $369.15$335.72 $295.53 $270.20 $268.56 $269.18 $307.05 $240.37 $410.66 $371.54$340.03 $299.33 $273.67 $272.01 $272.63 $310.99 $243.45 $415.93 $376.31$344.34 $303.12 $277.14 $275.46 $276.09 $314.93 $246.54 $421.21 $381.08$350.81 $308.82 $282.34 $280.63 $281.28 $320.85 $251.17 $429.12 $388.24$357.01 $314.27 $287.33 $285.59 $286.24 $326.52 $255.61 $436.70 $395.10$365.63 $321.86 $294.27 $292.49 $293.16 $334.40 $261.78 $447.24 $404.64$376.41 $331.35 $302.94 $301.11 $301.80 $344.26 $269.49 $460.43 $416.57$389.07 $342.50 $313.14 $311.24 $311.95 $355.84 $278.56 $475.92 $430.58$404.16 $355.78 $325.28 $323.31 $324.05 $369.64 $289.36 $494.37 $447.28$421.13 $370.72 $338.94 $336.89 $337.66 $385.17 $301.52 $515.14 $466.06$440.53 $387.80 $354.56 $352.41 $353.22 $402.91 $315.41 $538.87 $487.53$459.66 $404.64 $369.95 $367.71 $368.55 $420.40 $329.10 $562.27 $508.71$481.22 $423.62 $387.30 $384.95 $385.84 $440.12 $344.54 $588.63 $532.56$502.51 $442.35 $404.43 $401.98 $402.90 $459.59 $359.78 $614.67 $556.12$525.95 $462.99 $423.30 $420.73 $421.70 $481.03 $376.56 $643.34 $582.06$549.66 $483.86 $442.38 $439.70 $440.71 $502.71 $393.54 $672.35 $608.30$575.25 $506.39 $462.98 $460.18 $461.23 $526.12 $411.86 $703.66 $636.63$600.85 $528.93 $483.58 $480.65 $481.76 $549.53 $430.19 $734.97 $664.95$628.60 $553.36 $505.92 $502.85 $504.01 $574.91 $450.06 $768.91 $695.67$656.62 $578.02 $528.47 $525.27 $526.47 $600.54 $470.12 $803.19 $726.68$686.53 $604.35 $552.54 $549.19 $550.45 $627.90 $491.53 $839.77 $759.78$701.35 $617.40 $564.47 $561.05 $562.34 $641.45 $502.14 $857.90 $776.18$731.26 $643.73 $588.54 $584.97 $586.32 $668.80 $523.56 $894.48 $809.28$757.13 $666.49 $609.36 $605.67 $607.05 $692.46 $542.08 $926.12 $837.90$774.10 $681.44 $623.02 $619.24 $620.67 $707.99 $554.23 $946.89 $856.69$795.39 $700.18 $640.15 $636.27 $637.73 $727.45 $569.47 $972.92 $880.25$808.31 $711.55 $650.55 $646.61 $648.09 $739.27 $578.72 $988.73 $894.55
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3Moda Health Plan Inc
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500
$205.01 $171.98 $139.67 $230.70 $227.72 $215.31 $209.23 $208.84 $203.66$322.84 $270.84 $219.95 $363.31 $358.62 $339.07 $329.49 $328.88 $320.73$322.84 $270.84 $219.95 $363.31 $358.62 $339.07 $329.49 $328.88 $320.73$322.84 $270.84 $219.95 $363.31 $358.62 $339.07 $329.49 $328.88 $320.73$322.84 $270.84 $219.95 $363.31 $358.62 $339.07 $329.49 $328.88 $320.73$324.14 $271.92 $220.83 $364.77 $360.06 $340.42 $330.81 $330.19 $322.01$330.59 $277.34 $225.23 $372.03 $367.23 $347.20 $337.40 $336.77 $328.43$338.34 $283.84 $230.51 $380.75 $375.83 $355.34 $345.31 $344.66 $336.12$350.93 $294.40 $239.08 $394.92 $389.82 $368.56 $358.16 $357.49 $348.63$361.26 $303.07 $246.12 $406.55 $401.30 $379.41 $368.70 $368.01 $358.89$366.43 $307.40 $249.64 $412.36 $407.03 $384.84 $373.97 $373.27 $364.03$374.18 $313.90 $254.92 $421.08 $415.64 $392.98 $381.88 $381.17 $371.72$381.93 $320.40 $260.20 $429.80 $424.25 $401.11 $389.79 $389.06 $379.42$386.77 $324.46 $263.50 $435.25 $429.63 $406.20 $394.73 $393.99 $384.23$391.93 $328.80 $267.02 $441.06 $435.37 $411.63 $400.00 $399.25 $389.36$394.52 $330.96 $268.78 $443.97 $438.23 $414.34 $402.64 $401.89 $391.93$397.10 $333.13 $270.54 $446.87 $441.10 $417.05 $405.28 $404.52 $394.50$399.68 $335.30 $272.30 $449.78 $443.97 $419.76 $407.91 $407.15 $397.06$402.26 $337.46 $274.06 $452.69 $446.84 $422.48 $410.55 $409.78 $399.63$407.43 $341.80 $277.57 $458.50 $452.58 $427.90 $415.82 $415.04 $404.76$412.60 $346.13 $281.09 $464.31 $458.32 $433.33 $421.09 $420.30 $409.89$420.34 $352.63 $286.37 $473.03 $466.92 $441.46 $429.00 $428.20 $417.59$427.77 $358.86 $291.43 $481.39 $475.17 $449.26 $436.58 $435.76 $424.96$438.10 $367.53 $298.47 $493.02 $486.65 $460.11 $447.12 $446.28 $435.23$451.01 $378.36 $307.27 $507.55 $500.99 $473.67 $460.30 $459.44 $448.06$466.19 $391.09 $317.61 $524.62 $517.85 $489.61 $475.79 $474.90 $463.13$484.27 $406.26 $329.92 $544.97 $537.93 $508.60 $494.24 $493.31 $481.09$504.61 $423.32 $343.78 $567.86 $560.52 $529.96 $515.00 $514.03 $501.30$527.85 $442.82 $359.62 $594.02 $586.35 $554.37 $538.72 $537.71 $524.39$550.77 $462.05 $375.23 $619.81 $611.81 $578.45 $562.11 $561.06 $547.16$576.60 $483.71 $392.83 $648.88 $640.50 $605.57 $588.47 $587.37 $572.82$602.11 $505.11 $410.20 $677.58 $668.83 $632.36 $614.50 $613.35 $598.16$630.19 $528.67 $429.34 $709.19 $700.03 $661.86 $643.17 $641.97 $626.06$658.60 $552.51 $448.69 $741.16 $731.59 $691.69 $672.16 $670.91 $654.28$689.27 $578.24 $469.59 $775.67 $765.66 $723.91 $703.47 $702.15 $684.75$719.94 $603.97 $490.48 $810.19 $799.72 $756.12 $734.77 $733.39 $715.22$753.20 $631.86 $513.14 $847.61 $836.66 $791.04 $768.71 $767.27 $748.26$786.77 $660.03 $536.01 $885.39 $873.96 $826.30 $802.97 $801.47 $781.61$822.61 $690.09 $560.43 $925.72 $913.77 $863.94 $839.55 $837.98 $817.21$840.36 $704.99 $572.52 $945.70 $933.49 $882.59 $857.67 $856.06 $834.85$876.20 $735.05 $596.94 $986.03 $973.30 $920.22 $894.24 $892.57 $870.46$907.19 $761.05 $618.05 $1,020.91 $1,007.72 $952.77 $925.87 $924.14 $901.25$927.53 $778.11 $631.91 $1,043.80 $1,030.32 $974.14 $946.63 $944.86 $921.45$953.04 $799.51 $649.29 $1,072.50 $1,058.65 $1,000.92 $972.66 $970.84 $946.79$968.52 $812.50 $659.83 $1,089.94 $1,075.86 $1,017.20 $988.48 $986.63 $962.18
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3
PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
$183.04 $179.60 $182.86 $176.55 $171.83 $167.64 $163.81 $154.88 $175.31$288.25 $282.83 $287.97 $278.02 $270.61 $264.00 $257.97 $243.91 $276.08$288.25 $282.83 $287.97 $278.02 $270.61 $264.00 $257.97 $243.91 $276.08$288.25 $282.83 $287.97 $278.02 $270.61 $264.00 $257.97 $243.91 $276.08$288.25 $282.83 $287.97 $278.02 $270.61 $264.00 $257.97 $243.91 $276.08$289.40 $283.97 $289.12 $279.14 $271.69 $265.05 $259.01 $244.89 $277.19$295.17 $289.62 $294.88 $284.70 $277.10 $270.33 $264.17 $249.77 $282.71$302.08 $296.41 $301.79 $291.37 $283.59 $276.67 $270.36 $255.62 $289.34$313.32 $307.44 $313.02 $302.21 $294.15 $286.96 $280.42 $265.13 $300.10$322.55 $316.49 $322.23 $311.11 $302.81 $295.41 $288.67 $272.94 $308.94$327.16 $321.02 $326.84 $315.56 $307.14 $299.64 $292.80 $276.84 $313.36$334.08 $327.81 $333.75 $322.23 $313.63 $305.97 $298.99 $282.69 $319.98$341.00 $334.59 $340.66 $328.90 $320.13 $312.31 $305.18 $288.55 $326.61$345.32 $338.84 $344.98 $333.07 $324.19 $316.27 $309.05 $292.21 $330.75$349.93 $343.36 $349.59 $337.52 $328.51 $320.49 $313.18 $296.11 $335.17$352.24 $345.62 $351.90 $339.75 $330.68 $322.60 $315.24 $298.06 $337.38$354.54 $347.89 $354.20 $341.97 $332.84 $324.72 $317.31 $300.01 $339.58$356.85 $350.15 $356.50 $344.19 $335.01 $326.83 $319.37 $301.96 $341.79$359.16 $352.41 $358.81 $346.42 $337.17 $328.94 $321.44 $303.91 $344.00$363.77 $356.94 $363.41 $350.87 $341.50 $333.16 $325.56 $307.82 $348.42$368.38 $361.46 $368.02 $355.32 $345.83 $337.39 $329.69 $311.72 $352.84$375.30 $368.25 $374.93 $361.99 $352.33 $343.72 $335.88 $317.57 $359.46$381.93 $374.76 $381.56 $368.38 $358.55 $349.79 $341.82 $323.18 $365.81$391.15 $383.81 $390.77 $377.28 $367.21 $358.24 $350.07 $330.99 $374.65$402.68 $395.12 $402.29 $388.40 $378.04 $368.80 $360.39 $340.74 $385.69$416.23 $408.41 $415.82 $401.47 $390.75 $381.21 $372.52 $352.21 $398.67$432.37 $424.25 $431.95 $417.04 $405.91 $395.99 $386.96 $365.87 $414.13$450.53 $442.07 $450.09 $434.55 $422.96 $412.63 $403.21 $381.23 $431.52$471.28 $462.43 $470.83 $454.57 $442.44 $431.63 $421.79 $398.80 $451.40$491.75 $482.52 $491.27 $474.31 $461.65 $450.38 $440.10 $416.11 $471.00$514.81 $505.14 $514.31 $496.55 $483.30 $471.50 $460.74 $435.63 $493.09$537.58 $527.49 $537.06 $518.52 $504.68 $492.35 $481.12 $454.90 $514.90$562.66 $552.09 $562.11 $542.70 $528.22 $515.32 $503.57 $476.12 $538.92$588.02 $576.98 $587.45 $567.17 $552.03 $538.55 $526.27 $497.58 $563.21$615.41 $603.85 $614.81 $593.58 $577.74 $563.63 $550.78 $520.75 $589.44$642.79 $630.72 $642.17 $619.99 $603.45 $588.71 $575.28 $543.92 $615.67$672.48 $659.85 $671.83 $648.63 $631.32 $615.90 $601.85 $569.05 $644.10$702.46 $689.27 $701.78 $677.55 $659.47 $643.36 $628.68 $594.41 $672.82$734.45 $720.66 $733.74 $708.41 $689.50 $672.66 $657.32 $621.49 $703.46$750.31 $736.22 $749.58 $723.70 $704.39 $687.18 $671.51 $634.90 $718.65$782.30 $767.61 $781.54 $754.56 $734.42 $716.49 $700.14 $661.98 $749.29$809.97 $794.77 $809.19 $781.25 $760.40 $741.83 $724.91 $685.39 $775.80$828.13 $812.58 $827.33 $798.76 $777.45 $758.46 $741.16 $700.76 $793.19$850.91 $834.93 $850.08 $820.73 $798.83 $779.32 $761.54 $720.03 $815.00$864.74 $848.50 $863.90 $834.07 $811.82 $791.99 $773.92 $731.74 $828.25
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 3
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
$170.23 $148.44 $137.39 $186.03 $177.77 $171.09 $150.61 $137.70 $136.87$268.09 $233.77 $216.35 $292.96 $279.95 $269.44 $237.19 $216.85 $215.54$268.09 $233.77 $216.35 $292.96 $279.95 $269.44 $237.19 $216.85 $215.54$268.09 $233.77 $216.35 $292.96 $279.95 $269.44 $237.19 $216.85 $215.54$268.09 $233.77 $216.35 $292.96 $279.95 $269.44 $237.19 $216.85 $215.54$269.16 $234.70 $217.22 $294.13 $281.07 $270.52 $238.14 $217.72 $216.40$274.52 $239.38 $221.55 $299.99 $286.67 $275.91 $242.88 $222.06 $220.71$280.95 $244.99 $226.74 $307.02 $293.39 $282.37 $248.57 $227.26 $225.89$291.41 $254.11 $235.18 $318.45 $304.31 $292.88 $257.82 $235.72 $234.29$299.99 $261.59 $242.10 $327.82 $313.26 $301.50 $265.41 $242.66 $241.19$304.28 $265.33 $245.56 $332.51 $317.74 $305.81 $269.21 $246.13 $244.64$310.71 $270.94 $250.75 $339.54 $324.46 $312.28 $274.90 $251.33 $249.81$317.15 $276.55 $255.95 $346.57 $331.18 $318.75 $280.59 $256.54 $254.98$321.17 $280.06 $259.19 $350.96 $335.38 $322.79 $284.15 $259.79 $258.22$325.46 $283.80 $262.65 $355.65 $339.86 $327.10 $287.94 $263.26 $261.66$327.60 $285.67 $264.39 $357.99 $342.10 $329.26 $289.84 $264.99 $263.39$329.75 $287.54 $266.12 $360.34 $344.34 $331.41 $291.74 $266.73 $265.11$331.89 $289.41 $267.85 $362.68 $346.58 $333.57 $293.64 $268.46 $266.84$334.04 $291.28 $269.58 $365.03 $348.82 $335.72 $295.53 $270.20 $268.56$338.32 $295.02 $273.04 $369.71 $353.30 $340.03 $299.33 $273.67 $272.01$342.61 $298.76 $276.50 $374.40 $357.78 $344.34 $303.12 $277.14 $275.46$349.05 $304.37 $281.69 $381.43 $364.50 $350.81 $308.82 $282.34 $280.63$355.21 $309.74 $286.67 $388.17 $370.93 $357.01 $314.27 $287.33 $285.59$363.79 $317.22 $293.59 $397.54 $379.89 $365.63 $321.86 $294.27 $292.49$374.52 $326.58 $302.25 $409.26 $391.09 $376.41 $331.35 $302.94 $301.11$387.12 $337.56 $312.42 $423.03 $404.25 $389.07 $342.50 $313.14 $311.24$402.13 $350.65 $324.53 $439.44 $419.93 $404.16 $355.78 $325.28 $323.31$419.02 $365.38 $338.16 $457.89 $437.56 $421.13 $370.72 $338.94 $336.89$438.32 $382.21 $353.74 $478.99 $457.72 $440.53 $387.80 $354.56 $352.41$457.35 $398.81 $369.10 $499.79 $477.60 $459.66 $404.64 $369.95 $367.71$478.80 $417.51 $386.41 $523.22 $499.99 $481.22 $423.62 $387.30 $384.95$499.98 $435.98 $403.50 $546.37 $522.11 $502.51 $442.35 $404.43 $401.98$523.30 $456.32 $422.32 $571.85 $546.46 $525.95 $462.99 $423.30 $420.73$546.90 $476.89 $441.36 $597.63 $571.10 $549.66 $483.86 $442.38 $439.70$572.36 $499.10 $461.92 $625.46 $597.69 $575.25 $506.39 $462.98 $460.18$597.83 $521.30 $482.47 $653.30 $624.29 $600.85 $528.93 $483.58 $480.65$625.44 $545.38 $504.75 $683.47 $653.12 $628.60 $553.36 $505.92 $502.85$653.33 $569.70 $527.26 $713.94 $682.24 $656.62 $578.02 $528.47 $525.27$683.08 $595.64 $551.27 $746.46 $713.31 $686.53 $604.35 $552.54 $549.19$697.83 $608.50 $563.17 $762.57 $728.71 $701.35 $617.40 $564.47 $561.05$727.59 $634.45 $587.19 $795.09 $759.79 $731.26 $643.73 $588.54 $584.97$753.32 $656.89 $607.96 $823.21 $786.66 $757.13 $666.49 $609.36 $605.67$770.21 $671.62 $621.59 $841.67 $804.30 $774.10 $681.44 $623.02 $619.24$791.39 $690.09 $638.68 $864.81 $826.41 $795.39 $700.18 $640.15 $636.27$804.26 $701.31 $649.06 $878.87 $839.85 $808.32 $711.56 $650.56 $646.62
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4Moda Health Plan Inc
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
$137.18 $156.48 $122.50 $209.28 $189.35 $205.01 $171.98 $139.67 $248.63$216.03 $246.43 $192.91 $329.58 $298.19 $322.84 $270.84 $219.95 $391.55$216.03 $246.43 $192.91 $329.58 $298.19 $322.84 $270.84 $219.95 $391.55$216.03 $246.43 $192.91 $329.58 $298.19 $322.84 $270.84 $219.95 $391.55$216.03 $246.43 $192.91 $329.58 $298.19 $322.84 $270.84 $219.95 $391.55$216.90 $247.41 $193.68 $330.90 $299.38 $324.14 $271.92 $220.83 $393.12$221.22 $252.34 $197.54 $337.49 $305.34 $330.59 $277.34 $225.23 $400.95$226.40 $258.26 $202.17 $345.40 $312.50 $338.34 $283.84 $230.51 $410.34$234.83 $267.87 $209.69 $358.26 $324.13 $350.93 $294.40 $239.08 $425.61$241.74 $275.75 $215.87 $368.80 $333.67 $361.26 $303.07 $246.12 $438.14$245.20 $279.69 $218.95 $374.08 $338.44 $366.43 $307.40 $249.64 $444.41$250.38 $285.61 $223.58 $381.98 $345.60 $374.18 $313.90 $254.92 $453.81$255.57 $291.52 $228.21 $389.89 $352.75 $381.93 $320.40 $260.20 $463.20$258.81 $295.22 $231.11 $394.84 $357.23 $386.77 $324.46 $263.50 $469.08$262.27 $299.16 $234.19 $400.11 $362.00 $391.93 $328.80 $267.02 $475.34$263.99 $301.13 $235.74 $402.75 $364.38 $394.52 $330.96 $268.78 $478.47$265.72 $303.11 $237.28 $405.39 $366.77 $397.10 $333.13 $270.54 $481.61$267.45 $305.08 $238.82 $408.02 $369.15 $399.68 $335.30 $272.30 $484.74$269.18 $307.05 $240.37 $410.66 $371.54 $402.26 $337.46 $274.06 $487.87$272.63 $310.99 $243.45 $415.93 $376.31 $407.43 $341.80 $277.57 $494.14$276.09 $314.93 $246.54 $421.21 $381.08 $412.60 $346.13 $281.09 $500.40$281.28 $320.85 $251.17 $429.12 $388.24 $420.34 $352.63 $286.37 $509.80$286.24 $326.52 $255.61 $436.70 $395.10 $427.77 $358.86 $291.43 $518.80$293.16 $334.40 $261.78 $447.24 $404.64 $438.10 $367.53 $298.47 $531.33$301.80 $344.26 $269.49 $460.43 $416.57 $451.01 $378.36 $307.27 $546.99$311.95 $355.84 $278.56 $475.92 $430.58 $466.19 $391.09 $317.61 $565.40$324.05 $369.64 $289.36 $494.37 $447.28 $484.27 $406.26 $329.92 $587.32$337.66 $385.17 $301.52 $515.14 $466.06 $504.61 $423.32 $343.78 $611.99$353.22 $402.91 $315.41 $538.87 $487.53 $527.85 $442.82 $359.62 $640.18$368.55 $420.40 $329.10 $562.27 $508.71 $550.77 $462.05 $375.23 $667.98$385.84 $440.12 $344.54 $588.63 $532.56 $576.60 $483.71 $392.83 $699.31$402.90 $459.59 $359.78 $614.67 $556.12 $602.11 $505.11 $410.20 $730.24$421.70 $481.03 $376.56 $643.34 $582.06 $630.19 $528.67 $429.34 $764.30$440.71 $502.71 $393.54 $672.35 $608.30 $658.60 $552.51 $448.69 $798.76$461.23 $526.12 $411.86 $703.66 $636.63 $689.27 $578.24 $469.59 $835.96$481.76 $549.53 $430.19 $734.97 $664.95 $719.94 $603.97 $490.48 $873.16$504.01 $574.91 $450.06 $768.91 $695.67 $753.20 $631.86 $513.14 $913.49$526.47 $600.54 $470.12 $803.19 $726.68 $786.77 $660.03 $536.01 $954.21$550.45 $627.90 $491.53 $839.77 $759.78 $822.61 $690.09 $560.43 $997.67$562.34 $641.45 $502.14 $857.90 $776.18 $840.36 $704.99 $572.52 $1,019.20$586.32 $668.80 $523.56 $894.48 $809.28 $876.20 $735.05 $596.94 $1,062.67$607.05 $692.46 $542.08 $926.12 $837.90 $907.19 $761.05 $618.05 $1,100.25$620.67 $707.99 $554.23 $946.89 $856.69 $927.53 $778.11 $631.91 $1,124.92$637.73 $727.45 $569.47 $972.92 $880.25 $953.04 $799.51 $649.29 $1,155.85$648.10 $739.28 $578.73 $988.74 $894.56 $968.53 $812.51 $659.84 $1,174.65
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health Plan Inc
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000
$245.42 $232.04 $225.49 $225.07 $219.49 $197.26 $193.56 $197.07 $190.27$386.49 $365.42 $355.10 $354.44 $345.65 $310.65 $304.82 $310.35 $299.63$386.49 $365.42 $355.10 $354.44 $345.65 $310.65 $304.82 $310.35 $299.63$386.49 $365.42 $355.10 $354.44 $345.65 $310.65 $304.82 $310.35 $299.63$386.49 $365.42 $355.10 $354.44 $345.65 $310.65 $304.82 $310.35 $299.63$388.04 $366.88 $356.52 $355.85 $347.04 $311.89 $306.04 $311.59 $300.83$395.77 $374.19 $363.62 $362.94 $353.95 $318.11 $312.13 $317.80 $306.82$405.04 $382.96 $372.15 $371.45 $362.25 $325.56 $319.45 $325.24 $314.01$420.12 $397.21 $385.99 $385.27 $375.73 $337.68 $331.34 $337.35 $325.70$432.49 $408.90 $397.36 $396.61 $386.79 $347.62 $341.09 $347.28 $335.29$438.67 $414.75 $403.04 $402.28 $392.32 $352.59 $345.97 $352.24 $340.08$447.95 $423.52 $411.56 $410.79 $400.61 $360.04 $353.28 $359.69 $347.27$457.22 $432.29 $420.08 $419.30 $408.91 $367.50 $360.60 $367.14 $354.47$463.02 $437.77 $425.41 $424.61 $414.09 $372.16 $365.17 $371.80 $358.96$469.20 $443.62 $431.09 $430.29 $419.62 $377.13 $370.05 $376.76 $363.75$472.29 $446.54 $433.93 $433.12 $422.39 $379.61 $372.49 $379.24 $366.15$475.39 $449.46 $436.77 $435.96 $425.16 $382.10 $374.92 $381.73 $368.55$478.48 $452.39 $439.61 $438.79 $427.92 $384.58 $377.36 $384.21 $370.95$481.57 $455.31 $442.46 $441.63 $430.69 $387.07 $379.80 $386.69 $373.34$487.75 $461.16 $448.14 $447.30 $436.22 $392.04 $384.68 $391.66 $378.14$493.94 $467.00 $453.82 $452.97 $441.75 $397.01 $389.56 $396.62 $382.93$503.21 $475.77 $462.34 $461.48 $450.04 $404.47 $396.87 $404.07 $390.12$512.10 $484.18 $470.51 $469.63 $457.99 $411.61 $403.88 $411.21 $397.01$524.47 $495.87 $481.87 $480.97 $469.05 $421.55 $413.64 $421.14 $406.60$539.93 $510.49 $496.08 $495.15 $482.88 $433.98 $425.83 $433.56 $418.59$558.10 $527.66 $512.77 $511.81 $499.13 $448.58 $440.16 $448.14 $432.67$579.74 $548.13 $532.65 $531.65 $518.48 $465.97 $457.22 $465.52 $449.45$604.09 $571.15 $555.02 $553.98 $540.26 $485.55 $476.43 $485.07 $468.33$631.92 $597.46 $580.59 $579.50 $565.15 $507.91 $498.38 $507.42 $489.90$659.36 $623.40 $605.80 $604.67 $589.69 $529.97 $520.02 $529.45 $511.17$690.28 $652.64 $634.21 $633.02 $617.34 $554.82 $544.40 $554.28 $535.14$720.81 $681.50 $662.26 $661.02 $644.65 $579.36 $568.48 $578.80 $558.81$754.43 $713.30 $693.16 $691.86 $674.72 $606.39 $595.00 $605.80 $584.88$788.45 $745.45 $724.41 $723.05 $705.14 $633.73 $621.83 $633.11 $611.25$825.16 $780.17 $758.14 $756.72 $737.97 $663.24 $650.78 $662.59 $639.72$861.88 $814.88 $791.87 $790.39 $770.81 $692.75 $679.74 $692.08 $668.18$901.69 $852.52 $828.45 $826.90 $806.41 $724.75 $711.14 $724.04 $699.04$941.88 $890.52 $865.38 $863.76 $842.36 $757.05 $742.84 $756.32 $730.20$984.78 $931.09 $904.80 $903.10 $880.73 $791.54 $776.67 $790.77 $763.46
$1,006.04 $951.18 $924.33 $922.60 $899.74 $808.62 $793.44 $807.84 $779.94$1,048.94 $991.74 $963.74 $961.94 $938.11 $843.10 $827.27 $842.28 $813.20$1,086.05 $1,026.82 $997.83 $995.96 $971.29 $872.93 $856.53 $872.08 $841.97$1,110.39 $1,049.85 $1,020.20 $1,018.29 $993.07 $892.50 $875.74 $891.63 $860.84$1,140.93 $1,078.71 $1,048.26 $1,046.29 $1,020.37 $917.04 $899.82 $916.15 $884.52$1,159.48 $1,096.25 $1,065.30 $1,063.31 $1,036.96 $931.95 $914.45 $931.04 $898.90
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
$185.19 $180.67 $176.55 $166.92 $188.94 $183.47 $159.98 $148.06 $200.49$291.64 $284.51 $278.02 $262.87 $297.54 $288.92 $251.94 $233.17 $315.73$291.64 $284.51 $278.02 $262.87 $297.54 $288.92 $251.94 $233.17 $315.73$291.64 $284.51 $278.02 $262.87 $297.54 $288.92 $251.94 $233.17 $315.73$291.64 $284.51 $278.02 $262.87 $297.54 $288.92 $251.94 $233.17 $315.73$292.80 $285.65 $279.14 $263.92 $298.73 $290.08 $252.95 $234.10 $316.99$298.64 $291.34 $284.70 $269.18 $304.68 $295.86 $257.98 $238.77 $323.30$305.64 $298.17 $291.37 $275.49 $311.82 $302.79 $264.03 $244.36 $330.88$317.01 $309.27 $302.21 $285.74 $323.43 $314.06 $273.86 $253.46 $343.19$326.34 $318.37 $311.11 $294.15 $332.95 $323.30 $281.92 $260.92 $353.30$331.01 $322.92 $315.56 $298.36 $337.71 $327.93 $285.95 $264.65 $358.35$338.01 $329.75 $322.23 $304.66 $344.85 $334.86 $292.00 $270.24 $365.93$345.01 $336.58 $328.90 $310.97 $351.99 $341.79 $298.04 $275.84 $373.50$349.38 $340.85 $333.07 $314.92 $356.45 $346.13 $301.82 $279.34 $378.24$354.05 $345.40 $337.52 $319.12 $361.22 $350.75 $305.85 $283.07 $383.29$356.38 $347.68 $339.75 $321.23 $363.60 $353.06 $307.87 $284.93 $385.82$358.71 $349.95 $341.97 $323.33 $365.98 $355.37 $309.88 $286.80 $388.34$361.05 $352.23 $344.19 $325.43 $368.36 $357.69 $311.90 $288.66 $390.87$363.38 $354.50 $346.42 $327.53 $370.74 $360.00 $313.91 $290.53 $393.40$368.05 $359.06 $350.87 $331.74 $375.50 $364.62 $317.95 $294.26 $398.45$372.71 $363.61 $355.32 $335.95 $380.26 $369.24 $321.98 $297.99 $403.50$379.71 $370.44 $361.99 $342.25 $387.40 $376.18 $328.02 $303.59 $411.08$386.42 $376.98 $368.38 $348.30 $394.24 $382.82 $333.82 $308.95 $418.34$395.75 $386.09 $377.28 $356.71 $403.76 $392.07 $341.88 $316.41 $428.44$407.42 $397.47 $388.40 $367.23 $415.67 $403.62 $351.96 $325.74 $441.07$421.12 $410.84 $401.47 $379.58 $429.65 $417.20 $363.80 $336.70 $455.91$437.46 $426.77 $417.04 $394.30 $446.31 $433.38 $377.91 $349.75 $473.59$455.83 $444.70 $434.55 $410.86 $465.06 $451.58 $393.78 $364.44 $493.48$476.83 $465.18 $454.57 $429.79 $486.48 $472.39 $411.92 $381.23 $516.21$497.53 $485.38 $474.31 $448.45 $507.61 $492.90 $429.81 $397.79 $538.63$520.86 $508.14 $496.55 $469.48 $531.41 $516.01 $449.96 $416.44 $563.89$543.90 $530.62 $518.52 $490.25 $554.92 $538.84 $469.86 $434.86 $588.83$569.28 $555.37 $542.70 $513.12 $580.80 $563.98 $491.78 $455.15 $616.30$594.94 $580.41 $567.17 $536.25 $606.98 $589.40 $513.95 $475.67 $644.08$622.64 $607.44 $593.58 $561.22 $635.25 $616.85 $537.89 $497.82 $674.08$650.35 $634.47 $619.99 $586.20 $663.52 $644.30 $561.82 $519.97 $704.07$680.39 $663.77 $648.63 $613.27 $694.16 $674.05 $587.77 $543.98 $736.59$710.72 $693.36 $677.55 $640.61 $725.11 $704.10 $613.97 $568.23 $769.43$743.09 $724.94 $708.41 $669.79 $758.14 $736.17 $641.94 $594.12 $804.47$759.13 $740.59 $723.70 $684.25 $774.50 $752.06 $655.79 $606.94 $821.84$791.50 $772.17 $754.56 $713.43 $807.53 $784.13 $683.76 $632.82 $856.88$819.50 $799.48 $781.25 $738.66 $836.09 $811.87 $707.94 $655.21 $887.19$837.87 $817.41 $798.76 $755.22 $854.84 $830.07 $723.82 $669.90 $907.08$860.91 $839.88 $820.73 $775.99 $878.34 $852.90 $743.72 $688.32 $932.02$874.91 $853.54 $834.07 $788.61 $892.62 $866.77 $755.81 $699.51 $947.18
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Summit
Exclusive 2000
$191.58 $184.39 $162.32 $148.40 $147.50 $147.84 $168.64 $174.40$301.71 $290.38 $255.62 $233.71 $232.29 $232.82 $265.58 $274.64$301.71 $290.38 $255.62 $233.71 $232.29 $232.82 $265.58 $274.64$301.71 $290.38 $255.62 $233.71 $232.29 $232.82 $265.58 $274.64$301.71 $290.38 $255.62 $233.71 $232.29 $232.82 $265.58 $274.64$302.91 $291.54 $256.64 $234.64 $233.22 $233.76 $266.64 $275.74$308.95 $297.35 $261.76 $239.32 $237.87 $238.41 $271.95 $281.23$316.19 $304.32 $267.89 $244.93 $243.44 $244.00 $278.33 $287.82$327.96 $315.64 $277.86 $254.04 $252.50 $253.08 $288.69 $298.53$337.61 $324.94 $286.04 $261.52 $259.93 $260.53 $297.18 $307.32$342.44 $329.58 $290.13 $265.26 $263.65 $264.26 $301.43 $311.72$349.68 $336.55 $296.26 $270.87 $269.23 $269.84 $307.81 $318.31$356.92 $343.52 $302.40 $276.48 $274.80 $275.43 $314.18 $324.90$361.45 $347.88 $306.23 $279.98 $278.28 $278.92 $318.16 $329.02$366.27 $352.52 $310.32 $283.72 $282.00 $282.65 $322.41 $333.41$368.69 $354.85 $312.37 $285.59 $283.86 $284.51 $324.54 $335.61$371.10 $357.17 $314.41 $287.46 $285.72 $286.37 $326.66 $337.81$373.51 $359.49 $316.46 $289.33 $287.58 $288.24 $328.79 $340.01$375.93 $361.81 $318.50 $291.20 $289.43 $290.10 $330.91 $342.20$380.76 $366.46 $322.59 $294.94 $293.15 $293.82 $335.16 $346.60$385.58 $371.11 $326.68 $298.68 $296.87 $297.55 $339.41 $350.99$392.82 $378.08 $332.82 $304.29 $302.44 $303.14 $345.78 $357.58$399.76 $384.75 $338.70 $309.66 $307.79 $308.49 $351.89 $363.90$409.42 $394.05 $346.88 $317.14 $315.22 $315.94 $360.39 $372.69$421.49 $405.66 $357.10 $326.49 $324.51 $325.26 $371.01 $383.67$435.67 $419.31 $369.12 $337.47 $335.43 $336.20 $383.50 $396.58$452.56 $435.57 $383.43 $350.56 $348.44 $349.24 $398.37 $411.96$471.57 $453.86 $399.54 $365.28 $363.07 $363.90 $415.10 $429.26$493.29 $474.77 $417.94 $382.11 $379.80 $380.67 $434.22 $449.04$514.71 $495.39 $436.09 $398.70 $396.29 $397.20 $453.08 $468.54$538.85 $518.62 $456.54 $417.40 $414.87 $415.82 $474.33 $490.51$562.69 $541.56 $476.73 $435.86 $433.22 $434.22 $495.31 $512.20$588.93 $566.82 $498.97 $456.20 $453.43 $454.47 $518.41 $536.10$615.48 $592.38 $521.47 $476.76 $473.87 $474.96 $541.78 $560.27$644.15 $619.96 $545.75 $498.97 $495.94 $497.08 $567.01 $586.36$672.81 $647.55 $570.03 $521.17 $518.01 $519.20 $592.24 $612.45$703.89 $677.46 $596.36 $545.24 $541.94 $543.18 $619.60 $640.74$735.26 $707.66 $622.95 $569.54 $566.09 $567.39 $647.22 $669.30$768.75 $739.89 $651.32 $595.49 $591.88 $593.24 $676.70 $699.78$785.35 $755.86 $665.38 $608.34 $604.65 $606.04 $691.30 $714.89$818.84 $788.09 $693.76 $634.28 $630.44 $631.88 $720.78 $745.37$847.80 $815.97 $718.30 $656.72 $652.74 $654.24 $746.28 $771.74$866.81 $834.26 $734.40 $671.44 $667.37 $668.90 $763.01 $789.04$890.64 $857.20 $754.59 $689.90 $685.72 $687.30 $783.99 $810.74$905.12 $871.14 $766.86 $701.12 $696.87 $698.47 $796.74 $823.92
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 4
Moda Health
Synergy
Exclusive 5000
Moda Health
Summit
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Platinum
Summit
Exclusive 250
PPO Synergy
Exclusive
1000A
PPO Summit
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
$132.02 $136.22 $225.55 $233.72 $204.06 $211.37 $220.94 $185.35 $150.52$207.90 $214.52 $355.20 $368.06 $321.36 $332.87 $347.94 $291.89 $237.04$207.90 $214.52 $355.20 $368.06 $321.36 $332.87 $347.94 $291.89 $237.04$207.90 $214.52 $355.20 $368.06 $321.36 $332.87 $347.94 $291.89 $237.04$207.90 $214.52 $355.20 $368.06 $321.36 $332.87 $347.94 $291.89 $237.04$208.73 $215.37 $356.62 $369.53 $322.65 $334.20 $349.33 $293.05 $237.99$212.89 $219.66 $363.72 $376.90 $329.07 $340.86 $356.29 $298.89 $242.73$217.88 $224.81 $372.25 $385.73 $336.79 $348.85 $364.64 $305.90 $248.42$225.99 $233.18 $386.10 $400.08 $349.32 $361.83 $378.21 $317.28 $257.67$232.64 $240.04 $397.47 $411.86 $359.60 $372.48 $389.34 $326.62 $265.25$235.97 $243.48 $403.15 $417.75 $364.74 $377.81 $394.91 $331.29 $269.04$240.96 $248.62 $411.67 $426.58 $372.46 $385.80 $403.26 $338.30 $274.73$245.95 $253.77 $420.20 $435.42 $380.17 $393.79 $411.61 $345.30 $280.42$249.07 $256.99 $425.53 $440.94 $384.99 $398.78 $416.83 $349.68 $283.98$252.39 $260.42 $431.21 $446.83 $390.13 $404.11 $422.39 $354.35 $287.77$254.06 $262.14 $434.05 $449.77 $392.70 $406.77 $425.18 $356.68 $289.67$255.72 $263.86 $436.89 $452.72 $395.27 $409.43 $427.96 $359.02 $291.56$257.38 $265.57 $439.73 $455.66 $397.85 $412.10 $430.74 $361.36 $293.46$259.05 $267.29 $442.58 $458.61 $400.42 $414.76 $433.53 $363.69 $295.35$262.37 $270.72 $448.26 $464.49 $405.56 $420.09 $439.10 $368.36 $299.15$265.70 $274.15 $453.94 $470.38 $410.70 $425.41 $444.66 $373.03 $302.94$270.69 $279.30 $462.47 $479.22 $418.41 $433.40 $453.01 $380.04 $308.63$275.47 $284.23 $470.64 $487.68 $425.80 $441.06 $461.02 $386.75 $314.08$282.12 $291.10 $482.00 $499.46 $436.09 $451.71 $472.15 $396.09 $321.67$290.44 $299.68 $496.21 $514.18 $448.94 $465.02 $486.07 $407.77 $331.15$300.21 $309.76 $512.90 $531.48 $464.05 $480.67 $502.42 $421.48 $342.29$311.85 $321.77 $532.80 $552.09 $482.04 $499.31 $521.90 $437.83 $355.56$324.95 $335.29 $555.17 $575.28 $502.29 $520.28 $543.82 $456.22 $370.50$339.92 $350.73 $580.75 $601.78 $525.43 $544.25 $568.88 $477.23 $387.56$354.68 $365.96 $605.97 $627.91 $548.24 $567.88 $593.58 $497.96 $404.39$371.31 $383.13 $634.38 $657.36 $573.95 $594.51 $621.41 $521.31 $423.36$387.74 $400.07 $662.44 $686.44 $599.34 $620.81 $648.90 $544.37 $442.08$405.83 $418.74 $693.34 $718.46 $627.30 $649.77 $679.17 $569.76 $462.71$424.12 $437.61 $724.60 $750.85 $655.58 $679.06 $709.79 $595.45 $483.57$443.87 $457.99 $758.34 $785.81 $686.11 $710.68 $742.84 $623.18 $506.09$463.62 $478.37 $792.09 $820.78 $716.64 $742.31 $775.90 $650.91 $528.60$485.04 $500.47 $828.67 $858.69 $749.74 $776.59 $811.74 $680.97 $553.02$506.66 $522.78 $865.61 $896.97 $783.16 $811.21 $847.92 $711.33 $577.67$529.74 $546.59 $905.04 $937.82 $818.83 $848.16 $886.54 $743.73 $603.98$541.17 $558.39 $924.58 $958.07 $836.50 $866.47 $905.68 $759.78 $617.02$564.25 $582.20 $964.00 $998.92 $872.17 $903.42 $944.30 $792.18 $643.33$584.21 $602.79 $998.10 $1,034.25 $903.02 $935.37 $977.70 $820.20 $666.09$597.30 $616.31 $1,020.48 $1,057.44 $923.27 $956.34 $999.62 $838.59 $681.02$613.73 $633.25 $1,048.54 $1,086.52 $948.66 $982.64 $1,027.11 $861.65 $699.75$623.71 $643.55 $1,065.59 $1,104.19 $964.08 $998.62 $1,043.81 $875.66 $711.13
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5Moda Health Plan Inc
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500
$239.07 $235.98 $223.12 $216.82 $216.41 $211.05 $189.68 $186.11 $189.49$376.49 $371.63 $351.36 $341.44 $340.80 $332.36 $298.70 $293.09 $298.41$376.49 $371.63 $351.36 $341.44 $340.80 $332.36 $298.70 $293.09 $298.41$376.49 $371.63 $351.36 $341.44 $340.80 $332.36 $298.70 $293.09 $298.41$376.49 $371.63 $351.36 $341.44 $340.80 $332.36 $298.70 $293.09 $298.41$378.00 $373.11 $352.77 $342.81 $342.17 $333.69 $299.90 $294.27 $299.60$385.53 $380.55 $359.80 $349.64 $348.98 $340.34 $305.87 $300.13 $305.57$394.56 $389.47 $368.23 $357.83 $357.16 $348.31 $313.04 $307.16 $312.74$409.24 $403.96 $381.93 $371.15 $370.45 $361.28 $324.69 $318.59 $324.37$421.29 $415.85 $393.18 $382.07 $381.36 $371.91 $334.25 $327.97 $333.92$427.32 $421.80 $398.80 $387.54 $386.81 $377.23 $339.03 $332.66 $338.70$436.35 $430.72 $407.23 $395.73 $394.99 $385.21 $346.20 $339.69 $345.86$445.39 $439.64 $415.66 $403.93 $403.17 $393.18 $353.36 $346.73 $353.02$451.03 $445.21 $420.93 $409.05 $408.28 $398.17 $357.84 $351.13 $357.50$457.06 $451.16 $426.56 $414.51 $413.74 $403.49 $362.62 $355.81 $362.27$460.07 $454.13 $429.37 $417.24 $416.46 $406.14 $365.01 $358.16 $364.66$463.08 $457.10 $432.18 $419.97 $419.19 $408.80 $367.40 $360.50 $367.05$466.09 $460.08 $434.99 $422.71 $421.92 $411.46 $369.79 $362.85 $369.43$469.11 $463.05 $437.80 $425.44 $424.64 $414.12 $372.18 $365.19 $371.82$475.13 $468.99 $443.42 $430.90 $430.09 $419.44 $376.96 $369.88 $376.60$481.15 $474.94 $449.04 $436.36 $435.55 $424.76 $381.74 $374.57 $381.37$490.19 $483.86 $457.48 $444.56 $443.73 $432.73 $388.91 $381.61 $388.53$498.85 $492.41 $465.56 $452.41 $451.56 $440.38 $395.78 $388.35 $395.40$510.90 $504.30 $476.80 $463.34 $462.47 $451.01 $405.34 $397.73 $404.94$525.96 $519.16 $490.85 $477.00 $476.10 $464.31 $417.29 $409.45 $416.88$543.65 $536.63 $507.37 $493.04 $492.12 $479.93 $431.33 $423.23 $430.91$564.73 $557.44 $527.05 $512.16 $511.21 $498.54 $448.05 $439.64 $447.62$588.45 $580.85 $549.18 $533.68 $532.68 $519.48 $466.87 $458.10 $466.42$615.56 $607.61 $574.48 $558.26 $557.21 $543.41 $488.38 $479.21 $487.90$642.29 $634.00 $599.43 $582.50 $581.41 $567.01 $509.59 $500.02 $509.09$672.41 $663.73 $627.54 $609.82 $608.68 $593.60 $533.48 $523.46 $532.96$702.15 $693.09 $655.29 $636.79 $635.60 $619.85 $557.08 $546.62 $556.54$734.91 $725.42 $685.86 $666.50 $665.25 $648.77 $583.07 $572.12 $582.50$768.04 $758.12 $716.78 $696.54 $695.24 $678.02 $609.35 $597.91 $608.76$803.81 $793.43 $750.16 $728.98 $727.62 $709.59 $637.73 $625.75 $637.11$839.57 $828.73 $783.54 $761.42 $759.99 $741.16 $666.10 $653.60 $665.46$878.35 $867.01 $819.73 $796.59 $795.10 $775.40 $696.87 $683.79 $696.19$917.51 $905.66 $856.27 $832.10 $830.54 $809.96 $727.94 $714.27 $727.23$959.30 $946.91 $895.27 $870.00 $868.37 $846.85 $761.09 $746.80 $760.35$980.00 $967.35 $914.60 $888.78 $887.11 $865.13 $777.52 $762.92 $776.76
$1,021.79 $1,008.60 $953.60 $926.68 $924.94 $902.03 $810.68 $795.45 $809.89$1,057.94 $1,044.27 $987.33 $959.45 $957.66 $933.93 $839.35 $823.59 $838.54$1,081.66 $1,067.69 $1,009.47 $980.97 $979.13 $954.87 $858.17 $842.06 $857.34$1,111.40 $1,097.05 $1,037.22 $1,007.94 $1,006.05 $981.13 $881.77 $865.21 $880.91$1,129.47 $1,114.88 $1,054.09 $1,024.33 $1,022.41 $997.08 $896.11 $879.28 $895.23
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5
Value 2000 Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
$182.95 $178.07 $173.72 $169.76 $160.50 $181.67 $176.41 $153.83 $142.37$288.11 $280.42 $273.57 $267.33 $252.76 $286.10 $277.81 $242.25 $224.20$288.11 $280.42 $273.57 $267.33 $252.76 $286.10 $277.81 $242.25 $224.20$288.11 $280.42 $273.57 $267.33 $252.76 $286.10 $277.81 $242.25 $224.20$288.11 $280.42 $273.57 $267.33 $252.76 $286.10 $277.81 $242.25 $224.20$289.26 $281.54 $274.67 $268.40 $253.77 $287.24 $278.92 $243.22 $225.10$295.02 $287.15 $280.14 $273.75 $258.82 $292.96 $284.48 $248.06 $229.58$301.94 $293.88 $286.70 $280.16 $264.89 $299.83 $291.14 $253.88 $234.96$313.17 $304.82 $297.37 $290.59 $274.75 $310.99 $301.98 $263.32 $243.71$322.39 $313.79 $306.13 $299.14 $282.84 $320.14 $310.87 $271.08 $250.88$327.00 $318.28 $310.50 $303.42 $286.88 $324.72 $315.31 $274.95 $254.47$333.92 $325.01 $317.07 $309.84 $292.95 $331.59 $321.98 $280.77 $259.85$340.83 $331.74 $323.63 $316.25 $299.01 $338.45 $328.65 $286.58 $265.23$345.15 $335.94 $327.74 $320.26 $302.80 $342.75 $332.82 $290.21 $268.59$349.76 $340.43 $332.12 $324.54 $306.85 $347.32 $337.26 $294.09 $272.18$352.07 $342.67 $334.30 $326.68 $308.87 $349.61 $339.48 $296.03 $273.97$354.37 $344.92 $336.49 $328.82 $310.89 $351.90 $341.71 $297.96 $275.77$356.68 $347.16 $338.68 $330.96 $312.91 $354.19 $343.93 $299.90 $277.56$358.98 $349.40 $340.87 $333.09 $314.94 $356.48 $346.15 $301.84 $279.35$363.59 $353.89 $345.25 $337.37 $318.98 $361.06 $350.60 $305.72 $282.94$368.20 $358.38 $349.62 $341.65 $323.03 $365.63 $355.04 $309.59 $286.53$375.12 $365.11 $356.19 $348.07 $329.09 $372.50 $361.71 $315.41 $291.91$381.74 $371.56 $362.48 $354.21 $334.90 $379.08 $368.10 $320.98 $297.07$390.96 $380.53 $371.24 $362.77 $342.99 $388.23 $376.99 $328.73 $304.24$402.49 $391.75 $382.18 $373.46 $353.10 $399.68 $388.10 $338.42 $313.21$416.03 $404.93 $395.04 $386.03 $364.98 $413.13 $401.16 $349.81 $323.75$432.16 $420.63 $410.36 $401.00 $379.14 $429.15 $416.71 $363.37 $336.30$450.31 $438.30 $427.59 $417.84 $395.06 $447.17 $434.22 $378.63 $350.43$471.06 $458.49 $447.29 $437.09 $413.26 $467.77 $454.22 $396.07 $366.57$491.51 $478.40 $466.71 $456.07 $431.21 $488.08 $473.94 $413.27 $382.49$514.56 $500.83 $488.60 $477.45 $451.43 $510.97 $496.17 $432.65 $400.42$537.32 $522.98 $510.21 $498.57 $471.39 $533.57 $518.11 $451.79 $418.14$562.39 $547.38 $534.01 $521.83 $493.38 $558.46 $542.28 $472.87 $437.64$587.74 $572.06 $558.08 $545.36 $515.63 $583.64 $566.73 $494.19 $457.37$615.11 $598.70 $584.07 $570.75 $539.64 $610.82 $593.12 $517.20 $478.67$642.48 $625.34 $610.06 $596.15 $563.65 $638.00 $619.52 $540.21 $499.97$672.16 $654.22 $638.24 $623.68 $589.69 $667.47 $648.13 $565.16 $523.06$702.12 $683.38 $666.69 $651.49 $615.97 $697.22 $677.02 $590.36 $546.38$734.10 $714.51 $697.06 $681.16 $644.03 $728.98 $707.86 $617.25 $571.27$749.95 $729.93 $712.11 $695.86 $657.93 $744.71 $723.14 $630.57 $583.60$781.93 $761.06 $742.47 $725.54 $685.99 $776.47 $753.97 $657.46 $608.48$809.58 $787.98 $768.73 $751.20 $710.25 $803.93 $780.64 $680.72 $630.01$827.73 $805.65 $785.97 $768.04 $726.17 $821.96 $798.15 $695.98 $644.13$850.50 $827.80 $807.58 $789.16 $746.14 $844.56 $820.09 $715.12 $661.84$864.32 $841.26 $820.71 $801.99 $758.27 $858.29 $833.43 $726.74 $672.60
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
$192.78 $184.22 $177.30 $156.08 $142.70 $141.83 $142.16 $162.16 $126.94$303.58 $290.10 $279.21 $245.79 $224.72 $223.36 $223.87 $255.37 $199.91$303.58 $290.10 $279.21 $245.79 $224.72 $223.36 $223.87 $255.37 $199.91$303.58 $290.10 $279.21 $245.79 $224.72 $223.36 $223.87 $255.37 $199.91$303.58 $290.10 $279.21 $245.79 $224.72 $223.36 $223.87 $255.37 $199.91$304.80 $291.26 $280.33 $246.77 $225.62 $224.25 $224.76 $256.39 $200.71$310.87 $297.07 $285.91 $251.69 $230.11 $228.72 $229.24 $261.49 $204.70$318.16 $304.03 $292.61 $257.59 $235.51 $234.08 $234.61 $267.62 $209.50$329.99 $315.34 $303.50 $267.17 $244.27 $242.79 $243.35 $277.58 $217.30$339.71 $324.63 $312.44 $275.04 $251.46 $249.94 $250.51 $285.75 $223.70$344.57 $329.27 $316.91 $278.97 $255.06 $253.51 $254.09 $289.84 $226.89$351.85 $336.23 $323.61 $284.87 $260.45 $258.87 $259.46 $295.97 $231.69$359.14 $343.19 $330.31 $290.77 $265.84 $264.23 $264.84 $302.10 $236.49$363.69 $347.54 $334.50 $294.46 $269.21 $267.58 $268.20 $305.93 $239.49$368.55 $352.19 $338.96 $298.39 $272.81 $271.16 $271.78 $310.01 $242.69$370.98 $354.51 $341.20 $300.35 $274.61 $272.94 $273.57 $312.06 $244.29$373.41 $356.83 $343.43 $302.32 $276.40 $274.73 $275.36 $314.10 $245.88$375.84 $359.15 $345.66 $304.29 $278.20 $276.52 $277.15 $316.14 $247.48$378.26 $361.47 $347.90 $306.25 $280.00 $278.30 $278.94 $318.18 $249.08$383.12 $366.11 $352.37 $310.19 $283.59 $281.88 $282.52 $322.27 $252.28$387.98 $370.75 $356.83 $314.12 $287.19 $285.45 $286.10 $326.36 $255.48$395.27 $377.72 $363.53 $320.02 $292.58 $290.81 $291.48 $332.49 $260.28$402.25 $384.39 $369.96 $325.67 $297.75 $295.95 $296.63 $338.36 $264.88$411.96 $393.67 $378.89 $333.54 $304.94 $303.10 $303.79 $346.53 $271.27$424.11 $405.28 $390.06 $343.37 $313.93 $312.03 $312.75 $356.74 $279.27$438.37 $418.91 $403.18 $354.92 $324.49 $322.53 $323.27 $368.75 $288.66$455.37 $435.16 $418.82 $368.68 $337.08 $335.04 $335.80 $383.05 $299.86$474.50 $453.43 $436.41 $384.17 $351.24 $349.11 $349.91 $399.14 $312.45$496.36 $474.32 $456.51 $401.87 $367.41 $365.19 $366.03 $417.52 $326.85$517.91 $494.92 $476.34 $419.32 $383.37 $381.05 $381.92 $435.65 $341.04$542.20 $518.13 $498.67 $438.98 $401.35 $398.92 $399.83 $456.08 $357.03$566.18 $541.04 $520.73 $458.40 $419.10 $416.56 $417.52 $476.26 $372.83$592.59 $566.28 $545.02 $479.78 $438.65 $435.99 $436.99 $498.47 $390.22$619.31 $591.81 $569.59 $501.41 $458.43 $455.65 $456.69 $520.94 $407.81$648.15 $619.37 $596.12 $524.76 $479.77 $476.87 $477.96 $545.20 $426.80$676.99 $646.93 $622.64 $548.11 $501.12 $498.09 $499.23 $569.46 $445.79$708.26 $676.81 $651.40 $573.43 $524.27 $521.09 $522.29 $595.77 $466.38$739.83 $706.98 $680.44 $598.99 $547.64 $544.32 $545.57 $622.32 $487.17$773.53 $739.18 $711.43 $626.27 $572.58 $569.11 $570.42 $650.67 $509.36$790.23 $755.14 $726.79 $639.79 $584.94 $581.40 $582.73 $664.72 $520.36$823.92 $787.34 $757.78 $667.07 $609.89 $606.19 $607.58 $693.06 $542.55$853.07 $815.19 $784.59 $690.67 $631.46 $627.63 $629.07 $717.58 $561.74$872.19 $833.47 $802.18 $706.15 $645.62 $641.70 $643.18 $733.66 $574.33$896.18 $856.39 $824.23 $725.57 $663.37 $659.35 $660.86 $753.84 $590.12$910.75 $870.31 $837.64 $737.37 $674.16 $670.07 $671.61 $766.10 $599.72
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 5 Area 6Moda Health Plan Inc
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A
$216.87 $196.22 $212.44 $178.22 $144.73 $246.24 $243.06 $229.81 $223.32$341.54 $309.00 $334.55 $280.66 $227.93 $387.78 $382.78 $361.90 $351.69$341.54 $309.00 $334.55 $280.66 $227.93 $387.78 $382.78 $361.90 $351.69$341.54 $309.00 $334.55 $280.66 $227.93 $387.78 $382.78 $361.90 $351.69$341.54 $309.00 $334.55 $280.66 $227.93 $387.78 $382.78 $361.90 $351.69$342.90 $310.24 $335.89 $281.78 $228.84 $389.34 $384.31 $363.35 $353.09$349.73 $316.42 $342.58 $287.40 $233.40 $397.09 $391.96 $370.59 $360.13$357.93 $323.83 $350.61 $294.13 $238.87 $406.40 $401.15 $379.28 $368.57$371.25 $335.88 $363.66 $305.08 $247.76 $421.52 $416.08 $393.39 $382.28$382.18 $345.77 $374.37 $314.06 $255.05 $433.93 $428.33 $404.97 $393.54$387.64 $350.72 $379.72 $318.55 $258.70 $440.14 $434.45 $410.76 $399.16$395.84 $358.13 $387.75 $325.28 $264.17 $449.44 $443.64 $419.45 $407.60$404.04 $365.55 $395.78 $332.02 $269.64 $458.75 $452.82 $428.13 $416.04$409.16 $370.18 $400.80 $336.23 $273.05 $464.57 $458.57 $433.56 $421.32$414.62 $375.13 $406.15 $340.72 $276.70 $470.77 $464.69 $439.35 $426.95$417.36 $377.60 $408.82 $342.97 $278.52 $473.87 $467.75 $442.25 $429.76$420.09 $380.07 $411.50 $345.21 $280.35 $476.98 $470.82 $445.14 $432.57$422.82 $382.54 $414.18 $347.46 $282.17 $480.08 $473.88 $448.04 $435.39$425.55 $385.02 $416.85 $349.70 $284.00 $483.18 $476.94 $450.93 $438.20$431.02 $389.96 $422.21 $354.19 $287.64 $489.38 $483.06 $456.72 $443.83$436.48 $394.90 $427.56 $358.68 $291.29 $495.59 $489.19 $462.51 $449.45$444.68 $402.32 $435.59 $365.42 $296.76 $504.90 $498.38 $471.20 $457.90$452.53 $409.43 $443.28 $371.87 $302.00 $513.81 $507.18 $479.52 $465.98$463.46 $419.31 $453.99 $380.86 $309.29 $526.22 $519.43 $491.10 $477.24$477.12 $431.67 $467.37 $392.08 $318.41 $541.74 $534.74 $505.58 $491.31$493.18 $446.20 $483.10 $405.27 $329.12 $559.96 $552.73 $522.59 $507.83$512.30 $463.50 $501.83 $420.99 $341.89 $581.68 $574.17 $542.86 $527.53$533.82 $482.97 $522.91 $438.67 $356.25 $606.11 $598.28 $565.66 $549.69$558.41 $505.22 $547.00 $458.88 $372.66 $634.03 $625.84 $591.71 $575.01$582.66 $527.16 $570.75 $478.81 $388.84 $661.56 $653.02 $617.41 $599.98$609.98 $551.88 $597.51 $501.26 $407.07 $692.58 $683.64 $646.36 $628.11$636.96 $576.29 $623.94 $523.43 $425.08 $723.22 $713.88 $674.95 $655.89$666.68 $603.17 $653.05 $547.85 $444.91 $756.96 $747.18 $706.44 $686.49$696.73 $630.36 $682.49 $572.55 $464.97 $791.08 $780.86 $738.28 $717.44$729.18 $659.72 $714.27 $599.21 $486.62 $827.92 $817.23 $772.67 $750.85$761.62 $689.07 $746.06 $625.87 $508.27 $864.76 $853.59 $807.05 $784.26$796.80 $720.90 $780.51 $654.78 $531.75 $904.70 $893.02 $844.32 $820.48$832.32 $753.04 $815.31 $683.97 $555.45 $945.03 $932.83 $881.96 $857.06$870.23 $787.33 $852.44 $715.12 $580.75 $988.08 $975.31 $922.13 $896.10$889.02 $804.33 $870.84 $730.56 $593.29 $1,009.40 $996.37 $942.04 $915.44$926.93 $838.63 $907.98 $761.71 $618.59 $1,052.45 $1,038.86 $982.21 $954.48$959.71 $868.29 $940.10 $788.65 $640.47 $1,089.67 $1,075.60 $1,016.95 $988.24$981.23 $887.76 $961.17 $806.34 $654.83 $1,114.11 $1,099.72 $1,039.75 $1,010.39
$1,008.21 $912.17 $987.60 $828.51 $672.84 $1,144.74 $1,129.96 $1,068.34 $1,038.18$1,024.61 $927.00 $1,003.66 $841.98 $683.78 $1,163.35 $1,148.33 $1,085.71 $1,055.06
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500
$222.90 $217.38 $195.37 $191.70 $195.18 $188.44 $183.41 $178.93 $174.85$351.03 $342.33 $307.66 $301.89 $307.36 $296.75 $288.83 $281.78 $275.35$351.03 $342.33 $307.66 $301.89 $307.36 $296.75 $288.83 $281.78 $275.35$351.03 $342.33 $307.66 $301.89 $307.36 $296.75 $288.83 $281.78 $275.35$351.03 $342.33 $307.66 $301.89 $307.36 $296.75 $288.83 $281.78 $275.35$352.43 $343.70 $308.89 $303.09 $308.59 $297.94 $289.99 $282.91 $276.45$359.45 $350.55 $315.05 $309.13 $314.74 $303.87 $295.76 $288.54 $281.96$367.88 $358.76 $322.43 $316.38 $322.12 $311.00 $302.70 $295.30 $288.57$381.57 $372.11 $334.43 $328.15 $334.10 $322.57 $313.96 $306.29 $299.31$392.80 $383.07 $344.27 $337.81 $343.94 $332.06 $323.20 $315.31 $308.12$398.42 $388.55 $349.20 $342.64 $348.86 $336.81 $327.82 $319.82 $312.52$406.84 $396.76 $356.58 $349.89 $356.23 $343.93 $334.76 $326.58 $319.13$415.27 $404.98 $363.97 $357.13 $363.61 $351.06 $341.69 $333.34 $325.74$420.53 $410.11 $368.58 $361.66 $368.22 $355.51 $346.02 $337.57 $329.87$426.15 $415.59 $373.50 $366.49 $373.14 $360.26 $350.64 $342.08 $334.28$428.96 $418.33 $375.96 $368.90 $375.60 $362.63 $352.95 $344.33 $336.48$431.76 $421.07 $378.43 $371.32 $378.06 $365.00 $355.26 $346.59 $338.68$434.57 $423.81 $380.89 $373.73 $380.52 $367.38 $357.57 $348.84 $340.88$437.38 $426.54 $383.35 $376.15 $382.98 $369.75 $359.89 $351.10 $343.09$443.00 $432.02 $388.27 $380.98 $387.89 $374.50 $364.51 $355.60 $347.49$448.61 $437.50 $393.19 $385.81 $392.81 $379.25 $369.13 $360.11 $351.90$457.04 $445.72 $400.58 $393.06 $400.19 $386.37 $376.06 $366.88 $358.51$465.11 $453.59 $407.65 $400.00 $407.26 $393.20 $382.70 $373.36 $364.84$476.34 $464.54 $417.50 $409.66 $417.09 $402.69 $391.95 $382.37 $373.65$490.39 $478.24 $429.80 $421.73 $429.39 $414.56 $403.50 $393.64 $384.67$506.88 $494.33 $444.26 $435.92 $443.83 $428.51 $417.07 $406.89 $397.61$526.54 $513.50 $461.49 $452.83 $461.05 $445.13 $433.25 $422.67 $413.03$548.66 $535.06 $480.88 $471.85 $480.41 $463.82 $451.45 $440.42 $430.37$573.93 $559.71 $503.03 $493.58 $502.54 $485.19 $472.24 $460.71 $450.20$598.85 $584.02 $524.87 $515.02 $524.36 $506.26 $492.75 $480.71 $469.75$626.94 $611.40 $549.49 $539.17 $548.95 $530.00 $515.86 $503.26 $491.78$654.67 $638.45 $573.79 $563.02 $573.23 $553.44 $538.67 $525.52 $513.53$685.21 $668.23 $600.56 $589.28 $599.97 $579.26 $563.80 $550.03 $537.49$716.10 $698.36 $627.63 $615.85 $627.02 $605.37 $589.22 $574.83 $561.72$749.44 $730.88 $656.86 $644.53 $656.22 $633.56 $616.66 $601.60 $587.87$782.79 $763.40 $686.09 $673.20 $685.42 $661.76 $644.10 $628.37 $614.03$818.95 $798.66 $717.78 $704.30 $717.08 $692.32 $673.85 $657.39 $642.39$855.45 $834.26 $749.77 $735.70 $749.05 $723.18 $703.89 $686.69 $671.03$894.42 $872.26 $783.92 $769.20 $783.16 $756.12 $735.95 $717.97 $701.59$913.73 $891.09 $800.85 $785.81 $800.07 $772.44 $751.83 $733.47 $716.74$952.69 $929.09 $835.00 $819.32 $834.18 $805.38 $783.89 $764.75 $747.30$986.39 $961.95 $864.53 $848.30 $863.69 $833.87 $811.62 $791.80 $773.74
$1,008.50 $983.52 $883.92 $867.32 $883.06 $852.57 $829.82 $809.55 $791.08$1,036.23 $1,010.56 $908.22 $891.17 $907.34 $876.01 $852.63 $831.81 $812.84$1,053.08 $1,026.99 $922.99 $905.66 $922.09 $890.25 $866.50 $845.33 $826.05
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
$165.32 $187.12 $181.70 $158.44 $146.64 $198.56 $189.74 $182.62 $160.76$260.34 $294.68 $286.14 $249.52 $230.93 $312.69 $298.81 $287.59 $253.16$260.34 $294.68 $286.14 $249.52 $230.93 $312.69 $298.81 $287.59 $253.16$260.34 $294.68 $286.14 $249.52 $230.93 $312.69 $298.81 $287.59 $253.16$260.34 $294.68 $286.14 $249.52 $230.93 $312.69 $298.81 $287.59 $253.16$261.38 $295.86 $287.29 $250.51 $231.85 $313.94 $300.00 $288.74 $254.18$266.59 $301.75 $293.01 $255.50 $236.47 $320.20 $305.98 $294.49 $259.24$272.84 $308.83 $299.88 $261.49 $242.01 $327.70 $313.15 $301.39 $265.31$282.99 $320.32 $311.04 $271.22 $251.02 $339.89 $324.80 $312.61 $275.19$291.32 $329.75 $320.19 $279.21 $258.41 $349.90 $334.37 $321.81 $283.29$295.49 $334.46 $324.77 $283.20 $262.10 $354.90 $339.15 $326.41 $287.34$301.74 $341.53 $331.64 $289.19 $267.64 $362.41 $346.32 $333.32 $293.42$307.98 $348.61 $338.51 $295.18 $273.19 $369.91 $353.49 $340.22 $299.49$311.89 $353.03 $342.80 $298.92 $276.65 $374.60 $357.97 $344.53 $303.29$316.05 $357.74 $347.38 $302.91 $280.35 $379.61 $362.75 $349.13 $307.34$318.14 $360.10 $349.67 $304.91 $282.19 $382.11 $365.14 $351.43 $309.37$320.22 $362.46 $351.96 $306.90 $284.04 $384.61 $367.53 $353.73 $311.39$322.30 $364.81 $354.25 $308.90 $285.89 $387.11 $369.92 $356.03 $313.42$324.38 $367.17 $356.54 $310.90 $287.74 $389.61 $372.31 $358.34 $315.44$328.55 $371.89 $361.11 $314.89 $291.43 $394.62 $377.09 $362.94 $319.49$332.72 $376.60 $365.69 $318.88 $295.13 $399.62 $381.88 $367.54 $323.54$338.96 $383.67 $372.56 $324.87 $300.67 $407.12 $389.05 $374.44 $329.62$344.95 $390.45 $379.14 $330.61 $305.98 $414.32 $395.92 $381.05 $335.44$353.28 $399.88 $388.30 $338.59 $313.37 $424.32 $405.48 $390.26 $343.54$363.70 $411.67 $399.74 $348.57 $322.61 $436.83 $417.43 $401.76 $353.67$375.93 $425.52 $413.19 $360.30 $333.46 $451.53 $431.48 $415.28 $365.57$390.51 $442.02 $429.22 $374.27 $346.39 $469.04 $448.21 $431.38 $379.74$406.91 $460.59 $447.24 $389.99 $360.94 $488.74 $467.04 $449.50 $395.69$425.66 $481.80 $467.84 $407.96 $377.57 $511.25 $488.55 $470.21 $413.92$444.14 $502.73 $488.16 $425.67 $393.96 $533.45 $509.76 $490.63 $431.90$464.97 $526.30 $511.05 $445.63 $412.44 $558.47 $533.67 $513.63 $452.15$485.54 $549.58 $533.66 $465.35 $430.68 $583.17 $557.28 $536.35 $472.15$508.19 $575.22 $558.55 $487.05 $450.77 $610.37 $583.27 $561.37 $494.17$531.10 $601.15 $583.73 $509.01 $471.09 $637.89 $609.57 $586.68 $516.45$555.83 $629.14 $610.92 $532.71 $493.03 $667.59 $637.95 $614.00 $540.50$580.56 $657.14 $638.10 $556.42 $514.97 $697.30 $666.34 $641.32 $564.55$607.38 $687.49 $667.57 $582.12 $538.75 $729.51 $697.12 $670.94 $590.63$634.45 $718.14 $697.33 $608.07 $562.77 $762.03 $728.19 $700.85 $616.96$663.35 $750.85 $729.09 $635.76 $588.40 $796.74 $761.36 $732.78 $645.06$677.67 $767.05 $744.83 $649.49 $601.10 $813.93 $777.79 $748.59 $658.98$706.57 $799.76 $776.59 $677.18 $626.74 $848.64 $810.96 $780.52 $687.08$731.56 $828.05 $804.06 $701.14 $648.91 $878.66 $839.65 $808.12 $711.39$747.96 $846.62 $822.09 $716.86 $663.45 $898.36 $858.47 $826.24 $727.34$768.53 $869.90 $844.70 $736.57 $681.70 $923.06 $882.08 $848.96 $747.34$781.02 $884.04 $858.43 $748.55 $692.78 $938.07 $896.42 $862.77 $759.49
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 6
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Summit
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
Moda Health
Summit
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Platinum
Summit
Exclusive 250
$146.98 $146.09 $146.42 $167.02 $172.72 $130.75 $134.91 $223.38 $231.47$231.46 $230.06 $230.59 $263.03 $272.00 $205.90 $212.45 $351.78 $364.52$231.46 $230.06 $230.59 $263.03 $272.00 $205.90 $212.45 $351.78 $364.52$231.46 $230.06 $230.59 $263.03 $272.00 $205.90 $212.45 $351.78 $364.52$231.46 $230.06 $230.59 $263.03 $272.00 $205.90 $212.45 $351.78 $364.52$232.39 $230.98 $231.51 $264.08 $273.09 $206.73 $213.30 $353.19 $365.98$237.02 $235.58 $236.12 $269.34 $278.53 $210.85 $217.55 $360.22 $373.27$242.57 $241.10 $241.65 $275.65 $285.06 $215.79 $222.65 $368.67 $382.02$251.60 $250.07 $250.65 $285.91 $295.66 $223.82 $230.94 $382.39 $396.24$259.00 $257.43 $258.02 $294.33 $304.37 $230.41 $237.74 $393.64 $407.90$262.71 $261.12 $261.71 $298.53 $308.72 $233.70 $241.13 $399.27 $413.73$268.26 $266.64 $267.25 $304.85 $315.25 $238.64 $246.23 $407.71 $422.48$273.82 $272.16 $272.78 $311.16 $321.78 $243.58 $251.33 $416.16 $431.23$277.29 $275.61 $276.24 $315.11 $325.86 $246.67 $254.52 $421.43 $436.70$280.99 $279.29 $279.93 $319.31 $330.21 $249.97 $257.92 $427.06 $442.53$282.84 $281.13 $281.78 $321.42 $332.38 $251.61 $259.62 $429.88 $445.45$284.70 $282.97 $283.62 $323.52 $334.56 $253.26 $261.32 $432.69 $448.36$286.55 $284.81 $285.46 $325.63 $336.74 $254.91 $263.02 $435.51 $451.28$288.40 $286.65 $287.31 $327.73 $338.91 $256.56 $264.72 $438.32 $454.20$292.10 $290.33 $291.00 $331.94 $343.26 $259.85 $268.12 $443.95 $460.03$295.81 $294.01 $294.69 $336.15 $347.62 $263.14 $271.52 $449.58 $465.86$301.36 $299.53 $300.22 $342.46 $354.14 $268.09 $276.61 $458.02 $474.61$306.68 $304.83 $305.53 $348.51 $360.40 $272.82 $281.50 $466.11 $482.99$314.09 $312.19 $312.90 $356.93 $369.10 $279.41 $288.30 $477.37 $494.66$323.35 $321.39 $322.13 $367.45 $379.98 $287.65 $296.80 $491.44 $509.24$334.23 $332.20 $332.97 $379.81 $392.77 $297.32 $306.78 $507.97 $526.37$347.19 $345.09 $345.88 $394.54 $408.00 $308.86 $318.68 $527.67 $546.78$361.77 $359.58 $360.40 $411.11 $425.14 $321.83 $332.07 $549.83 $569.75$378.44 $376.14 $377.01 $430.05 $444.72 $336.65 $347.36 $575.16 $596.00$394.87 $392.48 $393.38 $448.72 $464.03 $351.27 $362.45 $600.14 $621.88$413.39 $410.88 $411.83 $469.76 $485.79 $367.74 $379.44 $628.28 $651.04$431.67 $429.06 $430.04 $490.54 $507.28 $384.01 $396.23 $656.07 $679.84$451.81 $449.07 $450.10 $513.43 $530.94 $401.92 $414.71 $686.68 $711.55$472.18 $469.32 $470.39 $536.57 $554.88 $420.04 $433.41 $717.63 $743.63$494.17 $491.17 $492.30 $561.56 $580.72 $439.60 $453.59 $751.05 $778.26$516.16 $513.03 $514.21 $586.55 $606.56 $459.16 $473.77 $784.47 $812.89$540.00 $536.72 $537.96 $613.64 $634.58 $480.37 $495.65 $820.71 $850.43$564.07 $560.65 $561.94 $640.99 $662.86 $501.79 $517.75 $857.29 $888.34$589.76 $586.19 $587.53 $670.19 $693.06 $524.64 $541.33 $896.34 $928.80$602.49 $598.84 $600.21 $684.66 $708.02 $535.97 $553.02 $915.69 $948.85$628.18 $624.38 $625.81 $713.85 $738.21 $558.82 $576.60 $954.73 $989.32$650.40 $646.46 $647.94 $739.10 $764.32 $578.59 $596.99 $988.51 $1,024.31$664.99 $660.96 $662.47 $755.67 $781.46 $591.56 $610.38 $1,010.67 $1,047.27$683.27 $679.13 $680.69 $776.45 $802.94 $607.83 $627.16 $1,038.46 $1,076.07$694.38 $690.17 $691.76 $789.08 $816.00 $617.71 $637.36 $1,055.34 $1,093.57
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7Moda Health Plan Inc
PPO Synergy
Exclusive
1000A
PPO Summit
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
Moda Health
Oregon
Standard
Bronze
PPO Platinum
250
PPO Platinum
500 PPO 500 PPO 1000A
$202.10 $209.34 $218.82 $183.57 $149.07 $248.63 $245.42 $232.04 $225.49$318.27 $329.67 $344.59 $289.08 $234.76 $391.55 $386.49 $365.42 $355.10$318.27 $329.67 $344.59 $289.08 $234.76 $391.55 $386.49 $365.42 $355.10$318.27 $329.67 $344.59 $289.08 $234.76 $391.55 $386.49 $365.42 $355.10$318.27 $329.67 $344.59 $289.08 $234.76 $391.55 $386.49 $365.42 $355.10$319.54 $330.99 $345.97 $290.24 $235.70 $393.12 $388.04 $366.88 $356.52$325.91 $337.58 $352.86 $296.02 $240.40 $400.95 $395.77 $374.19 $363.62$333.55 $345.50 $361.13 $302.96 $246.03 $410.34 $405.04 $382.96 $372.15$345.96 $358.35 $374.57 $314.23 $255.19 $425.61 $420.12 $397.21 $385.99$356.15 $368.90 $385.60 $323.48 $262.70 $438.14 $432.49 $408.90 $397.36$361.24 $374.18 $391.11 $328.11 $266.46 $444.41 $438.67 $414.75 $403.04$368.88 $382.09 $399.38 $335.04 $272.09 $453.81 $447.95 $423.52 $411.56$376.51 $390.00 $407.65 $341.98 $277.72 $463.20 $457.22 $432.29 $420.08$381.29 $394.95 $412.82 $346.32 $281.25 $469.08 $463.02 $437.77 $425.41$386.38 $400.22 $418.33 $350.94 $285.00 $475.34 $469.20 $443.62 $431.09$388.93 $402.86 $421.09 $353.26 $286.88 $478.47 $472.29 $446.54 $433.93$391.47 $405.50 $423.85 $355.57 $288.76 $481.61 $475.39 $449.46 $436.77$394.02 $408.13 $426.60 $357.88 $290.64 $484.74 $478.48 $452.39 $439.61$396.57 $410.77 $429.36 $360.19 $292.52 $487.87 $481.57 $455.31 $442.46$401.66 $416.05 $434.87 $364.82 $296.27 $494.14 $487.75 $461.16 $448.14$406.75 $421.32 $440.39 $369.44 $300.03 $500.40 $493.94 $467.00 $453.82$414.39 $429.23 $448.66 $376.38 $305.66 $509.80 $503.21 $475.77 $462.34$421.71 $436.82 $456.58 $383.03 $311.06 $518.80 $512.10 $484.18 $470.51$431.89 $447.36 $467.61 $392.28 $318.57 $531.33 $524.47 $495.87 $481.87$444.62 $460.55 $481.39 $403.84 $327.96 $546.99 $539.93 $510.49 $496.08$459.58 $476.05 $497.59 $417.43 $339.00 $565.40 $558.10 $527.66 $512.77$477.41 $494.51 $516.89 $433.62 $352.14 $587.32 $579.74 $548.13 $532.65$497.46 $515.28 $538.60 $451.83 $366.93 $611.99 $604.09 $571.15 $555.02$520.37 $539.01 $563.41 $472.65 $383.84 $640.18 $631.92 $597.46 $580.59$542.97 $562.42 $587.87 $493.17 $400.51 $667.98 $659.36 $623.40 $605.80$568.43 $588.79 $615.44 $516.30 $419.29 $699.31 $690.28 $652.64 $634.21$593.58 $614.84 $642.66 $539.13 $437.83 $730.24 $720.81 $681.50 $662.26$621.27 $643.52 $672.64 $564.28 $458.26 $764.30 $754.43 $713.30 $693.16$649.27 $672.53 $702.96 $589.72 $478.92 $798.76 $788.45 $745.45 $724.41$679.51 $703.85 $735.70 $617.18 $501.22 $835.96 $825.16 $780.17 $758.14$709.74 $735.17 $768.44 $644.65 $523.52 $873.16 $861.88 $814.88 $791.87$742.53 $769.12 $803.93 $674.42 $547.70 $913.49 $901.69 $852.52 $828.45$775.63 $803.41 $839.77 $704.49 $572.12 $954.21 $941.88 $890.52 $865.38$810.95 $840.00 $878.02 $736.57 $598.18 $997.67 $984.78 $931.09 $904.80$828.46 $858.14 $896.97 $752.47 $611.09 $1,019.20 $1,006.04 $951.18 $924.33$863.79 $894.73 $935.22 $784.56 $637.15 $1,062.67 $1,048.94 $991.74 $963.74$894.34 $926.38 $968.30 $812.31 $659.68 $1,100.25 $1,086.05 $1,026.82 $997.83$914.39 $947.15 $990.01 $830.53 $674.47 $1,124.92 $1,110.39 $1,049.85 $1,020.20$939.54 $973.19 $1,017.23 $853.36 $693.02 $1,155.85 $1,140.93 $1,078.71 $1,048.26$954.81 $989.02 $1,033.77 $867.24 $704.29 $1,174.65 $1,159.48 $1,096.25 $1,065.30
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7
PPO 1000B PPO 1500 PPO 2500 PPO 3000 Value 1500 Value 2000 Value 2500 Value 3000 Value 3500
$225.07 $219.49 $197.26 $193.56 $197.07 $190.27 $185.19 $180.67 $176.55$354.44 $345.65 $310.65 $304.82 $310.35 $299.63 $291.64 $284.51 $278.02$354.44 $345.65 $310.65 $304.82 $310.35 $299.63 $291.64 $284.51 $278.02$354.44 $345.65 $310.65 $304.82 $310.35 $299.63 $291.64 $284.51 $278.02$354.44 $345.65 $310.65 $304.82 $310.35 $299.63 $291.64 $284.51 $278.02$355.85 $347.04 $311.89 $306.04 $311.59 $300.83 $292.80 $285.65 $279.14$362.94 $353.95 $318.11 $312.13 $317.80 $306.82 $298.64 $291.34 $284.70$371.45 $362.25 $325.56 $319.45 $325.24 $314.01 $305.64 $298.17 $291.37$385.27 $375.73 $337.68 $331.34 $337.35 $325.70 $317.01 $309.27 $302.21$396.61 $386.79 $347.62 $341.09 $347.28 $335.29 $326.34 $318.37 $311.11$402.28 $392.32 $352.59 $345.97 $352.24 $340.08 $331.01 $322.92 $315.56$410.79 $400.61 $360.04 $353.28 $359.69 $347.27 $338.01 $329.75 $322.23$419.30 $408.91 $367.50 $360.60 $367.14 $354.47 $345.01 $336.58 $328.90$424.61 $414.09 $372.16 $365.17 $371.80 $358.96 $349.38 $340.85 $333.07$430.29 $419.62 $377.13 $370.05 $376.76 $363.75 $354.05 $345.40 $337.52$433.12 $422.39 $379.61 $372.49 $379.24 $366.15 $356.38 $347.68 $339.75$435.96 $425.16 $382.10 $374.92 $381.73 $368.55 $358.71 $349.95 $341.97$438.79 $427.92 $384.58 $377.36 $384.21 $370.95 $361.05 $352.23 $344.19$441.63 $430.69 $387.07 $379.80 $386.69 $373.34 $363.38 $354.50 $346.42$447.30 $436.22 $392.04 $384.68 $391.66 $378.14 $368.05 $359.06 $350.87$452.97 $441.75 $397.01 $389.56 $396.62 $382.93 $372.71 $363.61 $355.32$461.48 $450.04 $404.47 $396.87 $404.07 $390.12 $379.71 $370.44 $361.99$469.63 $457.99 $411.61 $403.88 $411.21 $397.01 $386.42 $376.98 $368.38$480.97 $469.05 $421.55 $413.64 $421.14 $406.60 $395.75 $386.09 $377.28$495.15 $482.88 $433.98 $425.83 $433.56 $418.59 $407.42 $397.47 $388.40$511.81 $499.13 $448.58 $440.16 $448.14 $432.67 $421.12 $410.84 $401.47$531.65 $518.48 $465.97 $457.22 $465.52 $449.45 $437.46 $426.77 $417.04$553.98 $540.26 $485.55 $476.43 $485.07 $468.33 $455.83 $444.70 $434.55$579.50 $565.15 $507.91 $498.38 $507.42 $489.90 $476.83 $465.18 $454.57$604.67 $589.69 $529.97 $520.02 $529.45 $511.17 $497.53 $485.38 $474.31$633.02 $617.34 $554.82 $544.40 $554.28 $535.14 $520.86 $508.14 $496.55$661.02 $644.65 $579.36 $568.48 $578.80 $558.81 $543.90 $530.62 $518.52$691.86 $674.72 $606.39 $595.00 $605.80 $584.88 $569.28 $555.37 $542.70$723.05 $705.14 $633.73 $621.83 $633.11 $611.25 $594.94 $580.41 $567.17$756.72 $737.97 $663.24 $650.78 $662.59 $639.72 $622.64 $607.44 $593.58$790.39 $770.81 $692.75 $679.74 $692.08 $668.18 $650.35 $634.47 $619.99$826.90 $806.41 $724.75 $711.14 $724.04 $699.04 $680.39 $663.77 $648.63$863.76 $842.36 $757.05 $742.84 $756.32 $730.20 $710.72 $693.36 $677.55$903.10 $880.73 $791.54 $776.67 $790.77 $763.46 $743.09 $724.94 $708.41$922.60 $899.74 $808.62 $793.44 $807.84 $779.94 $759.13 $740.59 $723.70$961.94 $938.11 $843.10 $827.27 $842.28 $813.20 $791.50 $772.17 $754.56$995.96 $971.29 $872.93 $856.53 $872.08 $841.97 $819.50 $799.48 $781.25
$1,018.29 $993.07 $892.50 $875.74 $891.63 $860.84 $837.87 $817.41 $798.76$1,046.29 $1,020.37 $917.04 $899.82 $916.15 $884.52 $860.91 $839.88 $820.73$1,063.31 $1,036.96 $931.95 $914.45 $931.04 $898.90 $874.91 $853.54 $834.07
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Value 5000
Moda Health
Connexus
Aspire 2000
Moda Health
Connexus
Aspire 2500
Moda Health
Connexus
Fundamental
3500
Moda Health
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Moda Health
Connexus HSA
2000
Moda Health
Connexus HSA
2500
Moda Health
Connexus HSA
3250
$166.92 $188.94 $183.47 $159.98 $148.06 $200.49 $191.58 $184.39 $162.32$262.87 $297.54 $288.92 $251.94 $233.17 $315.73 $301.71 $290.38 $255.62$262.87 $297.54 $288.92 $251.94 $233.17 $315.73 $301.71 $290.38 $255.62$262.87 $297.54 $288.92 $251.94 $233.17 $315.73 $301.71 $290.38 $255.62$262.87 $297.54 $288.92 $251.94 $233.17 $315.73 $301.71 $290.38 $255.62$263.92 $298.73 $290.08 $252.95 $234.10 $316.99 $302.91 $291.54 $256.64$269.18 $304.68 $295.86 $257.98 $238.77 $323.30 $308.95 $297.35 $261.76$275.49 $311.82 $302.79 $264.03 $244.36 $330.88 $316.19 $304.32 $267.89$285.74 $323.43 $314.06 $273.86 $253.46 $343.19 $327.96 $315.64 $277.86$294.15 $332.95 $323.30 $281.92 $260.92 $353.30 $337.61 $324.94 $286.04$298.36 $337.71 $327.93 $285.95 $264.65 $358.35 $342.44 $329.58 $290.13$304.66 $344.85 $334.86 $292.00 $270.24 $365.93 $349.68 $336.55 $296.26$310.97 $351.99 $341.79 $298.04 $275.84 $373.50 $356.92 $343.52 $302.40$314.92 $356.45 $346.13 $301.82 $279.34 $378.24 $361.45 $347.88 $306.23$319.12 $361.22 $350.75 $305.85 $283.07 $383.29 $366.27 $352.52 $310.32$321.23 $363.60 $353.06 $307.87 $284.93 $385.82 $368.69 $354.85 $312.37$323.33 $365.98 $355.37 $309.88 $286.80 $388.34 $371.10 $357.17 $314.41$325.43 $368.36 $357.69 $311.90 $288.66 $390.87 $373.51 $359.49 $316.46$327.53 $370.74 $360.00 $313.91 $290.53 $393.40 $375.93 $361.81 $318.50$331.74 $375.50 $364.62 $317.95 $294.26 $398.45 $380.76 $366.46 $322.59$335.95 $380.26 $369.24 $321.98 $297.99 $403.50 $385.58 $371.11 $326.68$342.25 $387.40 $376.18 $328.02 $303.59 $411.08 $392.82 $378.08 $332.82$348.30 $394.24 $382.82 $333.82 $308.95 $418.34 $399.76 $384.75 $338.70$356.71 $403.76 $392.07 $341.88 $316.41 $428.44 $409.42 $394.05 $346.88$367.23 $415.67 $403.62 $351.96 $325.74 $441.07 $421.49 $405.66 $357.10$379.58 $429.65 $417.20 $363.80 $336.70 $455.91 $435.67 $419.31 $369.12$394.30 $446.31 $433.38 $377.91 $349.75 $473.59 $452.56 $435.57 $383.43$410.86 $465.06 $451.58 $393.78 $364.44 $493.48 $471.57 $453.86 $399.54$429.79 $486.48 $472.39 $411.92 $381.23 $516.21 $493.29 $474.77 $417.94$448.45 $507.61 $492.90 $429.81 $397.79 $538.63 $514.71 $495.39 $436.09$469.48 $531.41 $516.01 $449.96 $416.44 $563.89 $538.85 $518.62 $456.54$490.25 $554.92 $538.84 $469.86 $434.86 $588.83 $562.69 $541.56 $476.73$513.12 $580.80 $563.98 $491.78 $455.15 $616.30 $588.93 $566.82 $498.97$536.25 $606.98 $589.40 $513.95 $475.67 $644.08 $615.48 $592.38 $521.47$561.22 $635.25 $616.85 $537.89 $497.82 $674.08 $644.15 $619.96 $545.75$586.20 $663.52 $644.30 $561.82 $519.97 $704.07 $672.81 $647.55 $570.03$613.27 $694.16 $674.05 $587.77 $543.98 $736.59 $703.89 $677.46 $596.36$640.61 $725.11 $704.10 $613.97 $568.23 $769.43 $735.26 $707.66 $622.95$669.79 $758.14 $736.17 $641.94 $594.12 $804.47 $768.75 $739.89 $651.32$684.25 $774.50 $752.06 $655.79 $606.94 $821.84 $785.35 $755.86 $665.38$713.43 $807.53 $784.13 $683.76 $632.82 $856.88 $818.84 $788.09 $693.76$738.66 $836.09 $811.87 $707.94 $655.21 $887.19 $847.80 $815.97 $718.30$755.22 $854.84 $830.07 $723.82 $669.90 $907.08 $866.81 $834.26 $734.40$775.99 $878.34 $852.90 $743.72 $688.32 $932.02 $890.64 $857.20 $754.59$788.61 $892.62 $866.77 $755.81 $699.51 $947.18 $905.12 $871.14 $766.86
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Area 7
Moda Health
Connexus
Essence 5000
Moda Health
Connexus
Essence 6000
Moda Health
Connexus Basic
6500
Moda Health
Synergy
Exclusive 2000
Moda Health
Synergy
Exclusive 5000
PPO Platinum
Synergy
Exclusive 250
PPO Synergy
Exclusive
1000A
Moda Health
Oregon
Standard Gold
Moda Health
Oregon
Standard Silver
$148.40 $147.50 $147.84 $168.64 $132.02 $225.55 $204.06 $220.94 $185.35$233.71 $232.29 $232.82 $265.58 $207.90 $355.20 $321.36 $347.94 $291.89$233.71 $232.29 $232.82 $265.58 $207.90 $355.20 $321.36 $347.94 $291.89$233.71 $232.29 $232.82 $265.58 $207.90 $355.20 $321.36 $347.94 $291.89$233.71 $232.29 $232.82 $265.58 $207.90 $355.20 $321.36 $347.94 $291.89$234.64 $233.22 $233.76 $266.64 $208.73 $356.62 $322.65 $349.33 $293.05$239.32 $237.87 $238.41 $271.95 $212.89 $363.72 $329.07 $356.29 $298.89$244.93 $243.44 $244.00 $278.33 $217.88 $372.25 $336.79 $364.64 $305.90$254.04 $252.50 $253.08 $288.69 $225.99 $386.10 $349.32 $378.21 $317.28$261.52 $259.93 $260.53 $297.18 $232.64 $397.47 $359.60 $389.34 $326.62$265.26 $263.65 $264.26 $301.43 $235.97 $403.15 $364.74 $394.91 $331.29$270.87 $269.23 $269.84 $307.81 $240.96 $411.67 $372.46 $403.26 $338.30$276.48 $274.80 $275.43 $314.18 $245.95 $420.20 $380.17 $411.61 $345.30$279.98 $278.28 $278.92 $318.16 $249.07 $425.53 $384.99 $416.83 $349.68$283.72 $282.00 $282.65 $322.41 $252.39 $431.21 $390.13 $422.39 $354.35$285.59 $283.86 $284.51 $324.54 $254.06 $434.05 $392.70 $425.18 $356.68$287.46 $285.72 $286.37 $326.66 $255.72 $436.89 $395.27 $427.96 $359.02$289.33 $287.58 $288.24 $328.79 $257.38 $439.73 $397.85 $430.74 $361.36$291.20 $289.43 $290.10 $330.91 $259.05 $442.58 $400.42 $433.53 $363.69$294.94 $293.15 $293.82 $335.16 $262.37 $448.26 $405.56 $439.10 $368.36$298.68 $296.87 $297.55 $339.41 $265.70 $453.94 $410.70 $444.66 $373.03$304.29 $302.44 $303.14 $345.78 $270.69 $462.47 $418.41 $453.01 $380.04$309.66 $307.79 $308.49 $351.89 $275.47 $470.64 $425.80 $461.02 $386.75$317.14 $315.22 $315.94 $360.39 $282.12 $482.00 $436.09 $472.15 $396.09$326.49 $324.51 $325.26 $371.01 $290.44 $496.21 $448.94 $486.07 $407.77$337.47 $335.43 $336.20 $383.50 $300.21 $512.90 $464.05 $502.42 $421.48$350.56 $348.44 $349.24 $398.37 $311.85 $532.80 $482.04 $521.90 $437.83$365.28 $363.07 $363.90 $415.10 $324.95 $555.17 $502.29 $543.82 $456.22$382.11 $379.80 $380.67 $434.22 $339.92 $580.75 $525.43 $568.88 $477.23$398.70 $396.29 $397.20 $453.08 $354.68 $605.97 $548.24 $593.58 $497.96$417.40 $414.87 $415.82 $474.33 $371.31 $634.38 $573.95 $621.41 $521.31$435.86 $433.22 $434.22 $495.31 $387.74 $662.44 $599.34 $648.90 $544.37$456.20 $453.43 $454.47 $518.41 $405.83 $693.34 $627.30 $679.17 $569.76$476.76 $473.87 $474.96 $541.78 $424.12 $724.60 $655.58 $709.79 $595.45$498.97 $495.94 $497.08 $567.01 $443.87 $758.34 $686.11 $742.84 $623.18$521.17 $518.01 $519.20 $592.24 $463.62 $792.09 $716.64 $775.90 $650.91$545.24 $541.94 $543.18 $619.60 $485.04 $828.67 $749.74 $811.74 $680.97$569.54 $566.09 $567.39 $647.22 $506.66 $865.61 $783.16 $847.92 $711.33$595.49 $591.88 $593.24 $676.70 $529.74 $905.04 $818.83 $886.54 $743.73$608.34 $604.65 $606.04 $691.30 $541.17 $924.58 $836.50 $905.68 $759.78$634.28 $630.44 $631.88 $720.78 $564.25 $964.00 $872.17 $944.30 $792.18$656.72 $652.74 $654.24 $746.28 $584.21 $998.10 $903.02 $977.70 $820.20$671.44 $667.37 $668.90 $763.01 $597.30 $1,020.48 $923.27 $999.62 $838.59$689.90 $685.72 $687.30 $783.99 $613.73 $1,048.54 $948.66 $1,027.11 $861.65$701.12 $696.87 $698.47 $796.74 $623.71 $1,065.59 $964.08 $1,043.81 $875.66
RATE TABLES AND FACTORS
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
PlanHIOS Plan Id
0-2021222324252627282930313233343536373839404142434445464748495051525354555657585960616263
64+
Moda Health
Oregon
Standard
Bronze
$150.52$237.04$237.04$237.04$237.04$237.99$242.73$248.42$257.67$265.25$269.04$274.73$280.42$283.98$287.77$289.67$291.56$293.46$295.35$299.15$302.94$308.63$314.08$321.67$331.15$342.29$355.56$370.50$387.56$404.39$423.36$442.08$462.71$483.57$506.09$528.60$553.02$577.67$603.98$617.02$643.33$666.09$681.02$699.75$711.13
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 1 - Employee Only
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $659.01 $667.14 $675.38 $683.71
PPO Platinum 500 $650.50 $658.52 $666.65 $674.88
PPO 500 $615.03 $622.62 $630.30 $638.08
PPO 1000A $597.66 $605.04 $612.50 $620.06
PPO 1000B $596.55 $603.91 $611.36 $618.91
PPO 1500 $581.77 $588.95 $596.21 $603.57
PPO 2500 $522.85 $529.30 $535.83 $542.44
PPO 3000 $513.03 $519.36 $525.77 $532.26
Value 1500 $522.34 $528.79 $535.31 $541.92Value 2000 $504.31 $510.53 $516.83 $523.21
Value 2000 (Rose City) $465.81 $471.56 $477.38 $483.27
Value 2500 $490.85 $496.90 $503.04 $509.24
Value 3000 $478.86 $484.77 $490.75 $496.81
Value 3500 $467.94 $473.71 $479.56 $485.48
Value 5000 $442.43 $447.89 $453.42 $459.01
Moda Health Connexus Aspire 2000 $500.79 $506.97 $513.22 $519.56
Moda Health Connexus Aspire 2500 $486.28 $492.28 $498.36 $504.51
Moda Health Connexus Fundamental 3500 $424.03 $429.26 $434.56 $439.92
Moda Health Connexus Fundamental 5000 $392.44 $397.28 $402.19 $407.15
Moda Health Connexus HSA 1500 $531.39 $537.95 $544.59 $551.31
Moda Health Connexus HSA 2000 $507.80 $514.07 $520.41 $526.83
Moda Health Connexus HSA 2500 $488.74 $494.77 $500.87 $507.05
Moda Health Connexus HSA 3250 $430.23 $435.54 $440.92 $446.36
Moda Health Connexus Essence 5000 $393.35 $398.20 $403.11 $408.09
Moda Health Rose City Essence 5000 $361.39 $365.85 $370.36 $374.93
Moda Health Connexus Essence 6000 $390.97 $395.79 $400.68 $405.62
Moda Health Connexus Basic 6500 $391.86 $396.70 $401.59 $406.55
Moda Health Synergy Exclusive 2000 $446.99 $452.51 $458.09 $463.75
Moda Health Synergy Exclusive 5000 $349.92 $354.23 $358.61 $363.03
PPO Platinum Synergy Exclusive 250 $597.83 $605.20 $612.67 $620.23
PPO Synergy Exclusive 1000A $540.88 $547.55 $554.31 $561.15
Moda Health Oregon Standard Gold $585.61 $592.83 $600.15 $607.56
Moda Health Oregon Standard Silver $491.27 $497.33 $503.47 $509.68
Moda Health Oregon Standard Bronze $398.96 $403.88 $408.87 $413.91
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 1 - Employee + Spouse
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,318.02 $1,334.29 $1,350.75 $1,367.43
PPO Platinum 500 $1,300.99 $1,317.05 $1,333.30 $1,349.76
PPO 500 $1,230.06 $1,245.24 $1,260.61 $1,276.17
PPO 1000A $1,195.32 $1,210.07 $1,225.01 $1,240.13
PPO 1000B $1,193.09 $1,207.81 $1,222.72 $1,237.81
PPO 1500 $1,163.53 $1,177.89 $1,192.43 $1,207.14
PPO 2500 $1,045.69 $1,058.60 $1,071.66 $1,084.89
PPO 3000 $1,026.06 $1,038.72 $1,051.54 $1,064.52
Value 1500 $1,044.68 $1,057.57 $1,070.63 $1,083.84
Value 2000 $1,008.61 $1,021.06 $1,033.66 $1,046.42
Value 2000 (Rose City) $931.62 $943.12 $954.76 $966.54
Value 2500 $981.69 $993.81 $1,006.07 $1,018.49
Value 3000 $957.72 $969.54 $981.51 $993.62
Value 3500 $935.87 $947.42 $959.11 $970.95
Value 5000 $884.86 $895.78 $906.84 $918.03
Moda Health Connexus Aspire 2000 $1,001.57 $1,013.93 $1,026.44 $1,039.11
Moda Health Connexus Aspire 2500 $972.56 $984.56 $996.71 $1,009.02
Moda Health Connexus Fundamental 3500 $848.06 $858.53 $869.12 $879.85
Moda Health Connexus Fundamental 5000 $784.88 $794.57 $804.37 $814.30
Moda Health Connexus HSA 1500 $1,062.78 $1,075.90 $1,089.18 $1,102.62
Moda Health Connexus HSA 2000 $1,015.60 $1,028.13 $1,040.82 $1,053.67
Moda Health Connexus HSA 2500 $977.47 $989.53 $1,001.75 $1,014.11
Moda Health Connexus HSA 3250 $860.46 $871.08 $881.83 $892.71
Moda Health Connexus Essence 5000 $786.69 $796.40 $806.23 $816.18
Moda Health Rose City Essence 5000 $722.77 $731.69 $740.72 $749.86
Moda Health Connexus Essence 6000 $781.93 $791.58 $801.35 $811.24
Moda Health Connexus Basic 6500 $783.72 $793.39 $803.18 $813.10
Moda Health Synergy Exclusive 2000 $893.98 $905.01 $916.18 $927.49
Moda Health Synergy Exclusive 5000 $699.83 $708.47 $717.21 $726.06
PPO Platinum Synergy Exclusive 250 $1,195.65 $1,210.41 $1,225.35 $1,240.47
PPO Synergy Exclusive 1000A $1,081.75 $1,095.10 $1,108.62 $1,122.30
Moda Health Oregon Standard Gold $1,171.21 $1,185.66 $1,200.30 $1,215.11
Moda Health Oregon Standard Silver $982.53 $994.66 $1,006.93 $1,019.36
Moda Health Oregon Standard Bronze $797.92 $807.77 $817.74 $827.83
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 1 - Employee + Family
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,878.18 $1,901.36 $1,924.82 $1,948.58
PPO Platinum 500 $1,853.91 $1,876.79 $1,899.95 $1,923.40
PPO 500 $1,752.84 $1,774.47 $1,796.37 $1,818.54
PPO 1000A $1,703.33 $1,724.35 $1,745.63 $1,767.18
PPO 1000B $1,700.15 $1,721.14 $1,742.38 $1,763.88
PPO 1500 $1,658.03 $1,678.49 $1,699.21 $1,720.18
PPO 2500 $1,490.11 $1,508.50 $1,527.12 $1,545.96
PPO 3000 $1,462.14 $1,480.18 $1,498.45 $1,516.94
Value 1500 $1,488.67 $1,507.04 $1,525.64 $1,544.47
Value 2000 $1,437.27 $1,455.01 $1,472.97 $1,491.14
Value 2000 (Rose City) $1,327.56 $1,343.94 $1,360.53 $1,377.32
Value 2500 $1,398.91 $1,416.17 $1,433.65 $1,451.35
Value 3000 $1,364.75 $1,381.59 $1,398.65 $1,415.91
Value 3500 $1,333.61 $1,350.07 $1,366.74 $1,383.60
Value 5000 $1,260.93 $1,276.49 $1,292.24 $1,308.19
Moda Health Connexus Aspire 2000 $1,427.24 $1,444.85 $1,462.68 $1,480.74
Moda Health Connexus Aspire 2500 $1,385.90 $1,403.00 $1,420.32 $1,437.85
Moda Health Connexus Fundamental 3500 $1,208.49 $1,223.40 $1,238.50 $1,253.78
Moda Health Connexus Fundamental 5000 $1,118.45 $1,132.26 $1,146.23 $1,160.38
Moda Health Connexus HSA 1500 $1,514.46 $1,533.15 $1,552.07 $1,571.23
Moda Health Connexus HSA 2000 $1,447.23 $1,465.09 $1,483.17 $1,501.48
Moda Health Connexus HSA 2500 $1,392.89 $1,410.09 $1,427.49 $1,445.11
Moda Health Connexus HSA 3250 $1,226.16 $1,241.29 $1,256.61 $1,272.12
Moda Health Connexus Essence 5000 $1,121.03 $1,134.87 $1,148.88 $1,163.05
Moda Health Rose City Essence 5000 $1,029.95 $1,042.66 $1,055.53 $1,068.55
Moda Health Connexus Essence 6000 $1,114.25 $1,128.00 $1,141.92 $1,156.02
Moda Health Connexus Basic 6500 $1,116.80 $1,130.58 $1,144.54 $1,158.66
Moda Health Synergy Exclusive 2000 $1,273.92 $1,289.64 $1,305.56 $1,321.67
Moda Health Synergy Exclusive 5000 $997.26 $1,009.57 $1,022.03 $1,034.64
PPO Platinum Synergy Exclusive 250 $1,703.80 $1,724.83 $1,746.12 $1,767.67
PPO Synergy Exclusive 1000A $1,541.49 $1,560.52 $1,579.78 $1,599.28
Moda Health Oregon Standard Gold $1,668.97 $1,689.57 $1,710.42 $1,731.53
Moda Health Oregon Standard Silver $1,400.11 $1,417.39 $1,434.88 $1,452.59
Moda Health Oregon Standard Bronze $1,137.04 $1,151.07 $1,165.28 $1,179.66
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 1 - Employee + Child(ren)
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,219.17 $1,234.22 $1,249.45 $1,264.87
PPO Platinum 500 $1,203.42 $1,218.27 $1,233.30 $1,248.52
PPO 500 $1,137.81 $1,151.85 $1,166.06 $1,180.46
PPO 1000A $1,105.67 $1,119.32 $1,133.13 $1,147.12
PPO 1000B $1,103.61 $1,117.23 $1,131.02 $1,144.98
PPO 1500 $1,076.27 $1,089.55 $1,103.00 $1,116.61
PPO 2500 $967.26 $979.20 $991.29 $1,003.52
PPO 3000 $949.11 $960.82 $972.68 $984.68
Value 1500 $966.33 $978.26 $990.33 $1,002.55
Value 2000 $932.96 $944.48 $956.14 $967.94
Value 2000 (Rose City) $861.75 $872.38 $883.15 $894.05
Value 2500 $908.06 $919.27 $930.62 $942.10
Value 3000 $885.89 $896.82 $907.89 $919.10
Value 3500 $865.68 $876.36 $887.18 $898.13
Value 5000 $818.50 $828.60 $838.82 $849.18
Moda Health Connexus Aspire 2000 $926.45 $937.89 $949.46 $961.18
Moda Health Connexus Aspire 2500 $899.62 $910.72 $921.96 $933.34
Moda Health Connexus Fundamental 3500 $784.46 $794.14 $803.94 $813.86
Moda Health Connexus Fundamental 5000 $726.01 $734.97 $744.05 $753.23
Moda Health Connexus HSA 1500 $983.07 $995.20 $1,007.49 $1,019.92
Moda Health Connexus HSA 2000 $939.43 $951.02 $962.76 $974.64
Moda Health Connexus HSA 2500 $904.16 $915.32 $926.62 $938.05
Moda Health Connexus HSA 3250 $795.93 $805.75 $815.69 $825.76
Moda Health Connexus Essence 5000 $727.69 $736.67 $745.76 $754.97
Moda Health Rose City Essence 5000 $668.56 $676.81 $685.17 $693.62
Moda Health Connexus Essence 6000 $723.29 $732.21 $741.25 $750.40
Moda Health Connexus Basic 6500 $724.94 $733.89 $742.95 $752.11
Moda Health Synergy Exclusive 2000 $826.93 $837.14 $847.47 $857.93
Moda Health Synergy Exclusive 5000 $647.34 $655.33 $663.42 $671.61
PPO Platinum Synergy Exclusive 250 $1,105.98 $1,119.63 $1,133.44 $1,147.43
PPO Synergy Exclusive 1000A $1,000.62 $1,012.97 $1,025.47 $1,038.13
Moda Health Oregon Standard Gold $1,083.37 $1,096.74 $1,110.28 $1,123.98
Moda Health Oregon Standard Silver $908.84 $920.06 $931.41 $942.91
Moda Health Oregon Standard Bronze $738.08 $747.19 $756.41 $765.74
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 2 - Employee Only
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $635.94 $643.79 $651.74 $659.78
PPO Platinum 500 $627.73 $635.47 $643.32 $651.26
PPO 500 $593.50 $600.83 $608.24 $615.75
PPO 1000A $576.74 $583.86 $591.07 $598.36
PPO 1000B $575.67 $582.77 $589.96 $597.24
PPO 1500 $561.40 $568.33 $575.35 $582.45
PPO 2500 $504.55 $510.77 $517.08 $523.46
PPO 3000 $495.07 $501.18 $507.37 $513.63
Value 1500 $504.06 $510.28 $516.58 $522.95Value 2000 $486.65 $492.66 $498.74 $504.90
Value 2500 $473.67 $479.51 $485.43 $491.42
Value 3000 $462.10 $467.80 $473.58 $479.42
Value 3500 $451.56 $457.13 $462.77 $468.48
Value 5000 $426.94 $432.21 $437.55 $442.95
Moda Health Connexus Aspire 2000 $483.26 $489.22 $495.26 $501.37
Moda Health Connexus Aspire 2500 $469.26 $475.05 $480.91 $486.85
Moda Health Connexus Fundamental 3500 $409.19 $414.24 $419.35 $424.53
Moda Health Connexus Fundamental 5000 $378.70 $383.38 $388.11 $392.90
Moda Health Connexus HSA 1500 $512.79 $519.12 $525.53 $532.01
Moda Health Connexus HSA 2000 $490.03 $496.07 $502.20 $508.40
Moda Health Connexus HSA 2500 $471.63 $477.45 $483.34 $489.31
Moda Health Connexus HSA 3250 $415.17 $420.30 $425.48 $430.73
Moda Health Connexus Essence 5000 $379.58 $384.26 $389.01 $393.81
Moda Health Connexus Essence 6000 $377.28 $381.94 $386.65 $391.42
Moda Health Connexus Basic 6500 $378.14 $382.81 $387.54 $392.32
Moda Health Synergy Exclusive 2000 $431.35 $436.67 $442.06 $447.51
Moda Health Synergy Exclusive 5000 $337.67 $341.84 $346.05 $350.33
PPO Platinum Synergy Exclusive 250 $576.90 $584.02 $591.23 $598.53
PPO Synergy Exclusive 1000A $521.94 $528.39 $534.91 $541.51
Moda Health Oregon Standard Gold $565.11 $572.08 $579.14 $586.29
Moda Health Oregon Standard Silver $474.07 $479.92 $485.84 $491.84
Moda Health Oregon Standard Bronze $385.00 $389.75 $394.56 $399.43
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 2 - Employee + Spouse
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,271.89 $1,287.59 $1,303.48 $1,319.57
PPO Platinum 500 $1,255.46 $1,270.95 $1,286.64 $1,302.52
PPO 500 $1,187.01 $1,201.66 $1,216.49 $1,231.50
PPO 1000A $1,153.48 $1,167.72 $1,182.13 $1,196.72
PPO 1000B $1,151.33 $1,165.54 $1,179.93 $1,194.49
PPO 1500 $1,122.81 $1,136.66 $1,150.69 $1,164.89
PPO 2500 $1,009.09 $1,021.54 $1,034.15 $1,046.92
PPO 3000 $990.15 $1,002.37 $1,014.74 $1,027.26
Value 1500 $1,008.12 $1,020.56 $1,033.15 $1,045.90
Value 2000 $973.31 $985.32 $997.48 $1,009.79
Value 2500 $947.33 $959.02 $970.86 $982.84
Value 3000 $924.20 $935.61 $947.15 $958.84
Value 3500 $903.11 $914.26 $925.54 $936.97
Value 5000 $853.89 $864.43 $875.10 $885.90
Moda Health Connexus Aspire 2000 $966.52 $978.44 $990.52 $1,002.74
Moda Health Connexus Aspire 2500 $938.52 $950.10 $961.83 $973.70
Moda Health Connexus Fundamental 3500 $818.38 $828.48 $838.70 $849.05
Moda Health Connexus Fundamental 5000 $757.41 $766.76 $776.22 $785.80
Moda Health Connexus HSA 1500 $1,025.58 $1,038.24 $1,051.05 $1,064.03
Moda Health Connexus HSA 2000 $980.05 $992.15 $1,004.39 $1,016.79
Moda Health Connexus HSA 2500 $943.26 $954.90 $966.69 $978.62
Moda Health Connexus HSA 3250 $830.34 $840.59 $850.97 $861.47
Moda Health Connexus Essence 5000 $759.16 $768.53 $778.01 $787.61
Moda Health Connexus Essence 6000 $754.56 $763.88 $773.30 $782.85
Moda Health Connexus Basic 6500 $756.29 $765.62 $775.07 $784.64
Moda Health Synergy Exclusive 2000 $862.69 $873.34 $884.12 $895.03
Moda Health Synergy Exclusive 5000 $675.34 $683.67 $692.11 $700.65
PPO Platinum Synergy Exclusive 250 $1,153.80 $1,168.04 $1,182.46 $1,197.05
PPO Synergy Exclusive 1000A $1,043.89 $1,056.77 $1,069.81 $1,083.02
Moda Health Oregon Standard Gold $1,130.22 $1,144.17 $1,158.29 $1,172.58
Moda Health Oregon Standard Silver $948.14 $959.84 $971.69 $983.68
Moda Health Oregon Standard Bronze $769.99 $779.50 $789.12 $798.86
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 2 - Employee + Family
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,812.44 $1,834.81 $1,857.46 $1,880.38
PPO Platinum 500 $1,789.02 $1,811.10 $1,833.46 $1,856.08
PPO 500 $1,691.49 $1,712.36 $1,733.50 $1,754.89
PPO 1000A $1,643.71 $1,664.00 $1,684.54 $1,705.33
PPO 1000B $1,640.65 $1,660.90 $1,681.39 $1,702.15
PPO 1500 $1,600.00 $1,619.75 $1,639.74 $1,659.97
PPO 2500 $1,437.95 $1,455.70 $1,473.67 $1,491.86
PPO 3000 $1,410.96 $1,428.37 $1,446.00 $1,463.85
Value 1500 $1,436.57 $1,454.30 $1,472.24 $1,490.41
Value 2000 $1,386.96 $1,404.08 $1,421.41 $1,438.95
Value 2500 $1,349.95 $1,366.61 $1,383.47 $1,400.55
Value 3000 $1,316.98 $1,333.24 $1,349.69 $1,366.35
Value 3500 $1,286.94 $1,302.82 $1,318.90 $1,335.18
Value 5000 $1,216.79 $1,231.81 $1,247.01 $1,262.40
Moda Health Connexus Aspire 2000 $1,377.28 $1,394.28 $1,411.49 $1,428.91
Moda Health Connexus Aspire 2500 $1,337.39 $1,353.90 $1,370.61 $1,387.52
Moda Health Connexus Fundamental 3500 $1,166.19 $1,180.58 $1,195.15 $1,209.90
Moda Health Connexus Fundamental 5000 $1,079.31 $1,092.63 $1,106.11 $1,119.77
Moda Health Connexus HSA 1500 $1,461.46 $1,479.49 $1,497.75 $1,516.24
Moda Health Connexus HSA 2000 $1,396.58 $1,413.81 $1,431.26 $1,448.93
Moda Health Connexus HSA 2500 $1,344.14 $1,360.73 $1,377.53 $1,394.53
Moda Health Connexus HSA 3250 $1,183.24 $1,197.84 $1,212.63 $1,227.59
Moda Health Connexus Essence 5000 $1,081.80 $1,095.15 $1,108.66 $1,122.35
Moda Health Connexus Essence 6000 $1,075.25 $1,088.52 $1,101.96 $1,115.56
Moda Health Connexus Basic 6500 $1,077.71 $1,091.01 $1,104.48 $1,118.11
Moda Health Synergy Exclusive 2000 $1,229.33 $1,244.51 $1,259.87 $1,275.42
Moda Health Synergy Exclusive 5000 $962.35 $974.23 $986.25 $998.43
PPO Platinum Synergy Exclusive 250 $1,644.17 $1,664.46 $1,685.00 $1,705.80
PPO Synergy Exclusive 1000A $1,487.54 $1,505.90 $1,524.49 $1,543.30
Moda Health Oregon Standard Gold $1,610.56 $1,630.44 $1,650.56 $1,670.93
Moda Health Oregon Standard Silver $1,351.10 $1,367.78 $1,384.66 $1,401.75
Moda Health Oregon Standard Bronze $1,097.24 $1,110.78 $1,124.49 $1,138.37
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 2 - Employee + Child(Ren)
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,176.50 $1,191.02 $1,205.72 $1,220.60
PPO Platinum 500 $1,161.30 $1,175.63 $1,190.14 $1,204.83
PPO 500 $1,097.98 $1,111.53 $1,125.25 $1,139.14
PPO 1000A $1,066.97 $1,080.14 $1,093.47 $1,106.97
PPO 1000B $1,064.98 $1,078.13 $1,091.43 $1,104.90
PPO 1500 $1,038.60 $1,051.41 $1,064.39 $1,077.53
PPO 2500 $933.41 $944.93 $956.59 $968.40
PPO 3000 $915.89 $927.19 $938.63 $950.22
Value 1500 $932.51 $944.02 $955.67 $967.46
Value 2000 $900.31 $911.42 $922.67 $934.06
Value 2500 $876.28 $887.10 $898.04 $909.13
Value 3000 $854.88 $865.44 $876.12 $886.93
Value 3500 $835.38 $845.69 $856.13 $866.69
Value 5000 $789.85 $799.60 $809.46 $819.46
Moda Health Connexus Aspire 2000 $894.03 $905.06 $916.23 $927.54
Moda Health Connexus Aspire 2500 $868.13 $878.85 $889.69 $900.67
Moda Health Connexus Fundamental 3500 $757.00 $766.34 $775.80 $785.38
Moda Health Connexus Fundamental 5000 $700.60 $709.25 $718.00 $726.87
Moda Health Connexus HSA 1500 $948.66 $960.37 $972.23 $984.22
Moda Health Connexus HSA 2000 $906.55 $917.74 $929.07 $940.53
Moda Health Connexus HSA 2500 $872.51 $883.28 $894.18 $905.22
Moda Health Connexus HSA 3250 $768.07 $777.55 $787.14 $796.86
Moda Health Connexus Essence 5000 $702.22 $710.89 $719.66 $728.54
Moda Health Connexus Essence 6000 $697.97 $706.58 $715.31 $724.13
Moda Health Connexus Basic 6500 $699.57 $708.20 $716.94 $725.79
Moda Health Synergy Exclusive 2000 $797.99 $807.84 $817.81 $827.90
Moda Health Synergy Exclusive 5000 $624.69 $632.40 $640.20 $648.10
PPO Platinum Synergy Exclusive 250 $1,067.27 $1,080.44 $1,093.77 $1,107.27
PPO Synergy Exclusive 1000A $965.60 $977.51 $989.58 $1,001.79
Moda Health Oregon Standard Gold $1,045.45 $1,058.35 $1,071.42 $1,084.64
Moda Health Oregon Standard Silver $877.03 $887.86 $898.81 $909.91
Moda Health Oregon Standard Bronze $712.24 $721.03 $729.93 $738.94
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 3 - Employee Only
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $635.94 $643.79 $651.74 $659.78
PPO Platinum 500 $627.73 $635.47 $643.32 $651.26
PPO 500 $593.50 $600.83 $608.24 $615.75
PPO 1000A $576.74 $583.86 $591.07 $598.36
PPO 1000B $575.67 $582.77 $589.96 $597.24
PPO 1500 $561.40 $568.33 $575.35 $582.45
PPO 2500 $504.55 $510.77 $517.08 $523.46
PPO 3000 $495.07 $501.18 $507.37 $513.63
Value 1500 $504.06 $510.28 $516.58 $522.95Value 2000 $486.65 $492.66 $498.74 $504.90
Value 2500 $473.67 $479.51 $485.43 $491.42
Value 3000 $462.10 $467.80 $473.58 $479.42
Value 3500 $451.56 $457.13 $462.77 $468.48
Value 5000 $426.94 $432.21 $437.55 $442.95
Moda Health Connexus Aspire 2000 $483.26 $489.22 $495.26 $501.37
Moda Health Connexus Aspire 2500 $469.26 $475.05 $480.91 $486.85
Moda Health Connexus Fundamental 3500 $409.19 $414.24 $419.35 $424.53
Moda Health Connexus Fundamental 5000 $378.70 $383.38 $388.11 $392.90
Moda Health Connexus HSA 1500 $512.79 $519.12 $525.53 $532.01
Moda Health Connexus HSA 2000 $490.03 $496.07 $502.20 $508.40
Moda Health Connexus HSA 2500 $471.63 $477.45 $483.34 $489.31
Moda Health Connexus HSA 3250 $415.17 $420.30 $425.48 $430.73
Moda Health Connexus Essence 5000 $379.58 $384.26 $389.01 $393.81
Moda Health Connexus Essence 6000 $377.28 $381.94 $386.65 $391.42
Moda Health Connexus Basic 6500 $378.14 $382.81 $387.54 $392.32
Moda Health Synergy Exclusive 2000 $431.35 $436.67 $442.06 $447.51
Moda Health Synergy Exclusive 5000 $337.67 $341.84 $346.05 $350.33
PPO Platinum Synergy Exclusive 250 $576.90 $584.02 $591.23 $598.53
PPO Synergy Exclusive 1000A $521.94 $528.39 $534.91 $541.51
Moda Health Oregon Standard Gold $565.11 $572.08 $579.14 $586.29
Moda Health Oregon Standard Silver $474.07 $479.92 $485.84 $491.84
Moda Health Oregon Standard Bronze $385.00 $389.75 $394.56 $399.43
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 3 - Employee + Spouse
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,271.89 $1,287.59 $1,303.48 $1,319.57
PPO Platinum 500 $1,255.46 $1,270.95 $1,286.64 $1,302.52
PPO 500 $1,187.01 $1,201.66 $1,216.49 $1,231.50
PPO 1000A $1,153.48 $1,167.72 $1,182.13 $1,196.72
PPO 1000B $1,151.33 $1,165.54 $1,179.93 $1,194.49
PPO 1500 $1,122.81 $1,136.66 $1,150.69 $1,164.89
PPO 2500 $1,009.09 $1,021.54 $1,034.15 $1,046.92
PPO 3000 $990.15 $1,002.37 $1,014.74 $1,027.26
Value 1500 $1,008.12 $1,020.56 $1,033.15 $1,045.90
Value 2000 $973.31 $985.32 $997.48 $1,009.79
Value 2500 $947.33 $959.02 $970.86 $982.84
Value 3000 $924.20 $935.61 $947.15 $958.84
Value 3500 $903.11 $914.26 $925.54 $936.97
Value 5000 $853.89 $864.43 $875.10 $885.90
Moda Health Connexus Aspire 2000 $966.52 $978.44 $990.52 $1,002.74
Moda Health Connexus Aspire 2500 $938.52 $950.10 $961.83 $973.70
Moda Health Connexus Fundamental 3500 $818.38 $828.48 $838.70 $849.05
Moda Health Connexus Fundamental 5000 $757.41 $766.76 $776.22 $785.80
Moda Health Connexus HSA 1500 $1,025.58 $1,038.24 $1,051.05 $1,064.03
Moda Health Connexus HSA 2000 $980.05 $992.15 $1,004.39 $1,016.79
Moda Health Connexus HSA 2500 $943.26 $954.90 $966.69 $978.62
Moda Health Connexus HSA 3250 $830.34 $840.59 $850.97 $861.47
Moda Health Connexus Essence 5000 $759.16 $768.53 $778.01 $787.61
Moda Health Connxus Essence 6000 $754.56 $763.88 $773.30 $782.85
Moda Health Connexus Basic 6500 $756.29 $765.62 $775.07 $784.64
Moda Health Synergy Exclusive 2000 $862.69 $873.34 $884.12 $895.03
Moda Health Synergy Exclusive 5000 $675.34 $683.67 $692.11 $700.65
PPO Platinum Synergy Exclusive 250 $1,153.80 $1,168.04 $1,182.46 $1,197.05
PPO Synergy Exclusive 1000A $1,043.89 $1,056.77 $1,069.81 $1,083.02
Moda Health Oregon Standard Gold $1,130.22 $1,144.17 $1,158.29 $1,172.58
Moda Health Oregon Standard Silver $948.14 $959.84 $971.69 $983.68
Moda Health Oregon Standard Bronze $769.99 $779.50 $789.12 $798.86
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 3 - Employee + Family
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,812.44 $1,834.81 $1,857.46 $1,880.38
PPO Platinum 500 $1,789.02 $1,811.10 $1,833.46 $1,856.08
PPO 500 $1,691.49 $1,712.36 $1,733.50 $1,754.89
PPO 1000A $1,643.71 $1,664.00 $1,684.54 $1,705.33
PPO 1000B $1,640.65 $1,660.90 $1,681.39 $1,702.15
PPO 1500 $1,600.00 $1,619.75 $1,639.74 $1,659.97
PPO 2500 $1,437.95 $1,455.70 $1,473.67 $1,491.86
PPO 3000 $1,410.96 $1,428.37 $1,446.00 $1,463.85
Value 1500 $1,436.57 $1,454.30 $1,472.24 $1,490.41
Value 2000 $1,386.96 $1,404.08 $1,421.41 $1,438.95
Value 2500 $1,349.95 $1,366.61 $1,383.47 $1,400.55
Value 3000 $1,316.98 $1,333.24 $1,349.69 $1,366.35
Value 3500 $1,286.94 $1,302.82 $1,318.90 $1,335.18
Value 5000 $1,216.79 $1,231.81 $1,247.01 $1,262.40
Moda Health Connexus Aspire 2000 $1,377.28 $1,394.28 $1,411.49 $1,428.91
Moda Health Connexus Aspire 2500 $1,337.39 $1,353.90 $1,370.61 $1,387.52
Moda Health Connexus Fundamental 3500 $1,166.19 $1,180.58 $1,195.15 $1,209.90
Moda Health Connexus Fundamental 5000 $1,079.31 $1,092.63 $1,106.11 $1,119.77
Moda Health Connexus HSA 1500 $1,461.46 $1,479.49 $1,497.75 $1,516.24
Moda Health Connexus HSA 2000 $1,396.58 $1,413.81 $1,431.26 $1,448.93
Moda Health Connexus HSA 2500 $1,344.14 $1,360.73 $1,377.53 $1,394.53
Moda Health Connexus HSA 3250 $1,183.24 $1,197.84 $1,212.63 $1,227.59
Moda Health Connexus Essence 5000 $1,081.80 $1,095.15 $1,108.66 $1,122.35
Moda Health Connxus Essence 6000 $1,075.25 $1,088.52 $1,101.96 $1,115.56
Moda Health Connexus Basic 6500 $1,077.71 $1,091.01 $1,104.48 $1,118.11
Moda Health Synergy Exclusive 2000 $1,229.33 $1,244.51 $1,259.87 $1,275.42
Moda Health Synergy Exclusive 5000 $962.35 $974.23 $986.25 $998.43
PPO Platinum Synergy Exclusive 250 $1,644.17 $1,664.46 $1,685.00 $1,705.80
PPO Synergy Exclusive 1000A $1,487.54 $1,505.90 $1,524.49 $1,543.30
Moda Health Oregon Standard Gold $1,610.56 $1,630.44 $1,650.56 $1,670.93
Moda Health Oregon Standard Silver $1,351.10 $1,367.78 $1,384.66 $1,401.75
Moda Health Oregon Standard Bronze $1,097.24 $1,110.78 $1,124.49 $1,138.37
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 3 - Employee + Child(ren)
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,176.50 $1,191.02 $1,205.72 $1,220.60
PPO Platinum 500 $1,161.30 $1,175.63 $1,190.14 $1,204.83
PPO 500 $1,097.98 $1,111.53 $1,125.25 $1,139.14
PPO 1000A $1,066.97 $1,080.14 $1,093.47 $1,106.97
PPO 1000B $1,064.98 $1,078.13 $1,091.43 $1,104.90
PPO 1500 $1,038.60 $1,051.41 $1,064.39 $1,077.53
PPO 2500 $933.41 $944.93 $956.59 $968.40
PPO 3000 $915.89 $927.19 $938.63 $950.22
Value 1500 $932.51 $944.02 $955.67 $967.46
Value 2000 $900.31 $911.42 $922.67 $934.06
Value 2500 $876.28 $887.10 $898.04 $909.13
Value 3000 $854.88 $865.44 $876.12 $886.93
Value 3500 $835.38 $845.69 $856.13 $866.69
Value 5000 $789.85 $799.60 $809.46 $819.46
Moda Health Connexus Aspire 2000 $894.03 $905.06 $916.23 $927.54
Moda Health Connexus Aspire 2500 $868.13 $878.85 $889.69 $900.67
Moda Health Connexus Fundamental 3500 $757.00 $766.34 $775.80 $785.38
Moda Health Connexus Fundamental 5000 $700.60 $709.25 $718.00 $726.87
Moda Health Connexus HSA 1500 $948.66 $960.37 $972.23 $984.22
Moda Health Connexus HSA 2000 $906.55 $917.74 $929.07 $940.53
Moda Health Connexus HSA 2500 $872.51 $883.28 $894.18 $905.22
Moda Health Connexus HSA 3250 $768.07 $777.55 $787.14 $796.86
Moda Health Connexus Essence 5000 $702.22 $710.89 $719.66 $728.54
Moda Health Connexus Essence 6000 $697.97 $706.58 $715.31 $724.13
Moda Health Connexus Basic 6500 $699.57 $708.20 $716.94 $725.79
Moda Health Synergy Exclusive 2000 $797.99 $807.84 $817.81 $827.90
Moda Health Synergy Exclusive 5000 $624.69 $632.40 $640.20 $648.10
PPO Platinum Synergy Exclusive 250 $1,067.27 $1,080.44 $1,093.77 $1,107.27
PPO Synergy Exclusive 1000A $965.60 $977.51 $989.58 $1,001.79
Moda Health Oregon Standard Gold $1,045.45 $1,058.35 $1,071.42 $1,084.64
Moda Health Oregon Standard Silver $877.03 $887.86 $898.81 $909.91
Moda Health Oregon Standard Bronze $712.24 $721.03 $729.93 $738.94
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 4 - Employee Only
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $685.37 $693.83 $702.39 $711.06
PPO Platinum 500 $676.51 $684.86 $693.32 $701.87
PPO 500 $639.63 $647.53 $655.52 $663.61
PPO 1000A $621.57 $629.24 $637.00 $644.87
PPO 1000B $620.41 $628.06 $635.82 $643.66
PPO 1500 $605.04 $612.50 $620.06 $627.71
PPO 2500 $543.76 $550.47 $557.26 $564.14
PPO 3000 $533.55 $540.14 $546.80 $553.55
Value 1500 $543.23 $549.94 $556.73 $563.60Value 2000 $524.48 $530.95 $537.50 $544.14
Value 2500 $510.48 $516.78 $523.16 $529.61
Value 3000 $498.01 $504.16 $510.38 $516.68
Value 3500 $486.65 $492.66 $498.74 $504.89
Value 5000 $460.13 $465.81 $471.55 $477.37
Moda Health Connexus Aspire 2000 $520.82 $527.24 $533.75 $540.34
Moda Health Connexus Aspire 2500 $505.73 $511.97 $518.29 $524.69
Moda Health Connexus Fundamental 3500 $440.99 $446.43 $451.94 $457.52
Moda Health Connexus Fundamental 5000 $408.14 $413.17 $418.27 $423.44
Moda Health Connexus HSA 1500 $552.65 $559.47 $566.37 $573.36
Moda Health Connexus HSA 2000 $528.11 $534.63 $541.23 $547.91
Moda Health Connexus HSA 2500 $508.28 $514.56 $520.91 $527.34
Moda Health Connexus HSA 3250 $447.44 $452.96 $458.55 $464.21
Moda Health Connexus Essence 5000 $409.08 $414.13 $419.24 $424.41
Moda Health Connexus Essence 6000 $406.60 $411.62 $416.70 $421.84
Moda Health Connexus Basic 6500 $407.53 $412.56 $417.66 $422.81
Moda Health Synergy Exclusive 2000 $464.87 $470.61 $476.42 $482.29
Moda Health Summit Exclusive 2000 $480.73 $486.66 $492.67 $498.75
Moda Health Synergy Exclusive 5000 $363.91 $368.40 $372.95 $377.55
Moda Health Summit Exclusive 5000 $375.49 $380.12 $384.81 $389.56
PPO Platinum Synergy Exclusive 250 $621.74 $629.41 $637.18 $645.04
PPO Platinum Summit Exclusive 250 $644.26 $652.21 $660.26 $668.41
PPO Synergy Exclusive 1000A $562.51 $569.45 $576.48 $583.60
PPO Summit Exclusive 1000A $582.66 $589.85 $597.13 $604.50
Moda Health Oregon Standard Gold $609.03 $616.55 $624.16 $631.86
Moda Health Oregon Standard Silver $510.92 $517.22 $523.60 $530.07
Moda Health Oregon Standard Bronze $414.92 $420.04 $425.22 $430.47
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 4 - Employee + Spouse
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,370.74 $1,387.66 $1,404.78 $1,422.12
PPO Platinum 500 $1,353.03 $1,369.73 $1,386.63 $1,403.75
PPO 500 $1,279.26 $1,295.05 $1,311.03 $1,327.21
PPO 1000A $1,243.13 $1,258.48 $1,274.01 $1,289.73
PPO 1000B $1,240.81 $1,256.13 $1,271.63 $1,287.32
PPO 1500 $1,210.07 $1,225.01 $1,240.12 $1,255.43
PPO 2500 $1,087.52 $1,100.94 $1,114.53 $1,128.28
PPO 3000 $1,067.10 $1,080.27 $1,093.60 $1,107.10
Value 1500 $1,086.47 $1,099.88 $1,113.45 $1,127.19
Value 2000 $1,048.95 $1,061.90 $1,075.01 $1,088.27
Value 2500 $1,020.96 $1,033.56 $1,046.31 $1,059.23
Value 3000 $996.03 $1,008.32 $1,020.77 $1,033.36
Value 3500 $973.30 $985.32 $997.48 $1,009.79
Value 5000 $920.25 $931.61 $943.11 $954.75
Moda Health Connexus Aspire 2000 $1,041.63 $1,054.49 $1,067.50 $1,080.68
Moda Health Connexus Aspire 2500 $1,011.46 $1,023.95 $1,036.58 $1,049.38
Moda Health Connexus Fundamental 3500 $881.98 $892.87 $903.89 $915.04
Moda Health Connexus Fundamental 5000 $816.28 $826.35 $836.55 $846.87
Moda Health Connexus HSA 1500 $1,105.29 $1,118.93 $1,132.74 $1,146.72
Moda Health Connexus HSA 2000 $1,056.22 $1,069.26 $1,082.46 $1,095.82
Moda Health Connexus HSA 2500 $1,016.57 $1,029.12 $1,041.82 $1,054.67
Moda Health Connexus HSA 3250 $894.88 $905.92 $917.10 $928.42
Moda Health Connexus Essence 5000 $818.16 $828.26 $838.48 $848.83
Moda Health Connexus Essence 6000 $813.21 $823.24 $833.40 $843.69
Moda Health Connexus Basic 6500 $815.07 $825.13 $835.31 $845.62
Moda Health Synergy Exclusive 2000 $929.74 $941.21 $952.83 $964.59
Moda Health Summit Exclusive 2000 $961.46 $973.33 $985.34 $997.50
Moda Health Synergy Exclusive 5000 $727.82 $736.81 $745.90 $755.11
Moda Health Summit Exclusive 5000 $750.97 $760.24 $769.62 $779.12
PPO Platinum Synergy Exclusive 250 $1,243.48 $1,258.82 $1,274.36 $1,290.09
PPO Platinum Summit Exclusive 250 $1,288.52 $1,304.42 $1,320.52 $1,336.82
PPO Synergy Exclusive 1000A $1,125.02 $1,138.90 $1,152.96 $1,167.19
PPO Summit Exclusive 1000A $1,165.32 $1,179.70 $1,194.26 $1,209.00
Moda Health Oregon Standard Gold $1,218.06 $1,233.09 $1,248.31 $1,263.72
Moda Health Oregon Standard Silver $1,021.83 $1,034.44 $1,047.21 $1,060.13
Moda Health Oregon Standard Bronze $829.84 $840.08 $850.45 $860.94
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 4 - Employee + Family
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,953.31 $1,977.41 $2,001.82 $2,026.52
PPO Platinum 500 $1,928.07 $1,951.86 $1,975.95 $2,000.34
PPO 500 $1,822.95 $1,845.45 $1,868.22 $1,891.28
PPO 1000A $1,771.46 $1,793.33 $1,815.46 $1,837.87
PPO 1000B $1,768.16 $1,789.98 $1,812.07 $1,834.44
PPO 1500 $1,724.35 $1,745.63 $1,767.18 $1,788.99
PPO 2500 $1,549.71 $1,568.84 $1,588.20 $1,607.80
PPO 3000 $1,520.62 $1,539.39 $1,558.39 $1,577.62
Value 1500 $1,548.22 $1,567.32 $1,586.67 $1,606.25
Value 2000 $1,494.76 $1,513.21 $1,531.88 $1,550.79
Value 2500 $1,454.86 $1,472.82 $1,491.00 $1,509.40
Value 3000 $1,419.34 $1,436.86 $1,454.59 $1,472.54
Value 3500 $1,386.96 $1,404.08 $1,421.41 $1,438.95
Value 5000 $1,311.36 $1,327.55 $1,343.93 $1,360.52
Moda Health Connexus Aspire 2000 $1,484.33 $1,502.65 $1,521.19 $1,539.97
Moda Health Connexus Aspire 2500 $1,441.33 $1,459.12 $1,477.13 $1,495.36
Moda Health Connexus Fundamental 3500 $1,256.82 $1,272.34 $1,288.04 $1,303.94
Moda Health Connexus Fundamental 5000 $1,163.19 $1,177.55 $1,192.08 $1,206.79
Moda Health Connexus HSA 1500 $1,575.04 $1,594.48 $1,614.16 $1,634.08
Moda Health Connexus HSA 2000 $1,505.12 $1,523.70 $1,542.50 $1,561.54
Moda Health Connexus HSA 2500 $1,448.61 $1,466.49 $1,484.59 $1,502.91
Moda Health Connexus HSA 3250 $1,275.20 $1,290.94 $1,306.87 $1,323.00
Moda Health Connexus Essence 5000 $1,165.87 $1,180.26 $1,194.83 $1,209.58
Moda Health Connexus Essence 6000 $1,158.82 $1,173.12 $1,187.60 $1,202.26
Moda Health Connexus Basic 6500 $1,161.47 $1,175.81 $1,190.32 $1,205.01
Moda Health Synergy Exclusive 2000 $1,324.88 $1,341.23 $1,357.78 $1,374.54
Moda Health Summit Exclusive 2000 $1,370.08 $1,386.99 $1,404.11 $1,421.44
Moda Health Synergy Exclusive 5000 $1,037.15 $1,049.95 $1,062.91 $1,076.02
Moda Health Summit Exclusive 5000 $1,070.14 $1,083.34 $1,096.72 $1,110.25
PPO Platinum Synergy Exclusive 250 $1,771.95 $1,793.82 $1,815.96 $1,838.37
PPO Platinum Summit Exclusive 250 $1,836.14 $1,858.80 $1,881.74 $1,904.97
PPO Synergy Exclusive 1000A $1,603.15 $1,622.94 $1,642.97 $1,663.25
PPO Summit Exclusive 1000A $1,660.58 $1,681.08 $1,701.82 $1,722.83
Moda Health Oregon Standard Gold $1,735.73 $1,757.16 $1,778.84 $1,800.80
Moda Health Oregon Standard Silver $1,456.11 $1,474.08 $1,492.27 $1,510.69
Moda Health Oregon Standard Bronze $1,182.52 $1,197.11 $1,211.89 $1,226.84
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 4 - Employee + Child(ren)
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,267.94 $1,283.58 $1,299.43 $1,315.46
PPO Platinum 500 $1,251.55 $1,267.00 $1,282.64 $1,298.47
PPO 500 $1,183.32 $1,197.92 $1,212.71 $1,227.67
PPO 1000A $1,149.90 $1,164.09 $1,178.46 $1,193.00
PPO 1000B $1,147.75 $1,161.92 $1,176.26 $1,190.78
PPO 1500 $1,119.32 $1,133.13 $1,147.12 $1,161.27
PPO 2500 $1,005.95 $1,018.37 $1,030.94 $1,043.66
PPO 3000 $987.07 $999.25 $1,011.58 $1,024.07
Value 1500 $1,004.98 $1,017.39 $1,029.94 $1,042.65
Value 2000 $970.28 $982.26 $994.38 $1,006.65
Value 2500 $944.39 $956.04 $967.84 $979.79
Value 3000 $921.33 $932.70 $944.21 $955.86
Value 3500 $900.31 $911.42 $922.67 $934.05
Value 5000 $851.24 $861.74 $872.38 $883.14
Moda Health Connexus Aspire 2000 $963.51 $975.40 $987.44 $999.63
Moda Health Connexus Aspire 2500 $935.60 $947.15 $958.84 $970.67
Moda Health Connexus Fundamental 3500 $815.83 $825.90 $836.10 $846.41
Moda Health Connexus Fundamental 5000 $755.05 $764.37 $773.81 $783.36
Moda Health Connexus HSA 1500 $1,022.39 $1,035.01 $1,047.79 $1,060.72
Moda Health Connexus HSA 2000 $977.01 $989.07 $1,001.27 $1,013.63
Moda Health Connexus HSA 2500 $940.33 $951.93 $963.68 $975.57
Moda Health Connexus HSA 3250 $827.76 $837.98 $848.32 $858.79
Moda Health Connexus Essence 5000 $756.80 $766.14 $775.59 $785.16
Moda Health Connexus Essence 6000 $752.22 $761.50 $770.90 $780.41
Moda Health Connexus Basic 6500 $753.94 $763.24 $772.66 $782.20
Moda Health Synergy Exclusive 2000 $860.01 $870.62 $881.37 $892.25
Moda Health Summit Exclusive 2000 $889.35 $900.33 $911.44 $922.69
Moda Health Synergy Exclusive 5000 $673.24 $681.55 $689.96 $698.47
Moda Health Summit Exclusive 5000 $694.65 $703.22 $711.90 $720.69
PPO Platinum Synergy Exclusive 250 $1,150.22 $1,164.41 $1,178.78 $1,193.33
PPO Platinum Summit Exclusive 250 $1,191.88 $1,206.59 $1,221.48 $1,236.56
PPO Synergy Exclusive 1000A $1,040.64 $1,053.49 $1,066.49 $1,079.65
PPO Summit Exclusive 1000A $1,077.92 $1,091.22 $1,104.69 $1,118.33
Moda Health Oregon Standard Gold $1,126.70 $1,140.61 $1,154.69 $1,168.94
Moda Health Oregon Standard Silver $945.19 $956.86 $968.67 $980.62
Moda Health Oregon Standard Bronze $767.60 $777.07 $786.66 $796.37
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 5 - Employee Only
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $659.01 $667.14 $675.38 $683.71
PPO Platinum 500 $650.50 $658.52 $666.65 $674.88
PPO 500 $615.03 $622.62 $630.30 $638.08
PPO 1000A $597.66 $605.04 $612.50 $620.06
PPO 1000B $596.55 $603.91 $611.36 $618.91
PPO 1500 $581.77 $588.95 $596.21 $603.57
PPO 2500 $522.85 $529.30 $535.83 $542.44
PPO 3000 $513.03 $519.36 $525.77 $532.26
Value 1500 $522.34 $528.79 $535.31 $541.92Value 2000 $504.31 $510.53 $516.83 $523.21
Value 2500 $490.85 $496.90 $503.04 $509.24
Value 3000 $478.86 $484.77 $490.75 $496.81
Value 3500 $467.94 $473.71 $479.56 $485.48
Value 5000 $442.43 $447.89 $453.42 $459.01
Moda Health Connexus Aspire 2000 $500.79 $506.97 $513.22 $519.56
Moda Health Connexus Aspire 2500 $486.28 $492.28 $498.36 $504.51
Moda Health Connexus Fundamental 3500 $424.03 $429.26 $434.56 $439.92
Moda Health Connexus Fundamental 5000 $392.44 $397.28 $402.19 $407.15
Moda Health Connexus HSA 1500 $531.39 $537.95 $544.59 $551.31
Moda Health Connexus HSA 2000 $507.80 $514.07 $520.41 $526.83
Moda Health Connexus HSA 2500 $488.74 $494.77 $500.87 $507.05
Moda Health Connexus HSA 3250 $430.23 $435.54 $440.92 $446.36
Moda Health Connexus Essence 5000 $393.35 $398.20 $403.11 $408.09
Moda Health Connexus Essence 6000 $390.97 $395.79 $400.68 $405.62
Moda Health Connexus Basic 6500 $391.86 $396.70 $401.59 $406.55
Moda Health Synergy Exclusive 2000 $446.99 $452.51 $458.09 $463.75
Moda Health Synergy Exclusive 5000 $349.92 $354.23 $358.61 $363.03
PPO Platinum Synergy Exclusive 250 $597.83 $605.20 $612.67 $620.23
PPO Synergy Exclusive 1000A $540.88 $547.55 $554.31 $561.15
Moda Health Oregon Standard Gold $585.61 $592.83 $600.15 $607.56
Moda Health Oregon Standard Silver $491.27 $497.33 $503.47 $509.68
Moda Health Oregon Standard Bronze $398.96 $403.88 $408.87 $413.91
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 5 - Employee + Spouse
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,318.02 $1,334.29 $1,350.75 $1,367.43
PPO Platinum 500 $1,300.99 $1,317.05 $1,333.30 $1,349.76
PPO 500 $1,230.06 $1,245.24 $1,260.61 $1,276.17
PPO 1000A $1,195.32 $1,210.07 $1,225.01 $1,240.13
PPO 1000B $1,193.09 $1,207.81 $1,222.72 $1,237.81
PPO 1500 $1,163.53 $1,177.89 $1,192.43 $1,207.14
PPO 2500 $1,045.69 $1,058.60 $1,071.66 $1,084.89
PPO 3000 $1,026.06 $1,038.72 $1,051.54 $1,064.52
Value 1500 $1,044.68 $1,057.57 $1,070.63 $1,083.84
Value 2000 $1,008.61 $1,021.06 $1,033.66 $1,046.42
Value 2500 $981.69 $993.81 $1,006.07 $1,018.49
Value 3000 $957.72 $969.54 $981.51 $993.62
Value 3500 $935.87 $947.42 $959.11 $970.95
Value 5000 $884.86 $895.78 $906.84 $918.03
Moda Health Connexus Aspire 2000 $1,001.57 $1,013.93 $1,026.44 $1,039.11
Moda Health Connexus Aspire 2500 $972.56 $984.56 $996.71 $1,009.02
Moda Health Connexus Fundamental 3500 $848.06 $858.53 $869.12 $879.85
Moda Health Connexus Fundamental 5000 $784.88 $794.57 $804.37 $814.30
Moda Health Connexus HSA 1500 $1,062.78 $1,075.90 $1,089.18 $1,102.62
Moda Health Connexus HSA 2000 $1,015.60 $1,028.13 $1,040.82 $1,053.67
Moda Health Connexus HSA 2500 $977.47 $989.53 $1,001.75 $1,014.11
Moda Health Connexus HSA 3250 $860.46 $871.08 $881.83 $892.71
Moda Health Connexus Essence 5000 $786.69 $796.40 $806.23 $816.18
Moda Health Connexus Essence 6000 $781.93 $791.58 $801.35 $811.24
Moda Health Connexus Basic 6500 $783.72 $793.39 $803.18 $813.10
Moda Health Synergy Exclusive 2000 $893.98 $905.01 $916.18 $927.49
Moda Health Synergy Exclusive 5000 $699.83 $708.47 $717.21 $726.06
PPO Platinum Synergy Exclusive 250 $1,195.65 $1,210.41 $1,225.35 $1,240.47
PPO Synergy Exclusive 1000A $1,081.75 $1,095.10 $1,108.62 $1,122.30
Moda Health Oregon Standard Gold $1,171.21 $1,185.66 $1,200.30 $1,215.11
Moda Health Oregon Standard Silver $982.53 $994.66 $1,006.93 $1,019.36
Moda Health Oregon Standard Bronze $797.92 $807.77 $817.74 $827.83
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 5 - Employee + Family
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,878.18 $1,901.36 $1,924.82 $1,948.58
PPO Platinum 500 $1,853.91 $1,876.79 $1,899.95 $1,923.40
PPO 500 $1,752.84 $1,774.47 $1,796.37 $1,818.54
PPO 1000A $1,703.33 $1,724.35 $1,745.63 $1,767.18
PPO 1000B $1,700.15 $1,721.14 $1,742.38 $1,763.88
PPO 1500 $1,658.03 $1,678.49 $1,699.21 $1,720.18
PPO 2500 $1,490.11 $1,508.50 $1,527.12 $1,545.96
PPO 3000 $1,462.14 $1,480.18 $1,498.45 $1,516.94
Value 1500 $1,488.67 $1,507.04 $1,525.64 $1,544.47
Value 2000 $1,437.27 $1,455.01 $1,472.97 $1,491.14
Value 2500 $1,398.91 $1,416.17 $1,433.65 $1,451.35
Value 3000 $1,364.75 $1,381.59 $1,398.65 $1,415.91
Value 3500 $1,333.61 $1,350.07 $1,366.74 $1,383.60
Value 5000 $1,260.93 $1,276.49 $1,292.24 $1,308.19
Moda Health Connexus Aspire 2000 $1,427.24 $1,444.85 $1,462.68 $1,480.74
Moda Health Connexus Aspire 2500 $1,385.90 $1,403.00 $1,420.32 $1,437.85
Moda Health Connexus Fundamental 3500 $1,208.49 $1,223.40 $1,238.50 $1,253.78
Moda Health Connexus Fundamental 5000 $1,118.45 $1,132.26 $1,146.23 $1,160.38
Moda Health Connexus HSA 1500 $1,514.46 $1,533.15 $1,552.07 $1,571.23
Moda Health Connexus HSA 2000 $1,447.23 $1,465.09 $1,483.17 $1,501.48
Moda Health Connexus HSA 2500 $1,392.89 $1,410.09 $1,427.49 $1,445.11
Moda Health Connexus HSA 3250 $1,226.16 $1,241.29 $1,256.61 $1,272.12
Moda Health Connexus Essence 5000 $1,121.03 $1,134.87 $1,148.88 $1,163.05
Moda Health Connexus Essence 6000 $1,114.25 $1,128.00 $1,141.92 $1,156.02
Moda Health Connexus Basic 6500 $1,116.80 $1,130.58 $1,144.54 $1,158.66
Moda Health Synergy Exclusive 2000 $1,273.92 $1,289.64 $1,305.56 $1,321.67
Moda Health Synergy Exclusive 5000 $997.26 $1,009.57 $1,022.03 $1,034.64
PPO Platinum Synergy Exclusive 250 $1,703.80 $1,724.83 $1,746.12 $1,767.67
PPO Synergy Exclusive 1000A $1,541.49 $1,560.52 $1,579.78 $1,599.28
Moda Health Oregon Standard Gold $1,668.97 $1,689.57 $1,710.42 $1,731.53
Moda Health Oregon Standard Silver $1,400.11 $1,417.39 $1,434.88 $1,452.59
Moda Health Oregon Standard Bronze $1,137.04 $1,151.07 $1,165.28 $1,179.66
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Geographic Average Rate
Area 5 - Employee + Child(ren)
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,219.17 $1,234.22 $1,249.45 $1,264.87
PPO Platinum 500 $1,203.42 $1,218.27 $1,233.30 $1,248.52
PPO 500 $1,137.81 $1,151.85 $1,166.06 $1,180.46
PPO 1000A $1,105.67 $1,119.32 $1,133.13 $1,147.12
PPO 1000B $1,103.61 $1,117.23 $1,131.02 $1,144.98
PPO 1500 $1,076.27 $1,089.55 $1,103.00 $1,116.61
PPO 2500 $967.26 $979.20 $991.29 $1,003.52
PPO 3000 $949.11 $960.82 $972.68 $984.68
Value 1500 $966.33 $978.26 $990.33 $1,002.55
Value 2000 $932.96 $944.48 $956.14 $967.94
Value 2500 $908.06 $919.27 $930.62 $942.10
Value 3000 $885.89 $896.82 $907.89 $919.10
Value 3500 $865.68 $876.36 $887.18 $898.13
Value 5000 $818.50 $828.60 $838.82 $849.18
Moda Health Connexus Aspire 2000 $926.45 $937.89 $949.46 $961.18
Moda Health Connexus Aspire 2500 $899.62 $910.72 $921.96 $933.34
Moda Health Connexus Fundamental 3500 $784.46 $794.14 $803.94 $813.86
Moda Health Connexus Fundamental 5000 $726.01 $734.97 $744.05 $753.23
Moda Health Connexus HSA 1500 $983.07 $995.20 $1,007.49 $1,019.92
Moda Health Connexus HSA 2000 $939.43 $951.02 $962.76 $974.64
Moda Health Connexus HSA 2500 $904.16 $915.32 $926.62 $938.05
Moda Health Connexus HSA 3250 $795.93 $805.75 $815.69 $825.76
Moda Health Connexus Essence 5000 $727.69 $736.67 $745.76 $754.97
Moda Health Connexus Essence 6000 $723.29 $732.21 $741.25 $750.40
Moda Health Connexus Basic 6500 $724.94 $733.89 $742.95 $752.11
Moda Health Synergy Exclusive 2000 $826.93 $837.14 $847.47 $857.93
Moda Health Synergy Exclusive 5000 $647.34 $655.33 $663.42 $671.61
PPO Platinum Synergy Exclusive 250 $1,105.98 $1,119.63 $1,133.44 $1,147.43
PPO Synergy Exclusive 1000A $1,000.62 $1,012.97 $1,025.47 $1,038.13
Moda Health Oregon Standard Gold $1,083.37 $1,096.74 $1,110.28 $1,123.98
Moda Health Oregon Standard Silver $908.84 $920.06 $931.41 $942.91
Moda Health Oregon Standard Bronze $738.08 $747.19 $756.41 $765.74
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2015
Geographic Average Rate
Area 6 - Employee Only
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $678.78 $687.16 $695.64 $704.22
PPO Platinum 500 $670.01 $678.28 $686.65 $695.12
PPO 500 $633.48 $641.30 $649.21 $657.23
PPO 1000A $615.59 $623.19 $630.88 $638.66
PPO 1000B $614.44 $622.02 $629.70 $637.47
PPO 1500 $599.22 $606.61 $614.10 $621.68
PPO 2500 $538.53 $545.18 $551.91 $558.72
PPO 3000 $528.42 $534.94 $541.54 $548.23
Value 1500 $538.01 $544.65 $551.37 $558.18Value 2000 $519.43 $525.84 $532.33 $538.90
Value 2500 $505.57 $511.81 $518.13 $524.52
Value 3000 $493.23 $499.31 $505.48 $511.71
Value 3500 $481.97 $487.92 $493.94 $500.04
Value 5000 $455.70 $461.33 $467.02 $472.78
Moda Health Connexus Aspire 2000 $515.81 $522.17 $528.62 $535.14
Moda Health Connexus Aspire 2500 $500.87 $507.05 $513.31 $519.64
Moda Health Connexus Fundamental 3500 $436.75 $442.14 $447.60 $453.12
Moda Health Connexus Fundamental 5000 $404.21 $409.20 $414.25 $419.36
Moda Health Connexus HSA 1500 $547.33 $554.09 $560.93 $567.85
Moda Health Connexus HSA 2000 $523.03 $529.49 $536.02 $542.64
Moda Health Connexus HSA 2500 $503.40 $509.61 $515.90 $522.27
Moda Health Connexus HSA 3250 $443.14 $448.61 $454.14 $459.75
Moda Health Connexus Essence 5000 $405.15 $410.15 $415.21 $420.33
Moda Health Connexus Essence 6000 $402.69 $407.66 $412.70 $417.79
Moda Health Connexus Basic 6500 $403.62 $408.60 $413.64 $418.75
Moda Health Synergy Exclusive 2000 $460.40 $466.08 $471.83 $477.66
Moda Health Summit Exclusive 2000 $476.11 $481.98 $487.93 $493.95
Moda Health Synergy Exclusive 5000 $360.41 $364.86 $369.36 $373.92
Moda Health Summit Exclusive 5000 $371.88 $376.47 $381.11 $385.82
PPO Platinum Synergy Exclusive 250 $615.76 $623.36 $631.05 $638.84
PPO Platinum Summit Exclusive 250 $638.06 $645.94 $653.91 $661.98
PPO Synergy Exclusive 1000A $557.10 $563.98 $570.94 $577.98
PPO Summit Exclusive 1000A $577.06 $584.18 $591.39 $598.69
Moda Health Oregon Standard Gold $603.17 $610.62 $618.15 $625.78
Moda Health Oregon Standard Silver $506.00 $512.25 $518.57 $524.97
Moda Health Oregon Standard Bronze $410.93 $416.00 $421.13 $426.33
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2015
Geographic Average Rate
Area 6 - Employee + Spouse
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,357.56 $1,374.32 $1,391.28 $1,408.45
PPO Platinum 500 $1,340.02 $1,356.56 $1,373.30 $1,390.25
PPO 500 $1,266.96 $1,282.60 $1,298.43 $1,314.45
PPO 1000A $1,231.18 $1,246.37 $1,261.76 $1,277.33
PPO 1000B $1,228.88 $1,244.05 $1,259.40 $1,274.95
PPO 1500 $1,198.44 $1,213.23 $1,228.20 $1,243.36
PPO 2500 $1,077.06 $1,090.35 $1,103.81 $1,117.43
PPO 3000 $1,056.84 $1,069.89 $1,083.09 $1,096.46
Value 1500 $1,076.02 $1,089.30 $1,102.74 $1,116.35
Value 2000 $1,038.87 $1,051.69 $1,064.67 $1,077.81
Value 2500 $1,011.14 $1,023.62 $1,036.25 $1,049.04
Value 3000 $986.45 $998.63 $1,010.95 $1,023.43
Value 3500 $963.95 $975.84 $987.89 $1,000.08
Value 5000 $911.41 $922.65 $934.04 $945.57
Moda Health Connexus Aspire 2000 $1,031.62 $1,044.35 $1,057.24 $1,070.29
Moda Health Connexus Aspire 2500 $1,001.74 $1,014.10 $1,026.62 $1,039.29
Moda Health Connexus Fundamental 3500 $873.50 $884.28 $895.20 $906.24
Moda Health Connexus Fundamental 5000 $808.43 $818.40 $828.50 $838.73
Moda Health Connexus HSA 1500 $1,094.66 $1,108.17 $1,121.85 $1,135.70
Moda Health Connexus HSA 2000 $1,046.07 $1,058.98 $1,072.05 $1,085.28
Moda Health Connexus HSA 2500 $1,006.79 $1,019.22 $1,031.80 $1,044.53
Moda Health Connexus HSA 3250 $886.27 $897.21 $908.29 $919.50
Moda Health Connexus Essence 5000 $810.29 $820.29 $830.42 $840.66
Moda Health Connexus Essence 6000 $805.39 $815.33 $825.39 $835.58
Moda Health Connexus Basic 6500 $807.23 $817.19 $827.28 $837.49
Moda Health Synergy Exclusive 2000 $920.80 $932.16 $943.67 $955.31
Moda Health Summit Exclusive 2000 $952.21 $963.97 $975.86 $987.91
Moda Health Synergy Exclusive 5000 $720.82 $729.72 $738.73 $747.84
Moda Health Summit Exclusive 5000 $743.75 $752.93 $762.22 $771.63
PPO Platinum Synergy Exclusive 250 $1,231.52 $1,246.72 $1,262.11 $1,277.68
PPO Platinum Summit Exclusive 250 $1,276.13 $1,291.88 $1,307.82 $1,323.96
PPO Synergy Exclusive 1000A $1,114.20 $1,127.95 $1,141.87 $1,155.97
PPO Summit Exclusive 1000A $1,154.12 $1,168.36 $1,182.78 $1,197.38
Moda Health Oregon Standard Gold $1,206.35 $1,221.23 $1,236.31 $1,251.57
Moda Health Oregon Standard Silver $1,012.01 $1,024.50 $1,037.14 $1,049.94
Moda Health Oregon Standard Bronze $821.86 $832.00 $842.27 $852.66
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2015
Geographic Average Rate
Area 6 - Employee + Family
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,934.52 $1,958.40 $1,982.57 $2,007.04
PPO Platinum 500 $1,909.53 $1,933.10 $1,956.95 $1,981.11
PPO 500 $1,805.42 $1,827.70 $1,850.26 $1,873.10
PPO 1000A $1,754.43 $1,776.08 $1,798.00 $1,820.19
PPO 1000B $1,751.16 $1,772.77 $1,794.65 $1,816.80
PPO 1500 $1,707.77 $1,728.85 $1,750.19 $1,771.79
PPO 2500 $1,534.81 $1,553.75 $1,572.93 $1,592.34
PPO 3000 $1,506.00 $1,524.59 $1,543.40 $1,562.45
Value 1500 $1,533.33 $1,552.25 $1,571.41 $1,590.80
Value 2000 $1,480.39 $1,498.66 $1,517.15 $1,535.88
Value 2500 $1,440.88 $1,458.66 $1,476.66 $1,494.89
Value 3000 $1,405.69 $1,423.04 $1,440.61 $1,458.39
Value 3500 $1,373.62 $1,390.58 $1,407.74 $1,425.11
Value 5000 $1,298.75 $1,314.78 $1,331.01 $1,347.44
Moda Health Connexus Aspire 2000 $1,470.05 $1,488.20 $1,506.56 $1,525.16
Moda Health Connexus Aspire 2500 $1,427.47 $1,445.09 $1,462.93 $1,480.98
Moda Health Connexus Fundamental 3500 $1,244.74 $1,260.10 $1,275.65 $1,291.40
Moda Health Connexus Fundamental 5000 $1,152.01 $1,166.23 $1,180.62 $1,195.19
Moda Health Connexus HSA 1500 $1,559.90 $1,579.15 $1,598.64 $1,618.37
Moda Health Connexus HSA 2000 $1,490.65 $1,509.04 $1,527.67 $1,546.52
Moda Health Connexus HSA 2500 $1,434.68 $1,452.39 $1,470.31 $1,488.46
Moda Health Connexus HSA 3250 $1,262.94 $1,278.53 $1,294.31 $1,310.28
Moda Health Connexus Essence 5000 $1,154.66 $1,168.91 $1,183.34 $1,197.95
Moda Health Connexus Essence 6000 $1,147.68 $1,161.84 $1,176.18 $1,190.70
Moda Health Connexus Basic 6500 $1,150.31 $1,164.50 $1,178.87 $1,193.42
Moda Health Synergy Exclusive 2000 $1,312.14 $1,328.33 $1,344.73 $1,361.32
Moda Health Summit Exclusive 2000 $1,356.91 $1,373.65 $1,390.61 $1,407.77
Moda Health Synergy Exclusive 5000 $1,027.18 $1,039.85 $1,052.69 $1,065.68
Moda Health Summit Exclusive 5000 $1,059.85 $1,072.93 $1,086.17 $1,099.58
PPO Platinum Synergy Exclusive 250 $1,754.92 $1,776.57 $1,798.50 $1,820.70
PPO Platinum Summit Exclusive 250 $1,818.48 $1,840.93 $1,863.65 $1,886.65
PPO Synergy Exclusive 1000A $1,587.74 $1,607.33 $1,627.17 $1,647.25
PPO Summit Exclusive 1000A $1,644.61 $1,664.91 $1,685.46 $1,706.26
Moda Health Oregon Standard Gold $1,719.04 $1,740.26 $1,761.74 $1,783.48
Moda Health Oregon Standard Silver $1,442.11 $1,459.91 $1,477.92 $1,496.16
Moda Health Oregon Standard Bronze $1,171.15 $1,185.60 $1,200.23 $1,215.05
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2015
Geographic Average Rate
Area 6 - Employee + Child(ren)
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,255.74 $1,271.24 $1,286.93 $1,302.81
PPO Platinum 500 $1,239.52 $1,254.82 $1,270.30 $1,285.98
PPO 500 $1,171.94 $1,186.40 $1,201.05 $1,215.87
PPO 1000A $1,138.84 $1,152.90 $1,167.13 $1,181.53
PPO 1000B $1,136.72 $1,150.75 $1,164.95 $1,179.33
PPO 1500 $1,108.55 $1,122.23 $1,136.09 $1,150.11
PPO 2500 $996.28 $1,008.58 $1,021.02 $1,033.63
PPO 3000 $977.58 $989.64 $1,001.86 $1,014.22
Value 1500 $995.32 $1,007.60 $1,020.04 $1,032.63
Value 2000 $960.95 $972.81 $984.82 $996.97
Value 2500 $935.31 $946.85 $958.53 $970.36
Value 3000 $912.47 $923.73 $935.13 $946.67
Value 3500 $891.65 $902.65 $913.80 $925.07
Value 5000 $843.05 $853.46 $863.99 $874.65
Moda Health Connexus Aspire 2000 $954.25 $966.02 $977.95 $990.02
Moda Health Connexus Aspire 2500 $926.61 $938.04 $949.62 $961.34
Moda Health Connexus Fundamental 3500 $807.99 $817.96 $828.06 $838.28
Moda Health Connexus Fundamental 5000 $747.79 $757.02 $766.37 $775.83
Moda Health Connexus HSA 1500 $1,012.56 $1,025.06 $1,037.71 $1,050.52
Moda Health Connexus HSA 2000 $967.61 $979.56 $991.64 $1,003.88
Moda Health Connexus HSA 2500 $931.28 $942.78 $954.41 $966.19
Moda Health Connexus HSA 3250 $819.80 $829.92 $840.16 $850.53
Moda Health Connexus Essence 5000 $749.52 $758.77 $768.13 $777.61
Moda Health Connexus Essence 6000 $744.98 $754.18 $763.49 $772.91
Moda Health Connexus Basic 6500 $746.69 $755.90 $765.23 $774.68
Moda Health Synergy Exclusive 2000 $851.74 $862.25 $872.89 $883.67
Moda Health Summit Exclusive 2000 $880.80 $891.67 $902.67 $913.81
Moda Health Synergy Exclusive 5000 $666.76 $674.99 $683.32 $691.76
Moda Health Summit Exclusive 5000 $687.97 $696.46 $705.06 $713.76
PPO Platinum Synergy Exclusive 250 $1,139.16 $1,153.21 $1,167.45 $1,181.86
PPO Platinum Summit Exclusive 250 $1,180.42 $1,194.99 $1,209.74 $1,224.67
PPO Synergy Exclusive 1000A $1,030.64 $1,043.36 $1,056.23 $1,069.27
PPO Summit Exclusive 1000A $1,067.56 $1,080.73 $1,094.07 $1,107.57
Moda Health Oregon Standard Gold $1,115.87 $1,129.64 $1,143.58 $1,157.70
Moda Health Oregon Standard Silver $936.11 $947.66 $959.35 $971.19
Moda Health Oregon Standard Bronze $760.22 $769.60 $779.10 $788.71
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2015
Geographic Average Rate
Area 7 - Employee Only
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $685.37 $693.83 $702.39 $711.06
PPO Platinum 500 $676.51 $684.86 $693.32 $701.87
PPO 500 $639.63 $647.53 $655.52 $663.61
PPO 1000A $621.57 $629.24 $637.00 $644.87
PPO 1000B $620.41 $628.06 $635.82 $643.66
PPO 1500 $605.04 $612.50 $620.06 $627.71
PPO 2500 $543.76 $550.47 $557.26 $564.14
PPO 3000 $533.55 $540.14 $546.80 $553.55
Value 1500 $543.23 $549.94 $556.73 $563.60Value 2000 $524.48 $530.95 $537.50 $544.14
Value 2500 $510.48 $516.78 $523.16 $529.61
Value 3000 $498.01 $504.16 $510.38 $516.68
Value 3500 $486.65 $492.66 $498.74 $504.89
Value 5000 $460.13 $465.81 $471.55 $477.37
Moda Health Connexus Aspire 2000 $520.82 $527.24 $533.75 $540.34
Moda Health Connexus Aspire 2500 $505.73 $511.97 $518.29 $524.69
Moda Health Connexus Fundamental 3500 $440.99 $446.43 $451.94 $457.52
Moda Health Connexus Fundamental 5000 $408.14 $413.17 $418.27 $423.44
Moda Health Connexus HSA 1500 $552.65 $559.47 $566.37 $573.36
Moda Health Connexus HSA 2000 $528.11 $534.63 $541.23 $547.91
Moda Health Connexus HSA 2500 $508.28 $514.56 $520.91 $527.34
Moda Health Connexus HSA 3250 $447.44 $452.96 $458.55 $464.21
Moda Health Connexus Essence 5000 $409.08 $414.13 $419.24 $424.41
Moda Health Connexus Essence 6000 $406.60 $411.62 $416.70 $421.84
Moda Health Connexus Basic 6500 $407.53 $412.56 $417.66 $422.81
Moda Health Synergy Exclusive 2000 $464.87 $470.61 $476.42 $482.29
Moda Health Synergy Exclusive 5000 $363.91 $368.40 $372.95 $377.55
PPO Platinum Synergy Exclusive 250 $621.74 $629.41 $637.18 $645.04
PPO Synergy Exclusive 1000A $562.51 $569.45 $576.48 $583.60
Moda Health Oregon Standard Gold $609.03 $616.55 $624.16 $631.86
Moda Health Oregon Standard Silver $510.92 $517.22 $523.60 $530.07
Moda Health Oregon Standard Bronze $414.92 $420.04 $425.22 $430.47
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2015
Geographic Average Rate
Area 7 - Employee + Spouse
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,370.74 $1,387.66 $1,404.78 $1,422.12
PPO Platinum 500 $1,353.03 $1,369.73 $1,386.63 $1,403.75
PPO 500 $1,279.26 $1,295.05 $1,311.03 $1,327.21
PPO 1000A $1,243.13 $1,258.48 $1,274.01 $1,289.73
PPO 1000B $1,240.81 $1,256.13 $1,271.63 $1,287.32
PPO 1500 $1,210.07 $1,225.01 $1,240.12 $1,255.43
PPO 2500 $1,087.52 $1,100.94 $1,114.53 $1,128.28
PPO 3000 $1,067.10 $1,080.27 $1,093.60 $1,107.10
Value 1500 $1,086.47 $1,099.88 $1,113.45 $1,127.19
Value 2000 $1,048.95 $1,061.90 $1,075.01 $1,088.27
Value 2500 $1,020.96 $1,033.56 $1,046.31 $1,059.23
Value 3000 $996.03 $1,008.32 $1,020.77 $1,033.36
Value 3500 $973.30 $985.32 $997.48 $1,009.79
Value 5000 $920.25 $931.61 $943.11 $954.75
Moda Health Connexus Aspire 2000 $1,041.63 $1,054.49 $1,067.50 $1,080.68
Moda Health Connexus Aspire 2500 $1,011.46 $1,023.95 $1,036.58 $1,049.38
Moda Health Connexus Fundamental 3500 $881.98 $892.87 $903.89 $915.04
Moda Health Connexus Fundamental 5000 $816.28 $826.35 $836.55 $846.87
Moda Health Connexus HSA 1500 $1,105.29 $1,118.93 $1,132.74 $1,146.72
Moda Health Connexus HSA 2000 $1,056.22 $1,069.26 $1,082.46 $1,095.82
Moda Health Connexus HSA 2500 $1,016.57 $1,029.12 $1,041.82 $1,054.67
Moda Health Connexus HSA 3250 $894.88 $905.92 $917.10 $928.42
Moda Health Connexus Essence 5000 $818.16 $828.26 $838.48 $848.83
Moda Health Connexus Essence 6000 $813.21 $823.24 $833.40 $843.69
Moda Health Connexus Basic 6500 $815.07 $825.13 $835.31 $845.62
Moda Health Synergy Exclusive 2000 $929.74 $941.21 $952.83 $964.59
Moda Health Synergy Exclusive 5000 $727.82 $736.81 $745.90 $755.11
PPO Platinum Synergy Exclusive 250 $1,243.48 $1,258.82 $1,274.36 $1,290.09
PPO Synergy Exclusive 1000A $1,125.02 $1,138.90 $1,152.96 $1,167.19
Moda Health Oregon Standard Gold $1,218.06 $1,233.09 $1,248.31 $1,263.72
Moda Health Oregon Standard Silver $1,021.83 $1,034.44 $1,047.21 $1,060.13
Moda Health Oregon Standard Bronze $829.84 $840.08 $850.45 $860.94
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2015
Geographic Average Rate
Area 7 - Employee + Family
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,953.31 $1,977.41 $2,001.82 $2,026.52
PPO Platinum 500 $1,928.07 $1,951.86 $1,975.95 $2,000.34
PPO 500 $1,822.95 $1,845.45 $1,868.22 $1,891.28
PPO 1000A $1,771.46 $1,793.33 $1,815.46 $1,837.87
PPO 1000B $1,768.16 $1,789.98 $1,812.07 $1,834.44
PPO 1500 $1,724.35 $1,745.63 $1,767.18 $1,788.99
PPO 2500 $1,549.71 $1,568.84 $1,588.20 $1,607.80
PPO 3000 $1,520.62 $1,539.39 $1,558.39 $1,577.62
Value 1500 $1,548.22 $1,567.32 $1,586.67 $1,606.25
Value 2000 $1,494.76 $1,513.21 $1,531.88 $1,550.79
Value 2500 $1,454.86 $1,472.82 $1,491.00 $1,509.40
Value 3000 $1,419.34 $1,436.86 $1,454.59 $1,472.54
Value 3500 $1,386.96 $1,404.08 $1,421.41 $1,438.95
Value 5000 $1,311.36 $1,327.55 $1,343.93 $1,360.52
Moda Health Connexus Aspire 2000 $1,484.33 $1,502.65 $1,521.19 $1,539.97
Moda Health Connexus Aspire 2500 $1,441.33 $1,459.12 $1,477.13 $1,495.36
Moda Health Connexus Fundamental 3500 $1,256.82 $1,272.34 $1,288.04 $1,303.94
Moda Health Connexus Fundamental 5000 $1,163.19 $1,177.55 $1,192.08 $1,206.79
Moda Health Connexus HSA 1500 $1,575.04 $1,594.48 $1,614.16 $1,634.08
Moda Health Connexus HSA 2000 $1,505.12 $1,523.70 $1,542.50 $1,561.54
Moda Health Connexus HSA 2500 $1,448.61 $1,466.49 $1,484.59 $1,502.91
Moda Health Connexus HSA 3250 $1,275.20 $1,290.94 $1,306.87 $1,323.00
Moda Health Connexus Essence 5000 $1,165.87 $1,180.26 $1,194.83 $1,209.58
Moda Health Connexus Essence 6000 $1,158.82 $1,173.12 $1,187.60 $1,202.26
Moda Health Connexus Basic 6500 $1,161.47 $1,175.81 $1,190.32 $1,205.01
Moda Health Synergy Exclusive 2000 $1,324.88 $1,341.23 $1,357.78 $1,374.54
Moda Health Synergy Exclusive 5000 $1,037.15 $1,049.95 $1,062.91 $1,076.02
PPO Platinum Synergy Exclusive 250 $1,771.95 $1,793.82 $1,815.96 $1,838.37
PPO Synergy Exclusive 1000A $1,603.15 $1,622.94 $1,642.97 $1,663.25
Moda Health Oregon Standard Gold $1,735.73 $1,757.16 $1,778.84 $1,800.80
Moda Health Oregon Standard Silver $1,456.11 $1,474.08 $1,492.27 $1,510.69
Moda Health Oregon Standard Bronze $1,182.52 $1,197.11 $1,211.89 $1,226.84
RATE TABLES AND FACTORS: Geographic Average Rate
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2015
Geographic Average Rate
Area 7 - Employee + Child(ren)
Plan 2016 Q1 2016 Q2 2016 Q3 2016 Q4
PPO Platinum 250 $1,267.94 $1,283.58 $1,299.43 $1,315.46
PPO Platinum 500 $1,251.55 $1,267.00 $1,282.64 $1,298.47
PPO 500 $1,183.32 $1,197.92 $1,212.71 $1,227.67
PPO 1000A $1,149.90 $1,164.09 $1,178.46 $1,193.00
PPO 1000B $1,147.75 $1,161.92 $1,176.26 $1,190.78
PPO 1500 $1,119.32 $1,133.13 $1,147.12 $1,161.27
PPO 2500 $1,005.95 $1,018.37 $1,030.94 $1,043.66
PPO 3000 $987.07 $999.25 $1,011.58 $1,024.07
Value 1500 $1,004.98 $1,017.39 $1,029.94 $1,042.65
Value 2000 $970.28 $982.26 $994.38 $1,006.65
Value 2500 $944.39 $956.04 $967.84 $979.79
Value 3000 $921.33 $932.70 $944.21 $955.86
Value 3500 $900.31 $911.42 $922.67 $934.05
Value 5000 $851.24 $861.74 $872.38 $883.14
Moda Health Connexus Aspire 2000 $963.51 $975.40 $987.44 $999.63
Moda Health Connexus Aspire 2500 $935.60 $947.15 $958.84 $970.67
Moda Health Connexus Fundamental 3500 $815.83 $825.90 $836.10 $846.41
Moda Health Connexus Fundamental 5000 $755.05 $764.37 $773.81 $783.36
Moda Health Connexus HSA 1500 $1,022.39 $1,035.01 $1,047.79 $1,060.72
Moda Health Connexus HSA 2000 $977.01 $989.07 $1,001.27 $1,013.63
Moda Health Connexus HSA 2500 $940.33 $951.93 $963.68 $975.57
Moda Health Connexus HSA 3250 $827.76 $837.98 $848.32 $858.79
Moda Health Connexus Essence 5000 $756.80 $766.14 $775.59 $785.16
Moda Health Connexus Essence 6000 $752.22 $761.50 $770.90 $780.41
Moda Health Connexus Basic 6500 $753.94 $763.24 $772.66 $782.20
Moda Health Synergy Exclusive 2000 $860.01 $870.62 $881.37 $892.25
Moda Health Synergy Exclusive 5000 $673.24 $681.55 $689.96 $698.47
PPO Platinum Synergy Exclusive 250 $1,150.22 $1,164.41 $1,178.78 $1,193.33
PPO Synergy Exclusive 1000A $1,040.64 $1,053.49 $1,066.49 $1,079.65
Moda Health Oregon Standard Gold $1,126.70 $1,140.61 $1,154.69 $1,168.94
Moda Health Oregon Standard Silver $945.19 $956.86 $968.67 $980.62
Moda Health Oregon Standard Bronze $767.60 $777.07 $786.66 $796.37
Supporting Document Schedules Satisfied - Item: 4872 - Individual and Small Group Health Benefit Plan Rate FilingsComments:Attachment(s): Moda Small Group 2016 Product Standards.pdfItem Status:Status Date:
Satisfied - Item: 3894 Certification of ComplianceComments:Attachment(s): Moda SMGR 2016 Certificate of Compliance.pdfItem Status:Status Date:
Satisfied - Item: HBP - Actuarial Memorandum - SG and IndividualComments:
Attachment(s):SMGR Part III Rate Filing Documentation and Actuarial Memorandum.pdfActuarial Memorandum.pdfRisk Corridor Calculator.pdf
Item Status:Status Date:
Satisfied - Item: HBP -Exhibit 1: Development of Rate ChangeComments:Attachment(s): Exhibit 1.pdfItem Status:Status Date:
Satisfied - Item: HBP - Exhibit 2: Covered Benefit or Plan Design ChangesComments:Attachment(s): Exhibit 2.pdfItem Status:Status Date:
Satisfied - Item: HBP- Exhibit 3:Average Annual Rate ChangeComments:Attachment(s): Exhibit 3.pdf
SERFF Tracking #: ODSV-130056446 State Tracking #: ODSV-130056446 Company Tracking #: 2015-21-01-OR
State: Oregon Filing Company: Moda Health Plan, Inc.
TOI/Sub-TOI: H16G Group Health - Major Medical/H16G.003A Small Group Only - PPO
Product Name: Oregon Small Group Rates 2016
Project Name/Number: Oregon Small Group 2016 Rates/2015-21-01-OR
PDF Pipeline for SERFF Tracking Number ODSV-130056446 Generated 05/01/2015 05:42 PM
Item Status:Status Date:
Satisfied - Item: HBP - Exhibit 4: Trend Information and ProjectionComments:
Attachment(s): Exhibit 4.1.pdfExhibit 4.2.pdf
Item Status:Status Date:
Satisfied - Item: HBP - Exhibit 5: Statement of Administrative Expenses and PremiumComments:Attachment(s): Exhibit 5.pdfItem Status:Status Date:
Satisfied - Item: HBP - Exhibit 6: Plan RelativitiesComments:Attachment(s): Exhibit 6.pdfItem Status:Status Date:
Satisfied - Item: HBP - Appendix I: Insurer's Financial Position:Comments:
Attachment(s):2014 MHP Annual-Pages.pdf2014 MHP SHCE.pdfModa Health Small Group Appendix I.pdf
Item Status:Status Date:
Satisfied - Item: HBP - Appendix II: Cost Containment and Quality Improvement EffortsComments:Attachment(s): Moda Health Small Group Appendix II.pdfItem Status:Status Date:
Satisfied - Item: Standard Review QuestionsComments:
SERFF Tracking #: ODSV-130056446 State Tracking #: ODSV-130056446 Company Tracking #: 2015-21-01-OR
State: Oregon Filing Company: Moda Health Plan, Inc.
TOI/Sub-TOI: H16G Group Health - Major Medical/H16G.003A Small Group Only - PPO
Product Name: Oregon Small Group Rates 2016
Project Name/Number: Oregon Small Group 2016 Rates/2015-21-01-OR
PDF Pipeline for SERFF Tracking Number ODSV-130056446 Generated 05/01/2015 05:42 PM
Attachment(s): Standard Review Questions.pdfItem Status:Status Date:
Satisfied - Item: Unified Rate Review TemplateComments:Attachment(s): Unified_Rate_Review_Template v3m.pdfItem Status:Status Date:
Satisfied - Item: Standard Plan RatesComments:Attachment(s): 2016 Proposed Small Group Standard Plan Rates.pdfItem Status:Status Date:
Satisfied - Item: Additional ExhibitsComments:
Attachment(s):Development of Benefit Adjustments.pdfMarket Index Rates.pdfPlan Index Rate.pdfProjected Age Distribution.pdf
Item Status:Status Date:
SERFF Tracking #: ODSV-130056446 State Tracking #: ODSV-130056446 Company Tracking #: 2015-21-01-OR
State: Oregon Filing Company: Moda Health Plan, Inc.
TOI/Sub-TOI: H16G Group Health - Major Medical/H16G.003A Small Group Only - PPO
Product Name: Oregon Small Group Rates 2016
Project Name/Number: Oregon Small Group 2016 Rates/2015-21-01-OR
PDF Pipeline for SERFF Tracking Number ODSV-130056446 Generated 05/01/2015 05:42 PM
440-4872 (12/14 INS) 1
Department of Consumer & Business Services
Oregon Insurance Division – 5 P.O. Box 14480
350 Winter St. NE Salem, OR 97309-0405 Phone (503) 947-7983
Standards for Filing Individual and Small Group Health Benefit Plan Rates
This checklist must be submitted with your filing in compliance with OAR 836-010-0011(2). These standards are summaries, and review of the entire statute or rule may be necessary. Complete each item to confirm that diligent consideration has been given to each and is certified by the signature on the certification of compliance form. “Not applicable” can be used only if the item does not apply to the rates being filed. Not including required information may cause this filing to be considered incomplete and returned without review. These standards are subject to change as HHS releases more information. Insurer Name: Date: TOI (type of insurance): Sub-TOI:
H15I – Individual Health - Hospital/Surgical/Medical Expense H15I.001- Hospital/Surgical/Medical Expense H16G – Group Health Major Medical H16G.001A – Any size group – PPO
H16G.001B – Any size group – POS H16G.001C – Any size group – Other H16G.003A – Small Group only - PPO H16G.003B – Small Group only – PPO Basic H16G.003D – Small Group only – POS H16G.003E – Small Group only – POS Basic H16G.003G – Small Group only – Other
H16I – Individual Health – Major Medical H16I.005A – Individual – PPO H16I.005B – Individual – POS H16I.005C – Individual – Other Product Type:
HMO PPO EPO POS HSA HDHP FFS Other
440-4872 (12/14 INS) 2
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
SUBMISSION PACKAGE REQUIREMENTS
OAR 836-010-0011 Required forms are located on SERFF or on our Web site: http://insurance.oregon.gov/docs/serff/filing_requirements.html.
Paper filings: These items must be submitted with your filing for it to be accepted as complete:
NAIC transmittal form
Two self addressed stamped envelopes, one in which Insurance Division can return the approved filing
Complete copy of the filing on a CD, with each document as a separate PDF
Yes N/A
ORS 743.018 OAR 836-010-0011 (2)
If SERFF is not functioning, filing must be submitted by the deadline by one of the following methods:
Email [email protected]
CD rom (postmarked by due date)
Paper filing (postmarked by due date) The filing must be entered into SERFF at the earliest availability
Confirm
OAR 836-053-0473 (2)(m) Third party filer’s letter of authorization Yes N/A
OAR 836-053-0471 (2)(l) Certification of compliance form signed and dated by an authorized person
Confirm
OAR 836-010-0011(2) Product standards (this document) for rates with boxes checked. Confirm
OAR 836-010-0011(2) Naming convention of all electronic files consistent with the Product Standard Category (left column) attached to the appropriate section in SERFF
Confirm
ORS 731.296 (Grandfathered and Transitional plans only) Draft letter to consumer advising them of the rate change will be provided before the rate review is complete.
Yes N/A
GRANDFATHERED STATUS
Grandfathered Plans 45 CFR (A)(B) Part 147
Effective for plan years on or after 1/1/2014, filings for “Grandfathered” status health plans must be pooled separately from “Non-Grandfathered” status health plans. Each filing must stand alone.
Confirm
REVIEW REQUESTED ORS 742.003(1),
OAR 836-010-0011(3), ORS 743.767, OAR 836-010-0021(1)
The following are submitted in this filing for review (select one): 1. New rate filing 2. Rate change 3. Continued use of existing rates
The annual geographic average rate (GAR) filing is satisfied through the inclusion of GARs in the Rate Tables and Factors exhibit.
Yes No
440-4872 (12/14 INS) 3
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
FORM NUMBERS ORS 731.296 A list of policy form numbers to be listed on the Rate/Rule Schedule tab in SERFF.
Confirm
HEALTHCARE REFORM ELEMENTS
PPACA Public Law 111-148 CFR Title 45 Single Risk Pool CFR 45 (A)(B) Part 156 sub part 156.80 Grandfathered Plans CFR 45 (A)(B) Part 147 sub part 147.140 Age Banding CFR 45 (A)(B) Part 147 sub part 147.102(a)(1)(iii). Per Member Rating CFR 45 (A)(B) Part 147 sub part 147.102(c)(1). Composite Rating CFR 45 (A)(B) Part 147 sub part 147.102(c)(3). Tobacco Factors Composite Rating CFR 45 (A)(B) Part 147 sub part 147.102(a)(iv).
2015 Alignment of Individual Market
All ACA compliant products issued on or after January 1, 2014 may only provide coverage through December 31 of that year.
Rates and benefits for the same plan offered in and out of the Exchange must be identical
Single Pool Rating:
All associations (except student health plans available through a bona fide association) must be included in the base experience
Grandfathered plans:
Grandfathered plans are not subject to any of the new rating and benefit provisions effective in 2014
3 to 1 Age Banding Rating Restrictions:
Age factors will be standardized statewide and will be restricted to a 3 to 1 ratio The federal age factors will be used for small group and individual ACA compliant plans and individual Transitional plans
List bill (Individual ACA compliant filings):
All individual rates will be priced per member, with a maximum of 3 children under 21
Composite rating (Small Group ACA compliant filings):
Per-member build-up of rates is required to determine group aggregate premium based on census at time of quote
Standardized tier factors must be used for allocation of group aggregate to group members; changes from current tier factors must be revenue neutral
Standardized tier factors: Employee Only: 1.0; Employee + Spouse: 2.0; Employee + Child = 1.85; Family: 2.85 (note that children include all dependent children ages 0 to 25)
Tobacco Rating Factors (Individual ACA compliant plans):
Tobacco factors may not exceed 1.5
The age band ratio for smokers may not exceed 3 to 1.
Children under 18 may not be charged a tobacco load.
Yes N/A
440-4872 (12/14 INS) 4
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
HEALTHCARE REFORM ELEMENTS
Medical Loss Ratio CFR 45 (A)(B) Part 158 sub part B 158.210.
Federal MLR:
Rates may not be set such that the anticipated federal MLR is under 80%.
When determining reasonability of rates, Oregon does not recognize federal credibility standards in calculation of the Federal MLR
Yes N/A
Confirm
HEALTHCARE REFORM ELEMENTS
FEDERAL REGULATIONS Insurer Fee CFR 45 (A)(B) Part 156 sub part B 156.50. (De minimis) CFR 45 (A)(B) Part 156 sub part 156.140(a) (Actuarial Value) CFR 45 (A)(B) Part 156 sub part 156.135(a)
Fees and Assessments (General):
Fees must reflect an average total cost over the plan year Insurer’s Fee:
This fee is not considered a deduction for tax purposes
The unique tax implications should be added to margin, since they do not reflect explicit costs associated with the health benefit plans
Actuarial Value (AV) Calculator:
All metal tier plans, both inside and outside the exchange must meet the de minimis range (within 2%) for one of the 4 metal tiers: bronze, silver, gold, platinum
Catastrophic plans do not have an AV requirement
Actuarial value is determined based on Essential Health Benefits only
Where appropriate, the AV calculator should determine the objective differences between plans
Where the AV calculator is not appropriate, methodology must be consistent across all plans
The AV calculator is not required for determining pricing relativities
Yes N/A
Confirm
HEALTHCARE REFORM ELEMENTS The “3 Rs”
FEDERAL REGULATIONS Public Law 111-148
(Federal Reinsurance) CFR 45 (A)(B) Part 153 sub part (C) 153.405
(State Reinsurance) CFR 45 (A)(B) Part 153 sub part (C) 153.210
Reinsurance (Federal and State Supplemental):
Use parameters and assessments provided by federal and state regulators
Claims adjustments on individual filings must be consistent with average market risk
Embedded pediatric dental qualifies for reinsurance
Stand alone dental does not qualify for reinsurance
Reinsurance payments in the base period experience are inappropriate adjustments for projecting future claims
Yes N/A
Confirm
440-4872 (12/14 INS) 5
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
(Federal Risk Adjustment) CFR 45 (A)(B) Part 153 sub part(s) (D) 153.610 (Risk Corridor) CFR 45 (A)(B) Part 153 sub part(s) (F) 153.500
Risk Adjustment
Carrier projected claims must be adjusted to reflect average experience for the market
Risk adjustment payments in the base period experience are appropriate adjustments for projecting future claims
Risk Corridor:
Health benefit plans should not be priced to anticipate an impact of the risk corridor program
Any findings regarding risk corridor payments will result in adjustments to the approved rates, consistent with the company’s business plan.
Confirm
FILING DESCRIPTION
OAR 836-053-0473 (2)(a) The document labeled FILING DESCRIPTION is submitted in the form of a cover letter summarizing the reasons for rate change and includes: Filing Information:
Description of the benefit plan(s) Prior Filing Information:
Most recent prior SERFF filing number(s) and approval date(s)
Current HIOS Submission Tracking ID
Comparison of actual and expected results, including the following:
o Projected claims, admin and profit percentages from the prior filing with the rating period that most closely matches the experience period of this filing (Rate Filing Summary, “to” percentages)
o Actual claims, admin, and profit percentages from this filing (Rate Filing Summary, “from” percentages
Quantify primary differences between actual and expected results.
Yes N/A
440-4872 (12/14 INS) 6
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
FILING DESCRIPTION
OAR 836-053-0473 (2)(a) Rate Change Summary:
Type of rate change request: annual, quarterly, other (explain)
Identify the intended duration of rate change request (typically 12 months)
Effective dates of all rate change requests, if not annual
Confirm average rate change, minimum and maximum rate impact (do not include any impact from demographic shifts)
Briefly list key changes in the filing: o Rating factors o New and discontinued plans o Significant benefit changes
Filing Impact:
Identify the total members, subscribers, and groups affected by this rate filing and source of the counts, typically a snapshot of the most recent enrollment (e.g. members effective July 1,2013)
Identify how membership is projected to change between the experience period and rating period, as appropriate:
o Anticipated membership on the effective date of the filing
o Estimated average membership for the filing period o Projected membership for the end of the rating period, if
the proposed premium rate is approved as filed
Yes N/A
440-4872 (12/14 INS) 7
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
RATE TABLES AND FACTORS
OAR 836-053-0473 (2)(b) A document labeled RATE TABLES AND FACTORS that includes: Introduction:
Indicate whether the rate changes are the same for all policies
If the rate change is not uniform for all policies, clear explanation of how the rate changes apply to different policies
o Identify the rate factors that are changing o Refer to table demonstrating a meaningful distribution
of rate changes(Exhibit 4)
Clear instructions, including a calculation, so that any member or group can determine the rates for each benefit plan, each age bracket, each geographic area, each rate tier, and all other variables used to determine rates
Cross-reference supporting exhibits: Benefit changes (Exhibit 2), Plan Relativities(Exhibit 6)
Identify any rating factors that are not used to develop rates Rate Tables:
Rate tables containing, at a minimum, the base rates for each available plan
Geographic Average Rate (GAR) table containing family type, geographic area, and average of highest and lowest rates resulting from the application of other rating factors
(Small Group only) Rates may vary quarterly based on trend Rate Factors:
Tables for all factors not already included in the rate tables: o Age o Tobacco o Family/Rating Tier o Geographic Area
The following factors are no longer allowed for plans issued on or after 2014
o Contribution o Participation o Wellness program participation o Duration of in-force coverage o Experience adjustments
Identify each rate factor that is changing as a result of this filing o Include the previous rate factors o Calculate the rate impact for each change
Yes N/A
440-4872 (12/14 INS) 8
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
ACTUARIAL MEMORANDUM
OAR 836-053-0473 (2)(c) This is the primary supporting document for the filing and should satisfy both state and federal memorandum requirements. All other supporting documentation should be provided as Exhibits to accompany the memorandum. A document labeled ACTUARIAL MEMORANDUM that includes: Company’s Identifying Information:
Company Legal Name
State: Oregon
HIOS Issuer ID
Market: Individual or Small Group
Effective Date Company Contact Information:
Name and contact information of the filer
Name and contact information for secondary contact Introduction:
Identify the benefit plans impacted by the rate change request
Overview of the filing o Identify the base rate increase, as calculated in the
Development of Rate Change exhibit. (Exhibit 1) o Quantify the impact of all rate factor changes and
whether those changes are revenue neutral, as identified in the Rate Table and Factors exhibit
o Quantify any impacts of the changes to the benefit plan, as described in the Covered Benefit Design Changes (Exhibit 2)
o Demonstrate the calculation of the average annual rate change (Exhibit 3)
Fill out and include Summary of Filed Rating Assumptions (see template) in Actuarial Memorandum.
Yes N/A
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GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
ACTUARIAL MEMORANDUM
OAR 836-053-0473 (2)(c) Discussion:
Description of any changes in rating methodology, supported by sufficient detail to permit the division to evaluate the effect on rates
Discussion of all assumptions and calculations pertinent to the proposed rate
o (Small Group only) If rates vary more frequently than annually, provided information to justify such variation in rates
o Provide justification and need for assumptions, identifying relevant sources if the assumption is data driven
o Tie together the administrative costs presented in the Development of Rate Change (Exhibit 1) and Statement of Administrative Expenses (Exhibit 5)
o Consideration of credibility of calculations and data
Demonstrate how projected claims on Exhibit 1 tie to the Index Rate shown on the URRT.
Demonstrate starting with the Index rate how the rates for each plan are calculated utilizing network/area, pricing relativity, age factors and admin only.
Demonstrate that the anticipated Risk Corridor payments/receipts are zero.
We expect use of HHS guidance or generally accepted actuarial principles
Mandates:
Identify all mandated state and federal changes to the filing including, but not limited to:
o New benefits (EHB), including effective dates and pricing methodology
o New fees, including implementation and justification o “3 R’s”: Reinsurance, Risk Adjustment, Risk Corridor o Exchange impacts: fees, reallocation impacts o Impact of cost sharing subsidies on plan pricing o Impact of market changes: Transitional and Small
Group Expansion o Guaranteed issue
Yes N/A
440-4872 (12/14 INS) 10
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
ACTUARIAL MEMORANDUM
OAR 836-053-0473 (2)(c) Certification:
Identify that the filing is consistent with the company’s internal business plans
Confirm all calculations are based on generally accepted actuarial rating principles for rating blocks of business
Signature of and date that a qualified actuary reviewed the rate filing
Contact information of peer review actuary (Per ASOP #8, definition 2.2, the peer review actuary is also a filing actuary, but Oregon is not requesting a signature from that actuary)
Confirm
DEVELOPMENT OF RATE CHANGE OR BASE RATE (Exhibit 1)
OAR 836-053-0473 (2)(d) Please refer to provided template. A document labeled DEVELOPMENT OF RATE CHANGE OR BASE RATE including :
Detailed calculation of how the proposed rate or rate change was determined:
o Base period data appropriate for risk pool o All adjustments from base period claims to projected
claims o Addition of all expenses and margin to costs o All adjustments from base period premiums to current
premiums o Calculation of final required premium and rate increase o Loss ratio demonstrations o Federal MLR calculation
Sufficient detail to allow division to review and determine reasonability and actuarial soundness of assumptions, calculations, and estimates
o Distinguish between data, assumptions, and calculations
o Provide calculated aggregate and PMPM values o Provide all formulas
Cross-reference supporting exhibits: Trend (Exhibit 4), Admin (Exhibit 5)
Confirm
440-4872 (12/14 INS) 11
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
COVERED BENEFIT OR PLAN DESIGN CHANGES (Exhibit 2)
OAR 836-053-0473 (2)(e) A document labeled COVERED BENEFIT OR PLAN DESIGN CHANGES that:
Explains benefit and administrative changes with rating impact, including:
o Covered benefit level changes o Member cost-sharing changes o Elimination of plans o Implementation of new plan designs o Provider network changes o New utilization or prior authorization programs o Changes to eligibility requirements o Changes to exclusions o Any other change in the plan offerings that impacts
costs or coverage provided o Complete description of plan changes made due to
federal healthcare reform including the total premium percentage increase attributed to these changes and a specific breakdown that shows the benefit change and percentage of rate increase for each benefit
o Percentage rating impact for each item, as well as the total impact
o Members impacted by change
Yes N/A
SUMMARY OF RATE INCREASES (Exhibit 3)
OAR 836-053-0473 (2)(f) Please refer to provided template A document labeled SUMMARY OF RATE INCREASES including:
Table showing the following for all effective dates (quarterly for small group, for example):
o Effective date o Membership count o Requested average annual rate change o Minimum annual rate impact o Maximum annual rate impact o Rate change from prior effective date (if not annual)
If applicable, a table showing a meaningful distribution of rate increases across the entire pool.
Estimate the contributing factors to the rate increase: trend, rating changes, margin changes, benefit changes, other
Yes N/A
440-4872 (12/14 INS) 12
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
TREND INFORMATION AND PROJECTION (Exhibit 4)
OAR 836-053-0473 (2)(g) A document labeled TREND INFORMATION AND PROJECTION that includes:
Presentation of all significant variables of trend by these categories, if used.
o Utilization trend o Cost trends by major service category, with a
distribution of claims Hospital Physician Pharmacy Other
o Deductible leveraging, if not reflected in the Plan Relativity exhibit
o Technology/intensity o Other factors (please specify)
Cost trends should be supported by known contractual increases in hospital and professional agreements. Support needs to be quantitative and specific.
Quantify savings from the reduction of “bad debt” due to ACA coverage expansion. Show where this savings is reflected in the trend and/or rate development.
Mathematical development of the pricing trend used in the Development of Rate Change
Historical monthly average allowed claim costs for at least the immediately preceding three years when applicable
o This information based on allocated costs if the insurer’s structure doesn’t include claims cost
o Both un-normalized and normalized monthly average claim costs for same period. Claims should be normalized for applicable premium rating factors
o Explanation of normalization method used and discussion of impact on trend
Notes:
Carriers may not include a trend margin, or fluctuation factor in the development of trend.
Effective 1/1/2015, underwriting wear-off no longer applies to individual health plans.
Yes N/A
440-4872 (12/14 INS) 13
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
STATEMENT OF ADMINISTRATIVE EXPENSES (Exhibit 5)
OAR 836-053-0473 (2)(h) Please refer to provided template. A document labeled STATEMENT OF ADMINISTRATIVE EXPENSES including:
A chart illustrating a breakdown of the insurer’s administrative expenses including:
o 5 years of historical data tying to financials o Projected expenses for the filing effective date
A detailed breakdown of fees and taxes
Target margin for the projected period
Total retention for the base period and projected period
Reports retention on a percentage of premium basis broken down by operating expenses, commissions, state assessments and tax, and profit
Reports retention on a per member per month (PMPM) basis
Identify fixed or variable expenses (or a combination of both)
Reflect actual assessment of fees (Reinsurance assessment, ACA insurer fee, Exchange fees, other). The cost charge to the premium must cover the cost for that period, and not a projection of expected future fees.
A description in plain language of the contributing costs of premium retention
o Explanation of the basis for any proposed premium rate increase or decrease related to changes in the administrative expenses
o Explanation of how administrative expenses for the filed line of business are allocated
o Includes a description of retention – “retention” means the amount to be retained by the insurer to cover all of the insurer’s non-claim costs including expected profit or contribution to surplus for a nonprofit entity
Confirm
PLAN RELATIVITIES (Exhibit 6)
OAR 836-053-0473 (2)(i) Please refer to provided template. A document labeled PLAN RELATIVITIES that:
Explains the presentation of rates for each benefit plan
Explains the methodology used to develop the benefit plan relativities
Confirm
440-4872 (12/14 INS) 14
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
PLAN RELATIVITIES (Exhibit 6)
OAR 836-053-0473 (2)(i)
CCIIO has provided an Actuarial Value (AV) calculator to be used to determine the metal tier/level of benefits for each plan.
If the AV calculator was not used to determine the metal level for any plan, a supporting exhibit must be included explaining the methodology used to develop the AV.
Most, but not all benefit differences, are expected to be priced based on the AV calculator. If the plan relativities differ from the AV (for example, network differences), identify the factors resulting in the difference.
Demonstrates the comparison and reasonableness of benefits and costs between plans
If a plan includes benefit substitutions that are over 1% of total claims, then data must provide data supporting the calculation.
Compares plan relativities to the last filing, when relativities change, including deductible leveraging
This exhibit should be identical between the plan filing and the rate filing.
The plan name,
issuer plan identification number (HIOS plan ID),
metal level or catastrophic plan,
List of Geographic areas that plan will be offered (1-7)
whether the plan will be sold: o inside the Exchange only, (in) o outside the Exchange only. (out) o both inside and outside the Exchange, or (both)
Whether or not pediatric dental is embedded (yes/no)
INSURER’S FINANCIAL POSITION (Appendix I)
OAR 836-053-0473 (2)(j) A document labeled INSURER’S FINANCIAL POSITION that includes:
Information about the company’s financial position including but not limited to profitability, surplus, reserves, and investment earnings
Discussion of whether the proposed change in the premium rate is necessary to maintain the company’s solvency or to maintain rate stability and prevent excessive rate increases for the line of business in the future
Yes N/A
440-4872 (12/14 INS) 15
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
INSURER’S FINANCIAL POSITION (Appendix I)
OAR 836-053-0473 (2)(j) Although public documents filed with the department as part of
the annual statement or other requisite filings may be referenced in this item, information about the company’s profitability, surplus, reserves, and investment earnings must still be included in the Insurer’s Financial Position document; if such references are made, include copies of the supporting documents with this filing
Specifically provide the following pages from the Annual Statement:
o Assets, Liabilities, and Revenue (pages 2-4) o Supplemental Healthcare Exhibit (Part 1, both for
business in the State of Oregon and the grant total pages)
The last 5 years of RBC and a statement regarding the need for surplus
Yes N/A
COST CONTAINMENT AND QUALITY IMPROVEMENT EFFORTS (Appendix II)
OAR 836-053-0473 (2)(k) A document labeled COST CONTAINMENT AND QUALITY IMPROVEMENT EFFORTS that:
Identifies new health care cost containment efforts and quality improvement efforts since the last rate filing for the same category of health benefit plan, with estimated savings for the projection period
Describes significant changes to existing health care cost containment initiatives and quality improvement efforts, with estimated savings for the projection period, savings realized over the prior experience period, and a description of how the company is measuring the impact of its initiatives
Includes information about whether the cost containment initiatives reduce costs by eliminating waste, improving efficiency, by improving health outcomes through incentives, or by elimination or reduction of covered services or reduction in the fees paid to providers for services
Confirm
STANDARD REVIEW QUESTIONS (Appendix III)
Please refer to provided template. A document labeled STANDARD REVIEW QUESTIONS that answers the questions provided in the template.
Confirm
440-4872 (12/14 INS) 16
GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS Category Reference Description of review standards requirements Answers Page #
COST AND QUALITY METRICS
OREGON HEALTH POLICY BOARD CFR 45 (A)(B) Part 158 sub part 158.150 ORS 743.018 (5)(f)
Fill out the following information on the provided template. Provide, for public review, the following metrics, as recommended by the Oregon Health Policy Board: Recommendation to Governor Kitzhaber
Utilization per 1,000 members and per member per month costs for
o Inpatient Admissions/Days o Outpatient Visits o Emergency Department Visits o Primary Care Visits o Specialty Care Visits o Rx Scripts o Other Claims
Quality metrics for CY2013, as reported to the following entities o NCQA:
Breast Cancer Screening Comprehensive Diabetes Care: Hemoglobin
A1c (HbA1c) Testing o CCO Metrics:
Follow-Up After Hospitalization for Mental Illness*
Developmental Screening in the First Three Years of Life*
CAHPS: Access to Care*
Confirm
HIOS URRT SUBMISSION
CFR Part 154.200 CFR Part 156.80
All ACA Compliant plans (even off exchange only plans) must be submitted on HIOS when this rate filing is submitted via SERFF.
The filing tracking number should be the Rate Filing SERFF Tracking number.
The URRT must be updated after the rate filing is approved.
Yes N/A
Confirm
440-3894(rev. 3/02/ins)
Department of Consumer & Business Services Oregon Insurance Division - 5
350 Winter St. NE, Rm. 440 Salem, Oregon 97301-3883
Phone (503) 947-7983
CERTIFICATE OF COMPLIANCE
I, the undersigned authorized filer, hereby certify that the filing submitted complies with the applicable Oregon laws, Oregon Administrative Rules, Oregon Insurance Bulletins and applicable filing requirements and product standards set forth on the Insurance Division’s web site and that the filing is not false or misleading in any material respect. I further certify that I am authorized to sign and submit this certificate on behalf of the Company identified below (hereinafter Company). I, the undersigned authorized officer, a duly authorized officer of Company, certify that the undersigned authorized filer is authorized to certify on behalf of Company that this filing complies with the Oregon laws, Oregon Administrative Rules, Oregon Insurance Bulletins and applicable filing requirements and product standards set forth on the Insurance Division’s web site and that the filing is not false or misleading in any material respect. I understand that the Oregon Insurance Division will rely on this certificate and, should it be determined that this filing is materially false or misleading, appropriate corrective and disciplinary action including monetary penalties, as authorized by law, will be taken by the Oregon Insurance Division against the Company. Moda Health Plan, Inc 2015-21-01-OR Name of Company Company’s filing number or the primary form number
for the filing 4/30/2015 Signature of authorized filer Date Jennifer Halttunen, ASA, MAAA 601 SW Second Ave Print name of authorized filer Address of Company or authorized filer Supervisor, Pooled Products and Actuarial Portland, OR 97204-3156 Title City State ZIP 503-265-5733 [email protected] Direct telephone number of authorized filer E-mail address of authorized filer 800-852-5195 503-243-3949 Toll free or collect phone number Fax number of authorized filer 4/30/2015 Signature of authorized officer and title Date Kraig E. Anderson, FSA, MAAA Senior VP, Actuarial and Underwriting Print name of authorized officer and title
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
1 | P a g e
General Information
Company Identifying Information
Company Legal Name: Moda Health Plan, Inc.
State: Oregon
HIOS Issuer ID: 39424
Market: Small Group
Effective Date: January 1, 2016
Company Contact Information
Primary Contact
Name: Henry Stender
Telephone Number: 503-228-6554 x1032
Email Address: [email protected]
Secondary Contact
Name: Jennifer Halttunen, ASA, MAAA
Telephone Number: 503-265-5733
Email Address: [email protected]
Proposed Rate Increase
The average rate increase for all members is 4.2%. The proposed rate increase varies by
product, plan, and rating area and rates in the filing vary by plan, age, and geographic area. The
federal age factor is used for age rating and the plan rating is detailed in the Plan Adjusted Index
Rate section. Geographic factors are shown in the Geographic Calibration section. The average
rate increase was calculated by comparing the weighted average premium for current members
on the 2015 plans and rates to the weighted average premium for current members on the 2016
plans and rates.
2015 $396.85
2016 $413.60
Rate Change 4.2%
The only adjustments included in the filed rate change is to adjustment from Moda experience
in 2014 to the market experience in 2014 as well as a benefit adjustment applied to the
transitional policies included in the experience period. There is no adjustment for the expansion
of the small group market from 1-50 to 1-100. The adjustments are discussed in more detail
below. The rates also include cost and utilization trends and changes in taxes and fees.
Differences in the rate change between products and plans are driven by an update to projected
paid to allowed ratios for renewing plans and mapping members from discontinued plans to
new plans. All plans impacted and member mapping is shown below. Variations in rate increase
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
2 | P a g e
by area are the result of implementing new area factors. The change in area factors is a revenue
neutral change.
2015 Plan 2016 Plan
PPO 500 PPO 500
PPO 1000A PPO 1000A
PPO 1000B PPO 1000B
PPO 1500 PPO 1500
PPO 2000 PPO 2500
PPO 3000 PPO 3000
Value 1500 Value 1500
Value 2000 Value 2000
Value 2500 Value 2500
Value 3000 Value 3000
Value 3500 Value 3500
Beneficial 1500 Moda Health Connexus Aspire 2000
Beneficial 2000 Moda Health Connexus Aspire 2000
Focus 2000 Moda Health Connexus Aspire 2000
Beneficial 3500 Moda Health Connexus Fundamental 3500
Beneficial 4000 Moda Health Connexus Fundamental 3500
Beneficial 4500 Moda Health Connexus Essence 5000
Beneficial 5000 Moda Health Connexus Essence 5000
Focus 5000 Moda Health Connexus Essence 5000
HSA 1500 Moda Health Connexus HSA 1500
HSA 2000 Moda Health Connexus HSA 2000
HSA 3000 Moda Health Connexus HSA 2500
HSA 4000 Moda Health Connexus HSA 3250
Moda Health Oregon Standard Gold Moda Health Oregon Standard Gold
Moda Health Oregon Standard Silver Moda Health Oregon Standard Silver
Moda Health Oregon Standard Bronze Moda Health Oregon Standard Bronze
Experience Period Premium and Claims
Experience Period
Market: Oregon Small Group Medical and Prescription Drug plans
Incurred dates: January 1 through December 31, 2014
Paid through date: March 31, 2015
Premiums (net of MLR Rebate) in Experience Period
Earned premiums: $57,940,496
Member Months: 158,254
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
3 | P a g e
MLR rebates refunded: $0
Anticipated MLR rebates: No MLR rebates are anticipated
Allowed and Incurred Claims Incurred During the Experience Period
Incurred paid claims: $42,402,514
Completed incurred paid claims: $43,080,384
Incurred allowed claims: $57,257,471
Completed incurred allowed claims: $58,126,655
Incurred but not paid claims: $677,870
• The experience period contains both single risk pool compliant and non-single risk pool
compliant plans. The only adjustment applies to the non-single risk pool compliant plans
is to account for EHBs that were not covered in the experience period.
• Experience for groups size 51-100 was not included in the experience period per the
2016 Unified Rate Review Instructions.
• Paid and allowed claims come directly from issuer’s claim records.
• IBNR is estimated monthly by the actuarial department and is modeled at the reserve
cell level. Key features distinguishing reserve cells include payer type (Medicare or
Commercial), state, funding type, and segment (group or individual business). The data
used in this analysis is reconciled to other financial reports to ensure validity. The
starting point for the actuarial analysis are completion factors produced by a proprietary
model using historical data. Because the model does not take into account such
important factors as payment cycles, changes in processing speed, or changes in claims
volume, the actuaries generally use the Bornhuetter-Ferguson (BF) method to produce
modified completion factors for recent months. The method for each reserve cell is set
ahead of time unless a one-off issue arises that makes this method inappropriate. The
actuaries then review the estimates for reasonableness and make adjustments using
actuarial judgment. This requires knowledge of changes in internal business practices,
other internal variables, and various calculated measures.
Benefit Categories
Claims are categorized using claim level service code and provider information to the categories
as specified in the 2016 Unified Rate Review Instructions.
Projection Factors
Changes in the Morbidity of the Population Insured: The 7.3% adjustment for the change
in the morbidity of the insured population adjusts from the morbidity of insured population in
the experience period to the morbidity of the 2014 Oregon Small Group market. Both Moda and
market factors were calculated using results from the Wakely National Simulation for all factors
used in the left side of the HHS risk transfer formula.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
4 | P a g e
The transfer formula compares the difference in actual “morbidity results” between an issuer
and market with the difference in allowable rating factors, adjustment is meant to adjust the
actual experience of the issuer to the market level. Following this reasoning, we have used the
following calculation to compare Moda experience to Market experience:
����� � ��� � �� �����∑ �� �� ����� � ��� � ��� �������
11.1361.218 � 1.073
The 2014 Moda Health results from the full experience period (January through December) is
used as the base factor. This was compared to the completed 2014 market level results. Market
level results were completed using the assumption that all members were enrolled for the
duration of the year. This is consistent with the assumption that members will be continually
enrolled in future years.
Moving from 2014 to 2016, we do not project a change in the market morbidity factor despite
the expansion of small group from 1-50 to 1-100. Since Oregon is allowed transitional policies
for both 1-50 and 51-100 through October 2016, only the groups that would benefit from the
change will move into the market. Those with better risk (and subsequently lower rates
currently), will renew as transitional and/or early renew prior to October 2016. Overall the 51-
100 market has a lower morbidity factor that the 1-50 market. Considering the above selection,
we project the average morbidity of the groups entering the 2016 Small Group market will be
substantially equal to the 2014 market morbidity factor.
Where: %& � Transferforissuer/ 01222 � StateAveragePremium 0:;<& � Issuer/′splanliabilityriskscore EFG& � Issuer/′sinduceddemandfactor I;G& � Issuer/′sallowableratingfactor IK& � Issuer/′smetallevelactuarialvalue LMG& � Issuer/′sgeographiccostfactor 1& � Issuer/′sshareofStateenrollment, andthedenominatorissummed acrossallissuersintheriskpoolinthemarket + state
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
5 | P a g e
Changes in Benefits: The only adjustment for benefits is to account for plans that did not
include prescription drug coverage and pediatric vision coverage in the experience period. The
detail for this calculation is in the Development of Benefit Adjustments Exhibit. The total impact
is 0.8%.
Changes in Demographics: An explicit adjustment for changes in demographics has not been
included in this filing. The analysis to adjust to the overall market morbidity includes impacts of
the demographics of both the experience data as well as the projected population in the PLRS
comparison. Including an additional adjustment would be redundant.
Other Adjustments: There are no other adjustments included in the filing.
Trend Factors (cost/utilization): [Development of Trend] Medical cost and utilization trends
are developed from Oregon Commercial group claims. The cost trends have been reviewed for
consistency with recent and anticipated changes in reimbursement rates and points of service.
Moda implements the same medical management techniques for both individual and group
segments corporately; so utilization trends are not expected to vary between these segments.
The annualized 2-year trend (over the last 2 years) is used for the utilization trend projections
for each of the medical service categories. The block of experience used in the analysis has
approximately 48,000 lives.
The Pharmacy cost trend is based on historic cost trends in Moda's Commercial pharmacy
network. The cost trends are broken out by drug type - Specialty, Traditional Generics, and
Traditional Brand. The annualized 2-year trend is used for the Specialty cost trend. Since the cost
data for Traditional drug spending is affected by a network price change starting in mid-2012,
the 2-year annualized trend is not used for traditional drugs. Instead the 1-year 2014/2013 trend
is used as the cost trend for traditional drugs. Traditional and Specialty cost trends are blended
together using current and projected spend levels to get the overall rx cost trend.
The Pharmacy utilization trend is also based on claims and enrollment from Commercial groups.
Moda Health uses the same utilization management techniques (formulary, prior authorization
programs) for group and individual segments corporately. Utilization is also broken out by drug
type - Specialty, Traditional Generics, and Traditional Brand. Annualized 2-year trends are used
to project the utilizations trends in each drug type.
Credibility Manual Rate Development
No manual rates were used.
Credibility of Experience
Due to the size of the block in the experience period, no credibility adjustments were used for
developing rates. Credibility of the medical experience period has been determined based on
the Medicare credibility formula:
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
6 | P a g e
� �P ��24,000
100% < P158,25424,000
This formula was ultimately chosen as it is it is a published and documented formula. The
formula was developed primarily for use in Medicare Advantage rate filings, which generally
have higher claims volume than a full commercial market. Given the margin by which the
minimum threshold for full credibility is exceeded, however, the difference in claims volume is
more than adequately compensated for.
Paid to Allowed Ratio
The 2014 Milliman Managed Care Rating Model (MCRM) was used as the basis to develop
expected allowed and paid claims for the varying cost sharing designs. Utilization adjustments
included in the model reflect the effect of cost sharing and benefit design. The MCRM was
calibrated to reflect cost and utilization experience of commercial business for Oregon. The
calibrated Rating Model, when populated with a benefit design, produces both projected
allowed and paid claims PMPM for benefit design. The model was run for each of the Moda
Health medical and pharmacy benefit designs.
Paid amounts produced in the MCRM model were adjusted for deductible leveraging using
Milliman factors.
Plan Name
Projected
Membership
Projected
Allowed
Projected
Paid
Deductible
Leveraging
Factor
Plan
Specific
Paid to
Allowed
PPO Platinum 250 145 $448.71 $416.01 1.006 93.2%
PPO Platinum 500 145 $448.71 $409.86 1.008 92.0%
PPO 500 2,895 $442.69 $382.31 1.008 87.0%
PPO 1000A 2,316 $442.69 $370.46 1.010 84.6%
PPO 1000B 1,737 $441.27 $368.58 1.010 84.4%
PPO 1500 2,200 $442.69 $359.93 1.012 82.3%
PPO 2500 2,605 $433.29 $315.42 1.016 74.0%
PPO 3000 869 $433.29 $309.50 1.016 72.6%
PPO 3000 (Portland) 579 $433.29 $309.50 1.016 72.6%
Value 1500 1,158 $438.91 $320.41 1.012 73.9%
Value 2000 1,447 $438.91 $308.76 1.014 71.4%
Value 2000 (Rose City) 58 $412.21 $286.43 1.014 70.5%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
7 | P a g e
Value 2500 579 $438.91 $299.96 1.016 69.4%
Value 3000 1,737 $438.91 $292.63 1.016 67.8%
Value 3500 290 $438.91 $285.96 1.016 66.2%
Value 5000 290 $438.91 $268.85 1.022 62.6%
Moda Health Connexus
Aspire 2000 2,026 $439.94 $307.33 1.014 70.9%
Moda Health Connexus
Aspire 2500 579 $439.94 $297.86 1.016 68.8%
Moda Health Connexus
Fundamental 3500 1,158 $446.16 $263.40 1.016 60.0%
Moda Health Connexus
Fundamental 5000 145 $446.16 $242.41 1.022 55.5%
Moda Health Connexus
HSA 1500 290 $448.00 $332.71 1.012 75.2%
Moda Health Connexus
HSA 2000 290 $448.00 $317.33 1.014 71.8%
Moda Health Connexus
HSA 2500 290 $448.00 $304.85 1.016 69.1%
Moda Health Connexus
HSA 3250 290 $446.16 $267.25 1.016 60.9%
Moda Health Connexus
Essence 5000 869 $442.98 $241.24 1.022 55.7%
Moda Health Rose City
Essence 5000 58 $416.28 $222.74 1.022 54.7%
Moda Health Connexus
Essence 6000 290 $442.98 $239.78 1.022 55.3%
Moda Health Connexus
Basic 6500 145 $446.16 $242.05 1.022 55.4%
Moda Health Connexus
Basic 6500 145 $446.16 $242.05 1.022 55.4%
Moda Health Synergy
Exclusive 2000 145 $408.82 $279.97 1.014 69.5%
Moda Health Summit
Exclusive 2000 145 $400.26 $273.31 1.014 69.3%
Moda Health Synergy
Exclusive 5000 145 $412.86 $219.67 1.022 54.4%
Moda Health Summit
Exclusive 5000 145 $404.22 $213.97 1.022 54.1%
PPO Platinum Synergy
Exclusive 250 145 $418.62 $386.68 1.006 92.9%
PPO Platinum Summit
Exclusive 250 145 $410.35 $378.72 1.006 92.8%
PPO Synergy Exclusive
1000A 145 $412.87 $343.41 1.010 84.0%
PPO Summit Exclusive 145 $404.60 $336.11 1.010 83.9%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
8 | P a g e
1000A
Moda Health Oregon
Standard Gold 579 $446.09 $365.78 1.010 82.9%
Moda Health Oregon
Standard Silver 1,447 $441.79 $302.18 1.016 69.5%
Moda Health Oregon
Standard Bronze 145 $446.16 $246.44 1.022 56.4%
Risk Adjustment and Reinsurance
Experience Period Risk Adjustment and Reinsurance Adjustment PMPM:
For the experience period, the overall Risk Adjustment PMPM was estimated using the results of
the Wakely National Simulation for January through December and the HHS risk transfer
formula. The estimated risk adjustment payable is $3.73 PMPM for 2014.
Reinsurance does not apply to the Small Group market.
Projected Risk Adjustments PMPM
Moda Health has developed the rates for this risk pool assuming the projected insured
population morbidity is equivalent to the market average morbidity. No risk adjustments are
projected, only the Risk Adjustment user fee is included in this section of the URRT. Below is the
development of the market wide adjustment for Risk Adjustment in the development of the
Market Average Index Rate.
Risk Adjustment
(A) Risk Adjustment Program Fee, PMPM $0.15
(B) Projected Risk Adjustment recoveries/payments $0.00
(C) Recoveries net of premium, PMPM [B-A] -$0.15
(D) Paid to Allowed Ratio 74.5%
(E) Risk Adjustment (market-wide) [C/D] -$0.20
Projected ACA Reinsurance Recoveries Net of Reinsurance Premium (Individual
Market Only)
Below is the development of the market wide adjustment for the Reinsurance assessment in the
development of the Market Average Index Rate [Development of Market Adjusted Index Rate].
Federal Reinsurance
(A) Federal Reinsurance Program Premium -$2.25
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
9 | P a g e
(B) Recoveries net of Premium $0.00
(C) Paid to Allowed Ratio 74.5%
(D) Program Adjustment (market-wide) [B/C] -$3.02
Non-Benefit Expenses and Profit & Risk
Administrative Expense Load
[Exhibit 5] Administrative expenses are allocated based on total enrollment, with individual and
small group lines of business receiving higher weights than large group to account for the higher
costs of administering the policy versus a large group policy. The projected expenses for 2016
are $39.55 PMPM. Commissions are paid at 4.0% of premium and utilization of agents is
assumed to be 100%.
Profit (or Contribution to Surplus) & Risk Margin
Moda Health has built in a 2.5% margin and contribution to reserves, consistent with corporate
practice. In order to maintain solvency and adequate risk based capital levels, we believe it is
prudent for us to make a reasonable contribution to capital as we grow in the Oregon market. A
margin contribution of 2.5% of premium is reasonable and ensures that we are able to meet our
future financial obligations to our policyholders.
Taxes and Fees
Federal transitional reinsurance program and risk adjustment fees have not been included in
this section.
• Moda’s health insurer fee for 2016 was estimated from the ground up using internally
forecasted 2015 premium, the total national assessment of $11,300,000,000, and
estimated 2015 national premium base per an updated study from Oliver Wyman. To
arrive at Moda’s share of the assessment, the first $25,000,000 in premium and 50% of
the next $25,000,000 in premium was excluded as prescribed by law, and then divided
by the estimated national premium base. Moda’s total payable amount was then
calculated by multiplying the national assessment by Moda’s share of the national
assessment. To calculate the amount that must be collected, this amount was then
divided by .58 to account for 35% federal tax and 7% state tax. This final figure was
divided by internally forecasted 2016 premium to arrive at the percent of premium
charged to each policy in 2016.
• The PCORI fee is set by the Federal government.
PMPM % of premium
ACA issuer’s fee 3.5%
PCORI $0.20
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
10 | P a g e
• The Exchange User fee for Oregon is $9.66 PMPM. The assessment for members
enrolled through and exchange must be charged consistently for the inside and outside
market plans. Moda Health has estimated that 5% of the enrollment will come through
an exchange in 2016. The resulting $0.48 PMPM is included in premium. Below is the
development of the market wide adjustment for the exchange fee in the development
of the Market Average Index Rate [Development of Market Adjusted Index Rate].
Exchange User Fee Adjustment
(A) Exchange User Fee $9.66
(B) Exchange Enrollment Projection 5%
(C) Paid to Allowed Ratio 74.5%
(D) Exchange User Fee Adjustment (market-wide) [A*B/C] $0.65
Projected Loss Ratio
The projected loss ratio has been calculated using projected incurred claims net of risk
adjustment and reinsurance.
The projected MLR has been calculated using the methodology below.
MLR Calculation
(A) Incurred Claims $327.35
(B) Admin $39.55
(C) Commission $16.44
(D) Insurer Fee $14.39
(E) HCR - Funding of Patient-Centered Outcomes Research Fee $0.20
(F) Exchange User Fee $0.48
(G) Reinsurance Assessment $2.25
(H) Risk Adjustment User Fee $0.15
(I) Contribution to Overhead $10.28
(J) Total Premium Rate $411.09
MLR = A / (J-D-E-F-G-H)
MLR: 83.2%
Incurred Claims $327.35
Projected Premium $411.09
Projected Loss Ratio 79.6%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
11 | P a g e
Single Risk Pool
In accordance with 45 CFR part 156, §156.80(d), the index rate that is effective January 1, 2016
for the Oregon Small Group market is based on the total allowed claims costs for providing
essential health benefits within the single risk pool of that market. The index rate shown on the
URRT is the weighted average of index rate for each quarter since Moda Health includes trend in
our rating. The weighted average index rate has been adjusted on a market-wide basis for the
state based on the total expected market-wide payments and charges under the risk adjustment
and reinsurance programs, and exchange user fees. The premium rate for all of the Moda Health
Oregon small group benefit plans use the applicable plan adjusted index rate, subject only to the
plan-level adjustments permitted. Premium rates for a particular plan may vary from its index
rate for a relevant market based only on the following actuarially justified plan-specific factors:
Plan-specific factors allowed and used in this filing
• The actuarial value and cost-sharing design of the plan.
• Administrative costs, excluding Exchange user fees.
• The plan's provider network, delivery system characteristics, and utilization
management practices.
• The benefits provided under the plan that are in addition to the essential health
benefits. These additional benefits must be pooled with similar benefits within the
single risk pool and the claims experience from those benefits must be utilized to
determine rate variations for plans that offer those benefits in addition to essential
health benefits.
Plan-specific factors allowed but not used in this filing
• With respect to catastrophic plans, the expected impact of the specific eligibility
categories for those plans.
Index Rate
Moda Health has developed a market-wide index rate for the Oregon small group market in
accordance with 45 CFR part 156, §156.80(d)(1). The following table shows the numerical
development of the index rate for the first quarter.
Index Rate Development Total
PMPM
(A) Experience Period Allowed Claims $ 361.81
(B-1) Completed Experience Period Allowed Claims $ 367.30
(B-2) Non-EHB Allowed Claims $ 5.56
(B) Experience Period Index Rate $ 361.74
(C) Trend 5.2%
(D) Trend Factor (1+C)^2 1.106
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
12 | P a g e
(E) Adjustment to Market Morbidity 1.073
(F) Benefits Adjustments 1.008
(G) Projected 2016 Market Allowed Claims
(A*C*D*F) $ 439.36
(H) Projected % Non-EHB Claims 0.03%
(I) Projection Period Index Rate [H/(1-I)] $ 437.89
Weighted Average Index Rate Development
(A) Annual Trend 5.2%
(B) Quarterly Trend Factor 1.013
(C) Q1 Index Rate $ 437.89
(D) Q2 Index Rate $ 443.47
(E) Q3 Index Rate $ 449.11
(F) Q4 Index Rate $ 454.82
(G) Weighted Average Index Rate $ 446.32
Experience Period Index Rate: The experience period index rate is equal to 98.5% of allowed
claims for the experience period. There are a limited number of non-single risk pool compliant
plans included in the experience period, but these plans cover substantially similar benefits to
the single risk pool compliant plans. The only non-EHB benefits included in the experience
period are for alternative care services.
Projection Period Index Rate: All adjustments to get from the experience period allowed claims
to the projected 2016 allowed claims have been previously discussed in the Projection Factors
section of this document. The only non-EHB benefits included in the projection period are for
alternative care services. Membership is assumed to be distributed through the year equally.
This assumption is used to calculate the weighted average index rate for the year above.
Moda Health does not provide any transitional or grand-fathered policies. The index rate will
change at uniform 3 month intervals and is applied uniformly to all products/plan combinations
in the single risk pool.
Market Adjusted Index Rate
[Market Adjusted Index Rates] The Market Adjusted Index Rate is calculated as the Index Rate
adjusted for the federal reinsurance program, risk adjustment, and exchange user fees. Since
the Market Adjusted Index Rate is based on allowed claims, the three market modifiers have
been applied at an allowed claims rate. The calculations of these adjustments are detailed in the
respective sections of this document.
Market Adjusted Index Rate
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
13 | P a g e
Index Rate $446.32
Federal Reinsurance Program Adjustment $3.02
Risk Adjustment $0.20
Exchange User Fee Adjustment $5.60
Market Adjusted Index Rate $450.19
Plan Adjusted Index Rates
[Plan Adjusted Index Rates] The Plan Adjusted Index Rates may vary from the Market Adjusted
Index Rate based on limited allowable plan level modifiers in accordance with 45 CFR part 156,
§156.80(d)(2). All adjustments were developed uniformly and consistently for all plans, using
the same methods and calculations. The allowable adjustments are:
• Actuarial value and cost sharing: As discussed in the Paid to Allowed Ratio section of
this document, relative allowed and paid claims were developed for each plan based on
actuarial value and cost sharing.
• Provider network, delivery system and utilization management: There are four
provider networks included in this filing. Since the experience period data is based on a
Connexus centered portfolio, those plans have a factor of 1. The Rose City network
factors have not changed from 2015 and factors were developed for Synergy and
Summit.
• Benefits in addition to the EHB’s: The only benefits in addition to EHB are alternative
care benefits. These are projected to be a small portion of the actual claims for the plans
where these are included.
• Distribution and administrative costs: Based on the projected membership distributions
to be discussed in the Membership Projections section, non-benefit expenses were
converted to a fixed percentage of expected paid claims, to be applied uniformly across
all plans. The resulting plan adjusted index rates represent the average demographic of
the Oregon Small Group single risk pool.
Plan Name Paid to
Allowed
Network Non-
EHBs
Catastrophic
Plan
Administrative
Costs
Plan
Adjusted
Index
Rate
PPO Platinum 250 93.24% 1.000 1.000 1.000 1.247 $523.31
PPO Platinum 500 92.04% 1.000 1.000 1.000 1.247 $516.55
PPO 500 87.02% 1.000 1.000 1.000 1.247 $488.38
PPO 1000A 84.56% 1.000 1.000 1.000 1.247 $474.59
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
14 | P a g e
PPO 1000B 84.40% 1.000 1.000 1.000 1.247 $473.70
PPO 1500 82.31% 1.000 1.000 1.000 1.247 $461.97
PPO 2500 73.98% 1.000 1.000 1.000 1.247 $415.18
PPO 3000 72.59% 1.000 1.000 1.000 1.247 $407.39
PPO 3000 (Portland) 72.59% 1.000 1.000 1.000 1.247 $407.39
Value 1500 73.90% 1.000 1.000 1.000 1.247 $414.78
Value 2000 71.35% 1.000 1.000 1.000 1.247 $400.46
Value 2000 (Rose City) 70.48% 0.935 1.000 1.000 1.247 $369.89
Value 2500 69.45% 1.000 1.000 1.000 1.247 $389.77
Value 3000 67.75% 1.000 1.000 1.000 1.247 $380.25
Value 3500 66.21% 1.000 1.000 1.000 1.247 $371.58
Value 5000 62.60% 1.000 1.000 1.000 1.247 $351.32
Moda Health Connexus
Aspire 2000
70.85% 1.000 1.000 1.000 1.247 $397.66
Moda Health Connexus
Aspire 2500
68.80% 1.000 1.000 1.000 1.247 $386.14
Moda Health Connexus
Fundamental 3500
59.99% 1.000 1.000 1.000 1.247 $336.71
Moda Health Connexus
Fundamental 5000
55.52% 1.000 1.000 1.000 1.247 $311.63
Moda Health Connexus
HSA 1500
75.18% 1.000 1.000 1.000 1.247 $421.97
Moda Health Connexus
HSA 2000
71.85% 1.000 1.000 1.000 1.247 $403.23
Moda Health Connexus
HSA 2500
69.15% 1.000 1.000 1.000 1.247 $388.09
Moda Health Connexus
HSA 3250
60.87% 1.000 1.000 1.000 1.247 $341.64
Moda Health Connexus
Essence 5000
55.65% 1.000 1.000 1.000 1.247 $312.35
Moda Health Rose City
Essence 5000
54.68% 0.935 1.000 1.000 1.247 $286.97
Moda Health Connexus
Essence 6000
55.32% 1.000 1.000 1.000 1.247 $310.46
Moda Health Connexus
Basic 6500
55.44% 1.000 1.000 1.000 1.247 $311.17
Moda Health Connexus
Basic 6500
55.44% 1.000 1.000 1.000 1.247 $311.17
Moda Health Synergy
Exclusive 2000
69.46% 0.911 1.000 1.000 1.247 $354.95
Moda Health Summit
Exclusive 2000
69.26% 0.944 1.000 1.000 1.247 $367.06
Moda Health Synergy
Exclusive 5000
54.37% 0.911 1.000 1.000 1.247 $277.86
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
15 | P a g e
Moda Health Summit
Exclusive 5000
54.10% 0.944 1.000 1.000 1.247 $286.70
PPO Platinum Synergy
Exclusive 250
92.90% 0.911 1.000 1.000 1.247 $474.72
PPO Platinum Summit
Exclusive 250
92.82% 0.944 1.000 1.000 1.247 $491.92
PPO Synergy Exclusive
1000A
84.05% 0.911 1.000 1.000 1.247 $429.50
PPO Summit Exclusive
1000A
83.94% 0.944 1.000 1.000 1.247 $444.88
Moda Health Oregon
Standard Gold
82.85% 1.000 1.000 1.000 1.247 $465.02
Moda Health Oregon
Standard Silver
69.51% 1.000 1.000 1.000 1.247 $390.11
Moda Health Oregon
Standard Bronze
56.45% 1.000 1.000 1.000 1.247 $316.81
Calibration
Age Curve Calibration
[Projected Age Distribution] The mandatory Federal age curve has been used to calibrate the
plan adjusted index rates. A projected age distribution for the projection period is applied to
the Federal age curve, giving projected average age factor of 1.420 which has been applied
uniformly across all plans. The projected age distribution is equal to the market age distribution
as reported in the Wakely National Simulation.
Age Band
Federal Age
Factor
Projection Period
Membership
Distribution
0-20 0.635 20.8%
21 1.000 1.1%
22 1.000 1.3%
23 1.000 1.5%
24 1.000 1.5%
25 1.004 1.4%
26 1.024 1.7%
27 1.048 1.8%
28 1.087 1.8%
29 1.119 1.8%
30 1.135 1.9%
31 1.159 2.0%
32 1.183 1.9%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
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33 1.198 2.0%
34 1.214 2.0%
35 1.222 2.0%
36 1.230 1.9%
37 1.238 1.9%
38 1.246 1.9%
39 1.262 1.9%
40 1.278 2.0%
41 1.302 1.9%
42 1.325 2.0%
43 1.357 2.1%
44 1.397 2.1%
45 1.444 2.1%
46 1.500 1.8%
47 1.563 1.9%
48 1.635 1.8%
49 1.706 1.8%
50 1.786 2.0%
51 1.865 1.9%
52 1.952 2.0%
53 2.040 2.0%
54 2.135 1.9%
55 2.230 2.0%
56 2.333 1.8%
57 2.437 1.7%
58 2.548 1.7%
59 2.603 1.7%
60 2.714 1.8%
61 2.810 1.6%
62 2.873 1.3%
63 2.952 1.2%
64+ 3.000 1.9%
Geographic Factor Calibration
With recent growth, Moda Health has calculated different geographic factors for each rating
region. Area factors were calculated by comparing 2014 claims costs between each region for
the Commercial and Individual segments. The above factors reflect only a slight adjustment
from the 2015 Small Group area factors.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
17 | P a g e
Region Area
Factor
Percent of Membership
Region 1 1.000 32.2%
Region 2 0.965 22.8%
Region 3 0.965 11.8%
Region 4 1.040 11.5%
Region 5 1.000 8.7%
Region 6 1.030 6.7%
Region 7 1.040 6.3%
Weighted Average
(Calibration Factor) 0.997
The weighted average of the above factors is used to calibrate the Plan Adjusted Index Rates.
The membership distribution is the distribution of Moda Health Small Group members during
the experience period.
Consumer Adjusted Premium Rate Development
To arrive at the consumer adjusted premium rate, the Plan Adjusted Index Rate is divided by the
Age Curve Calibration Factor and the Geographic Calibration Factor and multiplied by the
Federal Age Factor, Region Area Factor, and adjustment for quarterly trend. Quarterly trend
adjustments are show in the table below. Since the Plan Adjusted Index rate is calculated from
the weighted average index rate, the adjustment for the first two quarters will be less than one.
Q1 Trend Adjustment 0.981
Q2 Trend Adjustment 0.994
Q3 Trend Adjustment 1.006
Q4 Trend Adjustment 1.019
See the sample calculation below for a 40 year old on the PPO 500 in Region 1 for Q2. Please
note that rates for each group member are developed using the calculations below. Group
premiums are billed on a composite basis follow state guidance.
(A) Plan Adjusted Index Rate $488.38
(B) Age Curve Calibration Factor 1.420
(C) Geographic Calibration Factor 0.997
(D) Calibrated Plan Adjusted Index Rate
(A/(B*C)) $344.85
(E) Area Factor (Region 1) 1.000
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
18 | P a g e
(F) Age Factor (Age 40) 1.278
(G) Quarter Adjustment (Q2) 0.994
(H) Consumer Adjusted Premium Rate
(D*E*F) $437.92
AV Metal Values
The AV Metal Values included in Worksheet 2 of the Part I Unified Rate Review Template are
entirely based on the Federal AV Calculator.
Plan Name Metal tier AV Metal Value
PPO Platinum 250 Platinum 88.2%
PPO Platinum 500 Platinum 88.0%
PPO 500 Gold 81.6%
PPO 1000A Gold 79.8%
PPO 1000B Gold 78.8%
PPO 1500 Gold 78.5%
PPO 2500 Silver 72.0%
PPO 3000 Silver 71.7%
PPO 3000 (Portland) Silver 71.7%
Value 1500 Silver 71.7%
Value 2000 Silver 71.1%
Value 2000 (Rose City) Silver 71.0%
Value 2500 Silver 70.6%
Value 3000 Silver 70.5%
Value 3500 Silver 70.3%
Value 5000 Silver 69.0%
Moda Health Connexus Aspire 2000 Silver 71.9%
Moda Health Connexus Aspire 2500 Silver 71.4%
Moda Health Connexus Fundamental
3500 Bronze 61.2%
Moda Health Connexus Fundamental
5000 Bronze 59.6%
Moda Health Connexus HSA 1500 Silver 72.0%
Moda Health Connexus HSA 2000 Silver 69.7%
Moda Health Connexus HSA 2500 Silver 68.1%
Moda Health Connexus HSA 3250 Bronze 61.9%
Moda Health Connexus Essence 5000 Bronze 62.0%
Moda Health Rose City Essence 5000 Bronze 62.0%
Moda Health Connexus Essence 6000 Bronze 61.4%
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
19 | P a g e
Moda Health Connexus Basic 6500 Bronze 61.9%
Moda Health Connexus Basic 6500 Bronze 61.9%
Moda Health Synergy Exclusive 2000 Silver 71.0%
Moda Health Summit Exclusive 2000 Silver 71.0%
Moda Health Synergy Exclusive 5000 Bronze 62.0%
Moda Health Summit Exclusive 5000 Bronze 62.0%
PPO Platinum Synergy Exclusive 250 Platinum 88.2%
PPO Platinum Summit Exclusive 250 Platinum 88.2%
PPO Synergy Exclusive 1000A Gold 79.8%
PPO Summit Exclusive 1000A Gold 79.8%
Moda Health Oregon Standard Gold Gold 78.4%
Moda Health Oregon Standard Silver Silver 69.7%
Moda Health Oregon Standard Bronze Bronze 61.6%
AV Pricing Values
[Plan Adjusted Index Rate] Differences in the AV Pricing Values are based entirely on the
differences in cost-sharing designs of the plans, as allowed by 45 CFR part 156, §156.80(d).
Assumed differences in utilization are based on differences in the relative projected allowed as
developed within the Milliman pricing model. The model projects utilization patterns based on
historic, nationwide data, and is based primarily on differences in deductible level. No plan
specific adjustments have been made to account for health status. The AV Pricing Value
represents the cumulative effects of adjustments to move from the Market Adjusted Index Rate
to the Plan adjusted Index rate. The AV Pricing Values are calculated by dividing the Plan
Adjusted Index Rate by the Market Adjusted Index rate.
Plan Name
AV
Pricing
Value
PPO Platinum 250 1.162
PPO Platinum 500 1.147
PPO 500 1.085
PPO 1000A 1.054
PPO 1000B 1.052
PPO 1500 1.026
PPO 2500 0.922
PPO 3000 0.905
PPO 3000 (Portland) 0.905
Value 1500 0.921
Value 2000 0.890
Value 2000 (Rose City) 0.822
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
20 | P a g e
Value 2500 0.866
Value 3000 0.845
Value 3500 0.825
Value 5000 0.780
Moda Health Connexus Aspire 2000 0.883
Moda Health Connexus Aspire 2500 0.858
Moda Health Connexus Fundamental
3500 0.748
Moda Health Connexus Fundamental
5000 0.692
Moda Health Connexus HSA 1500 0.937
Moda Health Connexus HSA 2000 0.896
Moda Health Connexus HSA 2500 0.862
Moda Health Connexus HSA 3250 0.759
Moda Health Connexus Essence 5000 0.694
Moda Health Rose City Essence 5000 0.637
Moda Health Connexus Essence 6000 0.690
Moda Health Connexus Basic 6500 0.691
Moda Health Connexus Basic 6500 0.691
Moda Health Synergy Exclusive 2000 0.788
Moda Health Summit Exclusive 2000 0.815
Moda Health Synergy Exclusive 5000 0.617
Moda Health Summit Exclusive 5000 0.637
PPO Platinum Synergy Exclusive 250 1.054
PPO Platinum Summit Exclusive 250 1.093
PPO Synergy Exclusive 1000A 0.954
PPO Summit Exclusive 1000A 0.988
Moda Health Oregon Standard Gold 1.033
Moda Health Oregon Standard Silver 0.867
Moda Health Oregon Standard Bronze 0.704
Membership Projections
Membership projections are based on emerging 2015 Moda Health experience. The projection
includes assumptions that members currently on the 2015 Moda Health plans that will be
discontinued will move to the replacements for those plans and any new membership will have
the same distribution as members in early 2015.
Plan Name Members
PPO Platinum 250 145
PPO Platinum 500 145
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
21 | P a g e
PPO 500 2,895
PPO 1000A 2,316
PPO 1000B 1,737
PPO 1500 2,200
PPO 2500 2,605
PPO 3000 869
PPO 3000 (Portland) 579
Value 1500 1,158
Value 2000 1,447
Value 2000 (Rose City) 58
Value 2500 579
Value 3000 1,737
Value 3500 290
Value 5000 290
Moda Health Connexus Aspire 2000 2,026
Moda Health Connexus Aspire 2500 579
Moda Health Connexus Fundamental
3500 1,158
Moda Health Connexus Fundamental
5000 145
Moda Health Connexus HSA 1500 290
Moda Health Connexus HSA 2000 290
Moda Health Connexus HSA 2500 290
Moda Health Connexus HSA 3250 290
Moda Health Connexus Essence 5000 869
Moda Health Rose City Essence 5000 58
Moda Health Connexus Essence 6000 290
Moda Health Connexus Basic 6500 145
Moda Health Connexus Basic 6500 145
Moda Health Synergy Exclusive 2000 145
Moda Health Summit Exclusive 2000 145
Moda Health Synergy Exclusive 5000 145
Moda Health Summit Exclusive 5000 145
PPO Platinum Synergy Exclusive 250 145
PPO Platinum Summit Exclusive 250 145
PPO Synergy Exclusive 1000A 145
PPO Summit Exclusive 1000A 145
Moda Health Oregon Standard Gold 579
Moda Health Oregon Standard Silver 1,447
Moda Health Oregon Standard Bronze 145
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
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Terminated Products
The following plans were available in 2014 but were terminated for 2015:
PPO 500B
PPO 500C
PPO 1000C
The following plans were available in 2015, but will be terminated prior to 2016:
Beneficial 1500
Beneficial 2000
Beneficial 3500
Beneficial 4000
Beneficial 4500
Beneficial 5000
HSA 1500
HSA 2000
HSA 3000
HSA 4000
HSA 5000
Focus 2000
Focus 5000
Focus – Rose City 2000
Focus – Rose City 5000
Mapping of plans between 2015 and 2016 is shown below. This is the mapping used to
categorize experience on Worksheet 2 of the URRT as well as calculate the anticipated rate
increase.
2015 Plan 2016 Plan
PPO 500 PPO 500
PPO 1000A PPO 1000A
PPO 1000B PPO 1000B
PPO 1500 PPO 1500
PPO 2000 PPO 2500
PPO 3000 PPO 3000
Value 1500 Value 1500
Value 2000 Value 2000
Value 2500 Value 2500
Value 3000 Value 3000
Value 3500 Value 3500
Beneficial 1500 Moda Health Connexus Aspire 2000
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
23 | P a g e
Beneficial 2000 Moda Health Connexus Aspire 2000
Focus 2000 Moda Health Connexus Aspire 2000
Beneficial 3500 Moda Health Connexus Fundamental 3500
Beneficial 4000 Moda Health Connexus Fundamental 3500
Beneficial 4500 Moda Health Connexus Essence 5000
Beneficial 5000 Moda Health Connexus Essence 5000
Focus 5000 Moda Health Connexus Essence 5000
HSA 1500 Moda Health Connexus HSA 1500
HSA 2000 Moda Health Connexus HSA 2000
HSA 3000 Moda Health Connexus HSA 2500
HSA 4000 Moda Health Connexus HSA 3250
Moda Health Oregon Standard Gold Moda Health Oregon Standard Gold
Moda Health Oregon Standard Silver Moda Health Oregon Standard Silver
Moda Health Oregon Standard Bronze Moda Health Oregon Standard Bronze
Plan Type
Most plans for the 2015 plan year are listed in Worksheet 2, Section I of the Part I Unified Rate
Review Template as “PPO”. Synergy and Summit plans most resemble a “POS” plan type.
Risk Corridor Demonstration
Please see the attached Risk Corridor Demonstration Exhibit for a detailed demonstration that
the projected rates yield a projected risk corridor receivable/payment of zero.
Peer Review Actuary Contact
Kirsten Staveland, ASA, MAAA
503-265-2976
Warning Alerts
None
Reliance
All data and assumptions, except those otherwise noted throughout this document, were
prepared by a team of Moda Health employees which includes the certifying actuary.
Actuarial Certification
I, Jennifer Halttunen, am an employee of Moda Health Plan, Inc. and am a member in good
standing of the American Academy of Actuaries.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
24 | P a g e
I have reviewed this rate filing and certify that the projected index rate is:
• In compliance with all applicable Oregon State and Federal Statutes and Regulations (45
CFR part 156, §156.80(d)(1))
• Developed in compliance with the applicable Actuarial Standards of Practice
• Reasonable in relation to the benefits provided and the population anticipated to be
covered
• Neither excessive nor deficient
I further certify that:
• The index rate and only allowable modifiers as described in 45 CFR part 156,
§156.80(d)(1) and 45 CFR part 156, §156.80(d)(2) were used to generate plan level rates
• The percent of total premium that represents essential health benefits included in
Worksheet 2, Sections III and IV were calculated in accordance with actuarial standards
of practice.
• The Federal AV Calculator was used to determine the AV Metal Values shown in
Worksheet 2 of the Part I Unified Rate Review Template for all plans.
All rates, calculations and values were developed accordance with generally accepted actuarial
principles and methodologies and in accordance with the Code of Professional Conduct and the
following Actuarial Standards of Practice:
• ASOP No. 5, Incurred Health and Disability Claims
• ASOP No. 8, Regulatory Filings for Health Plan Entities
• ASOP No. 12, Risk Classification
• ASOP No. 23, Data Quality
• ASOP No. 25, Credibility Procedures Applicable to Accident and Health, Group Term Life,
and Property/Casualty Coverages
• ASOP No. 26, Compliance with Statutory and Regulatory Requirements for the Actuarial
Certification of Small Employer Health Benefit Plans
• ASOP No. 41, Actuarial Communications
I meet the Academy qualification standards to render this opinion and am familiar with the
specific requirements of Oregon State and Federal Statutes and Regulations regarding the rating
and underwriting of small group health benefit plans.
_________________________________ __4/30/2015___
Signature Date
Jennifer Halttunen, ASA, MAAA
Supervisor – Pooled Products and Actuarial
Moda Health Plan, Inc.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
25 | P a g e
601 SW Second Ave.
Portland, OR 97204-3156
503-265-5733
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
1 | P a g e
General Information
Company Identifying Information
Company Legal Name: Moda Health Plan, Inc.
State: Oregon
HIOS Issuer ID: 39424
Market: Small Group
Effective Date: January 1, 2016
Company Contact Information
Primary Contact
Name: Henry Stender
Telephone Number: 503-228-6554 x1032
Email Address: [email protected]
Secondary Contact
Name: Jennifer Halttunen, ASA, MAAA
Telephone Number: 503-265-5733
Email Address: [email protected]
Proposed Rate Increase
The average rate increase for all members is 4.2%. The proposed rate increase varies by
product, plan, and rating area and rates in the filing vary by plan, age, and geographic area. The
federal age factor is used for age rating and the plan rating is detailed in the Plan Adjusted Index
Rate section. Geographic factors are shown in the Geographic Calibration section. The average
rate increase was calculated by comparing the weighted average premium for current members
on the 2015 plans and rates to the weighted average premium for current members on the 2016
plans and rates.
2015 $396.85
2016 $413.60
Rate Change 4.2%
The only adjustments included in the filed rate change is to adjustment from Moda experience
in 2014 to the market experience in 2014 as well as a benefit adjustment applied to the
transitional policies included in the experience period. There is no adjustment for the expansion
of the small group market from 1-50 to 1-100. The adjustments are discussed in more detail
below. The rates also include cost and utilization trends and changes in taxes and fees.
Differences in the rate change between products and plans are driven by an update to projected
paid to allowed ratios for renewing plans and mapping members from discontinued plans to
new plans. All plans impacted and member mapping is shown below. Variations in rate increase
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
2 | P a g e
by area are the result of implementing new area factors. The change in area factors is a revenue
neutral change.
2015 Plan 2016 Plan
PPO 500 PPO 500
PPO 1000A PPO 1000A
PPO 1000B PPO 1000B
PPO 1500 PPO 1500
PPO 2000 PPO 2500
PPO 3000 PPO 3000
Value 1500 Value 1500
Value 2000 Value 2000
Value 2500 Value 2500
Value 3000 Value 3000
Value 3500 Value 3500
Beneficial 1500 Moda Health Connexus Aspire 2000
Beneficial 2000 Moda Health Connexus Aspire 2000
Focus 2000 Moda Health Connexus Aspire 2000
Beneficial 3500 Moda Health Connexus Fundamental 3500
Beneficial 4000 Moda Health Connexus Fundamental 3500
Beneficial 4500 Moda Health Connexus Essence 5000
Beneficial 5000 Moda Health Connexus Essence 5000
Focus 5000 Moda Health Connexus Essence 5000
HSA 1500 Moda Health Connexus HSA 1500
HSA 2000 Moda Health Connexus HSA 2000
HSA 3000 Moda Health Connexus HSA 2500
HSA 4000 Moda Health Connexus HSA 3250
Moda Health Oregon Standard Gold Moda Health Oregon Standard Gold
Moda Health Oregon Standard Silver Moda Health Oregon Standard Silver
Moda Health Oregon Standard Bronze Moda Health Oregon Standard Bronze
Experience Period Premium and Claims
Experience Period
Market: Oregon Small Group Medical and Prescription Drug plans
Incurred dates: January 1 through December 31, 2014
Paid through date: March 31, 2015
Premiums (net of MLR Rebate) in Experience Period
Earned premiums: $57,940,496
Member Months: 158,254
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
3 | P a g e
MLR rebates refunded: $0
Anticipated MLR rebates: No MLR rebates are anticipated
Allowed and Incurred Claims Incurred During the Experience Period
Incurred paid claims: $42,402,514
Completed incurred paid claims: $43,080,384
Incurred allowed claims: $57,257,471
Completed incurred allowed claims: $58,126,655
Incurred but not paid claims: $677,870
• The experience period contains both single risk pool compliant and non-single risk pool
compliant plans. The only adjustment applies to the non-single risk pool compliant plans
is to account for EHBs that were not covered in the experience period.
• Experience for groups size 51-100 was not included in the experience period per the
2016 Unified Rate Review Instructions.
• Paid and allowed claims come directly from issuer’s claim records.
• IBNR is estimated monthly by the actuarial department and is modeled at the reserve
cell level. Key features distinguishing reserve cells include payer type (Medicare or
Commercial), state, funding type, and segment (group or individual business). The data
used in this analysis is reconciled to other financial reports to ensure validity. The
starting point for the actuarial analysis are completion factors produced by a proprietary
model using historical data. Because the model does not take into account such
important factors as payment cycles, changes in processing speed, or changes in claims
volume, the actuaries generally use the Bornhuetter-Ferguson (BF) method to produce
modified completion factors for recent months. The method for each reserve cell is set
ahead of time unless a one-off issue arises that makes this method inappropriate. The
actuaries then review the estimates for reasonableness and make adjustments using
actuarial judgment. This requires knowledge of changes in internal business practices,
other internal variables, and various calculated measures.
Benefit Categories
Claims are categorized using claim level service code and provider information to the categories
as specified in the 2016 Unified Rate Review Instructions.
Projection Factors
Changes in the Morbidity of the Population Insured: The 7.3% adjustment for the change
in the morbidity of the insured population adjusts from the morbidity of insured population in
the experience period to the morbidity of the 2014 Oregon Small Group market. Both Moda and
market factors were calculated using results from the Wakely National Simulation for all factors
used in the left side of the HHS risk transfer formula.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
4 | P a g e
The transfer formula compares the difference in actual “morbidity results” between an issuer
and market with the difference in allowable rating factors, adjustment is meant to adjust the
actual experience of the issuer to the market level. Following this reasoning, we have used the
following calculation to compare Moda experience to Market experience:
����� � ��� � �� �����∑ �� �� ����� � ��� � ��� �������
11.1361.218 � 1.073
The 2014 Moda Health results from the full experience period (January through December) is
used as the base factor. This was compared to the completed 2014 market level results. Market
level results were completed using the assumption that all members were enrolled for the
duration of the year. This is consistent with the assumption that members will be continually
enrolled in future years.
Moving from 2014 to 2016, we do not project a change in the market morbidity factor despite
the expansion of small group from 1-50 to 1-100. Since Oregon is allowed transitional policies
for both 1-50 and 51-100 through October 2016, only the groups that would benefit from the
change will move into the market. Those with better risk (and subsequently lower rates
currently), will renew as transitional and/or early renew prior to October 2016. Overall the 51-
100 market has a lower morbidity factor that the 1-50 market. Considering the above selection,
we project the average morbidity of the groups entering the 2016 Small Group market will be
substantially equal to the 2014 market morbidity factor.
Where: %& � Transferforissuer/ 01222 � StateAveragePremium 0:;<& � Issuer/′splanliabilityriskscore EFG& � Issuer/′sinduceddemandfactor I;G& � Issuer/′sallowableratingfactor IK& � Issuer/′smetallevelactuarialvalue LMG& � Issuer/′sgeographiccostfactor 1& � Issuer/′sshareofStateenrollment, andthedenominatorissummed acrossallissuersintheriskpoolinthemarket + state
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
5 | P a g e
Changes in Benefits: The only adjustment for benefits is to account for plans that did not
include prescription drug coverage and pediatric vision coverage in the experience period. The
detail for this calculation is in the Development of Benefit Adjustments Exhibit. The total impact
is 0.8%.
Changes in Demographics: An explicit adjustment for changes in demographics has not been
included in this filing. The analysis to adjust to the overall market morbidity includes impacts of
the demographics of both the experience data as well as the projected population in the PLRS
comparison. Including an additional adjustment would be redundant.
Other Adjustments: There are no other adjustments included in the filing.
Trend Factors (cost/utilization): [Development of Trend] Medical cost and utilization trends
are developed from Oregon Commercial group claims. The cost trends have been reviewed for
consistency with recent and anticipated changes in reimbursement rates and points of service.
Moda implements the same medical management techniques for both individual and group
segments corporately; so utilization trends are not expected to vary between these segments.
The annualized 2-year trend (over the last 2 years) is used for the utilization trend projections
for each of the medical service categories. The block of experience used in the analysis has
approximately 48,000 lives.
The Pharmacy cost trend is based on historic cost trends in Moda's Commercial pharmacy
network. The cost trends are broken out by drug type - Specialty, Traditional Generics, and
Traditional Brand. The annualized 2-year trend is used for the Specialty cost trend. Since the cost
data for Traditional drug spending is affected by a network price change starting in mid-2012,
the 2-year annualized trend is not used for traditional drugs. Instead the 1-year 2014/2013 trend
is used as the cost trend for traditional drugs. Traditional and Specialty cost trends are blended
together using current and projected spend levels to get the overall rx cost trend.
The Pharmacy utilization trend is also based on claims and enrollment from Commercial groups.
Moda Health uses the same utilization management techniques (formulary, prior authorization
programs) for group and individual segments corporately. Utilization is also broken out by drug
type - Specialty, Traditional Generics, and Traditional Brand. Annualized 2-year trends are used
to project the utilizations trends in each drug type.
Credibility Manual Rate Development
No manual rates were used.
Credibility of Experience
Due to the size of the block in the experience period, no credibility adjustments were used for
developing rates. Credibility of the medical experience period has been determined based on
the Medicare credibility formula:
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
6 | P a g e
� =P ��24,000
100% < P158,25424,000
This formula was ultimately chosen as it is it is a published and documented formula. The
formula was developed primarily for use in Medicare Advantage rate filings, which generally
have higher claims volume than a full commercial market. Given the margin by which the
minimum threshold for full credibility is exceeded, however, the difference in claims volume is
more than adequately compensated for.
Paid to Allowed Ratio
The 2014 Milliman Managed Care Rating Model (MCRM) was used as the basis to develop
expected allowed and paid claims for the varying cost sharing designs. Utilization adjustments
included in the model reflect the effect of cost sharing and benefit design. The MCRM was
calibrated to reflect cost and utilization experience of commercial business for Oregon. The
calibrated Rating Model, when populated with a benefit design, produces both projected
allowed and paid claims PMPM for benefit design. The model was run for each of the Moda
Health medical and pharmacy benefit designs.
Paid amounts produced in the MCRM model were adjusted for deductible leveraging using
Milliman factors.
Plan Name
Projected
Membership
Projected
Allowed
Projected
Paid
Deductible
Leveraging
Factor
Plan
Specific
Paid to
Allowed
PPO Platinum 250 145 $448.71 $416.01 1.006 93.2%
PPO Platinum 500 145 $448.71 $409.86 1.008 92.0%
PPO 500 2,895 $442.69 $382.31 1.008 87.0%
PPO 1000A 2,316 $442.69 $370.46 1.010 84.6%
PPO 1000B 1,737 $441.27 $368.58 1.010 84.4%
PPO 1500 2,200 $442.69 $359.93 1.012 82.3%
PPO 2500 2,605 $433.29 $315.42 1.016 74.0%
PPO 3000 869 $433.29 $309.50 1.016 72.6%
PPO 3000 (Portland) 579 $433.29 $309.50 1.016 72.6%
Value 1500 1,158 $438.91 $320.41 1.012 73.9%
Value 2000 1,447 $438.91 $308.76 1.014 71.4%
Value 2000 (Rose City) 58 $412.21 $286.43 1.014 70.5%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
7 | P a g e
Value 2500 579 $438.91 $299.96 1.016 69.4%
Value 3000 1,737 $438.91 $292.63 1.016 67.8%
Value 3500 290 $438.91 $285.96 1.016 66.2%
Value 5000 290 $438.91 $268.85 1.022 62.6%
Moda Health Connexus
Aspire 2000 2,026 $439.94 $307.33 1.014 70.9%
Moda Health Connexus
Aspire 2500 579 $439.94 $297.86 1.016 68.8%
Moda Health Connexus
Fundamental 3500 1,158 $446.16 $263.40 1.016 60.0%
Moda Health Connexus
Fundamental 5000 145 $446.16 $242.41 1.022 55.5%
Moda Health Connexus
HSA 1500 290 $448.00 $332.71 1.012 75.2%
Moda Health Connexus
HSA 2000 290 $448.00 $317.33 1.014 71.8%
Moda Health Connexus
HSA 2500 290 $448.00 $304.85 1.016 69.1%
Moda Health Connexus
HSA 3250 290 $446.16 $267.25 1.016 60.9%
Moda Health Connexus
Essence 5000 869 $442.98 $241.24 1.022 55.7%
Moda Health Rose City
Essence 5000 58 $416.28 $222.74 1.022 54.7%
Moda Health Connexus
Essence 6000 290 $442.98 $239.78 1.022 55.3%
Moda Health Connexus
Basic 6500 145 $446.16 $242.05 1.022 55.4%
Moda Health Connexus
Basic 6500 145 $446.16 $242.05 1.022 55.4%
Moda Health Synergy
Exclusive 2000 145 $408.82 $279.97 1.014 69.5%
Moda Health Summit
Exclusive 2000 145 $400.26 $273.31 1.014 69.3%
Moda Health Synergy
Exclusive 5000 145 $412.86 $219.67 1.022 54.4%
Moda Health Summit
Exclusive 5000 145 $404.22 $213.97 1.022 54.1%
PPO Platinum Synergy
Exclusive 250 145 $418.62 $386.68 1.006 92.9%
PPO Platinum Summit
Exclusive 250 145 $410.35 $378.72 1.006 92.8%
PPO Synergy Exclusive
1000A 145 $412.87 $343.41 1.010 84.0%
PPO Summit Exclusive 145 $404.60 $336.11 1.010 83.9%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
8 | P a g e
1000A
Moda Health Oregon
Standard Gold 579 $446.09 $365.78 1.010 82.9%
Moda Health Oregon
Standard Silver 1,447 $441.79 $302.18 1.016 69.5%
Moda Health Oregon
Standard Bronze 145 $446.16 $246.44 1.022 56.4%
Risk Adjustment and Reinsurance
Experience Period Risk Adjustment and Reinsurance Adjustment PMPM:
For the experience period, the overall Risk Adjustment PMPM was estimated using the results of
the Wakely National Simulation for January through December and the HHS risk transfer
formula. The estimated risk adjustment payable is $3.73 PMPM for 2014.
Reinsurance does not apply to the Small Group market.
Projected Risk Adjustments PMPM
Moda Health has developed the rates for this risk pool assuming the projected insured
population morbidity is equivalent to the market average morbidity. No risk adjustments are
projected, only the Risk Adjustment user fee is included in this section of the URRT. Below is the
development of the market wide adjustment for Risk Adjustment in the development of the
Market Average Index Rate.
Risk Adjustment
(A) Risk Adjustment Program Fee, PMPM $0.15
(B) Projected Risk Adjustment recoveries/payments $0.00
(C) Recoveries net of premium, PMPM [B-A] -$0.15
(D) Paid to Allowed Ratio 74.5%
(E) Risk Adjustment (market-wide) [C/D] -$0.20
Projected ACA Reinsurance Recoveries Net of Reinsurance Premium (Individual
Market Only)
Below is the development of the market wide adjustment for the Reinsurance assessment in the
development of the Market Average Index Rate [Development of Market Adjusted Index Rate].
Federal Reinsurance
(A) Federal Reinsurance Program Premium -$2.25
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
9 | P a g e
(B) Recoveries net of Premium $0.00
(C) Paid to Allowed Ratio 74.5%
(D) Program Adjustment (market-wide) [B/C] -$3.02
Non-Benefit Expenses and Profit & Risk
Administrative Expense Load
[Exhibit 5] Administrative expenses are allocated based on total enrollment, with individual and
small group lines of business receiving higher weights than large group to account for the higher
costs of administering the policy versus a large group policy. The projected expenses for 2016
are $39.55 PMPM. Commissions are paid at 4.0% of premium and utilization of agents is
assumed to be 100%.
Profit (or Contribution to Surplus) & Risk Margin
Moda Health has built in a 2.5% margin and contribution to reserves, consistent with corporate
practice. In order to maintain solvency and adequate risk based capital levels, we believe it is
prudent for us to make a reasonable contribution to capital as we grow in the Oregon market. A
margin contribution of 2.5% of premium is reasonable and ensures that we are able to meet our
future financial obligations to our policyholders.
Taxes and Fees
Federal transitional reinsurance program and risk adjustment fees have not been included in
this section.
• Moda’s health insurer fee for 2016 was estimated from the ground up using internally
forecasted 2015 premium, the total national assessment of $11,300,000,000, and
estimated 2015 national premium base per an updated study from Oliver Wyman. To
arrive at Moda’s share of the assessment, the first $25,000,000 in premium and 50% of
the next $25,000,000 in premium was excluded as prescribed by law, and then divided
by the estimated national premium base. Moda’s total payable amount was then
calculated by multiplying the national assessment by Moda’s share of the national
assessment. To calculate the amount that must be collected, this amount was then
divided by .58 to account for 35% federal tax and 7% state tax. This final figure was
divided by internally forecasted 2016 premium to arrive at the percent of premium
charged to each policy in 2016.
• The PCORI fee is set by the Federal government.
PMPM % of premium
ACA issuer’s fee 3.5%
PCORI $0.20
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
10 | P a g e
• The Exchange User fee for Oregon is $9.66 PMPM. The assessment for members
enrolled through and exchange must be charged consistently for the inside and outside
market plans. Moda Health has estimated that 5% of the enrollment will come through
an exchange in 2016. The resulting $0.48 PMPM is included in premium. Below is the
development of the market wide adjustment for the exchange fee in the development
of the Market Average Index Rate [Development of Market Adjusted Index Rate].
Exchange User Fee Adjustment
(A) Exchange User Fee $9.66
(B) Exchange Enrollment Projection 5%
(C) Paid to Allowed Ratio 74.5%
(D) Exchange User Fee Adjustment (market-wide) [A*B/C] $0.65
Projected Loss Ratio
The projected loss ratio has been calculated using projected incurred claims net of risk
adjustment and reinsurance.
The projected MLR has been calculated using the methodology below.
MLR Calculation
(A) Incurred Claims $327.35
(B) Admin $39.55
(C) Commission $16.44
(D) Insurer Fee $14.39
(E) HCR - Funding of Patient-Centered Outcomes Research Fee $0.20
(F) Exchange User Fee $0.48
(G) Reinsurance Assessment $2.25
(H) Risk Adjustment User Fee $0.15
(I) Contribution to Overhead $10.28
(J) Total Premium Rate $411.09
MLR = A / (J-D-E-F-G-H)
MLR: 83.2%
Incurred Claims $327.35
Projected Premium $411.09
Projected Loss Ratio 79.6%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
11 | P a g e
Single Risk Pool
In accordance with 45 CFR part 156, §156.80(d), the index rate that is effective January 1, 2016
for the Oregon Small Group market is based on the total allowed claims costs for providing
essential health benefits within the single risk pool of that market. The index rate shown on the
URRT is the weighted average of index rate for each quarter since Moda Health includes trend in
our rating. The weighted average index rate has been adjusted on a market-wide basis for the
state based on the total expected market-wide payments and charges under the risk adjustment
and reinsurance programs, and exchange user fees. The premium rate for all of the Moda Health
Oregon small group benefit plans use the applicable plan adjusted index rate, subject only to the
plan-level adjustments permitted. Premium rates for a particular plan may vary from its index
rate for a relevant market based only on the following actuarially justified plan-specific factors:
Plan-specific factors allowed and used in this filing
• The actuarial value and cost-sharing design of the plan.
• Administrative costs, excluding Exchange user fees.
• The plan's provider network, delivery system characteristics, and utilization
management practices.
• The benefits provided under the plan that are in addition to the essential health
benefits. These additional benefits must be pooled with similar benefits within the
single risk pool and the claims experience from those benefits must be utilized to
determine rate variations for plans that offer those benefits in addition to essential
health benefits.
Plan-specific factors allowed but not used in this filing
• With respect to catastrophic plans, the expected impact of the specific eligibility
categories for those plans.
Index Rate
Moda Health has developed a market-wide index rate for the Oregon small group market in
accordance with 45 CFR part 156, §156.80(d)(1). The following table shows the numerical
development of the index rate for the first quarter.
Index Rate Development Total
PMPM
(A) Experience Period Allowed Claims $ 361.81
(B-1) Completed Experience Period Allowed Claims $ 367.30
(B-2) Non-EHB Allowed Claims $ 5.56
(B) Experience Period Index Rate $ 361.74
(C) Trend 5.2%
(D) Trend Factor (1+C)^2 1.106
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
12 | P a g e
(E) Adjustment to Market Morbidity 1.073
(F) Benefits Adjustments 1.008
(G) Projected 2016 Market Allowed Claims
(A*C*D*F) $ 439.36
(H) Projected % Non-EHB Claims 0.03%
(I) Projection Period Index Rate [H/(1-I)] $ 437.89
Weighted Average Index Rate Development
(A) Annual Trend 5.2%
(B) Quarterly Trend Factor 1.013
(C) Q1 Index Rate $ 437.89
(D) Q2 Index Rate $ 443.47
(E) Q3 Index Rate $ 449.11
(F) Q4 Index Rate $ 454.82
(G) Weighted Average Index Rate $ 446.32
Experience Period Index Rate: The experience period index rate is equal to 98.5% of allowed
claims for the experience period. There are a limited number of non-single risk pool compliant
plans included in the experience period, but these plans cover substantially similar benefits to
the single risk pool compliant plans. The only non-EHB benefits included in the experience
period are for alternative care services.
Projection Period Index Rate: All adjustments to get from the experience period allowed claims
to the projected 2016 allowed claims have been previously discussed in the Projection Factors
section of this document. The only non-EHB benefits included in the projection period are for
alternative care services. Membership is assumed to be distributed through the year equally.
This assumption is used to calculate the weighted average index rate for the year above.
Moda Health does not provide any transitional or grand-fathered policies. The index rate will
change at uniform 3 month intervals and is applied uniformly to all products/plan combinations
in the single risk pool.
Market Adjusted Index Rate
[Market Adjusted Index Rates] The Market Adjusted Index Rate is calculated as the Index Rate
adjusted for the federal reinsurance program, risk adjustment, and exchange user fees. Since
the Market Adjusted Index Rate is based on allowed claims, the three market modifiers have
been applied at an allowed claims rate. The calculations of these adjustments are detailed in the
respective sections of this document.
Market Adjusted Index Rate
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
13 | P a g e
Index Rate $446.32
Federal Reinsurance Program Adjustment $3.02
Risk Adjustment $0.20
Exchange User Fee Adjustment $5.60
Market Adjusted Index Rate $450.19
Plan Adjusted Index Rates
[Plan Adjusted Index Rates] The Plan Adjusted Index Rates may vary from the Market Adjusted
Index Rate based on limited allowable plan level modifiers in accordance with 45 CFR part 156,
§156.80(d)(2). All adjustments were developed uniformly and consistently for all plans, using
the same methods and calculations. The allowable adjustments are:
• Actuarial value and cost sharing: As discussed in the Paid to Allowed Ratio section of
this document, relative allowed and paid claims were developed for each plan based on
actuarial value and cost sharing.
• Provider network, delivery system and utilization management: There are four
provider networks included in this filing. Since the experience period data is based on a
Connexus centered portfolio, those plans have a factor of 1. The Rose City network
factors have not changed from 2015 and factors were developed for Synergy and
Summit.
• Benefits in addition to the EHB’s: The only benefits in addition to EHB are alternative
care benefits. These are projected to be a small portion of the actual claims for the plans
where these are included.
• Distribution and administrative costs: Based on the projected membership distributions
to be discussed in the Membership Projections section, non-benefit expenses were
converted to a fixed percentage of expected paid claims, to be applied uniformly across
all plans. The resulting plan adjusted index rates represent the average demographic of
the Oregon Small Group single risk pool.
Plan Name Paid to
Allowed
Network Non-
EHBs
Catastrophic
Plan
Administrative
Costs
Plan
Adjusted
Index
Rate
PPO Platinum 250 93.24% 1.000 1.000 1.000 1.247 $523.31
PPO Platinum 500 92.04% 1.000 1.000 1.000 1.247 $516.55
PPO 500 87.02% 1.000 1.000 1.000 1.247 $488.38
PPO 1000A 84.56% 1.000 1.000 1.000 1.247 $474.59
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
14 | P a g e
PPO 1000B 84.40% 1.000 1.000 1.000 1.247 $473.70
PPO 1500 82.31% 1.000 1.000 1.000 1.247 $461.97
PPO 2500 73.98% 1.000 1.000 1.000 1.247 $415.18
PPO 3000 72.59% 1.000 1.000 1.000 1.247 $407.39
PPO 3000 (Portland) 72.59% 1.000 1.000 1.000 1.247 $407.39
Value 1500 73.90% 1.000 1.000 1.000 1.247 $414.78
Value 2000 71.35% 1.000 1.000 1.000 1.247 $400.46
Value 2000 (Rose City) 70.48% 0.935 1.000 1.000 1.247 $369.89
Value 2500 69.45% 1.000 1.000 1.000 1.247 $389.77
Value 3000 67.75% 1.000 1.000 1.000 1.247 $380.25
Value 3500 66.21% 1.000 1.000 1.000 1.247 $371.58
Value 5000 62.60% 1.000 1.000 1.000 1.247 $351.32
Moda Health Connexus
Aspire 2000
70.85% 1.000 1.000 1.000 1.247 $397.66
Moda Health Connexus
Aspire 2500
68.80% 1.000 1.000 1.000 1.247 $386.14
Moda Health Connexus
Fundamental 3500
59.99% 1.000 1.000 1.000 1.247 $336.71
Moda Health Connexus
Fundamental 5000
55.52% 1.000 1.000 1.000 1.247 $311.63
Moda Health Connexus
HSA 1500
75.18% 1.000 1.000 1.000 1.247 $421.97
Moda Health Connexus
HSA 2000
71.85% 1.000 1.000 1.000 1.247 $403.23
Moda Health Connexus
HSA 2500
69.15% 1.000 1.000 1.000 1.247 $388.09
Moda Health Connexus
HSA 3250
60.87% 1.000 1.000 1.000 1.247 $341.64
Moda Health Connexus
Essence 5000
55.65% 1.000 1.000 1.000 1.247 $312.35
Moda Health Rose City
Essence 5000
54.68% 0.935 1.000 1.000 1.247 $286.97
Moda Health Connexus
Essence 6000
55.32% 1.000 1.000 1.000 1.247 $310.46
Moda Health Connexus
Basic 6500
55.44% 1.000 1.000 1.000 1.247 $311.17
Moda Health Connexus
Basic 6500
55.44% 1.000 1.000 1.000 1.247 $311.17
Moda Health Synergy
Exclusive 2000
69.46% 0.911 1.000 1.000 1.247 $354.95
Moda Health Summit
Exclusive 2000
69.26% 0.944 1.000 1.000 1.247 $367.06
Moda Health Synergy
Exclusive 5000
54.37% 0.911 1.000 1.000 1.247 $277.86
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
15 | P a g e
Moda Health Summit
Exclusive 5000
54.10% 0.944 1.000 1.000 1.247 $286.70
PPO Platinum Synergy
Exclusive 250
92.90% 0.911 1.000 1.000 1.247 $474.72
PPO Platinum Summit
Exclusive 250
92.82% 0.944 1.000 1.000 1.247 $491.92
PPO Synergy Exclusive
1000A
84.05% 0.911 1.000 1.000 1.247 $429.50
PPO Summit Exclusive
1000A
83.94% 0.944 1.000 1.000 1.247 $444.88
Moda Health Oregon
Standard Gold
82.85% 1.000 1.000 1.000 1.247 $465.02
Moda Health Oregon
Standard Silver
69.51% 1.000 1.000 1.000 1.247 $390.11
Moda Health Oregon
Standard Bronze
56.45% 1.000 1.000 1.000 1.247 $316.81
Calibration
Age Curve Calibration
[Projected Age Distribution] The mandatory Federal age curve has been used to calibrate the
plan adjusted index rates. A projected age distribution for the projection period is applied to
the Federal age curve, giving projected average age factor of 1.420 which has been applied
uniformly across all plans. The projected age distribution is equal to the market age distribution
as reported in the Wakely National Simulation.
Age Band
Federal Age
Factor
Projection Period
Membership
Distribution
0-20 0.635 20.8%
21 1.000 1.1%
22 1.000 1.3%
23 1.000 1.5%
24 1.000 1.5%
25 1.004 1.4%
26 1.024 1.7%
27 1.048 1.8%
28 1.087 1.8%
29 1.119 1.8%
30 1.135 1.9%
31 1.159 2.0%
32 1.183 1.9%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
16 | P a g e
33 1.198 2.0%
34 1.214 2.0%
35 1.222 2.0%
36 1.230 1.9%
37 1.238 1.9%
38 1.246 1.9%
39 1.262 1.9%
40 1.278 2.0%
41 1.302 1.9%
42 1.325 2.0%
43 1.357 2.1%
44 1.397 2.1%
45 1.444 2.1%
46 1.500 1.8%
47 1.563 1.9%
48 1.635 1.8%
49 1.706 1.8%
50 1.786 2.0%
51 1.865 1.9%
52 1.952 2.0%
53 2.040 2.0%
54 2.135 1.9%
55 2.230 2.0%
56 2.333 1.8%
57 2.437 1.7%
58 2.548 1.7%
59 2.603 1.7%
60 2.714 1.8%
61 2.810 1.6%
62 2.873 1.3%
63 2.952 1.2%
64+ 3.000 1.9%
Geographic Factor Calibration
With recent growth, Moda Health has calculated different geographic factors for each rating
region. Area factors were calculated by comparing 2014 claims costs between each region for
the Commercial and Individual segments. The above factors reflect only a slight adjustment
from the 2015 Small Group area factors.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
17 | P a g e
Region Area
Factor
Percent of Membership
Region 1 1.000 32.2%
Region 2 0.965 22.8%
Region 3 0.965 11.8%
Region 4 1.040 11.5%
Region 5 1.000 8.7%
Region 6 1.030 6.7%
Region 7 1.040 6.3%
Weighted Average
(Calibration Factor) 0.997
The weighted average of the above factors is used to calibrate the Plan Adjusted Index Rates.
The membership distribution is the distribution of Moda Health Small Group members during
the experience period.
Consumer Adjusted Premium Rate Development
To arrive at the consumer adjusted premium rate, the Plan Adjusted Index Rate is divided by the
Age Curve Calibration Factor and the Geographic Calibration Factor and multiplied by the
Federal Age Factor, Region Area Factor, and adjustment for quarterly trend. Quarterly trend
adjustments are show in the table below. Since the Plan Adjusted Index rate is calculated from
the weighted average index rate, the adjustment for the first two quarters will be less than one.
Q1 Trend Adjustment 0.981
Q2 Trend Adjustment 0.994
Q3 Trend Adjustment 1.006
Q4 Trend Adjustment 1.019
See the sample calculation below for a 40 year old on the PPO 500 in Region 1 for Q2. Please
note that rates for each group member are developed using the calculations below. Group
premiums are billed on a composite basis follow state guidance.
(A) Plan Adjusted Index Rate $488.38
(B) Age Curve Calibration Factor 1.420
(C) Geographic Calibration Factor 0.997
(D) Calibrated Plan Adjusted Index Rate
(A/(B*C)) $344.85
(E) Area Factor (Region 1) 1.000
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
18 | P a g e
(F) Age Factor (Age 40) 1.278
(G) Quarter Adjustment (Q2) 0.994
(H) Consumer Adjusted Premium Rate
(D*E*F) $437.92
AV Metal Values
The AV Metal Values included in Worksheet 2 of the Part I Unified Rate Review Template are
entirely based on the Federal AV Calculator.
Plan Name Metal tier AV Metal Value
PPO Platinum 250 Platinum 88.2%
PPO Platinum 500 Platinum 88.0%
PPO 500 Gold 81.6%
PPO 1000A Gold 79.8%
PPO 1000B Gold 78.8%
PPO 1500 Gold 78.5%
PPO 2500 Silver 72.0%
PPO 3000 Silver 71.7%
PPO 3000 (Portland) Silver 71.7%
Value 1500 Silver 71.7%
Value 2000 Silver 71.1%
Value 2000 (Rose City) Silver 71.0%
Value 2500 Silver 70.6%
Value 3000 Silver 70.5%
Value 3500 Silver 70.3%
Value 5000 Silver 69.0%
Moda Health Connexus Aspire 2000 Silver 71.9%
Moda Health Connexus Aspire 2500 Silver 71.4%
Moda Health Connexus Fundamental
3500 Bronze 61.2%
Moda Health Connexus Fundamental
5000 Bronze 59.6%
Moda Health Connexus HSA 1500 Silver 72.0%
Moda Health Connexus HSA 2000 Silver 69.7%
Moda Health Connexus HSA 2500 Silver 68.1%
Moda Health Connexus HSA 3250 Bronze 61.9%
Moda Health Connexus Essence 5000 Bronze 62.0%
Moda Health Rose City Essence 5000 Bronze 62.0%
Moda Health Connexus Essence 6000 Bronze 61.4%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
19 | P a g e
Moda Health Connexus Basic 6500 Bronze 61.9%
Moda Health Connexus Basic 6500 Bronze 61.9%
Moda Health Synergy Exclusive 2000 Silver 71.0%
Moda Health Summit Exclusive 2000 Silver 71.0%
Moda Health Synergy Exclusive 5000 Bronze 62.0%
Moda Health Summit Exclusive 5000 Bronze 62.0%
PPO Platinum Synergy Exclusive 250 Platinum 88.2%
PPO Platinum Summit Exclusive 250 Platinum 88.2%
PPO Synergy Exclusive 1000A Gold 79.8%
PPO Summit Exclusive 1000A Gold 79.8%
Moda Health Oregon Standard Gold Gold 78.4%
Moda Health Oregon Standard Silver Silver 69.7%
Moda Health Oregon Standard Bronze Bronze 61.6%
AV Pricing Values
[Plan Adjusted Index Rate] Differences in the AV Pricing Values are based entirely on the
differences in cost-sharing designs of the plans, as allowed by 45 CFR part 156, §156.80(d).
Assumed differences in utilization are based on differences in the relative projected allowed as
developed within the Milliman pricing model. The model projects utilization patterns based on
historic, nationwide data, and is based primarily on differences in deductible level. No plan
specific adjustments have been made to account for health status. The AV Pricing Value
represents the cumulative effects of adjustments to move from the Market Adjusted Index Rate
to the Plan adjusted Index rate. The AV Pricing Values are calculated by dividing the Plan
Adjusted Index Rate by the Market Adjusted Index rate.
Plan Name
AV
Pricing
Value
PPO Platinum 250 1.162
PPO Platinum 500 1.147
PPO 500 1.085
PPO 1000A 1.054
PPO 1000B 1.052
PPO 1500 1.026
PPO 2500 0.922
PPO 3000 0.905
PPO 3000 (Portland) 0.905
Value 1500 0.921
Value 2000 0.890
Value 2000 (Rose City) 0.822
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
20 | P a g e
Value 2500 0.866
Value 3000 0.845
Value 3500 0.825
Value 5000 0.780
Moda Health Connexus Aspire 2000 0.883
Moda Health Connexus Aspire 2500 0.858
Moda Health Connexus Fundamental
3500 0.748
Moda Health Connexus Fundamental
5000 0.692
Moda Health Connexus HSA 1500 0.937
Moda Health Connexus HSA 2000 0.896
Moda Health Connexus HSA 2500 0.862
Moda Health Connexus HSA 3250 0.759
Moda Health Connexus Essence 5000 0.694
Moda Health Rose City Essence 5000 0.637
Moda Health Connexus Essence 6000 0.690
Moda Health Connexus Basic 6500 0.691
Moda Health Connexus Basic 6500 0.691
Moda Health Synergy Exclusive 2000 0.788
Moda Health Summit Exclusive 2000 0.815
Moda Health Synergy Exclusive 5000 0.617
Moda Health Summit Exclusive 5000 0.637
PPO Platinum Synergy Exclusive 250 1.054
PPO Platinum Summit Exclusive 250 1.093
PPO Synergy Exclusive 1000A 0.954
PPO Summit Exclusive 1000A 0.988
Moda Health Oregon Standard Gold 1.033
Moda Health Oregon Standard Silver 0.867
Moda Health Oregon Standard Bronze 0.704
Membership Projections
Membership projections are based on emerging 2015 Moda Health experience. The projection
includes assumptions that members currently on the 2015 Moda Health plans that will be
discontinued will move to the replacements for those plans and any new membership will have
the same distribution as members in early 2015.
Plan Name Members
PPO Platinum 250 145
PPO Platinum 500 145
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
21 | P a g e
PPO 500 2,895
PPO 1000A 2,316
PPO 1000B 1,737
PPO 1500 2,200
PPO 2500 2,605
PPO 3000 869
PPO 3000 (Portland) 579
Value 1500 1,158
Value 2000 1,447
Value 2000 (Rose City) 58
Value 2500 579
Value 3000 1,737
Value 3500 290
Value 5000 290
Moda Health Connexus Aspire 2000 2,026
Moda Health Connexus Aspire 2500 579
Moda Health Connexus Fundamental
3500 1,158
Moda Health Connexus Fundamental
5000 145
Moda Health Connexus HSA 1500 290
Moda Health Connexus HSA 2000 290
Moda Health Connexus HSA 2500 290
Moda Health Connexus HSA 3250 290
Moda Health Connexus Essence 5000 869
Moda Health Rose City Essence 5000 58
Moda Health Connexus Essence 6000 290
Moda Health Connexus Basic 6500 145
Moda Health Connexus Basic 6500 145
Moda Health Synergy Exclusive 2000 145
Moda Health Summit Exclusive 2000 145
Moda Health Synergy Exclusive 5000 145
Moda Health Summit Exclusive 5000 145
PPO Platinum Synergy Exclusive 250 145
PPO Platinum Summit Exclusive 250 145
PPO Synergy Exclusive 1000A 145
PPO Summit Exclusive 1000A 145
Moda Health Oregon Standard Gold 579
Moda Health Oregon Standard Silver 1,447
Moda Health Oregon Standard Bronze 145
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
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Terminated Products
The following plans were available in 2014 but were terminated for 2015:
PPO 500B
PPO 500C
PPO 1000C
The following plans were available in 2015, but will be terminated prior to 2016:
Beneficial 1500
Beneficial 2000
Beneficial 3500
Beneficial 4000
Beneficial 4500
Beneficial 5000
HSA 1500
HSA 2000
HSA 3000
HSA 4000
HSA 5000
Focus 2000
Focus 5000
Focus – Rose City 2000
Focus – Rose City 5000
Mapping of plans between 2015 and 2016 is shown below. This is the mapping used to
categorize experience on Worksheet 2 of the URRT as well as calculate the anticipated rate
increase.
2015 Plan 2016 Plan
PPO 500 PPO 500
PPO 1000A PPO 1000A
PPO 1000B PPO 1000B
PPO 1500 PPO 1500
PPO 2000 PPO 2500
PPO 3000 PPO 3000
Value 1500 Value 1500
Value 2000 Value 2000
Value 2500 Value 2500
Value 3000 Value 3000
Value 3500 Value 3500
Beneficial 1500 Moda Health Connexus Aspire 2000
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
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Beneficial 2000 Moda Health Connexus Aspire 2000
Focus 2000 Moda Health Connexus Aspire 2000
Beneficial 3500 Moda Health Connexus Fundamental 3500
Beneficial 4000 Moda Health Connexus Fundamental 3500
Beneficial 4500 Moda Health Connexus Essence 5000
Beneficial 5000 Moda Health Connexus Essence 5000
Focus 5000 Moda Health Connexus Essence 5000
HSA 1500 Moda Health Connexus HSA 1500
HSA 2000 Moda Health Connexus HSA 2000
HSA 3000 Moda Health Connexus HSA 2500
HSA 4000 Moda Health Connexus HSA 3250
Moda Health Oregon Standard Gold Moda Health Oregon Standard Gold
Moda Health Oregon Standard Silver Moda Health Oregon Standard Silver
Moda Health Oregon Standard Bronze Moda Health Oregon Standard Bronze
Plan Type
Most plans for the 2015 plan year are listed in Worksheet 2, Section I of the Part I Unified Rate
Review Template as “PPO”. Synergy and Summit plans most resemble a “POS” plan type.
Risk Corridor Demonstration
Please see the attached Risk Corridor Demonstration Exhibit for a detailed demonstration that
the projected rates yield a projected risk corridor receivable/payment of zero.
Peer Review Actuary Contact
Kirsten Staveland, ASA, MAAA
503-265-2976
Warning Alerts
None
Reliance
All data and assumptions, except those otherwise noted throughout this document, were
prepared by a team of Moda Health employees which includes the certifying actuary.
Actuarial Certification
I, Jennifer Halttunen, am an employee of Moda Health Plan, Inc. and am a member in good
standing of the American Academy of Actuaries.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
24 | P a g e
I have reviewed this rate filing and certify that the projected index rate is:
• In compliance with all applicable Oregon State and Federal Statutes and Regulations (45
CFR part 156, §156.80(d)(1))
• Developed in compliance with the applicable Actuarial Standards of Practice
• Reasonable in relation to the benefits provided and the population anticipated to be
covered
• Neither excessive nor deficient
I further certify that:
• The index rate and only allowable modifiers as described in 45 CFR part 156,
§156.80(d)(1) and 45 CFR part 156, §156.80(d)(2) were used to generate plan level rates
• The percent of total premium that represents essential health benefits included in
Worksheet 2, Sections III and IV were calculated in accordance with actuarial standards
of practice.
• The Federal AV Calculator was used to determine the AV Metal Values shown in
Worksheet 2 of the Part I Unified Rate Review Template for all plans.
All rates, calculations and values were developed accordance with generally accepted actuarial
principles and methodologies and in accordance with the Code of Professional Conduct and the
following Actuarial Standards of Practice:
• ASOP No. 5, Incurred Health and Disability Claims
• ASOP No. 8, Regulatory Filings for Health Plan Entities
• ASOP No. 12, Risk Classification
• ASOP No. 23, Data Quality
• ASOP No. 25, Credibility Procedures Applicable to Accident and Health, Group Term Life,
and Property/Casualty Coverages
• ASOP No. 26, Compliance with Statutory and Regulatory Requirements for the Actuarial
Certification of Small Employer Health Benefit Plans
• ASOP No. 41, Actuarial Communications
I meet the Academy qualification standards to render this opinion and am familiar with the
specific requirements of Oregon State and Federal Statutes and Regulations regarding the rating
and underwriting of small group health benefit plans.
_________________________________ __4/30/2015___
Signature Date
Jennifer Halttunen, ASA, MAAA
Supervisor – Pooled Products and Actuarial
Moda Health Plan, Inc.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
25 | P a g e
601 SW Second Ave.
Portland, OR 97204-3156
503-265-5733
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
1 | P a g e
General Information
Company Identifying Information
Company Legal Name: Moda Health Plan, Inc.
State: Oregon
HIOS Issuer ID: 39424
Market: Small Group
Effective Date: January 1, 2016
Company Contact Information
Primary Contact
Name: Henry Stender
Telephone Number: 503-228-6554 x1032
Email Address: [email protected]
Secondary Contact
Name: Jennifer Halttunen, ASA, MAAA
Telephone Number: 503-265-5733
Email Address: [email protected]
Proposed Rate Increase
The average rate increase for all members is 4.2%. The proposed rate increase varies by
product, plan, and rating area and rates in the filing vary by plan, age, and geographic area. The
federal age factor is used for age rating and the plan rating is detailed in the Plan Adjusted Index
Rate section. Geographic factors are shown in the Geographic Calibration section. The average
rate increase was calculated by comparing the weighted average premium for current members
on the 2015 plans and rates to the weighted average premium for current members on the 2016
plans and rates.
2015 $396.85
2016 $413.60
Rate Change 4.2%
The only adjustments included in the filed rate change is to adjustment from Moda experience
in 2014 to the market experience in 2014 as well as a benefit adjustment applied to the
transitional policies included in the experience period. There is no adjustment for the expansion
of the small group market from 1-50 to 1-100. The adjustments are discussed in more detail
below. The rates also include cost and utilization trends and changes in taxes and fees.
Differences in the rate change between products and plans are driven by an update to projected
paid to allowed ratios for renewing plans and mapping members from discontinued plans to
new plans. All plans impacted and member mapping is shown below. Variations in rate increase
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
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by area are the result of implementing new area factors. The change in area factors is a revenue
neutral change.
2015 Plan 2016 Plan
PPO 500 PPO 500
PPO 1000A PPO 1000A
PPO 1000B PPO 1000B
PPO 1500 PPO 1500
PPO 2000 PPO 2500
PPO 3000 PPO 3000
Value 1500 Value 1500
Value 2000 Value 2000
Value 2500 Value 2500
Value 3000 Value 3000
Value 3500 Value 3500
Beneficial 1500 Moda Health Connexus Aspire 2000
Beneficial 2000 Moda Health Connexus Aspire 2000
Focus 2000 Moda Health Connexus Aspire 2000
Beneficial 3500 Moda Health Connexus Fundamental 3500
Beneficial 4000 Moda Health Connexus Fundamental 3500
Beneficial 4500 Moda Health Connexus Essence 5000
Beneficial 5000 Moda Health Connexus Essence 5000
Focus 5000 Moda Health Connexus Essence 5000
HSA 1500 Moda Health Connexus HSA 1500
HSA 2000 Moda Health Connexus HSA 2000
HSA 3000 Moda Health Connexus HSA 2500
HSA 4000 Moda Health Connexus HSA 3250
Moda Health Oregon Standard Gold Moda Health Oregon Standard Gold
Moda Health Oregon Standard Silver Moda Health Oregon Standard Silver
Moda Health Oregon Standard Bronze Moda Health Oregon Standard Bronze
Experience Period Premium and Claims
Experience Period
Market: Oregon Small Group Medical and Prescription Drug plans
Incurred dates: January 1 through December 31, 2014
Paid through date: March 31, 2015
Premiums (net of MLR Rebate) in Experience Period
Earned premiums: $57,940,496
Member Months: 158,254
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
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MLR rebates refunded: $0
Anticipated MLR rebates: No MLR rebates are anticipated
Allowed and Incurred Claims Incurred During the Experience Period
Incurred paid claims: $42,402,514
Completed incurred paid claims: $43,080,384
Incurred allowed claims: $57,257,471
Completed incurred allowed claims: $58,126,655
Incurred but not paid claims: $677,870
• The experience period contains both single risk pool compliant and non-single risk pool
compliant plans. The only adjustment applies to the non-single risk pool compliant plans
is to account for EHBs that were not covered in the experience period.
• Experience for groups size 51-100 was not included in the experience period per the
2016 Unified Rate Review Instructions.
• Paid and allowed claims come directly from issuer’s claim records.
• IBNR is estimated monthly by the actuarial department and is modeled at the reserve
cell level. Key features distinguishing reserve cells include payer type (Medicare or
Commercial), state, funding type, and segment (group or individual business). The data
used in this analysis is reconciled to other financial reports to ensure validity. The
starting point for the actuarial analysis are completion factors produced by a proprietary
model using historical data. Because the model does not take into account such
important factors as payment cycles, changes in processing speed, or changes in claims
volume, the actuaries generally use the Bornhuetter-Ferguson (BF) method to produce
modified completion factors for recent months. The method for each reserve cell is set
ahead of time unless a one-off issue arises that makes this method inappropriate. The
actuaries then review the estimates for reasonableness and make adjustments using
actuarial judgment. This requires knowledge of changes in internal business practices,
other internal variables, and various calculated measures.
Benefit Categories
Claims are categorized using claim level service code and provider information to the categories
as specified in the 2016 Unified Rate Review Instructions.
Projection Factors
Changes in the Morbidity of the Population Insured: The 7.3% adjustment for the change
in the morbidity of the insured population adjusts from the morbidity of insured population in
the experience period to the morbidity of the 2014 Oregon Small Group market. Both Moda and
market factors were calculated using results from the Wakely National Simulation for all factors
used in the left side of the HHS risk transfer formula.
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
4 | P a g e
The transfer formula compares the difference in actual “morbidity results” between an issuer
and market with the difference in allowable rating factors, adjustment is meant to adjust the
actual experience of the issuer to the market level. Following this reasoning, we have used the
following calculation to compare Moda experience to Market experience:
����� � ��� � �� �����∑ �� �� ����� � ��� � ��� �������
11.1361.218 � 1.073
The 2014 Moda Health results from the full experience period (January through December) is
used as the base factor. This was compared to the completed 2014 market level results. Market
level results were completed using the assumption that all members were enrolled for the
duration of the year. This is consistent with the assumption that members will be continually
enrolled in future years.
Moving from 2014 to 2016, we do not project a change in the market morbidity factor despite
the expansion of small group from 1-50 to 1-100. Since Oregon is allowed transitional policies
for both 1-50 and 51-100 through October 2016, only the groups that would benefit from the
change will move into the market. Those with better risk (and subsequently lower rates
currently), will renew as transitional and/or early renew prior to October 2016. Overall the 51-
100 market has a lower morbidity factor that the 1-50 market. Considering the above selection,
we project the average morbidity of the groups entering the 2016 Small Group market will be
substantially equal to the 2014 market morbidity factor.
Where: %& � Transferforissuer/ 01222 � StateAveragePremium 0:;<& � Issuer/′splanliabilityriskscore EFG& � Issuer/′sinduceddemandfactor I;G& � Issuer/′sallowableratingfactor IK& � Issuer/′smetallevelactuarialvalue LMG& � Issuer/′sgeographiccostfactor 1& � Issuer/′sshareofStateenrollment, andthedenominatorissummed acrossallissuersintheriskpoolinthemarket + state
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
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Changes in Benefits: The only adjustment for benefits is to account for plans that did not
include prescription drug coverage and pediatric vision coverage in the experience period. The
detail for this calculation is in the Development of Benefit Adjustments Exhibit. The total impact
is 0.8%.
Changes in Demographics: An explicit adjustment for changes in demographics has not been
included in this filing. The analysis to adjust to the overall market morbidity includes impacts of
the demographics of both the experience data as well as the projected population in the PLRS
comparison. Including an additional adjustment would be redundant.
Other Adjustments: There are no other adjustments included in the filing.
Trend Factors (cost/utilization): [Development of Trend] Medical cost and utilization trends
are developed from Oregon Commercial group claims. The cost trends have been reviewed for
consistency with recent and anticipated changes in reimbursement rates and points of service.
Moda implements the same medical management techniques for both individual and group
segments corporately; so utilization trends are not expected to vary between these segments.
The annualized 2-year trend (over the last 2 years) is used for the utilization trend projections
for each of the medical service categories. The block of experience used in the analysis has
approximately 48,000 lives.
The Pharmacy cost trend is based on historic cost trends in Moda's Commercial pharmacy
network. The cost trends are broken out by drug type - Specialty, Traditional Generics, and
Traditional Brand. The annualized 2-year trend is used for the Specialty cost trend. Since the cost
data for Traditional drug spending is affected by a network price change starting in mid-2012,
the 2-year annualized trend is not used for traditional drugs. Instead the 1-year 2014/2013 trend
is used as the cost trend for traditional drugs. Traditional and Specialty cost trends are blended
together using current and projected spend levels to get the overall rx cost trend.
The Pharmacy utilization trend is also based on claims and enrollment from Commercial groups.
Moda Health uses the same utilization management techniques (formulary, prior authorization
programs) for group and individual segments corporately. Utilization is also broken out by drug
type - Specialty, Traditional Generics, and Traditional Brand. Annualized 2-year trends are used
to project the utilizations trends in each drug type.
Credibility Manual Rate Development
No manual rates were used.
Credibility of Experience
Due to the size of the block in the experience period, no credibility adjustments were used for
developing rates. Credibility of the medical experience period has been determined based on
the Medicare credibility formula:
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
6 | P a g e
� =P ��24,000
100% < P158,25424,000
This formula was ultimately chosen as it is it is a published and documented formula. The
formula was developed primarily for use in Medicare Advantage rate filings, which generally
have higher claims volume than a full commercial market. Given the margin by which the
minimum threshold for full credibility is exceeded, however, the difference in claims volume is
more than adequately compensated for.
Paid to Allowed Ratio
The 2014 Milliman Managed Care Rating Model (MCRM) was used as the basis to develop
expected allowed and paid claims for the varying cost sharing designs. Utilization adjustments
included in the model reflect the effect of cost sharing and benefit design. The MCRM was
calibrated to reflect cost and utilization experience of commercial business for Oregon. The
calibrated Rating Model, when populated with a benefit design, produces both projected
allowed and paid claims PMPM for benefit design. The model was run for each of the Moda
Health medical and pharmacy benefit designs.
Paid amounts produced in the MCRM model were adjusted for deductible leveraging using
Milliman factors.
Plan Name
Projected
Membership
Projected
Allowed
Projected
Paid
Deductible
Leveraging
Factor
Plan
Specific
Paid to
Allowed
PPO Platinum 250 145 $448.71 $416.01 1.006 93.2%
PPO Platinum 500 145 $448.71 $409.86 1.008 92.0%
PPO 500 2,895 $442.69 $382.31 1.008 87.0%
PPO 1000A 2,316 $442.69 $370.46 1.010 84.6%
PPO 1000B 1,737 $441.27 $368.58 1.010 84.4%
PPO 1500 2,200 $442.69 $359.93 1.012 82.3%
PPO 2500 2,605 $433.29 $315.42 1.016 74.0%
PPO 3000 869 $433.29 $309.50 1.016 72.6%
PPO 3000 (Portland) 579 $433.29 $309.50 1.016 72.6%
Value 1500 1,158 $438.91 $320.41 1.012 73.9%
Value 2000 1,447 $438.91 $308.76 1.014 71.4%
Value 2000 (Rose City) 58 $412.21 $286.43 1.014 70.5%
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
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Value 2500 579 $438.91 $299.96 1.016 69.4%
Value 3000 1,737 $438.91 $292.63 1.016 67.8%
Value 3500 290 $438.91 $285.96 1.016 66.2%
Value 5000 290 $438.91 $268.85 1.022 62.6%
Moda Health Connexus
Aspire 2000 2,026 $439.94 $307.33 1.014 70.9%
Moda Health Connexus
Aspire 2500 579 $439.94 $297.86 1.016 68.8%
Moda Health Connexus
Fundamental 3500 1,158 $446.16 $263.40 1.016 60.0%
Moda Health Connexus
Fundamental 5000 145 $446.16 $242.41 1.022 55.5%
Moda Health Connexus
HSA 1500 290 $448.00 $332.71 1.012 75.2%
Moda Health Connexus
HSA 2000 290 $448.00 $317.33 1.014 71.8%
Moda Health Connexus
HSA 2500 290 $448.00 $304.85 1.016 69.1%
Moda Health Connexus
HSA 3250 290 $446.16 $267.25 1.016 60.9%
Moda Health Connexus
Essence 5000 869 $442.98 $241.24 1.022 55.7%
Moda Health Rose City
Essence 5000 58 $416.28 $222.74 1.022 54.7%
Moda Health Connexus
Essence 6000 290 $442.98 $239.78 1.022 55.3%
Moda Health Connexus
Basic 6500 145 $446.16 $242.05 1.022 55.4%
Moda Health Connexus
Basic 6500 145 $446.16 $242.05 1.022 55.4%
Moda Health Synergy
Exclusive 2000 145 $408.82 $279.97 1.014 69.5%
Moda Health Summit
Exclusive 2000 145 $400.26 $273.31 1.014 69.3%
Moda Health Synergy
Exclusive 5000 145 $412.86 $219.67 1.022 54.4%
Moda Health Summit
Exclusive 5000 145 $404.22 $213.97 1.022 54.1%
PPO Platinum Synergy
Exclusive 250 145 $418.62 $386.68 1.006 92.9%
PPO Platinum Summit
Exclusive 250 145 $410.35 $378.72 1.006 92.8%
PPO Synergy Exclusive
1000A 145 $412.87 $343.41 1.010 84.0%
PPO Summit Exclusive 145 $404.60 $336.11 1.010 83.9%
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
8 | P a g e
1000A
Moda Health Oregon
Standard Gold 579 $446.09 $365.78 1.010 82.9%
Moda Health Oregon
Standard Silver 1,447 $441.79 $302.18 1.016 69.5%
Moda Health Oregon
Standard Bronze 145 $446.16 $246.44 1.022 56.4%
Risk Adjustment and Reinsurance
Experience Period Risk Adjustment and Reinsurance Adjustment PMPM:
For the experience period, the overall Risk Adjustment PMPM was estimated using the results of
the Wakely National Simulation for January through December and the HHS risk transfer
formula. The estimated risk adjustment payable is $3.73 PMPM for 2014.
Reinsurance does not apply to the Small Group market.
Projected Risk Adjustments PMPM
Moda Health has developed the rates for this risk pool assuming the projected insured
population morbidity is equivalent to the market average morbidity. No risk adjustments are
projected, only the Risk Adjustment user fee is included in this section of the URRT. Below is the
development of the market wide adjustment for Risk Adjustment in the development of the
Market Average Index Rate.
Risk Adjustment
(A) Risk Adjustment Program Fee, PMPM $0.15
(B) Projected Risk Adjustment recoveries/payments $0.00
(C) Recoveries net of premium, PMPM [B-A] -$0.15
(D) Paid to Allowed Ratio 74.5%
(E) Risk Adjustment (market-wide) [C/D] -$0.20
Projected ACA Reinsurance Recoveries Net of Reinsurance Premium (Individual
Market Only)
Below is the development of the market wide adjustment for the Reinsurance assessment in the
development of the Market Average Index Rate [Development of Market Adjusted Index Rate].
Federal Reinsurance
(A) Federal Reinsurance Program Premium -$2.25
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
9 | P a g e
(B) Recoveries net of Premium $0.00
(C) Paid to Allowed Ratio 74.5%
(D) Program Adjustment (market-wide) [B/C] -$3.02
Non-Benefit Expenses and Profit & Risk
Administrative Expense Load
[Exhibit 5] Administrative expenses are allocated based on total enrollment, with individual and
small group lines of business receiving higher weights than large group to account for the higher
costs of administering the policy versus a large group policy. The projected expenses for 2016
are $39.55 PMPM. Commissions are paid at 4.0% of premium and utilization of agents is
assumed to be 100%.
Profit (or Contribution to Surplus) & Risk Margin
Moda Health has built in a 2.5% margin and contribution to reserves, consistent with corporate
practice. In order to maintain solvency and adequate risk based capital levels, we believe it is
prudent for us to make a reasonable contribution to capital as we grow in the Oregon market. A
margin contribution of 2.5% of premium is reasonable and ensures that we are able to meet our
future financial obligations to our policyholders.
Taxes and Fees
Federal transitional reinsurance program and risk adjustment fees have not been included in
this section.
• Moda’s health insurer fee for 2016 was estimated from the ground up using internally
forecasted 2015 premium, the total national assessment of $11,300,000,000, and
estimated 2015 national premium base per an updated study from Oliver Wyman. To
arrive at Moda’s share of the assessment, the first $25,000,000 in premium and 50% of
the next $25,000,000 in premium was excluded as prescribed by law, and then divided
by the estimated national premium base. Moda’s total payable amount was then
calculated by multiplying the national assessment by Moda’s share of the national
assessment. To calculate the amount that must be collected, this amount was then
divided by .58 to account for 35% federal tax and 7% state tax. This final figure was
divided by internally forecasted 2016 premium to arrive at the percent of premium
charged to each policy in 2016.
• The PCORI fee is set by the Federal government.
PMPM % of premium
ACA issuer’s fee 3.5%
PCORI $0.20
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
10 | P a g e
• The Exchange User fee for Oregon is $9.66 PMPM. The assessment for members
enrolled through and exchange must be charged consistently for the inside and outside
market plans. Moda Health has estimated that 5% of the enrollment will come through
an exchange in 2016. The resulting $0.48 PMPM is included in premium. Below is the
development of the market wide adjustment for the exchange fee in the development
of the Market Average Index Rate [Development of Market Adjusted Index Rate].
Exchange User Fee Adjustment
(A) Exchange User Fee $9.66
(B) Exchange Enrollment Projection 5%
(C) Paid to Allowed Ratio 74.5%
(D) Exchange User Fee Adjustment (market-wide) [A*B/C] $0.65
Projected Loss Ratio
The projected loss ratio has been calculated using projected incurred claims net of risk
adjustment and reinsurance.
The projected MLR has been calculated using the methodology below.
MLR Calculation
(A) Incurred Claims $327.35
(B) Admin $39.55
(C) Commission $16.44
(D) Insurer Fee $14.39
(E) HCR - Funding of Patient-Centered Outcomes Research Fee $0.20
(F) Exchange User Fee $0.48
(G) Reinsurance Assessment $2.25
(H) Risk Adjustment User Fee $0.15
(I) Contribution to Overhead $10.28
(J) Total Premium Rate $411.09
MLR = A / (J-D-E-F-G-H)
MLR: 83.2%
Incurred Claims $327.35
Projected Premium $411.09
Projected Loss Ratio 79.6%
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
11 | P a g e
Single Risk Pool
In accordance with 45 CFR part 156, §156.80(d), the index rate that is effective January 1, 2016
for the Oregon Small Group market is based on the total allowed claims costs for providing
essential health benefits within the single risk pool of that market. The index rate shown on the
URRT is the weighted average of index rate for each quarter since Moda Health includes trend in
our rating. The weighted average index rate has been adjusted on a market-wide basis for the
state based on the total expected market-wide payments and charges under the risk adjustment
and reinsurance programs, and exchange user fees. The premium rate for all of the Moda Health
Oregon small group benefit plans use the applicable plan adjusted index rate, subject only to the
plan-level adjustments permitted. Premium rates for a particular plan may vary from its index
rate for a relevant market based only on the following actuarially justified plan-specific factors:
Plan-specific factors allowed and used in this filing
• The actuarial value and cost-sharing design of the plan.
• Administrative costs, excluding Exchange user fees.
• The plan's provider network, delivery system characteristics, and utilization
management practices.
• The benefits provided under the plan that are in addition to the essential health
benefits. These additional benefits must be pooled with similar benefits within the
single risk pool and the claims experience from those benefits must be utilized to
determine rate variations for plans that offer those benefits in addition to essential
health benefits.
Plan-specific factors allowed but not used in this filing
• With respect to catastrophic plans, the expected impact of the specific eligibility
categories for those plans.
Index Rate
Moda Health has developed a market-wide index rate for the Oregon small group market in
accordance with 45 CFR part 156, §156.80(d)(1). The following table shows the numerical
development of the index rate for the first quarter.
Index Rate Development Total
PMPM
(A) Experience Period Allowed Claims $ 361.81
(B-1) Completed Experience Period Allowed Claims $ 367.30
(B-2) Non-EHB Allowed Claims $ 5.56
(B) Experience Period Index Rate $ 361.74
(C) Trend 5.2%
(D) Trend Factor (1+C)^2 1.106
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
12 | P a g e
(E) Adjustment to Market Morbidity 1.073
(F) Benefits Adjustments 1.008
(G) Projected 2016 Market Allowed Claims
(A*C*D*F) $ 439.36
(H) Projected % Non-EHB Claims 0.03%
(I) Projection Period Index Rate [H/(1-I)] $ 437.89
Weighted Average Index Rate Development
(A) Annual Trend 5.2%
(B) Quarterly Trend Factor 1.013
(C) Q1 Index Rate $ 437.89
(D) Q2 Index Rate $ 443.47
(E) Q3 Index Rate $ 449.11
(F) Q4 Index Rate $ 454.82
(G) Weighted Average Index Rate $ 446.32
Experience Period Index Rate: The experience period index rate is equal to 98.5% of allowed
claims for the experience period. There are a limited number of non-single risk pool compliant
plans included in the experience period, but these plans cover substantially similar benefits to
the single risk pool compliant plans. The only non-EHB benefits included in the experience
period are for alternative care services.
Projection Period Index Rate: All adjustments to get from the experience period allowed claims
to the projected 2016 allowed claims have been previously discussed in the Projection Factors
section of this document. The only non-EHB benefits included in the projection period are for
alternative care services. Membership is assumed to be distributed through the year equally.
This assumption is used to calculate the weighted average index rate for the year above.
Moda Health does not provide any transitional or grand-fathered policies. The index rate will
change at uniform 3 month intervals and is applied uniformly to all products/plan combinations
in the single risk pool.
Market Adjusted Index Rate
[Market Adjusted Index Rates] The Market Adjusted Index Rate is calculated as the Index Rate
adjusted for the federal reinsurance program, risk adjustment, and exchange user fees. Since
the Market Adjusted Index Rate is based on allowed claims, the three market modifiers have
been applied at an allowed claims rate. The calculations of these adjustments are detailed in the
respective sections of this document.
Market Adjusted Index Rate
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
13 | P a g e
Index Rate $446.32
Federal Reinsurance Program Adjustment $3.02
Risk Adjustment $0.20
Exchange User Fee Adjustment $5.60
Market Adjusted Index Rate $450.19
Plan Adjusted Index Rates
[Plan Adjusted Index Rates] The Plan Adjusted Index Rates may vary from the Market Adjusted
Index Rate based on limited allowable plan level modifiers in accordance with 45 CFR part 156,
§156.80(d)(2). All adjustments were developed uniformly and consistently for all plans, using
the same methods and calculations. The allowable adjustments are:
• Actuarial value and cost sharing: As discussed in the Paid to Allowed Ratio section of
this document, relative allowed and paid claims were developed for each plan based on
actuarial value and cost sharing.
• Provider network, delivery system and utilization management: There are four
provider networks included in this filing. Since the experience period data is based on a
Connexus centered portfolio, those plans have a factor of 1. The Rose City network
factors have not changed from 2015 and factors were developed for Synergy and
Summit.
• Benefits in addition to the EHB’s: The only benefits in addition to EHB are alternative
care benefits. These are projected to be a small portion of the actual claims for the plans
where these are included.
• Distribution and administrative costs: Based on the projected membership distributions
to be discussed in the Membership Projections section, non-benefit expenses were
converted to a fixed percentage of expected paid claims, to be applied uniformly across
all plans. The resulting plan adjusted index rates represent the average demographic of
the Oregon Small Group single risk pool.
Plan Name Paid to
Allowed
Network Non-
EHBs
Catastrophic
Plan
Administrative
Costs
Plan
Adjusted
Index
Rate
PPO Platinum 250 93.24% 1.000 1.000 1.000 1.247 $523.31
PPO Platinum 500 92.04% 1.000 1.000 1.000 1.247 $516.55
PPO 500 87.02% 1.000 1.000 1.000 1.247 $488.38
PPO 1000A 84.56% 1.000 1.000 1.000 1.247 $474.59
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
14 | P a g e
PPO 1000B 84.40% 1.000 1.000 1.000 1.247 $473.70
PPO 1500 82.31% 1.000 1.000 1.000 1.247 $461.97
PPO 2500 73.98% 1.000 1.000 1.000 1.247 $415.18
PPO 3000 72.59% 1.000 1.000 1.000 1.247 $407.39
PPO 3000 (Portland) 72.59% 1.000 1.000 1.000 1.247 $407.39
Value 1500 73.90% 1.000 1.000 1.000 1.247 $414.78
Value 2000 71.35% 1.000 1.000 1.000 1.247 $400.46
Value 2000 (Rose City) 70.48% 0.935 1.000 1.000 1.247 $369.89
Value 2500 69.45% 1.000 1.000 1.000 1.247 $389.77
Value 3000 67.75% 1.000 1.000 1.000 1.247 $380.25
Value 3500 66.21% 1.000 1.000 1.000 1.247 $371.58
Value 5000 62.60% 1.000 1.000 1.000 1.247 $351.32
Moda Health Connexus
Aspire 2000
70.85% 1.000 1.000 1.000 1.247 $397.66
Moda Health Connexus
Aspire 2500
68.80% 1.000 1.000 1.000 1.247 $386.14
Moda Health Connexus
Fundamental 3500
59.99% 1.000 1.000 1.000 1.247 $336.71
Moda Health Connexus
Fundamental 5000
55.52% 1.000 1.000 1.000 1.247 $311.63
Moda Health Connexus
HSA 1500
75.18% 1.000 1.000 1.000 1.247 $421.97
Moda Health Connexus
HSA 2000
71.85% 1.000 1.000 1.000 1.247 $403.23
Moda Health Connexus
HSA 2500
69.15% 1.000 1.000 1.000 1.247 $388.09
Moda Health Connexus
HSA 3250
60.87% 1.000 1.000 1.000 1.247 $341.64
Moda Health Connexus
Essence 5000
55.65% 1.000 1.000 1.000 1.247 $312.35
Moda Health Rose City
Essence 5000
54.68% 0.935 1.000 1.000 1.247 $286.97
Moda Health Connexus
Essence 6000
55.32% 1.000 1.000 1.000 1.247 $310.46
Moda Health Connexus
Basic 6500
55.44% 1.000 1.000 1.000 1.247 $311.17
Moda Health Connexus
Basic 6500
55.44% 1.000 1.000 1.000 1.247 $311.17
Moda Health Synergy
Exclusive 2000
69.46% 0.911 1.000 1.000 1.247 $354.95
Moda Health Summit
Exclusive 2000
69.26% 0.944 1.000 1.000 1.247 $367.06
Moda Health Synergy
Exclusive 5000
54.37% 0.911 1.000 1.000 1.247 $277.86
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
15 | P a g e
Moda Health Summit
Exclusive 5000
54.10% 0.944 1.000 1.000 1.247 $286.70
PPO Platinum Synergy
Exclusive 250
92.90% 0.911 1.000 1.000 1.247 $474.72
PPO Platinum Summit
Exclusive 250
92.82% 0.944 1.000 1.000 1.247 $491.92
PPO Synergy Exclusive
1000A
84.05% 0.911 1.000 1.000 1.247 $429.50
PPO Summit Exclusive
1000A
83.94% 0.944 1.000 1.000 1.247 $444.88
Moda Health Oregon
Standard Gold
82.85% 1.000 1.000 1.000 1.247 $465.02
Moda Health Oregon
Standard Silver
69.51% 1.000 1.000 1.000 1.247 $390.11
Moda Health Oregon
Standard Bronze
56.45% 1.000 1.000 1.000 1.247 $316.81
Calibration
Age Curve Calibration
[Projected Age Distribution] The mandatory Federal age curve has been used to calibrate the
plan adjusted index rates. A projected age distribution for the projection period is applied to
the Federal age curve, giving projected average age factor of 1.420 which has been applied
uniformly across all plans. The projected age distribution is equal to the market age distribution
as reported in the Wakely National Simulation.
Age Band
Federal Age
Factor
Projection Period
Membership
Distribution
0-20 0.635 20.8%
21 1.000 1.1%
22 1.000 1.3%
23 1.000 1.5%
24 1.000 1.5%
25 1.004 1.4%
26 1.024 1.7%
27 1.048 1.8%
28 1.087 1.8%
29 1.119 1.8%
30 1.135 1.9%
31 1.159 2.0%
32 1.183 1.9%
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
16 | P a g e
33 1.198 2.0%
34 1.214 2.0%
35 1.222 2.0%
36 1.230 1.9%
37 1.238 1.9%
38 1.246 1.9%
39 1.262 1.9%
40 1.278 2.0%
41 1.302 1.9%
42 1.325 2.0%
43 1.357 2.1%
44 1.397 2.1%
45 1.444 2.1%
46 1.500 1.8%
47 1.563 1.9%
48 1.635 1.8%
49 1.706 1.8%
50 1.786 2.0%
51 1.865 1.9%
52 1.952 2.0%
53 2.040 2.0%
54 2.135 1.9%
55 2.230 2.0%
56 2.333 1.8%
57 2.437 1.7%
58 2.548 1.7%
59 2.603 1.7%
60 2.714 1.8%
61 2.810 1.6%
62 2.873 1.3%
63 2.952 1.2%
64+ 3.000 1.9%
Geographic Factor Calibration
With recent growth, Moda Health has calculated different geographic factors for each rating
region. Area factors were calculated by comparing 2014 claims costs between each region for
the Commercial and Individual segments. The above factors reflect only a slight adjustment
from the 2015 Small Group area factors.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
17 | P a g e
Region Area
Factor
Percent of Membership
Region 1 1.000 32.2%
Region 2 0.965 22.8%
Region 3 0.965 11.8%
Region 4 1.040 11.5%
Region 5 1.000 8.7%
Region 6 1.030 6.7%
Region 7 1.040 6.3%
Weighted Average
(Calibration Factor) 0.997
The weighted average of the above factors is used to calibrate the Plan Adjusted Index Rates.
The membership distribution is the distribution of Moda Health Small Group members during
the experience period.
Consumer Adjusted Premium Rate Development
To arrive at the consumer adjusted premium rate, the Plan Adjusted Index Rate is divided by the
Age Curve Calibration Factor and the Geographic Calibration Factor and multiplied by the
Federal Age Factor, Region Area Factor, and adjustment for quarterly trend. Quarterly trend
adjustments are show in the table below. Since the Plan Adjusted Index rate is calculated from
the weighted average index rate, the adjustment for the first two quarters will be less than one.
Q1 Trend Adjustment 0.981
Q2 Trend Adjustment 0.994
Q3 Trend Adjustment 1.006
Q4 Trend Adjustment 1.019
See the sample calculation below for a 40 year old on the PPO 500 in Region 1 for Q2. Please
note that rates for each group member are developed using the calculations below. Group
premiums are billed on a composite basis follow state guidance.
(A) Plan Adjusted Index Rate $488.38
(B) Age Curve Calibration Factor 1.420
(C) Geographic Calibration Factor 0.997
(D) Calibrated Plan Adjusted Index Rate
(A/(B*C)) $344.85
(E) Area Factor (Region 1) 1.000
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
18 | P a g e
(F) Age Factor (Age 40) 1.278
(G) Quarter Adjustment (Q2) 0.994
(H) Consumer Adjusted Premium Rate
(D*E*F) $437.92
AV Metal Values
The AV Metal Values included in Worksheet 2 of the Part I Unified Rate Review Template are
entirely based on the Federal AV Calculator.
Plan Name Metal tier AV Metal Value
PPO Platinum 250 Platinum 88.2%
PPO Platinum 500 Platinum 88.0%
PPO 500 Gold 81.6%
PPO 1000A Gold 79.8%
PPO 1000B Gold 78.8%
PPO 1500 Gold 78.5%
PPO 2500 Silver 72.0%
PPO 3000 Silver 71.7%
PPO 3000 (Portland) Silver 71.7%
Value 1500 Silver 71.7%
Value 2000 Silver 71.1%
Value 2000 (Rose City) Silver 71.0%
Value 2500 Silver 70.6%
Value 3000 Silver 70.5%
Value 3500 Silver 70.3%
Value 5000 Silver 69.0%
Moda Health Connexus Aspire 2000 Silver 71.9%
Moda Health Connexus Aspire 2500 Silver 71.4%
Moda Health Connexus Fundamental
3500 Bronze 61.2%
Moda Health Connexus Fundamental
5000 Bronze 59.6%
Moda Health Connexus HSA 1500 Silver 72.0%
Moda Health Connexus HSA 2000 Silver 69.7%
Moda Health Connexus HSA 2500 Silver 68.1%
Moda Health Connexus HSA 3250 Bronze 61.9%
Moda Health Connexus Essence 5000 Bronze 62.0%
Moda Health Rose City Essence 5000 Bronze 62.0%
Moda Health Connexus Essence 6000 Bronze 61.4%
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
19 | P a g e
Moda Health Connexus Basic 6500 Bronze 61.9%
Moda Health Connexus Basic 6500 Bronze 61.9%
Moda Health Synergy Exclusive 2000 Silver 71.0%
Moda Health Summit Exclusive 2000 Silver 71.0%
Moda Health Synergy Exclusive 5000 Bronze 62.0%
Moda Health Summit Exclusive 5000 Bronze 62.0%
PPO Platinum Synergy Exclusive 250 Platinum 88.2%
PPO Platinum Summit Exclusive 250 Platinum 88.2%
PPO Synergy Exclusive 1000A Gold 79.8%
PPO Summit Exclusive 1000A Gold 79.8%
Moda Health Oregon Standard Gold Gold 78.4%
Moda Health Oregon Standard Silver Silver 69.7%
Moda Health Oregon Standard Bronze Bronze 61.6%
AV Pricing Values
[Plan Adjusted Index Rate] Differences in the AV Pricing Values are based entirely on the
differences in cost-sharing designs of the plans, as allowed by 45 CFR part 156, §156.80(d).
Assumed differences in utilization are based on differences in the relative projected allowed as
developed within the Milliman pricing model. The model projects utilization patterns based on
historic, nationwide data, and is based primarily on differences in deductible level. No plan
specific adjustments have been made to account for health status. The AV Pricing Value
represents the cumulative effects of adjustments to move from the Market Adjusted Index Rate
to the Plan adjusted Index rate. The AV Pricing Values are calculated by dividing the Plan
Adjusted Index Rate by the Market Adjusted Index rate.
Plan Name
AV
Pricing
Value
PPO Platinum 250 1.162
PPO Platinum 500 1.147
PPO 500 1.085
PPO 1000A 1.054
PPO 1000B 1.052
PPO 1500 1.026
PPO 2500 0.922
PPO 3000 0.905
PPO 3000 (Portland) 0.905
Value 1500 0.921
Value 2000 0.890
Value 2000 (Rose City) 0.822
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
20 | P a g e
Value 2500 0.866
Value 3000 0.845
Value 3500 0.825
Value 5000 0.780
Moda Health Connexus Aspire 2000 0.883
Moda Health Connexus Aspire 2500 0.858
Moda Health Connexus Fundamental
3500 0.748
Moda Health Connexus Fundamental
5000 0.692
Moda Health Connexus HSA 1500 0.937
Moda Health Connexus HSA 2000 0.896
Moda Health Connexus HSA 2500 0.862
Moda Health Connexus HSA 3250 0.759
Moda Health Connexus Essence 5000 0.694
Moda Health Rose City Essence 5000 0.637
Moda Health Connexus Essence 6000 0.690
Moda Health Connexus Basic 6500 0.691
Moda Health Connexus Basic 6500 0.691
Moda Health Synergy Exclusive 2000 0.788
Moda Health Summit Exclusive 2000 0.815
Moda Health Synergy Exclusive 5000 0.617
Moda Health Summit Exclusive 5000 0.637
PPO Platinum Synergy Exclusive 250 1.054
PPO Platinum Summit Exclusive 250 1.093
PPO Synergy Exclusive 1000A 0.954
PPO Summit Exclusive 1000A 0.988
Moda Health Oregon Standard Gold 1.033
Moda Health Oregon Standard Silver 0.867
Moda Health Oregon Standard Bronze 0.704
Membership Projections
Membership projections are based on emerging 2015 Moda Health experience. The projection
includes assumptions that members currently on the 2015 Moda Health plans that will be
discontinued will move to the replacements for those plans and any new membership will have
the same distribution as members in early 2015.
Plan Name Members
PPO Platinum 250 145
PPO Platinum 500 145
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
21 | P a g e
PPO 500 2,895
PPO 1000A 2,316
PPO 1000B 1,737
PPO 1500 2,200
PPO 2500 2,605
PPO 3000 869
PPO 3000 (Portland) 579
Value 1500 1,158
Value 2000 1,447
Value 2000 (Rose City) 58
Value 2500 579
Value 3000 1,737
Value 3500 290
Value 5000 290
Moda Health Connexus Aspire 2000 2,026
Moda Health Connexus Aspire 2500 579
Moda Health Connexus Fundamental
3500 1,158
Moda Health Connexus Fundamental
5000 145
Moda Health Connexus HSA 1500 290
Moda Health Connexus HSA 2000 290
Moda Health Connexus HSA 2500 290
Moda Health Connexus HSA 3250 290
Moda Health Connexus Essence 5000 869
Moda Health Rose City Essence 5000 58
Moda Health Connexus Essence 6000 290
Moda Health Connexus Basic 6500 145
Moda Health Connexus Basic 6500 145
Moda Health Synergy Exclusive 2000 145
Moda Health Summit Exclusive 2000 145
Moda Health Synergy Exclusive 5000 145
Moda Health Summit Exclusive 5000 145
PPO Platinum Synergy Exclusive 250 145
PPO Platinum Summit Exclusive 250 145
PPO Synergy Exclusive 1000A 145
PPO Summit Exclusive 1000A 145
Moda Health Oregon Standard Gold 579
Moda Health Oregon Standard Silver 1,447
Moda Health Oregon Standard Bronze 145
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Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
22 | P a g e
Terminated Products
The following plans were available in 2014 but were terminated for 2015:
PPO 500B
PPO 500C
PPO 1000C
The following plans were available in 2015, but will be terminated prior to 2016:
Beneficial 1500
Beneficial 2000
Beneficial 3500
Beneficial 4000
Beneficial 4500
Beneficial 5000
HSA 1500
HSA 2000
HSA 3000
HSA 4000
HSA 5000
Focus 2000
Focus 5000
Focus – Rose City 2000
Focus – Rose City 5000
Mapping of plans between 2015 and 2016 is shown below. This is the mapping used to
categorize experience on Worksheet 2 of the URRT as well as calculate the anticipated rate
increase.
2015 Plan 2016 Plan
PPO 500 PPO 500
PPO 1000A PPO 1000A
PPO 1000B PPO 1000B
PPO 1500 PPO 1500
PPO 2000 PPO 2500
PPO 3000 PPO 3000
Value 1500 Value 1500
Value 2000 Value 2000
Value 2500 Value 2500
Value 3000 Value 3000
Value 3500 Value 3500
Beneficial 1500 Moda Health Connexus Aspire 2000
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
23 | P a g e
Beneficial 2000 Moda Health Connexus Aspire 2000
Focus 2000 Moda Health Connexus Aspire 2000
Beneficial 3500 Moda Health Connexus Fundamental 3500
Beneficial 4000 Moda Health Connexus Fundamental 3500
Beneficial 4500 Moda Health Connexus Essence 5000
Beneficial 5000 Moda Health Connexus Essence 5000
Focus 5000 Moda Health Connexus Essence 5000
HSA 1500 Moda Health Connexus HSA 1500
HSA 2000 Moda Health Connexus HSA 2000
HSA 3000 Moda Health Connexus HSA 2500
HSA 4000 Moda Health Connexus HSA 3250
Moda Health Oregon Standard Gold Moda Health Oregon Standard Gold
Moda Health Oregon Standard Silver Moda Health Oregon Standard Silver
Moda Health Oregon Standard Bronze Moda Health Oregon Standard Bronze
Plan Type
Most plans for the 2015 plan year are listed in Worksheet 2, Section I of the Part I Unified Rate
Review Template as “PPO”. Synergy and Summit plans most resemble a “POS” plan type.
Risk Corridor Demonstration
Please see the attached Risk Corridor Demonstration Exhibit for a detailed demonstration that
the projected rates yield a projected risk corridor receivable/payment of zero.
Peer Review Actuary Contact
Kirsten Staveland, ASA, MAAA
503-265-2976
Warning Alerts
None
Reliance
All data and assumptions, except those otherwise noted throughout this document, were
prepared by a team of Moda Health employees which includes the certifying actuary.
Actuarial Certification
I, Jennifer Halttunen, am an employee of Moda Health Plan, Inc. and am a member in good
standing of the American Academy of Actuaries.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
24 | P a g e
I have reviewed this rate filing and certify that the projected index rate is:
• In compliance with all applicable Oregon State and Federal Statutes and Regulations (45
CFR part 156, §156.80(d)(1))
• Developed in compliance with the applicable Actuarial Standards of Practice
• Reasonable in relation to the benefits provided and the population anticipated to be
covered
• Neither excessive nor deficient
I further certify that:
• The index rate and only allowable modifiers as described in 45 CFR part 156,
§156.80(d)(1) and 45 CFR part 156, §156.80(d)(2) were used to generate plan level rates
• The percent of total premium that represents essential health benefits included in
Worksheet 2, Sections III and IV were calculated in accordance with actuarial standards
of practice.
• The Federal AV Calculator was used to determine the AV Metal Values shown in
Worksheet 2 of the Part I Unified Rate Review Template for all plans.
All rates, calculations and values were developed accordance with generally accepted actuarial
principles and methodologies and in accordance with the Code of Professional Conduct and the
following Actuarial Standards of Practice:
• ASOP No. 5, Incurred Health and Disability Claims
• ASOP No. 8, Regulatory Filings for Health Plan Entities
• ASOP No. 12, Risk Classification
• ASOP No. 23, Data Quality
• ASOP No. 25, Credibility Procedures Applicable to Accident and Health, Group Term Life,
and Property/Casualty Coverages
• ASOP No. 26, Compliance with Statutory and Regulatory Requirements for the Actuarial
Certification of Small Employer Health Benefit Plans
• ASOP No. 41, Actuarial Communications
I meet the Academy qualification standards to render this opinion and am familiar with the
specific requirements of Oregon State and Federal Statutes and Regulations regarding the rating
and underwriting of small group health benefit plans.
_________________________________ __4/30/2015___
Signature Date
Jennifer Halttunen, ASA, MAAA
Supervisor – Pooled Products and Actuarial
Moda Health Plan, Inc.
Actuarial Memorandum and Certification
Moda Health Plan, Inc.
January 1, 2016 Oregon Small Group Rate Filing
25 | P a g e
601 SW Second Ave.
Portland, OR 97204-3156
503-265-5733
Rating Assumption Moda Health Plan, Inc.
Starting Point 2014 Small Group experience
Projected Member Months 347,391
Morbidity Changes 7.3%
Market Merger Impact 0.0%
Pent-up Demand 0.0%
Bad Debt Adjustments 0.0%
Net State & Federal Reinsurance Impact 0.0%
Risk Adjustment/Average Market Risk Impact 0.0%
Risk Corridor Impact 0.0%
2015 Net Paid Claims PMPM (prior filing) $303.17
2016 Net Paid Claims PMPM $329.75
Average Annual Rate Change 4.2%
Summary of Filed Rating Assumptions 2016 Non-Grandfathered, ACA Compliant Plans
Risk Corridor Calculation 2016 Projections Notes
Incurred Claims 113,717,789$ From Wkst 1
- Risk adjustment receivable (52,109)$ Assumed Market Avg
- Pharmacy rebates -$ Included above
Claims Costs 113,665,680$
Claims Costs 113,665,680$
+ Quality and HIT expenses 568,328$ As a percent based on 2014
Allowable Costs 114,234,009$
Premium 142,809,010$ From Wkst 1
- Allowable Costs (114,234,009)$
- Tax Liabilities 5,235,583$ From Wkst 1
- Administrative Costs 19,451,674$ From Wkst 1
Pre-Tax Profits 53,262,260$
Premium 142,809,010$
- Federal Income Tax (18,641,791)$
- Tax Liabilities 5,235,583$
After-tax premium earned 129,402,803$
Profit 34,620,469$
Profit Floor 6,470,140$
Calculated Profits 34,620,469$
Administrative Cost + Commission (19,451,674)$
Calculated Profits 34,620,469$
Administrative Cost Ceiling 28,468,617$
Calculated Administrative Costs 15,168,794$
Calculated Administrative Costs 15,168,794$
+ Tax Liabilities (5,235,583)$
+ Federal Income Tax 18,641,791$
Allowable Administrative Costs 28,575,002$
Target Amount 114,234,009$
Allowable Costs 114,234,009$
Risk Corridors Ratio 100.00%
Risk Corridors Recovery Percent 0.00%
Risk Corridors Receipt/(Payment) -$
DEVELOPMENT OF RATE CHANGES OR BASE RATE
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Experience Period (from January 1, 2014 to December 31, 2014)
Rating Period (January 1, 2016 to December 31, 2016)
Experience: Total PMPM % of Revenue
( A ) Experience Period Member Months 158,254
( B ) Expected Member Months in the Rating Period 347,391
( C ) Experience Period Premium $57,940,496 $366.12 100.0%
( D ) Experience Period Completed Incurred Claims $43,080,384 $272.22 74.4%
( E ) Experience Period Completed Allowed Claims $58,126,655 $367.30
( F ) Adjustments (Explain) $0
( G ) Adjusted Allowed Claims $58,126,655 $367.30
Experience Period Medical Loss Ratio ( D/C ) 74.4%
Claims development: Total PMPM
Adjusted Allowed Claims ( E ) $58,126,655 $367.30
( H ) Benefit Adjustment (Exhibit 7.2) 1.008
( I ) Network Adjustment 1.000
( J ) Average Market Risk Adjustment 1.073
( K ) Change in Market Morbidity Adjustment 1.000
( L ) Pricing Trend (Exhibit 4) 5.2%
( M ) Months of Trend 24
( N ) Trend Factor 1.106
( O ) Reinsurance Recoveries: State 1.000
( P ) Reinsurance Recoveries: Federal 1.000
( Q ) Plan Adjustment (Exhibit 9) 0.745
( R ) Projected Incurred Claims (E*H*I*J*K*N*O*P*Q) $51,804,149 $327.35
Admin Development (See Exhibit 5) Total PMPM % of Revenue
( S ) Administrative Expenses $13,739,314 $39.55 9.6%
( T ) Commissions $5,712,360 $16.44 4.0%
( U ) Taxes and Fees $6,069,322 $17.47 4.2%
( V ) Total Administrative Costs $25,520,996 $73.46 17.9%
Premium development Total PMPM
( W ) Experience Period Premium ( C ) $57,940,496 $366.12
( X ) Adjustments for Approved Rate Changes 1.130
( Y ) Adjusted Earned Premium $65,453,925 $413.60
Proposed Base Rate Development: Total PMPM % of Revenue
( Z ) Projected Incurred Claims $113,717,789 $327.35 79.6%
( AA ) Total Administrative Costs $25,520,996 $73.46 17.9%
( AB ) Margin $3,570,225 $10.28 2.5%
( AC ) Required Revenue $142,809,010 $411.09 100.0%
( AD ) Requested Base Rate $142,809,010 $411.09 100.0%
( AE ) Requested Rate Increase 4.2%
Target Medical Loss Ratio 79.6%
Federal MLR Calculation 83.2%
COVERED BENEFIT OR PLAN DESIGN CHANGES
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Covered benefit level changes
None
Member cost sharing changes
Plan Changes
Moda Health Oregon Standard Gold Deductible changed from $1,300 to $1,250
PPO 2500 Deductible changed from $2,000 to $2,500
PPO 500, PPO 1000A, PPO 1000B, PPO 1500 Out of Pocket Max Changed from $4,000 to $5,000
PPO 2500, PPO 3000, Value 1500, Value 2000, Value 2500, Value 3000, Value
3500
Out of Pocket Max Changed from $6,600 to $6,850
PPO 2500, PPO 3000 Plan coinsurance changed from 20% to 25%
PPO 500, PPO 1000A, PPO 1000B, PPO 1500, PPO 2500, PPO 3000, Value
1500, Value 2000, Value 2500, Value 3000, Value 3500
Emergency Room copay amount changed from $200 to $250
PPO 2500, PPO 3000 Emergency Room coinsurance amount changed form 20% to 25%
PPO 500, PPO 1000A, PPO 1000B, PPO 1500 Primary Care, Urgent Care, Alternative Care, Mental Health Office Visit changed from $15 to $20
PPO 2500, PPO 3000 Primary Care, Urgent Care, Alternative Care, Mental Health Office Visit changed from $25 to $30
PPO 500, PPO 1000A, PPO 1000B, PPO 1500 Specialist and Therapist copay changed from $30 to $40
PPO 2500, PPO 3000 Specialist and Therapist visits changed from $45 to $50
PPO 2500, PPO 3000, Value 1500, Value 2000, Value 2500, Value 3000, Value
3500
Generic drugs copay changed from $15 to $20
Elimination of plans
The following plans are considered eliminated:
Beneficial 1500
Beneficial 2000
Beneficial 3500
Beneficial 4000
Beneficial 4500
Beneficial 5000
HSA 1500
HSA 2000
HSA 3000
HSA 4000
HSA 5000
Focus 2000
Focus 5000
Focus - Rose City 2000
Focus - Rose City 5000
COVERED BENEFIT OR PLAN DESIGN CHANGES
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Implementation of new plan designs
The following plans are considered new:
PPO Platinum 250
PPO Platinum 500
PPO 3000
Value 2000 (Rose City)
Value 5000
Moda Health Connexus Aspire 2000
Moda Health Connexus Aspire 2500
Moda Health Connexus Fundamental 3500
Moda Health Connexus Fundamental 5000
Moda Health Connexus HSA 1500
Moda Health Connexus HSA 2000
Moda Health Connexus HSA 2500
Moda Health Connexus HSA 3250
Moda Health Connexus Essence 5000
Moda Health Rose City Essence 5000
Moda Health Connexus Essence 6000
Moda Health Connexus Basic 6500
Moda Health Connexus Basic 6500
Moda Health Synergy Exclusive 2000
Moda Health Summit Exclusive 2000
Moda Health Synergy Exclusive 5000
Moda Health Summit Exclusive 5000
PPO Platinum Synergy Exclusive 250
PPO Platinum Summit Exclusive 250
PPO Synergy Exclusive 1000A
PPO Summit Exclusive 1000A
Provider network changes
Synergy and Summit are new networks that will be offered in 2016.
New utilization of prior authorization programs
There have been no updates to utilization or prior authorization programs.
Changes to eligibility requirements
No changes
Changes to exclusions
No changes
Any other change in the plan offerings that impact costs or coverage provided
There are no other changes that impact costs or coverage provided.
All cost sharing changes were incorporated into the updated plan relativity modeling and specific impacts are not available. Updated plan relativities are detailed in Exhibit 6.
SUMMARY OF RATE INCREASES
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
2016 Rate Effective Date
Requested Annual
Rate Change From
Last Effective Date
Minimum
Rate Change
Maximum
Rate Change
Renewing
Members
January 4.9% 0.5% 24.3% 5,705
April (small group only) 4.8% 0.4% 24.2% 3,499
July (small group only) 4.7% 0.3% 24.1% 3,230
October (small group only) 4.6% 0.2% 24.0% 3,703
Total 4.9% 0.2% 24.3% 16,137
Distribution of rate changes (across all effective dates)
Rate increase Distribution Members
0-3% 44% 7,116
3-5% 26% 4,220
5-7% 11% 1,819
7-11% 4% 687
11-15% 6% 986
15-20% 6% 992
20-25% 2% 317
Total 100% 16,137
Estimate of Contributing Factors in Rate Request
Contributing Factors Magnitude of Impact
Trend 5.2%
Experience -0.9%
Administrative expenses -0.3%
Contribution to Overhead 0.0%
Change in Benefit Assumptions 0.3%
Change in age/area distribution 0.0%
Mandates 0.0%
Change in Fees and Taxes 0.0%
Morbidity 0.0%
Total 4.2%
The calculated 2016 effective rate of 4.9% show above will not reconcile with the effective rate of 4.2% below. The first
rate is weighted by member months while the latter is weighted premium.
TREND INFORMATION AND PROJECTION
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Moda Health Plan, Inc.
Utilization
Category
Average 12 month
Trend
Claim
WeightsInpatient 0.4% 25.4%Physician 0.4% 31.8%Other -0.3% 30.6%Rx 0.5% 12.2%
0.2%
Cost Trend
Category
Average 12 month
Trend
Claim
WeightsInpatient 5.0% 25.5%Physician 1.6% 32.0%Other 6.5% 30.3%Rx 10.0% 12.3%
5.0%Total Annual Trend
Utilization 100.2%Cost 105.0%Total 105.2%
Moda’s primary effort to identify and realize reductions in uncompensated care is the
development of the Beacon Network. This network is designed specifically as a statewide
network for Oregon Individual plans. With the reduction in the number of uninsured and the
expansion of the Individual market, Moda is focusing the potential savings in that market to
manage the costs. As such, there is no adjustment included in this filing.
TREND INFORMATION AND PROJECTION
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Month
Completed
Allowed Claims
PMPM
Normalized
Completed
Allowed Claims
PMPM
Rolling 12-Month
Average Normalized
Completed Allowed
PMPM
Historic Annual
Trend
2012-01 $302.51 $249.52
2012-02 $270.04 $222.92
2012-03 $352.09 $290.37
2012-04 $336.86 $277.85
2012-05 $320.64 $263.60
2012-06 $280.20 $230.70
2012-07 $271.43 $220.84
2012-08 $306.96 $246.73
2012-09 $245.33 $194.19
2012-10 $334.15 $262.21
2012-11 $306.95 $238.94
2012-12 $289.33 $222.84 $242.66
2013-01 $290.01 $218.78 $239.62
2013-02 $339.32 $254.50 $242.44
2013-03 $342.64 $256.66 $240.29
2013-04 $354.77 $264.27 $239.99
2013-05 $335.19 $248.88 $239.26
2013-06 $333.10 $246.52 $240.47
2013-07 $362.52 $266.47 $244.08
2013-08 $349.46 $256.05 $244.93
2013-09 $321.10 $234.71 $247.64
2013-10 $372.03 $271.87 $248.55
2013-11 $362.44 $264.21 $250.56
2013-12 $417.61 $304.88 $257.26 6.0%
2014-01 $363.35 $262.37 $260.95 8.9%
2014-02 $296.25 $212.50 $256.48 5.8%
2014-03 $315.35 $225.90 $253.20 5.4%
2014-04 $396.94 $284.56 $255.75 6.6%
2014-05 $375.60 $268.04 $257.58 7.7%
2014-06 $305.22 $216.23 $253.76 5.5%
2014-07 $358.90 $254.30 $252.96 3.6%
2014-08 $385.12 $273.11 $254.98 4.1%
2014-09 $407.14 $288.69 $259.83 4.9%
2014-10 $396.67 $280.66 $261.34 5.1%
2014-11 $348.81 $245.80 $259.61 3.6%
2014-12 $404.93 $284.16 $259.72 1.0%
Average Annual Trend 5.2%
STATEMENT OF ADMINISTRATIVE EXPENSES
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Expenses 2010 2011 2012 2013 2014 Fixed or Fixed or
PMPM PMPM PMPM PMPM PMPM Variable PMPM % of Premium Variable PMPM % of Premium
Salaries, Wages, Employment Taxes & Other Benefits $24.14 $25.50 $26.77 $26.76 $27.35 Variable $24.61 6.3% Variable $25.71 6.3%
Cost Depreciation: equipment, software, furniture, etc. $2.85 $2.85 $3.00 $3.39 $2.36 Fixed $2.12 0.5% Fixed $2.22 0.5%
Rent (Occupancy) $1.39 $1.33 $1.23 $2.54 $2.10 Fixed $1.89 0.5% Fixed $1.98 0.5%
Marketing & Advertising $0.23 $0.26 $0.37 $0.74 $1.93 Fixed $1.74 0.4% Fixed $1.82 0.4%
General Office Expenses: sundries, supplies, telephone, printing,
postage, etc. $1.49 $1.38 $1.23 $1.27 $3.93 Mostly Variable $3.54 0.9% Mostly Variable $3.70 0.9%
Third Party Administration Expenses or Fees or Other Group
Service Expense or Fees $1.01 $0.98 $0.99 $0.95 $1.03 Fixed $0.92 0.2% Fixed $0.97 0.2%
Legal Fees and Expenses & Other Professional or Consulting
Fees $0.49 $0.46 $0.53 $0.71 $2.95 Mostly Variable $2.65 0.7% Mostly Variable $2.77 0.7%Traveling Expenses $0.26 $0.32 $0.33 $0.38 $0.42 Variable $0.38 0.1% Variable $0.39 0.1%
Total Expenses Incurred $31.86 $33.08 $34.45 $36.75 $42.07 $37.86 9.7% $39.55 9.6%
Premium Retention 2010 2011 2012 2013 2014 Fixed or Fixed or
PMPM PMPM PMPM PMPM PMPM Variable PMPM % of Premium Variable PMPM % of Premium
Expenses (from above table) $31.86 $33.08 $34.45 $36.75 $42.07 $37.86 9.7% $39.55 9.6%
Commissions $141.80 $12.30 $13.37 $14.90 $16.49 Variable $17.51 4.5% Variable $16.44 4.0%
Insurer Fee $0.00 $0.00 $0.00 $0.00 $11.65 Variable 0.0% Variable $14.39 3.5%
Risk Adjustment Program Fee $0.00 $0.00 $0.00 $0.00 $0.08 Variable $0.15 0.0% Variable $0.15 0.0%
Oregon Supplemental Reinsurance program fee $0.00 $0.00 $0.00 $0.00 $3.86 Variable $3.50 0.9% Variable $0.00 0.0%
HCR - Funding of Patient-Centered Outcomes Research Fee $0.00 $0.00 $0.00 $0.00 $0.17 Variable $0.19 0.0% Variable $0.20 0.0%
ACA Federal Reinsurance Fee $0.00 $0.00 $0.00 $0.00 $5.25 Variable $3.67 0.9% Variable $2.25 0.5%
Oregon Exchange Fee $0.00 Variable $0.00 0.0% Variable $0.48 0.1%
Profit/Margin $10.28 2.5%
Total Premium Retention $173.66 $45.38 $47.82 $51.65 $79.57 $62.89 16.2% $83.74 20.4%
2015 Current Filing period
2015 Current Filing period
PLAN RELATIVITIES
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Plan ID Marketing Name Metal Tier
Plan
Actuarial
Value
AV
Calculator
Used
Previous
Filing Plan
Relativity
Plan Relativity
% change
in plan
relativity
Identify
quarter
and year
Benefit
Substitution(s)
Exchange
StatusGeographic Areas Offered
Pediatric
Dental
Embedded
1 39424OR1160007 PPO Platinum 250 Platinum 88.2% Yes N/A 1.162 N/A Q1 2016 No Both Statewide No
2 39424OR1160008 PPO Platinum 500 Platinum 88.0% Yes N/A 1.147 N/A Q1 2016 No Both Statewide No
3 39424OR1160001 PPO 500 Gold 81.6% Yes 1.065 1.085 1.9% Q1 2016 No Both Statewide No
4 39424OR1160002 PPO 1000A Gold 79.8% Yes 1.033 1.054 2.0% Q1 2016 No Both Statewide No
5 39424OR1160003 PPO 1000B Gold 78.8% Yes 1.027 1.052 2.5% Q1 2016 No Out Statewide No
6 39424OR1160004 PPO 1500 Gold 78.5% Yes 1.006 1.026 2.0% Q1 2016 No Both Statewide No
7 39424OR1160005 PPO 2500 Silver 72.0% Yes 0.926 0.922 -0.4% Q1 2016 No Out Statewide No
8 39424OR1160006 PPO 3000 Silver 71.7% Yes 0.884 0.905 2.4% Q1 2016 No Both 2,3,4,5,6,7 No
9 39424OR1160009 PPO 3000 Silver 71.7% Yes N/A 0.905 N/A Q1 2016 No Out 1 No
10 39424OR1170001 Value 1500 Silver 71.7% Yes 0.896 0.921 2.8% Q1 2016 No Out Statewide No
11 39424OR1170002 Value 2000 Silver 71.1% Yes 0.878 0.890 1.4% Q1 2016 No Out Statewide No
12 39424OR1170007 Value 2000 (Rose City) Silver 71.0% Yes N/A 0.822 N/A Q1 2016 No In 1 No
13 39424OR1170003 Value 2500 Silver 70.6% Yes 0.859 0.866 0.8% Q1 2016 No Out Statewide No
14 39424OR1170004 Value 3000 Silver 70.5% Yes 0.842 0.845 0.3% Q1 2016 No Out Statewide No
15 39424OR1170005 Value 3500 Silver 70.3% Yes 0.826 0.825 -0.1% Q1 2016 No Out Statewide No
16 39424OR1170006 Value 5000 Silver 69.0% Yes N/A 0.780 N/A Q1 2016 No Out Statewide No
17 39424OR1340001 Moda Health Connexus Aspire 2000 Silver 71.9% Yes N/A 0.883 N/A Q1 2016 No Out Statewide No
18 39424OR1340002 Moda Health Connexus Aspire 2500 Silver 71.4% Yes N/A 0.858 N/A Q1 2016 No Both Statewide No
19 39424OR1360001 Moda Health Connexus Fundamental 3500 Bronze 61.2% Yes N/A 0.748 N/A Q1 2016 No Both Statewide No
20 39424OR1360002 Moda Health Connexus Fundamental 5000 Bronze 59.6% Yes N/A 0.692 N/A Q1 2016 No Out Statewide No
21 39424OR1520001 Moda Health Connexus HSA 1500 Silver 72.0% Yes N/A 0.937 N/A Q1 2016 No Both Statewide No
22 39424OR1520002 Moda Health Connexus HSA 2000 Silver 69.7% Yes N/A 0.896 N/A Q1 2016 No Out Statewide No
23 39424OR1520003 Moda Health Connexus HSA 2500 Silver 68.1% Yes N/A 0.862 N/A Q1 2016 No Out Statewide No
24 39424OR1510001 Moda Health Connexus HSA 3250 Bronze 61.9% Yes N/A 0.759 N/A Q1 2016 No Both Statewide No
25 39424OR1410001 Moda Health Connexus Essence 5000 Bronze 62.0% Yes N/A 0.694 N/A Q1 2016 No Out Statewide No
26 39424OR1410002 Moda Health Rose City Essence 5000 Bronze 62.0% Yes N/A 0.637 N/A Q1 2016 No In 1 No
27 39424OR1410003 Moda Health Connexus Essence 6000 Bronze 61.4% Yes N/A 0.690 N/A Q1 2016 No Out Statewide No
28 39424OR1450001 Moda Health Connexus Basic 6500 Bronze 61.9% Yes N/A 0.691 N/A Q1 2016 No Both 2,3,4,5,6,7 No
29 39424OR1450002 Moda Health Connexus Basic 6500 Bronze 61.9% Yes N/A 0.691 N/A Q1 2016 No Out 1 No
30 39424OR1550001 Moda Health Synergy Exclusive 2000 Silver 71.0% Yes N/A 0.788 N/A Q1 2016 No Both 1,2,3,4 (partial), 5, 6 (partial), 7 No
31 39424OR1550002 Moda Health Summit Exclusive 2000 Silver 71.0% Yes N/A 0.815 N/A Q1 2016 No Both 4 (partial) and 6 (partial) No
32 39424OR1530001 Moda Health Synergy Exclusive 5000 Bronze 62.0% Yes N/A 0.617 N/A Q1 2016 No Both 1,2,3,4 (partial), 5, 6 (partial), 7 No
33 39424OR1530002 Moda Health Summit Exclusive 5000 Bronze 62.0% Yes N/A 0.637 N/A Q1 2016 No Both 4 (partial) and 6 (partial) No
34 39424OR1540001 PPO Platinum Synergy Exclusive 250 Platinum 88.2% Yes N/A 1.054 N/A Q1 2016 No Both 1,2,3,4 (partial), 5, 6 (partial), 7 No
35 39424OR1540002 PPO Platinum Summit Exclusive 250 Platinum 88.2% Yes N/A 1.093 N/A Q1 2016 No Both 4 (partial) and 6 (partial) No
36 39424OR1540003 PPO Synergy Exclusive 1000A Gold 79.8% Yes N/A 0.954 N/A Q1 2016 No Both 1,2,3,4 (partial), 5, 6 (partial), 7 No
37 39424OR1540004 PPO Summit Exclusive 1000A Gold 79.8% Yes N/A 0.988 N/A Q1 2016 No Both 4 (partial) and 6 (partial) No
38 39424OR1220001 Moda Health Oregon Standard Gold Gold 78.4% Yes 1.021 1.033 1.2% Q1 2016 No Both Statewide No
39 39424OR1220002 Moda Health Oregon Standard Silver Silver 69.7% Yes 0.867 0.867 0.0% Q1 2016 No Both Statewide No
40 39424OR1230001 Moda Health Oregon Standard Bronze Bronze 61.6% Yes 0.637 0.704 10.4% Q1 2016 No Both Statewide No
Plan relativities for 2016 include modeling updates, deductible leveraging, and cost sharing changes. Since benefit modifications were included in the updated modeling, specific impacts are not broken out. A summary of benefit
changes is available in Exhibit 2.
ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Moda Health Plan, Inc.
ASSETSCurrent Year Prior Year
1
Assets
2
Nonadmitted Assets
3Net Admitted Assets
(Cols. 1 - 2)
4Net Admitted
Assets
1. Bonds (Schedule D) ��������� ��������� ����������
2. Stocks (Schedule D):
2.1 Preferred stocks
2.2 Common stocks ��������� ��������� ����������
3. Mortgage loans on real estate (Schedule B):
3.1 First liens
3.2 Other than first liens
4. Real estate (Schedule A):
4.1 Properties occupied by the company (less $
encumbrances)
4.2 Properties held for the production of income (less
$ encumbrances)
4.3 Properties held for sale (less $
encumbrances)
5. Cash ($ ����������� , Schedule E - Part 1), cash equivalents
($ , Schedule E - Part 2) and short-term
investments ($ ������� , Schedule DA) ��������� ��������� �����������
6. Contract loans, (including $ premium notes)
7. Derivatives (Schedule DB)
8. Other invested assets (Schedule BA) �������� �������� ����������
9. Receivables for securities ������� �������
10. Securities lending reinvested collateral assets (Schedule DL)
11. Aggregate write-ins for invested assets
12. Subtotals, cash and invested assets (Lines 1 to 11) ��������� ��������� ���������
13. Title plants less $ charged off (for Title insurers
only)
14. Investment income due and accrued ������ ������ �����
15. Premiums and considerations:
15.1 Uncollected premiums and agents' balances in the course of collection �������� �������� ���������
15.2 Deferred premiums, agents' balances and installments booked but
deferred and not yet due (including $
earned but unbilled premiums)
15.3 Accrued retrospective premiums ��������� ���������
16. Reinsurance:
16.1 Amounts recoverable from reinsurers ���������� ���������� ���������
16.2 Funds held by or deposited with reinsured companies
16.3 Other amounts receivable under reinsurance contracts
17. Amounts receivable relating to uninsured plans ��������� ��������� ����������
18.1 Current federal and foreign income tax recoverable and interest thereon
18.2 Net deferred tax asset �������� ��������
19. Guaranty funds receivable or on deposit
20. Electronic data processing equipment and software ���������� ����������
21. Furniture and equipment, including health care delivery assets
($ )
22. Net adjustment in assets and liabilities due to foreign exchange rates
23. Receivables from parent, subsidiaries and affiliates ���������� ���������� ��������
24. Health care ($ �������� ) and other amounts receivable �������� �������� �������� ������
25. Aggregate write-ins for other than invested assets ��������� ����� �������� �������
26. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines 12 to 25) ����������� ��������� ���������� ����������
27. From Separate Accounts, Segregated Accounts and Protected Cell Accounts
28. Total (Lines 26 and 27) ����������� ��������� ���������� ����������
DETAILS OF WRITE-INS
1101.
1102.
1103.
1198. Summary of remaining write-ins for Line 11 from overflow page
1199. Totals (Lines 1101 thru 1103 plus 1198)(Line 11 above)
2501. ��������������������� ����� �����
2502. ����� ����!�"��� ������� ������� �������
2503. ��#$�%���&��� ����!�"�� ��������� ���������
2598. Summary of remaining write-ins for Line 25 from overflow page
2599. Totals (Lines 2501 thru 2503 plus 2598)(Line 25 above) ��������� ����� �������� �������
2
ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Moda Health Plan, Inc.
LIABILITIES, CAPITAL AND SURPLUSCurrent Year Prior Year
1
Covered
2
Uncovered
3
Total
4
Total
1. Claims unpaid (less $ ����������� reinsurance ceded) ���������� ��������� ���������� ����������
2. Accrued medical incentive pool and bonus amounts � � � �
3. Unpaid claims adjustment expenses ��������� ������� ���������� ���������
4. Aggregate health policy reserves, including the liability of
$ � for medical loss ratio rebate per the Public
Health Service Act ��������� � ��������� ���������
5. Aggregate life policy reserves � � � �
6. Property/casualty unearned premium reserves � � � �
7. Aggregate health claim reserves � � � �
8. Premiums received in advance ����������� � ����������� ��������
9. General expenses due or accrued ��������� � ��������� ���������
10.1 Current federal and foreign income tax payable and interest thereon
(including $ ��������� on realized capital gains (losses)) ��������� � ��������� ���������
10.2 Net deferred tax liability � � � ����
11. Ceded reinsurance premiums payable ���������� � ���������� �
12. Amounts withheld or retained for the account of others ������� � ������� ��������
13. Remittances and items not allocated � � � �
14. Borrowed money (including $ � current) and
interest thereon $ � (including
$ � current) � � � �
15. Amounts due to parent, subsidiaries and affiliates ������ � ������ ����������
16. Derivatives � � � �
17. Payable for securities ��������� � ��������� ������
18. Payable for securities lending � � � �
19. Funds held under reinsurance treaties (with $ �
authorized reinsurers, $ � unauthorized
reinsurers and $ � certified reinsurers) � � � �
20. Reinsurance in unauthorized and certified ($ �
companies � � � �
21. Net adjustments in assets and liabilities due to foreign exchange rates � � � �
22. Liability for amounts held under uninsured plans ���������� � ���������� ����������
23. Aggregate write-ins for other liabilities (including $ �
current) ��������� � ��������� �������
24. Total liabilities (Lines 1 to 23) ������������ �������� ����������� �����������
25. Aggregate write-ins for special surplus funds XXX XXX ���������� �
26. Common capital stock XXX XXX ���������� ����������
27. Preferred capital stock XXX XXX � �
28. Gross paid in and contributed surplus XXX XXX ���������� ����������
29. Surplus notes XXX XXX ����������� �����������
30. Aggregate write-ins for other than special surplus funds XXX XXX � �
31. Unassigned funds (surplus) XXX XXX ��������� ����������
32. Less treasury stock, at cost:
32.1 � shares common (value included in Line 26
$ � ) XXX XXX � �
32.2 � shares preferred (value included in Line 27
$ � ) XXX XXX � �
33. Total capital and surplus (Lines 25 to 31 minus Line 32) XXX XXX ������������ ��������
34. Total liabilities, capital and surplus (Lines 24 and 33) XXX XXX ����������� �����������
DETAILS OF WRITE-INS
2301. ������������������� �������� � �������� �������
2302. ��� �!�"#�����������$��� ���������� � ���������� �
2303. � � � � �
2398. Summary of remaining write-ins for Line 23 from overflow page � � � �
2399. Totals (Lines 2301 thru 2303 plus 2398)(Line 23 above) ��������� � ��������� �������
2501. %#���#���������������&���'(�!'!�%�����������)��� XXX XXX ���������� �
2502. � XXX XXX � �
2503. � XXX XXX � �
2598. Summary of remaining write-ins for Line 25 from overflow page XXX XXX � �
2599. Totals (Lines 2501 thru 2503 plus 2598)(Line 25 above) XXX XXX ���������� �
3001. � XXX XXX � �
3002. � XXX XXX � �
3003. � XXX XXX � �
3098. Summary of remaining write-ins for Line 30 from overflow page XXX XXX � �
3099. Totals (Lines 3001 thru 3003 plus 3098)(Line 30 above) XXX XXX � �
3
ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Moda Health Plan, Inc.
STATEMENT OF REVENUE AND EXPENSES Current Year Prior Year
1Uncovered
2Total
3Total
1. Member Months XXX ���������� �������
2. Net premium income ( including $ � non-health premium income) XXX ����������� �����������
3. Change in unearned premium reserves and reserve for rate credits XXX ������ ��������
4. Fee-for-service (net of $ � medical expenses) XXX � �
5. Risk revenue XXX � �
6. Aggregate write-ins for other health care related revenues XXX � �
7. Aggregate write-ins for other non-health revenues XXX � �
8. Total revenues (Lines 2 to 7) XXX ��������� ������������
Hospital and Medical:
9. Hospital/medical benefits � ���������� �����������
10. Other professional services � ����������� ����������
11. Outside referrals � ���������� ���������
12. Emergency room and out-of-area � ���������� ���������
13. Prescription drugs � ��������� ���������
14. Aggregate write-ins for other hospital and medical � � �
15. Incentive pool, withhold adjustments and bonus amounts � � �
16. Subtotal (Lines 9 to 15) � ��������� �����������
Less:
17. Net reinsurance recoveries � ��������� ��������
18. Total hospital and medical (Lines 16 minus 17) � ����������� ������������
19. Non-health claims (net) � � �
20. Claims adjustment expenses, including $ ���������� cost containment expenses � ��������� �������
21. General administrative expenses � ���������� ��������
22. Increase in reserves for life and accident and health contracts (including $ �
increase in reserves for life only) � � �
23. Total underwriting deductions (Lines 18 through 22) � ����������� �����������
24. Net underwriting gain or (loss) (Lines 8 minus 23) XXX �������� �������
25. Net investment income earned (Exhibit of Net Investment Income, Line 17) � ��������� �������
26. Net realized capital gains (losses) less capital gains tax of $ �������� � ������ ������
27. Net investment gains (losses) (Lines 25 plus 26) � ��������� ���������
28. Net gain or (loss) from agents’ or premium balances charged off [(amount recovered
$ � ) (amount charged off $ � )] � � �
29. Aggregate write-ins for other income or expenses � ���� �������
30. Net income or (loss) after capital gains tax and before all other federal income taxes (Lines 24 plus 27 plus 28 plus 29) XXX �������� ��������
31. Federal and foreign income taxes incurred XXX �������� ��������
32. Net income (loss) (Lines 30 minus 31) XXX ��������� ��������
DETAILS OF WRITE-INS
0601. � XXX � �
0602. � XXX � �
0603 � XXX � �
0698. Summary of remaining write-ins for Line 6 from overflow page XXX � �
0699. Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) XXX � �
0701. � XXX � �
0702. � XXX � �
0703 � XXX � �
0798. Summary of remaining write-ins for Line 7 from overflow page XXX � �
0799. Totals (Lines 0701 thru 0703 plus 0798)(Line 7 above) XXX � �
1401. � � � �
1402. � � � �
1403. � � � �
1498. Summary of remaining write-ins for Line 14 from overflow page � � �
1499. Totals (Lines 1401 thru 1403 plus 1498)(Line 14 above) � � �
2901. ��������������������� � ������ �������
2902. ������������������� � ������ ������
2903 � � � �
2998. Summary of remaining write-ins for Line 29 from overflow page � � �
2999. Totals (Lines 2901 thru 2903 plus 2998)(Line 29 above) � ���� �������
4
��������������������������������������������������������������������SUPPLEMENT FOR THE YEAR 2014 OF THE Moda Health Plan, Inc.
SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1(To Be Filed by April 1 - Not for Rebate Purposes)
REPORT FOR: 1. CORPORATION Moda Health Plan, Inc. 2. 601 SW Second Ave Portland, OR 97204 (LOCATION)
NAIC Group Code 1313 BUSINESS IN THE STATE OF Oregon DURING THE YEAR 2014 NAIC Company Code 47098 Business Subject to MLR 10 11 12 13 14 15
Comprehensive Health Coverage Mini-Med Plans Expatriate Plans 91
Individual
2SmallGroup
Employer
3LargeGroup
Employer
4
Individual
5SmallGroup
Employer
6LargeGroup
Employer
7
SmallGroup
8
LargeGroup
StudentHealthPlans
GovernmentBusiness
(excluded by statute)
OtherHealth
BusinessAggregate(2% rule)
Subtotal(Cols. 1
through 12)Uninsured
PlansTotal
13 + 14
1. Premium:
1.1 Health premiums earned (From Part 2, Line 1.11) ������������ �������� ����������� � � � � � � ����������� ������� � ������� XXX �������
1.2 Federal high risk pools � � � � � � � � � � � � � XXX �
1.3 State high risk pools � � � � � � � � � � � � � XXX �
1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) ������������ �������� ����������� � � � � � � ����������� ������� � ������� XXX �������
1.5 Federal taxes and federal assessments ������� ��������� ������� � � � � � � ������� ��������� � ��������� �������� ���������
1.6 State insurance, premium and other taxes (Similar local taxes of
$ � ) ����� ������ ������� � � � � � � ������ ������ � ������� ������� ���������
1.6a Community Benefit Expenditures (informational only) � � � � � � � � � � � � � � �
1.7 Regulatory authority licenses and fees ���������� �������� ���������� � � � � � � � � � ��������� � ���������
1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) ����������� ��������� ����������� � � � � � � ����������� ���������� � ���������� XXX �����������
1.9 Net Assumed less Ceded reinsurance premiums earned ��������� ������ �������� � � � � � � ������ �������� � ��������� XXX ���������
1.10 Other Adjustments due to MLR calculations - Premiums � � � � � � � � � � � � � XXX �
1.11 Risk Revenue � � � � � � � � � � � � � XXX �
1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) ������������ �������� ������������ � � � � � � ����������� �������� � ��������� XXX �����������
2. Claims:
2.1 Incurred claims excluding prescription drugs ���������� ���������� ���������� � � � � � � ���������� ��������� � ��������� XXX ���������
2.2 Prescription drugs ��������� ��������� �������� � � � � � � ��������� �������� � ����������� XXX �����������
2.3 Pharmaceutical rebates ������� ������ �������� � � � � � � ������ � � ����� XXX �����
2.4 State stop loss, market stabilization and claim/census based assessments (informational only) � � � � � � � � � � � � � XXX �
3. Incurred medical incentive pools and bonuses � � � � � � � � � � � � � XXX �
4. Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) � � � � � � � � � � � � � � �
5. 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) �������� ������� ���������� � � � � � � ���������� ������� � ������������ XXX ������������
5.1 Net Assumed less Ceded reinsurance claims incurred ������������ ����� ������� � � � � � � � ������� � ����������� XXX �����������
5.2 Other Adjustments due to MLR calculations - Claims � � � � � � � � � � � � � XXX �
5.3 Rebates paid � � � � � � � � � XXX XXX XXX � XXX �
5.4 Estimated rebates unpaid prior year � � � � � � � � � XXX XXX XXX � XXX �
5.5 Estimated rebates unpaid current year � � � � � � � � � XXX XXX XXX � XXX �
5.6 Fee for service and co-pay revenue � � � � � � � � � � � � � XXX �
5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) ���������� �������� ���������� � � � � � � ���������� ��������� � ��������� XXX ���������
216-1
.OR
SUPPLEMENT FOR THE YEAR 2014 OF THE Moda Health Plan, Inc.
SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued)Business Subject to MLR 10 11 12 13 14 15
Comprehensive Health Coverage Mini-Med Plans Expatriate Plans 91
Individual
2SmallGroup
Employer
3LargeGroup
Employer
4
Individual
5SmallGroup
Employer
6LargeGroup
Employer
7
SmallGroup
8
LargeGroup
StudentHealthPlans
GovernmentBusiness
(excluded by statute)
OtherHealth
BusinessAggregate(2% rule)
Subtotal(Cols. 1
through 12)Uninsured
PlansTotal
13 + 14
6. Improving Health Care Quality Expenses Incurred:
6.1 Improve health outcomes ���������� �������� ����� � � � � � � ������ ������� � ���������� ��������� ��������
6.2 Activities to prevent hospital readmissions �������� ������ ��� � � � � � � ��� ������ � ������� ���� �������
6.3 Improve patient safety and reduce medical errors ������ ������ ������ � � � � � � ���� ������ � ������� ������ ������
6.4 Wellness and health promotion activities ������� ������ ������ � � � � � � ����� ������ � �������� ������ ����
6.5 Health Information Technology expenses related to health improvement ������� ������ �������� � � � � � � ������� ����� � ������� ��������� ���������
6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) ��������� ���� ������ � � � � � � ������ ������ � ������ �������� ���������
7. Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6)/Line 1.8 � ���� � ��� � ���� � ���� � ���� � ���� � ���� � ���� � ���� XXX XXX XXX XXX XXX XXX
8. Claims Adjustment Expenses:
8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 ���������� �������� �������� � � � � � � ����� ������ � ��������� �������� ��������
8.2 All other claims adjustment expenses ���������� ��������� ��������� � � � � � � ������� ������ � ����������� �������� �������
8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) ������� ��������� �������� � � � � � � ������� �������� � ���������� ���������� ����������
9. Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) � ���� � ���� � ���� � ���� � ���� � ���� � ���� � ���� � ���� � ���� � ���� � ���� XXX XXX XXX
10. General and Administrative (G&A) Expenses:
10.1 Direct sales salaries and benefits �������� ��������� ������� � � � � � � ������ ���� � ��������� �������� ���������
10.2 Agents and brokers fees and commissions ����������� ���������� ������� � � � � � � ������ ������ � ��������� ������� ��������
10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) �������� ������ ������ � � � � � � ������� ������� � ���������� �������� ��������
10.4 Other general and administrative expenses ������� �������� �������� � � � � � � ����� ������ � �������� �������� ��������
10.4a Community Benefit Expenditures (informational only) � � � � � � � � � � � � � � �
10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) ��������� ���������� �������� � � � � � � ��� �������� � ��������� ���������� ���������
11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) ������������ �������� ��������� � � � � � � ����� ����������� � ��������� XXX ������������
12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ���������� ����������
13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ��������� XXX ���������
14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX �������� XXX ��������
15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ���������� XXX ���������
16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 6.5) ������ ����� ������ � � � � � � �� � � ��� ������ ������
16. 16a ICD-10 Implementation Expenses (informational only; already included in line 6.5) � � � � � � � � � � � � � � �
OTHER INDICATORS:
1. Number of certificates/policies ���� ����� ������� � � � � � � ����� � � ������� � �������
2. Number of Covered Lives �������� ����� ����� � � � � � � ����� � � ������� � �������
3. Number of Groups XXX ������ ���� XXX � � � � � � � � ����� � �����
4. Member Months ��������� ������ ������ � � � � � � ������� � � ��������� � ���������
Is run off business reported in Columns 1 through 9? ������������������� If yes, show the amount of premiums and claims included. Premiums $ � Claims $ �
216-2
.OR
��������������������������������������������������������������������SUPPLEMENT FOR THE YEAR 2014 OF THE Moda Health Plan, Inc.
SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2(To Be Filed by April 1 - Not for Rebate Purposes)
REPORT FOR: 1. CORPORATION Moda Health Plan, Inc. 2. 601 SW Second Ave Portland, OR 97204 (LOCATION)
NAIC Group Code 1313 BUSINESS IN THE STATE OF Oregon DURING THE YEAR 2014 NAIC Company Code 47098 Business Subject to MLR 10 11 12 13
Comprehensive Health Coverage Mini-Med Plans Expatriate Plans: 91
Individual
2SmallGroup
Employer
3LargeGroup
Employer
4
Individual
5SmallGroup
Employer
6LargeGroup
Employer
7
SmallGroup
8
LargeGroup
StudentHealthPlans
GovernmentBusiness
(excluded by statute)
OtherHealth
Business
Aggregate
(2% rule)Total(a)
1. Health Premiums Earned:1.1 Direct premiums written ������������ ��������� ��������� � � � � � � �������� ��������� � ����������
1.2 Unearned premium prior year ����� � � � � � � � � � � � �����
1.3 Unearned premium current year � � � � � � � � � � � � �
1.4 Change in unearned premium (Lines 1.2 - 1.3) ����� � � � � � � � � � � � �����
1.5 Paid rate credits � � � � � � � � � � � � �
1.6 Reserve for rate credits current year � � � � � � � � � � � � �
1.7 Reserve for rate credits prior year � � � � � � � � � � � � �
1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) � � � � � � � � � � � � �
1.9 Premium balances written off � � � � � � � � � � � � �
1.10 Group conversion charge � � � � � � � � � � � � �
1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) ������������ ��������� ��������� � � � � � � �������� ��������� � �����������
1.12 Assumed premiums earned from non-affiliates � � � � � � � � � � � � �
1.13 Net Assumed less Ceded premiums earned from affiliates � � � � � � � � � � � � �
1.14 Ceded premiums earned to non-affiliates �������� ������� ������� � � � � � � ������� ����� � �������
1.15 Other Adjustments due to MLR calculation - Premiums � � � � � � � � � � � � �
1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) ����������� ���������� ���������� � � � � � � ������ ��������� � ����������
2. Direct Claims Incurred:2.1 Paid claims during the year ������ ����������� ��������� � � � � � � �������� �������� � �����������
2.2 Direct claim liability current year ����������� ���������� ���������� � � � � � � ������ ����� � ���������
2.3 Direct claim liability prior year �������� ��������� ���������� � � � � � � ������ ���� � ����������
2.4 Direct claim reserves current year � � � � � � � � � � � � �
2.5 Direct claim reserves prior year � � � � � � � � � � � � �
2.6 Direct contract reserves current year � � � � � � � � � � � � �
2.7 Direct contract reserves prior year � � � � � � � � � � � � �
2.8 Paid rate credits � � � � � � � � � � � � �
2.9 Reserve for rate credits current year � � � � � � � � � � � � �
2.10 Reserve for rate credits prior year � � � � � � � � � � � � �
2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) � � � � � � � � � � � � �
2.11a Paid medical incentive pools and bonuses current year � � � � � � � � � � � � �
2.11b Accrued medical incentive pools and bonuses current year � � � � � � � � � � � � �
2.11c Accrued medical incentive pools and bonuses prior year � � � � � � � � � � � � �
2.12 Net healthcare receivables (Lines 2.12a - 2.12b) � � � � � � � � � � � � �
2.12a Healthcare receivables current year � � � � � � � � � � � � �
2.12b Healthcare receivables prior year � � � � � � � � � � � � �
2.13 Group conversion charge � � � � � � � � � � � � �
2.14 Multi-option coverage blended rate adjustment � � � � � � � � � � � � �
2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 - 2.10 + 2.11 - 2.12 + 2.13 + 2.14) ������������ ���������� ��������� � � � � � � ���������� �������� � ����������
2.16 Assumed incurred claims from non-affiliates � � � � � � � � � � � � �
2.17 Net assumed less ceded incurred claims from affiliates � � � � � � � � � � � � �
2.18 Ceded incurred claims to non-affiliates ��������� ������� ������ � � � � � � � ������� � ���������
2.19 Other adjustments due to MLR calculation - Claims � � � � � � � � � � � � �
2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) ������������ ��������� ���������� � � � � � � ���������� ������� � �����������
3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above (informational only) � � � � � � � � � � � � �
(a) Column 13, Line 1.1 includes direct written premium of $ � for stand-alone dental and $ � for stand-alone vision policies.
216-3
.OR
��������������������������������������������������������������������SUPPLEMENT FOR THE YEAR 2014 OF THE Moda Health Plan, Inc.
SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3(To Be Filed by April 1 - Not for Rebate Purposes)
REPORT FOR: 1. CORPORATION Moda Health Plan, Inc. 2. 601 SW Second Ave Portland, OR 97204
(LOCATION)NAIC Group Code 1313 BUSINESS IN THE STATE OF Oregon DURING THE YEAR 2014 NAIC Company Code 47098
All Expenses Improving Health Care Quality Expenses Claims Adjustment Expenses 9 101
ImproveHealth
Outcomes
2Activities to
PreventHospital
Readmissions
3Improve
Patient Safety and Reduce
Medical Errors
4Wellness &
HealthPromotion Activities
5
HITExpenses
6
Total(1 to 5)
7
CostContainment
Expenses
8Other
ClaimsAdjustmentExpenses
GeneralAdministrative
Expenses
TotalExpenses
(6 to 9)
1. Individual Comprehensive Coverage Expenses:
1.1 Salaries (including $ � for affiliated services) �������� ������� ������ �������� �������� �������� ��������� ����������� ��������� ����������
1.2 Outsourced Services � � � � � � ������� ��������� ��������� ��������
1.3 EDP Equipment and Software (incl $ � for affiliated services) � � � � ������� ������� �������� ��������� ������ ���������
1.4 Other Equipment (excl. EDP) (incl $ � for affiliated services) ����� ���� ���� ��� � ����� ������ �������� ����� �������
1.5 Accreditation and Certification (incl $ � for affiliated services) � XXX XXX XXX XXX � � � � �
1.6 Other Expenses (incl $ � for affiliated services) ������ ������ ������ ������ � ������ �������� ��������� ����������� ���������
1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) ��������� ������ ������ �������� �������� �������� ������ ���������� ���������� ����������
1.8 Reimbursements by uninsured plans and fiscal intermediaries � � � � � � ��������� ��������� ������� ����������
1.9 Taxes, Licenses and Fees (in total, for tying purposes) XXX XXX XXX XXX XXX XXX XXX XXX �������� ��������
1.10 Total (1.7 to 1.9) ��������� ������ ������ �������� �������� �������� ���������� ���������� ������� �����������
1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) � � � � � � ������ � � ������
2. Small Group Comprehensive Coverage Expenses:
2.1 Salaries (including $ � for affiliated services) �������� ����� ������� ������ ���� �������� ������� ��������� ���������� �������
2.2 Outsourced Services � � � � � � ������� ������ ������� ��������
2.3 EDP Equipment and Software (incl $ � for affiliated services) � � � � ����� ����� ������� ������� ������ ��������
2.4 Other Equipment (excl. EDP) (incl $ � for affiliated services) ���� �� �� ��� � ���� ��� ������ ������� ������
2.5 Accreditation and Certification (incl $ � for affiliated services) � XXX XXX XXX XXX � � � � �
2.6 Other Expenses (incl $ � for affiliated services) ������ ����� ������ ������ � ������ ������� ���������� ��������� ���������
2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) ������� ������ ������� ������� ������ ����� ��������� ��������� ��������� ��������
2.8 Reimbursements by uninsured plans and fiscal intermediaries � � � � � � ������ ���������� �������� �������
2.9 Taxes, Licenses and Fees (in total, for tying purposes) XXX XXX XXX XXX XXX XXX XXX XXX ������ ������
2.10 Total (2.7 to 2.9) ������� ������ ������� ������� ������ ����� ������� ��������� ���������� ���������
2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) � � � � � � ������ � � ������
3. Large Group Comprehensive Coverage Expenses:
3.1 Salaries (including $ � for affiliated services) ����� ������ ����� ������� ������� �������� �������� ��������� ������ �������
3.2 Outsourced Services � � � � � � ����� �������� ������ �������
3.3 EDP Equipment and Software (incl $ � for affiliated services) � � � � ������� ������� ������ ������� ���� �������
3.4 Other Equipment (excl. EDP) (incl $ � for affiliated services) ���� �� ���� ��� � ��� ���� ������ ������ ������
3.5 Accreditation and Certification (incl $ � for affiliated services) � XXX XXX XXX XXX � � � � �
3.6 Other Expenses (incl $ � for affiliated services) ������� ���� ����� ������ � ������� �������� ������� �������� ���������
3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) ������� ���� ������ ����� ������ ������ ����� ���������� �������� ���������
3.8 Reimbursements by uninsured plans and fiscal intermediaries � � � � � � �������� ������ ���������� �������
3.9 Taxes, Licenses and Fees (in total, for tying purposes) XXX XXX XXX XXX XXX XXX XXX XXX �������� ��������
3.10 Total (3.7 to 3.9) ������� ���� ������ ����� ������ ������ �������� ���������� �������� ���������
3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) � � � � � � ����� � � �����
216-4
.OR
SUPPLEMENT FOR THE YEAR 2014 OF THE Moda Health Plan, Inc.
SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued)All Expenses Improving Health Care Quality Expenses Claims Adjustment Expenses 9 10
1
ImproveHealth
Outcomes
2Activities to
PreventHospital
Readmissions
3Improve
Patient Safety and Reduce
Medical Errors
4Wellness &
HealthPromotion Activities
5
HITExpenses
6
Total(1 to 5)
7
CostContainment
Expenses
8Other
ClaimsAdjustmentExpenses
GeneralAdministrative
Expenses
TotalExpenses
(6 to 9)
4. Individual Mini-Med Plans Expenses:
4.1 Salaries (including $ � for affiliated services) � � � � � � � � � �
4.2 Outsourced Services � � � � � � � � � �
4.3 EDP Equipment and Software (incl $ � for affiliated services) � � � � � � � � � �
4.4 Other Equipment (excl. EDP) (incl $ � for affiliated services) � � � � � � � � � �
4.5 Accreditation and Certification (incl $ � for affiliated services) � XXX XXX XXX XXX � � � � �
4.6 Other Expenses (incl $ � for affiliated services) � � � � � � � � � �
4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) � � � � � � � � � �
4.8 Reimbursements by uninsured plans and fiscal intermediaries � � � � � � � � � �
4.9 Taxes, Licenses and Fees (in total, for tying purposes) XXX XXX XXX XXX XXX XXX XXX XXX � �
4.10 Total (4.7 to 4.9) � � � � � � � � � �
4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) � � � � � � � � � �
5. Small Group Mini-Med Plans Expenses:
5.1 Salaries (including $ � for affiliated services) � � � � � � � � � �
5.2 Outsourced Services � � � � � � � � � �
5.3 EDP Equipment and Software (incl $ � for affiliated services) � � � � � � � � � �
5.4 Other Equipment (excl. EDP) (incl $ � for affiliated services) � � � � � � � � � �
5.5 Accreditation and Certification (incl $ � for affiliated services) � XXX XXX XXX XXX � � � � �
5.6 Other Expenses (incl $ � for affiliated services) � � � � � � � � � �
5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) � � � � � � � � � �
5.8 Reimbursements by uninsured plans and fiscal intermediaries � � � � � � � � � �
5.9 Taxes, Licenses and Fees (in total, for tying purposes) XXX XXX XXX XXX XXX XXX XXX XXX � �
5.10 Total (5.7 to 5.9) � � � � � � � � � �
5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) � � � � � � � � � �
6. Large Group Mini-Med Plans Expenses:
6.1 Salaries (including $ � for affiliated services) � � � � � � � � � �
6.2 Outsourced Services � � � � � � � � � �
6.3 EDP Equipment and Software (incl $ � for affiliated services) � � � � � � � � � �
6.4 Other Equipment (excl. EDP) (incl $ � for affiliated services) � � � � � � � � � �
6.5 Accreditation and Certification (incl $ � for affiliated services) � XXX XXX XXX XXX � � � � �
6.6 Other Expenses (incl $ � for affiliated services) � � � � � � � � � �
6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) � � � � � � � � � �
6.8 Reimbursements by uninsured plans and fiscal intermediaries � � � � � � � � � �
6.9 Taxes, Licenses and Fees (in total, for tying purposes) XXX XXX XXX XXX XXX XXX XXX XXX � �
6.10 Total (6.7 to 6.9) � � � � � � � � � �
6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) � � � � � � � � � �
216-5
.OR
SUPPLEMENT FOR THE YEAR 2014 OF THE Moda Health Plan, Inc.
SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued)All Expenses Improving Health Care Quality Expenses Claims Adjustment Expenses 9 10
1
ImproveHealth
Outcomes
2Activities to
PreventHospital
Readmissions
3Improve
Patient Safety and Reduce
Medical Errors
4Wellness &
HealthPromotion Activities
5
HITExpenses
6
Total(1 to 5)
7
CostContainment
Expenses
8Other
ClaimsAdjustmentExpenses
GeneralAdministrative
Expenses
TotalExpenses
(6 to 9)
7. Small Group Expatriate Plans Expenses:
7.1 Salaries (including $ � for affiliated services) � � � � � � � � � �
7.2 Outsourced Services � � � � � � � � � �
7.3 EDP Equipment and Software (incl $ � for affiliated services) � � � � � � � � � �
7.4 Other Equipment (excl. EDP) (incl $ � for affiliated services) � � � � � � � � � �
7.5 Accreditation and Certification (incl $ � for affiliated services) � XXX XXX XXX XXX � � � � �
7.6 Other Expenses (incl $ � for affiliated services) � � � � � � � � � �
7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) � � � � � � � � � �
7.8 Reimbursements by uninsured plans and fiscal intermediaries � � � � � � � � � �
7.9 Taxes, Licenses and Fees (in total, for tying purposes) XXX XXX XXX XXX XXX XXX XXX XXX � �
7.10 Total (7.7 to 7.9) � � � � � � � � � �
7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) � � � � � � � � � �
8. Large Group Expatriate Plans Expenses:
8.1 Salaries (including $ � for affiliated services) � � � � � � � � � �
8.2 Outsourced Services � � � � � � � � � �
8.3 EDP Equipment and Software (incl $ � for affiliated services) � � � � � � � � � �
8.4 Other Equipment (excl. EDP) (incl $ � for affiliated services) � � � � � � � � � �
8.5 Accreditation and Certification (incl $ � for affiliated services) � XXX XXX XXX XXX � � � � �
8.6 Other Expenses (incl $ � for affiliated services) � � � � � � � � � �
8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) � � � � � � � � � �
8.8 Reimbursements by uninsured plans and fiscal intermediaries � � � � � � � � � �
8.9 Taxes, Licenses and Fees (in total, for tying purposes) XXX XXX XXX XXX XXX XXX XXX XXX � �
8.10 Total (8.7 to 8.9) � � � � � � � � � �
8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) � � � � � � � � � �
9. Student Health Plans Expenses:
9.1 Salaries (including $ � for affiliated services) � � � � � � � � � �
9.2 Outsourced Services � � � � � � � � � �
9.3 EDP Equipment and Software (incl $ � for affiliated services) � � � � � � � � � �
9.4 Other Equipment (excl. EDP) (incl $ � for affiliated services) � � � � � � � � � �
9.5 Accreditation and Certification (incl $ � for affiliated services) � XXX XXX XXX XXX � � � � �
9.6 Other Expenses (incl $ � for affiliated services) � � � � � � � � � �
9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) � � � � � � � � � �
9.8 Reimbursements by uninsured plans and fiscal intermediaries � � � � � � � � � �
9.9 Taxes, Licenses and Fees (in total, for tying purposes) XXX XXX XXX XXX XXX XXX XXX XXX � �
9.10 Total (9.7 to 9.9) � � � � � � � � � �
9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) � � � � � � � � � �
216-6
.OR
Insurer’s Financial Position Appendix I
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
As of December 31, 2014, the Company had total admitted assets of $353.7 million and capital and
surplus of $121.1 million. For the year ended December 31, 2014, the Company had a net loss of $5.2
million comprised of an underwriting loss of $11.0 million, $7.5 million in investment earnings and
income taxes and other expenses of $1.7 million. Reserves for 2014 were $93.5 million up from $33.4
million in 2013. For more details on our financial position, profitability, surplus, reserves and investment
earnings, please see attached excerpts from our annual statement filing.
Over the past five years, the Company’s cumulative net income is a cumulative gain of $17.1 million
($3.6 million gain in 2010, $5.9 million gain in 2011, $5.3 million gain in 2012, $7.5 million gain in 2013
and $5.2 million loss in 2014).
The requested change in the premium rate for this filing is necessary to cover increasing hospital and
medical expenses as well as to maintain adequate surplus levels and prevent significant rate increases
on this segment of our business in future filings. We have included 2.5% margin in this rate filing.
Risk Based Capital for the Last 5 Years
2010 731%
2011 756%
2012 661%
2013 582%
2014 454%
COST CONTAINMENT AND QUALITY IMPROVEMENT EFFORTS Appendix II
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
1 | P a g e
Moda Health strives to manage costs while providing the highest quality service and care for our members. Our
programs help members meet their health care needs through prevention, wellness and condition specific
programs. We are continually looking for opportunities to help members maximize the effectiveness of their
health care dollars. Here are a few examples of ongoing cost containment and quality improvement efforts at
Moda Health.
Medical Quality Improvement Committee (MQIC) –Comprised of representatives from multiple departments that
oversees Moda Health quality improvement programs. This committee monitors and evaluates the health care
services provided to Moda Health members in Oregon, Washington, and Alaska to ensure that they meet current
medical practice and service standards. The MQIC meets at least six times per year and facilitates communication
among Moda Health departments, providers, employer groups and members to ensure the delivery of healthcare
services in an efficient management of resources.
Pharmacy and Therapeutics Committee – Chaired by a Moda Health medical director, this robust multi-
department committee oversees drug formulary decisions to ensure the availability of safe and effective drug
choices by: promoting evidence-based standards in the formulary decision-making process to ensure clinical
efficacy, patient safety, and cost-effective medication options; establishing policies and procedures to educate and
inform health care providers, members and clients about drug products and appropriate use; as well as developing
protocols and procedures for the ease of and access to non-formulary drugs.
Case Management and Care Coordination - Our programs use evidence-based medicine and best practice clinical
care guidelines. The guidelines are used when prior authorizing inpatient and surgical admissions, durable medical
equipment, outpatient therapies and chiropractic care, acupuncture and massage therapy. In addition, evidence
based-guidelines are used to assign initial length of stay, continued stay, and to confirm the appropriate level of
care for inpatient, acute rehabilitation and skilled nursing facility admissions.
Care coordination nurses follow members through preauthorization of an inpatient admission, inpatient
concurrent review, discharge planning, and the recovery phase of an acute condition, when coordination of
additional services is needed. The care management programs use nationally recognized clinical care guidelines
developed through evidence-based medicine and best practice. This approach supports our readmission
prevention program.
Moda Health has ongoing quality improvement projects for congestive heart failure (CHF), inpatient readmissions,
depression screening, and hospice utilization. These efforts also include communication among case managers,
health coaches, and behavioral healthcare coordinators to ensure the members receive the appropriate level of
care with the appropriate provider.
To ensure quality centers of excellence are available for transplant care, specialized cancer care that is not
available locally, kidney dialysis, and complex neonatal case management.
Utilization management delegation – In an effort to reduce costs and improve efficiencies and quality, Moda
Health delegates some utilization management activities to other entities who are experts in their fields. The
Medical Management Delegation Committee meets quarterly to review utilization and denial reports and other
information submitted by the delegated entity. For Oregon, Moda Health delegates utilization management
activities for advanced imaging and specialty oncology drugs. Using delegated utilization management programs
continues to reduce unwarranted variation and high utilization. This arrangement also provides peer-to-peer
communication with providers.
Advanced Imaging Review – Driven by high-tech services such as CT, MRI, Nuclear Medicine, and PET, outpatient
diagnostic imaging has become the fastest growing medical expenditure in the United States. Imaging services per
COST CONTAINMENT AND QUALITY IMPROVEMENT EFFORTS Appendix II
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
2 | P a g e
Medicare beneficiary increased by 62% between 1999 and 2004. The increase in imaging use has also caused an
equally dramatic increase in the amount of radiation exposure associated with these studies.
At Moda Health our focus is to improve patient safety, enhance quality of health care and facilitate cost effective
evidence-based care. Image management allows these goals to be achieved. The program promotes the
appropriate use of diagnostic imaging through the application of widely accepted clinical guidelines. This leads to
improved clinical quality and appropriate cost management in diagnostic imaging. Utilization of advanced imaging
has decreased ~4% since the implementation of this program without any evidence of compromising the quality of
patient care.
Length of stay review - assignment of initial length of stay days, and concurrent review of hospital, inpatient
rehabilitation and skilled nursing facility stays for extension of the length of stay days, based on evidence based,
best practice targets. This initiative has decreased the average length of stay ~.3%
Inpatient Care Coordination RNs are assigned to facilities, by regions in the states of Oregon, Washington and
Alaska, to review inpatient admission length of stay. The same nurse following hospital admissions in a particular
region of Oregon is also assigned network hospitals regionally that are contiguous to the areas assigned. The
regions are as follows:
• Portland Metro
• North Coast
• Valley
• South Coast/Southwest Oregon
• Central Oregon/ Gorge
• Eastern/South Central Oregon
• Clark County
Advantages to assigning by facility and region:
• Positive provider relationships: The facility nurse knows which nurse to call at Moda Health
• Reduced inpatient length of stay and correct level of care: The facility nurse calls the Moda Health nurse
directly to expedite authorization and transition to a skilled facility, rehabilitation facility, or to home
care, when assistance with discharge planning is needed
• Smooth transitions of care: The same Moda Health nurse follows the member when a transfer to a
neighboring facility in a border state is required for a specialized, or higher, level of care.
Health Promotion and Engagement - Health Promotion and Engagement designs a comprehensive and integrated
suite of programs and services for members at all stages of life and health aimed at improving population health,
as well as members’ experience of care, all while reducing costs. These programs and services assist members in
making informed decisions and promote a wide array of key health promotion and wellness activities including:
• Research/implementation of quality initiatives
• Wellness consulting
• Disease management and health coaching
• Community events
One-on-one disease management and health coaching - Our multidisciplinary team of clinicians, including
registered nurses, registered dieticians, social workers and dental hygienists, provides Moda Health members with
one-on-one support in the following nine health areas: Cardiac care, Dental Care, Depression Care, Respiratory
Care, Women’s Health and Maternity Care, Weight Care, Spine & Joint Care, and Lifestyle Coaching. The purpose
of one-on-one disease management and health coaching is to assist members with self-management of their
condition, prevent development and progression of complications, and improve adherence to their medical care
regime.
COST CONTAINMENT AND QUALITY IMPROVEMENT EFFORTS Appendix II
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
3 | P a g e
Moda Health Post-hospitalization care management - Care coordination nurses follow all members with post
hospital needs (home health, home infusion, palliative and hospice care) and refer to case management if
additional long term or complex needs are identified. Cases are referred to health coaching programs when post
hospital discharge needs are complete and member requires follow up for chronic illness, depression care, or
lifestyle coaching
• All Mental Health hospitalizations and chemical dependency facility discharges trigger both a seven and
thirty day follow up by Moda Health Behavioral Health to assure the member has an outpatient follow up
appointment, before leaving the facility. Behavioral health contacts the member to remind them of the
appointment and confirms with the provider that the member kept the appointment. This is augmented
by trigger diagnosis, internal case review hospital follow up, care coordination and case management
referral, Co-morbid diagnosis and medical management review committee.
• All congestive heart failure (CHF) hospitalizations trigger a follow-up within seven days by Medical
Management & Health Coaching. This is augmented by trigger Diagnosis, internal Case Review- hospital
follow up, Care coordination and Case Management referral, Co-morbid diagnosis and medical
management review committee.
Standard Review Questions
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
1. What is the greatest financial loss and gain that the company believes is conceivable in 2015? 2016?
a. Please describe the nature, extent, and results of stress testing performed in developing the
proposed rates. b. How have these projections changed since last year’s filing?
For 2015, we believe that the loss/gain will likely be between 3% and -2%. With the consistent
performance of the market and limited changes in the transitional policies, there is much less
uncertainty than other years. Similar to individual, we reviewed the assumptions market morbidity
changes and Moda specific mix of membership. Results from 2014 are showing that these factors
will be the most influential in the potential gains and losses for this segment. For the 2016 filing, the
assumptions chosen reflect our best estimates of the change in market morbidity and reflect an
average market risk. Testing the reasonable range of values for these factors, the potential financial
gains and losses would fall between +2% to -3%. The primary driver of this range is the uncertainty
in selection from transitional policies and the market expansion. This testing does not incorporate
any impact of risk corridor. This range is consistent with the results from last year’s filing. The dollar
magnitude of gains and losses will depend on the membership and subsequent premiums.
2. What adjustments have been made to reflect the inclusion, if any, of association business in the
single risk pool?
Moda Health does not have significant association plan membership that is expected to enter the
small group market in 2016. We believe that this transition would have been made in 2014, if at all.
No adjustments have been made to reflect the inclusion of current association plan members.
3. What was the average age factor for 2014 premiums? What are the initial age factors for 2015
premiums?
The average factor for our 2014 experience was 1.421. The initial age factor for 2015 is 1.441.
4. Describe the steps your company takes to ensure adequate access to care.
In the Oregon state service area, Moda Health sets and negotiates reimbursement rates and
contract terms consistent with the goals of maintaining a robust network of providers that meets
both national and Moda Health standards for availability and access. This ensures that members’
clinical needs can be met within the provider network while optimizing the affordability of
healthcare coverage and services.
As part of our ongoing quality improvement efforts, Moda Health monitors these standards for
availability of participating primary care practitioners (PCP) and high-volume specialty care
practitioners (SCP). Moda Health conducts annual provider access evaluations to identify areas of
improvement. We used the results of these evaluations and recommendations to develop an
improvement plan. We are investing in new software resources and hiring additional team members
to increase the emphasis in this area.
Standard Review Questions
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
For primary care, the Moda Health standards are the greater of 1:500 physician-to-member ratio or
50 percent of available providers in a geographical area. This exceeds the generally accepted
national standard of a 1:1,000 ratio and results in a standard of three PCP’s per 500 members in a
geographical area or six times greater availability than national standards require. In 2013, we
identified that four counties did not meet Moda Health’s highest standards for primary care access
in the Internal Medicine category and that six counties did not meet the standards in the Pediatrics
category. Additional providers are available in the specific provider categories reviewed in these
counties, thus allowing for potential access improvement.
For specialty care, Moda Health’s highest standard is to have a specialist to member ratio of 1:2,000.
Or, in cases where the ratio is less than the standard, the goal is to have at least 50 percent of
available specialty care physicians in the network for the 11 high-volume specialties we have
identified. All 36 Oregon counties meet or exceed the national standards.
5. Describe the steps your company takes to measure and improve quality of care.
We use the Healthcare Effectiveness Data and Information Set (HEDIS) to measure the quality of
care and service provided to our commercial members in Oregon, Washington and Alaska for
preventative health, early diagnosis and management of chronic disease. We also use the
Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which asks members
about their experience and satisfaction with their healthcare. HEDIS and CAHPS measures were
developed by the National Committee for Quality Assurance and are used to help health plans
measure performance in a broach range of important aspects of care and service. We use HEDIS to
identify improvement opportunities, measure the effectiveness of quality improvement projects for
member care, and provide purchasers and consumers with the information they need to make
reliable comparisons of health plan performance.
Internally, Moda Health has a 19-member Medical Quality Improvement Committee comprised of
medical directors and decision-making representatives and operational leaders from 16 key
departments and service areas. In 2013, we added a representative from the Medial Informatics
team. The Committee meets at least six times a year and on an as needed basis. Additionally, Moda
Health has a Quality Council comprised of three community-based clinical practitioners, our medial
directors, and leadership from five Moda Health departments or divisions.
In 2014, many of our practitioners were engaged in our quality programs. Here are some key areas
in which Moda Health collaborated with providers:
• Five of our quality committees include community based practitioners.
• The majority of our quality improvement projects to improve member care included both
member and provider components. For example, we sent members’ PCPs information
regarding needed screenings, routine care and medication adherence information via letter
and individual chart-ready patient reports.
Standard Review Questions
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
• In our voluntary health coaching programs, we notified providers about member
enrollment, communicated action plans, set six-month and annual updates, and
documented physician feedback and information in the members’ records.
• Through our utilization management program, we provided our practitioners with the
option to reconsider an initial denial by consulting with our medical directors or an
independent reviewer, when indicated.
• Our quarterly provider newsletter effectively communicates with providers and obtains
feedback on an ongoing basis.
• We sent our providers notification about our quality improvement program, clinical care
guidelines, medical, behavioral health and pharmaceutical utilization management
procedures, and members’ rights and responsibilities that are posted on our provider
website.
One-on-one Health Coaching Impact
Clinical outcomes for our Cardiac Care, Depression Care and Diabetes Care health coaching
programs were more favorable for Moda Health members who participated in health coaching. For
example, 73percent of Moda Health members who participated in health coaching had an anti-
hypertension medication possession ratio (MPR) greater than 0.8, compared with 68 percent of
Moda Health members who did not contact a health coach. In addition, 68 percent of members
who participated in our Depression Care program had an MPR greater than 0.8, compared with 59
percent of members who did not contact a health coach; and 43 percent of members enrolled in our
Diabetes care program received a dilated eye exam, compared to 25 percent of those not enrolled.
Care4Life
Starting in August 2013, Moda Health partnered with Voxiva, Inc. to offer the Care4Life program to
all Moda Health members. Care4Life is an educational program for individuals with type 2 diabetes
that delivers a series of text messages designed to educate, empower, and support participants.
The program is based on the National Diabetes Education Program and the American Association of
Diabetes Educators Seven Step Program. Our Health Coaching, Case Management and Customer
Services teams promote Care4Life to members they work with on a daily basis.
Weight Care Program
The goals of the Weight Care program are for members to have a 5 percent and 10 percent
reduction in weight within six to 12 months of program enrollment. Health coaches collect the
member’s weight upon program enrollment and then again every one to two months. In 2014,
program participants saw an average weight loss of 12.2 pounds, representing an average loss of 6
percent, meeting the program goal.
In 2014, Moda Health will continue to dedicate significant energy and resources to monitoring
processes, improving quality and demonstrating health plan best practices in Oregon, Washington
and Alaska. Our commitment to quality will continue to differentiate us in the marketplace. Our
Standard Review Questions
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
quality initiatives are supported plan-wide, and our goal remains consistent to: provide better care
that is cost-effective to ensure the health of our members and the communities we serve.
6. How have members on discontinued plans been mapped to available plans?
The members are mapping using the following crosswalk.
2015 Plan 2016 Plan
PPO 500 PPO 500
PPO 1000A PPO 1000A
PPO 1000B PPO 1000B
PPO 1500 PPO 1500
PPO 2000 PPO 2500
PPO 3000 PPO 3000
Value 1500 Value 1500
Value 2000 Value 2000
Value 2500 Value 2500
Value 3000 Value 3000
Value 3500 Value 3500
Beneficial 1500 Moda Health Connexus Aspire 2000
Beneficial 2000 Moda Health Connexus Aspire 2000
Focus 2000 Moda Health Connexus Aspire 2000
Beneficial 3500 Moda Health Connexus Fundamental 3500
Beneficial 4000 Moda Health Connexus Fundamental 3500
Beneficial 4500 Moda Health Connexus Essence 5000
Beneficial 5000 Moda Health Connexus Essence 5000
Focus 5000 Moda Health Connexus Essence 5000
HSA 1500 Moda Health Connexus HSA 1500
HSA 2000 Moda Health Connexus HSA 2000
HSA 3000 Moda Health Connexus HSA 2500
HSA 4000 Moda Health Connexus HSA 3250
Moda Health Oregon Standard Gold Moda Health Oregon Standard Gold
Moda Health Oregon Standard Silver Moda Health Oregon Standard Silver
Moda Health Oregon Standard Bronze Moda Health Oregon Standard Bronze
7. Identify all products in the Supplemental Healthcare Exhibit subtotal appropriate for this
Individual/Small Group filing. If you are using company historical data for your experience, please
reconcile the premium and claim totals reported in the development of rate change with the
corresponding totals in the Supplemental Health Care Exhibit, Part 1.
Standard Review Questions
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
The products included in the experience period are consistent with those in the Supplemental
Healthcare Exhibit subtotal.
Premiums: The premium in the base experience data reflects solely the premiums earned in 2014 as of
March 31, 2015. The Supplemental Healthcare Exhibit (SHCE) reflects earned premium as of December
31, 2014, risk adjustment, and risk corridor. A direct comparison shows a difference of 1.5%. This is
within a reasonable margin considering the different time periods for the underlying earned premium
data.
Premium $57,940,496
Risk Corridor -$108,192
Risk Adjustment -$175,937
Total $57,656,367
SHCE Premium $58,520,603
Percent Difference 1.5%
Claims: Both claims in the experience data and claims on the SHCE include paid claims, pharmacy
rebates, and estimates for incurred but not reported claims. The experience data is calculated as of
March 31, 2015 and the SHCE data is as of December 31, 2014. The difference is due to improved
estimates of 2014 liabilities with the additional run-out.
SHCE Claims
$43,069,475
Claims $43,080,384
Percent Difference 0.03%
8. Identify which cost and quality measures are contributing to changes in reported costs on the
Supplemental Healthcare Exhibit over the last 2 years.
The only changes in programs that are included in the reports costs for cost and quality
measures are outlined below:
Expense Change Description
Oncology Initiative Removed
Implement oncology management of specific drugs,
including prior authorization
ICD 10 Conversion Removed Implement ICD 10 diagnostic codes
Social Wellth Added
Digital health experiences ;leveraging mobile health
technologies for consumers
Medical Home with Risk Reporting Added
Utilization and financial reporting for provider
participating in shared risk payment models
Standard Review Questions
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
Magellan Added
Implement management of specialty drugs,
including prior authorizations
9. Research continues to support the claim that uncompensated care has dropped significantly. Please
see the recent research completed by OHSU here: http://annfammed.org/content/13/1/10.full
List the company’s efforts to identify reductions in uncompensated care as a result of the Medicaid
expansion and the individual mandate. What has the company done to reduce the burden of
uncompensated care on the commercial market? Describe the result of these efforts.
Moda’s primary effort to identify and realize reductions in uncompensated care is the
development of the Beacon Network. This network is designed specifically as a statewide network for
Oregon Individual plans. With the reduction in the number of uninsured and the expansion of the
Individual market, Moda is focusing the potential savings in that market to manage the costs. As such,
there is no adjustment included in this filing.
The hepatitis C drug Sovaldi has received national attention as a major contributor to health costs in
2014. Questions 10-11 identify the cost drivers related to this drug in Oregon.
10. What is/are the company’s coverage/limitations on the drug?
For All Plans the combined medical and pharmacy out-of-pocket max applies and Sovaldi must
be accessed through an exclusive specialty pharmacy.
Platinum/Gold/Silver: Covered at 50% / deductible waived
Bronze: Covered at 50% / deductible applies
Catastrophic: Covered at 100% / deductible applies
11. In the base period, what is the pmpm cost associated with the drug?
Moving forward, concern about costs associated with Sovaldi has declined in relation to costs
associated with Harvoni, a new higher cost treatment for Hepatitis C.
Allowed PMPM Sovaldi
OR SMGR $1.07
ACA only $1.63
Paid
OR SMGR $1.01
Standard Review Questions
Company Name: Moda Health Plan, Inc.
Market: Small Group
Effective Date: January 1, 2016
ACA only $1.54
12. What percentage of base period claims is prescription drug claims?
11.8% of allowed claims in the experience period are for prescription drugs.
13. What is the estimated risk corridor payment for the base period?
The estimate risk corridor payable for the base period is $108,192.
Small Group:
16. Confirm whether transitional plans will be continued or discontinued. Identify how this rate filing
reflects adjustments for any changes.
Moda Health does not currently offer any transitional policies to the 1-50 market. The filing does not
adjust for a change in market morbidity since transitional policies will likely continue to renew through
October or renew early such that a morbidity change will not be reflected in the projection period.
17. Identify the following aggregate information regarding groups sized 51-100 that has been included
in the base experience of this filing?
a. # of groups
b. # of members
c. completed, incurred claims
d. premium
e. If part of this experience is included on another filing, the percentage of total membership for
groups sized 51-100 included on this filing.
Experience for the groups 51-99 was not included in the base experience for this filing per the 2016
Unified Rate Review Instructions. The expansion of this market was considered when preparing this rate
filing.
Moda Health 2014 experience for groups sized 51-99 is as follows:
a. Number of groups: 144
b. Medical member months: 108490
c. Completed, incurred claims (Medical and Rx): $33,876,856.54
d. Premium (Medical and Rx): $37,146,335.69
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A B C D E F G H I J K L M N O P Q R S T U V W X Y
Unified Rate Review v2.0.4
Company Legal Name: Moda Health Plan, Inc State: OR
HIOS Issuer ID: 39424 Market: Small Group
Effective Date of Rate Change(s): 1/1/2016
Market Level Calculations (Same for all Plans)
Section I: Experience period data
Experience Period: 1/1/2014 to 12/31/2014
Experience Period
Aggregate Amount PMPM % of Prem
Premiums (net of MLR Rebate) in Experience Period: $57,940,496 $366.12 100.00%
Incurred Claims in Experience Period $43,080,384 272.22 74.35%
Allowed Claims: $58,126,655 367.30 100.32%
Index Rate of Experience Period 361.74
Experience Period Member Months 158,254
Section II: Allowed Claims, PMPM basis
Experience Period Projection Period: 1/1/2016 to 12/31/2016 Mid-point to Mid-point, Experience to Projection: 24 months
on Actual Experience Allowed
Adj't. from Experience to
Projection Period Projections, before credibility Adjustment Credibility Manual
Benefit Category
Utilization
Description
Utilization per
1,000
Average
Cost/Service PMPM
Pop'l risk
Morbidity Other Cost Util
Utilization per
1,000
Average
Cost/Service PMPM
Utilization
per 1,000
Average
Cost/Service PMPM
Inpatient Hospital Services 5,822.79 $187.12 $90.80 1.073 1.008 1.050 1.002 6,272.87 $207.95 $108.70 0.00 $0.00 $0.00
Outpatient Hospital Services 12,166.14 108.06 109.56 1.073 1.008 1.050 1.002 13,106.54 120.09 131.16 0.00 0.00 0.00
Professional Services 19,269.50 70.98 113.98 1.073 1.008 1.050 1.002 20,758.96 78.88 136.46 0.00 0.00 0.00
Other Medical Services 0.00 0.00 0.00 1.073 1.008 1.050 1.002 0.00 0.00 0.00 0.00 0.00 0.00
Capitation Services 873.84 128.98 9.39 1.073 1.008 1.050 1.002 941.38 143.34 11.24 0.00 0.00 0.00
Prescription Drug Prescriptions 8,916.63 58.65 43.58 1.073 1.008 1.050 1.002 9,605.85 65.18 52.17 0.00 0.00 0.00
Total $367.30 $439.74 $0.00
After Credibility Projected Period Totals
Section III: Projected Experience: Projected Allowed Experience Claims PMPM (w/applied credibility if applicable) 100.00% 0.00% $439.74 $152,763,219
Paid to Allowed Average Factor in Projection Period 0.745
Projected Incurred Claims, before ACA rein & Risk Adj't, PMPM $327.63 $113,816,603
Projected Risk Adjustments PMPM -0.15 (52,109)
Projected Incurred Claims, before reinsurance recoveries, net of rein prem, PMPM $327.78 $113,868,712
Projected ACA reinsurance recoveries, net of rein prem, PMPM -2.25 (781,630)
Projected Incurred Claims $330.03 $114,650,341
Administrative Expense Load 13.6% 56.04 19,468,438
Profit & Risk Load 2.5% 10.29 3,573,305
Taxes & Fees 3.7% 15.08 5,240,099
Single Risk Pool Gross Premium Avg. Rate, PMPM $411.44 $142,932,183
Index Rate for Projection Period 437.89
% increase over Experience Period 12.38%
% Increase, annualized: 6.01%
Projected Member Months 347,391
Information Not Releasable to the Public Unless Authorized by Law: This information has not been publically disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
Annualized Trend
Factors
1 of 3
Product-Plan Data Collection
Company Legal Name: Moda Health Plan, Inc State: OR
HIOS Issuer ID: 39424 Market: Small Group
Effective Date of Rate Change(s):
Product/Plan Level Calculations
Section I: General Product and Plan Information
Product
Product ID:
Metal: Platinum Platinum Gold Gold Gold Gold Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Bronze Bronze Silver
AV Metal Value 0.882 0.880 0.816 0.798 0.788 0.785 0.720 0.717 0.717 0.717 0.711 0.710 0.706 0.705 0.703 0.690 0.719 0.714 0.612 0.596 0.720
AV Pricing Value 1.162 1.147 1.085 1.054 1.052 1.026 0.922 0.905 0.905 0.921 0.890 0.822 0.866 0.845 0.825 0.780 0.883 0.858 0.748 0.692 0.937
Plan Type: PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO
Plan Name
PPO Platinum 250 PPO Platinum 500 PPO 500 PPO 1000A PPO 1000B PPO 1500 PPO 2500 PPO 3000 PPO 3000 Value 1500 Value 2000
Value 2000 (Rose
City) Value 2500 Value 3000 Value 3500 Value 5000
Moda Health
Connexus Aspire
2000
Moda Health
Connexus Aspire
2500
Connexus
Fundamental
3500
Connexus
Fundamental
5000
Moda Health
Connexus HSA
1500
Plan ID (Standard Component ID): 39424OR1160007 39424OR1160008 39424OR1160001 39424OR1160002 39424OR1160003 39424OR1160004 39424OR1160005 39424OR1160006 39424OR1160009 39424OR1170001 39424OR1170002 39424OR1170007 39424OR1170003 39424OR1170004 39424OR1170005 39424OR1170006 39424OR1340001 39424OR1340002 39424OR1360001 39424OR1360002 39424OR1520001
Exchange Plan? Yes Yes Yes Yes No Yes No Yes No No No Yes No No No No No Yes Yes No Yes
Historical Rate Increase - Calendar Year - 2 0.00% 0.00% 0.00% 0.00% 0.00%
Historical Rate Increase - Calendar Year - 1 0.00% 0.00% 0.00% 0.00% 0.00%
Historical Rate Increase - Calendar Year 0 0.00% 0.00% 0.00% 0.00% 0.00%
Effective Date of Proposed Rates 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016 1/1/2016
Rate Change % (over prior filing) 0.00% 0.00% 0.18% 0.33% 1.57% 0.26% 1.41% 4.28% 0.00% 6.16% 4.67% 0.00% 4.02% 3.57% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
Cum'tive Rate Change % (over 12 mos prior) 0.00% 0.00% 0.18% 0.33% 1.57% 0.26% 1.41% 4.28% 0.00% 6.16% 4.67% 0.00% 4.02% 3.57% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
Proj'd Per Rate Change % (over Exper. Period) 2.28% 2.72% 4.06% 2.85% 4.89% 8.06% 7.86% 6.35% 5.59% 4.91% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Product Threshold Rate Increase %
Section II: Components of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM)
Plan ID (Standard Component ID): Total 39424OR1160007 39424OR1160008 39424OR1160001 39424OR1160002 39424OR1160003 39424OR1160004 39424OR1160005 39424OR1160006 39424OR1160009 39424OR1170001 39424OR1170002 39424OR1170007 39424OR1170003 39424OR1170004 39424OR1170005 39424OR1170006 39424OR1340001 39424OR1340002 39424OR1360001 39424OR1360002 39424OR1520001
Inpatient $0.92 $0.00 $0.00 $4.50 $2.43 $9.51 -$3.96 -$0.13 $5.84 $0.00 $2.27 $4.25 $0.00 $3.68 -$1.97 -$5.07 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Outpatient $1.11 $0.00 $0.00 $5.42 $2.93 $11.47 -$4.78 -$0.16 $7.04 $0.00 $2.74 $5.12 $0.00 $4.44 -$2.38 -$6.12 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Professional $1.16 $0.00 $0.00 $5.64 $3.05 $11.94 -$4.97 -$0.16 $7.33 $0.00 $2.85 $5.33 $0.00 $4.62 -$2.48 -$6.37 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Prescription Drug $0.44 $0.00 $0.00 $2.16 $1.17 $4.56 -$1.90 -$0.06 $2.80 $0.00 $1.09 $2.04 $0.00 $1.77 -$0.95 -$2.43 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Other $0.10 $0.00 $0.00 $0.47 $0.25 $0.98 -$0.41 -$0.01 $0.60 $0.00 $0.24 $0.44 $0.00 $0.38 -$0.20 -$0.52 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Capitation $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Administration $0.63 $0.00 $0.00 $3.09 $1.67 $6.53 -$2.72 -$0.09 $4.01 $0.00 $1.56 $2.92 $0.00 $2.53 -$1.36 -$3.48 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Taxes & Fees $0.17 $0.00 $0.00 $0.83 $0.45 $1.76 -$0.73 -$0.02 $1.08 $0.00 $0.42 $0.79 $0.00 $0.68 -$0.37 -$0.94 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Risk & Profit Charge $0.12 $0.00 $0.00 $0.57 $0.31 $1.20 -$0.50 -$0.02 $0.74 $0.00 $0.29 $0.54 $0.00 $0.46 -$0.25 -$0.64 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Total Rate Increase $4.66 $0.00 $0.00 $22.68 $12.26 $47.95 -$19.97 -$0.65 $29.44 $11.46 $21.43 $18.56 -$9.96 -$25.58 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Member Cost Share Increase $0.92 $0.00 $0.00 $2.64 $1.75 $6.93 -$3.36 -$0.18 $8.69 $0.00 $3.16 $6.72 $0.00 $6.39 -$3.70 -$10.21 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Average Current Rate PMPM $294.58 $465.71 $462.34 $425.75 $481.95 $415.83 $377.95 $403.32 $379.05 $371.20 $390.21 $397.16
Projected Member Months 347,391 1,737 1,737 34,739 27,791 20,843 26,401 31,265 10,422 6,948 13,896 17,369 695 6,948 20,843 3,474 3,474 24,317 6,948 13,896 1,737 3,474
Section III: Experience Period Information
Plan ID (Standard Component ID): Total 39424OR1160007 39424OR1160008 39424OR1160001 39424OR1160002 39424OR1160003 39424OR1160004 39424OR1160005 39424OR1160006 39424OR1160009 39424OR1170001 39424OR1170002 39424OR1170007 39424OR1170003 39424OR1170004 39424OR1170005 39424OR1170006 39424OR1340001 39424OR1340002 39424OR1360001 39424OR1360002 39424OR1520001
Plan Adjusted Index Rate $366.12 $477.49 $462.01 $455.24 $449.18 $395.85 $377.01 $384.57 $376.56 $369.13 $362.45
Member Months 158,254 9,428 9,157 5,757 6,149 10,437 4,558 3,606 4,495 1,650 6,124
Total Premium (TP) $58,231,158 $0 $0 $4,501,776 $4,048,309 $2,407,314 $2,641,053 $4,218,139 $1,732,995 $0 $1,316,403 $1,782,523 $0 $640,654 $2,293,520 $0 $0 $0 $0 $0 $0 $0
EHB Percent of TP, [see instructions] 98.49% 98.82% 98.81% 97.34% 98.57% 98.76% 99.16% 99.02% 98.45% 98.73% 98.47%
state mandated benefits portion of TP that are other
than EHB 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
Other benefits portion of TP 1.51% 100.00% 100.00% 1.18% 1.19% 2.66% 1.43% 1.24% 0.84% 100.00% 0.98% 1.55% 100.00% 1.27% 1.53% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
Total Allowed Claims (TAC) $58,105,105 $3,634,955 $4,929,776 $2,322,759 $3,415,186 $4,028,311 $1,904,771 $1,773,039 $3,058,528 $283,445 $1,600,439
EHB Percent of TAC, [see instructions] 98.50% 98.82% 98.81% 97.34% 98.57% 98.76% 99.16% 99.02% 98.45% 98.73% 98.47% state mandated benefits portion of TAC that are
other than EHB 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
Other benefits portion of TAC 1.50% 100.00% 100.00% 1.18% 1.19% 2.66% 1.43% 1.24% 0.84% 100.00% 0.98% 1.55% 100.00% 1.27% 1.53% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
Allowed Claims which are not the issuer's obligation: $15,037,634 $643,797 $855,306 $543,421 $760,847 $1,052,421 $390,800 $452,367 $537,799 $89,901 $530,808Portion of above payable by HHS's funds on
behalf of insured person, in dollars $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0Portion of above payable by HHS on behalf of
insured person, as % 0.00% #DIV/0! #DIV/0! 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% #DIV/0! 0.00% 0.00% #DIV/0! 0.00% 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Total Incurred claims, payable with issuer funds $43,067,472 $0 $0 $2,991,158 $4,074,471 $1,779,338 $2,654,339 $2,975,890 $1,513,972 $0 $1,320,672 $2,520,728 $0 $193,544 $1,069,631 $0 $0 $0 $0 $0 $0 $0
Net Amt of Rein $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Net Amt of Risk Adj -$590,644.41 $167,668.16 $1,034,990.55 $26,040.52 $653,486.45 $186,045.88 $206,155.38 $232,960.70 $431,573.00 -$243,621.68 -$553,097.23
Incurred Claims PMPM $272.14 #DIV/0! #DIV/0! $317.26 $444.96 $309.07 $431.67 $285.13 $332.16 #DIV/0! $366.24 $560.78 #DIV/0! $117.30 $174.66 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Allowed Claims PMPM $367.16 #DIV/0! #DIV/0! $385.55 $538.36 $403.47 $555.41 $385.96 $417.90 #DIV/0! $491.69 $680.43 #DIV/0! $171.78 $261.34 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
EHB portion of Allowed Claims, PMPM $361.65 #DIV/0! #DIV/0! $381.00 $531.95 $392.73 $547.46 $381.18 $414.39 #DIV/0! $486.87 $669.88 #DIV/0! $169.60 $257.34 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Section IV: Projected (12 months following effective date)
Plan ID (Standard Component ID): Total 39424OR1160007 39424OR1160008 39424OR1160001 39424OR1160002 39424OR1160003 39424OR1160004 39424OR1160005 39424OR1160006 39424OR1160009 39424OR1170001 39424OR1170002 39424OR1170007 39424OR1170003 39424OR1170004 39424OR1170005 39424OR1170006 39424OR1340001 39424OR1340002 39424OR1360001 39424OR1360002 39424OR1520001
Plan Adjusted Index Rate $416.79 $523.31 $516.55 $488.38 $474.59 $473.70 $461.97 $415.18 $407.39 $407.39 $414.78 $400.46 $369.89 $389.77 $380.25 $371.58 $351.32 $397.66 $386.14 $336.71 $311.63 $421.97
Member Months 347,391 1,737 1,737 34,739 27,791 20,843 26,401 31,265 10,422 6,948 13,896 17,369 695 6,948 20,843 3,474 3,474 24,317 6,948 13,896 1,737 3,474
Total Premium (TP) $144,788,774 $908,982 $897,243 $16,965,870 $13,189,380 $9,873,402 $12,196,408 $12,980,707 $4,245,790 $2,830,526 $5,763,779 $6,955,570 $257,072 $2,708,139 $7,925,606 $1,290,867 $1,220,499 $9,670,005 $2,682,928 $4,678,985 $541,303 $1,465,918
EHB Percent of TP, [see instructions] 99.53% 99.40% 99.40% 99.38% 99.38% 99.59% 99.37% 99.58% 99.34% 99.59% 99.58% 99.59% 99.29% 99.59% 99.59% 99.59% 99.59% 99.59% 99.33% 99.70% 100.00% 99.35%
state mandated benefits portion of TP that are other
than EHB 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
Other benefits portion of TP 0.47% 0.60% 0.60% 0.62% 0.62% 0.41% 0.63% 0.42% 0.66% 0.41% 0.42% 0.41% 0.71% 0.41% 0.41% 0.41% 0.41% 0.41% 0.67% 0.30% 0.00% 0.65%
Total Allowed Claims (TAC) $152,630,762 $779,416 $779,416 $15,378,628 $12,302,814 $9,197,400 $11,687,474 $13,546,893 $4,515,775 $3,010,517 $6,099,158 $7,623,509 $286,484 $3,049,579 $9,148,299 $1,524,790 $1,524,790 $10,698,074 $3,056,718 $6,199,803 $774,975 $1,556,335
EHB Percent of TAC, [see instructions] 99.55% 99.40% 99.40% 99.38% 99.38% 99.59% 99.37% 99.58% 99.34% 99.59% 99.58% 99.59% 99.29% 99.59% 99.59% 99.59% 99.59% 99.59% 99.33% 99.70% 100.00% 99.35%
state mandated benefits portion of TAC that are
other than EHB 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
Other benefits portion of TAC 0.45% 0.60% 0.60% 0.62% 0.62% 0.41% 0.63% 0.42% 0.66% 0.41% 0.42% 0.41% 0.71% 0.41% 0.41% 0.41% 0.41% 0.41% 0.67% 0.30% 0.00% 0.65%
Allowed Claims which are not the issuer's obligation $38,131,345 $48,781 $58,166 $1,918,414 $1,836,989 $1,387,712 $2,007,996 $3,455,205 $1,214,499 $809,666 $1,560,413 $2,144,927 $83,006 $916,086 $2,903,298 $507,470 $562,500 $3,063,372 $938,029 $2,449,025 $340,764 $378,402
Portion of above payable by HHS's funds on
behalf of insured person, in dollars $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
Portion of above payable by HHS on behalf of
insured person, as % 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
Total Incurred claims, payable with issuer funds $114,499,422 $730,635 $721,250 $13,460,214 $10,465,825 $7,809,688 $9,679,478 $10,091,688 $3,301,276 $2,200,851 $4,538,745 $5,478,582 $203,478 $2,133,494 $6,245,000 $1,017,320 $962,290 $7,634,702 $2,118,689 $3,750,778 $434,212 $1,177,934
Net Amt of Rein -$781,631 -$3,908 -$3,908 -$78,163 -$62,530 -$46,897 -$59,402 -$70,346 -$23,450 -$15,633 -$31,266 -$39,080 -$1,564 -$15,633 -$46,897 -$7,817 -$7,817 -$54,713 -$15,633 -$31,266 -$3,908 -$7,817
1/1/2016
PPO
39424OR116
0.00%
0.00%
0.00%
#VALUE! 4.31%
New Beneficial 2000
39424OR134
#DIV/0!
Value
39424OR117
0.00%
0.00%
0.00%
#DIV/0!
New Beneficial 3500
39424OR136
Net Amt of Risk Adj $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
Description
21-year-old, single, non-tobacco user $219.51
40-year-old, single, non-tobacco user $280.54
60-year-old, single, non-tobacco user $595.76
21-year-old, single, non-tobacco user $270.30
40-year-old, single, non-tobacco user $345.44
60-year-old, single, non-tobacco user $733.60
21-year-old, single, non-tobacco user $322.21
40-year-old, single, non-tobacco user $411.78
60-year-old, single, non-tobacco user $874.47
Standard Silver Plan
Standard Gold Plan
Portland Area Proposed Rates Examples2016 Small Group Non-Grandfathered Plans
Standard Bronze Plan
Clackamas, Multnomah, Washington, Yamhill Counties
Description
21-year-old, single, non-tobacco user $211.83
40-year-old, single, non-tobacco user $270.72
60-year-old, single, non-tobacco user $574.91
21-year-old, single, non-tobacco user $260.84
40-year-old, single, non-tobacco user $333.35
60-year-old, single, non-tobacco user $707.92
21-year-old, single, non-tobacco user $310.93
40-year-old, single, non-tobacco user $397.37
60-year-old, single, non-tobacco user $843.86
Standard Silver Plan
Standard Gold Plan
Standard Bronze Plan
Eugene Area Proposed Rate Examples2016 Small Group Non-Grandfathered Plans
Benton, Lane, Linn Counties
Description
21-year-old, single, non-tobacco user $211.83
40-year-old, single, non-tobacco user $270.72
60-year-old, single, non-tobacco user $574.91
21-year-old, single, non-tobacco user $260.84
40-year-old, single, non-tobacco user $333.35
60-year-old, single, non-tobacco user $707.92
21-year-old, single, non-tobacco user $310.93
40-year-old, single, non-tobacco user $397.37
60-year-old, single, non-tobacco user $843.86
Standard Silver Plan
Standard Gold Plan
Standard Bronze Plan
Salem Area Proposed Rate Examples2016 Small Group Non-Grandfathered Plans
Marion, Polk Counties
Description
21-year-old, single, non-tobacco user $228.29
40-year-old, single, non-tobacco user $291.76
60-year-old, single, non-tobacco user $619.59
21-year-old, single, non-tobacco user $281.11
40-year-old, single, non-tobacco user $359.26
60-year-old, single, non-tobacco user $762.94
21-year-old, single, non-tobacco user $335.09
40-year-old, single, non-tobacco user $428.25
60-year-old, single, non-tobacco user $909.45
Standard Silver Plan
Standard Gold Plan
Standard Bronze Plan
Bend Area Proposed Rate Examples2016 Small Group Non-Grandfathered Plans
Deschutes, Klamath, Lake Counties
Description
21-year-old, single, non-tobacco user $219.51
40-year-old, single, non-tobacco user $280.54
60-year-old, single, non-tobacco user $595.76
21-year-old, single, non-tobacco user $270.30
40-year-old, single, non-tobacco user $345.44
60-year-old, single, non-tobacco user $733.60
21-year-old, single, non-tobacco user $322.21
40-year-old, single, non-tobacco user $411.78
60-year-old, single, non-tobacco user $874.47
Standard Silver Plan
Standard Gold Plan
Standard Bronze Plan
North Coast Proposed Rate Examples2016 Small Group Non-Grandfathered Plans
Clatsop, Columbia, Coos, Curry, Lincoln, Tillamook Counties
Description
21-year-old, single, non-tobacco user $226.10
40-year-old, single, non-tobacco user $288.95
60-year-old, single, non-tobacco user $613.63
21-year-old, single, non-tobacco user $278.41
40-year-old, single, non-tobacco user $355.81
60-year-old, single, non-tobacco user $755.60
21-year-old, single, non-tobacco user $331.87
40-year-old, single, non-tobacco user $424.13
60-year-old, single, non-tobacco user $900.70
Standard Silver Plan
Standard Gold Plan
Standard Bronze Plan
Pendleton-Hermiston Area Proposed Rate Examples2016 Small Group Non-Grandfathered Plans
Baker, Crook, Gilliam, Grant, Harney, Hood River, Jefferson, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa, Wasco, Wheeler Counties
Description
21-year-old, single, non-tobacco user $228.29
40-year-old, single, non-tobacco user $291.76
60-year-old, single, non-tobacco user $619.59
21-year-old, single, non-tobacco user $281.11
40-year-old, single, non-tobacco user $359.26
60-year-old, single, non-tobacco user $762.94
21-year-old, single, non-tobacco user $335.09
40-year-old, single, non-tobacco user $428.25
60-year-old, single, non-tobacco user $909.45
Standard Silver Plan
Standard Gold Plan
Standard Bronze Plan
Medford Area Proposed Rate Examples2016 Small Group Non-Grandfathered Plans
Douglas, Jackson, Josephine Counties
Development of Benefit AdjustmentsModa Health Plan, Inc.
Pediatric Vision
Member Months 158,254
Member months that cover pediactric vision 103,830
Member months that do not cover pediatric vision 54,424
Total Pediatric vision Allowed Costs $65,572
Pediatric vision Allowed Cost PMPM $0.63
Increase in Pediatric Vision Allowed Costs $34,370
PMPM $0.22
Total Allowed Costs PMPM $367.30
% increase for Pediatric Vision 0.06%
Rx Coverage
Member Months total
Member months that cover rx 149,305
Member months that do not cover rx 8,949
Total Rx Allowed Costs $6,896,832
rx Allowed Cost PMPM $46.19
Increase in rx Allowed Costs $413,380
PMPM $2.61
Total Allowed Costs PMPM $367.30
% increase for rx 0.71%
Development of Market Adjusted Index RateModa Health Plan, Inc.
Adjustment for Trend
Quarter 1 Index Rate $437.89
Annual Trend 1.052
Quarter 1 Trend 1.000
Quarter 2 Trend 1.013
Quarter 3 Trend 1.026
Quarter 4 Trend 1.039
Weighted Average Index Rate $446.32
Adjustment for Risk Adjustment
Risk Adjustment Fee PMPM $0.15
Paid to Allowed Ratio 0.745
Adjustment to Market Index Rate $0.20
Adjustment for Reinsurance
Projected Premium PMPM $2.25
Projected Recoveries PMPM $0.00
Paid to Allowed Ratio 0.745
Adjustment to Market Index Rate $3.02
Adjustment for Exchange User Fee
State QHP Assessment $9.66
Exchange Enrollment Projection 5%
Paid to Allowed Ratio 0.745
Adjustment to Market Index Rate $0.65
Market Adjusted Index Rate
Weighted Average Index Rate $446.32
Adjustment for Risk Adjustment $0.20
Adjustment for Reinsurance $3.02
Adjustment for Exchange User Fee $0.65
Market Adjusted Index Rate $450.19
Calculation of Trend Adjustment
Index
Rate
Risk
Adjustment Reinsurance
Exchange
User Fee
Market
Adjusted
Index
Rate
Factor to
Weighted
Average Market
Adjusted Index
Rate
Q1 $437.89 $0.20 $3.02 $0.65 $441.76 0.981
Q2 $443.47 $0.20 $3.02 $0.65 $447.34 0.994
Q3 $449.11 $0.20 $3.02 $0.65 $452.98 1.006
Q4 $454.82 $0.20 $3.02 $0.65 $458.69 1.019
Plan Adjusted Index RateModa Health Plan, Inc.
Market Adjusted Index Rate 450.19
Plan Name
Projected
Membership Metal tier
AV Metal
Value**
Paid to
Allowed Network Non-EHBs
Catastrophi
c Plan
Administrat
ive Costs
Plan Adjusted
Index Rate Pricing AV Age Calibration
Geographic
Calibration
Tobacco
Calibration
Calibrated Plan
Adjusted Index
Rate
PPO Platinum 250 1,737 Platinum 88.21% 93.24% 1.000 1.000 1.000 1.247 $523.31 1.16 1.42 0.997 1.00 $369.51
PPO Platinum 500 1,737 Platinum 88.02% 92.04% 1.000 1.000 1.000 1.247 $516.55 1.15 1.42 0.997 1.00 $364.74
PPO 500 34,739 Gold 81.62% 87.02% 1.000 1.000 1.000 1.247 $488.38 1.08 1.42 0.997 1.00 $344.85
PPO 1000A 27,791 Gold 79.78% 84.56% 1.000 1.000 1.000 1.247 $474.59 1.05 1.42 0.997 1.00 $335.12
PPO 1000B 20,843 Gold 78.79% 84.40% 1.000 1.000 1.000 1.247 $473.70 1.05 1.42 0.997 1.00 $334.49
PPO 1500 26,401 Gold 78.49% 82.31% 1.000 1.000 1.000 1.247 $461.97 1.03 1.42 0.997 1.00 $326.20
PPO 2500 31,265 Silver 72.00% 73.98% 1.000 1.000 1.000 1.247 $415.18 0.92 1.42 0.997 1.00 $293.17
PPO 3000 10,422 Silver 71.74% 72.59% 1.000 1.000 1.000 1.247 $407.39 0.90 1.42 0.997 1.00 $287.66
PPO 3000 10,422 Silver 71.74% 72.59% 1.000 1.000 1.000 1.247 $407.39 0.90 1.42 0.997 1.00 $287.66
Value 1500 13,896 Silver 71.74% 73.90% 1.000 1.000 1.000 1.247 $414.78 0.92 1.42 0.997 1.00 $292.88
Value 2000 17,369 Silver 71.10% 71.35% 1.000 1.000 1.000 1.247 $400.46 0.89 1.42 0.997 1.00 $282.77
Value 2000 (Rose City) 695 Silver 70.97% 70.48% 0.935 1.000 1.000 1.247 $369.89 0.82 1.42 0.997 1.00 $261.18
Value 2500 6,948 Silver 70.63% 69.45% 1.000 1.000 1.000 1.247 $389.77 0.87 1.42 0.997 1.00 $275.22
Value 3000 20,843 Silver 70.51% 67.75% 1.000 1.000 1.000 1.247 $380.25 0.84 1.42 0.997 1.00 $268.50
Value 3500 3,474 Silver 70.33% 66.21% 1.000 1.000 1.000 1.247 $371.58 0.83 1.42 0.997 1.00 $262.38
Value 5000 3,474 Silver 68.97% 62.60% 1.000 1.000 1.000 1.247 $351.32 0.78 1.42 0.997 1.00 $248.07
Moda Health Connexus Aspire 2000 24,317 Silver 71.93% 70.85% 1.000 1.000 1.000 1.247 $397.66 0.88 1.42 0.997 1.00 $280.80
Moda Health Connexus Aspire 2500 6,948 Silver 71.37% 68.80% 1.000 1.000 1.000 1.247 $386.14 0.86 1.42 0.997 1.00 $272.66
Moda Health Connexus Fundamental 3500 13,896 Bronze 61.18% 59.99% 1.000 1.000 1.000 1.247 $336.71 0.75 1.42 0.997 1.00 $237.76
Moda Health Connexus Fundamental 5000 1,737 Bronze 59.61% 55.52% 1.000 1.000 1.000 1.247 $311.63 0.69 1.42 0.997 1.00 $220.05
Moda Health Connexus HSA 1500 3,474 Silver 71.98% 75.18% 1.000 1.000 1.000 1.247 $421.97 0.94 1.42 0.997 1.00 $297.96
Moda Health Connexus HSA 2000 3,474 Silver 69.69% 71.85% 1.000 1.000 1.000 1.247 $403.23 0.90 1.42 0.997 1.00 $284.73
Moda Health Connexus HSA 2500 3,474 Silver 68.06% 69.15% 1.000 1.000 1.000 1.247 $388.09 0.86 1.42 0.997 1.00 $274.04
Moda Health Connexus HSA 3250 3,474 Bronze 61.89% 60.87% 1.000 1.000 1.000 1.247 $341.64 0.76 1.42 0.997 1.00 $241.23
Moda Health Connexus Essence 5000 10,422 Bronze 61.97% 55.65% 1.000 1.000 1.000 1.247 $312.35 0.69 1.42 0.997 1.00 $220.55
Moda Health Rose City Essence 5000 695 Bronze 61.97% 54.68% 0.935 1.000 1.000 1.247 $286.97 0.64 1.42 0.997 1.00 $202.63
Moda Health Connexus Essence 6000 3,474 Bronze 61.43% 55.32% 1.000 1.000 1.000 1.247 $310.46 0.69 1.42 0.997 1.00 $219.22
Moda Health Connexus Basic 6500 1,737 Bronze 61.85% 55.44% 1.000 1.000 1.000 1.247 $311.17 0.69 1.42 0.997 1.00 $219.72
Moda Health Connexus Basic 6500 1,737 Bronze 61.85% 55.44% 1.000 1.000 1.000 1.247 $311.17 0.69 1.42 0.997 1.00 $219.72
Moda Health Synergy Exclusive 2000 1,737 Silver 70.97% 69.46% 0.911 1.000 1.000 1.247 $354.95 0.79 1.42 0.997 1.00 $250.63
Moda Health Summit Exclusive 2000 1,737 Silver 70.97% 69.26% 0.944 1.000 1.000 1.247 $367.06 0.82 1.42 0.997 1.00 $259.18
Moda Health Synergy Exclusive 5000 1,737 Bronze 61.97% 54.37% 0.911 1.000 1.000 1.247 $277.86 0.62 1.42 0.997 1.00 $196.20
Moda Health Summit Exclusive 5000 1,737 Bronze 61.97% 54.10% 0.944 1.000 1.000 1.247 $286.70 0.64 1.42 0.997 1.00 $202.44
PPO Platinum Synergy Exclusive 250 1,737 Platinum 88.21% 92.90% 0.911 1.000 1.000 1.247 $474.72 1.05 1.42 0.997 1.00 $335.21
PPO Platinum Summit Exclusive 250 1,737 Platinum 88.21% 92.82% 0.944 1.000 1.000 1.247 $491.92 1.09 1.42 0.997 1.00 $347.35
PPO Synergy Exclusive 1000A 1,737 Gold 79.78% 84.05% 0.911 1.000 1.000 1.247 $429.50 0.95 1.42 0.997 1.00 $303.27
PPO Summit Exclusive 1000A 1,737 Gold 79.78% 83.94% 0.944 1.000 1.000 1.247 $444.88 0.99 1.42 0.997 1.00 $314.14
Moda Health Oregon Standard Gold 6,948 Gold 78.36% 82.85% 1.000 1.000 1.000 1.247 $465.02 1.03 1.42 0.997 1.00 $328.35
Moda Health Oregon Standard Silver 17,369 Silver 69.69% 69.51% 1.000 1.000 1.000 1.247 $390.11 0.87 1.42 0.997 1.00 $275.46
Moda Health Oregon Standard Bronze 1,737 Bronze 61.64% 56.45% 1.000 1.000 1.000 1.247 $316.81 0.70 1.42 0.997 1.00 $223.70
** Calculated using the Federal Actuarial Value Calculator
Projected Age DistributionModa Health Plan, Inc.
Age Band
Federal Age
Factor
Experience Period
Membership Distribution
Projection Period
Membership Distribution
0-20 0.635 22.8% 20.8%
21 1.000 1.3% 1.1%
22 1.000 1.4% 1.3%
23 1.000 1.4% 1.5%
24 1.000 1.7% 1.5%
25 1.004 1.8% 1.4%
26 1.024 1.3% 1.7%
27 1.048 1.4% 1.8%
28 1.087 1.5% 1.8%
29 1.119 1.6% 1.8%
30 1.135 1.6% 1.9%
31 1.159 1.9% 2.0%
32 1.183 1.9% 1.9%
33 1.198 1.7% 2.0%
34 1.214 1.7% 2.0%
35 1.222 1.7% 2.0%
36 1.230 1.7% 1.9%
37 1.238 1.9% 1.9%
38 1.246 1.8% 1.9%
39 1.262 1.9% 1.9%
40 1.278 1.9% 2.0%
41 1.302 1.9% 1.9%
42 1.325 1.7% 2.0%
43 1.357 2.1% 2.1%
44 1.397 1.9% 2.1%
45 1.444 2.0% 2.1%
46 1.500 1.9% 1.8%
47 1.563 1.8% 1.9%
48 1.635 1.7% 1.8%
49 1.706 1.8% 1.8%
50 1.786 2.0% 2.0%
51 1.865 1.9% 1.9%
52 1.952 2.0% 2.0%
53 2.040 2.1% 2.0%
54 2.135 1.9% 1.9%
55 2.230 2.1% 2.0%
56 2.333 1.8% 1.8%
57 2.437 1.9% 1.7%
58 2.548 1.6% 1.7%
59 2.603 1.6% 1.7%
60 2.714 1.7% 1.8%
61 2.810 1.7% 1.6%
62 2.873 1.4% 1.3%
63 2.952 1.3% 1.2%
64+ 3.000 2.2% 1.9%
Weighted Average 1.421 1.420