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Filing at a Glance Company: National Guardian Life Insurance Company Product Name: Student Health Insurance State: Pennsylvania TOI: H22 Student Health Insurance Sub-TOI: H22.000 Student Health Insurance Filing Type: Rate Date Submitted: 02/06/2017 SERFF Tr Num: NGLI-130907676 SERFF Status: Assigned State Tr Num: NGLI-130907676 State Status: Received Review in Progress Co Tr Num: NBH 280 2017 RATE Implementation Date Requested: 03/31/2017 Author(s): Susan Long, Julie Guess Reviewer(s): Rashmi Mathur (primary) Disposition Date: Disposition Status: Implementation Date: State Filing Description: SERFF Tracking #: NGLI-130907676 State Tracking #: NGLI-130907676 Company Tracking #: NBH 280 2017 RATE State: Pennsylvania Filing Company: National Guardian Life Insurance Company TOI/Sub-TOI: H22 Student Health Insurance/H22.000 Student Health Insurance Product Name: Student Health Insurance Project Name/Number: 2017-18 Student Health Rate filing/2017-18 Student Health Rate Filing PDF Pipeline for SERFF Tracking Number NGLI-130907676 Generated 02/10/2017 01:34 PM

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Page 1: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

Filing at a Glance

Company: National Guardian Life Insurance Company

Product Name: Student Health Insurance

State: Pennsylvania

TOI: H22 Student Health Insurance

Sub-TOI: H22.000 Student Health Insurance

Filing Type: Rate

Date Submitted: 02/06/2017

SERFF Tr Num: NGLI-130907676

SERFF Status: Assigned

State Tr Num: NGLI-130907676

State Status: Received Review in Progress

Co Tr Num: NBH 280 2017 RATE

ImplementationDate Requested:

03/31/2017

Author(s): Susan Long, Julie Guess

Reviewer(s): Rashmi Mathur (primary)

Disposition Date:

Disposition Status:

Implementation Date:

State Filing Description:

SERFF Tracking #: NGLI-130907676 State Tracking #: NGLI-130907676 Company Tracking #: NBH 280 2017 RATE

State: Pennsylvania Filing Company: National Guardian Life Insurance Company

TOI/Sub-TOI: H22 Student Health Insurance/H22.000 Student Health Insurance

Product Name: Student Health Insurance

Project Name/Number: 2017-18 Student Health Rate filing/2017-18 Student Health Rate Filing

PDF Pipeline for SERFF Tracking Number NGLI-130907676 Generated 02/10/2017 01:34 PM

Page 2: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

General Information

Company and Contact

Filing Fees

Project Name: 2017-18 Student Health Rate filing Status of Filing in Domicile: Not Filed

Project Number: 2017-18 Student Health Rate Filing Date Approved in Domicile:

Requested Filing Mode: Review & Approval Domicile Status Comments:

Explanation for Combination/Other: Market Type: Group

Submission Type: New Submission Group Market Size: Small and Large

Group Market Type: Blanket Overall Rate Impact:

Filing Status Changed: 02/07/2017

State Status Changed: 02/08/2017 Deemer Date:

Created By: Julie Guess Submitted By: Julie Guess

Corresponding Filing Tracking Number:

State TOI: H22 Student Health Insurance State Sub-TOI: H22.000 Student Health Insurance

PPACA: Non-Grandfathered Immed Mkt Reforms

PPACA Notes: null

Include Exchange Intentions: No

Additional Benefits: No

Filing Description:

The 2017-18 blanket student health insurance rates are attached to this filing. The 2016 rates were approved on July 6, 2015;SERFF tracking number NGLI-130480053. We will be filing the 2017-18 forms as soon as the 2016-17 form filing is approved.

Please feel free to contact me if you have any questions.

Julie [email protected], extension 5035

Filing Contact InformationJulie Guess, Compliance Analyst [email protected]

2 East Gilman St.

Madison, WI 53703

608-443-5035 [Phone]

Filing Company InformationNational Guardian Life InsuranceCompany

P.O. Box 1191

Madison, WI 53701-1191

(800) 626-7931 ext. 5325[Phone]

CoCode: 66583

Group Code: 1211

Group Name:

FEIN Number: 39-0493780

State of Domicile: Wisconsin

Company Type: LAH

State ID Number:

Fee Required? No

Retaliatory? No

SERFF Tracking #: NGLI-130907676 State Tracking #: NGLI-130907676 Company Tracking #: NBH 280 2017 RATE

State: Pennsylvania Filing Company: National Guardian Life Insurance Company

TOI/Sub-TOI: H22 Student Health Insurance/H22.000 Student Health Insurance

Product Name: Student Health Insurance

Project Name/Number: 2017-18 Student Health Rate filing/2017-18 Student Health Rate Filing

PDF Pipeline for SERFF Tracking Number NGLI-130907676 Generated 02/10/2017 01:34 PM

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Fee Explanation:

SERFF Tracking #: NGLI-130907676 State Tracking #: NGLI-130907676 Company Tracking #: NBH 280 2017 RATE

State: Pennsylvania Filing Company: National Guardian Life Insurance Company

TOI/Sub-TOI: H22 Student Health Insurance/H22.000 Student Health Insurance

Product Name: Student Health Insurance

Project Name/Number: 2017-18 Student Health Rate filing/2017-18 Student Health Rate Filing

PDF Pipeline for SERFF Tracking Number NGLI-130907676 Generated 02/10/2017 01:34 PM

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Supporting Document Schedules Satisfied - Item: Transmittal Letter (A&H)Comments:Attachment(s): 2017-18 Rate filing cover letter.pdfItem Status:Status Date:

Satisfied - Item: Actuarial Memorandum and Explanatory Information (A&H)Comments:Attachment(s): NBH-280 (2016) PA PPO REV 16 Actuarial memo.pdfItem Status:Status Date:

Satisfied - Item: Rate Manual as ,pdfComments:Attachment(s): NBH-280 (2015) PPO PA rev 16 Rate Manual.pdfItem Status:Status Date:

SERFF Tracking #: NGLI-130907676 State Tracking #: NGLI-130907676 Company Tracking #: NBH 280 2017 RATE

State: Pennsylvania Filing Company: National Guardian Life Insurance Company

TOI/Sub-TOI: H22 Student Health Insurance/H22.000 Student Health Insurance

Product Name: Student Health Insurance

Project Name/Number: 2017-18 Student Health Rate filing/2017-18 Student Health Rate Filing

PDF Pipeline for SERFF Tracking Number NGLI-130907676 Generated 02/10/2017 01:34 PM

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February 3, 2017 Pennsylvania Insurance Department 1326 Strawberry Square Harrisburg, PA 17120 RE: Rate for Policy form NBH-280 (2015) PPO PA rev 2016, et al VIA SERFF To the Department: The attached student health insurance rates are being submitted for review and approval by the Pennsylvania Insurance Department. The rates are for the 2017-18 school year. 1. Company Name/NAIC – National Guardian Life Insurance Company, 66583. 2. Form number – NBH-280 (2015) PPO PA rev 2016, et al 3. Estimated effective dates of coverage – August 1, 2017-July 31, 2018 4. Current number of covered lives and policyholders (as of November 1, 2016) – please see actuarial materials 5. Rating areas – please see actuarial materials. If you have questions, please feel free to contact me. Julie Guess [email protected] Product Compliance Analyst National Guardian Life Insurance Company Two East Gilman Street Madison, WI 53703 608-443-5035

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ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 1 of 10

1. General Information

a. Company Information:

• Company Legal Name: National Guardian Life Insurance Co • NAIC Number: 66583

b. Company Contact Information:

• Primary Contact Name: Alan Shulman, ASA MAAA • Primary Contact Telephone Number: 315-797-5200 x276 • Primary Contact Address: 70 Genesee St Utica NY 13502 • Primary Contact Email Address: [email protected]

c. Scope and Purpose of the Filing:

This filing is to submit our rate manual to be used in experience rating ACA compliant Student Health plans for the 2017 school year. Separate rate filings will be submitted for specific schools, if required, when quotes are issued.

d. Market: Student Health e. Policy Forms:

NBH-280 (2015) PPO PA Rev 2016 Brief description of the Benefits: Benefits for PPACA compliant student plan including all essential health benefits f. Marketing Method: Marketed through independent agents/MGUs g. Identification of Block as Open or Closed:

Open

h. Terminated Products/Plans:

Page 7: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 2 of 10

N/A 2. Proposed Rates

a. History of Rate Adjustments: None b. Effective Date and Implementation of Proposed Rate Adjustment: 8/1/17 c. Proposed Percentage Rate Adjustment: N/A d. Brief Description of How Rates were Determined: See attached rate manual pages for our rating formula with full definitions. The rate manual’s Starting Claim Cost was developed from experience of several schools throughout the US with high maximum plans similar to a package of PPACA-compliant benefits, or PPACA compliant for 2014 school year and greater. This development is shown in Section 3(c).

Plans will be experience rated according to the formula on page 4 of the rate manual.

e. Average Annual Premium per Member:

N/A

f. Number of Policy Holders and Covered Lives in the States:

0

3. Base Period Premium and Claims

a. Dates of Service for the Base Period Used to Develop Rates:

8/15/13 to 8/15/16 or

2013 to 2015 school year

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ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 3 of 10

b. Date Through Which Claims Were Paid:

9/30/16

c. Estimated of Allowed Claims During the Base Period Used to Develop Rates:

See 6(a)

d. Treatment of Experience for Grandfathered Policies:

N/A

e. Method Used for Determining Allowed Claims:

Experience for PPACA compliant plans for 2013 through 2015 school years.

f. Incurred But Not Paid Claims:

See Chart above

g. Premium in Base Period (Before MLR Rebates):

4. Adjustments to Allowed Claims During the Base Period

Benefit change factors were based on internal experience and account for the increase in plan maximums from 2013 ($500K) to unlimited.

New Essential Health Benefits were considered de minimus for the purpose of this filing as Preventive benefits were already included in data and pediatric dental/vision only applies to a fraction of our potential population due to age and low child dependent enrollment.

a. Private Reinsurance:

None factored into experience

b. Pooling:

Pooling table in rate manual, developed from internal experience.

5. Projection Factors

a. Changes in Covered Services:

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ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 4 of 10

Benefit change factors based on internal data.

c. Trend Factors (cost/utilization):

Trend factors were based on the 2016 Milliman Medical Index adjusted for school year dates vs. calendar year. We are using a trend of 7% for future periods as this is closer to the recent historic average. Cost trends have typically exceeded utilization trends in the past so the following breakdown supports this.

Cost Utilization

• Inpatient 3.9% 3% • Outpatient 3.9% 3% • Professional 3.9% 3% • Other Medical 3.9% 3% • Prescription Drugs 3.9% 3%

d. Projected Changes in the Demographics of the Population Insured:

None

e. Projected Changes in the Morbidity of the Population Insured:

None

e. Other Projected Changes:

6. Credibility Manual Rate Development

a. Methodology Used to Develop the Credibility Manual Rate:

The pricing model used is based on a starting point of Allowed Charges, which is then adjusted to reflect cost-sharing with the insured. The data used for the starting claim cost was derived from several years of experience for PPACA compliant plans. These schools were located in several states throughout the US. To arrive at the starting claim cost before cost-sharing, we used the trended Allowed Charges (after network discounts) from these plans as shown below:

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ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 5 of 10

The Trended Incurred Allowed per Person of $1,672 is the Starting Claim Cost in the Rate Manual. Deductible and cost sharing factors, network discounts

School Year2013 2014 2015 2016

A Allowed Charges 10,796,198$ 34,097,370$ 41,173,562$ B Area Rating Factor 1.0020 1.0140 1.0313 C Adjusted Allowed Charges 10,774,318$ 33,625,602$ 39,924,180$ D Completion factor 1.0000 1.0026 1.1011E Benefit Change factor 1.009 1.000 1.000F Incurred Allowed Charges 10,871,287$ 33,713,028$ 43,960,515$ G Exposure 10170 24959 28000H Incurred Allowed per person 1,069$ 1,351$ 1,570$

Annual Trend AssumptionI 5.9% 5.3% 6.1% 7.0%J 1.266 1.195 1.135

K Trended Incurred Allowed Charges 13,761,661$ 40,294,525$ 49,888,090$ L Exposure 10170 24959 28000M Trended Incurred Allowed per person 1,353$ 1,614$ 1,782$ N Percent Applied 0.1 0.4 0.5

O 2017 Projected Allowed 1,672$ P Allowed to Charges Ratio 0.7737 0.7142 0.6833Q Average Discount 0.705

DefinititionsA Allowed Charges including network discountsB Average Geographic Rating Factor based on CMS data (see below)C A/BD Completion Factors based on internal dataE Factor to increase plan maximum to unlimitedF C*D*EG Average insured exposureH F/GI Trends based on Milliman IndexJ Cumulative Trend FactorK F*JL ExposureM K/LN Weight applied to each yearO 2017 Projected Allowed = Sum(N*M)P Average discount from ChargesQ Average discount weighted - sum(P*N)

Page 11: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 6 of 10

b. Source and Appropriateness of Experience Data Used:

Internal experience was considered credible for manual rating

c. Adjustments Made to the Data:

Benefit adjustments made according to Milliman study mentioned above

d. Inclusion of Capitation Payments:

N/A

7. Credibility

Please note that student health is not subject to single risk pool requirements

a. Credibility Methodology: The credibility formula is comprised of two elements. The first is a standard formula based on traditional credibility formula (Z=sqrt(n/k), where k is the value needed for full credibility, based on confidence intervals). The second is an additional factor to account for the percentage the experience rate is of the manual rate. We multiply this percentage times the remaining credibility (1-Z). Our rationale is that student plans can vary widely in experience from the mean due to the particular nature and usage of the plan, and that the traditional formula does not fully reflect this variance. Thus additional credibility is applied to account for wide swings in experience.

b. Credibility Level(s):

8. Credibility Adjusted Projected Claims PMPM

N/A

9. Projected Index Rate

N/A – Student insurance rated based on a nationwide pool

Enrollment needed for full credibility 2800

Credibility formula Sqrt(N/2800)+(1-Sqrt(N/2800))(1-E/M)N=Sum(enrollment/completion factor)

E=Experience RateM=Manual rate

Page 12: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 7 of 10

10. Market Adjusted Index Rate

N/A

a. Risk Transfer Payments/Charges:

N/A

b. Transitional Reinsurance:

No longer applicable

c. Connector User Fees:

N/A

11. Paid to Allowed Ratio

Student not subject to single risk pool requirement

12. Non-Benefit Expenses Including Risk and Profit Margin

a. Projected Non-Benefit Expenses:

ADMINISTRATIVE EXPENSES

Ranges Commission:

0-3%

Claim Payor/TPA:

5-12% QIE

0-2%

Carrier:

3-6% Profit Margin:

3-5%

Ranges are determined by relationship with claim payor/TPA and what is charged for their services The total administrative expense/profit will not exceed the amount constrained by the Federal Minimum Loss Ratio according to the following formula. QIE stands for quality improvement expenses.

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ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 8 of 10

Taxes and Assessments

PPACA PCORI Fee (Per Life, Same All Classes) $2.21(.1%) State Premium Tax & Assessments 2.00%

PPACA Annual Health Insurer (HI) Fee 1.6%

Federal Minimum Loss Ratio calculation

In general,

(Claims+QIE Expenses)/(Premium-Taxes and Fees)

Claims Cost – $1,255.94

QIE pp expenses - $0 PPACA pp fees - $2.21 Total retention including profit and percentage fees (incl QIE as %) - .22 QIE % Fees – 2% Taxes – 3.6% (Claims Cost + QIE % Fees (Premium) + QIE PP expenses)/(Premium-Taxes*Premium-PPACA pp fees) (1255.94+.02*1675+0)/(1675-.036*1675-2.21)=80% Where premium =, (Claims Cost +QIE pp expenses + PPACA pp fees)/ (1-Total Retention+QIE % Fees)*(1-Taxes-(QIE % Fees)/(1-Total retention+QIE % Fees)) (1255.94+0+2.21)/ (1-.22+.02)*(1-.036-(.02/(1-.22+.02))) = $1,675 (rounded to nearest dollar)

b. Varying Non-Benefit Expenses by Plan:

None

13. Allowable Rating Factors

a. Age Factors:

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ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 9 of 10

None

b. Geographic Factors: The table of geographic rating factors in the rate manual is based on CMS published data for Medicare beneficiaries in Pennsylvania and is used as a proxy for cost differentials by the allowed rating regions. The rating areas are based on the CMS list of counties by rating area. While no data is available considering the difference in mix of services between a student and Medicare population, the differentials are considered reliable as an indicator of cost differentials amongst various areas. In theory, the mix of services may have an impact on the cost differentials but we consider it most likely that both professional and facility charges will be similarly high or low depending on the cost of living in each region. The national average from the Medicare data is $9,500.63.

c. Tobacco Factors: None

d. Family Composition:

Factor

Student-Only

1.00

14. Development of Rate Tables N/A

15. Company Financial Position NGL is an A- rated carrier by AM Best. Loss Ratios

a. Loss Ratio Requirements:

Plans will be rated at or above the defined permissible loss ratio of 80% (excluding the impact of State premium taxes and Federal/PPACA fees and assessments, as allowed by law).

b. Projected Federal MLR:

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ACTUARIAL MEMORANDUM NATIONAL GUARDIAN LIFE INSURANCE COMPANY

PENNSYLVANIA NBH-280 (2015) PPO PA Rev 2016

2/3/2017 Page 10 of 10

80%

16. Reliance N/A

17. Projected Enrollment 1000

18. Actuarial Certifications

I, Alan Shulman, ASA MAAA, am a member of the American Academy of Actuaries (Academy) and I meet the Academy qualification standards for rendering this opinion. I certify that, to the best of my knowledge and judgment: • The entire rate filing is in compliance with the applicable laws of the state of Pennsylvania and with the rules of the Office of the Commissioner of Insurance, • The development of the projected index rate and all rating factors is in compliance with all applicable federal statutes and regulations, • Each school will be rated using “school-specific community rating” as outlined in CMS-9972-F • The index rate and allowable modifiers as described in 45 CFR § 156.80 (d)(1) and 45 CFR § 156.80(d)(2) are used in the development of plan-specific premium rates, • All plans will meet the minimum value requirements detailed in 45 CFR § 147.145 (b)(2), • The methodology used to calculate the AV Metal Value for each plan complies with federal regulations, • The geographic rating factors reflect only differences in the costs of delivery and do not include differences for population morbidity by geographic area, • The entire rate filing, including development of the projected index rate and all rating factors, complies with all applicable Actuarial Standards of Practice, • The projected index rate and rating factors are reasonable in relation to the benefits provided and the population anticipated to be covered, and • The premium schedule, including the projected index rate and rating factors, is not excessive, deficient, nor unfairly discriminatory.

_____________________

Alan Shulman, ASA MAAA

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

Rate Manual Explanation

Page 4 of the rate manual, labelled Experience Rating Formula, is a demonstration of how rates will be calculated for new and renewal schools.  Much of this data comes from school specific information entered on page 2 and 3.  The first section shows school specific premium and claims experience and gross rates, along with completion factors taken from page 12, based on the effective date of the current plan and the claims paid through date entered on page 2.  Claims The estimated lives is the total premium divided by the gross rate, and the lives used for credibility are the estimated lives divided by the completion factor.  Next we calculate a Pure Rate which is the complete claims divided by estimated lives, which is then adjusted by the product change factors detailed on page 3.In the following section we apply the trend factors as described in the actuarial memorandum and detailed on page 2.  The permissible loss ratio is for demonstration purposes and is defined below as Retention%.  The calculation of the Gross Rate for a given year, P), is as follows:

% 1 %

%

Definitions:Claims – The Pure Rate (N)QIEpp – Quality improvement expenses per personPCORIpp – PCORI fees per personRetention% ‐ The sum of all Percentage expenses, such as TPA, Quality improvement (on a % basis), Carrier fee, and profit margin (all listed on page 2)Premium Tax and Health Insurer Fee are self‐explanatory, and are expressed as a percent of premium.

Next, we apply weights for each experience year and arrive at a weighted gross rate for the rating period (R).  We then apply a pooling charge depending on the pooling level chosen.  The pooling charges are laid out on page 15.  Rows U and V are for demonstration purposes only.  The manual rate is the rate calculated for the current plan using the rate model discussed below.

The plan designs entered on page 3 are used to generate plan change factors shown on the bottom of the page.  The cost sharing options are run through pages 7 and 8 for non‐drug and drug benefits, respectively.  The details of the calculations on these pages are defined on the page, and are based on the model in the textbook, Group Insurance ed. Bluhm.  The factors for deductibles and maximums used in the model are shown on pages 16 and 17.  Assumptions for copay adjustments are listed on page 9.  In general, we start at the total assumed allowed amount per person, remove the costs for copay benefits, then apply deductible and coinsurance factors.  Seperately (L to AA) we make adjustments for copays and add those net amounts back in for a total claim cost (AE).  Below are additional adjustments to copay benefits if deductibles and coinsurance also apply.  Then this claims cost is used on page 10 where rating area factors (pp 18‐25) and Network factors (page 14) applied.  These are discussed in more detail on the memorandum.The credibility formula used in X is shown on page 15.  The credibility weighted rate is the standard formula Exp Rate * Zc + Manual Rate * (1‐Zc), where Zc is the credibility factor.  The 

1

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

Domestic Plan: International Plan:

Name of School:

City: Phiuladelphia State: PA Zip Code: 19152 Commission: 0.00%

IPEDS ID: County: TPA/MGU: 10.75% See Plan Design & History Tab

Number of All Students: 1,000              Effective Date: Premium Tax: 2.00% Exp Mos

Number of UG Students: 800                 New/Renewal: QIE 2.00% 2013‐2014: 1.000                                      42                                     

Full‐time Enrollment %: Policy Number: Carrier: 6.00% 2014‐2015: 1.001                                      30                                     

Number of Eligible Students: ‐                  Carrier: Profit Margin: 3.25% 2015‐2016: 1.039                                      18                                     

Participation %: #DIV/0! Pooling Max: Total Expenses: 22.00% 2016‐2017: 4.314                                      6                                       

Total PLR: 78.00% 01/31/2017

Incumbent Carrier: United Healthcare Annual

Incumbent Producer: CHP

Incumbent Claim Payor: CHP Rate History Years => 2013‐2014 2014‐2015 2015‐2016 2016‐2017

NGL/CT Producer: CHP Agent Number: I5 Student 1,500.00                           1,550.00                      1,700.00                                 1,800.00                          

NGL/CT Claim Payor: CHP Spouse

Each Child

Enrollment Process: Waiver Child(ren)

Full‐time Minimum Hours: 12 Cigna

Benefit Period: Policy Term Cigna Prior Years => 2013‐2014 2014‐2015 2015‐2016 2016‐2017

AV Calculator % (Proposed): Gold Student NA 1.033                           1.097                                      1.059                               

Notes: Spouse NA #DIV/0! #DIV/0! #DIV/0!

Each Child NA #DIV/0! #DIV/0! #DIV/0!

Child(ren) NA #DIV/0! #DIV/0! #DIV/0!

Experience Years => 2013‐2014 2014‐2015 2015‐2016 2016‐2017

Gross Premium: 300,000                            302,000                       310,000                                  325,000                           

Paid Claims: 220,000                            350,000                       200,000                                  70,000                             

Number of Insured: 200                                   195                              182                                         181                                  

Large Claims : ‐                                    200,000                       ‐                                          ‐                                   

Weights 0.200                                0.300                           0.400                                      0.100                               

Travel Assistance: Rate:

Future Health: Rate:

College Navigator Link http://nces.ed.gov/collegenavigator/?q=florida+a%26m&s=all&id=

ABC University

Philadelphia 

New

NGL

100,000$                                                                                              

80.00%

Premium/Claims Experience

Proposed PPO Network:

Metal Tier:

2017‐2018 Rate Calculation ‐ Information Sheet ‐ (Complete All Shaded Areas)

Rate History

PPO/Non‐PPO:

Current PPO Network:

Completion Factors

Claims Paid Through Date:

Rates/Rate History Term of Coverage (ie. Annual):

Rate Adjustment Factor/Prior Years

Permissable Loss Ratio (PLR) Calculation Assumptions

08/01/2016

2

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIATRUE TRUE TRUE TRUE

Current Plan History Proposed

Plan Design 2016‐2017 2013‐2014 2014‐2015 2015‐2016 2017‐2018

Plan Maximum: Unlimited Unlimited Unlimited Unlimited Unlimited

Deductible:

Network: 100$              100$           100$            100$           250$            

Non‐Network:

Co‐insurance:

Network: 80% 80% 80% 80% 80%

Non‐Network:

Out‐of‐Pocket Maximum:

Network: 6,500$           6,500$        6,500$         6,500$        6,500$         

Non‐Network:

Prescription Drug (Rx): D C D C D C D C D C

Generic Copay: 20$                10$             10$              20$             20$              

Brand Copay: 40$                25$             25$              40$             40$              

Non‐Preferred Brand Copay: 60$                25$             25$              60$             60$              

Specialty Copay: 100$              25$             25$              100$           100$            

Deductible:

Co‐insurance:

OOP Max

Co‐pays: D C D C D C D C D C

Dr Office Visits (PCP): 25$                25$             25$              25$             25$              

Dr Office Visits (Specialist): 50$                50$             50$              50$             50$              

OP Visits (Mental /Sub. Abuse):

Emergency Room:

Urgent Care:

Inpatient:

Consultant:

Therapies (PT, ST, OT):

Diag. X‐ray:

Home Health:

OP Surgery:

Transgender Covered?

Claim Cost $1,350.78 $1,380.99 $1,380.99 $1,350.97 $1,317.50

Plan Factor 1.000 1.022 1.022 1.000 0.975

Same Same Same Same

3

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIAEXPERIENCE RATING FORMULAEXAMPLE CALCULATION BASED ON SAMPLE DATA SHOWN/ASSUMEDSchool: ABC UniversityClaims as of: 1/31/2017Runout 6Plan Maximum: UnlimitedPooling Point Assumed: $100,000

2013 2014 2015 2016

A Premium............................................ $300,000 $302,000 $310,000 $325,000B Claims Paid to Date........................... $220,000 $150,000 $200,000 $70,000C Projection Factor................................ 1.000 1.001 1.039 4.314D Ultimate Claims.................................. $220,000 $150,141 $207,892 $301,963E Loss Ratio.......................................... 73.3% 49.7% 67.1% 92.9%

F Gross Rate................................. Total 1,500.00 1,550.00 1,700.00 1,800.00 G …….est lives…………………………. 758 200 195 182 181

G2 Lives For Credibility 612 200 195 175 42H Pure Rate......................................... $1,100 $771 $1,140 $1,672I Product Change Factor...................... 0.98 0.98 1.00 1.00J As is Product Pure Rate.................... $1,076 $754 $1,140 $1,672

Annual Increase............ -30% 51% 47%

K Inflation/Cost Shift............................. 5.9% 5.3% 6.1% 6.1%L Percent Applicable............................. 100% 100% 100% 100%M Trend Factor Applied......................... 1.255 1.185 1.126 1.061

For as is Product:N Pure Rate................................ $1,351 $1,407 $1,283 $1,774O Permissable Loss Ratio.................. 78.0% 78.0% 78.0% 78.0%P Gross Rate..................................... 1,801.57$ 1,875.99$ 1,711.39$ 2,365.07$ Q Weight......... ...........…................... 20% 30% 40% 10%

R Gross Rate Before Pooling................ $1,844S Pooling Charge 11.9% based on Plan Maximum and Pooling Point from aboveT Gross Rate Needed $2,064

U Comm: 0.0%V CT Administration: 22.0%

W Manual Rate $1,717.00X Credibility Factor 58% based on avg # students and # months experienceY Credibility Weighted Rate $1,916.79 02/10/17

Z Network differential 1.00AA Network differential adjusted Rate $1,917.00

Rate Change Proposed 0.06

4

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIAEXPERIENCE RATING FORMULA DEFINITIONS

A) Premium – Annual premium collected B) Claims Paid to Date – Annual Claims paid for the school year to the

“Claims as of” date. C) Projection Factor – Factor to bring paid claims to incurred claims for

the school year. Based on internal paid claims data and updated monthly.

D) Ultimate Claims – B*C E) Loss ratio – D/A F) Gross rate – Annual premium rate per student. G) Estimated lives – A/F

G2) Lives / Completion Factor H) Pure Rate – D/G, annual claims per student I) Product Change Factor – Factor to account for actuarial value of a

change in benefits. J) H*I K) Inflation/Cost Shift – Medical cost inflation factor based on industry

expectations. L) Percent Applicable – Some plans have limits or caps on benefits and

therefore a full inflation factor is not appropriate. This percentage accounts for how much of the trend factor to use.

M) Trend Factor Applied – 1+(K*L)t * 1+(K*L)t-1….. N) For as is Product Pure Rate - J*M O) Permissible Loss Ratio – 1-U-V. P) Gross Rate – (N+QIEpp+FEDpp)/(O(1-PTAX-HIF-QIE%/O)) Q) Weight – The weight given to each experience period. The total

weights must add to one.

R) Gross Rate Before Pooling - t

n

tt QP *

1

S) Pooling Charge – From Pooling Charge Table T) Gross Rate Needed – R *(1+S) U) Commission % - Commissions as a percent of premium V) CT Administrative charge – The percent of premium allocated to

Commercial Travelers for Administration , Profit and Contingencies W) Manual Rate – Final Rate Derived by rating manual for the plan

benefits

5

Page 21: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

Proposed

School Name: ABC University Plan Design 2017‐2018

Prepared by: Company: Plan Maximum: Unlimited

Producer: CHP Deductible:

Date: Network: 250$           

Claim Payor: CHP Non‐Network: ‐$            

Co‐insurance:

Efffective Date: 08/01/2016 New/Renewal: New Approved by: Company: Network: 80%

Non‐Network: 0%

Expenses: Date: Out‐of‐Pocket Maximum:

Commissions: 0.00% Network: 6,500$        

Claim Payor: 10.75% Comments/Notes: Non‐Network: ‐$            

Premium Tax: 2.00% Prescription Drug (Rx): D C

PPACCA % Fees: 1.60% Generic Copay: 20$              0 0

QIE 2.00% Brand Copay: 40$              0 0

Carrier: 6.00% Non‐Preferred Brand Copay: 60$              0 0

Gross Margin: 3.25% Specialty Copay: 100$            0 0

  Total Expenses: 25.60% Deductible: ‐$            

  TLR: 74.40% Co‐insurance: 0%

OOP Max ‐$           

Co‐pays: D C

Current Plan Design Rates Dr Office Visits (PCP): 25$             0 0

Dr Office Visits (Specialist): 50$             0 0

OP Visits (Mental /Sub. Abuse): ‐$            0 0

Student Spouse Child Child(ren) Student Emergency Room: ‐$            0 0

Annual 1,800.00$    ‐$              ‐$                     ‐$             1,917.00$                 Urgent Care: ‐$            0 0

Inpatient: ‐$            0 0

Additional Annual Costs per Insured Consultant: ‐$            0 0

Travel Assistance: ‐$                           Therapies (PT, ST, OT): ‐$            0 0

Final Commissionable Rate: 1,917.00$                 Diag. X‐ray: ‐$            0 0

Home Health: ‐$            0 0

2016‐2017 Rate Adjustment: 1.065                        OP Surgery: ‐$            0 0

AV Calculator Proposed Plan: 80.00%

Metal Level Proposed Plan: Gold

Fees allolcated outside of MLR: Proposed Network Cigna

PCORI Fee 2.17$                       PPACA Reinsurance FeeHealth Insurer Fee 30.67$                     Premium Tax: 38.34$                     

Total Fees Allocated Outside of MLR: 71.18$                     

2017‐2018 Proposed Plan Factor: 0.975

2017‐2018 Proposed Plan Rate: 1,869.00$                

NGL/CTProposed Underwriting

2016‐2017 Rates 2017‐2018 Rates

6

Page 22: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

Non Drug Apply ApplyPlan Design Copays Deductible CoinsuranceAnnual Max Unlimited Dr Office Visits (PCP): $25 Blue font and this color shading indicates a user input for the rating modelDeductible $250 Dr Office Visits (Specialist): $50Coinsurance 80% OP Visits (Mental /Sub. Abuse): $0Out of Pocket Max $6,500 Emergency Room: $0

Urgent Care: $0Inpatient: $0

enter $0 if none Consultant: $0Therapies (PT, ST, OT): $0Diag. X‐ray: $0Home Health: $0OP Surgery: $0

Calculation $1,435.68 DefinitionsA Starting Claims Cost w/o copays $1,296.30 A Total Allowed Charges for all benefits, minus AC (Gross) minus AD plus AC (net applicablB Annual Max Unlimited B Annual benefit maximum for the planC Value of Max $1,296.30 C The value of claims under the annual maximumD Deductible 250$ D Deductible for the plan under which no benefit is paidE Value of Deductible 78.94$ E The value of claims under the deductible (Ded Factor page '% of Total' column * A)F Coinsurance 80% F Percentage of benefits paid by the plan once deductible is metG Out of Pocket Max 6,471$ G Maximum dollar value of coinsurance paid by the insuredH OOP Allowed Charges 32,607$ H G/(1-F)+D, The level of allowed charges over which the plan pays 100%I Value of Claims Over OOP $318.79 I Value of claims for which the plan pays 100%J Value of OOP 977.50$ J A-I, The value of claims under the Out of Pocket MaxK Net Claims Cost 1,037.65$ K (J-E)*F+(C-J)*1, Total value of benefits paid by the plan assuming no copays

Gross Net Copay ValueL Dr Office Visits (PCP): $59.69 $49.08 $10.61M Dr Office Visits (Specialist): $50.85 $32.77 $18.07N OP Visits (Mental /Sub. Abuse): $0.00 $0.00 $0.00O Emergency Room: $0.00 $0.00 $0.00P Urgent Care: $0.00 $0.00 $0.00Q Inpatient: $0.00 $0.00 $0.00R Consultant: $0.00 $0.00 $0.00S Therapies (PT, ST, OT): $0.00 $0.00 $0.00T Diag. X‐ray: $0.00 $0.00 $0.00U Home Health: $0.00 $0.00 $0.00V OP Surgery: $0.00 $0.00 $0.00X Generic:Y Brand:

Z Non‐Preferred Brand:

AA Specilaty:

AB Total Copay Cost PMPY $110.54 $81.85 $28.68 AB Sum of net and gross copay values

AC Net Value of Copays $81.85 AC Net Value of Benefits subject to copaysAD Additional Benefits not subject to Cost Sharing 28.84$ AD Value of Preventive Benefits

AE Total Claims Cost 1,148.34$ AE K*AA+Y+Z-X (Copay Value)

Ded/Coins Coins Only Deductible OnlyGross PMPY Net PMPY Net Applicable Adjustment Adjustment

Dr Office Visits (PCP): 59.69 49.08 -$ -$ -$ Dr Office Visits (Specialist): 50.85 32.77 -$ -$ -$ OP Visits (Mental /Sub. Abuse): 54.45 54.45 -$ -$ -$ Emergency Room: 248.71 248.71 -$ -$ -$ Urgent Care: 11.09 11.09 -$ -$ -$ Inpatient: 412.62 412.62 -$ -$ -$ Consultant: 8.93 8.93 -$ -$ -$ Therapies (PT, ST, OT): 41.95 41.95 -$ -$ -$ Diag. X‐ray: 102.44 102.44 -$ -$ -$ Home Health: 2.50 2.50 -$ -$ -$ OP Surgery: 155.53 155.53 -$ -$ -$

AF Total $1,148.75 $1,120.06 $0.00 $0.00 $0.00

Benefits with no Cost Sharing Net PMPYAGPreventive 28.84$

L-AA Net and Gross values of benefits with copays attached

7

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIAPRESCRIPTION DRUGS Apply ApplyPlan Design Copays Deductible CoinsuranceAnnual Max Unlimited Blue font and this color shading indicates a user input for the rating modelDeductible $0Coinsurance $0 Drug-Generic $20Out of Pocket Max $0 Drug-Brand $40

Drug-non pref Bran $60Drug-Spec $100

enter $0 if none

ADCalculation $236.32 DefinitionsA Starting Claims Cost w/o copays $5.73 A Total Allowed Charges for non-copay benefits (AD-Z(1)-AC+Z(3))B Annual Max Unlimited B Annual benefit maximum for the planC Value of Max $5.73 C The value of claims under the annual maximumD Deductible -$ D Deductible for the plan under which no benefit is paidE Value of Deductible -$ E The value of claims under the deductibleF Coinsurance 0% F Percentage of benefits paid by the plan once deductible is metG Out of Pocket Max (67)$ G Maximum dollar value of coinsurance paid by the insuredH OOP Allowed Charges 0$ H G/(1-F)+D, The level of allowed charges over which the plan pays 100%I Value of Claims Over OOP $24.69 I Value of claims for which the plan pays 100%J Value of OOP -$ J A-I, The value of claims under the Out of Pocket MaxK Net Claims Cost 5.73$ K (J-E)*F+(C-J)*1, Total value of benefits paid by the plan assuming no copays

Gross Net Copay ValueL ER PMPYM Visit PMPYN Drug-Generic $41.87 $15.58 $26.29O Drug-Brand $137.76 $103.59 $34.17P Drug-non pref Brand $26.29 $20.49 $5.80Q Drug-Spec $24.67 $23.77 $0.90R Outpatient Surgery PMPYS Physical Therapy PMPYT Diagnostic X-Ray PMPYU Home Health PMPYV Inpatient PMPYW Consulting Physician PMPYX Total Copay Cost PMPY $230.59 $163.43 $67.16 X Sum of net and gross copay values

Y Net Value of Copays $163.43 Y Net Value of Benefits subject to copaysZ Additional Benefits -$ Z

AA Product Change Factor 1.0000 AA Product of all benefit factors reflecting changes in benefits from rate manuaAB Total Claims Cost 169.16$ AB K*AA+Y+Z-X (Copay Value)

1 2 Ded/Coins Coins Only Deductible OnlyGross PMPY Net PMPY Net Applicable Adjustment Adjustment

Drug-Generic $41.87 $15.58 -$ -$ -$ Drug-Brand $137.76 $103.59 -$ -$ -$ Drug-non pref Brand $26.29 $20.49 -$ -$ -$ Drug-Spec $24.67 $23.77 -$ -$ -$

Z Total $230.59 $163.43 $0.00Copay Value $67.16

benefits with no Cost Sharing Net PMPYAC

L-W Net and Gross values of benefits with copays attached

8

Page 24: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

COPAY DATAAverage Average

Benefit Claims/personallowed/claim pmpmAMB SURG CENTER 0.0074 9,597.06$ 70.57$ AMBULANCE 0.0131 1,614.23$ 21.08$ DME/SUPPLIES 0.0389 395.35$ 15.39$ Generic 1.31 31.85 41.87Pref Brand 0.85 161.28 137.76Non Pref Brand 0.10 271.92 26.29Specialty 0.01 2,739.56 24.67 $230.59HOSPITAL - ER 0.1075 2,312.78$ 248.71$ HOSPITAL - INP ALC/SUB 0.0006 2,975.04$ 1.73$ HOSPITAL - INP MATERNITY 0.0030 8,534.45$ 25.77$ HOSPITAL - INP MH 0.0021 11,960.38$ 25.62$ HOSPITAL - INP NEWBORN 0.0019 3,074.77$ 5.84$ HOSPITAL - INPATIENT 0.0148 24,388.00$ 361.23$ HOSPITAL - OUT ALC/SUB 0.0038 3,631.62$ 13.85$ HOSPITAL - OUT PSYCH 0.0065 1,954.22$ 12.80$ HOSPITAL - OUTPATIENT 0.1611 1,930.33$ 311.05$ INJECTIONS/DRUGS 0.0427 985.04$ 42.03$ OTHER 0.1137 676.94$ 76.98$ PATHOLOGY 0.7000 191.18$ 133.83$ PHYS - ALC/SUB 0.0106 476.78$ 5.04$ PHYS - CHIRO 0.0564 95.71$ 5.40$ PHYS - CONSULTS 0.0304 293.29$ 8.93$ PHYS - HOSP/ER VISITS 0.1856 532.51$ 98.83$ PHYS - IMMUN 0.0741 85.06$ 6.30$ PHYS - OTHER 0.6218 280.44$ 174.38$ PHYS - PREVENTIVE 0.1643 175.53$ 28.84$ PHYS - PSYCH 0.1922 257.13$ 49.41$ PHYS - SURG INP 0.0071 3,037.71$ 21.64$ PHYS - SURG OTHER 0.3073 478.75$ 147.10$ PT/OT 0.2197 190.90$ 41.95$ RADIOLOGY 0.2834 361.45$ 102.44$ URGENT CARE 0.0440 251.75$ 11.09$ PCP Visit 0.4244 140.66$ 59.69$ Spec Visit 0.3615 140.66$ 50.85$ Home Health 0.0050 500.00$ 2.50$

2,411.45$ Trend Calculation Cost Weight Cost Trend UtilizationInpatient 420.20$ 17% 0.018 0.03 0.183Outpatient 586.41$ 24% 0.018 0.03 0.255Professional 1,060.80$ 44% 0.039 0.03 0.471Other 113.45$ 5% 0.039 0.03 0.050Drug 230.59 10% 0.039 0.03 0.102

6.1%

9

Page 25: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIAManual Rate Calculation

Unlimited Annual Max Rating Area Factor$250 Deductible 1915280% Coinsurance 1.17

$6,500 OOP Max NetworkAssumed Copays Cigna

Dr Office Visits (PCP): $25 0.81Dr Office Visits (Specialist): $50OP Visits (Mental /Sub. Abuse): $0Emergency Room: $0Urgent Care: $0Inpatient: $0Consultant: $0Therapies (PT, ST, OT): $0Diag. X‐ray: $0Home Health: $0OP Surgery: $0Drug-Generic $20Drug-Brand $40Drug-non pref Brand $60Drug-Spec $100

School Year 2017

Total Claims Cost (from Pricing Defs) $1,317.50$1,544.37$1,255.94

PPACA-Compliant Expenses 20.0%QIE 2.00%

Additional Assessments Exempt from PPACAState Premium Tax & Assesments 2.00%

PPACA Annual Health Insurer (HI) Fee* 1.60%Total Additional Assessments Exempt from PPACA 3.60%

% of prem+ PPACA Transitional Reins Fee (Per Life, Same All Classes)* $0.00 0.0%

+ PPACA PCORI Fee (Per Life, Same All Classes) $2.21 0.1%Total Rate $2.21

Class Final Annual Rates # covered lives assumedStudent-Only 1,675.00$ 1

Geographic Adjusted Claim CostsGeographic & Network Adjusted Claim Costs

10

Page 26: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIAADMINISTRATIVE EXPENSES

Ranges

Commission: 0‐3%

Claim Payor/TPA: 5‐12%

QIE 0‐2%

Carrier: 3‐6%

Profit Margin: 3‐5%

Ranges are determined by relationship with claim payor/TPA and what is charged for their services

The total administrative expense/profit will not exceed the amount constrained by the Federal 

Minimum Loss Ratio according to the following formula

(Claims+QIE Expenses)/(Premium‐Taxes and Fees)

11

Page 27: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

COMPLETION FACTORS Used unless school specific experience is available and credible

Use for 2017‐2018 PolicyTerm

Months of Paid Claims Coverage1 793.7318

2 117.3963

3 20.2106  

4 10.6262  

5 6.4143     

6 4.3138     

7 3.2374     

8 2.4376     

9 1.9857     

10 1.6878     

11 1.4727     

12 1.3083     

13 1.1755     

14 1.1011     

15 1.0735     

16 1.0570     

17 1.0495     

18 1.0395     

19 1.0305     

20 1.0215     

21 1.0153     

22 1.0111     

23 1.0074     

24 1.0074     

25 1.0069     

26 1.0026     

27 1.0013     

28 1.0009     

29 1.0009     

30 1.0009     

31 1.0009     

32 1.0009     

33 1.0009     

34 1.0000     

35 1.0000     

36 1.0000     

37 1.0000     

38 1.0000     

39 1.0000     

40 1.0000     

41 1.0000     

42 1.0000     

43 1.0000     

44 1.0000     

45 1.0000     

46 1.0000     

47 1.0000     

48 1.0000     

49 1.0000     

50 1.0000     

51 1.0000     

52 1.0000     

53 1.0000     

54 1.0000     

55 1.0000     

56 1.0000     

57 1.0000     

58 1.0000     

59 1.0000     

60 1.0000     

61 1.0000     

62 1.0000     

63 1.0000     

64 1.0000     

65 1.0000     

66 1.0000     

67 1.0000     

68 1.0000     

69 1.0000     

70 1.0000     

71 1.0000     

72 1.0000     

73 1.0000     

12

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIACTM Effective Premium Tax Rates By State

Effective Premium

State State Tax Rate

AL Alabama 1.600% (1.6% generally, 0.5% for group policies with less than 50 members)

AK Alaska 2.700%

AZ Arizona 2.000%

AR Arkansas 2.500%

CA California 2.350%

CO Colorado 2.000%

CT Connecticut 1.750%

DE Delaware 2.000%

DC District of Columbia 2.000%

FL Florida 1.750%

GA Georgia 2.250%

HI Hawaii 4.265%

ID Idaho 1.500%

IL Illinois 0.400%

IN Indiana 1.300%

IA Iowa 1.000%

KS Kansas 2.000%

KY Kentucky 1.500%

LA Louisiana 2.250%

ME Maine 2.000%

MD Maryland 2.000%

MA Massachusetts 2.000%

MI Michigan 1.250%

MN Minnesota 2.000%

MS Mississippi 3.000%

MO Missouri 2.000%

MT Montana 2.750%

NE Nebraska 1.000%

NV Nevada 3.500%

NH New Hampshire 2.000%

NJ New Jersey 1.050%

NM New Mexico 3.003%

NY New York 3.750%

NC North Carolina 2.000% (1.9% generally, Regulatory Charge adds effective 0.1%)

ND North Dakota 1.750%

OH Ohio 1.400%

OK Oklahoma 2.250%

OR Oregon 0.000%

PA Pennsylvania 2.000%

RI Rhode Island 2.000%

SC South Carolina 1.250%

SD South Dakota 2.500%

TN Tennessee 1.750%

TX Texas 2.750%

UT Utah 2.250%

VT Vermont 2.000%

VA Virginia 2.250%

WA Washington 2.000%

WV West Virginia 3.000%

WI Wisconsin 0.000%

WY Wyoming 0.750%

13

Page 29: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIACurrent Proposed

Cigna 1 Cigna 1

PAPhiladelphia PAPhiladelphia

PAPhiladelphia PAPhiladelphia

58 58

0.573333333 0.573333333

1

 Current Experience Factor 0.705                            

Network adjustment Factor 0.81                              

NETWORK DISCOUNT FACTORS

State County code Cigna Magnacare First Health PHCS Multiplan BCBS United Aetna

AL Other ALOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

AL Jefferson ALJefferson 0.48        0.80             0.68        0.76          0.48         0.48          0.48        

CA Los Angeles CALos Angeles 0.53 0.60 0.69 0.80 0.53         0.53          0.53        

CA San Fransisco CASan Fransisco 0.60 0.69 0.71 0.80 0.60         0.60          0.60        

CA Other CAOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

CO Other COOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

CT Other CTOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

DC Other DCOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

FL Volusia FLVolusia 0.48        0.68             1.00        0.80          0.48         0.48          0.48        

FL Duval FLDuval 0.54        0.66             0.76        0.80          0.54         0.54          0.54        

FL Miami‐Dade FLMiami‐Dade 0.45        0.74             0.70        0.80          0.45         0.45          0.45        

FL Orange FLOrange 0.43        0.71             0.72        0.80          0.43         0.43          0.43        

FL Other FLOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

HI Other HIOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

ID Other IDOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

IL Cook ILCook 0.48        0.73             0.68        0.80          0.48         0.48          0.48        

IL Other ILOther 0.61        0.72             0.80        0.77          0.61         0.61          0.61        

IN Marion INMarion 0.67        0.76             0.80        0.80          0.67         0.67          0.67        

IN Other INOther 0.67        0.92             0.71        0.80          0.67         0.67          0.67        

KS Other KSOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

LA E. Baton Rouge LAE. Baton Rouge 0.538 0.73 0.627 0.69 0.538 0.538 0.538

LA Orleans LAOrleans 0.473 0.71 0.689 0.69 0.473 0.473 0.473

LA Other LAOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

MA Berkshire MABerkshire 0.60        0.73             0.77        0.81          0.60         0.60          0.60        

MA Franklin MAFranklin 0.60        0.73             0.77        0.81          0.60         0.60          0.60        

MA Hampshire MAHampshire 0.60        0.73             0.77        0.81          0.60         0.60          0.60        

MA Hampden MAHampden 0.60        0.73             0.77        0.81          0.60         0.60          0.60        

MA Worcester MAWorcester 0.60        0.73             0.77        0.81          0.60         0.60          0.60        

MA Other MAOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

MD Baltimore MDBaltimore 0.65        0.80             0.92        0.87          0.65         0.65          0.65        

MD Other MDOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

MN Other MNOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

MN Hennepin MNHennepin 0.60        0.77             0.77        0.88          0.60         0.60          0.60        

MN Olmsted MNOlmsted 0.98        1.00             0.96        0.88          0.98         0.98          0.98        

MN Saint Louis MNSaint Louis 0.76        1.00             0.85        0.88          0.76         0.76          0.76        

MN Hennepin MNHennepin 0.60        0.77             0.77        0.88          0.60         0.60          0.60        

MN Olmsted MNOlmsted 0.97        1.00             0.96        0.88          0.97         0.97          0.97        

MN Other MNOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

MO St. Louis MOSt. Louis 0.43        0.71             0.71        0.71          0.43         0.43          0.43        

MO Boone MOBoone 0.71        0.65             0.67        0.74          0.71         0.71          0.71        

MO Jackson MOJackson 0.50        0.71             0.71        0.71          0.50         0.50          0.50        

MS Other MSOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

NC Mecklenburg NCMecklenburg 0.61        0.91             0.80        0.85          0.61         0.61          0.61        

NC Wake NCWake 0.53        0.67             0.77        0.85          0.53         0.53          0.53        

NC Durham NCDurham 0.53        0.67             0.77        0.85          0.53         0.53          0.53        

NC Other NCOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

NH Other NHOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

NJ Mercer NJMercer 0.47        0.76             0.65        0.76          0.47         0.47          0.47        

NJ Other NJOther 0.44        0.63             0.65        0.73          0.44         0.44          0.44        

NY Erie NYErie 0.61        0.71            0.71             0.71        0.76          0.61         0.61          0.61        

NY Albany NYAlbany 0.48        0.75            0.71             0.71        0.79          0.48         0.48          0.48        

NY NYC NYNYC 0.51        0.53            0.71             0.71        0.72          0.51         0.51          0.51        

NY Other NYOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

OH Hamilton OHHamilton 0.64        0.81             0.81        0.81          0.64         0.64          0.64        

OH Cuyahoga OHCuyahoga 0.61        0.76             0.85        0.84          0.61         0.61          0.61        

OH Lucas OHLucas 0.45        0.71             0.79        0.84          0.45         0.45          0.45        

OH Other OHOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

PA Philadelphia PAPhiladelphia 0.57        0.73             0.73        1.00          0.57         0.57          0.57        

PA Allegheny PAAllegheny 0.60        0.67             0.80        0.87          0.60         0.60          0.60        

PA Other PAOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

RI Other RIOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

SC Charleston SCCharleston 0.61        0.75             0.76        0.83          0.61         0.61          0.61        

SC Richland SCRichland 0.60        0.61             0.76        0.83          0.60         0.60          0.60        

SC Other SCOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

TN Shelby TNShelby 0.52        0.85             0.64        0.79          0.36         0.36          0.36        

TN Davidson TNDavidson 0.64        0.71             0.67        0.79          0.52         0.52          0.52        

TN Other TNOther 0.71        0.71             0.71        0.71          0.71         0.71          0.71        

14

Page 30: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIACredibilityEnrollment needed for full credibility 2800

Credibility formula Sqrt(N/2800)+(1-Sqrt(N/2800))*absolute(1-(E/M))N=Sum(enrollment/completion factor)

E=Experience RateM=Manual rate

Pooling Charges

Pooling Point Unlimited$25,000 26.2%$50,000 17.6%$100,000 11.9%$250,000 6.0%$500,000 0.9%

Weights for Experience RatingMonths ofrunout Year-3 Year-2 Year-1

<= 5 20.00% 40.00% 40.00%

6 20.00% 30.00% 40.00%

7 10.00% 30.00% 40.00%

8 10.00% 25.00% 35.00%

9 10.00% 20.00% 30.00%

>= 10 10.00% 15.00% 25.00%

Rating Structure

Class FactorStudent-Only 1.00

Plan Maximum

15

Page 31: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIADeductible Factors DEDUCTIBLE FACTORS

Deductible Annual Cost Value Over Ded Value of Ded0 $1,435.68

25 $1,435.62 $1,424.85 $10.84 0.75%50 $1,435.07 $1,414.37 $21.31 1.48%75 $1,434.62 $1,404.16 $31.52 2.20%

100 $1,433.20 $1,394.32 $41.36 2.88%150 $1,430.53 $1,377.29 $58.39 4.07%200 $1,427.52 $1,361.96 $73.72 5.13%250 $1,423.93 $1,348.25 $87.43 6.09%300 $1,420.42 $1,335.06 $100.62 7.01%350 $1,416.37 $1,321.30 $114.39 7.97%400 $1,411.79 $1,308.16 $127.52 8.88%500 $1,400.26 $1,284.17 $151.51 10.55%600 $1,392.99 $1,264.02 $171.66 11.96%700 $1,384.88 $1,244.59 $191.09 13.31%750 $1,381.36 $1,235.67 $200.01 13.93%800 $1,376.94 $1,226.39 $209.29 14.58%900 $1,368.59 $1,208.29 $227.39 15.84%

1000 $1,360.16 $1,191.12 $244.56 17.03%1500 $1,324.70 $1,117.64 $318.04 22.15%2000 $1,286.95 $1,056.80 $378.88 26.39%2500 $1,253.13 $1,004.89 $430.79 30.01%3000 $1,219.05 $959.83 $475.85 33.14%5000 $1,112.45 $829.49 $606.19 42.22%

10000 $928.83 $648.09 $787.59 54.86%15000 $818.68 $542.02 $893.67 62.25%20000 $736.49 $467.60 $968.08 67.43%25000 $663.44 $412.51 $1,023.17 71.27%30000 $590.98 $372.09 $1,063.59 74.08%35000 $540.91 $341.28 $1,094.40 76.23%40000 $504.47 $316.32 $1,119.36 77.97%45000 $469.17 $295.84 $1,139.84 79.39%50000 $441.65 $278.69 $1,156.99 80.59%55000 $407.36 $264.77 $1,170.91 81.56%60000 $401.09 $252.20 $1,183.48 82.43%65000 $380.61 $240.98 $1,194.70 83.21%70000 $360.92 $231.29 $1,204.39 83.89%75000 $334.46 $223.35 $1,212.33 84.44%80000 $320.31 $216.61 $1,219.08 84.91%85000 $317.29 $210.26 $1,225.42 85.35%90000 $307.69 $204.36 $1,231.33 85.77%95000 $304.30 $198.75 $1,236.93 86.16%

100000 $293.59 $193.59 $1,242.09 86.52%105000 $289.83 $188.72 $1,246.96 86.86%110000 $281.95 $184.17 $1,251.51 87.17%115000 $281.95 $179.72 $1,255.96 87.48%120000 $277.63 $175.41 $1,260.27 87.78%125000 $277.63 $171.15 $1,264.53 88.08%130000 $272.95 $167.02 $1,268.66 88.37%135000 $268.08 $163.08 $1,272.60 88.64%140000 $263.03 $159.33 $1,276.36 88.90%145000 $257.79 $155.75 $1,279.93 89.15%150000 $257.79 $152.23 $1,283.45 89.40%200000 $239.53 $121.01 $1,314.67 91.57%250000 $239.53 $91.38 $1,344.30 93.64%300000 $210.15 $65.70 $1,369.98 95.42%400000 $149.27 $30.75 $1,404.93 97.86%500000 $69.86 $14.31 $1,421.37 99.00%600000 $50.28 $5.83 $1,429.85 99.59%700000 $26.99 $1.07 $1,434.62 99.93%800000 $0.00 $0.00 $1,435.68 100.00%900000 $0.00 $0.00 $1,435.68 100.00%

1000000 $0.00 $0.00 $1,435.68 100.00%1250000 $0.00 $0.00 $1,435.68 100.00%1500000 $0.00 $0.00 $1,435.68 100.00%1750000 $0.00 $0.00 $1,435.68 100.00%2000000 $0.00 $0.00 $1,435.68 100.00%5000000 $0.00 $0.00 $1,435.68 100.00%

16

Page 32: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

Deductible Factors - Presciption Drugs

Deductible Annual Cost Value Over Ded Value of Ded0 $236.3225 $235.96 $229.73 $6.59 2.79%50 $234.76 $223.57 $12.75 5.40%75 $233.32 $217.80 $18.52 7.84%100 $231.96 $213.79 $22.53 9.53%150 $229.10 $205.73 $30.59 12.94%200 $224.90 $197.29 $39.02 16.51%250 $221.12 $190.21 $46.11 19.51%300 $217.35 $183.41 $52.91 22.39%350 $214.06 $178.35 $57.97 24.53%400 $210.03 $175.12 $61.20 25.90%500 $203.77 $167.31 $69.01 29.20%600 $196.22 $157.36 $78.95 33.41%700 $191.13 $148.96 $87.36 36.97%750 $187.91 $145.17 $91.15 38.57%800 $185.42 $144.82 $91.50 38.72%900 $180.28 $139.94 $96.38 40.78%1000 $174.80 $145.02 $91.30 38.64%1500 $157.88 $126.20 $110.12 46.60%2000 $143.79 $111.93 $124.39 52.64%2500 $132.77 $100.35 $135.97 57.53%3000 $124.99 $103.87 $132.45 56.05%5000 $104.24 $85.72 $150.60 63.73%10000 $83.40 $63.40 $172.92 73.17%15000 $64.23 $48.67 $187.65 79.40%20000 $48.58 $32.28 $204.04 86.34%25000 $43.86 $25.33 $210.99 89.28%30000 $41.91 $26.35 $209.97 88.85%35000 $34.96 $22.00 $214.32 90.69%40000 $29.59 $17.74 $218.58 92.49%45000 $26.54 $16.53 $219.79 93.00%50000 $23.11 $15.70 $220.62 93.36%55000 $19.31 $11.16 $225.16 95.28%60000 $19.31 $10.42 $225.90 95.59%65000 $19.31 $9.68 $226.64 95.90%70000 $19.31 $8.94 $227.38 96.22%75000 $19.31 $8.20 $228.12 96.53%80000 $19.31 $10.42 $225.90 95.59%85000 $16.30 $10.00 $226.32 95.77%90000 $13.11 $9.77 $226.55 95.87%95000 $9.73 $6.21 $230.11 97.37%100000 $9.73 $6.02 $230.30 97.45%105000 $9.73 $5.84 $230.48 97.53%110000 $9.73 $5.65 $230.67 97.61%115000 $9.73 $5.46 $230.85 97.69%120000 $9.73 $5.28 $231.04 97.77%125000 $9.73 $5.09 $231.22 97.84%130000 $9.73 $4.91 $231.41 97.92%135000 $9.73 $4.72 $231.60 98.00%140000 $9.73 $4.54 $231.78 98.08%145000 $9.73 $4.35 $231.97 98.16%150000 $9.73 $4.17 $232.15 98.24%200000 $9.73 $2.32 $234.00 99.02%250000 $9.73 $9.73 $226.59 95.88%300000 $0.00 $0.00 $236.32 100.00%400000 $0.00 $0.00 $236.32 100.00%500000 $0.00 $0.00 $236.32 100.00%600000 $0.00 $0.00 $236.32 100.00%700000 $0.00 $0.00 $236.32 100.00%800000 $0.00 $0.00 $236.32 100.00%900000 $0.00 $0.00 $236.32 100.00%1000000 $0.00 $0.00 $236.32 100.00%1250000 $0.00 $0.00 $236.32 100.00%1500000 $0.00 $0.00 $236.32 100.00%1750000 $0.00 $0.00 $236.32 100.00%2000000 $0.00 $0.00 $236.32 100.00%5000000 $0.00 $0.00 $236.32 100.00%

17

Page 33: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

RATING AREAS

AK Anchorage Rating Area 1

AK Dillingham Rating Area 1

AK Valdez‐Cordova Rating Area 1

AK Bethel Rating Area 2

AK Bristol Bay Rating Area 2

AK Denali Rating Area 2

AK Fairbanks North Star Rating Area 2

AK Kenai Peninsula Rating Area 2

AK Kodiak Island Rating Area 2

AK Matanuska‐Susitna Rating Area 2

AK Nome Rating Area 2

AK North Slope Rating Area 2

AK Northwest Arctic Rating Area 2

AK Southeast Fairbanks Rating Area 2

AK Wade Hampton Rating Area 2

AK Yukon‐Koyukuk Rating Area 2

AK Haines Rating Area 3

AK Hoonah‐Angoon Rating Area 3

AK Juneau Rating Area 3

AK Ketchikan Gateway Rating Area 3

AK Petersburg Rating Area 3

AK Prince of Wales‐Hyder Rating Area 3

AK Sitka Rating Area 3

AK Skagway Rating Area 3

AL Calhoun Rating Area 1AL Lee Rating Area 2AL Bibb Rating Area 3AL Blount Rating Area 3AL Chilton Rating Area 3AL Jefferson Rating Area 3AL St. Clair Rating Area 3AL Shelby Rating Area 3AL Walker Rating Area 3AL Russell Rating Area 4AL Lawrence Rating Area 5AL Morgan Rating Area 5AL Geneva Rating Area 6AL Henry Rating Area 6AL Houston Rating Area 6AL Colbert Rating Area 7AL Lauderdale Rating Area 7AL Etowah Rating Area 8AL Limestone Rating Area 9AL Madison Rating Area 9AL Mobile Rating Area 10AL Autauga Rating Area 11AL Elmore Rating Area 11AL Lowndes Rating Area 11AL Montgomery Rating Area 11AL Greene Rating Area 12AL Hale Rating Area 12AL Tuscaloosa Rating Area 12AL Baldwin Rating Area 13AL Barbour Rating Area 13AL Bullock Rating Area 13AL Butler Rating Area 13AL Chambers Rating Area 13AL Cherokee Rating Area 13AL Choctaw Rating Area 13AL Clarke Rating Area 13AL Clay Rating Area 13AL Cleburne Rating Area 13AL Coffee Rating Area 13AL Conecuh Rating Area 13AL Coosa Rating Area 13AL Covington Rating Area 13AL Crenshaw Rating Area 13AL Cullman Rating Area 13AL Dale Rating Area 13AL Dallas Rating Area 13AL DeKalb Rating Area 13AL Escambia Rating Area 13AL Fayette Rating Area 13AL Franklin Rating Area 13AL Jackson Rating Area 13AL Lamar Rating Area 13AL Macon Rating Area 13AL Marion Rating Area 13AL Marengo Rating Area 13AL Marshall Rating Area 13AL Monroe Rating Area 13AL Perry Rating Area 13AL Pickens Rating Area 13AL Pike Rating Area 13AL Randolph Rating Area 13AL Sumter Rating Area 13AL Talladega Rating Area 13AL Tallapoosa Rating Area 13AL Washington Rating Area 13AL Wilcox Rating Area 13AL Winston Rating Area 13AR Cleburne Rating Area 1AR Lonoke Rating Area 1AR Pulaski Rating Area 1AR Yell Rating Area 1AR Conway Rating Area 1AR Perry Rating Area 1AR Saline Rating Area 1AR Faulkner Rating Area 1AR Pope Rating Area 1AR Van Buren Rating Area 1AR Grant Rating Area 1AR Prairie Rating Area 1AR White Rating Area 1AR Clay Rating Area 2AR Fulton Rating Area 2AR Jackson Rating Area 2AR Randolph Rating Area 2AR Woodruff Rating Area 2AR Craighead Rating Area 2AR Greene Rating Area 2AR Lawrence Rating Area 2AR Sharp Rating Area 2AR Crittenden Rating Area 2AR Independence Rating Area 2AR Mississippi Rating Area 2AR St. Francis Rating Area 2AR Cross Rating Area 2AR Izard Rating Area 2AR Poinsett Rating Area 2AR Stone Rating Area 2AR Baxter Rating Area 3AR Madison Rating Area 3AR Washington Rating Area 3AR Benton Rating Area 3AR Marion Rating Area 3AR Boone Rating Area 3

Page 34: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

AR Newton Rating Area 3AR Carroll Rating Area 3AR Searcy Rating Area 3AR Clark Rating Area 4AR Pike Rating Area 4AR Garland Rating Area 4AR Hot Spring Rating Area 4AR Montgomery Rating Area 4AR Arkansas Rating Area 5AR Cleveland Rating Area 5AR Jefferson Rating Area 5AR Phillips Rating Area 5AR Ashley Rating Area 5AR Dallas Rating Area 5AR Lee Rating Area 5AR Bradley Rating Area 5AR Desha Rating Area 5AR Lincoln Rating Area 5AR Chicot Rating Area 5AR Drew Rating Area 5AR Monroe Rating Area 5AR Calhoun Rating Area 6AR Lafayette Rating Area 6AR Ouachita Rating Area 6AR Columbia Rating Area 6AR Little River Rating Area 6AR Sevier Rating Area 6AR Hempstead Rating Area 6AR Miller Rating Area 6AR Union Rating Area 6AR Howard Rating Area 6AR Nevada Rating Area 6AR Crawford Rating Area 7AR Scott Rating Area 7AR Polk Rating Area 7AR Franklin Rating Area 7AR Sebastian Rating Area 7AR Johnson Rating Area 7AR Logan Rating Area 7AZ Mohave Rating Area 1

AZ Coconino Rating Area 1

AZ Apache Rating Area 1

AZ Navajo Rating Area 1

AZ Yavapai Rating Area 2

AZ Lapaz Rating Area 3

AZ Yuma Rating Area 3

AZ Maricopa Rating Area 4

AZ Pinal Rating Area 5

AZ Gila Rating Area 5

AZ Pima Rating Area 6

AZ Santa Cruz Rating Area 6

AZ Graham Rating Area 7

AZ Greenlee Rating Area 7

AZ Cochise Rating Area 7CA Alpine Rating Area 1CA Del Norte Rating Area 1CA Siskiyou Rating Area 1CA Modoc Rating Area 1CA Lassen Rating Area 1CA Shasta Rating Area 1CA Trinity Rating Area 1CA Humboldt Rating Area 1CA Tehama Rating Area 1CA Plumas Rating Area 1CA Nevada Rating Area 1CA Sierra Rating Area 1CA Mendocino Rating Area 1CA Lake Rating Area 1CA Butte Rating Area 1CA Glenn Rating Area 1CA Sutter Rating Area 1CA Yuba Rating Area 1CA Colusa Rating Area 1CA Amador Rating Area 1CA Calaveras Rating Area 1CA Tuolumne Rating Area 1CA Napa Rating Area 2CA Sonoma Rating Area 2CA Solano Rating Area 2CA Marin Rating Area 2CA Sacramento Rating Area 3CA Placer Rating Area 3CA El Dorado Rating Area 3CA Yolo Rating Area 3CA San Francisco Rating Area 4CA Contra Costa Rating Area 5CA Alameda Rating Area 6CA Santa Clara Rating Area 7CA San Mateo Rating Area 8CA Santa Cruz Rating Area 9CA Monterey Rating Area 9CA San Benito Rating Area 9CA San Joaquin Rating Area 10CA Stanislaus Rating Area 10CA Merced Rating Area 10CA Mariposa Rating Area 10CA Tulare Rating Area 10CA Madera Rating Area 11CA Fresno Rating Area 11CA Kings Rating Area 11CA San Luis Obispo Rating Area 12CA Santa Barbara Rating Area 12CA Ventura Rating Area 12CA Mono Rating Area 13CA Inyo Rating Area 13CA Imperia Rating Area 13CA Kern Rating Area 14CA Los Angeles Rating Area 15CA Los Angeles Rating Area 15CA Los Angeles Rating Area 15CA Los Angeles Rating Area 15CA Los Angeles Rating Area 15CA Los Angeles Rating Area 15CA Los Angeles Rating Area 15CA Los Angeles Rating Area 15CA Los Angeles Rating Area 15CA Los Angeles Rating Area 15CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA Los Angeles Rating Area 16CA San Bernardino Rating Area 17CA Riverside Rating Area 17CA Orange Rating Area 18CA San Diego Rating Area 19CO BOULDER Rating Area 1CO El Paso Rating Area 2CO Teller Rating Area 2

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

CO Adams Rating Area 3CO Arapahoe Rating Area 3CO Broomfield Rating Area 3CO Clear Creek Rating Area 3CO Denver Rating Area 3CO Douglas Rating Area 3CO Elbert Rating Area 3CO Gilpin Rating Area 3CO Jefferson Rating Area 3CO Park Rating Area 3CO Larimer Rating Area 4CO Mesa Rating Area 5CO Weld Rating Area 6CO Pueblo Rating Area 7CO Alamosa Rating Area 8CO Baca Rating Area 8CO Bent Rating Area 8CO Chaffee Rating Area 8CO Cheyenne Rating Area 8CO Conejos Rating Area 8CO Costilla Rating Area 8CO Crowley Rating Area 8CO Custer Rating Area 8CO Fremont Rating Area 8CO Huerfano Rating Area 8CO Kiowa Rating Area 8CO Kit Carson Rating Area 8CO Las Animas Rating Area 8CO Lincoln Rating Area 8CO Logan Rating Area 8CO Mineral Rating Area 8CO Morgan Rating Area 8CO Otero Rating Area 8CO Phillips Rating Area 8CO Prowers Rating Area 8CO Rio Grande Rating Area 8CO Saguache Rating Area 8CO Sedgwick Rating Area 8CO Washington Rating Area 8CO Yuma Rating Area 8CO Archuleta Rating Area 9CO Delta Rating Area 9CO Dolores Rating Area 9CO Eagle Rating Area 9CO Garfield Rating Area 9CO Grand Rating Area 9CO Gunnison Rating Area 9CO Hinsdale Rating Area 9CO Jackson Rating Area 9CO La Plata Rating Area 9CO Lake Rating Area 9CO Moffat Rating Area 9CO Montezuma Rating Area 9CO Montrose Rating Area 9CO Ouray Rating Area 9CO Pitkin Rating Area 9CO Rio Blanco Rating Area 9CO Routt Rating Area 9CO San Juan Rating Area 9CO San Miguel Rating Area 9CO Summit Rating Area 9CT Fairfield Rating Area 1CT Hartford Rating Area 2CT Litchfield Rating Area 3CT Middlesex Rating Area 4CT New Haven Rating Area 5CT New London Rating Area 6CT Tolland Rating Area 7CT Windham Rating Area 8DC District of Columbia Rating Area 1DE Kent Rating Area 1DE New Castle Rating Area 1DE Sussex Rating Area 1FL Alachua Rating Area 1FL Baker Rating Area 2FL Bay Rating Area 3FL Bradford Rating Area 4FL Brevard Rating Area 5FL Broward Rating Area 6FL Calhoun Rating Area 7FL Charlotte Rating Area 8FL Citrus Rating Area 9FL Clay Rating Area 10FL Collier Rating Area 11FL Columbia Rating Area 12FL De Soto Rating Area 13FL Dixie Rating Area 14FL Duval Rating Area 15FL Escambia Rating Area 16FL Flagler Rating Area 17FL Franklin Rating Area 18FL Gadsden Rating Area 19FL Gilchrist Rating Area 20FL Glades Rating Area 21FL Gulf Rating Area 22FL Hamilton Rating Area 23FL Hardee Rating Area 24FL Hendry Rating Area 25FL Hernando Rating Area 26FL Highlands Rating Area 27FL Hillsborough Rating Area 28FL Holmes Rating Area 29FL Indian River Rating Area 30FL Jackson Rating Area 31FL Jefferson Rating Area 32FL Lafayette Rating Area 33FL Lake Rating Area 34FL Lee Rating Area 35FL Leon Rating Area 36FL Levy Rating Area 37FL Liberty Rating Area 38FL Madison Rating Area 39FL Manatee Rating Area 40FL Marion Rating Area 41FL Martin Rating Area 42FL Miami-Dade Rating Area 43FL Monroe Rating Area 44FL Nassau Rating Area 45FL Okaloosa Rating Area 46FL Okeechobee Rating Area 47FL Orange Rating Area 48FL Osceola Rating Area 49FL Palm Beach Rating Area 50FL Pasco Rating Area 51FL Pinellas Rating Area 52FL Polk Rating Area 53FL Putnam Rating Area 54FL Santa Rosa Rating Area 55FL Sarasota Rating Area 56FL Seminole Rating Area 57FL St. Johns Rating Area 58FL St. Lucie Rating Area 59FL Sumter Rating Area 60FL Suwannee Rating Area 61FL Taylor Rating Area 62FL Union Rating Area 63FL Volusia Rating Area 64FL Wakulla Rating Area 65FL Walton Rating Area 66

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

FL Washington Rating Area 67GA Baker Rating Area 1GA Calhoun Rating Area 1GA Clay Rating Area 1GA Crisp Rating Area 1GA Dougherty Rating Area 1GA Lee Rating Area 1GA Mitchell Rating Area 1GA Randolph Rating Area 1GA Schley Rating Area 1GA Sumter Rating Area 1GA Terrell Rating Area 1GA Worth Rating Area 1GA Barrow Rating Area 2GA Clarke Rating Area 2GA Elbert Rating Area 2GA Greene Rating Area 2GA Jackson Rating Area 2GA Madison Rating Area 2GA Morgan Rating Area 2GA Oconee Rating Area 2GA Oglethorpe Rating Area 2GA Bartow Rating Area 3GA Butts Rating Area 3GA Cherokee Rating Area 3GA Clayton Rating Area 3GA Cobb Rating Area 3GA Coweta Rating Area 3GA De Kalb Rating Area 3GA Douglas Rating Area 3GA Fayette Rating Area 3GA Forsyth Rating Area 3GA Fulton Rating Area 3GA Gwinnett Rating Area 3GA Henry Rating Area 3GA Jasper Rating Area 3GA Lamar Rating Area 3GA Newton Rating Area 3GA Paulding Rating Area 3GA Pike Rating Area 3GA Rockdale Rating Area 3GA Spalding Rating Area 3GA Walton Rating Area 3GA Carroll Rating Area 4GA Haralson Rating Area 4GA Heard Rating Area 4GA Burke Rating Area 5GA Columbia Rating Area 5GA Emanuel Rating Area 5GA Glascock Rating Area 5GA Jefferson Rating Area 5GA Jenkins Rating Area 5GA Lincoln Rating Area 5GA Mc Duffie Rating Area 5GA Richmond Rating Area 5GA Taliaferro Rating Area 5GA Warren Rating Area 5GA Wilkes Rating Area 5GA Bacon Rating Area 6GA Brantley Rating Area 6GA Camden Rating Area 6GA Charlton Rating Area 6GA Glynn Rating Area 6GA Mc Intosh Rating Area 6GA Pierce Rating Area 6GA Ware Rating Area 6GA Wayne Rating Area 6GA Catoosa Rating Area 7GA Dade Rating Area 7GA Ewalker Rating Area 7GA Chattahoochee Rating Area 8GA Harris Rating Area 8GA Macon Rating Area 8GA Marion Rating Area 8GA Meriwether Rating Area 8GA Muscogee Rating Area 8GA Quitman Rating Area 8GA Stewart Rating Area 8GA Talbot Rating Area 8GA Taylor Rating Area 8GA Troup Rating Area 8GA Upson Rating Area 8GA Webster Rating Area 8GA Fannin Rating Area 9GA Murray Rating Area 9GA Whitfield Rating Area 9GA Banks Rating Area 10GA Dawson Rating Area 10GA Franklin Rating Area 10GA Habersham Rating Area 10GA Hall Rating Area 10GA Hart Rating Area 10GA Lumpkin Rating Area 10GA Rabun Rating Area 10GA Stephens Rating Area 10GA Towns Rating Area 10GA Union Rating Area 10GA White Rating Area 10GA Atkinson Rating Area 11GA Coffee Rating Area 11GA Jeff Davis Rating Area 11GA Johnson Rating Area 11GA Laurens Rating Area 11GA Montgomery Rating Area 11GA Telfair Rating Area 11GA Toombs Rating Area 11GA Treutlen Rating Area 11GA Wheeler Rating Area 11GA Bibb Rating Area 12GA Bleckley Rating Area 12GA Crawford Rating Area 12GA Dodge Rating Area 12GA Dooly Rating Area 12GA Houston Rating Area 12GA Jones Rating Area 12GA Monroe Rating Area 12GA Peach Rating Area 12GA Pulaski Rating Area 12GA Putnam Rating Area 12GA Twiggs Rating Area 12GA Wilcox Rating Area 12GA Chattooga Rating Area 13GA Floyd Rating Area 13GA Gilmer Rating Area 13GA Gordon Rating Area 13GA Pickens Rating Area 13GA Polk Rating Area 13GA Appling Rating Area 14GA Bryan Rating Area 14GA Bulloch Rating Area 14GA Candler Rating Area 14GA Chatham Rating Area 14GA Effingham Rating Area 14GA Evans Rating Area 14GA Liberty Rating Area 14GA Long Rating Area 14GA Screven Rating Area 14GA Tattnall Rating Area 14GA Ben Hill Rating Area 15

Page 37: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

GA Berrien Rating Area 15GA Brooks Rating Area 15GA Clinch Rating Area 15GA Colquitt Rating Area 15GA Cook Rating Area 15GA Decatur Rating Area 15GA Early Rating Area 15GA Echols Rating Area 15GA Grady Rating Area 15GA Irwin Rating Area 15GA Lanier Rating Area 15GA Lowndes Rating Area 15GA Miller Rating Area 15GA Seminole Rating Area 15GA Thomas Rating Area 15GA Tift Rating Area 15GA Turner Rating Area 15GA Baldwin Rating Area 16GA Hancock Rating Area 16GA Washington Rating Area 16GA Wilkinson Rating Area 16GA Walker Rating Area 7HI Honolulu Rating Area 1HI Hawaii Rating Area 1HI Maui Rating Area 1HI Kalawao Rating Area 1HI Kauai Rating Area 1IA Boone Rating Area 1IA Calhoun Rating Area 1IA Carroll Rating Area 1IA Greene Rating Area 1IA Grundy Rating Area 1IA Hamilton Rating Area 1IA Hardin Rating Area 1IA Marshall Rating Area 1IA Poweshiek Rating Area 1IA Story Rating Area 1IA Tama Rating Area 1IA Webster Rating Area 1IA Dallas Rating Area 2IA Jasper Rating Area 2IA Madison Rating Area 2IA Marion Rating Area 2IA Polk Rating Area 2IA Warren Rating Area 2IA Buena Vista Rating Area 3IA Cherokee Rating Area 3IA Clay Rating Area 3IA Crawford Rating Area 3IA Dickinson Rating Area 3IA Ida Rating Area 3IA Lyon Rating Area 3IA Monona Rating Area 3IA OBrien Rating Area 3IA Osceola Rating Area 3IA Palo Alto Rating Area 3IA Plymouth Rating Area 3IA Pocahontas Rating Area 3IA Sac Rating Area 3IA Sioux Rating Area 3IA Woodbury Rating Area 3IA Adair Rating Area 4IA Adams Rating Area 4IA Audubon Rating Area 4IA Cass Rating Area 4IA Clarke Rating Area 4IA Decatur Rating Area 4IA Fremont Rating Area 4IA Guthrie Rating Area 4IA Harrison Rating Area 4IA Mills Rating Area 4IA Montgomery Rating Area 4IA Page Rating Area 4IA Pottawattamie Rating Area 4IA Ringgold Rating Area 4IA Shelby Rating Area 4IA Taylor Rating Area 4IA Union Rating Area 4IA Appanoose Rating Area 5IA Davis Rating Area 5IA Des Moines Rating Area 5IA Henry Rating Area 5IA Jefferson Rating Area 5IA Keokuk Rating Area 5IA Lee Rating Area 5IA Louisa Rating Area 5IA Lucas Rating Area 5IA Mahaska Rating Area 5IA Monroe Rating Area 5IA Muscatine Rating Area 5IA Van Buren Rating Area 5IA Wapello Rating Area 5IA Washington Rating Area 5IA Wayne Rating Area 5IA Benton Rating Area 6IA Black Hawk Rating Area 6IA Buchanan Rating Area 6IA Cedar Rating Area 6IA Clayton Rating Area 6IA Clinton Rating Area 6IA Delaware Rating Area 6IA Dubuque Rating Area 6IA Iowa Rating Area 6IA Jackson Rating Area 6IA Johnson Rating Area 6IA Jones Rating Area 6IA Linn Rating Area 6IA Scott Rating Area 6IA Allamakee Rating Area 7IA Bremer Rating Area 7IA Butler Rating Area 7IA Cerro Gordo Rating Area 7IA Chickasaw Rating Area 7IA Emmet Rating Area 7IA Fayette Rating Area 7IA Floyd Rating Area 7IA Franklin Rating Area 7IA Hancock Rating Area 7IA Howard Rating Area 7IA Humboldt Rating Area 7IA Kossuth Rating Area 7IA Mitchell Rating Area 7IA Winnebago Rating Area 7IA Winneshiek Rating Area 7IA Worth Rating Area 7IA Wright Rating Area 7ID Bannock Rating Area 1ID Bear Lake Rating Area 1ID Bingham Rating Area 1ID Butte Rating Area 1ID Caribou Rating Area 1ID Custer Rating Area 1ID Franklin Rating Area 1ID Oneida Rating Area 1ID Power Rating Area 1ID Blaine Rating Area 2ID Camas Rating Area 2ID Cassia Rating Area 2ID Gooding Rating Area 2

Page 38: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

ID Lincoln Rating Area 2ID Minidoka Rating Area 2ID Twin Falls Rating Area 2ID Bonneville Rating Area 3ID Clark Rating Area 3ID Fremont Rating Area 3ID Jefferson Rating Area 3ID Jerome Rating Area 3ID Lemhi Rating Area 3ID Madison Rating Area 3ID Teton Rating Area 3ID Clearwater Rating Area 4ID Idaho Rating Area 4ID Lewis Rating Area 4ID Nez Perce Rating Area 4ID Adams Rating Area 5ID Boise Rating Area 5ID Boundary Rating Area 5ID Canyon Rating Area 5ID Elmore Rating Area 5ID Gem Rating Area 5ID Owyhee Rating Area 5ID Payette Rating Area 5ID Valley Rating Area 5ID Washington Rating Area 5ID ADA Rating Area 6ID Benewah Rating Area 7ID Bonner Rating Area 7ID Kootenai Rating Area 7ID Latah Rating Area 7ID Shoshone Rating Area 7IL Cook Rating Area 1IL Lake Rating Area 2IL McHenry Rating Area 2IL Dupage Rating Area 3IL Kane Rating Area 3IL Grundy Rating Area 4IL Kankakee Rating Area 4IL Kendall Rating Area 4IL Will Rating Area 4IL Boone Rating Area 5IL Carroll Rating Area 5IL DeKalb Rating Area 5IL Jo Daviess Rating Area 5IL Lee Rating Area 5IL Ogle Rating Area 5IL Stephenson Rating Area 5IL Winnebago Rating Area 5IL Bureau Rating Area 6IL Hancock Rating Area 6IL Henderson Rating Area 6IL Henry Rating Area 6IL Mercer Rating Area 6IL Rock Island Rating Area 6IL Warren Rating Area 6IL Whiteside Rating Area 6IL Knox Rating Area 7IL LaSalle Rating Area 7IL Marshall Rating Area 7IL McDonough Rating Area 7IL Peoria Rating Area 7IL Putnam Rating Area 7IL Stark Rating Area 7IL Tazewel Rating Area 7IL Woodford Rating Area 7IL Fulton Rating Area 7IL McLean Rating Area 8IL Livingston Rating Area 8IL DeWitt Rating Area 8IL Champaign Rating Area 9IL Coles Rating Area 9IL Douglas Rating Area 9IL Edgar Rating Area 9IL Piatt Rating Area 9IL Ford Rating Area 9IL Iroquois Rating Area 9IL Vermillion Rating Area 9IL Clark Rating Area 9IL Cumberland Rating Area 9IL Adams Rating Area 10IL Brown Rating Area 10IL Cass Rating Area 10IL Christian Rating Area 10IL Logan Rating Area 10IL Macon Rating Area 10IL Mason Rating Area 10IL Menard Rating Area 10IL Morgan Rating Area 10IL Moultrie Rating Area 10IL Pike Rating Area 10IL Sangamon Rating Area 10IL Schuyler Rating Area 10IL Scott Rating Area 10IL Shelby Rating Area 10IL Bond Rating Area 11IL Calhoun Rating Area 11IL Clinton Rating Area 11IL Greene Rating Area 11IL Jersey Rating Area 11IL Macoupin Rating Area 11IL Montgomery Rating Area 11IL Randolph Rating Area 11IL Washington Rating Area 11IL Madison Rating Area 12IL Monroe Rating Area 12IL St. Clair Rating Area 12IL Alexander Rating Area 13IL Clay Rating Area 13IL Crawford Rating Area 13IL Edwards Rating Area 13IL Effingham Rating Area 13IL Fayette Rating Area 13IL Franklin Rating Area 13IL Gallatin Rating Area 13IL Hamilton Rating Area 13IL Hardin Rating Area 13IL Jackson Rating Area 13IL Jasper Rating Area 13IL Jefferson Rating Area 13IL Johnson Rating Area 13IL Lawrence Rating Area 13IL Marion Rating Area 13IL Massac Rating Area 13IL Perry Rating Area 13IL Pope Rating Area 13IL Pulaski Rating Area 13IL Richland Rating Area 13IL Saline Rating Area 13IL Union Rating Area 13IL Wabash Rating Area 13IL Wayne Rating Area 13IL White Rating Area 13IL Williamson Rating Area 13IN Lake Rating Area 1IN La Porte Rating Area 1IN Porter Rating Area 1IN Elkhart Rating Area 2IN Kosciusko Rating Area 2IN Marshall Rating Area 2

Page 39: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

IN St. Joseph Rating Area 2IN Starke Rating Area 2IN Adams Rating Area 3IN De Kalb Rating Area 3IN Huntington Rating Area 3IN LaGrange Rating Area 3IN Noble Rating Area 3IN Steuben Rating Area 3IN Wabash Rating Area 3IN Wells Rating Area 3IN Whitley Rating Area 3IN Allen Rating Area 4IN Benton Rating Area 5IN Jasper Rating Area 5IN Newton Rating Area 5IN Warren Rating Area 5IN White Rating Area 5IN Cass Rating Area 6IN Fulton Rating Area 6IN Howard Rating Area 6IN Miami Rating Area 6IN Pulaski Rating Area 6IN Carroll Rating Area 7IN Clinton Rating Area 7IN Fountain Rating Area 7IN Montgomery Rating Area 7IN Putnam Rating Area 7IN Tippecanoe Rating Area 7IN Tipton Rating Area 7IN Blackford Rating Area 8IN Delaware Rating Area 8IN Grant Rating Area 8IN Jay Rating Area 8IN Randolph Rating Area 8IN Clay Rating Area 9IN Parke Rating Area 9IN Sullivan Rating Area 9IN Vermillion Rating Area 9IN Vigo Rating Area 9IN Boone Rating Area 10IN Hamilton Rating Area 10IN Marion Rating Area 10IN Morgan Rating Area 10IN Shelby Rating Area 10IN Hendricks Rating Area 10IN Fayette Rating Area 11IN Hancock Rating Area 11IN Henry Rating Area 11IN Madison Rating Area 11IN Union Rating Area 11IN Wayne Rating Area 11IN Bartholomew Rating Area 12IN Decatur Rating Area 12IN Jackson Rating Area 12IN Jennings Rating Area 12IN Rush Rating Area 12IN Brown Rating Area 13IN Johnson Rating Area 13IN Lawrence Rating Area 13IN Monroe Rating Area 13IN Owen Rating Area 13IN Dearborn Rating Area 14IN Franklin Rating Area 14IN Ohio Rating Area 14IN Ripley Rating Area 14IN Switzerland Rating Area 14IN Daviess Rating Area 15IN Dubois Rating Area 15IN Greene Rating Area 15IN Knox Rating Area 15IN Martin Rating Area 15IN Orange Rating Area 15IN Perry Rating Area 15IN Pike Rating Area 15IN Spencer Rating Area 15IN Clark Rating Area 16IN Crawford Rating Area 16IN Floyd Rating Area 16IN Harrison Rating Area 16IN Jefferson Rating Area 16IN Scott Rating Area 16IN Washington Rating Area 16IN Gibson Rating Area 17IN Posey Rating Area 17IN Warrick Rating Area 17IN Vanderburgh Rating Area 17KS Leavenworth Rating Area 1KS Wyandotte Rating Area 1KS Johnson Rating Area 1KS Miami Rating Area 1KS Marshall Rating Area 2KS Nemaha Rating Area 2KS Brown Rating Area 2KS Doniphan Rating Area 2KS Pottawatomie Rating Area 2KS Jackson Rating Area 2KS Atchison Rating Area 2KS Wabaunsee Rating Area 2KS Shawnee Rating Area 2KS Jefferson Rating Area 2KS Lyon Rating Area 2KS Osage Rating Area 2KS Douglas Rating Area 2KS Franklin Rating Area 2KS Coffey Rating Area 2KS Anderson Rating Area 2KS Linn Rating Area 2KS Jewell Rating Area 3KS Republic Rating Area 3KS Washington Rating Area 3KS Mitchell Rating Area 3KS Cloud Rating Area 3KS Clay Rating Area 3KS Riley Rating Area 3KS Lincoln Rating Area 3KS Ottawa Rating Area 3KS Ellsworth Rating Area 3KS Saline Rating Area 3KS Dickinson Rating Area 3KS Geary Rating Area 3KS Morris Rating Area 3KS Cheyenne Rating Area 4KS Rawlins Rating Area 4KS Decatur Rating Area 4KS Norton Rating Area 4KS Phillips Rating Area 4KS Smith Rating Area 4KS Sherman Rating Area 4KS Thomas Rating Area 4KS Sheridan Rating Area 4KS Graham Rating Area 4KS Rooks Rating Area 4KS Osborne Rating Area 4KS Wallace Rating Area 4KS Logan Rating Area 4KS Gove Rating Area 4KS Trego Rating Area 4KS Ellis Rating Area 4KS Russell Rating Area 4

Page 40: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

KS Greeley Rating Area 4KS Wichita Rating Area 4KS Scott Rating Area 4KS Lane Rating Area 4KS Ness Rating Area 4KS Rush Rating Area 4KS Barton Rating Area 4KS Hamilton Rating Area 5KS Kearny Rating Area 5KS Finney Rating Area 5KS Hodgeman Rating Area 5KS Pawnee Rating Area 5KS Stafford Rating Area 5KS Stanton Rating Area 5KS Grant Rating Area 5KS Haskell Rating Area 5KS Gray Rating Area 5KS Ford Rating Area 5KS Edwards Rating Area 5KS Kiowa Rating Area 5KS Pratt Rating Area 5KS Morton Rating Area 5KS Stevens Rating Area 5KS Seward Rating Area 5KS Meade Rating Area 5KS Clark Rating Area 5KS Comanche Rating Area 5KS Barber Rating Area 5KS Rice Rating Area 6KS Reno Rating Area 6KS Kingman Rating Area 6KS Harper Rating Area 6KS McPherson Rating Area 6KS Harvey Rating Area 6KS Sedgwick Rating Area 6KS Sumner Rating Area 6KS Marion Rating Area 6KS Butler Rating Area 6KS Cowley Rating Area 6KS Chase Rating Area 6KS Greenwood Rating Area 6KS Elk Rating Area 6KS Chautauqua Rating Area 6KS Wilson Rating Area 6KS Montgomery Rating Area 6KS Woodson Rating Area 7KS Allen Rating Area 7KS Neosho Rating Area 7KS Labette Rating Area 7KS Bourbon Rating Area 7KS Crawford Rating Area 7KS Cherokee Rating Area 7KY Ballard Rating Area 1KY Caldwel Rating Area 1KY Calloway Rating Area 1KY Carlisle Rating Area 1KY Crittenden Rating Area 1KY Fulton Rating Area 1KY Graves Rating Area 1KY Hickman Rating Area 1KY Livingston Rating Area 1KY Lyon Rating Area 1KY Marshall Rating Area 1KY Mc Cracken Rating Area 1KY Christian Rating Area 2KY Daviess Rating Area 2KY Hancock Rating Area 2KY Henderson Rating Area 2KY Hopkins Rating Area 2KY Mc Lean Rating Area 2KY Muhlenberg Rating Area 2KY Ohio Rating Area 2KY Trigg Rating Area 2KY Todd Rating Area 2KY Union Rating Area 2KY Webster Rating Area 2KY Breckinridge Rating Area 3KY Bullitt Rating Area 3KY Carroll Rating Area 3KY Grayson Rating Area 3KY Hardin Rating Area 3KY Henry Rating Area 3KY Jefferson Rating Area 3KY Larue Rating Area 3KY Marion Rating Area 3KY Meade Rating Area 3KY Nelson Rating Area 3KY Oldham Rating Area 3KY Shelby Rating Area 3KY Spencer Rating Area 3KY Trimble Rating Area 3KY Washington Rating Area 3KY Adair Rating Area 4KY Allen Rating Area 4KY Barren Rating Area 4KY Butler Rating Area 4KY Casey Rating Area 4KY Clinton Rating Area 4KY Cumberland Rating Area 4KY Edmonson Rating Area 4KY Green Rating Area 4KY Hart Rating Area 4KY Logan Rating Area 4KY Mc Creary Rating Area 4KY Metcalfe Rating Area 4KY Monroe Rating Area 4KY Pulaski Rating Area 4KY Russell Rating Area 4KY Simpson Rating Area 4KY Taylor Rating Area 4KY Warren Rating Area 4KY Wayne Rating Area 4KY Anderson Rating Area 5KY Bourbon Rating Area 5KY Boyle Rating Area 5KY Clark Rating Area 5KY Estill Rating Area 5KY Fayette Rating Area 5KY Franklin Rating Area 5KY Garrard Rating Area 5KY Harrison Rating Area 5KY Jackson Rating Area 5KY Jessamine Rating Area 5KY Lincoln Rating Area 5KY Madison Rating Area 5KY Mercer Rating Area 5KY Montgomery Rating Area 5KY Nicholas Rating Area 5KY Owen Rating Area 5KY Powell Rating Area 5KY Rockcastle Rating Area 5KY Scott Rating Area 5KY Woodford Rating Area 5KY Boone Rating Area 6KY Campbel Rating Area 6KY Gallatin Rating Area 6KY Grant Rating Area 6KY Kenton Rating Area 6KY Pendleton Rating Area 6

Page 41: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

KY Bath Rating Area 7KY Boyd Rating Area 7KY Bracken Rating Area 7KY Carter Rating Area 7KY Elliott Rating Area 7KY Fleming Rating Area 7KY Greenup Rating Area 7KY Lawrence Rating Area 7KY Lewis Rating Area 7KY Mason Rating Area 7KY Menifee Rating Area 7KY Morgan Rating Area 7KY Robertson Rating Area 7KY Rowan Rating Area 7KY Bell Rating Area 8KY Breathitt Rating Area 8KY Clay Rating Area 8KY Floyd Rating Area 8KY Harlan Rating Area 8KY Johnson Rating Area 8KY Knott Rating Area 8KY Knox Rating Area 8KY Laurel Rating Area 8KY Lee Rating Area 8KY Leslie Rating Area 8KY Letcher Rating Area 8KY Magoffin Rating Area 8KY Martin Rating Area 8KY Owsley Rating Area 8KY Perry Rating Area 8KY Pike Rating Area 8KY Whitley Rating Area 8KY Wolfe Rating Area 8LA Orleans Rating Area 1LA St. Bernard Rating Area 1LA Plaquemines Rating Area 1LA Jefferson Rating Area 1LA St. Charles Rating Area 1LA St. John Baptist Rating Area 1LA St. James Rating Area 1LA St. Tammany Rating Area 1LA Lafourche Rating Area 2LA Terrebonne Rating Area 2LA Assumption Rating Area 2LA Lafayette Rating Area 3LA St. Martin Rating Area 3LA St. Mary Rating Area 3LA Iberia Rating Area 3LA Vermilion Rating Area 3LA Acadia Rating Area 3LA St. Landry Rating Area 3LA Evangeline Rating Area 3LA Cameron Rating Area 4LA Jeffrson Davis Rating Area 4LA Calcasieu Rating Area 4LA Allen Rating Area 4LA Beauregard Rating Area 4LA E. Baton Rouge Rating Area 5LA W. Baton Rouge Rating Area 5LA Iberville Rating Area 5LA Pointe Coupee Rating Area 5LA West Feliciana Rating Area 5LA East Feliciana Rating Area 5LA Ascension Rating Area 5LA Livingston Rating Area 5LA St. Helena Rating Area 5LA Tangipahoa Rating Area 5LA Washington Rating Area 5LA Rapides Rating Area 6LA Vernon Rating Area 6LA Avoyelles Rating Area 6LA Concordia Rating Area 6LA Catahoula Rating Area 6LA La Salle Rating Area 6LA Grant Rating Area 6LA Winn Rating Area 6LA Ouachita Rating Area 7LA East Carroll Rating Area 7LA West Carroll Rating Area 7LA Madison Rating Area 7LA Tensas Rating Area 7LA Franklin Rating Area 7LA Richland Rating Area 7LA Morehouse Rating Area 7LA Caldwel Rating Area 7LA Jackson Rating Area 7LA Lincoln Rating Area 7LA Union Rating Area 7LA Bossier Rating Area 8LA Caddo Rating Area 8LA Webster Rating Area 8LA Claiborne Rating Area 8LA Bienville Rating Area 8LA Red River Rating Area 8LA De Soto Rating Area 8LA Natchitoches Rating Area 8LA Sabine Rating Area 8MA Berkshire Rating Area 1MA Franklin Rating Area 1MA Hampden Rating Area 1MA Hampshire Rating Area 1MA Worcester Rating Area 1MA Middlesex Rating Area 2MA Norfolk Rating Area 3MA Plymouth Rating Area 3MA Essex Rating Area 4MA Suffolk Rating Area 5MA Bristol Rating Area 6MA Barnstable Rating Area 7MA Dukes Rating Area 7MA Nantucket Rating Area 7MD Baltimore City Rating Area 1MD Baltimore Rating Area 1MD Harford Rating Area 1MD Howard Rating Area 1MD Anne Arundel Rating Area 1MD St. Marys Rating Area 2MD Charles Rating Area 2MD Calvert Rating Area 2MD Cecil Rating Area 2MD Kent Rating Area 2MD Queen Annes Rating Area 2MD Talbot Rating Area 2MD Caroline Rating Area 2MD Dorchester Rating Area 2MD Wicomico Rating Area 2MD Somerset Rating Area 2MD Worcester Rating Area 2MD Montgomery Rating Area 3MD Prince Georges Rating Area 3MD Garrett Rating Area 4MD Allegany Rating Area 4MD Washington Rating Area 4MD Carroll Rating Area 4MD Frederick Rating Area 4ME Cumberland Rating Area 1ME Sagadahoc Rating Area 1ME York Rating Area 1ME Knox Rating Area 2

Page 42: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

ME Kennebec Rating Area 2ME Lincoln Rating Area 2ME Oxford Rating Area 2ME Androscoggin Rating Area 3ME Waldo Rating Area 3ME Franklin Rating Area 3ME Penobscot Rating Area 3ME Somerset Rating Area 3ME Piscataquis Rating Area 3ME Hancock Rating Area 4ME Aroostook Rating Area 4ME Washington Rating Area 4MI Monroe Rating Area 1MI Wayne Rating Area 1MI Macomb Rating Area 2MI Oakland Rating Area 2MI St. Clair Rating Area 3MI Lenawee Rating Area 4MI Washtenaw Rating Area 4MI Livingston Rating Area 4MI Lapeer Rating Area 5MI Genesee Rating Area 5MI Shiawassee Rating Area 5MI Huron Rating Area 6MI Sanilac Rating Area 6MI Tuscola Rating Area 6MI Clinton Rating Area 7MI Eaton Rating Area 7MI Hillsdale Rating Area 7MI Ingham Rating Area 7MI Jackson Rating Area 7MI Arenac Rating Area 8MI Gratiot Rating Area 8MI Saginaw Rating Area 8MI Bay Rating Area 8MI Berrien Rating Area 9MI St. Joseph Rating Area 9MI Cass Rating Area 9MI Van Buren Rating Area 9MI Branch Rating Area 10MI Calhoun Rating Area 10MI Kalamazoo Rating Area 10MI Allegan Rating Area 11MI Barry Rating Area 11MI Ionia Rating Area 12MI Kent Rating Area 12MI Lake Rating Area 12MI Mason Rating Area 12MI Mecosta Rating Area 12MI Montcalm Rating Area 12MI Muskegon Rating Area 12MI Newaygo Rating Area 12MI Oceana Rating Area 12MI Osceola Rating Area 12MI Ottawa Rating Area 12MI Gladwin Rating Area 13MI Clare Rating Area 13MI Isabella Rating Area 13MI Midland Rating Area 13MI Antrim Rating Area 14MI Benzie Rating Area 14MI Charlevoix Rating Area 14MI Emmet Rating Area 14MI Grand Traverse Rating Area 14MI Manistee Rating Area 14MI Kalkaska Rating Area 14MI Missaukee Rating Area 14MI Wexford Rating Area 14MI Leelanau Rating Area 14MI Alcona Rating Area 15MI Alpena Rating Area 15MI Cheboygan Rating Area 15MI Chippewa Rating Area 15MI Crawford Rating Area 15MI Iosco Rating Area 15MI Mackinac Rating Area 15MI Montmorency Rating Area 15MI Ogemaw Rating Area 15MI Oscoda Rating Area 15MI Otsego Rating Area 15MI Presque Isle Rating Area 15MI Roscommon Rating Area 15MI Alger Rating Area 16MI Baraga Rating Area 16MI Delta Rating Area 16MI Dickinson Rating Area 16MI Gogebic Rating Area 16MI Houghton Rating Area 16MI Iron Rating Area 16MI Keweenaw Rating Area 16MI Luce Rating Area 16MI Marquette Rating Area 16MI Menominee Rating Area 16MI Ontonagon Rating Area 16MI Schoolcraft Rating Area 16MN Dodge Rating Area 1MN Fillmore Rating Area 1MN Freeborn Rating Area 1MN Goodhue Rating Area 1MN Houston Rating Area 1MN Mower Rating Area 1MN Olmsted Rating Area 1MN Steele Rating Area 1MN Wabasha Rating Area 1MN Winona Rating Area 1MN Carlton Rating Area 2MN Cook Rating Area 2MN Itasca Rating Area 2MN Koochiching Rating Area 2MN Lake Rating Area 2MN Lake of Woods Rating Area 2MN St. Louis Rating Area 2MN Blue Earth Rating Area 3MN Faribault Rating Area 3MN Waseca Rating Area 3MN Le Sueur Rating Area 3MN Martin Rating Area 3MN Nicollet Rating Area 3MN Rice Rating Area 3MN Watonwan Rating Area 3MN Brown Rating Area 4MN Cottonwood Rating Area 4MN Jackson Rating Area 4MN Lincoln Rating Area 4MN Murray Rating Area 4MN Nobles Rating Area 4MN Pipestone Rating Area 4MN Redwood Rating Area 4MN Rock Rating Area 4MN Chippewa Rating Area 5MN Big Stone Rating Area 5MN Kandiyohi Rating Area 5MN Lac Qui Parle Rating Area 5MN Lyon Rating Area 5MN Mc Leod Rating Area 5MN Meeker Rating Area 5MN Renville Rating Area 5MN Sibley Rating Area 5MN Swift Rating Area 5

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

MN Yellow Medcine Rating Area 5MN Becker Rating Area 6MN Clay Rating Area 6MN Douglas Rating Area 6MN Grant Rating Area 6MN Otter Tail Rating Area 6MN Pope Rating Area 6MN Stevens Rating Area 6MN Traverse Rating Area 6MN Wilkin Rating Area 6MN Aitkin Rating Area 7MN Beltrami Rating Area 7MN Cass Rating Area 7MN Chisago Rating Area 7MN Crow Wing Rating Area 7MN Hubbard Rating Area 7MN Isanti Rating Area 7MN Kanabec Rating Area 7MN Mille Lacs Rating Area 7MN Morrison Rating Area 7MN Pine Rating Area 7MN Roseau Rating Area 7MN Todd Rating Area 7MN Wadena Rating Area 7MN Anoka Rating Area 8MN Benton Rating Area 8MN Carver Rating Area 8MN Dakota Rating Area 8MN Hennepin Rating Area 8MN Ramsey Rating Area 8MN Scott Rating Area 8MN Sherburne Rating Area 8MN Stearns Rating Area 8MN Washington Rating Area 8MN Wright Rating Area 8MN Clearwater Rating Area 9MN Kittson Rating Area 9MN Mahnomen Rating Area 9MN Marshall Rating Area 9MN Norman Rating Area 9MN Pennington Rating Area 9MN Polk Rating Area 9MN Red Lake Rating Area 9MO Atchison Rating Area 1MO Nodaway Rating Area 1MO Holt Rating Area 1MO Andrew Rating Area 1MO Buchanan Rating Area 1MO Worth Rating Area 1MO Gentry Rating Area 1MO De Kalb Rating Area 1MO Clinton Rating Area 1MO Harrison Rating Area 1MO Daviess Rating Area 1MO Caldwel Rating Area 1MO Ray Rating Area 1MO Mercer Rating Area 1MO Grundy Rating Area 1MO Livingston Rating Area 1MO Carroll Rating Area 1MO Putnam Rating Area 2MO Sullivan Rating Area 2MO Linn Rating Area 2MO Schuyler Rating Area 2MO Adair Rating Area 2MO Macon Rating Area 2MO Scotland Rating Area 2MO Knox Rating Area 2MO Shelby Rating Area 2MO Clark Rating Area 2MO Lewis Rating Area 2MO Marion Rating Area 2MO Ralls Rating Area 2MO Pike Rating Area 2MO Platte Rating Area 3MO Clay Rating Area 3MO Jackson Rating Area 3MO Cass Rating Area 3MO Bates Rating Area 4MO Vernon Rating Area 4MO Lafayette Rating Area 4MO Johnson Rating Area 4MO Henry Rating Area 4MO St. Clair Rating Area 4MO Saline Rating Area 4MO Pettis Rating Area 4MO Benton Rating Area 4MO Chariton Rating Area 5MO Randolph Rating Area 5MO Monroe Rating Area 5MO Howard Rating Area 5MO Boone Rating Area 5MO Audrain Rating Area 5MO Cooper Rating Area 5MO Morgan Rating Area 5MO Camden Rating Area 5MO Moniteau Rating Area 5MO Cole Rating Area 5MO Miller Rating Area 5MO Callaway Rating Area 5MO Osage Rating Area 5MO Maries Rating Area 5MO Montgomery Rating Area 5MO Gasconade Rating Area 5MO Lincoln Rating Area 6MO Warren Rating Area 6MO St. Charles Rating Area 6MO St. Louis Rating Area 6MO St. Louis City Rating Area 6MO Franklin Rating Area 6MO Jefferson Rating Area 6MO Washington Rating Area 6MO St. Francois Rating Area 6MO Ste. Genevieve Rating Area 6MO Barton Rating Area 7MO Jasper Rating Area 7MO Newton Rating Area 7MO Mc Donald Rating Area 7MO Cedar Rating Area 8MO Dade Rating Area 8MO Lawrence Rating Area 8MO Barry Rating Area 8MO Hickory Rating Area 8MO Polk Rating Area 8MO Greene Rating Area 8MO Christian Rating Area 8MO Stone Rating Area 8MO Taney Rating Area 8MO Dallas Rating Area 8MO Laclede Rating Area 8MO Webster Rating Area 8MO Wright Rating Area 8MO Douglas Rating Area 8MO Ozark Rating Area 8MO Pulaski Rating Area 9MO Phelps Rating Area 9MO Crawford Rating Area 9MO Texas Rating Area 9MO Dent Rating Area 9

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

MO Reynolds Rating Area 9MO Iron Rating Area 9MO Shannon Rating Area 9MO Carter Rating Area 9MO Howell Rating Area 9MO Oregon Rating Area 9MO Ripley Rating Area 9MO Perry Rating Area 10MO Madison Rating Area 10MO Bollinger Rating Area 10MO Cape Girardeau Rating Area 10MO Wayne Rating Area 10MO Butler Rating Area 10MO Stoddard Rating Area 10MO Scott Rating Area 10MO Mississippi Rating Area 10MO New Madrid Rating Area 10MO Pemiscot Rating Area 10MO Dunklin Rating Area 10MS Tunica Rating Area 1MS Tate Rating Area 1MS Marshall Rating Area 1MS De Soto Rating Area 1MS Benton Rating Area 2MS Tippah Rating Area 2MS Union Rating Area 2MS Pontotoc Rating Area 2MS Lee Rating Area 2MS Itawamba Rating Area 2MS Warren Rating Area 3MS Madison Rating Area 3MS Hinds Rating Area 3MS Rankin Rating Area 3MS Copiah Rating Area 3MS Simpson Rating Area 3MS Lamar Rating Area 4MS Forrest Rating Area 4MS Perry Rating Area 4MS Greene Rating Area 4MS Pearl River Rating Area 4MS Jones Rating Area 4MS Stone Rating Area 5MS George Rating Area 5MS Hancock Rating Area 5MS Harrison Rating Area 5MS Jackson Rating Area 5MS Adams Rating Area 6MS Alcorn Rating Area 6MS Amite Rating Area 6MS Attala Rating Area 6MS Bolivar Rating Area 6MS Calhoun Rating Area 6MS Carroll Rating Area 6MS Chickasaw Rating Area 6MS Choctaw Rating Area 6MS Claiborne Rating Area 6MS Clarke Rating Area 6MS Clay Rating Area 6MS Coahoma Rating Area 6MS Covington Rating Area 6MS Franklin Rating Area 6MS Grenada Rating Area 6MS Holmes Rating Area 6MS Humphreys Rating Area 6MS Issaquena Rating Area 6MS Jasper Rating Area 6MS Jefferson Rating Area 6MS Jefferson Davis Rating Area 6MS Kemper Rating Area 6MS Lafayette Rating Area 6MS Lauderdale Rating Area 6MS Lawrence Rating Area 6MS Leake Rating Area 6MS Leflore Rating Area 6MS Lincoln Rating Area 6MS Lowndes Rating Area 6MS Marion Rating Area 6MS Monroe Rating Area 6MS Montgomery Rating Area 6MS Neshoba Rating Area 6MS Newton Rating Area 6MS Noxubee Rating Area 6MS Oktibbeha Rating Area 6MS Panola Rating Area 6MS Pike Rating Area 6MS Prentiss Rating Area 6MS Quitman Rating Area 6MS Scott Rating Area 6MS Sharkey Rating Area 6MS Smith Rating Area 6MS Sunflower Rating Area 6MS Tallahatchie Rating Area 6MS Tishomingo Rating Area 6MS Walthall Rating Area 6MS Washington Rating Area 6MS Wayne Rating Area 6MS Webster Rating Area 6MS Wilkinson Rating Area 6MS Winston Rating Area 6MS Yalobusha Rating Area 6MS Yazoo Rating Area 6MT Musselshell Rating Area 1MT Yellowstone Rating Area 1MT Carbon Rating Area 1MT Stillwater Rating Area 1MT Sweet Grass Rating Area 1MT Chouteau Rating Area 2MT Teton Rating Area 2MT Lewis and Clark Rating Area 2MT Broadwater Rating Area 2MT Jefferson Rating Area 2MT Deer Lodge Rating Area 2MT Silver Bow Rating Area 2MT Gallatin Rating Area 2MT Cascade Rating Area 2MT Judith Basin Rating Area 2MT Flathead Rating Area 3MT Lake Rating Area 3MT Missoula Rating Area 3MT Beaverhead Rating Area 4MT Big Horn Rating Area 4MT Blaine Rating Area 4MT Carter Rating Area 4MT Custer Rating Area 4MT Daniels Rating Area 4MT Dawson Rating Area 4MT Fallon Rating Area 4MT Fergus Rating Area 4MT Garfield Rating Area 4MT Glacier Rating Area 4MT Golden Valley Rating Area 4MT Granite Rating Area 4MT Hill Rating Area 4MT Liberty Rating Area 4

Page 45: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

MT Lincoln Rating Area 4MT Madison Rating Area 4MT McCone Rating Area 4MT Meagher Rating Area 4MT Mineral Rating Area 4MT Park Rating Area 4MT Petroleum Rating Area 4MT Phillips Rating Area 4MT Pondera Rating Area 4MT Powder River Rating Area 4MT Powell Rating Area 4MT Prairie Rating Area 4MT Ravalli Rating Area 4MT Richland Rating Area 4MT Roosevelt Rating Area 4MT Rosebud Rating Area 4MT Sanders Rating Area 4MT Sheridan Rating Area 4MT Toole Rating Area 4MT Treasure Rating Area 4MT Valley Rating Area 4MT Wheatland Rating Area 4MT Wibaux Rating Area 4NC Avery Rating Area 1NC Buncombe Rating Area 1NC Cherokee Rating Area 1NC Clay Rating Area 1NC Graham Rating Area 1NC Haywood Rating Area 1NC Henderson Rating Area 1NC Jackson Rating Area 1NC Mc Dowell Rating Area 1NC Macon Rating Area 1NC Madison Rating Area 1NC Mitchell Rating Area 1NC Polk Rating Area 1NC Rutherford Rating Area 1NC Swain Rating Area 1NC Transylvania Rating Area 1NC Yancey Rating Area 1NC Alexander Rating Area 2NC Burke Rating Area 2NC Caldwell Rating Area 2NC Iredell Rating Area 2NC Catawba Rating Area 2NC Alleghany Rating Area 3NC Ashe Rating Area 3NC Watauga Rating Area 3NC Wilkes Rating Area 3NC Anson Rating Area 4NC Cabarrus Rating Area 4NC Mecklenburg Rating Area 4NC Rowan Rating Area 4NC Stanly Rating Area 4NC Union Rating Area 4NC Cleveland Rating Area 5NC Gaston Rating Area 5NC Lincoln Rating Area 5NC Davidson Rating Area 6NC Davie Rating Area 6NC Forsyth Rating Area 6NC Stokes Rating Area 6NC Surry Rating Area 6NC Yadkin Rating Area 6NC Guilford Rating Area 7NC Randolph Rating Area 7NC Rockingham Rating Area 7NC Montgomery Rating Area 8NC Moore Rating Area 8NC Bladen Rating Area 9NC Cumberland Rating Area 9NC Harnett Rating Area 9NC Hoke Rating Area 9NC Richmond Rating Area 9NC Robeson Rating Area 9NC Sampson Rating Area 9NC Scotland Rating Area 9NC Granville Rating Area 10NC Vance Rating Area 10NC Warren Rating Area 10NC Alamance Rating Area 11NC Caswell Rating Area 11NC Chatham Rating Area 11NC Durham Rating Area 11NC Lee Rating Area 11NC Orange Rating Area 11NC Person Rating Area 11NC Bertie Rating Area 12NC Camden Rating Area 12NC Chowan Rating Area 12NC Currituck Rating Area 12NC Gates Rating Area 12NC Halifax Rating Area 12NC Hertford Rating Area 12NC Martin Rating Area 12NC Northampton Rating Area 12NC Pasquotank Rating Area 12NC Perquimans Rating Area 12NC Franklin Rating Area 13NC Johnston Rating Area 13NC Wake Rating Area 13NC Edgecombe Rating Area 14NC Greene Rating Area 14NC Nash Rating Area 14NC Pitt Rating Area 14NC Wilson Rating Area 14NC Wayne Rating Area 14NC Brunswick Rating Area 15NC Columbus Rating Area 15NC Duplin Rating Area 15NC New Hanover Rating Area 15NC Onslow Rating Area 15NC Pender Rating Area 15NC Beaufort Rating Area 16NC Carteret Rating Area 16NC Craven Rating Area 16NC Dare Rating Area 16NC Hyde Rating Area 16NC Jones Rating Area 16NC Pamlico Rating Area 16NC Tyrrell Rating Area 16NC Washington Rating Area 16NC Lenoir Rating Area 16ND Burleigh Rating Area 1ND Morton Rating Area 1ND Cass Rating Area 2ND Grand Forks Rating Area 3ND Adams Rating Area 4

Page 46: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

ND Barnes Rating Area 4ND Benson Rating Area 4ND Billings Rating Area 4ND Bottineau Rating Area 4ND Bowman Rating Area 4ND Burke Rating Area 4ND Cavalier Rating Area 4ND Dickey Rating Area 4ND Divide Rating Area 4ND Dunn Rating Area 4ND Eddy Rating Area 4ND Emmons Rating Area 4ND Foster Rating Area 4ND Golden Valley Rating Area 4ND Grant Rating Area 4ND Griggs Rating Area 4ND Hettinger Rating Area 4ND Kidder Rating Area 4ND La Moure Rating Area 4ND Logan Rating Area 4ND McHenry Rating Area 4ND McIntosh Rating Area 4ND McKenzie Rating Area 4ND McLean Rating Area 4ND Mercer Rating Area 4ND Mountrail Rating Area 4ND Nelson Rating Area 4ND Oliver Rating Area 4ND Pembina Rating Area 4ND Pierce Rating Area 4ND Ramsey Rating Area 4ND Ransom Rating Area 4ND Renville Rating Area 4ND Richland Rating Area 4ND Rolette Rating Area 4ND Sargent Rating Area 4ND Sheridan Rating Area 4ND Sioux Rating Area 4ND Slope Rating Area 4ND Stark Rating Area 4ND Steele Rating Area 4ND Stutsman Rating Area 4ND Towner Rating Area 4ND Traill Rating Area 4ND Walsh Rating Area 4ND Ward Rating Area 4ND Wells Rating Area 4ND Williams Rating Area 4NE Burt Rating Area 1NE Butler Rating Area 1NE Cass Rating Area 1NE Cuming Rating Area 1NE Dakota Rating Area 1NE Dodge Rating Area 1NE Douglas Rating Area 1NE Lancaster Rating Area 1NE Sarpy Rating Area 1NE Saunders Rating Area 1NE Thurston Rating Area 1NE Washington Rating Area 1NE Fillmore Rating Area 2NE Gage Rating Area 2NE Hamilton Rating Area 2NE Jefferson Rating Area 2NE Johnson Rating Area 2NE Nemaha Rating Area 2NE Otoe Rating Area 2NE Pawnee Rating Area 2NE Polk Rating Area 2NE Richardson Rating Area 2NE Saline Rating Area 2NE Seward Rating Area 2NE Thayer Rating Area 2NE York Rating Area 2NE Antelope Rating Area 3NE Boone Rating Area 3NE Boyd Rating Area 3NE Brown Rating Area 3NE Cedar Rating Area 3NE Colfax Rating Area 3NE Dixon Rating Area 3NE Greeley Rating Area 3NE Holt Rating Area 3NE Keya Paha Rating Area 3NE Knox Rating Area 3NE Madison Rating Area 3NE Merrick Rating Area 3NE Nance Rating Area 3NE Pierce Rating Area 3NE Platte Rating Area 3NE Stanton Rating Area 3NE Wayne Rating Area 3NE Wheeler Rating Area 3NE Blaine Rating Area 3NE Buffalo Rating Area 3NE Custer Rating Area 3NE Dawson Rating Area 3NE Garfield Rating Area 3NE Hall Rating Area 3NE Howard Rating Area 3NE Logan Rating Area 3NE Loup Rating Area 3NE Phelps Rating Area 3NE Sherman Rating Area 3NE Valley Rating Area 3NE Adams Rating Area 3NE Clay Rating Area 3NE Franklin Rating Area 3NE Furnas Rating Area 3NE Gosper Rating Area 3NE Harlan Rating Area 3NE Kearney Rating Area 3NE Nuckolls Rating Area 3NE Webster Rating Area 3NE Chase Rating Area 4NE Dundy Rating Area 4NE Frontier Rating Area 4NE Hayes Rating Area 4NE Hitchcock Rating Area 4NE Red Willow Rating Area 4NE Arthur Rating Area 4NE Banner Rating Area 4NE Cherry Rating Area 4NE Cheyenne Rating Area 4NE Deuel Rating Area 4NE Garden Rating Area 4NE Hooker Rating Area 4NE Keith Rating Area 4NE Kimball Rating Area 4NE Lincoln Rating Area 4NE Mc Pherson Rating Area 4NE Perkins Rating Area 4NE Thomas Rating Area 4

Page 47: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

NE Rock Rating Area 4NE Box Butte Rating Area 4NE Grant Rating Area 4NE Morrill Rating Area 4NE Scott Bluff Rating Area 4NE Sheridan Rating Area 4NE Sioux Rating Area 4NE Dawes Rating Area 4NH Rockingham Rating Area 1NH Strafford Rating Area 1NH Hillsborough Rating Area 1NH Belknap Rating Area 1NH Carroll Rating Area 1NH Cheshire Rating Area 1NH Coos Rating Area 1NH Grafton Rating Area 1NH Merrimack Rating Area 1NH Sullivan Rating Area 1NJ Warren Rating Area 1NJ Atlantic Rating Area 1NJ Bergen Rating Area 1NJ Essex Rating Area 1NJ Hudson Rating Area 1NJ Hunterdon Rating Area 1NJ Middlesex Rating Area 1NJ Monmouth Rating Area 1NJ Morris Rating Area 1NJ Ocean Rating Area 1NJ Passaic Rating Area 1NJ Somerset Rating Area 1NJ Sussex Rating Area 1NJ Union Rating Area 1NJ Cape May Rating Area 1NJ Burlington Rating Area 1NJ Camden Rating Area 1NJ Gloucester Rating Area 1NJ Salem Rating Area 1NJ Mercer Rating Area 1NJ Cumberland Rating Area 1NM Bernalillo Rating Area 1

NM Sandoval Rating Area 1

NM Torrance Rating Area 1

NM Valencia Rating Area 1

NM San Juan Rating Area 2

NM Dona Ana Rating Area 3

NM Santa Fe Rating Area 4

NM Catron Rating Area 5

NM Chaves Rating Area 5

NM Cibola Rating Area 5

NM Colfax Rating Area 5

NM Curry Rating Area 5

NM De Baca Rating Area 5

NM Eddy Rating Area 5

NM Grant Rating Area 5

NM Guadalupe Rating Area 5

NM Harding Rating Area 5

NM Hidalgo Rating Area 5

NM Lea Rating Area 5

NM Lincoln Rating Area 5

NM Los Alamos Rating Area 5

NM Luna Rating Area 5

NM McKinley Rating Area 5

NM Mora Rating Area 5

NM Otero Rating Area 5

NM Quay Rating Area 5

NM Rio Arriba Rating Area 5

NM Roosevelt Rating Area 5

NM San Miguel Rating Area 5

NM Sierra Rating Area 5

NM Socorro Rating Area 5

NM Taos Rating Area 5

NM Union Rating Area 5

NV Nye Rating Area 1NV Clark Rating Area 1NV Washoe Rating Area 2NV Carson City Rating Area 3NV Douglas Rating Area 3NV Lyon Rating Area 3NV Storey Rating Area 3NV Esmeralda Rating Area 4NV Eureka Rating Area 4NV Humboldt Rating Area 4NV Lander Rating Area 4NV Lincoln Rating Area 4NV Elko Rating Area 4NV Mineral Rating Area 4NV Pershing Rating Area 4NV White Pine Rating Area 4NV Churchill Rating Area 4NY ALBANY Rating Area 1

NY ALLEGANY Rating Area 2

NY BRONX Rating Area 4

NY BROOME Rating Area 6

NY CATTARAUGUS Rating Area 2

NY CAYUGA Rating Area 6

NY CHAUTAUQUA Rating Area 2

NY CHEMUNG Rating Area 6

NY CHENANGO Rating Area 7

NY CLINTON Rating Area 7

NY COLUMBIA Rating Area 1

NY CORTLAND Rating Area 6

NY DELAWARE Rating Area 3

NY DUTCHESS Rating Area 3

NY ERIE Rating Area 2

NY ESSEX Rating Area 7

NY FRANKLIN Rating Area 7

NY FULTON Rating Area 1

NY GENESEE Rating Area 2

NY GREENE Rating Area 1

NY HAMILTON Rating Area 7

NY HERKIMER Rating Area 7

NY JEFFERSON Rating Area 7

NY KINGS Rating Area 4

NY LEWIS Rating Area 7

NY LIVINGSTON Rating Area 5

NY MADISON Rating Area 7

NY MONROE Rating Area 5

NY MONTGOMERY Rating Area 1

NY NASSAU Rating Area 8

NY NEW YORK Rating Area 4

NY NIAGARA Rating Area 2

NY ONEIDA Rating Area 7

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NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

NY ONONDAGA Rating Area 6

NY ONTARIO Rating Area 5

NY ORANGE Rating Area 3

NY ORLEANS Rating Area 2

NY OSWEGO Rating Area 7

NY OTSEGO Rating Area 7

NY PUTNAM Rating Area 3

NY QUEENS Rating Area 4

NY RENSSELAER Rating Area 1

NY RICHMOND Rating Area 4

NY ROCKLAND Rating Area 4

NY SARATOGA Rating Area 1

NY SCHENECTADY Rating Area 1

NY SCHOHARIE Rating Area 1

NY SCHUYLER Rating Area 6

NY SENECA Rating Area 5

NY ST LAWRENCE Rating Area 7

NY STEUBEN Rating Area 6

NY SUFFOLK Rating Area 8

NY SULLIVAN Rating Area 3

NY TIOGA Rating Area 6

NY TOMPKINS Rating Area 6

NY ULSTER Rating Area 3

NY WARREN Rating Area 1

NY WASHINGTON Rating Area 1

NY WAYNE Rating Area 5

NY WESTCHESTER Rating Area 4

NY WYOMING Rating Area 2

NY YATES Rating Area 5

OH Williams Rating Area 1 ALBANY

OH Fulton Rating Area 1 ALLEGANY

OH Lucas Rating Area 1 BRONX

OH Defiance Rating Area 1 BROOME

OH Henry Rating Area 1 CATTARAUGUS

OH Wood Rating Area 1 CAYUGA

OH Paulding Rating Area 2 CHAUTAUQUA

OH Putnam Rating Area 2 CHEMUNG

OH Hancock Rating Area 2 CHENANGO

OH Van Wert Rating Area 2 CLINTON

OH Allen Rating Area 2 COLUMBIA

OH Hardin Rating Area 2 CORTLAND

OH Mercer Rating Area 2 DELAWARE

OH Auglaize Rating Area 2 DUTCHESS

OH Darke Rating Area 3 ERIE

OH Shelby Rating Area 3 ESSEX

OH Miami Rating Area 3 FRANKLINOH Champaign Rating Area 3 FULTONOH Clark Rating Area 3 GENESEEOH Preble Rating Area 3 GREENEOH Montgomery Rating Area 3 HAMILTONOH Greene Rating Area 3 HERKIMEROH Butler Rating Area 4 JEFFERSONOH Warren Rating Area 4 KINGSOH Hamilton Rating Area 4 LEWISOH Clinton Rating Area 5 LIVINGSTONOH Highland Rating Area 5 MADISONOH Clermont Rating Area 5 MONROEOH Brown Rating Area 5 MONTGOMERYOH Adams Rating Area 5 NASSAUOH Ottawa Rating Area 6 NEW YORKOH Sandusky Rating Area 6 NIAGARAOH Erie Rating Area 6 ONEIDAOH Seneca Rating Area 6 ONONDAGAOH Huron Rating Area 6 ONTARIOOH Wyandot Rating Area 6 ORANGEOH Crawford Rating Area 7 ORLEANSOH Richland Rating Area 7 OSWEGOOH Marion Rating Area 8 OTSEGOOH Morrow Rating Area 8 PUTNAMOH Logan Rating Area 9 QUEENSOH Union Rating Area 9 RENSSELAEROH Delaware Rating Area 9 RICHMONDOH Knox Rating Area 9 ROCKLANDOH Licking Rating Area 9 SARATOGAOH Franklin Rating Area 9 SCHENECTADYOH Madison Rating Area 9 SCHOHARIEOH Fairfield Rating Area 9 SCHUYLEROH Pickaway Rating Area 9 SENECAOH Fayette Rating Area 9 ST. LAWRENCEOH Ross Rating Area 10 STEUBENOH Vinton Rating Area 10 SUFFOLKOH Pike Rating Area 10 SULLIVANOH Jackson Rating Area 10 TIOGAOH Scioto Rating Area 10 TOMPKINSOH Lawrence Rating Area 10 ULSTEROH Galia Rating Area 10 WARRENOH Lorain Rating Area 11 WASHINGTONOH Cuyahoga Rating Area 11 WAYNEOH Lake Rating Area 11 WESTCHESTEROH Geauga Rating Area 11 WYOMINGOH Ashtabula Rating Area 11 YATESOH Ashland Rating Area 12OH Medina Rating Area 12OH Summit Rating Area 12OH Portage Rating Area 12OH Trumbull Rating Area 13OH Mahoning Rating Area 13OH Columbiana Rating Area 13OH Wayne Rating Area 14OH Holmes Rating Area 14OH Stark Rating Area 15OH Carroll Rating Area 15OH Coshocton Rating Area 16OH Tuscarawas Rating Area 16OH Harrison Rating Area 16OH Jefferson Rating Area 16OH Muskingum Rating Area 16OH Guernsey Rating Area 16OH Belmont Rating Area 16OH Perry Rating Area 16OH Morgan Rating Area 16OH Noble Rating Area 16OH Monroe Rating Area 16OH Hocking Rating Area 17OH Athens Rating Area 17OH Washington Rating Area 17OH Meigs Rating Area 17OK Le Flore Rating Area 1OK Sequoyah Rating Area 1OK Comanche Rating Area 2OK Canadian Rating Area 3OK Cleveland Rating Area 3OK Grady Rating Area 3OK Lincoln Rating Area 3OK Logan Rating Area 3OK McClain Rating Area 3OK Oklahoma Rating Area 3OK Creek Rating Area 4OK Okmulgee Rating Area 4OK Osage Rating Area 4

Page 49: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

OK Pawnee Rating Area 4OK Rogers Rating Area 4OK Tulsa Rating Area 4OK Wagoner Rating Area 4OK Adair Rating Area 5OK Alfalfa Rating Area 5OK Atoka Rating Area 5OK Beaver Rating Area 5OK Blaine Rating Area 5OK Bryan Rating Area 5OK Caddo Rating Area 5OK Carter Rating Area 5OK Cherokee Rating Area 5OK Choctaw Rating Area 5OK Cimarron Rating Area 5OK Coal Rating Area 5OK Cotton Rating Area 5OK Craig Rating Area 5OK Custer Rating Area 5OK Delaware Rating Area 5OK Dewey Rating Area 5OK Ellis Rating Area 5OK Garfield Rating Area 5OK Garvin Rating Area 5OK Grant Rating Area 5OK Greer Rating Area 5OK Harmon Rating Area 5OK Harper Rating Area 5OK Haskell Rating Area 5OK Hughes Rating Area 5OK Jackson Rating Area 5OK Jefferson Rating Area 5OK Johnston Rating Area 5OK Kay Rating Area 5OK Kingfisher Rating Area 5OK Kiowa Rating Area 5OK Latimer Rating Area 5OK Love Rating Area 5OK Major Rating Area 5OK Marshall Rating Area 5OK Mayes Rating Area 5OK McCurtain Rating Area 5OK McIntosh Rating Area 5OK Murray Rating Area 5OK Muskogee Rating Area 5OK Noble Rating Area 5OK Nowata Rating Area 5OK Okfuskee Rating Area 5OK Ottawa Rating Area 5OK Payne Rating Area 5OK Pittsburg Rating Area 5OK Pontotoc Rating Area 5OK Pottawatomie Rating Area 5OK Pushmataha Rating Area 5OK Roger Mills Rating Area 5OK Seminole Rating Area 5OK Stephens Rating Area 5OK Texas Rating Area 5OK Tillman Rating Area 5OK Washington Rating Area 5OK Washita Rating Area 5OK Woods Rating Area 5OK Woodward Rating Area 5OK Beckham Rating Area 5OR Clackamas Rating Area 1OR Multnomah Rating Area 1OR Washington Rating Area 1OR Yamhil Rating Area 1OR Benton Rating Area 2OR Lane Rating Area 2OR Linn Rating Area 2OR Marion Rating Area 3OR Polk Rating Area 3OR Deschutes Rating Area 4OR Klamath Rating Area 4OR Lake Rating Area 4OR Clatsop Rating Area 5OR Columbia Rating Area 5OR Coos Rating Area 5OR Curry Rating Area 5OR Lincoln Rating Area 5OR Tillamook Rating Area 5OR Baker Rating Area 6OR Crook Rating Area 6OR Gilliam Rating Area 6OR Grant Rating Area 6OR Harney Rating Area 6OR Hood River Rating Area 6OR Jefferson Rating Area 6OR Malheur Rating Area 6OR Morrow Rating Area 6OR Sherman Rating Area 6OR Umatilla Rating Area 6OR Union Rating Area 6OR Wallowa Rating Area 6OR Wasco Rating Area 6OR Wheeler Rating Area 6OR Douglas Rating Area 7OR Jackson Rating Area 7OR Josephine Rating Area 7PA Erie Rating Area 1PA Crawford Rating Area 1PA Mercer Rating Area 1PA Venango Rating Area 1PA Clarion Rating Area 1PA Forest Rating Area 1PA Warren Rating Area 1PA McKean Rating Area 1PA Elk Rating Area 2PA Cameron Rating Area 2PA Potter Rating Area 2PA Tioga Rating Area 3PA Clinton Rating Area 3PA Lycoming Rating Area 3PA Sullivan Rating Area 3PA Bradford Rating Area 3PA Susquehanna Rating Area 3PA Wyoming Rating Area 3PA Lackawanna Rating Area 3PA Wayne Rating Area 3PA Pike Rating Area 3PA Monroe Rating Area 3PA Carbon Rating Area 3PA Luzerne Rating Area 3PA Lawrence Rating Area 4PA Beaver Rating Area 4PA Washington Rating Area 4PA Greene Rating Area 4PA Butler Rating Area 4PA Allegheny Rating Area 4PA Westmoreland Rating Area 4PA Armstrong Rating Area 4PA Indiana Rating Area 4PA Fayette Rating Area 4PA Jefferson Rating Area 5PA Clearfield Rating Area 5PA Cambria Rating Area 5PA Somerset Rating Area 5PA Bedford Rating Area 5

Page 50: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

PA Blair Rating Area 5PA Huntingdon Rating Area 5PA Centre Rating Area 6PA Mifflin Rating Area 6PA Union Rating Area 6PA Snyder Rating Area 6PA Montour Rating Area 6PA Northumberland Rating Area 6PA Columbia Rating Area 6PA Schuylkill Rating Area 6PA Lehigh Rating Area 6PA Northampton Rating Area 6PA Adams Rating Area 7PA York Rating Area 7PA Lancaster Rating Area 7PA Berks Rating Area 7PA Chester Rating Area 8PA Delaware Rating Area 8PA Montgomery Rating Area 8PA Bucks Rating Area 8PA Philadelphia Rating Area 8PA Fulton Rating Area 9PA Franklin Rating Area 9PA Cumberland Rating Area 9PA Perry Rating Area 9PA Juniata Rating Area 9PA Dauphin Rating Area 9PA Lebanon Rating Area 9RI Bristol Rating Area 1RI Kent Rating Area 1RI Newport Rating Area 1RI Providence Rating Area 1RI Washington Rating Area 1SC Abbeville Rating Area 1SC Aiken Rating Area 2SC Allendale Rating Area 3SC Anderson Rating Area 4SC Bamberg Rating Area 5SC Barnwell Rating Area 6SC Beaufort Rating Area 7SC Berkeley Rating Area 8SC Calhoun Rating Area 9SC Charleston Rating Area 10SC Cherokee Rating Area 11SC Chester Rating Area 12SC Chesterfield Rating Area 13SC Clarendon Rating Area 14SC Colleton Rating Area 15SC Darlington Rating Area 16SC Dillon Rating Area 17SC Dorchester Rating Area 18SC Edgefield Rating Area 19SC Fairfield Rating Area 20SC Florence Rating Area 21SC Georgetown Rating Area 22SC Greenville Rating Area 23SC Greenwood Rating Area 24SC Hampton Rating Area 25SC Horry Rating Area 26SC Jasper Rating Area 27SC Kershaw Rating Area 28SC Lancaster Rating Area 29SC Laurens Rating Area 30SC Lee Rating Area 31SC Lexington Rating Area 32SC McCormick Rating Area 33SC Marion Rating Area 34SC Marlboro Rating Area 35SC Newberry Rating Area 36SC Oconee Rating Area 37SC Orangeburg Rating Area 38SC Pickens Rating Area 39SC Richland Rating Area 40SC Saluda Rating Area 41SC Spartanburg Rating Area 42SC Sumter Rating Area 43SC Union Rating Area 44SC Williamsburg Rating Area 45SC York Rating Area 46SD Harding Rating Area 1SD Butte Rating Area 1SD Perkins Rating Area 1SD Corson Rating Area 1SD Dewey Rating Area 1SD Ziebach Rating Area 1SD Haakon Rating Area 1SD Jackson Rating Area 1SD Bennett Rating Area 1SD Shannon Rating Area 1SD Fall River Rating Area 1SD Custer Rating Area 1SD Pennington Rating Area 1SD Lawrence Rating Area 1SD Meade Rating Area 1SD Stanley Rating Area 1SD Jones Rating Area 1SD Lyman Rating Area 1SD Mellette Rating Area 1SD Todd Rating Area 1SD Tripp Rating Area 1SD Gregory Rating Area 1SD lake Rating Area 2SD Moody Rating Area 2SD Mc Cook Rating Area 2SD Minnehaha Rating Area 2SD Turner Rating Area 2SD Lincoln Rating Area 2SD Clay Rating Area 2SD Union Rating Area 2SD Campbel Rating Area 3SD Walworth Rating Area 3SD Potter Rating Area 3SD Mc Pherson Rating Area 3SD Edmunds Rating Area 3SD Faulk Rating Area 3SD Brown Rating Area 3SD Spink Rating Area 3SD Marshall Rating Area 3SD Roberts Rating Area 3SD Day Rating Area 3SD Grant Rating Area 3SD Codington Rating Area 3SD Clark Rating Area 3SD Hamlin Rating Area 3SD Deuel Rating Area 3SD Brookings Rating Area 3SD Kingsbury Rating Area 3SD Beadle Rating Area 3SD Sully Rating Area 4SD Hughes Rating Area 4SD Hyde Rating Area 4SD Hand Rating Area 4SD Buffalo Rating Area 4SD Jerauld Rating Area 4SD Sanborn Rating Area 4SD Miner Rating Area 4SD Brule Rating Area 4SD Aurora Rating Area 4SD Davison Rating Area 4

Page 51: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

SD Hanson Rating Area 4SD Douglas Rating Area 4SD Charles Mix Rating Area 4SD Hutchinson Rating Area 4SD Bon Homme Rating Area 4SD Yankton Rating Area 4TN Carter Rating Area 1TN Greene Rating Area 1TN Hancock Rating Area 1TN Hawkins Rating Area 1TN Johnson Rating Area 1TN Sullivan Rating Area 1TN Unicoi Rating Area 1TN Washington Rating Area 1TN Anderson Rating Area 2TN Blount Rating Area 2TN Campbel Rating Area 2TN Claiborne Rating Area 2TN Cocke Rating Area 2TN Grainger Rating Area 2TN Hamblen Rating Area 2TN Jefferson Rating Area 2TN Knox Rating Area 2TN Loudon Rating Area 2TN Monroe Rating Area 2TN Morgan Rating Area 2TN Roane Rating Area 2TN Scott Rating Area 2TN Sevier Rating Area 2TN Union Rating Area 2TN Bledsoe Rating Area 3TN Bradley Rating Area 3TN Franklin Rating Area 3TN Grundy Rating Area 3TN Hamilton Rating Area 3TN Marion Rating Area 3TN Mc Minn Rating Area 3TN Meigs Rating Area 3TN Polk Rating Area 3TN Rhea Rating Area 3TN Sequatchie Rating Area 3TN Cheatham Rating Area 4TN Davidson Rating Area 4TN Montgomery Rating Area 4TN Robertson Rating Area 4TN Rutherford Rating Area 4TN Sumner Rating Area 4TN Trousdale Rating Area 4TN Williamson Rating Area 4TN Wilson Rating Area 4TN Benton Rating Area 5TN Carroll Rating Area 5TN Chester Rating Area 5TN Crockett Rating Area 5TN Decatur Rating Area 5TN Dyer Rating Area 5TN Gibson Rating Area 5TN Hardeman Rating Area 5TN Hardin Rating Area 5TN Henderson Rating Area 5TN Henry Rating Area 5TN Lake Rating Area 5TN Madison Rating Area 5TN Mc Nairy Rating Area 5TN Obion Rating Area 5TN Weakley Rating Area 5TN Fayette Rating Area 6TN Haywood Rating Area 6TN Lauderdale Rating Area 6TN Shelby Rating Area 6TN Tipton Rating Area 6TN Cannon Rating Area 7TN Clay Rating Area 7TN Cumberland Rating Area 7TN De Kalb Rating Area 7TN Fentress Rating Area 7TN Jackson Rating Area 7TN Macon Rating Area 7TN Overton Rating Area 7TN Pickett Rating Area 7TN Putnam Rating Area 7TN Smith Rating Area 7TN Van Buren Rating Area 7TN Warren Rating Area 7TN White Rating Area 7TN Bedford Rating Area 8TN Coffee Rating Area 8TN Dickson Rating Area 8TN Giles Rating Area 8TN Hickman Rating Area 8TN Houston Rating Area 8TN Humphreys Rating Area 8TN Lawrence Rating Area 8TN Lewis Rating Area 8TN Lincoln Rating Area 8TN Marshall Rating Area 8TN Maury Rating Area 8TN Moore Rating Area 8TN Perry Rating Area 8TN Stewart Rating Area 8TN Wayne Rating Area 8TX Callahan Rating Area 1TX Jones Rating Area 1TX Taylor Rating Area 1TX Armstrong Rating Area 2TX Carson Rating Area 2TX Potter Rating Area 2TX Randall Rating Area 2TX Bastrop Rating Area 3TX Caldwel Rating Area 3TX Hays Rating Area 3TX Travis Rating Area 3TX Williamson Rating Area 3TX Hardin Rating Area 4TX Jefferson Rating Area 4TX Orange Rating Area 4TX Cameron Rating Area 5TX Brazos Rating Area 6TX Burleson Rating Area 6TX Robertson Rating Area 6TX Aransas Rating Area 7TX Nueces Rating Area 7TX San Patricio Rating Area 7TX Collin Rating Area 8TX Dallas Rating Area 8TX Delta Rating Area 8TX Denton Rating Area 8TX Ellis Rating Area 8TX Hunt Rating Area 8TX Johnson Rating Area 8TX Kaufman Rating Area 8TX Parker Rating Area 8TX Rockwall Rating Area 8TX Tarrant Rating Area 8TX Wise Rating Area 8TX El Paso Rating Area 9TX Austin Rating Area 10TX Brazoria Rating Area 10TX Chambers Rating Area 10

Page 52: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

TX Fort Bend Rating Area 10TX Galveston Rating Area 10TX Harris Rating Area 10TX Liberty Rating Area 10TX Montgomery Rating Area 10TX San Jacinto Rating Area 10TX Waller Rating Area 10TX Bell Rating Area 11TX Coryell Rating Area 11TX Lampasas Rating Area 11TX Webb Rating Area 12TX Gregg Rating Area 13TX Rusk Rating Area 13TX Upshur Rating Area 13TX Crosby Rating Area 14TX Lubbock Rating Area 14TX Hidalgo Rating Area 15TX Midland Rating Area 16TX Ector Rating Area 17TX Irion Rating Area 18TX Tom Green Rating Area 18TX Atascosa Rating Area 19TX Bandera Rating Area 19TX Bexar Rating Area 19TX Comal Rating Area 19TX Guadalupe Rating Area 19TX Kendall Rating Area 19TX Medina Rating Area 19TX Wilson Rating Area 19TX Grayson Rating Area 20TX Bowie Rating Area 21TX Smith Rating Area 22TX Calhoun Rating Area 23TX Goliad Rating Area 23TX Victoria Rating Area 23TX Mc Lennan Rating Area 24TX Archer Rating Area 25TX Clay Rating Area 25TX Wichita Rating Area 25TX Jim Wells Rating Area 26TX Andrews Rating Area 26TX Henderson Rating Area 26TX Matagorda Rating Area 26TX Bee Rating Area 26TX Howard Rating Area 26TX Fannin Rating Area 26TX Hutchinson Rating Area 26TX Washington Rating Area 26TX Brown Rating Area 26TX Navarro Rating Area 26TX Val Verde Rating Area 26TX Moore Rating Area 26TX Maverick Rating Area 26TX Wharton Rating Area 26TX Gillespie Rating Area 26TX Cooke Rating Area 26TX Hood Rating Area 26TX Somervell Rating Area 26TX Deaf Smith Rating Area 26TX Walker Rating Area 26TX Cherokee Rating Area 26TX Kerr Rating Area 26TX Kenedy Rating Area 26TX Kleberg Rating Area 26TX Dawson Rating Area 26TX Hockley Rating Area 26TX Angelina Rating Area 26TX Burnet Rating Area 26TX Harrison Rating Area 26TX Palo Pinto Rating Area 26TX Titus Rating Area 26TX Nacogdoches Rating Area 26TX Anderson Rating Area 26TX Gray Rating Area 26TX Roberts Rating Area 26TX Lamar Rating Area 26TX Reeves Rating Area 26TX Hale Rating Area 26TX Willacy Rating Area 26TX Starr Rating Area 26TX Scurry Rating Area 26TX Erath Rating Area 26TX Hopkins Rating Area 26TX Nolan Rating Area 26TX Uvalde Rating Area 26TX Wilbarger Rating Area 26TX Camp Rating Area 26TX Cass Rating Area 26TX Castro Rating Area 26TX Childress Rating Area 26TX Cochran Rating Area 26TX Coke Rating Area 26TX Coleman Rating Area 26TX Collingsworth Rating Area 26TX Colorado Rating Area 26TX Comanche Rating Area 26TX Concho Rating Area 26TX Cottle Rating Area 26TX Crane Rating Area 26TX Crockett Rating Area 26TX Culberson Rating Area 26TX Dallam Rating Area 26TX De Witt Rating Area 26TX Dickens Rating Area 26TX Dimmit Rating Area 26TX Donley Rating Area 26TX Duval Rating Area 26TX Eastland Rating Area 26TX Edwards Rating Area 26TX Falls Rating Area 26TX Fayette Rating Area 26TX Fisher Rating Area 26TX Floyd Rating Area 26TX Foard Rating Area 26TX Franklin Rating Area 26TX Freestone Rating Area 26TX Frio Rating Area 26TX Gaines Rating Area 26TX Garza Rating Area 26TX Glasscock Rating Area 26TX Gonzales Rating Area 26TX Grimes Rating Area 26TX Upton Rating Area 26TX Van Zandt Rating Area 26TX Ward Rating Area 26TX Wheeler Rating Area 26TX Winkler Rating Area 26TX Wood Rating Area 26TX Yoakum Rating Area 26TX Young Rating Area 26TX Zapata Rating Area 26TX Zavala Rating Area 26TX Brooks Rating Area 26TX Bailey Rating Area 26TX Baylor Rating Area 26TX Blanco Rating Area 26TX Borden Rating Area 26TX Bosque Rating Area 26TX Brewster Rating Area 26

Page 53: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

TX Briscoe Rating Area 26TX Shackelford Rating Area 26TX Shelby Rating Area 26TX Sherman Rating Area 26TX Stephens Rating Area 26TX Sterling Rating Area 26TX Stonewal Rating Area 26TX Sutton Rating Area 26TX Swisher Rating Area 26TX Terrell Rating Area 26TX Terry Rating Area 26TX Throckmorton Rating Area 26TX Trinity Rating Area 26TX Tyler Rating Area 26TX Rains Rating Area 26TX Reagan Rating Area 26TX Real Rating Area 26TX Red River Rating Area 26TX Refugio Rating Area 26TX Runnels Rating Area 26TX Sabine Rating Area 26TX San Augustine Rating Area 26TX San Saba Rating Area 26TX Schleicher Rating Area 26TX Morris Rating Area 26TX Motley Rating Area 26TX Newton Rating Area 26TX Nolan Rating Area 26TX Ochiltree Rating Area 26TX Oldham Rating Area 26TX Panola Rating Area 26TX Parmer Rating Area 26TX Pecos Rating Area 26TX Polk Rating Area 26TX Presidio Rating Area 26TX Madison Rating Area 26TX Marion Rating Area 26TX Martin Rating Area 26TX Mason Rating Area 26TX Mc Culloch Rating Area 26TX Mc Mullen Rating Area 26TX Menard Rating Area 26TX Milam Rating Area 26TX Mills Rating Area 26TX Mitchell Rating Area 26TX Montague Rating Area 26TX Hall Rating Area 26TX Hamilton Rating Area 26TX Hansford Rating Area 26TX Hardeman Rating Area 26TX Hartley Rating Area 26TX Haskell Rating Area 26TX Hemphill Rating Area 26TX Hill Rating Area 26TX Houston Rating Area 26TX Hudspeth Rating Area 26TX Jack Rating Area 26TX Jackson Rating Area 26TX Jasper Rating Area 26TX Jim Hogg Rating Area 26TX Jeff Davis Rating Area 26TX Karnes Rating Area 26TX Kent Rating Area 26TX Kimble Rating Area 26TX King Rating Area 26TX Kinney Rating Area 26TX Knox Rating Area 26TX La Salle Rating Area 26TX Lamb Rating Area 26TX Lavaca Rating Area 26TX Lee Rating Area 26TX Leon Rating Area 26TX Limestone Rating Area 26TX Lipscomb Rating Area 26TX Live Oak Rating Area 26TX Llano Rating Area 26TX Loving Rating Area 26TX Lynn Rating Area 26UT Cache Rating Area 1

UT Rich Rating Area 1

UT Box Elder Rating Area 2

UT Morgan Rating Area 2

UT Weber Rating Area 2

UT Davis Rating Area 3

UT Salt Lake Rating Area 3

UT Summit Rating Area 3

UT Tooele Rating Area 3

UT Wasatch Rating Area 3

UT Utah Rating Area 4

UT Iron Rating Area 5

UT Washington Rating Area 5

UT Beaver Rating Area 6

UT Carbon Rating Area 6

UT Daggett Rating Area 6

UT Duchesne Rating Area 6

UT Emery Rating Area 6

UT Garfield Rating Area 6

UT Grand Rating Area 6

UT Juab Rating Area 6

UT Kane Rating Area 6

UT Millard Rating Area 6

UT Piute Rating Area 6

UT San Juan Rating Area 6

UT Sanpete Rating Area 6

UT Sevier Rating Area 6

UT Uintah Rating Area 6

UT Wayne Rating Area 6

VA Giles Rating Area 1VA Montgomery Rating Area 1VA Pulaski Rating Area 1VA Radford City Rating Area 1VA Albemarle Rating Area 2VA Fluvanna Rating Area 2VA Greene Rating Area 2VA Nelson Rating Area 2VA Charlottesville City Rating Area 2VA Pittsylvania Rating Area 3VA Danville City Rating Area 3VA Rockingham Rating Area 4VA Harrisonburg City Rating Area 4VA Scott Rating Area 5VA Washington Rating Area 5VA Bristol City Rating Area 5VA Amherst Rating Area 6VA Appomattox Rating Area 6VA Bedford Rating Area 6VA Campbell Rating Area 6VA Bedford City Rating Area 6VA Lynchburg City Rating Area 6

Page 54: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

VA Amelia Rating Area 7VA Caroline Rating Area 7VA Charles City Rating Area 7VA Chesterfield Rating Area 7VA Cumberland Rating Area 7VA Dinwiddie Rating Area 7VA Goochland Rating Area 7VA Hanover Rating Area 7VA Henrico Rating Area 7VA King and Queen Rating Area 7VA King William Rating Area 7VA Louisa Rating Area 7VA New Kent Rating Area 7VA Powhatan Rating Area 7VA Prince George Rating Area 7VA Sussex Rating Area 7VA Colonial Heights City Rating Area 7VA Hopewell City Rating Area 7VA Petersburg City Rating Area 7VA Richmond City Rating Area 7VA Botetourt Rating Area 8VA Craig Rating Area 8VA Franklin Rating Area 8VA Roanoke Rating Area 8VA Roanoke City Rating Area 8VA Salem City Rating Area 8VA Gloucester Rating Area 9VA Isle of Wight Rating Area 9VA James City Rating Area 9VA Mathews Rating Area 9VA Surry Rating Area 9VA York Rating Area 9VA Chesapeake City Rating Area 9VA Hampton City Rating Area 9VA Newport News City Rating Area 9VA Norfolk City Rating Area 9VA Poquoson Rating Area 9VA Portsmouth City Rating Area 9VA Suffolk City Rating Area 9VA Virginia Beach City Rating Area 9VA Williamsburg City Rating Area 9VA Arlington Rating Area 10VA Clarke Rating Area 10VA Fairfax Rating Area 10VA Fauquier Rating Area 10VA Loudoun Rating Area 10VA Prince William Rating Area 10VA Spotsylvania Rating Area 10VA Stafford Rating Area 10VA Warren Rating Area 10VA Alexandria City Rating Area 10VA Fairfax City Rating Area 10VA Falls Church City Rating Area 10VA Fredericksburg City Rating Area 10VA Manassas City Rating Area 10VA Manassas Park City Rating Area 10VA Frederick Rating Area 11VA Winchester City Rating Area 11VA Accomack Rating Area 12VA Alleghany Rating Area 12VA Augusta Rating Area 12VA Bath Rating Area 12VA Bland Rating Area 12VA Brunswick Rating Area 12VA Buchanan Rating Area 12VA Buckingham Rating Area 12VA Carroll Rating Area 12VA Charlotte Rating Area 12VA Culpeper Rating Area 12VA Dickenson Rating Area 12VA Essex Rating Area 12VA Floyd Rating Area 12VA Grayson Rating Area 12VA Greensville Rating Area 12VA Halifax Rating Area 12VA Henry Rating Area 12VA Highland Rating Area 12VA King George Rating Area 12VA Lancaster Rating Area 12VA Lee Rating Area 12VA Lunenburg Rating Area 12VA Madison Rating Area 12VA Mecklenburg Rating Area 12VA Middlesex Rating Area 12VA Northampton Rating Area 12VA Northumberlnd Rating Area 12VA Nottoway Rating Area 12VA Orange Rating Area 12VA Page Rating Area 12VA Patrick Rating Area 12VA Prince Edward Rating Area 12VA Rappahannock Rating Area 12VA Richmond Rating Area 12VA Rockbridge Rating Area 12VA Russell Rating Area 12VA Shenandoah Rating Area 12VA Smyth Rating Area 12VA Southampton Rating Area 12VA Tazewel Rating Area 12VA Westmoreland Rating Area 12VA Wise Rating Area 12VA Wythe Rating Area 12VA Buena Vista City Rating Area 12VA Covington City Rating Area 12VA Emporia City Rating Area 12VA Franklin City Rating Area 12VA Galax City Rating Area 12VA Lexington City Rating Area 12VA Martinsville City Rating Area 12VA Norton City Rating Area 12VA Staunton City Rating Area 12VA Waynesboro City Rating Area 12VT Chittenden Rating Area 1VT Franklin Rating Area 1VT Grand Isle Rating Area 1VT Addison Rating Area 1VT Bennington Rating Area 1VT Caledonia Rating Area 1VT Essex Rating Area 1VT Lamoille Rating Area 1VT Orange Rating Area 1VT Orleans Rating Area 1VT Rutland Rating Area 1VT Washington Rating Area 1VT Windham Rating Area 1VT Windsor Rating Area 1WA King Rating Area 1

WA Clallam Rating Area 2

WA Cowlitz Rating Area 2

WA Grays Harbor Rating Area 2

WA Island Rating Area 2

WA Jefferson Rating Area 2

WA Mason Rating Area 2

WA Lewis Rating Area 2

WA Kitsap Rating Area 2

Page 55: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

WA Pacific Rating Area 2

WA Pierce Rating Area 2

WA San Juan Rating Area 2

WA Skagit Rating Area 2

WA Snohomish Rating Area 2

WA Thurston Rating Area 2

WA Wahkiakum Rating Area 2

WA Whatcom Rating Area 2

WA Clark Rating Area 3

WA Klickitat Rating Area 3

WA Skamania Rating Area 3

WA Ferry Rating Area 4

WA Lincoln Rating Area 4

WA Pend Oreille Rating Area 4

WA Spokane Rating Area 4

WA Stevens Rating Area 4

WA Adams Rating Area 5

WA Asotin Rating Area 5

WA Benton Rating Area 5

WA Chelan Rating Area 5

WA Columbia Rating Area 5

WA Douglas Rating Area 5

WA Franklin Rating Area 5

WA Garfield Rating Area 5

WA Grant Rating Area 5

WA Kittitas Rating Area 5

WA Okanogan Rating Area 5

WA Walla Walla Rating Area 5

WA Whitman Rating Area 5

WA Yakima Rating Area 5

WI Milwaukee Rating Area 1WI Dane Rating Area 2WI Polk Rating Area 3WI St. Croix Rating Area 3WI Pierce Rating Area 3WI Dunn Rating Area 4WI Pepin Rating Area 4WI Chippewa Rating Area 4WI Eau Claire Rating Area 4WI Douglas Rating Area 5WI Bayfield Rating Area 5WI Ashland Rating Area 5WI Burnett Rating Area 5WI Washburn Rating Area 5WI Sawyer Rating Area 5WI Buffalo Rating Area 6WI Trempealeau Rating Area 6WI Jackson Rating Area 6WI La Crosse Rating Area 6WI Monroe Rating Area 6WI Vernon Rating Area 7WI Crawford Rating Area 7WI Grant Rating Area 7WI Iowa Rating Area 7WI LaFayette Rating Area 7WI Barron Rating Area 8WI Rusk Rating Area 8WI Price Rating Area 8WI Taylor Rating Area 8WI Clark Rating Area 8WI Racine Rating Area 9WI Kenosha Rating Area 9WI Lincoln Rating Area 10WI Marathon Rating Area 10WI Wood Rating Area 10WI Portage Rating Area 10WI Waupaca Rating Area 11WI Outagamie Rating Area 11WI Waushara Rating Area 11WI Winnebago Rating Area 11WI Calumet Rating Area 11WI Fond du Lac Rating Area 11WI Sheboygan Rating Area 11WI Dodge Rating Area 11WI Washington Rating Area 12WI Ozaukee Rating Area 12WI Waukesha Rating Area 12WI Iron Rating Area 13WI Vilas Rating Area 13WI Oneida Rating Area 13WI Forest Rating Area 13WI Florence Rating Area 13WI Langlade Rating Area 13WI Green Rating Area 14WI Rock Rating Area 14WI Walworth Rating Area 14WI Jefferson Rating Area 14WI Columbia Rating Area 14WI Juneau Rating Area 15WI Adams Rating Area 15WI Marquette Rating Area 15WI Green Lake Rating Area 15WI Richland Rating Area 15WI Sauk Rating Area 15WI Marinette Rating Area 16WI Oconto Rating Area 16WI Menominee Rating Area 16WI Shawano Rating Area 16WI Brown Rating Area 16WI Manitowoc Rating Area 16WI Kewaunee Rating Area 16WI Door Rating Area 16WV Braxton Rating Area 1WV Calhoun Rating Area 1WV Clay Rating Area 1WV Fayette Rating Area 1WV Greenbrier Rating Area 1WV Nicholas Rating Area 1WV Roane Rating Area 1WV Kanawha Rating Area 2WV Boone Rating Area 3WV Lincoln Rating Area 3WV Logan Rating Area 3WV Mc Dowell Rating Area 3WV Mingo Rating Area 3WV Wyoming Rating Area 3WV Mercer Rating Area 4WV Monroe Rating Area 4WV Raleigh Rating Area 4WV Summers Rating Area 4WV Cabell Rating Area 5WV Mason Rating Area 5WV Putnam Rating Area 5WV Wayne Rating Area 5WV Berkeley Rating Area 6

Page 56: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIA

WV Jefferson Rating Area 6WV Grant Rating Area 7WV Hampshire Rating Area 7WV Hardy Rating Area 7WV Mineral Rating Area 7WV Morgan Rating Area 7WV Pendleton Rating Area 7WV Doddridge Rating Area 8WV Gilmer Rating Area 8WV Lewis Rating Area 8WV Marion Rating Area 8WV Monongalia Rating Area 8WV Wetzel Rating Area 8WV Barbour Rating Area 9WV Harrison Rating Area 9WV Pocahontas Rating Area 9WV Preston Rating Area 9WV Randolph Rating Area 9WV Taylor Rating Area 9WV Tucker Rating Area 9WV Upshur Rating Area 9WV Webster Rating Area 9WV Jackson Rating Area 10WV Pleasants Rating Area 10WV Ritchie Rating Area 10WV Tyler Rating Area 10WV Wirt Rating Area 10WV Wood Rating Area 10WV Brooke Rating Area 11WV Hancock Rating Area 11WV Marshall Rating Area 11WV Ohio Rating Area 11WY Natrona Rating Area 1WY Laramie Rating Area 2WY Albany Rating Area 3WY Big Horn Rating Area 3WY Campbel Rating Area 3WY Carbon Rating Area 3WY Converse Rating Area 3WY Crook Rating Area 3WY Fremont Rating Area 3WY Goshen Rating Area 3WY Hot Springs Rating Area 3WY Johnson Rating Area 3WY Lincoln Rating Area 3WY Niobrara Rating Area 3WY Park Rating Area 3WY Platte Rating Area 3WY Sheridan Rating Area 3WY Sublette Rating Area 3WY Sweetwater Rating Area 3WY Teton Rating Area 3WY Uinta Rating Area 3WY Washakie Rating Area 3WY Weston Rating Area 3

Page 57: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIARATING AREA FACTORSAK Rating Area 1 0.8700

AK Rating Area 2 0.8400

AK Rating Area 3 0.9100

AL Rating Area 1 0.9200    

AL Rating Area 2 0.7700    

AL Rating Area 3 0.9000    

AL Rating Area 4 0.9200    

AL Rating Area 5 0.8700    

AL Rating Area 6 0.8600    

AL Rating Area 7 0.8500    

AL Rating Area 8 1.0000    

AL Rating Area 10 0.9100    

AL Rating Area 13 0.8800    

AL Rating Area 11 0.8600    

AL Rating Area 9 0.9200    

AL Rating Area 12 0.8800    

AR Rating Area 1 0.8500    

AR Rating Area 2 0.8800    

AR Rating Area 3 0.7900    

AR Rating Area 4 0.8300    

AR Rating Area 5 0.9000    

AR Rating Area 6 0.8900    

AR Rating Area 7 0.8300    

AZ Rating Area 1 0.9100    

AZ Rating Area 2 0.8100    

AZ Rating Area 3 0.9600    

AZ Rating Area 4 0.9500    

AZ Rating Area 5 0.9400    

AZ Rating Area 6 0.8100    

AZ Rating Area 7 0.8100    

CA Rating Area 1 0.9100    

CA Rating Area 10 1.0100    

CA Rating Area 11 1.0200    

CA Rating Area 12 0.9700    

CA Rating Area 13 1.0500    

CA Rating Area 14 1.1300    

CA Rating Area 15 1.3800    CA Rating Area 17 1.1000    

CA Rating Area 18 1.1500    

CA Rating Area 19 1.0200    

CA Rating Area 2 0.9800    

CA Rating Area 3 0.9700    

CA Rating Area 4 1.0700    

CA Rating Area 5 1.0800    

CA Rating Area 6 1.1400    

CA Rating Area 7 1.0500    

CA Rating Area 8 0.9600    

CA Rating Area 9 0.9500    

CO Rating Area 1 0.8200    

CO Rating Area 2 0.8000    

CO Rating Area 3 0.9300    

CO Rating Area 4 0.7800    

CO Rating Area 5 0.7000    

CO Rating Area 6 0.8800    

CO Rating Area 7 0.8500    

CO Rating Area 8 0.8300    

CO Rating Area 9 0.7300    

CT Rating Area 1 1.1800    

CT Rating Area 2 1.1300    

CT Rating Area 3 1.0400    

CT Rating Area 4 1.0900    

CT Rating Area 5 1.2600    

CT Rating Area 6 1.1000    

42

Page 58: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIARATING AREA FACTORSCT Rating Area 7 1.0300    

CT Rating Area 8 1.1100    

DC Rating Area 1 1.2000    

DE Rating Area 1 1.0400    

FL Rating Area 1 1.0700    

FL Rating Area 10 1.0900    

FL Rating Area 11 0.9700    

FL Rating Area 12 1.1100    

FL Rating Area 13 1.0800    

FL Rating Area 14 1.0200    

FL Rating Area 15 1.2200    

FL Rating Area 16 0.9700    

FL Rating Area 17 0.9300    

FL Rating Area 18 0.9300    

FL Rating Area 19 0.9500    

FL Rating Area 2 1.1800    

FL Rating Area 20 1.0800    

FL Rating Area 21 1.2600    

FL Rating Area 22 1.0000    

FL Rating Area 23 1.0000    

FL Rating Area 24 1.1200    

FL Rating Area 25 1.1400    

FL Rating Area 26 1.0900    

FL Rating Area 27 1.1400    

FL Rating Area 28 1.1700    

FL Rating Area 29 0.9500    

FL Rating Area 3 1.0500    

FL Rating Area 30 0.9800    

FL Rating Area 31 0.9300    

FL Rating Area 32 1.0400    

FL Rating Area 33 1.1100    

FL Rating Area 34 1.0100    

FL Rating Area 35 1.0100    

FL Rating Area 36 0.9300    

FL Rating Area 37 1.0000    

FL Rating Area 38 0.9800    

FL Rating Area 39 0.9200    

FL Rating Area 4 1.0900    

FL Rating Area 40 1.0300    

FL Rating Area 41 1.0300    

FL Rating Area 42 1.0300    

FL Rating Area 43 1.6800    

FL Rating Area 44 0.9400    

FL Rating Area 45 0.9700    

FL Rating Area 46 0.9500    

FL Rating Area 47 1.2400    

FL Rating Area 48 1.1600    

FL Rating Area 49 1.0800    

FL Rating Area 5 1.0200    

FL Rating Area 50 1.2600    

FL Rating Area 51 1.0900    

FL Rating Area 52 1.1900    

FL Rating Area 53 1.0700    

FL Rating Area 54 1.0900    

FL Rating Area 55 0.9300    

FL Rating Area 56 0.9700    

FL Rating Area 57 1.1300    

FL Rating Area 58 0.9900    

FL Rating Area 59 1.1200    

FL Rating Area 6 1.3500    

FL Rating Area 60 0.9400    

FL Rating Area 61 0.9800    

FL Rating Area 62 0.9200    

43

Page 59: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIARATING AREA FACTORSFL Rating Area 63 1.1000    

FL Rating Area 64 1.0000    

FL Rating Area 65 0.9700    

FL Rating Area 66 0.9000    

FL Rating Area 67 0.8900    

FL Rating Area 7 1.0100    

FL Rating Area 8 1.0300    

FL Rating Area 9 0.9900    

GA Rating Area 1 0.9200    

GA Rating Area 10 0.8800    

GA Rating Area 11 0.9900    

GA Rating Area 12 1.0200    

GA Rating Area 13 0.9400    

GA Rating Area 14 0.9500    

GA Rating Area 15 0.9400    

GA Rating Area 16 0.9600    

GA Rating Area 2 0.8800    

GA Rating Area 3 0.9600    

GA Rating Area 4 0.9100    

GA Rating Area 5 0.9100    

GA Rating Area 6 0.9500    

GA Rating Area 7 0.9300    

GA Rating Area 8 0.9400    

GA Rating Area 9 0.8500    

HI Rating Area 1 0.7300    

IA Rating Area 1 0.8000    

IA Rating Area 2 0.7600    

IA Rating Area 3 0.8400    

IA Rating Area 4 0.9000    

IA Rating Area 5 0.8200    

IA Rating Area 6 0.8300    

IA Rating Area 7 0.8600    

ID Rating Area 1 0.8800    

ID Rating Area 2 0.8300    

ID Rating Area 3 0.8500    

ID Rating Area 4 0.8200    

ID Rating Area 5 0.7800    

ID Rating Area 6 0.7800    

ID Rating Area 7 0.7600    

IL Rating Area 1 1.1869    

IL Rating Area 2 0.9928    

IL Rating Area 3 0.9943    

IL Rating Area 4 1.0189    

IL Rating Area 5 0.8796    

IL Rating Area 6 0.8324    

IL Rating Area 7 0.8887    

IL Rating Area 8 0.8766    

IL Rating Area 10 0.8931    

IL Rating Area 13 0.9310    

IL Rating Area 11 0.9012    

IL Rating Area 9 0.9279    

IL Rating Area 12 0.9295    

IN Rating Area 1 1.1200    

IN Rating Area 10 1.0300    

IN Rating Area 11 0.9700    

IN Rating Area 12 0.8600    

IN Rating Area 13 0.8400    

IN Rating Area 14 0.8500    

IN Rating Area 15 0.9100    

IN Rating Area 16 1.0000    

IN Rating Area 17 0.9600    

IN Rating Area 2 0.8900    

IN Rating Area 3 0.8200    

44

Page 60: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIARATING AREA FACTORSIN Rating Area 4 0.9100    

IN Rating Area 5 0.9400    

IN Rating Area 6 0.9300    

IN Rating Area 7 0.9400    

IN Rating Area 8 0.9400    

IN Rating Area 9 1.0300    

KS Rating Area 1 0.9600    

KS Rating Area 2 0.8800    

KS Rating Area 3 0.8700    

KS Rating Area 4 1.0700    

KS Rating Area 5 0.9200    

KS Rating Area 6 0.8700    

KS Rating Area 7 0.9200    

KY Rating Area 1 0.8700    

KY Rating Area 2 0.8700    

KY Rating Area 3 0.9300    

KY Rating Area 4 0.9200    

KY Rating Area 5 0.9200    

KY Rating Area 6 0.9800    

KY Rating Area 7 0.9200    

KY Rating Area 8 0.9000    

LA Rating Area 1 1.1100    

LA Rating Area 2 0.9300    

LA Rating Area 3 1.0300    

LA Rating Area 4 1.0100    

LA Rating Area 5 1.1200    

LA Rating Area 6 1.0600    

LA Rating Area 7 1.1500    

LA Rating Area 8 1.1200    

MA Rating Area 1 1.0400    

MA Rating Area 2 1.1200    

MA Rating Area 3 1.1700    

MA Rating Area 4 1.1000    

MA Rating Area 5 1.2800    

MA Rating Area 6 1.0900    

MA Rating Area 7 1.0800    

MD Rating Area 1 1.2600    

MD Rating Area 2 1.1200    

MD Rating Area 3 1.0800    

MD Rating Area 4 1.0800    

ME Rating Area 1 0.8600    

ME Rating Area 2 0.8100    

ME Rating Area 3 0.8500    

ME Rating Area 4 0.8600    

MI Rating Area 1 1.3000    

MI Rating Area 10 0.9300    

MI Rating Area 11 0.8500    

MI Rating Area 12 0.9000    

MI Rating Area 13 0.9000    

MI Rating Area 14 0.8200    

MI Rating Area 15 0.8900    

MI Rating Area 16 0.7900    

MI Rating Area 2 1.1800    

MI Rating Area 3 0.9600    

MI Rating Area 4 0.9600    

MI Rating Area 5 1.2200    

MI Rating Area 6 1.0200    

MI Rating Area 7 1.0100    

MI Rating Area 8 1.0200    

MI Rating Area 9 0.9100    

MN Rating Area 1 0.8300    

MN Rating Area 2 0.8200    

MN Rating Area 3 0.8500    

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Page 61: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIARATING AREA FACTORSMN Rating Area 4 0.9500    

MN Rating Area 5 0.8900    

MN Rating Area 6 0.8800    

MN Rating Area 7 0.8600    

MN Rating Area 8 0.9200    

MN Rating Area 9 0.8900    

MO Rating Area 1 0.9900    

MO Rating Area 10 0.8800    

MO Rating Area 2 0.9300    

MO Rating Area 3 0.9800    

MO Rating Area 4 0.8900    

MO Rating Area 5 0.8200    

MO Rating Area 6 1.0200    

MO Rating Area 7 0.8900    

MO Rating Area 8 0.8100    

MO Rating Area 9 0.8400    

MS Rating Area 1 0.9900    

MS Rating Area 2 0.8700    

MS Rating Area 3 0.9800    

MS Rating Area 4 1.0100    

MS Rating Area 5 0.9700    

MS Rating Area 6 1.0300    

MT Rating Area 1 0.7900    

MT Rating Area 2 0.7500    

MT Rating Area 3 0.7100    

MT Rating Area 4 0.7300    

NC Rating Area 1 0.7900    

NC Rating Area 10 0.9100    

NC Rating Area 11 0.9400    

NC Rating Area 12 0.9500    

NC Rating Area 13 0.8700    

NC Rating Area 14 0.9900    

NC Rating Area 15 0.9000    

NC Rating Area 16 0.8700    

NC Rating Area 2 0.8700    

NC Rating Area 3 0.8800    

NC Rating Area 4 0.9400    

NC Rating Area 5 0.9400    

NC Rating Area 6 0.9800    

NC Rating Area 7 0.9000    

NC Rating Area 8 0.8700    

NC Rating Area 9 1.0100    

ND Rating Area 1 0.8200    

ND Rating Area 2 0.8500    

ND Rating Area 3 0.9000    

ND Rating Area 4 0.8300    

NE Rating Area 1 0.8700    

NE Rating Area 2 0.9500    

NE Rating Area 3 0.9200    

NE Rating Area 4 0.9100    

NH Rating Area 1 0.8900    

NJ Rating Area 1 1.1829    

NM Rating Area 1 0.7600    

NM Rating Area 2 0.9100    

NM Rating Area 3 0.8500    

NM Rating Area 4 0.6500    

NM Rating Area 5 0.8100    

NV Rating Area 1 1.0900    

NV Rating Area 2 0.8500    

NV Rating Area 3 0.8500    

NV Rating Area 4 1.0000    

NY Rating Area 1 0.8241    

NY Rating Area 2 0.8423    

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Page 62: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIARATING AREA FACTORSNY Rating Area 3 1.0295    

NY Rating Area 4 1.4069    

NY Rating Area 5 0.8584    

NY Rating Area 6 0.8389    

NY Rating Area 7 0.8404    

NY Rating Area 8 1.2394    

OH Rating Area 1 1.0760    

OH Rating Area 2 0.9178    

OH Rating Area 3 1.0199    

OH Rating Area 4 1.0579    

OH Rating Area 5 0.9760    

OH Rating Area 6 0.9725    

OH Rating Area 7 0.9584    

OH Rating Area 8 1.0319    

OH Rating Area 10 0.9607    

OH Rating Area 13 1.0139    

OH Rating Area 11 1.0645    

OH Rating Area 9 1.0227    

OH Rating Area 12 0.8701    

OH Rating Area 17 0.9665    

OH Rating Area 16 0.9962    

OH Rating Area 15 0.8383    

OH Rating Area 14 0.7450    

OK Rating Area 1 0.9500    

OK Rating Area 2 0.8800    

OK Rating Area 3 0.9800    

OK Rating Area 4 0.9100    

OK Rating Area 5 0.9500    

OR Rating Area 1 0.8200    

OR Rating Area 2 0.7500    

OR Rating Area 3 0.8000    

OR Rating Area 4 0.7400    

OR Rating Area 5 0.8100    

OR Rating Area 6 0.8000    

OR Rating Area 7 0.7100    

PA Rating Area 1 0.9232    

PA Rating Area 2 0.9493    

PA Rating Area 3 0.9388    

PA Rating Area 4 1.0292    

PA Rating Area 5 0.9670    

PA Rating Area 6 0.9887    

PA Rating Area 7 0.9310    

PA Rating Area 8 1.1722    

PA Rating Area 9 0.9552    

PA Grand Total 1.0321    

RI Rating Area 1 1.0200    

SC Rating Area 1 0.9100    

SC Rating Area 10 0.9400    

SC Rating Area 11 0.8300    

SC Rating Area 12 0.9300    

SC Rating Area 13 0.8700    

SC Rating Area 14 0.9400    

SC Rating Area 15 1.0900    

SC Rating Area 16 0.9900    

SC Rating Area 17 0.9500    

SC Rating Area 18 0.8900    

SC Rating Area 19 0.8800    

SC Rating Area 2 0.8500    

SC Rating Area 20 0.9500    

SC Rating Area 21 0.9600    

SC Rating Area 22 0.9200    

SC Rating Area 23 0.8900    

SC Rating Area 24 0.9600    

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Page 63: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIARATING AREA FACTORSSC Rating Area 25 0.9800    

SC Rating Area 26 0.8400    

SC Rating Area 27 0.9900    

SC Rating Area 28 0.9100    

SC Rating Area 29 0.9600    

SC Rating Area 3 1.0900    

SC Rating Area 30 0.9600    

SC Rating Area 31 1.0200    

SC Rating Area 32 0.8500    

SC Rating Area 33 0.8300    

SC Rating Area 34 0.9500    

SC Rating Area 35 0.9400    

SC Rating Area 36 0.8500    

SC Rating Area 37 0.8400    

SC Rating Area 38 0.9600    

SC Rating Area 39 0.9000    

SC Rating Area 4 0.9700    

SC Rating Area 40 0.9100    

SC Rating Area 41 0.9200    

SC Rating Area 42 0.9000    

SC Rating Area 43 1.0000    

SC Rating Area 44 0.9700    

SC Rating Area 45 0.9800    

SC Rating Area 46 0.8600    

SC Rating Area 5 1.0000    

SC Rating Area 6 0.8900    

SC Rating Area 7 0.8100    

SC Rating Area 8 0.9300    

SC Rating Area 9 0.9800    

SD Rating Area 1 0.8000    

SD Rating Area 2 0.8300    

SD Rating Area 3 0.8500    

SD Rating Area 4 0.8100    

TN Rating Area 1 0.8100    

TN Rating Area 2 0.8400    

TN Rating Area 3 0.9300    

TN Rating Area 4 0.9300    

TN Rating Area 5 0.9300    

TN Rating Area 6 1.0200    

TN Rating Area 7 0.8900    

TN Rating Area 8 0.9400    

TX Rating Area 1 0.9900    

TX Rating Area 10 1.2600    

TX Rating Area 11 0.9800    

TX Rating Area 12 1.1800    

TX Rating Area 13 1.0900    

TX Rating Area 14 1.1000    

TX Rating Area 15 1.2600    

TX Rating Area 16 0.9100    

TX Rating Area 17 1.0000    

TX Rating Area 18 0.9200    

TX Rating Area 19 1.0100    

TX Rating Area 2 0.9900    

TX Rating Area 20 1.1800    

TX Rating Area 21 0.9800    

TX Rating Area 22 1.1100    

TX Rating Area 23 1.0800    

TX Rating Area 24 0.8800    

TX Rating Area 25 1.1500    

TX Rating Area 26 1.0400    

TX Rating Area 3 1.0000    

TX Rating Area 4 1.1600    

TX Rating Area 5 1.2000    

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Page 64: Filing at a Glance · 2017-02-28 · PPACA Notes: null Include Exchange Intentions: No Additional Benefits: No Filing Description: The 2017-18 blanket student health insurance rates

NATIONAL GUARDIAN LIFE INSURANCE CO

RATE MANUAL

POLICY NBH‐280 (2015) PPO PA REV 16

PENNSYLVANIARATING AREA FACTORSTX Rating Area 6 1.0000    

TX Rating Area 7 1.0900    

TX Rating Area 8 1.1700    

TX Rating Area 9 1.0300    

UT Rating Area 1 0.8400    

UT Rating Area 2 0.8400    

UT Rating Area 3 0.8600    

UT Rating Area 4 0.8900    

UT Rating Area 5 0.8200    

UT Rating Area 6 0.8100    

VA Rating Area 1 0.8300    

VA Rating Area 10 0.8500    

VA Rating Area 11 0.8000    

VA Rating Area 12 0.8400    

VA Rating Area 2 0.8500    

VA Rating Area 3 0.9200    

VA Rating Area 4 0.8500    

VA Rating Area 5 0.8100    

VA Rating Area 6 0.8600    

VA Rating Area 7 0.9300    

VA Rating Area 8 0.8200    

VA Rating Area 9 0.9200    

VT Rating Area 1 0.8296    

WA Rating Area 1 0.8800    

WA Rating Area 2 0.8200    

WA Rating Area 3 0.8600    

WA Rating Area 4 0.8800    

WA Rating Area 5 0.8500    

WI Rating Area 1 1.0481    

WI Rating Area 2 0.7885    

WI Rating Area 3 0.8656    

WI Rating Area 4 0.8692    

WI Rating Area 5 0.8187    

WI Rating Area 6 0.7941    

WI Rating Area 7 0.8102    

WI Rating Area 8 0.8544    

WI Rating Area 10 0.7769    

WI Rating Area 13 0.7824    

WI Rating Area 11 0.7685    

WI Rating Area 9 0.9546    

WI Rating Area 12 0.8157    

WI Rating Area 16 0.7983    

WI Rating Area 15 0.7821    

WI Rating Area 14 0.8167    

WV Rating Area 1 0.8300    

WV Rating Area 10 0.8600    

WV Rating Area 11 0.9600    

WV Rating Area 2 0.9100    

WV Rating Area 3 0.8500    

WV Rating Area 4 0.8600    

WV Rating Area 5 0.8700    

WV Rating Area 6 0.8200    

WV Rating Area 7 0.8600    

WV Rating Area 8 0.9000    

WV Rating Area 9 0.8500    WY Rating Area 1 0.8600WY Rating Area 2 0.8900WY Rating Area 3 0.8000

49