filing at a glance - myportal.dfs.ny.gov … · serff tracking #: hlft-132346272 state tracking #:...

Filing at a Glance

Company: Healthfirst Insurance Company, Inc.

Product Name: HFIC Individual Rates Filing 2021

State: New York

TOI: H16I Individual Health - Major Medical

Sub-TOI: H16I.005D Individual - EPO

Filing Type: 2021 Prior Approval ACA Rates

Date Submitted: 05/18/2020

SERFF Tr Num: HLFT-132346272

SERFF Status: Pending State Action

State Tr Num: 2020050262

State Status: CP-xx-RR

Co Tr Num:

ImplementationDate Requested:

01/01/2021

Author(s):

Reviewer(s):

Disposition Date:

Disposition Status:

Implementation Date:

State Filing Description:

SERFF Tracking #: HLFT-132346272 State Tracking #: 2020050262 Company Tracking #:

State: New York Filing Company: Healthfirst Insurance Company, Inc.

TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005D Individual - EPO


Project Name/Number: /

PDF Pipeline for SERFF Tracking Number HLFT-132346272 Generated 05/26/2020 09:14 AM

General Information

Company and Contact

Filing Fees

State Specific

Project Name: Status of Filing in Domicile:

Project Number: Date Approved in Domicile:

Requested Filing Mode: Review & Approval Domicile Status Comments:

Explanation for Combination/Other: Market Type: Individual

Submission Type: New Submission Individual Market Type: Individual

Overall Rate Impact: Filing Status Changed: 05/22/2020

State Status Changed: 05/22/2020

Deemer Date: Created By:

Submitted By: Corresponding Filing Tracking Number:

PPACA: Not PPACA-Related

PPACA Notes: null

Include Exchange Intentions: No

Filing Description:

Healthfirst Insurance Company, Inc.'s initial submission of its 2021 Individual off-Exchange rate filing.

The SERFF tracking number of the associated form filing is: HLFT-132346263.

The SERFF tracking number of the corresponding Prior Approval prefiling is HLFT-132345859.

Filing Contact Information

Filing Company InformationHealthfirst Insurance Company,Inc.

100 Church Street

18th Floor

New York, NY 10007

(212) 801-6210 ext. [Phone]

CoCode: 16031

Group Code: 4778

Group Name: Healthfirst Inc Grp

FEIN Number: 46-4545744

State of Domicile: New York

Company Type:

State ID Number:

Fee Required? No

Retaliatory? No

Fee Explanation:

1. Is a parallel filing being submitted for another issuing entity of the same parent organization? Yes/No (If Yes, enter name







of other entity, submission date, and SERFF Tracking Number of the parallel file.): No2. Does this filing contain a dental, vision or health insurance policy or contract that uses a network of health care providers?(If Yes, enter the PNDS Network ID number and name. If the network has not been filed in PNDS, it must be filed within 60days of approval.): Yes. Healthfirst Total EPO. NYN002.3. : N/A4. Type of filing? Enter Form and Rate, Form only, Rate only (Form only should be used ONLY when the filing only containsan application, advertisement, administrative form, or is a group prefiling notification, out-of-state, or a report filing. Formsubmissions with no proposed rate impact are considered form and rate filings and require an actuarial memorandum.): Formand Rate5. Is this a Rate only filing? Yes/No [If Yes, enter one: Commission/Fee Schedule, DBL Loss Ratio Monitoring, ExperienceFiling Monitoring, Experience Rating Formula, Medicare Supplement Annual Filing (other than rate adjustment), RateAdjustment, or Other with brief explanation).]: No6. Does this submission contain a form subject to Regulation 123 (i.e., the certificate is deemed delivered in New York State)?Yes/No (If Yes, provide a full explanation in the Filing Description field.): No7. Did this insurer prefile group coverage for this group under Section 52.32 prior to this filing? Yes/No (If Yes, enter thestate tracking number assigned and the effective date of coverage.): No8. Does this submission contain any form which is subject to review by the Life Bureau, the Property Bureau or both? Yes/No(If Yes, identify the forms, the Bureau, the date submitted, and the SERFF file number.): No9. Does this filing contain forms that replace any other previously approved forms? Yes/No (If Yes, identify the formnumbers, the file number, and the date of approval of the forms being replaced in the Filing Description field.): No







Rate Information Rate data applies to filing.

Filing Method:

Rate Change Type: Increase

Overall Percentage of Last Rate Revision: %

Effective Date of Last Rate Revision: 01/01/2020

Filing Method of Last Filing:

SERFF Tracking Number of Last Filing:

Company Rate Information

Company

Name:

Company

Rate

Change:

Overall %

Indicated

Change:

Overall %

Rate

Impact:

Written

Premium

Change for

this Program:

Number of Policy

Holders Affected

for this Program:

Written

Premium for

this Program:

Maximum %

Change

(where req'd):

Minimum %

Change

(where req'd):

Healthfirst InsuranceCompany, Inc.

Increase 1.820% 1.820% $28,622 92 $1,575,075 3.000% %







Rate Review Detail

COMPANY:Company Name: Healthfirst Insurance Company, Inc.

HHS Issuer Id: 61405

PRODUCTS:

Product Name HIOS Product ID HIOS Submission ID Number of Covered

LivesHealthfirst Total EPO 147

Trend Factors: 5.4% Medical, 8.7% Rx, 6.6% annually

FORMS:New Policy Forms: HFIC-IND-21-OFF, HFIC-CO-21-OFF

Affected Forms:

Other Affected Forms:

REQUESTED RATE CHANGE INFORMATION:Change Period: Annual

Member Months: 1,764

Benefit Change: Increase

Percent Change Requested: Min: 0.0 Max: 3.0 Avg: 1.82

PRIOR RATE:Total Earned Premium: 1,575,075.00

Total Incurred Claims: 1,343,539.00

Annual $: Min: 575.62 Max: 1,210.37 Avg: 892.90

REQUESTED RATE:Projected Earned Premium: 1,603,697.00

Projected Incurred Claims: 1,367,954.00

Annual $: Min: 592.89 Max: 1,210.37 Avg: 909.13







Rate/Rule Schedule

Item

No.

Schedule

Item

Status

Document Name

Affected Form Numbers

(Separated with commas) Rate Action Rate Action Information Attachments

1 HFIC Individual Rate Manual New HFIC_RateManual_Individual OffExchange_2021.pdf,HFIC Ind 2021 RateManual_FINAL.xlsx,







Healthfirst Insurance Company, Inc. Individual Market – Effective January 1, 2021

Page 1 of 18

HEALTHFIRST INSURANCE COMPANY, INC.

Rate Manual Pursuant to New York Insurance Law Section 3231(e)(1)

Individual EPO Rates and Forms Submission

Effective January 1, 2021


Page 2 of 18

TABLE OF CONTENTS

I. Off-Exchange Individual Plan Rates………………………………………………………………………………… 3

A. Rate Pages – Off-Exchange EPO Plans………………............................................ 4

B. Description of Rating Classes, Factors, and Premium Discounts……………………. 8

C. Rate Calculation Example…………………………………………………………..…………………. 9

D. Expected Loss Ratio(s)………………………………………………………………………….……… 10

E. Commissions/Fees………………………………………………………………………………………… 11

II. Description of Benefits, Types of Coverage, Limitations, Exclusions, Issue Limits, and Renewal Conditions……………………………………………………………..……………… 12

A. Healthfirst Bronze Total EPO Non-Standard Benefits..…………………………………… 13

B. Healthfirst Silver Total EPO Non-Standard Benefits…..…………………………………… 14

C. Healthfirst Gold Total EPO Non-Standard Benefits..…………………………………….… 15

D. Healthfirst Platinum Total EPO Non-Standard Benefits..………………………………… 16


Page 3 of 18

SECTION I

Off-Exchange Individual EPO Plan Rates


Page 4 of 18

Section I.A – Rate Pages

HEALTHFIRST INSURANCE COMPANY, INC. OFF-EXCHANGE INDIVIDUAL EPO PLANS

RATE PAGES - EFFECTIVE JANUARY 1, 2021 AREAS: NEW YORK, KINGS, QUEENS, RICHMOND, & BRONX COUNTIES (Rating Region #4)

Platinum

Applicable Form Numbers: HFIC-STDIND-21, HFIC-STDCO-21, HFIC-PSOB-21

Premium Per Month

Product HIOS ID Product Description Single Single + Spouse

Single + Child(ren)

Single + Spouse + Child(ren)

Healthfirst Platinum Total EPO 61405NY0020010 Dependent to Age 26 $1,203.18 $2,406.36 $2,045.41 $3,429.06

Healthfirst Platinum Total EPO, Age 29 Rider 61405NY0020011 Dependent to Age 29 $1,215.20 $2,430.40 $2,065.84 $3,463.32

One Child Two Children Three or More

Healthfirst Platinum Total EPO Child-Only 61405NY0020012 Child-Only $495.70 $991.40 $1,487.10

Gold

Applicable Form Numbers: HFIC-STDIND-21, HFIC-STDCO-21, HFIC-GSOB-21

Premium Per Month


Single + Child(ren)


Healthfirst Gold Total EPO 61405NY0020007 Dependent to Age 26 $1,005.03 $2,010.06 $1,708.55 $2,864.34

Healthfirst Gold Total EPO, Age 29 Rider 61405NY0020008 Dependent to Age 29 $1,015.09 $2,030.18 $1,725.65 $2,893.01


Healthfirst Gold Total EPO Child-Only 61405NY0020009 Child-Only $414.06 $828.12 $1,242.18


Page 5 of 18

Silver

Applicable Form Numbers: HFIC-STDIND-21, HFIC-STDCO-21, HFIC-SSOB-21

Premium Per Month


Single + Child(ren)


Healthfirst Silver Total EPO 61405NY0020004 Dependent to Age 26 $799.39 $1,598.78 $1,358.96 $2,278.26

Healthfirst Silver Total EPO, Age 29 Rider 61405NY0020005 Dependent to Age 29 $807.39 $1,614.78 $1,372.56 $2,301.06


Healthfirst Silver Total EPO Child-Only 61405NY0020006 Child-Only $329.36 $658.72 $988.08

Bronze

Applicable Form Numbers: HFIC-STDIND-21, HFIC-STDCO-21, HFIC-BSOB-21

Premium Per Month


Single + Child(ren)


Healthfirst Bronze Total EPO 61405NY0020001 Dependent to Age 26 $607.68 $1,215.36 $1,033.06 $1,731.89

Healthfirst Bronze Total EPO, Age 29 Rider 61405NY0020002 Dependent to Age 29 $613.77 $1,227.54 $1,043.41 $1,749.24


Healthfirst Bronze Total EPO Child-Only 61405NY0020003 Child-Only $250.35 $500.70 $751.05


Page 6 of 18

HEALTHFIRST INSURANCE COMPANY, INC. OFF-EXCHANGE INDIVIDUAL EPO PLANS

RATE PAGES - EFFECTIVE JANUARY 1, 2021 AREAS: NASSAU & SUFFOLK COUNTIES (Rating Region #8)

Platinum

Applicable Form Numbers: HFIC-STDIND-21, HFIC-STDCO-21, HFIC-PSOB-21

Premium Per Month


Single + Child(ren)


Healthfirst Platinum Total EPO 61405NY0020010 Dependent to Age 26 $1,240.56 $2,481.12 $2,108.95 $3,535.60

Healthfirst Platinum Total EPO, Age 29 Rider 61405NY0020011 Dependent to Age 29 $1,252.95 $2,505.90 $2,130.02 $3,570.91


Healthfirst Platinum Total EPO Child-Only 61405NY0020012 Child-Only $511.10 $1,022.20 $1,533.30

Gold

Applicable Form Numbers: HFIC-STDIND-21, HFIC-STDCO-21, HFIC-GSOB-21

Premium Per Month


Single + Child(ren)


Healthfirst Gold Total EPO 61405NY0020007 Dependent to Age 26 $1,036.26 $2,072.52 $1,761.64 $2,953.34

Healthfirst Gold Total EPO, Age 29 Rider 61405NY0020008 Dependent to Age 29 $1,046.62 $2,093.24 $1,779.25 $2,982.87


Healthfirst Gold Total EPO Child-Only 61405NY0020009 Child-Only $426.93 $853.86 $1,280.79


Page 7 of 18

Silver

Applicable Form Numbers: HFIC-STDIND-21, HFIC-STDCO-21, HFIC-SSOB-21

Premium Per Month


Single + Child(ren)


Healthfirst Silver Total EPO 61405NY0020004 Dependent to Age 26 $824.23 $1,648.46 $1,401.19 $2,349.06

Healthfirst Silver Total EPO, Age 29 Rider 61405NY0020005 Dependent to Age 29 $832.48 $1,664.96 $1,415.22 $2,372.57


Healthfirst Silver Total EPO Child-Only 61405NY0020006 Child-Only $339.59 $679.18 $1,018.77

Bronze

Applicable Form Numbers: HFIC-STDIND-21, HFIC-STDCO-21, HFIC-BSOB-21

Premium Per Month


Single + Child(ren)


Healthfirst Bronze Total EPO 61405NY0020001 Dependent to Age 26 $626.56 $1,253.12 $1,065.15 $1,785.70

Healthfirst Bronze Total EPO, Age 29 Rider 61405NY0020002 Dependent to Age 29 $632.83 $1,265.66 $1,075.81 $1,803.57


Healthfirst Bronze Total EPO Child-Only 61405NY0020003 Child-Only $258.14 $516.28 $774.42


Page 8 of 18

Section I.B – Description of Rating Classes, Factors, & Premium Discounts

Family/Census Tier

Census Tiers Cost Factor

Single 1.000

Single + Spouse 2.000

Single + Child(ren) 1.700

Single + Spouse + Child(ren) 2.850

Child Only 0.412

Rating Region

Rating Region Counties Included Area Factor

New York City Bronx, Kings, New York, Queens, Richmond 1.000

Long Island Nassau, Suffolk 1.031

Family Planning Benefits

Dependent Age Limit

Dependent Age Limit Cost Factor

26 1.000

29 1.010

Plan Variations Cost Factor

Family Planning Coverage 1.000

Domestic Partner Coverage 1.000

Pediatric Dental Coverage 1.000


Page 9 of 18

Section I.C – Rate Calculation Example

Healthfirst premium rates are developed in accordance with New York’s community rating law, and

without any discounts or surcharge factors.

EXAMPLE:

Consumer Profile:

• Census Tier: An individual (subscriber) in self-only coverage

• Residence: Queens County (Rating Region 4)

• Plan: Healthfirst Bronze Total EPO, not choosing the Age 29 Rider.

One would proceed to page 5 and refer to the table listing Bronze-level plans. Next, one would refer to

the row labeled, “Healthfirst Bronze Total EPO” and cross-reference the row labeled, “Single.” The rate

for this plan is $607.68 per month.


Page 10 of 18

Section I.D – Expected Loss Ratios

The projected loss ratio using the Federal medical loss ratio (MLR) methodology is 86.7%. The expected

loss ratio under New York State’s MLR methodology is 83.5%.


Page 11 of 18

Section I.E – Broker/Agent Commissions & Fees

The products and plans listed herein do not include any consideration related to broker/agent

commissions and/or fees. Accordingly, brokers/agents who sell these products and plans will not be

compensated by Healthfirst for such sale.


Page 12 of 18

SECTION II

Description of Benefits, Types of Coverage, Limitations, Exclusions, Issue Limits,

& Renewal Conditions


Page 13 of 18

Section II.A – Healthfirst Bronze Total EPO Non-Standard Plan Benefit Description

Bronze Total EPO

Individual Deductible $5,950

Max Out of Pocket (Individual) $6,900

Primary Care Doctor Visit 50% coinsurance after deductible

Specialist Doctor Visit 50% coinsurance after deductible

Lab Diagnostic 50% coinsurance after deductible

Emergency Room (Cost sharing waived if admitted)

50% coinsurance after deductible

Hospital Outpatient Facility: Surgery 50% coinsurance after deductible

Ambulatory Surgery Center 50% coinsurance after deductible

Inpatient Facility 50% coinsurance after deductible

SNF 200 days per plan year


Physical Therapy 60 visits per condition, per lifetime, combined ST therapies outpatient


Occupational Therapy 60 visits per condition, per lifetime, combined ST therapies outpatient


Speech Therapy 60 visits per condition, per lifetime, combined ST therapies outpatient


Mental Health/Substance Abuse - Inpatient 50% coinsurance after deductible


Page 14 of 18

Bronze Total EPO

Mental Health/Substance Abuse - Outpatient / Behavioral Health


Retail Generic Drugs 50% coinsurance after deductible

Retail Preferred Drugs 50% coinsurance after deductible

Retail Non-Preferred Drugs 50% coinsurance after deductible

Section II.B – Healthfirst Silver Total EPO Non-Standard Plan Benefit Description

Silver Total EPO

Individual Deductible $4,300


Primary Care Doctor Visit

$35 copay/visit

Specialist Doctor Visit $70 copay/visit

Lab Diagnostic Office: PCP - $35 copay/visit SPC - $70

copay/visit; Facility: $70 copay/visit


$600 copay/visit after deductible

Hospital Outpatient Facility: Surgery 40% coins after deductible

Ambulatory Surgery Center 40% coins after deductible

Inpatient Facility 40% coins after deductible


40% coins after deductible


Page 15 of 18

Silver Total EPO


$70 copay/visit


$70 copay/visit


$70 copay/visit

Mental Health/Substance Abuse - Inpatient 40% coins after deductible


$35 copay/visit

Retail Generic Drugs $20

Retail Preferred Drugs $60

Retail Non-Preferred Drugs $110

Section II.C – Healthfirst Gold Total EPO Non-Standard Plan Benefit Description

Gold Total EPO

Individual Deductible $0


Primary Care Doctor Visit $25 copay/visit


Lab Diagnostic Office: PCP - $25 copay/visit; SPC -$40



Page 16 of 18

Gold Total EPO


$350 copay/visit

Hospital Outpatient Facility: Surgery $300 copay

Ambulatory Surgery Center $300 copay

Inpatient Facility $500/visit


$500/visit


$40 copay/visit


$40 copay/visit


$40 copay/visit

Mental Health/Substance Abuse - Inpatient $500/visit


$25 copay/visit

Retail Generic Drugs $10

Retail Preferred Drugs $50

Retail Non-Preferred Drugs $85


Page 17 of 18

Section II.D – Healthfirst Platinum Total EPO Non-Standard Plan Benefit Description

Platinum Total EPO

Individual Deductible $0


Primary Care Doctor Visit $20 copay/visit


Lab Diagnostic Office: PCP - $20 copay/visit ; SPC -$35



$250 copay/visit

Hospital Outpatient Facility: Surgery $200 copay

Ambulatory Surgery Center $200 copay

Inpatient Facility $500 copay


$500 copay


$35 copay/visit


$35 copay/visit


Page 18 of 18

Platinum Total EPO


$35 copay/visit

Mental Health/Substance Abuse - Inpatient $500 copay


$20 copay/visit

Retail Generic Drugs $10 copay

Retail Preferred Drugs $30 copay

Retail Non-Preferred Drugs $60 copay

Supporting Document Schedules Satisfied - Item: 2021 Rate Filing ChecklistComments:Attachment(s): HFIC IND 2021_rate_filing_checklist 051820.pdfItem Status:Status Date:

Satisfied - Item: Actuarial MemorandumComments:

Attachment(s):File 1 - QHP - WNRAR-IND-Y5891889-20200320.xlsxFile 2 - TPIR.ZGKSBPP2CD QHP 2019.xlsxHFIC IND - Spreadsheet for Risk Adjsutment 052220.xlsxHFIC_IND_2021_ActuarialMemo_052220.pdf

Item Status:Status Date:

Satisfied - Item: Actuarial Memorandum and CertificationsComments:

Attachment(s):File 1 - QHP - WNRAR-IND-Y5891889-20200320.xlsxFile 2 - TPIR.ZGKSBPP2CD QHP 2019.xlsxHFIC IND - Spreadsheet for Risk Adjsutment 052220.xlsxHFIC_IND_2021_ActuarialMemo_052220.pdf


Satisfied - Item: Actuarial Value CalculationsComments:Attachment(s): HFIC IND 2021 AV Screenshots.pdfItem Status:Status Date:

Satisfied - Item: Exhibit 11: General InformationComments:

Attachment(s): HFIC IND 2021_exh11.pdfHFIC IND 2021_exh11.xlsm








Satisfied - Item: Exhibit 13a: Numerical Summary and Rate Indication CalculationComments:

Attachment(s): HFIC IND_2021_exh13A.xlsmHFIC IND_2021_exh13A.pdf


Satisfied - Item: Exhibit 13b: Narrative SummaryComments:Attachment(s): Narrative Summary_HFIC Individual OffExchange 2021_FINAL.pdfItem Status:Status Date:

Satisfied - Item: Exhibit 13c: Average Premium DetailsComments:

Attachment(s): HFIC IND 2021_exh13C.pdfHFIC IND 2021_exh13C.xlsm


Satisfied - Item: Exhibit 14: Summary of Requested Percentage ChangesComments:



Bypassed - Item: Exhibit 15a: Product Discontinuance CertificationBypass Reason: The company is not discontinuing any products for the 2021 plan year.Attachment(s):Item Status:Status Date:

Satisfied - Item: Exhibit 15b: MHPAEA Compliance CertificationComments:Attachment(s): HFIC IND 2021_exh15B_MHPAEA_Cert_Signed 051320.pdfItem Status:Status Date:







Satisfied - Item: Exhibit 16: Summary of Policy Form & Product ChangesComments:

Attachment(s): HFIC IND_2021_exh16.pdfHFIC IND_2021_exh16.xlsm


Satisfied - Item: Exhibit 17: Claims ExperienceComments:



Satisfied - Item: Exhibit 18: Index Rate/Plan-Design Level AdjustmentComments:



Satisfied - Item: Exhibit 23: Summary of Requested 2020 Premium RatesComments:



Bypassed - Item: Final Notice of Proposed Rate AdjustmentBypass Reason: N/A - not yet available.Attachment(s):Item Status:Status Date:

Satisfied - Item: Initial Notice of Proposed Rate AdjustmentComments:Attachment(s): HFIC IND_2021 Rate adjustment notice - Individual Policyholder (Off-Exchange).pdfItem Status:







Status Date:

Satisfied - Item: Redacted Documents for Web PostingComments:

Attachment(s): HFIC IND 2021_exh11_Redacted.pdfHFIC_IND_2021_ActuarialMemo_052220_Redacted.pdf


Satisfied - Item: Unified Rate Review TemplateComments:

Attachment(s): HFIC_IND_2021_URRT.pdfHFIC_IND_2021_URRT.xlsm








NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES Checklist for the Filing of 2021 Individual Premium Rates

For On-Exchange Plans and Off-Exchange Plans

1. Under which Section of the New York State Insurance Law is this filing being made? (3231(e)(1), 4308(c), 3231(d), or 4308(b))

2. For filings made pursuant to 3231(e)(1) and 4308(c):

a. Did the Company submit a combined filing for “On” and “Off” Exchange rates per the instructions along with

a separate form filing that both contain cross references to each other? N/A

b. For Individual filings, do the Exhibits only contain Individual plan/experience data per the instructions? Yes

c. For Small Group filings, do the Exhibits only contain Small Group plan/experience data per the instructions?

3. Does this filing introduce any new plans (i.e., new 14-digit HIOS IDs)? No

4. Has the Company provided two versions (i.e., PDF and Excel) of all rate filing Exhibits? Yes

5. Do the values in Line 10 of Exhibit 18 match the totals in column 14.4 of Exhibit 17 for the applicable Market Segments? Yes

6. Do the values in Line 10A of Exhibit 18 match the totals in column 14.7 of Exhibit 17 for the applicable Market Segments? Yes

7. Do the values in Line 10B of Exhibit 18 match the totals in column 14.3 of Exhibit 17 for the applicable Market Segments? Yes

8. Confirm that the 2021 version (updated in 2020) of the rate filing Exhibits were utilized (Yes/No: Respond “Yes” to confirm). Yes

9. With regard to the “Rate Review Detail” screen in SERFF:

a. Was it completed in a manner consistent with the Company’s 2020 premium rate filings? Yes

b. Do the “Average” percentages look reasonable (e.g., do they fall between “Minimum” and “Maximum” percentages? Yes

c. Do the “Minimum” and “Maximum” values appear reasonable in light of changes that are being proposed? Yes

d. Are the “Minimum”, “Maximum” and “Average” values stated on an Annualized PMPM basis (as opposed to annual

premium)?

e. Are all items that are not applicable left blank (i.e., Items that are not applicable should be left blank)? Yes

f. Have the “Requested Rate Period” data fields been populated with non-zero values? Yes

10. Is the information presented in Exhibit 18 provided at the HIOS SCID level (i.e., are there 14 digits in the HIOS ID?) Yes

11. Does Exhibit 23 contain rates for every distinct 14-digit HIOS ID as opposed to only the “Base” plan rates? Yes

12. Does the Company’s claim experience for 2019 include two months of run-out? Yes

13. Is the rate manual provided in both PDF and Excel format per our instructions? Yes

14. Were adequate details (as well as a spreadsheet) included with the Actuarial Memorandum regarding how DFS should modify

the Company’s 2021 assumption for risk adjustment to the extent actual 2019 results are different from expected? Yes

15. Does the PMPM value in Cell Q-74 of Exhibit 13C equal the value in Cell D-98 (Line 54 Column D) of Exhibit 18? Yes

16. Does the PMPM value in Cell Z-74 of Exhibit 13C equal the value in Cell D-104 (Line 56 Column D) of Exhibit 18? Yes

17. Does the total premium value in Cell G-24 of Exhibit 14 equal the value in Cell Q-61 of Exhibit 13c? Yes

18. Does the overall rate change calculated in Exhibit 13c accurately represent the Company’s expectation of the rate change? Yes

a. If not, did the Company’s Actuary reach out to DFS and resolve the issue? (Note that any such issues should be resolved prior to submission of the filing by contacting Frank Horn via e-mail at [email protected] or by phone at (518) 473- 5454).

Name of the Chief Actuary responsible for this filing:

Signature:

Date:

E-mail Address:

Phone Number:

Yes

3231(e)(1)

mailto:[email protected]

EXHIBIT 13a: NUMERICAL SUMMARY AND RATE INDICATION CALCULATIONNUMERICAL SUMMARY

Healthfirst Insurance Company, Inc.16031

SERFF Tracking #: HLFT-132345859Market Segment: Individual

1 Please complete the Numerical Summary below as well as the Narrative Summary (a separate attachment) for each market segment for which a rate filing is being submitted.2 The Narrative Summary must be in plain English and should clearly and simply explain the reasons for the requested rate adjustment (This should be included in the provided blank template "2021 Exhibit 13b - Narrative Summary.docx")3 The purpose of the Narrative Summary is to provide a written explanation to the company's policyholders to help them understand the reasons why a rate increase is needed. 4 The purpose of the Numerical Summary is to provide a clear and simple overview of the requested rate adjustment. 5 These Summaries (with the exception of the Rate Indication Calculation Section) will be public documents and will be posted on DFS’s website and furnished by DFS to the public upon request. 6 The company should submit these Summaries to DFS ten (10) days before submitting a rate adjustment f iling.7 A draft of these Summaries and of the Initial Notice must be included in a "Prior Approval Pre-filing" submitted to DFS via SERFF.8 Once reviewed by DFS, these Summaries must be posted to a location on its website that is publicly available and accessible without the need for a user ID/password. 9 Links should be provided on key pages of the company's website so that the information may be easily located.

10 Any change(s) made to the Narrative Summary/Numerical Summary subsequent to the posting must be submitted to DFS with the specific change(s) identified.11 Rate Change Adjustment calculations between Year 2020 and 2021 should be based on the DFS Membership Survey data as of 3/31/2020.12 This exhibit must be submitted as an Excel file and as a PDF file.

A. Average 2020 and 2021 Premium Rates:1 Weighted Average Monthly Base Premium Rates are as calculated in Row 32 of the appropriate columns in Exhibit 13c (Columns L-P for 2020 and Columns U-Y for 2021)2 Premium Rates for 2021 should be Consistent with the Premium Rates reflected in Exhibit 23.

Average Individual Rate Average Individual Rate Average Individual Rate Average Individual Rate Average Individual RatePlatinum Gold Silver Bronze Catastrophic

2020 Weighted Average Base Premium Rates 1,300.61$ 1,044.78$ 896.35$ 644.21$ 2021 Weighted Average Base Premium Rates 1,320.38$ 1,064.69$ 911.43$ 660.33$

B. Weighted Average Annual Percentage Requested Adjustments:

2020 Weighted Average PMPM Rate 2021 Weighted Average PMPM Rate2020 to 2021 All - Metals All - Metals

Requested Rate Adjustment 1.81718% 892.90$ 909.13$ From Cells Q-74 and Z-74 of Exhibit 13c

C. Weighted Average Annual Percentage Adjustments for each of the Past Two Years [If Applicable]*:2018 to 2019 2019 to 2020

Average Rate Adjustment Requested 15.00000% 12.00000%Average Rate Adjustment Approved 8.80000% 9.80000%

D. Average Medical Loss Ratios [MLR] for All Policies Impacted [Ratios of Incurred Claims to Earned Premiums] [If Applicable]*:2017 2018 2019

MLR 107.8% 63.8% 60.0%

E. Claim Trend Rates and Average Ratios to Earned Premiums [Per Exhibit 19 for 2019-2021 and Comparable Exhibits for 2019] [If Applicable]*:2019 2020 2021

Annual Claim Trend Rates 6.5% 6.5% 6.6%Expense Ratios 20.0% 19.6% 15.9%Pre Tax Profit Ratios 1.5% 1.5% 1.5%* If no products were offered in a particular year, indicate "N/A" in the applicable box.

Company NAIC Code:

Exhibit 13a Updated by DFS 3/20/2020 1This document was created by an application that isn’t licensed to use novaPDF.Purchase a license to generate PDF files without this notice.

http://www.novapdf.com/

NARRATIVE SUMMARY

Community-Rated Individual Commercial Comprehensive Premium Rate Filings Plan Year 2021

Healthfirst Insurance Company, Inc. (Healthfirst) has submitted to the New York Department of

Financial Services (DFS) an application to adjust premium rates for direct pay individual market

health insurance coverage effective in 2021. Healthfirst has requested an increase in premium rates

for plans offered in 2021. The Department of Financial Services is reviewing Healthfirst’s requested

premium rate increase and will determine if the rates are appropriate based on the available

evidence.

The requested rate adjustments will affect all currently enrolled individual market subscribers

renewing coverage for the 2021 calendar year as well as new individual policies issued during the

2021 calendar year. Final rate adjustments approved by DFS will be effective January 1, 2021. The

rates are guaranteed for a 12-month period ending December 31, 2021 and are subject to New

York’s community rating and guarantee issue laws. Subscribers’ rates will vary according to the

benefit plan in which they enroll, as well as the census/family tier they select.

As of the date of the submission of this Narrative Summary, approximately 150 covered lives (i.e.,

subscribers and their covered dependents) are estimated to be affected by the rate adjustment.

A Description of Your Premium Rate

Your health insurance premium rate has two main components. One is the costs of paying for

medical care and the other is Healthfirst’s administrative costs.

1. Medical care costs. The largest portion of your health insurance premium rate goes toward

paying for the costs of the medical claims submitted by you and other members enrolled in

Healthfirst’s individual market plans. Under New York law, at least 82 percent of the premium

Healthfirst’s members pay must be put toward paying for the costs of medical claims. More

than 82 percent of Healthfirst’s premium dollars is used for paying medical expenses.

2. Administrative costs. Administrative expenses include a wide range of services and

functions, such as processing claims and upgrading technology to keep pace with the rapidly

changing health care sector. It also accounts for an array of member-centric expenses such

as conducting medical necessity reviews, managing members’ complex and chronic

conditions, maintaining a robust provider network, and partnering with the community on

health education initiatives.

Healthfirst takes a meaningful and evidence-based approach to determining how much of a rate

adjustment to request from DFS.

Narrative Summary – Healthfirst Insurance Company, Inc. Individual Plans –2021 NAIC 16031

Your Rate Adjustment Explained

Healthfirst is applying for a rate adjustment to account for marketplace trends and to reflect actual

and anticipated claims costs. While several market forces continue to drive health care costs higher

more generally, Healthfirst continues to strengthen the effectiveness of its care management and

quality improvement programs and robust network.

Healthfirst is requesting a higher rate for 2021 because several market forces continue to drive health care costs higher. These forces include:

• Cost increases for inpatient hospital, outpatient hospital, and physician services

• Cost increases for prescription drugs, including the increased use of expensive specialty prescriptions.

The overall requested rate increase is 2.4%. The premium rate increases, by plan metal level, that

Healthfirst is requesting are summarized in the table below:

Off-Exchange Individual EPO Plan Name Requested Increase

Healthfirst Platinum Total EPO

NYC: 3.0%

Long Island: 0.0%

Healthfirst Gold Total EPO

NYC: 3.0%

Long Island: 0.0%

Healthfirst Silver Total EPO

NYC: 3.0%

Long Island: 0.0%

Healthfirst Bronze Total EPO

NYC: 3.0% Long Island: 0.0%

Final Rate Adjustment

The final rate adjustment that Healthfirst members experience may differ than what DFS eventually approves. Healthfirst will notify its currently enrolled members approximately 60 days prior to the new rate taking effect.

EXHIBIT 13C - AVERAGE PREMIUM DETAILS

Company Name: Healthfirst Insurance Company, Inc.NAIC Code: 16031


1 Please complete all of the shaded boxes in rows 24-47 below. The goal of this Exhibit is to calculate the rate change being requested in a consistent manner for all insurers. 2 The "Weighted Average Monthly Base Premiums" in cells C24-G31 should be calculated as a weighted average of the insurer's base premiums (i.e., single adult rates prior to application of tier factors, etc.) using the number of plan subscribers as the weights. 3 Cells L24 - P31, should be a recalculation of cells C24-G31 where any plans (and associated members enrolled in those plans as of 3/31/2020) that will no longer be offered in 2021 are removed.4 The sum of cells C37-G44 should be equal to the Company's total membership for the relevant market as of 3/31/2020.5 Cells L37-P44 should be equal to cells C37-G44 less any members that are enrolled in plans that will no longer be offered in 2021.6 If the Company is not eliminating any plans in 2021, then cells C24-G31 and L24-P31 should be the same, as should cells C37-G44 and L37-P44.7 The "Conversion Factors" should be the factors that were developed in pricing to convert the "Weighted Average Monthly Base Premiums" to "Weighted Average Monthly PMPM Premium Rates". These factors should be adjusted as necessary to reflect any changes that are not reflected in the Base Premiums.8 The value in cell Q74 of this Exhibit should match cell D98 (Line 54) of Exhibit 18.9 The value in cell Z74 of this Exhibit should match cell D104 (Line 56) of Exhibit 18.

2020 Weighted Average Monthly Base Premiums - CALCULATED BASED ON ACTUAL DISTRIBUTION AS OF 3/31/2020 (Weighted by number 2020 Weighted Average Monthly Base Premiums - RE-CALCULATED USING ONLY THE SUBSET OF 2020 PLANS THAT WILL STILL 2021 Weighted Average Monthly Proposed Base Premiums - THESE BASE PREMIUMS SHOULD BE CALCULATED USING THE SAME Change in Weighted Average Monthly Base Premiums of subscribers) BE AVAILABLE IN 2021 (weighted by subscribers in those specific plans) POPULATION OF SUBSCRIBERS THAT WAS USED TO CALCULATE CELLS L22 - P29) Average Monthly Base Premium assuming 3/31/2020 membership Average Monthly Base Premium paid assuming 3/31/2020 membership and all policies are paid in full for the entire year) Average Base Premium paid assuming 3/31/2020 membership and all policies are paid in full for the entire year) Average Base Premium paid assuming 3/31/2020 membership and all policies are paid in full for the entire year)

Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals1 - Albany Area 1 - Albany Area 0 0 0 0 0 1 - Albany Area 1 - Albany Area2 -Buffalo Area 2 -Buffalo Area 0 0 0 0 0 2 -Buffalo Area 2 -Buffalo Area

3- Mid-Hudson Area 3- Mid-Hudson Area 0 0 0 0 0 3- Mid-Hudson Area 3- Mid-Hudson Area4- NYC Area 1,263 1,055 900 638 968.40 4- NYC Area 1,263 1,055 900 638 0 968.40 4- NYC Area 1301.05 1086.78 927.39 657.11 997.45 4- NYC Area 3.00% 3.00% 3.00% 3.00% 3.00%

5- Rochester Area 5- Rochester Area 0 0 0 0 0 5- Rochester Area 5- Rochester Area6- Syracuse Area 6- Syracuse Area 0 0 0 0 0 6- Syracuse Area 6- Syracuse Area

7- Utica/Watertown Area 7- Utica/Watertown Area 0 0 0 0 0 7- Utica/Watertown Area 7- Utica/Watertown Area8- Long Island Area 1,341 1,027 891 678 1024.09 8- Long Island Area 1,341 1,027 891 678 0 1024.09 8- Long Island Area 1341.47 1027.22 891.27 677.52 1024.09 8- Long Island Area 0.00% 0.00% 0.00% 0.00% 0.00%

9 - All Regions 1300.61 1044.78 896.35 644.21 989.62 9 - All Regions 1300.61 1044.78 896.35 644.21 989.62 To Exhibit 13a (Section A) 9 - All Regions 1320.38 1064.69 911.43 660.33 1007.60 To Exhibit 13a (Section A) 9 - All Regions 1.52% 1.91% 1.68% 2.50% 1.82%

2020 Members - as of 3/31/2020 - Actual Distribution (All members as of 3/31/2020 should be included) Members - as of 3/31/2020 - Only those members currently enrolled in plans that will continue to be offered in 2021 Members - as of 3/31/2020 - Only those members currently enrolled in plans that will continue to be offered in 2021 Change in Members - as of 3/31/2020 - Change due to current 2020 plans not being offered in 2021.

Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals1 - Albany Area 1 - Albany Area - - - - - 1 - Albany Area 1 - Albany Area2 -Buffalo Area 2 -Buffalo Area - - - - - 2 -Buffalo Area 2 -Buffalo Area

3- Mid-Hudson Area 3- Mid-Hudson Area - - - - - 3- Mid-Hudson Area 3- Mid-Hudson Area4- NYC Area 12 39 24 16 91 4- NYC Area 12 39 24 16 - 91 4- NYC Area 12 39 24 16 91 4- NYC Area 0.00% 0.00% 0.00% 0.00% 0.00%

5- Rochester Area 5- Rochester Area - - - - - 5- Rochester Area 5- Rochester Area6- Syracuse Area 6- Syracuse Area - - - - - 6- Syracuse Area 6- Syracuse Area

7- Utica/Watertown Area 7- Utica/Watertown Area - - - - - 7- Utica/Watertown Area 7- Utica/Watertown Area8- Long Island Area 11 23 19 3 56 8- Long Island Area 11 23 19 3 - 56 8- Long Island Area 11 23 19 3 56 8- Long Island Area 0.00% 0.00% 0.00% 0.00% 0.00%

9 - All Regions 23 62 43 19 147 9 - All Regions 23 62 43 19 147 Should equal Cell H-24 of Exhibit 14 9 - All Regions 23 62 43 19 147 9 - All Regions 0.00% 0.00% 0.00% 0.00% 0.00%

2020 Conversion Factor - A 0.9023 Must be less than or equal to 1.000 2020 Conversion Factor - B 0.9023 Must be less than or equal to 1.000 2021 Conversion Factor 0.9023 Must be less than or equal to 1.000 Change in Conversion Factor 0.00000%

2020 Estimated Aggregate Annualized Premium by Metal and Region - based on membership as of 3/31/2020 2020 Estimated Aggregate Annualized Premium by Metal and Region - based on membership as of 3/31/2020 2021 Estimated Aggregate Annualized Premium by Metal and Region - based on membership as of 3/31/2020 Change in Aggregate Annualized Premiums - based on membership as of 3/31/2020 (Ignoring any plan eliminations) Aggregate premium that would be collected assuming 3/31/2020 membership and all policies are paid in full for the entire year) Aggregate premium that would be collected assuming 3/31/2020 membership and all policies are paid in full for the entire year) - Adjusted for plan eliminations Aggregate premium that would be collected assuming 3/31/2020 membership and all policies are paid in full for the entire year) - Adjusted for plan eliminations

Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals1 - Albany Area 1 - Albany Area - - - - - - 1 - Albany Area 1 - Albany Area2 -Buffalo Area 2 -Buffalo Area - - - - - - 2 -Buffalo Area 2 -Buffalo Area

3- Mid-Hudson Area 3- Mid-Hudson Area - - - - - - 3- Mid-Hudson Area 3- Mid-Hudson Area4- NYC Area 164,118 445,541 233,967 110,519 954,145 4- NYC Area 164,118 445,541 233,967 110,519 - 954,145 4- NYC Area 169,041 458,906 240,986 113,835 982,767 4- NYC Area 3.00% 3.00% 3.00% 3.00% 3.00%

5- Rochester Area 5- Rochester Area - - - - - - 5- Rochester Area 5- Rochester Area6- Syracuse Area 6- Syracuse Area - - - - - - 6- Syracuse Area 6- Syracuse Area

7- Utica/Watertown Area 7- Utica/Watertown Area - - - - - - 7- Utica/Watertown Area 7- Utica/Watertown Area8- Long Island Area 159,768 255,805 183,350 22,007 620,930 8- Long Island Area 159,768 255,805 183,350 22,007 - 620,930 8- Long Island Area 159,768 255,805 183,350 22,007 620,930 8- Long Island Area 0.00% 0.00% 0.00% 0.00% 0.00%

9 - All Regions 323,887 701,346 417,317 132,526 1,575,075 9 - All Regions 323,887 701,346 417,317 132,526 - 1,575,075 Should equal Cell G-24 of Exhibit 14 9 - All Regions 328,810 714,711 424,335 135,842 1,603,697 9 - All Regions 1.52% 1.91% 1.68% 2.50% 1.82%

2020 Weighted Average Monthly PMPM Premium Rates 2020 Weighted Average Monthly PMPM Premium Rates - Reflecting adjustment for eliminated plans 2021 Weighted Average Monthly PMPM Premium Rates -Reflecting adjustment for eliminated plans Change in Weighted Average PMPM Premiums

Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals1 - Albany Area 1 - Albany Area 1 - Albany Area 1 - Albany Area2 -Buffalo Area 2 -Buffalo Area 2 -Buffalo Area 2 -Buffalo Area

3- Mid-Hudson Area 3- Mid-Hudson Area 3- Mid-Hudson Area 3- Mid-Hudson Area4- NYC Area 1,139.71 952.01 812.38 575.62 873.76 4- NYC Area 1,139.71 952.01 812.38 575.62 873.76 4- NYC Area 1,173.90 980.57 836.76 592.89 899.97 4- NYC Area 3.00% 3.00% 3.00% 3.00% 3.00%

5- Rochester Area 5- Rochester Area 5- Rochester Area 5- Rochester Area6- Syracuse Area 6- Syracuse Area 6- Syracuse Area 6- Syracuse Area

7- Utica/Watertown Area 7- Utica/Watertown Area 7- Utica/Watertown Area 7- Utica/Watertown Area8- Long Island Area 1,210.37 926.83 804.17 611.31 924.00 8- Long Island Area 1,210.37 926.83 804.17 611.31 924.00 8- Long Island Area 1,210.37 926.83 804.17 611.31 924.00 8- Long Island Area 0.00% 0.00% 0.00% 0.00% 0.00%

9 - All Regions 1,173.50 942.67 808.75 581.25 892.90 9 - All Regions 1,173.50 942.67 808.75 581.25 892.90 To Exhibit 13a (Section B) 9 - All Regions 1,191.34 960.63 822.36 595.80 909.13 To Exhibit 13a (Section B) Total 1.52% 1.91% 1.68% 2.50% 1.82%

Exhibit 13c Updated by DFS 3/20/2020 1

EXHIBIT 13C - SUPPLEMENT - DISTRIBUTION BY RATING TIERS



1 Please complete all of the shaded boxes in rows 28-52 below. The goal of this Exhibit is to provide insight with regard to how the Company's distribution of business by rating tier compares with the assumptions included in the required DFS Rating Tier Factors.2 The "2020 Weighted Average Monthly Tier Premiums by Metal level" in cells C28-G32 should be calculated as a weighted average of the actual premiums the insurer charges its subscribers (i.e., single adult rates with the tier factor included) using the Company's

actual number of subscribers as of 3/31/2020. FORMULA: For each Metal Level and Rating Tier = (SUM [Monthly premium charged for each Subscriber]) / (Total Number of Subscribers)3 Cells L28 - P32, should be a recalculation of cells C28-G32 where any plans (and associated members enrolled in those plans as of 3/31/2020) that will no longer be offered in 2021 are removed.4 Cells T28 - Y32, should be a recalculation of cells L28-P32 where the 2020 Subscriber premiums are replaced with the Proposed 2021 Subscriber Premiums (This calculation should also exclude any members currently in plans that will no longer be offered in 2021).5 The sum of cells C38-G42 should be equal to the Company's total number of subscribers for the relevant market as of 3/31/2020.6 Cells L38-P42 should be equal to cells C38-G42 less any subscribers that are enrolled in plans that will no longer be offered in 2021.7 The sum of cells C48-G52 should be equal to the Company's total number of members for the relevant market as of 3/31/2020.8 Cells L48-P52 should be equal to cells C48-G52 less any members that are enrolled in plans that will no longer be offered in 2021.9 If the Company is not eliminating any plans in 2021, then cells C28-G32 and L28-P32 should be the same, as should cells C38-G42 and L38-P42, as well as cells C48-G52 and L48-P52.

DFS RATING TIERSSingle 1.0000 Two Adults 2.0000 Adult + Child(ren) 1.7000 Family 2.8500

2020 Weighted Average Monthly Tier Premiums by Metal level - All Members Child-Only 0.4120 2020 Weighted Average Monthly Tier Premiums by Metal level - Continuing Members Only

Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals Rating Tier Platinum Gold Silver Bronze Catastrophic All MetalsSingle Adult 1,295.79 1,070.83 926.52 642.36 1,021.03 Single Adult 1,295.79 1,070.83 926.52 642.36 - 1,021.03

2 Adults 2,682.94 2,168.40 1,730.51 1,355.04 2,072.41 2 Adults 2,682.94 2,168.40 1,730.51 1,355.04 - 2,072.41 Adult plus Child(ren) 2,280.50 1,793.72 1,490.43 - 1,709.10 Adult plus Child(ren) 2,280.50 1,793.72 1,490.43 - - 1,709.10

Family 3,599.99 3,108.32 2,434.88 1,818.21 2,673.56 Family 3,599.99 3,108.32 2,434.88 1,818.21 - 2,673.56 Child Only - 461.65 - - 461.65 Child Only - 461.65 - - - 461.65

All Rating Tiers 1,674.74 1,498.45 1,402.22 897.73 1,426.70 All Rating Tiers 1,674.74 1,498.45 1,402.22 897.73 1,426.70

2020 Subscribers - as of 3/31/2020 - Actual Distribution (All subscribers as of 3/31/2020 should be included) 2020 Subscribers - as of 3/31/2020 - Only those subscribers currently enrolled in plans that will continue to be offered in 2021

Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals Rating Tier Platinum Gold Silver Bronze Catastrophic All MetalsSingle Adult 12 25 12 9 58 Single Adult 12 25 12 9 - 58

2 Adults 2 9 4 1 16 2 Adults 2 9 4 1 - 16 Adult plus Child(ren) 1 1 3 - 5 Adult plus Child(ren) 1 1 3 - - 5

Family 1 4 4 2 11 Family 1 4 4 2 - 11 Child Only - 2 - - 2 Child Only - 2 - - - 2

All Rating Tiers 16 41 23 12 92 All Rating Tiers 16 41 23 12 92

2020 Members - as of 3/31/2020 - Actual Distribution (All members as of 3/31/2020 should be included) 2020 Members - as of 3/31/2020 - Only those members currently enrolled in plans that will continue to be offered in 2021

Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals Rating Tier Platinum Gold Silver Bronze Catastrophic All MetalsSingle Adult 12 25 12 9 58 Single Adult 12 25 12 9 - 58

2 Adults 4 18 8 2 32 2 Adults 4 18 8 2 - 32 Adult plus Child(ren) 2 2 10 - 14 Adult plus Child(ren) 2 2 10 - - 14

Family 5 15 13 8 41 Family 5 15 13 8 - 41 Child Only - 2 - - 2 Child Only - 2 - - - 2

All Rating Tiers 23 62 43 19 147 All Rating Tiers 23 62 43 19 147

2020 Actual Members Per Policy by Metal and Rating Tier - based on membership as of 3/31/2020 - All Members 2020 Actual Members Per Policy by Metal and Rating Tier - based on membership as of 3/31/2020 - Continuing Members Only

Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals Rating Tier Platinum Gold Silver Bronze Catastrophic All MetalsSingle Adult 1.0000 1.0000 1.0000 1.0000 1.0000 Single Adult 1.0000 1.0000 1.0000 1.0000 1.0000

2 Adults 2.0000 2.0000 2.0000 2.0000 2.0000 2 Adults 2.0000 2.0000 2.0000 2.0000 2.0000 Adult plus Child(ren) 2.0000 2.0000 3.3333 2.8000 Adult plus Child(ren) 2.0000 2.0000 3.3333 2.8000

Family 5.0000 3.7500 3.2500 4.0000 3.7273 Family 5.0000 3.7500 3.2500 4.0000 3.7273 Child Only 1.0000 1.0000 Child Only 1.0000 1.0000

Wghtd Avg - All Rating Tiers 1.4375 1.5122 1.8696 1.5833 1.5978 Wghtd Avg - All Rating Tiers 1.4375 1.5122 1.8696 1.5833 1.5978

2020 Implied Members Per Policy by Metal and Rating Tier (Using Required Factors) - based on membership as of 3/31/2020 - All Members 2020 Implied Members Per Policy by Metal and Rating Tier (Using Required Factors) - based on membership as of 3/31/2020 - Continuing Members only

Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals Rating Tier Platinum Gold Silver Bronze Catastrophic All MetalsSingle Adult 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 Single Adult 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

2 Adults 2.0000 2.0000 2.0000 2.0000 2.0000 2.0000 2 Adults 2.0000 2.0000 2.0000 2.0000 2.0000 2.0000 Adult plus Child(ren) 1.7000 1.7000 1.7000 1.7000 1.7000 1.7000 Adult plus Child(ren) 1.7000 1.7000 1.7000 1.7000 1.7000 1.7000

Family 2.8500 2.8500 2.8500 2.8500 2.8500 2.8500 Family 2.8500 2.8500 2.8500 2.8500 2.8500 2.8500 Child Only 0.4120 0.4120 0.4120 0.4120 0.4120 0.4120 Child Only 0.4120 0.4120 0.4120 0.4120 0.4120 0.4120

Wghtd Avg - All Rating Tiers 1.2844 1.3884 1.5870 1.3917 1.4204 Wghtd Avg - All Rating Tiers 1.2844 1.3884 1.5870 1.3917 1.4204

2020 Ratio of Actual to Expected Members Per Policy by Metal and Rating Tier - based on membership as of 3/31/2020 - All Members 2020 Ratio of Actual to Expected Members Per Policy by Metal and Rating Tier - based on membership as of 3/31/2020 - Continuing Members Only

Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals Rating Tier Platinum Gold Silver Bronze Catastrophic All MetalsSingle Adult 1.0000 1.0000 1.0000 1.0000 1.0000 Single Adult 1.0000 1.0000 1.0000 1.0000 1.0000

2 Adults 1.0000 1.0000 1.0000 1.0000 1.0000 2 Adults 1.0000 1.0000 1.0000 1.0000 1.0000 Adult plus Child(ren) 1.1765 1.1765 1.9608 1.6471 Adult plus Child(ren) 1.1765 1.1765 1.9608 1.6471

Family 1.7544 1.3158 1.1404 1.4035 1.3078 Family 1.7544 1.3158 1.1404 1.4035 1.3078 Child Only 2.4272 2.4272 Child Only 2.4272 2.4272

Ratio (Expected/Actual) 1.1192 1.0892 1.1781 1.1377 1.1249 Ratio (Expected/Actual) 1.1192 1.0892 1.1781 1.1377 1.1249

Exhibit 13c Supp Updated by DFS 3/20/2020

2021 Weighted Average Monthly Tier Premiums by Metal level - Continuing Members Only Change in Weighted Average Monthly Tier Premiums

Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals Rating Tier Platinum Gold Silver Bronze Catastrophic All MetalsSingle Adult 1,315.49 1,091.24 942.10 658.43 1,039.62 Single Adult 1.52% 1.91% 1.68% 2.50% 1.82%

2 Adults 2,723.72 2,209.72 1,759.61 1,388.94 2,110.14 2 Adults 1.52% 1.91% 1.68% 2.50% 1.82%Adult plus Child(ren) 2,315.16 1,827.90 1,515.50 - 1,737.91 Adult plus Child(ren) 1.52% 1.91% 1.68% 1.69%

Family 3,654.71 3,167.55 2,475.83 1,863.70 2,723.24 Family 1.52% 1.91% 1.68% 2.50% 1.86%Child Only - 470.45 - - 470.45 Child Only 1.91% 1.91%

All Rating Tiers 1,700.20 1,527.01 1,425.80 920.18 1,452.68 All Rating Tiers 1.52% 1.91% 1.68% 2.50% 1.82%

Change in Subscribers - as of 3/31/2020 - Change due to current 2020 plans not being offered in 2021.

Rating Tier Platinum Gold Silver Bronze Catastrophic All MetalsSingle Adult 0.00% 0.00% 0.00% 0.00% 0.00%

2 Adults 0.00% 0.00% 0.00% 0.00% 0.00%Adult plus Child(ren) 0.00% 0.00% 0.00% 0.00%

Family 0.00% 0.00% 0.00% 0.00% 0.00%Child Only 0.00% 0.00%

All Rating Tiers 0.00% 0.00% 0.00% 0.00% 0.00%

Change in Members - as of 3/31/2020 - Change due to current 2020 plans not being offered in 2021.




All Rating Tiers 0.00% 0.00% 0.00% 0.00% 0.00%

Change in Actual Members Per Policy




Wghtd Avg - All Rating Tiers 0.00% 0.00% 0.00% 0.00% 0.00%

Change in Weighted Average Implied Tier Factors

Rating Tier Platinum Gold Silver Bronze Catastrophic All MetalsSingle Adult 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

2 Adults 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%Adult plus Child(ren) 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Family 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%Child Only 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Wghtd Avg - All Rating Tiers 0.00% 0.00% 0.00% 0.00% 0.00%

Change in Actual to Expected Members Per Policy Due to Retired Plans




Ratio (Expected/Actual) 0.00% 0.00% 0.00% 0.00% 0.00%

Exhibit 13c Supp Updated by DFS 3/20/2020

Company Name: Healthfirst Insurance Company, Inc.NAIC Code: 16031 NOTE: THIS EXHIBIT SHOULD NOT INCLUDE MEMBERS OR SUBSCRIBERS THAT ARE CURRENTLY ENROLLED IN PLANS THAT WILL NOT BE AVAILABLE IN 2021SERFF Tracking #: HLFT-132346272Market Segment: Individual

12345

6789

10111213 The Total Annualized Premium in Cell G-24 of this Exhibit should equal the total in Cell Q-61 of Exhibit 13c.14 The Total Number of Members and Subscribers in Cells H-24 and I-24 of this Exhibit should equal the totals in Cells Q-45 of Exhibit 13c and Cells Q-43 of Exhibit 13c-Supplement respectively (i.e., Only those members/subscribers currently enrolled in plans that will continue to be offered in 2021).

Totals $1,575,075 147 92

Annualized Premiums as of Total # of Members as of Total # of Subscribers as of

3/31/2020 3/31/2020 3/31/2020 Decrease No Change 0.1% - 4.9% 5.0% - 9.9% 10.0% - 14.9% 15.0% - 19.9% 20.0% - 24.9% 25.0% - 29.9% 30.0% - 39.9% 40.0% - 49.9% 50.0% or higher Lowest Highest Weighted Avg

Individual 01/01/21 Platinum 4- NYC Area Healthfirst Platinum Total EPO Healthfirst Platinum Total EPO $164,118 12 8 12 3.00% 3.00% 3.00%Individual 01/01/21 Gold 4- NYC Area Healthfirst Gold Total EPO Healthfirst Gold Total EPO $445,541 39 27 39 3.00% 3.00% 3.00%Individual 01/01/21 Silver 4- NYC Area Healthfirst Silver Total EPO Healthfirst Silver Total EPO $233,967 24 14 24 3.00% 3.00% 3.00%

Individual 01/01/21 Bronze 4- NYC Area Healthfirst Bronze Total EPO Healthfirst Bronze Total EPO $110,519 16 10 16 3.00% 3.00% 3.00%

Individual 01/01/21 Platinum 8- Long Island Area Healthfirst Platinum Total EPO Healthfirst Platinum Total EPO $159,768 11 8 11 0.00% 0.00% 0.00%Individual 01/01/21 Gold 8- Long Island Area Healthfirst Gold Total EPO Healthfirst Gold Total EPO $255,805 23 14 23 0.00% 0.00% 0.00%Individual 01/01/21 Silver 8- Long Island Area Healthfirst Silver Total EPO Healthfirst Silver Total EPO $183,350 19 9 19 0.00% 0.00% 0.00%

Individual 01/01/21 Bronze 8- Long Island Area Healthfirst Bronze Total EPO Healthfirst Bronze Total EPO $22,007 3 2 3 0.00% 0.00% 0.00%IndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividualIndividual

Requested Percentage Rate Change

Percentage Rate Changes should be calculated using membership as of 3/31/2020.This exhibit must be submitted as an Excel file and as a PDF file.

Market Segment Effective Date of New RateMetal Level

(or Catastrophic) Rating Region Product Name Product Street NameDISTRIBUTION OF MEMBERS - Number of Members with Requested Percentage Rate Change at Renewal

The weighted average percentage should be developed based on annualized premium volume or membership for that metal level, and rating region, including any applicable riders.

EXHIBIT 14: SUMMARY OF REQUESTED PERCENTAGE CHANGES

Use this Exhibit for both Individual and Small Group Market Plans. A separate Exhibit should be provided for Individual and Small Group filings.Market segment refers to Individual (which includes Catastrophic) or Small Group.The requested percentage rate change reflects the expected change in premium rates that would apply to the contract holder (or member for Small Group business) on that contract holder's next rate change date for each contract holder within the indicated combination of metal level, rating region, and product name.The "Product Street Name" is the product name as advertised to consumers (i.e., as consumers are likely to refer to this product/metal level when communicating with DFS). A separate row is to be used for each combination of metal level, rating region and product name.

If the percentage changes (lowest and highest and weighted average) are identical for all the rating regions, then separate rows by rating region need not be used, and "All Regions" can be shown in the Rating Region column. If the rate change range information differs by rating region, then separate rows need to be used for each rating region the insurer uses. Rating region names used on this exhibit are to use the standard rating region names developed by DFS (e.g., Albany Area, Buffalo Area, etc.).The "requested rate change" includes the impact of any riders (such as: age 29, domestic partner, family planning, pediatric dental, etc.)."Lowest" should be the smallest percentage change that could affect any contract holder due to the submitted rate filing with that metal level and rating region, including any applicable riders."Highest" should be the largest percentage change that could affect any contract holder due to the submitted rate filing with that metal level and rating region, including any applicable riders.

The effective date is the earliest date that the proposed new rate would become effective if approved. The Effective Date for Individual is 1/1/2021. Effective Dates for Small Group are 1/1/2021, 4/1/2021, 7/1/2021 and 10/1/2021.

Exhibit 14 Updated by DFS 3/20/2020 1

Exhibit 15b MHPAEA Compliance Certification

I, ___________, certify that the mental health and substance use disorder [name of Company Officer]

(MH/SUD) benefits applicable to this filing by ________________________ comply with the Mental [name of health insurer]

Health Parity and Addiction Equity Act and any regulations promulgated thereunder (MHPAEA). The

medical/surgical and MH/SUD benefits applicable to this filing have been tested for compliance with

MHPAEA’s financial requirements and quantitative treatment limitations rules, including the

Substantially All and Predominant tests. This compliance certification pertains to the medical and

behavioral benefit designs provided by ________________________ and does not opine on the [name of health insurer]

compliance of any wellness or incentive programs that ________________________ may choose to offer. [name of health insurer]

To measure compliance, we created an actuarial cost model of the medical/surgical benefits that included

mapping the underlying experience data allowed healthcare costs for the plans included in this filing

into the six benefit classifications (or sub-classifications allowed for outpatient benefits) that MHPAEA

permits. We tested the financial requirements and quantitative treatment limitations imposed on the

MH/SUD benefits related to this filing and determined that they are no more restrictive than the

predominant financial requirements or treatment limitations applied to substantially all medical or

surgical benefits related to this filing.

I am an officer of ___________________________ with knowledge of the issuer’s comprehensive [name of health insurer]

medical expense products and the laws and regulations applicable to those products. To the best of my

knowledge and belief the above information is true, accurate and complete.

Signature: __________ Printed name and title: Date: ______________________ Phone: _____________________________ Email Address ___________________________________

Healthfirst Insurance Company, Inc.




05-13-2020

Company Name: Healthfirst Insurance Company, Inc.

NAIC Code: 16031

SERFF Number: HLFT-132346272

Market Segment: Individual

Instructions:

1) This Exhibit summarizes all benefit/rate changes filed after the initial rate filing that impacts the rate tables in this current filing.

2)

3)

4) Extend the worksheet to add more rows as needed. Only use the first tab for data entry.

5)

Filing Status SERFF # NY State Tracking # Date of Submission Policy Form #

Product Name (including Street

Name)

Brief Description of Benefit/Rate

Change Approval Date

Approved HLFT-130534550 2016050165 5/9/2016 HFIC-IND-17-OFF HFIC-CO-17-OFF HFIC-IND-BSOB-17 HFIC-IND-SSOB-17 HFIC-IND-GSOB-17 HFIC-IND-PSOB-17 Healthfirst Total EPO Initial Filing 9/26/2016

Approved HLFT-131030835 2017050238 5/15/2017 HFIC-IND-18-OFF HFIC-CO-18-OFF HFIC-IND-BSOB-18 HFIC-IND-SSOB-18 HFIC-IND-GSOB-18 HFIC-IND-PSOB-18Healthfirst Total EPO Rate increase requested. 9/22/2017

Approved HLFT-131487229 2018050256 5/14/2018 HFIC-IND-19-OFF HFIC-CO-19-OFF HFIC-IND-BSOB-19 HFIC-IND-SSOB-19 HFIC-IND-GSOB-19 HFIC-IND-PSOB-19Healthfirst Total EPO Rate increase requested. 11/26/2018

Approved HLFT-131930115 2019050286 5/20/2019

HFIC-IND-20-OFF

HFIC-CO-20-OFF

HFIC-IND-BSOB-

20

HFIC-IND-SSOB-

20

HFIC-IND-GSOB-

20

HFIC-IND-PSOB-

20 Healthfirst Total EPO Rate increase requested. 1/15/2020

EXHIBIT 16: SUMMARY OF POLICY FORM AND PRODUCT CHANGES

The product street name is the product name as advertised to consumers (i.e., as consumers are likely to refer to this product/policy form when communicating with DFS).

Enter filing status (approved or pending) using the drop down list. For pending files leave the approval date blank.

This form must be submitted as an Excel file and as a PDF file.

List of rate filings that have been approved since the §3231(d) or §4308(b) initial rate filing, or are currently pending with DFS.


EXHIBIT 17: HISTORICAL CLAIM DATA BY POLICY FORMS INCLUDED IN RATE ADJUSTMENT FILING

Company Name: NAIC Code: SERFF Number: Market Segment:

1 Complete a separate ROW for each relevant policy form as indicated below. • Information requested applies to New York State business only for each rating region and all regions combined. • Include riders that may be available with that policy form in each policy form response. Discontinued policy forms and products are to be included in the Exhibit. • Complete additional rows as needed to include all base medical policy forms that were offered in the applicable market segment.

2 This Exhibit must report the latest two years of experience for the following categories of business, broken out by rating region, and for all regions combined:

Market DescriptionMarket Segment (Entry for Exhibit 17, Column 4)

Group Definition Counting Method Notes Standardized Premium Scale

Individual ACA Compliant Individual Plans Individual-ACA N/A N/A Issued on or after 1/1/2017 2020 Rates

Catastrophic ACA Compliant Catastrophic Plans Catastrophic N/A N/A Issued on or after 1/1/2017 2020 Rates

Small Group

Experience of ACA Compliant Small Group Plans (Excluding Healthy New York plans) that were written or renewed on or after 1/1/2017 SG-ACA-FTE 1-100

Current New York (FTE)

All relevant experience in the calendar year

4th Quarter 2020 for rolling; 2020 for non-rolling

Small Group - HNYExperience of Small Group Healthy New York Plans that were written or renewed on or after 1/1/2017 SG-ACA-HNY-FTE 1-50

Current New York (FTE)

All relevant experience in the calendar year

4th Quarter 2020 for rolling; 2020 for non-rolling

3 Product type is HMO, HMO based POS, POS-OON, EPO, PPO, Comprehensive Major Medical, Non-HMO based POS, and Consumer Health Plans. Indicate appropriate designation for policy form, etc.4 The product street name is the product name as advertised to consumers (i.e., as consumers are likely to refer to this product/policy form when communicating with DFS.5 Paid claims in Columns 14.6 - 14.7 and 15.6 - 15.7 are all claims paid during experience period that are attributed to the calendar year in question. 6 If members, covered lives or member months are not known, use reasonable estimates (note methodology used in the actuarial memorandum).7 This exhibit must be submitted as an Excel file and as a PDF file. Only use the first tab for data entry.8 These categories should be mutually exclusive (i.e., the sum of the values in a particular column should represent the total for the entire legal entity.9 With regard to Small Group, the experience reported in this Exhibit should include only business that was considered "Small Group" according to the applicable rules at the time the underlying policies were in-force.

a. Any portion of a group's experience that was considered "Large" based on the rules that were applicable at that time, should not be included in this Exhibit.

Healthfirst Insurance Company, Inc.16031

HLFT-132346272Individual

Exhibit 17 - Instructions Last Updated 3/20/2020 1

1.a Company Name

1.b NAIC Code 1.c SERFF Number

1d.Base medical

policy form number

1e.Product Name

(per Rate Manual)

1f.Product

Street Name as indicated

to consumers2.

Filing Type

3.Effective date of last rate change

4.Market Segment

5A.Rating Region

5B.Product Type (see "Instructions"

tab for examples)

6. Is a rolling

rate structure

used for this base

medical policy form? (Yes or No)

7.Is base medical policy form open

(new sales allowed) or closed

(no new sales)

8.Number of

policyholders affected by rate

change. (For group business this is number

of groups.)

9.Number of

covered lives affected by rate

changeHealthfirst Insurance 16031 HLFT-132346272 Healthfirst Healthfirst 3231(e)(1) 1/1/2019 Individual-ACA 4 - NYC Area EPO No New sales allowed 8 12 Healthfirst Insurance 16031 HLFT-132346272 Healthfirst Gold Healthfirst 3231(e)(1) 1/1/2019 Individual-ACA 4 - NYC Area EPO No New sales allowed 27 39 Healthfirst Insurance 16031 HLFT-132346272 Healthfirst Silver Healthfirst 3231(e)(1) 1/1/2019 Individual-ACA 4 - NYC Area EPO No New sales allowed 14 24 Healthfirst Insurance 16031 HLFT-132346272 Healthfirst Healthfirst 3231(e)(1) 1/1/2019 Individual-ACA 4 - NYC Area EPO No New sales allowed 10 16 Healthfirst Insurance 16031 HLFT-132346272 Healthfirst Healthfirst 3231(e)(1) 1/1/2019 Individual-ACA 8 - Long Island Area EPO No New sales allowed 8 11 Healthfirst Insurance 16031 HLFT-132346272 Healthfirst Gold Healthfirst 3231(e)(1) 1/1/2019 Individual-ACA 8 - Long Island Area EPO No New sales allowed 14 23 Healthfirst Insurance 16031 HLFT-132346272 Healthfirst Silver Healthfirst 3231(e)(1) 1/1/2019 Individual-ACA 8 - Long Island Area EPO No New sales allowed 9 19 Healthfirst Insurance 16031 HLFT-132346272 Healthfirst Healthfirst 3231(e)(1) 1/1/2019 Individual-ACA 8 - Long Island Area EPO No New sales allowed 2 3 Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272Healthfirst Insurance 16031 HLFT-132346272

Data Item for Specified Base Medical Policy Form


14.1Beginning Date

of the experience

period(mm/dd/yyyy)

14.2Ending Date of the experience

period(mm/dd/yyyy)

14.3Member months for experience period

14.4Earned premiums for experience period ($)

14.5Standardized earned

premiums for experience period ($)

14.6 Claims Paid in calendar year 2019 on claims incurred during calendar year 2019 -

before any adjustment for federal risk adjustment, federal reinsurance, risk corridors, state stop-loss

pools, or commercial stop-loss payments ($)

14.6a Claims Paid in calendar year 2020

(during the months of January and February

only) on claims incurred during calendar year 2019 - before any

adjustment for federal risk adjustment, federal

reinsurance, risk corridors, state stop-loss


14.6b Estimated claims remaining to be

paid in the future on claims incurred during

2019 - before any adjustment for federal

risk adjustment, federal reinsurance, risk

corridors, state stop-loss pools, or commercial

stop-loss payments ($)

14.6c Rx Rebates associated with claims

reported in Columns 14.6 and 14.6a (enter as a

positive value) ($)

14.6d Estimated Rx Rebates associated with

claims reported in Column 14.6b or not otherwise included in

14.6c (enter as a positive value) ($)

14.7 Total Incurred Claims for

calendar year 2019 Net of Rx Rebates ($)

14.8Adjustment to the

incurred claims for the period due to receipts from state or federal

reinsurance or stop loss pools (enter receipts from

the pool as a negative value) ($)


incurred claims for the period due to receipts

from or payments to the federal risk adjustment

pool (enter receipts as a negative value and

payments to the pool as a positive value) ($)

14.10Administrative expenses

for experience period (including commissions and premium taxes, but excluding federal and

state income taxes) ($)

15.1Beginning date of the

experience period(mm/dd/yyyy)

15.2Ending Date of the experience period

(mm/dd/yyyy)1/1/2019 12/31/2019 100.00 98,899 109,611 171,086 1,548 6,042 5,878 0 $ 172,798.02 $ - $ (16,027) $ 14,373 1/1/2018 12/31/20181/1/2019 12/31/2019 565.00 471,151 522,185 367,524 12,855 6,826 57,115 0 $ 330,089.45 $ - $ (90,392) $ 69,552 1/1/2018 12/31/20181/1/2019 12/31/2019 376.00 251,843 279,122 116,168 1,548 2,111 14,558 0 $ 105,269.43 $ - $ (57,697) $ 38,063 1/1/2018 12/31/20181/1/2019 12/31/2019 193.00 104,258 115,551 64,057 13,658 4,959 109 0 $ 82,565.43 $ - $ (34,618) $ 17,091 1/1/2018 12/31/20181/1/2019 12/31/2019 53.00 61,175 67,801 28,477 2,425 1,406 4,620 0 $ 27,688.29 $ - $ (8,494) $ 8,708 1/1/2018 12/31/20181/1/2019 12/31/2019 289.00 265,131 293,849 243,697 35,113 17,843 31,986 0 $ 264,667.41 $ - $ (46,478) $ 38,736 1/1/2018 12/31/20181/1/2019 12/31/2019 179.00 106,258 117,767 13,820 187 450 1,190 0 $ 13,266.96 $ - $ (27,406) $ 16,407 1/1/2018 12/31/20181/1/2019 12/31/2019 8.00 5,137 5,693 5,944 0 105 0 0 $ 6,049.47 $ - $ (1,442) $ 814 1/1/2018 12/31/2018

$ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

2019 Experience Period (NY statewide experience, base medical policy form + associated riders)


15.3Member months for experience period

15.4Earned premiums for experience period ($)

15.5Standardized earned

premiums for experience period ($)

15.6 Claims Paid in calendar year 2018 on claims incurred during calendar year 2018 -

before any adjustment for federal risk adjustment, federal reinsurance, risk corridors, state stop-loss


15.6a Claims Paid in calendar year 2019

(during the months of January and February

only) on claims incurred during calendar year 2018 - before any

adjustment for federal risk adjustment, federal

reinsurance, risk corridors, state stop-loss


15.6b All other claim amounts associated with claims incurred during the 2018 calendar year that are not included in

15.6 and 15.6a (i.e., Payments through

February of 2020 plus any remaining IBNR

associated with claims that were incurred during

2018) - before any adjustment for federal

risk adjustment, federal reinsurance, risk

corridors, state stop-loss pools, or commercial

stop-loss payments ($)

15.6c Rx Rebates associated with claims

reported in Columns 15.6 and 15.6a (enter as a

positive value) ($)

15.6d Estimated Rx Rebates associated with

claims reported in Column 15.6b or not otherwise included in

15.6c (enter as a positive value) ($)

15.7 Total Incurred claims for

calendar year 2018 Net of Rx Rebates ($)


incurred claims for the period due to receipts from state or federal

reinsurance or stop loss pools (enter receipts from

the pool as a negative value) ($)


incurred claims for the period due to receipts

from or payments to the federal risk adjustment

pool (enter receipts as a negative value and

payments to the pool as a positive value) ($)

15.10Administrative expenses

for experience period (including commissions and premium taxes, but excluding federal and

state income taxes) ($)108 $ 93,389 $ 103,504 $ 260,532 $ 19,316 $ 21,274 $ 2,529 $ - $ 298,592.72 $ - $ (1,580) $ 11,664 618 $ 488,667 $ 541,598 $ 322,792 $ 15,310 $ (51) $ 48,293 $ - $ 289,757.88 $ - $ (9,056) $ 60,806 546 $ 311,251 $ 344,965 $ 81,402 $ 3,450 $ 1,332 $ 13,053 $ - $ 73,130.92 $ - $ (7,754) $ 39,354 159 $ 84,506 $ 93,660 $ 3,291 $ 123 $ 154 $ 210 $ - $ 3,357.46 $ - $ (2,560) $ 10,751 35 $ 32,995 $ 36,569 $ 15,861 $ 91 $ 14 $ 3,240 $ - $ 12,725.67 $ - $ (512) $ 4,144

277 $ 218,709 $ 242,399 $ 109,250 $ 14,431 $ 3,642 $ 11,087 $ - $ 116,236.03 $ - $ (4,053) $ 27,521 242 $ 114,517 $ 126,921 $ 35,556 $ 1,240 $ 327 $ 1,731 $ - $ 35,393.25 $ - $ (3,526) $ 14,539 27 $ 14,713 $ 16,306 $ 383 $ 2,519 $ 1,875 $ - $ - $ 4,776.80 $ - $ (395) $ 1,866

$ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

2018 Experience Period (NY statewide experience, base medical policy form + associated riders)


Exhibit 18 - Index Rate/Plan-Design Level Adjustment Worksheet


SERFF Number: HLFT-132346272Market Segment : Individual

A separate column must be used for each base plan design (i.e., for each separate and distinct 14 digit HIOS ID)

Line # General***ACA Compliant Plans

Only Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 71 Product* XXXXXXX Individual Individual Individual Individual Individual Individual Individual 2 Product ID* XXXXXXX 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002 61405NY0023 Metal Level (or catastrophic)* XXXXXXX Bronze Bronze Bronze Silver Silver Silver Gold4 AV Metal Value (HHS Calculator)* XXXXXXX 0.64990 0.64990 0.64990 0.71900 0.71900 0.71900 0.81980 5 AV Pricing Value (total, risk pool experience based)* XXXXXXX 0.64990 0.64990 0.64990 0.74057 0.74057 0.74057 0.88538 6 Plan Type* XXXXXXX EPO EPO EPO EPO EPO EPO EPO7 Plan Name* XXXXXXX

Dependent Age 26

Dependent Age 29

Only

Dependent Age 26

Dependent Age 29

Only

Dependent Age 26

8 HIOS Plan ID (14 Digits)* XXXXXXX 61405NY0020001 61405NY0020002 61405NY0020003 61405NY0020004 61405NY0020005 61405NY0020006 61405NY00200079 Exchange Plan?* XXXXXXX Off Off Off Off Off Off Off

9A 2021 Plan Status (as compared to 2020) XXXXXXX Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod* This field should be the same as used in the Unified Rate Review Template, Worksheet 2

Amounts should be consistent with appropriate categories in Column 14.3 of Exhibit 17Experience Period Index Rate Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7

10 Earned Premiums for Latest Experience Period # 1,363,852.01 95,088.62 0.00 1,159.32 348,727.18 15,254.19 0.00 701,560.4410A Incurred Claims for Latest Experience Period # 1,002,394.43 90,110.03 0.00 511.17 115,885.76 5,732.68 0.00 606,599.0210B Member-Months for Latest Experience Period # 1,763.00 196.00 0.00 5.00 519.00 36.00 0.00 814.0010C Average PMPM Incurred Claims [(10A)/(10B)] = (Initial Index PMPM) 568.57313 459.74505 0.00000 102.23400 223.28663 159.24111 0.00000 745.2076411 Average Pricing Actuarial Value reflected in experience period 0.8100812 AV Adjusted Experience Period Index Rate PMPM = [(10C) / (11)] 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151

# Amounts should be prior to any adjustments for Federal Risk Adjustment and Healthy NY Stop-Loss Reimbursements, and should be consistent with the amounts reported in Column 14.7 of Exhibit 17 for the relevant market categories.

Market Wide Adjustments to the AV Adjusted Experience Period Index Rate All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 713 Impact of adjusting experience period data to EHB benefit level ** 1.0000014 Market wide adjustment for changes in provider network ** 1.0000015 Market wide adjustment for fee schedule changes ** 0.9686616 Market wide adjustment for utilization management changes ** 1.0000017 Market wide adjustment for impact on claim costs from quality improvement and cost containment initiatives ** 1.0000018 Claim trend projection factor (midpoint of experience period to mid point of rate applicability period) 1.1364519 Federal Risk Adjustment Program Impact (less than 1.00 to reflect a recovery, more than 1.00 to reflect a payment to the pool) ** 1.0099620 Impact of adjustments due to experience period claim data not being sufficiently credible ** 1.0000021 Adjustment for changes in distribution of risk pool membership by rating regions (i.e., standard rating regions) ** 1.0000022 Change in morbidity not reflected in the experience data that is known and quantifiable at the time of the rate filing ** 1.00000

23a Impact of changes in New York State Law that are not reflected in the experience data ** 1.01073

23b

2020 Covid-19 Impact – Impact associated with state requirements that were intended to diagnose, treat, or avoid contact with Covid-19 which were imposed during the 2020 calendar year, but not included in 2020

pricing. ** 1.00000

23c2021 Covid-19 Impact – Expected impact associated with worsening morbidity and other costs resulting from

Covid-19 with respect to the 2021 calendar year. ** 1.0000024 Covered Lives Assessment and Taxes 1.0483725 PCORI, Risk Adjustment User Fee 1.0006426 Expanded Urgent Care 1.0120427 High Cost Risk Pool, Adjustment for credibility of data 1.1131128 Impact of Market Wide Adjustments (= Product L13 through L27) 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796

** Not Included in Claim Trend Adjustment

Plan Level Adjustments Average - All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 729 Index Rate - After Marketwide Adjustments 932.0554 932.05543 932.05543 932.05543 932.05543 932.05543 932.05543 932.0554330 Pricing actuarial value (without induced demand factor) # 0.7775 0.64990 0.64990 0.64990 0.71900 0.71900 0.71900 0.8198031 Pricing actuarial value (only the induced demand factor) # 1.0660 1.00000 1.00000 1.00000 1.03000 1.03000 1.03000 1.0800032 Impact of provider network characteristics ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000033 Impact of delivery system characteristics ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000034 Impact of utilization management practices ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000035 Impact on claim costs from quality improvement and cost containment initiatives ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000036 Benefits in additional to EHB (greater than 1.00) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000037 Impact of eligibility categories (catastrophic plans only) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000038 Addition of Out of Network Benefit Option (e.g., POS or PPO, if applicable) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000039 Impact of Adjustment for NYS Stop Loss reimbursements on SG HNY 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000040 Impact of Age 26 / Age 29 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000041 Impact of Family Planning / No Family Planning 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000042 Impact of Dental vs No Dental 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000043 Premium Curve Adjustment 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000044 Impact of loss of CSR Funding (A common factor to be applied uniformly to all silver plans only - if applicable) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000045 Rating Region Factor 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

46a Other 1 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000046b Other 2 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000046c Other 3 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000046d Other 4 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000047 Impact of Plan Wide Adjustments (= Weighted Average Factor using Line 55a) 0.83204 0.64990 0.64990 0.64990 0.74057 0.74057 0.74057 0.88538

# Reflects changes that impact an entire standard population (e.g., cost sharing and other changes that are not based on health status, age, gender or occupation).## Beyond what is reflected in Market Wide adjustments

48a Adjusted Incurred Claims (Excluding Admin Expense and Profit) 1,367,215.50

ExpensesWeighted Average - All

Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 749 Plan Expected Costs 775.51 605.74 605.74 605.74 690.25 690.25 690.25 825.2350 FIXED EXPENSE: Administrative Costs (excluding Exchange user fees and profits) - to be expressed as a PMPM Amount ### 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.0000051 VARIABLE EXPENSE: Administrative costs (excluding Exchange user fees and profits) - to be expressed as a percentage ### 13.200% 13.200% 13.200% 13.200% 13.200% 13.200% 13.200% 13.200%52 VARIABLE EXPENSE: Profit/Contribution to surplus margins - to be expressed as a percentage ### 1.500% 1.500% 1.500% 1.500% 1.500% 1.500% 1.500% 1.500%53 Total Expense Load as a percentage of Premium (= [L50 + (L51 + L52) * L56] / L56) 14.700% 14.700% 14.700% 14.700% 14.700% 14.700% 14.700% 14.700%

### The combined factors for Administrative Costs (Fixed and Variable) and Profit/Contribution to surplus margins cannot exceed 18% (equivalent to a factor of 1.2195 ( = 1.00 / 0.82) applied to Line 49). The "FIXED EXPENSE" amount in Line 50 must be entered as a PMPM and "VARIABLE EXPENSE" amounts in Lines 51 and 52 must be entered as a percentage of premium.

2020 Premium Rates and Membership All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 754 2020 PMPM Rates (First Quarter 2020 rates for Small Group)*** 892.90 566.99 0.00 0.00 767.42 642.79 0.00 1,005.0555 2020 Members as of 3/31/2020 (The total should tie to the 3/31/2020 Membership Survey Total) 147.00 19.00 0.00 0.00 37.00 6.00 0.00 57.00

55a 2020 Members as of 3/31/2020 - Only those enrolled in plans that will still be available in 2021 147.00 19.00 0.00 0.00 37.00 6.00 0.00 57.00

Calculation of Final 2021 Rates All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 756 TOTAL PROJECTED INDEX RATE PMPM (= [(L49 + L50) / (1 - L51 - L52)]) 909.15 710.13 710.13 710.13 809.21 809.21 809.21 967.4457 Percent Change in Premium Rates (= L56 / L54) 1.82% 25.25% 5.45% 25.89% -3.74%

*** The information in the "General" Section above should also be completed for any 2020 plans that will no longer be available in 2021.*** The Average PMPM rate for "All Plans" should be used for All Non-ACA Compliant Plans Weighted Average PMPM: 909.15

Difference From Line 56 Col D: 0.00Overall Average Impact: 1.82% Percentage Difference: 0.0%


Exhibit 18 Supplement


SERFF Number: HLFT-132346272Market Segment : Individual

Expense Data - Individual 2021 Expected 2020 Expected 2019 Expected 2018 Expected 2019 Actual 2018 ActualPeriod assumed - beginning date 1/1/2021 1/1/2020 1/1/2019 1/1/2018 1/1/2019 1/1/2018

Period assumed - ending date 12/31/2021 12/31/2020 12/31/2019 12/31/2018 12/31/2019 12/31/2018Average annual claim trend assumed 6.60% 6.50% 6.50% 6.00% 40.04% 6.00%

Regulatory authority licenses and fees, including New York State 206 assessment expenses - as a % of gross premium 0.68% 0.68% 0.57% 0.57% 0.68% 0.57%Administrative expenses for activities that improve health care quality as defined in the NAIC Annual Statement Supplement Health Care Exhibit - as a % of gross premium 0.80% 0.80% 0.80% 0.62% 0.80% 0.62%

Commissions and broker fees - as a % of gross premium 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%Premium Taxes - as a % of gross premium 2.05% 1.75% 1.75% 1.75% 1.75% 1.75%

Other state and federal taxes and assessments (other than income taxes and covered lives assessment) - as a % of gross premium 0.00% 2.20% 2.70% 2.40% 0.00% 2.40%Other administrative expenses - as a % of gross premium 12.40% 14.20% 14.20% 14.38% 13.19% 14.38%

Subtotal 15.930% 19.630% 20.020% 19.720% 16.419% 19.720%

After tax underwriting margin (profit/contribution to surplus) - as a % of gross premium 1.50% 1.50% 1.50% 1.30% 1.50% 1.30%State income tax component - as a % of gross premium 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

State income tax rate assumed (e.g. 3%) 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%Federal income tax component - as a % of gross premium 0.30% 0.30% 0.30% 0.70% 0.30% 0.70%

Federal income tax rate assumed (e.g. 30%) 20.00% 20.00% 20.00% 35.00% 20.00% 35.00%Reduction for assumed net investment income - as a % of gross premium (enter as a negative value) 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Subtotal 1.800% 1.800% 1.800% 2.000% 1.800% 2.000%

Total 17.730% 21.430% 21.820% 21.720% 18.219% 21.720%

Exhibit 18 Supplement Updated by DFS - 3/20/2020 1

EXHIBIT 23: SUMMARY OF REQUESTED 2021 PREMIUM RATES

Company Name: Healthfirst Insurance Company, Inc.NAIC Code: 16031SERFF Number: HLFT-132346272Market Segment: Individual

1 Purpose of this Exhibit is to provide the actual distribution of all base Premium Rates for all Metal Levels and Regions.2 Premium rates and member months are required for Calendar Years 2018 - 2021 for Individual (Individual only) and First Quarter 2018 - 2021 for Small Group (Employee only).3 Membership must be consistent with the applicable DFS survey as of 3/31 for each of the respective years.4 Premium rates must be based on the subscriber (Individual) or employee (Small Group) rate and should not be a PMPM amount.5 Premiums should be reported for all plan variations (e.g., if the Company has different rates when family planning, pediatric dental, domestic partner, or age 29 coverage are added, etc.).6 Additional guidance is provided in the various headings of the Exhibit.7 This exhibit must be submitted as an Excel and as a PDF file.8 The "PNDS Identifier" represents the code used in the Department of Health's PNDS system to identify the specific provider network associated with a particular plan. 9 The "Company Network Identifier" represents the specific code used by the Company to identify each distinct provider network used by the Company.

Exhibit 23 - Instructions Updated by DFS 3/20/2020 1

1. Company Name 2. NAIC Code 3. SERFF Number 4. Market

5. Current HIOS ID (14 Digits)

6. Previous HIOS ID (14 Digits)

7. Metal Level or Catastrophic

8. Exchange ["On"/"Off"]

9. Plan Type [Standard or Non-

Standard]

10.Limiting Child

Age? (26 or 30)

11. Domestic Partner

Coverage Included? (yes,

no)

12. Family

Planning Coverage? (included, excluded)

13. Pediatric

Dental Coverage

Included? (yes, no)

14. Out of Network

Benefits? (yes, no)

15. Includes

Benefits in Addition to

EHB? (yes, no)

16. Healthy New

York (yes, no)

17. Child-Only

Plan (yes, no)

18. Tiered Network Plan (yes, no)

19. HSA Plan (yes,

no)20.

PNDS Identifier

21. Company Network Identifier

Healthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020001 61405NY0020001 Bronze Off Non-Standard 26 Yes Included Yes No Yes No No No No NYN002 Healthfirst EPO N

Healthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020002 61405NY0020002 Bronze Off Non-Standard 30 Yes Included Yes No Yes No No No No NYN002 Healthfirst EPO N

Healthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020003 61405NY0020003 Bronze Off Non-Standard Yes Included Yes No Yes No Yes No No NYN002 Healthfirst EPO N

Healthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020004 61405NY0020004 Silver – Non-CSR Off Non-Standard 26 Yes Included Yes No Yes No No No No NYN002 Healthfirst EPO N

Healthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020005 61405NY0020005 Silver – Non-CSR Off Non-Standard 30 Yes Included Yes No Yes No No No No NYN002 Healthfirst EPO NHealthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020006 61405NY0020006 Silver – Non-CSR Off Non-Standard Yes Included Yes No Yes No Yes No No NYN002 Healthfirst EPO NHealthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020007 61405NY0020007 Gold Off Non-Standard 26 Yes Included Yes No Yes No No No No NYN002 Healthfirst EPO NHealthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020008 61405NY0020008 Gold Off Non-Standard 30 Yes Included Yes No Yes No No No No NYN002 Healthfirst EPO NHealthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020009 61405NY0020009 Gold Off Non-Standard Yes Included Yes No Yes No Yes No No NYN002 Healthfirst EPO NHealthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020010 61405NY0020010 Platinum Off Non-Standard 26 Yes Included Yes No Yes No No No No NYN002 Healthfirst EPO NHealthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020011 61405NY0020011 Platinum Off Non-Standard 30 Yes Included Yes No Yes No No No No NYN002 Healthfirst EPO NHealthfirst Insurance 16031 HLFT-132346272 Individual 61405NY0020012 61405NY0020012 Platinum Off Non-Standard Yes Included Yes No Yes No Yes No No NYN002 Healthfirst EPO NHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 IndividualHealthfirst Insurance 16031 HLFT-132346272 Individual

PLAN INFORMATION


Region 1 - 2018 Rate (Albany)

Region 2 - 2018 Rate (Buffalo)

Region 3 - 2018 Rate (Mid-Hudson)

Region 4 - 2018 Rate (New York)

Region 5 - 2018 Rate (Rochester)

Region 6 - 2018 Rate (Syracuse)

Region 7 - 2018 Rate (Utica)

Region 8 - 2018 Rate (Long

Island)Region 1 - 2018 MMs (Albany)

Region 2 - 2018 MMs (Buffalo)

Region 3 - 2018 MMs (Mid-Hudson)

Region 4 - 2018 MMs (New York)

Region 5 - 2018 MMs (Rochester)

Region 6 - 2018 MMs (Syracuse)

Region 7 - 2018 MMs (Utica)

Region 8 - 2018 MMs (Long

Island)

etwork 544.92 544.92 159.00 27.00

etwork 550.37 550.37 0.00 0.00

etwork 224.50 224.50 0.00 0.00

etwork 659.35 659.35 510.00 242.00

etwork 665.95 665.95 36.00 0.00 etwork 271.66 271.66 0.00 0.00 etwork 790.16 790.16 594.00 241.00 etwork 798.06 798.06 24.00 36.00 etwork 325.54 325.54 0.00 0.00 etwork 942.71 942.71 93.00 35.00 etwork 952.13 952.13 0.00 0.00 etwork 388.39 388.39 15.00 0.00

2018 PREMIUM RATES 2018 MEMBER MONTHS










Island)Region 1 - 2019 MMs (Albany)

Region 2 - 2019 MMs (Buffalo)

Region 3 - 2019 MMs (Mid-Hudson)

Region 4 - 2019 MMs (New York)

Region 5 - 2019 MMs (Rochester)

Region 6 - 2019 MMs (Syracuse)

Region 7 - 2019 MMs (Utica)

Region 8 - 2019 MMs (Long

Island)

537.42 570.74 188.00 8.00

542.80 576.45 0.00 0.00

221.41 235.14 5.00 0.00

706.97 750.80 352.00 167.00

714.04 758.32 24.00 12.00291.28 309.34 0.00 0.00888.83 943.94 538.00 276.00897.72 953.38 24.00 12.00366.19 388.90 3.00 1.00

1,064.07 1,130.04 92.00 49.001,074.70 1,141.33 0.00 0.00

438.39 465.57 8.00 4.00

2019 PREMIUM RATES 2019 MEMBER MONTHS










Island)

Region 1 - 2020 Members as of

3/31/2020 (Albany)


3/31/2020 (Buffalo)

Region 3 - 2020 Members as of 3/31/2020 (Mid-

Hudson)

Region 4 - 2020 Members as of 3/31/2020 (New

York)


3/31/2020 (Rochester)


3/31/2020 (Syracuse)


3/31/2020 (Utica)


3/31/2020 (Long Island)

589.98 626.56 16.00 3.00

595.89 632.83 0.00 0.00

243.06 258.14 0.00 0.00

776.11 824.23 18.00 19.00

783.87 832.48 6.00 0.00319.77 339.59 0.00 0.00975.76 1,036.26 39.00 18.00985.52 1,046.62 0.00 3.00402.00 426.93 0.00 2.00

1,168.14 1,240.56 12.00 11.001,179.81 1,252.95 0.00 0.00

481.26 511.10 0.00 0.00

2020 MEMBERS (per DFS Membership Survey)2020 PREMIUM RATES










Island)


3/31/2020 (Albany)


3/31/2020 (Buffalo)


Hudson)


York)






3/31/2020 (Utica)




3/31/2020 (Albany)


3/31/2020 (Buffalo)


Hudson)


York)






3/31/2020 (Utica)



607.68 626.56 16.00 3.00

613.77 632.83 0.00 0.00

250.35 258.14 0.00 0.00

799.39 824.23 18.00 19.00

807.39 832.48 6.00 0.00329.36 339.59 0.00 0.00

1,005.03 1,036.26 39.00 18.001,015.09 1,046.62 0.00 3.00

414.06 426.93 0.00 2.001,203.18 1,240.56 12.00 11.001,215.20 1,252.95 0.00 0.00

495.70 511.10 0.00 0.00

2021 PREMIUM RATES2020 MEMBERS (Should be consistent with DFS Membership Survey) - Only those members currently enrolled in 2020 plans that will continue to be offered in 2021

2020 MEMBERS - Only those members currently enrolled in 2020 plans Including plans that will be discontinued in 2021 ***** Columns CH - CO apply to SMALL GROUP ONLY *****


5/5/2020 «SubscirberFirstName» «SubscriberLastName» «AddressLine1» «AddressLine2» «CITY», «STATE» «ZipCode» Re: Notice of Proposed Premium Rate Change Healthfirst [Plan Name] - HIOS ID 61405NY002[XXXX] Dear Healthfirst Member: Healthfirst Insurance Company, Inc. (Healthfirst) is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your premium rates for 2021. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change If approved, the percentage change to your premium is [XX]%. If you enrolled through the NY State of Health, the state’s health plan marketplace, and you qualified for financial assistance called an Advanced Premium Tax Credit (APTC), your current premium is less than the amount shown above. Your 2021 premium will also be less than shown above if you qualify for the APTC again next year. NY State of Health will calculate your eligibility for financial assistance each year. Please note that while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Also, the final approved rate may differ because DFS may modify the proposed rate. Why We Are Requesting a Rate Change Healthfirst is requesting a higher rate for 2021 because several market forces continue to drive health care costs higher. These forces include:

• Cost increases for inpatient hospital, outpatient hospital, and physician services

• Cost increases for prescription drugs, including the increased use of expensive specialty prescriptions

DFS’s view of these matters may differ.

30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Healthfirst for additional information at:

Healthfirst Insurance Company, Inc. 100 Church Street New York, NY 10007 1-855-789-3668 www.healthfirst.org

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows:

DFS Website: https://www.dfs.ny.gov/consumers/health_insurance/health_insurance_premiums

United States Postal Service:

NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you choose to submit comments to DFS, please include the following information:

1. The name of your insurer, which is Healthfirst Insurance Company, Inc. 2. The name of your plan, which is Healthfirst [Plan Name] 3. Indicate you have individual coverage 4. Your HIOS identification number, which is 61405NY002[XXXX]

Written comments submitted to DFS will be posted on the DFS website without your personal information. Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Healthfirst website: www.healthfirst.org/priorapproval DFS website: https://www.dfs.ny.gov/consumers/health_insurance/health_insurance_premiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2021 renewal date.

https://www.dfs.ny.gov/consumers/health_insurance/health_insurance_premiums

https://www.dfs.ny.gov/consumers/health_insurance/health_insurance_premiums

Sincerely,

Joseph S. Chalastra Senior Vice President, Operations

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations. Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132).

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-866-305-0408 (TTY 1-888-542-3821)。

© 2020 HF Management Services, LLC


NAIC Code: 16031

SERFF Tracking #: HLFT-132346272

Market Segment: Individual

A. Insurer Information: A&H - 42 For Profit 16031Company submitting the rate filing request Company Type Org. Type Company NAIC Code

B. Contact Person: Rate filing contact person name, title Contact phone number Contact Email address

C. Actuarial Contact (If different from above): Actuary name, title Actuary phone number Actuary Email address

D. New Rate Information: HLFT-132346272New rate applicability period New rate effective date SERFF Tracking Number

E.

F. Provide responses for the following questions:

1.

2.

3.

4.

5.

6

Notes:(1)

(2)

EXHIBIT 11: GENERAL INFORMATION


100 Church Street, New York, NY 10007

Company mailing address

Confirm that initial notices have not been sent to any impacted policyholders and will not be sent until the Company has

received confirmation that all relevant 2021 rate applications have been posted on the Department's website. See note

(2). Initial notices have not yet been sent to impacted policyholders and will not be sent until the DFS posts the

relevant 2021 rate applications.

1/1/21 - 12/31/21 1/1/2021

Market segment included in filing (e.g., Small Group (including Healthy NY Small Group), Individual - only one market

segment per rate adjustment filing): Individual

Response

Does this filing include any revision to contract language that is not yet approved? See note (1). If yes, provide a brief

description of the contract language changes included in this filing.

No

Are there any rate filings submitted and not yet approved that if approved would affect the rate tables included in this

rate filing? If yes, mention these filings on Exhibit 16.

No

As mentioned in the checklist, this combined non-grandfathered product rate adjustment and form/rate filing can only include minor contract revisions, such as due to changes in the model language, changes to the catastrophic

plan due to change in out of pocket maximum, changes to the standard plan designs. Substantial changes need to be submitted as a separate rate and form filing (e.g., a new plan design not replacing an existing plan design,

contract language changes not just due to changes in the model language).

For purposes of complying with §3231(e)(1)(A) and §4308(c)(2) of the New York Insurance Law, rate applications will be considered to have been submitted after all of the relevant rate applications have been posted on the

Department's website. Once the rate applications have been posted, the Department will send a blast email instructing insurers to send their initial rate notices to policy/certificate holders. Notices should not be sent prior to

having received the blast email from the Department. Note that the 60 (or 80) day review period will begin on the day in which DFS designates as the filing due date and the 30 day consumer comment period will begin on the

date DFS sends the blast email to insurers.

Have all the required exhibits been submitted with this rate filing? If any exhibit is not applicable, has an explanation

been provided why such exhibit is not applicable?

Yes

Did the company submit a "Prior Approval Pre-filing" containing a draft of the initial notice and a draft of the narrative

summary and numerical summary associated with this rate filing? Indicate Yes or No, and if Yes, please provide the

SERFF number of the pre-filing.

Yes, HLFT-132345859

45 CFR 154.215 requires companies to submit rate filings via SERFF and HIOS simultaneously. Did the company

submit this rate filing in HIOS? If yes, please provide the HIOS submission tracking number.

Yes, 61405-1753161481937258508


Confidential and Proprietary


Part III Actuarial Memorandum

Individual Rate Filing

Off‐Exchange

Effective January 1, 2021

General Information

Document Overview

This document contains the Part III Actuarial Memorandum for Healthfirst Insurance Company, Inc. (HFIC) rate

filing, for the Individual block of business with an effective date of January 1, 2021. This actuarial

memorandum is submitted in conjunction with the Part I Unified Rate Review Template (URRT).

The purpose of the actuarial memorandum is to provide certain information related to the submission,

including support for the values entered into the URRT, which supports compliance with the market rating

rules and reasonableness of applicable rate increases. This information may not be appropriate for other

purposes.

This memorandum is intended for use by the New York Department of Financial Services (DFS), the Center for

Consumer Information and Insurance Oversight (CCIIO), and their subcontractors to assist in the review of

HFIC’s Individual rate filing. The memorandum contains information that is confidential and proprietary to

HFIC; therefore, the memorandum should not be distributed to any other parties unless required by law.

HFIC entered the small group and individual commercial markets on January 1, 2017. As of March 2020, total

HFIC Individual membership is 147. At no time between January 2017 and March 2020 did HFIC Individual

membership exceed 190.

The results are actuarial projections. Actual experience is likely to differ for a number of reasons including

population changes, claims experience, risk adjustment, and other deviations from assumptions.

Company Identifying Information

• Company Legal Name: Healthfirst Insurance Company, Inc.

• State: New York

• HIOS Issuer ID: 61405

• Market: Individual

• Effective Date: January 1, 2021

Company Contact Information

• Primary Contact Name:

• Primary Contact Telephone Number:

• Primary Contact Email Address:

This memorandum is organized into the following sections:

• Section 1: Development of the index rate

• Section 2: Supporting Detail on Material Assumptions

• Section 3: Additional Notes

• Section 4: Actuarial Certification

Our appendices to this Actuarial Memorandum are the following:

• Appendix A: Market-wide Index Rate Adjustments

• Appendix B: Quality Improvement Program

• Appendix C: Exhibit 18

• Appendix D: AV Calculator Snapshots

Section 1: Development of the Index Rate

We develop the Index Rate in Exhibit 18; our description follows the lines of Exhibit 18.

1.1 Experience Period Premium and Claims

Our experience is based on HFIC Individual (HFIC) premium and claims experience incurred in 2019 and paid through February 2020. With 147 average monthly members, this block is not fully credible for 2021 rating purposes. Therefore, the individual experience of another company, Healthfirst PHSP, Inc. (“Healthfirst PHSP”), which is controlled by a common parent company, is used as a benchmark for the rates developed for HFIC Individual. To have a consistent set of rating exhibits, we complete the exhibits as if HFIC is fully credible, and develop an adjustment factor in Exhibit 18, Row 27 to link the HFIC experience to the much larger QHP Individual experience.

Manual rates were not used in our development of rates for 2021.

Capitation payments are included in the claims experience for 2019.

The average pricing actuarial value reflected in the experience is 0.81008 (Line 11).

1.2 Market Level Adjustments

The following adjustments were made to the starting QHP data discussed above. Each one of these factors is included in Exhibit 18 required by New York State. For your review, we have included the market-wide adjustments from Exhibit 18 in Appendix A and have identified the line numbers from Exhibit 18 that reference the adjustments discussed below.

For market-wide adjustments, the following lines have factors of 1.000 in Exhibit 18:

• Line 13: Adjustment for EHB Benefit Level (no vision and drug benefits)

• Line 14: Change to Provider Network

• Line 15: Market-wide adjustments for fee schedule changes

• Line 16: Market wide adjustment for utilization management changes

• Line 17: Market wide adjustment for impact on claim costs from quality improvement and cost containment

initiatives

• Line 20: Impact of adjustments due to experience period claim data not being sufficiently credible

• Line 21: Adjustment for changes in distribution of risk pool membership by rating regions (i.e., standard rating

regions)

• Line 22: Impact on risk pool of changes in expected covered membership risk characteristics (Small Group

Only)

For market-wide adjustments, the following lines have factors not equal to 1.000 in Exhibit 18:

• Claims Trend Projection Factor (Line 18) -

We assume an annual trend of 6.6% from the experience period to the projection period. This annual trend of 6.6% gives us a trend factor of 1.136. We discuss trend further in Section 2.1 of this document.

• Federal Risk Adjustment (Line 19) -

We use the following terminology in this rate filing:

• A negative amount is a payable amount while a positive number is a receivable amount.

• CMS terminology, with the abbreviations used in this document, are the following:

• Transfer Amount Before RADV PLRS Adjustment (RA)

• RADV PLRS Adjustment (RADV)

• Transfer Amount After RADV PLRS Adjustment (RA After RADV)

For Risk Adjustment, HFIC is too small a block on which obtain credible risk adjustment estimates for rating

purposes. The factor we use Is from Healthfirst PHSP, as follows:

Wakely gave an estimate of RA of ($6.34) per member per month (pmpm) for 2021; this ($6.34) pmpm is the amount of risk adjustment of 2019 based on 2021 risk adjustment parameters. For 2021, the relative weights for risk adjustment are adjusted nationally based on emerging claim experience by diagnosis. This ($6.34) does not take into account trend in market average premium. The risk calculations for Healthfirst QHP by CMS and Wakely are shown in Files 1 and 2, respectively, When we combine this estimate of risk adjustment of ($6.34) pmpm and an assumption that the market average premium will increase by 5.00% annually from 2019 to 2021, we obtain our expected RA for 2021 of $6.99 pmpm and our RA factor of 1.01:

The RADV audit for 2020 is cancelled. With RADV scheduled to resume in 2021 after a one year hiatus, we assume that RADV for 2021 will be zero. The RA After RADV for 2021 is priced at ($6.99) pmpm.

If the actual risk adjustment for Healthfirst QHP, including RADV (RA After RADV), varies from

this ($10) pmpm payment estimate, it could affect the adequacy of our rates for HFIC

Individual.

Impact of changes in New York State Law that are not reflected in the experience data ** (Line 23a)

When we estimate the change for a specific benefit to be less than 0.1% of premium, we do not change premium for this benefit. We estimate that the new benefits will increase premium 1.07%, calculated as follows:

The Mental Health & Autism benefit, priced at 0.28% of claims for 2020, is not the experience for

2019. The Out-of-Network rider with a rate of 0.33% of premium was filed on or around December

19, 2019. We estimate that the expansion of the provision of the OON rider would increase rates

another 0.33%.

The new dialysis benefit effective January 1, 2020 is priced at 0.13% of claims, calculated as follows:

2021 Estimated RA Based on 2019 Experience (6.34) (1)

Annual Trend - Market Average Premium 5.00% (2)

2 year trend factor 1.1025 (3) = (1+(2))^2

Expected 2021 RA - Method 1 (6.99) (4) = (1) * (3)

AV Adjusted Index Rate, Line 12, Exhibit 18 701.87 (5)

RA Factor 1.0100 (6) = 1 - (4)/(5)

In Premium

Benefit Effective Year For 2020 Percent of Claims

Mental Health & Autism 2020 Yes 0.28%

OON - December 2019 2020 No 0.33%

OON - Expansion in Bill YY 2021 N/A 0.33%

Dialysis 2021 N/A 0.13%

Total 1.07%

Factor 1.0107

Covered Lives Assessment and Taxes (Line 24)

The factor for Covered Lives Assessment, Section 206, and Premium taxes are covered as follows:

PCORI, Risk Adjustment User Fee (Line 25)

For 2021, the Risk Adjustment User Fee and PCORI are estimated at $0.25 and $0.20, respectively.

With a PMPM base of $701.87, we get a factor of 1.00064.

Expanded Urgent Care (Line 26)

An additional benefit is access to CVS Minute Clinic. We calculate the cost of this expanded benefit as

follows:

New Benefit: Maximum $100 copay for insulin

Only members who choose Bronze plan are subject to

deductible on insulin.

Assumed Utilization Per Year Subject to Copay * 0.01 (1)

Cost Per Rx 690.00$ (2)

Copay 100.00 (3)

Cost After Copay Per Rx 590.00 (4) = (2) - (3)

Cost PMPM 0.49 (5) = (4) * (1)/12


Index Rate 0.0013 (7) = 1 + (5)/(6)

* Rate is based on all members, not just choosing Bronze plans

Covered Lives Assessment (CLA)

NYC LI

Per Year 173.53$ 60.60$ (1) 2020 CLA Rates

Per Month 14.46 5.05 (2) Per Month

Count 91 58 149 (3) Members - assume all single contracts

Total Estimated Revenue 1,316$ 293$ 1,609$ (4) = (2) * (3)

CLA PMPM 2019 $14.82 (5) = (4)/(3)

Trend Factor 1.000 (6) Zero Trend

CLA PMPM 2021 14.82 (7) = (5) * (6)


CLA As Percent of Index Rate 0.0211 (9)

Section 206 and Premium Tax

Section 206 0.678% (10)

Premium Tax, Including MTA Add-On 2.048% (11)

Total

Factor 1.0484 (12)=(9)+(10)+(11)+1

Stop-Loss and Adjustment for credibility of data (Line 27)

Through the Affordable Care Act, a High‐Cost Risk Pool with an attachment point of $1 million was established. Wakely has estimated the cost of this coverage for 2021 at 0.28%. for Individual plans In 2019, HFIC had zero claims over $1 million. Thus, the premium for this coverage is a cost without corresponding recoveries. The factor is 1.0028.

For claims incurred in 2019, and paid through March 2020, Incurred medical and pharmacy claims for HFIC is $579.99 and for Healthfirst QHP, it is $386.94 PMPM; with HFIC experience being 50% Higher than Healthfirst QHP after the rate increase for both HFIC and Healthfirst QHP of 3.0% for NYC and 0% for Long Island. The factor of 1.11031 accomplishes this. We get a combined factor for stop-loss and credibility of 1.11311 (= 1.11031 + 0.0028).

1.3 Plan Level Adjustments

Plan level adjustments that have a factor of 1.000 are the following: Line 32: Provider network characteristics Line 33: Delivery system characteristics

Line 34: Impact of utilization management practices

Line 35: Impact on claim costs from quality improvement and cost containment initiatives

Line 36: Benefits in additional to EHB (greater than 1.00)

Line 37: Impact of eligibility categories (catastrophic plans only)

Line 38: Addition of Out of Network Benefit Option (e.g., POS or PPO, if applicable)

Line 39: Impact of Adjustment for NYS Stop Loss reimbursements on SG HNY

Line 41: Impact of Family Planning/No Family Planning

2020 Cost Per Expanded Office Visit - 99202 99.00$ (1)

Utilzation/Year 0.9755 (2)

2020 Cost Per Member Per Year 96.57 (3) = (1) * (2)

Trend to 2021 5.0% (4)

With Trend from 2020 to 2021 101.40 (5) = (3) * (1+ (4))

Per Month 8.45$ (6) = (5) / 12


Minit Clinic Factor for Exhibit 18 1.01204 (8) = (6)/(7) +1

Line 42: Impact of Domestic Partner/Non-Domestic Partner

Line 43: Premium Curve Adjustment

Line 43a: Impact of loss of CSR Funding (A common factor to be applied uniformly to all silver plans only - if

applicable)

Line 43b: Rating Region Factor

Factors not equal to one are the following:

• Pricing actuarial value (without induced demand factor) (Line 30):

HFIC Individual is only offering non-Standard plans:

Metal Level AV Value

Platinum 0.8780 Gold 0.8198 Silver 0.7190 Bronze 0.6499

• Pricing actuarial value (only the induced demand factor) (Line 31):

• Dependent coverage to age 29 (Line 40):

We increase rates by 1% for dependent coverage to continue to age 29. Since zero of our current

Individual HFIC members have dependent coverage to age 29, the weight factor is 1.000.

• Administrative Costs – Fixed Expense (Line 50):

Our administrative cost, fixed expense, is included in Line 51.

• Administrative Costs – Variable Expense (Line 51):

Our administrative load is 13.2% of premium.

Metal Induced

Level Demand

Platinum 1.15

Gold 1.08

Silver 1.03

Bronze 1.00

• Profit/Contribution to Surplus (Line 52):

Our target margin is 1.5% of premium.

Section 2: Supporting Detail on Material Assumptions

2.1 Trend

The annual trend factors used are the following:

Inpatient: 5.4%

Outpatient: 5.4%

Physician: 5.4%

Prescription drug: 8.7%

Leveraging impact: 0.0%

Overall trend: 6.6%

The trend factors above are for cost and utilization trend combined.

With total claim costs at 64% and 36% for medical and Rx, respectively, we obtain an annualized trend of

6.6%, which equals 64% * 5.4% + 36% * 8.7%. The 2-year trend factor is 1.1365.

These annual trends of 5.4% Medical and 8.7% prescription drug are for 2018 through 2021 in the AV

calculator documentation

Other sources of trend are the following:

• The Segal Company projects trend for EPO’s (which HFIC plans are) to 2020 at 7.6%, which is

higher than the trend that we are using.

• The PWC Medical Cost Growth rate is 5.7% for 2018 and 2019, and 6.0% for 2020.

• Deloitte estimates overall trend from 2018 to 2022 at 5.4%.

• The Milliman Medical Index (MMI) for medical cost increases from 2017 to 2018 is 2.9% and

3.8% from 2018 to 2019 for medical and prescription trend combined. These trends are lower

than almost all of the other sources.

2.2 Administrative Expenses and Taxes

The administrative expense is expected to be and priced at 13.2% of premium.

Healthfirst utilized an allocation methodology that distributes departmental costs using driver- based

allocation, for example, membership, number of claims, number of calls, premium revenue, etc. We also

distinguish departments between “fixed and variable” depending on the impact of membership growth on

staffing levels. For example, Claims is considered a variable department since claims volume varies

proportionately by membership. On the other hand, Finance Corporate, for example, is a department

unaffected by membership growth for the most part.

Exchange administrative projections were driven by three main components – Projected 2020 membership,

premium revenue and medical costs. These components under our products were used to drive cost

allocations for “variable” departments while a “current run-rate” pmpm was used to drive “fixed”

departments, with nominal inflation.

Our administrative costs include, but are not limited to, marketing and sales, enrollment, claims administration,

medical management, member services, network management, product management, clinical and quality

performance management, compliance, legal, regulatory, finance and actuarial. This fee will not include the

taxes and fees described below.

Our quality improvement/cost containment programs that impact the health plans, are estimated at 0.80% of

premium and is included in the 13.2% estimate. Please refer to Appendix B for a description of all quality

improvement/cost containment programs that impact the health plans included in the risk pool. This should

tie in with the activities that improve health care quality, as specified in Exhibit 19 (DFS), the HHS MLR report

and the Supplemental Health Care Exhibit.

2.3 Target Margin

The target margin is 1.5% of premium.

Profit or Contribution to Surplus margin of 1.5% was included in all plans. This is consistent with our current

ROI for other products. Healthfirst recognizes the need to have positive margins on our programs. We believe

that our 1.5% operating margin would provide necessary capital to invest in the company’s infrastructure,

provide adequate capital to meet reserve requirements for Healthfirst, and provide high quality care to our

members.

The ROI for HFIC (Individual and Group combined) in 2018 is 1.11% and 2.65% for 2019. 2018 is the first year

with at least 1,000 members in Group and Individual combined in every month of the year.

2.4 Adjustments to Actuarial Benefit Values and Actuarial Pricing Values

This is discussed in Section 1.3, under the discussion of the adjustment factor for line 30 of Exhibit 18.

2.5 Conversion Factors

The final premium rates for Employee Only, Employee and Spouse, Employee and Child(ren) and

Employee/Spouse/Child(ren) are based on census factors prescribed by CMS:

Census Tiers Relativity

Single 1.000

Single+Spouse 2.000

Single+Child(ren) 1.700

Single+Spouse+Child(ren) 2.850

Child Only 0.412

For a Child Only plan that covers two children in a family, the premium rate would be twice the one child

premium rate. For a Child Only plan that covers three or more children in a family, the premium rate would

be three times the one child premium rate, consistent with HHS Regulations.

For a Child Only plan that covers two children in a family, the premium rate would be twice the one child

premium rate. For a Child Only plan that covers three or more children in a family, the premium rate would

be three times the one child premium rate, consistent with HHS Regulations.

We have developed loading factors based on our March 2020 membership. Our loading factor from the

per member rate to the single rate is 1.1083. This 1.1083 is the reciprocal of 0.9023, as shown in cells c47,

L47, and U47 in Exhibit 13c.

The development of the conversion factor is shown in the table below:

Loading

Census Tiers Relativity Factor

Single 1 1.1083

Single+Spouse 2 2.2166

Single+Child(ren) 1.7 1.8841

Single+Spouse+Child(ren) 2.85 3.1587

Child Only 0.412 0.4566

2.6 Standardized Rating Regions

Healthfirst will offer its products in two of the eight standardized rating regions in New York State:

• New York – Our service area includes Bronx, Kings, New York, Queens, and Richmond counties.

• Long Island – Our service area includes Nassau and Suffolk counties.

The area factors to be used for 2021 are as follows:

Region Counties Included Area Factor

New York City Area

Bronx, Kings, New York, Queens, Richmond 1.000

Long Island Nassau, Suffolk 1.031

The Long Island Factor is reduced from 1.06 to 1.03. Members in New York City will be seeing a 3.0%

increase while members on Long Island will be seeing a 0.0% increase.

2.7 Federal Risk Adjustment

We discuss federal risk adjustment in the section on line 19 on the development of the index rate.

2.8 Material Pricing Used for Morbidity No adjustments were made to morbidity.

2.09 Consistency

This Actuarial Memorandum is consistent with Exhibit 18 (Index rates).

2.10 Out-of-Network Benefits

No specific adjustments were made for out-of-network benefits.

2.11 Premiums in Same Metal Level

There are no significant premium rate differences between plans in the same metal level.

2.12 Proprietary Studies

Data used is from HFIC and from Healthfirst QHP PHSP, with the Healthfirst QHP PHSP data assumed to be

100% credible.

2.13 Management Adjustments

The adjustments made to the data are explained in this Actuarial Memorandum.

2.14 Other Adjustments

As mentioned above, the adjustments to data are explained in this Actuarial Memorandum.

2.15 Data Sources

All data is from ACA Compliant plans.

2.16 Summary of Rate Increases

We have no new benefit plans. Members in New York City will be seeing a 3.0% increase while members on Long Island will be seeing a 0.0% increase from 2020 to 2021.

Section 3: Additional Notes

3.1 MLR

Two loss ratios are calculated, one consistent with the New York State prescribed Medical Loss Ratio (MLR)

methodology and one based on the Federal definition. The anticipated New York MLR is 85.3%, which exceeds

the minimum allowable MLR of 82%. The anticipated Federal MLR is 88.5%, which exceeds the Federal

minimum MLR of 80%.

3.2 Plan Type

The Plan Types listed in the URRT accurately describe Healthfirst’ s plans.

3.3 Reliance

In the preparation of this filing, I relied upon estimates from CMS and Wakely and Associates for their estimates

of risk adjustment.

I performed general reasonableness checks, but I have not audited the data and have relied upon its accuracy.

To the extent that the underlying data is inaccurate, this filing may also be inaccurate. Actual results will almost

certainly vary from those projected in the filing. This is due to random fluctuations, unexpected large claims,

changes in population and other such factors.

Section 4: Actuarial Certification

I, am a member of the

Society of Actuaries and a member of the American Academy of Actuaries. I meet the “Qualification Standards

of Actuarial Opinion” as adopted by the American Academy of Actuaries.

I certify that:

(a) The filing is in compliance with all applicable laws and regulations of the State of New York, as well as

Federal Statutes and Regulations;

(b) The filing is in compliance with the appropriate Actuarial Standards of Practice (ASOP’s) including but not

limited to:

− ASOP No. 5, Incurred Health and Disability Claims

− ASOP No. 8, Regulatory Filings for Health Plan Entities

− ASOP No. 12, Risk Classification

− ASOP No. 23, Data Quality

− ASOP No. 25, Credibility Procedures Applicable to Accident and Health, Group Term Life, and

Property/Casualty Coverages

− ASOP No. 41, Actuarial Communications

− ASOP No. 42, Determining Health and Disability Liabilities other than Liabilities for Incurred Claims

− ASOP No. 45, The Use of Health Status Based Risk Adjustment Methodologies

− ASOP No. 50, Determining Actuarial Value and Minimum Value under the ACA

(c) These rates have been established to produce an expected loss ratio that meets the minimum requirement

of the State of New York;

(d) The benefits are reasonable in relation to the premiums charged; and

(e) The premiums are not unreasonable, excessive, inadequate, or unfairly discriminatory

Please note that the Part I Unified Rate Review Template does not demonstrate the process used by

Healthfirst to develop the rates. Rather, it represents information required by Federal regulation to be

provided in support of the review for certification of qualified health plans for Federally facilitated exchanges

and for certification that the index rate is developed in accordance with Federal regulation and used

consistently and only adjusted by the allowable modifiers.

If you have any questions, please e-mail me at

Appendix A

Market Wide Adjustments to the AV Adjusted Experience Period Index Rate All Plans

13 Impact of adjusting experience period data to EHB benefit level ** 1.00000

14 Market wide adjustment for changes in provider network ** 1.00000

15 Market wide adjustment for fee schedule changes ** 0.96866

16 Market wide adjustment for utilization management changes ** 1.00000

17 Market wide adjustment for impact on claim costs from quality improvement and cost containment initiatives ** 1.00000

18 Claim trend projection factor (midpoint of experience period to mid point of rate applicability period) 1.13645

19 Federal Risk Adjustment Program Impact (less than 1.00 to reflect a recovery, more than 1.00 to reflect a payment to the pool) ** 1.00996

20 Impact of adjustments due to experience period claim data not being sufficiently credible ** 1.00000

21 Adjustment for changes in distribution of risk pool membership by rating regions (i.e., standard rating regions) ** 1.00000

22 Change in morbidity not reflected in the experience data that is known and quantifiable at the time of the rate filing ** 1.00000


23b

2020 Covid-19 Impact – Impact associated with state requirements that were intended to diagnose, treat, or

avoid contact with Covid-19 which were imposed during the 2020 calendar year, but not included in 2020

pricing. ** 1.00000

23c

2021 Covid-19 Impact – Expected impact associated with worsening morbidity and other costs resulting from

Covid-19 with respect to the 2021 calendar year. ** 1.00000

24 Covered Lives Assessment and Taxes 1.04837

25 PCORI, Risk Adjustment User Fee 1.00064

26 Expanded Urgent Care 1.01204

27 High Cost Risk Pool, Adjustment for credibility of data 1.11311

28 Impact of Market Wide Adjustments (= Product L13 through L27) 1.32796

Appendix B

Healthfirst 2021 Quality Strategy

A. Improving Health Outcomes Healthfirst implements health promotion and care management programs to contribute in a meaningful way to improved health outcomes for our members. The objective of these programs is to increase member access and engagement with preventive health services, especially the patient-centered medical home, to promote appropriate utilization of services for acute and chronic care. Additional objectives of these programs include optimization of member capability for self-management and collaboration with the provider’s care and treatment strategies. Preventive Health: Member Access and Engagement Healthfirst provides members with health information, health promotion education and participation in care management program opportunities. For example, at the Healthfirst Healthy Living website, members have access to information that can help them understand how they can best fulfill prevention needs such as mammography and colon cancer screening. Central to the initial engagement of members is the assistance that Healthfirst provides to members to schedule an appointment with their primary care provider after enrollment. Healthfirst Member Services is available to assist the member with contacting their assigned primary care provider and making the first appointment. Chronic Care Management: Promoting Self-Management and Adherence to Care / Care Compliance Healthfirst works collaboratively with primary care, mental health and substance abuse and specialty practices to promote the delivery of evidence-based care to our members living with chronic conditions using a three-pronged approach:

1) Promoting Health Knowledge and Self-Management: using a variety of approaches, Healthfirst reaches out to members to close gaps in knowledge about their conditions and critical adherence and self-management strategies. Members are educated on the importance of adhering to medications and recognizing potential adverse effects associated with their therapeutic regimens. Efforts are made to identify and manage potential barriers to therapy to minimize the potential of medication non-compliance. Materials are produced based on the needs of members identified through quality and utilization reports, as well as from feedback from our members and providers. Examples include printed brochures, newsletters, targeted member letter and reminder campaigns.

2) Care Management: Based on the profile of disease prevalence and utilization patterns of our members, Healthfirst welcomes members to participate in focused disease management programs and initiatives. Conditions that may be addressed by our care managers include: diabetes, asthma, schizophrenia and sickle cell anemia.

3) Patient centered medical home: Healthfirst supports physicians and clinicians in the medical home by providing opportunities to refer members with complex needs to care management, and by sharing care plans with the patient’s key providers when there is a change in health status or as requested.

Provider Partnership and Collaboration Healthfirst works closely and collaboratively with its primary care practices to meet the health needs of our members. Many of our primary care practices have met NCQA criteria for designation as a “patient centered medical home,” or PCMH. Health outcome targets are defined no less than annually and shared with the Healthfirst provider network to

create a shared agenda to improve health outcomes for our members. Tools to support providers in caring for and serving our members include:

• Provider clinical bulletins detailing pragmatic ways to promote evidenced based care and improved outcomes

• Provider Symposia, which allows Healthfirst providers to highlight and share their best practices

• Provider Partnership Practice meetings for Healthfirst care management, quality and network staff to provide interim reports with feedback on utilization and quality, as well as satisfaction and medication utilization and adherence

Monitoring and Performance Improvement No less than four times per year, Healthfirst administrative and clinical teams, along with Healthfirst community providers, meet to review care management and quality activity and outcomes. At these quality meetings, thresholds and targets for quality performance are approved, trends in health outcomes and plan performance are reviewed, recommendations are made and work plans are monitored. Clinical Quality and Care Management programs are initiated to close gaps in targeted health outcomes and to improve strategies for identifying and minimizing medication barriers, thus improving compliance and therapeutic outcomes. Furthermore, Healthfirst’s Behavioral Health Services unit conducts additional quality improvement subcommittee meetings, which ultimately report up to the organization’s Quality Improvement Committee. Recognizing the significance of behavioral health, the focus of these subcommittee meetings is to monitor and develop various quality metrics, outcomes and performance improvement initiatives specific to behavioral health.

B. Preventing Hospital Readmissions Healthfirst members at high risk for poor health outcomes and / or challenges in navigating the health care delivery system are identified based on patterns of utilization, such as fewer than expected primary care visits, frequent inpatient admissions, readmissions within 30 days in a defined time period or presence of a condition that places them at high risk for readmission such as congestive heart failure. These members are enrolled in complex care management. They receive intensive outreach that includes a detailed assessment which forms the foundation for a comprehensive care plan to address the areas of need. Once outreach and assessment are complete, the care manager will offer community based services to support high risk members, such as home visits, medication reconciliation and post discharge coaching and reminders. Whenever possible, Healthfirst care managers work closely with hospital discharge planners to ensure a safe hospital discharge. Healthfirst also collaborates with providers and community based organizations to identify regional strategies to address difficult psychosocial issues such as homelessness, mental health and substance abuse community programs and innovative strategies to address navigation and cultural barriers to effective health care. Healthfirst offers primary care provider practices near real time notice that their assigned members have been hospitalized to promote the implementation of practice care coordination, including early appointments for members post discharge. The Healthfirst primary care practices receive feedback about the types of emergency department visits, preventable admissions and readmissions that their population of members has experienced in the previous quarter and year.

C. Improving Patient Safety Healthfirst has implemented two major approaches for improving the safety of our patients. Medication Management Healthfirst supports and promotes the use of electronic prescribing and medication reconciliation to reduce polypharmacy and improved communication between the patient, the pharmacist and the prescriber. Through our pharmacy benefit manager, Healthfirst utilizes all point of sale edits available to improve the likelihood that members receive an optimized medication regimen. Pharmacy formulary notifications and other prescriber concerns related

to the pharmacy benefit are distributed via multiple modalities which may include the Healthfirst portal, mail and email. Patients are educated through our newsletter about safe use of prescription medication. Quality Assurance Reviews The Healthfirst Care Management Department and Medical Directors investigate potential quality assurance issues as reported by members, providers or Healthfirst staff to determine specific areas of risk for poor health outcomes for our members. Trends in provider, practice or network performance are discussed, and when necessary Healthfirst requires corrective action plans to avoid recurrence of confirmed quality of care events.

D. Wellness and Health Promotion Activities Healthfirst has a number of wellness and health promotion programs that seek to meaningfully improve health outcomes for our members by increasing member access to preventive health services, promoting appropriate utilization of services for acute and chronic care, and optimizing member health status. Vendor Engagement Strategy In an attempt to better align with the growth and top quality strategy needs of the enterprise, the Spectrum of Health group was divided into two separate teams: Clinical Quality (CQ) Vendor Engagement and Clinical Quality Outreach. The primary focus of the CQ Vendor Engagement team is to initiate, manage and evaluate all vendors touching our members with the intent of improving health outcomes as measured by HEDIS, CMS Stars, QARR and QRS quality ratings. The Clinical Quality Outreach team’s primary objective continues to be the engagement of members with the intent of closing HEDIS care gaps utilizing live calls and other communication modalities. The teams also collaborate to complete quality rubrics and manage clinical studies including Performance Improvement Projects (PIPs) and required vendor-issued Corrective Action Plans (CAPs). The two teams continue to work closely with other key departments to ensure a seamless experience for our members when interacting with vendors. The Vendor Engagement Outreach Program is outcomes-focused, seeking to:

• Promote access to age and gender appropriate primary, secondary and tertiary prevention services

• Ensure age and gender appropriate preventive and care management milestones are met

• Facilitate management of chronic illness

• Optimize the functional status of members in the community Vendor Engagement Outreach programs meet the targeted needs of beneficiaries by utilizing the following strategies where appropriate:

• Population based education tools such as web-based information

• Targeted education, reminders and alerts in the form of personalized live calls, emails, text messages (SMS), IVR calls, and/or letters for members/providers with care gaps in preventive or chronic care services

• Provider-based outreach, education, and support

• Community-based outreach and education in collaboration with community partners with a shared vision regarding health promotion goals

Healthfirst continually evaluates and improves health promotion programming by collecting, analyzing, and acting on performance data trends. Provider Collaboration & Reporting Healthfirst regularly collaborates with providers with the objective of meaningfully improving health outcomes for members. Communication occurs via telephone, on-site visits, webinars, and publication of relevant articles in newsletters and via the web portal, provider clinical bulletins, and targeted mailings.

Key components of Healthfirst’s provider reporting efforts include:

• Quality Reporting: provider quality reports are posted on the Healthfirst provider web portal for concurrent review of status for HEDIS and New York State QARR measures in comparison with HF targets

• Member Missing Services Lists: lists of providers’ measure-specific non-compliant members in their panel are posted to the provider web portal. Providers are encouraged to outreach members needing services (e.g., preventive screenings, recommended lab tests, communications on medication adherence) and schedule appointments to close gaps in care.

E. Reducing Health and Health Care Disparities Healthfirst is a regionally focused health plan with strong community partnerships and established processes and programs to reduce health and healthcare disparities among its members. Language Services Healthfirst’s member-facing staff is reflective of its diverse membership. Member Services Representatives are available to speak to members in English, Spanish, Mandarin, Cantonese and Russian. To serve members with other language preferences, Healthfirst uses a language line service. Healthfirst continually evaluates use and performance of the language line to identify opportunities for improvement as well as emerging language needs. Community Outreach Healthfirst has 15 community offices that are each fully staffed with representatives to answer questions. In addition to these community offices, Healthfirst also has mobile vans, mall kiosks, and tables set up in local hospitals, clinics, and other locations to serve members. Representatives are fluent in the languages commonly spoken in the surrounding communities and provide the following services for members:

• Renewing or re-certifying health insurance

• Providing information about the health services and benefits offered by Healthfirst

• Addressing general member questions or needs, such as changing Primary Doctor (PCP), changing address or other personal information, or requesting a new member ID card

• Providing tips, brochures, and other information to help live a healthier life

• Linking members to other helpful community organizations Healthfirst hosts and/or supports over 600 community events per year. Examples of events that Healthfirst has supported include:

• Health Literacy Events

• Health Fairs / Street Fairs

• Nutrition Workshop / Healthy Cooking Contest

• Breast Cancer / HIV / Blood Pressure / A1C Screenings

• Diabetes Prevention & Health Awareness Days

• Infant Immunization Events

• Men’s Health Awareness Events

• Healthy Heart Day Events

• Healthy Kids & Baby Showers

• Chronic Care Workshops

• Physical Wellness and Exercise Workshops

• Brown Bag Workshops (Pharmacist review medications with attendees)

• World Health Day Events

• Community Running Events

• Holiday celebrations (e.g., Lunar Chinese New Year, Three Kings Day, Dominican Heritage, Black History Month, Women’s History Month, Veterans Day)

• Family Day Events (located at NYCHA housing)

Cultural Competency Trainings Healthfirst has a comprehensive cultural competency training program. The objective of this program is to support the organization in its aims to (1) deliver the highest-quality service to every member regardless of race, ethnicity, culture, or language proficiency and (2) eliminate racial/ethnic disparities in health care. Healthfirst’s Member Services department serves as the front line staff for member questions and concerns. All member services representatives participate in an interactive, instructor-led cultural sensitivity training when they are hired. In subsequent years, Member Services representatives are required to take an annual refresher course on cultural sensitivity. In addition, all Healthfirst employees are required to annually complete an online cultural competency course, the objective of which is to raise awareness of cultural competence activities and opportunities for growth as part of an effort to improve each employee’s ability to serve our members and their communities with cultural awareness and sensitivity.

F. Behavioral Health Services The behavioral health program provides access to a full continuum of care, utilizing acute inpatient services, partial hospitalization and intensive outpatient programs along with ambulatory outpatient care. The program is designed to assist members in finding the appropriate provider to meet their needs and to facilitate timely access to treatments and services including emergency, urgent and routine office care. Healthfirst is ready to work with members to determine a specific provider and, where necessary and desired, assist the member in obtaining an appointment. Additionally, we provide members access to Behavioral Health Clinicians 24/7. The program includes diagnostic-specific programs such as intensive outpatient programs that target substance use and eating disorders. Healthfirst is also making access easier for members via the use of telehealth as a vehicle for those who have difficulty attending appointments in person. Members who have been hospitalized receive support within the community during the initial post-hospitalization period to improve the potential success of connection to the next treatment component. These activities serve to increase the likelihood of the member maintaining and enhancing progress made in the hospital and decrease the risks of readmission. Healthfirst recognizes that many of those suffering from a mental illness or substance use disorders also have significant physical illnesses and psychosocial issues such as housing instability, unemployment and food insecurity. Through its care management program, Healthfirst provides care management, care coordination and navigation assistance to reduce gaps in care and improve health outcomes by facilitating access to preventive care, treatment and support services for both child and adult members. Healthfirst care managers with medical and behavioral health expertise work closely with members, families, providers, social service agencies and community based organizations to provide a unique, member-centric, integrated and holistic approach to care. Healthfirst‘s Behavioral Health Quality Improvement and Utilization Management committee monitors the quality and timeliness of such services/interventions to ensure outcomes that are consistent with both national and state benchmarks and internally established targets.

Appendix C

Exhibit 18 - Index Rate/Plan-Design Level Adjustment Worksheet


NAIC Code: 16031

SERFF Number: HLFT-132346272

Market Segment : Individual

A separate column must be used for each base plan design (i.e., for each separate and distinct 14 digit HIOS ID)

Line # General***

ACA Compliant Plans

Only Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12

1 Product* XXXXXXX Individual Individual Individual Individual Individual Individual Individual Individual Individual Individual Individual Individual

2 Product ID* XXXXXXX 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002 61405NY002

3 Metal Level (or catastrophic)* XXXXXXX Bronze Bronze Bronze Silver Silver Silver Gold Gold Gold Platinum Platinum Platinum

4 AV Metal Value (HHS Calculator)* XXXXXXX 0.64990 0.64990 0.64990 0.71900 0.71900 0.71900 0.81980 0.81980 0.81980 0.87800 0.87800 0.87800

5 AV Pricing Value (total, risk pool experience based)* XXXXXXX 0.64990 0.64990 0.64990 0.74057 0.74057 0.74057 0.88538 0.88538 0.88538 1.00970 1.00970 1.00970

6 Plan Type* XXXXXXX EPO EPO EPO EPO EPO EPO EPO EPO EPO EPO EPO EPO

7 Plan Name* XXXXXXX

Bronze Total EPO with

Dependent Age 26

Bronze Total EPO with

Dependent Age 29

Bronze Total EPO Child

Only

Silver Total EPO with

Dependent Age 26

Silver Total EPO with

Dependent Age 29

Silver Total EPO Child

Only

Gold Total EPO with

Dependent Age 26

Gold Total EPO with

Dependent Age 29

Gold Total EPO Child

Only

Platinum Total EPO with

Dependent Age 26

Platinum Total EPO with

Dependent Age 29

Platinum Total EPO Child

Only

8 HIOS Plan ID (14 Digits)* XXXXXXX 61405NY0020001 61405NY0020002 61405NY0020003 61405NY0020004 61405NY0020005 61405NY0020006 61405NY0020007 61405NY0020008 61405NY0020009 61405NY0020010 61405NY0020011 61405NY0020012

9 Exchange Plan?* XXXXXXX Off Off Off Off Off Off Off Off Off Off Off Off

9A 2021 Plan Status (as compared to 2020) XXXXXXX Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod

* This field should be the same as used in the Unified Rate Review Template, Worksheet 2

Amounts should be consistent with appropriate categories in Column 14.3 of Exhibit 17

Experience Period Index Rate Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12

10 Earned Premiums for Latest Experience Period # 1,363,852.01 95,088.62 0.00 1,159.32 348,727.18 15,254.19 0.00 701,560.44 34,145.01 1,629.05 160,779.13 0.00 5,509.06

10A Incurred Claims for Latest Experience Period # 1,002,394.43 90,110.03 0.00 511.17 115,885.76 5,732.68 0.00 606,599.02 1,137.57 153.99 181,976.52 0.00 287.69

10B Member-Months for Latest Experience Period # 1,763.00 196.00 0.00 5.00 519.00 36.00 0.00 814.00 36.00 4.00 141.00 0.00 12.00

10C Average PMPM Incurred Claims [(10A)/(10B)] = (Initial Index PMPM) 568.57313 459.74505 0.00000 102.23400 223.28663 159.24111 0.00000 745.20764 31.59917 38.49750 1290.61362 0.00000 23.97417

11 Average Pricing Actuarial Value reflected in experience period 0.81008

12 AV Adjusted Experience Period Index Rate PMPM = [(10C) / (11)] 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151 701.87151

# Amounts should be prior to any adjustments for Federal Risk Adjustment and Healthy NY Stop-Loss Reimbursements, and should be consistent with the amounts reported in Column 14.7 of Exhibit 17 for the relevant market categories.

Market Wide Adjustments to the AV Adjusted Experience Period Index Rate All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12

13 Impact of adjusting experience period data to EHB benefit level ** 1.00000

14 Market wide adjustment for changes in provider network ** 1.00000

15 Market wide adjustment for fee schedule changes ** 0.96866

16 Market wide adjustment for utilization management changes ** 1.00000

17 Market wide adjustment for impact on claim costs from quality improvement and cost containment initiatives ** 1.00000

18 Claim trend projection factor (midpoint of experience period to mid point of rate applicability period) 1.13645

19 Federal Risk Adjustment Program Impact (less than 1.00 to reflect a recovery, more than 1.00 to reflect a payment to the pool) ** 1.00996

20 Impact of adjustments due to experience period claim data not being sufficiently credible ** 1.00000

21 Adjustment for changes in distribution of risk pool membership by rating regions (i.e., standard rating regions) ** 1.00000

22 Change in morbidity not reflected in the experience data that is known and quantifiable at the time of the rate filing ** 1.00000


23b

2020 Covid-19 Impact – Impact associated with state requirements that were intended to diagnose, treat, or

avoid contact with Covid-19 which were imposed during the 2020 calendar year, but not included in 2020

pricing. ** 1.00000

23c

2021 Covid-19 Impact – Expected impact associated with worsening morbidity and other costs resulting from

Covid-19 with respect to the 2021 calendar year. ** 1.00000

24 Covered Lives Assessment and Taxes 1.04837

25 PCORI, Risk Adjustment User Fee 1.00064

26 Expanded Urgent Care 1.01204

27 High Cost Risk Pool, Adjustment for credibility of data 1.11311

28 Impact of Market Wide Adjustments (= Product L13 through L27) 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796 1.32796

** Not Included in Claim Trend Adjustment

Plan Level Adjustments Average - All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12

29 Index Rate - After Marketwide Adjustments 932.0554 932.05543 932.05543 932.05543 932.05543 932.05543 932.05543 932.05543 932.05543 932.05543 932.05543 932.05543 932.05543

30 Pricing actuarial value (without induced demand factor) # 0.7775 0.64990 0.64990 0.64990 0.71900 0.71900 0.71900 0.81980 0.81980 0.81980 0.87800 0.87800 0.87800

31 Pricing actuarial value (only the induced demand factor) # 1.0660 1.00000 1.00000 1.00000 1.03000 1.03000 1.03000 1.08000 1.08000 1.08000 1.15000 1.15000 1.15000

32 Impact of provider network characteristics ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

33 Impact of delivery system characteristics ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

34 Impact of utilization management practices ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

35 Impact on claim costs from quality improvement and cost containment initiatives ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

36 Benefits in additional to EHB (greater than 1.00) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

37 Impact of eligibility categories (catastrophic plans only) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

38 Addition of Out of Network Benefit Option (e.g., POS or PPO, if applicable) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

39 Impact of Adjustment for NYS Stop Loss reimbursements on SG HNY 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

40 Impact of Age 26 / Age 29 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

41 Impact of Family Planning / No Family Planning 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

42 Impact of Dental vs No Dental 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

43 Premium Curve Adjustment 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

44 Impact of loss of CSR Funding (A common factor to be applied uniformly to all silver plans only - if applicable) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

45 Rating Region Factor 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

46a Other 1 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

46b Other 2 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

46c Other 3 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

46d Other 4 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

47 Impact of Plan Wide Adjustments (= Weighted Average Factor using Line 55a) 0.83204 0.64990 0.64990 0.64990 0.74057 0.74057 0.74057 0.88538 0.88538 0.88538 1.00970 1.00970 1.00970

# Reflects changes that impact an entire standard population (e.g., cost sharing and other changes that are not based on health status, age, gender or occupation).

## Beyond what is reflected in Market Wide adjustments

48a Adjusted Incurred Claims (Excluding Admin Expense and Profit) 1,367,215.50

Expenses

Weighted Average - All

Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12

49 Plan Expected Costs 775.51 605.74 605.74 605.74 690.25 690.25 690.25 825.23 825.23 825.23 941.10 941.10 941.10

50 FIXED EXPENSE: Administrative Costs (excluding Exchange user fees and profits) - to be expressed as a PMPM Amount ### 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000

51 VARIABLE EXPENSE: Administrative costs (excluding Exchange user fees and profits) - to be expressed as a percentage ### 13.200% 13.200% 13.200% 13.200% 13.200% 13.200% 13.200% 13.200% 13.200% 13.200% 13.200% 13.200% 13.200%

52 VARIABLE EXPENSE: Profit/Contribution to surplus margins - to be expressed as a percentage ### 1.500% 1.500% 1.500% 1.500% 1.500% 1.500% 1.500% 1.500% 1.500% 1.500% 1.500% 1.500% 1.500%

53 Total Expense Load as a percentage of Premium (= [L50 + (L51 + L52) * L56] / L56) 14.700% 14.700% 14.700% 14.700% 14.700% 14.700% 14.700% 14.700% 14.700% 14.700% 14.700% 14.700% 14.700%

### The combined factors for Administrative Costs (Fixed and Variable) and Profit/Contribution to surplus margins cannot exceed 18% (equivalent to a factor of 1.2195 ( = 1.00 / 0.82) applied to Line 49).

The "FIXED EXPENSE" amount in Line 50 must be entered as a PMPM and "VARIABLE EXPENSE" amounts in Lines 51 and 52 must be entered as a percentage of premium.

2020 Premium Rates and Membership All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12

54 2020 PMPM Rates (First Quarter 2020 rates for Small Group)*** 892.90 566.99 0.00 0.00 767.42 642.79 0.00 1,005.05 1,075.16 461.66 1,165.03 0.00 0.00

55 2020 Members as of 3/31/2020 (The total should tie to the 3/31/2020 Membership Survey Total) 147.00 19.00 0.00 0.00 37.00 6.00 0.00 57.00 3.00 2.00 23.00 0.00 0.00

55a 2020 Members as of 3/31/2020 - Only those enrolled in plans that will still be available in 2021 147.00 19.00 0.00 0.00 37.00 6.00 0.00 57.00 3.00 2.00 23.00 0.00 0.00

Calculation of Final 2021 Rates All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12

56 TOTAL PROJECTED INDEX RATE PMPM (= [(L49 + L50) / (1 - L51 - L52)]) 909.15 710.13 710.13 710.13 809.21 809.21 809.21 967.44 967.44 967.44 1,103.28 1,103.28 1,103.28

57 Percent Change in Premium Rates (= L56 / L54) 1.82% 25.25% 5.45% 25.89% -3.74% -10.02% 109.56% -5.30%

*** The information in the "General" Section above should also be completed for any 2020 plans that will no longer be available in 2021.

*** The Average PMPM rate for "All Plans" should be used for All Non-ACA Compliant Plans Weighted Average PMPM: 909.15

Difference From Line 56 Col D: 0.00

Overall Average Impact: 1.82% Percentage Difference: 0.0%

Appendix D

User Inputs for Plan Parameters

Use Integrated Medical and Drug Deductible?

Apply Inpatient Copay per Day? HSA/HRA Employer Contribution? Tiered Network Plan?

Apply Skilled Nursing Facility Copay per Day?

Use Separate MOOP for Medical and Drug Spending?

Indicate if Plan Meets CSR or Expanded Bronze AV Standard?

Desired Metal Tier

Medical Drug Combined Medical Drug Combined

Deductible ($) $0.00

Coinsurance (%, Insurer's Cost Share) 100.00%

MOOP ($) $2,000.00

MOOP if Separate ($)

Click Here for Important Instructions Tier 1 Tier 2

Type of BenefitSubject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical

Emergency Room Services $250.00

All Inpatient Hospital Services (inc. MH/SUD) $500.00

Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and

X-rays)$20.00

Specialist Visit $35.00

Mental/Behavioral Health and Substance Use Disorder Outpatient

Services$20.00

Imaging (CT/PET Scans, MRIs) $35.00

Speech Therapy $35.00

Occupational and Physical Therapy$35.00

Preventive Care/Screening/Immunization 100% $0.00 100% $0.00

Laboratory Outpatient and Professional Services $20.00

X-rays and Diagnostic Imaging $27.50

Skilled Nursing Facility $500.00

Outpatient Facility Fee (e.g., Ambulatory Surgery Center) $200.00

Outpatient Surgery Physician/Surgical Services $200.00

Drugs

Generics $10.00

Preferred Brand Drugs $30.00

Non-Preferred Brand Drugs $60.00

Specialty Drugs (i.e. high-cost) $60.00

Options for Additional Benefit Design Limits: Plan Description:

Set a Maximum on Specialty Rx Coinsurance Payments? Name: [Input Plan Name]

Specialty Rx Coinsurance Maximum: Plan HIOS ID: [Input Plan HIOS ID]

Set a Maximum Number of Days for Charging an IP Copay? Issuer HIOS ID: [Input Issuer HIOS ID]

# Days (1-10): AVC Version: 2021_1j

Begin Primary Care Cost-Sharing After a Set Number of Visits?

# Visits (1-10):

Begin Primary Care Deductible/Coinsurance After a Set Number of

Copays?

# Copays (1-10):

Output

Status/Error Messages: Calculation Successful.

Actuarial Value: 87.80%

Metal Tier: Platinum

Additional Notes:

Calculation Time: 0.1719 seconds

Draft 2021 AV Calculator

NOTE: Service-specific cost-sharing is applying for service(s) with fac/prof components, overriding outpatient inputs for those service(s).

Copay applies only after

deductible?

HSA/HRA Options Tiered Network Option

Annual Contribution Amount:2nd Tier Utilization:

1st Tier Utilization:

Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design

Tier 1 Tier 2

Calculate

All

All

All

All

All

All

All

All

All All

All All

Plan name: Healthfirst Platinum Total EPO







Desired Metal Tier


Deductible ($) $0.00


MOOP ($) $5,250.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical


All Inpatient Hospital Services (inc. MH/SUD) $500.00


X-rays)$25.00



Services$25.00







Skilled Nursing Facility $500.00

Outpatient Facility Fee (e.g., Ambulatory Surgery Center) $300.00

Outpatient Surgery Physician/Surgical Services $300.00

Drugs

Generics $10.00








# Days (1-10): 2021_1j


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:


Final 2021 AV Calculator

NOTE: Service-specific cost-sharing is applying for service(s) with fac/prof components, overriding outpatient inputs for those service(s).


deductible?





Tier 1 Tier 2

Calculate

All

All

All

All

All

All

All

All

All All

All All

Plan name: Healthfirst Gold Total EPO







Desired Metal Tier


Deductible ($) $4,300.00


MOOP ($) $8,150.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical


All Inpatient Hospital Services (inc. MH/SUD)


X-rays)$35.00



Services$35.00







Skilled Nursing Facility

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

Outpatient Surgery Physician/Surgical Services

Drugs

Generics $20.00








# Days (1-10): AVC Version: 2021_1j


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:


Draft 2021 AV Calculator


deductible?





Tier 1 Tier 2

Calculate

All

All

All

All

All

All

All

All

All All

All All

Plan name: Healthfirst Silver Total EPO







Desired Metal Tier


Deductible ($) $5,950.00


MOOP ($) $6,900.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical

Emergency Room Services

All Inpatient Hospital Services (inc. MH/SUD)


X-rays)

Specialist Visit


Services

Imaging (CT/PET Scans, MRIs)

Speech Therapy

Occupational and Physical Therapy


Laboratory Outpatient and Professional Services

X-rays and Diagnostic Imaging

Skilled Nursing Facility

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

Outpatient Surgery Physician/Surgical Services

Drugs

Generics

Preferred Brand Drugs

Non-Preferred Brand Drugs

Specialty Drugs (i.e. high-cost)





# Days (1-10): 2021_1j


# Visits (1-10):


Copays?

# Copays (1-10):

Output

Status/Error Messages: Expanded Bronze Standard (56% to 65%), Calculation Successful.


Metal Tier: Bronze

Additional Notes:


Final 2021 AV Calculator


deductible?





Tier 1 Tier 2

Calculate

All

All

All

All

All

All

All

All

All All

All All

Plan name: Healthfirst Bronze Total EPO

1

23

4

5

678910111213141516171819202122

23242526272829303132333435363738394041

4243444546474849

5051

A B C D E F G H I J K L M N O P Q R S TPr Unified Rate Review v5.2 [assistive technology users, please reference cell A1 for instructions] To add a product to Worksheet 2 - Plan Product Info, select the Add Product button or Ctrl + Shift + P.

To add a plan to Worksheet 2 - Plan Product Info, select the Add Plan button or Ctrl + Shift + L.Company Legal Name: Healthfirst Insurance Company, Inc. State: NY To validate, select the Validate button or Ctrl + Shift + I.HIOS Issuer ID: 61405 Market: Individual To finalize, select the Finalize button or Ctrl + Shift + F.

Effective Date of Rate Change(s): 1/1/2021

Section I: Experience Period DataExperience Period: 1/1/2019 to 12/31/2019

Total PMPM$1,237,399.00 $701.87

$0.00 $0.00$1,002,394.00 $568.57

$282,556.00 $160.27$1,363,852.00 $773.60

1,763

Section II: Projections

Benefit Category Experience Period Index Rate PMPM Cost Utilization Cost Utilization

Trended EHB Allowed Claims PMPM

Inpatient Hospital $194.25 1.054 1.000 1.054 1.000 $215.80Outpatient Hospital $55.66 1.054 1.000 1.054 1.000 $61.83Professional $169.50 1.054 1.000 1.054 1.000 $188.30Other Medical $17.28 1.054 1.000 1.054 1.000 $19.20Capitation $7.47 1.054 1.000 1.054 1.000 $8.30Prescription Drug $257.70 1.087 1.000 1.087 1.000 $304.49Total $701.86 $797.91

Morbidity Adjustment 1.000Demographic Shift 1.000Plan Design Changes 1.000Other 0.963Adjusted Trended EHB Allowed Claims PMPM for 1/1/2021 $768.39

Manual EHB Allowed Claims PMPM $708.86Applied Credibility % 100.00%

Projected Period TotalsProjected Index Rate for 1/1/2021 $768.39 $112,953.33Reinsurance $0.00 $0.00Risk Adjustment Payment/Charge -$6.99 -$1,027.53Exchange User Fees 0.00% $0.00Market Adjusted Index Rate $775.38 $113,980.86

Projected Member Months 147

Information Not Releasable to the Public Unless Authorized by Law: This information has not been publically disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Market Level Calculations (Same for all Plans)

Year 1 Trend Year 2 Trend

Allowed ClaimsReinsuranceIncurred Claims in Experience PeriodRisk AdjustmentExperience Period PremiumExperience Period Member Months

1 of 1

Press TAB and directional arro Product-Plan Data Collection [assistive technology users, please reference cell A1 for instructions] To add a product to Worksheet 2 - Plan Product Info, select the Add Product button or Ctrl + Shift + P.

To add a plan to Worksheet 2 - Plan Product Info, select the Add Plan button or Ctrl + Shift + L.

Company Legal Name: Healthfirst Insurance Company, Inc. State: NY To validate, select the Validate button or Ctrl + Shift + I.

HIOS Issuer ID: 61405 Market: Individual To finalize, select the Finalize button or Ctrl + Shift + F.Effective Date of Rate Change(s): 1/1/2021 To remove a product, navigate to the corresponding Product Name/Product ID field and select the Remove Product button or Ctrl + Shift + Q.

To remove a plan, navigate to the corresponding Plan Name/Plan ID field and select the Remove Plan button or Ctrl + Shift + A.

Field # Section I: General Product and Plan Information1.1 Product Name1.2 Product ID1.3 Plan Name Bronze Total EPO Bronze Total EPO Bronze Total EPO Silver Total EPO Silver Total EPO Silver Total EPO Gold Total EPO Gold Total EPO Gold Total EPO Platinum Total Platinum Total Platinum Total 1.4 Plan ID (Standard Component ID) 61405NY0020001 61405NY0020002 61405NY0020003 61405NY0020004 61405NY0020005 61405NY0020006 61405NY0020007 61405NY0020008 61405NY0020009 61405NY0020010 61405NY0020011 61405NY00200121.5 Metal Bronze Bronze Bronze Silver Silver Silver Gold Gold Gold Platinum Platinum Platinum1.6 AV Metal Value 0.650 0.650 0.650 0.719 0.719 0.719 0.820 0.820 0.820 0.878 0.878 0.8781.7 Plan Category Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing1.8 Plan Type EPO EPO EPO EPO EPO EPO EPO EPO EPO EPO EPO EPO1.9 Exchange Plan? No No No No No No No No No No No No

1.10 Effective Date of Proposed Rates 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/20211.11 Cumulative Rate Change % (over 12 mos prior) 9.80% 9.80% 9.80% 9.80% 9.80% 9.80% 9.80% 9.80% 9.80% 9.80% 9.80% 9.80%1.12 Product Rate Increase %1.13 Submission Level Rate Increase %

Worksheet 1 Totals Section II: Experience Period and Current Plan Level Information2.1 Plan ID (Standard Component ID) Total 61405NY0020001 61405NY0020002 61405NY0020003 61405NY0020004 61405NY0020005 61405NY0020006 61405NY0020007 61405NY0020008 61405NY0020009 61405NY0020010 61405NY0020011 61405NY0020012

$1,237,399 2.2 Allowed Claims $1,237,398 $143,911 $0 $816 $162,075 $8,018 $0 $733,245 $1,375 $186 $187,476 $0 $296$0 2.3 Reinsurance $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

2.4 Member Cost Sharing $235,002 $53,801 $0 $305 $46,189 $2,285 $0 $126,646 $237 $32 $5,499 $0 $82.5 Cost Sharing Reduction $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$1,002,394 2.6 Incurred Claims $1,002,396 $90,110 $0 $511 $115,886 $5,733 $0 $606,599 $1,138 $154 $181,977 $0 $288$282,556 2.7 Risk Adjustment Transfer Amount $282,556 $31,413 $0 $801 $83,180 $5,770 $0 $130,460 $5,770 $641 $22,598 $0 $1,923

$1,363,852 2.8 Premium $1,363,852 $95,089 $0 $1,159 $348,727 $15,254 $0 $701,560 $34,145 $1,629 $160,779 $0 $5,5091,763 2.9 Experience Period Member Months 1,763 196 0 5 519 36 0 814 36 4 141 0 12

2.10 Current Enrollment 152 19 1 1 37 6 1 57 3 2 23 1 12.11 Current Premium PMPM $863.53 $566.99 $0.01 $0.01 $767.42 $642.79 $0.01 $1,005.05 $1,075.16 $461.66 $1,165.03 $0.01 $0.012.12 Loss Ratio 60.88% 71.23% #DIV/0! 26.07% 26.83% 27.27% #DIV/0! 72.91% 2.85% 6.78% 99.24% #DIV/0! 3.88%

Per Member Per Month2.13 Allowed Claims $701.87 $734.24 #DIV/0! $163.20 $312.28 $222.72 #DIV/0! $900.79 $38.19 $46.50 $1,329.62 #DIV/0! $24.672.14 Reinsurance $0.00 $0.00 #DIV/0! $0.00 $0.00 $0.00 #DIV/0! $0.00 $0.00 $0.00 $0.00 #DIV/0! $0.002.15 Member Cost Sharing $133.30 $274.49 #DIV/0! $61.00 $89.00 $63.47 #DIV/0! $155.58 $6.58 $8.00 $39.00 #DIV/0! $0.672.16 Cost Sharing Reduction $0.00 $0.00 #DIV/0! $0.00 $0.00 $0.00 #DIV/0! $0.00 $0.00 $0.00 $0.00 #DIV/0! $0.002.17 Incurred Claims $568.57 $459.74 #DIV/0! $102.20 $223.29 $159.25 #DIV/0! $745.21 $31.61 $38.50 $1,290.62 #DIV/0! $24.002.18 Risk Adjustment Transfer Amount $160.27 $160.27 #DIV/0! $160.20 $160.27 $160.28 #DIV/0! $160.27 $160.28 $160.25 $160.27 #DIV/0! $160.252.19 Premium $773.60 $485.15 #DIV/0! $231.86 $671.92 $423.73 #DIV/0! $861.87 $948.47 $407.26 $1,140.28 #DIV/0! $459.09

Section III: Plan Adjustment Factors3.1 Plan ID (Standard Component ID) 61405NY0020001 61405NY0020002 61405NY0020003 61405NY0020004 61405NY0020005 61405NY0020006 61405NY0020007 61405NY0020008 61405NY0020009 61405NY0020010 61405NY0020011 61405NY00200123.2 Market Adjusted Index Rate3.3 AV and Cost Sharing Design of Plan 0.6499 0.6499 0.6499 0.7406 0.7406 0.7406 0.8854 0.8854 0.8854 1.0097 1.0097 1.00973.4 Provider Network Adjustment 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.00003.5 Benefits in Addition to EHB 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

Administrative Costs3.6 Administrative Expense 13.20% 13.20% 13.20% 13.20% 13.20% 13.20% 13.20% 13.20% 13.20% 13.20% 13.20% 13.20%3.7 Taxes and Fees 2.73% 2.73% 2.73% 2.73% 2.73% 2.73% 2.73% 2.73% 2.73% 2.73% 2.73% 2.73%3.8 Profit & Risk Load 1.50% 1.50% 1.50% 1.50% 1.50% 1.50% 1.50% 1.50% 1.50% 1.50% 1.50% 1.50%3.9 Catastrophic Adjustment 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

3.10 Plan Adjusted Index Rate $610.29 $610.29 $610.29 $695.47 $695.47 $695.47 $831.44 $831.44 $831.44 $948.17 $948.17 $948.17

3.11 Age Calibration Factor 1.00003.12 Geographic Calibration Factor 1.00003.13 Tobacco Calibration Factor 1.00003.14 Calibrated Plan Adjusted Index Rate $610.29 $610.29 $610.29 $695.47 $695.47 $695.47 $831.44 $831.44 $831.44 $948.17 $948.17 $948.17

Section IV: Projected Plan Level Information4.1 Plan ID (Standard Component ID) Total 61405NY0020001 61405NY0020002 61405NY0020003 61405NY0020004 61405NY0020005 61405NY0020006 61405NY0020007 61405NY0020008 61405NY0020009 61405NY0020010 61405NY0020011 61405NY00200124.2 Allowed Claims $135,752 $17,504 $0 $0 $34,136 $5,536 $0 $52,678 $2,772 $1,848 $21,278 $0 $04.3 Reinsurance $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $04.4 Member Cost Sharing $22,782 $6,128 $0 $0 $8,856 $1,436 $0 $6,038 $318 $212 -$206 $0 $04.5 Cost Sharing Reduction $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $04.6 Incurred Claims $112,970 $11,376 $0 $0 $25,280 $4,100 $0 $46,640 $2,454 $1,636 $21,484 $0 $04.7 Risk Adjustment Transfer Amount -$1,028 -$133 $0 $0 -$259 -$42 $0 -$398 -$21 -$14 -$161 $0 $04.8 Premium $133,645 $13,493 $0 $0 $29,941 $4,855 $0 $55,144 $2,902 $1,935 $25,375 $0 $04.9 Projected Member Months 147 19 0 0 37 6 0 57 3 2 23 0 0

4.10 Loss Ratio 85.19% 85.15% #DIV/0! #DIV/0! 85.17% 85.18% #DIV/0! 85.19% 85.17% 85.17% 85.21% #DIV/0! #DIV/0!Per Member Per Month

4.11 Allowed Claims $923.48 $921.26 #DIV/0! #DIV/0! $922.59 $922.67 #DIV/0! $924.18 $924.00 $924.00 $925.13 #DIV/0! #DIV/0!4.12 Reinsurance $0.00 $0.00 #DIV/0! #DIV/0! $0.00 $0.00 #DIV/0! $0.00 $0.00 $0.00 $0.00 #DIV/0! #DIV/0!4.13 Member Cost Sharing $154.98 $322.53 #DIV/0! #DIV/0! $239.35 $239.33 #DIV/0! $105.93 $106.00 $106.00 -$8.96 #DIV/0! #DIV/0!4.14 Cost Sharing Reduction $0.00 $0.00 #DIV/0! #DIV/0! $0.00 $0.00 #DIV/0! $0.00 $0.00 $0.00 $0.00 #DIV/0! #DIV/0!4.15 Incurred Claims $768.50 $598.74 #DIV/0! #DIV/0! $683.24 $683.33 #DIV/0! $818.25 $818.00 $818.00 $934.09 #DIV/0! #DIV/0!4.16 Risk Adjustment Transfer Amount -$6.99 -$7.00 #DIV/0! #DIV/0! -$7.00 -$7.00 #DIV/0! -$6.98 -$7.00 -$7.00 -$7.00 #DIV/0! #DIV/0!4.17 Premium $909.15 $710.13 #DIV/0! #DIV/0! $809.21 $809.21 #DIV/0! $967.44 $967.44 $967.44 $1,103.28 #DIV/0! #DIV/0!

1.00001.00001.0000

$775.38

Product/Plan Level Calculations

HFIC Individual 61405NY002

9.79%9.79%

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Rating Area Rating FactorRating Area 4 1.0000Rating Area 8 1.0310