HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 1

Rates Effective 1/1/2020

Index:

Page # Description

1 Overview

2 Region Definition

3 Commission Schedules

4 Rate Calculation Examples

5 Expected Medical Loss Ratios

6-16 Benefit Summary Small Group Plans

17-56 Small Group Rates

Overview:

The rates contained within this rate manual are for use the small group markets. The group

medical and pharmacy rates are effective 1/1/2020 through 12/31/2020 and roll on a

quarterly basis. The rates are guaranteed for one year from the effective date of the group's

policy. For groups, the rates are applicable based on the quarter in which the effective date

for the plan year begins. The county the group is located in from the region definition should

be used to pick the applicable regional rate. The rates included in this rate manual are filed

under HealthNow policy form numbers: CN1C3S0441_0519, CH1C4F0452_0519,

CG1C4S0469_0519.

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 2

Rates Effective 1/1/2020

Region Definition:

Geographic Factor

Region Counties Small Group

1 Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady,

Schoharie, Warren, Washington 1.161

2 Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming

0.942

7 Clinton, Essex 1.161

Notes:

1. Region #7 includes more counties than listed but HealthNow will only participate within the listed counties. 2. Regions #1 and #7 use pooled experience for credibility.

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 3

Rates Effective 1/1/2020

Small Group Commission Schedules:

Western New York

New/Existing Business

Product Commission

PPO

POS

HMO

Northeastern New York

New Business

Rating Commission

Community Rated 3.75% POS, EPO, PPO, HMO, HDHP of monthly paid premium.

Existing Business

Rating Commission

Community Rated 3.75% POS, EPO, PPO, HMO, HDHP.

Effective first of month following BOR appointment.

3.75% of monthly paid premium.

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 4

Rates Effective 1/1/2020

Small Group Rate Calculation Example:

Rate Calculation Example - Small Group

The following Steps are used to calculate premium rates.

Small Group

Bronze POS Classic; Individual ; Age 26 ; Quarter 1

Region 1 Region 2 Region 7

a Projected Index Rate 396.40 325.91 396.40

b Step Up Factor 1.183 1.183 1.183

d Tier Factor Rate (single) 1.00 1.00 1.00

Final Rate = a*b*c*d 468.80 385.43 468.80

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 5

Rates Effective 1/1/2020

Medical Loss Ratios

New York State Loss Ratio

Market Loss Ratio

Small Group 83.3%

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 6 Rate Manual - Page 7

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Metal Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum

PlanPlatinum POS

Classic

Platinum Make

AvailablePlatinum PPO Plus Platinum EX Plus Platinum POS Plus

Platinum Plus

align Tiered

Platinum Plus

align Tiered

Platinum Plus

focus Tiered

Platinum Plus

focus Tiered

Region Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2

Standard/ NonStandard Non-Standard Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Availability Off Both Off Off Off Off Off Off Off

AV

First Dollar $0 $0 $0 $0 $0 $0 $0 $0 $0

Deductible (single) $0 $0 $0 $0 $0 $0 $1,500 $0 $1,500

Coinsurance (Member) N/A N/A N/A N/A N/A N/A 39% N/A 39%

OOP Maximum (single) $2,000 $2,000 $3,500 $3,500 $3,500 $3,500 $3,500 $3,500 $3,500

Deductible Applies to Rx No No No No No No Yes No Yes

Embedded Deductible Yes Yes Yes Yes Yes Yes Yes Yes Yes

Inpatient Hospital

ASA Rehab $500* $500* $500* $500* $500* $500* 50% $500* 50%

Detox $500* $500* $500* $500* $500* $500* 50% $500* 50%

Maternity $500* $500* $500* $500* $500* $500* 50% $500* 50%

Med/Surg $500* $500* $500* $500* $500* $500* 50% $500* 50%

Mental Health $500* $500* $500* $500* $500* $500* 50% $500* 50%

Newborn $500* $500* $500* $500* $500* $500* 50% $500* 50%

Residential Care $500* $500* $500* $500* $500* $500* 50% $500* 50%

SNF $500* $500* $500* $500* $500* $500* 50% $500* 50%

Outpatient Facility

Preventive* $0* $0* $0* $0* $0* $0* $0* $0* $0*

Abortion - Elective $100* $100* $150* $150* $150* $150* 50% $150* 50%

Abortion - Non Elective $0* $0* $0* $0* $0* $0* $0* $0* $0*

Cardiology $35* $35* $25* $25* $25* $25* 50% $25* 50%

Chemotherapy $35* $35* $25* $25* $25* $25* 50% $25* 50%

Diagnostic $35* $35* $25* $25* $25* $25* 50% $25* 50%

Dialysis $35* $35* $25* $25* $25* $25* 50% $25* 50%

Emergency Room $100* $100* $150* $150* $150* $150* $150 $150* $150

Home Health $15* $15* $5* $5* $5* $5* 50% $5* 50%

Hospice $15* $15* $5* $5* $5* $5* 50% $5* 50%

Infusion Therapy $15* $15* $5* $5* $5* $5* 50% $5* 50%

Laboratory Tests $35* $35* $0* $0* $0* $0* 50% $0* 50%

Mental Health / Substance Abuse $15* $15* $5* $5* $5* $5* 50% $5* 50%

Outpatient Surgery $100* $100* $150* $150* $150* $150* 50% $150* 50%

Pre-Admission Testing $0* $0* $0* $0* $0* $0* 50% $0* 50%

PT / OT / ST $15* $25* $5* $5* $5* $5* 50% $5* 50%

Radiation Therapy $15* $15* $5* $5* $5* $5* 50% $5* 50%

Radiology $35* $35* $25* $25* $25* $25* 50% $25* 50%

Radiology - Advanced $35* $35* $25* $25* $25* $25* 50% $25* 50%

Urgent Care $55* $55* $40* $40* $40* $40* $40 $40* $40

Other $35* $35* $25* $25* $25* $25* 50% $25* 50%

Professional

Preventive* $0* $0* $0* $0* $0* $0* $0* $0* $0*

Office/Home Visit - PCP $15* $15* $5* $5* $5* $5* 50% $5* 50%

Office/Home Visit - SCP $35* $35* $25* $25* $25* $25* 50% $25* 50%

Advanced Radiology $35* $35* $25* $25* $25* $25* 50% $25* 50%

Allergy Shots $25* $25* $15* $15* $15* $15* 50% $15* 50%

Allergy Tests $25* $25* $15* $15* $15* $15* 50% $15* 50%

Ambulance $100* $100* $150* $150* $150* $150* $150 $150* $150

Anesthesia $0* $0* $0* $0* $0* $0* 50% $0* 50%

Cardiovascular $35* $35* $25* $25* $25* $25* 50% $25* 50%

Chemotherapy $35* $35* $25* $25* $25* $25* 50% $25* 50%

Chiropractic $35* $35* $25* $25* $25* $25* 50% $25* 50%

Consults $25* $25* $15* $15* $15* $15* 50% $15* 50%

Diabetic Drugs/Supplies $15* $15* $5* $5* $5* $5* 50% $5* 50%

Diabetic Education $15* $15* $5* $5* $5* $5* 50% $5* 50%

Dialysis $35* $35* $25* $25* $25* $25* 50% $25* 50%

DME and Supplies 50%* 50%* 50%* 50%* 50%* 50%* 50% 50%* 50%

Facility Visits $0* $0* $0* $0* $0* $0* 50% $0* 50%

Hearing Aid 50%* 50%* 50%* 50%* 50%* 50%* 50% 50%* 50%

Hearing Exam $25* $25* $15* $15* $15* $15* 50% $15* 50%

Home Care $15* $15* $5* $5* $5* $5* 50% $5* 50%

Maternity $15* $15* $5* $5* $5* $5* 50% $5* 50%

Mental Health $15* $15* $5* $5* $5* $5* 50% $5* 50%

Office-Administered Drugs $25* $25* $15* $15* $15* $15* 50% $15* 50%

Pathology / Laboratory $35* $35* $0* $0* $0* $0* 50% $0* 50%

Prosthetics & Orthotics 50%* 50%* 50%* 50%* 50%* 50%* 50% 50%* 50%

PT/OT/ST $15* $25* $5* $5* $5* $5* 50% $5* 50%

Radiation Therapy $15* $15* $5* $5* $5* $5* 50% $5* 50%

Radiology $35* $35* $25* $25* $25* $25* 50% $25* 50%

Substance Abuse $15* $15* $5* $5* $5* $5* 50% $5* 50%

Surgery - Facility (IP) $0* $0* $0* $0* $0* $0* 50% $0* 50%

Surgery - Facility (OP) $100* $100* $150* $150* $150* $150* 50% $150* 50%

Surgery - Office $25* $25* $15* $15* $15* $15* 50% $15* 50%

Vision - Exam $25* $25* $15* $15* $15* $15* 50% $15* 50%

Vision - Lenses & Frames 10%* 10%* 10%* 10%* 10%* 10%* 10% 10%* 10%

Other $35* $35* $25* $25* $25* $25* 50% $25* 50%

Drug

Generic $10* $10* $5* $5* $5* $5* $5 $5* $5

Brand $30* $30* $25* $25* $25* $25* $30 $25* $30

Non Formulary $60* $60* 50%* 50%* 50%* 50%* 50% 50%* 50%

Supplies $15* $15* $5* $5* $5* $5* 50% $5* 50%

Out of Network

First Dollar $0 $0 $0 $0 $0 $0 $0 $0 $0

Deductible (single) $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000

Coinsurance (Member) 50% 20% 50% 50% 50% 50% 50% 50% 50%

OOP Maximum (single) $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 7 Rate Manual - Page 8

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Platinum Platinum Gold Gold Gold Gold Gold Gold Gold Platinum Plus

align Select

Platinum Plus

focus SelectGold POS Classic Gold Healthy NY Gold Aqua Gold Complete Gold PPO 7100 Gold POS 7100EX Gold POS 7100

Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2

Non-Standard Non-Standard Non-Standard Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Off Off Off Both Off Off Off Off Off

$0 $0 $0 $0 $600 $0 $0 $0 $0

$0 $0 $600 $600 $1,000 $3,000 $1,400 $1,400 $1,400

N/A N/A N/A N/A 40% 0% N/A N/A N/A

$3,500 $3,500 $4,000 $4,000 $8,150 $3,000 $3,900 $3,900 $3,900

No No No No No Yes Yes Yes Yes

Yes Yes Yes Yes Yes No No No No

$500* $500* $1,000 $1,000 40% $0 $500 $500 $500

$500* $500* $1,000 $1,000 40% $0 $500 $500 $500

$500* $500* $1,000 $1,000 40% $0 $500 $500 $500

$500* $500* $1,000 $1,000 40% $0 $500 $500 $500

$500* $500* $1,000 $1,000 40% $0 $500 $500 $500

$500* $500* $1,000 $1,000 40% $0 $500 $500 $500

$500* $500* $1,000 $1,000 40% $0 $500 $500 $500

$500* $500* $1,000 $1,000 40% $0 $500 $500 $500

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$150* $150* $100 $100 40% $0 $150 $150 $150

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$25* $25* $40 $40 40% $0 $40 $40 $40

$25* $25* $40 $40 40% $0 $40 $40 $40

$25* $25* $40 $40 40% $0 $40 $40 $40

$25* $25* $40 $40 40% $0 $40 $40 $40

$150* $150* $150 $150 40% $0 $200 $200 $200

$5* $5* $25 $25 40% $0 $20 $20 $20

$5* $5* $25 $25 40% $0 $20 $20 $20

$5* $5* $25 $25 40% $0 $20 $20 $20

$0* $0* $40 $40 40% $0 $40 $40 $40

$5* $5* $25 $25 40% $0 $20 $20 $20

$150* $150* $100 $100 40% $0 $150 $150 $150

$0* $0* $0 $0 40% $0 $0 $0 $0

$5* $5* $25 $30 40% $0 $20 $20 $20

$5* $5* $25 $25 40% $0 $20 $20 $20

$25* $25* $40 $40 40% $0 $40 $40 $40

$25* $25* $40 $40 40% $0 $40 $40 $40

$40* $40* $60 $60 40% $0 $50 $50 $50

$25* $25* $40 $40 40% $0 $40 $40 $40

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$5* $5* $25 $25 40% $0 $20 $20 $20

$25* $25* $40 $40 40% $0 $40 $40 $40

$25* $25* $40 $40 40% $0 $40 $40 $40

$15* $15* $33 $33 40% $0 $30 $30 $30

$15* $15* $33 $33 40% $0 $30 $30 $30

$150* $150* $150 $150 40% $0 $200 $200 $200

$0* $0* $0 $0 40% $0 $0 $0 $0

$25* $25* $40 $40 40% $0 $40 $40 $40

$25* $25* $40 $40 40% $0 $40 $40 $40

$25* $25* $40 $40 40% $0 $40 $40 $40

$15* $15* $33 $33 40% $0 $30 $30 $30

$5* $5* $25 $25 40% $0 $20 $20 $20

$5* $5* $25 $25 40% $0 $20 $20 $20

$25* $25* $40 $40 40% $0 $40 $40 $40

50%* 50%* 50% 50% 40% $0 50% 50% 50%

$0* $0* $0 $0 40% $0 $0 $0 $0

50%* 50%* 50% 50% 40% $0 50% 50% 50%

$15* $15* $33 $33 40% $0 $30 $30 $30

$5* $5* $25 $25 40% $0 $20 $20 $20

$5* $5* $25 $25 40% $0 $20 $20 $20

$5* $5* $25 $25 40% $0 $20 $20 $20

$15* $15* $33 $33 40% $0 $30 $30 $30

$0* $0* $40 $40 40% $0 $40 $40 $40

50%* 50%* 50% 50% 40% $0 50% 50% 50%

$5* $5* $25 $30 40% $0 $20 $20 $20

$5* $5* $25 $25 40% $0 $20 $20 $20

$25* $25* $40 $40 40% $0 $40 $40 $40

$5* $5* $25 $25 40% $0 $20 $20 $20

$0* $0* $0 $0 40% $0 $0 $0 $0

$150* $150* $100 $100 40% $0 $150 $150 $150

$15* $15* $33 $33 40% $0 $30 $30 $30

$15* $15* $33 $33 40% $0 $30 $30 $30

10%* 10%* 20% 20% 20% 20% 20% 20% 20%

$25* $25* $40 $40 40% $0 $40 $40 $40

$5* $5* $10* $10* $15* $0 $5 $5 $5

$25* $25* $35* $35* $50* $0 $30 $30 $30

50%* 50%* $70* $70* 50%* $0 50% 50% 50%

$5* $5* $25 $25 40% $0 $20 $20 $20

$0 $0 $0 N/A $0 $0 $0 $0 $0

$5,000 $5,000 $5,000 N/A $5,000 $5,000 $5,000 $5,000 $5,000

50% 50% 50% N/A 50% 50% 50% 50% 50%

$10,000 $10,000 $10,000 N/A $10,000 $10,000 $10,000 $10,000 $10,000

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 8 Rate Manual - Page 9

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Gold Gold Gold Gold Gold Gold Silver Silver Silver Gold 7100 align

Tiered

Gold 7100 align

Tiered

Gold 7100 focus

Tiered

Gold 7100 focus

Tiered

Gold 7100 align

Select

Gold 7100 focus

SelectSilver POS Classic Silver Aqua Silver PPO 7100

Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2

Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Off Off Off Off Off Off Off Off Off

$0 $0 $0 $0 $0 $0 $0 $300 $0

$1,400 $1,400 $1,400 $1,400 $1,400 $1,400 $1,300 $2,500 $1,900

N/A 40% N/A 40% N/A N/A N/A 50% N/A

$3,900 $3,900 $3,900 $3,900 $3,900 $3,900 $7,900 $8,150 $6,900

Yes Yes Yes Yes Yes Yes No No Yes

No No No No No No Yes Yes No

$500 50% $500 50% $500 $500 $1,500 50% $750

$500 50% $500 50% $500 $500 $1,500 50% $750

$500 50% $500 50% $500 $500 $1,500 50% $750

$500 50% $500 50% $500 $500 $1,500 50% $750

$500 50% $500 50% $500 $500 $1,500 50% $750

$500 50% $500 50% $500 $500 $1,500 50% $750

$500 50% $500 50% $500 $500 $1,500 50% $750

$500 50% $500 50% $500 $500 $1,500 50% $750

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$150 50% $150 50% $150 $150 $150 50% $150

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$40 50% $40 50% $40 $40 $50 50% $50

$40 50% $40 50% $40 $40 $50 50% $50

$40 50% $40 50% $40 $40 $50 50% $50

$40 50% $40 50% $40 $40 $50 50% $50

$200 $200 $200 $200 $200 $200 $250 50% $250

$20 50% $20 50% $20 $20 $30 50% $25

$20 50% $20 50% $20 $20 $30 50% $25

$20 50% $20 50% $20 $20 $30 50% $25

$40 50% $40 50% $40 $40 $50 50% $50

$20 50% $20 50% $20 $20 $30 50% $25

$150 50% $150 50% $150 $150 $150 50% $150

$0 50% $0 50% $0 $0 $0 50% $0

$20 50% $20 50% $20 $20 $30 50% $25

$20 50% $20 50% $20 $20 $30 50% $25

$40 50% $40 50% $40 $40 $50 50% $50

$40 50% $40 50% $40 $40 $50 50% $50

$50 $50 $50 $50 $50 $50 $70 50% $75

$40 50% $40 50% $40 $40 $50 50% $50

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$20 50% $20 50% $20 $20 $30 50% $25

$40 50% $40 50% $40 $40 $50 50% $50

$40 50% $40 50% $40 $40 $50 50% $50

$30 50% $30 50% $30 $30.00 $40.00 50% $37.50

$30 50% $30 50% $30 $30.00 $40.00 50% $37.50

$200 $200 $200 $200 $200 $200 $250 50% $250

$0 50% $0 50% $0 $0 $0 50% $0

$40 50% $40 50% $40 $40 $50 50% $50

$40 50% $40 50% $40 $40 $50 50% $50

$40 50% $40 50% $40 $40 $50 50% $50

$30 50% $30 50% $30 $30.00 $40.00 50% $37.50

$20 50% $20 50% $20 $20 $30 50% $25

$20 50% $20 50% $20 $20 $30 50% $25

$40 50% $40 50% $40 $40 $50 50% $50

50% 50% 50% 50% 50% 50% 50% 50% 50%

$0 50% $0 50% $0 $0 $0 50% $0

50% 50% 50% 50% 50% 50% 50% 50% 50%

$30 50% $30 50% $30 $30 $40 50% $37.50

$20 50% $20 50% $20 $20 $30 50% $25

$20 50% $20 50% $20 $20 $30 50% $25

$20 50% $20 50% $20 $20 $30 50% $25

$30 50% $30 50% $30 $30.00 $40.00 50% $37.50

$40 50% $40 50% $40 $40 $50 50% $50

50% 50% 50% 50% 50% 50% 50% 50% 50%

$20 50% $20 50% $20 $20 $30 50% $25

$20 50% $20 50% $20 $20 $30 50% $25

$40 50% $40 50% $40 $40 $50 50% $50

$20 50% $20 50% $20 $20 $30 50% $25

$0 50% $0 50% $0 $0 $0 50% $0

$150 50% $150 50% $150 $150 $150 50% $150

$30 50% $30 50% $30 $30.00 $40.00 50% $37.50

$30 50% $30 50% $30 $30 $40 50% $38

20% 20% 20% 20% 20% 20% 30% 30% 30%

$40 50% $40 50% $40 $40 $50 50% $50

$5 $5 $5 $5 $5 $5 $10* $15* $5

$30 $30 $30 $30 $30 $30 $35* $50* $30

50% 50% 50% 50% 50% 50% $70* 50%* 50%

$20 50% $20 50% $20 $20 $30 50% $25

$0 $0 $0 $0 $0 $0 $0 $0 $0

$5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000

50% 50% 50% 50% 50% 50% 50% 50% 50%

$10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 9 Rate Manual - Page 10

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Silver Silver Silver Silver Silver Silver Silver Silver Silver

Silver POS 7100EX Silver POS 7100Silver 7100 align

Tiered

Silver 7100 align

Tiered

Silver 7100 focus

Tiered

Silver 7100 focus

Tiered

Silver 7100 align

Select

Silver 7100 focus

SelectSilver PPO 8100

Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2

Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Off Off Off Off Off Off Off Off Off

$0 $0 $0 $0 $0 $0 $0 $0 $0

$1,900 $1,900 $1,900 $5,000 $1,900 $5,000 $1,900 $1,900 $2,900

N/A N/A N/A 40% N/A 40% N/A N/A 40%

$6,900 $6,900 $6,900 $6,900 $6,900 $6,900 $6,900 $6,900 $6,900

Yes Yes Yes Yes Yes Yes Yes Yes Yes

No No No No No No No No No

$750 $750 $750 50% $750 50% $750 $750 40%

$750 $750 $750 50% $750 50% $750 $750 40%

$750 $750 $750 50% $750 50% $750 $750 40%

$750 $750 $750 50% $750 50% $750 $750 40%

$750 $750 $750 50% $750 50% $750 $750 40%

$750 $750 $750 50% $750 50% $750 $750 40%

$750 $750 $750 50% $750 50% $750 $750 40%

$750 $750 $750 50% $750 50% $750 $750 40%

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$150 $150 $150 50% $150 50% $150 $150 40%

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$50 $50 $50 50% $50 50% $50 $50 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$250 $250 $250 $250 $250 $250 $250 $250 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$150 $150 $150 50% $150 50% $150 $150 40%

$0 $0 $0 50% $0 50% $0 $0 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$75 $75 $75 $75 $75 $75 $75 $75 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$25 $25 $25 50% $25 50% $25 $25 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$37.50 $37.50 $37.50 50% $37.50 50% $37.50 $38 40%

$37.50 $37.50 $37.50 50% $37.50 50% $37.50 $38 40%

$250 $250 $250 $250 $250 $250 $250 $250 40%

$0 $0 $0 50% $0 50% $0 $0 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$37.50 $37.50 $37.50 50% $37.50 50% $37.50 $38 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$50 $50 $50 50% $50 50% $50 $50 40%

50% 50% 50% 50% 50% 50% 50% 50% 40%

$0 $0 $0 50% $0 50% $0 $0 40%

50% 50% 50% 50% 50% 50% 50% 50% 40%

$37.50 $37.50 $37.50 50% $37.50 50% $37.50 $38 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$37.50 $37.50 $37.50 50% $37.50 50% $37.50 $38 40%

$50 $50 $50 50% $50 50% $50 $50 40%

50% 50% 50% 50% 50% 50% 50% 50% 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$50 $50 $50 50% $50 50% $50 $50 40%

$25 $25 $25 50% $25 50% $25 $25 40%

$0 $0 $0 50% $0 50% $0 $0 40%

$150 $150 $150 50% $150 50% $150 $150 40%

$37.50 $37.50 $37.50 50% $37.50 50% $37.50 $38 40%

$38 $38 $38 50% $38 50% $37.50 $38 40%

30% 30% 30% 30% 30% 30% 30% 30% 30%

$50 $50 $50 50% $50 50% $50 $50 40%

$5 $5 $5 $5 $5 $5 $5 $5 $5

$30 $30 $30 $30 $30 $30 $30 $30 $30

50% 50% 50% 50% 50% 50% 50% 50% 50%

$25 $25 $25 50% $25 50% $25 $25 40%

$0 $0 $0 $0 $0 $0 $0 $0 $0

$5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000

50% 50% 50% 50% 50% 50% 50% 50% 50%

$10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 10 Rate Manual - Page 11

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Silver Silver Silver Silver Silver Silver Silver Silver Bronze Bronze

Silver POS 8100EX Silver POS 8100Silver 8100 align

Tiered

Silver 8100 align

Tiered

Silver 8100 focus

Tiered

Silver 8100 focus

Tiered

Silver 8100 align

Select

Silver 8100 focus

Select

Bronze POS

ClassicBronze 8100EX

Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2

Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Off Off Off Off Off Off Off Off Off Off

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$2,900 $2,900 $2,900 $5,000 $2,900 $5,000 $2,900 $2,900 $4,425 $6,900

40% 40% 40% 40% 40% 40% 40% 40% 50% 0%

$6,900 $6,900 $6,900 $6,900 $6,900 $6,900 $6,900 $6,900 $8,150 $6,900

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

No No No No No No No No Yes Yes

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

$0* $0* $0* $0* $0* $0* $0* $0* $0* $0*

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

$0* $0* $0* $0* $0* $0* $0* $0* $0* $0*

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 35% 40% 35% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 35% 40% 35% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

$0* $0* $0* $0* $0* $0* $0* $0* $0* $0*

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 35% 40% 35% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

30% 30% 30% 30% 30% 30% 30% 30% 50% 50%

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

$5 $5 $5 $5 $5 $5 $5 $5 $10 $0

$30 $30 $30 $30 $30 $30 $30 $30 $35 $0

50% 50% 50% 50% 50% 50% 50% 50% $70 $0

40% 40% 40% 50% 40% 50% 40% 40% 50% 0%

$0 $0 $0 $0 $0 $0 $0 $0 $0 N/A

$5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 N/A

50% 50% 50% 50% 50% 50% 50% 50% 50% N/A

$10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 N/A

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 11

Rates Effective 1/1/2020

Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze Bronze

Bronze HMO 8100Bronze 8100 align

Select

Bronze 8100 focus

Select

Bronze align

Tiered

Bronze align

Tiered

Bronze focus

Tiered

Bronze focus

Tiered

Bronze align

Select

Bronze focus

Select

Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2 Region #2

Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Off Off Off Off Off Off Off Off Off

$0 $0 $0 $0 $0 $0 $0 $0 $0

$6,900 $6,900 $6,900 $8,000 $8,150 $8,000 $8,150 $8,000 $8,000

0% 0% 0% 50% 17% 50% 17% 50% 50%

$6,900 $6,900 $6,900 $8,150 $8,150 $8,150 $8,150 $8,150 $8,150

Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

$0* $0* $0* $0* $0* $0* $0* $0* $0*

0% 0% 0% 50% 0% 50% 0% 50% 50%

$0* $0* $0* $0* $0* $0* $0* $0* $0*

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 50% 50% 50% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 50% 50% 50% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

$0* $0* $0* $0* $0* $0* $0* $0* $0*

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 50% 50% 50% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

50% 50% 50% 50% 50% 50% 50% 50% 50%

0% 0% 0% 50% 0% 50% 0% 50% 50%

$0 $0 $0 $10 $10 $10 $10 $10 $10

$0 $0 $0 $1 $1 $1 $1 $1 $1

$0 $0 $0 $1 $1 $1 $1 $1 $1

0% 0% 0% 50% 0% 50% 0% 50% 50%

N/A N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A N/A

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 12 Rate Manual - Page 13

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Metal Platinum Platinum Platinum Platinum Platinum Platinum Gold Gold Gold

PlanPlatinum POS

Classic

Platinum HMO

Classic

Platinum Make

AvailablePlatinum PPO Platinum EX Platinum Radius Gold POS Classic Gold HMO Classic Gold Healthy NY

Region Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7

Standard/ NonStandard Non-Standard Non-Standard Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Availability Off Off Both Off Off Off Off Off Off

AV

First Dollar $0 $0 $0 $0 $0 $0 $0 $0 $0

Deductible (single) $0 $0 $0 $0 $0 $0 $600 $600 $600

Coinsurance (Member) N/A N/A N/A N/A N/A N/A N/A N/A N/A

OOP Maximum (single) $2,000 $2,000 $2,000 $5,000 $5,000 $5,000 $4,000 $4,000 $4,000

Deductible Applies to Rx No No No No No No No No No

Embedded Deductible Yes Yes Yes Yes Yes Yes Yes Yes Yes

Inpatient Hospital

ASA Rehab $500* $500* $500* $250* $250* $250* $1,000 $1,000 $1,000

Detox $500* $500* $500* $250* $250* $250* $1,000 $1,000 $1,000

Maternity $500* $500* $500* $250* $250* $250* $1,000 $1,000 $1,000

Med/Surg $500* $500* $500* $250* $250* $250* $1,000 $1,000 $1,000

Mental Health $500* $500* $500* $250* $250* $250* $1,000 $1,000 $1,000

Newborn $500* $500* $500* $250* $250* $250* $1,000 $1,000 $1,000

Residential Care $500* $500* $500* $250* $250* $250* $1,000 $1,000 $1,000

SNF $500* $500* $500* $250* $250* $250* $1,000 $1,000 $1,000

Outpatient Facility

Preventive* $0* $0* $0* $0* $0* $0* $0* $0* $0*

Abortion - Elective $100* $100* $100* $100* $100* $100* $100 $100 $100

Abortion - Non Elective $0* $0* $0* $0* $0* $0* $0* $0* $0*

Cardiology $35* $35* $35* $20* $20* $20* $40 $40 $40

Chemotherapy $35* $35* $35* $20* $20* $20* $40 $40 $40

Diagnostic $35* $35* $35* $20* $20* $20* $40 $40 $40

Dialysis $35* $35* $35* $20* $20* $20* $40 $40 $40

Emergency Room $100* $100* $100* $100* $100* $100* $150 $150 $150

Home Health $15* $15* $15* $15* $15* $15* $25 $25 $25

Hospice $15* $15* $15* $15* $15* $15* $25 $25 $25

Infusion Therapy $15* $15* $15* $15* $15* $15* $25 $25 $25

Laboratory Tests $15* $15* $35* $15* $15* $15* $25 $25 $40

Mental Health / Substance Abuse $15* $15* $15* $15* $15* $15* $25 $25 $25

Outpatient Surgery $100* $100* $100* $100* $100* $100* $100 $100 $100

Pre-Admission Testing $0* $0* $0* $0* $0* $0* $0 $0 $0

PT / OT / ST $15* $15* $25* $15* $15* $15* $25 $25 $25

Radiation Therapy $15* $15* $15* $15* $15* $15* $25 $25 $25

Radiology $35* $35* $35* $20* $20* $20* $40 $40 $40

Radiology - Advanced $35* $35* $35* $20* $20* $20* $40 $40 $40

Urgent Care $55* $55* $55* $50* $50* $50* $60 $60 $60

Other $35* $35* $35* $20* $20* $20* $40 $40 $40

Professional

Preventive* $0* $0* $0* $0* $0* $0* $0* $0* $0*

Office/Home Visit - PCP $15* $15* $15* $15* $15* $15* $25 $25 $25

Office/Home Visit - SCP $35* $35* $35* $20* $20* $20* $40 $40 $40

Advanced Radiology $35* $35* $35* $20* $20* $20* $40 $40 $40

Allergy Shots $25* $25* $25* $17.5* $17.5* $17.5* $32.50 $32.50 $33

Allergy Tests $25* $25* $25* $17.5* $17.5* $17.5* $32.50 $32.50 $33

Ambulance $100* $100* $100* $100* $100* $100* $150 $150 $150

Anesthesia $0* $0* $0* $0* $0* $0* $0 $0 $0

Cardiovascular $35* $35* $35* $20* $20* $20* $40 $40 $40

Chemotherapy $35* $35* $35* $20* $20* $20* $40 $40 $40

Chiropractic $35* $35* $35* $20* $20* $20* $40 $40 $40

Consults $25* $25* $25* $17.5* $17.5* $17.5* $32.50 $32.50 $33

Diabetic Drugs/Supplies $15* $15* $15* $15* $15* $15* $25 $25 $25

Diabetic Education $15* $15* $15* $15* $15* $15* $25 $25 $25

Dialysis $35* $35* $35* $20* $20* $20* $40 $40 $40

DME and Supplies 50%* 50%* 50%* 50%* 50%* 50%* 50% 50% 50%

Facility Visits $0* $0* $0* $0* $0* $0* $0 $0 $0

Hearing Aid 50%* 50%* 50%* 50%* 50%* 50%* 50% 50% 50%

Hearing Exam $25* $25* $25* $17.5* $17.5* $17.5* $33 $33 $33

Home Care $15* $15* $15* $15* $15* $15* $25 $25 $25

Maternity $15* $15* $15* $15* $15* $15* $25 $25 $25

Mental Health $15* $15* $15* $15* $15* $15* $25 $25 $25

Office-Administered Drugs $25* $25* $25* $17.5* $17.5* $17.5* $32.50 $32.50 $33

Pathology / Laboratory $15* $15* $35* $15* $15* $15* $25 $25 $40

Prosthetics & Orthotics 50%* 50%* 50%* 50%* 50%* 50%* 50% 50% 50%

PT/OT/ST $15* $15* $25* $15* $15* $15* $25 $25 $25

Radiation Therapy $15* $15* $15* $15* $15* $15* $25 $25 $25

Radiology $35* $35* $35* $20* $20* $20* $40 $40 $40

Substance Abuse $15* $15* $15* $15* $15* $15* $25 $25 $25

Surgery - Facility (IP) $0* $0* $0* $0* $0* $0* $0 $0 $0

Surgery - Facility (OP) $100* $100* $100* $100* $100* $100* $100 $100 $100

Surgery - Office $25* $25* $25* $17.5* $17.5* $17.5* $32.50 $32.50 $33

Vision - Exam $25* $25* $25* $17.5* $17.5* $17.5* $33 $33 $33

Vision - Lenses & Frames 10%* 10%* 10%* 10%* 10%* 10%* 20% 20% 20%

Other $35* $35* $35* $20* $20* $20* $40 $40 $40

Drug

Generic $10* $10* $10* $10* $10* $10* $10* $10* $10*

Brand $30* $30* $30* $35* $35* $35* $35* $35* $35*

Non Formulary $60* $60* $60* $70* $70* $70* $70* $70* $70*

Supplies $15* $15* $15* $15* $15* $15* $25 $25 $25

Out of Network

First Dollar $0 N/A $0 $0 $0 $0 $0 N/A N/A

Deductible (single) $5,000 N/A $5,000 $5,000 $5,000 $5,000 $5,000 N/A N/A

Coinsurance (Member) 50% N/A 50% 50% 50% 50% 50% N/A N/A

OOP Maximum (single) $10,000 N/A $10,000 $10,000 $10,000 $10,000 $10,000 N/A N/A

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 13 Rate Manual - Page 14

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Gold Gold Gold Gold Platinum Platinum Platinum Platinum Platinum

Gold EPO high Gold Radius high Gold EX high Gold HMO 200 PlusPlatinum POS

Classic

Platinum HMO

Classic

Platinum Make

AvailablePlatinum PPO Platinum EX

Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7

Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Standard Non-Standard Non-Standard

Off Off Off Off Off Off Both Off Off

$0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $500 $0 $0 $0 $0 $0

N/A N/A N/A N/A N/A N/A N/A N/A N/A

$8,150 $8,150 $8,150 $7,000 $2,000 $2,000 $2,000 $5,000 $5,000

No No No No No No No No No

Yes Yes Yes Yes Yes Yes Yes Yes Yes

$1000* $1000* $1000* $1,000 $500* $500* $500* $250* $250*

$1000* $1000* $1000* $1,000 $500* $500* $500* $250* $250*

$1000* $1000* $1000* $1,000 $500* $500* $500* $250* $250*

$1000* $1000* $1000* $1,000 $500* $500* $500* $250* $250*

$1000* $1000* $1000* $1,000 $500* $500* $500* $250* $250*

$1000* $1000* $1000* $1,000 $500* $500* $500* $250* $250*

$1000* $1000* $1000* $1,000 $500* $500* $500* $250* $250*

$1000* $1000* $1000* $1,000 $500* $500* $500* $250* $250*

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$200* $200* $200* $300 $100* $100* $100* $100* $100*

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$300* $300* $300* $300 $100* $100* $100* $100* $100*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$25* $25* $25* $35 $15* $15* $35* $15* $15*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$200* $200* $200* $300 $100* $100* $100* $100* $100*

$0* $0* $0* $0 $0* $0* $0* $0* $0*

$25* $25* $25* $35 $15* $15* $25* $15* $15*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$75* $75* $75* $75 $55* $55* $55* $50* $50*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$32.5* $32.5* $32.5* $42.50 $25* $25* $25* $17.5* $17.5*

$32.5* $32.5* $32.5* $42.50 $25* $25* $25* $17.5* $17.5*

$300* $300* $300* $300 $100* $100* $100* $100* $100*

$0* $0* $0* $0 $0* $0* $0* $0* $0*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$32.5* $32.5* $32.5* $42.50 $25* $25* $25* $17.5* $17.5*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

50%* 50%* 50%* 50% 50%* 50%* 50%* 50%* 50%*

$0* $0* $0* $0 $0* $0* $0* $0* $0*

50%* 50%* 50%* 50% 50%* 50%* 50%* 50%* 50%*

$32.5* $32.5* $32.5* $43 $25* $25* $25* $17.5* $17.5*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$32.5* $32.5* $32.5* $42.50 $25* $25* $25* $17.5* $17.5*

$25* $25* $25* $35 $15* $15* $35* $15* $15*

50%* 50%* 50%* 50% 50%* 50%* 50%* 50%* 50%*

$25* $25* $25* $35 $15* $15* $25* $15* $15*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

$0* $0* $0* $0 $0* $0* $0* $0* $0*

$200* $200* $200* $300 $100* $100* $100* $100* $100*

$32.5* $32.5* $32.5* $42.50 $25* $25* $25* $17.5* $17.5*

$32.5* $32.5* $32.5* $42.50 $25* $25* $25* $17.5* $17.5*

20%* 20%* 20%* 20% 10%* 10%* 10%* 10%* 10%*

$40* $40* $40* $50 $35* $35* $35* $20* $20*

$10* $10* $10* $10* $10* $10* $10* $10* $10*

$35* $35* $35* $35 $30* $30* $30* $35* $35*

$70* $70* $70* $70 $60* $60* $60* $70* $70*

$25* $25* $25* $35 $15* $15* $15* $15* $15*

N/A $0 $0 N/A $0 N/A $0 $0 $0

N/A $5,000 $5,000 N/A $5,000 N/A $5,000 $5,000 $5,000

N/A 50% 50% N/A 50% N/A 50% 50% 50%

N/A $10,000 $10,000 N/A $10,000 N/A $10,000 $10,000 $10,000

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 14 Rate Manual - Page 15

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Platinum Gold Gold Gold Gold Gold Gold Gold Gold

Platinum Radius Gold POS Classic Gold HMO Classic Gold Healthy NY Gold EPO high Gold Radius high Gold EX high Gold HMO 200 Plus Gold EPO

Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7

Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Off Off Off Off Off Off Off Off Off

$0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $600 $600 $600 $0 $0 $0 $500 $750

N/A N/A N/A N/A N/A N/A N/A N/A 30%

$5,000 $4,000 $4,000 $4,000 $8,150 $8,150 $8,150 $7,000 $8,150

No No No No No No No No No

Yes Yes Yes Yes Yes Yes Yes Yes Yes

$250* $1,000 $1,000 $1,000 $1000* $1000* $1000* $1,000 $0

$250* $1,000 $1,000 $1,000 $1000* $1000* $1000* $1,000 $0

$250* $1,000 $1,000 $1,000 $1000* $1000* $1000* $1,000 $0

$250* $1,000 $1,000 $1,000 $1000* $1000* $1000* $1,000 $0

$250* $1,000 $1,000 $1,000 $1000* $1000* $1000* $1,000 $0

$250* $1,000 $1,000 $1,000 $1000* $1000* $1000* $1,000 $0

$250* $1,000 $1,000 $1,000 $1000* $1000* $1000* $1,000 $0

$250* $1,000 $1,000 $1,000 $1000* $1000* $1000* $1,000 $0

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$100* $100 $100 $100 $200* $200* $200* $300 $0

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$100* $150 $150 $150 $300* $300* $300* $300 $350*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$15* $25 $25 $40 $25* $25* $25* $35 $25*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$100* $100 $100 $100 $200* $200* $200* $300 $0

$0* $0 $0 $0 $0* $0* $0* $0 $0

$15* $25 $25 $25 $25* $25* $25* $35 $25

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$20* $40 $40 $40 $40* $40* $40* $50 $0

$20* $40 $40 $40 $40* $40* $40* $50 $0

$50* $60 $60 $60 $75* $75* $75* $75 $100*

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$20* $40 $40 $40 $40* $40* $40* $50 $0

$17.5* $33 $32.50 $33 $32.5* $32.5* $32.5* $43 $37.5*

$17.5* $33 $32.50 $33 $32.5* $32.5* $32.5* $43 $37.5*

$100* $150 $150 $150 $300* $300* $300* $300 $350*

$0* $0 $0 $0 $0* $0* $0* 0 0.3

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$17.5* $33 $32.50 $33 $32.5* $32.5* $32.5* $43 $37.5*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$20* $40 $40 $40 $40* $40* $40* $50 $50*

50%* 50% 50% 50% 50%* 50%* 50%* 0.5 30%*

$0* $0 $0 $0 $0* $0* $0* 0 0.3

50%* 50% 50% 50% 50%* 50%* 50%* 0.5 30%*

$17.5* $33 $32.50 $33 $32.5* $32.5* $32.5* $43 $37.5*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$17.5* $33 $32.50 $33 $32.5* $32.5* $32.5* $43 $37.5*

$15* $25 $25 $40 $25* $25* $25* $35 $25*

50%* 50% 50% 50% 50%* 50%* 50%* 0.5 30%*

$15* $25 $25 $25 $25* $25* $25* $35 $25

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$20* $40 $40 $40 $40* $40* $40* $50 $0

$15* $25 $25 $25 $25* $25* $25* $35 $25*

$0* $0 $0 $0 $0* $0* $0* 0 0.3

$100* $100 $100 $100 $200* $200* $200* $300 $0

$17.5* $33 $32.50 $33 $32.5* $32.5* $32.5* $43 $37.5*

$17.5* $33 $32.50 $33 $32.5* $32.5* $32.5* $43 $37.5*

10%* 20% 20% 20% 20%* 20%* 20%* 0.2 0.2

$20* $40 $40 $40 $40* $40* $40* $50 $50*

$10* $10* $10* $10* $10* $10* $10* $10* $10*

$35* $35* $35* $35* $35* $35* $35* $35 $35*

$70* $70* $70* $70* $70* $70* $70* $70 $70*

$15* $25 $25 $25 $25* $25* $25* 35 $25*

$0 $0 N/A N/A N/A $0 $0 N/A N/A

$5,000 $5,000 N/A N/A N/A $5,000 $5,000 N/A N/A

50% 50% N/A N/A N/A 50% 50% N/A N/A

$10,000 $10,000 N/A N/A N/A $10,000 $10,000 N/A N/A

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 15 Rate Manual - Page 16

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Gold Gold Gold Silver Silver Silver Silver Silver Silver

Gold Radius Gold EX Gold POS 8000 Silver POS Classic Silver HMO Classic Silver EPO 6300 Silver EX 6300 Silver HMO 6300 Silver EPO 8000

Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7

Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Off Off Off Off Off Off Off Off Off

$0 $0 $0 $0 $0 $0 $0 $0 $0

$750 $750 $2,000 $1,700 $1,700 $1,500 $1,500 $1,500 $3,700

30% 30% 0% N/A N/A N/A N/A N/A 0%

$8,150 $8,150 $4,000 $7,900 $7,900 $6,900 $6,900 $6,900 $6,900

No No Yes No No Yes Yes Yes Yes

Yes Yes No Yes Yes No No No Yes

$0 $0 $0 $1,500 $1,500 $500 $500 $500 $0

$0 $0 $0 $1,500 $1,500 $500 $500 $500 $0

$0 $0 $0 $1,500 $1,500 $500 $500 $500 $0

$0 $0 $0 $1,500 $1,500 $500 $500 $500 $0

$0 $0 $0 $1,500 $1,500 $500 $500 $500 $0

$0 $0 $0 $1,500 $1,500 $500 $500 $500 $0

$0 $0 $0 $1,500 $1,500 $500 $500 $500 $0

$0 $0 $0 $1,500 $1,500 $500 $500 $500 $0

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$0 $0 $0 $150 $150 $250 $250 $250 $0

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$50* $50* $0 $50 $50 $60 $60 $60 $0

$50* $50* $0 $50 $50 $60 $60 $60 $0

$50* $50* $0 $50 $50 $60 $60 $60 $0

$50* $50* $0 $50 $50 $60 $60 $60 $0

$350* $350* $0 $250 $250 $250 $250 $250 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$0 $0 $0 $150 $150 $250 $250 $250 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0

$25 $25 $0 $30 $30 $40 $40 $40 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$0 $0 $0 $50 $50 $60 $60 $60 $0

$0 $0 $0 $50 $50 $60 $60 $60 $0

$100* $100* $0 $70 $70 $75 $75 $75 $0

$50* $50* $0 $50 $50 $60 $60 $60 $0

$0* $0* $0* $0* $0* $0* $0* $0* $0*

$25* $25* $0 $30 $30 $40 $40 $40 $0

$50* $50* $0 $50 $50 $60 $60 $60 $0

$0 $0 $0 $50 $50 $60 $60 $60 $0

$37.5* $37.5* $0 $40 $40 $50 $50 $50 $0

$37.5* $37.5* $0 $40 $40 $50 $50 $50 $0

$350* $350* $0 $250 $250 $250 $250 $250 $0

0.3 0.3 0 0 0 0 0 0 0

$50* $50* $0 $50 $50 $60 $60 $60 $0

$50* $50* $0 $50 $50 $60 $60 $60 $0

$50* $50* $0 $50 $50 $60 $60 $60 $0

$37.5* $37.5* $0 $40 $40 $50 $50 $50 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$50* $50* $0 $50 $50 $60 $60 $60 $0

30%* 30%* 0 0.5 0.5 0.5 0.5 0.5 0

0.3 0.3 0 0 0 0 0 0 0

30%* 30%* 0 0.5 0.5 0.5 0.5 0.5 0

$37.5* $37.5* $0 $40 $40 $50 $50 $50 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$37.5* $37.5* $0 $40 $40 $50 $50 $50 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

30%* 30%* 0 0.5 0.5 0.5 0.5 0.5 0

$25 $25 $0 $30 $30 $40 $40 $40 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

$0 $0 $0 $50 $50 $60 $60 $60 $0

$25* $25* $0 $30 $30 $40 $40 $40 $0

0.3 0.3 0 0 0 0 0 0 0

$0 $0 $0 $150 $150 $250 $250 $250 $0

$37.5* $37.5* $0 $40 $40 $50 $50 $50 $0

$37.5* $37.5* $0 $40 $40 $50 $50 $50 $0

0.2 0.2 0.2 0.3 0.3 0.3 0.3 0.3 0.3

$50* $50* $0 $50 $50 $60 $60 $60 $0

$10* $10* $10 $10* $10* $10 $10 $10 $10

$35* $35* $35 $35* $35* $35 $35 $35 $35

$70* $70* $70 $70* $70* $70 $70 $70 $70

$25* $25* 0 30 30 40 40 40 0

$0 $0 $0 $0 N/A N/A $0 N/A N/A

$5,000 $5,000 $5,000 $5,000 N/A N/A $5,000 N/A N/A

50% 50% 50% 50% N/A N/A 50% N/A N/A

$10,000 $10,000 $10,000 $10,000 N/A N/A $10,000 N/A N/A

HealthNow New York Inc. HealthNow New York Inc.

2020 New York State Exchange Rate Submission 2020 New York State Exchange Rate Submission

Rate Manual - Page 15 Rate Manual - Page 16

Rates Effective 1/1/2020 Rates Effective 1/1/2020

Silver Silver Bronze Bronze Bronze Bronze Bronze

Silver EX 8000 Silver POS 8000 Bronze POS ClassicBronze HMO

ClassicBronze EPO 6300 Bronze Value Bronze HMO

Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7 Regions #1 and #7

Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard Non-Standard

Off Off Off Off Off Off Off

$0 $0 $0 $0 $0 $0 $0

$3,700 $3,700 $4,425 $4,425 $5,000 $6,900 $7,000

0% 0% 50% 50% N/A 0% 0%

$6,900 $6,900 $8,150 $8,150 $6,900 $6,900 $8,150

Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes

$0 $0 $1 $1 $1,500 $0 $0

$0 $0 $1 $1 $1,500 $0 $0

$0 $0 $1 $1 $1,500 $0 $0

$0 $0 $1 $1 $1,500 $0 $0

$0 $0 $1 $1 $1,500 $0 $0

$0 $0 $1 $1 $1,500 $0 $0

$0 $0 $1 $1 $1,500 $0 $0

$0 $0 $1 $1 $1,500 $0 $0

$0* $0* $0* $0* $0* $0* $0*

$0 $0 $1 $1 $750 $0 $0

$0* $0* $0* $0* $0* $0* $0*

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $750 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $750 $0 $0

$0 $0 $1 $1 $0 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $75 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0* $0* $0* $0* $0* $0* $0*

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $50 $0 $0

$0 $0 $1 $1 $50 $0 $0

$0 $0 $1 $1 $750 $0 $0

0 0 0.5 0.5 0 0 0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $50 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $60 $0 $0

0 0 0.5 0.5 0.5 0 0

0 0 0.5 0.5 0 0 0

0 0 0.5 0.5 0.5 0 0

$0 $0 $1 $1 $50 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $50 $0 $0

$0 $0 $1 $1 $40 $0 $0

0 0 0.5 0.5 0.5 0 0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $40 $0 $0

$0 $0 $1 $1 $60 $0 $0

$0 $0 $1 $1 $40 $0 $0

0 0 0.5 0.5 0 0 0

$0 $0 $1 $1 $750 $0 $0

$0 $0 $1 $1 $50 $0 $0

$0 $0 $1 $1 $50 $0 $0

0.3 0.3 0.5 0.5 0.5 0.5 0.5

$0 $0 $1 $1 $60 $0 $0

$10 $10 $10 $10 $10 $0 $10

$35 $35 $35 $35 $50 $0 $1

$70 $70 $70 $70 $100 $0 $1

0 0 0.5 0.5 40 0 0

$0 $0 $0 N/A N/A N/A N/A

$5,000 $5,000 $5,000 N/A N/A N/A N/A

50% 50% 50% N/A N/A N/A N/A

$10,000 $10,000 $10,000 N/A N/A N/A N/A

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 17

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q1:

Single Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

36346NY0250001 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250002 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250003 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250004 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250005 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250006 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250007 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250008 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0470001 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 468.80 937.60 796.96 1,336.08

36346NY0470002 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 468.80 937.60 796.96 1,336.08

36346NY0470003 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 471.01 942.02 800.72 1,342.38

36346NY0470004 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 471.01 942.02 800.72 1,342.38

36346NY0470005 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 468.80 937.60 796.96 1,336.08

36346NY0470006 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 468.80 937.60 796.96 1,336.08

36346NY0470007 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 471.01 942.02 800.72 1,342.38

36346NY0470008 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 471.01 942.02 800.72 1,342.38

36346NY0470014 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 604.93 1,209.86 1,028.38 1,724.05

36346NY0470015 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 604.93 1,209.86 1,028.38 1,724.05

36346NY0470016 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 607.80 1,215.60 1,033.26 1,732.23

36346NY0470017 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 607.80 1,215.60 1,033.26 1,732.23

36346NY0470018 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 604.93 1,209.86 1,028.38 1,724.05

36346NY0470019 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 604.93 1,209.86 1,028.38 1,724.05

36346NY0470020 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 607.80 1,215.60 1,033.26 1,732.23

36346NY0470021 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 607.80 1,215.60 1,033.26 1,732.23

36346NY0470026 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 680.97 1,361.94 1,157.65 1,940.76

36346NY0470027 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 680.97 1,361.94 1,157.65 1,940.76

36346NY0470028 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 684.21 1,368.42 1,163.16 1,950.00

36346NY0470029 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 684.21 1,368.42 1,163.16 1,950.00

36346NY0470030 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 680.97 1,361.94 1,157.65 1,940.76

36346NY0470031 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 680.97 1,361.94 1,157.65 1,940.76

36346NY0470032 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 684.21 1,368.42 1,163.16 1,950.00

36346NY0470033 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 684.21 1,368.42 1,163.16 1,950.00

36346NY0470035 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 775.03 1,550.06 1,317.55 2,208.84

36346NY0470036 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 775.03 1,550.06 1,317.55 2,208.84

36346NY0470037 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 778.73 1,557.46 1,323.84 2,219.38

36346NY0470038 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 778.73 1,557.46 1,323.84 2,219.38

36346NY0470039 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 775.03 1,550.06 1,317.55 2,208.84

36346NY0470040 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 775.03 1,550.06 1,317.55 2,208.84

36346NY0470041 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 778.73 1,557.46 1,323.84 2,219.38

36346NY0470042 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 778.73 1,557.46 1,323.84 2,219.38

36346NY0470050 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 774.10 1,548.20 1,315.97 2,206.19

36346NY0470051 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 774.10 1,548.20 1,315.97 2,206.19

36346NY0470052 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 777.80 1,555.60 1,322.26 2,216.73

36346NY0470053 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 777.80 1,555.60 1,322.26 2,216.73

36346NY0470054 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 774.10 1,548.20 1,315.97 2,206.19

36346NY0470055 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 774.10 1,548.20 1,315.97 2,206.19

36346NY0470056 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 777.80 1,555.60 1,322.26 2,216.73

36346NY0470057 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 777.80 1,555.60 1,322.26 2,216.73

36346NY0550033 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 656.91 1,313.82 1,116.75 1,872.19

36346NY0550034 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 656.91 1,313.82 1,116.75 1,872.19

36346NY0550035 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 660.04 1,320.08 1,122.07 1,881.11

36346NY0550036 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 660.04 1,320.08 1,122.07 1,881.11

36346NY0550037 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 656.91 1,313.82 1,116.75 1,872.19

36346NY0550038 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 656.91 1,313.82 1,116.75 1,872.19

36346NY0550039 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 660.04 1,320.08 1,122.07 1,881.11

36346NY0550040 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 660.04 1,320.08 1,122.07 1,881.11

36346NY0550041 Bronze Value Uniform Mod Age 26 Regions 1 and 7 480.20 960.40 816.34 1,368.57

36346NY0550042 Bronze Value Uniform Mod Age 26 Regions 1 and 7 480.20 960.40 816.34 1,368.57

36346NY0550043 Bronze Value Uniform Mod Age 30 Regions 1 and 7 482.47 964.94 820.20 1,375.04

36346NY0550044 Bronze Value Uniform Mod Age 30 Regions 1 and 7 482.47 964.94 820.20 1,375.04

36346NY0550045 Bronze Value Uniform Mod Age 26 Regions 1 and 7 480.20 960.40 816.34 1,368.57

36346NY0550046 Bronze Value Uniform Mod Age 26 Regions 1 and 7 480.20 960.40 816.34 1,368.57

36346NY0550047 Bronze Value Uniform Mod Age 30 Regions 1 and 7 482.47 964.94 820.20 1,375.04

36346NY0550048 Bronze Value Uniform Mod Age 30 Regions 1 and 7 482.47 964.94 820.20 1,375.04

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 18

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q1:

Single

Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

36346NY0550049 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 448.15 896.30 761.86 1,277.23

36346NY0550050 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 448.15 896.30 761.86 1,277.23

36346NY0550051 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 450.27 900.54 765.46 1,283.27

36346NY0550052 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 450.27 900.54 765.46 1,283.27

36346NY0550053 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 448.15 896.30 761.86 1,277.23

36346NY0550054 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 448.15 896.30 761.86 1,277.23

36346NY0550055 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 450.27 900.54 765.46 1,283.27

36346NY0550056 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 450.27 900.54 765.46 1,283.27

36346NY0550057 Bronze HMO Classic NEW Age 26 Regions 1 and 7 454.65 909.30 772.91 1,295.75

36346NY0550058 Bronze HMO Classic NEW Age 26 Regions 1 and 7 454.65 909.30 772.91 1,295.75

36346NY0550059 Bronze HMO Classic NEW Age 30 Regions 1 and 7 456.80 913.60 776.56 1,301.88

36346NY0550060 Bronze HMO Classic NEW Age 30 Regions 1 and 7 456.80 913.60 776.56 1,301.88

36346NY0550061 Bronze HMO Classic NEW Age 26 Regions 1 and 7 454.65 909.30 772.91 1,295.75

36346NY0550062 Bronze HMO Classic NEW Age 26 Regions 1 and 7 454.65 909.30 772.91 1,295.75

36346NY0550063 Bronze HMO Classic NEW Age 30 Regions 1 and 7 456.80 913.60 776.56 1,301.88

36346NY0550064 Bronze HMO Classic NEW Age 30 Regions 1 and 7 456.80 913.60 776.56 1,301.88

36346NY0550065 Silver HMO Classic NEW Age 26 Regions 1 and 7 592.63 1,185.26 1,007.47 1,689.00

36346NY0550066 Silver HMO Classic NEW Age 26 Regions 1 and 7 592.63 1,185.26 1,007.47 1,689.00

36346NY0550067 Silver HMO Classic NEW Age 30 Regions 1 and 7 595.45 1,190.90 1,012.27 1,697.03

36346NY0550068 Silver HMO Classic NEW Age 30 Regions 1 and 7 595.45 1,190.90 1,012.27 1,697.03

36346NY0550069 Silver HMO Classic NEW Age 26 Regions 1 and 7 592.63 1,185.26 1,007.47 1,689.00

36346NY0550070 Silver HMO Classic NEW Age 26 Regions 1 and 7 592.63 1,185.26 1,007.47 1,689.00

36346NY0550071 Silver HMO Classic NEW Age 30 Regions 1 and 7 595.45 1,190.90 1,012.27 1,697.03

36346NY0550072 Silver HMO Classic NEW Age 30 Regions 1 and 7 595.45 1,190.90 1,012.27 1,697.03

36346NY0550073 Gold HMO Classic NEW Age 26 Regions 1 and 7 669.71 1,339.42 1,138.51 1,908.67

36346NY0550074 Gold HMO Classic NEW Age 26 Regions 1 and 7 669.71 1,339.42 1,138.51 1,908.67

36346NY0550075 Gold HMO Classic NEW Age 30 Regions 1 and 7 672.90 1,345.80 1,143.93 1,917.77

36346NY0550076 Gold HMO Classic NEW Age 30 Regions 1 and 7 672.90 1,345.80 1,143.93 1,917.77

36346NY0550077 Gold HMO Classic NEW Age 26 Regions 1 and 7 669.71 1,339.42 1,138.51 1,908.67

36346NY0550078 Gold HMO Classic NEW Age 26 Regions 1 and 7 669.71 1,339.42 1,138.51 1,908.67

36346NY0550079 Gold HMO Classic NEW Age 30 Regions 1 and 7 672.90 1,345.80 1,143.93 1,917.77

36346NY0550080 Gold HMO Classic NEW Age 30 Regions 1 and 7 672.90 1,345.80 1,143.93 1,917.77

36346NY0550081 Platinum HMO Classic NEW Age 26 Regions 1 and 7 765.06 1,530.12 1,300.60 2,180.42

36346NY0550082 Platinum HMO Classic NEW Age 26 Regions 1 and 7 765.06 1,530.12 1,300.60 2,180.42

36346NY0550083 Platinum HMO Classic NEW Age 30 Regions 1 and 7 768.71 1,537.42 1,306.81 2,190.82

36346NY0550084 Platinum HMO Classic NEW Age 30 Regions 1 and 7 768.71 1,537.42 1,306.81 2,190.82

36346NY0550085 Platinum HMO Classic NEW Age 26 Regions 1 and 7 765.06 1,530.12 1,300.60 2,180.42

36346NY0550086 Platinum HMO Classic NEW Age 26 Regions 1 and 7 765.06 1,530.12 1,300.60 2,180.42

36346NY0550087 Platinum HMO Classic NEW Age 30 Regions 1 and 7 768.71 1,537.42 1,306.81 2,190.82

36346NY0550088 Platinum HMO Classic NEW Age 30 Regions 1 and 7 768.71 1,537.42 1,306.81 2,190.82

36346NY0550089 Silver HMO 6300 NEW Age 26 Regions 1 and 7 578.89 1,157.78 984.11 1,649.84

36346NY0550090 Silver HMO 6300 NEW Age 26 Regions 1 and 7 578.89 1,157.78 984.11 1,649.84

36346NY0550091 Silver HMO 6300 NEW Age 30 Regions 1 and 7 581.64 1,163.28 988.79 1,657.67

36346NY0550092 Silver HMO 6300 NEW Age 30 Regions 1 and 7 581.64 1,163.28 988.79 1,657.67

36346NY0550093 Silver HMO 6300 NEW Age 26 Regions 1 and 7 578.89 1,157.78 984.11 1,649.84

36346NY0550094 Silver HMO 6300 NEW Age 26 Regions 1 and 7 578.89 1,157.78 984.11 1,649.84

36346NY0550095 Silver HMO 6300 NEW Age 30 Regions 1 and 7 581.64 1,163.28 988.79 1,657.67

36346NY0550096 Silver HMO 6300 NEW Age 30 Regions 1 and 7 581.64 1,163.28 988.79 1,657.67

36346NY0640009 Gold EPO Uniform Mod Age 26 Regions 1 and 7 725.27 1,450.54 1,232.96 2,067.02

36346NY0640010 Gold EPO Uniform Mod Age 26 Regions 1 and 7 725.27 1,450.54 1,232.96 2,067.02

36346NY0640011 Gold EPO Uniform Mod Age 30 Regions 1 and 7 728.73 1,457.46 1,238.84 2,076.88

36346NY0640012 Gold EPO Uniform Mod Age 30 Regions 1 and 7 728.73 1,457.46 1,238.84 2,076.88

36346NY0640013 Gold EPO Uniform Mod Age 26 Regions 1 and 7 725.27 1,450.54 1,232.96 2,067.02

36346NY0640014 Gold EPO Uniform Mod Age 26 Regions 1 and 7 725.27 1,450.54 1,232.96 2,067.02

36346NY0640015 Gold EPO Uniform Mod Age 30 Regions 1 and 7 728.73 1,457.46 1,238.84 2,076.88

36346NY0640016 Gold EPO Uniform Mod Age 30 Regions 1 and 7 728.73 1,457.46 1,238.84 2,076.88

36346NY0640033 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 611.18 1,222.36 1,039.01 1,741.86

36346NY0640034 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 611.18 1,222.36 1,039.01 1,741.86

36346NY0640035 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 614.09 1,228.18 1,043.95 1,750.16

36346NY0640036 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 614.09 1,228.18 1,043.95 1,750.16

36346NY0640037 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 611.18 1,222.36 1,039.01 1,741.86

36346NY0640038 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 611.18 1,222.36 1,039.01 1,741.86

36346NY0640039 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 614.09 1,228.18 1,043.95 1,750.16

36346NY0640040 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 614.09 1,228.18 1,043.95 1,750.16

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 19

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q1:

Single

Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

36346NY0640041 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 655.87 1,311.74 1,114.98 1,869.23

36346NY0640042 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 655.87 1,311.74 1,114.98 1,869.23

36346NY0640043 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 659.00 1,318.00 1,120.30 1,878.15

36346NY0640044 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 659.00 1,318.00 1,120.30 1,878.15

36346NY0640045 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 655.87 1,311.74 1,114.98 1,869.23

36346NY0640046 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 655.87 1,311.74 1,114.98 1,869.23

36346NY0640047 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 659.00 1,318.00 1,120.30 1,878.15

36346NY0640048 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 659.00 1,318.00 1,120.30 1,878.15

36346NY0640081 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 554.30 1,108.60 942.31 1,579.76

36346NY0640082 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 554.30 1,108.60 942.31 1,579.76

36346NY0640083 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 556.93 1,113.86 946.78 1,587.25

36346NY0640084 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 556.93 1,113.86 946.78 1,587.25

36346NY0640085 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 554.30 1,108.60 942.31 1,579.76

36346NY0640086 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 554.30 1,108.60 942.31 1,579.76

36346NY0640087 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 556.93 1,113.86 946.78 1,587.25

36346NY0640088 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 556.93 1,113.86 946.78 1,587.25

36346NY0640089 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 788.69 1,577.38 1,340.77 2,247.77

36346NY0640090 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 788.69 1,577.38 1,340.77 2,247.77

36346NY0640091 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 792.45 1,584.90 1,347.17 2,258.48

36346NY0640092 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 792.45 1,584.90 1,347.17 2,258.48

36346NY0640093 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 788.69 1,577.38 1,340.77 2,247.77

36346NY0640094 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 788.69 1,577.38 1,340.77 2,247.77

36346NY0640095 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 792.45 1,584.90 1,347.17 2,258.48

36346NY0640096 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 792.45 1,584.90 1,347.17 2,258.48

36346NY0650001 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 870.04 1,740.08 1,479.07 2,479.61

36346NY0650002 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 870.04 1,740.08 1,479.07 2,479.61

36346NY0650003 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 874.20 1,748.40 1,486.14 2,491.47

36346NY0650004 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 874.20 1,748.40 1,486.14 2,491.47

36346NY0650005 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 870.04 1,740.08 1,479.07 2,479.61

36346NY0650006 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 870.04 1,740.08 1,479.07 2,479.61

36346NY0650007 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 874.20 1,748.40 1,486.14 2,491.47

36346NY0650008 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 874.20 1,748.40 1,486.14 2,491.47

36346NY0690009 Gold Radius Uniform Mod Age 26 Regions 1 and 7 651.65 1,303.30 1,107.81 1,857.20

36346NY0690010 Gold Radius Uniform Mod Age 26 Regions 1 and 7 651.65 1,303.30 1,107.81 1,857.20

36346NY0690011 Gold Radius Uniform Mod Age 30 Regions 1 and 7 654.75 1,309.50 1,113.08 1,866.04

36346NY0690012 Gold Radius Uniform Mod Age 30 Regions 1 and 7 654.75 1,309.50 1,113.08 1,866.04

36346NY0690013 Gold Radius Uniform Mod Age 26 Regions 1 and 7 651.65 1,303.30 1,107.81 1,857.20

36346NY0690014 Gold Radius Uniform Mod Age 26 Regions 1 and 7 651.65 1,303.30 1,107.81 1,857.20

36346NY0690015 Gold Radius Uniform Mod Age 30 Regions 1 and 7 654.75 1,309.50 1,113.08 1,866.04

36346NY0690016 Gold Radius Uniform Mod Age 30 Regions 1 and 7 654.75 1,309.50 1,113.08 1,866.04

36346NY0690049 Gold EX Uniform Mod Age 26 Regions 1 and 7 679.80 1,359.60 1,155.66 1,937.43

36346NY0690050 Gold EX Uniform Mod Age 26 Regions 1 and 7 679.80 1,359.60 1,155.66 1,937.43

36346NY0690051 Gold EX Uniform Mod Age 30 Regions 1 and 7 683.04 1,366.08 1,161.17 1,946.66

36346NY0690052 Gold EX Uniform Mod Age 30 Regions 1 and 7 683.04 1,366.08 1,161.17 1,946.66

36346NY0690053 Gold EX Uniform Mod Age 26 Regions 1 and 7 679.80 1,359.60 1,155.66 1,937.43

36346NY0690054 Gold EX Uniform Mod Age 26 Regions 1 and 7 679.80 1,359.60 1,155.66 1,937.43

36346NY0690055 Gold EX Uniform Mod Age 30 Regions 1 and 7 683.04 1,366.08 1,161.17 1,946.66

36346NY0690056 Gold EX Uniform Mod Age 30 Regions 1 and 7 683.04 1,366.08 1,161.17 1,946.66

36346NY0690057 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 552.53 1,105.06 939.30 1,574.71

36346NY0690058 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 552.53 1,105.06 939.30 1,574.71

36346NY0690059 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 555.16 1,110.32 943.77 1,582.21

36346NY0690060 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 555.16 1,110.32 943.77 1,582.21

36346NY0690061 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 552.53 1,105.06 939.30 1,574.71

36346NY0690062 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 552.53 1,105.06 939.30 1,574.71

36346NY0690063 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 555.16 1,110.32 943.77 1,582.21

36346NY0690064 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 555.16 1,110.32 943.77 1,582.21

36346NY0690065 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 576.19 1,152.38 979.52 1,642.14

36346NY0690066 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 576.19 1,152.38 979.52 1,642.14

36346NY0690067 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 578.92 1,157.84 984.16 1,649.92

36346NY0690068 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 578.92 1,157.84 984.16 1,649.92

36346NY0690069 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 576.19 1,152.38 979.52 1,642.14

36346NY0690070 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 576.19 1,152.38 979.52 1,642.14

36346NY0690071 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 578.92 1,157.84 984.16 1,649.92

36346NY0690072 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 578.92 1,157.84 984.16 1,649.92

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 20

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q1:

Single

Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

36346NY0690081 Platinum EX Uniform Mod Age 26 Regions 1 and 7 803.40 1,606.80 1,365.78 2,289.69

36346NY0690082 Platinum EX Uniform Mod Age 26 Regions 1 and 7 803.40 1,606.80 1,365.78 2,289.69

36346NY0690083 Platinum EX Uniform Mod Age 30 Regions 1 and 7 807.23 1,614.46 1,372.29 2,300.61

36346NY0690084 Platinum EX Uniform Mod Age 30 Regions 1 and 7 807.23 1,614.46 1,372.29 2,300.61

36346NY0690085 Platinum EX Uniform Mod Age 26 Regions 1 and 7 803.40 1,606.80 1,365.78 2,289.69

36346NY0690086 Platinum EX Uniform Mod Age 26 Regions 1 and 7 803.40 1,606.80 1,365.78 2,289.69

36346NY0690087 Platinum EX Uniform Mod Age 30 Regions 1 and 7 807.23 1,614.46 1,372.29 2,300.61

36346NY0690088 Platinum EX Uniform Mod Age 30 Regions 1 and 7 807.23 1,614.46 1,372.29 2,300.61

36346NY0690089 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 769.88 1,539.76 1,308.80 2,194.16

36346NY0690090 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 769.88 1,539.76 1,308.80 2,194.16

36346NY0690091 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 773.56 1,547.12 1,315.05 2,204.65

36346NY0690092 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 773.56 1,547.12 1,315.05 2,204.65

36346NY0690093 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 769.88 1,539.76 1,308.80 2,194.16

36346NY0690094 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 769.88 1,539.76 1,308.80 2,194.16

36346NY0690095 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 773.56 1,547.12 1,315.05 2,204.65

36346NY0690096 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 773.56 1,547.12 1,315.05 2,204.65

36346NY0690105 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 706.75 1,413.50 1,201.48 2,014.24

36346NY0690106 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 706.75 1,413.50 1,201.48 2,014.24

36346NY0690107 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 710.12 1,420.24 1,207.20 2,023.84

36346NY0690108 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 710.12 1,420.24 1,207.20 2,023.84

36346NY0690109 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 706.75 1,413.50 1,201.48 2,014.24

36346NY0690110 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 706.75 1,413.50 1,201.48 2,014.24

36346NY0690111 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 710.12 1,420.24 1,207.20 2,023.84

36346NY0690112 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 710.12 1,420.24 1,207.20 2,023.84

36346NY0690113 Gold EX high Uniform Mod Age 26 Regions 1 and 7 737.40 1,474.80 1,253.58 2,101.59

36346NY0690114 Gold EX high Uniform Mod Age 26 Regions 1 and 7 737.40 1,474.80 1,253.58 2,101.59

36346NY0690115 Gold EX high Uniform Mod Age 30 Regions 1 and 7 740.92 1,481.84 1,259.56 2,111.62

36346NY0690116 Gold EX high Uniform Mod Age 30 Regions 1 and 7 740.92 1,481.84 1,259.56 2,111.62

36346NY0690117 Gold EX high Uniform Mod Age 26 Regions 1 and 7 737.40 1,474.80 1,253.58 2,101.59

36346NY0690118 Gold EX high Uniform Mod Age 26 Regions 1 and 7 737.40 1,474.80 1,253.58 2,101.59

36346NY0690119 Gold EX high Uniform Mod Age 30 Regions 1 and 7 740.92 1,481.84 1,259.56 2,111.62

36346NY0690120 Gold EX high Uniform Mod Age 30 Regions 1 and 7 740.92 1,481.84 1,259.56 2,111.62

36346NY0690121 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 627.44 1,254.88 1,066.65 1,788.20

36346NY0690122 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 627.44 1,254.88 1,066.65 1,788.20

36346NY0690123 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 630.42 1,260.84 1,071.71 1,796.70

36346NY0690124 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 630.42 1,260.84 1,071.71 1,796.70

36346NY0690125 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 627.44 1,254.88 1,066.65 1,788.20

36346NY0690126 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 627.44 1,254.88 1,066.65 1,788.20

36346NY0690127 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 630.42 1,260.84 1,071.71 1,796.70

36346NY0690128 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 630.42 1,260.84 1,071.71 1,796.70

36346NY0690129 Silver EX 6300 NEW Age 26 Regions 1 and 7 616.78 1,233.56 1,048.53 1,757.82

36346NY0690130 Silver EX 6300 NEW Age 26 Regions 1 and 7 616.78 1,233.56 1,048.53 1,757.82

36346NY0690131 Silver EX 6300 NEW Age 30 Regions 1 and 7 619.71 1,239.42 1,053.51 1,766.17

36346NY0690132 Silver EX 6300 NEW Age 30 Regions 1 and 7 619.71 1,239.42 1,053.51 1,766.17

36346NY0690133 Silver EX 6300 NEW Age 26 Regions 1 and 7 616.78 1,233.56 1,048.53 1,757.82

36346NY0690134 Silver EX 6300 NEW Age 26 Regions 1 and 7 616.78 1,233.56 1,048.53 1,757.82

36346NY0690135 Silver EX 6300 NEW Age 30 Regions 1 and 7 619.71 1,239.42 1,053.51 1,766.17

36346NY0690136 Silver EX 6300 NEW Age 30 Regions 1 and 7 619.71 1,239.42 1,053.51 1,766.17

49526NY0280001 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280002 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280003 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280004 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280005 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280006 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280007 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280008 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0680289 Platinum POS Plus Uniform Mod Age 26 Region 2 620.38 1,240.76 1,054.65 1,768.08

49526NY0680290 Platinum POS Plus Uniform Mod Age 26 Region 2 620.38 1,240.76 1,054.65 1,768.08

49526NY0680291 Platinum POS Plus Uniform Mod Age 30 Region 2 623.33 1,246.66 1,059.66 1,776.49

49526NY0680292 Platinum POS Plus Uniform Mod Age 30 Region 2 623.33 1,246.66 1,059.66 1,776.49

49526NY0680293 Platinum POS Plus Uniform Mod Age 26 Region 2 620.38 1,240.76 1,054.65 1,768.08

49526NY0680294 Platinum POS Plus Uniform Mod Age 26 Region 2 620.38 1,240.76 1,054.65 1,768.08

49526NY0680295 Platinum POS Plus Uniform Mod Age 30 Region 2 623.33 1,246.66 1,059.66 1,776.49

49526NY0680296 Platinum POS Plus Uniform Mod Age 30 Region 2 623.33 1,246.66 1,059.66 1,776.49

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 21

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q1:

Single

Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

49526NY0520009 Bronze focus Tiered Uniform Mod Age 26 Region 2 342.41 684.82 582.10 975.87

49526NY0520010 Bronze focus Tiered Uniform Mod Age 26 Region 2 342.41 684.82 582.10 975.87

49526NY0520011 Bronze focus Tiered Uniform Mod Age 30 Region 2 344.01 688.02 584.82 980.43

49526NY0520012 Bronze focus Tiered Uniform Mod Age 30 Region 2 344.01 688.02 584.82 980.43

49526NY0520013 Bronze focus Tiered Uniform Mod Age 26 Region 2 342.41 684.82 582.10 975.87

49526NY0520014 Bronze focus Tiered Uniform Mod Age 26 Region 2 342.41 684.82 582.10 975.87

49526NY0520015 Bronze focus Tiered Uniform Mod Age 30 Region 2 344.01 688.02 584.82 980.43

49526NY0520016 Bronze focus Tiered Uniform Mod Age 30 Region 2 344.01 688.02 584.82 980.43

49526NY0520017 Bronze align Tiered Uniform Mod Age 26 Region 2 342.41 684.82 582.10 975.87

49526NY0520018 Bronze align Tiered Uniform Mod Age 26 Region 2 342.41 684.82 582.10 975.87

49526NY0520019 Bronze align Tiered Uniform Mod Age 30 Region 2 344.01 688.02 584.82 980.43

49526NY0520020 Bronze align Tiered Uniform Mod Age 30 Region 2 344.01 688.02 584.82 980.43

49526NY0520021 Bronze align Tiered Uniform Mod Age 26 Region 2 342.41 684.82 582.10 975.87

49526NY0520022 Bronze align Tiered Uniform Mod Age 26 Region 2 342.41 684.82 582.10 975.87

49526NY0520023 Bronze align Tiered Uniform Mod Age 30 Region 2 344.01 688.02 584.82 980.43

49526NY0520024 Bronze align Tiered Uniform Mod Age 30 Region 2 344.01 688.02 584.82 980.43

49526NY0520025 Bronze align Select Uniform Mod Age 26 Region 2 333.35 666.70 566.70 950.05

49526NY0520026 Bronze align Select Uniform Mod Age 26 Region 2 333.35 666.70 566.70 950.05

49526NY0520027 Bronze align Select Uniform Mod Age 30 Region 2 334.91 669.82 569.35 954.49

49526NY0520028 Bronze align Select Uniform Mod Age 30 Region 2 334.91 669.82 569.35 954.49

49526NY0520029 Bronze align Select Uniform Mod Age 26 Region 2 333.35 666.70 566.70 950.05

49526NY0520030 Bronze align Select Uniform Mod Age 26 Region 2 333.35 666.70 566.70 950.05

49526NY0520031 Bronze align Select Uniform Mod Age 30 Region 2 334.91 669.82 569.35 954.49

49526NY0520032 Bronze align Select Uniform Mod Age 30 Region 2 334.91 669.82 569.35 954.49

49526NY0520033 Bronze focus Select Uniform Mod Age 26 Region 2 333.35 666.70 566.70 950.05

49526NY0520034 Bronze focus Select Uniform Mod Age 26 Region 2 333.35 666.70 566.70 950.05

49526NY0520035 Bronze focus Select Uniform Mod Age 30 Region 2 334.91 669.82 569.35 954.49

49526NY0520036 Bronze focus Select Uniform Mod Age 30 Region 2 334.91 669.82 569.35 954.49

49526NY0520037 Bronze focus Select Uniform Mod Age 26 Region 2 333.35 666.70 566.70 950.05

49526NY0520038 Bronze focus Select Uniform Mod Age 26 Region 2 333.35 666.70 566.70 950.05

49526NY0520039 Bronze focus Select Uniform Mod Age 30 Region 2 334.91 669.82 569.35 954.49

49526NY0520040 Bronze focus Select Uniform Mod Age 30 Region 2 334.91 669.82 569.35 954.49

49526NY0520041 Bronze HMO 8100 New Age 26 Region 2 378.94 757.88 644.20 1,079.98

49526NY0520042 Bronze HMO 8100 New Age 26 Region 2 378.94 757.88 644.20 1,079.98

49526NY0520043 Bronze HMO 8100 New Age 30 Region 2 380.72 761.44 647.22 1,085.05

49526NY0520044 Bronze HMO 8100 New Age 30 Region 2 380.72 761.44 647.22 1,085.05

49526NY0520045 Bronze HMO 8100 New Age 26 Region 2 378.94 757.88 644.20 1,079.98

49526NY0520046 Bronze HMO 8100 New Age 26 Region 2 378.94 757.88 644.20 1,079.98

49526NY0520047 Bronze HMO 8100 New Age 30 Region 2 380.72 761.44 647.22 1,085.05

49526NY0520048 Bronze HMO 8100 New Age 30 Region 2 380.72 761.44 647.22 1,085.05

49526NY0520049 Bronze 8100 align Select New Age 26 Region 2 347.91 695.82 591.45 991.54

49526NY0520050 Bronze 8100 align Select New Age 26 Region 2 347.91 695.82 591.45 991.54

49526NY0520051 Bronze 8100 align Select New Age 30 Region 2 349.54 699.08 594.22 996.19

49526NY0520052 Bronze 8100 align Select New Age 30 Region 2 349.54 699.08 594.22 996.19

49526NY0520053 Bronze 8100 align Select New Age 26 Region 2 347.91 695.82 591.45 991.54

49526NY0520054 Bronze 8100 align Select New Age 26 Region 2 347.91 695.82 591.45 991.54

49526NY0520055 Bronze 8100 align Select New Age 30 Region 2 349.54 699.08 594.22 996.19

49526NY0520056 Bronze 8100 align Select New Age 30 Region 2 349.54 699.08 594.22 996.19

49526NY0520057 Bronze 8100 focus Select New Age 26 Region 2 347.91 695.82 591.45 991.54

49526NY0520058 Bronze 8100 focus Select New Age 26 Region 2 347.91 695.82 591.45 991.54

49526NY0520059 Bronze 8100 focus Select New Age 30 Region 2 349.54 699.08 594.22 996.19

49526NY0520060 Bronze 8100 focus Select New Age 30 Region 2 349.54 699.08 594.22 996.19

49526NY0520061 Bronze 8100 focus Select New Age 26 Region 2 347.91 695.82 591.45 991.54

49526NY0520062 Bronze 8100 focus Select New Age 26 Region 2 347.91 695.82 591.45 991.54

49526NY0520063 Bronze 8100 focus Select New Age 30 Region 2 349.54 699.08 594.22 996.19

49526NY0520064 Bronze 8100 focus Select New Age 30 Region 2 349.54 699.08 594.22 996.19

49526NY0560001 Bronze POS Classic Uniform Mod Age 26 Region 2 385.43 770.86 655.23 1,098.48

49526NY0560002 Bronze POS Classic Uniform Mod Age 26 Region 2 385.43 770.86 655.23 1,098.48

49526NY0560003 Bronze POS Classic Uniform Mod Age 30 Region 2 387.24 774.48 658.31 1,103.63

49526NY0560004 Bronze POS Classic Uniform Mod Age 30 Region 2 387.24 774.48 658.31 1,103.63

49526NY0560005 Bronze POS Classic Uniform Mod Age 26 Region 2 385.43 770.86 655.23 1,098.48

49526NY0560006 Bronze POS Classic Uniform Mod Age 26 Region 2 385.43 770.86 655.23 1,098.48

49526NY0560007 Bronze POS Classic Uniform Mod Age 30 Region 2 387.24 774.48 658.31 1,103.63

49526NY0560008 Bronze POS Classic Uniform Mod Age 30 Region 2 387.24 774.48 658.31 1,103.63

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 22

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q1:

Single

Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

49526NY0560025 Silver POS Classic Uniform Mod Age 26 Region 2 500.55 1,001.10 850.94 1,426.57

49526NY0560026 Silver POS Classic Uniform Mod Age 26 Region 2 500.55 1,001.10 850.94 1,426.57

49526NY0560027 Silver POS Classic Uniform Mod Age 30 Region 2 502.93 1,005.86 854.98 1,433.35

49526NY0560028 Silver POS Classic Uniform Mod Age 30 Region 2 502.93 1,005.86 854.98 1,433.35

49526NY0560029 Silver POS Classic Uniform Mod Age 26 Region 2 500.55 1,001.10 850.94 1,426.57

49526NY0560030 Silver POS Classic Uniform Mod Age 26 Region 2 500.55 1,001.10 850.94 1,426.57

49526NY0560031 Silver POS Classic Uniform Mod Age 30 Region 2 502.93 1,005.86 854.98 1,433.35

49526NY0560032 Silver POS Classic Uniform Mod Age 30 Region 2 502.93 1,005.86 854.98 1,433.35

49526NY0560057 Gold POS Classic Uniform Mod Age 26 Region 2 554.17 1,108.34 942.09 1,579.38

49526NY0560058 Gold POS Classic Uniform Mod Age 26 Region 2 554.17 1,108.34 942.09 1,579.38

49526NY0560059 Gold POS Classic Uniform Mod Age 30 Region 2 556.80 1,113.60 946.56 1,586.88

49526NY0560060 Gold POS Classic Uniform Mod Age 30 Region 2 556.80 1,113.60 946.56 1,586.88

49526NY0560061 Gold POS Classic Uniform Mod Age 26 Region 2 554.17 1,108.34 942.09 1,579.38

49526NY0560062 Gold POS Classic Uniform Mod Age 26 Region 2 554.17 1,108.34 942.09 1,579.38

49526NY0560063 Gold POS Classic Uniform Mod Age 30 Region 2 556.80 1,113.60 946.56 1,586.88

49526NY0560064 Gold POS Classic Uniform Mod Age 30 Region 2 556.80 1,113.60 946.56 1,586.88

49526NY0560089 Platinum POS Classic Uniform Mod Age 26 Region 2 630.36 1,260.72 1,071.61 1,796.53

49526NY0560090 Platinum POS Classic Uniform Mod Age 26 Region 2 630.36 1,260.72 1,071.61 1,796.53

49526NY0560091 Platinum POS Classic Uniform Mod Age 30 Region 2 633.36 1,266.72 1,076.71 1,805.08

49526NY0560092 Platinum POS Classic Uniform Mod Age 30 Region 2 633.36 1,266.72 1,076.71 1,805.08

49526NY0560093 Platinum POS Classic Uniform Mod Age 26 Region 2 630.36 1,260.72 1,071.61 1,796.53

49526NY0560094 Platinum POS Classic Uniform Mod Age 26 Region 2 630.36 1,260.72 1,071.61 1,796.53

49526NY0560095 Platinum POS Classic Uniform Mod Age 30 Region 2 633.36 1,266.72 1,076.71 1,805.08

49526NY0560096 Platinum POS Classic Uniform Mod Age 30 Region 2 633.36 1,266.72 1,076.71 1,805.08

49526NY0560105 Platinum Make Available Uniform Mod Age 26 Region 2 628.59 1,257.18 1,068.60 1,791.48

49526NY0560106 Platinum Make Available Uniform Mod Age 26 Region 2 628.59 1,257.18 1,068.60 1,791.48

49526NY0560107 Platinum Make Available Uniform Mod Age 30 Region 2 631.59 1,263.18 1,073.70 1,800.03

49526NY0560108 Platinum Make Available Uniform Mod Age 30 Region 2 631.59 1,263.18 1,073.70 1,800.03

49526NY0560109 Platinum Make Available Uniform Mod Age 26 Region 2 628.59 1,257.18 1,068.60 1,791.48

49526NY0560110 Platinum Make Available Uniform Mod Age 26 Region 2 628.59 1,257.18 1,068.60 1,791.48

49526NY0560111 Platinum Make Available Uniform Mod Age 30 Region 2 631.59 1,263.18 1,073.70 1,800.03

49526NY0560112 Platinum Make Available Uniform Mod Age 30 Region 2 631.59 1,263.18 1,073.70 1,800.03

49526NY0630001 Bronze 8100EX New Age 26 Region 2 395.13 790.26 671.72 1,126.12

49526NY0630002 Bronze 8100EX New Age 26 Region 2 395.13 790.26 671.72 1,126.12

49526NY0630003 Bronze 8100EX New Age 30 Region 2 396.99 793.98 674.88 1,131.42

49526NY0630004 Bronze 8100EX New Age 30 Region 2 396.99 793.98 674.88 1,131.42

49526NY0630005 Bronze 8100EX New Age 26 Region 2 395.13 790.26 671.72 1,126.12

49526NY0630006 Bronze 8100EX New Age 26 Region 2 395.13 790.26 671.72 1,126.12

49526NY0630007 Bronze 8100EX New Age 30 Region 2 396.99 793.98 674.88 1,131.42

49526NY0630008 Bronze 8100EX New Age 30 Region 2 396.99 793.98 674.88 1,131.42

49526NY0640001 Gold PPO 7100 Uniform Mod Age 26 Region 2 653.48 1,306.96 1,110.92 1,862.42

49526NY0640002 Gold PPO 7100 Uniform Mod Age 26 Region 2 653.48 1,306.96 1,110.92 1,862.42

49526NY0640003 Gold PPO 7100 Uniform Mod Age 30 Region 2 656.59 1,313.18 1,116.20 1,871.28

49526NY0640004 Gold PPO 7100 Uniform Mod Age 30 Region 2 656.59 1,313.18 1,116.20 1,871.28

49526NY0640005 Gold PPO 7100 Uniform Mod Age 26 Region 2 653.48 1,306.96 1,110.92 1,862.42

49526NY0640006 Gold PPO 7100 Uniform Mod Age 26 Region 2 653.48 1,306.96 1,110.92 1,862.42

49526NY0640007 Gold PPO 7100 Uniform Mod Age 30 Region 2 656.59 1,313.18 1,116.20 1,871.28

49526NY0640008 Gold PPO 7100 Uniform Mod Age 30 Region 2 656.59 1,313.18 1,116.20 1,871.28

49526NY0640009 Silver PPO 8100 Uniform Mod Age 26 Region 2 538.86 1,077.72 916.06 1,535.75

49526NY0640010 Silver PPO 8100 Uniform Mod Age 26 Region 2 538.86 1,077.72 916.06 1,535.75

49526NY0640011 Silver PPO 8100 Uniform Mod Age 30 Region 2 541.42 1,082.84 920.41 1,543.05

49526NY0640012 Silver PPO 8100 Uniform Mod Age 30 Region 2 541.42 1,082.84 920.41 1,543.05

49526NY0640013 Silver PPO 8100 Uniform Mod Age 26 Region 2 538.86 1,077.72 916.06 1,535.75

49526NY0640014 Silver PPO 8100 Uniform Mod Age 26 Region 2 538.86 1,077.72 916.06 1,535.75

49526NY0640015 Silver PPO 8100 Uniform Mod Age 30 Region 2 541.42 1,082.84 920.41 1,543.05

49526NY0640016 Silver PPO 8100 Uniform Mod Age 30 Region 2 541.42 1,082.84 920.41 1,543.05

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 23

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q1:

Single

Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

49526NY0640033 Silver PPO 7100 Uniform Mod Age 26 Region 2 594.42 1,188.84 1,010.51 1,694.10

49526NY0640034 Silver PPO 7100 Uniform Mod Age 26 Region 2 594.42 1,188.84 1,010.51 1,694.10

49526NY0640035 Silver PPO 7100 Uniform Mod Age 30 Region 2 597.25 1,194.50 1,015.33 1,702.16

49526NY0640036 Silver PPO 7100 Uniform Mod Age 30 Region 2 597.25 1,194.50 1,015.33 1,702.16

49526NY0640037 Silver PPO 7100 Uniform Mod Age 26 Region 2 594.42 1,188.84 1,010.51 1,694.10

49526NY0640038 Silver PPO 7100 Uniform Mod Age 26 Region 2 594.42 1,188.84 1,010.51 1,694.10

49526NY0640039 Silver PPO 7100 Uniform Mod Age 30 Region 2 597.25 1,194.50 1,015.33 1,702.16

49526NY0640040 Silver PPO 7100 Uniform Mod Age 30 Region 2 597.25 1,194.50 1,015.33 1,702.16

49526NY0640041 Platinum PPO Plus New Age 26 Region 2 790.41 1,580.82 1,343.70 2,252.67

49526NY0640042 Platinum PPO Plus New Age 26 Region 2 790.41 1,580.82 1,343.70 2,252.67

49526NY0640043 Platinum PPO Plus New Age 30 Region 2 794.18 1,588.36 1,350.11 2,263.41

49526NY0640044 Platinum PPO Plus New Age 30 Region 2 794.18 1,588.36 1,350.11 2,263.41

49526NY0640045 Platinum PPO Plus New Age 26 Region 2 790.41 1,580.82 1,343.70 2,252.67

49526NY0640046 Platinum PPO Plus New Age 26 Region 2 790.41 1,580.82 1,343.70 2,252.67

49526NY0640047 Platinum PPO Plus New Age 30 Region 2 794.18 1,588.36 1,350.11 2,263.41

49526NY0640048 Platinum PPO Plus New Age 30 Region 2 794.18 1,588.36 1,350.11 2,263.41

49526NY0680001 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 580.93 1,161.86 987.58 1,655.65

49526NY0680002 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 580.93 1,161.86 987.58 1,655.65

49526NY0680003 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 583.69 1,167.38 992.27 1,663.52

49526NY0680004 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 583.69 1,167.38 992.27 1,663.52

49526NY0680005 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 580.93 1,161.86 987.58 1,655.65

49526NY0680006 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 580.93 1,161.86 987.58 1,655.65

49526NY0680007 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 583.69 1,167.38 992.27 1,663.52

49526NY0680008 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 583.69 1,167.38 992.27 1,663.52

49526NY0680009 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 484.21 968.42 823.16 1,380.00

49526NY0680010 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 484.21 968.42 823.16 1,380.00

49526NY0680011 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 486.50 973.00 827.05 1,386.53

49526NY0680012 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 486.50 973.00 827.05 1,386.53

49526NY0680013 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 484.21 968.42 823.16 1,380.00

49526NY0680014 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 484.21 968.42 823.16 1,380.00

49526NY0680015 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 486.50 973.00 827.05 1,386.53

49526NY0680016 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 486.50 973.00 827.05 1,386.53

49526NY0680017 Gold POS 7100 Uniform Mod Age 26 Region 2 513.95 1,027.90 873.72 1,464.76

49526NY0680018 Gold POS 7100 Uniform Mod Age 26 Region 2 513.95 1,027.90 873.72 1,464.76

49526NY0680019 Gold POS 7100 Uniform Mod Age 30 Region 2 516.39 1,032.78 877.86 1,471.71

49526NY0680020 Gold POS 7100 Uniform Mod Age 30 Region 2 516.39 1,032.78 877.86 1,471.71

49526NY0680021 Gold POS 7100 Uniform Mod Age 26 Region 2 513.95 1,027.90 873.72 1,464.76

49526NY0680022 Gold POS 7100 Uniform Mod Age 26 Region 2 513.95 1,027.90 873.72 1,464.76

49526NY0680023 Gold POS 7100 Uniform Mod Age 30 Region 2 516.39 1,032.78 877.86 1,471.71

49526NY0680024 Gold POS 7100 Uniform Mod Age 30 Region 2 516.39 1,032.78 877.86 1,471.71

49526NY0680025 Gold POS 7100EX Uniform Mod Age 26 Region 2 535.36 1,070.72 910.11 1,525.78

49526NY0680026 Gold POS 7100EX Uniform Mod Age 26 Region 2 535.36 1,070.72 910.11 1,525.78

49526NY0680027 Gold POS 7100EX Uniform Mod Age 30 Region 2 537.90 1,075.80 914.43 1,533.02

49526NY0680028 Gold POS 7100EX Uniform Mod Age 30 Region 2 537.90 1,075.80 914.43 1,533.02

49526NY0680029 Gold POS 7100EX Uniform Mod Age 26 Region 2 535.36 1,070.72 910.11 1,525.78

49526NY0680030 Gold POS 7100EX Uniform Mod Age 26 Region 2 535.36 1,070.72 910.11 1,525.78

49526NY0680031 Gold POS 7100EX Uniform Mod Age 30 Region 2 537.90 1,075.80 914.43 1,533.02

49526NY0680032 Gold POS 7100EX Uniform Mod Age 30 Region 2 537.90 1,075.80 914.43 1,533.02

49526NY0680041 Gold Aqua Uniform Mod Age 26 Region 2 500.65 1,001.30 851.11 1,426.85

49526NY0680042 Gold Aqua Uniform Mod Age 26 Region 2 500.65 1,001.30 851.11 1,426.85

49526NY0680043 Gold Aqua Uniform Mod Age 30 Region 2 503.02 1,006.04 855.13 1,433.61

49526NY0680044 Gold Aqua Uniform Mod Age 30 Region 2 503.02 1,006.04 855.13 1,433.61

49526NY0680045 Gold Aqua Uniform Mod Age 26 Region 2 500.65 1,001.30 851.11 1,426.85

49526NY0680046 Gold Aqua Uniform Mod Age 26 Region 2 500.65 1,001.30 851.11 1,426.85

49526NY0680047 Gold Aqua Uniform Mod Age 30 Region 2 503.02 1,006.04 855.13 1,433.61

49526NY0680048 Gold Aqua Uniform Mod Age 30 Region 2 503.02 1,006.04 855.13 1,433.61

49526NY0680049 Silver POS 7100 Uniform Mod Age 26 Region 2 468.06 936.12 795.70 1,333.97

49526NY0680050 Silver POS 7100 Uniform Mod Age 26 Region 2 468.06 936.12 795.70 1,333.97

49526NY0680051 Silver POS 7100 Uniform Mod Age 30 Region 2 470.27 940.54 799.46 1,340.27

49526NY0680052 Silver POS 7100 Uniform Mod Age 30 Region 2 470.27 940.54 799.46 1,340.27

49526NY0680053 Silver POS 7100 Uniform Mod Age 26 Region 2 468.06 936.12 795.70 1,333.97

49526NY0680054 Silver POS 7100 Uniform Mod Age 26 Region 2 468.06 936.12 795.70 1,333.97

49526NY0680055 Silver POS 7100 Uniform Mod Age 30 Region 2 470.27 940.54 799.46 1,340.27

49526NY0680056 Silver POS 7100 Uniform Mod Age 30 Region 2 470.27 940.54 799.46 1,340.27

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 24

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q1:

Single

Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

49526NY0680057 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 439.43 878.86 747.03 1,252.38

49526NY0680058 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 439.43 878.86 747.03 1,252.38

49526NY0680059 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 441.51 883.02 750.57 1,258.30

49526NY0680060 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 441.51 883.02 750.57 1,258.30

49526NY0680061 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 439.43 878.86 747.03 1,252.38

49526NY0680062 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 439.43 878.86 747.03 1,252.38

49526NY0680063 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 441.51 883.02 750.57 1,258.30

49526NY0680064 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 441.51 883.02 750.57 1,258.30

49526NY0680065 Silver POS 8100EX Uniform Mod Age 26 Region 2 442.37 884.74 752.03 1,260.75

49526NY0680066 Silver POS 8100EX Uniform Mod Age 26 Region 2 442.37 884.74 752.03 1,260.75

49526NY0680067 Silver POS 8100EX Uniform Mod Age 30 Region 2 444.46 888.92 755.58 1,266.71

49526NY0680068 Silver POS 8100EX Uniform Mod Age 30 Region 2 444.46 888.92 755.58 1,266.71

49526NY0680069 Silver POS 8100EX Uniform Mod Age 26 Region 2 442.37 884.74 752.03 1,260.75

49526NY0680070 Silver POS 8100EX Uniform Mod Age 26 Region 2 442.37 884.74 752.03 1,260.75

49526NY0680071 Silver POS 8100EX Uniform Mod Age 30 Region 2 444.46 888.92 755.58 1,266.71

49526NY0680072 Silver POS 8100EX Uniform Mod Age 30 Region 2 444.46 888.92 755.58 1,266.71

49526NY0680081 Silver POS 8100 Uniform Mod Age 26 Region 2 424.88 849.76 722.30 1,210.91

49526NY0680082 Silver POS 8100 Uniform Mod Age 26 Region 2 424.88 849.76 722.30 1,210.91

49526NY0680083 Silver POS 8100 Uniform Mod Age 30 Region 2 426.88 853.76 725.70 1,216.61

49526NY0680084 Silver POS 8100 Uniform Mod Age 30 Region 2 426.88 853.76 725.70 1,216.61

49526NY0680085 Silver POS 8100 Uniform Mod Age 26 Region 2 424.88 849.76 722.30 1,210.91

49526NY0680086 Silver POS 8100 Uniform Mod Age 26 Region 2 424.88 849.76 722.30 1,210.91

49526NY0680087 Silver POS 8100 Uniform Mod Age 30 Region 2 426.88 853.76 725.70 1,216.61

49526NY0680088 Silver POS 8100 Uniform Mod Age 30 Region 2 426.88 853.76 725.70 1,216.61

49526NY0680089 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 580.93 1,161.86 987.58 1,655.65

49526NY0680090 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 580.93 1,161.86 987.58 1,655.65

49526NY0680091 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 583.69 1,167.38 992.27 1,663.52

49526NY0680092 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 583.69 1,167.38 992.27 1,663.52

49526NY0680093 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 580.93 1,161.86 987.58 1,655.65

49526NY0680094 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 580.93 1,161.86 987.58 1,655.65

49526NY0680095 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 583.69 1,167.38 992.27 1,663.52

49526NY0680096 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 583.69 1,167.38 992.27 1,663.52

49526NY0680097 Gold Complete Uniform Mod Age 26 Region 2 495.17 990.34 841.79 1,411.23

49526NY0680098 Gold Complete Uniform Mod Age 26 Region 2 495.17 990.34 841.79 1,411.23

49526NY0680099 Gold Complete Uniform Mod Age 30 Region 2 497.51 995.02 845.77 1,417.90

49526NY0680100 Gold Complete Uniform Mod Age 30 Region 2 497.51 995.02 845.77 1,417.90

49526NY0680101 Gold Complete Uniform Mod Age 26 Region 2 495.17 990.34 841.79 1,411.23

49526NY0680102 Gold Complete Uniform Mod Age 26 Region 2 495.17 990.34 841.79 1,411.23

49526NY0680103 Gold Complete Uniform Mod Age 30 Region 2 497.51 995.02 845.77 1,417.90

49526NY0680104 Gold Complete Uniform Mod Age 30 Region 2 497.51 995.02 845.77 1,417.90

49526NY0680105 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 484.21 968.42 823.16 1,380.00

49526NY0680106 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 484.21 968.42 823.16 1,380.00

49526NY0680107 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 486.50 973.00 827.05 1,386.53

49526NY0680108 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 486.50 973.00 827.05 1,386.53

49526NY0680109 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 484.21 968.42 823.16 1,380.00

49526NY0680110 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 484.21 968.42 823.16 1,380.00

49526NY0680111 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 486.50 973.00 827.05 1,386.53

49526NY0680112 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 486.50 973.00 827.05 1,386.53

49526NY0680121 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 439.43 878.86 747.03 1,252.38

49526NY0680122 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 439.43 878.86 747.03 1,252.38

49526NY0680123 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 441.51 883.02 750.57 1,258.30

49526NY0680124 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 441.51 883.02 750.57 1,258.30

49526NY0680125 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 439.43 878.86 747.03 1,252.38

49526NY0680126 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 439.43 878.86 747.03 1,252.38

49526NY0680127 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 441.51 883.02 750.57 1,258.30

49526NY0680128 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 441.51 883.02 750.57 1,258.30

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 25

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q1:

Single

Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

49526NY0680153 Silver POS 7100EX Uniform Mod Age 26 Region 2 487.45 974.90 828.67 1,389.23

49526NY0680154 Silver POS 7100EX Uniform Mod Age 26 Region 2 487.45 974.90 828.67 1,389.23

49526NY0680155 Silver POS 7100EX Uniform Mod Age 30 Region 2 489.76 979.52 832.59 1,395.82

49526NY0680156 Silver POS 7100EX Uniform Mod Age 30 Region 2 489.76 979.52 832.59 1,395.82

49526NY0680157 Silver POS 7100EX Uniform Mod Age 26 Region 2 487.45 974.90 828.67 1,389.23

49526NY0680158 Silver POS 7100EX Uniform Mod Age 26 Region 2 487.45 974.90 828.67 1,389.23

49526NY0680159 Silver POS 7100EX Uniform Mod Age 30 Region 2 489.76 979.52 832.59 1,395.82

49526NY0680160 Silver POS 7100EX Uniform Mod Age 30 Region 2 489.76 979.52 832.59 1,395.82

49526NY0680177 Silver 8100 align Select Uniform Mod Age 26 Region 2 383.20 766.40 651.44 1,092.12

49526NY0680178 Silver 8100 align Select Uniform Mod Age 26 Region 2 383.20 766.40 651.44 1,092.12

49526NY0680179 Silver 8100 align Select Uniform Mod Age 30 Region 2 385.00 770.00 654.50 1,097.25

49526NY0680180 Silver 8100 align Select Uniform Mod Age 30 Region 2 385.00 770.00 654.50 1,097.25

49526NY0680181 Silver 8100 align Select Uniform Mod Age 26 Region 2 383.20 766.40 651.44 1,092.12

49526NY0680182 Silver 8100 align Select Uniform Mod Age 26 Region 2 383.20 766.40 651.44 1,092.12

49526NY0680183 Silver 8100 align Select Uniform Mod Age 30 Region 2 385.00 770.00 654.50 1,097.25

49526NY0680184 Silver 8100 align Select Uniform Mod Age 30 Region 2 385.00 770.00 654.50 1,097.25

49526NY0680185 Silver 8100 focus Select Uniform Mod Age 26 Region 2 383.20 766.40 651.44 1,092.12

49526NY0680186 Silver 8100 focus Select Uniform Mod Age 26 Region 2 383.20 766.40 651.44 1,092.12

49526NY0680187 Silver 8100 focus Select Uniform Mod Age 30 Region 2 385.00 770.00 654.50 1,097.25

49526NY0680188 Silver 8100 focus Select Uniform Mod Age 30 Region 2 385.00 770.00 654.50 1,097.25

49526NY0680189 Silver 8100 focus Select Uniform Mod Age 26 Region 2 383.20 766.40 651.44 1,092.12

49526NY0680190 Silver 8100 focus Select Uniform Mod Age 26 Region 2 383.20 766.40 651.44 1,092.12

49526NY0680191 Silver 8100 focus Select Uniform Mod Age 30 Region 2 385.00 770.00 654.50 1,097.25

49526NY0680192 Silver 8100 focus Select Uniform Mod Age 30 Region 2 385.00 770.00 654.50 1,097.25

49526NY0680193 Silver 7100 align Select Uniform Mod Age 26 Region 2 421.85 843.70 717.15 1,202.27

49526NY0680194 Silver 7100 align Select Uniform Mod Age 26 Region 2 421.85 843.70 717.15 1,202.27

49526NY0680195 Silver 7100 align Select Uniform Mod Age 30 Region 2 423.84 847.68 720.53 1,207.94

49526NY0680196 Silver 7100 align Select Uniform Mod Age 30 Region 2 423.84 847.68 720.53 1,207.94

49526NY0680197 Silver 7100 align Select Uniform Mod Age 26 Region 2 421.85 843.70 717.15 1,202.27

49526NY0680198 Silver 7100 align Select Uniform Mod Age 26 Region 2 421.85 843.70 717.15 1,202.27

49526NY0680199 Silver 7100 align Select Uniform Mod Age 30 Region 2 423.84 847.68 720.53 1,207.94

49526NY0680200 Silver 7100 align Select Uniform Mod Age 30 Region 2 423.84 847.68 720.53 1,207.94

49526NY0680201 Silver 7100 focus Select Uniform Mod Age 26 Region 2 421.85 843.70 717.15 1,202.27

49526NY0680202 Silver 7100 focus Select Uniform Mod Age 26 Region 2 421.85 843.70 717.15 1,202.27

49526NY0680203 Silver 7100 focus Select Uniform Mod Age 30 Region 2 423.84 847.68 720.53 1,207.94

49526NY0680204 Silver 7100 focus Select Uniform Mod Age 30 Region 2 423.84 847.68 720.53 1,207.94

49526NY0680205 Silver 7100 focus Select Uniform Mod Age 26 Region 2 421.85 843.70 717.15 1,202.27

49526NY0680206 Silver 7100 focus Select Uniform Mod Age 26 Region 2 421.85 843.70 717.15 1,202.27

49526NY0680207 Silver 7100 focus Select Uniform Mod Age 30 Region 2 423.84 847.68 720.53 1,207.94

49526NY0680208 Silver 7100 focus Select Uniform Mod Age 30 Region 2 423.84 847.68 720.53 1,207.94

49526NY0680209 Gold 7100 align Select Uniform Mod Age 26 Region 2 462.93 925.86 786.98 1,319.35

49526NY0680210 Gold 7100 align Select Uniform Mod Age 26 Region 2 462.93 925.86 786.98 1,319.35

49526NY0680211 Gold 7100 align Select Uniform Mod Age 30 Region 2 465.12 930.24 790.70 1,325.59

49526NY0680212 Gold 7100 align Select Uniform Mod Age 30 Region 2 465.12 930.24 790.70 1,325.59

49526NY0680213 Gold 7100 align Select Uniform Mod Age 26 Region 2 462.93 925.86 786.98 1,319.35

49526NY0680214 Gold 7100 align Select Uniform Mod Age 26 Region 2 462.93 925.86 786.98 1,319.35

49526NY0680215 Gold 7100 align Select Uniform Mod Age 30 Region 2 465.12 930.24 790.70 1,325.59

49526NY0680216 Gold 7100 align Select Uniform Mod Age 30 Region 2 465.12 930.24 790.70 1,325.59

49526NY0680217 Gold 7100 focus Select Uniform Mod Age 26 Region 2 462.93 925.86 786.98 1,319.35

49526NY0680218 Gold 7100 focus Select Uniform Mod Age 26 Region 2 462.93 925.86 786.98 1,319.35

49526NY0680219 Gold 7100 focus Select Uniform Mod Age 30 Region 2 465.12 930.24 790.70 1,325.59

49526NY0680220 Gold 7100 focus Select Uniform Mod Age 30 Region 2 465.12 930.24 790.70 1,325.59

49526NY0680221 Gold 7100 focus Select Uniform Mod Age 26 Region 2 462.93 925.86 786.98 1,319.35

49526NY0680222 Gold 7100 focus Select Uniform Mod Age 26 Region 2 462.93 925.86 786.98 1,319.35

49526NY0680223 Gold 7100 focus Select Uniform Mod Age 30 Region 2 465.12 930.24 790.70 1,325.59

49526NY0680224 Gold 7100 focus Select Uniform Mod Age 30 Region 2 465.12 930.24 790.70 1,325.59

49526NY0680225 Silver Aqua Uniform Mod Age 26 Region 2 455.02 910.04 773.53 1,296.81

49526NY0680226 Silver Aqua Uniform Mod Age 26 Region 2 455.02 910.04 773.53 1,296.81

49526NY0680227 Silver Aqua Uniform Mod Age 30 Region 2 457.17 914.34 777.19 1,302.93

49526NY0680228 Silver Aqua Uniform Mod Age 30 Region 2 457.17 914.34 777.19 1,302.93

49526NY0680229 Silver Aqua Uniform Mod Age 26 Region 2 455.02 910.04 773.53 1,296.81

49526NY0680230 Silver Aqua Uniform Mod Age 26 Region 2 455.02 910.04 773.53 1,296.81

49526NY0680231 Silver Aqua Uniform Mod Age 30 Region 2 457.17 914.34 777.19 1,302.93

49526NY0680232 Silver Aqua Uniform Mod Age 30 Region 2 457.17 914.34 777.19 1,302.93

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 26

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q1:

Single

Q1: Subscriber

& Spouse

Q1: Subscriber &

Child(ren)

Q1:

Family

49526NY0680233 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 400.82 801.64 681.39 1,142.34

49526NY0680234 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 400.82 801.64 681.39 1,142.34

49526NY0680235 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 402.71 805.42 684.61 1,147.72

49526NY0680236 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 402.71 805.42 684.61 1,147.72

49526NY0680237 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 400.82 801.64 681.39 1,142.34

49526NY0680238 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 400.82 801.64 681.39 1,142.34

49526NY0680239 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 402.71 805.42 684.61 1,147.72

49526NY0680240 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 402.71 805.42 684.61 1,147.72

49526NY0680241 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 400.82 801.64 681.39 1,142.34

49526NY0680242 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 400.82 801.64 681.39 1,142.34

49526NY0680243 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 402.71 805.42 684.61 1,147.72

49526NY0680244 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 402.71 805.42 684.61 1,147.72

49526NY0680245 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 400.82 801.64 681.39 1,142.34

49526NY0680246 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 400.82 801.64 681.39 1,142.34

49526NY0680247 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 402.71 805.42 684.61 1,147.72

49526NY0680248 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 402.71 805.42 684.61 1,147.72

49526NY0680265 Platinum EX Plus New Age 26 Region 2 646.47 1,292.94 1,099.00 1,842.44

49526NY0680266 Platinum EX Plus New Age 26 Region 2 646.47 1,292.94 1,099.00 1,842.44

49526NY0680267 Platinum EX Plus New Age 30 Region 2 649.55 1,299.10 1,104.24 1,851.22

49526NY0680268 Platinum EX Plus New Age 30 Region 2 649.55 1,299.10 1,104.24 1,851.22

49526NY0680269 Platinum EX Plus New Age 26 Region 2 646.47 1,292.94 1,099.00 1,842.44

49526NY0680270 Platinum EX Plus New Age 26 Region 2 646.47 1,292.94 1,099.00 1,842.44

49526NY0680271 Platinum EX Plus New Age 30 Region 2 649.55 1,299.10 1,104.24 1,851.22

49526NY0680272 Platinum EX Plus New Age 30 Region 2 649.55 1,299.10 1,104.24 1,851.22

49526NY0680273 Platinum align Select Plus New Age 26 Region 2 558.20 1,116.40 948.94 1,590.87

49526NY0680274 Platinum align Select Plus New Age 26 Region 2 558.20 1,116.40 948.94 1,590.87

49526NY0680275 Platinum align Select Plus New Age 30 Region 2 560.85 1,121.70 953.45 1,598.42

49526NY0680276 Platinum align Select Plus New Age 30 Region 2 560.85 1,121.70 953.45 1,598.42

49526NY0680277 Platinum align Select Plus New Age 26 Region 2 558.20 1,116.40 948.94 1,590.87

49526NY0680278 Platinum align Select Plus New Age 26 Region 2 558.20 1,116.40 948.94 1,590.87

49526NY0680279 Platinum align Select Plus New Age 30 Region 2 560.85 1,121.70 953.45 1,598.42

49526NY0680280 Platinum align Select Plus New Age 30 Region 2 560.85 1,121.70 953.45 1,598.42

49526NY0680281 Platinum focus Select Plus New Age 26 Region 2 558.20 1,116.40 948.94 1,590.87

49526NY0680282 Platinum focus Select Plus New Age 26 Region 2 558.20 1,116.40 948.94 1,590.87

49526NY0680283 Platinum focus Select Plus New Age 30 Region 2 560.85 1,121.70 953.45 1,598.42

49526NY0680284 Platinum focus Select Plus New Age 30 Region 2 560.85 1,121.70 953.45 1,598.42

49526NY0680285 Platinum focus Select Plus New Age 26 Region 2 558.20 1,116.40 948.94 1,590.87

49526NY0680286 Platinum focus Select Plus New Age 26 Region 2 558.20 1,116.40 948.94 1,590.87

49526NY0680287 Platinum focus Select Plus New Age 30 Region 2 560.85 1,121.70 953.45 1,598.42

49526NY0680288 Platinum focus Select Plus New Age 30 Region 2 560.85 1,121.70 953.45 1,598.42

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 27

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q2:

Single Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

36346NY0250001 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250002 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250003 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250004 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250005 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250006 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250007 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250008 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0470001 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 476.40 952.80 809.88 1,357.74

36346NY0470002 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 476.40 952.80 809.88 1,357.74

36346NY0470003 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 478.65 957.30 813.71 1,364.15

36346NY0470004 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 478.65 957.30 813.71 1,364.15

36346NY0470005 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 476.40 952.80 809.88 1,357.74

36346NY0470006 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 476.40 952.80 809.88 1,357.74

36346NY0470007 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 478.65 957.30 813.71 1,364.15

36346NY0470008 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 478.65 957.30 813.71 1,364.15

36346NY0470014 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 614.74 1,229.48 1,045.06 1,752.01

36346NY0470015 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 614.74 1,229.48 1,045.06 1,752.01

36346NY0470016 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 617.66 1,235.32 1,050.02 1,760.33

36346NY0470017 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 617.66 1,235.32 1,050.02 1,760.33

36346NY0470018 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 614.74 1,229.48 1,045.06 1,752.01

36346NY0470019 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 614.74 1,229.48 1,045.06 1,752.01

36346NY0470020 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 617.66 1,235.32 1,050.02 1,760.33

36346NY0470021 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 617.66 1,235.32 1,050.02 1,760.33

36346NY0470026 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 692.01 1,384.02 1,176.42 1,972.23

36346NY0470027 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 692.01 1,384.02 1,176.42 1,972.23

36346NY0470028 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 695.31 1,390.62 1,182.03 1,981.63

36346NY0470029 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 695.31 1,390.62 1,182.03 1,981.63

36346NY0470030 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 692.01 1,384.02 1,176.42 1,972.23

36346NY0470031 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 692.01 1,384.02 1,176.42 1,972.23

36346NY0470032 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 695.31 1,390.62 1,182.03 1,981.63

36346NY0470033 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 695.31 1,390.62 1,182.03 1,981.63

36346NY0470035 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 787.60 1,575.20 1,338.92 2,244.66

36346NY0470036 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 787.60 1,575.20 1,338.92 2,244.66

36346NY0470037 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 791.36 1,582.72 1,345.31 2,255.38

36346NY0470038 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 791.36 1,582.72 1,345.31 2,255.38

36346NY0470039 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 787.60 1,575.20 1,338.92 2,244.66

36346NY0470040 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 787.60 1,575.20 1,338.92 2,244.66

36346NY0470041 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 791.36 1,582.72 1,345.31 2,255.38

36346NY0470042 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 791.36 1,582.72 1,345.31 2,255.38

36346NY0470050 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 786.65 1,573.30 1,337.31 2,241.95

36346NY0470051 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 786.65 1,573.30 1,337.31 2,241.95

36346NY0470052 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 790.41 1,580.82 1,343.70 2,252.67

36346NY0470053 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 790.41 1,580.82 1,343.70 2,252.67

36346NY0470054 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 786.65 1,573.30 1,337.31 2,241.95

36346NY0470055 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 786.65 1,573.30 1,337.31 2,241.95

36346NY0470056 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 790.41 1,580.82 1,343.70 2,252.67

36346NY0470057 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 790.41 1,580.82 1,343.70 2,252.67

36346NY0550033 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 667.56 1,335.12 1,134.85 1,902.55

36346NY0550034 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 667.56 1,335.12 1,134.85 1,902.55

36346NY0550035 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 670.74 1,341.48 1,140.26 1,911.61

36346NY0550036 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 670.74 1,341.48 1,140.26 1,911.61

36346NY0550037 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 667.56 1,335.12 1,134.85 1,902.55

36346NY0550038 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 667.56 1,335.12 1,134.85 1,902.55

36346NY0550039 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 670.74 1,341.48 1,140.26 1,911.61

36346NY0550040 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 670.74 1,341.48 1,140.26 1,911.61

36346NY0550041 Bronze Value Uniform Mod Age 26 Regions 1 and 7 487.99 975.98 829.58 1,390.77

36346NY0550042 Bronze Value Uniform Mod Age 26 Regions 1 and 7 487.99 975.98 829.58 1,390.77

36346NY0550043 Bronze Value Uniform Mod Age 30 Regions 1 and 7 490.29 980.58 833.49 1,397.33

36346NY0550044 Bronze Value Uniform Mod Age 30 Regions 1 and 7 490.29 980.58 833.49 1,397.33

36346NY0550045 Bronze Value Uniform Mod Age 26 Regions 1 and 7 487.99 975.98 829.58 1,390.77

36346NY0550046 Bronze Value Uniform Mod Age 26 Regions 1 and 7 487.99 975.98 829.58 1,390.77

36346NY0550047 Bronze Value Uniform Mod Age 30 Regions 1 and 7 490.29 980.58 833.49 1,397.33

36346NY0550048 Bronze Value Uniform Mod Age 30 Regions 1 and 7 490.29 980.58 833.49 1,397.33

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 28

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q2:

Single

Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

36346NY0550049 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 455.42 910.84 774.21 1,297.95

36346NY0550050 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 455.42 910.84 774.21 1,297.95

36346NY0550051 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 457.57 915.14 777.87 1,304.07

36346NY0550052 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 457.57 915.14 777.87 1,304.07

36346NY0550053 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 455.42 910.84 774.21 1,297.95

36346NY0550054 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 455.42 910.84 774.21 1,297.95

36346NY0550055 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 457.57 915.14 777.87 1,304.07

36346NY0550056 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 457.57 915.14 777.87 1,304.07

36346NY0550057 Bronze HMO Classic NEW Age 26 Regions 1 and 7 462.02 924.04 785.43 1,316.76

36346NY0550058 Bronze HMO Classic NEW Age 26 Regions 1 and 7 462.02 924.04 785.43 1,316.76

36346NY0550059 Bronze HMO Classic NEW Age 30 Regions 1 and 7 464.21 928.42 789.16 1,323.00

36346NY0550060 Bronze HMO Classic NEW Age 30 Regions 1 and 7 464.21 928.42 789.16 1,323.00

36346NY0550061 Bronze HMO Classic NEW Age 26 Regions 1 and 7 462.02 924.04 785.43 1,316.76

36346NY0550062 Bronze HMO Classic NEW Age 26 Regions 1 and 7 462.02 924.04 785.43 1,316.76

36346NY0550063 Bronze HMO Classic NEW Age 30 Regions 1 and 7 464.21 928.42 789.16 1,323.00

36346NY0550064 Bronze HMO Classic NEW Age 30 Regions 1 and 7 464.21 928.42 789.16 1,323.00

36346NY0550065 Silver HMO Classic NEW Age 26 Regions 1 and 7 602.24 1,204.48 1,023.81 1,716.38

36346NY0550066 Silver HMO Classic NEW Age 26 Regions 1 and 7 602.24 1,204.48 1,023.81 1,716.38

36346NY0550067 Silver HMO Classic NEW Age 30 Regions 1 and 7 605.11 1,210.22 1,028.69 1,724.56

36346NY0550068 Silver HMO Classic NEW Age 30 Regions 1 and 7 605.11 1,210.22 1,028.69 1,724.56

36346NY0550069 Silver HMO Classic NEW Age 26 Regions 1 and 7 602.24 1,204.48 1,023.81 1,716.38

36346NY0550070 Silver HMO Classic NEW Age 26 Regions 1 and 7 602.24 1,204.48 1,023.81 1,716.38

36346NY0550071 Silver HMO Classic NEW Age 30 Regions 1 and 7 605.11 1,210.22 1,028.69 1,724.56

36346NY0550072 Silver HMO Classic NEW Age 30 Regions 1 and 7 605.11 1,210.22 1,028.69 1,724.56

36346NY0550073 Gold HMO Classic NEW Age 26 Regions 1 and 7 680.57 1,361.14 1,156.97 1,939.62

36346NY0550074 Gold HMO Classic NEW Age 26 Regions 1 and 7 680.57 1,361.14 1,156.97 1,939.62

36346NY0550075 Gold HMO Classic NEW Age 30 Regions 1 and 7 683.81 1,367.62 1,162.48 1,948.86

36346NY0550076 Gold HMO Classic NEW Age 30 Regions 1 and 7 683.81 1,367.62 1,162.48 1,948.86

36346NY0550077 Gold HMO Classic NEW Age 26 Regions 1 and 7 680.57 1,361.14 1,156.97 1,939.62

36346NY0550078 Gold HMO Classic NEW Age 26 Regions 1 and 7 680.57 1,361.14 1,156.97 1,939.62

36346NY0550079 Gold HMO Classic NEW Age 30 Regions 1 and 7 683.81 1,367.62 1,162.48 1,948.86

36346NY0550080 Gold HMO Classic NEW Age 30 Regions 1 and 7 683.81 1,367.62 1,162.48 1,948.86

36346NY0550081 Platinum HMO Classic NEW Age 26 Regions 1 and 7 777.47 1,554.94 1,321.70 2,215.79

36346NY0550082 Platinum HMO Classic NEW Age 26 Regions 1 and 7 777.47 1,554.94 1,321.70 2,215.79

36346NY0550083 Platinum HMO Classic NEW Age 30 Regions 1 and 7 781.18 1,562.36 1,328.01 2,226.36

36346NY0550084 Platinum HMO Classic NEW Age 30 Regions 1 and 7 781.18 1,562.36 1,328.01 2,226.36

36346NY0550085 Platinum HMO Classic NEW Age 26 Regions 1 and 7 777.47 1,554.94 1,321.70 2,215.79

36346NY0550086 Platinum HMO Classic NEW Age 26 Regions 1 and 7 777.47 1,554.94 1,321.70 2,215.79

36346NY0550087 Platinum HMO Classic NEW Age 30 Regions 1 and 7 781.18 1,562.36 1,328.01 2,226.36

36346NY0550088 Platinum HMO Classic NEW Age 30 Regions 1 and 7 781.18 1,562.36 1,328.01 2,226.36

36346NY0550089 Silver HMO 6300 NEW Age 26 Regions 1 and 7 588.28 1,176.56 1,000.08 1,676.60

36346NY0550090 Silver HMO 6300 NEW Age 26 Regions 1 and 7 588.28 1,176.56 1,000.08 1,676.60

36346NY0550091 Silver HMO 6300 NEW Age 30 Regions 1 and 7 591.07 1,182.14 1,004.82 1,684.55

36346NY0550092 Silver HMO 6300 NEW Age 30 Regions 1 and 7 591.07 1,182.14 1,004.82 1,684.55

36346NY0550093 Silver HMO 6300 NEW Age 26 Regions 1 and 7 588.28 1,176.56 1,000.08 1,676.60

36346NY0550094 Silver HMO 6300 NEW Age 26 Regions 1 and 7 588.28 1,176.56 1,000.08 1,676.60

36346NY0550095 Silver HMO 6300 NEW Age 30 Regions 1 and 7 591.07 1,182.14 1,004.82 1,684.55

36346NY0550096 Silver HMO 6300 NEW Age 30 Regions 1 and 7 591.07 1,182.14 1,004.82 1,684.55

36346NY0640009 Gold EPO Uniform Mod Age 26 Regions 1 and 7 737.03 1,474.06 1,252.95 2,100.54

36346NY0640010 Gold EPO Uniform Mod Age 26 Regions 1 and 7 737.03 1,474.06 1,252.95 2,100.54

36346NY0640011 Gold EPO Uniform Mod Age 30 Regions 1 and 7 740.55 1,481.10 1,258.94 2,110.57

36346NY0640012 Gold EPO Uniform Mod Age 30 Regions 1 and 7 740.55 1,481.10 1,258.94 2,110.57

36346NY0640013 Gold EPO Uniform Mod Age 26 Regions 1 and 7 737.03 1,474.06 1,252.95 2,100.54

36346NY0640014 Gold EPO Uniform Mod Age 26 Regions 1 and 7 737.03 1,474.06 1,252.95 2,100.54

36346NY0640015 Gold EPO Uniform Mod Age 30 Regions 1 and 7 740.55 1,481.10 1,258.94 2,110.57

36346NY0640016 Gold EPO Uniform Mod Age 30 Regions 1 and 7 740.55 1,481.10 1,258.94 2,110.57

36346NY0640033 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 621.09 1,242.18 1,055.85 1,770.11

36346NY0640034 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 621.09 1,242.18 1,055.85 1,770.11

36346NY0640035 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 624.05 1,248.10 1,060.89 1,778.54

36346NY0640036 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 624.05 1,248.10 1,060.89 1,778.54

36346NY0640037 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 621.09 1,242.18 1,055.85 1,770.11

36346NY0640038 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 621.09 1,242.18 1,055.85 1,770.11

36346NY0640039 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 624.05 1,248.10 1,060.89 1,778.54

36346NY0640040 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 624.05 1,248.10 1,060.89 1,778.54

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 29

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q2:

Single

Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

36346NY0640041 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 666.51 1,333.02 1,133.07 1,899.55

36346NY0640042 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 666.51 1,333.02 1,133.07 1,899.55

36346NY0640043 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 669.69 1,339.38 1,138.47 1,908.62

36346NY0640044 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 669.69 1,339.38 1,138.47 1,908.62

36346NY0640045 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 666.51 1,333.02 1,133.07 1,899.55

36346NY0640046 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 666.51 1,333.02 1,133.07 1,899.55

36346NY0640047 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 669.69 1,339.38 1,138.47 1,908.62

36346NY0640048 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 669.69 1,339.38 1,138.47 1,908.62

36346NY0640081 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 563.29 1,126.58 957.59 1,605.38

36346NY0640082 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 563.29 1,126.58 957.59 1,605.38

36346NY0640083 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 565.96 1,131.92 962.13 1,612.99

36346NY0640084 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 565.96 1,131.92 962.13 1,612.99

36346NY0640085 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 563.29 1,126.58 957.59 1,605.38

36346NY0640086 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 563.29 1,126.58 957.59 1,605.38

36346NY0640087 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 565.96 1,131.92 962.13 1,612.99

36346NY0640088 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 565.96 1,131.92 962.13 1,612.99

36346NY0640089 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 801.48 1,602.96 1,362.52 2,284.22

36346NY0640090 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 801.48 1,602.96 1,362.52 2,284.22

36346NY0640091 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 805.30 1,610.60 1,369.01 2,295.11

36346NY0640092 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 805.30 1,610.60 1,369.01 2,295.11

36346NY0640093 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 801.48 1,602.96 1,362.52 2,284.22

36346NY0640094 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 801.48 1,602.96 1,362.52 2,284.22

36346NY0640095 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 805.30 1,610.60 1,369.01 2,295.11

36346NY0640096 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 805.30 1,610.60 1,369.01 2,295.11

36346NY0650001 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 884.15 1,768.30 1,503.06 2,519.83

36346NY0650002 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 884.15 1,768.30 1,503.06 2,519.83

36346NY0650003 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 888.38 1,776.76 1,510.25 2,531.88

36346NY0650004 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 888.38 1,776.76 1,510.25 2,531.88

36346NY0650005 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 884.15 1,768.30 1,503.06 2,519.83

36346NY0650006 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 884.15 1,768.30 1,503.06 2,519.83

36346NY0650007 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 888.38 1,776.76 1,510.25 2,531.88

36346NY0650008 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 888.38 1,776.76 1,510.25 2,531.88

36346NY0690009 Gold Radius Uniform Mod Age 26 Regions 1 and 7 662.22 1,324.44 1,125.77 1,887.33

36346NY0690010 Gold Radius Uniform Mod Age 26 Regions 1 and 7 662.22 1,324.44 1,125.77 1,887.33

36346NY0690011 Gold Radius Uniform Mod Age 30 Regions 1 and 7 665.37 1,330.74 1,131.13 1,896.30

36346NY0690012 Gold Radius Uniform Mod Age 30 Regions 1 and 7 665.37 1,330.74 1,131.13 1,896.30

36346NY0690013 Gold Radius Uniform Mod Age 26 Regions 1 and 7 662.22 1,324.44 1,125.77 1,887.33

36346NY0690014 Gold Radius Uniform Mod Age 26 Regions 1 and 7 662.22 1,324.44 1,125.77 1,887.33

36346NY0690015 Gold Radius Uniform Mod Age 30 Regions 1 and 7 665.37 1,330.74 1,131.13 1,896.30

36346NY0690016 Gold Radius Uniform Mod Age 30 Regions 1 and 7 665.37 1,330.74 1,131.13 1,896.30

36346NY0690049 Gold EX Uniform Mod Age 26 Regions 1 and 7 690.82 1,381.64 1,174.39 1,968.84

36346NY0690050 Gold EX Uniform Mod Age 26 Regions 1 and 7 690.82 1,381.64 1,174.39 1,968.84

36346NY0690051 Gold EX Uniform Mod Age 30 Regions 1 and 7 694.12 1,388.24 1,180.00 1,978.24

36346NY0690052 Gold EX Uniform Mod Age 30 Regions 1 and 7 694.12 1,388.24 1,180.00 1,978.24

36346NY0690053 Gold EX Uniform Mod Age 26 Regions 1 and 7 690.82 1,381.64 1,174.39 1,968.84

36346NY0690054 Gold EX Uniform Mod Age 26 Regions 1 and 7 690.82 1,381.64 1,174.39 1,968.84

36346NY0690055 Gold EX Uniform Mod Age 30 Regions 1 and 7 694.12 1,388.24 1,180.00 1,978.24

36346NY0690056 Gold EX Uniform Mod Age 30 Regions 1 and 7 694.12 1,388.24 1,180.00 1,978.24

36346NY0690057 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 561.49 1,122.98 954.53 1,600.25

36346NY0690058 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 561.49 1,122.98 954.53 1,600.25

36346NY0690059 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 564.16 1,128.32 959.07 1,607.86

36346NY0690060 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 564.16 1,128.32 959.07 1,607.86

36346NY0690061 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 561.49 1,122.98 954.53 1,600.25

36346NY0690062 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 561.49 1,122.98 954.53 1,600.25

36346NY0690063 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 564.16 1,128.32 959.07 1,607.86

36346NY0690064 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 564.16 1,128.32 959.07 1,607.86

36346NY0690065 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 585.53 1,171.06 995.40 1,668.76

36346NY0690066 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 585.53 1,171.06 995.40 1,668.76

36346NY0690067 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 588.31 1,176.62 1,000.13 1,676.68

36346NY0690068 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 588.31 1,176.62 1,000.13 1,676.68

36346NY0690069 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 585.53 1,171.06 995.40 1,668.76

36346NY0690070 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 585.53 1,171.06 995.40 1,668.76

36346NY0690071 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 588.31 1,176.62 1,000.13 1,676.68

36346NY0690072 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 588.31 1,176.62 1,000.13 1,676.68

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 30

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q2:

Single

Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

36346NY0690081 Platinum EX Uniform Mod Age 26 Regions 1 and 7 816.43 1,632.86 1,387.93 2,326.83

36346NY0690082 Platinum EX Uniform Mod Age 26 Regions 1 and 7 816.43 1,632.86 1,387.93 2,326.83

36346NY0690083 Platinum EX Uniform Mod Age 30 Regions 1 and 7 820.32 1,640.64 1,394.54 2,337.91

36346NY0690084 Platinum EX Uniform Mod Age 30 Regions 1 and 7 820.32 1,640.64 1,394.54 2,337.91

36346NY0690085 Platinum EX Uniform Mod Age 26 Regions 1 and 7 816.43 1,632.86 1,387.93 2,326.83

36346NY0690086 Platinum EX Uniform Mod Age 26 Regions 1 and 7 816.43 1,632.86 1,387.93 2,326.83

36346NY0690087 Platinum EX Uniform Mod Age 30 Regions 1 and 7 820.32 1,640.64 1,394.54 2,337.91

36346NY0690088 Platinum EX Uniform Mod Age 30 Regions 1 and 7 820.32 1,640.64 1,394.54 2,337.91

36346NY0690089 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 782.37 1,564.74 1,330.03 2,229.75

36346NY0690090 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 782.37 1,564.74 1,330.03 2,229.75

36346NY0690091 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 786.10 1,572.20 1,336.37 2,240.39

36346NY0690092 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 786.10 1,572.20 1,336.37 2,240.39

36346NY0690093 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 782.37 1,564.74 1,330.03 2,229.75

36346NY0690094 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 782.37 1,564.74 1,330.03 2,229.75

36346NY0690095 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 786.10 1,572.20 1,336.37 2,240.39

36346NY0690096 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 786.10 1,572.20 1,336.37 2,240.39

36346NY0690105 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 718.21 1,436.42 1,220.96 2,046.90

36346NY0690106 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 718.21 1,436.42 1,220.96 2,046.90

36346NY0690107 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 721.64 1,443.28 1,226.79 2,056.67

36346NY0690108 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 721.64 1,443.28 1,226.79 2,056.67

36346NY0690109 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 718.21 1,436.42 1,220.96 2,046.90

36346NY0690110 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 718.21 1,436.42 1,220.96 2,046.90

36346NY0690111 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 721.64 1,443.28 1,226.79 2,056.67

36346NY0690112 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 721.64 1,443.28 1,226.79 2,056.67

36346NY0690113 Gold EX high Uniform Mod Age 26 Regions 1 and 7 749.36 1,498.72 1,273.91 2,135.68

36346NY0690114 Gold EX high Uniform Mod Age 26 Regions 1 and 7 749.36 1,498.72 1,273.91 2,135.68

36346NY0690115 Gold EX high Uniform Mod Age 30 Regions 1 and 7 752.94 1,505.88 1,280.00 2,145.88

36346NY0690116 Gold EX high Uniform Mod Age 30 Regions 1 and 7 752.94 1,505.88 1,280.00 2,145.88

36346NY0690117 Gold EX high Uniform Mod Age 26 Regions 1 and 7 749.36 1,498.72 1,273.91 2,135.68

36346NY0690118 Gold EX high Uniform Mod Age 26 Regions 1 and 7 749.36 1,498.72 1,273.91 2,135.68

36346NY0690119 Gold EX high Uniform Mod Age 30 Regions 1 and 7 752.94 1,505.88 1,280.00 2,145.88

36346NY0690120 Gold EX high Uniform Mod Age 30 Regions 1 and 7 752.94 1,505.88 1,280.00 2,145.88

36346NY0690121 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 637.62 1,275.24 1,083.95 1,817.22

36346NY0690122 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 637.62 1,275.24 1,083.95 1,817.22

36346NY0690123 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 640.64 1,281.28 1,089.09 1,825.82

36346NY0690124 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 640.64 1,281.28 1,089.09 1,825.82

36346NY0690125 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 637.62 1,275.24 1,083.95 1,817.22

36346NY0690126 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 637.62 1,275.24 1,083.95 1,817.22

36346NY0690127 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 640.64 1,281.28 1,089.09 1,825.82

36346NY0690128 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 640.64 1,281.28 1,089.09 1,825.82

36346NY0690129 Silver EX 6300 NEW Age 26 Regions 1 and 7 626.78 1,253.56 1,065.53 1,786.32

36346NY0690130 Silver EX 6300 NEW Age 26 Regions 1 and 7 626.78 1,253.56 1,065.53 1,786.32

36346NY0690131 Silver EX 6300 NEW Age 30 Regions 1 and 7 629.76 1,259.52 1,070.59 1,794.82

36346NY0690132 Silver EX 6300 NEW Age 30 Regions 1 and 7 629.76 1,259.52 1,070.59 1,794.82

36346NY0690133 Silver EX 6300 NEW Age 26 Regions 1 and 7 626.78 1,253.56 1,065.53 1,786.32

36346NY0690134 Silver EX 6300 NEW Age 26 Regions 1 and 7 626.78 1,253.56 1,065.53 1,786.32

36346NY0690135 Silver EX 6300 NEW Age 30 Regions 1 and 7 629.76 1,259.52 1,070.59 1,794.82

36346NY0690136 Silver EX 6300 NEW Age 30 Regions 1 and 7 629.76 1,259.52 1,070.59 1,794.82

49526NY0280001 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280002 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280003 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280004 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280005 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280006 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280007 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280008 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0680289 Platinum POS Plus Uniform Mod Age 26 Region 2 630.44 1,260.88 1,071.75 1,796.75

49526NY0680290 Platinum POS Plus Uniform Mod Age 26 Region 2 630.44 1,260.88 1,071.75 1,796.75

49526NY0680291 Platinum POS Plus Uniform Mod Age 30 Region 2 633.44 1,266.88 1,076.85 1,805.30

49526NY0680292 Platinum POS Plus Uniform Mod Age 30 Region 2 633.44 1,266.88 1,076.85 1,805.30

49526NY0680293 Platinum POS Plus Uniform Mod Age 26 Region 2 630.44 1,260.88 1,071.75 1,796.75

49526NY0680294 Platinum POS Plus Uniform Mod Age 26 Region 2 630.44 1,260.88 1,071.75 1,796.75

49526NY0680295 Platinum POS Plus Uniform Mod Age 30 Region 2 633.44 1,266.88 1,076.85 1,805.30

49526NY0680296 Platinum POS Plus Uniform Mod Age 30 Region 2 633.44 1,266.88 1,076.85 1,805.30

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 31

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q2:

Single

Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

49526NY0520009 Bronze focus Tiered Uniform Mod Age 26 Region 2 347.96 695.92 591.53 991.69

49526NY0520010 Bronze focus Tiered Uniform Mod Age 26 Region 2 347.96 695.92 591.53 991.69

49526NY0520011 Bronze focus Tiered Uniform Mod Age 30 Region 2 349.59 699.18 594.30 996.33

49526NY0520012 Bronze focus Tiered Uniform Mod Age 30 Region 2 349.59 699.18 594.30 996.33

49526NY0520013 Bronze focus Tiered Uniform Mod Age 26 Region 2 347.96 695.92 591.53 991.69

49526NY0520014 Bronze focus Tiered Uniform Mod Age 26 Region 2 347.96 695.92 591.53 991.69

49526NY0520015 Bronze focus Tiered Uniform Mod Age 30 Region 2 349.59 699.18 594.30 996.33

49526NY0520016 Bronze focus Tiered Uniform Mod Age 30 Region 2 349.59 699.18 594.30 996.33

49526NY0520017 Bronze align Tiered Uniform Mod Age 26 Region 2 347.96 695.92 591.53 991.69

49526NY0520018 Bronze align Tiered Uniform Mod Age 26 Region 2 347.96 695.92 591.53 991.69

49526NY0520019 Bronze align Tiered Uniform Mod Age 30 Region 2 349.59 699.18 594.30 996.33

49526NY0520020 Bronze align Tiered Uniform Mod Age 30 Region 2 349.59 699.18 594.30 996.33

49526NY0520021 Bronze align Tiered Uniform Mod Age 26 Region 2 347.96 695.92 591.53 991.69

49526NY0520022 Bronze align Tiered Uniform Mod Age 26 Region 2 347.96 695.92 591.53 991.69

49526NY0520023 Bronze align Tiered Uniform Mod Age 30 Region 2 349.59 699.18 594.30 996.33

49526NY0520024 Bronze align Tiered Uniform Mod Age 30 Region 2 349.59 699.18 594.30 996.33

49526NY0520025 Bronze align Select Uniform Mod Age 26 Region 2 338.76 677.52 575.89 965.47

49526NY0520026 Bronze align Select Uniform Mod Age 26 Region 2 338.76 677.52 575.89 965.47

49526NY0520027 Bronze align Select Uniform Mod Age 30 Region 2 340.34 680.68 578.58 969.97

49526NY0520028 Bronze align Select Uniform Mod Age 30 Region 2 340.34 680.68 578.58 969.97

49526NY0520029 Bronze align Select Uniform Mod Age 26 Region 2 338.76 677.52 575.89 965.47

49526NY0520030 Bronze align Select Uniform Mod Age 26 Region 2 338.76 677.52 575.89 965.47

49526NY0520031 Bronze align Select Uniform Mod Age 30 Region 2 340.34 680.68 578.58 969.97

49526NY0520032 Bronze align Select Uniform Mod Age 30 Region 2 340.34 680.68 578.58 969.97

49526NY0520033 Bronze focus Select Uniform Mod Age 26 Region 2 338.76 677.52 575.89 965.47

49526NY0520034 Bronze focus Select Uniform Mod Age 26 Region 2 338.76 677.52 575.89 965.47

49526NY0520035 Bronze focus Select Uniform Mod Age 30 Region 2 340.34 680.68 578.58 969.97

49526NY0520036 Bronze focus Select Uniform Mod Age 30 Region 2 340.34 680.68 578.58 969.97

49526NY0520037 Bronze focus Select Uniform Mod Age 26 Region 2 338.76 677.52 575.89 965.47

49526NY0520038 Bronze focus Select Uniform Mod Age 26 Region 2 338.76 677.52 575.89 965.47

49526NY0520039 Bronze focus Select Uniform Mod Age 30 Region 2 340.34 680.68 578.58 969.97

49526NY0520040 Bronze focus Select Uniform Mod Age 30 Region 2 340.34 680.68 578.58 969.97

49526NY0520041 Bronze HMO 8100 New Age 26 Region 2 385.09 770.18 654.65 1,097.51

49526NY0520042 Bronze HMO 8100 New Age 26 Region 2 385.09 770.18 654.65 1,097.51

49526NY0520043 Bronze HMO 8100 New Age 30 Region 2 386.89 773.78 657.71 1,102.64

49526NY0520044 Bronze HMO 8100 New Age 30 Region 2 386.89 773.78 657.71 1,102.64

49526NY0520045 Bronze HMO 8100 New Age 26 Region 2 385.09 770.18 654.65 1,097.51

49526NY0520046 Bronze HMO 8100 New Age 26 Region 2 385.09 770.18 654.65 1,097.51

49526NY0520047 Bronze HMO 8100 New Age 30 Region 2 386.89 773.78 657.71 1,102.64

49526NY0520048 Bronze HMO 8100 New Age 30 Region 2 386.89 773.78 657.71 1,102.64

49526NY0520049 Bronze 8100 align Select New Age 26 Region 2 353.55 707.10 601.04 1,007.62

49526NY0520050 Bronze 8100 align Select New Age 26 Region 2 353.55 707.10 601.04 1,007.62

49526NY0520051 Bronze 8100 align Select New Age 30 Region 2 355.21 710.42 603.86 1,012.35

49526NY0520052 Bronze 8100 align Select New Age 30 Region 2 355.21 710.42 603.86 1,012.35

49526NY0520053 Bronze 8100 align Select New Age 26 Region 2 353.55 707.10 601.04 1,007.62

49526NY0520054 Bronze 8100 align Select New Age 26 Region 2 353.55 707.10 601.04 1,007.62

49526NY0520055 Bronze 8100 align Select New Age 30 Region 2 355.21 710.42 603.86 1,012.35

49526NY0520056 Bronze 8100 align Select New Age 30 Region 2 355.21 710.42 603.86 1,012.35

49526NY0520057 Bronze 8100 focus Select New Age 26 Region 2 353.55 707.10 601.04 1,007.62

49526NY0520058 Bronze 8100 focus Select New Age 26 Region 2 353.55 707.10 601.04 1,007.62

49526NY0520059 Bronze 8100 focus Select New Age 30 Region 2 355.21 710.42 603.86 1,012.35

49526NY0520060 Bronze 8100 focus Select New Age 30 Region 2 355.21 710.42 603.86 1,012.35

49526NY0520061 Bronze 8100 focus Select New Age 26 Region 2 353.55 707.10 601.04 1,007.62

49526NY0520062 Bronze 8100 focus Select New Age 26 Region 2 353.55 707.10 601.04 1,007.62

49526NY0520063 Bronze 8100 focus Select New Age 30 Region 2 355.21 710.42 603.86 1,012.35

49526NY0520064 Bronze 8100 focus Select New Age 30 Region 2 355.21 710.42 603.86 1,012.35

49526NY0560001 Bronze POS Classic Uniform Mod Age 26 Region 2 391.68 783.36 665.86 1,116.29

49526NY0560002 Bronze POS Classic Uniform Mod Age 26 Region 2 391.68 783.36 665.86 1,116.29

49526NY0560003 Bronze POS Classic Uniform Mod Age 30 Region 2 393.52 787.04 668.98 1,121.53

49526NY0560004 Bronze POS Classic Uniform Mod Age 30 Region 2 393.52 787.04 668.98 1,121.53

49526NY0560005 Bronze POS Classic Uniform Mod Age 26 Region 2 391.68 783.36 665.86 1,116.29

49526NY0560006 Bronze POS Classic Uniform Mod Age 26 Region 2 391.68 783.36 665.86 1,116.29

49526NY0560007 Bronze POS Classic Uniform Mod Age 30 Region 2 393.52 787.04 668.98 1,121.53

49526NY0560008 Bronze POS Classic Uniform Mod Age 30 Region 2 393.52 787.04 668.98 1,121.53

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 32

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q2:

Single

Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

49526NY0560025 Silver POS Classic Uniform Mod Age 26 Region 2 508.67 1,017.34 864.74 1,449.71

49526NY0560026 Silver POS Classic Uniform Mod Age 26 Region 2 508.67 1,017.34 864.74 1,449.71

49526NY0560027 Silver POS Classic Uniform Mod Age 30 Region 2 511.09 1,022.18 868.85 1,456.61

49526NY0560028 Silver POS Classic Uniform Mod Age 30 Region 2 511.09 1,022.18 868.85 1,456.61

49526NY0560029 Silver POS Classic Uniform Mod Age 26 Region 2 508.67 1,017.34 864.74 1,449.71

49526NY0560030 Silver POS Classic Uniform Mod Age 26 Region 2 508.67 1,017.34 864.74 1,449.71

49526NY0560031 Silver POS Classic Uniform Mod Age 30 Region 2 511.09 1,022.18 868.85 1,456.61

49526NY0560032 Silver POS Classic Uniform Mod Age 30 Region 2 511.09 1,022.18 868.85 1,456.61

49526NY0560057 Gold POS Classic Uniform Mod Age 26 Region 2 563.16 1,126.32 957.37 1,605.01

49526NY0560058 Gold POS Classic Uniform Mod Age 26 Region 2 563.16 1,126.32 957.37 1,605.01

49526NY0560059 Gold POS Classic Uniform Mod Age 30 Region 2 565.83 1,131.66 961.91 1,612.62

49526NY0560060 Gold POS Classic Uniform Mod Age 30 Region 2 565.83 1,131.66 961.91 1,612.62

49526NY0560061 Gold POS Classic Uniform Mod Age 26 Region 2 563.16 1,126.32 957.37 1,605.01

49526NY0560062 Gold POS Classic Uniform Mod Age 26 Region 2 563.16 1,126.32 957.37 1,605.01

49526NY0560063 Gold POS Classic Uniform Mod Age 30 Region 2 565.83 1,131.66 961.91 1,612.62

49526NY0560064 Gold POS Classic Uniform Mod Age 30 Region 2 565.83 1,131.66 961.91 1,612.62

49526NY0560089 Platinum POS Classic Uniform Mod Age 26 Region 2 640.58 1,281.16 1,088.99 1,825.65

49526NY0560090 Platinum POS Classic Uniform Mod Age 26 Region 2 640.58 1,281.16 1,088.99 1,825.65

49526NY0560091 Platinum POS Classic Uniform Mod Age 30 Region 2 643.63 1,287.26 1,094.17 1,834.35

49526NY0560092 Platinum POS Classic Uniform Mod Age 30 Region 2 643.63 1,287.26 1,094.17 1,834.35

49526NY0560093 Platinum POS Classic Uniform Mod Age 26 Region 2 640.58 1,281.16 1,088.99 1,825.65

49526NY0560094 Platinum POS Classic Uniform Mod Age 26 Region 2 640.58 1,281.16 1,088.99 1,825.65

49526NY0560095 Platinum POS Classic Uniform Mod Age 30 Region 2 643.63 1,287.26 1,094.17 1,834.35

49526NY0560096 Platinum POS Classic Uniform Mod Age 30 Region 2 643.63 1,287.26 1,094.17 1,834.35

49526NY0560105 Platinum Make Available Uniform Mod Age 26 Region 2 638.78 1,277.56 1,085.93 1,820.52

49526NY0560106 Platinum Make Available Uniform Mod Age 26 Region 2 638.78 1,277.56 1,085.93 1,820.52

49526NY0560107 Platinum Make Available Uniform Mod Age 30 Region 2 641.83 1,283.66 1,091.11 1,829.22

49526NY0560108 Platinum Make Available Uniform Mod Age 30 Region 2 641.83 1,283.66 1,091.11 1,829.22

49526NY0560109 Platinum Make Available Uniform Mod Age 26 Region 2 638.78 1,277.56 1,085.93 1,820.52

49526NY0560110 Platinum Make Available Uniform Mod Age 26 Region 2 638.78 1,277.56 1,085.93 1,820.52

49526NY0560111 Platinum Make Available Uniform Mod Age 30 Region 2 641.83 1,283.66 1,091.11 1,829.22

49526NY0560112 Platinum Make Available Uniform Mod Age 30 Region 2 641.83 1,283.66 1,091.11 1,829.22

49526NY0630001 Bronze 8100EX New Age 26 Region 2 401.54 803.08 682.62 1,144.39

49526NY0630002 Bronze 8100EX New Age 26 Region 2 401.54 803.08 682.62 1,144.39

49526NY0630003 Bronze 8100EX New Age 30 Region 2 403.43 806.86 685.83 1,149.78

49526NY0630004 Bronze 8100EX New Age 30 Region 2 403.43 806.86 685.83 1,149.78

49526NY0630005 Bronze 8100EX New Age 26 Region 2 401.54 803.08 682.62 1,144.39

49526NY0630006 Bronze 8100EX New Age 26 Region 2 401.54 803.08 682.62 1,144.39

49526NY0630007 Bronze 8100EX New Age 30 Region 2 403.43 806.86 685.83 1,149.78

49526NY0630008 Bronze 8100EX New Age 30 Region 2 403.43 806.86 685.83 1,149.78

49526NY0640001 Gold PPO 7100 Uniform Mod Age 26 Region 2 664.08 1,328.16 1,128.94 1,892.63

49526NY0640002 Gold PPO 7100 Uniform Mod Age 26 Region 2 664.08 1,328.16 1,128.94 1,892.63

49526NY0640003 Gold PPO 7100 Uniform Mod Age 30 Region 2 667.24 1,334.48 1,134.31 1,901.63

49526NY0640004 Gold PPO 7100 Uniform Mod Age 30 Region 2 667.24 1,334.48 1,134.31 1,901.63

49526NY0640005 Gold PPO 7100 Uniform Mod Age 26 Region 2 664.08 1,328.16 1,128.94 1,892.63

49526NY0640006 Gold PPO 7100 Uniform Mod Age 26 Region 2 664.08 1,328.16 1,128.94 1,892.63

49526NY0640007 Gold PPO 7100 Uniform Mod Age 30 Region 2 667.24 1,334.48 1,134.31 1,901.63

49526NY0640008 Gold PPO 7100 Uniform Mod Age 30 Region 2 667.24 1,334.48 1,134.31 1,901.63

49526NY0640009 Silver PPO 8100 Uniform Mod Age 26 Region 2 547.60 1,095.20 930.92 1,560.66

49526NY0640010 Silver PPO 8100 Uniform Mod Age 26 Region 2 547.60 1,095.20 930.92 1,560.66

49526NY0640011 Silver PPO 8100 Uniform Mod Age 30 Region 2 550.20 1,100.40 935.34 1,568.07

49526NY0640012 Silver PPO 8100 Uniform Mod Age 30 Region 2 550.20 1,100.40 935.34 1,568.07

49526NY0640013 Silver PPO 8100 Uniform Mod Age 26 Region 2 547.60 1,095.20 930.92 1,560.66

49526NY0640014 Silver PPO 8100 Uniform Mod Age 26 Region 2 547.60 1,095.20 930.92 1,560.66

49526NY0640015 Silver PPO 8100 Uniform Mod Age 30 Region 2 550.20 1,100.40 935.34 1,568.07

49526NY0640016 Silver PPO 8100 Uniform Mod Age 30 Region 2 550.20 1,100.40 935.34 1,568.07

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 33

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q2:

Single

Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

49526NY0640033 Silver PPO 7100 Uniform Mod Age 26 Region 2 604.06 1,208.12 1,026.90 1,721.57

49526NY0640034 Silver PPO 7100 Uniform Mod Age 26 Region 2 604.06 1,208.12 1,026.90 1,721.57

49526NY0640035 Silver PPO 7100 Uniform Mod Age 30 Region 2 606.94 1,213.88 1,031.80 1,729.78

49526NY0640036 Silver PPO 7100 Uniform Mod Age 30 Region 2 606.94 1,213.88 1,031.80 1,729.78

49526NY0640037 Silver PPO 7100 Uniform Mod Age 26 Region 2 604.06 1,208.12 1,026.90 1,721.57

49526NY0640038 Silver PPO 7100 Uniform Mod Age 26 Region 2 604.06 1,208.12 1,026.90 1,721.57

49526NY0640039 Silver PPO 7100 Uniform Mod Age 30 Region 2 606.94 1,213.88 1,031.80 1,729.78

49526NY0640040 Silver PPO 7100 Uniform Mod Age 30 Region 2 606.94 1,213.88 1,031.80 1,729.78

49526NY0640041 Platinum PPO Plus New Age 26 Region 2 803.23 1,606.46 1,365.49 2,289.21

49526NY0640042 Platinum PPO Plus New Age 26 Region 2 803.23 1,606.46 1,365.49 2,289.21

49526NY0640043 Platinum PPO Plus New Age 30 Region 2 807.06 1,614.12 1,372.00 2,300.12

49526NY0640044 Platinum PPO Plus New Age 30 Region 2 807.06 1,614.12 1,372.00 2,300.12

49526NY0640045 Platinum PPO Plus New Age 26 Region 2 803.23 1,606.46 1,365.49 2,289.21

49526NY0640046 Platinum PPO Plus New Age 26 Region 2 803.23 1,606.46 1,365.49 2,289.21

49526NY0640047 Platinum PPO Plus New Age 30 Region 2 807.06 1,614.12 1,372.00 2,300.12

49526NY0640048 Platinum PPO Plus New Age 30 Region 2 807.06 1,614.12 1,372.00 2,300.12

49526NY0680001 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 590.35 1,180.70 1,003.60 1,682.50

49526NY0680002 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 590.35 1,180.70 1,003.60 1,682.50

49526NY0680003 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 593.16 1,186.32 1,008.37 1,690.51

49526NY0680004 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 593.16 1,186.32 1,008.37 1,690.51

49526NY0680005 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 590.35 1,180.70 1,003.60 1,682.50

49526NY0680006 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 590.35 1,180.70 1,003.60 1,682.50

49526NY0680007 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 593.16 1,186.32 1,008.37 1,690.51

49526NY0680008 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 593.16 1,186.32 1,008.37 1,690.51

49526NY0680009 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 492.06 984.12 836.50 1,402.37

49526NY0680010 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 492.06 984.12 836.50 1,402.37

49526NY0680011 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 494.39 988.78 840.46 1,409.01

49526NY0680012 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 494.39 988.78 840.46 1,409.01

49526NY0680013 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 492.06 984.12 836.50 1,402.37

49526NY0680014 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 492.06 984.12 836.50 1,402.37

49526NY0680015 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 494.39 988.78 840.46 1,409.01

49526NY0680016 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 494.39 988.78 840.46 1,409.01

49526NY0680017 Gold POS 7100 Uniform Mod Age 26 Region 2 522.28 1,044.56 887.88 1,488.50

49526NY0680018 Gold POS 7100 Uniform Mod Age 26 Region 2 522.28 1,044.56 887.88 1,488.50

49526NY0680019 Gold POS 7100 Uniform Mod Age 30 Region 2 524.76 1,049.52 892.09 1,495.57

49526NY0680020 Gold POS 7100 Uniform Mod Age 30 Region 2 524.76 1,049.52 892.09 1,495.57

49526NY0680021 Gold POS 7100 Uniform Mod Age 26 Region 2 522.28 1,044.56 887.88 1,488.50

49526NY0680022 Gold POS 7100 Uniform Mod Age 26 Region 2 522.28 1,044.56 887.88 1,488.50

49526NY0680023 Gold POS 7100 Uniform Mod Age 30 Region 2 524.76 1,049.52 892.09 1,495.57

49526NY0680024 Gold POS 7100 Uniform Mod Age 30 Region 2 524.76 1,049.52 892.09 1,495.57

49526NY0680025 Gold POS 7100EX Uniform Mod Age 26 Region 2 544.04 1,088.08 924.87 1,550.51

49526NY0680026 Gold POS 7100EX Uniform Mod Age 26 Region 2 544.04 1,088.08 924.87 1,550.51

49526NY0680027 Gold POS 7100EX Uniform Mod Age 30 Region 2 546.62 1,093.24 929.25 1,557.87

49526NY0680028 Gold POS 7100EX Uniform Mod Age 30 Region 2 546.62 1,093.24 929.25 1,557.87

49526NY0680029 Gold POS 7100EX Uniform Mod Age 26 Region 2 544.04 1,088.08 924.87 1,550.51

49526NY0680030 Gold POS 7100EX Uniform Mod Age 26 Region 2 544.04 1,088.08 924.87 1,550.51

49526NY0680031 Gold POS 7100EX Uniform Mod Age 30 Region 2 546.62 1,093.24 929.25 1,557.87

49526NY0680032 Gold POS 7100EX Uniform Mod Age 30 Region 2 546.62 1,093.24 929.25 1,557.87

49526NY0680041 Gold Aqua Uniform Mod Age 26 Region 2 508.77 1,017.54 864.91 1,449.99

49526NY0680042 Gold Aqua Uniform Mod Age 26 Region 2 508.77 1,017.54 864.91 1,449.99

49526NY0680043 Gold Aqua Uniform Mod Age 30 Region 2 511.18 1,022.36 869.01 1,456.86

49526NY0680044 Gold Aqua Uniform Mod Age 30 Region 2 511.18 1,022.36 869.01 1,456.86

49526NY0680045 Gold Aqua Uniform Mod Age 26 Region 2 508.77 1,017.54 864.91 1,449.99

49526NY0680046 Gold Aqua Uniform Mod Age 26 Region 2 508.77 1,017.54 864.91 1,449.99

49526NY0680047 Gold Aqua Uniform Mod Age 30 Region 2 511.18 1,022.36 869.01 1,456.86

49526NY0680048 Gold Aqua Uniform Mod Age 30 Region 2 511.18 1,022.36 869.01 1,456.86

49526NY0680049 Silver POS 7100 Uniform Mod Age 26 Region 2 475.65 951.30 808.61 1,355.60

49526NY0680050 Silver POS 7100 Uniform Mod Age 26 Region 2 475.65 951.30 808.61 1,355.60

49526NY0680051 Silver POS 7100 Uniform Mod Age 30 Region 2 477.90 955.80 812.43 1,362.02

49526NY0680052 Silver POS 7100 Uniform Mod Age 30 Region 2 477.90 955.80 812.43 1,362.02

49526NY0680053 Silver POS 7100 Uniform Mod Age 26 Region 2 475.65 951.30 808.61 1,355.60

49526NY0680054 Silver POS 7100 Uniform Mod Age 26 Region 2 475.65 951.30 808.61 1,355.60

49526NY0680055 Silver POS 7100 Uniform Mod Age 30 Region 2 477.90 955.80 812.43 1,362.02

49526NY0680056 Silver POS 7100 Uniform Mod Age 30 Region 2 477.90 955.80 812.43 1,362.02

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 34

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q2:

Single

Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

49526NY0680057 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 446.56 893.12 759.15 1,272.70

49526NY0680058 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 446.56 893.12 759.15 1,272.70

49526NY0680059 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 448.67 897.34 762.74 1,278.71

49526NY0680060 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 448.67 897.34 762.74 1,278.71

49526NY0680061 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 446.56 893.12 759.15 1,272.70

49526NY0680062 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 446.56 893.12 759.15 1,272.70

49526NY0680063 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 448.67 897.34 762.74 1,278.71

49526NY0680064 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 448.67 897.34 762.74 1,278.71

49526NY0680065 Silver POS 8100EX Uniform Mod Age 26 Region 2 449.54 899.08 764.22 1,281.19

49526NY0680066 Silver POS 8100EX Uniform Mod Age 26 Region 2 449.54 899.08 764.22 1,281.19

49526NY0680067 Silver POS 8100EX Uniform Mod Age 30 Region 2 451.67 903.34 767.84 1,287.26

49526NY0680068 Silver POS 8100EX Uniform Mod Age 30 Region 2 451.67 903.34 767.84 1,287.26

49526NY0680069 Silver POS 8100EX Uniform Mod Age 26 Region 2 449.54 899.08 764.22 1,281.19

49526NY0680070 Silver POS 8100EX Uniform Mod Age 26 Region 2 449.54 899.08 764.22 1,281.19

49526NY0680071 Silver POS 8100EX Uniform Mod Age 30 Region 2 451.67 903.34 767.84 1,287.26

49526NY0680072 Silver POS 8100EX Uniform Mod Age 30 Region 2 451.67 903.34 767.84 1,287.26

49526NY0680081 Silver POS 8100 Uniform Mod Age 26 Region 2 431.77 863.54 734.01 1,230.54

49526NY0680082 Silver POS 8100 Uniform Mod Age 26 Region 2 431.77 863.54 734.01 1,230.54

49526NY0680083 Silver POS 8100 Uniform Mod Age 30 Region 2 433.80 867.60 737.46 1,236.33

49526NY0680084 Silver POS 8100 Uniform Mod Age 30 Region 2 433.80 867.60 737.46 1,236.33

49526NY0680085 Silver POS 8100 Uniform Mod Age 26 Region 2 431.77 863.54 734.01 1,230.54

49526NY0680086 Silver POS 8100 Uniform Mod Age 26 Region 2 431.77 863.54 734.01 1,230.54

49526NY0680087 Silver POS 8100 Uniform Mod Age 30 Region 2 433.80 867.60 737.46 1,236.33

49526NY0680088 Silver POS 8100 Uniform Mod Age 30 Region 2 433.80 867.60 737.46 1,236.33

49526NY0680089 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 590.35 1,180.70 1,003.60 1,682.50

49526NY0680090 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 590.35 1,180.70 1,003.60 1,682.50

49526NY0680091 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 593.16 1,186.32 1,008.37 1,690.51

49526NY0680092 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 593.16 1,186.32 1,008.37 1,690.51

49526NY0680093 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 590.35 1,180.70 1,003.60 1,682.50

49526NY0680094 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 590.35 1,180.70 1,003.60 1,682.50

49526NY0680095 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 593.16 1,186.32 1,008.37 1,690.51

49526NY0680096 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 593.16 1,186.32 1,008.37 1,690.51

49526NY0680097 Gold Complete Uniform Mod Age 26 Region 2 503.20 1,006.40 855.44 1,434.12

49526NY0680098 Gold Complete Uniform Mod Age 26 Region 2 503.20 1,006.40 855.44 1,434.12

49526NY0680099 Gold Complete Uniform Mod Age 30 Region 2 505.58 1,011.16 859.49 1,440.90

49526NY0680100 Gold Complete Uniform Mod Age 30 Region 2 505.58 1,011.16 859.49 1,440.90

49526NY0680101 Gold Complete Uniform Mod Age 26 Region 2 503.20 1,006.40 855.44 1,434.12

49526NY0680102 Gold Complete Uniform Mod Age 26 Region 2 503.20 1,006.40 855.44 1,434.12

49526NY0680103 Gold Complete Uniform Mod Age 30 Region 2 505.58 1,011.16 859.49 1,440.90

49526NY0680104 Gold Complete Uniform Mod Age 30 Region 2 505.58 1,011.16 859.49 1,440.90

49526NY0680105 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 492.06 984.12 836.50 1,402.37

49526NY0680106 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 492.06 984.12 836.50 1,402.37

49526NY0680107 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 494.39 988.78 840.46 1,409.01

49526NY0680108 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 494.39 988.78 840.46 1,409.01

49526NY0680109 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 492.06 984.12 836.50 1,402.37

49526NY0680110 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 492.06 984.12 836.50 1,402.37

49526NY0680111 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 494.39 988.78 840.46 1,409.01

49526NY0680112 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 494.39 988.78 840.46 1,409.01

49526NY0680121 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 446.56 893.12 759.15 1,272.70

49526NY0680122 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 446.56 893.12 759.15 1,272.70

49526NY0680123 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 448.67 897.34 762.74 1,278.71

49526NY0680124 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 448.67 897.34 762.74 1,278.71

49526NY0680125 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 446.56 893.12 759.15 1,272.70

49526NY0680126 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 446.56 893.12 759.15 1,272.70

49526NY0680127 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 448.67 897.34 762.74 1,278.71

49526NY0680128 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 448.67 897.34 762.74 1,278.71

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 35

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q2:

Single

Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

49526NY0680153 Silver POS 7100EX Uniform Mod Age 26 Region 2 495.35 990.70 842.10 1,411.75

49526NY0680154 Silver POS 7100EX Uniform Mod Age 26 Region 2 495.35 990.70 842.10 1,411.75

49526NY0680155 Silver POS 7100EX Uniform Mod Age 30 Region 2 497.70 995.40 846.09 1,418.45

49526NY0680156 Silver POS 7100EX Uniform Mod Age 30 Region 2 497.70 995.40 846.09 1,418.45

49526NY0680157 Silver POS 7100EX Uniform Mod Age 26 Region 2 495.35 990.70 842.10 1,411.75

49526NY0680158 Silver POS 7100EX Uniform Mod Age 26 Region 2 495.35 990.70 842.10 1,411.75

49526NY0680159 Silver POS 7100EX Uniform Mod Age 30 Region 2 497.70 995.40 846.09 1,418.45

49526NY0680160 Silver POS 7100EX Uniform Mod Age 30 Region 2 497.70 995.40 846.09 1,418.45

49526NY0680177 Silver 8100 align Select Uniform Mod Age 26 Region 2 389.41 778.82 662.00 1,109.82

49526NY0680178 Silver 8100 align Select Uniform Mod Age 26 Region 2 389.41 778.82 662.00 1,109.82

49526NY0680179 Silver 8100 align Select Uniform Mod Age 30 Region 2 391.24 782.48 665.11 1,115.03

49526NY0680180 Silver 8100 align Select Uniform Mod Age 30 Region 2 391.24 782.48 665.11 1,115.03

49526NY0680181 Silver 8100 align Select Uniform Mod Age 26 Region 2 389.41 778.82 662.00 1,109.82

49526NY0680182 Silver 8100 align Select Uniform Mod Age 26 Region 2 389.41 778.82 662.00 1,109.82

49526NY0680183 Silver 8100 align Select Uniform Mod Age 30 Region 2 391.24 782.48 665.11 1,115.03

49526NY0680184 Silver 8100 align Select Uniform Mod Age 30 Region 2 391.24 782.48 665.11 1,115.03

49526NY0680185 Silver 8100 focus Select Uniform Mod Age 26 Region 2 389.41 778.82 662.00 1,109.82

49526NY0680186 Silver 8100 focus Select Uniform Mod Age 26 Region 2 389.41 778.82 662.00 1,109.82

49526NY0680187 Silver 8100 focus Select Uniform Mod Age 30 Region 2 391.24 782.48 665.11 1,115.03

49526NY0680188 Silver 8100 focus Select Uniform Mod Age 30 Region 2 391.24 782.48 665.11 1,115.03

49526NY0680189 Silver 8100 focus Select Uniform Mod Age 26 Region 2 389.41 778.82 662.00 1,109.82

49526NY0680190 Silver 8100 focus Select Uniform Mod Age 26 Region 2 389.41 778.82 662.00 1,109.82

49526NY0680191 Silver 8100 focus Select Uniform Mod Age 30 Region 2 391.24 782.48 665.11 1,115.03

49526NY0680192 Silver 8100 focus Select Uniform Mod Age 30 Region 2 391.24 782.48 665.11 1,115.03

49526NY0680193 Silver 7100 align Select Uniform Mod Age 26 Region 2 428.69 857.38 728.77 1,221.77

49526NY0680194 Silver 7100 align Select Uniform Mod Age 26 Region 2 428.69 857.38 728.77 1,221.77

49526NY0680195 Silver 7100 align Select Uniform Mod Age 30 Region 2 430.71 861.42 732.21 1,227.52

49526NY0680196 Silver 7100 align Select Uniform Mod Age 30 Region 2 430.71 861.42 732.21 1,227.52

49526NY0680197 Silver 7100 align Select Uniform Mod Age 26 Region 2 428.69 857.38 728.77 1,221.77

49526NY0680198 Silver 7100 align Select Uniform Mod Age 26 Region 2 428.69 857.38 728.77 1,221.77

49526NY0680199 Silver 7100 align Select Uniform Mod Age 30 Region 2 430.71 861.42 732.21 1,227.52

49526NY0680200 Silver 7100 align Select Uniform Mod Age 30 Region 2 430.71 861.42 732.21 1,227.52

49526NY0680201 Silver 7100 focus Select Uniform Mod Age 26 Region 2 428.69 857.38 728.77 1,221.77

49526NY0680202 Silver 7100 focus Select Uniform Mod Age 26 Region 2 428.69 857.38 728.77 1,221.77

49526NY0680203 Silver 7100 focus Select Uniform Mod Age 30 Region 2 430.71 861.42 732.21 1,227.52

49526NY0680204 Silver 7100 focus Select Uniform Mod Age 30 Region 2 430.71 861.42 732.21 1,227.52

49526NY0680205 Silver 7100 focus Select Uniform Mod Age 26 Region 2 428.69 857.38 728.77 1,221.77

49526NY0680206 Silver 7100 focus Select Uniform Mod Age 26 Region 2 428.69 857.38 728.77 1,221.77

49526NY0680207 Silver 7100 focus Select Uniform Mod Age 30 Region 2 430.71 861.42 732.21 1,227.52

49526NY0680208 Silver 7100 focus Select Uniform Mod Age 30 Region 2 430.71 861.42 732.21 1,227.52

49526NY0680209 Gold 7100 align Select Uniform Mod Age 26 Region 2 470.44 940.88 799.75 1,340.75

49526NY0680210 Gold 7100 align Select Uniform Mod Age 26 Region 2 470.44 940.88 799.75 1,340.75

49526NY0680211 Gold 7100 align Select Uniform Mod Age 30 Region 2 472.66 945.32 803.52 1,347.08

49526NY0680212 Gold 7100 align Select Uniform Mod Age 30 Region 2 472.66 945.32 803.52 1,347.08

49526NY0680213 Gold 7100 align Select Uniform Mod Age 26 Region 2 470.44 940.88 799.75 1,340.75

49526NY0680214 Gold 7100 align Select Uniform Mod Age 26 Region 2 470.44 940.88 799.75 1,340.75

49526NY0680215 Gold 7100 align Select Uniform Mod Age 30 Region 2 472.66 945.32 803.52 1,347.08

49526NY0680216 Gold 7100 align Select Uniform Mod Age 30 Region 2 472.66 945.32 803.52 1,347.08

49526NY0680217 Gold 7100 focus Select Uniform Mod Age 26 Region 2 470.44 940.88 799.75 1,340.75

49526NY0680218 Gold 7100 focus Select Uniform Mod Age 26 Region 2 470.44 940.88 799.75 1,340.75

49526NY0680219 Gold 7100 focus Select Uniform Mod Age 30 Region 2 472.66 945.32 803.52 1,347.08

49526NY0680220 Gold 7100 focus Select Uniform Mod Age 30 Region 2 472.66 945.32 803.52 1,347.08

49526NY0680221 Gold 7100 focus Select Uniform Mod Age 26 Region 2 470.44 940.88 799.75 1,340.75

49526NY0680222 Gold 7100 focus Select Uniform Mod Age 26 Region 2 470.44 940.88 799.75 1,340.75

49526NY0680223 Gold 7100 focus Select Uniform Mod Age 30 Region 2 472.66 945.32 803.52 1,347.08

49526NY0680224 Gold 7100 focus Select Uniform Mod Age 30 Region 2 472.66 945.32 803.52 1,347.08

49526NY0680225 Silver Aqua Uniform Mod Age 26 Region 2 462.40 924.80 786.08 1,317.84

49526NY0680226 Silver Aqua Uniform Mod Age 26 Region 2 462.40 924.80 786.08 1,317.84

49526NY0680227 Silver Aqua Uniform Mod Age 30 Region 2 464.58 929.16 789.79 1,324.05

49526NY0680228 Silver Aqua Uniform Mod Age 30 Region 2 464.58 929.16 789.79 1,324.05

49526NY0680229 Silver Aqua Uniform Mod Age 26 Region 2 462.40 924.80 786.08 1,317.84

49526NY0680230 Silver Aqua Uniform Mod Age 26 Region 2 462.40 924.80 786.08 1,317.84

49526NY0680231 Silver Aqua Uniform Mod Age 30 Region 2 464.58 929.16 789.79 1,324.05

49526NY0680232 Silver Aqua Uniform Mod Age 30 Region 2 464.58 929.16 789.79 1,324.05

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 36

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q2:

Single

Q2: Subscriber

& Spouse

Q2: Subscriber &

Child(ren)

Q2:

Family

49526NY0680233 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 407.32 814.64 692.44 1,160.86

49526NY0680234 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 407.32 814.64 692.44 1,160.86

49526NY0680235 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 409.24 818.48 695.71 1,166.33

49526NY0680236 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 409.24 818.48 695.71 1,166.33

49526NY0680237 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 407.32 814.64 692.44 1,160.86

49526NY0680238 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 407.32 814.64 692.44 1,160.86

49526NY0680239 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 409.24 818.48 695.71 1,166.33

49526NY0680240 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 409.24 818.48 695.71 1,166.33

49526NY0680241 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 407.32 814.64 692.44 1,160.86

49526NY0680242 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 407.32 814.64 692.44 1,160.86

49526NY0680243 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 409.24 818.48 695.71 1,166.33

49526NY0680244 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 409.24 818.48 695.71 1,166.33

49526NY0680245 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 407.32 814.64 692.44 1,160.86

49526NY0680246 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 407.32 814.64 692.44 1,160.86

49526NY0680247 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 409.24 818.48 695.71 1,166.33

49526NY0680248 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 409.24 818.48 695.71 1,166.33

49526NY0680265 Platinum EX Plus New Age 26 Region 2 656.95 1,313.90 1,116.82 1,872.31

49526NY0680266 Platinum EX Plus New Age 26 Region 2 656.95 1,313.90 1,116.82 1,872.31

49526NY0680267 Platinum EX Plus New Age 30 Region 2 660.08 1,320.16 1,122.14 1,881.23

49526NY0680268 Platinum EX Plus New Age 30 Region 2 660.08 1,320.16 1,122.14 1,881.23

49526NY0680269 Platinum EX Plus New Age 26 Region 2 656.95 1,313.90 1,116.82 1,872.31

49526NY0680270 Platinum EX Plus New Age 26 Region 2 656.95 1,313.90 1,116.82 1,872.31

49526NY0680271 Platinum EX Plus New Age 30 Region 2 660.08 1,320.16 1,122.14 1,881.23

49526NY0680272 Platinum EX Plus New Age 30 Region 2 660.08 1,320.16 1,122.14 1,881.23

49526NY0680273 Platinum align Select Plus New Age 26 Region 2 567.25 1,134.50 964.33 1,616.66

49526NY0680274 Platinum align Select Plus New Age 26 Region 2 567.25 1,134.50 964.33 1,616.66

49526NY0680275 Platinum align Select Plus New Age 30 Region 2 569.95 1,139.90 968.92 1,624.36

49526NY0680276 Platinum align Select Plus New Age 30 Region 2 569.95 1,139.90 968.92 1,624.36

49526NY0680277 Platinum align Select Plus New Age 26 Region 2 567.25 1,134.50 964.33 1,616.66

49526NY0680278 Platinum align Select Plus New Age 26 Region 2 567.25 1,134.50 964.33 1,616.66

49526NY0680279 Platinum align Select Plus New Age 30 Region 2 569.95 1,139.90 968.92 1,624.36

49526NY0680280 Platinum align Select Plus New Age 30 Region 2 569.95 1,139.90 968.92 1,624.36

49526NY0680281 Platinum focus Select Plus New Age 26 Region 2 567.25 1,134.50 964.33 1,616.66

49526NY0680282 Platinum focus Select Plus New Age 26 Region 2 567.25 1,134.50 964.33 1,616.66

49526NY0680283 Platinum focus Select Plus New Age 30 Region 2 569.95 1,139.90 968.92 1,624.36

49526NY0680284 Platinum focus Select Plus New Age 30 Region 2 569.95 1,139.90 968.92 1,624.36

49526NY0680285 Platinum focus Select Plus New Age 26 Region 2 567.25 1,134.50 964.33 1,616.66

49526NY0680286 Platinum focus Select Plus New Age 26 Region 2 567.25 1,134.50 964.33 1,616.66

49526NY0680287 Platinum focus Select Plus New Age 30 Region 2 569.95 1,139.90 968.92 1,624.36

49526NY0680288 Platinum focus Select Plus New Age 30 Region 2 569.95 1,139.90 968.92 1,624.36

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 37

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q3:

Single Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

36346NY0250001 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250002 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250003 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250004 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250005 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250006 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250007 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250008 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0470001 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 484.13 968.26 823.02 1,379.77

36346NY0470002 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 484.13 968.26 823.02 1,379.77

36346NY0470003 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 486.41 972.82 826.90 1,386.27

36346NY0470004 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 486.41 972.82 826.90 1,386.27

36346NY0470005 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 484.13 968.26 823.02 1,379.77

36346NY0470006 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 484.13 968.26 823.02 1,379.77

36346NY0470007 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 486.41 972.82 826.90 1,386.27

36346NY0470008 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 486.41 972.82 826.90 1,386.27

36346NY0470014 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 624.71 1,249.42 1,062.01 1,780.42

36346NY0470015 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 624.71 1,249.42 1,062.01 1,780.42

36346NY0470016 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 627.67 1,255.34 1,067.04 1,788.86

36346NY0470017 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 627.67 1,255.34 1,067.04 1,788.86

36346NY0470018 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 624.71 1,249.42 1,062.01 1,780.42

36346NY0470019 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 624.71 1,249.42 1,062.01 1,780.42

36346NY0470020 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 627.67 1,255.34 1,067.04 1,788.86

36346NY0470021 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 627.67 1,255.34 1,067.04 1,788.86

36346NY0470026 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 703.24 1,406.48 1,195.51 2,004.23

36346NY0470027 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 703.24 1,406.48 1,195.51 2,004.23

36346NY0470028 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 706.58 1,413.16 1,201.19 2,013.75

36346NY0470029 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 706.58 1,413.16 1,201.19 2,013.75

36346NY0470030 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 703.24 1,406.48 1,195.51 2,004.23

36346NY0470031 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 703.24 1,406.48 1,195.51 2,004.23

36346NY0470032 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 706.58 1,413.16 1,201.19 2,013.75

36346NY0470033 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 706.58 1,413.16 1,201.19 2,013.75

36346NY0470035 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 800.37 1,600.74 1,360.63 2,281.05

36346NY0470036 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 800.37 1,600.74 1,360.63 2,281.05

36346NY0470037 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 804.19 1,608.38 1,367.12 2,291.94

36346NY0470038 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 804.19 1,608.38 1,367.12 2,291.94

36346NY0470039 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 800.37 1,600.74 1,360.63 2,281.05

36346NY0470040 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 800.37 1,600.74 1,360.63 2,281.05

36346NY0470041 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 804.19 1,608.38 1,367.12 2,291.94

36346NY0470042 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 804.19 1,608.38 1,367.12 2,291.94

36346NY0470050 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 799.41 1,598.82 1,359.00 2,278.32

36346NY0470051 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 799.41 1,598.82 1,359.00 2,278.32

36346NY0470052 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 803.23 1,606.46 1,365.49 2,289.21

36346NY0470053 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 803.23 1,606.46 1,365.49 2,289.21

36346NY0470054 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 799.41 1,598.82 1,359.00 2,278.32

36346NY0470055 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 799.41 1,598.82 1,359.00 2,278.32

36346NY0470056 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 803.23 1,606.46 1,365.49 2,289.21

36346NY0470057 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 803.23 1,606.46 1,365.49 2,289.21

36346NY0550033 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 678.39 1,356.78 1,153.26 1,933.41

36346NY0550034 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 678.39 1,356.78 1,153.26 1,933.41

36346NY0550035 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 681.62 1,363.24 1,158.75 1,942.62

36346NY0550036 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 681.62 1,363.24 1,158.75 1,942.62

36346NY0550037 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 678.39 1,356.78 1,153.26 1,933.41

36346NY0550038 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 678.39 1,356.78 1,153.26 1,933.41

36346NY0550039 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 681.62 1,363.24 1,158.75 1,942.62

36346NY0550040 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 681.62 1,363.24 1,158.75 1,942.62

36346NY0550041 Bronze Value Uniform Mod Age 26 Regions 1 and 7 495.90 991.80 843.03 1,413.32

36346NY0550042 Bronze Value Uniform Mod Age 26 Regions 1 and 7 495.90 991.80 843.03 1,413.32

36346NY0550043 Bronze Value Uniform Mod Age 30 Regions 1 and 7 498.25 996.50 847.03 1,420.01

36346NY0550044 Bronze Value Uniform Mod Age 30 Regions 1 and 7 498.25 996.50 847.03 1,420.01

36346NY0550045 Bronze Value Uniform Mod Age 26 Regions 1 and 7 495.90 991.80 843.03 1,413.32

36346NY0550046 Bronze Value Uniform Mod Age 26 Regions 1 and 7 495.90 991.80 843.03 1,413.32

36346NY0550047 Bronze Value Uniform Mod Age 30 Regions 1 and 7 498.25 996.50 847.03 1,420.01

36346NY0550048 Bronze Value Uniform Mod Age 30 Regions 1 and 7 498.25 996.50 847.03 1,420.01

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 38

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q3:

Single

Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

36346NY0550049 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 462.80 925.60 786.76 1,318.98

36346NY0550050 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 462.80 925.60 786.76 1,318.98

36346NY0550051 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 464.99 929.98 790.48 1,325.22

36346NY0550052 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 464.99 929.98 790.48 1,325.22

36346NY0550053 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 462.80 925.60 786.76 1,318.98

36346NY0550054 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 462.80 925.60 786.76 1,318.98

36346NY0550055 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 464.99 929.98 790.48 1,325.22

36346NY0550056 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 464.99 929.98 790.48 1,325.22

36346NY0550057 Bronze HMO Classic NEW Age 26 Regions 1 and 7 469.52 939.04 798.18 1,338.13

36346NY0550058 Bronze HMO Classic NEW Age 26 Regions 1 and 7 469.52 939.04 798.18 1,338.13

36346NY0550059 Bronze HMO Classic NEW Age 30 Regions 1 and 7 471.74 943.48 801.96 1,344.46

36346NY0550060 Bronze HMO Classic NEW Age 30 Regions 1 and 7 471.74 943.48 801.96 1,344.46

36346NY0550061 Bronze HMO Classic NEW Age 26 Regions 1 and 7 469.52 939.04 798.18 1,338.13

36346NY0550062 Bronze HMO Classic NEW Age 26 Regions 1 and 7 469.52 939.04 798.18 1,338.13

36346NY0550063 Bronze HMO Classic NEW Age 30 Regions 1 and 7 471.74 943.48 801.96 1,344.46

36346NY0550064 Bronze HMO Classic NEW Age 30 Regions 1 and 7 471.74 943.48 801.96 1,344.46

36346NY0550065 Silver HMO Classic NEW Age 26 Regions 1 and 7 612.01 1,224.02 1,040.42 1,744.23

36346NY0550066 Silver HMO Classic NEW Age 26 Regions 1 and 7 612.01 1,224.02 1,040.42 1,744.23

36346NY0550067 Silver HMO Classic NEW Age 30 Regions 1 and 7 614.92 1,229.84 1,045.36 1,752.52

36346NY0550068 Silver HMO Classic NEW Age 30 Regions 1 and 7 614.92 1,229.84 1,045.36 1,752.52

36346NY0550069 Silver HMO Classic NEW Age 26 Regions 1 and 7 612.01 1,224.02 1,040.42 1,744.23

36346NY0550070 Silver HMO Classic NEW Age 26 Regions 1 and 7 612.01 1,224.02 1,040.42 1,744.23

36346NY0550071 Silver HMO Classic NEW Age 30 Regions 1 and 7 614.92 1,229.84 1,045.36 1,752.52

36346NY0550072 Silver HMO Classic NEW Age 30 Regions 1 and 7 614.92 1,229.84 1,045.36 1,752.52

36346NY0550073 Gold HMO Classic NEW Age 26 Regions 1 and 7 691.61 1,383.22 1,175.74 1,971.09

36346NY0550074 Gold HMO Classic NEW Age 26 Regions 1 and 7 691.61 1,383.22 1,175.74 1,971.09

36346NY0550075 Gold HMO Classic NEW Age 30 Regions 1 and 7 694.90 1,389.80 1,181.33 1,980.47

36346NY0550076 Gold HMO Classic NEW Age 30 Regions 1 and 7 694.90 1,389.80 1,181.33 1,980.47

36346NY0550077 Gold HMO Classic NEW Age 26 Regions 1 and 7 691.61 1,383.22 1,175.74 1,971.09

36346NY0550078 Gold HMO Classic NEW Age 26 Regions 1 and 7 691.61 1,383.22 1,175.74 1,971.09

36346NY0550079 Gold HMO Classic NEW Age 30 Regions 1 and 7 694.90 1,389.80 1,181.33 1,980.47

36346NY0550080 Gold HMO Classic NEW Age 30 Regions 1 and 7 694.90 1,389.80 1,181.33 1,980.47

36346NY0550081 Platinum HMO Classic NEW Age 26 Regions 1 and 7 790.07 1,580.14 1,343.12 2,251.70

36346NY0550082 Platinum HMO Classic NEW Age 26 Regions 1 and 7 790.07 1,580.14 1,343.12 2,251.70

36346NY0550083 Platinum HMO Classic NEW Age 30 Regions 1 and 7 793.84 1,587.68 1,349.53 2,262.44

36346NY0550084 Platinum HMO Classic NEW Age 30 Regions 1 and 7 793.84 1,587.68 1,349.53 2,262.44

36346NY0550085 Platinum HMO Classic NEW Age 26 Regions 1 and 7 790.07 1,580.14 1,343.12 2,251.70

36346NY0550086 Platinum HMO Classic NEW Age 26 Regions 1 and 7 790.07 1,580.14 1,343.12 2,251.70

36346NY0550087 Platinum HMO Classic NEW Age 30 Regions 1 and 7 793.84 1,587.68 1,349.53 2,262.44

36346NY0550088 Platinum HMO Classic NEW Age 30 Regions 1 and 7 793.84 1,587.68 1,349.53 2,262.44

36346NY0550089 Silver HMO 6300 NEW Age 26 Regions 1 and 7 597.82 1,195.64 1,016.29 1,703.79

36346NY0550090 Silver HMO 6300 NEW Age 26 Regions 1 and 7 597.82 1,195.64 1,016.29 1,703.79

36346NY0550091 Silver HMO 6300 NEW Age 30 Regions 1 and 7 600.66 1,201.32 1,021.12 1,711.88

36346NY0550092 Silver HMO 6300 NEW Age 30 Regions 1 and 7 600.66 1,201.32 1,021.12 1,711.88

36346NY0550093 Silver HMO 6300 NEW Age 26 Regions 1 and 7 597.82 1,195.64 1,016.29 1,703.79

36346NY0550094 Silver HMO 6300 NEW Age 26 Regions 1 and 7 597.82 1,195.64 1,016.29 1,703.79

36346NY0550095 Silver HMO 6300 NEW Age 30 Regions 1 and 7 600.66 1,201.32 1,021.12 1,711.88

36346NY0550096 Silver HMO 6300 NEW Age 30 Regions 1 and 7 600.66 1,201.32 1,021.12 1,711.88

36346NY0640009 Gold EPO Uniform Mod Age 26 Regions 1 and 7 748.98 1,497.96 1,273.27 2,134.59

36346NY0640010 Gold EPO Uniform Mod Age 26 Regions 1 and 7 748.98 1,497.96 1,273.27 2,134.59

36346NY0640011 Gold EPO Uniform Mod Age 30 Regions 1 and 7 752.56 1,505.12 1,279.35 2,144.80

36346NY0640012 Gold EPO Uniform Mod Age 30 Regions 1 and 7 752.56 1,505.12 1,279.35 2,144.80

36346NY0640013 Gold EPO Uniform Mod Age 26 Regions 1 and 7 748.98 1,497.96 1,273.27 2,134.59

36346NY0640014 Gold EPO Uniform Mod Age 26 Regions 1 and 7 748.98 1,497.96 1,273.27 2,134.59

36346NY0640015 Gold EPO Uniform Mod Age 30 Regions 1 and 7 752.56 1,505.12 1,279.35 2,144.80

36346NY0640016 Gold EPO Uniform Mod Age 30 Regions 1 and 7 752.56 1,505.12 1,279.35 2,144.80

36346NY0640033 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 631.16 1,262.32 1,072.97 1,798.81

36346NY0640034 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 631.16 1,262.32 1,072.97 1,798.81

36346NY0640035 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 634.17 1,268.34 1,078.09 1,807.38

36346NY0640036 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 634.17 1,268.34 1,078.09 1,807.38

36346NY0640037 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 631.16 1,262.32 1,072.97 1,798.81

36346NY0640038 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 631.16 1,262.32 1,072.97 1,798.81

36346NY0640039 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 634.17 1,268.34 1,078.09 1,807.38

36346NY0640040 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 634.17 1,268.34 1,078.09 1,807.38

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 39

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q3:

Single

Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

36346NY0640041 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 677.31 1,354.62 1,151.43 1,930.33

36346NY0640042 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 677.31 1,354.62 1,151.43 1,930.33

36346NY0640043 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 680.55 1,361.10 1,156.94 1,939.57

36346NY0640044 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 680.55 1,361.10 1,156.94 1,939.57

36346NY0640045 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 677.31 1,354.62 1,151.43 1,930.33

36346NY0640046 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 677.31 1,354.62 1,151.43 1,930.33

36346NY0640047 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 680.55 1,361.10 1,156.94 1,939.57

36346NY0640048 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 680.55 1,361.10 1,156.94 1,939.57

36346NY0640081 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 572.42 1,144.84 973.11 1,631.40

36346NY0640082 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 572.42 1,144.84 973.11 1,631.40

36346NY0640083 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 575.14 1,150.28 977.74 1,639.15

36346NY0640084 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 575.14 1,150.28 977.74 1,639.15

36346NY0640085 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 572.42 1,144.84 973.11 1,631.40

36346NY0640086 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 572.42 1,144.84 973.11 1,631.40

36346NY0640087 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 575.14 1,150.28 977.74 1,639.15

36346NY0640088 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 575.14 1,150.28 977.74 1,639.15

36346NY0640089 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 814.48 1,628.96 1,384.62 2,321.27

36346NY0640090 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 814.48 1,628.96 1,384.62 2,321.27

36346NY0640091 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 818.36 1,636.72 1,391.21 2,332.33

36346NY0640092 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 818.36 1,636.72 1,391.21 2,332.33

36346NY0640093 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 814.48 1,628.96 1,384.62 2,321.27

36346NY0640094 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 814.48 1,628.96 1,384.62 2,321.27

36346NY0640095 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 818.36 1,636.72 1,391.21 2,332.33

36346NY0640096 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 818.36 1,636.72 1,391.21 2,332.33

36346NY0650001 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 898.49 1,796.98 1,527.43 2,560.70

36346NY0650002 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 898.49 1,796.98 1,527.43 2,560.70

36346NY0650003 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 902.78 1,805.56 1,534.73 2,572.92

36346NY0650004 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 902.78 1,805.56 1,534.73 2,572.92

36346NY0650005 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 898.49 1,796.98 1,527.43 2,560.70

36346NY0650006 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 898.49 1,796.98 1,527.43 2,560.70

36346NY0650007 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 902.78 1,805.56 1,534.73 2,572.92

36346NY0650008 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 902.78 1,805.56 1,534.73 2,572.92

36346NY0690009 Gold Radius Uniform Mod Age 26 Regions 1 and 7 672.96 1,345.92 1,144.03 1,917.94

36346NY0690010 Gold Radius Uniform Mod Age 26 Regions 1 and 7 672.96 1,345.92 1,144.03 1,917.94

36346NY0690011 Gold Radius Uniform Mod Age 30 Regions 1 and 7 676.16 1,352.32 1,149.47 1,927.06

36346NY0690012 Gold Radius Uniform Mod Age 30 Regions 1 and 7 676.16 1,352.32 1,149.47 1,927.06

36346NY0690013 Gold Radius Uniform Mod Age 26 Regions 1 and 7 672.96 1,345.92 1,144.03 1,917.94

36346NY0690014 Gold Radius Uniform Mod Age 26 Regions 1 and 7 672.96 1,345.92 1,144.03 1,917.94

36346NY0690015 Gold Radius Uniform Mod Age 30 Regions 1 and 7 676.16 1,352.32 1,149.47 1,927.06

36346NY0690016 Gold Radius Uniform Mod Age 30 Regions 1 and 7 676.16 1,352.32 1,149.47 1,927.06

36346NY0690049 Gold EX Uniform Mod Age 26 Regions 1 and 7 702.03 1,404.06 1,193.45 2,000.79

36346NY0690050 Gold EX Uniform Mod Age 26 Regions 1 and 7 702.03 1,404.06 1,193.45 2,000.79

36346NY0690051 Gold EX Uniform Mod Age 30 Regions 1 and 7 705.37 1,410.74 1,199.13 2,010.30

36346NY0690052 Gold EX Uniform Mod Age 30 Regions 1 and 7 705.37 1,410.74 1,199.13 2,010.30

36346NY0690053 Gold EX Uniform Mod Age 26 Regions 1 and 7 702.03 1,404.06 1,193.45 2,000.79

36346NY0690054 Gold EX Uniform Mod Age 26 Regions 1 and 7 702.03 1,404.06 1,193.45 2,000.79

36346NY0690055 Gold EX Uniform Mod Age 30 Regions 1 and 7 705.37 1,410.74 1,199.13 2,010.30

36346NY0690056 Gold EX Uniform Mod Age 30 Regions 1 and 7 705.37 1,410.74 1,199.13 2,010.30

36346NY0690057 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 570.60 1,141.20 970.02 1,626.21

36346NY0690058 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 570.60 1,141.20 970.02 1,626.21

36346NY0690059 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 573.31 1,146.62 974.63 1,633.93

36346NY0690060 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 573.31 1,146.62 974.63 1,633.93

36346NY0690061 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 570.60 1,141.20 970.02 1,626.21

36346NY0690062 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 570.60 1,141.20 970.02 1,626.21

36346NY0690063 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 573.31 1,146.62 974.63 1,633.93

36346NY0690064 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 573.31 1,146.62 974.63 1,633.93

36346NY0690065 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 595.03 1,190.06 1,011.55 1,695.84

36346NY0690066 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 595.03 1,190.06 1,011.55 1,695.84

36346NY0690067 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 597.85 1,195.70 1,016.35 1,703.87

36346NY0690068 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 597.85 1,195.70 1,016.35 1,703.87

36346NY0690069 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 595.03 1,190.06 1,011.55 1,695.84

36346NY0690070 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 595.03 1,190.06 1,011.55 1,695.84

36346NY0690071 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 597.85 1,195.70 1,016.35 1,703.87

36346NY0690072 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 597.85 1,195.70 1,016.35 1,703.87

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 40

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q3:

Single

Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

36346NY0690081 Platinum EX Uniform Mod Age 26 Regions 1 and 7 829.67 1,659.34 1,410.44 2,364.56

36346NY0690082 Platinum EX Uniform Mod Age 26 Regions 1 and 7 829.67 1,659.34 1,410.44 2,364.56

36346NY0690083 Platinum EX Uniform Mod Age 30 Regions 1 and 7 833.62 1,667.24 1,417.15 2,375.82

36346NY0690084 Platinum EX Uniform Mod Age 30 Regions 1 and 7 833.62 1,667.24 1,417.15 2,375.82

36346NY0690085 Platinum EX Uniform Mod Age 26 Regions 1 and 7 829.67 1,659.34 1,410.44 2,364.56

36346NY0690086 Platinum EX Uniform Mod Age 26 Regions 1 and 7 829.67 1,659.34 1,410.44 2,364.56

36346NY0690087 Platinum EX Uniform Mod Age 30 Regions 1 and 7 833.62 1,667.24 1,417.15 2,375.82

36346NY0690088 Platinum EX Uniform Mod Age 30 Regions 1 and 7 833.62 1,667.24 1,417.15 2,375.82

36346NY0690089 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 795.05 1,590.10 1,351.59 2,265.89

36346NY0690090 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 795.05 1,590.10 1,351.59 2,265.89

36346NY0690091 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 798.85 1,597.70 1,358.05 2,276.72

36346NY0690092 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 798.85 1,597.70 1,358.05 2,276.72

36346NY0690093 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 795.05 1,590.10 1,351.59 2,265.89

36346NY0690094 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 795.05 1,590.10 1,351.59 2,265.89

36346NY0690095 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 798.85 1,597.70 1,358.05 2,276.72

36346NY0690096 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 798.85 1,597.70 1,358.05 2,276.72

36346NY0690105 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 729.86 1,459.72 1,240.76 2,080.10

36346NY0690106 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 729.86 1,459.72 1,240.76 2,080.10

36346NY0690107 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 733.34 1,466.68 1,246.68 2,090.02

36346NY0690108 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 733.34 1,466.68 1,246.68 2,090.02

36346NY0690109 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 729.86 1,459.72 1,240.76 2,080.10

36346NY0690110 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 729.86 1,459.72 1,240.76 2,080.10

36346NY0690111 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 733.34 1,466.68 1,246.68 2,090.02

36346NY0690112 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 733.34 1,466.68 1,246.68 2,090.02

36346NY0690113 Gold EX high Uniform Mod Age 26 Regions 1 and 7 761.51 1,523.02 1,294.57 2,170.30

36346NY0690114 Gold EX high Uniform Mod Age 26 Regions 1 and 7 761.51 1,523.02 1,294.57 2,170.30

36346NY0690115 Gold EX high Uniform Mod Age 30 Regions 1 and 7 765.15 1,530.30 1,300.76 2,180.68

36346NY0690116 Gold EX high Uniform Mod Age 30 Regions 1 and 7 765.15 1,530.30 1,300.76 2,180.68

36346NY0690117 Gold EX high Uniform Mod Age 26 Regions 1 and 7 761.51 1,523.02 1,294.57 2,170.30

36346NY0690118 Gold EX high Uniform Mod Age 26 Regions 1 and 7 761.51 1,523.02 1,294.57 2,170.30

36346NY0690119 Gold EX high Uniform Mod Age 30 Regions 1 and 7 765.15 1,530.30 1,300.76 2,180.68

36346NY0690120 Gold EX high Uniform Mod Age 30 Regions 1 and 7 765.15 1,530.30 1,300.76 2,180.68

36346NY0690121 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 647.96 1,295.92 1,101.53 1,846.69

36346NY0690122 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 647.96 1,295.92 1,101.53 1,846.69

36346NY0690123 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 651.03 1,302.06 1,106.75 1,855.44

36346NY0690124 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 651.03 1,302.06 1,106.75 1,855.44

36346NY0690125 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 647.96 1,295.92 1,101.53 1,846.69

36346NY0690126 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 647.96 1,295.92 1,101.53 1,846.69

36346NY0690127 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 651.03 1,302.06 1,106.75 1,855.44

36346NY0690128 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 651.03 1,302.06 1,106.75 1,855.44

36346NY0690129 Silver EX 6300 NEW Age 26 Regions 1 and 7 636.95 1,273.90 1,082.82 1,815.31

36346NY0690130 Silver EX 6300 NEW Age 26 Regions 1 and 7 636.95 1,273.90 1,082.82 1,815.31

36346NY0690131 Silver EX 6300 NEW Age 30 Regions 1 and 7 639.97 1,279.94 1,087.95 1,823.91

36346NY0690132 Silver EX 6300 NEW Age 30 Regions 1 and 7 639.97 1,279.94 1,087.95 1,823.91

36346NY0690133 Silver EX 6300 NEW Age 26 Regions 1 and 7 636.95 1,273.90 1,082.82 1,815.31

36346NY0690134 Silver EX 6300 NEW Age 26 Regions 1 and 7 636.95 1,273.90 1,082.82 1,815.31

36346NY0690135 Silver EX 6300 NEW Age 30 Regions 1 and 7 639.97 1,279.94 1,087.95 1,823.91

36346NY0690136 Silver EX 6300 NEW Age 30 Regions 1 and 7 639.97 1,279.94 1,087.95 1,823.91

49526NY0280001 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280002 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280003 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280004 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280005 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280006 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280007 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280008 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0680289 Platinum POS Plus Uniform Mod Age 26 Region 2 640.66 1,281.32 1,089.12 1,825.88

49526NY0680290 Platinum POS Plus Uniform Mod Age 26 Region 2 640.66 1,281.32 1,089.12 1,825.88

49526NY0680291 Platinum POS Plus Uniform Mod Age 30 Region 2 643.71 1,287.42 1,094.31 1,834.57

49526NY0680292 Platinum POS Plus Uniform Mod Age 30 Region 2 643.71 1,287.42 1,094.31 1,834.57

49526NY0680293 Platinum POS Plus Uniform Mod Age 26 Region 2 640.66 1,281.32 1,089.12 1,825.88

49526NY0680294 Platinum POS Plus Uniform Mod Age 26 Region 2 640.66 1,281.32 1,089.12 1,825.88

49526NY0680295 Platinum POS Plus Uniform Mod Age 30 Region 2 643.71 1,287.42 1,094.31 1,834.57

49526NY0680296 Platinum POS Plus Uniform Mod Age 30 Region 2 643.71 1,287.42 1,094.31 1,834.57

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 41

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q3:

Single

Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

49526NY0520009 Bronze focus Tiered Uniform Mod Age 26 Region 2 353.61 707.22 601.14 1,007.79

49526NY0520010 Bronze focus Tiered Uniform Mod Age 26 Region 2 353.61 707.22 601.14 1,007.79

49526NY0520011 Bronze focus Tiered Uniform Mod Age 30 Region 2 355.26 710.52 603.94 1,012.49

49526NY0520012 Bronze focus Tiered Uniform Mod Age 30 Region 2 355.26 710.52 603.94 1,012.49

49526NY0520013 Bronze focus Tiered Uniform Mod Age 26 Region 2 353.61 707.22 601.14 1,007.79

49526NY0520014 Bronze focus Tiered Uniform Mod Age 26 Region 2 353.61 707.22 601.14 1,007.79

49526NY0520015 Bronze focus Tiered Uniform Mod Age 30 Region 2 355.26 710.52 603.94 1,012.49

49526NY0520016 Bronze focus Tiered Uniform Mod Age 30 Region 2 355.26 710.52 603.94 1,012.49

49526NY0520017 Bronze align Tiered Uniform Mod Age 26 Region 2 353.61 707.22 601.14 1,007.79

49526NY0520018 Bronze align Tiered Uniform Mod Age 26 Region 2 353.61 707.22 601.14 1,007.79

49526NY0520019 Bronze align Tiered Uniform Mod Age 30 Region 2 355.26 710.52 603.94 1,012.49

49526NY0520020 Bronze align Tiered Uniform Mod Age 30 Region 2 355.26 710.52 603.94 1,012.49

49526NY0520021 Bronze align Tiered Uniform Mod Age 26 Region 2 353.61 707.22 601.14 1,007.79

49526NY0520022 Bronze align Tiered Uniform Mod Age 26 Region 2 353.61 707.22 601.14 1,007.79

49526NY0520023 Bronze align Tiered Uniform Mod Age 30 Region 2 355.26 710.52 603.94 1,012.49

49526NY0520024 Bronze align Tiered Uniform Mod Age 30 Region 2 355.26 710.52 603.94 1,012.49

49526NY0520025 Bronze align Select Uniform Mod Age 26 Region 2 344.25 688.50 585.23 981.11

49526NY0520026 Bronze align Select Uniform Mod Age 26 Region 2 344.25 688.50 585.23 981.11

49526NY0520027 Bronze align Select Uniform Mod Age 30 Region 2 345.86 691.72 587.96 985.70

49526NY0520028 Bronze align Select Uniform Mod Age 30 Region 2 345.86 691.72 587.96 985.70

49526NY0520029 Bronze align Select Uniform Mod Age 26 Region 2 344.25 688.50 585.23 981.11

49526NY0520030 Bronze align Select Uniform Mod Age 26 Region 2 344.25 688.50 585.23 981.11

49526NY0520031 Bronze align Select Uniform Mod Age 30 Region 2 345.86 691.72 587.96 985.70

49526NY0520032 Bronze align Select Uniform Mod Age 30 Region 2 345.86 691.72 587.96 985.70

49526NY0520033 Bronze focus Select Uniform Mod Age 26 Region 2 344.25 688.50 585.23 981.11

49526NY0520034 Bronze focus Select Uniform Mod Age 26 Region 2 344.25 688.50 585.23 981.11

49526NY0520035 Bronze focus Select Uniform Mod Age 30 Region 2 345.86 691.72 587.96 985.70

49526NY0520036 Bronze focus Select Uniform Mod Age 30 Region 2 345.86 691.72 587.96 985.70

49526NY0520037 Bronze focus Select Uniform Mod Age 26 Region 2 344.25 688.50 585.23 981.11

49526NY0520038 Bronze focus Select Uniform Mod Age 26 Region 2 344.25 688.50 585.23 981.11

49526NY0520039 Bronze focus Select Uniform Mod Age 30 Region 2 345.86 691.72 587.96 985.70

49526NY0520040 Bronze focus Select Uniform Mod Age 30 Region 2 345.86 691.72 587.96 985.70

49526NY0520041 Bronze HMO 8100 New Age 26 Region 2 391.33 782.66 665.26 1,115.29

49526NY0520042 Bronze HMO 8100 New Age 26 Region 2 391.33 782.66 665.26 1,115.29

49526NY0520043 Bronze HMO 8100 New Age 30 Region 2 393.17 786.34 668.39 1,120.53

49526NY0520044 Bronze HMO 8100 New Age 30 Region 2 393.17 786.34 668.39 1,120.53

49526NY0520045 Bronze HMO 8100 New Age 26 Region 2 391.33 782.66 665.26 1,115.29

49526NY0520046 Bronze HMO 8100 New Age 26 Region 2 391.33 782.66 665.26 1,115.29

49526NY0520047 Bronze HMO 8100 New Age 30 Region 2 393.17 786.34 668.39 1,120.53

49526NY0520048 Bronze HMO 8100 New Age 30 Region 2 393.17 786.34 668.39 1,120.53

49526NY0520049 Bronze 8100 align Select New Age 26 Region 2 359.29 718.58 610.79 1,023.98

49526NY0520050 Bronze 8100 align Select New Age 26 Region 2 359.29 718.58 610.79 1,023.98

49526NY0520051 Bronze 8100 align Select New Age 30 Region 2 360.97 721.94 613.65 1,028.76

49526NY0520052 Bronze 8100 align Select New Age 30 Region 2 360.97 721.94 613.65 1,028.76

49526NY0520053 Bronze 8100 align Select New Age 26 Region 2 359.29 718.58 610.79 1,023.98

49526NY0520054 Bronze 8100 align Select New Age 26 Region 2 359.29 718.58 610.79 1,023.98

49526NY0520055 Bronze 8100 align Select New Age 30 Region 2 360.97 721.94 613.65 1,028.76

49526NY0520056 Bronze 8100 align Select New Age 30 Region 2 360.97 721.94 613.65 1,028.76

49526NY0520057 Bronze 8100 focus Select New Age 26 Region 2 359.29 718.58 610.79 1,023.98

49526NY0520058 Bronze 8100 focus Select New Age 26 Region 2 359.29 718.58 610.79 1,023.98

49526NY0520059 Bronze 8100 focus Select New Age 30 Region 2 360.97 721.94 613.65 1,028.76

49526NY0520060 Bronze 8100 focus Select New Age 30 Region 2 360.97 721.94 613.65 1,028.76

49526NY0520061 Bronze 8100 focus Select New Age 26 Region 2 359.29 718.58 610.79 1,023.98

49526NY0520062 Bronze 8100 focus Select New Age 26 Region 2 359.29 718.58 610.79 1,023.98

49526NY0520063 Bronze 8100 focus Select New Age 30 Region 2 360.97 721.94 613.65 1,028.76

49526NY0520064 Bronze 8100 focus Select New Age 30 Region 2 360.97 721.94 613.65 1,028.76

49526NY0560001 Bronze POS Classic Uniform Mod Age 26 Region 2 398.03 796.06 676.65 1,134.39

49526NY0560002 Bronze POS Classic Uniform Mod Age 26 Region 2 398.03 796.06 676.65 1,134.39

49526NY0560003 Bronze POS Classic Uniform Mod Age 30 Region 2 399.90 799.80 679.83 1,139.72

49526NY0560004 Bronze POS Classic Uniform Mod Age 30 Region 2 399.90 799.80 679.83 1,139.72

49526NY0560005 Bronze POS Classic Uniform Mod Age 26 Region 2 398.03 796.06 676.65 1,134.39

49526NY0560006 Bronze POS Classic Uniform Mod Age 26 Region 2 398.03 796.06 676.65 1,134.39

49526NY0560007 Bronze POS Classic Uniform Mod Age 30 Region 2 399.90 799.80 679.83 1,139.72

49526NY0560008 Bronze POS Classic Uniform Mod Age 30 Region 2 399.90 799.80 679.83 1,139.72

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 42

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q3:

Single

Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

49526NY0560025 Silver POS Classic Uniform Mod Age 26 Region 2 516.92 1,033.84 878.76 1,473.22

49526NY0560026 Silver POS Classic Uniform Mod Age 26 Region 2 516.92 1,033.84 878.76 1,473.22

49526NY0560027 Silver POS Classic Uniform Mod Age 30 Region 2 519.37 1,038.74 882.93 1,480.20

49526NY0560028 Silver POS Classic Uniform Mod Age 30 Region 2 519.37 1,038.74 882.93 1,480.20

49526NY0560029 Silver POS Classic Uniform Mod Age 26 Region 2 516.92 1,033.84 878.76 1,473.22

49526NY0560030 Silver POS Classic Uniform Mod Age 26 Region 2 516.92 1,033.84 878.76 1,473.22

49526NY0560031 Silver POS Classic Uniform Mod Age 30 Region 2 519.37 1,038.74 882.93 1,480.20

49526NY0560032 Silver POS Classic Uniform Mod Age 30 Region 2 519.37 1,038.74 882.93 1,480.20

49526NY0560057 Gold POS Classic Uniform Mod Age 26 Region 2 572.29 1,144.58 972.89 1,631.03

49526NY0560058 Gold POS Classic Uniform Mod Age 26 Region 2 572.29 1,144.58 972.89 1,631.03

49526NY0560059 Gold POS Classic Uniform Mod Age 30 Region 2 575.01 1,150.02 977.52 1,638.78

49526NY0560060 Gold POS Classic Uniform Mod Age 30 Region 2 575.01 1,150.02 977.52 1,638.78

49526NY0560061 Gold POS Classic Uniform Mod Age 26 Region 2 572.29 1,144.58 972.89 1,631.03

49526NY0560062 Gold POS Classic Uniform Mod Age 26 Region 2 572.29 1,144.58 972.89 1,631.03

49526NY0560063 Gold POS Classic Uniform Mod Age 30 Region 2 575.01 1,150.02 977.52 1,638.78

49526NY0560064 Gold POS Classic Uniform Mod Age 30 Region 2 575.01 1,150.02 977.52 1,638.78

49526NY0560089 Platinum POS Classic Uniform Mod Age 26 Region 2 650.97 1,301.94 1,106.65 1,855.26

49526NY0560090 Platinum POS Classic Uniform Mod Age 26 Region 2 650.97 1,301.94 1,106.65 1,855.26

49526NY0560091 Platinum POS Classic Uniform Mod Age 30 Region 2 654.07 1,308.14 1,111.92 1,864.10

49526NY0560092 Platinum POS Classic Uniform Mod Age 30 Region 2 654.07 1,308.14 1,111.92 1,864.10

49526NY0560093 Platinum POS Classic Uniform Mod Age 26 Region 2 650.97 1,301.94 1,106.65 1,855.26

49526NY0560094 Platinum POS Classic Uniform Mod Age 26 Region 2 650.97 1,301.94 1,106.65 1,855.26

49526NY0560095 Platinum POS Classic Uniform Mod Age 30 Region 2 654.07 1,308.14 1,111.92 1,864.10

49526NY0560096 Platinum POS Classic Uniform Mod Age 30 Region 2 654.07 1,308.14 1,111.92 1,864.10

49526NY0560105 Platinum Make Available Uniform Mod Age 26 Region 2 649.14 1,298.28 1,103.54 1,850.05

49526NY0560106 Platinum Make Available Uniform Mod Age 26 Region 2 649.14 1,298.28 1,103.54 1,850.05

49526NY0560107 Platinum Make Available Uniform Mod Age 30 Region 2 652.24 1,304.48 1,108.81 1,858.88

49526NY0560108 Platinum Make Available Uniform Mod Age 30 Region 2 652.24 1,304.48 1,108.81 1,858.88

49526NY0560109 Platinum Make Available Uniform Mod Age 26 Region 2 649.14 1,298.28 1,103.54 1,850.05

49526NY0560110 Platinum Make Available Uniform Mod Age 26 Region 2 649.14 1,298.28 1,103.54 1,850.05

49526NY0560111 Platinum Make Available Uniform Mod Age 30 Region 2 652.24 1,304.48 1,108.81 1,858.88

49526NY0560112 Platinum Make Available Uniform Mod Age 30 Region 2 652.24 1,304.48 1,108.81 1,858.88

49526NY0630001 Bronze 8100EX New Age 26 Region 2 408.05 816.10 693.69 1,162.94

49526NY0630002 Bronze 8100EX New Age 26 Region 2 408.05 816.10 693.69 1,162.94

49526NY0630003 Bronze 8100EX New Age 30 Region 2 409.97 819.94 696.95 1,168.41

49526NY0630004 Bronze 8100EX New Age 30 Region 2 409.97 819.94 696.95 1,168.41

49526NY0630005 Bronze 8100EX New Age 26 Region 2 408.05 816.10 693.69 1,162.94

49526NY0630006 Bronze 8100EX New Age 26 Region 2 408.05 816.10 693.69 1,162.94

49526NY0630007 Bronze 8100EX New Age 30 Region 2 409.97 819.94 696.95 1,168.41

49526NY0630008 Bronze 8100EX New Age 30 Region 2 409.97 819.94 696.95 1,168.41

49526NY0640001 Gold PPO 7100 Uniform Mod Age 26 Region 2 674.85 1,349.70 1,147.25 1,923.32

49526NY0640002 Gold PPO 7100 Uniform Mod Age 26 Region 2 674.85 1,349.70 1,147.25 1,923.32

49526NY0640003 Gold PPO 7100 Uniform Mod Age 30 Region 2 678.06 1,356.12 1,152.70 1,932.47

49526NY0640004 Gold PPO 7100 Uniform Mod Age 30 Region 2 678.06 1,356.12 1,152.70 1,932.47

49526NY0640005 Gold PPO 7100 Uniform Mod Age 26 Region 2 674.85 1,349.70 1,147.25 1,923.32

49526NY0640006 Gold PPO 7100 Uniform Mod Age 26 Region 2 674.85 1,349.70 1,147.25 1,923.32

49526NY0640007 Gold PPO 7100 Uniform Mod Age 30 Region 2 678.06 1,356.12 1,152.70 1,932.47

49526NY0640008 Gold PPO 7100 Uniform Mod Age 30 Region 2 678.06 1,356.12 1,152.70 1,932.47

49526NY0640009 Silver PPO 8100 Uniform Mod Age 26 Region 2 556.48 1,112.96 946.02 1,585.97

49526NY0640010 Silver PPO 8100 Uniform Mod Age 26 Region 2 556.48 1,112.96 946.02 1,585.97

49526NY0640011 Silver PPO 8100 Uniform Mod Age 30 Region 2 559.12 1,118.24 950.50 1,593.49

49526NY0640012 Silver PPO 8100 Uniform Mod Age 30 Region 2 559.12 1,118.24 950.50 1,593.49

49526NY0640013 Silver PPO 8100 Uniform Mod Age 26 Region 2 556.48 1,112.96 946.02 1,585.97

49526NY0640014 Silver PPO 8100 Uniform Mod Age 26 Region 2 556.48 1,112.96 946.02 1,585.97

49526NY0640015 Silver PPO 8100 Uniform Mod Age 30 Region 2 559.12 1,118.24 950.50 1,593.49

49526NY0640016 Silver PPO 8100 Uniform Mod Age 30 Region 2 559.12 1,118.24 950.50 1,593.49

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 43

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q3:

Single

Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

49526NY0640033 Silver PPO 7100 Uniform Mod Age 26 Region 2 613.86 1,227.72 1,043.56 1,749.50

49526NY0640034 Silver PPO 7100 Uniform Mod Age 26 Region 2 613.86 1,227.72 1,043.56 1,749.50

49526NY0640035 Silver PPO 7100 Uniform Mod Age 30 Region 2 616.78 1,233.56 1,048.53 1,757.82

49526NY0640036 Silver PPO 7100 Uniform Mod Age 30 Region 2 616.78 1,233.56 1,048.53 1,757.82

49526NY0640037 Silver PPO 7100 Uniform Mod Age 26 Region 2 613.86 1,227.72 1,043.56 1,749.50

49526NY0640038 Silver PPO 7100 Uniform Mod Age 26 Region 2 613.86 1,227.72 1,043.56 1,749.50

49526NY0640039 Silver PPO 7100 Uniform Mod Age 30 Region 2 616.78 1,233.56 1,048.53 1,757.82

49526NY0640040 Silver PPO 7100 Uniform Mod Age 30 Region 2 616.78 1,233.56 1,048.53 1,757.82

49526NY0640041 Platinum PPO Plus New Age 26 Region 2 816.25 1,632.50 1,387.63 2,326.31

49526NY0640042 Platinum PPO Plus New Age 26 Region 2 816.25 1,632.50 1,387.63 2,326.31

49526NY0640043 Platinum PPO Plus New Age 30 Region 2 820.15 1,640.30 1,394.26 2,337.43

49526NY0640044 Platinum PPO Plus New Age 30 Region 2 820.15 1,640.30 1,394.26 2,337.43

49526NY0640045 Platinum PPO Plus New Age 26 Region 2 816.25 1,632.50 1,387.63 2,326.31

49526NY0640046 Platinum PPO Plus New Age 26 Region 2 816.25 1,632.50 1,387.63 2,326.31

49526NY0640047 Platinum PPO Plus New Age 30 Region 2 820.15 1,640.30 1,394.26 2,337.43

49526NY0640048 Platinum PPO Plus New Age 30 Region 2 820.15 1,640.30 1,394.26 2,337.43

49526NY0680001 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 599.92 1,199.84 1,019.86 1,709.77

49526NY0680002 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 599.92 1,199.84 1,019.86 1,709.77

49526NY0680003 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 602.77 1,205.54 1,024.71 1,717.89

49526NY0680004 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 602.77 1,205.54 1,024.71 1,717.89

49526NY0680005 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 599.92 1,199.84 1,019.86 1,709.77

49526NY0680006 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 599.92 1,199.84 1,019.86 1,709.77

49526NY0680007 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 602.77 1,205.54 1,024.71 1,717.89

49526NY0680008 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 602.77 1,205.54 1,024.71 1,717.89

49526NY0680009 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 500.04 1,000.08 850.07 1,425.11

49526NY0680010 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 500.04 1,000.08 850.07 1,425.11

49526NY0680011 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 502.41 1,004.82 854.10 1,431.87

49526NY0680012 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 502.41 1,004.82 854.10 1,431.87

49526NY0680013 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 500.04 1,000.08 850.07 1,425.11

49526NY0680014 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 500.04 1,000.08 850.07 1,425.11

49526NY0680015 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 502.41 1,004.82 854.10 1,431.87

49526NY0680016 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 502.41 1,004.82 854.10 1,431.87

49526NY0680017 Gold POS 7100 Uniform Mod Age 26 Region 2 530.75 1,061.50 902.28 1,512.64

49526NY0680018 Gold POS 7100 Uniform Mod Age 26 Region 2 530.75 1,061.50 902.28 1,512.64

49526NY0680019 Gold POS 7100 Uniform Mod Age 30 Region 2 533.27 1,066.54 906.56 1,519.82

49526NY0680020 Gold POS 7100 Uniform Mod Age 30 Region 2 533.27 1,066.54 906.56 1,519.82

49526NY0680021 Gold POS 7100 Uniform Mod Age 26 Region 2 530.75 1,061.50 902.28 1,512.64

49526NY0680022 Gold POS 7100 Uniform Mod Age 26 Region 2 530.75 1,061.50 902.28 1,512.64

49526NY0680023 Gold POS 7100 Uniform Mod Age 30 Region 2 533.27 1,066.54 906.56 1,519.82

49526NY0680024 Gold POS 7100 Uniform Mod Age 30 Region 2 533.27 1,066.54 906.56 1,519.82

49526NY0680025 Gold POS 7100EX Uniform Mod Age 26 Region 2 552.86 1,105.72 939.86 1,575.65

49526NY0680026 Gold POS 7100EX Uniform Mod Age 26 Region 2 552.86 1,105.72 939.86 1,575.65

49526NY0680027 Gold POS 7100EX Uniform Mod Age 30 Region 2 555.49 1,110.98 944.33 1,583.15

49526NY0680028 Gold POS 7100EX Uniform Mod Age 30 Region 2 555.49 1,110.98 944.33 1,583.15

49526NY0680029 Gold POS 7100EX Uniform Mod Age 26 Region 2 552.86 1,105.72 939.86 1,575.65

49526NY0680030 Gold POS 7100EX Uniform Mod Age 26 Region 2 552.86 1,105.72 939.86 1,575.65

49526NY0680031 Gold POS 7100EX Uniform Mod Age 30 Region 2 555.49 1,110.98 944.33 1,583.15

49526NY0680032 Gold POS 7100EX Uniform Mod Age 30 Region 2 555.49 1,110.98 944.33 1,583.15

49526NY0680041 Gold Aqua Uniform Mod Age 26 Region 2 517.02 1,034.04 878.93 1,473.51

49526NY0680042 Gold Aqua Uniform Mod Age 26 Region 2 517.02 1,034.04 878.93 1,473.51

49526NY0680043 Gold Aqua Uniform Mod Age 30 Region 2 519.47 1,038.94 883.10 1,480.49

49526NY0680044 Gold Aqua Uniform Mod Age 30 Region 2 519.47 1,038.94 883.10 1,480.49

49526NY0680045 Gold Aqua Uniform Mod Age 26 Region 2 517.02 1,034.04 878.93 1,473.51

49526NY0680046 Gold Aqua Uniform Mod Age 26 Region 2 517.02 1,034.04 878.93 1,473.51

49526NY0680047 Gold Aqua Uniform Mod Age 30 Region 2 519.47 1,038.94 883.10 1,480.49

49526NY0680048 Gold Aqua Uniform Mod Age 30 Region 2 519.47 1,038.94 883.10 1,480.49

49526NY0680049 Silver POS 7100 Uniform Mod Age 26 Region 2 483.36 966.72 821.71 1,377.58

49526NY0680050 Silver POS 7100 Uniform Mod Age 26 Region 2 483.36 966.72 821.71 1,377.58

49526NY0680051 Silver POS 7100 Uniform Mod Age 30 Region 2 485.65 971.30 825.61 1,384.10

49526NY0680052 Silver POS 7100 Uniform Mod Age 30 Region 2 485.65 971.30 825.61 1,384.10

49526NY0680053 Silver POS 7100 Uniform Mod Age 26 Region 2 483.36 966.72 821.71 1,377.58

49526NY0680054 Silver POS 7100 Uniform Mod Age 26 Region 2 483.36 966.72 821.71 1,377.58

49526NY0680055 Silver POS 7100 Uniform Mod Age 30 Region 2 485.65 971.30 825.61 1,384.10

49526NY0680056 Silver POS 7100 Uniform Mod Age 30 Region 2 485.65 971.30 825.61 1,384.10

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 44

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q3:

Single

Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

49526NY0680057 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 453.80 907.60 771.46 1,293.33

49526NY0680058 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 453.80 907.60 771.46 1,293.33

49526NY0680059 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 455.95 911.90 775.12 1,299.46

49526NY0680060 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 455.95 911.90 775.12 1,299.46

49526NY0680061 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 453.80 907.60 771.46 1,293.33

49526NY0680062 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 453.80 907.60 771.46 1,293.33

49526NY0680063 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 455.95 911.90 775.12 1,299.46

49526NY0680064 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 455.95 911.90 775.12 1,299.46

49526NY0680065 Silver POS 8100EX Uniform Mod Age 26 Region 2 456.83 913.66 776.61 1,301.97

49526NY0680066 Silver POS 8100EX Uniform Mod Age 26 Region 2 456.83 913.66 776.61 1,301.97

49526NY0680067 Silver POS 8100EX Uniform Mod Age 30 Region 2 458.99 917.98 780.28 1,308.12

49526NY0680068 Silver POS 8100EX Uniform Mod Age 30 Region 2 458.99 917.98 780.28 1,308.12

49526NY0680069 Silver POS 8100EX Uniform Mod Age 26 Region 2 456.83 913.66 776.61 1,301.97

49526NY0680070 Silver POS 8100EX Uniform Mod Age 26 Region 2 456.83 913.66 776.61 1,301.97

49526NY0680071 Silver POS 8100EX Uniform Mod Age 30 Region 2 458.99 917.98 780.28 1,308.12

49526NY0680072 Silver POS 8100EX Uniform Mod Age 30 Region 2 458.99 917.98 780.28 1,308.12

49526NY0680081 Silver POS 8100 Uniform Mod Age 26 Region 2 438.77 877.54 745.91 1,250.49

49526NY0680082 Silver POS 8100 Uniform Mod Age 26 Region 2 438.77 877.54 745.91 1,250.49

49526NY0680083 Silver POS 8100 Uniform Mod Age 30 Region 2 440.84 881.68 749.43 1,256.39

49526NY0680084 Silver POS 8100 Uniform Mod Age 30 Region 2 440.84 881.68 749.43 1,256.39

49526NY0680085 Silver POS 8100 Uniform Mod Age 26 Region 2 438.77 877.54 745.91 1,250.49

49526NY0680086 Silver POS 8100 Uniform Mod Age 26 Region 2 438.77 877.54 745.91 1,250.49

49526NY0680087 Silver POS 8100 Uniform Mod Age 30 Region 2 440.84 881.68 749.43 1,256.39

49526NY0680088 Silver POS 8100 Uniform Mod Age 30 Region 2 440.84 881.68 749.43 1,256.39

49526NY0680089 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 599.92 1,199.84 1,019.86 1,709.77

49526NY0680090 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 599.92 1,199.84 1,019.86 1,709.77

49526NY0680091 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 602.77 1,205.54 1,024.71 1,717.89

49526NY0680092 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 602.77 1,205.54 1,024.71 1,717.89

49526NY0680093 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 599.92 1,199.84 1,019.86 1,709.77

49526NY0680094 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 599.92 1,199.84 1,019.86 1,709.77

49526NY0680095 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 602.77 1,205.54 1,024.71 1,717.89

49526NY0680096 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 602.77 1,205.54 1,024.71 1,717.89

49526NY0680097 Gold Complete Uniform Mod Age 26 Region 2 511.36 1,022.72 869.31 1,457.38

49526NY0680098 Gold Complete Uniform Mod Age 26 Region 2 511.36 1,022.72 869.31 1,457.38

49526NY0680099 Gold Complete Uniform Mod Age 30 Region 2 513.78 1,027.56 873.43 1,464.27

49526NY0680100 Gold Complete Uniform Mod Age 30 Region 2 513.78 1,027.56 873.43 1,464.27

49526NY0680101 Gold Complete Uniform Mod Age 26 Region 2 511.36 1,022.72 869.31 1,457.38

49526NY0680102 Gold Complete Uniform Mod Age 26 Region 2 511.36 1,022.72 869.31 1,457.38

49526NY0680103 Gold Complete Uniform Mod Age 30 Region 2 513.78 1,027.56 873.43 1,464.27

49526NY0680104 Gold Complete Uniform Mod Age 30 Region 2 513.78 1,027.56 873.43 1,464.27

49526NY0680105 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 500.04 1,000.08 850.07 1,425.11

49526NY0680106 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 500.04 1,000.08 850.07 1,425.11

49526NY0680107 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 502.41 1,004.82 854.10 1,431.87

49526NY0680108 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 502.41 1,004.82 854.10 1,431.87

49526NY0680109 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 500.04 1,000.08 850.07 1,425.11

49526NY0680110 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 500.04 1,000.08 850.07 1,425.11

49526NY0680111 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 502.41 1,004.82 854.10 1,431.87

49526NY0680112 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 502.41 1,004.82 854.10 1,431.87

49526NY0680121 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 453.80 907.60 771.46 1,293.33

49526NY0680122 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 453.80 907.60 771.46 1,293.33

49526NY0680123 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 455.95 911.90 775.12 1,299.46

49526NY0680124 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 455.95 911.90 775.12 1,299.46

49526NY0680125 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 453.80 907.60 771.46 1,293.33

49526NY0680126 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 453.80 907.60 771.46 1,293.33

49526NY0680127 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 455.95 911.90 775.12 1,299.46

49526NY0680128 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 455.95 911.90 775.12 1,299.46

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 45

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q3:

Single

Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

49526NY0680153 Silver POS 7100EX Uniform Mod Age 26 Region 2 503.39 1,006.78 855.76 1,434.66

49526NY0680154 Silver POS 7100EX Uniform Mod Age 26 Region 2 503.39 1,006.78 855.76 1,434.66

49526NY0680155 Silver POS 7100EX Uniform Mod Age 30 Region 2 505.77 1,011.54 859.81 1,441.44

49526NY0680156 Silver POS 7100EX Uniform Mod Age 30 Region 2 505.77 1,011.54 859.81 1,441.44

49526NY0680157 Silver POS 7100EX Uniform Mod Age 26 Region 2 503.39 1,006.78 855.76 1,434.66

49526NY0680158 Silver POS 7100EX Uniform Mod Age 26 Region 2 503.39 1,006.78 855.76 1,434.66

49526NY0680159 Silver POS 7100EX Uniform Mod Age 30 Region 2 505.77 1,011.54 859.81 1,441.44

49526NY0680160 Silver POS 7100EX Uniform Mod Age 30 Region 2 505.77 1,011.54 859.81 1,441.44

49526NY0680177 Silver 8100 align Select Uniform Mod Age 26 Region 2 395.73 791.46 672.74 1,127.83

49526NY0680178 Silver 8100 align Select Uniform Mod Age 26 Region 2 395.73 791.46 672.74 1,127.83

49526NY0680179 Silver 8100 align Select Uniform Mod Age 30 Region 2 397.59 795.18 675.90 1,133.13

49526NY0680180 Silver 8100 align Select Uniform Mod Age 30 Region 2 397.59 795.18 675.90 1,133.13

49526NY0680181 Silver 8100 align Select Uniform Mod Age 26 Region 2 395.73 791.46 672.74 1,127.83

49526NY0680182 Silver 8100 align Select Uniform Mod Age 26 Region 2 395.73 791.46 672.74 1,127.83

49526NY0680183 Silver 8100 align Select Uniform Mod Age 30 Region 2 397.59 795.18 675.90 1,133.13

49526NY0680184 Silver 8100 align Select Uniform Mod Age 30 Region 2 397.59 795.18 675.90 1,133.13

49526NY0680185 Silver 8100 focus Select Uniform Mod Age 26 Region 2 395.73 791.46 672.74 1,127.83

49526NY0680186 Silver 8100 focus Select Uniform Mod Age 26 Region 2 395.73 791.46 672.74 1,127.83

49526NY0680187 Silver 8100 focus Select Uniform Mod Age 30 Region 2 397.59 795.18 675.90 1,133.13

49526NY0680188 Silver 8100 focus Select Uniform Mod Age 30 Region 2 397.59 795.18 675.90 1,133.13

49526NY0680189 Silver 8100 focus Select Uniform Mod Age 26 Region 2 395.73 791.46 672.74 1,127.83

49526NY0680190 Silver 8100 focus Select Uniform Mod Age 26 Region 2 395.73 791.46 672.74 1,127.83

49526NY0680191 Silver 8100 focus Select Uniform Mod Age 30 Region 2 397.59 795.18 675.90 1,133.13

49526NY0680192 Silver 8100 focus Select Uniform Mod Age 30 Region 2 397.59 795.18 675.90 1,133.13

49526NY0680193 Silver 7100 align Select Uniform Mod Age 26 Region 2 435.64 871.28 740.59 1,241.57

49526NY0680194 Silver 7100 align Select Uniform Mod Age 26 Region 2 435.64 871.28 740.59 1,241.57

49526NY0680195 Silver 7100 align Select Uniform Mod Age 30 Region 2 437.70 875.40 744.09 1,247.45

49526NY0680196 Silver 7100 align Select Uniform Mod Age 30 Region 2 437.70 875.40 744.09 1,247.45

49526NY0680197 Silver 7100 align Select Uniform Mod Age 26 Region 2 435.64 871.28 740.59 1,241.57

49526NY0680198 Silver 7100 align Select Uniform Mod Age 26 Region 2 435.64 871.28 740.59 1,241.57

49526NY0680199 Silver 7100 align Select Uniform Mod Age 30 Region 2 437.70 875.40 744.09 1,247.45

49526NY0680200 Silver 7100 align Select Uniform Mod Age 30 Region 2 437.70 875.40 744.09 1,247.45

49526NY0680201 Silver 7100 focus Select Uniform Mod Age 26 Region 2 435.64 871.28 740.59 1,241.57

49526NY0680202 Silver 7100 focus Select Uniform Mod Age 26 Region 2 435.64 871.28 740.59 1,241.57

49526NY0680203 Silver 7100 focus Select Uniform Mod Age 30 Region 2 437.70 875.40 744.09 1,247.45

49526NY0680204 Silver 7100 focus Select Uniform Mod Age 30 Region 2 437.70 875.40 744.09 1,247.45

49526NY0680205 Silver 7100 focus Select Uniform Mod Age 26 Region 2 435.64 871.28 740.59 1,241.57

49526NY0680206 Silver 7100 focus Select Uniform Mod Age 26 Region 2 435.64 871.28 740.59 1,241.57

49526NY0680207 Silver 7100 focus Select Uniform Mod Age 30 Region 2 437.70 875.40 744.09 1,247.45

49526NY0680208 Silver 7100 focus Select Uniform Mod Age 30 Region 2 437.70 875.40 744.09 1,247.45

49526NY0680209 Gold 7100 align Select Uniform Mod Age 26 Region 2 478.07 956.14 812.72 1,362.50

49526NY0680210 Gold 7100 align Select Uniform Mod Age 26 Region 2 478.07 956.14 812.72 1,362.50

49526NY0680211 Gold 7100 align Select Uniform Mod Age 30 Region 2 480.33 960.66 816.56 1,368.94

49526NY0680212 Gold 7100 align Select Uniform Mod Age 30 Region 2 480.33 960.66 816.56 1,368.94

49526NY0680213 Gold 7100 align Select Uniform Mod Age 26 Region 2 478.07 956.14 812.72 1,362.50

49526NY0680214 Gold 7100 align Select Uniform Mod Age 26 Region 2 478.07 956.14 812.72 1,362.50

49526NY0680215 Gold 7100 align Select Uniform Mod Age 30 Region 2 480.33 960.66 816.56 1,368.94

49526NY0680216 Gold 7100 align Select Uniform Mod Age 30 Region 2 480.33 960.66 816.56 1,368.94

49526NY0680217 Gold 7100 focus Select Uniform Mod Age 26 Region 2 478.07 956.14 812.72 1,362.50

49526NY0680218 Gold 7100 focus Select Uniform Mod Age 26 Region 2 478.07 956.14 812.72 1,362.50

49526NY0680219 Gold 7100 focus Select Uniform Mod Age 30 Region 2 480.33 960.66 816.56 1,368.94

49526NY0680220 Gold 7100 focus Select Uniform Mod Age 30 Region 2 480.33 960.66 816.56 1,368.94

49526NY0680221 Gold 7100 focus Select Uniform Mod Age 26 Region 2 478.07 956.14 812.72 1,362.50

49526NY0680222 Gold 7100 focus Select Uniform Mod Age 26 Region 2 478.07 956.14 812.72 1,362.50

49526NY0680223 Gold 7100 focus Select Uniform Mod Age 30 Region 2 480.33 960.66 816.56 1,368.94

49526NY0680224 Gold 7100 focus Select Uniform Mod Age 30 Region 2 480.33 960.66 816.56 1,368.94

49526NY0680225 Silver Aqua Uniform Mod Age 26 Region 2 469.90 939.80 798.83 1,339.22

49526NY0680226 Silver Aqua Uniform Mod Age 26 Region 2 469.90 939.80 798.83 1,339.22

49526NY0680227 Silver Aqua Uniform Mod Age 30 Region 2 472.12 944.24 802.60 1,345.54

49526NY0680228 Silver Aqua Uniform Mod Age 30 Region 2 472.12 944.24 802.60 1,345.54

49526NY0680229 Silver Aqua Uniform Mod Age 26 Region 2 469.90 939.80 798.83 1,339.22

49526NY0680230 Silver Aqua Uniform Mod Age 26 Region 2 469.90 939.80 798.83 1,339.22

49526NY0680231 Silver Aqua Uniform Mod Age 30 Region 2 472.12 944.24 802.60 1,345.54

49526NY0680232 Silver Aqua Uniform Mod Age 30 Region 2 472.12 944.24 802.60 1,345.54

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 46

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q3:

Single

Q3: Subscriber

& Spouse

Q3: Subscriber &

Child(ren)

Q3:

Family

49526NY0680233 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 413.93 827.86 703.68 1,179.70

49526NY0680234 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 413.93 827.86 703.68 1,179.70

49526NY0680235 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 415.88 831.76 707.00 1,185.26

49526NY0680236 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 415.88 831.76 707.00 1,185.26

49526NY0680237 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 413.93 827.86 703.68 1,179.70

49526NY0680238 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 413.93 827.86 703.68 1,179.70

49526NY0680239 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 415.88 831.76 707.00 1,185.26

49526NY0680240 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 415.88 831.76 707.00 1,185.26

49526NY0680241 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 413.93 827.86 703.68 1,179.70

49526NY0680242 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 413.93 827.86 703.68 1,179.70

49526NY0680243 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 415.88 831.76 707.00 1,185.26

49526NY0680244 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 415.88 831.76 707.00 1,185.26

49526NY0680245 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 413.93 827.86 703.68 1,179.70

49526NY0680246 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 413.93 827.86 703.68 1,179.70

49526NY0680247 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 415.88 831.76 707.00 1,185.26

49526NY0680248 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 415.88 831.76 707.00 1,185.26

49526NY0680265 Platinum EX Plus New Age 26 Region 2 667.61 1,335.22 1,134.94 1,902.69

49526NY0680266 Platinum EX Plus New Age 26 Region 2 667.61 1,335.22 1,134.94 1,902.69

49526NY0680267 Platinum EX Plus New Age 30 Region 2 670.79 1,341.58 1,140.34 1,911.75

49526NY0680268 Platinum EX Plus New Age 30 Region 2 670.79 1,341.58 1,140.34 1,911.75

49526NY0680269 Platinum EX Plus New Age 26 Region 2 667.61 1,335.22 1,134.94 1,902.69

49526NY0680270 Platinum EX Plus New Age 26 Region 2 667.61 1,335.22 1,134.94 1,902.69

49526NY0680271 Platinum EX Plus New Age 30 Region 2 670.79 1,341.58 1,140.34 1,911.75

49526NY0680272 Platinum EX Plus New Age 30 Region 2 670.79 1,341.58 1,140.34 1,911.75

49526NY0680273 Platinum align Select Plus New Age 26 Region 2 576.45 1,152.90 979.97 1,642.88

49526NY0680274 Platinum align Select Plus New Age 26 Region 2 576.45 1,152.90 979.97 1,642.88

49526NY0680275 Platinum align Select Plus New Age 30 Region 2 579.19 1,158.38 984.62 1,650.69

49526NY0680276 Platinum align Select Plus New Age 30 Region 2 579.19 1,158.38 984.62 1,650.69

49526NY0680277 Platinum align Select Plus New Age 26 Region 2 576.45 1,152.90 979.97 1,642.88

49526NY0680278 Platinum align Select Plus New Age 26 Region 2 576.45 1,152.90 979.97 1,642.88

49526NY0680279 Platinum align Select Plus New Age 30 Region 2 579.19 1,158.38 984.62 1,650.69

49526NY0680280 Platinum align Select Plus New Age 30 Region 2 579.19 1,158.38 984.62 1,650.69

49526NY0680281 Platinum focus Select Plus New Age 26 Region 2 576.45 1,152.90 979.97 1,642.88

49526NY0680282 Platinum focus Select Plus New Age 26 Region 2 576.45 1,152.90 979.97 1,642.88

49526NY0680283 Platinum focus Select Plus New Age 30 Region 2 579.19 1,158.38 984.62 1,650.69

49526NY0680284 Platinum focus Select Plus New Age 30 Region 2 579.19 1,158.38 984.62 1,650.69

49526NY0680285 Platinum focus Select Plus New Age 26 Region 2 576.45 1,152.90 979.97 1,642.88

49526NY0680286 Platinum focus Select Plus New Age 26 Region 2 576.45 1,152.90 979.97 1,642.88

49526NY0680287 Platinum focus Select Plus New Age 30 Region 2 579.19 1,158.38 984.62 1,650.69

49526NY0680288 Platinum focus Select Plus New Age 30 Region 2 579.19 1,158.38 984.62 1,650.69

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 47

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

36346NY0250001 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250002 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250003 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250004 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250005 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250006 Gold Healthy NY Uniform Mod Age 26 Regions 1 and 7 494.11 988.22 839.99 1,408.21

36346NY0250007 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0250008 Gold Healthy NY Uniform Mod Age 30 Regions 1 and 7 496.45 992.90 843.97 1,414.88

36346NY0470001 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 491.98 983.96 836.37 1,402.14

36346NY0470002 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 491.98 983.96 836.37 1,402.14

36346NY0470003 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 494.30 988.60 840.31 1,408.76

36346NY0470004 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 494.30 988.60 840.31 1,408.76

36346NY0470005 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 491.98 983.96 836.37 1,402.14

36346NY0470006 Bronze POS Classic Uniform Mod Age 26 Regions 1 and 7 491.98 983.96 836.37 1,402.14

36346NY0470007 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 494.30 988.60 840.31 1,408.76

36346NY0470008 Bronze POS Classic Uniform Mod Age 30 Regions 1 and 7 494.30 988.60 840.31 1,408.76

36346NY0470014 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 634.84 1,269.68 1,079.23 1,809.29

36346NY0470015 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 634.84 1,269.68 1,079.23 1,809.29

36346NY0470016 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 637.85 1,275.70 1,084.35 1,817.87

36346NY0470017 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 637.85 1,275.70 1,084.35 1,817.87

36346NY0470018 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 634.84 1,269.68 1,079.23 1,809.29

36346NY0470019 Silver POS Classic Uniform Mod Age 26 Regions 1 and 7 634.84 1,269.68 1,079.23 1,809.29

36346NY0470020 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 637.85 1,275.70 1,084.35 1,817.87

36346NY0470021 Silver POS Classic Uniform Mod Age 30 Regions 1 and 7 637.85 1,275.70 1,084.35 1,817.87

36346NY0470026 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 714.64 1,429.28 1,214.89 2,036.72

36346NY0470027 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 714.64 1,429.28 1,214.89 2,036.72

36346NY0470028 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 718.04 1,436.08 1,220.67 2,046.41

36346NY0470029 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 718.04 1,436.08 1,220.67 2,046.41

36346NY0470030 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 714.64 1,429.28 1,214.89 2,036.72

36346NY0470031 Gold POS Classic Uniform Mod Age 26 Regions 1 and 7 714.64 1,429.28 1,214.89 2,036.72

36346NY0470032 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 718.04 1,436.08 1,220.67 2,046.41

36346NY0470033 Gold POS Classic Uniform Mod Age 30 Regions 1 and 7 718.04 1,436.08 1,220.67 2,046.41

36346NY0470035 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 813.35 1,626.70 1,382.70 2,318.05

36346NY0470036 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 813.35 1,626.70 1,382.70 2,318.05

36346NY0470037 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 817.23 1,634.46 1,389.29 2,329.11

36346NY0470038 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 817.23 1,634.46 1,389.29 2,329.11

36346NY0470039 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 813.35 1,626.70 1,382.70 2,318.05

36346NY0470040 Platinum POS Classic Uniform Mod Age 26 Regions 1 and 7 813.35 1,626.70 1,382.70 2,318.05

36346NY0470041 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 817.23 1,634.46 1,389.29 2,329.11

36346NY0470042 Platinum POS Classic Uniform Mod Age 30 Regions 1 and 7 817.23 1,634.46 1,389.29 2,329.11

36346NY0470050 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 812.37 1,624.74 1,381.03 2,315.25

36346NY0470051 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 812.37 1,624.74 1,381.03 2,315.25

36346NY0470052 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 816.26 1,632.52 1,387.64 2,326.34

36346NY0470053 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 816.26 1,632.52 1,387.64 2,326.34

36346NY0470054 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 812.37 1,624.74 1,381.03 2,315.25

36346NY0470055 Platinum Make Available Uniform Mod Age 26 Regions 1 and 7 812.37 1,624.74 1,381.03 2,315.25

36346NY0470056 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 816.26 1,632.52 1,387.64 2,326.34

36346NY0470057 Platinum Make Available Uniform Mod Age 30 Regions 1 and 7 816.26 1,632.52 1,387.64 2,326.34

36346NY0550033 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 689.39 1,378.78 1,171.96 1,964.76

36346NY0550034 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 689.39 1,378.78 1,171.96 1,964.76

36346NY0550035 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 692.67 1,385.34 1,177.54 1,974.11

36346NY0550036 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 692.67 1,385.34 1,177.54 1,974.11

36346NY0550037 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 689.39 1,378.78 1,171.96 1,964.76

36346NY0550038 Gold HMO 200 Plus Uniform Mod Age 26 Regions 1 and 7 689.39 1,378.78 1,171.96 1,964.76

36346NY0550039 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 692.67 1,385.34 1,177.54 1,974.11

36346NY0550040 Gold HMO 200 Plus Uniform Mod Age 30 Regions 1 and 7 692.67 1,385.34 1,177.54 1,974.11

36346NY0550041 Bronze Value Uniform Mod Age 26 Regions 1 and 7 503.94 1,007.88 856.70 1,436.23

36346NY0550042 Bronze Value Uniform Mod Age 26 Regions 1 and 7 503.94 1,007.88 856.70 1,436.23

36346NY0550043 Bronze Value Uniform Mod Age 30 Regions 1 and 7 506.33 1,012.66 860.76 1,443.04

36346NY0550044 Bronze Value Uniform Mod Age 30 Regions 1 and 7 506.33 1,012.66 860.76 1,443.04

36346NY0550045 Bronze Value Uniform Mod Age 26 Regions 1 and 7 503.94 1,007.88 856.70 1,436.23

36346NY0550046 Bronze Value Uniform Mod Age 26 Regions 1 and 7 503.94 1,007.88 856.70 1,436.23

36346NY0550047 Bronze Value Uniform Mod Age 30 Regions 1 and 7 506.33 1,012.66 860.76 1,443.04

36346NY0550048 Bronze Value Uniform Mod Age 30 Regions 1 and 7 506.33 1,012.66 860.76 1,443.04

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 48

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

36346NY0550049 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 470.31 940.62 799.53 1,340.38

36346NY0550050 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 470.31 940.62 799.53 1,340.38

36346NY0550051 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 472.53 945.06 803.30 1,346.71

36346NY0550052 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 472.53 945.06 803.30 1,346.71

36346NY0550053 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 470.31 940.62 799.53 1,340.38

36346NY0550054 Bronze HMO Uniform Mod Age 26 Regions 1 and 7 470.31 940.62 799.53 1,340.38

36346NY0550055 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 472.53 945.06 803.30 1,346.71

36346NY0550056 Bronze HMO Uniform Mod Age 30 Regions 1 and 7 472.53 945.06 803.30 1,346.71

36346NY0550057 Bronze HMO Classic NEW Age 26 Regions 1 and 7 477.13 954.26 811.12 1,359.82

36346NY0550058 Bronze HMO Classic NEW Age 26 Regions 1 and 7 477.13 954.26 811.12 1,359.82

36346NY0550059 Bronze HMO Classic NEW Age 30 Regions 1 and 7 479.39 958.78 814.96 1,366.26

36346NY0550060 Bronze HMO Classic NEW Age 30 Regions 1 and 7 479.39 958.78 814.96 1,366.26

36346NY0550061 Bronze HMO Classic NEW Age 26 Regions 1 and 7 477.13 954.26 811.12 1,359.82

36346NY0550062 Bronze HMO Classic NEW Age 26 Regions 1 and 7 477.13 954.26 811.12 1,359.82

36346NY0550063 Bronze HMO Classic NEW Age 30 Regions 1 and 7 479.39 958.78 814.96 1,366.26

36346NY0550064 Bronze HMO Classic NEW Age 30 Regions 1 and 7 479.39 958.78 814.96 1,366.26

36346NY0550065 Silver HMO Classic NEW Age 26 Regions 1 and 7 621.93 1,243.86 1,057.28 1,772.50

36346NY0550066 Silver HMO Classic NEW Age 26 Regions 1 and 7 621.93 1,243.86 1,057.28 1,772.50

36346NY0550067 Silver HMO Classic NEW Age 30 Regions 1 and 7 624.89 1,249.78 1,062.31 1,780.94

36346NY0550068 Silver HMO Classic NEW Age 30 Regions 1 and 7 624.89 1,249.78 1,062.31 1,780.94

36346NY0550069 Silver HMO Classic NEW Age 26 Regions 1 and 7 621.93 1,243.86 1,057.28 1,772.50

36346NY0550070 Silver HMO Classic NEW Age 26 Regions 1 and 7 621.93 1,243.86 1,057.28 1,772.50

36346NY0550071 Silver HMO Classic NEW Age 30 Regions 1 and 7 624.89 1,249.78 1,062.31 1,780.94

36346NY0550072 Silver HMO Classic NEW Age 30 Regions 1 and 7 624.89 1,249.78 1,062.31 1,780.94

36346NY0550073 Gold HMO Classic NEW Age 26 Regions 1 and 7 702.82 1,405.64 1,194.79 2,003.04

36346NY0550074 Gold HMO Classic NEW Age 26 Regions 1 and 7 702.82 1,405.64 1,194.79 2,003.04

36346NY0550075 Gold HMO Classic NEW Age 30 Regions 1 and 7 706.17 1,412.34 1,200.49 2,012.58

36346NY0550076 Gold HMO Classic NEW Age 30 Regions 1 and 7 706.17 1,412.34 1,200.49 2,012.58

36346NY0550077 Gold HMO Classic NEW Age 26 Regions 1 and 7 702.82 1,405.64 1,194.79 2,003.04

36346NY0550078 Gold HMO Classic NEW Age 26 Regions 1 and 7 702.82 1,405.64 1,194.79 2,003.04

36346NY0550079 Gold HMO Classic NEW Age 30 Regions 1 and 7 706.17 1,412.34 1,200.49 2,012.58

36346NY0550080 Gold HMO Classic NEW Age 30 Regions 1 and 7 706.17 1,412.34 1,200.49 2,012.58

36346NY0550081 Platinum HMO Classic NEW Age 26 Regions 1 and 7 802.89 1,605.78 1,364.91 2,288.24

36346NY0550082 Platinum HMO Classic NEW Age 26 Regions 1 and 7 802.89 1,605.78 1,364.91 2,288.24

36346NY0550083 Platinum HMO Classic NEW Age 30 Regions 1 and 7 806.72 1,613.44 1,371.42 2,299.15

36346NY0550084 Platinum HMO Classic NEW Age 30 Regions 1 and 7 806.72 1,613.44 1,371.42 2,299.15

36346NY0550085 Platinum HMO Classic NEW Age 26 Regions 1 and 7 802.89 1,605.78 1,364.91 2,288.24

36346NY0550086 Platinum HMO Classic NEW Age 26 Regions 1 and 7 802.89 1,605.78 1,364.91 2,288.24

36346NY0550087 Platinum HMO Classic NEW Age 30 Regions 1 and 7 806.72 1,613.44 1,371.42 2,299.15

36346NY0550088 Platinum HMO Classic NEW Age 30 Regions 1 and 7 806.72 1,613.44 1,371.42 2,299.15

36346NY0550089 Silver HMO 6300 NEW Age 26 Regions 1 and 7 607.51 1,215.02 1,032.77 1,731.40

36346NY0550090 Silver HMO 6300 NEW Age 26 Regions 1 and 7 607.51 1,215.02 1,032.77 1,731.40

36346NY0550091 Silver HMO 6300 NEW Age 30 Regions 1 and 7 610.40 1,220.80 1,037.68 1,739.64

36346NY0550092 Silver HMO 6300 NEW Age 30 Regions 1 and 7 610.40 1,220.80 1,037.68 1,739.64

36346NY0550093 Silver HMO 6300 NEW Age 26 Regions 1 and 7 607.51 1,215.02 1,032.77 1,731.40

36346NY0550094 Silver HMO 6300 NEW Age 26 Regions 1 and 7 607.51 1,215.02 1,032.77 1,731.40

36346NY0550095 Silver HMO 6300 NEW Age 30 Regions 1 and 7 610.40 1,220.80 1,037.68 1,739.64

36346NY0550096 Silver HMO 6300 NEW Age 30 Regions 1 and 7 610.40 1,220.80 1,037.68 1,739.64

36346NY0640009 Gold EPO Uniform Mod Age 26 Regions 1 and 7 761.13 1,522.26 1,293.92 2,169.22

36346NY0640010 Gold EPO Uniform Mod Age 26 Regions 1 and 7 761.13 1,522.26 1,293.92 2,169.22

36346NY0640011 Gold EPO Uniform Mod Age 30 Regions 1 and 7 764.76 1,529.52 1,300.09 2,179.57

36346NY0640012 Gold EPO Uniform Mod Age 30 Regions 1 and 7 764.76 1,529.52 1,300.09 2,179.57

36346NY0640013 Gold EPO Uniform Mod Age 26 Regions 1 and 7 761.13 1,522.26 1,293.92 2,169.22

36346NY0640014 Gold EPO Uniform Mod Age 26 Regions 1 and 7 761.13 1,522.26 1,293.92 2,169.22

36346NY0640015 Gold EPO Uniform Mod Age 30 Regions 1 and 7 764.76 1,529.52 1,300.09 2,179.57

36346NY0640016 Gold EPO Uniform Mod Age 30 Regions 1 and 7 764.76 1,529.52 1,300.09 2,179.57

36346NY0640033 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 641.40 1,282.80 1,090.38 1,827.99

36346NY0640034 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 641.40 1,282.80 1,090.38 1,827.99

36346NY0640035 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 644.45 1,288.90 1,095.57 1,836.68

36346NY0640036 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 644.45 1,288.90 1,095.57 1,836.68

36346NY0640037 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 641.40 1,282.80 1,090.38 1,827.99

36346NY0640038 Silver EPO 8000 Uniform Mod Age 26 Regions 1 and 7 641.40 1,282.80 1,090.38 1,827.99

36346NY0640039 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 644.45 1,288.90 1,095.57 1,836.68

36346NY0640040 Silver EPO 8000 Uniform Mod Age 30 Regions 1 and 7 644.45 1,288.90 1,095.57 1,836.68

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 49

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

36346NY0640041 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 688.30 1,376.60 1,170.11 1,961.66

36346NY0640042 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 688.30 1,376.60 1,170.11 1,961.66

36346NY0640043 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 691.58 1,383.16 1,175.69 1,971.00

36346NY0640044 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 691.58 1,383.16 1,175.69 1,971.00

36346NY0640045 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 688.30 1,376.60 1,170.11 1,961.66

36346NY0640046 Silver EPO 6300 Uniform Mod Age 26 Regions 1 and 7 688.30 1,376.60 1,170.11 1,961.66

36346NY0640047 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 691.58 1,383.16 1,175.69 1,971.00

36346NY0640048 Silver EPO 6300 Uniform Mod Age 30 Regions 1 and 7 691.58 1,383.16 1,175.69 1,971.00

36346NY0640081 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 581.71 1,163.42 988.91 1,657.87

36346NY0640082 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 581.71 1,163.42 988.91 1,657.87

36346NY0640083 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 584.47 1,168.94 993.60 1,665.74

36346NY0640084 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 584.47 1,168.94 993.60 1,665.74

36346NY0640085 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 581.71 1,163.42 988.91 1,657.87

36346NY0640086 Bronze EPO 6300 Uniform Mod Age 26 Regions 1 and 7 581.71 1,163.42 988.91 1,657.87

36346NY0640087 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 584.47 1,168.94 993.60 1,665.74

36346NY0640088 Bronze EPO 6300 Uniform Mod Age 30 Regions 1 and 7 584.47 1,168.94 993.60 1,665.74

36346NY0640089 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 827.69 1,655.38 1,407.07 2,358.92

36346NY0640090 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 827.69 1,655.38 1,407.07 2,358.92

36346NY0640091 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 831.63 1,663.26 1,413.77 2,370.15

36346NY0640092 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 831.63 1,663.26 1,413.77 2,370.15

36346NY0640093 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 827.69 1,655.38 1,407.07 2,358.92

36346NY0640094 Gold EPO high Uniform Mod Age 26 Regions 1 and 7 827.69 1,655.38 1,407.07 2,358.92

36346NY0640095 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 831.63 1,663.26 1,413.77 2,370.15

36346NY0640096 Gold EPO high Uniform Mod Age 30 Regions 1 and 7 831.63 1,663.26 1,413.77 2,370.15

36346NY0650001 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 913.06 1,826.12 1,552.20 2,602.22

36346NY0650002 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 913.06 1,826.12 1,552.20 2,602.22

36346NY0650003 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 917.42 1,834.84 1,559.61 2,614.65

36346NY0650004 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 917.42 1,834.84 1,559.61 2,614.65

36346NY0650005 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 913.06 1,826.12 1,552.20 2,602.22

36346NY0650006 Platinum PPO Uniform Mod Age 26 Regions 1 and 7 913.06 1,826.12 1,552.20 2,602.22

36346NY0650007 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 917.42 1,834.84 1,559.61 2,614.65

36346NY0650008 Platinum PPO Uniform Mod Age 30 Regions 1 and 7 917.42 1,834.84 1,559.61 2,614.65

36346NY0690009 Gold Radius Uniform Mod Age 26 Regions 1 and 7 683.87 1,367.74 1,162.58 1,949.03

36346NY0690010 Gold Radius Uniform Mod Age 26 Regions 1 and 7 683.87 1,367.74 1,162.58 1,949.03

36346NY0690011 Gold Radius Uniform Mod Age 30 Regions 1 and 7 687.12 1,374.24 1,168.10 1,958.29

36346NY0690012 Gold Radius Uniform Mod Age 30 Regions 1 and 7 687.12 1,374.24 1,168.10 1,958.29

36346NY0690013 Gold Radius Uniform Mod Age 26 Regions 1 and 7 683.87 1,367.74 1,162.58 1,949.03

36346NY0690014 Gold Radius Uniform Mod Age 26 Regions 1 and 7 683.87 1,367.74 1,162.58 1,949.03

36346NY0690015 Gold Radius Uniform Mod Age 30 Regions 1 and 7 687.12 1,374.24 1,168.10 1,958.29

36346NY0690016 Gold Radius Uniform Mod Age 30 Regions 1 and 7 687.12 1,374.24 1,168.10 1,958.29

36346NY0690049 Gold EX Uniform Mod Age 26 Regions 1 and 7 713.41 1,426.82 1,212.80 2,033.22

36346NY0690050 Gold EX Uniform Mod Age 26 Regions 1 and 7 713.41 1,426.82 1,212.80 2,033.22

36346NY0690051 Gold EX Uniform Mod Age 30 Regions 1 and 7 716.81 1,433.62 1,218.58 2,042.91

36346NY0690052 Gold EX Uniform Mod Age 30 Regions 1 and 7 716.81 1,433.62 1,218.58 2,042.91

36346NY0690053 Gold EX Uniform Mod Age 26 Regions 1 and 7 713.41 1,426.82 1,212.80 2,033.22

36346NY0690054 Gold EX Uniform Mod Age 26 Regions 1 and 7 713.41 1,426.82 1,212.80 2,033.22

36346NY0690055 Gold EX Uniform Mod Age 30 Regions 1 and 7 716.81 1,433.62 1,218.58 2,042.91

36346NY0690056 Gold EX Uniform Mod Age 30 Regions 1 and 7 716.81 1,433.62 1,218.58 2,042.91

36346NY0690057 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 579.85 1,159.70 985.75 1,652.57

36346NY0690058 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 579.85 1,159.70 985.75 1,652.57

36346NY0690059 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 582.61 1,165.22 990.44 1,660.44

36346NY0690060 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 582.61 1,165.22 990.44 1,660.44

36346NY0690061 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 579.85 1,159.70 985.75 1,652.57

36346NY0690062 Silver POS 8000 Uniform Mod Age 26 Regions 1 and 7 579.85 1,159.70 985.75 1,652.57

36346NY0690063 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 582.61 1,165.22 990.44 1,660.44

36346NY0690064 Silver POS 8000 Uniform Mod Age 30 Regions 1 and 7 582.61 1,165.22 990.44 1,660.44

36346NY0690065 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 604.68 1,209.36 1,027.96 1,723.34

36346NY0690066 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 604.68 1,209.36 1,027.96 1,723.34

36346NY0690067 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 607.54 1,215.08 1,032.82 1,731.49

36346NY0690068 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 607.54 1,215.08 1,032.82 1,731.49

36346NY0690069 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 604.68 1,209.36 1,027.96 1,723.34

36346NY0690070 Silver EX 8000 Uniform Mod Age 26 Regions 1 and 7 604.68 1,209.36 1,027.96 1,723.34

36346NY0690071 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 607.54 1,215.08 1,032.82 1,731.49

36346NY0690072 Silver EX 8000 Uniform Mod Age 30 Regions 1 and 7 607.54 1,215.08 1,032.82 1,731.49

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 50

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

36346NY0690081 Platinum EX Uniform Mod Age 26 Regions 1 and 7 843.12 1,686.24 1,433.30 2,402.89

36346NY0690082 Platinum EX Uniform Mod Age 26 Regions 1 and 7 843.12 1,686.24 1,433.30 2,402.89

36346NY0690083 Platinum EX Uniform Mod Age 30 Regions 1 and 7 847.14 1,694.28 1,440.14 2,414.35

36346NY0690084 Platinum EX Uniform Mod Age 30 Regions 1 and 7 847.14 1,694.28 1,440.14 2,414.35

36346NY0690085 Platinum EX Uniform Mod Age 26 Regions 1 and 7 843.12 1,686.24 1,433.30 2,402.89

36346NY0690086 Platinum EX Uniform Mod Age 26 Regions 1 and 7 843.12 1,686.24 1,433.30 2,402.89

36346NY0690087 Platinum EX Uniform Mod Age 30 Regions 1 and 7 847.14 1,694.28 1,440.14 2,414.35

36346NY0690088 Platinum EX Uniform Mod Age 30 Regions 1 and 7 847.14 1,694.28 1,440.14 2,414.35

36346NY0690089 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 807.95 1,615.90 1,373.52 2,302.66

36346NY0690090 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 807.95 1,615.90 1,373.52 2,302.66

36346NY0690091 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 811.81 1,623.62 1,380.08 2,313.66

36346NY0690092 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 811.81 1,623.62 1,380.08 2,313.66

36346NY0690093 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 807.95 1,615.90 1,373.52 2,302.66

36346NY0690094 Platinum Radius Uniform Mod Age 26 Regions 1 and 7 807.95 1,615.90 1,373.52 2,302.66

36346NY0690095 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 811.81 1,623.62 1,380.08 2,313.66

36346NY0690096 Platinum Radius Uniform Mod Age 30 Regions 1 and 7 811.81 1,623.62 1,380.08 2,313.66

36346NY0690105 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 741.69 1,483.38 1,260.87 2,113.82

36346NY0690106 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 741.69 1,483.38 1,260.87 2,113.82

36346NY0690107 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 745.23 1,490.46 1,266.89 2,123.91

36346NY0690108 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 745.23 1,490.46 1,266.89 2,123.91

36346NY0690109 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 741.69 1,483.38 1,260.87 2,113.82

36346NY0690110 Gold Radius high Uniform Mod Age 26 Regions 1 and 7 741.69 1,483.38 1,260.87 2,113.82

36346NY0690111 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 745.23 1,490.46 1,266.89 2,123.91

36346NY0690112 Gold Radius high Uniform Mod Age 30 Regions 1 and 7 745.23 1,490.46 1,266.89 2,123.91

36346NY0690113 Gold EX high Uniform Mod Age 26 Regions 1 and 7 773.86 1,547.72 1,315.56 2,205.50

36346NY0690114 Gold EX high Uniform Mod Age 26 Regions 1 and 7 773.86 1,547.72 1,315.56 2,205.50

36346NY0690115 Gold EX high Uniform Mod Age 30 Regions 1 and 7 777.55 1,555.10 1,321.84 2,216.02

36346NY0690116 Gold EX high Uniform Mod Age 30 Regions 1 and 7 777.55 1,555.10 1,321.84 2,216.02

36346NY0690117 Gold EX high Uniform Mod Age 26 Regions 1 and 7 773.86 1,547.72 1,315.56 2,205.50

36346NY0690118 Gold EX high Uniform Mod Age 26 Regions 1 and 7 773.86 1,547.72 1,315.56 2,205.50

36346NY0690119 Gold EX high Uniform Mod Age 30 Regions 1 and 7 777.55 1,555.10 1,321.84 2,216.02

36346NY0690120 Gold EX high Uniform Mod Age 30 Regions 1 and 7 777.55 1,555.10 1,321.84 2,216.02

36346NY0690121 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 658.46 1,316.92 1,119.38 1,876.61

36346NY0690122 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 658.46 1,316.92 1,119.38 1,876.61

36346NY0690123 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 661.59 1,323.18 1,124.70 1,885.53

36346NY0690124 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 661.59 1,323.18 1,124.70 1,885.53

36346NY0690125 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 658.46 1,316.92 1,119.38 1,876.61

36346NY0690126 Gold POS 8000 Uniform Mod Age 26 Regions 1 and 7 658.46 1,316.92 1,119.38 1,876.61

36346NY0690127 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 661.59 1,323.18 1,124.70 1,885.53

36346NY0690128 Gold POS 8000 Uniform Mod Age 30 Regions 1 and 7 661.59 1,323.18 1,124.70 1,885.53

36346NY0690129 Silver EX 6300 NEW Age 26 Regions 1 and 7 647.28 1,294.56 1,100.38 1,844.75

36346NY0690130 Silver EX 6300 NEW Age 26 Regions 1 and 7 647.28 1,294.56 1,100.38 1,844.75

36346NY0690131 Silver EX 6300 NEW Age 30 Regions 1 and 7 650.35 1,300.70 1,105.60 1,853.50

36346NY0690132 Silver EX 6300 NEW Age 30 Regions 1 and 7 650.35 1,300.70 1,105.60 1,853.50

36346NY0690133 Silver EX 6300 NEW Age 26 Regions 1 and 7 647.28 1,294.56 1,100.38 1,844.75

36346NY0690134 Silver EX 6300 NEW Age 26 Regions 1 and 7 647.28 1,294.56 1,100.38 1,844.75

36346NY0690135 Silver EX 6300 NEW Age 30 Regions 1 and 7 650.35 1,300.70 1,105.60 1,853.50

36346NY0690136 Silver EX 6300 NEW Age 30 Regions 1 and 7 650.35 1,300.70 1,105.60 1,853.50

49526NY0280001 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280002 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280003 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280004 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280005 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280006 Gold Healthy NY Uniform Mod Age 26 Region 2 397.64 795.28 675.99 1,133.27

49526NY0280007 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0280008 Gold Healthy NY Uniform Mod Age 30 Region 2 399.51 799.02 679.17 1,138.60

49526NY0680289 Platinum POS Plus Uniform Mod Age 26 Region 2 651.05 1,302.10 1,106.79 1,855.49

49526NY0680290 Platinum POS Plus Uniform Mod Age 26 Region 2 651.05 1,302.10 1,106.79 1,855.49

49526NY0680291 Platinum POS Plus Uniform Mod Age 30 Region 2 654.15 1,308.30 1,112.06 1,864.33

49526NY0680292 Platinum POS Plus Uniform Mod Age 30 Region 2 654.15 1,308.30 1,112.06 1,864.33

49526NY0680293 Platinum POS Plus Uniform Mod Age 26 Region 2 651.05 1,302.10 1,106.79 1,855.49

49526NY0680294 Platinum POS Plus Uniform Mod Age 26 Region 2 651.05 1,302.10 1,106.79 1,855.49

49526NY0680295 Platinum POS Plus Uniform Mod Age 30 Region 2 654.15 1,308.30 1,112.06 1,864.33

49526NY0680296 Platinum POS Plus Uniform Mod Age 30 Region 2 654.15 1,308.30 1,112.06 1,864.33

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 51

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

49526NY0520009 Bronze focus Tiered Uniform Mod Age 26 Region 2 359.34 718.68 610.88 1,024.12

49526NY0520010 Bronze focus Tiered Uniform Mod Age 26 Region 2 359.34 718.68 610.88 1,024.12

49526NY0520011 Bronze focus Tiered Uniform Mod Age 30 Region 2 361.02 722.04 613.73 1,028.91

49526NY0520012 Bronze focus Tiered Uniform Mod Age 30 Region 2 361.02 722.04 613.73 1,028.91

49526NY0520013 Bronze focus Tiered Uniform Mod Age 26 Region 2 359.34 718.68 610.88 1,024.12

49526NY0520014 Bronze focus Tiered Uniform Mod Age 26 Region 2 359.34 718.68 610.88 1,024.12

49526NY0520015 Bronze focus Tiered Uniform Mod Age 30 Region 2 361.02 722.04 613.73 1,028.91

49526NY0520016 Bronze focus Tiered Uniform Mod Age 30 Region 2 361.02 722.04 613.73 1,028.91

49526NY0520017 Bronze align Tiered Uniform Mod Age 26 Region 2 359.34 718.68 610.88 1,024.12

49526NY0520018 Bronze align Tiered Uniform Mod Age 26 Region 2 359.34 718.68 610.88 1,024.12

49526NY0520019 Bronze align Tiered Uniform Mod Age 30 Region 2 361.02 722.04 613.73 1,028.91

49526NY0520020 Bronze align Tiered Uniform Mod Age 30 Region 2 361.02 722.04 613.73 1,028.91

49526NY0520021 Bronze align Tiered Uniform Mod Age 26 Region 2 359.34 718.68 610.88 1,024.12

49526NY0520022 Bronze align Tiered Uniform Mod Age 26 Region 2 359.34 718.68 610.88 1,024.12

49526NY0520023 Bronze align Tiered Uniform Mod Age 30 Region 2 361.02 722.04 613.73 1,028.91

49526NY0520024 Bronze align Tiered Uniform Mod Age 30 Region 2 361.02 722.04 613.73 1,028.91

49526NY0520025 Bronze align Select Uniform Mod Age 26 Region 2 349.83 699.66 594.71 997.02

49526NY0520026 Bronze align Select Uniform Mod Age 26 Region 2 349.83 699.66 594.71 997.02

49526NY0520027 Bronze align Select Uniform Mod Age 30 Region 2 351.47 702.94 597.50 1,001.69

49526NY0520028 Bronze align Select Uniform Mod Age 30 Region 2 351.47 702.94 597.50 1,001.69

49526NY0520029 Bronze align Select Uniform Mod Age 26 Region 2 349.83 699.66 594.71 997.02

49526NY0520030 Bronze align Select Uniform Mod Age 26 Region 2 349.83 699.66 594.71 997.02

49526NY0520031 Bronze align Select Uniform Mod Age 30 Region 2 351.47 702.94 597.50 1,001.69

49526NY0520032 Bronze align Select Uniform Mod Age 30 Region 2 351.47 702.94 597.50 1,001.69

49526NY0520033 Bronze focus Select Uniform Mod Age 26 Region 2 349.83 699.66 594.71 997.02

49526NY0520034 Bronze focus Select Uniform Mod Age 26 Region 2 349.83 699.66 594.71 997.02

49526NY0520035 Bronze focus Select Uniform Mod Age 30 Region 2 351.47 702.94 597.50 1,001.69

49526NY0520036 Bronze focus Select Uniform Mod Age 30 Region 2 351.47 702.94 597.50 1,001.69

49526NY0520037 Bronze focus Select Uniform Mod Age 26 Region 2 349.83 699.66 594.71 997.02

49526NY0520038 Bronze focus Select Uniform Mod Age 26 Region 2 349.83 699.66 594.71 997.02

49526NY0520039 Bronze focus Select Uniform Mod Age 30 Region 2 351.47 702.94 597.50 1,001.69

49526NY0520040 Bronze focus Select Uniform Mod Age 30 Region 2 351.47 702.94 597.50 1,001.69

49526NY0520041 Bronze HMO 8100 New Age 26 Region 2 397.68 795.36 676.06 1,133.39

49526NY0520042 Bronze HMO 8100 New Age 26 Region 2 397.68 795.36 676.06 1,133.39

49526NY0520043 Bronze HMO 8100 New Age 30 Region 2 399.54 799.08 679.22 1,138.69

49526NY0520044 Bronze HMO 8100 New Age 30 Region 2 399.54 799.08 679.22 1,138.69

49526NY0520045 Bronze HMO 8100 New Age 26 Region 2 397.68 795.36 676.06 1,133.39

49526NY0520046 Bronze HMO 8100 New Age 26 Region 2 397.68 795.36 676.06 1,133.39

49526NY0520047 Bronze HMO 8100 New Age 30 Region 2 399.54 799.08 679.22 1,138.69

49526NY0520048 Bronze HMO 8100 New Age 30 Region 2 399.54 799.08 679.22 1,138.69

49526NY0520049 Bronze 8100 align Select New Age 26 Region 2 365.11 730.22 620.69 1,040.56

49526NY0520050 Bronze 8100 align Select New Age 26 Region 2 365.11 730.22 620.69 1,040.56

49526NY0520051 Bronze 8100 align Select New Age 30 Region 2 366.82 733.64 623.59 1,045.44

49526NY0520052 Bronze 8100 align Select New Age 30 Region 2 366.82 733.64 623.59 1,045.44

49526NY0520053 Bronze 8100 align Select New Age 26 Region 2 365.11 730.22 620.69 1,040.56

49526NY0520054 Bronze 8100 align Select New Age 26 Region 2 365.11 730.22 620.69 1,040.56

49526NY0520055 Bronze 8100 align Select New Age 30 Region 2 366.82 733.64 623.59 1,045.44

49526NY0520056 Bronze 8100 align Select New Age 30 Region 2 366.82 733.64 623.59 1,045.44

49526NY0520057 Bronze 8100 focus Select New Age 26 Region 2 365.11 730.22 620.69 1,040.56

49526NY0520058 Bronze 8100 focus Select New Age 26 Region 2 365.11 730.22 620.69 1,040.56

49526NY0520059 Bronze 8100 focus Select New Age 30 Region 2 366.82 733.64 623.59 1,045.44

49526NY0520060 Bronze 8100 focus Select New Age 30 Region 2 366.82 733.64 623.59 1,045.44

49526NY0520061 Bronze 8100 focus Select New Age 26 Region 2 365.11 730.22 620.69 1,040.56

49526NY0520062 Bronze 8100 focus Select New Age 26 Region 2 365.11 730.22 620.69 1,040.56

49526NY0520063 Bronze 8100 focus Select New Age 30 Region 2 366.82 733.64 623.59 1,045.44

49526NY0520064 Bronze 8100 focus Select New Age 30 Region 2 366.82 733.64 623.59 1,045.44

49526NY0560001 Bronze POS Classic Uniform Mod Age 26 Region 2 404.49 808.98 687.63 1,152.80

49526NY0560002 Bronze POS Classic Uniform Mod Age 26 Region 2 404.49 808.98 687.63 1,152.80

49526NY0560003 Bronze POS Classic Uniform Mod Age 30 Region 2 406.39 812.78 690.86 1,158.21

49526NY0560004 Bronze POS Classic Uniform Mod Age 30 Region 2 406.39 812.78 690.86 1,158.21

49526NY0560005 Bronze POS Classic Uniform Mod Age 26 Region 2 404.49 808.98 687.63 1,152.80

49526NY0560006 Bronze POS Classic Uniform Mod Age 26 Region 2 404.49 808.98 687.63 1,152.80

49526NY0560007 Bronze POS Classic Uniform Mod Age 30 Region 2 406.39 812.78 690.86 1,158.21

49526NY0560008 Bronze POS Classic Uniform Mod Age 30 Region 2 406.39 812.78 690.86 1,158.21

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 52

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

49526NY0560025 Silver POS Classic Uniform Mod Age 26 Region 2 525.30 1,050.60 893.01 1,497.11

49526NY0560026 Silver POS Classic Uniform Mod Age 26 Region 2 525.30 1,050.60 893.01 1,497.11

49526NY0560027 Silver POS Classic Uniform Mod Age 30 Region 2 527.80 1,055.60 897.26 1,504.23

49526NY0560028 Silver POS Classic Uniform Mod Age 30 Region 2 527.80 1,055.60 897.26 1,504.23

49526NY0560029 Silver POS Classic Uniform Mod Age 26 Region 2 525.30 1,050.60 893.01 1,497.11

49526NY0560030 Silver POS Classic Uniform Mod Age 26 Region 2 525.30 1,050.60 893.01 1,497.11

49526NY0560031 Silver POS Classic Uniform Mod Age 30 Region 2 527.80 1,055.60 897.26 1,504.23

49526NY0560032 Silver POS Classic Uniform Mod Age 30 Region 2 527.80 1,055.60 897.26 1,504.23

49526NY0560057 Gold POS Classic Uniform Mod Age 26 Region 2 581.57 1,163.14 988.67 1,657.47

49526NY0560058 Gold POS Classic Uniform Mod Age 26 Region 2 581.57 1,163.14 988.67 1,657.47

49526NY0560059 Gold POS Classic Uniform Mod Age 30 Region 2 584.33 1,168.66 993.36 1,665.34

49526NY0560060 Gold POS Classic Uniform Mod Age 30 Region 2 584.33 1,168.66 993.36 1,665.34

49526NY0560061 Gold POS Classic Uniform Mod Age 26 Region 2 581.57 1,163.14 988.67 1,657.47

49526NY0560062 Gold POS Classic Uniform Mod Age 26 Region 2 581.57 1,163.14 988.67 1,657.47

49526NY0560063 Gold POS Classic Uniform Mod Age 30 Region 2 584.33 1,168.66 993.36 1,665.34

49526NY0560064 Gold POS Classic Uniform Mod Age 30 Region 2 584.33 1,168.66 993.36 1,665.34

49526NY0560089 Platinum POS Classic Uniform Mod Age 26 Region 2 661.53 1,323.06 1,124.60 1,885.36

49526NY0560090 Platinum POS Classic Uniform Mod Age 26 Region 2 661.53 1,323.06 1,124.60 1,885.36

49526NY0560091 Platinum POS Classic Uniform Mod Age 30 Region 2 664.68 1,329.36 1,129.96 1,894.34

49526NY0560092 Platinum POS Classic Uniform Mod Age 30 Region 2 664.68 1,329.36 1,129.96 1,894.34

49526NY0560093 Platinum POS Classic Uniform Mod Age 26 Region 2 661.53 1,323.06 1,124.60 1,885.36

49526NY0560094 Platinum POS Classic Uniform Mod Age 26 Region 2 661.53 1,323.06 1,124.60 1,885.36

49526NY0560095 Platinum POS Classic Uniform Mod Age 30 Region 2 664.68 1,329.36 1,129.96 1,894.34

49526NY0560096 Platinum POS Classic Uniform Mod Age 30 Region 2 664.68 1,329.36 1,129.96 1,894.34

49526NY0560105 Platinum Make Available Uniform Mod Age 26 Region 2 659.67 1,319.34 1,121.44 1,880.06

49526NY0560106 Platinum Make Available Uniform Mod Age 26 Region 2 659.67 1,319.34 1,121.44 1,880.06

49526NY0560107 Platinum Make Available Uniform Mod Age 30 Region 2 662.82 1,325.64 1,126.79 1,889.04

49526NY0560108 Platinum Make Available Uniform Mod Age 30 Region 2 662.82 1,325.64 1,126.79 1,889.04

49526NY0560109 Platinum Make Available Uniform Mod Age 26 Region 2 659.67 1,319.34 1,121.44 1,880.06

49526NY0560110 Platinum Make Available Uniform Mod Age 26 Region 2 659.67 1,319.34 1,121.44 1,880.06

49526NY0560111 Platinum Make Available Uniform Mod Age 30 Region 2 662.82 1,325.64 1,126.79 1,889.04

49526NY0560112 Platinum Make Available Uniform Mod Age 30 Region 2 662.82 1,325.64 1,126.79 1,889.04

49526NY0630001 Bronze 8100EX New Age 26 Region 2 414.67 829.34 704.94 1,181.81

49526NY0630002 Bronze 8100EX New Age 26 Region 2 414.67 829.34 704.94 1,181.81

49526NY0630003 Bronze 8100EX New Age 30 Region 2 416.62 833.24 708.25 1,187.37

49526NY0630004 Bronze 8100EX New Age 30 Region 2 416.62 833.24 708.25 1,187.37

49526NY0630005 Bronze 8100EX New Age 26 Region 2 414.67 829.34 704.94 1,181.81

49526NY0630006 Bronze 8100EX New Age 26 Region 2 414.67 829.34 704.94 1,181.81

49526NY0630007 Bronze 8100EX New Age 30 Region 2 416.62 833.24 708.25 1,187.37

49526NY0630008 Bronze 8100EX New Age 30 Region 2 416.62 833.24 708.25 1,187.37

49526NY0640001 Gold PPO 7100 Uniform Mod Age 26 Region 2 685.79 1,371.58 1,165.84 1,954.50

49526NY0640002 Gold PPO 7100 Uniform Mod Age 26 Region 2 685.79 1,371.58 1,165.84 1,954.50

49526NY0640003 Gold PPO 7100 Uniform Mod Age 30 Region 2 689.05 1,378.10 1,171.39 1,963.79

49526NY0640004 Gold PPO 7100 Uniform Mod Age 30 Region 2 689.05 1,378.10 1,171.39 1,963.79

49526NY0640005 Gold PPO 7100 Uniform Mod Age 26 Region 2 685.79 1,371.58 1,165.84 1,954.50

49526NY0640006 Gold PPO 7100 Uniform Mod Age 26 Region 2 685.79 1,371.58 1,165.84 1,954.50

49526NY0640007 Gold PPO 7100 Uniform Mod Age 30 Region 2 689.05 1,378.10 1,171.39 1,963.79

49526NY0640008 Gold PPO 7100 Uniform Mod Age 30 Region 2 689.05 1,378.10 1,171.39 1,963.79

49526NY0640009 Silver PPO 8100 Uniform Mod Age 26 Region 2 565.50 1,131.00 961.35 1,611.68

49526NY0640010 Silver PPO 8100 Uniform Mod Age 26 Region 2 565.50 1,131.00 961.35 1,611.68

49526NY0640011 Silver PPO 8100 Uniform Mod Age 30 Region 2 568.19 1,136.38 965.92 1,619.34

49526NY0640012 Silver PPO 8100 Uniform Mod Age 30 Region 2 568.19 1,136.38 965.92 1,619.34

49526NY0640013 Silver PPO 8100 Uniform Mod Age 26 Region 2 565.50 1,131.00 961.35 1,611.68

49526NY0640014 Silver PPO 8100 Uniform Mod Age 26 Region 2 565.50 1,131.00 961.35 1,611.68

49526NY0640015 Silver PPO 8100 Uniform Mod Age 30 Region 2 568.19 1,136.38 965.92 1,619.34

49526NY0640016 Silver PPO 8100 Uniform Mod Age 30 Region 2 568.19 1,136.38 965.92 1,619.34

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 53

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

49526NY0640033 Silver PPO 7100 Uniform Mod Age 26 Region 2 623.81 1,247.62 1,060.48 1,777.86

49526NY0640034 Silver PPO 7100 Uniform Mod Age 26 Region 2 623.81 1,247.62 1,060.48 1,777.86

49526NY0640035 Silver PPO 7100 Uniform Mod Age 30 Region 2 626.78 1,253.56 1,065.53 1,786.32

49526NY0640036 Silver PPO 7100 Uniform Mod Age 30 Region 2 626.78 1,253.56 1,065.53 1,786.32

49526NY0640037 Silver PPO 7100 Uniform Mod Age 26 Region 2 623.81 1,247.62 1,060.48 1,777.86

49526NY0640038 Silver PPO 7100 Uniform Mod Age 26 Region 2 623.81 1,247.62 1,060.48 1,777.86

49526NY0640039 Silver PPO 7100 Uniform Mod Age 30 Region 2 626.78 1,253.56 1,065.53 1,786.32

49526NY0640040 Silver PPO 7100 Uniform Mod Age 30 Region 2 626.78 1,253.56 1,065.53 1,786.32

49526NY0640041 Platinum PPO Plus New Age 26 Region 2 829.49 1,658.98 1,410.13 2,364.05

49526NY0640042 Platinum PPO Plus New Age 26 Region 2 829.49 1,658.98 1,410.13 2,364.05

49526NY0640043 Platinum PPO Plus New Age 30 Region 2 833.45 1,666.90 1,416.87 2,375.33

49526NY0640044 Platinum PPO Plus New Age 30 Region 2 833.45 1,666.90 1,416.87 2,375.33

49526NY0640045 Platinum PPO Plus New Age 26 Region 2 829.49 1,658.98 1,410.13 2,364.05

49526NY0640046 Platinum PPO Plus New Age 26 Region 2 829.49 1,658.98 1,410.13 2,364.05

49526NY0640047 Platinum PPO Plus New Age 30 Region 2 833.45 1,666.90 1,416.87 2,375.33

49526NY0640048 Platinum PPO Plus New Age 30 Region 2 833.45 1,666.90 1,416.87 2,375.33

49526NY0680001 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 609.65 1,219.30 1,036.41 1,737.50

49526NY0680002 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 609.65 1,219.30 1,036.41 1,737.50

49526NY0680003 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 612.55 1,225.10 1,041.34 1,745.77

49526NY0680004 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 612.55 1,225.10 1,041.34 1,745.77

49526NY0680005 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 609.65 1,219.30 1,036.41 1,737.50

49526NY0680006 Platinum align Tiered Plus Uniform Mod Age 26 Region 2 609.65 1,219.30 1,036.41 1,737.50

49526NY0680007 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 612.55 1,225.10 1,041.34 1,745.77

49526NY0680008 Platinum align Tiered Plus Uniform Mod Age 30 Region 2 612.55 1,225.10 1,041.34 1,745.77

49526NY0680009 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 508.15 1,016.30 863.86 1,448.23

49526NY0680010 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 508.15 1,016.30 863.86 1,448.23

49526NY0680011 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 510.55 1,021.10 867.94 1,455.07

49526NY0680012 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 510.55 1,021.10 867.94 1,455.07

49526NY0680013 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 508.15 1,016.30 863.86 1,448.23

49526NY0680014 Gold 7100 align Tiered Uniform Mod Age 26 Region 2 508.15 1,016.30 863.86 1,448.23

49526NY0680015 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 510.55 1,021.10 867.94 1,455.07

49526NY0680016 Gold 7100 align Tiered Uniform Mod Age 30 Region 2 510.55 1,021.10 867.94 1,455.07

49526NY0680017 Gold POS 7100 Uniform Mod Age 26 Region 2 539.36 1,078.72 916.91 1,537.18

49526NY0680018 Gold POS 7100 Uniform Mod Age 26 Region 2 539.36 1,078.72 916.91 1,537.18

49526NY0680019 Gold POS 7100 Uniform Mod Age 30 Region 2 541.92 1,083.84 921.26 1,544.47

49526NY0680020 Gold POS 7100 Uniform Mod Age 30 Region 2 541.92 1,083.84 921.26 1,544.47

49526NY0680021 Gold POS 7100 Uniform Mod Age 26 Region 2 539.36 1,078.72 916.91 1,537.18

49526NY0680022 Gold POS 7100 Uniform Mod Age 26 Region 2 539.36 1,078.72 916.91 1,537.18

49526NY0680023 Gold POS 7100 Uniform Mod Age 30 Region 2 541.92 1,083.84 921.26 1,544.47

49526NY0680024 Gold POS 7100 Uniform Mod Age 30 Region 2 541.92 1,083.84 921.26 1,544.47

49526NY0680025 Gold POS 7100EX Uniform Mod Age 26 Region 2 561.83 1,123.66 955.11 1,601.22

49526NY0680026 Gold POS 7100EX Uniform Mod Age 26 Region 2 561.83 1,123.66 955.11 1,601.22

49526NY0680027 Gold POS 7100EX Uniform Mod Age 30 Region 2 564.50 1,129.00 959.65 1,608.83

49526NY0680028 Gold POS 7100EX Uniform Mod Age 30 Region 2 564.50 1,129.00 959.65 1,608.83

49526NY0680029 Gold POS 7100EX Uniform Mod Age 26 Region 2 561.83 1,123.66 955.11 1,601.22

49526NY0680030 Gold POS 7100EX Uniform Mod Age 26 Region 2 561.83 1,123.66 955.11 1,601.22

49526NY0680031 Gold POS 7100EX Uniform Mod Age 30 Region 2 564.50 1,129.00 959.65 1,608.83

49526NY0680032 Gold POS 7100EX Uniform Mod Age 30 Region 2 564.50 1,129.00 959.65 1,608.83

49526NY0680041 Gold Aqua Uniform Mod Age 26 Region 2 525.40 1,050.80 893.18 1,497.39

49526NY0680042 Gold Aqua Uniform Mod Age 26 Region 2 525.40 1,050.80 893.18 1,497.39

49526NY0680043 Gold Aqua Uniform Mod Age 30 Region 2 527.89 1,055.78 897.41 1,504.49

49526NY0680044 Gold Aqua Uniform Mod Age 30 Region 2 527.89 1,055.78 897.41 1,504.49

49526NY0680045 Gold Aqua Uniform Mod Age 26 Region 2 525.40 1,050.80 893.18 1,497.39

49526NY0680046 Gold Aqua Uniform Mod Age 26 Region 2 525.40 1,050.80 893.18 1,497.39

49526NY0680047 Gold Aqua Uniform Mod Age 30 Region 2 527.89 1,055.78 897.41 1,504.49

49526NY0680048 Gold Aqua Uniform Mod Age 30 Region 2 527.89 1,055.78 897.41 1,504.49

49526NY0680049 Silver POS 7100 Uniform Mod Age 26 Region 2 491.20 982.40 835.04 1,399.92

49526NY0680050 Silver POS 7100 Uniform Mod Age 26 Region 2 491.20 982.40 835.04 1,399.92

49526NY0680051 Silver POS 7100 Uniform Mod Age 30 Region 2 493.52 987.04 838.98 1,406.53

49526NY0680052 Silver POS 7100 Uniform Mod Age 30 Region 2 493.52 987.04 838.98 1,406.53

49526NY0680053 Silver POS 7100 Uniform Mod Age 26 Region 2 491.20 982.40 835.04 1,399.92

49526NY0680054 Silver POS 7100 Uniform Mod Age 26 Region 2 491.20 982.40 835.04 1,399.92

49526NY0680055 Silver POS 7100 Uniform Mod Age 30 Region 2 493.52 987.04 838.98 1,406.53

49526NY0680056 Silver POS 7100 Uniform Mod Age 30 Region 2 493.52 987.04 838.98 1,406.53

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 54

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

49526NY0680057 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 461.16 922.32 783.97 1,314.31

49526NY0680058 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 461.16 922.32 783.97 1,314.31

49526NY0680059 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 463.34 926.68 787.68 1,320.52

49526NY0680060 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 463.34 926.68 787.68 1,320.52

49526NY0680061 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 461.16 922.32 783.97 1,314.31

49526NY0680062 Silver 7100 align Tiered Uniform Mod Age 26 Region 2 461.16 922.32 783.97 1,314.31

49526NY0680063 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 463.34 926.68 787.68 1,320.52

49526NY0680064 Silver 7100 align Tiered Uniform Mod Age 30 Region 2 463.34 926.68 787.68 1,320.52

49526NY0680065 Silver POS 8100EX Uniform Mod Age 26 Region 2 464.24 928.48 789.21 1,323.08

49526NY0680066 Silver POS 8100EX Uniform Mod Age 26 Region 2 464.24 928.48 789.21 1,323.08

49526NY0680067 Silver POS 8100EX Uniform Mod Age 30 Region 2 466.44 932.88 792.95 1,329.35

49526NY0680068 Silver POS 8100EX Uniform Mod Age 30 Region 2 466.44 932.88 792.95 1,329.35

49526NY0680069 Silver POS 8100EX Uniform Mod Age 26 Region 2 464.24 928.48 789.21 1,323.08

49526NY0680070 Silver POS 8100EX Uniform Mod Age 26 Region 2 464.24 928.48 789.21 1,323.08

49526NY0680071 Silver POS 8100EX Uniform Mod Age 30 Region 2 466.44 932.88 792.95 1,329.35

49526NY0680072 Silver POS 8100EX Uniform Mod Age 30 Region 2 466.44 932.88 792.95 1,329.35

49526NY0680081 Silver POS 8100 Uniform Mod Age 26 Region 2 445.89 891.78 758.01 1,270.79

49526NY0680082 Silver POS 8100 Uniform Mod Age 26 Region 2 445.89 891.78 758.01 1,270.79

49526NY0680083 Silver POS 8100 Uniform Mod Age 30 Region 2 447.99 895.98 761.58 1,276.77

49526NY0680084 Silver POS 8100 Uniform Mod Age 30 Region 2 447.99 895.98 761.58 1,276.77

49526NY0680085 Silver POS 8100 Uniform Mod Age 26 Region 2 445.89 891.78 758.01 1,270.79

49526NY0680086 Silver POS 8100 Uniform Mod Age 26 Region 2 445.89 891.78 758.01 1,270.79

49526NY0680087 Silver POS 8100 Uniform Mod Age 30 Region 2 447.99 895.98 761.58 1,276.77

49526NY0680088 Silver POS 8100 Uniform Mod Age 30 Region 2 447.99 895.98 761.58 1,276.77

49526NY0680089 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 609.65 1,219.30 1,036.41 1,737.50

49526NY0680090 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 609.65 1,219.30 1,036.41 1,737.50

49526NY0680091 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 612.55 1,225.10 1,041.34 1,745.77

49526NY0680092 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 612.55 1,225.10 1,041.34 1,745.77

49526NY0680093 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 609.65 1,219.30 1,036.41 1,737.50

49526NY0680094 Platinum focus Tiered Plus Uniform Mod Age 26 Region 2 609.65 1,219.30 1,036.41 1,737.50

49526NY0680095 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 612.55 1,225.10 1,041.34 1,745.77

49526NY0680096 Platinum focus Tiered Plus Uniform Mod Age 30 Region 2 612.55 1,225.10 1,041.34 1,745.77

49526NY0680097 Gold Complete Uniform Mod Age 26 Region 2 519.65 1,039.30 883.41 1,481.00

49526NY0680098 Gold Complete Uniform Mod Age 26 Region 2 519.65 1,039.30 883.41 1,481.00

49526NY0680099 Gold Complete Uniform Mod Age 30 Region 2 522.11 1,044.22 887.59 1,488.01

49526NY0680100 Gold Complete Uniform Mod Age 30 Region 2 522.11 1,044.22 887.59 1,488.01

49526NY0680101 Gold Complete Uniform Mod Age 26 Region 2 519.65 1,039.30 883.41 1,481.00

49526NY0680102 Gold Complete Uniform Mod Age 26 Region 2 519.65 1,039.30 883.41 1,481.00

49526NY0680103 Gold Complete Uniform Mod Age 30 Region 2 522.11 1,044.22 887.59 1,488.01

49526NY0680104 Gold Complete Uniform Mod Age 30 Region 2 522.11 1,044.22 887.59 1,488.01

49526NY0680105 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 508.15 1,016.30 863.86 1,448.23

49526NY0680106 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 508.15 1,016.30 863.86 1,448.23

49526NY0680107 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 510.55 1,021.10 867.94 1,455.07

49526NY0680108 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 510.55 1,021.10 867.94 1,455.07

49526NY0680109 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 508.15 1,016.30 863.86 1,448.23

49526NY0680110 Gold 7100 focus Tiered Uniform Mod Age 26 Region 2 508.15 1,016.30 863.86 1,448.23

49526NY0680111 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 510.55 1,021.10 867.94 1,455.07

49526NY0680112 Gold 7100 focus Tiered Uniform Mod Age 30 Region 2 510.55 1,021.10 867.94 1,455.07

49526NY0680121 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 461.16 922.32 783.97 1,314.31

49526NY0680122 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 461.16 922.32 783.97 1,314.31

49526NY0680123 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 463.34 926.68 787.68 1,320.52

49526NY0680124 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 463.34 926.68 787.68 1,320.52

49526NY0680125 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 461.16 922.32 783.97 1,314.31

49526NY0680126 Silver 7100 focus Tiered Uniform Mod Age 26 Region 2 461.16 922.32 783.97 1,314.31

49526NY0680127 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 463.34 926.68 787.68 1,320.52

49526NY0680128 Silver 7100 focus Tiered Uniform Mod Age 30 Region 2 463.34 926.68 787.68 1,320.52

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 55

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

49526NY0680153 Silver POS 7100EX Uniform Mod Age 26 Region 2 511.55 1,023.10 869.64 1,457.92

49526NY0680154 Silver POS 7100EX Uniform Mod Age 26 Region 2 511.55 1,023.10 869.64 1,457.92

49526NY0680155 Silver POS 7100EX Uniform Mod Age 30 Region 2 513.98 1,027.96 873.77 1,464.84

49526NY0680156 Silver POS 7100EX Uniform Mod Age 30 Region 2 513.98 1,027.96 873.77 1,464.84

49526NY0680157 Silver POS 7100EX Uniform Mod Age 26 Region 2 511.55 1,023.10 869.64 1,457.92

49526NY0680158 Silver POS 7100EX Uniform Mod Age 26 Region 2 511.55 1,023.10 869.64 1,457.92

49526NY0680159 Silver POS 7100EX Uniform Mod Age 30 Region 2 513.98 1,027.96 873.77 1,464.84

49526NY0680160 Silver POS 7100EX Uniform Mod Age 30 Region 2 513.98 1,027.96 873.77 1,464.84

49526NY0680177 Silver 8100 align Select Uniform Mod Age 26 Region 2 402.15 804.30 683.66 1,146.13

49526NY0680178 Silver 8100 align Select Uniform Mod Age 26 Region 2 402.15 804.30 683.66 1,146.13

49526NY0680179 Silver 8100 align Select Uniform Mod Age 30 Region 2 404.04 808.08 686.87 1,151.51

49526NY0680180 Silver 8100 align Select Uniform Mod Age 30 Region 2 404.04 808.08 686.87 1,151.51

49526NY0680181 Silver 8100 align Select Uniform Mod Age 26 Region 2 402.15 804.30 683.66 1,146.13

49526NY0680182 Silver 8100 align Select Uniform Mod Age 26 Region 2 402.15 804.30 683.66 1,146.13

49526NY0680183 Silver 8100 align Select Uniform Mod Age 30 Region 2 404.04 808.08 686.87 1,151.51

49526NY0680184 Silver 8100 align Select Uniform Mod Age 30 Region 2 404.04 808.08 686.87 1,151.51

49526NY0680185 Silver 8100 focus Select Uniform Mod Age 26 Region 2 402.15 804.30 683.66 1,146.13

49526NY0680186 Silver 8100 focus Select Uniform Mod Age 26 Region 2 402.15 804.30 683.66 1,146.13

49526NY0680187 Silver 8100 focus Select Uniform Mod Age 30 Region 2 404.04 808.08 686.87 1,151.51

49526NY0680188 Silver 8100 focus Select Uniform Mod Age 30 Region 2 404.04 808.08 686.87 1,151.51

49526NY0680189 Silver 8100 focus Select Uniform Mod Age 26 Region 2 402.15 804.30 683.66 1,146.13

49526NY0680190 Silver 8100 focus Select Uniform Mod Age 26 Region 2 402.15 804.30 683.66 1,146.13

49526NY0680191 Silver 8100 focus Select Uniform Mod Age 30 Region 2 404.04 808.08 686.87 1,151.51

49526NY0680192 Silver 8100 focus Select Uniform Mod Age 30 Region 2 404.04 808.08 686.87 1,151.51

49526NY0680193 Silver 7100 align Select Uniform Mod Age 26 Region 2 442.71 885.42 752.61 1,261.72

49526NY0680194 Silver 7100 align Select Uniform Mod Age 26 Region 2 442.71 885.42 752.61 1,261.72

49526NY0680195 Silver 7100 align Select Uniform Mod Age 30 Region 2 444.80 889.60 756.16 1,267.68

49526NY0680196 Silver 7100 align Select Uniform Mod Age 30 Region 2 444.80 889.60 756.16 1,267.68

49526NY0680197 Silver 7100 align Select Uniform Mod Age 26 Region 2 442.71 885.42 752.61 1,261.72

49526NY0680198 Silver 7100 align Select Uniform Mod Age 26 Region 2 442.71 885.42 752.61 1,261.72

49526NY0680199 Silver 7100 align Select Uniform Mod Age 30 Region 2 444.80 889.60 756.16 1,267.68

49526NY0680200 Silver 7100 align Select Uniform Mod Age 30 Region 2 444.80 889.60 756.16 1,267.68

49526NY0680201 Silver 7100 focus Select Uniform Mod Age 26 Region 2 442.71 885.42 752.61 1,261.72

49526NY0680202 Silver 7100 focus Select Uniform Mod Age 26 Region 2 442.71 885.42 752.61 1,261.72

49526NY0680203 Silver 7100 focus Select Uniform Mod Age 30 Region 2 444.80 889.60 756.16 1,267.68

49526NY0680204 Silver 7100 focus Select Uniform Mod Age 30 Region 2 444.80 889.60 756.16 1,267.68

49526NY0680205 Silver 7100 focus Select Uniform Mod Age 26 Region 2 442.71 885.42 752.61 1,261.72

49526NY0680206 Silver 7100 focus Select Uniform Mod Age 26 Region 2 442.71 885.42 752.61 1,261.72

49526NY0680207 Silver 7100 focus Select Uniform Mod Age 30 Region 2 444.80 889.60 756.16 1,267.68

49526NY0680208 Silver 7100 focus Select Uniform Mod Age 30 Region 2 444.80 889.60 756.16 1,267.68

49526NY0680209 Gold 7100 align Select Uniform Mod Age 26 Region 2 485.82 971.64 825.89 1,384.59

49526NY0680210 Gold 7100 align Select Uniform Mod Age 26 Region 2 485.82 971.64 825.89 1,384.59

49526NY0680211 Gold 7100 align Select Uniform Mod Age 30 Region 2 488.12 976.24 829.80 1,391.14

49526NY0680212 Gold 7100 align Select Uniform Mod Age 30 Region 2 488.12 976.24 829.80 1,391.14

49526NY0680213 Gold 7100 align Select Uniform Mod Age 26 Region 2 485.82 971.64 825.89 1,384.59

49526NY0680214 Gold 7100 align Select Uniform Mod Age 26 Region 2 485.82 971.64 825.89 1,384.59

49526NY0680215 Gold 7100 align Select Uniform Mod Age 30 Region 2 488.12 976.24 829.80 1,391.14

49526NY0680216 Gold 7100 align Select Uniform Mod Age 30 Region 2 488.12 976.24 829.80 1,391.14

49526NY0680217 Gold 7100 focus Select Uniform Mod Age 26 Region 2 485.82 971.64 825.89 1,384.59

49526NY0680218 Gold 7100 focus Select Uniform Mod Age 26 Region 2 485.82 971.64 825.89 1,384.59

49526NY0680219 Gold 7100 focus Select Uniform Mod Age 30 Region 2 488.12 976.24 829.80 1,391.14

49526NY0680220 Gold 7100 focus Select Uniform Mod Age 30 Region 2 488.12 976.24 829.80 1,391.14

49526NY0680221 Gold 7100 focus Select Uniform Mod Age 26 Region 2 485.82 971.64 825.89 1,384.59

49526NY0680222 Gold 7100 focus Select Uniform Mod Age 26 Region 2 485.82 971.64 825.89 1,384.59

49526NY0680223 Gold 7100 focus Select Uniform Mod Age 30 Region 2 488.12 976.24 829.80 1,391.14

49526NY0680224 Gold 7100 focus Select Uniform Mod Age 30 Region 2 488.12 976.24 829.80 1,391.14

49526NY0680225 Silver Aqua Uniform Mod Age 26 Region 2 477.52 955.04 811.78 1,360.93

49526NY0680226 Silver Aqua Uniform Mod Age 26 Region 2 477.52 955.04 811.78 1,360.93

49526NY0680227 Silver Aqua Uniform Mod Age 30 Region 2 479.77 959.54 815.61 1,367.34

49526NY0680228 Silver Aqua Uniform Mod Age 30 Region 2 479.77 959.54 815.61 1,367.34

49526NY0680229 Silver Aqua Uniform Mod Age 26 Region 2 477.52 955.04 811.78 1,360.93

49526NY0680230 Silver Aqua Uniform Mod Age 26 Region 2 477.52 955.04 811.78 1,360.93

49526NY0680231 Silver Aqua Uniform Mod Age 30 Region 2 479.77 959.54 815.61 1,367.34

49526NY0680232 Silver Aqua Uniform Mod Age 30 Region 2 479.77 959.54 815.61 1,367.34

HealthNow New York Inc.

2020 New York State Exchange Rate Submission

Rate Manual - Page 56

Rates Effective 1/1/2020

HIOS Plan Name Plan Status Age Region

Q4:

Single Q4: Subscriber &

Spouse

Q4: Subscriber &

Child(ren)

Q4:

Family

49526NY0680233 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 420.64 841.28 715.09 1,198.82

49526NY0680234 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 420.64 841.28 715.09 1,198.82

49526NY0680235 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 422.62 845.24 718.45 1,204.47

49526NY0680236 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 422.62 845.24 718.45 1,204.47

49526NY0680237 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 420.64 841.28 715.09 1,198.82

49526NY0680238 Silver 8100 align Tiered Uniform Mod Age 26 Region 2 420.64 841.28 715.09 1,198.82

49526NY0680239 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 422.62 845.24 718.45 1,204.47

49526NY0680240 Silver 8100 align Tiered Uniform Mod Age 30 Region 2 422.62 845.24 718.45 1,204.47

49526NY0680241 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 420.64 841.28 715.09 1,198.82

49526NY0680242 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 420.64 841.28 715.09 1,198.82

49526NY0680243 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 422.62 845.24 718.45 1,204.47

49526NY0680244 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 422.62 845.24 718.45 1,204.47

49526NY0680245 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 420.64 841.28 715.09 1,198.82

49526NY0680246 Silver 8100 focus Tiered Uniform Mod Age 26 Region 2 420.64 841.28 715.09 1,198.82

49526NY0680247 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 422.62 845.24 718.45 1,204.47

49526NY0680248 Silver 8100 focus Tiered Uniform Mod Age 30 Region 2 422.62 845.24 718.45 1,204.47

49526NY0680265 Platinum EX Plus New Age 26 Region 2 678.43 1,356.86 1,153.33 1,933.53

49526NY0680266 Platinum EX Plus New Age 26 Region 2 678.43 1,356.86 1,153.33 1,933.53

49526NY0680267 Platinum EX Plus New Age 30 Region 2 681.67 1,363.34 1,158.84 1,942.76

49526NY0680268 Platinum EX Plus New Age 30 Region 2 681.67 1,363.34 1,158.84 1,942.76

49526NY0680269 Platinum EX Plus New Age 26 Region 2 678.43 1,356.86 1,153.33 1,933.53

49526NY0680270 Platinum EX Plus New Age 26 Region 2 678.43 1,356.86 1,153.33 1,933.53

49526NY0680271 Platinum EX Plus New Age 30 Region 2 681.67 1,363.34 1,158.84 1,942.76

49526NY0680272 Platinum EX Plus New Age 30 Region 2 681.67 1,363.34 1,158.84 1,942.76

49526NY0680273 Platinum align Select Plus New Age 26 Region 2 585.80 1,171.60 995.86 1,669.53

49526NY0680274 Platinum align Select Plus New Age 26 Region 2 585.80 1,171.60 995.86 1,669.53

49526NY0680275 Platinum align Select Plus New Age 30 Region 2 588.58 1,177.16 1,000.59 1,677.45

49526NY0680276 Platinum align Select Plus New Age 30 Region 2 588.58 1,177.16 1,000.59 1,677.45

49526NY0680277 Platinum align Select Plus New Age 26 Region 2 585.80 1,171.60 995.86 1,669.53

49526NY0680278 Platinum align Select Plus New Age 26 Region 2 585.80 1,171.60 995.86 1,669.53

49526NY0680279 Platinum align Select Plus New Age 30 Region 2 588.58 1,177.16 1,000.59 1,677.45

49526NY0680280 Platinum align Select Plus New Age 30 Region 2 588.58 1,177.16 1,000.59 1,677.45

49526NY0680281 Platinum focus Select Plus New Age 26 Region 2 585.80 1,171.60 995.86 1,669.53

49526NY0680282 Platinum focus Select Plus New Age 26 Region 2 585.80 1,171.60 995.86 1,669.53

49526NY0680283 Platinum focus Select Plus New Age 30 Region 2 588.58 1,177.16 1,000.59 1,677.45

49526NY0680284 Platinum focus Select Plus New Age 30 Region 2 588.58 1,177.16 1,000.59 1,677.45

49526NY0680285 Platinum focus Select Plus New Age 26 Region 2 585.80 1,171.60 995.86 1,669.53

49526NY0680286 Platinum focus Select Plus New Age 26 Region 2 585.80 1,171.60 995.86 1,669.53

49526NY0680287 Platinum focus Select Plus New Age 30 Region 2 588.58 1,177.16 1,000.59 1,677.45

49526NY0680288 Platinum focus Select Plus New Age 30 Region 2 588.58 1,177.16 1,000.59 1,677.45