NY State of Health - SHOP Medical Rates

New York State of Health Employee Only Rate in NYSOH Rating Region*

Carrier Small Business Marketplace Product Description Product Type Metal Level Plan Type Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 Link to Carrier Benefit Summaries

BlueShield of Northeastern NY Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning POS 1-Platinum Standard $658.81 $683.99 www.bsneny.com/platinumSHOP

BlueShield of Northeastern NY Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 2-Gold Standard $542.54 $562.78 www.bsneny.com/goldSHOP

BlueShield of Northeastern NY Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning POS 3-Silver Standard $486.89 $505.24 www.bsneny.com/silverSHOP

BlueShield of Northeastern NY Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 4-Bronze Standard $386.15 $400.08 www.bsneny.com/bronzeSHOP

CDPHP Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 1-Platinum Standard $515.46 $582.73 $578.09 $555.20 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 2-Gold Standard $452.41 $511.45 $507.38 $487.29 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 3-Silver Standard $384.93 $435.17 $431.70 $414.61 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 4-Bronze Standard $328.82 $371.73 $368.77 $354.17 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning EPO 1-Platinum NonStand 1 $526.00 $594.65 $589.91 $566.56 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning EPO 2-Gold NonStand 1 $468.55 $529.70 $525.48 $504.68 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning EPO 3-Silver NonStand 1 $388.21 $438.87 $435.38 $418.14 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning EPO 4-Bronze NonStand 1 $322.33 $364.40 $361.50 $347.19 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Platinum SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning PPO 1-Platinum NonStand 2 $563.28 $636.79 $631.72 $606.71 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Gold SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning EPO 2-Gold NonStand 2 $448.78 $507.34 $503.30 $483.38 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Silver SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning PPO 3-Silver NonStand 2 $391.88 $443.02 $439.50 $422.10 https://www.cdphp.com/Exchange/TCE/small-group

CDPHP Bronze SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning EPO 4-Bronze NonStand 2 $311.14 $351.74 $348.94 $335.12 https://www.cdphp.com/Exchange/TCE/small-group

Excellus Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning PPO 1-Platinum Standard $563.25 $563.25 $435.16 $529.12 $563.25 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY0980010

Excellus Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning PPO 2-Gold Standard $486.86 $486.86 $376.15 $457.36 $486.86 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY0990042

Excellus Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning PPO 3-Silver Standard $420.33 $420.33 $324.75 $394.88 $420.33 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY0990010

Excellus Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning PPO 4-Bronze Standard $328.39 $328.39 $253.71 $308.49 $328.39 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY1000010

Excellus Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning PPO 1-Platinum NonStand 1 $563.95 $563.95 $435.70 $529.79 $563.95 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY0980026

Excellus Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning PPO 2-Gold NonStand 1 $451.17 $451.17 $348.56 $423.83 $451.17 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY1000074

Excellus Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning PPO 3-Silver NonStand 1 $384.02 $384.02 $296.69 $360.75 $384.02 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY1000082

Excellus Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning PPO 4-Bronze NonStand 1 $310.11 $310.11 $239.58 $291.31 $310.11 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY1000154

Health Republic Insurance Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 1-Platinum Standard $426.04 $398.81 $478.57 $561.14 $392.06 $414.04 $402.87 $561.14 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Health Republic Insurance Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 2-Gold Standard $362.34 $339.19 $407.01 $477.24 $333.44 $352.13 $342.64 $477.24 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Health Republic Insurance Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 3-Silver Standard $310.10 $290.28 $348.33 $408.44 $285.36 $301.36 $293.24 $408.44 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Health Republic Insurance Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning EPO 4-Bronze Standard $253.67 $237.46 $284.95 $334.11 $233.44 $246.52 $239.88 $334.11 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Health Republic Insurance Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning EPO 1-Platinum NonStand 1 $408.43 $382.33 $458.79 $537.95 $375.86 $396.93 $386.22 $537.95 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Health Republic Insurance Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning EPO 2-Gold NonStand 1 $362.05 $338.92 $406.69 $476.86 $333.17 $351.85 $342.36 $476.86 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Health Republic Insurance Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning EPO 3-Silver NonStand 1 $309.87 $290.07 $348.08 $408.14 $285.16 $301.14 $293.02 $408.14 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Health Republic Insurance Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning EPO 4-Bronze NonStand 1 $219.89 $205.84 $247.01 $289.63 $202.36 $213.70 $207.94 $289.63 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Health Republic Insurance Silver SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning EPO 3-Silver NonStand 2 $292.37 $273.69 $328.42 $385.10 $269.06 $284.14 $276.48 $385.10 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Independent Health Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning POS 1-Platinum Standard $530.11 https://www.independenthealth.com/Exchange/SmallGroup/Platinum/18029NY1170008.aspx

Independent Health Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning POS 2-Gold Standard $446.96 https://www.independenthealth.com/Exchange/SmallGroup/Gold/18029NY1200008.aspx

Independent Health Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning POS 3-Silver Standard $381.47 https://www.independenthealth.com/Exchange/SmallGroup/Silver/18029NY1240008.aspx

Independent Health Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning POS 4-Bronze Standard $322.85 https://www.independenthealth.com/Exchange/SmallGroup/Bronze/18029NY1300008.aspx

Independent Health Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning POS 1-Platinum NonStand 1 $513.40 https://www.independenthealth.com/Exchange/SmallGroup/Platinum/18029NY1170024.aspx

Independent Health Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning POS 2-Gold NonStand 1 $431.45 https://www.independenthealth.com/Exchange/SmallGroup/Gold/18029NY1200024.aspx

Independent Health Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning POS 3-Silver NonStand 1 $361.15 https://www.independenthealth.com/Exchange/SmallGroup/Silver/18029NY1240024.aspx

Independent Health Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning POS 4-Bronze NonStand 1 $298.55 https://www.independenthealth.com/Exchange/SmallGroup/Bronze/18029NY1300024.aspx

Independent Health Platinum SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning POS 1-Platinum NonStand 2 $513.40 https://www.independenthealth.com/Exchange/SmallGroup/Platinum/18029NY1170056.aspx

Independent Health Gold SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning PPO 2-Gold NonStand 2 $467.59 https://www.independenthealth.com/Exchange/SmallGroup/Gold/18029NY1210008.aspx

Independent Health Silver SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning PPO 3-Silver NonStand 2 $405.61 https://www.independenthealth.com/Exchange/SmallGroup/Silver/18029NY1250008.aspx







Independent Health Bronze SHOP NS4 Age 26, No Dental, Domestic Partner & Family Planning PPO 4-Bronze NonStand 4 $359.95 https://www.independenthealth.com/Exchange/SmallGroup/Bronze/18029NY1270008.aspx

MetroPlus Platinum SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning HMO 1-Platinum Standard $479.50 www.metroplus.org\MarketPlus

MetroPlus Gold SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning HMO 2-Gold Standard $427.34 www.metroplus.org\MarketPlus

MetroPlus Silver SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning HMO 3-Silver Standard $387.23 www.metroplus.org\MarketPlus

MetroPlus Bronze SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning HMO 4-Bronze Standard $359.97 www.metroplus.org\MarketPlus

MVP Health Care Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning HMO 1-Platinum Standard $526.60 $435.55 $592.43 $754.80 $440.48 $572.13 $537.03 www.discovermvp.com/ny/st/shop/platinum/

MVP Health Care Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning HMO 2-Gold Standard $446.55 $369.34 $502.37 $640.06 $373.52 $485.16 $455.39 www.discovermvp.com/ny/st/shop/gold/

MVP Health Care Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning HMO 3-Silver Standard $370.98 $306.83 $417.35 $531.73 $310.31 $403.05 $378.32 www.discovermvp.com/ny/st/shop/silver/

MVP Health Care Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning HMO 4-Bronze Standard $285.30 $235.97 $320.96 $408.93 $238.64 $309.97 $290.95 www.discovermvp.com/ny/st/shop/bronze/

MVP Health Care Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning HMO 1-Platinum NonStand 1 $526.93 $435.81 $592.79 $755.26 $440.75 $572.48 $537.35 www.discovermvp.com/ny/ns/shop/platinum/

MVP Health Care Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning HMO 2-Gold NonStand 1 $440.56 $364.38 $495.62 $631.46 $368.51 $478.64 $449.27 www.discovermvp.com/ny/ns/shop/gold/

MVP Health Care Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning HMO 3-Silver NonStand 1 $357.24 $295.46 $401.89 $512.04 $298.81 $388.12 $364.31 www.discovermvp.com/ny/ns/shop/silver/

MVP Health Care Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning HMO 4-Bronze NonStand 1 $295.86 $244.70 $332.84 $424.07 $247.47 $321.44 $301.72 www.discovermvp.com/ny/ns/shop/bronze/

MVP Health Care Platinum SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning HMO 1-Platinum NonStand 2 $530.29 $438.59 $596.58 $760.08 $443.57 $576.14 $540.79 www.discovermvp.com/ny/ns/shop/platinum/

MVP Health Care Gold SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning HMO 2-Gold NonStand 2 $418.97 $346.52 $471.34 $600.52 $350.45 $455.19 $427.26 www.discovermvp.com/ny/ns/shop/gold/





North Shore-LIJ Platinum SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning EPO 1-Platinum Standard $682.93 $682.93 www.NSLIJCareConnect.com/member/group/SBC

North Shore-LIJ Gold SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning EPO 2-Gold Standard $594.07 $594.07 www.NSLIJCareConnect.com/member/group/SBC

North Shore-LIJ Silver SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning EPO 3-Silver Standard $516.96 $516.96 www.NSLIJCareConnect.com/member/group/SBC

North Shore-LIJ Bronze SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning EPO 4-Bronze Standard $421.61 $421.61 www.NSLIJCareConnect.com/member/group/SBC

Oxford Health Insurance Platinum SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning EPO 1-Platinum Standard $773.65 $773.65 $773.65 www.welcometouhc.com/shopny

Oxford Health Insurance Gold SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning EPO 2-Gold Standard $655.79 $655.79 $655.79 www.welcometouhc.com/shopny

Oxford Health Insurance Silver SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning EPO 3-Silver Standard $554.71 $554.71 $554.71 www.welcometouhc.com/shopny

Oxford Health Insurance Bronze SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning EPO 4-Bronze Standard $473.25 $473.25 $473.25 www.welcometouhc.com/shopny

Oxford Health Insurance Platinum SHOP NS1 Dependent Age 26, Dental, Domestic Partner & Family Planning PPO 1-Platinum NonStand 1 $836.98 $836.98 $836.98 www.welcometouhc.com/shopny

Oxford Health Insurance Silver SHOP NS1 Dependent Age 26, Dental, Domestic Partner & Family Planning PPO 3-Silver NonStand 1 $612.25 $612.25 $612.25 www.welcometouhc.com/shopny

Univera Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning PPO 1-Platinum Standard $547.25 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1020010

Univera Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning PPO 2-Gold Standard $473.04 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1030042

Univera Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning PPO 3-Silver Standard $408.40 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1030010

Univera Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning PPO 4-Bronze Standard $319.07 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1040010

Univera Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning PPO 1-Platinum NonStand 1 $547.95 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1020026

Univera Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning PPO 2-Gold NonStand 1 $438.36 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1040074

Univera Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning PPO 3-Silver NonStand 1 $373.11 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1040090

Univera Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning PPO 4-Bronze NonStand 1 $301.30 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1040154

*Link to Rating Region Map: http://info.nystateofhealth.ny.gov/sites/default/files/Attachment%20C%20-%20Rating%20Regions%2C%20new%203-27-13.pdf

http://info.nystateofhealth.ny.gov/sites/default/files/Attachment C - Rating Regions%2C new 3-27-13.pdf

Documents

NY State of Health - SHOP Medical Rates