Highmark Coverage Advantage 2021 Small Group Market Rates...Ms. Tracie Gray, Director Highmark...

July 20, 2020

Ms. Tracie Gray, Director Bureau of Life, Accident & Health Insurance Commonwealth of Pennsylvania Insurance Department 1311 Strawberry Square Harrisburg, PA 17120 Re: Highmark Inc. 2021 ACA Rate Filing (Small Group Market) Highmark Filing #1A-SG-HIGHMARK-2020 (SERFF Filing # HGHM-132381011)

This constitutes Notice pursuant to Section 707 of the Pennsylvania

Right-to-Know Law that the attached Highmark Inc. 2021 Small Group Market Rates Filing contains Trade Secret and Confidential Proprietary Information. Therefore, Highmark Inc. must, prior to the release of any

portion of this Filing, be notified of any request by a third party for access to this Filing, and the Trade Secret and/or Confidential Proprietary

Information identified by Highmark Inc. should be redacted before release.

Dear Ms. Gray: This Filing revises the original Highmark Inc. (NAIC # 54771; HIOS Issuer ID # 33709) Small Group Market Off Exchange ACA rate filing and the supporting rate development for policies with effective dates on or after January 1, 2021. The Company proposes to revise its morbidity assumptions in response to the PA Insurance Department’s COVID-19 Impact Guidance. This revision changes the Company’s average rate change requested from -0.26% to 1.59%. In the event the Department decides to publish this Filing in the PA Bulletin, the company information requested as per the Department’s 2021 ACA-Compliant Health Insurance Rate Filing Guidance, Section B, is provided below: 1. Company Name & NAIC #: Highmark Inc., NAIC # 54771 (“Company”) 2. Market: Small Group (“Market”) 3. On or Off Exchange: This Company’s products are offered Off Exchange only 4. Effective date of coverage: January 1, 2021

Ms. Tracie Gray, Director Highmark Coverage Advantage 2021 Small Group Market Rates July 20, 2020 Page 2 of 4

5. Average rate change requested: 1.59% increase 6. Range of rate change requested: -0.69% to 7.10%

7. Total additional annual revenue generated from the proposed rate change: $790,968 8. Product(s): PPO, EPO 9. Rating Areas and the change from 2020: Regions 1, 2, 4, 5, 6, 7, 9 (Western and Central

PA)

There are no changes in our covered Rating Areas from the 2020 rate filing. 10. Metal Levels and Catastrophic Plans: This filing reflects that the Company anticipates

selling the following Metal Levels of coverage in the indicated Market: Platinum, Gold, Silver, and Bronze

11. Current number of covered lives and of policyholders as of February 1, 2020: 7,275 covered

lives; 4224 policyholders 12. Number of plans offered in 2021 and the change this represents from 2020: 51

The Company offered 36 plans in 2020. For 2021, the Company is offering 18 new plans in the Market, and removing 3 plans from the Market.

Please note that inclusion of premium rates in this filing for a given offering should not be construed to mean that the offering will ultimately be made available for sale in the market. Final offering decisions will be made consistent with and within the timelines set forth in CMS rules and/or ACA regulations.

13. Corresponding contract form number, SERFF and Binder ID numbers: The

corresponding SERFF binder number is HGHM-PA21-125098236 affecting the following Company products and forms:

Product Name / Type Contract Form & SERFF # Balance PPO PPO-SM/WG-8; HGHM-132368614 Health Savings HDHP PPO HDHP-SM/WG-8; HGHM-132368618 Premier Balance EPO CONB/EPO-SM/WG-5; HGHM-132368620 Together Blue EPO TB/EPO-SM/WG; HGHM-132368642 Together Blue HDHP EPO TB/EPO-HDHP-SM/WG; HGHM-132368588

14. HIOS Issuer ID # and submission tracking number: HIOS Issuer ID # 33709, Company

Filing # 1A-SG-HIGHMARK-2020 (SERFF Filing # HGHM-132381011)


Additional Filing Disclosures The Company has submitted all Required Documents stipulated by the Department, including the federal documents related to this filing, in its SERFF submission. In addition to the Required Documents, the Company has submitted a Supplemental Exhibits file containing additional detailed exhibits on items referenced in the PA Actuarial Memorandum. All tables, exhibits, and detail in support of this filing and the PA Actuarial Memorandum have been included in Excel format. For the Department’s benefit, the Excel files have retained their formulas to the extent possible. CMS has instructed issuers that it no longer requires any interim changes to the URRT to be submitted to HIOS. CMS is requesting that only the initial URRT and the final URRT be submitted to HIOS. Potential for Material Unforeseen Impacts: This filing assumes that there will be no significant changes in legislation, regulations or otherwise (i.e. rules, regulatory guidance, etc.) impacting the ACA market, and that there are no significant changes in the participation of QHP issuers that would materially change risk adjustment transfer amounts. Modifications to the rate development may be necessary if significant unforeseen events occur. Examples include, but are not limited to, repeal or invalidation of the ACA or material developments in the course of the COVID-19 pandemic. As a result, Highmark reserves the right to submit a revised filing. Request for Confidentiality Please note that the rates and the supporting rate development contained in this Filing are competitively sensitive, are not in the public domain, and constitute business confidential proprietary/trade secret information that would cause harm to the competitive position of Highmark Inc. if disclosed to the public. Public disclosure of any information contained in this Filing would allow Highmark Inc. competitors to better understand or discover its confidential and proprietary rating, pricing and/or marketing practices, would undermine competition in the Small Group market, and could have negative consequences for the operation of Highmark Inc.’s business. Therefore, Highmark Inc. asserts that this Filing, in its entirety, constitutes Trade Secret and Confidential Proprietary Information and should not be disclosed. It is our understanding that the Department does not intend to publish the confidential and proprietary information contained in this Filing or to otherwise permit this Filing and its confidential information, other than the redacted information and final approved rates, to be disclosed or released.


Furthermore and pursuant to the Pennsylvania Right-to-Know Law (“RTKL”), Highmark Inc. must be notified prior to release of information contained in this Filing and be given the opportunity to respond to requests for such information. Should the Department receive such request or require the release of information contained in this Filing for its own purposes, Highmark Inc asserts its right to release a redacted version of the Filing. In accordance with the RTKL, please contact the Highmark Inc. RTKL representative identified below prior to release of any information contained in this Filing:

Lisa Martinelli, Esq. RTKL Representative VP Chief Privacy Officer

120 Fifth Avenue, FAP Suite 2114 Pittsburgh, PA 15222 Furthermore, it should be noted that Highmark Inc. is equally concerned that even if this information is released in aggregate form, it still may be easy to identify the carrier that submitted it.

Should you have any questions regarding the attached Filing, please feel free to contact me at (412) 544-3845 or via e-mail at: [email protected]. Sincerely, Cory Orzak, FSA, MAAA Vice President, Actuarial Services Highmark Inc. cc: Tija Hilton-Phillips, Esq.

Nicholas Sarneso William R. Sarniak Ryan Slean

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Pennsylvania Actuarial Memorandum

1. BasicInformationandData

A. CompanyInformation(Table0)Table 0 has been completed as per the instructions. Please refer to the Excel file “2021_SmGrp_HMK_PAAMExhibits_072020.xlsm” submitted with this filing containing the department’s required tables.

Note that for the remainder of this document, “Company” refers to Highmark, Inc., “Market” refers to Small Group, and “Rating Area” refers to Pennsylvania Rating Regions 1, 2, 4, 5, 6, 7 and 9 (Western and Central PA). Service area L was added since the last approved filing.

B. RateHistoryandProposedVariationsinRateChangesThe most recent three years of historical rate changes in the Pennsylvania Small Group Market for the Company are as follows:

Year Avg. Increase SERFF ID# 2020 6.6% HGHM‐131937189

Third and Fourth Quarter 2019 Rate Change 15.9% HGHM‐131864069

2019 18.5% HGHM‐131496088 2018 2.2% HGHM‐131014769

Rate changes vary by plan, as plan benefits need adjusted to help maintain compliance with metal level requirements. Other base rate components (pricing actuarial factor and network discount) are also re‐evaluated each year. For 2021, the Company’s proposed rate revisions vary by plan, according to the detail presented in the URRT, Worksheet 2, and the PA Rate Template Table 10.

C. AverageRateChangeThe average rate change from Table 10, column AC is a 1.6% increase. This rate change reflects the change for first quarter 2021 rates over 2020 first quarter rates.

For comparison, the change in 21‐year‐old non‐tobacco premium PMPM calculated in Table 11, cell AN13, is a 2.1% increase.

D. MembershipCount(Table1)Table 1 has been completed according to the instructions with the average age, age breakdown and total number of members or member months, as indicated in the table. For the 2/1/2020 data, this table reflects all Small Group enrollment, including enrollment from 2019 and 2020 plan year plans.

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E. BenefitChangesMost plans required benefit changes because of the new Actuarial Value (AV) calculator released for 2021 effective dates. The plan changes were mostly required so that the plans remained within the defined metal level AV requirements, and were enacted by adjusting member cost sharing and the maximum out of pocket levels.

For the 2021 plan year, there were no benefit changes necessary to the Company’s plans to cover the benefits contained in the state’s Essential Health Benefit (EHB) benchmark plan.

F. ExperiencePeriodClaimsandPremium(Table2)Please see Table 2 for the experience period data for the most recent calendar year, for the Company and Market. The experience period paid claims data represents the 2019 calendar year results for all non‐grandfathered policies in the single risk pool, with run out through February 29, 2020 (2 months). This data is consistent with the data reported in Section I of Worksheet I of the URRT (see below commentary). The Company has offered only ACA‐compliant policies in the Market in the experience period. As such, there is no transitional policy experience to report.

The components of this exhibit were developed as follows:

The Earned Premium represents actual revenues earned in the experience period. The Allowed Claims represent our best estimate of the total claims prior to member cost sharing

incurred during the experience period. The Allowed Claims include: o Two months of run out from the end of the experience period, o Claims processed outside of the Company’s claims system (e.g., settlements), and o Our best estimate of claims incurred but not paid as of the end of the run out period.

Note that the Incurred Claims and Allowed Claims presented in the URRT are net of the Prescription Drug Rebates, while Table 2 has the Prescription Drug Rebates separately identified. As per the URR instructions, Allowed Claims do not include reinsurance recoveries or pooling charges, nor do they include quality incentive payments.

There are no non‐EHB benefits or costs in the experience period. The EHB coverage for pediatric vision benefits are provided by our vision coverage vendor under

a capitation arrangement. These costs are $0.62 PMPM across each member in the experience period, and are reflected in Table 2 under the Total EHB Capitation section.

The Estimated Risk Adjustment represents our best estimate of the year end risk adjustment transfer payment that the Company will incur based on the results in the experience period. This amount reflects the Department’s calculated revised risk adjustment transfer amount sent to the Company on June 30, 2020

The calculated loss ratio is 81.58%.

G. CredibilityofData(Tables2b,3b,4b)We do not use a rigid credibility formula or pre‐defined manual rate in the small group market. Based on professional judgment, if the experience can be used to produce reasonable results, it will be considered fully credible in lieu of a rigid formula. The experience period data for this Company is large enough to be

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fully credible. The results are based 100% on the experience period data, adjusted as described herein. Given the Company’s fully credible rate development, Tables 2b, 3b, and 4b have not been populated.

H. TrendIdentification(Table3)Table 3 identifies the annual medical and prescription drug allowed claims cost and utilization trends, as requested by the Pennsylvania Insurance Department. The definitions of service categories, cost, and utilization in Table 3 are consistent with the URRT instructions. The numbers entered in the Cost and Utilization columns are consistent with those entered in Worksheet I, Section 2 of the URRT, except as noted below.

To arrive at our trend assumption, the experience period cost and utilization data were pulled from the Company’s claims systems by the defined benefit categories. For the trend component development, the Company uses results from the combined experience of the following companies within the Highmark corporate family: Highmark Inc., Highmark Choice Company, Highmark Health Insurance Company, and Highmark Coverage Advantage. The combined experience used is limited to the Company’s Rating Area and Market, and provides a more credible base to analyze the trend components impacting the business in the Company’s Market. The trend development uses a projection of allowed claim PMPMs by service category that takes into account many factors, including the Company’s expectations of changes in in‐network provider contracting levels, changes in out‐of‐network costs, changes in utilization from medical management programs, and changes in drug costs from impacts such as generic drug development and new drug treatments. To reflect the impact of provider contracting on trend, changes in in‐network provider contracting levels, either known or anticipated, are factored into the cost component of trend using detailed analysis of the impact on claim levels from each material provider arrangement.

These projected costs measure and normalize for benefit leveraging, population aging, and historical changes in fee schedules, as well as company‐wide utilization management programs, and external trend drivers. Based upon the coverage and demographics of our membership, our historical claim levels, adjusted for these factors and projected forward, represent the best estimates of trend for this block of business. Please note that since these historical claim levels are normalized throughout to account for these forces impacting claim utilization and costs, the claim levels presented will not reflect actual experience claim levels.

For the rate development, the Company uses the aggregate claim trend for all types of service, applied to the experience period. This is done so that the combined trend is reasonable in consideration of the various pricing trend components and the overall anticipated trend level. Based on a review of the projected normalized annual trends for 2020 and 2021, an overall claim trend of 9.6% (8.5% cost; 1.0% utilization) was selected for the 2021 rate development. Please refer to the “Trend Support” exhibit in the “2021 Supplemental Exhibits ‐ HMK.xlsx” file showing the historical and projected normalized claim values for the Company’s trend determination, along with the Company’s proposed rate trend.

For this Small Group Market filing, quarterly rates are proposed, with rates adjusted each quarter based on the Total Annual Trend presented in Table 3, excluding the Induced Utilization trend. The quarterly

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trend is based on the cost and utilization trend from Table 3. Note that we zeroed out the impact of the Capitation trend in the Composite URRT Trend. The change in the Capitation charge is reflected in the Change in Benefits adjustment discussed below.

I. HistoricalExperience(Table4)Table 4 presents the most recent 48 months (4 calendar years) of Company data with run‐out through February 29, 2020. Allowed claims are sourced from claim records with adjustments for claims that are outside of the claims processing system such as hospital settlements. This data, combined with the data from other companies within Highmark's corporate family, was used to develop the trend in Table 3. Please see Section H for further details.

The Company has offered only ACA‐compliant policies in the Market in the experience period. As such, there is no transitional policy experience to report.

2. RateDevelopment&Change

A. ProjectedIndexRate,Market‐AdjustedIndexRate,&TotalAllowedClaims(Table5)

The development of the Projected Index Rate, Projected Market‐Adjusted Index Rate, and Projected Total Allowed Claims, shown in Table 5, closely follows that utilized in the development presented in Worksheet 1 of the URRT, a discussion of which can be found in the Part III Actuarial Memorandum submitted in the Rate Filing Justification. Some of the items separately identified in Table 5 include:

The Change in Morbidity represents an adjustment from the experience period claims to the projection period. Pursuant to the Department’s COVID‐19 Impact Guidance, the Company has included a 1.9% morbidity adjustment due to the impact of COVID‐19 on 2021 claims costs. See below for additional commentary related to the projection period assumptions.

The Change in Demographics adjustment reflects the change in age and geography factors we expect from the experience period to the projection period.

The Change in Network adjustment reflects the change in the allowed claims we anticipate due to changes in in‐network discount levels between the experience period and the projection period.

The Change in Benefits adjustment reflects the change in the EHB benefits (pediatric benefits) we anticipate between the experience period and the projection period, as well as the change in expected pharmacy rebates. See below for additional commentary related to these cost changes.

Please see the worksheet named “Table 5 Support” in the “2021 Supplemental Exhibits ‐ HMK.xlsx” file for the calculation of these factors from our experience period data and projected rate results.

Our initial step in developing the index rates is to determine the expected covered membership for the rating period. We estimate the covered member base by adjusting for those groups known to have lapsed during the experience period, and those that we expect will lapse prior to the projection period. Then we

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add in expected new business from groups with current transitional coverage moving to ACA plans, and groups currently with another carrier.

As we have seen through the transitional coverage availability period, many of the Small Group market customers have retained their pre‐ACA coverage, and have yet to join the ACA risk pool. With the transitional coverage provisions extension through the end of 2021 for groups that renew on or prior to October 1, 2021, we continue to believe that many groups, especially lower‐risk groups, will continue to retain their current transitional coverage until required to transfer coverage. We are expecting that enrollment drops slightly and that we lose some of the better risk groups. Also, with the continued availability of transitional coverage, we expect any new groups moving into ACA products from transitional coverage will be of higher morbidity.

Impact of COVID‐19

The Change in Morbidity – All Other factor was increased by 1.9% to reflect the estimated impact of COVID‐19 on 2021 claim costs. The drivers of the increase are costs directly related to COVID‐19, such as a possible vaccine and continued cost sharing waivers, as well as other care delivery changes. Due to these factors we are currently estimating an impact to 2021 claim costs of 1.9% in the PA Small Group ACA market. The components of the adjustment are discussed below.

COVID‐19 Treatment Costs (1.6% increase in 2021 claims): The primary driver for 2021 is the cost of a potential new vaccine. We assume a vaccine is available and 90% of members get it in 2021, either in the office or at a retail pharmacy. Additionally, we assume some vaccines will be administered in an additional office visit with waived cost sharing. Also, we assume COVID‐19 testing will be required before any outpatient procedure.

Care Delivery Change (0.3% increase in 2021 claims): We assume some increase in cost of care due to member health deteriorating slightly. Additionally, we assume a higher intensity of services per visit as providers re‐engage with their patients. Finally, we assume some care will be shifted to more expensive sites of service.

Total Morbidity Adjustment

In total, the Company expects that morbidity will worsen from the experience period and reflect this with a Change in Morbidity – All Other adjustment of 1.106.

The Change in Benefits adjustment reflects our estimate of the additional costs associated with the addition of EHBs from the experience period to the coverage period, as well as a change in expected Pharmacy rebates.

The combination of the above assumptions results in a Change in Benefits factor of 0.982.

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The development of the Projected Paid to Allowed Ratio shown in Table 5 is presented in the “2021 Supplemental Exhibits ‐ HMK.xlsx” file in the “Table 5 Paid‐to‐Allowed” worksheet. This value is consistent with the paid‐to‐allowed ratio in the URRT Worksheet 2, line 4.15 Incurred Claims, divided by line 4.11 Allowed Claims.

Table 5 reflects that we are assuming a Projected Risk Adjustment receipt in the projection period of $3.13 PMPM. To arrive at the anticipated risk transfer for 2021, we bring in the risk adjustment calculation components for the projected 2021 Company portfolio (as discussed above), and use our current knowledge of the Pennsylvania Small Group market profile to estimate the risk adjustment components for the entire state Market. This Market‐wide profile is developed from available Market data, including the Interim Summary Report on Risk Adjustment for the 2019 Benefit Year published by CMS, the PA Insurance Department’s calculation of 2019 risk adjustment transfer amounts using the final RATEE files, prior years’ risk adjustment transfer results, publicly available data (such as MLR reports and rate filings), and outside expertise from actuarial consultants.

The Company considered the impact of the high‐cost risk pooling payment for the Small Group market, first implemented in 2018, in its development of its anticipated risk transfer for 2021, and is assuming that the net cost (payments less recoveries) will be negligible for the 2021 projection period.

The Projected Paid Exchange User Fees are developed from the Exchange user fees to be charged by CMS in 2021, multiplied by the percentage of business we expect to purchase Market coverage through the Exchange for this Company. For this Company, all business will be offered Off Exchange in 2021, so there are no Exchange User Fees charged in the rate development.

For this Small Group Market filing, Table 5A has been completed, showing the number of member months renewing by quarter, and the quarterly Single Risk Pool Projected Allowed Claims.

B. RetentionItems(Table6)Table 6 has been completed with the requested retention elements for the proposed rates for the rating period. The administrative expenses and taxes and fees presented in the rate development in Table 6 cell C53 equal the Taxes and Fees in Table 10.

Administrative costs reflect internal costs that the Company is projected to incur in the projected experience period, and are developed from standard expense allocation methods. Agent/broker fees and commissions reflect our anticipated costs for these items in the experience period.

The development of internal administrative costs utilizes an allocation of Company costs back to lines of business. The allocation method uses measureable stats such as claims worked, inquiries worked, contracts, and members to allocate the majority of expenses. When possible, expenses are direct charged if they can be identified by product instead of going through an allocation method. For corporate allocations, a TCI (total costs incurred) methodology is generally used to allocate by product.

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The Health Insurance Provider Fee has been repealed for calendar years beginning after December 31, 2020. As such, a charge for this fee is no longer reflected in the rate development.

In addition, the Patient‐Centered Outcomes Research Institute (PCORI) Fee was extended for an additional 10 years, and will be collected for all 2021 policy years. As such, the taxes and fees reflected in this filing include the anticipated PCORI fee to be collected.

The following Taxes and Fees were included in the rate development:

$0.23 PMPM for the PCORI Fee; and $0.25 PMPM for the Risk Adjustment User Fee

Note the following regarding plan level retention items:

The rate development reflects a 0.00% profit and risk load for all products and plans. The Company has voluntarily refrained from including a profit and risk load in this filing. By this voluntary action, the Company is not waiving any right to include a profit and risk load which the Company believes is consistent with historical and legal interpretations of the Company and the Department.

The administrative expenses as a percentage of expected claims do not vary by plan. Expenses for Quality Improvement Initiatives are estimated to be 7% of internal Company

expenses, based upon historical analysis of these costs.

C. NormalizedMarket‐AdjustedProjectedAllowedTotalClaims(Table7)The normalization factors presented in Table 7 are each determined from the underlying membership demographics expected in the projected rating period. The 2020 values are pulled from the prior year’s filing, while the 2021 values represent our projection for 2021 assumed in the 2021 rate development.

The Age Factor is the weighted average of the Average Age Factors for the Current ACA Book of Business as of the End of Year 2019 and for the Membership Moving to the ACA Book (from transitional and new business).

The Geographic Calibration Factor is the weighted average of the Area Factors by County. This average is weighted by membership.

The Tobacco Surcharge is not applicable since the Company does not use one.

D. ComponentsofRateChange(Tables8and9)Table 8 presents the components of change in the proposed 2021 Calibrated Plan Adjusted Index Rate (PMPM). The 2020 base period allowed claims is carried over from the 2020 rate filing. Row H of Table 8 may differ from Row A due to the detailed breakdown of all the components of the increases in rows B through G not calculating exactly to the change in the calibrated plan adjusted index rate in Row A, which is the more accurate percentage change based on the rate development.

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Table 9 presents the data elements supporting the calculations in Table 8. The amounts shown in the 2020 Column match those entered in the 2020 Column in the plan year 2020 rate filing.

3. PlanRateDevelopment(Table10)Table 10 showing the plan rate development has been completed following the instructions in the 2021 ACA‐Compliant Health Insurance Rate Filing Guidance. This table shows the plans that the Company intends to offer in 2021, as well as plans discontinued from the 2020 portfolio for 2021. Since many Small Group market enrollees as of 2/1/2020 are still in plan year 2019 plans, the enrollees in plan year 2019 plans were mapped to the plan year 2020 plan that we anticipate they will renew into in 2020. The calibrated plan adjusted index rates for 2021 and 2020, and all of the supporting factors, are calculated according to the instructions.

Each plan takes the Market Adjusted Index Rate and multiplies by the Pricing AV, Benefit Richness Factor, Benefits in Addition to EHB Factor, Provider Network Factor, Catastrophic Eligibility Factor, and Non‐Funding of CSR Adjustment Factor (not applicable to Small Group) in order to calculate the Pure Premium. The Pure Premium is then grossed up to account for expenses (Admin Costs, Taxes & Fees, and Profit or Contingency) in order to calculate the Calibrated Plan Adjusted Index Rate. Since each component of the Calibrated Plan Adjusted Index Rate is applied multiplicatively (including the Plan AV Pricing Value), plan premiums are in proportion to the Plan AV Pricing Values.

Note that the HHS Actuarial Value Calculator was able to accommodate all of the Company’s benefit designs, and that no adjustments were needed from the values produced by the calculator.

The requested Induced Utilization Exhibit was completed and is presented within the “2021 Supplemental Exhibits ‐ HMK.xlsx” file submitted with this filing (worksheet named “Induced Utilization”). Note that the calculated Induced Utilization factor in Column (8) is a component of the Actuarial Value Allowable Modifier. As such, it is adjusted by the Average Benefit Richness normalization factor of 1.115. In multiplying the Induced Utilization column (8) result by the Average Benefit Richness normalization factor, the result is the Induced Utilization factor appropriate for the plan’s metal level (before normalization). These induced demand factors are consistent with the methodology described in the Department’s rate filing guidance, which utilizes each plan’s actuarial value to establish the appropriate induced demand factor for the plan.

The member‐weighted average of the pure plan‐level Induced Utilization factors in the last column of the induced utilization exhibit against the projected membership does match the 1.000 expectation of the Department. This calculation can be seen at the bottom of the Induced Utilization Exhibit, where the formulas used in the calculation have been retained.

The Child Capping Adjustment is applied to the Age Calibration Factor in Table 10 to reflect the limitation on the number of children allowed in rating. This factor is determined by estimating the amount of lost revenue due to this restriction, and applying the resulting factor to the normalized age factor in the base rate development. Support for the calibration factors is shown in the “2021 Supplemental Exhibits ‐ HMK.xlsx” file on the worksheet named “Table 10 Calibration Factors”.

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4. PlanPremiumDevelopmentfor21‐Year‐OldNon‐TobaccoUser(Table11)

Table 11 presents the Company’s 21‐year‐old non‐tobacco premium in the Market for each rating quarter in 2021. As mentioned in Section 1.C above, the change in 21‐year‐old non‐tobacco premium PMPM calculated in this table is a 2.1% increase, while the “percent rate change requested” from the SERFF Rate Review Detail Screen (and Table 10) is 1.6%.

5. PlanFactors

A. AgeandTobaccoFactors(Table12)Please see Table 12 for the Company’s age and tobacco factors.

B. GeographicFactors(Table13)Please see Table 13 for the Company’s geographic factors. The Company’s factors for the rating period are unchanged from the currently approved factors.

As mentioned in the Cover Letter, the Company is not changing its product offerings by Rating Area.

C. NetworkFactors(Table14)Please see Table 14 for the Company’s network rating factors.

D. ServiceAreaCompositionThe Company follows the Rating Area designations created by the state. All counties within a Rating Area are serviced by the Company, according to the Rating Areas specified in Table 14. The Company has submitted its current 2020 service area and its proposed 2021 service area in the file “Pennsylvania Counties Map ‐ 2021 Filings ‐ HMK.pdf” submitted with this filing. Service zone L has been added for the Company’s 2021 rate filing.

E. CompositeRatingThe Company is currently not planning to use CMS’s composite rating method for any of its off‐SHOP plans offered during the rating period.

6. ActuarialCertificationsIam a member of the American Academy of Actuaries and meet its qualification standards for actuaries issuing statements of actuarial opinions in the United States. This filing is prepared on behalf of the Company to accompany its rate filing (for calendar year 2021) for the Small Group Market off the Pennsylvania Exchange.

I hereby certify that the projected index rate is, to the best of my knowledge and understanding:

In compliance with all applicable State and Federal Statutes and Regulations (45 CFR 156.80 and 147.102)

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Developed in compliance with the applicable Actuarial Standards of Practice Reasonable in relation to the benefits provided and the population anticipated to be covered Neither excessive nor deficient.

I certify that the Index Rate and only the allowable modifiers as described in 45 CFR 156.80(d)(1) and 45 CFR 156.80(d)(2) were used to generate plan level rates.

I certify that all factor, benefit and other changes from the prior approved filing have been disclosed in the 2021 PA Actuarial Memorandum Rate Exhibits.

I certify that new plans are not considered modifications of existing plans (per the uniform modification standards in 45 CFR 147.106).

I certify that the geographic rating factors reflect only differences in the costs of delivery (which can include unit cost and provider practice pattern differences) and do not include differences for population morbidity by geographic area.

I certify that the AV Calculator was used to determine the AV Metal Values shown in Part I of Worksheet 2 in the URRT for all plans.

The Unified Rate Review Template does not demonstrate the process used by the Company to develop the rates. Rather, it represents information required by Federal regulation to be provided in support of the review of rate increases, for certification of Qualified Health Plans for Federally‐facilitated Exchanges, and for certification that the Index Rate is developed in accordance with Federal regulation and used consistently and only adjusted by the allowable modifiers.

I certify that the information presented in the PA Actuarial Memorandum and PA Actuarial Memorandum Rate Exhibits is consistent with the information presented in the 2021 Rate Filing Justification.

Signed: [Redacted]

Date: 07/20/2020

Attachment I

Rate Change Summary

Highmark, Inc. – Small Group Plans Rate request filing ID # HGHM‐132381011 ‐ This document is prepared by the insurance company submitting the rate filing as a consumer tool to help explain the rate filing. It is not intended to describe or include all factors or information considered in the review process. For more information, see the filing at http://www.insurance.pa.gov/Consumers/ACARelatedFilings/

Overview Initial requested average rate change: 1.59%1 Revised requested average rate change: N/A1

Range of requested rate change: ‐0.69% to 7.10% Effective date: January 1, 2021 Mapped Members: 7,275 Available in: Rating Areas 1,2,4,5,6,7,9

Key information Jan. 2019‐Dec. 2019 financial experience

The company expects its annual medical costs to increase 9.6%.

Explanation of requested rate change The proposed increases are being driven by rising medical care costs, which are expected to continue through the remainder of 2020 and throughout 2021 as a result of both higher utilization and the increasing cost of healthcare services, and the underlying morbidity of the population within Highmark’s ACA products.

1 Note that insurers will have the opportunity to revise their rate change request in July, after they are scheduled to receive updated information about the impact of a federal program called risk adjustment. This document will be updated accordingly at that time.

How it plans to spend your premiumThis is how the insurance company plans tospend the premium it collects in 2021:

Claims:Administrative: Taxes & fees: Profit:

89.92%9.99% 0.09% 0.00%

Premiums $57,205,824

Claims $47,568,246

Administrative expenses $7,304,471

Taxes & fees $40,033

Company made (after taxes) $2,290,074

PA Rate Template Part I

Data Relevant to the Rate Filing

Table 0. Identifying Information

Carrier Name: Highmark, Inc.Product(s): PPOMarket Segment: Small GroupRate Effective Date: 01/01/2021 to 12/31/2021Base Period Start Date: 01/01/2019 to 12/31/2019Date of Most Recent Membership: 02/01/2020

Table 1. Number of Members

Member-months Members Member-months

Experience PeriodCurrent Period

(as of 02-01-2020)Projected Rating Period

Average Age 37.0 36.7 37.7

Total 113,775 7,275 89,736

Carrier Name: Highmark, Inc.Product(s): PPOMarket Segment: Small GroupRate Effective Date: 01/01/2021

Table 2b. Manual Experience Period Claims and Premiums

Earned Premium Paid Claims Ultimate Incurred Claims Member MonthsEstimated Cost Sharing

(Member & HHS)Allowed Claims (Non-Capitated)

Non-EHB portion of Allowed

ClaimsTotal Prescription Drug Rebates* Total EHB Capitation Total Non-EHB Capitation Estimated Risk Adjustment

Estimated Reinsurance

Recoveries$0.00 $0.00

Experience Period Total Allowed EHB Claims + EHB Capitation PMPM (net of prescription drug rebates) -$

Loss Ratio 0.00%

*Express Prescription Drug Rebates as a negative number

Table 3b. Manual Trend Components

Cost* Utilization* Induced Demand* Composite Trend Weight*

0.00%0.00%0.00%0.00%

0.00%

0.00% 0.00%

24

1.000* Express Cost, Utilization, Induced Utilization and Weight as percentages

Table 4b. Historical Manual Experience

Month-Year Total Annual Premium Incurred Claims Completion Factors* Ultimate Incurred Claims Members Ultimate Incurred PMPMEstimated Annual Cost Sharing

(Member + HHS)Prescription Drug Rebates**

Allowed Claims (Net of

Prescription Drug Rebates)Allowed PMPM

Jan-16 $63,941,455.53 1.0000 $ 63,940,208.88 195,769 $ 326.61 ($1,356,137.60) $76,425,344.10 $ 390.39Feb-16 $63,127,614.76 1.0000 $ 63,130,025.03 195,124 $ 323.54 ($1,351,885.75) $73,310,757.79 $ 375.71

Mar-16 $66,897,739.20 1.0000 $ 66,900,621.32 194,739 $ 343.54 ($1,350,163.03) $77,712,628.97 $ 399.06Apr-16 $67,937,581.88 1.0000 $ 67,939,158.09 193,358 $ 351.36 ($1,339,487.65) $78,425,908.91 $ 405.60

May-16 $64,695,923.69 1.0000 $ 64,699,146.57 192,301 $ 336.45 ($1,332,429.14) $74,193,498.31 $ 385.82Jun-16 $64,144,162.88 1.0000 $ 64,147,250.75 191,752 $ 334.53 ($1,329,112.51) $73,194,752.46 $ 381.72Jul-16 $65,330,187.78 0.9999 $ 65,333,492.97 187,281 $ 348.85 ($1,295,439.96) $74,945,747.68 $ 400.18

Aug-16 $62,136,187.93 0.9999 $ 62,139,966.50 186,892 $ 332.49 ($1,293,436.54) $70,917,233.20 $ 379.46Sep-16 $63,828,365.05 0.9999 $ 63,834,615.85 185,980 $ 343.23 ($1,288,272.71) $72,662,919.36 $ 390.70Oct-16 $73,619,330.59 0.9999 $ 73,625,089.38 183,897 $ 400.36 ($1,274,099.16) $82,710,784.08 $ 449.77Nov-16 $65,423,312.09 0.9999 $ 65,429,866.38 182,039 $ 359.43 ($1,261,611.00) $73,489,476.47 $ 403.70

Dec-16 $50,509,021.55 0.9999 $ 50,514,995.95 155,936 $ 323.95 ($1,076,410.39) $61,649,951.22 $ 395.35

Jan-17 $50,299,506.10 0.9999 $ 50,305,766.78 148,910 $ 337.83 ($1,198,800.07) $60,728,600.39 $ 407.82Feb-17 $46,941,660.07 0.9999 $ 46,948,651.15 147,485 $ 318.33 ($1,187,373.20) $55,878,924.31 $ 378.88

Mar-17 $52,243,703.37 0.9998 $ 52,253,085.81 146,458 $ 356.78 ($1,179,193.80) $61,536,362.04 $ 420.16Apr-17 $48,555,119.55 0.9998 $ 48,565,851.47 144,861 $ 335.26 ($1,166,181.17) $56,989,787.16 $ 393.41

May-17 $46,795,316.83 0.9997 $ 46,809,101.43 144,318 $ 324.35 ($1,161,771.49) $54,369,238.18 $ 376.73Jun-17 $48,990,550.34 0.9996 $ 49,009,204.99 143,690 $ 341.08 ($1,156,986.70) $56,901,173.21 $ 396.00Jul-17 $49,398,471.97 0.9995 $ 49,425,471.25 141,240 $ 349.94 ($1,136,715.38) $57,359,036.33 $ 406.11

Aug-17 $45,298,780.54 0.9992 $ 45,334,981.68 140,453 $ 322.78 ($1,130,481.58) $52,536,245.95 $ 374.05Sep-17 $49,204,969.14 0.9991 $ 49,249,652.13 139,786 $ 352.32 ($1,125,476.66) $56,261,319.30 $ 402.48Oct-17 $50,343,185.61 0.9990 $ 50,395,775.03 136,899 $ 368.12 ($1,102,666.03) $57,648,343.67 $ 421.10Nov-17 $48,434,109.71 0.9987 $ 48,499,365.71 135,529 $ 357.85 ($1,092,087.90) $55,279,086.25 $ 407.88

Dec-17 $37,882,445.78 0.9984 $ 37,942,705.96 119,708 $ 316.96 ($968,513.87) $46,507,748.82 $ 388.51

Jan-18 $35,851,012.54 0.9967 $ 35,970,402.08 115,355 $ 311.82 ($1,059,753.41) $43,216,878.35 $ 374.64Feb-18 $39,096,921.17 0.9957 $ 39,266,208.74 114,159 $ 343.96 ($1,049,341.76) $46,213,492.33 $ 404.82

Mar-18 $39,271,994.81 0.9939 $ 39,512,693.03 112,315 $ 351.80 ($1,033,281.70) $46,475,063.82 $ 413.79Apr-18 $36,906,088.95 0.9928 $ 37,174,742.73 110,392 $ 336.75 ($1,015,751.61) $42,912,024.23 $ 388.72

May-18 $36,035,090.28 0.9901 $ 36,395,700.27 108,518 $ 335.39 ($999,675.37) $41,937,321.61 $ 386.45Jun-18 $38,618,369.54 0.9884 $ 39,070,338.09 106,994 $ 365.16 ($986,642.43) $44,465,153.33 $ 415.59Jul-18 $33,983,924.56 0.9861 $ 34,462,901.28 104,072 $ 331.14 ($959,357.32) $39,322,193.31 $ 377.84

Aug-18 $38,740,821.57 0.9797 $ 39,542,202.61 103,112 $ 383.49 ($950,941.30) $44,828,081.40 $ 434.75Sep-18 $35,616,267.57 0.9727 $ 36,614,550.37 102,092 $ 358.64 ($942,268.87) $41,410,500.25 $ 405.62Oct-18 $35,156,572.70 0.9569 $ 36,738,505.89 100,287 $ 366.33 ($926,210.35) $41,596,501.73 $ 414.77Nov-18 $35,224,728.06 0.9314 $ 37,819,996.57 99,299 $ 380.87 ($917,595.89) $42,549,962.56 $ 428.50

Dec-18 $24,884,347.56 0.8308 $ 29,953,408.44 88,996 $ 336.57 ($824,964.71) $36,663,159.26 $ 411.96

Jan-19 #DIV/0! #DIV/0! #DIV/0!Feb-19 #DIV/0! #DIV/0! #DIV/0!

Mar-19 #DIV/0! #DIV/0! #DIV/0!Apr-19 #DIV/0! #DIV/0! #DIV/0!

May-19 #DIV/0! #DIV/0! #DIV/0!Jun-19 #DIV/0! #DIV/0! #DIV/0!Jul-19 #DIV/0! #DIV/0! #DIV/0!

Aug-19 #DIV/0! #DIV/0! #DIV/0!Sep-19 #DIV/0! #DIV/0! #DIV/0!Oct-19 #DIV/0! #DIV/0! #DIV/0!Nov-19 #DIV/0! #DIV/0! #DIV/0!

Dec-19 #DIV/0! #DIV/0! #DIV/0!* Express Completion Factor as a percentage**Express Prescription Drug Rebates as a negative number

$541,452,302.85 $69,068,682.09

Prescription Drugs

Total Annual Trend

Months of Trend

Total Applied Trend Projection Factor

$672,154,095.30 $97,256,252.19

$812,034,612.95 $118,004,564.89

Capitation

Service Category

Inpatient HospitalOutpatient HospitalProfessionalOther Medical

Continuance Table for Calculating Reinsurance Impact - Individual Market Only, Experience Period Information

Carrier Name: Highmark, Inc. Attachment Point: $60,000

Product(s): PPO Reinsurance Cap: $100,000

Market Segment: Small Group Coinsurance Rate: 60%

Rate Effective Date: 01/01/2021

Incurred Dates: 1/1/2019 to 12/31/2019 Proj. Incurred Claim Impact: 0.0%

Unique Members Member Months Total Incurred Claims

Total Incurred Claims with

Reinsurance

$0 $29,999 $0

$30,000 $34,999 $0

$35,000 $39,999 $0

$40,000 $44,999 $0

$45,000 $49,999 $0

$50,000 $54,999 $0

$55,000 $59,999 $0

$60,000 $64,999 $0

$65,000 $69,999 $0

$70,000 $74,999 $0

$75,000 $79,999 $0

$80,000 $84,999 $0

$85,000 $89,999 $0

$90,000 $94,999 $0

$95,000 $99,999 $0

$100,000 $109,999 $0

$110,000 $119,999 $0

$120,000 $129,999 $0

$130,000 $139,999 $0

$140,000 $149,999 $0

$150,000 $159,999 $0

$160,000 $169,999 $0

$170,000 $179,999 $0

$180,000 $189,999 $0

$190,000 $199,999 $0

$200,000 $209,999 $0

$210,000 $219,999 $0

$220,000 $229,999 $0

$230,000 $239,999 $0

$240,000 $249,999 $0

$250,000 $259,999 $0

$260,000 $269,999 $0

$270,000 $279,999 $0

$280,000 $289,999 $0

$290,000 $299,999 $0

$300,000 $324,999 $0

$325,000 $349,999 $0

$350,000 $374,999 $0

$375,000 $399,999 $0

$400,000 $424,999 $0

$425,000 $449,999 $0

$450,000 $474,999 $0

$475,000 $499,999 $0

$500,000 $599,999 $0

$600,000 $699,999 $0

$700,000 $799,999 $0

$800,000 $899,999 $0

$900,000 $999,999 $0

$1,000,000+ $0

Total 0 0 $0 $0

Individual ACA Compliant Policies Only: Incurred Dates 1/1/2019 to 12/31/2019

Annual Incurred Claims Range

Continuance Table for Calculating Reinsurance Impact - Individual Market Only, Projection Period Information

Carrier Name: Highmark, Inc. Attachment Point: $60,000

Product(s): PPO Reinsurance Cap: $100,000

Market Segment: Small Group Coinsurance Rate: 60%

Rate Effective Date: 01/01/2021

Proj. Incurred Claim Impact: 0.0%

Proj. Morbidity Impact: -0.1%

Unique Members Member Months Total Incurred Claims

Total Incurred Claims with

Reinsurance

$0 $29,999 $0

$30,000 $34,999 $0

$35,000 $39,999 $0

$40,000 $44,999 $0

$45,000 $49,999 $0

$50,000 $54,999 $0

$55,000 $59,999 $0

$60,000 $64,999 $0

$65,000 $69,999 $0

$70,000 $74,999 $0

$75,000 $79,999 $0

$80,000 $84,999 $0

$85,000 $89,999 $0

$90,000 $94,999 $0

$95,000 $99,999 $0

$100,000 $109,999 $0

$110,000 $119,999 $0

$120,000 $129,999 $0

$130,000 $139,999 $0

$140,000 $149,999 $0

$150,000 $159,999 $0

$160,000 $169,999 $0

$170,000 $179,999 $0

$180,000 $189,999 $0

$190,000 $199,999 $0

$200,000 $209,999 $0

$210,000 $219,999 $0

$220,000 $229,999 $0

$230,000 $239,999 $0

$240,000 $249,999 $0

$250,000 $259,999 $0

$260,000 $269,999 $0

$270,000 $279,999 $0

$280,000 $289,999 $0

$290,000 $299,999 $0

$300,000 $324,999 $0

$325,000 $349,999 $0

$350,000 $374,999 $0

$375,000 $399,999 $0

$400,000 $424,999 $0

$425,000 $449,999 $0

$450,000 $474,999 $0

$475,000 $499,999 $0

$500,000 $599,999 $0

$600,000 $699,999 $0

$700,000 $799,999 $0

$800,000 $899,999 $0

$900,000 $999,999 $0

$1,000,000+ $0

Total 0 0 $0 $0

Reinsurance Program Impact Continuance Table Development - Plan Year 2021

Annual Incurred Claims Range

PA Rate Template Part IIRate Development and ChangeCarrier Name: Highmark, Inc.Product(s): PPOMarket Segment: Small GroupRate Effective Date: 01/01/2021

Table 5. Development of the Projected Index Rate, Market-Adjusted Index Rate, and Total Allowed Claims

Development of the Projected Index RateActual Experience

DataManual Data

Total Allowed EHB Claims + EHB Capitation PMPM (net of prescription drug rebates) PMPM 485.19$ -$

PA Rate Template Part IIITable 10. Plan Rates

Age Calibration Factor 1.514

Carrier Name: Highmark, Inc. Geographic Calibration Factor 0.971Product(s): PPO Tobacco Calibration Factor 1.000Market Segment: Small Group Aggregate Calibration Factor 1.470Rate Effective Date: 01/01/2021Base Period Start Date 01/01/2019Date of Most Recent Membership: 02/01/2020Market Adjusted Index Rate: 594.74$

Plan Number

HIOS Plan ID

(Standard

Component)

Plan Type

(HMO, POS, PPO, EPO,

Indemnity, Other)

1/1/2020 Plan

Marketing Name

Existing, Modified,

New, Discontinued

& Mapped,

Discontinued & Not

Mapped (E,M,N,DM,

DNM) for 2021

1/1/2021 HIOS Plan ID

(If 1/1/2020 Plan

Discontinued &

Mapped)

Metallic

Tier

Metallic

Tier

Actuarial

Value

Standard AV,

Approach (1),

Approach (2)

Exchange

On/Off or

Off

Pricing AV

(company-

determined

AV)

Benefit

Richness

(induced

demand)

Benefits in

addition to

EHB

Provider

Network

Catastrophic

Eligibility

Non-Funding

of CSR

Adjustment Pure Premium Admin Costs

Taxes & Fees (not

including

Exchange fees)

Profit or

Contingency

Total

Covered Lives

Mapped into

2021 Plans @ 02-

01-2020

Total Projected

Lives

2020 Calibrated

Plan Adjusted

Index Rate

PMPM

2021

Calibrated Plan

Adjusted Index

Rate PMPM

Proposed

Rate Change

Compared to

Prior 12

months

% of Total

Covered Lives 1 2 3 4 5 6 7 8 9 Total

2021

Continued/

Discontinued

Plans

Indicator

Totals - Current Membership 0.825 0.854 1.003 1.000 1.014 1.000 1.000 517.96$ 10.0% 0.1% 0.0% 7,275 7,478 385.79$ 391.94$ 1.6% 1,055 32 - 5,895 224 69 - - - 7,275

Total - Projected Membership 0.821 0.848 1.000 1.000 0.999 1.000 1.000 506.42$ 10.0% 0.1% 0.0% 0

Transitional Plans TRANSITIONAL N/A TRANSITIONAL DNM TRANSITIONAL 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 - 0

Plan 1 33709PA0560032 PPO

Premier Balance PPO $0 Platinum a

Community Blue Plan M 33709PA0560032 Platinum 0.91993795 Standard Off 0.935 1.058 1.000 1.014 1.000 1.000 $597.03 10.0% 0.1% 0.0% 314 1,276 $449.94 451.77$ 0.4% 4.3% 23 - - 291 - - - - - 314 1

Plan 2 33709PA0560033 PPO

Premier Balance PPO $250

Platinum a Community Blue Plan M 33709PA0560033 Platinum 0.90528777 Standard Off 0.931 1.054 1.000 1.014 1.000 1.000 $591.96 10.0% 0.1% 0.0% 41 328 $440.30 447.94$ 1.7% 0.6% 4 - - 37 - - - - - 41 1

Plan 3 33709PA0560043 PPO

Premier Balance PPO $0 Gold a

Community Blue Plan M 33709PA0560043 Gold 0.80219114 Standard Off 0.865 1.007 1.000 1.014 1.000 1.000 $525.74 10.0% 0.1% 0.0% 61 449 $386.31 397.82$ 3.0% 0.8% 24 - - 37 - - - - - 61 1

Plan 4 33709PA0560034 PPO

Premier Balance PPO $250 Gold a


Plan 5 33709PA0560035 PPO

Premier Balance PPO $500 a

Community Blue Plan M 33709PA0560035 Gold 0.80572247 Standard Off 0.855 1.001 1.000 1.014 1.000 1.000 $515.93 10.0% 0.1% 0.0% 178 1,117 $380.57 390.40$ 2.6% 2.4% 75 - - 103 - - - - - 178 1

Plan 6 33709PA0560036 PPO


Community Blue Plan M 33709PA0560036 Gold 0.80878642 Standard Off 0.851 0.998 1.000 1.014 1.000 1.000 $512.81 10.0% 0.1% 0.0% 68 205 $378.89 388.04$ 2.4% 0.9% - - - 68 - - - - - 68 1

Plan 7 33709PA0560037 PPO



Plan 8 33709PA0560038 PPO



Plan 9 33709PA0560040 PPO



Plan 10 33709PA0560041 PPO



Plan 11 33709PA0560039 PPO



Plan 12 33709PA0560042 PPO

Premier Balance PPO $5000 1x a


Plan 13 33709PA0570014 PPO

Balance PPO $1000 a Community

Blue Plan M 33709PA0570014 Gold 0.78762925 Standard Off 0.800 0.969 1.000 1.014 1.000 1.000 $467.69 10.0% 0.1% 0.0% 7 20 $355.10 353.90$ -0.3% 0.1% - - - 7 - - - - - 7 1

Plan 14 33709PA0570015 PPO



Plan 15 33709PA0570016 PPO



Plan 16 33709PA0450005 PPO

Health Savings PPO $1500 a


Plan 17 33709PA0640006 PPO

Health Savings PPO Embedded

$2800 a Community Blue Plan M 33709PA0640006 Silver 0.71851443 Standard Off 0.766 0.951 1.000 1.014 1.000 1.000 $439.41 10.0% 0.1% 0.0% 45 73 $322.57 332.50$ 3.1% 0.6% 9 - - 36 - - - - - 45 1

Plan 18 33709PA0640007 PPO


$3700 a Community Blue Plan M 33709PA0640007 Silver 0.71878742 Standard Off 0.749 0.944 1.000 1.014 1.000 1.000 $426.63 10.0% 0.1% 0.0% 36 54 $320.32 322.83$ 0.8% 0.5% - - - 36 - - - - - 36 1

Plan 19 33709PA1110001 EPO

Premier Balance EPO $250 a


Plan 20 33709PA1110002 EPO


Community Blue Plan M 33709PA1110002 Gold 0.81368295 Standard Off 0.842 0.993 1.000 0.972 1.000 1.000 $483.20 10.0% 0.1% 0.0% 26 94 $366.08 365.63$ -0.1% 0.4% - - - 26 - - - - - 26 1

Plan 21 33709PA1110003 EPO



Plan 22 33709PA1110004 EPO



Plan 23 33709PA1110005 EPO



Plan 24 33709PA1110006 EPO



Plan 25 33709PA0440016 PPO

Premier Balance PPO $250 IP a

Community Blue Plan M 33709PA0440016 Gold 0.79943655 Standard Off 0.859 1.004 1.000 1.064 1.000 1.000 $545.59 10.0% 0.1% 0.0% 20 147 $401.66 412.84$ 2.8% 0.3% - - - - 20 - - - - 20 1

Plan 26 33709PA0440017 PPO


Community Blue Plan M 33709PA0440017 Gold 0.80455512 Standard Off 0.847 0.996 1.000 1.064 1.000 1.000 $533.64 10.0% 0.1% 0.0% 34 61 $394.90 403.81$ 2.3% 0.5% 8 14 - - 8 4 - - - 34 1

Plan 27 33709PA0440018 PPO


Community Blue Plan M 33709PA0440018 Gold 0.79846805 Standard Off 0.808 0.973 1.000 1.064 1.000 1.000 $497.01 10.0% 0.1% 0.0% 18 40 $374.47 376.08$ 0.4% 0.2% - - - - 14 4 - - - 18 1

Plan 28 33709PA0570017 PPO


Blue Plan M 33709PA0570017 Silver 0.71985127 Standard Off 0.742 0.940 1.000 1.014 1.000 1.000 $421.01 10.0% 0.1% 0.0% 14 113 $310.55 318.58$ 2.6% 0.2% - - - 14 - - - - - 14 1

Plan 29 33709PA0570018 PPO


Blue Plan M 33709PA0570018 Silver 0.71753252 Standard Off 0.722 0.932 1.000 1.014 1.000 1.000 $405.78 10.0% 0.1% 0.0% 33 78 $302.74 307.05$ 1.4% 0.5% 3 - - 30 - - - - - 33 1

Plan 30 33709PA0570019 PPO

Balance PPO $5000 1x a Community

Blue Plan M 33709PA0570019 Silver 0.71918335 Standard Off 0.736 0.938 1.000 1.014 1.000 1.000 $416.70 10.0% 0.1% 0.0% 26 48 $294.41 315.32$ 7.1% 0.4% - - - 26 - - - - - 26 1

Plan 31 33709PA1030001 PPO

Conemaugh Region Flex Blue PPO

$500 M 33709PA1030001 Gold 0.80060612 Standard Off 0.843 0.993 1.000 1.025 1.000 1.000 $510.28 10.0% 0.1% 0.0% - 24 $384.08 386.12$ 0.5% 0.0% - - - - - - - - - - 1

Plan 32 33709PA1100001 PPO

Conemaugh Region Flex Blue PPO

$2800Q M 33709PA1100001 Silver 0.71701696 Standard Off 0.760 0.948 1.000 1.025 1.000 1.000 $439.37 10.0% 0.1% 0.0% - 24 $324.71 332.47$ 2.4% 0.0% - - - - - - - - - - 1

Plan 33 33709PA0920001 PPO

Health Savings Flex PPO Embedded

$6100 a Community Blue Plan M 33709PA0920001 Bronze 0.64982592 Standard Off 0.683 0.918 1.000 1.068 1.000 1.000 $397.94 10.0% 0.1% 0.0% - 24 $300.56 301.12$ 0.2% 0.0% - - - - - - - - - - 1

Plan 34 33709PA0640011 PPO


$5500 a Community Blue Plan N 33709PA0640011 Silver 0.66042826 Standard Off 0.685 0.918 1.000 1.014 1.000 1.000 $379.33 10.0% 0.1% 0.0% - 24 $0.00 287.04$ 0.0% 0.0% - - - - - - - - - - 1

Plan 35 33709PA0640012 PPO



Plan 36 33709PA0640013 PPO



Plan 37 33709PA0560044 PPO


Community Blue Plan N 33709PA0560044 Gold 0.81339437 Standard Off 0.805 0.971 1.000 1.014 1.000 1.000 $471.67 10.0% 0.1% 0.0% - 24 $0.00 356.91$ 0.0% 0.0% - - - - - - - - - - 1

Plan 38 33709PA0560045 PPO


Community Blue Plan N 33709PA0560045 Gold 0.78519675 Standard Off 0.799 0.968 1.000 1.014 1.000 1.000 $466.75 10.0% 0.1% 0.0% - 24 $0.00 353.19$ 0.0% 0.0% - - - - - - - - - - 1

Plan 39 33709PA0560046 PPO


Community Blue Plan N 33709PA0560046 Silver 0.71160213 Standard Off 0.724 0.933 1.000 1.014 1.000 1.000 $407.54 10.0% 0.1% 0.0% - 24 $0.00 308.38$ 0.0% 0.0% - - - - - - - - - - 1

Plan 40 33709PA0640014 PPO


$6850 a Community Blue Plan N 33709PA0640014 Bronze 0.64944916 Standard Off 0.667 0.913 1.000 1.014 1.000 1.000 $367.17 10.0% 0.1% 0.0% - 24 $0.00 277.84$ 0.0% 0.0% - - - - - - - - - - 1

Plan 41 33709PA0640015 PPO


$6850 a Community Blue Plan N 33709PA0640015 Bronze 0.64944916 Standard Off 0.667 0.913 1.000 1.064 1.000 1.000 $384.95 10.0% 0.1% 0.0% - 24 $0.00 291.29$ 0.0% 0.0% - - - - - - - - - - 1

Plan 42 33709PA1190001 EPO Together Blue EPO Platinum $250 N 33709PA1190001 Platinum 0.89624302 Standard Off 0.906 1.036 1.000 0.768 1.000 1.000 $429.07 10.0% 0.1% 0.0% - 44 $0.00 324.68$ 0.0% 0.0% - - - - - - - - - - 1

Plan 43 33709PA1190002 EPO Together Blue EPO $0 N 33709PA1190002 Gold 0.81938771 Standard Off 0.866 1.008 1.000 0.768 1.000 1.000 $398.70 10.0% 0.1% 0.0% - 44 $0.00 301.69$ 0.0% 0.0% - - - - - - - - - - 1




Plan 47 33709PA1190006 EPO Together Blue EPO $2500 1x N 33709PA1190006 Gold 0.79487912 Standard Off 0.778 0.957 1.000 0.768 1.000 1.000 $340.03 10.0% 0.1% 0.0% - 44 $0.00 257.30$ 0.0% 0.0% - - - - - - - - - - 1

Plan 48 33709PA1190007 EPO Together Blue EPO $5000 1x N 33709PA1190007 Gold 0.78964858 Standard Off 0.742 0.940 1.000 0.768 1.000 1.000 $318.72 10.0% 0.1% 0.0% - 44 $0.00 241.17$ 0.0% 0.0% - - - - - - - - - - 1

Plan 49 33709PA1190008 EPO Together Blue EPO $2000 N 33709PA1190008 Silver 0.71774439 Standard Off 0.688 0.919 1.000 0.768 1.000 1.000 $288.92 10.0% 0.1% 0.0% - 44 $0.00 218.62$ 0.0% 0.0% - - - - - - - - - - 1

Plan 50 33709PA1200001 EPO

Together Blue EPO Embedded

Q$3650 N 33709PA1200001 Silver 0.71214225 Standard Off 0.694 0.922 1.000 0.768 1.000 1.000 $292.40 10.0% 0.1% 0.0% - 44 $0.00 221.26$ 0.0% 0.0% - - - - - - - - - - 1

Plan 51 33709PA1200002 EPO

Together Blue EPO Embedded

Q$6650 N 33709PA1200002 Bronze 0.64943893 Standard Off 0.590 0.895 1.000 0.768 1.000 1.000 $241.54 10.0% 0.1% 0.0% - 44 $0.00 182.77$ 0.0% 0.0% - - - - - - - - - - 1

Plan 52 33709PA0440009 PPO

Premier Balance PPO $750 IP A a

Community Blue Flex Plan DM 33709PA0440017 Gold 0.80455512 Standard Off 0.847 0.996 1.000 1.064 1.000 1.000 $533.64 10.0% 0.1% 0.0% 24 - $394.90 403.81$ 2.3% 0.3% - - - - 24 - - - - 24 1

Plan 53 33709PA0440014 PPO


Community Blue Flex Plan DM 33709PA0440016 Gold 0.79943655 Standard Off 0.859 1.004 1.000 1.064 1.000 1.000 $545.59 10.0% 0.1% 0.0% 135 - $401.66 412.84$ 2.8% 1.9% 14 - - - 62 59 - - - 135 1

Plan 54 33709PA0440015 PPO


Community Blue Flex Plan DM 33709PA0440018 Gold 0.79846805 Standard Off 0.808 0.973 1.000 1.064 1.000 1.000 $497.01 10.0% 0.1% 0.0% 24 - $374.47 376.08$ 0.4% 0.3% - 12 - - 12 - - - - 24 1

Plan 55 33709PA0450004 PPO

Health Savings PPO $1500 a

Community Blue Flex Plan DM 33709PA0450005 Gold 0.81914412 Standard Off 0.825 0.983 1.000 1.014 1.000 1.000 $489.29 10.0% 0.1% 0.0% 80 - $367.15 370.24$ 0.8% 1.1% - - - 80 - - - - - 80 1

Plan 56 33709PA0460008 PPO

Flex PPO PA Mountains Healthcare

Region $500/$1500 a Community

Blue Plan DM 33709PA0440017 Gold 0.80455512 Standard Off 0.847 0.996 1.000 1.064 1.000 1.000 $533.64 10.0% 0.1% 0.0% 6 - $394.90 403.81$ 2.3% 0.1% - 6 - - - - - - - 6 1

Plan 57 33709PA0560007 PPO

Premier Balance PPO $0 Platinum A

a Community Blue Flex Plan DM 33709PA0560032 Platinum 0.91993795 Standard Off 0.935 1.058 1.000 1.014 1.000 1.000 $597.03 10.0% 0.1% 0.0% 1,030 - $449.94 451.77$ 0.4% 14.2% 57 - - 973 - - - - - 1,030 1

Plan 58 33709PA0560009 PPO

Premier Balance PPO $250

Platinum A a Community Blue Flex

Plan DM 33709PA0560033 Platinum 0.90528777 Standard Off 0.931 1.054 1.000 1.014 1.000 1.000 $591.96 10.0% 0.1% 0.0% 304 - $440.30 447.94$ 1.7% 4.2% 102 - - 202 - - - - - 304 1

Plan 59 33709PA0560011 PPO

Premier Balance PPO $0 Gold A a

Community Blue Flex Plan DM 33709PA0560043 Gold 0.80219114 Standard Off 0.865 1.007 1.000 1.014 1.000 1.000 $525.74 10.0% 0.1% 0.0% 411 - $386.31 397.82$ 3.0% 5.6% 12 - - 399 - - - - - 411 1

Plan 60 33709PA0560013 PPO

Premier Balance PPO $250 Gold A a


Plan 61 33709PA0560015 PPO

Premier Balance PPO $500 A a

Community Blue Flex Plan DM 33709PA0560035 Gold 0.80572247 Standard Off 0.855 1.001 1.000 1.014 1.000 1.000 $515.93 10.0% 0.1% 0.0% 997 - $380.57 390.40$ 2.6% 13.7% 167 - - 796 34 - - - - 997 1

Plan 62 33709PA0560017 PPO



Plan 63 33709PA0560019 PPO



Plan 64 33709PA0560021 PPO



Plan 65 33709PA0560023 PPO



Plan 66 33709PA0560027 PPO


Community Blue Flex Plan DM 33709PA0560041 Gold 0.81552664 Standard Off 0.814 0.976 1.000 1.014 1.000 1.000 $479.32 10.0% 0.1% 0.0% 248 - $360.45 362.70$ 0.6% 3.4% - - - 248 - - - - - 248 1

Plan 67 33709PA0560030 PPO



Plan 68 33709PA0560031 PPO


Community Blue Flex Plan DM 33709PA0560042 Gold 0.79107113 Standard Off 0.781 0.959 1.000 1.014 1.000 1.000 $451.89 10.0% 0.1% 0.0% - - $333.87 341.94$ 2.4% 0.0% - - - - - - - - - - 1

Plan 69 33709PA0570008 PPO


Blue Flex Plan DM 33709PA0570017 Silver 0.71985127 Standard Off 0.742 0.940 1.000 1.014 1.000 1.000 $421.01 10.0% 0.1% 0.0% 105 - $310.55 318.58$ 2.6% 1.4% 98 - - 7 - - - - - 105 1

Plan 70 33709PA0570009 PPO


Blue Flex Plan DM 33709PA0570018 Silver 0.71753252 Standard Off 0.722 0.932 1.000 1.014 1.000 1.000 $405.78 10.0% 0.1% 0.0% 49 - $302.74 307.05$ 1.4% 0.7% - - - 49 - - - - - 49 1

Plan 71 33709PA0570010 PPO

Balance PPO $5000 1x a Community

Blue Flex Plan DM 33709PA0570019 Silver 0.71918335 Standard Off 0.736 0.938 1.000 1.014 1.000 1.000 $416.70 10.0% 0.1% 0.0% 24 - $294.41 315.32$ 7.1% 0.3% 4 - - 20 - - - - - 24 1

Plan 72 33709PA0570011 PPO

Balance PPO $1750 A a Community

Blue Flex Plan DM 33709PA0570015 Gold 0.80194231 Standard Off 0.792 0.964 1.000 1.014 1.000 1.000 $460.52 10.0% 0.1% 0.0% 38 - $350.13 348.48$ -0.5% 0.5% 7 - - 31 - - - - - 38 1

Plan 73 33709PA0570012 PPO


Blue Flex Plan DM 33709PA0570016 Gold 0.79920512 Standard Off 0.786 0.961 1.000 1.014 1.000 1.000 $455.86 10.0% 0.1% 0.0% 109 - $347.36 344.95$ -0.7% 1.5% 53 - - 56 - - - - - 109 1

Plan 74 33709PA0570013 PPO


Blue Flex Plan DM 33709PA0570014 Gold 0.78762925 Standard Off 0.800 0.969 1.000 1.014 1.000 1.000 $467.69 10.0% 0.1% 0.0% 14 - $355.10 353.90$ -0.3% 0.2% - - - 14 - - - - - 14 1

Plan 75 33709PA0630002 EPO

Connect Blue EPO $100 a

Community Blue Plan DM 33709PA1110001 Gold 0.81782552 Standard Off 0.855 1.001 1.000 0.972 1.000 1.000 $494.53 10.0% 0.1% 0.0% 27 - $371.68 374.21$ 0.7% 0.4% 6 - - 21 - - - - - 27 1

Plan 76 33709PA0630003 EPO


Community Blue Plan DM 33709PA1110001 Gold 0.81782552 Standard Off 0.855 1.001 1.000 0.972 1.000 1.000 $494.53 10.0% 0.1% 0.0% 78 - $371.68 374.21$ 0.7% 1.1% 2 - - 76 - - - - - 78 1

Plan 77 33709PA0630004 EPO


Community Blue Plan DM 33709PA1110002 Gold 0.81368295 Standard Off 0.842 0.993 1.000 0.972 1.000 1.000 $483.20 10.0% 0.1% 0.0% 73 - $366.08 365.63$ -0.1% 1.0% 32 - - 41 - - - - - 73 1

Plan 78 33709PA0630005 EPO



Plan 79 33709PA0630006 EPO


Community Blue Plan DM 33709PA1110004 Gold 0.81044357 Standard Off 0.834 0.988 1.000 0.972 1.000 1.000 $476.34 10.0% 0.1% 0.0% 16 - $360.49 360.45$ 0.0% 0.2% - - - 16 - - - - - 16 1

Plan 80 33709PA0630008 EPO



Plan 81 33709PA0630010 EPO


Community Blue Plan DM 33709PA1110006 Gold 0.78966864 Standard Off 0.789 0.963 1.000 0.972 1.000 1.000 $438.86 10.0% 0.1% 0.0% 19 - $333.66 332.08$ -0.5% 0.3% - - - 19 - - - - - 19 1

Plan 82 33709PA0630011 EPO


Community Blue Plan DM 33709PA1110006 Gold 0.78966864 Standard Off 0.789 0.963 1.000 0.972 1.000 1.000 $438.86 10.0% 0.1% 0.0% 13 - $333.66 332.08$ -0.5% 0.2% - - - 13 - - - - - 13 1

Plan 83 33709PA0640001 PPO


$2700 a Community Blue Flex Plan DM 33709PA0640006 Silver 0.71851443 Standard Off 0.766 0.951 1.000 1.014 1.000 1.000 $439.41 10.0% 0.1% 0.0% 32 - $322.57 332.50$ 3.1% 0.4% - - - 32 - - - - - 32 1

Plan 84 33709PA0640002 PPO


$3200 a Community Blue Flex Plan DM 33709PA0640007 Silver 0.71878742 Standard Off 0.749 0.944 1.000 1.014 1.000 1.000 $426.63 10.0% 0.1% 0.0% 21 - $320.32 322.83$ 0.8% 0.3% - - - 21 - - - - - 21 1

Plan 85 33709PA0640003 PPO


$5500 a Community Blue Flex Plan DM 33709PA0640011 Silver 0.66042826 Standard Off 0.685 0.918 1.000 1.014 1.000 1.000 $379.33 10.0% 0.1% 0.0% 38 - $272.62 287.04$ 5.3% 0.5% 3 - - 35 - - - - - 38 1

Plan 86 33709PA0640004 PPO


$5500 a Community Blue Flex Plan DM 33709PA0640012 Silver 0.66042826 Standard Off 0.685 0.918 1.000 1.064 1.000 1.000 $397.70 10.0% 0.1% 0.0% 52 - $285.82 300.94$ 5.3% 0.7% - - - - 50 2 - - - 52 1

Plan 87 33709PA0640005 PPO


$6000 a Community Blue Flex Plan DM 33709PA0640013 Silver 0.66025842 Standard Off 0.686 0.919 1.000 1.014 1.000 1.000 $380.20 10.0% 0.1% 0.0% 19 - $274.63 287.70$ 4.8% 0.3% 1 - - 18 - - - - - 19 1

Plan 88 33709PA0720001 EPO

Conemaugh Region Connect Blue

EPO $0 DM 33709PA1030001 Gold 0.80060612 Standard Off 0.843 0.993 1.000 1.025 1.000 1.000 $510.28 10.0% 0.1% 0.0% - - $384.08 386.12$ 0.5% 0.0% - - - - - - - - - - 1

Plan 89 33709PA0720002 EPO


EPO $1000 DM 33709PA1030001 Gold 0.80060612 Standard Off 0.843 0.993 1.000 1.025 1.000 1.000 $510.28 10.0% 0.1% 0.0% - - $384.08 386.12$ 0.5% 0.0% - - - - - - - - - - 1

Plan 90 33709PA0720003 EPO


EPO $3800 DM 33709PA1100001 Silver 0.71701696 Standard Off 0.760 0.948 1.000 1.025 1.000 1.000 $439.37 10.0% 0.1% 0.0% - - $324.71 332.47$ 2.4% 0.0% - - - - - - - - - - 1

Plan 91 33709PA0900001 EPO


EPO Embedded $5000 DM 33709PA1100001 Silver 0.71701696 Standard Off 0.760 0.948 1.000 1.025 1.000 1.000 $439.37 10.0% 0.1% 0.0% - - $324.71 332.47$ 2.4% 0.0% - - - - - - - - - - 1

Plan 92 33709PA0640008 PPO


$5500 a Community Blue Plan DM 33709PA0640011 Silver 0.66042826 Standard Off 0.685 0.918 1.000 1.014 1.000 1.000 $379.33 10.0% 0.1% 0.0% 15 - $272.62 287.04$ 5.3% 0.2% - - - 15 - - - - - 15 1

Plan 93 33709PA0640010 PPO


$5500 a Community Blue Plan DM 33709PA0640012 Silver 0.66042826 Standard Off 0.685 0.918 1.000 1.064 1.000 1.000 $397.70 10.0% 0.1% 0.0% - - $285.82 300.94$ 5.3% 0.0% - - - - - - - - - - 1

Plan 94 33709PA0640009 PPO


$6000 a Community Blue Plan DM 33709PA0640013 Silver 0.66025842 Standard Off 0.686 0.919 1.000 1.014 1.000 1.000 $380.20 10.0% 0.1% 0.0% 21 - $274.63 287.70$ 4.8% 0.3% 11 - - 10 - - - - - 21 1

Plan 95 $0.00 - -$ 0.0% 0.0% - 0

Plan 96 $0.00 - -$ 0.0% 0.0% - 0

Plan 97 $0.00 - -$ 0.0% 0.0% - 0

Plan 98 $0.00 - -$ 0.0% 0.0% - 0

Plan 99 $0.00 - -$ 0.0% 0.0% - 0

Plan 100 $0.00 - -$ 0.0% 0.0% - 0

02-01-2020 Number of Covered Lives by Rating Area

Calibration Total Covered Lives @ 02-01-2020

7,275

45 CFR Part 156.8 (d) (2) Allowable Factors

PA Rate Template Part IV B - Small Group AnnualTable 11. Plan Premium Development for 21-Year-Old Non-Tobacco User

Carrier Name: Highmark, Inc.Product(s): PPOMarket Segment: Smal l GroupRate Effective Date: 01/01/2021

Plan Number

HIOS Plan ID (Standard

Component)

1/1/2020 Plan

Marketing Name

Discontinued,

New, Modified,

Existing (D,N,M,E)

for 2021

1/1/2021 HIOS Plan ID (If

1/1/2020 Plan

Discontinued & Mapped) Metallic Tier

Exchange

On/Off or Off 1 2 3 4 5 6 7 8 9

Average

(weighted

by

enrollment

by rating

area) 1 2 3 4 5 6 7 8 9

Average

(weighted

by

enrollment

by rating

area) 1 2 3 4 5 6 7 8 9

Average

(weighted

by

enrollment

by rating

area) 1 2 3 4 5 6 7 8 9

Average

(weighted

by

enrollment

by rating

area)

Totals 366.15$ 375.62$ -$ 373.61$ 239.51$ 403.57$ -$ -$ -$ 368.69$ 373.89$ 381.61$ -$ 381.61$ 367.53$ 423.22$ -$ -$ -$ 380.45$ 1.8% 1.6% 0.0% 1.5% 1.4% 2.5% 0.0% 0.0% 0.0% 2.1% 382.55$ 390.45$ -$ 390.45$ 376.05$ 433.03$ -$ -$ -$ 389.27$

Plan 1 33709PA0560032Premier Balance PPO $0 Platinum a Community Blue PlanM 33709PA0560032 Platinum Off $436.44 $0.00 $0.00 $436.44 $0.00 $0.00 $0.00 $0.00 $0.00 436.44$ 438.22$ 438.22$ -$ 438.22$ 438.22$ 469.84$ 469.84$ -$ 460.81$ 438.22$ 0.4% 0.4% 0.4% 448.38$ 448.38$ -$ 448.38$ 448.38$ 480.74$ 480.74$ -$ 471.49$ 448.38$

Plan 2 33709PA0560033Premier Balance PPO $250 Platinum a Community Blue PlanM 33709PA0560033 Platinum Off $427.09 $0.00 $0.00 $427.09 $0.00 $0.00 $0.00 $0.00 $0.00 427.09$ 434.50$ 434.50$ -$ 434.50$ 434.50$ 465.85$ 465.85$ -$ 456.89$ 434.50$ 1.7% 1.7% 1.7% 444.57$ 444.57$ -$ 444.57$ 444.57$ 476.65$ 476.65$ -$ 467.49$ 444.57$

Plan 3 33709PA0560043Premier Balance PPO $0 Gold a Community Blue PlanM 33709PA0560043 Gold Off $374.73 $0.00 $0.00 $374.73 $0.00 $0.00 $0.00 $0.00 $0.00 374.73$ 385.89$ 385.89$ -$ 385.89$ 385.89$ 413.74$ 413.74$ -$ 405.78$ 385.89$ 3.0% 3.0% 3.0% 394.83$ 394.83$ -$ 394.83$ 394.83$ 423.33$ 423.33$ -$ 415.19$ 394.83$

Plan 4 33709PA0560034Premier Balance PPO $250 Gold a Community Blue PlanM 33709PA0560034 Gold Off $373.22 $0.00 $0.00 $373.22 $0.00 $0.00 $0.00 $0.00 $0.00 373.22$ 384.30$ 384.30$ -$ 384.30$ 384.30$ 412.04$ 412.04$ -$ 404.11$ 384.30$ 3.0% 3.0% 3.0% 393.21$ 393.21$ -$ 393.21$ 393.21$ 421.59$ 421.59$ -$ 413.48$ 393.21$

Plan 5 33709PA0560035Premier Balance PPO $500 a Community Blue PlanM 33709PA0560035 Gold Off $369.15 $0.00 $0.00 $369.15 $0.00 $0.00 $0.00 $0.00 $0.00 369.15$ 378.69$ 378.69$ -$ 378.69$ 378.69$ 406.02$ 406.02$ -$ 398.21$ 378.69$ 2.6% 2.6% 2.6% 387.47$ 387.47$ -$ 387.47$ 387.47$ 415.43$ 415.43$ -$ 407.44$ 387.47$







Plan 12 33709PA0560042Premier Balance PPO $5000 1x a Community Blue PlanM 33709PA0560042 Gold Off $323.85 $0.00 $0.00 $323.85 $0.00 $0.00 $0.00 $0.00 $0.00 323.85$ 331.69$ 331.69$ -$ 331.69$ 331.69$ 355.62$ 355.62$ -$ 348.78$ 331.69$ 2.4% 2.4% 2.4% 339.37$ 339.37$ -$ 339.37$ 339.37$ 363.87$ 363.87$ -$ 356.87$ 339.37$

Plan 13 33709PA0570014Balance PPO $1000 a Community Blue PlanM 33709PA0570014 Gold Off $344.44 $0.00 $0.00 $344.44 $0.00 $0.00 $0.00 $0.00 $0.00 344.44$ 343.28$ 343.28$ -$ 343.28$ 343.28$ 368.06$ 368.06$ -$ 360.98$ 343.28$ -0.3% -0.3% -0.3% 351.24$ 351.24$ -$ 351.24$ 351.24$ 376.59$ 376.59$ -$ 369.35$ 351.24$



Plan 16 33709PA0450005Health Savings PPO $1500 a Community Blue PlanM 33709PA0450005 Gold Off $356.14 $0.00 $0.00 $356.14 $0.00 $0.00 $0.00 $0.00 $0.00 356.14$ 359.14$ 359.14$ -$ 359.14$ 359.14$ 385.05$ 385.05$ -$ 377.65$ 359.14$ 0.8% 0.8% 0.8% 367.46$ 367.46$ -$ 367.46$ 367.46$ 393.98$ 393.98$ -$ 386.40$ 367.46$

Plan 17 33709PA0640006Health Savings PPO Embedded $2800 a Community Blue PlanM 33709PA0640006 Silver Off $312.89 $0.00 $0.00 $312.89 $0.00 $0.00 $0.00 $0.00 $0.00 312.89$ 322.53$ 322.53$ -$ 322.53$ 322.53$ 345.80$ 345.80$ -$ 339.15$ 322.53$ 3.1% 3.1% 3.1% 330.00$ 330.00$ -$ 330.00$ 330.00$ 353.82$ 353.82$ -$ 347.01$ 330.00$

Plan 18 33709PA0640007Health Savings PPO Embedded $3700 a Community Blue PlanM 33709PA0640007 Silver Off $310.71 $0.00 $0.00 $310.71 $0.00 $0.00 $0.00 $0.00 $0.00 310.71$ 313.15$ 313.15$ -$ 313.15$ 313.15$ 335.75$ 335.75$ -$ 329.29$ 313.15$ 0.8% 0.8% 0.8% 320.41$ 320.41$ -$ 320.41$ 320.41$ 343.53$ 343.53$ -$ 336.92$ 320.41$

Plan 19 33709PA1110001Premier Balance EPO $250 a Community Blue PlanM 33709PA1110001 Gold Off $360.53 $0.00 $0.00 $360.53 $0.00 $0.00 $0.00 $0.00 $0.00 360.53$ 362.98$ 362.98$ -$ 362.98$ 362.98$ 389.17$ 389.17$ -$ 381.69$ 362.98$ 0.7% 0.7% 0.7% 371.39$ 371.39$ -$ 371.39$ 371.39$ 398.20$ 398.20$ -$ 390.54$ 371.39$

Plan 20 33709PA1110002Premier Balance EPO $500 a Community Blue PlanM 33709PA1110002 Gold Off $355.10 $0.00 $0.00 $355.10 $0.00 $0.00 $0.00 $0.00 $0.00 355.10$ 354.67$ 354.67$ -$ 354.67$ 354.67$ 380.26$ 380.26$ -$ 372.95$ 354.67$ -0.1% -0.1% -0.1% 362.89$ 362.89$ -$ 362.89$ 362.89$ 389.08$ 389.08$ -$ 381.59$ 362.89$


Plan 22 33709PA1110004Premier Balance EPO $900 a Community Blue PlanM 33709PA1110004 Gold Off $349.67 $0.00 $0.00 $349.67 $0.00 $0.00 $0.00 $0.00 $0.00 349.67$ 349.63$ 349.63$ -$ 349.63$ 349.63$ 374.86$ 374.86$ -$ 367.65$ 349.63$ 0.0% 0.0% 0.0% 357.74$ 357.74$ -$ 357.74$ 357.74$ 383.55$ 383.55$ -$ 376.18$ 357.74$


Plan 24 33709PA1110006Premier Balance EPO $2500 a Community Blue PlanM 33709PA1110006 Gold Off $323.65 $0.00 $0.00

Highmark Coverage Advantage 2021 Small Group Market Rates...Ms. Tracie Gray, Director Highmark...

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