SERFF Tracking #: State Tracking #: Company Tracking #: 2021 … · 2020. 5. 29. · Filing at a...

Filing at a Glance Company: Capital District Physicians Health Plan Inc

Product Name: 2021 SG HMO Renewal

State: New York

TOI: HOrg02G Group Health Organizations - Health Maintenance (HMO)

Sub-TOI: HOrg02G.004F Small Group Only - HMO

Filing Type: 2021 Prior Approval ACA Rates

Date Submitted: 05/18/2020

SERFF Tr Num: CAPD-132341192

SERFF Status: Assigned

State Tr Num: 2020050231

State Status: CP-xx-UR

Co Tr Num: 2021 SG HMO RENEWAL

ImplementationDate Requested:

01/01/2021

Author(s):

Reviewer(s):

Disposition Date:

Disposition Status:

Implementation Date:

SERFF Tracking #: CAPD-132341192 State Tracking #: 2020050231 Company Tracking #: 2021 SG HMO RENEWAL

State: New York Filing Company: Capital District Physicians Health Plan Inc

TOI/Sub-TOI: HOrg02G Group Health Organizations - Health Maintenance (HMO)/HOrg02G.004F Small Group Only- HMO


Project Name/Number: /

PDF Pipeline for SERFF Tracking Number CAPD-132341192 Generated 05/26/2020 01:17 PM

General Information

Company and Contact

Filing Fees

State Specific

Project Name: Status of Filing in Domicile:

Project Number: Date Approved in Domicile:

Requested Filing Mode: Review & Approval Domicile Status Comments:

Explanation for Combination/Other: Market Type: Group

Submission Type: Group Market Size: Small

Group Market Type: Overall Rate Impact:

Filing Status Changed: 05/19/2020

State Status Changed: 05/19/2020 Deemer Date:

Created By: Submitted By:

Corresponding Filing Tracking Number: CAPD-132346843

PPACA: Not PPACA-Related

PPACA Notes: null

Include Exchange Intentions: No

Filing Description:

2021 SG HMO Renewal Rates Form filings: CAPD-132346843 & CAPD-132346845

Filing Contact Information

Filing Company InformationCapital District Physicians HealthPlan Inc

Patroon Creek Corporate Center

1223 Washington Avenue

Albany, NY 12206-1057

(518) 641-3000 ext. [Phone]

CoCode: 95491

Group Code: -99

Group Name:

FEIN Number: 14-1641028

State of Domicile: New York

Company Type:

State ID Number: 95491

Fee Required? No

Retaliatory? No

Fee Explanation:

1. Is a parallel filing being submitted for another issuing entity of the same parent organization? Yes/No (If Yes, enter nameof other entity, submission date, and SERFF Tracking Number of the parallel file.): No2. Does this filing contain a dental, vision or health insurance policy or contract that uses a network of health care providers?(If Yes, enter the PNDS Network ID number and name. If the network has not been filed in PNDS, it must be filed within 60







days of approval.): CDPHP NYN0023. : NA4. Type of filing? Enter Form and Rate, Form only, Rate only (Form only should be used ONLY when the filing only containsan application, advertisement, administrative form, or is a group prefiling notification, out-of-state, or a report filing. Formsubmissions with no proposed rate impact are considered form and rate filings and require an actuarial memorandum.): RateOnly5. Is this a Rate only filing? Yes/No [If Yes, enter one: Commission/Fee Schedule, DBL Loss Ratio Monitoring, ExperienceFiling Monitoring, Experience Rating Formula, Medicare Supplement Annual Filing (other than rate adjustment), RateAdjustment, or Other with brief explanation).]: Yes, Normal Pre approval6. Does this submission contain a form subject to Regulation 123 (i.e., the certificate is deemed delivered in New York State)?Yes/No (If Yes, provide a full explanation in the Filing Description field.): No7. Did this insurer prefile group coverage for this group under Section 52.32 prior to this filing? Yes/No (If Yes, enter thestate tracking number assigned and the effective date of coverage.): Yes, CAPD-132341163, 1/1/20218. Does this submission contain any form which is subject to review by the Life Bureau, the Property Bureau or both? Yes/No(If Yes, identify the forms, the Bureau, the date submitted, and the SERFF file number.): No9. Does this filing contain forms that replace any other previously approved forms? Yes/No (If Yes, identify the formnumbers, the file number, and the date of approval of the forms being replaced in the Filing Description field.): No







Rate Information Rate data applies to filing.

Filing Method: 2021 Prior Approval ACA Rates

Rate Change Type: Increase

Overall Percentage of Last Rate Revision: 4.270%

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

Filing Method of Last Filing: Prior Approval Off-Exchange Rates Rate Adjustment Purusant 4308(c )

SERFF Tracking Number of Last Filing:

Company Rate Information

Company

Name:

Company

Rate

Change:

Overall %

Indicated

Change:

Overall %

Rate

Impact:

Written

Premium

Change for

this Program:

Number of Policy

Holders Affected

for this Program:

Written

Premium for

this Program:

Maximum %

Change

(where req'd):

Minimum %

Change

(where req'd):

Capital DistrictPhysicians HealthPlan Inc

Increase 7.380% 7.380% $4,405,633 6,982 $64,101,575 9.430% -3.630%



TOI/Sub-TOI: HOrg02G Group Health Organizations - Health Maintenance (HMO)/HOrg02G.004F Small Group Only - HMO




Rate Review Detail

COMPANY:Company Name: Capital District Physicians Health Plan Inc

HHS Issuer Id: 94788

PRODUCTS:

Product Name HIOS Product ID HIOS Submission ID Number of Covered

LivesHMO 10977

Trend Factors:

FORMS:New Policy Forms: 01-0006-2021

Affected Forms:

Other Affected Forms:

REQUESTED RATE CHANGE INFORMATION:Change Period: Annual

Member Months: 93,330

Benefit Change: Increase

Percent Change Requested: Min: -3.63 Max: 9.43 Avg: 7.38

PRIOR RATE:Total Earned Premium: 43,150,358.00

Total Incurred Claims: 37,578,329.00

Annual $: Min: 426.16 Max: 633.38 Avg: 453.19

REQUESTED RATE:Projected Earned Premium: 64,101,575.00

Projected Incurred Claims: 55,824,104.00

Annual $: Min: 463.76 Max: 616.11 Avg: 486.64







Rate/Rule Schedule

Item

No.

Schedule

Item

Status

Document Name

Affected Form Numbers

(Separated with commas) Rate Action Rate Action Information Attachments

1 Manual New 2021 Rate Manual -SG HMO Off Exch.pdf,2021 Rate Manual -SG HMO OffExch.xlsx, 2021 RateManual - SG HMO OnExch.pdf, 2021 RateManual - SG HMO OnExch.xlsx,



TOI/Sub-TOI: HOrg02G Group Health Organizations - Health Maintenance (HMO)/HOrg02G.004F Small Group Only - HMO




Capital District Physicians' Health Plan2021 Premium Rate Filing

SG HMO - Off Exchange Products

TABLE OF CONTENTS

Table of Contents 1

I. Rate Pages

Small Group

Albany Region 2-3

Mid-Hudson Region 4-5

Syracuse Region 6-7

Utica/Watertown Region 8-9

II. Benefit Summary 10-13

III. Conversion Factor 14

IV. Region Factors 15

V. Tier Factors 16

VI. Rate Calculation 17

VII. Expected Loss Ratio 18

VIII. Factors for Base Plan Variations 19

IX. Commission Schedule 20

K:\Dept\FINANCE\ACTSRV\SHARED\ACTSRV\PRODUCT FILINGS\2021 Product Filings\SG HMO-HNY\2. Renewal\SERFF\2021 Rate Manual - SG HMO Off Exch 5/14/2020

Capital District Physicians' Health PlanAlbany Region

Small Group Rates Off-Exchange

Proposed Premium Rates Effective 1/1/2021

Metal Tier Product Line Old Name New Name

First Quarter 2021 (1/1/2021 - 3/31/2021)

Gold HMO SHGFHN50 SHGFHN58

Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family

Silver HDHMO SHSF3016 SHSF3024

Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family

2020 2021 2020 2021 2020 2021 2020 2021

Quarter 1 Quarter 1 Quarter 1 Quarter 1 Quarter 2 Quarter 2 Quarter 2 Quarter 2 Quarter 3 Quarter 3 Quarter 3 Quarter 3 Quarter 4 Quarter 4 Quarter 4 Quarter 4

Current Proposed Amount of Percent Current Proposed Amount of Percent Current Proposed Amount of Percent Current Proposed Amount of Percent

Rate Rate Adjustment Change Rate Rate Adjustment Change Rate Rate Adjustment Change Rate Rate Adjustment Change

First Quarter 2021 (1/1/2021 - 3/31/2021) Second Quarter 2021 (4/1/2021 - 6/30/2021) Third Quarter 2021 (7/1/2021 - 9/30/2021) Fourth Quarter 2021 (10/1/2021 - 12/31/2021)

483.83$ $521.38 37.55$ 7.76% 492.65$ $530.65 38.00$ 7.71% 501.62$ 540.09$ 38.47$ 7.67% 510.76$ 549.69$ 38.93$ 7.62%

967.66$ 1,042.77$ 75.11$ 7.76% 985.29$ 1,061.30$ 76.01$ 7.71% 1,003.25$ 1,080.17$ 76.92$ 7.67% 1,021.53$ 1,099.37$ 77.84$ 7.62%

822.51$ 886.35$ 63.84$ 7.76% 837.50$ 902.11$ 64.61$ 7.71% 852.76$ 918.15$ 65.39$ 7.67% 868.30$ 934.47$ 66.17$ 7.62%

1,378.92$ 1,485.94$ 107.02$ 7.76% 1,404.04$ 1,512.36$ 108.32$ 7.71% 1,429.63$ 1,539.24$ 109.61$ 7.67% 1,455.68$ 1,566.61$ 110.93$ 7.62%

486.16$ 522.50$ 36.34$ 7.47% 495.02$ 531.79$ 36.77$ 7.43% 504.04$ 541.24$ 37.20$ 7.38% 513.22$ 550.86$ 37.64$ 7.33%

972.32$ 1,045.00$ 72.68$ 7.47% 990.04$ 1,063.58$ 73.54$ 7.43% 1,008.08$ 1,082.49$ 74.41$ 7.38% 1,026.45$ 1,101.73$ 75.28$ 7.33%

826.47$ 888.25$ 61.78$ 7.48% 841.53$ 904.04$ 62.51$ 7.43% 856.87$ 920.11$ 63.24$ 7.38% 872.48$ 936.47$ 63.99$ 7.33%

1,385.56$ 1,489.13$ 103.57$ 7.47% 1,410.80$ 1,515.60$ 104.80$ 7.43% 1,436.51$ 1,542.54$ 106.03$ 7.38% 1,462.69$ 1,569.97$ 107.28$ 7.33%

477.29$ 516.11$ 38.82$ 8.13% 485.99$ 525.29$ 39.30$ 8.09% 494.84$ 534.63$ 39.79$ 8.04% 503.86$ 544.13$ 40.27$ 7.99%

954.58$ 1,032.23$ 77.65$ 8.13% 971.97$ 1,050.58$ 78.61$ 8.09% 989.69$ 1,069.25$ 79.56$ 8.04% 1,007.72$ 1,088.26$ 80.54$ 7.99%

811.39$ 877.39$ 66.00$ 8.13% 826.18$ 892.99$ 66.81$ 8.09% 841.23$ 908.87$ 67.64$ 8.04% 856.56$ 925.02$ 68.46$ 7.99%

1,360.28$ 1,470.92$ 110.64$ 8.13% 1,385.06$ 1,497.07$ 112.01$ 8.09% 1,410.30$ 1,523.69$ 113.39$ 8.04% 1,436.00$ 1,550.77$ 114.77$ 7.99%

483.83$ 521.38$ 37.55$ 7.76% 492.65$ 530.65$ 38.00$ 7.71% 501.62$ 540.09$ 38.47$ 7.67% 510.76$ 549.69$ 38.93$ 7.62%

967.66$ 1,042.77$ 75.11$ 7.76% 985.29$ 1,061.30$ 76.01$ 7.71% 1,003.25$ 1,080.17$ 76.92$ 7.67% 1,021.53$ 1,099.37$ 77.84$ 7.62%

822.51$ 886.35$ 63.84$ 7.76% 837.50$ 902.11$ 64.61$ 7.71% 852.76$ 918.15$ 65.39$ 7.67% 868.30$ 934.47$ 66.17$ 7.62%

1,378.92$ 1,485.94$ 107.02$ 7.76% 1,404.04$ 1,512.36$ 108.32$ 7.71% 1,429.63$ 1,539.24$ 109.61$ 7.67% 1,455.68$ 1,566.61$ 110.93$ 7.62%

479.58$ 517.22$ 37.64$ 7.85% 488.32$ 526.41$ 38.09$ 7.80% 497.22$ 535.77$ 38.55$ 7.75% 506.28$ 545.30$ 39.02$ 7.71%

959.16$ 1,034.44$ 75.28$ 7.85% 976.64$ 1,052.83$ 76.19$ 7.80% 994.43$ 1,071.54$ 77.11$ 7.75% 1,012.55$ 1,090.59$ 78.04$ 7.71%

815.29$ 879.27$ 63.98$ 7.85% 830.14$ 894.90$ 64.76$ 7.80% 845.27$ 910.81$ 65.54$ 7.75% 860.67$ 927.00$ 66.33$ 7.71%

1,366.80$ 1,474.07$ 107.27$ 7.85% 1,391.71$ 1,500.28$ 108.57$ 7.80% 1,417.07$ 1,526.95$ 109.88$ 7.75% 1,442.89$ 1,554.09$ 111.20$ 7.71%

486.16$ 522.50$ 36.34$ 7.47% 495.02$ 531.79$ 36.77$ 7.43% 504.04$ 541.24$ 37.20$ 7.38% 513.22$ 550.86$ 37.64$ 7.33%

972.32$ 1,045.00$ 72.68$ 7.47% 990.04$ 1,063.58$ 73.54$ 7.43% 1,008.08$ 1,082.49$ 74.41$ 7.38% 1,026.45$ 1,101.73$ 75.28$ 7.33%

826.47$ 888.25$ 61.78$ 7.48% 841.53$ 904.04$ 62.51$ 7.43% 856.87$ 920.11$ 63.24$ 7.38% 872.48$ 936.47$ 63.99$ 7.33%

1,385.56$ 1,489.13$ 103.57$ 7.47% 1,410.80$ 1,515.60$ 104.80$ 7.43% 1,436.51$ 1,542.54$ 106.03$ 7.38% 1,462.69$ 1,569.97$ 107.28$ 7.33%

479.58$ 517.22$ 37.64$ 7.85% 488.32$ 526.41$ 38.09$ 7.80% 497.22$ 535.77$ 38.55$ 7.75% 506.28$ 545.30$ 39.02$ 7.71%

959.16$ 1,034.44$ 75.28$ 7.85% 976.64$ 1,052.83$ 76.19$ 7.80% 994.43$ 1,071.54$ 77.11$ 7.75% 1,012.55$ 1,090.59$ 78.04$ 7.71%

815.29$ 879.27$ 63.98$ 7.85% 830.14$ 894.90$ 64.76$ 7.80% 845.27$ 910.81$ 65.54$ 7.75% 860.67$ 927.00$ 66.33$ 7.71%

1,366.80$ 1,474.07$ 107.27$ 7.85% 1,391.71$ 1,500.28$ 108.57$ 7.80% 1,417.07$ 1,526.95$ 109.88$ 7.75% 1,442.89$ 1,554.09$ 111.20$ 7.71%

477.29$ 516.11$ 38.82$ 8.13% 485.99$ 525.29$ 39.30$ 8.09% 494.84$ 534.63$ 39.79$ 8.04% 503.86$ 544.13$ 40.27$ 7.99%

954.58$ 1,032.23$ 77.65$ 8.13% 971.97$ 1,050.58$ 78.61$ 8.09% 989.69$ 1,069.25$ 79.56$ 8.04% 1,007.72$ 1,088.26$ 80.54$ 7.99%

811.39$ 877.39$ 66.00$ 8.13% 826.18$ 892.99$ 66.81$ 8.09% 841.23$ 908.87$ 67.64$ 8.04% 856.56$ 925.02$ 68.46$ 7.99%

1,360.28$ 1,470.92$ 110.64$ 8.13% 1,385.06$ 1,497.07$ 112.01$ 8.09% 1,410.30$ 1,523.69$ 113.39$ 8.04% 1,436.00$ 1,550.77$ 114.77$ 7.99%

480.66$ 526.00$ 45.34$ 9.43% 489.42$ 535.35$ 45.93$ 9.38% 498.34$ 544.87$ 46.53$ 9.34% 507.42$ 554.56$ 47.14$ 9.29%

961.32$ 1,052.01$ 90.69$ 9.43% 978.84$ 1,070.71$ 91.87$ 9.39% 996.67$ 1,089.74$ 93.07$ 9.34% 1,014.83$ 1,109.12$ 94.29$ 9.29%

817.12$ 894.20$ 77.08$ 9.43% 832.01$ 910.10$ 78.09$ 9.39% 847.17$ 926.28$ 79.11$ 9.34% 862.61$ 942.75$ 80.14$ 9.29%

1,369.88$ 1,499.11$ 129.23$ 9.43% 1,394.84$ 1,525.76$ 130.92$ 9.39% 1,420.26$ 1,552.88$ 132.62$ 9.34% 1,446.14$ 1,580.49$ 134.35$ 9.29%

482.97$ 527.13$ 44.16$ 9.14% 491.77$ 536.50$ 44.73$ 9.10% 500.73$ 546.04$ 45.31$ 9.05% 509.85$ 555.75$ 45.90$ 9.00%

965.93$ 1,054.26$ 88.33$ 9.14% 983.53$ 1,073.00$ 89.47$ 9.10% 1,001.45$ 1,092.08$ 90.63$ 9.05% 1,019.70$ 1,111.49$ 91.79$ 9.00%

821.04$ 896.12$ 75.08$ 9.14% 836.00$ 912.05$ 76.05$ 9.10% 851.24$ 928.27$ 77.03$ 9.05% 866.75$ 944.77$ 78.02$ 9.00%

1,376.45$ 1,502.32$ 125.87$ 9.14% 1,401.53$ 1,529.03$ 127.50$ 9.10% 1,427.07$ 1,556.21$ 129.14$ 9.05% 1,453.08$ 1,583.88$ 130.80$ 9.00%

474.16$ 520.68$ 46.52$ 9.81% 482.80$ 529.94$ 47.14$ 9.76% 491.60$ 539.36$ 47.76$ 9.72% 500.56$ 548.95$ 48.39$ 9.67%

948.33$ 1,041.37$ 93.04$ 9.81% 965.61$ 1,059.88$ 94.27$ 9.76% 983.20$ 1,078.72$ 95.52$ 9.72% 1,001.12$ 1,097.90$ 96.78$ 9.67%

806.08$ 885.16$ 79.08$ 9.81% 820.76$ 900.90$ 80.14$ 9.76% 835.72$ 916.91$ 81.19$ 9.71% 850.95$ 933.21$ 82.26$ 9.67%

1,351.36$ 1,483.95$ 132.59$ 9.81% 1,375.99$ 1,510.33$ 134.34$ 9.76% 1,401.06$ 1,537.18$ 136.12$ 9.72% 1,426.59$ 1,564.50$ 137.91$ 9.67%

480.66$ 526.00$ 45.34$ 9.43% 489.42$ 535.35$ 45.93$ 9.38% 498.34$ 544.87$ 46.53$ 9.34% 507.42$ 554.56$ 47.14$ 9.29%

961.32$ 1,052.01$ 90.69$ 9.43% 978.84$ 1,070.71$ 91.87$ 9.39% 996.67$ 1,089.74$ 93.07$ 9.34% 1,014.83$ 1,109.12$ 94.29$ 9.29%

817.12$ 894.20$ 77.08$ 9.43% 832.01$ 910.10$ 78.09$ 9.39% 847.17$ 926.28$ 79.11$ 9.34% 862.61$ 942.75$ 80.14$ 9.29%

1,369.88$ 1,499.11$ 129.23$ 9.43% 1,394.84$ 1,525.76$ 130.92$ 9.39% 1,420.26$ 1,552.88$ 132.62$ 9.34% 1,446.14$ 1,580.49$ 134.35$ 9.29%

476.44$ 521.80$ 45.36$ 9.52% 485.12$ 531.08$ 45.96$ 9.47% 493.96$ 540.52$ 46.56$ 9.43% 502.96$ 550.13$ 47.17$ 9.38%

952.87$ 1,043.60$ 90.73$ 9.52% 970.24$ 1,062.15$ 91.91$ 9.47% 987.92$ 1,081.03$ 93.11$ 9.42% 1,005.92$ 1,100.25$ 94.33$ 9.38%

809.94$ 887.06$ 77.12$ 9.52% 824.70$ 902.83$ 78.13$ 9.47% 839.73$ 918.88$ 79.15$ 9.43% 855.03$ 935.21$ 80.18$ 9.38%

1,357.84$ 1,487.13$ 129.29$ 9.52% 1,382.59$ 1,513.56$ 130.97$ 9.47% 1,407.78$ 1,540.47$ 132.69$ 9.43% 1,433.43$ 1,567.86$ 134.43$ 9.38%

482.97$ 527.13$ 44.16$ 9.14% 491.77$ 536.50$ 44.73$ 9.10% 500.73$ 546.04$ 45.31$ 9.05% 509.85$ 555.75$ 45.90$ 9.00%

965.93$ 1,054.26$ 88.33$ 9.14% 983.53$ 1,073.00$ 89.47$ 9.10% 1,001.45$ 1,092.08$ 90.63$ 9.05% 1,019.70$ 1,111.49$ 91.79$ 9.00%

821.04$ 896.12$ 75.08$ 9.14% 836.00$ 912.05$ 76.05$ 9.10% 851.24$ 928.27$ 77.03$ 9.05% 866.75$ 944.77$ 78.02$ 9.00%

1,376.45$ 1,502.32$ 125.87$ 9.14% 1,401.53$ 1,529.03$ 127.50$ 9.10% 1,427.07$ 1,556.21$ 129.14$ 9.05% 1,453.08$ 1,583.88$ 130.80$ 9.00%

2021 SG HMO Off Exchange Rate Manual Page 2





First Quarter 2021 (1/1/2021 - 3/31/2021)

Gold HMO SHGFHN50 SHGFHN58Silver HDHMO SHSF3022 SHSF3030

Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family

Gold HMO SHGF5001 SHGF5017

Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family

2020 2021 2020 2021 2020 2021 2020 2021





476.44$ 521.80$ 45.36$ 9.52% 485.12$ 531.08$ 45.96$ 9.47% 493.96$ 540.52$ 46.56$ 9.43% 502.96$ 550.13$ 47.17$ 9.38%

952.87$ 1,043.60$ 90.73$ 9.52% 970.24$ 1,062.15$ 91.91$ 9.47% 987.92$ 1,081.03$ 93.11$ 9.42% 1,005.92$ 1,100.25$ 94.33$ 9.38%

809.94$ 887.06$ 77.12$ 9.52% 824.70$ 902.83$ 78.13$ 9.47% 839.73$ 918.88$ 79.15$ 9.43% 855.03$ 935.21$ 80.18$ 9.38%

1,357.84$ 1,487.13$ 129.29$ 9.52% 1,382.59$ 1,513.56$ 130.97$ 9.47% 1,407.78$ 1,540.47$ 132.69$ 9.43% 1,433.43$ 1,567.86$ 134.43$ 9.38%

474.16$ 520.68$ 46.52$ 9.81% 482.80$ 529.94$ 47.14$ 9.76% 491.60$ 539.36$ 47.76$ 9.72% 500.56$ 548.95$ 48.39$ 9.67%

948.33$ 1,041.37$ 93.04$ 9.81% 965.61$ 1,059.88$ 94.27$ 9.76% 983.20$ 1,078.72$ 95.52$ 9.72% 1,001.12$ 1,097.90$ 96.78$ 9.67%

806.08$ 885.16$ 79.08$ 9.81% 820.76$ 900.90$ 80.14$ 9.76% 835.72$ 916.91$ 81.19$ 9.71% 850.95$ 933.21$ 82.26$ 9.67%

1,351.36$ 1,483.95$ 132.59$ 9.81% 1,375.99$ 1,510.33$ 134.34$ 9.76% 1,401.06$ 1,537.18$ 136.12$ 9.72% 1,426.59$ 1,564.50$ 137.91$ 9.67%

581.34$ 613.13$ 31.79$ 5.47% 591.94$ 624.03$ 32.09$ 5.42% 602.72$ 635.13$ 32.41$ 5.38% 613.71$ 646.42$ 32.71$ 5.33%

1,162.69$ 1,226.27$ 63.58$ 5.47% 1,183.87$ 1,248.07$ 64.20$ 5.42% 1,205.45$ 1,270.25$ 64.80$ 5.38% 1,227.41$ 1,292.84$ 65.43$ 5.33%

988.28$ 1,042.33$ 54.05$ 5.47% 1,006.29$ 1,060.86$ 54.57$ 5.42% 1,024.63$ 1,079.72$ 55.09$ 5.38% 1,043.30$ 1,098.91$ 55.61$ 5.33%

1,656.83$ 1,747.43$ 90.60$ 5.47% 1,687.02$ 1,778.49$ 91.47$ 5.42% 1,717.76$ 1,810.11$ 92.35$ 5.38% 1,749.06$ 1,842.29$ 93.23$ 5.33%

584.15$ 614.46$ 30.31$ 5.19% 594.79$ 625.38$ 30.59$ 5.14% 605.63$ 636.50$ 30.87$ 5.10% 616.67$ 647.82$ 31.15$ 5.05%

1,168.30$ 1,228.92$ 60.62$ 5.19% 1,189.59$ 1,250.77$ 61.18$ 5.14% 1,211.26$ 1,273.00$ 61.74$ 5.10% 1,233.34$ 1,295.64$ 62.30$ 5.05%

993.05$ 1,044.58$ 51.53$ 5.19% 1,011.15$ 1,063.15$ 52.00$ 5.14% 1,029.57$ 1,082.05$ 52.48$ 5.10% 1,048.33$ 1,101.29$ 52.96$ 5.05%

1,664.83$ 1,751.21$ 86.38$ 5.19% 1,695.16$ 1,782.35$ 87.19$ 5.14% 1,726.05$ 1,814.03$ 87.98$ 5.10% 1,757.50$ 1,846.28$ 88.78$ 5.05%

573.44$ 606.87$ 33.43$ 5.83% 583.89$ 617.66$ 33.77$ 5.78% 594.53$ 628.64$ 34.11$ 5.74% 605.36$ 639.81$ 34.45$ 5.69%

1,146.88$ 1,213.74$ 66.86$ 5.83% 1,167.78$ 1,235.31$ 67.53$ 5.78% 1,189.05$ 1,257.27$ 68.22$ 5.74% 1,210.72$ 1,279.63$ 68.91$ 5.69%

974.85$ 1,031.68$ 56.83$ 5.83% 992.61$ 1,050.02$ 57.41$ 5.78% 1,010.70$ 1,068.68$ 57.98$ 5.74% 1,029.11$ 1,087.68$ 58.57$ 5.69%

1,634.30$ 1,729.57$ 95.27$ 5.83% 1,664.08$ 1,760.32$ 96.24$ 5.78% 1,694.40$ 1,791.62$ 97.22$ 5.74% 1,725.28$ 1,823.47$ 98.19$ 5.69%

581.34$ 613.13$ 31.79$ 5.47% 591.94$ 624.03$ 32.09$ 5.42% 602.72$ 635.13$ 32.41$ 5.38% 613.71$ 646.42$ 32.71$ 5.33%

1,162.69$ 1,226.27$ 63.58$ 5.47% 1,183.87$ 1,248.07$ 64.20$ 5.42% 1,205.45$ 1,270.25$ 64.80$ 5.38% 1,227.41$ 1,292.84$ 65.43$ 5.33%

988.28$ 1,042.33$ 54.05$ 5.47% 1,006.29$ 1,060.86$ 54.57$ 5.42% 1,024.63$ 1,079.72$ 55.09$ 5.38% 1,043.30$ 1,098.91$ 55.61$ 5.33%

1,656.83$ 1,747.43$ 90.60$ 5.47% 1,687.02$ 1,778.49$ 91.47$ 5.42% 1,717.76$ 1,810.11$ 92.35$ 5.38% 1,749.06$ 1,842.29$ 93.23$ 5.33%

576.21$ 608.18$ 31.97$ 5.55% 586.70$ 618.99$ 32.29$ 5.50% 597.40$ 630.00$ 32.60$ 5.46% 608.28$ 641.20$ 32.92$ 5.41%

1,152.41$ 1,216.36$ 63.95$ 5.55% 1,173.41$ 1,237.99$ 64.58$ 5.50% 1,194.79$ 1,260.00$ 65.21$ 5.46% 1,216.56$ 1,282.40$ 65.84$ 5.41%

979.55$ 1,033.91$ 54.36$ 5.55% 997.40$ 1,052.29$ 54.89$ 5.50% 1,015.57$ 1,071.00$ 55.43$ 5.46% 1,034.08$ 1,090.04$ 55.96$ 5.41%

1,642.18$ 1,733.32$ 91.14$ 5.55% 1,672.11$ 1,764.13$ 92.02$ 5.50% 1,702.58$ 1,795.49$ 92.91$ 5.46% 1,733.60$ 1,827.41$ 93.81$ 5.41%

584.15$ 614.46$ 30.31$ 5.19% 594.79$ 625.38$ 30.59$ 5.14% 605.63$ 636.50$ 30.87$ 5.10% 616.67$ 647.82$ 31.15$ 5.05%

1,168.30$ 1,228.92$ 60.62$ 5.19% 1,189.59$ 1,250.77$ 61.18$ 5.14% 1,211.26$ 1,273.00$ 61.74$ 5.10% 1,233.34$ 1,295.64$ 62.30$ 5.05%

993.05$ 1,044.58$ 51.53$ 5.19% 1,011.15$ 1,063.15$ 52.00$ 5.14% 1,029.57$ 1,082.05$ 52.48$ 5.10% 1,048.33$ 1,101.29$ 52.96$ 5.05%

1,664.83$ 1,751.21$ 86.38$ 5.19% 1,695.16$ 1,782.35$ 87.19$ 5.14% 1,726.05$ 1,814.03$ 87.98$ 5.10% 1,757.50$ 1,846.28$ 88.78$ 5.05%

576.21$ 608.18$ 31.97$ 5.55% 586.70$ 618.99$ 32.29$ 5.50% 597.40$ 630.00$ 32.60$ 5.46% 608.28$ 641.20$ 32.92$ 5.41%

1,152.41$ 1,216.36$ 63.95$ 5.55% 1,173.41$ 1,237.99$ 64.58$ 5.50% 1,194.79$ 1,260.00$ 65.21$ 5.46% 1,216.56$ 1,282.40$ 65.84$ 5.41%

979.55$ 1,033.91$ 54.36$ 5.55% 997.40$ 1,052.29$ 54.89$ 5.50% 1,015.57$ 1,071.00$ 55.43$ 5.46% 1,034.08$ 1,090.04$ 55.96$ 5.41%

1,642.18$ 1,733.32$ 91.14$ 5.55% 1,672.11$ 1,764.13$ 92.02$ 5.50% 1,702.58$ 1,795.49$ 92.91$ 5.46% 1,733.60$ 1,827.41$ 93.81$ 5.41%

573.44$ 606.87$ 33.43$ 5.83% 583.89$ 617.66$ 33.77$ 5.78% 594.53$ 628.64$ 34.11$ 5.74% 605.36$ 639.81$ 34.45$ 5.69%

1,146.88$ 1,213.74$ 66.86$ 5.83% 1,167.78$ 1,235.31$ 67.53$ 5.78% 1,189.05$ 1,257.27$ 68.22$ 5.74% 1,210.72$ 1,279.63$ 68.91$ 5.69%

974.85$ 1,031.68$ 56.83$ 5.83% 992.61$ 1,050.02$ 57.41$ 5.78% 1,010.70$ 1,068.68$ 57.98$ 5.74% 1,029.11$ 1,087.68$ 58.57$ 5.69%

1,634.30$ 1,729.57$ 95.27$ 5.83% 1,664.08$ 1,760.32$ 96.24$ 5.78% 1,694.40$ 1,791.62$ 97.22$ 5.74% 1,725.28$ 1,823.47$ 98.19$ 5.69%


Capital District Physicians' Health PlanMid-Hudson




First Quarter 2021 (1/1/2021 - 3/31/2021)


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2020 2021 2020 2021 2020 2021 2020 2021





691.47$ $679.12 (12.35)$ -1.79% 704.07$ $691.19 (12.88)$ -1.83% 716.90$ 703.48$ (13.42)$ -1.87% 729.97$ 715.98$ (13.99)$ -1.92%

1,382.94$ 1,358.23$ (24.71)$ -1.79% 1,408.14$ 1,382.38$ (25.76)$ -1.83% 1,433.80$ 1,406.96$ (26.84)$ -1.87% 1,459.93$ 1,431.97$ (27.96)$ -1.92%

1,175.50$ 1,154.50$ (21.00)$ -1.79% 1,196.92$ 1,175.02$ (21.90)$ -1.83% 1,218.73$ 1,195.91$ (22.82)$ -1.87% 1,240.94$ 1,217.17$ (23.77)$ -1.92%

1,970.70$ 1,935.48$ (35.22)$ -1.79% 2,006.61$ 1,969.89$ (36.72)$ -1.83% 2,043.17$ 2,004.91$ (38.26)$ -1.87% 2,080.40$ 2,040.55$ (39.85)$ -1.92%

694.80$ 680.60$ (14.20)$ -2.04% 707.46$ 692.70$ (14.76)$ -2.09% 720.35$ 705.01$ (15.34)$ -2.13% 733.48$ 717.54$ (15.94)$ -2.17%

1,389.60$ 1,361.19$ (28.41)$ -2.04% 1,414.93$ 1,385.39$ (29.54)$ -2.09% 1,440.71$ 1,410.02$ (30.69)$ -2.13% 1,466.96$ 1,435.09$ (31.87)$ -2.17%

1,181.16$ 1,157.02$ (24.14)$ -2.04% 1,202.69$ 1,177.58$ (25.11)$ -2.09% 1,224.60$ 1,198.52$ (26.08)$ -2.13% 1,246.92$ 1,219.83$ (27.09)$ -2.17%

1,980.19$ 1,939.70$ (40.49)$ -2.04% 2,016.27$ 1,974.19$ (42.08)$ -2.09% 2,053.01$ 2,009.28$ (43.73)$ -2.13% 2,090.42$ 2,045.00$ (45.42)$ -2.17%

682.13$ 672.14$ (9.99)$ -1.46% 694.56$ 684.09$ (10.47)$ -1.51% 707.21$ 696.25$ (10.96)$ -1.55% 720.10$ 708.62$ (11.48)$ -1.59%

1,364.25$ 1,344.27$ (19.98)$ -1.46% 1,389.11$ 1,368.17$ (20.94)$ -1.51% 1,414.42$ 1,392.49$ (21.93)$ -1.55% 1,440.20$ 1,417.25$ (22.95)$ -1.59%

1,159.61$ 1,142.63$ (16.98)$ -1.46% 1,180.74$ 1,162.95$ (17.79)$ -1.51% 1,202.26$ 1,183.62$ (18.64)$ -1.55% 1,224.17$ 1,204.66$ (19.51)$ -1.59%

1,944.06$ 1,915.59$ (28.47)$ -1.46% 1,979.48$ 1,949.64$ (29.84)$ -1.51% 2,015.55$ 1,984.30$ (31.25)$ -1.55% 2,052.28$ 2,019.58$ (32.70)$ -1.59%

691.47$ 679.12$ (12.35)$ -1.79% 704.07$ 691.19$ (12.88)$ -1.83% 716.90$ 703.48$ (13.42)$ -1.87% 729.97$ 715.98$ (13.99)$ -1.92%

1,382.94$ 1,358.23$ (24.71)$ -1.79% 1,408.14$ 1,382.38$ (25.76)$ -1.83% 1,433.80$ 1,406.96$ (26.84)$ -1.87% 1,459.93$ 1,431.97$ (27.96)$ -1.92%

1,175.50$ 1,154.50$ (21.00)$ -1.79% 1,196.92$ 1,175.02$ (21.90)$ -1.83% 1,218.73$ 1,195.91$ (22.82)$ -1.87% 1,240.94$ 1,217.17$ (23.77)$ -1.92%

1,970.70$ 1,935.48$ (35.22)$ -1.79% 2,006.61$ 1,969.89$ (36.72)$ -1.83% 2,043.17$ 2,004.91$ (38.26)$ -1.87% 2,080.40$ 2,040.55$ (39.85)$ -1.92%

685.40$ 673.60$ (11.80)$ -1.72% 697.89$ 685.58$ (12.31)$ -1.76% 710.60$ 697.76$ (12.84)$ -1.81% 723.55$ 710.17$ (13.38)$ -1.85%

1,370.80$ 1,347.20$ (23.60)$ -1.72% 1,395.78$ 1,371.15$ (24.63)$ -1.76% 1,421.21$ 1,395.53$ (25.68)$ -1.81% 1,447.11$ 1,420.34$ (26.77)$ -1.85%

1,165.18$ 1,145.12$ (20.06)$ -1.72% 1,186.41$ 1,165.48$ (20.93)$ -1.76% 1,208.03$ 1,186.20$ (21.83)$ -1.81% 1,230.04$ 1,207.29$ (22.75)$ -1.85%

1,953.39$ 1,919.76$ (33.63)$ -1.72% 1,988.98$ 1,953.89$ (35.09)$ -1.76% 2,025.22$ 1,988.63$ (36.59)$ -1.81% 2,062.13$ 2,023.98$ (38.15)$ -1.85%

694.80$ 680.60$ (14.20)$ -2.04% 707.46$ 692.70$ (14.76)$ -2.09% 720.35$ 705.01$ (15.34)$ -2.13% 733.48$ 717.54$ (15.94)$ -2.17%

1,389.60$ 1,361.19$ (28.41)$ -2.04% 1,414.93$ 1,385.39$ (29.54)$ -2.09% 1,440.71$ 1,410.02$ (30.69)$ -2.13% 1,466.96$ 1,435.09$ (31.87)$ -2.17%

1,181.16$ 1,157.02$ (24.14)$ -2.04% 1,202.69$ 1,177.58$ (25.11)$ -2.09% 1,224.60$ 1,198.52$ (26.08)$ -2.13% 1,246.92$ 1,219.83$ (27.09)$ -2.17%

1,980.19$ 1,939.70$ (40.49)$ -2.04% 2,016.27$ 1,974.19$ (42.08)$ -2.09% 2,053.01$ 2,009.28$ (43.73)$ -2.13% 2,090.42$ 2,045.00$ (45.42)$ -2.17%

685.40$ 673.60$ (11.80)$ -1.72% 697.89$ 685.58$ (12.31)$ -1.76% 710.60$ 697.76$ (12.84)$ -1.81% 723.55$ 710.17$ (13.38)$ -1.85%

1,370.80$ 1,347.20$ (23.60)$ -1.72% 1,395.78$ 1,371.15$ (24.63)$ -1.76% 1,421.21$ 1,395.53$ (25.68)$ -1.81% 1,447.11$ 1,420.34$ (26.77)$ -1.85%

1,165.18$ 1,145.12$ (20.06)$ -1.72% 1,186.41$ 1,165.48$ (20.93)$ -1.76% 1,208.03$ 1,186.20$ (21.83)$ -1.81% 1,230.04$ 1,207.29$ (22.75)$ -1.85%

1,953.39$ 1,919.76$ (33.63)$ -1.72% 1,988.98$ 1,953.89$ (35.09)$ -1.76% 2,025.22$ 1,988.63$ (36.59)$ -1.81% 2,062.13$ 2,023.98$ (38.15)$ -1.85%

682.13$ 672.14$ (9.99)$ -1.46% 694.56$ 684.09$ (10.47)$ -1.51% 707.21$ 696.25$ (10.96)$ -1.55% 720.10$ 708.62$ (11.48)$ -1.59%

1,364.25$ 1,344.27$ (19.98)$ -1.46% 1,389.11$ 1,368.17$ (20.94)$ -1.51% 1,414.42$ 1,392.49$ (21.93)$ -1.55% 1,440.20$ 1,417.25$ (22.95)$ -1.59%

1,159.61$ 1,142.63$ (16.98)$ -1.46% 1,180.74$ 1,162.95$ (17.79)$ -1.51% 1,202.26$ 1,183.62$ (18.64)$ -1.55% 1,224.17$ 1,204.66$ (19.51)$ -1.59%

1,944.06$ 1,915.59$ (28.47)$ -1.46% 1,979.48$ 1,949.64$ (29.84)$ -1.51% 2,015.55$ 1,984.30$ (31.25)$ -1.55% 2,052.28$ 2,019.58$ (32.70)$ -1.59%

686.94$ 685.24$ (1.70)$ -0.25% 699.46$ 697.42$ (2.04)$ -0.29% 712.20$ 709.82$ (2.38)$ -0.33% 725.18$ 722.44$ (2.74)$ -0.38%

1,373.88$ 1,370.47$ (3.41)$ -0.25% 1,398.92$ 1,394.84$ (4.08)$ -0.29% 1,424.41$ 1,419.63$ (4.78)$ -0.34% 1,450.36$ 1,444.87$ (5.49)$ -0.38%

1,167.80$ 1,164.90$ (2.90)$ -0.25% 1,189.08$ 1,185.61$ (3.47)$ -0.29% 1,210.75$ 1,206.69$ (4.06)$ -0.34% 1,232.81$ 1,228.14$ (4.67)$ -0.38%

1,957.78$ 1,952.93$ (4.85)$ -0.25% 1,993.46$ 1,987.64$ (5.82)$ -0.29% 2,029.78$ 2,022.98$ (6.80)$ -0.34% 2,066.77$ 2,058.94$ (7.83)$ -0.38%

690.24$ 686.73$ (3.51)$ -0.51% 702.81$ 698.94$ (3.87)$ -0.55% 715.62$ 711.36$ (4.26)$ -0.60% 728.66$ 724.01$ (4.65)$ -0.64%

1,380.47$ 1,373.46$ (7.01)$ -0.51% 1,405.63$ 1,397.88$ (7.75)$ -0.55% 1,431.24$ 1,422.73$ (8.51)$ -0.59% 1,457.32$ 1,448.02$ (9.30)$ -0.64%

1,173.40$ 1,167.44$ (5.96)$ -0.51% 1,194.78$ 1,188.20$ (6.58)$ -0.55% 1,216.56$ 1,209.32$ (7.24)$ -0.60% 1,238.72$ 1,230.82$ (7.90)$ -0.64%

1,967.18$ 1,957.18$ (10.00)$ -0.51% 2,003.02$ 1,991.98$ (11.04)$ -0.55% 2,039.52$ 2,027.39$ (12.13)$ -0.59% 2,076.68$ 2,063.43$ (13.25)$ -0.64%

677.66$ 678.19$ 0.53$ 0.08% 690.00$ 690.25$ 0.25$ 0.04% 702.58$ 702.52$ (0.06)$ -0.01% 715.38$ 715.01$ (0.37)$ -0.05%

1,355.31$ 1,356.38$ 1.07$ 0.08% 1,380.01$ 1,380.49$ 0.48$ 0.03% 1,405.15$ 1,405.04$ (0.11)$ -0.01% 1,430.76$ 1,430.01$ (0.75)$ -0.05%

1,152.02$ 1,152.92$ 0.90$ 0.08% 1,173.01$ 1,173.42$ 0.41$ 0.03% 1,194.38$ 1,194.28$ (0.10)$ -0.01% 1,216.15$ 1,215.51$ (0.64)$ -0.05%

1,931.32$ 1,932.84$ 1.52$ 0.08% 1,966.51$ 1,967.20$ 0.69$ 0.04% 2,002.35$ 2,002.18$ (0.17)$ -0.01% 2,038.83$ 2,037.77$ (1.06)$ -0.05%

686.94$ 685.24$ (1.70)$ -0.25% 699.46$ 697.42$ (2.04)$ -0.29% 712.20$ 709.82$ (2.38)$ -0.33% 725.18$ 722.44$ (2.74)$ -0.38%

1,373.88$ 1,370.47$ (3.41)$ -0.25% 1,398.92$ 1,394.84$ (4.08)$ -0.29% 1,424.41$ 1,419.63$ (4.78)$ -0.34% 1,450.36$ 1,444.87$ (5.49)$ -0.38%

1,167.80$ 1,164.90$ (2.90)$ -0.25% 1,189.08$ 1,185.61$ (3.47)$ -0.29% 1,210.75$ 1,206.69$ (4.06)$ -0.34% 1,232.81$ 1,228.14$ (4.67)$ -0.38%

1,957.78$ 1,952.93$ (4.85)$ -0.25% 1,993.46$ 1,987.64$ (5.82)$ -0.29% 2,029.78$ 2,022.98$ (6.80)$ -0.34% 2,066.77$ 2,058.94$ (7.83)$ -0.38%

680.91$ 679.67$ (1.24)$ -0.18% 693.31$ 691.75$ (1.56)$ -0.23% 705.95$ 704.05$ (1.90)$ -0.27% 718.81$ 716.56$ (2.25)$ -0.31%

1,361.81$ 1,359.34$ (2.47)$ -0.18% 1,386.63$ 1,383.50$ (3.13)$ -0.23% 1,411.89$ 1,408.10$ (3.79)$ -0.27% 1,437.62$ 1,433.13$ (4.49)$ -0.31%

1,157.54$ 1,155.44$ (2.10)$ -0.18% 1,178.63$ 1,175.98$ (2.65)$ -0.22% 1,200.11$ 1,196.88$ (3.23)$ -0.27% 1,221.98$ 1,218.16$ (3.82)$ -0.31%

1,940.58$ 1,937.05$ (3.53)$ -0.18% 1,975.94$ 1,971.49$ (4.45)$ -0.23% 2,011.95$ 2,006.54$ (5.41)$ -0.27% 2,048.61$ 2,042.21$ (6.40)$ -0.31%

690.24$ 686.73$ (3.51)$ -0.51% 702.81$ 698.94$ (3.87)$ -0.55% 715.62$ 711.36$ (4.26)$ -0.60% 728.66$ 724.01$ (4.65)$ -0.64%

1,380.47$ 1,373.46$ (7.01)$ -0.51% 1,405.63$ 1,397.88$ (7.75)$ -0.55% 1,431.24$ 1,422.73$ (8.51)$ -0.59% 1,457.32$ 1,448.02$ (9.30)$ -0.64%

1,173.40$ 1,167.44$ (5.96)$ -0.51% 1,194.78$ 1,188.20$ (6.58)$ -0.55% 1,216.56$ 1,209.32$ (7.24)$ -0.60% 1,238.72$ 1,230.82$ (7.90)$ -0.64%

1,967.18$ 1,957.18$ (10.00)$ -0.51% 2,003.02$ 1,991.98$ (11.04)$ -0.55% 2,039.52$ 2,027.39$ (12.13)$ -0.59% 2,076.68$ 2,063.43$ (13.25)$ -0.64%






First Quarter 2021 (1/1/2021 - 3/31/2021)


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2020 2021 2020 2021 2020 2021 2020 2021





680.91$ 679.67$ (1.24)$ -0.18% 693.31$ 691.75$ (1.56)$ -0.23% 705.95$ 704.05$ (1.90)$ -0.27% 718.81$ 716.56$ (2.25)$ -0.31%

1,361.81$ 1,359.34$ (2.47)$ -0.18% 1,386.63$ 1,383.50$ (3.13)$ -0.23% 1,411.89$ 1,408.10$ (3.79)$ -0.27% 1,437.62$ 1,433.13$ (4.49)$ -0.31%

1,157.54$ 1,155.44$ (2.10)$ -0.18% 1,178.63$ 1,175.98$ (2.65)$ -0.22% 1,200.11$ 1,196.88$ (3.23)$ -0.27% 1,221.98$ 1,218.16$ (3.82)$ -0.31%

1,940.58$ 1,937.05$ (3.53)$ -0.18% 1,975.94$ 1,971.49$ (4.45)$ -0.23% 2,011.95$ 2,006.54$ (5.41)$ -0.27% 2,048.61$ 2,042.21$ (6.40)$ -0.31%

677.66$ 678.19$ 0.53$ 0.08% 690.00$ 690.25$ 0.25$ 0.04% 702.58$ 702.52$ (0.06)$ -0.01% 715.38$ 715.01$ (0.37)$ -0.05%

1,355.31$ 1,356.38$ 1.07$ 0.08% 1,380.01$ 1,380.49$ 0.48$ 0.03% 1,405.15$ 1,405.04$ (0.11)$ -0.01% 1,430.76$ 1,430.01$ (0.75)$ -0.05%

1,152.02$ 1,152.92$ 0.90$ 0.08% 1,173.01$ 1,173.42$ 0.41$ 0.03% 1,194.38$ 1,194.28$ (0.10)$ -0.01% 1,216.15$ 1,215.51$ (0.64)$ -0.05%

1,931.32$ 1,932.84$ 1.52$ 0.08% 1,966.51$ 1,967.20$ 0.69$ 0.04% 2,002.35$ 2,002.18$ (0.17)$ -0.01% 2,038.83$ 2,037.77$ (1.06)$ -0.05%

830.84$ 800.65$ (30.19)$ -3.63% 845.97$ 814.89$ (31.08)$ -3.67% 861.39$ 829.37$ (32.02)$ -3.72% 877.09$ 844.12$ (32.97)$ -3.76%

1,661.67$ 1,601.30$ (60.37)$ -3.63% 1,691.95$ 1,629.77$ (62.18)$ -3.68% 1,722.78$ 1,658.74$ (64.04)$ -3.72% 1,754.17$ 1,688.23$ (65.94)$ -3.76%

1,412.42$ 1,361.11$ (51.31)$ -3.63% 1,438.16$ 1,385.31$ (52.85)$ -3.67% 1,464.36$ 1,409.93$ (54.43)$ -3.72% 1,491.05$ 1,435.00$ (56.05)$ -3.76%

2,367.88$ 2,281.86$ (86.02)$ -3.63% 2,411.03$ 2,322.42$ (88.61)$ -3.68% 2,454.96$ 2,363.71$ (91.25)$ -3.72% 2,499.69$ 2,405.73$ (93.96)$ -3.76%

834.85$ 802.41$ (32.44)$ -3.89% 850.06$ 816.68$ (33.38)$ -3.93% 865.55$ 831.19$ (34.36)$ -3.97% 881.32$ 845.97$ (35.35)$ -4.01%

1,669.69$ 1,604.82$ (64.87)$ -3.89% 1,700.11$ 1,633.35$ (66.76)$ -3.93% 1,731.09$ 1,662.39$ (68.70)$ -3.97% 1,762.64$ 1,691.94$ (70.70)$ -4.01%

1,419.24$ 1,364.10$ (55.14)$ -3.89% 1,445.10$ 1,388.35$ (56.75)$ -3.93% 1,471.43$ 1,413.03$ (58.40)$ -3.97% 1,498.24$ 1,438.15$ (60.09)$ -4.01%

2,379.31$ 2,286.87$ (92.44)$ -3.89% 2,422.66$ 2,327.53$ (95.13)$ -3.93% 2,466.81$ 2,368.90$ (97.91)$ -3.97% 2,511.76$ 2,411.02$ (100.74)$ -4.01%

819.54$ 792.35$ (27.19)$ -3.32% 834.47$ 806.44$ (28.03)$ -3.36% 849.68$ 820.78$ (28.90)$ -3.40% 865.16$ 835.37$ (29.79)$ -3.44%

1,639.08$ 1,584.71$ (54.37)$ -3.32% 1,668.94$ 1,612.88$ (56.06)$ -3.36% 1,699.35$ 1,641.55$ (57.80)$ -3.40% 1,730.32$ 1,670.73$ (59.59)$ -3.44%

1,393.21$ 1,347.00$ (46.21)$ -3.32% 1,418.60$ 1,370.95$ (47.65)$ -3.36% 1,444.45$ 1,395.32$ (49.13)$ -3.40% 1,470.77$ 1,420.12$ (50.65)$ -3.44%

2,335.68$ 2,258.21$ (77.47)$ -3.32% 2,378.24$ 2,298.35$ (79.89)$ -3.36% 2,421.58$ 2,339.21$ (82.37)$ -3.40% 2,465.70$ 2,380.80$ (84.90)$ -3.44%

830.84$ 800.65$ (30.19)$ -3.63% 845.97$ 814.89$ (31.08)$ -3.67% 861.39$ 829.37$ (32.02)$ -3.72% 877.09$ 844.12$ (32.97)$ -3.76%

1,661.67$ 1,601.30$ (60.37)$ -3.63% 1,691.95$ 1,629.77$ (62.18)$ -3.68% 1,722.78$ 1,658.74$ (64.04)$ -3.72% 1,754.17$ 1,688.23$ (65.94)$ -3.76%

1,412.42$ 1,361.11$ (51.31)$ -3.63% 1,438.16$ 1,385.31$ (52.85)$ -3.67% 1,464.36$ 1,409.93$ (54.43)$ -3.72% 1,491.05$ 1,435.00$ (56.05)$ -3.76%

2,367.88$ 2,281.86$ (86.02)$ -3.63% 2,411.03$ 2,322.42$ (88.61)$ -3.68% 2,454.96$ 2,363.71$ (91.25)$ -3.72% 2,499.69$ 2,405.73$ (93.96)$ -3.76%

823.49$ 794.09$ (29.40)$ -3.57% 838.50$ 808.21$ (30.29)$ -3.61% 853.78$ 822.58$ (31.20)$ -3.65% 869.33$ 837.20$ (32.13)$ -3.70%

1,646.98$ 1,588.19$ (58.79)$ -3.57% 1,676.99$ 1,616.42$ (60.57)$ -3.61% 1,707.55$ 1,645.16$ (62.39)$ -3.65% 1,738.67$ 1,674.40$ (64.27)$ -3.70%

1,399.94$ 1,349.96$ (49.98)$ -3.57% 1,425.45$ 1,373.96$ (51.49)$ -3.61% 1,451.42$ 1,398.38$ (53.04)$ -3.65% 1,477.87$ 1,423.24$ (54.63)$ -3.70%

2,346.95$ 2,263.17$ (83.78)$ -3.57% 2,389.72$ 2,303.40$ (86.32)$ -3.61% 2,433.26$ 2,344.35$ (88.91)$ -3.65% 2,477.60$ 2,386.03$ (91.57)$ -3.70%

834.85$ 802.41$ (32.44)$ -3.89% 850.06$ 816.68$ (33.38)$ -3.93% 865.55$ 831.19$ (34.36)$ -3.97% 881.32$ 845.97$ (35.35)$ -4.01%

1,669.69$ 1,604.82$ (64.87)$ -3.89% 1,700.11$ 1,633.35$ (66.76)$ -3.93% 1,731.09$ 1,662.39$ (68.70)$ -3.97% 1,762.64$ 1,691.94$ (70.70)$ -4.01%

1,419.24$ 1,364.10$ (55.14)$ -3.89% 1,445.10$ 1,388.35$ (56.75)$ -3.93% 1,471.43$ 1,413.03$ (58.40)$ -3.97% 1,498.24$ 1,438.15$ (60.09)$ -4.01%

2,379.31$ 2,286.87$ (92.44)$ -3.89% 2,422.66$ 2,327.53$ (95.13)$ -3.93% 2,466.81$ 2,368.90$ (97.91)$ -3.97% 2,511.76$ 2,411.02$ (100.74)$ -4.01%

823.49$ 794.09$ (29.40)$ -3.57% 838.50$ 808.21$ (30.29)$ -3.61% 853.78$ 822.58$ (31.20)$ -3.65% 869.33$ 837.20$ (32.13)$ -3.70%

1,646.98$ 1,588.19$ (58.79)$ -3.57% 1,676.99$ 1,616.42$ (60.57)$ -3.61% 1,707.55$ 1,645.16$ (62.39)$ -3.65% 1,738.67$ 1,674.40$ (64.27)$ -3.70%

1,399.94$ 1,349.96$ (49.98)$ -3.57% 1,425.45$ 1,373.96$ (51.49)$ -3.61% 1,451.42$ 1,398.38$ (53.04)$ -3.65% 1,477.87$ 1,423.24$ (54.63)$ -3.70%

2,346.95$ 2,263.17$ (83.78)$ -3.57% 2,389.72$ 2,303.40$ (86.32)$ -3.61% 2,433.26$ 2,344.35$ (88.91)$ -3.65% 2,477.60$ 2,386.03$ (91.57)$ -3.70%

819.54$ 792.35$ (27.19)$ -3.32% 834.47$ 806.44$ (28.03)$ -3.36% 849.68$ 820.78$ (28.90)$ -3.40% 865.16$ 835.37$ (29.79)$ -3.44%

1,639.08$ 1,584.71$ (54.37)$ -3.32% 1,668.94$ 1,612.88$ (56.06)$ -3.36% 1,699.35$ 1,641.55$ (57.80)$ -3.40% 1,730.32$ 1,670.73$ (59.59)$ -3.44%

1,393.21$ 1,347.00$ (46.21)$ -3.32% 1,418.60$ 1,370.95$ (47.65)$ -3.36% 1,444.45$ 1,395.32$ (49.13)$ -3.40% 1,470.77$ 1,420.12$ (50.65)$ -3.44%

2,335.68$ 2,258.21$ (77.47)$ -3.32% 2,378.24$ 2,298.35$ (79.89)$ -3.36% 2,421.58$ 2,339.21$ (82.37)$ -3.40% 2,465.70$ 2,380.80$ (84.90)$ -3.44%


Capital District Physicians' Health PlanSyracuse Region




First Quarter 2021 (1/1/2021 - 3/31/2021)


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2020 2021 2020 2021 2020 2021 2020 2021





548.07$ $602.86 54.79$ 10.00% 558.06$ $613.58 55.52$ 9.95% 568.23$ 624.48$ 56.25$ 9.90% 578.58$ 635.58$ 57.00$ 9.85%

1,096.14$ 1,205.72$ 109.58$ 10.00% 1,116.12$ 1,227.15$ 111.03$ 9.95% 1,136.45$ 1,248.97$ 112.52$ 9.90% 1,157.16$ 1,271.17$ 114.01$ 9.85%

931.72$ 1,024.86$ 93.14$ 10.00% 948.70$ 1,043.08$ 94.38$ 9.95% 965.99$ 1,061.62$ 95.63$ 9.90% 983.59$ 1,080.49$ 96.90$ 9.85%

1,562.00$ 1,718.14$ 156.14$ 10.00% 1,590.47$ 1,748.69$ 158.22$ 9.95% 1,619.45$ 1,779.78$ 160.33$ 9.90% 1,648.96$ 1,811.42$ 162.46$ 9.85%

550.71$ 604.16$ 53.45$ 9.71% 560.75$ 614.90$ 54.15$ 9.66% 570.96$ 625.83$ 54.87$ 9.61% 581.37$ 636.96$ 55.59$ 9.56%

1,101.42$ 1,208.32$ 106.90$ 9.71% 1,121.49$ 1,229.81$ 108.32$ 9.66% 1,141.93$ 1,251.67$ 109.74$ 9.61% 1,162.73$ 1,273.92$ 111.19$ 9.56%

936.21$ 1,027.08$ 90.87$ 9.71% 953.27$ 1,045.34$ 92.07$ 9.66% 970.64$ 1,063.92$ 93.28$ 9.61% 988.32$ 1,082.83$ 94.51$ 9.56%

1,569.53$ 1,721.86$ 152.33$ 9.71% 1,598.12$ 1,752.47$ 154.35$ 9.66% 1,627.25$ 1,783.63$ 156.38$ 9.61% 1,656.90$ 1,815.34$ 158.44$ 9.56%

540.66$ 596.70$ 56.04$ 10.37% 550.51$ 607.31$ 56.80$ 10.32% 560.55$ 618.11$ 57.56$ 10.27% 570.76$ 629.10$ 58.34$ 10.22%

1,081.33$ 1,193.41$ 112.08$ 10.37% 1,101.03$ 1,214.62$ 113.59$ 10.32% 1,121.09$ 1,236.22$ 115.13$ 10.27% 1,141.52$ 1,258.19$ 116.67$ 10.22%

919.13$ 1,014.40$ 95.27$ 10.37% 935.87$ 1,032.43$ 96.56$ 10.32% 952.93$ 1,050.79$ 97.86$ 10.27% 970.29$ 1,069.47$ 99.18$ 10.22%

1,540.89$ 1,700.61$ 159.72$ 10.37% 1,568.97$ 1,730.84$ 161.87$ 10.32% 1,597.56$ 1,761.61$ 164.05$ 10.27% 1,626.67$ 1,792.93$ 166.26$ 10.22%

548.07$ 602.86$ 54.79$ 10.00% 558.06$ 613.58$ 55.52$ 9.95% 568.23$ 624.48$ 56.25$ 9.90% 578.58$ 635.58$ 57.00$ 9.85%

1,096.14$ 1,205.72$ 109.58$ 10.00% 1,116.12$ 1,227.15$ 111.03$ 9.95% 1,136.45$ 1,248.97$ 112.52$ 9.90% 1,157.16$ 1,271.17$ 114.01$ 9.85%

931.72$ 1,024.86$ 93.14$ 10.00% 948.70$ 1,043.08$ 94.38$ 9.95% 965.99$ 1,061.62$ 95.63$ 9.90% 983.59$ 1,080.49$ 96.90$ 9.85%

1,562.00$ 1,718.14$ 156.14$ 10.00% 1,590.47$ 1,748.69$ 158.22$ 9.95% 1,619.45$ 1,779.78$ 160.33$ 9.90% 1,648.96$ 1,811.42$ 162.46$ 9.85%

543.26$ 598.00$ 54.74$ 10.08% 553.16$ 608.63$ 55.47$ 10.03% 563.24$ 619.45$ 56.21$ 9.98% 573.50$ 630.46$ 56.96$ 9.93%

1,086.51$ 1,195.99$ 109.48$ 10.08% 1,106.31$ 1,217.25$ 110.94$ 10.03% 1,126.47$ 1,238.89$ 112.42$ 9.98% 1,147.00$ 1,260.92$ 113.92$ 9.93%

923.54$ 1,016.59$ 93.05$ 10.08% 940.37$ 1,034.66$ 94.29$ 10.03% 957.50$ 1,053.06$ 95.56$ 9.98% 974.95$ 1,071.78$ 96.83$ 9.93%

1,548.28$ 1,704.29$ 156.01$ 10.08% 1,576.49$ 1,734.58$ 158.09$ 10.03% 1,605.22$ 1,765.42$ 160.20$ 9.98% 1,634.47$ 1,796.81$ 162.34$ 9.93%

550.71$ 604.16$ 53.45$ 9.71% 560.75$ 614.90$ 54.15$ 9.66% 570.96$ 625.83$ 54.87$ 9.61% 581.37$ 636.96$ 55.59$ 9.56%

1,101.42$ 1,208.32$ 106.90$ 9.71% 1,121.49$ 1,229.81$ 108.32$ 9.66% 1,141.93$ 1,251.67$ 109.74$ 9.61% 1,162.73$ 1,273.92$ 111.19$ 9.56%

936.21$ 1,027.08$ 90.87$ 9.71% 953.27$ 1,045.34$ 92.07$ 9.66% 970.64$ 1,063.92$ 93.28$ 9.61% 988.32$ 1,082.83$ 94.51$ 9.56%

1,569.53$ 1,721.86$ 152.33$ 9.71% 1,598.12$ 1,752.47$ 154.35$ 9.66% 1,627.25$ 1,783.63$ 156.38$ 9.61% 1,656.90$ 1,815.34$ 158.44$ 9.56%

543.26$ 598.00$ 54.74$ 10.08% 553.16$ 608.63$ 55.47$ 10.03% 563.24$ 619.45$ 56.21$ 9.98% 573.50$ 630.46$ 56.96$ 9.93%

1,086.51$ 1,195.99$ 109.48$ 10.08% 1,106.31$ 1,217.25$ 110.94$ 10.03% 1,126.47$ 1,238.89$ 112.42$ 9.98% 1,147.00$ 1,260.92$ 113.92$ 9.93%

923.54$ 1,016.59$ 93.05$ 10.08% 940.37$ 1,034.66$ 94.29$ 10.03% 957.50$ 1,053.06$ 95.56$ 9.98% 974.95$ 1,071.78$ 96.83$ 9.93%

1,548.28$ 1,704.29$ 156.01$ 10.08% 1,576.49$ 1,734.58$ 158.09$ 10.03% 1,605.22$ 1,765.42$ 160.20$ 9.98% 1,634.47$ 1,796.81$ 162.34$ 9.93%

540.66$ 596.70$ 56.04$ 10.37% 550.51$ 607.31$ 56.80$ 10.32% 560.55$ 618.11$ 57.56$ 10.27% 570.76$ 629.10$ 58.34$ 10.22%

1,081.33$ 1,193.41$ 112.08$ 10.37% 1,101.03$ 1,214.62$ 113.59$ 10.32% 1,121.09$ 1,236.22$ 115.13$ 10.27% 1,141.52$ 1,258.19$ 116.67$ 10.22%

919.13$ 1,014.40$ 95.27$ 10.37% 935.87$ 1,032.43$ 96.56$ 10.32% 952.93$ 1,050.79$ 97.86$ 10.27% 970.29$ 1,069.47$ 99.18$ 10.22%

1,540.89$ 1,700.61$ 159.72$ 10.37% 1,568.97$ 1,730.84$ 161.87$ 10.32% 1,597.56$ 1,761.61$ 164.05$ 10.27% 1,626.67$ 1,792.93$ 166.26$ 10.22%

544.48$ 608.25$ 63.77$ 11.71% 554.40$ 619.07$ 64.67$ 11.66% 564.50$ 630.07$ 65.57$ 11.62% 574.79$ 641.27$ 66.48$ 11.57%

1,088.96$ 1,216.50$ 127.54$ 11.71% 1,108.80$ 1,238.13$ 129.33$ 11.66% 1,129.01$ 1,260.14$ 131.13$ 11.61% 1,149.58$ 1,282.54$ 132.96$ 11.57%

925.62$ 1,034.03$ 108.41$ 11.71% 942.48$ 1,052.41$ 109.93$ 11.66% 959.66$ 1,071.12$ 111.46$ 11.61% 977.14$ 1,090.16$ 113.02$ 11.57%

1,551.77$ 1,733.52$ 181.75$ 11.71% 1,580.04$ 1,764.34$ 184.30$ 11.66% 1,608.83$ 1,795.70$ 186.87$ 11.62% 1,638.15$ 1,827.63$ 189.48$ 11.57%

547.09$ 609.57$ 62.48$ 11.42% 557.06$ 620.41$ 63.35$ 11.37% 567.21$ 631.44$ 64.23$ 11.32% 577.55$ 642.66$ 65.11$ 11.27%

1,094.18$ 1,219.14$ 124.96$ 11.42% 1,114.12$ 1,240.81$ 126.69$ 11.37% 1,134.42$ 1,262.87$ 128.45$ 11.32% 1,155.09$ 1,285.32$ 130.23$ 11.27%

930.06$ 1,036.27$ 106.21$ 11.42% 947.00$ 1,054.69$ 107.69$ 11.37% 964.26$ 1,073.44$ 109.18$ 11.32% 981.83$ 1,092.52$ 110.69$ 11.27%

1,559.21$ 1,737.27$ 178.06$ 11.42% 1,587.62$ 1,768.16$ 180.54$ 11.37% 1,616.55$ 1,799.59$ 183.04$ 11.32% 1,646.01$ 1,831.58$ 185.57$ 11.27%

537.12$ 602.04$ 64.92$ 12.09% 546.91$ 612.74$ 65.83$ 12.04% 556.87$ 623.64$ 66.77$ 11.99% 567.02$ 634.72$ 67.70$ 11.94%

1,074.24$ 1,204.08$ 129.84$ 12.09% 1,093.81$ 1,225.49$ 131.68$ 12.04% 1,113.75$ 1,247.27$ 133.52$ 11.99% 1,134.04$ 1,269.45$ 135.41$ 11.94%

913.10$ 1,023.47$ 110.37$ 12.09% 929.74$ 1,041.66$ 111.92$ 12.04% 946.68$ 1,060.18$ 113.50$ 11.99% 963.93$ 1,079.03$ 115.10$ 11.94%

1,530.79$ 1,715.82$ 185.03$ 12.09% 1,558.69$ 1,746.32$ 187.63$ 12.04% 1,587.09$ 1,777.36$ 190.27$ 11.99% 1,616.01$ 1,808.96$ 192.95$ 11.94%

544.48$ 608.25$ 63.77$ 11.71% 554.40$ 619.07$ 64.67$ 11.66% 564.50$ 630.07$ 65.57$ 11.62% 574.79$ 641.27$ 66.48$ 11.57%

1,088.96$ 1,216.50$ 127.54$ 11.71% 1,108.80$ 1,238.13$ 129.33$ 11.66% 1,129.01$ 1,260.14$ 131.13$ 11.61% 1,149.58$ 1,282.54$ 132.96$ 11.57%

925.62$ 1,034.03$ 108.41$ 11.71% 942.48$ 1,052.41$ 109.93$ 11.66% 959.66$ 1,071.12$ 111.46$ 11.61% 977.14$ 1,090.16$ 113.02$ 11.57%

1,551.77$ 1,733.52$ 181.75$ 11.71% 1,580.04$ 1,764.34$ 184.30$ 11.66% 1,608.83$ 1,795.70$ 186.87$ 11.62% 1,638.15$ 1,827.63$ 189.48$ 11.57%

539.70$ 603.34$ 63.64$ 11.79% 549.53$ 614.07$ 64.54$ 11.74% 559.54$ 624.99$ 65.45$ 11.70% 569.74$ 636.10$ 66.36$ 11.65%

1,079.39$ 1,206.69$ 127.30$ 11.79% 1,099.06$ 1,228.14$ 129.08$ 11.74% 1,119.09$ 1,249.97$ 130.88$ 11.70% 1,139.48$ 1,272.19$ 132.71$ 11.65%

917.48$ 1,025.68$ 108.20$ 11.79% 934.20$ 1,043.92$ 109.72$ 11.74% 951.22$ 1,062.48$ 111.26$ 11.70% 968.56$ 1,081.36$ 112.80$ 11.65%

1,538.13$ 1,719.53$ 181.40$ 11.79% 1,566.16$ 1,750.10$ 183.94$ 11.74% 1,594.70$ 1,781.21$ 186.51$ 11.70% 1,623.76$ 1,812.87$ 189.11$ 11.65%

547.09$ 609.57$ 62.48$ 11.42% 557.06$ 620.41$ 63.35$ 11.37% 567.21$ 631.44$ 64.23$ 11.32% 577.55$ 642.66$ 65.11$ 11.27%

1,094.18$ 1,219.14$ 124.96$ 11.42% 1,114.12$ 1,240.81$ 126.69$ 11.37% 1,134.42$ 1,262.87$ 128.45$ 11.32% 1,155.09$ 1,285.32$ 130.23$ 11.27%

930.06$ 1,036.27$ 106.21$ 11.42% 947.00$ 1,054.69$ 107.69$ 11.37% 964.26$ 1,073.44$ 109.18$ 11.32% 981.83$ 1,092.52$ 110.69$ 11.27%

1,559.21$ 1,737.27$ 178.06$ 11.42% 1,587.62$ 1,768.16$ 180.54$ 11.37% 1,616.55$ 1,799.59$ 183.04$ 11.32% 1,646.01$ 1,831.58$ 185.57$ 11.27%






First Quarter 2021 (1/1/2021 - 3/31/2021)


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2020 2021 2020 2021 2020 2021 2020 2021





539.70$ 603.34$ 63.64$ 11.79% 549.53$ 614.07$ 64.54$ 11.74% 559.54$ 624.99$ 65.45$ 11.70% 569.74$ 636.10$ 66.36$ 11.65%

1,079.39$ 1,206.69$ 127.30$ 11.79% 1,099.06$ 1,228.14$ 129.08$ 11.74% 1,119.09$ 1,249.97$ 130.88$ 11.70% 1,139.48$ 1,272.19$ 132.71$ 11.65%

917.48$ 1,025.68$ 108.20$ 11.79% 934.20$ 1,043.92$ 109.72$ 11.74% 951.22$ 1,062.48$ 111.26$ 11.70% 968.56$ 1,081.36$ 112.80$ 11.65%

1,538.13$ 1,719.53$ 181.40$ 11.79% 1,566.16$ 1,750.10$ 183.94$ 11.74% 1,594.70$ 1,781.21$ 186.51$ 11.70% 1,623.76$ 1,812.87$ 189.11$ 11.65%

537.12$ 602.04$ 64.92$ 12.09% 546.91$ 612.74$ 65.83$ 12.04% 556.87$ 623.64$ 66.77$ 11.99% 567.02$ 634.72$ 67.70$ 11.94%

1,074.24$ 1,204.08$ 129.84$ 12.09% 1,093.81$ 1,225.49$ 131.68$ 12.04% 1,113.75$ 1,247.27$ 133.52$ 11.99% 1,134.04$ 1,269.45$ 135.41$ 11.94%

913.10$ 1,023.47$ 110.37$ 12.09% 929.74$ 1,041.66$ 111.92$ 12.04% 946.68$ 1,060.18$ 113.50$ 11.99% 963.93$ 1,079.03$ 115.10$ 11.94%

1,530.79$ 1,715.82$ 185.03$ 12.09% 1,558.69$ 1,746.32$ 187.63$ 12.04% 1,587.09$ 1,777.36$ 190.27$ 11.99% 1,616.01$ 1,808.96$ 192.95$ 11.94%

658.53$ 709.99$ 51.46$ 7.81% 670.53$ 722.61$ 52.08$ 7.77% 682.75$ 735.46$ 52.71$ 7.72% 695.19$ 748.54$ 53.35$ 7.67%

1,317.06$ 1,419.98$ 102.92$ 7.81% 1,341.06$ 1,445.23$ 104.17$ 7.77% 1,365.50$ 1,470.92$ 105.42$ 7.72% 1,390.38$ 1,497.07$ 106.69$ 7.67%

1,119.50$ 1,206.99$ 87.49$ 7.82% 1,139.90$ 1,228.44$ 88.54$ 7.77% 1,160.68$ 1,250.28$ 89.60$ 7.72% 1,181.82$ 1,272.51$ 90.69$ 7.67%

1,876.82$ 2,023.48$ 146.66$ 7.81% 1,911.02$ 2,059.45$ 148.43$ 7.77% 1,945.84$ 2,096.06$ 150.22$ 7.72% 1,981.29$ 2,133.33$ 152.04$ 7.67%

661.71$ 711.54$ 49.83$ 7.53% 673.77$ 724.19$ 50.42$ 7.48% 686.05$ 737.07$ 51.02$ 7.44% 698.55$ 750.17$ 51.62$ 7.39%

1,323.42$ 1,423.09$ 99.67$ 7.53% 1,347.54$ 1,448.39$ 100.85$ 7.48% 1,372.09$ 1,474.13$ 102.04$ 7.44% 1,397.09$ 1,500.34$ 103.25$ 7.39%

1,124.91$ 1,209.62$ 84.71$ 7.53% 1,145.41$ 1,231.13$ 85.72$ 7.48% 1,166.28$ 1,253.01$ 86.73$ 7.44% 1,187.53$ 1,275.29$ 87.76$ 7.39%

1,885.87$ 2,027.90$ 142.03$ 7.53% 1,920.24$ 2,063.95$ 143.71$ 7.48% 1,955.23$ 2,100.64$ 145.41$ 7.44% 1,990.86$ 2,137.99$ 147.13$ 7.39%

649.58$ 702.68$ 53.10$ 8.17% 661.41$ 715.17$ 53.76$ 8.13% 673.47$ 727.88$ 54.41$ 8.08% 685.74$ 740.82$ 55.08$ 8.03%

1,299.16$ 1,405.35$ 106.19$ 8.17% 1,322.83$ 1,430.34$ 107.51$ 8.13% 1,346.93$ 1,455.77$ 108.84$ 8.08% 1,371.48$ 1,481.65$ 110.17$ 8.03%

1,104.28$ 1,194.55$ 90.27$ 8.17% 1,124.40$ 1,215.79$ 91.39$ 8.13% 1,144.89$ 1,237.40$ 92.51$ 8.08% 1,165.75$ 1,259.40$ 93.65$ 8.03%

1,851.30$ 2,002.63$ 151.33$ 8.17% 1,885.03$ 2,038.23$ 153.20$ 8.13% 1,919.38$ 2,074.47$ 155.09$ 8.08% 1,954.35$ 2,111.34$ 156.99$ 8.03%

658.53$ 709.99$ 51.46$ 7.81% 670.53$ 722.61$ 52.08$ 7.77% 682.75$ 735.46$ 52.71$ 7.72% 695.19$ 748.54$ 53.35$ 7.67%

1,317.06$ 1,419.98$ 102.92$ 7.81% 1,341.06$ 1,445.23$ 104.17$ 7.77% 1,365.50$ 1,470.92$ 105.42$ 7.72% 1,390.38$ 1,497.07$ 106.69$ 7.67%

1,119.50$ 1,206.99$ 87.49$ 7.82% 1,139.90$ 1,228.44$ 88.54$ 7.77% 1,160.68$ 1,250.28$ 89.60$ 7.72% 1,181.82$ 1,272.51$ 90.69$ 7.67%

1,876.82$ 2,023.48$ 146.66$ 7.81% 1,911.02$ 2,059.45$ 148.43$ 7.77% 1,945.84$ 2,096.06$ 150.22$ 7.72% 1,981.29$ 2,133.33$ 152.04$ 7.67%

652.71$ 704.21$ 51.50$ 7.89% 664.61$ 716.73$ 52.12$ 7.84% 676.72$ 729.47$ 52.75$ 7.79% 689.05$ 742.44$ 53.39$ 7.75%

1,305.42$ 1,408.42$ 103.00$ 7.89% 1,329.21$ 1,433.46$ 104.25$ 7.84% 1,353.43$ 1,458.94$ 105.51$ 7.80% 1,378.09$ 1,484.88$ 106.79$ 7.75%

1,109.61$ 1,197.16$ 87.55$ 7.89% 1,129.83$ 1,218.44$ 88.61$ 7.84% 1,150.42$ 1,240.10$ 89.68$ 7.80% 1,171.38$ 1,262.15$ 90.77$ 7.75%

1,860.23$ 2,007.00$ 146.77$ 7.89% 1,894.12$ 2,042.68$ 148.56$ 7.84% 1,928.64$ 2,079.00$ 150.36$ 7.80% 1,963.78$ 2,115.95$ 152.17$ 7.75%

661.71$ 711.54$ 49.83$ 7.53% 673.77$ 724.19$ 50.42$ 7.48% 686.05$ 737.07$ 51.02$ 7.44% 698.55$ 750.17$ 51.62$ 7.39%

1,323.42$ 1,423.09$ 99.67$ 7.53% 1,347.54$ 1,448.39$ 100.85$ 7.48% 1,372.09$ 1,474.13$ 102.04$ 7.44% 1,397.09$ 1,500.34$ 103.25$ 7.39%

1,124.91$ 1,209.62$ 84.71$ 7.53% 1,145.41$ 1,231.13$ 85.72$ 7.48% 1,166.28$ 1,253.01$ 86.73$ 7.44% 1,187.53$ 1,275.29$ 87.76$ 7.39%

1,885.87$ 2,027.90$ 142.03$ 7.53% 1,920.24$ 2,063.95$ 143.71$ 7.48% 1,955.23$ 2,100.64$ 145.41$ 7.44% 1,990.86$ 2,137.99$ 147.13$ 7.39%

652.71$ 704.21$ 51.50$ 7.89% 664.61$ 716.73$ 52.12$ 7.84% 676.72$ 729.47$ 52.75$ 7.79% 689.05$ 742.44$ 53.39$ 7.75%

1,305.42$ 1,408.42$ 103.00$ 7.89% 1,329.21$ 1,433.46$ 104.25$ 7.84% 1,353.43$ 1,458.94$ 105.51$ 7.80% 1,378.09$ 1,484.88$ 106.79$ 7.75%

1,109.61$ 1,197.16$ 87.55$ 7.89% 1,129.83$ 1,218.44$ 88.61$ 7.84% 1,150.42$ 1,240.10$ 89.68$ 7.80% 1,171.38$ 1,262.15$ 90.77$ 7.75%

1,860.23$ 2,007.00$ 146.77$ 7.89% 1,894.12$ 2,042.68$ 148.56$ 7.84% 1,928.64$ 2,079.00$ 150.36$ 7.80% 1,963.78$ 2,115.95$ 152.17$ 7.75%

649.58$ 702.68$ 53.10$ 8.17% 661.41$ 715.17$ 53.76$ 8.13% 673.47$ 727.88$ 54.41$ 8.08% 685.74$ 740.82$ 55.08$ 8.03%

1,299.16$ 1,405.35$ 106.19$ 8.17% 1,322.83$ 1,430.34$ 107.51$ 8.13% 1,346.93$ 1,455.77$ 108.84$ 8.08% 1,371.48$ 1,481.65$ 110.17$ 8.03%

1,104.28$ 1,194.55$ 90.27$ 8.17% 1,124.40$ 1,215.79$ 91.39$ 8.13% 1,144.89$ 1,237.40$ 92.51$ 8.08% 1,165.75$ 1,259.40$ 93.65$ 8.03%

1,851.30$ 2,002.63$ 151.33$ 8.17% 1,885.03$ 2,038.23$ 153.20$ 8.13% 1,919.38$ 2,074.47$ 155.09$ 8.08% 1,954.35$ 2,111.34$ 156.99$ 8.03%


Capital District Physicians' Health PlanUtica/Watertown Region




First Quarter 2021 (1/1/2021 - 3/31/2021)


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2020 2021 2020 2021 2020 2021 2020 2021





541.44$ $581.33 39.89$ 7.37% 551.31$ $591.66 40.35$ 7.32% 561.35$ 602.18$ 40.83$ 7.27% 571.58$ 612.89$ 41.31$ 7.23%

1,082.88$ 1,162.66$ 79.78$ 7.37% 1,102.61$ 1,183.33$ 80.72$ 7.32% 1,122.70$ 1,204.37$ 81.67$ 7.27% 1,143.16$ 1,225.78$ 82.62$ 7.23%

920.45$ 988.26$ 67.81$ 7.37% 937.22$ 1,005.83$ 68.61$ 7.32% 954.30$ 1,023.71$ 69.41$ 7.27% 971.69$ 1,041.91$ 70.22$ 7.23%

1,543.10$ 1,656.79$ 113.69$ 7.37% 1,571.22$ 1,686.24$ 115.02$ 7.32% 1,599.85$ 1,716.22$ 116.37$ 7.27% 1,629.00$ 1,746.73$ 117.73$ 7.23%

544.05$ 582.58$ 38.53$ 7.08% 553.96$ 592.94$ 38.98$ 7.04% 564.05$ 603.48$ 39.43$ 6.99% 574.33$ 614.21$ 39.88$ 6.94%

1,088.09$ 1,165.17$ 77.08$ 7.08% 1,107.92$ 1,185.88$ 77.96$ 7.04% 1,128.11$ 1,206.97$ 78.86$ 6.99% 1,148.67$ 1,228.42$ 79.75$ 6.94%

924.88$ 990.39$ 65.51$ 7.08% 941.73$ 1,008.00$ 66.27$ 7.04% 958.89$ 1,025.92$ 67.03$ 6.99% 976.37$ 1,044.16$ 67.79$ 6.94%

1,550.53$ 1,660.37$ 109.84$ 7.08% 1,578.79$ 1,689.88$ 111.09$ 7.04% 1,607.56$ 1,719.93$ 112.37$ 6.99% 1,636.85$ 1,750.50$ 113.65$ 6.94%

534.12$ 575.41$ 41.29$ 7.73% 543.85$ 585.64$ 41.79$ 7.68% 553.76$ 596.05$ 42.29$ 7.64% 563.85$ 606.65$ 42.80$ 7.59%

1,068.24$ 1,150.82$ 82.58$ 7.73% 1,087.71$ 1,171.28$ 83.57$ 7.68% 1,107.53$ 1,192.10$ 84.57$ 7.64% 1,127.71$ 1,213.29$ 85.58$ 7.59%

908.01$ 978.20$ 70.19$ 7.73% 924.55$ 995.59$ 71.04$ 7.68% 941.40$ 1,013.29$ 71.89$ 7.64% 958.55$ 1,031.30$ 72.75$ 7.59%

1,522.24$ 1,639.92$ 117.68$ 7.73% 1,549.98$ 1,669.07$ 119.09$ 7.68% 1,578.23$ 1,698.74$ 120.51$ 7.64% 1,606.98$ 1,728.94$ 121.96$ 7.59%

541.44$ 581.33$ 39.89$ 7.37% 551.31$ 591.66$ 40.35$ 7.32% 561.35$ 602.18$ 40.83$ 7.27% 571.58$ 612.89$ 41.31$ 7.23%

1,082.88$ 1,162.66$ 79.78$ 7.37% 1,102.61$ 1,183.33$ 80.72$ 7.32% 1,122.70$ 1,204.37$ 81.67$ 7.27% 1,143.16$ 1,225.78$ 82.62$ 7.23%

920.45$ 988.26$ 67.81$ 7.37% 937.22$ 1,005.83$ 68.61$ 7.32% 954.30$ 1,023.71$ 69.41$ 7.27% 971.69$ 1,041.91$ 70.22$ 7.23%

1,543.10$ 1,656.79$ 113.69$ 7.37% 1,571.22$ 1,686.24$ 115.02$ 7.32% 1,599.85$ 1,716.22$ 116.37$ 7.27% 1,629.00$ 1,746.73$ 117.73$ 7.23%

536.68$ 576.65$ 39.97$ 7.45% 546.46$ 586.90$ 40.44$ 7.40% 556.42$ 597.34$ 40.92$ 7.35% 566.56$ 607.96$ 41.40$ 7.31%

1,073.37$ 1,153.30$ 79.93$ 7.45% 1,092.93$ 1,173.81$ 80.88$ 7.40% 1,112.84$ 1,194.67$ 81.83$ 7.35% 1,133.12$ 1,215.91$ 82.79$ 7.31%

912.36$ 980.31$ 67.95$ 7.45% 928.99$ 997.73$ 68.74$ 7.40% 945.91$ 1,015.47$ 69.56$ 7.35% 963.15$ 1,033.52$ 70.37$ 7.31%

1,529.55$ 1,643.46$ 113.91$ 7.45% 1,557.42$ 1,672.67$ 115.25$ 7.40% 1,585.80$ 1,702.41$ 116.61$ 7.35% 1,614.69$ 1,732.67$ 117.98$ 7.31%

544.05$ 582.58$ 38.53$ 7.08% 553.96$ 592.94$ 38.98$ 7.04% 564.05$ 603.48$ 39.43$ 6.99% 574.33$ 614.21$ 39.88$ 6.94%

1,088.09$ 1,165.17$ 77.08$ 7.08% 1,107.92$ 1,185.88$ 77.96$ 7.04% 1,128.11$ 1,206.97$ 78.86$ 6.99% 1,148.67$ 1,228.42$ 79.75$ 6.94%

924.88$ 990.39$ 65.51$ 7.08% 941.73$ 1,008.00$ 66.27$ 7.04% 958.89$ 1,025.92$ 67.03$ 6.99% 976.37$ 1,044.16$ 67.79$ 6.94%

1,550.53$ 1,660.37$ 109.84$ 7.08% 1,578.79$ 1,689.88$ 111.09$ 7.04% 1,607.56$ 1,719.93$ 112.37$ 6.99% 1,636.85$ 1,750.50$ 113.65$ 6.94%

536.68$ 576.65$ 39.97$ 7.45% 546.46$ 586.90$ 40.44$ 7.40% 556.42$ 597.34$ 40.92$ 7.35% 566.56$ 607.96$ 41.40$ 7.31%

1,073.37$ 1,153.30$ 79.93$ 7.45% 1,092.93$ 1,173.81$ 80.88$ 7.40% 1,112.84$ 1,194.67$ 81.83$ 7.35% 1,133.12$ 1,215.91$ 82.79$ 7.31%

912.36$ 980.31$ 67.95$ 7.45% 928.99$ 997.73$ 68.74$ 7.40% 945.91$ 1,015.47$ 69.56$ 7.35% 963.15$ 1,033.52$ 70.37$ 7.31%

1,529.55$ 1,643.46$ 113.91$ 7.45% 1,557.42$ 1,672.67$ 115.25$ 7.40% 1,585.80$ 1,702.41$ 116.61$ 7.35% 1,614.69$ 1,732.67$ 117.98$ 7.31%

534.12$ 575.41$ 41.29$ 7.73% 543.85$ 585.64$ 41.79$ 7.68% 553.76$ 596.05$ 42.29$ 7.64% 563.85$ 606.65$ 42.80$ 7.59%

1,068.24$ 1,150.82$ 82.58$ 7.73% 1,087.71$ 1,171.28$ 83.57$ 7.68% 1,107.53$ 1,192.10$ 84.57$ 7.64% 1,127.71$ 1,213.29$ 85.58$ 7.59%

908.01$ 978.20$ 70.19$ 7.73% 924.55$ 995.59$ 71.04$ 7.68% 941.40$ 1,013.29$ 71.89$ 7.64% 958.55$ 1,031.30$ 72.75$ 7.59%

1,522.24$ 1,639.92$ 117.68$ 7.73% 1,549.98$ 1,669.07$ 119.09$ 7.68% 1,578.23$ 1,698.74$ 120.51$ 7.64% 1,606.98$ 1,728.94$ 121.96$ 7.59%

537.89$ 586.52$ 48.63$ 9.04% 547.69$ 596.95$ 49.26$ 8.99% 557.67$ 607.56$ 49.89$ 8.95% 567.83$ 618.36$ 50.53$ 8.90%

1,075.78$ 1,173.04$ 97.26$ 9.04% 1,095.39$ 1,193.89$ 98.50$ 8.99% 1,115.35$ 1,215.12$ 99.77$ 8.95% 1,135.67$ 1,236.72$ 101.05$ 8.90%

914.42$ 997.08$ 82.66$ 9.04% 931.08$ 1,014.81$ 83.73$ 8.99% 948.04$ 1,032.85$ 84.81$ 8.95% 965.32$ 1,051.21$ 85.89$ 8.90%

1,532.99$ 1,671.58$ 138.59$ 9.04% 1,560.92$ 1,701.30$ 140.38$ 8.99% 1,589.37$ 1,731.54$ 142.17$ 8.95% 1,618.33$ 1,762.32$ 143.99$ 8.90%

540.47$ 587.79$ 47.32$ 8.76% 550.32$ 598.24$ 47.92$ 8.71% 560.35$ 608.87$ 48.52$ 8.66% 570.56$ 619.70$ 49.14$ 8.61%

1,080.94$ 1,175.57$ 94.63$ 8.75% 1,100.64$ 1,196.47$ 95.83$ 8.71% 1,120.70$ 1,217.74$ 97.04$ 8.66% 1,141.12$ 1,239.39$ 98.27$ 8.61%

918.80$ 999.24$ 80.44$ 8.75% 935.55$ 1,017.00$ 81.45$ 8.71% 952.59$ 1,035.08$ 82.49$ 8.66% 969.95$ 1,053.48$ 83.53$ 8.61%

1,540.35$ 1,675.19$ 134.84$ 8.75% 1,568.41$ 1,704.97$ 136.56$ 8.71% 1,596.99$ 1,735.28$ 138.29$ 8.66% 1,626.09$ 1,766.13$ 140.04$ 8.61%

530.62$ 580.54$ 49.92$ 9.41% 540.29$ 590.86$ 50.57$ 9.36% 550.13$ 601.37$ 51.24$ 9.31% 560.16$ 612.06$ 51.90$ 9.27%

1,061.24$ 1,161.09$ 99.85$ 9.41% 1,080.58$ 1,181.73$ 101.15$ 9.36% 1,100.27$ 1,202.74$ 102.47$ 9.31% 1,120.32$ 1,224.12$ 103.80$ 9.27%

902.06$ 986.92$ 84.86$ 9.41% 918.49$ 1,004.47$ 85.98$ 9.36% 935.23$ 1,022.33$ 87.10$ 9.31% 952.27$ 1,040.50$ 88.23$ 9.27%

1,512.27$ 1,654.55$ 142.28$ 9.41% 1,539.83$ 1,683.96$ 144.13$ 9.36% 1,567.88$ 1,713.90$ 146.02$ 9.31% 1,596.45$ 1,744.37$ 147.92$ 9.27%

537.89$ 586.52$ 48.63$ 9.04% 547.69$ 596.95$ 49.26$ 8.99% 557.67$ 607.56$ 49.89$ 8.95% 567.83$ 618.36$ 50.53$ 8.90%

1,075.78$ 1,173.04$ 97.26$ 9.04% 1,095.39$ 1,193.89$ 98.50$ 8.99% 1,115.35$ 1,215.12$ 99.77$ 8.95% 1,135.67$ 1,236.72$ 101.05$ 8.90%

914.42$ 997.08$ 82.66$ 9.04% 931.08$ 1,014.81$ 83.73$ 8.99% 948.04$ 1,032.85$ 84.81$ 8.95% 965.32$ 1,051.21$ 85.89$ 8.90%

1,532.99$ 1,671.58$ 138.59$ 9.04% 1,560.92$ 1,701.30$ 140.38$ 8.99% 1,589.37$ 1,731.54$ 142.17$ 8.95% 1,618.33$ 1,762.32$ 143.99$ 8.90%

533.17$ 581.80$ 48.63$ 9.12% 542.88$ 592.14$ 49.26$ 9.07% 552.77$ 602.67$ 49.90$ 9.03% 562.85$ 613.38$ 50.53$ 8.98%

1,066.33$ 1,163.59$ 97.26$ 9.12% 1,085.76$ 1,184.28$ 98.52$ 9.07% 1,105.55$ 1,205.33$ 99.78$ 9.03% 1,125.69$ 1,226.76$ 101.07$ 8.98%

906.38$ 989.05$ 82.67$ 9.12% 922.90$ 1,006.64$ 83.74$ 9.07% 939.71$ 1,024.53$ 84.82$ 9.03% 956.84$ 1,042.75$ 85.91$ 8.98%

1,519.52$ 1,658.12$ 138.60$ 9.12% 1,547.21$ 1,687.60$ 140.39$ 9.07% 1,575.40$ 1,717.60$ 142.20$ 9.03% 1,604.11$ 1,748.13$ 144.02$ 8.98%

540.47$ 587.79$ 47.32$ 8.76% 550.32$ 598.24$ 47.92$ 8.71% 560.35$ 608.87$ 48.52$ 8.66% 570.56$ 619.70$ 49.14$ 8.61%

1,080.94$ 1,175.57$ 94.63$ 8.75% 1,100.64$ 1,196.47$ 95.83$ 8.71% 1,120.70$ 1,217.74$ 97.04$ 8.66% 1,141.12$ 1,239.39$ 98.27$ 8.61%

918.80$ 999.24$ 80.44$ 8.75% 935.55$ 1,017.00$ 81.45$ 8.71% 952.59$ 1,035.08$ 82.49$ 8.66% 969.95$ 1,053.48$ 83.53$ 8.61%

1,540.35$ 1,675.19$ 134.84$ 8.75% 1,568.41$ 1,704.97$ 136.56$ 8.71% 1,596.99$ 1,735.28$ 138.29$ 8.66% 1,626.09$ 1,766.13$ 140.04$ 8.61%






First Quarter 2021 (1/1/2021 - 3/31/2021)


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2020 2021 2020 2021 2020 2021 2020 2021





533.17$ 581.80$ 48.63$ 9.12% 542.88$ 592.14$ 49.26$ 9.07% 552.77$ 602.67$ 49.90$ 9.03% 562.85$ 613.38$ 50.53$ 8.98%

1,066.33$ 1,163.59$ 97.26$ 9.12% 1,085.76$ 1,184.28$ 98.52$ 9.07% 1,105.55$ 1,205.33$ 99.78$ 9.03% 1,125.69$ 1,226.76$ 101.07$ 8.98%

906.38$ 989.05$ 82.67$ 9.12% 922.90$ 1,006.64$ 83.74$ 9.07% 939.71$ 1,024.53$ 84.82$ 9.03% 956.84$ 1,042.75$ 85.91$ 8.98%

1,519.52$ 1,658.12$ 138.60$ 9.12% 1,547.21$ 1,687.60$ 140.39$ 9.07% 1,575.40$ 1,717.60$ 142.20$ 9.03% 1,604.11$ 1,748.13$ 144.02$ 8.98%

530.62$ 580.54$ 49.92$ 9.41% 540.29$ 590.86$ 50.57$ 9.36% 550.13$ 601.37$ 51.24$ 9.31% 560.16$ 612.06$ 51.90$ 9.27%

1,061.24$ 1,161.09$ 99.85$ 9.41% 1,080.58$ 1,181.73$ 101.15$ 9.36% 1,100.27$ 1,202.74$ 102.47$ 9.31% 1,120.32$ 1,224.12$ 103.80$ 9.27%

902.06$ 986.92$ 84.86$ 9.41% 918.49$ 1,004.47$ 85.98$ 9.36% 935.23$ 1,022.33$ 87.10$ 9.31% 952.27$ 1,040.50$ 88.23$ 9.27%

1,512.27$ 1,654.55$ 142.28$ 9.41% 1,539.83$ 1,683.96$ 144.13$ 9.36% 1,567.88$ 1,713.90$ 146.02$ 9.31% 1,596.45$ 1,744.37$ 147.92$ 9.27%

650.56$ 684.40$ 33.84$ 5.20% 662.42$ 696.57$ 34.15$ 5.16% 674.49$ 708.95$ 34.46$ 5.11% 686.78$ 721.55$ 34.77$ 5.06%

1,301.13$ 1,368.80$ 67.67$ 5.20% 1,324.84$ 1,393.13$ 68.29$ 5.15% 1,348.98$ 1,417.90$ 68.92$ 5.11% 1,373.56$ 1,443.11$ 69.55$ 5.06%

1,105.96$ 1,163.48$ 57.52$ 5.20% 1,126.11$ 1,184.16$ 58.05$ 5.15% 1,146.63$ 1,205.21$ 58.58$ 5.11% 1,167.52$ 1,226.64$ 59.12$ 5.06%

1,854.11$ 1,950.54$ 96.43$ 5.20% 1,887.89$ 1,985.21$ 97.32$ 5.15% 1,922.29$ 2,020.51$ 98.22$ 5.11% 1,957.32$ 2,056.43$ 99.11$ 5.06%

653.70$ 685.89$ 32.19$ 4.92% 665.62$ 698.08$ 32.46$ 4.88% 677.74$ 710.49$ 32.75$ 4.83% 690.09$ 723.13$ 33.04$ 4.79%

1,307.41$ 1,371.78$ 64.37$ 4.92% 1,331.23$ 1,396.17$ 64.94$ 4.88% 1,355.49$ 1,420.99$ 65.50$ 4.83% 1,380.19$ 1,446.25$ 66.06$ 4.79%

1,111.30$ 1,166.02$ 54.72$ 4.92% 1,131.55$ 1,186.74$ 55.19$ 4.88% 1,152.16$ 1,207.84$ 55.68$ 4.83% 1,173.16$ 1,229.31$ 56.15$ 4.79%

1,863.06$ 1,954.79$ 91.73$ 4.92% 1,897.00$ 1,989.54$ 92.54$ 4.88% 1,931.57$ 2,024.91$ 93.34$ 4.83% 1,966.77$ 2,060.91$ 94.14$ 4.79%

641.72$ 677.36$ 35.64$ 5.55% 653.41$ 689.40$ 35.99$ 5.51% 665.32$ 701.66$ 36.34$ 5.46% 677.44$ 714.13$ 36.69$ 5.42%

1,283.44$ 1,354.72$ 71.28$ 5.55% 1,306.82$ 1,378.81$ 71.99$ 5.51% 1,330.63$ 1,403.32$ 72.69$ 5.46% 1,354.88$ 1,428.27$ 73.39$ 5.42%

1,090.92$ 1,151.51$ 60.59$ 5.55% 1,110.80$ 1,171.99$ 61.19$ 5.51% 1,131.04$ 1,192.82$ 61.78$ 5.46% 1,151.65$ 1,214.03$ 62.38$ 5.42%

1,828.90$ 1,930.48$ 101.58$ 5.55% 1,862.22$ 1,964.80$ 102.58$ 5.51% 1,896.15$ 1,999.73$ 103.58$ 5.46% 1,930.71$ 2,035.28$ 104.57$ 5.42%

650.56$ 684.40$ 33.84$ 5.20% 662.42$ 696.57$ 34.15$ 5.16% 674.49$ 708.95$ 34.46$ 5.11% 686.78$ 721.55$ 34.77$ 5.06%

1,301.13$ 1,368.80$ 67.67$ 5.20% 1,324.84$ 1,393.13$ 68.29$ 5.15% 1,348.98$ 1,417.90$ 68.92$ 5.11% 1,373.56$ 1,443.11$ 69.55$ 5.06%

1,105.96$ 1,163.48$ 57.52$ 5.20% 1,126.11$ 1,184.16$ 58.05$ 5.15% 1,146.63$ 1,205.21$ 58.58$ 5.11% 1,167.52$ 1,226.64$ 59.12$ 5.06%

1,854.11$ 1,950.54$ 96.43$ 5.20% 1,887.89$ 1,985.21$ 97.32$ 5.15% 1,922.29$ 2,020.51$ 98.22$ 5.11% 1,957.32$ 2,056.43$ 99.11$ 5.06%

644.81$ 678.84$ 34.03$ 5.28% 656.56$ 690.91$ 34.35$ 5.23% 668.53$ 703.19$ 34.66$ 5.18% 680.71$ 715.69$ 34.98$ 5.14%

1,289.63$ 1,357.67$ 68.04$ 5.28% 1,313.13$ 1,381.81$ 68.68$ 5.23% 1,337.05$ 1,406.38$ 69.33$ 5.19% 1,361.42$ 1,431.38$ 69.96$ 5.14%

1,096.18$ 1,154.02$ 57.84$ 5.28% 1,116.16$ 1,174.54$ 58.38$ 5.23% 1,136.50$ 1,195.42$ 58.92$ 5.18% 1,157.21$ 1,216.67$ 59.46$ 5.14%

1,837.72$ 1,934.69$ 96.97$ 5.28% 1,871.21$ 1,969.08$ 97.87$ 5.23% 1,905.30$ 2,004.09$ 98.79$ 5.19% 1,940.02$ 2,039.71$ 99.69$ 5.14%

653.70$ 685.89$ 32.19$ 4.92% 665.62$ 698.08$ 32.46$ 4.88% 677.74$ 710.49$ 32.75$ 4.83% 690.09$ 723.13$ 33.04$ 4.79%

1,307.41$ 1,371.78$ 64.37$ 4.92% 1,331.23$ 1,396.17$ 64.94$ 4.88% 1,355.49$ 1,420.99$ 65.50$ 4.83% 1,380.19$ 1,446.25$ 66.06$ 4.79%

1,111.30$ 1,166.02$ 54.72$ 4.92% 1,131.55$ 1,186.74$ 55.19$ 4.88% 1,152.16$ 1,207.84$ 55.68$ 4.83% 1,173.16$ 1,229.31$ 56.15$ 4.79%

1,863.06$ 1,954.79$ 91.73$ 4.92% 1,897.00$ 1,989.54$ 92.54$ 4.88% 1,931.57$ 2,024.91$ 93.34$ 4.83% 1,966.77$ 2,060.91$ 94.14$ 4.79%

644.81$ 678.84$ 34.03$ 5.28% 656.56$ 690.91$ 34.35$ 5.23% 668.53$ 703.19$ 34.66$ 5.18% 680.71$ 715.69$ 34.98$ 5.14%

1,289.63$ 1,357.67$ 68.04$ 5.28% 1,313.13$ 1,381.81$ 68.68$ 5.23% 1,337.05$ 1,406.38$ 69.33$ 5.19% 1,361.42$ 1,431.38$ 69.96$ 5.14%

1,096.18$ 1,154.02$ 57.84$ 5.28% 1,116.16$ 1,174.54$ 58.38$ 5.23% 1,136.50$ 1,195.42$ 58.92$ 5.18% 1,157.21$ 1,216.67$ 59.46$ 5.14%

1,837.72$ 1,934.69$ 96.97$ 5.28% 1,871.21$ 1,969.08$ 97.87$ 5.23% 1,905.30$ 2,004.09$ 98.79$ 5.19% 1,940.02$ 2,039.71$ 99.69$ 5.14%

641.72$ 677.36$ 35.64$ 5.55% 653.41$ 689.40$ 35.99$ 5.51% 665.32$ 701.66$ 36.34$ 5.46% 677.44$ 714.13$ 36.69$ 5.42%

1,283.44$ 1,354.72$ 71.28$ 5.55% 1,306.82$ 1,378.81$ 71.99$ 5.51% 1,330.63$ 1,403.32$ 72.69$ 5.46% 1,354.88$ 1,428.27$ 73.39$ 5.42%

1,090.92$ 1,151.51$ 60.59$ 5.55% 1,110.80$ 1,171.99$ 61.19$ 5.51% 1,131.04$ 1,192.82$ 61.78$ 5.46% 1,151.65$ 1,214.03$ 62.38$ 5.42%

1,828.90$ 1,930.48$ 101.58$ 5.55% 1,862.22$ 1,964.80$ 102.58$ 5.51% 1,896.15$ 1,999.73$ 103.58$ 5.46% 1,930.71$ 2,035.28$ 104.57$ 5.42%


Capital District Physicians' Health Plan

Benefit Summary Updated 4/30/20 SH


Proposed Premium Rates Effective 1/1/2021 15 16

Form Number Size Product Metal Tier HIOS ID

2020 Plan

Code

2021 Plan

Code Standard? OV SP

01-0006-2021 SG HMO Gold 94788NY0260065 SHGFHN50 SHGFHN58 Standard 25 40








01-0006-2021 SG HDHMO Silver 94788NY0260081 SHSF3016 SHSF3024 Non-Standard 25 50








01-0006-2021 SG HMO Gold 94788NY0260097 SHGF5001 SHGF5017 Non-Standard $0 EPC/$50 50








Page 10

2020 Plan

Code

2021 Plan

Code

SHGFHN50 SHGFHN58

SHGFHN51 SHGFHN59

SHGFHN52 SHGFHN60

SHGFHN53 SHGFHN61

SHGFHN54 SHGFHN62

SHGFHN55 SHGFHN63

SHGFHN56 SHGFHN64

SHGFHN57 SHGFHN65

SHSF3016 SHSF3024

SHSF3017 SHSF3025

SHSF3018 SHSF3026

SHSF3019 SHSF3027

SHSF3020 SHSF3028

SHSF3021 SHSF3029

SHSF3022 SHSF3030

SHSF3023 SHSF3031

SHGF5001 SHGF5017

SHGF5002 SHGF5018

SHGF5003 SHGF5019

SHGF5004 SHGF5020

SHGF5005 SHGF5021

SHGF5006 SHGF5022

SHGF5007 SHGF5023

SHGF5008 SHGF5024

17 18 19 20 21 22 23 24 25 26 27 28

INN HOSP OUT SURG

OUT SURG -

PHYSICIAN ER AMB DME

URGENT

CARE DIABETIC PT/OT/ST

RADIOLOGY

IMAGING

RADIOLOGY

XRAY LAB COIN INN Ded Single INN Ded Family

1000 100 100 150 150 20% 60 25 30 40 40 40 0 600 1200

1000 100 100 150 150 20% 60 25 30 40 40 40 0 600 1200

1000 100 100 150 150 20% 60 25 30 40 40 40 0 600 1200

1000 100 100 150 150 20% 60 25 30 40 40 40 0 600 1200

1000 100 100 150 150 20% 60 25 30 40 40 40 0 600 1200

1000 100 100 150 150 20% 60 25 30 40 40 40 0 600 1200

1000 100 100 150 150 20% 60 25 30 40 40 40 0 600 1200

1000 100 100 150 150 20% 60 25 30 40 40 40 0 600 1200

500 200 200 300 300 0.5 60 25 50 50 50 50 0 2200 4400

500 200 200 300 300 0.5 60 25 50 50 50 50 0 2200 4400

500 200 200 300 300 0.5 60 25 50 50 50 50 0 2200 4400

500 200 200 300 300 0.5 60 25 50 50 50 50 0 2200 4400

500 200 200 300 300 0.5 60 25 50 50 50 50 0 2200 4400

500 200 200 300 300 0.5 60 25 50 50 50 50 0 2200 4400

500 200 200 300 300 0.5 60 25 50 50 50 50 0 2200 4400

500 200 200 300 300 0.5 60 25 50 50 50 50 0 2200 4400

1500 250 50 500 500 0.5 100 50 50 50 50 50 0 0 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0 0 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0 0 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0 0 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0 0 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0 0 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0 0 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0 0 0

Page 11

2020 Plan

Code

2021 Plan

Code

SHGFHN50 SHGFHN58

SHGFHN51 SHGFHN59

SHGFHN52 SHGFHN60

SHGFHN53 SHGFHN61

SHGFHN54 SHGFHN62

SHGFHN55 SHGFHN63

SHGFHN56 SHGFHN64

SHGFHN57 SHGFHN65

SHSF3016 SHSF3024

SHSF3017 SHSF3025

SHSF3018 SHSF3026

SHSF3019 SHSF3027

SHSF3020 SHSF3028

SHSF3021 SHSF3029

SHSF3022 SHSF3030

SHSF3023 SHSF3031

SHGF5001 SHGF5017

SHGF5002 SHGF5018

SHGF5003 SHGF5019

SHGF5004 SHGF5020

SHGF5005 SHGF5021

SHGF5006 SHGF5022

SHGF5007 SHGF5023

SHGF5008 SHGF5024

29 30 31 32 33 34 35 36 37 38 39

INN Max Single INN Max Family OON COIN OON Ded Single OON Ded Family OON Max Single OON Max Family

Aggregate/

Embedded Product Line Benefit Type Rx Benefit

4000 8000 N/A N/A N/A N/A N/A Embedded HNY Copayment $10/$35/$70








5500 11000 N/A N/A N/A N/A N/A Aggregate HDHMOQualified High

Deductible$10/$40/$60















7900 15800 N/A N/A N/A N/A N/A Embedded HMO Copayment $0/$50/$80








Page 12

2020 Plan

Code

2021 Plan

Code

SHGFHN50 SHGFHN58

SHGFHN51 SHGFHN59

SHGFHN52 SHGFHN60

SHGFHN53 SHGFHN61

SHGFHN54 SHGFHN62

SHGFHN55 SHGFHN63

SHGFHN56 SHGFHN64

SHGFHN57 SHGFHN65

SHSF3016 SHSF3024

SHSF3017 SHSF3025

SHSF3018 SHSF3026

SHSF3019 SHSF3027

SHSF3020 SHSF3028

SHSF3021 SHSF3029

SHSF3022 SHSF3030

SHSF3023 SHSF3031

SHGF5001 SHGF5017

SHGF5002 SHGF5018

SHGF5003 SHGF5019

SHGF5004 SHGF5020

SHGF5005 SHGF5021

SHGF5006 SHGF5022

SHGF5007 SHGF5023

SHGF5008 SHGF5024

40 41 42 43 44 45

Riders Additional Benefits Additional Benefits Additional Benefits Additional Benefits Additional Benefits

No Riders No Riders No Riders No Riders No Riders No Riders

Age 29 No Riders No Riders No Riders No Riders No Riders

No Family Planning No Riders No Riders No Riders No Riders No Riders

DP No Riders No Riders No Riders No Riders No Riders

Age 29 + No Family Planning No Riders No Riders No Riders No Riders No Riders

Age 29 + DP No Riders No Riders No Riders No Riders No Riders

Age 29 + DP + No Family Planning No Riders No Riders No Riders No Riders No Riders

DP + No Family Planning No Riders No Riders No Riders No Riders No Riders

No Riders Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

Age 29 Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

DP Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

Age 29 + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

Age 29 + DP Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

Age 29 + DP + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

DP + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

No Riders Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

Age 29 Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

DP Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

Age 29 + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

Age 29 + DP Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

Age 29 + DP + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

DP + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture Lasik Surgery ($750 Max)Gym

Membership

Page 13

Exhibit C


Small Group HMO

Conversion Factor Summary - 4-tier only

IV. Conversion Factor

Average Weighted Desired Weighted

Contract Contract Contract Loading Loading Conversion

Mix Size Size Factors Factors Factor

Four Tier Premiums

Single 68.5% 1.00 0.685 1.000 0.685

Double 12.7% 2.00 0.253 2.000 0.253

Emp/Child(ren) 4.4% 2.54 0.111 1.700 0.074

Family 14.5% 3.92 0.568 2.850 0.413

Total 4T 100.0% 1.617 1.426 1.134

1.134

Filed 2020 1.138

Page 14

V. Area Factors

2021 Rating Factors

Rating Region

Region 1

(Albany Area)

Region 3

(Mid-Hudson Area)

Region 6

(Syracuse Area)

Region 7

(Utica/Watertown

Area)

Regional Rating Factor 0.9736 1.2896 1.1368 1.0937

Normalized to Albany Area 1.0000 1.3246 1.1677 1.1234

Counties: Albany Delaware Broome Chenango

Columbia Dutchess Tioga Clinton

Fulton Orange Essex

Greene Ulster Franklin

Montgomery Hamilton

Rensselaer Herkimer

Saratoga Jefferson

Schenectady Lewis

Schoharie Madison

Warren Oneida

Washington Otsego

St. Lawerence


HMO Products

Regional Area Factors

EXEMPTION FROM FOIL REQUESTED

Page 15

VI. Tier Factors

2021 Rating Factors

Rating Method Contract Type Small Group

4-Tier Individual 1

Employee + Spouse 2.00

Employee + Child(ren) 1.70

Family 2.85


HMO Product

Tier Factors

Page 16

VI. Rate Calculation

Plan Code Single Double Emp/Child(ren) Family

SHGFHN58 $521.38 $1,042.77 $886.35 $1,485.94

Final Rates $521.38 $1,042.77 $886.35 $1,485.94


Small Group HMO Product

Sample Rate Calculation

Sample rate calculation for a small group off exchange HMO (HNY) benefit package in the Albany region

Page 17


HMO Product

Expected Loss Ratio

All policy forms in all regions

VIII. Expected Loss Ratio

87.51%

Page 18

Base Plan Base Plan Variation Adjustment

Characteristic Factor Characteristic FactorWithout Through Age 29 Coverage 1.000 With Through Age 29 Coverage 1.0023

With Family Planning Coverage 1.000 Without Family Planning Coverage 0.9892

With Domestic Partner Coverage 1.000 Without Domestic Partner Coverage 1.0000

Without Pediatric Dental Coverage 1.000 With Pediatric Dental Coverage N/A


HMO Product

Factors for Base Plan Variations

Page 19

2021 HMO Commercial Commission Schedule

Capital District Physicians’ Health Plan, Inc.

Note: Agent/Broker is required to have a minimum book of business of 20 Subscribers by July 31 in order to remain active.

SMALL GROUP HMO

(Applies to new, renewal, and broker of record changes)

4 percent first $1.5 million of employer group premium

2.5 percent next $1,500,001+ of premium

Page 20

Capital District Physicians' Health Plan2021 Premium Rate Filing

SG HMO - On Exchange Products

TABLE OF CONTENTS

Table of Contents 1

I. Rate Pages

Albany Region 2-3

Mid-Hudson Region 4-5

Syracuse Region 6-7

Utica/Watertown Region 8-9

II. Benefit Summary 10-14

III. Conversion Factor 15

IV. Region Factors 16

V. Tier Factors 17

VI. Rate Calculation 18

VII. Expected Loss Ratio 19

VIII. Factors for Base Plan Variations 20

IX. Commission Schedule 21

K:\Dept\FINANCE\ACTSRV\SHARED\ACTSRV\Pricing Team\2021 Pricing\7. Filing Preparation\3. SG HMO\2021 Rate Manual - SG HMO On Exch 5/11/2020


Small Group Rates On-Exchange



First Quarter 2021 (1/1/2021 - 3/31/2021)

Silver HDHMO SHSX3016 SHSX3024

Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family

Gold HMO SHGX5001 SHGX5017

Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family

2020 2021 2020 2021 2020 2021 2020 2021





480.66$ $526.00 45.34$ 9.43% 489.42$ $535.35 45.93$ 9.38% 498.34$ 544.87$ 46.53$ 9.34% 507.42$ 554.56$ 47.14$ 9.29%

961.32$ 1,052.01$ 90.69$ 9.43% 978.84$ 1,070.71$ 91.87$ 9.39% 996.67$ 1,089.74$ 93.07$ 9.34% 1,014.83$ 1,109.12$ 94.29$ 9.29%

817.12$ 894.20$ 77.08$ 9.43% 832.01$ 910.10$ 78.09$ 9.39% 847.17$ 926.28$ 79.11$ 9.34% 862.61$ 942.75$ 80.14$ 9.29%

1,369.88$ 1,499.11$ 129.23$ 9.43% 1,394.84$ 1,525.76$ 130.92$ 9.39% 1,420.26$ 1,552.88$ 132.62$ 9.34% 1,446.14$ 1,580.49$ 134.35$ 9.29%

482.97$ 527.13$ 44.16$ 9.14% 491.77$ 536.50$ 44.73$ 9.10% 500.73$ 546.04$ 45.31$ 9.05% 509.85$ 555.75$ 45.90$ 9.00%

965.93$ 1,054.26$ 88.33$ 9.14% 983.53$ 1,073.00$ 89.47$ 9.10% 1,001.45$ 1,092.08$ 90.63$ 9.05% 1,019.70$ 1,111.49$ 91.79$ 9.00%

821.04$ 896.12$ 75.08$ 9.14% 836.00$ 912.05$ 76.05$ 9.10% 851.24$ 928.27$ 77.03$ 9.05% 866.75$ 944.77$ 78.02$ 9.00%

1,376.45$ 1,502.32$ 125.87$ 9.14% 1,401.53$ 1,529.03$ 127.50$ 9.10% 1,427.07$ 1,556.21$ 129.14$ 9.05% 1,453.08$ 1,583.88$ 130.80$ 9.00%

474.16$ 520.68$ 46.52$ 9.81% 482.80$ 529.94$ 47.14$ 9.76% 491.60$ 539.36$ 47.76$ 9.72% 500.56$ 548.95$ 48.39$ 9.67%

948.33$ 1,041.37$ 93.04$ 9.81% 965.61$ 1,059.88$ 94.27$ 9.76% 983.20$ 1,078.72$ 95.52$ 9.72% 1,001.12$ 1,097.90$ 96.78$ 9.67%

806.08$ 885.16$ 79.08$ 9.81% 820.76$ 900.90$ 80.14$ 9.76% 835.72$ 916.91$ 81.19$ 9.71% 850.95$ 933.21$ 82.26$ 9.67%

1,351.36$ 1,483.95$ 132.59$ 9.81% 1,375.99$ 1,510.33$ 134.34$ 9.76% 1,401.06$ 1,537.18$ 136.12$ 9.72% 1,426.59$ 1,564.50$ 137.91$ 9.67%

480.66$ 526.00$ 45.34$ 9.43% 489.42$ 535.35$ 45.93$ 9.38% 498.34$ 544.87$ 46.53$ 9.34% 507.42$ 554.56$ 47.14$ 9.29%

961.32$ 1,052.01$ 90.69$ 9.43% 978.84$ 1,070.71$ 91.87$ 9.39% 996.67$ 1,089.74$ 93.07$ 9.34% 1,014.83$ 1,109.12$ 94.29$ 9.29%

817.12$ 894.20$ 77.08$ 9.43% 832.01$ 910.10$ 78.09$ 9.39% 847.17$ 926.28$ 79.11$ 9.34% 862.61$ 942.75$ 80.14$ 9.29%

1,369.88$ 1,499.11$ 129.23$ 9.43% 1,394.84$ 1,525.76$ 130.92$ 9.39% 1,420.26$ 1,552.88$ 132.62$ 9.34% 1,446.14$ 1,580.49$ 134.35$ 9.29%

476.44$ 521.80$ 45.36$ 9.52% 485.12$ 531.08$ 45.96$ 9.47% 493.96$ 540.52$ 46.56$ 9.43% 502.96$ 550.13$ 47.17$ 9.38%

952.87$ 1,043.60$ 90.73$ 9.52% 970.24$ 1,062.15$ 91.91$ 9.47% 987.92$ 1,081.03$ 93.11$ 9.42% 1,005.92$ 1,100.25$ 94.33$ 9.38%

809.94$ 887.06$ 77.12$ 9.52% 824.70$ 902.83$ 78.13$ 9.47% 839.73$ 918.88$ 79.15$ 9.43% 855.03$ 935.21$ 80.18$ 9.38%

1,357.84$ 1,487.13$ 129.29$ 9.52% 1,382.59$ 1,513.56$ 130.97$ 9.47% 1,407.78$ 1,540.47$ 132.69$ 9.43% 1,433.43$ 1,567.86$ 134.43$ 9.38%

482.97$ 527.13$ 44.16$ 9.14% 491.77$ 536.50$ 44.73$ 9.10% 500.73$ 546.04$ 45.31$ 9.05% 509.85$ 555.75$ 45.90$ 9.00%

965.93$ 1,054.26$ 88.33$ 9.14% 983.53$ 1,073.00$ 89.47$ 9.10% 1,001.45$ 1,092.08$ 90.63$ 9.05% 1,019.70$ 1,111.49$ 91.79$ 9.00%

821.04$ 896.12$ 75.08$ 9.14% 836.00$ 912.05$ 76.05$ 9.10% 851.24$ 928.27$ 77.03$ 9.05% 866.75$ 944.77$ 78.02$ 9.00%

1,376.45$ 1,502.32$ 125.87$ 9.14% 1,401.53$ 1,529.03$ 127.50$ 9.10% 1,427.07$ 1,556.21$ 129.14$ 9.05% 1,453.08$ 1,583.88$ 130.80$ 9.00%

476.44$ 521.80$ 45.36$ 9.52% 485.12$ 531.08$ 45.96$ 9.47% 493.96$ 540.52$ 46.56$ 9.43% 502.96$ 550.13$ 47.17$ 9.38%

952.87$ 1,043.60$ 90.73$ 9.52% 970.24$ 1,062.15$ 91.91$ 9.47% 987.92$ 1,081.03$ 93.11$ 9.42% 1,005.92$ 1,100.25$ 94.33$ 9.38%

809.94$ 887.06$ 77.12$ 9.52% 824.70$ 902.83$ 78.13$ 9.47% 839.73$ 918.88$ 79.15$ 9.43% 855.03$ 935.21$ 80.18$ 9.38%

1,357.84$ 1,487.13$ 129.29$ 9.52% 1,382.59$ 1,513.56$ 130.97$ 9.47% 1,407.78$ 1,540.47$ 132.69$ 9.43% 1,433.43$ 1,567.86$ 134.43$ 9.38%

474.16$ 520.68$ 46.52$ 9.81% 482.80$ 529.94$ 47.14$ 9.76% 491.60$ 539.36$ 47.76$ 9.72% 500.56$ 548.95$ 48.39$ 9.67%

948.33$ 1,041.37$ 93.04$ 9.81% 965.61$ 1,059.88$ 94.27$ 9.76% 983.20$ 1,078.72$ 95.52$ 9.72% 1,001.12$ 1,097.90$ 96.78$ 9.67%

806.08$ 885.16$ 79.08$ 9.81% 820.76$ 900.90$ 80.14$ 9.76% 835.72$ 916.91$ 81.19$ 9.71% 850.95$ 933.21$ 82.26$ 9.67%

1,351.36$ 1,483.95$ 132.59$ 9.81% 1,375.99$ 1,510.33$ 134.34$ 9.76% 1,401.06$ 1,537.18$ 136.12$ 9.72% 1,426.59$ 1,564.50$ 137.91$ 9.67%

581.34$ 613.13$ 31.79$ 5.47% 591.94$ 624.03$ 32.09$ 5.42% 602.72$ 635.13$ 32.41$ 5.38% 613.71$ 646.42$ 32.71$ 5.33%

1,162.69$ 1,226.27$ 63.58$ 5.47% 1,183.87$ 1,248.07$ 64.20$ 5.42% 1,205.45$ 1,270.25$ 64.80$ 5.38% 1,227.41$ 1,292.84$ 65.43$ 5.33%

988.28$ 1,042.33$ 54.05$ 5.47% 1,006.29$ 1,060.86$ 54.57$ 5.42% 1,024.63$ 1,079.72$ 55.09$ 5.38% 1,043.30$ 1,098.91$ 55.61$ 5.33%

1,656.83$ 1,747.43$ 90.60$ 5.47% 1,687.02$ 1,778.49$ 91.47$ 5.42% 1,717.76$ 1,810.11$ 92.35$ 5.38% 1,749.06$ 1,842.29$ 93.23$ 5.33%

584.15$ 614.46$ 30.31$ 5.19% 594.79$ 625.38$ 30.59$ 5.14% 605.63$ 636.50$ 30.87$ 5.10% 616.67$ 647.82$ 31.15$ 5.05%

1,168.30$ 1,228.92$ 60.62$ 5.19% 1,189.59$ 1,250.77$ 61.18$ 5.14% 1,211.26$ 1,273.00$ 61.74$ 5.10% 1,233.34$ 1,295.64$ 62.30$ 5.05%

993.05$ 1,044.58$ 51.53$ 5.19% 1,011.15$ 1,063.15$ 52.00$ 5.14% 1,029.57$ 1,082.05$ 52.48$ 5.10% 1,048.33$ 1,101.29$ 52.96$ 5.05%

1,664.83$ 1,751.21$ 86.38$ 5.19% 1,695.16$ 1,782.35$ 87.19$ 5.14% 1,726.05$ 1,814.03$ 87.98$ 5.10% 1,757.50$ 1,846.28$ 88.78$ 5.05%

573.44$ 606.87$ 33.43$ 5.83% 583.89$ 617.66$ 33.77$ 5.78% 594.53$ 628.64$ 34.11$ 5.74% 605.36$ 639.81$ 34.45$ 5.69%

1,146.88$ 1,213.74$ 66.86$ 5.83% 1,167.78$ 1,235.31$ 67.53$ 5.78% 1,189.05$ 1,257.27$ 68.22$ 5.74% 1,210.72$ 1,279.63$ 68.91$ 5.69%

974.85$ 1,031.68$ 56.83$ 5.83% 992.61$ 1,050.02$ 57.41$ 5.78% 1,010.70$ 1,068.68$ 57.98$ 5.74% 1,029.11$ 1,087.68$ 58.57$ 5.69%

1,634.30$ 1,729.57$ 95.27$ 5.83% 1,664.08$ 1,760.32$ 96.24$ 5.78% 1,694.40$ 1,791.62$ 97.22$ 5.74% 1,725.28$ 1,823.47$ 98.19$ 5.69%

581.34$ 613.13$ 31.79$ 5.47% 591.94$ 624.03$ 32.09$ 5.42% 602.72$ 635.13$ 32.41$ 5.38% 613.71$ 646.42$ 32.71$ 5.33%

1,162.69$ 1,226.27$ 63.58$ 5.47% 1,183.87$ 1,248.07$ 64.20$ 5.42% 1,205.45$ 1,270.25$ 64.80$ 5.38% 1,227.41$ 1,292.84$ 65.43$ 5.33%

988.28$ 1,042.33$ 54.05$ 5.47% 1,006.29$ 1,060.86$ 54.57$ 5.42% 1,024.63$ 1,079.72$ 55.09$ 5.38% 1,043.30$ 1,098.91$ 55.61$ 5.33%

1,656.83$ 1,747.43$ 90.60$ 5.47% 1,687.02$ 1,778.49$ 91.47$ 5.42% 1,717.76$ 1,810.11$ 92.35$ 5.38% 1,749.06$ 1,842.29$ 93.23$ 5.33%

576.21$ 608.18$ 31.97$ 5.55% 586.70$ 618.99$ 32.29$ 5.50% 597.40$ 630.00$ 32.60$ 5.46% 608.28$ 641.20$ 32.92$ 5.41%

1,152.41$ 1,216.36$ 63.95$ 5.55% 1,173.41$ 1,237.99$ 64.58$ 5.50% 1,194.79$ 1,260.00$ 65.21$ 5.46% 1,216.56$ 1,282.40$ 65.84$ 5.41%

979.55$ 1,033.91$ 54.36$ 5.55% 997.40$ 1,052.29$ 54.89$ 5.50% 1,015.57$ 1,071.00$ 55.43$ 5.46% 1,034.08$ 1,090.04$ 55.96$ 5.41%

1,642.18$ 1,733.32$ 91.14$ 5.55% 1,672.11$ 1,764.13$ 92.02$ 5.50% 1,702.58$ 1,795.49$ 92.91$ 5.46% 1,733.60$ 1,827.41$ 93.81$ 5.41%

584.15$ 614.46$ 30.31$ 5.19% 594.79$ 625.38$ 30.59$ 5.14% 605.63$ 636.50$ 30.87$ 5.10% 616.67$ 647.82$ 31.15$ 5.05%

1,168.30$ 1,228.92$ 60.62$ 5.19% 1,189.59$ 1,250.77$ 61.18$ 5.14% 1,211.26$ 1,273.00$ 61.74$ 5.10% 1,233.34$ 1,295.64$ 62.30$ 5.05%

993.05$ 1,044.58$ 51.53$ 5.19% 1,011.15$ 1,063.15$ 52.00$ 5.14% 1,029.57$ 1,082.05$ 52.48$ 5.10% 1,048.33$ 1,101.29$ 52.96$ 5.05%

1,664.83$ 1,751.21$ 86.38$ 5.19% 1,695.16$ 1,782.35$ 87.19$ 5.14% 1,726.05$ 1,814.03$ 87.98$ 5.10% 1,757.50$ 1,846.28$ 88.78$ 5.05%

2021 SG HMO On Exchange Rate Manual Page 2





First Quarter 2021 (1/1/2021 - 3/31/2021)

Silver HDHMO SHSX3016 SHSX3024Gold HMO SHGX5007 SHGX5023

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2020 2021 2020 2021 2020 2021 2020 2021





576.21$ 608.18$ 31.97$ 5.55% 586.70$ 618.99$ 32.29$ 5.50% 597.40$ 630.00$ 32.60$ 5.46% 608.28$ 641.20$ 32.92$ 5.41%

1,152.41$ 1,216.36$ 63.95$ 5.55% 1,173.41$ 1,237.99$ 64.58$ 5.50% 1,194.79$ 1,260.00$ 65.21$ 5.46% 1,216.56$ 1,282.40$ 65.84$ 5.41%

979.55$ 1,033.91$ 54.36$ 5.55% 997.40$ 1,052.29$ 54.89$ 5.50% 1,015.57$ 1,071.00$ 55.43$ 5.46% 1,034.08$ 1,090.04$ 55.96$ 5.41%

1,642.18$ 1,733.32$ 91.14$ 5.55% 1,672.11$ 1,764.13$ 92.02$ 5.50% 1,702.58$ 1,795.49$ 92.91$ 5.46% 1,733.60$ 1,827.41$ 93.81$ 5.41%

573.44$ 606.87$ 33.43$ 5.83% 583.89$ 617.66$ 33.77$ 5.78% 594.53$ 628.64$ 34.11$ 5.74% 605.36$ 639.81$ 34.45$ 5.69%

1,146.88$ 1,213.74$ 66.86$ 5.83% 1,167.78$ 1,235.31$ 67.53$ 5.78% 1,189.05$ 1,257.27$ 68.22$ 5.74% 1,210.72$ 1,279.63$ 68.91$ 5.69%

974.85$ 1,031.68$ 56.83$ 5.83% 992.61$ 1,050.02$ 57.41$ 5.78% 1,010.70$ 1,068.68$ 57.98$ 5.74% 1,029.11$ 1,087.68$ 58.57$ 5.69%

1,634.30$ 1,729.57$ 95.27$ 5.83% 1,664.08$ 1,760.32$ 96.24$ 5.78% 1,694.40$ 1,791.62$ 97.22$ 5.74% 1,725.28$ 1,823.47$ 98.19$ 5.69%






First Quarter 2021 (1/1/2021 - 3/31/2021)


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686.94$ $685.24 (1.70)$ -0.25% 699.46$ $697.42 (2.04)$ -0.29% 712.20$ 709.82$ (2.38)$ -0.33% 725.18$ 722.44$ (2.74)$ -0.38%

1,373.88$ 1,370.47$ (3.41)$ -0.25% 1,398.92$ 1,394.84$ (4.08)$ -0.29% 1,424.41$ 1,419.63$ (4.78)$ -0.34% 1,450.36$ 1,444.87$ (5.49)$ -0.38%

1,167.80$ 1,164.90$ (2.90)$ -0.25% 1,189.08$ 1,185.61$ (3.47)$ -0.29% 1,210.75$ 1,206.69$ (4.06)$ -0.34% 1,232.81$ 1,228.14$ (4.67)$ -0.38%

1,957.78$ 1,952.93$ (4.85)$ -0.25% 1,993.46$ 1,987.64$ (5.82)$ -0.29% 2,029.78$ 2,022.98$ (6.80)$ -0.34% 2,066.77$ 2,058.94$ (7.83)$ -0.38%

690.24$ 686.73$ (3.51)$ -0.51% 702.81$ 698.94$ (3.87)$ -0.55% 715.62$ 711.36$ (4.26)$ -0.60% 728.66$ 724.01$ (4.65)$ -0.64%

1,380.47$ 1,373.46$ (7.01)$ -0.51% 1,405.63$ 1,397.88$ (7.75)$ -0.55% 1,431.24$ 1,422.73$ (8.51)$ -0.59% 1,457.32$ 1,448.02$ (9.30)$ -0.64%

1,173.40$ 1,167.44$ (5.96)$ -0.51% 1,194.78$ 1,188.20$ (6.58)$ -0.55% 1,216.56$ 1,209.32$ (7.24)$ -0.60% 1,238.72$ 1,230.82$ (7.90)$ -0.64%

1,967.18$ 1,957.18$ (10.00)$ -0.51% 2,003.02$ 1,991.98$ (11.04)$ -0.55% 2,039.52$ 2,027.39$ (12.13)$ -0.59% 2,076.68$ 2,063.43$ (13.25)$ -0.64%

677.66$ 678.19$ 0.53$ 0.08% 690.00$ 690.25$ 0.25$ 0.04% 702.58$ 702.52$ (0.06)$ -0.01% 715.38$ 715.01$ (0.37)$ -0.05%

1,355.31$ 1,356.38$ 1.07$ 0.08% 1,380.01$ 1,380.49$ 0.48$ 0.03% 1,405.15$ 1,405.04$ (0.11)$ -0.01% 1,430.76$ 1,430.01$ (0.75)$ -0.05%

1,152.02$ 1,152.92$ 0.90$ 0.08% 1,173.01$ 1,173.42$ 0.41$ 0.03% 1,194.38$ 1,194.28$ (0.10)$ -0.01% 1,216.15$ 1,215.51$ (0.64)$ -0.05%

1,931.32$ 1,932.84$ 1.52$ 0.08% 1,966.51$ 1,967.20$ 0.69$ 0.04% 2,002.35$ 2,002.18$ (0.17)$ -0.01% 2,038.83$ 2,037.77$ (1.06)$ -0.05%

686.94$ 685.24$ (1.70)$ -0.25% 699.46$ 697.42$ (2.04)$ -0.29% 712.20$ 709.82$ (2.38)$ -0.33% 725.18$ 722.44$ (2.74)$ -0.38%

1,373.88$ 1,370.47$ (3.41)$ -0.25% 1,398.92$ 1,394.84$ (4.08)$ -0.29% 1,424.41$ 1,419.63$ (4.78)$ -0.34% 1,450.36$ 1,444.87$ (5.49)$ -0.38%

1,167.80$ 1,164.90$ (2.90)$ -0.25% 1,189.08$ 1,185.61$ (3.47)$ -0.29% 1,210.75$ 1,206.69$ (4.06)$ -0.34% 1,232.81$ 1,228.14$ (4.67)$ -0.38%

1,957.78$ 1,952.93$ (4.85)$ -0.25% 1,993.46$ 1,987.64$ (5.82)$ -0.29% 2,029.78$ 2,022.98$ (6.80)$ -0.34% 2,066.77$ 2,058.94$ (7.83)$ -0.38%

680.91$ 679.67$ (1.24)$ -0.18% 693.31$ 691.75$ (1.56)$ -0.23% 705.95$ 704.05$ (1.90)$ -0.27% 718.81$ 716.56$ (2.25)$ -0.31%

1,361.81$ 1,359.34$ (2.47)$ -0.18% 1,386.63$ 1,383.50$ (3.13)$ -0.23% 1,411.89$ 1,408.10$ (3.79)$ -0.27% 1,437.62$ 1,433.13$ (4.49)$ -0.31%

1,157.54$ 1,155.44$ (2.10)$ -0.18% 1,178.63$ 1,175.98$ (2.65)$ -0.22% 1,200.11$ 1,196.88$ (3.23)$ -0.27% 1,221.98$ 1,218.16$ (3.82)$ -0.31%

1,940.58$ 1,937.05$ (3.53)$ -0.18% 1,975.94$ 1,971.49$ (4.45)$ -0.23% 2,011.95$ 2,006.54$ (5.41)$ -0.27% 2,048.61$ 2,042.21$ (6.40)$ -0.31%

690.24$ 686.73$ (3.51)$ -0.51% 702.81$ 698.94$ (3.87)$ -0.55% 715.62$ 711.36$ (4.26)$ -0.60% 728.66$ 724.01$ (4.65)$ -0.64%

1,380.47$ 1,373.46$ (7.01)$ -0.51% 1,405.63$ 1,397.88$ (7.75)$ -0.55% 1,431.24$ 1,422.73$ (8.51)$ -0.59% 1,457.32$ 1,448.02$ (9.30)$ -0.64%

1,173.40$ 1,167.44$ (5.96)$ -0.51% 1,194.78$ 1,188.20$ (6.58)$ -0.55% 1,216.56$ 1,209.32$ (7.24)$ -0.60% 1,238.72$ 1,230.82$ (7.90)$ -0.64%

1,967.18$ 1,957.18$ (10.00)$ -0.51% 2,003.02$ 1,991.98$ (11.04)$ -0.55% 2,039.52$ 2,027.39$ (12.13)$ -0.59% 2,076.68$ 2,063.43$ (13.25)$ -0.64%

680.91$ 679.67$ (1.24)$ -0.18% 693.31$ 691.75$ (1.56)$ -0.23% 705.95$ 704.05$ (1.90)$ -0.27% 718.81$ 716.56$ (2.25)$ -0.31%

1,361.81$ 1,359.34$ (2.47)$ -0.18% 1,386.63$ 1,383.50$ (3.13)$ -0.23% 1,411.89$ 1,408.10$ (3.79)$ -0.27% 1,437.62$ 1,433.13$ (4.49)$ -0.31%

1,157.54$ 1,155.44$ (2.10)$ -0.18% 1,178.63$ 1,175.98$ (2.65)$ -0.22% 1,200.11$ 1,196.88$ (3.23)$ -0.27% 1,221.98$ 1,218.16$ (3.82)$ -0.31%

1,940.58$ 1,937.05$ (3.53)$ -0.18% 1,975.94$ 1,971.49$ (4.45)$ -0.23% 2,011.95$ 2,006.54$ (5.41)$ -0.27% 2,048.61$ 2,042.21$ (6.40)$ -0.31%

677.66$ 678.19$ 0.53$ 0.08% 690.00$ 690.25$ 0.25$ 0.04% 702.58$ 702.52$ (0.06)$ -0.01% 715.38$ 715.01$ (0.37)$ -0.05%

1,355.31$ 1,356.38$ 1.07$ 0.08% 1,380.01$ 1,380.49$ 0.48$ 0.03% 1,405.15$ 1,405.04$ (0.11)$ -0.01% 1,430.76$ 1,430.01$ (0.75)$ -0.05%

1,152.02$ 1,152.92$ 0.90$ 0.08% 1,173.01$ 1,173.42$ 0.41$ 0.03% 1,194.38$ 1,194.28$ (0.10)$ -0.01% 1,216.15$ 1,215.51$ (0.64)$ -0.05%

1,931.32$ 1,932.84$ 1.52$ 0.08% 1,966.51$ 1,967.20$ 0.69$ 0.04% 2,002.35$ 2,002.18$ (0.17)$ -0.01% 2,038.83$ 2,037.77$ (1.06)$ -0.05%

830.84$ 800.65$ (30.19)$ -3.63% 845.97$ 814.89$ (31.08)$ -3.67% 861.39$ 829.37$ (32.02)$ -3.72% 877.09$ 844.12$ (32.97)$ -3.76%

1,661.67$ 1,601.30$ (60.37)$ -3.63% 1,691.95$ 1,629.77$ (62.18)$ -3.68% 1,722.78$ 1,658.74$ (64.04)$ -3.72% 1,754.17$ 1,688.23$ (65.94)$ -3.76%

1,412.42$ 1,361.11$ (51.31)$ -3.63% 1,438.16$ 1,385.31$ (52.85)$ -3.67% 1,464.36$ 1,409.93$ (54.43)$ -3.72% 1,491.05$ 1,435.00$ (56.05)$ -3.76%

2,367.88$ 2,281.86$ (86.02)$ -3.63% 2,411.03$ 2,322.42$ (88.61)$ -3.68% 2,454.96$ 2,363.71$ (91.25)$ -3.72% 2,499.69$ 2,405.73$ (93.96)$ -3.76%

834.85$ 802.41$ (32.44)$ -3.89% 850.06$ 816.68$ (33.38)$ -3.93% 865.55$ 831.19$ (34.36)$ -3.97% 881.32$ 845.97$ (35.35)$ -4.01%

1,669.69$ 1,604.82$ (64.87)$ -3.89% 1,700.11$ 1,633.35$ (66.76)$ -3.93% 1,731.09$ 1,662.39$ (68.70)$ -3.97% 1,762.64$ 1,691.94$ (70.70)$ -4.01%

1,419.24$ 1,364.10$ (55.14)$ -3.89% 1,445.10$ 1,388.35$ (56.75)$ -3.93% 1,471.43$ 1,413.03$ (58.40)$ -3.97% 1,498.24$ 1,438.15$ (60.09)$ -4.01%

2,379.31$ 2,286.87$ (92.44)$ -3.89% 2,422.66$ 2,327.53$ (95.13)$ -3.93% 2,466.81$ 2,368.90$ (97.91)$ -3.97% 2,511.76$ 2,411.02$ (100.74)$ -4.01%

819.54$ 792.35$ (27.19)$ -3.32% 834.47$ 806.44$ (28.03)$ -3.36% 849.68$ 820.78$ (28.90)$ -3.40% 865.16$ 835.37$ (29.79)$ -3.44%

1,639.08$ 1,584.71$ (54.37)$ -3.32% 1,668.94$ 1,612.88$ (56.06)$ -3.36% 1,699.35$ 1,641.55$ (57.80)$ -3.40% 1,730.32$ 1,670.73$ (59.59)$ -3.44%

1,393.21$ 1,347.00$ (46.21)$ -3.32% 1,418.60$ 1,370.95$ (47.65)$ -3.36% 1,444.45$ 1,395.32$ (49.13)$ -3.40% 1,470.77$ 1,420.12$ (50.65)$ -3.44%

2,335.68$ 2,258.21$ (77.47)$ -3.32% 2,378.24$ 2,298.35$ (79.89)$ -3.36% 2,421.58$ 2,339.21$ (82.37)$ -3.40% 2,465.70$ 2,380.80$ (84.90)$ -3.44%

830.84$ 800.65$ (30.19)$ -3.63% 845.97$ 814.89$ (31.08)$ -3.67% 861.39$ 829.37$ (32.02)$ -3.72% 877.09$ 844.12$ (32.97)$ -3.76%

1,661.67$ 1,601.30$ (60.37)$ -3.63% 1,691.95$ 1,629.77$ (62.18)$ -3.68% 1,722.78$ 1,658.74$ (64.04)$ -3.72% 1,754.17$ 1,688.23$ (65.94)$ -3.76%

1,412.42$ 1,361.11$ (51.31)$ -3.63% 1,438.16$ 1,385.31$ (52.85)$ -3.67% 1,464.36$ 1,409.93$ (54.43)$ -3.72% 1,491.05$ 1,435.00$ (56.05)$ -3.76%

2,367.88$ 2,281.86$ (86.02)$ -3.63% 2,411.03$ 2,322.42$ (88.61)$ -3.68% 2,454.96$ 2,363.71$ (91.25)$ -3.72% 2,499.69$ 2,405.73$ (93.96)$ -3.76%

823.49$ 794.09$ (29.40)$ -3.57% 838.50$ 808.21$ (30.29)$ -3.61% 853.78$ 822.58$ (31.20)$ -3.65% 869.33$ 837.20$ (32.13)$ -3.70%

1,646.98$ 1,588.19$ (58.79)$ -3.57% 1,676.99$ 1,616.42$ (60.57)$ -3.61% 1,707.55$ 1,645.16$ (62.39)$ -3.65% 1,738.67$ 1,674.40$ (64.27)$ -3.70%

1,399.94$ 1,349.96$ (49.98)$ -3.57% 1,425.45$ 1,373.96$ (51.49)$ -3.61% 1,451.42$ 1,398.38$ (53.04)$ -3.65% 1,477.87$ 1,423.24$ (54.63)$ -3.70%

2,346.95$ 2,263.17$ (83.78)$ -3.57% 2,389.72$ 2,303.40$ (86.32)$ -3.61% 2,433.26$ 2,344.35$ (88.91)$ -3.65% 2,477.60$ 2,386.03$ (91.57)$ -3.70%

834.85$ 802.41$ (32.44)$ -3.89% 850.06$ 816.68$ (33.38)$ -3.93% 865.55$ 831.19$ (34.36)$ -3.97% 881.32$ 845.97$ (35.35)$ -4.01%

1,669.69$ 1,604.82$ (64.87)$ -3.89% 1,700.11$ 1,633.35$ (66.76)$ -3.93% 1,731.09$ 1,662.39$ (68.70)$ -3.97% 1,762.64$ 1,691.94$ (70.70)$ -4.01%

1,419.24$ 1,364.10$ (55.14)$ -3.89% 1,445.10$ 1,388.35$ (56.75)$ -3.93% 1,471.43$ 1,413.03$ (58.40)$ -3.97% 1,498.24$ 1,438.15$ (60.09)$ -4.01%

2,379.31$ 2,286.87$ (92.44)$ -3.89% 2,422.66$ 2,327.53$ (95.13)$ -3.93% 2,466.81$ 2,368.90$ (97.91)$ -3.97% 2,511.76$ 2,411.02$ (100.74)$ -4.01%






First Quarter 2021 (1/1/2021 - 3/31/2021)


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2020 2021 2020 2021 2020 2021 2020 2021





823.49$ 794.09$ (29.40)$ -3.57% 838.50$ 808.21$ (30.29)$ -3.61% 853.78$ 822.58$ (31.20)$ -3.65% 869.33$ 837.20$ (32.13)$ -3.70%

1,646.98$ 1,588.19$ (58.79)$ -3.57% 1,676.99$ 1,616.42$ (60.57)$ -3.61% 1,707.55$ 1,645.16$ (62.39)$ -3.65% 1,738.67$ 1,674.40$ (64.27)$ -3.70%

1,399.94$ 1,349.96$ (49.98)$ -3.57% 1,425.45$ 1,373.96$ (51.49)$ -3.61% 1,451.42$ 1,398.38$ (53.04)$ -3.65% 1,477.87$ 1,423.24$ (54.63)$ -3.70%

2,346.95$ 2,263.17$ (83.78)$ -3.57% 2,389.72$ 2,303.40$ (86.32)$ -3.61% 2,433.26$ 2,344.35$ (88.91)$ -3.65% 2,477.60$ 2,386.03$ (91.57)$ -3.70%

819.54$ 792.35$ (27.19)$ -3.32% 834.47$ 806.44$ (28.03)$ -3.36% 849.68$ 820.78$ (28.90)$ -3.40% 865.16$ 835.37$ (29.79)$ -3.44%

1,639.08$ 1,584.71$ (54.37)$ -3.32% 1,668.94$ 1,612.88$ (56.06)$ -3.36% 1,699.35$ 1,641.55$ (57.80)$ -3.40% 1,730.32$ 1,670.73$ (59.59)$ -3.44%

1,393.21$ 1,347.00$ (46.21)$ -3.32% 1,418.60$ 1,370.95$ (47.65)$ -3.36% 1,444.45$ 1,395.32$ (49.13)$ -3.40% 1,470.77$ 1,420.12$ (50.65)$ -3.44%

2,335.68$ 2,258.21$ (77.47)$ -3.32% 2,378.24$ 2,298.35$ (79.89)$ -3.36% 2,421.58$ 2,339.21$ (82.37)$ -3.40% 2,465.70$ 2,380.80$ (84.90)$ -3.44%






First Quarter 2021 (1/1/2021 - 3/31/2021)


Single

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Single

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Single

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Single

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Single

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2020 2021 2020 2021 2020 2021 2020 2021





544.48$ $608.25 63.77$ 11.71% 554.40$ $619.07 64.67$ 11.66% 564.50$ 630.07$ 65.57$ 11.62% 574.79$ 641.27$ 66.48$ 11.57%

1,088.96$ 1,216.50$ 127.54$ 11.71% 1,108.80$ 1,238.13$ 129.33$ 11.66% 1,129.01$ 1,260.14$ 131.13$ 11.61% 1,149.58$ 1,282.54$ 132.96$ 11.57%

925.62$ 1,034.03$ 108.41$ 11.71% 942.48$ 1,052.41$ 109.93$ 11.66% 959.66$ 1,071.12$ 111.46$ 11.61% 977.14$ 1,090.16$ 113.02$ 11.57%

1,551.77$ 1,733.52$ 181.75$ 11.71% 1,580.04$ 1,764.34$ 184.30$ 11.66% 1,608.83$ 1,795.70$ 186.87$ 11.62% 1,638.15$ 1,827.63$ 189.48$ 11.57%

547.09$ 609.57$ 62.48$ 11.42% 557.06$ 620.41$ 63.35$ 11.37% 567.21$ 631.44$ 64.23$ 11.32% 577.55$ 642.66$ 65.11$ 11.27%

1,094.18$ 1,219.14$ 124.96$ 11.42% 1,114.12$ 1,240.81$ 126.69$ 11.37% 1,134.42$ 1,262.87$ 128.45$ 11.32% 1,155.09$ 1,285.32$ 130.23$ 11.27%

930.06$ 1,036.27$ 106.21$ 11.42% 947.00$ 1,054.69$ 107.69$ 11.37% 964.26$ 1,073.44$ 109.18$ 11.32% 981.83$ 1,092.52$ 110.69$ 11.27%

1,559.21$ 1,737.27$ 178.06$ 11.42% 1,587.62$ 1,768.16$ 180.54$ 11.37% 1,616.55$ 1,799.59$ 183.04$ 11.32% 1,646.01$ 1,831.58$ 185.57$ 11.27%

537.12$ 602.04$ 64.92$ 12.09% 546.91$ 612.74$ 65.83$ 12.04% 556.87$ 623.64$ 66.77$ 11.99% 567.02$ 634.72$ 67.70$ 11.94%

1,074.24$ 1,204.08$ 129.84$ 12.09% 1,093.81$ 1,225.49$ 131.68$ 12.04% 1,113.75$ 1,247.27$ 133.52$ 11.99% 1,134.04$ 1,269.45$ 135.41$ 11.94%

913.10$ 1,023.47$ 110.37$ 12.09% 929.74$ 1,041.66$ 111.92$ 12.04% 946.68$ 1,060.18$ 113.50$ 11.99% 963.93$ 1,079.03$ 115.10$ 11.94%

1,530.79$ 1,715.82$ 185.03$ 12.09% 1,558.69$ 1,746.32$ 187.63$ 12.04% 1,587.09$ 1,777.36$ 190.27$ 11.99% 1,616.01$ 1,808.96$ 192.95$ 11.94%

544.48$ 608.25$ 63.77$ 11.71% 554.40$ 619.07$ 64.67$ 11.66% 564.50$ 630.07$ 65.57$ 11.62% 574.79$ 641.27$ 66.48$ 11.57%

1,088.96$ 1,216.50$ 127.54$ 11.71% 1,108.80$ 1,238.13$ 129.33$ 11.66% 1,129.01$ 1,260.14$ 131.13$ 11.61% 1,149.58$ 1,282.54$ 132.96$ 11.57%

925.62$ 1,034.03$ 108.41$ 11.71% 942.48$ 1,052.41$ 109.93$ 11.66% 959.66$ 1,071.12$ 111.46$ 11.61% 977.14$ 1,090.16$ 113.02$ 11.57%

1,551.77$ 1,733.52$ 181.75$ 11.71% 1,580.04$ 1,764.34$ 184.30$ 11.66% 1,608.83$ 1,795.70$ 186.87$ 11.62% 1,638.15$ 1,827.63$ 189.48$ 11.57%

539.70$ 603.34$ 63.64$ 11.79% 549.53$ 614.07$ 64.54$ 11.74% 559.54$ 624.99$ 65.45$ 11.70% 569.74$ 636.10$ 66.36$ 11.65%

1,079.39$ 1,206.69$ 127.30$ 11.79% 1,099.06$ 1,228.14$ 129.08$ 11.74% 1,119.09$ 1,249.97$ 130.88$ 11.70% 1,139.48$ 1,272.19$ 132.71$ 11.65%

917.48$ 1,025.68$ 108.20$ 11.79% 934.20$ 1,043.92$ 109.72$ 11.74% 951.22$ 1,062.48$ 111.26$ 11.70% 968.56$ 1,081.36$ 112.80$ 11.65%

1,538.13$ 1,719.53$ 181.40$ 11.79% 1,566.16$ 1,750.10$ 183.94$ 11.74% 1,594.70$ 1,781.21$ 186.51$ 11.70% 1,623.76$ 1,812.87$ 189.11$ 11.65%

547.09$ 609.57$ 62.48$ 11.42% 557.06$ 620.41$ 63.35$ 11.37% 567.21$ 631.44$ 64.23$ 11.32% 577.55$ 642.66$ 65.11$ 11.27%

1,094.18$ 1,219.14$ 124.96$ 11.42% 1,114.12$ 1,240.81$ 126.69$ 11.37% 1,134.42$ 1,262.87$ 128.45$ 11.32% 1,155.09$ 1,285.32$ 130.23$ 11.27%

930.06$ 1,036.27$ 106.21$ 11.42% 947.00$ 1,054.69$ 107.69$ 11.37% 964.26$ 1,073.44$ 109.18$ 11.32% 981.83$ 1,092.52$ 110.69$ 11.27%

1,559.21$ 1,737.27$ 178.06$ 11.42% 1,587.62$ 1,768.16$ 180.54$ 11.37% 1,616.55$ 1,799.59$ 183.04$ 11.32% 1,646.01$ 1,831.58$ 185.57$ 11.27%

539.70$ 603.34$ 63.64$ 11.79% 549.53$ 614.07$ 64.54$ 11.74% 559.54$ 624.99$ 65.45$ 11.70% 569.74$ 636.10$ 66.36$ 11.65%

1,079.39$ 1,206.69$ 127.30$ 11.79% 1,099.06$ 1,228.14$ 129.08$ 11.74% 1,119.09$ 1,249.97$ 130.88$ 11.70% 1,139.48$ 1,272.19$ 132.71$ 11.65%

917.48$ 1,025.68$ 108.20$ 11.79% 934.20$ 1,043.92$ 109.72$ 11.74% 951.22$ 1,062.48$ 111.26$ 11.70% 968.56$ 1,081.36$ 112.80$ 11.65%

1,538.13$ 1,719.53$ 181.40$ 11.79% 1,566.16$ 1,750.10$ 183.94$ 11.74% 1,594.70$ 1,781.21$ 186.51$ 11.70% 1,623.76$ 1,812.87$ 189.11$ 11.65%

537.12$ 602.04$ 64.92$ 12.09% 546.91$ 612.74$ 65.83$ 12.04% 556.87$ 623.64$ 66.77$ 11.99% 567.02$ 634.72$ 67.70$ 11.94%

1,074.24$ 1,204.08$ 129.84$ 12.09% 1,093.81$ 1,225.49$ 131.68$ 12.04% 1,113.75$ 1,247.27$ 133.52$ 11.99% 1,134.04$ 1,269.45$ 135.41$ 11.94%

913.10$ 1,023.47$ 110.37$ 12.09% 929.74$ 1,041.66$ 111.92$ 12.04% 946.68$ 1,060.18$ 113.50$ 11.99% 963.93$ 1,079.03$ 115.10$ 11.94%

1,530.79$ 1,715.82$ 185.03$ 12.09% 1,558.69$ 1,746.32$ 187.63$ 12.04% 1,587.09$ 1,777.36$ 190.27$ 11.99% 1,616.01$ 1,808.96$ 192.95$ 11.94%

658.53$ 709.99$ 51.46$ 7.81% 670.53$ 722.61$ 52.08$ 7.77% 682.75$ 735.46$ 52.71$ 7.72% 695.19$ 748.54$ 53.35$ 7.67%

1,317.06$ 1,419.98$ 102.92$ 7.81% 1,341.06$ 1,445.23$ 104.17$ 7.77% 1,365.50$ 1,470.92$ 105.42$ 7.72% 1,390.38$ 1,497.07$ 106.69$ 7.67%

1,119.50$ 1,206.99$ 87.49$ 7.82% 1,139.90$ 1,228.44$ 88.54$ 7.77% 1,160.68$ 1,250.28$ 89.60$ 7.72% 1,181.82$ 1,272.51$ 90.69$ 7.67%

1,876.82$ 2,023.48$ 146.66$ 7.81% 1,911.02$ 2,059.45$ 148.43$ 7.77% 1,945.84$ 2,096.06$ 150.22$ 7.72% 1,981.29$ 2,133.33$ 152.04$ 7.67%

661.71$ 711.54$ 49.83$ 7.53% 673.77$ 724.19$ 50.42$ 7.48% 686.05$ 737.07$ 51.02$ 7.44% 698.55$ 750.17$ 51.62$ 7.39%

1,323.42$ 1,423.09$ 99.67$ 7.53% 1,347.54$ 1,448.39$ 100.85$ 7.48% 1,372.09$ 1,474.13$ 102.04$ 7.44% 1,397.09$ 1,500.34$ 103.25$ 7.39%

1,124.91$ 1,209.62$ 84.71$ 7.53% 1,145.41$ 1,231.13$ 85.72$ 7.48% 1,166.28$ 1,253.01$ 86.73$ 7.44% 1,187.53$ 1,275.29$ 87.76$ 7.39%

1,885.87$ 2,027.90$ 142.03$ 7.53% 1,920.24$ 2,063.95$ 143.71$ 7.48% 1,955.23$ 2,100.64$ 145.41$ 7.44% 1,990.86$ 2,137.99$ 147.13$ 7.39%

649.58$ 702.68$ 53.10$ 8.17% 661.41$ 715.17$ 53.76$ 8.13% 673.47$ 727.88$ 54.41$ 8.08% 685.74$ 740.82$ 55.08$ 8.03%

1,299.16$ 1,405.35$ 106.19$ 8.17% 1,322.83$ 1,430.34$ 107.51$ 8.13% 1,346.93$ 1,455.77$ 108.84$ 8.08% 1,371.48$ 1,481.65$ 110.17$ 8.03%

1,104.28$ 1,194.55$ 90.27$ 8.17% 1,124.40$ 1,215.79$ 91.39$ 8.13% 1,144.89$ 1,237.40$ 92.51$ 8.08% 1,165.75$ 1,259.40$ 93.65$ 8.03%

1,851.30$ 2,002.63$ 151.33$ 8.17% 1,885.03$ 2,038.23$ 153.20$ 8.13% 1,919.38$ 2,074.47$ 155.09$ 8.08% 1,954.35$ 2,111.34$ 156.99$ 8.03%

658.53$ 709.99$ 51.46$ 7.81% 670.53$ 722.61$ 52.08$ 7.77% 682.75$ 735.46$ 52.71$ 7.72% 695.19$ 748.54$ 53.35$ 7.67%

1,317.06$ 1,419.98$ 102.92$ 7.81% 1,341.06$ 1,445.23$ 104.17$ 7.77% 1,365.50$ 1,470.92$ 105.42$ 7.72% 1,390.38$ 1,497.07$ 106.69$ 7.67%

1,119.50$ 1,206.99$ 87.49$ 7.82% 1,139.90$ 1,228.44$ 88.54$ 7.77% 1,160.68$ 1,250.28$ 89.60$ 7.72% 1,181.82$ 1,272.51$ 90.69$ 7.67%

1,876.82$ 2,023.48$ 146.66$ 7.81% 1,911.02$ 2,059.45$ 148.43$ 7.77% 1,945.84$ 2,096.06$ 150.22$ 7.72% 1,981.29$ 2,133.33$ 152.04$ 7.67%

652.71$ 704.21$ 51.50$ 7.89% 664.61$ 716.73$ 52.12$ 7.84% 676.72$ 729.47$ 52.75$ 7.79% 689.05$ 742.44$ 53.39$ 7.75%

1,305.42$ 1,408.42$ 103.00$ 7.89% 1,329.21$ 1,433.46$ 104.25$ 7.84% 1,353.43$ 1,458.94$ 105.51$ 7.80% 1,378.09$ 1,484.88$ 106.79$ 7.75%

1,109.61$ 1,197.16$ 87.55$ 7.89% 1,129.83$ 1,218.44$ 88.61$ 7.84% 1,150.42$ 1,240.10$ 89.68$ 7.80% 1,171.38$ 1,262.15$ 90.77$ 7.75%

1,860.23$ 2,007.00$ 146.77$ 7.89% 1,894.12$ 2,042.68$ 148.56$ 7.84% 1,928.64$ 2,079.00$ 150.36$ 7.80% 1,963.78$ 2,115.95$ 152.17$ 7.75%

661.71$ 711.54$ 49.83$ 7.53% 673.77$ 724.19$ 50.42$ 7.48% 686.05$ 737.07$ 51.02$ 7.44% 698.55$ 750.17$ 51.62$ 7.39%

1,323.42$ 1,423.09$ 99.67$ 7.53% 1,347.54$ 1,448.39$ 100.85$ 7.48% 1,372.09$ 1,474.13$ 102.04$ 7.44% 1,397.09$ 1,500.34$ 103.25$ 7.39%

1,124.91$ 1,209.62$ 84.71$ 7.53% 1,145.41$ 1,231.13$ 85.72$ 7.48% 1,166.28$ 1,253.01$ 86.73$ 7.44% 1,187.53$ 1,275.29$ 87.76$ 7.39%

1,885.87$ 2,027.90$ 142.03$ 7.53% 1,920.24$ 2,063.95$ 143.71$ 7.48% 1,955.23$ 2,100.64$ 145.41$ 7.44% 1,990.86$ 2,137.99$ 147.13$ 7.39%






First Quarter 2021 (1/1/2021 - 3/31/2021)


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2020 2021 2020 2021 2020 2021 2020 2021





652.71$ 704.21$ 51.50$ 7.89% 664.61$ 716.73$ 52.12$ 7.84% 676.72$ 729.47$ 52.75$ 7.79% 689.05$ 742.44$ 53.39$ 7.75%

1,305.42$ 1,408.42$ 103.00$ 7.89% 1,329.21$ 1,433.46$ 104.25$ 7.84% 1,353.43$ 1,458.94$ 105.51$ 7.80% 1,378.09$ 1,484.88$ 106.79$ 7.75%

1,109.61$ 1,197.16$ 87.55$ 7.89% 1,129.83$ 1,218.44$ 88.61$ 7.84% 1,150.42$ 1,240.10$ 89.68$ 7.80% 1,171.38$ 1,262.15$ 90.77$ 7.75%

1,860.23$ 2,007.00$ 146.77$ 7.89% 1,894.12$ 2,042.68$ 148.56$ 7.84% 1,928.64$ 2,079.00$ 150.36$ 7.80% 1,963.78$ 2,115.95$ 152.17$ 7.75%

649.58$ 702.68$ 53.10$ 8.17% 661.41$ 715.17$ 53.76$ 8.13% 673.47$ 727.88$ 54.41$ 8.08% 685.74$ 740.82$ 55.08$ 8.03%

1,299.16$ 1,405.35$ 106.19$ 8.17% 1,322.83$ 1,430.34$ 107.51$ 8.13% 1,346.93$ 1,455.77$ 108.84$ 8.08% 1,371.48$ 1,481.65$ 110.17$ 8.03%

1,104.28$ 1,194.55$ 90.27$ 8.17% 1,124.40$ 1,215.79$ 91.39$ 8.13% 1,144.89$ 1,237.40$ 92.51$ 8.08% 1,165.75$ 1,259.40$ 93.65$ 8.03%

1,851.30$ 2,002.63$ 151.33$ 8.17% 1,885.03$ 2,038.23$ 153.20$ 8.13% 1,919.38$ 2,074.47$ 155.09$ 8.08% 1,954.35$ 2,111.34$ 156.99$ 8.03%






First Quarter 2021 (1/1/2021 - 3/31/2021)


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Single

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Single

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Single

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Single

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Single

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Single

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2020 2021 2020 2021 2020 2021 2020 2021





537.89$ $586.52 48.63$ 9.04% 547.69$ $596.95 49.26$ 8.99% 557.67$ 607.56$ 49.89$ 8.95% 567.83$ 618.36$ 50.53$ 8.90%

1,075.78$ 1,173.04$ 97.26$ 9.04% 1,095.39$ 1,193.89$ 98.50$ 8.99% 1,115.35$ 1,215.12$ 99.77$ 8.95% 1,135.67$ 1,236.72$ 101.05$ 8.90%

914.42$ 997.08$ 82.66$ 9.04% 931.08$ 1,014.81$ 83.73$ 8.99% 948.04$ 1,032.85$ 84.81$ 8.95% 965.32$ 1,051.21$ 85.89$ 8.90%

1,532.99$ 1,671.58$ 138.59$ 9.04% 1,560.92$ 1,701.30$ 140.38$ 8.99% 1,589.37$ 1,731.54$ 142.17$ 8.95% 1,618.33$ 1,762.32$ 143.99$ 8.90%

540.47$ 587.79$ 47.32$ 8.76% 550.32$ 598.24$ 47.92$ 8.71% 560.35$ 608.87$ 48.52$ 8.66% 570.56$ 619.70$ 49.14$ 8.61%

1,080.94$ 1,175.57$ 94.63$ 8.75% 1,100.64$ 1,196.47$ 95.83$ 8.71% 1,120.70$ 1,217.74$ 97.04$ 8.66% 1,141.12$ 1,239.39$ 98.27$ 8.61%

918.80$ 999.24$ 80.44$ 8.75% 935.55$ 1,017.00$ 81.45$ 8.71% 952.59$ 1,035.08$ 82.49$ 8.66% 969.95$ 1,053.48$ 83.53$ 8.61%

1,540.35$ 1,675.19$ 134.84$ 8.75% 1,568.41$ 1,704.97$ 136.56$ 8.71% 1,596.99$ 1,735.28$ 138.29$ 8.66% 1,626.09$ 1,766.13$ 140.04$ 8.61%

530.62$ 580.54$ 49.92$ 9.41% 540.29$ 590.86$ 50.57$ 9.36% 550.13$ 601.37$ 51.24$ 9.31% 560.16$ 612.06$ 51.90$ 9.27%

1,061.24$ 1,161.09$ 99.85$ 9.41% 1,080.58$ 1,181.73$ 101.15$ 9.36% 1,100.27$ 1,202.74$ 102.47$ 9.31% 1,120.32$ 1,224.12$ 103.80$ 9.27%

902.06$ 986.92$ 84.86$ 9.41% 918.49$ 1,004.47$ 85.98$ 9.36% 935.23$ 1,022.33$ 87.10$ 9.31% 952.27$ 1,040.50$ 88.23$ 9.27%

1,512.27$ 1,654.55$ 142.28$ 9.41% 1,539.83$ 1,683.96$ 144.13$ 9.36% 1,567.88$ 1,713.90$ 146.02$ 9.31% 1,596.45$ 1,744.37$ 147.92$ 9.27%

537.89$ 586.52$ 48.63$ 9.04% 547.69$ 596.95$ 49.26$ 8.99% 557.67$ 607.56$ 49.89$ 8.95% 567.83$ 618.36$ 50.53$ 8.90%

1,075.78$ 1,173.04$ 97.26$ 9.04% 1,095.39$ 1,193.89$ 98.50$ 8.99% 1,115.35$ 1,215.12$ 99.77$ 8.95% 1,135.67$ 1,236.72$ 101.05$ 8.90%

914.42$ 997.08$ 82.66$ 9.04% 931.08$ 1,014.81$ 83.73$ 8.99% 948.04$ 1,032.85$ 84.81$ 8.95% 965.32$ 1,051.21$ 85.89$ 8.90%

1,532.99$ 1,671.58$ 138.59$ 9.04% 1,560.92$ 1,701.30$ 140.38$ 8.99% 1,589.37$ 1,731.54$ 142.17$ 8.95% 1,618.33$ 1,762.32$ 143.99$ 8.90%

533.17$ 581.80$ 48.63$ 9.12% 542.88$ 592.14$ 49.26$ 9.07% 552.77$ 602.67$ 49.90$ 9.03% 562.85$ 613.38$ 50.53$ 8.98%

1,066.33$ 1,163.59$ 97.26$ 9.12% 1,085.76$ 1,184.28$ 98.52$ 9.07% 1,105.55$ 1,205.33$ 99.78$ 9.03% 1,125.69$ 1,226.76$ 101.07$ 8.98%

906.38$ 989.05$ 82.67$ 9.12% 922.90$ 1,006.64$ 83.74$ 9.07% 939.71$ 1,024.53$ 84.82$ 9.03% 956.84$ 1,042.75$ 85.91$ 8.98%

1,519.52$ 1,658.12$ 138.60$ 9.12% 1,547.21$ 1,687.60$ 140.39$ 9.07% 1,575.40$ 1,717.60$ 142.20$ 9.03% 1,604.11$ 1,748.13$ 144.02$ 8.98%

540.47$ 587.79$ 47.32$ 8.76% 550.32$ 598.24$ 47.92$ 8.71% 560.35$ 608.87$ 48.52$ 8.66% 570.56$ 619.70$ 49.14$ 8.61%

1,080.94$ 1,175.57$ 94.63$ 8.75% 1,100.64$ 1,196.47$ 95.83$ 8.71% 1,120.70$ 1,217.74$ 97.04$ 8.66% 1,141.12$ 1,239.39$ 98.27$ 8.61%

918.80$ 999.24$ 80.44$ 8.75% 935.55$ 1,017.00$ 81.45$ 8.71% 952.59$ 1,035.08$ 82.49$ 8.66% 969.95$ 1,053.48$ 83.53$ 8.61%

1,540.35$ 1,675.19$ 134.84$ 8.75% 1,568.41$ 1,704.97$ 136.56$ 8.71% 1,596.99$ 1,735.28$ 138.29$ 8.66% 1,626.09$ 1,766.13$ 140.04$ 8.61%

533.17$ 581.80$ 48.63$ 9.12% 542.88$ 592.14$ 49.26$ 9.07% 552.77$ 602.67$ 49.90$ 9.03% 562.85$ 613.38$ 50.53$ 8.98%

1,066.33$ 1,163.59$ 97.26$ 9.12% 1,085.76$ 1,184.28$ 98.52$ 9.07% 1,105.55$ 1,205.33$ 99.78$ 9.03% 1,125.69$ 1,226.76$ 101.07$ 8.98%

906.38$ 989.05$ 82.67$ 9.12% 922.90$ 1,006.64$ 83.74$ 9.07% 939.71$ 1,024.53$ 84.82$ 9.03% 956.84$ 1,042.75$ 85.91$ 8.98%

1,519.52$ 1,658.12$ 138.60$ 9.12% 1,547.21$ 1,687.60$ 140.39$ 9.07% 1,575.40$ 1,717.60$ 142.20$ 9.03% 1,604.11$ 1,748.13$ 144.02$ 8.98%

530.62$ 580.54$ 49.92$ 9.41% 540.29$ 590.86$ 50.57$ 9.36% 550.13$ 601.37$ 51.24$ 9.31% 560.16$ 612.06$ 51.90$ 9.27%

1,061.24$ 1,161.09$ 99.85$ 9.41% 1,080.58$ 1,181.73$ 101.15$ 9.36% 1,100.27$ 1,202.74$ 102.47$ 9.31% 1,120.32$ 1,224.12$ 103.80$ 9.27%

902.06$ 986.92$ 84.86$ 9.41% 918.49$ 1,004.47$ 85.98$ 9.36% 935.23$ 1,022.33$ 87.10$ 9.31% 952.27$ 1,040.50$ 88.23$ 9.27%

1,512.27$ 1,654.55$ 142.28$ 9.41% 1,539.83$ 1,683.96$ 144.13$ 9.36% 1,567.88$ 1,713.90$ 146.02$ 9.31% 1,596.45$ 1,744.37$ 147.92$ 9.27%

650.56$ 684.40$ 33.84$ 5.20% 662.42$ 696.57$ 34.15$ 5.16% 674.49$ 708.95$ 34.46$ 5.11% 686.78$ 721.55$ 34.77$ 5.06%

1,301.13$ 1,368.80$ 67.67$ 5.20% 1,324.84$ 1,393.13$ 68.29$ 5.15% 1,348.98$ 1,417.90$ 68.92$ 5.11% 1,373.56$ 1,443.11$ 69.55$ 5.06%

1,105.96$ 1,163.48$ 57.52$ 5.20% 1,126.11$ 1,184.16$ 58.05$ 5.15% 1,146.63$ 1,205.21$ 58.58$ 5.11% 1,167.52$ 1,226.64$ 59.12$ 5.06%

1,854.11$ 1,950.54$ 96.43$ 5.20% 1,887.89$ 1,985.21$ 97.32$ 5.15% 1,922.29$ 2,020.51$ 98.22$ 5.11% 1,957.32$ 2,056.43$ 99.11$ 5.06%

653.70$ 685.89$ 32.19$ 4.92% 665.62$ 698.08$ 32.46$ 4.88% 677.74$ 710.49$ 32.75$ 4.83% 690.09$ 723.13$ 33.04$ 4.79%

1,307.41$ 1,371.78$ 64.37$ 4.92% 1,331.23$ 1,396.17$ 64.94$ 4.88% 1,355.49$ 1,420.99$ 65.50$ 4.83% 1,380.19$ 1,446.25$ 66.06$ 4.79%

1,111.30$ 1,166.02$ 54.72$ 4.92% 1,131.55$ 1,186.74$ 55.19$ 4.88% 1,152.16$ 1,207.84$ 55.68$ 4.83% 1,173.16$ 1,229.31$ 56.15$ 4.79%

1,863.06$ 1,954.79$ 91.73$ 4.92% 1,897.00$ 1,989.54$ 92.54$ 4.88% 1,931.57$ 2,024.91$ 93.34$ 4.83% 1,966.77$ 2,060.91$ 94.14$ 4.79%

641.72$ 677.36$ 35.64$ 5.55% 653.41$ 689.40$ 35.99$ 5.51% 665.32$ 701.66$ 36.34$ 5.46% 677.44$ 714.13$ 36.69$ 5.42%

1,283.44$ 1,354.72$ 71.28$ 5.55% 1,306.82$ 1,378.81$ 71.99$ 5.51% 1,330.63$ 1,403.32$ 72.69$ 5.46% 1,354.88$ 1,428.27$ 73.39$ 5.42%

1,090.92$ 1,151.51$ 60.59$ 5.55% 1,110.80$ 1,171.99$ 61.19$ 5.51% 1,131.04$ 1,192.82$ 61.78$ 5.46% 1,151.65$ 1,214.03$ 62.38$ 5.42%

1,828.90$ 1,930.48$ 101.58$ 5.55% 1,862.22$ 1,964.80$ 102.58$ 5.51% 1,896.15$ 1,999.73$ 103.58$ 5.46% 1,930.71$ 2,035.28$ 104.57$ 5.42%

650.56$ 684.40$ 33.84$ 5.20% 662.42$ 696.57$ 34.15$ 5.16% 674.49$ 708.95$ 34.46$ 5.11% 686.78$ 721.55$ 34.77$ 5.06%

1,301.13$ 1,368.80$ 67.67$ 5.20% 1,324.84$ 1,393.13$ 68.29$ 5.15% 1,348.98$ 1,417.90$ 68.92$ 5.11% 1,373.56$ 1,443.11$ 69.55$ 5.06%

1,105.96$ 1,163.48$ 57.52$ 5.20% 1,126.11$ 1,184.16$ 58.05$ 5.15% 1,146.63$ 1,205.21$ 58.58$ 5.11% 1,167.52$ 1,226.64$ 59.12$ 5.06%

1,854.11$ 1,950.54$ 96.43$ 5.20% 1,887.89$ 1,985.21$ 97.32$ 5.15% 1,922.29$ 2,020.51$ 98.22$ 5.11% 1,957.32$ 2,056.43$ 99.11$ 5.06%

644.81$ 678.84$ 34.03$ 5.28% 656.56$ 690.91$ 34.35$ 5.23% 668.53$ 703.19$ 34.66$ 5.18% 680.71$ 715.69$ 34.98$ 5.14%

1,289.63$ 1,357.67$ 68.04$ 5.28% 1,313.13$ 1,381.81$ 68.68$ 5.23% 1,337.05$ 1,406.38$ 69.33$ 5.19% 1,361.42$ 1,431.38$ 69.96$ 5.14%

1,096.18$ 1,154.02$ 57.84$ 5.28% 1,116.16$ 1,174.54$ 58.38$ 5.23% 1,136.50$ 1,195.42$ 58.92$ 5.18% 1,157.21$ 1,216.67$ 59.46$ 5.14%

1,837.72$ 1,934.69$ 96.97$ 5.28% 1,871.21$ 1,969.08$ 97.87$ 5.23% 1,905.30$ 2,004.09$ 98.79$ 5.19% 1,940.02$ 2,039.71$ 99.69$ 5.14%

653.70$ 685.89$ 32.19$ 4.92% 665.62$ 698.08$ 32.46$ 4.88% 677.74$ 710.49$ 32.75$ 4.83% 690.09$ 723.13$ 33.04$ 4.79%

1,307.41$ 1,371.78$ 64.37$ 4.92% 1,331.23$ 1,396.17$ 64.94$ 4.88% 1,355.49$ 1,420.99$ 65.50$ 4.83% 1,380.19$ 1,446.25$ 66.06$ 4.79%

1,111.30$ 1,166.02$ 54.72$ 4.92% 1,131.55$ 1,186.74$ 55.19$ 4.88% 1,152.16$ 1,207.84$ 55.68$ 4.83% 1,173.16$ 1,229.31$ 56.15$ 4.79%

1,863.06$ 1,954.79$ 91.73$ 4.92% 1,897.00$ 1,989.54$ 92.54$ 4.88% 1,931.57$ 2,024.91$ 93.34$ 4.83% 1,966.77$ 2,060.91$ 94.14$ 4.79%






First Quarter 2021 (1/1/2021 - 3/31/2021)


Single

Double

Emp/Child(ren)

Family


Single

Double

Emp/Child(ren)

Family

2020 2021 2020 2021 2020 2021 2020 2021





644.81$ 678.84$ 34.03$ 5.28% 656.56$ 690.91$ 34.35$ 5.23% 668.53$ 703.19$ 34.66$ 5.18% 680.71$ 715.69$ 34.98$ 5.14%

1,289.63$ 1,357.67$ 68.04$ 5.28% 1,313.13$ 1,381.81$ 68.68$ 5.23% 1,337.05$ 1,406.38$ 69.33$ 5.19% 1,361.42$ 1,431.38$ 69.96$ 5.14%

1,096.18$ 1,154.02$ 57.84$ 5.28% 1,116.16$ 1,174.54$ 58.38$ 5.23% 1,136.50$ 1,195.42$ 58.92$ 5.18% 1,157.21$ 1,216.67$ 59.46$ 5.14%

1,837.72$ 1,934.69$ 96.97$ 5.28% 1,871.21$ 1,969.08$ 97.87$ 5.23% 1,905.30$ 2,004.09$ 98.79$ 5.19% 1,940.02$ 2,039.71$ 99.69$ 5.14%

641.72$ 677.36$ 35.64$ 5.55% 653.41$ 689.40$ 35.99$ 5.51% 665.32$ 701.66$ 36.34$ 5.46% 677.44$ 714.13$ 36.69$ 5.42%

1,283.44$ 1,354.72$ 71.28$ 5.55% 1,306.82$ 1,378.81$ 71.99$ 5.51% 1,330.63$ 1,403.32$ 72.69$ 5.46% 1,354.88$ 1,428.27$ 73.39$ 5.42%

1,090.92$ 1,151.51$ 60.59$ 5.55% 1,110.80$ 1,171.99$ 61.19$ 5.51% 1,131.04$ 1,192.82$ 61.78$ 5.46% 1,151.65$ 1,214.03$ 62.38$ 5.42%

1,828.90$ 1,930.48$ 101.58$ 5.55% 1,862.22$ 1,964.80$ 102.58$ 5.51% 1,896.15$ 1,999.73$ 103.58$ 5.46% 1,930.71$ 2,035.28$ 104.57$ 5.42%



Benefit Summary Updated 4/30/20 SH


Proposed Premium Rates Effective 1/1/2021 15 16

Form Number Size Product Metal Tier HIOS ID

2020 Plan

Code

2021 Plan

Code Standard? OV SP

01-0006-2021 SG HDHMO Silver 94788NY0260081 SHSX3016 SHSX3024 Non-Standard 25 50








01-0006-2021 SG HMO Gold 94788NY0260097 SHGX5001 SHGX5017 Non-Standard $0 EPC/$50 50








Page 10

2020 Plan

Code

2021 Plan

Code

SHSX3016 SHSX3024

SHSX3017 SHSX3025

SHSX3018 SHSX3026

SHSX3019 SHSX3027

SHSX3020 SHSX3028

SHSX3021 SHSX3029

SHSX3022 SHSX3030

SHSX3023 SHSX3031

SHGX5001 SHGX5017

SHGX5002 SHGX5018

SHGX5003 SHGX5019

SHGX5004 SHGX5020

SHGX5005 SHGX5021

SHGX5006 SHGX5022

SHGX5007 SHGX5023

SHGX5008 SHGX5024

17 18 19 20 21 22 23 24 25 26

INN HOSP OUT SURG

OUT SURG -

PHYSICIAN ER AMB DME

URGENT

CARE DIABETIC PT/OT/ST

RADIOLOGY

IMAGING RADIOLOGY XRAY LAB COIN

500 200 200 300 300 0.5 60 25 50 50 50 50 0

500 200 200 300 300 0.5 60 25 50 50 50 50 0

500 200 200 300 300 0.5 60 25 50 50 50 50 0

500 200 200 300 300 0.5 60 25 50 50 50 50 0

500 200 200 300 300 0.5 60 25 50 50 50 50 0

500 200 200 300 300 0.5 60 25 50 50 50 50 0

500 200 200 300 300 0.5 60 25 50 50 50 50 0

500 200 200 300 300 0.5 60 25 50 50 50 50 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0

1500 250 50 500 500 0.5 100 50 50 50 50 50 0

Page 11

2020 Plan

Code

2021 Plan

Code

SHSX3016 SHSX3024

SHSX3017 SHSX3025

SHSX3018 SHSX3026

SHSX3019 SHSX3027

SHSX3020 SHSX3028

SHSX3021 SHSX3029

SHSX3022 SHSX3030

SHSX3023 SHSX3031

SHGX5001 SHGX5017

SHGX5002 SHGX5018

SHGX5003 SHGX5019

SHGX5004 SHGX5020

SHGX5005 SHGX5021

SHGX5006 SHGX5022

SHGX5007 SHGX5023

SHGX5008 SHGX5024

27 28 29 30 31 32 33 34 35 36 37

INN Ded Single INN Ded Family INN Max Single INN Max Family OON COIN OON Ded Single OON Ded Family OON Max Single OON Max Family

Aggregate/

Embedded Product Line

2200 4400 5500 11000 N/A N/A N/A N/A N/A Aggregate HDHMO








0 0 7900 15800 N/A N/A N/A N/A N/A Embedded HMO








Page 12

2020 Plan

Code

2021 Plan

Code

SHSX3016 SHSX3024

SHSX3017 SHSX3025

SHSX3018 SHSX3026

SHSX3019 SHSX3027

SHSX3020 SHSX3028

SHSX3021 SHSX3029

SHSX3022 SHSX3030

SHSX3023 SHSX3031

SHGX5001 SHGX5017

SHGX5002 SHGX5018

SHGX5003 SHGX5019

SHGX5004 SHGX5020

SHGX5005 SHGX5021

SHGX5006 SHGX5022

SHGX5007 SHGX5023

SHGX5008 SHGX5024

38 39 40 41 42 43

Benefit Type Rx Benefit Riders Additional Benefits Additional Benefits Additional Benefits

Qualified High

Deductible$10/$40/$60 No Riders Adult Vision/HW SNF - 200 to 365 days Acupuncture

Qualified High

Deductible$10/$40/$60 Age 29 Adult Vision/HW SNF - 200 to 365 days Acupuncture

Qualified High

Deductible$10/$40/$60 No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture

Qualified High

Deductible$10/$40/$60 DP Adult Vision/HW SNF - 200 to 365 days Acupuncture

Qualified High

Deductible$10/$40/$60 Age 29 + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture

Qualified High

Deductible$10/$40/$60 Age 29 + DP Adult Vision/HW SNF - 200 to 365 days Acupuncture

Qualified High

Deductible$10/$40/$60 Age 29 + DP + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture

Qualified High

Deductible$10/$40/$60 DP + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture

Copayment $0/$50/$80 No Riders Adult Vision/HW SNF - 200 to 365 days Acupuncture

Copayment $0/$50/$80 Age 29 Adult Vision/HW SNF - 200 to 365 days Acupuncture

Copayment $0/$50/$80 No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture

Copayment $0/$50/$80 DP Adult Vision/HW SNF - 200 to 365 days Acupuncture

Copayment $0/$50/$80 Age 29 + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture

Copayment $0/$50/$80 Age 29 + DP Adult Vision/HW SNF - 200 to 365 days Acupuncture

Copayment $0/$50/$80 Age 29 + DP + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture

Copayment $0/$50/$80 DP + No Family Planning Adult Vision/HW SNF - 200 to 365 days Acupuncture

Page 13

2020 Plan

Code

2021 Plan

Code

SHSX3016 SHSX3024

SHSX3017 SHSX3025

SHSX3018 SHSX3026

SHSX3019 SHSX3027

SHSX3020 SHSX3028

SHSX3021 SHSX3029

SHSX3022 SHSX3030

SHSX3023 SHSX3031

SHGX5001 SHGX5017

SHGX5002 SHGX5018

SHGX5003 SHGX5019

SHGX5004 SHGX5020

SHGX5005 SHGX5021

SHGX5006 SHGX5022

SHGX5007 SHGX5023

SHGX5008 SHGX5024

44 45

Additional Benefits Additional Benefits

Lasik Surgery ($750 Max)Gym

Membership


Membership


Membership


Membership


Membership


Membership


Membership


Membership


Membership


Membership


Membership


Membership


Membership


Membership


Membership


Membership

Page 14

Exhibit C


Small Group HMO

Conversion Factor Summary - 4-tier only

IV. Conversion Factor

Average Weighted Desired Weighted

Contract Contract Contract Loading Loading Conversion

Mix Size Size Factors Factors Factor

Four Tier Premiums

Single 68.5% 1.00 0.685 1.000 0.685

Double 12.7% 2.00 0.253 2.000 0.253

Emp/Child(ren) 4.4% 2.54 0.111 1.700 0.074

Family 14.5% 3.92 0.568 2.850 0.413

Total 4T 100.0% 1.617 1.426 1.134

1.134

Filed 2020 1.138

Page 15

V. Area Factors

2021 Rating Factors

Rating Region

Region 1

(Albany Area)

Region 3

(Mid-Hudson Area)

Region 6

(Syracuse Area)

Region 7

(Utica/Watertown

Area)

Regional Rating Factor 0.9736 1.2896 1.1368 1.0937

Normalized to Albany Area 1.0000 1.3246 1.1677 1.1234

Counties: Albany Delaware Broome Chenango

Columbia Dutchess Tioga Clinton

Fulton Orange Essex

Greene Ulster Franklin

Montgomery Hamilton

Rensselaer Herkimer

Saratoga Jefferson

Schenectady Lewis

Schoharie Madison

Warren Oneida

Washington Otsego

St. Lawerence


HMO Products

Regional Area Factors

EXEMPTION FROM FOIL REQUESTED

Page 16

VI. Tier Factors

2021 Rating Factors

Rating Method Contract Type Small Group

4-Tier Individual 1

Employee + Spouse 2.00

Employee + Child(ren) 1.70

Family 2.85


HMO Product

Tier Factors

Page 17

VI. Rate Calculation

Plan Code Single Double Emp/Child(ren) Family

SHSX3024 $526.00 $1,052.01 $894.20 $1,499.11

Final Rates $526.00 $1,052.01 $894.20 $1,499.11


Small Group HMO Product

Sample Rate Calculation

Sample rate calculation for a small group off exchange HMO (HNY) benefit package in the Albany region

Page 18


HMO Product

Expected Loss Ratio

All policy forms in all regions

VIII. Expected Loss Ratio

87.51%

Page 19

Base Plan Base Plan Variation Adjustment

Characteristic Factor Characteristic FactorWithout Through Age 29 Coverage 1.000 With Through Age 29 Coverage 1.0023

With Family Planning Coverage 1.000 Without Family Planning Coverage 0.9892

With Domestic Partner Coverage 1.000 Without Domestic Partner Coverage 1.0000

Without Pediatric Dental Coverage 1.000 With Pediatric Dental Coverage N/A


HMO Product

Factors for Base Plan Variations

Page 20

2021 HMO Commercial Commission Schedule

Capital District Physicians’ Health Plan, Inc.

Note: Agent/Broker is required to have a minimum book of business of 20 Subscribers by July 31 in order to remain active.

SMALL GROUP HMO

(Applies to new, renewal, and broker of record changes)

4 percent first $1.5 million of employer group premium

2.5 percent next $1,500,001+ of premium

Page 21

Rate Filing Checklist – Last updated: 4/10/2020

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

For On-Exchange Plans and Off-Exchange Plans

1. Under which Section of the New York State Insurance Law is this filing being made? (3231(e)(1), 4308(c), 3231(d), or 4308(b)) 4308(c)2. For filings made pursuant to 3231(e)(1) and 4308(c):

a. Did the Company submit a combined filing for “On” and “Off” Exchange rates per the instructions along with a separate form filing that both contain cross references to each other? Yes

b. For Individual filings, do the Exhibits only contain Individual plan/experience data per the instructions? N/A c. For Small Group filings, do the Exhibits only contain Small Group plan/experience data per the instructions? Yes

3. Does this filing introduce any new plans (i.e., new 14-digit HIOS IDs)? Yes4. Has the Company provided two versions (i.e., PDF and Excel) of all rate filing Exhibits? Yes_ 5. Do the values in Line 10 of Exhibit 18 match the totals in column 14.4 of Exhibit 17 for the applicable Market Segments? Yes 6. Do the values in Line 10A of Exhibit 18 match the totals in column 14.7 of Exhibit 17 for the applicable Market Segments? Yes 7. Do the values in Line 10B of Exhibit 18 match the totals in column 14.3 of Exhibit 17 for the applicable Market Segments? Yes8. Confirm that the 2021 version (updated in 2020) of the rate filing Exhibits were utilized (Yes/No: Respond “Yes” to confirm). Yes9. With regard to the “Rate Review Detail” screen in SERFF:

a. Was it completed in a manner consistent with the Company’s 2020 premium rate filings? Yesb. Do the “Average” percentages look reasonable (e.g., do they fall between “Minimum” and “Maximum” percentages? Yes c. Do the “Minimum” and “Maximum” values appear reasonable in light of changes that are being proposed? Yes d. Are the “Minimum”, “Maximum” and “Average” values stated on an Annualized PMPM basis (as opposed to annual

premium)? Yes e. Are all items that are not applicable left blank (i.e., Items that are not applicable should be left blank)? Yes f. Have the “Requested Rate Period” data fields been populated with non-zero values? Yes

10. Is the information presented in Exhibit 18 provided at the HIOS SCID level (i.e., are there 14 digits in the HIOS ID?) Yes 11. Does Exhibit 23 contain rates for every distinct 14-digit HIOS ID as opposed to only the “Base” plan rates? Yes_ 12. Does the Company’s claim experience for 2019 include two months of run-out? Yes13. Is the rate manual provided in both PDF and Excel format per our instructions?14. Were adequate details (as well as a spreadsheet) included with the Actuarial Memorandum regarding how DFS should modify

the Company’s 2021 assumption for risk adjustment to the extent actual 2019 results are different from expected? Yes 15. Does the PMPM value in Cell Q-74 of Exhibit 13C equal the value in Cell D-98 (Line 54 Column D) of Exhibit 18? No 16. Does the PMPM value in Cell Z-74 of Exhibit 13C equal the value in Cell D-104 (Line 56 Column D) of Exhibit 18? No 17. Does the total premium value in Cell G-24 of Exhibit 14 equal the value in Cell Q-61 of Exhibit 13c? No 18. Does the overall rate change calculated in Exhibit 13c accurately represent the Company’s expectation of the rate change? Yes

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

Name of the Chief Actuary responsible for this filing:Signature:Date: E-mail Address:Phone Number:

Yes

mailto:[email protected]

Name:

201

HIOS IDs:

94788NY0260065-00

94788NY0260066-00

94788NY0260067-00

94788NY0260068-00

94788NY0260069-00

94788NY0260070-00

94788NY0260071-00

94788NY0260072-00

Issuer HIOS ID:

94788

User Inputs for Plan Parameters

Use Integrated Medical and Drug Deductible?

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

Apply Skilled Nursing Facility Copay per Day?

Use Separate MOOP for Medical and Drug Spending?

Indicate if Plan Meets CSR or Expanded Bronze AV Standard?

Desired Metal Tier

Medical Drug Combined Medical Drug Combined

Deductible ($) $600.00 $0.00

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

MOOP ($)

MOOP if Separate ($)

Click Here for Important Instructions Tier 1 Tier 2

Type of BenefitSubject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical

Emergency Room Services $150.00

All Inpatient Hospital Services (inc. MH/SUD) $1,000.00

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

X-rays)$25.00

Specialist Visit $40.00

Mental/Behavioral Health and Substance Use Disorder Outpatient

Services$25.00

Imaging (CT/PET Scans, MRIs) $40.00

Speech Therapy $30.00

Occupational and Physical Therapy$30.00

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

Laboratory Outpatient and Professional Services $40.00

X-rays and Diagnostic Imaging $40.00

Skilled Nursing Facility $1,000.00

Outpatient Facility Fee (e.g., Ambulatory Surgery Center) $100.00

Outpatient Surgery Physician/Surgical Services $100.00

Drugs

Generics $10.00

Preferred Brand Drugs $35.00

Non-Preferred Brand Drugs $70.00

Specialty Drugs (i.e. high-cost) $70.00

Options for Additional Benefit Design Limits: Plan Description:

Set a Maximum on Specialty Rx Coinsurance Payments? Name: 201

Specialty Rx Coinsurance Maximum: Plan HIOS ID: 94788NY0260065-00

Set a Maximum Number of Days for Charging an IP Copay? Issuer HIOS ID: 94788

# Days (1-10): 2021_1j

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

# Visits (1-10):

Begin Primary Care Deductible/Coinsurance After a Set Number of

Copays?

# Copays (1-10):

Output

Status/Error Messages: Calculation Successful.

Actuarial Value: 81.88%

Metal Tier: Gold

Additional Notes:

Calculation Time: 0.1133 seconds

Final 2021 AV Calculator

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

Copay applies only after

deductible?

HSA/HRA Options Tiered Network Option

Annual Contribution Amount:2nd Tier Utilization:

1st Tier Utilization:

Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design

Tier 1 Tier 2

$4,000.00

Calculate

All

All

All

All

All

All

All

All

All All

All All

Name:

201

HIOS IDs:

94788NY0260065-00

94788NY0260066-00

94788NY0260067-00

94788NY0260068-00

94788NY0260069-00

94788NY0260070-00

94788NY0260071-00

94788NY0260072-00

Issuer HIOS ID:

94788

Name:

224

HIOS IDs:

94788NY0260097-00

94788NY0260098-00

94788NY0260099-00

94788NY0260100-00

94788NY0260101-00

94788NY0260102-00

94788NY0260103-00

94788NY0260104-00

94788NY0260097-01

94788NY0260098-01

94788NY0260099-01

94788NY0260100-01

94788NY0260101-01

94788NY0260102-01

94788NY0260103-01

94788NY0260104-01

Issuer HIOS ID:

94788







Desired Metal Tier


Deductible ($) $0.00 $0.00

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

MOOP ($)




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical


All Inpatient Hospital Services (inc. MH/SUD) $1,500.00


X-rays)$26.17



Services$50.00







Skilled Nursing Facility $1,500.00



Drugs

Generics $0.00








# Days (1-10): 2021_1j


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Gold

Additional Notes:





deductible?





Tier 1 Tier 2

$7,900.00

Calculate

All

All

All

All

All

All

All

All

All All

All All

Name:

224

HIOS IDs:

94788NY0260097-00

94788NY0260098-00

94788NY0260099-00

94788NY0260100-00

94788NY0260101-00

94788NY0260102-00

94788NY0260103-00

94788NY0260104-00

94788NY0260097-01

94788NY0260098-01

94788NY0260099-01

94788NY0260100-01

94788NY0260101-01

94788NY0260102-01

94788NY0260103-01

94788NY0260104-01

Issuer HIOS ID:

94788

Name:

324

HIOS IDs:

94788NY0260081-00

94788NY0260082-00

94788NY0260083-00

94788NY0260084-00

94788NY0260085-00

94788NY0260086-00

94788NY0260087-00

94788NY0260088-00

94788NY0260081-01

94788NY0260082-01

94788NY0260083-01

94788NY0260084-01

94788NY0260085-01

94788NY0260086-01

94788NY0260087-01

94788NY0260088-01

Issuer HIOS ID:

94788







Desired Metal Tier


Deductible ($) $2,200.00

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

MOOP ($) $5,500.00




Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical


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


X-rays)$25.00



Services$25.00







Skilled Nursing Facility $500.00



Drugs

Generics $10.00








# Days (1-10): 2021_1j


# Visits (1-10):


Copays?

# Copays (1-10):

Output



Metal Tier: Silver

Additional Notes:





deductible?





Tier 1 Tier 2

Calculate

All

All

All

All

All

All

All

All

All All

All All

Name:

324

HIOS IDs:

94788NY0260081-00

94788NY0260082-00

94788NY0260083-00

94788NY0260084-00

94788NY0260085-00

94788NY0260086-00

94788NY0260087-00

94788NY0260088-00

94788NY0260081-01

94788NY0260082-01

94788NY0260083-01

94788NY0260084-01

94788NY0260085-01

94788NY0260086-01

94788NY0260087-01

94788NY0260088-01

Issuer HIOS ID:

94788

EXHIBIT 13a: NUMERICAL SUMMARY AND RATE INDICATION CALCULATION

NUMERICAL SUMMARY

CDPHP

95491

SERFF Tracking #: CAPD-132341192

Market Segment: Small Group

1 Please complete the Numerical Summary below as well as the Narrative Summary (a separate attachment) for each market segment for which a rate filing is being submitted.

2 The Narrative Summary must be in plain English and should clearly and simply explain the reasons for the requested rate adjustment (This should be included in the provided blank template "2021 Exhibit 13b - Narrative Summary.docx")

3 The purpose of the Narrative Summary is to provide a written explanation to the company's policyholders to help them understand the reasons why a rate increase is needed.

4 The purpose of the Numerical Summary is to provide a clear and simple overview of the requested rate adjustment.

5 These Summaries (with the exception of the Rate Indication Calculation Section) will be public documents and will be posted on DFS’s website and furnished by DFS to the public upon request.

6 The company should submit these Summaries to DFS ten (10) days before submitting a rate adjustment filing.

7 A draft of these Summaries and of the Initial Notice must be included in a "Prior Approval Pre-filing" submitted to DFS via SERFF.

8 Once reviewed by DFS, these Summaries must be posted to a location on its website that is publicly available and accessible without the need for a user ID/password.

9 Links should be provided on key pages of the company's website so that the information may be easily located.

10 Any change(s) made to the Narrative Summary/Numerical Summary subsequent to the posting must be submitted to DFS with the specific change(s) identified.

11 Rate Change Adjustment calculations between Year 2020 and 2021 should be based on the DFS Membership Survey data as of 3/31/2020.

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

A. Average 2020 and 2021 Premium Rates:

1 Weighted Average Monthly Base Premium Rates are as calculated in Row 32 of the appropriate columns in Exhibit 13c (Columns L-P for 2020 and Columns U-Y for 2021)

2 Premium Rates for 2021 should be Consistent with the Premium Rates reflected in Exhibit 23.

Average Individual Rate Average Individual Rate Average Individual Rate Average Individual Rate Average Individual Rate

Platinum Gold Silver Bronze Catastrophic

2020 Weighted Average Base Premium Rates 550.20$ 489.41$

2021 Weighted Average Base Premium Rates 581.59$ 529.49$

B. Weighted Average Annual Percentage Requested Adjustments:

2020 Weighted Average PMPM Rate 2021 Weighted Average PMPM Rate

2020 to 2021 All - Metals All - Metals

Requested Rate Adjustment 7.38012% 453.19$ 486.64$ From Cells Q-74 and Z-74 of Exhibit 13c

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

2018 to 2019 2019 to 2020

Average Rate Adjustment Requested 6.73173% 4.27071%

Average Rate Adjustment Approved 0.00438% 4.27071%

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

2017 2018 2019

MLR 90.7% 82.0% 89.9%

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

2019 2020 2021

Annual Claim Trend Rates 11.2% 6.0% 6.1%

Expense Ratios 15.4% 11.9% 11.5%

Pre Tax Profit Ratios 1.0% 1.0% 1.0%

* If no products were offered in a particular year, indicate "N/A" in the applicable box.

Company

NAIC Code:

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

Exhibit 13b – Narrative Summary Last Updated: 5/5/2020

EXHIBIT 13b: NARRATIVE SUMMARY

Company Name: CDPHP

NAIC Code: 95491



Capital District Physicians’ Health Plan, Inc. (CDPHP®) offers a health maintenance organization (HMO) on a community-rated basis to small groups. CDPHP has filed a request for approval by the New York State Department of Financial Services for a change to the premium for this product effective January 1, 2021. Policyholders will receive rate adjustments upon their renewal in 2021. The weighted average rate adjustment is 7.4%. 10,977 members and 6,982 policyholders are affected by this request. As a not-for-profit health plan, CDPHP takes seriously its responsibility to control rising health care costs and be a good steward of your premium dollars. However, we continue to battle the rising cost of care, driven primarily by state and federal regulations and taxes, specialty drugs, provider consolidation — and most recently, the harmful impact to our economy and health care system of the COVID-19 pandemic. These factors have resulted in the need to increase insurance premiums. We are working hard to alleviate these cost increases in a variety of ways, such as:

The CDPHP Enhanced Primary Care (EPC) program, a nationally-recognized patient-centered medical home that encourages high-quality, cost-effective services at the primary care level.

Our innovative hospital experience program which connects CDPHP nurses and service staff to assist patients at the bedside, improving members’ experience of care while reducing costs and unnecessary readmissions to hospitals.

Dedicating resources to improving the overall health of our membership.

More convenient access to care through our telemedicine (live video doctor visits) partners, Doctor On Demand and ER Anywhere.

CDPHP Price Check, a cost transparency tool that provides members estimated costs on a range of health care services.

Movement of services to more cost-effective outpatient settings, such as freestanding surgical centers.

Case management and medication therapy management services, available at no out-of-pocket cost.

Mental health and substance use programs, including access to a 24-hour crisis line. The 2021 expected change in medical and pharmacy costs due to trends is +6.1%. Federal Risk Adjustment is a program that requires insurance carriers with low-risk members to pay into a fund that covers high-risk members. As a result of the anticipated payable from this program, the rates have decreased 4.0%. HNY Stop Loss is a reinsurance program offered by New York state that limits the plan’s liability for claims which exceed a certain threshold. As a result of the anticipated receivable from this program, the rates are impacted +0.5%.

Exhibit 13b – Narrative Summary Last Updated: 5/5/2020

Federal ACA fees were removed for 2021 and will have a favorable impact of 1.0%. CDPHP is required by New York state insurance law to meet a minimum medical loss ratio

(MLR) standard of 82%. This means that 82% of premiums must be used to cover health care

costs. CDPHP will exceed this minimum requirement in 2021 with an MLR of 87.5%.

EXHIBIT 13C - AVERAGE PREMIUM DETAILS

Company Name: CDPHP

NAIC Code: 95491



1 Please complete all of the shaded boxes in rows 24-47 below. The goal of this Exhibit is to calculate the rate change being requested in a consistent manner for all insurers.

2 The "Weighted Average Monthly Base Premiums" in cells C24-G31 should be calculated as a weighted average of the insurer's base premiums (i.e., single adult rates prior to application of tier factors, etc.) using the number of plan subscribers as the weights.

3 Cells L24 - P31, should be a recalculation of cells C24-G31 where any plans (and associated members enrolled in those plans as of 3/31/2020) that will no longer be offered in 2021 are removed.

4 The sum of cells C37-G44 should be equal to the Company's total membership for the relevant market as of 3/31/2020.

5 Cells L37-P44 should be equal to cells C37-G44 less any members that are enrolled in plans that will no longer be offered in 2021.

6 If the Company is not eliminating any plans in 2021, then cells C24-G31 and L24-P31 should be the same, as should cells C37-G44 and L37-P44.

7 The "Conversion Factors" should be the factors that were developed in pricing to convert the "Weighted Average Monthly Base Premiums" to "Weighted Average Monthly PMPM Premium Rates". These factors should be adjusted as necessary to reflect any changes that are not reflected in the Base Premiums.

8 The value in cell Q74 of this Exhibit should match cell D98 (Line 54) of Exhibit 18.

9 The value in cell Z74 of this Exhibit should match cell D104 (Line 56) of Exhibit 18.

2020 Weighted Average Monthly Base Premiums - CALCULATED BASED ON ACTUAL DISTRIBUTION AS OF 3/31/2020 (Weighted by number 2020 Weighted Average Monthly Base Premiums - RE-CALCULATED USING ONLY THE SUBSET OF 2020 PLANS THAT WILL STILL

of subscribers) BE AVAILABLE IN 2021 (weighted by subscribers in those specific plans)

Average Monthly Base Premium assuming 3/31/2020 membership Average Monthly Base Premium paid assuming 3/31/2020 membership and all policies are paid in full for the entire year)

Region Platinum Gold Silver Bronze Catastrophic All Metals Region Platinum Gold Silver Bronze Catastrophic All Metals

1 - Albany Area 0 550 485 0 0 516.73 1 - Albany Area 0 544 485 0 0 510.39

2 -Buffalo Area 0 0 0 0 0 2 -Buffalo Area 0 0 0 0 0

3- Mid-Hudson Area 0 740 697 0 0 723.97 3- Mid-Hudson Area 0 721 697 0 0 710.17

4- NYC Area 0 0 0 0 0 4- NYC Area 0 0 0 0 0

5- Rochester Area 0 0 0 0 0 5- Rochester Area 0 0 0 0 0

6- Syracuse Area 0 0 0 6- Syracuse Area 0 0 0

7- Utica/Watertown Area 0 642 539 0 0 584.99 7- Utica/Watertown Area 0 642 539 0 0 580.23

8- Long Island Area 8- Long Island Area

9 - All Regions 556.36 489.41 522.52 9 - All Regions 550.20 489.41 515.69 To Exhibit 13a (Section A)

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


1 - Albany Area - 5,875 6,085 - - 11,960 1 - Albany Area - 4,578 6,085 - - 10,663

2 -Buffalo Area - - - - - 2 -Buffalo Area - - - - -

3- Mid-Hudson Area - 206 126 - - 332 3- Mid-Hudson Area - 153 126 - - 279

4- NYC Area - - - - - 4- NYC Area - - - - -

5- Rochester Area - - - - - 5- Rochester Area - - - - -

6- Syracuse Area - - - - 6- Syracuse Area - - - -

7- Utica/Watertown Area - 17 21 - - 38 7- Utica/Watertown Area - 14 21 - - 35

8- Long Island Area - - - - - 8- Long Island Area

9 - All Regions 6,098 6,232 12,330 9 - All Regions 4,745 6,232 10,977 Should equal Cell H-24 of Exhibit 14

2020 Conversion Factor - A 0.8788 Must be less than or equal to 1.000 2020 Conversion Factor - B 0.8788 Must be less than or equal to 1.000

2020 Estimated Aggregate Annualized Premium by Metal and Region - based on membership as of 3/31/2020 2020 Estimated Aggregate Annualized Premium by Metal and Region - based on membership as of 3/31/2020

Aggregate premium that would be collected assuming 3/31/2020 membership and all policies are paid in full for the entire year) Aggregate premium that would be collected assuming 3/31/2020 membership and all policies are paid in full for the entire year) - Adjusted for plan eliminations


1 - Albany Area - 34,054,414 31,118,394 - - 65,172,808 1 - Albany Area - 26,273,916 31,118,394 - - 57,392,310

2 -Buffalo Area - - - - - - 2 -Buffalo Area - - - - - -

3- Mid-Hudson Area - 1,608,145 926,591 - - 2,534,736 3- Mid-Hudson Area - 1,162,880 926,591 - - 2,089,471

4- NYC Area - - - - - - 4- NYC Area - - - - - -

5- Rochester Area - - - - - - 5- Rochester Area - - - - - -

6- Syracuse Area - - - 6- Syracuse Area - - -

7- Utica/Watertown Area - 115,090 119,334 - - 234,424 7- Utica/Watertown Area - 94,827 119,334 - - 214,161


9 - All Regions - 35,777,649 32,164,319 - - 67,941,968 9 - All Regions - 27,531,622 32,164,319 - - 59,695,942 Should equal Cell G-24 of Exhibit 14

2020 Weighted Average Monthly PMPM Premium Rates 2020 Weighted Average Monthly PMPM Premium Rates - Reflecting adjustment for eliminated plans


1 - Albany Area 483.04 426.16 454.10 1 - Albany Area 478.26 426.16 448.53

2 -Buffalo Area 2 -Buffalo Area

3- Mid-Hudson Area 650.54 612.82 636.23 3- Mid-Hudson Area 633.38 612.82 624.10

4- NYC Area 4- NYC Area

5- Rochester Area 5- Rochester Area

6- Syracuse Area 6- Syracuse Area

7- Utica/Watertown Area 564.17 473.55 514.09 7- Utica/Watertown Area 564.44 473.55 509.91


9 - All Regions 488.93 430.10 459.19 9 - All Regions 483.52 430.10 453.19 To Exhibit 13a (Section B)

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

2021 Weighted Average Monthly Proposed Base Premiums - THESE BASE PREMIUMS SHOULD BE CALCULATED USING THE SAME Change in Weighted Average Monthly Base Premiums

POPULATION OF SUBSCRIBERS THAT WAS USED TO CALCULATE CELLS L22 - P29)

Average Base Premium paid assuming 3/31/2020 membership and all policies are paid in full for the entire year) Average Base Premium paid assuming 3/31/2020 membership and all policies are paid in full for the entire year)


1 - Albany Area 0.00 577.38 526.07 0.00 0.00 548.10 1 - Albany Area 6.09% 8.48% 7.39%

2 -Buffalo Area 0.00 0.00 0.00 0.00 0.00 2 -Buffalo Area

3- Mid-Hudson Area 0.00 698.88 685.25 0.00 0.00 692.72 3- Mid-Hudson Area -3.03% -1.73% -2.46%

4- NYC Area 0.00 0.00 0.00 0.00 0.00 4- NYC Area

5- Rochester Area 0.00 0.00 0.00 0.00 0.00 5- Rochester Area

6- Syracuse Area 0.00 0.00 0.00 6- Syracuse Area

7- Utica/Watertown Area 0.00 675.81 586.99 0.00 0.00 622.52 7- Utica/Watertown Area 5.22% 8.93% 7.29%


9 - All Regions 581.59 529.49 552.01 To Exhibit 13a (Section A) 9 - All Regions 5.70% 8.19% 7.04%

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


1 - Albany Area 4,578 6,085 10,663 1 - Albany Area -22.08% 0.00% -10.84%


3- Mid-Hudson Area 153 126 279 3- Mid-Hudson Area -25.73% 0.00% -15.96%




7- Utica/Watertown Area 14 21 35 7- Utica/Watertown Area -17.65% 0.00% -7.89%


Should equal Cell H-24 of Exhibit 14 9 - All Regions 4,745 6,232 10,977 9 - All Regions -22.19% 0.00% -10.97%

2021 Conversion Factor 0.8816 Must be less than or equal to 1.000 Change in Conversion Factor 0.31497%

2021 Estimated Aggregate Annualized Premium by Metal and Region - based on membership as of 3/31/2020 Change in Aggregate Annualized Premiums - based on membership as of 3/31/2020 (Ignoring any plan eliminations)

Aggregate premium that would be collected assuming 3/31/2020 membership and all policies are paid in full for the entire year) - Adjusted for plan eliminations


1 - Albany Area 27,962,414 33,864,094 61,826,508 1 - Albany Area -17.89% 8.82% -5.13%


3- Mid-Hudson Area 1,131,178 913,395 2,044,573 3- Mid-Hudson Area -29.66% -1.42% -19.34%




7- Utica/Watertown Area 100,090 130,404 230,494 7- Utica/Watertown Area -13.03% 9.28% -1.68%


Should equal Cell G-24 of Exhibit 14 9 - All Regions 29,193,682 34,907,892 64,101,575 9 - All Regions -18.40% 8.53% -5.65%

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


1 - Albany Area 509.00 463.76 483.19 1 - Albany Area 6.43% 8.82% 7.73%


3- Mid-Hudson Area 616.11 604.10 610.68 3- Mid-Hudson Area -2.73% -1.42% -2.15%




7- Utica/Watertown Area 595.77 517.48 548.80 7- Utica/Watertown Area 5.55% 9.28% 7.63%


9 - All Regions 512.71 466.78 486.64 To Exhibit 13a (Section B) Total 6.04% 8.53% 7.38%

Exhibit 13c Updated by DFS 3/20/2020 2

EXHIBIT 13C - SUPPLEMENT - DISTRIBUTION BY RATING TIERS

Company Name: CDPHP

NAIC Code: 95491



1 Please complete all of the shaded boxes in rows 28-52 below. The goal of this Exhibit is to provide insight with regard to how the Company's distribution of business by rating tier compares with the assumptions included in the required DFS Rating Tier Factors.

2 The "2020 Weighted Average Monthly Tier Premiums by Metal level" in cells C28-G32 should be calculated as a weighted average of the actual premiums the insurer charges its subscribers (i.e., single adult rates with the tier factor included) using the Company's

actual number of subscribers as of 3/31/2020. FORMULA: For each Metal Level and Rating Tier = (SUM [Monthly premium charged for each Subscriber]) / (Total Number of Subscribers)

3 Cells L28 - P32, should be a recalculation of cells C28-G32 where any plans (and associated members enrolled in those plans as of 3/31/2020) that will no longer be offered in 2021 are removed.

4 Cells T28 - Y32, should be a recalculation of cells L28-P32 where the 2020 Subscriber premiums are replaced with the Proposed 2021 Subscriber Premiums (This calculation should also exclude any members currently in plans that will no longer be offered in 2021).

5 The sum of cells C38-G42 should be equal to the Company's total number of subscribers for the relevant market as of 3/31/2020.

6 Cells L38-P42 should be equal to cells C38-G42 less any subscribers that are enrolled in plans that will no longer be offered in 2021.

7 The sum of cells C48-G52 should be equal to the Company's total number of members for the relevant market as of 3/31/2020.

8 Cells L48-P52 should be equal to cells C48-G52 less any members that are enrolled in plans that will no longer be offered in 2021.

9 If the Company is not eliminating any plans in 2021, then cells C28-G32 and L28-P32 should be the same, as should cells C38-G42 and L38-P42, as well as cells C48-G52 and L48-P52.

DFS RATING TIERS

Single 1.0000

Two Adults 2.0000

Adult + Child(ren) 1.7000

Family 2.8500

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

Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals

Single Adult 560.18 496.48 529.36 Single Adult 553.01 496.48 522.34

2 Adults 1,119.15 989.27 1,055.29 2 Adults 1,108.53 989.27 1,043.25

Adult plus Child(ren) 951.24 837.66 897.21 Adult plus Child(ren) 936.91 837.66 883.59

Family 1,582.71 1,403.06 1,483.80 Family 1,549.30 1,403.06 1,458.31

Child Only Child Only

All Rating Tiers 767.01 704.49 736.19 All Rating Tiers 751.26 704.49 725.40

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


Single Adult - 2,819 2,642 - - 5,461 Single Adult - 2,228 2,642 - - 4,870

2 Adults - 520 503 - - 1,023 2 Adults - 416 503 - - 919

Adult plus Child(ren) - 183 166 - - 349 Adult plus Child(ren) - 143 166 - - 309

Family - 449 550 - - 999 Family - 334 550 - - 884

Child Only - - - - - Child Only - - - - -

All Rating Tiers 3,971 3,861 7,832 All Rating Tiers 3,121 3,861 6,982

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


Single Adult - 2,819 2,642 - - 5,461 Single Adult - 2,228 2,642 - - 4,870

2 Adults - 1,040 1,006 - - 2,046 2 Adults - 832 1,006 - - 1,838

Adult plus Child(ren) - 479 408 - - 887 Adult plus Child(ren) - 376 408 - - 784

Family - 1,760 2,176 - - 3,936 Family - 1,309 2,176 - - 3,485

Child Only - - - - - Child Only - - - - -

All Rating Tiers 6,098 6,232 12,330 All Rating Tiers 4,745 6,232 10,977

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



2 Adults 2.0000 2.0000 2.0000 2 Adults 2.0000 2.0000 2.0000


Family 3.9198 3.9564 3.9399 Family 3.9192 3.9564 3.9423


Wghtd Avg - All Rating Tiers 1.5356 1.6141 1.5743 Wghtd Avg - All Rating Tiers 1.5203 1.6141 1.5722

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


Single Adult 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 Single Adult 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

2 Adults 2.0000 2.0000 2.0000 2.0000 2.0000 2.0000 2 Adults 2.0000 2.0000 2.0000 2.0000 2.0000 2.0000

Adult plus Child(ren) 1.7000 1.7000 1.7000 1.7000 1.7000 1.7000 Adult plus Child(ren) 1.7000 1.7000 1.7000 1.7000 1.7000 1.7000

Family 2.8500 2.8500 2.8500 2.8500 2.8500 2.8500 Family 2.8500 2.8500 2.8500 2.8500 2.8500 2.8500

Child Only 0.4120 0.4120 0.4120 0.4120 0.4120 0.4120 Child Only 0.4120 0.4120 0.4120 0.4120 0.4120 0.4120

Wghtd Avg - All Rating Tiers 1.3724 1.4239 1.3978 Wghtd Avg - All Rating Tiers 1.3633 1.4239 1.3968

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



2 Adults 1.0000 1.0000 1.0000 2 Adults 1.0000 1.0000 1.0000


Family 1.3754 1.3882 1.3824 Family 1.3751 1.3882 1.3833


Ratio (Expected/Actual) 1.1190 1.1336 1.1263 Ratio (Expected/Actual) 1.1152 1.1336 1.1255

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

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


Single Adult 585.06 541.29 561.31 Single Adult 5.80% 9.02% 7.46%

2 Adults 1,173.31 1,079.98 1,122.23 2 Adults 5.84% 9.17% 7.57%

Adult plus Child(ren) 993.08 915.36 951.33 Adult plus Child(ren) 5.99% 9.28% 7.67%

Family 1,643.69 1,533.68 1,575.25 Family 6.09% 9.31% 8.02%


All Rating Tiers 795.45 768.92 780.78 All Rating Tiers 5.88% 9.15% 7.63%

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

Rating Tier Platinum Gold Silver Bronze Catastrophic All Metals

Single Adult -20.96% 0.00% -10.82%

2 Adults -20.00% 0.00% -10.17%

Adult plus Child(ren) -21.86% 0.00% -11.46%

Family -25.61% 0.00% -11.51%

Child Only

All Rating Tiers -21.41% 0.00% -10.85%

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


Single Adult -20.96% 0.00% -10.82%

2 Adults -20.00% 0.00% -10.17%

Adult plus Child(ren) -21.50% 0.00% -11.61%

Family -25.63% 0.00% -11.46%

Child Only

All Rating Tiers -22.19% 0.00% -10.97%

Change in Actual Members Per Policy


Single Adult 0.00% 0.00% 0.00%

2 Adults 0.00% 0.00% 0.00%

Adult plus Child(ren) 0.45% 0.00% -0.17%

Family -0.02% 0.00% 0.06%

Child Only

Wghtd Avg - All Rating Tiers -1.00% 0.00% -0.13%

Change in Weighted Average Implied Tier Factors


Single Adult 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

2 Adults 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

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

Family 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

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

Wghtd Avg - All Rating Tiers -0.66% 0.00% -0.07%

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


Single Adult 0.00% 0.00% 0.00%

2 Adults 0.00% 0.00% 0.00%

Adult plus Child(ren) 0.45% 0.00% -0.17%

Family -0.02% 0.00% 0.06%

Child Only

Ratio (Expected/Actual) -0.34% 0.00% -0.07%

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

Company Name: CDPHP

NAIC Code: 95491 NOTE: THIS EXHIBIT SHOULD NOT INCLUDE MEMBERS OR SUBSCRIBERS THAT ARE CURRENTLY ENROLLED IN PLANS THAT WILL NOT BE AVAILABLE IN 2021



1

2

3

4

5

6

7

8

9

10

11

12

13 The Total Annualized Premium in Cell G-24 of this Exhibit should equal the total in Cell Q-61 of Exhibit 13c.

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

Totals $60,055,792 10,977 6,982

Annualized Premiums

as of Total # of Members as of Total # of Subscribers as of

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

Small Group 01/01/21 Gold 1 - Albany Area HMO HMO $24,320,337 4,210 2,716 0 0 0 4,210 0 0 0 0 0 0 0 5.19% 7.76% 6.15%

Small Group 04/01/21 Gold 1 - Albany Area HMO HMO $831,666 160 110 0 0 0 160 0 0 0 0 0 0 0 7.43% 7.71% 7.68%



Small Group 01/01/21 Silver 1 - Albany Area HMO HMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Gold 3 - Mid-Hudson Area HMO HMO $569,055 73 56 73 0 0 0 0 0 0 0 0 0 0 -3.63% -1.79% -2.50%




Small Group 01/01/21 Silver 3 - Mid-Hudson Area HMO HMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Gold 6 - Syracuse Area HMO HMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Silver 6 - Syracuse Area HMO HMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Gold 7 - Utica/Watertown Area HMO HMO $89,187 13 11 0 0 0 13 0 0 0 0 0 0 0 5.20% 5.20% 5.20%

Small Group 04/01/21 Gold 7 - Utica/Watertown Area HMO HMO $5,814 1 1 0 0 0 1 0 0 0 0 0 0 0 7.32% 7.32% 7.32%

Small Group 07/01/21 Gold 7 - Utica/Watertown Area HMO HMO 0 0 0 0 0 0 0 0 0 0 0 0 0

Small Group 10/01/21 Gold 7 - Utica/Watertown Area HMO HMO 0 0 0 0 0 0 0 0 0 0 0 0 0

Small Group 01/01/21 Silver 7 - Utica/Watertown Area HMO HMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Gold 1 - Albany Area HDHMO HDHMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Silver 1 - Albany Area HDHMO HDHMO $15,654,452 3,088 1,974 0 0 0 3,088 0 0 0 0 0 0 0 9.14% 9.43% 9.43%

Small Group 04/01/21 Silver 1 - Albany Area HDHMO HDHMO $4,351,288 842 459 0 0 0 842 0 0 0 0 0 0 0 9.10% 9.39% 9.31%

Small Group 07/01/21 Silver 1 - Albany Area HDHMO HDHMO $4,559,688 867 530 0 0 0 867 0 0 0 0 0 0 0 9.05% 9.34% 9.29%

Small Group 10/01/21 Silver 1 - Albany Area HDHMO HDHMO $6,892,986 1,288 783 0 0 0 1,288 0 0 0 0 0 0 0 9.00% 9.29% 9.28%

Small Group 01/01/21 Gold 3 - Mid-Hudson Area HDHMO HDHMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Silver 3 - Mid-Hudson Area HDHMO HDHMO $130,396 18 17 18 0 0 0 0 0 0 0 0 0 0 -0.25% -0.25% -0.25%




Small Group 01/01/21 Gold 6 - Syracuse Area HDHMO HDHMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Silver 6 - Syracuse Area HDHMO HDHMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Gold 7 - Utica/Watertown Area HDHMO HDHMO 0 0 0 0 0 0 0 0 0 0 0 0 0




Small Group 01/01/21 Silver 7 - Utica/Watertown Area HDHMO HDHMO $119,338 21 16 0 0 0 21 0 0 0 0 0 0 0 8.75% 9.04% 8.93%

Small Group 04/01/21 Silver 7 - Utica/Watertown Area HDHMO HDHMO 0 0 0 0 0 0 0 0 0 0 0 0 0



Small Group

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

EXHIBIT 14: SUMMARY OF REQUESTED PERCENTAGE CHANGES

Use this Exhibit for both Individual and Small Group Market Plans. A separate Exhibit should be provided for Individual and Small Group filings.

Market segment refers to Individual (which includes Catastrophic) or Small Group.

The requested percentage rate change reflects the expected change in premium rates that would apply to the contract holder (or member for Small Group business) on that contract holder's next rate change date for each contract holder within the indicated combination of metal level, rating region, and product name.

The "Product Street Name" is the product name as advertised to consumers (i.e., as consumers are likely to refer to this product/metal level when communicating with DFS). A separate row is to be used for each combination of metal level, rating region and product name.

If the percentage changes (lowest and highest and weighted average) are identical for all the rating regions, then separate rows by rating region need not be used, and "All Regions" can be shown in the Rating Region column. If the rate change range information differs by rating region, then separate rows need to be used for each rating region the

insurer uses. Rating region names used on this exhibit are to use the standard rating region names developed by DFS (e.g., Albany Area, Buffalo Area, etc.).

The "requested rate change" includes the impact of any riders (such as: age 29, domestic partner, family planning, pediatric dental, etc.).

"Lowest" should be the smallest percentage change that could affect any contract holder due to the submitted rate filing with that metal level and rating region, including any applicable riders.

"Highest" should be the largest percentage change that could affect any contract holder due to the submitted rate filing with that metal level and rating region, including any applicable riders.

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

Requested Percentage Rate Change

Percentage Rate Changes should be calculated using membership as of 3/31/2020.

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

Market Segment Effective Date of New Rate

Metal Level

(or Catastrophic) Rating Region Product Name Product Street Name

DISTRIBUTION OF MEMBERS - Number of Members with Requested Percentage Rate Change at Renewal

Exhibit 14 Updated by DFS 3/20/2020 1

Company Name: CDPHP

NAIC Code: 95491

SERFF Number: CAPD-132341192


Instructions:

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

2)

3)

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

5)

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

Product Name (including Street

Name)

Brief Description of Benefit/Rate

Change Approval Date

Pending CAPD-132346843 5/18/2020 HMO, HDHMO

2021 Exchange Medical Forms-

On Exchange

Pending CAPD-132346845 5/18/2020 HMO, HDHMO

2021 Exchange Medical Forms-

Off Exchange

EXHIBIT 16: SUMMARY OF POLICY FORM AND PRODUCT CHANGES

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

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

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

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


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

Company Name:

NAIC Code:

SERFF Number:

Market Segment:

1 Complete a separate ROW for each relevant policy form as indicated below.

• Information requested applies to New York State business only for each rating region and all regions combined.

• Include riders that may be available with that policy form in each policy form response. Discontinued policy forms and products are to be included in the Exhibit.

• Complete additional rows as needed to include all base medical policy forms that were offered in the applicable market segment.

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

Market Description

Market Segment (Entry for

Exhibit 17, Column 4)

Group

Definition Counting Method Notes Standardized Premium Scale

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

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

Small Group

Experience of ACA Compliant Small Group Plans

(Excluding Healthy New York plans) that were

written or renewed on or after 1/1/2017 SG-ACA-FTE 1-100

Current New York

(FTE)

All relevant experience in

the calendar year

4th Quarter 2020 for rolling;

2020 for non-rolling

Small Group - HNY

Experience of Small Group Healthy New York Plans

that were written or renewed on or after 1/1/2017 SG-ACA-HNY-FTE 1-50

Current New York

(FTE)

All relevant experience in

the calendar year

4th Quarter 2020 for rolling;

2020 for non-rolling

3 Product type is HMO, HMO based POS, POS-OON, EPO, PPO, Comprehensive Major Medical, Non-HMO based POS, and Consumer Health Plans. Indicate appropriate designation for policy form, etc.

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

5 Paid claims in Columns 14.6 - 14.7 and 15.6 - 15.7 are all claims paid during experience period that are attributed to the calendar year in question.

6 If members, covered lives or member months are not known, use reasonable estimates (note methodology used in the actuarial memorandum).

7 This exhibit must be submitted as an Excel file and as a PDF file. Only use the first tab for data entry.

8 These categories should be mutually exclusive (i.e., the sum of the values in a particular column should represent the total for the entire legal entity.

9 With regard to Small Group, the experience reported in this Exhibit should include only business that was considered "Small Group" according to the applicable rules at the time the underlying policies were in-force.

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

CDPHP

95491

CAPD-132341192

Small Group

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

1.a Company Name

1.b

NAIC

Code 1.c SERFF Number

1d.

Base medical

policy form

number

1e.

Product Name

(per Rate

Manual)

1f.

Product

Street Name

as indicated

to consumers

2.

Filing Type

3.

Effective date of

last rate change

4.

Market Segment

5A.

Rating Region

5B.

Product Type (see "Instructions"

tab for examples)

6.

Is a rolling

rate

structure

used for this

base

medical

policy form?

(Yes or No)

7.

Is base medical

policy form open

(new sales

allowed) or closed

(no new sales)

8.

Number of

policyholders

affected by rate

change. (For

group business

this is number

of groups.)

9.

Number of

covered lives

affected by rate

change

CDPHP 95491 CAPD-132341192 01-0006-2021 HMO Small HNY HMO 1/1/2020 SG-ACA-HNY-FTE 1 - Albany Area HMO Yes New sales allowed 351 1,823

CDPHP 95491 CAPD-132341192 01-0006-2021 HMO Small HNY HMO 1/1/2020 SG-ACA-HNY-FTE 3 - Mid-Hudson Area HMO Yes New sales allowed 29 128

CDPHP 95491 CAPD-132341192 01-0006-2021 HMO Small HNY HMO 1/1/2020 SG-ACA-HNY-FTE 6 - Syracuse Area HMO Yes New sales allowed

CDPHP 95491 CAPD-132341192 01-0006-2021 HMO Small HNY HMO 1/1/2020 SG-ACA-HNY-FTE 7 - Utica/Watertown Area HMO Yes New sales allowed 1 1

CDPHP 95491 CAPD-132341192 01-0006-2021 HMO Small HMO HMO 1/1/2020 SG-ACA-FTE 1 - Albany Area HMO Yes New sales allowed 1,184 10,137

CDPHP 95491 CAPD-132341192 01-0006-2021 HMO Small HMO HMO 1/1/2020 SG-ACA-FTE 3 - Mid-Hudson Area HMO Yes New sales allowed 41 204

CDPHP 95491 CAPD-132341192 01-0006-2021 HMO Small HMO HMO 1/1/2020 SG-ACA-FTE 6 - Syracuse Area HMO Yes New sales allowed - -

CDPHP 95491 CAPD-132341192 01-0006-2021 HMO Small HMO HMO 1/1/2020 SG-ACA-FTE 7 - Utica/Watertown Area HMO Yes New sales allowed 7 37

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

CDPHP 95491 CAPD-132341192

Data Item for Specified Base Medical Policy Form


14.1

Beginning Date

of the

experience

period

(mm/dd/yyyy)

14.2

Ending Date of

the experience

period

(mm/dd/yyyy)

14.3

Member months for

experience period

14.4

Earned premiums for

experience period ($)

14.5

Standardized earned

premiums for experience

period ($)

14.6 Claims Paid

in calendar year 2019 on

claims incurred during

calendar year 2019 -

before any adjustment for

federal risk adjustment,

federal reinsurance, risk

corridors, state stop-loss

pools, or commercial

stop-loss payments ($)

14.6a Claims Paid in

calendar year 2020

(during the months of

January and February

only) on claims incurred

during calendar year

2019 - before any

adjustment for federal

risk adjustment, federal

reinsurance, risk




14.6b Estimated

claims remaining to be

paid in the future on


2019 - before any



reinsurance, risk




14.6c Rx Rebates

associated with claims

reported in Columns 14.6

and 14.6a (enter as a

positive value) ($)

14.6d Estimated Rx

Rebates associated with

claims reported in

Column 14.6b or not

otherwise included in

14.6c (enter as a positive

value) ($)

14.7 Total

Incurred Claims for

calendar year 2019 Net of

Rx Rebates ($)

14.8

Adjustment to the

incurred claims for the

period due to receipts

from state or federal

reinsurance or stop loss

pools (enter receipts from

the pool as a negative

value) ($)

14.9

Adjustment to the



from or payments to the

federal risk adjustment

pool (enter receipts as a

negative value and

payments to the pool as a

positive value) ($)

14.10

Administrative expenses

for experience period

(including commissions

and premium taxes, but

excluding federal and

state income taxes) ($)

1/1/2019 12/31/2019 21485.00 8,525,902 9,216,500 8,482,638 486,439 41,239 627,273 0 $ 8,383,043.31 $ (1,511,849) $ 1,876,527 $ 932,390

1/1/2019 12/31/2019 1359.00 834,119 901,683 483,690 98,457 8,347 39,677 0 $ 550,817.51 $ (106,964) $ 369,256 $ 58,977

1/1/2019 12/31/2019 0.00 0 0 0 0 0 0 $ - $ - $ - $ -

1/1/2019 12/31/2019 32.00 17,780 19,220 2,165 0 0 934 0 $ 1,230.78 $ - $ 13,762 $ 1,389

1/1/2019 12/31/2019 69441.00 29,910,503 32,333,253 19,259,853 2,071,898 130,068 1,564,266 0 $ 19,897,553.85 $ 6,276,191 $ 3,524,668

1/1/2019 12/31/2019 984.00 612,240 661,832 342,020 157,360 14,347 22,201 0 $ 491,525.93 $ 284,316 $ 50,025

1/1/2019 12/31/2019 6.00 3,388 3,662 315 0 0 135 $ 179.51 $ 2,516 $ 305

1/1/2019 12/31/2019 23.00 13,143 14,208 6,049 0 0 519 $ 5,529.61 $ 8,388 $ 1,169

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

2019 Experience Period

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


15.1

Beginning date of the

experience period

(mm/dd/yyyy)

15.2

Ending Date of the

experience period

(mm/dd/yyyy)

15.3

Member months for

experience period

15.4

Earned premiums for

experience period ($)

15.5

Standardized earned

premiums for experience

period ($)

15.6 Claims Paid

in calendar year 2018 on


calendar year 2018 -

before any adjustment for

federal risk adjustment,

federal reinsurance, risk




15.6a Claims Paid in

calendar year 2019

(during the months of

January and February

only) on claims incurred

during calendar year

2018 - before any



reinsurance, risk




15.6b All other claim

amounts associated with


the 2018 calendar year

that are not included in

15.6 and 15.6a (i.e.,

Payments through

February of 2020 plus

any remaining IBNR


that were incurred during

2018) - before any



reinsurance, risk




15.6c Rx Rebates


reported in Columns 15.6

and 15.6a (enter as a

positive value) ($)

15.6d Estimated Rx

Rebates associated with

claims reported in

Column 15.6b or not

otherwise included in

15.6c (enter as a positive

value) ($)

15.7 Total

Incurred claims for

calendar year 2018 Net of

Rx Rebates ($)

15.8

Adjustment to the



from state or federal

reinsurance or stop loss

pools (enter receipts from

the pool as a negative

value) ($)

15.9

Adjustment to the



from or payments to the

federal risk adjustment

pool (enter receipts as a

negative value and

payments to the pool as a

positive value) ($)

15.10

Administrative expenses

for experience period

(including commissions

and premium taxes, but

excluding federal and

state income taxes) ($)

1/1/2018 12/31/2018 20,956 $ 8,449,060 $ 9,791,041 $ 6,420,441 $ 436,061 $ 106,672 $ 444,375 $ - $ 6,518,798.54 $ (1,080,914) $ 2,274,693 $ 1,079,547

1/1/2018 12/31/2018 1,854 $ 1,011,999 $ 1,172,736 $ 604,763 $ 19,487 $ 1,310 $ 39,314 $ - $ 586,245.53 $ (137,062) $ 393,630 $ 95,495

1/1/2018 12/31/2018 0 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

1/1/2018 12/31/2018 69 $ 36,586 $ 42,397 $ 5,291 $ 722 $ - $ 1,463 $ - $ 4,549.58 $ - $ (3,030) $ 3,554

1/1/2018 12/31/2018 30,866 $ 12,726,252 $ 14,747,588 $ 7,372,360 $ 928,941 $ 135,791 $ 419,396 $ 8,017,696.53 $ 3,034,620 $ 1,513,079

1/1/2018 12/31/2018 232 $ 142,048 $ 164,609 $ 78,018 $ 12,991 $ 289 $ 3,152 $ 88,145.80 $ 44,259 $ 11,371

1/1/2018 12/31/2018 0 $ - $ - $ - $ - $ - $ - $ - $ - $ -

1/1/2018 12/31/2018 0 $ - $ - $ - $ - $ - $ - $ - $ - $ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

2018 Experience Period

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


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

Company Name: CDPHP

NAIC Code: 95491


Market Segment : Small Group

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

Line # General***

1 Product*

2 Product ID*

3 Metal Level (or catastrophic)*

4 AV Metal Value (HHS Calculator)*

5 AV Pricing Value (total, risk pool experience based)*

6 Plan Type*

7 Plan Name*

8 HIOS Plan ID (14 Digits)*

9 Exchange Plan?*

9A 2021 Plan Status (as compared to 2020)

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

Experience Period Index Rate

10 Earned Premiums for Latest Experience Period #

10A Incurred Claims for Latest Experience Period #

10B Member-Months for Latest Experience Period #

10C Average PMPM Incurred Claims [(10A)/(10B)] = (Initial Index PMPM)

11 Average Pricing Actuarial Value reflected in experience period

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

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

Market Wide Adjustments to the AV Adjusted Experience Period Index Rate

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

14 Market wide adjustment for changes in provider network **

15 Market wide adjustment for fee schedule changes **

16 Market wide adjustment for utilization management changes **

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

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

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

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

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

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

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

23b

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

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

pricing. **

23c

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

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

24 Other 1 (specify)




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

** Not Included in Claim Trend Adjustment


Plan Level Adjustments

29 Index Rate - After Marketwide Adjustments

30 Pricing actuarial value (without induced demand factor) #

31 Pricing actuarial value (only the induced demand factor) #

32 Impact of provider network characteristics ##

33 Impact of delivery system characteristics ##

34 Impact of utilization management practices ##

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

36 Benefits in additional to EHB (greater than 1.00)

37 Impact of eligibility categories (catastrophic plans only)

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

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

40 Impact of Age 26 / Age 29

41 Impact of Family Planning / No Family Planning

42 Impact of Dental vs No Dental

43 Premium Curve Adjustment

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

45 Rating Region Factor

46a Other 1 (specify)

46b Other 2 (specify)

46c Other 3 (specify)

46d Other 4 (specify)

47 Impact of Plan Wide Adjustments (= Weighted Average Factor using Line 55a)

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

## Beyond what is reflected in Market Wide adjustments

48a Adjusted Incurred Claims (Excluding Admin Expense and Profit)

Expenses

49 Plan Expected Costs

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

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

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

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

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

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

2020 Premium Rates and Membership

54 2020 PMPM Rates (First Quarter 2020 rates for Small Group)***

55 2020 Members as of 3/31/2020 (The total should tie to the 3/31/2020 Membership Survey Total)

55a 2020 Members as of 3/31/2020 - Only those enrolled in plans that will still be available in 2021

Calculation of Final 2021 Rates

56 TOTAL PROJECTED INDEX RATE PMPM (= [(L49 + L50) / (1 - L51 - L52)])

57 Percent Change in Premium Rates (= L56 / L54)

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

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

Overall Average Impact: 7.37%


ACA Compliant Plans

Only Plan 1 Plan 2 Plan 3 Plan 4 Plan 5

XXXXXXX 94788NY 94788NY 94788NY 94788NY 94788NY

XXXXXXX 94788NY026 94788NY026 94788NY026 94788NY026 94788NY026

XXXXXXX Gold Gold Gold Gold Gold

XXXXXXX 0.81880 0.81880 0.81880 0.81880 0.81880

XXXXXXX 1.40807 1.40807 1.40807 1.40807 1.40807

XXXXXXX HMO HMO HMO HMO HMO

XXXXXXX SHGFHN58 SHGFHN59 SHGFHN60 SHGFHN61 SHGFHN62

XXXXXXX 94788NY0260065 94788NY0260066 94788NY0260067 94788NY0260068 94788NY0260069

XXXXXXX Off Off Off Off Off

XXXXXXX No Change No Change No Change No Change No Change

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

Plan 1 Plan 2 Plan 3 Plan 4 Plan 5

39,917,074.63 1,071,270.06 252,889.63 0.00 7,600,639.30 0.00

29,329,880.50 709,598.95 229,409.76 0.00 5,913,115.08 0.00

93,330.00 2,258.00 730.00 0.00 18,816.00 0.00

314.25994 314.25994 314.25995 0.00000 314.25994 0.00000

0.79141

397.08994 397.08994 397.08994 397.08994 397.08994 397.08994

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

All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5

0.99374

1.00000

1.00000

1.00000

1.00000

1.12424

1.20822

1.00000

1.04461

1.00000

1.00000

0.96250

1.03750

1.00000

1.00000

1.00000

1.00000

1.40807 1.40807 1.40807 1.40807 1.40807 1.40807


Average - All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5

559.1314 559.13139 559.13139 559.13139 559.13139 559.13139

0.7530 0.82296 0.82296 0.82296 0.82296 0.82296

1.0516 1.08000 1.08000 1.08000 1.08000 1.08000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0128 1.00320 1.00320 1.00320 1.00320 1.00320

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

0.9690 0.82549 0.82549 0.82549 0.82549 0.82549

1.0002 1.00000 1.00230 1.00000 1.00000 1.00230

1.0000 1.00000 1.00000 0.98915 1.00000 0.98915

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

0.9820 1.03592 0.97358 1.00000 0.98984 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

1.0000 1.00000 1.00000 1.00000 1.00000 1.00000

0.76135 0.76248 0.71824 0.72805 0.72856 0.72973

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

39,730,183.06

Weighted Average - All

Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5

425.70 426.32 401.59 407.08 407.36 408.01

29.26667 29.26667 29.26667 29.26667 29.26667 29.26667

5.461% 5.461% 5.461% 5.461% 5.461% 5.461%

1.000% 1.000% 1.000% 1.000% 1.000% 1.000%

12.479% 12.470% 12.815% 12.735% 12.731% 12.722%

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

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


452.99 464.96 430.24 436.14

12,330.00 225.00 57.00 0.00 1,594.00 0.00

10,977.00 225.00 57.00 0.00 1,594.00 0.00


486.39 487.06 460.62 466.49 466.79 467.49

7.37% 4.75% 7.06% 7.03%

Weighted Average PMPM: 486.39

Difference From Line 56 Col D: 0.00

Percentage Difference: 0.0%


Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11

94788NY 94788NY 94788NY 94788NY 94788NY 94788NY

94788NY026 94788NY026 94788NY026 94788NY026 94788NY026 94788NY026

Gold Gold Gold Gold Gold Gold

0.81880 0.81880 0.81880 0.78280 0.78280 0.78280

1.40807 1.40807 1.40807 - - -

HMO HMO HMO HMO HMO HMO

SHGFHN63 SHGFHN64 SHGFHN65 SHGF2128 SHGF2129 SHGF2130

94788NY0260070 94788NY0260071 94788NY0260072 94788NY0260089 94788NY0260090 94788NY0260091

Off Off Off Both Both Both

No Change No Change No Change Not Offered Not Offered Not Offered


453,001.66 0.00 0.00 181,737.35 8,065.68 0.00

345,685.94 0.00 0.00 115,333.40 4,399.64 0.00

1,100.00 0.00 0.00 367.00 14.00 0.00

314.25995 0.00000 0.00000 314.25995 314.26000 0.00000

397.08994 397.08994 397.08994


1.40807 1.40807 1.40807



559.13139 559.13139 559.13139 559.13139 559.13139 559.13139

0.82296 0.82296 0.82296 0.00000 0.00000 0.00000

1.08000 1.08000 1.08000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00320 1.00320 1.00320 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

0.82549 0.82549 0.82549 0.00000 0.00000 0.00000

1.00230 1.00230 1.00000 0.00000 0.00000 0.00000

1.00000 0.98915 0.98915 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

0.98190 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 0.00000 0.00000 0.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

0.72438 0.72973 0.72805


405.02 408.01 407.08

29.26667 29.26667 29.26667

5.461% 5.461% 5.461%

1.000% 1.000% 1.000%

12.765% 12.722% 12.735%


435.02 0.00 0.00

76.00 0.00 0.00 73.00 6.00 0.00

76.00 0.00 0.00


464.29 467.49 466.49

6.73%



94788NY 94788NY 94788NY 94788NY 94788NY 94788NY

94788NY026 94788NY026 94788NY026 94788NY026 94788NY026 94788NY026

Gold Gold Gold Gold Gold Silver

0.78280 0.78280 0.78280 0.78280 0.78280 0.71449

- - - - - 1.40807


SHGF2131 SHGF2132 SHGF2133 SHGF2134 SHGF2135 SHSF3024

94788NY0260092 94788NY0260093 94788NY0260094 94788NY0260095 94788NY0260096 94788NY0260081

Both Both Both Both Both Both

Not Offered Not Offered Not Offered Not Offered Not Offered Uniform Mod


4,621,695.87 0.00 193,073.05 0.00 0.00 781,067.03

2,931,102.49 0.00 116,590.44 0.00 0.00 580,438.12

9,327.00 0.00 371.00 0.00 0.00 1,847.00

314.25994 0.00000 314.25995 0.00000 0.00000 314.25995

397.08994


1.40807



559.13139 559.13139 559.13139 559.13139 559.13139 559.13139

0.00000 0.00000 0.00000 0.00000 0.00000 0.71082

0.00000 0.00000 0.00000 0.00000 0.00000 1.03000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.01487

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 0.97358

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

0.00000 0.00000 0.00000 0.00000 0.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

0.72341


404.48

29.26667

5.461%

1.000%

12.773%


0.00 0.00 425.88

1,240.00 0.00 34.00 0.00 0.00 286.00

286.00


463.71

8.88%



94788NY 94788NY 94788NY 94788NY 94788NY 94788NY

94788NY026 94788NY026 94788NY026 94788NY026 94788NY026 94788NY026

Silver Silver Silver Silver Silver Silver

0.71449 0.71449 0.71449 0.71449 0.71449 0.71449

1.40807 1.40807 1.40807 1.40807 1.40807 1.40807


SHSF3025 SHSF3026 SHSF3027 SHSF3028 SHSF3029 SHSF3030

94788NY0260082 94788NY0260083 94788NY0260084 94788NY0260085 94788NY0260086 94788NY0260087


Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod


26,305.47 0.00 22,584,622.74 0.00 2,142,706.79 0.00

17,912.82 0.00 16,667,404.61 0.00 1,698,889.25 0.00

57.00 0.00 53,037.00 0.00 5,406.00 0.00

314.26000 0.00000 314.25994 0.00000 314.25994 0.00000

397.08994 397.08994 397.08994 397.08994 397.08994 397.08994


1.40807 1.40807 1.40807 1.40807 1.40807 1.40807



559.13139 559.13139 559.13139 559.13139 559.13139 559.13139

0.71082 0.71082 0.71082 0.71082 0.71082 0.71082

1.03000 1.03000 1.03000 1.03000 1.03000 1.03000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.01487 1.01487 1.01487 1.01487 1.01487 1.01487

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00230 1.00000 1.00000 1.00230 1.00230 1.00230

1.00000 0.98915 1.00000 0.98915 1.00000 0.98915

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

0.97358 1.00000 0.98098 1.00000 0.97761 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

0.72507 0.73498 0.72890 0.73667 0.72807 0.73667


405.41 410.95 407.55 411.89 407.09 411.89

29.26667 29.26667 29.26667 29.26667 29.26667 29.26667

5.461% 5.461% 5.461% 5.461% 5.461% 5.461%

1.000% 1.000% 1.000% 1.000% 1.000% 1.000%

12.759% 12.680% 12.729% 12.667% 12.735% 12.667%


432.16 430.30 432.82

5.00 0.00 5,467.00 0.00 474.00 0.00

5.00 0.00 5,467.00 0.00 474.00 0.00


464.70 470.62 466.99 471.63 466.50 471.63

7.53% 8.53% 7.78%



94788NY 94788NY 94788NY 94788NY 94788NY 94788NY

94788NY026 94788NY026 94788NY026 94788NY026 94788NY026 94788NY026

Silver Gold Gold Gold Gold Gold

0.71449 0.80105 0.80105 0.80105 0.80105 0.80105

1.40807 1.40807 1.40807 1.40807 1.40807 1.40807


SHSF3031 SHGF5017 SHGF5018 SHGF5019 SHGF5020 SHGF5021

94788NY0260088 94788NY0260097 94788NY0260098 94788NY0260099 94788NY0260100 94788NY0260101


Uniform Mod No Change No Change No Change No Change No Change


0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00000 0.00000 0.00000 0.00000 0.00000 0.00000

397.08994 397.08994 397.08994 397.08994 397.08994 397.08994


1.40807 1.40807 1.40807 1.40807 1.40807 1.40807



559.13139 559.13139 559.13139 559.13139 559.13139 559.13139

0.71082 0.79833 0.79833 0.79833 0.79833 0.79833

1.03000 1.08000 1.08000 1.08000 1.08000 1.08000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.01487 1.01487 1.01487 1.01487 1.01487 1.01487

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00230 1.00000 1.00000 1.00230

0.98915 1.00000 1.00000 0.98915 1.00000 0.98915

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 0.97358 0.97358 1.00000 0.97732 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

0.73498 0.85191 0.85386 0.86553 0.85517 0.86752


410.95 476.33 477.42 483.95 478.15 485.06

29.26667 29.26667 29.26667 29.26667 29.26667 29.26667

5.461% 5.461% 5.461% 5.461% 5.461% 5.461%

1.000% 1.000% 1.000% 1.000% 1.000% 1.000%

12.680% 11.876% 11.864% 11.796% 11.857% 11.784%


510.89 513.35 513.36

0.00 102.00 2.00 0.00 2,535.00 0.00

0.00 102.00 2.00 0.00 2,535.00 0.00


470.62 540.52 541.69 548.66 542.47 549.85

5.80% 5.52% 5.67%


Plan 30 Plan 31 Plan 32

94788NY 94788NY 94788NY

94788NY026 94788NY026 94788NY026

Gold Gold Gold

0.80105 0.80105 0.80105

1.40807 1.40807 1.40807

HMO HMO HMO

SHGF5022 SHGF5023 SHGF5024

94788NY0260102 94788NY0260103 94788NY0260104

Both Both Both

No Change No Change No Change


0.00 0.00 0.00

0.00 0.00 0.00

0.00 0.00 0.00

0.00000 0.00000 0.00000

397.08994 397.08994 397.08994


1.40807 1.40807 1.40807



559.13139 559.13139 559.13139

0.79833 0.79833 0.79833

1.08000 1.08000 1.08000

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

1.01487 1.01487 1.01487

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

1.00230 1.00230 1.00000

1.00000 0.98915 0.98915

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

0.97358 1.00000 1.00000

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

1.00000 1.00000 1.00000

0.85386 0.86752 0.86553


477.42 485.06 483.95

29.26667 29.26667 29.26667

5.461% 5.461% 5.461%

1.000% 1.000% 1.000%

11.864% 11.784% 11.796%


513.35

154.00 0.00 0.00

154.00 0.00 0.00


541.69 549.85 548.66

5.52%


Exhibit 18 Supplement

Company Name: CDPHP

NAIC Code: 95491


Market Segment : Small Group

Expense Data - Small Group 2021 Expected 2020 Expected 2019 Expected 2018 Expected 2019 Actual 2018 Actual

Period assumed - beginning date 1/1/2021 1/1/2020 1/1/2019 1/1/2018 1/1/2019 1/1/2018

Period assumed - ending date 12/31/2021 12/31/2020 12/31/2019 12/31/2018 12/31/2019 12/31/2018

Average annual claim trend assumed 6.03% 6.50% 6.31% 6.35% 11.18% 4.67%

Regulatory authority licenses and fees, including New York State 206 assessment expenses - as a % of gross premium 0.50% 0.55% 0.75% 1.06% 0.52% 0.48%

Administrative expenses for activities that improve health care quality as defined in the NAIC Annual Statement Supplement Health Care Exhibit - as a % of gross premium 0.56% 1.04% 1.89% 1.50% 1.33% 1.16%

Commissions and broker fees - as a % of gross premium 2.98% 3.07% 2.85% 2.80% 3.72% 5.23%

Premium Taxes - as a % of gross premium 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Other state and federal taxes and assessments (other than income taxes and covered lives assessment) - as a % of gross premium 0.08% 1.07% 0.10% 0.99% 0.08% 0.49%

Other administrative expenses - as a % of gross premium 7.36% 6.18% 9.84% 6.77% 5.76% 3.68%

Subtotal 11.488% 11.913% 15.438% 13.115% 11.421% 11.041%

After tax underwriting margin (profit/contribution to surplus) - as a % of gross premium 1.00% 1.00% 1.00% 1.00% 0.00% 0.00%

State income tax component - as a % of gross premium 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

State income tax rate assumed (e.g. 3%) 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Federal income tax component - as a % of gross premium 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Federal income tax rate assumed (e.g. 30%) 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Reduction for assumed net investment income - as a % of gross premium (enter as a negative value) 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Subtotal 1.000% 1.000% 1.000% 1.000% 0.000% 0.000%

Total 12.488% 12.913% 16.438% 14.115% 11.421% 11.041%

Exhibit 18 Supplement Updated by DFS - 3/20/2020 15

EXHIBIT 23: SUMMARY OF REQUESTED 2021 PREMIUM RATES

Company Name: CDPHP

NAIC Code: 95491



1 Purpose of this Exhibit is to provide the actual distribution of all base Premium Rates for all Metal Levels and Regions.

2 Premium rates and member months are required for Calendar Years 2018 - 2021 for Individual (Individual only) and First Quarter 2018 - 2021 for Small Group (Employee only).

3 Membership must be consistent with the applicable DFS survey as of 3/31 for each of the respective years.

4 Premium rates must be based on the subscriber (Individual) or employee (Small Group) rate and should not be a PMPM amount.

5 Premiums should be reported for all plan variations (e.g., if the Company has different rates when family planning, pediatric dental, domestic partner, or age 29 coverage are added, etc.).

6 Additional guidance is provided in the various headings of the Exhibit.

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

8 The "PNDS Identifier" represents the code used in the Department of Health's PNDS system to identify the specific provider network associated with a particular plan.

9 The "Company Network Identifier" represents the specific code used by the Company to identify each distinct provider network used by the Company.

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

1. Company

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

5. Current HIOS

ID (14 Digits)

6. Previous HIOS

ID (14 Digits)

7. Metal Level or

Catastrophic

8. Exchange

["On"/"Off"]

9. Plan Type

[Standard or Non-

Standard]

10.

Limiting Child

Age?

(26 or 30)

11.

Domestic

Partner

Coverage

Included? (yes,

no)

12.

Family

Planning

Coverage?

(included,

excluded)

13.

Pediatric

Dental

Coverage

Included? (yes,

no)

14. Out of

Network

Benefits? (yes,

no)

15.

Includes

Benefits in

Addition to

EHB?

(yes, no)

16.

Healthy New

York

(yes, no)

17.

Child-Only

Plan (yes, no)

18.

Tiered Network

Plan (yes, no)

19.

HSA Plan (yes,

no)

20.

PNDS Identifier

21.

Company

Network

Identifier

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260065 Gold Off Standard 26 Yes included no no no yes no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260066 Gold Off Standard 30 Yes included no no no yes no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260067 Gold Off Standard 26 Yes excluded no no no yes no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260068 Gold Off Standard 26 No included no no no yes no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260069 Gold Off Standard 30 Yes excluded no no no yes no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260070 Gold Off Standard 30 No included no no no yes no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260071 Gold Off Standard 30 No excluded no no no yes no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260072 Gold Off Standard 26 No excluded no no no yes no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260089 Gold Off Non-Standard 26 Yes included no no yes no no no no 0147 NYN001


CDPHP 95491 CAPD-132341192 Small Group 94788NY0260091 Gold Off Non-Standard 26 Yes excluded no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260092 Gold Off Non-Standard 26 No included no no yes no no no no 0147 NYN001



CDPHP 95491 CAPD-132341192 Small Group 94788NY0260095 Gold Off Non-Standard 30 No excluded no no yes no no no no 0147 NYN001


CDPHP 95491 CAPD-132341192 Small Group 94788NY0260081 Silver Off Non-Standard 26 Yes included no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260082 Silver Off Non-Standard 30 Yes included no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260083 Silver Off Non-Standard 26 Yes excluded no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260084 Silver Off Non-Standard 26 No included no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260085 Silver Off Non-Standard 30 Yes excluded no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260086 Silver Off Non-Standard 30 No included no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260087 Silver Off Non-Standard 30 No excluded no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260088 Silver Off Non-Standard 26 No excluded no no yes no no no no 0147 NYN001









CDPHP 95491 CAPD-132341192 Small Group 94788NY0260089 Gold On Non-Standard 26 Yes included no no yes no no no no 0147 NYN001


CDPHP 95491 CAPD-132341192 Small Group 94788NY0260091 Gold On Non-Standard 26 Yes excluded no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260092 Gold On Non-Standard 26 No included no no yes no no no no 0147 NYN001



CDPHP 95491 CAPD-132341192 Small Group 94788NY0260095 Gold On Non-Standard 30 No excluded no no yes no no no no 0147 NYN001


CDPHP 95491 CAPD-132341192 Small Group 94788NY0260081 Silver On Non-Standard 26 Yes included no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260082 Silver On Non-Standard 30 Yes included no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260083 Silver On Non-Standard 26 Yes excluded no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260084 Silver On Non-Standard 26 No included no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260085 Silver On Non-Standard 30 Yes excluded no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260086 Silver On Non-Standard 30 No included no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260087 Silver On Non-Standard 30 No excluded no no yes no no no no 0147 NYN001

CDPHP 95491 CAPD-132341192 Small Group 94788NY0260088 Silver On Non-Standard 26 No excluded no no yes no no no no 0147 NYN001









PLAN INFORMATION


Region 1 - 2018

Rate (Albany)

Region 2 - 2018

Rate (Buffalo)

Region 3 - 2018

Rate (Mid-

Hudson)

Region 4 - 2018

Rate (New York)

Region 5 - 2018

Rate (Rochester)

Region 6 - 2018

Rate (Syracuse)

Region 7 - 2018

Rate (Utica)

Region 8 - 2018

Rate (Long

Island)

Region 1 - 2018

MMs (Albany)

Region 2 - 2018

MMs (Buffalo)

Region 3 - 2018

MMs (Mid-

Hudson)

Region 4 - 2018

MMs (New York)

Region 5 - 2018

MMs (Rochester)

Region 6 - 2018

MMs (Syracuse)

Region 7 - 2018

MMs (Utica)

Region 8 - 2018

MMs (Long

Island)

464.47 665.68 556.74 547.23 1,402.00 392.00 31.00

465.63 667.34 558.13 548.60 659.00

460.08 659.39 551.48 542.06

464.47 665.68 556.74 547.23 17,972.00 1,211.00 38.00

461.23 661.04 552.86 543.42

465.63 667.34 558.13 548.60 920.00 251.00

461.23 661.04 552.86 543.42

460.08 659.39 551.48 542.06

464.63 665.91 556.94 547.43 712.00 12.00

465.80 667.58 558.33 548.80 36.00

460.25 659.63 551.68 542.26

464.63 665.91 556.94 547.43 26,521.00 204.00

461.40 661.28 553.06 543.61

465.80 667.58 558.33 548.80 3,583.00 16.00

461.40 661.28 553.06 543.61

460.25 659.63 551.68 542.26

464.63 665.91 556.94 547.43

465.80 667.58 558.33 548.80

460.25 659.63 551.68 542.26

464.63 665.91 556.94 547.43 14.00

461.40 661.28 553.06 543.61

465.80 667.58 558.33 548.80

461.40 661.28 553.06 543.61

460.25 659.63 551.68 542.26

2018 PREMIUM RATES 2018 MEMBER MONTHS


Region 1 - 2019

Rate (Albany)

Region 2 - 2019

Rate (Buffalo)

Region 3 - 2019

Rate (Mid-

Hudson)

Region 4 - 2019

Rate (New York)

Region 5 - 2019

Rate (Rochester)

Region 6 - 2019

Rate (Syracuse)

Region 7 - 2019

Rate (Utica)

Region 8 - 2019

Rate (Long

Island)

Region 1 - 2019

MMs (Albany)

Region 2 - 2019

MMs (Buffalo)

Region 3 - 2019

MMs (Mid-

Hudson)

Region 4 - 2019

MMs (New York)

Region 5 - 2019

MMs (Rochester)

Region 6 - 2019

MMs (Syracuse)

Region 7 - 2019

MMs (Utica)

Region 8 - 2019

MMs (Long

Island)

449.87 644.75 539.24 530.03 1,843.00 383.00 32.00

451.33 646.85 540.99 531.75 730.00

443.37 635.44 531.45 522.37

449.87 644.75 539.24 530.03 18,036.00 780.00

444.81 637.50 533.18 524.07

451.33 646.85 540.99 531.75 904.00 196.00

444.81 637.50 533.18 524.07

443.37 635.44 531.45 522.37

546.39 783.09 654.94 643.75 345.00 22.00

548.18 785.65 657.08 645.86 14.00

538.44 771.69 645.41 634.38

546.39 783.09 654.94 643.75 8,994.00 259.00 3.00

540.20 774.22 647.52 636.46

548.18 785.65 657.08 645.86 371.00

540.20 774.22 647.52 636.46

538.44 771.69 645.41 634.38

471.02 675.07 564.59 554.95 1,847.00

472.55 677.26 566.43 556.75 57.00

464.20 665.30 556.42 546.92

471.02 675.07 564.59 554.95 51,496.00 663.00 20.00

465.71 667.45 558.23 548.69

472.55 677.26 566.43 556.75 5,370.00 36.00

465.71 667.45 558.23 548.69

464.20 665.30 556.42 546.92

546.39 783.09 654.94 643.75

548.18 785.65 657.08 645.86

538.44 771.69 645.41 634.38

546.39 783.09 654.94 643.75 71.00

540.20 774.22 647.52 636.46

548.18 785.65 657.08 645.86

540.20 774.22 647.52 636.46

538.44 771.69 645.41 634.38

471.02 675.07 564.59 554.95

472.55 677.26 566.43 556.75

464.20 665.30 556.42 546.92

471.02 675.07 564.59 554.95 848.00 4.00 6.00

465.71 667.45 558.23 548.69

472.55 677.26 566.43 556.75

465.71 667.45 558.23 548.69

464.20 665.30 556.42 546.92

2019 PREMIUM RATES 2019 MEMBER MONTHS


Region 1 - 2020

Rate (Albany)

Region 2 - 2020

Rate (Buffalo)

Region 3 - 2020

Rate (Mid-

Hudson)

Region 4 - 2020

Rate (New York)

Region 5 - 2020

Rate (Rochester)

Region 6 - 2020

Rate (Syracuse)

Region 7 - 2020

Rate (Utica)

Region 8 - 2020

Rate (Long

Island)

Region 1 - 2020

Members as of

3/31/2020

(Albany)

Region 2 - 2020

Members as of

3/31/2020

(Buffalo)

Region 3 - 2020

Members as of

3/31/2020 (Mid-

Hudson)

Region 4 - 2020

Members as of

3/31/2020 (New

York)

Region 5 - 2020

Members as of

3/31/2020

(Rochester)

Region 6 - 2020

Members as of

3/31/2020

(Syracuse)

Region 7 - 2020

Members as of

3/31/2020 (Utica)

Region 8 - 2020

Members as of

3/31/2020 (Long

Island)

483.83 691.47 548.07 541.44 180.00 44.00 1.00

486.16 694.80 550.71 544.05 57.00

477.29 682.13 540.66 534.12

483.83 691.47 548.07 541.44 1,512.00 82.00

479.58 685.40 543.26 536.68

486.16 694.80 550.71 544.05 74.00 2.00

479.58 685.40 543.26 536.68

477.29 682.13 540.66 534.12

562.29 803.60 636.95 629.24 51.00 22.00

565.00 807.48 640.02 632.27 6.00

554.65 792.69 628.29 620.69

562.29 803.60 636.95 629.24 1,203.00 31.00 3.00

557.32 796.50 631.32 623.68

565.00 807.48 640.02 632.27 34.00

557.32 796.50 631.32 623.68

554.65 792.69 628.29 620.69

480.66 686.94 544.48 537.89 286.00

482.97 690.24 547.09 540.47 5.00

474.16 677.66 537.12 530.62

480.66 686.94 544.48 537.89 5,292.00 114.00 13.00

476.44 680.91 539.70 533.17

482.97 690.24 547.09 540.47 463.00 3.00 8.00

476.44 680.91 539.70 533.17

474.16 677.66 537.12 530.62

581.34 830.84 658.53 650.56 102.00

584.15 834.85 661.71 653.70 2.00

573.44 819.54 649.58 641.72

581.34 830.84 658.53 650.56 2,491.00 21.00 13.00

576.21 823.49 652.71 644.81

584.15 834.85 661.71 653.70 154.00

576.21 823.49 652.71 644.81

573.44 819.54 649.58 641.72

562.29 803.60 636.95 629.24

565.00 807.48 640.02 632.27

554.65 792.69 628.29 620.69

562.29 803.60 636.95 629.24 3.00

557.32 796.50 631.32 623.68

565.00 807.48 640.02 632.27

557.32 796.50 631.32 623.68

554.65 792.69 628.29 620.69

480.66 686.94 544.48 537.89

482.97 690.24 547.09 540.47

474.16 677.66 537.12 530.62

480.66 686.94 544.48 537.89 39.00 9.00

476.44 680.91 539.70 533.17

482.97 690.24 547.09 540.47

476.44 680.91 539.70 533.17

474.16 677.66 537.12 530.62

581.34 830.84 658.53 650.56

584.15 834.85 661.71 653.70

573.44 819.54 649.58 641.72

581.34 830.84 658.53 650.56 6.00 4.00

576.21 823.49 652.71 644.81

584.15 834.85 661.71 653.70

576.21 823.49 652.71 644.81

573.44 819.54 649.58 641.72

2020 MEMBERS (per DFS Membership Survey)2020 PREMIUM RATES


Region 1 - 2021

Rate (Albany)

Region 2 - 2021

Rate (Buffalo)

Region 3 - 2021

Rate (Mid-

Hudson)

Region 4 - 2021

Rate (New York)

Region 5 - 2021

Rate (Rochester)

Region 6 - 2021

Rate (Syracuse)

Region 7 - 2021

Rate (Utica)

Region 8 - 2021

Rate (Long

Island)

Region 1 - 2020

Members as of

3/31/2020

(Albany)

Region 2 - 2020

Members as of

3/31/2020

(Buffalo)

Region 3 - 2020

Members as of

3/31/2020 (Mid-

Hudson)

Region 4 - 2020

Members as of

3/31/2020 (New

York)

Region 5 - 2020

Members as of

3/31/2020

(Rochester)

Region 6 - 2020

Members as of

3/31/2020

(Syracuse)

Region 7 - 2020

Members as of

3/31/2020 (Utica)

Region 8 - 2020

Members as of

3/31/2020 (Long

Island)

Region 1 - 2020

Members as of

3/31/2020

(Albany)

Region 2 - 2020

Members as of

3/31/2020

(Buffalo)

Region 3 - 2020

Members as of

3/31/2020 (Mid-

Hudson)

Region 4 - 2020

Members as of

3/31/2020 (New

York)

Region 5 - 2020

Members as of

3/31/2020

(Rochester)

Region 6 - 2020

Members as of

3/31/2020

(Syracuse)

Region 7 - 2020

Members as of

3/31/2020 (Utica)

Region 8 - 2020

Members as of

3/31/2020 (Long

Island)

521.38 679.12 602.86 581.33 180.00 44.00 1.00

522.50 680.60 604.16 582.58 57.00

516.11 672.14 596.70 575.41

521.38 679.12 602.86 581.33 1,512.00 82.00

517.22 673.60 597.99 576.65

522.50 680.60 604.16 582.58 74.00 2.00

517.22 673.60 597.99 576.65

516.11 672.14 596.70 575.41

5.00

381.00 20.00

3.00

526.00 685.24 608.25 586.52 286.00 157.00

527.13 686.73 609.57 587.79 5.00

520.68 678.19 602.04 580.54

526.00 685.24 608.25 586.52 5,292.00 114.00 13.00 2,828.00 13.00 13.00

521.80 679.67 603.34 581.80

527.13 686.73 609.57 587.79 463.00 3.00 8.00 76.00 8.00

521.80 679.67 603.34 581.80

520.68 678.19 602.04 580.54

613.13 800.65 709.99 684.40 102.00 102.00

614.46 802.41 711.54 685.89 2.00 2.00

606.87 792.35 702.68 677.36

613.13 800.65 709.99 684.40 2,491.00 21.00 13.00 2,491.00 21.00 13.00

608.18 794.09 704.21 678.84

614.46 802.41 711.54 685.89 154.00 154.00

608.18 794.09 704.21 678.84

606.87 792.35 702.68 677.36

3.00

526.00 685.24 608.25 586.52

527.13 686.73 609.57 587.79

520.68 678.19 602.04 580.54

526.00 685.24 608.25 586.52 39.00 9.00 27.00 5.00

521.80 679.67 603.34 581.80

527.13 686.73 609.57 587.79

521.80 679.67 603.34 581.80

520.68 678.19 602.04 580.54

613.13 800.65 709.99 684.40

614.46 802.41 711.54 685.89

606.87 792.35 702.68 677.36

613.13 800.65 709.99 684.40 6.00 4.00 6.00 4.00

608.18 794.09 704.21 678.84

614.46 802.41 711.54 685.89

608.18 794.09 704.21 678.84

606.87 792.35 702.68 677.36

2021 PREMIUM RATES

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

offered in 2021

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

apply to SMALL GROUP ONLY *****


«Letter_Date» Group #: «Group_Identifier»

Health Benefit Administrator

«Group_Name»

«Group_Address1»

«Group_Address2»

«Groups_City», «Group_State» «Group_Zip»

Dear Employer:

Your group health insurance coverage is coming up for renewal. Your group policy will be automatically

renewed on «Renewal_Date» as long as your group continues to be eligible. Your group’s members will

be automatically re-enrolled unless you choose another policy. Included are changes we’ll be making to

your policy, the new premium for this policy, and some information about options if you wish to change

policies.

Premium rate changes

The premium rates for your health insurance policy are changing. The new rates will take effect on

«Renewal_Date». The new rates below have been approved by the New York State Department of

Financial Services (DFS).

Proposed 2021 Benefit Package Current 2020 Benefit Package

Medical Plan: «New_Internal_Code»

«Future_Off_Ex_Market_Plan_Na

me»

«Current_Internal_Code»

«Current_Off_Ex_Market_Plan_Na

me»

Office Visit Copay: «Future_OV» «Current_OV»

Specialist Visit Copay: «Future_SP» «Current_SP»

In-Network Deductible: «Future_INN_Ded_Single» /

«Future_INN_Ded_Family»

«Current_INN_Ded_Single» /

«Current_INN_Ded_Family»

Deductible Type: «Future_Deductible_Accumulation

»

«Current_Deductible_Accumulation

»

Out-of-Network Deductible: «Future_OON_Ded_Single» /

«Future_OON_Ded_Family»

«Current_OON_Ded_Single» /

«Current_OON_Ded_Family»

In-Network Coinsurance: «Future_Coins» «Current_Coins»

Out-of-Network Coinsurance: «Future_OON_COIN» «Current_OON_COIN»

In-Network Maximum: «Future_INN_Max_Single» /

«Future_INN_Max_Family»

«Current_INN_Max_Single» /

«Current_INN_Max_Family»

Out-of-Network Maximum: «Future_OON_Max_Single» /

«Future_OON_Max_Family»

«Current_OON_Max_Single» /

«Current_OON_Max_Family»

Inpatient Hospital: «Future_INN_HOSP» «Current_INN_HOSP»

Outpatient Surgery: «Future_Outpatient__Ambulatory_

Surgery»

«Current_Outpatient__Ambulatory_

Surgery»

Emergency Room: «Future_ER» «Current_ER»

Ambulance: «Future_AMB» «Current_AMB»

Urgent Care: «Future_Urgent_Care» «Current_Urgent_Care»

Durable Medical Equipment: «Future_DME» «Current_DME»

NOTICE OF RENEWAL AND 2021 PREMIUM RATES

Physical/Occupational/Speech Therapy: «Future_PT_OT_ST» «Current_PT_OT_ST»

Rx: «Future_Rx_Tier_1» /

«Future_Rx_Tier_2» /

«Future_Rx_Tier_3»

«Current_Rx_Tier_1» /

«Current_Rx_Tier_2» /

«Current_Rx_Tier_3»

Other Options: Dependent to 29 and Domestic

Partner - Same or Opposite Sex

Dependent to 29 and Domestic

Partner - Same or Opposite Sex

Proposed 2021 Monthly Premium Current 2020 Monthly Premium

Individual: «Future_Single» «Current_Single»

Employee+1: «Future_Double» «Current_Double»

Employee/Child: «Future_EmpChildren» «Current_EmpChildren»

Family: «Future_Family» «Current_Family»

*Total Monthly Premium: «Future_Premium» «Current_Premium»

*This will provide an estimate based on current enrollment of your group. This amount may change depending on the individuals who actually enroll in the policy.

You may visit the DFS website at www.dfs.ny.gov for more information regarding this rate change. You

may also contact us by calling your CDPHP® account representative at (518) «Rep_Phone», or visit our

website at www.cdphp.com for further information about this rate change.

Other changes to your current health insurance policy

The name of your new policy is: «Future_Off_Ex_Market_Plan_Name». The benefit changes for

your 2021 plan include:

«Gym_Reimbursement_1»

«Gym_Reimbursement_2»

«Telemedicine»

«Removal_of_Max_Allowed»

«Acupunture»

«Adult_Vision»

«LASIK»

«Rx_Prefered_Locations_1»

«Rx_Preferred_Providers_2»

«Plan_3221»

«Plan_3222»

See chart above for cost-share changes

Coverage options

If you do not want your group’s current policy to automatically renew, you have the option of choosing a

different policy either from us or from another insurer. Remember, CDPHP® has a wide range of product

offerings to fit any budget. If your current plan does not meet your needs, please contact your broker or

CDPHP account representative at (518) «Rep_Phone» to discuss alternative benefit solutions customized

to fit your business needs. You may purchase a new policy from us or another insurer directly, or with the

help of a broker or agent.

You may request a NYS Small Business employer eligibility determination through the NY State of

Health Small Business Marketplace (the “Marketplace”) if your employees will be enrolled in a

Marketplace certified insurance policy. The determination allows employers to access the federal small

business health care tax credit. If your employees enroll in a Marketplace certified policy offered through

a variety of different insurance companies including us, you can request an eligibility determination

through the Marketplace. If you meet all the IRS guidelines, you may be eligible for the small business

health care tax credit. You can get that credit only if the Marketplace determines that you are an eligible

employer and only if your employees enroll in a Marketplace certified insurance policy.

You generally can buy coverage for your group at any time throughout the year, but to avoid gaps in

coverage, you should enroll at least 21 days before your renewal date of «Renewal_Date».

To avoid gaps in coverage when purchasing a new Marketplace policy, enrollment must be completed by

the end of the month, one month prior to the policy end date (for example, November 30 for policies

effective January 1; December 31 for policies effective February 1). Fifteen-day extensions are available.

Please visit www.nystateofhealth.ny.gov or call the Small Business Marketplace Customer Service at 1-

855-355-5777 for details.

Before you decide

Call the insurer or visit the insurer’s website to check which doctors, other health care providers, and

prescription medications are covered by the new policy. This is an important step in selecting a policy that

best meets the needs of your group. If you are considering a new policy from us, our website address is

www.cdphp.com.

If you have questions

• Call your broker or your CDPHP account representative at (518) «Rep_Phone» between 8:30 a.m. and 5

p.m., or visit our website at www.cdphp.com.

• Visit www.nystateofhealth.ny.gov to learn more about the New York State of Health Small Business

Marketplace, or call Marketplace Customer Service at 1-855-355-5777.

Getting help in other languages:

Para obtener asistencia en Espanol, Ilame al 1-800-777-2273.

Please communicate this information to the individual subscribers who receive coverage through this

group policy. If you wish to have CDPHP notify your employees directly, please notify your account

representative within three (3) days of receipt of this notice. A sample member notification is enclosed

with this mailing. We recommend that you provide any additional information with this notice, such as

expected changes in employee contribution levels, that may help your employees better understand their

health coverage costs.

[Date]

Health Benefits Administrator Group Number: [Group Identifier] [Group Name] [Address] [City State Zip]

Re: Notice of Proposed Premium Rate Change [Plan Name and Health Insurance Oversight System (HIOS) Plan ID number]

Dear Health Benefits Administrator:

[Capital District Physicians’ Health Plan, Inc. (CDPHP®); CDPHP Universal Benefits,® Inc. (CDPHP UBI)] is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group premium rates for 2021. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS.

DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change.

Proposed Premium Rate Changes

If approved, the percentage change to your group’s premium is [rate change]%.

Please note that while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features that your group policyholder selects on renewal. Also, the final approved rate may differ because DFS may modify the proposed rate.

Why We Are Requesting a Rate Change

As a not-for-profit health plan, CDPHP takes seriously its responsibility to control rising health care costs and be a good steward of your premium dollars. However, we continue to battle the rising cost of care, driven primarily by state and federal regulations and taxes, specialty drugs, provider consolidation — and most recently, the harmful impact to our economy and health care system of the COVID-19 pandemic. These factors have resulted in the need to increase insurance premiums. We are working hard to alleviate these cost increases in a variety of ways, such as:

The CDPHP Enhanced Primary Care (EPC) program, a nationally-recognized patient-centeredmedical home that encourages high-quality, cost-effective services at the primary care level.

Our innovative hospital experience program which connects CDPHP nurses and service staff toassist patients at the bedside, improving members’ experience of care while reducing costs andunnecessary readmissions to hospitals.

Dedicating resources to improving the overall health of our membership.

More convenient access to care through our telemedicine (live video doctor visits) partners, Doctor On Demand and ER Anywhere.

CDPHP Price Check, a cost transparency tool that provides members estimated costs on a range of health care services.

Movement of services to more cost-effective outpatient settings, such as freestanding surgical centers.

Case management and medication therapy management services, available at no out-of-pocket cost.

Mental health and substance use programs, including access to a 24-hour crisis line. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact [CDPHP; CDPHP UBI] for additional information at:

[CDPHP; CDPHP UBI] 500 Patroon Creek Blvd. Albany, NY 12206 1-800-777-2273 www.cdphp.com

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

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

United States Postal Service:

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

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

1. The name of your insurer 2. The name of your plan 3. Whether you have individual or group coverage 4. Your HIOS Plan ID number, which is [Insert the HIOS Plan ID #]

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

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

[CDPHP; CDPHP UBI] website: www.cdphp.com

DFS website: https://myportal.dfs.ny.gov/web/prior-approval/rate-applications-by-company

Notice of Approved Premium Rate

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

Enclosed is a copy of a notice that employees enrolled in your CDPHP group plan are required to receive.

If you are unable or unwilling to deliver the notice to your employees, please let us know within three business days via email at [email protected]. If you would prefer a PDF of the document, or need additional copies, please indicate the correct contact person, address, and quantity desired.

Sincerely,

https://myportal.dfs.ny.gov/web/prior-approval/rate-applications-by-company

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rates noted above, you will receive final rate information at least 60 days before your 2021 renewal date. Enclosed is a copy of a notice that employees enrolled in your CDPHP group plan are required to receive. If you are unable or unwilling to deliver the notice to your employees, please let us know within three business days via email at [email protected]. If you would prefer a PDF of the document, or need additional copies, please indicate the correct contact person, address, and quantity desired. Sincerely,

Capital District Physicians’ Health Plan

Premium Rate Filing

FORMS # 01-0006-2021

ACTUARIAL MEMORANDUM

Small Group

On and Off Exchange Filing

General Information

Company Legal Name: Capital District Physicians’ Health Plan

State: New York

HIOS Issuer ID: 94788

QHP Template SERFF #: CAPD-132341192

Market: Small Group

Effective Date: January through December 2021

Primary Contact Name:

Primary Contact Telephone Number:

Primary Contact Email Address:

This document contains the Actuarial Memorandum for Capital District Physicians’ Health Plan (“CDPHP”) block of

business, effective January 1, 2021. These rates are guaranteed 12 months after the group’s effective date. This actuarial

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

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

filings, including support for the values entered in the Part I Unified Rate Review Template. This memorandum may not

be appropriate for other purposes.

Identification

I, , am a Member of the American Academy of Actuaries. I meet the Academy qualification standards

for rendering an opinion in the area of health insurance. This filing meets all Affordable Care Act (“ACA”) requirements

for Essential Health Benefits (“EHB”), risk pooling, actuarial value (“AV”), induced demand, metal level requirements,

standardized rating regions, and standardized census tier factors as further described below.

Proposed Rates

CDPHP is filing small group rates with effective dates beginning January 1, 2021 for plans to be marketed on and off the

NYHBE. The plan designs included in this filing are compliant with the EHB in accordance with the ACA. The

projected plan claim costs have been derived from the combined base claims experience for CDPHP’s small group HMO

pool. Plan design pricing considered assumptions for Induced Demand and AV as specified in the HHS Notice of

Benefit and Payment Parameters for 2021. Federal Risk Adjustment Program payments have been incorporated into the

premium rate development as further described below. The overall weighted average rate adjustment requested is 7.38% as

indicated on Exhibit 13c.

Experience Period Premium and Claims

The base period data used in the development of the medical expenses is the Small Group HMO pooled incurred claims and

membership for all in-force plans, for the 12 months ending December 2019, paid through February 2020. The impact of

NYS Regulation 146 risk adjustment pool and NYS Healthy NY Stop-loss Reimbursement pool was excluded from the base

period starting claims costs.


Premium Rate Filing

FORMS # 01-0006-2021

Worksheet 1 HHS Unified Rate Review Template

Earned Premiums are reported for the base period in-force membership in the small group pool. Premiums were obtained

from CDPHP’s data warehouse eligibility and premium tables. Earned premiums shown on Worksheet 1 were not impacted

by Federal MLR rebates as there were no rebates expected during the experience period.

Incurred claims and allowed claims presented on Worksheet 1 come directly from CDPHP’s claim payment records in the

data warehouse combined with capitated expenses and NYS HCRA surcharges from the accounting general ledger for the

base period

Estimates for incurred but not reported (“IBNR”) claims are included and were derived using a standard industry lag

methodology. The standard lag methodology used combines large and small group historical lag triangles separated for

Inpatient, Outpatient, Professional, and Pharmacy type of services. Large and small group blocks are combined to ensure

the credibility of each lag cell. Final estimated reserve levels at the group size level are allocated based upon paid claims

by group size during the period. The base period claims include 2 months of paid run-out and therefore, IBNR is 0.5% of

the base period starting claim cost.

Benefit Categories

The benefit categories are defined using standard industry definitions for Inpatient, Outpatient, Professional and Pharmacy

claims. Each claim, as it is adjudicated in the claims system and then loaded in the data warehouse, is mapped to the

appropriate category using one or more criteria including facility Bill Type, DRG code, Revenue Code, Procedure code,

CPT/HCPCS code, or NDC code. These categorizations are applied consistently across all financial related reporting. The

“Other” medical category includes case management, incentives, HCRA, home health, DME and orthotics.

General Overview of Proposed Rate Development

The general methodology used to develop the premium rates applies factors to the Index Rate for each component of the

rate buildup. Each component was compared to the starting net trended per member per month (“PMPM”) claims cost to

develop the applicable factor. The rates for the corresponding plan designs were developed by taking the product of the

following:

- Base Period Index Rate

- Impact of Essential Health Benefits

- Claim Trend Projection

- Federal Risk Adjustment

- Impact of COVID-19 - Pricing Actuarial Value without induced demand

- Pricing Actuarial Value – Induced Demand

- Benefits in addition to the Essential Health Benefits

- Healthy New York Stoploss - Additional Plan Specific Factors

The resulting PMPM, based on the above components, is then multiplied by a regional factor.

The Administrative Expense and Profit are applied following the regional adjustment. The expenses are split between variable

and fixed expenses in order to be consistent with the calculations in Exhibit 18. The fixed expenses is added first, followed

by the variable expense.

Lastly, the conversion factor is applied to obtain the single rate.


Premium Rate Filing

FORMS # 01-0006-2021

Index Rate

The starting point claims PMPM for in-force plans, the Base Period Index Rate, was developed from the claims experience

as described above and the average AV for all in-force plans included in the base experience period.

Base Period In-force plan Index Rate Development

Average Incurred Claims PMPM $314.26 A

Average AV Pricing Value 0.7914 B

Small Group HMO Index Rate (Exhibit 18, line 12) $397.09 C = A / B

Membership Projections

The projected membership for 2021 is based on the current distribution for the plans in the experience period. This

projection is indicated on Worksheet 2 of the Unified Rate Review Template (URRT).

Impact of Market Wide Adjustments

Impact of compliance with Essential Health benefits

The impact of the additional costs associated with benefits in excess of the Essential Health benefits in the base period

experience as noted below are derived on Exhibit A and applied on Exhibit 18, Line 13 consistently for all plans in each

metal tier. This adjustment to the base claim experience was applied only for the proportion of membership in the base

that currently include these benefits.

Skilled Nursing Facility – Increase days from 200 to 365

Adult Vision Exam and Hardware

Acupuncture

Lasik Surgery

Gym Membership

Hearing Aids

Impact of changes in the provider network, fee schedules levels, utilization management, and Quality Improvements that

apply to the entire market-wide risk pool not included in the claim trend

There are no changes planned for the composition of the provider network, fee schedules levels, utilization management, or

quality improvements in the projection period compared to the base period.

Impact on risk pool in expected covered membership risk characteristics

A factor of 1.0446 has been added to capture the membership changes not reflected in the base data. In 2020, CDPHP

introduced a new Gold plan. This plan has experienced significant membership growth in just the first 3 months of 2020.

Thirty-six percent (36%) of the membership is from CDPHP. The average pmpm for these members is thirty-five percent

(35%) higher than the existing HMO pool. Weighting these two blocks together results in an increase of 4.5% above the

2019 starting claim costs.

Impact of anticipated changes in the distribution of the membership in the risk pool by the standard rating regions

There has been no adjustment to the membership in the risk pool by the standard rating regions.


Premium Rate Filing

FORMS # 01-0006-2021

Federal Risk Adjustment Program

CDPHP relied on final risk adjustment results from 2017 and 2018, along with our latest internal results from 2019, to

project anticipated payment transfer results in the final CMS report to be issued on June 30, 2020. To estimate 2020, we

adjusted our factors to reflect the enrollment shift recognized in early 2020. We anticipate this shift will continue throughout

the 2020 benefit year.

MM

2020 RA Transfer (Payment)/Refund

Estimate

2020 RA Transfer (Payment)/Refund

Estimate PMPM

SG HMO/HNY 155,839 ($14,195,069) ($91.09)

RADV Adjustment ($200,107) ($14,395,176) ($92.37)

The resulting PMPM was converted to a factor based upon overall average Projected Index rate PMPM for all metal tier

plans on and off the Exchange. This factor, 1.208, was applied consistently across plans in each metal tier.

Exhibit RA has been provided to determine the impact to the proposed rates, in the event of a change in risk adjustment.

Credibility Adjustment:

The experience period used in the development of the 2021 premium rates is fully credible based on the member months

covered in the underlying claims experience.

Claim Trend Projection: Cost and Utilization Trend Factors

The average annual trend factor applied is 6.0%. The effective trend based on 24 months from the midpoint of the base

period to the midpoint of the rate period is 12.4%.

The allowed trend factors developed by type of service are shown in Exhibit B. The basis for development of trends is

CDPHP/CDPHP UBI’s commercial pool historical experience data, actual and projected contract provider reimbursement

rates, and input from CDPHP’s medical utilization management team and the following assumptions.

Service Mix Intensity: No additional adjustment has been made

Case Mix: No additional adjustment has been made

Adverse Selection: No additional adjustment for adverse selection has been incorporated in the annual trend

assumptions.

Deductible Leveraging: No explicit additional adjustments have been applied

Inpatient: Medical management programs will hold trend below the industry trend. Programs include Care

Management, Diabetic Management, and Readmission Avoidance.

Outpatient: More procedures are moving to ambulatory surgery centers. CDPHP’s patient centered medical

home program (EPC) enhances access to primary care services for members thereby decreasing the number

of ER visits. Admission review of all requested inpatient stays has resulted in higher trends in observation

room care and decreased inpatient stays.


Premium Rate Filing

FORMS # 01-0006-2021

Professional: Continued movement of services to the more appropriate setting will result in more

outpatient/office/telephonic services. Emphasis on primary care services and management of specialty care

through value based programs.

Other Medical: An increase in homecare is expected as more palliative care services are provided. Number of

genetic tests available continues to expand. Continued focus on educating participating providers on evidence

based use of high tech imaging. Increases in surgery result in increased durable medical equipment.

Pharmacy: Utilization and cost trends are based on the projected trends from CDPHP’s Pharmacy Benefit

Manager, Caremark, as well as input from CDPHP’s Pharmacy Management. Number and cost of Specialty Rx

continues to increase.

Annual rate trends are shown in the following table:

Projected Paid Trend Factor 2020 7.3%

Projected Paid Trend Factor 2021 7.3%

A quarterly trend of 1.78% was applied to the second, third and fourth quarter rolling rates. This trend was derived by

taking one-quarter of the trend factor used in the 2021 projection.

Plan Level Adjustments

AV Metal Values

The HHS AV Calculator was used to determine the Actuarial Value for all plans designs submitted in this rate filing.

AV Pricing Values

The AV Pricing Value for each plan design was determined using CDPHP’s in house pricing tool. The pricing tool applies

factors for each applicable cost share corresponding to each plan design. The pricing AV is determined by applying the cost

share factor for each benefit, and dividing the expected paid claims to the starting allowed claims for each plan. The Induced

Demand factors included in the final pricing are consistent with the factors included in the HHS Notice of Benefits and

Payment Parameters for 2021.

Induced Demand

Platinum 1.1500

Gold 1.0800

Silver 1.0300

Bronze 1.0000


Premium Rate Filing

FORMS # 01-0006-2021

Portfolio changes

CDPHP is retiring one plan design for 2021 at the Gold Metal level. This includes the following HIOS IDs:

94788NY0260089

94788NY0260090

94788NY0260091

94788NY0260092

94788NY0260093

94788NY0260094

94788NY0260095

94788NY0260096

Impact of changes in characteristics for provider network, delivery systems, utilization management, and claim cost for

quality improvements

There are no changes planned for the characteristics of the provider network, delivery system, utilization management, or

claim costs for quality improvements in the projection period compared to the base period. No adjustments were applied

outside the claim trend development.

Benefit in addition to the Essential Health benefits

Unique plan designs have been created to incorporate the following additional benefits (Exhibit C):

Mandatory Make Available Benefits

Dependent coverage extended from age 26 to 29

Domestic Partner

Family Planning

Additional Benefits Available

Adult Vision Exam and Hardware -Exam available once per year

Skilled Nursing Facility – extends coverage from 200 days to 365 days

Acupuncture – maximum of 10 visits per year

Lasik Surgery – maximum reimbursement of $750

Gym Membership - $200/$100 for Subscriber/Spouse every six (6) months with documentation of fifty (50) visits.

Added 01/2020

Cicotti Center (Next Step & Kids on the Move) – Reimbursement of $50 enrollment fee upon completion of the program

Child Birthing classes – reimbursement up to $75

Telenutrition – Nutritional counseling has been added as part of the Telemedicine benefit

Fertility Preservation – NYS Mandate


Premium Rate Filing

FORMS # 01-0006-2021

Added 01/2021

Hearing Aids, $899 Copay Each

OP Cardiac and Pulmonary Rehab – Cost Share after any deductible has been removed

Home Health Visits - Cost Share after any deductible has been removed

HSA Preventive Carve outs – Additional benefits will not be subject to deductible per the USPTF recommendations

Reduced Cost Share for CHF – Cost share will be waived for follow-up visits after an IP stay for a period of 3 months

Digital Smoking Cessation – New app based program to support smoking cessation

Adult Hardware Carved out of Deductible, on non-qualified high deductible plans only.

Administrative Expense Load

The administrative expense load is based on actual 2019 administrative expense, along with 2020 budgeted expense in the

current small group market.

Taxes and Fees

PCORI: PCORI has not been included since PCORI will not be assessed for plan years ending after July 31st, 2020. Source: NYS DFS Instructions for the filing of 2021 Premium Rates

Risk Adjustment Fee: $0.19 pmpm has been included Source: NYS DFS Instructions for the filing of 2021 Premium Rates

NYS Regulatory Authority license and fees: Based on a percent of premium using prior year actuals

The total load for Administrative Expense and Contribution to Surplus compared to prior year actual is shown in the

following table. Non-benefit expense load is applied consistently for all plans across all metal tiers.

SG HMO 2021 % of

Premium Projected

% of Premium based on

2019 Actuals

2020 Filing % of

Premium Projected

General Administrative Expense 7.36% 5.76% 6.18%

Broker Commissions 2.98% 3.72% 3.07%

Quality Improvement 0.56% 1.33% 1.04%

Community Benefits 0.00% 0.00% 0.00%

Subtotal – Excluding ACA Taxes and Fees 10.90% 10.82% 10.29%

NYS Regulatory Authority license and fees 0.50% 0.52% 0.55%

ACA Insurers tax 0.00% 0.00% 1.00%

Risk Adjustment 0.08% 0.08% 0.07%

Total Administrative Expense Including ACA 11.49% 11.42% 11.91%

Profit and contribution to Surplus 1.00% 0.0% (a loss was incurred) 1.00%

Total Retention including Profit 12.49% 11.42% 12.91%


Premium Rate Filing

FORMS # 01-0006-2021

Other Adjustments

Impact of COVID-19

CDPHP has included -3.75% for 2020, and +3.75% for 2021 as we believe over the course of this time period the net impact

will be zero. The decrease in 2020 is based on very limited data: addition of 0.58% for member cost share liability waiver, and

-4.33% to account for the decrease in utilization of services. Assuming there is not a second wave of the virus at the end of

2020, we expect utilization to increase slightly higher than historical levels into 2021, as deferred services are rendered. The

3.75% increase in 2021, is a return to full capacity in 2021 compared to the reduced capacity currently being experienced, as

well as normal trend. This estimate does not include any impact for the premium grace period extension as we are not

experiencing significant premium deferral at this time. CDPHP has also not included any charges for the anticipated antibody

testing, as it is too early to estimate the impact, although early indicators suggest this could wipe out any savings currently

being experienced due to lower utilization of services. In the event the actual savings in 2020 results in an MLR below the

minimum threshold, rebates will be distributed as required, current estimates do not show any line of business falling below

regulatory MLR limits.

Healthy New York Stop-loss

The projected Healthy New York Stop-loss recovery has been set at 0.825; $87.00 PMPM as per the DFS instructions.

Additional Factors applied to Premium rate build up

Conversion Factor

The single conversion factor was calculated using subscribers and members enrolled in this small group product for calendar

year 2019. See Exhibit G.

Regional Factors

CDPHP is expanding into Jefferson, Lewis and St. Lawrence counties effective 1/1/2021. CDPHP is currently in region 7,

therefore, the counties will be rolled in with the existing regional factors.

The regional factors have been updated for 2021 using small group and individual combined 2019 allowed costs, paid as of

February 2020. The estimated 2019 Risk Adjustment Transfer was incorporated into the allowed costs. Due to the lack of

credibility in regions 6 and 7, a credibility factor has been applied to each region compared to region 1. The credibility

factors used are the same as submitted and approved for the experience rated products. The overall impact of this change is

0%. See Exhibit H.

Exhibit Differences

Exhibit 23 vs Exhibits 13c and 14: As per the instructions, Exhibit 23 explicitly asks for members on a 2020 plan that will

still be offered in 2021. Therefore members still on a 2019 plan, which have not renewed yet, have been excluded. Exhibits

13c and 14 include all members as of 3/31/20 on plans that continue to 2021, regardless of the benefit plan year.

Exhibit 13c vs Exhibit 14: As indicated above, Exhibit 13c weights the single rate by subscribers. Exhibit 14 weights the

PMPM by membership. As a result the annual premium and average increases are slightly off.

Exhibit 13c vs Exhibit 18: These exhibits differ slightly. When one HIOS ID is used, Exhibits 13c and 18 match exactly.

Once multiple HIOS IDs are introduced, the weighting of the regional factor at the plan level in exhibit 18 vs the weighting

of the regions in exhibit 13c do not produce the same result.


Premium Rate Filing

FORMS # 01-0006-2021

Dental

CDPHP has entered into a partnership with Delta Dental to provide pediatric dental benefits. These benefits are in

compliance with the EHB in accordance with the ACA. CDPHP will assume the marketing, enrollment, billing and

renewal responsibilities, while Delta Dental will assume the underwriting risk and administration of the benefits as a

standalone contract.

Advance Primary Care (APC) Initiatives

An adjustment for funding the Advanced Primary Care (APC) initiatives in 2020 has not been included in the 2020 MLR

calculation. Since CDPHP has been involved in these types of programs with its provider community for the past several

years, it has already made significant investment of resources in the transformation of participating primary care practices.

CDPHP’s Enhanced Primary Care (EPC) program has transitioned primary care doctors from a historic fee-for-service (FFS)

payment model, to a risk-adjusted global payment with the addition of a Triple Aim performance bonus. The base payment

model is a risk-adjusted comprehensive global payment that pays providers above the traditional model (FFS/Care

Coordination/PIPs). Throughout the last 10+ years, CDPHP has given a significant amount of funding and resources to

support the transition to value-based care for participating providers. As new practices seek to transform to the APC model

CDPHP will provide them additional transformation assistance.

Historical Claim Data by Policy Form (Exhibit 17)

For each experience period represented in this exhibit, incurred claims and membership for all in-force plans, for each 12

month period, includes paid claims and revised estimates for remaining reserves as of March 2020. Exhibit 17 includes data

for all rating regions

Standardized premium factors were developed in Exhibit M and was based on the scale required by the NYS Department of

Financial Services.

Projected Loss Ratio

The projected medical loss ratio based on the New York State definition is 87.5%.

Exhibit 15b MHPAEA Compliance Certification

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

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

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

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

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

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

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

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

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

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

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

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

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

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

surgical benefits related to this filing.

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

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

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

Signature: ___________________________________________________________________________ Printed name and title: _________________________________________________________________ Date: ______________________ Phone: ___________________________________________________ Email Address: _______________________________________________________________________

CPA, Executive VP, CF0

CDPHP

CDPHP

CDPHP

CDPHP

5/11/20

Company Name: CDPHP

NAIC Code: 95491



A. Insurer Information: HMO-44 Not-for-Profit 95491Company submitting the rate filing request Company Type Org. Type Company NAIC Code

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

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

D. New Rate Information: CAPD-132341192New rate applicability period New rate effective date SERFF Tracking Number

E.

F. Provide responses for the following questions:

1.

2.

3.

4.

5.

6

Notes:(1)

(2)

EXHIBIT 11: GENERAL INFORMATION

CDPHP

500 Patroon Creek Blvd, Albany NY 12206

Company mailing address

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

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

(2).

Yes

January 1, 2021 - December 31, 2021 1/1/2021

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

segment per rate adjustment filing): Small Group (Including Healthy NY)

Response

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

description of the contract language changes included in this filing.

Yes 2021 Model Language

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

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

No

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

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

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

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

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

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

date DFS sends the blast email to insurers.

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

been provided why such exhibit is not applicable?

Yes

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

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

SERFF number of the pre-filing.

Yes, CAPD-132341163

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

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

Yes, 94788-1751532659789956099


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A B C D E F G H

Pr

esUnified Rate Review v5.1 [assistive technology users, please reference cell A1 for instructions]

Company Legal Name: Capital District Physicians' Health Plan


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

Section I: Experience Period Data

Experience Period: 1/1/2019 to 12/31/2019

Total PMPM

$37,060,404.40 $397.09

$0.00 $0.00

$29,329,880.50 $314.26

-$8,621,084.85 -$92.37

$39,917,074.63 $427.70

93,330

Section II: Projections

Benefit CategoryExperience Period Index

Rate PMPM Cost Utilization Cost UtilizationTrended EHB Allowed Claims

PMPM

Inpatient Hospital $82.82 1.077 0.993 1.083 1.009 $96.79

Outpatient Hospital $84.84 1.036 1.027 1.061 1.009 $96.64

Professional $123.18 1.023 1.009 1.023 1.009 $131.24

Other Medical $39.56 1.105 1.006 1.048 1.006 $46.36

Capitation $14.43 1.034 1.000 1.020 1.000 $15.22

Prescription Drug $52.26 1.052 1.020 1.056 1.020 $60.40

Total $397.09 $446.65

Morbidity Adjustment 1.000

Demographic Shift 1.000

Plan Design Changes 0.994

Other 1.043

Adjusted Trended EHB Allowed Claims PMPM for 1/1/2021 $463.06

Manual EHB Allowed Claims PMPM $0.00

Applied Credibility % 100.00%

Projected Period Totals

Projected Index Rate for 1/1/2021 $463.06 $60,996,115.44

Reinsurance $0.00 $0.00

Risk Adjustment Payment/Charge -$92.37 -$12,167,345.88

Exchange User Fees 0.00% $0.00

Market Adjusted Index Rate $555.43 $73,163,461.32

Projected Member Months 131,724

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

to the full extent of the law.

Market Level Calculations (Same for all Plans)

Year 1 Trend Year 2 Trend

Allowed Claims

Reinsurance

Incurred Claims in Experience Period

Risk Adjustment

Experience Period Premium

Experience Period Member Months

1 of 10

Press TAB and directional arrow keys to read through the document. If macros are disabled, press and hold the ALT key and press the F, then I, and then N key. After that, select the Enable All Content option by pressing enter. (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells P1 through P6. If screen reader fails to announce a cell after performing a dropdown selection, please press F2 and then ESC to force the screen reader to resume.Product-Plan Data Collection [assistive technology users, please reference cell A1 for instructions]

Company Legal Name: Capital District Physicians' Health Plan


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

Field # Section I: General Product and Plan Information

1.1 Product Name

1.2 Product ID

1.3 Plan Name SHGFHN58 SHGFHN59 SHGFHN60 SHGFHN61 SHGFHN62 SHGFHN63

1.4 Plan ID (Standard Component ID) 94788NY0260065 94788NY0260066 94788NY0260067 94788NY0260068 94788NY0260069 94788NY0260070

1.5 Metal Gold Gold Gold Gold Gold Gold

1.6 AV Metal Value 0.819 0.819 0.819 0.819 0.819 0.819

1.7 Plan Category Renewing Renewing Renewing Renewing Renewing Renewing

1.8 Plan Type HMO HMO HMO HMO HMO HMO

1.9 Exchange Plan? No No No No No No

1.10 Effective Date of Proposed Rates 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021

1.11 Cumulative Rate Change % (over 12 mos prior) 7.76% 7.47% 8.13% 7.76% 7.85% 7.47%

1.12 Product Rate Increase %

1.13 Submission Level Rate Increase %

Worksheet 1 Totals Section II: Experience Period and Current Plan Level Information

2.1 Plan ID (Standard Component ID) Total 94788NY0260065 94788NY0260066 94788NY0260067 94788NY0260068 94788NY0260069 94788NY0260070

$37,060,404 2.2 Allowed Claims $37,060,404 $896,629 $289,876 $0 $7,471,644 $0 $436,799

$0 2.3 Reinsurance $0 $0 $0 $0 $0 $0 $0

2.4 Member Cost Sharing $7,730,524 $187,030 $60,466 $0 $1,558,529 $0 $91,113

2.5 Cost Sharing Reduction $0 $0 $0 $0 $0 $0 $0

$29,329,881 2.6 Incurred Claims $29,329,881 $709,599 $229,410 $0 $5,913,115 $0 $345,686

-$8,621,085 2.7 Risk Adjustment Transfer Amount -$8,621,085 -$208,576 -$67,432 $0 -$1,738,073 $0 -$101,609

$39,917,075 2.8 Premium $39,917,075 $1,071,270 $252,890 $0 $7,600,639 $0 $453,002

93,330 2.9 Experience Period Member Months 93,330 2,258 730 0 18,816 0 1,100

2.10 Current Enrollment 12,330 225 57 0 1,594 0 76

2.11 Current Premium PMPM $522.46 $529.08 $489.58 $0.00 $496.28 $0.00 $495.01

2.12 Loss Ratio 93.72% 82.25% 123.70% #DIV/0! 100.86% #DIV/0! 98.38%

Per Member Per Month

2.13 Allowed Claims $397.09 $397.09 $397.09 #DIV/0! $397.09 #DIV/0! $397.09

2.14 Reinsurance $0.00 $0.00 $0.00 #DIV/0! $0.00 #DIV/0! $0.00

2.15 Member Cost Sharing $82.83 $82.83 $82.83 #DIV/0! $82.83 #DIV/0! $82.83

2.16 Cost Sharing Reduction $0.00 $0.00 $0.00 #DIV/0! $0.00 #DIV/0! $0.00

2.17 Incurred Claims $314.26 $314.26 $314.26 #DIV/0! $314.26 #DIV/0! $314.26

2.18 Risk Adjustment Transfer Amount -$92.37 -$92.37 -$92.37 #DIV/0! -$92.37 #DIV/0! -$92.37

2.19 Premium $427.70 $474.43 $346.42 #DIV/0! $403.95 #DIV/0! $411.82

Product/Plan Level Calculations

HMO

94788NY026

7.98%

7.98%

Section III: Plan Adjustment Factors

3.1 Plan ID (Standard Component ID) 94788NY0260065 94788NY0260066 94788NY0260067 94788NY0260068 94788NY0260069 94788NY0260070

3.2 Market Adjusted Index Rate

3.3 AV and Cost Sharing Design of Plan 0.8188 0.8188 0.8188 0.8188 0.8188 0.8188

3.4 Provider Network Adjustment 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

3.5 Benefits in Addition to EHB 1.0032 1.0032 1.0032 1.0032 1.0032 1.0032

Administrative Costs

3.6 Administrative Expense 10.90% 10.90% 10.90% 10.90% 10.90% 10.90%

3.7 Taxes and Fees 0.59% 0.59% 0.59% 0.59% 0.59% 0.59%

3.8 Profit & Risk Load 1.00% 1.00% 1.00% 1.00% 1.00% 1.00%

3.9 Catastrophic Adjustment 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

3.10 Plan Adjusted Index Rate $521.36 $521.36 $521.36 $521.36 $521.36 $521.36

3.11 Age Calibration Factor 1.0000

3.12 Geographic Calibration Factor 1.0000

3.13 Tobacco Calibration Factor 1.0000

3.14 Calibrated Plan Adjusted Index Rate $521.36 $521.36 $521.36 $521.36 $521.36 $521.36

Section IV: Projected Plan Level Information

4.1 Plan ID (Standard Component ID) Total 94788NY0260065 94788NY0260066 94788NY0260067 94788NY0260068 94788NY0260069 94788NY0260070

4.2 Allowed Claims $60,996,115 $1,186,644 $301,308 $0 $8,406,715 $0 $401,744

4.3 Reinsurance $325,971 $37,573 $9,519 $0 $266,187 $0 $12,691

4.4 Member Cost Sharing $14,825,520 $215,020 $54,597 $0 $1,523,297 $0 $72,796

4.5 Cost Sharing Reduction $0 $0 $0 $0 $0 $0 $0

4.6 Incurred Claims $45,844,624 $934,051 $237,192 $0 $6,617,231 $0 $316,256

4.7 Risk Adjustment Transfer Amount -$12,167,618 -$249,405 -$63,182 $0 -$1,766,893 $0 -$84,243

4.8 Premium $64,069,300 $1,315,070 $315,064 $0 $8,928,734 $0 $423,431

4.9 Projected Member Months 131,724 2,700 684 0 19,128 0 912

4.10 Loss Ratio 88.33% 87.65% 94.17% #DIV/0! 92.40% #DIV/0! 93.24%

Per Member Per Month

4.11 Allowed Claims $463.06 $439.50 $440.51 #DIV/0! $439.50 #DIV/0! $440.51

4.12 Reinsurance $2.47 $13.92 $13.92 #DIV/0! $13.92 #DIV/0! $13.92

4.13 Member Cost Sharing $112.55 $79.64 $79.82 #DIV/0! $79.64 #DIV/0! $79.82

4.14 Cost Sharing Reduction $0.00 $0.00 $0.00 #DIV/0! $0.00 #DIV/0! $0.00

4.15 Incurred Claims $348.04 $345.94 $346.77 #DIV/0! $345.94 #DIV/0! $346.77

4.16 Risk Adjustment Transfer Amount -$92.37 -$92.37 -$92.37 #DIV/0! -$92.37 #DIV/0! -$92.37

4.17 Premium $486.39 $487.06 $460.62 #DIV/0! $466.79 #DIV/0! $464.29

1.0000

1.0000

1.0000

$555.43

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

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

State: NY To validate, select the Validate button or Ctrl + Shift + I.

Market: Small Group To finalize, select the Finalize button or Ctrl + Shift + F.

To remove a product, navigate to the corresponding Product Name/Product ID field and select the Remove Product button or Ctrl + Shift + Q.

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

SHGFHN64 SHGFHN65 SHGF2128 SHGF2129 SHGF2130 SHGF2131 SHGF2132 SHGF2133 SHGF2134 SHGF2135 SHSF3024

94788NY0260071 94788NY0260072 94788NY0260089 94788NY0260090 94788NY0260091 94788NY0260092 94788NY0260093 94788NY0260094 94788NY0260095 94788NY0260096 94788NY0260081

Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Silver

0.819 0.819 0.783 0.783 0.783 0.783 0.783 0.783 0.783 0.783 0.715

Renewing Renewing Terminated Terminated Terminated Terminated Terminated Terminated Terminated Terminated Renewing

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

No No Yes Yes Yes Yes Yes Yes Yes Yes Yes

1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021

7.85% 8.13% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% -100.00% 9.43%


$0 $0 $145,732 $5,559 $0 $3,703,658 $0 $147,320 $0 $0 $733,425

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

$0 $0 $30,399 $1,160 $0 $772,555 $0 $30,730 $0 $0 $152,987

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

$0 $0 $115,333 $4,400 $0 $2,931,102 $0 $116,590 $0 $0 $580,438

$0 $0 -$33,901 -$1,293 $0 -$861,554 $0 -$34,270 $0 $0 -$170,611

$0 $0 $181,737 $8,066 $0 $4,621,696 $0 $193,073 $0 $0 $781,067

0 0 367 14 0 9,327 0 371 0 0 1,847

0 0 73 6 0 1,240 0 34 0 0 286

$0.00 $0.00 $645.88 $575.30 $0.00 $575.43 $0.00 $574.39 $0.00 $0.00 $484.61

#DIV/0! #DIV/0! 78.01% 64.96% #DIV/0! 77.95% #DIV/0! 73.42% #DIV/0! #DIV/0! 95.08%

#DIV/0! #DIV/0! $397.09 $397.09 #DIV/0! $397.09 #DIV/0! $397.09 #DIV/0! #DIV/0! $397.09





#DIV/0! #DIV/0! -$92.37 -$92.37 #DIV/0! -$92.37 #DIV/0! -$92.37 #DIV/0! #DIV/0! -$92.37



HMO

94788NY026

7.98%

7.98%


0.8188 0.8188 0.7828 0.7828 0.7828 0.7828 0.7828 0.7828 0.7828 0.7828 0.7145

1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

1.0032 1.0032 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.0149

10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90%

0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59%

1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00%

1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

$521.36 $521.36 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $460.25

$521.36 $521.36 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $460.25


$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $1,522,698

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

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $434,730

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

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $1,087,968

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 -$317,021

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $1,591,446

0 0 0 0 0 0 0 0 0 0 3,432

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 85.37%

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! $443.68





#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! -$92.37


1.0000

1.0000

1.0000

$555.43

To remove a product, navigate to the corresponding Product Name/Product ID field and select the Remove Product button or Ctrl + Shift + Q.

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

SHSF3025 SHSF3026 SHSF3027 SHSF3028 SHSF3029 SHSF3030 SHSF3031 SHGF5017 SHGF5018 SHGF5019 SHGF5020


Silver Silver Silver Silver Silver Silver Silver Gold Gold Gold Gold

0.715 0.715 0.715 0.715 0.715 0.715 0.715 0.801 0.801 0.801 0.801

Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021 1/1/2021

9.14% 9.81% 9.43% 9.52% 9.14% 9.52% 9.81% 5.47% 5.19% 5.83% 5.47%


$22,634 $0 $21,060,459 $0 $2,146,668 $0 $0 $0 $0 $0 $0

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

$4,721 $0 $4,393,055 $0 $447,779 $0 $0 $0 $0 $0 $0

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

$17,913 $0 $16,667,405 $0 $1,698,889 $0 $0 $0 $0 $0 $0

-$5,265 $0 -$4,899,137 $0 -$499,363 $0 $0 $0 $0 $0 $0

$26,305 $0 $22,584,623 $0 $2,142,707 $0 $0 $0 $0 $0 $0

57 0 53,037 0 5,406 0 0 0 0 0 0

5 0 5,467 0 474 0 0 102 2 0 2,535

$491.77 $0.00 $489.64 $0.00 $492.51 $0.00 $0.00 $581.34 $584.15 $0.00 $584.16

85.14% #DIV/0! 94.24% #DIV/0! 103.38% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

$397.09 #DIV/0! $397.09 #DIV/0! $397.09 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!





-$92.37 #DIV/0! -$92.37 #DIV/0! -$92.37 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!



HMO

94788NY026

7.98%

7.98%


0.7145 0.7145 0.7145 0.7145 0.7145 0.7145 0.7145 0.8010 0.8010 0.8010 0.8010

1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

1.0149 1.0149 1.0149 1.0149 1.0149 1.0149 1.0149 1.0149 1.0149 1.0149 1.0149

10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90% 10.90%

0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59% 0.59%

1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00%

1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

$460.25 $460.25 $460.25 $460.25 $460.25 $460.25 $460.25 $515.97 $515.97 $515.97 $515.97

$460.25 $460.25 $460.25 $460.25 $460.25 $460.25 $460.25 $515.97 $515.97 $515.97 $515.97


$26,682 $0 $29,106,957 $0 $2,529,435 $0 $0 $639,524 $12,569 $0 $15,894,063

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

$7,618 $0 $8,310,036 $0 $722,154 $0 $0 $127,265 $2,501 $0 $3,162,918

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

$19,064 $0 $20,796,921 $0 $1,807,281 $0 $0 $512,259 $10,067 $0 $12,731,144

-$5,542 $0 -$6,059,977 $0 -$525,412 $0 $0 -$113,063 -$2,217 $0 -$2,809,958

$27,882 $0 $30,636,620 $0 $2,653,425 $0 $0 $661,595 $13,001 $0 $16,501,988

60 0 65,604 0 5,688 0 0 1,224 24 0 30,420

85.34% #DIV/0! 84.62% #DIV/0! 84.93% #DIV/0! #DIV/0! 93.39% 93.36% #DIV/0! 92.98%

$444.70 #DIV/0! $443.68 #DIV/0! $444.70 #DIV/0! #DIV/0! $522.49 $523.69 #DIV/0! $522.49





-$92.37 #DIV/0! -$92.37 #DIV/0! -$92.37 #DIV/0! #DIV/0! -$92.37 -$92.37 #DIV/0! -$92.37


1.0000

1.0000

1.0000

$555.43

SHGF5021 SHGF5022 SHGF5023 SHGF5024

94788NY0260101 94788NY0260102 94788NY0260103 94788NY0260104

Gold Gold Gold Gold

0.801 0.801 0.801 0.801

Renewing Renewing Renewing Renewing

HMO HMO HMO HMO

Yes Yes Yes Yes

1/1/2021 1/1/2021 1/1/2021 1/1/2021

5.55% 5.19% 5.55% 5.83%

94788NY0260101 94788NY0260102 94788NY0260103 94788NY0260104

$0 $0 $0 $0

$0 $0 $0 $0

$0 $0 $0 $0

$0 $0 $0 $0

$0 $0 $0 $0

$0 $0 $0 $0

$0 $0 $0 $0

0 0 0 0

0 154 0 0

$0.00 $584.15 $0.00 $0.00

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

HMO

94788NY026

7.98%

7.98%

94788NY0260101 94788NY0260102 94788NY0260103 94788NY0260104

0.8010 0.8010 0.8010 0.8010

1.0000 1.0000 1.0000 1.0000

1.0149 1.0149 1.0149 1.0149

10.90% 10.90% 10.90% 10.90%

0.59% 0.59% 0.59% 0.59%

1.00% 1.00% 1.00% 1.00%

1.0000 1.0000 1.0000 1.0000

$515.97 $515.97 $515.97 $515.97

$515.97 $515.97 $515.97 $515.97

94788NY0260101 94788NY0260102 94788NY0260103 94788NY0260104

$0 $967,777 $0 $0

$0 $0 $0 $0

$0 $192,588 $0 $0

$0 $0 $0 $0

$0 $775,189 $0 $0

$0 -$170,704 $0 $0

$0 $1,001,043 $0 $0

0 1,848 0 0

#DIV/0! 93.36% #DIV/0! #DIV/0!

#DIV/0! $523.69 #DIV/0! #DIV/0!

#DIV/0! $0.00 #DIV/0! #DIV/0!

#DIV/0! $104.21 #DIV/0! #DIV/0!

#DIV/0! $0.00 #DIV/0! #DIV/0!

#DIV/0! $419.47 #DIV/0! #DIV/0!

#DIV/0! -$92.37 #DIV/0! #DIV/0!

#DIV/0! $541.69 #DIV/0! #DIV/0!

1.0000

1.0000

1.0000

$555.43

Rating Area Data Collection [assistive technology users, please reference cell A2 for instructions]

Press TAB and directional arrow keys to read through the document. If macros are disabled, press and hold the ALT key and press the F, then I, and then N key. After that, select the Enable All Content option by pressing enter. (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells C1 through C4. If screen reader fails to announce a cell after performing a dropdown selection, please press F2 and then ESC to force the screen reader to resume.

Rating Area Rating Factor

Rating Area 1 1.0000




SERFF Tracking #: State Tracking #: Company Tracking #: 2021 … · 2020. 5. 29. · Filing at a...

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