SERFF Tracking #: State Tracking #: Company Tracking #: New … · 2019-05-23 · Filing at a...

Filing at a Glance

Company: Healthfirst Health Plan, Inc.Product Name: HFHP Small Group Rates Filing 2020State: New YorkTOI: HOrg02G Group Health Organizations - Health Maintenance (HMO)Sub-TOI: HOrg02G.004F Small Group Only - HMOFiling Type: 2020 Prior Approval ACA RatesDate Submitted: 05/13/2019SERFF Tr Num: HLFT-131929303SERFF Status: Pending State ActionState Tr Num: 2019050191State Status: CP-xx-RRCo Tr Num:

ImplementationDate Requested:

01/01/2020

Author(s):

Reviewer(s):Disposition Date:Disposition Status:Implementation Date:

State Filing Description:

SERFF Tracking #: HLFT-131929303 State Tracking #: 2019050191 Company Tracking #:

State: New York Filing Company: Healthfirst Health Plan, Inc.TOI/Sub-TOI: HOrg02G Group Health Organizations - Health Maintenance (HMO)/HOrg02G.004F Small Group Only

- HMOProduct Name: HFHP Small Group Rates Filing 2020Project Name/Number: /

PDF Pipeline for SERFF Tracking Number HLFT-131929303 Generated 05/21/2019 09:55 AM

General Information

Company and Contact

Filing Fees

State Specific

Project Name: Status of Filing in Domicile:Project Number: Date Approved in Domicile:Requested Filing Mode: Review & Approval Domicile Status Comments:Explanation for Combination/Other: Market Type: GroupSubmission Type: New Submission Group Market Size: SmallGroup Market Type: Employer Overall Rate Impact:Filing Status Changed: 05/17/2019State Status Changed: 05/17/2019 Deemer Date:Created By: Submitted By: Corresponding Filing Tracking Number:

PPACA: Not PPACA-Related

PPACA Notes: nullInclude Exchange Intentions: No

Filing Description:Healthfirst Health Plan, Inc.'s initial submission of its 2020 small group rate filing (including Healthy NY small group).

The state tracking number of the corresponding Prior Approval prefiling is 2019050056.

The SERFF tracking number of the associated form filing is HLFT-131930111.

Filing Contact Information

212-801-6210 [Phone]212-801-6197 [FAX]

Filing Company InformationHealthfirst Health Plan, Inc.100 Church StreetNew York, NY 10007(212) 801-6210 ext. [Phone]

CoCode: 95284Group Code: 4778Group Name:FEIN Number: 11-3029569

State of Domicile: New YorkCompany Type:State ID Number:

Fee Required? No

Retaliatory? No

Fee Explanation:

1. Is a parallel filing being submitted for another issuing entity of the same parent organization? Yes/No (If Yes, enter nameof other entity, submission date, and SERFF Tracking Number of the parallel file.): No





2. Does this filing contain a dental, vision or health insurance policy or contract that uses a network of health care providers?(If Yes, enter the PNDS Network ID number and name. If the network has not been filed in PNDS, it must be filed within 60days of approval.): Yes. Healthfirst Commercial MCO; NYOCOM13. : N/A4. Type of filing? Enter Form and Rate, Form only, Rate only (Form only should be used ONLY when the filing only containsan application, advertisement, administrative form, or is a group prefiling notification, out-of-state, or a report filing. Formsubmissions with no proposed rate impact are considered form and rate filings and require an actuarial memorandum.): 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, prior approval rate adjustment6. Does this submission contain a form subject to Regulation 123 (i.e., the certificate is deemed delivered in New York State)?Yes/No (If Yes, provide a full explanation in the Filing Description field.): No7. Did this insurer prefile group coverage for this group under Section 52.32 prior to this filing? Yes/No (If Yes, enter thestate tracking number assigned and the effective date of coverage.): No8. Does this submission contain any form which is subject to review by the Life Bureau, the Property Bureau or both? Yes/No(If Yes, identify the forms, the Bureau, the date submitted, and the SERFF file number.): No9. Does this filing contain forms that replace any other previously approved forms? Yes/No (If Yes, identify the formnumbers, the file number, and the date of approval of the forms being replaced in the Filing Description field.): No





Rate Information Rate data applies to filing.

Filing Method:Rate Change Type: %Overall Percentage of Last Rate Revision: %Effective Date of Last Rate Revision:Filing Method of Last Filing:SERFF Tracking Number of Last Filing:

Company Rate Information

CompanyName:

CompanyRateChange:

Overall %IndicatedChange:

Overall %RateImpact:

WrittenPremiumChange forthis Program:

Number of PolicyHolders Affectedfor this Program:

WrittenPremium forthis Program:

Maximum %Change(where req'd):

Minimum %Change(where req'd):

Healthfirst HealthPlan, Inc.

Increase 15.000% 15.000% $19,951 23 $133,008 15.000% 15.000%


State: New York Filing Company: Healthfirst Health Plan, Inc.TOI/Sub-TOI: HOrg02G Group Health Organizations - Health Maintenance (HMO)/HOrg02G.004F Small Group Only - HMOProduct Name: HFHP Small Group Rates Filing 2020Project Name/Number: /


Rate Review Detail COMPANY:Company Name: Healthfirst Health Plan, Inc.HHS Issuer Id: 83744

PRODUCTS:

Product Name HIOS Product ID HIOS Submission ID Number of CoveredLives

Healthfirst Small Group HMO/HealthfirstHealthy NY

23

Trend Factors: 4.35% Medical. 9.0% Pharmacy

FORMS:New Policy Forms: See associated form filing.Affected Forms:Other Affected Forms:

REQUESTED RATE CHANGE INFORMATION:Change Period: AnnualMember Months: 276Benefit Change: IncreasePercent Change Requested: Min: 15.0 Max: 15.0 Avg: 15.0

PRIOR RATE:Total Earned Premium: 133,008.00Total Incurred Claims: 110,397.00Annual $: Min: 481.91 Max: 481.91 Avg: 481.91

REQUESTED RATE:Projected Earned Premium: 152,959.00Projected Incurred Claims: 126,956.00Annual $: Min: 554.20 Max: 554.20 Avg: 554.20





Rate/Rule Schedule

ItemNo.

ScheduleItemStatus

Document NameAffected Form Numbers(Separated with commas) Rate Action Rate Action Information Attachments

1 HFHP Small Group RateManual 2020

New HFHP_RateManual_CombinedSmall Group_2020.pdf,HFHP SG 2020 RateManual 051319.xlsx,




HEALTHFIRST HEALTH PLAN, INC.

Rate Manual Pursuant to New York Insurance Law Section 4308(c)

Small Group & Healthy NY HMO Rates Submission

Effective January 1, 2020

_____________________________________________________________________________________ Healthfirst Health Plan, Inc. – Rate Manual Small Group Rates & Forms, Effective January 1, 2020 Page 2 of 19

TABLE OF CONTENTS

I. Small Group HMO Plan Rates…………………………………………….……………………..…….….3

A. Rate Pages ………………………………………………………………………………………………...…..4

B. Healthy NY Rate Pages………………………………………………………………………….…….…..8

C. Description of Rating Classes, Factors, and Premium Discounts……….……….…..….12

D. Rate Calculation Examples……………………………………………………………..………….…….14

E. Expected Loss Ratio(s)…………………………………………………………………………………...…15

F. Broker/Agent Commissions & Fees….………………………………………………………………16

II. Description of Benefits, Types of Coverage, Limitations, Exclusions, Issue Limits, and Renewal Conditions………………………………………………………….…….. 17

_____________________________________________________________________________________ Healthfirst Health Plan, Inc. – Rate Manual Small Group Rates & Forms, Effective January 1, 2020 Page 3 of 19

SECTION I Off-Exchange Small Group HMO

Premium Rates

_____________________________________________________________________________________________________________________ Healthfirst Health Plan, Inc. – Rate Manual Small Group Rates & Forms, Effective January 1, 2020 Page 4 of 19

Section I.A – Rate Pages

HEALTHFIRST HEALTH PLAN, INC. OFF-EXCHANGE SMALL GROUP HMO

RATE PAGES - EFFECTIVE JANUARY 1, 2020 AREAS: NEW YORK, KINGS, QUEENS, RICHMOND, BRONX, NASSAU, AND SUFFOLK COUNTIES

Quarter 1 2020

Applicable form numbers: HFHP-SG-20-OFF; HFHP-SG-SOB-20-OFF

Metal Level Product HIOS ID Single Single + Spouse Single + Child(ren)

Single + Spouse + Child(ren)

GoldHealthfirst HMO B, Domestic Partner & Family Planning 83744NY0010025 $939.81 $1,879.62 $1,597.68 $2,678.46

GoldHealthfirst HMO B, Age 29 RiderDomestic Partner & Family Planning 83744NY0010026 $971.16 $1,942.32 $1,650.97 $2,767.81

GoldHealthfirst HMO B, No Domestic Partner & Family Planning 83744NY0010027 $939.81 $1,879.62 $1,597.68 $2,678.46

GoldHealthfirst HMO B, Age 29 Rider, No Domestic Partner & Family Planning 83744NY0010028 $971.16 $1,942.32 $1,650.97 $2,767.81

GoldHealthfirst HMO B, No Domestic Partner & No Family Planning 83744NY0010029 $932.86 $1,865.72 $1,585.86 $2,658.65

GoldHealthfirst HMO B, Age 29 Rider, No Domestic Partner & No Family Planning 83744NY0010030 $963.98 $1,927.96 $1,638.77 $2,747.34

GoldHealthfirst HMO B, Domestic Partner & No Family Planning 83744NY0010031 $932.86 $1,865.72 $1,585.86 $2,658.65

GoldHealthfirst HMO B, Age 29 Rider, Domestic Partner & No Family Planning 83744NY0010032 $963.98 $1,927.96 $1,638.77 $2,747.34

Premium Rate Per Month


Quarter 2 2020





GoldHealthfirst HMO B, Age 29 RiderDomestic Partner & Family Planning 83744NY0010026 $986.70 $1,973.40 $1,677.39 $2,812.10


GoldHealthfirst HMO B, Age 29 Rider, No Domestic Partner & Family Planning 83744NY0010028 $986.70 $1,973.40 $1,677.39 $2,812.10







Quarter 3 2020





GoldHealthfirst HMO B, Age 29 RiderDomestic Partner & Family Planning 83744NY0010026 $1,002.49 $2,004.98 $1,704.23 $2,857.10


GoldHealthfirst HMO B, Age 29 Rider, No Domestic Partner & Family Planning 83744NY0010028 $1,002.49 $2,004.98 $1,704.23 $2,857.10







Quarter 4 2020





GoldHealthfirst HMO B, Age 29 RiderDomestic Partner & Family Planning 83744NY0010026 $1,018.53 $2,037.06 $1,731.50 $2,902.81


GoldHealthfirst HMO B, Age 29 Rider, No Domestic Partner & Family Planning 83744NY0010028 $1,018.53 $2,037.06 $1,731.50 $2,902.81


GoldHealthfirst HMO B, Age 29 Rider, No Domestic Partner & No Family Planning 83744NY0010030 $1,010.99 $2,021.98 $1,718.68 $2,881.32


GoldHealthfirst HMO B, Age 29 Rider, Domestic Partner & No Family Planning 83744NY0010032 $1,010.99 $2,021.98 $1,718.68 $2,881.32



Section I.B – Rate Pages

HEALTHFIRST HEALTH PLAN, INC. OFF-EXCHANGE HEALTHY NY SMALL GROUP HMO

RATE PAGES - EFFECTIVE JANUARY 1, 2020 AREAS: NEW YORK, KINGS, QUEENS, RICHMOND, BRONX, NASSAU, AND SUFFOLK COUNTIES

Quarter 1 2020

Applicable form numbers: HFHP-HNY-20-OFF; HFHP-HNY-SOB-20



GoldHealthfirst Healthy NY, Domestic Partner & Family Planning 83744NY0020009 $827.70 $1,655.40 $1,407.09 $2,358.95

GoldHealthfirst Healthy NY, Age 29 Rider, Domestic Partner & Family Planning 83744NY0020010 $855.30 $1,710.60 $1,454.01 $2,437.61

GoldHealthfirst Healthy NY, No Domestic Partner & Family Planning 83744NY0020011 $827.70 $1,655.40 $1,407.09 $2,358.95

GoldHealthfirst Healthy NY, Age 29 Rider, No Domestic Partner & Family Planning 83744NY0020012 $855.30 $1,710.60 $1,454.01 $2,437.61

GoldHealthfirst Healthy NY, No Domestic Partner & No Family Planning 83744NY0020013 $820.74 $1,641.48 $1,395.26 $2,339.11

GoldHealthfirst Healthy NY, Age 29 Rider, No Domestic Partner & No Family Planning 83744NY0020014 $848.08 $1,696.16 $1,441.74 $2,417.03

GoldHealthfirst Healthy NY, Domestic Partner & No Family Planning 83744NY0020015 $820.74 $1,641.48 $1,395.26 $2,339.11

GoldHealthfirst Healthy NY, Age 29 Rider, Domestic Partner & No Family Planning 83744NY0020016 $848.08 $1,696.16 $1,441.74 $2,417.03



Quarter 2 2020














Quarter 3 2020














Quarter 4 2020 Applicable form numbers: HFHP-HNY-20-OFF; HFHP-HNY-SOB-20












_______________________________________________________________________________________ Healthfirst Health Plan, Inc. – Rate Manual Small Group Rates & Forms, Effective January 1, 2020 Page 12 of 19

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

As illustrated below, Healthfirst Health Plan’s premium rates vary based on only several factors: dependent age limit, the inclusion of a pediatric dental benefit, the inclusion of family planning benefits, and family/census tier.

Family/Census Tier

Census Tiers Cost Factor

Single 1.000

Single + Spouse 2.000

Single + Child(ren) 1.700

Single + Spouse + Child(ren) 2.850

Rating Region

Rating Region Counties Included Area Factor

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

Long Island Nassau, Suffolk 1.000

Family Planning Benefits

Family Planning Rider Cost Factor

Included 1.000

Not Included 0.992

Dependent Age Limit

Dependent Age Limit Cost Factor

26 1.000

29 1.033


Domestic Partner Coverage

Domestic Partner Cost Factor

Covered 1.000

Not Covered 1.000


Section I.D – Rate Calculation Examples

The entirety of premium rates for Healthfirst Health Plan, Inc.’s small group plans is listed above in the rate tables in section I.A. An example of how to look up a particular premium rate is below.

EXAMPLE:

Consumer Profile: An employee (subscriber) of a Richmond County-based employer who is electing to cover himself, with coverage effective in the first quarter of 2020, and not choosing the Age 29 Rider.

Rate Look-Up Solution: One would proceed to page 4 and refer to the first table. Next, the consumer would refer to the row labeled, “Healthfirst HMO B” and cross-reference the row labeled, “Single.” The rate for this plan is $939.81 per month.


Section I.E – Expected Loss Ratios

The projected loss ratio using the Federal medical loss ratio (MLR) methodology is 83.8%. The expected loss ratio under New York State’s MLR methodology is 83.0%.


Section I.F – Broker/Agents Commissions & Fees

Brokers/agents who sell the products and plans listed herein will not be compensated by Healthfirst for such sale. These products and plans thus do not include any consideration related to broker/agent commissions and/or fees.


SECTION II

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

& Renewal Conditions


Section II – Off-Exchange Small Group HMO (& Healthy NY) Gold Benefit Description (with Family Planning)

Healthfirst HMO B/Healthy NY

Individual Deductible $600 Max Out of Pocket (Individual) $4,000

Primary Care Doctor Visit $25 copayment after deductible Specialist Doctor Visit $40 copayment after deductible

Preventive Care 100% covered as per Essential Health Benefits guidelines

Emergency Room (Cost sharing waived if admitted) $150 copayment after deductible

Ambulatory Surgical Center Facility Fee $100 copayment after deductible

Ambulatory Surgical Professional $100 copayment after deductible

Lab Diagnostic

Office: PCP - $25 copay after deductible SPC -$40 copay after deductible Outpatient Hospital Services: $40 copay after deductible

Inpatient Hospital Services [and Birthing Center]

$1,000 copayment after deductible per Admission

Rehabilitation Services (Physical Therapy, Occupational Therapy or Speech Therapy)

$30 copayment after deductible

Skill Nursing Facility 200 days per plan year


Inpatient Habilitation Services (Physical, Speech & Occupational therapy)


Inpatient Rehabilitation Services (Physical, Speech & Occupational therapy)


Mental Health/Substance Abuse - Inpatient


Mental Health/Substance Abuse - Outpatient / Behavioral Health $25 copayment after deductible

Retail Generic Drugs (Tier 1) $10 copayment


Healthfirst HMO B/Healthy NY Retail Preferred Drugs (Tier 2) $35 copayment Retail Non-Preferred Drugs (Tier 3) $70 copayment

The benefits below would be excluded for the Off-Exchange Small Group HMO Gold and Healthy New York benefit when an eligible religious employer elects to opt-out of the family planning benefits.

• Contraceptive drugs and devices (or generic Rx drug equivalents approved as substitutes by the FDA)

• Counseling on the use of contraceptives and related topics • Sterilization procedures for women • Vasectomies • Elective abortions

Supporting Document Schedules Satisfied - Item: 2020 Rate Filing ChecklistComments:Attachment(s): HFHP SG Checklist 2020.pdfItem Status:Status Date:

Satisfied - Item: Actuarial Memorandum and CertificationsComments:Attachment(s): HFHP_SG_Actuarial_Memorandum_2020_FINAL_051319.pdfItem Status:Status Date:

Satisfied - Item: Actuarial Value CalculationsComments:Attachment(s): HFHP AV Screenshots For 2020 Rate Filing.pdfItem Status:Status Date:

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

Attachment(s): HFHP 2020_exh13A_050919.xlsmHFHP 2020_exh13A_050919.pdf

Item Status:Status Date:

Satisfied - Item: Exhibit 13b: Narrative SummaryComments:Attachment(s): Narrative Summary_HFHP Small Group and HNY OffExchange 2020.pdfItem Status:Status Date:

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

Attachment(s): HFHP 2020_exh13C_05132019.pdfHFHP 2020_exh13C_05132019.xlsm





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

Attachment(s): HFHP 2020_exh14_05132019.pdfHFHP 2020_exh14_05132019.xlsm


Bypassed - Item: Exhibit 15a: Product Discontinuance CertificationBypass Reason: The company is not discontinuing any plans.Attachment(s):Item Status:Status Date:

Satisfied - Item: Exhibit 15b: MHPAEA Compliance CertificationComments:Attachment(s): HFHP SG 2020 Exh 15B MHPAEA Cert Signed.pdfItem Status:Status Date:

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

Attachment(s): HFHP 2020_exh16_05092019.xlsmHFHP 2020_exh16_05092019.pdf


Satisfied - Item: Exhibit 17: Claims ExperienceComments:



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




Attachment(s): HFHP 2020_exh18_05132019.xlsmHFHP 2020_exh18_05132019.pdf


Satisfied - Item: Exhibit 19: Summary of Average Claim Trend and Admin Expenses and Profit MarginComments:



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



Bypassed - Item: Final Notice of Proposed Rate AdjustmentBypass Reason: The final notice is not yet available.Attachment(s):Item Status:Status Date:

Satisfied - Item: Initial Notice of Proposed Rate AdjustmentComments:

Attachment(s):2020 Rate adjustment notice - Group Certificate Holder HFHP (HMOB) v2.pdf2020 Rate adjustment notice - Group Certificate Holder HFHP (HNY) v2.pdf2020 Rate adjustment notice - Group Policyholder HFHP (HMOB) v2.pdf2020 Rate adjustment notice - Group Policyholder HFHP (HNY) v2.pdf


Satisfied - Item: Redacted Documents for Web PostingComments:




Attachment(s):

HFHP 2020_exh21A_05132019_Redacted.pdfHFHP 2020_exh21B_05132019_Redacted.pdfHFHP 2020_exh22_05132019_Redacted.pdfHFHP_SG_Actuarial_Memorandum_2020_FINAL_051319_Redacted.pdfHFHP 2020_exh11_05132019_Redacted.pdf


Satisfied - Item: Unified Rate Review TemplateComments:

Attachment(s): HFHP Unified_Rate_Review_Template (HNY) 051319.pdfHFHP Unified_Rate_Review_Template (HNY) 051319.xlsm


Satisfied - Item: Supplemental Actuarial FilesComments:

Attachment(s):File 2 - QHP 2018 Interim Risk Adjustment.xlsxFile 1 - Wakely - Dec 2018 - QHP - WNRAR-IND-Y5891889-20190220.xlsxResponse to Obj 051519_HFHP SG.xlsx





NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES

Checklist for the Filing of 2020 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)(l), 4308(c), 3231{d), or4308{b)) 4308(c)2. For filings made pursuant to 3231{e)(l) and 4308{c):

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

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

N/A

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

3. Does this filing introduce any new plans {i.e., new 14-digit HIOSIDs)? �N�o�-4. Has the Company provided two versions (i.e., PDF and Excel) of all rate filing Exhibits and Rate Manual? �Y�e=-s __ 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? ....:Y

-=e

=-s __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? �Y�e �s __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? �Y�e �s __8. Confirm that the 2020 version (updated in 2019) of the rate filing Exhibits were utilized {Yes/No: Respond "Yes" to confirm). _Y�e=s __9. With regard to the "Rate Review Detail" screen in SERFF:

a. Was it completed in a manner consistent with 2019 premium rate filings? b. Do the "Average" percentages look reasonable (e.g., do they fall between "Minimum" and "Maximum" percentages?c. Do the "Minimum" and "Maximum" values appear reasonable in light of changes that are being proposed? d. Are the "Minimum", "Maximum" and "Average" values stated on an Annualized PMPM basis (as opposed to annual

premium)? e. Are all items that are not applicable left blank (i.e., Items that are not applicable should be left blank)?f. Have the "Requested Rate Period" data fields been populated with non-zero values?

10. Is the information presented in Exhibit 18 provided at the HIOS SCIO level {i.e., are there 14 digits in the HIOS ID?)11. Does Exhibit 23 contain rates for every distinct 14-digit HIOS ID as opposed to only the "Base" plan rates?12. Does the Company's claim experience for 2018 include two months of run-out?13. 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 2020 assumption for risk adjustment to the extent actual 2018 results are different from expected?15. Does the PMPM value in Cell Q-74 of Exhibit 13C equal the value in Cell D-96 {Line 54 Column D) of Exhibit 18? 16. Does the PMPM value in Cell Z-74 of Exhibit 13C equal the value in Cell D-102 {Line 56 Column D) of Exhibit 18? 17. Does the overall rate change calculated in Exhibit 13c accurately represent the Company's expectation of the rate change?

a. If not, did the Company's Actuary reach out too submission of the filing by contacting

Healthfirst Healthplan {HFHP}

Yes YesYes

Yes

YesYesYesYesYes

YesYesYes Yes

Explanation of 2c: Healthfirst PHSP QHP experience, which is fully credible, is used in determining the rates for HFHP Small Group, which does nothave credible experience.

he Chief Actuary responsible forth is filing: � _

EXHIBIT 13a: NUMERICAL SUMMARY AND RATE INDICATION CALCULATION

NUMERICAL SUMMARY

Healthfirst Health Plan, Inc.95284

SERFF Tracking #: HLFT-131929303Market 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 "2020 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 2019 and 2020 should be based on the DFS Membership Survey data as of 3/31/2019.12 This exhibit must be submitted as an Excel file and as a PDF file.

A. Average 2019 and 2020 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 2019 and Columns U-Y for 2020)2 Premium Rates for 2020 should be Consistent with the Premium Rates reflected in Exhibit 23.

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

2019 Weighted Average Base Premium Rates 719.74$ 2020 Weighted Average Base Premium Rates 827.70$

B. Weighted Average Annual Percentage Requested Adjustments:

2019 Weighted Average PMPM Rate 2020 Weighted Average PMPM Rate2019 to 2020 All - Metals All - Metals

Requested Rate Adjustment 15.00000% 481.91$ 554.20$ 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]*:2017 to 2018 2018 to 2019

Average Rate Adjustment Requested 10.00000% 21.00000%Average Rate Adjustment Approved 6.10000% 16.00000%

D. Average Medical Loss Ratios [MLR] for All Policies Impacted [Ratios of Incurred Claims to Earned Premiums] [If Applicable]*:2016 2017 2018

MLR 22.9% 23.5% 46.0%

E. Claim Trend Rates and Average Ratios to Earned Premiums [Per Exhibit 19 for 2018‐2020 and Comparable Exhibits for 2018] [If Applicable]*:2018 2019 2020

Annual Claim Trend Rates 6.0% 6.5% 6.2%Expense Ratios 13.6% 13.6% 13.7%Pre Tax Profit Ratios 5.0% 2.0% 4.0%* If no products were offered in a particular year, indicate "N/A" in the applicable box.

Company NAIC Code:

Exhibit 13a Updated by DFS 3/14/2018 1

NARRATIVE SUMMARY

Community-Rated Small Group Commercial Comprehensive Premium Rate Filings Plan Year 2020

Healthfirst Health Plan, Inc. (“Healthfirst”) has submitted to the N ew York Department of Financial Services ( DFS) an appl ication to a djust pr emium r ates for s mall gr oup m arket h ealth i nsurance coverage – including Healthfirst’s Healthy NY product – effective in 2020. Healthfirst has requested an increase in premium rates for plans offered in 2020. Th e Department of Fi nancial Services is reviewing Healthfirst’s requested premium rate increase and will determine if the rates are appropriate based on the available evidence.

The r equested r ate adj ustments w ill affec t a ll currently enr olled s mall gr oup m arket s ubscribers renewing coverage for the 2020 calendar year as well as new small group policies issued during the 2020 calendar year. Final rate adjustments approved by DFS will be effective January 1, 2020. The rates are guaranteed for a 12 -month per iod ending December 31, 2 020 and ar e subject to New York’s community rating and guarantee issue laws. Subscribers’ rates will vary according to the benefit plan in which they enroll, as well as the census/family tier they select.

As of the d ate of the submission of this Narrative Summary, approximately 25 covered l ives ( i.e., subscribers and their covered dependents) are estimated to be affected by the rate adjustment.

A Description of Your Premium Rate Your heal th i nsurance premium r ate has tw o main c omponents. O ne i s the c osts of pay ing for medical care and the other is Healthfirst’s administrative costs.

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

paying for the costs of the medical claims submitted by you and other members enrolled in Healthfirst’s s mall gr oup m arket pl ans. U nder N ew Y ork l aw, at l east 82 per cent of the premium H ealthfirst’s members pay m ust be put tow ard pay ing for the c osts of m edical claims. M ore than 82 per cent of H ealthfirst’s p remium dol lars i s us ed for pay ing medical expenses.

2. Administrative cost s. Administrative ex penses i nclude a w ide r ange of s ervices an d

functions, such as processing claims and upgrading technology to keep pace with the rapidly changing health care sector. It also accounts for an array of member-centric expenses such as c onducting m edical nec essity r eviews, m anaging m embers’ c omplex and c hronic conditions, m aintaining a r obust pr ovider netw ork, and par tnering w ith the c ommunity on health education initiatives.

Healthfirst takes a meaningful and evidence-based approach to determining how much of a rate adjustment to request from DFS.

Your Rate Adjustment Explained Healthfirst is applying for a rate adjustment to account for marketplace trends and to reflect actual and anticipated claims costs. While several market forces continue to drive health care costs higher more generally, Healthfirst continues to s trengthen the effec tiveness of i ts care management and quality improvement programs and robust network.

Healthfirst is requesting a higher rate for 2020 because several market forces continue to drive health care costs higher. These forces include:

• Cost increases for inpatient hospital, outpatient hospital, and physician services • Cost increases for prescription drugs, including the increased use of expensive specialty

prescriptions. The premium rate increase that Healthfirst is requesting is 15%.

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

Narrative Summary – Healthfirst Health Plan, Inc. Small Group HMO Plans – 2020 NAIC 95284

EXHIBIT 13C ‐ AVERAGE PREMIUM DETAILS

Company Name: Healthfirst Health Plan, Inc.NAIC Code: 95284

SERFF Tracking #: HLFT‐131929303Market Segment: Small Group

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 3/31/2019) that will no longer be offered in 2020 are removed.The sum of cells C37‐G44 should be equal to the Company's total membership for the relevant market as of 3/31/2019.

4 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 2020.5 If the Company is not eliminating any plans in 2020, then cells C24‐G31 and L24‐P31 should be the same, as should cells C37‐G44 and L37‐P44.6 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.7 The value in cell Q74 of this Exhibit should match cell D96 (Line 54) of Exhibit 18.8 The value in cell Z74 of this Exhibit should match cell D102 (Line 56) of Exhibit 18.

2019 Weighted Average Monthly Base Premiums ‐ CALCULATED BASED ON ACTUAL DISTRIBUTION AS OF 3/31/2019 (Weighted by number 2019 Weighted Average Monthly Base Premiums ‐ RE‐CALCULATED USING ONLY THE SUBSET OF 2019 PLANS THAT WILL STILL 2020 Weighted Average Monthly Proposed Base Premiums ‐ THESE BASE PREMIUMS SHOULD BE CALCULATED USING THE SAME Change in Weighted Average Monthly Base Premiums of subscribers) BE AVAILABLE IN 2020 (weighted by subscribers in those specific plans) POPULATION OF SUBSCRIBERS THAT WAS USED TO CALCULATE CELLS L22 ‐ P29) Average Monthly Base Premium assuming 3/31/2019 membership Average Monthly Base Premium paid assuming 3/31/2019 membership and all policies are paid in full for the entire year) Average Base Premium paid assuming 3/31/2019 membership and all policies are paid in full for the entire year) Average Base Premium paid assuming 3/31/2019 membership and all policies are paid in full for the entire year)

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

3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area4‐ NYC Area 720 719.74 4‐ NYC Area 720 719.74 4‐ NYC Area 827.70 827.70 4‐ NYC Area 15.00% 15.00%

5‐ Rochester Area 5‐ Rochester Area 5‐ Rochester Area 5‐ Rochester Area6‐ Syracuse Area 6‐ Syracuse Area 6‐ Syracuse Area 6‐ Syracuse Area

7‐ Utica/Watertown Area 7‐ Utica/Watertown Area 7‐ Utica/Watertown Area 7‐ Utica/Watertown Area8‐ Long Island Area 8‐ Long Island Area 8‐ Long Island Area 8‐ Long Island Area

9 ‐ All Regions 719.74 719.74 9 ‐ All Regions 719.74 719.74 To Exhibit 13a (Section A) 9 ‐ All Regions 827.70 827.70 To Exhibit 13a (Section A) 9 ‐ All Regions 15.00% 15.00%

2019 Members ‐ as of 3/31/2019 ‐ Actual Distribution (All members as of 3/31/2019 should be included) Members ‐ as of 3/31/2019 ‐ Only those members currently enrolled in plans that will continue to be offered in 2020 Members ‐ as of 3/31/2019 ‐ Only those members currently enrolled in plans that will continue to be offered in 2020 Change in Members ‐ as of 3/31/2019 ‐ Change due to current 2019 plans not being offered in 2020.


3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area4‐ NYC Area 23 23 4‐ NYC Area 23 23 4‐ NYC Area 23 23 4‐ NYC Area 0.00% 0.00%



9 ‐ All Regions 23 23 9 ‐ All Regions 23 23 Should equal Cell H‐24 of Exhibit 14 9 ‐ All Regions 23 23 9 ‐ All Regions 0.00% 0.00%

2019 Conversion Factor ‐ A 0.6696 Must be less than or equal to 1.000 2019 Conversion Factor ‐ B 0.6696 Must be less than or equal to 1.000 2020 Conversion Factor 0.6696 Must be less than or equal to 1.000 Change in Conversion Factor 0.00000%

2019 Estimated Aggregate Annualized Premium by Metal and Region ‐ based on membership as of 3/31/2019 2019 Estimated Aggregate Annualized Premium by Metal and Region ‐ based on membership as of 3/31/2019 2020 Estimated Aggregate Annualized Premium by Metal and Region ‐ based on membership as of 3/31/2019 Change in Aggregate Annualized Premiums ‐ based on membership as of 3/31/2019 (Ignoring any plan eliminations) Aggregate premium that would be collected assuming 3/31/2019 membership and all policies are paid in full for the entire year) Aggregate premium that would be collected assuming 3/31/2019 membership and all policies are paid in full for the entire year) ‐ Adjusted for plan eliminations Aggregate premium that would be collected assuming 3/31/2019 membership and all policies are paid in full for the entire year) ‐ Adjusted for plan eliminations


3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area4‐ NYC Area 133,008 133,008 4‐ NYC Area 133,008 133,008 4‐ NYC Area 152,959 152,959 4‐ NYC Area 15.00% 15.00%



9 ‐ All Regions 133,008 133,008 9 ‐ All Regions 133,008 133,008 Should equal Cell G‐24 of Exhibit 14 9 ‐ All Regions 152,959 152,959 9 ‐ All Regions 15.00% 15.00%

2019 Weighted Average Monthly PMPM Premium Rates 2019 Weighted Average Monthly PMPM Premium Rates ‐ Reflecting adjustment for eliminated plans 2020 Weighted Average Monthly PMPM Premium Rates ‐Reflecting adjustment for eliminated plans Change in Weighted Average PMPM Premiums


3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area 3‐ Mid‐Hudson Area4‐ NYC Area 481.91 481.91 4‐ NYC Area 481.91 481.91 4‐ NYC Area 554.20 554.20 4‐ NYC Area 15.00% 15.00%



9 ‐ All Regions 481.91 481.91 9 ‐ All Regions 481.91 481.91 To Exhibit 13a (Section B) 9 ‐ All Regions 554.20 554.20 To Exhibit 13a (Section B) Total 15.00% 15.00%

Exhibit 13c Updated by DFS 3/14/2018 1

Company Name: Healthfirst Health Plan, Inc.NAIC Code: 95284 NOTE: THIS EXHIBIT SHOULD NOT INCLUDE MEMBERS THAT ARE CURRENTLY ENROLLED IN PLANS THAT WILL NOT BE AVAILABLE IN 2020SERFF Tracking #: HLFT-131929303Market Segment: Small Group

12345

6789

10111213 The Total Annualized Premium in Cell G-24 of this Exhibit should equal the total in Cell Q-61 of Exhibit 13c.14 The Total Number of Members in Cell H-24 of this Exhibit should equal the total in Cell Q-45 of Exhibit 13c (i.e., Only those members currently enrolled in plans that will continue to be offered in 2020)

Totals $133,008 23 6

Annualized Premiums as of Total # of Members as of

Total # of Contracts (Certificates for SG) as of

3/31/2019 3/31/2019 3/31/2019 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 AvgSmall Group 01/01/20 Gold 9 - All Regions Healthy NY Healthy NY $133,008 23 6 23 15.00% 15.00% 15.00%Small Group 01/01/20 Gold 9 - All Regions HMO B HMO B $0 0 0Small GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall GroupSmall Group

Requested Percentage Rate Change

Percentage Rate Changes should be calculated using membership as of 3/31/2019.This exhibit must be submitted as an Excel file and as a PDF file.

Market Segment Effective Date of New RateMetal Level

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

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

EXHIBIT 14: SUMMARY OF REQUESTED PERCENTAGE CHANGES

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

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

The effective date is the earliest date that the proposed new rate would become effective if approved. The Effective Date for Individual is 1/1/2020. Effective Dates for Small Group are 1/1/2020, 4/1/2020, 7/1/2020 and 10/1/2020.

Exhibit 14 Updated by DFS 3/14/2018 1


Company Name: Healthfirst Health Plan, Inc.NAIC Code: 95284SERFF Number: HLFT-131929303Market Segment: Small Group

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 DateApproved HLFT-129572246 2014060263 6/13/2014 MHI-HNY-SG-15 MH Healthfirst Healthy NY Requested a rate decrease. 11/13/2014Approved HLFT-130051200 2015050292 5/15/2015 MHI-HNY-SG-15 MH Healthfirst Healthy NY Requested a rate increase 9/22/2015Approved HLFT-129571793 2014060264 6/13/2014 MHI-SG-15-OFF MH HMO B Requested a rate decrease. 11/13/2014Approved HLFT-130051080 2015050289 5/15/2015 MHI-SG-15-OFF MH HMO B Requested a rate increase 9/22/2015Approved HLFT-130569296 2016050213 5/16/2016 HFHP-HNY-17-OFFHHealthfirst Healthy NY Requested a rate increase 9/26/2016Approved HLFT-130569296 2016050213 5/16/2016 HFHP-SG-17-OFF H HMO B Requested a rate increase 9/26/2016Approved HLFT-131030786 2017050237 5/15/2017 HFHP-HNY-18-OFFHHealthfirst Healthy NY Requested a rate increase 9/22/2017Approved HLFT-131030786 2017050237 5/15/2017 HFHP-SG-18-OFF H HMO B Requested a rate increase 9/22/2017Approved HLFT-131487154 2018050257 5/14/2018 HFHP-HNY-19-OFF Healthfirst Healthy NY Requested a rate increase 11/26/2018Approved HLFT-131487154 2018050257 5/14/2018 HFHP-SG-19-OFF HMO B Requested a rate increase 11/26/2018

EXHIBIT 16: SUMMARY OF POLICY FORM AND PRODUCT CHANGES

The product street name is the product name as advertised to consumers (i.e., as consumers are likely to refer to this product/policy form when communicating with DFS).Enter filing status (approved or pending) using the drop down list. For pending files leave the approval date blank.

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

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

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

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

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

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

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

Group Definition Counting Method Notes Standardized Premium Scale

Individual ACA Compliant Individual Plans Individual‐ACA N/A N/A Issued on or after 1/1/2016 2019 Rates

Catastrophic ACA Compliant Catastrophic Plans Catastrophic N/A N/A Issued on or after 1/1/2016 2019 Rates

Small Group

Experience of ACA Compliant Small Group Plans (Excluding Healthy New York plans) that were written or renewed on or after 1/1/2016 SG‐ACA‐FTE 1‐100

Current New York (FTE)

All relevant experience in the calendar year

4th Quarter 2019 for rolling; 2019 for non‐rolling

Small Group ‐ HNYExperience of Small Group Healthy New York Plans that were written or renewed on or after 1/1/2016 SG‐ACA‐HNY‐FTE 1‐50

Current New York (FTE)

All relevant experience in the calendar year

4th Quarter 2019 for rolling; 2019 for non‐rolling

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

Healthfirst Health Plan, Inc.95284

HLFT‐131929303Small Group

Exhibit 17 ‐ Instructions Last Updated 5/1/2017 1

1.a Company Name

1.b NAIC Code 1.c SERFF Number

1d.Base medical

policy form number

1e.Product Name

(per Rate Manual)

1f.Product

Street Name as indicated

to consumers2.

Filing Type

3.Effective date of last rate change

(mm/dd/yy)4.

Market Segment5A.

Rating Region

5B.Product Type (see "Instructions"

tab for examples)

6. Is a rolling

rate structure

used for this base

medical policy form? (Yes or No)

7.Is base medical policy form open

(new sales allowed) or closed

(no new sales)

8.Number of

policyholders affected by rate

change. (For group business this is number

of groups.)

9.Number of

covered lives affected by rate

changeHealthfirst Health Plan, Inc. 95284 HLFT-131929303 HFHP-HNY- Healthfirst Healthfirst 4308(c) 1/1/2019 SG-ACA-HNY-FTE 9 - All Regions HMO No New sales allowed 6 23 Healthfirst Health Plan, Inc. 95284 HLFT-131929303 HFHP-SG-20- Healthfirst HMO Healthfirst 4308(c) 1/1/2019 SG-ACA-FTE 9 - All Regions HMO No New sales allowedHealthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303Healthfirst Health Plan, Inc. 95284 HLFT-131929303

Data Item for Specified Base Medical Policy Form


14.1Beginning Date

of the experience

period (mm/dd/y)

14.2Ending Date of the experience

period (mm/dd/yy)

14.3Member months for experience period

14.4Earned premiums for experience period ($)

14.5Standardized earned

premiums for experience period ($)

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

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

pools, or commercial stop-loss payments ($)

14.6a Claims Paid in calendar year 2019

(during the months of January and February

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

adjustment for federal risk adjustment, federal

reinsurance, risk corridors, state stop-loss


14.6b Estimated claims remaining to be

paid in the future on claims incurred during

2018 - before any adjustment for federal

risk adjustment, federal reinsurance, risk

corridors, state stop-loss pools, or commercial

stop-loss payments ($)

14.6c Rx Rebates associated with claims

reported in Columns 14.6and 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 positivevalue) ($)

14.7 Total Incurred Claims for

calendar year 2018 Net of Rx Rebates ($)

14.8Adjustment to the

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

reinsurance or stop loss pools (enter receipts from

the pool as a negative value) ($)


incurred claims for the period due to receipts

from or payments to the federal risk adjustment

pool (enter receipts as a negative value and

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

14.10Administrative expenses

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

state income taxes) ($)

15.1Beginning date of the

experience period (mm/dd/yy)

15.2Ending Date of the experience period

(mm/dd/yy)1/1/2018 12/31/2018 264.00 109,677 127,225 50,497 0 0 0 0 $ 50,496.55 $ - $ 15,355 $ 14,200 1/1/2017 12/31/20171/1/2018 12/31/2018 $ - 1/1/2017 12/31/2017

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

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


15.3Member months for experience period

15.4Earned premiums for experience period ($)

15.5Standardized earned

premiums for experience period ($)

15.6 Claims Paid in calendar year 2017 on claims incurred during calendar year 2017 -

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


15.6a Claims Paid in calendar year 2018

(during the months of January and February

only) on claims incurred during calendar year 2017 - before any

adjustment for federal risk adjustment, federal

reinsurance, risk corridors, state stop-loss


15.6b All other claim amounts associated with claims incurred during the 2017 calendar year that are not included in

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

February of 2019 plus any remaining IBNR

associated with claims that were incurred during

2017) - before any adjustment for federal

risk adjustment, federal reinsurance, risk

corridors, state stop-loss pools, or commercial

stop-loss payments ($)

15.6c Rx Rebates associated with claims

reported in Columns 15.6and 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 positivevalue) ($)

15.7 Total Incurred claims for

calendar year 2017 Net of Rx Rebates ($)


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

reinsurance or stop loss pools (enter receipts from

the pool as a negative value) ($)


incurred claims for the period due to receipts

from or payments to the federal risk adjustment

pool (enter receipts as a negative value and

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

15.10Administrative expenses

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

state income taxes) ($)301 $ 175,938 $ 186,670 $ 35,632 $ - $ - $ - $ - $ 35,632.41 $ - $ 24,631 $ 18,157

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

2017 Experience Period (NY statewide experience, base medical policy form + associated riders)



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


SERFF Number: HLFT-131929303Market 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***ACA Compliant Plans

Only Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 71 Product* XXXXXXX

p HNY

p HNY

p HNY

p HNY

p HNY

p HNY

p HNY

2 Product ID* XXXXXXX 83744NY002 83744NY002 83744NY002 83744NY002 83744NY002 83744NY002 83744NY002 3 Metal Level (or catastrophic)* XXXXXXX Gold Gold Gold Gold Gold Gold Gold 4 AV Metal Value (HHS Calculator)* XXXXXXX 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 5 AV Pricing Value (total, risk pool experience based)* XXXXXXX 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 6 Plan Type* XXXXXXX HMO HMO HMO HMO HMO HMO HMO 7 Plan Name* XXXXXXX

p Dependent Age 26,

p Dependent Age 29,

p Dependent Age 26, No




p Dependent Age 26,

8 HIOS Plan ID (14 Digits)* XXXXXXX 83744NY0020009 83744NY0020010 83744NY0020011 83744NY0020012 83744NY0020013 83744NY0020014 83744NY00200159 Exchange Plan?* XXXXXXX Off Off Off Off Off Off Off

9A 2020 Plan Status (as compared to 2019) XXXXXXX Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod* This field should be the same as used in the Unified Rate Review Template, Worksheet 2

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

10 Earned Premiums for Latest Experience Period # 109,676.69 109,676.6910A Incurred Claims for Latest Experience Period # 50,496.55 50,496.5510B Member-Months for Latest Experience Period # 264.00 264.0010C Average PMPM Incurred Claims [(10A)/(10B)] = (Initial Index PMPM) 191.27481 191.27481 0.00000 0.00000 0.00000 0.00000 0.00000 0.0000011 Average Pricing Actuarial Value reflected in experience period 0.8491012 AV Adjusted Experience Period Index Rate PMPM = [(10C) / (11)] 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877

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

Market Wide Adjustments to the AV Adjusted Experience Period Index Rate All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 713 Impact of adjusting experience period data to EHB benefit level ** 1.0000014 Market wide adjustment for changes in provider network ** 1.0000015 Market wide adjustment for fee schedule changes ** 1.0000016 Market wide adjustment for utilization management changes ** 1.0000017 Market wide adjustment for impact on claim costs from quality improvement and cost containment initiatives ** 1.0000018 Claim trend projection factor (midpoint of experience period to mid point of rate applicability period) 1.1274719 Federal Risk Adjustment Program Impact (less than 1.00 to reflect a recovery, more than 1.00 to reflect a payment to the pool) ** 1.1617120 Impact of adjustments due to experience period claim data not being sufficiently credible ** 1.0000021 Adjustment for changes in distribution of risk pool membership by rating regions (i.e., standard rating regions) ** 1.0000022 Change in morbidity not reflected in the experience data that is known and quantifiable at the time of the rate filing ** 1.0000023 Impact of ACA Provision 9010 - Health Insurance Providers Fee ** 1.00000

23a Impact of changes in New York State Law that are not reflected in the experience data ** 1.0028024 Adjustment for credibility 1.6760625 Covered Lives 1.0317426 PCORI, Risk Adjustment User Fees, and Regulatory Tax 1.0118127 Factor for Small Membership 1.0176028 Impact of Market Wide Adjustments (= Product L13 through L27) 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858

** Not Included in Claim Trend Adjustment

Plan Level Adjustments Average - All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 729 Index Rate - After Marketwide Adjustments 526.8097 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.8097430 Pricing actuarial value (without induced demand factor) # 0.8085 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.8085031 Pricing actuarial value (only the induced demand factor) # 1.0800 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.0800032 Impact of provider network characteristics ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000033 Impact of delivery system characteristics ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000034 Impact of utilization management practices ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000035 Impact on claim costs from quality improvement and cost containment initiatives ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000036 Benefits in additional to EHB (greater than 1.00) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000037 Impact of eligibility categories (catastrophic plans only) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000038 Addition of Out of Network Benefit Option (e.g., POS or PPO, if applicable) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000039 Impact of Adjustment for NYS Stop Loss reimbursements on SG HNY 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000040 Impact of Age 26 / Age 29 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000041 Impact of Family Planning / No Family Planning 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000042 Impact of Dental vs No Dental 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000043 Premium Curve Adjustment 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

43a Impact of loss of CSR Funding (A common factor to be applied uniformly to all silver plans only - if applicable) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000043b Rating Region Factor 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000044 Other 1 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000045 Other 2 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000046 Other 3 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000047 Impact of Plan Wide Adjustments (= Weighted Average Factor using Line 55a) 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318

# 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) 121,439.93

ExpensesWeighted Average - All

Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 749 Plan Expected Costs 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.0050 FIXED EXPENSE: Administrative Costs (excluding Exchange user fees and profits) - to be expressed as a PMPM Amount ### 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.0000051 VARIABLE EXPENSE: Administrative costs (excluding Exchange user fees and profits) - to be expressed as a percentage ### 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000%52 VARIABLE EXPENSE: Profit/Contribution to surplus margins - to be expressed as a percentage ### 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000%53 Total Expense Load as a percentage of Premium (= [L50 + (L51 + L52) * L56] / L56) 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000%

### 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.

2019 Premium Rates and Membership All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 754 2019 PMPM Rates (First Quarter 2019 rates for Small Group)*** 481.91 481.9155 2019 Members as of 3/31/2019 (The total should tie to the 3/31/2019 Membership Survey Total) 23.00 23.00

55a 2019 Members as of 3/31/2019 - Only those enrolled in plans that will still be available in 2020 23.00 23.00 0.00 0.00 0.00 0.00 0.00 0.00

Calculation of Final 2020 Rates All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 756 TOTAL PROJECTED INDEX RATE PMPM (= [(L49 + L50) / (1 - L51 - L52)]) 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.2257 Percent Change in Premium Rates (= L56 / L54) 15.00% 15.00%

*** The information in the "General" Section above should also be completed for any 2019 plans that will no longer be available in 2020.*** The Average PMPM rate for "All Plans" should be used for All Non-ACA Compliant Plans Weighted Average PMPM: 554.22

Difference From Line 56 Col D: 0.00Overall Average Impact: 15.00% Percentage Difference: 0.0%

Exhibit 18 Supplement Last Updated - 4/10/2018 1

Exhibit 18 Supplement



Expense Data - Small Group 2020 Expected 2019 Expected 2018 Expected 2017 Expected 2018 Actual 2017 ActualPeriod assumed - beginning date 1/1/2020 1/1/2019 1/1/2018 1/1/2017 1/1/2018 1/1/2017

Period assumed - ending date 12/31/2020 12/31/2019 12/31/2018 12/31/2017 12/31/2018 12/31/2017Average annual claim trend assumed 6.50% 6.50% 6.00% 5.00% 6.00% 5.00%

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

Commissions and broker fees - as a % of gross premium 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%Premium Taxes - as a % of gross premium 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 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%Other administrative expenses - as a % of gross premium 12.20% 12.20% 12.38% 12.98% 12.38% 12.98%

Subtotal 13.678% 13.567% 13.567% 14.167% 13.567% 14.167%

After tax underwriting margin (profit/contribution to surplus) - as a % of gross premium 4.00% 2.00% 5.00% 3.50% 5.00% 5.00%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 4.000% 2.000% 5.000% 3.500% 5.000% 5.000%

Total 17.678% 15.567% 18.567% 17.667% 18.567% 19.167%

EXHIBIT 19 - SUMMARY OF AVERAGE CLAIM TREND AND ADMINISTRATIVE EXPENSES AND PROFIT MARGIN

Company Name: Healthfirst Health Plan, Inc.NAIC Code: 95284SERFF Number: HLFT-131929303 Market Segment: Small Group

1 Complete a separate ROW for each Metal Level/Product for all ACA compliant business written or renewed on or after 1/1/2016 in the relevant market for which the Company had business in-force during the applicable experience period. • Information should be for all the benefits included in that plan design including any riders (medical, drugs, etc.). • Enter in column 1 the Metal Tier level. • Enter in column 2 the plan designation as to On/Off Plan and Std/Non Standard Plan. • Enter in column 3 the Estimated Membership as of a recent date mm/dd/yyy; enter the date in column heading. • Append additional rows to the end of the existing rows as needed. Only use the first tab for data entry.

2 The average claim trend is the average annualized claim trend that is used in the applicable rate adjustment filing to project the source data forward to the applicable rating period (e.g. 10.0%).

3 Enter the required information for the new rate period included in this rate adjustment filing. This refers to the various expense components and profit margin included in the requested rates and the average annual claim trend assumed.

4 Enter the corresponding information requested for the immediately prior rate and form filing. This refers to the various expense components in the requested rates submitted for the immediately prior rate and form filing and the average claim trend assumed. If there is no immediately prior rate and form filing, enter the data from the initial rate and form filing.

5 ACA Fees that may be applicable are to be entered in columns 6.1 and 16.1.6 This exhibit must be submitted as an Excel file and as a PDF file.

Exhibit 19 ‐ Instructions Updated by DFS 3/14/2018 1

A. Company Name B. NAIC Code C. SERFF Number D. Market1.

Metal Level

2. On/Off Exchange Designation and

Standard/Non Std

3. Estimated

Membership as of 03/31/2019

4.1 Period assumed -

beginning date (mm/dd/yy)

4.2Period assumed -

ending date (mm/dd/yy)

5. Average annual

claim trend assumed

6.1 Regulatory authoritylicenses and fees, including New York

State 206 assessment

expenses - as a % of gross premium

6.2 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

6.3Commissions and

broker fees - as a %of gross premium

6.4Premium Taxes - as

a % of gross premium

6.5 Other state and

federal taxes and assessments (other than income taxes and covered lives

assessment) - as a % of gross premium

6.6 Other administrativeexpenses - as a % of gross premium

6.7Subtotal columns 6.1 through 6.6

7. After tax

underwriting margin (profit/contribution

to surplus) - as a % of gross premium

8. State income tax

component - as a %of gross premium

8.1 State income tax

rate assumed (e.g. 3%)

9.Federal income tax component - as a %of gross premium

9.1Federal income tax rate assumed (e.g.

30%)

10.Reduction for assumed net

investment income -as a % of gross

premium (enter as anegative value)

11.Subtotal columns

6.7 + 7 + 8 + 9 + 10Healthfirst Health Pl 95284 HLFT‐131929303 Small Group Gold Non Standard off exchang 23.00 1/1/2020 12/31/2020 6.50% 0.68% 0.80% 0.00% 0.00% 0.00% 12.20% 13.68% 4.00% 0.00% 0.00% 0.00% 0.00% 0.00% 17.68%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%Healthfirst Health Pl 95284 HLFT‐131929303 Small Group 0.00% 0.00%

General Information For the rate period included in this rate adjustment filing


14.1 Period assumed -

beginning date (mm/dd/yy)

14.2Period assumed -

ending date (mm/dd/yy)

15. Average annual

claim trend assumed

16.1 Regulatory authoritylicenses and fees, including New York

State 206 assessment

expenses - as a % of gross premium

16.2 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

16.3Commissions and

broker fees - as a %of gross premium

16.4Premium Taxes - as

a % of gross premium

16.5 Other state and

federal taxes and assessments (other than income taxes and covered lives

assessment) - as a % of gross premium

16.6 Other administrativeexpenses - as a % of gross premium

16.7Subtotal columns 16.1 through 16.6

17 After tax

underwriting margin (profit/contribution

to surplus) - as a % of gross premium

18State income tax

component - as a %of gross premium

18.1 State income tax

rate assumed (e.g. 3%)

19Federal income tax component - as a %of gross premium

19.1Federal income tax rate assumed (e.g.

30%)

20Reduction for assumed net

investment income -as a % of gross

premium (enter as anegative value)

21Subtotal columns

16.7 + 17 + 18 + 19 +20

1/1/2019 12/31/2019 6.50% 0.57% 0.80% 0.00% 0.00% 0.00% 12.20% 13.57% 5.00% 0.00% 0.00% 0.00% 0.00% 0.00% 18.57%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%0.00% 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%0.00% 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%0.00% 0.00%0.00% 0.00%0.00% 0.00%

For the rate period included in the prior rate and form filing


EXHIBIT 23: SUMMARY OF REQUESTED 2020 PREMIUM RATES

Company Name: Healthfirst Health Plan, Inc.NAIC Code: 95284SERFF Number: HLFT-131929303Market Segment: Small Group

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 2017 - 2020 for Individual (Individual only) and First Quarter 2017 - 2020 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 3/14/2018 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 [Std or Non Std]

10.Limiting Child

Age? (26 or 30)

11. Domestic Partner

Coverage Included? (yes,

no)

12. Family

Planning Coverage? (included, excluded)

13. Pediatric

Dental Coverage

Included? (yes, no)

14. Out of Network

Benefits? (yes, no)

15. Includes

Benefits in Addition to

EHB? (yes, no)

16. Healthy New

York (yes, no)

17. Child-Only

Plan (yes, no)

18. Tiered Network Plan (yes, no)

19. HSA Plan (yes,

no)20.

PNDS Identifier

21. Company Network Identifier

Healthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0020009 83744NY0020009 Gold Off Non-Standard 26 Yes Included Yes No Yes Yes No No No NYOCOM1 Healthfirst HMO L




Healthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0020013 83744NY0020013 Gold Off Non-Standard 26 Yes Excluded Yes No Yes Yes No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0020014 83744NY0020014 Gold Off Non-Standard 30 Yes Excluded Yes No Yes Yes No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0020015 83744NY0020015 Gold Off Non-Standard 26 Yes Excluded Yes No Yes Yes No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0020016 83744NY0020016 Gold Off Non-Standard 30 Yes Excluded Yes No Yes Yes No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0010025 83744NY0010025 Gold Off Non-Standard 26 Yes Included Yes No Yes No No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0010026 83744NY0010026 Gold Off Non-Standard 30 Yes Included Yes No Yes No No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0010027 83744NY0010027 Gold Off Non-Standard 26 Yes Included Yes No Yes No No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0010028 83744NY0010028 Gold Off Non-Standard 30 Yes Included Yes No Yes No No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0010029 83744NY0010029 Gold Off Non-Standard 26 Yes Excluded Yes No Yes No No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0010030 83744NY0010030 Gold Off Non-Standard 30 Yes Excluded Yes No Yes No No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0010031 83744NY0010031 Gold Off Non-Standard 26 Yes Excluded Yes No Yes No No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small Group 83744NY0010032 83744NY0010032 Gold Off Non-Standard 30 Yes Excluded Yes No Yes No No No No NYOCOM1 Healthfirst HMO LHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small GroupHealthfirst Health P 95284 HLFT-131929303 Small Group

PLAN INFORMATION


Region 1 - 2017 Rate (Albany)

Region 2 - 2017 Rate (Buffalo)

Region 3 - 2017 Rate (Mid-Hudson)

Region 4 - 2017 Rate (New York)

Region 5 - 2017 Rate (Rochester)

Region 6 - 2017 Rate (Syracuse)

Region 7 - 2017 Rate (Utica)

Region 8 - 2017 Rate (Long

Island)Region 1 - 2017 MMs (Albany)

Region 2 - 2017 MMs (Buffalo)

Region 3 - 2017 MMs (Mid-Hudson)

Region 4 - 2017 MMs (New York)

Region 5 - 2017 MMs (Rochester)

Region 6 - 2017 MMs (Syracuse)

Region 7 - 2017 MMs (Utica)

Region 8 - 2017 MMs (Long

Island)

Leaf Plan Network 584.51 584.51 301.00

Leaf Plan Network 603.99 603.99



Leaf Plan Network 579.59 579.59Leaf Plan Network 598.90 598.90Leaf Plan Network 579.59 579.59Leaf Plan Network 598.90 598.90Leaf Plan Network 663.67 663.67Leaf Plan Network 685.81 685.81Leaf Plan Network 663.67 663.67Leaf Plan Network 685.81 685.81Leaf Plan Network 658.76 658.76Leaf Plan Network 680.74 680.74Leaf Plan Network 658.76 658.76Leaf Plan Network 680.74 680.74

2017 PREMIUM RATES 2017 MEMBER MONTHS










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)

620.26 620.26 264.00

640.94 640.94

620.26 620.26

640.94 640.94

615.04 615.04635.53 635.53615.04 615.04635.53 635.53704.27 704.27727.76 727.76704.27 704.27727.76 727.76699.06 699.06722.38 722.38699.06 699.06722.38 722.38

2018 PREMIUM RATES 2018 MEMBER MONTHS










Island)

Region 1 - 2019 Members as of

3/31/2019 (Albany)


3/31/2019 (Buffalo)

Region 3 - 2019 Members as of 3/31/2019 (Mid-

Hudson)

Region 4 - 2019 Members as of 3/31/2019 (New

York)


3/31/2019 (Rochester)


3/31/2019 (Syracuse)


3/31/2019 (Utica)


3/31/2019 (Long Island)

719.74 719.74 23.00

743.74 743.74

719.74 719.74

743.74 743.74

713.69 713.69737.46 737.46713.69 713.69737.46 737.46817.23 817.23844.49 844.49817.23 817.23844.49 844.49811.18 811.18838.24 838.24811.18 811.18838.24 838.24

2019 MEMBERS (per DFS Membership Survey)2019 PREMIUM RATES










Island)


3/31/2019 (Albany)


3/31/2019 (Buffalo)


Hudson)


York)






3/31/2019 (Utica)




3/31/2019 (Albany)


3/31/2019 (Buffalo)


Hudson)


York)






3/31/2019 (Utica)



827.70 827.70 23.00

855.30 855.30

827.70 827.70

855.30 855.30

820.74 820.74848.08 848.08820.74 820.74848.08 848.08939.81 939.81971.16 971.16939.81 939.81971.16 971.16932.86 932.86963.98 963.98932.86 932.86963.98 963.98

2020 PREMIUM RATES2019 MEMBERS (Should be consistent with DFS Membership Survey) ‐ Only those members currently enrolled in 2019 plans that will continue to be offered in 2020

2019 MEMBERS ‐ Only those members currently enrolled in 2019 plans Including plans that will be discontinued in 2020 ***** Columns CH ‐ CO apply to SMALL GROUP ONLY *****


5/7/2019 «SubscirberFirstName» «SubscriberLastName» «AddressLine1» «AddressLine2» «CITY», «STATE» «ZipCode» Re: Notice of Proposed Premium Rate Change Healthfirst [Plan Name] - HIOS ID 83744NY001[XXXX] Dear Healthfirst Member: Healthfirst Health Plan, Inc. (Healthfirst) is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group premium rates for 2020. 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 [XX]%. Please note that while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Also, the final approved rate may differ because DFS may modify the proposed rate. Why We Are Requesting a Rate Change Healthfirst is requesting a higher rate for 2020 because several market forces continue to drive health care costs higher. These forces include:

Cost increases for inpatient hospital, outpatient hospital, and physician services Cost increases for prescription drugs, including the increased use of expensive specialty

prescriptions DFS’s view of these matters may differ. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice.

You can contact Healthfirst for additional information at:

Healthfirst Health Plan, Inc. 100 Church Street New York, NY 10007 1-888-260-1010 www.healthfirst.org

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

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

United States Postal Service:

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

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

1. The name of your insurer, which is Healthfirst Health Plan, Inc. 2. The name of your plan, which is Healthfirst [Plan Name] 3. Indicate you have group coverage 4. Your HIOS identification number, which is 83744NY001[XXXX]

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

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

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2020 renewal date. Sincerely,

Kevin Barth Senior Vice President, Operations

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


5/7/2019 «SubscirberFirstName» «SubscriberLastName» «AddressLine1» «AddressLine2» «CITY», «STATE» «ZipCode» Re: Notice of Proposed Premium Rate Change Healthfirst [Plan Name] - HIOS ID 83744NY002[XXXX] Dear Healthfirst Member: Healthfirst Health Plan, Inc. (Healthfirst) is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group premium rates for 2020. 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 [XX]%. Please note that while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Also, the final approved rate may differ because DFS may modify the proposed rate. Why We Are Requesting a Rate Change Healthfirst is requesting a higher rate for 2020 because several market forces continue to drive health care costs higher. These forces include:



5/7/2019 [Contact Name] [Group Name ] [Address] [City, State Zip] Re: Notice of Proposed Premium Rate Change Healthfirst [Plan Name] - HIOS ID 83744NY001[XXXX] Dear Healthfirst Group Policy Holder: Healthfirst Health Plan, Inc. (Healthfirst) is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your premium rates for 2020. 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 premium is [XX]%. Please note that while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Also, the final approved rate may differ because DFS may modify the proposed rate. Why We Are Requesting a Rate Change Healthfirst is requesting a higher rate for 2020 because several market forces continue to drive health care costs higher. These forces include:


prescriptions

DFS’s view of these matters may differ.

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

5/7/2019 [Contact Name] [Group Name ] [Address] [City, State Zip] Re: Notice of Proposed Premium Rate Change Healthfirst [Plan Name] - HIOS ID 83744NY002[XXXX] Dear Healthfirst Group Policy Holder: Healthfirst Health Plan, Inc. (Healthfirst) is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your premium rates for 2020. 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 premium is [XX]%. Please note that while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Also, the final approved rate may differ because DFS may modify the proposed rate. Why We Are Requesting a Rate Change Healthfirst is requesting a higher rate for 2020 because several market forces continue to drive health care costs higher. These forces include:



CONFIDENTIAL AND PROPRIETARY

Healthfirst Health Plan, Inc.

Part III Actuarial Memorandum

Small Group Off-Exchange

Effective January 1, 2020

Confidential and Proprietary

Healthfirst Health Plan, Inc. – Small Group 2020 Actuarial Memo Page 2 of 22

General Information

Document Overview

This document contains the Part III Actuarial Memorandum for Healthfirst Health Plan, Inc. (HFHP) rate filing, for the Small Group block of business with an effective date of January 1, 2020.

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

The purpose of the actuarial memorandum is to provide certain information related to the submission, including support for the values entered into the URRT, which supports compliance with the market rating rules and reasonableness of applicable rate increases. This information may not be appropriate for other purposes.

This memorandum is intended for use by the New York Department of Financial Services (DFS), the Center for Consumer Information and Insurance Oversight (CCIIO), and their subcontractors to assist in the review of the HFHP Small Group rate filing. The memorandum contains information that is confidential and proprietary to HFHP; therefore, the memorandum should not be distributed to any other parties unless required by law.

The results are actuarial projections. Actual experience is likely to differ for a number of reasons including population changes, claims experience, risk adjustment, and other deviations from assumptions.

Company Identifying Information

• Company Legal Name: Healthfirst Health Plan, Inc.

• State: New York

• HIOS Issuer ID: 83744

• Market: Small Group

• Effective Date: January 1, 2020

Company Contact Information

• Primary Contact Name:

• Primary Contact Telephone Number:

• Primary Contact Email Address:



This memorandum is organized into the following sections:

• Section 1: Development of the index rate • Section 2: Supporting Detail on Material Assumptions • Section 3: Additional Notes • Section 4: Actuarial Certification

Our appendices to this Actuarial Memorandum are the following:

• Appendix A: Market‐wide Index Rate Adjustments • Appendix B: Quality Improvement Program • Appendix C: Exhibit 18 • Appendix D: AV Calculator Snapshots

Section 1: Development of the Index Rate

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

1.1 Experience Period Premium and Claims

HFHP has consistently had less than 40 members throughout 2018 and as of March 2019, has 23 members, which is a population not large enough to assign any credibility to its experience. Therefore, our experience is based on the experience of Healthfirst PHSP QHP (Healthfirst PHSP). We use individual premium and claims experience incurred in 2018 and paid through February 2019.

Adjustments also include retroactive cancellations due to the 90‐day grace period for non‐payment of claims.

Manual rates were not used in our development of rates for 2020.

Capitation payments are included in the claims experience for 2018.

The average pricing actuarial value reflected in the experience is 0.84910 (Line 11).

1.2 Market Level Adjustments

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

For market‐wide adjustments, the following lines have factors of 1.000 in Exhibit 18: • Line 14: Change to Provider Network • Line 15: Market‐wide adjustments for fee schedule changes • Line 16: Market wide adjustment for utilization management changes • Line 17: Market wide adjustment for impact on claim costs from quality improvement and cost containment

initiatives



• Line 20: Impact of adjustments due to experience period claim data not being sufficiently credible • Line 21: Adjustment for changes in distribution of risk pool membership by rating regions (i.e., standard rating

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

Only)

• Line 23: 9010 Tax

The Health Insurance Excise Tax (ACA Premium Tax) is not included. HFHP is exempt in 2020 since

• It is incorporated as a nonprofit corporation under state law; • No part of the entity’s profits insures to any private shareholder or individual, no

substantial part of its activities include carrying on propaganda or otherwise attempting to influence legislation, and does not participate in or intervene in any political campaign on behalf of or in opposition to any candidate for public office, and

• More than 80% of the entity’s gross revenues are received from government programs that target low income, disabled or elderly populations.

Other factors are the following:

• Adjustment for EHB Benefit Level (Line 13) ‐ HFHP does not off vision and dental, resulting in a factor of 1.0000.

• Claims Trend Projection Factor (Line 18) ‐

Based on QHP experience, we assume an annual trend of 6.2% from the experience period to the projection period. This annual trend of 6.2% gives us a trend factor of 1.127. We discuss trend further in Section 2.1 of this document.

• Federal Risk Adjustment (Line 19) – Since HFHP is expected to have less than 500 member‐months in 2020, it will elect to have 14% of premium as a risk adjustment (RA) payment. We calculate the factor as follows:

For 2018, a RADV (Risk Adjustment Data Validation) calculation is included with risk adjustment. Due to the uncertainty of the RADV calculation, we are assuming that our RADV receipt/payment will be zero and the risk adjustment receipt for QHP will be $2.82. If the actual risk adjustment for all of QHP in 2018, including RADV, varies from this $3 PMPM receipt estimate, it could affect the adequacy of our rates.

QHP Premium 538.68$ (1)% of premium to RA 0.14 (2) ‐ line 24 Risk adjustment payment 75.42$ (3) = (3) = (1) * (2)Claims Experience HFHP 191.27 (4) Line 10cQHP/HFIC ‐ Exp Index Rates 2.44 (5)

Claims Credible Base 466.35 (6) = (4) * (5) Risk Adjustment Factor 1.1617 (7) = (3)/(6) + 1



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

When we estimate the change for a specific benefit to be less than 0.1% of premium, we do not change premium for this benefit. We estimate that the new benefits will increase premium 0.28%, calculated as follows:

The factor for this 0.28% increase in benefits is 1.0028.

• Adjustment for Credibility (Line 24) ‐ We assume that QHP is 100% credible while HFHP is mainly non‐credible. To account for this, we adjust with the following factors:

We adjust for the difference between the HFHP experience index rate and the QHP index rate We adjust for the difference in conversion factors.

Our calculation is as follows:

• Covered Lives Assessment (Line 25) – Covered Lives Assessment is added to the base medical expenses. Our estimates are based on the following:

As % of premiumNew Benefit

1) No separate catastrophic risk pool N/A2) Fertility treatment past age 44, fertility preservation <0.1%3) Mental health – no initial pre‐cert for members under 18 0.18%4) Expanded autism benefit 0.10%5) No limit on enteral benefit – currently $2,500 <0.1%6) Substance abuse inpatient treatment expanded from 14 to 28 days <0.1%

Total effect on Premium 0.28%

A change estimated at less than 0.1% of premium is not factored into the needed premium increase.

QHP Experience Period Index Rate 549.23$ (1)HFHP Experience Period Index Rate 225.27 (2)Experience Period Index Rate Adjustment 2.44 (3) = (1)/(2)QHP Conversion Factor 0.9740 (4)Conversion Factors 0.6696 (5)Conversion Adjustment 0.6874 (6) = (5)/(4)Total Credibility Adjustment 1.6761 (7) = (3) * (6)

Covered Lives from QHP ‐ PMPM 14.80$ Claims Credible Base (Derived for Line 19) 466.35 Factor 1.032



• Taxes and Fees (Line 26) ‐ We combine the following costs:

• The Risk Adjustment User Fee at $0.18 per member per month, $2.16 per year; this $0.18 pmpm is 0.06% of premium.

• The Section 206 Assessment is 0.678% of premium.

• Since HFHP is not‐ for‐profit, it does not pay the state premium tax. • Through the Affordable Care Act, a High‐Cost Risk Pool with an attachment point of $1 million was

established effective January 1, 2018. Payments have not yet been made to this program for 2018; thus we have not expensed this cost for 2018. Wakely has estimated the cost of this coverage for 2020 at 0.44%. In 2018, QHP had zero claims over $1 million. Thus, the premium for this coverage is a cost without corresponding recoveries.

• Note that the Patient Centered Outcomes Research (PCORI) Tax is eliminated for 2020.

When we combine these taxes and fees, we get a factor of 1.0118.

• Adjustment for Offering Plan to Few Groups (Line 27) ‐ With this plan only being offered to few groups, we can assume that the groups selecting this plan are selecting it specifically because they plan to use benefits more than average. We expect an increased cost of 1.76% due to this factor, giving us a factor of 1.0176.

1.3 Plan Level Adjustments

Plan level adjustments that have a factor of 1.000 are the following:

• Line 32: Provider network characteristics • Line 33: Delivery system characteristics • Line 34: Impact of utilization management practices

• Line 35: Impact on claim costs from quality improvement and cost containment initiatives (Line 35): • • Line 36: Benefits in additional to EHB (greater than 1.00) • Line 37: Impact of eligibility categories (catastrophic plans only) • Line 38: Addition of Out of Network Benefit Option (e.g., POS or PPO, if

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

• Line 40: Impact of Age 26/Age 29 • Line 41: Impact of Family Planning/No Family Planning • Line 42: Impact of Domestic Partner/Non‐Domestic Partner • Line 43: Premium Curve Adjustment • Line 43a: Impact of loss of CSR Funding (A common factor to be applied uniformly to all silver plans only ‐ if

applicable) • Line 43a: Rating Region Factor



Factors not equal to one are the following:

• Pricing actuarial value (without induced demand factor) (Line 30): We are offering only Gold‐level plans; whose AV value is 0.8085.

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

We only offer Gold plans, with an induced demand factor of 1.08.

• Administrative Costs – Fixed Expense (Line 50): Our administrative cost, fixed expense, is zero.

• Administrative Costs – Variable Expense (Line 51):

Our administrative load is 13.0% of premium.

• Profit/Contribution to Surplus and Commission (Line 52): Our target margin is 4% of premium. Our commission is 0% of premium.

Section 2: Supporting Detail on Material Assumptions

2.1 Trend

The annual trend factors used are the following:

Inpatient: 4.35% Outpatient: 4.35% Physician: 4.35% Prescription drug: 9.0% Leveraging impact: 0.0% Overall trend: 6.2%

The trend factors above are for cost and utilization trend combined. Where medical and prescription drug (Rx) costs were listed separately, we use our distribution of costs, which is 60.7% and 39.3% for medical and Rx, respectively. Our sources of trend are the following:

• The AV calculator assumes the following trends, as published with the AV calculator methodology:

Over the 2 years, from 2018 to 2020, we get annual trends of 5.6% for medical and 10.6% for Rx. • CVS/Caremark, the Rx vendor for QHP, estimates trends at 9.6% from 2018 to 2019 and at 8.4% from

2019 to 2020. • The Milliman Medical Index (MMI) for medical cost increases from 2017 to 2018 is 4.5% for medical and

prescription trend combined.

AV 2020 Calculator2018 to 2019 2019 to 2020

Medical 5.4% 6.1%Rx 11.5% 9.8%



• The PWC Medical Cost Growth rate to 2018 is 6.0% trend. • The Segal Company projects trend for HMO’s to 2018 at 6.6% for medical and 7.5% for prescription drug. • Petersen‐Kaiser project overall claim trend at 3.9% from 2018 to 2019 and at 4.3% from 2019 to 2020.

Based on the data above, we value our annualized trend at 6.2%, with a factor of 1.12747 in line 18.

Given our limited QHP experience, we can’t assign specific provider trend.

2.2 Administrative Expenses and Taxes

The administrative expense is expected to be and priced at 13.0% of premium.

Healthfirst utilized an allocation methodology that distributes departmental costs using driver‐ based allocation, for example, membership, number of claims, number of calls, premium revenue, etc. We also distinguish departments between “fixed and variable” depending on the impact of membership growth on staffing levels. For example, Claims is considered a variable department since claims volume varies proportionately by membership. On the other hand, Finance Corporate, for example, is a department unaffected by membership growth for the most part.

Administrative projections were driven by three main components – Projected 2020 membership, premium revenue and medical costs. These factors were used to drive cost allocations for “variable” departments while a “current run‐rate” pmpm was used to drive “fixed” departments, with nominal inflation.

Our administrative costs include, but are not limited to, marketing and sales, enrollment, claims administration, medical management, member services, network management, product management, clinical and quality performance management, compliance, legal, regulatory, finance and actuarial. This fee will not include the taxes and fees described below.

Our quality improvement/cost containment programs that impact the health plans, are estimated at 0.80% of premium and is included in the 13.0% estimate. Please refer to Appendix B for a description of all quality improvement/cost containment programs that impact the health plans included in the risk pool. This should tie in with the activities that improve health care quality, as specified in Exhibit 19 (DFS), the HHS MLR report and the Supplemental Health Care Exhibit.

2.3 Profit and Commission

The target margin is 4.0% of premium. Commission is 0% of premium; no commission is paid for HFHP business.

Profit or Contribution to Surplus margin of 4.0% is included in all plans. This is consistent with our current ROI for other products. HFHP recognizes the need to have positive margins on our programs. We believe that our 4.0% operating margin would provide necessary capital to invest in the company’s infrastructure, provide adequate capital to meet reserve requirements for HFHP, and provide high quality care to our members.

The ROI for HFHP’s investment portfolio in calendar years 2014 through 2018 are as follows:



The average ROI for the last five years is 1.11%.

2.4 Conversion Factors

The final premium rates for Employee Only, Employee and Spouse, Employee and Child(ren) and Employee/Spouse/Child(ren) are based on census factors prescribed by CMS:

Census Tiers Relativity Single 1.000 Single+Spouse 2.000 Single+Child(ren) 1.700 Single+Spouse+Child(ren) 2.850 Child Only 0.412

For a Child Only plan that covers two children in a family, the premium rate would be twice the one child premium rate. For a Child Only plan that covers three or more children in a family, the premium rate would be three times the one child premium rate, consistent with HHS Regulations.

We have developed loading factors based on our March 2019 membership. Our loading factor from the per member rate to the single rate is 1.4935. This 1.4935 is the reciprocal of 0.6696, as shown in cells c47, L47, and U47 in Exhibit 13c.

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

YearTotal Rate of Return

2018 2.49%2017 1.00%2016 0.87%2015 0.52%2014 0.62%

LoadingCensus Tiers Relativity FactorSingle 1 1.4935 Single+Spouse 2 2.9870 Single+Child(ren) 1.7 2.5390 Single+Spouse+Child(ren) 2.85 4.2565 Child Only 0.412 0.6153



2.5 Standardized Rating Regions

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

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

The area factors to be used for 2020 are as follows:

Region Counties Included Area Factor

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

1.000

Long Island Nassau, Suffolk 1.000

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

2.7 Material Pricing Used for Morbidity

No adjustments were made to morbidity.

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

2.9 Out-of-Network Benefits

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

2.10 Premiums in Same Metal Level There are no significant premium rate differences between plans in the same metal level.

2.11 Proprietary Studies

Data from 2018 for Healthfirst PHSP is assumed to be 100% credible.

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

2.13 Other Adjustments

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

2.14 Data Sources Experience data is from Healthfirst PHSP individual plans, which are all ACA Compliant plans. HFHP data is used in all exhibits except Exhibit 18.

2.15 Summary of Rate Increases

All rates are increased 15.0%.



Section 3: Additional Notes

3.1 MLR Calculations

Two loss ratios are calculated, one consistent with the New York State prescribed Medical Loss Ratio (MLR) methodology and one based on the Federal definition. The anticipated New York MLR is 83.0%, which equals the minimum allowable MLR of 82%. The anticipated Federal MLR is 83.8%, which exceeds the Federal minimum MLR of 80%.

3.2 Plan Type

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

3.3 Reliance In the preparation of this filing, I relied upon estimates from CMS and Wakely and Associates for their estimates of risk adjustment.

I performed general reasonableness checks, but I have not audited the data and have relied upon its accuracy. To the extent that the underlying data is inaccurate, this filing may also be inaccurate. Actual results will almost certainly vary from those projected in the filing. This is due to random fluctuations, unexpected large claims, changes in population and other such factors.



Section 4: Actuarial Certification

I, am a member of the Society of Actuaries and a member of the American Academy of Actuaries. I meet the “Qualification Standards of Actuarial Opinion” as adopted by the American Academy of Actuaries.

I certify that:

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

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

− ASOP No. 5, Incurred Health and Disability Claims

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

− ASOP No. 12, Risk Classification

− ASOP No. 23, Data Quality

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

− ASOP No. 41, Actuarial Communications

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

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

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

(c) These rates have been established to produce an expected loss ratio that meets the minimum requirement of the State of New York;

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

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

Please note that the Part I Unified Rate Review Template does not demonstrate the process used by Healthfirst Insurance Company, Inc. to develop the rates. Rather, it represents information required by Federal regulation to be provided in support of the review for certification of qualified health plans for Federally facilitated exchanges and for certification that the index rate is developed in accordance with Federal regulation and used consistently and only adjusted by the allowable modifiers.



If you have any questions, please e‐mail me at J or call me at

Appendix A

Market Wide Adjustments to the AV Adjusted Experience Period Index Rate All Plans13 Impact of adjusting experience period data to EHB benefit level ** 1.0000014 Market wide adjustment for changes in provider network ** 1.0000015 Market wide adjustment for fee schedule changes ** 1.0000016 Market wide adjustment for utilization management changes ** 1.0000017 Market wide adjustment for impact on c laim costs from quality improvement and cost containment initiatives ** 1.0000018 Claim trend projection factor (midpoint of experience period to mid point of rate applicability period) 1.1274719 Federal Risk Adjustment Program Impact (less than 1.00 to reflect a recovery, more than 1.00 to reflect a payment to the pool) ** 1.1617120 Impact of adjustments due to experience period claim data not being sufficiently credible ** 1.0000021 Adjustment for changes in distribution of risk pool membership by rating regions (i.e., standard rating regions) ** 1.0000022 Change in morbidity not reflected in the experience data that is known and quantifiable at the time of the rate filing ** 1.0000023 Impact of ACA Provision 9010 - Health Insurance Providers Fee ** 1.00000

23a Impact of changes in New York State Law that are not reflected in the experience data ** 1.0028024 Adjustment for credibility 1.6760625 Covered Lives 1.0317426 PCORI, Risk Adjustment User Fees, and Regulatory Tax 1.0118127 Factor for Small Membership 1.0176028 Impact of Market Wide Adjustments (= Product L13 through L27) 2.33858

Appendix B


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

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

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

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

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

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

outcomes • Provider Symposia, which allows Healthfirst providers to highlight and share their best practices • Provider Partnership Practice meetings for Healthfirst care management, quality and network staff to provide

interim reports with feedback on utilization and quality, as well as satisfactionand medication utilization and adherence

Monitoring and Performance Improvement No less than quarterly, Healthfirst administrative and clinical teams as well as providers and member representatives meet to review care management and quality activity and outcomes. At these quality meetings, thresholds and targets for quality performance are approved, trends in health outcomes and plan performance are reviewed, recommendations are made and work plans are monitored. Clinical Quality and Care Management programs are initiated to close gaps in targeted health outcomes and to improve strategies for identifying and minimizing medication barriers, thus improving compliance and therapeutic outcomes. Furthermore, Healthfirst’s Behavioral Health Services unit conducts additional quality improvement subcommittee meetings, which ultimately report up to the organization’s Quality Improvement Committee. Recognizing the significance of behavioral health, the focus of these subcommittee meetings is to monitor and develop various quality metrics, outcomes and performance improvement initiatives specific to behavioral health. B. Preventing Hospital Readmissions Healthfirst members at high risk for poor health outcomes and / or challenges in navigating the health care delivery system are identified based on patterns of utilization, such as fewer than expected primary care visits, frequent inpatient admissions, readmissions within 30 days in a defined time period or presence of a condition that places them at high risk for readmission such as congestive heart failure. These members are enrolled in complex case management. They receive intensive outreach that includes a detailed assessment which forms the foundation for a comprehensive care plan to address the areas of need. Once outreach and assessment are complete, the case manager will offer community based services to support high risk members, such as home visits, medication reconciliation and post discharge coaching and reminders. Whenever possible, Healthfirst case managers work closely with hospital discharge planners to ensure a safe hospital discharge. Healthfirst also collaborates with providers and community based organizations to identify regional strategies to address difficult psychosocial issues such as homelessness, mental health and substance abuse community programs and innovative strategies to address navigation and cultural barriers to effective health care. Healthfirst offers primary care provider practices near real time notice that their assigned members have been hospitalized to promote the implementation of practice care coordination, including early appointments for members post discharge. The Healthfirst primary care practices receive feedback about the types of emergency department visits, preventable admissions and readmissions that their population of members has experienced in the previous quarter and year. C. Improving Patient Safety Healthfirst has implemented three major approaches to improving the safety of our patients. Medication Management Healthfirst supports and promotes the use of electronic prescribing and medication reconciliation to reduce polypharmacy and improved communication between the patient, the pharmacist and the prescriber. Through our pharmacy benefit manager, Healthfirst utilizes all point of sale edits available to improve the likelihood that members receive an optimized medication regimen. Pharmacy formulary notifications and other prescriber concerns related to the pharmacy benefit are distributed via multiple modalities which may include the Healthfirst portal, mail and email. Patients are educated through our newsletter about safe use of prescription medication. Reducing Antibiotic Resistance Healthfirst actively educates and monitors non evidence based use of antibiotics in primary care, urgent care settings and other practices to reduce the likelihood of the development of antibiotic resistance in the communities that we serve.

These efforts include a provider bulletin with patient education material and quality reports that monitor the use of antibiotics for patients with uncomplicated acute bronchitis and viral upper respiratory infections. Pharmacy data is also available to support these efforts. Healthfirst offers provider workshops to consider alternatives to antibiotic prescriptions as appropriate. Quality Assurance Reviews The Healthfirst Medical Management Department and medical directors investigate potential quality assurance issues as reported by members, providers or Healthfirst staff to determine specific areas of risk for poor health outcomes for our members. Trends in provider, practice or network performance are discussed, and when necessary Healthfirst requires corrective action plans to avoid recurrence of confirmed quality of care events. D. Wellness and Health Promotion Activities Healthfirst has a number of wellness and health promotion programs that seek to meaningfully improve health outcomes for our members by increasing member access to preventive health services, promoting appropriate utilization of services for acute and chronic care, and optimizing member health status. Spectrum of Health The Spectrum of Health program promotes health and wellness in collaboration with each member’s primary care provider, clinical specialists and subspecialists that support the health goals of each target population of members. The Spectrum of Health process begins with an assessment of health risk and key determinants of member wellness, matching member needs with available resources and providing targeted education, alerts, reminders and assistance to aid members in connecting with the health care delivery system. The Spectrum of Health Program is outcomes focused, seeking to:

• Promote access to age and gender appropriate primary, secondary and tertiary prevention services • Ensure that age and gender appropriate preventive and care management milestones are met • Facilitate management of chronic illness • Optimize the functional status of members in the community

Spectrum of Health meets the targeted needs of beneficiaries by utilizing the following strategies:

• Population based education tools such as newsletters, health hints and web based information • Targeted education, reminders and alerts in the form of personalized live calls, text messages (SMS), IVR calls, and

letters for members/providers with care gaps in preventive or chronic care services. • Provider based outreach, education, and support • Community based outreach and education in collaboration with community partners with a shared

vision regarding health promotion goals Healthfirst continually evaluates and improves health promotion programming by collecting, analyzing, and acting on performance data. Provider Collaboration & Reporting Healthfirst regularly collaborates with providers with the objective of meaningfully improving health outcomes for members. Communication occurs via telephone, on‐site visits, relevant articles in newsletters and the web portal, provider clinical bulletins, and targeted mailings. Key components of Healthfirst’s provider reporting efforts include:

• Quality Reporting: provider quality reports are posted on the Healthfirst provider web portal for concurrent

review of status for HEDIS and New York State QARR measures in comparison with HF targets • Member Missing Services Lists: lists of providers’ measure‐specific non‐compliant members in their panel are

posted to the provider web portal. Providers are encouraged to outreach members needing services (e.g., preventive screenings, recommended lab tests, communications on medication adherence) and schedule appointments to close gaps in care

Member Health Assessment Healthfirst seeks to engage members in their health by providing access to a member health assessment (HA). Results of member HAs are used to:

• Generate member care plans • Helps identify members who may benefit from Healthfirst’s wellness campaigns and care management

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

• Renewing or re‐certifying health insurance • Providing information about the health services and benefits offered by Healthfirst • Addressing general member questions or needs, such as changing Primary Doctor (PCP), changing address

or other personal information, or requesting a new member ID card • Providing tips, brochures, and other information to help live a healthier life • Linking members to other helpful community organizations

Healthfirst hosts and/or supports over 600 community events per year. Examples of events that Healthfirst has supported in the last year include:

• Health Literacy Events • Health Fairs / Street Fairs • Nutrition Workshop / Healthy Cooking Contest • Breast Cancer / HIV / Blood Pressure / A1C Screenings • Diabetes Prevention & Health Awareness Days • Infant Immunization Events • Men’s Health Awareness Events • Healthy Heart Day Events

• Healthy Kids & Baby Showers • Chronic Care Workshops • Physical Wellness and Exercise Workshops • Brown Bag Workshops (Pharmacist review medications with attendees) • World Health Day Events • Community Running Events • Holiday celebrations (e.g., Lunar Chinese New Year, Three Kings Day, Dominican Heritage, Black History Month,

Women’s History Month, Veterans Day) • Family Day Events (NYCHA)

Cultural Competency Trainings Healthfirst has a comprehensive cultural competency training program. The objective of this program is to support the organization in its aims to (1) deliver the highest‐quality service to every member regardless of race, ethnicity, culture, or language proficiency and (2) eliminate racial/ethnic disparities in health care. Healthfirst’s Member Services department serves as the front line staff for member questions and concerns. All member services representatives participate in an interactive, instructor‐led cultural sensitivity training when they are hired. In subsequent years, Member Services representatives are required to take an annual refresher course on cultural sensitivity. In addition, all Healthfirst employees are required to annually take an online cultural competency course, the objective of which is to raise awareness of cultural competence activities and opportunities for growth as part of an effort to improve each employee’s ability to serve our members and their communities with cultural awareness and sensitivity. F. Behavioral Health Services The behavioral health program provides a full continuum of care, utilizing acute inpatient services, partial hospitalization and intensive outpatient programs along with ambulatory outpatient care. The program is designed to assist members in finding the appropriate provider to meet their needs and to facilitate timely access to treatments and services including emergency, urgent and routine office care. Healthfirst is ready to work with members to determine a specific provider and, where necessary and desired, assist the member in obtaining an appointment. The program includes diagnostic‐specific programs such as intensive outpatient programs that target substance use and eating disorders. Healthfirst is exploring the potential use of services that make access easier for members such as the use of tele‐mental health as a vehicle for those who have difficulty attending appointments in offices to receive care closer to or in their homes. Members who have been hospitalized receive an agreed‐upon specific discharge plan from Healthfirst as well as support within the community during the initial post‐hospitalization period to improve the potential success of connection to the next treatment component. These activities serve to increase the likelihood of the member maintaining and enhancing progress made in the hospital and decrease the risks of readmission. Healthfirst recognizes that many of those suffering from a mental illness or substance use disorder also have significant physical illnesses and psychosocial issues such as homelessness, poverty and illiteracy. Through its care management program, Healthfirst provides case management, care coordination and navigation assistance to reduce gaps in care and disparity in outcomes by facilitating access to preventive care, treatment and support services. Healthfirst care managers with medical and behavioral health expertise work closely with members, families, providers, social service agencies and community based organizations to provide a unique, member‐centric, integrated and holistic approach to care. Healthfirst‘s Behavioral Health Quality subcommittees monitor the quality and timeliness of such services/interventions to ensure outcomes that are consistent with both national and state benchmarks and internally established targets.

Appendix C

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



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

Line # General***ACA Compliant Plans

Only Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 161 Product* XXXXXXX

p HNY

p HNY

p HNY

p HNY

p HNY

p HNY

p HNY

p HNY HMO B Small Group HMO B Small Group HMO B Small Group HMO B Small Group HMO B Small Group HMO B Small Group HMO B Small Group HMO B Small Group

2 Product ID* XXXXXXX 83744NY002 83744NY002 83744NY002 83744NY002 83744NY002 83744NY002 83744NY002 83744NY002 83744NY001 83744NY001 83744NY001 83744NY001 83744NY001 83744NY001 83744NY001 83744NY001 3 Metal Level (or catastrophic)* XXXXXXX Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold 4 AV Metal Value (HHS Calculator)* XXXXXXX 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 5 AV Pricing Value (total, risk pool experience based)* XXXXXXX 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 6 Plan Type* XXXXXXX HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO Renewing HMO 7 Plan Name* XXXXXXX

p Dependent Age 26,

p Dependent Age 29,





p Dependent Age 26,

p Dependent Age 29,

p Dependent Age 26,

p Dependent Age 29,




p Dependent Age 29, No HMO

p Dependent Age 29,

8 HIOS Plan ID (14 Digits)* XXXXXXX 83744NY0020009 83744NY0020010 83744NY0020011 83744NY0020012 83744NY0020013 83744NY0020014 83744NY0020015 83744NY0020016 83744NY0010025 83744NY0010026 83744NY0010027 83744NY0010028 83744NY0010029 83744NY0010030 No 83744NY00100329 Exchange Plan?* XXXXXXX No No No No No No No No No No No No No No No No

9A 2020 Plan Status (as compared to 2019) XXXXXXX Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod Uniform Mod* This field should be the same as used in the Unified Rate Review Template, Worksheet 2

Amounts should be consistent with appropriate categories in Column 14.3 of Exhibit 17Experience Period Index Rate Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 16

10 Earned Premiums for Latest Experience Period # 109,676.69 109,676.6910A Incurred Claims for Latest Experience Period # 50,496.55 50,496.5510B Member-Months for Latest Experience Period # 264.00 264.0010C Average PMPM Incurred Claims [(10A)/(10B)] = (Initial Index PMPM) 191.27481 191.27481 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.0000011 Average Pricing Actuarial Value reflected in experience period 0.8491012 AV Adjusted Experience Period Index Rate PMPM = [(10C) / (11)] 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877 225.26877

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

Market Wide Adjustments to the AV Adjusted Experience Period Index Rate All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 1613 Impact of adjusting experience period data to EHB benefit level ** 1.0000014 Market wide adjustment for changes in provider network ** 1.0000015 Market wide adjustment for fee schedule changes ** 1.0000016 Market wide adjustment for utilization management changes ** 1.0000017 Market wide adjustment for impact on c laim costs from quality improvement and cost containment initiatives ** 1.0000018 Claim trend projection factor (midpoint of experience period to mid point of rate applicability period) 1.1274719 Federal Risk Adjustment Program Impact (less than 1.00 to reflect a recovery, more than 1.00 to reflect a payment to the pool) ** 1.1617120 Impact of adjustments due to experience period claim data not being sufficiently credible ** 1.0000021 Adjustment for changes in distribution of risk pool membership by rating regions (i.e., standard rating regions) ** 1.0000022 Change in morbidity not reflected in the experience data that is known and quantifiable at the time of the rate filing ** 1.0000023 Impact of ACA Provision 9010 - Health Insurance Providers Fee ** 1.00000

23a Impact of changes in New York State Law that are not reflected in the experience data ** 1.0028024 Adjustment for credibility 1.6760625 Covered Lives 1.0317426 PCORI, Risk Adjustment User Fees, and Regulatory Tax 1.0118127 Factor for Small Membership 1.0176028 Impact of Market Wide Adjustments (= Product L13 through L27) 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858 2.33858

** Not Included in Claim Trend Adjustment

Plan Level Adjustments Average - All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 1629 Index Rate - After Marketwide Adjustments 526.8097 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.80974 526.8097430 Pricing actuarial value (without induced demand factor) # 0.8085 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.80850 0.8085031 Pricing actuarial value (only the induced demand factor) # 1.0800 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.08000 1.0800032 Impact of provider network characteristics ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000033 Impact of delivery system characteristics ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000034 Impact of utilization management practices ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000035 Impact on c laim costs from quality improvement and cost containment initiatives ## 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000036 Benefits in additional to EHB (greater than 1.00) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000037 Impact of eligibility categories (catastrophic plans only) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000038 Addition of Out of Network Benefit Option (e.g., POS or PPO, if applicable) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000039 Impact of Adjustment for NYS Stop Loss reimbursements on SG HNY 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000040 Impact of Age 26 / Age 29 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000041 Impact of Family Planning / No Family Planning 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000042 Impact of Dental vs No Dental 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000043 Premium Curve Adjustment 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000

43a Impact of loss of CSR Funding (A common factor to be applied uniformly to all silver plans only - if applicable) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000043b Rating Region Factor 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000044 Other 1 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000045 Other 2 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000046 Other 3 (specify) 1.0000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.00000 1.0000047 Impact of Plan Wide Adjustments (= Weighted Average Factor using Line 55a) 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318 0.87318

# 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) 121,439.93

ExpensesWeighted Average - All

Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 1649 Plan Expected Costs 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.00 460.0050 FIXED EXPENSE: Administrative Costs (excluding Exchange user fees and profits) - to be expressed as a PMPM Amount ### 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.0000051 VARIABLE EXPENSE: Administrative costs (excluding Exchange user fees and profits) - to be expressed as a percentage ### 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000% 13.000%52 VARIABLE EXPENSE: P rofit/Contribution to surplus margins - to be expressed as a percentage ### 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000% 4.000%53 Total Expense Load as a percentage of Premium (= [L50 + (L51 + L52) * L56] / L56) 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000% 17.000%

### 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). T he "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.

2019 Premium Rates and Membership All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 1654 2019 PMPM Rates (First Quarter 2019 rates for Small Group)*** 481.91 481.9155 2019 Members as of 3/31/2019 (The total should tie to the 3/31/2019 Membership Survey Total) 23.00 23.00

55a 2019 Members as of 3/31/2019 - Only those enrolled in plans that will still be available in 2020 23.00 23.00 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

Calculation of Final 2020 Rates All Plans Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 1656 TOTAL PROJECTED INDEX RATE PMPM (= [(L49 + L50) / (1 - L51 - L52)]) 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.22 554.2257 Percent Change in Premium Rates (= L56 / L54) 15.00% 15.00%

*** The information in the "General" Section above should also be completed for any 2019 plans that will no longer be available in 2020.*** The Average PMPM rate for "All Plans" should be used for All Non-ACA Compliant Plans Weighted Average PMPM: 554.22

Difference From Line 56 Col D: 0.00Overall Average Impact: 15.00% Percentage Difference: 0.0%

Appendix D


Company Name: Healthfirst Health Plan, Inc.NAIC Code: 95284SERFF Tracking #: HLFT-131929303Market Segment: Small Group

A. Insurer Information: HMO - 44 For Profit 95284Company submitting the rate filing request Company Type Org. Type Company NAIC Code

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

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

D. New Rate Information: HLFT-131929303New rate applicability period New rate effective date SERFF Tracking Number

E.

F. Provide responses for the following questions:1.

2.

3.

4.

5.

6

Notes:(1)

(2)

EXHIBIT 11: GENERAL INFORMATION


100 Church Street, 18th Floor, New York, NY 10007Company 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 2020 rate applications have been posted on the Department's website. See note (2). Initial notices have not yet been sent to impacted policyholders and will not be sent until the DFS posts the

relevant 2020 rate applications

January 1, 2020 - December 31, 2020 1/1/2020

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

ResponseDoes 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.

NoAre 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 theDepartment'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 priorto 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 beginon 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?

YesDid the company submit a "Prior Approval Pre-filing" containing a draft of the initial notice and a draft of the narrative summary and numerical summary associated with this rate filing? Indicate Yes or No, and if Yes, please provide the SERFF number of the pre-filing.

Yes, HLFT-13191339645 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. 83744-1482892079297991694

1 of 2

1

23

4

5

678910111213141516171819202122

23242526272829303132333435363738394041

4243444546474849

5051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111

112113114115116117118119120121122123124125126127128129130131132

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA AB AC AD AEIf Unified Rate Review v5.0 To add a product to Worksheet 2 - Plan Product Info, select the Add Product button or Ctrl + Shift + P.

To add a plan to Worksheet 2 - Plan Product Info, select the Add Plan button or Ctrl + Shift + L.Company Legal Name: Healthfirst Health Plan, Inc. State: NY To validate, select the Validate button or Ctrl + Shift + I.HIOS Issuer ID: 83744 Market: Small Group To finalize, select the Finalize button or Ctrl + Shift + F.

Effective Date of Rate Change(s): 1/1/2020

Section I: Experience Period DataExperience Period: 1/1/2018 to 12/31/2018

Total PMPM$59,471.00 $225.27

$0.00 $0.00$50,497.00 $191.28

-$15,355.00 -$58.16$109,677.00 $415.44

264

Section II: Projections

Cost Utilization Cost UtilizationInpatient Hospital $12.48 1.044 1.000 1.044 1.000 $13.60Outpatient Hospital $28.86 1.044 1.000 1.044 1.000 $31.46Professional $69.89 1.044 1.000 1.044 1.000 $76.18Other Medical $18.25 1.044 1.000 1.044 1.000 $19.89Capitation $8.82 1.044 1.000 1.044 1.000 $9.61Prescription Drug $86.97 1.080 1.010 1.080 1.010 $103.48Total $225.27 $254.22

1.0001.0001.0002.074

1/1/2020 $527.25

$253.98100.00%

Projected Period Totals1/1/2020 $527.25 $145,521.00

$0.00 $0.00-$77.59 -$21,414.84

0.00% $0.00$604.84 $166,935.84

276

OtherAdjusted Trended EHB Allowed Claims PMPM for

Morbidity Adjustment

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.

Projected Member Months

Projected Index Rate forReinsuranceRisk Adjustment Payment/ChargeExchange User FeesMarket Adjusted Index Rate

Applied Credibility %Manual EHB Allowed Claims PMPM

Demographic ShiftPlan Design Changes

Market Level Calculations (Same for all Plans)

Trended EHB Allowed Claims PMPM

Year 1 Trend Year 2 Trend

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

Benefit CategoryExperience Period Index

Rate PMPM

2 of 2

133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263264265266267268269270

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA AB AC AD AE

If macros are disabled, press a Product-Plan Data Collection To add a product to Worksheet 2 - Plan Product Info, select the Add Product button or Ctrl + Shift + P.

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

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

HIOS Issuer ID: 83744 Market: Small Group To finalize, select the Finalize button or Ctrl + Shift + F.Effective Date of Rate Change(s): 1/1/2020

Field # Section I: General Product and Plan Information1.1 Product Name1.2 Product ID

1.3 Plan Name

HNY Small Group Gold Dependent

Age 26, Domestic Partner & Family

Planning


Age 29, Domestic Partner & Family

Planning


Age 26, No Domestic Partner

& Family Planning



& Family Planning



& No Family Planning



& No Family Planning


Age 26, Domestic Partner & No

Family Planning


Age 29, Domestic Partner & No

Family Planning 1.4 Plan ID (Standard Component ID) 83744NY0020009 83744NY0020010 83744NY0020011 83744NY0020012 83744NY0020013 83744NY0020014 83744NY0020015 83744NY00200161.5 Metal Gold Gold Gold Gold Gold Gold Gold Gold1.6 AV Metal Value 0.809 0.809 0.809 0.809 0.809 0.809 0.809 0.8091.7 Plan Category Renewing Renewing Renewing Renewing Renewing Renewing Renewing Renewing1.8 Plan Type HMO HMO HMO HMO HMO HMO HMO HMO1.9 Exchange Plan? No No No No No No No No

1.10 Effective Date of Proposed Rates 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/20201.11 Cumulative Rate Change % (over 12 mos prior) 16.04% 16.04% 16.04% 16.04% 16.04% 16.04% 16.04% 16.04%1.12 Product Rate Increase %1.13 Submission Level Rate Increase %

Worksheet 1 Totals Section II: Experience Period and Current Plan Level Information2.1 Plan ID (Standard Component ID) Total 83744NY0020009 83744NY0020010 83744NY0020011 83744NY0020012 83744NY0020013 83744NY0020014 83744NY0020015 83744NY0020016

$59,471 2.2 Allowed Claims $59,471 $59,471 $0 $0 $0 $0 $0 $0 $0$0 2.3 Reinsurance $0 $0 $0 $0 $0 $0 $0 $0 $0

2.4 Member Cost Sharing $8,974 $8,974 $0 $0 $0 $0 $0 $0 $02.5 Cost Sharing Reduction $0 $0 $0 $0 $0 $0 $0 $0 $0

$50,497 2.6 Incurred Claims $50,497 $50,497 $0 $0 $0 $0 $0 $0 $0-$15,355 2.7 Risk Adjustment Transfer Amount -$15,355 -$15,355 $0 $0 $0 $0 $0 $0 $0$109,677 2.8 Premium $109,677 $109,677 $0 $0 $0 $0 $0 $0 $0

264 2.9 Experience Period Member Months 264 264 0 0 0 0 0 0 02.10 Current Enrollment 23 23 0 0 0 0 0 0 02.11 Current Premium PMPM $481.91 $481.91 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.002.12 Loss Ratio 53.54% 53.54% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Per Member Per Month2.13 Allowed Claims $225.27 $225.27 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!2.14 Reinsurance $0.00 $0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!2.15 Member Cost Sharing $33.99 $33.99 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!2.16 Cost Sharing Reduction $0.00 $0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!2.17 Incurred Claims $191.28 $191.28 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!2.18 Risk Adjustment Transfer Amount -$58.16 -$58.16 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!2.19 Premium $415.44 $415.44 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Section III: Plan Adjustment Factors3.1 Plan ID (Standard Component ID) 83744NY0020009 83744NY0020010 83744NY0020011 83744NY0020012 83744NY0020013 83744NY0020014 83744NY0020015 83744NY00200163.2 Market Adjusted Index Rate3.3 AV and Cost Sharing Design of Plan 0.8732 0.8732 0.8732 0.8732 0.8732 0.8732 0.8732 0.87323.4 Provider Network Adjustment 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.00003.5 Benefits in Addition to EHB 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

Administrative Costs3.6 Administrative Expense 13.00% 13.00% 13.00% 13.00% 13.00% 13.00% 13.00% 13.00%3.7 Taxes and Fees 0.68% 0.68% 0.68% 0.68% 0.68% 0.68% 0.68% 0.68%3.8 Profit & Risk Load 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00%3.9 Catastrophic Adjustment 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

3.10 Plan Adjusted Index Rate $641.58 $641.58 $641.58 $641.58 $641.58 $641.58 $641.58 $641.58

3.11 Age Calibration Factor 1.00003.12 Geographic Calibration Factor 1.00003.13 Tobacco Calibration Factor 1.00003.14 Calibrated Plan Adjusted Index Rate $641.58 $641.58 $641.58 $641.58 $641.58 $641.58 $641.58 $641.58

Section IV: Projected Plan Level Information4.1 Plan ID (Standard Component ID) Total 83744NY0020009 83744NY0020010 83744NY0020011 83744NY0020012 83744NY0020013 83744NY0020014 83744NY0020015 83744NY00200164.2 Allowed Claims $145,399 $145,399 $0 $0 $0 $0 $0 $0 $04.3 Reinsurance $0 $0 $0 $0 $0 $0 $0 $0 $04.4 Member Cost Sharing $18,440 $18,440 $0 $0 $0 $0 $0 $0 $04.5 Cost Sharing Reduction $0 $0 $0 $0 $0 $0 $0 $0 $04.6 Incurred Claims $126,959 $126,959 $0 $0 $0 $0 $0 $0 $04.7 Risk Adjustment Transfer Amount -$21,415 -$21,415 $0 $0 $0 $0 $0 $0 $04.8 Premium $152,958 $152,958 $0 $0 $0 $0 $0 $0 $04.9 Projected Member Months 276 276 0 0 0 0 0 0 0

4.10 Loss Ratio 96.52% 96.52% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!Per Member Per Month

4.11 Allowed Claims $526.81 $526.81 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!4.12 Reinsurance $0.00 $0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!4.13 Member Cost Sharing $66.81 $66.81 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!4.14 Cost Sharing Reduction $0.00 $0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!4.15 Incurred Claims $460.00 $460.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!4.16 Risk Adjustment Transfer Amount -$77.59 -$77.59 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!4.17 Premium $554.20 $554.20 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

1.00001.00001.0000

$604.84

Product/Plan Level Calculations

HFHP HMO Small Group HNY83744NY002

16.04%16.04%

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