Filing at a Glance - Pennsylvania at a Glance Company: UPMC Health Benefits, Inc. Product Name: UPMC...

Filing at a Glance

Company: UPMC Health Benefits, Inc.

Product Name: UPMC HB 2018 GRIP - Value and Goals

State: Pennsylvania

TOI: H16I Individual Health - Major Medical

Sub-TOI: H16I.005C Individual - Other

Filing Type: Rate - M.U. (Medically underwritten)

Date Submitted: 08/08/2017

SERFF Tr Num: UPMC-131136230

SERFF Status: Assigned

State Tr Num: UPMC-131136230

State Status: Received Review in Progress

Co Tr Num:

ImplementationDate Requested:

01/01/2018

Author(s): Michael Lovely, Jacqueline DeCoursey, Adam Pittler, Timothy Gaborek, Kara Stonebraker,Nikki Senrud, Yuna Oh, Nicole Patillo, Julianna Makrinos, Stephanie Dulz, Stephanie Fahy,Dominique Bailey

Reviewer(s): Rashmi Mathur (primary)

Disposition Date:

Disposition Status:

Implementation Date:

State Filing Description:

ind rri=4.09%

SERFF Tracking #: UPMC-131136230 State Tracking #: UPMC-131136230 Company Tracking #:

State: Pennsylvania Filing Company: UPMC Health Benefits, Inc.

TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005C Individual - Other


Project Name/Number: /

PDF Pipeline for SERFF Tracking Number UPMC-131136230 Generated 08/15/2017 11:03 AM

General Information

Company and Contact

Filing Fees

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: Individual

Submission Type: New Submission Individual Market Type: Individual

Overall Rate Impact: 4.09% Filing Status Changed: 08/11/2017

State Status Changed: 08/14/2017

Deemer Date: Created By: Timothy Gaborek

Submitted By: Timothy Gaborek Corresponding Filing Tracking Number: Value: UPMC-127741169, UPMC-129866647, UPMC-130253074 Goal:UPMC-128778648, UPMC-129866621, UPMC-130253081

State TOI: H16I Individual Health - Major Medical

State Sub-TOI: H16I.005C Individual - Other

PPACA: Not PPACA-Related

PPACA Notes: null

Include Exchange Intentions: No

Additional Benefits: No

Filing Description:

UPMC HB 2018 GRIP - Value and Goals

Filing Contact InformationMike Lovely, Manager, Actuarial Services [email protected]

600 Grant St.

Pittsburgh, PA 15212

412-454-7849 [Phone]

Filing Company InformationUPMC Health Benefits, Inc.

US Steel Tower

600 Grant Street

Pittsburgh, PA 15219

(412) 454-5180 ext. [Phone]

CoCode: 11018

Group Code: 1324

Group Name: UPMC

FEIN Number: 25-1844144

State of Domicile:Pennsylvania

Company Type: Property &Casualty

State ID Number:

Fee Required? No

Retaliatory? No

Fee Explanation:







Rate Information Rate data applies to filing.

Filing Method:

Rate Change Type: Increase

Overall Percentage of Last Rate Revision: 4.460%

Effective Date of Last Rate Revision: 01/01/2017

Filing Method of Last Filing:

Company Rate Information

Company

Name:

Company

Rate

Change:

Overall %

Indicated

Change:

Overall %

Rate

Impact:

Written

Premium

Change for

this Program:

Number of Policy

Holders Affected

for this Program:

Written

Premium for

this Program:

Maximum %

Change

(where req'd):

Minimum %

Change

(where req'd):

UPMC HealthBenefits, Inc.

Increase 4.090% 4.090% $-413,808 1,926 $7,545,328 4.090% 4.090%







Rate Review Detail

COMPANY:Company Name: UPMC Health Benefits, Inc.

HHS Issuer Id: 67430

PRODUCTS:

Product Name HIOS Product ID HIOS Submission ID Number of Covered

LivesUPMC HB 2018 GRIP - Value and Goals 1926

Trend Factors:

FORMS:New Policy Forms: 0

Affected Forms: 0

Other Affected Forms: 0

REQUESTED RATE CHANGE INFORMATION:Change Period: Annual

Member Months: 26,258

Benefit Change: None

Percent Change Requested: Min: 4.09 Max: 4.09 Avg: 4.09

PRIOR RATE:Total Earned Premium: 7,959,137.00

Total Incurred Claims: 6,506,781.00

Annual $: Min: 89.08 Max: 1,477.68 Avg: 303.11

REQUESTED RATE:Projected Earned Premium: 7,545,328.00

Projected Incurred Claims: 6,187,169.00

Annual $: Min: 92.66 Max: 1,538.90 Avg: 315.45







Rate/Rule Schedule

Item

No.

Schedule

Item

Status

Document Name

Affected Form Numbers

(Separated with commas) Rate Action Rate Action Information Attachments

1 Rate Table Value: UPMC-127741169,UPMC-129866647, UPMC-130253074 Goal: UPMC-128778648, UPMC-129866621, UPMC-130253081

Revised Previous State Filing Number:UPMC-130671623Percent Rate Change Request:4.46

GRIP_RateFiling_RateTables_ValuesandGoalsPlans (Eff1.1.2018).pdf,GRIP_RateFiling_RateTables_ValuesandGoalsPlans (Eff1.1.2018).xlsx,







Attachment GRIP_RateFiling_RateTables_ValuesandGoalsPlans (Eff 1.1.2018).xlsx is not a PDFdocument and cannot be reproduced here.







UPMC Health Benefits, Inc.Monthly Rates by Attained Age, Effective January 1, 2018*

Area 1: Allegheny, Armstrong, Beaver, Butler, Fayette, Washington and Westmoreland

Area 2: Erie

Area 3: Bedford, Blair, Cambria, Cameron, Centre, Clarion, Clearfield, Crawford, Elk, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango and Warren

Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Tier 6Policy Form

Number Plan Area Deductible Age Male Female Male Female Male Female Male Female Male Female Male Female

610 EPO Area 1 $500 00 - 01 269.32$ 269.32$ 309.72$ 309.72$ 403.98$ 403.98$ 511.70$ 511.70$ 632.90$ 632.90$ 754.09$ 754.09$

610 EPO Area 1 $500 02 -19 136.29 136.29 156.74 156.74 204.44 204.44 258.96 258.96 320.29 320.29 381.62 381.62

610 EPO Area 1 $500 20 - 24 131.95 196.65 151.74 226.14 171.54 255.64 197.93 294.97 230.91 344.13 263.90 393.29

610 EPO Area 1 $500 25 - 29 136.76 249.09 157.28 286.46 177.79 323.82 205.14 373.64 239.33 435.91 273.53 498.18

610 EPO Area 1 $500 30 - 34 159.60 305.80 183.54 351.67 207.48 397.54 239.40 458.69 279.30 535.14 319.20 611.59

610 EPO Area 1 $500 35 - 39 193.42 305.87 222.44 351.75 251.45 397.63 290.14 458.80 338.49 535.27 386.85 611.73

610 EPO Area 1 $500 40 - 44 234.54 340.93 269.73 392.06 304.91 443.20 351.82 511.39 410.45 596.62 469.09 681.85

610 EPO Area 1 $500 45 - 49 298.90 382.12 343.73 439.43 388.57 496.75 448.35 573.17 523.07 668.70 597.80 764.23

610 EPO Area 1 $500 50 - 54 389.72 453.28 448.18 521.28 506.64 589.27 584.59 679.93 682.02 793.25 779.45 906.57

610 EPO Area 1 $500 55 - 59 519.58 521.47 597.52 599.69 675.46 677.91 779.37 782.21 909.27 912.57 1,039.17 1,042.94

610 EPO Area 1 $500 60 - 64 712.00 617.00 818.80 709.55 925.60 802.10 1,068.00 925.50 1,246.00 1,079.75 1,424.00 1,234.01

610 EPO Area 1 $1,000 00 - 01 246.59$ 246.59$ 283.58$ 283.58$ 369.89$ 369.89$ 468.53$ 468.53$ 579.50$ 579.50$ 690.46$ 690.46$

610 EPO Area 1 $1,000 02 -19 126.37 126.37 145.33 145.33 189.56 189.56 240.11 240.11 296.98 296.98 353.84 353.84

610 EPO Area 1 $1,000 20 - 24 122.44 179.83 140.81 206.80 159.17 233.77 183.66 269.74 214.27 314.70 244.88 359.65

610 EPO Area 1 $1,000 25 - 29 126.80 226.88 145.82 260.91 164.84 294.94 190.20 340.32 221.90 397.04 253.60 453.76

610 EPO Area 1 $1,000 30 - 34 147.44 277.76 169.55 319.43 191.67 361.09 221.15 416.65 258.01 486.09 294.87 555.53

610 EPO Area 1 $1,000 35 - 39 178.01 277.82 204.71 319.49 231.41 361.17 267.01 416.73 311.52 486.19 356.02 555.64

610 EPO Area 1 $1,000 40 - 44 215.17 311.32 247.44 358.02 279.72 404.71 322.75 466.98 376.55 544.81 430.34 622.64

610 EPO Area 1 $1,000 45 - 49 273.34 348.56 314.34 400.85 355.34 453.13 410.00 522.84 478.34 609.98 546.67 697.12

610 EPO Area 1 $1,000 50 - 54 355.42 412.87 408.73 474.81 462.04 536.74 533.13 619.31 621.98 722.53 710.84 825.75

610 EPO Area 1 $1,000 55 - 59 472.80 474.50 543.72 545.68 614.64 616.85 709.20 711.76 827.40 830.38 945.60 949.01

610 EPO Area 1 $1,000 60 - 64 646.68 560.84 743.69 644.96 840.69 729.09 970.03 841.25 1,131.70 981.46 1,293.37 1,121.67

610 EPO Area 1 $2,500 00 - 01 216.60$ 216.60$ 249.09$ 249.09$ 324.90$ 324.90$ 411.54$ 411.54$ 509.02$ 509.02$ 606.49$ 606.49$

610 EPO Area 1 $2,500 02 -19 113.26 113.26 130.25 130.25 169.89 169.89 215.19 215.19 266.16 266.16 317.12 317.12

610 EPO Area 1 $2,500 20 - 24 109.89 157.94 126.38 181.63 142.86 205.32 164.84 236.91 192.31 276.39 219.79 315.88

610 EPO Area 1 $2,500 25 - 29 113.63 197.97 130.67 227.66 147.71 257.36 170.44 296.95 198.85 346.44 227.25 395.93

610 EPO Area 1 $2,500 30 - 34 131.37 241.26 151.07 277.45 170.78 313.63 197.05 361.89 229.90 422.20 262.74 482.51

610 EPO Area 1 $2,500 35 - 39 157.66 241.31 181.30 277.51 204.95 313.71 236.48 361.97 275.90 422.30 315.31 482.63

610 EPO Area 1 $2,500 40 - 44 189.59 272.24 218.03 313.08 246.47 353.91 284.39 408.36 331.79 476.42 379.18 544.48

610 EPO Area 1 $2,500 45 - 49 239.60 304.25 275.54 349.89 311.48 395.52 359.39 456.37 419.29 532.44 479.19 608.50

610 EPO Area 1 $2,500 50 - 54 310.15 359.53 356.68 413.46 403.20 467.39 465.23 539.30 542.77 629.18 620.31 719.07

610 EPO Area 1 $2,500 55 - 59 411.04 412.52 472.70 474.40 534.36 536.27 616.56 618.78 719.33 721.91 822.09 825.04

610 EPO Area 1 $2,500 60 - 64 560.46 486.69 644.53 559.69 728.60 632.69 840.69 730.03 980.81 851.70 1,120.93 973.37

610 EPO Area 1 $5,000 00 - 01 198.78$ 198.78$ 228.59$ 228.59$ 298.16$ 298.16$ 377.67$ 377.67$ 467.12$ 467.12$ 556.57$ 556.57$

610 EPO Area 1 $5,000 02 -19 105.47 105.47 121.29 121.29 158.20 158.20 200.38 200.38 247.84 247.84 295.30 295.30

610 EPO Area 1 $5,000 20 - 24 102.43 144.77 117.79 166.48 133.16 188.20 153.64 217.15 179.25 253.34 204.86 289.54

610 EPO Area 1 $5,000 25 - 29 105.81 180.59 121.68 207.68 137.55 234.77 158.71 270.89 185.16 316.04 211.61 361.19

610 EPO Area 1 $5,000 30 - 34 121.82 219.33 140.09 252.23 158.36 285.13 182.72 328.99 213.18 383.82 243.63 438.66

610 EPO Area 1 $5,000 35 - 39 145.55 219.37 167.38 252.28 189.21 285.18 218.32 329.06 254.71 383.90 291.10 438.74

610 EPO Area 1 $5,000 40 - 44 174.39 249.01 200.55 286.36 226.71 323.71 261.59 373.51 305.18 435.76 348.78 498.01

610 EPO Area 1 $5,000 45 - 49 219.53 277.91 252.46 319.59 285.38 361.28 329.29 416.86 384.17 486.33 439.05 555.81

610 EPO Area 1 $5,000 50 - 54 283.24 327.82 325.73 377.00 368.22 426.17 424.86 491.74 495.67 573.69 566.48 655.65

610 EPO Area 1 $5,000 55 - 59 374.34 375.66 430.49 432.01 486.64 488.36 561.51 563.49 655.09 657.40 748.68 751.32

610 EPO Area 1 $5,000 60 - 64 509.22 442.60 585.60 508.99 661.98 575.38 763.82 663.90 891.13 774.55 1,018.43 885.20

610 EPO Area 1 $0 00 - 01 267.12$ 267.12$ 307.19$ 307.19$ 400.68$ 400.68$ 507.52$ 507.52$ 627.73$ 627.73$ 747.93$ 747.93$

610 EPO Area 1 $0 02 -19 135.34 135.34 155.64 155.64 203.01 203.01 257.15 257.15 318.06 318.06 378.96 378.96

610 EPO Area 1 $0 20 - 24 131.04 195.31 150.70 224.61 170.36 253.91 196.56 292.97 229.32 341.80 262.09 390.62

610 EPO Area 1 $0 25 - 29 135.81 247.33 156.18 284.43 176.56 321.53 203.72 371.00 237.67 432.83 271.62 494.66

610 EPO Area 1 $0 30 - 34 158.44 303.58 182.20 349.12 205.97 394.66 237.65 455.37 277.26 531.27 316.87 607.16

610 EPO Area 1 $0 35 - 39 191.95 303.65 220.74 349.20 249.53 394.75 287.92 455.48 335.91 531.39 383.90 607.31

610 EPO Area 1 $0 40 - 44 232.68 338.07 267.59 388.78 302.49 439.49 349.03 507.11 407.20 591.63 465.37 676.15

610 EPO Area 1 $0 45 - 49 296.44 378.88 340.91 435.71 385.38 492.54 444.66 568.32 518.77 663.04 592.89 757.76

610 EPO Area 1 $0 50 - 54 386.42 449.39 444.38 516.80 502.34 584.21 579.63 674.09 676.23 786.44 772.83 898.79

610 EPO Area 1 $0 55 - 59 515.07 516.94 592.33 594.48 669.59 672.03 772.60 775.41 901.37 904.65 1,030.14 1,033.89

610 EPO Area 1 $0 60 - 64 705.70 611.59 811.56 703.33 917.41 795.07 1,058.55 917.39 1,234.98 1,070.28 1,411.41 1,223.18

610 EPO Area 2 $500 00 - 01 289.91$ 289.91$ 333.40$ 333.40$ 434.87$ 434.87$ 550.84$ 550.84$ 681.30$ 681.30$ 811.76$ 811.76$

610 EPO Area 2 $500 02 -19 145.31 145.31 167.10 167.10 217.96 217.96 276.08 276.08 341.47 341.47 406.86 406.86

610 EPO Area 2 $500 20 - 24 140.58 210.91 161.67 242.55 182.75 274.18 210.87 316.37 246.02 369.09 281.16 421.82

610 EPO Area 2 $500 25 - 29 145.80 267.91 167.67 308.10 189.55 348.29 218.71 401.87 255.16 468.85 291.61 535.83

610 EPO Area 2 $500 30 - 34 170.64 329.57 196.24 379.01 221.84 428.44 255.96 494.36 298.63 576.75 341.29 659.14

610 EPO Area 2 $500 35 - 39 207.41 329.64 238.52 379.09 269.63 428.53 311.11 494.46 362.96 576.87 414.81 659.28

610 EPO Area 2 $500 40 - 44 252.12 367.75 289.93 422.91 327.75 478.08 378.17 551.63 441.20 643.57 504.23 735.50

610 EPO Area 2 $500 45 - 49 322.08 412.55 370.39 474.43 418.70 536.31 483.11 618.82 563.63 721.96 644.15 825.10

610 EPO Area 2 $500 50 - 54 420.81 489.92 483.93 563.41 547.05 636.89 631.21 734.88 736.41 857.36 841.62 979.84

610 EPO Area 2 $500 55 - 59 561.99 564.04 646.29 648.64 730.59 733.25 842.99 846.06 983.49 987.07 1,123.99 1,128.08

610 EPO Area 2 $500 60 - 64 771.21 667.93 886.89 768.11 1,002.58 868.30 1,156.82 1,001.89 1,349.62 1,168.87 1,542.42 1,335.85

610 EPO Area 2 $1,000 00 - 01 265.20$ 265.20$ 304.98$ 304.98$ 397.80$ 397.80$ 503.88$ 503.88$ 623.22$ 623.22$ 742.57$ 742.57$

610 EPO Area 2 $1,000 02 -19 134.51 134.51 154.68 154.68 201.76 201.76 255.56 255.56 316.09 316.09 376.62 376.62

610 EPO Area 2 $1,000 20 - 24 130.23 192.63 149.77 221.52 169.30 250.42 195.35 288.94 227.91 337.10 260.47 385.26

610 EPO Area 2 $1,000 25 - 29 134.96 243.78 155.20 280.35 175.45 316.92 202.44 365.68 236.18 426.62 269.92 487.57

610 EPO Area 2 $1,000 30 - 34 157.40 299.10 181.01 343.96 204.62 388.83 236.10 448.65 275.45 523.42 314.80 598.19

610 EPO Area 2 $1,000 35 - 39 190.64 299.17 219.24 344.04 247.83 388.92 285.96 448.75 333.62 523.54 381.28 598.34

610 EPO Area 2 $1,000 40 - 44 231.04 335.57 265.69 385.91 300.35 436.25 346.56 503.36 404.32 587.26 462.08 671.15

610 EPO Area 2 $1,000 45 - 49 294.29 376.06 338.43 432.46 382.57 488.87 441.43 564.08 515.00 658.10 588.57 752.11

610 EPO Area 2 $1,000 50 - 54 383.52 445.97 441.05 512.87 498.58 579.77 575.28 668.96 671.16 780.45 767.04 891.95

610 EPO Area 2 $1,000 55 - 59 511.12 512.98 587.79 589.93 664.46 666.88 766.68 769.47 894.47 897.72 1,022.25 1,025.97

610 EPO Area 2 $1,000 60 - 64 700.19 606.85 805.22 697.88 910.25 788.91 1,050.29 910.28 1,225.34 1,062.00 1,400.39 1,213.71

610 EPO Area 2 $2,500 00 - 01 232.60$ 232.60$ 267.49$ 267.49$ 348.90$ 348.90$ 441.94$ 441.94$ 546.61$ 546.61$ 651.28$ 651.28$

610 EPO Area 2 $2,500 02 -19 120.26 120.26 138.29 138.29 180.38 180.38 228.49 228.49 282.60 282.60 336.71 336.71

610 EPO Area 2 $2,500 20 - 24 116.59 168.83 134.08 194.15 151.57 219.47 174.89 253.24 204.04 295.45 233.19 337.65

610 EPO Area 2 $2,500 25 - 29 120.65 212.34 138.75 244.20 156.85 276.05 180.98 318.52 211.14 371.60 241.31 424.69

610 EPO Area 2 $2,500 30 - 34 139.94 259.41 160.93 298.32 181.92 337.23 209.91 389.12 244.90 453.97 279.88 518.82

610 EPO Area 2 $2,500 35 - 39 168.51 259.47 193.79 298.39 219.07 337.31 252.77 389.20 294.90 454.07 337.03 518.94

610 EPO Area 2 $2,500 40 - 44 203.25 293.09 233.73 337.06 264.22 381.02 304.87 439.64 355.68 512.91 406.49 586.19

610 EPO Area 2 $2,500 45 - 49 257.59 327.90 296.23 377.08 334.87 426.26 386.39 491.84 450.79 573.82 515.19 655.79

610 EPO Area 2 $2,500 50 - 54 334.31 387.99 384.46 446.19 434.60 504.39 501.47 581.99 585.05 678.99 668.62 775.98

610 EPO Area 2 $2,500 55 - 59 443.99 445.59 510.58 512.43 577.18 579.27 665.98 668.39 776.98 779.78 887.97 891.18

610 EPO Area 2 $2,500 60 - 64 606.47 526.25 697.44 605.19 788.41 684.12 909.70 789.37 1,061.32 920.94 1,212.94 1,052.50

610 EPO Area 2 $5,000 00 - 01 213.22$ 213.22$ 245.21$ 245.21$ 319.84$ 319.84$ 405.13$ 405.13$ 501.08$ 501.08$ 597.03$ 597.03$

610 EPO Area 2 $5,000 02 -19 111.78 111.78 128.55 128.55 167.67 167.67 212.39 212.39 262.69 262.69 312.99 312.99

610 EPO Area 2 $5,000 20 - 24 108.47 154.52 124.75 177.70 141.02 200.87 162.71 231.78 189.83 270.41 216.95 309.04

610 EPO Area 2 $5,000 25 - 29 112.14 193.45 128.96 222.47 145.78 251.49 168.20 290.18 196.24 338.54 224.27 386.91

610 EPO Area 2 $5,000 30 - 34 129.55 235.57 148.99 270.90 168.42 306.24 194.33 353.35 226.72 412.24 259.10 471.13

610 EPO Area 2 $5,000 35 - 39 155.36 235.61 178.66 270.95 201.96 306.29 233.03 353.41 271.87 412.31 310.71 471.22

610 EPO Area 2 $5,000 40 - 44 186.71 267.83 214.72 308.00 242.72 348.18 280.07 401.74 326.74 468.70 373.42 535.66

610 EPO Area 2 $5,000 45 - 49 235.79 299.25 271.16 344.14 306.53 389.03 353.69 448.88 412.64 523.69 471.59 598.51

610 EPO Area 2 $5,000 50 - 54 305.04 353.52 350.80 406.54 396.56 459.57 457.57 530.27 533.83 618.65 610.09 707.03

610 EPO Area 2 $5,000 55 - 59 404.07 405.52 464.68 466.35 525.30 527.18 606.11 608.28 707.13 709.66 808.15 811.04

610 EPO Area 2 $5,000 60 - 64 550.74 478.33 633.35 550.08 715.96 621.83 826.11 717.49 963.79 837.07 1,101.48 956.66

610 EPO Area 2 $0 00 - 01 287.53$ 287.53$ 330.66$ 330.66$ 431.29$ 431.29$ 546.30$ 546.30$ 675.69$ 675.69$ 805.08$ 805.08$

610 EPO Area 2 $0 02 -19 144.26 144.26 165.90 165.90 216.39 216.39 274.09 274.09 339.00 339.00 403.92 403.92

610 EPO Area 2 $0 20 - 24 139.59 209.46 160.53 240.88 181.46 272.30 209.38 314.19 244.28 366.56 279.17 418.93

610 EPO Area 2 $0 25 - 29 144.77 266.01 166.48 305.91 188.20 345.81 217.15 399.02 253.34 465.52 289.54 532.02

610 EPO Area 2 $0 30 - 34 169.37 327.17 194.77 376.25 220.18 425.32 254.05 490.76 296.39 572.55 338.73 654.34

610 EPO Area 2 $0 35 - 39 205.80 327.24 236.67 376.33 267.54 425.42 308.70 490.86 360.15 572.68 411.60 654.49

610 EPO Area 2 $0 40 - 44 250.09 364.66 287.60 419.36 325.11 474.06 375.13 546.99 437.65 638.15 500.17 729.32

610 EPO Area 2 $0 45 - 49 319.39 409.03 367.30 470.38 415.21 531.74 479.09 613.54 558.94 715.80 638.79 818.06

610 EPO Area 2 $0 50 - 54 417.22 485.67 479.80 558.52 542.38 631.38 625.83 728.51 730.13 849.93 834.43 971.35

610 EPO Area 2 $0 55 - 59 557.08 559.13 640.65 643.00 724.21 726.86 835.62 838.69 974.89 978.47 1,114.17 1,118.25

610 EPO Area 2 $0 60 - 64 764.36 662.03 879.01 761.34 993.66 860.64 1,146.53 993.05 1,337.62 1,158.56 1,528.71 1,324.07

610 EPO Area 3 $500 00 - 01 235.15$ 235.15$ 270.43$ 270.43$ 352.73$ 352.73$ 446.79$ 446.79$ 552.61$ 552.61$ 658.43$ 658.43$

610 EPO Area 3 $500 02 -19 121.38 121.38 139.58 139.58 182.06 182.06 230.62 230.62 285.23 285.23 339.85 339.85

610 EPO Area 3 $500 20 - 24 117.66 172.99 135.31 198.93 152.96 224.88 176.49 259.48 205.90 302.72 235.32 345.97

610 EPO Area 3 $500 25 - 29 121.77 217.85 140.04 250.53 158.31 283.21 182.66 326.78 213.10 381.24 243.55 435.70

610 EPO Area 3 $500 30 - 34 141.30 266.37 162.50 306.32 183.70 346.28 211.96 399.55 247.28 466.14 282.61 532.73

610 EPO Area 3 $500 35 - 39 170.25 266.42 195.78 306.39 221.32 346.35 255.37 399.63 297.93 466.24 340.49 532.85

610 EPO Area 3 $500 40 - 44 205.42 296.41 236.23 340.88 267.04 385.34 308.13 444.62 359.48 518.72 410.84 592.83

610 EPO Area 3 $500 45 - 49 260.46 331.66 299.53 381.41 338.60 431.15 390.69 497.49 455.81 580.40 520.92 663.31

610 EPO Area 3 $500 50 - 54 338.16 392.52 388.88 451.40 439.61 510.28 507.24 588.78 591.78 686.91 676.32 785.04

610 EPO Area 3 $500 55 - 59 449.24 450.86 516.62 518.49 584.01 586.11 673.86 676.28 786.17 789.00 898.48 901.71

610 EPO Area 3 $500 60 - 64 613.79 532.55 705.86 612.43 797.93 692.31 920.68 798.82 1,074.13 931.96 1,227.58 1,065.10

610 EPO Area 3 $1,000 00 - 01 215.72$ 215.72$ 248.08$ 248.08$ 323.58$ 323.58$ 409.87$ 409.87$ 506.95$ 506.95$ 604.02$ 604.02$

610 EPO Area 3 $1,000 02 -19 112.87 112.87 129.81 129.81 169.31 169.31 214.46 214.46 265.26 265.26 316.05 316.05

610 EPO Area 3 $1,000 20 - 24 109.52 158.61 125.95 182.40 142.38 206.19 164.29 237.91 191.67 277.56 219.05 317.21

610 EPO Area 3 $1,000 25 - 29 113.24 198.86 130.23 228.69 147.22 258.52 169.87 298.29 198.18 348.01 226.49 397.72

610 EPO Area 3 $1,000 30 - 34 130.90 242.38 150.54 278.74 170.17 315.09 196.35 363.57 229.08 424.16 261.80 484.76

610 EPO Area 3 $1,000 35 - 39 157.05 242.44 180.60 278.80 204.16 315.17 235.57 363.65 274.83 424.26 314.09 484.87

610 EPO Area 3 $1,000 40 - 44 188.84 271.08 217.17 311.74 245.49 352.40 283.26 406.62 330.47 474.39 377.68 542.16

610 EPO Area 3 $1,000 45 - 49 238.59 302.94 274.38 348.38 310.17 393.83 357.88 454.41 417.53 530.15 477.18 605.89

610 EPO Area 3 $1,000 50 - 54 308.81 357.96 355.13 411.65 401.45 465.35 463.21 536.94 540.41 626.43 617.61 715.92

610 EPO Area 3 $1,000 55 - 59 409.21 410.67 470.59 472.28 531.98 533.88 613.82 616.01 716.12 718.68 818.42 821.35

610 EPO Area 3 $1,000 60 - 64 557.92 484.49 641.61 557.16 725.30 629.83 836.88 726.73 976.36 847.85 1,115.84 968.97

610 EPO Area 3 $2,500 00 - 01 190.06$ 190.06$ 218.57$ 218.57$ 285.09$ 285.09$ 361.11$ 361.11$ 446.64$ 446.64$ 532.17$ 532.17$

610 EPO Area 3 $2,500 02 -19 101.66 101.66 116.91 116.91 152.49 152.49 193.16 193.16 238.90 238.90 284.65 284.65

610 EPO Area 3 $2,500 20 - 24 98.78 139.87 113.60 160.85 128.41 181.83 148.17 209.81 172.87 244.77 197.56 279.74

610 EPO Area 3 $2,500 25 - 29 101.97 174.12 117.27 200.24 132.57 226.36 152.96 261.18 178.45 304.71 203.95 348.24

610 EPO Area 3 $2,500 30 - 34 117.15 211.15 134.72 242.83 152.29 274.50 175.72 316.73 205.01 369.52 234.29 422.30

610 EPO Area 3 $2,500 35 - 39 139.63 211.21 160.57 242.89 181.52 274.57 209.44 316.81 244.35 369.62 279.26 422.42

610 EPO Area 3 $2,500 40 - 44 166.95 237.65 192.00 273.30 217.04 308.95 250.43 356.48 292.17 415.89 333.91 475.30

610 EPO Area 3 $2,500 45 - 49 209.73 265.05 241.19 304.80 272.65 344.56 314.60 397.57 367.03 463.83 419.47 530.09

610 EPO Area 3 $2,500 50 - 54 270.08 312.34 310.60 359.19 351.11 406.04 405.13 468.51 472.65 546.59 540.17 624.68

610 EPO Area 3 $2,500 55 - 59 356.40 357.65 409.86 411.29 463.32 464.94 534.60 536.47 623.69 625.88 712.79 715.29

610 EPO Area 3 $2,500 60 - 64 484.16 421.06 556.79 484.22 629.41 547.38 726.24 631.59 847.28 736.86 968.32 842.12

610 EPO Area 3 $5,000 00 - 01 174.82$ 174.82$ 201.04$ 201.04$ 262.22$ 262.22$ 332.15$ 332.15$ 410.82$ 410.82$ 489.49$ 489.49$

610 EPO Area 3 $5,000 02 -19 95.00 95.00 109.26 109.26 142.51 142.51 180.51 180.51 223.26 223.26 266.01 266.01

610 EPO Area 3 $5,000 20 - 24 92.39 128.62 106.25 147.91 120.11 167.20 138.59 192.92 161.69 225.08 184.79 257.23

610 EPO Area 3 $5,000 25 - 29 95.27 159.26 109.57 183.15 123.86 207.04 142.91 238.89 166.73 278.70 190.55 318.52

610 EPO Area 3 $5,000 30 - 34 108.99 192.39 125.33 221.25 141.68 250.10 163.48 288.58 190.72 336.68 217.97 384.78

610 EPO Area 3 $5,000 35 - 39 129.28 192.43 148.67 221.30 168.07 250.16 193.92 288.65 226.24 336.75 258.57 384.86

610 EPO Area 3 $5,000 40 - 44 153.95 217.78 177.04 250.45 200.14 283.11 230.93 326.67 269.41 381.12 307.90 435.56

610 EPO Area 3 $5,000 45 - 49 192.57 242.51 221.46 278.88 250.34 315.26 288.86 363.76 337.00 424.39 385.15 485.01

610 EPO Area 3 $5,000 50 - 54 247.06 285.20 284.12 327.98 321.18 370.76 370.59 427.80 432.36 499.10 494.12 570.40

610 EPO Area 3 $5,000 55 - 59 324.99 326.12 373.73 375.04 422.48 423.96 487.48 489.18 568.73 570.71 649.97 652.24

610 EPO Area 3 $5,000 60 - 64 440.32 383.36 506.37 440.86 572.42 498.37 660.48 575.04 770.56 670.88 880.64 766.72

610 EPO Area 3 $0 00 - 01 233.28$ 233.28$ 268.27$ 268.27$ 349.92$ 349.92$ 443.23$ 443.23$ 548.21$ 548.21$ 653.18$ 653.18$

610 EPO Area 3 $0 02 -19 120.55 120.55 138.64 138.64 180.83 180.83 229.05 229.05 283.30 283.30 337.55 337.55

610 EPO Area 3 $0 20 - 24 116.88 171.85 134.41 197.63 151.94 223.40 175.32 257.77 204.54 300.74 233.75 343.70

610 EPO Area 3 $0 25 - 29 120.95 216.35 139.09 248.80 157.24 281.25 181.43 324.52 211.66 378.61 241.90 432.69

610 EPO Area 3 $0 30 - 34 140.30 264.48 161.34 304.15 182.39 343.82 210.45 396.72 245.52 462.84 280.59 528.96

610 EPO Area 3 $0 35 - 39 168.97 264.53 194.31 304.22 219.66 343.90 253.45 396.80 295.69 462.94 337.94 529.07

610 EPO Area 3 $0 40 - 44 203.81 293.97 234.39 338.07 264.96 382.16 305.72 440.96 356.67 514.45 407.63 587.95

610 EPO Area 3 $0 45 - 49 258.36 328.89 297.11 378.22 335.87 427.56 387.54 493.33 452.13 575.56 516.72 657.78

610 EPO Area 3 $0 50 - 54 335.32 389.20 385.62 447.58 435.92 505.96 502.98 583.80 586.81 681.10 670.64 778.40

610 EPO Area 3 $0 55 - 59 445.38 446.98 512.18 514.03 578.99 581.08 668.07 670.47 779.41 782.22 890.76 893.96

610 EPO Area 3 $0 60 - 64 608.41 527.91 699.67 607.10 790.93 686.29 912.61 791.87 1,064.71 923.85 1,216.82 1,055.82

630 GOALS Area 1 $1,200 00 - 01 264.83$ 264.83$ 302.23$ 302.23$ 389.49$ 389.49$ 489.22$ 489.22$ 601.42$ 601.42$ 713.61$ 713.61$

630 GOALS Area 1 $1,200 02 - 19 136.68 136.68 154.86 154.86 197.28 197.28 245.75 245.75 300.28 300.28 354.81 354.81

630 GOALS Area 1 $1,200 20 - 24 168.58 168.58 191.54 191.54 214.50 214.50 245.12 245.12 283.39 283.39 321.66 321.66

630 GOALS Area 1 $1,200 25 - 29 193.85 193.85 220.60 220.60 247.35 247.35 283.02 283.02 327.61 327.61 372.20 372.20

630 GOALS Area 1 $1,200 30 - 34 234.51 234.51 267.36 267.36 300.21 300.21 344.01 344.01 398.77 398.77 453.52 453.52

630 GOALS Area 1 $1,200 35 - 39 247.26 247.26 282.02 282.02 316.79 316.79 363.14 363.14 421.08 421.08 479.02 479.02

630 GOALS Area 1 $1,200 40 - 44 290.32 290.32 331.54 331.54 372.76 372.76 427.72 427.72 496.43 496.43 565.13 565.13

630 GOALS Area 1 $1,200 45 - 49 341.44 341.44 390.33 390.33 439.22 439.22 504.40 504.40 585.89 585.89 667.37 667.37

630 GOALS Area 1 $1,200 50 - 54 417.57 417.57 477.88 477.88 538.19 538.19 618.60 618.60 719.12 719.12 819.63 819.63

630 GOALS Area 1 $1,200 55 - 59 507.02 507.02 580.75 580.75 654.48 654.48 752.78 752.78 875.67 875.67 998.55 998.55

630 GOALS Area 1 $1,200 60 - 64 558.97 558.97 640.49 640.49 722.01 722.01 830.70 830.70 966.56 966.56 1,102.43 1,102.43

630 GOALS Area 1 $2,000 00 - 01 245.09$ 245.09$ 279.53$ 279.53$ 359.89$ 359.89$ 451.73$ 451.73$ 555.04$ 555.04$ 658.36$ 658.36$

630 GOALS Area 1 $2,000 02 - 19 127.09 127.09 143.83 143.83 182.89 182.89 227.53 227.53 277.74 277.74 327.96 327.96

630 GOALS Area 1 $2,000 20 - 24 156.46 156.46 177.61 177.61 198.75 198.75 226.94 226.94 262.19 262.19 297.43 297.43

630 GOALS Area 1 $2,000 25 - 29 179.73 179.73 204.37 204.37 229.00 229.00 261.85 261.85 302.91 302.91 343.96 343.96

630 GOALS Area 1 $2,000 30 - 34 217.17 217.17 247.43 247.43 277.68 277.68 318.01 318.01 368.43 368.43 418.85 418.85

630 GOALS Area 1 $2,000 35 - 39 228.92 228.92 260.93 260.93 292.94 292.94 335.63 335.63 388.98 388.98 442.33 442.33

630 GOALS Area 1 $2,000 40 - 44 268.56 268.56 306.52 306.52 344.48 344.48 395.10 395.10 458.36 458.36 521.63 521.63

630 GOALS Area 1 $2,000 45 - 49 315.64 315.64 360.66 360.66 405.68 405.68 465.71 465.71 540.74 540.74 615.78 615.78

630 GOALS Area 1 $2,000 50 - 54 385.74 385.74 441.28 441.28 496.82 496.82 570.86 570.86 663.43 663.43 755.99 755.99

630 GOALS Area 1 $2,000 55 - 59 468.12 468.12 536.01 536.01 603.91 603.91 694.43 694.43 807.58 807.58 920.74 920.74

630 GOALS Area 1 $2,000 60 - 64 515.95 515.95 591.02 591.02 666.09 666.09 766.18 766.18 891.29 891.29 1,016.40 1,016.40

630 GOALS Area 2 $1,200 00 - 01 277.51$ 277.51$ 316.81$ 316.81$ 408.51$ 408.51$ 513.31$ 513.31$ 631.21$ 631.21$ 749.12$ 749.12$

630 GOALS Area 2 $1,200 02 - 19 142.85 142.85 161.95 161.95 206.52 206.52 257.46 257.46 314.76 314.76 372.07 372.07

630 GOALS Area 2 $1,200 20 - 24 177.01 177.01 201.24 201.24 225.47 225.47 257.77 257.77 298.15 298.15 338.53 338.53

630 GOALS Area 2 $1,200 25 - 29 210.58 210.58 239.85 239.85 269.11 269.11 308.13 308.13 356.90 356.90 405.67 405.67

630 GOALS Area 2 $1,200 30 - 34 254.03 254.03 289.81 289.81 325.59 325.59 373.30 373.30 432.93 432.93 492.56 492.56

630 GOALS Area 2 $1,200 35 - 39 267.77 267.77 305.61 305.61 343.45 343.45 393.90 393.90 456.97 456.97 520.04 520.04

630 GOALS Area 2 $1,200 40 - 44 306.92 306.92 350.64 350.64 394.35 394.35 452.63 452.63 525.49 525.49 598.35 598.35

630 GOALS Area 2 $1,200 45 - 49 358.01 358.01 409.39 409.39 460.76 460.76 529.27 529.27 614.90 614.90 700.52 700.52

630 GOALS Area 2 $1,200 50 - 54 438.01 438.01 501.39 501.39 564.77 564.77 649.27 649.27 754.90 754.90 860.53 860.53

630 GOALS Area 2 $1,200 55 - 59 532.02 532.02 609.50 609.50 686.97 686.97 790.28 790.28 919.41 919.41 1,048.54 1,048.54

630 GOALS Area 2 $1,200 60 - 64 586.60 586.60 672.27 672.27 757.93 757.93 872.15 872.15 1,014.93 1,014.93 1,157.71 1,157.71

630 GOALS Area 2 $2,000 00 - 01 256.77$ 256.77$ 292.96$ 292.96$ 377.40$ 377.40$ 473.91$ 473.91$ 582.48$ 582.48$ 691.05$ 691.05$

630 GOALS Area 2 $2,000 02 - 19 132.77 132.77 150.36 150.36 191.40 191.40 238.31 238.31 291.08 291.08 343.85 343.85

630 GOALS Area 2 $2,000 20 - 24 164.23 164.23 186.54 186.54 208.85 208.85 238.60 238.60 275.78 275.78 312.96 312.96

630 GOALS Area 2 $2,000 25 - 29 195.14 195.14 222.09 222.09 249.04 249.04 284.97 284.97 329.88 329.88 374.79 374.79

630 GOALS Area 2 $2,000 30 - 34 235.15 235.15 268.10 268.10 301.05 301.05 344.98 344.98 399.89 399.89 454.80 454.80

630 GOALS Area 2 $2,000 35 - 39 247.80 247.80 282.65 282.65 317.49 317.49 363.95 363.95 422.03 422.03 480.10 480.10

630 GOALS Area 2 $2,000 40 - 44 283.86 283.86 324.11 324.11 364.36 364.36 418.04 418.04 485.13 485.13 552.21 552.21

630 GOALS Area 2 $2,000 45 - 49 330.90 330.90 378.21 378.21 425.52 425.52 488.60 488.60 567.45 567.45 646.30 646.30

630 GOALS Area 2 $2,000 50 - 54 404.57 404.57 462.93 462.93 521.29 521.29 599.11 599.11 696.37 696.37 793.64 793.64

630 GOALS Area 2 $2,000 55 - 59 491.14 491.14 562.48 562.48 633.83 633.83 728.96 728.96 847.86 847.86 966.77 966.77

630 GOALS Area 2 $2,000 60 - 64 541.40 541.40 620.29 620.29 699.17 699.17 804.35 804.35 935.83 935.83 1,067.30 1,067.30

630 GOALS Area 3 $1,200 00 - 01 252.55$ 252.55$ 288.11$ 288.11$ 371.08$ 371.08$ 465.90$ 465.90$ 572.57$ 572.57$ 679.25$ 679.25$

630 GOALS Area 3 $1,200 02 - 19 130.72 130.72 148.00 148.00 188.33 188.33 234.41 234.41 286.26 286.26 338.11 338.11

630 GOALS Area 3 $1,200 20 - 24 161.63 161.63 183.55 183.55 205.47 205.47 234.70 234.70 271.23 271.23 307.76 307.76

630 GOALS Area 3 $1,200 25 - 29 192.00 192.00 218.48 218.48 244.96 244.96 280.26 280.26 324.38 324.38 368.51 368.51

630 GOALS Area 3 $1,200 30 - 34 231.31 231.31 263.69 263.69 296.06 296.06 339.22 339.22 393.17 393.17 447.13 447.13

630 GOALS Area 3 $1,200 35 - 39 243.74 243.74 277.98 277.98 312.21 312.21 357.86 357.86 414.92 414.92 471.98 471.98

630 GOALS Area 3 $1,200 40 - 44 279.17 279.17 318.72 318.72 358.27 358.27 411.00 411.00 476.92 476.92 542.84 542.84

630 GOALS Area 3 $1,200 45 - 49 325.39 325.39 371.87 371.87 418.36 418.36 480.34 480.34 557.81 557.81 635.28 635.28

630 GOALS Area 3 $1,200 50 - 54 397.77 397.77 455.11 455.11 512.46 512.46 588.91 588.91 684.48 684.48 780.05 780.05

630 GOALS Area 3 $1,200 55 - 59 482.83 482.83 552.93 552.93 623.02 623.02 716.49 716.49 833.32 833.32 950.15 950.15

630 GOALS Area 3 $1,200 60 - 64 532.21 532.21 609.72 609.72 687.23 687.23 790.57 790.57 919.75 919.75 1,048.92 1,048.92

630 GOALS Area 3 $2,000 00 - 01 233.79$ 233.79$ 266.53$ 266.53$ 342.94$ 342.94$ 430.25$ 430.25$ 528.48$ 528.48$ 626.71$ 626.71$

630 GOALS Area 3 $2,000 02 - 19 121.60 121.60 137.51 137.51 174.65 174.65 217.09 217.09 264.83 264.83 312.58 312.58

630 GOALS Area 3 $2,000 20 - 24 150.07 150.07 170.25 170.25 190.44 190.44 217.35 217.35 250.99 250.99 284.63 284.63

630 GOALS Area 3 $2,000 25 - 29 178.03 178.03 202.41 202.41 226.79 226.79 259.30 259.30 299.94 299.94 340.57 340.57

630 GOALS Area 3 $2,000 30 - 34 214.23 214.23 244.04 244.04 273.85 273.85 313.60 313.60 363.28 363.28 412.96 412.96

630 GOALS Area 3 $2,000 35 - 39 225.68 225.68 257.20 257.20 288.73 288.73 330.77 330.77 383.31 383.31 435.85 435.85

630 GOALS Area 3 $2,000 40 - 44 258.30 258.30 294.72 294.72 331.14 331.14 379.70 379.70 440.40 440.40 501.10 501.10

630 GOALS Area 3 $2,000 45 - 49 300.86 300.86 343.67 343.67 386.47 386.47 443.55 443.55 514.89 514.89 586.23 586.23

630 GOALS Area 3 $2,000 50 - 54 367.52 367.52 420.32 420.32 473.12 473.12 543.53 543.53 631.53 631.53 719.53 719.53

630 GOALS Area 3 $2,000 55 - 59 445.84 445.84 510.39 510.39 574.94 574.94 661.01 661.01 768.59 768.59 876.18 876.18

630 GOALS Area 3 $2,000 60 - 64 491.31 491.31 562.69 562.69 634.06 634.06 729.22 729.22 848.18 848.18 967.13 967.13

* These rates are monthly; automatic monthly bank withdrawals rates will be the same as monthly rates;

quarterly rates will be three times of the monthly rates.

Supporting Document Schedules Satisfied - Item: Transmittal Letter (A&H)Comments:Attachment(s): UPMC HB GRIP Values & Goals Transmittal Letter UPMC-131136230.pdfItem Status:Status Date:

Satisfied - Item: Actuarial Memorandum and Explanatory Information (A&H)Comments:Attachment(s): Actuarial Memorandum GRIP Values & Goals UPMC-131136230.pdfItem Status:Status Date:







August 8, 2017

Ms. Johanna Fabian-Marks

Commonwealth of Pennsylvania Insurance Department

Insurance Product Regulation & Market Enforcement

Actuarial Review Division

Bureau of Accident & Health Insurance

1311 Strawberry Square

Harrisburg, PA 17120

Dear Ms. Fabian-Marks:

Guaranteed Renewable Individual Product Rate Filing for January 1, 2018 Effective Date

UPMC Health Benefits, Inc. respectfully requests approval of a rate filing for Individual medical products. The

rates are proposed for effective dates of January 1, 2018 through October 1, 2018, for plan offerings as

implemented under the Patient Protection and Affordable Care Act (PPACA).

The Commissioner has discretion regarding the publication of rate filings in the Pennsylvania Bulletin. If the

Department decides to publish notice of this filing, we suggest the following notice language:

UPMC Health Benefits, Inc.

Guaranteed Renewable Individual Product Rate Filing

On August 8, 2017, UPMC Health Benefits, Inc. submitted for approval a rate filing for use with

Individual customers.

An Actuarial Memorandum and rate development exhibit are included in this rate filing. If you have any

questions or require additional information, please call me at 412-454-1230 or email me at [email protected].

Sincerely,

Stephanie Dulz, FSA, MAAA

Actuarial Memorandum General Info

This actuarial memorandum provides the detail behind the rate filing submitted by UPMC Health

Benefits, Inc. for Individual transitional policies.

Company Identifying Information: Company Legal Name: UPMC Health Benefits, Inc. State: PA HIOS Issuer ID: 67430 Market: Individual Effective Date: 1/1/2018 Company Contact Information: Primary Contact Name: Stephanie Dulz, FSA, MAAA Primary Contact Telephone Number: 412-454-1230 Primary Contact Email Address: [email protected]

Filing Information:

Rate Filing SERFF Tracking #: UPMC-131136230

Form Filing SERFF Tracking #:

Initial Filings: UPMC-127741169, UPMC-128778648

Mental Health Parity Amendments: UPMC-129866647, UPMC-129866621

Spousal Eligibility Amendments: UPMC-130253074, UPMC-130253081

Rate Increase

The rate increase for these plans is 4.09%. This is a flat increase across all plans that does not vary by

age, gender, or area.

Timeframe

This product will be renewed as part of the transitional policy extension as detailed in the CMS bulletin titled ‘Insurance Standards Bulletin Series -- INFORMATION – Extension of Transitional Policy through Calendar Year 2018’ dated February 23, 2017. Per the bulletin, members that have a renewal date between January 1, 2018 and October 1, 2018 will be able to renew with the end date of the renewal

plan as December 31, 2018. No plans will be allowed to renew after October 1, 2018.

Benefits offered

Standard medical benefits are included in these plans. They are slightly different from ACA-compliant plans. The main differences are that private duty nursing and bariatric surgery are covered but fertility treatment is not.

Network

Our Premium network is used for all plans. This is the same Premium network used for ACA-compliant

plans.

Areas Offered

This product will be offered to current members in 29 counties:

ALLEGHENY BUTLER CLEARFIELD FOREST LAWRENCE VENANGO

ARMSTRONG CAMBRIA CRAWFORD GREENE MCKEAN WARREN

BEAVER CAMERON ELK HUNTINGDON MERCER WASHINGTON

BEDFORD CENTRE ERIE INDIANA POTTER WESTMORELAND

BLAIR CLARION FAYETTE JEFFERSON SOMERSET

Experience Period

The experience period for claims data used in the rate development was 6-1-2016 through 5-31-2017

with claim runout period through 6-30-2017.

Trend

Experience period allowed claims are trended to the projected time period. Because of the declining

enrollment and resulting lack of consistency in membership over time, we used our commercial block of

business to develop trend. The same commercial block was used in the Individual ACA filings so we used

the same time period and thus the same trend amount for consistency.

Benefit Design

There are no changes in benefits offered between the experience period and projection period.

Cost Sharing

The actuarial value calculated from the experience period was used for the projection period to

calculate paid amounts from allowed amounts. Given the changing experience and the low actuarial

value overall, we expect leveraging to have a minimal impact and thus did not increase actuarial values

for plans from experience period.

Retention

A target loss ratio of 82% was used to calculate premium from projected paid amount. This exceeds the

80% minimum required for individual plans under PPACA. This results in the following components of

retention:

PMPM % of Premium

Projected 2018 Premium $305.67

Average PMPM quality initiative expense: $1.66 0.54%

PCORI Fee (PMPM): $0.20 0.07%

% Premium Tax: $6.11 2.00%

Admin Expenses PMPM $45.68 14.95%

Projected Incurred PMPM $250.65 82.00%

Profit: $1.36 0.45%

Included in the $1.66 quality improvement PMPM are a number of focused quality improvement

initiatives, including but not limited to rare & chronic disease management, an optimal discharge

planning program, a full-time telephonic nurse advice line, and a congestive heart failure tele-

monitoring program.

These types of medical insurance plans would be subjected to the Health Insurance Tax (HIT) under

PPACA. But the first $25M of revenue is exempt from assessment and we don’t believe UPMC Health

Benefits, Inc. will exceed this threshold. Because of this, we have not included any amounts for HIT.

Actuarial Certification

I, Stephanie Dulz, am a Member of the American Academy of Actuaries. I am currently a Manager in the

Actuarial Services department for UPMC Health Plan. I certify that the methods used in calculating the

rates in this filing were actuarially sound, consistently applied and consistent with generally accepted

actuarial practice. I also certify that, to the best of my knowledge, the data used for these calculations

was sound and reliable; the assumptions were sound and consistently applied; the rates produced are

adequate, not excessive, and are in compliance the Actuarial Standards of Practice.

_____________ ________8/8/2017_

Stephanie Dulz, FSA, MAAA Date

UPMC Health Plan

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