Aetna Life Insurance Company. New York Individual. Rate Manual. Table of Contents. Description. General A-1. Premium Rate Manual A-2 A-4
|
|
- Brian Charles
- 2 years ago
- Views:
Transcription
1 Rate Manual Table of Contents Description Page General A-1 Premium Rate Manual A-2 A-4 Product Summary and Actuarial Values B-1 B-10 Plan Forms and Actuarial Value Benefits Rate Tables C-1 D-1 D-12 List of Applicable Forms E-1 Commissions Schedule and Incentive Fees F-1 Loss Ratio G-1 Marketing and Underwriting H-1
2 General This rate manual contains worksheets and instructions for calculating the community rates for the New York Individual Plans available from Aetna Life Insurance Company. It is in accordance with Insurance Law Section 3231 (d) Rate Applications and includes rates for Aetna s new products that will be offered effective January 1, A - 1
3 Premium Rate Manual The following steps are used to calculate premium rates Base Rate Silver Base Premium Rate $ Dependent Up to Age 30 Rider The Federal Health Care Reform allows for continue coverage for dependents on their parent s health plan until age 26. The New York "Age 29" Dependent Coverage Extension permits young adults to continue or obtain coverage under a parent s policy through the age of 29. For subscribers who choose to have the Dependent Up to Age 30 rider, the Silver Base Premium Rate is 3% higher than the rate shown in Step 1 above. The Silver Base Premium Rate with Dependent Up to Age 30 rider is: 3. Plan Pricing Values Silver Base Premium Rate $ The plan factors shown on page C-1 reflect the pricing differential for each product. 4. Standardized Rating Region The table below shows the rating area factors that reflect differences in cost by geographic area. The rating regions listed below are based on the required ACA standardized rating regions. Rating Region Region 1 Region 2 Region 3 Region 4 Counties Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington egany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming Delaware, Dutchess, Orange, Putnam, Sullivan, Ulster Bronx, Kings, New York, Queens, Richmond, Rockland, Westchester Area Factor Region 5 Livingston, Monroe, Ontario, Seneca, Wayne, Yates 0.70 Region 6 Broome, Cayuga, Chemung, Cortland, Onondaga, Schuyler, Steuben, Tioga, Tompkins 0.79 Region 7 Chenango, Clinton, Essex, Franklin, Hamilton, Herkimer, Jefferson, Lewis, Madison, Oneida, Oswego, Otsego, St. Lawrence 0.82 Region 8 Nassau, Suffolk 1.00 A - 2
4 5. Standardized Census Tiers of Aetna s products will be priced to reflect the following the tiers and relativities specified by the DFS. 6. Child Only Plans Tier Relativities Single 1.00 Single + Spouse 2.00 Single + Child(ren) 1.70 Single + Spouse + Child(ren) 2.85 Aetna will offer one Child Only product in each metal tier. The Child Only rate is set at 41.2% of the corresponding single rate product. 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. 7. Subscriber Rate One Child Two Children Three or More Children One Child Rate * 2 One Child Rate * 3 For subscribers without the Dependent Up to Age 30 rider, the subscriber rate is equal to Step 1 x Step 3 x Step 4 x Step 5 or Step 6, rounded to the nearest dollar. For subscribers who choose the Dependent Up to Age 30 rider, the subscriber rate is equal to Step 2 x Step 3 x Step 4 x Step 5 or Step 6, rounded to the nearest dollar. The rate tables are shown on pages D-2 to D-12. The applicability period for the rate tables is January 1, 2014 through December 31, Examples of Rate Calculations Region 3 with NY Aetna Advantage 2000 PD: OAEPO (Base Silver) Plan Single: Round($ *1.0 * 0.89 * 1.0,0) = $531 Single + Spouse: Round($ *1.0 * 0.89 * 2.0,0) = $1,063 Single + Child(ren): Round($ *1.0 * 0.89 * 1.7,0) = $903 Single + Spouse + Child(ren): Round($ *1.0 * 0.89 * 2.85,0) = $1,514 Single + Child(ren) with Dependent Up to Age 30 Rider: Round($ *1.0 * 0.89 * 1.7,0) = $930 A - 3
5 Single + Spouse + Child(ren) with Dependent Up to Age 30 Rider: Round($ *1.0 * 0.89 * 2.85,0) = $1,560 One Child: Round($ *1.0 * 0.89 * 0.412,0) = $219 Two Children: Round($ *1.0 * 0.89 * 0.412,0) * 2 = $219 * 2 = $438 Three or More Children: Round($ *1.0 * 0.89 * 0.412,0) * 3 = $219 * 3 = $657 Region 8 with NY Aetna Advantage 2000 PD: OAEPO (Base Silver) Plan Single: Round($ *1.0 * 1.0 * 1.0,0) = $597 Single + Spouse: Round($ *1.0 * 1.0 * 2.0,0) = $1,194 Single + Child(ren): Round($ *1.0 * 1.0 * 1.7,0) = $1,015 Single + Spouse + Child(ren): Round($ *1.0 * 1.0 * 2.85,0) = $1,701 Single + Child(ren) with Dependent Up to Age 30 Rider: Round($ *1.0 * 1.0 * 1.7,0) = $1,045 Single + Spouse + Child(ren) with Dependent Up to Age 30 Rider: Round($ *1.0 * 1.0 * 2.85,0) = $1,752 One Child: Round($ *1.0 * 1.0 * 0.412,0) = $246 Two Children: Round($ *1.0 * 1.0 * 0.412,0) * 2 = $246 * 2 = $492 Three or More Children: Round($ *1.0 * 1.0 * 0.412,0) * 3 = $246 * 3 = $738 A - 4
6 Summary of Benefits Covered NY AETNA ADVANTAGEPLUS 3000 PD: OAEPO NY AETNA ADVANTAGEPLUS 3000 PD: OAEPO New York Bronze Plan Summary of Features In-Network Deductible Individual $3,000 Family $6,000 Coinsurance (Member Responsibility) 50% $0 once out-of-pocket max. is satisfied Out-of-Pocket Maximum Individual $6,350 Familiy $12,700 cost sharing accumulates to the Out of Pocket Maximum above Primary Care Visit to Treat an Injury or Illness 50% after deductible (excludes Preventative and X-rays) 50% after deductible Specialist Visit 50% after deductible Inpatient Hospital Services (includes Mental/Behavioral Health and Substance Abuse) 50% after deductible Emergency Room Services Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services Imaging (CT/PET Scans, MRIs) 50% after deductible 50% after deductible 50% after deductible Rehabilitative Speech Therapy 50% after deductible Rehabilitative Occupational and Rehabilitative Physical Therapy 50% after deductible Preventive Care/Screening/Immunization 0% Laboratory Outpatient and Professional Services 50% after deductible X-rays and Diagnostic Imaging Skilled Nursing Facility Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services 50% after deductible 50% after deductible 50% after deductible 50% after deductible Pharmacy In-Network Pharmacy Deductible Individual Family Generics Preferred Brand Drugs Non-Preferred Brand Drugs Specialty Drugs (i.e. high-cost) Integrated with medical Integrated with medical $10 copay $35 copay $70 copay Paid at three tier cost structure NOTE: The plan benefits listed above are identical to the benefits of the Child-Only plan and the Dependent Coverage Up to Age 30 rider. B - 1
7 NY AETNA ADVANTAGEPLUS 3000 PD: OAEPO Actuarial Value Snapshot The Actuarial Value Calculator (AV Calculator) is designed to give an estimate of network liability for a given plan design. This build of the AV Calculator uses data from a large national commercial database to build continuance tables by metal tier. User Inputs for Plan Parameters Use Integrated Medical and Drug Deductible? Apply Inpatient Copay per Day? HSA/HRA Options HSA/HRA Employer Contribution? Narrow Network Options Blended Network/POS Plan? Apply Skilled Nursing Facility Copay per Day? 1st Tier Utilization: Annual Contribution Amount: Use Separate OOP Maximum for Medical and Drug Spending? 2nd Tier Utilization: Indicate if Plan Meets CSR Standard? Desired Metal Tier Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design Medical Drug Combined Medical Drug Combined Deductible ($) $3, Coinsurance (%, Insurer's Cost Share) 50.00% OOP Maximum ($) $6, OOP Maximum if Separate ($) Click Here for Important Instructions Type of Benefit Deductible? Coinsurance? Medical Emergency Room Services 50% Inpatient Hospital Services (inc. MHSA) 50% Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and X- rays) 50% Specialist Visit 50% Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services 50% Imaging (CT/PET Scans, MRIs) 50% Rehabilitative Speech Therapy 50% Tier 1 Tier 2 Coinsurance, if different Copay, if separate Deductible? Coinsurance? Coinsurance, if different Rehabilitative Occupational and Rehabilitative Physical Therapy 50% Preventive Care/Screening/Immunization 100% $ % $0.00 Laboratory Outpatient and Professional Services 50% X-rays and Diagnostic Imaging 50% Skilled Nursing Facility 50% Outpatient Facility Fee (e.g., Ambulatory Surgery Center) % Outpatient Surgery Physician/Surgical Services % Drugs Generics $10.00 Preferred Brand Drugs $35.00 Non-Preferred Brand Drugs $70.00 Specialty Drugs (i.e. high-cost) $70.00 Options for Additional Benefit Design Limits: Set a Maximum on Specialty Rx Coinsurance Payments? Specialty Rx Coinsurance Maximum: Set a Maximum Number of Days for Charging an IP Copay? # Days (1-10): Begin Primary Care Cost-Sharing After a Set Number of Visits? # Visits (1-10): Begin Primary Care Deductible/Coinsurance After a Set Number of Copays? # Copays (1-10): Output Calculate Status/Error Messages: Calculation Successful. Actuarial Value: 62.0% Metal Tier: Bronze Copay, if separate This product, NY Aetna AdvantagePlus 3000 PD: OAEPO, satisfies the HHS guidelines for a Bronze plan with an Actuarial Value of 62.0% NOTE: The plan benefits listed above are identical to the benefits of the Child-Only plan and the Dependent Coverage Up to Age 30 rider. B - 2
8 Summary of Benefits Covered NY AETNA PINNACLE PD: OAEPO NY AETNA PINNACLE PD: OAEPO New York Platinum Plan Summary of Features In-Network Deductible Individual $0 Family $0 Coinsurance (Member Responsibility) 10% $0 once out-of-pocket max. is satisfied Out-of-Pocket Maximum Individual $2,000 Familiy $4,000 cost sharing accumulates to the Out of Pocket Maximum above Primary Care Visit to Treat an Injury or Illness $15 per visit (excludes Preventative and X-rays) $35 per visit Specialist Visit $35 per visit Inpatient Hospital Services (includes Mental/Behavioral Health and Substance Abuse) $500/Admit Emergency Room Services Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services Imaging (CT/PET Scans, MRIs) $100 per visit $15 per visit $35 per visit Rehabilitative Speech Therapy $25 per visit Rehabilitative Occupational and Rehabilitative Physical Therapy $25 per visit Preventive Care/Screening/Immunization 0% Laboratory Outpatient and Professional Services $35 per visit X-rays and Diagnostic Imaging $35 per visit Skilled Nursing Facility $500/Admit Outpatient Facility Fee (e.g., Ambulatory Surgery Center) $100 per visit Outpatient Surgery Physician/Surgical Services 0% Pharmacy In-Network Pharmacy Deductible Individual $0 Family $0 Generics $10 copay Preferred Brand Drugs $30 copay Non-Preferred Brand Drugs $60 copay Specialty Drugs (i.e. high-cost) paid at three tier structure NOTE: The plan benefits listed above are identical to the benefits of the Child-Only plan and the Dependent Coverage Up to Age 30 rider. B - 3
9 NY AETNA PINNACLE PD: OAEPO Actuarial Value Snapshot The Actuarial Value Calculator (AV Calculator) is designed to give an estimate of network liability for a given plan design. This build of the AV Calculator uses data from a large national commercial database to build continuance tables by metal tier. User Inputs for Plan Parameters Use Integrated Medical and Drug Deductible? Apply Inpatient Copay per Day? HSA/HRA Options HSA/HRA Employer Contribution? Narrow Network Options Blended Network/POS Plan? Apply Skilled Nursing Facility Copay per Day? 1st Tier Utilization: Annual Contribution Amount: Use Separate OOP Maximum for Medical and Drug Spending? 2nd Tier Utilization: Indicate if Plan Meets CSR Standard? Desired Metal Tier Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design Medical Drug Combined Medical Drug Combined Deductible ($) $0.00 $0.00 Coinsurance (%, Insurer's Cost Share) % % OOP Maximum ($) OOP Maximum if Separate ($) $2, Click Here for Important Instructions Type of Benefit Deductible? Coinsurance? Coinsurance, if different Copay, if separate Medical Emergency Room Services $ Inpatient Hospital Services (inc. MHSA) $ Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and X-rays) $15.00 Specialist Visit $35.00 Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services $15.00 Imaging (CT/PET Scans, MRIs) $35.00 Rehabilitative Speech Therapy $25.00 Deductible? Coinsurance, if Coinsurance? different Rehabilitative Occupational and Rehabilitative Physical Therapy $25.00 Preventive Care/Screening/Immunization 100% $ % $0.00 Laboratory Outpatient and Professional Services $35.00 X-rays and Diagnostic Imaging $35.00 Skilled Nursing Facility $ Outpatient Facility Fee (e.g., Ambulatory Surgery Center) % Outpatient Surgery Physician/Surgical Services % Drugs Generics $10.00 Preferred Brand Drugs $30.00 Non-Preferred Brand Drugs $60.00 Specialty Drugs (i.e. high-cost) $60.00 Options for Additional Benefit Design Limits: Set a Maximum on Specialty Rx Coinsurance Payments? Specialty Rx Coinsurance Maximum: Set a Maximum Number of Days for Charging an IP Copay? # Days (1-10): Begin Primary Care Cost-Sharing After a Set Number of Visits? # Visits (1-10): Begin Primary Care Deductible/Coinsurance After a Set Number of Copays? # Copays (1-10): Output Calculate Status/Error Messages: Calculation Successful. Actuarial Value: 88.1% Metal Tier: Empire Tier 1 Tier 2 This product, NY Aetna Pinnacle PD: OAEPO, satisfies the HHS guidelines for an Platinum plan with an Actuarial Value of 88.1% Copay, if separate NOTE: The plan benefits listed above are identical to the benefits of the Child-Only plan and the Dependent Coverage Up to Age 30 rider. B - 4
10 Summary of Benefits Covered NY AETNA PINNACLE PD: OAMC NY AETNA PINNACLE PD: OAMC New York Platinum Plan Summary of Features In-Network Out-of-Network Deductible Individual $0 $1,000 Family $0 $2,000 Coinsurance (Member Responsibility) 10% 20% $0 once out-of-pocket max. is satisfied Out-of-Pocket Maximum Individual $2,000 $3,000 Familiy $4,000 $5,000 cost sharing accumulates to the Out of Pocket Maximum above Primary Care Visit to Treat an Injury or Illness $15 per visit 20% after deductible (excludes Preventative and X-rays) Specialist Visit $35 per visit 20% after deductible Inpatient Hospital Services (excludes Mental/Behavioral Health and Substance Abuse) $500/Admit 20% after deductible Emergency Room Services $100 per visit $100 per visit Mental/Behavioral Health and Substance Abuse Disorder Inpatient Services $500/Admit 10% after deductible Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services $15 per visit 10% after deductible Imaging (CT/PET Scans, MRIs) $35 per visit 20% after deductible Rehabilitative Speech Therapy $25 per visit 20% after deductible Rehabilitative Occupational and Rehabilitative Physical Therapy $25 per visit 20% after deductible Preventive Care/Screening/Immunization 0% 20% after deductible Laboratory Outpatient and Professional Services $35 per visit 20% after deductible X-rays and Diagnostic Imaging $35 per visit 20% after deductible Skilled Nursing Facility $500/Admit 20% after deductible Outpatient Facility Fee (e.g., Ambulatory Surgery Center) $100 per visit 20% after deductible Outpatient Surgery Physician/Surgical Services 0% 20% after deductible Pharmacy In-Network Out-of-Network Pharmacy Deductible Individual $0 Not Applicable Family $0 Not Applicable Generics $10 Not Covered Preferred Brand Drugs $30 Not Covered Non-Preferred Brand Drugs $60 Not Covered Specialty Drugs (i.e. high-cost) paid at three tier structure Not Covered B - 5
11 NY AETNA PINNACLE PD: OAMC Actuarial Value Snapshot The Actuarial Value Calculator (AV Calculator) is designed to give an estimate of network liability for a given plan design. This build of the AV Calculator uses data from a large national commercial database to build continuance tables by metal tier. User Inputs for Plan Parameters Use Integrated Medical and Drug Deductible? Apply Inpatient Copay per Day? HSA/HRA Options HSA/HRA Employer Contribution? Narrow Network Options Blended Network/POS Plan? Apply Skilled Nursing Facility Copay per Day? 1st Tier Utilization: Annual Contribution Amount: Use Separate OOP Maximum for Medical and Drug Spending? 2nd Tier Utilization: Indicate if Plan Meets CSR Standard? Desired Metal Tier Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design Medical Drug Combined Medical Drug Combined Deductible ($) $0.00 $0.00 Coinsurance (%, Insurer's Cost Share) % % OOP Maximum ($) OOP Maximum if Separate ($) $2, Click Here for Important Instructions Type of Benefit Deductible? Coinsurance? Coinsurance, if different Copay, if separate Medical Emergency Room Services $ Inpatient Hospital Services (inc. MHSA) $ Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and X-rays) $15.00 Specialist Visit $35.00 Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services $15.00 Imaging (CT/PET Scans, MRIs) $35.00 Rehabilitative Speech Therapy $25.00 Deductible? Coinsurance, if Coinsurance? different Rehabilitative Occupational and Rehabilitative Physical Therapy $25.00 Preventive Care/Screening/Immunization 100% $ % $0.00 Laboratory Outpatient and Professional Services $35.00 X-rays and Diagnostic Imaging $35.00 Skilled Nursing Facility $ Outpatient Facility Fee (e.g., Ambulatory Surgery Center) % Outpatient Surgery Physician/Surgical Services % Drugs Generics $10.00 Preferred Brand Drugs $30.00 Non-Preferred Brand Drugs $60.00 Specialty Drugs (i.e. high-cost) $60.00 Options for Additional Benefit Design Limits: Set a Maximum on Specialty Rx Coinsurance Payments? Specialty Rx Coinsurance Maximum: Set a Maximum Number of Days for Charging an IP Copay? # Days (1-10): Begin Primary Care Cost-Sharing After a Set Number of Visits? # Visits (1-10): Begin Primary Care Deductible/Coinsurance After a Set Number of Copays? # Copays (1-10): Output Calculate Status/Error Messages: Calculation Successful. Actuarial Value: 88.1% Metal Tier: Empire Tier 1 Tier 2 This product, NY Aetna Pinnacle PD: OAMC, satisfies the HHS guidelines for an Platinum plan with an Actuarial Value of 88.1% Copay, if separate B - 6
12 Summary of Benefits Covered NY AETNA PREMIER 600 PD: OAEPO NY AETNA PREMIER 600 PD: OAEPO New York Gold Plan Summary of Features In-Network Deductible Individual $600 Family $1,200 Coinsurance (Member Responsibility) 20% $0 once out-of-pocket max. is satisfied Out-of-Pocket Maximum Individual $4,000 Familiy $8,000 cost sharing accumulates to the Out of Pocket Maximum above Primary Care Visit to Treat an Injury or Illness $25 per visit after deductible (excludes Preventative and X-rays) $40 per visit after deductible Specialist Visit $40 per visit after deductible Inpatient Hospital Services (includes Mental/Behavioral Health and Substance Abuse) $1,000/Admit Emergency Room Services Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services Imaging (CT/PET Scans, MRIs) $150 per visit after deductible $25 per visit after deductible $40 per visit after deductible Rehabilitative Speech Therapy $30 per visit after deductible Rehabilitative Occupational and Rehabilitative Physical Therapy $30 per visit after deductible Preventive Care/Screening/Immunization 0% Laboratory Outpatient and Professional Services $40 per visit after deductible X-rays and Diagnostic Imaging Skilled Nursing Facility Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services $40 per visit after deductible $1,000/Admit $100 per visit after deductible $100 per visit after deductible Pharmacy In-Network Pharmacy Deductible Individual Family Generics Preferred Brand Drugs Non-Preferred Brand Drugs Specialty Drugs (i.e. high-cost) None None $10 copay $35 copay $70 copay Paid as three tier cost structure NOTE: The plan benefits listed above are identical to the benefits of the Child-Only plan and the Dependent Coverage Up to Age 30 rider. B - 7
13 NY AETNA PREMIER 600 PD: OAEPO Actuarial Value Snapshot The Actuarial Value Calculator (AV Calculator) is designed to give an estimate of network liability for a given plan design. This build of the AV Calculator uses data from a large national commercial database to build continuance tables by metal tier. User Inputs for Plan Parameters Use Integrated Medical and Drug Deductible? Apply Inpatient Copay per Day? HSA/HRA Options HSA/HRA Employer Contribution? Narrow Network Options Blended Network/POS Plan? Apply Skilled Nursing Facility Copay per Day? 1st Tier Utilization: Annual Contribution Amount: Use Separate OOP Maximum for Medical and Drug Spending? 2nd Tier Utilization: Indicate if Plan Meets CSR Standard? Desired Metal Tier Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design Medical Drug Combined Medical Drug Combined Deductible ($) $ $0.00 Coinsurance (%, Insurer's Cost Share) % % OOP Maximum ($) OOP Maximum if Separate ($) $4, Click Here for Important Instructions Type of Benefit Deductible? Coinsurance? Tier 1 Tier 2 Coinsurance, if different Copay, if separate Deductible? Coinsurance? Medical Emergency Room Services $ Inpatient Hospital Services (inc. MHSA) $1, Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and X-rays) $25.00 Specialist Visit $40.00 Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services $25.00 Imaging (CT/PET Scans, MRIs) $40.00 Rehabilitative Speech Therapy $30.00 Coinsurance, if different Rehabilitative Occupational and Rehabilitative Physical Therapy $30.00 Preventive Care/Screening/Immunization 100% $ % $0.00 Laboratory Outpatient and Professional Services $40.00 X-rays and Diagnostic Imaging $40.00 Skilled Nursing Facility $1, Outpatient Facility Fee (e.g., Ambulatory Surgery Center) % Outpatient Surgery Physician/Surgical Services % Drugs Generics $10.00 Preferred Brand Drugs $35.00 Non-Preferred Brand Drugs $70.00 Specialty Drugs (i.e. high-cost) $70.00 Options for Additional Benefit Design Limits: Set a Maximum on Specialty Rx Coinsurance Payments? Specialty Rx Coinsurance Maximum: Set a Maximum Number of Days for Charging an IP Copay? # Days (1-10): Begin Primary Care Cost-Sharing After a Set Number of Visits? # Visits (1-10): Begin Primary Care Deductible/Coinsurance After a Set Number of Copays? # Copays (1-10): Output Calculate Status/Error Messages: Calculation Successful. Actuarial Value: 79.0% Metal Tier: Gold This product, NY Aetna Premier 600 PD: OAEPO, satisfies the HHS guidelines for a Gold plan with an Actuarial Value of 79.0% Copay, if separate NOTE: The plan benefits listed above are identical to the benefits of the Child-Only plan and the Dependent Coverage Up to Age 30 rider. B - 8
14 Summary of Benefits Covered NY AETNA ADVANTAGE 2000 PD: OAEPO NY AETNA ADVANTAGE 2000 PD: OAEPO New York Silver Plan Summary of Features In-Network Deductible Individual $2,000 Family $4,000 Coinsurance (Member Responsibility) 30% $0 once out-of-pocket max. is satisfied Out-of-Pocket Maximum Individual $5,500 Familiy $11,000 cost sharing accumulates to the Out of Pocket Maximum above Primary Care Visit to Treat an Injury or Illness $30 per visit after deductible (excludes Preventative and X-rays) $50 per visit after deductible Specialist Visit $50 per visit after deductible Inpatient Hospital Services (includes Mental/Behavioral Health and Substance Abuse) $1,500/Admit Emergency Room Services Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services Imaging (CT/PET Scans, MRIs) $150 per visit after deductible $30 per visit after deductible $50 per visit after deductible Rehabilitative Speech Therapy $30 per visit after deductible Rehabilitative Occupational and Rehabilitative Physical Therapy $30 per visit after deductible Preventive Care/Screening/Immunization 0% Laboratory Outpatient and Professional Services $50 per visit after deductible X-rays and Diagnostic Imaging Skilled Nursing Facility Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services $50 per visit after deductible $1,500/Admit $100 per visit after deductible $100 per visit after deductible Pharmacy In-Network Pharmacy Deductible Individual Family Generics Preferred Brand Drugs Non-Preferred Brand Drugs Specialty Drugs (i.e. high-cost) None None $10 copay $35 copay $70 copay Paid as three tier cost structure NOTE: The plan benefits listed above are identical to the benefits of the Child-Only plan and the Dependent Coverage Up to Age 30 rider. B - 9
15 NY AETNA ADVANTAGE 2000 PD: OAEPO Actuarial Value Snapshot The Actuarial Value Calculator (AV Calculator) is designed to give an estimate of network liability for a given plan design. This build of the AV Calculator uses data from a large national commercial database to build continuance tables by metal tier. User Inputs for Plan Parameters Use Integrated Medical and Drug Deductible? Apply Inpatient Copay per Day? HSA/HRA Options HSA/HRA Employer Contribution? Narrow Network Options Blended Network/POS Plan? Apply Skilled Nursing Facility Copay per Day? 1st Tier Utilization: Annual Contribution Amount: Use Separate OOP Maximum for Medical and Drug Spending? 2nd Tier Utilization: Indicate if Plan Meets CSR Standard? Desired Metal Tier Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design Medical Drug Combined Medical Drug Combined Deductible ($) $2, $0.00 Coinsurance (%, Insurer's Cost Share) % % OOP Maximum ($) OOP Maximum if Separate ($) $5, Click Here for Important Instructions Type of Benefit Deductible? Coinsurance? Coinsurance, if different Copay, if separate Medical Emergency Room Services $ Inpatient Hospital Services (inc. MHSA) $1, Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and X- rays) $30.00 Specialist Visit $50.00 Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services $30.00 Imaging (CT/PET Scans, MRIs) $50.00 Rehabilitative Speech Therapy $30.00 Deductible? Coinsurance, if Coinsurance? different Rehabilitative Occupational and Rehabilitative Physical Therapy $30.00 Preventive Care/Screening/Immunization 100% $ % $0.00 Laboratory Outpatient and Professional Services $50.00 X-rays and Diagnostic Imaging $50.00 Skilled Nursing Facility $1, Outpatient Facility Fee (e.g., Ambulatory Surgery Center) % Outpatient Surgery Physician/Surgical Services % Drugs Generics $10.00 Preferred Brand Drugs $35.00 Non-Preferred Brand Drugs $70.00 Specialty Drugs (i.e. high-cost) $70.00 Options for Additional Benefit Design Limits: Set a Maximum on Specialty Rx Coinsurance Payments? Specialty Rx Coinsurance Maximum: Set a Maximum Number of Days for Charging an IP Copay? # Days (1-10): Begin Primary Care Cost-Sharing After a Set Number of Visits? # Visits (1-10): Begin Primary Care Deductible/Coinsurance After a Set Number of Copays? # Copays (1-10): Output Calculate Status/Error Messages: Calculation Successful. Actuarial Value: 70.7% Metal Tier: Silver Tier 1 Tier 2 This product, NY Aetna Advantage 2000 PD: OAEPO, satisfies the HHS guidelines for a Silver plan with an Actuarial Value of 70.7% Copay, if separate NOTE: The plan benefits listed above are identical to the benefits of the Child-Only plan and the Dependent Coverage Up to Age 30 rider. B - 10
16 Form # HIOS Plan ID Plan Exchange ON/OFF Metallic Tier Actuarial Value Plan Factors S2aOffHIXGR SB 17210NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver 70.7% S2aOffHIXGR SB 17210NY NY Aetna Advantage 2000 PD: OAEPO C/O OFF Silver 70.7% OffHIXGR Deps Age NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver 70.7% B2aOffHIXGR SB 17210NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze 62.0% B2aOffHIXGR SB 17210NY NY Aetna AdvantagePlus 3000 PD: OAEPO C/O OFF Bronze 62.0% OffHIXGR Deps Age NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze 62.0% P2aOffHIXGR SB 17210NY NY Aetna Pinnacle PD: OAEPO OFF Platinum 88.1% P2aOffHIXGR SB 17210NY NY Aetna Pinnacle PD: OAEPO C/O OFF Platinum 88.1% OffHIXGR Deps Age NY NY Aetna Pinnacle PD: OAEPO DEP 30 OFF Platinum 88.1% G2aOffHIXGR SB 17210NY NY Aetna Premier 600 PD: OAEPO OFF Gold 79.0% G2aOffHIXGR SB 17210NY NY Aetna Premier 600 PD: OAEPO C/O OFF Gold 79.0% OffHIXGR Deps Age NY NY Aetna Premier 600 PD: OAEPO DEP 30 OFF Gold 79.0% P3aOffHIXGR SB 17210NY NY Aetna Pinnacle PD: OAMC OFF Platinum 88.1% C - 1
17 Premium Rates Monthly rates for effective dates January 1, 2014 through December 31, 2014 are shown on pages D-2 through D-12. D - 1
18 Monthly Premium January 1, 2014 through December 31, 2014 HIOS Plan-Id Plan Exchange Monthly Metallic Tier Rating Area Tier ON/OFF Premium 17210NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 1 Single $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 1 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 1 Single + Spouse $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 1 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 2 Single $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 2 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 2 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 2 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 3 Single $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 3 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 3 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 3 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 4 Single $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 4 Single + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 4 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 4 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 5 Single $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 5 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 5 Single + Spouse $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 5 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 6 Single $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 6 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 6 Single + Spouse $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 6 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 7 Single $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 7 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 7 Single + Spouse $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 7 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 8 Single $ NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 8 Single + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 8 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO OFF Silver Region 8 Single + Spouse + Child(ren) $1,701 D - 2
19 Monthly Premium January 1, 2014 through December 31, 2014 HIOS Plan-Id Plan Exchange Monthly Metallic Tier Rating Area Tier ON/OFF Premium 17210NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 1 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 1 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 1 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 1 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 2 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 2 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 2 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 2 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 3 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 3 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 3 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 3 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 4 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 4 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 4 Single + Spouse $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 4 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 5 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 5 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 5 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 5 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 6 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 6 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 6 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 6 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 7 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 7 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 7 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 7 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 8 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 8 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 8 Single + Spouse $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO OFF Bronze Region 8 Single + Spouse + Child(ren) $1,462 D - 3
20 Monthly Premium January 1, 2014 through December 31, 2014 HIOS Plan-Id Plan Exchange Monthly Metallic Tier Rating Area Tier ON/OFF Premium 17210NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 1 Single $ NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 1 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 1 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 1 Single + Spouse + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 2 Single $ NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 2 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 2 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 2 Single + Spouse + Child(ren) $2, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 3 Single $ NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 3 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 3 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 3 Single + Spouse + Child(ren) $2, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 4 Single $ NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 4 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 4 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 4 Single + Spouse + Child(ren) $2, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 5 Single $ NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 5 Single + Child(ren) $ NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 5 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 5 Single + Spouse + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 6 Single $ NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 6 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 6 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 6 Single + Spouse + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 7 Single $ NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 7 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 7 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 7 Single + Spouse + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 8 Single $ NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 8 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 8 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAEPO OFF Platinum Region 8 Single + Spouse + Child(ren) $2,278 D - 4
21 Monthly Premium January 1, 2014 through December 31, 2014 HIOS Plan-Id Plan Exchange Monthly Metallic Tier Rating Area Tier ON/OFF Premium 17210NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 1 Single $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 1 Single + Child(ren) $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 1 Single + Spouse $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 1 Single + Spouse + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 2 Single $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 2 Single + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 2 Single + Spouse $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 2 Single + Spouse + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 3 Single $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 3 Single + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 3 Single + Spouse $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 3 Single + Spouse + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 4 Single $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 4 Single + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 4 Single + Spouse $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 4 Single + Spouse + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 5 Single $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 5 Single + Child(ren) $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 5 Single + Spouse $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 5 Single + Spouse + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 6 Single $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 6 Single + Child(ren) $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 6 Single + Spouse $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 6 Single + Spouse + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 7 Single $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 7 Single + Child(ren) $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 7 Single + Spouse $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 7 Single + Spouse + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 8 Single $ NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 8 Single + Child(ren) $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 8 Single + Spouse $1, NY NY Aetna Premier 600 PD: OAEPO OFF Gold Region 8 Single + Spouse + Child(ren) $1,962 D - 5
22 Monthly Premium January 1, 2014 through December 31, 2014 HIOS Plan-Id Plan Exchange Monthly Metallic Tier Rating Area Tier ON/OFF Premium 17210NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 1 Single $ NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 1 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 1 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 1 Single + Spouse + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 2 Single $ NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 2 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 2 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 2 Single + Spouse + Child(ren) $2, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 3 Single $ NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 3 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 3 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 3 Single + Spouse + Child(ren) $2, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 4 Single $ NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 4 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 4 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 4 Single + Spouse + Child(ren) $2, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 5 Single $ NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 5 Single + Child(ren) $ NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 5 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 5 Single + Spouse + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 6 Single $ NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 6 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 6 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 6 Single + Spouse + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 7 Single $ NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 7 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 7 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 7 Single + Spouse + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 8 Single $ NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 8 Single + Child(ren) $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 8 Single + Spouse $1, NY NY Aetna Pinnacle PD: OAMC OFF Platinum Region 8 Single + Spouse + Child(ren) $2,303 D - 6
23 Monthly Premium (with Dependent Coverage Up to Age 30 Rider) January 1, 2014 through December 31, 2014 HIOS Plan-Id Plan Exchange Monthly Metallic Tier Rating Area Tier ON/OFF Premium 17210NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 1 Single $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 1 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 1 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 1 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 2 Single $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 2 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 2 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 2 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 3 Single $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 3 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 3 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 3 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 4 Single $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 4 Single + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 4 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 4 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 5 Single $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 5 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 5 Single + Spouse $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 5 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 6 Single $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 6 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 6 Single + Spouse $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 6 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 7 Single $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 7 Single + Child(ren) $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 7 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 7 Single + Spouse + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 8 Single $ NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 8 Single + Child(ren) $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 8 Single + Spouse $1, NY NY Aetna Advantage 2000 PD: OAEPO DEP 30 OFF Silver Region 8 Single + Spouse + Child(ren) $1,752 D - 7
24 Monthly Premium (with Dependent Coverage Up to Age 30 Rider) January 1, 2014 through December 31, 2014 HIOS Plan-Id Plan Exchange Monthly Metallic Tier Rating Area Tier ON/OFF Premium 17210NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 1 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 1 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 1 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 1 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 2 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 2 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 2 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 2 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 3 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 3 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 3 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 3 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 4 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 4 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 4 Single + Spouse $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 4 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 5 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 5 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 5 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 5 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 6 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 6 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 6 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 6 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 7 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 7 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 7 Single + Spouse $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 7 Single + Spouse + Child(ren) $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 8 Single $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 8 Single + Child(ren) $ NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 8 Single + Spouse $1, NY NY Aetna AdvantagePlus 3000 PD: OAEPO DEP 30 OFF Bronze Region 8 Single + Spouse + Child(ren) $1,506 D - 8
Aetna Life Insurance Company. New York Individual. Rate Manual. Table of Contents. Description. Table of Contents A-1. General A-2
Rate Manual Table of Contents Description Page Table of Contents A-1 General A-2 Premium Rate Manual Product Summary and Actuarial Values A-3-A-5 B-1-B-11 Plan Forms and Actuarial Value Benefits C-1 Rate
Aetna Small Business Health Plan Options
Aetna Small Business Health Options NYC Community SM Manhattan, Bronx, Queens, Staten Island and Brooklyn RATES EECTIVE 01/01/01 through 0/1/01 Options NYC Community SM 1-1 NYC Community SM Referred Specialist
AOT (Assisted Outpatient Treatment) Court Orders
Row Created Date Time Data Level Indicator County or Region 01/13/2016 10:54:18 AM Statewide Statewide 01/13/2016 10:54:18 AM Region Central 01/13/2016 10:54:18 AM Region Hudson River 01/13/2016 10:54:18
Health Plans by Counties and Boroughs
Albany County Health Plans by Counties and Boroughs Empire Blue Cross HealthNow dba BlueCross BlueShield of Northeastern NY Allegany County HealthNow dba BlueCross BlueShield of Western NY Bronx Affinity
Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010
This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make available Plans A & B and either C or F. Some plans may not be available in your state.
Investors Title Insurance Company - New York Approved Settlement Providers
( ALL COUNTIES ) First Resource Title & Abstract, LLC 229175 Entire Firm 102 Motor Parkway, Suite 220 Hinman, Howard & Kattell 131803 Entire Firm 700 Security Mutual Building Exchange St. Land Record Services,
CEMA COSTS AND PROCEDURES
CEMA COSTS AND PROCEDURES Bank of America: Upfront fee of $150.00 attorney fee (total attorney fee of $425.00) ; Upfront $700.00 BANK CHECK to Bank of America, N.A.; Borrower authorization required; Turnaround
Rates and the Choices pamphlets are also available online at www.cs.ny.gov/ employee-benefits.
New York State Correctional Officers & Police Benevolent Association, Inc. 102 Hackett Boulevard - Albany, NY 12209 (518) 427-1551 www.nyscopba.org nyscopba@nyscopba.org TO: FROM: NYSCOPBA Chief Sector
New York State Catholic Health Plan, Inc. dba Fidelis Care New York. Rate Manual - Individual Effective Date: January 1, 2015.
New York State Catholic Health Plan, Inc. dba Fidelis Care New York Rate Manual - Individual Effective Date: January 1, 2015 Table of Contents Rate Pages Page 2-5 Counties Within each Rating Region Page
2012 Salary Survey Results
2012 Salary Survey Results The New York State Association of School Business Officials March 2013 The salary information that follows is taken from the 2012 Salary Survey of the NYSASBO membership conducted
7/14/2015 APPLICATION TO THE NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES FOR A PREMIUM ADJUSTMENT. NAIC #: 55204 SERFF Tracking #s: HLTH-130145438
1. Introduction. 7/14/2015 APPLICATION TO THE NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES FOR A PREMIUM ADJUSTMENT NAIC #: 55204 SERFF Tracking #s: HLTH-130145438 TO BE EFFECTIVE UPON 2016 RENEWAL
New York State Department of Health Division of Managed Care and Program Evaluation County Directory of Managed Care Plans
Wednesday, February 10, 2016 Page 1 of 62 Albany 7. 8. Capital District Physicians' Health Plan, Inc. YES YES YES Empire HealthChoice HMO, Inc. YES *** *** Health Insurance Plan of Greater New York YES
SUNY Contributions to New York s Physician Population
RESEARCH BRIEF July 2015 SUNY Contributions to New York s Physician Population Highlights Nearly 1 in 5 of New York physicians is a graduate of a SUNY medical school and/or received graduate medical training
Conventional Plus/FHA Plus Programs Participating Lenders
Conventional Plus/FHA Plus Programs Participating Lenders Region/County Lender Name Location/Telephone # Region 1: Buffalo Cattaraugus, Chautauqua, Erie, and Niagara Region 2: Rochester Genesee, Livingston,
7/18/2014 APPLICATION TO THE NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES FOR A PREMIUM ADJUSTMENT. NAIC #: SERFF Tracking #s: HLTH
1. Introduction. 7/18/2014 APPLICATION TO THE NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES FOR A PREMIUM ADJUSTMENT NAIC #: 55204 SERFF Tracking #s: HLTH-129631427 TO BE EFFECTIVE UPON 2015 RENEWAL
Lawyers caring. Lawyers sharing.
Lawyers caring. Lawyers sharing. Around the corner. Around the state. The New York Bar Foundation is the charitable arm of the New York State Bar Association. Through the caring and sharing of lawyers,
Population Health Improvement Program
Population Health Improvement Program Overview May 2015 May 2015 Population Health Improvement Program Overview 2 PHIP Overview The New York State Department of Health s Population Health Improvement Program
TOURISM: BUILT TO LEAD NEW YORK S ECONOMY
TOURISM: BUILT TO LEAD NEW YORK S ECONOMY 2016 support THE I NY MATCHING GRANT PROGRAM Authored by New York State Tourism Industry Coalition Executive Summary Tourism Economic Growth: Travel & tourism
& DEADLINES NYSHIP RATES FOR DECEMBER 2014
DECEMBER 2014 NYSHIP RATES & DEADLINES FOR 2015 For Employees of the State of New York who are unrepresented or in Negotiating Units that have agreements/awards with New York State effective October 1,
Rates NYSHIP. & Deadlines for 2016. November 2015. Choose Your Health Insurance Plan For 2016 by December 18, 2015
NYSHIP Rates & Deadlines for 2016 November 2015 For Employees of the State of New York and their enrolled Dependents Choose Your Health Insurance Plan For 2016 by December 18, 2015 Now is the Option Transfer
Local. Per Additional Second Increment Cost (4- decimal)
Local Tables LOT 1 Local Services - Regional* Per 1st Second Increment (4- decimal) Dedicated Per Additional Second Increment (4- decimal) Per 1st _60 Second Increment (4- decimal) Switched Per Additional
Date: March 7, Division: Health and Long Term Care. SUBJECT: Assisted Living Program (ALP) Rates and Rate Codes
+------------------------------------------+ LOCAL COMMISSIONERS MEMORANDUM +------------------------------------------+ DSS-4037EL (Rev. 9/89) Transmittal No: 96 LCM-24 Date: March 7, 1996 Division: Health
title insurance company
title insurance company April 2005 Pursuant to Article 23 of the Insurance Law, TIRSA has been duly designed as the New York Insurance Department s statistical agent for collecting, compiling and furnishing
Annual Conference Sponsorship and Exhibitor Opportunities
80 Years and Still Growing ROI CODING EHR INNOVATI O N ANALYTICS WE ARE NYHIMA DATA GOVERNANCE AdHIMA HIMANNY CNYHIMA RRHIMA HIMAWNY SENYHIMA TZHIMA HIMANYC LIHIMA Annual Conference Sponsorship and Exhibitor
Housing Affordability in New York State
Housing Affordability in New York State March 2014 Thomas P. DiNapoli New York State Comptroller Prepared by the Office of Budget and Policy Analysis Additional copies of this report may be obtained from:
New York State Department of Health Division of Managed Care and Program Evaluation Managed Care Plan Directory
Friday, August 07, 2015 Page 1 of 28 Aetna Health Inc. HMO (Health Maintenance Organization) 2/3/1986 For-profit 1160286 100 Park Avenue, 12th Floor New York, NY 10017 (212) 457-0700 Mr. Steven Logan,
Nursing Schools of New York State
Nursing Schools of New York State Central Region Counties in region: Broome, Cayuga, Chenango, Clinton, Cortland, Delaware, Essex, Fulton, Franklin, Hamilton, Herkimer, Jefferson, Madison, Montgomery,
Financial Levels for Medicaid and Related Program Eligibility
2016 NYS INCOME AND RESOURCE STANDARDS AND FEDERAL POVERTY LEVELS ( Reference Documents: SA 2015-00031 -01, GIS 14 MA/029, GIS14 MA/08, GIS 15 MA/01, GIS 15 MA/03, GIS 15 MA/10,GIS 15 MA/21, MBL-Transmittal
Preventing Chronic Diseases
Priority Areas of County Health Departments The following information was obtained through the New York State Department of Health. It was provided to them by the Prevention Agenda Technical Support Awardees
New York State Office of Mental Health Organization, Structure and Facilities
Appendix D New York State Office of Mental Health Organization, Structure and This Appendix contains contact information on the OMH Field Offices, State Operated and Forensic Services. Central Office The
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Minimum Value Calculator Methodology DEPARTMENT OF HEALTH AND HUMAN SERVICES Patient Protection and Affordable Care Act; Minimum Value Calculator Methodology AGENCY: Department of Health and Human Services
Albany Guardian Society Long Term Care Update
Redesign Medicaid in New York State Albany Guardian Society Long Term Care Update Mark Kissinger, Director Division of Long Term Care, Office of Health Insurance Programs NYS Department of Health April
A JAILHOUSE LAWYER S MANUAL
A JAILHOUSE LAWYER S MANUAL Appendix III: Addresses of New York District Attorneys Columbia Human Rights Law Review Ninth Edition 2011 LEGAL DISCLAIMER A Jailhouse Lawyer s Manual is written and updated
Counties and Casino Gaming in New York State: Moving Forward
Counties and Casino Gaming in New York State: Moving Forward December 2013 Mark R. Alger President Stephen J. Acquario Executive Director NYSAC December 2013 1 COUNTIES AND CASINO GAMING IN NEW YORK STATE:
Franklin Central School District
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Franklin Central School District Health Insurance Cost Savings Report of Examination Period Covered: January
Capital Region BOCES
O f f i c e o f t h e N e w Y o r k S t a t e C o m p t r o l l e r Division of Local Government & School Accountability Capital Region BOCES Claims Auditing Report of Examination Period Covered: July
Monticello Central School District
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Monticello Central School District Information Technology Cost Savings Report of Examination Period Covered:
Naples Central School District
O f f i c e o f t h e N e w Y o r k S t a t e C o m p t r o l l e r Division of Local Government & School Accountability Naples Central School District Online Banking Report of Examination Period Covered:
3CS: COOPERATION AND CONSOLIDATION CONSULTING SERVICE (Technical Assistance Program)
3CS: COOPERATION AND CONSOLIDATION CONSULTING SERVICE (Technical Assistance Program) Objective: 3CS is a facilitation service designed to help local officials eliminate duplication of effort and provide
Broadalbin-Perth Central School District
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Broadalbin-Perth Central School District Health Insurance Buyouts and Separation Payments Report of Examination
Property Taxes in New York. Trudi Renwick Senior Economist Fiscal Policy Institute May 14, 2008
Property Taxes in New York Trudi Renwick Senior Economist Fiscal Policy Institute May 14, 2008 1 The root causes of the rising property taxes in New York: The responsibilities that New York State assigns
NEW YORK STATE MEDICAID PROGRAM MANAGED CARE REFERENCE GUIDE: ENROLLEE ROSTERS
NEW YORK STATE MEDICAID PROGRAM MANAGED CARE REFERENCE GUIDE: ENROLLEE ROSTERS TABLE OF CONTENTS Section I Purpose Statement... 2 Section II Enrollee Rosters... 3 Monthly Managed Care Roster File Layout
What is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/cuhealthplan or by calling 1-800-735-6072.
What is the overall deductible? $250 per person/$500 per family. Are there other deductibles for specific services? No.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions
Blank Summary of Coverage
Blank Summary of Coverage This is not a policy. You can get the policy at www.insurancecompany.com/plan1500 or by calling 1-800-XXX-XXXX. A policy has more detail about how to use the plan and what you
Eldred Central School District
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Eldred Central School District Virtual Desktops: Cost Savings and Energy Conservation Report of Examination
Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions
Aetna Medicare Advantage HMO SHBP Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.state.nj.us/treasury/pensions/health-benefits.shtml or
Briefing Document on Employment and Wages in New York State s Fast-Food Restaurants. Prepared for the Minimum Wage Board. May 2015
Briefing Document on Employment and Wages in New York State s Fast-Food Restaurants Prepared for the Minimum Wage Board May 2015 by Division of Research and Statistics New York State Department of Labor
West Islip Union Free School District
O f f i c e o f t h e N e w Y o r k S t a t e C o m p t r o l l e r Division of Local Government & School Accountability West Islip Union Free School District Payroll Report of Examination Period Covered:
Individual Plan: Silver 1 93-95 Coverage Period: 01/01/2014-12/31/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cchpsc.org or by calling 1-800-580-8736 or TTY 1-800-545-8279
Hicksville Union Free School District
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Hicksville Union Free School District Purchasing Report of Examination Period Covered: July 1, 2014 October
A JAILHOUSE LAWYER S MANUAL
A JAILHOUSE LAWYER S MANUAL Appendix II: New York State: Filing Instructions & Addresses of New York State Courts Columbia Human Rights Law Review Ninth Edition 2011 LEGAL DISCLAIMER A Jailhouse Lawyer
PART I Introduction to Civil Litigation
PART I Introduction to Civil Litigation CHAPTER 1 Litigation and the Paralegal KEY POINTS New York has its own rules of civil procedure, known as the Civil Practice Laws and Rules (CPLR). New York also
PERFORMANCE AND ACCOUNTABILITY MATRIX 5. Contract/Award Procurement Performance/ Accountability Goals
1. Program Name Community Solutions for Transportation 11 (CST 11) 2. SFY 2009-10 2011-12 3. Appropriation Level $54,884 $112,000 4. Funding Level Total PERFORMANCE AND ACCOUNTABILITY MATRIX 5. 6. 7. Contract/Award
Massachusetts. HPHC Insurance Company The Harvard Pilgrim Best Buy HSA PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs
Massachusetts HPHC Insurance Company The Harvard Pilgrim Best Buy HSA PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014 12/31/2014 Coverage for: Individual
Genworth 2015 Cost of Care Survey New York
Cost of Care Survey 2015 Genworth 2015 Cost of Care Survey State-Specific Data 118928NY 04/01/15 Homemaker Services Hourly Rates USA $8 $20 $40 $44,616 2% Whole State $9 $21 $36 $48,048 1% Albany Schenectady
Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts
Massachusetts The Harvard Pilgrim Best Buy HMO Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage for: Individual + Family Plan Type: HMO This
Waverly Central School District
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Waverly Central School District Financial Condition Report of Examination Period Covered: July 1, 2011 March
Massachusetts. HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs
Massachusetts HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 6/1/2013 5/31/2014 Coverage for: Individual
Volunteer Firemen s Benevolent Association of North Tonawanda
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Volunteer Firemen s Benevolent Association of North Tonawanda Foreign Fire Insurance Tax Moneys Report of
Massachusetts. Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO
Massachusetts The HPHC Insurance Company PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO This
Massachusetts. Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO
Massachusetts The HPHC Insurance Company PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO This
Village of Dannemora
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Village of Dannemora Internal Controls Over Cash Receipts Report of Examination Period Covered: June 1, 2011
Massachusetts. HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs
HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Massachusetts Coverage Period: 6/1/2013 5/31/2014 Coverage for: Individual
Massachusetts. Coverage Period: 07/01/2014 06/30/2015 Coverage for: Individual + Family Plan Type: HMO
Massachusetts Harvard Pilgrim Health Care, Inc. The Harvard Pilgrim Best Buy Tiered Copayment ChoiceNet HMO-WSHG Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period:
St Olaf College Coverage Period: Beginning on or after 09-01-2014
St Olaf College Summary of Benefits and Coverage: What this Plan covers & What it Costs Coverage Period: Beginning on or after 09-01-2014 Coverage for: Single and family coverage Plan Type: PPO This is
Alfred-Almond Central School District
O f f i c e o f t h e N e w Y o r k S t a t e C o m p t r o l l e r Division of Local Government & School Accountability Alfred-Almond Central School District Financial Software Access and Monitoring Report
Coverage Period: 8/1/2013-7/31/2014 Coverage for: Insured Student+Dependent Plan Type: PPO. Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.gallagherkoster.com/colgate or by calling 1 877-371-9621.
Queensbury Union Free School District
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Queensbury Union Free School District Server Virtualization Technology Report of Examination Period Covered:
The Harvard Pilgrim/HPHC Insurance Company POS Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts
Massachusetts The Harvard Pilgrim/HPHC Insurance Company POS Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage Period: 01/01/2016 12/31/2016 Coverage for: Individual + Family Plan
You can see the specialist you choose without permission from this plan.
Primary Select Silver I Plan: Health Republic Insurance of New York Coverage Period: 01/01/2014 12/31/2014 This is only a summary. If you want more detail about your coverage and costs, you can get the
January 1, 2015 December 31, 2015
Summary of Benefits, and without Rx (HMO-POS) CMS Contract # H3328 January 1, 2015 December 31, 2015 Thank you for your interest in s. Our plans are offered by New York State Catholic Health Inc. /Fidelis
Uneven Progress: Upstate Employment Trends Since the Great Recession
Uneven Progress: Upstate Employment Trends Since the Great Recession OFFICE OF THE NEW YORK STATE COMPTROLLER Thomas P. DiNapoli, State Comptroller AUGUST 2016 Message from the Comptroller August 2016
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.arml.org\benefit_programs.html or by calling 1-501-978-6137.
Local Commissioners Memorandum
Andrew M. Cuomo Governor NEW YORK STATE OFFICE OF CHILDREN & FAMILY SERVICES 52 WASHINGTON STREET RENSSELAER, NY 12144 Gladys Carrión, Esq. Commissioner Local Commissioners Memorandum Transmittal: 11-OCFS-LCM-14
NY State of Health: The Official Health Plan Marketplace 2014 Open Enrollment Report June 2014
NY State of Health: The Official Health Plan Marketplace 2014 Open Enrollment Report June 2014 Page 0 of 45 Table of Contents Section1: Introduction... 2 Section 2: Individual Marketplace... 3 Enrollment
BlueSelect Silver ValueTwo for Individuals
BlueSelect Silver ValueTwo for Individuals Coverage Period: 1/1/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Single Plan Type: PPO This is only
Southern Tier Region. 2013 $53,200 2014 $82,100 54% increase 2013 to 2014 2015 $89,800 9% increase 2014 to 2015
T H E F A C T S A B O U T Taxes on New Yorkers who purchase private health insurance Estimated annual state and federal taxes and fees paid by an upstate New York business with 75-125 employees Central
LGC HealthTrust: MT Blue 5-RX10/20/45 Coverage Period: 07/01/2013 06/30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-800-870-3057. Important Questions
Manhattan School of Music: BCS Insurance Company Coverage Period: 8/27/2014-8/27/2015 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cirstudenthealth.com/msmnyc or by calling 1-800-322-9901.
Frequently Used Abbreviations in This Book 1. A Chronological Snapshot of New York History and Family History, 1609 1945 2
Table of Contents Foreword Preface Introduction: How to Use This Book 1 Frequently Used Abbreviations in This Book 1 A Chronological Snapshot of New York History and Family History, 1609 1945 2 Part One
Massachusetts. The Harvard Pilgrim Tiered Copayment HMO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts
The Harvard Pilgrim Tiered Copayment HMO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Massachusetts Coverage Period: 07/01/2015 06/30/2016 Coverage for: Individual + Family Plan Type:
Massachusetts. The HPHC Insurance Company Best Buy Tiered Copayment ChoiceNet PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts
Massachusetts The HPHC Insurance Company Best Buy Tiered Copayment ChoiceNet PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage Period: 07/01/2015 06/30/2016 Coverage for: Individual
Health Alliance Plan. Coverage Period: 01/01/2014-12/31/2014. document at www.hap.org or by calling 1-800-759-3436.
Health Alliance Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage for: Individual Family Plan Type: HMO This is only a summary.
Gregory E. Young, MD, F.A.C.E.P. Medical Director, Western Region New York State Department of Health
Gregory E. Young, MD, F.A.C.E.P. Medical Director, Western Region New York State Department of Health Public Health Impact of Strokes: United States Every 45 seconds, someone in the U.S. has a stroke.
You can see the specialist you choose without permission from this plan.
: Blue Option / Gold 800 Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual / Family Plan Type: EPO This is only a summary.
Cherokee Insurance High Deductible Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-800-201-0450 Important Questions Answers Why this
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.thehealthplan.com or by calling 1-800-504-0443. Important
BlueCross BlueShield of North Carolina: Blue Advantage Platinum 500 (broad network)
BlueCross BlueShield of North Carolina: Blue Advantage Platinum 500 (broad network) $$start$$ Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
REPORT OF THE IMPACT OF ADVANCE DEPOSIT WAGERING ON HORSE RACING AND PARI-MUTUEL HANDLE IN NEW YORK STATE
STATE OF NEW YORK RACING AND WAGERING BOARD REPORT OF THE IMPACT OF ADVANCE DEPOSIT WAGERING ON HORSE RACING AND PARI-MUTUEL HANDLE IN NEW YORK STATE September 14, 2012 REPORT OF IMPACT OF ACCOUNT WAGERING
Operating Engineers Public Employees Health and Welfare Trust Fund Plan D vs PERS CHOICE and PERS SELECT PPO Plan
Calendar Year Deductible $500 Individual / $1,000 Family per calendar year Does not apply to PPO physician office visits, PPO preventive care or hospital emergency room charges for an emergency medical
New York State County Sales Tax Collections by Region
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT AND SCHOOL ACCOUNTABILITY New York State County Sales Tax Collections by Region Thomas P. DiNapoli State Comptroller For additional
Town of Hartland. Fleet Management. Report of Examination. Thomas P. DiNapoli. Period Covered: January 1, 2010 September 21, 2011 2011M-239
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Town of Hartland Fleet Management Report of Examination Period Covered: January 1, 2010 September 21, 2011
Schenectady County Community College
O FFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF LOCAL GOVERNMENT & SCHOOL ACCOUNTABILITY Schenectady County Community College Internal Controls Over Selected Financial Operations Report of Examination
Massachusetts. Coverage Period: 1/1/2015 12/31/2015
Massachusetts The Harvard Pilgrim Hospital Prefer Best Buy Tiered Copayment HMO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 1/1/2015 12/31/2015 Coverage for:
Important Questions Answers Why this Matters: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://knowyourbenefits.dfa.ms.gov or by calling 1-866-586-2781.
Important Questions Answers Why this Matters: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cirstudenthealth.com/udmercy or by calling 1-800-322-9901.
Cayuga County Community College
O f f i c e o f t h e N e w Y o r k S t a t e C o m p t r o l l e r Division of Local Government & School Accountability Cayuga County Community College Information Technology Report of Examination Period
Monumental Life Insurance Company: Northpoint Bible College Student Injury and Sickness Plan Coverage Period: 08/20/2013 08/20/2014
Summary of Benefits and Coverage: What this Covers & What it Costs Coverage for: Individual Type: PPO This is only a summary. If you want more detail about your coverage and costs, you can get the complete