Nebraska Insurance Department. QHP Proposed Rates in Nebraska Individual Medical Plans. Area 1-680-681

The Nebraska Department of Insurance is posting the following sample premium rates of all health plans that were submitted for use for plans under the federal Affordable Care Act in Nebraska during 2014. These proposed rates were submitted for actuarial review to determine compliance with Nebraska and federal law. These proposed rates are considered to be in draft form for those plans. Some plans will be offered on the federally facilitated marketplace. Others will be offered outside of the federally facilitated marketplace. The federally facilitated marketplace may review these plans again. The sample premium rates are being presented only as a preliminary tool for comparison. Individual premium rates will be different based on geography, tobacco use and age. Please note that this information includes three sample age band rates. When open enrollment for the 2014 year begins on October 1, 2013 please remember that if you have any questions about your insurance options, you may review the resources available on www.healthcare.gov and you should not hesitate to contact your local Nebraska agent or broker. Your agent or broker may be able to assist you in deciding between the options available.

Individual Medical s Type ID Company Area 1-680-681 NON Catastrophic 29678NE1060001 BCBS BlueEssentialsPlus $6350 Catastrophic Both 157.57 199.21 366.40 207.99 262.96 483.65 43198NE0200005 CoOportunity CoOportunity Premier Catastrophic Both 191.26 241.81 444.75 286.69 362.47 666.67 15438NE0150004 Coventry Catastrophic 100% HMO Methodist Health Partners On 113.51 143.51 263.94 136.21 172.21 316.73 15438NE0160004 Coventry Catastrophic 100% POS MIPPA On 116.00 146.66 269.75 139.20 175.99 323.70 15438NE0170004 Coventry Catastrophic 100% HMO Alegent Creighton Health On 119.93 151.63 278.88 143.92 181.96 334.66 15438NE0180004 Coventry Catastrophic 100% POS On 133.18 168.38 309.69 159.82 202.06 371.63 77931NE0110003 Health Alliance Midwest Guide HMO QHDHP 6500/13000 0% 6500/13000 RxDed Both 188.65 238.51 438.68 222.61 281.44 517.64 15438NE0150009 Coventry Catastrophic 100% HMO PD Methodist Health Partners Off 116.98 147.90 272.03 140.38 177.48 326.44 15438NE0160009 Coventry Catastrophic 100% POS PD MIPPA Off 119.48 151.06 277.84 143.38 181.27 333.41 15438NE0170009 Coventry Catastrophic 100% HMO PD Alegent Creighton Health Off 123.41 156.03 286.97 148.09 187.24 344.36 15438NE0180009 Coventry Catastrophic 100% POS PD Off 136.66 172.78 317.78 163.99 207.34 381.34 19524NE0160007 Time Catastrophic 1 Off 179.82 227.34 418.14 215.85 272.81 501.70 19524NE0160016 Time Catastrophic 1 Off 179.82 227.34 418.14 215.85 272.81 501.70 Bronze 29678NE0940001 BCBS SelectBlue Plus $4500 Bronze Both 196.95 249.01 457.99 259.97 328.69 604.54 29678NE0980001 BCBS SelectBlue Plus $2750 HDHP Bronze Both 166.12 210.03 386.29 219.28 277.23 509.90 29678NE0980002 BCBS SelectBlue Plus $4750 HDHP Bronze Both 161.58 204.29 375.74 213.29 269.66 495.97 29678NE1050001 BCBS BlueEssentialsPlus $3500 Bronze Both 231.08 292.16 537.36 305.03 385.65 709.31 29678NE1050002 BCBS BlueEssentialsPlus $4000 Bronze Both 232.38 293.81 540.38 306.75 387.82 713.30 29678NE1050003 BCBS BlueEssentialsPlus $4500 Bronze Both 231.97 293.29 539.43 306.21 387.14 712.05 29678NE1050004 BCBS BlueEssentialsPlus $5500 Bronze Both 229.66 290.36 534.04 303.15 383.28 704.94 29678NE1100001 BCBS BlueEssentialsPlus $2500 HDHP Bronze Both 200.49 253.49 466.22 264.65 334.60 615.41 29678NE1100002 BCBS BlueEssentialsPlus $4000 HDHP Bronze Both 193.95 245.22 451.02 256.02 323.69 595.34 29678NE1100003 BCBS BlueEssentialsPlus $4750 HDHP Bronze Both 188.83 238.74 439.10 249.25 315.13 579.61 29678NE1100004 BCBS BlueEssentialsPlus $6325 HDHP Bronze Both 178.16 225.25 414.29 235.17 297.33 546.86 43198NE0200004 CoOportunity CoOportunity Premier Bronze Both 211.57 267.49 491.98 317.14 400.96 737.46 43198NE0200008 CoOportunity CoOportunity Premier HSA Bronze Both 205.85 260.26 478.68 308.57 390.13 717.55 15438NE0150003 Coventry Bronze $10 Copay HMO Methodist Health Partners On 182.19 230.35 423.67 218.63 276.42 508.40 15438NE0150005 Coventry Bronze Deductible Only HMO HSA Eligible Methodist Health Partners On 170.38 215.41 396.19 204.46 258.49 475.43 15438NE0160003 Coventry Bronze $10 Copay POS MIPPA On 186.09 235.27 432.73 223.31 282.32 519.28 15438NE0160005 Coventry Bronze Deductible Only POS HSA Eligible MIPPA On 174.03 220.03 404.69 208.84 264.04 485.63 15438NE0170003 Coventry Bronze $10 Copay HMO Alegent Creighton Health On 192.22 243.02 446.98 230.66 291.62 536.38 15438NE0170005 Coventry Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health On 179.78 227.30 418.06 215.74 272.76 501.67 15438NE0180003 Coventry Bronze $10 Copay POS On 212.89 269.16 495.04 255.47 322.99 594.05 15438NE0180005 Coventry Bronze Deductible Only POS HSA Eligible On 199.17 251.82 463.16 239.00 302.18 555.79 77931NE0110002 Health Alliance Midwest Guide HMO QHDHP 2750/5500 50% 6500/13000 Rx3 Both 222.10 280.81 516.48 262.08 331.36 609.45 15438NE0150008 Coventry Bronze $10 Copay HMO PD Methodist Health Partners Off 185.67 234.75 431.76 222.80 281.70 518.11 15438NE0150010 Coventry Bronze Deductible Only HMO PD HSA Eligible Methodist Health Partners Off 173.86 219.81 404.28 208.63 263.77 485.14 15438NE0160008 Coventry Bronze $10 Copay POS PD MIPPA Off 189.57 239.67 440.82 227.48 287.60 528.98 15438NE0160010 Coventry Bronze Deductible Only POS PD HSA Eligible MIPPA Off 177.51 224.43 412.78 213.01 269.32 495.34 15438NE0170008 Coventry Bronze $10 Copay HMO PD Alegent Creighton Health Off 195.69 247.42 455.07 234.83 296.90 546.08 15438NE0170010 Coventry Bronze Deductible Only HMO PD HSA Eligible Alegent Creighton Health Off 183.26 231.70 426.15 219.91 278.04 511.38 15438NE0180008 Coventry Bronze $10 Copay POS PD Off 216.37 273.55 503.13 259.64 328.26 603.76 15438NE0180010 Coventry Bronze Deductible Only POS PD HSA Eligible Off 202.65 256.22 471.25 243.18 307.46 565.50 19524NE0160001 Time CoreMed - Bronze 1 Off 220.67 278.99 513.13 264.88 334.79 615.68 19524NE0160002 Time CoreMed - Bronze 3 Off 229.62 290.31 533.95 275.63 348.37 640.65 19524NE0160008 Time OneDeductible - Bronze 1 Off 218.06 275.69 507.07 261.75 330.83 608.40 19524NE0160009 Time OneDeductible - Bronze 2 Off 219.56 277.59 510.55 263.55 333.11 612.58 19524NE0160010 Time CoreMed - Bronze 1 Off 220.67 278.99 513.13 264.88 334.79 615.68 19524NE0160011 Time CoreMed - Bronze 3 Off 229.62 290.31 533.95 275.63 348.37 640.65 19524NE0160017 Time OneDeductible - Bronze 1 Off 218.06 275.69 507.07 261.75 330.83 608.40 19524NE0160018 Time OneDeductible - Bronze 2 Off 219.56 277.59 510.55 263.55 333.11 612.58 19524NE0160019 Time CoreMed - Bronze 2 Off 228.50 288.89 531.34 274.28 346.67 637.52 19524NE0160020 Time CoreMed - Bronze 2 Off 228.50 288.89 531.34 274.28 346.67 637.52 19524NE0160021 Time CoreMed - Bronze 4 Off 227.00 287.00 527.85 272.48 344.39 633.34 19524NE0160022 Time CoreMed - Bronze 5 Off 230.35 291.24 535.65 276.51 349.48 642.70 19524NE0160023 Time CoreMed - Bronze 4 Off 227.00 287.00 527.85 272.48 344.39 633.34 19524NE0160024 Time CoreMed - Bronze 5 Off 230.35 291.24 535.65 276.51 349.48 642.70 Lewis Ellis, Inc. - Actuaries Consultants 8/21/2013

Individual Medical s Type ID Company Silver Area 1-680-681 NON 29678NE0930001 BCBS SelectBlue Plus $2000 Silver Both 249.47 315.40 580.10 329.30 416.33 765.74 29678NE0970001 BCBS SelectBlue Plus $1500 HDHP Silver Both 210.13 265.68 488.64 277.38 350.69 645.01 29678NE1040001 BCBS BlueEssentialsPlus $2500 Silver Both 291.03 367.95 676.75 384.16 485.70 893.32 29678NE1090001 BCBS BlueEssentialsPlus $1900 HDHP Silver Both 244.82 309.53 569.31 323.17 408.58 751.49 43198NE0200003 CoOportunity CoOportunity Premier Silver Both 250.28 316.44 582.00 375.17 474.34 872.42 43198NE0200007 CoOportunity CoOportunity Premier HSA Silver Both 240.98 304.67 560.36 361.21 456.69 839.96 15438NE0150002 Coventry Silver $10 Copay HMO Methodist Health Partners On 222.23 280.97 516.77 266.68 337.16 620.12 15438NE0160002 Coventry Silver $10 Copay POS MIPPA On 226.94 286.93 527.73 272.33 344.32 633.28 15438NE0170002 Coventry Silver $10 Copay HMO Alegent Creighton Health On 234.35 296.29 544.96 281.22 355.55 653.95 15438NE0180002 Coventry Silver $10 Copay POS On 259.35 327.90 603.08 311.22 393.48 723.70 77931NE0090002 Health Alliance Midwest Pathfinder POS 1750/3500 30% 5500/11000 Rx3 Both 294.41 372.23 684.62 347.40 439.23 807.85 77931NE0090003 Health Alliance Midwest Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5 Both 266.57 337.03 619.87 314.55 397.70 731.45 77931NE0110001 Health Alliance Midwest Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2 Both 283.84 358.86 660.03 334.93 423.45 778.84 77931NE0120003 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2 Both 303.05 383.15 704.70 357.60 452.12 831.55 Gold 15438NE0150007 Coventry Silver $10 Copay HMO PD Methodist Health Partners Off 216.55 273.79 503.57 259.86 328.55 604.28 15438NE0160007 Coventry Silver $10 Copay POS PD MIPPA Off 221.08 279.51 514.08 265.30 335.41 616.90 15438NE0170007 Coventry Silver $10 Copay HMO PD Alegent Creighton Health Off 228.19 288.51 530.63 273.83 346.21 636.76 15438NE0180007 Coventry Silver $10 Copay POS PD Off 252.20 318.86 586.46 302.64 382.63 703.75 19524NE0160003 Time CoreMed - Silver 1 Off 264.14 333.95 614.22 317.07 400.74 736.96 19524NE0160004 Time CoreMed - Silver 3 Off 264.14 333.95 614.22 317.07 400.74 736.96 19524NE0160012 Time CoreMed - Silver 1 Off 264.14 333.95 614.22 317.07 400.74 736.96 19524NE0160013 Time CoreMed - Silver 3 Off 264.14 333.95 614.22 317.07 400.74 736.96 19524NE0160025 Time CoreMed - Silver 2 Off 269.13 340.26 625.82 323.05 408.31 750.88 19524NE0160026 Time CoreMed - Silver 4 Off 276.05 349.02 641.93 331.37 418.82 770.21 19524NE0160029 Time CoreMed - Silver 2 Off 269.13 340.26 625.82 323.05 408.31 750.88 19524NE0160030 Time CoreMed - Silver 4 Off 276.05 349.02 641.93 331.37 418.82 770.21 29678NE0920001 BCBS SelectBlue Plus $750 Gold Both 295.09 373.08 686.19 389.51 492.47 905.77 29678NE1030001 BCBS BlueEssentialsPlus $1000 Gold Both 329.62 416.74 766.49 435.09 550.10 1,011.76 43198NE0200002 CoOportunity CoOportunity Premier Gold Both 291.53 368.59 677.92 437.02 552.53 1,016.23 43198NE0200006 CoOportunity CoOportunity Premier HSA Gold Both 280.75 354.95 652.85 420.83 532.07 978.60 15438NE0150001 Coventry Gold $5 Copay HMO Methodist Health Partners On 251.81 318.37 585.55 302.17 382.04 702.66 15438NE0160001 Coventry Gold $5 Copay POS MIPPA On 257.12 325.08 597.91 308.54 390.10 717.49 15438NE0170001 Coventry Gold $5 Copay HMO Alegent Creighton Health On 265.48 335.65 617.34 318.58 402.78 740.81 15438NE0180001 Coventry Gold $5 Copay POS On 293.67 371.29 682.89 352.40 445.55 819.47 77931NE0090001 Health Alliance Midwest Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2 Both 299.81 379.05 697.17 353.78 447.28 822.66 77931NE0120001 Health Alliance Midwest Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed Both 320.96 405.80 746.36 378.73 478.84 880.70 77931NE0120002 Health Alliance Midwest Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed Both 309.95 391.88 720.76 365.74 462.42 850.50 15438NE0150006 Coventry Gold $5 Copay HMO PD Methodist Health Partners Off 255.29 322.76 593.64 306.35 387.31 712.37 15438NE0160006 Coventry Gold $5 Copay POS PD MIPPA Off 260.60 329.48 606.00 312.72 395.38 727.20 15438NE0170006 Coventry Gold $5 Copay HMO PD Alegent Creighton Health Off 268.96 340.05 625.43 322.75 408.06 750.52 15438NE0180006 Coventry Gold $5 Copay POS PD Off 297.15 375.69 690.98 356.58 450.83 829.18 19524NE0160005 Time CoreMed - Gold 1 Off 317.22 401.06 737.66 380.78 481.28 885.07 19524NE0160014 Time CoreMed - Gold 1 Off 317.22 401.06 737.66 380.78 481.28 885.07 19524NE0160027 Time CoreMed - Gold 2 Off 328.89 415.82 764.80 394.80 498.99 917.64 19524NE0160031 Time CoreMed - Gold 2 Off 328.89 415.82 764.80 394.80 498.99 917.64 Platinum 43198NE0200001 CoOportunity CoOportunity Premier Platinum Both 333.00 421.02 774.36 499.17 631.11 1,160.77 19524NE0160006 Time CoreMed - Platinum 1 Off 378.08 478.01 879.17 453.84 573.61 1,054.86 19524NE0160015 Time CoreMed - Platinum 1 Off 378.08 478.01 879.17 453.84 573.61 1,054.86 19524NE0160028 Time CoreMed - Platinum 2 Off 377.65 477.46 878.17 453.32 572.96 1,053.66 19524NE0160032 Time CoreMed - Platinum 2 Off 377.65 477.46 878.17 453.32 572.96 1,053.66 Lewis Ellis, Inc. - Actuaries Consultants 8/21/2013

Individual Medical s Type ID Company Area 2-683-685 NON Catastrophic 29678NE1060001 BCBS BlueEssentialsPlus $6350 Catastrophic Both 157.57 199.21 366.40 207.99 262.96 483.65 43198NE0200005 CoOportunity CoOportunity Premier Catastrophic Both 152.83 193.22 355.39 229.09 289.65 532.73 15438NE0150004 Coventry Catastrophic 100% HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160004 Coventry Catastrophic 100% POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170004 Coventry Catastrophic 100% HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180004 Coventry Catastrophic 100% POS On 128.81 162.85 299.52 154.57 195.42 359.42 77931NE0110003 Health Alliance Midwest Guide HMO QHDHP 6500/13000 0% 6500/13000 RxDed Both 181.18 229.07 421.31 213.79 270.30 497.15 15438NE0150009 Coventry Catastrophic 100% HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160009 Coventry Catastrophic 100% POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170009 Coventry Catastrophic 100% HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180009 Coventry Catastrophic 100% POS PD Off 132.17 167.11 307.35 158.60 200.53 368.82 19524NE0160007 Time Catastrophic 1 Off 178.17 225.26 414.31 213.87 270.32 497.11 19524NE0160016 Time Catastrophic 1 Off 178.17 225.26 414.31 213.87 270.32 497.11 Bronze 29678NE0940001 BCBS SelectBlue Plus $4500 Bronze Both 196.95 249.01 457.99 259.97 328.69 604.54 29678NE0980001 BCBS SelectBlue Plus $2750 HDHP Bronze Both 166.12 210.03 386.29 219.28 277.23 509.90 29678NE0980002 BCBS SelectBlue Plus $4750 HDHP Bronze Both 161.58 204.29 375.74 213.29 269.66 495.97 29678NE1050001 BCBS BlueEssentialsPlus $3500 Bronze Both 231.08 292.16 537.36 305.03 385.65 709.31 29678NE1050002 BCBS BlueEssentialsPlus $4000 Bronze Both 232.38 293.81 540.38 306.75 387.82 713.30 29678NE1050003 BCBS BlueEssentialsPlus $4500 Bronze Both 231.97 293.29 539.43 306.21 387.14 712.05 29678NE1050004 BCBS BlueEssentialsPlus $5500 Bronze Both 229.66 290.36 534.04 303.15 383.28 704.94 29678NE1100001 BCBS BlueEssentialsPlus $2500 HDHP Bronze Both 200.49 253.49 466.22 264.65 334.60 615.41 29678NE1100002 BCBS BlueEssentialsPlus $4000 HDHP Bronze Both 193.95 245.22 451.02 256.02 323.69 595.34 29678NE1100003 BCBS BlueEssentialsPlus $4750 HDHP Bronze Both 188.83 238.74 439.10 249.25 315.13 579.61 29678NE1100004 BCBS BlueEssentialsPlus $6325 HDHP Bronze Both 178.16 225.25 414.29 235.17 297.33 546.86 43198NE0200004 CoOportunity CoOportunity Premier Bronze Both 169.05 213.74 393.11 253.42 320.40 589.29 43198NE0200008 CoOportunity CoOportunity Premier HSA Bronze Both 164.49 207.97 382.51 246.57 311.75 573.38 15438NE0150003 Coventry Bronze $10 Copay HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0150005 Coventry Bronze Deductible Only HMO HSA Eligible Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160003 Coventry Bronze $10 Copay POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0160005 Coventry Bronze Deductible Only POS HSA Eligible MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170003 Coventry Bronze $10 Copay HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0170005 Coventry Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180003 Coventry Bronze $10 Copay POS On 205.90 260.32 478.79 247.08 312.38 574.55 15438NE0180005 Coventry Bronze Deductible Only POS HSA Eligible On 192.63 243.55 447.95 231.16 292.26 537.54 77931NE0110002 Health Alliance Midwest Guide HMO QHDHP 2750/5500 50% 6500/13000 Rx3 Both 213.31 269.69 496.02 251.71 318.23 585.30 15438NE0150008 Coventry Bronze $10 Copay HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0150010 Coventry Bronze Deductible Only HMO PD HSA Eligible Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160008 Coventry Bronze $10 Copay POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0160010 Coventry Bronze Deductible Only POS PD HSA Eligible MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170008 Coventry Bronze $10 Copay HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0170010 Coventry Bronze Deductible Only HMO PD HSA Eligible Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180008 Coventry Bronze $10 Copay POS PD Off 209.26 264.57 486.61 251.11 317.48 583.93 15438NE0180010 Coventry Bronze Deductible Only POS PD HSA Eligible Off 196.00 247.80 455.77 235.20 297.36 546.92 19524NE0160001 Time CoreMed - Bronze 1 Off 218.65 276.45 508.46 262.47 331.74 610.06 19524NE0160002 Time CoreMed - Bronze 3 Off 227.51 287.64 529.05 273.10 345.17 634.77 19524NE0160008 Time OneDeductible - Bronze 1 Off 216.07 273.18 502.44 259.36 327.81 602.84 19524NE0160009 Time OneDeductible - Bronze 2 Off 217.55 275.06 505.90 261.15 330.07 606.99 19524NE0160010 Time CoreMed - Bronze 1 Off 218.65 276.45 508.46 262.47 331.74 610.06 19524NE0160011 Time CoreMed - Bronze 3 Off 227.51 287.64 529.05 273.10 345.17 634.77 19524NE0160017 Time OneDeductible - Bronze 1 Off 216.07 273.18 502.44 259.36 327.81 602.84 19524NE0160018 Time OneDeductible - Bronze 2 Off 217.55 275.06 505.90 261.15 330.07 606.99 19524NE0160019 Time CoreMed - Bronze 2 Off 226.41 286.25 526.49 271.78 343.50 631.70 19524NE0160020 Time CoreMed - Bronze 2 Off 226.41 286.25 526.49 271.78 343.50 631.70 19524NE0160021 Time CoreMed - Bronze 4 Off 224.93 284.38 523.05 270.00 341.26 627.58 19524NE0160022 Time CoreMed - Bronze 5 Off 228.24 288.57 530.75 273.98 346.29 636.82 19524NE0160023 Time CoreMed - Bronze 4 Off 224.93 284.38 523.05 270.00 341.26 627.58 19524NE0160024 Time CoreMed - Bronze 5 Off 228.24 288.57 530.75 273.98 346.29 636.82 Lewis Ellis, Inc. - Actuaries Consultants 8/21/2013

Individual Medical s Type ID Company Silver Area 2-683-685 NON 29678NE0930001 BCBS SelectBlue Plus $2000 Silver Both 249.47 315.40 580.10 329.30 416.33 765.74 29678NE0970001 BCBS SelectBlue Plus $1500 HDHP Silver Both 210.13 265.68 488.64 277.38 350.69 645.01 29678NE1040001 BCBS BlueEssentialsPlus $2500 Silver Both 291.03 367.95 676.75 384.16 485.70 893.32 29678NE1090001 BCBS BlueEssentialsPlus $1900 HDHP Silver Both 244.82 309.53 569.31 323.17 408.58 751.49 43198NE0200003 CoOportunity CoOportunity Premier Silver Both 199.99 252.85 465.05 299.79 379.03 697.13 43198NE0200007 CoOportunity CoOportunity Premier HSA Silver Both 192.56 243.46 447.77 288.64 364.93 671.20 15438NE0150002 Coventry Silver $10 Copay HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160002 Coventry Silver $10 Copay POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170002 Coventry Silver $10 Copay HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180002 Coventry Silver $10 Copay POS On 250.83 317.13 583.28 301.00 380.56 699.94 77931NE0090002 Health Alliance Midwest Pathfinder POS 1750/3500 30% 5500/11000 Rx3 Both 282.75 357.49 657.51 333.65 421.84 775.86 77931NE0090003 Health Alliance Midwest Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5 Both 256.01 323.68 595.32 302.09 381.94 702.48 77931NE0110001 Health Alliance Midwest Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2 Both 272.60 344.65 633.89 321.67 406.69 747.99 77931NE0120003 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2 Both 291.04 367.97 676.79 343.43 434.20 798.61 Gold 15438NE0150007 Coventry Silver $10 Copay HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160007 Coventry Silver $10 Copay POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170007 Coventry Silver $10 Copay HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180007 Coventry Silver $10 Copay POS PD Off 243.92 308.39 567.20 292.70 370.07 680.64 19524NE0160003 Time CoreMed - Silver 1 Off 261.72 330.89 608.59 314.16 397.07 730.21 19524NE0160004 Time CoreMed - Silver 3 Off 261.72 330.89 608.59 314.16 397.07 730.21 19524NE0160012 Time CoreMed - Silver 1 Off 261.72 330.89 608.59 314.16 397.07 730.21 19524NE0160013 Time CoreMed - Silver 3 Off 261.72 330.89 608.59 314.16 397.07 730.21 19524NE0160025 Time CoreMed - Silver 2 Off 266.67 337.16 620.12 320.11 404.59 744.04 19524NE0160026 Time CoreMed - Silver 4 Off 273.53 345.83 636.06 328.34 414.99 763.16 19524NE0160029 Time CoreMed - Silver 2 Off 266.67 337.16 620.12 320.11 404.59 744.04 19524NE0160030 Time CoreMed - Silver 4 Off 273.53 345.83 636.06 328.34 414.99 763.16 29678NE0920001 BCBS SelectBlue Plus $750 Gold Both 295.09 373.08 686.19 389.51 492.47 905.77 29678NE1030001 BCBS BlueEssentialsPlus $1000 Gold Both 329.62 416.74 766.49 435.09 550.10 1,011.76 43198NE0200002 CoOportunity CoOportunity Premier Gold Both 232.96 294.53 541.72 349.20 441.50 812.03 43198NE0200006 CoOportunity CoOportunity Premier HSA Gold Both 224.33 283.63 521.66 336.28 425.17 781.98 15438NE0150001 Coventry Gold $5 Copay HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160001 Coventry Gold $5 Copay POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170001 Coventry Gold $5 Copay HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180001 Coventry Gold $5 Copay POS On 284.03 359.10 660.47 340.84 430.92 792.56 77931NE0090001 Health Alliance Midwest Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2 Both 287.94 364.04 669.56 339.77 429.57 790.08 77931NE0120001 Health Alliance Midwest Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed Both 308.25 389.73 716.80 363.74 459.88 845.82 77931NE0120002 Health Alliance Midwest Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed Both 297.68 376.36 692.22 351.26 444.10 816.82 15438NE0150006 Coventry Gold $5 Copay HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160006 Coventry Gold $5 Copay POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170006 Coventry Gold $5 Copay HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180006 Coventry Gold $5 Copay POS PD Off 287.39 363.35 668.29 344.87 436.02 801.95 19524NE0160005 Time CoreMed - Gold 1 Off 314.33 397.41 730.93 377.31 476.89 877.00 19524NE0160014 Time CoreMed - Gold 1 Off 314.33 397.41 730.93 377.31 476.89 877.00 19524NE0160027 Time CoreMed - Gold 2 Off 325.91 412.05 757.86 391.21 494.46 909.31 19524NE0160031 Time CoreMed - Gold 2 Off 325.91 412.05 757.86 391.21 494.46 909.31 Platinum 43198NE0200001 CoOportunity CoOportunity Premier Platinum Both 266.10 336.43 618.78 398.88 504.31 927.55 19524NE0160006 Time CoreMed - Platinum 1 Off 374.63 473.65 871.15 449.70 568.38 1,045.24 19524NE0160015 Time CoreMed - Platinum 1 Off 374.63 473.65 871.15 449.70 568.38 1,045.24 19524NE0160028 Time CoreMed - Platinum 2 Off 374.20 473.10 870.16 449.18 567.73 1,044.04 19524NE0160032 Time CoreMed - Platinum 2 Off 374.20 473.10 870.16 449.18 567.73 1,044.04 Lewis Ellis, Inc. - Actuaries Consultants 8/21/2013

Individual Medical s Type ID Company Area 3-686-689 NON Catastrophic 29678NE1060001 BCBS BlueEssentialsPlus $6350 Catastrophic Both 157.57 199.21 366.40 207.99 262.96 483.65 43198NE0200005 CoOportunity CoOportunity Premier Catastrophic Both 142.42 180.07 331.19 213.50 269.93 496.47 15438NE0150004 Coventry Catastrophic 100% HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160004 Coventry Catastrophic 100% POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170004 Coventry Catastrophic 100% HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180004 Coventry Catastrophic 100% POS On 129.60 163.86 301.37 155.52 196.63 361.64 77931NE0110003 Health Alliance Midwest Guide HMO QHDHP 6500/13000 0% 6500/13000 RxDed Both n/a n/a n/a n/a n/a n/a 15438NE0150009 Coventry Catastrophic 100% HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160009 Coventry Catastrophic 100% POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170009 Coventry Catastrophic 100% HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180009 Coventry Catastrophic 100% POS PD Off 132.99 168.14 309.25 159.59 201.77 371.10 19524NE0160007 Time Catastrophic 1 Off 204.15 258.11 474.73 245.06 309.73 569.60 19524NE0160016 Time Catastrophic 1 Off 204.15 258.11 474.73 245.06 309.73 569.60 Bronze 29678NE0940001 BCBS SelectBlue Plus $4500 Bronze Both 196.95 249.01 457.99 259.97 328.69 604.54 29678NE0980001 BCBS SelectBlue Plus $2750 HDHP Bronze Both 166.12 210.03 386.29 219.28 277.23 509.90 29678NE0980002 BCBS SelectBlue Plus $4750 HDHP Bronze Both 161.58 204.29 375.74 213.29 269.66 495.97 29678NE1050001 BCBS BlueEssentialsPlus $3500 Bronze Both 231.08 292.16 537.36 305.03 385.65 709.31 29678NE1050002 BCBS BlueEssentialsPlus $4000 Bronze Both 232.38 293.81 540.38 306.75 387.82 713.30 29678NE1050003 BCBS BlueEssentialsPlus $4500 Bronze Both 231.97 293.29 539.43 306.21 387.14 712.05 29678NE1050004 BCBS BlueEssentialsPlus $5500 Bronze Both 229.66 290.36 534.04 303.15 383.28 704.94 29678NE1100001 BCBS BlueEssentialsPlus $2500 HDHP Bronze Both 200.49 253.49 466.22 264.65 334.60 615.41 29678NE1100002 BCBS BlueEssentialsPlus $4000 HDHP Bronze Both 193.95 245.22 451.02 256.02 323.69 595.34 29678NE1100003 BCBS BlueEssentialsPlus $4750 HDHP Bronze Both 188.83 238.74 439.10 249.25 315.13 579.61 29678NE1100004 BCBS BlueEssentialsPlus $6325 HDHP Bronze Both 178.16 225.25 414.29 235.17 297.33 546.86 43198NE0200004 CoOportunity CoOportunity Premier Bronze Both 157.56 199.20 366.38 236.17 298.59 549.18 43198NE0200008 CoOportunity CoOportunity Premier HSA Bronze Both 153.30 193.82 356.48 229.79 290.53 534.36 15438NE0150003 Coventry Bronze $10 Copay HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0150005 Coventry Bronze Deductible Only HMO HSA Eligible Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160003 Coventry Bronze $10 Copay POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0160005 Coventry Bronze Deductible Only POS HSA Eligible MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170003 Coventry Bronze $10 Copay HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0170005 Coventry Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180003 Coventry Bronze $10 Copay POS On 207.17 261.92 481.74 248.60 314.30 578.09 15438NE0180005 Coventry Bronze Deductible Only POS HSA Eligible On 193.82 245.05 450.71 232.58 294.06 540.85 77931NE0110002 Health Alliance Midwest Guide HMO QHDHP 2750/5500 50% 6500/13000 Rx3 Both n/a n/a n/a n/a n/a n/a 15438NE0150008 Coventry Bronze $10 Copay HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0150010 Coventry Bronze Deductible Only HMO PD HSA Eligible Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160008 Coventry Bronze $10 Copay POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0160010 Coventry Bronze Deductible Only POS PD HSA Eligible MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170008 Coventry Bronze $10 Copay HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0170010 Coventry Bronze Deductible Only HMO PD HSA Eligible Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180008 Coventry Bronze $10 Copay POS PD Off 210.55 266.20 489.62 252.66 319.44 587.54 15438NE0180010 Coventry Bronze Deductible Only POS PD HSA Eligible Off 197.21 249.33 458.59 236.65 299.20 550.31 19524NE0160001 Time CoreMed - Bronze 1 Off 250.53 316.75 582.59 300.74 380.11 699.01 19524NE0160002 Time CoreMed - Bronze 3 Off 260.69 329.59 606.20 312.93 395.51 727.35 19524NE0160008 Time OneDeductible - Bronze 1 Off 247.58 313.02 575.72 297.19 375.62 690.77 19524NE0160009 Time OneDeductible - Bronze 2 Off 249.27 315.15 579.64 299.22 378.18 695.47 19524NE0160010 Time CoreMed - Bronze 1 Off 250.53 316.75 582.59 300.74 380.11 699.01 19524NE0160011 Time CoreMed - Bronze 3 Off 260.69 329.59 606.20 312.93 395.51 727.35 19524NE0160017 Time OneDeductible - Bronze 1 Off 247.58 313.02 575.72 297.19 375.62 690.77 19524NE0160018 Time OneDeductible - Bronze 2 Off 249.27 315.15 579.64 299.22 378.18 695.47 19524NE0160019 Time CoreMed - Bronze 2 Off 259.41 327.98 603.23 311.39 393.57 723.78 19524NE0160020 Time CoreMed - Bronze 2 Off 259.41 327.98 603.23 311.39 393.57 723.78 19524NE0160021 Time CoreMed - Bronze 4 Off 257.73 325.86 599.33 309.38 391.03 719.10 19524NE0160022 Time CoreMed - Bronze 5 Off 261.54 330.67 608.18 313.95 396.80 729.71 19524NE0160023 Time CoreMed - Bronze 4 Off 257.73 325.86 599.33 309.38 391.03 719.10 19524NE0160024 Time CoreMed - Bronze 5 Off 261.54 330.67 608.18 313.95 396.80 729.71 Lewis Ellis, Inc. - Actuaries Consultants 8/21/2013

Individual Medical s Type ID Company Silver Area 3-686-689 NON 29678NE0930001 BCBS SelectBlue Plus $2000 Silver Both 249.47 315.40 580.10 329.30 416.33 765.74 29678NE0970001 BCBS SelectBlue Plus $1500 HDHP Silver Both 210.13 265.68 488.64 277.38 350.69 645.01 29678NE1040001 BCBS BlueEssentialsPlus $2500 Silver Both 291.03 367.95 676.75 384.16 485.70 893.32 29678NE1090001 BCBS BlueEssentialsPlus $1900 HDHP Silver Both 244.82 309.53 569.31 323.17 408.58 751.49 43198NE0200003 CoOportunity CoOportunity Premier Silver Both 186.39 235.65 433.42 279.39 353.23 649.68 43198NE0200007 CoOportunity CoOportunity Premier HSA Silver Both 179.45 226.88 417.29 269.00 340.10 625.53 15438NE0150002 Coventry Silver $10 Copay HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160002 Coventry Silver $10 Copay POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170002 Coventry Silver $10 Copay HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180002 Coventry Silver $10 Copay POS On 252.38 319.09 586.88 302.86 382.91 704.26 77931NE0090002 Health Alliance Midwest Pathfinder POS 1750/3500 30% 5500/11000 Rx3 Both n/a n/a n/a n/a n/a n/a 77931NE0090003 Health Alliance Midwest Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5 Both n/a n/a n/a n/a n/a n/a 77931NE0110001 Health Alliance Midwest Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2 Both n/a n/a n/a n/a n/a n/a 77931NE0120003 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2 Both n/a n/a n/a n/a n/a n/a Gold 15438NE0150007 Coventry Silver $10 Copay HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160007 Coventry Silver $10 Copay POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170007 Coventry Silver $10 Copay HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180007 Coventry Silver $10 Copay POS PD Off 245.42 310.29 570.70 294.50 372.35 684.84 19524NE0160003 Time CoreMed - Silver 1 Off 299.90 379.16 697.37 359.99 454.99 836.73 19524NE0160004 Time CoreMed - Silver 3 Off 299.90 379.16 697.37 359.99 454.99 836.73 19524NE0160012 Time CoreMed - Silver 1 Off 299.90 379.16 697.37 359.99 454.99 836.73 19524NE0160013 Time CoreMed - Silver 3 Off 299.90 379.16 697.37 359.99 454.99 836.73 19524NE0160025 Time CoreMed - Silver 2 Off 305.57 386.33 710.56 366.80 463.60 852.55 19524NE0160026 Time CoreMed - Silver 4 Off 313.41 396.25 728.81 376.22 475.51 874.45 19524NE0160029 Time CoreMed - Silver 2 Off 305.57 386.33 710.56 366.80 463.60 852.55 19524NE0160030 Time CoreMed - Silver 4 Off 313.41 396.25 728.81 376.22 475.51 874.45 29678NE0920001 BCBS SelectBlue Plus $750 Gold Both 295.09 373.08 686.19 389.51 492.47 905.77 29678NE1030001 BCBS BlueEssentialsPlus $1000 Gold Both 329.62 416.74 766.49 435.09 550.10 1,011.76 43198NE0200002 CoOportunity CoOportunity Premier Gold Both 217.10 274.49 504.85 325.45 411.47 756.79 43198NE0200006 CoOportunity CoOportunity Premier HSA Gold Both 209.08 264.34 486.18 313.40 396.24 728.78 15438NE0150001 Coventry Gold $5 Copay HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160001 Coventry Gold $5 Copay POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170001 Coventry Gold $5 Copay HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180001 Coventry Gold $5 Copay POS On 285.78 361.32 664.55 342.94 433.58 797.46 77931NE0090001 Health Alliance Midwest Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2 Both n/a n/a n/a n/a n/a n/a 77931NE0120001 Health Alliance Midwest Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed Both n/a n/a n/a n/a n/a n/a 77931NE0120002 Health Alliance Midwest Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed Both n/a n/a n/a n/a n/a n/a 15438NE0150006 Coventry Gold $5 Copay HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160006 Coventry Gold $5 Copay POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170006 Coventry Gold $5 Copay HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180006 Coventry Gold $5 Copay POS PD Off 289.17 365.60 672.42 347.00 438.72 806.90 19524NE0160005 Time CoreMed - Gold 1 Off 360.16 455.35 837.50 432.32 546.42 1,004.86 19524NE0160014 Time CoreMed - Gold 1 Off 360.16 455.35 837.50 432.32 546.42 1,004.86 19524NE0160027 Time CoreMed - Gold 2 Off 373.42 472.12 868.35 448.25 566.55 1,041.88 19524NE0160031 Time CoreMed - Gold 2 Off 373.42 472.12 868.35 448.25 566.55 1,041.88 Platinum 43198NE0200001 CoOportunity CoOportunity Premier Platinum Both 247.99 313.53 576.67 371.74 469.99 864.43 19524NE0160006 Time CoreMed - Platinum 1 Off 429.25 542.71 998.17 515.26 651.25 1,197.64 19524NE0160015 Time CoreMed - Platinum 1 Off 429.25 542.71 998.17 515.26 651.25 1,197.64 19524NE0160028 Time CoreMed - Platinum 2 Off 428.77 542.10 997.05 514.69 650.52 1,196.30 19524NE0160032 Time CoreMed - Platinum 2 Off 428.77 542.10 997.05 514.69 650.52 1,196.30 Lewis Ellis, Inc. - Actuaries Consultants 8/21/2013

Individual Medical s Type ID Company Area 4-690-693 NON Catastrophic 29678NE1060001 BCBS BlueEssentialsPlus $6350 Catastrophic Both 157.57 199.21 366.40 207.99 262.96 483.65 43198NE0200005 CoOportunity CoOportunity Premier Catastrophic Both 142.08 179.63 330.38 212.97 269.27 495.25 15438NE0150004 Coventry Catastrophic 100% HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160004 Coventry Catastrophic 100% POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170004 Coventry Catastrophic 100% HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180004 Coventry Catastrophic 100% POS On 133.18 168.38 309.69 159.82 202.06 371.63 77931NE0110003 Health Alliance Midwest Guide HMO QHDHP 6500/13000 0% 6500/13000 RxDed Both n/a n/a n/a n/a n/a n/a 15438NE0150009 Coventry Catastrophic 100% HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160009 Coventry Catastrophic 100% POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170009 Coventry Catastrophic 100% HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180009 Coventry Catastrophic 100% POS PD Off 136.66 172.78 317.78 163.99 207.34 381.34 19524NE0160007 Time Catastrophic 1 Off 200.37 253.33 465.93 240.52 303.99 559.04 19524NE0160016 Time Catastrophic 1 Off 200.37 253.33 465.93 240.52 303.99 559.04 Bronze 29678NE0940001 BCBS SelectBlue Plus $4500 Bronze Both 196.95 249.01 457.99 259.97 328.69 604.54 29678NE0980001 BCBS SelectBlue Plus $2750 HDHP Bronze Both 166.12 210.03 386.29 219.28 277.23 509.90 29678NE0980002 BCBS SelectBlue Plus $4750 HDHP Bronze Both 161.58 204.29 375.74 213.29 269.66 495.97 29678NE1050001 BCBS BlueEssentialsPlus $3500 Bronze Both 231.08 292.16 537.36 305.03 385.65 709.31 29678NE1050002 BCBS BlueEssentialsPlus $4000 Bronze Both 232.38 293.81 540.38 306.75 387.82 713.30 29678NE1050003 BCBS BlueEssentialsPlus $4500 Bronze Both 231.97 293.29 539.43 306.21 387.14 712.05 29678NE1050004 BCBS BlueEssentialsPlus $5500 Bronze Both 229.66 290.36 534.04 303.15 383.28 704.94 29678NE1100001 BCBS BlueEssentialsPlus $2500 HDHP Bronze Both 200.49 253.49 466.22 264.65 334.60 615.41 29678NE1100002 BCBS BlueEssentialsPlus $4000 HDHP Bronze Both 193.95 245.22 451.02 256.02 323.69 595.34 29678NE1100003 BCBS BlueEssentialsPlus $4750 HDHP Bronze Both 188.83 238.74 439.10 249.25 315.13 579.61 29678NE1100004 BCBS BlueEssentialsPlus $6325 HDHP Bronze Both 178.16 225.25 414.29 235.17 297.33 546.86 43198NE0200004 CoOportunity CoOportunity Premier Bronze Both 157.16 198.70 365.45 235.59 297.86 547.84 43198NE0200008 CoOportunity CoOportunity Premier HSA Bronze Both 152.92 193.34 355.61 229.23 289.82 533.05 15438NE0150003 Coventry Bronze $10 Copay HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0150005 Coventry Bronze Deductible Only HMO HSA Eligible Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160003 Coventry Bronze $10 Copay POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0160005 Coventry Bronze Deductible Only POS HSA Eligible MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170003 Coventry Bronze $10 Copay HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0170005 Coventry Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180003 Coventry Bronze $10 Copay POS On 212.89 269.16 495.04 255.47 322.99 594.05 15438NE0180005 Coventry Bronze Deductible Only POS HSA Eligible On 199.17 251.82 463.16 239.00 302.18 555.79 77931NE0110002 Health Alliance Midwest Guide HMO QHDHP 2750/5500 50% 6500/13000 Rx3 Both n/a n/a n/a n/a n/a n/a 15438NE0150008 Coventry Bronze $10 Copay HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0150010 Coventry Bronze Deductible Only HMO PD HSA Eligible Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160008 Coventry Bronze $10 Copay POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0160010 Coventry Bronze Deductible Only POS PD HSA Eligible MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170008 Coventry Bronze $10 Copay HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0170010 Coventry Bronze Deductible Only HMO PD HSA Eligible Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180008 Coventry Bronze $10 Copay POS PD Off 216.37 273.55 503.13 259.64 328.26 603.76 15438NE0180010 Coventry Bronze Deductible Only POS PD HSA Eligible Off 202.65 256.22 471.25 243.18 307.46 565.50 19524NE0160001 Time CoreMed - Bronze 1 Off 245.88 310.87 571.77 295.15 373.05 686.03 19524NE0160002 Time CoreMed - Bronze 3 Off 255.86 323.49 594.97 307.13 388.18 713.87 19524NE0160008 Time OneDeductible - Bronze 1 Off 242.98 307.20 565.02 291.67 368.64 677.93 19524NE0160009 Time OneDeductible - Bronze 2 Off 244.65 309.31 568.89 293.67 371.17 682.58 19524NE0160010 Time CoreMed - Bronze 1 Off 245.88 310.87 571.77 295.15 373.05 686.03 19524NE0160011 Time CoreMed - Bronze 3 Off 255.86 323.49 594.97 307.13 388.18 713.87 19524NE0160017 Time OneDeductible - Bronze 1 Off 242.98 307.20 565.02 291.67 368.64 677.93 19524NE0160018 Time OneDeductible - Bronze 2 Off 244.65 309.31 568.89 293.67 371.17 682.58 19524NE0160019 Time CoreMed - Bronze 2 Off 254.61 321.91 592.07 305.63 386.29 710.39 19524NE0160020 Time CoreMed - Bronze 2 Off 254.61 321.91 592.07 305.63 386.29 710.39 19524NE0160021 Time CoreMed - Bronze 4 Off 252.96 319.82 588.22 303.64 383.78 705.77 19524NE0160022 Time CoreMed - Bronze 5 Off 256.69 324.53 596.89 308.12 389.44 716.18 19524NE0160023 Time CoreMed - Bronze 4 Off 252.96 319.82 588.22 303.64 383.78 705.77 19524NE0160024 Time CoreMed - Bronze 5 Off 256.69 324.53 596.89 308.12 389.44 716.18 Lewis Ellis, Inc. - Actuaries Consultants 8/21/2013

Individual Medical s Type ID Company Silver Area 4-690-693 NON 29678NE0930001 BCBS SelectBlue Plus $2000 Silver Both 249.47 315.40 580.10 329.30 416.33 765.74 29678NE0970001 BCBS SelectBlue Plus $1500 HDHP Silver Both 210.13 265.68 488.64 277.38 350.69 645.01 29678NE1040001 BCBS BlueEssentialsPlus $2500 Silver Both 291.03 367.95 676.75 384.16 485.70 893.32 29678NE1090001 BCBS BlueEssentialsPlus $1900 HDHP Silver Both 244.82 309.53 569.31 323.17 408.58 751.49 43198NE0200003 CoOportunity CoOportunity Premier Silver Both 185.93 235.07 432.35 278.69 352.36 648.07 43198NE0200007 CoOportunity CoOportunity Premier HSA Silver Both 179.01 226.32 416.26 268.33 339.25 623.97 15438NE0150002 Coventry Silver $10 Copay HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160002 Coventry Silver $10 Copay POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170002 Coventry Silver $10 Copay HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180002 Coventry Silver $10 Copay POS On 259.35 327.90 603.08 311.22 393.48 723.70 77931NE0090002 Health Alliance Midwest Pathfinder POS 1750/3500 30% 5500/11000 Rx3 Both n/a n/a n/a n/a n/a n/a 77931NE0090003 Health Alliance Midwest Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5 Both n/a n/a n/a n/a n/a n/a 77931NE0110001 Health Alliance Midwest Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2 Both n/a n/a n/a n/a n/a n/a 77931NE0120003 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2 Both n/a n/a n/a n/a n/a n/a Gold 15438NE0150007 Coventry Silver $10 Copay HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160007 Coventry Silver $10 Copay POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170007 Coventry Silver $10 Copay HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180007 Coventry Silver $10 Copay POS PD Off 252.20 318.86 586.46 302.64 382.63 703.75 19524NE0160003 Time CoreMed - Silver 1 Off 294.33 372.13 684.43 353.31 446.55 821.21 19524NE0160004 Time CoreMed - Silver 3 Off 294.33 372.13 684.43 353.31 446.55 821.21 19524NE0160012 Time CoreMed - Silver 1 Off 294.33 372.13 684.43 353.31 446.55 821.21 19524NE0160013 Time CoreMed - Silver 3 Off 294.33 372.13 684.43 353.31 446.55 821.21 19524NE0160025 Time CoreMed - Silver 2 Off 299.90 379.16 697.37 359.99 454.99 836.73 19524NE0160026 Time CoreMed - Silver 4 Off 307.60 388.90 715.28 369.24 466.68 858.22 19524NE0160029 Time CoreMed - Silver 2 Off 299.90 379.16 697.37 359.99 454.99 836.73 19524NE0160030 Time CoreMed - Silver 4 Off 307.60 388.90 715.28 369.24 466.68 858.22 29678NE0920001 BCBS SelectBlue Plus $750 Gold Both 295.09 373.08 686.19 389.51 492.47 905.77 29678NE1030001 BCBS BlueEssentialsPlus $1000 Gold Both 329.62 416.74 766.49 435.09 550.10 1,011.76 43198NE0200002 CoOportunity CoOportunity Premier Gold Both 216.57 273.81 503.61 324.64 410.45 754.91 43198NE0200006 CoOportunity CoOportunity Premier HSA Gold Both 208.55 263.68 484.96 312.63 395.26 726.98 15438NE0150001 Coventry Gold $5 Copay HMO Methodist Health Partners On n/a n/a n/a n/a n/a n/a 15438NE0160001 Coventry Gold $5 Copay POS MIPPA On n/a n/a n/a n/a n/a n/a 15438NE0170001 Coventry Gold $5 Copay HMO Alegent Creighton Health On n/a n/a n/a n/a n/a n/a 15438NE0180001 Coventry Gold $5 Copay POS On 293.67 371.29 682.89 352.40 445.55 819.47 77931NE0090001 Health Alliance Midwest Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2 Both n/a n/a n/a n/a n/a n/a 77931NE0120001 Health Alliance Midwest Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed Both n/a n/a n/a n/a n/a n/a 77931NE0120002 Health Alliance Midwest Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed Both n/a n/a n/a n/a n/a n/a 15438NE0150006 Coventry Gold $5 Copay HMO PD Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0160006 Coventry Gold $5 Copay POS PD MIPPA Off n/a n/a n/a n/a n/a n/a 15438NE0170006 Coventry Gold $5 Copay HMO PD Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0180006 Coventry Gold $5 Copay POS PD Off 297.15 375.69 690.98 356.58 450.83 829.18 19524NE0160005 Time CoreMed - Gold 1 Off 353.48 446.91 821.98 424.31 536.29 986.24 19524NE0160014 Time CoreMed - Gold 1 Off 353.48 446.91 821.98 424.31 536.29 986.24 19524NE0160027 Time CoreMed - Gold 2 Off 366.50 463.37 852.24 439.94 556.04 1,022.55 19524NE0160031 Time CoreMed - Gold 2 Off 366.50 463.37 852.24 439.94 556.04 1,022.55 Platinum 43198NE0200001 CoOportunity CoOportunity Premier Platinum Both 247.37 312.75 575.23 370.81 468.82 862.28 19524NE0160006 Time CoreMed - Platinum 1 Off 421.30 532.65 979.67 505.72 639.18 1,175.45 19524NE0160015 Time CoreMed - Platinum 1 Off 421.30 532.65 979.67 505.72 639.18 1,175.45 19524NE0160028 Time CoreMed - Platinum 2 Off 420.80 532.03 978.53 505.12 638.43 1,174.07 19524NE0160032 Time CoreMed - Platinum 2 Off 420.80 532.03 978.53 505.12 638.43 1,174.07 Lewis Ellis, Inc. - Actuaries Consultants 8/21/2013

Small Group Medical s Type ID Company Area 1-680-681 NON Bronze 29678NE1220001 BCBS BluePridePlus Option 301 HDHP Bronze Both 250.77 317.05 583.14 250.77 317.05 583.14 29678NE1220002 BCBS BluePridePlus Option 302 HDHP Bronze Both 246.61 311.79 573.47 246.61 311.79 573.47 29678NE1220003 BCBS BluePridePlus Option 304 HDHP Bronze Both 243.40 307.74 566.00 243.40 307.74 566.00 29678NE1220004 BCBS BluePridePlus Option 305 HDHP Bronze Both 241.71 305.60 562.07 241.71 305.60 562.07 29678NE1220005 BCBS BluePridePlus Option 306 HDHP Bronze Both 249.95 316.01 581.22 249.95 316.01 581.22 29678NE1340001 BCBS SelectBluePlus Option 403 HDHP Bronze Both 206.48 261.06 480.15 206.48 261.06 480.15 43198NE0210004 CoOportunity CoOportunity Premier Bronze Both 221.11 279.55 514.16 331.44 419.04 770.73 43198NE0210007 CoOportunity CoOportunity Premier HSA Bronze Both 217.34 274.79 505.41 325.80 411.92 757.61 15438NE0190003 Coventry Bronze Essential #2 HMO Methodist Health Partners S On 241.38 305.18 561.30 289.66 366.22 673.56 15438NE0190004 Coventry Bronze Essential #5 HMO Methodist Health Partners S On 243.68 308.09 566.65 292.42 369.71 679.98 15438NE0200003 Coventry Bronze Essential #2 HMO Alegent Creighton Health S On 251.58 318.07 585.02 301.90 381.68 702.02 15438NE0200004 Coventry Bronze Essential #5 HMO Alegent Creighton Health S On 254.00 321.14 590.65 304.80 385.37 708.78 15438NE0220003 Coventry Bronze Essential #2 HMO S On 272.62 344.67 633.94 327.14 413.60 760.73 15438NE0220004 Coventry Bronze Essential #5 HMO S On 275.29 348.05 640.16 330.35 417.66 768.19 77931NE0050003 Health Alliance Midwest Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3 Both 210.42 266.03 489.30 248.30 313.92 577.37 29678NE1160001 BCBS BluePridePlus Option 303 Bronze Off 290.57 367.37 675.69 290.57 367.37 675.69 29678NE1220006 BCBS BluePridePlus Option 307 HDHP Bronze Off 219.49 277.51 510.41 219.49 277.51 510.41 15438NE0190007 Coventry Bronze Essential #2 HMO Methodist Health Partners Off 245.11 309.90 569.98 294.13 371.88 683.98 15438NE0190008 Coventry Bronze Essential #5 HMO Methodist Health Partners Off 247.42 312.81 575.34 296.90 375.37 690.41 15438NE0200007 Coventry Bronze Essential #2 HMO Alegent Creighton Health Off 255.31 322.80 593.70 306.37 387.36 712.44 15438NE0200008 Coventry Bronze Essential #5 HMO Alegent Creighton Health Off 257.74 325.86 599.34 309.29 391.03 719.21 15438NE0220007 Coventry Bronze Essential #2 HMO Off 276.35 349.40 642.63 331.62 419.28 771.16 15438NE0220008 Coventry Bronze Essential #5 HMO Off 279.03 352.78 648.84 334.84 423.34 778.61 80698NE0140015 John Alden Assurant Small Group Select - Bronze 1 Off 301.82 381.59 701.85 301.82 381.59 701.85 80698NE0140016 John Alden Assurant Small Group Select - Bronze 2 Off 309.58 391.39 719.87 309.58 391.39 719.87 80698NE0140017 John Alden Assurant Small Group Select - Bronze 3 Off 318.36 402.50 740.30 318.36 402.50 740.30 80698NE0140031 John Alden Assurant Small Group Select - Bronze 1 Off 301.82 381.59 701.85 301.82 381.59 701.85 80698NE0140032 John Alden Assurant Small Group Select - Bronze 2 Off 309.58 391.39 719.87 309.58 391.39 719.87 80698NE0140033 John Alden Assurant Small Group Select - Bronze 3 Off 318.36 402.50 740.30 318.36 402.50 740.30 80698NE0140047 John Alden Assurant Small Group Select - Bronze 4 Off 319.39 403.81 742.71 319.39 403.81 742.71 80698NE0140048 John Alden Assurant Small Group Select - Bronze 4 Off 319.39 403.81 742.71 319.39 403.81 742.71 80698NE0140049 John Alden Assurant Small Group Select - OneDeductible - Bronze 2 Off 302.86 382.90 704.25 302.86 382.90 704.25 80698NE0140052 John Alden Assurant Small Group Select - OneDeductible - Bronze 2 Off 302.86 382.90 704.25 302.86 382.90 704.25 19524NE0170015 Time Assurant Small Group Select - Bronze 1 Off 301.82 381.59 701.85 301.82 381.59 701.85 19524NE0170016 Time Assurant Small Group Select - Bronze 2 Off 309.58 391.39 719.87 309.58 391.39 719.87 19524NE0170017 Time Assurant Small Group Select - Bronze 3 Off 318.36 402.50 740.30 318.36 402.50 740.30 19524NE0170031 Time Assurant Small Group Select - Bronze 1 Off 301.82 381.59 701.85 301.82 381.59 701.85 19524NE0170032 Time Assurant Small Group Select - Bronze 2 Off 309.58 391.39 719.87 309.58 391.39 719.87 19524NE0170033 Time Assurant Small Group Select - Bronze 3 Off 318.36 402.50 740.30 318.36 402.50 740.30 19524NE0170047 Time Assurant Small Group Select - Bronze 4 Off 319.39 403.81 742.71 319.39 403.81 742.71 19524NE0170048 Time Assurant Small Group Select - Bronze 4 Off 319.39 403.81 742.71 319.39 403.81 742.71 19524NE0170049 Time Assurant Small Group Select - OneDeductible - Bronze 2 Off 302.86 382.90 704.25 302.86 382.90 704.25 19524NE0170052 Time Assurant Small Group Select - OneDeductible - Bronze 2 Off 302.86 382.90 704.25 302.86 382.90 704.25 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Silver Area 1-680-681 NON 29678NE1140002 BCBS BluePridePlus Option 202 Silver Both 341.48 431.74 794.07 341.48 431.74 794.07 29678NE1210001 BCBS BluePridePlus Option 203 HDHP Silver Both 304.64 385.16 708.41 304.64 385.16 708.41 29678NE1330001 BCBS SelectBluePlus Option 402 HDHP Silver Both 260.54 329.40 605.85 260.54 329.40 605.85 43198NE0210003 CoOportunity CoOportunity Premier Silver Both 276.39 349.44 642.71 414.30 523.80 963.39 43198NE0210006 CoOportunity CoOportunity Premier HSA Silver Both 256.05 323.72 595.41 383.81 485.25 892.50 15438NE0190002 Coventry Silver Security #2 HMO Methodist Health Partners S On 277.38 350.69 645.01 332.86 420.83 774.01 15438NE0200002 Coventry Silver Security #2 HMO Alegent Creighton Health S On 289.46 365.97 673.11 347.35 439.16 807.73 15438NE0220002 Coventry Silver Security #2 HMO S On 314.39 397.49 731.08 377.27 476.99 877.30 77931NE0010002 Health Alliance Midwest Pathfinder POS 1750/3500 30% 5500/11000 Rx3 Both 278.38 351.96 647.34 328.49 415.31 763.86 77931NE0010003 Health Alliance Midwest Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5 Both 257.76 325.89 599.39 304.16 384.55 707.28 77931NE0020003 Health Alliance Midwest Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3 Both 245.13 309.93 570.03 289.25 365.72 672.64 77931NE0050001 Health Alliance Midwest Guide HMO QHDHP 1750/3500 20% 550/11000 Rx2 Both 270.38 341.85 628.75 319.05 403.38 741.93 77931NE0050002 Health Alliance Midwest Guide HMO QHDHP 1500/3000 30% 5250/10500 Rx3 Both 264.70 334.67 615.53 312.35 394.91 726.33 77931NE0060003 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2 Both 286.80 362.60 666.91 338.42 427.87 786.95 29678NE1140001 BCBS BluePridePlus Option 201 Silver Off 359.03 453.92 834.87 359.03 453.92 834.87 15438NE0190006 Coventry Silver Security #2 HMO Methodist Health Partners Off 281.77 356.25 655.22 338.12 427.50 786.26 15438NE0200006 Coventry Silver Security #2 HMO Alegent Creighton Health Off 293.86 371.53 683.33 352.63 445.84 820.00 15438NE0220006 Coventry Silver Security #2 HMO Off 318.79 403.05 741.30 382.55 483.66 889.56 80698NE0140001 John Alden Assurant Small Group Select - Silver 5 Off 379.02 479.19 881.34 379.02 479.19 881.34 80698NE0140002 John Alden Assurant Small Group Select - Silver 8 Off 383.27 484.57 891.25 383.27 484.57 891.25 80698NE0140008 John Alden Assurant Small Group Select - Silver 5 Off 379.02 479.19 881.34 379.02 479.19 881.34 80698NE0140009 John Alden Assurant Small Group Select - Silver 8 Off 383.27 484.57 891.25 383.27 484.57 891.25 80698NE0140018 John Alden Assurant Small Group Select - Silver 1 Off 362.51 458.32 842.97 362.51 458.32 842.97 80698NE0140019 John Alden Assurant Small Group Select - Silver 2 Off 366.24 463.04 851.63 366.24 463.04 851.63 80698NE0140020 John Alden Assurant Small Group Select - Silver 3 Off 369.43 467.07 859.06 369.43 467.07 859.06 80698NE0140021 John Alden Assurant Small Group Select - Silver 4 Off 371.56 469.76 864.02 371.56 469.76 864.02 80698NE0140022 John Alden Assurant Small Group Select - Silver 6 Off 379.02 479.19 881.34 379.02 479.19 881.34 80698NE0140023 John Alden Assurant Small Group Select - Silver 7 Off 380.62 481.21 885.06 380.62 481.21 885.06 80698NE0140034 John Alden Assurant Small Group Select - Silver 1 Off 362.51 458.32 842.97 362.51 458.32 842.97 80698NE0140035 John Alden Assurant Small Group Select - Silver 2 Off 366.24 463.04 851.63 366.24 463.04 851.63 80698NE0140036 John Alden Assurant Small Group Select - Silver 3 Off 369.43 467.07 859.06 369.43 467.07 859.06 80698NE0140037 John Alden Assurant Small Group Select - Silver 4 Off 371.56 469.76 864.02 371.56 469.76 864.02 80698NE0140038 John Alden Assurant Small Group Select - Silver 6 Off 379.02 479.19 881.34 379.02 479.19 881.34 80698NE0140039 John Alden Assurant Small Group Select - Silver 7 Off 380.62 481.21 885.06 380.62 481.21 885.06 80698NE0140050 John Alden Assurant Small Group Select - OneDeductible - Silver 4 Off 362.51 458.32 842.97 362.51 458.32 842.97 80698NE0140053 John Alden Assurant Small Group Select - OneDeductible - Silver 4 Off 362.51 458.32 842.97 362.51 458.32 842.97 19524NE0170001 Time Assurant Small Group Select - Silver 5 Off 379.02 479.19 881.34 379.02 479.19 881.34 19524NE0170002 Time Assurant Small Group Select - Silver 8 Off 383.27 484.57 891.25 383.27 484.57 891.25 19524NE0170008 Time Assurant Small Group Select - Silver 5 Off 379.02 479.19 881.34 379.02 479.19 881.34 19524NE0170009 Time Assurant Small Group Select - Silver 8 Off 383.27 484.57 891.25 383.27 484.57 891.25 19524NE0170018 Time Assurant Small Group Select - Silver 1 Off 362.51 458.32 842.97 362.51 458.32 842.97 19524NE0170019 Time Assurant Small Group Select - Silver 2 Off 366.24 463.04 851.63 366.24 463.04 851.63 19524NE0170020 Time Assurant Small Group Select - Silver 3 Off 369.43 467.07 859.06 369.43 467.07 859.06 19524NE0170021 Time Assurant Small Group Select - Silver 4 Off 371.56 469.76 864.02 371.56 469.76 864.02 19524NE0170022 Time Assurant Small Group Select - Silver 6 Off 379.02 479.19 881.34 379.02 479.19 881.34 19524NE0170023 Time Assurant Small Group Select - Silver 7 Off 380.62 481.21 885.06 380.62 481.21 885.06 19524NE0170034 Time Assurant Small Group Select - Silver 1 Off 362.51 458.32 842.97 362.51 458.32 842.97 19524NE0170035 Time Assurant Small Group Select - Silver 2 Off 366.24 463.04 851.63 366.24 463.04 851.63 19524NE0170036 Time Assurant Small Group Select - Silver 3 Off 369.43 467.07 859.06 369.43 467.07 859.06 19524NE0170037 Time Assurant Small Group Select - Silver 4 Off 371.56 469.76 864.02 371.56 469.76 864.02 19524NE0170038 Time Assurant Small Group Select - Silver 6 Off 379.02 479.19 881.34 379.02 479.19 881.34 19524NE0170039 Time Assurant Small Group Select - Silver 7 Off 380.62 481.21 885.06 380.62 481.21 885.06 19524NE0170050 Time Assurant Small Group Select - OneDeductible - Silver 4 Off 362.51 458.32 842.97 362.51 458.32 842.97 19524NE0170053 Time Assurant Small Group Select - OneDeductible - Silver 4 Off 362.51 458.32 842.97 362.51 458.32 842.97 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Gold Area 1-680-681 NON 29678NE1120003 BCBS BluePridePlus Option 103 Gold Both 413.77 523.14 962.17 413.77 523.14 962.17 29678NE1200002 BCBS BluePridePlus Option 106 HDHP Gold Both 400.59 506.47 931.53 400.59 506.47 931.53 29678NE1260001 BCBS SelectBluePlus Option 401 Gold Both 363.14 459.12 844.43 363.14 459.12 844.43 43198NE0210002 CoOportunity CoOportunity Premier Gold Both 303.58 383.83 705.95 455.06 575.34 1,058.19 43198NE0210005 CoOportunity CoOportunity Premier HSA Gold Both 294.52 372.36 684.87 441.48 558.17 1,026.61 15438NE0190001 Coventry Gold Freedon #3 HMO Methodist Health Partners S On 323.75 409.32 752.85 388.50 491.18 903.42 15438NE0200001 Coventry Gold Freedom #3 HMO Alegent Creighton Health S On 338.27 427.68 786.60 405.92 513.22 943.92 15438NE0220001 Coventry Gold Freedom #3 HMO S On 368.21 465.53 856.22 441.85 558.64 1,027.46 77931NE0010001 Health Alliance Midwest Pathfinder POS 20/40 1200.2400 20% 4000/8000 Rx2 Both 300.05 379.36 697.74 354.06 447.64 823.33 77931NE0020001 Health Alliance Midwest Guide HMO 25/50 1600/3200 10% 4000/8000 Rx2 Both 287.01 362.87 667.40 338.67 428.19 787.53 77931NE0060001 Health Alliance Midwest Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed Both 321.09 405.96 746.67 378.89 479.03 881.07 77931NE0060002 Health Alliance Midwest Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed Both 310.15 392.13 721.22 365.98 462.71 851.04 77931NE0060004 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 0% 1750/3500 RxDed Both 334.14 422.46 777.00 394.29 498.50 916.86 29678NE1120001 BCBS BluePridePlus Option 101 Gold Off 429.84 543.45 999.55 429.84 543.45 999.55 29678NE1120002 BCBS BluePridePlus Option 102 Gold Off 424.53 536.74 987.20 424.53 536.74 987.20 29678NE1120004 BCBS BluePridePlus Option 104 Gold Off 422.20 533.79 981.77 422.20 533.79 981.77 29678NE1200001 BCBS BluePridePlus Option 105 HDHP Gold Off 378.80 478.92 880.86 378.80 478.92 880.86 15438NE0190005 Coventry Gold Freedom #3 HMO Methodist Health Partners Off 328.80 415.71 764.60 394.56 498.85 917.52 15438NE0200005 Coventry Gold Freedom #3 HMO Alegent Creighton Health Off 343.32 434.06 798.35 411.98 520.87 958.02 15438NE0220005 Coventry Gold Freedom #3 HMO Off 373.26 471.92 867.97 447.91 566.30 1,041.56 80698NE0140003 John Alden Assurant Small Group Select - Gold 5 Off 444.86 562.43 1,034.46 444.86 562.43 1,034.46 80698NE0140004 John Alden Assurant Small Group Select - Gold 6 Off 450.44 569.48 1,047.43 450.44 569.48 1,047.43 80698NE0140010 John Alden Assurant Small Group Select - Gold 5 Off 444.86 562.43 1,034.46 444.86 562.43 1,034.46 80698NE0140011 John Alden Assurant Small Group Select - Gold 6 Off 450.44 569.48 1,047.43 450.44 569.48 1,047.43 80698NE0140024 John Alden Assurant Small Group Select - Gold 1 Off 435.37 550.43 1,012.39 435.37 550.43 1,012.39 80698NE0140025 John Alden Assurant Small Group Select - Gold 2 Off 435.93 551.13 1,013.69 435.93 551.13 1,013.69 80698NE0140026 John Alden Assurant Small Group Select - Gold 3 Off 435.93 551.13 1,013.69 435.93 551.13 1,013.69 80698NE0140027 John Alden Assurant Small Group Select - Gold 4 Off 442.63 559.60 1,029.26 442.63 559.60 1,029.26 80698NE0140028 John Alden Assurant Small Group Select - Gold 7 Off 457.14 577.95 1,063.01 457.14 577.95 1,063.01 80698NE0140040 John Alden Assurant Small Group Select - Gold 1 Off 435.37 550.43 1,012.39 435.37 550.43 1,012.39 80698NE0140041 John Alden Assurant Small Group Select - Gold 2 Off 435.93 551.13 1,013.69 435.93 551.13 1,013.69 80698NE0140042 John Alden Assurant Small Group Select - Gold 3 Off 435.93 551.13 1,013.69 435.93 551.13 1,013.69 80698NE0140043 John Alden Assurant Small Group Select - Gold 4 Off 442.63 559.60 1,029.26 442.63 559.60 1,029.26 80698NE0140044 John Alden Assurant Small Group Select - Gold 7 Off 457.14 577.95 1,063.01 457.14 577.95 1,063.01 80698NE0140051 John Alden Assurant Small Group Select - OneDeductible - Gold 4 Off 440.39 556.78 1,024.07 440.39 556.78 1,024.07 80698NE0140054 John Alden Assurant Small Group Select - OneDeductible - Gold 4 Off 440.39 556.78 1,024.07 440.39 556.78 1,024.07 19524NE0170003 Time Assurant Small Group Select - Gold 5 Off 444.86 562.43 1,034.46 444.86 562.43 1,034.46 19524NE0170004 Time Assurant Small Group Select - Gold 6 Off 450.44 569.48 1,047.43 450.44 569.48 1,047.43 19524NE0170010 Time Assurant Small Group Select - Gold 5 Off 444.86 562.43 1,034.46 444.86 562.43 1,034.46 19524NE0170011 Time Assurant Small Group Select - Gold 6 Off 450.44 569.48 1,047.43 450.44 569.48 1,047.43 19524NE0170024 Time Assurant Small Group Select - Gold 1 Off 435.37 550.43 1,012.39 435.37 550.43 1,012.39 19524NE0170025 Time Assurant Small Group Select - Gold 2 Off 435.93 551.13 1,013.69 435.93 551.13 1,013.69 19524NE0170026 Time Assurant Small Group Select - Gold 3 Off 435.93 551.13 1,013.69 435.93 551.13 1,013.69 19524NE0170027 Time Assurant Small Group Select - Gold 4 Off 442.63 559.60 1,029.26 442.63 559.60 1,029.26 19524NE0170028 Time Assurant Small Group Select - Gold 7 Off 457.14 577.95 1,063.01 457.14 577.95 1,063.01 19524NE0170040 Time Assurant Small Group Select - Gold 1 Off 435.37 550.43 1,012.39 435.37 550.43 1,012.39 19524NE0170041 Time Assurant Small Group Select - Gold 2 Off 435.93 551.13 1,013.69 435.93 551.13 1,013.69 19524NE0170042 Time Assurant Small Group Select - Gold 3 Off 435.93 551.13 1,013.69 435.93 551.13 1,013.69 19524NE0170043 Time Assurant Small Group Select - Gold 4 Off 442.63 559.60 1,029.26 442.63 559.60 1,029.26 19524NE0170044 Time Assurant Small Group Select - Gold 7 Off 457.14 577.95 1,063.01 457.14 577.95 1,063.01 19524NE0170051 Time Assurant Small Group Select - OneDeductible - Gold 4 Off 440.39 556.78 1,024.07 440.39 556.78 1,024.07 19524NE0170054 Time Assurant Small Group Select - OneDeductible - Gold 4 Off 440.39 556.78 1,024.07 440.39 556.78 1,024.07 Platinum 43198NE0210001 CoOportunity CoOportunity Premier Platinum Both 345.15 436.38 802.60 517.38 654.13 1,203.10 80698NE0140005 John Alden Assurant Small Group Select - Platinum 2 Off 523.62 662.00 1,217.60 523.62 662.00 1,217.60 80698NE0140006 John Alden Assurant Small Group Select - Platinum 4 Off 539.07 681.54 1,253.52 539.07 681.54 1,253.52 80698NE0140007 John Alden Assurant Small Group Select - Platinum 5 Off 542.04 685.30 1,260.43 542.04 685.30 1,260.43 80698NE0140012 John Alden Assurant Small Group Select - Platinum 2 Off 523.62 662.00 1,217.60 523.62 662.00 1,217.60 80698NE0140013 John Alden Assurant Small Group Select - Platinum 4 Off 539.07 681.54 1,253.52 539.07 681.54 1,253.52 80698NE0140014 John Alden Assurant Small Group Select - Platinum 5 Off 542.04 685.30 1,260.43 542.04 685.30 1,260.43 80698NE0140029 John Alden Assurant Small Group Select - Platinum 1 Off 523.62 662.00 1,217.60 523.62 662.00 1,217.60 80698NE0140030 John Alden Assurant Small Group Select - Platinum 3 Off 525.40 664.25 1,221.74 525.40 664.25 1,221.74 80698NE0140045 John Alden Assurant Small Group Select - Platinum 1 Off 523.62 662.00 1,217.60 523.62 662.00 1,217.60 80698NE0140046 John Alden Assurant Small Group Select - Platinum 3 Off 525.40 664.25 1,221.74 525.40 664.25 1,221.74 19524NE0170005 Time Assurant Small Group Select - Platinum 2 Off 523.62 662.00 1,217.60 523.62 662.00 1,217.60 19524NE0170006 Time Assurant Small Group Select - Platinum 4 Off 539.07 681.54 1,253.52 539.07 681.54 1,253.52 19524NE0170007 Time Assurant Small Group Select - Platinum 5 Off 542.04 685.30 1,260.43 542.04 685.30 1,260.43 19524NE0170012 Time Assurant Small Group Select - Platinum 2 Off 523.62 662.00 1,217.60 523.62 662.00 1,217.60 19524NE0170013 Time Assurant Small Group Select - Platinum 4 Off 539.07 681.54 1,253.52 539.07 681.54 1,253.52 19524NE0170014 Time Assurant Small Group Select - Platinum 5 Off 542.04 685.30 1,260.43 542.04 685.30 1,260.43 19524NE0170029 Time Assurant Small Group Select - Platinum 1 Off 523.62 662.00 1,217.60 523.62 662.00 1,217.60 19524NE0170030 Time Assurant Small Group Select - Platinum 3 Off 525.40 664.25 1,221.74 525.40 664.25 1,221.74 19524NE0170045 Time Assurant Small Group Select - Platinum 1 Off 523.62 662.00 1,217.60 523.62 662.00 1,217.60 19524NE0170046 Time Assurant Small Group Select - Platinum 3 Off 525.40 664.25 1,221.74 525.40 664.25 1,221.74 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Market Type Area 2-683-685 NON Bronze 29678NE1220001 BCBS BluePridePlus Option 301 HDHP Bronze Small Group Both 250.77 317.05 583.14 250.77 317.05 583.14 29678NE1220002 BCBS BluePridePlus Option 302 HDHP Bronze Small Group Both 246.61 311.79 573.47 246.61 311.79 573.47 29678NE1220003 BCBS BluePridePlus Option 304 HDHP Bronze Small Group Both 243.40 307.74 566.00 243.40 307.74 566.00 29678NE1220004 BCBS BluePridePlus Option 305 HDHP Bronze Small Group Both 241.71 305.60 562.07 241.71 305.60 562.07 29678NE1220005 BCBS BluePridePlus Option 306 HDHP Bronze Small Group Both 249.95 316.01 581.22 249.95 316.01 581.22 29678NE1340001 BCBS SelectBluePlus Option 403 HDHP Bronze Small Group Both 206.48 261.06 480.15 206.48 261.06 480.15 43198NE0210004 CoOportunity CoOportunity Premier Bronze Small Group Both 176.64 223.33 410.76 264.78 334.76 615.71 43198NE0210007 CoOportunity CoOportunity Premier HSA Bronze Small Group Both 173.63 219.53 403.76 260.28 329.08 605.25 15438NE0190003 Coventry Bronze Essential #2 HMO Methodist Health Partners S Small Group On n/a n/a n/a n/a n/a n/a 15438NE0190004 Coventry Bronze Essential #5 HMO Methodist Health Partners S Small Group On n/a n/a n/a n/a n/a n/a 15438NE0200003 Coventry Bronze Essential #2 HMO Alegent Creighton Health S Small Group On n/a n/a n/a n/a n/a n/a 15438NE0200004 Coventry Bronze Essential #5 HMO Alegent Creighton Health S Small Group On n/a n/a n/a n/a n/a n/a 15438NE0220003 Coventry Bronze Essential #2 HMO S Small Group On 263.67 333.36 613.13 316.40 400.03 735.76 15438NE0220004 Coventry Bronze Essential #5 HMO S Small Group On 266.25 336.62 619.14 319.50 403.94 742.97 77931NE0050003 Health Alliance Midwest Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3 Small Group Both 202.08 255.49 469.92 238.45 301.48 554.51 29678NE1160001 BCBS BluePridePlus Option 303 Bronze Small Group Off 290.57 367.37 675.69 290.57 367.37 675.69 29678NE1220006 BCBS BluePridePlus Option 307 HDHP Bronze Small Group Off 219.49 277.51 510.41 219.49 277.51 510.41 15438NE0190007 Coventry Bronze Essential #2 HMO Methodist Health Partners Small Group Off n/a n/a n/a n/a n/a n/a 15438NE0190008 Coventry Bronze Essential #5 HMO Methodist Health Partners Small Group Off n/a n/a n/a n/a n/a n/a 15438NE0200007 Coventry Bronze Essential #2 HMO Alegent Creighton Health Small Group Off n/a n/a n/a n/a n/a n/a 15438NE0200008 Coventry Bronze Essential #5 HMO Alegent Creighton Health Small Group Off n/a n/a n/a n/a n/a n/a 15438NE0220007 Coventry Bronze Essential #2 HMO Small Group Off 267.28 337.92 621.52 320.74 405.50 745.82 15438NE0220008 Coventry Bronze Essential #5 HMO Small Group Off 269.86 341.19 627.53 323.83 409.43 753.04 80698NE0140015 John Alden Assurant Small Group Select - Bronze 1 Small Group Off 296.36 374.68 689.14 296.36 374.68 689.14 80698NE0140016 John Alden Assurant Small Group Select - Bronze 2 Small Group Off 303.97 384.31 706.84 303.97 384.31 706.84 80698NE0140017 John Alden Assurant Small Group Select - Bronze 3 Small Group Off 312.60 395.21 726.90 312.60 395.21 726.90 80698NE0140031 John Alden Assurant Small Group Select - Bronze 1 Small Group Off 296.36 374.68 689.14 296.36 374.68 689.14 80698NE0140032 John Alden Assurant Small Group Select - Bronze 2 Small Group Off 303.97 384.31 706.84 303.97 384.31 706.84 80698NE0140033 John Alden Assurant Small Group Select - Bronze 3 Small Group Off 312.60 395.21 726.90 312.60 395.21 726.90 80698NE0140047 John Alden Assurant Small Group Select - Bronze 4 Small Group Off 313.61 396.50 729.26 313.61 396.50 729.26 80698NE0140048 John Alden Assurant Small Group Select - Bronze 4 Small Group Off 313.61 396.50 729.26 313.61 396.50 729.26 80698NE0140049 John Alden Assurant Small Group Select - OneDeductible - Bronze 2 Small Group Off 297.37 375.97 691.50 297.37 375.97 691.50 80698NE0140052 John Alden Assurant Small Group Select - OneDeductible - Bronze 2 Small Group Off 297.37 375.97 691.50 297.37 375.97 691.50 19524NE0170015 Time Assurant Small Group Select - Bronze 1 Small Group Off 296.36 374.68 689.14 296.36 374.68 689.14 19524NE0170016 Time Assurant Small Group Select - Bronze 2 Small Group Off 303.97 384.31 706.84 303.97 384.31 706.84 19524NE0170017 Time Assurant Small Group Select - Bronze 3 Small Group Off 312.60 395.21 726.90 312.60 395.21 726.90 19524NE0170031 Time Assurant Small Group Select - Bronze 1 Small Group Off 296.36 374.68 689.14 296.36 374.68 689.14 19524NE0170032 Time Assurant Small Group Select - Bronze 2 Small Group Off 303.97 384.31 706.84 303.97 384.31 706.84 19524NE0170033 Time Assurant Small Group Select - Bronze 3 Small Group Off 312.60 395.21 726.90 312.60 395.21 726.90 19524NE0170047 Time Assurant Small Group Select - Bronze 4 Small Group Off 313.61 396.50 729.26 313.61 396.50 729.26 19524NE0170048 Time Assurant Small Group Select - Bronze 4 Small Group Off 313.61 396.50 729.26 313.61 396.50 729.26 19524NE0170049 Time Assurant Small Group Select - OneDeductible - Bronze 2 Small Group Off 297.37 375.97 691.50 297.37 375.97 691.50 19524NE0170052 Time Assurant Small Group Select - OneDeductible - Bronze 2 Small Group Off 297.37 375.97 691.50 297.37 375.97 691.50 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Silver Market Type Area 2-683-685 NON 29678NE1140002 BCBS BluePridePlus Option 202 Silver Small Group Both 341.48 431.74 794.07 341.48 431.74 794.07 29678NE1210001 BCBS BluePridePlus Option 203 HDHP Silver Small Group Both 304.64 385.16 708.41 304.64 385.16 708.41 29678NE1330001 BCBS SelectBluePlus Option 402 HDHP Silver Small Group Both 260.54 329.40 605.85 260.54 329.40 605.85 43198NE0210003 CoOportunity CoOportunity Premier Silver Small Group Both 220.79 279.15 513.43 330.97 418.45 769.63 43198NE0210006 CoOportunity CoOportunity Premier HSA Silver Small Group Both 204.55 258.61 475.65 306.61 387.66 712.99 15438NE0190002 Coventry Silver Security #2 HMO Methodist Health Partners S Small Group On n/a n/a n/a n/a n/a n/a 15438NE0200002 Coventry Silver Security #2 HMO Alegent Creighton Health S Small Group On n/a n/a n/a n/a n/a n/a 15438NE0220002 Coventry Silver Security #2 HMO S Small Group On 304.07 384.44 707.08 364.88 461.33 848.50 77931NE0010002 Health Alliance Midwest Pathfinder POS 1750/3500 30% 5500/11000 Rx3 Small Group Both 267.35 338.02 621.70 315.47 398.86 733.61 77931NE0010003 Health Alliance Midwest Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5 Small Group Both 247.55 312.98 575.65 292.11 369.32 679.27 77931NE0020003 Health Alliance Midwest Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3 Small Group Both 235.43 297.65 547.45 277.81 351.23 645.99 77931NE0050001 Health Alliance Midwest Guide HMO QHDHP 1750/3500 20% 550/11000 Rx2 Small Group Both 259.68 328.31 603.84 306.42 387.41 712.53 77931NE0050002 Health Alliance Midwest Guide HMO QHDHP 1500/3000 30% 5250/10500 Rx3 Small Group Both 254.22 321.41 591.16 299.98 379.26 697.57 77931NE0060003 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2 Small Group Both 275.44 348.24 640.50 325.02 410.92 755.79 29678NE1140001 BCBS BluePridePlus Option 201 Silver Small Group Off 359.03 453.92 834.87 359.03 453.92 834.87 15438NE0190006 Coventry Silver Security #2 HMO Methodist Health Partners Small Group Off n/a n/a n/a n/a n/a n/a 15438NE0200006 Coventry Silver Security #2 HMO Alegent Creighton Health Small Group Off n/a n/a n/a n/a n/a n/a 15438NE0220006 Coventry Silver Security #2 HMO Small Group Off 308.32 389.81 716.96 369.98 467.77 860.35 80698NE0140001 John Alden Assurant Small Group Select - Silver 5 Small Group Off 372.15 470.50 865.39 372.15 470.50 865.39 80698NE0140002 John Alden Assurant Small Group Select - Silver 8 Small Group Off 376.33 475.80 875.11 376.33 475.80 875.11 80698NE0140008 John Alden Assurant Small Group Select - Silver 5 Small Group Off 372.15 470.50 865.39 372.15 470.50 865.39 80698NE0140009 John Alden Assurant Small Group Select - Silver 8 Small Group Off 376.33 475.80 875.11 376.33 475.80 875.11 80698NE0140018 John Alden Assurant Small Group Select - Silver 1 Small Group Off 355.95 450.03 827.71 355.95 450.03 827.71 80698NE0140019 John Alden Assurant Small Group Select - Silver 2 Small Group Off 359.60 454.65 836.22 359.60 454.65 836.22 80698NE0140020 John Alden Assurant Small Group Select - Silver 3 Small Group Off 362.75 458.62 843.51 362.75 458.62 843.51 80698NE0140021 John Alden Assurant Small Group Select - Silver 4 Small Group Off 364.84 461.25 848.37 364.84 461.25 848.37 80698NE0140022 John Alden Assurant Small Group Select - Silver 6 Small Group Off 372.15 470.50 865.39 372.15 470.50 865.39 80698NE0140023 John Alden Assurant Small Group Select - Silver 7 Small Group Off 373.71 472.49 869.03 373.71 472.49 869.03 80698NE0140034 John Alden Assurant Small Group Select - Silver 1 Small Group Off 355.95 450.03 827.71 355.95 450.03 827.71 80698NE0140035 John Alden Assurant Small Group Select - Silver 2 Small Group Off 359.60 454.65 836.22 359.60 454.65 836.22 80698NE0140036 John Alden Assurant Small Group Select - Silver 3 Small Group Off 362.75 458.62 843.51 362.75 458.62 843.51 80698NE0140037 John Alden Assurant Small Group Select - Silver 4 Small Group Off 364.84 461.25 848.37 364.84 461.25 848.37 80698NE0140038 John Alden Assurant Small Group Select - Silver 6 Small Group Off 372.15 470.50 865.39 372.15 470.50 865.39 80698NE0140039 John Alden Assurant Small Group Select - Silver 7 Small Group Off 373.71 472.49 869.03 373.71 472.49 869.03 80698NE0140050 John Alden Assurant Small Group Select - OneDeductible - Silver 4 Small Group Off 355.95 450.03 827.71 355.95 450.03 827.71 80698NE0140053 John Alden Assurant Small Group Select - OneDeductible - Silver 4 Small Group Off 355.95 450.03 827.71 355.95 450.03 827.71 19524NE0170001 Time Assurant Small Group Select - Silver 5 Small Group Off 372.15 470.50 865.39 372.15 470.50 865.39 19524NE0170002 Time Assurant Small Group Select - Silver 8 Small Group Off 376.33 475.80 875.11 376.33 475.80 875.11 19524NE0170008 Time Assurant Small Group Select - Silver 5 Small Group Off 372.15 470.50 865.39 372.15 470.50 865.39 19524NE0170009 Time Assurant Small Group Select - Silver 8 Small Group Off 376.33 475.80 875.11 376.33 475.80 875.11 19524NE0170018 Time Assurant Small Group Select - Silver 1 Small Group Off 355.95 450.03 827.71 355.95 450.03 827.71 19524NE0170019 Time Assurant Small Group Select - Silver 2 Small Group Off 359.60 454.65 836.22 359.60 454.65 836.22 19524NE0170020 Time Assurant Small Group Select - Silver 3 Small Group Off 362.75 458.62 843.51 362.75 458.62 843.51 19524NE0170021 Time Assurant Small Group Select - Silver 4 Small Group Off 364.84 461.25 848.37 364.84 461.25 848.37 19524NE0170022 Time Assurant Small Group Select - Silver 6 Small Group Off 372.15 470.50 865.39 372.15 470.50 865.39 19524NE0170023 Time Assurant Small Group Select - Silver 7 Small Group Off 373.71 472.49 869.03 373.71 472.49 869.03 19524NE0170034 Time Assurant Small Group Select - Silver 1 Small Group Off 355.95 450.03 827.71 355.95 450.03 827.71 19524NE0170035 Time Assurant Small Group Select - Silver 2 Small Group Off 359.60 454.65 836.22 359.60 454.65 836.22 19524NE0170036 Time Assurant Small Group Select - Silver 3 Small Group Off 362.75 458.62 843.51 362.75 458.62 843.51 19524NE0170037 Time Assurant Small Group Select - Silver 4 Small Group Off 364.84 461.25 848.37 364.84 461.25 848.37 19524NE0170038 Time Assurant Small Group Select - Silver 6 Small Group Off 372.15 470.50 865.39 372.15 470.50 865.39 19524NE0170039 Time Assurant Small Group Select - Silver 7 Small Group Off 373.71 472.49 869.03 373.71 472.49 869.03 19524NE0170050 Time Assurant Small Group Select - OneDeductible - Silver 4 Small Group Off 355.95 450.03 827.71 355.95 450.03 827.71 19524NE0170053 Time Assurant Small Group Select - OneDeductible - Silver 4 Small Group Off 355.95 450.03 827.71 355.95 450.03 827.71 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Gold Market Type Area 2-683-685 NON 29678NE1120003 BCBS BluePridePlus Option 103 Gold Small Group Both 413.77 523.14 962.17 413.77 523.14 962.17 29678NE1200002 BCBS BluePridePlus Option 106 HDHP Gold Small Group Both 400.59 506.47 931.53 400.59 506.47 931.53 29678NE1260001 BCBS SelectBluePlus Option 401 Gold Small Group Both 363.14 459.12 844.43 363.14 459.12 844.43 43198NE0210002 CoOportunity CoOportunity Premier Gold Small Group Both 242.52 306.62 563.95 363.54 459.63 845.37 43198NE0210005 CoOportunity CoOportunity Premier HSA Gold Small Group Both 235.28 297.46 547.11 352.68 445.90 820.12 15438NE0190001 Coventry Gold Freedon #3 HMO Methodist Health Partners S Small Group On n/a n/a n/a n/a n/a n/a 15438NE0200001 Coventry Gold Freedom #3 HMO Alegent Creighton Health S Small Group On n/a n/a n/a n/a n/a n/a 15438NE0220001 Coventry Gold Freedom #3 HMO S Small Group On 356.12 450.24 828.11 427.34 540.29 993.73 77931NE0010001 Health Alliance Midwest Pathfinder POS 20/40 1200.2400 20% 4000/8000 Rx2 Small Group Both 288.17 364.34 670.10 340.04 429.92 790.72 77931NE0020001 Health Alliance Midwest Guide HMO 25/50 1600/3200 10% 4000/8000 Rx2 Small Group Both 275.64 348.49 640.97 325.26 411.22 756.34 77931NE0060001 Health Alliance Midwest Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed Small Group Both 308.38 389.89 717.09 363.89 460.07 846.17 77931NE0060002 Health Alliance Midwest Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed Small Group Both 297.87 376.60 692.66 351.49 444.39 817.34 77931NE0060004 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 0% 1750/3500 RxDed Small Group Both 320.91 405.73 746.23 378.67 478.76 880.55 29678NE1120001 BCBS BluePridePlus Option 101 Gold Small Group Off 429.84 543.45 999.55 429.84 543.45 999.55 29678NE1120002 BCBS BluePridePlus Option 102 Gold Small Group Off 424.53 536.74 987.20 424.53 536.74 987.20 29678NE1120004 BCBS BluePridePlus Option 104 Gold Small Group Off 422.20 533.79 981.77 422.20 533.79 981.77 29678NE1200001 BCBS BluePridePlus Option 105 HDHP Gold Small Group Off 378.80 478.92 880.86 378.80 478.92 880.86 15438NE0190005 Coventry Gold Freedom #3 HMO Methodist Health Partners Small Group Off n/a n/a n/a n/a n/a n/a 15438NE0200005 Coventry Gold Freedom #3 HMO Alegent Creighton Health Small Group Off n/a n/a n/a n/a n/a n/a 15438NE0220005 Coventry Gold Freedom #3 HMO Small Group Off 361.00 456.42 839.47 433.20 547.70 1,007.36 80698NE0140003 John Alden Assurant Small Group Select - Gold 5 Small Group Off 436.81 552.25 1,015.72 436.81 552.25 1,015.72 80698NE0140004 John Alden Assurant Small Group Select - Gold 6 Small Group Off 442.28 559.18 1,028.46 442.28 559.18 1,028.46 80698NE0140010 John Alden Assurant Small Group Select - Gold 5 Small Group Off 436.81 552.25 1,015.72 436.81 552.25 1,015.72 80698NE0140011 John Alden Assurant Small Group Select - Gold 6 Small Group Off 442.28 559.18 1,028.46 442.28 559.18 1,028.46 80698NE0140024 John Alden Assurant Small Group Select - Gold 1 Small Group Off 427.49 540.46 994.05 427.49 540.46 994.05 80698NE0140025 John Alden Assurant Small Group Select - Gold 2 Small Group Off 428.04 541.16 995.33 428.04 541.16 995.33 80698NE0140026 John Alden Assurant Small Group Select - Gold 3 Small Group Off 428.04 541.16 995.33 428.04 541.16 995.33 80698NE0140027 John Alden Assurant Small Group Select - Gold 4 Small Group Off 434.61 549.47 1,010.62 434.61 549.47 1,010.62 80698NE0140028 John Alden Assurant Small Group Select - Gold 7 Small Group Off 448.86 567.49 1,043.76 448.86 567.49 1,043.76 80698NE0140040 John Alden Assurant Small Group Select - Gold 1 Small Group Off 427.49 540.46 994.05 427.49 540.46 994.05 80698NE0140041 John Alden Assurant Small Group Select - Gold 2 Small Group Off 428.04 541.16 995.33 428.04 541.16 995.33 80698NE0140042 John Alden Assurant Small Group Select - Gold 3 Small Group Off 428.04 541.16 995.33 428.04 541.16 995.33 80698NE0140043 John Alden Assurant Small Group Select - Gold 4 Small Group Off 434.61 549.47 1,010.62 434.61 549.47 1,010.62 80698NE0140044 John Alden Assurant Small Group Select - Gold 7 Small Group Off 448.86 567.49 1,043.76 448.86 567.49 1,043.76 80698NE0140051 John Alden Assurant Small Group Select - OneDeductible - Gold 4 Small Group Off 432.42 546.71 1,005.52 432.42 546.71 1,005.52 80698NE0140054 John Alden Assurant Small Group Select - OneDeductible - Gold 4 Small Group Off 432.42 546.71 1,005.52 432.42 546.71 1,005.52 19524NE0170003 Time Assurant Small Group Select - Gold 5 Small Group Off 436.81 552.25 1,015.72 436.81 552.25 1,015.72 19524NE0170004 Time Assurant Small Group Select - Gold 6 Small Group Off 442.28 559.18 1,028.46 442.28 559.18 1,028.46 19524NE0170010 Time Assurant Small Group Select - Gold 5 Small Group Off 436.81 552.25 1,015.72 436.81 552.25 1,015.72 19524NE0170011 Time Assurant Small Group Select - Gold 6 Small Group Off 442.28 559.18 1,028.46 442.28 559.18 1,028.46 19524NE0170024 Time Assurant Small Group Select - Gold 1 Small Group Off 427.49 540.46 994.05 427.49 540.46 994.05 19524NE0170025 Time Assurant Small Group Select - Gold 2 Small Group Off 428.04 541.16 995.33 428.04 541.16 995.33 19524NE0170026 Time Assurant Small Group Select - Gold 3 Small Group Off 428.04 541.16 995.33 428.04 541.16 995.33 19524NE0170027 Time Assurant Small Group Select - Gold 4 Small Group Off 434.61 549.47 1,010.62 434.61 549.47 1,010.62 19524NE0170028 Time Assurant Small Group Select - Gold 7 Small Group Off 448.86 567.49 1,043.76 448.86 567.49 1,043.76 19524NE0170040 Time Assurant Small Group Select - Gold 1 Small Group Off 427.49 540.46 994.05 427.49 540.46 994.05 19524NE0170041 Time Assurant Small Group Select - Gold 2 Small Group Off 428.04 541.16 995.33 428.04 541.16 995.33 19524NE0170042 Time Assurant Small Group Select - Gold 3 Small Group Off 428.04 541.16 995.33 428.04 541.16 995.33 19524NE0170043 Time Assurant Small Group Select - Gold 4 Small Group Off 434.61 549.47 1,010.62 434.61 549.47 1,010.62 19524NE0170044 Time Assurant Small Group Select - Gold 7 Small Group Off 448.86 567.49 1,043.76 448.86 567.49 1,043.76 19524NE0170051 Time Assurant Small Group Select - OneDeductible - Gold 4 Small Group Off 432.42 546.71 1,005.52 432.42 546.71 1,005.52 19524NE0170054 Time Assurant Small Group Select - OneDeductible - Gold 4 Small Group Off 432.42 546.71 1,005.52 432.42 546.71 1,005.52 Platinum 43198NE0210001 CoOportunity CoOportunity Premier Platinum Small Group Both 275.73 348.61 641.17 413.32 522.57 961.13 80698NE0140005 John Alden Assurant Small Group Select - Platinum 2 Small Group Off 514.13 650.01 1,195.55 514.13 650.01 1,195.55 80698NE0140006 John Alden Assurant Small Group Select - Platinum 4 Small Group Off 529.31 669.20 1,230.83 529.31 669.20 1,230.83 80698NE0140007 John Alden Assurant Small Group Select - Platinum 5 Small Group Off 532.22 672.89 1,237.62 532.22 672.89 1,237.62 80698NE0140012 John Alden Assurant Small Group Select - Platinum 2 Small Group Off 514.13 650.01 1,195.55 514.13 650.01 1,195.55 80698NE0140013 John Alden Assurant Small Group Select - Platinum 4 Small Group Off 529.31 669.20 1,230.83 529.31 669.20 1,230.83 80698NE0140014 John Alden Assurant Small Group Select - Platinum 5 Small Group Off 532.22 672.89 1,237.62 532.22 672.89 1,237.62 80698NE0140029 John Alden Assurant Small Group Select - Platinum 1 Small Group Off 514.13 650.01 1,195.55 514.13 650.01 1,195.55 80698NE0140030 John Alden Assurant Small Group Select - Platinum 3 Small Group Off 515.88 652.23 1,199.62 515.88 652.23 1,199.62 80698NE0140045 John Alden Assurant Small Group Select - Platinum 1 Small Group Off 514.13 650.01 1,195.55 514.13 650.01 1,195.55 80698NE0140046 John Alden Assurant Small Group Select - Platinum 3 Small Group Off 515.88 652.23 1,199.62 515.88 652.23 1,199.62 19524NE0170005 Time Assurant Small Group Select - Platinum 2 Small Group Off 514.13 650.01 1,195.55 514.13 650.01 1,195.55 19524NE0170006 Time Assurant Small Group Select - Platinum 4 Small Group Off 529.31 669.20 1,230.83 529.31 669.20 1,230.83 19524NE0170007 Time Assurant Small Group Select - Platinum 5 Small Group Off 532.22 672.89 1,237.62 532.22 672.89 1,237.62 19524NE0170012 Time Assurant Small Group Select - Platinum 2 Small Group Off 514.13 650.01 1,195.55 514.13 650.01 1,195.55 19524NE0170013 Time Assurant Small Group Select - Platinum 4 Small Group Off 529.31 669.20 1,230.83 529.31 669.20 1,230.83 19524NE0170014 Time Assurant Small Group Select - Platinum 5 Small Group Off 532.22 672.89 1,237.62 532.22 672.89 1,237.62 19524NE0170029 Time Assurant Small Group Select - Platinum 1 Small Group Off 514.13 650.01 1,195.55 514.13 650.01 1,195.55 19524NE0170030 Time Assurant Small Group Select - Platinum 3 Small Group Off 515.88 652.23 1,199.62 515.88 652.23 1,199.62 19524NE0170045 Time Assurant Small Group Select - Platinum 1 Small Group Off 514.13 650.01 1,195.55 514.13 650.01 1,195.55 19524NE0170046 Time Assurant Small Group Select - Platinum 3 Small Group Off 515.88 652.23 1,199.62 515.88 652.23 1,199.62 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Bronze Area 3-686-689 NON 29678NE1220001 BCBS BluePridePlus Option 301 HDHP Bronze Both 243.32 307.64 565.82 243.32 307.64 565.82 29678NE1220002 BCBS BluePridePlus Option 302 HDHP Bronze Both 239.29 302.53 556.43 239.29 302.53 556.43 29678NE1220003 BCBS BluePridePlus Option 304 HDHP Bronze Both 236.17 298.59 549.19 236.17 298.59 549.19 29678NE1220004 BCBS BluePridePlus Option 305 HDHP Bronze Both 234.53 296.52 545.38 234.53 296.52 545.38 29678NE1220005 BCBS BluePridePlus Option 306 HDHP Bronze Both 242.52 306.62 563.96 242.52 306.62 563.96 29678NE1340001 BCBS SelectBluePlus Option 403 HDHP Bronze Both 200.35 253.30 465.88 200.35 253.30 465.88 43198NE0210004 CoOportunity CoOportunity Premier Bronze Both 164.59 208.09 382.73 246.71 311.92 573.69 43198NE0210007 CoOportunity CoOportunity Premier HSA Bronze Both 161.79 204.55 376.22 242.52 306.62 563.95 15438NE0190003 Coventry Bronze Essential #2 HMO Methodist Health Partners S On n/a n/a n/a n/a n/a n/a 15438NE0190004 Coventry Bronze Essential #5 HMO Methodist Health Partners S On n/a n/a n/a n/a n/a n/a 15438NE0200003 Coventry Bronze Essential #2 HMO Alegent Creighton Health S On n/a n/a n/a n/a n/a n/a 15438NE0200004 Coventry Bronze Essential #5 HMO Alegent Creighton Health S On n/a n/a n/a n/a n/a n/a 15438NE0220003 Coventry Bronze Essential #2 HMO S On 265.29 335.42 616.91 318.35 402.50 740.29 15438NE0220004 Coventry Bronze Essential #5 HMO S On 267.89 338.70 622.96 321.47 406.44 747.55 77931NE0050003 Health Alliance Midwest Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3 Both n/a n/a n/a n/a n/a n/a 29678NE1160001 BCBS BluePridePlus Option 303 Bronze Off 281.94 356.46 655.62 281.94 356.46 655.62 29678NE1220006 BCBS BluePridePlus Option 307 HDHP Bronze Off 212.98 269.27 495.25 212.98 269.27 495.25 15438NE0190007 Coventry Bronze Essential #2 HMO Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0190008 Coventry Bronze Essential #5 HMO Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0200007 Coventry Bronze Essential #2 HMO Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0200008 Coventry Bronze Essential #5 HMO Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0220007 Coventry Bronze Essential #2 HMO Off 268.93 340.01 625.36 322.72 408.01 750.43 15438NE0220008 Coventry Bronze Essential #5 HMO Off 271.53 343.30 631.41 325.84 411.96 757.69 80698NE0140015 John Alden Assurant Small Group Select - Bronze 1 Off 319.82 404.35 743.70 319.82 404.35 743.70 80698NE0140016 John Alden Assurant Small Group Select - Bronze 2 Off 328.04 414.74 762.80 328.04 414.74 762.80 80698NE0140017 John Alden Assurant Small Group Select - Bronze 3 Off 337.35 426.51 784.45 337.35 426.51 784.45 80698NE0140031 John Alden Assurant Small Group Select - Bronze 1 Off 319.82 404.35 743.70 319.82 404.35 743.70 80698NE0140032 John Alden Assurant Small Group Select - Bronze 2 Off 328.04 414.74 762.80 328.04 414.74 762.80 80698NE0140033 John Alden Assurant Small Group Select - Bronze 3 Off 337.35 426.51 784.45 337.35 426.51 784.45 80698NE0140047 John Alden Assurant Small Group Select - Bronze 4 Off 338.44 427.89 787.00 338.44 427.89 787.00 80698NE0140048 John Alden Assurant Small Group Select - Bronze 4 Off 338.44 427.89 787.00 338.44 427.89 787.00 80698NE0140049 John Alden Assurant Small Group Select - OneDeductible - Bronze 2 Off 320.92 405.73 746.25 320.92 405.73 746.25 80698NE0140052 John Alden Assurant Small Group Select - OneDeductible - Bronze 2 Off 320.92 405.73 746.25 320.92 405.73 746.25 19524NE0170015 Time Assurant Small Group Select - Bronze 1 Off 319.82 404.35 743.70 319.82 404.35 743.70 19524NE0170016 Time Assurant Small Group Select - Bronze 2 Off 328.04 414.74 762.80 328.04 414.74 762.80 19524NE0170017 Time Assurant Small Group Select - Bronze 3 Off 337.35 426.51 784.45 337.35 426.51 784.45 19524NE0170031 Time Assurant Small Group Select - Bronze 1 Off 319.82 404.35 743.70 319.82 404.35 743.70 19524NE0170032 Time Assurant Small Group Select - Bronze 2 Off 328.04 414.74 762.80 328.04 414.74 762.80 19524NE0170033 Time Assurant Small Group Select - Bronze 3 Off 337.35 426.51 784.45 337.35 426.51 784.45 19524NE0170047 Time Assurant Small Group Select - Bronze 4 Off 338.44 427.89 787.00 338.44 427.89 787.00 19524NE0170048 Time Assurant Small Group Select - Bronze 4 Off 338.44 427.89 787.00 338.44 427.89 787.00 19524NE0170049 Time Assurant Small Group Select - OneDeductible - Bronze 2 Off 320.92 405.73 746.25 320.92 405.73 746.25 19524NE0170052 Time Assurant Small Group Select - OneDeductible - Bronze 2 Off 320.92 405.73 746.25 320.92 405.73 746.25 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Silver Area 3-686-689 NON 29678NE1140002 BCBS BluePridePlus Option 202 Silver Both 331.34 418.92 770.49 331.34 418.92 770.49 29678NE1210001 BCBS BluePridePlus Option 203 HDHP Silver Both 295.59 373.72 687.37 295.59 373.72 687.37 29678NE1330001 BCBS SelectBluePlus Option 402 HDHP Silver Both 252.80 319.62 587.85 252.80 319.62 587.85 43198NE0210003 CoOportunity CoOportunity Premier Silver Both 205.73 260.11 478.41 308.38 389.89 717.11 43198NE0210006 CoOportunity CoOportunity Premier HSA Silver Both 190.59 240.96 443.19 285.70 361.21 664.35 15438NE0190002 Coventry Silver Security #2 HMO Methodist Health Partners S On n/a n/a n/a n/a n/a n/a 15438NE0200002 Coventry Silver Security #2 HMO Alegent Creighton Health S On n/a n/a n/a n/a n/a n/a 15438NE0220002 Coventry Silver Security #2 HMO S On 305.95 386.81 711.44 367.14 464.17 853.73 77931NE0010002 Health Alliance Midwest Pathfinder POS 1750/3500 30% 5500/11000 Rx3 Both n/a n/a n/a n/a n/a n/a 77931NE0010003 Health Alliance Midwest Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5 Both n/a n/a n/a n/a n/a n/a 77931NE0020003 Health Alliance Midwest Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3 Both n/a n/a n/a n/a n/a n/a 77931NE0050001 Health Alliance Midwest Guide HMO QHDHP 1750/3500 20% 550/11000 Rx2 Both n/a n/a n/a n/a n/a n/a 77931NE0050002 Health Alliance Midwest Guide HMO QHDHP 1500/3000 30% 5250/10500 Rx3 Both n/a n/a n/a n/a n/a n/a 77931NE0060003 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2 Both n/a n/a n/a n/a n/a n/a 29678NE1140001 BCBS BluePridePlus Option 201 Silver Off 348.36 440.44 810.07 348.36 440.44 810.07 15438NE0190006 Coventry Silver Security #2 HMO Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0200006 Coventry Silver Security #2 HMO Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0220006 Coventry Silver Security #2 HMO Off 310.22 392.22 721.38 372.26 470.66 865.66 80698NE0140001 John Alden Assurant Small Group Select - Silver 5 Off 401.62 507.76 933.90 401.62 507.76 933.90 80698NE0140002 John Alden Assurant Small Group Select - Silver 8 Off 406.13 513.47 944.40 406.13 513.47 944.40 80698NE0140008 John Alden Assurant Small Group Select - Silver 5 Off 401.62 507.76 933.90 401.62 507.76 933.90 80698NE0140009 John Alden Assurant Small Group Select - Silver 8 Off 406.13 513.47 944.40 406.13 513.47 944.40 80698NE0140018 John Alden Assurant Small Group Select - Silver 1 Off 384.13 485.66 893.25 384.13 485.66 893.25 80698NE0140019 John Alden Assurant Small Group Select - Silver 2 Off 388.08 490.65 902.42 388.08 490.65 902.42 80698NE0140020 John Alden Assurant Small Group Select - Silver 3 Off 391.46 494.93 910.29 391.46 494.93 910.29 80698NE0140021 John Alden Assurant Small Group Select - Silver 4 Off 393.72 497.78 915.55 393.72 497.78 915.55 80698NE0140022 John Alden Assurant Small Group Select - Silver 6 Off 401.62 507.76 933.90 401.62 507.76 933.90 80698NE0140023 John Alden Assurant Small Group Select - Silver 7 Off 403.31 509.90 937.84 403.31 509.90 937.84 80698NE0140034 John Alden Assurant Small Group Select - Silver 1 Off 384.13 485.66 893.25 384.13 485.66 893.25 80698NE0140035 John Alden Assurant Small Group Select - Silver 2 Off 388.08 490.65 902.42 388.08 490.65 902.42 80698NE0140036 John Alden Assurant Small Group Select - Silver 3 Off 391.46 494.93 910.29 391.46 494.93 910.29 80698NE0140037 John Alden Assurant Small Group Select - Silver 4 Off 393.72 497.78 915.55 393.72 497.78 915.55 80698NE0140038 John Alden Assurant Small Group Select - Silver 6 Off 401.62 507.76 933.90 401.62 507.76 933.90 80698NE0140039 John Alden Assurant Small Group Select - Silver 7 Off 403.31 509.90 937.84 403.31 509.90 937.84 80698NE0140050 John Alden Assurant Small Group Select - OneDeductible - Silver 4 Off 384.13 485.66 893.25 384.13 485.66 893.25 80698NE0140053 John Alden Assurant Small Group Select - OneDeductible - Silver 4 Off 384.13 485.66 893.25 384.13 485.66 893.25 19524NE0170001 Time Assurant Small Group Select - Silver 5 Off 401.62 507.76 933.90 401.62 507.76 933.90 19524NE0170002 Time Assurant Small Group Select - Silver 8 Off 406.13 513.47 944.40 406.13 513.47 944.40 19524NE0170008 Time Assurant Small Group Select - Silver 5 Off 401.62 507.76 933.90 401.62 507.76 933.90 19524NE0170009 Time Assurant Small Group Select - Silver 8 Off 406.13 513.47 944.40 406.13 513.47 944.40 19524NE0170018 Time Assurant Small Group Select - Silver 1 Off 384.13 485.66 893.25 384.13 485.66 893.25 19524NE0170019 Time Assurant Small Group Select - Silver 2 Off 388.08 490.65 902.42 388.08 490.65 902.42 19524NE0170020 Time Assurant Small Group Select - Silver 3 Off 391.46 494.93 910.29 391.46 494.93 910.29 19524NE0170021 Time Assurant Small Group Select - Silver 4 Off 393.72 497.78 915.55 393.72 497.78 915.55 19524NE0170022 Time Assurant Small Group Select - Silver 6 Off 401.62 507.76 933.90 401.62 507.76 933.90 19524NE0170023 Time Assurant Small Group Select - Silver 7 Off 403.31 509.90 937.84 403.31 509.90 937.84 19524NE0170034 Time Assurant Small Group Select - Silver 1 Off 384.13 485.66 893.25 384.13 485.66 893.25 19524NE0170035 Time Assurant Small Group Select - Silver 2 Off 388.08 490.65 902.42 388.08 490.65 902.42 19524NE0170036 Time Assurant Small Group Select - Silver 3 Off 391.46 494.93 910.29 391.46 494.93 910.29 19524NE0170037 Time Assurant Small Group Select - Silver 4 Off 393.72 497.78 915.55 393.72 497.78 915.55 19524NE0170038 Time Assurant Small Group Select - Silver 6 Off 401.62 507.76 933.90 401.62 507.76 933.90 19524NE0170039 Time Assurant Small Group Select - Silver 7 Off 403.31 509.90 937.84 403.31 509.90 937.84 19524NE0170050 Time Assurant Small Group Select - OneDeductible - Silver 4 Off 384.13 485.66 893.25 384.13 485.66 893.25 19524NE0170053 Time Assurant Small Group Select - OneDeductible - Silver 4 Off 384.13 485.66 893.25 384.13 485.66 893.25 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Gold Area 3-686-689 NON 29678NE1120003 BCBS BluePridePlus Option 103 Gold Both 401.48 507.60 933.59 401.48 507.60 933.59 29678NE1200002 BCBS BluePridePlus Option 106 HDHP Gold Both 388.69 491.43 903.86 388.69 491.43 903.86 29678NE1260001 BCBS SelectBluePlus Option 401 Gold Both 352.35 445.48 819.35 352.35 445.48 819.35 43198NE0210002 CoOportunity CoOportunity Premier Gold Both 225.97 285.70 525.47 338.73 428.27 787.69 43198NE0210005 CoOportunity CoOportunity Premier HSA Gold Both 219.22 277.16 509.77 328.62 415.48 764.17 15438NE0190001 Coventry Gold Freedon #3 HMO Methodist Health Partners S On n/a n/a n/a n/a n/a n/a 15438NE0200001 Coventry Gold Freedom #3 HMO Alegent Creighton Health S On n/a n/a n/a n/a n/a n/a 15438NE0220001 Coventry Gold Freedom #3 HMO S On 358.31 453.02 833.22 429.97 543.62 999.86 77931NE0010001 Health Alliance Midwest Pathfinder POS 20/40 1200.2400 20% 4000/8000 Rx2 Both n/a n/a n/a n/a n/a n/a 77931NE0020001 Health Alliance Midwest Guide HMO 25/50 1600/3200 10% 4000/8000 Rx2 Both n/a n/a n/a n/a n/a n/a 77931NE0060001 Health Alliance Midwest Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed Both n/a n/a n/a n/a n/a n/a 77931NE0060002 Health Alliance Midwest Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed Both n/a n/a n/a n/a n/a n/a 77931NE0060004 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 0% 1750/3500 RxDed Both n/a n/a n/a n/a n/a n/a 29678NE1120001 BCBS BluePridePlus Option 101 Gold Off 417.07 527.31 969.86 417.07 527.31 969.86 29678NE1120002 BCBS BluePridePlus Option 102 Gold Off 411.92 520.80 957.88 411.92 520.80 957.88 29678NE1120004 BCBS BluePridePlus Option 104 Gold Off 409.66 517.93 952.61 409.66 517.93 952.61 29678NE1200001 BCBS BluePridePlus Option 105 HDHP Gold Off 367.55 464.70 854.70 367.55 464.70 854.70 15438NE0190005 Coventry Gold Freedom #3 HMO Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0200005 Coventry Gold Freedom #3 HMO Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0220005 Coventry Gold Freedom #3 HMO Off 363.23 459.24 844.65 435.88 551.09 1,013.58 80698NE0140003 John Alden Assurant Small Group Select - Gold 5 Off 471.39 595.98 1,096.15 471.39 595.98 1,096.15 80698NE0140004 John Alden Assurant Small Group Select - Gold 6 Off 477.31 603.45 1,109.89 477.31 603.45 1,109.89 80698NE0140010 John Alden Assurant Small Group Select - Gold 5 Off 471.39 595.98 1,096.15 471.39 595.98 1,096.15 80698NE0140011 John Alden Assurant Small Group Select - Gold 6 Off 477.31 603.45 1,109.89 477.31 603.45 1,109.89 80698NE0140024 John Alden Assurant Small Group Select - Gold 1 Off 461.33 583.26 1,072.76 461.33 583.26 1,072.76 80698NE0140025 John Alden Assurant Small Group Select - Gold 2 Off 461.93 584.01 1,074.14 461.93 584.01 1,074.14 80698NE0140026 John Alden Assurant Small Group Select - Gold 3 Off 461.93 584.01 1,074.14 461.93 584.01 1,074.14 80698NE0140027 John Alden Assurant Small Group Select - Gold 4 Off 469.02 592.98 1,090.64 469.02 592.98 1,090.64 80698NE0140028 John Alden Assurant Small Group Select - Gold 7 Off 484.40 612.42 1,126.40 484.40 612.42 1,126.40 80698NE0140040 John Alden Assurant Small Group Select - Gold 1 Off 461.33 583.26 1,072.76 461.33 583.26 1,072.76 80698NE0140041 John Alden Assurant Small Group Select - Gold 2 Off 461.93 584.01 1,074.14 461.93 584.01 1,074.14 80698NE0140042 John Alden Assurant Small Group Select - Gold 3 Off 461.93 584.01 1,074.14 461.93 584.01 1,074.14 80698NE0140043 John Alden Assurant Small Group Select - Gold 4 Off 469.02 592.98 1,090.64 469.02 592.98 1,090.64 80698NE0140044 John Alden Assurant Small Group Select - Gold 7 Off 484.40 612.42 1,126.40 484.40 612.42 1,126.40 80698NE0140051 John Alden Assurant Small Group Select - OneDeductible - Gold 4 Off 466.66 589.99 1,085.14 466.66 589.99 1,085.14 80698NE0140054 John Alden Assurant Small Group Select - OneDeductible - Gold 4 Off 466.66 589.99 1,085.14 466.66 589.99 1,085.14 19524NE0170003 Time Assurant Small Group Select - Gold 5 Off 471.39 595.98 1,096.15 471.39 595.98 1,096.15 19524NE0170004 Time Assurant Small Group Select - Gold 6 Off 477.31 603.45 1,109.89 477.31 603.45 1,109.89 19524NE0170010 Time Assurant Small Group Select - Gold 5 Off 471.39 595.98 1,096.15 471.39 595.98 1,096.15 19524NE0170011 Time Assurant Small Group Select - Gold 6 Off 477.31 603.45 1,109.89 477.31 603.45 1,109.89 19524NE0170024 Time Assurant Small Group Select - Gold 1 Off 461.33 583.26 1,072.76 461.33 583.26 1,072.76 19524NE0170025 Time Assurant Small Group Select - Gold 2 Off 461.93 584.01 1,074.14 461.93 584.01 1,074.14 19524NE0170026 Time Assurant Small Group Select - Gold 3 Off 461.93 584.01 1,074.14 461.93 584.01 1,074.14 19524NE0170027 Time Assurant Small Group Select - Gold 4 Off 469.02 592.98 1,090.64 469.02 592.98 1,090.64 19524NE0170028 Time Assurant Small Group Select - Gold 7 Off 484.40 612.42 1,126.40 484.40 612.42 1,126.40 19524NE0170040 Time Assurant Small Group Select - Gold 1 Off 461.33 583.26 1,072.76 461.33 583.26 1,072.76 19524NE0170041 Time Assurant Small Group Select - Gold 2 Off 461.93 584.01 1,074.14 461.93 584.01 1,074.14 19524NE0170042 Time Assurant Small Group Select - Gold 3 Off 461.93 584.01 1,074.14 461.93 584.01 1,074.14 19524NE0170043 Time Assurant Small Group Select - Gold 4 Off 469.02 592.98 1,090.64 469.02 592.98 1,090.64 19524NE0170044 Time Assurant Small Group Select - Gold 7 Off 484.40 612.42 1,126.40 484.40 612.42 1,126.40 19524NE0170051 Time Assurant Small Group Select - OneDeductible - Gold 4 Off 466.66 589.99 1,085.14 466.66 589.99 1,085.14 19524NE0170054 Time Assurant Small Group Select - OneDeductible - Gold 4 Off 466.66 589.99 1,085.14 466.66 589.99 1,085.14 Platinum 43198NE0210001 CoOportunity CoOportunity Premier Platinum Both 256.92 324.82 597.43 385.12 486.91 895.55 80698NE0140005 John Alden Assurant Small Group Select - Platinum 2 Off 554.84 701.49 1,290.21 554.84 701.49 1,290.21 80698NE0140006 John Alden Assurant Small Group Select - Platinum 4 Off 571.22 722.19 1,328.28 571.22 722.19 1,328.28 80698NE0140007 John Alden Assurant Small Group Select - Platinum 5 Off 574.37 726.17 1,335.61 574.37 726.17 1,335.61 80698NE0140012 John Alden Assurant Small Group Select - Platinum 2 Off 554.84 701.49 1,290.21 554.84 701.49 1,290.21 80698NE0140013 John Alden Assurant Small Group Select - Platinum 4 Off 571.22 722.19 1,328.28 571.22 722.19 1,328.28 80698NE0140014 John Alden Assurant Small Group Select - Platinum 5 Off 574.37 726.17 1,335.61 574.37 726.17 1,335.61 80698NE0140029 John Alden Assurant Small Group Select - Platinum 1 Off 554.84 701.49 1,290.21 554.84 701.49 1,290.21 80698NE0140030 John Alden Assurant Small Group Select - Platinum 3 Off 556.73 703.87 1,294.60 556.73 703.87 1,294.60 80698NE0140045 John Alden Assurant Small Group Select - Platinum 1 Off 554.84 701.49 1,290.21 554.84 701.49 1,290.21 80698NE0140046 John Alden Assurant Small Group Select - Platinum 3 Off 556.73 703.87 1,294.60 556.73 703.87 1,294.60 19524NE0170005 Time Assurant Small Group Select - Platinum 2 Off 554.84 701.49 1,290.21 554.84 701.49 1,290.21 19524NE0170006 Time Assurant Small Group Select - Platinum 4 Off 571.22 722.19 1,328.28 571.22 722.19 1,328.28 19524NE0170007 Time Assurant Small Group Select - Platinum 5 Off 574.37 726.17 1,335.61 574.37 726.17 1,335.61 19524NE0170012 Time Assurant Small Group Select - Platinum 2 Off 554.84 701.49 1,290.21 554.84 701.49 1,290.21 19524NE0170013 Time Assurant Small Group Select - Platinum 4 Off 571.22 722.19 1,328.28 571.22 722.19 1,328.28 19524NE0170014 Time Assurant Small Group Select - Platinum 5 Off 574.37 726.17 1,335.61 574.37 726.17 1,335.61 19524NE0170029 Time Assurant Small Group Select - Platinum 1 Off 554.84 701.49 1,290.21 554.84 701.49 1,290.21 19524NE0170030 Time Assurant Small Group Select - Platinum 3 Off 556.73 703.87 1,294.60 556.73 703.87 1,294.60 19524NE0170045 Time Assurant Small Group Select - Platinum 1 Off 554.84 701.49 1,290.21 554.84 701.49 1,290.21 19524NE0170046 Time Assurant Small Group Select - Platinum 3 Off 556.73 703.87 1,294.60 556.73 703.87 1,294.60 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Bronze Area 4-690-693 NON 29678NE1220001 BCBS BluePridePlus Option 301 HDHP Bronze Both 260.70 329.61 606.24 260.70 329.61 606.24 29678NE1220002 BCBS BluePridePlus Option 302 HDHP Bronze Both 256.38 324.14 596.18 256.38 324.14 596.18 29678NE1220003 BCBS BluePridePlus Option 304 HDHP Bronze Both 253.04 319.92 588.42 253.04 319.92 588.42 29678NE1220004 BCBS BluePridePlus Option 305 HDHP Bronze Both 251.28 317.70 584.33 251.28 317.70 584.33 29678NE1220005 BCBS BluePridePlus Option 306 HDHP Bronze Both 259.84 328.52 604.24 259.84 328.52 604.24 29678NE1340001 BCBS SelectBluePlus Option 403 HDHP Bronze Both 214.66 271.40 499.16 214.66 271.40 499.16 43198NE0210004 CoOportunity CoOportunity Premier Bronze Both 164.17 207.56 381.76 246.09 311.14 572.26 43198NE0210007 CoOportunity CoOportunity Premier HSA Bronze Both 161.38 204.04 375.27 241.91 305.85 562.53 15438NE0190003 Coventry Bronze Essential #2 HMO Methodist Health Partners S On n/a n/a n/a n/a n/a n/a 15438NE0190004 Coventry Bronze Essential #5 HMO Methodist Health Partners S On n/a n/a n/a n/a n/a n/a 15438NE0200003 Coventry Bronze Essential #2 HMO Alegent Creighton Health S On n/a n/a n/a n/a n/a n/a 15438NE0200004 Coventry Bronze Essential #5 HMO Alegent Creighton Health S On n/a n/a n/a n/a n/a n/a 15438NE0220003 Coventry Bronze Essential #2 HMO S On 272.62 344.67 633.94 327.14 413.60 760.73 15438NE0220004 Coventry Bronze Essential #5 HMO S On 275.29 348.05 640.16 330.35 417.66 768.19 77931NE0050003 Health Alliance Midwest Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3 Both n/a n/a n/a n/a n/a n/a 29678NE1160001 BCBS BluePridePlus Option 303 Bronze Off 302.08 381.92 702.45 302.08 381.92 702.45 29678NE1220006 BCBS BluePridePlus Option 307 HDHP Bronze Off 228.19 288.50 530.62 228.19 288.50 530.62 15438NE0190007 Coventry Bronze Essential #2 HMO Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0190008 Coventry Bronze Essential #5 HMO Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0200007 Coventry Bronze Essential #2 HMO Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0200008 Coventry Bronze Essential #5 HMO Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0220007 Coventry Bronze Essential #2 HMO Off 276.35 349.40 642.63 331.62 419.28 771.16 15438NE0220008 Coventry Bronze Essential #5 HMO Off 279.03 352.78 648.84 334.84 423.34 778.61 80698NE0140015 John Alden Assurant Small Group Select - Bronze 1 Off 316.92 400.69 736.97 316.92 400.69 736.97 80698NE0140016 John Alden Assurant Small Group Select - Bronze 2 Off 325.06 410.99 755.90 325.06 410.99 755.90 80698NE0140017 John Alden Assurant Small Group Select - Bronze 3 Off 334.28 422.65 777.36 334.28 422.65 777.36 80698NE0140031 John Alden Assurant Small Group Select - Bronze 1 Off 316.92 400.69 736.97 316.92 400.69 736.97 80698NE0140032 John Alden Assurant Small Group Select - Bronze 2 Off 325.06 410.99 755.90 325.06 410.99 755.90 80698NE0140033 John Alden Assurant Small Group Select - Bronze 3 Off 334.28 422.65 777.36 334.28 422.65 777.36 80698NE0140047 John Alden Assurant Small Group Select - Bronze 4 Off 335.37 424.02 779.88 335.37 424.02 779.88 80698NE0140048 John Alden Assurant Small Group Select - Bronze 4 Off 335.37 424.02 779.88 335.37 424.02 779.88 80698NE0140049 John Alden Assurant Small Group Select - OneDeductible - Bronze 2 Off 318.00 402.07 739.50 318.00 402.07 739.50 80698NE0140052 John Alden Assurant Small Group Select - OneDeductible - Bronze 2 Off 318.00 402.07 739.50 318.00 402.07 739.50 19524NE0170015 Time Assurant Small Group Select - Bronze 1 Off 316.92 400.69 736.97 316.92 400.69 736.97 19524NE0170016 Time Assurant Small Group Select - Bronze 2 Off 325.06 410.99 755.90 325.06 410.99 755.90 19524NE0170017 Time Assurant Small Group Select - Bronze 3 Off 334.28 422.65 777.36 334.28 422.65 777.36 19524NE0170031 Time Assurant Small Group Select - Bronze 1 Off 316.92 400.69 736.97 316.92 400.69 736.97 19524NE0170032 Time Assurant Small Group Select - Bronze 2 Off 325.06 410.99 755.90 325.06 410.99 755.90 19524NE0170033 Time Assurant Small Group Select - Bronze 3 Off 334.28 422.65 777.36 334.28 422.65 777.36 19524NE0170047 Time Assurant Small Group Select - Bronze 4 Off 335.37 424.02 779.88 335.37 424.02 779.88 19524NE0170048 Time Assurant Small Group Select - Bronze 4 Off 335.37 424.02 779.88 335.37 424.02 779.88 19524NE0170049 Time Assurant Small Group Select - OneDeductible - Bronze 2 Off 318.00 402.07 739.50 318.00 402.07 739.50 19524NE0170052 Time Assurant Small Group Select - OneDeductible - Bronze 2 Off 318.00 402.07 739.50 318.00 402.07 739.50 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013

Small Group Medical s Type ID Company Silver Area 4-690-693 NON 29678NE1140002 BCBS BluePridePlus Option 202 Silver Both 355.01 448.84 825.52 355.01 448.84 825.52 29678NE1210001 BCBS BluePridePlus Option 203 HDHP Silver Both 316.71 400.42 736.47 316.71 400.42 736.47 29678NE1330001 BCBS SelectBluePlus Option 402 HDHP Silver Both 270.86 342.45 629.84 270.86 342.45 629.84 43198NE0210003 CoOportunity CoOportunity Premier Silver Both 205.21 259.45 477.19 307.61 388.91 715.31 43198NE0210006 CoOportunity CoOportunity Premier HSA Silver Both 190.11 240.36 442.07 284.97 360.29 662.67 15438NE0190002 Coventry Silver Security #2 HMO Methodist Health Partners S On n/a n/a n/a n/a n/a n/a 15438NE0200002 Coventry Silver Security #2 HMO Alegent Creighton Health S On n/a n/a n/a n/a n/a n/a 15438NE0220002 Coventry Silver Security #2 HMO S On 314.39 397.49 731.08 377.27 476.99 877.30 77931NE0010002 Health Alliance Midwest Pathfinder POS 1750/3500 30% 5500/11000 Rx3 Both n/a n/a n/a n/a n/a n/a 77931NE0010003 Health Alliance Midwest Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5 Both n/a n/a n/a n/a n/a n/a 77931NE0020003 Health Alliance Midwest Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3 Both n/a n/a n/a n/a n/a n/a 77931NE0050001 Health Alliance Midwest Guide HMO QHDHP 1750/3500 20% 550/11000 Rx2 Both n/a n/a n/a n/a n/a n/a 77931NE0050002 Health Alliance Midwest Guide HMO QHDHP 1500/3000 30% 5250/10500 Rx3 Both n/a n/a n/a n/a n/a n/a 77931NE0060003 Health Alliance Midwest Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2 Both n/a n/a n/a n/a n/a n/a 29678NE1140001 BCBS BluePridePlus Option 201 Silver Off 373.24 471.90 867.93 373.24 471.90 867.93 15438NE0190006 Coventry Silver Security #2 HMO Methodist Health Partners Off n/a n/a n/a n/a n/a n/a 15438NE0200006 Coventry Silver Security #2 HMO Alegent Creighton Health Off n/a n/a n/a n/a n/a n/a 15438NE0220006 Coventry Silver Security #2 HMO Off 318.79 403.05 741.30 382.55 483.66 889.56 80698NE0140001 John Alden Assurant Small Group Select - Silver 5 Off 397.97 503.18 925.46 397.97 503.18 925.46 80698NE0140002 John Alden Assurant Small Group Select - Silver 8 Off 402.44 508.83 935.86 402.44 508.83 935.86 80698NE0140008 John Alden Assurant Small Group Select - Silver 5 Off 397.97 503.18 925.46 397.97 503.18 925.46 80698NE0140009 John Alden Assurant Small Group Select - Silver 8 Off 402.44 508.83 935.86 402.44 508.83 935.86 80698NE0140018 John Alden Assurant Small Group Select - Silver 1 Off 380.65 481.27 885.16 380.65 481.27 885.16 80698NE0140019 John Alden Assurant Small Group Select - Silver 2 Off 384.56 486.21 894.26 384.56 486.21 894.26 80698NE0140020 John Alden Assurant Small Group Select - Silver 3 Off 387.91 490.46 902.06 387.91 490.46 902.06 80698NE0140021 John Alden Assurant Small Group Select - Silver 4 Off 390.14 493.28 907.25 390.14 493.28 907.25 80698NE0140022 John Alden Assurant Small Group Select - Silver 6 Off 397.97 503.18 925.46 397.97 503.18 925.46 80698NE0140023 John Alden Assurant Small Group Select - Silver 7 Off 399.65 505.30 929.36 399.65 505.30 929.36 80698NE0140034 John Alden Assurant Small Group Select - Silver 1 Off 380.65 481.27 885.16 380.65 481.27 885.16 80698NE0140035 John Alden Assurant Small Group Select - Silver 2 Off 384.56 486.21 894.26 384.56 486.21 894.26 80698NE0140036 John Alden Assurant Small Group Select - Silver 3 Off 387.91 490.46 902.06 387.91 490.46 902.06 80698NE0140037 John Alden Assurant Small Group Select - Silver 4 Off 390.14 493.28 907.25 390.14 493.28 907.25 80698NE0140038 John Alden Assurant Small Group Select - Silver 6 Off 397.97 503.18 925.46 397.97 503.18 925.46 80698NE0140039 John Alden Assurant Small Group Select - Silver 7 Off 399.65 505.30 929.36 399.65 505.30 929.36 80698NE0140050 John Alden Assurant Small Group Select - OneDeductible - Silver 4 Off 380.65 481.27 885.16 380.65 481.27 885.16 80698NE0140053 John Alden Assurant Small Group Select - OneDeductible - Silver 4 Off 380.65 481.27 885.16 380.65 481.27 885.16 19524NE0170001 Time Assurant Small Group Select - Silver 5 Off 397.97 503.18 925.46 397.97 503.18 925.46 19524NE0170002 Time Assurant Small Group Select - Silver 8 Off 402.44 508.83 935.86 402.44 508.83 935.86 19524NE0170008 Time Assurant Small Group Select - Silver 5 Off 397.97 503.18 925.46 397.97 503.18 925.46 19524NE0170009 Time Assurant Small Group Select - Silver 8 Off 402.44 508.83 935.86 402.44 508.83 935.86 19524NE0170018 Time Assurant Small Group Select - Silver 1 Off 380.65 481.27 885.16 380.65 481.27 885.16 19524NE0170019 Time Assurant Small Group Select - Silver 2 Off 384.56 486.21 894.26 384.56 486.21 894.26 19524NE0170020 Time Assurant Small Group Select - Silver 3 Off 387.91 490.46 902.06 387.91 490.46 902.06 19524NE0170021 Time Assurant Small Group Select - Silver 4 Off 390.14 493.28 907.25 390.14 493.28 907.25 19524NE0170022 Time Assurant Small Group Select - Silver 6 Off 397.97 503.18 925.46 397.97 503.18 925.46 19524NE0170023 Time Assurant Small Group Select - Silver 7 Off 399.65 505.30 929.36 399.65 505.30 929.36 19524NE0170034 Time Assurant Small Group Select - Silver 1 Off 380.65 481.27 885.16 380.65 481.27 885.16 19524NE0170035 Time Assurant Small Group Select - Silver 2 Off 384.56 486.21 894.26 384.56 486.21 894.26 19524NE0170036 Time Assurant Small Group Select - Silver 3 Off 387.91 490.46 902.06 387.91 490.46 902.06 19524NE0170037 Time Assurant Small Group Select - Silver 4 Off 390.14 493.28 907.25 390.14 493.28 907.25 19524NE0170038 Time Assurant Small Group Select - Silver 6 Off 397.97 503.18 925.46 397.97 503.18 925.46 19524NE0170039 Time Assurant Small Group Select - Silver 7 Off 399.65 505.30 929.36 399.65 505.30 929.36 19524NE0170050 Time Assurant Small Group Select - OneDeductible - Silver 4 Off 380.65 481.27 885.16 380.65 481.27 885.16 19524NE0170053 Time Assurant Small Group Select - OneDeductible - Silver 4 Off 380.65 481.27 885.16 380.65 481.27 885.16 Lewis Ellis, Inc - Actuaries and Consultants 8/21/2013