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APPROVED MONTHLY PREMIUM RATES - INDIVIDUAL STANDARD PLANS

Insurer ON/OFF Exchange Metal/Tier ALBANY BUFFALO MID HUDSON ROCHESTER SYRACUSE UTICA LONG ALL REGIONS COMB. AVG AETNA LIFE ON/OFF PLATINUM 710.86 798.86 798.86 769.53 AFFINITY ON PLATINUM 586.50 601.28 614.40 600.73 AMERICAN PROG ON PLATINUM 632.64 559.66 714.02 586.49 592.25 525.39 601.74 ATLANTIS OFF PLATINUM 737.05 737.05 CDPHP HMO ON/OFF PLATINUM 644.42 726.66 717.98 689.83 694.72 EMPIRE HMO ON/OFF PLATINUM 605.47 714.11 650.28 963.75 598.53 706.43 EXCELLUS ON/OFF PLATINUM 653.97 635.41 653.97 505.26 614.36 653.97 619.49 FREELANCERS ON/OFF PLATINUM 397.25 371.87 446.23 523.23 365.57 386.06 375.65 523.23 423.64 GHI OFF PLATINUM 796.85 737.26 873.13 852.26 720.23 771.34 805.42 918.01 809.31 HEALTHFIRST ON/OFF PLATINUM 623.30 623.30 623.30 HEALTHNOW ON/OFF PLATINUM 737.81 568.41 772.62 692.95 HIP HMO ON/OFF PLATINUM 555.61 555.61 631.43 580.88 HIPIC OFF PLATINUM 902.13 834.66 994.34 994.34 815.36 873.24 911.82 1,019.18 918.13 IHBC ON/OFF PLATINUM 618.94 618.94 METRO PLUS ON PLATINUM 443.24 443.24 MVPHP-HMO ON/OFF PLATINUM 542.94 493.30 664.59 864.34 476.36 620.41 581.67 606.23 NEW YORK FIDELIS ON PLATINUM 506.02 500.18 510.27 577.18 501.78 504.96 499.12 532.57 516.51 NORTHSHORE LIJ ON/OFF PLATINUM 568.13 568.13 568.13 OSCAR ON PLATINUM 602.75 602.75 602.75 OXFORD HMO OFF PLATINUM 965.24 965.24 965.24 965.24 UNITED ON PLATINUM 913.99 913.99 913.99 913.99

Insurer ON/OFF Exchange Metal/Tier ALBANY BUFFALO MID HUDSON NEW YORK ROCHESTER SYRACUSE UTICA LONG ISLAND ALL REGIONS COMB. AVG AETNA LIFE ON/OFF GOLD 613.08 688.37 688.37 663.27 AFFINITY ON GOLD 497.10 509.54 520.58 509.07 AMERICAN PROG ON GOLD 564.19 499.11 636.76 523.03 530.85 468.55 537.08 ATLANTIS OFF GOLD 638.47 638.47 CDPHP HMO ON/OFF GOLD 563.94 636.00 628.54 603.89 608.09 EMPIRE HMO ON/OFF GOLD 514.85 607.23 552.95 819.49 508.94 600.69 EXCELLUS ON/OFF GOLD 564.75 548.72 564.75 436.32 530.54 564.75 534.97 FREELANCERS ON/OFF GOLD 338.56 316.93 380.31 445.93 311.56 329.03 320.15 445.93 361.05 GHI OFF GOLD 669.64 619.56 733.74 716.19 605.24 648.19 676.84 771.45 680.11 HEALTHFIRST ON/OFF GOLD 526.02 526.02 526.02 HEALTHNOW ON/OFF GOLD 638.98 494.10 668.69 600.59 HIP HMO OFF GOLD 462.24 462.24 525.31 483.26 HIPIC OFF GOLD 743.80 688.17 819.83 819.83 672.27 719.98 751.79 840.32 757.00 IHBC ON/OFF GOLD 538.05 538.05 METRO PLUS ON GOLD 395.76 395.76 MVPHP-HMO ON/OFF GOLD 461.10 418.95 564.43 734.06 404.56 526.90 494.00 514.86 NEW YORK FIDELIS ON GOLD 418.82 413.99 422.34 477.71 415.31 417.94 413.11 440.79 427.50 NORTHSHORE LIJ ON/OFF GOLD 487.34 487.34 487.34 OSCAR ON GOLD 517.55 517.55 517.55 OXFORD HMO OFF GOLD 817.98 817.98 817.98 817.98 UNITED ON GOLD 749.13 749.13 749.13 749.13

Premiums above are for Single Adults [Employee Only]; Employees with Spouse: Multiply by 2.00; Employees with Child(ren): Multiply by 1.70; Employees with Family: Multiply by 2.85;

Insurer ON/OFF Exchange Metal/Tier ALBANY BUFFALO MID HUDSON NEW YORK ROCHESTER SYRACUSE UTICA LONG ISLAND ALL REGIONS COMB. AVG AETNA LIFE ON/OFF SILVER 530.95 597.44 597.44 575.28 AFFINITY ON SILVER 431.10 441.81 451.33 441.41 AMERICAN PROG ON SILVER 490.37 433.80 553.44 454.60 461.39 407.24 466.81 ATLANTIS OFF SILVER 546.12 546.12 CDPHP HMO ON/OFF SILVER 478.22 539.42 533.23 512.32 515.80 EMPIRE HMO ON/OFF SILVER 436.15 514.41 468.43 694.24 431.15 508.88 EXCELLUS ON/OFF SILVER 487.26 473.43 487.26 376.46 457.74 487.26 461.57 FREELANCERS ON/OFF SILVER 299.57 280.43 336.51 394.58 275.68 291.14 283.29 394.58 319.47 GHI OFF SILVER 569.66 527.05 624.18 609.27 514.88 551.42 575.78 656.27 578.56 HEALTHFIRST ON/OFF SILVER 450.00 450.00 450.00 HEALTHNOW ON/OFF SILVER 524.68 406.36 548.68 493.24 HIP HMO OFF SILVER 386.69 386.69 439.47 404.28 HIPIC OFF SILVER 615.72 569.67 678.66 678.66 556.51 596.01 622.34 695.62 626.65 IHBC ON/OFF SILVER 470.81 470.81 METRO PLUS ON SILVER 359.26 359.26 MVPHP-HMO ON/OFF SILVER 383.76 348.68 469.74 610.92 336.69 438.52 411.13 428.49 NEW YORK FIDELIS ON SILVER 342.05 338.11 344.93 390.15 339.18 341.34 337.39 360.00 349.14 NORTHSHORE LIJ ON/OFF SILVER 419.62 419.62 419.62 OSCAR ON SILVER 446.01 446.01 446.01 OXFORD HMO OFF SILVER 691.69 691.69 691.69 691.69 UNITED ON SILVER 635.60 635.60 635.60 635.60 APPROVED MONTHLY PREMIUM RATES - INDIVIDUAL STANDARD PLANS

Insurer ON/OFF Exchange Metal/Tier ALBANY BUFFALO MID HUDSON NEW YORK ROCHESTER SYRACUSE UTICA LONG ISLAND ALL REGIONS COMB. AVG AETNA LIFE ON/OFF BRONZE 456.63 513.35 513.35 494.44 AFFINITY ON BRONZE 369.49 378.58 386.67 378.25 AMERICAN PROG ON BRONZE 395.24 349.65 446.08 366.41 371.88 328.24 376.25 ATLANTIS OFF BRONZE 432.69 432.69 CDPHP HMO ON/OFF BRONZE 401.80 453.62 449.01 431.33 433.94 EMPIRE HMO ON/OFF BRONZE 378.45 446.36 406.46 602.40 374.11 441.56 EXCELLUS ON/OFF BRONZE 377.46 366.75 377.46 291.62 354.59 377.46 357.56 FREELANCERS ON/OFF BRONZE 236.70 221.58 265.89 311.77 217.83 230.04 223.84 311.77 252.43 GHI OFF BRONZE 479.95 444.06 525.89 513.32 433.79 464.59 485.11 552.92 487.45 HEALTHFIRST ON/OFF BRONZE 384.19 384.19 384.19 HEALTHNOW ON/OFF BRONZE 435.48 340.10 454.97 410.18 HIP HMO OFF BRONZE 334.28 334.28 379.90 349.49 HIPIC OFF BRONZE 526.85 487.45 580.70 580.70 476.18 509.97 532.51 595.21 536.20 IHBC ON/OFF BRONZE 395.74 395.74 METRO PLUS ON BRONZE 334.44 334.44 MVPHP-HMO ON/OFF BRONZE 296.62 269.50 363.08 472.21 260.24 338.94 317.79 331.20 NEW YORK FIDELIS ON BRONZE 270.32 267.20 272.59 308.33 268.05 269.75 266.63 284.50 275.92 NORTHSHORE LIJ ON/OFF BRONZE 330.13 330.13 330.13 OSCAR ON BRONZE 361.64 361.64 361.64 OXFORD HMO OFF BRONZE 589.91 589.91 589.91 589.91 UNITED ON BRONZE 548.06 548.06 548.06 548.06

Premiums above are for Single Adults [Employee Only]; Employees with Spouse: Multiply by 2.00; Employees with Child(ren): Multiply by 1.70; Employees with Family: Multiply by 2.85;

Insurer ON/OFF Exchange Metal/Tier ALBANY BUFFALO MID HUDSON NEW YORK ROCHESTER SYRACUSE UTICA LONG ISLAND ALL REGIONS COMB. AVG AETNA LIFE ON/OFF CATASTROPHIC 330.50 370.59 370.59 357.23 AFFINITY ON CATASTROPHIC 287.72 294.67 300.85 294.41 AMERICAN PROG ON CATASTROPHIC 357.93 316.63 403.96 331.82 336.77 297.25 340.73 ATLANTIS OFF CATASTROPHIC 301.05 301.05 CDPHP HMO ON/OFF CATASTROPHIC 376.50 425.02 420.64 404.09 406.56 EMPIRE HMO ON/OFF CATASTROPHIC 187.43 221.05 201.29 298.33 185.27 218.67 EXCELLUS ON/OFF CATASTROPHIC 372.38 361.79 372.38 287.70 349.82 372.38 352.74 FREELANCERS ON/OFF CATASTROPHIC 162.73 152.33 182.79 214.33 149.75 158.15 153.88 214.33 173.54 GHI OFF CATASTROPHIC HEALTHFIRST ON/OFF CATASTROPHIC 324.59 324.59 324.59 HEALTHNOW ON/OFF CATASTROPHIC 394.51 309.93 411.76 372.07 HIP HMO OFF CATASTROPHIC 204.22 204.22 231.99 213.48 HIPIC OFF CATASTROPHIC IHBC ON/OFF CATASTROPHIC 203.66 203.66 METRO PLUS ON CATASTROPHIC 328.38 328.38 MVPHP-HMO ON/OFF CATASTROPHIC 153.45 139.42 187.83 244.28 134.63 175.34 164.40 171.34 NEW YORK FIDELIS ON CATASTROPHIC 166.46 164.54 167.85 189.86 165.06 166.11 164.19 175.19 169.91 NORTHSHORE LIJ ON/OFF CATASTROPHIC 183.53 183.53 183.53 OSCAR ON CATASTROPHIC 226.93 226.93 226.93 OXFORD HMO OFF CATASTROPHIC UNITED ON CATASTROPHIC 334.94 334.94 334.94 334.94 APPROVED(MONTHLY(PREMIUM(RATES(2(SMALL(GROUP(STANDARD(PLANS

Insurer ON/OFF((Exchange Metal/Tier ALBANY BUFFALO MID(HUDSON NEW(YORK ROCHESTER SYRACUSE UTICA LONG(ISLAND ALL(REGIONS(COMB.(AVG AETNA(LIFE OFF PLATINUM 470.41 470.41 ATLANTIS OFF PLATINUM 597.63 597.63 CDPHP(HMO OFF PLATINUM 562.14 633.41 624.99 600.58 605.28 CDPHP(UBI ON/OFF PLATINUM 515.40 582.67 578.03 555.14 557.81 EMPIRE(BCBS OFF PLATINUM EMPIRE(HMO OFF PLATINUM EXCELLUS ON/OFF PLATINUM 585.73 569.08 585.73 452.52 550.24 585.73 554.84 FREELANCERS ON/OFF PLATINUM 432.86 405.21 486.23 570.13 398.34 420.67 409.33 570.13 461.61 GHI OFF PLATINUM HEALTHNOW ON/OFF PLATINUM 651.53 532.71 676.57 620.27 HIP(HMO OFF PLATINUM HIPIC OFF PLATINUM IHA(HMO OFF PLATINUM IHBC ON/OFF PLATINUM 539.34 539.34 MANAGED OFF PLATINUM METROPLUS ON PLATINUM 479.50 479.50 MVP(SERVICES OFF PLATINUM 535.71 593.73 602.68 767.86 448.10 582.03 546.32 690.84 595.91 MVPHP2HMO ON/OFF PLATINUM 539.61 446.29 607.05 773.42 451.35 586.25 550.28 564.89 NORTHSHORE(LIJ ON/OFF PLATINUM 746.14 746.14 746.14 OXFORD(HMO OFF PLATINUM 733.00 733.00 733.00 733.00 OXFORD(OHI ON/OFF PLATINUM 774.73 774.73 774.73 774.73 UNITED OFF PLATINUM 751.88 751.88

Insurer ON/OFF((Exchange Metal/Tier ALBANY BUFFALO MID(HUDSON NEW(YORK ROCHESTER SYRACUSE UTICA LONG(ISLAND ALL(REGIONS(COMB.(AVG AETNA(LIFE OFF GOLD 487.38 534.51 528.85 593.90 415.73 469.46 487.38 593.90 513.89 ATLANTIS OFF GOLD 517.68 517.68 CDPHP(HMO OFF GOLD 506.75 570.78 562.87 540.91 545.33 CDPHP(UBI ON/OFF GOLD 452.37 511.39 507.32 487.24 489.58 EMPIRE(BCBS OFF GOLD EMPIRE(HMO OFF GOLD 516.19 604.61 565.27 768.30 510.73 593.02 EXCELLUS ON/OFF GOLD 506.58 492.18 506.58 391.39 475.88 506.58 479.86 FREELANCERS ON/OFF GOLD 369.00 345.42 414.49 486.02 339.57 358.60 348.93 486.02 393.51 GHI OFF GOLD HEALTHNOW ON/OFF GOLD 535.95 438.63 556.08 510.22 HIP(HMO OFF GOLD 460.08 460.08 560.22 493.46 HIPIC OFF GOLD IHA(HMO OFF GOLD IHBC ON/OFF GOLD 464.09 464.09 MANAGED OFF GOLD 631.37 631.37 631.37 METROPLUS ON GOLD 427.34 427.34 MVP(SERVICES OFF GOLD 447.88 496.39 503.87 641.96 374.63 486.60 456.75 577.58 498.21 MVPHP2HMO ON/OFF GOLD 458.22 378.99 515.49 656.78 383.29 497.85 467.30 479.70 NORTHSHORE(LIJ ON/OFF GOLD 651.57 651.57 651.57 OXFORD(HMO OFF GOLD 632.80 632.80 632.80 632.80 OXFORD(OHI ON/OFF GOLD 656.70 656.70 656.70 656.70 UNITED OFF GOLD 693.74 568.84 742.34 635.93 591.17 589.07 605.37 632.35

Premiums(above(are(for(Single(Adults([Employee(Only]; Employees(with(Spouse:(MulWply(by(2.00; Employees(with(Child(ren):(MulWply(by(1.70; Employees(with(Family:(MulWply(by(2.85;

Insurer ON/OFF((Exchange Metal/Tier ALBANY BUFFALO MID(HUDSON NEW(YORK ROCHESTER SYRACUSE UTICA LONG(ISLAND ALL(REGIONS(COMB.(AVG AETNA(LIFE OFF SILVER 421.23 462.55 457.21 513.77 359.48 405.99 421.23 513.77 444.40 ATLANTIS OFF SILVER 442.81 442.81 CDPHP(HMO OFF SILVER CDPHP(UBI ON/OFF SILVER 384.89 435.12 431.66 414.57 416.56 EMPIRE(BCBS OFF SILVER 431.03 504.86 472.01 641.55 426.46 495.18 EMPIRE(HMO OFF SILVER EXCELLUS ON/OFF SILVER 437.84 425.40 437.84 338.27 411.32 437.84 414.75 FREELANCERS ON/OFF SILVER 316.68 296.44 355.72 417.10 291.42 307.76 299.46 417.10 337.71 GHI OFF SILVER HEALTHNOW ON/OFF SILVER 480.68 373.88 498.92 451.16 HIP(HMO OFF SILVER 392.54 392.54 446.11 410.40 HIPIC OFF SILVER 537.11 537.11 550.52 541.58 IHA(HMO OFF SILVER IHBC ON/OFF SILVER 400.76 400.76 MANAGED OFF SILVER METROPLUS ON SILVER 387.23 387.23 MVP(SERVICES OFF SILVER 363.15 402.48 408.55 520.52 303.76 394.55 370.34 468.32 403.96 MVPHP2HMO ON/OFF SILVER 381.31 315.38 428.99 546.56 318.96 414.28 388.86 399.19 NORTHSHORE(LIJ ON/OFF SILVER 568.05 568.05 568.05 OXFORD(HMO OFF SILVER OXFORD(OHI ON/OFF SILVER 555.48 555.48 555.48 555.48 UNITED OFF SILVER 596.18 488.84 637.94 546.50 528.52 506.23 509.57 544.82

Insurer ON/OFF((Exchange Metal/Tier ALBANY BUFFALO MID(HUDSON NEW(YORK ROCHESTER SYRACUSE UTICA LONG(ISLAND ALL(REGIONS(COMB.(AVG AETNA(LIFE OFF BRONZE 319.42 350.52 346.60 389.65 272.75 307.79 319.42 389.65 336.98 ATLANTIS OFF BRONZE 350.84 350.84 CDPHP(HMO OFF BRONZE CDPHP(UBI ON/OFF BRONZE 328.78 371.69 368.73 354.13 355.83 EMPIRE(BCBS OFF BRONZE 359.65 421.24 393.84 535.30 365.18 415.04 EMPIRE(HMO OFF BRONZE EXCELLUS ON/OFF BRONZE 341.38 331.68 341.38 263.74 320.71 341.38 323.38 FREELANCERS ON/OFF BRONZE 257.94 241.46 289.75 339.75 237.37 250.68 243.92 339.75 275.08 GHI OFF BRONZE 470.91 435.70 516.00 503.66 425.62 455.84 475.98 542.51 478.28 HEALTHNOW ON/OFF BRONZE 380.51 319.73 394.37 364.87 HIP(HMO OFF BRONZE 342.74 342.74 389.51 358.33 HIPIC OFF BRONZE IHA(HMO OFF BRONZE IHBC ON/OFF BRONZE 329.21 329.21 MANAGED OFF BRONZE METROPLUS ON BRONZE 359.97 359.97 MVP(SERVICES OFF BRONZE 303.72 336.60 341.67 435.32 254.04 329.97 309.72 391.66 337.84 MVPHP2HMO ON/OFF BRONZE 294.63 243.69 331.46 422.31 246.44 320.10 300.47 308.44 NORTHSHORE(LIJ ON/OFF BRONZE 466.81 466.81 466.81 OXFORD(HMO OFF BRONZE OXFORD(OHI ON/OFF BRONZE 473.91 473.91 473.91 473.91 UNITED OFF BRONZE

Premiums(above(are(for(Single(Adults([Employee(Only]; Employees(with(Spouse:(MulWply(by(2.00; Employees(with(Child(ren):(MulWply(by(1.70; Employees(with(Family:(MulWply(by(2.85;