Tennessee EPO. How to Determine Your Medical Plan Premium (Rate) Medical Plan Rating Rules. Medical Rating Area Table

Transcription

1 Tennessee EPO Cigna Medical and Pediatric Dental Plan Rate Sheet Medical and Pediatric Dental rates applicable for insurance policies with effective dates between January 1, 2017 and December 31, How to Determine Your Medical Plan Premium (Rate) 1. In the Medical Rating Area Table, find the county you reside in and the corresponding rating area. 2. Find the page that identifies your rating area in the top right corner. 3. In the first column of that page, find the age of the policyholder. 4. Find the column which identifies the plan you are interested in. That number is the monthly premium for non- tobacco users. 5. If there is more than one family member, locate the premium for their age(s), and then add all the premiums together. 6. If there are more than three children under the age of 21, see Medical Plan Rating Rules. 7. If there are adults age 18 and older that use tobacco, see Medical Plan Rating Rules to calculate the tobacco use rate adjustment. Medical Plan Rating Rules 1. Medical rates apply to a maximum of 3 children under the age of Tobacco Use Rate Adjustment (Applicable for customers age 18 and older.) For all plans, applicants who currently use or have used tobacco, except those used for religious or ceremonial purposes, an average of four times per week within the past 6 months will be assigned a 25% rate increase. * Note that other rating rules (e.g. maximum dependent age, allowable relationships) vary by state. See State Eligibility Requirements located on the left rail of the Tennessee page on Cigna.com. Medical Rating Area Table County Name Rating Area Carter Rating Area # 1 Cheatham Rating Area # 4 Davidson Rating Area # 4 Fayette Rating Area # 6 Greene Rating Area # 1

2 Hancock Rating Area # 1 Hawkins Rating Area # 1 Haywood Rating Area # 6 Johnson Rating Area # 1 Lauderdale Rating Area # 6 Montgomery Rating Area # 4 Robertson Rating Area # 4 Rutherford Rating Area # 4 Shelby Rating Area # 6 Sumner Rating Area # 4 Sullivan Rating Area # 1 Tipton Rating Area # 6 Trousdale Rating Area # 4 Unicoi Rating Area # 1 Washington Rating Area # 1 Williamson Rating Area # 4 Wilson Rating Area # 4 How to Determine Your Dental Plan Premium (Rate) 1. Medical plan rate does not include the Pediatric Dental premium. 2. In the Pediatric Dental Rate Area Table, find the area you reside and the corresponding monthly rate. That number is the monthly premium for one child or young adult. 3. Add rates below for each child and young adult up to age 19 for plans not sold on the Health Insurance Marketplace or up to age 21 for plans sold on the Health Insurance Marketplace. Pediatric Dental Plan Rating Rules 1. Pediatric Dental rates apply to a maximum of 3 children under the age of 19 (for plans not sold on the Health Insurance Marketplace) or under the age of 21 (for plans sold on the Health Insurance Marketplace). 2. Only children and young adults up to age 18 (for plans not sold on the Health Insurance Marketplace) or up to age 20 (for plans sold on the Health Insurance Marketplace) as of the policy effective date will receive and pay a premium for Pediatric Dental Essential Health Benefits. 3. Max Rating Rule for Pediatric Dental: The 3 child maximum rating rule will apply to the Pediatric Dental plans. The 3 oldest children under the age of 19 (for plans not sold on the Health Insurance Marketplace) or under the age of 21 (for plans sold on the Health Insurance Marketplace) eligible for pediatric dental benefits will receive a dental rate.

3 Additional plans are available statewide and can be purchased on the Health Insurance Marketplace. Pediatric Dental Rating Area Table Rating Area Monthly Rate Area 1 $20 Area 4 $26 Area 6 $20

4 Individual and Family Plans Tennessee:Rating Area 1 Cigna Health and Life Insurance Company Rating Area 1 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! 99248TN TN TN TN TN TN TN TN Cigna Cigna Cigna US-TN Cigna Cigna Cigna Cigna US-TN Cigna Connect HSA Connect 6400 Connect 6650 Connect 2500 Connect 3000 Connect 4000 Connect 3500 Connect $153 $153 $147 $184 $200 $193 $227 $ $241 $240 $231 $289 $315 $303 $357 $ $241 $240 $231 $289 $315 $303 $357 $ $241 $240 $231 $289 $315 $303 $357 $ $241 $240 $231 $289 $315 $303 $357 $ $242 $241 $232 $290 $317 $304 $359 $ $247 $246 $237 $296 $323 $311 $366 $ $252 $252 $242 $303 $330 $318 $374 $ $262 $261 $251 $314 $343 $330 $388 $ $270 $269 $259 $324 $353 $339 $400 $ $273 $273 $262 $328 $358 $344 $405 $ $279 $279 $268 $335 $365 $351 $414 $ $285 $284 $274 $342 $373 $359 $423 $ $289 $288 $277 $346 $378 $363 $428 $ $292 $292 $281 $351 $383 $368 $434 $ $294 $294 $283 $353 $385 $371 $436 $ $296 $296 $284 $356 $388 $373 $439 $ $298 $298 $286 $358 $390 $375 $442 $ $300 $299 $288 $360 $393 $378 $445 $ $304 $303 $292 $365 $398 $383 $451 $ $308 $307 $296 $370 $403 $388 $456 $ $314 $313 $301 $377 $411 $395 $465 $ $319 $318 $306 $383 $418 $402 $473 $ $327 $326 $314 $392 $428 $412 $485 $ $337 $336 $323 $404 $441 $424 $499 $ $348 $347 $334 $418 $455 $438 $516 $ $361 $361 $347 $434 $473 $455 $536 $ $377 $376 $361 $452 $493 $474 $558 $ $394 $393 $378 $473 $516 $496 $584 $ $411 $410 $395 $493 $538 $517 $609 $ $430 $429 $413 $517 $563 $542 $638 $ $449 $448 $431 $539 $588 $566 $666 $ $470 $469 $451 $565 $616 $592 $697 $ $491 $490 $472 $590 $643 $619 $729 $ $514 $513 $494 $617 $673 $647 $763 $ $537 $536 $516 $645 $703 $676 $797 $ $562 $561 $540 $675 $736 $708 $833 $ $587 $586 $564 $705 $768 $739 $870 $ $614 $612 $589 $737 $803 $773 $910 $1, $627 $626 $602 $753 $821 $789 $930 $1, $654 $652 $628 $785 $856 $823 $969 $1, $677 $675 $650 $813 $886 $852 $1,004 $1, $692 $691 $664 $831 $906 $871 $1,026 $1, $711 $710 $683 $854 $931 $895 $1,054 $1, $723 $721 $694 $868 $946 $910 $1,072 $1, $723 $721 $694 $868 $946 $910 $1,072 $1,177 AGE / Cigna Page 1 of 4

5 Individual and Family Plans Tennessee:Rating Area 4 Cigna Health and Life Insurance Company Rating Area 4 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! 99248TN TN TN TN TN TN TN TN Cigna Cigna Cigna US-TN Cigna Cigna Cigna Cigna US-TN Cigna Connect HSA Connect 6400 Connect 6650 Connect 2500 Connect 3000 Connect 4000 Connect 3500 Connect $165 $165 $159 $199 $217 $208 $245 $ $261 $260 $250 $313 $341 $328 $386 $ $261 $260 $250 $313 $341 $328 $386 $ $261 $260 $250 $313 $341 $328 $386 $ $261 $260 $250 $313 $341 $328 $386 $ $262 $261 $251 $314 $342 $329 $388 $ $267 $266 $256 $320 $349 $336 $396 $ $273 $272 $262 $328 $357 $344 $405 $ $283 $283 $272 $340 $371 $357 $420 $ $292 $291 $280 $350 $382 $367 $432 $ $296 $295 $284 $355 $387 $372 $438 $ $302 $301 $290 $363 $395 $380 $448 $ $308 $308 $296 $370 $403 $388 $457 $ $312 $311 $300 $375 $409 $393 $463 $ $316 $316 $304 $380 $414 $398 $469 $ $318 $318 $306 $382 $417 $401 $472 $ $320 $320 $308 $385 $419 $403 $475 $ $323 $322 $310 $387 $422 $406 $478 $ $325 $324 $312 $390 $425 $409 $481 $ $329 $328 $316 $395 $430 $414 $487 $ $333 $332 $320 $400 $436 $419 $494 $ $339 $338 $326 $407 $444 $427 $503 $ $345 $344 $331 $414 $452 $435 $512 $ $354 $353 $339 $424 $463 $445 $524 $ $364 $363 $349 $437 $476 $458 $540 $ $376 $375 $361 $452 $492 $474 $558 $ $391 $390 $375 $469 $512 $492 $579 $ $407 $406 $391 $489 $533 $513 $604 $ $426 $425 $409 $511 $558 $536 $632 $ $445 $443 $427 $534 $582 $560 $659 $ $465 $464 $447 $559 $609 $586 $690 $ $486 $485 $466 $583 $636 $612 $720 $ $509 $507 $488 $611 $666 $640 $754 $ $532 $530 $510 $638 $696 $669 $788 $ $556 $555 $534 $668 $728 $700 $825 $ $581 $580 $558 $698 $760 $731 $861 $ $608 $606 $584 $730 $796 $765 $901 $ $635 $633 $610 $762 $831 $799 $941 $1, $664 $662 $637 $797 $869 $836 $984 $1, $678 $677 $651 $814 $888 $854 $1,005 $1, $707 $706 $679 $849 $926 $890 $1,048 $1, $732 $730 $703 $879 $958 $922 $1,085 $1, $749 $747 $719 $899 $980 $942 $1,110 $1, $769 $767 $738 $923 $1,007 $968 $1,140 $1, $782 $780 $750 $938 $1,023 $984 $1,159 $1, $782 $780 $750 $938 $1,023 $984 $1,159 $1,273 AGE / Cigna Page 2 of 4

6 Individual and Family Plans Tennessee:Rating Area 6 Cigna Health and Life Insurance Company Rating Area 6 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! 99248TN TN TN TN TN TN TN TN Cigna Cigna Cigna Cigna US-TN Cigna Cigna Cigna US-TN Cigna LocalPlus Connect HSA Connect 6400 Connect 6650 Connect 2500 Connect 4000 Connect 3500 Connect $155 $165 $164 $158 $198 $207 $243 $ $244 $259 $259 $249 $311 $326 $382 $ $244 $259 $259 $249 $311 $326 $382 $ $244 $259 $259 $249 $311 $326 $382 $ $244 $259 $259 $249 $311 $326 $382 $ $245 $260 $260 $250 $312 $327 $384 $ $250 $266 $265 $255 $319 $334 $392 $ $255 $272 $271 $261 $326 $341 $401 $ $265 $282 $281 $271 $338 $354 $416 $ $273 $290 $290 $279 $348 $365 $428 $ $277 $294 $294 $283 $353 $370 $434 $ $282 $301 $300 $289 $361 $378 $443 $ $288 $307 $306 $295 $368 $385 $452 $ $292 $311 $310 $298 $373 $390 $458 $ $296 $315 $314 $302 $378 $396 $464 $ $298 $317 $316 $304 $380 $398 $467 $ $300 $319 $318 $306 $383 $401 $470 $ $302 $321 $321 $308 $385 $403 $474 $ $304 $323 $323 $310 $388 $406 $477 $ $308 $327 $327 $314 $393 $411 $483 $ $311 $332 $331 $318 $398 $416 $489 $ $317 $338 $337 $324 $405 $424 $498 $ $323 $344 $343 $330 $412 $432 $507 $ $331 $352 $351 $338 $422 $442 $519 $ $340 $362 $362 $348 $435 $455 $534 $ $352 $375 $374 $360 $449 $470 $552 $ $366 $389 $388 $373 $467 $489 $574 $ $381 $406 $405 $389 $486 $509 $598 $ $398 $424 $423 $407 $509 $533 $625 $ $416 $443 $442 $425 $531 $556 $653 $ $435 $463 $462 $445 $556 $582 $683 $ $454 $484 $483 $464 $580 $608 $713 $ $476 $506 $505 $486 $607 $636 $747 $ $497 $529 $528 $508 $635 $665 $780 $ $520 $554 $553 $532 $664 $696 $817 $ $543 $579 $577 $555 $694 $727 $853 $ $569 $605 $604 $581 $726 $760 $892 $ $594 $632 $631 $607 $758 $794 $932 $1, $621 $661 $660 $634 $793 $830 $975 $1, $634 $675 $674 $648 $810 $848 $996 $1, $661 $704 $703 $676 $844 $884 $1,038 $1, $685 $729 $728 $700 $874 $915 $1,075 $1, $700 $745 $744 $715 $894 $936 $1,099 $1, $719 $766 $764 $735 $918 $962 $1,129 $1, $731 $778 $777 $747 $933 $977 $1,147 $1, $731 $778 $777 $747 $933 $977 $1,147 $1,265 AGE / Cigna Page 3 of 4

7 Individual and Family Plans Cigna Health and Life Insurance Company Tennessee All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc. and Cigna HealthCare of Texas, Inc. In Arizona, HMO plans are offered by Cigna HealthCare of Arizona, Inc. In Texas, HMO plans are offered by Cigna HealthCare of Texas, Inc. All other individual medical plans are insured by CHLIC. Cigna marks are owned by Cigna Intellectual Property, Inc. Page 4 of 4