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

Transcription

1 SERFF Tracking Number: AETN State: Connecticut Filing Company: State Tracking Number: Company Tracking Number: CT TOI: H16I Individual Health - Major Medical Sub-TOI: H16I.005C Individual - Other Product Name: Individual Medical Project Name/Number: / Filing at a Glance Company: Product Name: Individual Medical SERFF Tr Num: AETN State: Connecticut TOI: H16I Individual Health - Major Medical SERFF Status: Submitted to State State Tr Num: Sub-TOI: H16I.005C Individual - Other Co Tr Num: CT State Status: Filing Type: Rate Reviewer(s): Authors: Bruce Campbell, Beatriz Disposition Date: Girasulo, Rick Rizzo, Josephine Williams Date Submitted: 05/06/2011 Disposition Status: Implementation Date Requested: 09/01/2011 Implementation Date: General Information Project Name: Status of Filing in Domicile: Not Filed Project Number: Date Approved in Domicile: Requested Filing Mode: Review & Approval Domicile Status Comments: Explanation for Combination/Other: Market Type: Individual Submission Type: New Submission Individual Market Type: Individual Overall Rate Impact: -10% Filing Status Changed: 05/06/2011 State Status Changed: Deemer Date: Created By: Josephine Williams Submitted By: Josephine Williams Corresponding Filing Tracking Number: PPACA: Not PPACA-Related PPACA Notes: null Filing Description: Rate filing for Individual Medical Expense Policies issued to residents of the State of Connecticut effective September 1, Company and Contact Filing Contact Information Josephine Williams, Williamsj4@aetna.com 151 Farmington Ave [Phone] Hartford, CT PDF Pipeline for SERFF Tracking Number AETN Generated 05/09/ :11 AM

2 SERFF Tracking Number: AETN State: Connecticut Filing Company: State Tracking Number: Company Tracking Number: CT TOI: H16I Individual Health - Major Medical Sub-TOI: H16I.005C Individual - Other Product Name: Individual Medical Project Name/Number: / Filing Company Information CoCode: State of Domicile: Connecticut 151 Farmington Avenue Group Code: 1 Company Type: Hartford, CT Group Name: State ID Number: (860) ext. [Phone] FEIN Number: Filing Fees Fee Required? Retaliatory? Fee Explanation: Per Company: No No Yes COMPANY AMOUNT DATE PROCESSED TRANSACTION # $ /06/2011 PDF Pipeline for SERFF Tracking Number AETN Generated 05/09/ :11 AM

3 SERFF Tracking Number: AETN State: Connecticut Filing Company: State Tracking Number: Company Tracking Number: CT TOI: H16I Individual Health - Major Medical Sub-TOI: H16I.005C Individual - Other Product Name: Individual Medical Project Name/Number: / Rate Information Rate data applies to filing. Filing Method: Review and Approve Rate Change Type: Decrease Overall Percentage of Last Rate Revision: 8.000% Effective Date of Last Rate Revision: 07/01/2010 Filing Method of Last Filing: Review and Approve Company Rate Information Company Name: Company Overall % Overall % Rate Written # of Policy Written Maximum % Minimum % Rate Indicated Impact: Premium Holders Premium for Change Change Change: Change: Change for Affected for this Program: (where (where this this Program: required): required): Program: Aetna Life Insurance Company Decrease % % $-3,944,039 9,745 $39,440, % % Product Type: HMO PPO EPO POS HSA HDHP FFS Other Covered Lives: 15,002 Policy Holders: 9,745 PDF Pipeline for SERFF Tracking Number AETN Generated 05/09/ :11 AM

4 SERFF Tracking Number: AETN State: Connecticut Filing Company: State Tracking Number: Company Tracking Number: CT TOI: H16I Individual Health - Major Medical Sub-TOI: H16I.005C Individual - Other Product Name: Individual Medical Project Name/Number: / Rate Review Details COMPANY: Company Name: HHS Issuer Id: Product Names: PPO and MCOA Trend Factors: 8.5% FORMS: New Policy Forms: Affected Forms: Other Affected Forms: GR-11741, GR HCRg 01, GR HCRng 01, GR REQUESTED RATE CHANGE INFORMATION: Change Period: Other Member Months: 182,439 Benefit Change: None Percent Change Requested: Min: Max: -5.0 Avg: PRIOR RATE: Total Earned Premium: 39,440, Total Incurred Claims: 22,170, Annual $: Min: Max: 18, Avg: 2, REQUESTED RATE: Projected Earned Premium: 35,496, Projected Incurred Claims: 23,944, Annual $: Min: Max: 14, Avg: 2, PDF Pipeline for SERFF Tracking Number AETN Generated 05/09/ :11 AM

5 SERFF Tracking Number: AETN State: Connecticut Filing Company: State Tracking Number: Company Tracking Number: CT TOI: H16I Individual Health - Major Medical Sub-TOI: H16I.005C Individual - Other Product Name: Individual Medical Project Name/Number: / Supporting Document Schedules Satisfied - Item: Actuarial Memorandum Comments: Attachments: CT Actuarial Memorandum_med 09_2011.pdf Exhibit D - Actuarial Certification.pdf Item Status: Status Date: Item Status: Status Date: Satisfied - Item: Proposed Rates - Existing Business (Exhibits H to L) Comments: Attachments: Exhibit H - for Original Coverage Eff Prior to (Block A).pdf Exhibit I - for Original Coverage Eff 06_01_2008 to 12_31_2009 (Block B).pdf Exhibit J - for Original Coverage Eff 01_01_2010 to 06_30_2010 (Block C).pdf Exhibit K - for Original Coverage Eff 07_01_2010 to 12_31_2010 (Block D).pdf Exhibit L - for Original Coverage Eff 01_01_2011 to 08_31_2011 (Block E).pdf Item Status: Status Date: Satisfied - Item: Proposed Rates - New Business (Exhibit M) Comments: Attachment: Exhibit M - for Original Coverage Eff 09_01_2011 and Later (Block F).pdf Satisfied - Item: Comments: Historical Experience, Trend, and Claim Triangle (Exhibit A to C) Item Status: Status Date: PDF Pipeline for SERFF Tracking Number AETN Generated 05/09/ :11 AM

6 SERFF Tracking Number: AETN State: Connecticut Filing Company: State Tracking Number: Company Tracking Number: CT TOI: H16I Individual Health - Major Medical Sub-TOI: H16I.005C Individual - Other Product Name: Individual Medical Project Name/Number: / Attachments: Exhibit A - Historical Experience.pdf Exhibit B - Trend by Service Category.pdf Exhibit C - Claim Lag Triangle.pdf Satisfied - Item: Age Gender, Rating Area, Summary of Benefits (Exhibits E to G) Comments: Attachments: Exhibit E - Age Gender Factors.pdf Exhibit F - Rating Area Factors.pdf Exhibit G - Summary of Benefits.pdf Item Status: Status Date: Satisfied - Item: Cover Letter Comments: Attachment: CT Rate Filing_Cover Letter_ pdf Item Status: Status Date: Satisfied - Item: Annual Statement Comments: Attachment: CT Annual Statement_CY 2010.pdf Item Status: Status Date: PDF Pipeline for SERFF Tracking Number AETN Generated 05/09/ :11 AM

7 AETNA LIFE INSURANCE COMPANY Actuarial Memorandum Policy Form(s): GR HCRng 01, GR SOC (12/08), and GR Scope and Purpose of Rate Filing The purpose of this filing is to (1) request approval of a premium rate revision for the existing Comprehensive Medical Expense and Limited Medical Expense benefit plans, and (2) to request approval of the proposed premium rates for new Comprehensive Medical Expense and Limited Medical Expense benefit plans offered to residents of the State of Connecticut. Existing Plans Subject to Premium Rate Revision Block A PPO $500 (version 02/01/2005) PPO $1,500 (version 02/01/2005) PPO $2,500 (version 02/01/2005) PPO $3,500 (version 07/01/2010 released as a benefit buy-down option) PPO $5,000 (version 02/01/2005) HDHP $2,750 (version 02/01/2005) HDHP $5,000 (version 02/01/2005) Preventative and Hospital Care $1,250 (version 12/01/2006) Preventative and Hospital Care $3,000 (version 12/01/2006) Block B MCOA First Dollar 30 (version 06/01/2008) MCOA First Dollar 40 (version 06/01/2008) MCOA $1,500 (version 06/01/2008) MCOA $2,500 (version 06/01/2008) MCOA $5,000 (version 06/01/2008) MCOA Value $2,500 (version 06/01/2008) MCOA HDHP $3,000 (version 06/01/2008) MCOA HDHP $5,000 (version 06/01/2008) MCOA Preventative and Hospital Care $1,250 (version 06/01/2008) MCOA Preventative and Hospital Care $3,000 (version 06/01/2008) MCOA $7,500 with Unlimited Primary Care Visits (version 07/01/2009) MCOA $750 with Medical 50K CYM (version 07/01/2009) MCOA $1,500 with Medical 50K CYM (version 07/01/2009) MCOA $2,500 with Medical 50K CYM (version 07/01/2009)

8 Block C MCOA $1,500 (version 01/01/2010) MCOA $2,500 (version 01/01/2010) MCOA $3,500 (version 01/01/2010) MCOA $5,000 (version 01/01/2010) MCOA Value $2,500 (version 01/01/2010) MCOA Value $5,000 (version 01/01/2010) MCOA HDHP $3,000 (version 01/01/2010) MCOA HDHP $5,000 (version 01/01/2010) MCOA Preventative and Hospital Care $3,000 (version 01/01/2010) MCOA $7,500 with Unlimited Primary Care Visits (version 01/01/2010) MCOA $750 with Medical 50K CYM (version 01/01/2010) MCOA $1,500 with Medical 50K CYM (version 01/01/2010) MCOA $2,500 with Medical 50K CYM (version 01/01/2010) Block D MCOA $1,500 (version 07/01/2010) MCOA $2,500 (version 07/01/2010) MCOA $3,500 (version 07/01/2010) MCOA $5,000 (version 07/01/2010) MCOA Value $2,500 (version 07/01/2010) MCOA Value $5,000 (version 07/01/2010) MCOA HDHP $3,000 (version 07/01/2010) MCOA HDHP $5,000 (version 07/01/2010) MCOA Preventative and Hospital Care $3,000 (version 07/01/2010) MCOA $7,500 with Unlimited Primary Care Visits (version 07/01/2010) Block E MCOA $1,500 (version 10/01/2010) MCOA $2,500 (version 10/01/2010) MCOA $3,500 (version 10/01/2010) MCOA $5,000 (version 10/01/2010) MCOA Value $2,500 (version 10/01/2010) MCOA Value $5,000 (version 10/01/2010) MCOA HDHP $3,000 (version 10/01/2010) MCOA HDHP $5,000 (version 10/01/2010) MCOA Preventative and Hospital Care $3,000 (version 10/01/2010) MCOA $7,500 with Unlimited Primary Care Visits (version 10/01/2010) The rates for existing benefit plans are included in this filing and will become effective for existing business September 1, All rate changes will be implemented on September 1, Note due to system implementation issues, the rates filed and approved associated with the HCR regulations (see SERFF Tracking Number AETN , approved on September 23, 2010) were implemented on a January 1, 2011 effective date. However, all benefits were updated with an effective date of October 1, The benefit plans and monthly premium rates associated with this postponement are referenced as Block E. 2

9 Block Definitions Please note the following block definitions as they will apply to the items discussed in this filing. Block A Defined by benefit plans released prior to June 1, 2008 where monthly premium rates were developed using 5-year age bands and a tabular contract tier logic. Block B Defined by benefit plans released June 1, 2008 through December 31, 2009 where monthly premium rates were developed using single-year age bands and a dynamic member-level rating methodology. In addition, these contracts were not subject to the subsequently filed quarterly rating methodology. Block C Defined by plans released January 1, 2010 through June 30, 2010 where monthly premium rates were developed using single-year age bands and a dynamic member-level rating methodology. Contracts issued during this period were subject to our quarterly rating methodology. Block D Defined by plans originally issued July 1, 2010 through December 31, 2010, where monthly premium rates were developed using single-year age bands and a dynamic member-level rating methodology. Regarding contracts issued October 1, 2010 through December 31, 2010, these contracts were sold in compliance with the benefit parameters set forth through Federal Healthcare Reform (HCR). Block E Defined by plans and rates originally filed for release effective October 1, 2010 in compliance with the benefit parameters set forth through HCR, but postponed for implementation due to system delays. Monthly premium rates were developed using single-year age bands and a dynamic member-level rating methodology. These plans and rates were subsequently implemented for new business effective January 1, 2011 through August 31, 2011, and were/are available to new business and renewal business during that period. Block F Defined by the new benefit plans proposed in this filing, where monthly premium rates are developed using single-year age bands and a dynamic member-level rating methodology. The benefits are in compliance with HCR. The development of the proposed base monthly premium rates for these benefit plans is discussed later in this filing. The proposed monthly premium rates for these plans are applicable to new business contracts with original effective dates of September 1, 2011 and later, and as well are applicable to any existing members choosing to migrate to these new plan designs. Applicability This rate filing is intended for new and existing business. There are no pending form filings at this time. Historical Experience The inception of this block of business was February 1, Exhibit A presents experience for this block of business since inception through December 31, 2010, paid through December 31, Historic Rate Changes Exhibit B details historic rate changes since inception. 3

10 Proposed Percentage Rate Change and Premium Rate Development We are proposing an overall average premium rate reduction of approximately 10% for all existing plans. Our assumption of medical claim trend in Connecticut has been held consistent with our previously filed assumption of approximately 8.5%. Given consideration to our Connecticut-specific experience, market conditions, and the developing effects and regulations associated with Federal Healthcare Reform, we are proposing a base premium rate decrease which varies by plan ranging from a 19.5% decrease to a 5% decrease, and results in the aggregate rate decrease of approximately 10.0%, as noted above. As discussed in the Quarterly Rating section below, we will be suspending our quarterly rating methodology and resetting our quarterly factors to As we complete this change, we expect that members renewing in quarters which historically had a non quarterly factor will realize a greater rate reduction. The additional rate reduction is expected to be approximately 1.2%. The following table presents the current base premium rates for all existing plans as previously filed in SERFF Filing Number AETN and AETN , approved on April 13, 2010 and September 23, 2010, respectively. These base premium rates are stated as of the July 1, 2010 effective rate level. Base Premium Rate - Currently Filed Benefit Plan Block A Block B Block C Block D Block E 500 Plan $ N/A N/A N/A N/A 1500 Plan $ $ $ $ $ Plan $ $ $ $ $ Plan $ N/A N/A $ $ Plan $ $ $ $ $ Plan N/A $96.83 $ $ $ HDHP 2750 Plan $ N/A N/A N/A N/A HDHP 3000 Plan N/A $ $ $ $ HDHP 5000 Plan $ $ $ $ $ Value 2500 Plan N/A $ $ $ $ Value 5000 Plan N/A N/A N/A $ $ PHC 1250 Plan $ $ $ N/A N/A PHC 3000 Plan $ $95.73 $ $ $ FD 30 Plan N/A $ $ N/A N/A FD 40 Plan N/A $ $ N/A N/A 750 CYM Plan N/A $ $ N/A N/A 1500 CYM Plan N/A $ $ N/A N/A 2500 CYM Plan N/A $ $ N/A N/A 4

11 The following table presents the proposed premium rate decrease by plan and the associated multiplicative rate change factor, as well as the aggregate rate decrease based on our membership distribution as of December 31, Benefit Plan Proposed Base Premium Rate Change Rate Change Factor 500 Plan (All Blocks) -19.5% Plan (All Blocks) -19.5% Plan (All Blocks) -19.5% Plan (All Blocks) -5.0% Plan (All Blocks) -5.0% Plan (All Blocks) -5.0% HDHP 2750 Plan (All Blocks) -5.0% HDHP 3000 (All Blocks) -5.0% HDHP 5000 (All Blocks) -5.0% Value 2500 (All Blocks) -10.0% Value 5000 (All Blocks) -5.0% PHC 1250 (All Blocks) -5.0% PHC 3000 (All Blocks) -5.0% FD 30 Plan (All Blocks) -10.0% FD 40 Plan (All Blocks) -10.0% CYM Plan (All Blocks) -5.0% ,500 CYM Plan (All Blocks) -5.0% ,500 CYM Plan (All Blocks) -5.0% Aggregate Rate Change -10.0% N/A The proposed base premium rate for each plan design is the product of the following: 1) the currently filed base premium rate, from above; and 2) the rate change factor, from above. The result is rounded to the nearest cent. The following table presents the resulting proposed base premium rate by plan by defined block of business. Base Premium Rate - Proposed Benefit Plan Block A Block B Block C Block D Block E 500 Plan $ N/A N/A N/A N/A 1500 Plan $ $ $ $ $ Plan $ $ $ $ $ Plan $ N/A N/A $ $ Plan $ $ $ $ $ Plan N/A $91.99 $96.29 $96.28 $97.06 HDHP 2750 Plan $ N/A N/A N/A N/A HDHP 3000 Plan N/A $ $ $ $ HDHP 5000 Plan $ $ $ $ $ Value 2500 Plan N/A $ $ $ $ Value 5000 Plan N/A N/A N/A $ $ PHC 1250 Plan $ $ $ N/A N/A PHC 3000 Plan $ $90.94 $95.19 $95.18 $96.81 FD 30 Plan N/A $ $ N/A N/A FD 40 Plan N/A $ $ N/A N/A 750 CYM Plan N/A $ $ N/A N/A 1500 CYM Plan N/A $ $ N/A N/A 2500 CYM Plan N/A $ $ N/A N/A Monthly premium rates by plan for our standard risk classification are developed by calculating the product of the following: 1) the proposed base premium rate, as shown above; 2) the applicable Age/Gender Factors, as provided in Exhibit E; and 3) the applicable Rating Area Factor, as shown in 5

12 Exhibit F. This result is rounded to the nearest dollar. The proposed monthly premium rates are shown in Exhibit H through Exhibit L. Quarterly Rating Beginning with policies effective September 1, 2011, we will be temporarily suspending our previously filed and approved quarterly rating methodology. Hence, the base premium rates for all plans referenced in this filing will be subject to a quarterly trend factor of 1.000, as detailed in the following table: Factor Applied to September 1, 2011 Effective Date Base Rate 09/01/ /30/ /01/ /31/ /01/2012 later Upon reinstatement of our quarterly rating methodology, we will notify the Department via a rate filing submission which will include the applicable factors by quarterly cohort. Proposed Plans This filing also proposes ten new benefit plans which are listed below: MCOA $1,500 (version 09/01/2011, Block F) MCOA $2,500 (version 09/01/2011, Block F) MCOA $5,000 (version 09/01/2011, Block F) MCOA $7,500 with Unlimited Primary Care Visits (version 09/01/2011, Block F) MCOA Value $3,000 (version 09/01/2011, Block F) MCOA Value $5,000 (version 09/01/2011, Block F) MCOA Value $10,000 (version 09/01/2011, Block F) MCOA HDHP $3,500 (version 09/01/2011, Block F) MCOA HDHP $5,500 (version 09/01/2011, Block F) MCOA Preventative and Hospital Care $2,750 (version 09/01/2011, Block F) A summary of benefits for each plan design is provided in Exhibit G, accompanying this filing. Upon approval from the State of Connecticut, these plans and premium rates will become effective and available for new and existing business September 1, 2011 and later. 6

13 Premium Rate Development The base premium rates for each of the new plan designs were developed by applying a benefit relativity factor to the base premium rates for an existing plan design. The benefit relativity factors reflect the actuarial value of the different benefit plans. The table below shows the relativity factor for each of the benefit plan designs, as well as the plan to which the factor was applied. New Benefit Plan (Block F) Benefit Relativity Factor Factor Applied to Existing Benefit Plan (Block E) MCOA $1, MCOA $1,500 MCOA $2, MCOA $2,500 MCOA $5, MCOA $5,000 MCOA $7,500 with Unlimited PCP Visits MCOA $7,500 with Unlimited PCP Visits MCOA Value $3, MCOA Value $5,000 MCOA Value $5, MCOA Value $5,000 MCOA Value $10, MCOA Value $5,000 MCOA HDHP $3, MCOA HDHP $3,000 MCOA HDHP $5, MCOA HDHP $5,000 MCOA PHC $2, MCOA PHC $3,000 In addition to the application of the benefit relativity factor, the base premium rates for each of the existing plan designs was adjusted by the proposed base premium rate change as discussed in the section above titled Proposed Percentage Rate Change and Premium Rate Development. The following table provides a restatement of the currently filed base premium rates for each of the applicable existing plan designs, as well as the applicable proposed base premium rate change and the applicable benefit relativity factor as discussed above and as used in the development of the new benefit plan base premium rates. In addition, the following table provides a listing of the resulting new benefit plans and the associated new benefit plan base premium rates. Block E Block F Benefit Plan Currently Filed Base Premium Rate Proposed Base Premium Rate Change Factor Benefit Relativity Factor Resulting Benefit Plan Resulting Base Premium Rate 1500 Plan $ Plan $ Plan $ Plan $ Plan $ Plan $ Plan $ Plan $92.57 HDHP 3000 Plan $ HDHP 3500 Plan $ HDHP 5000 Plan $ HDHP 5500 Plan $ Value 5000 Plan $ Value 3000 Plan $ Value 5000 Plan $ Value 5000 Plan $92.23 Value 5000 Plan $ Value 10,000 Plan $85.32 PHC 3000 Plan $ PHC 2750 Plan $ Monthly premium rates by plan for our standard risk classification are developed by calculating the product of the following: 1) the resulting base premium rate, as shown above; 2) the applicable Age/Gender Factors, as provided in Exhibit E; and 3) the applicable Rating Area Factor, as shown in Exhibit F. This result is rounded to the nearest dollar. The proposed rates for the new benefit plans are shown in Exhibit M. Upon approval from the State of Connecticut, the rates will become effective September 1,

14 Demographic Factors Age/gender slopes vary by plan and original coverage effective date ranges. These age/gender factors remain unchanged from prior filings. Exhibit E shows the age/gender factors. Area Factors Area factors vary by geographical location and remain the same as our previous filing. Please note that rating area definitions remain unchanged from our previous filing. The area factors are included in Exhibit F. Lifetime Loss Ratio The anticipated lifetime loss ratio is 80% for this product. Rates for Couple, Parent/Child(ren), and Family Contracts Rates for Single contracts are based on a table look up using attained age and sex of the individual. For contracts issued prior to June 1, 2008, the calculation of multi-party contracts is based on calculations for the single contract as follows: Couple Contracts: Charged a premium equal to the premium of a Single Male plus the premium of a Single Female of the same age. Male and Child(ren): Charged a premium equal to the premium of a Single Male plus twice the premium of a child Age Female and Child(ren): Charged a premium equal to the premium of a Single Female plus twice the premium of a child Age Family: Charged a premium equal to the premium of a Couple plus twice the premium of a child Age Note, our current dependent age guidelines for contracts issued to residents of the State of Connecticut allow for coverage of dependent children up to age 26. Premium rates for Couple, Parent/Child, and Family contracts issued on June 1, 2008 and later will be determined by the sum of the individual level rates based on attained age and gender of each member enrolled on the contract. As previously communicated, multi-person contracts issued with original effective dates of June 1, 2008 through March 31, 2011, were issued with a limit on the maximum number of covered child dependents for which a respective premium would be assigned with respect to Parent/Child(ren) and Family contracts. For multi-person contracts issued April 1, 2011 and later, this previously communicated limit was removed. The change was primarily driven by changes to dependent age coverage requirements resulting from Federal Healthcare Reform. This modification did not impact contracts issued prior to April 1, Further, this modification has had no impact on the base monthly premium rates contained in this filing. 8

15 Underwriting and Premium Classes Policy forms will be subject to medical underwriting. This filing proposes no changes to the general underwriting guidelines or our currently filed premium classifications discussed in our most recent rate filings. We have developed underwriting guidelines which determine which underwriting classification to place prospective members. These underwriting guidelines are based on the anticipated additional cost that would be attributable to the member s known medical conditions. These additional costs are based upon the judgment of medical personnel of the likelihood and frequency of necessary treatment for the known medical conditions as well as the cost of that treatment. For business issued prior to June 1, 2008, underwriting classifications are referred to as Level A, Level B, and Level C. Level A members will receive coverage at our lowest rates. Underwriting classification loads vary by rate-ups of 25% (Level B) and 50% (Level C) greater than the Level A rates. For business issued June 1, 2008 and later, policies are issued at eleven different underwriting levels. The lowest underwriting level would represent our standard level. The lowest underwriting level is our standard level, which is assigned a 0% rate-up. There are ten additional underwriting levels comprised of rate-up factors ranging from 10% to 100%. Rate-up factors will be assigned in increments of 10% up to a rate-up of 100%. The final rate for the underwritten policy will be determined as the standard rate multiplied by (1 + rate-up-factor). The underwriting classification will be assigned at the time the policy is issued, and will not be changed by Aetna if a member s health deteriorates after purchasing coverage. However, if the member applies to change their benefits, we will consider the member s medical condition at the time of the change request. If their health status at the time of the request warrants a different underwriting classification, then the member can accept the new coverage at the different underwriting classification or remain in their current coverage at their current underwriting classification. Proposed Effective Date We are proposing an effective date of September 1,

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17 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 1 Level A PPO $470 $470 $940 $846 $846 $1,316 1 $282 $282 $564 $658 $658 $ $188 $188 $376 $564 $564 $ $197 $282 $479 $573 $658 $ $225 $325 $550 $601 $701 $ $258 $355 $613 $634 $731 $ $303 $379 $682 $679 $755 $1, $361 $412 $773 $737 $788 $1, $446 $436 $882 $822 $812 $1, $577 $495 $1,072 $953 $871 $1, $750 $587 $1,337 $1,126 $963 $1, $1,053 $744 $1,797 $1,429 $1,120 $2, $1,127 $834 $1,961 $1,503 $1,210 $2,337 PPO $310 $310 $620 $558 $558 $868 1 $186 $186 $372 $434 $434 $ $124 $124 $248 $372 $372 $ $130 $187 $317 $378 $435 $ $151 $219 $370 $399 $467 $ $176 $242 $418 $424 $490 $ $210 $263 $473 $458 $511 $ $252 $289 $541 $500 $537 $ $315 $310 $625 $563 $558 $ $414 $354 $768 $662 $602 $1, $542 $424 $966 $790 $672 $1, $769 $543 $1,312 $1,017 $791 $1, $823 $608 $1,431 $1,071 $856 $1,679 PPO $212 $212 $424 $382 $382 $594 1 $127 $127 $254 $297 $297 $ $85 $85 $170 $255 $255 $ $91 $128 $219 $261 $298 $ $106 $153 $259 $276 $323 $ $125 $172 $297 $295 $342 $ $151 $189 $340 $321 $359 $ $184 $210 $394 $354 $380 $ $233 $228 $461 $403 $398 $ $307 $263 $570 $477 $433 $ $407 $318 $725 $577 $488 $ $580 $409 $989 $750 $579 $1, $621 $458 $1,079 $791 $628 $1,249 PPO $198 $198 $396 $356 $356 $554 1 $119 $119 $238 $277 $277 $ $79 $79 $158 $237 $237 $ $85 $120 $205 $243 $278 $ $99 $143 $242 $257 $301 $ $117 $161 $278 $275 $319 $ $141 $177 $318 $299 $335 $ $173 $196 $369 $331 $354 $ $218 $213 $431 $376 $371 $ $287 $246 $533 $445 $404 $ $380 $298 $678 $538 $456 $ $543 $383 $926 $701 $541 $1, $581 $429 $1,010 $739 $587 $1,168 Page 1 of 36

18 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 1 Level A PPO $169 $169 $338 $305 $305 $474 1 $101 $101 $202 $237 $237 $ $68 $68 $136 $204 $204 $ $73 $104 $177 $209 $240 $ $87 $127 $214 $223 $263 $ $106 $145 $251 $242 $281 $ $130 $162 $292 $266 $298 $ $161 $183 $344 $297 $319 $ $205 $203 $408 $341 $339 $ $275 $235 $510 $411 $371 $ $368 $288 $656 $504 $424 $ $530 $374 $904 $666 $510 $1, $567 $419 $986 $703 $555 $1,122 High Deductible Health Plan $217 $217 $434 $391 $391 $608 1 $130 $130 $260 $304 $304 $ $87 $87 $174 $261 $261 $ $93 $132 $225 $267 $306 $ $108 $157 $265 $282 $331 $ $129 $176 $305 $303 $350 $ $152 $193 $345 $326 $367 $ $189 $216 $405 $363 $390 $ $239 $234 $473 $413 $408 $ $315 $271 $586 $489 $445 $ $417 $327 $744 $591 $501 $ $595 $420 $1,015 $769 $594 $1, $636 $470 $1,106 $810 $644 $1,280 High Deductible Health Plan $168 $168 $336 $302 $302 $470 1 $101 $101 $202 $235 $235 $ $67 $67 $134 $201 $201 $ $72 $104 $176 $206 $238 $ $86 $126 $212 $220 $260 $ $105 $145 $250 $239 $279 $ $127 $161 $288 $261 $295 $ $160 $182 $342 $294 $316 $ $205 $202 $407 $339 $336 $ $274 $235 $509 $408 $369 $ $367 $288 $655 $501 $422 $ $529 $373 $902 $663 $507 $1, $566 $417 $983 $700 $551 $1,117 Preventive and Hospital Care $155 $155 $310 $279 $279 $434 1 $93 $93 $186 $217 $217 $ $62 $62 $124 $186 $186 $ $67 $95 $162 $191 $219 $ $80 $117 $197 $204 $241 $ $98 $134 $232 $222 $258 $ $119 $149 $268 $243 $273 $ $148 $168 $316 $272 $292 $ $188 $186 $374 $312 $310 $ $253 $216 $469 $377 $340 $ $337 $264 $601 $461 $388 $ $486 $344 $830 $610 $468 $ $521 $385 $906 $645 $509 $1,030 Page 2 of 36

19 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 1 Level A Preventive and Hospital Care $129 $129 $258 $233 $233 $362 1 $77 $77 $154 $181 $181 $ $52 $52 $104 $156 $156 $ $56 $79 $135 $160 $183 $ $67 $97 $164 $171 $201 $ $81 $111 $192 $185 $215 $ $99 $124 $223 $203 $228 $ $123 $140 $263 $227 $244 $ $157 $155 $312 $261 $259 $ $210 $180 $390 $314 $284 $ $281 $220 $501 $385 $324 $ $405 $286 $691 $509 $390 $ $433 $320 $753 $537 $424 $857 Page 3 of 36

20 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 1 Level B PPO $588 $588 $1,176 $1,058 $1,058 $1,646 1 $353 $353 $706 $823 $823 $1, $235 $235 $470 $705 $705 $ $246 $353 $599 $716 $823 $1, $281 $406 $687 $751 $876 $1, $323 $444 $767 $793 $914 $1, $379 $474 $853 $849 $944 $1, $451 $515 $966 $921 $985 $1, $558 $545 $1,103 $1,028 $1,015 $1, $721 $619 $1,340 $1,191 $1,089 $1, $938 $734 $1,672 $1,408 $1,204 $2, $1,316 $930 $2,246 $1,786 $1,400 $2, $1,409 $1,043 $2,452 $1,879 $1,513 $2,922 PPO $388 $388 $776 $698 $698 $1,086 1 $233 $233 $466 $543 $543 $ $155 $155 $310 $465 $465 $ $163 $234 $397 $473 $544 $ $189 $274 $463 $499 $584 $ $220 $303 $523 $530 $613 $ $263 $329 $592 $573 $639 $ $315 $361 $676 $625 $671 $ $394 $388 $782 $704 $698 $1, $518 $443 $961 $828 $753 $1, $678 $530 $1,208 $988 $840 $1, $961 $679 $1,640 $1,271 $989 $1, $1,029 $760 $1,789 $1,339 $1,070 $2,099 PPO $265 $265 $530 $477 $477 $742 1 $159 $159 $318 $371 $371 $ $106 $106 $212 $318 $318 $ $114 $160 $274 $326 $372 $ $133 $191 $324 $345 $403 $ $156 $215 $371 $368 $427 $ $189 $236 $425 $401 $448 $ $230 $263 $493 $442 $475 $ $291 $285 $576 $503 $497 $ $384 $329 $713 $596 $541 $ $509 $398 $907 $721 $610 $1, $725 $511 $1,236 $937 $723 $1, $776 $573 $1,349 $988 $785 $1,561 PPO $248 $248 $496 $446 $446 $694 1 $149 $149 $298 $347 $347 $ $99 $99 $198 $297 $297 $ $106 $150 $256 $304 $348 $ $124 $179 $303 $322 $377 $ $146 $201 $347 $344 $399 $ $176 $221 $397 $374 $419 $ $216 $245 $461 $414 $443 $ $273 $266 $539 $471 $464 $ $359 $308 $667 $557 $506 $ $475 $373 $848 $673 $571 $1, $679 $479 $1,158 $877 $677 $1, $726 $536 $1,262 $924 $734 $1,460 Page 4 of 36

21 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 1 Level B PPO $211 $211 $422 $381 $381 $592 1 $126 $126 $252 $296 $296 $ $85 $85 $170 $255 $255 $ $91 $130 $221 $261 $300 $ $109 $159 $268 $279 $329 $ $133 $181 $314 $303 $351 $ $163 $203 $366 $333 $373 $ $201 $229 $430 $371 $399 $ $256 $254 $510 $426 $424 $ $344 $294 $638 $514 $464 $ $460 $360 $820 $630 $530 $ $663 $468 $1,131 $833 $638 $1, $709 $524 $1,233 $879 $694 $1,403 High Deductible Health Plan $271 $271 $542 $489 $489 $760 1 $163 $163 $326 $381 $381 $ $109 $109 $218 $327 $327 $ $116 $165 $281 $334 $383 $ $135 $196 $331 $353 $414 $ $161 $220 $381 $379 $438 $ $190 $241 $431 $408 $459 $ $236 $270 $506 $454 $488 $ $299 $293 $592 $517 $511 $ $394 $339 $733 $612 $557 $ $521 $409 $930 $739 $627 $1, $744 $525 $1,269 $962 $743 $1, $795 $588 $1,383 $1,013 $806 $1,601 High Deductible Health Plan $210 $210 $420 $378 $378 $588 1 $126 $126 $252 $294 $294 $ $84 $84 $168 $252 $252 $ $90 $130 $220 $258 $298 $ $108 $158 $266 $276 $326 $ $131 $181 $312 $299 $349 $ $159 $201 $360 $327 $369 $ $200 $228 $428 $368 $396 $ $256 $253 $509 $424 $421 $ $343 $294 $637 $511 $462 $ $459 $360 $819 $627 $528 $ $661 $466 $1,127 $829 $634 $1, $708 $521 $1,229 $876 $689 $1,397 Preventive and Hospital Care $194 $194 $388 $350 $350 $544 1 $116 $116 $232 $272 $272 $ $78 $78 $156 $234 $234 $ $84 $119 $203 $240 $275 $ $100 $146 $246 $256 $302 $ $123 $168 $291 $279 $324 $ $149 $186 $335 $305 $342 $ $185 $210 $395 $341 $366 $ $235 $233 $468 $391 $389 $ $316 $270 $586 $472 $426 $ $421 $330 $751 $577 $486 $ $608 $430 $1,038 $764 $586 $1, $651 $481 $1,132 $807 $637 $1,288 Page 5 of 36

22 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 1 Level B Preventive and Hospital Care $161 $161 $322 $291 $291 $452 1 $96 $96 $192 $226 $226 $ $65 $65 $130 $195 $195 $ $70 $99 $169 $200 $229 $ $84 $121 $205 $214 $251 $ $101 $139 $240 $231 $269 $ $124 $155 $279 $254 $285 $ $154 $175 $329 $284 $305 $ $196 $194 $390 $326 $324 $ $263 $225 $488 $393 $355 $ $351 $275 $626 $481 $405 $ $506 $358 $864 $636 $488 $ $541 $400 $941 $671 $530 $1,071 Page 6 of 36

23 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 1 Level C PPO $705 $705 $1,410 $1,269 $1,269 $1,974 1 $423 $423 $846 $987 $987 $1, $282 $282 $564 $846 $846 $1, $296 $423 $719 $860 $987 $1, $338 $488 $826 $902 $1,052 $1, $387 $533 $920 $951 $1,097 $1, $455 $569 $1,024 $1,019 $1,133 $1, $542 $618 $1,160 $1,106 $1,182 $1, $669 $654 $1,323 $1,233 $1,218 $1, $866 $743 $1,609 $1,430 $1,307 $2, $1,125 $881 $2,006 $1,689 $1,445 $2, $1,580 $1,116 $2,696 $2,144 $1,680 $3, $1,691 $1,251 $2,942 $2,255 $1,815 $3,506 PPO $465 $465 $930 $837 $837 $1,302 1 $279 $279 $558 $651 $651 $ $186 $186 $372 $558 $558 $ $195 $281 $476 $567 $653 $ $227 $329 $556 $599 $701 $ $264 $363 $627 $636 $735 $ $315 $395 $710 $687 $767 $1, $378 $434 $812 $750 $806 $1, $473 $465 $938 $845 $837 $1, $621 $531 $1,152 $993 $903 $1, $813 $636 $1,449 $1,185 $1,008 $1, $1,154 $815 $1,969 $1,526 $1,187 $2, $1,235 $912 $2,147 $1,607 $1,284 $2,519 PPO $318 $318 $636 $574 $574 $892 1 $191 $191 $382 $447 $447 $ $128 $128 $256 $384 $384 $ $137 $192 $329 $393 $448 $ $159 $230 $389 $415 $486 $ $188 $258 $446 $444 $514 $ $227 $284 $511 $483 $540 $ $276 $315 $591 $532 $571 $ $350 $342 $692 $606 $598 $ $461 $395 $856 $717 $651 $1, $611 $477 $1,088 $867 $733 $1, $870 $614 $1,484 $1,126 $870 $1, $932 $687 $1,619 $1,188 $943 $1,875 PPO $297 $297 $594 $535 $535 $832 1 $179 $179 $358 $417 $417 $ $119 $119 $238 $357 $357 $ $128 $180 $308 $366 $418 $ $149 $215 $364 $387 $453 $ $176 $242 $418 $414 $480 $ $212 $266 $478 $450 $504 $ $260 $294 $554 $498 $532 $ $327 $320 $647 $565 $558 $ $431 $369 $800 $669 $607 $1, $570 $447 $1,017 $808 $685 $1, $815 $575 $1,390 $1,053 $813 $1, $872 $644 $1,516 $1,110 $882 $1,754 Page 7 of 36

24 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 1 Level C PPO $254 $254 $508 $458 $458 $712 1 $152 $152 $304 $356 $356 $ $102 $102 $204 $306 $306 $ $110 $156 $266 $314 $360 $ $131 $191 $322 $335 $395 $ $159 $218 $377 $363 $422 $ $195 $243 $438 $399 $447 $ $242 $275 $517 $446 $479 $ $308 $305 $613 $512 $509 $ $413 $353 $766 $617 $557 $ $552 $432 $984 $756 $636 $1, $795 $561 $1,356 $999 $765 $1, $851 $629 $1,480 $1,055 $833 $1,684 High Deductible Health Plan $326 $326 $652 $588 $588 $914 1 $195 $195 $390 $457 $457 $ $131 $131 $262 $393 $393 $ $140 $198 $338 $402 $460 $ $162 $236 $398 $424 $498 $ $194 $264 $458 $456 $526 $ $228 $290 $518 $490 $552 $ $284 $324 $608 $546 $586 $ $359 $351 $710 $621 $613 $ $473 $407 $880 $735 $669 $1, $626 $491 $1,117 $888 $753 $1, $893 $630 $1,523 $1,155 $892 $1, $954 $705 $1,659 $1,216 $967 $1,921 High Deductible Health Plan $252 $252 $504 $454 $454 $706 1 $152 $152 $304 $354 $354 $ $101 $101 $202 $303 $303 $ $108 $156 $264 $310 $358 $ $129 $189 $318 $331 $391 $ $158 $218 $376 $360 $420 $ $191 $242 $433 $393 $444 $ $240 $273 $513 $442 $475 $ $308 $303 $611 $510 $505 $ $411 $353 $764 $613 $555 $ $551 $432 $983 $753 $634 $1, $794 $560 $1,354 $996 $762 $1, $849 $626 $1,475 $1,051 $828 $1,677 Preventive and Hospital Care $233 $233 $466 $419 $419 $652 1 $140 $140 $280 $326 $326 $ $93 $93 $186 $279 $279 $ $101 $143 $244 $287 $329 $ $120 $176 $296 $306 $362 $ $147 $201 $348 $333 $387 $ $179 $224 $403 $365 $410 $ $222 $252 $474 $408 $438 $ $282 $279 $561 $468 $465 $ $380 $324 $704 $566 $510 $ $506 $396 $902 $692 $582 $1, $729 $516 $1,245 $915 $702 $1, $782 $578 $1,360 $968 $764 $1,546 Page 8 of 36

25 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 1 Level C Preventive and Hospital Care $194 $194 $388 $350 $350 $544 1 $116 $116 $232 $272 $272 $ $78 $78 $156 $234 $234 $ $84 $119 $203 $240 $275 $ $101 $146 $247 $257 $302 $ $122 $167 $289 $278 $323 $ $149 $186 $335 $305 $342 $ $185 $210 $395 $341 $366 $ $236 $233 $469 $392 $389 $ $315 $270 $585 $471 $426 $ $422 $330 $752 $578 $486 $ $608 $429 $1,037 $764 $585 $1, $650 $480 $1,130 $806 $636 $1,286 Page 9 of 36

26 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 2 Level A PPO $505 $505 $1,010 $909 $909 $1,414 1 $303 $303 $606 $707 $707 $1, $202 $202 $404 $606 $606 $ $212 $303 $515 $616 $707 $ $241 $349 $590 $645 $753 $ $277 $382 $659 $681 $786 $1, $326 $408 $734 $730 $812 $1, $388 $442 $830 $792 $846 $1, $479 $468 $947 $883 $872 $1, $620 $532 $1,152 $1,024 $936 $1, $805 $630 $1,435 $1,209 $1,034 $1, $1,132 $800 $1,932 $1,536 $1,204 $2, $1,211 $896 $2,107 $1,615 $1,300 $2,511 PPO $333 $333 $666 $599 $599 $932 1 $200 $200 $400 $466 $466 $ $133 $133 $266 $399 $399 $ $140 $201 $341 $406 $467 $ $163 $235 $398 $429 $501 $ $190 $260 $450 $456 $526 $ $226 $282 $508 $492 $548 $ $271 $311 $582 $537 $577 $ $339 $333 $672 $605 $599 $ $445 $381 $826 $711 $647 $1, $582 $456 $1,038 $848 $722 $1, $826 $584 $1,410 $1,092 $850 $1, $884 $654 $1,538 $1,150 $920 $1,804 PPO $227 $227 $454 $409 $409 $636 1 $136 $136 $272 $318 $318 $ $91 $91 $182 $273 $273 $ $97 $138 $235 $279 $320 $ $114 $164 $278 $296 $346 $ $135 $185 $320 $317 $367 $ $162 $203 $365 $344 $385 $ $198 $225 $423 $380 $407 $ $250 $245 $495 $432 $427 $ $330 $282 $612 $512 $464 $ $437 $342 $779 $619 $524 $ $624 $439 $1,063 $806 $621 $1, $667 $492 $1,159 $849 $674 $1,341 PPO $213 $213 $426 $383 $383 $596 1 $128 $128 $256 $298 $298 $ $85 $85 $170 $255 $255 $ $91 $129 $220 $261 $299 $ $106 $153 $259 $276 $323 $ $126 $173 $299 $296 $343 $ $152 $190 $342 $322 $360 $ $185 $211 $396 $355 $381 $ $234 $229 $463 $404 $399 $ $309 $264 $573 $479 $434 $ $409 $320 $729 $579 $490 $ $584 $411 $995 $754 $581 $1, $624 $461 $1,085 $794 $631 $1,255 Page 10 of 36

27 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 2 Level A PPO $181 $181 $362 $327 $327 $508 1 $109 $109 $218 $255 $255 $ $73 $73 $146 $219 $219 $ $78 $112 $190 $224 $258 $ $93 $137 $230 $239 $283 $ $114 $156 $270 $260 $302 $ $140 $174 $314 $286 $320 $ $173 $196 $369 $319 $342 $ $220 $218 $438 $366 $364 $ $296 $253 $549 $442 $399 $ $395 $309 $704 $541 $455 $ $569 $402 $971 $715 $548 $1, $609 $450 $1,059 $755 $596 $1,205 High Deductible Health Plan $233 $233 $466 $419 $419 $652 1 $140 $140 $280 $326 $326 $ $93 $93 $186 $279 $279 $ $100 $142 $242 $286 $328 $ $116 $168 $284 $302 $354 $ $139 $190 $329 $325 $376 $ $163 $208 $371 $349 $394 $ $203 $232 $435 $389 $418 $ $257 $252 $509 $443 $438 $ $338 $291 $629 $524 $477 $ $448 $351 $799 $634 $537 $ $639 $451 $1,090 $825 $637 $1, $684 $505 $1,189 $870 $691 $1,375 High Deductible Health Plan $181 $181 $362 $325 $325 $506 1 $108 $108 $216 $252 $252 $ $72 $72 $144 $216 $216 $ $78 $112 $190 $222 $256 $ $93 $135 $228 $237 $279 $ $113 $155 $268 $257 $299 $ $136 $173 $309 $280 $317 $ $172 $196 $368 $316 $340 $ $221 $217 $438 $365 $361 $ $294 $253 $547 $438 $397 $ $394 $309 $703 $538 $453 $ $568 $400 $968 $712 $544 $1, $608 $448 $1,056 $752 $592 $1,200 Preventive and Hospital Care $167 $167 $334 $301 $301 $468 1 $100 $100 $200 $234 $234 $ $67 $67 $134 $201 $201 $ $72 $102 $174 $206 $236 $ $86 $126 $212 $220 $260 $ $105 $143 $248 $239 $277 $ $128 $160 $288 $262 $294 $ $159 $180 $339 $293 $314 $ $202 $200 $402 $336 $334 $ $272 $232 $504 $406 $366 $ $363 $284 $647 $497 $418 $ $523 $369 $892 $657 $503 $1, $559 $414 $973 $693 $548 $1,107 Page 11 of 36

28 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 2 Level A Preventive and Hospital Care $139 $139 $278 $249 $249 $388 1 $83 $83 $166 $193 $193 $ $55 $55 $110 $165 $165 $ $60 $85 $145 $170 $195 $ $71 $105 $176 $181 $215 $ $87 $119 $206 $197 $229 $ $107 $133 $240 $217 $243 $ $132 $150 $282 $242 $260 $ $169 $166 $335 $279 $276 $ $226 $193 $419 $336 $303 $ $302 $236 $538 $412 $346 $ $435 $307 $742 $545 $417 $ $466 $344 $810 $576 $454 $920 Page 12 of 36

29 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 2 Level B PPO $631 $631 $1,262 $1,137 $1,137 $1,768 1 $379 $379 $758 $885 $885 $1, $253 $253 $506 $759 $759 $1, $265 $379 $644 $771 $885 $1, $301 $436 $737 $807 $942 $1, $346 $478 $824 $852 $984 $1, $408 $510 $918 $914 $1,016 $1, $485 $553 $1,038 $991 $1,059 $1, $599 $585 $1,184 $1,105 $1,091 $1, $775 $665 $1,440 $1,281 $1,171 $1, $1,006 $788 $1,794 $1,512 $1,294 $2, $1,415 $1,000 $2,415 $1,921 $1,506 $2, $1,514 $1,120 $2,634 $2,020 $1,626 $3,140 PPO $416 $416 $832 $748 $748 $1,164 1 $250 $250 $500 $582 $582 $ $166 $166 $332 $498 $498 $ $175 $251 $426 $507 $583 $ $204 $294 $498 $536 $626 $ $238 $325 $563 $570 $657 $ $283 $353 $636 $615 $685 $ $339 $389 $728 $671 $721 $1, $424 $416 $840 $756 $748 $1, $556 $476 $1,032 $888 $808 $1, $728 $570 $1,298 $1,060 $902 $1, $1,033 $730 $1,763 $1,365 $1,062 $2, $1,105 $818 $1,923 $1,437 $1,150 $2,255 PPO $284 $284 $568 $512 $512 $796 1 $170 $170 $340 $398 $398 $ $114 $114 $228 $342 $342 $ $121 $173 $294 $349 $401 $ $143 $205 $348 $371 $433 $ $169 $231 $400 $397 $459 $ $203 $254 $457 $431 $482 $ $248 $281 $529 $476 $509 $ $313 $306 $619 $541 $534 $ $413 $353 $766 $641 $581 $ $546 $428 $974 $774 $656 $1, $780 $549 $1,329 $1,008 $777 $1, $834 $615 $1,449 $1,062 $843 $1,677 PPO $266 $266 $532 $478 $478 $744 1 $160 $160 $320 $372 $372 $ $106 $106 $212 $318 $318 $ $114 $161 $275 $326 $373 $ $133 $191 $324 $345 $403 $ $158 $216 $374 $370 $428 $ $190 $238 $428 $402 $450 $ $231 $264 $495 $443 $476 $ $293 $286 $579 $505 $498 $ $386 $330 $716 $598 $542 $ $511 $400 $911 $723 $612 $1, $730 $514 $1,244 $942 $726 $1, $780 $576 $1,356 $992 $788 $1,568 Page 13 of 36

30 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 2 Level B PPO $226 $226 $452 $408 $408 $634 1 $136 $136 $272 $318 $318 $ $91 $91 $182 $273 $273 $ $98 $140 $238 $280 $322 $ $116 $171 $287 $298 $353 $ $143 $195 $338 $325 $377 $ $175 $218 $393 $357 $400 $ $216 $245 $461 $398 $427 $ $275 $273 $548 $457 $455 $ $370 $316 $686 $552 $498 $ $494 $386 $880 $676 $568 $1, $711 $503 $1,214 $893 $685 $1, $761 $563 $1,324 $943 $745 $1,506 High Deductible Health Plan $291 $291 $582 $523 $523 $814 1 $175 $175 $350 $407 $407 $ $116 $116 $232 $348 $348 $ $125 $178 $303 $357 $410 $ $145 $210 $355 $377 $442 $ $174 $238 $412 $406 $470 $ $204 $260 $464 $436 $492 $ $254 $290 $544 $486 $522 $ $321 $315 $636 $553 $547 $ $423 $364 $787 $655 $596 $1, $560 $439 $999 $792 $671 $1, $799 $564 $1,363 $1,031 $796 $1, $855 $631 $1,486 $1,087 $863 $1,718 High Deductible Health Plan $226 $226 $452 $406 $406 $632 1 $135 $135 $270 $315 $315 $ $90 $90 $180 $270 $270 $ $98 $140 $238 $278 $320 $ $116 $169 $285 $296 $349 $ $141 $194 $335 $321 $374 $ $170 $216 $386 $350 $396 $ $215 $245 $460 $395 $425 $ $276 $271 $547 $456 $451 $ $368 $316 $684 $548 $496 $ $493 $386 $879 $673 $566 $1, $710 $500 $1,210 $890 $680 $1, $760 $560 $1,320 $940 $740 $1,500 Preventive and Hospital Care $209 $209 $418 $377 $377 $586 1 $125 $125 $250 $293 $293 $ $84 $84 $168 $252 $252 $ $90 $128 $218 $258 $296 $ $108 $158 $266 $276 $326 $ $131 $179 $310 $299 $347 $ $160 $200 $360 $328 $368 $ $199 $225 $424 $367 $393 $ $253 $250 $503 $421 $418 $ $340 $290 $630 $508 $458 $ $454 $355 $809 $622 $523 $ $654 $461 $1,115 $822 $629 $1, $699 $518 $1,217 $867 $686 $1,385 Page 14 of 36

31 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 2 Level B Preventive and Hospital Care $174 $174 $348 $312 $312 $486 1 $104 $104 $208 $242 $242 $ $69 $69 $138 $207 $207 $ $75 $106 $181 $213 $244 $ $89 $131 $220 $227 $269 $ $109 $149 $258 $247 $287 $ $134 $166 $300 $272 $304 $ $165 $188 $353 $303 $326 $ $211 $208 $419 $349 $346 $ $283 $241 $524 $421 $379 $ $378 $295 $673 $516 $433 $ $544 $384 $928 $682 $522 $1, $583 $430 $1,013 $721 $568 $1,151 Page 15 of 36

32 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 2 Level C PPO $758 $758 $1,516 $1,364 $1,364 $2,122 1 $455 $455 $910 $1,061 $1,061 $1, $303 $303 $606 $909 $909 $1, $318 $455 $773 $924 $1,061 $1, $362 $524 $886 $968 $1,130 $1, $416 $573 $989 $1,022 $1,179 $1, $489 $612 $1,101 $1,095 $1,218 $1, $582 $663 $1,245 $1,188 $1,269 $1, $719 $702 $1,421 $1,325 $1,308 $2, $930 $798 $1,728 $1,536 $1,404 $2, $1,208 $945 $2,153 $1,814 $1,551 $2, $1,698 $1,200 $2,898 $2,304 $1,806 $3, $1,817 $1,344 $3,161 $2,423 $1,950 $3,767 PPO $500 $500 $1,000 $900 $900 $1,400 1 $300 $300 $600 $700 $700 $1, $200 $200 $400 $600 $600 $ $210 $302 $512 $610 $702 $ $245 $353 $598 $645 $753 $ $285 $390 $675 $685 $790 $1, $339 $423 $762 $739 $823 $1, $407 $467 $874 $807 $867 $1, $509 $500 $1,009 $909 $900 $1, $668 $572 $1,240 $1,068 $972 $1, $873 $684 $1,557 $1,273 $1,084 $1, $1,239 $876 $2,115 $1,639 $1,276 $2, $1,326 $981 $2,307 $1,726 $1,381 $2,707 PPO $341 $341 $682 $615 $615 $956 1 $204 $204 $408 $478 $478 $ $137 $137 $274 $411 $411 $ $146 $207 $353 $420 $481 $ $171 $246 $417 $445 $520 $ $203 $278 $481 $477 $552 $ $243 $305 $548 $517 $579 $ $297 $338 $635 $571 $612 $ $375 $368 $743 $649 $642 $1, $495 $423 $918 $769 $697 $1, $656 $513 $1,169 $930 $787 $1, $936 $659 $1,595 $1,210 $933 $1, $1,001 $738 $1,739 $1,275 $1,012 $2,013 PPO $320 $320 $640 $576 $576 $896 1 $192 $192 $384 $448 $448 $ $128 $128 $256 $384 $384 $ $137 $194 $331 $393 $450 $ $159 $230 $389 $415 $486 $ $189 $260 $449 $445 $516 $ $228 $285 $513 $484 $541 $ $278 $317 $595 $534 $573 $ $351 $344 $695 $607 $600 $ $464 $396 $860 $720 $652 $1, $614 $480 $1,094 $870 $736 $1, $876 $617 $1,493 $1,132 $873 $1, $936 $692 $1,628 $1,192 $948 $1,884 Page 16 of 36

33 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 2 Level C PPO $272 $272 $544 $492 $492 $764 1 $164 $164 $328 $384 $384 $ $110 $110 $220 $330 $330 $ $117 $168 $285 $337 $388 $ $140 $206 $346 $360 $426 $ $171 $234 $405 $391 $454 $ $210 $261 $471 $430 $481 $ $260 $294 $554 $480 $514 $ $330 $327 $657 $550 $547 $ $444 $380 $824 $664 $600 $1, $593 $464 $1,057 $813 $684 $1, $854 $603 $1,457 $1,074 $823 $1, $914 $675 $1,589 $1,134 $895 $1,809 High Deductible Health Plan $350 $350 $700 $630 $630 $980 1 $210 $210 $420 $490 $490 $ $140 $140 $280 $420 $420 $ $150 $213 $363 $430 $493 $ $174 $252 $426 $454 $532 $ $209 $285 $494 $489 $565 $ $245 $312 $557 $525 $592 $ $305 $348 $653 $585 $628 $ $386 $378 $764 $666 $658 $1, $507 $437 $944 $787 $717 $1, $672 $527 $1,199 $952 $807 $1, $959 $677 $1,636 $1,239 $957 $1, $1,026 $758 $1,784 $1,306 $1,038 $2,064 High Deductible Health Plan $272 $272 $544 $488 $488 $760 1 $162 $162 $324 $378 $378 $ $108 $108 $216 $324 $324 $ $117 $168 $285 $333 $384 $ $140 $203 $343 $356 $419 $ $170 $233 $403 $386 $449 $ $204 $260 $464 $420 $476 $ $258 $294 $552 $474 $510 $ $332 $326 $658 $548 $542 $ $441 $380 $821 $657 $596 $1, $591 $464 $1,055 $807 $680 $1, $852 $600 $1,452 $1,068 $816 $1, $912 $672 $1,584 $1,128 $888 $1,800 Preventive and Hospital Care $251 $251 $502 $453 $453 $704 1 $150 $150 $300 $352 $352 $ $101 $101 $202 $303 $303 $ $108 $153 $261 $310 $355 $ $129 $189 $318 $331 $391 $ $158 $215 $373 $360 $417 $ $192 $240 $432 $394 $442 $ $239 $270 $509 $441 $472 $ $303 $300 $603 $505 $502 $ $408 $348 $756 $610 $550 $ $545 $426 $971 $747 $628 $1, $785 $554 $1,339 $987 $756 $1, $839 $621 $1,460 $1,041 $823 $1,662 Page 17 of 36

34 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 2 Level C Preventive and Hospital Care $209 $209 $418 $375 $375 $584 1 $125 $125 $250 $291 $291 $ $83 $83 $166 $249 $249 $ $90 $128 $218 $256 $294 $ $107 $158 $265 $273 $324 $ $131 $179 $310 $297 $345 $ $161 $200 $361 $327 $366 $ $198 $225 $423 $364 $391 $ $254 $249 $503 $420 $415 $ $339 $290 $629 $505 $456 $ $453 $354 $807 $619 $520 $ $653 $461 $1,114 $819 $627 $1, $699 $516 $1,215 $865 $682 $1,381 Page 18 of 36

35 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 3 Level A PPO $505 $505 $1,010 $909 $909 $1,414 1 $303 $303 $606 $707 $707 $1, $202 $202 $404 $606 $606 $ $212 $303 $515 $616 $707 $ $241 $349 $590 $645 $753 $ $277 $382 $659 $681 $786 $1, $326 $408 $734 $730 $812 $1, $388 $442 $830 $792 $846 $1, $479 $468 $947 $883 $872 $1, $620 $532 $1,152 $1,024 $936 $1, $805 $630 $1,435 $1,209 $1,034 $1, $1,132 $800 $1,932 $1,536 $1,204 $2, $1,211 $896 $2,107 $1,615 $1,300 $2,511 PPO $333 $333 $666 $599 $599 $932 1 $200 $200 $400 $466 $466 $ $133 $133 $266 $399 $399 $ $140 $201 $341 $406 $467 $ $163 $235 $398 $429 $501 $ $190 $260 $450 $456 $526 $ $226 $282 $508 $492 $548 $ $271 $311 $582 $537 $577 $ $339 $333 $672 $605 $599 $ $445 $381 $826 $711 $647 $1, $582 $456 $1,038 $848 $722 $1, $826 $584 $1,410 $1,092 $850 $1, $884 $654 $1,538 $1,150 $920 $1,804 PPO $227 $227 $454 $409 $409 $636 1 $136 $136 $272 $318 $318 $ $91 $91 $182 $273 $273 $ $97 $138 $235 $279 $320 $ $114 $164 $278 $296 $346 $ $135 $185 $320 $317 $367 $ $162 $203 $365 $344 $385 $ $198 $225 $423 $380 $407 $ $250 $245 $495 $432 $427 $ $330 $282 $612 $512 $464 $ $437 $342 $779 $619 $524 $ $624 $439 $1,063 $806 $621 $1, $667 $492 $1,159 $849 $674 $1,341 PPO $213 $213 $426 $383 $383 $596 1 $128 $128 $256 $298 $298 $ $85 $85 $170 $255 $255 $ $91 $129 $220 $261 $299 $ $106 $153 $259 $276 $323 $ $126 $173 $299 $296 $343 $ $152 $190 $342 $322 $360 $ $185 $211 $396 $355 $381 $ $234 $229 $463 $404 $399 $ $309 $264 $573 $479 $434 $ $409 $320 $729 $579 $490 $ $584 $411 $995 $754 $581 $1, $624 $461 $1,085 $794 $631 $1,255 Page 19 of 36

36 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 3 Level A PPO $181 $181 $362 $327 $327 $508 1 $109 $109 $218 $255 $255 $ $73 $73 $146 $219 $219 $ $78 $112 $190 $224 $258 $ $93 $137 $230 $239 $283 $ $114 $156 $270 $260 $302 $ $140 $174 $314 $286 $320 $ $173 $196 $369 $319 $342 $ $220 $218 $438 $366 $364 $ $296 $253 $549 $442 $399 $ $395 $309 $704 $541 $455 $ $569 $402 $971 $715 $548 $1, $609 $450 $1,059 $755 $596 $1,205 High Deductible Health Plan $233 $233 $466 $419 $419 $652 1 $140 $140 $280 $326 $326 $ $93 $93 $186 $279 $279 $ $100 $142 $242 $286 $328 $ $116 $168 $284 $302 $354 $ $139 $190 $329 $325 $376 $ $163 $208 $371 $349 $394 $ $203 $232 $435 $389 $418 $ $257 $252 $509 $443 $438 $ $338 $291 $629 $524 $477 $ $448 $351 $799 $634 $537 $ $639 $451 $1,090 $825 $637 $1, $684 $505 $1,189 $870 $691 $1,375 High Deductible Health Plan $181 $181 $362 $325 $325 $506 1 $108 $108 $216 $252 $252 $ $72 $72 $144 $216 $216 $ $78 $112 $190 $222 $256 $ $93 $135 $228 $237 $279 $ $113 $155 $268 $257 $299 $ $136 $173 $309 $280 $317 $ $172 $196 $368 $316 $340 $ $221 $217 $438 $365 $361 $ $294 $253 $547 $438 $397 $ $394 $309 $703 $538 $453 $ $568 $400 $968 $712 $544 $1, $608 $448 $1,056 $752 $592 $1,200 Preventive and Hospital Care $167 $167 $334 $301 $301 $468 1 $100 $100 $200 $234 $234 $ $67 $67 $134 $201 $201 $ $72 $102 $174 $206 $236 $ $86 $126 $212 $220 $260 $ $105 $143 $248 $239 $277 $ $128 $160 $288 $262 $294 $ $159 $180 $339 $293 $314 $ $202 $200 $402 $336 $334 $ $272 $232 $504 $406 $366 $ $363 $284 $647 $497 $418 $ $523 $369 $892 $657 $503 $1, $559 $414 $973 $693 $548 $1,107 Page 20 of 36

37 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 3 Level A Preventive and Hospital Care $139 $139 $278 $249 $249 $388 1 $83 $83 $166 $193 $193 $ $55 $55 $110 $165 $165 $ $60 $85 $145 $170 $195 $ $71 $105 $176 $181 $215 $ $87 $119 $206 $197 $229 $ $107 $133 $240 $217 $243 $ $132 $150 $282 $242 $260 $ $169 $166 $335 $279 $276 $ $226 $193 $419 $336 $303 $ $302 $236 $538 $412 $346 $ $435 $307 $742 $545 $417 $ $466 $344 $810 $576 $454 $920 Page 21 of 36

38 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 3 Level B PPO $631 $631 $1,262 $1,137 $1,137 $1,768 1 $379 $379 $758 $885 $885 $1, $253 $253 $506 $759 $759 $1, $265 $379 $644 $771 $885 $1, $301 $436 $737 $807 $942 $1, $346 $478 $824 $852 $984 $1, $408 $510 $918 $914 $1,016 $1, $485 $553 $1,038 $991 $1,059 $1, $599 $585 $1,184 $1,105 $1,091 $1, $775 $665 $1,440 $1,281 $1,171 $1, $1,006 $788 $1,794 $1,512 $1,294 $2, $1,415 $1,000 $2,415 $1,921 $1,506 $2, $1,514 $1,120 $2,634 $2,020 $1,626 $3,140 PPO $416 $416 $832 $748 $748 $1,164 1 $250 $250 $500 $582 $582 $ $166 $166 $332 $498 $498 $ $175 $251 $426 $507 $583 $ $204 $294 $498 $536 $626 $ $238 $325 $563 $570 $657 $ $283 $353 $636 $615 $685 $ $339 $389 $728 $671 $721 $1, $424 $416 $840 $756 $748 $1, $556 $476 $1,032 $888 $808 $1, $728 $570 $1,298 $1,060 $902 $1, $1,033 $730 $1,763 $1,365 $1,062 $2, $1,105 $818 $1,923 $1,437 $1,150 $2,255 PPO $284 $284 $568 $512 $512 $796 1 $170 $170 $340 $398 $398 $ $114 $114 $228 $342 $342 $ $121 $173 $294 $349 $401 $ $143 $205 $348 $371 $433 $ $169 $231 $400 $397 $459 $ $203 $254 $457 $431 $482 $ $248 $281 $529 $476 $509 $ $313 $306 $619 $541 $534 $ $413 $353 $766 $641 $581 $ $546 $428 $974 $774 $656 $1, $780 $549 $1,329 $1,008 $777 $1, $834 $615 $1,449 $1,062 $843 $1,677 PPO $266 $266 $532 $478 $478 $744 1 $160 $160 $320 $372 $372 $ $106 $106 $212 $318 $318 $ $114 $161 $275 $326 $373 $ $133 $191 $324 $345 $403 $ $158 $216 $374 $370 $428 $ $190 $238 $428 $402 $450 $ $231 $264 $495 $443 $476 $ $293 $286 $579 $505 $498 $ $386 $330 $716 $598 $542 $ $511 $400 $911 $723 $612 $1, $730 $514 $1,244 $942 $726 $1, $780 $576 $1,356 $992 $788 $1,568 Page 22 of 36

39 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 3 Level B PPO $226 $226 $452 $408 $408 $634 1 $136 $136 $272 $318 $318 $ $91 $91 $182 $273 $273 $ $98 $140 $238 $280 $322 $ $116 $171 $287 $298 $353 $ $143 $195 $338 $325 $377 $ $175 $218 $393 $357 $400 $ $216 $245 $461 $398 $427 $ $275 $273 $548 $457 $455 $ $370 $316 $686 $552 $498 $ $494 $386 $880 $676 $568 $1, $711 $503 $1,214 $893 $685 $1, $761 $563 $1,324 $943 $745 $1,506 High Deductible Health Plan $291 $291 $582 $523 $523 $814 1 $175 $175 $350 $407 $407 $ $116 $116 $232 $348 $348 $ $125 $178 $303 $357 $410 $ $145 $210 $355 $377 $442 $ $174 $238 $412 $406 $470 $ $204 $260 $464 $436 $492 $ $254 $290 $544 $486 $522 $ $321 $315 $636 $553 $547 $ $423 $364 $787 $655 $596 $1, $560 $439 $999 $792 $671 $1, $799 $564 $1,363 $1,031 $796 $1, $855 $631 $1,486 $1,087 $863 $1,718 High Deductible Health Plan $226 $226 $452 $406 $406 $632 1 $135 $135 $270 $315 $315 $ $90 $90 $180 $270 $270 $ $98 $140 $238 $278 $320 $ $116 $169 $285 $296 $349 $ $141 $194 $335 $321 $374 $ $170 $216 $386 $350 $396 $ $215 $245 $460 $395 $425 $ $276 $271 $547 $456 $451 $ $368 $316 $684 $548 $496 $ $493 $386 $879 $673 $566 $1, $710 $500 $1,210 $890 $680 $1, $760 $560 $1,320 $940 $740 $1,500 Preventive and Hospital Care $209 $209 $418 $377 $377 $586 1 $125 $125 $250 $293 $293 $ $84 $84 $168 $252 $252 $ $90 $128 $218 $258 $296 $ $108 $158 $266 $276 $326 $ $131 $179 $310 $299 $347 $ $160 $200 $360 $328 $368 $ $199 $225 $424 $367 $393 $ $253 $250 $503 $421 $418 $ $340 $290 $630 $508 $458 $ $454 $355 $809 $622 $523 $ $654 $461 $1,115 $822 $629 $1, $699 $518 $1,217 $867 $686 $1,385 Page 23 of 36

40 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 3 Level B Preventive and Hospital Care $174 $174 $348 $312 $312 $486 1 $104 $104 $208 $242 $242 $ $69 $69 $138 $207 $207 $ $75 $106 $181 $213 $244 $ $89 $131 $220 $227 $269 $ $109 $149 $258 $247 $287 $ $134 $166 $300 $272 $304 $ $165 $188 $353 $303 $326 $ $211 $208 $419 $349 $346 $ $283 $241 $524 $421 $379 $ $378 $295 $673 $516 $433 $ $544 $384 $928 $682 $522 $1, $583 $430 $1,013 $721 $568 $1,151 Page 24 of 36

41 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 3 Level C PPO $758 $758 $1,516 $1,364 $1,364 $2,122 1 $455 $455 $910 $1,061 $1,061 $1, $303 $303 $606 $909 $909 $1, $318 $455 $773 $924 $1,061 $1, $362 $524 $886 $968 $1,130 $1, $416 $573 $989 $1,022 $1,179 $1, $489 $612 $1,101 $1,095 $1,218 $1, $582 $663 $1,245 $1,188 $1,269 $1, $719 $702 $1,421 $1,325 $1,308 $2, $930 $798 $1,728 $1,536 $1,404 $2, $1,208 $945 $2,153 $1,814 $1,551 $2, $1,698 $1,200 $2,898 $2,304 $1,806 $3, $1,817 $1,344 $3,161 $2,423 $1,950 $3,767 PPO $500 $500 $1,000 $900 $900 $1,400 1 $300 $300 $600 $700 $700 $1, $200 $200 $400 $600 $600 $ $210 $302 $512 $610 $702 $ $245 $353 $598 $645 $753 $ $285 $390 $675 $685 $790 $1, $339 $423 $762 $739 $823 $1, $407 $467 $874 $807 $867 $1, $509 $500 $1,009 $909 $900 $1, $668 $572 $1,240 $1,068 $972 $1, $873 $684 $1,557 $1,273 $1,084 $1, $1,239 $876 $2,115 $1,639 $1,276 $2, $1,326 $981 $2,307 $1,726 $1,381 $2,707 PPO $341 $341 $682 $615 $615 $956 1 $204 $204 $408 $478 $478 $ $137 $137 $274 $411 $411 $ $146 $207 $353 $420 $481 $ $171 $246 $417 $445 $520 $ $203 $278 $481 $477 $552 $ $243 $305 $548 $517 $579 $ $297 $338 $635 $571 $612 $ $375 $368 $743 $649 $642 $1, $495 $423 $918 $769 $697 $1, $656 $513 $1,169 $930 $787 $1, $936 $659 $1,595 $1,210 $933 $1, $1,001 $738 $1,739 $1,275 $1,012 $2,013 PPO $320 $320 $640 $576 $576 $896 1 $192 $192 $384 $448 $448 $ $128 $128 $256 $384 $384 $ $137 $194 $331 $393 $450 $ $159 $230 $389 $415 $486 $ $189 $260 $449 $445 $516 $ $228 $285 $513 $484 $541 $ $278 $317 $595 $534 $573 $ $351 $344 $695 $607 $600 $ $464 $396 $860 $720 $652 $1, $614 $480 $1,094 $870 $736 $1, $876 $617 $1,493 $1,132 $873 $1, $936 $692 $1,628 $1,192 $948 $1,884 Page 25 of 36

42 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 3 Level C PPO $272 $272 $544 $492 $492 $764 1 $164 $164 $328 $384 $384 $ $110 $110 $220 $330 $330 $ $117 $168 $285 $337 $388 $ $140 $206 $346 $360 $426 $ $171 $234 $405 $391 $454 $ $210 $261 $471 $430 $481 $ $260 $294 $554 $480 $514 $ $330 $327 $657 $550 $547 $ $444 $380 $824 $664 $600 $1, $593 $464 $1,057 $813 $684 $1, $854 $603 $1,457 $1,074 $823 $1, $914 $675 $1,589 $1,134 $895 $1,809 High Deductible Health Plan $350 $350 $700 $630 $630 $980 1 $210 $210 $420 $490 $490 $ $140 $140 $280 $420 $420 $ $150 $213 $363 $430 $493 $ $174 $252 $426 $454 $532 $ $209 $285 $494 $489 $565 $ $245 $312 $557 $525 $592 $ $305 $348 $653 $585 $628 $ $386 $378 $764 $666 $658 $1, $507 $437 $944 $787 $717 $1, $672 $527 $1,199 $952 $807 $1, $959 $677 $1,636 $1,239 $957 $1, $1,026 $758 $1,784 $1,306 $1,038 $2,064 High Deductible Health Plan $272 $272 $544 $488 $488 $760 1 $162 $162 $324 $378 $378 $ $108 $108 $216 $324 $324 $ $117 $168 $285 $333 $384 $ $140 $203 $343 $356 $419 $ $170 $233 $403 $386 $449 $ $204 $260 $464 $420 $476 $ $258 $294 $552 $474 $510 $ $332 $326 $658 $548 $542 $ $441 $380 $821 $657 $596 $1, $591 $464 $1,055 $807 $680 $1, $852 $600 $1,452 $1,068 $816 $1, $912 $672 $1,584 $1,128 $888 $1,800 Preventive and Hospital Care $251 $251 $502 $453 $453 $704 1 $150 $150 $300 $352 $352 $ $101 $101 $202 $303 $303 $ $108 $153 $261 $310 $355 $ $129 $189 $318 $331 $391 $ $158 $215 $373 $360 $417 $ $192 $240 $432 $394 $442 $ $239 $270 $509 $441 $472 $ $303 $300 $603 $505 $502 $ $408 $348 $756 $610 $550 $ $545 $426 $971 $747 $628 $1, $785 $554 $1,339 $987 $756 $1, $839 $621 $1,460 $1,041 $823 $1,662 Page 26 of 36

43 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 3 Level C Preventive and Hospital Care $209 $209 $418 $375 $375 $584 1 $125 $125 $250 $291 $291 $ $83 $83 $166 $249 $249 $ $90 $128 $218 $256 $294 $ $107 $158 $265 $273 $324 $ $131 $179 $310 $297 $345 $ $161 $200 $361 $327 $366 $ $198 $225 $423 $364 $391 $ $254 $249 $503 $420 $415 $ $339 $290 $629 $505 $456 $ $453 $354 $807 $619 $520 $ $653 $461 $1,114 $819 $627 $1, $699 $516 $1,215 $865 $682 $1,381 Page 27 of 36

44 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 4 Level A PPO $470 $470 $940 $846 $846 $1,316 1 $282 $282 $564 $658 $658 $ $188 $188 $376 $564 $564 $ $197 $282 $479 $573 $658 $ $225 $325 $550 $601 $701 $ $258 $355 $613 $634 $731 $ $303 $379 $682 $679 $755 $1, $361 $412 $773 $737 $788 $1, $446 $436 $882 $822 $812 $1, $577 $495 $1,072 $953 $871 $1, $750 $587 $1,337 $1,126 $963 $1, $1,053 $744 $1,797 $1,429 $1,120 $2, $1,127 $834 $1,961 $1,503 $1,210 $2,337 PPO $310 $310 $620 $558 $558 $868 1 $186 $186 $372 $434 $434 $ $124 $124 $248 $372 $372 $ $130 $187 $317 $378 $435 $ $151 $219 $370 $399 $467 $ $176 $242 $418 $424 $490 $ $210 $263 $473 $458 $511 $ $252 $289 $541 $500 $537 $ $315 $310 $625 $563 $558 $ $414 $354 $768 $662 $602 $1, $542 $424 $966 $790 $672 $1, $769 $543 $1,312 $1,017 $791 $1, $823 $608 $1,431 $1,071 $856 $1,679 PPO $212 $212 $424 $382 $382 $594 1 $127 $127 $254 $297 $297 $ $85 $85 $170 $255 $255 $ $91 $128 $219 $261 $298 $ $106 $153 $259 $276 $323 $ $125 $172 $297 $295 $342 $ $151 $189 $340 $321 $359 $ $184 $210 $394 $354 $380 $ $233 $228 $461 $403 $398 $ $307 $263 $570 $477 $433 $ $407 $318 $725 $577 $488 $ $580 $409 $989 $750 $579 $1, $621 $458 $1,079 $791 $628 $1,249 PPO $198 $198 $396 $356 $356 $554 1 $119 $119 $238 $277 $277 $ $79 $79 $158 $237 $237 $ $85 $120 $205 $243 $278 $ $99 $143 $242 $257 $301 $ $117 $161 $278 $275 $319 $ $141 $177 $318 $299 $335 $ $173 $196 $369 $331 $354 $ $218 $213 $431 $376 $371 $ $287 $246 $533 $445 $404 $ $380 $298 $678 $538 $456 $ $543 $383 $926 $701 $541 $1, $581 $429 $1,010 $739 $587 $1,168 Page 28 of 36

45 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 4 Level A PPO $169 $169 $338 $305 $305 $474 1 $101 $101 $202 $237 $237 $ $68 $68 $136 $204 $204 $ $73 $104 $177 $209 $240 $ $87 $127 $214 $223 $263 $ $106 $145 $251 $242 $281 $ $130 $162 $292 $266 $298 $ $161 $183 $344 $297 $319 $ $205 $203 $408 $341 $339 $ $275 $235 $510 $411 $371 $ $368 $288 $656 $504 $424 $ $530 $374 $904 $666 $510 $1, $567 $419 $986 $703 $555 $1,122 High Deductible Health Plan $217 $217 $434 $391 $391 $608 1 $130 $130 $260 $304 $304 $ $87 $87 $174 $261 $261 $ $93 $132 $225 $267 $306 $ $108 $157 $265 $282 $331 $ $129 $176 $305 $303 $350 $ $152 $193 $345 $326 $367 $ $189 $216 $405 $363 $390 $ $239 $234 $473 $413 $408 $ $315 $271 $586 $489 $445 $ $417 $327 $744 $591 $501 $ $595 $420 $1,015 $769 $594 $1, $636 $470 $1,106 $810 $644 $1,280 High Deductible Health Plan $168 $168 $336 $302 $302 $470 1 $101 $101 $202 $235 $235 $ $67 $67 $134 $201 $201 $ $72 $104 $176 $206 $238 $ $86 $126 $212 $220 $260 $ $105 $145 $250 $239 $279 $ $127 $161 $288 $261 $295 $ $160 $182 $342 $294 $316 $ $205 $202 $407 $339 $336 $ $274 $235 $509 $408 $369 $ $367 $288 $655 $501 $422 $ $529 $373 $902 $663 $507 $1, $566 $417 $983 $700 $551 $1,117 Preventive and Hospital Care $155 $155 $310 $279 $279 $434 1 $93 $93 $186 $217 $217 $ $62 $62 $124 $186 $186 $ $67 $95 $162 $191 $219 $ $80 $117 $197 $204 $241 $ $98 $134 $232 $222 $258 $ $119 $149 $268 $243 $273 $ $148 $168 $316 $272 $292 $ $188 $186 $374 $312 $310 $ $253 $216 $469 $377 $340 $ $337 $264 $601 $461 $388 $ $486 $344 $830 $610 $468 $ $521 $385 $906 $645 $509 $1,030 Page 29 of 36

46 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 4 Level A Preventive and Hospital Care $129 $129 $258 $233 $233 $362 1 $77 $77 $154 $181 $181 $ $52 $52 $104 $156 $156 $ $56 $79 $135 $160 $183 $ $67 $97 $164 $171 $201 $ $81 $111 $192 $185 $215 $ $99 $124 $223 $203 $228 $ $123 $140 $263 $227 $244 $ $157 $155 $312 $261 $259 $ $210 $180 $390 $314 $284 $ $281 $220 $501 $385 $324 $ $405 $286 $691 $509 $390 $ $433 $320 $753 $537 $424 $857 Page 30 of 36

47 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 4 Level B PPO $588 $588 $1,176 $1,058 $1,058 $1,646 1 $353 $353 $706 $823 $823 $1, $235 $235 $470 $705 $705 $ $246 $353 $599 $716 $823 $1, $281 $406 $687 $751 $876 $1, $323 $444 $767 $793 $914 $1, $379 $474 $853 $849 $944 $1, $451 $515 $966 $921 $985 $1, $558 $545 $1,103 $1,028 $1,015 $1, $721 $619 $1,340 $1,191 $1,089 $1, $938 $734 $1,672 $1,408 $1,204 $2, $1,316 $930 $2,246 $1,786 $1,400 $2, $1,409 $1,043 $2,452 $1,879 $1,513 $2,922 PPO $388 $388 $776 $698 $698 $1,086 1 $233 $233 $466 $543 $543 $ $155 $155 $310 $465 $465 $ $163 $234 $397 $473 $544 $ $189 $274 $463 $499 $584 $ $220 $303 $523 $530 $613 $ $263 $329 $592 $573 $639 $ $315 $361 $676 $625 $671 $ $394 $388 $782 $704 $698 $1, $518 $443 $961 $828 $753 $1, $678 $530 $1,208 $988 $840 $1, $961 $679 $1,640 $1,271 $989 $1, $1,029 $760 $1,789 $1,339 $1,070 $2,099 PPO $265 $265 $530 $477 $477 $742 1 $159 $159 $318 $371 $371 $ $106 $106 $212 $318 $318 $ $114 $160 $274 $326 $372 $ $133 $191 $324 $345 $403 $ $156 $215 $371 $368 $427 $ $189 $236 $425 $401 $448 $ $230 $263 $493 $442 $475 $ $291 $285 $576 $503 $497 $ $384 $329 $713 $596 $541 $ $509 $398 $907 $721 $610 $1, $725 $511 $1,236 $937 $723 $1, $776 $573 $1,349 $988 $785 $1,561 PPO $248 $248 $496 $446 $446 $694 1 $149 $149 $298 $347 $347 $ $99 $99 $198 $297 $297 $ $106 $150 $256 $304 $348 $ $124 $179 $303 $322 $377 $ $146 $201 $347 $344 $399 $ $176 $221 $397 $374 $419 $ $216 $245 $461 $414 $443 $ $273 $266 $539 $471 $464 $ $359 $308 $667 $557 $506 $ $475 $373 $848 $673 $571 $1, $679 $479 $1,158 $877 $677 $1, $726 $536 $1,262 $924 $734 $1,460 Page 31 of 36

48 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 4 Level B PPO $211 $211 $422 $381 $381 $592 1 $126 $126 $252 $296 $296 $ $85 $85 $170 $255 $255 $ $91 $130 $221 $261 $300 $ $109 $159 $268 $279 $329 $ $133 $181 $314 $303 $351 $ $163 $203 $366 $333 $373 $ $201 $229 $430 $371 $399 $ $256 $254 $510 $426 $424 $ $344 $294 $638 $514 $464 $ $460 $360 $820 $630 $530 $ $663 $468 $1,131 $833 $638 $1, $709 $524 $1,233 $879 $694 $1,403 High Deductible Health Plan $271 $271 $542 $489 $489 $760 1 $163 $163 $326 $381 $381 $ $109 $109 $218 $327 $327 $ $116 $165 $281 $334 $383 $ $135 $196 $331 $353 $414 $ $161 $220 $381 $379 $438 $ $190 $241 $431 $408 $459 $ $236 $270 $506 $454 $488 $ $299 $293 $592 $517 $511 $ $394 $339 $733 $612 $557 $ $521 $409 $930 $739 $627 $1, $744 $525 $1,269 $962 $743 $1, $795 $588 $1,383 $1,013 $806 $1,601 High Deductible Health Plan $210 $210 $420 $378 $378 $588 1 $126 $126 $252 $294 $294 $ $84 $84 $168 $252 $252 $ $90 $130 $220 $258 $298 $ $108 $158 $266 $276 $326 $ $131 $181 $312 $299 $349 $ $159 $201 $360 $327 $369 $ $200 $228 $428 $368 $396 $ $256 $253 $509 $424 $421 $ $343 $294 $637 $511 $462 $ $459 $360 $819 $627 $528 $ $661 $466 $1,127 $829 $634 $1, $708 $521 $1,229 $876 $689 $1,397 Preventive and Hospital Care $194 $194 $388 $350 $350 $544 1 $116 $116 $232 $272 $272 $ $78 $78 $156 $234 $234 $ $84 $119 $203 $240 $275 $ $100 $146 $246 $256 $302 $ $123 $168 $291 $279 $324 $ $149 $186 $335 $305 $342 $ $185 $210 $395 $341 $366 $ $235 $233 $468 $391 $389 $ $316 $270 $586 $472 $426 $ $421 $330 $751 $577 $486 $ $608 $430 $1,038 $764 $586 $1, $651 $481 $1,132 $807 $637 $1,288 Page 32 of 36

49 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 4 Level B Preventive and Hospital Care $161 $161 $322 $291 $291 $452 1 $96 $96 $192 $226 $226 $ $65 $65 $130 $195 $195 $ $70 $99 $169 $200 $229 $ $84 $121 $205 $214 $251 $ $101 $139 $240 $231 $269 $ $124 $155 $279 $254 $285 $ $154 $175 $329 $284 $305 $ $196 $194 $390 $326 $324 $ $263 $225 $488 $393 $355 $ $351 $275 $626 $481 $405 $ $506 $358 $864 $636 $488 $ $541 $400 $941 $671 $530 $1,071 Page 33 of 36

50 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 4 Level C PPO $705 $705 $1,410 $1,269 $1,269 $1,974 1 $423 $423 $846 $987 $987 $1, $282 $282 $564 $846 $846 $1, $296 $423 $719 $860 $987 $1, $338 $488 $826 $902 $1,052 $1, $387 $533 $920 $951 $1,097 $1, $455 $569 $1,024 $1,019 $1,133 $1, $542 $618 $1,160 $1,106 $1,182 $1, $669 $654 $1,323 $1,233 $1,218 $1, $866 $743 $1,609 $1,430 $1,307 $2, $1,125 $881 $2,006 $1,689 $1,445 $2, $1,580 $1,116 $2,696 $2,144 $1,680 $3, $1,691 $1,251 $2,942 $2,255 $1,815 $3,506 PPO $465 $465 $930 $837 $837 $1,302 1 $279 $279 $558 $651 $651 $ $186 $186 $372 $558 $558 $ $195 $281 $476 $567 $653 $ $227 $329 $556 $599 $701 $ $264 $363 $627 $636 $735 $ $315 $395 $710 $687 $767 $1, $378 $434 $812 $750 $806 $1, $473 $465 $938 $845 $837 $1, $621 $531 $1,152 $993 $903 $1, $813 $636 $1,449 $1,185 $1,008 $1, $1,154 $815 $1,969 $1,526 $1,187 $2, $1,235 $912 $2,147 $1,607 $1,284 $2,519 PPO $318 $318 $636 $574 $574 $892 1 $191 $191 $382 $447 $447 $ $128 $128 $256 $384 $384 $ $137 $192 $329 $393 $448 $ $159 $230 $389 $415 $486 $ $188 $258 $446 $444 $514 $ $227 $284 $511 $483 $540 $ $276 $315 $591 $532 $571 $ $350 $342 $692 $606 $598 $ $461 $395 $856 $717 $651 $1, $611 $477 $1,088 $867 $733 $1, $870 $614 $1,484 $1,126 $870 $1, $932 $687 $1,619 $1,188 $943 $1,875 PPO $297 $297 $594 $535 $535 $832 1 $179 $179 $358 $417 $417 $ $119 $119 $238 $357 $357 $ $128 $180 $308 $366 $418 $ $149 $215 $364 $387 $453 $ $176 $242 $418 $414 $480 $ $212 $266 $478 $450 $504 $ $260 $294 $554 $498 $532 $ $327 $320 $647 $565 $558 $ $431 $369 $800 $669 $607 $1, $570 $447 $1,017 $808 $685 $1, $815 $575 $1,390 $1,053 $813 $1, $872 $644 $1,516 $1,110 $882 $1,754 Page 34 of 36

51 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 4 Level C PPO $254 $254 $508 $458 $458 $712 1 $152 $152 $304 $356 $356 $ $102 $102 $204 $306 $306 $ $110 $156 $266 $314 $360 $ $131 $191 $322 $335 $395 $ $159 $218 $377 $363 $422 $ $195 $243 $438 $399 $447 $ $242 $275 $517 $446 $479 $ $308 $305 $613 $512 $509 $ $413 $353 $766 $617 $557 $ $552 $432 $984 $756 $636 $1, $795 $561 $1,356 $999 $765 $1, $851 $629 $1,480 $1,055 $833 $1,684 High Deductible Health Plan $326 $326 $652 $588 $588 $914 1 $195 $195 $390 $457 $457 $ $131 $131 $262 $393 $393 $ $140 $198 $338 $402 $460 $ $162 $236 $398 $424 $498 $ $194 $264 $458 $456 $526 $ $228 $290 $518 $490 $552 $ $284 $324 $608 $546 $586 $ $359 $351 $710 $621 $613 $ $473 $407 $880 $735 $669 $1, $626 $491 $1,117 $888 $753 $1, $893 $630 $1,523 $1,155 $892 $1, $954 $705 $1,659 $1,216 $967 $1,921 High Deductible Health Plan $252 $252 $504 $454 $454 $706 1 $152 $152 $304 $354 $354 $ $101 $101 $202 $303 $303 $ $108 $156 $264 $310 $358 $ $129 $189 $318 $331 $391 $ $158 $218 $376 $360 $420 $ $191 $242 $433 $393 $444 $ $240 $273 $513 $442 $475 $ $308 $303 $611 $510 $505 $ $411 $353 $764 $613 $555 $ $551 $432 $983 $753 $634 $1, $794 $560 $1,354 $996 $762 $1, $849 $626 $1,475 $1,051 $828 $1,677 Preventive and Hospital Care $233 $233 $466 $419 $419 $652 1 $140 $140 $280 $326 $326 $ $93 $93 $186 $279 $279 $ $101 $143 $244 $287 $329 $ $120 $176 $296 $306 $362 $ $147 $201 $348 $333 $387 $ $179 $224 $403 $365 $410 $ $222 $252 $474 $408 $438 $ $282 $279 $561 $468 $465 $ $380 $324 $704 $566 $510 $ $506 $396 $902 $692 $582 $1, $729 $516 $1,245 $915 $702 $1, $782 $578 $1,360 $968 $764 $1,546 Page 35 of 36

52 Exhibit H For Original Coverage Effective Dates Prior to June 1, 2008 State: Connecticut - Block A Rating Area: 4 Level C Preventive and Hospital Care $194 $194 $388 $350 $350 $544 1 $116 $116 $232 $272 $272 $ $78 $78 $156 $234 $234 $ $84 $119 $203 $240 $275 $ $101 $146 $247 $257 $302 $ $122 $167 $289 $278 $323 $ $149 $186 $335 $305 $342 $ $185 $210 $395 $341 $366 $ $236 $233 $469 $392 $389 $ $315 $270 $585 $471 $426 $ $422 $330 $752 $578 $486 $ $608 $429 $1,037 $764 $585 $1, $650 $480 $1,130 $806 $636 $1,286 Page 36 of 36

53 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 1 First Dollar 30 First Dollar 40 MCOA 1500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $412 $412 0 $352 $352 0 $348 $348 1 $247 $247 1 $211 $211 1 $209 $209 2 $132 $132 2 $113 $113 2 $111 $111 3 $132 $132 3 $113 $113 3 $111 $111 4 $132 $132 4 $113 $113 4 $111 $111 5 $132 $132 5 $113 $113 5 $111 $111 6 $132 $132 6 $113 $113 6 $111 $111 7 $132 $132 7 $113 $113 7 $111 $111 8 $132 $132 8 $113 $113 8 $111 $111 9 $132 $132 9 $113 $113 9 $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $133 $ $114 $ $113 $ $134 $ $114 $ $113 $ $134 $ $114 $ $113 $ $137 $ $117 $ $116 $ $140 $ $120 $ $119 $ $143 $ $122 $ $122 $ $146 $ $125 $ $125 $ $149 $ $127 $ $128 $ $152 $ $130 $ $131 $ $160 $ $136 $ $139 $ $168 $ $143 $ $146 $ $175 $ $150 $ $153 $ $183 $ $156 $ $161 $ $191 $ $163 $ $168 $ $193 $ $164 $ $170 $ $194 $ $166 $ $171 $ $196 $ $167 $ $173 $ $197 $ $168 $ $175 $ $199 $ $170 $ $177 $ $207 $ $177 $ $184 $ $215 $ $183 $ $192 $ $223 $ $190 $ $199 $ $231 $ $197 $ $207 $ $239 $ $204 $ $214 $ $260 $ $222 $ $234 $ $281 $ $240 $ $253 $ $301 $ $257 $ $273 $ $322 $ $275 $ $292 $ $343 $ $293 $ $311 $ $348 $ $297 $ $317 $ $354 $ $302 $ $323 $ $359 $ $306 $ $329 $ $364 $ $311 $ $335 $ $370 $ $315 $ $341 $ $391 $ $333 $ $361 $ $412 $ $351 $ $381 $ $433 $ $369 $ $401 $ $454 $ $387 $ $421 $ $475 $ $405 $ $441 $ $489 $ $418 $ $456 $ $504 $ $430 $ $470 $ $518 $ $443 $ $485 $ $533 $ $455 $ $499 $ $547 $ $467 $ $513 $ $592 $ $506 $ $556 $ $637 $ $544 $ $598 $ $682 $ $582 $ $640 $556 Page 1 of 20

54 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 1 MCOA 2500 MCOA 5000 MCOA 7500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $247 $247 0 $193 $193 0 $141 $141 1 $148 $148 1 $116 $116 1 $84 $84 2 $79 $79 2 $62 $62 2 $45 $45 3 $79 $79 3 $62 $62 3 $45 $45 4 $79 $79 4 $62 $62 4 $45 $45 5 $79 $79 5 $62 $62 5 $45 $45 6 $79 $79 6 $62 $62 6 $45 $45 7 $79 $79 7 $62 $62 7 $45 $45 8 $79 $79 8 $62 $62 8 $45 $45 9 $79 $79 9 $62 $62 9 $45 $45 10 $79 $79 10 $62 $62 10 $45 $45 11 $79 $79 11 $62 $62 11 $45 $45 12 $79 $79 12 $62 $62 12 $45 $45 13 $79 $79 13 $62 $62 13 $45 $45 14 $79 $79 14 $62 $62 14 $45 $45 15 $79 $79 15 $62 $62 15 $45 $45 16 $79 $79 16 $62 $62 16 $45 $45 17 $79 $79 17 $62 $62 17 $45 $45 18 $79 $79 18 $62 $62 18 $45 $45 19 $80 $ $62 $81 19 $46 $59 20 $80 $ $63 $83 20 $46 $61 21 $80 $ $63 $85 21 $46 $62 22 $83 $ $65 $91 22 $47 $66 23 $85 $ $67 $96 23 $49 $70 24 $87 $ $69 $ $50 $74 25 $89 $ $71 $ $52 $78 26 $92 $ $73 $ $54 $82 27 $94 $ $75 $ $55 $86 28 $99 $ $81 $ $59 $90 29 $105 $ $86 $ $63 $95 30 $111 $ $91 $ $66 $99 31 $116 $ $96 $ $70 $ $122 $ $101 $ $74 $ $123 $ $103 $ $75 $ $125 $ $104 $ $76 $ $127 $ $106 $ $77 $ $128 $ $107 $ $78 $ $130 $ $109 $ $80 $ $136 $ $115 $ $84 $ $142 $ $120 $ $88 $ $148 $ $126 $ $92 $ $154 $ $131 $ $96 $ $160 $ $137 $ $100 $ $175 $ $150 $ $109 $ $190 $ $163 $ $119 $ $205 $ $176 $ $128 $ $220 $ $189 $ $138 $ $235 $ $202 $ $148 $ $239 $ $207 $ $151 $ $244 $ $212 $ $155 $ $249 $ $217 $ $158 $ $253 $ $221 $ $161 $ $258 $ $226 $ $165 $ $274 $ $241 $ $176 $ $290 $ $255 $ $186 $ $306 $ $270 $ $197 $ $322 $ $284 $ $207 $ $338 $ $299 $ $218 $ $349 $ $310 $ $226 $ $361 $ $320 $ $234 $ $373 $ $331 $ $242 $ $384 $ $342 $ $250 $ $396 $ $353 $ $258 $ $428 $ $382 $ $279 $ $460 $ $411 $ $300 $ $493 $ $440 $ $321 $279 Page 2 of 20

55 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 1 MCOA HDHP 3000 MCOA HDHP 5000 MCOA Value 2500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $234 $234 0 $180 $180 0 $229 $229 1 $143 $143 1 $108 $108 1 $137 $137 2 $76 $76 2 $58 $58 2 $73 $73 3 $76 $76 3 $58 $58 3 $73 $73 4 $76 $76 4 $58 $58 4 $73 $73 5 $76 $76 5 $58 $58 5 $73 $73 6 $76 $76 6 $58 $58 6 $73 $73 7 $76 $76 7 $58 $58 7 $73 $73 8 $76 $76 8 $58 $58 8 $73 $73 9 $76 $76 9 $58 $58 9 $73 $73 10 $76 $76 10 $58 $58 10 $73 $73 11 $76 $76 11 $58 $58 11 $73 $73 12 $76 $76 12 $58 $58 12 $73 $73 13 $76 $76 13 $58 $58 13 $73 $73 14 $76 $76 14 $58 $58 14 $73 $73 15 $76 $76 15 $58 $58 15 $73 $73 16 $76 $76 16 $58 $58 16 $73 $73 17 $76 $76 17 $58 $58 17 $73 $73 18 $76 $76 18 $58 $58 18 $73 $73 19 $77 $ $60 $82 19 $74 $95 20 $78 $ $58 $78 20 $74 $98 21 $78 $ $59 $80 21 $75 $ $80 $ $61 $85 22 $77 $ $82 $ $63 $90 23 $79 $ $84 $ $65 $95 24 $81 $ $86 $ $67 $ $83 $ $88 $ $68 $ $85 $ $90 $ $70 $ $87 $ $96 $ $75 $ $92 $ $102 $ $80 $ $97 $ $107 $ $85 $ $102 $ $113 $ $90 $ $108 $ $118 $ $94 $ $113 $ $119 $ $96 $ $114 $ $120 $ $97 $ $116 $ $121 $ $99 $ $117 $ $122 $ $100 $ $119 $ $123 $ $102 $ $120 $ $130 $ $107 $ $126 $ $136 $ $112 $ $131 $ $142 $ $117 $ $137 $ $148 $ $122 $ $143 $ $155 $ $128 $ $148 $ $169 $ $140 $ $162 $ $184 $ $152 $ $176 $ $198 $ $164 $ $190 $ $213 $ $177 $ $204 $ $227 $ $189 $ $217 $ $232 $ $193 $ $222 $ $236 $ $198 $ $226 $ $241 $ $202 $ $230 $ $245 $ $207 $ $234 $ $250 $ $211 $ $239 $ $265 $ $225 $ $254 $ $280 $ $238 $ $268 $ $296 $ $252 $ $283 $ $311 $ $265 $ $298 $ $327 $ $279 $ $313 $ $338 $ $289 $ $324 $ $349 $ $299 $ $334 $ $360 $ $309 $ $345 $ $371 $ $319 $ $356 $ $382 $ $330 $ $366 $ $414 $ $357 $ $396 $ $445 $ $384 $ $426 $ $477 $ $411 $ $456 $396 Page 3 of 20

56 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 1 Preventive and Hospital Care 1250 Preventive and Hospital Care 3000 MCOA 750 w/ Medical $50K CYM Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $174 $174 0 $139 $139 0 $438 $438 1 $104 $104 1 $83 $83 1 $263 $263 2 $56 $56 2 $44 $44 2 $140 $140 3 $56 $56 3 $44 $44 3 $140 $140 4 $56 $56 4 $44 $44 4 $140 $140 5 $56 $56 5 $44 $44 5 $140 $140 6 $56 $56 6 $44 $44 6 $140 $140 7 $56 $56 7 $44 $44 7 $140 $140 8 $56 $56 8 $44 $44 8 $140 $140 9 $56 $56 9 $44 $44 9 $140 $ $56 $56 10 $44 $44 10 $140 $ $56 $56 11 $44 $44 11 $140 $ $56 $56 12 $44 $44 12 $140 $ $56 $56 13 $44 $44 13 $140 $ $56 $56 14 $44 $44 14 $140 $ $56 $56 15 $44 $44 15 $140 $ $56 $56 16 $44 $44 16 $140 $ $56 $56 17 $44 $44 17 $140 $ $56 $56 18 $44 $44 18 $140 $ $56 $73 19 $45 $58 19 $142 $ $57 $75 20 $45 $60 20 $142 $ $57 $77 21 $45 $62 21 $143 $ $59 $82 22 $47 $65 22 $147 $ $61 $87 23 $48 $69 23 $150 $ $63 $92 24 $50 $73 24 $154 $ $64 $96 25 $51 $77 25 $158 $ $66 $ $53 $81 26 $162 $ $68 $ $54 $85 27 $165 $ $73 $ $58 $89 28 $175 $ $77 $ $62 $94 29 $184 $ $82 $ $66 $98 30 $193 $ $87 $ $69 $ $202 $ $91 $ $73 $ $211 $ $93 $ $74 $ $214 $ $94 $ $75 $ $216 $ $96 $ $76 $ $218 $ $97 $ $78 $ $220 $ $99 $ $79 $ $223 $ $104 $ $83 $ $232 $ $109 $ $87 $ $242 $ $114 $ $91 $ $251 $ $119 $ $95 $ $260 $ $124 $ $99 $ $270 $ $135 $ $108 $ $294 $ $147 $ $118 $ $319 $ $159 $ $127 $ $343 $ $171 $ $136 $ $368 $ $183 $ $146 $ $392 $ $187 $ $149 $ $399 $ $191 $ $153 $ $407 $ $196 $ $156 $ $414 $ $200 $ $160 $ $422 $ $204 $ $163 $ $429 $ $218 $ $174 $ $454 $ $231 $ $184 $ $480 $ $244 $ $194 $ $505 $ $257 $ $205 $ $530 $ $270 $ $215 $ $555 $ $280 $ $223 $ $574 $ $290 $ $231 $ $592 $ $299 $ $239 $ $610 $ $309 $ $247 $ $628 $ $319 $ $255 $ $646 $ $345 $ $276 $ $699 $ $371 $ $296 $ $752 $ $398 $ $317 $ $805 $700 Page 4 of 20

57 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 1 MCOA 1500 w/ Medical $50K CYM MCOA 2500 w/ Medical $50K CYM Single Single Single Single Age Male Female Age Male Female 0 $336 $336 0 $248 $248 1 $202 $202 1 $149 $149 2 $108 $108 2 $79 $79 3 $108 $108 3 $79 $79 4 $108 $108 4 $79 $79 5 $108 $108 5 $79 $79 6 $108 $108 6 $79 $79 7 $108 $108 7 $79 $79 8 $108 $108 8 $79 $79 9 $108 $108 9 $79 $79 10 $108 $ $79 $79 11 $108 $ $79 $79 12 $108 $ $79 $79 13 $108 $ $79 $79 14 $108 $ $79 $79 15 $108 $ $79 $79 16 $108 $ $79 $79 17 $108 $ $79 $79 18 $108 $ $79 $79 19 $109 $ $80 $ $109 $ $81 $ $109 $ $81 $ $112 $ $83 $ $115 $ $85 $ $118 $ $88 $ $121 $ $90 $ $124 $ $92 $ $127 $ $94 $ $134 $ $100 $ $141 $ $105 $ $148 $ $111 $ $155 $ $117 $ $162 $ $122 $ $164 $ $124 $ $165 $ $126 $ $167 $ $127 $ $169 $ $129 $ $171 $ $130 $ $178 $ $136 $ $185 $ $143 $ $192 $ $149 $ $200 $ $155 $ $207 $ $161 $ $226 $ $176 $ $244 $ $191 $ $263 $ $206 $ $282 $ $221 $ $300 $ $236 $ $306 $ $240 $ $312 $ $245 $ $317 $ $250 $ $323 $ $254 $ $329 $ $259 $ $348 $ $275 $ $367 $ $291 $ $387 $ $307 $ $406 $ $323 $ $426 $ $339 $ $440 $ $351 $ $453 $ $362 $ $467 $ $374 $ $481 $ $386 $ $495 $ $397 $ $536 $ $430 $ $576 $ $462 $ $617 $ $495 $430 Page 5 of 20

58 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 2 First Dollar 30 First Dollar 40 MCOA 1500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $443 $443 0 $378 $378 0 $374 $374 1 $266 $266 1 $227 $227 1 $225 $225 2 $142 $142 2 $121 $121 2 $120 $120 3 $142 $142 3 $121 $121 3 $120 $120 4 $142 $142 4 $121 $121 4 $120 $120 5 $142 $142 5 $121 $121 5 $120 $120 6 $142 $142 6 $121 $121 6 $120 $120 7 $142 $142 7 $121 $121 7 $120 $120 8 $142 $142 8 $121 $121 8 $120 $120 9 $142 $142 9 $121 $121 9 $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $143 $ $122 $ $121 $ $144 $ $123 $ $122 $ $144 $ $123 $ $122 $ $147 $ $126 $ $125 $ $150 $ $128 $ $128 $ $154 $ $131 $ $132 $ $157 $ $134 $ $135 $ $160 $ $137 $ $138 $ $163 $ $139 $ $141 $ $172 $ $147 $ $149 $ $180 $ $154 $ $157 $ $188 $ $161 $ $165 $ $197 $ $168 $ $173 $ $205 $ $175 $ $180 $ $207 $ $177 $ $182 $ $209 $ $178 $ $184 $ $210 $ $179 $ $186 $ $212 $ $181 $ $188 $ $214 $ $182 $ $190 $ $222 $ $190 $ $198 $ $231 $ $197 $ $206 $ $240 $ $205 $ $214 $ $248 $ $212 $ $222 $ $257 $ $219 $ $230 $ $279 $ $238 $ $251 $ $302 $ $257 $ $272 $ $324 $ $277 $ $293 $ $346 $ $296 $ $314 $ $369 $ $315 $ $335 $ $374 $ $320 $ $341 $ $380 $ $324 $ $347 $ $386 $ $329 $ $353 $ $391 $ $334 $ $360 $ $397 $ $339 $ $366 $ $420 $ $358 $ $388 $ $442 $ $378 $ $409 $ $465 $ $397 $ $431 $ $488 $ $416 $ $453 $ $510 $ $436 $ $474 $ $526 $ $449 $ $490 $ $541 $ $462 $ $505 $ $557 $ $475 $ $521 $ $573 $ $489 $ $536 $ $588 $ $502 $ $552 $ $636 $ $543 $ $597 $ $685 $ $584 $ $642 $ $733 $ $625 $ $687 $598 Page 6 of 20

59 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 2 MCOA 2500 MCOA 5000 MCOA 7500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $265 $265 0 $207 $207 0 $151 $151 1 $159 $159 1 $124 $124 1 $91 $91 2 $85 $85 2 $66 $66 2 $48 $48 3 $85 $85 3 $66 $66 3 $48 $48 4 $85 $85 4 $66 $66 4 $48 $48 5 $85 $85 5 $66 $66 5 $48 $48 6 $85 $85 6 $66 $66 6 $48 $48 7 $85 $85 7 $66 $66 7 $48 $48 8 $85 $85 8 $66 $66 8 $48 $48 9 $85 $85 9 $66 $66 9 $48 $48 10 $85 $85 10 $66 $66 10 $48 $48 11 $85 $85 11 $66 $66 11 $48 $48 12 $85 $85 12 $66 $66 12 $48 $48 13 $85 $85 13 $66 $66 13 $48 $48 14 $85 $85 14 $66 $66 14 $48 $48 15 $85 $85 15 $66 $66 15 $48 $48 16 $85 $85 16 $66 $66 16 $48 $48 17 $85 $85 17 $66 $66 17 $48 $48 18 $85 $85 18 $66 $66 18 $48 $48 19 $86 $ $67 $87 19 $49 $63 20 $86 $ $67 $89 20 $49 $65 21 $86 $ $68 $92 21 $49 $67 22 $89 $ $70 $97 22 $51 $71 23 $91 $ $72 $ $53 $75 24 $94 $ $74 $ $54 $79 25 $96 $ $77 $ $56 $84 26 $98 $ $79 $ $57 $88 27 $101 $ $81 $ $59 $92 28 $107 $ $87 $ $63 $97 29 $113 $ $92 $ $67 $ $119 $ $98 $ $71 $ $125 $ $103 $ $75 $ $131 $ $109 $ $79 $ $133 $ $110 $ $80 $ $134 $ $112 $ $82 $ $136 $ $114 $ $83 $ $138 $ $115 $ $84 $ $140 $ $117 $ $85 $ $146 $ $123 $ $90 $ $153 $ $129 $ $94 $ $159 $ $135 $ $98 $ $166 $ $141 $ $103 $ $172 $ $147 $ $107 $ $188 $ $161 $ $117 $ $204 $ $175 $ $128 $ $220 $ $189 $ $138 $ $236 $ $203 $ $148 $ $252 $ $217 $ $159 $ $257 $ $223 $ $162 $ $262 $ $228 $ $166 $ $267 $ $233 $ $170 $ $272 $ $238 $ $174 $ $277 $ $243 $ $177 $ $294 $ $259 $ $189 $ $311 $ $274 $ $200 $ $329 $ $290 $ $211 $ $346 $ $305 $ $223 $ $363 $ $321 $ $234 $ $375 $ $333 $ $243 $ $388 $ $344 $ $251 $ $400 $ $356 $ $260 $ $413 $ $368 $ $268 $ $425 $ $379 $ $277 $ $460 $ $411 $ $299 $ $495 $ $442 $ $322 $ $530 $ $473 $ $345 $300 Page 7 of 20

60 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 2 MCOA HDHP 3000 MCOA HDHP 5000 MCOA Value 2500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $252 $252 0 $193 $193 0 $246 $246 1 $154 $154 1 $116 $116 1 $147 $147 2 $82 $82 2 $62 $62 2 $79 $79 3 $82 $82 3 $62 $62 3 $79 $79 4 $82 $82 4 $62 $62 4 $79 $79 5 $82 $82 5 $62 $62 5 $79 $79 6 $82 $82 6 $62 $62 6 $79 $79 7 $82 $82 7 $62 $62 7 $79 $79 8 $82 $82 8 $62 $62 8 $79 $79 9 $82 $82 9 $62 $62 9 $79 $79 10 $82 $82 10 $62 $62 10 $79 $79 11 $82 $82 11 $62 $62 11 $79 $79 12 $82 $82 12 $62 $62 12 $79 $79 13 $82 $82 13 $62 $62 13 $79 $79 14 $82 $82 14 $62 $62 14 $79 $79 15 $82 $82 15 $62 $62 15 $79 $79 16 $82 $82 16 $62 $62 16 $79 $79 17 $82 $82 17 $62 $62 17 $79 $79 18 $82 $82 18 $62 $62 18 $79 $79 19 $83 $ $64 $88 19 $80 $ $83 $ $63 $83 20 $80 $ $84 $ $63 $86 21 $80 $ $86 $ $65 $91 22 $82 $ $88 $ $67 $96 23 $85 $ $90 $ $69 $ $87 $ $93 $ $71 $ $89 $ $95 $ $74 $ $91 $ $97 $ $76 $ $93 $ $103 $ $81 $ $99 $ $109 $ $86 $ $105 $ $115 $ $91 $ $110 $ $121 $ $96 $ $116 $ $127 $ $101 $ $121 $ $128 $ $103 $ $123 $ $129 $ $105 $ $124 $ $130 $ $106 $ $126 $ $131 $ $108 $ $128 $ $132 $ $109 $ $129 $ $139 $ $115 $ $135 $ $146 $ $120 $ $141 $ $153 $ $126 $ $147 $ $159 $ $132 $ $153 $ $166 $ $137 $ $159 $ $182 $ $150 $ $174 $ $197 $ $163 $ $189 $ $213 $ $177 $ $204 $ $229 $ $190 $ $219 $ $244 $ $203 $ $234 $ $249 $ $208 $ $238 $ $254 $ $212 $ $243 $ $259 $ $217 $ $247 $ $263 $ $222 $ $252 $ $268 $ $227 $ $257 $ $285 $ $241 $ $272 $ $301 $ $256 $ $288 $ $318 $ $270 $ $304 $ $335 $ $285 $ $320 $ $351 $ $299 $ $336 $ $363 $ $310 $ $348 $ $375 $ $321 $ $359 $ $387 $ $332 $ $371 $ $399 $ $343 $ $382 $ $411 $ $354 $ $394 $ $445 $ $383 $ $426 $ $478 $ $412 $ $458 $ $512 $ $441 $ $490 $426 Page 8 of 20

61 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 2 Preventive and Hospital Care 1250 Preventive and Hospital Care 3000 MCOA 750 w/ Medical $50K CYM Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $187 $187 0 $149 $149 0 $471 $471 1 $112 $112 1 $90 $90 1 $283 $283 2 $60 $60 2 $48 $48 2 $151 $151 3 $60 $60 3 $48 $48 3 $151 $151 4 $60 $60 4 $48 $48 4 $151 $151 5 $60 $60 5 $48 $48 5 $151 $151 6 $60 $60 6 $48 $48 6 $151 $151 7 $60 $60 7 $48 $48 7 $151 $151 8 $60 $60 8 $48 $48 8 $151 $151 9 $60 $60 9 $48 $48 9 $151 $ $60 $60 10 $48 $48 10 $151 $ $60 $60 11 $48 $48 11 $151 $ $60 $60 12 $48 $48 12 $151 $ $60 $60 13 $48 $48 13 $151 $ $60 $60 14 $48 $48 14 $151 $ $60 $60 15 $48 $48 15 $151 $ $60 $60 16 $48 $48 16 $151 $ $60 $60 17 $48 $48 17 $151 $ $60 $60 18 $48 $48 18 $151 $ $61 $78 19 $48 $63 19 $153 $ $61 $81 20 $49 $64 20 $153 $ $61 $83 21 $49 $66 21 $153 $ $63 $88 22 $50 $70 22 $157 $ $65 $93 23 $52 $74 23 $161 $ $67 $98 24 $54 $78 24 $166 $ $69 $ $55 $83 25 $170 $ $71 $ $57 $87 26 $174 $ $73 $ $58 $91 27 $178 $ $78 $ $62 $96 28 $188 $ $83 $ $66 $ $198 $ $88 $ $70 $ $207 $ $93 $ $74 $ $217 $ $98 $ $78 $ $227 $ $100 $ $80 $ $229 $ $101 $ $81 $ $232 $ $103 $ $82 $ $234 $ $104 $ $83 $ $237 $ $106 $ $85 $ $239 $ $111 $ $89 $ $249 $ $117 $ $93 $ $260 $ $122 $ $97 $ $270 $ $127 $ $102 $ $280 $ $133 $ $106 $ $290 $ $146 $ $116 $ $316 $ $158 $ $126 $ $342 $ $171 $ $136 $ $369 $ $184 $ $147 $ $395 $ $196 $ $157 $ $421 $ $201 $ $160 $ $429 $ $206 $ $164 $ $437 $ $210 $ $168 $ $445 $ $215 $ $172 $ $453 $ $220 $ $175 $ $461 $ $234 $ $186 $ $488 $ $248 $ $198 $ $515 $ $262 $ $209 $ $542 $ $276 $ $220 $ $570 $ $290 $ $231 $ $597 $ $301 $ $240 $ $616 $ $311 $ $248 $ $636 $ $322 $ $257 $ $655 $ $332 $ $265 $ $675 $ $343 $ $274 $ $694 $ $371 $ $296 $ $751 $ $399 $ $318 $ $808 $ $427 $ $341 $ $865 $753 Page 9 of 20

62 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 2 MCOA 1500 w/ Medical $50K CYM MCOA 2500 w/ Medical $50K CYM Single Single Single Single Age Male Female Age Male Female 0 $361 $361 0 $266 $266 1 $217 $217 1 $160 $160 2 $116 $116 2 $85 $85 3 $116 $116 3 $85 $85 4 $116 $116 4 $85 $85 5 $116 $116 5 $85 $85 6 $116 $116 6 $85 $85 7 $116 $116 7 $85 $85 8 $116 $116 8 $85 $85 9 $116 $116 9 $85 $85 10 $116 $ $85 $85 11 $116 $ $85 $85 12 $116 $ $85 $85 13 $116 $ $85 $85 14 $116 $ $85 $85 15 $116 $ $85 $85 16 $116 $ $85 $85 17 $116 $ $85 $85 18 $116 $ $85 $85 19 $117 $ $86 $ $117 $ $87 $ $117 $ $87 $ $121 $ $89 $ $124 $ $92 $ $127 $ $94 $ $130 $ $96 $ $133 $ $99 $ $136 $ $101 $ $144 $ $107 $ $151 $ $113 $ $159 $ $119 $ $166 $ $125 $ $174 $ $131 $ $176 $ $133 $ $178 $ $135 $ $180 $ $137 $ $181 $ $138 $ $183 $ $140 $ $191 $ $147 $ $199 $ $153 $ $207 $ $160 $ $214 $ $166 $ $222 $ $173 $ $242 $ $189 $ $262 $ $205 $ $282 $ $221 $ $303 $ $237 $ $323 $ $253 $ $329 $ $258 $ $335 $ $263 $ $341 $ $268 $ $347 $ $273 $ $353 $ $278 $ $374 $ $295 $ $395 $ $313 $ $416 $ $330 $ $436 $ $347 $ $457 $ $365 $ $472 $ $377 $ $487 $ $389 $ $502 $ $402 $ $517 $ $414 $ $532 $ $427 $ $576 $ $462 $ $619 $ $497 $ $663 $ $532 $462 Page 10 of 20

63 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 3 First Dollar 30 First Dollar 40 MCOA 1500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $443 $443 0 $378 $378 0 $374 $374 1 $266 $266 1 $227 $227 1 $225 $225 2 $142 $142 2 $121 $121 2 $120 $120 3 $142 $142 3 $121 $121 3 $120 $120 4 $142 $142 4 $121 $121 4 $120 $120 5 $142 $142 5 $121 $121 5 $120 $120 6 $142 $142 6 $121 $121 6 $120 $120 7 $142 $142 7 $121 $121 7 $120 $120 8 $142 $142 8 $121 $121 8 $120 $120 9 $142 $142 9 $121 $121 9 $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $142 $ $121 $ $120 $ $143 $ $122 $ $121 $ $144 $ $123 $ $122 $ $144 $ $123 $ $122 $ $147 $ $126 $ $125 $ $150 $ $128 $ $128 $ $154 $ $131 $ $132 $ $157 $ $134 $ $135 $ $160 $ $137 $ $138 $ $163 $ $139 $ $141 $ $172 $ $147 $ $149 $ $180 $ $154 $ $157 $ $188 $ $161 $ $165 $ $197 $ $168 $ $173 $ $205 $ $175 $ $180 $ $207 $ $177 $ $182 $ $209 $ $178 $ $184 $ $210 $ $179 $ $186 $ $212 $ $181 $ $188 $ $214 $ $182 $ $190 $ $222 $ $190 $ $198 $ $231 $ $197 $ $206 $ $240 $ $205 $ $214 $ $248 $ $212 $ $222 $ $257 $ $219 $ $230 $ $279 $ $238 $ $251 $ $302 $ $257 $ $272 $ $324 $ $277 $ $293 $ $346 $ $296 $ $314 $ $369 $ $315 $ $335 $ $374 $ $320 $ $341 $ $380 $ $324 $ $347 $ $386 $ $329 $ $353 $ $391 $ $334 $ $360 $ $397 $ $339 $ $366 $ $420 $ $358 $ $388 $ $442 $ $378 $ $409 $ $465 $ $397 $ $431 $ $488 $ $416 $ $453 $ $510 $ $436 $ $474 $ $526 $ $449 $ $490 $ $541 $ $462 $ $505 $ $557 $ $475 $ $521 $ $573 $ $489 $ $536 $ $588 $ $502 $ $552 $ $636 $ $543 $ $597 $ $685 $ $584 $ $642 $ $733 $ $625 $ $687 $598 Page 11 of 20

64 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 3 MCOA 2500 MCOA 5000 MCOA 7500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $265 $265 0 $207 $207 0 $151 $151 1 $159 $159 1 $124 $124 1 $91 $91 2 $85 $85 2 $66 $66 2 $48 $48 3 $85 $85 3 $66 $66 3 $48 $48 4 $85 $85 4 $66 $66 4 $48 $48 5 $85 $85 5 $66 $66 5 $48 $48 6 $85 $85 6 $66 $66 6 $48 $48 7 $85 $85 7 $66 $66 7 $48 $48 8 $85 $85 8 $66 $66 8 $48 $48 9 $85 $85 9 $66 $66 9 $48 $48 10 $85 $85 10 $66 $66 10 $48 $48 11 $85 $85 11 $66 $66 11 $48 $48 12 $85 $85 12 $66 $66 12 $48 $48 13 $85 $85 13 $66 $66 13 $48 $48 14 $85 $85 14 $66 $66 14 $48 $48 15 $85 $85 15 $66 $66 15 $48 $48 16 $85 $85 16 $66 $66 16 $48 $48 17 $85 $85 17 $66 $66 17 $48 $48 18 $85 $85 18 $66 $66 18 $48 $48 19 $86 $ $67 $87 19 $49 $63 20 $86 $ $67 $89 20 $49 $65 21 $86 $ $68 $92 21 $49 $67 22 $89 $ $70 $97 22 $51 $71 23 $91 $ $72 $ $53 $75 24 $94 $ $74 $ $54 $79 25 $96 $ $77 $ $56 $84 26 $98 $ $79 $ $57 $88 27 $101 $ $81 $ $59 $92 28 $107 $ $87 $ $63 $97 29 $113 $ $92 $ $67 $ $119 $ $98 $ $71 $ $125 $ $103 $ $75 $ $131 $ $109 $ $79 $ $133 $ $110 $ $80 $ $134 $ $112 $ $82 $ $136 $ $114 $ $83 $ $138 $ $115 $ $84 $ $140 $ $117 $ $85 $ $146 $ $123 $ $90 $ $153 $ $129 $ $94 $ $159 $ $135 $ $98 $ $166 $ $141 $ $103 $ $172 $ $147 $ $107 $ $188 $ $161 $ $117 $ $204 $ $175 $ $128 $ $220 $ $189 $ $138 $ $236 $ $203 $ $148 $ $252 $ $217 $ $159 $ $257 $ $223 $ $162 $ $262 $ $228 $ $166 $ $267 $ $233 $ $170 $ $272 $ $238 $ $174 $ $277 $ $243 $ $177 $ $294 $ $259 $ $189 $ $311 $ $274 $ $200 $ $329 $ $290 $ $211 $ $346 $ $305 $ $223 $ $363 $ $321 $ $234 $ $375 $ $333 $ $243 $ $388 $ $344 $ $251 $ $400 $ $356 $ $260 $ $413 $ $368 $ $268 $ $425 $ $379 $ $277 $ $460 $ $411 $ $299 $ $495 $ $442 $ $322 $ $530 $ $473 $ $345 $300 Page 12 of 20

65 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 3 MCOA HDHP 3000 MCOA HDHP 5000 MCOA Value 2500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $252 $252 0 $193 $193 0 $246 $246 1 $154 $154 1 $116 $116 1 $147 $147 2 $82 $82 2 $62 $62 2 $79 $79 3 $82 $82 3 $62 $62 3 $79 $79 4 $82 $82 4 $62 $62 4 $79 $79 5 $82 $82 5 $62 $62 5 $79 $79 6 $82 $82 6 $62 $62 6 $79 $79 7 $82 $82 7 $62 $62 7 $79 $79 8 $82 $82 8 $62 $62 8 $79 $79 9 $82 $82 9 $62 $62 9 $79 $79 10 $82 $82 10 $62 $62 10 $79 $79 11 $82 $82 11 $62 $62 11 $79 $79 12 $82 $82 12 $62 $62 12 $79 $79 13 $82 $82 13 $62 $62 13 $79 $79 14 $82 $82 14 $62 $62 14 $79 $79 15 $82 $82 15 $62 $62 15 $79 $79 16 $82 $82 16 $62 $62 16 $79 $79 17 $82 $82 17 $62 $62 17 $79 $79 18 $82 $82 18 $62 $62 18 $79 $79 19 $83 $ $64 $88 19 $80 $ $83 $ $63 $83 20 $80 $ $84 $ $63 $86 21 $80 $ $86 $ $65 $91 22 $82 $ $88 $ $67 $96 23 $85 $ $90 $ $69 $ $87 $ $93 $ $71 $ $89 $ $95 $ $74 $ $91 $ $97 $ $76 $ $93 $ $103 $ $81 $ $99 $ $109 $ $86 $ $105 $ $115 $ $91 $ $110 $ $121 $ $96 $ $116 $ $127 $ $101 $ $121 $ $128 $ $103 $ $123 $ $129 $ $105 $ $124 $ $130 $ $106 $ $126 $ $131 $ $108 $ $128 $ $132 $ $109 $ $129 $ $139 $ $115 $ $135 $ $146 $ $120 $ $141 $ $153 $ $126 $ $147 $ $159 $ $132 $ $153 $ $166 $ $137 $ $159 $ $182 $ $150 $ $174 $ $197 $ $163 $ $189 $ $213 $ $177 $ $204 $ $229 $ $190 $ $219 $ $244 $ $203 $ $234 $ $249 $ $208 $ $238 $ $254 $ $212 $ $243 $ $259 $ $217 $ $247 $ $263 $ $222 $ $252 $ $268 $ $227 $ $257 $ $285 $ $241 $ $272 $ $301 $ $256 $ $288 $ $318 $ $270 $ $304 $ $335 $ $285 $ $320 $ $351 $ $299 $ $336 $ $363 $ $310 $ $348 $ $375 $ $321 $ $359 $ $387 $ $332 $ $371 $ $399 $ $343 $ $382 $ $411 $ $354 $ $394 $ $445 $ $383 $ $426 $ $478 $ $412 $ $458 $ $512 $ $441 $ $490 $426 Page 13 of 20

66 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 3 Preventive and Hospital Care 1250 Preventive and Hospital Care 3000 MCOA 750 w/ Medical $50K CYM Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $187 $187 0 $149 $149 0 $471 $471 1 $112 $112 1 $90 $90 1 $283 $283 2 $60 $60 2 $48 $48 2 $151 $151 3 $60 $60 3 $48 $48 3 $151 $151 4 $60 $60 4 $48 $48 4 $151 $151 5 $60 $60 5 $48 $48 5 $151 $151 6 $60 $60 6 $48 $48 6 $151 $151 7 $60 $60 7 $48 $48 7 $151 $151 8 $60 $60 8 $48 $48 8 $151 $151 9 $60 $60 9 $48 $48 9 $151 $ $60 $60 10 $48 $48 10 $151 $ $60 $60 11 $48 $48 11 $151 $ $60 $60 12 $48 $48 12 $151 $ $60 $60 13 $48 $48 13 $151 $ $60 $60 14 $48 $48 14 $151 $ $60 $60 15 $48 $48 15 $151 $ $60 $60 16 $48 $48 16 $151 $ $60 $60 17 $48 $48 17 $151 $ $60 $60 18 $48 $48 18 $151 $ $61 $78 19 $48 $63 19 $153 $ $61 $81 20 $49 $64 20 $153 $ $61 $83 21 $49 $66 21 $153 $ $63 $88 22 $50 $70 22 $157 $ $65 $93 23 $52 $74 23 $161 $ $67 $98 24 $54 $78 24 $166 $ $69 $ $55 $83 25 $170 $ $71 $ $57 $87 26 $174 $ $73 $ $58 $91 27 $178 $ $78 $ $62 $96 28 $188 $ $83 $ $66 $ $198 $ $88 $ $70 $ $207 $ $93 $ $74 $ $217 $ $98 $ $78 $ $227 $ $100 $ $80 $ $229 $ $101 $ $81 $ $232 $ $103 $ $82 $ $234 $ $104 $ $83 $ $237 $ $106 $ $85 $ $239 $ $111 $ $89 $ $249 $ $117 $ $93 $ $260 $ $122 $ $97 $ $270 $ $127 $ $102 $ $280 $ $133 $ $106 $ $290 $ $146 $ $116 $ $316 $ $158 $ $126 $ $342 $ $171 $ $136 $ $369 $ $184 $ $147 $ $395 $ $196 $ $157 $ $421 $ $201 $ $160 $ $429 $ $206 $ $164 $ $437 $ $210 $ $168 $ $445 $ $215 $ $172 $ $453 $ $220 $ $175 $ $461 $ $234 $ $186 $ $488 $ $248 $ $198 $ $515 $ $262 $ $209 $ $542 $ $276 $ $220 $ $570 $ $290 $ $231 $ $597 $ $301 $ $240 $ $616 $ $311 $ $248 $ $636 $ $322 $ $257 $ $655 $ $332 $ $265 $ $675 $ $343 $ $274 $ $694 $ $371 $ $296 $ $751 $ $399 $ $318 $ $808 $ $427 $ $341 $ $865 $753 Page 14 of 20

67 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 3 MCOA 1500 w/ Medical $50K CYM MCOA 2500 w/ Medical $50K CYM Single Single Single Single Age Male Female Age Male Female 0 $361 $361 0 $266 $266 1 $217 $217 1 $160 $160 2 $116 $116 2 $85 $85 3 $116 $116 3 $85 $85 4 $116 $116 4 $85 $85 5 $116 $116 5 $85 $85 6 $116 $116 6 $85 $85 7 $116 $116 7 $85 $85 8 $116 $116 8 $85 $85 9 $116 $116 9 $85 $85 10 $116 $ $85 $85 11 $116 $ $85 $85 12 $116 $ $85 $85 13 $116 $ $85 $85 14 $116 $ $85 $85 15 $116 $ $85 $85 16 $116 $ $85 $85 17 $116 $ $85 $85 18 $116 $ $85 $85 19 $117 $ $86 $ $117 $ $87 $ $117 $ $87 $ $121 $ $89 $ $124 $ $92 $ $127 $ $94 $ $130 $ $96 $ $133 $ $99 $ $136 $ $101 $ $144 $ $107 $ $151 $ $113 $ $159 $ $119 $ $166 $ $125 $ $174 $ $131 $ $176 $ $133 $ $178 $ $135 $ $180 $ $137 $ $181 $ $138 $ $183 $ $140 $ $191 $ $147 $ $199 $ $153 $ $207 $ $160 $ $214 $ $166 $ $222 $ $173 $ $242 $ $189 $ $262 $ $205 $ $282 $ $221 $ $303 $ $237 $ $323 $ $253 $ $329 $ $258 $ $335 $ $263 $ $341 $ $268 $ $347 $ $273 $ $353 $ $278 $ $374 $ $295 $ $395 $ $313 $ $416 $ $330 $ $436 $ $347 $ $457 $ $365 $ $472 $ $377 $ $487 $ $389 $ $502 $ $402 $ $517 $ $414 $ $532 $ $427 $ $576 $ $462 $ $619 $ $497 $ $663 $ $532 $462 Page 15 of 20

68 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 4 First Dollar 30 First Dollar 40 MCOA 1500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $412 $412 0 $352 $352 0 $348 $348 1 $247 $247 1 $211 $211 1 $209 $209 2 $132 $132 2 $113 $113 2 $111 $111 3 $132 $132 3 $113 $113 3 $111 $111 4 $132 $132 4 $113 $113 4 $111 $111 5 $132 $132 5 $113 $113 5 $111 $111 6 $132 $132 6 $113 $113 6 $111 $111 7 $132 $132 7 $113 $113 7 $111 $111 8 $132 $132 8 $113 $113 8 $111 $111 9 $132 $132 9 $113 $113 9 $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $132 $ $113 $ $111 $ $133 $ $114 $ $113 $ $134 $ $114 $ $113 $ $134 $ $114 $ $113 $ $137 $ $117 $ $116 $ $140 $ $120 $ $119 $ $143 $ $122 $ $122 $ $146 $ $125 $ $125 $ $149 $ $127 $ $128 $ $152 $ $130 $ $131 $ $160 $ $136 $ $139 $ $168 $ $143 $ $146 $ $175 $ $150 $ $153 $ $183 $ $156 $ $161 $ $191 $ $163 $ $168 $ $193 $ $164 $ $170 $ $194 $ $166 $ $171 $ $196 $ $167 $ $173 $ $197 $ $168 $ $175 $ $199 $ $170 $ $177 $ $207 $ $177 $ $184 $ $215 $ $183 $ $192 $ $223 $ $190 $ $199 $ $231 $ $197 $ $207 $ $239 $ $204 $ $214 $ $260 $ $222 $ $234 $ $281 $ $240 $ $253 $ $301 $ $257 $ $273 $ $322 $ $275 $ $292 $ $343 $ $293 $ $311 $ $348 $ $297 $ $317 $ $354 $ $302 $ $323 $ $359 $ $306 $ $329 $ $364 $ $311 $ $335 $ $370 $ $315 $ $341 $ $391 $ $333 $ $361 $ $412 $ $351 $ $381 $ $433 $ $369 $ $401 $ $454 $ $387 $ $421 $ $475 $ $405 $ $441 $ $489 $ $418 $ $456 $ $504 $ $430 $ $470 $ $518 $ $443 $ $485 $ $533 $ $455 $ $499 $ $547 $ $467 $ $513 $ $592 $ $506 $ $556 $ $637 $ $544 $ $598 $ $682 $ $582 $ $640 $556 Page 16 of 20

69 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 4 MCOA 2500 MCOA 5000 MCOA 7500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $247 $247 0 $193 $193 0 $141 $141 1 $148 $148 1 $116 $116 1 $84 $84 2 $79 $79 2 $62 $62 2 $45 $45 3 $79 $79 3 $62 $62 3 $45 $45 4 $79 $79 4 $62 $62 4 $45 $45 5 $79 $79 5 $62 $62 5 $45 $45 6 $79 $79 6 $62 $62 6 $45 $45 7 $79 $79 7 $62 $62 7 $45 $45 8 $79 $79 8 $62 $62 8 $45 $45 9 $79 $79 9 $62 $62 9 $45 $45 10 $79 $79 10 $62 $62 10 $45 $45 11 $79 $79 11 $62 $62 11 $45 $45 12 $79 $79 12 $62 $62 12 $45 $45 13 $79 $79 13 $62 $62 13 $45 $45 14 $79 $79 14 $62 $62 14 $45 $45 15 $79 $79 15 $62 $62 15 $45 $45 16 $79 $79 16 $62 $62 16 $45 $45 17 $79 $79 17 $62 $62 17 $45 $45 18 $79 $79 18 $62 $62 18 $45 $45 19 $80 $ $62 $81 19 $46 $59 20 $80 $ $63 $83 20 $46 $61 21 $80 $ $63 $85 21 $46 $62 22 $83 $ $65 $91 22 $47 $66 23 $85 $ $67 $96 23 $49 $70 24 $87 $ $69 $ $50 $74 25 $89 $ $71 $ $52 $78 26 $92 $ $73 $ $54 $82 27 $94 $ $75 $ $55 $86 28 $99 $ $81 $ $59 $90 29 $105 $ $86 $ $63 $95 30 $111 $ $91 $ $66 $99 31 $116 $ $96 $ $70 $ $122 $ $101 $ $74 $ $123 $ $103 $ $75 $ $125 $ $104 $ $76 $ $127 $ $106 $ $77 $ $128 $ $107 $ $78 $ $130 $ $109 $ $80 $ $136 $ $115 $ $84 $ $142 $ $120 $ $88 $ $148 $ $126 $ $92 $ $154 $ $131 $ $96 $ $160 $ $137 $ $100 $ $175 $ $150 $ $109 $ $190 $ $163 $ $119 $ $205 $ $176 $ $128 $ $220 $ $189 $ $138 $ $235 $ $202 $ $148 $ $239 $ $207 $ $151 $ $244 $ $212 $ $155 $ $249 $ $217 $ $158 $ $253 $ $221 $ $161 $ $258 $ $226 $ $165 $ $274 $ $241 $ $176 $ $290 $ $255 $ $186 $ $306 $ $270 $ $197 $ $322 $ $284 $ $207 $ $338 $ $299 $ $218 $ $349 $ $310 $ $226 $ $361 $ $320 $ $234 $ $373 $ $331 $ $242 $ $384 $ $342 $ $250 $ $396 $ $353 $ $258 $ $428 $ $382 $ $279 $ $460 $ $411 $ $300 $ $493 $ $440 $ $321 $279 Page 17 of 20

70 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 4 MCOA HDHP 3000 MCOA HDHP 5000 MCOA Value 2500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $234 $234 0 $180 $180 0 $229 $229 1 $143 $143 1 $108 $108 1 $137 $137 2 $76 $76 2 $58 $58 2 $73 $73 3 $76 $76 3 $58 $58 3 $73 $73 4 $76 $76 4 $58 $58 4 $73 $73 5 $76 $76 5 $58 $58 5 $73 $73 6 $76 $76 6 $58 $58 6 $73 $73 7 $76 $76 7 $58 $58 7 $73 $73 8 $76 $76 8 $58 $58 8 $73 $73 9 $76 $76 9 $58 $58 9 $73 $73 10 $76 $76 10 $58 $58 10 $73 $73 11 $76 $76 11 $58 $58 11 $73 $73 12 $76 $76 12 $58 $58 12 $73 $73 13 $76 $76 13 $58 $58 13 $73 $73 14 $76 $76 14 $58 $58 14 $73 $73 15 $76 $76 15 $58 $58 15 $73 $73 16 $76 $76 16 $58 $58 16 $73 $73 17 $76 $76 17 $58 $58 17 $73 $73 18 $76 $76 18 $58 $58 18 $73 $73 19 $77 $ $60 $82 19 $74 $95 20 $78 $ $58 $78 20 $74 $98 21 $78 $ $59 $80 21 $75 $ $80 $ $61 $85 22 $77 $ $82 $ $63 $90 23 $79 $ $84 $ $65 $95 24 $81 $ $86 $ $67 $ $83 $ $88 $ $68 $ $85 $ $90 $ $70 $ $87 $ $96 $ $75 $ $92 $ $102 $ $80 $ $97 $ $107 $ $85 $ $102 $ $113 $ $90 $ $108 $ $118 $ $94 $ $113 $ $119 $ $96 $ $114 $ $120 $ $97 $ $116 $ $121 $ $99 $ $117 $ $122 $ $100 $ $119 $ $123 $ $102 $ $120 $ $130 $ $107 $ $126 $ $136 $ $112 $ $131 $ $142 $ $117 $ $137 $ $148 $ $122 $ $143 $ $155 $ $128 $ $148 $ $169 $ $140 $ $162 $ $184 $ $152 $ $176 $ $198 $ $164 $ $190 $ $213 $ $177 $ $204 $ $227 $ $189 $ $217 $ $232 $ $193 $ $222 $ $236 $ $198 $ $226 $ $241 $ $202 $ $230 $ $245 $ $207 $ $234 $ $250 $ $211 $ $239 $ $265 $ $225 $ $254 $ $280 $ $238 $ $268 $ $296 $ $252 $ $283 $ $311 $ $265 $ $298 $ $327 $ $279 $ $313 $ $338 $ $289 $ $324 $ $349 $ $299 $ $334 $ $360 $ $309 $ $345 $ $371 $ $319 $ $356 $ $382 $ $330 $ $366 $ $414 $ $357 $ $396 $ $445 $ $384 $ $426 $ $477 $ $411 $ $456 $396 Page 18 of 20

71 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 4 Preventive and Hospital Care 1250 Preventive and Hospital Care 3000 MCOA 750 w/ Medical $50K CYM Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $174 $174 0 $139 $139 0 $438 $438 1 $104 $104 1 $83 $83 1 $263 $263 2 $56 $56 2 $44 $44 2 $140 $140 3 $56 $56 3 $44 $44 3 $140 $140 4 $56 $56 4 $44 $44 4 $140 $140 5 $56 $56 5 $44 $44 5 $140 $140 6 $56 $56 6 $44 $44 6 $140 $140 7 $56 $56 7 $44 $44 7 $140 $140 8 $56 $56 8 $44 $44 8 $140 $140 9 $56 $56 9 $44 $44 9 $140 $ $56 $56 10 $44 $44 10 $140 $ $56 $56 11 $44 $44 11 $140 $ $56 $56 12 $44 $44 12 $140 $ $56 $56 13 $44 $44 13 $140 $ $56 $56 14 $44 $44 14 $140 $ $56 $56 15 $44 $44 15 $140 $ $56 $56 16 $44 $44 16 $140 $ $56 $56 17 $44 $44 17 $140 $ $56 $56 18 $44 $44 18 $140 $ $56 $73 19 $45 $58 19 $142 $ $57 $75 20 $45 $60 20 $142 $ $57 $77 21 $45 $62 21 $143 $ $59 $82 22 $47 $65 22 $147 $ $61 $87 23 $48 $69 23 $150 $ $63 $92 24 $50 $73 24 $154 $ $64 $96 25 $51 $77 25 $158 $ $66 $ $53 $81 26 $162 $ $68 $ $54 $85 27 $165 $ $73 $ $58 $89 28 $175 $ $77 $ $62 $94 29 $184 $ $82 $ $66 $98 30 $193 $ $87 $ $69 $ $202 $ $91 $ $73 $ $211 $ $93 $ $74 $ $214 $ $94 $ $75 $ $216 $ $96 $ $76 $ $218 $ $97 $ $78 $ $220 $ $99 $ $79 $ $223 $ $104 $ $83 $ $232 $ $109 $ $87 $ $242 $ $114 $ $91 $ $251 $ $119 $ $95 $ $260 $ $124 $ $99 $ $270 $ $135 $ $108 $ $294 $ $147 $ $118 $ $319 $ $159 $ $127 $ $343 $ $171 $ $136 $ $368 $ $183 $ $146 $ $392 $ $187 $ $149 $ $399 $ $191 $ $153 $ $407 $ $196 $ $156 $ $414 $ $200 $ $160 $ $422 $ $204 $ $163 $ $429 $ $218 $ $174 $ $454 $ $231 $ $184 $ $480 $ $244 $ $194 $ $505 $ $257 $ $205 $ $530 $ $270 $ $215 $ $555 $ $280 $ $223 $ $574 $ $290 $ $231 $ $592 $ $299 $ $239 $ $610 $ $309 $ $247 $ $628 $ $319 $ $255 $ $646 $ $345 $ $276 $ $699 $ $371 $ $296 $ $752 $ $398 $ $317 $ $805 $700 Page 19 of 20

72 Exhibit I For Original Coverage Effective Dates Between June 1, 2008 and December 31, 2009 State: Connecticut - Block B Rating Area: 4 MCOA 1500 w/ Medical $50K CYM MCOA 2500 w/ Medical $50K CYM Single Single Single Single Age Male Female Age Male Female 0 $336 $336 0 $248 $248 1 $202 $202 1 $149 $149 2 $108 $108 2 $79 $79 3 $108 $108 3 $79 $79 4 $108 $108 4 $79 $79 5 $108 $108 5 $79 $79 6 $108 $108 6 $79 $79 7 $108 $108 7 $79 $79 8 $108 $108 8 $79 $79 9 $108 $108 9 $79 $79 10 $108 $ $79 $79 11 $108 $ $79 $79 12 $108 $ $79 $79 13 $108 $ $79 $79 14 $108 $ $79 $79 15 $108 $ $79 $79 16 $108 $ $79 $79 17 $108 $ $79 $79 18 $108 $ $79 $79 19 $109 $ $80 $ $109 $ $81 $ $109 $ $81 $ $112 $ $83 $ $115 $ $85 $ $118 $ $88 $ $121 $ $90 $ $124 $ $92 $ $127 $ $94 $ $134 $ $100 $ $141 $ $105 $ $148 $ $111 $ $155 $ $117 $ $162 $ $122 $ $164 $ $124 $ $165 $ $126 $ $167 $ $127 $ $169 $ $129 $ $171 $ $130 $ $178 $ $136 $ $185 $ $143 $ $192 $ $149 $ $200 $ $155 $ $207 $ $161 $ $226 $ $176 $ $244 $ $191 $ $263 $ $206 $ $282 $ $221 $ $300 $ $236 $ $306 $ $240 $ $312 $ $245 $ $317 $ $250 $ $323 $ $254 $ $329 $ $259 $ $348 $ $275 $ $367 $ $291 $ $387 $ $307 $ $406 $ $323 $ $426 $ $339 $ $440 $ $351 $ $453 $ $362 $ $467 $ $374 $ $481 $ $386 $ $495 $ $397 $ $536 $ $430 $ $576 $ $462 $ $617 $ $495 $430 Page 20 of 20

73 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 1 First Dollar 30 First Dollar 40 MCOA 1500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $431 $431 0 $368 $368 0 $365 $365 1 $259 $259 1 $221 $221 1 $219 $219 2 $138 $138 2 $118 $118 2 $117 $117 3 $138 $138 3 $118 $118 3 $117 $117 4 $138 $138 4 $118 $118 4 $117 $117 5 $138 $138 5 $118 $118 5 $117 $117 6 $138 $138 6 $118 $118 6 $117 $117 7 $138 $138 7 $118 $118 7 $117 $117 8 $138 $138 8 $118 $118 8 $117 $117 9 $138 $138 9 $118 $118 9 $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $140 $ $119 $ $118 $ $140 $ $119 $ $118 $ $140 $ $120 $ $119 $ $143 $ $122 $ $122 $ $147 $ $125 $ $125 $ $150 $ $128 $ $128 $ $153 $ $130 $ $131 $ $156 $ $133 $ $134 $ $159 $ $136 $ $138 $ $167 $ $143 $ $145 $ $175 $ $150 $ $153 $ $184 $ $157 $ $160 $ $192 $ $164 $ $168 $ $200 $ $171 $ $176 $ $202 $ $172 $ $178 $ $203 $ $173 $ $179 $ $205 $ $175 $ $181 $ $206 $ $176 $ $183 $ $208 $ $178 $ $185 $ $217 $ $185 $ $193 $ $225 $ $192 $ $201 $ $233 $ $199 $ $209 $ $242 $ $206 $ $217 $ $250 $ $214 $ $224 $ $272 $ $232 $ $245 $ $294 $ $251 $ $265 $ $316 $ $269 $ $285 $ $337 $ $288 $ $306 $ $359 $ $307 $ $326 $ $365 $ $311 $ $332 $ $370 $ $316 $ $338 $ $376 $ $321 $ $344 $ $381 $ $325 $ $351 $ $387 $ $330 $ $357 $ $409 $ $349 $ $378 $ $431 $ $368 $ $399 $ $453 $ $387 $ $420 $ $475 $ $406 $ $441 $ $497 $ $424 $ $462 $ $512 $ $437 $ $477 $ $527 $ $450 $ $492 $ $543 $ $463 $ $507 $ $558 $ $476 $ $522 $ $573 $ $489 $ $537 $ $620 $ $529 $ $582 $ $667 $ $569 $ $626 $ $714 $ $609 $ $670 $582 Page 1 of 20

74 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 1 MCOA 2500 MCOA 5000 MCOA 7500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $259 $259 0 $202 $202 0 $147 $147 1 $155 $155 1 $121 $121 1 $88 $88 2 $83 $83 2 $65 $65 2 $47 $47 3 $83 $83 3 $65 $65 3 $47 $47 4 $83 $83 4 $65 $65 4 $47 $47 5 $83 $83 5 $65 $65 5 $47 $47 6 $83 $83 6 $65 $65 6 $47 $47 7 $83 $83 7 $65 $65 7 $47 $47 8 $83 $83 8 $65 $65 8 $47 $47 9 $83 $83 9 $65 $65 9 $47 $47 10 $83 $83 10 $65 $65 10 $47 $47 11 $83 $83 11 $65 $65 11 $47 $47 12 $83 $83 12 $65 $65 12 $47 $47 13 $83 $83 13 $65 $65 13 $47 $47 14 $83 $83 14 $65 $65 14 $47 $47 15 $83 $83 15 $65 $65 15 $47 $47 16 $83 $83 16 $65 $65 16 $47 $47 17 $83 $83 17 $65 $65 17 $47 $47 18 $83 $83 18 $65 $65 18 $47 $47 19 $84 $ $65 $85 19 $48 $62 20 $84 $ $66 $87 20 $48 $63 21 $84 $ $66 $89 21 $48 $65 22 $87 $ $68 $95 22 $50 $69 23 $89 $ $70 $ $51 $73 24 $91 $ $72 $ $53 $77 25 $94 $ $75 $ $54 $81 26 $96 $ $77 $ $56 $85 27 $98 $ $79 $ $58 $89 28 $104 $ $84 $ $62 $94 29 $110 $ $90 $ $65 $99 30 $116 $ $95 $ $69 $ $122 $ $100 $ $73 $ $128 $ $106 $ $77 $ $129 $ $108 $ $78 $ $131 $ $109 $ $80 $ $133 $ $111 $ $81 $ $134 $ $113 $ $82 $ $136 $ $114 $ $83 $ $142 $ $120 $ $87 $ $149 $ $126 $ $92 $ $155 $ $132 $ $96 $ $161 $ $137 $ $100 $ $168 $ $143 $ $104 $ $183 $ $157 $ $114 $ $199 $ $171 $ $124 $ $214 $ $184 $ $134 $ $230 $ $198 $ $144 $ $246 $ $212 $ $154 $ $251 $ $217 $ $158 $ $255 $ $222 $ $162 $ $260 $ $227 $ $165 $ $265 $ $232 $ $169 $ $270 $ $237 $ $173 $ $287 $ $252 $ $184 $ $303 $ $267 $ $195 $ $320 $ $282 $ $206 $ $337 $ $297 $ $217 $ $354 $ $313 $ $228 $ $366 $ $324 $ $236 $ $378 $ $335 $ $245 $ $390 $ $347 $ $253 $ $402 $ $358 $ $261 $ $414 $ $370 $ $270 $ $448 $ $400 $ $292 $ $482 $ $430 $ $314 $ $516 $ $461 $ $336 $292 Page 2 of 20

75 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 1 MCOA HDHP 3000 MCOA HDHP 5000 MCOA Value 2500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $245 $245 0 $188 $188 0 $239 $239 1 $150 $150 1 $113 $113 1 $144 $144 2 $80 $80 2 $60 $60 2 $77 $77 3 $80 $80 3 $60 $60 3 $77 $77 4 $80 $80 4 $60 $60 4 $77 $77 5 $80 $80 5 $60 $60 5 $77 $77 6 $80 $80 6 $60 $60 6 $77 $77 7 $80 $80 7 $60 $60 7 $77 $77 8 $80 $80 8 $60 $60 8 $77 $77 9 $80 $80 9 $60 $60 9 $77 $77 10 $80 $80 10 $60 $60 10 $77 $77 11 $80 $80 11 $60 $60 11 $77 $77 12 $80 $80 12 $60 $60 12 $77 $77 13 $80 $80 13 $60 $60 13 $77 $77 14 $80 $80 14 $60 $60 14 $77 $77 15 $80 $80 15 $60 $60 15 $77 $77 16 $80 $80 16 $60 $60 16 $77 $77 17 $80 $80 17 $60 $60 17 $77 $77 18 $80 $80 18 $60 $60 18 $77 $77 19 $81 $ $62 $86 19 $78 $ $81 $ $61 $81 20 $78 $ $81 $ $61 $83 21 $78 $ $84 $ $63 $89 22 $80 $ $86 $ $66 $94 23 $82 $ $88 $ $68 $99 24 $84 $ $90 $ $70 $ $87 $ $92 $ $72 $ $89 $ $95 $ $74 $ $91 $ $100 $ $79 $ $96 $ $106 $ $84 $ $102 $ $112 $ $89 $ $107 $ $118 $ $94 $ $113 $ $124 $ $99 $ $118 $ $125 $ $100 $ $120 $ $126 $ $102 $ $121 $ $127 $ $103 $ $123 $ $128 $ $105 $ $124 $ $129 $ $107 $ $126 $ $136 $ $112 $ $132 $ $142 $ $117 $ $138 $ $149 $ $123 $ $143 $ $155 $ $128 $ $149 $ $162 $ $134 $ $155 $ $177 $ $146 $ $170 $ $192 $ $159 $ $184 $ $207 $ $172 $ $199 $ $223 $ $185 $ $213 $ $238 $ $198 $ $227 $ $243 $ $202 $ $232 $ $247 $ $207 $ $236 $ $252 $ $212 $ $241 $ $257 $ $216 $ $245 $ $261 $ $221 $ $250 $ $277 $ $235 $ $265 $ $294 $ $249 $ $281 $ $310 $ $263 $ $296 $ $326 $ $278 $ $312 $ $342 $ $292 $ $327 $ $354 $ $302 $ $339 $ $365 $ $313 $ $350 $ $377 $ $324 $ $361 $ $389 $ $334 $ $372 $ $400 $ $345 $ $383 $ $433 $ $373 $ $415 $ $466 $ $402 $ $446 $ $499 $ $430 $ $478 $415 Page 3 of 20

76 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 1 Preventive and Hospital Care 1250 Preventive and Hospital Care 3000 MCOA 750 w/ Medical $50K CYM Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $182 $182 0 $145 $145 0 $459 $459 1 $109 $109 1 $87 $87 1 $275 $275 2 $58 $58 2 $47 $47 2 $147 $147 3 $58 $58 3 $47 $47 3 $147 $147 4 $58 $58 4 $47 $47 4 $147 $147 5 $58 $58 5 $47 $47 5 $147 $147 6 $58 $58 6 $47 $47 6 $147 $147 7 $58 $58 7 $47 $47 7 $147 $147 8 $58 $58 8 $47 $47 8 $147 $147 9 $58 $58 9 $47 $47 9 $147 $ $58 $58 10 $47 $47 10 $147 $ $58 $58 11 $47 $47 11 $147 $ $58 $58 12 $47 $47 12 $147 $ $58 $58 13 $47 $47 13 $147 $ $58 $58 14 $47 $47 14 $147 $ $58 $58 15 $47 $47 15 $147 $ $58 $58 16 $47 $47 16 $147 $ $58 $58 17 $47 $47 17 $147 $ $58 $58 18 $47 $47 18 $147 $ $59 $76 19 $47 $61 19 $149 $ $59 $79 20 $47 $63 20 $149 $ $59 $81 21 $47 $64 21 $149 $ $61 $86 22 $49 $68 22 $153 $ $63 $91 23 $51 $72 23 $157 $ $65 $96 24 $52 $76 24 $161 $ $67 $ $54 $80 25 $165 $ $69 $ $55 $84 26 $169 $ $71 $ $57 $88 27 $173 $ $76 $ $61 $93 28 $183 $ $81 $ $65 $98 29 $192 $ $86 $ $69 $ $202 $ $91 $ $72 $ $212 $ $96 $ $76 $ $221 $ $97 $ $78 $ $224 $ $99 $ $79 $ $226 $ $100 $ $80 $ $228 $ $102 $ $81 $ $231 $ $103 $ $82 $ $233 $ $108 $ $86 $ $243 $ $114 $ $91 $ $253 $ $119 $ $95 $ $263 $ $124 $ $99 $ $273 $ $129 $ $103 $ $283 $ $142 $ $113 $ $308 $ $154 $ $123 $ $334 $ $167 $ $133 $ $359 $ $179 $ $143 $ $385 $ $191 $ $153 $ $410 $ $196 $ $156 $ $418 $ $200 $ $160 $ $426 $ $205 $ $164 $ $433 $ $209 $ $167 $ $441 $ $214 $ $171 $ $449 $ $228 $ $182 $ $475 $ $241 $ $193 $ $502 $ $255 $ $204 $ $528 $ $269 $ $214 $ $555 $ $283 $ $225 $ $581 $ $293 $ $234 $ $600 $ $303 $ $242 $ $619 $ $313 $ $250 $ $638 $ $324 $ $258 $ $657 $ $334 $ $267 $ $677 $ $361 $ $288 $ $732 $ $389 $ $310 $ $787 $ $416 $ $332 $ $843 $733 Page 4 of 20

77 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 1 MCOA 1500 w/ Medical $50K CYM MCOA 2500 w/ Medical $50K CYM Single Single Single Single Age Male Female Age Male Female 0 $352 $352 0 $260 $260 1 $211 $211 1 $156 $156 2 $113 $113 2 $83 $83 3 $113 $113 3 $83 $83 4 $113 $113 4 $83 $83 5 $113 $113 5 $83 $83 6 $113 $113 6 $83 $83 7 $113 $113 7 $83 $83 8 $113 $113 8 $83 $83 9 $113 $113 9 $83 $83 10 $113 $ $83 $83 11 $113 $ $83 $83 12 $113 $ $83 $83 13 $113 $ $83 $83 14 $113 $ $83 $83 15 $113 $ $83 $83 16 $113 $ $83 $83 17 $113 $ $83 $83 18 $113 $ $83 $83 19 $114 $ $84 $ $114 $ $84 $ $114 $ $85 $ $118 $ $87 $ $121 $ $89 $ $124 $ $92 $ $127 $ $94 $ $130 $ $96 $ $133 $ $99 $ $140 $ $105 $ $147 $ $110 $ $155 $ $116 $ $162 $ $122 $ $169 $ $128 $ $171 $ $130 $ $173 $ $131 $ $175 $ $133 $ $177 $ $135 $ $178 $ $136 $ $186 $ $143 $ $194 $ $149 $ $201 $ $156 $ $209 $ $162 $ $217 $ $168 $ $236 $ $184 $ $256 $ $200 $ $275 $ $215 $ $295 $ $231 $ $314 $ $247 $ $320 $ $252 $ $326 $ $256 $ $332 $ $261 $ $338 $ $266 $ $344 $ $271 $ $364 $ $288 $ $385 $ $305 $ $405 $ $321 $ $425 $ $338 $ $445 $ $355 $ $460 $ $367 $ $475 $ $379 $ $489 $ $392 $ $504 $ $404 $ $518 $ $416 $ $561 $ $450 $ $603 $ $484 $ $646 $ $518 $450 Page 5 of 20

78 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 2 First Dollar 30 First Dollar 40 MCOA 1500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $463 $463 0 $395 $395 0 $392 $392 1 $278 $278 1 $237 $237 1 $235 $235 2 $148 $148 2 $127 $127 2 $125 $125 3 $148 $148 3 $127 $127 3 $125 $125 4 $148 $148 4 $127 $127 4 $125 $125 5 $148 $148 5 $127 $127 5 $125 $125 6 $148 $148 6 $127 $127 6 $125 $125 7 $148 $148 7 $127 $127 7 $125 $125 8 $148 $148 8 $127 $127 8 $125 $125 9 $148 $148 9 $127 $127 9 $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $150 $ $128 $ $127 $ $150 $ $128 $ $127 $ $151 $ $129 $ $128 $ $154 $ $132 $ $131 $ $157 $ $134 $ $134 $ $161 $ $137 $ $138 $ $164 $ $140 $ $141 $ $167 $ $143 $ $144 $ $171 $ $146 $ $148 $ $180 $ $153 $ $156 $ $188 $ $161 $ $164 $ $197 $ $168 $ $172 $ $206 $ $176 $ $181 $ $215 $ $183 $ $189 $ $217 $ $185 $ $191 $ $218 $ $186 $ $193 $ $220 $ $188 $ $195 $ $222 $ $189 $ $197 $ $224 $ $191 $ $199 $ $233 $ $199 $ $207 $ $242 $ $206 $ $216 $ $251 $ $214 $ $224 $ $260 $ $222 $ $233 $ $269 $ $230 $ $241 $ $292 $ $250 $ $263 $ $316 $ $269 $ $285 $ $339 $ $289 $ $307 $ $362 $ $309 $ $328 $ $386 $ $329 $ $350 $ $392 $ $334 $ $357 $ $398 $ $339 $ $363 $ $404 $ $345 $ $370 $ $410 $ $350 $ $377 $ $416 $ $355 $ $383 $ $439 $ $375 $ $406 $ $463 $ $395 $ $428 $ $487 $ $416 $ $451 $ $510 $ $436 $ $474 $ $534 $ $456 $ $496 $ $550 $ $470 $ $513 $ $567 $ $484 $ $529 $ $583 $ $498 $ $545 $ $599 $ $512 $ $561 $ $616 $ $525 $ $577 $ $666 $ $569 $ $625 $ $717 $ $612 $ $672 $ $767 $ $655 $ $719 $626 Page 6 of 20

79 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 2 MCOA 2500 MCOA 5000 MCOA 7500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $278 $278 0 $217 $217 0 $158 $158 1 $167 $167 1 $130 $130 1 $95 $95 2 $89 $89 2 $69 $69 2 $51 $51 3 $89 $89 3 $69 $69 3 $51 $51 4 $89 $89 4 $69 $69 4 $51 $51 5 $89 $89 5 $69 $69 5 $51 $51 6 $89 $89 6 $69 $69 6 $51 $51 7 $89 $89 7 $69 $69 7 $51 $51 8 $89 $89 8 $69 $69 8 $51 $51 9 $89 $89 9 $69 $69 9 $51 $51 10 $89 $89 10 $69 $69 10 $51 $51 11 $89 $89 11 $69 $69 11 $51 $51 12 $89 $89 12 $69 $69 12 $51 $51 13 $89 $89 13 $69 $69 13 $51 $51 14 $89 $89 14 $69 $69 14 $51 $51 15 $89 $89 15 $69 $69 15 $51 $51 16 $89 $89 16 $69 $69 16 $51 $51 17 $89 $89 17 $69 $69 17 $51 $51 18 $89 $89 18 $69 $69 18 $51 $51 19 $90 $ $70 $91 19 $51 $66 20 $90 $ $70 $93 20 $51 $68 21 $91 $ $71 $96 21 $52 $70 22 $93 $ $73 $ $53 $74 23 $96 $ $75 $ $55 $79 24 $98 $ $78 $ $57 $83 25 $101 $ $80 $ $58 $87 26 $103 $ $83 $ $60 $92 27 $106 $ $85 $ $62 $96 28 $112 $ $91 $ $66 $ $118 $ $96 $ $70 $ $124 $ $102 $ $75 $ $131 $ $108 $ $79 $ $137 $ $114 $ $83 $ $139 $ $116 $ $84 $ $141 $ $117 $ $86 $ $142 $ $119 $ $87 $ $144 $ $121 $ $88 $ $146 $ $123 $ $89 $ $153 $ $129 $ $94 $ $160 $ $135 $ $99 $ $166 $ $141 $ $103 $ $173 $ $148 $ $108 $ $180 $ $154 $ $112 $ $197 $ $169 $ $123 $ $214 $ $183 $ $134 $ $230 $ $198 $ $144 $ $247 $ $213 $ $155 $ $264 $ $228 $ $166 $ $269 $ $233 $ $170 $ $274 $ $238 $ $174 $ $280 $ $244 $ $178 $ $285 $ $249 $ $182 $ $290 $ $254 $ $186 $ $308 $ $271 $ $197 $ $326 $ $287 $ $209 $ $344 $ $303 $ $221 $ $362 $ $320 $ $233 $ $380 $ $336 $ $245 $ $393 $ $348 $ $254 $ $406 $ $360 $ $263 $ $419 $ $373 $ $272 $ $432 $ $385 $ $281 $ $445 $ $397 $ $290 $ $481 $ $430 $ $313 $ $518 $ $462 $ $337 $ $554 $ $495 $ $361 $314 Page 7 of 20

80 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 2 MCOA HDHP 3000 MCOA HDHP 5000 MCOA Value 2500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $264 $264 0 $202 $202 0 $257 $257 1 $161 $161 1 $121 $121 1 $154 $154 2 $86 $86 2 $65 $65 2 $82 $82 3 $86 $86 3 $65 $65 3 $82 $82 4 $86 $86 4 $65 $65 4 $82 $82 5 $86 $86 5 $65 $65 5 $82 $82 6 $86 $86 6 $65 $65 6 $82 $82 7 $86 $86 7 $65 $65 7 $82 $82 8 $86 $86 8 $65 $65 8 $82 $82 9 $86 $86 9 $65 $65 9 $82 $82 10 $86 $86 10 $65 $65 10 $82 $82 11 $86 $86 11 $65 $65 11 $82 $82 12 $86 $86 12 $65 $65 12 $82 $82 13 $86 $86 13 $65 $65 13 $82 $82 14 $86 $86 14 $65 $65 14 $82 $82 15 $86 $86 15 $65 $65 15 $82 $82 16 $86 $86 16 $65 $65 16 $82 $82 17 $86 $86 17 $65 $65 17 $82 $82 18 $86 $86 18 $65 $65 18 $82 $82 19 $87 $ $67 $92 19 $83 $ $87 $ $66 $87 20 $84 $ $87 $ $66 $90 21 $84 $ $90 $ $68 $95 22 $86 $ $92 $ $70 $ $88 $ $95 $ $73 $ $91 $ $97 $ $75 $ $93 $ $99 $ $77 $ $95 $ $102 $ $79 $ $98 $ $108 $ $85 $ $104 $ $114 $ $90 $ $109 $ $121 $ $95 $ $115 $ $127 $ $101 $ $121 $ $133 $ $106 $ $127 $ $134 $ $108 $ $129 $ $135 $ $109 $ $130 $ $136 $ $111 $ $132 $ $138 $ $113 $ $134 $ $139 $ $114 $ $135 $ $146 $ $120 $ $142 $ $153 $ $126 $ $148 $ $160 $ $132 $ $154 $ $167 $ $138 $ $160 $ $174 $ $144 $ $167 $ $190 $ $157 $ $182 $ $206 $ $171 $ $198 $ $223 $ $185 $ $213 $ $239 $ $199 $ $229 $ $256 $ $212 $ $244 $ $261 $ $217 $ $249 $ $266 $ $222 $ $254 $ $271 $ $227 $ $259 $ $276 $ $232 $ $264 $ $281 $ $237 $ $269 $ $298 $ $253 $ $285 $ $315 $ $268 $ $302 $ $333 $ $283 $ $319 $ $350 $ $298 $ $335 $ $367 $ $313 $ $352 $ $380 $ $325 $ $364 $ $393 $ $336 $ $376 $ $405 $ $348 $ $388 $ $418 $ $359 $ $400 $ $430 $ $371 $ $412 $ $465 $ $401 $ $446 $ $501 $ $431 $ $480 $ $536 $ $462 $ $513 $445 Page 8 of 20

81 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 2 Preventive and Hospital Care 1250 Preventive and Hospital Care 3000 MCOA 750 w/ Medical $50K CYM Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $196 $196 0 $156 $156 0 $493 $493 1 $118 $118 1 $94 $94 1 $296 $296 2 $63 $63 2 $50 $50 2 $158 $158 3 $63 $63 3 $50 $50 3 $158 $158 4 $63 $63 4 $50 $50 4 $158 $158 5 $63 $63 5 $50 $50 5 $158 $158 6 $63 $63 6 $50 $50 6 $158 $158 7 $63 $63 7 $50 $50 7 $158 $158 8 $63 $63 8 $50 $50 8 $158 $158 9 $63 $63 9 $50 $50 9 $158 $ $63 $63 10 $50 $50 10 $158 $ $63 $63 11 $50 $50 11 $158 $ $63 $63 12 $50 $50 12 $158 $ $63 $63 13 $50 $50 13 $158 $ $63 $63 14 $50 $50 14 $158 $ $63 $63 15 $50 $50 15 $158 $ $63 $63 16 $50 $50 16 $158 $ $63 $63 17 $50 $50 17 $158 $ $63 $63 18 $50 $50 18 $158 $ $63 $82 19 $51 $66 19 $160 $ $64 $84 20 $51 $67 20 $160 $ $64 $87 21 $51 $69 21 $161 $ $66 $92 22 $53 $74 22 $165 $ $68 $98 23 $54 $78 23 $169 $ $70 $ $56 $82 24 $173 $ $72 $ $58 $86 25 $178 $ $75 $ $59 $91 26 $182 $ $77 $ $61 $95 27 $186 $ $82 $ $65 $ $196 $ $87 $ $70 $ $207 $ $92 $ $74 $ $217 $ $98 $ $78 $ $227 $ $103 $ $82 $ $238 $ $104 $ $83 $ $240 $ $106 $ $85 $ $243 $ $108 $ $86 $ $245 $ $109 $ $87 $ $248 $ $111 $ $88 $ $250 $ $117 $ $93 $ $261 $ $122 $ $97 $ $272 $ $128 $ $102 $ $282 $ $133 $ $106 $ $293 $ $139 $ $111 $ $304 $ $152 $ $122 $ $331 $ $166 $ $132 $ $358 $ $179 $ $143 $ $386 $ $192 $ $153 $ $413 $ $206 $ $164 $ $441 $ $211 $ $168 $ $449 $ $215 $ $172 $ $457 $ $220 $ $176 $ $466 $ $225 $ $180 $ $474 $ $230 $ $183 $ $482 $ $245 $ $195 $ $511 $ $259 $ $207 $ $539 $ $274 $ $219 $ $568 $ $289 $ $230 $ $596 $ $304 $ $242 $ $625 $ $315 $ $251 $ $645 $ $326 $ $260 $ $666 $ $337 $ $269 $ $686 $ $348 $ $278 $ $706 $ $359 $ $286 $ $727 $ $388 $ $310 $ $786 $ $418 $ $333 $ $846 $ $447 $ $357 $ $906 $788 Page 9 of 20

82 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 2 MCOA 1500 w/ Medical $50K CYM MCOA 2500 w/ Medical $50K CYM Single Single Single Single Age Male Female Age Male Female 0 $378 $378 0 $279 $279 1 $227 $227 1 $167 $167 2 $121 $121 2 $89 $89 3 $121 $121 3 $89 $89 4 $121 $121 4 $89 $89 5 $121 $121 5 $89 $89 6 $121 $121 6 $89 $89 7 $121 $121 7 $89 $89 8 $121 $121 8 $89 $89 9 $121 $121 9 $89 $89 10 $121 $ $89 $89 11 $121 $ $89 $89 12 $121 $ $89 $89 13 $121 $ $89 $89 14 $121 $ $89 $89 15 $121 $ $89 $89 16 $121 $ $89 $89 17 $121 $ $89 $89 18 $121 $ $89 $89 19 $122 $ $90 $ $123 $ $91 $ $123 $ $91 $ $126 $ $93 $ $130 $ $96 $ $133 $ $98 $ $136 $ $101 $ $139 $ $103 $ $143 $ $106 $ $150 $ $112 $ $158 $ $119 $ $166 $ $125 $ $174 $ $131 $ $182 $ $138 $ $184 $ $139 $ $186 $ $141 $ $188 $ $143 $ $190 $ $145 $ $192 $ $147 $ $200 $ $153 $ $208 $ $160 $ $216 $ $167 $ $224 $ $174 $ $233 $ $181 $ $254 $ $198 $ $275 $ $215 $ $296 $ $231 $ $317 $ $248 $ $338 $ $265 $ $344 $ $270 $ $350 $ $276 $ $357 $ $281 $ $363 $ $286 $ $370 $ $291 $ $391 $ $309 $ $413 $ $327 $ $435 $ $345 $ $457 $ $364 $ $479 $ $382 $ $494 $ $395 $ $510 $ $408 $ $526 $ $421 $ $541 $ $434 $ $557 $ $447 $ $603 $ $483 $ $648 $ $520 $ $694 $ $557 $483 Page 10 of 20

83 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 3 First Dollar 30 First Dollar 40 MCOA 1500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $463 $463 0 $395 $395 0 $392 $392 1 $278 $278 1 $237 $237 1 $235 $235 2 $148 $148 2 $127 $127 2 $125 $125 3 $148 $148 3 $127 $127 3 $125 $125 4 $148 $148 4 $127 $127 4 $125 $125 5 $148 $148 5 $127 $127 5 $125 $125 6 $148 $148 6 $127 $127 6 $125 $125 7 $148 $148 7 $127 $127 7 $125 $125 8 $148 $148 8 $127 $127 8 $125 $125 9 $148 $148 9 $127 $127 9 $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $148 $ $127 $ $125 $ $150 $ $128 $ $127 $ $150 $ $128 $ $127 $ $151 $ $129 $ $128 $ $154 $ $132 $ $131 $ $157 $ $134 $ $134 $ $161 $ $137 $ $138 $ $164 $ $140 $ $141 $ $167 $ $143 $ $144 $ $171 $ $146 $ $148 $ $180 $ $153 $ $156 $ $188 $ $161 $ $164 $ $197 $ $168 $ $172 $ $206 $ $176 $ $181 $ $215 $ $183 $ $189 $ $217 $ $185 $ $191 $ $218 $ $186 $ $193 $ $220 $ $188 $ $195 $ $222 $ $189 $ $197 $ $224 $ $191 $ $199 $ $233 $ $199 $ $207 $ $242 $ $206 $ $216 $ $251 $ $214 $ $224 $ $260 $ $222 $ $233 $ $269 $ $230 $ $241 $ $292 $ $250 $ $263 $ $316 $ $269 $ $285 $ $339 $ $289 $ $307 $ $362 $ $309 $ $328 $ $386 $ $329 $ $350 $ $392 $ $334 $ $357 $ $398 $ $339 $ $363 $ $404 $ $345 $ $370 $ $410 $ $350 $ $377 $ $416 $ $355 $ $383 $ $439 $ $375 $ $406 $ $463 $ $395 $ $428 $ $487 $ $416 $ $451 $ $510 $ $436 $ $474 $ $534 $ $456 $ $496 $ $550 $ $470 $ $513 $ $567 $ $484 $ $529 $ $583 $ $498 $ $545 $ $599 $ $512 $ $561 $ $616 $ $525 $ $577 $ $666 $ $569 $ $625 $ $717 $ $612 $ $672 $ $767 $ $655 $ $719 $626 Page 11 of 20

84 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 3 MCOA 2500 MCOA 5000 MCOA 7500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $278 $278 0 $217 $217 0 $158 $158 1 $167 $167 1 $130 $130 1 $95 $95 2 $89 $89 2 $69 $69 2 $51 $51 3 $89 $89 3 $69 $69 3 $51 $51 4 $89 $89 4 $69 $69 4 $51 $51 5 $89 $89 5 $69 $69 5 $51 $51 6 $89 $89 6 $69 $69 6 $51 $51 7 $89 $89 7 $69 $69 7 $51 $51 8 $89 $89 8 $69 $69 8 $51 $51 9 $89 $89 9 $69 $69 9 $51 $51 10 $89 $89 10 $69 $69 10 $51 $51 11 $89 $89 11 $69 $69 11 $51 $51 12 $89 $89 12 $69 $69 12 $51 $51 13 $89 $89 13 $69 $69 13 $51 $51 14 $89 $89 14 $69 $69 14 $51 $51 15 $89 $89 15 $69 $69 15 $51 $51 16 $89 $89 16 $69 $69 16 $51 $51 17 $89 $89 17 $69 $69 17 $51 $51 18 $89 $89 18 $69 $69 18 $51 $51 19 $90 $ $70 $91 19 $51 $66 20 $90 $ $70 $93 20 $51 $68 21 $91 $ $71 $96 21 $52 $70 22 $93 $ $73 $ $53 $74 23 $96 $ $75 $ $55 $79 24 $98 $ $78 $ $57 $83 25 $101 $ $80 $ $58 $87 26 $103 $ $83 $ $60 $92 27 $106 $ $85 $ $62 $96 28 $112 $ $91 $ $66 $ $118 $ $96 $ $70 $ $124 $ $102 $ $75 $ $131 $ $108 $ $79 $ $137 $ $114 $ $83 $ $139 $ $116 $ $84 $ $141 $ $117 $ $86 $ $142 $ $119 $ $87 $ $144 $ $121 $ $88 $ $146 $ $123 $ $89 $ $153 $ $129 $ $94 $ $160 $ $135 $ $99 $ $166 $ $141 $ $103 $ $173 $ $148 $ $108 $ $180 $ $154 $ $112 $ $197 $ $169 $ $123 $ $214 $ $183 $ $134 $ $230 $ $198 $ $144 $ $247 $ $213 $ $155 $ $264 $ $228 $ $166 $ $269 $ $233 $ $170 $ $274 $ $238 $ $174 $ $280 $ $244 $ $178 $ $285 $ $249 $ $182 $ $290 $ $254 $ $186 $ $308 $ $271 $ $197 $ $326 $ $287 $ $209 $ $344 $ $303 $ $221 $ $362 $ $320 $ $233 $ $380 $ $336 $ $245 $ $393 $ $348 $ $254 $ $406 $ $360 $ $263 $ $419 $ $373 $ $272 $ $432 $ $385 $ $281 $ $445 $ $397 $ $290 $ $481 $ $430 $ $313 $ $518 $ $462 $ $337 $ $554 $ $495 $ $361 $314 Page 12 of 20

85 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 3 MCOA HDHP 3000 MCOA HDHP 5000 MCOA Value 2500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $264 $264 0 $202 $202 0 $257 $257 1 $161 $161 1 $121 $121 1 $154 $154 2 $86 $86 2 $65 $65 2 $82 $82 3 $86 $86 3 $65 $65 3 $82 $82 4 $86 $86 4 $65 $65 4 $82 $82 5 $86 $86 5 $65 $65 5 $82 $82 6 $86 $86 6 $65 $65 6 $82 $82 7 $86 $86 7 $65 $65 7 $82 $82 8 $86 $86 8 $65 $65 8 $82 $82 9 $86 $86 9 $65 $65 9 $82 $82 10 $86 $86 10 $65 $65 10 $82 $82 11 $86 $86 11 $65 $65 11 $82 $82 12 $86 $86 12 $65 $65 12 $82 $82 13 $86 $86 13 $65 $65 13 $82 $82 14 $86 $86 14 $65 $65 14 $82 $82 15 $86 $86 15 $65 $65 15 $82 $82 16 $86 $86 16 $65 $65 16 $82 $82 17 $86 $86 17 $65 $65 17 $82 $82 18 $86 $86 18 $65 $65 18 $82 $82 19 $87 $ $67 $92 19 $83 $ $87 $ $66 $87 20 $84 $ $87 $ $66 $90 21 $84 $ $90 $ $68 $95 22 $86 $ $92 $ $70 $ $88 $ $95 $ $73 $ $91 $ $97 $ $75 $ $93 $ $99 $ $77 $ $95 $ $102 $ $79 $ $98 $ $108 $ $85 $ $104 $ $114 $ $90 $ $109 $ $121 $ $95 $ $115 $ $127 $ $101 $ $121 $ $133 $ $106 $ $127 $ $134 $ $108 $ $129 $ $135 $ $109 $ $130 $ $136 $ $111 $ $132 $ $138 $ $113 $ $134 $ $139 $ $114 $ $135 $ $146 $ $120 $ $142 $ $153 $ $126 $ $148 $ $160 $ $132 $ $154 $ $167 $ $138 $ $160 $ $174 $ $144 $ $167 $ $190 $ $157 $ $182 $ $206 $ $171 $ $198 $ $223 $ $185 $ $213 $ $239 $ $199 $ $229 $ $256 $ $212 $ $244 $ $261 $ $217 $ $249 $ $266 $ $222 $ $254 $ $271 $ $227 $ $259 $ $276 $ $232 $ $264 $ $281 $ $237 $ $269 $ $298 $ $253 $ $285 $ $315 $ $268 $ $302 $ $333 $ $283 $ $319 $ $350 $ $298 $ $335 $ $367 $ $313 $ $352 $ $380 $ $325 $ $364 $ $393 $ $336 $ $376 $ $405 $ $348 $ $388 $ $418 $ $359 $ $400 $ $430 $ $371 $ $412 $ $465 $ $401 $ $446 $ $501 $ $431 $ $480 $ $536 $ $462 $ $513 $445 Page 13 of 20

86 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 3 Preventive and Hospital Care 1250 Preventive and Hospital Care 3000 MCOA 750 w/ Medical $50K CYM Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $196 $196 0 $156 $156 0 $493 $493 1 $118 $118 1 $94 $94 1 $296 $296 2 $63 $63 2 $50 $50 2 $158 $158 3 $63 $63 3 $50 $50 3 $158 $158 4 $63 $63 4 $50 $50 4 $158 $158 5 $63 $63 5 $50 $50 5 $158 $158 6 $63 $63 6 $50 $50 6 $158 $158 7 $63 $63 7 $50 $50 7 $158 $158 8 $63 $63 8 $50 $50 8 $158 $158 9 $63 $63 9 $50 $50 9 $158 $ $63 $63 10 $50 $50 10 $158 $ $63 $63 11 $50 $50 11 $158 $ $63 $63 12 $50 $50 12 $158 $ $63 $63 13 $50 $50 13 $158 $ $63 $63 14 $50 $50 14 $158 $ $63 $63 15 $50 $50 15 $158 $ $63 $63 16 $50 $50 16 $158 $ $63 $63 17 $50 $50 17 $158 $ $63 $63 18 $50 $50 18 $158 $ $63 $82 19 $51 $66 19 $160 $ $64 $84 20 $51 $67 20 $160 $ $64 $87 21 $51 $69 21 $161 $ $66 $92 22 $53 $74 22 $165 $ $68 $98 23 $54 $78 23 $169 $ $70 $ $56 $82 24 $173 $ $72 $ $58 $86 25 $178 $ $75 $ $59 $91 26 $182 $ $77 $ $61 $95 27 $186 $ $82 $ $65 $ $196 $ $87 $ $70 $ $207 $ $92 $ $74 $ $217 $ $98 $ $78 $ $227 $ $103 $ $82 $ $238 $ $104 $ $83 $ $240 $ $106 $ $85 $ $243 $ $108 $ $86 $ $245 $ $109 $ $87 $ $248 $ $111 $ $88 $ $250 $ $117 $ $93 $ $261 $ $122 $ $97 $ $272 $ $128 $ $102 $ $282 $ $133 $ $106 $ $293 $ $139 $ $111 $ $304 $ $152 $ $122 $ $331 $ $166 $ $132 $ $358 $ $179 $ $143 $ $386 $ $192 $ $153 $ $413 $ $206 $ $164 $ $441 $ $211 $ $168 $ $449 $ $215 $ $172 $ $457 $ $220 $ $176 $ $466 $ $225 $ $180 $ $474 $ $230 $ $183 $ $482 $ $245 $ $195 $ $511 $ $259 $ $207 $ $539 $ $274 $ $219 $ $568 $ $289 $ $230 $ $596 $ $304 $ $242 $ $625 $ $315 $ $251 $ $645 $ $326 $ $260 $ $666 $ $337 $ $269 $ $686 $ $348 $ $278 $ $706 $ $359 $ $286 $ $727 $ $388 $ $310 $ $786 $ $418 $ $333 $ $846 $ $447 $ $357 $ $906 $788 Page 14 of 20

87 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 3 MCOA 1500 w/ Medical $50K CYM MCOA 2500 w/ Medical $50K CYM Single Single Single Single Age Male Female Age Male Female 0 $378 $378 0 $279 $279 1 $227 $227 1 $167 $167 2 $121 $121 2 $89 $89 3 $121 $121 3 $89 $89 4 $121 $121 4 $89 $89 5 $121 $121 5 $89 $89 6 $121 $121 6 $89 $89 7 $121 $121 7 $89 $89 8 $121 $121 8 $89 $89 9 $121 $121 9 $89 $89 10 $121 $ $89 $89 11 $121 $ $89 $89 12 $121 $ $89 $89 13 $121 $ $89 $89 14 $121 $ $89 $89 15 $121 $ $89 $89 16 $121 $ $89 $89 17 $121 $ $89 $89 18 $121 $ $89 $89 19 $122 $ $90 $ $123 $ $91 $ $123 $ $91 $ $126 $ $93 $ $130 $ $96 $ $133 $ $98 $ $136 $ $101 $ $139 $ $103 $ $143 $ $106 $ $150 $ $112 $ $158 $ $119 $ $166 $ $125 $ $174 $ $131 $ $182 $ $138 $ $184 $ $139 $ $186 $ $141 $ $188 $ $143 $ $190 $ $145 $ $192 $ $147 $ $200 $ $153 $ $208 $ $160 $ $216 $ $167 $ $224 $ $174 $ $233 $ $181 $ $254 $ $198 $ $275 $ $215 $ $296 $ $231 $ $317 $ $248 $ $338 $ $265 $ $344 $ $270 $ $350 $ $276 $ $357 $ $281 $ $363 $ $286 $ $370 $ $291 $ $391 $ $309 $ $413 $ $327 $ $435 $ $345 $ $457 $ $364 $ $479 $ $382 $ $494 $ $395 $ $510 $ $408 $ $526 $ $421 $ $541 $ $434 $ $557 $ $447 $ $603 $ $483 $ $648 $ $520 $ $694 $ $557 $483 Page 15 of 20

88 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 4 First Dollar 30 First Dollar 40 MCOA 1500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $431 $431 0 $368 $368 0 $365 $365 1 $259 $259 1 $221 $221 1 $219 $219 2 $138 $138 2 $118 $118 2 $117 $117 3 $138 $138 3 $118 $118 3 $117 $117 4 $138 $138 4 $118 $118 4 $117 $117 5 $138 $138 5 $118 $118 5 $117 $117 6 $138 $138 6 $118 $118 6 $117 $117 7 $138 $138 7 $118 $118 7 $117 $117 8 $138 $138 8 $118 $118 8 $117 $117 9 $138 $138 9 $118 $118 9 $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $138 $ $118 $ $117 $ $140 $ $119 $ $118 $ $140 $ $119 $ $118 $ $140 $ $120 $ $119 $ $143 $ $122 $ $122 $ $147 $ $125 $ $125 $ $150 $ $128 $ $128 $ $153 $ $130 $ $131 $ $156 $ $133 $ $134 $ $159 $ $136 $ $138 $ $167 $ $143 $ $145 $ $175 $ $150 $ $153 $ $184 $ $157 $ $160 $ $192 $ $164 $ $168 $ $200 $ $171 $ $176 $ $202 $ $172 $ $178 $ $203 $ $173 $ $179 $ $205 $ $175 $ $181 $ $206 $ $176 $ $183 $ $208 $ $178 $ $185 $ $217 $ $185 $ $193 $ $225 $ $192 $ $201 $ $233 $ $199 $ $209 $ $242 $ $206 $ $217 $ $250 $ $214 $ $224 $ $272 $ $232 $ $245 $ $294 $ $251 $ $265 $ $316 $ $269 $ $285 $ $337 $ $288 $ $306 $ $359 $ $307 $ $326 $ $365 $ $311 $ $332 $ $370 $ $316 $ $338 $ $376 $ $321 $ $344 $ $381 $ $325 $ $351 $ $387 $ $330 $ $357 $ $409 $ $349 $ $378 $ $431 $ $368 $ $399 $ $453 $ $387 $ $420 $ $475 $ $406 $ $441 $ $497 $ $424 $ $462 $ $512 $ $437 $ $477 $ $527 $ $450 $ $492 $ $543 $ $463 $ $507 $ $558 $ $476 $ $522 $ $573 $ $489 $ $537 $ $620 $ $529 $ $582 $ $667 $ $569 $ $626 $ $714 $ $609 $ $670 $582 Page 16 of 20

89 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 4 MCOA 2500 MCOA 5000 MCOA 7500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $259 $259 0 $202 $202 0 $147 $147 1 $155 $155 1 $121 $121 1 $88 $88 2 $83 $83 2 $65 $65 2 $47 $47 3 $83 $83 3 $65 $65 3 $47 $47 4 $83 $83 4 $65 $65 4 $47 $47 5 $83 $83 5 $65 $65 5 $47 $47 6 $83 $83 6 $65 $65 6 $47 $47 7 $83 $83 7 $65 $65 7 $47 $47 8 $83 $83 8 $65 $65 8 $47 $47 9 $83 $83 9 $65 $65 9 $47 $47 10 $83 $83 10 $65 $65 10 $47 $47 11 $83 $83 11 $65 $65 11 $47 $47 12 $83 $83 12 $65 $65 12 $47 $47 13 $83 $83 13 $65 $65 13 $47 $47 14 $83 $83 14 $65 $65 14 $47 $47 15 $83 $83 15 $65 $65 15 $47 $47 16 $83 $83 16 $65 $65 16 $47 $47 17 $83 $83 17 $65 $65 17 $47 $47 18 $83 $83 18 $65 $65 18 $47 $47 19 $84 $ $65 $85 19 $48 $62 20 $84 $ $66 $87 20 $48 $63 21 $84 $ $66 $89 21 $48 $65 22 $87 $ $68 $95 22 $50 $69 23 $89 $ $70 $ $51 $73 24 $91 $ $72 $ $53 $77 25 $94 $ $75 $ $54 $81 26 $96 $ $77 $ $56 $85 27 $98 $ $79 $ $58 $89 28 $104 $ $84 $ $62 $94 29 $110 $ $90 $ $65 $99 30 $116 $ $95 $ $69 $ $122 $ $100 $ $73 $ $128 $ $106 $ $77 $ $129 $ $108 $ $78 $ $131 $ $109 $ $80 $ $133 $ $111 $ $81 $ $134 $ $113 $ $82 $ $136 $ $114 $ $83 $ $142 $ $120 $ $87 $ $149 $ $126 $ $92 $ $155 $ $132 $ $96 $ $161 $ $137 $ $100 $ $168 $ $143 $ $104 $ $183 $ $157 $ $114 $ $199 $ $171 $ $124 $ $214 $ $184 $ $134 $ $230 $ $198 $ $144 $ $246 $ $212 $ $154 $ $251 $ $217 $ $158 $ $255 $ $222 $ $162 $ $260 $ $227 $ $165 $ $265 $ $232 $ $169 $ $270 $ $237 $ $173 $ $287 $ $252 $ $184 $ $303 $ $267 $ $195 $ $320 $ $282 $ $206 $ $337 $ $297 $ $217 $ $354 $ $313 $ $228 $ $366 $ $324 $ $236 $ $378 $ $335 $ $245 $ $390 $ $347 $ $253 $ $402 $ $358 $ $261 $ $414 $ $370 $ $270 $ $448 $ $400 $ $292 $ $482 $ $430 $ $314 $ $516 $ $461 $ $336 $292 Page 17 of 20

90 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 4 MCOA HDHP 3000 MCOA HDHP 5000 MCOA Value 2500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $245 $245 0 $188 $188 0 $239 $239 1 $150 $150 1 $113 $113 1 $144 $144 2 $80 $80 2 $60 $60 2 $77 $77 3 $80 $80 3 $60 $60 3 $77 $77 4 $80 $80 4 $60 $60 4 $77 $77 5 $80 $80 5 $60 $60 5 $77 $77 6 $80 $80 6 $60 $60 6 $77 $77 7 $80 $80 7 $60 $60 7 $77 $77 8 $80 $80 8 $60 $60 8 $77 $77 9 $80 $80 9 $60 $60 9 $77 $77 10 $80 $80 10 $60 $60 10 $77 $77 11 $80 $80 11 $60 $60 11 $77 $77 12 $80 $80 12 $60 $60 12 $77 $77 13 $80 $80 13 $60 $60 13 $77 $77 14 $80 $80 14 $60 $60 14 $77 $77 15 $80 $80 15 $60 $60 15 $77 $77 16 $80 $80 16 $60 $60 16 $77 $77 17 $80 $80 17 $60 $60 17 $77 $77 18 $80 $80 18 $60 $60 18 $77 $77 19 $81 $ $62 $86 19 $78 $ $81 $ $61 $81 20 $78 $ $81 $ $61 $83 21 $78 $ $84 $ $63 $89 22 $80 $ $86 $ $66 $94 23 $82 $ $88 $ $68 $99 24 $84 $ $90 $ $70 $ $87 $ $92 $ $72 $ $89 $ $95 $ $74 $ $91 $ $100 $ $79 $ $96 $ $106 $ $84 $ $102 $ $112 $ $89 $ $107 $ $118 $ $94 $ $113 $ $124 $ $99 $ $118 $ $125 $ $100 $ $120 $ $126 $ $102 $ $121 $ $127 $ $103 $ $123 $ $128 $ $105 $ $124 $ $129 $ $107 $ $126 $ $136 $ $112 $ $132 $ $142 $ $117 $ $138 $ $149 $ $123 $ $143 $ $155 $ $128 $ $149 $ $162 $ $134 $ $155 $ $177 $ $146 $ $170 $ $192 $ $159 $ $184 $ $207 $ $172 $ $199 $ $223 $ $185 $ $213 $ $238 $ $198 $ $227 $ $243 $ $202 $ $232 $ $247 $ $207 $ $236 $ $252 $ $212 $ $241 $ $257 $ $216 $ $245 $ $261 $ $221 $ $250 $ $277 $ $235 $ $265 $ $294 $ $249 $ $281 $ $310 $ $263 $ $296 $ $326 $ $278 $ $312 $ $342 $ $292 $ $327 $ $354 $ $302 $ $339 $ $365 $ $313 $ $350 $ $377 $ $324 $ $361 $ $389 $ $334 $ $372 $ $400 $ $345 $ $383 $ $433 $ $373 $ $415 $ $466 $ $402 $ $446 $ $499 $ $430 $ $478 $415 Page 18 of 20

91 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 4 Preventive and Hospital Care 1250 Preventive and Hospital Care 3000 MCOA 750 w/ Medical $50K CYM Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $182 $182 0 $145 $145 0 $459 $459 1 $109 $109 1 $87 $87 1 $275 $275 2 $58 $58 2 $47 $47 2 $147 $147 3 $58 $58 3 $47 $47 3 $147 $147 4 $58 $58 4 $47 $47 4 $147 $147 5 $58 $58 5 $47 $47 5 $147 $147 6 $58 $58 6 $47 $47 6 $147 $147 7 $58 $58 7 $47 $47 7 $147 $147 8 $58 $58 8 $47 $47 8 $147 $147 9 $58 $58 9 $47 $47 9 $147 $ $58 $58 10 $47 $47 10 $147 $ $58 $58 11 $47 $47 11 $147 $ $58 $58 12 $47 $47 12 $147 $ $58 $58 13 $47 $47 13 $147 $ $58 $58 14 $47 $47 14 $147 $ $58 $58 15 $47 $47 15 $147 $ $58 $58 16 $47 $47 16 $147 $ $58 $58 17 $47 $47 17 $147 $ $58 $58 18 $47 $47 18 $147 $ $59 $76 19 $47 $61 19 $149 $ $59 $79 20 $47 $63 20 $149 $ $59 $81 21 $47 $64 21 $149 $ $61 $86 22 $49 $68 22 $153 $ $63 $91 23 $51 $72 23 $157 $ $65 $96 24 $52 $76 24 $161 $ $67 $ $54 $80 25 $165 $ $69 $ $55 $84 26 $169 $ $71 $ $57 $88 27 $173 $ $76 $ $61 $93 28 $183 $ $81 $ $65 $98 29 $192 $ $86 $ $69 $ $202 $ $91 $ $72 $ $212 $ $96 $ $76 $ $221 $ $97 $ $78 $ $224 $ $99 $ $79 $ $226 $ $100 $ $80 $ $228 $ $102 $ $81 $ $231 $ $103 $ $82 $ $233 $ $108 $ $86 $ $243 $ $114 $ $91 $ $253 $ $119 $ $95 $ $263 $ $124 $ $99 $ $273 $ $129 $ $103 $ $283 $ $142 $ $113 $ $308 $ $154 $ $123 $ $334 $ $167 $ $133 $ $359 $ $179 $ $143 $ $385 $ $191 $ $153 $ $410 $ $196 $ $156 $ $418 $ $200 $ $160 $ $426 $ $205 $ $164 $ $433 $ $209 $ $167 $ $441 $ $214 $ $171 $ $449 $ $228 $ $182 $ $475 $ $241 $ $193 $ $502 $ $255 $ $204 $ $528 $ $269 $ $214 $ $555 $ $283 $ $225 $ $581 $ $293 $ $234 $ $600 $ $303 $ $242 $ $619 $ $313 $ $250 $ $638 $ $324 $ $258 $ $657 $ $334 $ $267 $ $677 $ $361 $ $288 $ $732 $ $389 $ $310 $ $787 $ $416 $ $332 $ $843 $733 Page 19 of 20

92 Exhibit J For Original Coverage Effective Dates Between January 1, 2010 to June 1, 2010 State: Connecticut - Block C Rating Area: 4 MCOA 1500 w/ Medical $50K CYM MCOA 2500 w/ Medical $50K CYM Single Single Single Single Age Male Female Age Male Female 0 $352 $352 0 $260 $260 1 $211 $211 1 $156 $156 2 $113 $113 2 $83 $83 3 $113 $113 3 $83 $83 4 $113 $113 4 $83 $83 5 $113 $113 5 $83 $83 6 $113 $113 6 $83 $83 7 $113 $113 7 $83 $83 8 $113 $113 8 $83 $83 9 $113 $113 9 $83 $83 10 $113 $ $83 $83 11 $113 $ $83 $83 12 $113 $ $83 $83 13 $113 $ $83 $83 14 $113 $ $83 $83 15 $113 $ $83 $83 16 $113 $ $83 $83 17 $113 $ $83 $83 18 $113 $ $83 $83 19 $114 $ $84 $ $114 $ $84 $ $114 $ $85 $ $118 $ $87 $ $121 $ $89 $ $124 $ $92 $ $127 $ $94 $ $130 $ $96 $ $133 $ $99 $ $140 $ $105 $ $147 $ $110 $ $155 $ $116 $ $162 $ $122 $ $169 $ $128 $ $171 $ $130 $ $173 $ $131 $ $175 $ $133 $ $177 $ $135 $ $178 $ $136 $ $186 $ $143 $ $194 $ $149 $ $201 $ $156 $ $209 $ $162 $ $217 $ $168 $ $236 $ $184 $ $256 $ $200 $ $275 $ $215 $ $295 $ $231 $ $314 $ $247 $ $320 $ $252 $ $326 $ $256 $ $332 $ $261 $ $338 $ $266 $ $344 $ $271 $ $364 $ $288 $ $385 $ $305 $ $405 $ $321 $ $425 $ $338 $ $445 $ $355 $ $460 $ $367 $ $475 $ $379 $ $489 $ $392 $ $504 $ $404 $ $518 $ $416 $ $561 $ $450 $ $603 $ $484 $ $646 $ $518 $450 Page 20 of 20

93 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 1 MCOA 1500 MCOA 2500 MCOA 3500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $357 $357 0 $253 $253 0 $243 $243 1 $214 $214 1 $152 $152 1 $136 $136 2 $114 $114 2 $81 $81 2 $72 $72 3 $114 $114 3 $81 $81 3 $72 $72 4 $114 $114 4 $81 $81 4 $72 $72 5 $114 $114 5 $81 $81 5 $72 $72 6 $114 $114 6 $81 $81 6 $72 $72 7 $114 $114 7 $81 $81 7 $72 $72 8 $114 $114 8 $81 $81 8 $72 $72 9 $114 $114 9 $81 $81 9 $72 $72 10 $114 $ $81 $81 10 $72 $72 11 $114 $ $81 $81 11 $72 $72 12 $114 $ $81 $81 12 $72 $72 13 $114 $ $81 $81 13 $72 $72 14 $114 $ $81 $81 14 $72 $72 15 $114 $ $81 $81 15 $72 $72 16 $114 $ $81 $81 16 $72 $72 17 $114 $ $81 $81 17 $72 $72 18 $114 $ $81 $81 18 $72 $72 19 $116 $ $82 $ $73 $95 20 $116 $ $82 $ $73 $97 21 $116 $ $83 $ $74 $ $119 $ $85 $ $76 $ $122 $ $87 $ $79 $ $126 $ $89 $ $81 $ $129 $ $92 $ $84 $ $132 $ $94 $ $86 $ $135 $ $96 $ $89 $ $142 $ $102 $ $95 $ $150 $ $108 $ $101 $ $157 $ $113 $ $107 $ $165 $ $119 $ $113 $ $172 $ $125 $ $119 $ $174 $ $127 $ $120 $ $176 $ $128 $ $122 $ $178 $ $130 $ $124 $ $180 $ $132 $ $126 $ $181 $ $133 $ $128 $ $189 $ $139 $ $134 $ $197 $ $146 $ $141 $ $205 $ $152 $ $147 $ $212 $ $158 $ $154 $ $220 $ $164 $ $160 $ $240 $ $180 $ $176 $ $260 $ $195 $ $191 $ $280 $ $210 $ $207 $ $299 $ $225 $ $222 $ $319 $ $241 $ $237 $ $325 $ $246 $ $243 $ $331 $ $250 $ $248 $ $337 $ $255 $ $254 $ $343 $ $260 $ $260 $ $349 $ $264 $ $265 $ $370 $ $281 $ $282 $ $391 $ $297 $ $299 $ $411 $ $314 $ $316 $ $432 $ $330 $ $333 $ $453 $ $347 $ $350 $ $467 $ $358 $ $363 $ $482 $ $370 $ $376 $ $497 $ $382 $ $389 $ $512 $ $394 $ $401 $ $527 $ $406 $ $414 $ $570 $ $439 $ $448 $ $613 $ $472 $ $482 $ $656 $ $506 $ $516 $449 Page 1 of 16

94 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 1 MCOA 5000 MCOA $7500 MCOA HDHP 3000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $198 $198 0 $147 $147 0 $284 $284 1 $119 $119 1 $88 $88 1 $173 $173 2 $63 $63 2 $47 $47 2 $93 $93 3 $63 $63 3 $47 $47 3 $93 $93 4 $63 $63 4 $47 $47 4 $93 $93 5 $63 $63 5 $47 $47 5 $93 $93 6 $63 $63 6 $47 $47 6 $93 $93 7 $63 $63 7 $47 $47 7 $93 $93 8 $63 $63 8 $47 $47 8 $93 $93 9 $63 $63 9 $47 $47 9 $93 $93 10 $63 $63 10 $47 $47 10 $93 $93 11 $63 $63 11 $47 $47 11 $93 $93 12 $63 $63 12 $47 $47 12 $93 $93 13 $63 $63 13 $47 $47 13 $93 $93 14 $63 $63 14 $47 $47 14 $93 $93 15 $63 $63 15 $47 $47 15 $93 $93 16 $63 $63 16 $47 $47 16 $93 $93 17 $63 $63 17 $47 $47 17 $93 $93 18 $63 $63 18 $47 $47 18 $93 $93 19 $64 $83 19 $48 $62 19 $94 $ $64 $85 20 $48 $63 20 $94 $ $64 $88 21 $48 $65 21 $94 $ $67 $93 22 $50 $69 22 $97 $ $69 $98 23 $51 $73 23 $99 $ $71 $ $53 $77 24 $102 $ $73 $ $54 $81 25 $104 $ $75 $ $56 $85 26 $107 $ $77 $ $58 $89 27 $109 $ $83 $ $62 $94 28 $116 $ $88 $ $65 $99 29 $123 $ $93 $ $69 $ $130 $ $98 $ $73 $ $137 $ $104 $ $77 $ $143 $ $105 $ $78 $ $145 $ $107 $ $80 $ $146 $ $109 $ $81 $ $147 $ $110 $ $82 $ $148 $ $112 $ $83 $ $149 $ $118 $ $87 $ $157 $ $123 $ $92 $ $164 $ $129 $ $96 $ $172 $ $135 $ $100 $ $180 $ $140 $ $104 $ $187 $ $154 $ $114 $ $205 $ $167 $ $124 $ $222 $ $181 $ $134 $ $240 $ $194 $ $144 $ $258 $ $208 $ $154 $ $275 $ $212 $ $158 $ $281 $ $217 $ $162 $ $286 $ $222 $ $165 $ $291 $ $227 $ $169 $ $297 $ $232 $ $173 $ $302 $ $247 $ $184 $ $321 $ $262 $ $195 $ $340 $ $277 $ $206 $ $358 $ $291 $ $217 $ $377 $ $306 $ $228 $ $396 $ $317 $ $236 $ $409 $ $329 $ $245 $ $423 $ $340 $ $253 $ $436 $ $351 $ $261 $ $450 $ $362 $ $270 $ $463 $ $392 $ $292 $ $501 $ $422 $ $314 $ $539 $ $451 $ $336 $ $577 $502 Page 2 of 16

95 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 1 MCOA HDHP 5000 MCOA Value 2500 MCOA Value 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $188 $188 0 $218 $218 0 $160 $160 1 $113 $113 1 $131 $131 1 $96 $96 2 $60 $60 2 $70 $70 2 $51 $51 3 $60 $60 3 $70 $70 3 $51 $51 4 $60 $60 4 $70 $70 4 $51 $51 5 $60 $60 5 $70 $70 5 $51 $51 6 $60 $60 6 $70 $70 6 $51 $51 7 $60 $60 7 $70 $70 7 $51 $51 8 $60 $60 8 $70 $70 8 $51 $51 9 $60 $60 9 $70 $70 9 $51 $51 10 $60 $60 10 $70 $70 10 $51 $51 11 $60 $60 11 $70 $70 11 $51 $51 12 $60 $60 12 $70 $70 12 $51 $51 13 $60 $60 13 $70 $70 13 $51 $51 14 $60 $60 14 $70 $70 14 $51 $51 15 $60 $60 15 $70 $70 15 $51 $51 16 $60 $60 16 $70 $70 16 $51 $51 17 $60 $60 17 $70 $70 17 $51 $51 18 $60 $60 18 $70 $70 18 $51 $51 19 $62 $86 19 $71 $91 19 $52 $67 20 $61 $81 20 $71 $93 20 $52 $69 21 $61 $83 21 $71 $96 21 $52 $71 22 $63 $89 22 $73 $ $54 $75 23 $65 $94 23 $75 $ $56 $80 24 $68 $99 24 $77 $ $57 $84 25 $70 $ $79 $ $59 $89 26 $72 $ $81 $ $61 $93 27 $74 $ $83 $ $63 $97 28 $79 $ $88 $ $67 $ $84 $ $93 $ $71 $ $89 $ $98 $ $76 $ $94 $ $103 $ $80 $ $99 $ $107 $ $84 $ $100 $ $109 $ $85 $ $102 $ $110 $ $87 $ $103 $ $112 $ $88 $ $105 $ $113 $ $89 $ $107 $ $115 $ $91 $ $112 $ $120 $ $95 $ $117 $ $125 $ $100 $ $123 $ $131 $ $104 $ $128 $ $136 $ $109 $ $134 $ $141 $ $114 $ $146 $ $154 $ $125 $ $159 $ $168 $ $135 $ $172 $ $181 $ $146 $ $185 $ $194 $ $157 $ $198 $ $207 $ $168 $ $202 $ $211 $ $172 $ $207 $ $215 $ $176 $ $212 $ $219 $ $180 $ $216 $ $223 $ $184 $ $221 $ $227 $ $188 $ $235 $ $242 $ $200 $ $249 $ $256 $ $212 $ $263 $ $270 $ $224 $ $278 $ $284 $ $236 $ $292 $ $298 $ $248 $ $302 $ $308 $ $257 $ $313 $ $318 $ $266 $ $324 $ $329 $ $275 $ $334 $ $339 $ $285 $ $345 $ $349 $ $294 $ $373 $ $377 $ $318 $ $401 $ $406 $ $342 $ $430 $ $435 $ $366 $318 Page 3 of 16

96 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 1 Preventive and Hospital Care 3000 Single Single Age Male Female 0 $145 $145 1 $87 $87 2 $47 $47 3 $47 $47 4 $47 $47 5 $47 $47 6 $47 $47 7 $47 $47 8 $47 $47 9 $47 $47 10 $47 $47 11 $47 $47 12 $47 $47 13 $47 $47 14 $47 $47 15 $47 $47 16 $47 $47 17 $47 $47 18 $47 $47 19 $47 $61 20 $47 $63 21 $47 $64 22 $49 $68 23 $51 $72 24 $52 $76 25 $54 $80 26 $55 $84 27 $57 $88 28 $61 $93 29 $65 $98 30 $69 $ $72 $ $76 $ $78 $ $79 $ $80 $ $81 $ $82 $ $86 $ $91 $ $95 $ $99 $ $103 $ $113 $ $123 $ $133 $ $143 $ $153 $ $156 $ $160 $ $163 $ $167 $ $171 $ $182 $ $193 $ $203 $ $214 $ $225 $ $234 $ $242 $ $250 $ $258 $ $266 $ $288 $ $310 $ $332 $289 Page 4 of 16

97 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 2 MCOA 1500 MCOA 2500 MCOA 3500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $384 $384 0 $272 $272 0 $261 $261 1 $230 $230 1 $163 $163 1 $146 $146 2 $123 $123 2 $87 $87 2 $78 $78 3 $123 $123 3 $87 $87 3 $78 $78 4 $123 $123 4 $87 $87 4 $78 $78 5 $123 $123 5 $87 $87 5 $78 $78 6 $123 $123 6 $87 $87 6 $78 $78 7 $123 $123 7 $87 $87 7 $78 $78 8 $123 $123 8 $87 $87 8 $78 $78 9 $123 $123 9 $87 $87 9 $78 $78 10 $123 $ $87 $87 10 $78 $78 11 $123 $ $87 $87 11 $78 $78 12 $123 $ $87 $87 12 $78 $78 13 $123 $ $87 $87 13 $78 $78 14 $123 $ $87 $87 14 $78 $78 15 $123 $ $87 $87 15 $78 $78 16 $123 $ $87 $87 16 $78 $78 17 $123 $ $87 $87 17 $78 $78 18 $123 $ $87 $87 18 $78 $78 19 $124 $ $88 $ $79 $ $125 $ $88 $ $79 $ $125 $ $89 $ $79 $ $128 $ $91 $ $82 $ $132 $ $94 $ $85 $ $135 $ $96 $ $87 $ $138 $ $99 $ $90 $ $142 $ $101 $ $92 $ $145 $ $103 $ $95 $ $153 $ $110 $ $102 $ $161 $ $116 $ $108 $ $169 $ $122 $ $114 $ $177 $ $128 $ $121 $ $185 $ $134 $ $127 $ $187 $ $136 $ $129 $ $189 $ $138 $ $131 $ $191 $ $140 $ $133 $ $193 $ $141 $ $135 $ $195 $ $143 $ $137 $ $203 $ $150 $ $144 $ $211 $ $156 $ $151 $ $220 $ $163 $ $158 $ $228 $ $170 $ $165 $ $236 $ $176 $ $172 $ $258 $ $193 $ $189 $ $279 $ $209 $ $205 $ $300 $ $226 $ $222 $ $322 $ $242 $ $238 $ $343 $ $259 $ $255 $ $350 $ $264 $ $261 $ $356 $ $269 $ $267 $ $363 $ $274 $ $273 $ $369 $ $279 $ $279 $ $376 $ $284 $ $285 $ $398 $ $302 $ $303 $ $420 $ $319 $ $322 $ $442 $ $337 $ $340 $ $464 $ $355 $ $358 $ $486 $ $372 $ $376 $ $502 $ $385 $ $390 $ $518 $ $398 $ $404 $ $534 $ $411 $ $418 $ $550 $ $423 $ $431 $ $566 $ $436 $ $445 $ $612 $ $472 $ $481 $ $659 $ $507 $ $518 $ $705 $ $543 $ $554 $482 Page 5 of 16

98 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 2 MCOA 5000 MCOA $7500 MCOA HDHP 3000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $212 $212 0 $158 $158 0 $305 $305 1 $127 $127 1 $95 $95 1 $186 $186 2 $68 $68 2 $51 $51 2 $99 $99 3 $68 $68 3 $51 $51 3 $99 $99 4 $68 $68 4 $51 $51 4 $99 $99 5 $68 $68 5 $51 $51 5 $99 $99 6 $68 $68 6 $51 $51 6 $99 $99 7 $68 $68 7 $51 $51 7 $99 $99 8 $68 $68 8 $51 $51 8 $99 $99 9 $68 $68 9 $51 $51 9 $99 $99 10 $68 $68 10 $51 $51 10 $99 $99 11 $68 $68 11 $51 $51 11 $99 $99 12 $68 $68 12 $51 $51 12 $99 $99 13 $68 $68 13 $51 $51 13 $99 $99 14 $68 $68 14 $51 $51 14 $99 $99 15 $68 $68 15 $51 $51 15 $99 $99 16 $68 $68 16 $51 $51 16 $99 $99 17 $68 $68 17 $51 $51 17 $99 $99 18 $68 $68 18 $51 $51 18 $99 $99 19 $69 $89 19 $51 $66 19 $101 $ $69 $92 20 $51 $68 20 $101 $ $69 $94 21 $52 $70 21 $101 $ $72 $ $53 $74 22 $104 $ $74 $ $55 $79 23 $107 $ $76 $ $57 $83 24 $109 $ $79 $ $58 $87 25 $112 $ $81 $ $60 $92 26 $115 $ $83 $ $62 $96 27 $118 $ $89 $ $66 $ $125 $ $94 $ $70 $ $132 $ $100 $ $75 $ $140 $ $106 $ $79 $ $147 $ $111 $ $83 $ $154 $ $113 $ $84 $ $155 $ $115 $ $86 $ $157 $ $117 $ $87 $ $158 $ $118 $ $88 $ $159 $ $120 $ $89 $ $160 $ $126 $ $94 $ $169 $ $132 $ $99 $ $177 $ $139 $ $103 $ $185 $ $145 $ $108 $ $193 $ $151 $ $112 $ $201 $ $165 $ $123 $ $220 $ $180 $ $134 $ $239 $ $194 $ $144 $ $258 $ $209 $ $155 $ $277 $ $223 $ $166 $ $296 $ $228 $ $170 $ $302 $ $234 $ $174 $ $307 $ $239 $ $178 $ $313 $ $244 $ $182 $ $319 $ $249 $ $186 $ $325 $ $265 $ $197 $ $345 $ $281 $ $209 $ $365 $ $297 $ $221 $ $385 $ $313 $ $233 $ $405 $ $329 $ $245 $ $425 $ $341 $ $254 $ $440 $ $353 $ $263 $ $454 $ $365 $ $272 $ $469 $ $377 $ $281 $ $483 $ $389 $ $290 $ $498 $ $421 $ $313 $ $539 $ $453 $ $337 $ $579 $ $485 $ $361 $ $620 $539 Page 6 of 16

99 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 2 MCOA HDHP 5000 MCOA Value 2500 MCOA Value 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $202 $202 0 $234 $234 0 $172 $172 1 $121 $121 1 $140 $140 1 $103 $103 2 $65 $65 2 $75 $75 2 $55 $55 3 $65 $65 3 $75 $75 3 $55 $55 4 $65 $65 4 $75 $75 4 $55 $55 5 $65 $65 5 $75 $75 5 $55 $55 6 $65 $65 6 $75 $75 6 $55 $55 7 $65 $65 7 $75 $75 7 $55 $55 8 $65 $65 8 $75 $75 8 $55 $55 9 $65 $65 9 $75 $75 9 $55 $55 10 $65 $65 10 $75 $75 10 $55 $55 11 $65 $65 11 $75 $75 11 $55 $55 12 $65 $65 12 $75 $75 12 $55 $55 13 $65 $65 13 $75 $75 13 $55 $55 14 $65 $65 14 $75 $75 14 $55 $55 15 $65 $65 15 $75 $75 15 $55 $55 16 $65 $65 16 $75 $75 16 $55 $55 17 $65 $65 17 $75 $75 17 $55 $55 18 $65 $65 18 $75 $75 18 $55 $55 19 $67 $92 19 $76 $97 19 $56 $72 20 $66 $87 20 $76 $ $56 $74 21 $66 $90 21 $76 $ $56 $76 22 $68 $95 22 $78 $ $58 $81 23 $70 $ $80 $ $60 $86 24 $73 $ $83 $ $62 $90 25 $75 $ $85 $ $64 $95 26 $77 $ $87 $ $66 $ $79 $ $89 $ $67 $ $85 $ $94 $ $72 $ $90 $ $100 $ $77 $ $95 $ $105 $ $81 $ $101 $ $110 $ $86 $ $106 $ $115 $ $90 $ $108 $ $117 $ $92 $ $109 $ $118 $ $93 $ $111 $ $120 $ $95 $ $113 $ $122 $ $96 $ $114 $ $123 $ $97 $ $120 $ $129 $ $102 $ $126 $ $135 $ $107 $ $132 $ $140 $ $112 $ $138 $ $146 $ $117 $ $143 $ $152 $ $122 $ $157 $ $166 $ $134 $ $171 $ $180 $ $146 $ $185 $ $194 $ $157 $ $199 $ $208 $ $169 $ $212 $ $222 $ $181 $ $217 $ $227 $ $185 $ $222 $ $231 $ $189 $ $227 $ $236 $ $194 $ $232 $ $240 $ $198 $ $237 $ $244 $ $202 $ $253 $ $260 $ $215 $ $268 $ $275 $ $228 $ $283 $ $290 $ $241 $ $298 $ $305 $ $254 $ $313 $ $320 $ $267 $ $325 $ $331 $ $276 $ $336 $ $342 $ $286 $ $348 $ $353 $ $296 $ $359 $ $364 $ $306 $ $371 $ $375 $ $315 $ $401 $ $406 $ $341 $ $431 $ $436 $ $367 $ $462 $ $467 $ $393 $342 Page 7 of 16

100 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 2 Preventive and Hospital Care 3000 Single Single Age Male Female 0 $156 $156 1 $94 $94 2 $50 $50 3 $50 $50 4 $50 $50 5 $50 $50 6 $50 $50 7 $50 $50 8 $50 $50 9 $50 $50 10 $50 $50 11 $50 $50 12 $50 $50 13 $50 $50 14 $50 $50 15 $50 $50 16 $50 $50 17 $50 $50 18 $50 $50 19 $51 $66 20 $51 $67 21 $51 $69 22 $53 $74 23 $54 $78 24 $56 $82 25 $58 $86 26 $59 $91 27 $61 $95 28 $65 $ $70 $ $74 $ $78 $ $82 $ $83 $ $85 $ $86 $ $87 $ $88 $ $93 $ $97 $ $102 $ $106 $ $111 $ $121 $ $132 $ $143 $ $153 $ $164 $ $168 $ $172 $ $176 $ $180 $ $183 $ $195 $ $207 $ $219 $ $230 $ $242 $ $251 $ $260 $ $269 $ $277 $ $286 $ $310 $ $333 $ $357 $310 Page 8 of 16

101 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 3 MCOA 1500 MCOA 2500 MCOA 3500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $384 $384 0 $272 $272 0 $261 $261 1 $230 $230 1 $163 $163 1 $146 $146 2 $123 $123 2 $87 $87 2 $78 $78 3 $123 $123 3 $87 $87 3 $78 $78 4 $123 $123 4 $87 $87 4 $78 $78 5 $123 $123 5 $87 $87 5 $78 $78 6 $123 $123 6 $87 $87 6 $78 $78 7 $123 $123 7 $87 $87 7 $78 $78 8 $123 $123 8 $87 $87 8 $78 $78 9 $123 $123 9 $87 $87 9 $78 $78 10 $123 $ $87 $87 10 $78 $78 11 $123 $ $87 $87 11 $78 $78 12 $123 $ $87 $87 12 $78 $78 13 $123 $ $87 $87 13 $78 $78 14 $123 $ $87 $87 14 $78 $78 15 $123 $ $87 $87 15 $78 $78 16 $123 $ $87 $87 16 $78 $78 17 $123 $ $87 $87 17 $78 $78 18 $123 $ $87 $87 18 $78 $78 19 $124 $ $88 $ $79 $ $125 $ $88 $ $79 $ $125 $ $89 $ $79 $ $128 $ $91 $ $82 $ $132 $ $94 $ $85 $ $135 $ $96 $ $87 $ $138 $ $99 $ $90 $ $142 $ $101 $ $92 $ $145 $ $103 $ $95 $ $153 $ $110 $ $102 $ $161 $ $116 $ $108 $ $169 $ $122 $ $114 $ $177 $ $128 $ $121 $ $185 $ $134 $ $127 $ $187 $ $136 $ $129 $ $189 $ $138 $ $131 $ $191 $ $140 $ $133 $ $193 $ $141 $ $135 $ $195 $ $143 $ $137 $ $203 $ $150 $ $144 $ $211 $ $156 $ $151 $ $220 $ $163 $ $158 $ $228 $ $170 $ $165 $ $236 $ $176 $ $172 $ $258 $ $193 $ $189 $ $279 $ $209 $ $205 $ $300 $ $226 $ $222 $ $322 $ $242 $ $238 $ $343 $ $259 $ $255 $ $350 $ $264 $ $261 $ $356 $ $269 $ $267 $ $363 $ $274 $ $273 $ $369 $ $279 $ $279 $ $376 $ $284 $ $285 $ $398 $ $302 $ $303 $ $420 $ $319 $ $322 $ $442 $ $337 $ $340 $ $464 $ $355 $ $358 $ $486 $ $372 $ $376 $ $502 $ $385 $ $390 $ $518 $ $398 $ $404 $ $534 $ $411 $ $418 $ $550 $ $423 $ $431 $ $566 $ $436 $ $445 $ $612 $ $472 $ $481 $ $659 $ $507 $ $518 $ $705 $ $543 $ $554 $482 Page 9 of 16

102 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 3 MCOA 5000 MCOA $7500 MCOA HDHP 3000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $212 $212 0 $158 $158 0 $305 $305 1 $127 $127 1 $95 $95 1 $186 $186 2 $68 $68 2 $51 $51 2 $99 $99 3 $68 $68 3 $51 $51 3 $99 $99 4 $68 $68 4 $51 $51 4 $99 $99 5 $68 $68 5 $51 $51 5 $99 $99 6 $68 $68 6 $51 $51 6 $99 $99 7 $68 $68 7 $51 $51 7 $99 $99 8 $68 $68 8 $51 $51 8 $99 $99 9 $68 $68 9 $51 $51 9 $99 $99 10 $68 $68 10 $51 $51 10 $99 $99 11 $68 $68 11 $51 $51 11 $99 $99 12 $68 $68 12 $51 $51 12 $99 $99 13 $68 $68 13 $51 $51 13 $99 $99 14 $68 $68 14 $51 $51 14 $99 $99 15 $68 $68 15 $51 $51 15 $99 $99 16 $68 $68 16 $51 $51 16 $99 $99 17 $68 $68 17 $51 $51 17 $99 $99 18 $68 $68 18 $51 $51 18 $99 $99 19 $69 $89 19 $51 $66 19 $101 $ $69 $92 20 $51 $68 20 $101 $ $69 $94 21 $52 $70 21 $101 $ $72 $ $53 $74 22 $104 $ $74 $ $55 $79 23 $107 $ $76 $ $57 $83 24 $109 $ $79 $ $58 $87 25 $112 $ $81 $ $60 $92 26 $115 $ $83 $ $62 $96 27 $118 $ $89 $ $66 $ $125 $ $94 $ $70 $ $132 $ $100 $ $75 $ $140 $ $106 $ $79 $ $147 $ $111 $ $83 $ $154 $ $113 $ $84 $ $155 $ $115 $ $86 $ $157 $ $117 $ $87 $ $158 $ $118 $ $88 $ $159 $ $120 $ $89 $ $160 $ $126 $ $94 $ $169 $ $132 $ $99 $ $177 $ $139 $ $103 $ $185 $ $145 $ $108 $ $193 $ $151 $ $112 $ $201 $ $165 $ $123 $ $220 $ $180 $ $134 $ $239 $ $194 $ $144 $ $258 $ $209 $ $155 $ $277 $ $223 $ $166 $ $296 $ $228 $ $170 $ $302 $ $234 $ $174 $ $307 $ $239 $ $178 $ $313 $ $244 $ $182 $ $319 $ $249 $ $186 $ $325 $ $265 $ $197 $ $345 $ $281 $ $209 $ $365 $ $297 $ $221 $ $385 $ $313 $ $233 $ $405 $ $329 $ $245 $ $425 $ $341 $ $254 $ $440 $ $353 $ $263 $ $454 $ $365 $ $272 $ $469 $ $377 $ $281 $ $483 $ $389 $ $290 $ $498 $ $421 $ $313 $ $539 $ $453 $ $337 $ $579 $ $485 $ $361 $ $620 $539 Page 10 of 16

103 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 3 MCOA HDHP 5000 MCOA Value 2500 MCOA Value 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $202 $202 0 $234 $234 0 $172 $172 1 $121 $121 1 $140 $140 1 $103 $103 2 $65 $65 2 $75 $75 2 $55 $55 3 $65 $65 3 $75 $75 3 $55 $55 4 $65 $65 4 $75 $75 4 $55 $55 5 $65 $65 5 $75 $75 5 $55 $55 6 $65 $65 6 $75 $75 6 $55 $55 7 $65 $65 7 $75 $75 7 $55 $55 8 $65 $65 8 $75 $75 8 $55 $55 9 $65 $65 9 $75 $75 9 $55 $55 10 $65 $65 10 $75 $75 10 $55 $55 11 $65 $65 11 $75 $75 11 $55 $55 12 $65 $65 12 $75 $75 12 $55 $55 13 $65 $65 13 $75 $75 13 $55 $55 14 $65 $65 14 $75 $75 14 $55 $55 15 $65 $65 15 $75 $75 15 $55 $55 16 $65 $65 16 $75 $75 16 $55 $55 17 $65 $65 17 $75 $75 17 $55 $55 18 $65 $65 18 $75 $75 18 $55 $55 19 $67 $92 19 $76 $97 19 $56 $72 20 $66 $87 20 $76 $ $56 $74 21 $66 $90 21 $76 $ $56 $76 22 $68 $95 22 $78 $ $58 $81 23 $70 $ $80 $ $60 $86 24 $73 $ $83 $ $62 $90 25 $75 $ $85 $ $64 $95 26 $77 $ $87 $ $66 $ $79 $ $89 $ $67 $ $85 $ $94 $ $72 $ $90 $ $100 $ $77 $ $95 $ $105 $ $81 $ $101 $ $110 $ $86 $ $106 $ $115 $ $90 $ $108 $ $117 $ $92 $ $109 $ $118 $ $93 $ $111 $ $120 $ $95 $ $113 $ $122 $ $96 $ $114 $ $123 $ $97 $ $120 $ $129 $ $102 $ $126 $ $135 $ $107 $ $132 $ $140 $ $112 $ $138 $ $146 $ $117 $ $143 $ $152 $ $122 $ $157 $ $166 $ $134 $ $171 $ $180 $ $146 $ $185 $ $194 $ $157 $ $199 $ $208 $ $169 $ $212 $ $222 $ $181 $ $217 $ $227 $ $185 $ $222 $ $231 $ $189 $ $227 $ $236 $ $194 $ $232 $ $240 $ $198 $ $237 $ $244 $ $202 $ $253 $ $260 $ $215 $ $268 $ $275 $ $228 $ $283 $ $290 $ $241 $ $298 $ $305 $ $254 $ $313 $ $320 $ $267 $ $325 $ $331 $ $276 $ $336 $ $342 $ $286 $ $348 $ $353 $ $296 $ $359 $ $364 $ $306 $ $371 $ $375 $ $315 $ $401 $ $406 $ $341 $ $431 $ $436 $ $367 $ $462 $ $467 $ $393 $342 Page 11 of 16

104 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 3 Preventive and Hospital Care 3000 Single Single Age Male Female 0 $156 $156 1 $94 $94 2 $50 $50 3 $50 $50 4 $50 $50 5 $50 $50 6 $50 $50 7 $50 $50 8 $50 $50 9 $50 $50 10 $50 $50 11 $50 $50 12 $50 $50 13 $50 $50 14 $50 $50 15 $50 $50 16 $50 $50 17 $50 $50 18 $50 $50 19 $51 $66 20 $51 $67 21 $51 $69 22 $53 $74 23 $54 $78 24 $56 $82 25 $58 $86 26 $59 $91 27 $61 $95 28 $65 $ $70 $ $74 $ $78 $ $82 $ $83 $ $85 $ $86 $ $87 $ $88 $ $93 $ $97 $ $102 $ $106 $ $111 $ $121 $ $132 $ $143 $ $153 $ $164 $ $168 $ $172 $ $176 $ $180 $ $183 $ $195 $ $207 $ $219 $ $230 $ $242 $ $251 $ $260 $ $269 $ $277 $ $286 $ $310 $ $333 $ $357 $310 Page 12 of 16

105 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 4 MCOA 1500 MCOA 2500 MCOA 3500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $357 $357 0 $253 $253 0 $243 $243 1 $214 $214 1 $152 $152 1 $136 $136 2 $114 $114 2 $81 $81 2 $72 $72 3 $114 $114 3 $81 $81 3 $72 $72 4 $114 $114 4 $81 $81 4 $72 $72 5 $114 $114 5 $81 $81 5 $72 $72 6 $114 $114 6 $81 $81 6 $72 $72 7 $114 $114 7 $81 $81 7 $72 $72 8 $114 $114 8 $81 $81 8 $72 $72 9 $114 $114 9 $81 $81 9 $72 $72 10 $114 $ $81 $81 10 $72 $72 11 $114 $ $81 $81 11 $72 $72 12 $114 $ $81 $81 12 $72 $72 13 $114 $ $81 $81 13 $72 $72 14 $114 $ $81 $81 14 $72 $72 15 $114 $ $81 $81 15 $72 $72 16 $114 $ $81 $81 16 $72 $72 17 $114 $ $81 $81 17 $72 $72 18 $114 $ $81 $81 18 $72 $72 19 $116 $ $82 $ $73 $95 20 $116 $ $82 $ $73 $97 21 $116 $ $83 $ $74 $ $119 $ $85 $ $76 $ $122 $ $87 $ $79 $ $126 $ $89 $ $81 $ $129 $ $92 $ $84 $ $132 $ $94 $ $86 $ $135 $ $96 $ $89 $ $142 $ $102 $ $95 $ $150 $ $108 $ $101 $ $157 $ $113 $ $107 $ $165 $ $119 $ $113 $ $172 $ $125 $ $119 $ $174 $ $127 $ $120 $ $176 $ $128 $ $122 $ $178 $ $130 $ $124 $ $180 $ $132 $ $126 $ $181 $ $133 $ $128 $ $189 $ $139 $ $134 $ $197 $ $146 $ $141 $ $205 $ $152 $ $147 $ $212 $ $158 $ $154 $ $220 $ $164 $ $160 $ $240 $ $180 $ $176 $ $260 $ $195 $ $191 $ $280 $ $210 $ $207 $ $299 $ $225 $ $222 $ $319 $ $241 $ $237 $ $325 $ $246 $ $243 $ $331 $ $250 $ $248 $ $337 $ $255 $ $254 $ $343 $ $260 $ $260 $ $349 $ $264 $ $265 $ $370 $ $281 $ $282 $ $391 $ $297 $ $299 $ $411 $ $314 $ $316 $ $432 $ $330 $ $333 $ $453 $ $347 $ $350 $ $467 $ $358 $ $363 $ $482 $ $370 $ $376 $ $497 $ $382 $ $389 $ $512 $ $394 $ $401 $ $527 $ $406 $ $414 $ $570 $ $439 $ $448 $ $613 $ $472 $ $482 $ $656 $ $506 $ $516 $449 Page 13 of 16

106 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 4 MCOA 5000 MCOA $7500 MCOA HDHP 3000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $198 $198 0 $147 $147 0 $284 $284 1 $119 $119 1 $88 $88 1 $173 $173 2 $63 $63 2 $47 $47 2 $93 $93 3 $63 $63 3 $47 $47 3 $93 $93 4 $63 $63 4 $47 $47 4 $93 $93 5 $63 $63 5 $47 $47 5 $93 $93 6 $63 $63 6 $47 $47 6 $93 $93 7 $63 $63 7 $47 $47 7 $93 $93 8 $63 $63 8 $47 $47 8 $93 $93 9 $63 $63 9 $47 $47 9 $93 $93 10 $63 $63 10 $47 $47 10 $93 $93 11 $63 $63 11 $47 $47 11 $93 $93 12 $63 $63 12 $47 $47 12 $93 $93 13 $63 $63 13 $47 $47 13 $93 $93 14 $63 $63 14 $47 $47 14 $93 $93 15 $63 $63 15 $47 $47 15 $93 $93 16 $63 $63 16 $47 $47 16 $93 $93 17 $63 $63 17 $47 $47 17 $93 $93 18 $63 $63 18 $47 $47 18 $93 $93 19 $64 $83 19 $48 $62 19 $94 $ $64 $85 20 $48 $63 20 $94 $ $64 $88 21 $48 $65 21 $94 $ $67 $93 22 $50 $69 22 $97 $ $69 $98 23 $51 $73 23 $99 $ $71 $ $53 $77 24 $102 $ $73 $ $54 $81 25 $104 $ $75 $ $56 $85 26 $107 $ $77 $ $58 $89 27 $109 $ $83 $ $62 $94 28 $116 $ $88 $ $65 $99 29 $123 $ $93 $ $69 $ $130 $ $98 $ $73 $ $137 $ $104 $ $77 $ $143 $ $105 $ $78 $ $145 $ $107 $ $80 $ $146 $ $109 $ $81 $ $147 $ $110 $ $82 $ $148 $ $112 $ $83 $ $149 $ $118 $ $87 $ $157 $ $123 $ $92 $ $164 $ $129 $ $96 $ $172 $ $135 $ $100 $ $180 $ $140 $ $104 $ $187 $ $154 $ $114 $ $205 $ $167 $ $124 $ $222 $ $181 $ $134 $ $240 $ $194 $ $144 $ $258 $ $208 $ $154 $ $275 $ $212 $ $158 $ $281 $ $217 $ $162 $ $286 $ $222 $ $165 $ $291 $ $227 $ $169 $ $297 $ $232 $ $173 $ $302 $ $247 $ $184 $ $321 $ $262 $ $195 $ $340 $ $277 $ $206 $ $358 $ $291 $ $217 $ $377 $ $306 $ $228 $ $396 $ $317 $ $236 $ $409 $ $329 $ $245 $ $423 $ $340 $ $253 $ $436 $ $351 $ $261 $ $450 $ $362 $ $270 $ $463 $ $392 $ $292 $ $501 $ $422 $ $314 $ $539 $ $451 $ $336 $ $577 $502 Page 14 of 16

107 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 4 MCOA HDHP 5000 MCOA Value 2500 MCOA Value 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $188 $188 0 $218 $218 0 $160 $160 1 $113 $113 1 $131 $131 1 $96 $96 2 $60 $60 2 $70 $70 2 $51 $51 3 $60 $60 3 $70 $70 3 $51 $51 4 $60 $60 4 $70 $70 4 $51 $51 5 $60 $60 5 $70 $70 5 $51 $51 6 $60 $60 6 $70 $70 6 $51 $51 7 $60 $60 7 $70 $70 7 $51 $51 8 $60 $60 8 $70 $70 8 $51 $51 9 $60 $60 9 $70 $70 9 $51 $51 10 $60 $60 10 $70 $70 10 $51 $51 11 $60 $60 11 $70 $70 11 $51 $51 12 $60 $60 12 $70 $70 12 $51 $51 13 $60 $60 13 $70 $70 13 $51 $51 14 $60 $60 14 $70 $70 14 $51 $51 15 $60 $60 15 $70 $70 15 $51 $51 16 $60 $60 16 $70 $70 16 $51 $51 17 $60 $60 17 $70 $70 17 $51 $51 18 $60 $60 18 $70 $70 18 $51 $51 19 $62 $86 19 $71 $91 19 $52 $67 20 $61 $81 20 $71 $93 20 $52 $69 21 $61 $83 21 $71 $96 21 $52 $71 22 $63 $89 22 $73 $ $54 $75 23 $65 $94 23 $75 $ $56 $80 24 $68 $99 24 $77 $ $57 $84 25 $70 $ $79 $ $59 $89 26 $72 $ $81 $ $61 $93 27 $74 $ $83 $ $63 $97 28 $79 $ $88 $ $67 $ $84 $ $93 $ $71 $ $89 $ $98 $ $76 $ $94 $ $103 $ $80 $ $99 $ $107 $ $84 $ $100 $ $109 $ $85 $ $102 $ $110 $ $87 $ $103 $ $112 $ $88 $ $105 $ $113 $ $89 $ $107 $ $115 $ $91 $ $112 $ $120 $ $95 $ $117 $ $125 $ $100 $ $123 $ $131 $ $104 $ $128 $ $136 $ $109 $ $134 $ $141 $ $114 $ $146 $ $154 $ $125 $ $159 $ $168 $ $135 $ $172 $ $181 $ $146 $ $185 $ $194 $ $157 $ $198 $ $207 $ $168 $ $202 $ $211 $ $172 $ $207 $ $215 $ $176 $ $212 $ $219 $ $180 $ $216 $ $223 $ $184 $ $221 $ $227 $ $188 $ $235 $ $242 $ $200 $ $249 $ $256 $ $212 $ $263 $ $270 $ $224 $ $278 $ $284 $ $236 $ $292 $ $298 $ $248 $ $302 $ $308 $ $257 $ $313 $ $318 $ $266 $ $324 $ $329 $ $275 $ $334 $ $339 $ $285 $ $345 $ $349 $ $294 $ $373 $ $377 $ $318 $ $401 $ $406 $ $342 $ $430 $ $435 $ $366 $318 Page 15 of 16

108 Exhibit K For Original Coverage Effective Dates Between July 1, 2010 and December 31, 2010 State: Connecticut - Block D Rating Area: 4 Preventive and Hospital Care 3000 Single Single Age Male Female 0 $145 $145 1 $87 $87 2 $47 $47 3 $47 $47 4 $47 $47 5 $47 $47 6 $47 $47 7 $47 $47 8 $47 $47 9 $47 $47 10 $47 $47 11 $47 $47 12 $47 $47 13 $47 $47 14 $47 $47 15 $47 $47 16 $47 $47 17 $47 $47 18 $47 $47 19 $47 $61 20 $47 $63 21 $47 $64 22 $49 $68 23 $51 $72 24 $52 $76 25 $54 $80 26 $55 $84 27 $57 $88 28 $61 $93 29 $65 $98 30 $69 $ $72 $ $76 $ $78 $ $79 $ $80 $ $81 $ $82 $ $86 $ $91 $ $95 $ $99 $ $103 $ $113 $ $123 $ $133 $ $143 $ $153 $ $156 $ $160 $ $163 $ $167 $ $171 $ $182 $ $193 $ $203 $ $214 $ $225 $ $234 $ $242 $ $250 $ $258 $ $266 $ $288 $ $310 $ $332 $289 Page 16 of 16

109 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 1 MCOA 1500 MCOA 2500 MCOA 3500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $571 $571 0 $420 $420 0 $404 $404 1 $258 $258 1 $190 $190 1 $183 $183 2 $168 $168 2 $124 $124 2 $119 $119 3 $156 $156 3 $115 $115 3 $111 $111 4 $144 $144 4 $106 $106 4 $102 $102 5 $133 $133 5 $98 $98 5 $94 $94 6 $125 $125 6 $92 $92 6 $89 $89 7 $119 $119 7 $88 $88 7 $84 $84 8 $116 $116 8 $85 $85 8 $82 $82 9 $116 $116 9 $85 $85 9 $82 $82 10 $119 $ $87 $87 10 $84 $84 11 $124 $ $91 $91 11 $88 $88 12 $131 $ $97 $97 12 $93 $93 13 $133 $ $98 $ $94 $99 14 $142 $ $105 $ $101 $ $151 $ $112 $ $107 $ $160 $ $118 $ $113 $ $167 $ $123 $ $118 $ $171 $ $126 $ $121 $ $173 $ $128 $ $123 $ $167 $ $123 $ $118 $ $160 $ $118 $ $114 $ $150 $ $110 $ $106 $ $150 $ $110 $ $106 $ $151 $ $111 $ $107 $ $154 $ $114 $ $109 $ $159 $ $117 $ $113 $ $166 $ $122 $ $117 $ $172 $ $127 $ $122 $ $179 $ $132 $ $127 $ $184 $ $136 $ $130 $ $188 $ $138 $ $133 $ $191 $ $140 $ $135 $ $192 $ $141 $ $136 $ $193 $ $142 $ $137 $ $194 $ $143 $ $137 $ $195 $ $144 $ $138 $ $198 $ $146 $ $140 $ $203 $ $149 $ $144 $ $209 $ $154 $ $148 $ $216 $ $159 $ $153 $ $224 $ $165 $ $159 $ $233 $ $172 $ $165 $ $243 $ $179 $ $172 $ $252 $ $186 $ $179 $ $262 $ $193 $ $186 $ $273 $ $201 $ $193 $ $283 $ $208 $ $200 $ $293 $ $216 $ $208 $ $304 $ $224 $ $215 $ $316 $ $232 $ $223 $ $328 $ $242 $ $232 $ $343 $ $253 $ $243 $ $360 $ $265 $ $255 $ $380 $ $280 $ $269 $ $403 $ $296 $ $285 $ $426 $ $314 $ $302 $ $450 $ $331 $ $319 $ $474 $ $349 $ $335 $ $498 $ $367 $ $353 $ $522 $ $384 $ $370 $ $566 $ $417 $ $401 $ $614 $ $453 $ $435 $ $667 $ $491 $ $473 $ $724 $ $533 $ $513 $ $786 $ $579 $ $557 $385 Page 1 of 16

110 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 1 MCOA 5000 MCOA 7500 MCOA HDHP 3000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $354 $354 0 $263 $263 0 $472 $472 1 $160 $160 1 $119 $119 1 $213 $213 2 $104 $104 2 $77 $77 2 $139 $139 3 $97 $97 3 $72 $72 3 $129 $129 4 $89 $89 4 $66 $66 4 $119 $119 5 $83 $83 5 $61 $61 5 $110 $110 6 $77 $77 6 $57 $57 6 $103 $103 7 $74 $74 7 $55 $55 7 $98 $98 8 $72 $72 8 $53 $53 8 $96 $96 9 $72 $72 9 $53 $53 9 $96 $96 10 $73 $73 10 $55 $55 10 $98 $98 11 $77 $77 11 $57 $57 11 $102 $ $81 $81 12 $60 $60 12 $109 $ $82 $87 13 $61 $64 13 $110 $ $88 $93 14 $65 $69 14 $118 $ $94 $99 15 $70 $74 15 $125 $ $99 $ $74 $79 16 $132 $ $103 $ $77 $84 17 $138 $ $106 $ $79 $86 18 $141 $ $107 $ $80 $88 19 $143 $ $104 $ $77 $87 20 $138 $ $99 $ $74 $86 21 $133 $ $93 $ $69 $82 22 $124 $ $93 $ $69 $84 23 $124 $ $94 $ $70 $87 24 $125 $ $96 $ $71 $91 25 $128 $ $99 $ $73 $95 26 $132 $ $103 $ $76 $98 27 $137 $ $107 $ $79 $ $143 $ $111 $ $82 $ $148 $ $114 $ $85 $ $152 $ $117 $ $86 $ $155 $ $118 $ $88 $ $157 $ $119 $ $88 $ $159 $ $120 $ $89 $ $159 $ $120 $ $89 $ $160 $ $121 $ $90 $ $162 $ $123 $ $91 $ $164 $ $126 $ $93 $ $168 $ $129 $ $96 $ $173 $ $134 $ $99 $ $179 $ $139 $ $103 $ $185 $ $145 $ $107 $ $193 $ $151 $ $112 $ $201 $ $157 $ $116 $ $209 $ $163 $ $121 $ $217 $ $169 $ $125 $ $225 $ $175 $ $130 $ $234 $ $182 $ $135 $ $243 $ $189 $ $140 $ $251 $ $196 $ $145 $ $261 $ $204 $ $151 $ $271 $ $213 $ $158 $ $283 $ $223 $ $166 $ $297 $ $235 $ $175 $ $314 $ $250 $ $185 $ $333 $ $264 $ $196 $ $352 $ $279 $ $207 $ $372 $ $294 $ $218 $ $392 $ $309 $ $229 $ $411 $ $324 $ $240 $ $431 $ $351 $ $260 $ $468 $ $381 $ $283 $ $508 $ $414 $ $307 $ $551 $ $449 $ $333 $ $599 $ $488 $ $362 $ $650 $450 Page 2 of 16

111 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 1 MCOA HDHP 5000 MCOA VALUE 2500 MCOA VALUE 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $338 $338 0 $361 $361 0 $286 $286 1 $153 $153 1 $163 $163 1 $129 $129 2 $100 $100 2 $106 $106 2 $84 $84 3 $92 $92 3 $99 $99 3 $78 $78 4 $85 $85 4 $91 $91 4 $72 $72 5 $79 $79 5 $84 $84 5 $67 $67 6 $74 $74 6 $79 $79 6 $63 $63 7 $71 $71 7 $75 $75 7 $60 $60 8 $69 $69 8 $73 $73 8 $58 $58 9 $69 $69 9 $73 $73 9 $58 $58 10 $70 $70 10 $75 $75 10 $59 $59 11 $73 $73 11 $78 $78 11 $62 $62 12 $78 $78 12 $83 $83 12 $66 $66 13 $79 $83 13 $84 $88 13 $67 $70 14 $84 $88 14 $90 $94 14 $71 $75 15 $90 $95 15 $96 $ $76 $80 16 $95 $ $101 $ $80 $86 17 $99 $ $105 $ $84 $91 18 $101 $ $108 $ $86 $94 19 $103 $ $109 $ $87 $96 20 $99 $ $106 $ $84 $95 21 $95 $ $101 $ $80 $93 22 $89 $ $95 $ $75 $90 23 $89 $ $95 $ $75 $92 24 $90 $ $96 $ $76 $95 25 $91 $ $98 $ $77 $99 26 $94 $ $101 $ $80 $ $98 $ $105 $ $83 $ $102 $ $109 $ $86 $ $106 $ $113 $ $90 $ $109 $ $116 $ $92 $ $111 $ $119 $ $94 $ $113 $ $120 $ $96 $ $114 $ $121 $ $96 $ $114 $ $122 $ $97 $ $115 $ $122 $ $97 $ $116 $ $124 $ $98 $ $117 $ $125 $ $99 $ $120 $ $128 $ $102 $ $124 $ $132 $ $105 $ $128 $ $137 $ $108 $ $133 $ $142 $ $113 $ $138 $ $148 $ $117 $ $144 $ $153 $ $122 $ $149 $ $160 $ $127 $ $155 $ $166 $ $132 $ $161 $ $172 $ $137 $ $168 $ $179 $ $142 $ $174 $ $185 $ $147 $ $180 $ $192 $ $153 $ $187 $ $199 $ $158 $ $194 $ $207 $ $165 $ $203 $ $217 $ $172 $ $213 $ $227 $ $180 $ $225 $ $240 $ $190 $ $238 $ $254 $ $202 $ $252 $ $269 $ $214 $ $266 $ $284 $ $226 $ $280 $ $299 $ $238 $ $295 $ $315 $ $250 $ $309 $ $330 $ $262 $ $335 $ $358 $ $284 $ $364 $ $388 $ $308 $ $395 $ $422 $ $335 $ $429 $ $458 $ $363 $ $466 $ $497 $ $394 $273 Page 3 of 16

112 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 1 Preventive and Hospital Care 3000 Single Single Age Male Female 0 $262 $262 1 $118 $118 2 $77 $77 3 $72 $72 4 $66 $66 5 $61 $61 6 $57 $57 7 $55 $55 8 $53 $53 9 $53 $53 10 $54 $54 11 $57 $57 12 $60 $60 13 $61 $64 14 $65 $69 15 $69 $73 16 $73 $78 17 $77 $84 18 $78 $86 19 $79 $88 20 $77 $87 21 $74 $85 22 $69 $82 23 $69 $84 24 $69 $87 25 $71 $90 26 $73 $94 27 $76 $98 28 $79 $ $82 $ $84 $ $86 $ $87 $ $88 $ $88 $ $89 $ $90 $ $91 $ $93 $ $96 $ $99 $ $103 $ $107 $ $111 $ $116 $ $120 $ $125 $ $130 $ $135 $ $140 $ $145 $ $151 $ $157 $ $165 $ $174 $ $185 $ $195 $ $206 $ $217 $ $228 $ $239 $ $260 $ $282 $ $306 $ $332 $ $361 $250 Page 4 of 16

113 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 2 MCOA 1500 MCOA 2500 MCOA 3500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $613 $613 0 $452 $452 0 $434 $434 1 $277 $277 1 $204 $204 1 $196 $196 2 $181 $181 2 $133 $133 2 $128 $128 3 $168 $168 3 $124 $124 3 $119 $119 4 $154 $154 4 $114 $114 4 $109 $109 5 $143 $143 5 $105 $105 5 $101 $101 6 $134 $134 6 $99 $99 6 $95 $95 7 $128 $128 7 $94 $94 7 $91 $91 8 $125 $125 8 $92 $92 8 $88 $88 9 $124 $124 9 $92 $92 9 $88 $88 10 $127 $ $94 $94 10 $90 $90 11 $133 $ $98 $98 11 $94 $94 12 $141 $ $104 $ $100 $ $143 $ $105 $ $101 $ $153 $ $113 $ $108 $ $163 $ $120 $ $115 $ $172 $ $127 $ $122 $ $179 $ $132 $ $127 $ $184 $ $135 $ $130 $ $186 $ $137 $ $132 $ $180 $ $132 $ $127 $ $172 $ $127 $ $122 $ $161 $ $119 $ $114 $ $161 $ $118 $ $114 $ $162 $ $120 $ $115 $ $166 $ $122 $ $118 $ $171 $ $126 $ $121 $ $178 $ $131 $ $126 $ $185 $ $136 $ $131 $ $192 $ $141 $ $136 $ $198 $ $146 $ $140 $ $202 $ $149 $ $143 $ $205 $ $151 $ $145 $ $206 $ $152 $ $146 $ $207 $ $153 $ $147 $ $208 $ $153 $ $147 $ $210 $ $155 $ $149 $ $213 $ $157 $ $151 $ $218 $ $160 $ $154 $ $224 $ $165 $ $159 $ $232 $ $171 $ $164 $ $241 $ $178 $ $171 $ $251 $ $185 $ $178 $ $261 $ $192 $ $185 $ $271 $ $200 $ $192 $ $282 $ $208 $ $200 $ $293 $ $216 $ $208 $ $304 $ $224 $ $215 $ $315 $ $232 $ $223 $ $327 $ $241 $ $231 $ $339 $ $250 $ $240 $ $353 $ $260 $ $250 $ $368 $ $271 $ $261 $ $387 $ $285 $ $274 $ $408 $ $300 $ $289 $ $432 $ $319 $ $306 $ $458 $ $337 $ $324 $ $483 $ $356 $ $342 $ $509 $ $375 $ $360 $ $535 $ $394 $ $379 $ $561 $ $413 $ $397 $ $608 $ $448 $ $431 $ $660 $ $486 $ $468 $ $717 $ $528 $ $508 $ $778 $ $573 $ $551 $ $845 $ $622 $ $598 $414 Page 5 of 16

114 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 2 MCOA 5000 MCOA 7500 MCOA HDHP 3000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $380 $380 0 $282 $282 0 $507 $507 1 $172 $172 1 $127 $127 1 $229 $229 2 $112 $112 2 $83 $83 2 $149 $149 3 $104 $104 3 $77 $77 3 $139 $139 4 $96 $96 4 $71 $71 4 $128 $128 5 $89 $89 5 $66 $66 5 $118 $118 6 $83 $83 6 $62 $62 6 $111 $111 7 $79 $79 7 $59 $59 7 $106 $106 8 $77 $77 8 $57 $57 8 $103 $103 9 $77 $77 9 $57 $57 9 $103 $ $79 $79 10 $59 $59 10 $105 $ $83 $83 11 $61 $61 11 $110 $ $87 $87 12 $65 $65 12 $117 $ $89 $93 13 $66 $69 13 $118 $ $95 $ $70 $74 14 $126 $ $101 $ $75 $79 15 $134 $ $107 $ $79 $84 16 $142 $ $111 $ $82 $90 17 $148 $ $114 $ $85 $93 18 $152 $ $115 $ $86 $95 19 $154 $ $111 $ $83 $94 20 $149 $ $107 $ $79 $92 21 $142 $ $100 $ $74 $88 22 $133 $ $100 $ $74 $91 23 $133 $ $101 $ $75 $94 24 $134 $ $103 $ $76 $97 25 $137 $ $106 $ $79 $ $142 $ $110 $ $82 $ $147 $ $115 $ $85 $ $153 $ $119 $ $88 $ $159 $ $123 $ $91 $ $163 $ $125 $ $93 $ $167 $ $127 $ $94 $ $169 $ $128 $ $95 $ $171 $ $128 $ $95 $ $171 $ $129 $ $96 $ $172 $ $130 $ $97 $ $174 $ $132 $ $98 $ $176 $ $135 $ $100 $ $180 $ $139 $ $103 $ $185 $ $144 $ $107 $ $192 $ $150 $ $111 $ $199 $ $155 $ $115 $ $207 $ $162 $ $120 $ $216 $ $168 $ $125 $ $224 $ $175 $ $130 $ $233 $ $182 $ $135 $ $242 $ $189 $ $140 $ $251 $ $195 $ $145 $ $261 $ $203 $ $150 $ $270 $ $210 $ $156 $ $280 $ $219 $ $162 $ $292 $ $228 $ $169 $ $305 $ $240 $ $178 $ $320 $ $253 $ $188 $ $337 $ $268 $ $199 $ $357 $ $284 $ $211 $ $378 $ $300 $ $222 $ $399 $ $316 $ $234 $ $421 $ $332 $ $246 $ $442 $ $348 $ $258 $ $463 $ $377 $ $280 $ $503 $ $409 $ $304 $ $546 $ $444 $ $330 $ $593 $ $483 $ $358 $ $643 $ $524 $ $389 $ $698 $483 Page 6 of 16

115 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 2 MCOA HDHP 5000 MCOA VALUE 2500 MCOA VALUE 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $363 $363 0 $388 $388 0 $308 $308 1 $164 $164 1 $175 $175 1 $139 $139 2 $107 $107 2 $114 $114 2 $91 $91 3 $99 $99 3 $106 $106 3 $84 $84 4 $91 $91 4 $98 $98 4 $77 $77 5 $85 $85 5 $91 $91 5 $72 $72 6 $80 $80 6 $85 $85 6 $67 $67 7 $76 $76 7 $81 $81 7 $64 $64 8 $74 $74 8 $79 $79 8 $63 $63 9 $74 $74 9 $79 $79 9 $62 $62 10 $75 $75 10 $81 $81 10 $64 $64 11 $79 $79 11 $84 $84 11 $67 $67 12 $84 $84 12 $89 $89 12 $71 $71 13 $85 $89 13 $90 $95 13 $72 $75 14 $90 $95 14 $97 $ $77 $81 15 $96 $ $103 $ $82 $86 16 $102 $ $109 $ $86 $92 17 $106 $ $113 $ $90 $98 18 $109 $ $116 $ $92 $ $110 $ $118 $ $93 $ $106 $ $114 $ $90 $ $102 $ $109 $ $86 $ $95 $ $102 $ $81 $96 23 $95 $ $102 $ $81 $99 24 $96 $ $103 $ $81 $ $98 $ $105 $ $83 $ $101 $ $108 $ $86 $ $105 $ $113 $ $89 $ $110 $ $117 $ $93 $ $114 $ $121 $ $96 $ $117 $ $125 $ $99 $ $120 $ $128 $ $101 $ $121 $ $129 $ $103 $ $122 $ $130 $ $103 $ $123 $ $131 $ $104 $ $123 $ $132 $ $104 $ $124 $ $133 $ $105 $ $126 $ $135 $ $107 $ $129 $ $138 $ $109 $ $133 $ $142 $ $112 $ $137 $ $147 $ $116 $ $143 $ $152 $ $121 $ $148 $ $158 $ $126 $ $154 $ $165 $ $131 $ $161 $ $171 $ $136 $ $167 $ $178 $ $141 $ $173 $ $185 $ $147 $ $180 $ $192 $ $153 $ $187 $ $199 $ $158 $ $193 $ $207 $ $164 $ $201 $ $214 $ $170 $ $209 $ $223 $ $177 $ $218 $ $233 $ $185 $ $229 $ $244 $ $194 $ $242 $ $258 $ $205 $ $256 $ $273 $ $217 $ $271 $ $289 $ $230 $ $286 $ $305 $ $242 $ $301 $ $322 $ $255 $ $317 $ $338 $ $268 $ $332 $ $354 $ $281 $ $360 $ $384 $ $305 $ $391 $ $417 $ $331 $ $424 $ $453 $ $360 $ $461 $ $492 $ $390 $ $500 $ $534 $ $424 $293 Page 7 of 16

116 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 2 Preventive and Hospital Care 3000 Single Single Age Male Female 0 $281 $281 1 $127 $127 2 $83 $83 3 $77 $77 4 $71 $71 5 $66 $66 6 $62 $62 7 $59 $59 8 $57 $57 9 $57 $57 10 $58 $58 11 $61 $61 12 $65 $65 13 $66 $69 14 $70 $74 15 $75 $79 16 $79 $84 17 $82 $90 18 $84 $92 19 $85 $95 20 $82 $93 21 $79 $92 22 $74 $88 23 $74 $90 24 $75 $93 25 $76 $97 26 $79 $ $82 $ $85 $ $88 $ $91 $ $93 $ $94 $ $95 $ $95 $ $96 $ $96 $ $98 $ $100 $ $103 $ $107 $ $111 $ $115 $ $120 $ $124 $ $129 $ $134 $ $140 $ $145 $ $150 $ $156 $ $162 $ $169 $ $177 $ $187 $ $198 $ $210 $ $222 $ $234 $ $245 $ $257 $ $279 $ $303 $ $329 $ $357 $ $388 $268 Page 8 of 16

117 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 3 MCOA 1500 MCOA 2500 MCOA 3500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $613 $613 0 $452 $452 0 $434 $434 1 $277 $277 1 $204 $204 1 $196 $196 2 $181 $181 2 $133 $133 2 $128 $128 3 $168 $168 3 $124 $124 3 $119 $119 4 $154 $154 4 $114 $114 4 $109 $109 5 $143 $143 5 $105 $105 5 $101 $101 6 $134 $134 6 $99 $99 6 $95 $95 7 $128 $128 7 $94 $94 7 $91 $91 8 $125 $125 8 $92 $92 8 $88 $88 9 $124 $124 9 $92 $92 9 $88 $88 10 $127 $ $94 $94 10 $90 $90 11 $133 $ $98 $98 11 $94 $94 12 $141 $ $104 $ $100 $ $143 $ $105 $ $101 $ $153 $ $113 $ $108 $ $163 $ $120 $ $115 $ $172 $ $127 $ $122 $ $179 $ $132 $ $127 $ $184 $ $135 $ $130 $ $186 $ $137 $ $132 $ $180 $ $132 $ $127 $ $172 $ $127 $ $122 $ $161 $ $119 $ $114 $ $161 $ $118 $ $114 $ $162 $ $120 $ $115 $ $166 $ $122 $ $118 $ $171 $ $126 $ $121 $ $178 $ $131 $ $126 $ $185 $ $136 $ $131 $ $192 $ $141 $ $136 $ $198 $ $146 $ $140 $ $202 $ $149 $ $143 $ $205 $ $151 $ $145 $ $206 $ $152 $ $146 $ $207 $ $153 $ $147 $ $208 $ $153 $ $147 $ $210 $ $155 $ $149 $ $213 $ $157 $ $151 $ $218 $ $160 $ $154 $ $224 $ $165 $ $159 $ $232 $ $171 $ $164 $ $241 $ $178 $ $171 $ $251 $ $185 $ $178 $ $261 $ $192 $ $185 $ $271 $ $200 $ $192 $ $282 $ $208 $ $200 $ $293 $ $216 $ $208 $ $304 $ $224 $ $215 $ $315 $ $232 $ $223 $ $327 $ $241 $ $231 $ $339 $ $250 $ $240 $ $353 $ $260 $ $250 $ $368 $ $271 $ $261 $ $387 $ $285 $ $274 $ $408 $ $300 $ $289 $ $432 $ $319 $ $306 $ $458 $ $337 $ $324 $ $483 $ $356 $ $342 $ $509 $ $375 $ $360 $ $535 $ $394 $ $379 $ $561 $ $413 $ $397 $ $608 $ $448 $ $431 $ $660 $ $486 $ $468 $ $717 $ $528 $ $508 $ $778 $ $573 $ $551 $ $845 $ $622 $ $598 $414 Page 9 of 16

118 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 3 MCOA 5000 MCOA 7500 MCOA HDHP 3000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $380 $380 0 $282 $282 0 $507 $507 1 $172 $172 1 $127 $127 1 $229 $229 2 $112 $112 2 $83 $83 2 $149 $149 3 $104 $104 3 $77 $77 3 $139 $139 4 $96 $96 4 $71 $71 4 $128 $128 5 $89 $89 5 $66 $66 5 $118 $118 6 $83 $83 6 $62 $62 6 $111 $111 7 $79 $79 7 $59 $59 7 $106 $106 8 $77 $77 8 $57 $57 8 $103 $103 9 $77 $77 9 $57 $57 9 $103 $ $79 $79 10 $59 $59 10 $105 $ $83 $83 11 $61 $61 11 $110 $ $87 $87 12 $65 $65 12 $117 $ $89 $93 13 $66 $69 13 $118 $ $95 $ $70 $74 14 $126 $ $101 $ $75 $79 15 $134 $ $107 $ $79 $84 16 $142 $ $111 $ $82 $90 17 $148 $ $114 $ $85 $93 18 $152 $ $115 $ $86 $95 19 $154 $ $111 $ $83 $94 20 $149 $ $107 $ $79 $92 21 $142 $ $100 $ $74 $88 22 $133 $ $100 $ $74 $91 23 $133 $ $101 $ $75 $94 24 $134 $ $103 $ $76 $97 25 $137 $ $106 $ $79 $ $142 $ $110 $ $82 $ $147 $ $115 $ $85 $ $153 $ $119 $ $88 $ $159 $ $123 $ $91 $ $163 $ $125 $ $93 $ $167 $ $127 $ $94 $ $169 $ $128 $ $95 $ $171 $ $128 $ $95 $ $171 $ $129 $ $96 $ $172 $ $130 $ $97 $ $174 $ $132 $ $98 $ $176 $ $135 $ $100 $ $180 $ $139 $ $103 $ $185 $ $144 $ $107 $ $192 $ $150 $ $111 $ $199 $ $155 $ $115 $ $207 $ $162 $ $120 $ $216 $ $168 $ $125 $ $224 $ $175 $ $130 $ $233 $ $182 $ $135 $ $242 $ $189 $ $140 $ $251 $ $195 $ $145 $ $261 $ $203 $ $150 $ $270 $ $210 $ $156 $ $280 $ $219 $ $162 $ $292 $ $228 $ $169 $ $305 $ $240 $ $178 $ $320 $ $253 $ $188 $ $337 $ $268 $ $199 $ $357 $ $284 $ $211 $ $378 $ $300 $ $222 $ $399 $ $316 $ $234 $ $421 $ $332 $ $246 $ $442 $ $348 $ $258 $ $463 $ $377 $ $280 $ $503 $ $409 $ $304 $ $546 $ $444 $ $330 $ $593 $ $483 $ $358 $ $643 $ $524 $ $389 $ $698 $483 Page 10 of 16

119 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 3 MCOA HDHP 5000 MCOA VALUE 2500 MCOA VALUE 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $363 $363 0 $388 $388 0 $308 $308 1 $164 $164 1 $175 $175 1 $139 $139 2 $107 $107 2 $114 $114 2 $91 $91 3 $99 $99 3 $106 $106 3 $84 $84 4 $91 $91 4 $98 $98 4 $77 $77 5 $85 $85 5 $91 $91 5 $72 $72 6 $80 $80 6 $85 $85 6 $67 $67 7 $76 $76 7 $81 $81 7 $64 $64 8 $74 $74 8 $79 $79 8 $63 $63 9 $74 $74 9 $79 $79 9 $62 $62 10 $75 $75 10 $81 $81 10 $64 $64 11 $79 $79 11 $84 $84 11 $67 $67 12 $84 $84 12 $89 $89 12 $71 $71 13 $85 $89 13 $90 $95 13 $72 $75 14 $90 $95 14 $97 $ $77 $81 15 $96 $ $103 $ $82 $86 16 $102 $ $109 $ $86 $92 17 $106 $ $113 $ $90 $98 18 $109 $ $116 $ $92 $ $110 $ $118 $ $93 $ $106 $ $114 $ $90 $ $102 $ $109 $ $86 $ $95 $ $102 $ $81 $96 23 $95 $ $102 $ $81 $99 24 $96 $ $103 $ $81 $ $98 $ $105 $ $83 $ $101 $ $108 $ $86 $ $105 $ $113 $ $89 $ $110 $ $117 $ $93 $ $114 $ $121 $ $96 $ $117 $ $125 $ $99 $ $120 $ $128 $ $101 $ $121 $ $129 $ $103 $ $122 $ $130 $ $103 $ $123 $ $131 $ $104 $ $123 $ $132 $ $104 $ $124 $ $133 $ $105 $ $126 $ $135 $ $107 $ $129 $ $138 $ $109 $ $133 $ $142 $ $112 $ $137 $ $147 $ $116 $ $143 $ $152 $ $121 $ $148 $ $158 $ $126 $ $154 $ $165 $ $131 $ $161 $ $171 $ $136 $ $167 $ $178 $ $141 $ $173 $ $185 $ $147 $ $180 $ $192 $ $153 $ $187 $ $199 $ $158 $ $193 $ $207 $ $164 $ $201 $ $214 $ $170 $ $209 $ $223 $ $177 $ $218 $ $233 $ $185 $ $229 $ $244 $ $194 $ $242 $ $258 $ $205 $ $256 $ $273 $ $217 $ $271 $ $289 $ $230 $ $286 $ $305 $ $242 $ $301 $ $322 $ $255 $ $317 $ $338 $ $268 $ $332 $ $354 $ $281 $ $360 $ $384 $ $305 $ $391 $ $417 $ $331 $ $424 $ $453 $ $360 $ $461 $ $492 $ $390 $ $500 $ $534 $ $424 $293 Page 11 of 16

120 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 3 Preventive and Hospital Care 3000 Single Single Age Male Female 0 $281 $281 1 $127 $127 2 $83 $83 3 $77 $77 4 $71 $71 5 $66 $66 6 $62 $62 7 $59 $59 8 $57 $57 9 $57 $57 10 $58 $58 11 $61 $61 12 $65 $65 13 $66 $69 14 $70 $74 15 $75 $79 16 $79 $84 17 $82 $90 18 $84 $92 19 $85 $95 20 $82 $93 21 $79 $92 22 $74 $88 23 $74 $90 24 $75 $93 25 $76 $97 26 $79 $ $82 $ $85 $ $88 $ $91 $ $93 $ $94 $ $95 $ $95 $ $96 $ $96 $ $98 $ $100 $ $103 $ $107 $ $111 $ $115 $ $120 $ $124 $ $129 $ $134 $ $140 $ $145 $ $150 $ $156 $ $162 $ $169 $ $177 $ $187 $ $198 $ $210 $ $222 $ $234 $ $245 $ $257 $ $279 $ $303 $ $329 $ $357 $ $388 $268 Page 12 of 16

121 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 4 MCOA 1500 MCOA 2500 MCOA 3500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $571 $571 0 $420 $420 0 $404 $404 1 $258 $258 1 $190 $190 1 $183 $183 2 $168 $168 2 $124 $124 2 $119 $119 3 $156 $156 3 $115 $115 3 $111 $111 4 $144 $144 4 $106 $106 4 $102 $102 5 $133 $133 5 $98 $98 5 $94 $94 6 $125 $125 6 $92 $92 6 $89 $89 7 $119 $119 7 $88 $88 7 $84 $84 8 $116 $116 8 $85 $85 8 $82 $82 9 $116 $116 9 $85 $85 9 $82 $82 10 $119 $ $87 $87 10 $84 $84 11 $124 $ $91 $91 11 $88 $88 12 $131 $ $97 $97 12 $93 $93 13 $133 $ $98 $ $94 $99 14 $142 $ $105 $ $101 $ $151 $ $112 $ $107 $ $160 $ $118 $ $113 $ $167 $ $123 $ $118 $ $171 $ $126 $ $121 $ $173 $ $128 $ $123 $ $167 $ $123 $ $118 $ $160 $ $118 $ $114 $ $150 $ $110 $ $106 $ $150 $ $110 $ $106 $ $151 $ $111 $ $107 $ $154 $ $114 $ $109 $ $159 $ $117 $ $113 $ $166 $ $122 $ $117 $ $172 $ $127 $ $122 $ $179 $ $132 $ $127 $ $184 $ $136 $ $130 $ $188 $ $138 $ $133 $ $191 $ $140 $ $135 $ $192 $ $141 $ $136 $ $193 $ $142 $ $137 $ $194 $ $143 $ $137 $ $195 $ $144 $ $138 $ $198 $ $146 $ $140 $ $203 $ $149 $ $144 $ $209 $ $154 $ $148 $ $216 $ $159 $ $153 $ $224 $ $165 $ $159 $ $233 $ $172 $ $165 $ $243 $ $179 $ $172 $ $252 $ $186 $ $179 $ $262 $ $193 $ $186 $ $273 $ $201 $ $193 $ $283 $ $208 $ $200 $ $293 $ $216 $ $208 $ $304 $ $224 $ $215 $ $316 $ $232 $ $223 $ $328 $ $242 $ $232 $ $343 $ $253 $ $243 $ $360 $ $265 $ $255 $ $380 $ $280 $ $269 $ $403 $ $296 $ $285 $ $426 $ $314 $ $302 $ $450 $ $331 $ $319 $ $474 $ $349 $ $335 $ $498 $ $367 $ $353 $ $522 $ $384 $ $370 $ $566 $ $417 $ $401 $ $614 $ $453 $ $435 $ $667 $ $491 $ $473 $ $724 $ $533 $ $513 $ $786 $ $579 $ $557 $385 Page 13 of 16

122 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 4 MCOA 5000 MCOA 7500 MCOA HDHP 3000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $354 $354 0 $263 $263 0 $472 $472 1 $160 $160 1 $119 $119 1 $213 $213 2 $104 $104 2 $77 $77 2 $139 $139 3 $97 $97 3 $72 $72 3 $129 $129 4 $89 $89 4 $66 $66 4 $119 $119 5 $83 $83 5 $61 $61 5 $110 $110 6 $77 $77 6 $57 $57 6 $103 $103 7 $74 $74 7 $55 $55 7 $98 $98 8 $72 $72 8 $53 $53 8 $96 $96 9 $72 $72 9 $53 $53 9 $96 $96 10 $73 $73 10 $55 $55 10 $98 $98 11 $77 $77 11 $57 $57 11 $102 $ $81 $81 12 $60 $60 12 $109 $ $82 $87 13 $61 $64 13 $110 $ $88 $93 14 $65 $69 14 $118 $ $94 $99 15 $70 $74 15 $125 $ $99 $ $74 $79 16 $132 $ $103 $ $77 $84 17 $138 $ $106 $ $79 $86 18 $141 $ $107 $ $80 $88 19 $143 $ $104 $ $77 $87 20 $138 $ $99 $ $74 $86 21 $133 $ $93 $ $69 $82 22 $124 $ $93 $ $69 $84 23 $124 $ $94 $ $70 $87 24 $125 $ $96 $ $71 $91 25 $128 $ $99 $ $73 $95 26 $132 $ $103 $ $76 $98 27 $137 $ $107 $ $79 $ $143 $ $111 $ $82 $ $148 $ $114 $ $85 $ $152 $ $117 $ $86 $ $155 $ $118 $ $88 $ $157 $ $119 $ $88 $ $159 $ $120 $ $89 $ $159 $ $120 $ $89 $ $160 $ $121 $ $90 $ $162 $ $123 $ $91 $ $164 $ $126 $ $93 $ $168 $ $129 $ $96 $ $173 $ $134 $ $99 $ $179 $ $139 $ $103 $ $185 $ $145 $ $107 $ $193 $ $151 $ $112 $ $201 $ $157 $ $116 $ $209 $ $163 $ $121 $ $217 $ $169 $ $125 $ $225 $ $175 $ $130 $ $234 $ $182 $ $135 $ $243 $ $189 $ $140 $ $251 $ $196 $ $145 $ $261 $ $204 $ $151 $ $271 $ $213 $ $158 $ $283 $ $223 $ $166 $ $297 $ $235 $ $175 $ $314 $ $250 $ $185 $ $333 $ $264 $ $196 $ $352 $ $279 $ $207 $ $372 $ $294 $ $218 $ $392 $ $309 $ $229 $ $411 $ $324 $ $240 $ $431 $ $351 $ $260 $ $468 $ $381 $ $283 $ $508 $ $414 $ $307 $ $551 $ $449 $ $333 $ $599 $ $488 $ $362 $ $650 $450 Page 14 of 16

123 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 4 MCOA HDHP 5000 MCOA VALUE 2500 MCOA VALUE 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $338 $338 0 $361 $361 0 $286 $286 1 $153 $153 1 $163 $163 1 $129 $129 2 $100 $100 2 $106 $106 2 $84 $84 3 $92 $92 3 $99 $99 3 $78 $78 4 $85 $85 4 $91 $91 4 $72 $72 5 $79 $79 5 $84 $84 5 $67 $67 6 $74 $74 6 $79 $79 6 $63 $63 7 $71 $71 7 $75 $75 7 $60 $60 8 $69 $69 8 $73 $73 8 $58 $58 9 $69 $69 9 $73 $73 9 $58 $58 10 $70 $70 10 $75 $75 10 $59 $59 11 $73 $73 11 $78 $78 11 $62 $62 12 $78 $78 12 $83 $83 12 $66 $66 13 $79 $83 13 $84 $88 13 $67 $70 14 $84 $88 14 $90 $94 14 $71 $75 15 $90 $95 15 $96 $ $76 $80 16 $95 $ $101 $ $80 $86 17 $99 $ $105 $ $84 $91 18 $101 $ $108 $ $86 $94 19 $103 $ $109 $ $87 $96 20 $99 $ $106 $ $84 $95 21 $95 $ $101 $ $80 $93 22 $89 $ $95 $ $75 $90 23 $89 $ $95 $ $75 $92 24 $90 $ $96 $ $76 $95 25 $91 $ $98 $ $77 $99 26 $94 $ $101 $ $80 $ $98 $ $105 $ $83 $ $102 $ $109 $ $86 $ $106 $ $113 $ $90 $ $109 $ $116 $ $92 $ $111 $ $119 $ $94 $ $113 $ $120 $ $96 $ $114 $ $121 $ $96 $ $114 $ $122 $ $97 $ $115 $ $122 $ $97 $ $116 $ $124 $ $98 $ $117 $ $125 $ $99 $ $120 $ $128 $ $102 $ $124 $ $132 $ $105 $ $128 $ $137 $ $108 $ $133 $ $142 $ $113 $ $138 $ $148 $ $117 $ $144 $ $153 $ $122 $ $149 $ $160 $ $127 $ $155 $ $166 $ $132 $ $161 $ $172 $ $137 $ $168 $ $179 $ $142 $ $174 $ $185 $ $147 $ $180 $ $192 $ $153 $ $187 $ $199 $ $158 $ $194 $ $207 $ $165 $ $203 $ $217 $ $172 $ $213 $ $227 $ $180 $ $225 $ $240 $ $190 $ $238 $ $254 $ $202 $ $252 $ $269 $ $214 $ $266 $ $284 $ $226 $ $280 $ $299 $ $238 $ $295 $ $315 $ $250 $ $309 $ $330 $ $262 $ $335 $ $358 $ $284 $ $364 $ $388 $ $308 $ $395 $ $422 $ $335 $ $429 $ $458 $ $363 $ $466 $ $497 $ $394 $273 Page 15 of 16

124 Exhibit L For Original Coverage Effective Dates Between January 1, 2011 and August 31, 2011 State: Connecticut - Block E Rating Area: 4 Preventive and Hospital Care 3000 Single Single Age Male Female 0 $262 $262 1 $118 $118 2 $77 $77 3 $72 $72 4 $66 $66 5 $61 $61 6 $57 $57 7 $55 $55 8 $53 $53 9 $53 $53 10 $54 $54 11 $57 $57 12 $60 $60 13 $61 $64 14 $65 $69 15 $69 $73 16 $73 $78 17 $77 $84 18 $78 $86 19 $79 $88 20 $77 $87 21 $74 $85 22 $69 $82 23 $69 $84 24 $69 $87 25 $71 $90 26 $73 $94 27 $76 $98 28 $79 $ $82 $ $84 $ $86 $ $87 $ $88 $ $88 $ $89 $ $90 $ $91 $ $93 $ $96 $ $99 $ $103 $ $107 $ $111 $ $116 $ $120 $ $125 $ $130 $ $135 $ $140 $ $145 $ $151 $ $157 $ $165 $ $174 $ $185 $ $195 $ $206 $ $217 $ $228 $ $239 $ $260 $ $282 $ $306 $ $332 $ $361 $250 Page 16 of 16

125 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 1 MCOA 1500 MCOA 2500 MCOA 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $506 $506 0 $398 $398 0 $326 $326 1 $228 $228 1 $180 $180 1 $147 $147 2 $149 $149 2 $117 $117 2 $96 $96 3 $138 $138 3 $109 $109 3 $89 $89 4 $127 $127 4 $100 $100 4 $82 $82 5 $118 $118 5 $93 $93 5 $76 $76 6 $111 $111 6 $87 $87 6 $71 $71 7 $106 $106 7 $83 $83 7 $68 $68 8 $103 $103 8 $81 $81 8 $66 $66 9 $103 $103 9 $81 $81 9 $66 $66 10 $105 $ $83 $83 10 $68 $68 11 $110 $ $86 $86 11 $71 $71 12 $116 $ $92 $92 12 $75 $75 13 $118 $ $93 $97 13 $76 $80 14 $126 $ $99 $ $81 $85 15 $134 $ $106 $ $87 $91 16 $142 $ $111 $ $91 $98 17 $148 $ $116 $ $95 $ $151 $ $119 $ $98 $ $153 $ $121 $ $99 $ $148 $ $117 $ $96 $ $142 $ $112 $ $92 $ $133 $ $104 $ $86 $ $133 $ $104 $ $86 $ $134 $ $105 $ $86 $ $137 $ $108 $ $88 $ $141 $ $111 $ $91 $ $147 $ $116 $ $95 $ $153 $ $120 $ $99 $ $158 $ $125 $ $102 $ $163 $ $128 $ $105 $ $166 $ $131 $ $107 $ $169 $ $133 $ $109 $ $170 $ $134 $ $110 $ $171 $ $134 $ $110 $ $172 $ $135 $ $111 $ $173 $ $136 $ $112 $ $176 $ $138 $ $113 $ $180 $ $141 $ $116 $ $185 $ $146 $ $119 $ $191 $ $151 $ $124 $ $199 $ $156 $ $128 $ $207 $ $163 $ $133 $ $215 $ $169 $ $139 $ $224 $ $176 $ $144 $ $232 $ $183 $ $150 $ $242 $ $190 $ $156 $ $251 $ $197 $ $162 $ $260 $ $205 $ $168 $ $269 $ $212 $ $174 $ $279 $ $220 $ $180 $ $291 $ $229 $ $188 $ $304 $ $239 $ $196 $ $319 $ $251 $ $206 $ $336 $ $265 $ $217 $ $357 $ $281 $ $230 $ $377 $ $297 $ $244 $ $398 $ $314 $ $257 $ $420 $ $330 $ $271 $ $441 $ $347 $ $285 $ $462 $ $364 $ $298 $ $501 $ $395 $ $324 $ $544 $ $428 $ $351 $ $591 $ $465 $ $381 $ $642 $ $505 $ $414 $ $696 $ $548 $ $450 $311 Page 1 of 16

126 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 1 MCOA 7500 MCOA HDHP 3500 MCOA HDHP 5500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $250 $250 0 $400 $400 0 $330 $330 1 $113 $113 1 $181 $181 1 $149 $149 2 $74 $74 2 $118 $118 2 $97 $97 3 $68 $68 3 $109 $109 3 $90 $90 4 $63 $63 4 $101 $101 4 $83 $83 5 $58 $58 5 $93 $93 5 $77 $77 6 $55 $55 6 $88 $88 6 $72 $72 7 $52 $52 7 $84 $84 7 $69 $69 8 $51 $51 8 $81 $81 8 $67 $67 9 $51 $51 9 $81 $81 9 $67 $67 10 $52 $52 10 $83 $83 10 $69 $69 11 $54 $54 11 $87 $87 11 $72 $72 12 $58 $58 12 $92 $92 12 $76 $76 13 $58 $61 13 $93 $98 13 $77 $81 14 $62 $66 14 $100 $ $82 $86 15 $66 $70 15 $106 $ $88 $92 16 $70 $75 16 $112 $ $92 $99 17 $73 $80 17 $117 $ $96 $ $75 $82 18 $120 $ $99 $ $76 $84 19 $121 $ $100 $ $73 $83 20 $117 $ $97 $ $70 $82 21 $112 $ $93 $ $66 $78 22 $105 $ $87 $ $66 $80 23 $105 $ $87 $ $66 $83 24 $106 $ $87 $ $68 $86 25 $108 $ $89 $ $70 $90 26 $112 $ $92 $ $73 $94 27 $116 $ $96 $ $76 $97 28 $121 $ $100 $ $78 $ $125 $ $103 $ $81 $ $129 $ $106 $ $82 $ $132 $ $109 $ $84 $ $134 $ $110 $ $84 $ $135 $ $111 $ $85 $ $135 $ $112 $ $85 $ $136 $ $112 $ $86 $ $137 $ $113 $ $87 $ $139 $ $115 $ $89 $ $142 $ $117 $ $92 $ $146 $ $121 $ $95 $ $152 $ $125 $ $98 $ $157 $ $130 $ $102 $ $164 $ $135 $ $107 $ $170 $ $140 $ $111 $ $177 $ $146 $ $115 $ $184 $ $152 $ $120 $ $191 $ $158 $ $124 $ $198 $ $164 $ $129 $ $206 $ $170 $ $133 $ $213 $ $176 $ $138 $ $221 $ $183 $ $144 $ $230 $ $190 $ $150 $ $240 $ $198 $ $158 $ $252 $ $208 $ $167 $ $266 $ $220 $ $177 $ $282 $ $233 $ $187 $ $299 $ $246 $ $197 $ $315 $ $260 $ $208 $ $332 $ $274 $ $218 $ $349 $ $288 $ $229 $ $366 $ $302 $ $248 $ $397 $ $327 $ $270 $ $431 $ $355 $ $293 $ $468 $ $386 $ $318 $ $508 $ $419 $ $345 $ $551 $ $455 $315 Page 2 of 16

127 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 1 MCOA VALUE 3000 MCOA VALUE 5000 MCOA VALUE 10,000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $328 $328 0 $250 $250 0 $231 $231 1 $148 $148 1 $113 $113 1 $104 $104 2 $97 $97 2 $74 $74 2 $68 $68 3 $90 $90 3 $68 $68 3 $63 $63 4 $83 $83 4 $63 $63 4 $58 $58 5 $77 $77 5 $58 $58 5 $54 $54 6 $72 $72 6 $55 $55 6 $51 $51 7 $68 $68 7 $52 $52 7 $48 $48 8 $67 $67 8 $51 $51 8 $47 $47 9 $67 $67 9 $51 $51 9 $47 $47 10 $68 $68 10 $52 $52 10 $48 $48 11 $71 $71 11 $54 $54 11 $50 $50 12 $75 $75 12 $57 $57 12 $53 $53 13 $76 $80 13 $58 $61 13 $54 $56 14 $82 $86 14 $62 $65 14 $57 $60 15 $87 $92 15 $66 $70 15 $61 $65 16 $92 $98 16 $70 $75 16 $65 $69 17 $96 $ $73 $80 17 $67 $74 18 $98 $ $75 $82 18 $69 $76 19 $100 $ $76 $84 19 $70 $78 20 $96 $ $73 $83 20 $68 $77 21 $92 $ $70 $81 21 $65 $75 22 $86 $ $65 $78 22 $61 $72 23 $86 $ $65 $80 23 $61 $74 24 $87 $ $66 $83 24 $61 $77 25 $89 $ $68 $86 25 $62 $80 26 $92 $ $70 $90 26 $64 $83 27 $95 $ $72 $94 27 $67 $87 28 $99 $ $75 $97 28 $70 $90 29 $103 $ $78 $ $72 $93 30 $106 $ $80 $ $74 $95 31 $108 $ $82 $ $76 $97 32 $110 $ $83 $ $77 $99 33 $110 $ $84 $ $78 $ $111 $ $84 $ $78 $ $111 $ $85 $ $78 $ $112 $ $85 $ $79 $ $114 $ $87 $ $80 $ $117 $ $89 $ $82 $ $120 $ $91 $ $84 $ $124 $ $94 $ $87 $ $129 $ $98 $ $91 $ $134 $ $102 $ $94 $ $140 $ $106 $ $98 $ $145 $ $110 $ $102 $ $151 $ $115 $ $106 $ $157 $ $119 $ $110 $ $163 $ $124 $ $114 $ $169 $ $128 $ $119 $ $175 $ $133 $ $123 $ $181 $ $138 $ $128 $ $189 $ $143 $ $133 $ $197 $ $150 $ $139 $ $207 $ $157 $ $146 $ $218 $ $166 $ $154 $ $231 $ $176 $ $163 $ $245 $ $186 $ $172 $ $259 $ $197 $ $182 $ $272 $ $207 $ $192 $ $286 $ $218 $ $201 $ $300 $ $228 $ $211 $ $325 $ $247 $ $229 $ $353 $ $269 $ $248 $ $384 $ $292 $ $270 $ $416 $ $317 $ $293 $ $452 $ $344 $ $318 $220 Page 3 of 16

128 Exhibit M Preventive and Hospital Care 2750 Single Single Age Male Female 0 $280 $280 1 $126 $126 2 $83 $83 3 $77 $77 4 $71 $71 5 $65 $65 6 $61 $61 7 $58 $58 8 $57 $57 9 $57 $57 10 $58 $58 11 $61 $61 12 $64 $64 13 $65 $69 14 $70 $73 15 $74 $78 16 $78 $84 17 $82 $89 18 $84 $92 19 $85 $94 20 $82 $93 21 $79 $91 22 $73 $88 23 $73 $90 24 $74 $93 25 $76 $97 26 $78 $ $81 $ $85 $ $88 $ $90 $ $92 $ $93 $ $94 $ $95 $ $95 $ $96 $ $97 $ $99 $ $102 $ $106 $ $110 $ $115 $ $119 $ $124 $ $129 $ $134 $ $139 $ $144 $ $149 $ $155 $ $161 $ $168 $ $177 $ $186 $ $198 $ $209 $ $221 $ $232 $ $244 $ $256 $ $278 $ $301 $ $327 $ $355 $ $386 $267 For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 1 Page 4 of 16

129 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 2 MCOA 1500 MCOA 2500 MCOA 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $543 $543 0 $428 $428 0 $351 $351 1 $245 $245 1 $193 $193 1 $158 $158 2 $160 $160 2 $126 $126 2 $103 $103 3 $149 $149 3 $117 $117 3 $96 $96 4 $137 $137 4 $108 $108 4 $88 $88 5 $127 $127 5 $100 $100 5 $82 $82 6 $119 $119 6 $94 $94 6 $77 $77 7 $113 $113 7 $89 $89 7 $73 $73 8 $110 $110 8 $87 $87 8 $71 $71 9 $110 $110 9 $87 $87 9 $71 $71 10 $113 $ $89 $89 10 $73 $73 11 $118 $ $93 $93 11 $76 $76 12 $125 $ $98 $98 12 $81 $81 13 $127 $ $100 $ $82 $86 14 $135 $ $106 $ $87 $92 15 $144 $ $113 $ $93 $98 16 $152 $ $120 $ $98 $ $159 $ $125 $ $102 $ $163 $ $128 $ $105 $ $165 $ $130 $ $106 $ $159 $ $125 $ $103 $ $153 $ $120 $ $99 $ $143 $ $112 $ $92 $ $142 $ $112 $ $92 $ $144 $ $113 $ $93 $ $147 $ $116 $ $95 $ $152 $ $119 $ $98 $ $158 $ $124 $ $102 $ $164 $ $129 $ $106 $ $170 $ $134 $ $110 $ $175 $ $138 $ $113 $ $179 $ $141 $ $115 $ $181 $ $143 $ $117 $ $183 $ $144 $ $118 $ $184 $ $144 $ $118 $ $184 $ $145 $ $119 $ $186 $ $146 $ $120 $ $189 $ $149 $ $122 $ $193 $ $152 $ $125 $ $199 $ $156 $ $128 $ $206 $ $162 $ $133 $ $214 $ $168 $ $138 $ $222 $ $175 $ $143 $ $231 $ $182 $ $149 $ $240 $ $189 $ $155 $ $250 $ $197 $ $161 $ $260 $ $204 $ $168 $ $269 $ $212 $ $174 $ $279 $ $220 $ $180 $ $289 $ $228 $ $187 $ $300 $ $236 $ $194 $ $312 $ $246 $ $202 $ $326 $ $257 $ $211 $ $342 $ $270 $ $221 $ $361 $ $284 $ $233 $ $383 $ $302 $ $247 $ $405 $ $319 $ $262 $ $428 $ $337 $ $276 $ $451 $ $355 $ $291 $ $474 $ $373 $ $306 $ $497 $ $391 $ $321 $ $539 $ $424 $ $348 $ $585 $ $460 $ $377 $ $635 $ $500 $ $410 $ $689 $ $543 $ $445 $ $748 $ $589 $ $483 $334 Page 5 of 16

130 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 2 MCOA 7500 MCOA HDHP 3500 MCOA HDHP 5500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $269 $269 0 $430 $430 0 $355 $355 1 $122 $122 1 $194 $194 1 $160 $160 2 $79 $79 2 $127 $127 2 $105 $105 3 $74 $74 3 $118 $118 3 $97 $97 4 $68 $68 4 $108 $108 4 $89 $89 5 $63 $63 5 $100 $100 5 $83 $83 6 $59 $59 6 $94 $94 6 $78 $78 7 $56 $56 7 $90 $90 7 $74 $74 8 $55 $55 8 $87 $87 8 $72 $72 9 $55 $55 9 $87 $87 9 $72 $72 10 $56 $56 10 $89 $89 10 $74 $74 11 $58 $58 11 $93 $93 11 $77 $77 12 $62 $62 12 $99 $99 12 $82 $82 13 $63 $66 13 $100 $ $83 $87 14 $67 $70 14 $107 $ $88 $93 15 $71 $75 15 $114 $ $94 $99 16 $75 $81 16 $120 $ $99 $ $79 $86 17 $126 $ $104 $ $81 $88 18 $129 $ $106 $ $82 $91 19 $130 $ $108 $ $79 $89 20 $126 $ $104 $ $76 $88 21 $121 $ $100 $ $71 $84 22 $113 $ $93 $ $71 $86 23 $113 $ $93 $ $71 $89 24 $114 $ $94 $ $73 $93 25 $116 $ $96 $ $75 $97 26 $120 $ $99 $ $78 $ $125 $ $103 $ $81 $ $130 $ $107 $ $84 $ $135 $ $111 $ $87 $ $139 $ $114 $ $89 $ $142 $ $117 $ $90 $ $144 $ $118 $ $91 $ $145 $ $119 $ $91 $ $145 $ $120 $ $91 $ $146 $ $120 $ $92 $ $147 $ $121 $ $93 $ $149 $ $123 $ $96 $ $153 $ $126 $ $98 $ $157 $ $130 $ $102 $ $163 $ $134 $ $106 $ $169 $ $139 $ $110 $ $176 $ $145 $ $114 $ $183 $ $151 $ $119 $ $190 $ $157 $ $124 $ $198 $ $163 $ $129 $ $205 $ $169 $ $133 $ $213 $ $176 $ $138 $ $221 $ $182 $ $143 $ $229 $ $189 $ $149 $ $238 $ $196 $ $155 $ $247 $ $204 $ $162 $ $258 $ $213 $ $170 $ $271 $ $224 $ $179 $ $286 $ $236 $ $190 $ $303 $ $250 $ $201 $ $321 $ $265 $ $212 $ $339 $ $280 $ $223 $ $357 $ $294 $ $235 $ $375 $ $309 $ $246 $ $393 $ $324 $ $267 $ $426 $ $352 $ $290 $ $463 $ $382 $ $315 $ $503 $ $415 $ $341 $ $546 $ $450 $ $371 $ $592 $ $489 $338 Page 6 of 16

131 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 2 MCOA VALUE 3000 MCOA VALUE 5000 MCOA VALUE 10,000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $353 $353 0 $268 $268 0 $248 $248 1 $159 $159 1 $121 $121 1 $112 $112 2 $104 $104 2 $79 $79 2 $73 $73 3 $96 $96 3 $73 $73 3 $68 $68 4 $89 $89 4 $67 $67 4 $62 $62 5 $82 $82 5 $63 $63 5 $58 $58 6 $77 $77 6 $59 $59 6 $54 $54 7 $74 $74 7 $56 $56 7 $52 $52 8 $72 $72 8 $54 $54 8 $50 $50 9 $72 $72 9 $54 $54 9 $50 $50 10 $73 $73 10 $56 $56 10 $52 $52 11 $77 $77 11 $58 $58 11 $54 $54 12 $81 $81 12 $62 $62 12 $57 $57 13 $82 $86 13 $62 $66 13 $58 $61 14 $88 $92 14 $67 $70 14 $62 $65 15 $94 $99 15 $71 $75 15 $66 $69 16 $99 $ $75 $80 16 $69 $74 17 $103 $ $78 $86 17 $72 $79 18 $106 $ $80 $88 18 $74 $81 19 $107 $ $81 $90 19 $75 $83 20 $103 $ $79 $89 20 $73 $82 21 $99 $ $75 $87 21 $70 $81 22 $93 $ $70 $84 22 $65 $78 23 $92 $ $70 $86 23 $65 $80 24 $93 $ $71 $89 24 $66 $82 25 $95 $ $73 $93 25 $67 $86 26 $99 $ $75 $96 26 $69 $89 27 $102 $ $78 $ $72 $93 28 $107 $ $81 $ $75 $97 29 $110 $ $84 $ $78 $ $114 $ $86 $ $80 $ $116 $ $88 $ $82 $ $118 $ $89 $ $83 $ $119 $ $90 $ $83 $ $119 $ $91 $ $84 $ $120 $ $91 $ $84 $ $121 $ $92 $ $85 $ $123 $ $93 $ $86 $ $125 $ $95 $ $88 $ $129 $ $98 $ $91 $ $133 $ $101 $ $94 $ $139 $ $105 $ $98 $ $144 $ $110 $ $101 $ $150 $ $114 $ $105 $ $156 $ $119 $ $110 $ $162 $ $123 $ $114 $ $168 $ $128 $ $118 $ $175 $ $133 $ $123 $ $181 $ $138 $ $127 $ $188 $ $143 $ $132 $ $195 $ $148 $ $137 $ $203 $ $154 $ $143 $ $212 $ $161 $ $149 $ $222 $ $169 $ $156 $ $234 $ $178 $ $165 $ $249 $ $189 $ $175 $ $263 $ $200 $ $185 $ $278 $ $211 $ $195 $ $293 $ $222 $ $206 $ $307 $ $234 $ $216 $ $322 $ $245 $ $227 $ $350 $ $266 $ $246 $ $380 $ $289 $ $267 $ $412 $ $313 $ $290 $ $447 $ $340 $ $315 $ $486 $ $369 $ $342 $236 Page 7 of 16

132 Exhibit M Preventive and Hospital Care 2750 Single Single Age Male Female 0 $301 $301 1 $136 $136 2 $89 $89 3 $82 $82 4 $76 $76 5 $70 $70 6 $66 $66 7 $63 $63 8 $61 $61 9 $61 $61 10 $62 $62 11 $65 $65 12 $69 $69 13 $70 $74 14 $75 $79 15 $80 $84 16 $84 $90 17 $88 $96 18 $90 $99 19 $91 $ $88 $ $85 $98 22 $79 $94 23 $79 $97 24 $80 $ $81 $ $84 $ $87 $ $91 $ $94 $ $97 $ $99 $ $100 $ $101 $ $102 $ $102 $ $103 $ $105 $ $107 $ $110 $ $114 $ $118 $ $123 $ $128 $ $133 $ $138 $ $144 $ $149 $ $155 $ $160 $ $166 $ $173 $ $181 $ $190 $ $200 $ $212 $ $225 $ $237 $ $250 $ $262 $ $275 $ $298 $ $324 $ $352 $ $382 $ $415 $287 For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 2 Page 8 of 16

133 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 3 MCOA 1500 MCOA 2500 MCOA 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $543 $543 0 $428 $428 0 $351 $351 1 $245 $245 1 $193 $193 1 $158 $158 2 $160 $160 2 $126 $126 2 $103 $103 3 $149 $149 3 $117 $117 3 $96 $96 4 $137 $137 4 $108 $108 4 $88 $88 5 $127 $127 5 $100 $100 5 $82 $82 6 $119 $119 6 $94 $94 6 $77 $77 7 $113 $113 7 $89 $89 7 $73 $73 8 $110 $110 8 $87 $87 8 $71 $71 9 $110 $110 9 $87 $87 9 $71 $71 10 $113 $ $89 $89 10 $73 $73 11 $118 $ $93 $93 11 $76 $76 12 $125 $ $98 $98 12 $81 $81 13 $127 $ $100 $ $82 $86 14 $135 $ $106 $ $87 $92 15 $144 $ $113 $ $93 $98 16 $152 $ $120 $ $98 $ $159 $ $125 $ $102 $ $163 $ $128 $ $105 $ $165 $ $130 $ $106 $ $159 $ $125 $ $103 $ $153 $ $120 $ $99 $ $143 $ $112 $ $92 $ $142 $ $112 $ $92 $ $144 $ $113 $ $93 $ $147 $ $116 $ $95 $ $152 $ $119 $ $98 $ $158 $ $124 $ $102 $ $164 $ $129 $ $106 $ $170 $ $134 $ $110 $ $175 $ $138 $ $113 $ $179 $ $141 $ $115 $ $181 $ $143 $ $117 $ $183 $ $144 $ $118 $ $184 $ $144 $ $118 $ $184 $ $145 $ $119 $ $186 $ $146 $ $120 $ $189 $ $149 $ $122 $ $193 $ $152 $ $125 $ $199 $ $156 $ $128 $ $206 $ $162 $ $133 $ $214 $ $168 $ $138 $ $222 $ $175 $ $143 $ $231 $ $182 $ $149 $ $240 $ $189 $ $155 $ $250 $ $197 $ $161 $ $260 $ $204 $ $168 $ $269 $ $212 $ $174 $ $279 $ $220 $ $180 $ $289 $ $228 $ $187 $ $300 $ $236 $ $194 $ $312 $ $246 $ $202 $ $326 $ $257 $ $211 $ $342 $ $270 $ $221 $ $361 $ $284 $ $233 $ $383 $ $302 $ $247 $ $405 $ $319 $ $262 $ $428 $ $337 $ $276 $ $451 $ $355 $ $291 $ $474 $ $373 $ $306 $ $497 $ $391 $ $321 $ $539 $ $424 $ $348 $ $585 $ $460 $ $377 $ $635 $ $500 $ $410 $ $689 $ $543 $ $445 $ $748 $ $589 $ $483 $334 Page 9 of 16

134 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 3 MCOA 7500 MCOA HDHP 3500 MCOA HDHP 5500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $269 $269 0 $430 $430 0 $355 $355 1 $122 $122 1 $194 $194 1 $160 $160 2 $79 $79 2 $127 $127 2 $105 $105 3 $74 $74 3 $118 $118 3 $97 $97 4 $68 $68 4 $108 $108 4 $89 $89 5 $63 $63 5 $100 $100 5 $83 $83 6 $59 $59 6 $94 $94 6 $78 $78 7 $56 $56 7 $90 $90 7 $74 $74 8 $55 $55 8 $87 $87 8 $72 $72 9 $55 $55 9 $87 $87 9 $72 $72 10 $56 $56 10 $89 $89 10 $74 $74 11 $58 $58 11 $93 $93 11 $77 $77 12 $62 $62 12 $99 $99 12 $82 $82 13 $63 $66 13 $100 $ $83 $87 14 $67 $70 14 $107 $ $88 $93 15 $71 $75 15 $114 $ $94 $99 16 $75 $81 16 $120 $ $99 $ $79 $86 17 $126 $ $104 $ $81 $88 18 $129 $ $106 $ $82 $91 19 $130 $ $108 $ $79 $89 20 $126 $ $104 $ $76 $88 21 $121 $ $100 $ $71 $84 22 $113 $ $93 $ $71 $86 23 $113 $ $93 $ $71 $89 24 $114 $ $94 $ $73 $93 25 $116 $ $96 $ $75 $97 26 $120 $ $99 $ $78 $ $125 $ $103 $ $81 $ $130 $ $107 $ $84 $ $135 $ $111 $ $87 $ $139 $ $114 $ $89 $ $142 $ $117 $ $90 $ $144 $ $118 $ $91 $ $145 $ $119 $ $91 $ $145 $ $120 $ $91 $ $146 $ $120 $ $92 $ $147 $ $121 $ $93 $ $149 $ $123 $ $96 $ $153 $ $126 $ $98 $ $157 $ $130 $ $102 $ $163 $ $134 $ $106 $ $169 $ $139 $ $110 $ $176 $ $145 $ $114 $ $183 $ $151 $ $119 $ $190 $ $157 $ $124 $ $198 $ $163 $ $129 $ $205 $ $169 $ $133 $ $213 $ $176 $ $138 $ $221 $ $182 $ $143 $ $229 $ $189 $ $149 $ $238 $ $196 $ $155 $ $247 $ $204 $ $162 $ $258 $ $213 $ $170 $ $271 $ $224 $ $179 $ $286 $ $236 $ $190 $ $303 $ $250 $ $201 $ $321 $ $265 $ $212 $ $339 $ $280 $ $223 $ $357 $ $294 $ $235 $ $375 $ $309 $ $246 $ $393 $ $324 $ $267 $ $426 $ $352 $ $290 $ $463 $ $382 $ $315 $ $503 $ $415 $ $341 $ $546 $ $450 $ $371 $ $592 $ $489 $338 Page 10 of 16

135 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 3 MCOA VALUE 3000 MCOA VALUE 5000 MCOA VALUE 10,000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $353 $353 0 $268 $268 0 $248 $248 1 $159 $159 1 $121 $121 1 $112 $112 2 $104 $104 2 $79 $79 2 $73 $73 3 $96 $96 3 $73 $73 3 $68 $68 4 $89 $89 4 $67 $67 4 $62 $62 5 $82 $82 5 $63 $63 5 $58 $58 6 $77 $77 6 $59 $59 6 $54 $54 7 $74 $74 7 $56 $56 7 $52 $52 8 $72 $72 8 $54 $54 8 $50 $50 9 $72 $72 9 $54 $54 9 $50 $50 10 $73 $73 10 $56 $56 10 $52 $52 11 $77 $77 11 $58 $58 11 $54 $54 12 $81 $81 12 $62 $62 12 $57 $57 13 $82 $86 13 $62 $66 13 $58 $61 14 $88 $92 14 $67 $70 14 $62 $65 15 $94 $99 15 $71 $75 15 $66 $69 16 $99 $ $75 $80 16 $69 $74 17 $103 $ $78 $86 17 $72 $79 18 $106 $ $80 $88 18 $74 $81 19 $107 $ $81 $90 19 $75 $83 20 $103 $ $79 $89 20 $73 $82 21 $99 $ $75 $87 21 $70 $81 22 $93 $ $70 $84 22 $65 $78 23 $92 $ $70 $86 23 $65 $80 24 $93 $ $71 $89 24 $66 $82 25 $95 $ $73 $93 25 $67 $86 26 $99 $ $75 $96 26 $69 $89 27 $102 $ $78 $ $72 $93 28 $107 $ $81 $ $75 $97 29 $110 $ $84 $ $78 $ $114 $ $86 $ $80 $ $116 $ $88 $ $82 $ $118 $ $89 $ $83 $ $119 $ $90 $ $83 $ $119 $ $91 $ $84 $ $120 $ $91 $ $84 $ $121 $ $92 $ $85 $ $123 $ $93 $ $86 $ $125 $ $95 $ $88 $ $129 $ $98 $ $91 $ $133 $ $101 $ $94 $ $139 $ $105 $ $98 $ $144 $ $110 $ $101 $ $150 $ $114 $ $105 $ $156 $ $119 $ $110 $ $162 $ $123 $ $114 $ $168 $ $128 $ $118 $ $175 $ $133 $ $123 $ $181 $ $138 $ $127 $ $188 $ $143 $ $132 $ $195 $ $148 $ $137 $ $203 $ $154 $ $143 $ $212 $ $161 $ $149 $ $222 $ $169 $ $156 $ $234 $ $178 $ $165 $ $249 $ $189 $ $175 $ $263 $ $200 $ $185 $ $278 $ $211 $ $195 $ $293 $ $222 $ $206 $ $307 $ $234 $ $216 $ $322 $ $245 $ $227 $ $350 $ $266 $ $246 $ $380 $ $289 $ $267 $ $412 $ $313 $ $290 $ $447 $ $340 $ $315 $ $486 $ $369 $ $342 $236 Page 11 of 16

136 Exhibit M Preventive and Hospital Care 2750 Single Single Age Male Female 0 $301 $301 1 $136 $136 2 $89 $89 3 $82 $82 4 $76 $76 5 $70 $70 6 $66 $66 7 $63 $63 8 $61 $61 9 $61 $61 10 $62 $62 11 $65 $65 12 $69 $69 13 $70 $74 14 $75 $79 15 $80 $84 16 $84 $90 17 $88 $96 18 $90 $99 19 $91 $ $88 $ $85 $98 22 $79 $94 23 $79 $97 24 $80 $ $81 $ $84 $ $87 $ $91 $ $94 $ $97 $ $99 $ $100 $ $101 $ $102 $ $102 $ $103 $ $105 $ $107 $ $110 $ $114 $ $118 $ $123 $ $128 $ $133 $ $138 $ $144 $ $149 $ $155 $ $160 $ $166 $ $173 $ $181 $ $190 $ $200 $ $212 $ $225 $ $237 $ $250 $ $262 $ $275 $ $298 $ $324 $ $352 $ $382 $ $415 $287 For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 3 Page 12 of 16

137 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 4 MCOA 1500 MCOA 2500 MCOA 5000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $506 $506 0 $398 $398 0 $326 $326 1 $228 $228 1 $180 $180 1 $147 $147 2 $149 $149 2 $117 $117 2 $96 $96 3 $138 $138 3 $109 $109 3 $89 $89 4 $127 $127 4 $100 $100 4 $82 $82 5 $118 $118 5 $93 $93 5 $76 $76 6 $111 $111 6 $87 $87 6 $71 $71 7 $106 $106 7 $83 $83 7 $68 $68 8 $103 $103 8 $81 $81 8 $66 $66 9 $103 $103 9 $81 $81 9 $66 $66 10 $105 $ $83 $83 10 $68 $68 11 $110 $ $86 $86 11 $71 $71 12 $116 $ $92 $92 12 $75 $75 13 $118 $ $93 $97 13 $76 $80 14 $126 $ $99 $ $81 $85 15 $134 $ $106 $ $87 $91 16 $142 $ $111 $ $91 $98 17 $148 $ $116 $ $95 $ $151 $ $119 $ $98 $ $153 $ $121 $ $99 $ $148 $ $117 $ $96 $ $142 $ $112 $ $92 $ $133 $ $104 $ $86 $ $133 $ $104 $ $86 $ $134 $ $105 $ $86 $ $137 $ $108 $ $88 $ $141 $ $111 $ $91 $ $147 $ $116 $ $95 $ $153 $ $120 $ $99 $ $158 $ $125 $ $102 $ $163 $ $128 $ $105 $ $166 $ $131 $ $107 $ $169 $ $133 $ $109 $ $170 $ $134 $ $110 $ $171 $ $134 $ $110 $ $172 $ $135 $ $111 $ $173 $ $136 $ $112 $ $176 $ $138 $ $113 $ $180 $ $141 $ $116 $ $185 $ $146 $ $119 $ $191 $ $151 $ $124 $ $199 $ $156 $ $128 $ $207 $ $163 $ $133 $ $215 $ $169 $ $139 $ $224 $ $176 $ $144 $ $232 $ $183 $ $150 $ $242 $ $190 $ $156 $ $251 $ $197 $ $162 $ $260 $ $205 $ $168 $ $269 $ $212 $ $174 $ $279 $ $220 $ $180 $ $291 $ $229 $ $188 $ $304 $ $239 $ $196 $ $319 $ $251 $ $206 $ $336 $ $265 $ $217 $ $357 $ $281 $ $230 $ $377 $ $297 $ $244 $ $398 $ $314 $ $257 $ $420 $ $330 $ $271 $ $441 $ $347 $ $285 $ $462 $ $364 $ $298 $ $501 $ $395 $ $324 $ $544 $ $428 $ $351 $ $591 $ $465 $ $381 $ $642 $ $505 $ $414 $ $696 $ $548 $ $450 $311 Page 13 of 16

138 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 4 MCOA 7500 MCOA HDHP 3500 MCOA HDHP 5500 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $250 $250 0 $400 $400 0 $330 $330 1 $113 $113 1 $181 $181 1 $149 $149 2 $74 $74 2 $118 $118 2 $97 $97 3 $68 $68 3 $109 $109 3 $90 $90 4 $63 $63 4 $101 $101 4 $83 $83 5 $58 $58 5 $93 $93 5 $77 $77 6 $55 $55 6 $88 $88 6 $72 $72 7 $52 $52 7 $84 $84 7 $69 $69 8 $51 $51 8 $81 $81 8 $67 $67 9 $51 $51 9 $81 $81 9 $67 $67 10 $52 $52 10 $83 $83 10 $69 $69 11 $54 $54 11 $87 $87 11 $72 $72 12 $58 $58 12 $92 $92 12 $76 $76 13 $58 $61 13 $93 $98 13 $77 $81 14 $62 $66 14 $100 $ $82 $86 15 $66 $70 15 $106 $ $88 $92 16 $70 $75 16 $112 $ $92 $99 17 $73 $80 17 $117 $ $96 $ $75 $82 18 $120 $ $99 $ $76 $84 19 $121 $ $100 $ $73 $83 20 $117 $ $97 $ $70 $82 21 $112 $ $93 $ $66 $78 22 $105 $ $87 $ $66 $80 23 $105 $ $87 $ $66 $83 24 $106 $ $87 $ $68 $86 25 $108 $ $89 $ $70 $90 26 $112 $ $92 $ $73 $94 27 $116 $ $96 $ $76 $97 28 $121 $ $100 $ $78 $ $125 $ $103 $ $81 $ $129 $ $106 $ $82 $ $132 $ $109 $ $84 $ $134 $ $110 $ $84 $ $135 $ $111 $ $85 $ $135 $ $112 $ $85 $ $136 $ $112 $ $86 $ $137 $ $113 $ $87 $ $139 $ $115 $ $89 $ $142 $ $117 $ $92 $ $146 $ $121 $ $95 $ $152 $ $125 $ $98 $ $157 $ $130 $ $102 $ $164 $ $135 $ $107 $ $170 $ $140 $ $111 $ $177 $ $146 $ $115 $ $184 $ $152 $ $120 $ $191 $ $158 $ $124 $ $198 $ $164 $ $129 $ $206 $ $170 $ $133 $ $213 $ $176 $ $138 $ $221 $ $183 $ $144 $ $230 $ $190 $ $150 $ $240 $ $198 $ $158 $ $252 $ $208 $ $167 $ $266 $ $220 $ $177 $ $282 $ $233 $ $187 $ $299 $ $246 $ $197 $ $315 $ $260 $ $208 $ $332 $ $274 $ $218 $ $349 $ $288 $ $229 $ $366 $ $302 $ $248 $ $397 $ $327 $ $270 $ $431 $ $355 $ $293 $ $468 $ $386 $ $318 $ $508 $ $419 $ $345 $ $551 $ $455 $315 Page 14 of 16

139 Exhibit M For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 4 MCOA VALUE 3000 MCOA VALUE 5000 MCOA VALUE 10,000 Single Single Single Single Single Single Age Male Female Age Male Female Age Male Female 0 $328 $328 0 $250 $250 0 $231 $231 1 $148 $148 1 $113 $113 1 $104 $104 2 $97 $97 2 $74 $74 2 $68 $68 3 $90 $90 3 $68 $68 3 $63 $63 4 $83 $83 4 $63 $63 4 $58 $58 5 $77 $77 5 $58 $58 5 $54 $54 6 $72 $72 6 $55 $55 6 $51 $51 7 $68 $68 7 $52 $52 7 $48 $48 8 $67 $67 8 $51 $51 8 $47 $47 9 $67 $67 9 $51 $51 9 $47 $47 10 $68 $68 10 $52 $52 10 $48 $48 11 $71 $71 11 $54 $54 11 $50 $50 12 $75 $75 12 $57 $57 12 $53 $53 13 $76 $80 13 $58 $61 13 $54 $56 14 $82 $86 14 $62 $65 14 $57 $60 15 $87 $92 15 $66 $70 15 $61 $65 16 $92 $98 16 $70 $75 16 $65 $69 17 $96 $ $73 $80 17 $67 $74 18 $98 $ $75 $82 18 $69 $76 19 $100 $ $76 $84 19 $70 $78 20 $96 $ $73 $83 20 $68 $77 21 $92 $ $70 $81 21 $65 $75 22 $86 $ $65 $78 22 $61 $72 23 $86 $ $65 $80 23 $61 $74 24 $87 $ $66 $83 24 $61 $77 25 $89 $ $68 $86 25 $62 $80 26 $92 $ $70 $90 26 $64 $83 27 $95 $ $72 $94 27 $67 $87 28 $99 $ $75 $97 28 $70 $90 29 $103 $ $78 $ $72 $93 30 $106 $ $80 $ $74 $95 31 $108 $ $82 $ $76 $97 32 $110 $ $83 $ $77 $99 33 $110 $ $84 $ $78 $ $111 $ $84 $ $78 $ $111 $ $85 $ $78 $ $112 $ $85 $ $79 $ $114 $ $87 $ $80 $ $117 $ $89 $ $82 $ $120 $ $91 $ $84 $ $124 $ $94 $ $87 $ $129 $ $98 $ $91 $ $134 $ $102 $ $94 $ $140 $ $106 $ $98 $ $145 $ $110 $ $102 $ $151 $ $115 $ $106 $ $157 $ $119 $ $110 $ $163 $ $124 $ $114 $ $169 $ $128 $ $119 $ $175 $ $133 $ $123 $ $181 $ $138 $ $128 $ $189 $ $143 $ $133 $ $197 $ $150 $ $139 $ $207 $ $157 $ $146 $ $218 $ $166 $ $154 $ $231 $ $176 $ $163 $ $245 $ $186 $ $172 $ $259 $ $197 $ $182 $ $272 $ $207 $ $192 $ $286 $ $218 $ $201 $ $300 $ $228 $ $211 $ $325 $ $247 $ $229 $ $353 $ $269 $ $248 $ $384 $ $292 $ $270 $ $416 $ $317 $ $293 $ $452 $ $344 $ $318 $220 Page 15 of 16

140 Exhibit M Preventive and Hospital Care 2750 Single Single Age Male Female 0 $280 $280 1 $126 $126 2 $83 $83 3 $77 $77 4 $71 $71 5 $65 $65 6 $61 $61 7 $58 $58 8 $57 $57 9 $57 $57 10 $58 $58 11 $61 $61 12 $64 $64 13 $65 $69 14 $70 $73 15 $74 $78 16 $78 $84 17 $82 $89 18 $84 $92 19 $85 $94 20 $82 $93 21 $79 $91 22 $73 $88 23 $73 $90 24 $74 $93 25 $76 $97 26 $78 $ $81 $ $85 $ $88 $ $90 $ $92 $ $93 $ $94 $ $95 $ $95 $ $96 $ $97 $ $99 $ $102 $ $106 $ $110 $ $115 $ $119 $ $124 $ $129 $ $134 $ $139 $ $144 $ $149 $ $155 $ $161 $ $168 $ $177 $ $186 $ $198 $ $209 $ $221 $ $232 $ $244 $ $256 $ $278 $ $301 $ $327 $ $355 $ $386 $267 For Original Coverage Effective Dates Between September 1, 2011 and Later State: Connecticut - Block F Rating Area: 4 Page 16 of 16

141 Exhibit A State of Connecticut Policy Form(s): GR HCRng 01, GR SOC (12/08), GR Historical Experience DOS Members Earned Premium Completed Claims MBR Target MBR Actual to Expected CY ,230 $ 459,609 $ 104, % N/A N/A CY ,171 $ 2,777,729 $ 1,122, % N/A N/A CY ,835 $ 6,829,519 $ 4,218, % 57.9% CY ,749 $ 12,218,411 $ 6,396, % 59.9% Jan-09 7,992 $ 1,411,840 $ 685, % 58.5% Feb-09 8,640 $ 1,571,326 $ 673, % 58.1% Mar-09 9,175 $ 1,679,116 $ 1,185, % 57.7% Apr-09 9,525 $ 1,757,240 $ 852, % 58.1% May-09 10,039 $ 1,838,437 $ 937, % 58.2% Jun-09 10,445 $ 1,914,199 $ 1,148, % 59.1% Jul-09 10,576 $ 2,060,708 $ 1,057, % 59.7% Aug-09 10,880 $ 2,011,751 $ 1,073, % 60.3% Sep-09 11,075 $ 2,073,537 $ 1,073, % 61.2% Oct-09 11,184 $ 2,115,155 $ 1,012, % 61.9% Nov-09 11,341 $ 2,159,093 $ 1,098, % 62.3% Dec-09 11,617 $ 2,232,945 $ 1,319, % 62.8% Jan-10 11,974 $ 2,372,483 $ 957, % 61.8% Feb-10 12,271 $ 2,369,647 $ 998, % 61.9% Mar-10 12,454 $ 2,519,101 $ 1,204, % 62.2% Apr-10 12,559 $ 2,515,948 $ 1,466, % 63.2% May-10 12,660 $ 2,546,961 $ 1,376, % 63.6% Jun-10 12,739 $ 2,622,753 $ 1,327, % 63.9% Jul-10 12,924 $ 2,687,623 $ 1,558, % 64.6% Aug-10 13,169 $ 2,731,012 $ 1,635, % 64.6% Sep-10 13,449 $ 2,886,291 $ 1,662, % 64.9% Oct-10 13,832 $ 2,931,852 $ 2,114, % 64.3% Nov-10 14,469 $ 3,128,796 $ 1,668, % 63.6% Dec-10 15,087 $ 3,288,499 $ 1,736, % 63.1% 0.837

142 Exhibit B State of Connecticut Policy Form(s): GR HCRng 01, GR SOC (12/08), GR Trend 1. Experience PMPM by Service Category Q 2011 Trend Inpatient Facility $16.72 $21.64 $28.27 $ % Ambulatory Facility $7.66 $11.16 $12.06 $ % Emergency $3.17 $3.77 $4.62 $ % Specialist Physician $20.16 $21.89 $24.68 $ % Primary Physician $12.72 $11.87 $10.88 $ % Radiology $8.12 $6.92 $8.07 $ % Lab $3.76 $4.22 $4.94 $ % Pharmacy Rider (per rx mem) $8.19 $8.91 $9.66 $ % Other Medical $8.70 $7.36 $12.48 $ % Total Medical $89.28 $97.74 $ $ % 2. Unit Cost Q 2011 Trend Inpatient Facility $3, $3, $3, $6, % Ambulatory Facility $ $ $ $ % Emergency $37.92 $46.81 $59.61 $ % Specialist Physician $63.60 $67.57 $81.10 $ % Primary Physician $69.65 $65.41 $66.02 $ % Radiology $86.36 $72.19 $78.67 $ % Lab $8.81 $9.91 $11.66 $ % Pharmacy Rider (per script) N/A $25.09 $26.15 $ % Other Medical $58.78 $56.59 $90.78 $ % Total Medical $63.02 $69.56 $84.56 $ % 3. Utilization per 1000 Members Q 2011 Trend Inpatient Facility % Ambulatory Facility % Emergency 1, % Specialist Physician 3, , , , % Primary Physician 2, , , , % Radiology 1, , , , % Lab 5, , , , % Pharmacy Rider (per rx mem) N/A Other Medical 1, , , , % Total Medical 15, , , , %

143 Exhibit C Paid Claims Triangle forconnecticut - MED For claims incurred and paid fro Apr-07 through Mar-11 IVL Month Incurred INC INC + 1 INC + 2 INC + 3 INC + 4 INC + 5 INC + 6 INC + 7 INC + 8 INC + 9 INC + 10 INC + 11 INC + 12 INC + 13 INC + 14 INC + 15 INC + 16 INC + 17 INC + 18 MONTH PAID Apr , ,362 78,425 59,889 49,952 8,814 7,612 7,168 88,525 10, , , May-07 56, ,753 47,567 10,003 8,185 1, , Jun-07 45, ,838 18,807 7,197 40, , , Jul-07 88, ,977 44,919 7,863 1,393 2, Aug-07 52, ,334 34,278 9,751 54,922 7,521 3,972 6,489-1,496-1, Sep-07 36, ,499 11,389 9,558-4,381 35, , Oct-07 95, ,572 17,783 6,061 5,485 1,206 1,317 5, , Nov-07 68, ,108 24,330 10,451 21,407 1, , Dec-07 91, ,158 32,499 5,452 3, , ,192 1, ,956 0 Jan-08 53, ,714 43,962 10,724 2, , , , Feb-08 54, ,872 18,277 22,344 3,017 2, , Mar , ,982 39,019 4,771 2, , ,188-1, Apr , ,417 38,445 5,784 11, , , , May-08 92, ,064 20,414 18,352 3, , , Jun , ,792 59,084 6,752 1, , , Jul-08 96, , ,805 11,985 8,709 1,188 14,398 1,933 1, ,610 Aug-08 84, ,742 49,154 4,010 4,711 1,503 2,190 1, , , Sep , ,840 74, ,820 7, ,196 1, , Oct , , ,250 5,756 11,903 5,087 1, , Nov-08 94, , ,721 14,352 9,111 2, ,499 4, , Dec , , ,661 14,583 22, , , ,015-2, Jan-09 98, ,973 83,368 63,523 7,113 1, , , , , Feb-09 73, , ,087 6,367 5,179 4, , , Mar , , , , , , Apr , , ,032 47,257 6,054 2, , , , May , , ,617 33,635 3, ,225 3, ,787 6,073 3, , ,150 Jun , , ,606 11,362 7, , , , , Jul , ,370 65,894 25,283 21,463 9,336 2,220 9, , Aug , , ,317 48,693 34, ,306 2, , Sep , , ,945 29,045 4,001 1,236 2,859 1,911-1, ,619-7, ,166 Oct , , ,846 18,911 25,958 7, , Nov , , ,099 21,406-1, ,328 25, , Dec , ,120 79,384 32,530 12, ,670 3,720 27, , Jan , , ,218 7,967 6,317 1,024 2, , Feb-10 97, , ,992 15,697 5,789 4,891 7, , Mar , ,006 69,379 53,141 6,721 6,123 2,480 2, ,756 4,147-1,427 3, Apr , , , ,382 10, , , May , , ,119 35,794 5,117 1,338 9,689 9,133-3,037-5, Jun , , ,470 20,163 19,406 2,329 2, Jul , ,751 87,719 53,922 11, ,114 4,022-1,643-1, Aug , , ,931 58,957 5,616 4,091 1,451-3, Sep , , ,364 83,967 52,707 10,448-13, Oct , , ,946 48,549 8, , Nov , , ,530 20,301 40, Dec ,881 1,219, ,535 93, Jan , , , Feb ,650 1,057, Mar , Exhibit C - Claim Lag Triangle.xls (CT IVL) Page 1 of 3

144 Exhibit C Paid Claims Triangle for: Connecticut - MED For claims incurred and paid from: Apr-07 through Mar-11 Month Incurred MONTH PAID INC + 19 INC + 20 INC + 21 INC + 22 INC + 23 INC + 24 INC + 25 INC + 26 INC + 27 INC + 28 INC + 29 INC + 30 INC + 31 INC + 32 INC + 33 INC + 34 INC + 35 INC + 36 INC + 37 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 8, , , , , , , , , , , , , , , , , Exhibit C - Claim Lag Triangle.xls (CT IVL) Page 2 of 3

145 Exhibit C IVL Total Paids: Total Incurred Reserve: 39,949,361 42,536,027 2,586,666 Month Incurred Total by Total by Estimated Completion INC + 38 INC + 39 INC + 40 INC + 41 INC + 42 INC + 43 INC + 44 INC + 45 INC + 46 INC + 47 Pmt. Month DOS Incurreds Ratio PMPMs Enrollment Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar ,447 1, , , , % , , , , % , , , , % , , , , % , , , , , % , , , , , % , , , , % ,404 1, , , , % ,674 6, , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , , , , % , ,122 1,122,245 1,124, % , , , , % , , , , % , ,099,216 1,076,685 1,081, % , ,160, , , % , ,051, , , % , , , , % , , , , % , ,012, , , % , ,012,782 1,158,701 1,165, % , , , , % , , , , % , ,115,502 1,009,439 1,016, % , ,041,330 1,265,428 1,275, % , ,031,644 1,199,642 1,208, % , ,270,161 1,172,091 1,181, % , ,279,472 1,403,140 1,414, % , ,433,641 1,394,634 1,408, % , ,121,957 1,476,700 1,491, % , ,472,480 2,152,490 2,165, % , ,686,745 1,605,837 1,624, % , ,771,866 2,109,666 2,190, % , ,956,731 1,372,682 1,491, % , ,498,140 1,367,553 1,879, % , ,524, ,514 2,122, % ,251 Exhibit C - Claim Lag Triangle.xls (CT IVL) Page 3 of 3

146 Exhibit E State of Connecticut Age/Gender Factors Plans Effective Before June 2008 PPO 500 PPO 1500 PPO 2500 Age Male Female Age Male Female Age Male Female PPO 3500 PPO 5000 High Deductible 2750 Age Male Female Age Male Female Age Male Female High Deductible 5000 Preventative and Hospital Care 1250 Preventative and Hospital Care 3000 Age Male Female Age Male Female Age Male Female Page 1 of 4

147 Exhibit E State of Connecticut Age/Gender Factors Plans Effective June 1, 2008 to December 31, Plan, and CYM 1500 Plan 2500 Plan, Value 2500 Plan, 3500 Plan, 5000 Plan, Value 5000 Plan, 7500 Plan, and CYM 2500 Plan HDHP 5000 Plan, and PHC Plans Age Male Female Age Male Female Age Male Female Page 2 of 4

148 Exhibit E State of Connecticut Age/Gender Factors Plans Effective June 1, 2008 to December 31, 2010 High Deductible 3000 Plan First Dollar Plans CYM 750 Plan Age Male Female Age Male Female Age Male Female Page 3 of 4

149 Exhibit E State of Connecticut Policy Form(s): GR SOC (12/08), GR-96400, and GR HCRng 01 Age/Gender Factors Plans Effective January 1, 2011 and Later (Originally proposed effective October 1, 2010 and later) All Plans Age Male Female Page 4 of 4

150 AETNA LIFE INSURANCE COMPANY Area Factors State: Connecticut Policy Form(s): GR HCRng 01, GR SOC (12/08), and GR Exhibit F Rating Area Grouping Counties Included Factor 1 Hartford Fairfield New Haven Litchfield, Middlesex, New London, Tolland, Windham 0.940

151 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA $1,500 version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $1,500 / $3,000 $3,000 / $6,000 Coinsurance 20% 50% Coinsurance Maximum (Individual / Family) $1,500 / $3,000 $7,000 / $14,000 Out-of-Pocket Maximum (Individual / Family) $3,000 / $6,000 $10,000 / $20,000 Lifetime Maximum (cross applies to in and out of network) Unlimited Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) $30 copay, deductible waived 50% after deductible Specialist Office Visit $45 copay, deductible waived 50% after deductible Urgent Care Facility $50 copay, deductible waived 50% after deductible Hospital Admission 40% after deductible 50% after deductible Outpatient Surgery 40% after deductible 50% after deductible Emergency Room 20% after deductible 20% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray 20% after deductible 50% after deductible Mental Health - Serious Mental Illness (SMI) or Biologically Based Mental Health - Non-SMI or Non-Biologically Based Alcohol/Drug Abuse Services - Detoxification Alcohol/Drug Abuse Services - Rehabilitation 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Copay; deductible waived. 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Copay; deductible waived. 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Copay; deductible waived. 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Copay; deductible waived. 50% after deductible (Inpatient & Outpatient) 50% after deductible (Inpatient & Outpatient) 50% after deductible (Inpatient & Outpatient) 50% after deductible (Inpatient & Outpatient) Skilled Nursing Facility (30 days per calendar year) 20% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 20% after deductible 50% after deductible Home Health Care (80 visits per calendar year) 20% 25% Durable Medical Equipment 40% after deductible 50% after deductible Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) $500 $500 Generic Copay / Coinsurance $15 copay, Rx deductible waived 50%, Rx deductible waived Preferred Brand Copay / Coinsurance $35 copay 50% Non-Preferred Brand Copay / Coinsurance $40 copay 50% Self-Injectible Drugs Copay / Coinsurance 25% Not Covered (If medically necessary, 50% after $500 Deductible) Calendar Year Maximum per Individual Unlimited Unlimited Page 1 of 10

152 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA $2,500 version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $2,500 / $5,000 $5,000 / $10,000 Coinsurance 20% 50% Coinsurance Maximum (Individual / Family) $2,500 / $5,000 $5,000 / $10,000 Out-of-Pocket Maximum (Individual / Family) $5,000 / $10,000 $10,000 / $20,000 Lifetime Maximum (cross applies to in and out of network) Unlimited Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) $30 copay, deductible waived 50% after deductible Specialist Office Visit $45 copay, deductible waived 50% after deductible Urgent Care Facility $50 copay, deductible waived 50% after deductible Hospital Admission 20% after deductible 50% after deductible Outpatient Surgery 20% after deductible 50% after deductible Emergency Room 20% after deductible 20% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray 20% after deductible 50% after deductible 20% after deductible for Inpatient & Mental Health - Serious Mental Illness (SMI) or Biologically Based Outpatient. An office Visit would be subject 50% after deductible (Inpatient & Outpatient) to Copay; deductible waived. 20% after deductible for Inpatient & Mental Health - Non-SMI or Non-Biologically Based Outpatient. An office Visit would be subject 50% after deductible (Inpatient & Outpatient) to Copay; deductible waived. 20% after deductible for Inpatient & Alcohol/Drug Abuse Services - Detoxification Outpatient. An office Visit would be subject 50% after deductible (Inpatient & Outpatient) to Copay; deductible waived. 20% after deductible for Inpatient & Alcohol/Drug Abuse Services - Rehabilitation Outpatient. An office Visit would be subject 50% after deductible (Inpatient & Outpatient) to Copay; deductible waived. Skilled Nursing Facility (30 days per calendar year) 20% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 20% after deductible 50% after deductible Home Health Care (80 visits per calendar year) 20% 25% Durable Medical Equipment 40% after deductible 50% after deductible Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) $500 $500 Generic Copay / Coinsurance $15 copay, Rx deductible waived 50%, Rx deductible waived Preferred Brand Copay / Coinsurance $35 copay 50% Non-Preferred Brand Copay / Coinsurance $40 copay 50% Self-Injectible Drugs Copay / Coinsurance 25% Not Covered (If medically necessary, 50% after $500 Deductible) Calendar Year Maximum per Individual Unlimited Unlimited Page 2 of 10

153 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA $5,000 version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $5,000 / $10,000 $10,000 / $20,000 Coinsurance 20% 50% Coinsurance Maximum (Individual / Family) $5,000 / $10,000 $2,500 / $5,000 Out-of-Pocket Maximum (Individual / Family) $10,000 / $20,000 $12,500 / $25,000 Lifetime Maximum (cross applies to in and out of network) Unlimited Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) $30 copay, deductible waived 50% after deductible Specialist Office Visit $45 copay, deductible waived 50% after deductible Urgent Care Facility $50 copay, deductible waived 50% after deductible Hospital Admission 20% after deductible 50% after deductible Outpatient Surgery 20% after deductible 50% after deductible Emergency Room 20% after deductible 20% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray 20% after deductible 50% after deductible 20% after deductible for Inpatient & Mental Health - Serious Mental Illness (SMI) or Biologically Based Outpatient. An office Visit would be subject 50% after deductible (Inpatient & Outpatient) to Copay; deductible waived. 20% after deductible for Inpatient & Mental Health - Non-SMI or Non-Biologically Based Outpatient. An office Visit would be subject 50% after deductible (Inpatient & Outpatient) to Copay; deductible waived. 20% after deductible for Inpatient & Alcohol/Drug Abuse Services - Detoxification Outpatient. An office Visit would be subject 50% after deductible (Inpatient & Outpatient) to Copay; deductible waived. 20% after deductible for Inpatient & Alcohol/Drug Abuse Services - Rehabilitation Outpatient. An office Visit would be subject 50% after deductible (Inpatient & Outpatient) to Copay; deductible waived. Skilled Nursing Facility (30 days per calendar year) 20% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 20% after deductible 50% after deductible Home Health Care (80 visits per calendar year) 20% 25% Durable Medical Equipment 20% after deductible 50% after deductible Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) $500 $500 Generic Copay / Coinsurance $15 copay, Rx deductible waived 50%, Rx deductible waived Preferred Brand Copay / Coinsurance $35 copay 50% Non-Preferred Brand Copay / Coinsurance $40 copay 50% Self-Injectible Drugs Copay / Coinsurance 25% Not Covered (If medically necessary, 50% after $500 Deductible) Calendar Year Maximum per Individual Unlimited Unlimited Page 3 of 10

154 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA $7,500 with Unlimited Primary Care version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $7,500 / $15,000 $10,000 / $20,000 Coinsurance 20% 50% Coinsurance Maximum (Individual / Family) $2,500 / $5,000 $2,500 / $5,000 Out-of-Pocket Maximum (Individual / Family) $10,000 / $20,000 $12,500 / $25,000 Lifetime Maximum (cross applies to in and out of network) Unlimited Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) $30 copay, deductible waived 50% after deductible Specialist Office Visit 20% after deductible 50% after deductible Urgent Care Facility $50 copay, deductible waived 50% after deductible Hospital Admission 20% after deductible 50% after deductible Outpatient Surgery 20% after deductible 50% after deductible Emergency Room 20% after deductible 20% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray 20% after deductible 50% after deductible Mental Health - Serious Mental Illness (SMI) or Biologically Based Mental Health - Non-SMI or Non-Biologically Based Alcohol/Drug Abuse Services - Detoxification Alcohol/Drug Abuse Services - Rehabilitation 20% after deductible for Inpatient & Outpatient. 20% after deductible for Inpatient & Outpatient. 20% after deductible for Inpatient & Outpatient. 20% after deductible for Inpatient & Outpatient. 50% after deductible (Inpatient & Outpatient) 50% after deductible (Inpatient & Outpatient) 50% after deductible (Inpatient & Outpatient) 50% after deductible (Inpatient & Outpatient) Skilled Nursing Facility (30 days per calendar year) 20% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 20% after deductible 50% after deductible Home Health Care (80 visits per calendar year) 20% 25% Durable Medical Equipment 20% after deductible 50% after deductible Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) $500 $500 Generic Copay / Coinsurance $20 copay, Rx deductible waived 50%, Rx deductible waived Preferred Brand Copay / Coinsurance Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Non-Preferred Brand Copay / Coinsurance Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Self-Injectible Drugs Copay / Coinsurance Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Calendar Year Maximum per Individual Unlimited Unlimited Page 4 of 10

155 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA Value $3,000 version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $3,000 / $6,000 $6,000 / $12,000 Coinsurance 20% 50% Coinsurance Maximum (Individual / Family) $4,500 / $9,000 $2,500 / $5,000 Out-of-Pocket Maximum (Individual / Family) $7,500 / $15,000 $12,500 / $25,000 Lifetime Maximum (cross applies to in and out of network) Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) Specialist Office Visit Unlimited Visits 1-3: $30 Copay, deductible waived; Thereafter, Members pays 100% but Aetna Negotiated Charge applies. Aetna Pays 100% once OOP is reached Visits 1-3: $30 Copay, deductible waived; Thereafter, Members pays 100% but Aetna discount applies. Aetna Pays 100% once OOP is reached 50% after deductible 50% after deductible Urgent Care Facility $75 copay, deductible waived 50% after deductible Hospital Admission 40% after deductible 50% after deductible Outpatient Surgery 40% after deductible 50% after deductible Emergency Room 20% after deductible 20% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray 20% after deductible 50% after deductible Mental Health - Serious Mental Illness (SMI) or Biologically Based 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Mental Health - Non-SMI or Non-Biologically Based 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Alcohol/Drug Abuse Services - Detoxification 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Alcohol/Drug Abuse Services - Rehabilitation 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Skilled Nursing Facility (30 days per calendar year) 40% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 20% after deductible 50% after deductible Home Health Care (80 visits per calendar year) 20% 25% Durable Medical Equipment 40% after deductible 50% after deductible Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) $500 $500 Generic Copay / Coinsurance $20 copay, Rx deductible waived 50%, Rx deductible waived Preferred Brand Copay / Coinsurance Non-Preferred Brand Copay / Coinsurance Self-Injectible Drugs Copay / Coinsurance Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Not Covered (If medically necessary, 50% after $500 Deductible) Not Covered (If medically necessary, 50% after $500 Deductible) Calendar Year Maximum per Individual Unlimited Unlimited Page 5 of 10

156 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA Value $5,000 version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $5,000 / $10,000 $10,000 / $20,000 Coinsurance 20% 50% Coinsurance Maximum (Individual / Family) $7,500 / $15,000 $2,500 / $5,000 Out-of-Pocket Maximum (Individual / Family) $12,500 / $25,000 $12,500 / $25,000 Lifetime Maximum (cross applies to in and out of network) Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) Specialist Office Visit Unlimited Visits 1-3: $30 Copay, deductible waived; Thereafter, Members pays 100% but Aetna Negotiated Charge applies. Aetna Pays 100% once OOP is reached Visits 1-3: $30 Copay, deductible waived; Thereafter, Members pays 100% but Aetna Negotiated Charge applies. Aetna Pays 100% once OOP is reached 50% after deductible 50% after deductible Urgent Care Facility $75 copay, deductible waived 50% after deductible Hospital Admission 40% after deductible 50% after deductible Outpatient Surgery 40% after deductible 50% after deductible Emergency Room 20% after deductible 20% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray 20% after deductible 50% after deductible Mental Health - Serious Mental Illness (SMI) or Biologically Based 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Mental Health - Non-SMI or Non-Biologically Based 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Alcohol/Drug Abuse Services - Detoxification 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Alcohol/Drug Abuse Services - Rehabilitation 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Skilled Nursing Facility (30 days per calendar year) 40% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 20% after deductible 50% after deductible Home Health Care (80 visits per calendar year) 20% 25% Durable Medical Equipment 40% after deductible 50% after deductible Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) $500 $500 Generic Copay / Coinsurance $20 copay, Rx deductible waived 50%, Rx deductible waived Preferred Brand Copay / Coinsurance Non-Preferred Brand Copay / Coinsurance Self-Injectible Drugs Copay / Coinsurance Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Not Covered (If medically necessary, 50% after $500 Deductible) Not Covered (If medically necessary, 50% after $500 Deductible) Calendar Year Maximum per Individual Unlimited Unlimited Page 6 of 10

157 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA Value $10,000 version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $10,000 / $20,000 $10,000 / $20,000 Coinsurance 20% 50% Coinsurance Maximum (Individual / Family) $2,500 / $5,000 $2,500 / $5,000 Out-of-Pocket Maximum (Individual / Family) $12,500 / $25,000 $12,500 / $25,000 Lifetime Maximum (cross applies to in and out of network) Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) Specialist Office Visit Unlimited Visits 1-3: $30 Copay, deductible waived; Thereafter, Members pays 100% but Aetna Negotiated Charge applies. Aetna Pays 100% once OOP is reached Visits 1-3: $30 Copay, deductible waived; Thereafter, Members pays 100% but Aetna Negotiated Charge applies. Aetna Pays 100% once OOP is reached 50% after deductible 50% after deductible Urgent Care Facility $75 copay, deductible waived 50% after deductible Hospital Admission 40% after deductible 50% after deductible Outpatient Surgery 40% after deductible 50% after deductible Emergency Room 20% after deductible 20% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray 20% after deductible 50% after deductible Mental Health - Serious Mental Illness (SMI) or Biologically Based 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Mental Health - Non-SMI or Non-Biologically Based 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Alcohol/Drug Abuse Services - Detoxification 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Alcohol/Drug Abuse Services - Rehabilitation 20% after deductible for Inpatient & Outpatient. An office Visit would be subject to Visits 1-5: $45 Copay, deductible waived; Thereafter, Members pays 100% but Aetna 50% after deductible (Inpatient & Outpatient) Negotiated Charge applies. Aetna Pays 100% once OOP is reached Skilled Nursing Facility (30 days per calendar year) 40% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 20% after deductible 50% after deductible Home Health Care (80 visits per calendar year) 20% 25% Durable Medical Equipment 40% after deductible 50% after deductible Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) $500 $500 Generic Copay / Coinsurance $20 copay, Rx deductible waived 50%, Rx deductible waived Preferred Brand Copay / Coinsurance Non-Preferred Brand Copay / Coinsurance Self-Injectible Drugs Copay / Coinsurance Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Aetna Negotiated Charge Applies Not Covered (If medically necessary, 50% after $500 Deductible) Not Covered (If medically necessary, 50% after $500 Deductible) Not Covered (If medically necessary, 50% after $500 Deductible) Calendar Year Maximum per Individual Unlimited Unlimited Page 7 of 10

158 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA HDHP $3,500 version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $3,500 / $7,000 $7,000 / $14,000 Coinsurance 10% 50% Coinsurance Maximum (Individual / Family) $2,450 / $4,900 $6,500 / $13,000 Out-of-Pocket Maximum (Individual / Family) $5,950 / $11,900 $12,500 / $25,000 Lifetime Maximum (cross applies to in and out of network) Unlimited Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) 10% after deductible 50% after deductible Specialist Office Visit 10% after deductible 50% after deductible Urgent Care Facility 10% after deductible 50% after deductible Hospital Admission 10% after deductible 50% after deductible Outpatient Surgery 10% after deductible 50% after deductible Emergency Room 10% after deductible 0% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray 10% after deductible 50% after deductible Mental Health - Serious Mental Illness (SMI) or Biologically Based 10% after deductible Inpatient & Outpatient 50% after deductible Inpatient & Outpatient Mental Health - Non-SMI or Non-Biologically Based 10% after deductible Inpatient & Outpatient 50% after deductible Inpatient & Outpatient Alcohol/Drug Abuse Services - Detoxification 10% after deductible Inpatient & Outpatient 50% after deductible Inpatient & Outpatient Alcohol/Drug Abuse Services - Rehabilitation 10% after deductible Inpatient & Outpatient 50% after deductible Inpatient & Outpatient Skilled Nursing Facility (30 days per calendar year) 10% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 10% after deductible 50% after deductible Home Health Care (80 visits per calendar year) 10% 25% Durable Medical Equipment 10% after deductible 50% after deductible Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) Integrated with Medical/Rx deductible Integrated with Medical/Rx deductible Generic Copay / Coinsurance 10% after Medical/Rx deductible 50% after Medical/Rx deductible Preferred Brand Copay / Coinsurance 10% after Medical/Rx deductible 50% after Medical/Rx deductible Non-Preferred Brand Copay / Coinsurance 10% after Medical/Rx deductible 50% after Medical/Rx deductible Self-Injectible Drugs Copay / Coinsurance 10% after Medical/Rx deductible Not Covered (If medically necessary, 50% after Deductible) Calendar Year Maximum per Individual Unlimited Unlimited Page 8 of 10

159 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA HDHP $5,500 version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $5,500 / $11,000 $11,000 / $22,000 Coinsurance 0% 50% Coinsurance Maximum (Individual / Family) $0 / $0 $2,500 / $5,000 Out-of-Pocket Maximum (Individual / Family) $5,500 / $11,000 $12,500 / $25,000 Lifetime Maximum (cross applies to in and out of network) Unlimited Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) 0% after deductible 50% after deductible Specialist Office Visit 0% after deductible 50% after deductible Urgent Care Facility 0% after deductible 50% after deductible Hospital Admission 0% after deductible 50% after deductible Outpatient Surgery 0% after deductible 50% after deductible Emergency Room 0% after deductible 0% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray 0% after deductible 50% after deductible Mental Health - Serious Mental Illness (SMI) or Biologically Based 0% after deductible Inpatient & Outpatient 50% after deductible Inpatient & Outpatient Mental Health - Non-SMI or Non-Biologically Based 0% after deductible Inpatient & Outpatient 50% after deductible Inpatient & Outpatient Alcohol/Drug Abuse Services - Detoxification 0% after deductible Inpatient & Outpatient 50% after deductible Inpatient & Outpatient Alcohol/Drug Abuse Services - Rehabilitation 0% after deductible Inpatient & Outpatient 50% after deductible Inpatient & Outpatient Skilled Nursing Facility (30 days per calendar year) 0% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 0% after deductible 50% after deductible Home Health Care (80 visits per calendar year) 0% 25% Durable Medical Equipment 0% after deductible 50% after deductible Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) Integrated with Medical/Rx deductible Integrated with Medical/Rx deductible Generic Copay / Coinsurance 0% after Medical/Rx deductible 50% after Medical/Rx deductible Preferred Brand Copay / Coinsurance 0% after Medical/Rx deductible 50% after Medical/Rx deductible Non-Preferred Brand Copay / Coinsurance 0% after Medical/Rx deductible 50% after Medical/Rx deductible Self-Injectible Drugs Copay / Coinsurance 0% after Medical/Rx deductible Not Covered (If medically necessary, 50% after Deductible) Calendar Year Maximum per Individual Unlimited Unlimited Page 9 of 10

160 Exhibit G Policy Form GR HCRng 01 State of Connecticut Brief Summary of Benefit Plan For Original Coverage Effective Dates 09/01/2011 and Later MCOA Preventative and Hospital Care $2,750 version 09/01/2011 Member Benefits In-Network Out-of-Network Deductible (Individual / Family) $2,750 / $5,500 $5,500 / $11,000 Coinsurance 20% 50% Coinsurance Maximum (Individual / Family) $3,200 / $6,400 $6,400 / $12,800 Out-of-Pocket Maximum (Individual / Family) $5,950 / $11,900 $10,000 / $20,000 Lifetime Maximum (cross applies to in and out of network) Unlimited Non-specialist Office Visit (Internist, General/Family Practitioner or Pediatrician) Not Covered Not Covered Specialist Office Visit Not Covered Not Covered Urgent Care Facility Not Covered Not Covered Hospital Admission 20% after deductible 50% after deductible Outpatient Surgery 20% after deductible 50% after deductible Emergency Room 20% after deductible 20% after deductible Annual Routine Gyn Exam (Annual Pap/Mammogram) $0 copay, deductible waived $0 copay, deductible waived Maternity/Obstetrician Services Not Covered- except complications Not Covered- except complications Preventive Health $0 copay, deductible waived $0 copay, deductible waived Lab & X-Ray Not Covered Not Covered Mental Health - Serious Mental Illness (SMI) or Biologically Based 20% after deductible Inpatient & Outpatient 50% after deductible (Inpatient & Outpatient) Mental Health - Non-SMI or Non-Biologically Based 20% after deductible Inpatient & Outpatient 50% after deductible (Inpatient & Outpatient) Alcohol/Drug Abuse Services - Detoxification 20% after deductible Inpatient & Outpatient 50% after deductible (Inpatient & Outpatient) Alcohol/Drug Abuse Services - Rehabilitation 20% after deductible Inpatient & Outpatient 50% after deductible (Inpatient & Outpatient) Skilled Nursing Facility (30 days per calendar year) 20% after deductible 50% after deductible Physical/Occupational/Therapy ($25 maximum per visit, 24 visits per year) 1 Not Covered Not Covered Home Health Care (80 visits per calendar year) 20% 25% Durable Medical Equipment Not Covered Not Covered Pharmacy Pharmacy Deductible (separate deductible for In- and Out-of-network) Not Applicable Not Applicable Generic Copay / Coinsurance Not Covered - Aetna Negotiated Charge Applies Not Covered Preferred Brand Copay / Coinsurance Not Covered - Aetna Negotiated Charge Applies Not Covered Non-Preferred Brand Copay / Coinsurance Not Covered - Aetna Negotiated Charge Applies Not Covered Self-Injectible Drugs Copay / Coinsurance Not Covered - Aetna Negotiated Charge Applies Not Covered Calendar Year Maximum per Individual Not Applicable Not Applicable Page 10 of 10

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