Aetna Health Plans for Maine Rating Area 1 Counties Monthly Rates (Effective 01/01/2016*) Cumberland, Sagadahoc, York

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1 Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Maine Rating Area 1 Counties Monthly Rates (Effective 01/01/2016*) Cumberland, Sagadahoc, York Aetna Whole Health Bronze $35 Copay PD Aetna Whole Health Silver $10 Copay PD Aetna Whole Health Gold $5 Copay PD 0-20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ** $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ** $ $ *Networks may not be available in all zip codes and are subject to change. ** 65+ rates are not available to new applicants $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, ** $ $1, How to calculate your monthly payment Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of A (1/16)

2 Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

3 Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Maine Rating Area 2 Counties Monthly Rates (Effective 01/01/2016*) Knox, Lincoln, Oxford Aetna Whole Health Bronze $35 Copay PD Aetna Whole Health Silver $10 Copay PD Aetna Whole Health Gold $5 Copay PD 0-20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ** $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ** $ $ *Networks may not be available in all zip codes and are subject to change. ** 65+ rates are not available to new applicants $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, ** $1, $1, How to calculate your monthly payment Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of A (1/16)

4 Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

5 Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Maine Rating Area 3 Counties Monthly Rates (Effective 01/01/2016*) Androscoggin, Franklin, Waldo Aetna Whole Health Bronze $35 Copay PD Aetna Whole Health Silver $10 Copay PD Aetna Whole Health Gold $5 Copay PD 0-20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ** $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ** $ $ *Networks may not be available in all zip codes and are subject to change. ** 65+ rates are not available to new applicants $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $1, $1, ** $1, $1, How to calculate your monthly payment Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of A (1/16)

6 Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.