Standard Risk Rate Survey of the Individual Market. Eric D. Johnson, PhD Austin T. Noll, MS

Standard Risk Rate Survey of the Individual Market 2012 Eric D. Johnson, PhD Austin T. Noll, MS

Table of Contents What are the Standard Risk Rates? 3 How are the risk rates and area factors formulated? 4 Indemnity Standard Risk Rates 6 Preferred Provider/Exclusive Provider Standard Risk Rates 8 Health Maintenance Organization Standard Risk Rates 10 Appendix A: Comparison of Previously Published Standard Risk Rates 12 Appendix B: Comparison of Previously Published Area Factors 18 2

Standard Risk Rate Survey of the Individual Florida Market What are the Standard Risk Rates? The Standard Risk Rate Survey of the Individual Florida Market establishes an upper bound on the premium for converted policies. A converted policy is a policy which must be offered to an insured individual by an insurer when the insured s coverage under a major medical 1 group plan has been terminated for any reason other than non-payment of premiums (see Section 626.6675 F.S. for a full definition). The premium for a converted policy may not exceed 2 times the standard risk rate (SRR). The SRR is determined by the Florida Office of Insurance Regulation (Office) through a survey of all companies providing major medical insurance to individuals in Florida. The survey is done in 3 phases, the first of which requests premiums earned in the previous calendar year from individual major medical policies within Florida excluding any converted policies as defined above. This premium information is used to determine which companies make up 80% of the market share, referred to as the market share companies. The second phase requests the following information from the market share companies: Annual premiums from the first round broken down by each county in Florida, along with the number of policies in force within each county at the end of the last calendar year. This data is used to determine area factors which correct for differences in the cost of living throughout the state. The third phase requests the following information from the market share companies: Premiums by attained age (1-79 in 1 year steps) for the largest policy within the county which has the most total premium reported, referred to as the main policy. Benefits for the main policy along with correction factors which can be used to normalize the benefit/premium relation to the Standard Health Benefit Plan, defined in Rule 69O- 149.204 F.A.C. These factors allow for the averaging of premiums from many different companies by normalizing to the same set of benefits. The data is then used to calculate the weighted average premiums for all attained ages and an area factor for each Florida county (the county with the most total premiums will have an area factor of 1.0). This entire survey process is completed separately for indemnity polices, preferred provider/ exclusive provider policies (PPO), and health maintenance organization (HMO) contracts. 1 Major medical is used in general terms to define all types of coverage included in Section 627.6675 F.S. 3

Standard Risk Rate Survey of the Individual Florida Market How are the risk rates and area factors formulated? Standard Risk Rates The use of the Standard Risk Rates (SRR) is defined in Section 627.6675(3), F.S and published in Rules 69O.149.205-7 F.A.C. SRR is determined annually using the total annual premiums collected per company, the annual premium rates per age and a benefit normalizing factor, all for a particular county for the companies which make up the top 80% of major medical business in Florida. The following shows how to calculate SRR: where, is an index representing the age brackets, is an index representing the companies surveyed, is the weight factor, is the reported premium rate, is the reported annual premium collected, and is a reported factor which normalizes the benefit-premium ratio to the standard benefits and premiums defined in Rule 69O.149.204 F.A.C., all for the in the age bracket. company The calculated SRRs are then compared to the previously published standard risk rates and any changes are capped at. The final step is to smooth the SRR values using the simple moving average technique. Graphs and tables of the final calculated values can be found for Indemnity, PPO, and HMO within their respective sections of this report. 4

Standard Risk Rate Survey of the Individual Florida Market Area Factors The Area Factor (AF) represents a correction for the medical cost of living differences between the counties of the state of Florida as defined in Section 627.6675(3), F.S. and published in rule Rule 69O.149.205-7 F.A.C. AF is determined annually using the total annual premiums collected per county per company for a particular form for the companies which make up the top 80% of major medical business in Florida. The following shows how to calculate AF: Where, is an index representing the counties, is the normalized value of the weighted average of all company premium rates per county (see below), is the rate for the county with the largest reported total annual premium. is calculated as follow: where, is an index representing the companies surveyed, is the weight factor, is the premium rate, is the annual premium collected, and is the number of policies in force all for the company in the county. is then normalized based on the average age of policy/certificate holders in the county. The normalization is calculated as follows: where, is the average SRR for the average age of policy/certificate holders in all counties, and is the SRR for the average age of policy/certificate holders in county. is then conditionally normalized to the weighted average area factor of all neighboring counties, ; which is calculated as follows: where, is an index representing all counties that neighbor (share a border with) county. is then conditionally normalized as follows: where, and are the mean and standard deviation of the s. The AFs are then compared to the currently published area factors and any changes are capped at. Graphs and tables of the final calculated values can be found for Indemnity, PPO, and HMO within their respective sections of this report. 5

Standard Risk Rate Survey of the Individual Florida Market Indemnity Standard Risk Rates 1 st Phase - Determination of the top 80% of the market For the 1 st phase 27 companies were surveyed, those with a market share greater than 1% are shown in the table below. The highlighted companies are those that made up the top 80% of the market and were therefore included in the 2 nd and 3 rd phases. After the final phases were under way it was determined that State Farm had no open blocks of business and was therefore excluded from the survey. Company Name Premium M arket Share Cumulative M kt Shr BlueCross BlueShield of Florida $ 28,990,944 49.43% 49.43% Freedom Life Insurance Company of America $ 15,645,786 26.68% 76.11% State Farm Mutual Automobile Insurance Company $ 5,126,708 8.74% 84.85% US Life Insurance Company in the City of New York $ 4,212,354 7.18% 92.04% Trustmark Insurance Company $ 902,837 1.54% 93.58% Celtic Insurance $ 843,676 1.44% 95.01% Prudential $ 678,853 1.16% 96.17% Other $ 2,244,701 3.83% 100.00% $ 58,645,859 100.0% 2 nd and 3 rd Phases - Determination of the Standard Risk Rates A detailed explanation of the formulation of the standard risk rates can be found on page 4. The charts below show the weighted average reported rates for the 2011 survey (small dashed line), the currently published SRRs (large dashed line) and the currently proposed SRRs for 2012 (solid line) by attained age for both males and females. A table of these values can be found in Appendix A. There are significant inconsistencies in the currently published and reported data beyond age 65. These inconsistencies are most likely due to policy/ certificate holders becoming eligible for coverage through Medicare. Male Rate Schedule-Ind Female Rate Schedule-Ind Annual Premium Rate ($) Reported 2011 SRR 2012 SRR 2009 20,000 15,000 10,000 5,000-1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 Attained Age Annual Premium Rate ($) Reported 2011 SRR 2012 SRR 2009 25,000 20,000 15,000 10,000 5,000-1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 Attained Age 6

Standard Risk Rate Survey of the Individual Florida Market 2 nd and 3 rd Phases - Determination of Area Factors A detailed explanation of the formulation of the area factors can be found on page 5. The bar chart below shows the currently proposed Area Factors along with the associated change from the currently published Area Factors. If a bar is dark blue on top then the currently proposed value is the top of the dark blue section and the currently published value is the brown section (i.e. the Area Factor is being raised by the amount shown by the dark blue section). If the bar is light blue on top then the currently proposed value is the brown section and the currently published is the top of the light blue section (i.e. the Area Factor is being lowered by the amount shown by the light blue section). The area factors are normalized such that Palm Beach county has an uncapped area factor of 1.0. A table of these values can be found in Appendix B. The red represents the results from the 2011 Florida Price Level Index (FPLI) study published by the Bureau of Economic and Business Research Department (BEBR) at the University of Florida 1. This data serves only as a benchmark comparison for the area factors associated with the Standard Risk Rate Survey. Area Factors - Indemnity BEBR AF Lowered By This Amount AF Raised By This Amount Area Factor 1.5 1.4 1.3 1.2 1.1 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 - Washington Walton Wakulla Volusia Union Taylor Suwannee Sumter Seminole Sarasota Santa Rosa St. Lucie St. Johns Putnam Polk Pinellas Pasco Palm Beach Osceola Orange Okeechobee Okaloosa Nassau Monroe Martin Marion Manatee Madison Liberty Levy Leon Lee Lake Lafayette Jefferson Jackson Indian River Holmes Hillsborough Highlands Hernando Hendry Hardee Hamilton Gulf Glades Gilchrist Gadsden Franklin Flagler Escambia Duval Dixie De Soto Dade Columbia Collier Clay Citrus Charlotte Calhoun Broward Brevard Bradford Bay Baker Alachua 1 Source: http://www.bebr.ufl.edu/files/fpli_sp%202010.pdf 7

Standard Risk Rate Survey of the Individual Florida Market Preferred/Exclusive Provider Standard Risk Rates (PPO) 1 st Phase - Determination of the top 80% of the market For the 1 st phase 24 PPOs were surveyed, those with a market share greater than 1% are shown in the table below. The highlighted companies are those that made up the top 80% of the market and were therefore included in the 2 nd and 3 rd phases. Company Name Premium Market Share Cumulative Mkt Shr BlueCross BlueShield of Florida $ 850,295,112 59.29% 59.29% Golden Rule Insurance Carrier $ 313,459,483 21.86% 81.15% Humana Health Insurance Company of Florida $ 152,378,980 10.63% 91.78% Time Insurance Company $ 49,186,732 3.43% 95.21% American M edical Security Life Insurance Company $ 19,161,411 1.34% 96.54% Other $ 49,602,922 3.46% 100.00% $ 1,434,084,639 100.00% 2 nd and 3 rd Phases - Determination of the Standard Risk Rates A detailed explanation of the formulation of the standard risk rates can be found on page 4. The charts below show the weighted average reported rates for the 2011 survey (small dashed line), the currently published SRRs (large dashed line) and the currently proposed SRRs for 2012 (solid line) by attained age for both males and females. A table of these values can be found in Appendix A. Due to inconsistencies in the currently published and reported data beyond age 65 the calculated SRRs for these ages were assumed to grow at a constant rate with age. These inconsistencies are most likely due to policy/certificate holders becoming eligible for coverage through Medicare. Annual Premium Rate ($) Male Rate Schedule- PPO Reported 2011 SRR 2012 SRR 2009 12,000 10,000 8,000 6,000 4,000 2,000-1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 Attained Age Annual Premium Rate ($) Female Rate Schedule-PPO Reported 2011 SRR 2012 SRR 2009 10,000 8,000 6,000 4,000 2,000-1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 Attained Age 8

Standard Risk Rate Survey of the Individual Florida Market 2 nd and 3 rd Phases - Determination of Area Factors A detailed explanation of the formulation of the area factors can be found on page 5. The bar chart below shows the currently proposed Area Factors along with the associated change from the currently published Area Factors. If a bar is dark blue on top then the currently proposed value is the top of the dark blue section and the currently published value is the brown section (i.e. the Area Factor is being raised by the amount shown by the dark blue section). If the bar is light blue on top then the currently proposed value is the brown section and the currently published is the top of the light blue section (i.e. the Area Factor is being lowered by the amount shown by the light blue section). The area factors are normalized such that Palm Beach county has an uncapped area factor of 1.0. A table of these values can be found in Appendix B. The red represents the results from the 2011 Florida Price Level Index (FPLI) study published by the Bureau of Economic and Business Research Department (BEBR) at the University of Florida 1. This data serves only as a benchmark comparison for the area factors associated with the Standard Risk Rate Survey. Area Factors - PPO BEBR AF Lowered By This Amount AF Raised By This Amount Area Factor 1.50 1.40 1.30 1.20 1.10 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 - Washington Walton Wakulla Volusia Union Taylor Suwannee Sumter Seminole Sarasota Santa Rosa St. Lucie St. Johns Putnam Polk Pinellas Pasco Palm Beach Osceola Orange Okeechobee Okaloosa Nassau Monroe Martin Marion Manatee Madison Liberty Levy Leon Lee Lake Lafayette Jefferson Jackson Indian River Holmes Hillsborough Highlands Hernando Hendry Hardee Hamilton Gulf Glades Gilchrist Gadsden Franklin Flagler Escambia Duval Dixie De Soto Dade Columbia Collier Clay Citrus Charlotte Calhoun Broward Brevard Bradford Bay Baker Alachua 1 Source: http://www.bebr.ufl.edu/files/fpli_sp%202010.pdf 9

Standard Risk Rate Survey of the Individual Florida Market Health Maintenance Organization (HMO) 1 st Phase - Determination of the top 80% of the market For the 1 st phase 7 HMOs were surveyed, they are shown in the table below. The highlighted companies are those that made up the top 80% of the market and were therefore included in the 2 nd and 3 rd phases. Company Name Premium Market Share Cumulative Mkt Shr Aetna Health, Inc. of Florida $ 108,884,284 31.09% 31.09% Coventry Health Plan of Florida, Inc. $ 84,271,791 24.07% 55.16% Cigna $ 76,366,221 21.81% 76.97% Preferred Medical Plan, Inc. $ 60,065,954 17.15% 94.12% Health Options, Inc. $ 12,938,740 3.69% 97.82% AvMed Health Plans $ 4,821,611 1.38% 99.19% Medica Health Plans of Florida, Inc $ 2,825,416 0.81% 100.00% $ 350,174,018 100.00% 2 nd and 3 rd Phases - Determination of the Standard Risk Rates A detailed explanation of the formulation of the standard risk rates can be found on page 4. The charts below show the weighted average reported rates for the 2011 survey (small dashed line), the currently published SRRs (large dashed line) and the currently proposed SRRs for 2012 (solid line) by attained age for both males and females. A table of these values can be found in Appendix A. Due to inconsistencies in the currently published and reported data beyond age 65 the calculated SRRs for these ages were assumed to grow at a constant rate with age. These inconsistencies are most likely due to policy/certificate holders becoming eligible for coverage through Medicare. Annual Premium Rate ($) 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 - Male Rate Schedule-HMO Reported 2011 SRR 2012 SRR 2009 1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 Attained Age Annual Premium Rate ($) 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 - Female Rate Schedule-HMO Reported 2011 SRR 2012 SRR 2009 1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 Attained Age 10

Standard Risk Rate Survey of the Individual Florida Market 2 nd and 3 rd Phases - Determination of Area Factors A detailed explanation of the formulation of the area factors can be found on page 5. The bar chart below shows the currently proposed Area Factors along with the associated change from the currently published Area Factors. If a bar is dark blue on top then the currently proposed value is the top of the dark blue section and the currently published value is the brown section (i.e. the Area Factor is being raised by the amount shown by the dark blue section). If the bar is light blue on top then the currently proposed value is the brown section and the currently published is the top of the light blue section (i.e. the Area Factor is being lowered by the amount shown by the light blue section). The area factors are normalized such that Dade county has an uncapped area factor of 1.0. A table of these values can be found in Appendix B. The red represents the results from the 2011 Florida Price Level Index (FPLI) study published by the Bureau of Economic and Business Research Department (BEBR) at the University of Florida 1. This data serves only as a benchmark comparison for the area factors associated with the Standard Risk Rate Survey. Area Factors - HMO BEBR AF Lowered By This Amount AF Raised By This Amount Area Factor 1.5 1.4 1.3 1.2 1.1 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 - Washington Walton Wakulla Volusia Union Taylor Suwannee Sumter Seminole Sarasota Santa Rosa St. Lucie St. Johns Putnam Polk Pinellas Pasco Palm Beach Osceola Orange Okeechobee Okaloosa Nassau Monroe Martin Marion Manatee Madison Liberty Levy Leon Lee Lake Lafayette Jefferson Jackson Indian River Holmes Hillsborough Highlands Hernando Hendry Hardee Hamilton Gulf Glades Gilchrist Gadsden Franklin Flagler Escambia Duval Dixie De Soto Dade Columbia Collier Clay Citrus Charlotte Calhoun Broward Brevard Bradford Bay Baker Alachua 1 Source: http://www.bebr.ufl.edu/files/fpli_sp%202010.pdf 11

Appendix A Comparison with Previously Published Standard Risk Rates Indemnity Comparison to Previously Published Rates Average % Change 9.7% 9.6% 2009 2012 % Change Age Male Female Male Female Male Female 1 2,269.71 2,205.88 2,088.97 2,178.80-8.0% -1.2% 2 1,862.25 1,831.86 1,996.36 2,045.10 7.2% 11.6% 3 1,646.48 1,616.10 1,845.68 1,801.11 12.1% 11.4% 4 1,524.94 1,464.16 1,699.71 1,620.64 11.5% 10.7% 5 1,464.16 1,339.66 1,609.49 1,474.71 9.9% 10.1% 6 1,400.43 1,218.11 1,541.56 1,351.06 10.1% 10.9% 7 1,339.66 1,126.95 1,473.62 1,238.52 10.0% 9.9% 8 1,278.88 1,032.73 1,417.91 1,170.55 10.9% 13.3% 9 1,248.50 1,032.73 1,395.63 1,147.15 11.8% 11.1% 10 1,278.88 1,063.12 1,406.77 1,181.69 10.0% 11.2% 11 1,309.27 1,126.95 1,440.20 1,249.67 10.0% 10.9% 12 1,339.66 1,218.11 1,501.25 1,373.88 12.1% 12.8% 13 1,445.38 1,401.89 1,596.81 1,520.35 10.5% 8.4% 14 1,569.89 1,526.40 1,714.65 1,677.95 9.2% 9.9% 15 1,661.05 1,647.95 1,838.30 1,812.74 10.7% 10.0% 16 1,782.60 1,769.49 1,939.70 1,938.23 8.8% 9.5% 17 1,846.43 1,868.63 1,945.77 1,968.90 5.4% 5.4% 18 1,677.62 1,731.60 1,926.14 1,992.38 14.8% 15.1% 19 1,729.06 1,833.53 1,901.62 2,018.10 10.0% 10.1% 20 1,779.55 1,938.77 1,967.19 2,141.42 10.5% 10.5% 21 1,856.45 2,067.93 2,034.06 2,281.94 9.6% 10.3% 22 1,911.43 2,205.39 2,101.52 2,399.05 9.9% 8.8% 23 1,963.55 2,315.98 2,159.82 2,483.67 10.0% 7.2% 24 2,015.45 2,431.51 2,216.99 2,555.55 10.0% 5.1% 25 2,067.34 2,528.50 2,273.99 2,625.06 10.0% 3.8% 26 2,119.01 2,592.34 2,333.09 2,689.65 10.1% 3.8% 27 2,176.62 2,653.36 2,402.81 2,785.08 10.4% 5.0% 28 2,257.50 2,718.82 2,475.34 2,878.23 9.6% 5.9% 29 2,316.80 2,786.17 2,544.49 2,970.92 9.8% 6.6% 30 2,372.69 2,833.44 2,596.51 3,046.70 9.4% 7.5% 31 2,436.98 2,879.75 2,666.17 3,139.48 9.4% 9.0% 32 2,506.76 2,954.83 2,741.46 3,250.73 9.4% 10.0% 33 2,578.54 3,031.05 2,782.05 3,334.94 7.9% 10.0% 34 2,649.40 3,082.98 2,862.71 3,400.97 8.1% 10.3% 35 2,741.76 3,134.92 2,953.25 3,458.70 7.7% 10.3% 36 2,816.34 3,188.48 3,095.58 3,508.96 9.9% 10.1% 37 2,898.23 3,246.48 3,186.32 3,562.01 9.9% 9.7% 38 2,974.23 3,279.60 3,272.51 3,613.57 10.0% 10.2% 39 3,052.57 3,329.10 3,357.23 3,666.36 10.0% 10.1% 12

Indemnity Comparison to Previously Published Rates, continued 2009 2012 % Change Age Male Female Male Female Male Female 40 3,129.28 3,390.47 3,440.57 3,740.20 9.9% 10.3% 41 3,201.52 3,480.97 3,533.98 3,840.52 10.4% 10.3% 42 3,307.34 3,602.71 3,635.29 3,968.11 9.9% 10.1% 43 3,405.57 3,738.45 3,746.22 4,112.60 10.0% 10.0% 44 3,504.04 3,875.01 3,861.02 4,268.25 10.2% 10.1% 45 3,620.45 4,027.23 3,984.88 4,432.71 10.1% 10.1% 46 3,743.36 4,186.98 4,118.17 4,600.51 10.0% 9.9% 47 3,867.57 4,332.64 4,273.53 4,769.11 10.5% 10.1% 48 4,044.14 4,487.03 4,460.86 4,938.08 10.3% 10.1% 49 4,254.26 4,647.82 4,686.99 5,115.97 10.2% 10.1% 50 4,484.29 4,817.80 4,932.10 5,290.94 10.0% 9.8% 51 4,712.62 4,964.22 5,202.63 5,460.03 10.4% 10.0% 52 4,992.07 5,108.97 5,480.90 5,607.48 9.8% 9.8% 53 5,243.22 5,219.95 5,781.64 5,758.43 10.3% 10.3% 54 5,532.82 5,375.90 6,077.34 5,914.08 9.8% 10.0% 55 5,798.51 5,533.46 6,396.69 6,096.73 10.3% 10.2% 56 6,114.18 5,718.08 6,741.04 6,301.08 10.3% 10.2% 57 6,471.97 5,933.22 7,115.48 6,529.54 9.9% 10.1% 58 6,819.70 6,156.54 7,510.97 6,779.82 10.1% 10.1% 59 7,192.79 6,400.67 7,871.34 7,053.12 9.4% 10.2% 60 7,454.79 6,678.58 8,194.76 7,329.86 9.9% 9.8% 61 7,701.77 6,911.27 8,454.28 7,602.25 9.8% 10.0% 62 7,900.57 7,143.56 8,680.05 7,836.24 9.9% 9.7% 63 8,070.52 7,316.73 8,865.19 8,025.05 9.8% 9.7% 64 8,206.71 7,426.21 9,179.63 8,279.17 11.9% 11.5% 65 8,758.12 7,836.62 9,444.63 8,481.22 7.8% 8.2% 66 8,793.24 7,867.77 9,680.99 8,654.97 10.1% 10.0% 67 8,851.33 7,900.07 9,743.75 8,693.09 10.1% 10.0% 68 8,929.30 7,940.58 9,822.15 8,735.59 10.0% 10.0% 69 9,007.04 7,983.68 9,907.83 8,780.92 10.0% 10.0% 70 9,085.01 8,023.71 9,993.34 8,826.43 10.0% 10.0% 71 9,162.51 8,064.69 10,080.31 8,872.70 10.0% 10.0% 72 9,244.24 8,109.88 10,165.82 8,917.43 10.0% 10.0% 73 9,318.22 8,145.70 10,248.85 8,961.14 10.0% 10.0% 74 9,388.96 8,183.89 10,329.22 9,003.21 10.0% 10.0% 75 9,463.41 8,224.62 10,409.59 9,044.26 10.0% 10.0% 76 9,537.41 8,257.64 10,491.14 9,085.64 10.0% 10.0% 77 9,611.39 8,296.75 10,559.06 9,131.14 9.9% 10.1% 78 9,648.63 8,348.73 10,613.49 9,183.43 10.0% 10.0% 79 9,685.87 8,400.24 10,633.98 9,211.93 9.8% 9.7% 13

PPO Comparison to Previously Published Rates Average % Change 5.4% 4.1% 2009 2012 % Change Age Male Female Male Female Male Female 1 2,269.71 2,205.88 1,940.04 1,910.51-14.5% -13.4% 2 1,862.25 1,831.86 1,870.60 1,821.52 0.4% -0.6% 3 1,646.48 1,616.10 1,732.63 1,673.18 5.2% 3.5% 4 1,524.94 1,464.16 1,635.02 1,541.49 7.2% 5.3% 5 1,464.16 1,339.66 1,542.80 1,440.99 5.4% 7.6% 6 1,400.43 1,218.11 1,484.35 1,340.34 6.0% 10.0% 7 1,339.66 1,126.95 1,438.43 1,238.79 7.4% 9.9% 8 1,278.88 1,032.73 1,411.20 1,170.10 10.3% 13.3% 9 1,248.50 1,032.73 1,395.63 1,147.15 11.8% 11.1% 10 1,278.88 1,063.12 1,406.77 1,178.41 10.0% 10.8% 11 1,309.27 1,126.95 1,440.20 1,218.78 10.0% 8.1% 12 1,339.66 1,218.11 1,475.61 1,283.38 10.1% 5.4% 13 1,445.38 1,401.89 1,508.81 1,358.81 4.4% -3.1% 14 1,569.89 1,526.40 1,544.36 1,463.93-1.6% -4.1% 15 1,661.05 1,647.95 1,604.02 1,588.86-3.4% -3.6% 16 1,782.60 1,769.49 1,674.25 1,695.04-6.1% -4.2% 17 1,846.43 1,868.63 1,743.60 1,805.80-5.6% -3.4% 18 1,677.62 1,731.60 1,762.88 1,858.79 5.1% 7.3% 19 1,729.06 1,833.53 1,760.59 1,916.39 1.8% 4.5% 20 1,779.55 1,938.77 1,766.48 1,980.94-0.7% 2.2% 21 1,856.45 2,067.93 1,790.94 2,033.36-3.5% -1.7% 22 1,911.43 2,205.39 1,847.05 2,136.46-3.4% -3.1% 23 1,963.55 2,315.98 1,898.98 2,238.29-3.3% -3.4% 24 2,015.45 2,431.51 1,999.74 2,428.15-0.8% -0.1% 25 2,067.34 2,528.50 2,089.75 2,601.60 1.1% 2.9% 26 2,119.01 2,592.34 2,188.46 2,773.19 3.3% 7.0% 27 2,176.62 2,653.36 2,297.23 2,895.48 5.5% 9.1% 28 2,257.50 2,718.82 2,395.93 2,991.40 6.1% 10.0% 29 2,316.80 2,786.17 2,513.27 3,057.42 8.5% 9.7% 30 2,372.69 2,833.44 2,589.58 3,116.43 9.1% 10.0% 31 2,436.98 2,879.75 2,682.69 3,178.27 10.1% 10.4% 32 2,506.76 2,954.83 2,758.17 3,250.73 10.0% 10.0% 33 2,578.54 3,031.05 2,836.06 3,325.25 10.0% 9.7% 34 2,649.40 3,082.98 2,922.22 3,391.28 10.3% 10.0% 35 2,741.76 3,134.92 3,009.42 3,449.01 9.8% 10.0% 36 2,816.34 3,188.48 3,100.65 3,508.96 10.1% 10.1% 37 2,898.23 3,246.48 3,185.89 3,562.01 9.9% 9.7% 38 2,974.23 3,279.60 3,272.51 3,613.57 10.0% 10.2% 39 3,052.57 3,329.10 3,357.23 3,666.36 10.0% 10.1% 14

PPO Comparison to Previously Published Rates, continued 2009 2012 % Change Age Male Female Male Female Male Female 40 3,129.28 3,390.47 3,440.57 3,740.20 9.9% 10.3% 41 3,201.52 3,480.97 3,533.98 3,840.52 10.4% 10.3% 42 3,307.34 3,602.71 3,635.29 3,968.11 9.9% 10.1% 43 3,405.57 3,738.45 3,746.22 4,112.60 10.0% 10.0% 44 3,504.04 3,875.01 3,861.02 4,268.25 10.2% 10.1% 45 3,620.45 4,027.23 3,984.88 4,432.71 10.1% 10.1% 46 3,743.36 4,186.98 4,118.17 4,600.51 10.0% 9.9% 47 3,867.57 4,332.64 4,273.53 4,769.11 10.5% 10.1% 48 4,044.14 4,487.03 4,460.86 4,938.08 10.3% 10.1% 49 4,254.26 4,647.82 4,686.99 5,115.97 10.2% 10.1% 50 4,484.29 4,817.80 4,932.10 5,290.94 10.0% 9.8% 51 4,712.62 4,964.22 5,202.63 5,460.03 10.4% 10.0% 52 4,992.07 5,108.97 5,480.90 5,607.48 9.8% 9.8% 53 5,243.22 5,219.95 5,781.64 5,758.43 10.3% 10.3% 54 5,532.82 5,375.90 6,077.34 5,892.45 9.8% 9.6% 55 5,798.51 5,533.46 6,396.69 6,015.83 10.3% 8.7% 56 6,114.18 5,718.08 6,741.04 6,139.29 10.3% 7.4% 57 6,471.97 5,933.22 7,115.48 6,327.58 9.9% 6.6% 58 6,819.70 6,156.54 7,510.97 6,530.66 10.1% 6.1% 59 7,192.79 6,400.67 7,871.34 6,690.16 9.4% 4.5% 60 7,454.79 6,678.58 8,194.76 6,785.35 9.9% 1.6% 61 7,701.77 6,911.27 8,454.28 6,905.45 9.8% -0.1% 62 7,900.57 7,143.56 8,680.05 7,137.16 9.9% -0.1% 63 8,070.52 7,316.73 8,865.19 7,346.66 9.8% 0.4% 64 8,206.71 7,426.21 8,952.48 7,479.18 9.1% 0.7% 65 8,758.12 7,836.62 8,984.73 7,516.38 2.6% -4.1% 66 8,793.24 7,867.77 9,017.09 7,553.76 2.5% -4.0% 67 8,851.33 7,900.07 9,049.58 7,591.32 2.2% -3.9% 68 8,929.30 7,940.58 9,082.18 7,629.08 1.7% -3.9% 69 9,007.04 7,983.68 9,114.90 7,667.02 1.2% -4.0% 70 9,085.01 8,023.71 9,147.73 7,705.15 0.7% -4.0% 71 9,162.51 8,064.69 9,180.69 7,743.47 0.2% -4.0% 72 9,244.24 8,109.88 9,213.76 7,781.98-0.3% -4.0% 73 9,318.22 8,145.70 9,246.95 7,820.68-0.8% -4.0% 74 9,388.96 8,183.89 9,280.26 7,859.57-1.2% -4.0% 75 9,463.41 8,224.62 9,313.69 7,898.66-1.6% -4.0% 76 9,537.41 8,257.64 9,347.25 7,937.94-2.0% -3.9% 77 9,611.39 8,296.75 9,380.92 7,977.42-2.4% -3.8% 78 9,648.63 8,348.73 9,414.71 8,017.09-2.4% -4.0% 79 9,685.87 8,400.24 9,448.63 8,056.96-2.4% -4.1% 15

HMO Comparison to Previously Published Rates Average % Change -2.0% -7.2% 2009 2012 % Change Age Male Female Male Female Male Female 1 5,258.45 5,250.04 3,759.23 3,778.00-28.5% -28.0% 2 2,909.90 2,901.49 3,379.12 3,389.11 16.1% 16.8% 3 2,909.90 2,901.49 2,674.56 2,684.55-8.1% -7.5% 4 2,909.90 2,901.49 2,618.91 2,611.34-10.0% -10.0% 5 2,909.90 2,901.49 2,618.91 2,611.34-10.0% -10.0% 6 2,909.90 2,901.49 2,592.68 2,585.11-10.9% -10.9% 7 2,822.45 2,814.04 2,566.44 2,558.87-9.1% -9.1% 8 2,822.45 2,814.04 2,540.21 2,532.64-10.0% -10.0% 9 2,822.45 2,814.04 2,540.21 2,532.64-10.0% -10.0% 10 2,822.45 2,814.04 2,540.21 2,532.64-10.0% -10.0% 11 2,822.45 2,814.04 2,540.21 2,532.64-10.0% -10.0% 12 2,822.45 2,814.04 2,585.29 2,577.72-8.4% -8.4% 13 2,972.73 2,964.33 2,630.37 2,622.81-11.5% -11.5% 14 2,972.73 2,964.33 2,675.46 2,667.90-10.0% -10.0% 15 2,972.73 2,964.33 2,675.46 2,722.12-10.0% -8.2% 16 2,972.73 2,964.33 2,698.39 2,826.85-9.2% -4.6% 17 2,972.73 2,964.33 2,742.45 3,173.80-7.7% 7.1% 18 2,549.95 4,120.85 2,800.35 3,520.85 9.8% -14.6% 19 2,570.16 4,301.90 2,816.89 3,841.53 9.6% -10.7% 20 2,610.13 4,382.36 2,795.75 3,946.97 7.1% -9.9% 21 2,630.36 4,472.30 2,720.68 4,018.13 3.4% -10.2% 22 2,670.38 4,539.11 2,668.30 4,102.38-0.1% -9.6% 23 2,729.45 4,663.20 2,644.61 4,188.63-3.1% -10.2% 24 2,776.56 4,759.79 2,703.78 4,291.92-2.6% -9.8% 25 2,819.35 4,883.42 2,790.09 4,408.28-1.0% -9.7% 26 2,899.75 5,051.05 2,896.62 4,548.71-0.1% -9.9% 27 2,983.75 5,227.91 2,998.75 4,670.95 0.5% -10.7% 28 3,047.19 5,290.86 3,102.75 4,728.53 1.8% -10.6% 29 3,150.59 5,242.98 3,204.87 4,734.41 1.7% -9.7% 30 3,236.87 5,247.52 3,296.68 4,700.34 1.8% -10.4% 31 3,279.13 5,177.31 3,374.26 4,679.07 2.9% -9.6% 32 3,340.11 5,172.07 3,440.26 4,645.89 3.0% -10.2% 33 3,402.20 5,136.91 3,494.27 4,624.60 2.7% -10.0% 34 3,444.91 5,106.34 3,546.78 4,611.44 3.0% -9.7% 35 3,532.78 5,128.20 3,600.98 4,602.95 1.9% -10.2% 36 3,580.77 5,108.61 3,661.51 4,633.85 2.3% -9.3% 37 3,649.52 5,085.24 3,736.66 4,686.50 2.4% -7.8% 38 3,748.38 5,099.53 3,828.23 4,784.47 2.1% -6.2% 39 3,815.47 5,111.88 3,941.12 4,890.35 3.3% -4.3% 16

HMO Comparison to Previously Published Rates, continued 2009 2012 % Change Age Male Female Male Female Male Female 40 3,923.62 5,139.24 4,064.01 5,014.52 3.6% -2.4% 41 4,003.19 5,186.08 4,202.62 5,143.27 5.0% -0.8% 42 4,102.20 5,276.71 4,349.35 5,279.14 6.0% 0.0% 43 4,235.88 5,400.47 4,503.65 5,416.31 6.3% 0.3% 44 4,359.59 5,523.74 4,657.99 5,559.31 6.8% 0.6% 45 4,486.17 5,621.99 4,813.58 5,702.93 7.3% 1.4% 46 4,682.63 5,747.05 4,976.28 5,851.00 6.3% 1.8% 47 4,872.08 5,874.81 5,144.81 6,000.53 5.6% 2.1% 48 5,109.97 5,986.94 5,323.40 6,155.01 4.2% 2.8% 49 5,341.56 6,117.55 5,519.49 6,309.98 3.3% 3.1% 50 5,598.42 6,278.89 5,729.33 6,464.89 2.3% 3.0% 51 5,909.83 6,447.58 5,970.33 6,608.59 1.0% 2.5% 52 6,253.14 6,612.37 6,232.02 6,740.57-0.3% 1.9% 53 6,590.04 6,778.15 6,543.48 6,870.52-0.7% 1.4% 54 6,966.54 6,965.19 6,893.69 7,011.85-1.0% 0.7% 55 7,360.26 7,102.09 7,285.40 7,181.60-1.0% 1.1% 56 7,730.02 7,258.77 7,705.04 7,370.62-0.3% 1.5% 57 8,099.29 7,390.68 8,142.36 7,597.21 0.5% 2.8% 58 8,615.15 7,721.59 8,588.88 7,847.76-0.3% 1.6% 59 9,149.91 8,070.04 9,040.95 8,158.53-1.2% 1.1% 60 9,714.17 8,467.78 9,570.89 8,497.37-1.5% 0.3% 61 10,192.09 8,914.29 10,210.89 8,873.22 0.2% -0.5% 62 10,667.92 9,373.20 10,971.02 9,259.04 2.8% -1.2% 63 11,239.30 9,927.57 11,791.60 9,650.87 4.9% -2.8% 64 11,819.57 10,475.54 12,737.15 10,419.23 7.8% -0.5% 65 14,318.73 12,839.86 13,216.64 10,795.39-7.7% -15.9% 66 14,377.66 12,885.56 13,264.44 10,829.26-7.7% -16.0% 67 14,436.21 12,930.98 13,312.42 10,863.24-7.8% -16.0% 68 14,494.23 12,975.97 13,360.57 10,897.33-7.8% -16.0% 69 14,551.64 13,020.50 13,408.90 10,931.53-7.9% -16.0% 70 14,608.25 13,064.41 13,457.40 10,965.83-7.9% -16.1% 71 14,663.96 13,107.62 13,506.07 11,000.25-7.9% -16.1% 72 14,718.64 13,150.03 13,554.92 11,034.76-7.9% -16.1% 73 14,772.15 13,191.51 13,603.95 11,069.39-7.9% -16.1% 74 14,824.35 13,232.00 13,653.16 11,104.13-7.9% -16.1% 75 14,875.09 13,271.34 13,702.54 11,138.97-7.9% -16.1% 76 14,924.27 13,309.50 13,752.10 11,173.93-7.9% -16.0% 77 14,971.75 13,346.31 13,801.85 11,208.99-7.8% -16.0% 78 15,017.41 13,381.72 13,851.77 11,244.17-7.8% -16.0% 79 15,061.10 13,415.60 13,901.87 11,279.45-7.7% -15.9% 17

Appendix B Comparison with Previously Published Area Factors 18

Indemnity Comparison to Previously Published Area Factors Avg % Change 0.8% County 2009 2012 % Change Alachua 0.70 0.80 14.3% Baker 0.78 0.68-12.8% Bay 0.80 0.90 12.5% Bradford 0.82 0.88 7.6% Brevard 0.93 0.83-10.8% Broward 1.41 1.31-7.1% Calhoun 0.75 0.65-13.3% Charlotte 0.95 0.85-10.5% Citrus 0.72 0.82 13.9% Clay 0.80 0.84 4.5% Collier 0.93 1.03 10.8% Columbia 0.80 0.89 11.8% Dade 1.30 1.26-3.0% De Soto 0.74 0.84 13.5% Dixie 0.69 0.59-14.5% Duval 0.94 0.84-10.6% Escambia 0.77 0.87 13.0% Flagler 0.86 0.76-11.6% Franklin 0.75 0.85 13.3% Gadsden 0.75 0.85 13.3% Gilchrist 0.75 0.65-13.3% Glades 0.98 1.06 7.9% Gulf 0.76 0.68-10.5% Hamilton 0.77 0.69-10.7% Hardee 0.80 0.90 12.5% Hendry 0.97 0.87-10.3% Hernando 0.85 0.75-11.8% Highlands 0.71 0.81 14.1% Hillsborough 0.82 0.82-0.1% Holmes 0.75 0.84 12.1% Indian River 0.92 1.01 10.0% Jackson 0.77 0.87 13.0% Jefferson 0.75 0.85 13.3% Lafayette 0.78 0.80 2.6% County 2009 2012 % Change Lake 0.90 0.80-11.1% Lee 0.97 0.87-10.3% Leon 0.79 0.89 12.7% Levy 0.80 0.90 12.5% Liberty 0.75 0.85 13.3% Madison 0.79 0.89 12.7% Manatee 0.91 1.01 11.0% Marion 0.77 0.74-4.1% Martin 0.94 1.04 10.6% Monroe 1.30 1.20-7.7% Nassau 0.85 0.75-11.8% Okaloosa 0.76 0.86 13.2% Okeechobee 0.97 0.97-0.1% Orange 0.90 0.80-11.1% Osceola 0.91 0.81-11.0% Palm Beach 1.00 1.00 0.0% Pasco 0.90 0.80-11.1% Pinellas 0.87 0.84-3.1% Polk 0.84 0.94 11.9% Putnam 0.81 0.83 2.2% St. Johns 0.77 0.87 13.0% St. Lucie 0.99 0.89-10.1% Santa Rosa 0.77 0.87 13.0% Sarasota 0.76 0.86 13.2% Seminole 0.92 0.82-10.9% Sumter 0.81 0.71-12.3% Suwannee 0.82 0.72-12.2% Taylor 0.79 0.89 12.7% Union 0.79 0.69-12.7% Volusia 0.92 0.82-10.9% Wakulla 0.75 0.68-9.9% Walton 0.76 0.86 13.2% Washington 0.76 0.66-13.2% 19

PPO Comparison to Previously Published Area Factors Avg % Change 2.8% County 2009 2012 % Change Alachua 0.70 0.80 14.3% Baker 0.78 0.88 12.8% Bay 0.80 0.90 12.5% Bradford 0.82 0.83 1.8% Brevard 0.93 0.83-10.8% Broward 1.41 1.31-7.1% Calhoun 0.75 0.85 13.3% Charlotte 0.95 0.85-10.5% Citrus 0.72 0.81 12.0% Clay 0.80 0.89 11.3% Collier 0.93 0.90-3.6% Columbia 0.80 0.87 8.8% Dade 1.30 1.20-7.7% De Soto 0.74 0.82 10.6% Dixie 0.69 0.79 14.5% Duval 0.94 0.84-10.6% Escambia 0.77 0.87 13.0% Flagler 0.86 0.76-11.6% Franklin 0.75 0.85 13.3% Gadsden 0.75 0.85 13.3% Gilchrist 0.75 0.85 13.3% Glades 0.98 0.95-2.9% Gulf 0.76 0.86 13.2% Hamilton 0.77 0.83 7.9% Hardee 0.80 0.82 2.4% Hendry 0.97 0.92-5.1% Hernando 0.85 0.80-5.4% Highlands 0.71 0.65-8.4% Hillsborough 0.82 0.74-9.4% Holmes 0.75 0.85 13.3% Indian River 0.92 0.84-8.5% Jackson 0.77 0.87 13.0% Jefferson 0.75 0.84 12.0% Lafayette 0.78 0.88 12.8% County 2009 2012 % Change Lake 0.90 0.80-11.1% Lee 0.97 0.87-10.3% Leon 0.79 0.86 9.2% Levy 0.80 0.85 6.0% Liberty 0.75 0.85 13.3% Madison 0.79 0.84 6.4% Manatee 0.91 0.81-11.0% Marion 0.77 0.82 6.1% Martin 0.94 1.00 6.2% Monroe 1.30 1.20-7.7% Nassau 0.85 0.94 10.0% Okaloosa 0.76 0.86 13.2% Okeechobee 0.97 0.91-6.5% Orange 0.90 0.80-11.1% Osceola 0.91 0.81-11.0% Palm Beach 1.00 0.95-4.9% Pasco 0.90 0.81-10.0% Pinellas 0.87 0.82-6.2% Polk 0.84 0.74-11.9% Putnam 0.81 0.91 12.3% St. Johns 0.77 0.87 13.0% St. Lucie 0.99 0.92-7.5% Santa Rosa 0.77 0.87 13.0% Sarasota 0.76 0.66-12.9% Seminole 0.92 0.82-10.9% Sumter 0.81 0.91 11.9% Suwannee 0.82 0.92 12.2% Taylor 0.79 0.89 12.7% Union 0.79 0.86 8.9% Volusia 0.92 0.82-10.9% Wakulla 0.75 0.85 13.3% Walton 0.76 0.86 13.2% Washington 0.76 0.86 13.2% 20

HMO Comparison to Previously Published Area Factors Avg % Change 4.2% County 2009 2012 % Change Alachua 0.70 0.80 14.3% Baker 0.78 0.88 12.8% Bay 0.80 0.81 0.8% Bradford 0.82 0.92 12.2% Brevard 0.93 1.01 8.1% Broward 1.41 1.31-7.1% Calhoun 0.75 0.78 3.9% Charlotte 0.95 0.90-5.1% Citrus 0.72 0.82 13.9% Clay 0.80 0.90 12.5% Collier 0.93 0.97 4.3% Columbia 0.80 0.70-12.5% Dade 1.30 1.20-7.7% De Soto 0.74 0.84 13.5% Dixie 0.69 0.79 14.5% Duval 0.94 1.04 10.6% Escambia 0.77 0.67-13.0% Flagler 0.86 0.96 11.6% Franklin 0.75 0.65-13.3% Gadsden 0.75 0.72-4.5% Gilchrist 0.75 0.65-13.3% Glades 0.98 1.08 10.2% Gulf 0.76 0.66-13.2% Hamilton 0.77 0.87 13.0% Hardee 0.80 0.90 12.5% Hendry 0.97 0.88-9.5% Hernando 0.85 0.95 11.2% Highlands 0.71 0.81 14.1% Hillsborough 0.82 0.92 12.2% Holmes 0.75 0.84 12.6% Indian River 0.92 1.02 10.9% Jackson 0.77 0.67-13.0% Jefferson 0.75 0.72-3.9% Lafayette 0.78 0.72-7.2% County 2009 2012 % Change Lake 0.90 1.00 11.1% Lee 0.97 1.05 7.7% Leon 0.79 0.72-8.8% Levy 0.80 0.90 12.5% Liberty 0.75 0.72-4.4% Madison 0.79 0.73-7.9% Manatee 0.91 1.00 10.0% Marion 0.77 0.87 13.0% Martin 0.94 0.98 4.7% Monroe 1.30 1.20-7.7% Nassau 0.85 0.95 11.8% Okaloosa 0.76 0.86 13.2% Okeechobee 0.97 0.87-10.3% Orange 0.90 1.00 11.1% Osceola 0.91 0.99 8.7% Palm Beach 1.00 1.10 10.0% Pasco 0.90 1.00 11.1% Pinellas 0.87 0.97 11.5% Polk 0.84 0.94 11.9% Putnam 0.81 0.76-6.1% St. Johns 0.77 0.87 13.0% St. Lucie 0.99 0.93-5.7% Santa Rosa 0.77 0.87 13.0% Sarasota 0.76 0.86 13.2% Seminole 0.92 0.95 2.9% Sumter 0.81 0.87 7.1% Suwannee 0.82 0.76-7.7% Taylor 0.79 0.73-8.1% Union 0.79 0.89 12.7% Volusia 0.92 0.97 5.9% Wakulla 0.75 0.72-4.0% Walton 0.76 0.86 13.2% Washington 0.76 0.86 13.2% 21

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