2014 health insurance premiums for plans sold through the Health

Qualified Health Plan Individual Premium Rates for Arkansas

Company name Plan name Rating

Area

AGE Individual non‐

tobacco rate

Individual

tobacco rate

2014 health insurance premiums for plans sold through the Health Insurance MarketplaceAmbetter of Arkansas from Arkansas

Health and Wellness Solutions

Ambetter Bronze 1 1 0‐20 150.98 181.17

Ambetter of Arkansas from Arkansas


Ambetter Bronze 1 1 21 237.78 285.33



Ambetter Bronze 1 1 22 237.78 285.33



Ambetter Bronze 1 1 23 237.78 285.33

Ambetter of Arkansas from Arkansas Ambetter Bronze 1 1 24 237.78 285.33



Ambetter Bronze 1 1 25 238.72 286.46



Ambetter Bronze 1 1 26 243.48 292.17



Ambetter Bronze 1 1 27 249.18 299.01



Ambetter Bronze 1 1 28 258.46 310.15



Ambetter Bronze 1 1 29 266.06 319.27



Ambetter Bronze 1 1 30 269.87 323.84



Ambetter Bronze 1 1 31 275.58 330.69



Ambetter Bronze 1 1 32 281.28 337.53



Ambetter Bronze 1 1 33 284.85 341.82



Ambetter Bronze 1 1 34 288.65 346.38



Ambetter Bronze 1 1 35 290.55 348.66



Ambetter Bronze 1 1 36 292.46 350.95



Ambetter Bronze 1 1 37 294.36 353.23



Ambetter Bronze 1 1 38 296.26 355.51



Ambetter Bronze 1 1 39 300.07 360.08



Ambetter Bronze 1 1 40 303.87 364.64

Premiums are listed first by the insurance company, then by each company's plan. Premiums for each plan depend on the rating area, age, and, with some plans, the tobacco use of an individual. Premiums for each scenario are listed below.

These amounts do NOT include Advanced Premium Tax Credits eligible consumers could receive and which could lower their premiumssubstantially.

Depending on a sliding scale based on income, a consumer eligible for tax credits could pay as little as about 10 percent of the listed premium or as much as about 80 percent of the listed premium. To be eligible for these tax credits, an indvidual or family must make less than 400 percent of the Federal Poverty Level.

Consumers earning 400 percent or more of the Federal Poverty Level, may still purchase plans in the Marketplace but are NOT eligible for financial assistance. These consumers would pay the amount listed.

The rates below only apply to those consumers buying insurance in the individual market. Consumers with insurance through their employers or through Medicare are not affected.

Page 1 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 1 1 41 309.58 371.49



Ambetter Bronze 1 1 42 315.05 378.06



Ambetter Bronze 1 1 43 322.65 387.18



Ambetter Bronze 1 1 44 332.16 398.59



Ambetter Bronze 1 1 45 343.34 412



Ambetter Bronze 1 1 46 356.65 427.98



Ambetter Bronze 1 1 47 371.63 445.95



Ambetter Bronze 1 1 48 388.75 466.5



Ambetter Bronze 1 1 49 405.64 486.76



Ambetter Bronze 1 1 50 424.66 509.59



Ambetter Bronze 1 1 51 443.44 532.12



Ambetter Bronze 1 1 52 464.13 556.95



Ambetter Bronze 1 1 53 485.05 582.06



Ambetter Bronze 1 1 54 507.64 609.16



Ambetter Bronze 1 1 55 530.23 636.27



Ambetter Bronze 1 1 56 554.72 665.66



Ambetter Bronze 1 1 57 579.45 695.34









Ambetter Bronze 1 1 60 645.31 774.37



Ambetter Bronze 1 1 61 668.13 801.75

Page 2 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 1 1 62 683.11 819.73









Ambetter Bronze 1 1 65 and

over

713.3 855.96



Ambetter Bronze 1 3 0‐20 175.67 210.8



Ambetter Bronze 1 3 21 276.65 331.98



Ambetter Bronze 1 3 22 276.65 331.98



Ambetter Bronze 1 3 23 276.65 331.98



Ambetter Bronze 1 3 24 276.65 331.98






Ambetter Bronze 1 3 26 283.28 339.93






Ambetter Bronze 1 3 28 300.71 360.85



Ambetter Bronze 1 3 29 309.56 371.47



Ambetter Bronze 1 3 30 313.99 376.78



Ambetter Bronze 1 3 31 320.63 384.75



Ambetter Bronze 1 3 32 327.27 392.72









Ambetter Bronze 1 3 35 338.06 405.67



Ambetter Bronze 1 3 36 340.27 408.32

Page 3 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 1 3 37 342.48 410.97



Ambetter Bronze 1 3 38 344.69 413.62



Ambetter Bronze 1 3 39 349.12 418.94



Ambetter Bronze 1 3 40 353.55 424.26



Ambetter Bronze 1 3 41 360.19 432.22



Ambetter Bronze 1 3 42 366.55 439.86






Ambetter Bronze 1 3 44 386.47 463.76



Ambetter Bronze 1 3 45 399.47 479.36



Ambetter Bronze 1 3 46 414.96 497.95



Ambetter Bronze 1 3 47 432.39 518.86



Ambetter Bronze 1 3 48 452.31 542.77



Ambetter Bronze 1 3 49 471.95 566.34



Ambetter Bronze 1 3 50 494.08 592.89



Ambetter Bronze 1 3 51 515.94 619.12



Ambetter Bronze 1 3 52 540 648



Ambetter Bronze 1 3 53 564.35 677.22



Ambetter Bronze 1 3 54 590.63 708.75



Ambetter Bronze 1 3 55 616.91 740.29







Page 4 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 1 3 58 704.88 845.85









Ambetter Bronze 1 3 61 777.36 932.83



Ambetter Bronze 1 3 62 794.79 953.74



Ambetter Bronze 1 3 63 816.64 979.96



Ambetter Bronze 1 3 64 829.91 995.89




over

829.91 995.89



Ambetter Bronze 1 7 0‐20 157.56 189.07



Ambetter Bronze 1 7 21 248.13 297.75



Ambetter Bronze 1 7 22 248.13 297.75



Ambetter Bronze 1 7 23 248.13 297.75



Ambetter Bronze 1 7 24 248.13 297.75



Ambetter Bronze 1 7 25 249.11 298.93



Ambetter Bronze 1 7 26 254.07 304.88



Ambetter Bronze 1 7 27 260.03 312.03



Ambetter Bronze 1 7 28 269.71 323.65



Ambetter Bronze 1 7 29 277.64 333.16



Ambetter Bronze 1 7 30 281.61 337.93



Ambetter Bronze 1 7 31 287.57 345.08



Ambetter Bronze 1 7 32 293.52 352.22

Page 5 of 223



Area


tobacco rate

Individual

tobacco rate






Ambetter Bronze 1 7 34 301.22 361.46






Ambetter Bronze 1 7 36 305.19 366.22






Ambetter Bronze 1 7 38 309.16 370.99



Ambetter Bronze 1 7 39 313.13 375.75






Ambetter Bronze 1 7 41 323.05 387.66



Ambetter Bronze 1 7 42 328.76 394.51






Ambetter Bronze 1 7 44 346.62 415.94



Ambetter Bronze 1 7 45 358.28 429.93



Ambetter Bronze 1 7 46 372.18 446.61



Ambetter Bronze 1 7 47 387.81 465.37






Ambetter Bronze 1 7 49 423.29 507.94



Ambetter Bronze 1 7 50 443.14 531.76



Ambetter Bronze 1 7 51 462.74 555.28



Ambetter Bronze 1 7 52 484.33 581.19



Ambetter Bronze 1 7 53 506.16 607.39

Page 6 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 1 7 54 529.73 635.67






Ambetter Bronze 1 7 56 578.86 694.63






Ambetter Bronze 1 7 58 632.21 758.65



Ambetter Bronze 1 7 59 645.85 775.02



Ambetter Bronze 1 7 60 673.39 808.06



Ambetter Bronze 1 7 61 697.21 836.65



Ambetter Bronze 1 7 62 712.85 855.42



Ambetter Bronze 1 7 63 732.45 878.94



Ambetter Bronze 1 7 64 744.35 893.22




over

744.35 893.22



Ambetter Bronze 1 + Vision 1 0‐20 153.42 184.1



Ambetter Bronze 1 + Vision 1 21 241.61 289.93






















Page 7 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 8 of 223



Area


tobacco rate

Individual

tobacco rate
















































Ambetter Bronze 1 + Vision 1 65 and

over

724.79 869.74
















Page 9 of 223



Area


tobacco rate

Individual

tobacco rate







































Ambetter Bronze 1 + Vision 3 37 348 417.6

























Page 10 of 223



Area


tobacco rate

Individual

tobacco rate





























































over

843.29 1011.94




Page 11 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 12 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 13 of 223



Area


tobacco rate

Individual

tobacco rate










over

756.34 907.6



Ambetter Bronze 1 + Vision + Adult Dental 1 0‐20 161.48 193.77



Ambetter Bronze 1 + Vision + Adult Dental 1 21 254.31 305.17

















































Page 14 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 15 of 223



Area


tobacco rate

Individual

tobacco rate





















Ambetter Bronze 1 + Vision + Adult Dental 1 65 and

over

762.88 915.45











































Page 16 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 17 of 223



Area


tobacco rate

Individual

tobacco rate


































over

887.6 1065.12































Page 18 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 19 of 223



Area


tobacco rate

Individual

tobacco rate














































over

796.09 955.3



Ambetter Bronze 2 1 0‐20 137.78 165.33



Ambetter Bronze 2 1 21 216.99 260.38



Ambetter Bronze 2 1 22 216.99 260.38



Ambetter Bronze 2 1 23 216.99 260.38



Ambetter Bronze 2 1 24 216.99 260.38




Page 20 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 2 1 26 222.18 266.61



Ambetter Bronze 2 1 27 227.39 272.86



Ambetter Bronze 2 1 28 235.85 283.02






Ambetter Bronze 2 1 30 246.27 295.52



Ambetter Bronze 2 1 31 251.47 301.76



Ambetter Bronze 2 1 32 256.68 308.01



Ambetter Bronze 2 1 33 259.94 311.92



Ambetter Bronze 2 1 34 263.41 316.09



Ambetter Bronze 2 1 35 265.14 318.16



Ambetter Bronze 2 1 36 266.88 320.25



Ambetter Bronze 2 1 37 268.62 322.34



Ambetter Bronze 2 1 38 270.35 324.42



Ambetter Bronze 2 1 39 273.82 328.58



Ambetter Bronze 2 1 40 277.29 332.74






Ambetter Bronze 2 1 42 287.49 344.98



Ambetter Bronze 2 1 43 294.44 353.32



Ambetter Bronze 2 1 44 303.11 363.73



Ambetter Bronze 2 1 45 313.31 375.97



Ambetter Bronze 2 1 46 325.46 390.55

Page 21 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 2 1 47 339.13 406.95






Ambetter Bronze 2 1 49 370.16 444.19



Ambetter Bronze 2 1 50 387.52 465.02



Ambetter Bronze 2 1 51 404.66 485.59



Ambetter Bronze 2 1 52 423.54 508.24



Ambetter Bronze 2 1 53 442.63 531.15



Ambetter Bronze 2 1 54 463.24 555.88



Ambetter Bronze 2 1 55 483.86 580.63






Ambetter Bronze 2 1 57 528.77 634.52



Ambetter Bronze 2 1 58 552.85 663.42



Ambetter Bronze 2 1 59 564.79 677.74



Ambetter Bronze 2 1 60 588.87 706.64






Ambetter Bronze 2 1 62 623.37 748.04



Ambetter Bronze 2 1 63 640.51 768.61







over

650.92 781.1



Ambetter Bronze 2 3 0‐20 160.3 192.36



Ambetter Bronze 2 3 21 252.46 302.95

Page 22 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 2 3 22 252.46 302.95



Ambetter Bronze 2 3 23 252.46 302.95



Ambetter Bronze 2 3 24 252.46 302.95



Ambetter Bronze 2 3 25 253.46 304.15



Ambetter Bronze 2 3 26 258.51 310.21



Ambetter Bronze 2 3 27 264.56 317.47



Ambetter Bronze 2 3 28 274.41 329.29



Ambetter Bronze 2 3 29 282.49 338.98



Ambetter Bronze 2 3 30 286.53 343.83






Ambetter Bronze 2 3 32 298.64 358.36



Ambetter Bronze 2 3 33 302.43 362.91



Ambetter Bronze 2 3 34 306.47 367.76



Ambetter Bronze 2 3 35 308.49 370.18



Ambetter Bronze 2 3 36 310.51 372.61



Ambetter Bronze 2 3 37 312.53 375.03



Ambetter Bronze 2 3 38 314.55 377.46






Ambetter Bronze 2 3 40 322.63 387.15



Ambetter Bronze 2 3 41 328.69 394.42



Ambetter Bronze 2 3 42 334.49 401.38

Page 23 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 2 3 43 342.57 411.08






Ambetter Bronze 2 3 45 364.53 437.43






Ambetter Bronze 2 3 47 394.57 473.48









Ambetter Bronze 2 3 50 450.87 541.04



Ambetter Bronze 2 3 51 470.81 564.97



Ambetter Bronze 2 3 52 492.78 591.33



Ambetter Bronze 2 3 53 514.99 617.98



Ambetter Bronze 2 3 54 538.97 646.76



Ambetter Bronze 2 3 55 562.96 675.55



Ambetter Bronze 2 3 56 588.96 706.75



Ambetter Bronze 2 3 57 615.21 738.25



Ambetter Bronze 2 3 58 643.23 771.87



Ambetter Bronze 2 3 59 657.12 788.54



Ambetter Bronze 2 3 60 685.14 822.16



Ambetter Bronze 2 3 61 709.38 851.25



Ambetter Bronze 2 3 62 725.28 870.33



Ambetter Bronze 2 3 63 745.22 894.26

Page 24 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 2 3 64 757.33 908.79




over

757.33 908.79



Ambetter Bronze 2 7 0‐20 143.78 172.53



Ambetter Bronze 2 7 21 226.43 271.71



Ambetter Bronze 2 7 22 226.43 271.71



Ambetter Bronze 2 7 23 226.43 271.71



Ambetter Bronze 2 7 24 226.43 271.71



Ambetter Bronze 2 7 25 227.32 272.78



Ambetter Bronze 2 7 26 231.85 278.22



Ambetter Bronze 2 7 27 237.29 284.74



Ambetter Bronze 2 7 28 246.12 295.34



Ambetter Bronze 2 7 29 253.36 304.03



Ambetter Bronze 2 7 30 256.99 308.38






Ambetter Bronze 2 7 32 267.85 321.42






Ambetter Bronze 2 7 34 274.87 329.84



Ambetter Bronze 2 7 35 276.68 332.01






Ambetter Bronze 2 7 37 280.31 336.37



Ambetter Bronze 2 7 38 282.12 338.54

Page 25 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Bronze 2 7 39 285.74 342.88



Ambetter Bronze 2 7 40 289.36 347.23






Ambetter Bronze 2 7 42 300.01 360.01






Ambetter Bronze 2 7 44 316.31 379.57



Ambetter Bronze 2 7 45 326.95 392.34



Ambetter Bronze 2 7 46 339.63 407.55



Ambetter Bronze 2 7 47 353.89 424.66






Ambetter Bronze 2 7 49 386.27 463.52



Ambetter Bronze 2 7 50 404.38 485.25



Ambetter Bronze 2 7 51 422.27 506.72



Ambetter Bronze 2 7 52 441.97 530.36



Ambetter Bronze 2 7 53 461.89 554.26






Ambetter Bronze 2 7 55 504.91 605.89



Ambetter Bronze 2 7 56 528.24 633.88



Ambetter Bronze 2 7 57 551.78 662.13






Ambetter Bronze 2 7 59 589.37 707.24

Page 26 of 223



Area


tobacco rate

Individual

tobacco rate






Ambetter Bronze 2 7 61 636.24 763.48






Ambetter Bronze 2 7 63 668.39 802.06







over

679.25 815.1



Ambetter Bronze 2 + Vision 1 0‐20 140 168











































Page 27 of 223



Area


tobacco rate

Individual

tobacco rate






























Ambetter Bronze 2 + Vision 1 44 308 369.6


































Page 28 of 223



Area


tobacco rate

Individual

tobacco rate































over

661.4 793.68


































Page 29 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 30 of 223



Area


tobacco rate

Individual

tobacco rate











































over

769.53 923.43






















Page 31 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 32 of 223



Area


tobacco rate

Individual

tobacco rate























































over

690.19 828.22










Page 33 of 223



Area


tobacco rate

Individual

tobacco rate

































Ambetter Bronze 2 + Vision + Adult Dental 1 33 278 333.6































Page 34 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 35 of 223



Area


tobacco rate

Individual

tobacco rate




over

696.16 835.39






Ambetter Bronze 2 + Vision + Adult Dental 3 21 270 324























































Page 36 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 37 of 223



Area


tobacco rate

Individual

tobacco rate
















over

809.97 971.96

















































Page 38 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 39 of 223



Area


tobacco rate

Individual

tobacco rate




























over

726.46 871.75



Ambetter Gold 1 1 0‐20 199.28 239.13



Ambetter Gold 1 1 21 313.84 376.6



Ambetter Gold 1 1 22 313.84 376.6



Ambetter Gold 1 1 23 313.84 376.6



Ambetter Gold 1 1 24 313.84 376.6



Ambetter Gold 1 1 25 315.09 378.1



Ambetter Gold 1 1 26 321.37 385.64



Ambetter Gold 1 1 27 328.9 394.68



Ambetter Gold 1 1 28 341.14 409.36



Ambetter Gold 1 1 29 351.18 421.41



Ambetter Gold 1 1 30 356.2 427.44



Ambetter Gold 1 1 31 363.73 436.47

Page 40 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 1 1 32 371.27 445.52



Ambetter Gold 1 1 33 375.97 451.16



Ambetter Gold 1 1 34 381 457.2



Ambetter Gold 1 1 35 383.51 460.21



Ambetter Gold 1 1 36 386.02 463.22



Ambetter Gold 1 1 37 388.53 466.23



Ambetter Gold 1 1 38 391.04 469.24



Ambetter Gold 1 1 39 396.06 475.27



Ambetter Gold 1 1 40 401.08 481.29



Ambetter Gold 1 1 41 408.61 490.33



Ambetter Gold 1 1 42 415.83 498.99



Ambetter Gold 1 1 43 425.87 511.04



Ambetter Gold 1 1 44 438.43 526.11



Ambetter Gold 1 1 45 453.18 543.81



Ambetter Gold 1 1 46 470.75 564.9



Ambetter Gold 1 1 47 490.52 588.62



Ambetter Gold 1 1 48 513.12 615.74



Ambetter Gold 1 1 49 535.4 642.48



Ambetter Gold 1 1 50 560.51 672.61



Ambetter Gold 1 1 51 585.3 702.36



Ambetter Gold 1 1 52 612.6 735.12

Page 41 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 1 1 53 640.22 768.26



Ambetter Gold 1 1 54 670.04 804.04



Ambetter Gold 1 1 55 699.85 839.82



Ambetter Gold 1 1 56 732.18 878.61



Ambetter Gold 1 1 57 764.81 917.77



Ambetter Gold 1 1 58 799.65 959.58



Ambetter Gold 1 1 59 816.91 980.29



Ambetter Gold 1 1 60 851.75 1022.1



Ambetter Gold 1 1 61 881.87 1058.24



Ambetter Gold 1 1 62 901.65 1081.98



Ambetter Gold 1 1 63 926.44 1111.72



Ambetter Gold 1 1 64 941.49 1129.78



Ambetter Gold 1 1 65 and

over

941.49 1129.78



Ambetter Gold 1 3 0‐20 231.86 278.23



Ambetter Gold 1 3 21 365.15 438.18



Ambetter Gold 1 3 22 365.15 438.18



Ambetter Gold 1 3 23 365.15 438.18



Ambetter Gold 1 3 24 365.15 438.18



Ambetter Gold 1 3 25 366.6 439.92



Ambetter Gold 1 3 26 373.9 448.68



Ambetter Gold 1 3 27 382.67 459.2

Page 42 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 1 3 28 396.91 476.29



Ambetter Gold 1 3 29 408.59 490.3



Ambetter Gold 1 3 30 414.43 497.31



Ambetter Gold 1 3 31 423.2 507.84



Ambetter Gold 1 3 32 431.96 518.35



Ambetter Gold 1 3 33 437.44 524.92



Ambetter Gold 1 3 34 443.28 531.93



Ambetter Gold 1 3 35 446.2 535.44



Ambetter Gold 1 3 36 449.12 538.94



Ambetter Gold 1 3 37 452.04 542.44



Ambetter Gold 1 3 38 454.97 545.96



Ambetter Gold 1 3 39 460.81 552.97



Ambetter Gold 1 3 40 466.65 559.98



Ambetter Gold 1 3 41 475.41 570.49



Ambetter Gold 1 3 42 483.81 580.57



Ambetter Gold 1 3 43 495.5 594.6



Ambetter Gold 1 3 44 510.1 612.12



Ambetter Gold 1 3 45 527.26 632.71



Ambetter Gold 1 3 46 547.71 657.25



Ambetter Gold 1 3 47 570.71 684.85



Ambetter Gold 1 3 48 597.01 716.41

Page 43 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 1 3 49 622.93 747.51



Ambetter Gold 1 3 50 652.14 782.56



Ambetter Gold 1 3 51 680.99 817.18



Ambetter Gold 1 3 52 712.75 855.3



Ambetter Gold 1 3 53 744.89 893.86



Ambetter Gold 1 3 54 779.58 935.49



Ambetter Gold 1 3 55 814.26 977.11



Ambetter Gold 1 3 56 851.87 1022.24



Ambetter Gold 1 3 57 889.85 1067.82



Ambetter Gold 1 3 58 930.38 1116.45



Ambetter Gold 1 3 59 950.46 1140.55



Ambetter Gold 1 3 60 990.99 1189.18



Ambetter Gold 1 3 61 1026.05 1231.26



Ambetter Gold 1 3 62 1049.05 1258.86



Ambetter Gold 1 3 63 1077.9 1293.48



Ambetter Gold 1 3 64 1095.41 1314.49




over

1095.41 1314.49



Ambetter Gold 1 7 0‐20 207.96 249.55



Ambetter Gold 1 7 21 327.5 393







Page 44 of 223



Area


tobacco rate

Individual

tobacco rate






Ambetter Gold 1 7 25 328.8 394.56



Ambetter Gold 1 7 26 335.35 402.42



Ambetter Gold 1 7 27 343.21 411.85



Ambetter Gold 1 7 28 355.99 427.18



Ambetter Gold 1 7 29 366.47 439.76



Ambetter Gold 1 7 30 371.71 446.05



Ambetter Gold 1 7 31 379.57 455.48



Ambetter Gold 1 7 32 387.43 464.91



Ambetter Gold 1 7 33 392.34 470.8



Ambetter Gold 1 7 34 397.58 477.09



Ambetter Gold 1 7 35 400.2 480.24



Ambetter Gold 1 7 36 402.82 483.38



Ambetter Gold 1 7 37 405.44 486.52



Ambetter Gold 1 7 38 408.06 489.67



Ambetter Gold 1 7 39 413.3 495.96



Ambetter Gold 1 7 40 418.54 502.24



Ambetter Gold 1 7 41 426.4 511.68



Ambetter Gold 1 7 42 433.93 520.71



Ambetter Gold 1 7 43 444.41 533.29



Ambetter Gold 1 7 44 457.51 549.01

Page 45 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 1 7 45 472.9 567.48



Ambetter Gold 1 7 46 491.24 589.48



Ambetter Gold 1 7 47 511.87 614.24



Ambetter Gold 1 7 48 535.45 642.54



Ambetter Gold 1 7 49 558.7 670.44



Ambetter Gold 1 7 50 584.9 701.88



Ambetter Gold 1 7 51 610.78 732.93



Ambetter Gold 1 7 52 639.27 767.12



Ambetter Gold 1 7 53 668.09 801.7



Ambetter Gold 1 7 54 699.2 839.04



Ambetter Gold 1 7 55 730.31 876.37



Ambetter Gold 1 7 56 764.04 916.84



Ambetter Gold 1 7 57 798.1 957.72



Ambetter Gold 1 7 58 834.45 1001.34



Ambetter Gold 1 7 59 852.47 1022.96



Ambetter Gold 1 7 60 888.82 1066.58



Ambetter Gold 1 7 61 920.26 1104.31



Ambetter Gold 1 7 62 940.89 1129.06



Ambetter Gold 1 7 63 966.76 1160.11



Ambetter Gold 1 7 64 982.47 1178.96




over

982.47 1178.96

Page 46 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 1 + Vision 1 0‐20 202.5 243



Ambetter Gold 1 + Vision 1 21 318.9 382.68


























































Page 47 of 223



Area


tobacco rate

Individual

tobacco rate


















Ambetter Gold 1 + Vision 1 46 478.34 574














































Page 48 of 223



Area


tobacco rate

Individual

tobacco rate












Ambetter Gold 1 + Vision 1 65 and

over

956.66 1147.99



Ambetter Gold 1 + Vision 3 0‐20 235.6 282.72

















































Page 49 of 223



Area


tobacco rate

Individual

tobacco rate












Ambetter Gold 1 + Vision 3 40 474.17 569




















































Page 50 of 223



Area


tobacco rate

Individual

tobacco rate

























over

1113.06 1335.67








































Page 51 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 52 of 223



Area


tobacco rate

Individual

tobacco rate





































over

998.3 1197.96



Ambetter Gold 1 + Vision + Adult Dental 1 0‐20 213.14 255.76



Ambetter Gold 1 + Vision + Adult Dental 1 21 335.66 402.79






















Page 53 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 54 of 223



Area


tobacco rate

Individual

tobacco rate










































Ambetter Gold 1 + Vision + Adult Dental 1 63 990.84 1189






Ambetter Gold 1 + Vision + Adult Dental 1 65 and

over

1006.94 1208.32
















Page 55 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 56 of 223



Area


tobacco rate

Individual

tobacco rate





























































over

1171.56 1405.87




Page 57 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 58 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 59 of 223



Area


tobacco rate

Individual

tobacco rate










over

1050.76 1260.91



Ambetter Gold 2 1 0‐20 206.41 247.69



Ambetter Gold 2 1 21 325.06 390.07



Ambetter Gold 2 1 22 325.06 390.07



Ambetter Gold 2 1 23 325.06 390.07



Ambetter Gold 2 1 24 325.06 390.07



Ambetter Gold 2 1 25 326.35 391.62



Ambetter Gold 2 1 26 332.85 399.42



Ambetter Gold 2 1 27 340.66 408.79



Ambetter Gold 2 1 28 353.33 423.99



Ambetter Gold 2 1 29 363.73 436.47



Ambetter Gold 2 1 30 368.93 442.71



Ambetter Gold 2 1 31 376.74 452.08



Ambetter Gold 2 1 32 384.54 461.44



Ambetter Gold 2 1 33 389.41 467.29



Ambetter Gold 2 1 34 394.61 473.53



Ambetter Gold 2 1 35 397.21 476.65



Ambetter Gold 2 1 36 399.81 479.77



Ambetter Gold 2 1 37 402.42 482.9

Page 60 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 2 1 38 405.02 486.02



Ambetter Gold 2 1 39 410.22 492.26



Ambetter Gold 2 1 40 415.42 498.5



Ambetter Gold 2 1 41 423.22 507.86



Ambetter Gold 2 1 42 430.69 516.82



Ambetter Gold 2 1 43 441.1 529.32



Ambetter Gold 2 1 44 454.1 544.92



Ambetter Gold 2 1 45 469.38 563.25



Ambetter Gold 2 1 46 487.58 585.09



Ambetter Gold 2 1 47 508.06 609.67



Ambetter Gold 2 1 48 531.46 637.75



Ambetter Gold 2 1 49 554.54 665.44



Ambetter Gold 2 1 50 580.54 696.64



Ambetter Gold 2 1 51 606.22 727.46



Ambetter Gold 2 1 52 634.5 761.4



Ambetter Gold 2 1 53 663.11 795.73



Ambetter Gold 2 1 54 693.99 832.78



Ambetter Gold 2 1 55 724.87 869.84



Ambetter Gold 2 1 56 758.35 910.02



Ambetter Gold 2 1 57 792.15 950.58



Ambetter Gold 2 1 58 828.23 993.87

Page 61 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 2 1 59 846.11 1015.33



Ambetter Gold 2 1 60 882.19 1058.62



Ambetter Gold 2 1 61 913.4 1096.08



Ambetter Gold 2 1 62 933.88 1120.65



Ambetter Gold 2 1 63 959.56 1151.47



Ambetter Gold 2 1 64 975.15 1170.18




over

975.15 1170.18



Ambetter Gold 2 3 0‐20 240.15 288.18



Ambetter Gold 2 3 21 378.2 453.84



Ambetter Gold 2 3 22 378.2 453.84



Ambetter Gold 2 3 23 378.2 453.84



Ambetter Gold 2 3 24 378.2 453.84



Ambetter Gold 2 3 25 379.71 455.65



Ambetter Gold 2 3 26 387.27 464.72



Ambetter Gold 2 3 27 396.35 475.62



Ambetter Gold 2 3 28 411.1 493.32



Ambetter Gold 2 3 29 423.2 507.84



Ambetter Gold 2 3 30 429.25 515.1



Ambetter Gold 2 3 31 438.33 525.99



Ambetter Gold 2 3 32 447.4 536.88



Ambetter Gold 2 3 33 453.08 543.69

Page 62 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 2 3 34 459.13 550.95



Ambetter Gold 2 3 35 462.15 554.58



Ambetter Gold 2 3 36 465.18 558.21



Ambetter Gold 2 3 37 468.2 561.84



Ambetter Gold 2 3 38 471.23 565.47



Ambetter Gold 2 3 39 477.28 572.73



Ambetter Gold 2 3 40 483.33 579.99



Ambetter Gold 2 3 41 492.41 590.89



Ambetter Gold 2 3 42 501.11 601.33



Ambetter Gold 2 3 43 513.21 615.85



Ambetter Gold 2 3 44 528.34 634



Ambetter Gold 2 3 45 546.11 655.33



Ambetter Gold 2 3 46 567.29 680.74



Ambetter Gold 2 3 47 591.12 709.34



Ambetter Gold 2 3 48 618.35 742.02



Ambetter Gold 2 3 49 645.2 774.24



Ambetter Gold 2 3 50 675.45 810.54



Ambetter Gold 2 3 51 705.33 846.39



Ambetter Gold 2 3 52 738.23 885.87



Ambetter Gold 2 3 53 771.51 925.81



Ambetter Gold 2 3 54 807.44 968.92

Page 63 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 2 3 55 843.37 1012.04



Ambetter Gold 2 3 56 882.32 1058.78



Ambetter Gold 2 3 57 921.66 1105.99



Ambetter Gold 2 3 58 963.64 1156.36



Ambetter Gold 2 3 59 984.44 1181.32



Ambetter Gold 2 3 60 1026.42 1231.7



Ambetter Gold 2 3 61 1062.72 1275.26



Ambetter Gold 2 3 62 1086.55 1303.86



Ambetter Gold 2 3 63 1116.43 1339.71



Ambetter Gold 2 3 64 1134.57 1361.48




over

1134.57 1361.48



Ambetter Gold 2 7 0‐20 215.39 258.46



Ambetter Gold 2 7 21 339.21 407.05



Ambetter Gold 2 7 22 339.21 407.05



Ambetter Gold 2 7 23 339.21 407.05



Ambetter Gold 2 7 24 339.21 407.05



Ambetter Gold 2 7 25 340.56 408.67



Ambetter Gold 2 7 26 347.34 416.8



Ambetter Gold 2 7 27 355.48 426.57



Ambetter Gold 2 7 28 368.71 442.45



Ambetter Gold 2 7 29 379.57 455.48

Page 64 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 2 7 30 384.99 461.98



Ambetter Gold 2 7 31 393.13 471.75



Ambetter Gold 2 7 32 401.27 481.52



Ambetter Gold 2 7 33 406.36 487.63



Ambetter Gold 2 7 34 411.79 494.14



Ambetter Gold 2 7 35 414.5 497.4



Ambetter Gold 2 7 36 417.22 500.66



Ambetter Gold 2 7 37 419.93 503.91



Ambetter Gold 2 7 38 422.64 507.16



Ambetter Gold 2 7 39 428.07 513.68



Ambetter Gold 2 7 40 433.5 520.2



Ambetter Gold 2 7 41 441.64 529.96



Ambetter Gold 2 7 42 449.44 539.32



Ambetter Gold 2 7 43 460.29 552.34



Ambetter Gold 2 7 44 473.86 568.63



Ambetter Gold 2 7 45 489.81 587.77



Ambetter Gold 2 7 46 508.8 610.56



Ambetter Gold 2 7 47 530.17 636.2



Ambetter Gold 2 7 48 554.59 665.5



Ambetter Gold 2 7 49 578.68 694.41



Ambetter Gold 2 7 50 605.81 726.97

Page 65 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Gold 2 7 51 632.61 759.13



Ambetter Gold 2 7 52 662.12 794.54



Ambetter Gold 2 7 53 691.97 830.36



Ambetter Gold 2 7 54 724.19 869.02



Ambetter Gold 2 7 55 756.42 907.7



Ambetter Gold 2 7 56 791.35 949.62



Ambetter Gold 2 7 57 826.63 991.95



Ambetter Gold 2 7 58 864.28 1037.13



Ambetter Gold 2 7 59 882.94 1059.52



Ambetter Gold 2 7 60 920.59 1104.7



Ambetter Gold 2 7 61 953.15 1143.78



Ambetter Gold 2 7 62 974.52 1169.42



Ambetter Gold 2 7 63 1001.32 1201.58



Ambetter Gold 2 7 64 1017.59 1221.1




over

1017.59 1221.1



















Page 66 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 67 of 223



Area


tobacco rate

Individual

tobacco rate


























































over

990.86 1189.03







Page 68 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 69 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 70 of 223



Area


tobacco rate

Individual

tobacco rate







over

1152.85 1383.42


























































Page 71 of 223



Area


tobacco rate

Individual

tobacco rate
























Ambetter Gold 2 + Vision 7 46 517 620.4









Ambetter Gold 2 + Vision 7 49 588 705.6































Page 72 of 223



Area


tobacco rate

Individual

tobacco rate



















over

1033.99 1240.78














































Page 73 of 223



Area


tobacco rate

Individual

tobacco rate

































Ambetter Gold 2 + Vision + Adult Dental 1 45 502 602.4































Page 74 of 223



Area


tobacco rate

Individual

tobacco rate































over

1042.93 1251.51


































Page 75 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 76 of 223



Area


tobacco rate

Individual

tobacco rate











































over

1213.43 1456.11






















Page 77 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 78 of 223



Area


tobacco rate

Individual

tobacco rate
























Ambetter Gold 2 + Vision + Adult Dental 7 55 809 970.8































over

1088.32 1305.98



Ambetter Silver 1 1 0‐20 173.74 208.48



Ambetter Silver 1 1 21 273.62 328.34



Ambetter Silver 1 1 22 273.62 328.34

Page 79 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 1 1 23 273.62 328.34



Ambetter Silver 1 1 24 273.62 328.34



Ambetter Silver 1 1 25 274.71 329.65



Ambetter Silver 1 1 26 280.18 336.21



Ambetter Silver 1 1 27 286.75 344.1









Ambetter Silver 1 1 30 310.55 372.66



Ambetter Silver 1 1 31 317.12 380.54



Ambetter Silver 1 1 32 323.68 388.41



Ambetter Silver 1 1 33 327.79 393.34






Ambetter Silver 1 1 35 334.36 401.23



Ambetter Silver 1 1 36 336.54 403.84



Ambetter Silver 1 1 37 338.73 406.47









Ambetter Silver 1 1 40 349.68 419.61



Ambetter Silver 1 1 41 356.24 427.48



Ambetter Silver 1 1 42 362.54 435.04



Ambetter Silver 1 1 43 371.29 445.54

Page 80 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 1 1 44 382.24 458.68









Ambetter Silver 1 1 47 427.66 513.19



Ambetter Silver 1 1 48 447.36 536.83



Ambetter Silver 1 1 49 466.78 560.13






Ambetter Silver 1 1 51 510.29 612.34









Ambetter Silver 1 1 54 584.16 700.99



Ambetter Silver 1 1 55 610.16 732.19



Ambetter Silver 1 1 56 638.34 766









Ambetter Silver 1 1 59 712.22 854.66






Ambetter Silver 1 1 61 768.85 922.62






Ambetter Silver 1 1 63 807.71 969.25



Ambetter Silver 1 1 64 820.83 984.99

Page 81 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 1 1 65 and

over

820.83 984.99



Ambetter Silver 1 3 0‐20 202.15 242.58



Ambetter Silver 1 3 21 318.35 382.02



Ambetter Silver 1 3 22 318.35 382.02



Ambetter Silver 1 3 23 318.35 382.02



Ambetter Silver 1 3 24 318.35 382.02



Ambetter Silver 1 3 25 319.62 383.54



Ambetter Silver 1 3 26 325.98 391.17



Ambetter Silver 1 3 27 333.62 400.34



Ambetter Silver 1 3 28 346.04 415.24



Ambetter Silver 1 3 29 356.23 427.47



Ambetter Silver 1 3 30 361.32 433.58



Ambetter Silver 1 3 31 368.96 442.75






Ambetter Silver 1 3 33 381.38 457.65



Ambetter Silver 1 3 34 386.47 463.76



Ambetter Silver 1 3 35 389.02 466.82



Ambetter Silver 1 3 36 391.56 469.87



Ambetter Silver 1 3 37 394.11 472.93



Ambetter Silver 1 3 38 396.66 475.99




Page 82 of 223



Area


tobacco rate

Individual

tobacco rate






Ambetter Silver 1 3 41 414.48 497.37



Ambetter Silver 1 3 42 421.81 506.17



Ambetter Silver 1 3 43 431.99 518.38



Ambetter Silver 1 3 44 444.73 533.67



Ambetter Silver 1 3 45 459.69 551.62



Ambetter Silver 1 3 46 477.52 573.02



Ambetter Silver 1 3 47 497.57 597.08



Ambetter Silver 1 3 48 520.49 624.58






Ambetter Silver 1 3 50 568.56 682.27



Ambetter Silver 1 3 51 593.71 712.45



Ambetter Silver 1 3 52 621.41 745.69






Ambetter Silver 1 3 54 679.66 815.59



Ambetter Silver 1 3 55 709.91 851.89









Ambetter Silver 1 3 58 811.14 973.36



Ambetter Silver 1 3 59 828.65 994.38



Ambetter Silver 1 3 60 863.99 1036.78

Page 83 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 1 3 61 894.55 1073.46



Ambetter Silver 1 3 62 914.6 1097.52



Ambetter Silver 1 3 63 939.75 1127.7



Ambetter Silver 1 3 64 955.02 1146.02




over

955.02 1146.02



Ambetter Silver 1 7 0‐20 181.31 217.57



Ambetter Silver 1 7 21 285.53 342.63



Ambetter Silver 1 7 22 285.53 342.63



Ambetter Silver 1 7 23 285.53 342.63



Ambetter Silver 1 7 24 285.53 342.63



Ambetter Silver 1 7 25 286.66 343.99



Ambetter Silver 1 7 26 292.37 350.84



Ambetter Silver 1 7 27 299.23 359.07



Ambetter Silver 1 7 28 310.36 372.43






Ambetter Silver 1 7 30 324.07 388.88






Ambetter Silver 1 7 32 337.77 405.32



Ambetter Silver 1 7 33 342.06 410.47



Ambetter Silver 1 7 34 346.62 415.94



Ambetter Silver 1 7 35 348.91 418.69

Page 84 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 1 7 36 351.19 421.42



Ambetter Silver 1 7 37 353.48 424.17



Ambetter Silver 1 7 38 355.76 426.91



Ambetter Silver 1 7 39 360.33 432.39









Ambetter Silver 1 7 42 378.32 453.98



Ambetter Silver 1 7 43 387.45 464.94



Ambetter Silver 1 7 44 398.87 478.64



Ambetter Silver 1 7 45 412.29 494.74



Ambetter Silver 1 7 46 428.28 513.93



Ambetter Silver 1 7 47 446.27 535.52



Ambetter Silver 1 7 48 466.83 560.19






Ambetter Silver 1 7 50 509.94 611.92



Ambetter Silver 1 7 51 532.5 639






Ambetter Silver 1 7 53 582.47 698.96






Ambetter Silver 1 7 55 636.71 764.05



Ambetter Silver 1 7 56 666.12 799.34

Page 85 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 1 7 57 695.82 834.98



Ambetter Silver 1 7 58 727.51 873.01



Ambetter Silver 1 7 59 743.21 891.85



Ambetter Silver 1 7 60 774.91 929.89



Ambetter Silver 1 7 61 802.32 962.78



Ambetter Silver 1 7 62 820.31 984.37



Ambetter Silver 1 7 63 842.86 1011.43



Ambetter Silver 1 7 64 856.56 1027.87




over

856.56 1027.87



Ambetter Silver 1 + Vision 1 0‐20 176.54 211.84



Ambetter Silver 1 + Vision 1 21 278.03 333.63































Page 86 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 87 of 223



Area


tobacco rate

Individual

tobacco rate







































Ambetter Silver 1 + Vision 1 65 and

over

834.06 1000.87
























Ambetter Silver 1 + Vision 3 27 339 406.8

Page 88 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 89 of 223



Area


tobacco rate

Individual

tobacco rate




















































over

970.41 1164.49













Page 90 of 223



Area


tobacco rate

Individual

tobacco rate










































Ambetter Silver 1 + Vision 7 37 359.17 431






















Page 91 of 223



Area


tobacco rate

Individual

tobacco rate
































































over

870.36 1044.43

Page 92 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 1 + Vision + Adult Dental 1 0‐20 185.82 222.98



Ambetter Silver 1 + Vision + Adult Dental 1 21 292.64 351.16


























































Page 93 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 94 of 223



Area


tobacco rate

Individual

tobacco rate












Ambetter Silver 1 + Vision + Adult Dental 1 65 and

over

877.89 1053.46




















































Page 95 of 223



Area


tobacco rate

Individual

tobacco rate




































Ambetter Silver 1 + Vision + Adult Dental 3 48 556.67 668




























Page 96 of 223



Area


tobacco rate

Individual

tobacco rate

























over

1021.41 1225.69








































Page 97 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 98 of 223



Area


tobacco rate

Individual

tobacco rate





































over

916.1 1099.32



Ambetter Silver 2 1 0‐20 162.97 195.56



Ambetter Silver 2 1 21 256.66 307.99



Ambetter Silver 2 1 22 256.66 307.99



Ambetter Silver 2 1 23 256.66 307.99



Ambetter Silver 2 1 24 256.66 307.99



Ambetter Silver 2 1 25 257.68 309.21



Ambetter Silver 2 1 26 262.81 315.37



Ambetter Silver 2 1 27 268.97 322.76



Ambetter Silver 2 1 28 278.98 334.77

Page 99 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 2 1 29 287.19 344.62






Ambetter Silver 2 1 31 297.46 356.95



Ambetter Silver 2 1 32 303.62 364.34



Ambetter Silver 2 1 33 307.47 368.96



Ambetter Silver 2 1 34 311.57 373.88



Ambetter Silver 2 1 35 313.63 376.35



Ambetter Silver 2 1 36 315.68 378.81



Ambetter Silver 2 1 37 317.73 381.27



Ambetter Silver 2 1 38 319.79 383.74



Ambetter Silver 2 1 39 323.89 388.66



Ambetter Silver 2 1 40 328 393.6



Ambetter Silver 2 1 41 334.16 400.99



Ambetter Silver 2 1 42 340.06 408.07



Ambetter Silver 2 1 43 348.27 417.92



Ambetter Silver 2 1 44 358.54 430.24






Ambetter Silver 2 1 46 384.97 461.96



Ambetter Silver 2 1 47 401.14 481.36



Ambetter Silver 2 1 48 419.62 503.54




Page 100 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 2 1 50 458.38 550.05



Ambetter Silver 2 1 51 478.65 574.38



Ambetter Silver 2 1 52 500.98 601.17



Ambetter Silver 2 1 53 523.56 628.27



Ambetter Silver 2 1 54 547.95 657.54



Ambetter Silver 2 1 55 572.33 686.79



Ambetter Silver 2 1 56 598.76 718.51



Ambetter Silver 2 1 57 625.45 750.54



Ambetter Silver 2 1 58 653.94 784.72



Ambetter Silver 2 1 59 668.06 801.67



Ambetter Silver 2 1 60 696.55 835.86



Ambetter Silver 2 1 61 721.18 865.41



Ambetter Silver 2 1 62 737.35 884.82



Ambetter Silver 2 1 63 757.63 909.15



Ambetter Silver 2 1 64 769.94 923.92




over

769.94 923.92



Ambetter Silver 2 3 0‐20 189.62 227.54



Ambetter Silver 2 3 21 298.62 358.34



Ambetter Silver 2 3 22 298.62 358.34



Ambetter Silver 2 3 23 298.62 358.34



Ambetter Silver 2 3 24 298.62 358.34

Page 101 of 223



Area


tobacco rate

Individual

tobacco rate






Ambetter Silver 2 3 26 305.77 366.92



Ambetter Silver 2 3 27 312.94 375.52






Ambetter Silver 2 3 29 334.14 400.96












Ambetter Silver 2 3 33 357.73 429.27



Ambetter Silver 2 3 34 362.51 435.01






Ambetter Silver 2 3 36 367.29 440.74



Ambetter Silver 2 3 37 369.68 443.61



Ambetter Silver 2 3 38 372.06 446.47






Ambetter Silver 2 3 40 381.62 457.94



Ambetter Silver 2 3 41 388.79 466.54



Ambetter Silver 2 3 42 395.65 474.78



Ambetter Silver 2 3 43 405.21 486.25



Ambetter Silver 2 3 44 417.15 500.58



Ambetter Silver 2 3 45 431.19 517.42

Page 102 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 2 3 46 447.91 537.49



Ambetter Silver 2 3 47 466.72 560.06



Ambetter Silver 2 3 48 488.22 585.86






Ambetter Silver 2 3 50 533.31 639.97






Ambetter Silver 2 3 52 582.88 699.45



Ambetter Silver 2 3 53 609.16 730.99



Ambetter Silver 2 3 54 637.53 765.03



Ambetter Silver 2 3 55 665.89 799.06



Ambetter Silver 2 3 56 696.65 835.98






Ambetter Silver 2 3 58 760.85 913.02



Ambetter Silver 2 3 59 777.27 932.72






Ambetter Silver 2 3 61 839.09 1006.9



Ambetter Silver 2 3 62 857.9 1029.48



Ambetter Silver 2 3 63 881.49 1057.78



Ambetter Silver 2 3 64 895.81 1074.97




over

895.81 1074.97



Ambetter Silver 2 7 0‐20 170.07 204.08

Page 103 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 2 7 21 267.83 321.39



Ambetter Silver 2 7 22 267.83 321.39



Ambetter Silver 2 7 23 267.83 321.39



Ambetter Silver 2 7 24 267.83 321.39



Ambetter Silver 2 7 25 268.89 322.66






Ambetter Silver 2 7 27 280.68 336.81



Ambetter Silver 2 7 28 291.12 349.34



Ambetter Silver 2 7 29 299.69 359.62



Ambetter Silver 2 7 30 303.98 364.77






Ambetter Silver 2 7 32 316.83 380.19



Ambetter Silver 2 7 33 320.85 385.02



Ambetter Silver 2 7 34 325.13 390.15



Ambetter Silver 2 7 35 327.28 392.73






Ambetter Silver 2 7 37 331.56 397.87






Ambetter Silver 2 7 39 337.99 405.58



Ambetter Silver 2 7 40 342.27 410.72




Page 104 of 223



Area


tobacco rate

Individual

tobacco rate



Ambetter Silver 2 7 42 354.86 425.83



Ambetter Silver 2 7 43 363.43 436.11



Ambetter Silver 2 7 44 374.14 448.96



Ambetter Silver 2 7 45 386.73 464.07



Ambetter Silver 2 7 46 401.73 482.07






Ambetter Silver 2 7 48 437.89 525.46






Ambetter Silver 2 7 50 478.33 573.99



Ambetter Silver 2 7 51 499.48 599.37



Ambetter Silver 2 7 52 522.78 627.33



Ambetter Silver 2 7 53 546.35 655.62






Ambetter Silver 2 7 55 597.24 716.68



Ambetter Silver 2 7 56 624.82 749.78



Ambetter Silver 2 7 57 652.68 783.21






Ambetter Silver 2 7 59 697.13 836.55



Ambetter Silver 2 7 60 726.86 872.23



Ambetter Silver 2 7 61 752.57 903.08



Ambetter Silver 2 7 62 769.45 923.34

Page 105 of 223



Area


tobacco rate

Individual

tobacco rate






Ambetter Silver 2 7 64 803.45 964.14




over

803.45 964.14























































Page 106 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 107 of 223



Area


tobacco rate

Individual

tobacco rate






















over

782.34 938.8











































Page 108 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 109 of 223



Area


tobacco rate

Individual

tobacco rate


































over

910.24 1092.28































Page 110 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 111 of 223



Area


tobacco rate

Individual

tobacco rate







































Ambetter Silver 2 + Vision 7 63 803.34 964







over

816.4 979.68



















Page 112 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 113 of 223



Area


tobacco rate

Individual

tobacco rate


























































over

823.46 988.15







Page 114 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 115 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 116 of 223



Area


tobacco rate

Individual

tobacco rate







over

958.08 1149.69


























































Page 117 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 118 of 223



Area


tobacco rate

Individual

tobacco rate



















over

859.3 1031.16

Arkansas Blue Cross & Blue Shield Bronze 5500 1 0‐20 117.44 117.44

Arkansas Blue Cross & Blue Shield Bronze 5500 1 21 184.94 184.94














Arkansas Blue Cross & Blue Shield Bronze 5500 1 35 226 226






























Page 119 of 223



Area


tobacco rate

Individual

tobacco rate

Arkansas Blue Cross & Blue Shield Bronze 5500 1 65 and

over

554.82 554.82















































over

515.25 515.25















Page 120 of 223



Area


tobacco rate

Individual

tobacco rate

































over

521.13 521.13































Page 121 of 223



Area


tobacco rate

Individual

tobacco rate

















over

512.04 512.04














































Page 122 of 223



Area


tobacco rate

Individual

tobacco rate


over

549.45 549.45















































over

554.82 554.82















Page 123 of 223



Area


tobacco rate

Individual

tobacco rate

































over

496.56 496.56































Page 124 of 223



Area


tobacco rate

Individual

tobacco rate

















over

575.61 575.61














































Page 125 of 223



Area


tobacco rate

Individual

tobacco rate


over

534.57 534.57















































over

540.66 540.66















Page 126 of 223



Area


tobacco rate

Individual

tobacco rate

































over

531.24 531.24































Page 127 of 223



Area


tobacco rate

Individual

tobacco rate

















over

570.06 570.06














































Page 128 of 223



Area


tobacco rate

Individual

tobacco rate


over

575.61 575.61















































over

515.16 515.16















Page 129 of 223



Area


tobacco rate

Individual

tobacco rate

































over

543.15 543.15































Page 130 of 223



Area


tobacco rate

Individual

tobacco rate

















over

504.42 504.42














































Page 131 of 223



Area


tobacco rate

Individual

tobacco rate


over

510.18 510.18















































over

501.27 501.27















Page 132 of 223



Area


tobacco rate

Individual

tobacco rate

































over

537.9 537.9































Page 133 of 223



Area


tobacco rate

Individual

tobacco rate

















over

543.15 543.15














































Page 134 of 223



Area


tobacco rate

Individual

tobacco rate


over

486.12 486.12

Arkansas Blue Cross & Blue Shield Catastrophic 1 0‐20 108.71 108.71

Arkansas Blue Cross & Blue Shield Catastrophic 1 21 171.2 171.2












































Arkansas Blue Cross & Blue Shield Catastrophic 1 65 and

over

513.6 513.6















Page 135 of 223



Area


tobacco rate

Individual

tobacco rate








Arkansas Blue Cross & Blue Shield Catastrophic 2 41 207 207

























over

476.97 476.97































Page 136 of 223



Area


tobacco rate

Individual

tobacco rate

















over

482.43 482.43














































Page 137 of 223



Area


tobacco rate

Individual

tobacco rate


over

474 474















































over

508.65 508.65















Page 138 of 223



Area


tobacco rate

Individual

tobacco rate

































over

513.6 513.6































Page 139 of 223



Area


tobacco rate

Individual

tobacco rate

















over

459.66 459.66

Arkansas Blue Cross & Blue Shield Gold 1000 1 0‐20 167.15 167.15

Arkansas Blue Cross & Blue Shield Gold 1000 1 21 263.23 263.23

































Arkansas Blue Cross & Blue Shield Gold 1000 1 54 562 562











Page 140 of 223



Area


tobacco rate

Individual

tobacco rate

Arkansas Blue Cross & Blue Shield Gold 1000 1 65 and

over

789.69 789.69















































over

733.38 733.38

Arkansas Blue Cross & Blue Shield Gold 1000 3 0‐20 157 157














Page 141 of 223



Area


tobacco rate

Individual

tobacco rate

































over

741.75 741.75































Page 142 of 223



Area


tobacco rate

Individual

tobacco rate

















over

728.82 728.82














































Page 143 of 223



Area


tobacco rate

Individual

tobacco rate


over

782.07 782.07















































over

789.69 789.69















Page 144 of 223



Area


tobacco rate

Individual

tobacco rate

































over

706.77 706.77































Page 145 of 223



Area


tobacco rate

Individual

tobacco rate

















over

850.62 850.62














































Page 146 of 223



Area


tobacco rate

Individual

tobacco rate


over

789.96 789.96















































over

798.99 798.99















Page 147 of 223



Area


tobacco rate

Individual

tobacco rate

































over

785.04 785.04































Page 148 of 223



Area


tobacco rate

Individual

tobacco rate

















over

842.43 842.43














































Page 149 of 223



Area


tobacco rate

Individual

tobacco rate


over

850.62 850.62















































over

761.28 761.28

Arkansas Blue Cross & Blue Shield Silver 2500 1 0‐20 152.13 152.13

Arkansas Blue Cross & Blue Shield Silver 2500 1 21 239.58 239.58













Page 150 of 223



Area


tobacco rate

Individual

tobacco rate
































Arkansas Blue Cross & Blue Shield Silver 2500 1 65 and

over

718.74 718.74































Page 151 of 223



Area


tobacco rate

Individual

tobacco rate

















over

667.5 667.5
















Arkansas Blue Cross & Blue Shield Silver 2500 3 35 275 275






























Page 152 of 223



Area


tobacco rate

Individual

tobacco rate


over

675.12 675.12















































over

663.33 663.33















Page 153 of 223



Area


tobacco rate

Individual

tobacco rate

































over

711.81 711.81































Page 154 of 223



Area


tobacco rate

Individual

tobacco rate

















over

718.74 718.74














































Page 155 of 223



Area


tobacco rate

Individual

tobacco rate


over

643.26 643.26















































over

689.31 689.31















Page 156 of 223



Area


tobacco rate

Individual

tobacco rate

































over

640.17 640.17































Page 157 of 223



Area


tobacco rate

Individual

tobacco rate

















over

647.46 647.46














































Page 158 of 223



Area


tobacco rate

Individual

tobacco rate


over

636.18 636.18















































over

682.68 682.68















Page 159 of 223



Area


tobacco rate

Individual

tobacco rate

































over

689.31 689.31































Page 160 of 223



Area


tobacco rate

Individual

tobacco rate

















over

616.92 616.92

Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 0‐20 154.86 154.86

Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 21 243.87 243.87






















Page 161 of 223



Area


tobacco rate

Individual

tobacco rate























Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 1 65 and

over

731.61 731.61









Page 162 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 163 of 223



Area


tobacco rate

Individual

tobacco rate








over

679.44 679.44









Blue Cross Blue Shield Multi‐State Blue Cross Blue Shield 2000, a Multi‐State Plan 3 28 249 249
















Page 164 of 223



Area


tobacco rate

Individual

tobacco rate























over

687.21 687.21










Page 165 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 166 of 223



Area


tobacco rate

Individual

tobacco rate







over

675.21 675.21


























Page 167 of 223



Area


tobacco rate

Individual

tobacco rate






















over

724.56 724.56











Page 168 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 169 of 223



Area


tobacco rate

Individual

tobacco rate






over

731.61 731.61



























Page 170 of 223



Area


tobacco rate

Individual

tobacco rate





















over

654.78 654.78












Page 171 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 172 of 223



Area


tobacco rate

Individual

tobacco rate





over

848.52 848.52




























Page 173 of 223



Area


tobacco rate

Individual

tobacco rate




















over

788.04 788.04













Page 174 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 175 of 223



Area


tobacco rate

Individual

tobacco rate




over

797.01 797.01





























Page 176 of 223



Area


tobacco rate

Individual

tobacco rate



















over

783.12 783.12














Page 177 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 178 of 223



Area


tobacco rate

Individual

tobacco rate



over

840.36 840.36






























Page 179 of 223



Area


tobacco rate

Individual

tobacco rate


















over

848.52 848.52















Page 180 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 181 of 223



Area


tobacco rate

Individual

tobacco rate


over

759.42 759.42































Page 182 of 223



Area


tobacco rate

Individual

tobacco rate

















over

562.8 562.8
















Page 183 of 223



Area


tobacco rate

Individual

tobacco rate
































over

522.69 522.69

Page 184 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 185 of 223



Area


tobacco rate

Individual

tobacco rate
















over

528.66 528.66

















Page 186 of 223



Area


tobacco rate

Individual

tobacco rate































over

519.42 519.42


Page 187 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 188 of 223



Area


tobacco rate

Individual

tobacco rate















over

557.4 557.4


















Page 189 of 223



Area


tobacco rate

Individual

tobacco rate






























over

562.8 562.8



Page 190 of 223



Area


tobacco rate

Individual

tobacco rate
































Page 191 of 223



Area


tobacco rate

Individual

tobacco rate














over

503.7 503.7

QCA Health Plan, Inc. Bronze Basic Plus 1 0‐20 115.36 115.36


QCA Health Plan, Inc. Bronze Basic Plus 1 21 181.66 218

QCA Health Plan, Inc. Bronze Basic Plus 1 21 201.85 242.22


































Page 192 of 223



Area


tobacco rate

Individual

tobacco rate






















































QCA Health Plan, Inc. Bronze Basic Plus 1 65 and

over

544.99 653.99


over

605.55 726.65







Page 193 of 223



Area


tobacco rate

Individual

tobacco rate








QCA Health Plan, Inc. Bronze Basic Plus 2 33 266 319.2























QCA Health Plan, Inc. Bronze Basic Plus 2 56 518 621.6










over

666.1 799.32























Page 194 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 195 of 223



Area


tobacco rate

Individual

tobacco rate







over

490.49 588.59


over

544.99 653.99















































over

605.55 726.65








Page 196 of 223



Area


tobacco rate

Individual

tobacco rate








































over

544.99 653.99

QCA Health Plan, Inc. Bronze Premier Plus 1 0‐20 123.37 123.37


QCA Health Plan, Inc. Bronze Premier Plus 1 21 194.28 233.14





















Page 197 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 198 of 223



Area


tobacco rate

Individual

tobacco rate





QCA Health Plan, Inc. Bronze Premier Plus 1 65 and

over

582.85 699.42


over

647.61 777.14






















QCA Health Plan, Inc. Bronze Premier Plus 2 41 309.17 371

























over

712.37 854.85









Page 199 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 200 of 223



Area


tobacco rate

Individual

tobacco rate





















over

524.57 629.48


over

582.85 699.42









































Page 201 of 223



Area


tobacco rate

Individual

tobacco rate







over

647.61 777.14















































over

582.85 699.42

QCA Health Plan, Inc. Catastrophic Plus 1 0‐20 75.29 75.29


QCA Health Plan, Inc. Catastrophic Plus 1 21 118.56 142.28







Page 202 of 223



Area


tobacco rate

Individual

tobacco rate
























QCA Health Plan, Inc. Catastrophic Plus 1 36 145.83 175








































Page 203 of 223



Area


tobacco rate

Individual

tobacco rate















QCA Health Plan, Inc. Catastrophic Plus 1 63 350 420




QCA Health Plan, Inc. Catastrophic Plus 1 65 and

over

355.69 426.83


over

395.21 474.25










































Page 204 of 223



Area


tobacco rate

Individual

tobacco rate






over

434.73 521.68


























































Page 205 of 223



Area


tobacco rate

Individual

tobacco rate



































over

320.12 384.14


over

355.69 426.83



























Page 206 of 223



Area


tobacco rate

Individual

tobacco rate





















over

395.21 474.25











































Page 207 of 223



Area


tobacco rate

Individual

tobacco rate





over

355.69 426.83

QCA Health Plan, Inc. Gold Enhanced Plus 1 0‐20 167.45 167.45


QCA Health Plan, Inc. Gold Enhanced Plus 1 21 263.69 316.43









QCA Health Plan, Inc. Gold Enhanced Plus 1 25 294.17 353





























QCA Health Plan, Inc. Gold Enhanced Plus 1 40 337 404.4


















Page 208 of 223



Area


tobacco rate

Individual

tobacco rate

































QCA Health Plan, Inc. Gold Enhanced Plus 1 65 and

over

791.08 949.3


over

878.98 1054.78




























Page 209 of 223



Area


tobacco rate

Individual

tobacco rate




















over

966.88 1160.26












































Page 210 of 223



Area


tobacco rate

Individual

tobacco rate

















































over

711.98 854.37


over

791.08 949.3













Page 211 of 223



Area


tobacco rate

Individual

tobacco rate



































over

878.98 1054.78





























Page 212 of 223



Area


tobacco rate

Individual

tobacco rate



















over

791.08 949.3

QCA Health Plan, Inc. Gold Premier Plus 1 0‐20 172.3 172.3


QCA Health Plan, Inc. Gold Premier Plus 1 21 271.33 325.6



























QCA Health Plan, Inc. Gold Premier Plus 1 34 366 439.2















Page 213 of 223



Area


tobacco rate

Individual

tobacco rate















































QCA Health Plan, Inc. Gold Premier Plus 1 65 and

over

814 976.8


over

904.44 1085.33














Page 214 of 223



Area


tobacco rate

Individual

tobacco rate















QCA Health Plan, Inc. Gold Premier Plus 2 47 518.34 622



















over

994.89 1193.87






























Page 215 of 223



Area


tobacco rate

Individual

tobacco rate































































over

732.6 879.12

Page 216 of 223



Area


tobacco rate

Individual

tobacco rate


over

814 976.8















































over

904.44 1085.33















Page 217 of 223



Area


tobacco rate

Individual

tobacco rate

































over

814 976.8

QCA Health Plan, Inc. Silver Basic Plus 1 0‐20 160.06 160.06


QCA Health Plan, Inc. Silver Basic Plus 1 21 252.07 302.48












QCA Health Plan, Inc. Silver Basic Plus 1 27 264.17 317


QCA Health Plan, Inc. Silver Basic Plus 1 28 274 328.8














Page 218 of 223



Area


tobacco rate

Individual

tobacco rate





























































QCA Health Plan, Inc. Silver Basic Plus 1 65 and

over

756.21 907.45

Page 219 of 223



Area


tobacco rate

Individual

tobacco rate


over

840.24 1008.28















































over

924.26 1109.11















Page 220 of 223



Area


tobacco rate

Individual

tobacco rate
































































Page 221 of 223



Area


tobacco rate

Individual

tobacco rate















over

680.59 816.71


over

756.21 907.45














































Page 222 of 223



Area


tobacco rate

Individual

tobacco rate


over

840.24 1008.28















































over

756.21 907.45

Page 223 of 223

Documents

2014 health insurance premiums for plans sold through the Health