Filing at a Glance - myportal.dfs.ny.gov HCA_SG... · Loss Ratio Report, 3231(e) Loss Ratio Report, Experience Rating Formula, or Other with brief explanation).]: Yes- Prior Approval

Filing at a Glance

Company: Empire Health Choice Assurance, Inc.

Product Name: Small Group Article 42

State: New York

TOI: H16G Group Health - Major Medical

Sub-TOI: H16G.003A Small Group Only - PPO

Filing Type: 2019 Prior Approval ACA Rates

Date Submitted: 05/14/2018

SERFF Tr Num: AWLP-131478915

SERFF Status: Pending Industry Response

State Tr Num: 2018050217

State Status: CP-xx-CR

Co Tr Num: SMALL GROUP ARTICLE 42

ImplementationDate Requested:

01/01/2019

Disposition Date:

Disposition Status:

Implementation Date:

State Filing Description:

SERFF Tracking #: AWLP-131478915 State Tracking #: 2018050217 Company Tracking #: SMALL GROUP ARTICLE 42

State: New York Filing Company: Empire Health Choice Assurance, Inc.

TOI/Sub-TOI: H16G Group Health - Major Medical/H16G.003A Small Group Only - PPO


Project Name/Number: Small Group Article 42/

PDF Pipeline for SERFF Tracking Number AWLP-131478915 Generated 05/21/2018 07:14 AM

General Information

Company and Contact

Filing Fees

State Specific

Project Name: Small Group Article 42 Status of Filing in Domicile:

Project Number: Date Approved in Domicile:

Requested Filing Mode: Review & Approval Domicile Status Comments:

Explanation for Combination/Other: Market Type: Group

Submission Type: New Submission Group Market Size: Small

Group Market Type: Overall Rate Impact:

Filing Status Changed: 05/18/2018

State Status Changed: 05/18/2018 Deemer Date:

Corresponding Filing Tracking Number:

PPACA: Not PPACA-Related

PPACA Notes: null

Include Exchange Intentions: No

Filing Description:

Small Group Assurance

Form filing: AWLP-131479804

Filing Contact Information

Filing Company InformationEmpire Health Choice Assurance,Inc.

9 Pine St

New York, NY 10005

(212) 476-1000 ext. [Phone]

CoCode: 55093

Group Code: 671

Group Name: WellPoint Inc Group

FEIN Number: 23-7391136

State of Domicile: New York

Company Type: Life,Accident, Health

State ID Number:

Fee Required? No

Retaliatory? No

Fee Explanation:

1. Is a parallel filing being submitted for another issuing entity of the same parent organization? Yes/No (If Yes, enter nameof other entity, submission date, and SERFF Tracking Number of the parallel file.): Yes; Empire HealthChoice HMO, Inc.;5/14/18; AWLP-1314789212. Type of insurer? Article 43, HMO, Commercial, Municipal Coop, or Fraternal Benefit Society: Commercial







3. Is this filing for Group Remittance, Statutory Individual HMO, Statutory Individual POS, Blanket, or Healthy New York?Yes/No (If Yes, enter which one.): No4. Type of filing? Enter Form and Rate, Form only, Rate only (Form only should be used ONLY when the filing only containsan application, advertisement, administrative form, or is a group prefiling notification, out-of-state, or a report filing. Formsubmissions with no proposed rate impact are considered form and rate filings and require an actuarial memorandum.): RateOnly5. Is this a Rate only filing? Yes/No [If Yes, enter one: Commission/Fee Schedule, Prior Approval Rate Adjustment, DBLLoss Ratio Monitoring, Loss Ratio Experience Monitoring/Reporting, Medicare Supplement Annual Filing (other than rateadjustment), Medicare Supplement Refund Calculation Filing, Timothy's Law Subsidy Filing, Sole Proprietor Rating, 4308(h)Loss Ratio Report, 3231(e) Loss Ratio Report, Experience Rating Formula, or Other with brief explanation).]: Yes- PriorApproval Rate Adjustment6. Does this submission contain a form subject to Regulation 123? Yes/No (If Yes, provide a full explanation in the FilingDescription field.: No7. Did this insurer prefile group coverage for this group under Section 52.32 prior to this filing? Yes/No (If Yes, enter thestate tracking number assigned and the effective date of coverage.): No8. Does this submission contain any form which is subject to review by the Life Bureau, the Property Bureau or both? Yes/No(If Yes, identify the forms, the Bureau, the date submitted, and the SERFF file number.): No9. Does this filing contain forms that replace any other previously approved forms? Yes/No (If Yes, identify the formnumbers, the file number, and the date of approval of the forms being replaced in the Filing Description field.): No10. If this is a rate adjustment filing pursuant to Section 3231(e)(1) or 4308(c), did this insurer submit a "Prior ApprovalPrefiling" containing a draft narrative summary, a draft initial notification letter, and a draft numerical summary associated withthis filing? Yes/No (If Yes, enter the state tracking number and the SERFF tracking number of the prefile.): Yes, AWLP-131473035







Rate Information Rate data applies to filing.

Filing Method:

Rate Change Type: %

Overall Percentage of Last Rate Revision: %

Effective Date of Last Rate Revision:

Filing Method of Last Filing:

SERFF Tracking Number of Last Filing:

Company Rate Information

Company

Name:

Company

Rate

Change:

Overall %

Indicated

Change:

Overall %

Rate

Impact:

Written

Premium

Change for

this Program:

Number of Policy

Holders Affected

for this Program:

Written

Premium for

this Program:

Maximum %

Change

(where req'd):

Minimum %

Change

(where req'd):

Empire Health ChoiceAssurance, Inc.

Increase 6.030% 6.030% $9,493,780 9,328 $166,852,348 9.390% -2.730%







Rate Review Detail

COMPANY:Company Name: Empire Health Choice Assurance, Inc.

HHS Issuer Id: 44113

PRODUCTS:

Product Name HIOS Product ID HIOS Submission ID Number of Covered

LivesSmall Group Assurance 17719

Trend Factors:

FORMS:New Policy Forms: AWLP-131479804

Affected Forms:

Other Affected Forms:

REQUESTED RATE CHANGE INFORMATION:Change Period: Annual

Member Months: 212,628

Benefit Change: Increase

Percent Change Requested: Min: -2.73 Max: 9.39 Avg: 6.03

PRIOR RATE:Total Earned Premium: 157,358,567.00

Total Incurred Claims: 133,845,220.00

Annual $: Min: 425.61 Max: 939.19 Avg: 740.07

REQUESTED RATE:Projected Earned Premium: 166,852,348.00

Projected Incurred Claims: 141,920,389.00

Annual $: Min: 413.97 Max: 1,026.87 Avg: 784.71







Rate/Rule Schedule

Item

No.

Schedule

Item

Status

Document Name

Affected Form Numbers

(Separated with commas) Rate Action Rate Action Information Attachments

1 Rate Manual Pages New SG EPO RateManual.pdf, SG EPORate Manual.xlsb,Other manual pages -SG EPO.pdf, Othermanual pages - SGEPO.xlsx,







Index HIOSPlanName IndividualHusband/

WifeParent/Child(ren) Family

1 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA $446.93 $893.86 $759.78 $1,273.752 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut $443.79 $887.58 $754.44 $1,264.803 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut,Dep29 $450.41 $900.82 $765.70 $1,283.674 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut,Dep29,REAOptOut $450.41 $900.82 $765.70 $1,283.675 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut,REAOptOut $443.79 $887.58 $754.44 $1,264.806 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,Dep29 $453.56 $907.12 $771.05 $1,292.657 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,Dep29,REAOptOut $453.56 $907.12 $771.05 $1,292.658 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,REAOptOut $446.93 $893.86 $759.78 $1,273.759 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA $445.70 $891.40 $757.69 $1,270.2510 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut $442.62 $885.24 $752.45 $1,261.4711 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut,Dep29 $449.18 $898.36 $763.61 $1,280.1612 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut,Dep29,REAOptOut $449.18 $898.36 $763.61 $1,280.1613 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut,REAOptOut $442.62 $885.24 $752.45 $1,261.4714 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,Dep29 $452.33 $904.66 $768.96 $1,289.1415 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,Dep29,REAOptOut $452.33 $904.66 $768.96 $1,289.1416 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,REAOptOut $445.70 $891.40 $757.69 $1,270.2517 EmpireBronzeBlueAccessEPO7900/0%/7900 $431.08 $862.16 $732.84 $1,228.5818 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut $428.07 $856.14 $727.72 $1,220.0019 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut,Dep29 $434.43 $868.86 $738.53 $1,238.1320 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut,Dep29,REAOptOut $434.43 $868.86 $738.53 $1,238.1321 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut,REAOptOut $428.07 $856.14 $727.72 $1,220.0022 EmpireBronzeBlueAccessEPO7900/0%/7900,Dep29 $437.43 $874.86 $743.63 $1,246.6823 EmpireBronzeBlueAccessEPO7900/0%/7900,Dep29,REAOptOut $437.43 $874.86 $743.63 $1,246.6824 EmpireBronzeBlueAccessEPO7900/0%/7900,REAOptOut $431.08 $862.16 $732.84 $1,228.5825 EmpireBronzeBlueAccessGEPO6500/40%/7900 $467.43 $934.86 $794.63 $1,332.1826 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut $464.22 $928.44 $789.17 $1,323.0327 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut,Dep29 $471.12 $942.24 $800.90 $1,342.6928 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut,Dep29,REAOptOut $471.12 $942.24 $800.90 $1,342.6929 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut,REAOptOut $464.22 $928.44 $789.17 $1,323.0330 EmpireBronzeBlueAccessGEPO6500/40%/7900,Dep29 $474.40 $948.80 $806.48 $1,352.0431 EmpireBronzeBlueAccessGEPO6500/40%/7900,Dep29,REAOptOut $474.40 $948.80 $806.48 $1,352.0432 EmpireBronzeBlueAccessGEPO6500/40%/7900,REAOptOut $467.43 $934.86 $794.63 $1,332.1833 EmpireBronzeEPO5500/20%/6700w/HSA $479.04 $958.08 $814.37 $1,365.2634 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut $475.70 $951.40 $808.69 $1,355.7535 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut,Dep29 $482.87 $965.74 $820.88 $1,376.1836 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut,Dep29,REAOptOut $482.87 $965.74 $820.88 $1,376.1837 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut,REAOptOut $475.70 $951.40 $808.69 $1,355.7538 EmpireBronzeEPO5500/20%/6700w/HSA,Dep29 $486.29 $972.58 $826.69 $1,385.9339 EmpireBronzeEPO5500/20%/6700w/HSA,Dep29,REAOptOut $486.29 $972.58 $826.69 $1,385.9340 EmpireBronzeEPO5500/20%/6700w/HSA,REAOptOut $479.04 $958.08 $814.37 $1,365.2641 EmpireBronzeEPO5500/35%/6700w/HSA $477.81 $955.62 $812.28 $1,361.7642 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut $474.47 $948.94 $806.60 $1,352.2443 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut,Dep29 $481.57 $963.14 $818.67 $1,372.4744 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut,Dep29,REAOptOut $481.57 $963.14 $818.67 $1,372.4745 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut,REAOptOut $474.47 $948.94 $806.60 $1,352.2446 EmpireBronzeEPO5500/35%/6700w/HSA,Dep29 $484.99 $969.98 $824.48 $1,382.2247 EmpireBronzeEPO5500/35%/6700w/HSA,Dep29,REAOptOut $484.99 $969.98 $824.48 $1,382.2248 EmpireBronzeEPO5500/35%/6700w/HSA,REAOptOut $477.81 $955.62 $812.28 $1,361.7649 EmpireGoldBlueAccessEPO1250/20%/4000 $643.03 $1,286.06 $1,093.15 $1,832.6450 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut $638.52 $1,277.04 $1,085.48 $1,819.7851 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut,Dep29 $648.02 $1,296.04 $1,101.63 $1,846.8652 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut,Dep29,REAOptOut $648.02 $1,296.04 $1,101.63 $1,846.8653 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut,REAOptOut $638.52 $1,277.04 $1,085.48 $1,819.7854 EmpireGoldBlueAccessEPO1250/20%/4000,Dep29 $652.53 $1,305.06 $1,109.30 $1,859.7155 EmpireGoldBlueAccessEPO1250/20%/4000,Dep29,REAOptOut $652.53 $1,305.06 $1,109.30 $1,859.71

FormNumber(s):NY_EPO_DA_012019,NY_PPO_DA_012019

Albany(Region1)

SmallGroup

Quarter1:JanuaryMarch2019

RateManual

EmpireHealthChoiceAssurance,Inc.

EmpireHealthChoiceAssurance,Inc. II1 May2018


SmallGroup


RateManual


56 EmpireGoldBlueAccessEPO1250/20%/4000,REAOptOut $643.03 $1,286.06 $1,093.15 $1,832.6457 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA $610.03 $1,220.06 $1,037.05 $1,738.5958 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut $605.79 $1,211.58 $1,029.84 $1,726.5059 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut,Dep29 $614.81 $1,229.62 $1,045.18 $1,752.2160 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut,Dep29,REAOptOut $614.81 $1,229.62 $1,045.18 $1,752.2161 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut,REAOptOut $605.79 $1,211.58 $1,029.84 $1,726.5062 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,Dep29 $619.05 $1,238.10 $1,052.39 $1,764.2963 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,Dep29,REAOptOut $619.05 $1,238.10 $1,052.39 $1,764.2964 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,REAOptOut $610.03 $1,220.06 $1,037.05 $1,738.5965 EmpireGoldBlueAccessEPO25/0%/6000 $655.60 $1,311.20 $1,114.52 $1,868.4666 EmpireGoldBlueAccessEPO25/0%/6000,COptOut $651.09 $1,302.18 $1,106.85 $1,855.6167 EmpireGoldBlueAccessEPO25/0%/6000,COptOut,Dep29 $660.73 $1,321.46 $1,123.24 $1,883.0868 EmpireGoldBlueAccessEPO25/0%/6000,COptOut,Dep29,REAOptOut $660.73 $1,321.46 $1,123.24 $1,883.0869 EmpireGoldBlueAccessEPO25/0%/6000,COptOut,REAOptOut $651.09 $1,302.18 $1,106.85 $1,855.6170 EmpireGoldBlueAccessEPO25/0%/6000,Dep29 $665.30 $1,330.60 $1,131.01 $1,896.1171 EmpireGoldBlueAccessEPO25/0%/6000,Dep29,REAOptOut $665.30 $1,330.60 $1,131.01 $1,896.1172 EmpireGoldBlueAccessEPO25/0%/6000,REAOptOut $655.60 $1,311.20 $1,114.52 $1,868.4673 EmpireGoldBlueAccessEPO35/10%/5850 $647.88 $1,295.76 $1,101.40 $1,846.4674 EmpireGoldBlueAccessEPO35/10%/5850,COptOut $643.44 $1,286.88 $1,093.85 $1,833.8075 EmpireGoldBlueAccessEPO35/10%/5850,COptOut,Dep29 $652.94 $1,305.88 $1,110.00 $1,860.8876 EmpireGoldBlueAccessEPO35/10%/5850,COptOut,Dep29,REAOptOut $652.94 $1,305.88 $1,110.00 $1,860.8877 EmpireGoldBlueAccessEPO35/10%/5850,COptOut,REAOptOut $643.44 $1,286.88 $1,093.85 $1,833.8078 EmpireGoldBlueAccessEPO35/10%/5850,Dep29 $657.51 $1,315.02 $1,117.77 $1,873.9079 EmpireGoldBlueAccessEPO35/10%/5850,Dep29,REAOptOut $657.51 $1,315.02 $1,117.77 $1,873.9080 EmpireGoldBlueAccessEPO35/10%/5850,REAOptOut $647.88 $1,295.76 $1,101.40 $1,846.4681 EmpireGoldBlueAccessEPO500/20%/7350 $632.03 $1,264.06 $1,074.45 $1,801.2982 EmpireGoldBlueAccessEPO500/20%/7350,COptOut $627.66 $1,255.32 $1,067.02 $1,788.8383 EmpireGoldBlueAccessEPO500/20%/7350,COptOut,Dep29 $636.95 $1,273.90 $1,082.82 $1,815.3184 EmpireGoldBlueAccessEPO500/20%/7350,COptOut,Dep29,REAOptOut $636.95 $1,273.90 $1,082.82 $1,815.3185 EmpireGoldBlueAccessEPO500/20%/7350,COptOut,REAOptOut $627.66 $1,255.32 $1,067.02 $1,788.8386 EmpireGoldBlueAccessEPO500/20%/7350,Dep29 $641.39 $1,282.78 $1,090.36 $1,827.9687 EmpireGoldBlueAccessEPO500/20%/7350,Dep29,REAOptOut $641.39 $1,282.78 $1,090.36 $1,827.9688 EmpireGoldBlueAccessEPO500/20%/7350,REAOptOut $632.03 $1,264.06 $1,074.45 $1,801.2989 EmpireGoldBlueAccessGEPO1500/20%/6000 $578.73 $1,157.46 $983.84 $1,649.3890 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut $574.70 $1,149.40 $976.99 $1,637.9091 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut,Dep29 $583.24 $1,166.48 $991.51 $1,662.2392 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut,Dep29,REAOptOut $583.24 $1,166.48 $991.51 $1,662.2393 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut,REAOptOut $574.70 $1,149.40 $976.99 $1,637.9094 EmpireGoldBlueAccessGEPO1500/20%/6000,Dep29 $587.34 $1,174.68 $998.48 $1,673.9295 EmpireGoldBlueAccessGEPO1500/20%/6000,Dep29,REAOptOut $587.34 $1,174.68 $998.48 $1,673.9296 EmpireGoldBlueAccessGEPO1500/20%/6000,REAOptOut $578.73 $1,157.46 $983.84 $1,649.3897 EmpireGoldBlueAccessGEPO40/30%/6000 $600.73 $1,201.46 $1,021.24 $1,712.0898 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut $596.57 $1,193.14 $1,014.17 $1,700.2299 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut,Dep29 $605.45 $1,210.90 $1,029.27 $1,725.53100 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut,Dep29,REAOptOut $605.45 $1,210.90 $1,029.27 $1,725.53101 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut,REAOptOut $596.57 $1,193.14 $1,014.17 $1,700.22102 EmpireGoldBlueAccessGEPO40/30%/6000,Dep29 $609.62 $1,219.24 $1,036.35 $1,737.42103 EmpireGoldBlueAccessGEPO40/30%/6000,Dep29,REAOptOut $609.62 $1,219.24 $1,036.35 $1,737.42104 EmpireGoldBlueAccessGEPO40/30%/6000,REAOptOut $600.73 $1,201.46 $1,021.24 $1,712.08105 EmpireGoldEPO1000/10%/5000 $697.42 $1,394.84 $1,185.61 $1,987.65106 EmpireGoldEPO1000/10%/5000,COptOut $692.50 $1,385.00 $1,177.25 $1,973.63107 EmpireGoldEPO1000/10%/5000,COptOut,Dep29 $702.88 $1,405.76 $1,194.90 $2,003.21108 EmpireGoldEPO1000/10%/5000,COptOut,Dep29,REAOptOut $702.88 $1,405.76 $1,194.90 $2,003.21109 EmpireGoldEPO1000/10%/5000,COptOut,REAOptOut $692.50 $1,385.00 $1,177.25 $1,973.63110 EmpireGoldEPO1000/10%/5000,Dep29 $707.80 $1,415.60 $1,203.26 $2,017.23111 EmpireGoldEPO1000/10%/5000,Dep29,REAOptOut $707.80 $1,415.60 $1,203.26 $2,017.23112 EmpireGoldEPO1000/10%/5000,REAOptOut $697.42 $1,394.84 $1,185.61 $1,987.65113 EmpireGoldEPO1500/10%/7000 $680.34 $1,360.68 $1,156.58 $1,938.97



SmallGroup


RateManual


114 EmpireGoldEPO1500/10%/7000,COptOut $675.62 $1,351.24 $1,148.55 $1,925.52115 EmpireGoldEPO1500/10%/7000,COptOut,Dep29 $685.73 $1,371.46 $1,165.74 $1,954.33116 EmpireGoldEPO1500/10%/7000,COptOut,Dep29,REAOptOut $685.73 $1,371.46 $1,165.74 $1,954.33117 EmpireGoldEPO1500/10%/7000,COptOut,REAOptOut $675.62 $1,351.24 $1,148.55 $1,925.52118 EmpireGoldEPO1500/10%/7000,Dep29 $690.52 $1,381.04 $1,173.88 $1,967.98119 EmpireGoldEPO1500/10%/7000,Dep29,REAOptOut $690.52 $1,381.04 $1,173.88 $1,967.98120 EmpireGoldEPO1500/10%/7000,REAOptOut $680.34 $1,360.68 $1,156.58 $1,938.97121 EmpireGoldEPO25/0%/6000 $705.48 $1,410.96 $1,199.32 $2,010.62122 EmpireGoldEPO25/0%/6000,COptOut $700.56 $1,401.12 $1,190.95 $1,996.60123 EmpireGoldEPO25/0%/6000,COptOut,Dep29 $711.08 $1,422.16 $1,208.84 $2,026.58124 EmpireGoldEPO25/0%/6000,COptOut,Dep29,REAOptOut $711.08 $1,422.16 $1,208.84 $2,026.58125 EmpireGoldEPO25/0%/6000,COptOut,REAOptOut $700.56 $1,401.12 $1,190.95 $1,996.60126 EmpireGoldEPO25/0%/6000,Dep29 $716.07 $1,432.14 $1,217.32 $2,040.80127 EmpireGoldEPO25/0%/6000,Dep29,REAOptOut $716.07 $1,432.14 $1,217.32 $2,040.80128 EmpireGoldEPO25/0%/6000,REAOptOut $705.48 $1,410.96 $1,199.32 $2,010.62129 EmpireGoldEPO35/10%/5850 $697.14 $1,394.28 $1,185.14 $1,986.85130 EmpireGoldEPO35/10%/5850,COptOut $692.29 $1,384.58 $1,176.89 $1,973.03131 EmpireGoldEPO35/10%/5850,COptOut,Dep29 $702.61 $1,405.22 $1,194.44 $2,002.44132 EmpireGoldEPO35/10%/5850,COptOut,Dep29,REAOptOut $702.61 $1,405.22 $1,194.44 $2,002.44133 EmpireGoldEPO35/10%/5850,COptOut,REAOptOut $692.29 $1,384.58 $1,176.89 $1,973.03134 EmpireGoldEPO35/10%/5850,Dep29 $707.53 $1,415.06 $1,202.80 $2,016.46135 EmpireGoldEPO35/10%/5850,Dep29,REAOptOut $707.53 $1,415.06 $1,202.80 $2,016.46136 EmpireGoldEPO35/10%/5850,REAOptOut $697.14 $1,394.28 $1,185.14 $1,986.85137 EmpireGoldEPO500/20%/7350 $679.93 $1,359.86 $1,155.88 $1,937.80138 EmpireGoldEPO500/20%/7350,COptOut $675.14 $1,350.28 $1,147.74 $1,924.15139 EmpireGoldEPO500/20%/7350,COptOut,Dep29 $685.26 $1,370.52 $1,164.94 $1,952.99140 EmpireGoldEPO500/20%/7350,COptOut,Dep29,REAOptOut $685.26 $1,370.52 $1,164.94 $1,952.99141 EmpireGoldEPO500/20%/7350,COptOut,REAOptOut $675.14 $1,350.28 $1,147.74 $1,924.15142 EmpireGoldEPO500/20%/7350,Dep29 $690.04 $1,380.08 $1,173.07 $1,966.61143 EmpireGoldEPO500/20%/7350,Dep29,REAOptOut $690.04 $1,380.08 $1,173.07 $1,966.61144 EmpireGoldEPO500/20%/7350,REAOptOut $679.93 $1,359.86 $1,155.88 $1,937.80145 EmpirePlatinumBlueAccessEPO15/0%/3500 $736.02 $1,472.04 $1,251.23 $2,097.66146 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut $730.97 $1,461.94 $1,242.65 $2,083.26147 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut,Dep29 $741.76 $1,483.52 $1,260.99 $2,114.02148 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut,Dep29,REAOptOut $741.76 $1,483.52 $1,260.99 $2,114.02149 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut,REAOptOut $730.97 $1,461.94 $1,242.65 $2,083.26150 EmpirePlatinumBlueAccessEPO15/0%/3500,Dep29 $746.96 $1,493.92 $1,269.83 $2,128.84151 EmpirePlatinumBlueAccessEPO15/0%/3500,Dep29,REAOptOut $746.96 $1,493.92 $1,269.83 $2,128.84152 EmpirePlatinumBlueAccessEPO15/0%/3500,REAOptOut $736.02 $1,472.04 $1,251.23 $2,097.66153 EmpirePlatinumBlueAccessGEPO20/10%/5500 $690.31 $1,380.62 $1,173.53 $1,967.38154 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut $685.53 $1,371.06 $1,165.40 $1,953.76155 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut,Dep29 $695.71 $1,391.42 $1,182.71 $1,982.77156 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut,Dep29,REAOptOut $695.71 $1,391.42 $1,182.71 $1,982.77157 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut,REAOptOut $685.53 $1,371.06 $1,165.40 $1,953.76158 EmpirePlatinumBlueAccessGEPO20/10%/5500,Dep29 $700.56 $1,401.12 $1,190.95 $1,996.60159 EmpirePlatinumBlueAccessGEPO20/10%/5500,Dep29,REAOptOut $700.56 $1,401.12 $1,190.95 $1,996.60160 EmpirePlatinumBlueAccessGEPO20/10%/5500,REAOptOut $690.31 $1,380.62 $1,173.53 $1,967.38161 EmpirePlatinumEPO15/0%/3500 $792.80 $1,585.60 $1,347.76 $2,259.48162 EmpirePlatinumEPO15/0%/3500,COptOut $787.27 $1,574.54 $1,338.36 $2,243.72163 EmpirePlatinumEPO15/0%/3500,COptOut,Dep29 $799.02 $1,598.04 $1,358.33 $2,277.21164 EmpirePlatinumEPO15/0%/3500,COptOut,Dep29,REAOptOut $799.02 $1,598.04 $1,358.33 $2,277.21165 EmpirePlatinumEPO15/0%/3500,COptOut,REAOptOut $787.27 $1,574.54 $1,338.36 $2,243.72166 EmpirePlatinumEPO15/0%/3500,Dep29 $804.62 $1,609.24 $1,367.85 $2,293.17167 EmpirePlatinumEPO15/0%/3500,Dep29,REAOptOut $804.62 $1,609.24 $1,367.85 $2,293.17168 EmpirePlatinumEPO15/0%/3500,REAOptOut $792.80 $1,585.60 $1,347.76 $2,259.48169 EmpirePlatinumEPO5/0%/2600 $805.37 $1,610.74 $1,369.13 $2,295.30170 EmpirePlatinumEPO5/0%/2600,COptOut $799.77 $1,599.54 $1,359.61 $2,279.34171 EmpirePlatinumEPO5/0%/2600,COptOut,Dep29 $811.73 $1,623.46 $1,379.94 $2,313.43



SmallGroup


RateManual


172 EmpirePlatinumEPO5/0%/2600,COptOut,Dep29,REAOptOut $811.73 $1,623.46 $1,379.94 $2,313.43173 EmpirePlatinumEPO5/0%/2600,COptOut,REAOptOut $799.77 $1,599.54 $1,359.61 $2,279.34174 EmpirePlatinumEPO5/0%/2600,Dep29 $817.40 $1,634.80 $1,389.58 $2,329.59175 EmpirePlatinumEPO5/0%/2600,Dep29,REAOptOut $817.40 $1,634.80 $1,389.58 $2,329.59176 EmpirePlatinumEPO5/0%/2600,REAOptOut $805.37 $1,610.74 $1,369.13 $2,295.30177 EmpireSilverBlueAccessEPO1500/30%/7350 $550.58 $1,101.16 $935.99 $1,569.15178 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut $546.76 $1,093.52 $929.49 $1,558.27179 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut,Dep29 $554.89 $1,109.78 $943.31 $1,581.44180 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut,Dep29,REAOptOut $554.89 $1,109.78 $943.31 $1,581.44181 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut,REAOptOut $546.76 $1,093.52 $929.49 $1,558.27182 EmpireSilverBlueAccessEPO1500/30%/7350,Dep29 $558.71 $1,117.42 $949.81 $1,592.32183 EmpireSilverBlueAccessEPO1500/30%/7350,Dep29,REAOptOut $558.71 $1,117.42 $949.81 $1,592.32184 EmpireSilverBlueAccessEPO1500/30%/7350,REAOptOut $550.58 $1,101.16 $935.99 $1,569.15185 EmpireSilverBlueAccessEPO2500/30%/7500 $555.84 $1,111.68 $944.93 $1,584.14186 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut $552.02 $1,104.04 $938.43 $1,573.26187 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut,Dep29 $560.15 $1,120.30 $952.26 $1,596.43188 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut,Dep29,REAOptOut $560.15 $1,120.30 $952.26 $1,596.43189 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut,REAOptOut $552.02 $1,104.04 $938.43 $1,573.26190 EmpireSilverBlueAccessEPO2500/30%/7500,Dep29 $564.11 $1,128.22 $958.99 $1,607.71191 EmpireSilverBlueAccessEPO2500/30%/7500,Dep29,REAOptOut $564.11 $1,128.22 $958.99 $1,607.71192 EmpireSilverBlueAccessEPO2500/30%/7500,REAOptOut $555.84 $1,111.68 $944.93 $1,584.14193 EmpireSilverBlueAccessEPO2750/30%/7350 $564.52 $1,129.04 $959.68 $1,608.88194 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut $560.63 $1,121.26 $953.07 $1,597.80195 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut,Dep29 $568.89 $1,137.78 $967.11 $1,621.34196 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut,Dep29,REAOptOut $568.89 $1,137.78 $967.11 $1,621.34197 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut,REAOptOut $560.63 $1,121.26 $953.07 $1,597.80198 EmpireSilverBlueAccessEPO2750/30%/7350,Dep29 $572.86 $1,145.72 $973.86 $1,632.65199 EmpireSilverBlueAccessEPO2750/30%/7350,Dep29,REAOptOut $572.86 $1,145.72 $973.86 $1,632.65200 EmpireSilverBlueAccessEPO2750/30%/7350,REAOptOut $564.52 $1,129.04 $959.68 $1,608.88201 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA $533.23 $1,066.46 $906.49 $1,519.71202 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut $529.54 $1,059.08 $900.22 $1,509.19203 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut,Dep29 $537.39 $1,074.78 $913.56 $1,531.56204 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut,Dep29,REAOptOut $537.39 $1,074.78 $913.56 $1,531.56205 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut,REAOptOut $529.54 $1,059.08 $900.22 $1,509.19206 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,Dep29 $541.15 $1,082.30 $919.96 $1,542.28207 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,Dep29,REAOptOut $541.15 $1,082.30 $919.96 $1,542.28208 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,REAOptOut $533.23 $1,066.46 $906.49 $1,519.71209 EmpireSilverBlueAccessGEPO4000/40%/7350 $499.27 $998.54 $848.76 $1,422.92210 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut $495.85 $991.70 $842.95 $1,413.17211 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut,Dep29 $503.16 $1,006.32 $855.37 $1,434.01212 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut,Dep29,REAOptOut $503.16 $1,006.32 $855.37 $1,434.01213 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut,REAOptOut $495.85 $991.70 $842.95 $1,413.17214 EmpireSilverBlueAccessGEPO4000/40%/7350,Dep29 $506.72 $1,013.44 $861.42 $1,444.15215 EmpireSilverBlueAccessGEPO4000/40%/7350,Dep29,REAOptOut $506.72 $1,013.44 $861.42 $1,444.15216 EmpireSilverBlueAccessGEPO4000/40%/7350,REAOptOut $499.27 $998.54 $848.76 $1,422.92217 EmpireSilverEPO1500/30%/7350 $591.51 $1,183.02 $1,005.57 $1,685.80218 EmpireSilverEPO1500/30%/7350,COptOut $587.41 $1,174.82 $998.60 $1,674.12219 EmpireSilverEPO1500/30%/7350,COptOut,Dep29 $596.16 $1,192.32 $1,013.47 $1,699.06220 EmpireSilverEPO1500/30%/7350,COptOut,Dep29,REAOptOut $596.16 $1,192.32 $1,013.47 $1,699.06221 EmpireSilverEPO1500/30%/7350,COptOut,REAOptOut $587.41 $1,174.82 $998.60 $1,674.12222 EmpireSilverEPO1500/30%/7350,Dep29 $600.39 $1,200.78 $1,020.66 $1,711.11223 EmpireSilverEPO1500/30%/7350,Dep29,REAOptOut $600.39 $1,200.78 $1,020.66 $1,711.11224 EmpireSilverEPO1500/30%/7350,REAOptOut $591.51 $1,183.02 $1,005.57 $1,685.80225 EmpireSilverEPO2500/30%/7500 $597.25 $1,194.50 $1,015.33 $1,702.16226 EmpireSilverEPO2500/30%/7500,COptOut $593.08 $1,186.16 $1,008.24 $1,690.28227 EmpireSilverEPO2500/30%/7500,COptOut,Dep29 $601.96 $1,203.92 $1,023.33 $1,715.59228 EmpireSilverEPO2500/30%/7500,COptOut,Dep29,REAOptOut $601.96 $1,203.92 $1,023.33 $1,715.59229 EmpireSilverEPO2500/30%/7500,COptOut,REAOptOut $593.08 $1,186.16 $1,008.24 $1,690.28



SmallGroup


RateManual


230 EmpireSilverEPO2500/30%/7500,Dep29 $606.20 $1,212.40 $1,030.54 $1,727.67231 EmpireSilverEPO2500/30%/7500,Dep29,REAOptOut $606.20 $1,212.40 $1,030.54 $1,727.67232 EmpireSilverEPO2500/30%/7500,REAOptOut $597.25 $1,194.50 $1,015.33 $1,702.16233 EmpireSilverEPO2700/30%/5000w/HSA $554.89 $1,109.78 $943.31 $1,581.44234 EmpireSilverEPO2700/30%/5000w/HSA,COptOut $550.99 $1,101.98 $936.68 $1,570.32235 EmpireSilverEPO2700/30%/5000w/HSA,COptOut,Dep29 $559.26 $1,118.52 $950.74 $1,593.89236 EmpireSilverEPO2700/30%/5000w/HSA,COptOut,Dep29,REAOptOut $559.26 $1,118.52 $950.74 $1,593.89237 EmpireSilverEPO2700/30%/5000w/HSA,COptOut,REAOptOut $550.99 $1,101.98 $936.68 $1,570.32238 EmpireSilverEPO2700/30%/5000w/HSA,Dep29 $563.22 $1,126.44 $957.47 $1,605.18239 EmpireSilverEPO2700/30%/5000w/HSA,Dep29,REAOptOut $563.22 $1,126.44 $957.47 $1,605.18240 EmpireSilverEPO2700/30%/5000w/HSA,REAOptOut $554.89 $1,109.78 $943.31 $1,581.44241 EmpireSilverEPO2750/30%/7350 $606.68 $1,213.36 $1,031.36 $1,729.04242 EmpireSilverEPO2750/30%/7350,COptOut $602.44 $1,204.88 $1,024.15 $1,716.95243 EmpireSilverEPO2750/30%/7350,COptOut,Dep29 $611.46 $1,222.92 $1,039.48 $1,742.66244 EmpireSilverEPO2750/30%/7350,COptOut,Dep29,REAOptOut $611.46 $1,222.92 $1,039.48 $1,742.66245 EmpireSilverEPO2750/30%/7350,COptOut,REAOptOut $602.44 $1,204.88 $1,024.15 $1,716.95246 EmpireSilverEPO2750/30%/7350,Dep29 $615.77 $1,231.54 $1,046.81 $1,754.94247 EmpireSilverEPO2750/30%/7350,Dep29,REAOptOut $615.77 $1,231.54 $1,046.81 $1,754.94248 EmpireSilverEPO2750/30%/7350,REAOptOut $606.68 $1,213.36 $1,031.36 $1,729.04249 EmpireSilverEPO3000/0%/5250w/HSA $572.72 $1,145.44 $973.62 $1,632.25250 EmpireSilverEPO3000/0%/5250w/HSA,COptOut $568.76 $1,137.52 $966.89 $1,620.97251 EmpireSilverEPO3000/0%/5250w/HSA,COptOut,Dep29 $577.23 $1,154.46 $981.29 $1,645.11252 EmpireSilverEPO3000/0%/5250w/HSA,COptOut,Dep29,REAOptOut $577.23 $1,154.46 $981.29 $1,645.11253 EmpireSilverEPO3000/0%/5250w/HSA,COptOut,REAOptOut $568.76 $1,137.52 $966.89 $1,620.97254 EmpireSilverEPO3000/0%/5250w/HSA,Dep29 $581.33 $1,162.66 $988.26 $1,656.79255 EmpireSilverEPO3000/0%/5250w/HSA,Dep29,REAOptOut $581.33 $1,162.66 $988.26 $1,656.79256 EmpireSilverEPO3000/0%/5250w/HSA,REAOptOut $572.72 $1,145.44 $973.62 $1,632.25257 EmpireSilverEPO3000/30%/7350 $579.14 $1,158.28 $984.54 $1,650.55258 EmpireSilverEPO3000/30%/7350,COptOut $575.11 $1,150.22 $977.69 $1,639.06259 EmpireSilverEPO3000/30%/7350,COptOut,Dep29 $583.72 $1,167.44 $992.32 $1,663.60260 EmpireSilverEPO3000/30%/7350,COptOut,Dep29,REAOptOut $583.72 $1,167.44 $992.32 $1,663.60261 EmpireSilverEPO3000/30%/7350,COptOut,REAOptOut $575.11 $1,150.22 $977.69 $1,639.06262 EmpireSilverEPO3000/30%/7350,Dep29 $587.82 $1,175.64 $999.29 $1,675.29263 EmpireSilverEPO3000/30%/7350,Dep29,REAOptOut $587.82 $1,175.64 $999.29 $1,675.29264 EmpireSilverEPO3000/30%/7350,REAOptOut $579.14 $1,158.28 $984.54 $1,650.55265 EmpireSilverPPO3000/0%/5250w/HSA $666.60 $1,333.20 $1,133.22 $1,899.81266 EmpireSilverPPO3000/0%/5250w/HSA80thPercentileFairHealth $746.00 $1,492.00 $1,268.20 $2,126.10267 EmpireSilverPPO3000/0%/5250w/HSA80thPercentileFairHealth,COptOut $740.81 $1,481.62 $1,259.38 $2,111.31268 EmpireSilverPPO3000/0%/5250w/HSA80thPercentileFairHealth,COptOut,Dep29 $751.87 $1,503.74 $1,278.18 $2,142.83269 EmpireSilverPPO3000/0%/5250w/HSA80thPercentileFairHealth,COptOut,Dep29,REAOptOut $751.87 $1,503.74 $1,278.18 $2,142.83270 EmpireSilverPPO3000/0%/5250w/HSA80thPercentileFairHealth,COptOut,REAOptOut $740.81 $1,481.62 $1,259.38 $2,111.31271 EmpireSilverPPO3000/0%/5250w/HSA80thPercentileFairHealth,Dep29 $757.20 $1,514.40 $1,287.24 $2,158.02272 EmpireSilverPPO3000/0%/5250w/HSA80thPercentileFairHealth,Dep29,REAOptOut $757.20 $1,514.40 $1,287.24 $2,158.02273 EmpireSilverPPO3000/0%/5250w/HSA80thPercentileFairHealth,REAOptOut $746.00 $1,492.00 $1,268.20 $2,126.10274 EmpireSilverPPO3000/0%/5250w/HSA,COptOut $661.89 $1,323.78 $1,125.21 $1,886.39275 EmpireSilverPPO3000/0%/5250w/HSA,COptOut,Dep29 $671.86 $1,343.72 $1,142.16 $1,914.80276 EmpireSilverPPO3000/0%/5250w/HSA,COptOut,Dep29,REAOptOut $671.86 $1,343.72 $1,142.16 $1,914.80277 EmpireSilverPPO3000/0%/5250w/HSA,COptOut,REAOptOut $661.89 $1,323.78 $1,125.21 $1,886.39278 EmpireSilverPPO3000/0%/5250w/HSA,Dep29 $676.58 $1,353.16 $1,150.19 $1,928.25279 EmpireSilverPPO3000/0%/5250w/HSA,Dep29,REAOptOut $676.58 $1,353.16 $1,150.19 $1,928.25280 EmpireSilverPPO3000/0%/5250w/HSA,REAOptOut $666.60 $1,333.20 $1,133.22 $1,899.81



SmallGroup


RateManual




1 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA $595.61 $1,191.22 $1,012.54 $1,697.492 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut $591.42 $1,182.84 $1,005.41 $1,685.553 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut,Dep29 $600.25 $1,200.50 $1,020.43 $1,710.714 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut,Dep29,REAOptOut $600.25 $1,200.50 $1,020.43 $1,710.715 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut,REAOptOut $591.42 $1,182.84 $1,005.41 $1,685.556 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,Dep29 $604.44 $1,208.88 $1,027.55 $1,722.657 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,Dep29,REAOptOut $604.44 $1,208.88 $1,027.55 $1,722.658 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,REAOptOut $595.61 $1,191.22 $1,012.54 $1,697.499 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA $593.97 $1,187.94 $1,009.75 $1,692.8110 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut $589.87 $1,179.74 $1,002.78 $1,681.1311 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut,Dep29 $598.61 $1,197.22 $1,017.64 $1,706.0412 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut,Dep29,REAOptOut $598.61 $1,197.22 $1,017.64 $1,706.0413 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut,REAOptOut $589.87 $1,179.74 $1,002.78 $1,681.1314 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,Dep29 $602.80 $1,205.60 $1,024.76 $1,717.9815 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,Dep29,REAOptOut $602.80 $1,205.60 $1,024.76 $1,717.9816 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,REAOptOut $593.97 $1,187.94 $1,009.75 $1,692.8117 EmpireBronzeBlueAccessEPO7900/0%/7900 $574.48 $1,148.96 $976.62 $1,637.2718 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut $570.47 $1,140.94 $969.80 $1,625.8419 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut,Dep29 $578.94 $1,157.88 $984.20 $1,649.9820 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut,Dep29,REAOptOut $578.94 $1,157.88 $984.20 $1,649.9821 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut,REAOptOut $570.47 $1,140.94 $969.80 $1,625.8422 EmpireBronzeBlueAccessEPO7900/0%/7900,Dep29 $582.95 $1,165.90 $991.02 $1,661.4123 EmpireBronzeBlueAccessEPO7900/0%/7900,Dep29,REAOptOut $582.95 $1,165.90 $991.02 $1,661.4124 EmpireBronzeBlueAccessEPO7900/0%/7900,REAOptOut $574.48 $1,148.96 $976.62 $1,637.2725 EmpireBronzeBlueAccessGEPO6500/40%/7900 $622.92 $1,245.84 $1,058.96 $1,775.3226 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut $618.64 $1,237.28 $1,051.69 $1,763.1227 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut,Dep29 $627.84 $1,255.68 $1,067.33 $1,789.3428 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut,Dep29,REAOptOut $627.84 $1,255.68 $1,067.33 $1,789.3429 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut,REAOptOut $618.64 $1,237.28 $1,051.69 $1,763.1230 EmpireBronzeBlueAccessGEPO6500/40%/7900,Dep29 $632.21 $1,264.42 $1,074.76 $1,801.8031 EmpireBronzeBlueAccessGEPO6500/40%/7900,Dep29,REAOptOut $632.21 $1,264.42 $1,074.76 $1,801.8032 EmpireBronzeBlueAccessGEPO6500/40%/7900,REAOptOut $622.92 $1,245.84 $1,058.96 $1,775.3233 EmpireBronzeEPO5500/20%/6700w/HSA $638.40 $1,276.80 $1,085.28 $1,819.4434 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut $633.94 $1,267.88 $1,077.70 $1,806.7335 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut,Dep29 $643.50 $1,287.00 $1,093.95 $1,833.9836 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut,Dep29,REAOptOut $643.50 $1,287.00 $1,093.95 $1,833.9837 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut,REAOptOut $633.94 $1,267.88 $1,077.70 $1,806.7338 EmpireBronzeEPO5500/20%/6700w/HSA,Dep29 $648.06 $1,296.12 $1,101.70 $1,846.9739 EmpireBronzeEPO5500/20%/6700w/HSA,Dep29,REAOptOut $648.06 $1,296.12 $1,101.70 $1,846.9740 EmpireBronzeEPO5500/20%/6700w/HSA,REAOptOut $638.40 $1,276.80 $1,085.28 $1,819.4441 EmpireBronzeEPO5500/35%/6700w/HSA $636.76 $1,273.52 $1,082.49 $1,814.7742 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut $632.30 $1,264.60 $1,074.91 $1,802.0643 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut,Dep29 $641.77 $1,283.54 $1,091.01 $1,829.0444 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut,Dep29,REAOptOut $641.77 $1,283.54 $1,091.01 $1,829.0445 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut,REAOptOut $632.30 $1,264.60 $1,074.91 $1,802.0646 EmpireBronzeEPO5500/35%/6700w/HSA,Dep29 $646.32 $1,292.64 $1,098.74 $1,842.0147 EmpireBronzeEPO5500/35%/6700w/HSA,Dep29,REAOptOut $646.32 $1,292.64 $1,098.74 $1,842.0148 EmpireBronzeEPO5500/35%/6700w/HSA,REAOptOut $636.76 $1,273.52 $1,082.49 $1,814.7749 EmpireGoldBlueAccessEPO1250/20%/4000 $856.94 $1,713.88 $1,456.80 $2,442.2850 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut $850.93 $1,701.86 $1,446.58 $2,425.1551 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut,Dep29 $863.59 $1,727.18 $1,468.10 $2,461.2352 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut,Dep29,REAOptOut $863.59 $1,727.18 $1,468.10 $2,461.2353 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut,REAOptOut $850.93 $1,701.86 $1,446.58 $2,425.1554 EmpireGoldBlueAccessEPO1250/20%/4000,Dep29 $869.60 $1,739.20 $1,478.32 $2,478.3655 EmpireGoldBlueAccessEPO1250/20%/4000,Dep29,REAOptOut $869.60 $1,739.20 $1,478.32 $2,478.36

LongIsland(Region8)



SmallGroup


RateManual


56 EmpireGoldBlueAccessEPO1250/20%/4000,REAOptOut $856.94 $1,713.88 $1,456.80 $2,442.2857 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA $812.96 $1,625.92 $1,382.03 $2,316.9458 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut $807.31 $1,614.62 $1,372.43 $2,300.8359 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut,Dep29 $819.33 $1,638.66 $1,392.86 $2,335.0960 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut,Dep29,REAOptOut $819.33 $1,638.66 $1,392.86 $2,335.0961 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut,REAOptOut $807.31 $1,614.62 $1,372.43 $2,300.8362 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,Dep29 $824.98 $1,649.96 $1,402.47 $2,351.1963 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,Dep29,REAOptOut $824.98 $1,649.96 $1,402.47 $2,351.1964 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,REAOptOut $812.96 $1,625.92 $1,382.03 $2,316.9465 EmpireGoldBlueAccessEPO25/0%/6000 $873.70 $1,747.40 $1,485.29 $2,490.0566 EmpireGoldBlueAccessEPO25/0%/6000,COptOut $867.69 $1,735.38 $1,475.07 $2,472.9267 EmpireGoldBlueAccessEPO25/0%/6000,COptOut,Dep29 $880.52 $1,761.04 $1,496.88 $2,509.4868 EmpireGoldBlueAccessEPO25/0%/6000,COptOut,Dep29,REAOptOut $880.52 $1,761.04 $1,496.88 $2,509.4869 EmpireGoldBlueAccessEPO25/0%/6000,COptOut,REAOptOut $867.69 $1,735.38 $1,475.07 $2,472.9270 EmpireGoldBlueAccessEPO25/0%/6000,Dep29 $886.63 $1,773.26 $1,507.27 $2,526.9071 EmpireGoldBlueAccessEPO25/0%/6000,Dep29,REAOptOut $886.63 $1,773.26 $1,507.27 $2,526.9072 EmpireGoldBlueAccessEPO25/0%/6000,REAOptOut $873.70 $1,747.40 $1,485.29 $2,490.0573 EmpireGoldBlueAccessEPO35/10%/5850 $863.41 $1,726.82 $1,467.80 $2,460.7274 EmpireGoldBlueAccessEPO35/10%/5850,COptOut $857.49 $1,714.98 $1,457.73 $2,443.8575 EmpireGoldBlueAccessEPO35/10%/5850,COptOut,Dep29 $870.14 $1,740.28 $1,479.24 $2,479.9076 EmpireGoldBlueAccessEPO35/10%/5850,COptOut,Dep29,REAOptOut $870.14 $1,740.28 $1,479.24 $2,479.9077 EmpireGoldBlueAccessEPO35/10%/5850,COptOut,REAOptOut $857.49 $1,714.98 $1,457.73 $2,443.8578 EmpireGoldBlueAccessEPO35/10%/5850,Dep29 $876.24 $1,752.48 $1,489.61 $2,497.2879 EmpireGoldBlueAccessEPO35/10%/5850,Dep29,REAOptOut $876.24 $1,752.48 $1,489.61 $2,497.2880 EmpireGoldBlueAccessEPO35/10%/5850,REAOptOut $863.41 $1,726.82 $1,467.80 $2,460.7281 EmpireGoldBlueAccessEPO500/20%/7350 $842.28 $1,684.56 $1,431.88 $2,400.5082 EmpireGoldBlueAccessEPO500/20%/7350,COptOut $836.45 $1,672.90 $1,421.97 $2,383.8883 EmpireGoldBlueAccessEPO500/20%/7350,COptOut,Dep29 $848.84 $1,697.68 $1,443.03 $2,419.1984 EmpireGoldBlueAccessEPO500/20%/7350,COptOut,Dep29,REAOptOut $848.84 $1,697.68 $1,443.03 $2,419.1985 EmpireGoldBlueAccessEPO500/20%/7350,COptOut,REAOptOut $836.45 $1,672.90 $1,421.97 $2,383.8886 EmpireGoldBlueAccessEPO500/20%/7350,Dep29 $854.76 $1,709.52 $1,453.09 $2,436.0787 EmpireGoldBlueAccessEPO500/20%/7350,Dep29,REAOptOut $854.76 $1,709.52 $1,453.09 $2,436.0788 EmpireGoldBlueAccessEPO500/20%/7350,REAOptOut $842.28 $1,684.56 $1,431.88 $2,400.5089 EmpireGoldBlueAccessGEPO1500/20%/6000 $771.26 $1,542.52 $1,311.14 $2,198.0990 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut $765.88 $1,531.76 $1,302.00 $2,182.7691 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut,Dep29 $777.27 $1,554.54 $1,321.36 $2,215.2292 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut,Dep29,REAOptOut $777.27 $1,554.54 $1,321.36 $2,215.2293 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut,REAOptOut $765.88 $1,531.76 $1,302.00 $2,182.7694 EmpireGoldBlueAccessGEPO1500/20%/6000,Dep29 $782.73 $1,565.46 $1,330.64 $2,230.7895 EmpireGoldBlueAccessGEPO1500/20%/6000,Dep29,REAOptOut $782.73 $1,565.46 $1,330.64 $2,230.7896 EmpireGoldBlueAccessGEPO1500/20%/6000,REAOptOut $771.26 $1,542.52 $1,311.14 $2,198.0997 EmpireGoldBlueAccessGEPO40/30%/6000 $800.58 $1,601.16 $1,360.99 $2,281.6598 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut $795.02 $1,590.04 $1,351.53 $2,265.8199 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut,Dep29 $806.86 $1,613.72 $1,371.66 $2,299.55100 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut,Dep29,REAOptOut $806.86 $1,613.72 $1,371.66 $2,299.55101 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut,REAOptOut $795.02 $1,590.04 $1,351.53 $2,265.81102 EmpireGoldBlueAccessGEPO40/30%/6000,Dep29 $812.41 $1,624.82 $1,381.10 $2,315.37103 EmpireGoldBlueAccessGEPO40/30%/6000,Dep29,REAOptOut $812.41 $1,624.82 $1,381.10 $2,315.37104 EmpireGoldBlueAccessGEPO40/30%/6000,REAOptOut $800.58 $1,601.16 $1,360.99 $2,281.65105 EmpireGoldEPO1000/10%/5000 $929.42 $1,858.84 $1,580.01 $2,648.85106 EmpireGoldEPO1000/10%/5000,COptOut $922.87 $1,845.74 $1,568.88 $2,630.18107 EmpireGoldEPO1000/10%/5000,COptOut,Dep29 $936.71 $1,873.42 $1,592.41 $2,669.62108 EmpireGoldEPO1000/10%/5000,COptOut,Dep29,REAOptOut $936.71 $1,873.42 $1,592.41 $2,669.62109 EmpireGoldEPO1000/10%/5000,COptOut,REAOptOut $922.87 $1,845.74 $1,568.88 $2,630.18110 EmpireGoldEPO1000/10%/5000,Dep29 $943.26 $1,886.52 $1,603.54 $2,688.29111 EmpireGoldEPO1000/10%/5000,Dep29,REAOptOut $943.26 $1,886.52 $1,603.54 $2,688.29112 EmpireGoldEPO1000/10%/5000,REAOptOut $929.42 $1,858.84 $1,580.01 $2,648.85113 EmpireGoldEPO1500/10%/7000 $906.66 $1,813.32 $1,541.32 $2,583.98



SmallGroup


RateManual


114 EmpireGoldEPO1500/10%/7000,COptOut $900.37 $1,800.74 $1,530.63 $2,566.05115 EmpireGoldEPO1500/10%/7000,COptOut,Dep29 $913.85 $1,827.70 $1,553.55 $2,604.47116 EmpireGoldEPO1500/10%/7000,COptOut,Dep29,REAOptOut $913.85 $1,827.70 $1,553.55 $2,604.47117 EmpireGoldEPO1500/10%/7000,COptOut,REAOptOut $900.37 $1,800.74 $1,530.63 $2,566.05118 EmpireGoldEPO1500/10%/7000,Dep29 $920.23 $1,840.46 $1,564.39 $2,622.66119 EmpireGoldEPO1500/10%/7000,Dep29,REAOptOut $920.23 $1,840.46 $1,564.39 $2,622.66120 EmpireGoldEPO1500/10%/7000,REAOptOut $906.66 $1,813.32 $1,541.32 $2,583.98121 EmpireGoldEPO25/0%/6000 $940.17 $1,880.34 $1,598.29 $2,679.48122 EmpireGoldEPO25/0%/6000,COptOut $933.61 $1,867.22 $1,587.14 $2,660.79123 EmpireGoldEPO25/0%/6000,COptOut,Dep29 $947.63 $1,895.26 $1,610.97 $2,700.75124 EmpireGoldEPO25/0%/6000,COptOut,Dep29,REAOptOut $947.63 $1,895.26 $1,610.97 $2,700.75125 EmpireGoldEPO25/0%/6000,COptOut,REAOptOut $933.61 $1,867.22 $1,587.14 $2,660.79126 EmpireGoldEPO25/0%/6000,Dep29 $954.28 $1,908.56 $1,622.28 $2,719.70127 EmpireGoldEPO25/0%/6000,Dep29,REAOptOut $954.28 $1,908.56 $1,622.28 $2,719.70128 EmpireGoldEPO25/0%/6000,REAOptOut $940.17 $1,880.34 $1,598.29 $2,679.48129 EmpireGoldEPO35/10%/5850 $929.06 $1,858.12 $1,579.40 $2,647.82130 EmpireGoldEPO35/10%/5850,COptOut $922.59 $1,845.18 $1,568.40 $2,629.38131 EmpireGoldEPO35/10%/5850,COptOut,Dep29 $936.34 $1,872.68 $1,591.78 $2,668.57132 EmpireGoldEPO35/10%/5850,COptOut,Dep29,REAOptOut $936.34 $1,872.68 $1,591.78 $2,668.57133 EmpireGoldEPO35/10%/5850,COptOut,REAOptOut $922.59 $1,845.18 $1,568.40 $2,629.38134 EmpireGoldEPO35/10%/5850,Dep29 $942.90 $1,885.80 $1,602.93 $2,687.27135 EmpireGoldEPO35/10%/5850,Dep29,REAOptOut $942.90 $1,885.80 $1,602.93 $2,687.27136 EmpireGoldEPO35/10%/5850,REAOptOut $929.06 $1,858.12 $1,579.40 $2,647.82137 EmpireGoldEPO500/20%/7350 $906.11 $1,812.22 $1,540.39 $2,582.41138 EmpireGoldEPO500/20%/7350,COptOut $899.74 $1,799.48 $1,529.56 $2,564.26139 EmpireGoldEPO500/20%/7350,COptOut,Dep29 $913.21 $1,826.42 $1,552.46 $2,602.65140 EmpireGoldEPO500/20%/7350,COptOut,Dep29,REAOptOut $913.21 $1,826.42 $1,552.46 $2,602.65141 EmpireGoldEPO500/20%/7350,COptOut,REAOptOut $899.74 $1,799.48 $1,529.56 $2,564.26142 EmpireGoldEPO500/20%/7350,Dep29 $919.59 $1,839.18 $1,563.30 $2,620.83143 EmpireGoldEPO500/20%/7350,Dep29,REAOptOut $919.59 $1,839.18 $1,563.30 $2,620.83144 EmpireGoldEPO500/20%/7350,REAOptOut $906.11 $1,812.22 $1,540.39 $2,582.41145 EmpirePlatinumBlueAccessEPO15/0%/3500 $980.87 $1,961.74 $1,667.48 $2,795.48146 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut $974.13 $1,948.26 $1,656.02 $2,776.27147 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut,Dep29 $988.52 $1,977.04 $1,680.48 $2,817.28148 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut,Dep29,REAOptOut $988.52 $1,977.04 $1,680.48 $2,817.28149 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut,REAOptOut $974.13 $1,948.26 $1,656.02 $2,776.27150 EmpirePlatinumBlueAccessEPO15/0%/3500,Dep29 $995.44 $1,990.88 $1,692.25 $2,837.00151 EmpirePlatinumBlueAccessEPO15/0%/3500,Dep29,REAOptOut $995.44 $1,990.88 $1,692.25 $2,837.00152 EmpirePlatinumBlueAccessEPO15/0%/3500,REAOptOut $980.87 $1,961.74 $1,667.48 $2,795.48153 EmpirePlatinumBlueAccessGEPO20/10%/5500 $919.95 $1,839.90 $1,563.92 $2,621.86154 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut $913.58 $1,827.16 $1,553.09 $2,603.70155 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut,Dep29 $927.15 $1,854.30 $1,576.16 $2,642.38156 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut,Dep29,REAOptOut $927.15 $1,854.30 $1,576.16 $2,642.38157 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut,REAOptOut $913.58 $1,827.16 $1,553.09 $2,603.70158 EmpirePlatinumBlueAccessGEPO20/10%/5500,Dep29 $933.61 $1,867.22 $1,587.14 $2,660.79159 EmpirePlatinumBlueAccessGEPO20/10%/5500,Dep29,REAOptOut $933.61 $1,867.22 $1,587.14 $2,660.79160 EmpirePlatinumBlueAccessGEPO20/10%/5500,REAOptOut $919.95 $1,839.90 $1,563.92 $2,621.86161 EmpirePlatinumEPO15/0%/3500 $1,056.54 $2,113.08 $1,796.12 $3,011.14162 EmpirePlatinumEPO15/0%/3500,COptOut $1,049.16 $2,098.32 $1,783.57 $2,990.11163 EmpirePlatinumEPO15/0%/3500,COptOut,Dep29 $1,064.82 $2,129.64 $1,810.19 $3,034.74164 EmpirePlatinumEPO15/0%/3500,COptOut,Dep29,REAOptOut $1,064.82 $2,129.64 $1,810.19 $3,034.74165 EmpirePlatinumEPO15/0%/3500,COptOut,REAOptOut $1,049.16 $2,098.32 $1,783.57 $2,990.11166 EmpirePlatinumEPO15/0%/3500,Dep29 $1,072.29 $2,144.58 $1,822.89 $3,056.03167 EmpirePlatinumEPO15/0%/3500,Dep29,REAOptOut $1,072.29 $2,144.58 $1,822.89 $3,056.03168 EmpirePlatinumEPO15/0%/3500,REAOptOut $1,056.54 $2,113.08 $1,796.12 $3,011.14169 EmpirePlatinumEPO5/0%/2600 $1,073.29 $2,146.58 $1,824.59 $3,058.88170 EmpirePlatinumEPO5/0%/2600,COptOut $1,065.83 $2,131.66 $1,811.91 $3,037.62171 EmpirePlatinumEPO5/0%/2600,COptOut,Dep29 $1,081.76 $2,163.52 $1,838.99 $3,083.02



SmallGroup


RateManual


172 EmpirePlatinumEPO5/0%/2600,COptOut,Dep29,REAOptOut $1,081.76 $2,163.52 $1,838.99 $3,083.02173 EmpirePlatinumEPO5/0%/2600,COptOut,REAOptOut $1,065.83 $2,131.66 $1,811.91 $3,037.62174 EmpirePlatinumEPO5/0%/2600,Dep29 $1,089.32 $2,178.64 $1,851.84 $3,104.56175 EmpirePlatinumEPO5/0%/2600,Dep29,REAOptOut $1,089.32 $2,178.64 $1,851.84 $3,104.56176 EmpirePlatinumEPO5/0%/2600,REAOptOut $1,073.29 $2,146.58 $1,824.59 $3,058.88177 EmpireSilverBlueAccessEPO1500/30%/7350 $733.74 $1,467.48 $1,247.36 $2,091.16178 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut $728.64 $1,457.28 $1,238.69 $2,076.62179 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut,Dep29 $739.48 $1,478.96 $1,257.12 $2,107.52180 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut,Dep29,REAOptOut $739.48 $1,478.96 $1,257.12 $2,107.52181 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut,REAOptOut $728.64 $1,457.28 $1,238.69 $2,076.62182 EmpireSilverBlueAccessEPO1500/30%/7350,Dep29 $744.58 $1,489.16 $1,265.79 $2,122.05183 EmpireSilverBlueAccessEPO1500/30%/7350,Dep29,REAOptOut $744.58 $1,489.16 $1,265.79 $2,122.05184 EmpireSilverBlueAccessEPO1500/30%/7350,REAOptOut $733.74 $1,467.48 $1,247.36 $2,091.16185 EmpireSilverBlueAccessEPO2500/30%/7500 $740.75 $1,481.50 $1,259.28 $2,111.14186 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut $735.65 $1,471.30 $1,250.61 $2,096.60187 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut,Dep29 $746.49 $1,492.98 $1,269.03 $2,127.50188 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut,Dep29,REAOptOut $746.49 $1,492.98 $1,269.03 $2,127.50189 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut,REAOptOut $735.65 $1,471.30 $1,250.61 $2,096.60190 EmpireSilverBlueAccessEPO2500/30%/7500,Dep29 $751.77 $1,503.54 $1,278.01 $2,142.54191 EmpireSilverBlueAccessEPO2500/30%/7500,Dep29,REAOptOut $751.77 $1,503.54 $1,278.01 $2,142.54192 EmpireSilverBlueAccessEPO2500/30%/7500,REAOptOut $740.75 $1,481.50 $1,259.28 $2,111.14193 EmpireSilverBlueAccessEPO2750/30%/7350 $752.32 $1,504.64 $1,278.94 $2,144.11194 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut $747.13 $1,494.26 $1,270.12 $2,129.32195 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut,Dep29 $758.14 $1,516.28 $1,288.84 $2,160.70196 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut,Dep29,REAOptOut $758.14 $1,516.28 $1,288.84 $2,160.70197 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut,REAOptOut $747.13 $1,494.26 $1,270.12 $2,129.32198 EmpireSilverBlueAccessEPO2750/30%/7350,Dep29 $763.42 $1,526.84 $1,297.81 $2,175.75199 EmpireSilverBlueAccessEPO2750/30%/7350,Dep29,REAOptOut $763.42 $1,526.84 $1,297.81 $2,175.75200 EmpireSilverBlueAccessEPO2750/30%/7350,REAOptOut $752.32 $1,504.64 $1,278.94 $2,144.11201 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA $710.61 $1,421.22 $1,208.04 $2,025.24202 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut $705.69 $1,411.38 $1,199.67 $2,011.22203 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut,Dep29 $716.17 $1,432.34 $1,217.49 $2,041.08204 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut,Dep29,REAOptOut $716.17 $1,432.34 $1,217.49 $2,041.08205 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut,REAOptOut $705.69 $1,411.38 $1,199.67 $2,011.22206 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,Dep29 $721.17 $1,442.34 $1,225.99 $2,055.33207 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,Dep29,REAOptOut $721.17 $1,442.34 $1,225.99 $2,055.33208 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,REAOptOut $710.61 $1,421.22 $1,208.04 $2,025.24209 EmpireSilverBlueAccessGEPO4000/40%/7350 $665.36 $1,330.72 $1,131.11 $1,896.28210 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut $660.80 $1,321.60 $1,123.36 $1,883.28211 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut,Dep29 $670.55 $1,341.10 $1,139.94 $1,911.07212 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut,Dep29,REAOptOut $670.55 $1,341.10 $1,139.94 $1,911.07213 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut,REAOptOut $660.80 $1,321.60 $1,123.36 $1,883.28214 EmpireSilverBlueAccessGEPO4000/40%/7350,Dep29 $675.28 $1,350.56 $1,147.98 $1,924.55215 EmpireSilverBlueAccessGEPO4000/40%/7350,Dep29,REAOptOut $675.28 $1,350.56 $1,147.98 $1,924.55216 EmpireSilverBlueAccessGEPO4000/40%/7350,REAOptOut $665.36 $1,330.72 $1,131.11 $1,896.28217 EmpireSilverEPO1500/30%/7350 $788.28 $1,576.56 $1,340.08 $2,246.60218 EmpireSilverEPO1500/30%/7350,COptOut $782.82 $1,565.64 $1,330.79 $2,231.04219 EmpireSilverEPO1500/30%/7350,COptOut,Dep29 $794.48 $1,588.96 $1,350.62 $2,264.27220 EmpireSilverEPO1500/30%/7350,COptOut,Dep29,REAOptOut $794.48 $1,588.96 $1,350.62 $2,264.27221 EmpireSilverEPO1500/30%/7350,COptOut,REAOptOut $782.82 $1,565.64 $1,330.79 $2,231.04222 EmpireSilverEPO1500/30%/7350,Dep29 $800.12 $1,600.24 $1,360.20 $2,280.34223 EmpireSilverEPO1500/30%/7350,Dep29,REAOptOut $800.12 $1,600.24 $1,360.20 $2,280.34224 EmpireSilverEPO1500/30%/7350,REAOptOut $788.28 $1,576.56 $1,340.08 $2,246.60225 EmpireSilverEPO2500/30%/7500 $795.93 $1,591.86 $1,353.08 $2,268.40226 EmpireSilverEPO2500/30%/7500,COptOut $790.38 $1,580.76 $1,343.65 $2,252.58227 EmpireSilverEPO2500/30%/7500,COptOut,Dep29 $802.22 $1,604.44 $1,363.77 $2,286.33228 EmpireSilverEPO2500/30%/7500,COptOut,Dep29,REAOptOut $802.22 $1,604.44 $1,363.77 $2,286.33229 EmpireSilverEPO2500/30%/7500,COptOut,REAOptOut $790.38 $1,580.76 $1,343.65 $2,252.58



SmallGroup


RateManual


230 EmpireSilverEPO2500/30%/7500,Dep29 $807.86 $1,615.72 $1,373.36 $2,302.40231 EmpireSilverEPO2500/30%/7500,Dep29,REAOptOut $807.86 $1,615.72 $1,373.36 $2,302.40232 EmpireSilverEPO2500/30%/7500,REAOptOut $795.93 $1,591.86 $1,353.08 $2,268.40233 EmpireSilverEPO2700/30%/5000w/HSA $739.48 $1,478.96 $1,257.12 $2,107.52234 EmpireSilverEPO2700/30%/5000w/HSA,COptOut $734.29 $1,468.58 $1,248.29 $2,092.73235 EmpireSilverEPO2700/30%/5000w/HSA,COptOut,Dep29 $745.30 $1,490.60 $1,267.01 $2,124.11236 EmpireSilverEPO2700/30%/5000w/HSA,COptOut,Dep29,REAOptOut $745.30 $1,490.60 $1,267.01 $2,124.11237 EmpireSilverEPO2700/30%/5000w/HSA,COptOut,REAOptOut $734.29 $1,468.58 $1,248.29 $2,092.73238 EmpireSilverEPO2700/30%/5000w/HSA,Dep29 $750.59 $1,501.18 $1,276.00 $2,139.18239 EmpireSilverEPO2700/30%/5000w/HSA,Dep29,REAOptOut $750.59 $1,501.18 $1,276.00 $2,139.18240 EmpireSilverEPO2700/30%/5000w/HSA,REAOptOut $739.48 $1,478.96 $1,257.12 $2,107.52241 EmpireSilverEPO2750/30%/7350 $808.50 $1,617.00 $1,374.45 $2,304.23242 EmpireSilverEPO2750/30%/7350,COptOut $802.85 $1,605.70 $1,364.85 $2,288.12243 EmpireSilverEPO2750/30%/7350,COptOut,Dep29 $814.87 $1,629.74 $1,385.28 $2,322.38244 EmpireSilverEPO2750/30%/7350,COptOut,Dep29,REAOptOut $814.87 $1,629.74 $1,385.28 $2,322.38245 EmpireSilverEPO2750/30%/7350,COptOut,REAOptOut $802.85 $1,605.70 $1,364.85 $2,288.12246 EmpireSilverEPO2750/30%/7350,Dep29 $820.61 $1,641.22 $1,395.04 $2,338.74247 EmpireSilverEPO2750/30%/7350,Dep29,REAOptOut $820.61 $1,641.22 $1,395.04 $2,338.74248 EmpireSilverEPO2750/30%/7350,REAOptOut $808.50 $1,617.00 $1,374.45 $2,304.23249 EmpireSilverEPO3000/0%/5250w/HSA $763.24 $1,526.48 $1,297.51 $2,175.23250 EmpireSilverEPO3000/0%/5250w/HSA,COptOut $757.96 $1,515.92 $1,288.53 $2,160.19251 EmpireSilverEPO3000/0%/5250w/HSA,COptOut,Dep29 $769.25 $1,538.50 $1,307.73 $2,192.36252 EmpireSilverEPO3000/0%/5250w/HSA,COptOut,Dep29,REAOptOut $769.25 $1,538.50 $1,307.73 $2,192.36253 EmpireSilverEPO3000/0%/5250w/HSA,COptOut,REAOptOut $757.96 $1,515.92 $1,288.53 $2,160.19254 EmpireSilverEPO3000/0%/5250w/HSA,Dep29 $774.72 $1,549.44 $1,317.02 $2,207.95255 EmpireSilverEPO3000/0%/5250w/HSA,Dep29,REAOptOut $774.72 $1,549.44 $1,317.02 $2,207.95256 EmpireSilverEPO3000/0%/5250w/HSA,REAOptOut $763.24 $1,526.48 $1,297.51 $2,175.23257 EmpireSilverEPO3000/30%/7350 $771.80 $1,543.60 $1,312.06 $2,199.63258 EmpireSilverEPO3000/30%/7350,COptOut $766.43 $1,532.86 $1,302.93 $2,184.33259 EmpireSilverEPO3000/30%/7350,COptOut,Dep29 $777.90 $1,555.80 $1,322.43 $2,217.02260 EmpireSilverEPO3000/30%/7350,COptOut,Dep29,REAOptOut $777.90 $1,555.80 $1,322.43 $2,217.02261 EmpireSilverEPO3000/30%/7350,COptOut,REAOptOut $766.43 $1,532.86 $1,302.93 $2,184.33262 EmpireSilverEPO3000/30%/7350,Dep29 $783.37 $1,566.74 $1,331.73 $2,232.60263 EmpireSilverEPO3000/30%/7350,Dep29,REAOptOut $783.37 $1,566.74 $1,331.73 $2,232.60264 EmpireSilverEPO3000/30%/7350,REAOptOut $771.80 $1,543.60 $1,312.06 $2,199.63265 EmpireSilverPPO3000/0%/5250w/HSA $888.36 $1,776.72 $1,510.21 $2,531.83266 EmpireSilverPPO3000/0%/5250w/HSA,COptOut $882.07 $1,764.14 $1,499.52 $2,513.90267 EmpireSilverPPO3000/0%/5250w/HSA,COptOut,Dep29 $895.37 $1,790.74 $1,522.13 $2,551.80268 EmpireSilverPPO3000/0%/5250w/HSA,COptOut,Dep29,REAOptOut $895.37 $1,790.74 $1,522.13 $2,551.80269 EmpireSilverPPO3000/0%/5250w/HSA,COptOut,REAOptOut $882.07 $1,764.14 $1,499.52 $2,513.90270 EmpireSilverPPO3000/0%/5250w/HSA,Dep29 $901.65 $1,803.30 $1,532.81 $2,569.70271 EmpireSilverPPO3000/0%/5250w/HSA,Dep29,REAOptOut $901.65 $1,803.30 $1,532.81 $2,569.70272 EmpireSilverPPO3000/0%/5250w/HSA,REAOptOut $888.36 $1,776.72 $1,510.21 $2,531.83273 EmpireGoldPPO1000/10%/5000 $1,083.58 $2,167.16 $1,842.09 $3,088.20274 EmpireGoldPPO1000/10%/5000,COptOut $1,076.02 $2,152.04 $1,829.23 $3,066.66275 EmpireGoldPPO1000/10%/5000,COptOut,Dep29 $1,092.14 $2,184.28 $1,856.64 $3,112.60276 EmpireGoldPPO1000/10%/5000,COptOut,Dep29,REAOptOut $1,092.14 $2,184.28 $1,856.64 $3,112.60277 EmpireGoldPPO1000/10%/5000,COptOut,REAOptOut $1,076.02 $2,152.04 $1,829.23 $3,066.66278 EmpireGoldPPO1000/10%/5000,Dep29 $1,099.79 $2,199.58 $1,869.64 $3,134.40279 EmpireGoldPPO1000/10%/5000,Dep29,REAOptOut $1,099.79 $2,199.58 $1,869.64 $3,134.40280 EmpireGoldPPO1000/10%/5000,REAOptOut $1,083.58 $2,167.16 $1,842.09 $3,088.20281 EmpireGoldPPO1350/0%/3000w/HSA $1,016.66 $2,033.32 $1,728.32 $2,897.48282 EmpireGoldPPO1350/0%/3000w/HSA,COptOut $1,009.55 $2,019.10 $1,716.24 $2,877.22283 EmpireGoldPPO1350/0%/3000w/HSA,COptOut,Dep29 $1,024.67 $2,049.34 $1,741.94 $2,920.31284 EmpireGoldPPO1350/0%/3000w/HSA,COptOut,Dep29,REAOptOut $1,024.67 $2,049.34 $1,741.94 $2,920.31285 EmpireGoldPPO1350/0%/3000w/HSA,COptOut,REAOptOut $1,009.55 $2,019.10 $1,716.24 $2,877.22286 EmpireGoldPPO1350/0%/3000w/HSA,Dep29 $1,031.86 $2,063.72 $1,754.16 $2,940.80287 EmpireGoldPPO1350/0%/3000w/HSA,Dep29,REAOptOut $1,031.86 $2,063.72 $1,754.16 $2,940.80



SmallGroup


RateManual


288 EmpireGoldPPO1350/0%/3000w/HSA,REAOptOut $1,016.66 $2,033.32 $1,728.32 $2,897.48289 EmpirePlatinumPPO15/0%/350080thPercentileFAIRHealth $1,366.32 $2,732.64 $2,322.74 $3,894.01290 EmpirePlatinumPPO15/0%/350080thPercentileFAIRHealth,COptOut $1,356.85 $2,713.70 $2,306.65 $3,867.02291 EmpirePlatinumPPO15/0%/350080thPercentileFAIRHealth,COptOut,Dep29 $1,377.06 $2,754.12 $2,341.00 $3,924.62292 EmpirePlatinumPPO15/0%/350080thPercentileFAIRHealth,COptOut,Dep29,REAOptOut $1,377.06 $2,754.12 $2,341.00 $3,924.62293 EmpirePlatinumPPO15/0%/350080thPercentileFAIRHealth,COptOut,REAOptOut $1,356.85 $2,713.70 $2,306.65 $3,867.02294 EmpirePlatinumPPO15/0%/350080thPercentileFAIRHealth,Dep29 $1,386.71 $2,773.42 $2,357.41 $3,952.12295 EmpirePlatinumPPO15/0%/350080thPercentileFAIRHealth,Dep29,REAOptOut $1,386.71 $2,773.42 $2,357.41 $3,952.12296 EmpirePlatinumPPO15/0%/350080thPercentileFAIRHealth,REAOptOut $1,366.32 $2,732.64 $2,322.74 $3,894.01297 EmpirePlatinumPPO250/10%/5250 $1,195.67 $2,391.34 $2,032.64 $3,407.66298 EmpirePlatinumPPO250/10%/5250,COptOut $1,187.30 $2,374.60 $2,018.41 $3,383.81299 EmpirePlatinumPPO250/10%/5250,COptOut,Dep29 $1,205.05 $2,410.10 $2,048.59 $3,434.39300 EmpirePlatinumPPO250/10%/5250,COptOut,Dep29,REAOptOut $1,205.05 $2,410.10 $2,048.59 $3,434.39301 EmpirePlatinumPPO250/10%/5250,COptOut,REAOptOut $1,187.30 $2,374.60 $2,018.41 $3,383.81302 EmpirePlatinumPPO250/10%/5250,Dep29 $1,213.52 $2,427.04 $2,062.98 $3,458.53303 EmpirePlatinumPPO250/10%/5250,Dep29,REAOptOut $1,213.52 $2,427.04 $2,062.98 $3,458.53304 EmpirePlatinumPPO250/10%/5250,REAOptOut $1,195.67 $2,391.34 $2,032.64 $3,407.66305 EmpirePlatinumPPO5/0%/2600 $1,251.31 $2,502.62 $2,127.23 $3,566.23306 EmpirePlatinumPPO5/0%/2600,COptOut $1,242.57 $2,485.14 $2,112.37 $3,541.32307 EmpirePlatinumPPO5/0%/2600,COptOut,Dep29 $1,261.14 $2,522.28 $2,143.94 $3,594.25308 EmpirePlatinumPPO5/0%/2600,COptOut,Dep29,REAOptOut $1,261.14 $2,522.28 $2,143.94 $3,594.25309 EmpirePlatinumPPO5/0%/2600,COptOut,REAOptOut $1,242.57 $2,485.14 $2,112.37 $3,541.32310 EmpirePlatinumPPO5/0%/2600,Dep29 $1,270.07 $2,540.14 $2,159.12 $3,619.70311 EmpirePlatinumPPO5/0%/2600,Dep29,REAOptOut $1,270.07 $2,540.14 $2,159.12 $3,619.70312 EmpirePlatinumPPO5/0%/2600,REAOptOut $1,251.31 $2,502.62 $2,127.23 $3,566.23313 EmpireSilverPPO2700/30%/5000w/HSA $861.58 $1,723.16 $1,464.69 $2,455.50314 EmpireSilverPPO2700/30%/5000w/HSA,COptOut $855.57 $1,711.14 $1,454.47 $2,438.37315 EmpireSilverPPO2700/30%/5000w/HSA,COptOut,Dep29 $868.41 $1,736.82 $1,476.30 $2,474.97316 EmpireSilverPPO2700/30%/5000w/HSA,COptOut,Dep29,REAOptOut $868.41 $1,736.82 $1,476.30 $2,474.97317 EmpireSilverPPO2700/30%/5000w/HSA,COptOut,REAOptOut $855.57 $1,711.14 $1,454.47 $2,438.37318 EmpireSilverPPO2700/30%/5000w/HSA,Dep29 $874.51 $1,749.02 $1,486.67 $2,492.35319 EmpireSilverPPO2700/30%/5000w/HSA,Dep29,REAOptOut $874.51 $1,749.02 $1,486.67 $2,492.35320 EmpireSilverPPO2700/30%/5000w/HSA,REAOptOut $861.58 $1,723.16 $1,464.69 $2,455.50



SmallGroup


RateManual




1 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA $612.22 $1,224.44 $1,040.77 $1,744.832 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut $607.91 $1,215.82 $1,033.45 $1,732.543 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut,Dep29 $616.99 $1,233.98 $1,048.88 $1,758.424 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut,Dep29,REAOptOut $616.99 $1,233.98 $1,048.88 $1,758.425 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,COptOut,REAOptOut $607.91 $1,215.82 $1,033.45 $1,732.546 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,Dep29 $621.30 $1,242.60 $1,056.21 $1,770.717 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,Dep29,REAOptOut $621.30 $1,242.60 $1,056.21 $1,770.718 EmpireBronzeBlueAccessEPO5500/20%/6700w/HSA,REAOptOut $612.22 $1,224.44 $1,040.77 $1,744.839 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA $610.53 $1,221.06 $1,037.90 $1,740.0110 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut $606.32 $1,212.64 $1,030.74 $1,728.0111 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut,Dep29 $615.31 $1,230.62 $1,046.03 $1,753.6312 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut,Dep29,REAOptOut $615.31 $1,230.62 $1,046.03 $1,753.6313 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,COptOut,REAOptOut $606.32 $1,212.64 $1,030.74 $1,728.0114 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,Dep29 $619.61 $1,239.22 $1,053.34 $1,765.8915 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,Dep29,REAOptOut $619.61 $1,239.22 $1,053.34 $1,765.8916 EmpireBronzeBlueAccessEPO5500/35%/6700w/HSA,REAOptOut $610.53 $1,221.06 $1,037.90 $1,740.0117 EmpireBronzeBlueAccessEPO7900/0%/7900 $590.50 $1,181.00 $1,003.85 $1,682.9318 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut $586.39 $1,172.78 $996.86 $1,671.2119 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut,Dep29 $595.09 $1,190.18 $1,011.65 $1,696.0120 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut,Dep29,REAOptOut $595.09 $1,190.18 $1,011.65 $1,696.0121 EmpireBronzeBlueAccessEPO7900/0%/7900,COptOut,REAOptOut $586.39 $1,172.78 $996.86 $1,671.2122 EmpireBronzeBlueAccessEPO7900/0%/7900,Dep29 $599.21 $1,198.42 $1,018.66 $1,707.7523 EmpireBronzeBlueAccessEPO7900/0%/7900,Dep29,REAOptOut $599.21 $1,198.42 $1,018.66 $1,707.7524 EmpireBronzeBlueAccessEPO7900/0%/7900,REAOptOut $590.50 $1,181.00 $1,003.85 $1,682.9325 EmpireBronzeBlueAccessGEPO6500/40%/7900 $640.30 $1,280.60 $1,088.51 $1,824.8626 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut $635.90 $1,271.80 $1,081.03 $1,812.3227 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut,Dep29 $645.35 $1,290.70 $1,097.10 $1,839.2528 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut,Dep29,REAOptOut $645.35 $1,290.70 $1,097.10 $1,839.2529 EmpireBronzeBlueAccessGEPO6500/40%/7900,COptOut,REAOptOut $635.90 $1,271.80 $1,081.03 $1,812.3230 EmpireBronzeBlueAccessGEPO6500/40%/7900,Dep29 $649.85 $1,299.70 $1,104.75 $1,852.0731 EmpireBronzeBlueAccessGEPO6500/40%/7900,Dep29,REAOptOut $649.85 $1,299.70 $1,104.75 $1,852.0732 EmpireBronzeBlueAccessGEPO6500/40%/7900,REAOptOut $640.30 $1,280.60 $1,088.51 $1,824.8633 EmpireBronzeEPO5500/20%/6700w/HSA $656.21 $1,312.42 $1,115.56 $1,870.2034 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut $651.62 $1,303.24 $1,107.75 $1,857.1235 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut,Dep29 $661.45 $1,322.90 $1,124.47 $1,885.1336 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut,Dep29,REAOptOut $661.45 $1,322.90 $1,124.47 $1,885.1337 EmpireBronzeEPO5500/20%/6700w/HSA,COptOut,REAOptOut $651.62 $1,303.24 $1,107.75 $1,857.1238 EmpireBronzeEPO5500/20%/6700w/HSA,Dep29 $666.13 $1,332.26 $1,132.42 $1,898.4739 EmpireBronzeEPO5500/20%/6700w/HSA,Dep29,REAOptOut $666.13 $1,332.26 $1,132.42 $1,898.4740 EmpireBronzeEPO5500/20%/6700w/HSA,REAOptOut $656.21 $1,312.42 $1,115.56 $1,870.2041 EmpireBronzeEPO5500/35%/6700w/HSA $654.52 $1,309.04 $1,112.68 $1,865.3842 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut $649.94 $1,299.88 $1,104.90 $1,852.3343 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut,Dep29 $659.67 $1,319.34 $1,121.44 $1,880.0644 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut,Dep29,REAOptOut $659.67 $1,319.34 $1,121.44 $1,880.0645 EmpireBronzeEPO5500/35%/6700w/HSA,COptOut,REAOptOut $649.94 $1,299.88 $1,104.90 $1,852.3346 EmpireBronzeEPO5500/35%/6700w/HSA,Dep29 $664.35 $1,328.70 $1,129.40 $1,893.4047 EmpireBronzeEPO5500/35%/6700w/HSA,Dep29,REAOptOut $664.35 $1,328.70 $1,129.40 $1,893.4048 EmpireBronzeEPO5500/35%/6700w/HSA,REAOptOut $654.52 $1,309.04 $1,112.68 $1,865.3849 EmpireGoldBlueAccessEPO1250/20%/4000 $880.84 $1,761.68 $1,497.43 $2,510.3950 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut $874.67 $1,749.34 $1,486.94 $2,492.8151 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut,Dep29 $887.68 $1,775.36 $1,509.06 $2,529.8952 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut,Dep29,REAOptOut $887.68 $1,775.36 $1,509.06 $2,529.8953 EmpireGoldBlueAccessEPO1250/20%/4000,COptOut,REAOptOut $874.67 $1,749.34 $1,486.94 $2,492.8154 EmpireGoldBlueAccessEPO1250/20%/4000,Dep29 $893.85 $1,787.70 $1,519.55 $2,547.4755 EmpireGoldBlueAccessEPO1250/20%/4000,Dep29,REAOptOut $893.85 $1,787.70 $1,519.55 $2,547.47

MidHudson(Region3)



SmallGroup


RateManual


56 EmpireGoldBlueAccessEPO1250/20%/4000,REAOptOut $880.84 $1,761.68 $1,497.43 $2,510.3957 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA $835.64 $1,671.28 $1,420.59 $2,381.5758 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut $829.83 $1,659.66 $1,410.71 $2,365.0259 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut,Dep29 $842.19 $1,684.38 $1,431.72 $2,400.2460 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut,Dep29,REAOptOut $842.19 $1,684.38 $1,431.72 $2,400.2461 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,COptOut,REAOptOut $829.83 $1,659.66 $1,410.71 $2,365.0262 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,Dep29 $847.99 $1,695.98 $1,441.58 $2,416.7763 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,Dep29,REAOptOut $847.99 $1,695.98 $1,441.58 $2,416.7764 EmpireGoldBlueAccessEPO1350/0%/3000w/HSA,REAOptOut $835.64 $1,671.28 $1,420.59 $2,381.5765 EmpireGoldBlueAccessEPO25/0%/6000 $898.06 $1,796.12 $1,526.70 $2,559.4766 EmpireGoldBlueAccessEPO25/0%/6000,COptOut $891.89 $1,783.78 $1,516.21 $2,541.8967 EmpireGoldBlueAccessEPO25/0%/6000,COptOut,Dep29 $905.08 $1,810.16 $1,538.64 $2,579.4868 EmpireGoldBlueAccessEPO25/0%/6000,COptOut,Dep29,REAOptOut $905.08 $1,810.16 $1,538.64 $2,579.4869 EmpireGoldBlueAccessEPO25/0%/6000,COptOut,REAOptOut $891.89 $1,783.78 $1,516.21 $2,541.8970 EmpireGoldBlueAccessEPO25/0%/6000,Dep29 $911.36 $1,822.72 $1,549.31 $2,597.3871 EmpireGoldBlueAccessEPO25/0%/6000,Dep29,REAOptOut $911.36 $1,822.72 $1,549.31 $2,597.3872 EmpireGoldBlueAccessEPO25/0%/6000,REAOptOut $898.06 $1,796.12 $1,526.70 $2,559.4773 EmpireGoldBlueAccessEPO35/10%/5850 $887.49 $1,774.98 $1,508.73 $2,529.3574 EmpireGoldBlueAccessEPO35/10%/5850,COptOut $881.40 $1,762.80 $1,498.38 $2,511.9975 EmpireGoldBlueAccessEPO35/10%/5850,COptOut,Dep29 $894.41 $1,788.82 $1,520.50 $2,549.0776 EmpireGoldBlueAccessEPO35/10%/5850,COptOut,Dep29,REAOptOut $894.41 $1,788.82 $1,520.50 $2,549.0777 EmpireGoldBlueAccessEPO35/10%/5850,COptOut,REAOptOut $881.40 $1,762.80 $1,498.38 $2,511.9978 EmpireGoldBlueAccessEPO35/10%/5850,Dep29 $900.69 $1,801.38 $1,531.17 $2,566.9779 EmpireGoldBlueAccessEPO35/10%/5850,Dep29,REAOptOut $900.69 $1,801.38 $1,531.17 $2,566.9780 EmpireGoldBlueAccessEPO35/10%/5850,REAOptOut $887.49 $1,774.98 $1,508.73 $2,529.3581 EmpireGoldBlueAccessEPO500/20%/7350 $865.77 $1,731.54 $1,471.81 $2,467.4482 EmpireGoldBlueAccessEPO500/20%/7350,COptOut $859.78 $1,719.56 $1,461.63 $2,450.3783 EmpireGoldBlueAccessEPO500/20%/7350,COptOut,Dep29 $872.51 $1,745.02 $1,483.27 $2,486.6584 EmpireGoldBlueAccessEPO500/20%/7350,COptOut,Dep29,REAOptOut $872.51 $1,745.02 $1,483.27 $2,486.6585 EmpireGoldBlueAccessEPO500/20%/7350,COptOut,REAOptOut $859.78 $1,719.56 $1,461.63 $2,450.3786 EmpireGoldBlueAccessEPO500/20%/7350,Dep29 $878.60 $1,757.20 $1,493.62 $2,504.0187 EmpireGoldBlueAccessEPO500/20%/7350,Dep29,REAOptOut $878.60 $1,757.20 $1,493.62 $2,504.0188 EmpireGoldBlueAccessEPO500/20%/7350,REAOptOut $865.77 $1,731.54 $1,471.81 $2,467.4489 EmpireGoldBlueAccessGEPO1500/20%/6000 $792.77 $1,585.54 $1,347.71 $2,259.3990 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut $787.25 $1,574.50 $1,338.33 $2,243.6691 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut,Dep29 $798.95 $1,597.90 $1,358.22 $2,277.0192 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut,Dep29,REAOptOut $798.95 $1,597.90 $1,358.22 $2,277.0193 EmpireGoldBlueAccessGEPO1500/20%/6000,COptOut,REAOptOut $787.25 $1,574.50 $1,338.33 $2,243.6694 EmpireGoldBlueAccessGEPO1500/20%/6000,Dep29 $804.56 $1,609.12 $1,367.75 $2,293.0095 EmpireGoldBlueAccessGEPO1500/20%/6000,Dep29,REAOptOut $804.56 $1,609.12 $1,367.75 $2,293.0096 EmpireGoldBlueAccessGEPO1500/20%/6000,REAOptOut $792.77 $1,585.54 $1,347.71 $2,259.3997 EmpireGoldBlueAccessGEPO40/30%/6000 $822.91 $1,645.82 $1,398.95 $2,345.2998 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut $817.20 $1,634.40 $1,389.24 $2,329.0299 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut,Dep29 $829.36 $1,658.72 $1,409.91 $2,363.68100 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut,Dep29,REAOptOut $829.36 $1,658.72 $1,409.91 $2,363.68101 EmpireGoldBlueAccessGEPO40/30%/6000,COptOut,REAOptOut $817.20 $1,634.40 $1,389.24 $2,329.02102 EmpireGoldBlueAccessGEPO40/30%/6000,Dep29 $835.07 $1,670.14 $1,419.62 $2,379.95103 EmpireGoldBlueAccessGEPO40/30%/6000,Dep29,REAOptOut $835.07 $1,670.14 $1,419.62 $2,379.95104 EmpireGoldBlueAccessGEPO40/30%/6000,REAOptOut $822.91 $1,645.82 $1,398.95 $2,345.29105 EmpireGoldEPO1000/10%/5000 $955.35 $1,910.70 $1,624.10 $2,722.75106 EmpireGoldEPO1000/10%/5000,COptOut $948.61 $1,897.22 $1,612.64 $2,703.54107 EmpireGoldEPO1000/10%/5000,COptOut,Dep29 $962.83 $1,925.66 $1,636.81 $2,744.07108 EmpireGoldEPO1000/10%/5000,COptOut,Dep29,REAOptOut $962.83 $1,925.66 $1,636.81 $2,744.07109 EmpireGoldEPO1000/10%/5000,COptOut,REAOptOut $948.61 $1,897.22 $1,612.64 $2,703.54110 EmpireGoldEPO1000/10%/5000,Dep29 $969.57 $1,939.14 $1,648.27 $2,763.27111 EmpireGoldEPO1000/10%/5000,Dep29,REAOptOut $969.57 $1,939.14 $1,648.27 $2,763.27112 EmpireGoldEPO1000/10%/5000,REAOptOut $955.35 $1,910.70 $1,624.10 $2,722.75113 EmpireGoldEPO1500/10%/7000 $931.95 $1,863.90 $1,584.32 $2,656.06



SmallGroup


RateManual


114 EmpireGoldEPO1500/10%/7000,COptOut $925.49 $1,850.98 $1,573.33 $2,637.65115 EmpireGoldEPO1500/10%/7000,COptOut,Dep29 $939.34 $1,878.68 $1,596.88 $2,677.12116 EmpireGoldEPO1500/10%/7000,COptOut,Dep29,REAOptOut $939.34 $1,878.68 $1,596.88 $2,677.12117 EmpireGoldEPO1500/10%/7000,COptOut,REAOptOut $925.49 $1,850.98 $1,573.33 $2,637.65118 EmpireGoldEPO1500/10%/7000,Dep29 $945.89 $1,891.78 $1,608.01 $2,695.79119 EmpireGoldEPO1500/10%/7000,Dep29,REAOptOut $945.89 $1,891.78 $1,608.01 $2,695.79120 EmpireGoldEPO1500/10%/7000,REAOptOut $931.95 $1,863.90 $1,584.32 $2,656.06121 EmpireGoldEPO25/0%/6000 $966.39 $1,932.78 $1,642.86 $2,754.21122 EmpireGoldEPO25/0%/6000,COptOut $959.65 $1,919.30 $1,631.41 $2,735.00123 EmpireGoldEPO25/0%/6000,COptOut,Dep29 $974.07 $1,948.14 $1,655.92 $2,776.10124 EmpireGoldEPO25/0%/6000,COptOut,Dep29,REAOptOut $974.07 $1,948.14 $1,655.92 $2,776.10125 EmpireGoldEPO25/0%/6000,COptOut,REAOptOut $959.65 $1,919.30 $1,631.41 $2,735.00126 EmpireGoldEPO25/0%/6000,Dep29 $980.90 $1,961.80 $1,667.53 $2,795.57127 EmpireGoldEPO25/0%/6000,Dep29,REAOptOut $980.90 $1,961.80 $1,667.53 $2,795.57128 EmpireGoldEPO25/0%/6000,REAOptOut $966.39 $1,932.78 $1,642.86 $2,754.21129 EmpireGoldEPO35/10%/5850 $954.97 $1,909.94 $1,623.45 $2,721.66130 EmpireGoldEPO35/10%/5850,COptOut $948.33 $1,896.66 $1,612.16 $2,702.74131 EmpireGoldEPO35/10%/5850,COptOut,Dep29 $962.46 $1,924.92 $1,636.18 $2,743.01132 EmpireGoldEPO35/10%/5850,COptOut,Dep29,REAOptOut $962.46 $1,924.92 $1,636.18 $2,743.01133 EmpireGoldEPO35/10%/5850,COptOut,REAOptOut $948.33 $1,896.66 $1,612.16 $2,702.74134 EmpireGoldEPO35/10%/5850,Dep29 $969.20 $1,938.40 $1,647.64 $2,762.22135 EmpireGoldEPO35/10%/5850,Dep29,REAOptOut $969.20 $1,938.40 $1,647.64 $2,762.22136 EmpireGoldEPO35/10%/5850,REAOptOut $954.97 $1,909.94 $1,623.45 $2,721.66137 EmpireGoldEPO500/20%/7350 $931.39 $1,862.78 $1,583.36 $2,654.46138 EmpireGoldEPO500/20%/7350,COptOut $924.83 $1,849.66 $1,572.21 $2,635.77139 EmpireGoldEPO500/20%/7350,COptOut,Dep29 $938.69 $1,877.38 $1,595.77 $2,675.27140 EmpireGoldEPO500/20%/7350,COptOut,Dep29,REAOptOut $938.69 $1,877.38 $1,595.77 $2,675.27141 EmpireGoldEPO500/20%/7350,COptOut,REAOptOut $924.83 $1,849.66 $1,572.21 $2,635.77142 EmpireGoldEPO500/20%/7350,Dep29 $945.24 $1,890.48 $1,606.91 $2,693.93143 EmpireGoldEPO500/20%/7350,Dep29,REAOptOut $945.24 $1,890.48 $1,606.91 $2,693.93144 EmpireGoldEPO500/20%/7350,REAOptOut $931.39 $1,862.78 $1,583.36 $2,654.46145 EmpirePlatinumBlueAccessEPO15/0%/3500 $1,008.23 $2,016.46 $1,713.99 $2,873.46146 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut $1,001.30 $2,002.60 $1,702.21 $2,853.71147 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut,Dep29 $1,016.09 $2,032.18 $1,727.35 $2,895.86148 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut,Dep29,REAOptOut $1,016.09 $2,032.18 $1,727.35 $2,895.86149 EmpirePlatinumBlueAccessEPO15/0%/3500,COptOut,REAOptOut $1,001.30 $2,002.60 $1,702.21 $2,853.71150 EmpirePlatinumBlueAccessEPO15/0%/3500,Dep29 $1,023.20 $2,046.40 $1,739.44 $2,916.12151 EmpirePlatinumBlueAccessEPO15/0%/3500,Dep29,REAOptOut $1,023.20 $2,046.40 $1,739.44 $2,916.12152 EmpirePlatinumBlueAccessEPO15/0%/3500,REAOptOut $1,008.23 $2,016.46 $1,713.99 $2,873.46153 EmpirePlatinumBlueAccessGEPO20/10%/5500 $945.61 $1,891.22 $1,607.54 $2,694.99154 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut $939.06 $1,878.12 $1,596.40 $2,676.32155 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut,Dep29 $953.01 $1,906.02 $1,620.12 $2,716.08156 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut,Dep29,REAOptOut $953.01 $1,906.02 $1,620.12 $2,716.08157 EmpirePlatinumBlueAccessGEPO20/10%/5500,COptOut,REAOptOut $939.06 $1,878.12 $1,596.40 $2,676.32158 EmpirePlatinumBlueAccessGEPO20/10%/5500,Dep29 $959.65 $1,919.30 $1,631.41 $2,735.00159 EmpirePlatinumBlueAccessGEPO20/10%/5500,Dep29,REAOptOut $959.65 $1,919.30 $1,631.41 $2,735.00160 EmpirePlatinumBlueAccessGEPO20/10%/5500,REAOptOut $945.61 $1,891.22 $1,607.54 $2,694.99161 EmpirePlatinumEPO15/0%/3500 $1,086.01 $2,172.02 $1,846.22 $3,095.13162 EmpirePlatinumEPO15/0%/3500,COptOut $1,078.43 $2,156.86 $1,833.33 $3,073.53163 EmpirePlatinumEPO15/0%/3500,COptOut,Dep29 $1,094.53 $2,189.06 $1,860.70 $3,119.41164 EmpirePlatinumEPO15/0%/3500,COptOut,Dep29,REAOptOut $1,094.53 $2,189.06 $1,860.70 $3,119.41165 EmpirePlatinumEPO15/0%/3500,COptOut,REAOptOut $1,078.43 $2,156.86 $1,833.33 $3,073.53166 EmpirePlatinumEPO15/0%/3500,Dep29 $1,102.20 $2,204.40 $1,873.74 $3,141.27167 EmpirePlatinumEPO15/0%/3500,Dep29,REAOptOut $1,102.20 $2,204.40 $1,873.74 $3,141.27168 EmpirePlatinumEPO15/0%/3500,REAOptOut $1,086.01 $2,172.02 $1,846.22 $3,095.13169 EmpirePlatinumEPO5/0%/2600 $1,103.23 $2,206.46 $1,875.49 $3,144.21170 EmpirePlatinumEPO5/0%/2600,COptOut $1,095.55 $2,191.10 $1,862.44 $3,122.32171 EmpirePlatinumEPO5/0%/2600,COptOut,Dep29 $1,111.93 $2,223.86 $1,890.28 $3,169.00



SmallGroup


RateManual


172 EmpirePlatinumEPO5/0%/2600,COptOut,Dep29,REAOptOut $1,111.93 $2,223.86 $1,890.28 $3,169.00173 EmpirePlatinumEPO5/0%/2600,COptOut,REAOptOut $1,095.55 $2,191.10 $1,862.44 $3,122.32174 EmpirePlatinumEPO5/0%/2600,Dep29 $1,119.70 $2,239.40 $1,903.49 $3,191.15175 EmpirePlatinumEPO5/0%/2600,Dep29,REAOptOut $1,119.70 $2,239.40 $1,903.49 $3,191.15176 EmpirePlatinumEPO5/0%/2600,REAOptOut $1,103.23 $2,206.46 $1,875.49 $3,144.21177 EmpireSilverBlueAccessEPO1500/30%/7350 $754.21 $1,508.42 $1,282.16 $2,149.50178 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut $748.96 $1,497.92 $1,273.23 $2,134.54179 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut,Dep29 $760.10 $1,520.20 $1,292.17 $2,166.29180 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut,Dep29,REAOptOut $760.10 $1,520.20 $1,292.17 $2,166.29181 EmpireSilverBlueAccessEPO1500/30%/7350,COptOut,REAOptOut $748.96 $1,497.92 $1,273.23 $2,134.54182 EmpireSilverBlueAccessEPO1500/30%/7350,Dep29 $765.34 $1,530.68 $1,301.08 $2,181.22183 EmpireSilverBlueAccessEPO1500/30%/7350,Dep29,REAOptOut $765.34 $1,530.68 $1,301.08 $2,181.22184 EmpireSilverBlueAccessEPO1500/30%/7350,REAOptOut $754.21 $1,508.42 $1,282.16 $2,149.50185 EmpireSilverBlueAccessEPO2500/30%/7500 $761.41 $1,522.82 $1,294.40 $2,170.02186 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut $756.17 $1,512.34 $1,285.49 $2,155.08187 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut,Dep29 $767.31 $1,534.62 $1,304.43 $2,186.83188 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut,Dep29,REAOptOut $767.31 $1,534.62 $1,304.43 $2,186.83189 EmpireSilverBlueAccessEPO2500/30%/7500,COptOut,REAOptOut $756.17 $1,512.34 $1,285.49 $2,155.08190 EmpireSilverBlueAccessEPO2500/30%/7500,Dep29 $772.74 $1,545.48 $1,313.66 $2,202.31191 EmpireSilverBlueAccessEPO2500/30%/7500,Dep29,REAOptOut $772.74 $1,545.48 $1,313.66 $2,202.31192 EmpireSilverBlueAccessEPO2500/30%/7500,REAOptOut $761.41 $1,522.82 $1,294.40 $2,170.02193 EmpireSilverBlueAccessEPO2750/30%/7350 $773.30 $1,546.60 $1,314.61 $2,203.91194 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut $767.96 $1,535.92 $1,305.53 $2,188.69195 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut,Dep29 $779.29 $1,558.58 $1,324.79 $2,220.98196 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut,Dep29,REAOptOut $779.29 $1,558.58 $1,324.79 $2,220.98197 EmpireSilverBlueAccessEPO2750/30%/7350,COptOut,REAOptOut $767.96 $1,535.92 $1,305.53 $2,188.69198 EmpireSilverBlueAccessEPO2750/30%/7350,Dep29 $784.72 $1,569.44 $1,334.02 $2,236.45199 EmpireSilverBlueAccessEPO2750/30%/7350,Dep29,REAOptOut $784.72 $1,569.44 $1,334.02 $2,236.45200 EmpireSilverBlueAccessEPO2750/30%/7350,REAOptOut $773.30 $1,546.60 $1,314.61 $2,203.91201 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA $730.43 $1,460.86 $1,241.73 $2,081.73202 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut $725.38 $1,450.76 $1,233.15 $2,067.33203 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut,Dep29 $736.14 $1,472.28 $1,251.44 $2,098.00204 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut,Dep29,REAOptOut $736.14 $1,472.28 $1,251.44 $2,098.00205 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,COptOut,REAOptOut $725.38 $1,450.76 $1,233.15 $2,067.33206 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,Dep29 $741.29 $1,482.58 $1,260.19 $2,112.68207 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,Dep29,REAOptOut $741.29 $1,482.58 $1,260.19 $2,112.68208 EmpireSilverBlueAccessEPO3000/0%/5250w/HSA,REAOptOut $730.43 $1,460.86 $1,241.73 $2,081.73209 EmpireSilverBlueAccessGEPO4000/40%/7350 $683.91 $1,367.82 $1,162.65 $1,949.14210 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut $679.23 $1,358.46 $1,154.69 $1,935.81211 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut,Dep29 $689.25 $1,378.50 $1,171.73 $1,964.36212 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut,Dep29,REAOptOut $689.25 $1,378.50 $1,171.73 $1,964.36213 EmpireSilverBlueAccessGEPO4000/40%/7350,COptOut,REAOptOut $679.23 $1,358.46 $1,154.69 $1,935.81214 EmpireSilverBlueAccessGEPO4000/40%/7350,Dep29 $694.12 $1,388.24 $1,180.00 $1,978.24215 EmpireSilverBlueAccessGEPO4000/40%/7350,Dep29,REAOptOut $694.12 $1,388.24 $1,180.00 $1,978.24216 EmpireSilverBlueAccessGEPO4000/40%/7350,REAOptOut $683.91 $1,367.82 $1,162.65 $1,949.14217 EmpireSilverEPO1500/30%/7350 $810.27 $1,620.54 $1,377.46 $2,309.27218 EmpireSilverEPO1500/30%/7350,COptOut $804.65 $1,609.30 $1,367.91 $2,293.25219 EmpireSilverEPO1500/30%/7350,COptOut,Dep29 $816.64 $1,633.28 $1,388.29 $2,327.42220 EmpireSilverEPO1500/30%/7350,COptOut,Dep29,REAOptOut $816.64 $1,633.28 $1,388.29 $2,327.42221 EmpireSilverEPO1500/30%/7350,COptOut,REAOptOut $804.65 $1,609.30 $1,367.91 $2,293.25222 EmpireSilverEPO1500/30%/7350,Dep29 $822.44 $1,644.88 $1,398.15 $2,343.95223 EmpireSilverEPO1500/30%/7350,Dep29,REAOptOut $822.44 $1,644.88 $1,398.15 $2,343.95224 EmpireSilverEPO1500/30%/7350,REAOptOut $810.27 $1,620.54 $1,377.46 $2,309.27225 EmpireSilverEPO2500/30%/7500 $818.13 $1,636.26 $1,390.82 $2,331.67226 EmpireSilverEPO2500/30%/7500,COptOut $812.42 $1,624.84 $1,381.11 $2,315.40227 EmpireSilverEPO2500/30%/7500,COptOut,Dep29 $824.59 $1,649.18 $1,401.80 $2,350.08228 EmpireSilverEPO2500/30%/7500,COptOut,Dep29,REAOptOut $824.59 $1,649.18 $1,401.80 $2,350.08229 EmpireSilverEPO2500/30%/7500,COptOut,REAOptOut $812.42 $1,624.84 $1,381.11 $2,315.40



SmallGroup


RateManual


230 EmpireSilverEPO2500/30%/7500,Dep29 $830.39 $1,660.78 $1,411.66 $2,366.61231 EmpireSilverEPO2500/30%/7500,Dep29,REAOptOut $830.39 $1,660.78 $1,411.66 $2,366.61232 EmpireSilverEPO2500/30%/7500,REAOptOut $818.13 $1,636.26 $1,390.82 $2,331.67233 EmpireSilverEPO2700/30%/5000w/HSA $760.10 $1,520.20 $1,292.17 $2,166.29234 EmpireSilverEPO2700/30%/5000w/HSA,COptOut $754.77 $1,509.54 $1,283.11 $2,151.09235 EmpireSilverEPO2700/30%/5000w/HSA,COptOut,Dep29 $766.09 $1,532.18 $1,302.35 $2,183.36236 EmpireSilverEPO2700/30%/5000w/HSA,COptOut,Dep29,REAOptOut $766.09 $1,532.18 $1,302.35 $2,183.36237 EmpireSilverEPO2700/30%/5000w/HSA,COptOut,REAOptOut $754.77 $1,509.54 $1,283.11 $2,151.09238 EmpireSilverEPO2700/30%/5000w/HSA,Dep29 $771.52 $1,543.04 $1,311.58 $2,198.83239 EmpireSilverEPO2700/30%/5000w/HSA,Dep29,REAOptOut $771.52 $1,543.04 $1,311.58 $2,198.83240 EmpireSilverEPO2700/30%/5000w/HSA,REAOptOut $760.10 $1,520.20 $1,292.17 $2,166.29241 EmpireSilverEPO2750/30%/7350 $831.05 $1,662.10 $1,412.79 $2,368.49242 EmpireSilverEPO2750/30%/7350,COptOut $825.25 $1,650.50 $1,402.93 $2,351.96243 EmpireSilverEPO2750/30%/7350,COptOut,Dep29 $837.60 $1,675.20 $1,423.92 $2,387.16244 EmpireSilverEPO2750/30%/7350,COptOut,Dep29,REAOptOut $837.60 $1,675.20 $1,423.92 $2,387.16245 EmpireSilverEPO2750/30%/7350,COptOut,REAOptOut $825.25 $1,650.50 $1,402.93 $2,351.96246 EmpireSilverEPO2750/30%/7350,Dep29 $843.50 $1,687.00 $1,433.95 $2,403.98247 EmpireSilverEPO2750/30%/7350,Dep29,REAOptOut $843.50 $1,687.00 $1,433.95 $2,403.98248 EmpireSilverEPO2750/30%/7350,REAOptOut $831.05 $1,662.10 $1,412.79 $2,368.49249 EmpireSilverEPO3000/0%/5250w/HSA $784.53 $1,569.06 $1,333.70 $2,235.91250 EmpireSilverEPO3000/0%/5250w/HSA,COptOut $779.10 $1,558.20 $1,324.47 $2,220.44251 EmpireSilverEPO3000/0%/5250w/HSA,COptOut,Dep29 $790.71 $1,581.42 $1,344.21 $2,253.52252 EmpireSilverEPO3000/0%/5250w/HSA,COptOut,Dep29,REAOptOut $790.71 $1,581.42 $1,344.21 $2,253.52253 EmpireSilverEPO3000/0%/5250w/HSA,COptOut,REAOptOut $779.10 $1,558.20 $1,324.47 $2,220.44254 EmpireSilverEPO3000/0%/5250w/HSA,Dep29 $796.32 $1,592.64 $1,353.74 $2,269.51255 EmpireSilverEPO3000/0%/5250w/HSA,Dep29,REAOptOut $796.32 $1,592.64 $1,353.74 $2,269.51256 EmpireSilverEPO3000/0%/5250w/HSA,REAOptOut $784.53 $1,569.06 $1,333.70 $2,235.91257 EmpireSilverEPO3000/30%/7350 $793.33 $1,586.66 $1,348.66 $2,260.99258 EmpireSilverEPO3000/30%/7350,COptOut $787.81 $1,575.62 $1,339.28 $2,245.26259 EmpireSilverEPO3000/30%/7350,COptOut,Dep29 $799.60 $1,599.20 $1,359.32 $2,278.86260 EmpireSilverEPO3000/30%/7350,COptOut,Dep29,REAOptOut $799.60 $1,599.20 $1,359.32 $2,278.86261 EmpireSilverEPO3000/30%/7350,COptOut,REAOptOut $787.81 $1,575.62 $1,339.28 $2,245.26262 EmpireSilverEPO3000/30%/7350,Dep29 $805.22 $1,610.44 $1,368.87 $2,294.88263 EmpireSilverEPO3000/30%/7350,Dep29,REAOptOut $805.22 $1,610.44 $1,368.87 $2,294.88264 EmpireSilverEPO3000/30%/7350,REAOptOut $793.33 $1,586.66 $1,348.66 $2,260.99265 EmpireSilverPPO3000/0%/5250w/HSA $913.13 $1,826.26 $1,552.32 $2,602.42266 EmpireSilverPPO3000/0%/5250w/HSA,COptOut $906.68 $1,813.36 $1,541.36 $2,584.04267 EmpireSilverPPO3000/0%/5250w/HSA,COptOut,Dep29 $920.34 $1,840.68 $1,564.58 $2,622.97268 EmpireSilverPPO3000/0%/5250w/HSA,COptOut,Dep29,REAOptOut $920.34 $1,840.68 $1,564.58 $2,622.97269 EmpireSilverPPO3000/0%/5250w/HSA,COptOut,REAOptOut $906.68 $1,813.36 $1,541.36 $2,584.04270 EmpireSilverPPO3000/0%/5250w/HSA,Dep29 $926.80 $1,853.60 $1,575.56 $2,641.38271 EmpireSilverPPO3000/0%/5250w/HSA,Dep29,REAOptOut $926.80 $1,853.60 $1,575.56 $2,641.38272 EmpireSilverPPO3000/0%/5250w/HSA,REAOptOut $913.13 $1,826.26 $1,552.32 $2,602.42273 EmpireGoldPPO1000/10%/5000 $1,113.81 $2,227.62 $1,893.48 $3,174.36274 EmpireGoldPPO1000/10%/5000,COptOut $1,106.04 $2,212.08 $1,880.27 $3,152.21275 EmpireGoldPPO1000/10%/5000,COptOut,Dep29 $1,122.60 $2,245.20 $1,908.42 $3,199.41276 EmpireGoldPPO1000/10%/5000,COptOut,Dep29,REAOptOut $1,122.60 $2,245.20 $1,908.42 $3,199.41277 EmpireGoldPPO1000/10%/5000,COptOut,REAOptOut $1,106.04 $2,212.08 $1,880.27 $3,152.21278 EmpireGoldPPO1000/10%/5000,Dep29 $1,130.47 $2,260.94 $1,921.80 $3,221.84279 EmpireGoldPPO1000/10%/5000,Dep29,REAOptOut $1,130.47 $2,260.94 $1,921.80 $3,221.84280 EmpireGoldPPO1000/10%/5000,REAOptOut $1,113.81 $2,227.62 $1,893.48 $3,174.36281 EmpireGoldPPO1350/0%/3000w/HSA $1,045.01 $2,090.02 $1,776.52 $2,978.28282 EmpireGoldPPO1350/0%/3000w/HSA,COptOut $1,037.71 $2,075.42 $1,764.11 $2,957.47283 EmpireGoldPPO1350/0%/3000w/HSA,COptOut,Dep29 $1,053.25 $2,106.50 $1,790.53 $3,001.76284 EmpireGoldPPO1350/0%/3000w/HS

Documents

Filing at a Glance - myportal.dfs.ny.gov HCA_SG... · Loss Ratio Report, 3231(e) Loss Ratio Report, Experience Rating Formula, or Other with brief explanation).]: Yes- Prior Approval