Capital District Physicians’ Health Plan, Inc



CDPHP Universal Benefits, Inc.

500 Patroon Creek Blvd.

Albany, NY 12206-1057

August X, 2011

[Contact Name]

[Group Name]

[Address] Group ID#

[City State Zip]

Dear Employer Group Contact:

CDPHP Universal Benefits,® Inc. (CDPHP UBI) recently notified you that we have filed our 2012 community-rated premiums with the New York State Insurance Department (NYSID).

Please be advised that you may view a detailed narrative describing this year’s premium rate filing by going to our website at members, or to the NYSID website at ins.state.ny.us. As stated in our original letter, you have 30 days to contact CDPHP UBI or NYSID to request information about the rate change, or to submit written comments to NYSID.

Enclosed is a copy of a notice which employees enrolled in your group plan are required to receive. If, for any reason, you are unable or unwilling to deliver these notices to your employees, please let us know within three business days by contacting us at employerinfo@. If you would prefer a PDF of the document, or need additional copies, please contact us as shown below, and indicate the correct contact person, address, and quantity desired.

Sincerely,

Carole Montepare

Senior Vice President, Sales and Marketing

CDPHP Universal Benefits, Inc.

|CDPHP Universal Benefits, Inc. |Health Bureau—Premium Rate Adjustment |

|Att.: Membership & Billing |New York State Insurance Dept. |

|500 Patroon Creek Blvd. |25 Beaver Street |

|Albany, NY 12206-1057 |New York, NY 10004 |

| | |

|employerinfo@ | |

|(518) 641-3900 | |

| |PremiumRateIncreases@ins.state.ny.us |

| |1-800-342-3736 |

.

Important Information for CDPHP Universal Benefits, Inc. Plan Members

CDPHP Universal Benefits, ® Inc. (CDPHP UBI) has filed its 2012 community-rated premiums with the New York State Insurance Department (NYSID).

Please be aware that you may view a detailed narrative describing this year’s premium rate filing by going to our website at members, or to the NYSID website at ins.state.ny.us.

As stated in our original letter, you have 30 days to contact CDPHP UBI or NYSID to request information about the rate change, or to submit written comments to NYSID.

|CDPHP Universal Benefits, Inc. |Health Bureau—Premium Rate Adjustment |

|Att.: Membership & Billing |New York State Insurance Dept. |

|500 Patroon Creek Blvd. |25 Beaver Street |

|Albany, NY 12206-1057 |New York, NY 10004 |

| | |

| | |

|1-877-269-2134 | |

| |PremiumRateIncreases@ins.state.ny.us |

| |1-800-342-3736 |

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