Rate Manual HealthPlus HP, LLC I ... .gov

Rate Manual HealthPlus HP, LLC Table of Contents

I. Direct Payment Products Open for Enrollment

HealthPlus HMO ? On/Off Exchange

I-1

II. Appendix

Commission Schedule Broker Commission Sample Rate Calculation Opt-In Rider Area Factors Contract Type Factors Variation Factors Index

HealthPlus HP, LLC

May 2019

Rate Manual

HealthPlus HP, LLC Individual

2

Plan Name CATASTROPHIC HealthPlus Gatekeeper X, Catastrophic BRONZE HealthPlus Gatekeeper X for HSA, Bronze, Dep 25

SILVER

HealthPlus Gatekeeper X, Silver, Dep 25

GOLD

HealthPlus Gatekeeper X, Gold, Dep 25

PLATINUM

HealthPlus Gatekeeper X, Platinum, Dep 25

22

Deductible Single/ Family

120

125

Office Visit

PCP

Specialist

$8,150/ $16,300

3 @ $0 before Ded.

$0

$5,500/ $11,000

50%

50%

$1,300/ $2,600

$30

$50

$600/ $1,200

$25

$40

$0/$0

$15

$35

On Exchange Plans

Effective Date: January 1, 2020

28

26

In-Network Coverage Only

32

191

Network Coins

OOP Max Single/ Family

Retail Pharmacy Preferred / Non Preferred

Inpatient Hospital

Emergency Room (Facility)

0% 50% N/A N/A N/A

$8,150/ $16,300

$6,550/ $13,100

$7,900/ $15,800

$4,000/ $8,000

$2,000/ $4,000

$0

0%

Tier 1 - $10 Tier 2 - $35 Tier 3 - $70

50%

Tier 1 - $10 Tier 2 - $35 Tier 3 - $70; No Deductible

$1,500 per admit

Tier 1 - $10 Tier 2 - $35 Tier 3 - $70; No Deductible

$1,000 per admit

Tier 1 - $10 Tier 2 - $30 Tier 3 - $60; No Deductible

$500 per admit

0% 50% $250 $150 $100

188

Urgent Care

60

Outpt Hospital (Facility)

141

Maternity & Newborn Care

138

Mental Health & Substance Abuse

0%

0%

0%

0%

50%

50%

50%

50%

$70

$150 per use

$1,500 per admit, $100 for prenatal & delivery physician

$1,500 per admit, PCP copay for outpt

$60

$100 per use

$1,000 per admit, $100 for prenatal & delivery physician

$1,000 per admit, PCP copay for outpatient

$55

$500 per admit, $100 per use $100 for prenatal &

delivery physician

$500 per admit, PCP copay for outpatient

168

78

Rehab & Habilitative

Diagnostics

0%

0%

50%*

50%

$30 per visit*

$50 per visit

$30 per visit*

$40 per visit

$25 per visit*

$35 per visit

*limited to 60 visits per condition per plan year

All Plans include Pediatric Vision and the following:

Pediatric Dental

Preventive Dental Care

Routine Dental Care

Catastrophic

0% after deductible 0% after deductible

Bronze Silver Gold Platinum

50% after deductible 50% after deductible

$30 copay after deductible

$25 copay after deductible

$15 copay after deductible

$30 copay after deductible

$25 copay after deductible

$15 copay after deductible

Major Dental Care (Oral Surgery, Endodontics, Periodontics and

Prosthodontics) 0% after deductible

50% after deductible

$30 copay after deductible

$25 copay after deductible

$15 copay after deductible

Orthodontia 0% after deductible 50% after deductible $30 copay after deductible $25 copay after deductible $15 copay after deductible

HealthPlus HP, LLC

May 2019

Rate Manual

HealthPlus HP, LLC Individual

2

Plan Name CATASTROPHIC HealthPlus Gatekeeper, Catastrophic BRONZE HealthPlus Gatekeeper for HSA, Bronze, Dep 25 SILVER

HealthPlus Gatekeeper, Silver, Dep 25

GOLD

HealthPlus Gatekeeper, Gold, Dep 25

PLATINUM

HealthPlus Gatekeeper, Platinum, Dep 25

22 Deductible Single/ Family

120

125

Office Visit

PCP

Specialist

$8,150/ $16,300

3 @ $0 before Ded.

$0

$5,500/ $11,000

50%

50%

$1,300/ $2,600

$30

$50

$600/ $1,200

$25

$40

$0/$0

$15

$35

28

26

Network

OOP Max

Coins

Single/ Family

0%

$8,150/ $16,300

50%

$6,550/ $13,100

N/A

$7,900/ $15,800

N/A

$4,000/ $8,000

N/A

$2,000/ $4,000

Off Exchange Plans

Effective Date: January 1, 2020

In-Network Coverage Only

32

191

Retail Pharmacy

Inpatient

Emergency Room

Preferred / Non Preferred

Hospital

(Facility)

$0

0%

0%

Tier 1 - $10 Tier 2 - $35 Tier 3 - $70

50%

Tier 1 - $10 Tier 2 - $35 Tier 3 - $70; No Deductible

$1,500 per admit

Tier 1 - $10 Tier 2 - $35 Tier 3 - $70; No Deductible

$1,000 per admit

Tier 1 - $10 Tier 2 - $30 Tier 3 - $60; No Deductible

$500 per admit

50% $250 $150 $100

188 Urgent

Care

60 Outpt Hospital

141 Maternity & Newborn Care

138 Mental Health & Substance Abuse

0%

0%

0%

0%

50%

50%

50%

50%

$70

$150 per use

$1,500 per admit, $100 for prenatal & delivery physician

$1,500 per admit, PCP copay for outpt

$60

$100 per use

$1,000 per admit, $100 for prenatal & delivery physician

$1,000 per admit, PCP copay for outpatient

$55

$500 per admit, $100 per use $100 for prenatal &

delivery physician

$500 per admit, PCP copay for outpatient

168

78

Rehab & Habilitative

Diagnostics

0%

0%

50%*

50%

$30 per visit*

$50 per visit

$30 per visit*

$40 per visit

$25 per visit*

$35 per visit

*limited to 60 visits per condition per plan year

All Plans include Pediatric Vision and the following:

Pediatric Dental

Preventive Dental Care

Routine Dental Care

Catastrophic

0% after deductible 0% after deductible

Bronze

50% after deductible 50% after deductible

Silver Gold Platinum

$30 copay after deductible

$25 copay after deductible

$15 copay after deductible

$30 copay after deductible

$25 copay after deductible

$15 copay after deductible

Major Dental Care (Oral Surgery, Endodontics, Periodontics and

0% after deductible 50% after deductible

$30 copay after deductible

$25 copay after deductible

$15 copay after deductible

Orthodontia 0% after deductible 50% after deductible $30 copay after deductible $25 copay after deductible $15 copay after deductible

HealthPlus HP, LLC

May 2019

Rate Manual

HealthPlus HP, LLC Individual

Commission Schedule for HMO Plans Effective Date: January 1, 2020

Product Contract HMO New HMO Renewal

Per Member Per Month (PMPM) $0 $0

Notes: 1. This schedule applies to commissions paid on all new and renewal Individual commissionable products on or after the Effective Date.

2. This schedule applies to both on and off exchange products in the individual market.

HealthPlus HP, LLC

May 2019

Rate Manual HealthPlus HP, LLC

Individual On Exchange Sample Rate Calculation

Effective Date: January 1, 2020

Plan: HealthPlus Gatekeeper X, Gold, ST, INN, Pediatric Dental, Dep 29 Rating Region: Albany (Region 1) Expected Loss Ratio: 86.5%

Base Rates:

Individual $967.69

Husband/ Wife $1,935.38

Parent/ Child(ren)

$1,645.07

Family $2,757.92

TOTAL

$967.69 $1,935.38 $1,645.07 $2,757.92

HealthPlus HP, LLC

May 2019

Rate Manual

HealthPlus HP, LLC Individual

Off Exchange Sample Rate Calculation Effective Date: January 1, 2020

Plan: HealthPlus Gatekeeper, Gold, ST, INN, Pediatric Dental, Dep 29, SNF Rating Region: Albany (Region 1) Expected Loss Ratio: 86.5%

Base Rates:

Individual $968.42

Husband/ Parent/

Wife

Child(ren)

$1,936.84 $1,646.31

Family $2,760.00

TOTAL

$968.42 $1,936.84 $1,646.31 $2,760.00

HealthPlus HP, LLC

May 2019

Rating Area Description Albany

Long Island

Mid-Hudson

New York City

Upstate

Rate Manual

HealthPlus HP, LLC Individual

Area Factors Effective Date: January 1, 2020

Area Factor 0.8881

0.9189

Counties Included Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga,

Schenectady, Schoharie, Warren, and Washington

Nassau and Suffolk

1.0475

Delaware, Dutchess, Orange, Putnam, Sullivan, and Ulster

1.0442

Bronx, Kings, New York, Queens, Richmond, Rockland, and Westchester

1.4725

Clinton and Essex

HealthPlus HP, LLC

May 2019

Rate Manual

HealthPlus HP, LLC Individual

Contract Type Factors Effective Date: January 1, 2020

Contract Type Single Single + Spouse Single + Child(ren) Child Only Family

Factor 1.000 2.000 1.700 0.412 2.850

HealthPlus HP, LLC

May 2019

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download