Carrier BlueShield of Northeastern NY BlueShield of Northeastern NY BlueShield of Northeastern NY BlueShield of Northeastern NY

New York State of Health Small Business Marketplace Product Description Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning

Product Type POS EPO POS EPO

Metal Level 1-Platinum 2-Gold 3-Silver 4-Bronze

Plan Type Standard Standard Standard Standard

Region 1 $658.81 $542.54 $486.89 $386.15

Region 2

Employee Only Rate in NYSOH Rating Region* Region 3 Region 4 Region 5 Region 6 Region 7 $683.99 $562.78 $505.24 $400.08

Region 8 www.bsneny.com/platinumSHOP www.bsneny.com/goldSHOP www.bsneny.com/silverSHOP www.bsneny.com/bronzeSHOP

Link to Carrier Benefit Summaries

CDPHP CDPHP CDPHP CDPHP CDPHP CDPHP CDPHP CDPHP CDPHP CDPHP CDPHP CDPHP

Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Platinum SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning

EPO EPO EPO EPO EPO EPO EPO EPO PPO EPO PPO EPO

1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 2-Gold 3-Silver 4-Bronze

Standard Standard Standard Standard NonStand 1 NonStand 1 NonStand 1 NonStand 1 NonStand 2 NonStand 2 NonStand 2 NonStand 2

$515.46 $452.41 $384.93 $328.82 $526.00 $468.55 $388.21 $322.33 $563.28 $448.78 $391.88 $311.14

$582.73 $511.45 $435.17 $371.73 $594.65 $529.70 $438.87 $364.40 $636.79 $507.34 $443.02 $351.74

$578.09 $507.38 $431.70 $368.77 $589.91 $525.48 $435.38 $361.50 $631.72 $503.30 $439.50 $348.94

$555.20 $487.29 $414.61 $354.17 $566.56 $504.68 $418.14 $347.19 $606.71 $483.38 $422.10 $335.12

https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group https://www.cdphp.com/Exchange/TCE/small-group

Excellus Excellus Excellus Excellus Excellus Excellus Excellus Excellus

Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning

PPO PPO PPO PPO PPO PPO PPO PPO

1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 2-Gold 3-Silver 4-Bronze

Standard Standard Standard Standard NonStand 1 NonStand 1 NonStand 1 NonStand 1

$563.25 $486.86 $420.33 $328.39 $563.95 $451.17 $384.02 $310.11

$563.25 $486.86 $420.33 $328.39 $563.95 $451.17 $384.02 $310.11

$435.16 $376.15 $324.75 $253.71 $435.70 $348.56 $296.69 $239.58

$529.12 $457.36 $394.88 $308.49 $529.79 $423.83 $360.75 $291.31

$563.25 $486.86 $420.33 $328.39 $563.95 $451.17 $384.02 $310.11

https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY0980010 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY0990042 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY0990010 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY1000010 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY0980026 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY1000074 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY1000082 https://www.excellusbcbs.com/wps/portal/xl/poc?uri=sbc:PlanId=78124NY1000154

Health Republic Insurance Health Republic Insurance Health Republic Insurance Health Republic Insurance Health Republic Insurance Health Republic Insurance Health Republic Insurance Health Republic Insurance Health Republic Insurance

Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning

EPO EPO EPO EPO EPO EPO EPO EPO EPO

1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 2-Gold 3-Silver 4-Bronze 3-Silver

Standard Standard Standard Standard NonStand 1 NonStand 1 NonStand 1 NonStand 1 NonStand 2

$426.04 $362.34 $310.10 $253.67 $408.43 $362.05 $309.87 $219.89 $292.37

$398.81 $339.19 $290.28 $237.46 $382.33 $338.92 $290.07 $205.84 $273.69

$478.57 $407.01 $348.33 $284.95 $458.79 $406.69 $348.08 $247.01 $328.42

$561.14 $477.24 $408.44 $334.11 $537.95 $476.86 $408.14 $289.63 $385.10

$392.06 $333.44 $285.36 $233.44 $375.86 $333.17 $285.16 $202.36 $269.06

$414.04 $352.13 $301.36 $246.52 $396.93 $351.85 $301.14 $213.70 $284.14

$402.87 $342.64 $293.24 $239.88 $386.22 $342.36 $293.02 $207.94 $276.48

$561.14 $477.24 $408.44 $334.11 $537.95 $476.86 $408.14 $289.63

http://newyork.healthrepublic.us/product/education/summary-of-benefits http://newyork.healthrepublic.us/product/education/summary-of-benefits http://newyork.healthrepublic.us/product/education/summary-of-benefits http://newyork.healthrepublic.us/product/education/summary-of-benefits http://newyork.healthrepublic.us/product/education/summary-of-benefits http://newyork.healthrepublic.us/product/education/summary-of-benefits http://newyork.healthrepublic.us/product/education/summary-of-benefits http://newyork.healthrepublic.us/product/education/summary-of-benefits

$385.10 http://newyork.healthrepublic.us/product/education/summary-of-benefits

Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health Independent Health

Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Platinum SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS3 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS3 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS3 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS4 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS4 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS4 Age 26, No Dental, Domestic Partner & Family Planning

POS POS POS POS POS POS POS POS POS PPO PPO POS POS POS POS POS POS PPO

1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 2-Gold 3-Silver 4-Bronze 2-Gold 3-Silver 4-Bronze 2-Gold 3-Silver 4-Bronze

Standard Standard Standard Standard NonStand 1 NonStand 1 NonStand 1 NonStand 1 NonStand 2 NonStand 2 NonStand 2 NonStand 2 NonStand 3 NonStand 3 NonStand 3 NonStand 4 NonStand 4 NonStand 4

$530.11 $446.96 $381.47 $322.85 $513.40 $431.45 $361.15 $298.55 $513.40 $467.59 $405.61 $304.32 $412.92 $355.88 $317.09 $417.83 $362.42 $359.95

https://www.independenthealth.com/Exchange/SmallGroup/Platinum/18029NY1170008.aspx https://www.independenthealth.com/Exchange/SmallGroup/Gold/18029NY1200008.aspx https://www.independenthealth.com/Exchange/SmallGroup/Silver/18029NY1240008.aspx https://www.independenthealth.com/Exchange/SmallGroup/Bronze/18029NY1300008.aspx https://www.independenthealth.com/Exchange/SmallGroup/Platinum/18029NY1170024.aspx https://www.independenthealth.com/Exchange/SmallGroup/Gold/18029NY1200024.aspx https://www.independenthealth.com/Exchange/SmallGroup/Silver/18029NY1240024.aspx https://www.independenthealth.com/Exchange/SmallGroup/Bronze/18029NY1300024.aspx https://www.independenthealth.com/Exchange/SmallGroup/Platinum/18029NY1170056.aspx https://www.independenthealth.com/Exchange/SmallGroup/Gold/18029NY1210008.aspx https://www.independenthealth.com/Exchange/SmallGroup/Silver/18029NY1250008.aspx https://www.independenthealth.com/Exchange/SmallGroup/Bronze/18029NY1300040.aspx https://www.independenthealth.com/Exchange/SmallGroup/Gold/18029NY1200072.aspx https://www.independenthealth.com/Exchange/SmallGroup/Silver/18029NY1240056.aspx https://www.independenthealth.com/Exchange/SmallGroup/Bronze/18029NY1300056.aspx https://www.independenthealth.com/Exchange/SmallGroup/Gold/18029NY1200104.aspx https://www.independenthealth.com/Exchange/SmallGroup/Silver/18029NY1240088.aspx https://www.independenthealth.com/Exchange/SmallGroup/Bronze/18029NY1270008.aspx

MetroPlus MetroPlus MetroPlus MetroPlus

Platinum SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning

HMO HMO HMO HMO

1-Platinum 2-Gold 3-Silver 4-Bronze

Standard Standard Standard Standard

$479.50 $427.34 $387.23 $359.97

www.metroplus.org\MarketPlus www.metroplus.org\MarketPlus www.metroplus.org\MarketPlus www.metroplus.org\MarketPlus

MVP Health Care MVP Health Care MVP Health Care MVP Health Care MVP Health Care MVP Health Care MVP Health Care MVP Health Care MVP Health Care MVP Health Care

Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Platinum SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning

HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 2-Gold

Standard Standard Standard Standard NonStand 1 NonStand 1 NonStand 1 NonStand 1 NonStand 2 NonStand 2

$526.60 $446.55 $370.98 $285.30 $526.93 $440.56 $357.24 $295.86 $530.29 $418.97

$435.55 $369.34 $306.83 $235.97 $435.81 $364.38 $295.46 $244.70 $438.59 $346.52

$592.43 $502.37 $417.35 $320.96 $592.79 $495.62 $401.89 $332.84 $596.58 $471.34

$754.80 $640.06 $531.73 $408.93 $755.26 $631.46 $512.04 $424.07 $760.08 $600.52

$440.48 $373.52 $310.31 $238.64 $440.75 $368.51 $298.81 $247.47 $443.57 $350.45

$572.13 $485.16 $403.05 $309.97 $572.48 $478.64 $388.12 $321.44 $576.14 $455.19

$537.03 $455.39 $378.32 $290.95 $537.35 $449.27 $364.31 $301.72 $540.79 $427.26

www.discovermvp.com/ny/st/shop/platinum/ www.discovermvp.com/ny/st/shop/gold/ www.discovermvp.com/ny/st/shop/silver/ www.discovermvp.com/ny/st/shop/bronze/ www.discovermvp.com/ny/ns/shop/platinum/ www.discovermvp.com/ny/ns/shop/gold/ www.discovermvp.com/ny/ns/shop/silver/ www.discovermvp.com/ny/ns/shop/bronze/ www.discovermvp.com/ny/ns/shop/platinum/ www.discovermvp.com/ny/ns/shop/gold/

MVP Health Care MVP Health Care MVP Health Care MVP Health Care

Silver SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS2 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS3 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS3 Age 26, No Dental, Domestic Partner & Family Planning

HMO HMO HMO HMO

3-Silver 4-Bronze 3-Silver 4-Bronze

NonStand 2 NonStand 2 NonStand 3 NonStand 3

$368.79 $298.79 $370.80 $284.65

$305.02 $247.12 $306.68 $235.43

$414.89 $336.13 $417.15 $320.23

$528.60 $428.26 $531.48 $407.99

$308.48 $249.92 $310.16 $238.09

$400.67 $324.62 $402.86 $309.26

$376.09 $304.70 $378.14 $290.28

www.discovermvp.com/ny/ns/shop/silver/ www.discovermvp.com/ny/ns/shop/bronze/ www.discovermvp.com/ny/ns/shop/silver/ www.discovermvp.com/ny/ns/shop/bronze/

North Shore-LIJ North Shore-LIJ North Shore-LIJ North Shore-LIJ

Platinum SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning

EPO EPO EPO EPO

1-Platinum 2-Gold 3-Silver 4-Bronze

Standard Standard Standard Standard

$682.93 $594.07 $516.96 $421.61

$682.93 $594.07 $516.96 $421.61

www.NSLIJCareConnect.com/member/group/SBC www.NSLIJCareConnect.com/member/group/SBC www.NSLIJCareConnect.com/member/group/SBC www.NSLIJCareConnect.com/member/group/SBC

Oxford Health Insurance Oxford Health Insurance Oxford Health Insurance Oxford Health Insurance Oxford Health Insurance Oxford Health Insurance

Platinum SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, Dental, Domestic Partner & Family Planning Platinum SHOP NS1 Dependent Age 26, Dental, Domestic Partner & Family Planning Silver SHOP NS1 Dependent Age 26, Dental, Domestic Partner & Family Planning

EPO EPO EPO EPO PPO PPO

1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 3-Silver

Standard Standard Standard Standard NonStand 1 NonStand 1

$773.65 $655.79 $554.71 $473.25 $836.98 $612.25

$773.65 $655.79 $554.71 $473.25 $836.98 $612.25

$773.65 $655.79 $554.71 $473.25

www.welcometouhc.com/shopny www.welcometouhc.com/shopny www.welcometouhc.com/shopny www.welcometouhc.com/shopny

$836.98 www.welcometouhc.com/shopny $612.25 www.welcometouhc.com/shopny

Univera Univera Univera Univera Univera Univera Univera Univera

Platinum SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP St Dependent Age 26, No Dental, Domestic Partner & Family Planning Platinum SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Gold SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Silver SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning Bronze SHOP NS1 Age 26, No Dental, Domestic Partner & Family Planning

PPO PPO PPO PPO PPO PPO PPO PPO

1-Platinum 2-Gold 3-Silver 4-Bronze 1-Platinum 2-Gold 3-Silver 4-Bronze

Standard Standard Standard Standard NonStand 1 NonStand 1 NonStand 1 NonStand 1

$547.25 $473.04 $408.40 $319.07 $547.95 $438.36 $373.11 $301.30

https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1020010 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1030042 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1030010 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1040010 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1020026 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1040074 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1040090 https://www.univerahealthcare.com/wps/portal/uv/poc?uri=sbc:PlanId=78124NY1040154

*Link to Rating Region Map: http://info.nystateofhealth.ny.gov/sites/default/files/Attachment%20C%20-%20Rating%20Regions%2C%20new%203-27-13.pdf