Spreadsheet: e5533742-5f43-481e-8b32-68ceab193052
Sheet: A1.  Cover Sheet

[NAME]:  Cover Sheet
Section 1:  Rate Filing Information
1.  [NAME]: | [NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | HMO | POS | PPO | Indemnity | Other
2.  Plan Type(s):1 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | True | True | False | False | True
3.  Market Segment: | Small Group Market
4.  Rate Effective Date: | 2013-01-01 00:00:00
5.  [NAME] for the carrier and the person responsible for the filing:
6a.  Have there been changes to the rating methodology since the most recently approved rate filing? (Y/N)
6b.  If the answer above is "Y", then please provide a brief description of those changes:
7a.  Have there been changes to the benefits since the most recently approved rate filing? (Y/N)
7b.  If the answer above is "Y", then please provide a brief description of those changes.  Please identify benefit chages that are mandated (federal or state) versus benefit changes that are not mandated.
8.  Does this rate filing include all of the carrier’s health insurance rates for the applicable market segment? If not, please provide an explanation as to why.
9.  For a small group rate filing submission only:  Does carrier list bill any portion of its small group market?  If yes- please indicate which portion.
Notes:
1.  A rate filing may include more than one plan type.
Section 2:  Rate Filing Exhibits
Please indicate that each of the following exhibits are provided and complete:
 |  | Public Exhibit? | Excel or PDF? | Required for All Rate Filings? (New and Revised?)2
 |  | Y | Excel | New & Revised*
 |  | Y | Excel | New & Revised*
 |  | Y | Excel | Revised Only
 |  | Y | Excel | Revised Only
 |  | Y | Excel | Revised Only
Exhibit B1:  Plan Design and Plan Relativity Factors |  | Y | Excel | New & Revised*
 |  | Y | Excel | New & Revised
[NAME] (Non-Standardized Exhibit) |  | Y | PDF | New & Revised
Exhibit D1:  Description of Trend Assumptions (Non-Standardized Exhibit) |  | N | PDF | New & Revised
[NAME]Supporting Schedules for Trend Development (Non-Standardized Exhibit) |  | N | PDF | New & Revised
 |  | N | Excel | New & Revised*
 |  | Y | Excel | New & Revised*
 |  | Y | Excel | New & Revised*
Exhibit G1: Individual Market Example 1 (Non-Standardized Exhibit) |  | Y | PDF | New & Revised
Exhibit G2:  Individual Market Example 2 (Non-Standardized Exhibit) |  | Y | PDF | New & Revised
Exhibit G3:  Small Group Market Example 1 (Non-Standardized Exhibit) |  | Y | PDF | New & Revised
Exhibit G4:  Small Group Market Example 2 (Non-Standardized Exhibit) |  | Y | PDF | New & Revised
Exhibit G5: Illustrative Rates |  | Y | Excel | New & Revised
 |  | Y | Excel | New & Revised*
Exhibit H2:  Rating Factors (Non-Standardized Exhibit) |  | Y | PDF | New & Revised
Exhibit H3:  Description of Rating Factors (Non-Standardized Exhibit) |  | Y | PDF | New & Revised*
Exhibit H4:  Expected Distribution of Rating Factors (Non-Standardized Exhibit) |  | Y | PDF | New & Revised
Exhibit J1:  Health Coverage Plan Rate PMPM Development for Standard Health Coverage Plan |  | Y | Excel | New & Revised*
 |  | Y | Excel | New & Revised
 |  | Y | Excel | New & Revised*
Exhibit M3:  Description of Methodology for Projected Medical Loss Ratio (Non-Standardized Exhibit) |  | Y | PDF | New & Revised
Notes:
2.  Exhibits that are modified for rate revisions as compared to new filings as denoted with an asterisk (*).