Rates Table Template
Bronze 6110
2017 Rates Table Template v6.0
All fields with an asterisk ( * ) are required. To validate press Validate button or Ctrl + Shift + I. To finalize, press Finalize button or Ctrl + Shift + F.
If you are I, a and community rating state, Family Option under option Age and fill in allenter. columns. If macros are disabled, press and hold the ALT key and press the F, then then N key. After that, select select the Enable All Content by pressing (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells B1 through B5. If you are not community rating state, select 0-20 under Age and provide an Individual Rate for every age band. If Tobacco is Tobacco User/Non-Tobacco User, you must give a rate for Tobacco Use and Non-Tobacco Use. To add a new sheet, press the Add Sheet button, or Ctrl + Shift + H. All plans must have the same dates on a sheet. HIOS Issuer ID* 43633 Federal TIN* 00-0000000 Rate Effective Date* Rate Expiration Date*
Plan ID*
Required: Enter the 14-character Plan ID
1/1/2017 12/31/2017
Rating Area ID*
Tobacco*
Required: Select the Rating Area ID
Require: Select if Tobacco use of subscriber is used to determine if a person is eligible for a rate from a plan
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
Age*
Individual Rate*
Individual Tobacco Rate*
Required: Required: Select the age of a subscriber eligible for the Enter the rate of an Individual Non-Tobacco or rate No Preference enrollee on a plan
0-20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 and over
Required: Enter the rate of an Individual tobacco enrollee on a plan
82.42
82.42
129.80
142.78
129.80
142.78
129.80
142.78
129.80
142.78
130.32
143.35
132.92
146.21
136.03
149.63
141.09
155.20
145.25
159.78
147.32
162.05
150.44
165.48
153.56
168.92
155.50
171.05
157.58
173.34
158.62
174.48
159.66
175.63
160.69
176.76
161.73
177.90
163.81
180.19
165.89
182.48
169.00
185.90
171.99
189.19
176.14
193.75
181.33
199.46
187.43
206.17
194.70
214.17
202.88
223.17
212.23
233.45
221.44
243.58
231.83
255.01
242.08
266.29
253.37
278.71
264.80
291.28
277.13
304.84
289.46
318.41
302.83
333.11
316.33
347.96
330.73
363.80
337.87
371.66
352.28
387.51
364.74
401.21
372.92
410.21
383.17
421.49
389.40
428.34
389.40
428.34
2017 Rates Table Template v6.0
All fields with an asterisk ( * ) are required. To validate press Validate button or Ctrl + Shift + I. To finalize, press Finalize button or Ctrl + Shift + F.
If you are I, a and community rating state, Family Option under option Age and fill in allenter. columns. If macros are disabled, press and hold the ALT key and press the F, then then N key. After that, select select the Enable All Content by pressing (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells B1 through B5. If you are not community rating state, select 0-20 under Age and provide an Individual Rate for every age band. If Tobacco is Tobacco User/Non-Tobacco User, you must give a rate for Tobacco Use and Non-Tobacco Use. To add a new sheet, press the Add Sheet button, or Ctrl + Shift + H. All plans must have the same dates on a sheet. HIOS Issuer ID* 43633 Federal TIN* 00-0000000 Rate Effective Date* Rate Expiration Date*
Plan ID*
Required: Enter the 14-character Plan ID
1/1/2017 12/31/2017
Rating Area ID*
Tobacco*
Required: Select the Rating Area ID
Require: Select if Tobacco use of subscriber is used to determine if a person is eligible for a rate from a plan
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
43633PR0010001
Rating Area 1
Tobacco User/Non-Tobacco User
Age*
Individual Rate*
Individual Tobacco Rate*
Required: Required: Select the age of a subscriber eligible for the Enter the rate of an Individual Non-Tobacco or rate No Preference enrollee on a plan
0-20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 and over
Required: Enter the rate of an Individual tobacco enrollee on a plan
82.42
82.42
129.80
142.78
129.80
142.78
129.80
142.78
129.80
142.78
130.32
143.35
132.92
146.21
136.03
149.63
141.09
155.20
145.25
159.78
147.32
162.05
150.44
165.48
153.56
168.92
155.50
171.05
157.58
173.34
158.62
174.48
159.66
175.63
160.69
176.76
161.73
177.90
163.81
180.19
165.89
182.48
169.00
185.90
171.99
189.19
176.14
193.75
181.33
199.46
187.43
206.17
194.70
214.17
202.88
223.17
212.23
233.45
221.44
243.58
231.83
255.01
242.08
266.29
253.37
278.71
264.80
291.28
277.13
304.84
289.46
318.41
302.83
333.11
316.33
347.96
330.73
363.80
337.87
371.66
352.28
387.51
364.74
401.21
372.92
410.21
383.17
421.49
389.40
428.34
389.40
428.34
