Final Award of the 2021 Seal of Approval (VOTE)

AUDREY MORSE GASTEIER

Chief of Policy & Strategy

MARIA JOY DAWLEY

Director of Plan Management & Product Strategy

SAMUEL ADAMS

Senior Program Analyst, Health & Dental Plans

EDITH BOUCHER CALVAO, FSA, MAAA

Actuary

Board of Directors Meeting, September 10, 2020

2021 Final Seal of Approval

Today we share our recommendation for the award of the Final Seal of Approval

(SOA) for Qualified Health and Dental Plans for the 2021 Plan Year (PY), as well

as our recommendation for the PY 2021 ConnectorCare program.

▪ A vote today authorizing the Final SOA allows us to offer these plans for sale through the Health

Connector starting January 1, 2021

2

Mar 2020 Apr May Jun Jul Aug Sept Oct Nov Dec 2020

3/20: Release Medical and Dental RFRs

5/22: RFR Responses Due

Review and Analysis of Responses

7/1: Rates Filed with DOI

7/9: Conditional SOA – Board Meeting

Review and Analysis of Rates

9/10: Final SOA Awarded – Board Meeting

Analysis and Selection of ConnectorCare Plans

2021 Seal of Approval: Market Response Overview

The proposed final 2021 Qualified Health and Dental Plan shelves will offer

a range of plan designs, carriers, and premiums, featuring:

▪ A proposed ConnectorCare program design that continues to offer affordable choice

▪ A broad choice of carriers and plans for unsubsidized non-group and small group enrollees, with:

• 9 medical carriers submitting a total of 59 non-group and 72 small group Qualified Health Plans

(QHPs)

• 2 dental carriers submitting a total of 12 Qualified Dental Plans (QDPs) for on-Exchange sale*

▪ Moderate premium changes, though with wide variation among carriers and overall increases

higher than in recent years

3

Average Changes in Health Connector Premiums (without member aging): 2020-2021

Merged Market Total1

Unsubsidized & APTC-only

Medical Plans2

ConnectorCare Base Silver

Medical Plans3Dental Plans4

73,435 members5 223,604 members 110,189 members

7.9% 7.7% 7.9%-10.1%

* Consistent with Plan Year 2020, two additional carriers are recommended for certification of off-Exchange Qualified Dental Plans, for a total of 19 plans 1 For 2021, the total Division of Insurance merged market enrollment-weighted premium change without member aging, inclusive of the Health Connector, is 7.9% 2 Enrollment-weighted non-group premium change without member aging (~2%), assumes mapping to 2021 renewal plan 3 Enrollment-weighted non-group premium change from 2020 base silver plan to 2021 base silver plan without member aging (~2%), premium increases not directly reflected in

ConnectorCare enrollee contributions4 Enrollment-weighted non-group average premiums5 Enrollment data as of August 2020

Qualified Health Plans: Unsubsidized and APTC-Only

QHPs: Overview

The PY 2021 product shelf is mostly stable compared to PY 2020 for

unsubsidized and Advance Premium Tax Credit members, though

ConnectorCare members will experience a few notable changes.

5

▪ As in PYs 2019 and 2020, carriers continue to be required to offer

standard platinum, high gold, high silver, low silver (small group only)

and bronze plans, and a PPO plan for small groups, as well as a low

gold plan newly non-standardized for PY 2021

▪ There are no new carrier entrants for PY 2021. This is a change to

information presented to the Board in July, when AllWays intended to

participate as two distinct carriers in 2021

• AllWays no longer intends to submit products from a separate

“Select” carrier license and will instead offer a narrower-network

“Select” silver plan under the existing AllWays carrier that will

serve as its ConnectorCare offering

▪ There are no carrier departures

Platinum

High Gold

Low Gold

High Silver

Low Silver (SG)

Bronze

AllWays Health Partners Update

AllWays Health Partners no longer intends to sell plans under a separate “Select” carrier license

and will instead offer a narrower-network silver plan under the existing AllWays carrier. The network

has been expanded to meet ConnectorCare network adequacy standards.

6

Conditional SOA Submission Final SOA Submission

Entity Structure Two distinct carrier licenses One license

Network Smaller Select network, which did not meet

ConnectorCare network requirements in

certain areas of the Commonwealth

Smaller Select network, but with improvements

to broaden the network such that it meets

ConnectorCare standards in all regions with

the addition of many acute care hospitals and

associated providers

Plan Offerings All required standard plans for each metallic

tier on the smaller Select network

One new silver plan from the existing carrier on

the smaller Select network

ConnectorCare

Participation

ConnectorCare participation under only the

Select carrier

ConnectorCare participation under existing

carrier, using the Select network as the

ConnectorCare offering

ConnectorCare

Regional

Coverage

• Eastern portion of state only (except for

Cape Cod)

• Excludes Worcester County

• Continues to include Islands coverage

• No change from initial submission

QHPs: Non-Group Overview

Nine medical carriers responded to the 2021 Seal of Approval, submitting a

total of 59 non-group QHPs proposed for the Health Connector’s

consideration for 2021, a net increase of three plans from 2020.

7

▪ This reflects a net decrease of four plans since the July presentation, accounting for the withdrawal of

five plans from the separate AllWays Select carrier, and the addition of one narrower-network silver

plan from the existing AllWays carrier

Non-Group 2021

Issuers Platinum Gold Silver Bronze Catastrophic* Total 2021Total 2020 for

Comparison

AllWays Health Partners 1 2 2 1 0 6 5

Blue Cross Blue Shield 1 2 1 1 1 6 6

BMC HealthNet Plan 1 2 1 1 0 5 5

Fallon Health 2 4 3 2 1 12 13

Health New England 1 2 1 2 1 7 5

Harvard Pilgrim Health Care 1 2 1 2 0 6 5

Tufts Health Plan - Direct 1 2 1 2 1 7 7

Tufts Health Plan - Premier 1 2 1 1 0 5 5

United 1 2 1 1 0 5 5

Total 2021 10 20 12 13 4 59

Total 2020 for Comparison 10 21 11 11 3 56

QHPs: Small Group Overview

Nine medical carriers submitted a total of 72 small group QHPs for the Health

Connector’s consideration for 2021, a net increase of three plans from 2020.

8

▪ This reflects a net decrease of five plans since the July presentation, accounting for the withdrawal of

six plans from the separate AllWays Select carrier, and the addition of one narrower-network silver

plan from the existing AllWays carrier

Small Group 2021

Issuers Platinum Gold Silver Bronze Catastrophic Total 2021Total 2020 for

Comparison

AllWays Health Partners 1 2 4 1 N/A 8 7

Blue Cross Blue Shield 1 2 3 1 N/A 7 7

BMC HealthNet Plan 1 2 3 1 N/A 7 7

Fallon Health 2 4 6 2 N/A 14 15

Health New England 1 3 2 2 N/A 8 7

Harvard Pilgrim Health Care 1 3 2 2 N/A 8 7

Tufts Health Plan - Direct 1 2 2 2 N/A 7 7

Tufts Health Plan - Premier 1 2 3 1 N/A 7 6

United 1 2 2 1 N/A 6 6

Total 2021 10 22 27 13 N/A 72

Total 2020 for Comparison 10 23 25 11 N/A 69

QHPs: Unsubsidized & APTC-only Non-Group

Premium Changes

On average, unsubsidized and APTC-only non-group members will

experience a 7.7% rate increase before aging, and 9.4% after accounting

for aging, though increases vary by metallic tier.

9

Unsubsidized & APTC-only Average Changes in Premium by Tier, before Subsidies: 2020 to 2021 1,2

Platinum Gold 3

1 Non-group enrollment data from August 20202 Enrollment-weighted premium change with and without member aging (~2%), assumes mapping to 2021 renewal plan3 Some 2020 High Gold plan members will be mapped into a Low Gold plan, accounting for the relatively lower rate increase on the Gold tier

All Plans

(without

“aging”)

10.2% 2.2% 9.9% 7.2% 9.3%

All Plans (with

“aging”)12.0% 3.8% 11.7% 8.9% 11.1%

Bronze Catastrophic

3,870 members 8,558 members 25,607 members 34,560 members 840 members

Silver

QHPs: Unsubsidized & APTC-only Non-Group

Premium Changes (cont’d)

Premium changes vary significantly by carrier, compared to average

increases.

10

Unsubsidized & APTC-only Average Changes in Premium by Carrier: 2020 to 2021

Carriers Membership Share1 Premium Change (with

aging)2

Example of 2021 Silver

Plan Premium3

Tufts Health Plan – Direct 56% 12.9% $419.98

Tufts Health Plan – Premier 11% 8.6% $481.57

BMC HealthNet Plan 10% 4.8% $408.50

AllWays Health Partners 7% 6.7% $526.54

Blue Cross Blue Shield 7% 7.1% $591.49

Fallon Health 3% 4.8% $408.95

Health New England 3% 2.6% $368.50

Harvard Pilgrim Health Care 3% 3.0% $536.83

UnitedHealthcare 0.6% 13.5% $587.90

OVERALL 100% 9.4%

1 Enrollment data as of August 20202 Enrollment-weighted non-group premium change (2020 actuals to 2021 calculated) with member aging (~2%), assumes mapping to 2021

renewal plan3 2021 silver premium for an unsubsidized 40-year-old in Worcester for all carriers except United, which reflects a Boston-area premium as United

is only offered in the Boston area. For carriers with more than one silver plan, the premium for their base ConnectorCare silver plan is shown

QHPs: Unsubsidized and APTC-Only Non-

Group Premium Ranges

Unsubsidized and APTC-only enrollees will have products with a range

of premium costs available in each metallic tier.

11

1 Premiums reflect an unsubsidized 42 year-old individual in Worcester

Qualified Health Plans: ConnectorCare

2021 ConnectorCare Participation Changes

In PY 2021, HNE will expand its ConnectorCare geographic coverage, and

AllWays will offer a narrower ConnectorCare network and contract its

geographic coverage area.

▪ HNE plans to offer a larger geographic coverage area in PY 2021, newly entering Worcester County

• HNE currently offers unsubsidized and APTC-only coverage in Worcester County and meets

ConnectorCare network adequacy standards

• HNE’s Worcester County rates are competitive, placing them in the lowest-cost spot among

available carriers in the region

▪ As noted previously, in a change from its initial SOA submission, AllWays will continue to participate in

the ConnectorCare program under its existing carrier license, but with a narrower network and smaller

regional coverage area

• The ~550 AllWays ConnectorCare members in Worcester County will no longer have access to an

AllWays ConnectorCare plan due to the carrier’s withdrawal from the county

• AllWays added hospitals to the Select network in Bristol, Middlesex, Norfolk, Plymouth, and Suffolk

Counties for PY 2021 since its initial Select network submission in May

• The addition of these hospitals sufficiently addresses Health Connector staff’s concerns with the

adequacy of the network to serve ConnectorCare members, and staff recommend AllWays’

ConnectorCare participation in all proposed geographic regions

• However, some current members in the AllWays service area will still experience provider

disruption as the Select network is narrower than the existing AllWays network

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AllWays Select Network: Member Impact

The AllWays Select network represents broader provider coverage than

AllWays’ initial submission, but it will cause some disruption for

ConnectorCare members.

▪ The addition of hospitals and providers reflects improvements to the Select network in regions of

concern identified by staff, though some counties will have relatively narrower coverage

• At the time of the July Board meeting, in Bristol County, 27% of PCPs, 40% of

obstetricians/gynecologists, and 14% of cardiologists in the broader AllWays network were

retained in the Select network

• Those retention percentages have improved to 60% of PCPs, 50% of ob/gyns, and 35% of

cardiologists

• While provider retention remains low in Bristol and Plymouth Counties compared to other regions,

staff determined the network is sufficient in order to recommend AllWays’ ConnectorCare

participation in these areas

▪ Member disruption will occur as a result of this network change as fewer providers are covered under

the Select network

• Data from AllWays show approximately 17.8% of ConnectorCare members would experience at

least one disrupted relationship with a provider if they enroll in an AllWays Select ConnectorCare

plan in 2021*

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*Data represent AllWays ConnectorCare members as of June 2020 who utilized at least one health service in 2019. As the data does

not include health services utilized in 2020 due to claims lag, the proportion of provider disruption is potentially an undercount.

AllWays Select Network: Member Impact

(cont’d)The Health Connector will encourage AllWays ConnectorCare members to

review their provider coverage via targeted member communications and

online tools, and staff will monitor network performance throughout the plan

year.

▪ Through the Seal of Approval process, staff determine whether carriers’ proposed ConnectorCare

networks meet ConnectorCare network standards. Staff reviewed and determined the proposed networks

satisfy required standards, but also looked in greater detail at renewing member impact, described below

▪ AllWays ConnectorCare members in Worcester County will be mapped to lowest-cost carrier available,

which will be HNE for most members, and BMCHP for members in the westernmost portion of county

▪ Current AllWays members in all other regions will be able to remain with AllWays in PY 2021, but a subset

will experience a disruption in provider relationship

▪ Depending on where members live, they may be able to remain with their existing providers by switching

to a ConnectorCare plan from a different carrier

▪ Health Connector communications leading up to and during Open Enrollment will encourage all current

AllWays ConnectorCare members to check whether their preferred providers are in the new AllWays

Select network; AllWays will also send member mailings highlighting the narrower network

▪ The Health Connector will closely monitor the performance of the Select network through required

network access reports and member grievance reporting

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ConnectorCare: Carriers by Region

The 2021 ConnectorCare program will continue to feature statewide

coverage and access to two or more carriers in many regions.

▪ The chart below shows ConnectorCare carrier positions based on underlying 2021 premiums, relative

to rank ordering in 2020, for each region in the map at right. AllWays Health Partners, BMCHP, Fallon,

HNE, and Tufts Direct will continue to offer ConnectorCare coverage in PY 2021

16

Carriers in green have moved to a lower cost

position relative to 2020. Carriers in red have

moved to a higher cost position.

Region Lowest Cost 2nd Lowest Cost 3rd Lowest Cost 4th Lowest Cost

A1 BMCHP TD HNE

A2 TD HNE

A3 HNE

B1 BMCHP FCHP TD AHP

B2 HNE* BMCHP FCHP TD

C1 BMCHP TD AHP

C2 BMCHP TD FCHP AHP

C3 BMCHP TD FCHP HNE*

D1 BMCHP TD AHP

D2 BMCHP TD AHP FCHP

E1 BMCHP TD AHP

F1 BMCHP TD AHP

F2 AHP

G1 TD BMCHP

G2 AHP

G3 TD BMCHP AHP

*HNE is new to Regions B and C in 2021

ConnectorCare: Enrollee Contributions

The recommended ConnectorCare enrollee premium contributions will ensure

affordability and stability for enrollees, while continuing to promote competitive

pricing among carriers participating in the program.

▪ As in past years, all ConnectorCare members, regardless of where they reside, will have access to at least

one ConnectorCare plan at the Affordability Schedule-defined monthly cost

▪ The Health Connector recommends expanding access for enrollees in many regions to a second

ConnectorCare plan at or near the Affordability Schedule-defined monthly cost

• The 2021 premium stabilization approach provides Plan Type 1 and 2A (<150% FPL) members

additional plan choice at $0 in many regions, and allows for affordable choices for ConnectorCare

enrollees at higher income Plan Types (150%-300% FPL). This approach ensures stability for members

while also reflecting the rank order of underlaying premium rates so as to maintain incentives for

competition

• Carrier availability and pricing support the choice of at least two carriers at the Affordability Schedule-

defined monthly cost for the lowest-income members (<150% FPL) for all but one region (A2, with

Tufts Direct and HNE as offerings)

• Carrier pricing was sufficiently competitive to allow members at higher income levels additional

choices, with three or four plans near the Affordability Scheduled-defined monthly cost in some

regions

• This will minimize enrollee disruptions and promote market stability and carrier competitiveness in a

landscape where premiums continue to be impacted by federal CSR withdrawal

17

Qualified Dental Plans

QDPs: Overview

The Qualified Dental Plan shelf also remains stable from last year, with 12

plans available from two carriers through the Health Connector.

▪ Altus Dental and Delta Dental have submitted plans for certification and sale through the

Health Connector on both the non-group and small group shelves

▪ Blue Cross Blue Shield and Guardian have submitted plans for certification for the small

group market, but as in 2020, are recommended for a waiver of sales through the Health

Connector given sufficiency of existing choice

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Plan Year 2021 (No change from PY 2020)

Carriers Non-GroupSmall

Group

Intent to sell on

exchangeHigh Low Pedi Total

Altus Dental ✓ ✓ ✓ 1 1 1 3

Blue Cross Blue

Shield of MA✓ 1 1 2 4

Delta Dental of MA ✓ ✓ ✓ 2 3 4 9

Guardian ✓ 1 1 1 3

TOTAL 5 6 8 19

All carriers meet product shelf requirements for 2021.

QDPs: Premium Changes

Overall, QDP enrollees will see an average decrease in premiums of 10%.

20

Non-group Dental

Average Changes in Premium by Tier: 2020 to 2021 1

Family High Family Low Pediatric-only

27,183 members2 82,822 members 184 members

-13.8% -7.4% -24.3%

Small Group Dental

Average Changes in Premium by Tier: 2020 to 2021 1

Dental Average Changes in Premium by Carrier: 2020-2021

CarriersNon-group

Membership Share2

Non-Group

Premium Change1

Small

Group Membership Share2

Small Group

Premium Change1

Altus Dental 13% -35.3% 15% -1.9%

Delta Dental of MA 87% -4.3% 85% -11.2%

OVERALL -10.1%

1 Enrollment-weighted average premiums for plans sold through the Health Connector only.2 Enrollment as of August 2020

Family High Family Low

1,440 members2 644 members

-9.4% -11.0%

Vote

VOTE

The Health Connector recommends awarding the 2021 Final Seal of Approval to

all recommended QHPs and QDPs proposed by the following carriers:

▪ AllWays Health Partners

▪ Altus Dental

▪ Blue Cross Blue Shield of MA

▪ Boston Medical Center HealthNet Plan

▪ Delta Dental of MA

▪ Fallon Health

▪ Guardian

▪ Harvard Pilgrim Health Care

▪ Health New England

▪ Tufts Health Plan – Direct

▪ Tufts Health Plan – Premier

▪ UnitedHealthcare

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2021 Seal of Approval: Supplemental Materials

24

2021 Standard Qualified Health Plan DesignsPlan Feature/ Service

Note: “Deductible then…” means the member must first meet the

plan’s deductible; then, the member pays only the copay as listed for

in-network services.

Platinum High Gold High SilverLow Silver

(HSA compatible,

Small Group Only)

Bronze #1 Bronze #2(HSA compatible)

Annual Deductible – Combined$0 $0 $2,000 $2,000 $2,700 $3,600

$0 $0 $4,000 $4,000 $5,400 $7,200

Annual Deductible – MedicalN/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

Annual Deductible – Prescription DrugsN/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

Annual Out-of-Pocket Maximum$3,000 $5,000 $8,550 $6,850 $8,550 $7,000

$6,000 $10,000 $17,100 $13,700 $17,100 $14,000

Primary Care Provider (PCP) Office Visits and

Mental/Behavioral Health Outpatient Services$20 $25 $25 Deductible then $30 Deductible then $40 Deductible then $100

Specialist Office Visits $40 $50 $50 Deductible then $60 Deductible then $90 Deductible then $150

Urgent Care $40 $50 $50 Deductible then $60 Deductible then $90 Deductible then $150

Emergency Room $150 $300 Deductible then $300 Deductible then $300 Deductible then $750 Deductible then $1,750

Emergency Transportation $0 $0 Deductible then $0 Deductible then $0 Deductible then $0 Deductible then $0

Inpatient Hospitalization $500 $750 Deductible then $1,000 Deductible then $750 Deductible then $1,200 Deductible then $2,000

Skilled Nursing Facility $500 $750 Deductible then $1,000 Deductible then $750 Deductible then $1,200 Deductible then $2,000

Durable Medical Equipment 20 percent 20 percentDeductible then 20

percent

Deductible then 20

percent

Deductible then 20

percent

Deductible then 20

percent

Rehabilitative Occupational and Rehabilitative Physical Therapy $40 $50 $50 Deductible then $60 Deductible then $90 Deductible then $150

Laboratory Outpatient and Professional Services $0 $50 Deductible then $50 Deductible then $60 Deductible then $75 Deductible then $55

X-rays and Diagnostic Imaging $0 $75 Deductible then $75 Deductible then $75 Deductible then $100 Deductible then $140

High-Cost Imaging $150 $400 Deductible then $400 Deductible then $500 Deductible then $1,000 Deductible then $1,000

Outpatient Surgery: Ambulatory Surgery Center $250 $500 Deductible then $500 Deductible then $500 Deductible then $500 Deductible then $500

Outpatient Surgery: Physician/Surgical Services $0 $0 Deductible then $0 Deductible then $0 Deductible then $0 Deductible then $0

Prescription Drug

Retail Tier 1 $10 $25 $25 Deductible then $30 $30 Deductible then $30

Retail Tier 2 $25 $50 $50 Deductible then $60 Deductible then $100 Deductible then $150

Retail Tier 3 $50 $75 Deductible then $75 Deductible then $105 Deductible then $150 Deductible then $225

Mail Tier 1 $20 $50 $50 Deductible then $60 $60 Deductible then $60

Mail Tier 2 $50 $100 $100 Deductible then $120 Deductible then $200 Deductible then $300

Mail Tier 3 $150 $225 Deductible then $225 Deductible then $315 Deductible then $450 Deductible then $675

Federal Actuarial Value Calculator 89.25 percent 81.40 percent 71.97 percent 69.10 percent 64.98 percent 64.98 percent

Bold indicates changes from 2020.

ConnectorCare: 2021 Plan Designs

25

2021 ConnectorCare Enrollee Contributions

Region A1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 BMC $0 $0 $46 $89 $133

2 Tufts Direct $0 $0 $51 $101 $146

3 HNE $77 $78 $126 $171 $217

Region A2Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts Direct $0 $0 $46 $89 $133

2 HNE $15 $52 $110 $156 $201

Region A3Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 HNE $0 $0 $46 $89 $133

Region B1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 BMC $0 $0 $46 $89 $133

2 Fallon $0 $0 $46 $89 $133

3 Tufts Direct $0 $0 $51 $100 $144

4AllWays Health

Partners$138 $132 $181 $225 $272

Region C1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 BMC $0 $0 $46 $89 $133

2 Tufts Direct $0 $0 $51 $100 $144

3AllWays Health

Partners$191 $187 $237 $280 $325

Region D1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 BMC $0 $0 $46 $89 $133

2 Tufts Direct $0 $0 $50 $99 $144

3AllWays Health

Partners$162 $163 $213 $257 $303

Region E1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 BMC $0 $0 $46 $89 $133

2 Tufts Direct $0 $0 $51 $100 $145

3AllWays Health

Partners$220 $221 $272 $315 $359

Region F1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 BMC $0 $0 $46 $89 $133

2 Tufts Direct $0 $0 $51 $100 $145

3AllWays Health

Partners$208 $206 $257 $302 $350

Region

F2

Enrollee Premium Contribution By

Plan Type

1 2A 2B 3A 3B

1AllWays Health

Partners$0 $0 $46 $89 $133

Region

G1

Enrollee Premium Contribution By

Plan Type

1 2A 2B 3A 3B

1 Tufts Direct $0 $0 $46 $89 $133

2 BMC $0 $0 $55 $109 $155

Region G2Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1AllWays Health

Partners$0 $0 $46 $89 $133

Region C2Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 BMC $0 $0 $46 $89 $133

2 Tufts Direct $0 $0 $51 $100 $144

3 Fallon $0 $0 $52 $102 $147

4AllWays Health

Partners$191 $187 $237 $280 $325

Region G3Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts Direct $0 $0 $46 $89 $133

2 BMC $0 $0 $55 $109 $155

3AllWays Health

Partners$243 $256 $314 $359 $404

Region D2Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 BMC $0 $0 $46 $89 $133

2 Tufts Direct $0 $0 $50 $99 $144

3AllWays Health

Partners$162 $163 $213 $257 $303

4 Fallon $210 $210 $262 $305 $352

Region B2Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 HNE $0 $0 $46 $89 $133

2 BMC $0 $0 $62 $126 $173

3 Fallon $0 $0 $62 $126 $174

4 Tufts Direct $26 $57 $105 $148 $194

Region C3Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 BMC $0 $0 $46 $89 $133

2 Tufts Direct $0 $0 $51 $100 $144

3 Fallon $0 $0 $52 $102 $147

4 HNE $0 $0 $52 $103 $148

26

Qualified Dental Plans:

2021 Standardized Plan Designs

27

Plan Feature/ Service Family High Family Low Pediatric-only

Plan Year Deductible $50/$150 $50/$150 $50

Deductible Applies toMajor and Minor

Restorative

Major and Minor

Restorative

Major and Minor

Restorative

Plan Year Max (>=19 only) $1,250 $750 N/A

Plan Year MOOP <19 Only$350 (1 child)

$700 (2+ children)

$350 (1 child)

$700 (2+ children)$350 (1 child)

Preventive & Diagnostic Co-Insurance (In/out-of-Network) 0%/20% 0%/20% 0%/20%

Minor Restorative Co-Insurance (In/out-of-Network) 25%/45% 25%/45% 25%/45%

Major Restorative Co-Insurance (In/out-of-Network) 50%/70%

50%/70%

No Major Restorative

>=19

50%/70%

Medically Necessary Orthodontia, <19 only (In/out-of-

Network)50%/70% 50%/70% 50%/70%

Non-Medically Necessary Orthodontia, <19 only (In/out-of-

Network)N/A N/A N/A