73.03.333.1-01 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 1 Counties – Monthly Rates (Effective 01/01/2016*) Monroe, Wayne

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $127.75 $127.75

21 $201.18 $221.30 22 $201.18 $221.30 23 $201.18 $221.30 24 $201.18 $221.30 25 $201.98 $222.18 26 $206.01 $226.61 27 $210.84 $231.92 28 $218.68 $240.55 29 $225.12 $247.63 30 $228.34 $251.17 31 $233.17 $256.48 32 $238.00 $261.80 33 $241.01 $265.12 34 $244.23 $268.66 35 $245.84 $270.43 36 $247.45 $272.20 37 $249.06 $273.97 38 $250.67 $275.74 39 $253.89 $279.28 40 $257.11 $282.82 41 $261.94 $288.13 42 $266.56 $293.22 43 $273.00 $300.30 44 $281.05 $309.15 45 $290.50 $319.55 46 $301.77 $331.95 47 $314.44 $345.89 48 $328.93 $361.82 49 $343.21 $377.53 50 $359.31 $395.24 51 $375.20 $412.72 52 $392.70 $431.97 53 $410.41 $451.45 54 $429.52 $472.47 55 $448.63 $493.49 56 $469.35 $516.29 57 $490.28 $539.30 58 $512.61 $563.87 59 $523.67 $576.04 60 $546.00 $600.60 61 $565.32 $621.85 62 $577.99 $635.79 63 $593.88 $653.27 64 $603.34 $663.67 65+** $603.34 $663.67

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $129.41 $129.41

21 $203.79 $224.17 22 $203.79 $224.17 23 $203.79 $224.17 24 $203.79 $224.17 25 $204.60 $225.07 26 $208.68 $229.55 27 $213.57 $234.93 28 $221.52 $243.67 29 $228.04 $250.84 30 $231.30 $254.43 31 $236.19 $259.81 32 $241.08 $265.19 33 $244.14 $268.55 34 $247.40 $272.14 35 $249.03 $273.93 36 $250.66 $275.73 37 $252.29 $277.52 38 $253.92 $279.31 39 $257.18 $282.90 40 $260.44 $286.49 41 $265.33 $291.87 42 $270.02 $297.02 43 $276.54 $304.20 44 $284.69 $313.16 45 $294.27 $323.70 46 $305.68 $336.25 47 $318.52 $350.38 48 $333.20 $366.52 49 $347.67 $382.43 50 $363.97 $400.37 51 $380.07 $418.07 52 $397.80 $437.58 53 $415.73 $457.30 54 $435.09 $478.60 55 $454.45 $499.90 56 $475.44 $522.99 57 $496.64 $546.30 58 $519.26 $571.18 59 $530.46 $583.51 60 $553.09 $608.39 61 $572.65 $629.91 62 $585.49 $644.04 63 $601.59 $661.75 64 $611.17 $672.28 65+** $611.17 $672.28

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $150.11 $150.11

21 $236.39 $260.03 22 $236.39 $260.03 23 $236.39 $260.03 24 $236.39 $260.03 25 $237.34 $261.07 26 $242.07 $266.27 27 $247.74 $272.51 28 $256.96 $282.66 29 $264.52 $290.98 30 $268.31 $295.14 31 $273.98 $301.38 32 $279.65 $307.62 33 $283.20 $311.52 34 $286.98 $315.68 35 $288.87 $317.76 36 $290.76 $319.84 37 $292.66 $321.92 38 $294.55 $324.00 39 $298.33 $328.16 40 $302.11 $332.32 41 $307.78 $338.56 42 $313.22 $344.54 43 $320.79 $352.86 44 $330.24 $363.27 45 $341.35 $375.49 46 $354.59 $390.05 47 $369.48 $406.43 48 $386.50 $425.15 49 $403.29 $443.62 50 $422.20 $464.42 51 $440.87 $484.96 52 $461.44 $507.58 53 $482.24 $530.47 54 $504.70 $555.17 55 $527.16 $579.87 56 $551.51 $606.66 57 $576.09 $633.70 58 $602.33 $662.56 59 $615.33 $676.87 60 $641.57 $705.73 61 $664.27 $730.69 62 $679.16 $747.07 63 $697.83 $767.62 64 $708.94 $779.84 65+** $708.94 $779.84

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-02 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 2 Counties – Monthly Rates (Effective 01/01/2016*) Macomb, Oakland

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $125.24 $125.24

21 $197.24 $216.96 22 $197.24 $216.96 23 $197.24 $216.96 24 $197.24 $216.96 25 $198.02 $217.83 26 $201.97 $222.17 27 $206.70 $227.37 28 $214.39 $235.83 29 $220.71 $242.78 30 $223.86 $246.25 31 $228.60 $251.46 32 $233.33 $256.66 33 $236.29 $259.92 34 $239.44 $263.39 35 $241.02 $265.12 36 $242.60 $266.86 37 $244.18 $268.60 38 $245.76 $270.33 39 $248.91 $273.80 40 $252.07 $277.27 41 $256.80 $282.48 42 $261.34 $287.47 43 $267.65 $294.41 44 $275.54 $303.09 45 $284.81 $313.29 46 $295.85 $325.44 47 $308.28 $339.11 48 $322.48 $354.73 49 $336.48 $370.13 50 $352.26 $387.49 51 $367.84 $404.63 52 $385.00 $423.50 53 $402.36 $442.60 54 $421.10 $463.21 55 $439.84 $483.82 56 $460.15 $506.17 57 $480.66 $528.73 58 $502.56 $552.81 59 $513.40 $564.74 60 $535.30 $588.83 61 $554.23 $609.65 62 $566.66 $623.32 63 $582.24 $640.46 64 $591.51 $650.66 65+** $591.51 $650.66

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $126.87 $126.87

21 $199.79 $219.77 22 $199.79 $219.77 23 $199.79 $219.77 24 $199.79 $219.77 25 $200.59 $220.65 26 $204.59 $225.05 27 $209.38 $230.32 28 $217.18 $238.89 29 $223.57 $245.93 30 $226.77 $249.44 31 $231.56 $254.72 32 $236.36 $259.99 33 $239.35 $263.29 34 $242.55 $266.80 35 $244.15 $268.56 36 $245.75 $270.32 37 $247.34 $272.08 38 $248.94 $273.84 39 $252.14 $277.35 40 $255.34 $280.87 41 $260.13 $286.14 42 $264.73 $291.20 43 $271.12 $298.23 44 $279.11 $307.02 45 $288.50 $317.35 46 $299.69 $329.66 47 $312.28 $343.51 48 $326.66 $359.33 49 $340.85 $374.93 50 $356.83 $392.52 51 $372.62 $409.88 52 $390.00 $429.00 53 $407.58 $448.34 54 $426.56 $469.22 55 $445.54 $490.09 56 $466.12 $512.73 57 $486.90 $535.59 58 $509.07 $559.98 59 $520.06 $572.07 60 $542.24 $596.46 61 $561.42 $617.56 62 $574.01 $631.41 63 $589.79 $648.77 64 $599.18 $659.10 65+** $599.18 $659.10

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $147.17 $147.17

21 $231.76 $254.93 22 $231.76 $254.93 23 $231.76 $254.93 24 $231.76 $254.93 25 $232.69 $255.95 26 $237.32 $261.05 27 $242.88 $267.17 28 $251.92 $277.11 29 $259.34 $285.27 30 $263.05 $289.35 31 $268.61 $295.47 32 $274.17 $301.59 33 $277.65 $305.41 34 $281.35 $309.49 35 $283.21 $311.53 36 $285.06 $313.57 37 $286.92 $315.61 38 $288.77 $317.65 39 $292.48 $321.73 40 $296.19 $325.81 41 $301.75 $331.92 42 $307.08 $337.79 43 $314.50 $345.95 44 $323.77 $356.14 45 $334.66 $368.12 46 $347.64 $382.40 47 $362.24 $398.46 48 $378.92 $416.82 49 $395.38 $434.92 50 $413.92 $455.31 51 $432.23 $475.45 52 $452.39 $497.63 53 $472.79 $520.07 54 $494.80 $544.28 55 $516.82 $568.50 56 $540.69 $594.76 57 $564.80 $621.27 58 $590.52 $649.57 59 $603.27 $663.59 60 $628.99 $691.89 61 $651.24 $716.36 62 $665.84 $732.43 63 $684.15 $752.57 64 $695.04 $764.55 65+** $695.04 $764.55

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-03 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 3 Counties – Monthly Rates (Effective 01/01/2016*) Saint Clair

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $134.51 $134.51

21 $211.83 $233.01 22 $211.83 $233.01 23 $211.83 $233.01 24 $211.83 $233.01 25 $212.68 $233.95 26 $216.91 $238.61 27 $222.00 $244.20 28 $230.26 $253.29 29 $237.04 $260.74 30 $240.43 $264.47 31 $245.51 $270.06 32 $250.60 $275.66 33 $253.77 $279.15 34 $257.16 $282.88 35 $258.86 $284.74 36 $260.55 $286.61 37 $262.25 $288.47 38 $263.94 $290.34 39 $267.33 $294.06 40 $270.72 $297.79 41 $275.80 $303.38 42 $280.68 $308.74 43 $287.45 $316.20 44 $295.93 $325.52 45 $305.88 $336.47 46 $317.75 $349.52 47 $331.09 $364.20 48 $346.34 $380.98 49 $361.38 $397.52 50 $378.33 $416.16 51 $395.06 $434.57 52 $413.49 $454.84 53 $432.14 $475.35 54 $452.26 $497.48 55 $472.38 $519.62 56 $494.20 $543.62 57 $516.23 $567.86 58 $539.75 $593.72 59 $551.40 $606.54 60 $574.91 $632.40 61 $595.24 $654.77 62 $608.59 $669.45 63 $625.32 $687.86 64 $635.28 $698.81 65+** $635.28 $698.81

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $136.26 $136.26

21 $214.58 $236.04 22 $214.58 $236.04 23 $214.58 $236.04 24 $214.58 $236.04 25 $215.44 $236.98 26 $219.73 $241.70 27 $224.88 $247.37 28 $233.25 $256.57 29 $240.11 $264.12 30 $243.55 $267.90 31 $248.70 $273.57 32 $253.85 $279.23 33 $257.07 $282.77 34 $260.50 $286.55 35 $262.22 $288.44 36 $263.93 $290.32 37 $265.65 $292.21 38 $267.37 $294.10 39 $270.80 $297.88 40 $274.23 $301.65 41 $279.38 $307.32 42 $284.32 $312.75 43 $291.18 $320.30 44 $299.77 $329.74 45 $309.85 $340.84 46 $321.87 $354.05 47 $335.39 $368.93 48 $350.84 $385.92 49 $366.07 $402.68 50 $383.24 $421.56 51 $400.19 $440.21 52 $418.86 $460.74 53 $437.74 $481.51 54 $458.13 $503.94 55 $478.51 $526.36 56 $500.61 $550.67 57 $522.93 $575.22 58 $546.75 $601.42 59 $558.55 $614.40 60 $582.37 $640.60 61 $602.97 $663.26 62 $616.48 $678.13 63 $633.44 $696.78 64 $643.52 $707.87 65+** $643.52 $707.87

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $158.06 $158.06

21 $248.91 $273.80 22 $248.91 $273.80 23 $248.91 $273.80 24 $248.91 $273.80 25 $249.90 $274.89 26 $254.88 $280.37 27 $260.86 $286.94 28 $270.56 $297.62 29 $278.53 $306.38 30 $282.51 $310.76 31 $288.48 $317.33 32 $294.46 $323.90 33 $298.19 $328.01 34 $302.17 $332.39 35 $304.17 $334.58 36 $306.16 $336.77 37 $308.15 $338.96 38 $310.14 $341.15 39 $314.12 $345.53 40 $318.10 $349.92 41 $324.08 $356.49 42 $329.80 $362.78 43 $337.77 $371.55 44 $347.73 $382.50 45 $359.42 $395.37 46 $373.36 $410.70 47 $389.04 $427.95 48 $406.97 $447.66 49 $424.64 $467.10 50 $444.55 $489.01 51 $464.21 $510.64 52 $485.87 $534.46 53 $507.77 $558.55 54 $531.42 $584.56 55 $555.07 $610.57 56 $580.70 $638.77 57 $606.59 $667.25 58 $634.22 $697.64 59 $647.91 $712.70 60 $675.54 $743.09 61 $699.43 $769.38 62 $715.11 $786.63 63 $734.78 $808.26 64 $746.48 $821.12 65+** $746.48 $821.12

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-04 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 4 Counties – Monthly Rates (Effective 01/01/2016*) Lenawee, Livingston, Washtenaw

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $150.29 $150.29

21 $236.68 $260.35 22 $236.68 $260.35 23 $236.68 $260.35 24 $236.68 $260.35 25 $237.63 $261.39 26 $242.36 $266.60 27 $248.04 $272.85 28 $257.27 $283.00 29 $264.85 $291.33 30 $268.63 $295.50 31 $274.32 $301.75 32 $280.00 $308.00 33 $283.55 $311.90 34 $287.33 $316.07 35 $289.23 $318.15 36 $291.12 $320.23 37 $293.01 $322.31 38 $294.91 $324.40 39 $298.69 $328.56 40 $302.48 $332.73 41 $308.16 $338.98 42 $313.60 $344.96 43 $321.18 $353.30 44 $330.65 $363.71 45 $341.77 $375.95 46 $355.02 $390.53 47 $369.93 $406.93 48 $386.98 $425.67 49 $403.78 $444.16 50 $422.72 $464.99 51 $441.41 $485.55 52 $462.00 $508.20 53 $482.83 $531.12 54 $505.32 $555.85 55 $527.80 $580.58 56 $552.18 $607.40 57 $576.80 $634.47 58 $603.07 $663.37 59 $616.08 $677.69 60 $642.36 $706.59 61 $665.08 $731.59 62 $679.99 $747.99 63 $698.69 $768.56 64 $709.81 $780.79 65+** $709.81 $780.79

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $152.24 $152.24

21 $239.75 $263.73 22 $239.75 $263.73 23 $239.75 $263.73 24 $239.75 $263.73 25 $240.71 $264.78 26 $245.51 $270.06 27 $251.26 $276.39 28 $260.61 $286.67 29 $268.28 $295.11 30 $272.12 $299.33 31 $277.87 $305.66 32 $283.63 $311.99 33 $287.22 $315.95 34 $291.06 $320.17 35 $292.98 $322.28 36 $294.90 $324.39 37 $296.81 $326.50 38 $298.73 $328.61 39 $302.57 $332.82 40 $306.40 $337.04 41 $312.16 $343.37 42 $317.67 $349.44 43 $325.34 $357.88 44 $334.93 $368.43 45 $346.20 $380.82 46 $359.63 $395.59 47 $374.73 $412.21 48 $392.00 $431.20 49 $409.02 $449.92 50 $428.20 $471.02 51 $447.14 $491.85 52 $468.00 $514.80 53 $489.10 $538.01 54 $511.87 $563.06 55 $534.65 $588.11 56 $559.34 $615.28 57 $584.28 $642.71 58 $610.89 $671.98 59 $624.08 $686.48 60 $650.69 $715.76 61 $673.71 $741.08 62 $688.81 $757.69 63 $707.75 $778.53 64 $719.02 $790.92 65+** $719.02 $790.92

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $176.60 $176.60

21 $278.11 $305.92 22 $278.11 $305.92 23 $278.11 $305.92 24 $278.11 $305.92 25 $279.22 $307.14 26 $284.78 $313.26 27 $291.46 $320.61 28 $302.31 $332.54 29 $311.21 $342.33 30 $315.65 $347.22 31 $322.33 $354.56 32 $329.00 $361.90 33 $333.18 $366.49 34 $337.63 $371.39 35 $339.85 $373.84 36 $342.08 $376.28 37 $344.30 $378.73 38 $346.53 $381.18 39 $350.97 $386.07 40 $355.42 $390.97 41 $362.10 $398.31 42 $368.50 $405.35 43 $377.40 $415.13 44 $388.52 $427.37 45 $401.59 $441.75 46 $417.16 $458.88 47 $434.69 $478.15 48 $454.71 $500.18 49 $474.46 $521.90 50 $496.70 $546.37 51 $518.68 $570.54 52 $542.87 $597.16 53 $567.34 $624.08 54 $593.76 $653.14 55 $620.19 $682.20 56 $648.83 $713.71 57 $677.75 $745.53 58 $708.62 $779.49 59 $723.92 $796.31 60 $754.79 $830.27 61 $781.49 $859.64 62 $799.01 $878.91 63 $820.98 $903.08 64 $834.05 $917.46 65+** $834.05 $917.46

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-05 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 5 Counties – Monthly Rates (Effective 01/01/2016*) Genesee, Lapeer, Shiawassee

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $142.78 $142.78

21 $224.85 $247.33 22 $224.85 $247.33 23 $224.85 $247.33 24 $224.85 $247.33 25 $225.75 $248.32 26 $230.24 $253.27 27 $235.64 $259.21 28 $244.41 $268.85 29 $251.61 $276.77 30 $255.20 $280.72 31 $260.60 $286.66 32 $266.00 $292.60 33 $269.37 $296.31 34 $272.97 $300.26 35 $274.76 $302.24 36 $276.56 $304.22 37 $278.36 $306.20 38 $280.16 $308.18 39 $283.76 $312.13 40 $287.36 $316.09 41 $292.75 $322.03 42 $297.92 $327.72 43 $305.12 $335.63 44 $314.11 $345.52 45 $324.68 $357.15 46 $337.27 $371.00 47 $351.44 $386.58 48 $367.63 $404.39 49 $383.59 $421.95 50 $401.58 $441.74 51 $419.34 $461.28 52 $438.90 $482.79 53 $458.69 $504.56 54 $480.05 $528.06 55 $501.41 $551.55 56 $524.57 $577.03 57 $547.96 $602.75 58 $572.91 $630.21 59 $585.28 $643.81 60 $610.24 $671.26 61 $631.82 $695.01 62 $645.99 $710.59 63 $663.75 $730.13 64 $674.32 $741.75 65+** $674.32 $741.75

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $144.63 $144.63

21 $227.77 $250.54 22 $227.77 $250.54 23 $227.77 $250.54 24 $227.77 $250.54 25 $228.68 $251.54 26 $233.23 $256.55 27 $238.70 $262.57 28 $247.58 $272.34 29 $254.87 $280.36 30 $258.51 $284.36 31 $263.98 $290.38 32 $269.45 $296.39 33 $272.86 $300.15 34 $276.51 $304.16 35 $278.33 $306.16 36 $280.15 $308.17 37 $281.97 $310.17 38 $283.80 $312.17 39 $287.44 $316.18 40 $291.08 $320.19 41 $296.55 $326.21 42 $301.79 $331.97 43 $309.08 $339.98 44 $318.19 $350.01 45 $328.89 $361.78 46 $341.65 $375.81 47 $356.00 $391.60 48 $372.40 $409.64 49 $388.57 $427.42 50 $406.79 $447.47 51 $424.78 $467.26 52 $444.60 $489.06 53 $464.64 $511.10 54 $486.28 $534.91 55 $507.92 $558.71 56 $531.38 $584.51 57 $555.06 $610.57 58 $580.35 $638.38 59 $592.87 $652.16 60 $618.15 $679.97 61 $640.02 $704.02 62 $654.37 $719.81 63 $672.36 $739.60 64 $683.07 $751.37 65+** $683.07 $751.37

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $167.77 $167.77

21 $264.20 $290.62 22 $264.20 $290.62 23 $264.20 $290.62 24 $264.20 $290.62 25 $265.26 $291.79 26 $270.55 $297.60 27 $276.89 $304.57 28 $287.19 $315.91 29 $295.64 $325.21 30 $299.87 $329.86 31 $306.21 $336.83 32 $312.55 $343.81 33 $316.52 $348.17 34 $320.74 $352.82 35 $322.86 $355.14 36 $324.97 $357.47 37 $327.09 $359.79 38 $329.20 $362.12 39 $333.43 $366.77 40 $337.65 $371.42 41 $343.99 $378.39 42 $350.07 $385.08 43 $358.53 $394.38 44 $369.09 $406.00 45 $381.51 $419.66 46 $396.31 $435.94 47 $412.95 $454.25 48 $431.97 $475.17 49 $450.73 $495.81 50 $471.87 $519.06 51 $492.74 $542.02 52 $515.73 $567.30 53 $538.98 $592.87 54 $564.08 $620.48 55 $589.18 $648.09 56 $616.39 $678.03 57 $643.87 $708.25 58 $673.19 $740.51 59 $687.72 $756.50 60 $717.05 $788.76 61 $742.41 $816.66 62 $759.06 $834.97 63 $779.93 $857.92 64 $792.35 $871.58 65+** $792.35 $871.58

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-06 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 6 Counties – Monthly Rates (Effective 01/01/2016*) Huron, Sanilac, Tuscola

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $124.62 $124.62

21 $196.25 $215.87 22 $196.25 $215.87 23 $196.25 $215.87 24 $196.25 $215.87 25 $197.03 $216.74 26 $200.96 $221.06 27 $205.67 $226.24 28 $213.32 $234.66 29 $219.60 $241.56 30 $222.74 $245.02 31 $227.45 $250.20 32 $232.16 $255.38 33 $235.11 $258.62 34 $238.25 $262.07 35 $239.82 $263.80 36 $241.39 $265.53 37 $242.96 $267.25 38 $244.53 $268.98 39 $247.67 $272.43 40 $250.81 $275.89 41 $255.52 $281.07 42 $260.03 $286.03 43 $266.31 $292.94 44 $274.16 $301.58 45 $283.38 $311.72 46 $294.37 $323.81 47 $306.74 $337.41 48 $320.87 $352.95 49 $334.80 $368.28 50 $350.50 $385.55 51 $366.00 $402.61 52 $383.08 $421.39 53 $400.35 $440.38 54 $418.99 $460.89 55 $437.64 $481.40 56 $457.85 $503.63 57 $478.26 $526.09 58 $500.04 $550.05 59 $510.84 $561.92 60 $532.62 $585.88 61 $551.46 $606.61 62 $563.82 $620.21 63 $579.33 $637.26 64 $588.55 $647.41 65+** $588.55 $647.41

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $126.23 $126.23

21 $198.79 $218.67 22 $198.79 $218.67 23 $198.79 $218.67 24 $198.79 $218.67 25 $199.59 $219.55 26 $203.57 $223.92 27 $208.34 $229.17 28 $216.09 $237.70 29 $222.45 $244.70 30 $225.63 $248.20 31 $230.40 $253.44 32 $235.17 $258.69 33 $238.16 $261.97 34 $241.34 $265.47 35 $242.93 $267.22 36 $244.52 $268.97 37 $246.11 $270.72 38 $247.70 $272.47 39 $250.88 $275.97 40 $254.06 $279.47 41 $258.83 $284.71 42 $263.40 $289.74 43 $269.76 $296.74 44 $277.72 $305.49 45 $287.06 $315.77 46 $298.19 $328.01 47 $310.72 $341.79 48 $325.03 $357.53 49 $339.14 $373.06 50 $355.05 $390.55 51 $370.75 $407.83 52 $388.05 $426.85 53 $405.54 $446.10 54 $424.43 $466.87 55 $443.31 $487.64 56 $463.79 $510.17 57 $484.46 $532.91 58 $506.53 $557.18 59 $517.46 $569.21 60 $539.53 $593.48 61 $558.61 $614.48 62 $571.14 $628.25 63 $586.84 $645.53 64 $596.19 $655.80 65+** $596.19 $655.80

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $146.43 $146.43

21 $230.60 $253.66 22 $230.60 $253.66 23 $230.60 $253.66 24 $230.60 $253.66 25 $231.52 $254.67 26 $236.13 $259.75 27 $241.67 $265.84 28 $250.66 $275.73 29 $258.04 $283.84 30 $261.73 $287.90 31 $267.26 $293.99 32 $272.80 $300.08 33 $276.26 $303.88 34 $279.95 $307.94 35 $281.79 $309.97 36 $283.64 $312.00 37 $285.48 $314.03 38 $287.33 $316.06 39 $291.02 $320.12 40 $294.71 $324.18 41 $300.24 $330.26 42 $305.54 $336.10 43 $312.92 $344.22 44 $322.15 $354.36 45 $332.99 $366.28 46 $345.90 $380.49 47 $360.43 $396.47 48 $377.03 $414.73 49 $393.40 $432.74 50 $411.85 $453.04 51 $430.07 $473.07 52 $450.13 $495.14 53 $470.42 $517.47 54 $492.33 $541.56 55 $514.24 $565.66 56 $537.99 $591.79 57 $561.97 $618.17 58 $587.57 $646.32 59 $600.25 $660.28 60 $625.85 $688.43 61 $647.98 $712.78 62 $662.51 $728.76 63 $680.73 $748.80 64 $691.57 $760.72 65+** $691.57 $760.72

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-07 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 7 Counties – Monthly Rates (Effective 01/01/2016*) Clinton, Eaton, Hillsdale, Ingham, Jackson

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $151.55 $151.55

21 $238.65 $262.52 22 $238.65 $262.52 23 $238.65 $262.52 24 $238.65 $262.52 25 $239.61 $263.57 26 $244.38 $268.82 27 $250.11 $275.12 28 $259.42 $285.36 29 $267.05 $293.76 30 $270.87 $297.96 31 $276.60 $304.26 32 $282.33 $310.56 33 $285.91 $314.50 34 $289.73 $318.70 35 $291.64 $320.80 36 $293.55 $322.90 37 $295.45 $325.00 38 $297.36 $327.10 39 $301.18 $331.30 40 $305.00 $335.50 41 $310.73 $341.80 42 $316.22 $347.84 43 $323.85 $356.24 44 $333.40 $366.74 45 $344.62 $379.08 46 $357.98 $393.78 47 $373.02 $410.32 48 $390.20 $429.22 49 $407.15 $447.86 50 $426.24 $468.86 51 $445.09 $489.60 52 $465.85 $512.44 53 $486.86 $535.54 54 $509.53 $560.48 55 $532.20 $585.42 56 $556.78 $612.46 57 $581.60 $639.76 58 $608.09 $668.90 59 $621.22 $683.34 60 $647.71 $712.48 61 $670.62 $737.68 62 $685.66 $754.22 63 $704.51 $774.96 64 $715.73 $787.30 65+** $715.73 $787.30

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $153.51 $153.51

21 $241.75 $265.93 22 $241.75 $265.93 23 $241.75 $265.93 24 $241.75 $265.93 25 $242.72 $266.99 26 $247.55 $272.31 27 $253.35 $278.69 28 $262.78 $289.06 29 $270.52 $297.57 30 $274.39 $301.83 31 $280.19 $308.21 32 $285.99 $314.59 33 $289.62 $318.58 34 $293.49 $322.83 35 $295.42 $324.96 36 $297.35 $327.09 37 $299.29 $329.22 38 $301.22 $331.34 39 $305.09 $335.60 40 $308.96 $339.85 41 $314.76 $346.24 42 $320.32 $352.35 43 $328.06 $360.86 44 $337.73 $371.50 45 $349.09 $384.00 46 $362.63 $398.89 47 $377.86 $415.64 48 $395.26 $434.79 49 $412.43 $453.67 50 $431.77 $474.94 51 $450.87 $495.95 52 $471.90 $519.09 53 $493.17 $542.49 54 $516.14 $567.75 55 $539.10 $593.01 56 $564.00 $620.40 57 $589.15 $648.06 58 $615.98 $677.58 59 $629.28 $692.20 60 $656.11 $721.72 61 $679.32 $747.25 62 $694.55 $764.00 63 $713.65 $785.01 64 $725.01 $797.51 65+** $725.01 $797.51

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $178.07 $178.07

21 $280.43 $308.47 22 $280.43 $308.47 23 $280.43 $308.47 24 $280.43 $308.47 25 $281.55 $309.70 26 $287.16 $315.87 27 $293.89 $323.28 28 $304.82 $335.31 29 $313.80 $345.18 30 $318.29 $350.11 31 $325.02 $357.52 32 $331.75 $364.92 33 $335.95 $369.55 34 $340.44 $374.48 35 $342.68 $376.95 36 $344.93 $379.42 37 $347.17 $381.89 38 $349.41 $384.35 39 $353.90 $389.29 40 $358.39 $394.23 41 $365.12 $401.63 42 $371.57 $408.72 43 $380.54 $418.59 44 $391.76 $430.93 45 $404.94 $445.43 46 $420.64 $462.71 47 $438.31 $482.14 48 $458.50 $504.35 49 $478.41 $526.25 50 $500.84 $550.93 51 $523.00 $575.30 52 $547.39 $602.13 53 $572.07 $629.28 54 $598.71 $658.58 55 $625.35 $687.89 56 $654.24 $719.66 57 $683.40 $751.74 58 $714.53 $785.98 59 $729.95 $802.95 60 $761.08 $837.19 61 $788.00 $866.80 62 $805.67 $886.24 63 $827.82 $910.60 64 $841.00 $925.10 65+** $841.00 $925.10

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-08 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 8 Counties – Monthly Rates (Effective 01/01/2016*) Arenac, Bay, Gratiot, Saginaw

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $138.27 $138.27

21 $217.75 $239.52 22 $217.75 $239.52 23 $217.75 $239.52 24 $217.75 $239.52 25 $218.62 $240.48 26 $222.97 $245.27 27 $228.20 $251.02 28 $236.69 $260.36 29 $243.66 $268.03 30 $247.14 $271.86 31 $252.37 $277.61 32 $257.60 $283.36 33 $260.86 $286.95 34 $264.35 $290.78 35 $266.09 $292.70 36 $267.83 $294.61 37 $269.57 $296.53 38 $271.31 $298.45 39 $274.80 $302.28 40 $278.28 $306.11 41 $283.51 $311.86 42 $288.52 $317.37 43 $295.48 $325.03 44 $304.19 $334.61 45 $314.43 $345.87 46 $326.62 $359.28 47 $340.34 $374.37 48 $356.02 $391.62 49 $371.48 $408.63 50 $388.90 $427.79 51 $406.10 $446.71 52 $425.04 $467.55 53 $444.21 $488.63 54 $464.89 $511.38 55 $485.58 $534.14 56 $508.01 $558.81 57 $530.65 $583.72 58 $554.82 $610.30 59 $566.80 $623.48 60 $590.97 $650.06 61 $611.87 $673.06 62 $625.59 $688.15 63 $642.79 $707.07 64 $653.03 $718.33 65+** $653.03 $718.33

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $140.06 $140.06

21 $220.57 $242.63 22 $220.57 $242.63 23 $220.57 $242.63 24 $220.57 $242.63 25 $221.45 $243.60 26 $225.87 $248.45 27 $231.16 $254.28 28 $239.76 $263.74 29 $246.82 $271.50 30 $250.35 $275.38 31 $255.64 $281.21 32 $260.94 $287.03 33 $264.25 $290.67 34 $267.78 $294.55 35 $269.54 $296.49 36 $271.30 $298.43 37 $273.07 $300.38 38 $274.83 $302.32 39 $278.36 $306.20 40 $281.89 $310.08 41 $287.19 $315.90 42 $292.26 $321.48 43 $299.32 $329.25 44 $308.14 $338.95 45 $318.51 $350.36 46 $330.86 $363.94 47 $344.75 $379.23 48 $360.64 $396.70 49 $376.30 $413.93 50 $393.94 $433.34 51 $411.37 $452.50 52 $430.56 $473.61 53 $449.97 $494.96 54 $470.92 $518.01 55 $491.88 $541.06 56 $514.60 $566.06 57 $537.54 $591.29 58 $562.02 $618.22 59 $574.15 $631.57 60 $598.63 $658.50 61 $619.81 $681.79 62 $633.70 $697.08 63 $651.13 $716.24 64 $661.50 $727.65 65+** $661.50 $727.65

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $162.47 $162.47

21 $255.86 $281.45 22 $255.86 $281.45 23 $255.86 $281.45 24 $255.86 $281.45 25 $256.88 $282.57 26 $262.00 $288.20 27 $268.14 $294.96 28 $278.12 $305.93 29 $286.31 $314.94 30 $290.40 $319.44 31 $296.54 $326.20 32 $302.68 $332.95 33 $306.52 $337.17 34 $310.62 $341.68 35 $312.66 $343.93 36 $314.71 $346.18 37 $316.76 $348.43 38 $318.80 $350.68 39 $322.90 $355.19 40 $326.99 $359.69 41 $333.13 $366.44 42 $339.02 $372.92 43 $347.20 $381.92 44 $357.44 $393.18 45 $369.46 $406.41 46 $383.79 $422.17 47 $399.91 $439.90 48 $418.33 $460.17 49 $436.50 $480.15 50 $456.97 $502.66 51 $477.18 $524.90 52 $499.44 $549.39 53 $521.96 $574.15 54 $546.26 $600.89 55 $570.57 $627.63 56 $596.92 $656.62 57 $623.53 $685.89 58 $651.93 $717.13 59 $666.01 $732.61 60 $694.41 $763.85 61 $718.97 $790.87 62 $735.09 $808.60 63 $755.30 $830.83 64 $767.33 $844.06 65+** $767.33 $844.06

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-09 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 9 Counties – Monthly Rates (Effective 01/01/2016*) Berrien, Cass, Saint Joseph, Van Buren

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $147.79 $147.79

21 $232.74 $256.01 22 $232.74 $256.01 23 $232.74 $256.01 24 $232.74 $256.01 25 $233.67 $257.04 26 $238.32 $262.16 27 $243.91 $268.30 28 $252.99 $278.28 29 $260.43 $286.48 30 $264.16 $290.57 31 $269.74 $296.72 32 $275.33 $302.86 33 $278.82 $306.70 34 $282.54 $310.80 35 $284.41 $312.85 36 $286.27 $314.89 37 $288.13 $316.94 38 $289.99 $318.99 39 $293.72 $323.09 40 $297.44 $327.18 41 $303.02 $333.33 42 $308.38 $339.22 43 $315.83 $347.41 44 $325.13 $357.65 45 $336.07 $369.68 46 $349.11 $384.02 47 $363.77 $400.15 48 $380.53 $418.58 49 $397.05 $436.76 50 $415.67 $457.24 51 $434.06 $477.46 52 $454.30 $499.73 53 $474.79 $522.26 54 $496.90 $546.58 55 $519.01 $570.91 56 $542.98 $597.28 57 $567.18 $623.90 58 $593.02 $652.32 59 $605.82 $666.40 60 $631.65 $694.82 61 $653.99 $719.39 62 $668.66 $735.52 63 $687.04 $755.75 64 $697.98 $767.78 65+** $697.98 $767.78

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $149.71 $149.71

21 $235.76 $259.33 22 $235.76 $259.33 23 $235.76 $259.33 24 $235.76 $259.33 25 $236.70 $260.37 26 $241.42 $265.56 27 $247.07 $271.78 28 $256.27 $281.89 29 $263.81 $290.19 30 $267.58 $294.34 31 $273.24 $300.57 32 $278.90 $306.79 33 $282.44 $310.68 34 $286.21 $314.83 35 $288.09 $316.90 36 $289.98 $318.98 37 $291.87 $321.05 38 $293.75 $323.13 39 $297.53 $327.28 40 $301.30 $331.43 41 $306.96 $337.65 42 $312.38 $343.62 43 $319.92 $351.91 44 $329.35 $362.29 45 $340.43 $374.48 46 $353.64 $389.00 47 $368.49 $405.34 48 $385.46 $424.01 49 $402.20 $442.42 50 $421.06 $463.17 51 $439.69 $483.66 52 $460.20 $506.22 53 $480.94 $529.04 54 $503.34 $553.67 55 $525.74 $578.31 56 $550.02 $605.02 57 $574.54 $631.99 58 $600.71 $660.78 59 $613.68 $675.04 60 $639.84 $703.83 61 $662.48 $728.72 62 $677.33 $745.06 63 $695.95 $765.55 64 $707.03 $777.74 65+** $707.03 $777.74

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $173.66 $173.66

21 $273.47 $300.82 22 $273.47 $300.82 23 $273.47 $300.82 24 $273.47 $300.82 25 $274.57 $302.03 26 $280.04 $308.04 27 $286.60 $315.26 28 $297.27 $326.99 29 $306.02 $336.62 30 $310.39 $341.43 31 $316.96 $348.65 32 $323.52 $355.87 33 $327.62 $360.39 34 $332.00 $365.20 35 $334.19 $367.60 36 $336.37 $370.01 37 $338.56 $372.42 38 $340.75 $374.82 39 $345.13 $379.64 40 $349.50 $384.45 41 $356.06 $391.67 42 $362.35 $398.59 43 $371.11 $408.22 44 $382.04 $420.25 45 $394.90 $434.39 46 $410.21 $451.23 47 $427.44 $470.19 48 $447.13 $491.84 49 $466.55 $513.20 50 $488.43 $537.27 51 $510.03 $561.03 52 $533.82 $587.21 53 $557.89 $613.68 54 $583.87 $642.26 55 $609.85 $670.83 56 $638.02 $701.82 57 $666.46 $733.10 58 $696.81 $766.50 59 $711.85 $783.04 60 $742.21 $816.43 61 $768.46 $845.31 62 $785.69 $864.26 63 $807.30 $888.03 64 $820.15 $902.17 65+** $820.15 $902.17

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-10 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 10 Counties – Monthly Rates (Effective 01/01/2016*) Branch, Calhoun, Kalamazoo

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $144.03 $144.03

21 $226.82 $249.50 22 $226.82 $249.50 23 $226.82 $249.50 24 $226.82 $249.50 25 $227.73 $250.50 26 $232.26 $255.49 27 $237.71 $261.48 28 $246.55 $271.21 29 $253.81 $279.19 30 $257.44 $283.19 31 $262.89 $289.17 32 $268.33 $295.16 33 $271.73 $298.90 34 $275.36 $302.90 35 $277.18 $304.89 36 $278.99 $306.89 37 $280.80 $308.88 38 $282.62 $310.88 39 $286.25 $314.87 40 $289.88 $318.86 41 $295.32 $324.85 42 $300.54 $330.59 43 $307.80 $338.58 44 $316.87 $348.56 45 $327.53 $360.28 46 $340.23 $374.25 47 $354.52 $389.97 48 $370.85 $407.94 49 $386.96 $425.65 50 $405.10 $445.61 51 $423.02 $465.32 52 $442.75 $487.03 53 $462.71 $508.99 54 $484.26 $532.69 55 $505.81 $556.39 56 $529.17 $582.09 57 $552.76 $608.04 58 $577.94 $635.73 59 $590.41 $649.46 60 $615.59 $677.15 61 $637.37 $701.10 62 $651.66 $716.82 63 $669.57 $736.53 64 $680.24 $748.26 65+** $680.24 $748.26

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $145.90 $145.90

21 $229.76 $252.74 22 $229.76 $252.74 23 $229.76 $252.74 24 $229.76 $252.74 25 $230.68 $253.75 26 $235.28 $258.81 27 $240.79 $264.87 28 $249.75 $274.73 29 $257.10 $282.82 30 $260.78 $286.86 31 $266.30 $292.92 32 $271.81 $298.99 33 $275.26 $302.78 34 $278.93 $306.83 35 $280.77 $308.85 36 $282.61 $310.87 37 $284.45 $312.89 38 $286.28 $314.91 39 $289.96 $318.96 40 $293.64 $323.00 41 $299.15 $329.07 42 $304.44 $334.88 43 $311.79 $342.97 44 $320.98 $353.08 45 $331.78 $364.96 46 $344.64 $379.11 47 $359.12 $395.03 48 $375.66 $413.23 49 $391.98 $431.17 50 $410.36 $451.39 51 $428.51 $471.36 52 $448.50 $493.35 53 $468.72 $515.59 54 $490.54 $539.60 55 $512.37 $563.61 56 $536.04 $589.64 57 $559.93 $615.93 58 $585.44 $643.98 59 $598.07 $657.88 60 $623.58 $685.93 61 $645.63 $710.20 62 $660.11 $726.12 63 $678.26 $746.09 64 $689.06 $757.97 65+** $689.06 $757.97

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $169.24 $169.24

21 $266.52 $293.17 22 $266.52 $293.17 23 $266.52 $293.17 24 $266.52 $293.17 25 $267.59 $294.35 26 $272.92 $300.21 27 $279.32 $307.25 28 $289.71 $318.68 29 $298.24 $328.06 30 $302.50 $332.75 31 $308.90 $339.79 32 $315.30 $346.83 33 $319.29 $351.22 34 $323.56 $355.91 35 $325.69 $358.26 36 $327.82 $360.60 37 $329.95 $362.95 38 $332.09 $365.30 39 $336.35 $369.99 40 $340.62 $374.68 41 $347.01 $381.71 42 $353.14 $388.46 43 $361.67 $397.84 44 $372.33 $409.56 45 $384.86 $423.34 46 $399.78 $439.76 47 $416.57 $458.23 48 $435.76 $479.34 49 $454.69 $500.16 50 $476.01 $523.61 51 $497.06 $546.77 52 $520.25 $572.28 53 $543.71 $598.08 54 $569.02 $625.93 55 $594.34 $653.78 56 $621.80 $683.98 57 $649.51 $714.47 58 $679.10 $747.01 59 $693.76 $763.13 60 $723.34 $795.67 61 $748.93 $823.82 62 $765.72 $842.29 63 $786.77 $865.45 64 $799.30 $879.23 65+** $799.30 $879.23

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-11 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 11 Counties – Monthly Rates (Effective 01/01/2016*) Allegan, Barry

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $144.03 $144.03

21 $226.82 $249.50 22 $226.82 $249.50 23 $226.82 $249.50 24 $226.82 $249.50 25 $227.73 $250.50 26 $232.26 $255.49 27 $237.71 $261.48 28 $246.55 $271.21 29 $253.81 $279.19 30 $257.44 $283.19 31 $262.89 $289.17 32 $268.33 $295.16 33 $271.73 $298.90 34 $275.36 $302.90 35 $277.18 $304.89 36 $278.99 $306.89 37 $280.80 $308.88 38 $282.62 $310.88 39 $286.25 $314.87 40 $289.88 $318.86 41 $295.32 $324.85 42 $300.54 $330.59 43 $307.80 $338.58 44 $316.87 $348.56 45 $327.53 $360.28 46 $340.23 $374.25 47 $354.52 $389.97 48 $370.85 $407.94 49 $386.96 $425.65 50 $405.10 $445.61 51 $423.02 $465.32 52 $442.75 $487.03 53 $462.71 $508.99 54 $484.26 $532.69 55 $505.81 $556.39 56 $529.17 $582.09 57 $552.76 $608.04 58 $577.94 $635.73 59 $590.41 $649.46 60 $615.59 $677.15 61 $637.37 $701.10 62 $651.66 $716.82 63 $669.57 $736.53 64 $680.24 $748.26 65+** $680.24 $748.26

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $145.90 $145.90

21 $229.76 $252.74 22 $229.76 $252.74 23 $229.76 $252.74 24 $229.76 $252.74 25 $230.68 $253.75 26 $235.28 $258.81 27 $240.79 $264.87 28 $249.75 $274.73 29 $257.10 $282.82 30 $260.78 $286.86 31 $266.30 $292.92 32 $271.81 $298.99 33 $275.26 $302.78 34 $278.93 $306.83 35 $280.77 $308.85 36 $282.61 $310.87 37 $284.45 $312.89 38 $286.28 $314.91 39 $289.96 $318.96 40 $293.64 $323.00 41 $299.15 $329.07 42 $304.44 $334.88 43 $311.79 $342.97 44 $320.98 $353.08 45 $331.78 $364.96 46 $344.64 $379.11 47 $359.12 $395.03 48 $375.66 $413.23 49 $391.98 $431.17 50 $410.36 $451.39 51 $428.51 $471.36 52 $448.50 $493.35 53 $468.72 $515.59 54 $490.54 $539.60 55 $512.37 $563.61 56 $536.04 $589.64 57 $559.93 $615.93 58 $585.44 $643.98 59 $598.07 $657.88 60 $623.58 $685.93 61 $645.63 $710.20 62 $660.11 $726.12 63 $678.26 $746.09 64 $689.06 $757.97 65+** $689.06 $757.97

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $169.24 $169.24

21 $266.52 $293.17 22 $266.52 $293.17 23 $266.52 $293.17 24 $266.52 $293.17 25 $267.59 $294.35 26 $272.92 $300.21 27 $279.32 $307.25 28 $289.71 $318.68 29 $298.24 $328.06 30 $302.50 $332.75 31 $308.90 $339.79 32 $315.30 $346.83 33 $319.29 $351.22 34 $323.56 $355.91 35 $325.69 $358.26 36 $327.82 $360.60 37 $329.95 $362.95 38 $332.09 $365.30 39 $336.35 $369.99 40 $340.62 $374.68 41 $347.01 $381.71 42 $353.14 $388.46 43 $361.67 $397.84 44 $372.33 $409.56 45 $384.86 $423.34 46 $399.78 $439.76 47 $416.57 $458.23 48 $435.76 $479.34 49 $454.69 $500.16 50 $476.01 $523.61 51 $497.06 $546.77 52 $520.25 $572.28 53 $543.71 $598.08 54 $569.02 $625.93 55 $594.34 $653.78 56 $621.80 $683.98 57 $649.51 $714.47 58 $679.10 $747.01 59 $693.76 $763.13 60 $723.34 $795.67 61 $748.93 $823.82 62 $765.72 $842.29 63 $786.77 $865.45 64 $799.30 $879.23 65+** $799.30 $879.23

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-12 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 12 Counties – Monthly Rates (Effective 01/01/2016*) Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola, Ottawa

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $131.51 $131.51

21 $207.10 $227.81 22 $207.10 $227.81 23 $207.10 $227.81 24 $207.10 $227.81 25 $207.93 $228.72 26 $212.07 $233.27 27 $217.04 $238.74 28 $225.11 $247.63 29 $231.74 $254.92 30 $235.06 $258.56 31 $240.03 $264.03 32 $245.00 $269.50 33 $248.10 $272.91 34 $251.42 $276.56 35 $253.07 $278.38 36 $254.73 $280.20 37 $256.39 $282.03 38 $258.04 $283.85 39 $261.36 $287.49 40 $264.67 $291.14 41 $269.64 $296.60 42 $274.40 $301.84 43 $281.03 $309.13 44 $289.31 $318.25 45 $299.05 $328.95 46 $310.65 $341.71 47 $323.69 $356.06 48 $338.60 $372.46 49 $353.31 $388.64 50 $369.88 $406.86 51 $386.24 $424.86 52 $404.25 $444.68 53 $422.48 $464.73 54 $442.15 $486.37 55 $461.83 $508.01 56 $483.16 $531.47 57 $504.70 $555.17 58 $527.68 $580.45 59 $539.07 $592.98 60 $562.06 $618.27 61 $581.94 $640.14 62 $594.99 $654.49 63 $611.35 $672.49 64 $621.08 $683.19 65+** $621.08 $683.19

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $133.21 $133.21

21 $209.78 $230.76 22 $209.78 $230.76 23 $209.78 $230.76 24 $209.78 $230.76 25 $210.62 $231.69 26 $214.82 $236.30 27 $219.85 $241.84 28 $228.03 $250.84 29 $234.75 $258.22 30 $238.10 $261.91 31 $243.14 $267.45 32 $248.17 $272.99 33 $251.32 $276.45 34 $254.68 $280.15 35 $256.36 $281.99 36 $258.03 $283.84 37 $259.71 $285.68 38 $261.39 $287.53 39 $264.75 $291.22 40 $268.10 $294.91 41 $273.14 $300.45 42 $277.96 $305.76 43 $284.68 $313.14 44 $293.07 $322.37 45 $302.93 $333.22 46 $314.68 $346.14 47 $327.89 $360.68 48 $343.00 $377.30 49 $357.89 $393.68 50 $374.67 $412.14 51 $391.25 $430.37 52 $409.50 $450.45 53 $427.96 $470.75 54 $447.89 $492.68 55 $467.82 $514.60 56 $489.43 $538.37 57 $511.24 $562.37 58 $534.53 $587.98 59 $546.07 $600.67 60 $569.35 $626.29 61 $589.49 $648.44 62 $602.71 $662.98 63 $619.28 $681.21 64 $629.14 $692.06 65+** $629.14 $692.06

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $154.52 $154.52

21 $243.35 $267.68 22 $243.35 $267.68 23 $243.35 $267.68 24 $243.35 $267.68 25 $244.32 $268.75 26 $249.19 $274.11 27 $255.03 $280.53 28 $264.52 $290.97 29 $272.30 $299.53 30 $276.20 $303.82 31 $282.04 $310.24 32 $287.88 $316.67 33 $291.53 $320.68 34 $295.42 $324.96 35 $297.37 $327.11 36 $299.32 $329.25 37 $301.26 $331.39 38 $303.21 $333.53 39 $307.10 $337.81 40 $311.00 $342.10 41 $316.84 $348.52 42 $322.43 $354.68 43 $330.22 $363.24 44 $339.95 $373.95 45 $351.39 $386.53 46 $365.02 $401.52 47 $380.35 $418.39 48 $397.87 $437.66 49 $415.15 $456.66 50 $434.62 $478.08 51 $453.84 $499.22 52 $475.01 $522.51 53 $496.43 $546.07 54 $519.54 $571.50 55 $542.66 $596.93 56 $567.73 $624.50 57 $593.03 $652.34 58 $620.05 $682.05 59 $633.43 $696.77 60 $660.44 $726.49 61 $683.80 $752.18 62 $699.13 $769.05 63 $718.36 $790.19 64 $729.80 $802.77 65+** $729.80 $802.77

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-13 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 13 Counties – Monthly Rates (Effective 01/01/2016*) Clare, Gladwin, Isabella, Midland

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $142.78 $142.78

21 $224.85 $247.33 22 $224.85 $247.33 23 $224.85 $247.33 24 $224.85 $247.33 25 $225.75 $248.32 26 $230.24 $253.27 27 $235.64 $259.21 28 $244.41 $268.85 29 $251.61 $276.77 30 $255.20 $280.72 31 $260.60 $286.66 32 $266.00 $292.60 33 $269.37 $296.31 34 $272.97 $300.26 35 $274.76 $302.24 36 $276.56 $304.22 37 $278.36 $306.20 38 $280.16 $308.18 39 $283.76 $312.13 40 $287.36 $316.09 41 $292.75 $322.03 42 $297.92 $327.72 43 $305.12 $335.63 44 $314.11 $345.52 45 $324.68 $357.15 46 $337.27 $371.00 47 $351.44 $386.58 48 $367.63 $404.39 49 $383.59 $421.95 50 $401.58 $441.74 51 $419.34 $461.28 52 $438.90 $482.79 53 $458.69 $504.56 54 $480.05 $528.06 55 $501.41 $551.55 56 $524.57 $577.03 57 $547.96 $602.75 58 $572.91 $630.21 59 $585.28 $643.81 60 $610.24 $671.26 61 $631.82 $695.01 62 $645.99 $710.59 63 $663.75 $730.13 64 $674.32 $741.75 65+** $674.32 $741.75

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $144.63 $144.63

21 $227.77 $250.54 22 $227.77 $250.54 23 $227.77 $250.54 24 $227.77 $250.54 25 $228.68 $251.54 26 $233.23 $256.55 27 $238.70 $262.57 28 $247.58 $272.34 29 $254.87 $280.36 30 $258.51 $284.36 31 $263.98 $290.38 32 $269.45 $296.39 33 $272.86 $300.15 34 $276.51 $304.16 35 $278.33 $306.16 36 $280.15 $308.17 37 $281.97 $310.17 38 $283.80 $312.17 39 $287.44 $316.18 40 $291.08 $320.19 41 $296.55 $326.21 42 $301.79 $331.97 43 $309.08 $339.98 44 $318.19 $350.01 45 $328.89 $361.78 46 $341.65 $375.81 47 $356.00 $391.60 48 $372.40 $409.64 49 $388.57 $427.42 50 $406.79 $447.47 51 $424.78 $467.26 52 $444.60 $489.06 53 $464.64 $511.10 54 $486.28 $534.91 55 $507.92 $558.71 56 $531.38 $584.51 57 $555.06 $610.57 58 $580.35 $638.38 59 $592.87 $652.16 60 $618.15 $679.97 61 $640.02 $704.02 62 $654.37 $719.81 63 $672.36 $739.60 64 $683.07 $751.37 65+** $683.07 $751.37

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $167.77 $167.77

21 $264.20 $290.62 22 $264.20 $290.62 23 $264.20 $290.62 24 $264.20 $290.62 25 $265.26 $291.79 26 $270.55 $297.60 27 $276.89 $304.57 28 $287.19 $315.91 29 $295.64 $325.21 30 $299.87 $329.86 31 $306.21 $336.83 32 $312.55 $343.81 33 $316.52 $348.17 34 $320.74 $352.82 35 $322.86 $355.14 36 $324.97 $357.47 37 $327.09 $359.79 38 $329.20 $362.12 39 $333.43 $366.77 40 $337.65 $371.42 41 $343.99 $378.39 42 $350.07 $385.08 43 $358.53 $394.38 44 $369.09 $406.00 45 $381.51 $419.66 46 $396.31 $435.94 47 $412.95 $454.25 48 $431.97 $475.17 49 $450.73 $495.81 50 $471.87 $519.06 51 $492.74 $542.02 52 $515.73 $567.30 53 $538.98 $592.87 54 $564.08 $620.48 55 $589.18 $648.09 56 $616.39 $678.03 57 $643.87 $708.25 58 $673.19 $740.51 59 $687.72 $756.50 60 $717.05 $788.76 61 $742.41 $816.66 62 $759.06 $834.97 63 $779.93 $857.92 64 $792.35 $871.58 65+** $792.35 $871.58

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-14 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 14 Counties – Monthly Rates (Effective 01/01/2016*) Antrim, Benzie, Charlevoix, Emmet, Grand Traverse, Kalkaska, Leelanau, Manistee, Missaukee, Wexford

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $142.78 $142.78

21 $224.85 $247.33 22 $224.85 $247.33 23 $224.85 $247.33 24 $224.85 $247.33 25 $225.75 $248.32 26 $230.24 $253.27 27 $235.64 $259.21 28 $244.41 $268.85 29 $251.61 $276.77 30 $255.20 $280.72 31 $260.60 $286.66 32 $266.00 $292.60 33 $269.37 $296.31 34 $272.97 $300.26 35 $274.76 $302.24 36 $276.56 $304.22 37 $278.36 $306.20 38 $280.16 $308.18 39 $283.76 $312.13 40 $287.36 $316.09 41 $292.75 $322.03 42 $297.92 $327.72 43 $305.12 $335.63 44 $314.11 $345.52 45 $324.68 $357.15 46 $337.27 $371.00 47 $351.44 $386.58 48 $367.63 $404.39 49 $383.59 $421.95 50 $401.58 $441.74 51 $419.34 $461.28 52 $438.90 $482.79 53 $458.69 $504.56 54 $480.05 $528.06 55 $501.41 $551.55 56 $524.57 $577.03 57 $547.96 $602.75 58 $572.91 $630.21 59 $585.28 $643.81 60 $610.24 $671.26 61 $631.82 $695.01 62 $645.99 $710.59 63 $663.75 $730.13 64 $674.32 $741.75 65+** $674.32 $741.75

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $144.63 $144.63

21 $227.77 $250.54 22 $227.77 $250.54 23 $227.77 $250.54 24 $227.77 $250.54 25 $228.68 $251.54 26 $233.23 $256.55 27 $238.70 $262.57 28 $247.58 $272.34 29 $254.87 $280.36 30 $258.51 $284.36 31 $263.98 $290.38 32 $269.45 $296.39 33 $272.86 $300.15 34 $276.51 $304.16 35 $278.33 $306.16 36 $280.15 $308.17 37 $281.97 $310.17 38 $283.80 $312.17 39 $287.44 $316.18 40 $291.08 $320.19 41 $296.55 $326.21 42 $301.79 $331.97 43 $309.08 $339.98 44 $318.19 $350.01 45 $328.89 $361.78 46 $341.65 $375.81 47 $356.00 $391.60 48 $372.40 $409.64 49 $388.57 $427.42 50 $406.79 $447.47 51 $424.78 $467.26 52 $444.60 $489.06 53 $464.64 $511.10 54 $486.28 $534.91 55 $507.92 $558.71 56 $531.38 $584.51 57 $555.06 $610.57 58 $580.35 $638.38 59 $592.87 $652.16 60 $618.15 $679.97 61 $640.02 $704.02 62 $654.37 $719.81 63 $672.36 $739.60 64 $683.07 $751.37 65+** $683.07 $751.37

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $167.77 $167.77

21 $264.20 $290.62 22 $264.20 $290.62 23 $264.20 $290.62 24 $264.20 $290.62 25 $265.26 $291.79 26 $270.55 $297.60 27 $276.89 $304.57 28 $287.19 $315.91 29 $295.64 $325.21 30 $299.87 $329.86 31 $306.21 $336.83 32 $312.55 $343.81 33 $316.52 $348.17 34 $320.74 $352.82 35 $322.86 $355.14 36 $324.97 $357.47 37 $327.09 $359.79 38 $329.20 $362.12 39 $333.43 $366.77 40 $337.65 $371.42 41 $343.99 $378.39 42 $350.07 $385.08 43 $358.53 $394.38 44 $369.09 $406.00 45 $381.51 $419.66 46 $396.31 $435.94 47 $412.95 $454.25 48 $431.97 $475.17 49 $450.73 $495.81 50 $471.87 $519.06 51 $492.74 $542.02 52 $515.73 $567.30 53 $538.98 $592.87 54 $564.08 $620.48 55 $589.18 $648.09 56 $616.39 $678.03 57 $643.87 $708.25 58 $673.19 $740.51 59 $687.72 $756.50 60 $717.05 $788.76 61 $742.41 $816.66 62 $759.06 $834.97 63 $779.93 $857.92 64 $792.35 $871.58 65+** $792.35 $871.58

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-15 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 15 Counties – Monthly Rates (Effective 01/01/2016*) Alcona, Alpena, Cheboygan, Chippewa, Crawford, Iosco, Mackinac, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle, Roscommon

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $142.65 $142.65

21 $224.65 $247.12 22 $224.65 $247.12 23 $224.65 $247.12 24 $224.65 $247.12 25 $225.55 $248.10 26 $230.04 $253.05 27 $235.43 $258.98 28 $244.20 $268.62 29 $251.38 $276.52 30 $254.98 $280.48 31 $260.37 $286.41 32 $265.76 $292.34 33 $269.13 $296.05 34 $272.73 $300.00 35 $274.52 $301.98 36 $276.32 $303.95 37 $278.12 $305.93 38 $279.92 $307.91 39 $283.51 $311.86 40 $287.10 $315.81 41 $292.50 $321.75 42 $297.66 $327.43 43 $304.85 $335.34 44 $313.84 $345.22 45 $324.40 $356.84 46 $336.98 $370.67 47 $351.13 $386.24 48 $367.30 $404.04 49 $383.25 $421.58 50 $401.23 $441.35 51 $418.97 $460.87 52 $438.52 $482.37 53 $458.29 $504.12 54 $479.63 $527.59 55 $500.97 $551.07 56 $524.11 $576.52 57 $547.47 $602.22 58 $572.41 $629.65 59 $584.77 $643.24 60 $609.70 $670.67 61 $631.27 $694.40 62 $645.42 $709.97 63 $663.17 $729.49 64 $673.73 $741.10 65+** $673.73 $741.10

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $144.50 $144.50

21 $227.57 $250.32 22 $227.57 $250.32 23 $227.57 $250.32 24 $227.57 $250.32 25 $228.48 $251.32 26 $233.03 $256.33 27 $238.49 $262.34 28 $247.36 $272.10 29 $254.65 $280.11 30 $258.29 $284.12 31 $263.75 $290.12 32 $269.21 $296.13 33 $272.62 $299.89 34 $276.26 $303.89 35 $278.08 $305.89 36 $279.91 $307.90 37 $281.73 $309.90 38 $283.55 $311.90 39 $287.19 $315.91 40 $290.83 $319.91 41 $296.29 $325.92 42 $301.52 $331.68 43 $308.81 $339.69 44 $317.91 $349.70 45 $328.60 $361.46 46 $341.35 $375.48 47 $355.68 $391.25 48 $372.07 $409.28 49 $388.23 $427.05 50 $406.43 $447.07 51 $424.41 $466.85 52 $444.21 $488.63 53 $464.23 $510.66 54 $485.85 $534.44 55 $507.47 $558.22 56 $530.91 $584.00 57 $554.58 $610.03 58 $579.84 $637.82 59 $592.35 $651.59 60 $617.61 $679.37 61 $639.46 $703.40 62 $653.80 $719.17 63 $671.77 $738.95 64 $682.47 $750.72 65+** $682.47 $750.72

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $167.62 $167.62

21 $263.97 $290.37 22 $263.97 $290.37 23 $263.97 $290.37 24 $263.97 $290.37 25 $265.03 $291.53 26 $270.31 $297.34 27 $276.64 $304.31 28 $286.94 $315.63 29 $295.39 $324.92 30 $299.61 $329.57 31 $305.94 $336.54 32 $312.28 $343.51 33 $316.24 $347.86 34 $320.46 $352.51 35 $322.57 $354.83 36 $324.69 $357.16 37 $326.80 $359.48 38 $328.91 $361.80 39 $333.13 $366.45 40 $337.36 $371.09 41 $343.69 $378.06 42 $349.76 $384.74 43 $358.21 $394.03 44 $368.77 $405.65 45 $381.18 $419.29 46 $395.96 $435.56 47 $412.59 $453.85 48 $431.60 $474.75 49 $450.34 $495.37 50 $471.46 $518.60 51 $492.31 $541.54 52 $515.27 $566.80 53 $538.50 $592.35 54 $563.58 $619.94 55 $588.66 $647.53 56 $615.85 $677.43 57 $643.30 $707.63 58 $672.60 $739.86 59 $687.12 $755.83 60 $716.42 $788.06 61 $741.76 $815.94 62 $758.39 $834.23 63 $779.25 $857.17 64 $791.65 $870.82 65+** $791.65 $870.82

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.

73.03.333.1-16 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Michigan Rating Area 16 Counties – Monthly Rates (Effective 01/01/2016*) Alger, Baraga, Delta, Dickinson, Gogebic, Houghton, Iron, Keweenaw, Luce, Marquette, Menominee, Ontonagon, Schoolcraft

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $146.54 $146.54

21 $230.77 $253.84 22 $230.77 $253.84 23 $230.77 $253.84 24 $230.77 $253.84 25 $231.69 $254.86 26 $236.30 $259.93 27 $241.84 $266.03 28 $250.84 $275.93 29 $258.23 $284.05 30 $261.92 $288.11 31 $267.46 $294.20 32 $273.00 $300.30 33 $276.46 $304.10 34 $280.15 $308.16 35 $282.00 $310.19 36 $283.84 $312.23 37 $285.69 $314.26 38 $287.53 $316.29 39 $291.23 $320.35 40 $294.92 $324.41 41 $300.46 $330.50 42 $305.76 $336.34 43 $313.15 $344.46 44 $322.38 $354.62 45 $333.23 $366.55 46 $346.15 $380.76 47 $360.69 $396.76 48 $377.30 $415.03 49 $393.69 $433.05 50 $412.15 $453.36 51 $430.38 $473.42 52 $450.45 $495.50 53 $470.76 $517.84 54 $492.68 $541.95 55 $514.61 $566.07 56 $538.38 $592.21 57 $562.38 $618.61 58 $587.99 $646.79 59 $600.68 $660.75 60 $626.30 $688.93 61 $648.45 $713.30 62 $662.99 $729.29 63 $681.22 $749.34 64 $692.07 $761.27 65+** $692.07 $761.27

Aetna Bronze Deductible Only HSA Eligible OAMC PD

Age

Non Tobacco Tobacco

0-20 $148.44 $148.44

21 $233.76 $257.13 22 $233.76 $257.13 23 $233.76 $257.13 24 $233.76 $257.13 25 $234.69 $258.16 26 $239.37 $263.31 27 $244.98 $269.48 28 $254.10 $279.51 29 $261.58 $287.73 30 $265.32 $291.85 31 $270.93 $298.02 32 $276.54 $304.19 33 $280.04 $308.05 34 $283.78 $312.16 35 $285.65 $314.22 36 $287.52 $316.28 37 $289.39 $318.33 38 $291.26 $320.39 39 $295.00 $324.50 40 $298.74 $328.62 41 $304.35 $334.79 42 $309.73 $340.70 43 $317.21 $348.93 44 $326.56 $359.22 45 $337.55 $371.30 46 $350.64 $385.70 47 $365.37 $401.90 48 $382.20 $420.42 49 $398.79 $438.67 50 $417.49 $459.24 51 $435.96 $479.56 52 $456.30 $501.93 53 $476.87 $524.56 54 $499.08 $548.98 55 $521.28 $573.41 56 $545.36 $599.90 57 $569.67 $626.64 58 $595.62 $655.18 59 $608.47 $669.32 60 $634.42 $697.86 61 $656.86 $722.55 62 $671.59 $738.75 63 $690.06 $759.06 64 $701.04 $771.15 65+** $701.04 $771.15

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $172.18 $172.18

21 $271.16 $298.27 22 $271.16 $298.27 23 $271.16 $298.27 24 $271.16 $298.27 25 $272.24 $299.47 26 $277.67 $305.43 27 $284.17 $312.59 28 $294.75 $324.22 29 $303.42 $333.77 30 $307.76 $338.54 31 $314.27 $345.70 32 $320.78 $352.86 33 $324.85 $357.33 34 $329.18 $362.10 35 $331.35 $364.49 36 $333.52 $366.88 37 $335.69 $369.26 38 $337.86 $371.65 39 $342.20 $376.42 40 $346.54 $381.19 41 $353.05 $388.35 42 $359.28 $395.21 43 $367.96 $404.76 44 $378.81 $416.69 45 $391.55 $430.71 46 $406.74 $447.41 47 $423.82 $466.20 48 $443.34 $487.68 49 $462.59 $508.85 50 $484.29 $532.72 51 $505.71 $556.28 52 $529.30 $582.23 53 $553.16 $608.48 54 $578.92 $636.81 55 $604.68 $665.15 56 $632.61 $695.87 57 $660.81 $726.89 58 $690.91 $760.00 59 $705.82 $776.40 60 $735.92 $809.51 61 $761.95 $838.15 62 $779.03 $856.94 63 $800.46 $880.50 64 $813.20 $894.52 65+** $813.20 $894.52

How to calculate your monthly payment

Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.

*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.

www.aetna.com

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.