73.03.355.1-03 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 3 Counties – Monthly Rates (Effective 01/01/2016*) Bastrop, Caldwell, Hays, Travis, Williamson

Aetna Bronze HSA Eligible

PD

Age

Non Tobacco Tobacco

0-20 $124.73 $124.73

21 $196.42 $216.06 22 $196.42 $216.06 23 $196.42 $216.06 24 $196.42 $216.06 25 $197.21 $216.93 26 $201.14 $221.25 27 $205.85 $226.44 28 $213.51 $234.86 29 $219.80 $241.78 30 $222.94 $245.23 31 $227.65 $250.42 32 $232.37 $255.60 33 $235.31 $258.84 34 $238.46 $262.30 35 $240.03 $264.03 36 $241.60 $265.76 37 $243.17 $267.49 38 $244.74 $269.22 39 $247.88 $272.67 40 $251.03 $276.13 41 $255.74 $281.32 42 $260.26 $286.29 43 $266.54 $293.20 44 $274.40 $301.84 45 $283.63 $312.00 46 $294.63 $324.10 47 $307.01 $337.71 48 $321.15 $353.27 49 $335.10 $368.61 50 $350.81 $385.89 51 $366.33 $402.96 52 $383.42 $421.76 53 $400.70 $440.77 54 $419.36 $461.30 55 $438.02 $481.82 56 $458.25 $504.08 57 $478.68 $526.55 58 $500.48 $550.53 59 $511.29 $562.42 60 $533.09 $586.40 61 $551.95 $607.14 62 $564.32 $620.75 63 $579.84 $637.82 64 $589.07 $647.98 65+** $589.07 $647.98

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $133.44 $133.44

21 $210.14 $231.15 22 $210.14 $231.15 23 $210.14 $231.15 24 $210.14 $231.15 25 $210.98 $232.08 26 $215.18 $236.70 27 $220.23 $242.25 28 $228.42 $251.26 29 $235.15 $258.66 30 $238.51 $262.36 31 $243.55 $267.91 32 $248.60 $273.46 33 $251.75 $276.92 34 $255.11 $280.62 35 $256.79 $282.47 36 $258.47 $284.32 37 $260.15 $286.17 38 $261.83 $288.02 39 $265.20 $291.72 40 $268.56 $295.41 41 $273.60 $300.96 42 $278.44 $306.28 43 $285.16 $313.68 44 $293.57 $322.92 45 $303.44 $333.79 46 $315.21 $346.73 47 $328.45 $361.29 48 $343.58 $377.94 49 $358.50 $394.35 50 $375.31 $412.84 51 $391.91 $431.10 52 $410.19 $451.21 53 $428.69 $471.55 54 $448.65 $493.51 55 $468.61 $515.47 56 $490.26 $539.28 57 $512.11 $563.32 58 $535.44 $588.98 59 $546.99 $601.69 60 $570.32 $627.35 61 $590.49 $649.54 62 $603.73 $664.11 63 $620.33 $682.37 64 $630.21 $693.23 65+** $630.21 $693.23

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $167.71 $167.71

21 $264.12 $290.53 22 $264.12 $290.53 23 $264.12 $290.53 24 $264.12 $290.53 25 $265.17 $291.69 26 $270.46 $297.50 27 $276.79 $304.47 28 $287.09 $315.80 29 $295.55 $325.10 30 $299.77 $329.75 31 $306.11 $336.72 32 $312.45 $343.70 33 $316.41 $348.05 34 $320.64 $352.70 35 $322.75 $355.03 36 $324.86 $357.35 37 $326.98 $359.67 38 $329.09 $362.00 39 $333.32 $366.65 40 $337.54 $371.30 41 $343.88 $378.27 42 $349.95 $384.95 43 $358.41 $394.25 44 $368.97 $405.87 45 $381.38 $419.52 46 $396.18 $435.79 47 $412.81 $454.10 48 $431.83 $475.01 49 $450.58 $495.64 50 $471.71 $518.88 51 $492.58 $541.84 52 $515.56 $567.11 53 $538.80 $592.68 54 $563.89 $620.28 55 $588.98 $647.88 56 $616.18 $677.80 57 $643.65 $708.02 58 $672.97 $740.27 59 $687.50 $756.25 60 $716.81 $788.49 61 $742.17 $816.38 62 $758.81 $834.69 63 $779.67 $857.64 64 $792.09 $871.29 65+** $792.09 $871.29

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 Health Plans for Texas Rating Area 3 Counties – Monthly Rates (Effective 01/01/2016*) Bastrop, Caldwell, Hays, Travis, Williamson

Aetna Gold $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $194.28 $194.28

21 $305.95 $336.55 22 $305.95 $336.55 23 $305.95 $336.55 24 $305.95 $336.55 25 $307.18 $337.89 26 $313.29 $344.62 27 $320.64 $352.70 28 $332.57 $365.83 29 $342.36 $376.60 30 $347.25 $381.98 31 $354.60 $390.06 32 $361.94 $398.13 33 $366.53 $403.18 34 $371.42 $408.57 35 $373.87 $411.26 36 $376.32 $413.95 37 $378.77 $416.64 38 $381.22 $419.34 39 $386.11 $424.72 40 $391.01 $430.11 41 $398.35 $438.18 42 $405.39 $445.92 43 $415.18 $456.69 44 $427.41 $470.16 45 $441.79 $485.97 46 $458.93 $504.82 47 $478.20 $526.02 48 $500.23 $550.25 49 $521.95 $574.15 50 $546.43 $601.07 51 $570.60 $627.66 52 $597.22 $656.94 53 $624.14 $686.55 54 $653.21 $718.53 55 $682.27 $750.50 56 $713.78 $785.16 57 $745.60 $820.16 58 $779.56 $857.52 59 $796.39 $876.03 60 $830.35 $913.39 61 $859.72 $945.70 62 $879.00 $966.90 63 $903.17 $993.49 64 $917.55 $1,009.30 65+** $917.55 $1,009.30

*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.

73.03.355.1-04 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 4 Counties – Monthly Rates (Effective 01/01/2016*) Hardin, Jefferson, Orange

Aetna Bronze HSA Eligible

PD

Age

Non Tobacco Tobacco

0-20 $127.92 $127.92

21 $201.44 $221.59 22 $201.44 $221.59 23 $201.44 $221.59 24 $201.44 $221.59 25 $202.25 $222.47 26 $206.28 $226.91 27 $211.11 $232.22 28 $218.97 $240.87 29 $225.41 $247.96 30 $228.64 $251.50 31 $233.47 $256.82 32 $238.31 $262.14 33 $241.33 $265.46 34 $244.55 $269.01 35 $246.16 $270.78 36 $247.77 $272.55 37 $249.39 $274.33 38 $251.00 $276.10 39 $254.22 $279.64 40 $257.44 $283.19 41 $262.28 $288.51 42 $266.91 $293.60 43 $273.36 $300.69 44 $281.42 $309.56 45 $290.88 $319.97 46 $302.16 $332.38 47 $314.86 $346.34 48 $329.36 $362.30 49 $343.66 $378.03 50 $359.78 $395.76 51 $375.69 $413.26 52 $393.22 $432.54 53 $410.94 $452.04 54 $430.08 $473.09 55 $449.22 $494.14 56 $469.97 $516.96 57 $490.92 $540.01 58 $513.28 $564.60 59 $524.36 $576.79 60 $546.72 $601.39 61 $566.05 $622.66 62 $578.75 $636.62 63 $594.66 $654.13 64 $604.13 $664.54 65+** $604.13 $664.54

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $136.85 $136.85

21 $215.51 $237.06 22 $215.51 $237.06 23 $215.51 $237.06 24 $215.51 $237.06 25 $216.37 $238.01 26 $220.68 $242.75 27 $225.86 $248.44 28 $234.26 $257.69 29 $241.16 $265.27 30 $244.61 $269.07 31 $249.78 $274.76 32 $254.95 $280.45 33 $258.18 $284.00 34 $261.63 $287.79 35 $263.36 $289.69 36 $265.08 $291.59 37 $266.80 $293.48 38 $268.53 $295.38 39 $271.98 $299.17 40 $275.42 $302.97 41 $280.60 $308.66 42 $285.55 $314.11 43 $292.45 $321.69 44 $301.07 $331.18 45 $311.20 $342.32 46 $323.27 $355.59 47 $336.84 $370.53 48 $352.36 $387.60 49 $367.66 $404.43 50 $384.90 $423.39 51 $401.93 $442.12 52 $420.68 $462.75 53 $439.64 $483.61 54 $460.12 $506.13 55 $480.59 $528.65 56 $502.79 $553.07 57 $525.20 $577.72 58 $549.12 $604.04 59 $560.98 $617.07 60 $584.90 $643.39 61 $605.59 $666.15 62 $619.17 $681.08 63 $636.19 $699.81 64 $646.32 $710.95 65+** $646.32 $710.95

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $172.00 $172.00

21 $270.87 $297.95 22 $270.87 $297.95 23 $270.87 $297.95 24 $270.87 $297.95 25 $271.95 $299.15 26 $277.37 $305.11 27 $283.87 $312.26 28 $294.43 $323.88 29 $303.10 $333.41 30 $307.44 $338.18 31 $313.94 $345.33 32 $320.44 $352.48 33 $324.50 $356.95 34 $328.83 $361.72 35 $331.00 $364.10 36 $333.17 $366.48 37 $335.33 $368.87 38 $337.50 $371.25 39 $341.84 $376.02 40 $346.17 $380.79 41 $352.67 $387.94 42 $358.90 $394.79 43 $367.57 $404.32 44 $378.40 $416.24 45 $391.13 $430.25 46 $406.30 $446.93 47 $423.37 $465.70 48 $442.87 $487.16 49 $462.10 $508.31 50 $483.77 $532.15 51 $505.17 $555.69 52 $528.73 $581.61 53 $552.57 $607.83 54 $578.30 $636.13 55 $604.04 $664.44 56 $631.94 $695.13 57 $660.11 $726.12 58 $690.17 $759.19 59 $705.07 $775.58 60 $735.14 $808.65 61 $761.14 $837.25 62 $778.20 $856.02 63 $799.60 $879.56 64 $812.33 $893.57 65+** $812.33 $893.57

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 Health Plans for Texas Rating Area 4 Counties – Monthly Rates (Effective 01/01/2016*) Hardin, Jefferson, Orange

Aetna Gold $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $199.25 $199.25

21 $313.77 $345.15 22 $313.77 $345.15 23 $313.77 $345.15 24 $313.77 $345.15 25 $315.03 $346.53 26 $321.30 $353.43 27 $328.83 $361.72 28 $341.07 $375.18 29 $351.11 $386.22 30 $356.13 $391.74 31 $363.66 $400.03 32 $371.19 $408.31 33 $375.90 $413.49 34 $380.92 $419.01 35 $383.43 $421.77 36 $385.94 $424.53 37 $388.45 $427.29 38 $390.96 $430.06 39 $395.98 $435.58 40 $401.00 $441.10 41 $408.53 $449.38 42 $415.75 $457.32 43 $425.79 $468.37 44 $438.34 $482.17 45 $453.09 $498.40 46 $470.66 $517.72 47 $490.43 $539.47 48 $513.02 $564.32 49 $535.30 $588.82 50 $560.40 $616.44 51 $585.19 $643.70 52 $612.48 $673.73 53 $640.10 $704.10 54 $669.90 $736.89 55 $699.71 $769.68 56 $732.03 $805.23 57 $764.66 $841.13 58 $799.49 $879.44 59 $816.75 $898.42 60 $851.58 $936.74 61 $881.70 $969.87 62 $901.47 $991.61 63 $926.26 $1,018.88 64 $941.00 $1,035.10 65+** $941.00 $1,035.10

*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.

73.03.355.1-08 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 8 Counties – Monthly Rates (Effective 01/01/2016*) Collin, Dallas, Denton, Ellis, Parker, Rockwall, Tarrant

Aetna Bronze HSA Eligible

PD

Age

Non Tobacco Tobacco

0-20 $133.66 $133.66

21 $210.48 $231.53 22 $210.48 $231.53 23 $210.48 $231.53 24 $210.48 $231.53 25 $211.32 $232.46 26 $215.53 $237.09 27 $220.58 $242.64 28 $228.79 $251.67 29 $235.53 $259.08 30 $238.90 $262.79 31 $243.95 $268.34 32 $249.00 $273.90 33 $252.16 $277.37 34 $255.52 $281.08 35 $257.21 $282.93 36 $258.89 $284.78 37 $260.58 $286.63 38 $262.26 $288.49 39 $265.63 $292.19 40 $268.99 $295.89 41 $274.05 $301.45 42 $278.89 $306.78 43 $285.62 $314.18 44 $294.04 $323.45 45 $303.93 $334.33 46 $315.72 $347.29 47 $328.98 $361.88 48 $344.14 $378.55 49 $359.08 $394.99 50 $375.92 $413.51 51 $392.55 $431.80 52 $410.86 $451.94 53 $429.38 $472.32 54 $449.38 $494.31 55 $469.37 $516.31 56 $491.05 $540.16 57 $512.94 $564.24 58 $536.31 $589.94 59 $547.88 $602.67 60 $571.25 $628.37 61 $591.45 $650.60 62 $604.71 $665.18 63 $621.34 $683.47 64 $631.23 $694.36 65+** $631.23 $694.36

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $142.99 $142.99

21 $225.18 $247.70 22 $225.18 $247.70 23 $225.18 $247.70 24 $225.18 $247.70 25 $226.08 $248.69 26 $230.59 $253.64 27 $235.99 $259.59 28 $244.77 $269.25 29 $251.98 $277.18 30 $255.58 $281.14 31 $260.98 $287.08 32 $266.39 $293.03 33 $269.77 $296.74 34 $273.37 $300.71 35 $275.17 $302.69 36 $276.97 $304.67 37 $278.77 $306.65 38 $280.58 $308.63 39 $284.18 $312.60 40 $287.78 $316.56 41 $293.19 $322.50 42 $298.36 $328.20 43 $305.57 $336.13 44 $314.58 $346.04 45 $325.16 $357.68 46 $337.77 $371.55 47 $351.96 $387.15 48 $368.17 $404.99 49 $384.16 $422.57 50 $402.17 $442.39 51 $419.96 $461.96 52 $439.55 $483.51 53 $459.37 $505.31 54 $480.76 $528.84 55 $502.15 $552.37 56 $525.35 $577.88 57 $548.77 $603.64 58 $573.76 $631.14 59 $586.15 $644.76 60 $611.14 $672.25 61 $632.76 $696.03 62 $646.94 $711.64 63 $664.73 $731.21 64 $675.32 $742.85 65+** $675.32 $742.85

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $179.72 $179.72

21 $283.02 $311.32 22 $283.02 $311.32 23 $283.02 $311.32 24 $283.02 $311.32 25 $284.15 $312.57 26 $289.81 $318.79 27 $296.61 $326.27 28 $307.64 $338.41 29 $316.70 $348.37 30 $321.23 $353.35 31 $328.02 $360.82 32 $334.81 $368.29 33 $339.06 $372.96 34 $343.59 $377.95 35 $345.85 $380.44 36 $348.12 $382.93 37 $350.38 $385.42 38 $352.64 $387.91 39 $357.17 $392.89 40 $361.70 $397.87 41 $368.49 $405.34 42 $375.00 $412.50 43 $384.06 $422.47 44 $395.38 $434.92 45 $408.68 $449.55 46 $424.53 $466.98 47 $442.36 $486.60 48 $462.74 $509.01 49 $482.83 $531.12 50 $505.48 $556.02 51 $527.83 $580.62 52 $552.46 $607.70 53 $577.36 $635.10 54 $604.25 $664.67 55 $631.14 $694.25 56 $660.29 $726.32 57 $689.72 $758.69 58 $721.14 $793.25 59 $736.70 $810.37 60 $768.12 $844.93 61 $795.29 $874.82 62 $813.12 $894.43 63 $835.48 $919.03 64 $848.78 $933.66 65+** $848.78 $933.66

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 Health Plans for Texas Rating Area 8 Counties – Monthly Rates (Effective 01/01/2016*) Collin, Dallas, Denton, Ellis, Parker, Rockwall, Tarrant

Aetna Gold $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $208.18 $208.18

21 $327.85 $360.63 22 $327.85 $360.63 23 $327.85 $360.63 24 $327.85 $360.63 25 $329.16 $362.08 26 $335.72 $369.29 27 $343.59 $377.95 28 $356.37 $392.01 29 $366.86 $403.55 30 $372.11 $409.32 31 $379.98 $417.98 32 $387.85 $426.63 33 $392.76 $432.04 34 $398.01 $437.81 35 $400.63 $440.70 36 $403.26 $443.58 37 $405.88 $446.47 38 $408.50 $449.35 39 $413.75 $455.12 40 $418.99 $460.89 41 $426.86 $469.55 42 $434.40 $477.84 43 $444.89 $489.38 44 $458.01 $503.81 45 $473.41 $520.76 46 $491.77 $540.95 47 $512.43 $563.67 48 $536.03 $589.64 49 $559.31 $615.24 50 $585.54 $644.09 51 $611.44 $672.58 52 $639.96 $703.96 53 $668.81 $735.69 54 $699.96 $769.95 55 $731.10 $804.22 56 $764.87 $841.36 57 $798.97 $878.87 58 $835.36 $918.90 59 $853.39 $938.73 60 $889.78 $978.76 61 $921.26 $1,013.38 62 $941.91 $1,036.10 63 $967.81 $1,064.59 64 $983.22 $1,081.54 65+** $983.22 $1,081.54

*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.

73.03.355.1-10 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 10 Counties – Monthly Rates (Effective 01/01/2016*) Austin, Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, San Jacinto, Waller

Aetna Bronze HSA Eligible

PD

Age

Non Tobacco Tobacco

0-20 $127.53 $127.53

21 $200.84 $220.92 22 $200.84 $220.92 23 $200.84 $220.92 24 $200.84 $220.92 25 $201.64 $221.81 26 $205.66 $226.23 27 $210.48 $231.53 28 $218.31 $240.15 29 $224.74 $247.21 30 $227.95 $250.75 31 $232.77 $256.05 32 $237.59 $261.35 33 $240.61 $264.67 34 $243.82 $268.20 35 $245.43 $269.97 36 $247.03 $271.74 37 $248.64 $273.50 38 $250.25 $275.27 39 $253.46 $278.81 40 $256.67 $282.34 41 $261.49 $287.64 42 $266.11 $292.73 43 $272.54 $299.79 44 $280.57 $308.63 45 $290.01 $319.02 46 $301.26 $331.39 47 $313.91 $345.31 48 $328.37 $361.21 49 $342.63 $376.90 50 $358.70 $394.57 51 $374.57 $412.02 52 $392.04 $431.24 53 $409.71 $450.69 54 $428.79 $471.67 55 $447.87 $492.66 56 $468.56 $515.42 57 $489.45 $538.39 58 $511.74 $562.92 59 $522.79 $575.07 60 $545.08 $599.59 61 $564.36 $620.80 62 $577.01 $634.72 63 $592.88 $652.17 64 $602.32 $662.55 65+** $602.32 $662.55

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $136.44 $136.44

21 $214.87 $236.35 22 $214.87 $236.35 23 $214.87 $236.35 24 $214.87 $236.35 25 $215.73 $237.30 26 $220.02 $242.03 27 $225.18 $247.70 28 $233.56 $256.92 29 $240.44 $264.48 30 $243.87 $268.26 31 $249.03 $273.93 32 $254.19 $279.61 33 $257.41 $283.15 34 $260.85 $286.93 35 $262.57 $288.82 36 $264.29 $290.72 37 $266.01 $292.61 38 $267.72 $294.50 39 $271.16 $298.28 40 $274.60 $302.06 41 $279.76 $307.73 42 $284.70 $313.17 43 $291.57 $320.73 44 $300.17 $330.19 45 $310.27 $341.29 46 $322.30 $354.53 47 $335.84 $369.42 48 $351.31 $386.44 49 $366.56 $403.22 50 $383.75 $422.13 51 $400.73 $440.80 52 $419.42 $461.36 53 $438.33 $482.16 54 $458.74 $504.62 55 $479.15 $527.07 56 $501.29 $551.41 57 $523.63 $575.99 58 $547.48 $602.23 59 $559.30 $615.23 60 $583.15 $641.46 61 $603.78 $664.15 62 $617.31 $679.04 63 $634.29 $697.72 64 $644.39 $708.83 65+** $644.39 $708.83

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $171.49 $171.49

21 $270.06 $297.06 22 $270.06 $297.06 23 $270.06 $297.06 24 $270.06 $297.06 25 $271.14 $298.25 26 $276.54 $304.19 27 $283.02 $311.32 28 $293.55 $322.91 29 $302.19 $332.41 30 $306.52 $337.17 31 $313.00 $344.30 32 $319.48 $351.43 33 $323.53 $355.88 34 $327.85 $360.64 35 $330.01 $363.01 36 $332.17 $365.39 37 $334.33 $367.76 38 $336.49 $370.14 39 $340.81 $374.89 40 $345.13 $379.65 41 $351.62 $386.78 42 $357.83 $393.61 43 $366.47 $403.12 44 $377.27 $415.00 45 $389.96 $428.96 46 $405.09 $445.60 47 $422.10 $464.31 48 $441.54 $485.70 49 $460.72 $506.79 50 $482.32 $530.56 51 $503.66 $554.02 52 $527.15 $579.87 53 $550.92 $606.01 54 $576.57 $634.23 55 $602.23 $662.45 56 $630.05 $693.05 57 $658.13 $723.94 58 $688.11 $756.92 59 $702.96 $773.26 60 $732.94 $806.23 61 $758.86 $834.75 62 $775.88 $853.46 63 $797.21 $876.93 64 $809.90 $890.89 65+** $809.90 $890.89

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 Health Plans for Texas Rating Area 10 Counties – Monthly Rates (Effective 01/01/2016*) Austin, Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, San Jacinto, Waller

Aetna Gold $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $198.65 $198.65

21 $312.83 $344.12 22 $312.83 $344.12 23 $312.83 $344.12 24 $312.83 $344.12 25 $314.09 $345.49 26 $320.34 $352.38 27 $327.85 $360.63 28 $340.05 $374.06 29 $350.06 $385.07 30 $355.07 $390.57 31 $362.57 $398.83 32 $370.08 $407.09 33 $374.77 $412.25 34 $379.78 $417.76 35 $382.28 $420.51 36 $384.79 $423.26 37 $387.29 $426.02 38 $389.79 $428.77 39 $394.80 $434.28 40 $399.80 $439.78 41 $407.31 $448.04 42 $414.50 $455.96 43 $424.52 $466.97 44 $437.03 $480.73 45 $451.73 $496.90 46 $469.25 $516.18 47 $488.96 $537.85 48 $511.48 $562.63 49 $533.69 $587.06 50 $558.72 $614.59 51 $583.43 $641.78 52 $610.65 $671.72 53 $638.18 $702.00 54 $667.90 $734.69 55 $697.62 $767.38 56 $729.84 $802.83 57 $762.38 $838.61 58 $797.10 $876.81 59 $814.31 $895.74 60 $849.03 $933.93 61 $879.06 $966.97 62 $898.77 $988.65 63 $923.48 $1,015.83 64 $938.19 $1,032.01 65+** $938.19 $1,032.01

*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 Health Plans for Texas Rating Area 10 Counties – Monthly Rates (Effective 01/01/2016*) Fort Bend, Harris, Montgomery

Aetna Memorial Hermann

Bronze HSA Eligible PD

Age

Non Tobacco Tobacco

0-20 $130.86 $130.86

21 $206.08 $226.69 22 $206.08 $226.69 23 $206.08 $226.69 24 $206.08 $226.69 25 $206.90 $227.59 26 $211.02 $232.13 27 $215.97 $237.57 28 $224.01 $246.41 29 $230.60 $253.66 30 $233.90 $257.29 31 $238.84 $262.73 32 $243.79 $268.17 33 $246.88 $271.57 34 $250.18 $275.20 35 $251.83 $277.01 36 $253.48 $278.82 37 $255.12 $280.64 38 $256.77 $282.45 39 $260.07 $286.08 40 $263.37 $289.70 41 $268.31 $295.14 42 $273.05 $300.36 43 $279.65 $307.61 44 $287.89 $316.68 45 $297.58 $327.33 46 $309.12 $340.03 47 $322.10 $354.31 48 $336.94 $370.63 49 $351.57 $386.73 50 $368.05 $404.86 51 $384.33 $422.77 52 $402.26 $442.49 53 $420.40 $462.44 54 $439.98 $483.97 55 $459.55 $505.51 56 $480.78 $528.86 57 $502.21 $552.43 58 $525.09 $577.59 59 $536.42 $590.06 60 $559.29 $615.22 61 $579.08 $636.99 62 $592.06 $651.27 63 $608.34 $669.18 64 $618.03 $679.83 65+** $618.03 $679.83

Aetna Bronze $15 Copay Memorial Hermann PD

Age

Non Tobacco Tobacco

0-20 $139.98 $139.98

21 $220.43 $242.48 22 $220.43 $242.48 23 $220.43 $242.48 24 $220.43 $242.48 25 $221.32 $243.45 26 $225.72 $248.30 27 $231.01 $254.12 28 $239.61 $263.57 29 $246.67 $271.33 30 $250.19 $275.21 31 $255.48 $281.03 32 $260.77 $286.85 33 $264.08 $290.49 34 $267.61 $294.37 35 $269.37 $296.31 36 $271.13 $298.25 37 $272.90 $300.19 38 $274.66 $302.13 39 $278.19 $306.01 40 $281.71 $309.89 41 $287.00 $315.71 42 $292.07 $321.28 43 $299.13 $329.04 44 $307.95 $338.74 45 $318.31 $350.14 46 $330.65 $363.72 47 $344.54 $378.99 48 $360.41 $396.45 49 $376.06 $413.67 50 $393.69 $433.06 51 $411.11 $452.22 52 $430.29 $473.32 53 $449.69 $494.65 54 $470.63 $517.69 55 $491.57 $540.72 56 $514.27 $565.70 57 $537.20 $590.92 58 $561.67 $617.83 59 $573.79 $631.17 60 $598.26 $658.08 61 $619.42 $681.36 62 $633.31 $696.64 63 $650.72 $715.79 64 $661.08 $727.19 65+** $661.08 $727.19

Aetna Silver $10 Copay Memorial Hermann PD

Age

Non Tobacco Tobacco

0-20 $175.95 $175.95

21 $277.09 $304.80 22 $277.09 $304.80 23 $277.09 $304.80 24 $277.09 $304.80 25 $278.20 $306.02 26 $283.74 $312.11 27 $290.39 $319.43 28 $301.20 $331.32 29 $310.06 $341.07 30 $314.50 $345.95 31 $321.15 $353.26 32 $327.80 $360.58 33 $331.95 $365.15 34 $336.39 $370.03 35 $338.60 $372.46 36 $340.82 $374.90 37 $343.04 $377.34 38 $345.25 $379.78 39 $349.69 $384.66 40 $354.12 $389.53 41 $360.77 $396.85 42 $367.14 $403.86 43 $376.01 $413.61 44 $387.09 $425.80 45 $400.12 $440.13 46 $415.63 $457.20 47 $433.09 $476.40 48 $453.04 $498.35 49 $472.71 $519.99 50 $494.88 $544.37 51 $516.77 $568.45 52 $540.88 $594.97 53 $565.26 $621.79 54 $591.59 $650.74 55 $617.91 $679.70 56 $646.45 $711.10 57 $675.27 $742.79 58 $706.02 $776.63 59 $721.26 $793.39 60 $752.02 $827.22 61 $778.62 $856.48 62 $796.08 $875.69 63 $817.97 $899.77 64 $830.99 $914.09 65+** $830.99 $914.09

Aetna Gold $10 Copay Memorial Hermann PD

Age

Non Tobacco Tobacco

0-20 $203.81 $203.81

21 $320.96 $353.06 22 $320.96 $353.06 23 $320.96 $353.06 24 $320.96 $353.06 25 $322.25 $354.47 26 $328.67 $361.53 27 $336.37 $370.01 28 $348.89 $383.78 29 $359.16 $395.07 30 $364.29 $400.72 31 $372.00 $409.20 32 $379.70 $417.67 33 $384.51 $422.97 34 $389.65 $428.62 35 $392.22 $431.44 36 $394.79 $434.26 37 $397.35 $437.09 38 $399.92 $439.91 39 $405.06 $445.56 40 $410.19 $451.21 41 $417.90 $459.68 42 $425.28 $467.80 43 $435.55 $479.10 44 $448.39 $493.23 45 $463.47 $509.82 46 $481.45 $529.59 47 $501.67 $551.83 48 $524.78 $577.25 49 $547.56 $602.32 50 $573.24 $630.57 51 $598.60 $658.46 52 $626.52 $689.17 53 $654.77 $720.24 54 $685.26 $753.78 55 $715.75 $787.32 56 $748.81 $823.69 57 $782.19 $860.41 58 $817.82 $899.60 59 $835.47 $919.02 60 $871.10 $958.21 61 $901.91 $992.10 62 $922.13 $1,014.34 63 $947.49 $1,042.23 64 $962.57 $1,058.83 65+** $962.57 $1,058.83

*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.

73.03.355.1-11 B (1/16)

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

Aetna Bronze HSA Eligible

PD

Age

Non Tobacco Tobacco

0-20 $135.06 $135.06

21 $212.69 $233.96 22 $212.69 $233.96 23 $212.69 $233.96 24 $212.69 $233.96 25 $213.54 $234.89 26 $217.79 $239.57 27 $222.90 $245.19 28 $231.19 $254.31 29 $238.00 $261.80 30 $241.40 $265.54 31 $246.51 $271.16 32 $251.61 $276.77 33 $254.80 $280.28 34 $258.21 $284.03 35 $259.91 $285.90 36 $261.61 $287.77 37 $263.31 $289.64 38 $265.01 $291.51 39 $268.41 $295.26 40 $271.82 $299.00 41 $276.92 $304.61 42 $281.81 $310.00 43 $288.62 $317.48 44 $297.13 $326.84 45 $307.12 $337.84 46 $319.04 $350.94 47 $332.43 $365.68 48 $347.75 $382.52 49 $362.85 $399.13 50 $379.86 $417.85 51 $396.67 $436.33 52 $415.17 $456.69 53 $433.89 $477.28 54 $454.09 $499.50 55 $474.30 $521.73 56 $496.21 $545.83 57 $518.33 $570.16 58 $541.93 $596.13 59 $553.63 $609.00 60 $577.24 $634.97 61 $597.66 $657.43 62 $611.06 $672.16 63 $627.86 $690.65 64 $637.86 $701.64 65+** $637.86 $701.64

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $144.49 $144.49

21 $227.54 $250.30 22 $227.54 $250.30 23 $227.54 $250.30 24 $227.54 $250.30 25 $228.45 $251.30 26 $233.01 $256.31 27 $238.47 $262.31 28 $247.34 $272.07 29 $254.62 $280.08 30 $258.26 $284.09 31 $263.72 $290.10 32 $269.18 $296.10 33 $272.60 $299.86 34 $276.24 $303.86 35 $278.06 $305.87 36 $279.88 $307.87 37 $281.70 $309.87 38 $283.52 $311.87 39 $287.16 $315.88 40 $290.80 $319.88 41 $296.26 $325.89 42 $301.50 $331.65 43 $308.78 $339.66 44 $317.88 $349.67 45 $328.57 $361.43 46 $341.32 $375.45 47 $355.65 $391.22 48 $372.03 $409.24 49 $388.19 $427.01 50 $406.39 $447.03 51 $424.37 $466.81 52 $444.17 $488.58 53 $464.19 $510.61 54 $485.81 $534.39 55 $507.42 $558.17 56 $530.86 $583.95 57 $554.53 $609.98 58 $579.78 $637.76 59 $592.30 $651.53 60 $617.56 $679.31 61 $639.40 $703.34 62 $653.73 $719.11 63 $671.71 $738.88 64 $682.41 $750.65 65+** $682.41 $750.65

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $181.60 $181.60

21 $285.99 $314.59 22 $285.99 $314.59 23 $285.99 $314.59 24 $285.99 $314.59 25 $287.14 $315.85 26 $292.86 $322.14 27 $299.72 $329.69 28 $310.87 $341.96 29 $320.02 $352.03 30 $324.60 $357.06 31 $331.46 $364.61 32 $338.33 $372.16 33 $342.62 $376.88 34 $347.19 $381.91 35 $349.48 $384.43 36 $351.77 $386.95 37 $354.06 $389.46 38 $356.35 $391.98 39 $360.92 $397.01 40 $365.50 $402.05 41 $372.36 $409.60 42 $378.94 $416.83 43 $388.09 $426.90 44 $399.53 $439.48 45 $412.97 $454.27 46 $428.99 $471.89 47 $447.00 $491.71 48 $467.60 $514.36 49 $487.90 $536.69 50 $510.78 $561.86 51 $533.37 $586.71 52 $558.26 $614.08 53 $583.42 $641.76 54 $610.59 $671.65 55 $637.76 $701.54 56 $667.22 $733.94 57 $696.96 $766.66 58 $728.71 $801.58 59 $744.44 $818.88 60 $776.18 $853.80 61 $803.64 $884.00 62 $821.65 $903.82 63 $844.25 $928.67 64 $857.69 $943.46 65+** $857.69 $943.46

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 Health Plans for Texas Rating Area 11 Counties – Monthly Rates (Effective 01/01/2016*) Bell, Coryell, Lampasas

Aetna Gold $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $210.37 $210.37

21 $331.29 $364.42 22 $331.29 $364.42 23 $331.29 $364.42 24 $331.29 $364.42 25 $332.62 $365.88 26 $339.24 $373.17 27 $347.19 $381.91 28 $360.11 $396.12 29 $370.71 $407.79 30 $376.02 $413.62 31 $383.97 $422.36 32 $391.92 $431.11 33 $396.89 $436.58 34 $402.19 $442.41 35 $404.84 $445.32 36 $407.49 $448.24 37 $410.14 $451.15 38 $412.79 $454.07 39 $418.09 $459.90 40 $423.39 $465.73 41 $431.34 $474.47 42 $438.96 $482.86 43 $449.56 $494.52 44 $462.81 $509.09 45 $478.38 $526.22 46 $496.94 $546.63 47 $517.81 $569.59 48 $541.66 $595.83 49 $565.18 $621.70 50 $591.69 $650.85 51 $617.86 $679.64 52 $646.68 $711.35 53 $675.83 $743.42 54 $707.31 $778.04 55 $738.78 $812.66 56 $772.90 $850.19 57 $807.36 $888.09 58 $844.13 $928.54 59 $862.35 $948.59 60 $899.12 $989.04 61 $930.93 $1,024.02 62 $951.80 $1,046.98 63 $977.97 $1,075.77 64 $993.54 $1,092.90 65+** $993.54 $1,092.90

*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.

73.03.355.1-19 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 19 Counties – Monthly Rates (Effective 01/01/2016*) Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson

Aetna Bronze HSA Eligible

PD

Age

Non Tobacco Tobacco

0-20 $117.08 $117.08

21 $184.37 $202.81 22 $184.37 $202.81 23 $184.37 $202.81 24 $184.37 $202.81 25 $185.11 $203.62 26 $188.80 $207.68 27 $193.22 $212.54 28 $200.41 $220.45 29 $206.31 $226.94 30 $209.26 $230.19 31 $213.69 $235.06 32 $218.11 $239.92 33 $220.88 $242.96 34 $223.83 $246.21 35 $225.30 $247.83 36 $226.78 $249.45 37 $228.25 $251.08 38 $229.73 $252.70 39 $232.68 $255.94 40 $235.63 $259.19 41 $240.05 $264.06 42 $244.29 $268.72 43 $250.19 $275.21 44 $257.57 $283.32 45 $266.23 $292.86 46 $276.56 $304.21 47 $288.17 $316.99 48 $301.45 $331.59 49 $314.54 $345.99 50 $329.29 $362.22 51 $343.85 $378.24 52 $359.89 $395.88 53 $376.12 $413.73 54 $393.63 $433.00 55 $411.15 $452.26 56 $430.14 $473.15 57 $449.31 $494.24 58 $469.78 $516.76 59 $479.92 $527.91 60 $500.38 $550.42 61 $518.08 $569.89 62 $529.70 $582.67 63 $544.26 $598.69 64 $552.93 $608.22 65+** $552.93 $608.22

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $125.25 $125.25

21 $197.25 $216.97 22 $197.25 $216.97 23 $197.25 $216.97 24 $197.25 $216.97 25 $198.04 $217.84 26 $201.98 $222.18 27 $206.72 $227.39 28 $214.41 $235.85 29 $220.72 $242.79 30 $223.88 $246.26 31 $228.61 $251.47 32 $233.34 $256.68 33 $236.30 $259.93 34 $239.46 $263.41 35 $241.04 $265.14 36 $242.62 $266.88 37 $244.19 $268.61 38 $245.77 $270.35 39 $248.93 $273.82 40 $252.08 $277.29 41 $256.82 $282.50 42 $261.35 $287.49 43 $267.67 $294.43 44 $275.56 $303.11 45 $284.83 $313.31 46 $295.87 $325.46 47 $308.30 $339.13 48 $322.50 $354.75 49 $336.51 $370.16 50 $352.28 $387.51 51 $367.87 $404.65 52 $385.03 $423.53 53 $402.39 $442.62 54 $421.12 $463.24 55 $439.86 $483.85 56 $460.18 $506.20 57 $480.69 $528.76 58 $502.59 $552.85 59 $513.44 $564.78 60 $535.33 $588.86 61 $554.27 $609.69 62 $566.69 $623.36 63 $582.28 $640.50 64 $591.55 $650.70 65+** $591.55 $650.70

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $157.42 $157.42

21 $247.91 $272.70 22 $247.91 $272.70 23 $247.91 $272.70 24 $247.91 $272.70 25 $248.90 $273.80 26 $253.86 $279.25 27 $259.81 $285.79 28 $269.48 $296.43 29 $277.41 $305.16 30 $281.38 $309.52 31 $287.33 $316.06 32 $293.28 $322.61 33 $297.00 $326.70 34 $300.97 $331.06 35 $302.95 $333.24 36 $304.93 $335.43 37 $306.92 $337.61 38 $308.90 $339.79 39 $312.87 $344.15 40 $316.83 $348.52 41 $322.78 $355.06 42 $328.49 $361.33 43 $336.42 $370.06 44 $346.33 $380.97 45 $357.99 $393.79 46 $371.87 $409.06 47 $387.49 $426.24 48 $405.34 $445.87 49 $422.94 $465.23 50 $442.77 $487.05 51 $462.36 $508.59 52 $483.93 $532.32 53 $505.74 $556.32 54 $529.29 $582.22 55 $552.85 $608.13 56 $578.38 $636.22 57 $604.16 $664.58 58 $631.68 $694.85 59 $645.32 $709.85 60 $672.84 $740.12 61 $696.64 $766.30 62 $712.25 $783.48 63 $731.84 $805.02 64 $743.49 $817.84 65+** $743.49 $817.84

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 Health Plans for Texas Rating Area 19 Counties – Monthly Rates (Effective 01/01/2016*) Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson

Aetna Gold $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $182.36 $182.36

21 $287.18 $315.90 22 $287.18 $315.90 23 $287.18 $315.90 24 $287.18 $315.90 25 $288.33 $317.16 26 $294.07 $323.48 27 $300.97 $331.06 28 $312.17 $343.38 29 $321.36 $353.49 30 $325.95 $358.55 31 $332.84 $366.13 32 $339.74 $373.71 33 $344.04 $378.45 34 $348.64 $383.50 35 $350.94 $386.03 36 $353.23 $388.56 37 $355.53 $391.08 38 $357.83 $393.61 39 $362.42 $398.67 40 $367.02 $403.72 41 $373.91 $411.30 42 $380.52 $418.57 43 $389.71 $428.68 44 $401.19 $441.31 45 $414.69 $456.16 46 $430.77 $473.85 47 $448.86 $493.75 48 $469.54 $516.50 49 $489.93 $538.92 50 $512.91 $564.20 51 $535.59 $589.15 52 $560.58 $616.64 53 $585.85 $644.43 54 $613.13 $674.45 55 $640.41 $704.46 56 $669.99 $736.99 57 $699.86 $769.85 58 $731.74 $804.91 59 $747.53 $822.29 60 $779.41 $857.35 61 $806.98 $887.68 62 $825.07 $907.58 63 $847.76 $932.54 64 $861.26 $947.38 65+** $861.26 $947.38

*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 Health Plans for Texas Rating Area 19 Counties – Monthly Rates (Effective 01/01/2016*) Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson

Aetna Bronze HSA Eligible San Antonio Community

Plan PD

Age

Non Tobacco Tobacco

0-20 $116.82 $116.82

21 $183.97 $202.36 22 $183.97 $202.36 23 $183.97 $202.36 24 $183.97 $202.36 25 $184.70 $203.17 26 $188.38 $207.22 27 $192.80 $212.08 28 $199.97 $219.97 29 $205.86 $226.45 30 $208.80 $229.68 31 $213.22 $234.54 32 $217.63 $239.40 33 $220.39 $242.43 34 $223.34 $245.67 35 $224.81 $247.29 36 $226.28 $248.91 37 $227.75 $250.53 38 $229.22 $252.15 39 $232.17 $255.38 40 $235.11 $258.62 41 $239.53 $263.48 42 $243.76 $268.13 43 $249.64 $274.61 44 $257.00 $282.70 45 $265.65 $292.22 46 $275.95 $303.55 47 $287.54 $316.30 48 $300.79 $330.87 49 $313.85 $345.23 50 $328.57 $361.42 51 $343.10 $377.41 52 $359.11 $395.02 53 $375.30 $412.82 54 $392.77 $432.05 55 $410.25 $451.27 56 $429.20 $472.12 57 $448.33 $493.16 58 $468.75 $515.63 59 $478.87 $526.76 60 $499.29 $549.22 61 $516.95 $568.65 62 $528.54 $581.39 63 $543.07 $597.38 64 $551.72 $606.89 65+** $551.72 $606.89

Aetna Bronze $15 Copay San Antonio Community

Plan PD

Age

Non Tobacco Tobacco

0-20 $125.00 $125.00

21 $196.84 $216.53 22 $196.84 $216.53 23 $196.84 $216.53 24 $196.84 $216.53 25 $197.63 $217.40 26 $201.57 $221.73 27 $206.29 $226.92 28 $213.97 $235.37 29 $220.27 $242.30 30 $223.42 $245.76 31 $228.14 $250.96 32 $232.87 $256.15 33 $235.82 $259.40 34 $238.97 $262.87 35 $240.54 $264.60 36 $242.12 $266.33 37 $243.69 $268.06 38 $245.27 $269.80 39 $248.42 $273.26 40 $251.57 $276.72 41 $256.29 $281.92 42 $260.82 $286.90 43 $267.12 $293.83 44 $274.99 $302.49 45 $284.24 $312.67 46 $295.27 $324.79 47 $307.67 $338.43 48 $321.84 $354.03 49 $335.82 $369.40 50 $351.56 $386.72 51 $367.12 $403.83 52 $384.24 $422.66 53 $401.56 $441.72 54 $420.26 $462.29 55 $438.96 $482.86 56 $459.24 $505.16 57 $479.71 $527.68 58 $501.56 $551.72 59 $512.39 $563.63 60 $534.24 $587.66 61 $553.13 $608.45 62 $565.53 $622.09 63 $581.09 $639.19 64 $590.34 $649.37 65+** $590.34 $649.37

Aetna Silver $10 Copay San Antonio Community Plan

PD

Age

Non Tobacco Tobacco

0-20 $157.08 $157.08

21 $247.38 $272.11 22 $247.38 $272.11 23 $247.38 $272.11 24 $247.38 $272.11 25 $248.36 $273.20 26 $253.31 $278.64 27 $259.25 $285.17 28 $268.90 $295.79 29 $276.81 $304.49 30 $280.77 $308.85 31 $286.71 $315.38 32 $292.65 $321.91 33 $296.36 $325.99 34 $300.31 $330.35 35 $302.29 $332.52 36 $304.27 $334.70 37 $306.25 $336.88 38 $308.23 $339.05 39 $312.19 $343.41 40 $316.15 $347.76 41 $322.08 $354.29 42 $327.77 $360.55 43 $335.69 $369.26 44 $345.58 $380.14 45 $357.21 $392.93 46 $371.06 $408.17 47 $386.65 $425.31 48 $404.46 $444.90 49 $422.02 $464.22 50 $441.81 $485.99 51 $461.35 $507.49 52 $482.88 $531.16 53 $504.65 $555.11 54 $528.15 $580.96 55 $551.65 $606.81 56 $577.13 $634.84 57 $602.85 $663.14 58 $630.31 $693.34 59 $643.92 $708.31 60 $671.38 $738.51 61 $695.12 $764.64 62 $710.71 $781.78 63 $730.25 $803.28 64 $741.88 $816.07 65+** $741.88 $816.07

Aetna Gold $10 Copay San Antonio Community Plan

PD

Age

Non Tobacco Tobacco

0-20 $181.98 $181.98

21 $286.58 $315.23 22 $286.58 $315.23 23 $286.58 $315.23 24 $286.58 $315.23 25 $287.72 $316.49 26 $293.45 $322.80 27 $300.33 $330.36 28 $311.51 $342.66 29 $320.68 $352.75 30 $325.26 $357.79 31 $332.14 $365.36 32 $339.02 $372.92 33 $343.32 $377.65 34 $347.90 $382.69 35 $350.20 $385.22 36 $352.49 $387.74 37 $354.78 $390.26 38 $357.07 $392.78 39 $361.66 $397.83 40 $366.24 $402.87 41 $373.12 $410.43 42 $379.71 $417.68 43 $388.88 $427.77 44 $400.35 $440.38 45 $413.82 $455.20 46 $429.86 $472.85 47 $447.92 $492.71 48 $468.55 $515.41 49 $488.90 $537.79 50 $511.82 $563.01 51 $534.46 $587.91 52 $559.40 $615.34 53 $584.62 $643.08 54 $611.84 $673.02 55 $639.06 $702.97 56 $668.58 $735.44 57 $698.39 $768.22 58 $730.20 $803.22 59 $745.96 $820.55 60 $777.77 $855.54 61 $805.28 $885.81 62 $823.33 $905.67 63 $845.97 $930.57 64 $859.44 $945.39 65+** $859.44 $945.39

*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.

73.03.355.1-24 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 24 Counties – Monthly Rates (Effective 01/01/2016*) Mclennan

Aetna Bronze HSA Eligible

PD

Age

Non Tobacco Tobacco

0-20 $137.86 $137.86

21 $217.11 $238.82 22 $217.11 $238.82 23 $217.11 $238.82 24 $217.11 $238.82 25 $217.98 $239.77 26 $222.32 $244.55 27 $227.53 $250.28 28 $236.00 $259.60 29 $242.94 $267.24 30 $246.42 $271.06 31 $251.63 $276.79 32 $256.84 $282.52 33 $260.10 $286.11 34 $263.57 $289.93 35 $265.31 $291.84 36 $267.04 $293.75 37 $268.78 $295.66 38 $270.52 $297.57 39 $273.99 $301.39 40 $277.46 $305.21 41 $282.68 $310.94 42 $287.67 $316.44 43 $294.62 $324.08 44 $303.30 $333.63 45 $313.50 $344.86 46 $325.66 $358.23 47 $339.34 $373.27 48 $354.97 $390.47 49 $370.39 $407.43 50 $387.76 $426.53 51 $404.91 $445.40 52 $423.80 $466.18 53 $442.90 $487.19 54 $463.53 $509.88 55 $484.15 $532.57 56 $506.51 $557.17 57 $529.09 $582.00 58 $553.19 $608.51 59 $565.13 $621.65 60 $589.23 $648.16 61 $610.08 $671.08 62 $623.75 $686.13 63 $640.90 $705.00 64 $651.11 $716.22 65+** $651.11 $716.22

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $147.49 $147.49

21 $232.27 $255.50 22 $232.27 $255.50 23 $232.27 $255.50 24 $232.27 $255.50 25 $233.20 $256.52 26 $237.85 $261.63 27 $243.42 $267.76 28 $252.48 $277.73 29 $259.91 $285.90 30 $263.63 $289.99 31 $269.20 $296.12 32 $274.78 $302.25 33 $278.26 $306.09 34 $281.98 $310.18 35 $283.84 $312.22 36 $285.69 $314.26 37 $287.55 $316.31 38 $289.41 $318.35 39 $293.13 $322.44 40 $296.84 $326.53 41 $302.42 $332.66 42 $307.76 $338.54 43 $315.19 $346.71 44 $324.48 $356.93 45 $335.40 $368.94 46 $348.41 $383.25 47 $363.04 $399.34 48 $379.76 $417.74 49 $396.25 $435.88 50 $414.84 $456.32 51 $433.19 $476.50 52 $453.39 $498.73 53 $473.83 $521.22 54 $495.90 $545.49 55 $517.97 $569.76 56 $541.89 $596.08 57 $566.05 $622.65 58 $591.83 $651.01 59 $604.60 $665.06 60 $630.38 $693.42 61 $652.68 $717.95 62 $667.32 $734.05 63 $685.67 $754.23 64 $696.58 $766.24 65+** $696.58 $766.24

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $185.38 $185.38

21 $291.93 $321.13 22 $291.93 $321.13 23 $291.93 $321.13 24 $291.93 $321.13 25 $293.10 $322.41 26 $298.94 $328.83 27 $305.95 $336.54 28 $317.33 $349.06 29 $326.67 $359.34 30 $331.34 $364.48 31 $338.35 $372.18 32 $345.36 $379.89 33 $349.74 $384.71 34 $354.41 $389.85 35 $356.74 $392.42 36 $359.08 $394.98 37 $361.41 $397.55 38 $363.75 $400.12 39 $368.42 $405.26 40 $373.09 $410.40 41 $380.10 $418.11 42 $386.81 $425.49 43 $396.15 $435.77 44 $407.83 $448.61 45 $421.55 $463.71 46 $437.90 $481.69 47 $456.29 $501.92 48 $477.31 $525.04 49 $498.04 $547.84 50 $521.39 $573.53 51 $544.45 $598.90 52 $569.85 $626.84 53 $595.54 $655.10 54 $623.28 $685.60 55 $651.01 $716.11 56 $681.08 $749.19 57 $711.44 $782.58 58 $743.84 $818.23 59 $759.90 $835.89 60 $792.31 $871.54 61 $820.33 $902.36 62 $838.72 $922.59 63 $861.79 $947.96 64 $875.51 $963.06 65+** $875.51 $963.06

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 Health Plans for Texas Rating Area 24 Counties – Monthly Rates (Effective 01/01/2016*) Mclennan

Aetna Gold $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $214.74 $214.74

21 $338.17 $371.99 22 $338.17 $371.99 23 $338.17 $371.99 24 $338.17 $371.99 25 $339.53 $373.48 26 $346.29 $380.92 27 $354.41 $389.85 28 $367.59 $404.35 29 $378.42 $416.26 30 $383.83 $422.21 31 $391.94 $431.14 32 $400.06 $440.06 33 $405.13 $445.64 34 $410.54 $451.60 35 $413.25 $454.57 36 $415.95 $457.55 37 $418.66 $460.52 38 $421.36 $463.50 39 $426.77 $469.45 40 $432.19 $475.40 41 $440.30 $484.33 42 $448.08 $492.89 43 $458.90 $504.79 44 $472.43 $519.67 45 $488.32 $537.15 46 $507.26 $557.99 47 $528.56 $581.42 48 $552.91 $608.20 49 $576.92 $634.62 50 $603.98 $664.38 51 $630.69 $693.76 52 $660.11 $726.13 53 $689.87 $758.86 54 $722.00 $794.20 55 $754.13 $829.54 56 $788.96 $867.85 57 $824.13 $906.54 58 $861.67 $947.83 59 $880.26 $968.29 60 $917.80 $1,009.58 61 $950.27 $1,045.29 62 $971.57 $1,068.73 63 $998.29 $1,098.12 64 $1,014.18 $1,115.60 65+** $1,014.18 $1,115.60

*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.

73.03.355.1-26 B (1/16)

Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 26 Counties – Monthly Rates (Effective 01/01/2016*) Burnet, Colorado, Falls, Fayette, Jasper, Lee, Limestone, Llano, Matagorda, Palo Pinto, Tyler, Wharton

Aetna Bronze HSA Eligible

PD

Age

Non Tobacco Tobacco

0-20 $119.88 $119.88

21 $188.79 $207.67 22 $188.79 $207.67 23 $188.79 $207.67 24 $188.79 $207.67 25 $189.55 $208.50 26 $193.32 $212.65 27 $197.85 $217.64 28 $205.21 $225.74 29 $211.26 $232.38 30 $214.28 $235.70 31 $218.81 $240.69 32 $223.34 $245.67 33 $226.17 $248.79 34 $229.19 $252.11 35 $230.70 $253.77 36 $232.21 $255.43 37 $233.72 $257.09 38 $235.23 $258.76 39 $238.25 $262.08 40 $241.27 $265.40 41 $245.80 $270.39 42 $250.15 $275.16 43 $256.19 $281.81 44 $263.74 $290.11 45 $272.61 $299.87 46 $283.19 $311.50 47 $295.08 $324.59 48 $308.67 $339.54 49 $322.08 $354.28 50 $337.18 $370.90 51 $352.09 $387.30 52 $368.52 $405.37 53 $385.13 $423.64 54 $403.07 $443.37 55 $421.00 $463.10 56 $440.45 $484.49 57 $460.08 $506.09 58 $481.04 $529.14 59 $491.42 $540.56 60 $512.38 $563.61 61 $530.50 $583.55 62 $542.39 $596.63 63 $557.31 $613.04 64 $566.18 $622.80 65+** $566.18 $622.80

Aetna Bronze $15 Copay PD

Age

Non Tobacco Tobacco

0-20 $128.25 $128.25

21 $201.98 $222.17 22 $201.98 $222.17 23 $201.98 $222.17 24 $201.98 $222.17 25 $202.78 $223.06 26 $206.82 $227.50 27 $211.67 $232.84 28 $219.55 $241.50 29 $226.01 $248.61 30 $229.24 $252.17 31 $234.09 $257.50 32 $238.94 $262.83 33 $241.97 $266.16 34 $245.20 $269.72 35 $246.81 $271.49 36 $248.43 $273.27 37 $250.05 $275.05 38 $251.66 $276.83 39 $254.89 $280.38 40 $258.12 $283.94 41 $262.97 $289.27 42 $267.62 $294.38 43 $274.08 $301.49 44 $282.16 $310.38 45 $291.65 $320.82 46 $302.96 $333.26 47 $315.69 $347.26 48 $330.23 $363.25 49 $344.57 $379.03 50 $360.73 $396.80 51 $376.68 $414.35 52 $394.26 $433.68 53 $412.03 $453.23 54 $431.22 $474.34 55 $450.40 $495.44 56 $471.21 $518.33 57 $492.21 $541.43 58 $514.63 $566.10 59 $525.74 $578.32 60 $548.16 $602.98 61 $567.55 $624.31 62 $580.27 $638.30 63 $596.23 $655.85 64 $605.72 $666.30 65+** $605.72 $666.30

Aetna Silver $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $161.20 $161.20

21 $253.85 $279.24 22 $253.85 $279.24 23 $253.85 $279.24 24 $253.85 $279.24 25 $254.87 $280.36 26 $259.95 $285.94 27 $266.04 $292.64 28 $275.94 $303.53 29 $284.06 $312.47 30 $288.12 $316.94 31 $294.22 $323.64 32 $300.31 $330.34 33 $304.12 $334.53 34 $308.18 $339.00 35 $310.21 $341.23 36 $312.24 $343.47 37 $314.27 $345.70 38 $316.30 $347.93 39 $320.36 $352.40 40 $324.43 $356.87 41 $330.52 $363.57 42 $336.36 $369.99 43 $344.48 $378.93 44 $354.63 $390.10 45 $366.57 $403.22 46 $380.78 $418.86 47 $396.77 $436.45 48 $415.05 $456.56 49 $433.08 $476.38 50 $453.38 $498.72 51 $473.44 $520.78 52 $495.52 $545.08 53 $517.86 $569.65 54 $541.98 $596.18 55 $566.10 $622.71 56 $592.24 $651.47 57 $618.64 $680.51 58 $646.82 $711.50 59 $660.78 $726.86 60 $688.96 $757.86 61 $713.33 $784.66 62 $729.32 $802.26 63 $749.38 $824.32 64 $761.31 $837.44 65+** $761.31 $837.44

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 Health Plans for Texas Rating Area 26 Counties – Monthly Rates (Effective 01/01/2016*) Burnet, Colorado, Falls, Fayette, Jasper, Lee, Limestone, Llano, Matagorda, Palo Pinto, Tyler, Wharton

Aetna Gold $10 Copay PD

Age

Non Tobacco Tobacco

0-20 $186.73 $186.73

21 $294.06 $323.47 22 $294.06 $323.47 23 $294.06 $323.47 24 $294.06 $323.47 25 $295.24 $324.76 26 $301.12 $331.23 27 $308.18 $339.00 28 $319.65 $351.61 29 $329.06 $361.96 30 $333.76 $367.14 31 $340.82 $374.90 32 $347.88 $382.67 33 $352.29 $387.52 34 $356.99 $392.69 35 $359.35 $395.28 36 $361.70 $397.87 37 $364.05 $400.46 38 $366.40 $403.04 39 $371.11 $408.22 40 $375.81 $413.39 41 $382.87 $421.16 42 $389.63 $428.60 43 $399.04 $438.95 44 $410.81 $451.89 45 $424.63 $467.09 46 $441.10 $485.21 47 $459.62 $505.58 48 $480.79 $528.87 49 $501.67 $551.84 50 $525.20 $577.72 51 $548.43 $603.27 52 $574.01 $631.41 53 $599.89 $659.88 54 $627.83 $690.61 55 $655.76 $721.34 56 $686.05 $754.66 57 $716.63 $788.30 58 $749.27 $824.20 59 $765.45 $841.99 60 $798.09 $877.90 61 $826.32 $908.95 62 $844.84 $929.33 63 $868.08 $954.88 64 $881.90 $970.09 65+** $881.90 $970.09

*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.