Individual and Family Health Insurance Rates

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1 Individual and Family Health Insurance Rates New Business Rates Effective January 1, 2018 * *rates subject to change A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2 Illinois Rating Area Descriptions Rating Area Rating Area Description 1 Chicago - Central, IL 2 Chicago - North, IL 3 Chicago - West, IL 4 Chicago - South, IL 5 Rockford, IL 6 Quad Cities, IL 7 Peoria, IL 8 Bloomington, IL 9 Champaign, IL 10 Springfield, IL 11 East St. Louis, IL 12 St. Louis, IL 13 Southern, IL Rates Effective January 1, 2018 Page 1 of 44

3 Illinois County Mapping County Rating Area County Rating Area Adams 10 Lee 5 Alexander 13 Livingston 8 Bond 11 Logan 10 Boone 5 Macon 10 Brown 10 Macoupin 11 Bureau 6 Madison 12 Calhoun 11 Marion 13 Carroll 5 Marshall 7 Cass 10 Mason 10 Champaign 9 Massac 13 Christian 10 McDonough 7 Clark 9 McHenry 2 Clay 13 McLean 8 Clinton 11 Menard 10 Coles 9 Mercer 6 Cook 1 Monroe 12 Crawford 13 Montgomery 11 Cumberland 9 Morgan 10 DeKalb 5 Moultrie 10 DeWitt 8 Ogle 5 Douglas 9 Peoria 7 Dupage 3 Perry 13 Edgar 9 Piatt 9 Edwards 13 Pike 10 Effingham 13 Pope 13 Fayette 13 Pulaski 13 Ford 9 Putnam 7 Franklin 13 Randolph 11 Fulton 7 Richland 13 Gallatin 13 Rock Island 6 Greene 11 Saline 13 Grundy 4 Sangamon 10 Hamilton 13 Schuyler 10 Hancock 6 Scott 10 Hardin 13 Shelby 10 Henderson 6 St. Clair 12 Henry 6 Stark 7 Iroquois 9 Stephenson 5 Jackson 13 Tazewell 7 Jasper 13 Union 13 Jefferson 13 Vermilion 9 Jersey 11 Wabash 13 Jo Daviess 5 Warren 6 Johnson 13 Washington 11 Kane 3 Wayne 13 Kankakee 4 White 13 Kendall 4 Whiteside 6 Knox 7 Will 4 Lake 2 Williamson 13 LaSalle 7 Winnebago 5 Lawrence 13 Woodford 7 Rates Effective January 1, 2018 Page 1 of 1

4 Illinois Off Exchange (Gold) Chicago - Central, IL Blue Precision Gold HMO SM Blue Choice Preferred Gold PPO SM Blue FocusCare Gold SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 3 of 44

5 Illinois Off Exchange (Gold) Chicago - North, IL Blue Precision Gold HMO SM Blue Choice Preferred Gold PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 4 of 44

6 Illinois Off Exchange (Gold) Blue Precision Gold HMO SM Chicago - West, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 5 of 44

7 Illinois Off Exchange (Gold) Chicago - South, IL Blue Precision Gold HMO SM Blue Choice Preferred Gold PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 6 of 44

8 Illinois Off Exchange (Gold) Blue Precision Gold HMO SM Rockford, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 7 of 44

9 Illinois Off Exchange (Gold) Quad Cities, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 8 of 44

10 Illinois Off Exchange (Gold) Blue Precision Gold HMO SM Peoria, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 9 of 44

11 Illinois Off Exchange (Gold) Blue Precision Gold HMO SM Bloomington, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 10 of 44

12 Illinois Off Exchange (Gold) Champaign, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 11 of 44

13 Illinois Off Exchange (Gold) Springfield, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 12 of 44

14 Illinois Off Exchange (Gold) East St. Louis, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 13 of 44

15 Illinois Off Exchange (Gold) St. Louis, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 14 of 44

16 Illinois Off Exchange (Gold) Southern, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $2, $1, $2, $1, $2, Rates Effective January 1, 2018 Page 15 of 44

17 Illinois Off Exchange (Silver) Chicago - Central, IL Blue Precision Silver HMO SM BlueCare Direct Silver SM Blue Choice Preferred Silver PPO SM Blue FocusCare Silver SM 210 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $1, $1, $ $ $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, Rates Effective January 1, 2018 Page 16 of 44

18 Illinois Off Exchange (Silver) Chicago - North, IL Blue Precision Silver HMO SM BlueCare Direct Silver SM Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 17 of 44

19 Illinois Off Exchange (Silver) Chicago - West, IL Blue Precision Silver HMO SM BlueCare Direct Silver SM Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $1, $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, $1, $1, $1, $1, $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 18 of 44

20 Illinois Off Exchange (Silver) Chicago - South, IL Blue Precision Silver HMO SM BlueCare Direct Silver SM Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 19 of 44

21 Illinois Off Exchange (Silver) Blue Precision Silver HMO SM 206 Rockford, IL Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 20 of 44

22 Illinois Off Exchange (Silver) Quad Cities, IL Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 21 of 44

23 Illinois Off Exchange (Silver) Blue Precision Silver HMO SM 206 Peoria, IL Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 22 of 44

24 Illinois Off Exchange (Silver) Bloomington, IL Blue Precision Silver HMO SM Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 23 of 44

25 Illinois Off Exchange (Silver) Champaign, IL Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 24 of 44

26 Illinois Off Exchange (Silver) Springfield, IL Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 25 of 44

27 Illinois Off Exchange (Silver) East St. Louis, IL Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 26 of 44

28 Illinois Off Exchange (Silver) St. Louis, IL Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 27 of 44

29 Illinois Off Exchange (Silver) Southern, IL Blue Choice Preferred Silver PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $1, $2, Rates Effective January 1, 2018 Page 28 of 44

30 Illinois Off Exchange (Bronze) Chicago - Central, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM Blue FocusCare Bronze SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $ $ $1, $1, $1, $ $1, $ $ $ $1, $1, $1, $ $1, $ $ $ $1, $1, $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, Rates Effective January 1, 2018 Page 29 of 44

31 Illinois Off Exchange (Bronze) Chicago - North, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, Rates Effective January 1, 2018 Page 30 of 44

32 Illinois Off Exchange (Bronze) Chicago - West, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, Rates Effective January 1, 2018 Page 31 of 44

33 Illinois Off Exchange (Bronze) Chicago - South, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, Rates Effective January 1, 2018 Page 32 of 44

34 Illinois Off Exchange (Bronze) Blue Precision Bronze HMO SM 205 Rockford, IL Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 33 of 44

35 Illinois Off Exchange (Bronze) Quad Cities, IL Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, Rates Effective January 1, 2018 Page 34 of 44

36 Illinois Off Exchange (Bronze) Blue Precision Bronze HMO SM 205 Peoria, IL Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 35 of 44

37 Illinois Off Exchange (Bronze) Bloomington, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, Rates Effective January 1, 2018 Page 36 of 44

38 Illinois Off Exchange (Bronze) Champaign, IL Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 37 of 44

39 Illinois Off Exchange (Bronze) Springfield, IL Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 38 of 44

40 Illinois Off Exchange (Bronze) East St. Louis, IL Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, Rates Effective January 1, 2018 Page 39 of 44

41 Illinois Off Exchange (Bronze) St. Louis, IL Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, Rates Effective January 1, 2018 Page 40 of 44

42 Illinois Off Exchange (Bronze) Southern, IL Blue Choice Preferred Bronze PPO SM Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, Rates Effective January 1, 2018 Page 41 of 44

43 Illinois Off Exchange (Catastrophic) Rating Area Blue Choice Preferred Security PPO SM 200 Chicago - Central, IL Chicago - North, IL Chicago - West, IL Chicago - South, IL Rockford, IL Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, $ $1, $1, $1, Rates Effective January 1, 2018 Page 42 of 44

44 Illinois Off Exchange (Catastrophic) Rating Area Blue Choice Preferred Security PPO SM 200 Quad Cities, IL Peoria, IL Bloomington, IL Champaign, IL Springfield, IL Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $ $1, Rates Effective January 1, 2018 Page 43 of 44

45 Illinois Off Exchange (Catastrophic) Rating Area Blue Choice Preferred Security PPO SM 200 East St. Louis, IL St. Louis, IL Southern, IL Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $1, $ $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $1, Rates Effective January 1, 2018 Page 44 of 44

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