Individual and Family Health Insurance Rates

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 725737.1017

Texas Rating Area Descriptions Rating Area Rating Area Description 1 Abilene, TX 2 Amarillo, TX 3 Austin-Round Rock-San Marcos, TX 4 Beaumont-Port Arthur, TX 5 Brownsville-Harlingen, TX 6 College Station-Bryan, TX 7 Corpus Christi, TX 8 Dallas-Fort Worth-Arlington, TX 9 El Paso, TX 10 Houston-Sugar Land-Baytown, TX 11 Killeen-Temple-Fort Hood, TX 12 Laredo, TX 13 Longview, TX 14 Lubbock, TX 15 McAllen-Edinburg-Mission, TX 16 Midland, TX 17 Odessa, TX 18 San Angelo, TX 19 San Antonio-New Braunfels, TX 20 Sherman-Denison, TX 21 Texarkana, TX-Texarkana, AR 22 Tyler, TX 23 Victoria, TX 24 Waco, TX 25 Wichita Falls, TX 26 Non MSA Rates Effective January 1, 2018 Page 1 of 86

Texas County Mapping County Rating Area County Rating Area County Rating Area County Rating Area Anderson 26 Donley 26 Kaufman 8 Real 26 Andrews 26 Duval 26 Kendall 19 Red River 26 Angelina 26 Eastland 26 Kenedy 26 Reeves 26 Aransas 7 Ector 17 Kent 26 Refugio 26 Archer 25 Edwards 26 Kerr 26 Roberts 26 Armstrong 2 El Paso 9 Kimble 26 Robertson 6 Atascosa 19 Ellis 8 King 26 Rockwall 8 Austin 10 Erath 26 Kinney 26 Runnels 26 Bailey 26 Falls 26 Kleberg 26 Rusk 13 Bandera 19 Fannin 26 Knox 26 Sabine 26 Bastrop 3 Fayette 26 La Salle 26 San Augustine 26 Baylor 26 Fisher 26 Lamar 26 San Jacinto 10 Bee 26 Floyd 26 Lamb 26 San Patricio 7 Bell 11 Foard 26 Lampasas 11 San Saba 26 Bexar 19 Fort Bend 10 Lavaca 26 Schleicher 26 Blanco 26 Franklin 26 Lee 26 Scurry 26 Borden 26 Freestone 26 Leon 26 Shackelford 26 Bosque 26 Frio 26 Liberty 10 Shelby 26 Bowie 21 Gaines 26 Limestone 26 Sherman 26 Brazoria 10 Galveston 10 Lipscomb 26 Smith 22 Brazos 6 Garza 26 Live Oak 26 Somervell 26 Brewster 26 Gillespie 26 Llano 26 Starr 26 Briscoe 26 Glasscock 26 Loving 26 Stephens 26 Brooks 26 Goliad 23 Lubbock 14 Sterling 26 Brown 26 Gonzales 26 Lynn 26 Stonewall 26 Burleson 6 Gray 26 Madison 26 Sutton 26 Burnet 26 Grayson 20 Marion 26 Swisher 26 Caldwell 3 Gregg 13 Martin 26 Tarrant 8 Calhoun 23 Grimes 26 Mason 26 Taylor 1 Callahan 1 Guadalupe 19 Matagorda 26 Terrell 26 Cameron 5 Hale 26 Maverick 26 Terry 26 Camp 26 Hall 26 McCulloch 26 Throckmorton 26 Carson 2 Hamilton 26 McLennan 24 Titus 26 Cass 26 Hansford 26 McMullen 26 Tom Green 18 Castro 26 Hardeman 26 Medina 19 Travis 3 Chambers 10 Hardin 4 Menard 26 Trinity 26 Cherokee 26 Harris 10 Midland 16 Tyler 26 Childress 26 Harrison 26 Milam 26 Upshur 13 Clay 25 Hartley 26 Mills 26 Upton 26 Cochran 26 Haskell 26 Mitchell 26 Uvalde 26 Coke 26 Hays 3 Montague 26 Val Verde 26 Coleman 26 Hemphill 26 Montgomery 10 Van Zandt 26 Collin 8 Henderson 26 Moore 26 Victoria 23 Collingsworth 26 Hidalgo 15 Morris 26 Walker 26 Colorado 26 Hill 26 Motley 26 Waller 10 Comal 19 Hockley 26 Nacogdoches 26 Ward 26 Comanche 26 Hood 26 Navarro 26 Washington 26 Concho 26 Hopkins 26 Newton 26 Webb 12 Cooke 26 Houston 26 Nolan 26 Wharton 26 Coryell 11 Howard 26 Nueces 7 Wheeler 26 Cottle 26 Hudspeth 26 Ochiltree 26 Wichita 25 Crane 26 Hunt 8 Oldham 26 Wilbarger 26 Crockett 26 Hutchinson 26 Orange 4 Willacy 26 Crosby 14 Irion 18 Palo Pinto 26 Williamson 3 Culberson 26 Jack 26 Panola 26 Wilson 19 Dallam 26 Jackson 26 Parker 8 Winkler 26 Dallas 8 Jasper 26 Parmer 26 Wise 8 Dawson 26 Jeff Davis 26 Pecos 26 Wood 26 De Witt 26 Jefferson 4 Polk 26 Yoakum 26 Deaf Smith 26 Jim Hogg 26 Potter 2 Young 26 Delta 8 Jim Wells 26 Presidio 26 Zapata 26 Denton 8 Johnson 8 Rains 26 Zavala 26 Dickens 26 Jones 1 Randall 2 Dimmit 26 Karnes 26 Reagan 26 Rates Effective January 1, 2018 Page 2 of 86

Texas Off Exchange (Gold) Abilene, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $315.56 $315.56 $410.39 $410.39 $351.91 $351.91 15 $343.61 $343.61 $446.87 $446.87 $383.19 $383.19 16 $354.33 $354.33 $460.82 $460.82 $395.15 $395.15 17 $365.06 $365.06 $474.77 $474.77 $407.11 $407.11 18 $376.61 $376.61 $489.79 $489.79 $419.99 $419.99 19 $388.15 $388.15 $504.81 $504.81 $432.87 $432.87 20 $400.12 $400.12 $520.37 $520.37 $446.21 $446.21 21 $412.49 $412.49 $536.46 $536.46 $460.01 $460.01 22 $412.49 $412.49 $536.46 $536.46 $460.01 $460.01 23 $412.49 $412.49 $536.46 $536.46 $460.01 $460.01 24 $412.49 $412.49 $536.46 $536.46 $460.01 $460.01 25 $414.14 $414.14 $538.61 $538.61 $461.85 $461.85 26 $422.39 $422.39 $549.34 $549.34 $471.05 $471.05 27 $432.29 $432.29 $562.21 $562.21 $482.09 $482.09 28 $448.38 $448.38 $583.13 $583.13 $500.04 $500.04 29 $461.58 $461.58 $600.30 $600.30 $514.76 $514.76 30 $468.18 $531.01 $608.88 $690.60 $522.12 $592.19 31 $478.08 $542.24 $621.76 $705.20 $533.16 $604.71 32 $487.98 $553.47 $634.63 $719.80 $544.20 $617.23 33 $494.17 $560.48 $642.68 $728.93 $551.10 $625.05 34 $500.77 $567.97 $651.26 $738.66 $558.46 $633.40 35 $504.07 $618.89 $655.55 $804.89 $562.14 $690.19 36 $507.36 $622.94 $659.85 $810.16 $565.82 $694.71 37 $510.66 $627.00 $664.14 $815.43 $569.50 $699.23 38 $513.96 $631.05 $668.43 $820.70 $573.18 $703.75 39 $520.56 $639.15 $677.01 $831.23 $580.54 $712.78 40 $527.16 $679.72 $685.60 $884.01 $587.90 $758.03 41 $537.06 $692.49 $698.47 $900.61 $598.94 $772.27 42 $546.55 $704.73 $710.81 $916.52 $609.52 $785.92 43 $559.75 $721.75 $727.98 $938.65 $624.24 $804.90 44 $576.25 $743.02 $749.43 $966.32 $642.64 $828.62 45 $595.64 $785.41 $774.65 $1,021.45 $664.26 $875.89 46 $618.74 $815.87 $804.69 $1,061.06 $690.02 $909.86 47 $644.72 $850.13 $838.49 $1,105.63 $719.00 $948.08 48 $674.42 $889.30 $877.11 $1,156.56 $752.12 $991.75 49 $703.71 $927.91 $915.20 $1,206.78 $784.78 $1,034.82 50 $736.71 $974.08 $958.12 $1,266.82 $821.59 $1,086.30 51 $769.30 $1,017.16 $1,000.50 $1,322.86 $857.93 $1,134.35 52 $805.18 $1,064.61 $1,047.17 $1,384.57 $897.95 $1,187.26 53 $841.48 $1,112.61 $1,094.38 $1,446.99 $938.43 $1,240.79 54 $880.67 $1,164.42 $1,145.34 $1,514.37 $982.13 $1,298.57 55 $919.86 $1,203.36 $1,196.31 $1,565.01 $1,025.83 $1,341.99 56 $962.34 $1,258.94 $1,251.56 $1,637.29 $1,073.21 $1,403.98 57 $1,005.24 $1,315.06 $1,307.35 $1,710.28 $1,121.05 $1,466.56 58 $1,051.03 $1,374.95 $1,366.90 $1,788.18 $1,172.12 $1,533.36 59 $1,073.72 $1,404.63 $1,396.41 $1,826.78 $1,197.42 $1,566.46 60 $1,119.50 $1,438.34 $1,455.95 $1,870.61 $1,248.48 $1,604.05 61 $1,159.10 $1,489.22 $1,507.45 $1,936.78 $1,292.64 $1,660.78 62 $1,185.09 $1,522.60 $1,541.25 $1,980.20 $1,321.62 $1,698.02 63 $1,217.68 $1,564.47 $1,583.63 $2,034.65 $1,357.96 $1,744.71 64 $1,237.47 $1,589.91 $1,609.38 $2,067.73 $1,380.03 $1,773.08 65+ $1,237.47 $1,589.91 $1,609.38 $2,067.73 $1,380.03 $1,773.08 Rates Effective January 1, 2018 Page 3 of 86

Texas Off Exchange (Gold) Amarillo, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $329.31 $329.31 $428.28 $428.28 $351.13 $351.13 15 $358.58 $358.58 $466.35 $466.35 $382.34 $382.34 16 $369.77 $369.77 $480.90 $480.90 $394.28 $394.28 17 $380.97 $380.97 $495.46 $495.46 $406.21 $406.21 18 $393.02 $393.02 $511.13 $511.13 $419.06 $419.06 19 $405.07 $405.07 $526.81 $526.81 $431.92 $431.92 20 $417.55 $417.55 $543.04 $543.04 $445.23 $445.23 21 $430.47 $430.47 $559.84 $559.84 $459.00 $459.00 22 $430.47 $430.47 $559.84 $559.84 $459.00 $459.00 23 $430.47 $430.47 $559.84 $559.84 $459.00 $459.00 24 $430.47 $430.47 $559.84 $559.84 $459.00 $459.00 25 $432.19 $432.19 $562.08 $562.08 $460.83 $460.83 26 $440.80 $440.80 $573.28 $573.28 $470.01 $470.01 27 $451.13 $451.13 $586.71 $586.71 $481.03 $481.03 28 $467.92 $467.92 $608.55 $608.55 $498.93 $498.93 29 $481.69 $481.69 $626.46 $626.46 $513.62 $513.62 30 $488.58 $554.15 $635.42 $720.69 $520.96 $590.88 31 $498.91 $565.87 $648.85 $735.93 $531.98 $603.37 32 $509.24 $577.59 $662.29 $751.17 $542.99 $615.86 33 $515.70 $584.91 $670.69 $760.69 $549.88 $623.67 34 $522.59 $592.72 $679.65 $770.85 $557.22 $632.00 35 $526.03 $645.86 $684.12 $839.97 $560.89 $688.66 36 $529.48 $650.09 $688.60 $845.46 $564.57 $693.17 37 $532.92 $654.32 $693.08 $850.97 $568.24 $697.68 38 $536.36 $658.55 $697.56 $856.47 $571.91 $702.19 39 $543.25 $667.00 $706.52 $867.46 $579.25 $711.21 40 $550.14 $709.35 $715.48 $922.53 $586.60 $756.36 41 $560.47 $722.67 $728.91 $939.86 $597.61 $770.56 42 $570.37 $735.44 $741.79 $956.46 $608.17 $784.18 43 $584.15 $753.20 $759.70 $979.56 $622.86 $803.12 44 $601.37 $775.40 $782.10 $1,008.43 $641.22 $826.79 45 $621.60 $819.64 $808.41 $1,065.97 $662.79 $873.96 46 $645.70 $851.42 $839.76 $1,107.31 $688.50 $907.85 47 $672.82 $887.18 $875.03 $1,153.81 $717.41 $945.98 48 $703.82 $928.05 $915.34 $1,206.96 $750.46 $989.56 49 $734.38 $968.35 $955.09 $1,259.38 $783.05 $1,032.53 50 $768.82 $1,016.53 $999.87 $1,322.03 $819.77 $1,083.90 51 $802.82 $1,061.49 $1,044.10 $1,380.51 $856.03 $1,131.84 52 $840.28 $1,111.01 $1,092.81 $1,444.91 $895.96 $1,184.64 53 $878.16 $1,161.10 $1,142.07 $1,510.05 $936.35 $1,238.05 54 $919.05 $1,215.17 $1,195.26 $1,580.37 $979.96 $1,295.70 55 $959.95 $1,255.80 $1,248.44 $1,633.22 $1,023.56 $1,339.03 56 $1,004.28 $1,313.80 $1,306.11 $1,708.65 $1,070.84 $1,400.87 57 $1,049.05 $1,372.37 $1,364.33 $1,784.81 $1,118.57 $1,463.32 58 $1,096.84 $1,434.88 $1,426.47 $1,866.11 $1,169.52 $1,529.97 59 $1,120.51 $1,465.85 $1,457.26 $1,906.39 $1,194.77 $1,562.99 60 $1,168.29 $1,501.02 $1,519.41 $1,952.13 $1,245.72 $1,600.50 61 $1,209.62 $1,554.12 $1,573.15 $2,021.18 $1,289.78 $1,657.11 62 $1,236.74 $1,588.96 $1,608.42 $2,066.50 $1,318.70 $1,694.26 63 $1,270.74 $1,632.65 $1,652.65 $2,123.32 $1,354.96 $1,740.85 64 $1,291.41 $1,659.20 $1,679.52 $2,157.85 $1,377.00 $1,769.16 65+ $1,291.41 $1,659.20 $1,679.52 $2,157.85 $1,377.00 $1,769.16 Rates Effective January 1, 2018 Page 4 of 86

Texas Off Exchange (Gold) Austin-Round Rock-San Marcos, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $342.33 $342.33 $445.21 $445.21 $363.50 $363.50 15 $372.76 $372.76 $484.79 $484.79 $395.82 $395.82 16 $384.40 $384.40 $499.92 $499.92 $408.17 $408.17 17 $396.03 $396.03 $515.05 $515.05 $420.52 $420.52 18 $408.56 $408.56 $531.35 $531.35 $433.83 $433.83 19 $421.09 $421.09 $547.64 $547.64 $447.13 $447.13 20 $434.07 $434.07 $564.52 $564.52 $460.91 $460.91 21 $447.49 $447.49 $581.98 $581.98 $475.17 $475.17 22 $447.49 $447.49 $581.98 $581.98 $475.17 $475.17 23 $447.49 $447.49 $581.98 $581.98 $475.17 $475.17 24 $447.49 $447.49 $581.98 $581.98 $475.17 $475.17 25 $449.28 $449.28 $584.31 $584.31 $477.07 $477.07 26 $458.23 $458.23 $595.95 $595.95 $486.57 $486.57 27 $468.97 $468.97 $609.91 $609.91 $497.98 $497.98 28 $486.42 $486.42 $632.61 $632.61 $516.51 $516.51 29 $500.74 $500.74 $651.23 $651.23 $531.71 $531.71 30 $507.90 $576.07 $660.55 $749.19 $539.32 $611.69 31 $518.64 $588.25 $674.51 $765.03 $550.72 $624.63 32 $529.38 $600.43 $688.48 $780.88 $562.12 $637.56 33 $536.10 $608.04 $697.21 $790.78 $569.25 $645.64 34 $543.26 $616.16 $706.52 $801.34 $576.85 $654.27 35 $546.84 $671.40 $711.18 $873.18 $580.66 $712.93 36 $550.42 $675.80 $715.83 $878.90 $584.46 $717.59 37 $554.00 $680.20 $720.49 $884.62 $588.26 $722.27 38 $557.58 $684.59 $725.15 $890.33 $592.06 $726.93 39 $564.73 $693.38 $734.46 $901.76 $599.66 $736.26 40 $571.89 $737.40 $743.77 $959.01 $607.27 $783.01 41 $582.63 $751.25 $757.74 $977.03 $618.67 $797.71 42 $592.93 $764.52 $771.12 $994.29 $629.60 $811.81 43 $607.25 $782.99 $789.75 $1,018.30 $644.80 $831.41 44 $625.15 $806.06 $813.02 $1,048.31 $663.81 $855.92 45 $646.18 $852.05 $840.38 $1,108.12 $686.14 $904.75 46 $671.24 $885.09 $872.97 $1,151.10 $712.75 $939.84 47 $699.43 $922.27 $909.63 $1,199.44 $742.69 $979.31 48 $731.65 $964.75 $951.54 $1,254.69 $776.90 $1,024.42 49 $763.42 $1,006.65 $992.86 $1,309.18 $810.64 $1,068.91 50 $799.22 $1,056.73 $1,039.41 $1,374.31 $848.65 $1,122.09 51 $834.57 $1,103.47 $1,085.39 $1,435.10 $886.19 $1,171.72 52 $873.50 $1,154.95 $1,136.02 $1,502.05 $927.53 $1,226.38 53 $912.88 $1,207.02 $1,187.24 $1,569.77 $969.34 $1,281.67 54 $955.40 $1,263.23 $1,242.52 $1,642.87 $1,014.48 $1,341.35 55 $997.91 $1,305.46 $1,297.81 $1,697.80 $1,059.63 $1,386.20 56 $1,044.00 $1,365.76 $1,357.76 $1,776.22 $1,108.57 $1,450.23 57 $1,090.54 $1,426.64 $1,418.28 $1,855.40 $1,157.99 $1,514.88 58 $1,140.21 $1,491.62 $1,482.88 $1,939.90 $1,210.73 $1,583.87 59 $1,164.82 $1,523.82 $1,514.89 $1,981.78 $1,236.86 $1,618.06 60 $1,214.49 $1,560.38 $1,579.49 $2,029.33 $1,289.61 $1,656.89 61 $1,257.45 $1,615.58 $1,635.36 $2,101.11 $1,335.22 $1,715.50 62 $1,285.64 $1,651.80 $1,672.03 $2,148.22 $1,365.16 $1,753.96 63 $1,321.00 $1,697.22 $1,718.00 $2,207.29 $1,402.70 $1,802.19 64 $1,342.47 $1,724.81 $1,745.94 $2,243.18 $1,425.51 $1,831.49 65+ $1,342.47 $1,724.81 $1,745.94 $2,243.18 $1,425.51 $1,831.49 Rates Effective January 1, 2018 Page 5 of 86

Texas Off Exchange (Gold) Beaumont-Port Arthur, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $332.27 $332.27 $432.12 $432.12 $355.04 $355.04 15 $361.80 $361.80 $470.53 $470.53 $386.60 $386.60 16 $373.09 $373.09 $485.22 $485.22 $398.67 $398.67 17 $384.39 $384.39 $499.91 $499.91 $410.73 $410.73 18 $396.55 $396.55 $515.72 $515.72 $423.73 $423.73 19 $408.71 $408.71 $531.54 $531.54 $436.72 $436.72 20 $421.30 $421.30 $547.92 $547.92 $450.18 $450.18 21 $434.33 $434.33 $564.87 $564.87 $464.11 $464.11 22 $434.33 $434.33 $564.87 $564.87 $464.11 $464.11 23 $434.33 $434.33 $564.87 $564.87 $464.11 $464.11 24 $434.33 $434.33 $564.87 $564.87 $464.11 $464.11 25 $436.07 $436.07 $567.13 $567.13 $465.96 $465.96 26 $444.76 $444.76 $578.42 $578.42 $475.25 $475.25 27 $455.18 $455.18 $591.98 $591.98 $486.38 $486.38 28 $472.12 $472.12 $614.01 $614.01 $504.48 $504.48 29 $486.02 $486.02 $632.09 $632.09 $519.34 $519.34 30 $492.97 $559.13 $641.12 $727.16 $526.76 $597.45 31 $503.39 $570.95 $654.68 $742.54 $537.90 $610.09 32 $513.82 $582.77 $668.24 $757.92 $549.04 $622.72 33 $520.33 $590.16 $676.71 $767.52 $556.00 $630.61 34 $527.28 $598.04 $685.75 $777.78 $563.43 $639.04 35 $530.76 $651.66 $690.27 $847.51 $567.14 $696.33 36 $534.23 $655.93 $694.79 $853.06 $570.85 $700.89 37 $537.71 $660.20 $699.30 $858.61 $574.56 $705.45 38 $541.18 $664.46 $703.82 $864.16 $578.28 $710.01 39 $548.13 $672.99 $712.86 $875.25 $585.70 $719.12 40 $555.08 $715.72 $721.90 $930.81 $593.13 $764.78 41 $565.50 $729.16 $735.46 $948.30 $604.27 $779.14 42 $575.49 $742.04 $748.45 $965.05 $614.94 $792.91 43 $589.39 $759.96 $766.52 $988.36 $629.79 $812.06 44 $606.76 $782.36 $789.12 $1,017.49 $648.36 $835.99 45 $627.18 $827.00 $815.67 $1,075.54 $670.17 $883.69 46 $651.50 $859.07 $847.30 $1,117.25 $696.16 $917.96 47 $678.86 $895.15 $882.89 $1,164.17 $725.40 $956.51 48 $710.14 $936.38 $923.56 $1,217.80 $758.81 $1,000.57 49 $740.97 $977.05 $963.66 $1,270.68 $791.77 $1,044.02 50 $775.72 $1,025.66 $1,008.85 $1,333.90 $828.89 $1,095.97 51 $810.03 $1,071.02 $1,053.48 $1,392.90 $865.56 $1,144.44 52 $847.82 $1,120.99 $1,102.62 $1,457.88 $905.94 $1,197.83 53 $886.04 $1,171.52 $1,152.33 $1,523.61 $946.78 $1,251.83 54 $927.30 $1,226.08 $1,205.99 $1,594.56 $990.87 $1,310.13 55 $968.56 $1,267.08 $1,259.65 $1,647.88 $1,034.96 $1,353.93 56 $1,013.30 $1,325.60 $1,317.83 $1,723.99 $1,082.76 $1,416.47 57 $1,058.47 $1,384.69 $1,376.58 $1,800.84 $1,131.03 $1,479.61 58 $1,106.68 $1,447.76 $1,439.28 $1,882.86 $1,182.54 $1,547.00 59 $1,130.57 $1,479.01 $1,470.35 $1,923.51 $1,208.07 $1,580.40 60 $1,178.78 $1,514.50 $1,533.05 $1,969.66 $1,259.59 $1,618.32 61 $1,220.48 $1,568.07 $1,587.27 $2,039.33 $1,304.14 $1,675.56 62 $1,247.84 $1,603.23 $1,622.86 $2,085.05 $1,333.38 $1,713.13 63 $1,282.15 $1,647.31 $1,667.49 $2,142.39 $1,370.04 $1,760.23 64 $1,302.99 $1,674.10 $1,694.61 $2,177.22 $1,392.33 $1,788.85 65+ $1,302.99 $1,674.10 $1,694.61 $2,177.22 $1,392.33 $1,788.85 Rates Effective January 1, 2018 Page 6 of 86

Texas Off Exchange (Gold) Brownsville-Harlingen, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $259.24 $259.24 $337.15 $337.15 $292.73 $292.73 15 $282.28 $282.28 $367.11 $367.11 $318.75 $318.75 16 $291.09 $291.09 $378.57 $378.57 $328.70 $328.70 17 $299.90 $299.90 $390.03 $390.03 $338.65 $338.65 18 $309.39 $309.39 $402.37 $402.37 $349.37 $349.37 19 $318.88 $318.88 $414.71 $414.71 $360.08 $360.08 20 $328.70 $328.70 $427.49 $427.49 $371.18 $371.18 21 $338.87 $338.87 $440.71 $440.71 $382.66 $382.66 22 $338.87 $338.87 $440.71 $440.71 $382.66 $382.66 23 $338.87 $338.87 $440.71 $440.71 $382.66 $382.66 24 $338.87 $338.87 $440.71 $440.71 $382.66 $382.66 25 $340.23 $340.23 $442.48 $442.48 $384.19 $384.19 26 $347.00 $347.00 $451.29 $451.29 $391.84 $391.84 27 $355.14 $355.14 $461.87 $461.87 $401.03 $401.03 28 $368.35 $368.35 $479.05 $479.05 $415.95 $415.95 29 $379.20 $379.20 $493.16 $493.16 $428.19 $428.19 30 $384.62 $436.23 $500.21 $567.34 $434.32 $492.60 31 $392.75 $445.46 $510.79 $579.33 $443.50 $503.02 32 $400.88 $454.68 $521.36 $591.33 $452.68 $513.44 33 $405.97 $460.45 $527.97 $598.83 $458.42 $519.94 34 $411.39 $466.60 $535.03 $606.83 $464.55 $526.89 35 $414.10 $508.43 $538.55 $661.23 $467.61 $574.13 36 $416.81 $511.76 $542.08 $665.56 $470.67 $577.89 37 $419.52 $515.09 $545.60 $669.89 $473.73 $581.65 38 $422.23 $518.42 $549.13 $674.22 $476.79 $585.41 39 $427.65 $525.07 $556.18 $682.88 $482.91 $592.92 40 $433.08 $558.41 $563.23 $726.23 $489.04 $630.56 41 $441.21 $568.90 $573.81 $739.87 $498.22 $642.41 42 $449.00 $578.95 $583.94 $752.94 $507.02 $653.76 43 $459.85 $592.93 $598.05 $771.12 $519.27 $669.54 44 $473.40 $610.40 $615.68 $793.85 $534.57 $689.28 45 $489.33 $645.23 $636.39 $839.14 $552.56 $728.60 46 $508.31 $670.25 $661.07 $871.69 $573.99 $756.86 47 $529.65 $698.40 $688.83 $908.30 $598.09 $788.65 48 $554.05 $730.57 $720.57 $950.14 $625.65 $824.98 49 $578.11 $762.30 $751.86 $991.40 $652.81 $860.80 50 $605.22 $800.23 $787.11 $1,040.72 $683.43 $903.63 51 $631.99 $835.62 $821.93 $1,086.75 $713.66 $943.60 52 $661.47 $874.60 $860.27 $1,137.45 $746.95 $987.61 53 $691.30 $914.03 $899.05 $1,188.73 $780.62 $1,032.14 54 $723.49 $956.60 $940.92 $1,244.09 $816.97 $1,080.20 55 $755.68 $988.58 $982.79 $1,285.69 $853.33 $1,116.32 56 $790.58 $1,034.24 $1,028.18 $1,345.07 $892.74 $1,167.88 57 $825.83 $1,080.35 $1,074.02 $1,405.03 $932.54 $1,219.94 58 $863.44 $1,129.55 $1,122.94 $1,469.02 $975.01 $1,275.51 59 $882.08 $1,153.93 $1,147.18 $1,500.73 $996.06 $1,303.04 60 $919.69 $1,181.62 $1,196.09 $1,536.74 $1,038.53 $1,334.31 61 $952.23 $1,223.42 $1,238.40 $1,591.10 $1,075.27 $1,381.51 62 $973.57 $1,250.85 $1,266.17 $1,626.77 $1,099.38 $1,412.48 63 $1,000.35 $1,285.24 $1,300.98 $1,671.50 $1,129.61 $1,451.32 64 $1,016.61 $1,306.14 $1,322.13 $1,698.68 $1,147.98 $1,474.92 65+ $1,016.61 $1,306.14 $1,322.13 $1,698.68 $1,147.98 $1,474.92 Rates Effective January 1, 2018 Page 7 of 86

Texas Off Exchange (Gold) College Station-Bryan, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $330.56 $330.56 $429.90 $429.90 $351.97 $351.97 15 $359.94 $359.94 $468.12 $468.12 $383.25 $383.25 16 $371.18 $371.18 $482.73 $482.73 $395.22 $395.22 17 $382.41 $382.41 $497.34 $497.34 $407.18 $407.18 18 $394.51 $394.51 $513.07 $513.07 $420.06 $420.06 19 $406.61 $406.61 $528.81 $528.81 $432.94 $432.94 20 $419.14 $419.14 $545.11 $545.11 $446.29 $446.29 21 $432.10 $432.10 $561.97 $561.97 $460.09 $460.09 22 $432.10 $432.10 $561.97 $561.97 $460.09 $460.09 23 $432.10 $432.10 $561.97 $561.97 $460.09 $460.09 24 $432.10 $432.10 $561.97 $561.97 $460.09 $460.09 25 $433.83 $433.83 $564.21 $564.21 $461.93 $461.93 26 $442.47 $442.47 $575.45 $575.45 $471.13 $471.13 27 $452.84 $452.84 $588.94 $588.94 $482.17 $482.17 28 $469.70 $469.70 $610.86 $610.86 $500.12 $500.12 29 $483.52 $483.52 $628.84 $628.84 $514.84 $514.84 30 $490.44 $556.26 $637.83 $723.43 $522.20 $592.28 31 $500.81 $568.02 $651.32 $738.73 $533.24 $604.80 32 $511.18 $579.78 $664.81 $754.02 $544.28 $617.33 33 $517.66 $587.13 $673.23 $763.58 $551.19 $625.15 34 $524.57 $594.97 $682.23 $773.78 $558.55 $633.50 35 $528.03 $648.31 $686.72 $843.16 $562.23 $690.30 36 $531.49 $652.56 $691.22 $848.67 $565.91 $694.82 37 $534.94 $656.81 $695.71 $854.20 $569.59 $699.34 38 $538.40 $661.05 $700.21 $859.72 $573.27 $703.86 39 $545.31 $669.54 $709.20 $870.75 $580.63 $712.90 40 $552.23 $712.04 $718.19 $926.03 $587.99 $758.16 41 $562.60 $725.42 $731.68 $943.43 $599.03 $772.40 42 $572.54 $738.23 $744.60 $960.10 $609.62 $786.04 43 $586.36 $756.06 $762.59 $983.28 $624.34 $805.02 44 $603.65 $778.34 $785.07 $1,012.26 $642.74 $828.75 45 $623.96 $822.75 $811.48 $1,070.02 $664.37 $876.03 46 $648.15 $854.66 $842.95 $1,111.51 $690.13 $910.01 47 $675.38 $890.55 $878.35 $1,158.19 $719.12 $948.23 48 $706.49 $931.58 $918.81 $1,211.55 $752.24 $991.91 49 $737.17 $972.03 $958.71 $1,264.16 $784.91 $1,034.98 50 $771.74 $1,020.39 $1,003.67 $1,327.05 $821.72 $1,086.47 51 $805.87 $1,065.52 $1,048.07 $1,385.75 $858.06 $1,134.53 52 $843.47 $1,115.23 $1,096.96 $1,450.39 $898.09 $1,187.45 53 $881.49 $1,165.51 $1,146.41 $1,515.78 $938.58 $1,240.99 54 $922.54 $1,219.78 $1,199.80 $1,586.37 $982.29 $1,298.78 55 $963.59 $1,260.57 $1,253.18 $1,639.42 $1,026.00 $1,342.21 56 $1,008.10 $1,318.79 $1,311.07 $1,715.14 $1,073.38 $1,404.20 57 $1,053.04 $1,377.58 $1,369.51 $1,791.59 $1,121.23 $1,466.80 58 $1,101.00 $1,440.33 $1,431.89 $1,873.19 $1,172.30 $1,533.61 59 $1,124.76 $1,471.42 $1,462.80 $1,913.63 $1,197.61 $1,566.71 60 $1,172.73 $1,506.72 $1,525.17 $1,959.55 $1,248.68 $1,604.30 61 $1,214.21 $1,560.02 $1,579.12 $2,028.86 $1,292.85 $1,661.05 62 $1,241.43 $1,594.99 $1,614.53 $2,074.34 $1,321.83 $1,698.29 63 $1,275.57 $1,638.85 $1,658.92 $2,131.38 $1,358.18 $1,744.99 64 $1,296.30 $1,665.50 $1,685.91 $2,166.04 $1,380.27 $1,773.36 65+ $1,296.30 $1,665.50 $1,685.91 $2,166.04 $1,380.27 $1,773.36 Rates Effective January 1, 2018 Page 8 of 86

Texas Off Exchange (Gold) Corpus Christi, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $306.27 $306.27 $398.31 $398.31 $330.57 $330.57 15 $333.49 $333.49 $433.72 $433.72 $359.95 $359.95 16 $343.90 $343.90 $447.26 $447.26 $371.18 $371.18 17 $354.31 $354.31 $460.80 $460.80 $382.42 $382.42 18 $365.52 $365.52 $475.37 $475.37 $394.52 $394.52 19 $376.73 $376.73 $489.95 $489.95 $406.62 $406.62 20 $388.34 $388.34 $505.05 $505.05 $419.15 $419.15 21 $400.35 $400.35 $520.67 $520.67 $432.11 $432.11 22 $400.35 $400.35 $520.67 $520.67 $432.11 $432.11 23 $400.35 $400.35 $520.67 $520.67 $432.11 $432.11 24 $400.35 $400.35 $520.67 $520.67 $432.11 $432.11 25 $401.95 $401.95 $522.76 $522.76 $433.84 $433.84 26 $409.96 $409.96 $533.17 $533.17 $442.48 $442.48 27 $419.57 $419.57 $545.66 $545.66 $452.85 $452.85 28 $435.18 $435.18 $565.97 $565.97 $469.71 $469.71 29 $447.99 $447.99 $582.63 $582.63 $483.53 $483.53 30 $454.40 $515.38 $590.96 $670.27 $490.45 $556.27 31 $464.01 $526.28 $603.46 $684.44 $500.82 $568.03 32 $473.62 $537.18 $615.96 $698.62 $511.19 $579.79 33 $479.62 $543.99 $623.77 $707.47 $517.67 $587.14 34 $486.03 $551.25 $632.10 $716.92 $524.58 $594.98 35 $489.23 $600.68 $636.26 $781.20 $528.04 $648.33 36 $492.43 $604.61 $640.43 $786.31 $531.50 $652.57 37 $495.64 $608.54 $644.59 $791.43 $534.96 $656.82 38 $498.84 $612.48 $648.76 $796.55 $538.41 $661.06 39 $505.24 $620.34 $657.09 $806.77 $545.33 $669.55 40 $511.65 $659.72 $665.42 $857.99 $552.24 $712.06 41 $521.26 $672.11 $677.92 $874.10 $562.61 $725.43 42 $530.47 $683.99 $689.89 $889.55 $572.55 $738.25 43 $543.28 $700.50 $706.55 $911.03 $586.38 $756.08 44 $559.29 $721.15 $727.38 $937.88 $603.66 $778.36 45 $578.11 $762.30 $751.85 $991.39 $623.97 $822.77 46 $600.53 $791.86 $781.01 $1,029.84 $648.17 $854.68 47 $625.75 $825.11 $813.81 $1,073.09 $675.39 $890.57 48 $654.58 $863.12 $851.30 $1,122.52 $706.50 $931.60 49 $683.00 $900.60 $888.27 $1,171.27 $737.18 $972.05 50 $715.03 $945.41 $929.92 $1,229.54 $771.75 $1,020.41 51 $746.66 $987.23 $971.05 $1,283.93 $805.89 $1,065.55 52 $781.49 $1,033.28 $1,016.35 $1,343.82 $843.48 $1,115.25 53 $816.72 $1,079.87 $1,062.17 $1,404.40 $881.51 $1,165.53 54 $854.75 $1,130.16 $1,111.64 $1,469.81 $922.56 $1,219.81 55 $892.79 $1,167.94 $1,161.10 $1,518.95 $963.61 $1,260.60 56 $934.02 $1,221.89 $1,214.73 $1,589.11 $1,008.12 $1,318.82 57 $975.66 $1,276.36 $1,268.88 $1,659.95 $1,053.06 $1,377.61 58 $1,020.10 $1,334.49 $1,326.67 $1,735.55 $1,101.02 $1,440.36 59 $1,042.12 $1,363.30 $1,355.31 $1,773.01 $1,124.79 $1,471.45 60 $1,086.56 $1,396.01 $1,413.10 $1,815.56 $1,172.75 $1,506.75 61 $1,124.99 $1,445.39 $1,463.09 $1,879.78 $1,214.24 $1,560.05 62 $1,150.21 $1,477.79 $1,495.89 $1,921.92 $1,241.46 $1,595.03 63 $1,181.84 $1,518.43 $1,537.02 $1,974.77 $1,275.60 $1,638.89 64 $1,201.05 $1,543.12 $1,562.01 $2,006.88 $1,296.33 $1,665.53 65+ $1,201.05 $1,543.12 $1,562.01 $2,006.88 $1,296.33 $1,665.53 Rates Effective January 1, 2018 Page 9 of 86

Texas Off Exchange (Gold) Dallas-Fort Worth-Arlington, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $334.54 $334.54 $435.08 $435.08 $365.30 $365.30 15 $364.27 $364.27 $473.75 $473.75 $397.77 $397.77 16 $375.64 $375.64 $488.54 $488.54 $410.19 $410.19 17 $387.01 $387.01 $503.33 $503.33 $422.60 $422.60 18 $399.26 $399.26 $519.25 $519.25 $435.97 $435.97 19 $411.50 $411.50 $535.17 $535.17 $449.34 $449.34 20 $424.19 $424.19 $551.67 $551.67 $463.19 $463.19 21 $437.30 $437.30 $568.73 $568.73 $477.52 $477.52 22 $437.30 $437.30 $568.73 $568.73 $477.52 $477.52 23 $437.30 $437.30 $568.73 $568.73 $477.52 $477.52 24 $437.30 $437.30 $568.73 $568.73 $477.52 $477.52 25 $439.05 $439.05 $571.00 $571.00 $479.43 $479.43 26 $447.80 $447.80 $582.38 $582.38 $488.98 $488.98 27 $458.29 $458.29 $596.03 $596.03 $500.44 $500.44 28 $475.35 $475.35 $618.21 $618.21 $519.06 $519.06 29 $489.34 $489.34 $636.41 $636.41 $534.34 $534.34 30 $496.34 $562.95 $645.51 $732.14 $541.98 $614.71 31 $506.84 $574.85 $659.16 $747.62 $553.44 $627.71 32 $517.33 $586.76 $672.81 $763.10 $564.90 $640.71 33 $523.89 $594.20 $681.34 $772.77 $572.06 $648.83 34 $530.89 $602.13 $690.44 $783.10 $579.70 $657.50 35 $534.39 $656.12 $694.99 $853.30 $583.52 $716.45 36 $537.88 $660.41 $699.54 $858.89 $587.34 $721.14 37 $541.38 $664.71 $704.09 $864.48 $591.16 $725.83 38 $544.88 $669.01 $708.64 $870.07 $594.98 $730.52 39 $551.88 $677.59 $717.74 $881.24 $602.62 $739.90 40 $558.87 $720.61 $726.84 $937.18 $610.26 $786.87 41 $569.37 $734.15 $740.49 $954.78 $621.72 $801.65 42 $579.43 $747.12 $753.57 $971.65 $632.71 $815.82 43 $593.42 $765.16 $771.77 $995.12 $647.99 $835.52 44 $610.91 $787.71 $794.52 $1,024.45 $667.09 $860.14 45 $631.47 $832.65 $821.25 $1,082.90 $689.53 $909.22 46 $655.96 $864.94 $853.09 $1,124.89 $716.27 $944.48 47 $683.51 $901.27 $888.92 $1,172.13 $746.36 $984.14 48 $714.99 $942.79 $929.87 $1,226.13 $780.74 $1,029.48 49 $746.04 $983.73 $970.25 $1,279.37 $814.64 $1,074.18 50 $781.03 $1,032.67 $1,015.75 $1,343.03 $852.84 $1,127.63 51 $815.57 $1,078.35 $1,060.68 $1,402.43 $890.57 $1,177.50 52 $853.62 $1,128.65 $1,110.16 $1,467.85 $932.11 $1,232.43 53 $892.10 $1,179.54 $1,160.21 $1,534.03 $974.13 $1,288.00 54 $933.64 $1,234.47 $1,214.24 $1,605.47 $1,019.49 $1,347.98 55 $975.19 $1,275.74 $1,268.27 $1,659.15 $1,064.86 $1,393.05 56 $1,020.23 $1,334.67 $1,326.85 $1,735.78 $1,114.04 $1,457.39 57 $1,065.71 $1,394.16 $1,385.99 $1,813.16 $1,163.70 $1,522.36 58 $1,114.25 $1,457.66 $1,449.12 $1,895.74 $1,216.71 $1,591.70 59 $1,138.30 $1,489.13 $1,480.40 $1,936.66 $1,242.97 $1,626.05 60 $1,186.84 $1,524.86 $1,543.53 $1,983.13 $1,295.98 $1,665.07 61 $1,228.83 $1,578.80 $1,598.13 $2,053.28 $1,341.82 $1,723.97 62 $1,256.38 $1,614.19 $1,633.96 $2,099.31 $1,371.90 $1,762.62 63 $1,290.92 $1,658.58 $1,678.89 $2,157.04 $1,409.62 $1,811.09 64 $1,311.90 $1,685.55 $1,706.19 $2,192.11 $1,432.56 $1,840.53 65+ $1,311.90 $1,685.55 $1,706.19 $2,192.11 $1,432.56 $1,840.53 Rates Effective January 1, 2018 Page 10 of 86

Texas Off Exchange (Gold) El Paso, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $290.26 $290.26 $377.50 $377.50 $325.37 $325.37 15 $316.06 $316.06 $411.05 $411.05 $354.29 $354.29 16 $325.93 $325.93 $423.88 $423.88 $365.35 $365.35 17 $335.79 $335.79 $436.71 $436.71 $376.41 $376.41 18 $346.42 $346.42 $450.53 $450.53 $388.32 $388.32 19 $357.04 $357.04 $464.35 $464.35 $400.23 $400.23 20 $368.05 $368.05 $478.66 $478.66 $412.56 $412.56 21 $379.43 $379.43 $493.46 $493.46 $425.32 $425.32 22 $379.43 $379.43 $493.46 $493.46 $425.32 $425.32 23 $379.43 $379.43 $493.46 $493.46 $425.32 $425.32 24 $379.43 $379.43 $493.46 $493.46 $425.32 $425.32 25 $380.95 $380.95 $495.43 $495.43 $427.02 $427.02 26 $388.53 $388.53 $505.30 $505.30 $435.53 $435.53 27 $397.64 $397.64 $517.15 $517.15 $445.74 $445.74 28 $412.44 $412.44 $536.39 $536.39 $462.32 $462.32 29 $424.58 $424.58 $552.18 $552.18 $475.93 $475.93 30 $430.65 $488.45 $560.08 $635.24 $482.74 $547.53 31 $439.76 $498.77 $571.92 $648.67 $492.95 $559.10 32 $448.86 $509.10 $583.76 $662.10 $503.16 $570.68 33 $454.56 $515.56 $591.16 $670.50 $509.54 $577.91 34 $460.63 $522.44 $599.06 $679.45 $516.34 $585.63 35 $463.66 $569.28 $603.01 $740.37 $519.74 $638.14 36 $466.70 $573.01 $606.96 $745.22 $523.15 $642.32 37 $469.73 $576.74 $610.90 $750.07 $526.55 $646.50 38 $472.77 $580.46 $614.85 $754.91 $529.95 $650.67 39 $478.84 $587.92 $622.75 $764.61 $536.76 $659.03 40 $484.91 $625.24 $630.64 $813.15 $543.56 $700.87 41 $494.02 $636.98 $642.48 $828.42 $553.77 $714.03 42 $502.74 $648.24 $653.83 $843.06 $563.55 $726.64 43 $514.88 $663.89 $669.62 $863.42 $577.16 $744.19 44 $530.06 $683.46 $689.36 $888.86 $594.17 $766.13 45 $547.89 $722.45 $712.56 $939.58 $614.16 $809.84 46 $569.14 $750.47 $740.19 $976.01 $637.98 $841.24 47 $593.05 $781.99 $771.28 $1,017.01 $664.78 $876.58 48 $620.37 $818.01 $806.81 $1,063.85 $695.40 $916.96 49 $647.30 $853.54 $841.84 $1,110.05 $725.60 $956.77 50 $677.66 $896.00 $881.32 $1,165.28 $759.62 $1,004.38 51 $707.63 $935.63 $920.30 $1,216.82 $793.22 $1,048.80 52 $740.64 $979.28 $963.23 $1,273.58 $830.23 $1,097.73 53 $774.03 $1,023.43 $1,006.66 $1,331.00 $867.66 $1,147.22 54 $810.08 $1,071.09 $1,053.54 $1,392.99 $908.06 $1,200.64 55 $846.12 $1,106.90 $1,100.41 $1,439.56 $948.47 $1,240.79 56 $885.21 $1,158.03 $1,151.24 $1,506.05 $992.28 $1,298.09 57 $924.67 $1,209.65 $1,202.56 $1,573.19 $1,036.51 $1,355.96 58 $966.78 $1,264.74 $1,257.34 $1,644.84 $1,083.72 $1,417.72 59 $987.65 $1,292.04 $1,284.48 $1,680.35 $1,107.11 $1,448.32 60 $1,029.77 $1,323.05 $1,339.25 $1,720.67 $1,154.32 $1,483.08 61 $1,066.19 $1,369.85 $1,386.62 $1,781.53 $1,195.15 $1,535.53 62 $1,090.10 $1,400.56 $1,417.71 $1,821.47 $1,221.95 $1,569.96 63 $1,120.07 $1,439.07 $1,456.69 $1,871.56 $1,255.55 $1,613.13 64 $1,138.29 $1,462.47 $1,480.38 $1,901.99 $1,275.96 $1,639.36 65+ $1,138.29 $1,462.47 $1,480.38 $1,901.99 $1,275.96 $1,639.36 Rates Effective January 1, 2018 Page 11 of 86

Texas Off Exchange (Gold) Houston-Sugar Land-Baytown, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $319.54 $319.54 $415.57 $415.57 $358.22 $358.22 15 $347.94 $347.94 $452.51 $452.51 $390.07 $390.07 16 $358.80 $358.80 $466.64 $466.64 $402.24 $402.24 17 $369.66 $369.66 $480.76 $480.76 $414.41 $414.41 18 $381.36 $381.36 $495.97 $495.97 $427.53 $427.53 19 $393.05 $393.05 $511.18 $511.18 $440.64 $440.64 20 $405.17 $405.17 $526.93 $526.93 $454.22 $454.22 21 $417.70 $417.70 $543.23 $543.23 $468.27 $468.27 22 $417.70 $417.70 $543.23 $543.23 $468.27 $468.27 23 $417.70 $417.70 $543.23 $543.23 $468.27 $468.27 24 $417.70 $417.70 $543.23 $543.23 $468.27 $468.27 25 $419.37 $419.37 $545.40 $545.40 $470.14 $470.14 26 $427.72 $427.72 $556.27 $556.27 $479.50 $479.50 27 $437.75 $437.75 $569.31 $569.31 $490.74 $490.74 28 $454.04 $454.04 $590.49 $590.49 $509.00 $509.00 29 $467.40 $467.40 $607.88 $607.88 $523.99 $523.99 30 $474.09 $537.71 $616.57 $699.31 $531.48 $602.81 31 $484.11 $549.08 $629.61 $714.10 $542.72 $615.55 32 $494.14 $560.45 $642.64 $728.89 $553.96 $628.30 33 $500.40 $567.56 $650.79 $738.13 $560.98 $636.26 34 $507.09 $575.14 $659.48 $747.99 $568.47 $644.76 35 $510.43 $626.70 $663.83 $815.05 $572.22 $702.57 36 $513.77 $630.80 $668.17 $820.38 $575.97 $707.17 37 $517.11 $634.91 $672.52 $825.72 $579.71 $711.77 38 $520.45 $639.01 $676.87 $831.06 $583.46 $716.37 39 $527.14 $647.22 $685.56 $841.73 $590.95 $725.57 40 $533.82 $688.30 $694.25 $895.16 $598.44 $771.63 41 $543.84 $701.23 $707.29 $911.98 $609.68 $786.12 42 $553.45 $713.62 $719.78 $928.09 $620.45 $800.01 43 $566.82 $730.86 $737.17 $950.50 $635.44 $819.33 44 $583.52 $752.40 $758.89 $978.52 $654.17 $843.48 45 $603.16 $795.32 $784.43 $1,034.35 $676.18 $891.61 46 $626.55 $826.17 $814.85 $1,074.46 $702.40 $926.18 47 $652.86 $860.86 $849.07 $1,119.58 $731.90 $965.08 48 $682.94 $900.52 $888.18 $1,171.16 $765.61 $1,009.54 49 $712.59 $939.63 $926.75 $1,222.02 $798.86 $1,053.38 50 $746.01 $986.37 $970.21 $1,282.81 $836.32 $1,105.79 51 $779.01 $1,030.00 $1,013.13 $1,339.55 $873.31 $1,154.70 52 $815.35 $1,078.05 $1,060.39 $1,402.04 $914.05 $1,208.56 53 $852.10 $1,126.65 $1,108.19 $1,465.25 $955.26 $1,263.05 54 $891.79 $1,179.12 $1,159.80 $1,533.49 $999.75 $1,321.87 55 $931.47 $1,218.55 $1,211.41 $1,584.76 $1,044.23 $1,366.07 56 $974.49 $1,274.83 $1,267.36 $1,657.96 $1,092.46 $1,429.16 57 $1,017.93 $1,331.66 $1,323.85 $1,731.87 $1,141.16 $1,492.87 58 $1,064.30 $1,392.31 $1,384.15 $1,810.75 $1,193.14 $1,560.86 59 $1,087.27 $1,422.36 $1,414.03 $1,849.83 $1,218.89 $1,594.56 60 $1,133.63 $1,456.49 $1,474.33 $1,894.22 $1,270.87 $1,632.82 61 $1,173.73 $1,508.01 $1,526.48 $1,961.22 $1,315.83 $1,690.57 62 $1,200.05 $1,541.82 $1,560.70 $2,005.19 $1,345.33 $1,728.48 63 $1,233.05 $1,584.22 $1,603.62 $2,060.33 $1,382.32 $1,776.00 64 $1,253.10 $1,609.98 $1,629.69 $2,093.83 $1,404.81 $1,804.88 65+ $1,253.10 $1,609.98 $1,629.69 $2,093.83 $1,404.81 $1,804.88 Rates Effective January 1, 2018 Page 12 of 86

Texas Off Exchange (Gold) Killeen-Temple-Fort Hood, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $308.78 $308.78 $401.57 $401.57 $340.02 $340.02 15 $336.22 $336.22 $437.27 $437.27 $370.24 $370.24 16 $346.72 $346.72 $450.92 $450.92 $381.79 $381.79 17 $357.21 $357.21 $464.57 $464.57 $393.35 $393.35 18 $368.51 $368.51 $479.26 $479.26 $405.80 $405.80 19 $379.81 $379.81 $493.96 $493.96 $418.24 $418.24 20 $391.52 $391.52 $509.18 $509.18 $431.13 $431.13 21 $403.63 $403.63 $524.93 $524.93 $444.46 $444.46 22 $403.63 $403.63 $524.93 $524.93 $444.46 $444.46 23 $403.63 $403.63 $524.93 $524.93 $444.46 $444.46 24 $403.63 $403.63 $524.93 $524.93 $444.46 $444.46 25 $405.24 $405.24 $527.03 $527.03 $446.24 $446.24 26 $413.32 $413.32 $537.53 $537.53 $455.13 $455.13 27 $423.00 $423.00 $550.13 $550.13 $465.80 $465.80 28 $438.74 $438.74 $570.60 $570.60 $483.13 $483.13 29 $451.66 $451.66 $587.40 $587.40 $497.36 $497.36 30 $458.12 $519.60 $595.80 $675.76 $504.47 $572.17 31 $467.81 $530.59 $608.40 $690.04 $515.13 $584.27 32 $477.49 $541.57 $621.00 $704.33 $525.80 $596.36 33 $483.55 $548.44 $628.87 $713.26 $532.47 $603.92 34 $490.00 $555.76 $637.27 $722.79 $539.58 $611.99 35 $493.23 $605.59 $641.47 $787.59 $543.14 $666.86 36 $496.46 $609.56 $645.67 $792.75 $546.69 $671.23 37 $499.69 $613.52 $649.87 $797.91 $550.25 $675.59 38 $502.92 $617.49 $654.07 $803.06 $553.80 $679.96 39 $509.38 $625.41 $662.46 $813.37 $560.91 $688.69 40 $515.84 $665.12 $670.86 $865.01 $568.03 $732.41 41 $525.52 $677.61 $683.46 $881.26 $578.69 $746.17 42 $534.81 $689.58 $695.54 $896.83 $588.92 $759.35 43 $547.72 $706.24 $712.33 $918.48 $603.14 $777.69 44 $563.87 $727.05 $733.33 $945.56 $620.92 $800.61 45 $582.84 $768.53 $758.00 $999.50 $641.81 $846.29 46 $605.44 $798.34 $787.40 $1,038.26 $666.70 $879.11 47 $630.87 $831.87 $820.47 $1,081.87 $694.70 $916.03 48 $659.93 $870.19 $858.26 $1,131.71 $726.70 $958.22 49 $688.59 $907.97 $895.53 $1,180.85 $758.26 $999.84 50 $720.88 $953.15 $937.53 $1,239.60 $793.81 $1,049.58 51 $752.77 $995.31 $979.00 $1,294.43 $828.93 $1,096.00 52 $787.88 $1,041.74 $1,024.67 $1,354.81 $867.59 $1,147.13 53 $823.40 $1,088.70 $1,070.86 $1,415.90 $906.71 $1,198.85 54 $861.75 $1,139.40 $1,120.73 $1,481.83 $948.93 $1,254.68 55 $900.09 $1,177.50 $1,170.60 $1,531.38 $991.16 $1,296.63 56 $941.66 $1,231.89 $1,224.67 $1,602.11 $1,036.94 $1,356.52 57 $983.64 $1,286.80 $1,279.26 $1,673.53 $1,083.16 $1,416.99 58 $1,028.44 $1,345.41 $1,337.53 $1,749.75 $1,132.49 $1,481.53 59 $1,050.64 $1,374.45 $1,366.40 $1,787.52 $1,156.94 $1,513.51 60 $1,095.45 $1,407.43 $1,424.67 $1,830.41 $1,206.28 $1,549.82 61 $1,134.20 $1,457.21 $1,475.06 $1,895.16 $1,248.94 $1,604.64 62 $1,159.62 $1,489.88 $1,508.13 $1,937.65 $1,276.95 $1,640.62 63 $1,191.51 $1,530.85 $1,549.60 $1,990.93 $1,312.06 $1,685.73 64 $1,210.89 $1,555.74 $1,574.79 $2,023.30 $1,333.38 $1,713.14 65+ $1,210.89 $1,555.74 $1,574.79 $2,023.30 $1,333.38 $1,713.14 Rates Effective January 1, 2018 Page 13 of 86

Texas Off Exchange (Gold) Laredo, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $315.18 $315.18 $409.90 $409.90 $335.44 $335.44 15 $343.19 $343.19 $446.33 $446.33 $365.26 $365.26 16 $353.90 $353.90 $460.26 $460.26 $376.66 $376.66 17 $364.61 $364.61 $474.19 $474.19 $388.06 $388.06 18 $376.15 $376.15 $489.20 $489.20 $400.34 $400.34 19 $387.69 $387.69 $504.20 $504.20 $412.62 $412.62 20 $399.63 $399.63 $519.74 $519.74 $425.33 $425.33 21 $411.99 $411.99 $535.81 $535.81 $438.49 $438.49 22 $411.99 $411.99 $535.81 $535.81 $438.49 $438.49 23 $411.99 $411.99 $535.81 $535.81 $438.49 $438.49 24 $411.99 $411.99 $535.81 $535.81 $438.49 $438.49 25 $413.64 $413.64 $537.96 $537.96 $440.24 $440.24 26 $421.88 $421.88 $548.67 $548.67 $449.01 $449.01 27 $431.77 $431.77 $561.53 $561.53 $459.54 $459.54 28 $447.84 $447.84 $582.43 $582.43 $476.64 $476.64 29 $461.02 $461.02 $599.57 $599.57 $490.67 $490.67 30 $467.61 $530.37 $608.15 $689.76 $497.69 $564.48 31 $477.50 $541.58 $621.01 $704.35 $508.21 $576.41 32 $487.39 $552.80 $633.87 $718.93 $518.73 $588.35 33 $493.57 $559.80 $641.90 $728.05 $525.31 $595.81 34 $500.16 $567.28 $650.48 $737.77 $532.33 $603.76 35 $503.46 $618.14 $654.76 $803.92 $535.83 $657.90 36 $506.75 $622.19 $659.05 $809.18 $539.34 $662.20 37 $510.05 $626.24 $663.34 $814.45 $542.85 $666.51 38 $513.34 $630.28 $667.62 $819.71 $546.36 $670.82 39 $519.94 $638.38 $676.19 $830.23 $553.37 $679.43 40 $526.53 $678.90 $684.77 $882.94 $560.39 $722.56 41 $536.42 $691.65 $697.63 $899.52 $570.91 $736.14 42 $545.89 $703.87 $709.95 $915.41 $581.00 $749.14 43 $559.08 $720.87 $727.10 $937.52 $595.03 $767.23 44 $575.56 $742.12 $748.53 $965.15 $612.57 $789.85 45 $594.92 $784.46 $773.71 $1,020.22 $633.18 $834.91 46 $617.99 $814.88 $803.72 $1,059.78 $657.73 $867.29 47 $643.95 $849.11 $837.47 $1,104.29 $685.36 $903.71 48 $673.61 $888.22 $876.05 $1,155.16 $716.93 $945.34 49 $702.86 $926.79 $914.10 $1,205.33 $748.06 $986.39 50 $735.82 $972.90 $956.96 $1,265.29 $783.14 $1,035.47 51 $768.37 $1,015.94 $999.29 $1,321.26 $817.78 $1,081.27 52 $804.21 $1,063.33 $1,045.91 $1,382.89 $855.93 $1,131.71 53 $840.47 $1,111.27 $1,093.06 $1,445.24 $894.52 $1,182.73 54 $879.61 $1,163.02 $1,143.96 $1,512.54 $936.17 $1,237.81 55 $918.75 $1,201.90 $1,194.86 $1,563.12 $977.83 $1,279.20 56 $961.18 $1,257.42 $1,250.05 $1,635.31 $1,023.00 $1,338.28 57 $1,004.03 $1,313.47 $1,305.77 $1,708.21 $1,068.60 $1,397.94 58 $1,049.76 $1,373.29 $1,365.25 $1,786.02 $1,117.27 $1,461.61 59 $1,072.42 $1,402.94 $1,394.72 $1,824.57 $1,141.39 $1,493.16 60 $1,118.15 $1,436.60 $1,454.19 $1,868.35 $1,190.06 $1,528.99 61 $1,157.70 $1,487.42 $1,505.63 $1,934.44 $1,232.15 $1,583.07 62 $1,183.66 $1,520.76 $1,539.39 $1,977.81 $1,259.78 $1,618.56 63 $1,216.21 $1,562.58 $1,581.72 $2,032.19 $1,294.42 $1,663.07 64 $1,235.97 $1,587.99 $1,607.43 $2,065.23 $1,315.47 $1,690.11 65+ $1,235.97 $1,587.99 $1,607.43 $2,065.23 $1,315.47 $1,690.11 Rates Effective January 1, 2018 Page 14 of 86

Texas Off Exchange (Gold) Longview, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $317.01 $317.01 $412.28 $412.28 $352.22 $352.22 15 $345.19 $345.19 $448.93 $448.93 $383.53 $383.53 16 $355.96 $355.96 $462.94 $462.94 $395.50 $395.50 17 $366.74 $366.74 $476.95 $476.95 $407.47 $407.47 18 $378.34 $378.34 $492.04 $492.04 $420.36 $420.36 19 $389.94 $389.94 $507.13 $507.13 $433.25 $433.25 20 $401.96 $401.96 $522.76 $522.76 $446.60 $446.60 21 $414.39 $414.39 $538.93 $538.93 $460.42 $460.42 22 $414.39 $414.39 $538.93 $538.93 $460.42 $460.42 23 $414.39 $414.39 $538.93 $538.93 $460.42 $460.42 24 $414.39 $414.39 $538.93 $538.93 $460.42 $460.42 25 $416.05 $416.05 $541.09 $541.09 $462.26 $462.26 26 $424.34 $424.34 $551.87 $551.87 $471.47 $471.47 27 $434.28 $434.28 $564.80 $564.80 $482.52 $482.52 28 $450.44 $450.44 $585.82 $585.82 $500.47 $500.47 29 $463.70 $463.70 $603.06 $603.06 $515.21 $515.21 30 $470.34 $533.46 $611.69 $693.78 $522.57 $592.70 31 $480.28 $544.74 $624.62 $708.45 $533.62 $605.24 32 $490.23 $556.01 $637.56 $723.12 $544.67 $617.77 33 $496.44 $563.06 $645.64 $732.28 $551.58 $625.60 34 $503.07 $570.58 $654.26 $742.07 $558.95 $633.96 35 $506.39 $621.74 $658.57 $808.60 $562.63 $690.80 36 $509.70 $625.81 $662.89 $813.89 $566.31 $695.32 37 $513.02 $629.88 $667.20 $819.19 $570.00 $699.84 38 $516.33 $633.95 $671.51 $824.48 $573.68 $704.36 39 $522.96 $642.09 $680.13 $835.06 $581.05 $713.41 40 $529.59 $682.86 $688.75 $888.08 $588.41 $758.70 41 $539.54 $695.68 $701.69 $904.76 $599.46 $772.95 42 $549.07 $707.97 $714.08 $920.74 $610.05 $786.60 43 $562.33 $725.07 $731.33 $942.98 $624.79 $805.60 44 $578.91 $746.44 $752.89 $970.77 $643.20 $829.34 45 $598.38 $789.03 $778.22 $1,026.16 $664.84 $876.66 46 $621.59 $819.63 $808.40 $1,065.95 $690.62 $910.66 47 $647.70 $854.05 $842.35 $1,110.72 $719.63 $948.90 48 $677.53 $893.39 $881.15 $1,161.89 $752.78 $992.62 49 $706.95 $932.19 $919.42 $1,212.34 $785.47 $1,035.72 50 $740.10 $978.57 $962.53 $1,272.66 $822.30 $1,087.25 51 $772.84 $1,021.85 $1,005.11 $1,328.95 $858.68 $1,135.34 52 $808.89 $1,069.52 $1,051.99 $1,390.94 $898.73 $1,188.30 53 $845.36 $1,117.74 $1,099.42 $1,453.65 $939.25 $1,241.88 54 $884.73 $1,169.79 $1,150.62 $1,521.35 $982.99 $1,299.71 55 $924.09 $1,208.90 $1,201.82 $1,572.22 $1,026.73 $1,343.17 56 $966.78 $1,264.74 $1,257.33 $1,644.84 $1,074.15 $1,405.21 57 $1,009.87 $1,321.12 $1,313.38 $1,718.16 $1,122.04 $1,467.85 58 $1,055.87 $1,381.29 $1,373.20 $1,796.42 $1,173.14 $1,534.70 59 $1,078.66 $1,411.10 $1,402.84 $1,835.19 $1,198.46 $1,567.83 60 $1,124.66 $1,444.96 $1,462.66 $1,879.23 $1,249.57 $1,605.45 61 $1,164.44 $1,496.08 $1,514.40 $1,945.70 $1,293.77 $1,662.24 62 $1,190.55 $1,529.62 $1,548.35 $1,989.32 $1,322.78 $1,699.50 63 $1,223.29 $1,571.68 $1,590.93 $2,044.02 $1,359.15 $1,746.24 64 $1,243.17 $1,597.23 $1,616.79 $2,077.26 $1,381.26 $1,774.63 65+ $1,243.17 $1,597.23 $1,616.79 $2,077.26 $1,381.26 $1,774.63 Rates Effective January 1, 2018 Page 15 of 86

Texas Off Exchange (Gold) Lubbock, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $321.50 $321.50 $418.12 $418.12 $347.30 $347.30 15 $350.07 $350.07 $455.28 $455.28 $378.17 $378.17 16 $361.00 $361.00 $469.49 $469.49 $389.97 $389.97 17 $371.93 $371.93 $483.70 $483.70 $401.78 $401.78 18 $383.69 $383.69 $499.01 $499.01 $414.49 $414.49 19 $395.46 $395.46 $514.31 $514.31 $427.20 $427.20 20 $407.65 $407.65 $530.16 $530.16 $440.37 $440.37 21 $420.26 $420.26 $546.56 $546.56 $453.98 $453.98 22 $420.26 $420.26 $546.56 $546.56 $453.98 $453.98 23 $420.26 $420.26 $546.56 $546.56 $453.98 $453.98 24 $420.26 $420.26 $546.56 $546.56 $453.98 $453.98 25 $421.94 $421.94 $548.74 $548.74 $455.80 $455.80 26 $430.34 $430.34 $559.67 $559.67 $464.88 $464.88 27 $440.43 $440.43 $572.79 $572.79 $475.78 $475.78 28 $456.82 $456.82 $594.11 $594.11 $493.48 $493.48 29 $470.27 $470.27 $611.60 $611.60 $508.01 $508.01 30 $476.99 $541.00 $620.34 $703.59 $515.27 $584.42 31 $487.08 $552.44 $633.46 $718.47 $526.17 $596.78 32 $497.16 $563.88 $646.58 $733.35 $537.06 $609.14 33 $503.47 $571.03 $654.78 $742.65 $543.87 $616.86 34 $510.19 $578.66 $663.52 $752.57 $551.14 $625.10 35 $513.55 $630.54 $667.89 $820.04 $554.77 $681.15 36 $516.91 $634.67 $672.26 $825.40 $558.40 $685.60 37 $520.28 $638.80 $676.64 $830.78 $562.03 $690.07 38 $523.64 $642.92 $681.01 $836.14 $565.67 $694.52 39 $530.36 $651.18 $689.75 $846.88 $572.93 $703.44 40 $537.09 $692.52 $698.50 $900.64 $580.19 $748.10 41 $547.17 $705.52 $711.62 $917.56 $591.09 $762.15 42 $556.84 $717.99 $724.19 $933.77 $601.53 $775.61 43 $570.29 $735.33 $741.68 $956.32 $616.06 $794.35 44 $587.10 $757.00 $763.54 $984.51 $634.22 $817.76 45 $606.85 $800.19 $789.23 $1,040.68 $655.55 $864.41 46 $630.38 $831.22 $819.84 $1,081.03 $680.98 $897.94 47 $656.86 $866.13 $854.27 $1,126.44 $709.58 $935.65 48 $687.12 $906.03 $893.62 $1,178.33 $742.27 $978.75 49 $716.96 $945.38 $932.43 $1,229.50 $774.50 $1,021.25 50 $750.58 $992.41 $976.15 $1,290.67 $810.82 $1,072.06 51 $783.78 $1,036.31 $1,019.33 $1,347.75 $846.68 $1,119.48 52 $820.34 $1,084.65 $1,066.88 $1,410.63 $886.18 $1,171.70 53 $857.32 $1,133.55 $1,114.98 $1,474.22 $926.13 $1,224.53 54 $897.25 $1,186.34 $1,166.90 $1,542.88 $969.26 $1,281.55 55 $937.17 $1,226.01 $1,218.82 $1,594.46 $1,012.39 $1,324.41 56 $980.46 $1,282.63 $1,275.12 $1,668.11 $1,059.15 $1,385.58 57 $1,024.16 $1,339.81 $1,331.96 $1,742.47 $1,106.36 $1,447.34 58 $1,070.81 $1,400.83 $1,392.63 $1,821.83 $1,156.75 $1,513.26 59 $1,093.93 $1,431.07 $1,422.69 $1,861.16 $1,181.72 $1,545.93 60 $1,140.57 $1,465.41 $1,483.36 $1,905.82 $1,232.11 $1,583.02 61 $1,180.92 $1,517.24 $1,535.82 $1,973.23 $1,275.70 $1,639.02 62 $1,207.39 $1,551.26 $1,570.26 $2,017.47 $1,304.30 $1,675.76 63 $1,240.59 $1,593.92 $1,613.44 $2,072.94 $1,340.16 $1,721.84 64 $1,260.78 $1,619.83 $1,639.68 $2,106.65 $1,361.94 $1,749.84 65+ $1,260.78 $1,619.83 $1,639.68 $2,106.65 $1,361.94 $1,749.84 Rates Effective January 1, 2018 Page 16 of 86

Texas Off Exchange (Gold) McAllen-Edinburg-Mission, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $278.40 $278.40 $362.07 $362.07 $310.23 $310.23 15 $303.15 $303.15 $394.26 $394.26 $337.80 $337.80 16 $312.61 $312.61 $406.56 $406.56 $348.34 $348.34 17 $322.07 $322.07 $418.87 $418.87 $358.89 $358.89 18 $332.26 $332.26 $432.12 $432.12 $370.24 $370.24 19 $342.45 $342.45 $445.37 $445.37 $381.60 $381.60 20 $353.01 $353.01 $459.10 $459.10 $393.36 $393.36 21 $363.93 $363.93 $473.30 $473.30 $405.52 $405.52 22 $363.93 $363.93 $473.30 $473.30 $405.52 $405.52 23 $363.93 $363.93 $473.30 $473.30 $405.52 $405.52 24 $363.93 $363.93 $473.30 $473.30 $405.52 $405.52 25 $365.38 $365.38 $475.19 $475.19 $407.15 $407.15 26 $372.66 $372.66 $484.66 $484.66 $415.26 $415.26 27 $381.39 $381.39 $496.02 $496.02 $424.99 $424.99 28 $395.59 $395.59 $514.47 $514.47 $440.80 $440.80 29 $407.23 $407.23 $529.62 $529.62 $453.78 $453.78 30 $413.06 $468.49 $537.19 $609.29 $460.27 $522.04 31 $421.79 $478.39 $548.55 $622.17 $470.00 $533.08 32 $430.52 $488.30 $559.91 $635.05 $479.73 $544.11 33 $435.98 $494.49 $567.01 $643.10 $485.82 $551.01 34 $441.81 $501.10 $574.58 $651.69 $492.30 $558.37 35 $444.72 $546.02 $578.37 $710.12 $495.55 $608.43 36 $447.63 $549.60 $582.16 $714.77 $498.79 $612.42 37 $450.54 $553.17 $585.94 $719.42 $502.04 $616.40 38 $453.45 $556.75 $589.73 $724.07 $505.28 $620.39 39 $459.27 $563.90 $597.30 $733.37 $511.77 $628.35 40 $465.10 $599.69 $604.87 $779.92 $518.26 $668.24 41 $473.83 $610.96 $616.23 $794.57 $527.99 $680.79 42 $482.20 $621.75 $627.12 $808.61 $537.32 $692.82 43 $493.85 $636.77 $642.26 $828.14 $550.29 $709.55 44 $508.40 $655.54 $661.20 $852.55 $566.52 $730.46 45 $525.51 $692.94 $683.44 $901.19 $585.58 $772.14 46 $545.89 $719.81 $709.95 $936.14 $608.28 $802.08 47 $568.82 $750.04 $739.76 $975.45 $633.83 $835.77 48 $595.02 $784.59 $773.84 $1,020.39 $663.03 $874.27 49 $620.86 $818.66 $807.45 $1,064.70 $691.82 $912.24 50 $649.97 $859.39 $845.31 $1,117.67 $724.26 $957.62 51 $678.72 $897.40 $882.70 $1,167.10 $756.30 $999.98 52 $710.38 $939.27 $923.88 $1,221.55 $791.58 $1,046.63 53 $742.41 $981.61 $965.53 $1,276.62 $827.27 $1,093.81 54 $776.98 $1,027.33 $1,010.49 $1,336.07 $865.79 $1,144.75 55 $811.55 $1,061.68 $1,055.45 $1,380.75 $904.32 $1,183.03 56 $849.04 $1,110.71 $1,104.20 $1,444.52 $946.09 $1,237.67 57 $886.89 $1,160.22 $1,153.43 $1,508.91 $988.26 $1,292.84 58 $927.28 $1,213.07 $1,205.96 $1,577.64 $1,033.27 $1,351.73 59 $947.30 $1,239.25 $1,231.99 $1,611.69 $1,055.58 $1,380.90 60 $987.69 $1,268.99 $1,284.53 $1,650.37 $1,100.59 $1,414.04 61 $1,022.63 $1,313.88 $1,329.97 $1,708.74 $1,139.52 $1,464.06 62 $1,045.56 $1,343.33 $1,359.78 $1,747.05 $1,165.07 $1,496.88 63 $1,074.31 $1,380.27 $1,397.17 $1,795.09 $1,197.10 $1,538.04 64 $1,091.79 $1,402.71 $1,419.90 $1,824.28 $1,216.56 $1,563.05 65+ $1,091.79 $1,402.71 $1,419.90 $1,824.28 $1,216.56 $1,563.05 Rates Effective January 1, 2018 Page 17 of 86

Texas Off Exchange (Gold) Midland, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $312.78 $312.78 $406.78 $406.78 $336.78 $336.78 15 $340.59 $340.59 $442.94 $442.94 $366.71 $366.71 16 $351.22 $351.22 $456.77 $456.77 $378.16 $378.16 17 $361.85 $361.85 $470.59 $470.59 $389.61 $389.61 18 $373.29 $373.29 $485.48 $485.48 $401.93 $401.93 19 $384.74 $384.74 $500.37 $500.37 $414.26 $414.26 20 $396.60 $396.60 $515.79 $515.79 $427.03 $427.03 21 $408.87 $408.87 $531.74 $531.74 $440.23 $440.23 22 $408.87 $408.87 $531.74 $531.74 $440.23 $440.23 23 $408.87 $408.87 $531.74 $531.74 $440.23 $440.23 24 $408.87 $408.87 $531.74 $531.74 $440.23 $440.23 25 $410.50 $410.50 $533.87 $533.87 $441.99 $441.99 26 $418.68 $418.68 $544.51 $544.51 $450.80 $450.80 27 $428.49 $428.49 $557.27 $557.27 $461.36 $461.36 28 $444.44 $444.44 $578.01 $578.01 $478.53 $478.53 29 $457.52 $457.52 $595.02 $595.02 $492.62 $492.62 30 $464.06 $526.34 $603.53 $684.52 $499.66 $566.72 31 $473.88 $537.47 $616.29 $699.00 $510.23 $578.70 32 $483.69 $548.60 $629.05 $713.47 $520.79 $590.69 33 $489.82 $555.55 $637.03 $722.52 $527.40 $598.17 34 $496.36 $562.98 $645.54 $732.17 $534.44 $606.16 35 $499.63 $613.45 $649.79 $797.81 $537.96 $660.51 36 $502.90 $617.46 $654.05 $803.03 $541.49 $664.83 37 $506.18 $621.48 $658.30 $808.26 $545.01 $669.16 38 $509.45 $625.50 $662.55 $813.48 $548.53 $673.48 39 $515.99 $633.53 $671.06 $823.93 $555.57 $682.13 40 $522.53 $673.75 $679.57 $876.23 $562.62 $725.44 41 $532.34 $686.40 $692.33 $892.69 $573.18 $739.06 42 $541.75 $698.53 $704.56 $908.46 $583.31 $752.12 43 $554.83 $715.40 $721.58 $930.40 $597.40 $770.28 44 $571.19 $736.49 $742.85 $957.83 $615.00 $792.99 45 $590.40 $778.50 $767.84 $1,012.47 $635.70 $838.23 46 $613.30 $808.70 $797.62 $1,051.74 $660.35 $870.74 47 $639.06 $842.66 $831.12 $1,095.91 $688.08 $907.31 48 $668.50 $881.48 $869.40 $1,146.39 $719.78 $949.10 49 $697.52 $919.76 $907.16 $1,196.17 $751.04 $990.32 50 $730.23 $965.52 $949.69 $1,255.69 $786.25 $1,039.59 51 $762.53 $1,008.22 $991.70 $1,311.23 $821.03 $1,085.57 52 $798.11 $1,055.25 $1,037.96 $1,372.39 $859.33 $1,136.21 53 $834.09 $1,102.83 $1,084.76 $1,434.27 $898.07 $1,187.43 54 $872.93 $1,154.19 $1,135.27 $1,501.06 $939.90 $1,242.73 55 $911.77 $1,192.78 $1,185.79 $1,551.25 $981.72 $1,284.29 56 $953.88 $1,247.87 $1,240.56 $1,622.90 $1,027.06 $1,343.60 57 $996.41 $1,303.50 $1,295.86 $1,695.24 $1,072.85 $1,403.50 58 $1,041.79 $1,362.87 $1,354.88 $1,772.46 $1,121.71 $1,467.42 59 $1,064.28 $1,392.29 $1,384.13 $1,810.72 $1,145.92 $1,499.10 60 $1,109.66 $1,425.69 $1,443.15 $1,854.16 $1,194.79 $1,535.07 61 $1,148.91 $1,476.12 $1,494.20 $1,919.75 $1,237.05 $1,589.37 62 $1,174.67 $1,509.22 $1,527.70 $1,962.79 $1,264.79 $1,625.00 63 $1,206.97 $1,550.72 $1,569.71 $2,016.76 $1,299.57 $1,669.68 64 $1,226.61 $1,575.93 $1,595.22 $2,049.55 $1,320.69 $1,696.83 65+ $1,226.61 $1,575.93 $1,595.22 $2,049.55 $1,320.69 $1,696.83 Rates Effective January 1, 2018 Page 18 of 86

Texas Off Exchange (Gold) Odessa, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $321.94 $321.94 $418.70 $418.70 $344.24 $344.24 15 $350.56 $350.56 $455.92 $455.92 $374.84 $374.84 16 $361.50 $361.50 $470.15 $470.15 $386.54 $386.54 17 $372.44 $372.44 $484.38 $484.38 $398.24 $398.24 18 $384.23 $384.23 $499.70 $499.70 $410.84 $410.84 19 $396.01 $396.01 $515.03 $515.03 $423.44 $423.44 20 $408.22 $408.22 $530.90 $530.90 $436.49 $436.49 21 $420.84 $420.84 $547.32 $547.32 $449.99 $449.99 22 $420.84 $420.84 $547.32 $547.32 $449.99 $449.99 23 $420.84 $420.84 $547.32 $547.32 $449.99 $449.99 24 $420.84 $420.84 $547.32 $547.32 $449.99 $449.99 25 $422.52 $422.52 $549.51 $549.51 $451.79 $451.79 26 $430.94 $430.94 $560.45 $560.45 $460.79 $460.79 27 $441.04 $441.04 $573.59 $573.59 $471.59 $471.59 28 $457.45 $457.45 $594.94 $594.94 $489.13 $489.13 29 $470.92 $470.92 $612.45 $612.45 $503.53 $503.53 30 $477.66 $541.76 $621.21 $704.57 $510.73 $579.28 31 $487.76 $553.21 $634.34 $719.47 $521.53 $591.52 32 $497.86 $564.67 $647.48 $734.37 $532.33 $603.77 33 $504.17 $571.83 $655.69 $743.68 $539.08 $611.43 34 $510.90 $579.47 $664.45 $753.61 $546.28 $619.59 35 $514.27 $631.42 $668.82 $821.18 $549.88 $675.15 36 $517.64 $635.55 $673.20 $826.56 $553.48 $679.56 37 $521.00 $639.69 $677.58 $831.94 $557.08 $683.99 38 $524.37 $643.82 $681.96 $837.31 $560.68 $688.41 39 $531.10 $652.09 $690.72 $848.06 $567.88 $697.24 40 $537.84 $693.48 $699.47 $901.90 $575.08 $741.51 41 $547.94 $706.51 $712.61 $918.84 $585.88 $755.44 42 $557.62 $718.99 $725.20 $935.07 $596.23 $768.78 43 $571.08 $736.35 $742.71 $957.66 $610.63 $787.35 44 $587.92 $758.06 $764.60 $985.88 $628.63 $810.56 45 $607.70 $801.31 $790.33 $1,042.13 $649.78 $856.80 46 $631.26 $832.38 $820.98 $1,082.54 $674.98 $890.03 47 $657.78 $867.34 $855.46 $1,128.01 $703.33 $927.41 48 $688.08 $907.30 $894.87 $1,179.97 $735.73 $970.13 49 $717.96 $946.70 $933.73 $1,231.21 $767.68 $1,012.26 50 $751.62 $993.80 $977.51 $1,292.47 $803.67 $1,062.62 51 $784.87 $1,037.75 $1,020.75 $1,349.63 $839.22 $1,109.62 52 $821.48 $1,086.16 $1,068.37 $1,412.59 $878.37 $1,161.38 53 $858.52 $1,135.13 $1,116.53 $1,476.28 $917.97 $1,213.74 54 $898.50 $1,187.99 $1,168.53 $1,545.03 $960.72 $1,270.27 55 $938.48 $1,227.72 $1,220.52 $1,596.69 $1,003.47 $1,312.74 56 $981.82 $1,284.42 $1,276.90 $1,670.43 $1,049.82 $1,373.37 57 $1,025.59 $1,341.68 $1,333.82 $1,744.90 $1,096.62 $1,434.59 58 $1,072.30 $1,402.79 $1,394.57 $1,824.37 $1,146.56 $1,499.93 59 $1,095.45 $1,433.07 $1,424.67 $1,863.75 $1,171.31 $1,532.31 60 $1,142.16 $1,467.45 $1,485.42 $1,908.47 $1,221.26 $1,569.08 61 $1,182.56 $1,519.36 $1,537.97 $1,975.98 $1,264.46 $1,624.58 62 $1,209.08 $1,553.42 $1,572.45 $2,020.28 $1,292.81 $1,661.00 63 $1,242.32 $1,596.14 $1,615.69 $2,075.83 $1,328.36 $1,706.68 64 $1,262.52 $1,622.09 $1,641.96 $2,109.59 $1,349.97 $1,734.43 65+ $1,262.52 $1,622.09 $1,641.96 $2,109.59 $1,349.97 $1,734.43 Rates Effective January 1, 2018 Page 19 of 86

Texas Off Exchange (Gold) San Angelo, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $364.84 $364.84 $474.49 $474.49 $393.86 $393.86 15 $397.27 $397.27 $516.67 $516.67 $428.87 $428.87 16 $409.67 $409.67 $532.79 $532.79 $442.26 $442.26 17 $422.07 $422.07 $548.92 $548.92 $455.64 $455.64 18 $435.43 $435.43 $566.29 $566.29 $470.06 $470.06 19 $448.78 $448.78 $583.65 $583.65 $484.47 $484.47 20 $462.61 $462.61 $601.64 $601.64 $499.40 $499.40 21 $476.92 $476.92 $620.25 $620.25 $514.85 $514.85 22 $476.92 $476.92 $620.25 $620.25 $514.85 $514.85 23 $476.92 $476.92 $620.25 $620.25 $514.85 $514.85 24 $476.92 $476.92 $620.25 $620.25 $514.85 $514.85 25 $478.83 $478.83 $622.73 $622.73 $516.91 $516.91 26 $488.36 $488.36 $635.13 $635.13 $527.21 $527.21 27 $499.81 $499.81 $650.02 $650.02 $539.56 $539.56 28 $518.41 $518.41 $674.21 $674.21 $559.64 $559.64 29 $533.67 $533.67 $694.06 $694.06 $576.12 $576.12 30 $541.30 $613.95 $703.98 $798.46 $584.35 $662.78 31 $552.75 $626.93 $718.87 $815.34 $596.71 $676.79 32 $564.19 $639.91 $733.75 $832.23 $609.07 $690.80 33 $571.35 $648.02 $743.06 $842.78 $616.79 $699.56 34 $578.98 $656.68 $752.98 $854.03 $625.03 $708.91 35 $582.79 $715.55 $757.94 $930.60 $629.15 $772.46 36 $586.61 $720.24 $762.91 $936.69 $633.26 $777.52 37 $590.42 $724.93 $767.87 $942.79 $637.38 $782.58 38 $594.24 $729.61 $772.83 $948.88 $641.50 $787.64 39 $601.87 $738.98 $782.75 $961.06 $649.74 $797.75 40 $609.50 $785.89 $792.68 $1,022.08 $657.98 $848.39 41 $620.95 $800.65 $807.56 $1,041.27 $670.33 $864.33 42 $631.92 $814.80 $821.83 $1,059.67 $682.18 $879.60 43 $647.18 $834.47 $841.68 $1,085.26 $698.65 $900.84 44 $666.26 $859.07 $866.49 $1,117.25 $719.24 $927.39 45 $688.67 $908.08 $895.64 $1,180.99 $743.44 $980.30 46 $715.38 $943.30 $930.37 $1,226.79 $772.27 $1,018.32 47 $745.42 $982.91 $969.45 $1,278.31 $804.71 $1,061.09 48 $779.76 $1,028.19 $1,014.11 $1,337.20 $841.78 $1,109.97 49 $813.62 $1,072.84 $1,058.14 $1,395.27 $878.33 $1,158.17 50 $851.78 $1,126.22 $1,107.76 $1,464.69 $919.52 $1,215.79 51 $889.45 $1,176.03 $1,156.76 $1,529.47 $960.19 $1,269.57 52 $930.94 $1,230.89 $1,210.73 $1,600.82 $1,004.99 $1,328.79 53 $972.91 $1,286.39 $1,265.31 $1,672.99 $1,050.29 $1,388.70 54 $1,018.22 $1,346.29 $1,324.23 $1,750.90 $1,099.20 $1,453.37 55 $1,063.53 $1,391.31 $1,383.16 $1,809.45 $1,148.11 $1,501.97 56 $1,112.65 $1,455.57 $1,447.04 $1,893.02 $1,201.14 $1,571.34 57 $1,162.25 $1,520.45 $1,511.55 $1,977.40 $1,254.69 $1,641.38 58 $1,215.19 $1,589.71 $1,580.39 $2,067.47 $1,311.84 $1,716.14 59 $1,241.42 $1,624.02 $1,614.51 $2,112.10 $1,340.15 $1,753.19 60 $1,294.36 $1,662.99 $1,683.36 $2,162.78 $1,397.30 $1,795.25 61 $1,340.14 $1,721.81 $1,742.90 $2,239.28 $1,446.73 $1,858.76 62 $1,370.19 $1,760.42 $1,781.98 $2,289.48 $1,479.16 $1,900.43 63 $1,407.86 $1,808.82 $1,830.98 $2,352.44 $1,519.84 $1,952.68 64 $1,430.76 $1,838.23 $1,860.75 $2,390.69 $1,544.55 $1,984.44 65+ $1,430.76 $1,838.23 $1,860.75 $2,390.69 $1,544.55 $1,984.44 Rates Effective January 1, 2018 Page 20 of 86

Texas Off Exchange (Gold) San Antonio-New Braunfels, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $328.04 $328.04 $426.63 $426.63 $351.01 $351.01 15 $357.20 $357.20 $464.55 $464.55 $382.21 $382.21 16 $368.35 $368.35 $479.05 $479.05 $394.14 $394.14 17 $379.50 $379.50 $493.55 $493.55 $406.07 $406.07 18 $391.50 $391.50 $509.17 $509.17 $418.92 $418.92 19 $403.51 $403.51 $524.78 $524.78 $431.77 $431.77 20 $415.95 $415.95 $540.95 $540.95 $445.07 $445.07 21 $428.81 $428.81 $557.68 $557.68 $458.84 $458.84 22 $428.81 $428.81 $557.68 $557.68 $458.84 $458.84 23 $428.81 $428.81 $557.68 $557.68 $458.84 $458.84 24 $428.81 $428.81 $557.68 $557.68 $458.84 $458.84 25 $430.53 $430.53 $559.91 $559.91 $460.67 $460.67 26 $439.10 $439.10 $571.07 $571.07 $469.85 $469.85 27 $449.39 $449.39 $584.45 $584.45 $480.86 $480.86 28 $466.12 $466.12 $606.20 $606.20 $498.76 $498.76 29 $479.84 $479.84 $624.05 $624.05 $513.44 $513.44 30 $486.70 $552.02 $632.97 $717.92 $520.78 $590.67 31 $496.99 $563.69 $646.36 $733.10 $531.79 $603.16 32 $507.28 $575.36 $659.74 $748.28 $542.81 $615.65 33 $513.72 $582.66 $668.11 $757.76 $549.69 $623.46 34 $520.58 $590.44 $677.03 $767.89 $557.03 $631.78 35 $524.01 $643.38 $681.49 $836.73 $560.70 $688.43 36 $527.44 $647.59 $685.95 $842.21 $564.37 $692.93 37 $530.87 $651.80 $690.41 $847.69 $568.04 $697.44 38 $534.30 $656.01 $694.87 $853.17 $571.71 $701.95 39 $541.16 $664.43 $703.80 $864.12 $579.05 $710.96 40 $548.02 $706.62 $712.72 $918.98 $586.39 $756.10 41 $558.31 $719.89 $726.10 $936.24 $597.41 $770.30 42 $568.18 $732.61 $738.93 $952.78 $607.96 $783.91 43 $581.90 $750.30 $756.78 $975.79 $622.64 $802.84 44 $599.05 $772.41 $779.08 $1,004.55 $641.00 $826.50 45 $619.20 $816.48 $805.30 $1,061.86 $662.56 $873.66 46 $643.22 $848.15 $836.53 $1,103.04 $688.26 $907.54 47 $670.23 $883.77 $871.66 $1,149.37 $717.16 $945.65 48 $701.11 $924.48 $911.81 $1,202.32 $750.20 $989.21 49 $731.55 $964.62 $951.41 $1,254.53 $782.78 $1,032.17 50 $765.86 $1,012.62 $996.02 $1,316.94 $819.48 $1,083.52 51 $799.73 $1,057.41 $1,040.08 $1,375.19 $855.73 $1,131.45 52 $837.04 $1,106.73 $1,088.60 $1,439.34 $895.65 $1,184.23 53 $874.78 $1,156.63 $1,137.68 $1,504.24 $936.03 $1,237.62 54 $915.51 $1,210.49 $1,190.66 $1,574.29 $979.62 $1,295.25 55 $956.25 $1,250.97 $1,243.64 $1,626.93 $1,023.21 $1,338.56 56 $1,000.42 $1,308.75 $1,301.08 $1,702.07 $1,070.47 $1,400.39 57 $1,045.01 $1,367.09 $1,359.08 $1,777.94 $1,118.19 $1,462.81 58 $1,092.61 $1,429.35 $1,420.98 $1,858.92 $1,169.12 $1,529.44 59 $1,116.20 $1,460.21 $1,451.65 $1,899.05 $1,194.36 $1,562.45 60 $1,163.79 $1,495.24 $1,513.55 $1,944.62 $1,245.29 $1,599.95 61 $1,204.96 $1,548.13 $1,567.09 $2,013.40 $1,289.33 $1,656.54 62 $1,231.98 $1,582.84 $1,602.23 $2,058.54 $1,318.24 $1,693.68 63 $1,265.85 $1,626.37 $1,646.28 $2,115.15 $1,354.49 $1,740.25 64 $1,286.43 $1,652.81 $1,673.04 $2,149.54 $1,376.52 $1,768.55 65+ $1,286.43 $1,652.81 $1,673.04 $2,149.54 $1,376.52 $1,768.55 Rates Effective January 1, 2018 Page 21 of 86

Texas Off Exchange (Gold) Sherman-Denison, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $342.02 $342.02 $444.81 $444.81 $367.77 $367.77 15 $372.42 $372.42 $484.34 $484.34 $400.46 $400.46 16 $384.04 $384.04 $499.46 $499.46 $412.96 $412.96 17 $395.67 $395.67 $514.58 $514.58 $425.46 $425.46 18 $408.19 $408.19 $530.86 $530.86 $438.92 $438.92 19 $420.70 $420.70 $547.14 $547.14 $452.38 $452.38 20 $433.67 $433.67 $564.00 $564.00 $466.33 $466.33 21 $447.08 $447.08 $581.45 $581.45 $480.75 $480.75 22 $447.08 $447.08 $581.45 $581.45 $480.75 $480.75 23 $447.08 $447.08 $581.45 $581.45 $480.75 $480.75 24 $447.08 $447.08 $581.45 $581.45 $480.75 $480.75 25 $448.87 $448.87 $583.77 $583.77 $482.67 $482.67 26 $457.81 $457.81 $595.40 $595.40 $492.29 $492.29 27 $468.54 $468.54 $609.36 $609.36 $503.82 $503.82 28 $485.98 $485.98 $632.03 $632.03 $522.57 $522.57 29 $500.29 $500.29 $650.64 $650.64 $537.96 $537.96 30 $507.44 $575.54 $659.94 $748.51 $545.65 $618.88 31 $518.17 $587.71 $673.90 $764.33 $557.19 $631.96 32 $528.90 $599.88 $687.85 $780.16 $568.72 $645.05 33 $535.60 $607.48 $696.57 $790.05 $575.94 $653.23 34 $542.76 $615.60 $705.88 $800.61 $583.63 $661.95 35 $546.33 $670.79 $710.53 $872.38 $587.47 $721.30 36 $549.91 $675.18 $715.18 $878.09 $591.32 $726.02 37 $553.49 $679.57 $719.83 $883.81 $595.17 $730.75 38 $557.06 $683.96 $724.48 $889.52 $599.01 $735.47 39 $564.22 $692.75 $733.79 $900.94 $606.70 $744.91 40 $571.37 $736.72 $743.09 $958.14 $614.40 $792.20 41 $582.10 $750.56 $757.04 $976.13 $625.93 $807.08 42 $592.38 $763.82 $770.42 $993.38 $636.99 $821.34 43 $606.69 $782.27 $789.02 $1,017.37 $652.37 $841.17 44 $624.57 $805.33 $812.28 $1,047.35 $671.60 $865.97 45 $645.59 $851.27 $839.61 $1,107.11 $694.20 $915.37 46 $670.62 $884.28 $872.17 $1,150.04 $721.12 $950.87 47 $698.79 $921.42 $908.80 $1,198.34 $751.41 $990.81 48 $730.98 $963.87 $950.66 $1,253.55 $786.02 $1,036.45 49 $762.72 $1,005.73 $991.95 $1,307.98 $820.16 $1,081.46 50 $798.49 $1,055.76 $1,038.46 $1,373.06 $858.62 $1,135.26 51 $833.81 $1,102.46 $1,084.40 $1,433.79 $896.59 $1,185.48 52 $872.71 $1,153.89 $1,134.98 $1,500.67 $938.42 $1,240.78 53 $912.05 $1,205.91 $1,186.15 $1,568.33 $980.72 $1,296.72 54 $954.52 $1,262.07 $1,241.39 $1,641.37 $1,026.40 $1,357.10 55 $996.99 $1,304.27 $1,296.63 $1,696.25 $1,072.07 $1,402.48 56 $1,043.04 $1,364.51 $1,356.51 $1,774.59 $1,121.58 $1,467.26 57 $1,089.54 $1,425.33 $1,416.98 $1,853.70 $1,171.58 $1,532.66 58 $1,139.17 $1,490.26 $1,481.53 $1,938.13 $1,224.94 $1,602.47 59 $1,163.76 $1,522.42 $1,513.51 $1,979.96 $1,251.39 $1,637.06 60 $1,213.38 $1,558.95 $1,578.05 $2,027.47 $1,304.75 $1,676.34 61 $1,256.30 $1,614.10 $1,633.86 $2,099.19 $1,350.90 $1,735.64 62 $1,284.47 $1,650.28 $1,670.50 $2,146.25 $1,381.19 $1,774.55 63 $1,319.79 $1,695.66 $1,716.43 $2,205.27 $1,419.17 $1,823.35 64 $1,341.24 $1,723.23 $1,744.35 $2,241.13 $1,442.25 $1,852.99 65+ $1,341.24 $1,723.23 $1,744.35 $2,241.13 $1,442.25 $1,852.99 Rates Effective January 1, 2018 Page 22 of 86

Texas Off Exchange (Gold) Texarkana, TX-Texarkana, AR Blue Advantage Gold HMO SM 206 207 203 0-14 $317.81 $317.81 $413.32 $413.32 $342.65 $342.65 15 $346.06 $346.06 $450.06 $450.06 $373.10 $373.10 16 $356.86 $356.86 $464.10 $464.10 $384.75 $384.75 17 $367.66 $367.66 $478.15 $478.15 $396.39 $396.39 18 $379.29 $379.29 $493.28 $493.28 $408.94 $408.94 19 $390.92 $390.92 $508.41 $508.41 $421.48 $421.48 20 $402.97 $402.97 $524.08 $524.08 $434.47 $434.47 21 $415.43 $415.43 $540.28 $540.28 $447.90 $447.90 22 $415.43 $415.43 $540.28 $540.28 $447.90 $447.90 23 $415.43 $415.43 $540.28 $540.28 $447.90 $447.90 24 $415.43 $415.43 $540.28 $540.28 $447.90 $447.90 25 $417.09 $417.09 $542.45 $542.45 $449.70 $449.70 26 $425.40 $425.40 $553.25 $553.25 $458.65 $458.65 27 $435.37 $435.37 $566.22 $566.22 $469.40 $469.40 28 $451.58 $451.58 $587.29 $587.29 $486.87 $486.87 29 $464.87 $464.87 $604.58 $604.58 $501.20 $501.20 30 $471.52 $534.79 $613.22 $695.52 $508.37 $576.60 31 $481.49 $546.10 $626.19 $710.23 $519.12 $588.79 32 $491.46 $557.41 $639.16 $724.93 $529.87 $600.98 33 $497.69 $564.48 $647.26 $734.12 $536.59 $608.60 34 $504.34 $572.02 $655.91 $743.93 $543.76 $616.73 35 $507.66 $623.30 $660.23 $810.63 $547.34 $672.02 36 $510.98 $627.38 $664.55 $815.93 $550.92 $676.42 37 $514.31 $631.47 $668.87 $821.24 $554.50 $680.82 38 $517.63 $635.55 $673.19 $826.55 $558.09 $685.22 39 $524.28 $643.70 $681.84 $837.16 $565.25 $694.02 40 $530.92 $684.57 $690.48 $890.31 $572.42 $738.08 41 $540.89 $697.43 $703.45 $907.03 $583.17 $751.94 42 $550.45 $709.75 $715.88 $923.05 $593.47 $765.23 43 $563.74 $726.89 $733.17 $945.35 $607.81 $783.71 44 $580.36 $748.31 $754.78 $973.21 $625.72 $806.80 45 $599.88 $791.01 $780.17 $1,028.73 $646.77 $852.84 46 $623.15 $821.68 $810.43 $1,068.63 $671.86 $885.91 47 $649.32 $856.19 $844.46 $1,113.51 $700.07 $923.12 48 $679.23 $895.64 $883.37 $1,164.80 $732.32 $965.64 49 $708.73 $934.53 $921.73 $1,215.39 $764.12 $1,007.57 50 $741.96 $981.02 $964.95 $1,275.85 $799.96 $1,057.70 51 $774.78 $1,024.42 $1,007.63 $1,332.29 $835.34 $1,104.49 52 $810.92 $1,072.20 $1,054.64 $1,394.44 $874.31 $1,156.01 53 $847.48 $1,120.54 $1,102.18 $1,457.30 $913.72 $1,208.13 54 $886.95 $1,172.72 $1,153.51 $1,525.17 $956.27 $1,264.39 55 $926.41 $1,211.94 $1,204.83 $1,576.17 $998.83 $1,306.66 56 $969.20 $1,267.91 $1,260.48 $1,648.96 $1,044.96 $1,367.02 57 $1,012.41 $1,324.43 $1,316.67 $1,722.47 $1,091.54 $1,427.95 58 $1,058.52 $1,384.76 $1,376.65 $1,800.93 $1,141.26 $1,492.99 59 $1,081.37 $1,414.65 $1,406.36 $1,839.80 $1,165.89 $1,525.22 60 $1,127.48 $1,448.59 $1,466.33 $1,883.95 $1,215.61 $1,561.82 61 $1,167.37 $1,499.83 $1,518.20 $1,950.58 $1,258.61 $1,617.06 62 $1,193.54 $1,533.46 $1,552.24 $1,994.31 $1,286.83 $1,653.32 63 $1,226.36 $1,575.62 $1,594.92 $2,049.15 $1,322.21 $1,698.78 64 $1,246.29 $1,601.24 $1,620.84 $2,082.47 $1,343.70 $1,726.40 65+ $1,246.29 $1,601.24 $1,620.84 $2,082.47 $1,343.70 $1,726.40 Rates Effective January 1, 2018 Page 23 of 86

Texas Off Exchange (Gold) Tyler, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $307.55 $307.55 $399.98 $399.98 $347.93 $347.93 15 $334.89 $334.89 $435.53 $435.53 $378.86 $378.86 16 $345.34 $345.34 $449.12 $449.12 $390.68 $390.68 17 $355.79 $355.79 $462.72 $462.72 $402.51 $402.51 18 $367.05 $367.05 $477.36 $477.36 $415.24 $415.24 19 $378.30 $378.30 $492.00 $492.00 $427.98 $427.98 20 $389.96 $389.96 $507.16 $507.16 $441.17 $441.17 21 $402.02 $402.02 $522.84 $522.84 $454.81 $454.81 22 $402.02 $402.02 $522.84 $522.84 $454.81 $454.81 23 $402.02 $402.02 $522.84 $522.84 $454.81 $454.81 24 $402.02 $402.02 $522.84 $522.84 $454.81 $454.81 25 $403.63 $403.63 $524.94 $524.94 $456.63 $456.63 26 $411.67 $411.67 $535.39 $535.39 $465.73 $465.73 27 $421.32 $421.32 $547.94 $547.94 $476.64 $476.64 28 $437.00 $437.00 $568.33 $568.33 $494.38 $494.38 29 $449.86 $449.86 $585.06 $585.06 $508.93 $508.93 30 $456.30 $517.53 $593.43 $673.07 $516.21 $585.49 31 $465.94 $528.48 $605.98 $687.30 $527.13 $597.87 32 $475.59 $539.42 $618.53 $701.53 $538.04 $610.25 33 $481.62 $546.26 $626.37 $710.43 $544.86 $617.98 34 $488.06 $553.55 $634.73 $719.92 $552.14 $626.24 35 $491.27 $603.18 $638.92 $784.46 $555.78 $682.38 36 $494.49 $607.13 $643.10 $789.60 $559.42 $686.85 37 $497.70 $611.08 $647.28 $794.73 $563.06 $691.32 38 $500.92 $615.03 $651.46 $799.87 $566.69 $695.79 39 $507.35 $622.93 $659.83 $810.14 $573.97 $704.72 40 $513.79 $662.47 $668.20 $861.57 $581.25 $749.46 41 $523.43 $674.92 $680.74 $877.75 $592.16 $763.54 42 $532.68 $686.84 $692.77 $893.26 $602.62 $777.03 43 $545.55 $703.43 $709.50 $914.83 $617.18 $795.79 44 $561.63 $724.16 $730.41 $941.80 $635.37 $819.25 45 $580.52 $765.48 $754.99 $995.53 $656.75 $865.99 46 $603.03 $795.16 $784.27 $1,034.13 $682.22 $899.57 47 $628.36 $828.56 $817.21 $1,077.57 $710.87 $937.35 48 $657.31 $866.73 $854.85 $1,127.21 $743.62 $980.53 49 $685.85 $904.36 $891.97 $1,176.16 $775.91 $1,023.11 50 $718.01 $949.36 $933.80 $1,234.67 $812.29 $1,074.01 51 $749.77 $991.35 $975.11 $1,289.28 $848.22 $1,121.52 52 $784.75 $1,037.59 $1,020.59 $1,349.43 $887.79 $1,173.83 53 $820.13 $1,084.37 $1,066.60 $1,410.26 $927.81 $1,226.76 54 $858.32 $1,134.87 $1,116.27 $1,475.94 $971.02 $1,283.88 55 $896.51 $1,172.82 $1,165.94 $1,525.29 $1,014.23 $1,326.81 56 $937.92 $1,226.99 $1,219.80 $1,595.74 $1,061.07 $1,388.10 57 $979.73 $1,281.68 $1,274.17 $1,666.87 $1,108.37 $1,449.97 58 $1,024.35 $1,340.06 $1,332.21 $1,742.79 $1,158.86 $1,516.02 59 $1,046.47 $1,368.98 $1,360.97 $1,780.41 $1,183.87 $1,548.74 60 $1,091.09 $1,401.83 $1,419.00 $1,823.13 $1,234.36 $1,585.90 61 $1,129.68 $1,451.42 $1,469.19 $1,887.62 $1,278.02 $1,642.00 62 $1,155.01 $1,483.96 $1,502.13 $1,929.94 $1,306.67 $1,678.81 63 $1,186.77 $1,524.76 $1,543.44 $1,983.01 $1,342.60 $1,724.97 64 $1,206.06 $1,549.56 $1,568.52 $2,015.25 $1,364.43 $1,753.02 65+ $1,206.06 $1,549.56 $1,568.52 $2,015.25 $1,364.43 $1,753.02 Rates Effective January 1, 2018 Page 24 of 86

Texas Off Exchange (Gold) Victoria, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $326.32 $326.32 $424.40 $424.40 $341.34 $341.34 15 $355.33 $355.33 $462.12 $462.12 $371.68 $371.68 16 $366.42 $366.42 $476.54 $476.54 $383.29 $383.29 17 $377.51 $377.51 $490.97 $490.97 $394.89 $394.89 18 $389.46 $389.46 $506.50 $506.50 $407.38 $407.38 19 $401.40 $401.40 $522.03 $522.03 $419.87 $419.87 20 $413.77 $413.77 $538.12 $538.12 $432.81 $432.81 21 $426.57 $426.57 $554.76 $554.76 $446.20 $446.20 22 $426.57 $426.57 $554.76 $554.76 $446.20 $446.20 23 $426.57 $426.57 $554.76 $554.76 $446.20 $446.20 24 $426.57 $426.57 $554.76 $554.76 $446.20 $446.20 25 $428.27 $428.27 $556.98 $556.98 $447.98 $447.98 26 $436.80 $436.80 $568.08 $568.08 $456.91 $456.91 27 $447.04 $447.04 $581.39 $581.39 $467.62 $467.62 28 $463.68 $463.68 $603.03 $603.03 $485.02 $485.02 29 $477.33 $477.33 $620.78 $620.78 $499.30 $499.30 30 $484.15 $549.13 $629.66 $714.16 $506.44 $574.40 31 $494.39 $560.74 $642.97 $729.26 $517.14 $586.55 32 $504.63 $572.35 $656.29 $744.36 $527.85 $598.69 33 $511.03 $579.61 $664.61 $753.80 $534.55 $606.28 34 $517.85 $587.35 $673.48 $763.87 $541.69 $614.38 35 $521.26 $640.01 $677.92 $832.35 $545.26 $669.46 36 $524.68 $644.20 $682.36 $837.80 $548.83 $673.85 37 $528.09 $648.39 $686.80 $843.25 $552.39 $678.23 38 $531.50 $652.58 $691.24 $848.70 $555.96 $682.61 39 $538.33 $660.96 $700.11 $859.60 $563.10 $691.38 40 $545.15 $702.92 $708.99 $914.17 $570.24 $735.27 41 $555.39 $716.12 $722.30 $931.34 $580.95 $749.08 42 $565.20 $728.77 $735.06 $947.79 $591.21 $762.31 43 $578.85 $746.37 $752.82 $970.68 $605.49 $780.72 44 $595.91 $768.37 $775.01 $999.29 $623.34 $803.73 45 $615.96 $812.21 $801.08 $1,056.31 $644.31 $849.59 46 $639.85 $843.71 $832.15 $1,097.27 $669.30 $882.54 47 $666.72 $879.14 $867.10 $1,143.35 $697.41 $919.60 48 $697.44 $919.64 $907.04 $1,196.02 $729.54 $961.97 49 $727.72 $959.57 $946.43 $1,247.96 $761.22 $1,003.74 50 $761.85 $1,007.32 $990.81 $1,310.05 $796.91 $1,053.68 51 $795.55 $1,051.87 $1,034.64 $1,367.99 $832.16 $1,100.28 52 $832.66 $1,100.94 $1,082.90 $1,431.81 $870.98 $1,151.61 53 $870.20 $1,150.57 $1,131.72 $1,496.36 $910.25 $1,203.53 54 $910.72 $1,204.16 $1,184.42 $1,566.05 $952.64 $1,259.58 55 $951.24 $1,244.42 $1,237.13 $1,618.41 $995.02 $1,301.69 56 $995.18 $1,301.89 $1,294.27 $1,693.16 $1,040.98 $1,361.81 57 $1,039.54 $1,359.93 $1,351.96 $1,768.63 $1,087.39 $1,422.52 58 $1,086.89 $1,421.87 $1,413.54 $1,849.19 $1,136.92 $1,487.31 59 $1,110.35 $1,452.56 $1,444.05 $1,889.11 $1,161.46 $1,519.42 60 $1,157.70 $1,487.42 $1,505.63 $1,934.44 $1,210.98 $1,555.87 61 $1,198.65 $1,540.03 $1,558.89 $2,002.86 $1,253.82 $1,610.91 62 $1,225.53 $1,574.56 $1,593.84 $2,047.76 $1,281.93 $1,647.02 63 $1,259.22 $1,617.85 $1,637.67 $2,104.07 $1,317.18 $1,692.31 64 $1,279.71 $1,644.16 $1,664.28 $2,138.29 $1,338.60 $1,719.83 65+ $1,279.71 $1,644.16 $1,664.28 $2,138.29 $1,338.60 $1,719.83 Rates Effective January 1, 2018 Page 25 of 86

Texas Off Exchange (Gold) Waco, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $295.84 $295.84 $384.75 $384.75 $320.63 $320.63 15 $322.13 $322.13 $418.95 $418.95 $349.13 $349.13 16 $332.19 $332.19 $432.02 $432.02 $360.03 $360.03 17 $342.24 $342.24 $445.10 $445.10 $370.92 $370.92 18 $353.07 $353.07 $459.18 $459.18 $382.66 $382.66 19 $363.90 $363.90 $473.26 $473.26 $394.40 $394.40 20 $375.11 $375.11 $487.85 $487.85 $406.55 $406.55 21 $386.71 $386.71 $502.94 $502.94 $419.12 $419.12 22 $386.71 $386.71 $502.94 $502.94 $419.12 $419.12 23 $386.71 $386.71 $502.94 $502.94 $419.12 $419.12 24 $386.71 $386.71 $502.94 $502.94 $419.12 $419.12 25 $388.26 $388.26 $504.95 $504.95 $420.80 $420.80 26 $396.00 $396.00 $515.01 $515.01 $429.18 $429.18 27 $405.28 $405.28 $527.08 $527.08 $439.24 $439.24 28 $420.36 $420.36 $546.69 $546.69 $455.59 $455.59 29 $432.73 $432.73 $562.78 $562.78 $469.00 $469.00 30 $438.92 $497.82 $570.83 $647.44 $475.71 $539.55 31 $448.20 $508.35 $582.90 $661.13 $485.76 $550.96 32 $457.48 $518.88 $594.97 $674.82 $495.82 $562.36 33 $463.28 $525.46 $602.52 $683.37 $502.11 $569.49 34 $469.47 $532.47 $610.56 $692.50 $508.82 $577.10 35 $472.56 $580.21 $614.59 $754.59 $512.17 $628.84 36 $475.66 $584.01 $618.61 $759.53 $515.52 $632.96 37 $478.75 $587.81 $622.63 $764.47 $518.88 $637.08 38 $481.85 $591.61 $626.66 $769.41 $522.23 $641.19 39 $488.03 $599.21 $634.70 $779.29 $528.93 $649.42 40 $494.22 $637.25 $642.75 $828.76 $535.64 $690.65 41 $503.50 $649.22 $654.82 $844.33 $545.70 $703.63 42 $512.40 $660.69 $666.39 $859.24 $555.34 $716.06 43 $524.77 $676.64 $682.48 $880.00 $568.75 $733.35 44 $540.24 $696.58 $702.60 $905.93 $585.52 $754.96 45 $558.42 $736.33 $726.24 $957.62 $605.22 $798.04 46 $580.07 $764.88 $754.40 $994.76 $628.69 $828.99 47 $604.43 $797.01 $786.09 $1,036.53 $655.09 $863.80 48 $632.28 $833.72 $822.30 $1,084.28 $685.27 $903.59 49 $659.73 $869.93 $858.01 $1,131.37 $715.03 $942.83 50 $690.67 $913.21 $898.24 $1,187.66 $748.56 $989.74 51 $721.22 $953.60 $937.97 $1,240.19 $781.67 $1,033.52 52 $754.87 $998.08 $981.73 $1,298.04 $818.13 $1,081.73 53 $788.90 $1,043.08 $1,025.99 $1,356.56 $855.01 $1,130.50 54 $825.63 $1,091.66 $1,073.77 $1,419.74 $894.83 $1,183.15 55 $862.37 $1,128.16 $1,121.55 $1,467.21 $934.65 $1,222.71 56 $902.20 $1,180.26 $1,173.35 $1,534.97 $977.82 $1,279.18 57 $942.42 $1,232.88 $1,225.65 $1,603.40 $1,021.41 $1,336.20 58 $985.35 $1,289.03 $1,281.48 $1,676.43 $1,067.93 $1,397.06 59 $1,006.62 $1,316.85 $1,309.14 $1,712.62 $1,090.98 $1,427.22 60 $1,049.54 $1,348.45 $1,364.97 $1,753.71 $1,137.50 $1,461.47 61 $1,086.67 $1,396.15 $1,413.25 $1,815.74 $1,177.74 $1,513.16 62 $1,111.03 $1,427.45 $1,444.93 $1,856.45 $1,204.14 $1,547.08 63 $1,141.58 $1,466.70 $1,484.67 $1,907.50 $1,237.25 $1,589.62 64 $1,160.13 $1,490.55 $1,508.82 $1,938.51 $1,257.36 $1,615.47 65+ $1,160.13 $1,490.55 $1,508.82 $1,938.51 $1,257.36 $1,615.47 Rates Effective January 1, 2018 Page 26 of 86

Texas Off Exchange (Gold) Wichita Falls, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $363.43 $363.43 $472.66 $472.66 $408.38 $408.38 15 $395.74 $395.74 $514.67 $514.67 $444.68 $444.68 16 $408.09 $408.09 $530.74 $530.74 $458.56 $458.56 17 $420.44 $420.44 $546.80 $546.80 $472.44 $472.44 18 $433.74 $433.74 $564.10 $564.10 $487.39 $487.39 19 $447.05 $447.05 $581.40 $581.40 $502.34 $502.34 20 $460.82 $460.82 $599.32 $599.32 $517.82 $517.82 21 $475.08 $475.08 $617.85 $617.85 $533.83 $533.83 22 $475.08 $475.08 $617.85 $617.85 $533.83 $533.83 23 $475.08 $475.08 $617.85 $617.85 $533.83 $533.83 24 $475.08 $475.08 $617.85 $617.85 $533.83 $533.83 25 $476.98 $476.98 $620.32 $620.32 $535.97 $535.97 26 $486.48 $486.48 $632.68 $632.68 $546.64 $546.64 27 $497.88 $497.88 $647.51 $647.51 $559.46 $559.46 28 $516.41 $516.41 $671.61 $671.61 $580.28 $580.28 29 $531.61 $531.61 $691.38 $691.38 $597.36 $597.36 30 $539.21 $611.57 $701.26 $795.37 $605.90 $687.21 31 $550.61 $624.51 $716.09 $812.19 $618.71 $701.74 32 $562.01 $637.44 $730.92 $829.01 $631.52 $716.28 33 $569.14 $645.52 $740.19 $839.52 $639.53 $725.36 34 $576.74 $654.14 $750.07 $850.73 $648.07 $735.05 35 $580.54 $712.79 $755.02 $927.01 $652.34 $800.95 36 $584.34 $717.45 $759.96 $933.07 $656.61 $806.19 37 $588.14 $722.12 $764.90 $939.15 $660.89 $811.44 38 $591.94 $726.79 $769.84 $945.22 $665.16 $816.68 39 $599.55 $736.12 $779.73 $957.35 $673.70 $827.16 40 $607.15 $782.85 $789.62 $1,018.13 $682.24 $879.68 41 $618.55 $797.56 $804.44 $1,037.25 $695.05 $896.20 42 $629.48 $811.65 $818.65 $1,055.58 $707.33 $912.03 43 $644.68 $831.25 $838.43 $1,081.07 $724.41 $934.06 44 $663.68 $855.75 $863.14 $1,112.93 $745.76 $961.59 45 $686.01 $904.57 $892.18 $1,176.43 $770.85 $1,016.45 46 $712.61 $939.65 $926.78 $1,222.05 $800.75 $1,055.87 47 $742.54 $979.12 $965.70 $1,273.38 $834.38 $1,100.21 48 $776.75 $1,024.22 $1,010.19 $1,332.03 $872.82 $1,150.90 49 $810.48 $1,068.70 $1,054.06 $1,389.88 $910.72 $1,200.87 50 $848.49 $1,121.87 $1,103.48 $1,459.03 $953.43 $1,260.62 51 $886.02 $1,171.49 $1,152.30 $1,523.56 $995.60 $1,316.38 52 $927.35 $1,226.14 $1,206.05 $1,594.63 $1,042.04 $1,377.79 53 $969.15 $1,281.42 $1,260.42 $1,666.53 $1,089.02 $1,439.90 54 $1,014.29 $1,341.09 $1,319.12 $1,744.14 $1,139.73 $1,506.96 55 $1,059.42 $1,385.93 $1,377.81 $1,802.46 $1,190.45 $1,557.35 56 $1,108.35 $1,449.95 $1,441.45 $1,885.70 $1,245.43 $1,629.27 57 $1,157.76 $1,514.58 $1,505.71 $1,969.76 $1,300.95 $1,701.90 58 $1,210.49 $1,583.57 $1,574.29 $2,059.48 $1,360.21 $1,779.42 59 $1,236.62 $1,617.75 $1,608.27 $2,103.94 $1,389.57 $1,817.83 60 $1,289.36 $1,656.57 $1,676.85 $2,154.42 $1,448.82 $1,861.45 61 $1,334.96 $1,715.16 $1,736.17 $2,230.63 $1,500.07 $1,927.29 62 $1,364.89 $1,753.61 $1,775.09 $2,280.64 $1,533.70 $1,970.50 63 $1,402.42 $1,801.83 $1,823.90 $2,343.35 $1,575.87 $2,024.68 64 $1,425.24 $1,831.13 $1,853.55 $2,381.45 $1,601.49 $2,057.61 65+ $1,425.24 $1,831.13 $1,853.55 $2,381.45 $1,601.49 $2,057.61 Rates Effective January 1, 2018 Page 27 of 86

Texas Off Exchange (Gold) Non MSA, TX Blue Advantage Gold HMO SM 206 207 203 0-14 $321.97 $321.97 $418.73 $418.73 $334.15 $334.15 15 $350.59 $350.59 $455.95 $455.95 $363.86 $363.86 16 $361.53 $361.53 $470.18 $470.18 $375.21 $375.21 17 $372.47 $372.47 $484.42 $484.42 $386.57 $386.57 18 $384.26 $384.26 $499.74 $499.74 $398.80 $398.80 19 $396.04 $396.04 $515.07 $515.07 $411.03 $411.03 20 $408.25 $408.25 $530.94 $530.94 $423.70 $423.70 21 $420.88 $420.88 $547.36 $547.36 $436.80 $436.80 22 $420.88 $420.88 $547.36 $547.36 $436.80 $436.80 23 $420.88 $420.88 $547.36 $547.36 $436.80 $436.80 24 $420.88 $420.88 $547.36 $547.36 $436.80 $436.80 25 $422.56 $422.56 $549.55 $549.55 $438.55 $438.55 26 $430.98 $430.98 $560.50 $560.50 $447.29 $447.29 27 $441.08 $441.08 $573.64 $573.64 $457.77 $457.77 28 $457.49 $457.49 $594.98 $594.98 $474.80 $474.80 29 $470.96 $470.96 $612.50 $612.50 $488.78 $488.78 30 $477.69 $541.80 $621.26 $704.63 $495.77 $562.30 31 $487.79 $553.26 $634.39 $719.53 $506.25 $574.19 32 $497.90 $564.71 $647.53 $734.43 $516.74 $586.08 33 $504.21 $571.87 $655.74 $743.74 $523.29 $593.51 34 $510.94 $579.51 $664.50 $753.68 $530.28 $601.44 35 $514.31 $631.47 $668.88 $821.25 $533.77 $655.37 36 $517.68 $635.60 $673.26 $826.62 $537.27 $659.65 37 $521.04 $639.74 $677.64 $832.00 $540.76 $663.95 38 $524.41 $643.87 $682.01 $837.38 $544.26 $668.24 39 $531.14 $652.14 $690.77 $848.13 $551.24 $676.82 40 $537.88 $693.54 $699.53 $901.97 $558.23 $719.78 41 $547.98 $706.57 $712.67 $918.91 $568.72 $733.30 42 $557.66 $719.05 $725.26 $935.15 $578.76 $746.26 43 $571.13 $736.41 $742.77 $957.73 $592.74 $764.28 44 $587.96 $758.12 $764.67 $985.96 $610.21 $786.81 45 $607.74 $801.37 $790.39 $1,042.21 $630.74 $831.70 46 $631.31 $832.45 $821.04 $1,082.63 $655.20 $863.95 47 $657.83 $867.41 $855.53 $1,128.10 $682.72 $900.24 48 $688.13 $907.37 $894.94 $1,180.07 $714.17 $941.71 49 $718.01 $946.77 $933.80 $1,231.31 $745.18 $982.60 50 $751.68 $993.88 $977.59 $1,292.57 $780.13 $1,031.49 51 $784.93 $1,037.84 $1,020.83 $1,349.74 $814.64 $1,077.11 52 $821.55 $1,086.25 $1,068.45 $1,412.71 $852.64 $1,127.36 53 $858.59 $1,135.22 $1,116.62 $1,476.40 $891.08 $1,178.18 54 $898.57 $1,188.09 $1,168.62 $1,545.15 $932.57 $1,233.05 55 $938.55 $1,227.82 $1,220.62 $1,596.82 $974.07 $1,274.28 56 $981.90 $1,284.52 $1,277.00 $1,670.57 $1,019.06 $1,333.13 57 $1,025.67 $1,341.78 $1,333.92 $1,745.04 $1,064.49 $1,392.56 58 $1,072.39 $1,402.90 $1,394.68 $1,824.52 $1,112.97 $1,455.99 59 $1,095.54 $1,433.18 $1,424.79 $1,863.90 $1,137.00 $1,487.42 60 $1,142.26 $1,467.57 $1,485.54 $1,908.63 $1,185.48 $1,523.11 61 $1,182.66 $1,519.48 $1,538.09 $1,976.14 $1,227.41 $1,576.98 62 $1,209.18 $1,553.55 $1,572.57 $2,020.44 $1,254.93 $1,612.34 63 $1,242.42 $1,596.27 $1,615.82 $2,076.00 $1,289.44 $1,656.67 64 $1,262.64 $1,622.22 $1,642.08 $2,109.76 $1,310.40 $1,683.61 65+ $1,262.64 $1,622.22 $1,642.08 $2,109.76 $1,310.40 $1,683.61 Rates Effective January 1, 2018 Page 28 of 86

Texas Off Exchange (Silver) Abilene, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $321.87 $321.87 $315.72 $315.72 $369.85 $369.85 15 $350.48 $350.48 $343.78 $343.78 $402.72 $402.72 16 $361.42 $361.42 $354.51 $354.51 $415.29 $415.29 17 $372.36 $372.36 $365.24 $365.24 $427.86 $427.86 18 $384.14 $384.14 $376.80 $376.80 $441.40 $441.40 19 $395.92 $395.92 $388.35 $388.35 $454.94 $454.94 20 $408.12 $408.12 $400.32 $400.32 $468.96 $468.96 21 $420.74 $420.74 $412.70 $412.70 $483.46 $483.46 22 $420.74 $420.74 $412.70 $412.70 $483.46 $483.46 23 $420.74 $420.74 $412.70 $412.70 $483.46 $483.46 24 $420.74 $420.74 $412.70 $412.70 $483.46 $483.46 25 $422.43 $422.43 $414.35 $414.35 $485.40 $485.40 26 $430.84 $430.84 $422.61 $422.61 $495.07 $495.07 27 $440.94 $440.94 $432.51 $432.51 $506.67 $506.67 28 $457.35 $457.35 $448.61 $448.61 $525.52 $525.52 29 $470.81 $470.81 $461.81 $461.81 $540.99 $540.99 30 $477.54 $541.63 $468.42 $531.28 $548.73 $622.37 31 $487.64 $553.08 $478.32 $542.51 $560.33 $635.53 32 $497.74 $564.54 $488.23 $553.75 $571.94 $648.69 33 $504.05 $571.69 $494.42 $560.77 $579.19 $656.91 34 $510.78 $579.33 $501.02 $568.26 $586.92 $665.69 35 $514.15 $631.27 $504.32 $619.20 $590.79 $725.37 36 $517.51 $635.40 $507.62 $623.26 $594.66 $730.12 37 $520.88 $639.54 $510.92 $627.31 $598.53 $734.87 38 $524.25 $643.67 $514.23 $631.37 $602.39 $739.62 39 $530.98 $651.93 $520.83 $639.47 $610.13 $749.12 40 $537.71 $693.32 $527.43 $680.07 $617.87 $796.67 41 $547.81 $706.34 $537.34 $692.84 $629.47 $811.64 42 $557.49 $718.82 $546.83 $705.08 $640.59 $825.98 43 $570.95 $736.18 $560.04 $722.11 $656.06 $845.92 44 $587.78 $757.88 $576.54 $743.39 $675.40 $870.86 45 $607.55 $801.12 $595.94 $785.81 $698.12 $920.54 46 $631.12 $832.19 $619.05 $816.28 $725.19 $956.24 47 $657.62 $867.14 $645.05 $850.57 $755.65 $996.40 48 $687.92 $907.09 $674.77 $889.75 $790.46 $1,042.30 49 $717.79 $946.48 $704.07 $928.38 $824.79 $1,087.56 50 $751.45 $993.56 $737.08 $974.57 $863.46 $1,141.67 51 $784.69 $1,037.51 $769.69 $1,017.68 $901.66 $1,192.17 52 $821.29 $1,085.91 $805.59 $1,065.15 $943.72 $1,247.78 53 $858.32 $1,134.87 $841.91 $1,113.18 $986.26 $1,304.04 54 $898.29 $1,187.72 $881.12 $1,165.01 $1,032.19 $1,364.77 55 $938.26 $1,227.43 $920.32 $1,203.97 $1,078.12 $1,410.40 56 $981.59 $1,284.12 $962.83 $1,259.58 $1,127.92 $1,475.54 57 $1,025.35 $1,341.36 $1,005.75 $1,315.72 $1,178.20 $1,541.32 58 $1,072.05 $1,402.46 $1,051.56 $1,375.65 $1,231.86 $1,611.52 59 $1,095.20 $1,432.73 $1,074.26 $1,405.35 $1,258.45 $1,646.31 60 $1,141.90 $1,467.11 $1,120.07 $1,439.07 $1,312.12 $1,685.81 61 $1,182.29 $1,519.01 $1,159.69 $1,489.97 $1,358.53 $1,745.44 62 $1,208.80 $1,553.06 $1,185.69 $1,523.38 $1,388.99 $1,784.57 63 $1,242.04 $1,595.77 $1,218.29 $1,565.26 $1,427.18 $1,833.64 64 $1,262.22 $1,621.71 $1,238.10 $1,590.72 $1,450.38 $1,863.46 65+ $1,262.22 $1,621.71 $1,238.10 $1,590.72 $1,450.38 $1,863.46 Rates Effective January 1, 2018 Page 29 of 86

Texas Off Exchange (Silver) Amarillo, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $335.90 $335.90 $315.02 $315.02 $369.03 $369.03 15 $365.75 $365.75 $343.02 $343.02 $401.83 $401.83 16 $377.17 $377.17 $353.73 $353.73 $414.38 $414.38 17 $388.59 $388.59 $364.43 $364.43 $426.92 $426.92 18 $400.88 $400.88 $375.96 $375.96 $440.43 $440.43 19 $413.17 $413.17 $387.49 $387.49 $453.93 $453.93 20 $425.91 $425.91 $399.43 $399.43 $467.92 $467.92 21 $439.08 $439.08 $411.79 $411.79 $482.39 $482.39 22 $439.08 $439.08 $411.79 $411.79 $482.39 $482.39 23 $439.08 $439.08 $411.79 $411.79 $482.39 $482.39 24 $439.08 $439.08 $411.79 $411.79 $482.39 $482.39 25 $440.84 $440.84 $413.44 $413.44 $484.32 $484.32 26 $449.62 $449.62 $421.67 $421.67 $493.97 $493.97 27 $460.16 $460.16 $431.55 $431.55 $505.55 $505.55 28 $477.28 $477.28 $447.61 $447.61 $524.36 $524.36 29 $491.33 $491.33 $460.79 $460.79 $539.80 $539.80 30 $498.36 $565.24 $467.38 $530.10 $547.52 $620.99 31 $508.89 $577.19 $477.26 $541.31 $559.09 $634.13 32 $519.43 $589.14 $487.15 $552.52 $570.67 $647.26 33 $526.02 $596.61 $493.32 $559.53 $577.91 $655.46 34 $533.04 $604.58 $499.91 $567.00 $585.63 $664.22 35 $536.56 $658.78 $503.21 $617.84 $589.48 $723.77 36 $540.07 $663.09 $506.50 $621.88 $593.34 $728.51 37 $543.58 $667.41 $509.79 $625.93 $597.20 $733.25 38 $547.09 $671.72 $513.09 $629.97 $601.06 $737.98 39 $554.12 $680.35 $519.68 $638.06 $608.78 $747.46 40 $561.14 $723.54 $526.27 $678.57 $616.50 $794.91 41 $571.68 $737.13 $536.15 $691.31 $628.08 $809.84 42 $581.78 $750.15 $545.62 $703.52 $639.17 $824.15 43 $595.83 $768.27 $558.80 $720.51 $654.61 $844.05 44 $613.40 $790.91 $575.27 $741.75 $673.90 $868.93 45 $634.03 $836.04 $594.62 $784.07 $696.58 $918.51 46 $658.62 $868.46 $617.68 $814.48 $723.59 $954.13 47 $686.28 $904.93 $643.63 $848.68 $753.98 $994.20 48 $717.90 $946.62 $673.27 $887.78 $788.71 $1,040.00 49 $749.07 $987.72 $702.51 $926.33 $822.96 $1,085.16 50 $784.20 $1,036.87 $735.45 $972.42 $861.55 $1,139.15 51 $818.89 $1,082.73 $767.99 $1,015.43 $899.66 $1,189.53 52 $857.09 $1,133.24 $803.81 $1,062.80 $941.63 $1,245.02 53 $895.72 $1,184.33 $840.05 $1,110.71 $984.08 $1,301.15 54 $937.44 $1,239.48 $879.17 $1,162.44 $1,029.91 $1,361.75 55 $979.15 $1,280.92 $918.29 $1,201.31 $1,075.74 $1,407.28 56 $1,024.37 $1,340.09 $960.70 $1,256.79 $1,125.42 $1,472.28 57 $1,070.04 $1,399.82 $1,003.53 $1,312.81 $1,175.59 $1,537.91 58 $1,118.78 $1,463.58 $1,049.24 $1,372.61 $1,229.14 $1,607.96 59 $1,142.93 $1,495.17 $1,071.89 $1,402.24 $1,255.67 $1,642.67 60 $1,191.66 $1,531.05 $1,117.59 $1,435.89 $1,309.22 $1,682.08 61 $1,233.82 $1,585.21 $1,157.13 $1,486.68 $1,355.53 $1,741.58 62 $1,261.48 $1,620.75 $1,183.07 $1,520.01 $1,385.92 $1,780.62 63 $1,296.17 $1,665.31 $1,215.60 $1,561.80 $1,424.03 $1,829.59 64 $1,317.24 $1,692.39 $1,235.37 $1,587.20 $1,447.17 $1,859.34 65+ $1,317.24 $1,692.39 $1,235.37 $1,587.20 $1,447.17 $1,859.34 Rates Effective January 1, 2018 Page 30 of 86

Texas Off Exchange (Silver) Austin-Round Rock-San Marcos, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $349.18 $349.18 $326.12 $326.12 $382.03 $382.03 15 $380.22 $380.22 $355.11 $355.11 $415.99 $415.99 16 $392.09 $392.09 $366.19 $366.19 $428.98 $428.98 17 $403.95 $403.95 $377.27 $377.27 $441.96 $441.96 18 $416.73 $416.73 $389.21 $389.21 $455.94 $455.94 19 $429.51 $429.51 $401.15 $401.15 $469.93 $469.93 20 $442.75 $442.75 $413.51 $413.51 $484.41 $484.41 21 $456.44 $456.44 $426.30 $426.30 $499.39 $499.39 22 $456.44 $456.44 $426.30 $426.30 $499.39 $499.39 23 $456.44 $456.44 $426.30 $426.30 $499.39 $499.39 24 $456.44 $456.44 $426.30 $426.30 $499.39 $499.39 25 $458.27 $458.27 $428.00 $428.00 $501.39 $501.39 26 $467.40 $467.40 $436.53 $436.53 $511.37 $511.37 27 $478.35 $478.35 $446.76 $446.76 $523.36 $523.36 28 $496.15 $496.15 $463.38 $463.38 $542.84 $542.84 29 $510.76 $510.76 $477.03 $477.03 $558.82 $558.82 30 $518.06 $587.59 $483.85 $548.78 $566.81 $642.87 31 $529.02 $600.01 $494.08 $560.38 $578.79 $656.47 32 $539.97 $612.44 $504.31 $571.99 $590.78 $670.06 33 $546.82 $620.20 $510.70 $579.24 $598.27 $678.56 34 $554.12 $628.49 $517.52 $586.98 $606.26 $687.62 35 $557.77 $684.83 $520.93 $639.60 $610.25 $749.27 36 $561.43 $689.32 $524.35 $643.79 $614.25 $754.17 37 $565.08 $693.80 $527.76 $647.98 $618.24 $759.08 38 $568.73 $698.29 $531.17 $652.17 $622.24 $763.99 39 $576.03 $707.25 $537.99 $660.54 $630.23 $773.79 40 $583.34 $752.15 $544.81 $702.47 $638.22 $822.92 41 $594.29 $766.28 $555.04 $715.67 $650.21 $838.38 42 $604.79 $779.82 $564.84 $728.31 $661.69 $853.19 43 $619.39 $798.65 $578.49 $745.90 $677.67 $873.79 44 $637.65 $822.19 $595.54 $767.88 $697.65 $899.55 45 $659.11 $869.10 $615.57 $811.70 $721.12 $950.87 46 $684.67 $902.80 $639.45 $843.17 $749.08 $987.74 47 $713.42 $940.72 $666.30 $878.59 $780.55 $1,029.23 48 $746.29 $984.05 $697.00 $919.06 $816.50 $1,076.64 49 $778.69 $1,026.78 $727.26 $958.97 $851.96 $1,123.39 50 $815.21 $1,077.87 $761.37 $1,006.68 $891.91 $1,179.28 51 $851.27 $1,125.55 $795.04 $1,051.21 $931.36 $1,231.44 52 $890.98 $1,178.05 $832.13 $1,100.24 $974.81 $1,288.89 53 $931.15 $1,231.16 $869.65 $1,149.85 $1,018.75 $1,347.00 54 $974.51 $1,288.50 $910.14 $1,203.39 $1,066.20 $1,409.73 55 $1,017.87 $1,331.58 $950.64 $1,243.63 $1,113.64 $1,456.86 56 $1,064.88 $1,393.08 $994.55 $1,301.07 $1,165.08 $1,524.15 57 $1,112.35 $1,455.18 $1,038.89 $1,359.07 $1,217.01 $1,592.09 58 $1,163.02 $1,521.46 $1,086.20 $1,420.97 $1,272.44 $1,664.61 59 $1,188.12 $1,554.30 $1,109.65 $1,451.64 $1,299.91 $1,700.54 60 $1,238.79 $1,591.60 $1,156.97 $1,486.48 $1,355.34 $1,741.35 61 $1,282.61 $1,647.89 $1,197.89 $1,539.06 $1,403.28 $1,802.94 62 $1,311.36 $1,684.84 $1,224.75 $1,573.56 $1,434.75 $1,843.36 63 $1,347.42 $1,731.17 $1,258.43 $1,616.83 $1,474.20 $1,894.05 64 $1,369.32 $1,759.32 $1,278.90 $1,643.12 $1,498.17 $1,924.85 65+ $1,369.32 $1,759.32 $1,278.90 $1,643.12 $1,498.17 $1,924.85 Rates Effective January 1, 2018 Page 31 of 86

Texas Off Exchange (Silver) Beaumont-Port Arthur, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $338.91 $338.91 $318.53 $318.53 $373.14 $373.14 15 $369.04 $369.04 $346.84 $346.84 $406.31 $406.31 16 $380.56 $380.56 $357.66 $357.66 $418.99 $418.99 17 $392.07 $392.07 $368.49 $368.49 $431.67 $431.67 18 $404.48 $404.48 $380.15 $380.15 $445.33 $445.33 19 $416.88 $416.88 $391.81 $391.81 $458.99 $458.99 20 $429.73 $429.73 $403.88 $403.88 $473.13 $473.13 21 $443.02 $443.02 $416.37 $416.37 $487.76 $487.76 22 $443.02 $443.02 $416.37 $416.37 $487.76 $487.76 23 $443.02 $443.02 $416.37 $416.37 $487.76 $487.76 24 $443.02 $443.02 $416.37 $416.37 $487.76 $487.76 25 $444.79 $444.79 $418.04 $418.04 $489.72 $489.72 26 $453.66 $453.66 $426.37 $426.37 $499.47 $499.47 27 $464.29 $464.29 $436.36 $436.36 $511.18 $511.18 28 $481.57 $481.57 $452.60 $452.60 $530.20 $530.20 29 $495.74 $495.74 $465.92 $465.92 $545.81 $545.81 30 $502.83 $570.31 $472.58 $536.01 $553.61 $627.91 31 $513.46 $582.37 $482.58 $547.34 $565.32 $641.19 32 $524.10 $594.43 $492.57 $558.67 $577.02 $654.46 33 $530.74 $601.97 $498.81 $565.76 $584.34 $662.76 34 $537.83 $610.01 $505.48 $573.31 $592.15 $671.61 35 $541.37 $664.70 $508.81 $624.71 $596.05 $731.83 36 $544.92 $669.05 $512.14 $628.80 $599.95 $736.62 37 $548.46 $673.40 $515.47 $632.90 $603.85 $741.41 38 $552.01 $677.75 $518.80 $636.98 $607.75 $746.20 39 $559.09 $686.45 $525.46 $645.16 $615.56 $755.78 40 $566.18 $730.03 $532.12 $686.12 $623.36 $803.76 41 $576.82 $743.75 $542.12 $699.01 $635.07 $818.86 42 $587.00 $756.89 $551.69 $711.36 $646.29 $833.33 43 $601.18 $775.17 $565.02 $728.54 $661.90 $853.45 44 $618.90 $798.01 $581.67 $750.01 $681.41 $878.60 45 $639.72 $843.54 $601.24 $792.80 $704.33 $928.73 46 $664.53 $876.25 $624.56 $823.54 $731.65 $964.75 47 $692.44 $913.06 $650.79 $858.13 $762.38 $1,005.27 48 $724.34 $955.12 $680.77 $897.66 $797.49 $1,051.58 49 $755.80 $996.59 $710.33 $936.64 $832.13 $1,097.24 50 $791.24 $1,046.18 $743.64 $983.24 $871.15 $1,151.83 51 $826.24 $1,092.45 $776.54 $1,026.73 $909.68 $1,202.78 52 $864.78 $1,143.41 $812.76 $1,074.63 $952.12 $1,258.88 53 $903.77 $1,194.96 $849.40 $1,123.08 $995.04 $1,315.64 54 $945.85 $1,250.61 $888.96 $1,175.38 $1,041.38 $1,376.91 55 $987.94 $1,292.43 $928.51 $1,214.68 $1,087.71 $1,422.95 56 $1,033.57 $1,352.12 $971.40 $1,270.78 $1,137.95 $1,488.67 57 $1,079.65 $1,412.39 $1,014.70 $1,327.43 $1,188.68 $1,555.03 58 $1,128.82 $1,476.72 $1,060.92 $1,387.89 $1,242.82 $1,625.86 59 $1,153.19 $1,508.60 $1,083.82 $1,417.85 $1,269.65 $1,660.95 60 $1,202.36 $1,544.80 $1,130.04 $1,451.87 $1,323.79 $1,700.81 61 $1,244.89 $1,599.44 $1,170.01 $1,503.23 $1,370.62 $1,760.97 62 $1,272.80 $1,635.30 $1,196.24 $1,536.93 $1,401.35 $1,800.45 63 $1,307.80 $1,680.27 $1,229.13 $1,579.19 $1,439.88 $1,849.96 64 $1,329.06 $1,707.59 $1,249.11 $1,604.87 $1,463.28 $1,880.04 65+ $1,329.06 $1,707.59 $1,249.11 $1,604.87 $1,463.28 $1,880.04 Rates Effective January 1, 2018 Page 32 of 86

Texas Off Exchange (Silver) Brownsville-Harlingen, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $264.42 $264.42 $262.63 $262.63 $307.65 $307.65 15 $287.93 $287.93 $285.97 $285.97 $335.00 $335.00 16 $296.91 $296.91 $294.90 $294.90 $345.46 $345.46 17 $305.90 $305.90 $303.82 $303.82 $355.91 $355.91 18 $315.58 $315.58 $313.43 $313.43 $367.18 $367.18 19 $325.26 $325.26 $323.05 $323.05 $378.44 $378.44 20 $335.28 $335.28 $333.00 $333.00 $390.10 $390.10 21 $345.65 $345.65 $343.30 $343.30 $402.16 $402.16 22 $345.65 $345.65 $343.30 $343.30 $402.16 $402.16 23 $345.65 $345.65 $343.30 $343.30 $402.16 $402.16 24 $345.65 $345.65 $343.30 $343.30 $402.16 $402.16 25 $347.03 $347.03 $344.67 $344.67 $403.77 $403.77 26 $353.94 $353.94 $351.54 $351.54 $411.82 $411.82 27 $362.24 $362.24 $359.78 $359.78 $421.47 $421.47 28 $375.72 $375.72 $373.17 $373.17 $437.15 $437.15 29 $386.78 $386.78 $384.15 $384.15 $450.02 $450.02 30 $392.31 $444.96 $389.65 $441.94 $456.46 $517.71 31 $400.61 $454.37 $397.89 $451.28 $466.11 $528.66 32 $408.90 $463.78 $406.13 $460.63 $475.76 $539.61 33 $414.09 $469.66 $411.27 $466.47 $481.79 $546.45 34 $419.62 $475.93 $416.77 $472.70 $488.23 $553.75 35 $422.38 $518.60 $419.51 $515.08 $491.44 $603.39 36 $425.15 $522.00 $422.26 $518.45 $494.66 $607.34 37 $427.91 $525.39 $425.01 $521.82 $497.88 $611.30 38 $430.68 $528.79 $427.75 $525.20 $501.10 $615.25 39 $436.21 $535.58 $433.25 $531.94 $507.53 $623.14 40 $441.74 $569.58 $438.74 $565.71 $513.96 $662.70 41 $450.04 $580.28 $446.98 $576.33 $523.62 $675.15 42 $457.99 $590.53 $454.87 $586.52 $532.87 $687.08 43 $469.05 $604.79 $465.86 $600.68 $545.74 $703.67 44 $482.87 $622.61 $479.59 $618.39 $561.82 $724.41 45 $499.12 $658.14 $495.73 $653.67 $580.72 $765.74 46 $518.47 $683.66 $514.95 $679.02 $603.25 $795.44 47 $540.25 $712.37 $536.58 $707.53 $628.58 $828.85 48 $565.14 $745.19 $561.30 $740.13 $657.54 $867.03 49 $589.68 $777.55 $585.67 $772.27 $686.09 $904.68 50 $617.33 $816.23 $613.14 $810.69 $718.26 $949.69 51 $644.64 $852.34 $640.26 $846.55 $750.03 $991.69 52 $674.71 $892.10 $670.12 $886.04 $785.02 $1,037.96 53 $705.12 $932.32 $700.33 $925.98 $820.41 $1,084.75 54 $737.96 $975.73 $732.95 $969.11 $858.62 $1,135.27 55 $770.80 $1,008.36 $765.56 $1,001.51 $896.82 $1,173.23 56 $806.40 $1,054.93 $800.92 $1,047.77 $938.25 $1,227.41 57 $842.35 $1,101.96 $836.63 $1,094.47 $980.07 $1,282.13 58 $880.71 $1,152.15 $874.73 $1,144.32 $1,024.71 $1,340.53 59 $899.73 $1,177.02 $893.61 $1,169.02 $1,046.83 $1,369.46 60 $938.09 $1,205.26 $931.72 $1,197.07 $1,091.47 $1,402.32 61 $971.27 $1,247.89 $964.68 $1,239.42 $1,130.08 $1,451.93 62 $993.05 $1,275.87 $986.30 $1,267.20 $1,155.42 $1,484.48 63 $1,020.36 $1,310.95 $1,013.43 $1,302.05 $1,187.19 $1,525.30 64 $1,036.95 $1,332.27 $1,029.90 $1,323.22 $1,206.48 $1,550.10 65+ $1,036.95 $1,332.27 $1,029.90 $1,323.22 $1,206.48 $1,550.10 Rates Effective January 1, 2018 Page 33 of 86

Texas Off Exchange (Silver) College Station-Bryan, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $337.17 $337.17 $315.77 $315.77 $369.91 $369.91 15 $367.14 $367.14 $343.84 $343.84 $402.79 $402.79 16 $378.60 $378.60 $354.57 $354.57 $415.36 $415.36 17 $390.06 $390.06 $365.30 $365.30 $427.93 $427.93 18 $402.40 $402.40 $376.86 $376.86 $441.47 $441.47 19 $414.74 $414.74 $388.41 $388.41 $455.01 $455.01 20 $427.52 $427.52 $400.38 $400.38 $469.03 $469.03 21 $440.75 $440.75 $412.77 $412.77 $483.54 $483.54 22 $440.75 $440.75 $412.77 $412.77 $483.54 $483.54 23 $440.75 $440.75 $412.77 $412.77 $483.54 $483.54 24 $440.75 $440.75 $412.77 $412.77 $483.54 $483.54 25 $442.51 $442.51 $414.42 $414.42 $485.47 $485.47 26 $451.33 $451.33 $422.67 $422.67 $495.14 $495.14 27 $461.90 $461.90 $432.58 $432.58 $506.75 $506.75 28 $479.09 $479.09 $448.68 $448.68 $525.61 $525.61 29 $493.20 $493.20 $461.89 $461.89 $541.08 $541.08 30 $500.25 $567.38 $468.49 $531.36 $548.82 $622.47 31 $510.83 $579.38 $478.40 $542.60 $560.42 $635.63 32 $521.40 $591.38 $488.30 $553.83 $572.03 $648.79 33 $528.02 $598.87 $494.50 $560.86 $579.28 $657.02 34 $535.07 $606.87 $501.10 $568.35 $587.02 $665.80 35 $538.59 $661.28 $504.40 $619.30 $590.89 $725.49 36 $542.12 $665.61 $507.70 $623.36 $594.75 $730.24 37 $545.65 $669.94 $511.01 $627.41 $598.62 $734.99 38 $549.17 $674.27 $514.31 $631.47 $602.49 $739.74 39 $556.22 $682.93 $520.91 $639.57 $610.23 $749.24 40 $563.28 $726.29 $527.52 $680.18 $617.96 $796.80 41 $573.85 $739.93 $537.42 $692.95 $629.57 $811.77 42 $583.99 $753.00 $546.92 $705.20 $640.69 $826.11 43 $598.09 $771.18 $560.13 $722.23 $656.16 $846.06 44 $615.72 $793.91 $576.64 $743.51 $675.51 $871.00 45 $636.44 $839.21 $596.04 $785.93 $698.23 $920.69 46 $661.12 $871.75 $619.15 $816.41 $725.31 $956.39 47 $688.89 $908.37 $645.16 $850.70 $755.77 $996.56 48 $720.62 $950.21 $674.87 $889.89 $790.59 $1,042.47 49 $751.92 $991.47 $704.18 $928.53 $824.92 $1,087.74 50 $787.17 $1,040.80 $737.20 $974.73 $863.60 $1,141.86 51 $821.99 $1,086.84 $769.81 $1,017.84 $901.80 $1,192.36 52 $860.34 $1,137.54 $805.72 $1,065.32 $943.87 $1,247.98 53 $899.12 $1,188.82 $842.05 $1,113.35 $986.42 $1,304.25 54 $941.00 $1,244.19 $881.26 $1,165.20 $1,032.36 $1,364.98 55 $982.87 $1,285.79 $920.47 $1,204.16 $1,078.29 $1,410.63 56 $1,028.26 $1,345.17 $962.99 $1,259.78 $1,128.10 $1,475.78 57 $1,074.10 $1,405.14 $1,005.91 $1,315.94 $1,178.39 $1,541.56 58 $1,123.02 $1,469.14 $1,051.73 $1,375.87 $1,232.06 $1,611.78 59 $1,147.27 $1,500.85 $1,074.43 $1,405.57 $1,258.65 $1,646.57 60 $1,196.19 $1,536.86 $1,120.25 $1,439.30 $1,312.33 $1,686.08 61 $1,238.50 $1,591.23 $1,159.88 $1,490.21 $1,358.75 $1,745.72 62 $1,266.27 $1,626.90 $1,185.88 $1,523.62 $1,389.21 $1,784.86 63 $1,301.09 $1,671.64 $1,218.49 $1,565.51 $1,427.41 $1,833.94 64 $1,322.25 $1,698.82 $1,238.31 $1,590.97 $1,450.62 $1,863.76 65+ $1,322.25 $1,698.82 $1,238.31 $1,590.97 $1,450.62 $1,863.76 Rates Effective January 1, 2018 Page 34 of 86

Texas Off Exchange (Silver) Corpus Christi, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $312.40 $312.40 $296.57 $296.57 $347.42 $347.42 15 $340.17 $340.17 $322.93 $322.93 $378.30 $378.30 16 $350.78 $350.78 $333.01 $333.01 $390.11 $390.11 17 $361.40 $361.40 $343.09 $343.09 $401.91 $401.91 18 $372.83 $372.83 $353.94 $353.94 $414.63 $414.63 19 $384.27 $384.27 $364.80 $364.80 $427.34 $427.34 20 $396.11 $396.11 $376.04 $376.04 $440.51 $440.51 21 $408.36 $408.36 $387.67 $387.67 $454.14 $454.14 22 $408.36 $408.36 $387.67 $387.67 $454.14 $454.14 23 $408.36 $408.36 $387.67 $387.67 $454.14 $454.14 24 $408.36 $408.36 $387.67 $387.67 $454.14 $454.14 25 $409.99 $409.99 $389.22 $389.22 $455.96 $455.96 26 $418.16 $418.16 $396.97 $396.97 $465.04 $465.04 27 $427.96 $427.96 $406.28 $406.28 $475.94 $475.94 28 $443.89 $443.89 $421.40 $421.40 $493.65 $493.65 29 $456.96 $456.96 $433.80 $433.80 $508.18 $508.18 30 $463.49 $525.69 $440.00 $499.05 $515.45 $584.62 31 $473.29 $536.81 $449.31 $509.61 $526.35 $596.98 32 $483.09 $547.92 $458.61 $520.16 $537.25 $609.35 33 $489.22 $554.87 $464.43 $526.75 $544.06 $617.07 34 $495.75 $562.28 $470.63 $533.79 $551.32 $625.31 35 $499.02 $612.69 $473.73 $581.65 $554.96 $681.38 36 $502.28 $616.70 $476.83 $585.45 $558.59 $685.84 37 $505.55 $620.72 $479.93 $589.27 $562.22 $690.30 38 $508.82 $624.73 $483.04 $593.07 $565.86 $694.76 39 $515.35 $632.75 $489.24 $600.69 $573.12 $703.68 40 $521.89 $672.92 $495.44 $638.82 $580.39 $748.35 41 $531.69 $685.56 $504.75 $650.82 $591.29 $762.41 42 $541.08 $697.67 $513.66 $662.32 $601.73 $775.88 43 $554.15 $714.52 $526.07 $678.31 $616.27 $794.62 44 $570.48 $735.58 $541.57 $698.31 $634.43 $818.04 45 $589.67 $777.54 $559.79 $738.15 $655.78 $864.71 46 $612.54 $807.70 $581.50 $766.77 $681.21 $898.24 47 $638.27 $841.62 $605.93 $798.98 $709.82 $935.97 48 $667.67 $880.39 $633.84 $835.78 $742.52 $979.08 49 $696.66 $918.62 $661.36 $872.07 $774.76 $1,021.60 50 $729.33 $964.33 $692.38 $915.46 $811.09 $1,072.43 51 $761.59 $1,006.98 $723.00 $955.95 $846.97 $1,119.86 52 $797.12 $1,053.95 $756.73 $1,000.55 $886.48 $1,172.10 53 $833.06 $1,101.47 $790.85 $1,045.66 $926.44 $1,224.94 54 $871.85 $1,152.76 $827.67 $1,094.35 $969.59 $1,281.99 55 $910.65 $1,191.31 $864.50 $1,130.94 $1,012.73 $1,324.85 56 $952.71 $1,246.33 $904.43 $1,183.18 $1,059.51 $1,386.05 57 $995.18 $1,301.89 $944.75 $1,235.92 $1,106.74 $1,447.83 58 $1,040.50 $1,361.19 $987.78 $1,292.21 $1,157.15 $1,513.78 59 $1,062.96 $1,390.57 $1,009.10 $1,320.11 $1,182.12 $1,546.45 60 $1,108.29 $1,423.94 $1,052.13 $1,351.78 $1,232.53 $1,583.56 61 $1,147.50 $1,474.30 $1,089.35 $1,399.60 $1,276.13 $1,639.57 62 $1,173.22 $1,507.36 $1,113.77 $1,430.98 $1,304.74 $1,676.33 63 $1,205.48 $1,548.80 $1,144.40 $1,470.33 $1,340.62 $1,722.43 64 $1,225.08 $1,573.99 $1,163.01 $1,494.23 $1,362.42 $1,750.43 65+ $1,225.08 $1,573.99 $1,163.01 $1,494.23 $1,362.42 $1,750.43 Rates Effective January 1, 2018 Page 35 of 86

Texas Off Exchange (Silver) Dallas-Fort Worth-Arlington, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $341.23 $341.23 $327.73 $327.73 $383.92 $383.92 15 $371.56 $371.56 $356.86 $356.86 $418.05 $418.05 16 $383.16 $383.16 $368.00 $368.00 $431.09 $431.09 17 $394.76 $394.76 $379.14 $379.14 $444.14 $444.14 18 $407.25 $407.25 $391.13 $391.13 $458.19 $458.19 19 $419.74 $419.74 $403.13 $403.13 $472.25 $472.25 20 $432.67 $432.67 $415.55 $415.55 $486.80 $486.80 21 $446.05 $446.05 $428.40 $428.40 $501.86 $501.86 22 $446.05 $446.05 $428.40 $428.40 $501.86 $501.86 23 $446.05 $446.05 $428.40 $428.40 $501.86 $501.86 24 $446.05 $446.05 $428.40 $428.40 $501.86 $501.86 25 $447.84 $447.84 $430.12 $430.12 $503.86 $503.86 26 $456.76 $456.76 $438.68 $438.68 $513.90 $513.90 27 $467.46 $467.46 $448.97 $448.97 $525.94 $525.94 28 $484.86 $484.86 $465.67 $465.67 $545.52 $545.52 29 $499.13 $499.13 $479.38 $479.38 $561.58 $561.58 30 $506.27 $574.21 $486.24 $551.49 $569.61 $646.05 31 $516.97 $586.35 $496.52 $563.15 $581.65 $659.71 32 $527.68 $598.50 $506.80 $574.81 $593.70 $673.37 33 $534.37 $606.08 $513.23 $582.10 $601.22 $681.91 34 $541.51 $614.18 $520.08 $589.88 $609.25 $691.02 35 $545.08 $669.24 $523.51 $642.76 $613.27 $752.97 36 $548.64 $673.62 $526.93 $646.97 $617.28 $757.90 37 $552.21 $678.01 $530.36 $651.18 $621.30 $762.83 38 $555.78 $682.39 $533.79 $655.39 $625.31 $767.76 39 $562.92 $691.15 $540.64 $663.80 $633.34 $777.62 40 $570.06 $735.03 $547.50 $705.94 $641.37 $826.98 41 $580.76 $748.83 $557.78 $719.20 $653.42 $842.52 42 $591.02 $762.06 $567.63 $731.91 $664.96 $857.40 43 $605.29 $780.47 $581.34 $749.58 $681.02 $878.11 44 $623.14 $803.47 $598.48 $771.68 $701.09 $903.99 45 $644.10 $849.31 $618.61 $815.70 $724.68 $955.56 46 $669.08 $882.25 $642.60 $847.34 $752.78 $992.62 47 $697.18 $919.30 $669.59 $882.92 $784.40 $1,034.31 48 $729.30 $961.65 $700.44 $923.60 $820.53 $1,081.96 49 $760.97 $1,003.41 $730.85 $963.70 $856.17 $1,128.94 50 $796.65 $1,053.33 $765.13 $1,011.65 $896.31 $1,185.11 51 $831.89 $1,099.92 $798.97 $1,056.40 $935.96 $1,237.53 52 $870.69 $1,151.23 $836.24 $1,105.68 $979.62 $1,295.25 53 $909.95 $1,203.13 $873.94 $1,155.53 $1,023.79 $1,353.65 54 $952.32 $1,259.16 $914.64 $1,209.34 $1,071.46 $1,416.69 55 $994.70 $1,301.26 $955.34 $1,249.77 $1,119.14 $1,464.06 56 $1,040.64 $1,361.37 $999.46 $1,307.50 $1,170.83 $1,531.68 57 $1,087.03 $1,422.05 $1,044.02 $1,365.78 $1,223.02 $1,599.96 58 $1,136.54 $1,486.82 $1,091.57 $1,427.99 $1,278.73 $1,672.83 59 $1,161.07 $1,518.92 $1,115.13 $1,458.81 $1,306.33 $1,708.94 60 $1,210.59 $1,555.36 $1,162.68 $1,493.82 $1,362.04 $1,749.95 61 $1,253.41 $1,610.38 $1,203.81 $1,546.66 $1,410.21 $1,811.85 62 $1,281.51 $1,646.48 $1,230.80 $1,581.33 $1,441.83 $1,852.47 63 $1,316.75 $1,691.76 $1,264.64 $1,624.81 $1,481.48 $1,903.40 64 $1,338.15 $1,719.26 $1,285.20 $1,651.23 $1,505.58 $1,934.35 65+ $1,338.15 $1,719.26 $1,285.20 $1,651.23 $1,505.58 $1,934.35 Rates Effective January 1, 2018 Page 36 of 86

Texas Off Exchange (Silver) El Paso, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $296.07 $296.07 $291.91 $291.91 $341.96 $341.96 15 $322.39 $322.39 $317.85 $317.85 $372.35 $372.35 16 $332.45 $332.45 $327.77 $327.77 $383.97 $383.97 17 $342.51 $342.51 $337.70 $337.70 $395.60 $395.60 18 $353.35 $353.35 $348.38 $348.38 $408.11 $408.11 19 $364.18 $364.18 $359.06 $359.06 $420.63 $420.63 20 $375.41 $375.41 $370.13 $370.13 $433.59 $433.59 21 $387.02 $387.02 $381.58 $381.58 $447.00 $447.00 22 $387.02 $387.02 $381.58 $381.58 $447.00 $447.00 23 $387.02 $387.02 $381.58 $381.58 $447.00 $447.00 24 $387.02 $387.02 $381.58 $381.58 $447.00 $447.00 25 $388.57 $388.57 $383.10 $383.10 $448.79 $448.79 26 $396.31 $396.31 $390.73 $390.73 $457.73 $457.73 27 $405.60 $405.60 $399.89 $399.89 $468.46 $468.46 28 $420.69 $420.69 $414.77 $414.77 $485.89 $485.89 29 $433.07 $433.07 $426.98 $426.98 $500.19 $500.19 30 $439.27 $498.22 $433.09 $491.21 $507.35 $575.43 31 $448.55 $508.75 $442.25 $501.60 $518.08 $587.60 32 $457.84 $519.29 $451.41 $511.98 $528.80 $599.77 33 $463.65 $525.87 $457.13 $518.48 $535.51 $607.37 34 $469.84 $532.89 $463.23 $525.40 $542.66 $615.49 35 $472.94 $580.67 $466.29 $572.51 $546.24 $670.67 36 $476.03 $584.47 $469.34 $576.25 $549.81 $675.06 37 $479.13 $588.28 $472.39 $580.00 $553.39 $679.45 38 $482.23 $592.08 $475.44 $583.75 $556.96 $683.84 39 $488.42 $599.68 $481.55 $591.25 $564.12 $692.62 40 $494.61 $637.75 $487.66 $628.78 $571.27 $736.59 41 $503.90 $649.73 $496.81 $640.59 $582.00 $750.43 42 $512.80 $661.21 $505.59 $651.91 $592.28 $763.68 43 $525.18 $677.17 $517.80 $667.65 $606.58 $782.13 44 $540.66 $697.13 $533.06 $687.33 $624.46 $805.18 45 $558.85 $736.91 $551.00 $726.55 $645.47 $851.12 46 $580.53 $765.48 $572.37 $754.72 $670.50 $884.12 47 $604.91 $797.63 $596.40 $786.42 $698.66 $921.26 48 $632.78 $834.38 $623.88 $822.65 $730.85 $963.70 49 $660.25 $870.61 $650.97 $858.37 $762.59 $1,005.54 50 $691.22 $913.93 $681.50 $901.07 $798.35 $1,055.57 51 $721.79 $954.35 $711.64 $940.93 $833.66 $1,102.26 52 $755.46 $998.87 $744.84 $984.82 $872.55 $1,153.68 53 $789.52 $1,043.90 $778.42 $1,029.22 $911.88 $1,205.69 54 $826.28 $1,092.51 $814.67 $1,077.15 $954.35 $1,261.84 55 $863.05 $1,129.05 $850.92 $1,113.17 $996.81 $1,304.03 56 $902.91 $1,181.19 $890.22 $1,164.58 $1,042.86 $1,364.26 57 $943.16 $1,233.85 $929.90 $1,216.50 $1,089.34 $1,425.08 58 $986.12 $1,290.05 $972.26 $1,271.91 $1,138.96 $1,489.99 59 $1,007.41 $1,317.89 $993.24 $1,299.36 $1,163.55 $1,522.15 60 $1,050.37 $1,349.51 $1,035.60 $1,330.54 $1,213.16 $1,558.67 61 $1,087.52 $1,397.25 $1,072.23 $1,377.60 $1,256.08 $1,613.81 62 $1,111.90 $1,428.57 $1,096.27 $1,408.49 $1,284.24 $1,649.99 63 $1,142.48 $1,467.86 $1,126.42 $1,447.22 $1,319.55 $1,695.36 64 $1,161.06 $1,491.72 $1,144.74 $1,470.75 $1,341.00 $1,722.92 65+ $1,161.06 $1,491.72 $1,144.74 $1,470.75 $1,341.00 $1,722.92 Rates Effective January 1, 2018 Page 37 of 86

Texas Off Exchange (Silver) Houston-Sugar Land-Baytown, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $325.93 $325.93 $321.38 $321.38 $376.48 $376.48 15 $354.90 $354.90 $349.95 $349.95 $409.95 $409.95 16 $365.98 $365.98 $360.87 $360.87 $422.74 $422.74 17 $377.06 $377.06 $371.79 $371.79 $435.54 $435.54 18 $388.99 $388.99 $383.55 $383.55 $449.32 $449.32 19 $400.92 $400.92 $395.32 $395.32 $463.10 $463.10 20 $413.27 $413.27 $407.50 $407.50 $477.37 $477.37 21 $426.05 $426.05 $420.10 $420.10 $492.13 $492.13 22 $426.05 $426.05 $420.10 $420.10 $492.13 $492.13 23 $426.05 $426.05 $420.10 $420.10 $492.13 $492.13 24 $426.05 $426.05 $420.10 $420.10 $492.13 $492.13 25 $427.76 $427.76 $421.78 $421.78 $494.10 $494.10 26 $436.28 $436.28 $430.19 $430.19 $503.95 $503.95 27 $446.51 $446.51 $440.27 $440.27 $515.76 $515.76 28 $463.12 $463.12 $456.65 $456.65 $534.95 $534.95 29 $476.75 $476.75 $470.10 $470.10 $550.70 $550.70 30 $483.57 $548.47 $476.82 $540.81 $558.57 $633.53 31 $493.80 $560.07 $486.90 $552.24 $570.38 $646.93 32 $504.02 $571.66 $496.98 $563.68 $582.20 $660.33 33 $510.41 $578.91 $503.28 $570.82 $589.58 $668.70 34 $517.23 $586.64 $510.01 $578.45 $597.45 $677.63 35 $520.64 $639.24 $513.37 $630.31 $601.39 $738.38 36 $524.05 $643.42 $516.73 $634.44 $605.33 $743.22 37 $527.46 $647.61 $520.09 $638.57 $609.26 $748.05 38 $530.86 $651.80 $523.45 $642.69 $613.20 $752.89 39 $537.68 $660.16 $530.17 $650.94 $621.07 $762.55 40 $544.50 $702.07 $536.89 $692.27 $628.95 $810.96 41 $554.72 $715.26 $546.98 $705.27 $640.76 $826.20 42 $564.52 $727.90 $556.64 $717.73 $652.08 $840.79 43 $578.16 $745.48 $570.08 $735.06 $667.83 $861.10 44 $595.20 $767.45 $586.89 $756.73 $687.51 $886.48 45 $615.22 $811.23 $606.63 $799.90 $710.64 $937.05 46 $639.08 $842.69 $630.16 $830.92 $738.20 $973.39 47 $665.92 $878.09 $656.62 $865.82 $769.21 $1,014.27 48 $696.60 $918.53 $686.87 $905.71 $804.64 $1,061.00 49 $726.85 $958.42 $716.70 $945.04 $839.58 $1,107.07 50 $760.93 $1,006.11 $750.31 $992.05 $878.95 $1,162.15 51 $794.59 $1,050.61 $783.49 $1,035.93 $917.83 $1,213.55 52 $831.66 $1,099.62 $820.04 $1,084.26 $960.65 $1,270.16 53 $869.15 $1,149.19 $857.01 $1,133.14 $1,003.95 $1,327.43 54 $909.63 $1,202.71 $896.92 $1,185.91 $1,050.71 $1,389.25 55 $950.10 $1,242.92 $936.83 $1,225.56 $1,097.46 $1,435.70 56 $993.98 $1,300.33 $980.10 $1,282.17 $1,148.15 $1,502.01 57 $1,038.29 $1,358.30 $1,023.79 $1,339.32 $1,199.33 $1,568.96 58 $1,085.59 $1,420.16 $1,070.42 $1,400.33 $1,253.96 $1,640.43 59 $1,109.02 $1,450.82 $1,093.53 $1,430.55 $1,281.03 $1,675.84 60 $1,156.31 $1,485.63 $1,140.16 $1,464.88 $1,335.65 $1,716.05 61 $1,197.21 $1,538.18 $1,180.49 $1,516.70 $1,382.90 $1,776.75 62 $1,224.05 $1,572.66 $1,206.96 $1,550.70 $1,413.90 $1,816.58 63 $1,257.71 $1,615.91 $1,240.15 $1,593.34 $1,452.78 $1,866.53 64 $1,278.15 $1,642.18 $1,260.30 $1,619.25 $1,476.39 $1,896.88 65+ $1,278.15 $1,642.18 $1,260.30 $1,619.25 $1,476.39 $1,896.88 Rates Effective January 1, 2018 Page 38 of 86

Texas Off Exchange (Silver) Killeen-Temple-Fort Hood, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $314.95 $314.95 $305.04 $305.04 $357.35 $357.35 15 $342.95 $342.95 $332.16 $332.16 $389.11 $389.11 16 $353.65 $353.65 $342.53 $342.53 $401.26 $401.26 17 $364.36 $364.36 $352.89 $352.89 $413.40 $413.40 18 $375.88 $375.88 $364.06 $364.06 $426.48 $426.48 19 $387.41 $387.41 $375.22 $375.22 $439.56 $439.56 20 $399.35 $399.35 $386.79 $386.79 $453.11 $453.11 21 $411.70 $411.70 $398.75 $398.75 $467.12 $467.12 22 $411.70 $411.70 $398.75 $398.75 $467.12 $467.12 23 $411.70 $411.70 $398.75 $398.75 $467.12 $467.12 24 $411.70 $411.70 $398.75 $398.75 $467.12 $467.12 25 $413.35 $413.35 $400.35 $400.35 $468.99 $468.99 26 $421.58 $421.58 $408.32 $408.32 $478.33 $478.33 27 $431.46 $431.46 $417.89 $417.89 $489.54 $489.54 28 $447.52 $447.52 $433.44 $433.44 $507.76 $507.76 29 $460.70 $460.70 $446.20 $446.20 $522.71 $522.71 30 $467.28 $529.99 $452.58 $513.32 $530.18 $601.33 31 $477.16 $541.20 $462.15 $524.17 $541.39 $614.05 32 $487.04 $552.41 $471.72 $535.03 $552.60 $626.76 33 $493.22 $559.41 $477.70 $541.81 $559.61 $634.71 34 $499.81 $566.88 $484.08 $549.05 $567.08 $643.19 35 $503.10 $617.71 $487.27 $598.27 $570.82 $700.85 36 $506.39 $621.75 $490.46 $602.19 $574.56 $705.44 37 $509.69 $625.80 $493.65 $606.11 $578.29 $710.03 38 $512.98 $629.84 $496.84 $610.02 $582.03 $714.62 39 $519.57 $637.93 $503.22 $617.86 $589.51 $723.79 40 $526.16 $678.42 $509.60 $657.08 $596.98 $769.74 41 $536.04 $691.17 $519.17 $669.42 $608.19 $784.20 42 $545.51 $703.38 $528.34 $681.25 $618.93 $798.06 43 $558.68 $720.36 $541.10 $697.70 $633.88 $817.33 44 $575.15 $741.60 $557.05 $718.27 $652.57 $841.42 45 $594.50 $783.91 $575.80 $759.25 $674.52 $889.42 46 $617.55 $814.31 $598.13 $788.69 $700.68 $923.92 47 $643.49 $848.51 $623.25 $821.81 $730.11 $962.72 48 $673.13 $887.59 $651.96 $859.67 $763.74 $1,007.07 49 $702.36 $926.14 $680.27 $897.00 $796.91 $1,050.80 50 $735.30 $972.22 $712.17 $941.63 $834.28 $1,103.08 51 $767.83 $1,015.22 $743.67 $983.28 $871.18 $1,151.87 52 $803.64 $1,062.58 $778.36 $1,029.15 $911.82 $1,205.60 53 $839.87 $1,110.48 $813.45 $1,075.55 $952.93 $1,259.96 54 $878.99 $1,162.20 $851.33 $1,125.63 $997.30 $1,318.63 55 $918.10 $1,201.06 $889.21 $1,163.27 $1,041.68 $1,362.72 56 $960.50 $1,256.53 $930.29 $1,217.00 $1,089.79 $1,425.66 57 $1,003.32 $1,312.54 $971.76 $1,271.25 $1,138.37 $1,489.22 58 $1,049.02 $1,372.32 $1,016.02 $1,329.15 $1,190.22 $1,557.05 59 $1,071.66 $1,401.95 $1,037.95 $1,357.84 $1,215.91 $1,590.66 60 $1,117.36 $1,435.59 $1,082.21 $1,390.42 $1,267.76 $1,628.82 61 $1,156.88 $1,486.37 $1,120.49 $1,439.61 $1,312.61 $1,686.44 62 $1,182.82 $1,519.69 $1,145.61 $1,471.88 $1,342.04 $1,724.25 63 $1,215.35 $1,561.48 $1,177.11 $1,512.35 $1,378.94 $1,771.66 64 $1,235.10 $1,586.87 $1,196.25 $1,536.94 $1,401.36 $1,800.47 65+ $1,235.10 $1,586.87 $1,196.25 $1,536.94 $1,401.36 $1,800.47 Rates Effective January 1, 2018 Page 39 of 86

Texas Off Exchange (Silver) Laredo, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $321.48 $321.48 $300.94 $300.94 $352.54 $352.54 15 $350.06 $350.06 $327.69 $327.69 $383.88 $383.88 16 $360.98 $360.98 $337.92 $337.92 $395.86 $395.86 17 $371.91 $371.91 $348.15 $348.15 $407.84 $407.84 18 $383.67 $383.67 $359.17 $359.17 $420.75 $420.75 19 $395.44 $395.44 $370.18 $370.18 $433.65 $433.65 20 $407.63 $407.63 $381.59 $381.59 $447.02 $447.02 21 $420.24 $420.24 $393.39 $393.39 $460.84 $460.84 22 $420.24 $420.24 $393.39 $393.39 $460.84 $460.84 23 $420.24 $420.24 $393.39 $393.39 $460.84 $460.84 24 $420.24 $420.24 $393.39 $393.39 $460.84 $460.84 25 $421.92 $421.92 $394.96 $394.96 $462.68 $462.68 26 $430.32 $430.32 $402.83 $402.83 $471.90 $471.90 27 $440.41 $440.41 $412.27 $412.27 $482.96 $482.96 28 $456.80 $456.80 $427.62 $427.62 $500.93 $500.93 29 $470.24 $470.24 $440.20 $440.20 $515.68 $515.68 30 $476.97 $540.98 $446.50 $506.42 $523.05 $593.25 31 $487.05 $552.42 $455.94 $517.13 $534.11 $605.79 32 $497.14 $563.86 $465.38 $527.84 $545.17 $618.34 33 $503.44 $571.00 $471.28 $534.53 $552.09 $626.18 34 $510.17 $578.63 $477.58 $541.67 $559.46 $634.54 35 $513.53 $630.51 $480.72 $590.23 $563.15 $691.43 36 $516.89 $634.64 $483.87 $594.09 $566.83 $695.96 37 $520.25 $638.77 $487.02 $597.96 $570.52 $700.49 38 $523.61 $642.89 $490.16 $601.82 $574.21 $705.01 39 $530.34 $651.15 $496.46 $609.55 $581.58 $714.06 40 $537.06 $692.48 $502.75 $648.25 $588.95 $759.40 41 $547.15 $705.49 $512.19 $660.42 $600.01 $773.66 42 $556.81 $717.96 $521.24 $672.09 $610.61 $787.33 43 $570.26 $735.29 $533.83 $688.32 $625.36 $806.34 44 $587.07 $756.97 $549.57 $708.61 $643.79 $830.11 45 $606.82 $800.15 $568.06 $749.04 $665.45 $877.47 46 $630.35 $831.18 $590.09 $778.09 $691.26 $911.50 47 $656.83 $866.09 $614.87 $810.77 $720.29 $949.78 48 $687.08 $905.99 $643.19 $848.11 $753.47 $993.53 49 $716.92 $945.33 $671.12 $884.94 $786.19 $1,036.67 50 $750.54 $992.37 $702.59 $928.97 $823.06 $1,088.25 51 $783.74 $1,036.26 $733.67 $970.06 $859.47 $1,136.39 52 $820.30 $1,084.60 $767.90 $1,015.31 $899.56 $1,189.40 53 $857.28 $1,133.50 $802.52 $1,061.09 $940.11 $1,243.02 54 $897.20 $1,186.28 $839.89 $1,110.50 $983.89 $1,300.91 55 $937.13 $1,225.95 $877.26 $1,147.63 $1,027.67 $1,344.41 56 $980.41 $1,282.57 $917.78 $1,200.64 $1,075.14 $1,406.50 57 $1,024.11 $1,339.74 $958.69 $1,254.16 $1,123.07 $1,469.20 58 $1,070.76 $1,400.77 $1,002.36 $1,311.28 $1,174.22 $1,536.12 59 $1,093.87 $1,431.00 $1,023.99 $1,339.59 $1,199.57 $1,569.27 60 $1,140.52 $1,465.34 $1,067.66 $1,371.73 $1,250.72 $1,606.93 61 $1,180.86 $1,517.17 $1,105.43 $1,420.25 $1,294.96 $1,663.77 62 $1,207.34 $1,551.19 $1,130.21 $1,452.09 $1,323.99 $1,701.07 63 $1,240.54 $1,593.84 $1,161.29 $1,492.02 $1,360.40 $1,747.84 64 $1,260.72 $1,619.76 $1,180.17 $1,516.28 $1,382.52 $1,776.26 65+ $1,260.72 $1,619.76 $1,180.17 $1,516.28 $1,382.52 $1,776.26 Rates Effective January 1, 2018 Page 40 of 86

Texas Off Exchange (Silver) Longview, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $323.35 $323.35 $315.99 $315.99 $370.17 $370.17 15 $352.09 $352.09 $344.08 $344.08 $403.08 $403.08 16 $363.08 $363.08 $354.82 $354.82 $415.66 $415.66 17 $374.07 $374.07 $365.56 $365.56 $428.24 $428.24 18 $385.91 $385.91 $377.13 $377.13 $441.79 $441.79 19 $397.74 $397.74 $388.69 $388.69 $455.34 $455.34 20 $410.00 $410.00 $400.67 $400.67 $469.37 $469.37 21 $422.68 $422.68 $413.06 $413.06 $483.89 $483.89 22 $422.68 $422.68 $413.06 $413.06 $483.89 $483.89 23 $422.68 $422.68 $413.06 $413.06 $483.89 $483.89 24 $422.68 $422.68 $413.06 $413.06 $483.89 $483.89 25 $424.37 $424.37 $414.71 $414.71 $485.82 $485.82 26 $432.83 $432.83 $422.98 $422.98 $495.50 $495.50 27 $442.97 $442.97 $432.89 $432.89 $507.11 $507.11 28 $459.46 $459.46 $449.00 $449.00 $525.98 $525.98 29 $472.98 $472.98 $462.22 $462.22 $541.47 $541.47 30 $479.74 $544.13 $468.83 $531.74 $549.21 $622.92 31 $489.89 $555.63 $478.74 $542.99 $560.82 $636.09 32 $500.03 $567.14 $488.65 $554.23 $572.44 $649.26 33 $506.37 $574.33 $494.85 $561.26 $579.70 $657.49 34 $513.14 $582.00 $501.46 $568.75 $587.44 $666.27 35 $516.52 $634.18 $504.76 $619.75 $591.31 $726.01 36 $519.90 $638.33 $508.07 $623.80 $595.18 $730.76 37 $523.28 $642.49 $511.37 $627.86 $599.05 $735.52 38 $526.66 $646.64 $514.68 $631.92 $602.92 $740.27 39 $533.42 $654.94 $521.28 $640.03 $610.66 $749.77 40 $540.19 $696.52 $527.89 $680.66 $618.41 $797.37 41 $550.33 $709.60 $537.81 $693.45 $630.02 $812.35 42 $560.05 $722.14 $547.31 $705.70 $641.15 $826.70 43 $573.58 $739.58 $560.53 $722.74 $656.63 $846.66 44 $590.49 $761.37 $577.05 $744.05 $675.99 $871.62 45 $610.35 $804.81 $596.46 $786.50 $698.73 $921.35 46 $634.02 $836.02 $619.59 $817.00 $725.83 $957.08 47 $660.65 $871.13 $645.62 $851.31 $756.31 $997.27 48 $691.09 $911.26 $675.36 $890.53 $791.15 $1,043.21 49 $721.10 $950.84 $704.68 $929.20 $825.51 $1,088.52 50 $754.91 $998.14 $737.73 $975.43 $864.22 $1,142.67 51 $788.30 $1,042.29 $770.36 $1,018.57 $902.45 $1,193.21 52 $825.08 $1,090.91 $806.30 $1,066.09 $944.54 $1,248.88 53 $862.27 $1,140.10 $842.65 $1,114.15 $987.13 $1,305.18 54 $902.43 $1,193.19 $881.89 $1,166.03 $1,033.10 $1,365.96 55 $942.58 $1,233.09 $921.13 $1,205.02 $1,079.07 $1,411.63 56 $986.12 $1,290.04 $963.67 $1,260.68 $1,128.91 $1,476.83 57 $1,030.08 $1,347.54 $1,006.63 $1,316.88 $1,179.23 $1,542.67 58 $1,076.99 $1,408.92 $1,052.48 $1,376.86 $1,232.94 $1,612.93 59 $1,100.24 $1,439.33 $1,075.20 $1,406.58 $1,259.55 $1,647.75 60 $1,147.16 $1,473.87 $1,121.05 $1,440.33 $1,313.27 $1,687.29 61 $1,187.74 $1,526.00 $1,160.71 $1,491.28 $1,359.72 $1,746.97 62 $1,214.37 $1,560.22 $1,186.73 $1,524.71 $1,390.20 $1,786.13 63 $1,247.76 $1,603.12 $1,219.36 $1,566.63 $1,428.43 $1,835.25 64 $1,268.04 $1,629.19 $1,239.18 $1,592.11 $1,451.67 $1,865.09 65+ $1,268.04 $1,629.19 $1,239.18 $1,592.11 $1,451.67 $1,865.09 Rates Effective January 1, 2018 Page 41 of 86

Texas Off Exchange (Silver) Lubbock, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $327.93 $327.93 $311.58 $311.58 $365.00 $365.00 15 $357.08 $357.08 $339.27 $339.27 $397.45 $397.45 16 $368.22 $368.22 $349.86 $349.86 $409.85 $409.85 17 $379.37 $379.37 $360.45 $360.45 $422.26 $422.26 18 $391.37 $391.37 $371.86 $371.86 $435.62 $435.62 19 $403.37 $403.37 $383.26 $383.26 $448.98 $448.98 20 $415.80 $415.80 $395.07 $395.07 $462.81 $462.81 21 $428.66 $428.66 $407.29 $407.29 $477.13 $477.13 22 $428.66 $428.66 $407.29 $407.29 $477.13 $477.13 23 $428.66 $428.66 $407.29 $407.29 $477.13 $477.13 24 $428.66 $428.66 $407.29 $407.29 $477.13 $477.13 25 $430.38 $430.38 $408.92 $408.92 $479.03 $479.03 26 $438.95 $438.95 $417.07 $417.07 $488.58 $488.58 27 $449.24 $449.24 $426.84 $426.84 $500.03 $500.03 28 $465.96 $465.96 $442.73 $442.73 $518.64 $518.64 29 $479.67 $479.67 $455.76 $455.76 $533.90 $533.90 30 $486.53 $551.83 $462.28 $524.32 $541.54 $614.21 31 $496.82 $563.49 $472.05 $535.40 $552.99 $627.20 32 $507.11 $575.16 $481.83 $546.49 $564.44 $640.19 33 $513.54 $582.45 $487.94 $553.42 $571.60 $648.30 34 $520.40 $590.23 $494.45 $560.81 $579.23 $656.96 35 $523.83 $643.15 $497.71 $611.09 $583.05 $715.87 36 $527.25 $647.36 $500.97 $615.09 $586.86 $720.55 37 $530.68 $651.58 $504.23 $619.09 $590.68 $725.24 38 $534.11 $655.79 $507.49 $623.09 $594.50 $729.93 39 $540.97 $664.20 $514.00 $631.09 $602.13 $739.30 40 $547.83 $706.37 $520.52 $671.16 $609.77 $786.23 41 $558.12 $719.64 $530.29 $683.76 $621.22 $801.00 42 $567.98 $732.35 $539.66 $695.84 $632.19 $815.15 43 $581.70 $750.04 $552.70 $712.65 $647.46 $834.84 44 $598.84 $772.15 $568.99 $733.65 $666.54 $859.44 45 $618.99 $816.20 $588.13 $775.51 $688.97 $908.48 46 $642.99 $847.85 $610.94 $805.58 $715.69 $943.71 47 $670.00 $883.46 $636.60 $839.42 $745.75 $983.34 48 $700.86 $924.16 $665.92 $878.09 $780.10 $1,028.64 49 $731.30 $964.29 $694.84 $916.22 $813.98 $1,073.31 50 $765.59 $1,012.27 $727.42 $961.80 $852.15 $1,126.71 51 $799.46 $1,057.04 $759.60 $1,004.34 $889.84 $1,176.54 52 $836.75 $1,106.35 $795.03 $1,051.19 $931.35 $1,231.43 53 $874.47 $1,156.23 $830.88 $1,098.58 $973.34 $1,286.95 54 $915.19 $1,210.07 $869.57 $1,149.74 $1,018.66 $1,346.88 55 $955.92 $1,250.53 $908.26 $1,188.19 $1,063.99 $1,391.91 56 $1,000.07 $1,308.29 $950.21 $1,243.07 $1,113.13 $1,456.20 57 $1,044.65 $1,366.61 $992.57 $1,298.48 $1,162.76 $1,521.12 58 $1,092.23 $1,428.86 $1,037.78 $1,357.62 $1,215.72 $1,590.40 59 $1,115.81 $1,459.70 $1,060.18 $1,386.93 $1,241.96 $1,624.73 60 $1,163.39 $1,494.72 $1,105.39 $1,420.21 $1,294.92 $1,663.71 61 $1,204.54 $1,547.60 $1,144.49 $1,470.44 $1,340.72 $1,722.56 62 $1,231.55 $1,582.29 $1,170.15 $1,503.41 $1,370.78 $1,761.18 63 $1,265.41 $1,625.80 $1,202.33 $1,544.75 $1,408.48 $1,809.61 64 $1,285.98 $1,652.24 $1,221.87 $1,569.87 $1,431.39 $1,839.03 65+ $1,285.98 $1,652.24 $1,221.87 $1,569.87 $1,431.39 $1,839.03 Rates Effective January 1, 2018 Page 42 of 86

Texas Off Exchange (Silver) McAllen-Edinburg-Mission, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $283.97 $283.97 $278.32 $278.32 $326.04 $326.04 15 $309.21 $309.21 $303.06 $303.06 $355.02 $355.02 16 $318.87 $318.87 $312.52 $312.52 $366.10 $366.10 17 $328.52 $328.52 $321.98 $321.98 $377.18 $377.18 18 $338.91 $338.91 $332.16 $332.16 $389.12 $389.12 19 $349.30 $349.30 $342.35 $342.35 $401.05 $401.05 20 $360.07 $360.07 $352.90 $352.90 $413.41 $413.41 21 $371.21 $371.21 $363.81 $363.81 $426.19 $426.19 22 $371.21 $371.21 $363.81 $363.81 $426.19 $426.19 23 $371.21 $371.21 $363.81 $363.81 $426.19 $426.19 24 $371.21 $371.21 $363.81 $363.81 $426.19 $426.19 25 $372.69 $372.69 $365.27 $365.27 $427.90 $427.90 26 $380.11 $380.11 $372.55 $372.55 $436.42 $436.42 27 $389.02 $389.02 $381.28 $381.28 $446.65 $446.65 28 $403.50 $403.50 $395.47 $395.47 $463.27 $463.27 29 $415.38 $415.38 $407.11 $407.11 $476.91 $476.91 30 $421.32 $477.86 $412.93 $468.35 $483.73 $548.65 31 $430.23 $487.96 $421.66 $478.25 $493.96 $560.25 32 $439.14 $498.07 $430.39 $488.15 $504.19 $571.85 33 $444.70 $504.38 $435.85 $494.34 $510.58 $579.10 34 $450.64 $511.12 $441.67 $500.94 $517.40 $586.83 35 $453.61 $556.95 $444.58 $545.86 $520.81 $639.45 36 $456.58 $560.59 $447.49 $549.43 $524.22 $643.63 37 $459.55 $564.24 $450.40 $553.01 $527.63 $647.82 38 $462.52 $567.89 $453.31 $556.58 $531.04 $652.01 39 $468.46 $575.18 $459.13 $563.72 $537.86 $660.38 40 $474.40 $611.69 $464.96 $599.51 $544.68 $702.30 41 $483.31 $623.18 $473.69 $610.77 $554.90 $715.49 42 $491.85 $634.19 $482.05 $621.56 $564.71 $728.14 43 $503.73 $649.51 $493.70 $636.57 $578.35 $745.72 44 $518.57 $668.65 $508.25 $655.34 $595.39 $767.70 45 $536.02 $706.80 $525.35 $692.72 $615.42 $811.50 46 $556.81 $734.21 $545.72 $719.59 $639.29 $842.97 47 $580.19 $765.04 $568.64 $749.81 $666.14 $878.37 48 $606.92 $800.29 $594.84 $784.35 $696.83 $918.84 49 $633.28 $835.04 $620.67 $818.41 $727.09 $958.74 50 $662.97 $876.58 $649.77 $859.13 $761.18 $1,006.44 51 $692.30 $915.36 $678.51 $897.13 $794.85 $1,050.95 52 $724.59 $958.06 $710.17 $938.98 $831.93 $1,099.98 53 $757.26 $1,001.25 $742.18 $981.31 $869.44 $1,149.57 54 $792.52 $1,047.88 $776.74 $1,027.01 $909.92 $1,203.10 55 $827.79 $1,082.91 $811.31 $1,061.35 $950.41 $1,243.33 56 $866.02 $1,132.93 $848.78 $1,110.37 $994.31 $1,300.76 57 $904.63 $1,183.43 $886.62 $1,159.87 $1,038.63 $1,358.74 58 $945.83 $1,237.34 $927.00 $1,212.70 $1,085.94 $1,420.63 59 $966.25 $1,264.04 $947.01 $1,238.88 $1,109.38 $1,451.29 60 $1,007.45 $1,294.38 $987.39 $1,268.60 $1,156.69 $1,486.12 61 $1,043.09 $1,340.16 $1,022.32 $1,313.48 $1,197.61 $1,538.68 62 $1,066.47 $1,370.21 $1,045.24 $1,342.92 $1,224.46 $1,573.18 63 $1,095.80 $1,407.88 $1,073.98 $1,379.85 $1,258.12 $1,616.44 64 $1,113.63 $1,430.77 $1,091.43 $1,402.29 $1,278.57 $1,642.72 65+ $1,113.63 $1,430.77 $1,091.43 $1,402.29 $1,278.57 $1,642.72 Rates Effective January 1, 2018 Page 43 of 86

Texas Off Exchange (Silver) Midland, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $319.04 $319.04 $302.14 $302.14 $353.94 $353.94 15 $347.40 $347.40 $329.00 $329.00 $385.41 $385.41 16 $358.24 $358.24 $339.27 $339.27 $397.44 $397.44 17 $369.08 $369.08 $349.53 $349.53 $409.47 $409.47 18 $380.76 $380.76 $360.59 $360.59 $422.42 $422.42 19 $392.44 $392.44 $371.65 $371.65 $435.37 $435.37 20 $404.53 $404.53 $383.11 $383.11 $448.79 $448.79 21 $417.04 $417.04 $394.95 $394.95 $462.67 $462.67 22 $417.04 $417.04 $394.95 $394.95 $462.67 $462.67 23 $417.04 $417.04 $394.95 $394.95 $462.67 $462.67 24 $417.04 $417.04 $394.95 $394.95 $462.67 $462.67 25 $418.71 $418.71 $396.53 $396.53 $464.52 $464.52 26 $427.05 $427.05 $404.43 $404.43 $473.78 $473.78 27 $437.06 $437.06 $413.91 $413.91 $484.88 $484.88 28 $453.33 $453.33 $429.32 $429.32 $502.92 $502.92 29 $466.67 $466.67 $441.95 $441.95 $517.73 $517.73 30 $473.35 $536.87 $448.27 $508.43 $525.13 $595.61 31 $483.36 $548.22 $457.75 $519.18 $536.24 $608.20 32 $493.36 $559.57 $467.23 $529.93 $547.34 $620.80 33 $499.62 $566.67 $473.15 $536.65 $554.28 $628.67 34 $506.29 $574.24 $479.47 $543.82 $561.68 $637.06 35 $509.63 $625.72 $482.63 $592.58 $565.39 $694.18 36 $512.97 $629.82 $485.79 $596.46 $569.09 $698.72 37 $516.30 $633.92 $488.95 $600.34 $572.79 $703.27 38 $519.64 $638.01 $492.11 $604.22 $576.49 $707.81 39 $526.31 $646.20 $498.43 $611.97 $583.89 $716.90 40 $532.98 $687.23 $504.75 $650.82 $591.30 $762.41 41 $542.99 $700.13 $514.23 $663.05 $602.40 $776.73 42 $552.58 $712.50 $523.31 $674.76 $613.04 $790.46 43 $565.93 $729.71 $535.95 $691.06 $627.85 $809.55 44 $582.61 $751.22 $551.75 $711.43 $646.35 $833.41 45 $602.21 $794.08 $570.31 $752.02 $668.10 $880.96 46 $625.57 $824.87 $592.43 $781.18 $694.01 $915.12 47 $651.84 $859.52 $617.31 $813.99 $723.16 $953.55 48 $681.87 $899.11 $645.75 $851.49 $756.47 $997.48 49 $711.48 $938.16 $673.79 $888.46 $789.32 $1,040.80 50 $744.84 $984.83 $705.39 $932.66 $826.33 $1,092.58 51 $777.79 $1,028.39 $736.59 $973.92 $862.88 $1,140.90 52 $814.07 $1,076.36 $770.95 $1,019.35 $903.14 $1,194.13 53 $850.77 $1,124.89 $805.71 $1,065.31 $943.85 $1,247.96 54 $890.39 $1,177.28 $843.23 $1,114.92 $987.81 $1,306.08 55 $930.01 $1,216.64 $880.75 $1,152.20 $1,031.76 $1,349.75 56 $972.97 $1,272.83 $921.43 $1,205.41 $1,079.41 $1,412.09 57 $1,016.34 $1,329.57 $962.50 $1,259.15 $1,127.53 $1,475.04 58 $1,062.63 $1,390.13 $1,006.34 $1,316.50 $1,178.89 $1,542.22 59 $1,085.57 $1,420.14 $1,028.07 $1,344.91 $1,204.34 $1,575.51 60 $1,131.86 $1,454.21 $1,071.91 $1,377.18 $1,255.69 $1,613.32 61 $1,171.90 $1,505.65 $1,109.82 $1,425.90 $1,300.11 $1,670.38 62 $1,198.17 $1,539.41 $1,134.70 $1,457.87 $1,329.26 $1,707.83 63 $1,231.12 $1,581.74 $1,165.90 $1,497.95 $1,365.81 $1,754.79 64 $1,251.12 $1,607.46 $1,184.85 $1,522.31 $1,388.01 $1,783.32 65+ $1,251.12 $1,607.46 $1,184.85 $1,522.31 $1,388.01 $1,783.32 Rates Effective January 1, 2018 Page 44 of 86

Texas Off Exchange (Silver) Odessa, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $328.38 $328.38 $308.83 $308.83 $361.79 $361.79 15 $357.57 $357.57 $336.29 $336.29 $393.95 $393.95 16 $368.73 $368.73 $346.78 $346.78 $406.24 $406.24 17 $379.90 $379.90 $357.28 $357.28 $418.54 $418.54 18 $391.91 $391.91 $368.58 $368.58 $431.78 $431.78 19 $403.93 $403.93 $379.89 $379.89 $445.02 $445.02 20 $416.38 $416.38 $391.59 $391.59 $458.74 $458.74 21 $429.26 $429.26 $403.70 $403.70 $472.92 $472.92 22 $429.26 $429.26 $403.70 $403.70 $472.92 $472.92 23 $429.26 $429.26 $403.70 $403.70 $472.92 $472.92 24 $429.26 $429.26 $403.70 $403.70 $472.92 $472.92 25 $430.98 $430.98 $405.32 $405.32 $474.82 $474.82 26 $439.56 $439.56 $413.39 $413.39 $484.27 $484.27 27 $449.86 $449.86 $423.08 $423.08 $495.62 $495.62 28 $466.61 $466.61 $438.83 $438.83 $514.07 $514.07 29 $480.34 $480.34 $451.75 $451.75 $529.20 $529.20 30 $487.21 $552.60 $458.20 $519.70 $536.77 $608.80 31 $497.51 $564.28 $467.89 $530.69 $548.12 $621.68 32 $507.81 $575.96 $477.58 $541.67 $559.47 $634.55 33 $514.25 $583.27 $483.64 $548.54 $566.56 $642.59 34 $521.12 $591.06 $490.10 $555.87 $574.13 $651.18 35 $524.56 $644.05 $493.33 $605.71 $577.91 $709.56 36 $527.99 $648.26 $496.56 $609.67 $581.70 $714.20 37 $531.42 $652.48 $499.79 $613.64 $585.48 $718.85 38 $534.86 $656.70 $503.02 $617.60 $589.26 $723.50 39 $541.73 $665.13 $509.48 $625.53 $596.83 $732.79 40 $548.59 $707.36 $515.93 $665.24 $604.40 $779.31 41 $558.90 $720.64 $525.62 $677.74 $615.75 $793.94 42 $568.77 $733.37 $534.91 $689.71 $626.62 $807.97 43 $582.51 $751.09 $547.83 $706.37 $641.76 $827.48 44 $599.68 $773.22 $563.98 $727.19 $660.67 $851.87 45 $619.85 $817.34 $582.95 $768.68 $682.90 $900.47 46 $643.89 $849.03 $605.56 $798.49 $709.39 $935.40 47 $670.93 $884.69 $630.99 $832.02 $739.18 $974.68 48 $701.84 $925.45 $660.06 $870.35 $773.23 $1,019.58 49 $732.32 $965.63 $688.72 $908.15 $806.81 $1,063.86 50 $766.66 $1,013.68 $721.02 $953.33 $844.64 $1,116.78 51 $800.57 $1,058.51 $752.91 $995.50 $882.00 $1,166.18 52 $837.92 $1,107.89 $788.03 $1,041.93 $923.15 $1,220.58 53 $875.69 $1,157.84 $823.56 $1,088.91 $964.76 $1,275.61 54 $916.47 $1,211.76 $861.91 $1,139.62 $1,009.69 $1,335.02 55 $957.25 $1,252.28 $900.26 $1,177.72 $1,054.62 $1,379.65 56 $1,001.46 $1,310.12 $941.84 $1,232.12 $1,103.33 $1,443.38 57 $1,046.11 $1,368.52 $983.83 $1,287.04 $1,152.51 $1,507.72 58 $1,093.76 $1,430.85 $1,028.64 $1,345.66 $1,205.01 $1,576.39 59 $1,117.36 $1,461.73 $1,050.84 $1,374.71 $1,231.02 $1,610.42 60 $1,165.01 $1,496.81 $1,095.65 $1,407.70 $1,283.51 $1,649.06 61 $1,206.22 $1,549.75 $1,134.41 $1,457.49 $1,328.91 $1,707.39 62 $1,233.26 $1,584.50 $1,159.84 $1,490.17 $1,358.71 $1,745.67 63 $1,267.18 $1,628.07 $1,191.74 $1,531.14 $1,396.07 $1,793.67 64 $1,287.78 $1,654.54 $1,211.10 $1,556.04 $1,418.76 $1,822.84 65+ $1,287.78 $1,654.54 $1,211.10 $1,556.04 $1,418.76 $1,822.84 Rates Effective January 1, 2018 Page 45 of 86

Texas Off Exchange (Silver) San Angelo, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $372.14 $372.14 $353.35 $353.35 $413.94 $413.94 15 $405.22 $405.22 $384.76 $384.76 $450.73 $450.73 16 $417.87 $417.87 $396.77 $396.77 $464.80 $464.80 17 $430.52 $430.52 $408.78 $408.78 $478.87 $478.87 18 $444.14 $444.14 $421.71 $421.71 $494.02 $494.02 19 $457.76 $457.76 $434.64 $434.64 $509.17 $509.17 20 $471.87 $471.87 $448.04 $448.04 $524.86 $524.86 21 $486.46 $486.46 $461.90 $461.90 $541.09 $541.09 22 $486.46 $486.46 $461.90 $461.90 $541.09 $541.09 23 $486.46 $486.46 $461.90 $461.90 $541.09 $541.09 24 $486.46 $486.46 $461.90 $461.90 $541.09 $541.09 25 $488.40 $488.40 $463.74 $463.74 $543.26 $543.26 26 $498.13 $498.13 $472.98 $472.98 $554.08 $554.08 27 $509.81 $509.81 $484.07 $484.07 $567.07 $567.07 28 $528.78 $528.78 $502.08 $502.08 $588.17 $588.17 29 $544.35 $544.35 $516.86 $516.86 $605.48 $605.48 30 $552.13 $626.23 $524.25 $594.61 $614.14 $696.56 31 $563.81 $639.47 $535.34 $607.18 $627.13 $711.29 32 $575.48 $652.71 $546.42 $619.75 $640.11 $726.02 33 $582.78 $660.99 $553.35 $627.61 $648.23 $735.22 34 $590.56 $669.82 $560.74 $635.99 $656.89 $745.04 35 $594.45 $729.87 $564.44 $693.02 $661.22 $811.84 36 $598.34 $734.65 $568.13 $697.55 $665.54 $817.15 37 $602.24 $739.43 $571.83 $702.09 $669.87 $822.47 38 $606.13 $744.20 $575.52 $706.63 $674.20 $827.79 39 $613.91 $753.76 $582.91 $715.70 $682.86 $838.41 40 $621.69 $801.61 $590.30 $761.14 $691.52 $891.64 41 $633.37 $816.67 $601.39 $775.43 $704.50 $908.39 42 $644.56 $831.10 $612.01 $789.13 $716.95 $924.44 43 $660.12 $851.17 $626.79 $808.19 $734.26 $946.76 44 $679.58 $876.25 $645.27 $832.01 $755.91 $974.67 45 $702.45 $926.25 $666.98 $879.48 $781.34 $1,030.27 46 $729.69 $962.17 $692.85 $913.59 $811.64 $1,070.23 47 $760.34 $1,002.58 $721.94 $951.96 $845.73 $1,115.18 48 $795.36 $1,048.76 $755.20 $995.81 $884.69 $1,166.55 49 $829.90 $1,094.30 $788.00 $1,039.05 $923.10 $1,217.21 50 $868.82 $1,148.75 $824.95 $1,090.75 $966.39 $1,277.76 51 $907.25 $1,199.56 $861.44 $1,138.99 $1,009.14 $1,334.28 52 $949.57 $1,255.52 $901.62 $1,192.12 $1,056.21 $1,396.52 53 $992.38 $1,312.12 $942.27 $1,245.87 $1,103.83 $1,459.49 54 $1,038.59 $1,373.23 $986.15 $1,303.89 $1,155.23 $1,527.45 55 $1,084.80 $1,419.14 $1,030.03 $1,347.49 $1,206.64 $1,578.53 56 $1,134.91 $1,484.69 $1,077.61 $1,409.72 $1,262.37 $1,651.43 57 $1,185.50 $1,550.87 $1,125.64 $1,472.56 $1,318.64 $1,725.05 58 $1,239.50 $1,621.51 $1,176.91 $1,539.64 $1,378.71 $1,803.62 59 $1,266.25 $1,656.51 $1,202.32 $1,572.87 $1,408.47 $1,842.55 60 $1,320.25 $1,696.26 $1,253.59 $1,610.61 $1,468.53 $1,886.76 61 $1,366.95 $1,756.26 $1,297.93 $1,667.58 $1,520.47 $1,953.50 62 $1,397.60 $1,795.63 $1,327.03 $1,704.97 $1,554.56 $1,997.30 63 $1,436.03 $1,845.01 $1,363.52 $1,751.85 $1,597.31 $2,052.22 64 $1,459.38 $1,875.01 $1,385.70 $1,780.33 $1,623.27 $2,085.59 65+ $1,459.38 $1,875.01 $1,385.70 $1,780.33 $1,623.27 $2,085.59 Rates Effective January 1, 2018 Page 46 of 86

Texas Off Exchange (Silver) San Antonio-New Braunfels, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $334.60 $334.60 $314.91 $314.91 $368.90 $368.90 15 $364.35 $364.35 $342.90 $342.90 $401.69 $401.69 16 $375.72 $375.72 $353.60 $353.60 $414.23 $414.23 17 $387.09 $387.09 $364.31 $364.31 $426.77 $426.77 18 $399.34 $399.34 $375.83 $375.83 $440.27 $440.27 19 $411.58 $411.58 $387.36 $387.36 $453.78 $453.78 20 $424.27 $424.27 $399.30 $399.30 $467.76 $467.76 21 $437.39 $437.39 $411.65 $411.65 $482.23 $482.23 22 $437.39 $437.39 $411.65 $411.65 $482.23 $482.23 23 $437.39 $437.39 $411.65 $411.65 $482.23 $482.23 24 $437.39 $437.39 $411.65 $411.65 $482.23 $482.23 25 $439.14 $439.14 $413.29 $413.29 $484.16 $484.16 26 $447.89 $447.89 $421.53 $421.53 $493.80 $493.80 27 $458.38 $458.38 $431.41 $431.41 $505.37 $505.37 28 $475.44 $475.44 $447.46 $447.46 $524.18 $524.18 29 $489.44 $489.44 $460.63 $460.63 $539.61 $539.61 30 $496.44 $563.06 $467.22 $529.92 $547.33 $620.78 31 $506.93 $574.97 $477.10 $541.13 $558.90 $633.91 32 $517.43 $586.87 $486.98 $552.33 $570.47 $647.03 33 $523.99 $594.31 $493.15 $559.33 $577.71 $655.24 34 $530.99 $602.25 $499.74 $566.80 $585.42 $663.99 35 $534.49 $656.25 $503.03 $617.62 $589.28 $723.52 36 $537.99 $660.54 $506.32 $621.66 $593.14 $728.25 37 $541.49 $664.84 $509.62 $625.71 $597.00 $732.99 38 $544.99 $669.14 $512.91 $629.75 $600.85 $737.73 39 $551.99 $677.73 $519.50 $637.84 $608.57 $747.20 40 $558.98 $720.75 $526.08 $678.33 $616.29 $794.64 41 $569.48 $734.29 $535.96 $691.07 $627.86 $809.56 42 $579.54 $747.26 $545.43 $703.28 $638.95 $823.86 43 $593.54 $765.31 $558.60 $720.27 $654.38 $843.76 44 $611.03 $787.87 $575.07 $741.49 $673.67 $868.63 45 $631.59 $832.82 $594.42 $783.80 $696.34 $918.19 46 $656.08 $865.11 $617.47 $814.19 $723.34 $953.80 47 $683.64 $901.45 $643.40 $848.39 $753.72 $993.85 48 $715.13 $942.97 $673.04 $887.47 $788.44 $1,039.64 49 $746.19 $983.92 $702.27 $926.01 $822.68 $1,084.78 50 $781.18 $1,032.87 $735.20 $972.08 $861.26 $1,138.75 51 $815.73 $1,078.56 $767.72 $1,015.08 $899.35 $1,189.12 52 $853.78 $1,128.87 $803.53 $1,062.43 $941.31 $1,244.59 53 $892.27 $1,179.77 $839.76 $1,110.33 $983.74 $1,300.71 54 $933.83 $1,234.71 $878.86 $1,162.04 $1,029.55 $1,361.28 55 $975.38 $1,275.99 $917.97 $1,200.89 $1,075.37 $1,406.79 56 $1,020.43 $1,334.93 $960.37 $1,256.36 $1,125.03 $1,471.77 57 $1,065.92 $1,394.43 $1,003.18 $1,312.36 $1,175.19 $1,537.38 58 $1,114.47 $1,457.95 $1,048.87 $1,372.14 $1,228.71 $1,607.40 59 $1,138.53 $1,489.42 $1,071.51 $1,401.75 $1,255.24 $1,642.10 60 $1,187.08 $1,525.16 $1,117.21 $1,435.39 $1,308.76 $1,681.50 61 $1,229.06 $1,579.10 $1,156.73 $1,486.16 $1,355.06 $1,740.98 62 $1,256.62 $1,614.51 $1,182.66 $1,519.48 $1,385.44 $1,780.01 63 $1,291.17 $1,658.90 $1,215.18 $1,561.26 $1,423.53 $1,828.96 64 $1,312.17 $1,685.87 $1,234.95 $1,586.65 $1,446.69 $1,858.69 65+ $1,312.17 $1,685.87 $1,234.95 $1,586.65 $1,446.69 $1,858.69 Rates Effective January 1, 2018 Page 47 of 86

Texas Off Exchange (Silver) Sherman-Denison, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $348.86 $348.86 $329.95 $329.95 $386.52 $386.52 15 $379.87 $379.87 $359.27 $359.27 $420.88 $420.88 16 $391.73 $391.73 $370.49 $370.49 $434.01 $434.01 17 $403.58 $403.58 $381.70 $381.70 $447.15 $447.15 18 $416.35 $416.35 $393.78 $393.78 $461.30 $461.30 19 $429.12 $429.12 $405.86 $405.86 $475.44 $475.44 20 $442.35 $442.35 $418.36 $418.36 $490.10 $490.10 21 $456.03 $456.03 $431.30 $431.30 $505.25 $505.25 22 $456.03 $456.03 $431.30 $431.30 $505.25 $505.25 23 $456.03 $456.03 $431.30 $431.30 $505.25 $505.25 24 $456.03 $456.03 $431.30 $431.30 $505.25 $505.25 25 $457.85 $457.85 $433.03 $433.03 $507.27 $507.27 26 $466.97 $466.97 $441.65 $441.65 $517.38 $517.38 27 $477.92 $477.92 $452.00 $452.00 $529.51 $529.51 28 $495.70 $495.70 $468.83 $468.83 $549.21 $549.21 29 $510.29 $510.29 $482.63 $482.63 $565.38 $565.38 30 $517.59 $587.05 $489.53 $555.22 $573.46 $650.42 31 $528.53 $599.46 $499.88 $566.96 $585.59 $664.18 32 $539.48 $611.88 $510.23 $578.70 $597.71 $677.93 33 $546.32 $619.63 $516.70 $586.04 $605.29 $686.52 34 $553.62 $627.91 $523.60 $593.87 $613.38 $695.69 35 $557.26 $684.21 $527.05 $647.11 $617.42 $758.07 36 $560.91 $688.69 $530.50 $651.35 $621.46 $763.03 37 $564.56 $693.17 $533.95 $655.59 $625.50 $767.99 38 $568.21 $697.65 $537.40 $659.82 $629.55 $772.96 39 $575.51 $706.60 $544.30 $668.29 $637.63 $782.88 40 $582.80 $751.46 $551.20 $710.72 $645.71 $832.58 41 $593.75 $765.58 $561.56 $724.07 $657.84 $848.22 42 $604.23 $779.10 $571.48 $736.86 $669.46 $863.20 43 $618.83 $797.92 $585.28 $754.66 $685.63 $884.05 44 $637.07 $821.44 $602.53 $776.90 $705.84 $910.11 45 $658.50 $868.30 $622.80 $821.23 $729.59 $962.03 46 $684.04 $901.97 $646.95 $853.07 $757.88 $999.34 47 $712.77 $939.86 $674.13 $888.90 $789.71 $1,041.31 48 $745.60 $983.15 $705.18 $929.85 $826.09 $1,089.28 49 $777.98 $1,025.84 $735.80 $970.23 $861.96 $1,136.58 50 $814.46 $1,076.88 $770.31 $1,018.50 $902.38 $1,193.13 51 $850.49 $1,124.52 $804.38 $1,063.55 $942.30 $1,245.90 52 $890.16 $1,176.97 $841.90 $1,113.16 $986.25 $1,304.02 53 $930.29 $1,230.04 $879.86 $1,163.35 $1,030.72 $1,362.81 54 $973.62 $1,287.32 $920.83 $1,217.52 $1,078.71 $1,426.28 55 $1,016.94 $1,330.36 $961.80 $1,258.23 $1,126.71 $1,473.97 56 $1,063.91 $1,391.81 $1,006.23 $1,316.35 $1,178.76 $1,542.05 57 $1,111.34 $1,453.85 $1,051.08 $1,375.03 $1,231.30 $1,610.79 58 $1,161.96 $1,520.07 $1,098.96 $1,437.66 $1,287.38 $1,684.15 59 $1,187.04 $1,552.88 $1,122.68 $1,468.69 $1,315.17 $1,720.51 60 $1,237.66 $1,590.14 $1,170.55 $1,503.93 $1,371.26 $1,761.79 61 $1,281.43 $1,646.39 $1,211.96 $1,557.13 $1,419.76 $1,824.11 62 $1,310.16 $1,683.30 $1,239.13 $1,592.04 $1,451.59 $1,865.00 63 $1,346.19 $1,729.58 $1,273.20 $1,635.81 $1,491.51 $1,916.29 64 $1,368.09 $1,757.71 $1,293.90 $1,662.41 $1,515.75 $1,947.45 65+ $1,368.09 $1,757.71 $1,293.90 $1,662.41 $1,515.75 $1,947.45 Rates Effective January 1, 2018 Page 48 of 86

Texas Off Exchange (Silver) Texarkana, TX-Texarkana, AR Blue Advantage Silver HMO SM 205 102 202 0-14 $324.16 $324.16 $307.40 $307.40 $360.11 $360.11 15 $352.98 $352.98 $334.73 $334.73 $392.12 $392.12 16 $364.00 $364.00 $345.18 $345.18 $404.36 $404.36 17 $375.01 $375.01 $355.63 $355.63 $416.60 $416.60 18 $386.88 $386.88 $366.88 $366.88 $429.78 $429.78 19 $398.74 $398.74 $378.13 $378.13 $442.96 $442.96 20 $411.03 $411.03 $389.78 $389.78 $456.61 $456.61 21 $423.74 $423.74 $401.84 $401.84 $470.73 $470.73 22 $423.74 $423.74 $401.84 $401.84 $470.73 $470.73 23 $423.74 $423.74 $401.84 $401.84 $470.73 $470.73 24 $423.74 $423.74 $401.84 $401.84 $470.73 $470.73 25 $425.44 $425.44 $403.44 $403.44 $472.62 $472.62 26 $433.91 $433.91 $411.48 $411.48 $482.03 $482.03 27 $444.08 $444.08 $421.12 $421.12 $493.33 $493.33 28 $460.61 $460.61 $436.80 $436.80 $511.69 $511.69 29 $474.17 $474.17 $449.65 $449.65 $526.75 $526.75 30 $480.95 $545.49 $456.08 $517.29 $534.28 $605.99 31 $491.12 $557.03 $465.73 $528.23 $545.58 $618.80 32 $501.29 $568.56 $475.37 $539.17 $556.88 $631.61 33 $507.64 $575.77 $481.40 $546.00 $563.94 $639.62 34 $514.42 $583.46 $487.83 $553.30 $571.47 $648.16 35 $517.81 $635.77 $491.04 $602.90 $575.24 $706.28 36 $521.20 $639.93 $494.26 $606.85 $579.00 $710.90 37 $524.59 $644.10 $497.47 $610.80 $582.77 $715.53 38 $527.98 $648.26 $500.69 $614.75 $586.54 $720.15 39 $534.76 $656.58 $507.12 $622.64 $594.07 $729.39 40 $541.54 $698.27 $513.55 $662.17 $601.60 $775.70 41 $551.71 $711.38 $523.19 $674.60 $612.90 $790.27 42 $561.46 $723.95 $532.43 $686.52 $623.72 $804.23 43 $575.02 $741.43 $545.29 $703.10 $638.79 $823.65 44 $591.97 $763.28 $561.37 $723.82 $657.62 $847.93 45 $611.89 $806.83 $580.25 $765.12 $679.74 $896.31 46 $635.61 $838.12 $602.75 $794.79 $706.10 $931.07 47 $662.31 $873.32 $628.07 $828.17 $735.76 $970.17 48 $692.82 $913.55 $657.00 $866.32 $769.65 $1,014.86 49 $722.91 $953.22 $685.53 $903.94 $803.07 $1,058.93 50 $756.81 $1,000.65 $717.68 $948.92 $840.73 $1,111.62 51 $790.28 $1,044.91 $749.42 $990.89 $877.92 $1,160.79 52 $827.15 $1,093.65 $784.38 $1,037.11 $918.87 $1,214.93 53 $864.44 $1,142.96 $819.75 $1,083.87 $960.30 $1,269.71 54 $904.69 $1,196.18 $857.92 $1,134.34 $1,005.02 $1,328.84 55 $944.95 $1,236.18 $896.10 $1,172.27 $1,049.74 $1,373.27 56 $988.59 $1,293.28 $937.48 $1,226.42 $1,098.22 $1,436.70 57 $1,032.66 $1,350.93 $979.28 $1,281.09 $1,147.18 $1,500.74 58 $1,079.70 $1,412.46 $1,023.88 $1,339.44 $1,199.43 $1,569.10 59 $1,103.00 $1,442.95 $1,045.98 $1,368.35 $1,225.32 $1,602.97 60 $1,150.04 $1,477.57 $1,090.58 $1,401.18 $1,277.57 $1,641.43 61 $1,190.72 $1,529.84 $1,129.16 $1,450.75 $1,322.77 $1,699.49 62 $1,217.41 $1,564.13 $1,154.48 $1,483.27 $1,352.42 $1,737.59 63 $1,250.89 $1,607.14 $1,186.22 $1,524.06 $1,389.61 $1,785.37 64 $1,271.22 $1,633.28 $1,205.52 $1,548.84 $1,412.19 $1,814.40 65+ $1,271.22 $1,633.28 $1,205.52 $1,548.84 $1,412.19 $1,814.40 Rates Effective January 1, 2018 Page 49 of 86

Texas Off Exchange (Silver) Tyler, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $313.70 $313.70 $312.15 $312.15 $365.67 $365.67 15 $341.58 $341.58 $339.89 $339.89 $398.17 $398.17 16 $352.25 $352.25 $350.50 $350.50 $410.60 $410.60 17 $362.91 $362.91 $361.11 $361.11 $423.02 $423.02 18 $374.39 $374.39 $372.53 $372.53 $436.41 $436.41 19 $385.87 $385.87 $383.96 $383.96 $449.79 $449.79 20 $397.76 $397.76 $395.79 $395.79 $463.65 $463.65 21 $410.07 $410.07 $408.03 $408.03 $477.99 $477.99 22 $410.07 $410.07 $408.03 $408.03 $477.99 $477.99 23 $410.07 $410.07 $408.03 $408.03 $477.99 $477.99 24 $410.07 $410.07 $408.03 $408.03 $477.99 $477.99 25 $411.71 $411.71 $409.67 $409.67 $479.91 $479.91 26 $419.91 $419.91 $417.83 $417.83 $489.47 $489.47 27 $429.75 $429.75 $427.62 $427.62 $500.94 $500.94 28 $445.74 $445.74 $443.53 $443.53 $519.58 $519.58 29 $458.86 $458.86 $456.59 $456.59 $534.88 $534.88 30 $465.42 $527.89 $463.12 $525.27 $542.52 $615.33 31 $475.27 $539.05 $472.91 $536.38 $553.99 $628.34 32 $485.11 $550.21 $482.70 $547.48 $565.47 $641.35 33 $491.26 $557.18 $488.82 $554.42 $572.64 $649.48 34 $497.82 $564.63 $495.35 $561.83 $580.28 $658.16 35 $501.10 $615.25 $498.62 $612.20 $584.11 $717.17 36 $504.38 $619.28 $501.88 $616.21 $587.93 $721.86 37 $507.66 $623.31 $505.14 $620.22 $591.76 $726.56 38 $510.94 $627.33 $508.41 $624.23 $595.58 $731.25 39 $517.50 $635.39 $514.94 $632.24 $603.23 $740.64 40 $524.06 $675.73 $521.47 $672.38 $610.88 $787.66 41 $533.91 $688.42 $531.26 $685.01 $622.35 $802.46 42 $543.34 $700.58 $540.64 $697.11 $633.34 $816.63 43 $556.46 $717.50 $553.70 $713.94 $648.64 $836.36 44 $572.86 $738.65 $570.02 $734.99 $667.76 $861.01 45 $592.13 $780.79 $589.20 $776.92 $690.22 $910.13 46 $615.10 $811.07 $612.05 $807.05 $716.99 $945.42 47 $640.93 $845.13 $637.76 $840.94 $747.10 $985.13 48 $670.46 $884.06 $667.13 $879.68 $781.52 $1,030.51 49 $699.57 $922.45 $696.10 $917.88 $815.46 $1,075.26 50 $732.38 $968.35 $728.75 $963.55 $853.70 $1,128.76 51 $764.77 $1,011.18 $760.98 $1,006.17 $891.46 $1,178.69 52 $800.45 $1,058.35 $796.48 $1,053.10 $933.04 $1,233.67 53 $836.53 $1,106.07 $832.39 $1,100.58 $975.11 $1,289.29 54 $875.49 $1,157.57 $871.15 $1,151.84 $1,020.52 $1,349.33 55 $914.45 $1,196.28 $909.91 $1,190.35 $1,065.93 $1,394.45 56 $956.68 $1,251.53 $951.94 $1,245.33 $1,115.16 $1,458.85 57 $999.33 $1,307.32 $994.38 $1,300.84 $1,164.87 $1,523.88 58 $1,044.85 $1,366.87 $1,039.67 $1,360.09 $1,217.93 $1,593.29 59 $1,067.40 $1,396.37 $1,062.11 $1,389.45 $1,244.22 $1,627.68 60 $1,112.92 $1,429.88 $1,107.40 $1,422.79 $1,297.28 $1,666.74 61 $1,152.28 $1,480.45 $1,146.57 $1,473.12 $1,343.16 $1,725.70 62 $1,178.12 $1,513.65 $1,172.28 $1,506.14 $1,373.28 $1,764.39 63 $1,210.51 $1,555.27 $1,204.51 $1,547.56 $1,411.04 $1,812.90 64 $1,230.21 $1,580.56 $1,224.09 $1,572.72 $1,433.97 $1,842.38 65+ $1,230.21 $1,580.56 $1,224.09 $1,572.72 $1,433.97 $1,842.38 Rates Effective January 1, 2018 Page 50 of 86

Texas Off Exchange (Silver) Victoria, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $332.85 $332.85 $306.24 $306.24 $358.74 $358.74 15 $362.44 $362.44 $333.46 $333.46 $390.63 $390.63 16 $373.75 $373.75 $343.86 $343.86 $402.82 $402.82 17 $385.06 $385.06 $354.27 $354.27 $415.02 $415.02 18 $397.25 $397.25 $365.48 $365.48 $428.15 $428.15 19 $409.43 $409.43 $376.69 $376.69 $441.28 $441.28 20 $422.05 $422.05 $388.30 $388.30 $454.88 $454.88 21 $435.10 $435.10 $400.31 $400.31 $468.94 $468.94 22 $435.10 $435.10 $400.31 $400.31 $468.94 $468.94 23 $435.10 $435.10 $400.31 $400.31 $468.94 $468.94 24 $435.10 $435.10 $400.31 $400.31 $468.94 $468.94 25 $436.84 $436.84 $401.91 $401.91 $470.82 $470.82 26 $445.54 $445.54 $409.91 $409.91 $480.20 $480.20 27 $455.98 $455.98 $419.52 $419.52 $491.45 $491.45 28 $472.95 $472.95 $435.13 $435.13 $509.74 $509.74 29 $486.88 $486.88 $447.94 $447.94 $524.75 $524.75 30 $493.84 $560.11 $454.35 $515.32 $532.25 $603.68 31 $504.28 $571.96 $463.96 $526.22 $543.51 $616.45 32 $514.72 $583.80 $473.56 $537.12 $554.76 $629.21 33 $521.25 $591.20 $479.57 $543.93 $561.79 $637.19 34 $528.21 $599.10 $485.97 $551.19 $569.30 $645.70 35 $531.69 $652.81 $489.18 $600.61 $573.05 $703.59 36 $535.17 $657.08 $492.38 $604.54 $576.80 $708.19 37 $538.65 $661.36 $495.58 $608.48 $580.55 $712.80 38 $542.13 $665.63 $498.78 $612.41 $584.30 $717.41 39 $549.10 $674.18 $505.19 $620.27 $591.81 $726.62 40 $556.06 $716.98 $511.59 $659.65 $599.31 $772.75 41 $566.50 $730.45 $521.20 $672.04 $610.56 $787.26 42 $576.51 $743.35 $530.41 $683.91 $621.35 $801.17 43 $590.43 $761.30 $543.22 $700.43 $636.36 $820.52 44 $607.83 $783.74 $559.23 $721.07 $655.11 $844.70 45 $628.28 $828.46 $578.04 $762.21 $677.15 $892.90 46 $652.65 $860.58 $600.46 $791.77 $703.42 $927.52 47 $680.06 $896.73 $625.68 $825.02 $732.96 $966.48 48 $711.39 $938.04 $654.50 $863.03 $766.72 $1,011.00 49 $742.28 $978.77 $682.92 $900.50 $800.02 $1,054.90 50 $777.09 $1,027.47 $714.95 $945.31 $837.53 $1,107.39 51 $811.46 $1,072.91 $746.57 $987.12 $874.58 $1,156.37 52 $849.32 $1,122.96 $781.40 $1,033.17 $915.38 $1,210.31 53 $887.60 $1,173.59 $816.63 $1,079.74 $956.64 $1,264.88 54 $928.94 $1,228.24 $854.66 $1,130.03 $1,001.19 $1,323.78 55 $970.27 $1,269.31 $892.69 $1,167.81 $1,045.74 $1,368.04 56 $1,015.09 $1,327.94 $933.92 $1,221.75 $1,094.05 $1,431.23 57 $1,060.34 $1,387.13 $975.55 $1,276.21 $1,142.82 $1,495.03 58 $1,108.63 $1,450.31 $1,019.98 $1,334.34 $1,194.87 $1,563.13 59 $1,132.57 $1,481.62 $1,042.00 $1,363.14 $1,220.66 $1,596.87 60 $1,180.86 $1,517.17 $1,086.43 $1,395.85 $1,272.71 $1,635.18 61 $1,222.63 $1,570.84 $1,124.86 $1,445.23 $1,317.73 $1,693.02 62 $1,250.04 $1,606.05 $1,150.08 $1,477.63 $1,347.28 $1,730.98 63 $1,284.42 $1,650.22 $1,181.71 $1,518.26 $1,384.32 $1,778.58 64 $1,305.30 $1,677.05 $1,200.93 $1,542.94 $1,406.82 $1,807.50 65+ $1,305.30 $1,677.05 $1,200.93 $1,542.94 $1,406.82 $1,807.50 Rates Effective January 1, 2018 Page 51 of 86

Texas Off Exchange (Silver) Waco, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $301.75 $301.75 $287.65 $287.65 $336.97 $336.97 15 $328.58 $328.58 $313.22 $313.22 $366.93 $366.93 16 $338.83 $338.83 $323.00 $323.00 $378.38 $378.38 17 $349.09 $349.09 $332.77 $332.77 $389.83 $389.83 18 $360.13 $360.13 $343.30 $343.30 $402.17 $402.17 19 $371.18 $371.18 $353.83 $353.83 $414.50 $414.50 20 $382.62 $382.62 $364.74 $364.74 $427.27 $427.27 21 $394.45 $394.45 $376.02 $376.02 $440.49 $440.49 22 $394.45 $394.45 $376.02 $376.02 $440.49 $440.49 23 $394.45 $394.45 $376.02 $376.02 $440.49 $440.49 24 $394.45 $394.45 $376.02 $376.02 $440.49 $440.49 25 $396.03 $396.03 $377.52 $377.52 $442.25 $442.25 26 $403.92 $403.92 $385.04 $385.04 $451.06 $451.06 27 $413.38 $413.38 $394.07 $394.07 $461.63 $461.63 28 $428.77 $428.77 $408.73 $408.73 $478.81 $478.81 29 $441.39 $441.39 $420.76 $420.76 $492.91 $492.91 30 $447.70 $507.78 $426.78 $484.05 $499.95 $567.05 31 $457.17 $518.52 $435.80 $494.29 $510.53 $579.04 32 $466.63 $529.26 $444.83 $504.52 $521.10 $591.03 33 $472.55 $535.97 $450.47 $510.92 $527.71 $598.52 34 $478.86 $543.13 $456.48 $517.75 $534.75 $606.52 35 $482.02 $591.82 $459.49 $564.16 $538.28 $660.90 36 $485.17 $595.69 $462.50 $567.86 $541.80 $665.22 37 $488.33 $599.57 $465.51 $571.55 $545.32 $669.55 38 $491.49 $603.45 $468.52 $575.25 $548.85 $673.88 39 $497.80 $611.19 $474.53 $582.63 $555.90 $682.53 40 $504.11 $650.00 $480.55 $619.62 $562.94 $725.86 41 $513.57 $662.20 $489.57 $631.26 $573.52 $739.49 42 $522.65 $673.90 $498.22 $642.41 $583.65 $752.56 43 $535.27 $690.18 $510.25 $657.92 $597.74 $770.73 44 $551.05 $710.52 $525.30 $677.32 $615.36 $793.45 45 $569.59 $751.06 $542.97 $715.96 $636.07 $838.72 46 $591.68 $780.18 $564.03 $743.72 $660.73 $871.24 47 $616.53 $812.95 $587.71 $774.96 $688.48 $907.83 48 $644.93 $850.40 $614.79 $810.66 $720.20 $949.65 49 $672.93 $887.33 $641.48 $845.86 $751.47 $990.89 50 $704.49 $931.47 $671.57 $887.95 $786.71 $1,040.19 51 $735.65 $972.68 $701.27 $927.22 $821.51 $1,086.20 52 $769.97 $1,018.05 $733.99 $970.47 $859.83 $1,136.87 53 $804.68 $1,063.95 $767.07 $1,014.23 $898.60 $1,188.12 54 $842.15 $1,113.49 $802.80 $1,061.46 $940.44 $1,243.45 55 $879.62 $1,150.73 $838.52 $1,096.95 $982.29 $1,285.03 56 $920.25 $1,203.87 $877.25 $1,147.61 $1,027.66 $1,344.38 57 $961.28 $1,257.54 $916.35 $1,198.77 $1,073.47 $1,404.31 58 $1,005.06 $1,314.82 $958.09 $1,253.37 $1,122.36 $1,468.28 59 $1,026.75 $1,343.20 $978.77 $1,280.43 $1,146.59 $1,499.97 60 $1,070.54 $1,375.43 $1,020.51 $1,311.15 $1,195.49 $1,535.96 61 $1,108.41 $1,424.08 $1,056.61 $1,357.53 $1,237.77 $1,590.29 62 $1,133.26 $1,456.01 $1,080.30 $1,387.96 $1,265.52 $1,625.94 63 $1,164.42 $1,496.04 $1,110.00 $1,426.13 $1,300.32 $1,670.65 64 $1,183.35 $1,520.37 $1,128.06 $1,449.32 $1,321.47 $1,697.82 65+ $1,183.35 $1,520.37 $1,128.06 $1,449.32 $1,321.47 $1,697.82 Rates Effective January 1, 2018 Page 52 of 86

Texas Off Exchange (Silver) Wichita Falls, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $370.70 $370.70 $366.38 $366.38 $429.20 $429.20 15 $403.65 $403.65 $398.95 $398.95 $467.35 $467.35 16 $416.25 $416.25 $411.40 $411.40 $481.94 $481.94 17 $428.85 $428.85 $423.85 $423.85 $496.52 $496.52 18 $442.42 $442.42 $437.26 $437.26 $512.23 $512.23 19 $455.99 $455.99 $450.67 $450.67 $527.94 $527.94 20 $470.04 $470.04 $464.56 $464.56 $544.21 $544.21 21 $484.58 $484.58 $478.93 $478.93 $561.04 $561.04 22 $484.58 $484.58 $478.93 $478.93 $561.04 $561.04 23 $484.58 $484.58 $478.93 $478.93 $561.04 $561.04 24 $484.58 $484.58 $478.93 $478.93 $561.04 $561.04 25 $486.52 $486.52 $480.84 $480.84 $563.29 $563.29 26 $496.21 $496.21 $490.42 $490.42 $574.51 $574.51 27 $507.84 $507.84 $501.92 $501.92 $587.97 $587.97 28 $526.74 $526.74 $520.59 $520.59 $609.86 $609.86 29 $542.24 $542.24 $535.92 $535.92 $627.81 $627.81 30 $550.00 $623.81 $543.58 $616.53 $636.79 $722.24 31 $561.63 $637.00 $555.08 $629.57 $650.25 $737.52 32 $573.26 $650.19 $566.57 $642.61 $663.72 $752.79 33 $580.53 $658.43 $573.76 $650.75 $672.13 $762.33 34 $588.28 $667.23 $581.42 $659.45 $681.11 $772.51 35 $592.16 $727.05 $585.25 $718.57 $685.60 $841.77 36 $596.03 $731.81 $589.08 $723.27 $690.08 $847.28 37 $599.91 $736.57 $592.91 $727.98 $694.57 $852.80 38 $603.79 $741.33 $596.74 $732.68 $699.06 $858.31 39 $611.54 $750.85 $604.41 $742.09 $708.04 $869.33 40 $619.29 $798.51 $612.07 $789.20 $717.01 $924.52 41 $630.92 $813.51 $623.56 $804.02 $730.48 $941.88 42 $642.07 $827.88 $634.58 $818.23 $743.38 $958.52 43 $657.57 $847.88 $649.91 $837.99 $761.34 $981.67 44 $676.96 $872.87 $669.06 $862.69 $783.78 $1,010.60 45 $699.73 $922.67 $691.57 $911.91 $810.15 $1,068.26 46 $726.87 $958.45 $718.39 $947.27 $841.57 $1,109.69 47 $757.40 $998.70 $748.56 $987.06 $876.91 $1,156.30 48 $792.29 $1,044.71 $783.05 $1,032.53 $917.31 $1,209.56 49 $826.69 $1,090.08 $817.05 $1,077.36 $957.14 $1,262.09 50 $865.46 $1,144.31 $855.37 $1,130.96 $1,002.03 $1,324.88 51 $903.74 $1,194.92 $893.20 $1,180.99 $1,046.35 $1,383.48 52 $945.90 $1,250.67 $934.87 $1,236.08 $1,095.16 $1,448.02 53 $988.54 $1,307.05 $977.01 $1,291.81 $1,144.53 $1,513.30 54 $1,034.58 $1,367.92 $1,022.51 $1,351.97 $1,197.83 $1,583.77 55 $1,080.61 $1,413.66 $1,068.01 $1,397.17 $1,251.13 $1,636.73 56 $1,130.52 $1,478.95 $1,117.34 $1,461.70 $1,308.92 $1,712.32 57 $1,180.92 $1,544.88 $1,167.15 $1,526.86 $1,367.26 $1,788.65 58 $1,234.71 $1,615.24 $1,220.31 $1,596.41 $1,429.54 $1,870.12 59 $1,261.36 $1,650.11 $1,246.65 $1,630.86 $1,460.40 $1,910.49 60 $1,315.15 $1,689.70 $1,299.81 $1,670.00 $1,522.67 $1,956.33 61 $1,361.67 $1,749.47 $1,345.79 $1,729.07 $1,576.53 $2,025.53 62 $1,392.20 $1,788.69 $1,375.96 $1,767.83 $1,611.88 $2,070.94 63 $1,430.48 $1,837.88 $1,413.79 $1,816.44 $1,656.20 $2,127.89 64 $1,453.74 $1,867.76 $1,436.79 $1,845.98 $1,683.12 $2,162.49 65+ $1,453.74 $1,867.76 $1,436.79 $1,845.98 $1,683.12 $2,162.49 Rates Effective January 1, 2018 Page 53 of 86

Texas Off Exchange (Silver) Non MSA, TX Blue Advantage Silver HMO SM 205 102 202 0-14 $328.41 $328.41 $299.79 $299.79 $351.19 $351.19 15 $357.60 $357.60 $326.43 $326.43 $382.40 $382.40 16 $368.76 $368.76 $336.62 $336.62 $394.34 $394.34 17 $379.93 $379.93 $346.81 $346.81 $406.27 $406.27 18 $391.95 $391.95 $357.78 $357.78 $419.13 $419.13 19 $403.97 $403.97 $368.76 $368.76 $431.98 $431.98 20 $416.42 $416.42 $380.12 $380.12 $445.30 $445.30 21 $429.29 $429.29 $391.88 $391.88 $459.07 $459.07 22 $429.29 $429.29 $391.88 $391.88 $459.07 $459.07 23 $429.29 $429.29 $391.88 $391.88 $459.07 $459.07 24 $429.29 $429.29 $391.88 $391.88 $459.07 $459.07 25 $431.01 $431.01 $393.44 $393.44 $460.90 $460.90 26 $439.60 $439.60 $401.28 $401.28 $470.09 $470.09 27 $449.90 $449.90 $410.69 $410.69 $481.10 $481.10 28 $466.64 $466.64 $425.97 $425.97 $499.01 $499.01 29 $480.38 $480.38 $438.51 $438.51 $513.70 $513.70 30 $487.25 $552.64 $444.78 $504.47 $521.04 $590.97 31 $497.55 $564.33 $454.19 $515.14 $532.06 $603.46 32 $507.86 $576.01 $463.59 $525.80 $543.08 $615.96 33 $514.30 $583.31 $469.47 $532.47 $549.96 $623.77 34 $521.16 $591.10 $475.74 $539.58 $557.31 $632.10 35 $524.60 $644.10 $478.87 $587.96 $560.98 $688.77 36 $528.03 $648.32 $482.01 $591.81 $564.65 $693.28 37 $531.47 $652.54 $485.14 $595.66 $568.33 $697.79 38 $534.90 $656.75 $488.28 $599.51 $572.00 $702.30 39 $541.77 $665.18 $494.55 $607.21 $579.34 $711.32 40 $548.64 $707.41 $500.82 $645.75 $586.69 $756.47 41 $558.94 $720.70 $510.22 $657.88 $597.71 $770.68 42 $568.82 $733.43 $519.24 $669.51 $608.26 $784.30 43 $582.55 $751.15 $531.78 $685.67 $622.95 $803.24 44 $599.72 $773.28 $547.45 $705.88 $641.32 $826.91 45 $619.90 $817.40 $565.87 $746.16 $662.89 $874.09 46 $643.94 $849.10 $587.82 $775.09 $688.60 $907.99 47 $670.99 $884.76 $612.50 $807.65 $717.52 $946.12 48 $701.90 $925.52 $640.72 $844.85 $750.58 $989.71 49 $732.38 $965.71 $668.54 $881.54 $783.17 $1,032.69 50 $766.72 $1,013.76 $699.89 $925.40 $819.89 $1,084.07 51 $800.64 $1,058.60 $730.85 $966.33 $856.16 $1,132.01 52 $837.98 $1,107.98 $764.94 $1,011.41 $896.10 $1,184.82 53 $875.76 $1,157.93 $799.43 $1,057.01 $936.50 $1,238.24 54 $916.54 $1,211.86 $836.66 $1,106.23 $980.11 $1,295.90 55 $957.33 $1,252.38 $873.89 $1,143.22 $1,023.72 $1,339.23 56 $1,001.55 $1,310.22 $914.25 $1,196.02 $1,071.00 $1,401.09 57 $1,046.19 $1,368.63 $955.00 $1,249.33 $1,118.75 $1,463.54 58 $1,093.84 $1,430.96 $998.50 $1,306.24 $1,169.70 $1,530.21 59 $1,117.45 $1,461.85 $1,020.06 $1,334.43 $1,194.95 $1,563.24 60 $1,165.11 $1,496.93 $1,063.55 $1,366.45 $1,245.91 $1,600.75 61 $1,206.32 $1,549.88 $1,101.17 $1,414.79 $1,289.98 $1,657.37 62 $1,233.36 $1,584.63 $1,125.86 $1,446.51 $1,318.90 $1,694.52 63 $1,267.28 $1,628.20 $1,156.82 $1,486.28 $1,355.17 $1,741.12 64 $1,287.87 $1,654.67 $1,175.64 $1,510.45 $1,377.21 $1,769.43 65+ $1,287.87 $1,654.67 $1,175.64 $1,510.45 $1,377.21 $1,769.43 Rates Effective January 1, 2018 Page 54 of 86

Texas Off Exchange (Bronze) Abilene, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $231.65 $231.65 $280.17 $280.17 15 $252.24 $252.24 $305.07 $305.07 16 $260.12 $260.12 $314.59 $314.59 17 $267.99 $267.99 $324.12 $324.12 18 $276.47 $276.47 $334.37 $334.37 19 $284.95 $284.95 $344.62 $344.62 20 $293.73 $293.73 $355.24 $355.24 21 $302.81 $302.81 $366.23 $366.23 22 $302.81 $302.81 $366.23 $366.23 23 $302.81 $302.81 $366.23 $366.23 24 $302.81 $302.81 $366.23 $366.23 25 $304.03 $304.03 $367.70 $367.70 26 $310.08 $310.08 $375.02 $375.02 27 $317.35 $317.35 $383.81 $383.81 28 $329.16 $329.16 $398.09 $398.09 29 $338.85 $338.85 $409.81 $409.81 30 $343.69 $389.82 $415.67 $471.46 31 $350.96 $398.06 $424.46 $481.43 32 $358.23 $406.30 $433.25 $491.40 33 $362.77 $411.45 $438.75 $497.62 34 $367.62 $416.95 $444.61 $504.27 35 $370.04 $454.33 $447.54 $549.48 36 $372.46 $457.31 $450.47 $553.08 37 $374.88 $460.28 $453.39 $556.68 38 $377.31 $463.26 $456.32 $560.28 39 $382.15 $469.20 $462.18 $567.47 40 $387.00 $498.99 $468.04 $603.50 41 $394.26 $508.36 $476.83 $614.83 42 $401.23 $517.35 $485.26 $625.69 43 $410.92 $529.84 $496.98 $640.80 44 $423.03 $545.46 $511.63 $659.69 45 $437.26 $576.58 $528.84 $697.33 46 $454.22 $598.94 $549.35 $724.37 47 $473.30 $624.09 $572.42 $754.79 48 $495.10 $652.84 $598.79 $789.56 49 $516.60 $681.19 $624.79 $823.85 50 $540.83 $715.08 $654.09 $864.84 51 $564.75 $746.71 $683.02 $903.09 52 $591.09 $781.54 $714.88 $945.22 53 $617.74 $816.78 $747.11 $987.83 54 $646.51 $854.81 $781.90 $1,033.84 55 $675.27 $883.40 $816.70 $1,068.40 56 $706.46 $924.20 $854.42 $1,117.75 57 $737.96 $965.39 $892.51 $1,167.58 58 $771.57 $1,009.37 $933.16 $1,220.76 59 $788.22 $1,031.15 $953.30 $1,247.11 60 $821.84 $1,055.90 $993.95 $1,277.03 61 $850.91 $1,093.25 $1,029.11 $1,322.20 62 $869.98 $1,117.76 $1,052.18 $1,351.85 63 $893.91 $1,148.49 $1,081.12 $1,389.02 64 $908.43 $1,167.17 $1,098.69 $1,411.60 65+ $908.43 $1,167.17 $1,098.69 $1,411.60 Rates Effective January 1, 2018 Page 55 of 86

Texas Off Exchange (Bronze) Amarillo, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $241.75 $241.75 $279.55 $279.55 15 $263.24 $263.24 $304.40 $304.40 16 $271.45 $271.45 $313.90 $313.90 17 $279.67 $279.67 $323.40 $323.40 18 $288.52 $288.52 $333.63 $333.63 19 $297.37 $297.37 $343.86 $343.86 20 $306.53 $306.53 $354.46 $354.46 21 $316.01 $316.01 $365.42 $365.42 22 $316.01 $316.01 $365.42 $365.42 23 $316.01 $316.01 $365.42 $365.42 24 $316.01 $316.01 $365.42 $365.42 25 $317.28 $317.28 $366.88 $366.88 26 $323.60 $323.60 $374.19 $374.19 27 $331.18 $331.18 $382.96 $382.96 28 $343.50 $343.50 $397.21 $397.21 29 $353.62 $353.62 $408.91 $408.91 30 $358.67 $406.81 $414.75 $470.41 31 $366.26 $415.41 $423.52 $480.36 32 $373.84 $424.01 $432.29 $490.31 33 $378.58 $429.39 $437.78 $496.52 34 $383.64 $435.12 $443.62 $503.16 35 $386.17 $474.13 $446.55 $548.27 36 $388.69 $477.24 $449.47 $551.86 37 $391.22 $480.34 $452.39 $555.45 38 $393.75 $483.45 $455.32 $559.04 39 $398.81 $489.65 $461.16 $566.21 40 $403.86 $520.74 $467.01 $602.16 41 $411.45 $530.52 $475.78 $613.47 42 $418.71 $539.89 $484.18 $624.31 43 $428.83 $552.93 $495.88 $639.39 44 $441.47 $569.23 $510.49 $658.23 45 $456.32 $601.70 $527.67 $695.78 46 $474.02 $625.04 $548.13 $722.77 47 $493.93 $651.29 $571.15 $753.12 48 $516.68 $681.29 $597.46 $787.82 49 $539.11 $710.88 $623.41 $822.03 50 $564.40 $746.24 $652.64 $862.93 51 $589.36 $779.25 $681.51 $901.09 52 $616.85 $815.60 $713.30 $943.13 53 $644.66 $852.37 $745.46 $985.65 54 $674.68 $892.07 $780.18 $1,031.55 55 $704.70 $921.90 $814.89 $1,066.04 56 $737.25 $964.48 $852.53 $1,115.28 57 $770.12 $1,007.47 $890.53 $1,164.99 58 $805.20 $1,053.36 $931.09 $1,218.06 59 $822.58 $1,076.09 $951.19 $1,244.35 60 $857.65 $1,101.91 $991.75 $1,274.21 61 $887.99 $1,140.89 $1,026.84 $1,319.28 62 $907.90 $1,166.47 $1,049.86 $1,348.86 63 $932.86 $1,198.54 $1,078.72 $1,385.95 64 $948.03 $1,218.03 $1,096.26 $1,408.48 65+ $948.03 $1,218.03 $1,096.26 $1,408.48 Rates Effective January 1, 2018 Page 56 of 86

Texas Off Exchange (Bronze) Austin-Round Rock-San Marcos, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $251.31 $251.31 $289.40 $289.40 15 $273.65 $273.65 $315.12 $315.12 16 $282.19 $282.19 $324.96 $324.96 17 $290.73 $290.73 $334.79 $334.79 18 $299.93 $299.93 $345.38 $345.38 19 $309.13 $309.13 $355.98 $355.98 20 $318.65 $318.65 $366.95 $366.95 21 $328.51 $328.51 $378.30 $378.30 22 $328.51 $328.51 $378.30 $378.30 23 $328.51 $328.51 $378.30 $378.30 24 $328.51 $328.51 $378.30 $378.30 25 $329.82 $329.82 $379.81 $379.81 26 $336.39 $336.39 $387.38 $387.38 27 $344.28 $344.28 $396.45 $396.45 28 $357.09 $357.09 $411.21 $411.21 29 $367.60 $367.60 $423.31 $423.31 30 $372.86 $422.89 $429.37 $486.99 31 $380.74 $431.84 $438.45 $497.29 32 $388.62 $440.78 $447.52 $507.58 33 $393.55 $446.37 $453.20 $514.02 34 $398.81 $452.33 $459.25 $520.88 35 $401.44 $492.88 $462.28 $567.58 36 $404.06 $496.11 $465.30 $571.30 37 $406.69 $499.34 $468.33 $575.02 38 $409.32 $502.56 $471.36 $578.73 39 $414.58 $509.02 $477.41 $586.16 40 $419.83 $541.33 $483.46 $623.38 41 $427.72 $551.50 $492.54 $635.08 42 $435.27 $561.24 $501.24 $646.30 43 $445.78 $574.80 $513.35 $661.91 44 $458.93 $591.74 $528.48 $681.42 45 $474.37 $625.50 $546.26 $720.30 46 $492.76 $649.76 $567.44 $748.23 47 $513.46 $677.04 $591.28 $779.66 48 $537.11 $708.23 $618.51 $815.57 49 $560.43 $738.99 $645.37 $850.99 50 $586.71 $775.75 $675.64 $893.33 51 $612.67 $810.07 $705.52 $932.84 52 $641.25 $847.86 $738.43 $976.36 53 $670.16 $886.08 $771.73 $1,020.38 54 $701.36 $927.34 $807.66 $1,067.89 55 $732.57 $958.35 $843.60 $1,103.60 56 $766.41 $1,002.62 $882.57 $1,154.57 57 $800.57 $1,047.31 $921.91 $1,206.04 58 $837.04 $1,095.01 $963.90 $1,260.97 59 $855.11 $1,118.65 $984.71 $1,288.19 60 $891.57 $1,145.49 $1,026.70 $1,319.10 61 $923.11 $1,186.01 $1,063.01 $1,365.76 62 $943.80 $1,212.60 $1,086.85 $1,396.38 63 $969.75 $1,245.94 $1,116.73 $1,434.78 64 $985.53 $1,266.20 $1,134.90 $1,458.11 65+ $985.53 $1,266.20 $1,134.90 $1,458.11 Rates Effective January 1, 2018 Page 57 of 86

Texas Off Exchange (Bronze) Beaumont-Port Arthur, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $243.92 $243.92 $282.66 $282.66 15 $265.60 $265.60 $307.79 $307.79 16 $273.89 $273.89 $317.39 $317.39 17 $282.18 $282.18 $327.00 $327.00 18 $291.11 $291.11 $337.34 $337.34 19 $300.04 $300.04 $347.69 $347.69 20 $309.28 $309.28 $358.41 $358.41 21 $318.85 $318.85 $369.49 $369.49 22 $318.85 $318.85 $369.49 $369.49 23 $318.85 $318.85 $369.49 $369.49 24 $318.85 $318.85 $369.49 $369.49 25 $320.12 $320.12 $370.97 $370.97 26 $326.50 $326.50 $378.36 $378.36 27 $334.15 $334.15 $387.23 $387.23 28 $346.59 $346.59 $401.64 $401.64 29 $356.79 $356.79 $413.46 $413.46 30 $361.89 $410.46 $419.37 $475.65 31 $369.55 $419.14 $428.24 $485.71 32 $377.20 $427.82 $437.11 $495.77 33 $381.98 $433.24 $442.65 $502.05 34 $387.08 $439.03 $448.56 $508.76 35 $389.63 $478.39 $451.52 $554.37 36 $392.18 $481.52 $454.47 $558.00 37 $394.73 $484.66 $457.43 $561.63 38 $397.28 $487.79 $460.38 $565.26 39 $402.39 $494.05 $466.30 $572.52 40 $407.49 $525.41 $472.21 $608.86 41 $415.14 $535.28 $481.08 $620.30 42 $422.47 $544.74 $489.57 $631.26 43 $432.68 $557.90 $501.40 $646.50 44 $445.43 $574.34 $516.18 $665.56 45 $460.42 $607.11 $533.54 $703.53 46 $478.27 $630.65 $554.24 $730.81 47 $498.36 $657.14 $577.51 $761.51 48 $521.32 $687.41 $604.12 $796.59 49 $543.96 $717.26 $630.35 $831.18 50 $569.46 $752.94 $659.91 $872.53 51 $594.65 $786.25 $689.10 $911.13 52 $622.39 $822.92 $721.24 $953.63 53 $650.45 $860.03 $753.76 $996.62 54 $680.74 $900.08 $788.86 $1,043.03 55 $711.03 $930.17 $823.96 $1,077.91 56 $743.87 $973.13 $862.02 $1,127.69 57 $777.03 $1,016.51 $900.45 $1,177.96 58 $812.43 $1,062.81 $941.46 $1,231.62 59 $829.96 $1,085.75 $961.78 $1,258.20 60 $865.35 $1,111.81 $1,002.80 $1,288.39 61 $895.96 $1,151.13 $1,038.27 $1,333.97 62 $916.05 $1,176.94 $1,061.55 $1,363.87 63 $941.24 $1,209.31 $1,090.73 $1,401.38 64 $956.55 $1,228.97 $1,108.47 $1,424.16 65+ $956.55 $1,228.97 $1,108.47 $1,424.16 Rates Effective January 1, 2018 Page 58 of 86

Texas Off Exchange (Bronze) Brownsville-Harlingen, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $190.31 $190.31 $233.05 $233.05 15 $207.22 $207.22 $253.77 $253.77 16 $213.69 $213.69 $261.69 $261.69 17 $220.16 $220.16 $269.61 $269.61 18 $227.12 $227.12 $278.14 $278.14 19 $234.09 $234.09 $286.67 $286.67 20 $241.30 $241.30 $295.51 $295.51 21 $248.77 $248.77 $304.65 $304.65 22 $248.77 $248.77 $304.65 $304.65 23 $248.77 $248.77 $304.65 $304.65 24 $248.77 $248.77 $304.65 $304.65 25 $249.76 $249.76 $305.86 $305.86 26 $254.74 $254.74 $311.96 $311.96 27 $260.71 $260.71 $319.27 $319.27 28 $270.41 $270.41 $331.15 $331.15 29 $278.37 $278.37 $340.90 $340.90 30 $282.35 $320.24 $345.77 $392.18 31 $288.32 $327.02 $353.08 $400.47 32 $294.29 $333.79 $360.40 $408.76 33 $298.02 $338.02 $364.97 $413.94 34 $302.00 $342.53 $369.84 $419.47 35 $303.99 $373.24 $372.28 $457.08 36 $305.98 $375.69 $374.71 $460.07 37 $307.97 $378.13 $377.15 $463.07 38 $309.96 $380.57 $379.59 $466.06 39 $313.94 $385.46 $384.46 $472.04 40 $317.93 $409.93 $389.34 $502.01 41 $323.90 $417.63 $396.65 $511.44 42 $329.62 $425.01 $403.66 $520.48 43 $337.58 $435.27 $413.40 $533.05 44 $347.53 $448.10 $425.59 $548.76 45 $359.22 $473.67 $439.91 $580.06 46 $373.15 $492.04 $456.97 $602.56 47 $388.82 $512.70 $476.16 $627.87 48 $406.74 $536.32 $498.10 $656.79 49 $424.40 $559.61 $519.73 $685.31 50 $444.30 $587.45 $544.10 $719.41 51 $463.95 $613.44 $568.16 $751.23 52 $485.59 $642.05 $594.67 $786.27 53 $507.49 $671.00 $621.48 $821.72 54 $531.12 $702.25 $650.42 $859.99 55 $554.75 $725.73 $679.36 $888.74 56 $580.37 $759.25 $710.74 $929.79 57 $606.25 $793.09 $742.42 $971.24 58 $633.86 $829.21 $776.24 $1,015.47 59 $647.54 $847.11 $792.99 $1,037.39 60 $675.16 $867.44 $826.81 $1,062.29 61 $699.04 $898.12 $856.06 $1,099.86 62 $714.71 $918.26 $875.25 $1,124.52 63 $734.36 $943.51 $899.32 $1,155.44 64 $746.31 $958.85 $913.95 $1,174.23 65+ $746.31 $958.85 $913.95 $1,174.23 Rates Effective January 1, 2018 Page 59 of 86

Texas Off Exchange (Bronze) College Station-Bryan, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $242.67 $242.67 $280.21 $280.21 15 $264.24 $264.24 $305.12 $305.12 16 $272.48 $272.48 $314.64 $314.64 17 $280.73 $280.73 $324.17 $324.17 18 $289.61 $289.61 $334.42 $334.42 19 $298.50 $298.50 $344.68 $344.68 20 $307.69 $307.69 $355.30 $355.30 21 $317.21 $317.21 $366.29 $366.29 22 $317.21 $317.21 $366.29 $366.29 23 $317.21 $317.21 $366.29 $366.29 24 $317.21 $317.21 $366.29 $366.29 25 $318.48 $318.48 $367.76 $367.76 26 $324.82 $324.82 $375.08 $375.08 27 $332.44 $332.44 $383.87 $383.87 28 $344.81 $344.81 $398.16 $398.16 29 $354.96 $354.96 $409.88 $409.88 30 $360.03 $408.35 $415.74 $471.53 31 $367.65 $416.99 $424.53 $481.50 32 $375.26 $425.62 $433.32 $491.47 33 $380.02 $431.02 $438.82 $497.70 34 $385.09 $436.77 $444.68 $504.35 35 $387.63 $475.93 $447.61 $549.57 36 $390.17 $479.05 $450.54 $553.17 37 $392.71 $482.17 $453.47 $556.77 38 $395.24 $485.28 $456.40 $560.37 39 $400.32 $491.51 $462.26 $567.56 40 $405.40 $522.72 $468.12 $603.59 41 $413.01 $532.53 $476.91 $614.93 42 $420.30 $541.94 $485.33 $625.79 43 $430.45 $555.03 $497.06 $640.91 44 $443.14 $571.39 $511.71 $659.80 45 $458.05 $603.99 $528.92 $697.44 46 $475.82 $627.41 $549.44 $724.49 47 $495.80 $653.76 $572.51 $754.91 48 $518.64 $683.88 $598.88 $789.69 49 $541.16 $713.58 $624.89 $823.98 50 $566.54 $749.08 $654.19 $864.98 51 $591.60 $782.21 $683.13 $903.24 52 $619.20 $818.70 $715.00 $945.37 53 $647.11 $855.61 $747.23 $987.99 54 $677.24 $895.45 $782.03 $1,034.00 55 $707.38 $925.40 $816.83 $1,068.57 56 $740.05 $968.14 $854.56 $1,117.93 57 $773.04 $1,011.29 $892.65 $1,167.76 58 $808.25 $1,057.36 $933.31 $1,220.95 59 $825.70 $1,080.18 $953.45 $1,247.31 60 $860.91 $1,106.10 $994.11 $1,277.24 61 $891.36 $1,145.22 $1,029.28 $1,322.41 62 $911.35 $1,170.90 $1,052.35 $1,352.06 63 $936.41 $1,203.09 $1,081.29 $1,389.24 64 $951.63 $1,222.66 $1,098.87 $1,411.83 65+ $951.63 $1,222.66 $1,098.87 $1,411.83 Rates Effective January 1, 2018 Page 60 of 86

Texas Off Exchange (Bronze) Corpus Christi, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $224.84 $224.84 $263.17 $263.17 15 $244.82 $244.82 $286.57 $286.57 16 $252.46 $252.46 $295.51 $295.51 17 $260.10 $260.10 $304.46 $304.46 18 $268.33 $268.33 $314.09 $314.09 19 $276.56 $276.56 $323.72 $323.72 20 $285.09 $285.09 $333.70 $333.70 21 $293.90 $293.90 $344.02 $344.02 22 $293.90 $293.90 $344.02 $344.02 23 $293.90 $293.90 $344.02 $344.02 24 $293.90 $293.90 $344.02 $344.02 25 $295.08 $295.08 $345.39 $345.39 26 $300.96 $300.96 $352.27 $352.27 27 $308.01 $308.01 $360.53 $360.53 28 $319.47 $319.47 $373.95 $373.95 29 $328.88 $328.88 $384.96 $384.96 30 $333.58 $378.35 $390.46 $442.86 31 $340.63 $386.35 $398.72 $452.23 32 $347.69 $394.35 $406.97 $461.59 33 $352.09 $399.35 $412.13 $467.44 34 $356.80 $404.68 $417.64 $473.69 35 $359.15 $440.96 $420.39 $516.15 36 $361.50 $443.85 $423.14 $519.53 37 $363.85 $446.74 $425.89 $522.91 38 $366.20 $449.62 $428.65 $526.29 39 $370.90 $455.40 $434.15 $533.05 40 $375.61 $484.31 $439.66 $566.89 41 $382.66 $493.40 $447.91 $577.54 42 $389.42 $502.12 $455.82 $587.74 43 $398.83 $514.25 $466.83 $601.94 44 $410.58 $529.40 $480.59 $619.68 45 $424.39 $559.61 $496.76 $655.03 46 $440.85 $581.31 $516.03 $680.43 47 $459.37 $605.72 $537.70 $709.01 48 $480.53 $633.63 $562.47 $741.67 49 $501.40 $661.14 $586.90 $773.88 50 $524.91 $694.04 $614.42 $812.38 51 $548.13 $724.73 $641.59 $848.31 52 $573.70 $758.54 $671.52 $887.89 53 $599.56 $792.74 $701.80 $927.92 54 $627.48 $829.66 $734.48 $971.13 55 $655.40 $857.40 $767.16 $1,003.60 56 $685.67 $897.00 $802.59 $1,049.95 57 $716.24 $936.98 $838.37 $1,096.76 58 $748.86 $979.66 $876.56 $1,146.71 59 $765.03 $1,000.81 $895.48 $1,171.47 60 $797.65 $1,024.82 $933.67 $1,199.57 61 $825.87 $1,061.07 $966.69 $1,242.01 62 $844.38 $1,084.86 $988.36 $1,269.85 63 $867.60 $1,114.69 $1,015.54 $1,304.77 64 $881.70 $1,132.82 $1,032.06 $1,325.98 65+ $881.70 $1,132.82 $1,032.06 $1,325.98 Rates Effective January 1, 2018 Page 61 of 86

Texas Off Exchange (Bronze) Dallas-Fort Worth-Arlington, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $245.59 $245.59 $290.83 $290.83 15 $267.42 $267.42 $316.68 $316.68 16 $275.76 $275.76 $326.56 $326.56 17 $284.11 $284.11 $336.45 $336.45 18 $293.10 $293.10 $347.09 $347.09 19 $302.09 $302.09 $357.74 $357.74 20 $311.40 $311.40 $368.76 $368.76 21 $321.03 $321.03 $380.16 $380.16 22 $321.03 $321.03 $380.16 $380.16 23 $321.03 $321.03 $380.16 $380.16 24 $321.03 $321.03 $380.16 $380.16 25 $322.31 $322.31 $381.69 $381.69 26 $328.73 $328.73 $389.29 $389.29 27 $336.44 $336.44 $398.41 $398.41 28 $348.96 $348.96 $413.24 $413.24 29 $359.23 $359.23 $425.40 $425.40 30 $364.37 $413.27 $431.49 $489.39 31 $372.07 $422.01 $440.61 $499.74 32 $379.78 $430.74 $449.74 $510.09 33 $384.59 $436.20 $455.44 $516.56 34 $389.73 $442.03 $461.52 $523.46 35 $392.30 $481.66 $464.56 $570.39 36 $394.87 $484.81 $467.60 $574.12 37 $397.43 $487.97 $470.64 $577.86 38 $400.00 $491.12 $473.69 $581.59 39 $405.14 $497.43 $479.77 $589.06 40 $410.27 $529.01 $485.85 $626.45 41 $417.98 $538.94 $494.97 $638.22 42 $425.36 $548.46 $503.72 $649.50 43 $435.64 $561.71 $515.88 $665.18 44 $448.48 $578.27 $531.09 $684.79 45 $463.57 $611.26 $548.96 $723.86 46 $481.54 $634.96 $570.25 $751.93 47 $501.77 $661.63 $594.20 $783.51 48 $524.88 $692.11 $621.57 $819.60 49 $547.68 $722.16 $648.56 $855.19 50 $573.36 $758.09 $678.97 $897.74 51 $598.72 $791.63 $709.01 $937.45 52 $626.65 $828.55 $742.08 $981.18 53 $654.90 $865.91 $775.54 $1,025.41 54 $685.40 $906.23 $811.65 $1,073.17 55 $715.89 $936.53 $847.77 $1,109.05 56 $748.96 $979.79 $886.92 $1,160.27 57 $782.35 $1,023.47 $926.46 $1,212.00 58 $817.98 $1,070.08 $968.66 $1,267.20 59 $835.64 $1,093.18 $989.57 $1,294.55 60 $871.27 $1,119.41 $1,031.77 $1,325.62 61 $902.09 $1,159.01 $1,068.26 $1,372.51 62 $922.32 $1,184.99 $1,092.21 $1,403.28 63 $947.68 $1,217.58 $1,122.25 $1,441.86 64 $963.09 $1,237.37 $1,140.48 $1,465.31 65+ $963.09 $1,237.37 $1,140.48 $1,465.31 Rates Effective January 1, 2018 Page 62 of 86

Texas Off Exchange (Bronze) El Paso, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $213.08 $213.08 $259.04 $259.04 15 $232.03 $232.03 $282.06 $282.06 16 $239.27 $239.27 $290.87 $290.87 17 $246.51 $246.51 $299.67 $299.67 18 $254.31 $254.31 $309.15 $309.15 19 $262.11 $262.11 $318.63 $318.63 20 $270.19 $270.19 $328.45 $328.45 21 $278.54 $278.54 $338.61 $338.61 22 $278.54 $278.54 $338.61 $338.61 23 $278.54 $278.54 $338.61 $338.61 24 $278.54 $278.54 $338.61 $338.61 25 $279.66 $279.66 $339.97 $339.97 26 $285.23 $285.23 $346.74 $346.74 27 $291.91 $291.91 $354.87 $354.87 28 $302.77 $302.77 $368.07 $368.07 29 $311.69 $311.69 $378.91 $378.91 30 $316.14 $358.57 $384.32 $435.90 31 $322.83 $366.15 $392.45 $445.12 32 $329.51 $373.74 $400.58 $454.34 33 $333.69 $378.47 $405.66 $460.10 34 $338.15 $383.53 $411.07 $466.24 35 $340.38 $417.92 $413.78 $508.04 36 $342.61 $420.65 $416.49 $511.37 37 $344.83 $423.39 $419.20 $514.70 38 $347.06 $426.12 $421.91 $518.02 39 $351.52 $431.59 $427.33 $524.67 40 $355.98 $458.99 $432.75 $557.98 41 $362.66 $467.62 $440.87 $568.46 42 $369.07 $475.88 $448.66 $578.50 43 $377.98 $487.37 $459.50 $592.48 44 $389.12 $501.73 $473.04 $609.94 45 $402.21 $530.36 $488.96 $644.74 46 $417.81 $550.93 $507.92 $669.74 47 $435.36 $574.07 $529.25 $697.87 48 $455.42 $600.51 $553.63 $730.02 49 $475.19 $626.59 $577.67 $761.72 50 $497.48 $657.76 $604.76 $799.62 51 $519.48 $686.86 $631.51 $834.98 52 $543.71 $718.90 $660.97 $873.93 53 $568.22 $751.31 $690.77 $913.33 54 $594.69 $786.29 $722.94 $955.87 55 $621.15 $812.59 $755.10 $987.83 56 $649.84 $850.12 $789.98 $1,033.45 57 $678.81 $888.01 $825.20 $1,079.52 58 $709.72 $928.46 $862.78 $1,128.69 59 $725.04 $948.50 $881.41 $1,153.05 60 $755.96 $971.26 $918.99 $1,180.72 61 $782.70 $1,005.62 $951.50 $1,222.49 62 $800.25 $1,028.16 $972.83 $1,249.89 63 $822.25 $1,056.43 $999.58 $1,284.26 64 $835.62 $1,073.61 $1,015.83 $1,305.15 65+ $835.62 $1,073.61 $1,015.83 $1,305.15 Rates Effective January 1, 2018 Page 63 of 86

Texas Off Exchange (Bronze) Houston-Sugar Land-Baytown, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $234.58 $234.58 $285.19 $285.19 15 $255.43 $255.43 $310.54 $310.54 16 $263.40 $263.40 $320.24 $320.24 17 $271.37 $271.37 $329.93 $329.93 18 $279.96 $279.96 $340.37 $340.37 19 $288.54 $288.54 $350.81 $350.81 20 $297.44 $297.44 $361.62 $361.62 21 $306.64 $306.64 $372.80 $372.80 22 $306.64 $306.64 $372.80 $372.80 23 $306.64 $306.64 $372.80 $372.80 24 $306.64 $306.64 $372.80 $372.80 25 $307.86 $307.86 $374.29 $374.29 26 $314.00 $314.00 $381.75 $381.75 27 $321.35 $321.35 $390.70 $390.70 28 $333.31 $333.31 $405.23 $405.23 29 $343.13 $343.13 $417.16 $417.16 30 $348.03 $394.74 $423.13 $479.91 31 $355.39 $403.09 $432.08 $490.06 32 $362.75 $411.43 $441.02 $500.21 33 $367.35 $416.65 $446.62 $506.55 34 $372.26 $422.21 $452.58 $513.32 35 $374.71 $460.07 $455.56 $559.34 36 $377.16 $463.08 $458.54 $563.00 37 $379.62 $466.09 $461.53 $566.66 38 $382.07 $469.10 $464.51 $570.33 39 $386.97 $475.13 $470.47 $577.65 40 $391.88 $505.29 $476.44 $614.32 41 $399.24 $514.78 $485.39 $625.86 42 $406.29 $523.88 $493.96 $636.92 43 $416.11 $536.53 $505.89 $652.30 44 $428.37 $552.34 $520.80 $671.52 45 $442.78 $583.85 $538.32 $709.84 46 $459.95 $606.50 $559.20 $737.36 47 $479.27 $631.97 $582.69 $768.33 48 $501.35 $661.08 $609.53 $803.72 49 $523.12 $689.79 $636.00 $838.63 50 $547.65 $724.11 $665.82 $880.35 51 $571.88 $756.13 $695.27 $919.29 52 $598.55 $791.41 $727.71 $962.17 53 $625.54 $827.09 $760.51 $1,005.55 54 $654.67 $865.60 $795.93 $1,052.38 55 $683.80 $894.55 $831.35 $1,087.57 56 $715.38 $935.86 $869.74 $1,137.80 57 $747.27 $977.58 $908.52 $1,188.52 58 $781.31 $1,022.11 $949.90 $1,242.65 59 $798.17 $1,044.17 $970.40 $1,269.48 60 $832.21 $1,069.22 $1,011.78 $1,299.94 61 $861.65 $1,107.04 $1,047.57 $1,345.92 62 $880.97 $1,131.86 $1,071.06 $1,376.09 63 $905.19 $1,162.99 $1,100.51 $1,413.93 64 $919.92 $1,181.90 $1,118.40 $1,436.92 65+ $919.92 $1,181.90 $1,118.40 $1,436.92 Rates Effective January 1, 2018 Page 64 of 86

Texas Off Exchange (Bronze) Killeen-Temple-Fort Hood, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $226.67 $226.67 $270.70 $270.70 15 $246.82 $246.82 $294.76 $294.76 16 $254.53 $254.53 $303.96 $303.96 17 $262.23 $262.23 $313.16 $313.16 18 $270.53 $270.53 $323.07 $323.07 19 $278.82 $278.82 $332.97 $332.97 20 $287.42 $287.42 $343.24 $343.24 21 $296.31 $296.31 $353.85 $353.85 22 $296.31 $296.31 $353.85 $353.85 23 $296.31 $296.31 $353.85 $353.85 24 $296.31 $296.31 $353.85 $353.85 25 $297.49 $297.49 $355.27 $355.27 26 $303.42 $303.42 $362.34 $362.34 27 $310.53 $310.53 $370.84 $370.84 28 $322.09 $322.09 $384.64 $384.64 29 $331.57 $331.57 $395.96 $395.96 30 $336.31 $381.44 $401.62 $455.52 31 $343.42 $389.51 $410.11 $465.15 32 $350.53 $397.57 $418.61 $474.78 33 $354.98 $402.61 $423.91 $480.80 34 $359.72 $407.99 $429.58 $487.23 35 $362.09 $444.57 $432.41 $530.91 36 $364.46 $447.48 $435.24 $534.38 37 $366.83 $450.39 $438.07 $537.86 38 $369.20 $453.30 $440.90 $541.34 39 $373.94 $459.12 $446.56 $548.29 40 $378.68 $488.27 $452.22 $583.10 41 $385.79 $497.44 $460.72 $594.05 42 $392.61 $506.23 $468.85 $604.54 43 $402.09 $518.45 $480.18 $619.14 44 $413.94 $533.73 $494.33 $637.39 45 $427.87 $564.19 $510.96 $673.76 46 $444.46 $586.07 $530.78 $699.88 47 $463.13 $610.68 $553.07 $729.28 48 $484.46 $638.81 $578.55 $762.87 49 $505.50 $666.55 $603.67 $796.00 50 $529.20 $699.71 $631.98 $835.60 51 $552.61 $730.66 $659.93 $872.56 52 $578.39 $764.75 $690.72 $913.27 53 $604.47 $799.23 $721.86 $954.44 54 $632.62 $836.44 $755.47 $998.89 55 $660.76 $864.41 $789.09 $1,032.29 56 $691.28 $904.34 $825.54 $1,079.97 57 $722.10 $944.65 $862.34 $1,128.11 58 $754.99 $987.68 $901.61 $1,179.49 59 $771.29 $1,009.00 $921.08 $1,204.95 60 $804.18 $1,033.21 $960.35 $1,233.86 61 $832.62 $1,069.75 $994.32 $1,277.51 62 $851.29 $1,093.74 $1,016.62 $1,306.15 63 $874.70 $1,123.81 $1,044.57 $1,342.07 64 $888.93 $1,142.09 $1,061.55 $1,363.89 65+ $888.93 $1,142.09 $1,061.55 $1,363.89 Rates Effective January 1, 2018 Page 65 of 86

Texas Off Exchange (Bronze) Laredo, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $231.37 $231.37 $267.06 $267.06 15 $251.94 $251.94 $290.80 $290.80 16 $259.80 $259.80 $299.87 $299.87 17 $267.67 $267.67 $308.95 $308.95 18 $276.14 $276.14 $318.72 $318.72 19 $284.60 $284.60 $328.50 $328.50 20 $293.37 $293.37 $338.62 $338.62 21 $302.45 $302.45 $349.10 $349.10 22 $302.45 $302.45 $349.10 $349.10 23 $302.45 $302.45 $349.10 $349.10 24 $302.45 $302.45 $349.10 $349.10 25 $303.66 $303.66 $350.49 $350.49 26 $309.71 $309.71 $357.47 $357.47 27 $316.97 $316.97 $365.85 $365.85 28 $328.76 $328.76 $379.47 $379.47 29 $338.44 $338.44 $390.64 $390.64 30 $343.28 $389.35 $396.22 $449.40 31 $350.54 $397.58 $404.60 $458.90 32 $357.80 $405.81 $412.98 $468.40 33 $362.33 $410.96 $418.22 $474.34 34 $367.17 $416.45 $423.80 $480.68 35 $369.59 $453.78 $426.59 $523.77 36 $372.01 $456.75 $429.39 $527.20 37 $374.43 $459.73 $432.18 $530.63 38 $376.85 $462.70 $434.97 $534.06 39 $381.69 $468.64 $440.56 $540.92 40 $386.53 $498.39 $446.14 $575.26 41 $393.79 $507.75 $454.52 $586.06 42 $400.74 $516.72 $462.55 $596.41 43 $410.42 $529.20 $473.72 $610.82 44 $422.52 $544.80 $487.69 $628.82 45 $436.74 $575.88 $504.09 $664.70 46 $453.67 $598.21 $523.64 $690.48 47 $472.73 $623.34 $545.64 $719.47 48 $494.50 $652.05 $570.77 $752.62 49 $515.98 $680.37 $595.56 $785.30 50 $540.17 $714.22 $623.48 $824.37 51 $564.07 $745.81 $651.06 $860.83 52 $590.38 $780.60 $681.43 $900.99 53 $616.99 $815.79 $712.15 $941.61 54 $645.73 $853.78 $745.32 $985.46 55 $674.46 $882.33 $778.48 $1,018.41 56 $705.61 $923.08 $814.44 $1,065.45 57 $737.07 $964.23 $850.74 $1,112.94 58 $770.64 $1,008.15 $889.49 $1,163.64 59 $787.27 $1,029.91 $908.69 $1,188.75 60 $820.84 $1,054.62 $947.44 $1,217.28 61 $849.88 $1,091.93 $980.96 $1,260.33 62 $868.93 $1,116.41 $1,002.95 $1,288.59 63 $892.83 $1,147.10 $1,030.53 $1,324.02 64 $907.35 $1,165.76 $1,047.30 $1,345.55 65+ $907.35 $1,165.76 $1,047.30 $1,345.55 Rates Effective January 1, 2018 Page 66 of 86

Texas Off Exchange (Bronze) Longview, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $232.72 $232.72 $280.41 $280.41 15 $253.41 $253.41 $305.34 $305.34 16 $261.32 $261.32 $314.87 $314.87 17 $269.22 $269.22 $324.40 $324.40 18 $277.74 $277.74 $334.66 $334.66 19 $286.26 $286.26 $344.93 $344.93 20 $295.08 $295.08 $355.56 $355.56 21 $304.21 $304.21 $366.55 $366.55 22 $304.21 $304.21 $366.55 $366.55 23 $304.21 $304.21 $366.55 $366.55 24 $304.21 $304.21 $366.55 $366.55 25 $305.43 $305.43 $368.02 $368.02 26 $311.51 $311.51 $375.35 $375.35 27 $318.81 $318.81 $384.15 $384.15 28 $330.68 $330.68 $398.44 $398.44 29 $340.41 $340.41 $410.17 $410.17 30 $345.28 $391.61 $416.04 $471.87 31 $352.58 $399.89 $424.83 $481.85 32 $359.88 $408.18 $433.63 $491.83 33 $364.44 $413.35 $439.13 $498.06 34 $369.31 $418.87 $444.99 $504.71 35 $371.74 $456.43 $447.93 $549.96 36 $374.18 $459.41 $450.86 $553.56 37 $376.61 $462.40 $453.79 $557.17 38 $379.04 $465.39 $456.72 $560.77 39 $383.91 $471.37 $462.59 $567.97 40 $388.78 $501.29 $468.45 $604.02 41 $396.08 $510.71 $477.25 $615.37 42 $403.08 $519.73 $485.68 $626.24 43 $412.81 $532.28 $497.41 $641.36 44 $424.98 $547.97 $512.07 $660.27 45 $439.28 $579.23 $529.30 $697.94 46 $456.31 $601.69 $549.83 $725.00 47 $475.48 $626.97 $572.92 $755.45 48 $497.38 $655.85 $599.31 $790.25 49 $518.98 $684.33 $625.34 $824.57 50 $543.32 $718.37 $654.66 $865.59 51 $567.35 $750.15 $683.62 $903.88 52 $593.82 $785.14 $715.51 $946.05 53 $620.59 $820.54 $747.77 $988.70 54 $649.49 $858.75 $782.59 $1,034.74 55 $678.39 $887.47 $817.41 $1,069.34 56 $709.72 $928.45 $855.17 $1,118.73 57 $741.36 $969.84 $893.29 $1,168.60 58 $775.12 $1,014.02 $933.97 $1,221.82 59 $791.86 $1,035.90 $954.14 $1,248.20 60 $825.62 $1,060.76 $994.82 $1,278.15 61 $854.83 $1,098.28 $1,030.01 $1,323.36 62 $873.99 $1,122.90 $1,053.10 $1,353.03 63 $898.02 $1,153.78 $1,082.06 $1,390.23 64 $912.63 $1,172.54 $1,099.65 $1,412.84 65+ $912.63 $1,172.54 $1,099.65 $1,412.84 Rates Effective January 1, 2018 Page 67 of 86

Texas Off Exchange (Bronze) Lubbock, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $236.01 $236.01 $276.50 $276.50 15 $256.99 $256.99 $301.07 $301.07 16 $265.01 $265.01 $310.47 $310.47 17 $273.03 $273.03 $319.87 $319.87 18 $281.67 $281.67 $329.99 $329.99 19 $290.31 $290.31 $340.11 $340.11 20 $299.26 $299.26 $350.59 $350.59 21 $308.51 $308.51 $361.43 $361.43 22 $308.51 $308.51 $361.43 $361.43 23 $308.51 $308.51 $361.43 $361.43 24 $308.51 $308.51 $361.43 $361.43 25 $309.75 $309.75 $362.88 $362.88 26 $315.92 $315.92 $370.11 $370.11 27 $323.32 $323.32 $378.78 $378.78 28 $335.35 $335.35 $392.88 $392.88 29 $345.23 $345.23 $404.44 $404.44 30 $350.16 $397.16 $410.22 $465.28 31 $357.57 $405.55 $418.90 $475.12 32 $364.97 $413.95 $427.57 $484.95 33 $369.60 $419.20 $433.00 $491.10 34 $374.53 $424.80 $438.78 $497.66 35 $377.00 $462.88 $441.67 $542.28 36 $379.47 $465.91 $444.56 $545.83 37 $381.94 $468.95 $447.45 $549.38 38 $384.41 $471.98 $450.34 $552.93 39 $389.34 $478.03 $456.13 $560.03 40 $394.28 $508.38 $461.91 $595.59 41 $401.68 $517.93 $470.58 $606.77 42 $408.78 $527.08 $478.90 $617.49 43 $418.65 $539.81 $490.46 $632.40 44 $430.99 $555.72 $504.92 $651.04 45 $445.49 $587.43 $521.91 $688.19 46 $462.77 $610.21 $542.15 $714.88 47 $482.21 $635.84 $564.92 $744.90 48 $504.42 $665.13 $590.94 $779.21 49 $526.32 $694.01 $616.60 $813.05 50 $551.00 $728.54 $645.52 $853.50 51 $575.38 $760.76 $674.07 $891.25 52 $602.22 $796.25 $705.51 $932.83 53 $629.37 $832.15 $737.32 $974.89 54 $658.68 $870.90 $771.66 $1,020.29 55 $687.98 $900.02 $805.99 $1,054.40 56 $719.76 $941.59 $843.22 $1,103.10 57 $751.85 $983.56 $880.81 $1,152.27 58 $786.09 $1,028.36 $920.93 $1,204.76 59 $803.06 $1,050.56 $940.81 $1,230.76 60 $837.30 $1,075.77 $980.93 $1,260.29 61 $866.92 $1,113.82 $1,015.62 $1,304.87 62 $886.36 $1,138.79 $1,038.39 $1,334.13 63 $910.73 $1,170.11 $1,066.95 $1,370.81 64 $925.53 $1,189.13 $1,084.29 $1,393.10 65+ $925.53 $1,189.13 $1,084.29 $1,393.10 Rates Effective January 1, 2018 Page 68 of 86

Texas Off Exchange (Bronze) McAllen-Edinburg-Mission, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $204.38 $204.38 $246.98 $246.98 15 $222.54 $222.54 $268.93 $268.93 16 $229.49 $229.49 $277.33 $277.33 17 $236.44 $236.44 $285.72 $285.72 18 $243.92 $243.92 $294.76 $294.76 19 $251.40 $251.40 $303.80 $303.80 20 $259.15 $259.15 $313.16 $313.16 21 $267.16 $267.16 $322.85 $322.85 22 $267.16 $267.16 $322.85 $322.85 23 $267.16 $267.16 $322.85 $322.85 24 $267.16 $267.16 $322.85 $322.85 25 $268.23 $268.23 $324.14 $324.14 26 $273.57 $273.57 $330.60 $330.60 27 $279.98 $279.98 $338.35 $338.35 28 $290.40 $290.40 $350.94 $350.94 29 $298.95 $298.95 $361.27 $361.27 30 $303.23 $343.92 $366.43 $415.61 31 $309.64 $351.19 $374.18 $424.40 32 $316.05 $358.47 $381.93 $433.19 33 $320.06 $363.01 $386.77 $438.68 34 $324.33 $367.86 $391.94 $444.54 35 $326.47 $400.84 $394.52 $484.39 36 $328.61 $403.46 $397.11 $487.56 37 $330.75 $406.09 $399.69 $490.74 38 $332.88 $408.71 $402.27 $493.91 39 $337.16 $413.96 $407.44 $500.25 40 $341.43 $440.24 $412.60 $532.01 41 $347.84 $448.51 $420.35 $542.00 42 $353.99 $456.43 $427.78 $551.58 43 $362.54 $467.46 $438.11 $564.90 44 $373.22 $481.23 $451.02 $581.55 45 $385.78 $508.69 $466.19 $614.73 46 $400.74 $528.42 $484.27 $638.56 47 $417.57 $550.61 $504.61 $665.38 48 $436.81 $575.97 $527.86 $696.03 49 $455.78 $600.99 $550.78 $726.26 50 $477.15 $630.89 $576.61 $762.39 51 $498.25 $658.79 $602.11 $796.11 52 $521.50 $689.52 $630.20 $833.25 53 $545.01 $720.61 $658.61 $870.82 54 $570.39 $754.17 $689.28 $911.37 55 $595.77 $779.39 $719.95 $941.85 56 $623.29 $815.38 $753.21 $985.35 57 $651.07 $851.73 $786.78 $1,029.27 58 $680.73 $890.52 $822.62 $1,076.15 59 $695.42 $909.75 $840.38 $1,099.38 60 $725.07 $931.58 $876.21 $1,125.76 61 $750.72 $964.53 $907.21 $1,165.58 62 $767.55 $986.15 $927.55 $1,191.71 63 $788.66 $1,013.27 $953.05 $1,224.48 64 $801.48 $1,029.74 $968.55 $1,244.39 65+ $801.48 $1,029.74 $968.55 $1,244.39 Rates Effective January 1, 2018 Page 69 of 86

Texas Off Exchange (Bronze) Midland, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $229.62 $229.62 $268.12 $268.12 15 $250.03 $250.03 $291.95 $291.95 16 $257.83 $257.83 $301.06 $301.06 17 $265.63 $265.63 $310.18 $310.18 18 $274.04 $274.04 $319.99 $319.99 19 $282.44 $282.44 $329.80 $329.80 20 $291.15 $291.15 $339.97 $339.97 21 $300.15 $300.15 $350.48 $350.48 22 $300.15 $300.15 $350.48 $350.48 23 $300.15 $300.15 $350.48 $350.48 24 $300.15 $300.15 $350.48 $350.48 25 $301.35 $301.35 $351.88 $351.88 26 $307.36 $307.36 $358.89 $358.89 27 $314.56 $314.56 $367.31 $367.31 28 $326.27 $326.27 $380.97 $380.97 29 $335.87 $335.87 $392.19 $392.19 30 $340.67 $386.39 $397.80 $451.18 31 $347.88 $394.56 $406.21 $460.72 32 $355.08 $402.73 $414.62 $470.26 33 $359.58 $407.84 $419.88 $476.23 34 $364.38 $413.29 $425.49 $482.59 35 $366.79 $450.34 $428.29 $525.85 36 $369.19 $453.29 $431.09 $529.30 37 $371.59 $456.24 $433.90 $532.74 38 $373.99 $459.18 $436.70 $536.18 39 $378.79 $465.08 $442.31 $543.07 40 $383.59 $494.61 $447.92 $577.54 41 $390.80 $503.89 $456.33 $588.39 42 $397.70 $512.80 $464.39 $598.79 43 $407.31 $525.18 $475.61 $613.25 44 $419.31 $540.66 $489.62 $631.32 45 $433.42 $571.51 $506.10 $667.34 46 $450.23 $593.67 $525.72 $693.22 47 $469.14 $618.60 $547.80 $722.33 48 $490.75 $647.10 $573.04 $755.61 49 $512.06 $675.20 $597.92 $788.42 50 $536.07 $708.79 $625.96 $827.65 51 $559.78 $740.14 $653.65 $864.26 52 $585.90 $774.67 $684.14 $904.57 53 $612.31 $809.60 $714.98 $945.35 54 $640.82 $847.30 $748.28 $989.38 55 $669.34 $875.63 $781.58 $1,022.46 56 $700.25 $916.07 $817.68 $1,069.68 57 $731.47 $956.91 $854.13 $1,117.37 58 $764.79 $1,000.49 $893.03 $1,168.26 59 $781.30 $1,022.09 $912.31 $1,193.48 60 $814.61 $1,046.61 $951.21 $1,222.12 61 $843.43 $1,083.64 $984.86 $1,265.34 62 $862.34 $1,107.93 $1,006.94 $1,293.71 63 $886.05 $1,138.39 $1,034.63 $1,329.29 64 $900.45 $1,156.91 $1,051.44 $1,350.90 65+ $900.45 $1,156.91 $1,051.44 $1,350.90 Rates Effective January 1, 2018 Page 70 of 86

Texas Off Exchange (Bronze) Odessa, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $236.34 $236.34 $274.06 $274.06 15 $257.35 $257.35 $298.42 $298.42 16 $265.38 $265.38 $307.74 $307.74 17 $273.41 $273.41 $317.05 $317.05 18 $282.07 $282.07 $327.08 $327.08 19 $290.72 $290.72 $337.11 $337.11 20 $299.68 $299.68 $347.50 $347.50 21 $308.94 $308.94 $358.25 $358.25 22 $308.94 $308.94 $358.25 $358.25 23 $308.94 $308.94 $358.25 $358.25 24 $308.94 $308.94 $358.25 $358.25 25 $310.18 $310.18 $359.68 $359.68 26 $316.36 $316.36 $366.85 $366.85 27 $323.77 $323.77 $375.44 $375.44 28 $335.82 $335.82 $389.42 $389.42 29 $345.71 $345.71 $400.88 $400.88 30 $350.65 $397.71 $406.61 $461.18 31 $358.07 $406.12 $415.21 $470.93 32 $365.48 $414.53 $423.81 $480.68 33 $370.11 $419.78 $429.18 $486.78 34 $375.06 $425.39 $434.91 $493.28 35 $377.53 $463.53 $437.78 $537.50 36 $380.00 $466.56 $440.65 $541.02 37 $382.47 $469.60 $443.51 $544.54 38 $384.94 $472.63 $446.38 $548.06 39 $389.89 $478.70 $452.11 $555.10 40 $394.83 $509.09 $457.84 $590.34 41 $402.24 $518.65 $466.44 $601.43 42 $409.35 $527.82 $474.68 $612.05 43 $419.24 $540.56 $486.14 $626.83 44 $431.59 $556.50 $500.47 $645.31 45 $446.11 $588.25 $517.31 $682.13 46 $463.42 $611.06 $537.37 $708.58 47 $482.88 $636.72 $559.94 $738.34 48 $505.12 $666.05 $585.74 $772.35 49 $527.06 $694.98 $611.17 $805.89 50 $551.77 $729.55 $639.83 $845.98 51 $576.18 $761.82 $668.13 $883.40 52 $603.06 $797.36 $699.30 $924.61 53 $630.24 $833.31 $730.83 $966.30 54 $659.59 $872.12 $764.86 $1,011.30 55 $688.94 $901.28 $798.89 $1,045.11 56 $720.76 $942.90 $835.79 $1,093.38 57 $752.89 $984.94 $873.05 $1,142.12 58 $787.19 $1,029.80 $912.82 $1,194.14 59 $804.18 $1,052.03 $932.52 $1,219.92 60 $838.47 $1,077.27 $972.29 $1,249.19 61 $868.13 $1,115.38 $1,006.68 $1,293.38 62 $887.59 $1,140.38 $1,029.25 $1,322.38 63 $912.00 $1,171.74 $1,057.55 $1,358.74 64 $926.82 $1,190.79 $1,074.75 $1,380.83 65+ $926.82 $1,190.79 $1,074.75 $1,380.83 Rates Effective January 1, 2018 Page 71 of 86

Texas Off Exchange (Bronze) San Angelo, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $267.83 $267.83 $313.56 $313.56 15 $291.64 $291.64 $341.44 $341.44 16 $300.74 $300.74 $352.09 $352.09 17 $309.85 $309.85 $362.75 $362.75 18 $319.65 $319.65 $374.23 $374.23 19 $329.45 $329.45 $385.70 $385.70 20 $339.61 $339.61 $397.59 $397.59 21 $350.11 $350.11 $409.89 $409.89 22 $350.11 $350.11 $409.89 $409.89 23 $350.11 $350.11 $409.89 $409.89 24 $350.11 $350.11 $409.89 $409.89 25 $351.51 $351.51 $411.53 $411.53 26 $358.51 $358.51 $419.73 $419.73 27 $366.92 $366.92 $429.56 $429.56 28 $380.57 $380.57 $445.55 $445.55 29 $391.77 $391.77 $458.66 $458.66 30 $397.37 $450.70 $465.22 $527.66 31 $405.78 $460.23 $475.06 $538.81 32 $414.18 $469.76 $484.90 $549.97 33 $419.43 $475.72 $491.05 $556.94 34 $425.03 $482.07 $497.60 $564.38 35 $427.83 $525.29 $500.88 $614.98 36 $430.64 $528.73 $504.16 $619.01 37 $433.44 $532.17 $507.44 $623.04 38 $436.24 $535.61 $510.72 $627.06 39 $441.84 $542.49 $517.28 $635.11 40 $447.44 $576.93 $523.84 $675.43 41 $455.84 $587.76 $533.67 $688.12 42 $463.90 $598.15 $543.10 $700.28 43 $475.10 $612.59 $556.22 $717.19 44 $489.10 $630.65 $572.61 $738.33 45 $505.56 $666.63 $591.88 $780.45 46 $525.16 $692.48 $614.83 $810.72 47 $547.22 $721.57 $640.65 $844.77 48 $572.43 $754.81 $670.17 $883.68 49 $597.29 $787.58 $699.27 $922.06 50 $625.30 $826.77 $732.06 $967.93 51 $652.95 $863.34 $764.44 $1,010.74 52 $683.41 $903.61 $800.10 $1,057.89 53 $714.22 $944.35 $836.17 $1,105.59 54 $747.48 $988.33 $875.11 $1,157.07 55 $780.75 $1,021.37 $914.05 $1,195.76 56 $816.81 $1,068.55 $956.27 $1,250.99 57 $853.22 $1,116.18 $998.90 $1,306.76 58 $892.08 $1,167.02 $1,044.39 $1,366.28 59 $911.34 $1,192.21 $1,066.94 $1,395.77 60 $950.20 $1,220.82 $1,112.44 $1,429.26 61 $983.81 $1,264.00 $1,151.78 $1,479.81 62 $1,005.87 $1,292.34 $1,177.61 $1,512.99 63 $1,033.52 $1,327.87 $1,209.99 $1,554.59 64 $1,050.33 $1,349.46 $1,229.67 $1,579.87 65+ $1,050.33 $1,349.46 $1,229.67 $1,579.87 Rates Effective January 1, 2018 Page 72 of 86

Texas Off Exchange (Bronze) San Antonio-New Braunfels, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $240.82 $240.82 $279.45 $279.45 15 $262.22 $262.22 $304.29 $304.29 16 $270.41 $270.41 $313.79 $313.79 17 $278.59 $278.59 $323.29 $323.29 18 $287.41 $287.41 $333.51 $333.51 19 $296.22 $296.22 $343.74 $343.74 20 $305.35 $305.35 $354.34 $354.34 21 $314.79 $314.79 $365.30 $365.30 22 $314.79 $314.79 $365.30 $365.30 23 $314.79 $314.79 $365.30 $365.30 24 $314.79 $314.79 $365.30 $365.30 25 $316.05 $316.05 $366.76 $366.76 26 $322.35 $322.35 $374.06 $374.06 27 $329.90 $329.90 $382.83 $382.83 28 $342.18 $342.18 $397.08 $397.08 29 $352.25 $352.25 $408.77 $408.77 30 $357.29 $405.24 $414.61 $470.25 31 $364.85 $413.81 $423.38 $480.20 32 $372.40 $422.38 $432.14 $490.14 33 $377.12 $427.73 $437.62 $496.35 34 $382.16 $433.45 $443.47 $502.98 35 $384.68 $472.31 $446.39 $548.08 36 $387.20 $475.40 $449.31 $551.67 37 $389.72 $478.49 $452.24 $555.26 38 $392.23 $481.58 $455.16 $558.84 39 $397.27 $487.77 $461.00 $566.02 40 $402.31 $518.73 $466.85 $601.95 41 $409.86 $528.48 $475.61 $613.26 42 $417.10 $537.81 $484.02 $624.09 43 $427.18 $550.80 $495.71 $639.16 44 $439.77 $567.04 $510.32 $658.00 45 $454.56 $599.39 $527.49 $695.54 46 $472.19 $622.63 $547.94 $722.52 47 $492.02 $648.78 $570.96 $752.86 48 $514.69 $678.67 $597.26 $787.54 49 $537.04 $708.14 $623.19 $821.74 50 $562.22 $743.37 $652.42 $862.63 51 $587.09 $776.25 $681.28 $900.78 52 $614.48 $812.46 $713.06 $942.80 53 $642.18 $849.09 $745.20 $985.31 54 $672.09 $888.63 $779.91 $1,031.19 55 $701.99 $918.35 $814.61 $1,065.67 56 $734.41 $960.76 $852.23 $1,114.89 57 $767.15 $1,003.59 $890.22 $1,164.59 58 $802.10 $1,049.30 $930.77 $1,217.64 59 $819.41 $1,071.95 $950.86 $1,243.92 60 $854.35 $1,097.67 $991.41 $1,273.77 61 $884.57 $1,136.50 $1,026.48 $1,318.82 62 $904.40 $1,161.98 $1,049.49 $1,348.39 63 $929.27 $1,193.93 $1,078.35 $1,385.47 64 $944.37 $1,213.34 $1,095.90 $1,407.99 65+ $944.37 $1,213.34 $1,095.90 $1,407.99 Rates Effective January 1, 2018 Page 73 of 86

Texas Off Exchange (Bronze) Sherman-Denison, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $251.08 $251.08 $292.79 $292.79 15 $273.40 $273.40 $318.82 $318.82 16 $281.93 $281.93 $328.77 $328.77 17 $290.46 $290.46 $338.72 $338.72 18 $299.65 $299.65 $349.44 $349.44 19 $308.84 $308.84 $360.16 $360.16 20 $318.36 $318.36 $371.26 $371.26 21 $328.21 $328.21 $382.74 $382.74 22 $328.21 $328.21 $382.74 $382.74 23 $328.21 $328.21 $382.74 $382.74 24 $328.21 $328.21 $382.74 $382.74 25 $329.52 $329.52 $384.27 $384.27 26 $336.08 $336.08 $391.92 $391.92 27 $343.96 $343.96 $401.11 $401.11 28 $356.76 $356.76 $416.04 $416.04 29 $367.26 $367.26 $428.28 $428.28 30 $372.52 $422.51 $434.41 $492.71 31 $380.39 $431.44 $443.59 $503.12 32 $388.27 $440.38 $452.78 $513.54 33 $393.19 $445.96 $458.52 $520.05 34 $398.44 $451.91 $464.64 $527.00 35 $401.07 $492.43 $467.71 $574.25 36 $403.69 $495.66 $470.77 $578.01 37 $406.32 $498.88 $473.83 $581.77 38 $408.95 $502.10 $476.89 $585.53 39 $414.20 $508.55 $483.02 $593.05 40 $419.45 $540.84 $489.14 $630.70 41 $427.33 $550.99 $498.33 $642.54 42 $434.87 $560.73 $507.13 $653.89 43 $445.38 $574.27 $519.38 $669.68 44 $458.51 $591.20 $534.69 $689.42 45 $473.93 $624.93 $552.67 $728.76 46 $492.31 $649.16 $574.11 $757.02 47 $512.99 $676.43 $598.22 $788.81 48 $536.62 $707.59 $625.78 $825.15 49 $559.92 $738.31 $652.95 $860.98 50 $586.18 $775.04 $683.57 $903.82 51 $612.11 $809.33 $713.81 $943.79 52 $640.66 $847.08 $747.11 $987.82 53 $669.54 $885.27 $780.79 $1,032.36 54 $700.72 $926.50 $817.15 $1,080.43 55 $731.90 $957.48 $853.51 $1,116.56 56 $765.71 $1,001.70 $892.93 $1,168.13 57 $799.84 $1,046.35 $932.73 $1,220.20 58 $836.27 $1,094.01 $975.22 $1,275.78 59 $854.32 $1,117.62 $996.27 $1,303.32 60 $890.75 $1,144.44 $1,038.75 $1,334.59 61 $922.26 $1,184.92 $1,075.49 $1,381.80 62 $942.94 $1,211.49 $1,099.61 $1,412.77 63 $968.87 $1,244.80 $1,129.84 $1,451.62 64 $984.63 $1,265.04 $1,148.22 $1,475.23 65+ $984.63 $1,265.04 $1,148.22 $1,475.23 Rates Effective January 1, 2018 Page 74 of 86

Texas Off Exchange (Bronze) Texarkana, TX-Texarkana, AR Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $233.30 $233.30 $272.79 $272.79 15 $254.04 $254.04 $297.04 $297.04 16 $261.97 $261.97 $306.31 $306.31 17 $269.90 $269.90 $315.58 $315.58 18 $278.44 $278.44 $325.57 $325.57 19 $286.98 $286.98 $335.55 $335.55 20 $295.82 $295.82 $345.89 $345.89 21 $304.97 $304.97 $356.59 $356.59 22 $304.97 $304.97 $356.59 $356.59 23 $304.97 $304.97 $356.59 $356.59 24 $304.97 $304.97 $356.59 $356.59 25 $306.19 $306.19 $358.02 $358.02 26 $312.29 $312.29 $365.15 $365.15 27 $319.61 $319.61 $373.71 $373.71 28 $331.51 $331.51 $387.61 $387.61 29 $341.26 $341.26 $399.02 $399.02 30 $346.14 $392.60 $404.73 $459.05 31 $353.46 $400.90 $413.29 $468.75 32 $360.78 $409.20 $421.85 $478.46 33 $365.36 $414.39 $427.20 $484.52 34 $370.24 $419.92 $432.90 $491.00 35 $372.68 $457.57 $435.75 $535.02 36 $375.12 $460.57 $438.61 $538.52 37 $377.56 $463.56 $441.46 $542.02 38 $380.00 $466.56 $444.31 $545.53 39 $384.88 $472.55 $450.02 $552.53 40 $389.76 $502.55 $455.72 $587.61 41 $397.07 $511.99 $464.28 $598.64 42 $404.09 $521.03 $472.48 $609.22 43 $413.85 $533.62 $483.89 $623.93 44 $426.05 $549.34 $498.16 $642.32 45 $440.38 $580.69 $514.92 $678.97 46 $457.46 $603.21 $534.89 $705.30 47 $476.67 $628.54 $557.35 $734.92 48 $498.63 $657.49 $583.03 $768.78 49 $520.28 $686.05 $608.34 $802.16 50 $544.68 $720.18 $636.87 $842.07 51 $568.77 $752.03 $665.04 $879.32 52 $595.31 $787.11 $696.06 $920.33 53 $622.14 $822.60 $727.44 $961.83 54 $651.12 $860.91 $761.32 $1,006.62 55 $680.09 $889.69 $795.20 $1,040.28 56 $711.50 $930.79 $831.92 $1,088.32 57 $743.22 $972.28 $869.01 $1,136.84 58 $777.07 $1,016.56 $908.59 $1,188.62 59 $793.84 $1,038.50 $928.20 $1,214.28 60 $827.70 $1,063.42 $967.79 $1,243.41 61 $856.97 $1,101.04 $1,002.02 $1,287.39 62 $876.19 $1,125.72 $1,024.48 $1,316.26 63 $900.28 $1,156.68 $1,052.65 $1,352.45 64 $914.91 $1,175.49 $1,069.77 $1,374.44 65+ $914.91 $1,175.49 $1,069.77 $1,374.44 Rates Effective January 1, 2018 Page 75 of 86

Texas Off Exchange (Bronze) Tyler, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $225.77 $225.77 $277.00 $277.00 15 $245.84 $245.84 $301.62 $301.62 16 $253.52 $253.52 $311.03 $311.03 17 $261.19 $261.19 $320.45 $320.45 18 $269.45 $269.45 $330.59 $330.59 19 $277.72 $277.72 $340.73 $340.73 20 $286.27 $286.27 $351.23 $351.23 21 $295.13 $295.13 $362.09 $362.09 22 $295.13 $295.13 $362.09 $362.09 23 $295.13 $295.13 $362.09 $362.09 24 $295.13 $295.13 $362.09 $362.09 25 $296.31 $296.31 $363.54 $363.54 26 $302.21 $302.21 $370.78 $370.78 27 $309.29 $309.29 $379.47 $379.47 28 $320.80 $320.80 $393.59 $393.59 29 $330.25 $330.25 $405.18 $405.18 30 $334.97 $379.92 $410.97 $466.12 31 $342.05 $387.96 $419.66 $475.98 32 $349.14 $395.99 $428.35 $485.84 33 $353.56 $401.01 $433.78 $492.00 34 $358.29 $406.37 $439.58 $498.57 35 $360.65 $442.80 $442.47 $543.27 36 $363.01 $445.70 $445.37 $546.82 37 $365.37 $448.60 $448.27 $550.38 38 $367.73 $451.50 $451.16 $553.94 39 $372.45 $457.30 $456.96 $561.05 40 $377.17 $486.33 $462.75 $596.67 41 $384.26 $495.46 $471.44 $607.88 42 $391.05 $504.22 $479.77 $618.61 43 $400.49 $516.39 $491.35 $633.55 44 $412.29 $531.61 $505.84 $652.23 45 $426.17 $561.94 $522.86 $689.44 46 $442.69 $583.73 $543.13 $716.18 47 $461.29 $608.25 $565.95 $746.25 48 $482.54 $636.27 $592.02 $780.63 49 $503.49 $663.90 $617.72 $814.53 50 $527.10 $696.93 $646.69 $855.06 51 $550.41 $727.76 $675.30 $892.88 52 $576.09 $761.71 $706.80 $934.53 53 $602.06 $796.05 $738.66 $976.66 54 $630.10 $833.12 $773.06 $1,022.14 55 $658.14 $860.98 $807.46 $1,056.32 56 $688.53 $900.74 $844.75 $1,105.11 57 $719.23 $940.89 $882.41 $1,154.37 58 $751.99 $983.75 $922.60 $1,206.95 59 $768.22 $1,004.98 $942.52 $1,233.00 60 $800.98 $1,029.10 $982.71 $1,262.59 61 $829.31 $1,065.50 $1,017.47 $1,307.25 62 $847.90 $1,089.39 $1,040.28 $1,336.55 63 $871.22 $1,119.34 $1,068.89 $1,373.31 64 $885.39 $1,137.54 $1,086.27 $1,395.64 65+ $885.39 $1,137.54 $1,086.27 $1,395.64 Rates Effective January 1, 2018 Page 76 of 86

Texas Off Exchange (Bronze) Victoria, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $239.56 $239.56 $271.75 $271.75 15 $260.85 $260.85 $295.91 $295.91 16 $268.99 $268.99 $305.15 $305.15 17 $277.13 $277.13 $314.38 $314.38 18 $285.90 $285.90 $324.33 $324.33 19 $294.67 $294.67 $334.27 $334.27 20 $303.75 $303.75 $344.58 $344.58 21 $313.15 $313.15 $355.23 $355.23 22 $313.15 $313.15 $355.23 $355.23 23 $313.15 $313.15 $355.23 $355.23 24 $313.15 $313.15 $355.23 $355.23 25 $314.40 $314.40 $356.65 $356.65 26 $320.66 $320.66 $363.76 $363.76 27 $328.18 $328.18 $372.28 $372.28 28 $340.39 $340.39 $386.14 $386.14 29 $350.41 $350.41 $397.51 $397.51 30 $355.42 $403.12 $403.19 $457.30 31 $362.94 $411.64 $411.72 $466.97 32 $370.45 $420.17 $420.24 $476.64 33 $375.15 $425.49 $425.57 $482.68 34 $380.16 $431.18 $431.25 $489.13 35 $382.66 $469.84 $434.10 $532.98 36 $385.17 $472.91 $436.94 $536.47 37 $387.68 $475.99 $439.78 $539.96 38 $390.18 $479.06 $442.62 $543.45 39 $395.19 $485.21 $448.30 $550.43 40 $400.20 $516.02 $453.99 $585.37 41 $407.72 $525.71 $462.51 $596.37 42 $414.92 $535.00 $470.68 $606.90 43 $424.94 $547.92 $482.05 $621.56 44 $437.47 $564.07 $496.26 $639.88 45 $452.18 $596.25 $512.96 $676.39 46 $469.72 $619.37 $532.85 $702.62 47 $489.45 $645.39 $555.23 $732.13 48 $511.99 $675.12 $580.81 $765.85 49 $534.23 $704.43 $606.03 $799.11 50 $559.28 $739.48 $634.45 $838.87 51 $584.02 $772.19 $662.51 $875.97 52 $611.26 $808.21 $693.42 $916.83 53 $638.82 $844.65 $724.68 $958.17 54 $668.57 $883.98 $758.42 $1,002.79 55 $698.32 $913.54 $792.17 $1,036.32 56 $730.57 $955.73 $828.76 $1,084.18 57 $763.14 $998.34 $865.70 $1,132.51 58 $797.90 $1,043.81 $905.13 $1,184.10 59 $815.12 $1,066.34 $924.67 $1,209.65 60 $849.88 $1,091.93 $964.10 $1,238.68 61 $879.94 $1,130.55 $998.21 $1,282.50 62 $899.67 $1,155.89 $1,020.59 $1,311.25 63 $924.41 $1,187.68 $1,048.65 $1,347.30 64 $939.45 $1,206.99 $1,065.69 $1,369.21 65+ $939.45 $1,206.99 $1,065.69 $1,369.21 Rates Effective January 1, 2018 Page 77 of 86

Texas Off Exchange (Bronze) Waco, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $217.18 $217.18 $255.26 $255.26 15 $236.48 $236.48 $277.95 $277.95 16 $243.86 $243.86 $286.63 $286.63 17 $251.24 $251.24 $295.30 $295.30 18 $259.19 $259.19 $304.65 $304.65 19 $267.14 $267.14 $313.99 $313.99 20 $275.37 $275.37 $323.67 $323.67 21 $283.89 $283.89 $333.68 $333.68 22 $283.89 $283.89 $333.68 $333.68 23 $283.89 $283.89 $333.68 $333.68 24 $283.89 $283.89 $333.68 $333.68 25 $285.03 $285.03 $335.01 $335.01 26 $290.70 $290.70 $341.69 $341.69 27 $297.52 $297.52 $349.69 $349.69 28 $308.59 $308.59 $362.71 $362.71 29 $317.67 $317.67 $373.39 $373.39 30 $322.22 $365.46 $378.72 $429.55 31 $329.03 $373.19 $386.73 $438.63 32 $335.84 $380.91 $394.74 $447.72 33 $340.10 $385.74 $399.75 $453.39 34 $344.64 $390.89 $405.09 $459.45 35 $346.91 $425.94 $407.75 $500.64 36 $349.19 $428.73 $410.42 $503.92 37 $351.46 $431.52 $413.09 $507.20 38 $353.73 $434.31 $415.76 $510.47 39 $358.27 $439.88 $421.10 $517.03 40 $362.81 $467.81 $426.44 $549.85 41 $369.63 $476.59 $434.45 $560.18 42 $376.15 $485.02 $442.12 $570.08 43 $385.24 $496.73 $452.80 $583.84 44 $396.59 $511.37 $466.15 $601.05 45 $409.94 $540.54 $481.83 $635.34 46 $425.84 $561.51 $500.52 $659.98 47 $443.72 $585.09 $521.54 $687.70 48 $464.16 $612.04 $545.56 $719.38 49 $484.32 $638.62 $569.25 $750.62 50 $507.03 $670.39 $595.95 $787.96 51 $529.46 $700.04 $622.31 $822.82 52 $554.15 $732.70 $651.34 $861.20 53 $579.14 $765.73 $680.70 $900.03 54 $606.11 $801.39 $712.40 $941.94 55 $633.08 $828.19 $744.10 $973.44 56 $662.32 $866.44 $778.47 $1,018.40 57 $691.84 $905.06 $813.17 $1,063.79 58 $723.35 $946.29 $850.21 $1,112.25 59 $738.97 $966.71 $868.56 $1,136.25 60 $770.48 $989.91 $905.60 $1,163.52 61 $797.73 $1,024.93 $937.64 $1,204.67 62 $815.62 $1,047.90 $958.66 $1,231.68 63 $838.04 $1,076.72 $985.02 $1,265.55 64 $851.67 $1,094.23 $1,001.04 $1,286.13 65+ $851.67 $1,094.23 $1,001.04 $1,286.13 Rates Effective January 1, 2018 Page 78 of 86

Texas Off Exchange (Bronze) Wichita Falls, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $266.80 $266.80 $325.13 $325.13 15 $290.51 $290.51 $354.03 $354.03 16 $299.58 $299.58 $365.08 $365.08 17 $308.65 $308.65 $376.13 $376.13 18 $318.42 $318.42 $388.03 $388.03 19 $328.18 $328.18 $399.93 $399.93 20 $338.29 $338.29 $412.25 $412.25 21 $348.76 $348.76 $425.00 $425.00 22 $348.76 $348.76 $425.00 $425.00 23 $348.76 $348.76 $425.00 $425.00 24 $348.76 $348.76 $425.00 $425.00 25 $350.15 $350.15 $426.70 $426.70 26 $357.13 $357.13 $435.20 $435.20 27 $365.50 $365.50 $445.40 $445.40 28 $379.10 $379.10 $461.98 $461.98 29 $390.26 $390.26 $475.58 $475.58 30 $395.84 $448.96 $482.38 $547.11 31 $404.21 $458.46 $492.58 $558.68 32 $412.58 $467.95 $502.78 $570.25 33 $417.81 $473.88 $509.15 $577.48 34 $423.39 $480.21 $515.95 $585.19 35 $426.18 $523.26 $519.35 $637.66 36 $428.97 $526.69 $522.75 $641.83 37 $431.76 $530.12 $526.15 $646.01 38 $434.55 $533.54 $529.55 $650.18 39 $440.13 $540.39 $536.35 $658.53 40 $445.71 $574.70 $543.15 $700.34 41 $454.08 $585.49 $553.35 $713.49 42 $462.10 $595.84 $563.13 $726.10 43 $473.26 $610.23 $576.73 $743.63 44 $487.21 $628.21 $593.73 $765.55 45 $503.61 $664.05 $613.70 $809.23 46 $523.14 $689.81 $637.50 $840.61 47 $545.11 $718.78 $664.28 $875.91 48 $570.22 $751.89 $694.88 $916.26 49 $594.98 $784.54 $725.05 $956.05 50 $622.88 $823.57 $759.05 $1,003.62 51 $650.43 $860.00 $792.63 $1,048.01 52 $680.77 $900.12 $829.60 $1,096.90 53 $711.46 $940.70 $867.00 $1,146.35 54 $744.60 $984.51 $907.38 $1,199.74 55 $777.73 $1,017.43 $947.75 $1,239.85 56 $813.65 $1,064.42 $991.53 $1,297.12 57 $849.92 $1,111.87 $1,035.73 $1,354.94 58 $888.63 $1,162.51 $1,082.90 $1,416.65 59 $907.82 $1,187.60 $1,106.28 $1,447.23 60 $946.53 $1,216.10 $1,153.45 $1,481.96 61 $980.01 $1,259.11 $1,194.25 $1,534.38 62 $1,001.98 $1,287.34 $1,221.03 $1,568.78 63 $1,029.53 $1,322.74 $1,254.60 $1,611.91 64 $1,046.28 $1,344.25 $1,275.00 $1,638.12 65+ $1,046.28 $1,344.25 $1,275.00 $1,638.12 Rates Effective January 1, 2018 Page 79 of 86

Texas Off Exchange (Bronze) Non MSA, TX Blue Advantage Bronze HMO SM 204 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $236.36 $236.36 $266.03 $266.03 15 $257.37 $257.37 $289.68 $289.68 16 $265.40 $265.40 $298.72 $298.72 17 $273.44 $273.44 $307.76 $307.76 18 $282.09 $282.09 $317.50 $317.50 19 $290.74 $290.74 $327.23 $327.23 20 $299.70 $299.70 $337.32 $337.32 21 $308.97 $308.97 $347.75 $347.75 22 $308.97 $308.97 $347.75 $347.75 23 $308.97 $308.97 $347.75 $347.75 24 $308.97 $308.97 $347.75 $347.75 25 $310.20 $310.20 $349.14 $349.14 26 $316.38 $316.38 $356.10 $356.10 27 $323.80 $323.80 $364.44 $364.44 28 $335.85 $335.85 $378.01 $378.01 29 $345.74 $345.74 $389.13 $389.13 30 $350.68 $397.74 $394.70 $447.67 31 $358.09 $406.15 $403.04 $457.13 32 $365.51 $414.56 $411.39 $466.60 33 $370.14 $419.82 $416.61 $472.52 34 $375.09 $425.42 $422.17 $478.83 35 $377.56 $463.57 $424.95 $521.76 36 $380.03 $466.60 $427.74 $525.17 37 $382.50 $469.64 $430.52 $528.59 38 $384.97 $472.67 $433.30 $532.01 39 $389.92 $478.74 $438.86 $538.83 40 $394.86 $509.13 $444.43 $573.04 41 $402.28 $518.70 $452.77 $583.81 42 $409.38 $527.86 $460.77 $594.12 43 $419.27 $540.61 $471.90 $608.47 44 $431.63 $556.54 $485.81 $626.40 45 $446.15 $588.29 $502.15 $662.14 46 $463.45 $611.11 $521.63 $687.82 47 $482.92 $636.77 $543.54 $716.71 48 $505.16 $666.11 $568.57 $749.72 49 $527.10 $695.03 $593.27 $782.28 50 $551.82 $729.61 $621.09 $821.20 51 $576.23 $761.88 $648.56 $857.52 52 $603.11 $797.43 $678.81 $897.52 53 $630.30 $833.38 $709.41 $937.99 54 $659.65 $872.19 $742.45 $981.67 55 $689.00 $901.35 $775.49 $1,014.49 56 $720.82 $942.98 $811.31 $1,061.35 57 $752.96 $985.02 $847.47 $1,108.66 58 $787.25 $1,029.88 $886.07 $1,159.16 59 $804.24 $1,052.11 $905.20 $1,184.18 60 $838.54 $1,077.36 $943.80 $1,212.59 61 $868.20 $1,115.47 $977.18 $1,255.49 62 $887.67 $1,140.47 $999.09 $1,283.63 63 $912.07 $1,171.83 $1,026.56 $1,318.93 64 $926.91 $1,190.89 $1,043.25 $1,340.38 65+ $926.91 $1,190.89 $1,043.25 $1,340.38 Rates Effective January 1, 2018 Page 80 of 86

Texas Off Exchange (Catastrophic) Rating Area Abilene, TX Amarillo, TX Blue Advantage Security HMO SM 200 Austin-Round Rock-San Marcos, TX Beaumont-Port Arthur, TX Brownsville-Harlingen, TX Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $218.53 $218.53 $228.06 $228.06 $237.08 $237.08 $230.10 $230.10 $179.53 $179.53 15 $237.96 $237.96 $248.33 $248.33 $258.15 $258.15 $250.56 $250.56 $195.49 $195.49 16 $245.38 $245.38 $256.08 $256.08 $266.21 $266.21 $258.38 $258.38 $201.59 $201.59 17 $252.81 $252.81 $263.83 $263.83 $274.26 $274.26 $266.20 $266.20 $207.69 $207.69 18 $260.81 $260.81 $272.18 $272.18 $282.94 $282.94 $274.62 $274.62 $214.26 $214.26 19 $268.81 $268.81 $280.52 $280.52 $291.62 $291.62 $283.04 $283.04 $220.83 $220.83 20 $277.09 $277.09 $289.17 $289.17 $300.61 $300.61 $291.77 $291.77 $227.64 $227.64 21 $285.66 $285.66 $298.11 $298.11 $309.90 $309.90 $300.79 $300.79 $234.68 $234.68 22 $285.66 $285.66 $298.11 $298.11 $309.90 $309.90 $300.79 $300.79 $234.68 $234.68 23 $285.66 $285.66 $298.11 $298.11 $309.90 $309.90 $300.79 $300.79 $234.68 $234.68 24 $285.66 $285.66 $298.11 $298.11 $309.90 $309.90 $300.79 $300.79 $234.68 $234.68 25 $286.81 $286.81 $299.31 $299.31 $311.14 $311.14 $301.99 $301.99 $235.62 $235.62 26 $292.52 $292.52 $305.27 $305.27 $317.34 $317.34 $308.01 $308.01 $240.31 $240.31 27 $299.38 $299.38 $312.42 $312.42 $324.78 $324.78 $315.23 $315.23 $245.94 $245.94 28 $310.52 $310.52 $324.05 $324.05 $336.86 $336.86 $326.96 $326.96 $255.10 $255.10 29 $319.66 $319.66 $333.59 $333.59 $346.78 $346.78 $336.58 $336.58 $262.60 $262.60 30 $324.23 $367.74 $338.36 $383.77 $351.74 $398.94 $341.40 $387.21 $266.36 $302.11 31 $331.08 $375.52 $345.51 $391.88 $359.18 $407.38 $348.62 $395.40 $271.99 $308.49 32 $337.94 $383.29 $352.67 $400.00 $366.61 $415.81 $355.83 $403.59 $277.62 $314.88 33 $342.22 $388.15 $357.14 $405.07 $371.26 $421.09 $360.35 $408.70 $281.14 $318.87 34 $346.80 $393.34 $361.91 $410.48 $376.22 $426.71 $365.16 $414.16 $284.90 $323.13 35 $349.08 $428.60 $364.29 $447.28 $378.70 $464.97 $367.57 $451.30 $286.78 $352.10 36 $351.37 $431.41 $366.68 $450.21 $381.18 $468.01 $369.97 $454.25 $288.65 $354.41 37 $353.65 $434.21 $369.06 $453.14 $383.66 $471.06 $372.38 $457.21 $290.53 $356.72 38 $355.94 $437.02 $371.45 $456.07 $386.14 $474.10 $374.78 $460.16 $292.41 $359.02 39 $360.51 $442.63 $376.22 $461.92 $391.10 $480.19 $379.60 $466.07 $296.16 $363.63 40 $365.08 $470.73 $380.99 $491.25 $396.05 $510.67 $384.41 $495.66 $299.92 $386.71 41 $371.93 $479.57 $388.14 $500.47 $403.49 $520.26 $391.63 $504.97 $305.55 $393.98 42 $378.50 $488.04 $395.00 $509.31 $410.62 $529.46 $398.55 $513.89 $310.95 $400.94 43 $387.65 $499.83 $404.54 $521.61 $420.54 $542.24 $408.17 $526.30 $318.46 $410.62 44 $399.07 $514.56 $416.46 $536.99 $432.93 $558.22 $420.20 $541.81 $327.85 $422.72 45 $412.50 $543.92 $430.48 $567.63 $447.50 $590.07 $434.34 $572.72 $338.88 $446.84 46 $428.50 $565.01 $447.17 $589.64 $464.85 $612.96 $451.18 $594.93 $352.02 $464.17 47 $446.49 $588.74 $465.95 $614.40 $484.38 $638.70 $470.13 $619.92 $366.80 $483.66 48 $467.06 $615.86 $487.42 $642.71 $506.69 $668.12 $491.79 $648.48 $383.70 $505.95 49 $487.34 $642.61 $508.58 $670.61 $528.69 $697.13 $513.15 $676.64 $400.36 $527.92 50 $510.19 $674.58 $532.43 $703.98 $553.49 $731.82 $537.21 $710.30 $419.14 $554.18 51 $532.76 $704.42 $555.98 $735.12 $577.97 $764.19 $560.97 $741.72 $437.67 $578.69 52 $557.61 $737.28 $581.92 $769.41 $604.93 $799.84 $587.14 $776.32 $458.09 $605.69 53 $582.75 $770.52 $608.15 $804.10 $632.20 $835.90 $613.61 $811.32 $478.74 $633.00 54 $609.89 $806.40 $636.47 $841.54 $661.64 $874.82 $642.19 $849.10 $501.04 $662.47 55 $637.03 $833.36 $664.79 $869.68 $691.08 $904.07 $670.76 $877.49 $523.33 $684.62 56 $666.45 $871.85 $695.50 $909.85 $723.00 $945.83 $701.74 $918.02 $547.50 $716.25 57 $696.16 $910.72 $726.50 $950.41 $755.23 $987.99 $733.02 $958.94 $571.91 $748.17 58 $727.87 $952.20 $759.59 $993.70 $789.63 $1,032.99 $766.41 $1,002.62 $597.96 $782.25 59 $743.58 $972.75 $775.99 $1,015.15 $806.68 $1,055.29 $782.96 $1,024.26 $610.87 $799.14 60 $775.29 $996.09 $809.08 $1,039.51 $841.07 $1,080.61 $816.34 $1,048.84 $636.92 $818.31 61 $802.71 $1,031.33 $837.70 $1,076.28 $870.82 $1,118.84 $845.22 $1,085.94 $659.45 $847.26 62 $820.71 $1,054.45 $856.48 $1,100.40 $890.35 $1,143.92 $864.17 $1,110.28 $674.23 $866.25 63 $843.28 $1,083.44 $880.03 $1,130.66 $914.83 $1,175.38 $887.93 $1,140.81 $692.77 $890.07 64 $856.98 $1,101.06 $894.33 $1,149.05 $929.70 $1,194.49 $902.37 $1,159.36 $704.04 $904.54 65+ $856.98 $1,101.06 $894.33 $1,149.05 $929.70 $1,194.49 $902.37 $1,159.36 $704.04 $904.54 Rates Effective January 1, 2018 Page 81 of 86

Texas Off Exchange (Catastrophic) Rating Area College Station-Bryan, TX Corpus Christi, TX Blue Advantage Security HMO SM 200 Dallas-Fort Worth-Arlington, TX El Paso, TX Houston-Sugar Land- Baytown, TX Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $228.92 $228.92 $212.10 $212.10 $231.68 $231.68 $201.02 $201.02 $221.29 $221.29 15 $249.27 $249.27 $230.95 $230.95 $252.27 $252.27 $218.88 $218.88 $240.96 $240.96 16 $257.05 $257.05 $238.16 $238.16 $260.15 $260.15 $225.72 $225.72 $248.48 $248.48 17 $264.83 $264.83 $245.37 $245.37 $268.02 $268.02 $232.55 $232.55 $256.00 $256.00 18 $273.21 $273.21 $253.14 $253.14 $276.50 $276.50 $239.91 $239.91 $264.10 $264.10 19 $281.59 $281.59 $260.90 $260.90 $284.98 $284.98 $247.26 $247.26 $272.20 $272.20 20 $290.27 $290.27 $268.94 $268.94 $293.76 $293.76 $254.88 $254.88 $280.59 $280.59 21 $299.24 $299.24 $277.26 $277.26 $302.85 $302.85 $262.77 $262.77 $289.27 $289.27 22 $299.24 $299.24 $277.26 $277.26 $302.85 $302.85 $262.77 $262.77 $289.27 $289.27 23 $299.24 $299.24 $277.26 $277.26 $302.85 $302.85 $262.77 $262.77 $289.27 $289.27 24 $299.24 $299.24 $277.26 $277.26 $302.85 $302.85 $262.77 $262.77 $289.27 $289.27 25 $300.44 $300.44 $278.37 $278.37 $304.06 $304.06 $263.82 $263.82 $290.43 $290.43 26 $306.43 $306.43 $283.91 $283.91 $310.12 $310.12 $269.07 $269.07 $296.21 $296.21 27 $313.61 $313.61 $290.56 $290.56 $317.38 $317.38 $275.38 $275.38 $303.15 $303.15 28 $325.28 $325.28 $301.38 $301.38 $329.19 $329.19 $285.63 $285.63 $314.44 $314.44 29 $334.86 $334.86 $310.25 $310.25 $338.89 $338.89 $294.03 $294.03 $323.69 $323.69 30 $339.64 $385.22 $314.69 $356.92 $343.73 $389.86 $298.24 $338.26 $328.32 $372.38 31 $346.82 $393.37 $321.34 $364.46 $351.00 $398.10 $304.55 $345.42 $335.26 $380.26 32 $354.01 $401.51 $327.99 $372.01 $358.27 $406.35 $310.85 $352.57 $342.21 $388.13 33 $358.50 $406.61 $332.15 $376.73 $362.81 $411.50 $314.79 $357.04 $346.54 $393.05 34 $363.28 $412.04 $336.59 $381.76 $367.66 $417.00 $319.00 $361.81 $351.17 $398.30 35 $365.68 $448.98 $338.81 $415.99 $370.08 $454.38 $321.10 $394.25 $353.49 $434.01 36 $368.07 $451.92 $341.03 $418.71 $372.50 $457.36 $323.20 $396.83 $355.80 $436.85 37 $370.47 $454.86 $343.24 $421.44 $374.92 $460.33 $325.30 $399.41 $358.12 $439.69 38 $372.86 $457.80 $345.46 $424.16 $377.35 $463.31 $327.41 $401.99 $360.43 $442.54 39 $377.65 $463.67 $349.90 $429.60 $382.19 $469.26 $331.61 $407.15 $365.06 $448.22 40 $382.44 $493.11 $354.33 $456.88 $387.04 $499.05 $335.81 $433.00 $369.69 $476.67 41 $389.62 $502.37 $360.99 $465.46 $394.31 $508.42 $342.12 $441.13 $376.63 $485.63 42 $396.50 $511.25 $367.36 $473.68 $401.27 $517.40 $348.16 $448.92 $383.28 $494.20 43 $406.08 $523.59 $376.24 $485.12 $410.96 $529.90 $356.57 $459.77 $392.54 $506.14 44 $418.05 $539.03 $387.33 $499.42 $423.08 $545.52 $367.08 $473.32 $404.11 $521.06 45 $432.11 $569.78 $400.36 $527.91 $437.31 $576.64 $379.43 $500.32 $417.70 $550.79 46 $448.87 $591.88 $415.88 $548.39 $454.27 $599.00 $394.15 $519.72 $433.90 $572.15 47 $467.72 $616.73 $433.35 $571.42 $473.35 $624.16 $410.70 $541.55 $452.13 $596.18 48 $489.27 $645.15 $453.31 $597.74 $495.15 $652.91 $429.62 $566.50 $472.96 $623.64 49 $510.51 $673.16 $473.00 $623.70 $516.66 $681.26 $448.28 $591.10 $493.49 $650.72 50 $534.45 $706.65 $495.18 $654.73 $540.88 $715.16 $469.30 $620.51 $516.63 $683.09 51 $558.09 $737.91 $517.08 $683.69 $564.81 $746.79 $490.06 $647.95 $539.49 $713.31 52 $584.13 $772.33 $541.20 $715.58 $591.16 $781.63 $512.92 $678.18 $564.65 $746.58 53 $610.46 $807.15 $565.60 $747.84 $617.81 $816.87 $536.04 $708.76 $590.11 $780.24 54 $638.89 $844.74 $591.94 $782.67 $646.58 $854.91 $561.01 $741.76 $617.59 $816.58 55 $667.32 $872.98 $618.28 $808.84 $675.35 $883.49 $585.97 $766.56 $645.07 $843.88 56 $698.14 $913.30 $646.84 $846.20 $706.54 $924.30 $613.03 $801.97 $674.86 $882.86 57 $729.26 $954.02 $675.67 $883.92 $738.04 $965.50 $640.36 $837.72 $704.95 $922.21 58 $762.48 $997.47 $706.45 $924.18 $771.65 $1,009.48 $669.53 $875.87 $737.06 $964.22 59 $778.93 $1,019.00 $721.70 $944.13 $788.31 $1,031.27 $683.98 $894.78 $752.97 $985.03 60 $812.15 $1,043.45 $752.47 $966.78 $821.93 $1,056.01 $713.15 $916.25 $785.08 $1,008.67 61 $840.88 $1,080.36 $779.09 $1,000.98 $851.00 $1,093.36 $738.37 $948.66 $812.85 $1,044.35 62 $859.73 $1,104.58 $796.56 $1,023.42 $870.08 $1,117.88 $754.93 $969.93 $831.07 $1,067.76 63 $883.37 $1,134.96 $818.46 $1,051.56 $894.00 $1,148.62 $775.68 $996.60 $853.92 $1,097.12 64 $897.72 $1,153.41 $831.78 $1,068.66 $908.55 $1,167.29 $788.31 $1,012.80 $867.81 $1,114.96 65+ $897.72 $1,153.41 $831.78 $1,068.66 $908.55 $1,167.29 $788.31 $1,012.80 $867.81 $1,114.96 Rates Effective January 1, 2018 Page 82 of 86

Texas Off Exchange (Catastrophic) Rating Area Killeen-Temple-Fort Hood, TX Blue Advantage Security HMO SM 200 Laredo, TX Longview, TX Lubbock, TX McAllen-Edinburg-Mission, TX Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $213.84 $213.84 $218.27 $218.27 $219.54 $219.54 $222.65 $222.65 $192.80 $192.80 15 $232.84 $232.84 $237.67 $237.67 $239.05 $239.05 $242.44 $242.44 $209.94 $209.94 16 $240.11 $240.11 $245.09 $245.09 $246.52 $246.52 $250.00 $250.00 $216.49 $216.49 17 $247.38 $247.38 $252.51 $252.51 $253.98 $253.98 $257.57 $257.57 $223.05 $223.05 18 $255.21 $255.21 $260.50 $260.50 $262.01 $262.01 $265.72 $265.72 $230.10 $230.10 19 $263.03 $263.03 $268.48 $268.48 $270.05 $270.05 $273.87 $273.87 $237.16 $237.16 20 $271.14 $271.14 $276.76 $276.76 $278.37 $278.37 $282.31 $282.31 $244.47 $244.47 21 $279.53 $279.53 $285.32 $285.32 $286.98 $286.98 $291.04 $291.04 $252.03 $252.03 22 $279.53 $279.53 $285.32 $285.32 $286.98 $286.98 $291.04 $291.04 $252.03 $252.03 23 $279.53 $279.53 $285.32 $285.32 $286.98 $286.98 $291.04 $291.04 $252.03 $252.03 24 $279.53 $279.53 $285.32 $285.32 $286.98 $286.98 $291.04 $291.04 $252.03 $252.03 25 $280.64 $280.64 $286.46 $286.46 $288.13 $288.13 $292.20 $292.20 $253.04 $253.04 26 $286.23 $286.23 $292.17 $292.17 $293.87 $293.87 $298.02 $298.02 $258.08 $258.08 27 $292.94 $292.94 $299.01 $299.01 $300.75 $300.75 $305.01 $305.01 $264.13 $264.13 28 $303.84 $303.84 $310.14 $310.14 $311.95 $311.95 $316.36 $316.36 $273.96 $273.96 29 $312.79 $312.79 $319.27 $319.27 $321.13 $321.13 $325.67 $325.67 $282.02 $282.02 30 $317.26 $359.84 $323.84 $367.30 $325.72 $369.43 $330.33 $374.66 $286.05 $324.44 31 $323.97 $367.45 $330.68 $375.06 $332.61 $377.25 $337.32 $382.58 $292.10 $331.30 32 $330.68 $375.06 $337.53 $382.83 $339.50 $385.06 $344.30 $390.51 $298.15 $338.16 33 $334.87 $379.81 $341.81 $387.68 $343.80 $389.94 $348.67 $395.46 $301.93 $342.45 34 $339.34 $384.88 $346.38 $392.86 $348.39 $395.15 $353.32 $400.74 $305.96 $347.02 35 $341.58 $419.39 $348.66 $428.08 $350.69 $430.58 $355.65 $436.67 $307.98 $378.14 36 $343.82 $422.14 $350.94 $430.88 $352.98 $433.39 $357.98 $439.53 $310.00 $380.61 37 $346.05 $424.88 $353.22 $433.69 $355.28 $436.21 $360.31 $442.39 $312.01 $383.09 38 $348.29 $427.63 $355.51 $436.49 $357.58 $439.03 $362.64 $445.24 $314.03 $385.57 39 $352.76 $433.12 $360.07 $442.10 $362.17 $444.67 $367.29 $450.96 $318.06 $390.51 40 $357.23 $460.62 $364.64 $470.16 $366.76 $472.90 $371.95 $479.59 $322.09 $415.31 41 $363.94 $469.27 $371.48 $478.99 $373.65 $481.78 $378.93 $488.60 $328.14 $423.11 42 $370.37 $477.56 $378.05 $487.46 $380.25 $490.29 $385.63 $497.23 $333.94 $430.58 43 $379.32 $489.09 $387.18 $499.23 $389.43 $502.13 $394.94 $509.24 $342.00 $440.98 44 $390.50 $503.51 $398.59 $513.94 $400.91 $516.93 $406.58 $524.25 $352.09 $453.98 45 $403.63 $532.23 $412.00 $543.26 $414.40 $546.43 $420.26 $554.16 $363.93 $479.88 46 $419.29 $552.87 $427.98 $564.33 $430.47 $567.62 $436.56 $575.65 $378.04 $498.49 47 $436.90 $576.09 $445.95 $588.03 $448.55 $591.46 $454.90 $599.82 $393.92 $519.43 48 $457.02 $602.63 $466.50 $615.12 $469.21 $618.70 $475.85 $627.46 $412.07 $543.35 49 $476.87 $628.80 $486.75 $641.83 $489.59 $645.57 $496.51 $654.70 $429.96 $566.95 50 $499.23 $660.08 $509.58 $673.77 $512.55 $677.69 $519.80 $687.28 $450.12 $595.16 51 $521.31 $689.28 $532.12 $703.57 $535.22 $707.66 $542.79 $717.68 $470.04 $621.48 52 $545.63 $721.43 $556.94 $736.39 $560.18 $740.67 $568.11 $751.15 $491.96 $650.47 53 $570.23 $753.96 $582.05 $769.59 $585.44 $774.07 $593.72 $785.02 $514.14 $679.80 54 $596.79 $789.07 $609.15 $805.43 $612.70 $810.11 $621.37 $821.58 $538.08 $711.45 55 $623.34 $815.46 $636.26 $832.36 $639.96 $837.20 $649.02 $849.05 $562.03 $735.24 56 $652.13 $853.12 $665.65 $870.80 $669.52 $875.87 $679.00 $888.26 $587.99 $769.20 57 $681.20 $891.15 $695.32 $909.62 $699.37 $914.91 $709.26 $927.86 $614.20 $803.49 58 $712.23 $931.74 $726.99 $951.05 $731.22 $956.59 $741.57 $970.12 $642.17 $840.09 59 $727.60 $951.85 $742.68 $971.58 $747.01 $977.23 $757.58 $991.06 $656.03 $858.22 60 $758.63 $974.69 $774.35 $994.89 $778.86 $1,000.68 $789.88 $1,014.84 $684.01 $878.81 61 $785.47 $1,009.17 $801.74 $1,030.08 $806.41 $1,036.08 $817.82 $1,050.74 $708.20 $909.90 62 $803.08 $1,031.79 $819.72 $1,053.18 $824.49 $1,059.31 $836.16 $1,074.30 $724.08 $930.30 63 $825.16 $1,060.16 $842.26 $1,082.14 $847.16 $1,088.44 $859.15 $1,103.84 $743.99 $955.88 64 $838.59 $1,077.40 $855.96 $1,099.73 $860.94 $1,106.13 $873.12 $1,121.78 $756.09 $971.42 65+ $838.59 $1,077.40 $855.96 $1,099.73 $860.94 $1,106.13 $873.12 $1,121.78 $756.09 $971.42 Rates Effective January 1, 2018 Page 83 of 86

Texas Off Exchange (Catastrophic) Rating Area Blue Advantage Security HMO SM 200 Midland, TX Odessa, TX San Angelo, TX San Antonio-New Braunfels, TX Sherman-Denison, TX Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $216.61 $216.61 $222.96 $222.96 $252.66 $252.66 $227.18 $227.18 $236.86 $236.86 15 $235.87 $235.87 $242.77 $242.77 $275.12 $275.12 $247.37 $247.37 $257.91 $257.91 16 $243.23 $243.23 $250.35 $250.35 $283.71 $283.71 $255.09 $255.09 $265.96 $265.96 17 $250.59 $250.59 $257.93 $257.93 $292.30 $292.30 $262.81 $262.81 $274.01 $274.01 18 $258.52 $258.52 $266.09 $266.09 $301.55 $301.55 $271.13 $271.13 $282.68 $282.68 19 $266.45 $266.45 $274.25 $274.25 $310.79 $310.79 $279.44 $279.44 $291.35 $291.35 20 $274.66 $274.66 $282.70 $282.70 $320.37 $320.37 $288.06 $288.06 $300.33 $300.33 21 $283.15 $283.15 $291.45 $291.45 $330.28 $330.28 $296.97 $296.97 $309.62 $309.62 22 $283.15 $283.15 $291.45 $291.45 $330.28 $330.28 $296.97 $296.97 $309.62 $309.62 23 $283.15 $283.15 $291.45 $291.45 $330.28 $330.28 $296.97 $296.97 $309.62 $309.62 24 $283.15 $283.15 $291.45 $291.45 $330.28 $330.28 $296.97 $296.97 $309.62 $309.62 25 $284.28 $284.28 $292.61 $292.61 $331.60 $331.60 $298.15 $298.15 $310.86 $310.86 26 $289.95 $289.95 $298.44 $298.44 $338.21 $338.21 $304.09 $304.09 $317.05 $317.05 27 $296.74 $296.74 $305.44 $305.44 $346.13 $346.13 $311.22 $311.22 $324.48 $324.48 28 $307.79 $307.79 $316.80 $316.80 $359.02 $359.02 $322.80 $322.80 $336.56 $336.56 29 $316.85 $316.85 $326.13 $326.13 $369.58 $369.58 $332.30 $332.30 $346.46 $346.46 30 $321.38 $364.51 $330.79 $375.18 $374.87 $425.18 $337.06 $382.29 $351.42 $398.58 31 $328.17 $372.21 $337.79 $383.12 $382.80 $434.17 $344.18 $390.37 $358.85 $407.01 32 $334.97 $379.92 $344.78 $391.05 $390.72 $443.16 $351.31 $398.46 $366.28 $415.43 33 $339.22 $384.74 $349.15 $396.01 $395.68 $448.78 $355.76 $403.51 $370.92 $420.70 34 $343.75 $389.88 $353.82 $401.30 $400.96 $454.77 $360.52 $408.90 $375.88 $426.32 35 $346.01 $424.83 $356.15 $437.28 $403.60 $495.54 $362.89 $445.56 $378.35 $464.54 36 $348.28 $427.61 $358.48 $440.14 $406.25 $498.79 $365.27 $448.47 $380.83 $467.58 37 $350.54 $430.40 $360.81 $443.00 $408.89 $502.03 $367.64 $451.39 $383.31 $470.63 38 $352.81 $433.18 $363.14 $445.87 $411.53 $505.28 $370.02 $454.31 $385.78 $473.67 39 $357.34 $438.74 $367.80 $451.59 $416.81 $511.76 $374.77 $460.14 $390.74 $479.75 40 $361.87 $466.59 $372.47 $480.26 $422.10 $544.25 $379.52 $489.35 $395.69 $510.20 41 $368.66 $475.36 $379.46 $489.28 $430.03 $554.48 $386.65 $498.55 $403.12 $519.79 42 $375.18 $483.75 $386.17 $497.92 $437.62 $564.27 $393.48 $507.35 $410.24 $528.97 43 $384.24 $495.44 $395.49 $509.95 $448.19 $577.90 $402.98 $519.61 $420.15 $541.75 44 $395.56 $510.04 $407.15 $524.98 $461.40 $594.93 $414.86 $534.92 $432.54 $557.71 45 $408.87 $539.14 $420.85 $554.93 $476.93 $628.87 $428.82 $565.44 $447.09 $589.53 46 $424.73 $560.05 $437.17 $576.45 $495.42 $653.26 $445.45 $587.37 $464.43 $612.39 47 $442.57 $583.57 $455.53 $600.66 $516.23 $680.70 $464.16 $612.04 $483.93 $638.11 48 $462.95 $610.45 $476.51 $628.33 $540.01 $712.06 $485.54 $640.23 $506.23 $667.51 49 $483.06 $636.96 $497.21 $655.62 $563.46 $742.98 $506.62 $668.03 $528.21 $696.50 50 $505.71 $668.65 $520.52 $688.23 $589.88 $779.94 $530.38 $701.27 $552.98 $731.15 51 $528.08 $698.22 $543.55 $718.68 $615.97 $814.44 $553.84 $732.29 $577.44 $763.49 52 $552.71 $730.80 $568.90 $752.20 $644.71 $852.43 $579.68 $766.45 $604.38 $799.10 53 $577.63 $763.74 $594.55 $786.11 $673.77 $890.86 $605.81 $801.00 $631.62 $835.13 54 $604.53 $799.31 $622.24 $822.72 $705.15 $932.35 $634.02 $838.30 $661.04 $874.02 55 $631.43 $826.04 $649.92 $850.23 $736.53 $963.52 $662.23 $866.33 $690.45 $903.25 56 $660.59 $864.19 $679.94 $889.50 $770.55 $1,008.03 $692.82 $906.35 $722.34 $944.97 57 $690.04 $902.71 $710.25 $929.15 $804.89 $1,052.96 $723.70 $946.75 $754.54 $987.09 58 $721.47 $943.83 $742.60 $971.47 $841.56 $1,100.92 $756.67 $989.87 $788.91 $1,032.05 59 $737.05 $964.20 $758.63 $992.44 $859.72 $1,124.69 $773.00 $1,011.24 $805.94 $1,054.33 60 $768.48 $987.34 $790.98 $1,016.26 $896.38 $1,151.67 $805.96 $1,035.50 $840.30 $1,079.62 61 $795.66 $1,022.26 $818.96 $1,052.20 $928.09 $1,192.41 $834.47 $1,072.13 $870.03 $1,117.81 62 $813.50 $1,045.18 $837.32 $1,075.79 $948.90 $1,219.14 $853.18 $1,096.17 $889.53 $1,142.87 63 $835.87 $1,073.92 $860.35 $1,105.38 $974.99 $1,252.67 $876.64 $1,126.31 $913.99 $1,174.30 64 $849.45 $1,091.38 $874.35 $1,123.35 $990.84 $1,273.03 $890.91 $1,144.62 $928.86 $1,193.39 65+ $849.45 $1,091.38 $874.35 $1,123.35 $990.84 $1,273.03 $890.91 $1,144.62 $928.86 $1,193.39 Rates Effective January 1, 2018 Page 84 of 86

Texas Off Exchange (Catastrophic) Rating Area Texarkana, TX-Texarkana, AR Blue Advantage Security HMO SM 200 Tyler, TX Victoria, TX Waco, TX Wichita Falls, TX Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $220.09 $220.09 $212.99 $212.99 $225.99 $225.99 $204.88 $204.88 $251.69 $251.69 15 $239.65 $239.65 $231.92 $231.92 $246.08 $246.08 $223.09 $223.09 $274.06 $274.06 16 $247.13 $247.13 $239.16 $239.16 $253.76 $253.76 $230.05 $230.05 $282.62 $282.62 17 $254.61 $254.61 $246.40 $246.40 $261.44 $261.44 $237.01 $237.01 $291.17 $291.17 18 $262.67 $262.67 $254.19 $254.19 $269.71 $269.71 $244.51 $244.51 $300.38 $300.38 19 $270.73 $270.73 $261.99 $261.99 $277.98 $277.98 $252.01 $252.01 $309.59 $309.59 20 $279.07 $279.07 $270.06 $270.06 $286.55 $286.55 $259.78 $259.78 $319.13 $319.13 21 $287.70 $287.70 $278.41 $278.41 $295.41 $295.41 $267.81 $267.81 $329.00 $329.00 22 $287.70 $287.70 $278.41 $278.41 $295.41 $295.41 $267.81 $267.81 $329.00 $329.00 23 $287.70 $287.70 $278.41 $278.41 $295.41 $295.41 $267.81 $267.81 $329.00 $329.00 24 $287.70 $287.70 $278.41 $278.41 $295.41 $295.41 $267.81 $267.81 $329.00 $329.00 25 $288.85 $288.85 $279.53 $279.53 $296.59 $296.59 $268.88 $268.88 $330.32 $330.32 26 $294.60 $294.60 $285.10 $285.10 $302.50 $302.50 $274.24 $274.24 $336.90 $336.90 27 $301.51 $301.51 $291.78 $291.78 $309.59 $309.59 $280.67 $280.67 $344.80 $344.80 28 $312.73 $312.73 $302.64 $302.64 $321.11 $321.11 $291.11 $291.11 $357.63 $357.63 29 $321.94 $321.94 $311.54 $311.54 $330.56 $330.56 $299.68 $299.68 $368.16 $368.16 30 $326.54 $370.36 $316.00 $358.41 $335.29 $380.29 $303.97 $344.76 $373.42 $423.53 31 $333.44 $378.19 $322.68 $365.99 $342.38 $388.33 $310.39 $352.05 $381.32 $432.49 32 $340.35 $386.02 $329.36 $373.56 $349.47 $396.37 $316.82 $359.34 $389.21 $441.45 33 $344.66 $390.92 $333.54 $378.30 $353.90 $401.40 $320.84 $363.89 $394.15 $447.04 34 $349.27 $396.14 $337.99 $383.35 $358.63 $406.76 $325.12 $368.76 $399.41 $453.01 35 $351.57 $431.66 $340.22 $417.72 $360.99 $443.23 $327.27 $401.82 $402.04 $493.63 36 $353.87 $434.48 $342.45 $420.46 $363.36 $446.13 $329.41 $404.45 $404.68 $496.86 37 $356.17 $437.31 $344.68 $423.19 $365.72 $449.03 $331.55 $407.08 $407.31 $500.09 38 $358.47 $440.13 $346.90 $425.93 $368.08 $451.93 $333.69 $409.71 $409.94 $503.32 39 $363.08 $445.79 $351.36 $431.40 $372.81 $457.73 $337.98 $414.97 $415.20 $509.79 40 $367.68 $474.09 $355.81 $458.78 $377.53 $486.79 $342.26 $441.31 $420.47 $542.15 41 $374.59 $482.99 $362.49 $467.40 $384.62 $495.94 $348.69 $449.60 $428.36 $552.33 42 $381.20 $491.52 $368.90 $475.66 $391.42 $504.70 $354.85 $457.55 $435.93 $562.09 43 $390.41 $503.39 $377.81 $487.15 $400.87 $516.89 $363.42 $468.60 $446.46 $575.67 44 $401.92 $518.23 $388.94 $501.50 $412.69 $532.12 $374.13 $482.41 $459.62 $592.63 45 $415.44 $547.80 $402.03 $530.12 $426.57 $562.48 $386.72 $509.93 $475.08 $626.44 46 $431.55 $569.04 $417.62 $550.67 $443.12 $584.29 $401.72 $529.70 $493.51 $650.74 47 $449.68 $592.94 $435.16 $573.80 $461.73 $608.83 $418.59 $551.95 $514.23 $678.07 48 $470.39 $620.26 $455.21 $600.23 $483.00 $636.88 $437.87 $577.38 $537.92 $709.30 49 $490.82 $647.19 $474.97 $626.30 $503.97 $664.54 $456.89 $602.45 $561.28 $740.11 50 $513.83 $679.39 $497.25 $657.46 $527.60 $697.60 $478.31 $632.42 $587.60 $776.93 51 $536.56 $709.44 $519.24 $686.54 $550.94 $728.45 $499.47 $660.40 $613.59 $811.29 52 $561.59 $742.53 $543.46 $718.57 $576.64 $762.43 $522.77 $691.20 $642.22 $849.14 53 $586.91 $776.01 $567.96 $750.96 $602.64 $796.81 $546.34 $722.37 $671.17 $887.42 54 $614.24 $812.15 $594.41 $785.93 $630.70 $833.91 $571.78 $756.01 $702.43 $928.75 55 $641.57 $839.30 $620.86 $812.21 $658.77 $861.80 $597.22 $781.28 $733.68 $959.80 56 $671.20 $878.07 $649.54 $849.73 $689.19 $901.60 $624.80 $817.37 $767.57 $1,004.13 57 $701.12 $917.21 $678.49 $887.60 $719.92 $941.79 $652.66 $853.80 $801.78 $1,048.89 58 $733.06 $958.99 $709.40 $928.03 $752.71 $984.69 $682.38 $892.69 $838.30 $1,096.67 59 $748.88 $979.69 $724.71 $948.06 $768.95 $1,005.94 $697.11 $911.96 $856.40 $1,120.34 60 $780.82 $1,003.20 $755.61 $970.81 $801.74 $1,030.08 $726.84 $933.85 $892.92 $1,147.22 61 $808.44 $1,038.68 $782.34 $1,005.15 $830.10 $1,066.52 $752.55 $966.88 $924.50 $1,187.80 62 $826.56 $1,061.97 $799.88 $1,027.69 $848.71 $1,090.43 $769.42 $988.55 $945.23 $1,214.43 63 $849.29 $1,091.17 $821.88 $1,055.95 $872.05 $1,120.41 $790.58 $1,015.74 $971.22 $1,247.83 64 $863.10 $1,108.91 $835.23 $1,073.12 $886.23 $1,138.63 $803.43 $1,032.25 $987.00 $1,268.12 65+ $863.10 $1,108.91 $835.23 $1,073.12 $886.23 $1,138.63 $803.43 $1,032.25 $987.00 $1,268.12 Rates Effective January 1, 2018 Page 85 of 86