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RATE PAGESCompany Name:QCC Insurance CompanyProduct: PPOEffective Date of Rates: January 1, 2017 - December 31, 2017Plan ID (On Exchange) Plan ID (Off Exchange) Form # Rating Area Network Metal Plan Name Deductible Coinsurance Copays OOP Maximum Dental (Yes/No)Age 424344454647484950515253545556575859606162636465 31609PA007002308535 Rev. 1.168Personal Choice NetworkBronzePersonal Choice PPO Bronze 5,50050% 50 no ded/50% after ded 7,150NoNon-TobaccoTobacco 167.69 264.08 264.08 264.08 264.08 265.14 270.42 276.76 287.05 295.51 299.73 306.07 312.41 316.37 320.59 322.71 324.82 326.93 329.04 333.27 337.49 343.83 349.91 358.36 368.92 381.33 396.12 412.76 431.77 450.52 471.65 492.51 515.48 538.72 563.81 588.90 616.10 643.56 672.88 687.40 716.71 742.06 758.70 779.56 792.24 792.24 167.69 297.09 297.09 297.09 297.09 298.28 304.22 311.35 322.94 332.44 352.18 359.63 367.08 371.73 376.70 379.18 381.66 384.14 386.63 391.59 413.43 421.19 428.63 438.99 451.93 467.13 485.25 505.63 528.92 551.89 648.51 677.20 708.79 740.74 775.24 809.74 847.14 884.90 925.20 945.18 985.48 1,020.34 1,043.22 1,071.90 1,089.33 1,089.33Page Number: 731609PA016002008537 Rev. 1.168Personal Choice NetworkCatastrophicPersonal Choice Catastrophic 7,1500% 50 visits 1-3 no ded (0% after ded)/0% after ded 7,150NoNon-TobaccoTobacco 139.62 219.88 219.88 219.88 219.88 220.76 225.16 230.43 239.01 246.05 249.56 254.84 260.12 263.42 266.93 268.69 270.45 272.21 273.97 277.49 281.01 286.28 291.34 298.38 307.17 317.51 329.82 343.67 359.50 375.12 392.71 410.08 429.21 448.56 469.44 490.33 512.98 535.85 560.25 572.35 596.75 617.86 631.72 649.09 659.64 659.64 139.62 247.37 247.37 247.37 247.37 248.35 253.30 259.24 268.89 276.80 293.24 299.44 305.64 309.51 313.65 315.71 317.78 319.85 321.92 326.05 344.23 350.70 356.89 365.51 376.29 388.95 404.03 421.00 440.39 459.52 539.97 563.85 590.16 616.76 645.49 674.21 705.35 736.79 770.35 786.98 820.54 849.56 868.61 892.49 907.01 907.0131609PA007002708536 Rev. 1.168Personal Choice NetworkBronzePersonal Choice PPO Bronze Reserve 6,5000%0% after ded/0% after ded 6,500NoNon-TobaccoTobacco 157.19 247.55 247.55 247.55 247.55 248.54 253.49 259.43 269.09 277.01 280.97 286.91 292.85 296.56 300.53 302.51 304.49 306.47 308.45 312.41 316.37 322.31 328.00 335.93 345.83 357.46 371.33 386.92 404.74 422.32 442.12 461.68 483.22 505.00 528.52 552.04 577.53 603.28 630.76 644.37 671.85 695.62 711.21 730.77 742.65 742.65 157.19 278.49 278.49 278.49 278.49 279.61 285.18 291.86 302.72 311.63 330.14 337.12 344.10 348.46 353.12 355.44 357.77 360.10 362.43 367.08 387.55 394.83 401.80 411.51 423.64 437.89 454.87 473.98 495.81 517.34 607.92 634.81 664.42 694.38 726.71 759.05 794.11 829.51 867.29 886.01 923.79 956.47 977.92 1,004.81 1,021.14 1,021.1405/05/2016

Silver Plan Rates for Age 21 Non-Smoker, by Geographic Area and Exchange Status2017 On-Exchange Silver Plan RatesHIOS Plan ID # Rating Area 131609PA0070003Rating Area 2Rating Area 3Rating Area 4Rating Area 5Rating Area 6Rating Area 7Rating Area 8Rating Area 9 336.12

Silver Plan Rates for Age 21 Non-Smoker, by Geographic Area and Exchange Status2017 Off-Exchange Silver Plan RatesHIOS Plan ID # Rating Area 131609PA0070022Rating Area 2Rating Area 3Rating Area 4Rating Area 5Rating Area 6Rating Area 7Rating Area 8Rating Area 9 336.12

2017 Rates Table Template v6.0All fields with an asterisk ( * ) are required. To validate press Validate button or Ctrl Shift I. To finalize, press Finalize button or Ctrl Shift F.youF,arestate,selectOptionAgeandbyfillpressingin all columns.If macros are disabled, press and hold the ALT key and pressIfthethena I,communityand then N ratingkey. Afterthat,selectFamilythe EnableAll underContentoptionenter. (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells B1 through B5.If you are not community rating state, select 0-20 under Age and provide an Individual Rate for every age band.If Tobacco is Tobacco User/Non-Tobacco User, you must give a rate for Tobacco Use and Non-Tobacco Use.To add a new sheet, press the Add Sheet button, or Ctrl Shift H. All plans must have the same dates on a sheet.HIOS Issuer ID*Federal TIN* 23-2184623Rate Effective Date*Rate Expiration Date*316091/1/20173/31/2017Plan ID*Rating Area ID*Tobacco*Age*Individual Rate*Required:Enter the 14-character Plan IDRequired:Select the Rating Area IDRequire:Select if Tobacco use of subscriber is used todetermine if a person is eligible for a rate from aplanRequired:Select the age of a subscriber eligible for therate31609PA0150001Rating Area 8Tobacco User/Non-Tobacco User0-2031609PA0150001Rating Area 8Tobacco User/Non-Tobacco User2131609PA0150001Rating Area 8Tobacco User/Non-Tobacco User2231609PA0150001Rating Area 8Tobacco User/Non-Tobacco User2331609PA0150001Rating Area 8Tobacco User/Non-Tobacco User2431609PA0150001Rating Area 8Tobacco User/Non-Tobacco User2531609PA0150001Rating Area 8Tobacco User/Non-Tobacco User2631609PA0150001Rating Area 8Tobacco User/Non-Tobacco User2731609PA0150001Rating Area 8Tobacco User/Non-Tobacco User2831609PA0150001Rating Area 8Tobacco User/Non-Tobacco User2931609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3031609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3131609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3231609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3331609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3431609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3531609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3631609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3731609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3831609PA0150001Rating Area 8Tobacco User/Non-Tobacco User3931609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4031609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4131609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4231609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4331609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4431609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4531609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4631609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4731609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4831609PA0150001Rating Area 8Tobacco User/Non-Tobacco User4931609PA0150001Rating Area 8Tobacco User/Non-Tobacco User5031609PA0150001Rating Area 8Tobacco User/Non-Tobacco User5131609PA0150001Rating Area 8Tobacco User/Non-Tobacco User5231609PA0150001Rating Area 8Tobacco User/Non-Tobacco User5331609PA0150001Rating Area 8Tobacco User/Non-Tobacco User5431609PA0150001Rating Area 8Tobacco User/Non-Tobacco User5531609PA0150001Rating Area 8Tobacco User/Non-Tobacco User5631609PA0150001Rating Area 8Tobacco User/Non-Tobacco User5731609PA0150001Rating Area 8Tobacco User/Non-Tobacco User5831609PA0150001Rating Area 8Tobacco User/Non-Tobacco User59Individual Tobacco Rate*Required:Required:Enter the rate of an Individual Non-Tobacco or Enter the rate of an Individual tobacco enrolleeNo Preference enrollee on a planon a 9

31609PA0150001Rating Area 8Tobacco User/Non-Tobacco User6031609PA0150001Rating Area 8Tobacco User/Non-Tobacco User6131609PA0150001Rating Area 8Tobacco User/Non-Tobacco User6231609PA0150001Rating Area 8Tobacco User/Non-Tobacco User6331609PA0150001Rating Area 8Tobacco User/Non-Tobacco User6431609PA0150001Rating Area 8Tobacco User/Non-Tobacco User65 and over31609PA0150002Rating Area 8Tobacco User/Non-Tobacco User0-2031609PA0150002Rating Area 8Tobacco User/Non-Tobacco User2131609PA0150002Rating Area 8Tobacco User/Non-Tobacco User2231609PA0150002Rating Area 8Tobacco User/Non-Tobacco User2331609PA0150002Rating Area 8Tobacco User/Non-Tobacco User2431609PA0150002Rating Area 8Tobacco User/Non-Tobacco User2531609PA0150002Rating Area 8Tobacco User/Non-Tobacco User2631609PA0150002Rating Area 8Tobacco User/Non-Tobacco User2731609PA0150002Rating Area 8Tobacco User/Non-Tobacco User2831609PA0150002Rating Area 8Tobacco User/Non-Tobacco User2931609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3031609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3131609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3231609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3331609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3431609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3531609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3631609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3731609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3831609PA0150002Rating Area 8Tobacco User/Non-Tobacco User3931609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4031609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4131609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4231609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4331609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4431609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4531609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4631609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4731609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4831609PA0150002Rating Area 8Tobacco User/Non-Tobacco User4931609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5031609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5131609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5231609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5331609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5431609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5531609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5631609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5731609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5831609PA0150002Rating Area 8Tobacco User/Non-Tobacco User5931609PA0150002Rating Area 8Tobacco User/Non-Tobacco User6031609PA0150002Rating Area 8Tobacco User/Non-Tobacco User6131609PA0150002Rating Area 8Tobacco User/Non-Tobacco User6231609PA0150002Rating Area 8Tobacco User/Non-Tobacco User6331609PA0150002Rating Area 8Tobacco User/Non-Tobacco User6431609PA0150002Rating Area 8Tobacco User/Non-Tobacco User65 and over31609PA0150003Rating Area 8Tobacco User/Non-Tobacco User0-2031609PA0150003Rating Area 8Tobacco User/Non-Tobacco User2131609PA0150003Rating Area 8Tobacco User/Non-Tobacco User2231609PA0150003Rating Area 8Tobacco User/Non-Tobacco User2331609PA0150003Rating Area 8Tobacco User/Non-Tobacco User2431609PA0150003Rating Area 8Tobacco User/Non-Tobacco User2531609PA0150003Rating Area 8Tobacco User/Non-Tobacco .50

31609PA0150003Rating Area 8Tobacco User/Non-Tobacco User2731609PA0150003Rating Area 8Tobacco User/Non-Tobacco User2831609PA0150003Rating Area 8Tobacco User/Non-Tobacco User2931609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3031609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3131609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3231609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3331609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3431609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3531609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3631609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3731609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3831609PA0150003Rating Area 8Tobacco User/Non-Tobacco User3931609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4031609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4131609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4231609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4331609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4431609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4531609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4631609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4731609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4831609PA0150003Rating Area 8Tobacco User/Non-Tobacco User4931609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5031609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5131609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5231609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5331609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5431609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5531609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5631609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5731609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5831609PA0150003Rating Area 8Tobacco User/Non-Tobacco User5931609PA0150003Rating Area 8Tobacco User/Non-Tobacco User6031609PA0150003Rating Area 8Tobacco User/Non-Tobacco User6131609PA0150003Rating Area 8Tobacco User/Non-Tobacco User6231609PA0150003Rating Area 8Tobacco User/Non-Tobacco User6331609PA0150003Rating Area 8Tobacco User/Non-Tobacco User6431609PA0150003Rating Area 8Tobacco User/Non-Tobacco User65 and over31609PA0150004Rating Area 8Tobacco User/Non-Tobacco User0-2031609PA0150004Rating Area 8Tobacco User/Non-Tobacco User2131609PA0150004Rating Area 8Tobacco User/Non-Tobacco User2231609PA0150004Rating Area 8Tobacco User/Non-Tobacco User2331609PA0150004Rating Area 8Tobacco User/Non-Tobacco User2431609PA0150004Rating Area 8Tobacco User/Non-Tobacco User2531609PA0150004Rating Area 8Tobacco User/Non-Tobacco User2631609PA0150004Rating Area 8Tobacco User/Non-Tobacco User2731609PA0150004Rating Area 8Tobacco User/Non-Tobacco User2831609PA0150004Rating Area 8Tobacco User/Non-Tobacco User2931609PA0150004Rating Area 8Tobacco User/Non-Tobacco User3031609PA0150004Rating Area 8Tobacco User/Non-Tobacco User3131609PA0150004Rating Area 8Tobacco User/Non-Tobacco User3231609PA0150004Rating Area 8Tobacco User/Non-Tobacco User3331609PA0150004Rating Area 8Tobacco User/Non-Tobacco User3431609PA0150004Rating Area 8Tobacco User/Non-Tobacco User3531609PA0150004Rating Area 8Tobacco User/Non-Tobacco User3631609PA0150004Rating Area 8Tobacco User/Non-Tobacco User3731609PA0150004Rating Area 8Tobacco User/Non-Tobacco User3831609PA0150004Rating Area 8Tobacco User/Non-Tobacco 8.35541.90545.45548.99552.54559.64

31609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4031609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4131609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4231609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4331609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4431609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4531609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4631609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4731609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4831609PA0150004Rating Area 8Tobacco User/Non-Tobacco User4931609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5031609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5131609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5231609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5331609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5431609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5531609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5631609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5731609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5831609PA0150004Rating Area 8Tobacco User/Non-Tobacco User5931609PA0150004Rating Area 8Tobacco User/Non-Tobacco User6031609PA0150004Rating Area 8Tobacco User/Non-Tobacco User6131609PA0150004Rating Area 8Tobacco User/Non-Tobacco User6231609PA0150004Rating Area 8Tobacco User/Non-Tobacco User6331609PA0150004Rating Area 8Tobacco User/Non-Tobacco User6431609PA0150004Rating Area 8Tobacco User/Non-Tobacco User65 and over31609PA0150005Rating Area 8Tobacco User/Non-Tobacco User0-2031609PA0150005Rating Area 8Tobacco User/Non-Tobacco User2131609PA0150005Rating Area 8Tobacco User/Non-Tobacco User2231609PA0150005Rating Area 8Tobacco User/Non-Tobacco User2331609PA0150005Rating Area 8Tobacco User/Non-Tobacco User2431609PA0150005Rating Area 8Tobacco User/Non-Tobacco User2531609PA0150005Rating Area 8Tobacco User/Non-Tobacco User2631609PA0150005Rating Area 8Tobacco User/Non-Tobacco User2731609PA0150005Rating Area 8Tobacco User/Non-Tobacco User283160

Personal Choice PPO Gold Gold 0 20% 20/ 65 Personal Choice Network Personal Choice Network Page Number: 2 05/05/2016. RATE PAGES Company Name:QCC Insurance Company Product: PPO Effective Date of Rates: January 1, 2017 - December 31, 2017 Plan ID (On Exchange) P