This document contains information that consists of confidential, proprietary trade secrets under state and federal law.

Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

Missouri
Part III - Federal Actuarial Memorandum
UnitedHealthcare Life Insurance Company
NAIC Number: 0707-97179
FEIN: 86-0207231
HIOS Issuer ID: 14162
Purpose
Following is a rate filing prepared by UnitedHealthcare Life Insurance Company. This filing has been prepared to
provide the necessary information required by the Department of Health and Human Services. The purpose of this
memorandum is to provide information relevant to Part I - Unified Rate Review Template.
This filing establishes the rates intended to be used for individual Off-Exchange health benefit plans in Missouri for
2015.
This memorandum is intended solely for the information of and use by the Department of Health and Human
Services and the Missouri Department of Insurance. It will demonstrate compliance with state and federal laws and
regulations and is not intended to be used for any other purpose.
General Information
Company Identifying Information
Company Legal Name:
UnitedHealthcare Life Insurance Company
State:
Missouri
HIOS Issuer ID:
14162
Market:
Individual
Effective Date:
January 1, 2015
Company Contact Information
Primary Contact Name:
Primary Contact Telephone Number:
Primary Contact Email Address:

James M. Shallow, ASA, MAAA

(920) 661-1071
jshallow@unitedhealthone.com

Proposed Rate Increase

This is an initial filing. No rate increase is requested at this time.
Experience Period Premium and Claims
Paid Through Date
The experience period is January 1, 2013 to December 31, 2013, with claims paid through March 31, 2014.
Premiums (net of MLR Rebate) in Experience Period
Earned premium for non-grandfathered business in Missouri for 2013 was $109,774. We do not anticipate paying
MLR rebates in Missouri for the 2013 calendar year. Final MLR rebate calculations are unavailable at this time. We
can supply the final value upon request, when it is available.

Page 1 of 10

This document contains information that consists of confidential, proprietary trade secrets under state and federal law. Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

Allowed and Incurred Claims Incurred During the Experience Period

Claim liabilities for medical business are calculated using UnitedHealthcare Life Insurance Companys own
proprietary method. This approach estimates incurred but not paid claims using a regression model supplemented
by adjustments for pending large claims.
Completion factors, which represent the proportion of incurred claims that have been paid as of the valuation date,
are based on the historical pattern of paid claims. Claims data is arranged in a two-dimensional table, with the
incurred date representing the columns and the paid date representing the rows. The same completion factors are
applied to incurred and allowed claims amounts.
Benefit Categories
Claims were assigned to each of the benefit categories based on where services were administered and the types of
medical services rendered.
Projection Factors
UnitedHealthcare Life Insurance Company has no existing credible non-grandfathered individual market business in
Missouri. Therefore, no adjustment factors were developed.
Credibility Manual Rate Development
Source and Appropriateness of Data Used
These rates are intended to be used on a guarantee issue basis. As UnitedHealthcare Life Insurance Company does
not have credible experience for individual medical guarantee issue products, we relied on the guarantee issue
claims experience and rate development of affiliated small group carriers to develop the credibility manual rate.
The experience used in the development of these rates is net of the appropriate coordination of benefit recoveries.
Therefore, the rates reflect the necessary equitable reduction in premiums or costs to beneficiaries of such other
insurance or contract rights.
Data Adjustments
1. Estimated Morbidity Differential of the Population Insured
A key assumption in our manual rate development was the estimated morbidity differential between the
individual and small group markets. Our judgment was that historical morbidity differentials for very small
size employer groups versus the small group overall average would be an appropriate indicator for this
morbidity differential. The chart below shows the historical experience of affiliated small group carriers for
the following group sizes: 1-employee, 1-3 employees, and 1-50 employees. While historical morbidity for 1employee groups could indicate a morbidity load of greater than 100%, we realize that this reflects a level of
anti-selection due to the fact that the primary alternative market for these members was the highly
underwritten individual market. In the post-2014 guarantee issue environment for the individual market,
although we do expect there will still be some anti-selection in the individual market relative to the small
group market, we do not anticipate it being quite this high. Additionally, the new products will include more
extensive care management. Therefore, we have assumed morbidity for this product of 1.075 times that of a
comparable small group product before removing small group adjustments made due to early renewals and
small employer market dropout that are not applicable to these individual plans.

Page 2 of 10

This document contains information that consists of confidential, proprietary trade secrets under state and federal law. Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

Small
Group Size
1ee
1-3ees
1-50ees

Nationwide Experience
Earned
Incurred
Member
Premium
Claims
Months
45,744,151
58,576,101
87,361
410,313,807
379,506,863
855,464
6,028,225,051 4,519,101,029 14,970,587

Premium Claims
Claims vs
PMPM
PMPM
1-50 ees
$523.62 $670.51
2.221
$479.64 $443.63
1.470
$402.54 $301.87
1.000
Morbidity Load Assumption: 1.075

2. Trend / Emerging Experience

The manual rates were developed from an affiliated carriers small group projections for the 2014 calendar
year. They were adjusted for trend factors and emerging claims experience.
3. Benefit Differential
Adjustments were made to the affiliated small group carriers experience to reflect the benefit variations
between the small group portfolio and our individual product, as well as to account for any additional
individual mandated benefits not covered in the small group market. Additional adjustments were made to
reflect the addition of referral requirements in our individual product.
4. Demographic Adjustment
We anticipate our individual off exchange business will have a different age/gender composition compared
to that of the affiliated small group carriers business. Therefore, an adjustment was made to the manual
rate development to account for the difference in demographic mix.
Credibility of Experience
UnitedHealthcare Life Insurance Company has no existing credible non-grandfathered individual market business in
Missouri, so zero credibility is applied to the base period experience. We believe the affiliated small group
experience used for developing the manual rates to be fully credible. A specific credibility formula was not used for
this determination, but rather informed actuarial judgment. As ASOP 25, section 3.4 states: Professional Judgment
The actuary should use professional judgment when selecting, developing, or using a credibility procedure. The
use of credibility procedures is not always a precise mathematical process.
Paid-to-Allowed Ratio
A paid-to-allowed ratio was estimated for each plan by trending an affiliated carriers small group claims experience
to 2015 and accounting for the variation in cost-sharing parameters. These ratios were weighted by the projected
membership per plan to calculate the average paid-to-allowed factor shown in Worksheet 1 of the Unified Rate
Review Template.
Risk Adjustment and Reinsurance
Projected Risk Adjustments Net of Risk Adjustment User Fees
We are assuming zero net payments for risk adjustments. The HHS Notice of Benefit and Payment Parameters for
2015 specifies a risk adjustment user fee of $0.08 PMPM.
Projected ACA Reinsurance Recoveries Net of Reinsurance Premium
Reinsurance recoveries are expected to be 7.9% of incurred claims. This amount was derived using nationwide
experience from an affiliated carrier trended to 2015. The recoveries were then calculated using the 2015
Page 3 of 10

This document contains information that consists of confidential, proprietary trade secrets under state and federal law. Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

reinsurance parameters, as published in the HHS Notice of Benefit and Payment Parameters for 2015. The HHS
Notice of Benefit and Payment Parameters for 2015 specifies a reinsurance premium of $3.67 PMPM.
Non-Benefit Expenses and Profit
Administrative Expense Load
The 12.65% administrative expense load includes: commissions, quality improvements, and SG&A.
1. Commissions: We anticipate an average commission rate of approximately 5.00% of premium for 2015.
2. Quality Improvements: We assumed 0.20% of premium for quality improvements based on data from an
affiliated carrier.
3. SG&A: Our general and administrative expense assumption is based on experience of our affiliated
individual carriers expected 2015 expense level. For this product in the state of Missouri, this equates to
approximately 7.45% of premium for 2015.
Profit & Risk Margin
Our projected underwriting gain over the 2015 rating period is approximately 2.0% of premium.
Premium
Claims
Reinsurance Recoveries
Risk Adjustment Payments
Premium Tax
Reinsurance Fees
Risk Adjustment User Fee
Insurer Fees
PCORI Fees
Commissions
Quality Improvements
SG&A
Pre-Tax Income:
Income Tax *
After-Tax Income:

100.0%
-84.6%
6.7%
0.0%
-2.0%
-1.1%
-0.0%
-2.1%
-0.1%
-5.0%
-0.2%
-7.4%
4.2%
-2.2%
2.0%

*Income Tax is calculated as 35% * (Pre-Tax Income + Insurer Fees).

**Figures may not tally due to rounding of display in the exhibit.

Taxes and Fees

The 6.38% attributed to taxes and fees includes: premium tax, insurer fees, PCORI fees, and federal income tax.
1. Premium Tax: The premium tax rate is 2.00% for a POS product in the state of Missouri.
2. Insurer Fees: Each insurance carrier's assessment of insurer fees will be based on earned health insurance
premium in the prior year, with certain exclusions. UnitedHealthcare (parent company of UnitedHealthcare
Life Insurance Company) estimates that 2.13% of its 2015 premium will be allocated for insurer fees.
3. PCORI Fees: This product will be effective for the 2015 plan year. The PCORI fee is $2 per member per year,
or $0.17 PMPM. For this product in the state of Missouri, this equates to approximately 0.05% of premium.
4. Federal Income Tax: Income tax is projected to be 2.20% of premium and is calculated as 35% * (Pre-Tax
Income + Insurer Fees), since insurer fees are not tax deductible.
Page 4 of 10

This document contains information that consists of confidential, proprietary trade secrets under state and federal law. Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

Projected Loss Ratio

The projected loss ratio using the federally prescribed MLR methodology for calendar year 2015 is 84.4%.
Claims
Quality Improvements
Reinsurance Recoveries
Risk Adjustment Payments
Total MLR Claims
Premium
Premium Tax
Income Tax
Reinsurance Fee
Insurer Fees
PCORI Fee
Risk Adjustment User Fees
Total MLR Premium

MLR:

84.6%
0.2%
-6.7%
0.0%
78.1%
100.0%
-2.0%
-2.2%
-1.1%
-2.1%
-0.1%
-0.0%
92.5%
84.4%

*Income Tax is calculated as 35% * (Pre-Tax Income + Insurer Fees).

**Figures may not tally due to rounding of display in the exhibit.

Single Risk Pool

The single risk pool reflects all covered lives for every individual non-grandfathered product and plan combination
for UnitedHealthcare Life Insurance Company in the state of Missouri. It is established in accordance with the
requirements of 45 CFR part 156, 156.80(d).
Index Rate
The index rate represents 99.9% of the projected allowed claims PMPM for this block of business. Plans will cover a
limited amount for lodging and travel related to those receiving transplants, which represents approximately 0.1% of
claims. This coverage is non-EHB. The index rate for the projection period is $404.83.
Market Adjusted Index Rate
The market adjusted index rate includes market-wide adjustments for the federal reinsurance program, risk
adjustment, and exchange user fees. The total expected impact for reinsurance recoveries and reinsurance fees is
$18.91 PMPM. The total impact for risk adjustment payments and user fees are expected to be $0.08 PMPM. Please
refer to the Risk Adjustment and Reinsurance section for a brief description.
Since the Index Rate is at an allowed claim level and the reinsurance and risk adjustment values are at a paid level,
the reinsurance and risk adjustment values are first divided by the Paid to Allowed Average Factor to compute the
market adjustment. The market adjustment is then added to the Index Rate to yield the Market Adjusted Index Rate.
The resulting market adjusted index rate is $378.13.
Index Rate
Market Adjustment = ($0.08 - $18.91) / (0.705)
Market Adjusted Index Rate

**Figures may not tally due to rounding of display in the exhibit.

Page 5 of 10

$404.83
- $26.70
$378.13

This document contains information that consists of confidential, proprietary trade secrets under state and federal law. Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

Plan Adjusted Index Rates

The plan adjusted index rates for each plan are listed below. They were calculated by beginning with the market
adjusted index rate and adjusting for all allowable plan modifiers. The index rates vary due to different actuarial
values and cost sharing designs by plan. The weighted average, based on projected membership, is $337.95.
o
o
o
o
o
o
o
o
o
o

Platinum Copay Select:

Gold Copay Select 2 :
Gold Copay Select 1:
Silver HSA 100:
Silver Copay Select 2:
Silver Copay Select 1:
Bronze HSA 100:
Bronze Copay Select 1:
Bronze Copay Select 2:
Select Saver:

$428.56
$383.75
$375.78
$332.63
$331.96
$339.90
$276.19
$305.74
$304.08
$260.92

The calculation for the Gold Copay Select 2 plan is as follows:

Market Adjusted Index Rate
Benefits in addition to EHB
Paid to Allowed Average Factor
Distribution and Admin (Incl. Fees & Costs)
Actuarial Value & Cost Share=(Pricing AV=1.156)/(Avg=1.018)
Plan Adjusted Index Rate
**Figures may not tally due to rounding of display in the exhibit.

$378.13
+ $ 0.41
$378.54
x 0.705
$267.01
+ $ 70.94
$337.95
x 1.136
$383.75

Calibration
Calibration adjustments include age and geography, and they do not vary by plan.
Age Curve Calibration
The age calibration is 1.357, which is based on an average age assumption of 43 years. The HHS unisex age factors,
included in Attachment A, were used.
Geographic Factor Calibration
The geographic factor calibration is 1.000, which is based on our expected distribution of covered individuals.
Attachment A includes the geographic factors for each of the counties in which UnitedHealthcare Life Insurance
Company intends to market this product. Geographic factors are based on experience from an affiliated carrier.
Consumer Adjusted Premium Rate Development
The Consumer Adjusted Premium Rate is the final premium rate for each plan that is charged to an individual before
applying the rating adjustments of age, area, and tobacco status. It is developed by calibrating the Plan Adjusted
Index Rate for age and geography, and adjusting for any additional allowable rating factors specified by 45 CFR Part
147.102 (including tobacco).
Page 6 of 10

This document contains information that consists of confidential, proprietary trade secrets under state and federal law. Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

Tobacco Adjustment
The tobacco adjustment is 1.007, which is based on the expected average tobacco factor (1.000 for non-tobacco
users) for our expected distribution of covered individuals. See Attachment A for the tobacco factors by age.
Consumer Adjusted Premium Rates
The Consumer Adjusted Premium Rate is calculated as the Plan Adjusted Index Rate divided by the product of the
calibration factors and tobacco adjustment. Results for each plan are listed below. The weighted average, based on
projected membership, is $247.25.
o
o
o
o
o
o
o
o
o
o

Platinum Copay Select:

Gold Copay Select 2 :
Gold Copay Select 1:
Silver HSA 100:
Silver Copay Select 2:
Silver Copay Select 1:
Bronze HSA 100:
Bronze Copay Select 1:
Bronze Copay Select 2:
Select Saver:

$313.54
$280.75
$274.92
$243.35
$242.86
$248.45
$202.06
$223.68
$222.46
$190.89

AV Metal Values
One of our plan designs includes a per-occurrence copay paid in conjunction with coinsurance rates. This benefit
design is not directly compatible with the Actuarial Value (AV) calculator. For this unique plan design, the alternate
method described in 45 CFR 156.135(b)(2) was used for the AV calculations. Following is a description of how the
input for this unique benefit was modified to fit the parameters of the AV calculator.
Per-Occurrence Copay Paid in Conjunction with Coinsurance Rates
In order to modify the inputs for this type of benefit design to fit the parameters of the AV calculator, the following
formula was used to estimate the insurers cost share.
Effective Insurer Coinsurance Rate = ( 1

Member Copay
Average Unit Cost

) * ( 1 Member Coinsurance Rate)

The benefit was then marked as Subject to Deductible and Subject to Coinsurance with a Coinsurance, if
different equal to the effective insurer coinsurance rate as calculated above.
The average unit cost was calculated based on the claims data included within the AV calculator continuance tables
for each metal level. If the plan was expected to fall within a Silver Metal Tier, the average unit cost was calculated
from the Silver continuance tables. All enrollees within a continuance table were included in the calculation of the
average unit cost for each benefit type.

Page 7 of 10

This document contains information that consists of confidential, proprietary trade secrets under state and federal law. Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

Plans Impacted by Alternative Methodology

The following chart outlines which benefit adjustments were made to each plan included in this product.
Plan Name
Bronze Copay Select 2

Per-Occurrence Copay Paid in Conjunction

with Coinsurance Rates
- Inpatient Hospital Services

AV Pricing Values
The Silver Copay Select 2 plan is the fixed reference plan selected as the basis for the AV Pricing Values, with a
pricing value of 1.000. The variation in rating factors for the other plans is based on the actuarial value and costsharing design differentiation relative to the Silver Copay Select 2 plan.
The medical plan price relativities were developed using the proprietary UnitedHealthcare pricing model. This model
uses UnitedHealthcare nationwide experience data, which is fully credible. Claim data is then projected to the
pricing period based on national projections of utilization and unit costs. These projections are done at the service
category level (inpatient, outpatient, etc.). Benefit design parameters such as deductibles, copays, and coinsurance
rates are applied to the claim distributions of the matching service category. Cost-sharing is applied, and the values
of each service category are summed to determine an overall benefit value. This overall benefit value is then
compared to a base benefit design to calculate the plan relativity. All benefit plans are priced consistently with each
other, with the rates differing only by the estimated value of the benefit differences.
In order to preserve consistency, the same claim experience and projection assumptions are applied to all plan
relativity calculations. The plan specific adjustments to the market wide index rate do not reflect differences in
health status or risk selection.
Membership Projections
Since this is a new product with no historical experience, membership was estimated based on informed judgment.
Terminated Products
Existing non-grandfathered plans will be terminated by the end of the policy year, no later than the end of 2014.
This includes Products 14162MO001 to 14162MO015.
Plan Type
A plan type of POS has been selected for each plan, which describes the plans exactly.
Warning Alerts
There are no Warning Alerts in Worksheet 2 of the Unified Rate Review Template.
Reliance
Due to responsibility allocation, I relied on other UnitedHealthcare actuaries that have responsibility for small group
rate development to provide the affiliated carrier experience data and rate development procedure for the small
group rates.

Page 8 of 10

This document contains information that consists of confidential, proprietary trade secrets under state and federal law. Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

Actuarial Certification
I, James M. Shallow, am an Associate Director of Actuarial Services for United Healthcare's Individual Line of
Business, which includes UnitedHealthcare Life Insurance Companys health insurance products marketed to
individuals. I am a member of the American Academy of Actuaries, and I meet the Academy's qualification standards
for rendering statements of actuarial opinion, with respect to the filing of rates for health insurance products.
To the best of my knowledge and judgment:

The projected index rate is in compliance with all applicable state and federal statutes and regulations, and it
was developed in compliance with the applicable Actuarial Standards of Practice.
The benefits are reasonable in relation to the premiums charged and the population anticipated to be covered.
In addition, premiums are not inadequate, excessive, or unfairly discriminatory.
Only the allowable modifiers were used to generate plan level rates.
The percent of total premium that represents essential health benefits included in Worksheet 2, Sections III and
IV were calculated in accordance with actuarial standards of practice.
The AV calculator was used to determine the AV metal values shown in Worksheet 2 of the Unified Rate Review
Template. The alternate method described in 45 CFR 156.135(b)(2) was used to fit the parameters of the AV
calculator.
The Unified Rate Review Template does not demonstrate the process used by the issuer to develop the rates.
Rather, it represents information required by federal regulation to be provided in support of the review of rate
increases, for certification of qualified health plans for federally facilitated exchanges, and for certification that
the index rate is developed in accordance with federal regulation and used consistently and only adjusted by the
allowable modifiers.

James M. Shallow, ASA, MAAA

Associate Director, Actuarial Services

Date

Page 9 of 10

This document contains information that consists of confidential, proprietary trade secrets under state and federal law. Under
federal law, this information is exempt from disclosure under Exemption 4 of the U.S. Freedom of Information Act, 5 U.S.C. 552, is a
trade secret or confidential commercial or financial information as defined in 45 CFR 5.65, and protected from disclosure under 45
CFR 5.1 5.69, and 45 CFR 154.215 (i)(2). Under state law, this information is strictly confidential and protected from disclosure
by R.S.Mo. 374.01, 417.450 et seq. and 20 CSR 10-2.400. It may not be disclosed to any other person, including state or federal
regulatory agencies, unless UnitedHealthcare Life Insurance Company consents to the disclosure and the recipient agrees in writing
prior to receipt to maintain the confidential, proprietary trade secret nature of the information herein.

Attachment A:
[Redacted]

Page 10 of 10