Schedule B - Pricing.xlsx

This is a Schedule B Pricing document for the Michigan Public School Employees' Retirement System (MPSERS) HMO Premium Rates effective January 1, 2020 through December 31, 2020. The document establishes premium rates for health maintenance organization coverage under the MPSERS plan, with separate rate structures for participants with and without Medicare coverage. The pricing structure includes individual rates for self-only, spouse, and per-child coverage categories across both categories of participants.

The premium rates are differentiated based on whether the HMO is subject to the Section 9010 health insurer fee under the Patient Protection and Affordable Care Act (ACA). For participants without Medicare, self-only rates range from $682.32 to $686.00; spouse rates range from $566.04 to $569.10; and per-child rates range from $171.04 to $171.97. For participants with Medicare, self-only rates range from $131.21 to $143.94; spouse rates range from $113.68 to $126.22; and per-child rates range from $128.04 to $140.59. The Plan Sponsor will pay rates assuming waiver of the ACA health insurer fee unless the fee is in place, in which case the higher rates apply to cover the anticipated fee cost. The document stipulates that if the fee status changes at any point during the contract period, rate payments must be corrected prospectively and any overpayments must be recovered from the Contractor.