California Health Benefit Exchange QDP Certification Application for Plan Year 2018 Attachment C1 Current & Projected Enrollment

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1 Attachment C1 Current & Projected Enrollment Please provide the following for each product (DHMO/DPPO) in the individual market: 1 Effectuated Enrollment as of April 1, Effectuated means binder payment has been received for enrollees. Applicants not currently contracted should leave 2017 effectuated columns blank Enrollment Projections. These should reflect anticipated enrollment for the Plan Year Data submitted must be consistent with all SERFF templates and any other application submissions. DHMO Rating Region County 2017 Effectuated Enrollment 2018 Enrollment Projection 2017 Effectuated Enrollment 2018 Enrollment Projection DPPO Region 4 Region 5 Region 6 Region 7 Region Alpine Del Norte Siskiyou Modoc Lassen Shasta Trinity Humboldt Tehama Plumas Nevada Sierra Mendocino Lake Butte Glenn Sutter Yuba Colusa Amador Calaveras Tuolumne Napa Sonoma Solano Marin Sacramento Placer El Dorado Yolo San Francisco Contra Costa Alameda Santa Clara San Mateo Santa Cruz San Benito San Joaquin Stanislaus Merced Mariposa Tulare Fresno Kings Madera San Luis Obispo Ventura Santa Barbara Mono Inyo Imperial Kern San Bernardino Riverside Orange Statewide Total

2 Attachment C2 California Off Exchange Enrollment Please provide effectuated enrollment as of April 1, 2017 for each line of business. Effectuated means binder payment has been received for enrollees. Membership for employer based coverage should be reported based on member residence address as opposed to employer location. Data submitted must be consistent with all SERFF templates and any other application submissions. Rating Region County EmployerBased Individual Market Government Payers Region 4 Region 5 Region 6 Region 7 Region Alpine Del Norte Siskiyou Modoc Lassen Shasta Trinity Humboldt Tehama Plumas Nevada Sierra Mendocino Lake Butte Glenn Sutter Yuba Colusa Amador Calaveras Tuolumne Napa Sonoma Solano Marin Sacramento Placer El Dorado Yolo San Francisco Contra Costa Alameda Santa Clara San Mateo Santa Cruz San Benito San Joaquin Stanislaus Merced Mariposa Tulare Fresno Kings Madera San Luis Obispo Ventura Santa Barbara Mono Inyo Imperial Kern San Bernardino Riverside Orange Statewide Total CalPERS Large Group Small Group NonMirrored Off Exchange Tricare MediCal Medicare

3 Attachment D2 Media Plan Flowchart Media Plan Costs (rounded) 3Sep 10Sep 17Sep 24Sep 1Oct 8Oct 15Oct 22Oct 29Oct 5Nov 12Nov 19Nov 26Nov 3Dec 10Dec 17Dec 24Dec 31Dec 7Jan 14Jan 21Jan 28Jan 4Feb 11Feb 18Feb Television Radio OutofHome Print (Newsprint, Magazine, Freestanding) Direct Mail Shared Mail Search Engine Marketing Digital (display, video, mobile, radio) Social media marketing Other Community Events Other Lead Purchasing *Please add weeks, if needed *Use darker color to indicate media heavy up APPLICANT NAME OE Media Plan 2017 Q Q1

4 Attachment D2 Media Plan Flowchart Media Plan Costs (rounded) 3Sep 10Sep 17Sep 24Sep 1Oct 8Oct 15Oct 22Oct 29Oct 5Nov 12Nov 19Nov 26Nov 3Dec 10Dec 17Dec 24Dec 31Dec 7Jan 14Jan 21Jan 28Jan 4Feb 11Feb 18Feb Television 20M Radio 1.5M OutofHome 1M Print (Newsprint, Magazine, Freestanding) 1M Direct Mail 1M Shared Mail 0 Search Engine Marketing 250k Digital (display, video, mobile, radio) 300k Social media 500k marketing 250k Other Community Events 200k Other Lead Purchasing 50k *Please add weeks, if needed *Use darker color to indicate media heavy up SAMPLE COMPANY NAME OE Media Plan 2017 Q Q1

5 Attachment D3 OE 5 Estimated Media Spend by Designated Market Area APPLICANT NAME OE5 Estimated Media Spend by Designated Market Area Media/Market Television Radio OutofHome Print (Newsprint, Magazine, Freestanding) Direct Mail Shared Mail Search Engine Marketing Digital (display, video, mobile, radio) Social media marketing Other Community Events Other Lead Purchasing Total Sacramento Stockton Modesto San FranciscoOakland San Jose Santa BarbaraSanta MariaSan Luis Obispo Palm Springs Fresno Visalia Eureka Bakersfield ChicoRedding El Centro Total