Partner Agency Insurance Services

Member Level Rating And Your Small Business

Aug 28, 2013

How will member level rating affect the health care invoices I will get as a small business owner?

How will member level rating affect the health care invoices I will get as a small business owner?

As an Employer, will my January 2014 group health billing statements continue to look the same as today?

The Affordable Care Act (ACA) and new state laws create new rules for how small group health plan rates will be calculated in 2014. Small group billing will change to member level rating.

These changes may impact the total premiums; some may see significant change  though, for many employers, the changes may be modest. These changes are designed to make rates fairer and make it easier for clients to compare products and prices. Medical underwriting will not come into play with no pre-existing health conditions within new ACA-compliant health plans.

How will these changes affect the way ratings are figured?

Member level rating means that each member will have an individual charge, instead of “family” rate or “employee & children” rate, etc.

In a family, the subscriber or employee, can still cover dependents up to age 26. However, under each employee all dependents enrolled will be listed.  For instance, if there are 5 dependents over the age of 20 enrolled, all 5 are charged individually.

There are three catagories for determining rates

  1. The first category will encompass ages under 1 – 20.  In this catagory only the first three children in that category will be charged. So if the subscriber has 6 children under age 20, only the first 3 are charged.
  2. The next category is for ages 21 – 63. Every year the rate changes for this group.
  3. Ages 64+ the rates are the same.

We will share more on this topic as more of these details are made available.

Partner Agency Insurance Services can offer you affordable health care coverage for Individuals & Families or Employer Group coverage for groups of any size.  Please feel free to contact us for a complimentary quote from various insurance carriers for almost any kind of insurance at (714) 482-9500.

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