How to read a rate sheet for 2013 plans
Who is this for?
If the plan year for the health insurance you sponsor for your employees or group began before 2014, this information will help you understand your rate sheet.
We have this guide (PDF) with a sample rate sheet and a glossary to explain the terms used on the a sheet. It only applies to health insurance plans that began before Jan. 1, 2014. We've also provided more information below about sections and terms you'll see. If you have additional questions, please call your agent or sales representative.
Decoding the header
The factors and codes at the top of your rate sheet lets you know how we:
- Identify your company
- Determine how much you pay for insurance
The glossary in the rate sheet guide explains more about what these codes and factors are.
If you’re interested in learning more about how your rates are determined, check out our article about how rates are set.
Understanding certificates and riders
Certificates are the legal documents that define the benefits that make up your health care plan.
Riders are legal documents that let you customize your plan. You can add to, remove from or change the scope of your coverage by adding them to your certificates.
The certificates and riders section of your rate sheet lists all the coverage options you provide for your employees.
Figuring out your premiums
The rate sheet breaks down the premiums so you can see exactly how much you’re paying for medical, hospital, prescription drug, master medical, dental and vision coverage each month.
Your rate sheet lists the premiums for all possible combinations of coverage you offer to your employees.
- One person regular plans cover just the employee.
- Two person regular plans cover the employee and spouse.
- Family regular plans cover the employee, spouse and children or any other members on the plan.
- Complementary plans are Medicare plans. If any member of the plan is over age 65, that member will need a complementary plan. For example, if an employee is over 65, but his spouse isn’t, then that employee will need a one person regular plus one complementary plan.
Each plan has its own benefit ID. The benefit ID is the number printed on your employee’s insurance ID card.
What's advantage pricing?
If you have prescription drug or dental coverage, you can get up to a 4 percent discount on your medical coverage.
What's the CCF?
The Case Characteristic Factor is the total factor applied to determine your rate. It’s a combination of all the other factors, including the group size factor and the participation factor.