Let's start with the information beneath the heading that says "Benefit and Rate Schedule" on your rate sheet. It tells you when your plan becomes effective and your renewal month.
Beneath that is a section that identifies your company. It includes your:
- Customer ID and group division number.
- Participation factor. This relates to the percentage of your employees on the plan.
- Group size factor.
- SIC code (your type of business).
- Certification status. We conduct reviews at renewal to make sure your group still meets eligibility requirements and has the correct rating.
- Cluster code, an internal customer identifier.
If your business or group is enrolled through a chamber or association, it's listed under "Endorsed By."
In this same section, you'll find your Rating Type. Large group employers have 51 or more eligible employees. There are three kinds of large group segments.
- Large Group Non-Reform. Fewer than 50 of your employees are covered by the health plan you offer from us.
- ERS (Experience Rating System). More than 50 of your employees are covered by the health plan you offer from us.
- ASC (Automatic Service Contract). This is for self-funded groups, who act as their own insurer and pay us a fee to administer the plan.
Certificates and riders
The next thing you'll see listed are certificates and riders: the coverage options you provide for your employees.
- A certificate explains your plan's health benefits, what's covered and what's not. Your certificate also lists what you need to do to get those benefits, like meet a deductible, or pay a copay.
- Riders amend your certificate by adding, limiting, deleting or clarifying benefits.
Premium rates and RRL
Your rate sheet breaks down premiums so you can see exactly how much you’re paying for medical, hospital, prescription drug, dental and vision coverage each month. Although you'll still see a column for master medical, it'll be blank, because we don't sell it anymore.
Your rate sheet shows 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.
If you're a renewing customer, the last line lists your Relative Rate Level (RRL). It compares the base cost of your insurance to how your group uses it. This replaces the Case Characteristic Factor (CCF). We've always used relative rate level for ERS and self-funded groups. We're using it for large groups now, too.