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
- Your renewal month
- How we identify your company, including your customer ID, your group division number, your county and your rating type
Your rating type should say small group (reform). The word "reform" means your group has 50 or fewer eligible employees.
If your group is enrolled through a chamber or association, the name will be listed under "Endorsed By."
Your cluster code is used to tell us things like where you purchased your plan and what area of the state your headquarters is located.
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 the health benefits you have under your plan, 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.
If you're a renewing customer, this section may look different from your previous rate sheets. You may not see every rider listed, like your group's copays for emergency room visits.
You'll still see Medicare coverage listed that you provide for employees or retirees over age 65. Although these are called complementary plans, you still pay for them.
Age bands and premiums
Your rate page shows how much you’re paying for medical, prescription drug, dental and vision coverage per month for each employee. The amounts include all taxes and fees. There've been some changes in this section too, due to health care reform. Your premiums are now determined by the age of each employee and their family members on the plan.
If you use these figures to add up your premiums, remember that we only charge a premium for the three oldest children under 21 in a family.