How Do I Read a Rate Sheet?

If you offer employer-sponsored health insurance to your employees or group, this information will help you understand how to read your rate sheet. Your agent or sales representative is your best resource for understanding your rate sheet. But we can help give you an overview.

Because of health care reform, our plans have separate rate sheets for small groups and large groups. Select your group size below to learn more about rate sheets and how to read them, You can find your group size on your rate sheet, under "Rating Type". If it says Large Group Non-Reform, ERS or ASC, use the large group tab.

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 have been some changes in this section too, due to health care reform. Your premiums are 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.

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 - the percentage of your employees on the plan
  • Group size factor
  • Standard Industrial Classification (SIC) Code List - your business type
  • Certification status - to make sure your group 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."

Rating type

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.

Certificate 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.

Retiree discount

If you see "Medigap subsidy" on your rate sheet, this tells you you're getting our retiree discount.

Are you a current customer with questions? We can help.
Contact us

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