None of the carriers have been talking about this….but it could be a big deal. Individual and small group plans will set rates based on new rate tiers starting 1/1/2018.
Just when you thought it was safe to step into busy season….
There’s a rule change that hasn’t been widely publicized. Plans that currently provide rates using a 45-tier structure will need to expand to 51 tiers. Everyone is pretty familiar with rates under the current structure with rates sectioned out as: 0-20 tier, 21-24 tier, separate rates for those age 25-63, and 64+ tier.
As of 1/1/2018, all individual plans, as well as community (small group) plans that use full-tier rating, will need to break out rates further. Here’s a quick summary of how the new rate structure will affect members – especially those with children:
The rule of charging for up to three children ages 0-20 will continue – with clarification that a family will need to pay for their three oldest children in this range. And as you know, any family with children age 21+ will need to pay for each of those children (no maximum).
One more change for WA state
In Washington State, there will be one additional wrinkle for group-based community plans – those offered through Kaiser Permanente. Currently, Kaiser requires an employer to either purchase pediatric dental or family dental when enrolling in a medical plan directly with Kaiser. If an employer chooses the pediatric dental plan, an additional charge is added to the first three youngest children in a family from 0-18 only (children 19+ are not required to have pediatric dental under the ACA rules). If the employee and/or the spouse are under age 19, they get charged this fee as well. As of this writing, Kaiser is expected to continue this separate charge for pediatric dental. So get ready for some fun calculations for larger families.
The small group insurance carriers will continue to be allowed to offer the full 51-tier rates or “averaged” rates. We have not received verification that the 2-tier rating structure (0-20 and 21+ age tiers) will continue, but we are crossing our fingers.
Ahhhh, and so busy season begins. Hang on, we are in for an interesting ride!
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I love numbers. I'm a math geek. I read benefits industry articles and periodicals for relaxation (but, honestly, I'm still a fun gal). I also like to share what I've learned and you'll find it all here.