Group Insurance Premiums – Rating Factors
Health Care Reform AB 1083

To get a quote for your group just send us a census  or enter it ONLINE.

Blue Cross summary (Rev 8.2015) on rating factors for the end of grand mothering 12.2015

Small Biz Rating Criteria 2018 Update for Child Rates
Small Biz Rating Criteria 2018 Update for Child Rates

Matrix on age rating of new hires.

2018 Update for Child Rates

Health Care Reform CA Law AB 1083 Insurance Code 10753 et seq sets the rules for Small Employer Groups 1.1.2014, updating AB 1672.

Insurance Companies can only vary the rates by Age, Zip Code, Geographic Region and family status.   Click below to see the actual law.

graphic.map california health care reform rating regions
Rating Regions

Graphic Map of NEW Rating Regions

10753 Non Grandfathered Plans  *  10753 Non Grandfathered Plans

UHC Summary

 

Limited Rating – Premium Factors

Under Health Care Reform in CA you can only be charged a different premium for the following factors:

Age, Zip Code (Geographic Region) and if your coverage is for an individual or family.  No more charge for claims experience – RAF Factors or Pre Existing Conditions.

Contrast this with “Wellness” Discounts of 30% and 50% to stop smoking.

10753.14.  (a) The premium rate for a health benefit plan issued, amended, or renewed on or after January 1, 2014, shall vary with respect to the particular coverage involved only by the following:

[Thus one CANNOT be charged extra for using an Agent or Broker with all these benefits.]

[12 additional reasons to get your coverage thru Steve Shorr Insurance]

More on Rate Regulation & Filings with CA Dept. of Insurance

Get FREE no obligation Quotes  Arrange a consultation time.

   (1) Age, pursuant to the age bands established by the United States Secretary of Health and Human Services pursuant to Section 2701(a)(3) of the federal Public Health Service Act (42 U.S.C. Sec. 300gg(a)(3)). Rates based on age shall be determined based on the individual’s birthday and shall not vary by more than three to one for adults.

   (2) (A) Geographic region. [Zip Code] The geographic regions for purposes of rating shall be the following:

   (i) Region 1 shall consist of the Counties of Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino, Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, and Tuolumne.

(ii) Region 2 shall consist of the Counties of Napa, Sonoma, Solano, and Marin.

(iii) Region 3 shall consist of the Counties of Sacramento, Placer, El Dorado, and Yolo.

(iv) Region 4 shall consist of the County of San Francisco.

(v) Region 5 shall consist of the County of Contra Costa.

(vi) Region 6 shall consist of the County of Alameda.

(vii) Region 7 shall consist of the County of Santa Clara.

(viii) Region 8 shall consist of the County of San Mateo.

(ix) Region 9 shall consist of the Counties of Santa Cruz, Monterey, and San Benito.

(x) Region 10 shall consist of the Counties of San Joaquin, Stanislaus, Merced, Mariposa, and Tulare.

(xi) Region 11 shall consist of the Counties of Madera, Fresno, and Kings.

(xii) Region 12 shall consist of the Counties of San Luis Obispo, Santa Barbara, and Ventura.

(xiii) Region 13 shall consist of the Counties of Mono, Inyo, and Imperial.

(xiv) Region 14 shall consist of the County of Kern.

(xv) Region 15 shall consist of the ZIP Codes in Los Angeles County starting with 906 to 912, inclusive, 915, 917, 918, and 935.

(xvi) Region 16 shall consist of the ZIP Codes in Los Angeles County other than those identified in clause (xv).

(xvii) Region 17 shall consist of the Counties of San Bernardino and Riverside.

(xviii) Region 18 shall consist of the County of Orange.

(xix) Region 19 shall consist of the County of San Diego.

[Calif. Insurance Commissioner 2.20.2013 Proposal to divide into 18 Regions Los Angeles Times]

[Employer zip code, determines rates, however, residential zip by each employee is still needed on census to establish network availability, per Heide S email dated 9.9.2015]

   (B) No later than June 1, 2017, the department, in collaboration with the Exchange and the Department of Managed Health Care, shall review the geographic rating regions specified in this paragraph and the impacts of those regions on the health care coverage market in California, and make a report to the appropriate policy committees of the Legislature.

   (3) Whether the health benefit plan covers an individual or family, as described in PPACA.

   (b) The rate for a health benefit plan subject to this section shall not vary by any factor not described in this section.

[Guess we no longer have RAF of .9 to 1.1 anymore]

[Individual and Family Plans AB 1461 ]

[Thus one CANNOT be charged extra for using an Agent or Broker with all these benefits.]

   (c) The rating period for rates subject to this section shall be no less than 12 months from the date of issuance or renewal of the health benefit plan.

   (d) This section shall become inoperative if Section 2701 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg), as added by Section 1201 of PPACA, is repealed, in which case rates for health benefit plans subject to this section shall instead be subject to Section 10714, [RAF Factors] to the extent permitted by federal law, and all references to this section shall be deemed to be references to Section 10714.

10753.16.  In connection with the offering for sale of a health benefit plan subject to this chapter to small employers:   Each carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of the following:   (a) The provisions concerning the carrier’s ability to change premium rates and the factors that affect changes in premium rates. The carrier shall disclose that claims experience cannot be used.

[Guess we no longer have RAF of .9 to 1.1 anymore]

   (b) Provisions relating to the guaranteed issue of policies and contracts.

   (c) A statement that no preexisting condition provisions shall be allowed.

   (d) Provisions relating to the small employer’s right to apply for any health benefit plan written, issued, or administered by the carrier at the time of application for a new health benefit plan, or at the time of renewal of a health benefit plan.

   (e) The availability, upon request, of a listing of all the carrier’s benefit plan designs offered, both inside and outside the Exchange, including the rates for each benefit plan design.

Related Pages in AB 1083 Section

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