Group Insurance Premiums – Rating Factors
Health Care Reform AB 1083
Limited Rating – Premium Factors
Under Health Care Reform in California you can only be charged a different premium for the following factors:
- shall not vary by more than three to one for adults.
- 19 Zip Code (Geographic Regions) View Chart and if your coverage is for
- Individual or family Insurance Code §10753.14.
- (a)No more charge for claims experience – §10753.16. RAF Factors
- nor medical questions asked – No Pre X Clause
- CFR §146.121 Prohibiting discrimination against participants and beneficiaries based on a health factor.
- Nor genetics §146.122 Additional requirements prohibiting discrimination based on genetic information.
- Contrast this with “Wellness” Discounts of 30% and 50% to stop smoking.
- No extra charge for using an Agent or Broker
- 12 additional reasons to get your coverage thru Steve Shorr Insurance
- There was no extra charge for our services prior to ACA/Obamacare either.
- More on Rate Regulation & Filings with CA Dept. of Insurance
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Our Webpage on Insurance Coverage for
ACA Rate Rule for Dependent Children
The Final Rule directs all health plan issuers of non-grandfathered small group and individual plan coverage (on and off the Exchanges) to revise the member level rating age bands used for individuals 0-20 years of age from using one age band to now create 7 age bands.
The first age band cover ages 0-14, then single year age bands cover 15, 16, 17, 18, 19 and 20.
This change will align with utilization of services while smoothing rate increases over time. Kaiser
Rating Zip Codes, Counties – Geographic Region
10753.14 (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.
- What Is Group Coverage?
- Is Insurance Required?
- Is Your Business Eligible for Group Coverage?
- Who Is Eligible for Coverage?
- What Do Employers Have to Pay?