What is community rating?

Community rating was introduced as part of the Affordable Care Act (ACA) and applies to small groups with 1 to 100 employees. Community Rating only allows a member's location, age, and family size to be factored when determining rates. Health insurers in California are not allowed to rate members based on sex, gender, health status, or any other factors. 

How it works 

Rates are based on the combined rates for the ages of the employee, spouse, dependents 21 and older, and up to the three oldest dependents 20 or younger. 

*Some carriers may have rules on what rating region they would use when an employee lives in the carrier's service area but the employer is outside of the service area.

Example calculation 

To illustrate how the rating works, we’ll look a family with two adults (aged 45 and 48) and five children (aged 22, 18, 16, 14, and 10) on the Kaiser Permanente Platinum 90 HMO 0/10 + Child Dental Alt in San Francisco (Rating Region 4) as of January 1, 2021. The following image shows the age bands and rates for this family highlighted in yellow:

This family would be rated as follows:

Child 5 is free since this family has more than three children under the age of 21.

Please contact a member of your B&P Sales Team if you have any questions regarding community rating.


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