How to Set up Benefits Plan Rates

Contents

• Setting up Rates
• Tiers
  • Individual Banded Rates

Setting up Rates

Our system supports both individual banded rates and composite rates. Additional rate factors such location based rates, tobacco based rates, and age banded composite rates can be set up for health plans.

First, select Rate Type → Composite or Individual banded.

If a Composite Rate type is selected, select any applicable additional rate factors such as age banded composite rate, Tobacco rates and/or location based rates.

Tiers

You can select coverage tier for which rates will be calculated. The system supports following coverage tiers:

• Option1: Standard Composite (+Child, +Children)
  • Employee
  • Employee + Spouse
  • Employee + Child
  • Employee + Children
  • Family
• Option2: Standard Composite 2 (+Children)
  • Employee
  • Employee + Spouse
  • Employee + Children
  • Family
• Option4: Number of Children (+1, +2, +3 children)
  • Employee
  • Employee + Spouse
  • Employee + 1 Child
  • Employee + 2 Children
  • Employee + 3 or more Children
  • Employee + Spouse + 1 Child
  • Employee + Spouse + 2 Children
  • Employee + Spouse + 3 or more Children (Family)
• Option5: Employee / Dependents
  • Employee
  • Employee +1 Dependent
  • Employee + 2 or more Dependents
• Option6: Employee / Family
  • Employee
  • Family
• Option7: Employee Only
  • Employee

The number provided on the Max # of children covered under +child(ren) tier field will calculate the number of children up to this number under the +child(ren) category. This is for the rare plan that defines the maximum number of children on the Employee + Children coverage level tier before being considered Family rate.

If the Tobacco factor is desired, select Tobacco Rate Option. Tobacco/Non-tobacco rate option will provide two separate columns to enter Tobacco and Non-tobacco rates for each tier. If Tobacco Surcharge is chosen, rates will require to provide surcharge fee. You can set surcharge fee in a Dollar amount or percentage of the premium.

If the Age factor is checked then provide information on which age new enrollment should be rated. You may choose age at the time of enrollment or age at the time of policy start date. Age based composite rate will provide you with the ability to create age brackets.

Location rates allow users to add rate table for multiple locations. Our system supports rates based on Work Location or Employee Residence Location.

Select work location(s) and provide rates. Click Add Location Rates to set another location’s rate.

Individual Banded Rates

Individual Banded Rates can be set by selecting this option under Rate Type. Individual Banded Rates can also be based on Tobacco and Location conditions as described in Composite Rates. “Spouse Rate Based on Employee Age” option is selected then spousal premium will be calculated based on employee’s age.

Select Child Rate Options: (1) Age Rate (Based on Table) - This will calculate child’s premium based on the table rates. (2) Flat Child Rate - in such option, on such selection, provide a flat child rate. If dependent is a child then this flat rate will be considered in premium calculation.

If at a certain age of a child, adult rate would apply then provide age at which a child should be considered as an adult.

If the tobacco rate condition is selected, you can set conditions on how to calculate tobacco rates.

Examples are:

1. Individual is a tobacco user.
2. Apply tobacco rate when employee is a tobacco user (in this condition, if an employee is a tobacco user and spouse is not a tobacco user then also both will get tobacco rates).
3. Employee or Dependent is a tobacco user (if this condition is selected then tobacco rates will be applied to both employee and dependent rates if either is a tobacco user).

To enter rate manually, click Enter Rate Manually, select the first age bracket and last age to generate a table to enter appropriate rates.