Member-level Billing for Small Groups in 2014

[dgoldenz]

Sorry if this was posted earlier, but listening to a webinar from my GA right now and they are saying that groups will no longer have composite rates for employee/family/etc, and instead will have individual billing based on each member's age, zip code, and tobacco use, and the employee's dependents also have to be individually calculated and billed.

For example, a 50 year old employee with two kids that are 20 and 24, and one of them smokes, will have different rates for each kid. The employer will now be required to figure out how much is individually taken out of each employee's paycheck every pay cycle and different employees could end up paying different amounts. I have no idea how an employer is supposed to present rates to the employees when they are individually calculated. So ridiculous...

 

[leevena]

Could very well see this. Could also see some using composite.

 

[RayNY]

Mind if I ask which state/carrier this is referring to?

I received an update from EBIX (runs HealthConnect quoting software) basically showing how they are going to ask for the information you just described, effective 8/3/2013.

They're calling it the "ACA Census". Specifically, it asks for an ATNE (average total number of employees), asks dependent information for tiers other than individual, and states but does not show that smoker/nonsmoker will be an option as applicable.

Dependent info is name, relation, DOB, and zip (and presumably smoker/nonsmoker, but it's not shown).

I doubt it applies to me here in NY (community rating, no age banding, no smoker surcharge) but I can certainly see it applying to other states.

 

[dgoldenz]

I was told this applies to all employers whether it's state or federal exchange.

 

[stuy119]

This is how IL is going to have it.

 

[Sam]

In MD, some carriers have said they will definitely offer composite rates, but that they may make mid-year adjustments for new enrollees based on their actual rates for all of their tiers.

 

[Ann H]

Oh, this shall be fun. Age/tobacco rated or else composite rated but adjusted mid-term.

 

[NWBenefitProvider]

Some carriers in Wa are for sure doing this. Not sure about all. Regardless, the individual rate bands are going to be used. Whether each carrier makes it transparent may be up in the air. Not sure if they are required to or not?

My plan is to just tally the total number of employees and divide the total EE premium by that to get our own composite rates. We will base employer contribution on this amount. Yes, they will nbeed to be aware of additional premiums due for adding spouces and children, but very few of my groups cover them dues to cost. Considering GI on the individual market, I'm sure even fewr will turn to group for their spouses and kids.

 

[deathbyaca14]

I was at a BCBS of MI meeting here earlier this week. They reiterated that it will be member level rating for small groups in '14. Thats gonna be a shock to a lot of folks here in MI who have always had composite.