Previous > Configuring Plans > ELIGIBILITY
The Rates page contains the carrier monthly premiums. Carriers' age/area-specific rates for small-group medical plans are pre-populated in EaseCentral. If the plan you’re adding is not listed, the EaseCentral team can import rates for future use. Provide us with the carrier's rate booklet or file, including all plans for all rating areas, and we'll upload them into the system. This process can take 5-10 business days. You also have the ability to manually enter the rates if you choose.
To select rates from the EaseCentral library: click Set Rates From Library, enter the plan EFFECTIVE DATE, select LIBRARY, PLAN TYPE, STATE, CARRIER, RATE AREA, CATEGORY and PLAN then click Set Rates to add them to the plan. Note: If your agency is a client of one of our General Agent partners, and your agency has requested access to the General Agent library from the Marketplace > General Agents section in your agency site, you will see the General Agent as an option in the LIBRARY section. Select this option to choose rates made available by your General Agent. General Agent libraries may also populate plan details on the Profile page and Plan Summaries an Provider Finders in the Documents page.
If rates are not determined until after enrollment or should not be displayed to employees as they enroll, the HIDE RATES > Hide rates from employees option can be selected. We do not recommend selecting this option for employer paid plans. If the plan is fully employer sponsored, the employee will see a rate of $0.00 without checking the Hide rates from employees option.
In some cases, the RATE ADJUSTMENT FACTOR is based on a carrier's Risk Adjustment Factor and is different than 1.0. If this is the case you would choose Total Rate. The RAF would then be imported into the BENEFIT COST FACTOR field in each employee's Profile > Coverage page.
Employer Contribution can be used when an employer's contribution needs to be prorated or reduced based on an employee's FTE or full-time equivalent status. The BENEFIT COST FACTOR field in the employee profile would in this case be used to designate an employee's FTE status.
Example: An employer's contribution is $100 per month for a full-time employee. If an employee has .8 FTE status, enter .8 in the BENEFIT COST FACTOR field and if Rate Adjustment > Employer Contribution is chosen, the employer's contribution in this case would be decreased to 80% of the full contribution or $80 in this scenario.
TOBACCO SURCHARGE TYPE and amounts can be entered if applicable. If not applicable, leave the settings as displayed and they will not apply. Please see the Tobacco Cessation Program and Surcharges solution for more instructions about this option.
SPOUSE AGE > Base spouse age off employee age should be selected if the spouse's age is not factored into the rates and is based on the age of the employee. If this box is not checked, the spouse rate will be based upon his/her age.
ADULT CHILDREN > Base adult children off their age is selected by default and is the best practice for properly determining rates. The system will look at the age of the child and calculate costs according to the rate listed on the rate table.
SPOUSE TOBACCO > Base spouse tobacco use off employee use
RATE TYPE options include:
- Tier for large group composite plans.
- Tier-Table is used for plans that use different rates for ages and coverage tiers.
- Table is used for plans that use different rates for the ages of each participant. Note - all ages are based on the Age Determination rule on the Plan Eligibility page. Age Band Types include All Ages (starting with 0-17), All Ages (starting with 0-14), 5 Year Age Bands, and 10 Year Age Bands. There are additional options for TABLE COLUMNS if a Table rate type is used:
- Rates: This will rate each participant based on their age
- Employee & Spouse Rates: This will calculate the EE and spouse rate separately, based on their respective ages
- Gender Rates: This will rate each participant based on their age and gender
- Tobacco Rates: This will rate each participant on their age and tobacco use
- Gender & Tobacco Rates: This will rate each participant on their age, gender and tobacco use
- Employee & Spouse & Tobacco Rates: This will rate each participant on their age, relationship and tobacco use
If rates are tiered (e.g., Employee only; Employee + Spouse; Employee + Child(ren), and Employee + Family) they can be entered using the Rates > Tier option. Total monthly premiums would be entered in the Rate fields.
Different rates or rate rules can be assigned to Eligibility groups by selecting the appropriate Eligibility option and entering rates as needed. Any rates entered into the initial Eligibility option can be copied by selecting Actions > Copy Rates and selecting the eligibility group containing rates needing to be copied. Rates or rules in any Eligibilitycan be edited if they vary per option.