40
Content is valid through July 2021.
• 64 and older
When the image of the family is selected, the following text appears: Family Rating Standards Family premiums are based on the
premiums for each family member, including each family member’s age and tobacco use (subject to state law). The total family
premium includes premiums for up to three dependent children under the age of 21 and per-member rates for adults. In the case
of enrollment groups with more than three children, only the oldest three children are rated. However, under certain
circumstances, states may require the use of uniform family tiers and multipliers.
When the image of the map is selected, the following text appears:
Geographic Rating Standards
• Premiums reflect geographic rating areas, which are set by the state.
• For the individual market, the rating area is based on the primary policyholder’s address.
• For the small group market, rating area is based on:
• The group policyholder's principal business address; or
• In some circumstances, the business address within the plan’s service area where the greatest number of employees work as
of the beginning of the plan year; or
• If there is no such business address, the rating area where the greatest number of employees within the plan’s service area
live or reside as of the beginning of the plan year.
When the image of the cigarettes is selected, the following text appears:
Tobacco Rating Standards
• Health insurance issuers in the individual and small group markets generally cannot charge an individual who legally uses
tobacco products more than 1.5 times the non-tobacco user’s rate based on tobacco use.
• Tobacco rating can vary based on age (e.g., 1.2:1 for those under age 35).
• For employer insurance plans, issuers may impose the tobacco rating factor only if a tobacco-related wellness program (such
as a tobacco cessation program) that complies with federal rules regarding nondiscriminatory wellness programs is also
offered. Enrollees are able to avoid the tobacco surcharge by participating in such a wellness program.
The rating variation permitted for tobacco use can only be applied to the portion of the premium attributed to the individual family
member. If one member of a family smokes, only the portion of the premium attributed to his or her own coverage will be
affected—the portion of the premium for the other family members’ coverage is not affected.