Small Group Market Rating Reforms
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as of December 10, 2021
Location Age Rating Ratio State-Established Age Curve? Tobacco Rating Ratio Uniform Family Tiers? Average Enrollee Premiums? State-Specific Composite Premium Method? State expanded definition of small employer?
United States 3:1 Federal Default Age Curve 1.5:1 Per Member Rating N/A N/A N/A Alabama Yes Alaska Yes Arizona Yes Arkansas 1.2:1 Yes California 1:1 Yes Colorado 1.15:1 Yes Yes Connecticut 1:1 Delaware Yes District of Columbia Yes 1:1 Yes Florida Yes Georgia Yes Hawaii Yes Idaho Yes Illinois Yes Indiana Yes Iowa Yes Kansas Kentucky 1.4:1 Louisiana Yes Maine Yes Maryland Yes Massachusetts 2.1 Yes 1:1 Yes Michigan Minnesota Yes Mississippi Yes Missouri Montana Yes Nebraska Yes Nevada New Hampshire New Jersey 1.824:1 Yes 1:1 New Mexico New York 1:1 1:1 Yes Yes North Carolina 1.2:1 North Dakota Ohio Oklahoma Oregon 3:1 Yes 1.5:1 Yes Yes Pennsylvania Rhode Island 1:1 Yes South Carolina South Dakota Yes Tennessee Yes Texas Yes Utah Yes Yes Vermont 1:1 1:1 Yes Yes Virginia Yes Washington West Virginia Wisconsin Wyoming
Notes
The Market Rules and Rate Review Final Rule (45 CFR Part 147) provides that each state will have age rating ratios of 3:1 using a federally established age curve, tobacco rating ratios of no more than 1.5:1 and per member rating unless a state requests ratios less than the standard, is a community rating state with uniform family tiers, or allows for averaging of enrollee premiums in the small group market. The federal defaults are listed under the United States. If a cell is blank in the data table for a state, then the federal default applies.
The Protecting Affordable Coverage for Employees Act (Pub. L. 114-60) amended the definition of small employer in section 1304(b) of the Affordable Care Act and section 2791(e) of the Public Health Service Act to mean generally an employer with 1-50 employees, with the option for states to expand the definition of small employer to 1-100 employees.
For Federal default age curve and state-specific age curve variations, see .
For state-specific family tier ratios for NY and VT, see
Sources
Market Rating Reforms, State Specific Rating Variations , CCIIO; updated December 10, 2021.
Definitions
Average Enrollee Premiums : the state requires that all issuers use a composite premium methodology to bill consumers instead of a per-member only billing methodology. Unless the state has a CMS-approved state-specific alternative composite premium methodology, for plan years beginning on or after January 1, 2015, issuers in the state must composite using the federal default method of two tiers: one tier for all adults and a second tier for all children under 21.
State-Specific Composite Premium Method : the state has received authorization from CMS to require that all issuers use an alternative method to the federal default method using two tiers. In a state that has an approved alternate composite premium method, issuers that offer composite premiums in addition to per-member premiums must use the state-specific method when compositing premiums. If the state requires composite premiums, the state-specific composite premium method is the only billing method allowed. Employers and issuers in states with an approved alternate composite premium method should check with the state department of insurance to assure understanding of the alternate composite method.
State expanded definition of small employer : State has notified CMS that it will expand the definition of small employer from 1-50 employees to 1-100 employees.