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Child Age Band Rating Change Small Business Reminder

September 19, 2017

Currently, there is only one age band where all premium rates are the same for children ages 0 to 20. Recent Affordable Care Act (ACA) guidance requires insurers in states using the Federal uniform age curve to now have: 

  • One age band for children 0 to 14; and
  • Separate single age bands for children 15 through 20. 

UnitedHealthcare will implement a change to child age bands for rating purposes beginning with new and renewing all Small Business and UnitedHealthOne, effective Jan. 1, 2018. This new rating band structure will help “stair step” the premium increase that comes when a child turns 21. 

Customer Impact
Not all plans are impacted. If a plan is a grandfathered or Transitional Relief plan, the change will not apply. 

It will apply to:

  • Plans that are not grandfathered or that do not have Transitional Relief.
  • Both the individual and small group markets on and off the Exchange.
  • Plans currently with age bands and plans that are composite-rated. 

Background
Earlier regulations regarding market reform provided rating parameters for health insurance premiums for non-federal governmental plans. Regulations limited any variation in premiums for a particular plan or coverage to variations based on age, tobacco use, family size and geography. Today, the following standard age bands are used in states and markets subject to the ACA:

  • Children: A single age band covering children 0 to 20 years of age, where all premium rates are the same.
  • Adults: One-year age bands starting at age 21 and ending at age 63.
  • Older adults: Single age band covering individuals 64 years and older, where all premium rates are the same.

The rating for large families will not be impacted; the three oldest children under the age of 21 will continue to be used for rating. 

For more information please contact your representative.

Federal Approach
Beginning in 2018, insurers in states using the Federal uniform age curve must add single-age bands for children ages 15 to 20. The Centers for Medicare & Medicaid Services (CMS) standard child age bands and current (2017) and revised (2018) premium ratios are:

State Variations
Six states (Alabama*, Massachusetts, Minnesota, Mississippi, Oregon, Utah) and the District of Columbia have submitted and been approved for variations other than the federal child age band standard for 2018 -- New York is not currently age band rated:

 

*Alabama single age band applies to individual plans only.
Applies to New Jersey and Connecticut small group Oxford plans.

 

January 1, 2017 PDL Updates


The following updates will take effect for the OptumRx direct Prescription Drug Lists (PDLs) on January 1, 2017. Learn more

New Sales Automation Management Tool


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