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Building Premiums in the SHOP

Under the Affordable Care Act, premiums will be built differently than they have been in the past in many states. Under the Affordable Care Act:

  • Individual premiums reflect age, geographic location, and tobacco use.
  • The family premium is the sum of premiums attributable to each family member (with a limit on the number of rated children under age 21).
  • Group premiums are built up from members of the group, and each group’s rates will be based on the individual rates of its members.

Composite rates, based on an average characteristic of the group, such as the average age of the employees, will no longer be quoted by the health insurance issuer, unless required by a state. As you will see later in this course, employers may choose to use a “calculated composite premium” method to minimize the effect of the employee’s age on the employee’s contribution toward coverage.

Next Topic: Qualified Health Plans and Employer Contributions

If you are an agent see Insurance Agents and Obamacare.


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*ExploreObamacare.com is not affiliated with any government agency. All information provided is for informational purposes only and no guarantee of the accuracy is hereby implied. The information was the product of researching the Affordable Care Act Bill and is subject to change.
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