Plan rates and highlights

For small businesses with 1–100 full-time and full-time-equivalent employees.

Rates for subscribers and dependents are caliculated based on thier age at the start date of the last contract period (the renewal date). This means that a client's rates won't change if he or she has a birthday before it's time for the next renewal. This applies to subscribers and dependents who are enrolled from the contract start date and those added to the contract period midyear.

2022

2022 medical plan rates — non-metal plans
For effective dates January 1 — December 1, 2022
ZIP Codes
Effective January to December 2022

2021

2021 medical plan rates — metal plans

The 2021 rates for ACA-compliant metal plans use the employer's business ZIP code rather than the employee's residential one. The following factors determine the group’s metal plan rates:

  • There are 19 geographical rate areas based on county + ZIP code combinations. Refer to the ZIP code guide to identify the group's rate area.
  • California businesses are rated based on the physical business address using ZIP code and county. Groups located outside of California are assigned to rating area 4. If a qualifying small group is located out of the service area, then only employees living in the service area are eligible to enroll.
  • Rates are calculated by member-level ratings, or the age of each covered member as of the plan's effective date, including:
    • employee
    • spouse or domestic partner
    • no more than three children under age 21; other children under 21 are covered at no additional cost
    • all adult children ages 21 to 25, whether or not they're in school or living at home.

For convenience, the 2021 rate sheets are available for each rate area, specific to the employer's business ZIP code.

 

Zip Codes
Effective January to December 2021
2021 medical plan rates — non-metal plans
Medical plan rates — non-metal plans
For effective dates January 1 — December 1, 2021
Zip Codes
Effective January to December 2021

2020

Plan rates

2020 medical plan rates — metal plans

The 2020 rates for ACA-compliant metal plans use the employer’s business ZIP code rather than the employee’s residential one. The following factors determine the group’s metal plan rates:

  • There are 19 geographical rate areas based on county + ZIP code combinations. Refer to the ZIP code guide to identify the group’s rate area.
  • California businesses are rated based on the physical business address using ZIP code and county. Groups located outside of California are assigned to rating area 4. If a qualifying small group is located out of the service area, then only employees living in the service area are eligible to enroll.
  • Rates are calculated by member-level ratings, or the age of each covered member as of the plan's effective date, including:
    • employee
    • spouse or domestic partner
    • no more than three children under age 21; other children under 21 are covered at no additional cost
    • all adult children ages 21 to 25, whether or not they're in school or living at home.

For convenience, 2020 rate sheets are available for each rate area, specific to the employer's business ZIP code.

Medical plan rates — metal plans
For effective dates July 1 – December 1, 2020
For effective dates January 1 – June 1, 2020
Zip Codes
Effective January to December 2020
2020 medical plan rates — non-metal plans
Medical plan rates — non-metal plans
For effective dates January 1 — December 1, 2020
Zip Codes
Effective January to December 2020

Plan Highlights and benefits

Refer to the Plan Heiglights for a side-by-side comparison of what your emplyees can expect to pay for services in different health care plans. The benefit summaries for bronze, silver, gold, platinum, and nonmetal and nonmetal plans also provides an overview of each plan.

2022

2022 Plan Highlights – metal plans

For effective dates January 1 – December 1, 2022

2022 durable medical equipment (DME) benefits

All Affordable Care Act (ACA) metal plans now have supplemental and base durable medical equipment (DME) (upon renewal).

2021

2021 durable medical equipment (DME) benefits
All Affordable Care Act (ACA) metal plans now have supplemental and base durable medical equipment (DME) (upon renewal).

2020

2020 dental information

For effective dates January 1 – December 1, 2020

2020 durable medical equipment (DME) benefits

All Affordable Care Act (ACA) metal plans now have supplemental and base durable medical equipment (DME) (upon renewal).