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:
- 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.