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The Center for Consumer Information & Insurance Oversight

 

Market Rating Reforms

State Specific Rating Variations

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 table below includes only states that have implemented standards other than the federal defaults.  If a cell is blank or a state is not listed, the federal default applies. Please scroll down for more specific information on:

Updated September 9, 2014

 

  Individual Market Small Group Market
State Age Rating Ratio State-Established Age Curve Tobacco Rating Ratio Uniform Family Tiers Age Rating Ratio State-Established Age Curve Tobacco Rating Ratio Uniform Family Tiers Average Enrollee Premiums1 State-Specific Composite Premium Method2
Alabama                   Yes
Alaska                   Yes
Arkansas     1.2:1       1.2:1      
Arizona                   Yes
California     1:1       1:1      
Colorado     1.15:1       1.15:1      
Connecticut     1.5:1       1:1      
Delaware                 Yes  
District of Columbia   Yes 1:1     Yes 1:1    Yes  
Florida                   Yes
Georgia                   Yes
Idaho                   Yes
Indiana                   Yes
Kentucky     1.4:1       1.4:1      
Maryland                   Yes
Massachusetts 2.1 Yes 1:1   2.1 Yes 1:1     Yes
Minnesota   Yes       Yes        
Montana                   Yes
New Jersey     1:1   1.824:1* Yes  1:1      
New York 1:1   1:1 Yes 1:1   1:1 Yes    
North Carolina             1.2:1      
Oregon         3:1**   1.5:1**   Yes Yes
Rhode Island     1:1       1:1   Yes  
Tennessee                   Yes
Utah   Yes       Yes       Yes
Vermont 1:1   1:1 Yes 1:1   1:1 Yes    
Virginia                   Yes

* Overall 2:1 variation for small groups: NJSA 17B:27A-25.
**Overall 3:1 variation for small groups: ORS 743.737(11).

1 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.  

2 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 Specific Age Curve Variations

State Specific Age Curve Variations 8-9-2013 [PDF, 94 KB]

State Specific Family Tier Ratios

 

State One Adult Two Adults One Adult and One or More Children Two Adults and One or More Children
New York 1 2 1.7 2.85
Vermont 1 2 1.93 2.81