Issuers must enter the rates for each subscriber type offered within the parameters of the premium rate they are able to charge for each type of enrollee a plan covers. These rates are based on variables such as rate effective date, rate expiration date, age, rating area ID, and tobacco. These rates, in conjunction with the data from the Business Rules Template, are used to calculate premiums for each enrollment group.

Key Changes for PY21:
  • Federal TIN is removed from the template.
  • Issuers can assign the same set of rates to multiple Rating Areas within a template worksheet.

Tips for the Rates Table Section

  • SADPs should be entered on a separate Rates Table Template from QHPs.
  • Issuers are encouraged to use separate sheets for individual market plans and Small Business Health Option Program (SHOP) plans.
  • For individual market plans, the rate effective date must be January 1, 2021.
  • For SHOP plans with trended quarterly rates, the rate effective date must correspond with the calendar quarters (January 1, April 1, July 1, or October 1). Each worksheet in the Rates Table Template is bound to a separate effective date range. An issuer submitting SHOP trended quarterly rates should submit a separate worksheet for each date range that a set of rates will be in effect.