Setting Family Rated Plan Premium Rates by Rate Groups and Network

To set up premium rates based on the age of individuals covered by a plan with networks where billing rates vary by rate group and network, use the Premium Rates form.

You must enter a premium for each specific age group. If the plan imposes a surcharge for individuals that are smokers, then enter the surcharge in the Tobacco Surcharge column, otherwise leave that column blank or enter a zero.

If individual rates are the same at the beginning or end of the age range, you do not need to enter individual age rates. For example, assume that the rates start at age 20 and end at 65. For individuals on the plan who are 19 years of age or younger, the system uses the age 20 rate. For individuals who are older than 65, the system charges the age 65 rate.

To set family rated premium rates by rate groups and network:

Open the Premium Rates form.

Use this option	To define this
Benefit Plan ID	A value that is populated from the Group Benefit Plan form.
Network ID	A field that is displayed when Premium Rates Vary By Network is selected in the Other Processing Parameters panel. Note: When a benefit plan is set up to use networks (for billing, premium or both) and a network is marked as Inactive, the inactive network now displays in the Network ID dropdown with ‘(Inactive)’ next to it. All inactive networks filter to the bottom of the list in the order that they appear on the networks grid. You cannot modify or add new rates for Inactive networks. However, you can view existing rates for Inactive networks. When an inactive network is selected, the table is disabled. The Save and Delete buttons are also disabled. A warning message displays stating The selected network is inactive. No modifications can be made. Click the OK button to acknowledge the message.
Rate Group	The rates group to which the premium rates apply. This field displays when Rate Groups For Premium Rates is selected in the Group Benefit Plans panel.
Network ID	The Network field displays when you select Premium Rates Vary By Network in the Other Processing Parameters panel.
Effective Date	The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date.

Enter the following information for each year of age. Click + or press Tab.to create an additional age row.

Use this option	To define this
From Age	The first age for which you are setting the premium rate..
Premium	The premium cost for that age.
Tobacco Surcharge	The surcharge for tobacco use, if any.

Click Close when you are finished.