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SHOP and Premium Rate Variations

Premium rates will not vary based on health status, gender, or claims experience. Rates for new and renewal coverage in the SHOPs may be adjusted quarterly. However, for a given employer, the same rates will be in effect throughout the employer’s plan year (12 months).

Premium rates may vary by:

  • Age: the ratio of the premium for someone age 64 or older to the premium for someone who is 21 cannot be more than 3:1
  • Family composition, although there is a limit on the number of rated children under age 21
  • Geographic area: primary location of employer
  • Tobacco use: a surcharge may be applied to individual enrollees, but cannot equal more than 1.5 times the non-tobacco user's rate and must be offered with a wellness program that enrollees can participate in to remove the surcharge


Next Topic: Building Premiums in the SHOP

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