Rate Determination

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The rate information below is only for ACA-compliant BlueCare medical insurance plans offered by Blue Cross and Blue Shield of Kansas. It does not apply to grandfathered individual plans nor grandfathered group plans that are not ACA-compliant.

For individual plans

Because higher rates cause a strain on everyone's pocketbook, we feel it's important you understand factors affecting our 2018 individual plan rates.

In order for the benefit plans we offer to be sustainable, we must be able to collect enough money through premiums to pay for all the medical services our members need. Unfortunately, many Kansans who have purchased ACA-compliant individual plans since 2014 have proven to be a higher risk with existing chronic or long-term medical conditions. In addition, the increased costs of prescription drugs, new procedures and technologies have added to higher claims expense. Since the Marketplace opened, the amount we have paid out in claims has been significantly more than premiums collected – and that's before taking into account operating costs, government fees and taxes.

In addition, premium increases for family plans reflect a change in federal regulation on how premiums for children are calculated. From 2014-2017, children ages 0-20 were charged the same premium amount. Past experience shows that as children aged and got closer to adulthood, their use of medical care increased; the "one-size fits all" approach did not work. Beginning in 2018, children are now grouped into different age categories and each category has a different age factor.

For 2018, Blue Cross and Blue Shield of Kansas is offering new plans at the bronze, silver and gold metallic levels with an exclusive provider organization (EPO) network; we are discontinuing the HMO plans offered in the past through BlueCross BlueShield Kansas Solutions. By offering EPO plans, the company will pay to the state a premium tax rather than a privilege fee. The rate of the premium tax is lower and, therefore, adds less to the operating costs which are passed on to members as a portion of the premiums they pay.

Based on the factors and experience noted above, the rates for the Blue Cross and Blue Shield of Kansas individual benefit plans will increase from 9.4 percent to 33.9 percent as compared to the rates offered for similar BlueCross BlueShield Kansas Solutions plans in 2017.

In addition, individual members will see their premiums increase because they are a year older; this is often referred to as an "age bump" increase. The actual premium increase a member with one of these plans will receive depends on such factors as the member's choice of plan, age and location, whether or not the member uses tobacco products, and any changes in federal government tax subsidies.

For small group plans

There are many factors that go into determining health insurance premiums. Some of these factors include the past cost of paying the claims for all members with small group plans, the amount that we pay medical providers and hospitals for their services, and a prediction of future medical services that our members will need.

In addition, premium increases for family plans reflect a change in federal regulation on how premiums for children are calculated. From 2014-2017, children ages 0-20 were charged the same premium amount. Past experience shows that as children aged and got closer to adulthood, their use of medical care increased; the "one size fits all" approach did not work. Beginning in 2018, children are now grouped into different age categories and each category has a different age factor.

For 2018, Blue Cross and Blue Shield of Kansas is offering new plans at the bronze, silver and gold metallic levels with an exclusive provider organization (EPO) network; we are discontinuing the HMO plans offered in the past through BlueCross BlueShield Kansas Solutions. By offering EPO plans, the company will pay to the state a premium tax rather than a privilege fee. The rate of the premium tax is lower and, therefore, adds less to the operating costs which are passed on to members as a portion of the premiums they pay.

We also will continue to offer preferred provider organization (PPO) benefit plans to small groups who purchase directly from Blue Cross and Blue Shield of Kansas.

Based on the factors and experience noted above, the rates for the Blue Cross and Blue Shield of Kansas small group plans will increase from 0.8 percent to 12.6 percent as compared to the rates offered for similar plans in 2017.

The actual premium increase an enrolled small group will receive depends on such factors as the group's choice of plan, and the age and location of covered employees and dependents. In addition, premiums will be adjusted to reflect that covered employees and dependents are a year older; this is often referred to as an "age bump" increase.